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B0ST0MIENS1S- 


THE 


raft  Cirrnlar.   CM  1838. 

filing    tftr    CtitoriJoraHoii  of   tfje  .Journal*  Ijitljerto   fuioton  a*  **  <T1)r  fttrtfeat  $rea& 

anO  "STtjr  jlfle&ital  Circular," 


a  aSUehln  linrnil 


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MEDICINE  AND  MEDICAL  AFFAIRS. 


PROM     JANUARY     TO    JUNE, 


1 904. 


LONDON  :    8  HENRIETTA  STREET.  STRAND?    DUBLIN:   16  LINCOLN   PLACE, 


.-.;   f*H 


INDEX. 


Tin 


Supplement  to 
Medical  Preaa  and  Circular 


INDEX. 


VOL,    LXXVII    NEW    SERIES.     (VOL.    CXXVItl    OLD    SERIES.) 
JANUARY    TO  JUNE,    1904. 


Ataarco    ' 

Ahffdrat  University  (pass  li>t),  411 
Ataman  *ad  dcatli  ccrtincalcs,  405 
Ahr«L  Dr-  endocarditis,  51 
Atom  in  tlit  middle  ear,  504 
Abo*  cf  vaginal  inlecliotii,   ui 
Atttfcrttgd  service  between  England 

jad  America,  30 1 
A&adeatal  merairiuJ  poisoning,  295 
Axttoauna  in  cntklrrn,  90 

tedium  pTi..spU,-k        ,»rut 

adrenalin   in     vesica  I   dfcatate,     Dr. 

WTietU 
Acquired  mallomiatiou.  288 
Atttauniycosis  of  the  luius;  331 

for  malpraxjs,  17 
knout  of  high  and  sea  climates,  39 
tale  appendicitis.  Dr.  RuhcH,  112 
Acnie  general  peritonitb.  Dr.  Maun- 

*H,fci4 
Acwt  teuczxnia,  302 
Aflrtt  suffocative  pulmonary  utfema. 

* 
Adtnrxnaand  cancer  of  the  hrca,t,  jib 
Admumtrition  of  oxygen,  378 
Aaruul  ha-nnorrliu 
Atom  to  in  acute  glaucoma,  169 
Adreaafcn    in    neurotic    heart*    Dr. 

Adfuee  in  tnicro-anaslotmnii,  270 
Aflettiofei  of  the  knee,  473 
Ace- lout,  ihe,  93 
Albajntuuria.  Drr  Went,    143 
Akcftohstn   and   r*udl  d  etc  nor  alien 

Akkoiev  M-n^r  Sanatorium.  92 
AOrahsfyi  tnitk  food  chocolate,    i 33 
Al.i*«Li4  and  dental  caries,  by 
Abf«fu  areata*  607 
Abfvcb  ifeata      urcd    by    K^ntgen 

il  al  Culture 
tacrifaa quackery  "  in  tittki*,"  3-  1 
Amfcihesia  by  cocaine,    12 1 
teatihesia  during  operation  for  two 
<»a  of  atute  intestinal  obstruction, 
( Dr.  Fiekkn,  k< 

>ii  witfc  akrilc  wattf;  aJ7 


nm,  Mr    Mm 
Anaphtf  If? thr-lil,   577      . 

Anastomosis  ui  a  turn  a  1  b   >md    bowel 

2*8 
An  lent  eorset,  an,  401 
Aneurysm,  of  the  aorta,  4-* 2 
Anettrysma  spurium,   na 
Anger's  petroleum  emulsion,  301 
Angina  pectoris,  2S7 
Ankle -clonus,   391 

An t j -rank  treatment  in  Chicago,  332 
Antiseptic  shaving,  61  i 
Antisyphilitic  injections,  121 
Anntnermics    in    typhoid    fever,    yt 
An ti- vaccinationist  scheme  thwarted. 

An  u- vaccinationist  trick*,  59? 
Anti- vivisection  nospvtak 
Anti-vmseetiomst   town  council.   351 
1  Apparent    improvement    in    disease 

symptoms,   69 
I  Appearance  of  a  rash   following   the 
removal  or  tjonsib  and  adenoids,  Dr. 
Wingrave,  79 
I  Appendicitis  61 

1  Appendicitis,  Mr,   Morisou,   337,    380 
Appendicitis    with    perforation,    Mr, 

Connell,  653 
1  Appendix  abscess  in  the  rectovesical 

pouch,  Mr.  Owen,  165 
I  Application    of    pess?iri?»    and    their 
dangers,     Dr.    Macn  a  ugh  ton- J  ones 
{illustrated*,  tJ9 
Appcrtntments-~eml  of  each  No. 
Arctic  region  as  a  health  resort,  313 
Army  medical  militia 
Army  Medical  Service  [pass  list}.  191 
Arterial  sclerosis,  664 
Artificial  lunacy.   505 
Artificial  substitutes  fot   the  u 

*37 
Aspects  of  diphtheria.    Dr.   Forsyth, 

,      *33< 

Astplk-  vacciuatlim  pnd 
Associated  Hosnil  1  ■  n  .221 

Association  of  Medical  Diplomatic  of 

Scotland,  020 
Asthma  and  the  sleto^npli,  300 
A>ylum  fux  tic.  in-,.!,'    I  d  nl  m 
Asylum  Workers*  Aiiociatiua^  630 


Alalia , 

u>iio-u   ui   tht   slo- 
t,  393 
Ayr  District  Asylum,  4cm 

H.  \\\  and  Co,  all-gLuei  aneptic  serum 

syrin|te  (illustrated}.  38a 
Bacteria  and  cold,   17 
Ballachuli5h  quarry  dispute,  aas 
BallaaalDc  Avyluni,  497 
Balneological  C*mgress,  191 
Banks,  Sir  W.  M.,  modem  surgery  of 

the  prostate,  fli 
Barclay,  Mr.,  the  late,  490 
Bar  golfing  n wk  ly  r.  nml  golfers, 

4yo 
fsnr low's  tlisease,  1 
Bair,  Dr.t  prognosis  m  heart  disease, 


1^7,  iys 
321 


fseale, 


suppurative  apjicndicitis, 


Bed  books.  4; 

Belfast     Board    of    Guardians     .uul 
medical  mat  ten,  397 

Belfast  Corporation,  74.    700 

Belfast  Guardians  and   medical   fctt 
646 

Belfast  Hospital  for  Children,    iff 

Belfast  Maternity  Hospital,  246 

Belfast   milk  supply,   49 

Belfast  Dnh&ahmc  lloipitai,  407 

Belfast  Samaritan  Hospital,  24ft 

Belfast   L'nion   and   boarding 
children,    186 

Bulgravia  ■  Medical "'  Institute,  565 

fiellevue  Hospital,  340.   54* 

Bennett's    "  stave   o"   thumb  "    frac- 
ture, 439 

Benson,    Mr.t    surgiral    treatment    of 
*hf.rt  sight,  ^73 

BerUberi    at   JLorcn*o  Marques,   ioo, 

Ben-beri  in  monkeys,  377 

Besurmmg  the  thro<ir 

Ben-ies-Bains,  232 

Bid  we  II.  Mr.,  chronic  pancreatitis,  376 

Hi  lateral  tubal  pregnane  v,  i.'j 

Birth  of  uiani 

Birth.— ciju  cf  cath  No, 


Black,   Dr.  J,n.|>h,   4^H 

Bladder  irnuttun  in  git!-t  Mr.  Span* 
too.  198 

Boosting  extraordinary,  1*3 

liornyvat,  663 

Brenti  :oj 

Bristol  Eye  Hospital,  221 

British  Dalneiili>gical  Socle  is 

British  HynjsMo Logical  Society,  77 

British  Medical  Association  and  medi- 
cal defence,  243 

British  Medical  Association  and  the 
General  Medical  Council,  66 

Bntisl  Medical  Association's  pro- 
posed scheme  of  medical  detente. 
221 

British  Medical  Temperance  Assocta* 
turn,  585 

British  sanatoria  for  consumption,  8, 
34,  61,  a*,  115,  144,  170,  202t  1JI, 
as? '.  a»&*  3 1 3*  15*  (illustrated),  367. 
635,  661,  689 

Bromudenna  tuberosum.  149 

BrMiiipiniiSan2toiiuiii»  6§g 

Broncho-stenosis,  Dr.  Fraenkel,  306 

Hmwn  lecture,  703 

Buttermuk  for  infants,  614 

Buxton.  Dr.,  chTomform  in  surgical 
anasthesia  (ilhistrated),  103 

Byets,  1*rof.,  presenlation  k^r  3J7 

I  Cad  bury 's  eocoa  essence,  iu6 
f  .il. -.it'eous  vtsseli:,   64. 

ity  (pass  list,)  491, 

«3r 
Cam  pi  for  tbe  tuliert-ulous,  45 
Cancer  and  morphology,  127 
Cancer  and  radium  bromide.  4*9 
Cancer  and  the  vox  pupuli.  296 

and  uric  acid,   Dr.  H^ig.  627 
Ca&cor  of  the  bile-dm  ts.  Prof.  Debove 

387 
Cancer  of  the  rcctuuu  Dr,  Vincent,  \Uz 
Canter  research,  310 
Cireinoma,  316 

noma  and  struiitectoiny,  637 
Carcinoma  of  the  o?sophaguK  12 
«.   "ui' Jim  of  the  pancreas,  3(18 
1  Carcinoma  of  tccLuui.  Wr*  Muinmciy 
(      3&5 


9u] 
The  Medical 


to 

and  Circular. 


INDEX. 


Cardiac  asthma,  Prof.  Merklen,  469 

Cardiac  dropsy  in  children*  327 

Cardiac  surgery,  149 

Cardiff  Infirmary,  650 

Cardiolysis,  503 

Care  of  the  feeble-minded,  383 

Care  of  the  "  Register."  377 

Carless,  Mr.,  lymphangioma,  140 

Carnegie  trust,  2x6,  2x8 

Carr,  Dr.,  chronic  valvular  disease  of 

the  heart,  334 
lalon.  Dr.,  Harvrian  oration.  685 
Causation  of  constipation,  392 
Central   Midwives'  Board,    the,    144, 

4*0,  541,  59°.  6*5 
Central   Midwives'  Board   and   pupil 

midwives,  247 
Central   Midwives*  Board    and    Irish 

maternity  hospitals,  180,  187,  51 ' 
Central  Midwives*  Board  and  the  Irish 

hospitals,  301,  355 
Central  Midwives'  Board  and  the  Royal 

Academy  in  Ireland,  292 
Cerebral  angio-sarcoma,  122 
Cerebral  artcrio-sclerosis,  451 
Cerebral  tumour,  6x3 
Chalmers  Hospital,  272,  699 
Chappel,  Dr.,  limitation  of  medicine, 

in  abdominal  diseases,  254 
Chatel-Guyon,  177 
Cheinisse,  Dr.,  spondylitis  of  infective 


origin,    6 
hemistry  of  .1 


Chemistry  of  albumin,  Dr.  Klemperer, 

143 

Chemists'  exhibition,  the,  545 
Chinese  labour  importation,  3x8 
Chloroform,  death  under,  30  x 
Chloroform    in    surgical    anaesthesia, 

Dr.  Buxton  (illustrated),  303 
Chloroformed  calf  vaccine,  668 
Chloroma,  122 
Choice  of  a  table  water,  Dr.  Murrell, 

493 

Chronic  intestinal  obstruction,  Mr. 
Wallace,  282 

Chronic  middle-ear  deafness,  treat- 
ment by  ozone,  Mr.  Stoker,  281 

Chronic  nephritis  in  children,  662 

Chronic  pancreatitis,  Mr.  Bidwell,  576 

Chronic  rheumatism,  236 

Chronic  valvular  disease  of  the  heart, 
Dr.  Carr,  334 

Cicatrices    treated   by  thiosinnamin, 

538 

Cinematograph  in  medical  work,  321 

Cirrhosis  of  the  liver,  422 

Cobra  venom,  670 

Cold  abscess,  343 

Collection  of  bouse  refuse.  155 

Collier,  Mr.  M.,  latent  or  intermittent 
nasal  obstruction,  249 

Colloidal  stiver  in  erysipelas,  374 

Commemoration  day  at  Glasgow 
University,  461 

Common  causes  of  error  in  examina- 
tion of  the. chest,  Dr.  Squire,  $7$ 

Complications  of  measles,  270 

Compounding  by  medical  men,  265 

Compressed  air  illness,  46 

Confessions,  428 

Congenital  growth  of  the  conjunctiva, 
423 

Congenital  myatony,  344 

Conjoint  examinations  in  Ireland 
(pass  list),  191,  383.  49  *.  399 

Conjoint  examinations  in  Scotland 
(pass  list),  191,  437 

Connell,  Mr.,  appendicitis  with  per- 
foration, 653 

Consumption  in  Ireland,  695 

Consumption  question,  21 

Consumption  sanatorium  at  White 
Abbey,  102 

Consumptive  at  home,  the,  42 

Contagiousness  of  alopecia  areata,  21 

Contaminated  milk,  702 

Contaminated  shell-fish,  70 

Cornwall  as  a  winter  health  resort 
(illustrated),   204 

Coroners  and  medical  witnesses,  151 

Coroners  and  the  medical  profession, 
43i 

CORRESPONDENCE. 
A  disclaimer,  354 
"  A  new  treatment  for  boils,"  22 
Alopecia  and  dental  caries,  103,  135, 

158,  188,  246,  327,  354,  3*>,  433. 

462 
Amendment  of 'medical  law,  646 
Application   cf   pessaries   and    their 

dangers,  486 
M  Army  inefficiency,"  408 
British  Medical  Association,  T03 
Central  Midwives'  Board,  2x9,  62  x,  648 
Common-sense  view  of  consumption, 

647 
Cripple  at  the  corner,  676 


June  29,  1904. 


"  Cures  "  for  consumption,  22 

Dangers  of  pessaries,  397 

Diminishing  birth-rate,  315 

Doctors  v.  barristers  and  solicitors, 
X04 

Erythema  scarlatini  forme,  104,  133 

Great  Wyrley  cattle  outrages,  379 

Home  Omce  and  the  medical  profes- 
sion, 74,  X03 

Humour  in  practice,  648,  677 

Infants'  Health  Society,  462,  487 

Intra-uterine  application  of  super- 
heated steam,  5x5 

"  Koplik's  spots  in  measles,"  102,  133 

Legal  and  medical  profession,  272 

Lite  assurance  fees  for  medical 
examinations,  187. 

Lunacy  laws  and  professional  respon- 
sibility. 648,  676 

Lunacy  and  the  Archdeacon  s  brother, 
701 

Medical  diploma  tea'  society  of  .London 
702 

Medical  profession  in  Ireland  and  the 
private  entree,  273 

Midwives*  Institute,  701. 

Missing  link,  the,  104. 

"  Paknam  qui  meruit  ferat."— A 
protest,  433,  462,  542.  570,  597. 
648,  677  m 

Pathology  of  cutaneous  eruptions,  139 

Physical  education,  434 

Position  of  the  medical  attendant  in 
criminal  cases,  647 

Practice  of  medicine  and  dentistry  by 
companies,  297 

Question  of  exercise,  487 

Religious  mania,  407 

St.  Bartholomew's  Hospital,  104 

Sterilised  milk  foi  oniklren,  487 

Teaching  of  hygiene  and  temperance, 

159 
Universities  and  the  profession,  379, 

700 
Value  of  ethyl  chloride  in  dislocations, 

542 
Vermin  in  children's  heads,  543,  370 
Vivisection,  22  50 
What  is  alcohol  ?  <>: .'» 
What  is  brandy  and  what  is  whisky  ? 

647 
What  is  a  degenerate  ?  676,  701 

Coste,  Dr.,  typhoid  fever  relapses,  631 

Cragg's  research  prize,  221 

Cremation  statistics,  xoi 

Criminals  and  union  infirmaries,  72 

Crural  hernia,  288 

Cures — ancient  and  modern,  20 

Curse  of  corsets,  43 

Curtis,   Mr.,   perityphlitis  simulating 

malignant  disease,  601 
Cutaneous  disease  and   the  X-rays, 

Dr.  Jamieson,  32 
Cyst  simulating  femoral  hernia,  Dr. 

Snow,  202 


Dakhyl  v.  Laboucherc,  290 

Dangers  of  coke  fires,  18 

Dangers  of  the  bath,  68 

Danish  soldiers  poisoned  by  pork,  160 

Darmstadt  poisoning,  191 

"  Dartring  lanohne     toilet  soap,  134 

Dawson,  Dr.,  glycosuria  in  insanity, 

467 
Death  due  to  a  sedative,  481 
Death  from  "  laboratory  "  plague,  135 
Death  in  suicidal  hanging,  349 
Death  in  the  pot !   482 
Death  of   two  German   pioneers   in 

tuberculosis,  2x6 
Death  under  an  anesthetic,  371 
Death  under  ether,  23,  59 
Death-rate    in    the    South    African 

mines,  532 
Deaths— end  of  each  No. 
Deaths  under  anesthetics,  321 
Debove,   Prof.,   cancer  of   the   bile- 
ducts,  387 
Defective  hospital  administration.  428 
Degeneracy,  Dr.  Shuttleworth,  525 
Degenerate  or  deviate  ?  592 
Dejeuner  a  la  fourchette,  594 
Delayed    chloroform    poisoning,  Drs. 

Stiles  and  McDonald,  6c6 
Delusions  at  an  inquest,  431 
Dentists  for  soldiers,  275 
Dermatological  cases,  Dr.  Abrahams, 

169,  607 
Dermoid  cyst  of  both  ovaries,   Mr. 

Jessett,  446 
Dermoids :    ovarian  and  pelvic.  Mr. 

A-  Doran,  X37 
Detection  of  yeast  extract,  106 
Development  of  British  spas,  434 
Devonshire  Hospital,  383 
Diabetic  flours,  323  it  *^j 


Diagnosis    of    uterine    fibroma    and 

pregnancy,  422 
Diet  in  acute  B right's  disease,  504 
Diet  in  typhoid  fever,  404 
Dietetic  transformation,  $69 
Diminishing  birth-rate,  264,  482 
Diminishing    birth-rate,  Dr.  Taylor, 

223,  2)2 
Diphtheria  antitoxin,  19,  96 
Diphtheria  from  an  examination  hall, 

Dr.  McWalter,  327 
Discharged  lunatic  attendant,  5x2 
Diseases  of  the  bile-passages  and  in- 
flammation of  the  pancreas,  361 
Disputed  diagnosis,  a,  669 
District  nurses  in  Ireland,  339 
Disturbances  at  the  rectorial  address, 

132 
Diuresis,  329 
Doctors  in  politics,  323 
Domestic  animals  and  infection,  538 
Donations  and  bequests,  650 
Doran,  Mr.  A.,  dermoids  :  ovarian  and 

pelvic,  \-\7 
Double  resection  of  the  stomach,  663 
Downes'   electrothermic  anjjiotribes, 

684 
"  Dr."  Deighton's  great  walk,  373 
"  Dr.  Jim,"  241  , 

Draft    bill    for    the    registration    of 

nurses,  16 
Drapers'  School,  the,  135 
Drug   treatment  of   trypanosomiasis, 

643 
Drury,   Dr.,   perforation  in   typhoid 

fever,  29 
Dublin  hospitals    and   "  poor "  pa- 
tients, 68 
Dublin  hospitals  and  the  C.M.B.,  668 
Dublin  Sanitary  Association,  3x9 
Dublin    University    Piological   Asso- 
ciation, 355 
Dunbar's  antitoxin  in  hay  fever,  45 
Duncan,  Dr.,  rupture  of  a  tubal  preg- 
nancy, 200  :  position  of  the  medical 
attendant  in  criminal  cases,  629 
Dunstone  Park  Sanatorium,  633 
Durham  University  (pass  list),  463, 

Duty  of  medical  men  as  witnesses,  367, 

50  x 
Dysentery  in  children,  477 

Early  diagnosis  of  cirrhosis  of  the 
liver,  352 

Eating  of  rats  and  mice,  241 

Eccks,  Mr.  McA.,  inguinal  trusses  and 
their  manufacture,  277 

Ectopic  gestation  near  term  with  in- 
fected ovum.  Dr.  Goinard,  253 

Edge,  Dr.,  myoma  of  the  right  broad 
ligament,  445   .     ,    ,      . 

Edinburgh  Hospital  for  Incurables, 
646 

Edinburgh  medical  officer's  annual 
health  report,  541 

Edinburgh  rectorial  address,  102 

Edinburgh  Royal  Infirmary,  73.  74. 
X02 

Edinburgh  University  (pass  list),  5^ 

Edridge-Green,  Dr.,  theories  ol  colout 
vision,  361 

Education  by  suggestion,  71 

Effects  of  typhoid  fever  upon  the 
heart.  349  . 

Elephantiasticuiii  vagina*,  #" 

Elevated  climates,  177 

Endocarditis,  Dr.  Abram,  53 

Endovenous  medication,  135 

Enteric  fever,  Dr.  Smith,  34 

Enteric  fever  and  shell-fish,  412 

Enterostomy,  122 

"  Enule  "  brand  suppositories  (illus- 
trated), 488 

Epidemic  of  pseudo-rat  ies,  19 

Epilepsy,  208 

Epilepsy  and  crime,  &<) 

Epilepsy  and  genius,  181 

Epileptic  colony,  25 

Epileptic  in  custody.  514 

Epithelial  carcinoma  691 

Epsom  College,  s$$ 

Equipment  of  Queen's  College,  21 

Eruptions  simulating  scarlatina,  98 

Erythema  infectiosum,  691 

Erythema  scarlatiniforme,  71 

Etiology  of  emphysema,  40 

Ewald,  Dr.,  sanatogen  in  enteric 
fever,  307 

Excision  of  the  Gasserian  ganglion, 
Mr.  Gordon,  335 

Exeat  malaria !  403 

Experimental  typhoid,  456 

Experiments  on  animals,  <»>5 

Experiments  on  drugs,  Dr.  French,  497 

Experiments  with  new  drugs,  12 

Exploiting  of  disease,  156 

Extract  of  meat  and  yeast,  48 


Extra-systolic  irritation,  388 
Exukeram,  3x6 

Facial  paralysis  and  otitis,  344 
Focal  accumulation,  48 
Family  predisposition  to  disease,  215 
Fatal  case  of  pertussis  in  an  infant 

12  days  old,  Dr.  McWalter,  203 
Fatal  forceps  in  the  abdomen,  4A4 
Fatigue.  400 
Femoral    hernia     (illustrated),     Mr. 

Nicoll,  1 
Fibrocystic  tumour  of  tie  uterus,  I> 

Parsons,  309 
Fifteenth  International  Congress   of 

Medicine,  371,  649 
Finances  of  the  Meath  Hospital,  247 
First  Liverpool  graduates,  377 
FiscaHtis  and  the  medical  we-rld,  403 
Fleet  Street  critic  on  strychnine,  460 
Floggii*  in  the  navy.  436 
Fluid  on  the  chest,  Dr.  G.  Smith,  56 
Fluorescing  substances,  176 
Folk  medicine  in  East  Anglla,  696 
Food  and  Drugs  Act,  74 
Food  poisoning.  149 
Foreign  bodies  in  the  brain,  6x9 
Foreign  dispensary,  323 
Forensic  blood-test,  396 
Foreshore  nuisance,  132 
Forgotten  physician,  a,  46 
Formalin  in  milk,  432 
Forsyth,  Dr.,  aspects  of  diphtheria, 

633 
Foster  Green  Consumption  Hospital, 

132 
Foulds,  Dr.,  death  of,  702 
Four  patients  poisoned  at  a  lunatic 

asylum,  161 
Fracture  of  Cranium,  691 
Fraenkel,  Dr.,  broncho-stenosis,  306 
France,  Dr.,  influence  of  the  alternate 

electrical  current  on  the  organs  ox 

circulation,  376 
Free  dispensary  for  ahens,  221 
French  Congress  and  cfimatotberapy, 

French,  Dr.,  experiments  on  drugs. 

Fresh  air  and  diseases  of  the  chest,  373 
Fry's  cocoa  and  milk,  25 
Function  of  maternal  milk,  18 
Fussell's  pure  rich  cream,  301 
Future  01  photo-therapy,  3x9 

Galway  X-ray  case,  171,*  183 

Gastric  perforation,  504,  6^1 

Gastric  volvulus,  344 

General  Medical  Council,  390,  639 

General    Medical    Council,   seven tv- 
ninth  session,  380,  6x0 

Genesis  of  syphilitic  gumma ta,  90 

Gecman  birth-rate,  161 

German  dentist  for  the  Korean  Em- 
peror, 13a 

German  quack  in  court,  242 

Gift  to  the  Royal  Victoria  Hospital 
Belfast,  646  ^ 

Glandular  tuberculosis,  12 

Glasgow  Royal  Infirmary.  138 

Glasgow  University  (pass  list),  41  x 

Glaucoma  and  the  glaucoma  theories, 
Mr.  Paterson,  163 

Goinard,   Dr..   ectopic  gestation  near 
term  with  infected  ovum,  233 

Goldspohn's  operation,  663 

Gonorrhceal  infection  in  the  female. 
128 

Gordon.  Mr.  excision  of  the  Gasserian 
ganglion,  333 

Government  lunacy  bill,  the,  663 

Gram-positive  mycosis,  587 

Great    Wyrley  cattle-maiming    case 
378 

Gresham  lectures,  411 

Gunshot  wound  of  the  abdomen,  330 

Guthrie  lecture,  273 

Guy's  Hospital   and  charges  of  neg- 
lect, X37 

Hamatogen  tnal,  671 
Hasmaturia,  91 

Haemoglobin \n  the  muscles,  531 
Hamolvsin  in   normal  olood  serum. 

396 
Haemophilia,  423,  390 
Haig,  Dr.,  cancer  and  unc  acid,  627 
Hatley  Sanatorium,  202 
Harveian  oration,  Dr.  Caton,  685 
Haycock,  Dr.,  the  death  of,  134 
Hay  fever  season,  368 
Health  in  the  schools,  133 
Health  of  Belfast.  22,  x86,  313 
Health  of  hospital  residents,  129 
Health  of  the  Emperor  of  Germany 

x8x 
Hedley,  Dr.,  modern  physical  thera- 
peutics, 113 


INDEX. 


Supplement  to 
The  Medical  Preaa  and  * 


HtUeborc  poisoning,  jo 
hkj*u>  orThosis,  423 

H*r»u  epigastrica  bbera,  344 

H(TOi  cri  IB*  bladde 

Herpei  i»ter,  607 

tiiftcricil  medical  ejihibihno,  44 

Hotatrea*  colour- 1»- 

-  TimKKXK  Liruiteri,"  40 

HeS*Ul  amalgamation  in  Dublin,  2fr& 

ua**tal  decentrahsatiou  ami   trans- 

j*>pitaJ  tor  Disease*  o(  the  Skin  and 
Gneer,  Dufittn,    toj 
Ifc^nut  .^orsU«>H+  the,  171 

**»day  Fund,  545 
HotpiLib  ud  their  schools,  039 

Born  W 

HasaiaM  bonne  tuberculoid,  4='> 
H(ir«j>nin   L  *  affile  '*  work,   295 
HqfcfcX*?D.   Mr    J      btes-cnaial  i>- 
«Sm  of  the  si-iond  division  "1  the 
ei&  serve  (illustrated],  463 
Hrtr^Tuaimc  problem,  477 
H^ofcetra,  Mr.  F    Jordan,  4?*> 
SftitfbDbia,  477 
gnatx  ol  the  door-mat,   100 
HtjiEme  treatment  of  consumption, 

thfinM.     treatment     m     pulu 

is&erculovi*,  Pr«  Kelynsck,  4l6 
fl^trpvrtiia.  374 

■nci  in  neurasthenia,  Dr.  Let- 
nitte.  S2# 
H^<dermic  "  Ubkad  "  brand  pocket 
sue*  194 

isnnie  treatment  ol  syphilis.  &2 

IfejJ  dwr-rnat  an  (.illustrated),  32  ft 
bfsrtillofi  ol  Chinese  labourers,  640 
-'-a  |«aey  onsnnnwma,  563 

■esis  iance  of  the  ecu  to- 
*aao.  387 
labia  Medicat  Service  (pass  bat).  r  35 
fadrrtdiul  iHpilihl4%  513 
Indurative  pancreatitis,  38* 
Uhutnal  diseases  due  to  poison,  77 
ladastnal  plumbs m.  %f7 
htteute  retreats,  353 
Iabat  mortality,  68 1 
kUat  schools,  5614 
latecttons  erythema,  513 
later  tttftft  patten  ts  cm  railways,  149 

t    acute   rbeumatism.  73 
3*J 
Influent?  uf  the  alternating  electrical 
mniton  the  organs  of  circulation, 
Dt  Frame,  576 
Isgratiac  toenail,  208 
lafnsl  trashes  and  their  nianufac- 
McA,  Ectles,  177 
.    to  the  *pteeu  and  diaphragm, 

tBDtahuon  -  1 1 

■f  into  Dmdon  tuberculosis  ^14 
mimunity.  Dr.  Pearse,  55 
Insulate  of  medical  sciences,  107  1275 
lasuaace  examination  fees,  100 
Tnlerduage  01  medical  teachers,  536 
taterojsUI  nmsclea  in   thoracic  dfs- 

ktematioaal  Congress  ol  Dennato- 
bp,  rftj 
iiteuubooal    Congress    of    Ophthib 

TijiioBal  Congress  of  Otology,  jt 
l«mn.<"  lebef.  646 

A&OnaJ  Home  Rthef  ConfTess, 

imcot,   jo: 

teeood 
,  of  the  Mr.    J* 

a.   Jul  .1'.    4^ 

in     *;crcbr.i- 
.:'  menlnfiUs,  04 1 
forvej.tor  of  tlie   Largynga*t>  : 

lressin£t  Dr    Macoau^hton- 

J«0c; 

ti*>t<roi  idiosyncrasy,   Dr+  HellleW, 

^4Ti;,t'nuTii,    JOjt 

Ltab    and    the 

«UH   and    the 
L'mL**l  Mtd*Hves   Board,  Jl6 

Vil  ffraduAtci'  dmnrr,    ng 
Inih  H<^|icii  Sdaoob'  and  Graduate* 

nil  H.^pit*!  tor  Consump- 

hb  Pwc*law  Medical  Service,   Mr* 


Japanese  medical  services.  ta\ 
Jellett,  Dr.»  acid  Dr.  Earl,   primary 

sarconiA  of  the  vagina  in  the  adult 

lilhutratid),  413 
Jones,   Dr,   relatiuo  of  inebriety   to 

mental  disease,  jiSS 
Jones,  Mr.  Rr,  tuberculous  arthritis  in 

the  young.  550 
Jordan,  Mr.  FH  hydconietra,  470 
Juvenile  cigarette-smoking,  70 


Kelynack,  Dr.,  hy|tcmc  treatment  9\ 
consumption,  3?  t  bypirnic  treat- 
ment of  pulnscmary  turereolous,  410 

Kean<»dy,  Mr,,  new  retention  *plint  for 
congenital  talipes  equino-vanis 
iilln-trated)-,  331 

Ki tic's  vi? it  to  Ireland,  485 

trick,    Dr.,    newer   amrsthetie 
Agents,  57 

KlempercrjDr^  chenustry  ol  albumin, 
U3 

Kntix,  Dr.  W  ,  tbe  late,  ;4J 

K0C%'t  birthday,   44 

t£opbk"a  spots  in  measles,  67. 


Large  fibroma  of  the  broad  ligament, 

lir  l':ir^in^,  30 1 
Large    uterine    myoma    in    the    left 


a,  &}0 
1  a  dr\ 


— «,  Dr..  cutaneous  disease  and 
fcX<r»ys,  ja 


broad  bgament.  Dr.  Duncan,  308 
Laryngeal  crepitus  as  a  fign  of 


pul- 


monary turjerculousiSt  Dr,  Reuiun- 
ibamps,  418 

Latent  disease i  n  childhood,  770 

Latent  or  internuttent  nasal  obstruc- 
tion, Mr.  M-  Collier,  249 

Latent  or  internuttent  nasal  obstruc- 
tion, 271 

Law  and  medicine,  393 

Layman  in  medical  practice,  47* 

L  C.C  and  tuberculosis,  Gyr? 

Lead  in  cream  of  tartar,   161 

Lectures  in  medical  jurisprudence,  107 

Lectures  cm  medical  jurisprudence,  134 
190 

Leith  and  lijberculosls,  7**' 

Lejars,  Dr.,  surgical  intervention  in 
cancer,  336 ;  primary,  muscular 
tuberculosis,  037 

L^on,  Dr.  dr>  source  of  Safe*,  two 
during  operation,  ^2 

Lepra  tubero^anasstbetica,   148 

Lermitte,  L>r.,  hypnotms  iu  MHf> 
thenia,  526 

Lcucsima,  Ui 

Leucocyt"Siv  and  appendicttia,  60O 

Lifting  of  the  veil,  oi£j 

Light  and  hat' ten  a,    19O 

LimiUtiofls  of  11  nidi uu*  m  alxlouunal 
diseases,  Drr  Qiappcl,  354 

Limit*  of  niedical  aid,  482 

Literary  cicpnssion,  Sr>r 

Literary  notes  and  gossip,  24,  3*1,  517 
678 

LITERATURE. 

AfUrMi*eatment  ol  operation.-,  Mr 
Muiuawry,  1U 

Aids  to  physiology,  Mr.  Beale,  373 

Alpine  flora,  Df.  Hotovan.  43*> 

Analytical  chemistry,  Dr.  Muter,  76 

Atlas  of  human  anatomy,  Dr.Toldt. 

Bacteriology   of   every-day    practic, 

Dr.  Svnies,  4*9 
Ca«  of  infanK  Dr.  jex-Hlake,  409 
CataracLeatraciJon,  Professor  Heibea 

i8i 
riiarle*  White    I   Kc.S-.  Dr.  Culling- 

w«rtli.  435 
Dental  annuitl,  the.  43) 
Disease  in  children,  274 
£>iseases  uf  ll*e  lungs  and  Heart.  Dr, 

Lindtay,  39 B 

escl  ihr  skin,  l'i.  Cruckcr,  s+i 
Fhspcnsing  made  easy,    Dr,  Sotner- 

land,  4$t* 
Divine  hygiene,  Dr.  Rattray;  344 
Doctors  and  their  wcrk,  Mr.  *L  C alter, 

»7| 

Edintmrgb  Medical  jimmaL  300 
Klcinentary  dispensary  praetk 

lnce,   300 
JiifrTients   of   surgical   diagucfti^,    Mr, 

Gould,  i^S 

harmacopceia.  078 
Eye  symptom*,  Dr.  Uagennls,  39^ 
General  pathology   for   students,    Dr. 

Martin,  510 
Golden  rules   for  disease*  uf  infants 

and  children,  Dr,  Carpenter,  40^ 
Handbook     of     the     Fans     Medical 

School.  Dr.  Warden,  iftg 
Home  nursing,  Dr.  Myers,  56 
Hui nan  anatomy,  Dr.  Rosa,  too 
Infection  and  immunity,  Dr.  5km- 


Circular 

m 

n,  £100,000 


Insanity,  Df.  Vuunger,  4B9  |  ifcdical  Defence  Union,  56» 

MaciniUan1!  tiuid^  to  Switzerland^^    Medical  education  m  London,  £100.000 
Manual  lur  student*  ol  massage,  Miss        (,,    i2 ,  p* 

h  Hi  son,  infl  Medical  examination  of  tbe  spectacle 

listeria  medica  and  thera juries,  Dr        makers 


Man'rirf  mew*,**  duu  hh.ijjtuihi.,  i^,    .       niahers     324 

„ Phillip*.  4!8  ,  Medical  goff  match,  54* 

Mathematics  and   hygiene,   Dr,   ter-    Medical  golf  tournarnenl 


416.  bsi 


guson,  07S 
Medical  dicttpnarj',  T>r.  DorHng,  a-jS 
iCdsrifary  for  raidisive*,  Mr,  Wigpinj.. 

316 
Natural  mineral  waters,  409 
Nauheim      treatment^     Dr,     Thome 

JTiome,  516 
Nutrition  01  the  infant,  Dr.  Vimrnt. 

105 
Operative  surgery,  Sir  F,  Treves,   .r*o 
Operab/a  surgery,  Mr,  Wanng,  677 
Pathology  and  therapy  ol  disea=<-  >  I 
and     nulnn»>n,      Dr. 

■  "J"1*0*  7°       „     r             x           Meril  al  Sickness  and  Acdduu 
Practical  analotny,  Dr.  Cunningham,    ■•  »wwi  z>~i*t^«  ,..,    


golf  tournament. 
Medical  martyr,    101 
Medical  mayor's  "  consumption  cure," 

681 
Medical  Missionary  Association,  463 
Medical  officers  at  Hereford,  $iu 
Medical   officer   of    Limerick    female 

pnioj  i 

'I   ['li'-it"krraphers,   373 

Lice  in  the  Urauge  Rivet 


I  Medical  prices  ol  the  Paris  Academy 
of  Sciences,  135 


'  Medical  Register"  for   1904,  sit 

Dublin  34^ 
Medical  provost    of    Tnnity    College 

*&  I'ji.  27  ■,. 
Medical  side  of  the  Port  Arthur  fight  , 

Medical  tournament,  436 

Medical  witnesses  in  ar,  h+6 

Medical  women  practising  in  Scotland 

!>  X-ray      burn  '*  case,  a,  536 
"  Medicals  as  pirates,**  149 
Medicinal    treatment   of   disease    in 

children,  Dr.  Tresilian. 
Medicine  as  a  diplomatic  instrument, 

5I« 
Medicine  as  a  factor  ia  polilk*.  307 
Medicine  in  the  seventeenth  century, 

14S 
Medicine  militant,  205 
Medico-psychological  Association,  50 r, 

544  *~ 
Memorial  to  the  late  Dr.  j\  Manlcy,  ?5 
1  Memory,  *,&8 
Mercer rs  Hospital,  Dublin,  618 
Mrrklen,  Prot,,  cardiac  astbtna,  469 
Metrt»TTha^ani  fnun  libroin  1 
Mctrojpolitan  A^vluius  ik»ard,  ins 
London  open-air  sanatonum,  231  Microoes  as  instruments  o£  warfam, 

London  School  of  Medicine  tor  Women  ■      Q*  r  hi 

^jj,  I  Military  patkiils   ui   worfebowe  liuv 

D»don  School  o£  Tropical  Medicine,        W^Vfc  ^  tnwil_    JC- 
is  ■  (pas*  listDot  S  S  supply       *?"  '  454 

London  smail-^a  1  tat istics .  1 35  i  S^i J2S5?  *t  Jt>     J  5 

LgodOn  street  ambulance  scheme,  337  *«  1M<V^I    ».« 

™™uv  «   Irrlaod.   aitt  JJinei      |*Uu»is  in  tht   Ddiisvaal.  vjj 

Mnd''<'u    pbystcal    tinarapeubcs,    Dr, 

Hedky.    fij 
Modern  surgen'  «-t   iIil   prostate.  Sir 

W.  M.  Basks,  81 
Modem    treatment  ol    pajilytk   do* 

f>42 

Honey  and  bacb?rta,  v?4 

iv  of  ctmvalcaceucc.   O44 
te  Sana birimn  Cillustrntedi.  i4% 
I  Moore,  Dr,,  the  late,  s  1 
Moot*,  Sir  !.  W.,  public  health  pro- 
blems in  Ireland,  227 
Morbus  Barlow,  tju 
Morbus  Basedowii,  3&7 
More  ligbt,  19* 

More  smalbpox  In  London,  25 
More  thorough  study  of  therapeutics 

Mr.  Vinrace,  5 
Moser**  polyvalent  st>rum.  20a 
Motoratnla  cerebrabt,  330 
M-unt  Vernon  Hi*pitat,  33 
Mrs,  Eddy's  toothache,   133 
Multiple  fat tv  necrosis,  4*4 
Multiple    neurotic    gangrene    o!    the 
ikla,  03 


Practical  medn  inc.  Sir  J  .  Sff*  J 
Practice  ol  medicine,  Dr.  Andw 
Prevention     of     consumption,      Dr. 

.  220 
Social  evntutiou,   Mr.  Taylcr,  677 
Text-book  of  midwifery   for   nurses, 

Dr.  Jardiae,  299 
Test-tH*ik  of  surgerv,  Drs.  Keen  and 

White,    517 
Thesaurus     of    medical    words    and 

phrases,  1  -r) 

Transactions  ol   the  Clinical  Society 

of  London*  300 
Transactions  ot  the  Royal  Academy  of 

Medicine  in  Ireland,'  299 
Tropical  diseases,  Dr,  Manson 
Year-book  of  pharmacy,  189 
Year-book  of  treatment,  489 
Zoological    study    in    Malay  1     MM 

Annandale  and  Robinson 
Liver  and  bibaxy  systems.  303 
Liverpool  Medical  Institution,   to 7 
Liverpool  Sanatorium,  313 
Livingstone  CoIIcrc,  650 
London   and   Counties   Medical    Pro- 
tection Society,  329,  331 
London  herbalist's  husinos,  77 


Longevity  in  Ireland,  21ft 
Louecbe-WBams,  612 
Lunacy  in  Scotland,  300 
Lunacy-rate  tor  thirty  >ears,  272 
Lungs  of  Loudon,  -44 
Lupu»  tin  nidus,  304 
Lymphangioma,  Mr.  Car  less.  140 
1  vn  pi  itic  glands,  Dr,Trendcl,  114 
Lymphoid   kueocytha^mia,   331 


McCaw,  Dr,,  pteudo-bypertrophic 
paralysis,  jjo 

Mt  Donald,  Dr„  delayed  cljlorofotm 
poisoning,  Mi 

Macnaughton-Joncs,  Dr.,  apphcaiton 
ol  pes»anes  and  their  dangers  i '  1 1  u  -  - 
Irate*  iiigcresufl  ui 

farm  nrcamng,  19*;  l*owfies  etedro- 
iU  aiujioiribe^,  684 

Maiden.  Mr,  J .  R,  plants  wimh  induce 
aeaema,  347  .     _|  _ 

I  Maintenance  o|   the  Queen's  ColVege, 
'      Cork,  s>J 

Mai. -in a  m  Egypt 

Maiden  Sanatorium,   17" 


^  Ug  ntios    Muiide,3ey  Sanatorium,  34 

mm Fl4r*U  ot  tntereat,  Dr.  I'^doe,  \  U*™¥.  £«  iate  **>  21a 
Tj^»  Muriel*,  Dr.,  some  pneumonia*,  109  ; 


420 
Malignant  tumour  in  the  same  person, 

two  kinds  of,  62 
MiUKhcstcr  Hospital  forOmsumptiou, 

367      ,. 
Marmorek's  ipruiu.  374-   3JO 
Manage  -end  of  eacb  Ko. 
Massage  of  the  heart,  44 
Mastoiditis,  012 

Mater  Infirmoium  Hospilal,  313. 
Mawuell    Dr,,    acute    general    pcrj- 

tapitia,  (104 

HospitaL  4 'it 
Mediaeval  hospitals,  2O7 
.,   »3S 
Medical  amazon,  a,   (30 
Medical    and     Hygienic    LxHbitors* 

Associatiw,  598 
Medical  Benevolent  Fund  of  Ireland, 


630 

Mcdi. 


lea]  .  v .hat  volunteers,  5 ill 


choice  of  a  table-water,  4^3 
Muagrave,  Sir  J.,  tbe  death  of,  240 
Music  and  digestion,  184 

1  of  Ihc  right  broad  ligament. 

Dr.  Edge,  445, 
Myrtle,    Dr.,    jdrcnaliu    in    ucurptifl 

heart,  493 

Nana!  dilator,  ?-►: 

National  Hospital  for  Consumption, 

113 
National  laboratory  of  hygiene,  48 
Naval  M  I),  437 

Necrosis  of  fatty  U^uc,  &13 
Neglect  of  uterine  cancer,  364 
Nelson"*  ami,  268 
Neuro-fihroma,  237,  Ji6 
Neuropathic   factor   us    roembianou 

colitis,  430 
New  appointments  at  Dr,  Steevcos 

Hospital,  23 


June  29,  1904. 


INDEX. 


-L.  ..    Supplenwntto 

The  Medical  Prase  and  Circular. 


New  aseptic  vaccination  pad,  702 
New  audiometer,  a,  293 
Xew  Brompton  Hospital,  (**.) 
Newbolt,  Dr.,  two  cases  of  stone  in 

the  female  bladder,  383 
New  books  and  new  editions,  139,  300, 

490 
New  course  of  post-graduate  lectures, 

U  < 

New  dietary  disease,  331 
Newer  anaesthetic  agents,  Dr.  Kirk- 

patrick,  57 
New  home  for  consumptives,  371 
New  military  hospitals,  404 
New  patent  medicine  regulations,  401 
New  retention  splint  for  congenital 

talipes  equino-varus,  Mr.  Kennedy 

(illustrated),  331 
New  test  for  typhoid  bacilli,  395 
Newtownards  District  Nursing  Society, 

New  M  trust,"  97 

New  use  for  X-rays,  2x7 

Neuroses  associated  with  movable 
kidney,  296 

Nicoll,  Mr.,  femoral  hernia  (illus- 
trated), 1 

"  No  hats,"  672 

Nocturnal  restraint  of  infants,  333 

Non-recognition  of  Edinburgh  Uni- 
versity. 67  x 

Non-surgical  treatment  of  floating 
kidney,  72 

Non-toxic  preparation  of  iodine,  Dr. 
Wingrave,  360 

North  of  England  Obstetrical  and 
Gynaecological  Society,  134 

Northumberland  miners  and  doctors* 
fees,  703 

Notes  on  therapeutics  and  materia 
medica,  Dr.  D.  Walsh,  4x9,  444, 
467,  496 

Notonecta,  439      * 

Notices  to  correspondents— end  oi 
each  No. 

Notifications  and  erroneous  diagnosis 
"7 

&oYV  *, 

Nurses'  registration  bill,  221 

OBITUARY. 

Alcock,  Lieut.-Col.,  4x0;  Anderson, 
Dr..  328;  Archer,  Mr.  G.,  327; 
Badgar,  Mr.,  30 ;  Baker,  Mr.  ].  B., 
50;  Bartrum,  Mr.,  327;  Beattie, 
Dr.,  487;  Blen-Cunyngham,  Dr., 
23 ;  Brown.  Mr.,  4x0 ;  Bullin,  Mr., 
516 ;  Cardew,  Mr..  73  ;  Cayley, 
Dep.-Gen.,  333  ;  Colgate,  Mr.,  333  ; 
Coney,  Dr.  W.  (with  portrait),  160  ; 
Corbett,  Col.,  435  ;  Cree,  Lieut.-Col., 
23 ;  Davidson,  Dr.,  273 ;  Dawson, 
Mr.,  247;  Dearden,  Mr.,  679; 
Dettweiier,  Dr.,  73 ;  Dixon,  Dr.. 
273  ;  Donald,  Dr.  W.,  60  ;  Donald- 
son, Dr.,  434 ;  Dunlop,  Mr.,  382 ; 
Evans,  Mr.,  xoo ;  Ferxand,  Dr.,  328  ; 
Ferrand,  Lieut.-Col.,  $te  ;  Fletcher, 
Mr.,  30 ;  Garland,  Dr.,  73,  189 ; 
Gowring,  Mr.,  494;  Haines.  Dr., 
382  ;  Haran,  Mr.,  434  ;  Mayes.  Dr., 
343  ;  Haymes,  Capt.,  4x0  ;  Hepburn, 
Dr.,  3x6  ;  Hope,  Mr.,  343  ;  Hughes, 
Mr.,  327;  Ives,  Mr.,  679;  Jeuner, 
Dr.,  649  ;  Jolly,  Dr.,  31 ;  Kelly,  Dr., 
679 ;  Kennard,  Mr.,  220 ;  Kent, 
Mr.,  355  ;  Key,  Surgeon  W.  T.,  30  ; 
Kinner,  Mr.,  327 ;  Knox,  Dr.,  343  ; 
Kynsey,  Dr.,  73;  Lander,  Mr., 
434  ;  Lei  ten,  Dep.-Surg.-Gen.,  220  ; 
Lloyd,  Dep.-Gen.,  433  ;  Longden, 
Dr.,  189 ;  Mclnnes,  Hon.  T.  R.,  381 ; 
Mackod,  Insp.-Gen.,  22  x  ;  Marey, 
Prof.,  398 ;  Martin,  Dr.,  433 ;  May, 
Mr.,  4x0;  Meldon,  Dr.,  487; 
Moore,  Dr.  C.  F.,  23 ;  Niven,  Dr., 
220  ;  Nyhan,  Dr.,  273  I  O'Connor, 
Dr.,  189;  O'Neill,  Dr.,  543; 
Owen,  Dr.,  160;  Owen,  Mr.,  649; 
Palmer,  Mr.,  463;  Playfair, 
Dr.,  189 ;  Porteous,  Dr.,  189 ; 
Prytherch,  Dr..  382 ;  Renaud, 
Dr.,  4x0 ;  Richards,  Mr.,  381 ; 
Ross,  Sir  D.  P.,  649 ;  Saunders, 
Dr.,  30 ;  Scatnff,  Dr..  649 ;  Sieve- 
king.  Sir  C,  246  ;  Sisley,  Dr.,  343  ; 
Smiles,  Dr.,  434  ;  Smith,  Mr.,  160  ; 
Smyly.  Sir  P.  C,  409;  Steam, 
Surg.  F.,  434 1  Stuart,  Dr.,  382 ; 
Tagert,  Dr.,  50  ;  Thorn,  Surg.-Gen., 
649 ;  Thompson,  Sir  H.,  462 ; 
Thornton,  Mr.,  30:  Tuckett,  Mr., 
316;  Warburton,  Mr.,  189,  220; 
Way,  Dr.,  371 ;  Welland,  lieut, 
-  ;  Williams,  Mr.  J.,  106 ;  Wifcwn, 
•,  3*7. 


ft 


Observations  on  school  children,  376 
Obstructive  self-immolation,  98 
Occupation  and  residence,  401 
Ocular  basis  of  migraine,  184  J 
Official  b  air-split  ting,  437 
Old  Edinburgh  Infirmary,  326 
Olive  oi!  as  a  therapeutic  agent,  438 
One-sided  reciprocity,  96 

THE     OPERATING     THEATRES. 

Acton  Hoipitax,— 
Myomectomy  and  ventro-nxation, 
478 
Chelsea  Hospital  for  Women— 
Abdominal       hysterectomy       for 
myoma,  123 
French  Hospital  and  Dispensary— 

Resection  of  ribs,  263,  289 
Great  Northern  Hospital — 
Trephining  for  symptoms  of  cere- 
bral compression,  306 
Two  cases  of  gastric  ulcer,  2x0 
Guy's  Hospital — 
Excision  of  large   tumours,  123 
Hour-glass     contraction     of    the 

stomach.  41 
Mechanical  obstruction  of  the  large 

bowel,  238 
Obstructive  jaundice,  343 
Pancreatic  cyst,  41 
Two     operations     for    discarding 
the  big  bowel  from  the  gastro- 
intestinal tract,  691 
Hospital  por  Sick  Children— 
Strangulated  inguinal  hernia  in  an 
infant,  at.  three  weeks,  63 
King's  College  Hospital — 
Amputation  at  the  hip-joint,  388 
Excision  of  the  upper  part  of  the 
rectum  (Kraske*s  method) ;  re- 
storation of  canal,  64 
Italian  Hospital— 
New  method  of  excision  of   the 
tongue,  663 
London  Hospital — 
Cholelithiasis— empyema—  excision 

of  gall-bladder,  91 
Subdiaphragmatic   abscess  on  the 
left  side,  303 
Middlesex  Hospital — 
Excision  of  upper  jaw  for  malignant 

tumour,  661 
Strangulated  femoral  hernia,  397 
Strangulated  inguinal  hernia,  397 
North-West  London  Hospital — 
Appendicitis,  13 

Aspiration     of    pericardium     for 
sudden  increase  of  heart  dumess, 

Fistula  in  ano,  178 
Radical  cure,  613 
Tuberculous  disease  of  elbow-joint, 

263 
Wiring  fractured  patella,  14] 
Royal  Ear  Hospital— 

Dislocated  septum,  478 
Royal  Free  Hospital — 
Removal  of  a  large  ovarian  cyst, 
562 
St.  Bartholomew's  Hospital — 
Appendicectomy  during  pregnancy, 

209 
Excision   of   a   carcinoma   of   the 
tonsil,  424 
St.  Peter's  Hospital  por  Stone — 
Enucleation  of   the  prostate  and 

suprapubic  lithotomy,  332 
Intestinal  urethrotomy  for  stricture, 
1*7 
St.  Thomas's  Hospital— 
Complicated    ovarian    multilocular 

tumour,  370 
Nephrectomy   for  hydronephrosis, 

Pyo-nephrosis  secondary   to  renal 
calculus,  638 
West  I  on  don  Hospital — 
Gastrotomy     for     removal     of     a 
Murphy's  button,  288 

Operative  relief  of  the  lungs,  64 
Opotherapy  in  renal  disease,  39 
Origin  of  hernia,  369 
Osborne  College,  2x4 
Osteopathy,  154 

Ovariotomy  in  inoperable  cancer,  5  1 
Overton  Hall  Sanatorium,  8 
Owen,  Mr.,  appendix  abscess    in  the 
recto-vesica  poutb,  163 

Paratyphoid  fever,  94 
Paroxysmal  tachycar,  209 
Passing  of  the  coroner,  312 
Passive  immunising,  361 
Pasteurism  in  the  U.S.,  343 


Patent  medicine,  16 


Patent  medicines  and  press  criticisms, 

Patent  or  proprietary  poisons,  323 
Paterson,    Mr.,    glaucoma    and    the 

glaucoma  theories,  163 
Pathogenies  of  hipus,  432 
Pathology  of  chronic  alcoholism,  Dr. 

Robertson.  33 
Pauper  children,  669 
Pearse,  Dr.,  instances  of  immunity, 

55« 
Penalties  of  malpraxis  in  Germany, 

Perforation    in    typhoid    fever,    Dr. 

Drury.  and  Dr.  Taylor,  29 
Perforation  of  the  abdominal  aorta, 

Peritonitis  from  the  bile-passages,  386 
Perityphlitis    simulating    malignant 

disease.   Dr.  Sunderland  and  Mr. 

Curtis  ~  I 
Perrier,  a  new  sparkling  table-water, 

680 
Personal,  21,  73.  ">x,  X3i<  l57,  i&3> 

218,  243,  271,  297.  326,  232,  378, 

406,  432,  460,  485,  5x4,  340,  370, 

596»  6ai,  °45»  ^i9?  *„ 
Personal  equation  in  diet,  670 
Petticoats  as  bacteria  traps,  fioK 
Phalangeal  enlargement  in  rickets,  269 
Pharmaceutical  formula?,  481 
Pharmaceutical    Society    of    Great 

Britian,  77 
Pharmacopoeia  revision,  42 
Phonendcecope  n  medicine,  130 
Phthisiogenesis  and  anti-tubercle,  343 
Phthisiophbia,  94 
Phthisis  inapex  of  lung,  396 
Physical  education  in  schools,  308 
Physical     examination     of      school 

children,  326 
Physical  traUung  in  schools,  373 
Physicotherapy,  90 
Physiology  of  hunger,  376 
Physiology  of  shaving,  the,  68 
Piano-tuners'  lunacy.  438 
Pig-sticking  extraordinary,  68 
Pioneer  Association,  20 
Pirrie,  Mrs.,  and  the  Royal  Victoria 

Hospital,  407 
Pityriasis  fomcularis  chronica,  237 
"P.J.F."  266 

Plague,  30X,  373.  463.  545*  681 
Plague  at  Johannesburg,  323,  333,  403 
Plague  in  South  Africa,  383 
Plague  of  advertisement,  239 
Plants    which    induce    ecxema,    Mr. 

J.  H.  Maiden,  547 
Plea  of  insanity,  the,  212 
Plucky  rescue  Sy  medical  man,  243 
Plumbers'  Company  and  registration, 

20 
Plumbers'  registration,  484 
Plumbers'  registration  bill,  51 
Plumbers'   registration  examination, 

490 
Pneumatic  tourniquet,  309 
Pneumococcic  infection,  154 
Pneumonia  in  children,  xao 
Pocket-therapy,  204 
Poisoning  at  Portsmouth  Asylum,  247 
Poisoning   by   black   hellebore,    Dr. 

T.  C.  Thorowgood,  34 
Poisoning  by  eggs,  481 
Poisoning  by  honey.  47 
Poisoning  by  illuminating  gas,  6x9 
Poisoning  by  methyl  alcohol,  18 
police  court  vaccination,  3x4 
Poor-law    infirmary    and    puerperal 
]     fever,  266 

1  Poor-law  medical  relief,  461 
;  Popliteal    arterio-venous    aneurysm, 

Popular  impressionability,  457 
I  Popular  views  of  cancer,  242 

Portsmouth  Asylum,  the,  459 

Position  of  the  medical  man  in  cri- 
minal cases,  645 

Position  of  the  medical  attendant  in 
criminal  cases.  Dr.  Duncan,  629 

Post-graduate  classes  in  Dublin  Uni- 
1     versity,  274 

Post-graduate  work  in  Dublin,  336 

Postural  haemorrhages,  243 

Practical  importance  of  blood  pres- 
i     sure,  562 

Practice  by  companies,  620 

Practice  of  medicine  and  dentistry  by 
,      companies,  291 

"  Premature  burial,"  157,  458 

Preparations  from  the  intestinal  tract, 
1      176 
[  Prepared  air  in  hospitals,  393 

Presentation  to  a  medical  practitioner, 
437 

Presentation  to  a  Perthshire  surgeon 
(illustrated),  23 

,    rcssurc  stasis,  690 


Primary  diphtheria,  690 

Primary  muscular  tuberculosis,  ProC 

Lejars,  637 
Primary  sarcoma  of  the  vagina  in*  the 

adult,    Dr.    Jellett   and   Dr    Earl 

(illustrated),  4x3 
Primary  sores,  40 
Private  entree  to  the  Viceregal  court, 

Problem  of  the  vagrant,  333 
Process   for  exposing   the  posterior 
•  surface  of  the  liver,  237 
Prodromata  of  the  psychoses  and  ttxesr 

meaning.  123 
Prognosis  in  heart  disease,  240 
Prognosis  in  heart  disease,  Dr.  Barr, 

X07,  196 
Prognosis  in  tuberculous  affections, 

Pro-mortusectionist,  428 

Prone  position  in  the  after-treatment 
of  septic  peritonitis,  636 

Proposed  census  in  1906,  329 

Proposed  consumptive  sanatoria,  5x5 

Prosecution  of  an  unquanned  prac- 
titioner, 31 

Prosecution  under  the  Pharmacy  Act, 
397 

Prostate  gland,  40 

Protargol  in  gonorrhoea,  374 

Protozoa  and  disease,  644 

Professional  secrecy,  2x4 

Prof.  Koch's  present  position,  692 

Progress  of  smali-pox,  158 

Prudential  assurance,  274 

Pruritus  ani,  Mr.  Mummery,  364 

Pruritus  of  the  scalp,  607 

Prussic  and  phosphoric  acid  vapours, 
33* 

Pseudarthrosis,  Dr.  Ray  (illus- 
trated), sx 

Pseudohypertrophic  paralysis,  Dr. 
McCaw,  230 

Pseudoleukemia,  148 

Psoriasis,  xx 

Psoriasis  in  children,  Dr.  Meacbca 
(illustrated),  236 

Psoriasis  of  the  scalp,  343 

Psychology  of  school  punwunent,  402 

Public  health  legislation,  136 

Public  health  problems  in  Ireland. 
Sir  J.  W.  Moore,  227 

Public  night  shelters,  69 

Puerperal  paralysis,  614 

Pulmonary  cederaa,  128 

Pulmonary  ceteo-arthropatby,  L>r. 
Sevestre  (illustrated),  60 

Pulmonary  osteopathies,  130 

Purity  of  sweets,  269 

Purulent  perityphlitis,  262 

Purulent  typhlitis,  3x7 

Pus  in  urine,  477 


remedy,  a,  312 

ry  in  America,  670 

itue  Conference  at  Barbardos, 


Queensmen,  dinner  of  past  and  pre- 
sent, 326 
Question  of  fees,  246 


Radiography,  features  of,  369 
Radiometric  practice,  304 
Radium  and  cancer,  124,  346 
Radium  at  Bath,  268 
Radium  in  malignant  disease  of  the 

throat,  X83 
Radium  in  the  treatment  of  a  can 

cerous  throat,  Dr.  D.  Walsh,  163 
Raising  the  wind,  322 
R.A.M.C.  and  enteric  fever,  321 
Rapid  detection  of  ankylostomiasis, 

Rat  exterminator,  439 

Rats  and  rat-eating,  206 

Ray,  Dr.,  pseudarthrosis  (illustrated), 

3* 
Recent  plague  scare,  161 
Red  light  and  small-pox,  430 
Reducing  power  of  milk,  369 
Refinements  in  diagnosis,  403 
Reflex  facial  paralysis,  637 
Registration  of  bogus  medical  com- 
panies, 455 
Registration  of  nurses,  436 
Registration  of  nurses  in  America.  545 
Regius  professorship  at  Oxford,  182 
Relation  of  inebriety  to  mental  dis- 
ease, Dr.  Jones,  388 
Religion  and  poor-law  nurses,  17 
"  Religious  "  mania,  322 
Renal  and  cardiac  dropsy,  Dr.  Rcnaut, 
229 
Renal  opotherapy,  xx 


INDEX. 


Supplement  to 
The  Medical  Prose  and 


Circular. 


irMttt.  T*  .  Pm j1  and  rardiic  dropsy, 

£>peJfct  conical   therrnemeter  (illu*- 

trsnc 
Retort  e4  *h*  miDc-borar  disease* ,  669 
-  ~*ertnkwi*    396 

I  for  djipeptJc*v  314 
__itaoon  trom  asphvria,  31$ 
"  feturn  "  case  of  stark t  fever,  4*0 
ItiiJiiti  ■  medical  practice-,  483 
jjiciaiLK  iw*rt,  58ft 

lules,  so  4 

rtnre  of  the  liver,  330 

•  ferric  inflation,   199 
Kisle.  if  rarttpgraphers,  4** 
Rim?  *S*e*-  Canne*.  35  S 
H:V«^  Dr>*  patholoxy  ol  rhrome 

Kcto  i  A*  nue  organs  tn  disease,  5 10 
i  drrmatitts,  At) 


mlnn*- 


frrj  Axmv  Hedtca*  Collet* 
ft«xl  BntUh  \'ur»*<  Associal 


»t3 


-  -elation,  107 
total  Citv  "<  Dublin  Hospital  |l 
total  ColV»#e  of  Phvsinan*.  IjOndon, 

to*il  Collate  of  Sdeore  for  In- land. 

tofal  Cott>ge  of  Surgeons  of  England. 


f  son 


ReyaJ  CoikSTef  Snrgeious  in  Ireland, 
i^o,  599;  (pas*   UstJ  •?*  3*3r 

fepytJ  CoOege  of  Surgeons  of  England 
*•«  talk  *75.  4*3  .-_*_- 

toW  Collage  of  Surgeon*  of  EnsUiuri 
m&  fecMidwwn  Board,  jo  3 

Royal  College  of  Surgeon-;  of  Eduv 
'    (P* 


R    ?,>-. 


•  H 


rid 

Hitr  of  Pllbttc  Health,  411 
ftonl  Institution.  030 
tojynfl         Infirm  .4  r>         reconstruction 


atoctT>'- 
feval  Medical  Bnevolmt  Fund,  67 3 
Royal  Medical  Society **  annttal  dinner' 

RovaJ  University  of  Ireland,  37,  too 
Royal    University   of    Ireland    (pa** 

Royal  Victoria  Hospital,  353 
Roym]  Waterloo  Hospital,  400 

of  a  carcinomatous  liver,  03 
nl  a  tubal  pregnancy,   Dr. 


IT,,  acute 


iciti*,  112 


SaVof 


Dr. 


t  late  Dr„  117 
in     enteric     fever, 

the.  348 
j  Ml 
Unitary    inspection    of    restaurants. 

Tsajlii  1  j   Institute  of  Great  Britain, 

'  reforms.  13 
'  vol  no  tire  r  fafC*,  a*  630 
,  *47 

.  cutaneous  swellings,  iM 
fever  and  isolation  hospitals, 


At  Kidderminster,  iv* 
fever  pre  valence  and  isolation. 
131 
Sdubdt'i  spectnc  treatment  of  cancer, 

Star,  a?4 
Srteolbey**  beer,  the,  617 
Sctort  health.  4*1 
Scftoftl of  phytic  in  Ireland,  3^4 
Sriattt  of  wugeuicSi  360 

LdKooh  at  Cambridge.  544 
-  and  medical  education,  43 
"■ennft  in  mte<*npported 
bospiuK  534 
Scottish    Poor-Uw   Medical    Officers* 


-.  !!* 

Sea  hospice  lor  tuberculosi*.  663 
S<-n&ation*l  paralysis.  40 
Septfe  of  vision  in  medical  prat  tice,  4 03 
Serious  charge  again* t  a  medical  prac* 

titioner,  jag 
worn  W  puerperal  fever,  304 

therapy  10  tuberculosis,  667 
)  m  dunk,  643 

sbaDntb,  161 


Should  mcdirnl  men  dispense  ?  23 1 
Shuttlcworth,  Dr.,  degeneracy,  s;s 
Sight -testing  by  opticians,  133,  289 
Significance  of  albumoses,  47 
Significance  of  meianuria.  370 
Silent  operator,  the,  too 
Skipping,  484 
Small-poi,  336,  43 1 
Small-poi  at  the  London  Hospital,  320 
Small-pox  epidemic  in  Belfast,  673 
Small- por  hospital  action,  144 
Small-pox  in  Belfast,   102.  ija,  407, 

673*  700 
Small-pox  in  Co.  Derry,  64ft 
Small-pox  in  Getmanv. 
Small-pox  in  Glasgow.  319*    413>  ^o^ 
Small-pox  in  London,  325 
Small-pox  in  the  provinces,  217 
Small-pox  ships  for  sate,  51 
Smith,  Dr.,  entenc  fever,  54 
Smith.  Dr.  G  .  fluid  in  ti 
Smoking  in  reading- ro^ims,  7' 

Society  of   Apothecaries  of   Loodoa 

tpass  list  j  135,  tat.  411,  575.  6*J 
Society   of    Members    of    the    Roval 

College  rf  Surgeon*  in  En^l  md,  106 
Society  tor  the  Reliet  of  the  Widows 

and  Orphan*  of  Metlical  Men,  107. 

Some  pneumonia*,  Dr,  Murrell,  ion 

Some  reccfji  operatioitt  is  the  Rotmid  1 
pttSjL  Mr.  Tiveedv,  166 

Source  of  infection  during  vneratien, 
Dr.  de  Leoo+  82 

Southern  Medical  Society,  210 

Span  ton,    Mr.,    bladder   irritation   In 
j      girls,  198 

.  Spasmodic  agraphia,  son 
[Spondylitis    of    infective   onginr    Dr. 
Cheinisse,  6 

Sponge  in  abdomen,  621 

"Sponge"  case  and  medical  hUpOft- 

sthility,  638 
I  Spread  ol  irnall-pox,  102 
I  Spring  graduations,  407 

Squire,  Dr.,  common  causes  of 
In  examination  of  the  chest,  375 

Standardisation  of  disinfectants,  307 

Staphyfctcoceus  vaccine  in  the  treat- 
ment of  acne,  595 

State  medicine  in  Rus*iaj  1&3 

State  registration  of  nurses,  i}?.  14*, 
404 

State's  immoral  profit.  402 

St,  Bartholomew's  hospital.  93.   126 

Stenosis  of  the  kit  pulmonary  artery, 
91 

Sterilised  milk.  3*7 

St.  George's  Hospital  672 

Si  George** hospital  and  cmi Inclination, 
6nj 

Stiles,  Dr„  delayed  chloroform  poison- 
ing, 606 

Stoker,  Mr.,  treatment  of  middle-ear 
deamess  by  oiunc,  aoi 

Stone  in  the  female  bladder,  Dr.  New. 
bolt,  317 

Stourfiekl  Park  Sanatonum,  6* 

Strangulated  hernia,  Mr.  J  .  W.Taylor, 

„  *49 

Street  noises,  an 

Streets  at  night,  430 

St,  Thomas's  Hospital  house  appoint* 

ments.  631 
Study  of  advertisements.  535 
Study  of  medicine  in  Wales,  571 
Study  of  paralysis  agitam,  401 
Subcutaneous    nourishment    in  peri- 

l*i  636 
Submucous  myoma.  Dr.  Partem 

Suicide  in  h/*pmk,  481 

Sunderland,  Dr.,  pen  typhlitis  simu- 
lating malignant  disease,  601 

Supply  of  potsonou*  aJSkaJoidf  by 
chemists,  09 

Supposed  accidental  poisoning  of  an 
Edinburgh  demonstrator.  410 

Suppurative  appendicitis,  Mr.  Heale, 
521 

Surgery  of  the  diaphragm,  530 

Surgery  of  typhoid  perforation,  47 

Surgical  competitions,  a,  330 

Surgical  diagnosis  of  abdominal  con- 
ditions, *66 

Surgical  intervention  in  cancer.  Dr. 
Leiars,  336  .... 

Surgical  treatment  of  short  sight,  Mr. 
Benson.  571 

Sycosis  parasttarta,  637 

Syphilis  *n  the  infant,  30 


Schmidt**  specijtc  treat- 
o*  cancer   379 

Fofest  Sonatonttm,  237 


Tabes  dors  alis,  64 

■*  Tabloid  "  appeal.case.  the,  371 


'  Tabloid  ■    hyc^rargyri    perch knidi, 

35 

T.onia*  cumcrina?.  304 
Tamp*kn  ji£  with  tea  lures,  fit* 
Taylor,   Dr..    the  diminishing  birth- 

rate»     223,    252  J     perforation  in 

ryphoid  fever,  39 
Taylor,  Mr.  J  r  \V.P  strangulated  hernia. 

549 
Teaching  of  hygiene,   1S0 
Teaching  of  hygiene  and  leuipe ranee, 

129 
Teignmouth  tsolation  Hospital  050 
Temperance  refonn  in  t  re  land,  403 
Temperature  in  head  injuries,  337 
Tendon  plastiqueT  303 
Terminal  urjeiuia,   635 
"  The  mystery  of  lletjp,*1 
The  Victoria  Hospital 
Theatre  tire  at  Cihcago.  n 
I  hcocin  exanthemata,  ^61 
Theories  ol*  Wdft- 

Green,  301 
Theory  of  hearing,  17? 
Therapeutics  of  maak,  5.U 
Therapeutics  of  precious  ttoJMtj 
TbiosmnomiD    and    pyloric    sii 


Cork      Manic  al      avo       Sita-rTcai 
Sociktv— 
Cases,  473 

Five  cases  of  appendicitis,  13s 
Intestinal  obstruct* 
Perforation  01  the  intestines,  148 
Pulmonarv  tuberculosis,  14b 
Question  of  blood-letting  in  MW 
*  pulmou.iry  diseases,   11 
Some     diseases    of     the     p!ar<?nta 

causing  ebofttOO,  11 
Two  ovarian  tumours,  89 
Wr v-neck,   473 

EdIsKL'RCH     MXDICO-CRIRirRCtCAL 

HOC!  E.  TV"™" 

Acute  appendicitis,  116 

Ana  torn  v  of  thr  enlarged  prostate 

Ana'tomy  of  the  pelvic  f.i-cia  in  the 
mal< 

i  ltnical     notes      on       fuherculous 

;inhraU  in  the  ViMine,  ,s?9 
Electrical    currents    of     high    fre- 
quency, 283 
GlvoonRe reaction  of  the  blood«  173 
Streptotbrix  infection,    173 
Treatment     of    skin    diseases    by 
X-rays,  36 


370 
Three  instructive  cases  of  head  in|ury, 

_  P.r*  Rf**+  bP?  L    „       t        u  1  „  1    HanvatAW  Soctirv  or  Lo*nov- 
Tobin,    Mr.t    Insh   Poor-law  Medical        Aphasia  with  anomalous  symptoms. 

33S 


Service,  030 
Town  ambulance  service,  296 
Toys  and  tetanus,  672 
Tragedy  of  child-workers,  644 
Training  of  soldiers*  sight,  143 
"  Tramp  **  accommodation,  509 
Tramps  and  small-pox,  425,  437 

TRANSACTIONS   OF   SOCIETIES, 
AM&tnKJCTRAL  Culture  Sociftv — 
AmbidextL-ntv  and  primitive  man, 


British  Balkcolocical  and  Cuua- 

to logical  socixtv  — 

Physical  Therapeutics,   119 
British  Gynecological   Sociitv-    LujrxCOWXSiCAt. 


Cases,  471  , 

Intestinal    obstruction    with    gan» 

^rene  of  the  cacti m,  3  j3 
Osteo-arthnti*  of  the  spine,  1J9 
Pnerperal  septicaemia,  174 
Rapid  paraplegia.  11 
Raynaud's  disease,  359 
Severe  cases   ol    placenta    prarvia 

260 
Technique  of  aseptic  surgery,  450 
Treatment  of  malarial  fever,  3<fc> 
Tuberculous  ulceration,  140 
Value  of  X-rays,  340 

SOCIRTV      Of 


Bossi's  instrument  for  dilating  the 

cervix  uteri,  B7 
Discussion     of     the     dangers     ol 

pessaries,  354 
Fibroid  uterus  removed  for  menoT- 

rhagia,  3" 
Giant  myomata,  ^39 
New     method     01     treatment     in 

puerperal  eclampsia,   449 
Prevention  ol  post  -operative  ventral 

hernia,  6fjo 
Source  ot  infection  during  opera* 

tions  hitherto     not     sufficiently 

recognised,  87 
Specimens  and  cases.  448 
Successful  hysteTO-saJpingo-*>pho- 

rectomy  for  pelvic  suppuration. 

Valedictory  address,  S8 

BHltlSli       LAJtVNtJOLOCICALT       Rtll«0- 

LOGICAL,    a#o    OrotoojCAt    Asso- 
CIATIOH  — 

Acute  abscess  of  thyroid  body  after 
influenza,    337 

Aural  sepsis  healed  by  means  o! 
kelvolin  vapour,  143 

Case  of  postnasal  casts,  357 

Cases  shown,  t4S.  a«4 

Early  rupture  of  a  tubal  gestation, 
■05 

Epithelioma  "f  the  larynx  and 
cpsophaxu*,  35  7 

Latent  or  intermittent  nasal  ob- 
struction,  35S 

Nasal  obst ruction,  346 

New  invention,  284 
Cukicjil  SocieTV  or  LoKnoit— 

Cases,  233,  447 

Chronic  poJycvth*mia  with  en- 
larged spken,  283 

Diffuse  npomatosis,  85 

Fitmud  di*«ase  and  calculi  ol  the 
nanrrea*.  1 7: 

Foreign  bodv  impacted  in  bronchus, 

283 
Intestinal  obstruction,  339 
Ophthalmoplegia  externa,  &$ 
Pneurnoooccal  peritonitis,  33 
Pyopneumothorax,     577 
Recurrent  carcinoma  o!  the  breast, 

328 
Severe  and  fatal  hamiaturia,  339 
Total  paraplegia,  83 
Tumour  ol  the  left  auricle,  578 
Tum.JUC  of  the  liver,  85 
Two   cases  ol   malignant   ammiia. 

Value  of  the  X-rays  as  a  factor  in 
the  diagnosis  ol  pulmonary 
tuberculosis,  5*7 


LOS DON — 

Cases  .ind  specimens,  114*  4".  5 Bo 
Epithelioma  of  the  cricoid  plate  and 

of  the  cesonbafus,  118 
Mild  glanden,  207 

LrVMfOQL     MXDtCAIr     iKsTtTUTl 

Carcinoma  of  the  (esophagus,  4*0 

Cerebral  tumours,  MB 

Chronic  poisoning  from  anlinwmy, 

Congenital  hvdronrphro- 
Excision  of  Gasserian  ganglion,  43« 
Hot- air  cautery,  174 
Id  fan  t  mortality,  340 
tntra-vesical     separaiion     ol     Ice 

urine,  174 
Modem  Mirgerv  01  the  prostate,  88 
Perforating  ulcer  of  the  duodenum. 

260 
Perforating  ulcrf  of   the  stomach, 

Physical  signs  in  pleural  empyema, 

MintCU-LECAL  Society — 

Suicide  whilst  temporarily  Insane, 

601 
Weight  to  be  attached  to  medical 

evidence,  661 

MlDICn-PftVCHOLOCtCAl.    ASSOCIATION 
OFGaeAT  VR1TA1H    ASD    IftELAWD— 

Dementia  pracox,  609 
Epileptiform  setiures,  609 
Hallucinatory  mania  of  traumatic 
origin,  60S 
North-East       Lohuo*       Clinical 
Society — 

Limitations  of  medicine  in  abdo- 
minal disease,  261 
Osteo-sarcoma,  14? 
Scleroderma  and  alopecia  areata,  no 
Two  case  ol  dextrocardia,  609 
North    or    England    Orst£T*ical 
ano  Gyn,*coloc.!cal  Socirtv— 
AmenorrhoBa  associated  with  serious 

eve  symptoms,  313 
Card  specimens,   10 
Cheonic  endometritis,  tao 
Encysted  perimetritis,  313 
Pibro-myoma  uteri,   3I4 
Medical  indications  for  induction, 

Pathology     of     "  habitual "     and 

incomplete    abortion,    474 
Septate  uterus  and  vagina,  to 
Treatment  of  abortion,  475 
Treatment    of     ruptured     ectopic 

gestation,   365 
Unusual  case  of  ectopic  gestation, 
to 


Tha  Medical 


«ppta 
Praia 


to 

and  Circular 


INDEX. 


June  20,  1904. 


Otolooical  Society  of  the  United 
Kingdom— 

Development  of  the  mastoid,  688 
Etiology  and   treatment  of  laby- 
rinthine suppuration,  173,  541 
Introductory  address,  175 
Section  of  the  eighth  nerve,  688 

Royal   Academy  op   Medicine   in 
Ireland — 

Anatomy  of  the  pelvic  fascia,  145 
Attitude  of  the  profession  towards 

modern  education,  206 
Cases,  313 

Deformity  of  liver,  86 
Double-sided  dermoid  cysts,  233 
Effect  of  the  Midvrives  Act  of  1901 

on  Irish  training  institutions  ana 

nurses,  37 
Endothelioma,  233 
Fatal  case  of  myxcedema,  339 
Gastro-tetany,   421 
Glycosuria  and  insanity,  420 
l    Horseshoe  kidneys,   86 
Implantation    (ovarian)     tumours, 

235 
Milk,  286 

Paraffin  method  of  embedding,  86 
Pigmented  tumour,  341 
Points  in  the  pathology  of  senile 

hypertrophy  of  the  prostate,  234 
Poisoning  by  cantharides,  472 
Public  health  problems  in  Ireland, 

206 
Punctate  basophilia,  498 
Radium  in  therapeutics,  339 
Removal  of  the  caecum  ana  ascen- 
ding colon,  329 
Ringworm,  86 
Some  recent   methods   of  opening 

and  closing  the  abdomen,  430 
Teratoma,  235 
Trypanosomiasis,  499 
Tuberculosis  of  the  vaginal  portion 

of  the  cervix,  430 
Sheffield    Medico-Chirurgical 
Society — 
Cases,  421 
Society  for  tiie  Study  of  Disease 
in  Children — 

Abdominal  case  for  diagnosis,  9 
After-effects  of  polyneuritis,  9 
Cases.  260,  393,  499 
Certain    extra    and    intra-cranial 

haemorrhages   in   the   new-born, 

119 
Congenital  dilatation  of  the  colon 

608 
Displacement  01  the  thyroid,  9 
Exophthalmic  goitre,  9 


Sequel  of  a  case  oi  extreme  wasting! 

xi9 
Therapeutical  Society — 
Action  of  drugs  upon  the  pulmonary 

vessels,  6i| 
Ichthoform  and  ichthargan,  286 
New  discoveries  respecting  cancer, 

147 
.    Points  in  the  hygienic  treatment  of 

pulmonary  tuberculosis,   24  7 
Ulster  Medical  Society— 
Acute  lymphatic  leucaemia,   207 
Demonstrations,   366  1 
Ethvl       chloride     as     a     general 

anesthetic,  473 
Gastric  ulcer,  394 
Infectivity  ot  typhoid  fever,  366 
Pseudo-hypertrophic  paralysis,  207 
Question  of  smoking  at  meetings, 

120 

Severe  anaemia.  366 

Surgical    treatment    of    malignant 

tumours  of  the  breast,  17s 
Urology,  366 
West  London  Medico-Chirurgical 
Society — 

Adenoid  growths,  313 
Cases,  472 

Chronic  pancreatitis,  379 
Functional  albuminuria,  207 
Lessons  from  a  year's  fatalities,  570 
Lymhpo-sarcoma,  117 
Paralytic  deformities,  634 
Sarcoma tosis  cutis,  117 
Uses  of  paraffin  in  plastic  surgery, 

3H 

Traumatic  oedema  of  hands,  317 
Traumatism  and  phthisis,  184 
Treatment  of  the  blind  in  Ireland,  221 
Treatment  of  cancer,  179 
Treatment  of  cancer  by  adrenalin,  62 
Treatment  of  the  criminal,  389 
Treatment  of  epilepsy,  121 
Treatment  of  hiccough,  370 
Treatment  of  paralysis  agitans,  642 
Treatment  by  proxy.  457 
TrendeL  Dr.,  lymphatic  glands.  1x4 
Tresilian,  Dr.,  medicinal  treatment  of 

disease  in  children,  323 
Trinity   College,    Dublin   (pass   list), 

135,  x6i,  191,  X09,  571,  599,  651 
Triumph  of  the  picturesque,  394 
Tubercle  of  the  peritoneum,  63 
Tuberculosis,  343 
Tuberculosis  in  Ireland,  125 
Tuberculosis  in  the  diaphysts  of  long 

bones,  344 


Tuberculous  arthritis  in  the  young, 

Mr.  Jones,  330 
Tuberculous  infection  of  the  tonsils, 

130 
Tuberculous  infection  in  childhood, 

395*  392 
Tuberculous  kidney,  288 
Tumour  of  the  orbit,  360 
Typhoid  fever  and  malaria,  2x2 
Typhoid  fever  and  water  supply,  99 
Typhoid  fever  relapse,  Dr.  Coste,  63  x 
Typhoid  fever  among  the  Chinese,  128 
Typhoid  and  railways,  479 
Tweedy,  Mr.,  some  recent  operations 

in  the  Rotunda  Hospital,  166 


Ulcer  of  the  lesser  curvature  ot  the 

stomach,  662 
Ulster    Hospital    for    Women     and 

Children,  334 
Ultra-microscopic  germs,  267 
Ultramicroscopy,  508 
Unilateral  polyhydruria,  12 
Universal  training,  183 
University  candidates  for  the   army, 

University  of  Aberdeen,  623 

University  of  Cambridge,  329,  681 

University  of  Durham  health  scholar- 
ship, 57  x 

University  of  London  (pass  lists),  631 

University  of  Oxford,  329 

University  of  Wales  and  medical 
degrees,  630 

U.S.A.  antitoxin  ••  trust,"  185 

Use  of  the  birch,  439 


Vacancies— end  of  each  No. 
Vaccination  frauds  bv  a  medical  man^ 

f-95 
Vaccination  marks,  641 
Variation  of  temperature  in  insects, 

177    . 
Vegetarians  as  soldiers,  333 
Venereal  disease  in  the  army,  3x9 
Venous  haemorrhoids,  Mr.  Mummery, 

36? 
Ventilation  for  public  buildings,  243 
Ventilation   on   scientific   principles, 

161 
Vermin  in  children's  heads,  31 
Verminous  heads  in  children,  367 
Vertigo,  316 

Vesicular  diverticulum,  262 
Viceregal  slight  to  the  medical  pro- 
fession, 185,  215 


Victoria  University  (pass  Hst),  383 
Vincent,  Dr.,  cancer  of  the  rectum.  362 
Vinrace,  Mr.,  more  thorough  study  of 

therapeutics,  3 
Visitation  at  Queen's  College,  Gahray, 

Vital  statistics  in  Ireland,  619 
Vitiligo  and  lichen,  637 
"  Volkskuchenverein/r  477 
Voluntary  cardiac  Inhibition,  71 
Volunteer  Army  Medical  Corps,  191 
Voyages  d 'etudes  m6dicales,  6x9 

Wallace,  Mr.,  chronic  intestinal  ob- 
struction, 282 

Walsh,  Dr.  D.,  radium  in  the  treat- 
ment of  a  cancerous  throat,  163  : 
notes  on  therapeutics  and  materia 
medica,  4x9,  444,  467,  496 

Waning  birth-rates,  346 

Watercress  and  disease,  366 

Waterloo  festival  dinner,  318 

Way  to  prolong  life,  643 

Wearing  of  collegiate  robes,  313 

Welsh  infantile  mortality,  670 

Welsh  M.D.,  a,  6x7 

West  Iwondon  Hospital,  703 

West,  Dr.,  albuminuria,  142 

Western  Hospital,  Torquay,  661 

What  is  brandy  ?  427,  613 

What  is  brandy  case,  the,  396 

What  is  gynaecology  ?    668 

What  is  seboirhcea?    6x8 

Wheeler.  Dr.,  acid,  sodium,  phosphate 
and  adrenal  in  vesical  disease,  6K3 

Where  shall  I  send  my  patient  ?   405 

Whooping-cough,  696 

Wingrave,  Dr.,  appearance  of  a  rash 
following  the  removal  of  tonsils  and 
adenoids,  79 ;  non-toxic  prepara- 
tion of  iodine,  360 

Women  and  medicine,  698 

Woodburn  sanatorium.  700 

Woodhurst  Sanatorium,  144 

Wright's  liquor  carbonis  detergens, 
382 

X-rays  and  uterine  cancer,  154 
X-rays  in  the  diagnosis  of  phthisis,  369 


Zinc  valerianate,  133 
Zena,  386 


nft   tfimilar. 


"SALTJS   POPULI    STTPREMA    LEX.* 


Vol,  CXXVIIL 


WEDNESDAY,    JANUARY     6,    1904. 


No*    1, 


©ctg  trial  Communications- 


THE    RADICAL   CURE    OF 

FEMORAL     HERNIA  : 

\    MODIFICATION   OF  THE    Al'THuR'S 

OPERATION. 

Bv  JAMES   H.   NICOLE, 
MMf  of  Surgery  in  Anderson'*  College.  Glasgow. 

^ior*l  hernia\  as  nict  in  practice,  fall  into  one  or 
~  of  Iwo  classes  in  the  matter  ol  operative  procedure. 
simpler    cases,    small    herm;r    without    intra- 
I   tension  or  other  complication,  are  capable1 
lical    cure    by   the   simplest   of    measures.     Such 
have  been  repeatedly  cured  by  operative  proce- 
underfaken  for  the  relief  of  strangulation,  and  in 
.tended  to  serve  as  the  means  of  radical  cure. 
In    lhe$e  slighter  cases  any  of   the  simpler  iornis   of 
*jpei\i  I  be  depended  on  to  effect  a  cure.     Mere 

if  its  lumen  by  any  method  is 
Irequently  effective.  The  "  purse-String  "  suture  Of 
Fortunato  (1).  Curtis  (2),  and  others,  popu- 
larised by  Coley  (jh  Kocher's  operation,  and  the  more  j 
or  less  similar  suture  operations  of  Rassim  (4)-  Franz 
1  ahruius  (6),  Rotlioi  (7),  and  others  may  all  be 
relied  on  to  secure  the  permanent  disappearance  of  the 
hernia. 

The  more  severe  cases,   on    the  other  hand,    large 

hernia    in  patients  with  corpulent  abdomen  or  other 

able  feature,  are  apt  to  tax  the  principles  of 

ingeniously  devised  methods.     The  difficulties 

I  curt-  in  these  cases  have  been  such  as  to  lead 

surg*  Urge    experience    to    propose    operative 

v   striking     Thus,   the  canal   is   to 

be  plugged   by  the  healing  in  of   glass  balls,  of  wire 

ec,   or  even   [Chaput    (8)|   oi    transplanted    costal 

or    closed    by    operating    imm    within    the 

abdomen  after  preliminary  laparotomy,  or  by  way  ol 

the  inguinal  region  [Kuggi  (q),   Nasi   (iij),  Parlavecehio 

Buonamici  (12)  closed  the  canal  by  making  use 

M   the  fascia   trans versahsr  and   Gordon   ( 1 3 )   by  dis- 

placi:  njoined   tendon  of   the  internal  oblique 

avu!    trans  vers  a  lis  muscles    from    the    inguinal     to    the 

ral  region.     Flaps  of  bone  and   periosteum   have 

been    turned  over  from    the  os  pubis  [Trendelenburg, 

Kraske   (14),  and   others],   while  musculo- fascial   hups 

have    been    turned    up    from    the   pectineus    [Watson 

:ie  (15),  Saltzer  (10),   Prokupm  (17),  and  others] 

and   Irani  the  adductor  long  us  of  the  thigh  [Schwartz 

following  method  of  operating,  described  at  the 
meeting  ol  the  British  Medical  Association  in  Manches- 
1902,  I  originally  adoptee!  for  the  more  1 
severe  and  unfavourable  cases  of  Jemoral  hernia  only, 
L,*ve  come  to  regard  the  precision  of  the  closure 
effected   by  it  as  sufficient   inducement   to  extend   its, 
ice  to  all  cases.     The  use  of  the  sac  to  form  a1 
buttress  on  the  abdominal  aspect  of  the  ring,  and  the  ! 
re  of  the  canal  by  restoring  its  boundaries  to  their  ' 
d  relations  f and  not  by  the  transplantation  of 
neigh!  tructures),    are    ideas    familiar    in    the  | 

itive  treatment  of  hernia,  and  rendered  classic  bv  I 


Macewen  in  his  operation   for  inguinal  hernia.      I  bid 

restoration  may  be  accomplished  m  femoral  hernia 
with  a  degree  of  precision  and  completeness  not,  t 
believe,  attainable  m  any  other  form  of  hernia,  inas- 
much as  of  the  four  boundaries  of  the  femoral  ring  or 
canal,  two  only — the  anterior  and  the  external — are 
displaced  by  the  descent  of  the  hernia,  the  posterior 
(pubic  ramus)  and  the  internal  (Gimbernats  ligament \ 
being  incapable  of  displacement.  By  fixing  the 
anterior  boundary  (Pou part's  ligament)  to  the  posterior 
(the  ramus  of  the  os  pubis),  an  absolute  closure  of  the 
femoral  ring  to  the  extent  desired  is  readily  attained!. 
There  is  nothing,  therefore,  novel  in  the  principle  in- 
volved in  the  two  parts  of  the  operation.  The  tech- 
mqoc  alone  demands  description,  and  it  is  as  follows  ; — 

OPERAT  1 

This  consists  of  two  parts  : — 

[A)  Obliteration  of  the  Sac,  also  of  the  peritoneal 
depression  over  the  abdominal  aspect  of  the  ring,  and 
the  substitution  of  a  buttress  over  the  internal  aspect 
of  the  ring  : — 

t.  Expose  the  sac,  and  clear  it  from  surrounding 
tissues  (the  skm  incision  may  be  vertical  or  trans- 
verse), 

2.  Open  the  sac  longitudinally  In  its  middle  line,  and 
clear  of  contents. 

3.  Separate  it  from  parts  surrounding  its  neck,  in- 
cluding the  transversahs  and  iliac  fascia-,  for  one 
inch  round  the  abdominal  aspect  of  the  ring, 

4.  Bisect  the  sac  longitudinally  from  lundus  to  neck- 
(Fig.   1.) 

5.  Make  an  aperture  In  one- half  near  the  neck. 
(Fig,   u) 

&  Interlock  the  halves  by  putting  the  other  through 
the  aperture,  (Fig.  j)  In  certain  cases  it  lies  better 
if  previously  twisted  one  half  turn  on  its  longitudinal 
axis. 

7*  Reduce  the  whole  sac  through  th-^  femoral  ring 
into  the  extraperitoneal  space  previously  cleared  for 
it  by  detaching  its  neck  from  the  abdominal  aspect  uj 
the  ring.  The  sac  thus  lies  bunched  up  within  the 
abdomen,  between  the  peritoneum  and  the  transver- 
ahs  and  iliac  fascia1  over  the  internal  aperture  of  the 
femoral  canal. 

Where  the  sac  is  unnecessarily  large,  part  of  it  may 
be  cut  away  before  reducing  it  through  the  canal. 

[B)  Cloture  of  the  Femoral  h'nix    — 

1.  Carry  an  incision  (bone-deep)  from  the  femoral 
vein  along  the  pubic  ramus  to  the  region  of  the  pubic 
spine*  This  divides  the  pubic  portion  of  the  fascia 
lata,  the  origin  of  the  pectineus,  and  the  periosteum. 
Its  length  will  depend  on  the  extent  to  which  the 
femoral  vein  has  been  displaced  outwards  by  the 
presence  of  the  hernia,  and  will  vary  from  one  inch  to 
one  inch  and  a  half. 

2«  Detach  the  periosteum  to  a  limited  extent,  and 
retract   it. 

3.  Drill  the  bone  near  its  upper  edge  in  two  places* 
baH-inch  to  one  inch  apart  (one  drillhole  may  be  made 
to  suffice).  Any  bone  drill  or  punch  may  be  used. 
In  the  illustration  (Fig.  3)  the  simple  hand  drill,  and 
the  tongue  depressor  used  as  a  protecting  spatula,  are 
those  1  commonly  employ. 


2    The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


Jan,  6,  1904* 


4.  Pass  through  one  of  the  apertures  a  loop  of  stout 
catgut  or  other  absorbable  ligature.  (Fig.  3.)  This  may 
be  passed  by  threading  it  in  the  eye  of  a  curved  surgical 
needle,  or  by  pushing  it  through,  simply  doubled  on 
itself;  It  is,  however,  more  easily  passed  by  threading 
it  in. the  eye  of  the  bone  drill  or  in  the  eye  of  an  ordinary 
surgical  probe.  For  the  purpose  I  employ  a  special 
probe  in  which  the  eye  is  small  and  placed  very  near 


Fig.  1. — Sac  emptied,  detached  from  surrounding 
parts,  including  internal  aspect  of  abdominal  wall, 
for  one  inch  round  femoral  ring  ;  split  longitudinally, 
and  one-hall  incised  for  passage  of  the  other. 


Fig.  2. — Sac  ready  for  reduction,  with  halves  inter- 
locked.    (The  situation  of  the  aperture  in  the  sac  in 
Figs.  1  and  2,  and  the  relative  positions  of  the  two 
halves  of  the  sac  in  Fig.  2,  are  not,  in  the  interests  of 
semidiagrammatic  clearness  in  the  drawings,  quite 
those  of  actual  practice. ) 
the  extremity  of  the  handle.  (Fig.  4.)  The  advantage 
of  that  shape  and  position  of  the  eye  will  be  obvious  to 
those    familiar  with  drills  for  wiring  fractures,  or  to 


anyone  in  his  first  performance  of  this  operation.  With 
such  a  probe  the  operation  is  of  the  simplest ;  without 
it  some  difficulty  may  be  experienced  in  passing  the 
sutures  through  the  one  aperture  and  withdrawing 
them  through  the  other.  The  probe  should^be^of  the 
ordinary  pliable  type. 

5.  Divide  the  loop  of  ligature.     Thread  one'end  in"  a 
large  curved  surgical  needle  and  pas§  it  as  a^mattress 


Fig.    3. — Closure  of  ring  ;    drilling  of  bone  ;     looped 
catgut  suture  passed  through  first  drillhole. 


Fig.  4. — Closure  of  ring  ;  placing  of  the  loops  in 
Poupart's  ligament,  and  return  of  the  ends  through 
second  drillhole.  (One  loop  tied  loosely  to  indicate 
action  in  pulling  Poupart's  ligament  down  to  postero- 
superior  aspect  of  ramus  of  os  pubis.) 


J  ax.  6.  1 9^4. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press*    3 


sutarf  through  Pou  part's  ligament.     In  thread  it  from 

Repeat  this  with  the  second  end,  carrymg  it  through 
Poupiit *s  ligament  at  a  higher  Level  (Fig.  4),  avoiding 
Ofp  epi gastric  artery  to  the  outer  side,  and,  in 
malt'  patients,  the  spermatic  cord  above.  (In  very 
large  hernia?  the  loops,  instead  of  being  placed  the  one 
directly  above  the  level  of  the  other,  as  figured,  may 
be  made  to  diverge  in  the  hgament  so  as  to  M  gather  in  " 
tile  margin  of  the  aperture.) 

6*  By  means  of  the  probe  (into  the  eye  of  which  the 
ends  are  threaded ),  withdraw  both  ligatures  through 
the  second  drillhole  in  the  bone,  (Fig.  4.)  It  is  in  this 
part  of  the  operation  that  the  special  probe  is  of  par- 
ar  advantage. 
He  the  ends  of  each  loop  separately  over  the  front 
t  bone,  thus  bringing  Pou part's  ligament  down  to 
the  postero-superior  surface  of  the  bone  and  fixing  U 
amity  in  contact  with  that  surface,  constituting  what 


5* — Closure  of  ring  ;    bone  so  tares  tied  ;  com  pie- 
re  by   suture  of  fascia  lata  and  pecti- 
ns to  the  fixed  Poopart's  ligament, 

e fleet    an    extension    outwards    of    Gimbernat's 

ent.  and  absolutely  closing   the   femoral  ring   to 

whatever  extent  may  be  desired,  due  regard  being  paid 

ihe  femoral  vein.       The  degree  of 

occlusion  is  regulated  by  ihe  position  of  the  sutures  in 

Pou  part's  ligament,  but  not  by  the  tension  with  which 

they  are  is  latter  does  not  vary,  the  knots 

tied  in  all  cases  firmly  to  bring  the  hgament  into 

with  the  bone.  (Figs,  4  and  $♦) 

lo  make  the  closure  doubly  secure,  complete  the 

a   by  uniting,   by  interrupted   catgut  sutures, 

the  detached  margin  of  the  pectineal  origin,  and   the 

c    portion  of   the   fascia  lata  to  the   "*  anchored  " 

fcntpart's  Ligament.  (Fig 

Remarks*— The  operation  is  easily  performed.     The 
nrst    part  is  simple  by  on   With   some  of  the 

known   methods  ol  dealing   with   the  sac.   while   the 
uj  is  no  more  difficult  than  many  of    the  methods 
lure  employed  in  the  closure  of  hernial  apertures. 
thod  of  Tf**li*%  tkt   Sac.-  The  manoeuvre  of  re- 
turning the  emptied  sac  through  the  canal  of  a  hernia 
\\  new.     While  descriptions  of  such  operations  may 
I  far  back  in  surgical  records,  the  practice  was 
put  upon  a  formal  footing  by  Sir  William  Macewen, 
and  to  his  advocacy  is  due  the  general  recognition  of 
the  priat  value  of  the  buttress  formed  over  the  abdo- 
...f    the  ring   by   the  puckered-up    sac 
U&d  is  well  known,  puckers  up  the  sac  by  a 


11  gathering  **  suture  which,  passed  through  the  hernial 
canal  and  out  through  the  parietcs.  is  made  the  means 
it  puckering  up  the  sac  on  the  abdominal  aspect  of 
the  ring.  Variations  of  the  technique  by  which 
Maccwen's,  object  is  attained  have  been  introduced  by 
other  surgeons  [vide,  for  example,  the  operations  of 
Davis  (10)  and  Packard  (20)1  and  the  method  de- 
scribed above  is  but  one  of   these  variations. 

The  absence  of  all  sutures  in  the  sac  has  three 
advantages  : — 

1.  The  obvious  saving  of  time, 

2.  Avoidance  of  the  recognised  risk  of  strangulation, 
and  consequent  sloughing,  of  the  puekered-up  s,. 
the  grasp  of  the  ligature. 

3.  The  facility  with  which  the  entire  sac  may  be 
placed  within  the  abdomen.  A  suture  emerging  trum 
the  neck  of  a  large  sac  may,  while  polling  the  neck 
within  the  abdomen,  by  anchoring  it  to  the  parietes, 
leave  the  bulky  fundus  blocked  in  the  canal.  The 
absence  of  a  suture  permits  the  interlocked  sac  to  be 
pushed  as  tar  within  the  abdomen  as  may  be  desired. 

Against  these  advantages  there  is  to  be  placed,  I 
believe,  one  disadvantage,  and  that  a  minor  one,  in- 
volved in  the  absence  of  suture,  namely,  that  the  fixing 
of  thesac  in  position  depends  on  the  tying  ol  the  sutures 
closing  the  ring,  and  not  upon  a  special  sac  suture*  and 
that  therefore  it  is  necessary,  particularly  in  cases 
the  patient  has  M  strained  M  between  the  placing 
of  the  sac  and  the  tying  of  the  ring  sutures,  to  verify 
and,  if  need  be,  adjust  the  position  of  the  sac  before 
tying  the  sutures  closing  the  ring.  Once  lied,  these 
sutures  close  the  ring  absolutely,  and  no  prolapse  ol 
the  sac  into  the  canal  is  possible*  In  femoral  hernia  1 
have  never  seen  any  tendency  oi  the  sac  to  prolapse 
before  closure  of  the  ring,  but  I  have  seen  it  in  several 
cases  of  inguinal  hernia.  The  explanation  may  lie  111 
the  fact  that  the  inguinal  rings  are  more  freely  affected 
by  "  straining  M  or  deep  respiration  than  is  the  femoral. 
'hod  of  Closure  of  the  Femoral  Aperture. — In 
looking  into  the  literature  of  the  subject,  1  find  that 
Koux  (21}  has  also  been  carrying  out  in  the  closure  of 
the  ring  the  idea  of  attaching  Poupart's  ligament 
directly  to  the  bone,  though  employing  a  different 
method  to  attain  that  end,  namely,  the  use  of  a 
n-shaped  metal  nail  driven  through  "the  ligament  into 
the  bone  ;  and  it  is  somewhat  surprising  that  a  further 
search  {so  far  as  the  regrettable  decease  of  the  invaluable 
Index  M Adieus  permits  such  to  be  made)  should  reveal 
no  other  references  to  the  utilisation  of  so  conveniently 
placed  a  point  d'appui  as  is  offered  by  the  pubic  ramus 
for  the  closure  of  the  femoral  ring  on  the  classic  prin- 
ciple of  restoring  its  boundaries  to  their  correct,  or  to 
an  over-corrected,  position. 

The  method  uf  closing  the  ring  above  described,  and 
which   I  had  been  practising  for  some  time  before  I 
learned  of  Roux's  independent  work,  is,  in  my  probuHv 
too  partial  opinion,  preferable  to  that  adopted  by  b 
far  the  following  reasons  I — 

1,  Roux's  operation  involves  the  introduction  of  a 
metal  foreign  body.  The  subsequent  removal  of  this, 
if  desired,  involves  a  second  operation,  with  the  risk  of 
detaching  the  ligament  from  the  bone  in  withdrawing 
the  nail.  Its  permanent  retention,  on  the  other  hand, 
involves  the  chance  of  the  loosening  of  the  nail  by 
absorption  (possibly  necrosis)  of  the  bone,  as  occur 
infrequently  with  wire  sutures  in  fractures.  Should 
this  occur,  and  the  nail  become  dislodged  from  the  bone, 
by  the  natural  pull  of  Poupart's  ligament  or  otherwise , 
a  state  of  matters  is  established  in  which  every  move. 
ment  of  the  thigh  or  abdomen  would  menace  the 
femoral  vessels  and  the  peritoneum  with  punctui 

the  points  of  the  nail. 

2.  The  method  of  suture  employed  in  the  operation  I 
have  described  brings  Poupart's  ligament  down  to  the 
postero-superior  surface  of  the  bone,  attaching  it  there 
111  the  region  of  the  ileo-pectineal  line  on  the  plane  of 
Gimbemat's  ligament,  constituting  virtually  an  arti- 
ficial extension  of  that  ligament.  The  effect  of  such 
an  attachment,  as  a  study  of  the  anatomy  of  the  region 
will  show,  is  to  occlude  the  femoral  aperture  at  its 


4    Thb  Mxdical  Press. 


ORIGINAL  COMMUNICATIONS. 


Jan.  6.  1904. 


extreme  upper  (inner)  end  (the  plane  of  Gimbernat's 
ligament),  thus  shutting  its  mouth,  instead  of  closing 
its  throat  as  the  attachment  of  Poupart's  ligament  to 
the  superior  or  antero-superior  surface  of  the  bone  does. 

3.  By  varying  the  position  of  the  two  mattress  loops 
of  ligature,  or  by  making  them  diverge,  in  Poupart's 
ligament,  it  is  easy  to  effectually  close  the  largest 
femoral  ring  without  exerting  pressure  on  the  femoral 
vein.  The  tension  of  the  femoral  sheath  may  be  regu- 
lated with  precision. 

4.  Roux's  nail  attaches  Poupart's  ligament  to  the 
periosteum.  The  operation  above  described  attaches 
it  independently  to  both  bone  and  periosteum. 


will  be  the  attachment  of  Poupart's  ligament,  not  to 
the  postero-superior,  but  to  the  superior  surface  of  the 
bone,  a  much  less  efficient  attachment. 

To  the  skill  and  kindness  of  Dr.  John  Lindsay ,*"of 
Glasgow,  I  am  indebted  for  the  sketches  forming  the 
illustrations. 

References. 

1.  Fortunato,  Hildebrand  :  Jahresbericht,  1897. 

2.  Curtis,  quoted  by  Mayo.  Ann.  of  Surg.,  1809. 

3.  Coley,  Ann.  of  Surg.,  1901. 

4.  Bassini,  Lang.  Archiv,  1894. 

5.  Franz,  Deut.  Zeitschr.  f.  Chir.,  Bd.  li.  Heft  1. 

6.  Fabricius,  Wien.  klin.  Woch.,  1895  ;  Centralbl.  f. 
Chir.,  1 89 1. 


Fig.  6. — Anterior  lip  of  periosteal  incision  raised  in  the 

form  of  a  short  periosteo-fascial  flap  through  which 

the  sutures  have  been  passed. 

Modification  of  Operation. 

The  following  modification  is  not  intended  as  a 
regular  substitute  for  the  second  part  of  the  operation, 
the  closure  of  the  femoral  canal.  In  effect  it  is  less 
secure.  It  affords  the  means,  however,  of  attaching 
Poupart's  ligament  in  the  desired  'position  in  cases 
where  the  operator  is  not  supplied  with  a  drill,  as  when 
hurriedly  called  to  operate  in  a  case  of  strangulation. 

The  sac  having  been  reduced  into  the  abdomen,  and 
Poupart's  ligament  pushed  back  with  a  spatula,  an 
incision  is  carried  along  the  postero-superior  aspect  of 
the  pubic  ramus  from  the  femoral  vein  to  the  pubic 
spine  (or  part  of  that  distance).  This  divides  the 
periosteum.  Its  anterior  lip  is  then  raised  to  a  slight 
extent  by  any  convenient  elevator,  such  as  the  flat  end 
of  an  ordinary  probe  bent  to  a  suitable  angle,  or  the 
blade  of  a  pair  of  curved  scissors.  The  effect  of  this  is 
to  form  a  short  periosteo-fascial  flap,  the  size  of  which 
has,  for  the  purposes  of  illustration,  been  exaggerated 
in  Fig.  6. 

With  an  ordinary  curved  surgical  needle  the  catgut 
suture  is  carried  through  Poupart's  ligament,  divided, 
and  the  ends,  again  threaded  in  the  needle,  successively 
passed  into  the  periosteal  incision  and  out  again 
through  its  anterior  lip.  (Fig.  6.)  The  tying  of  these 
ends  lodges  the  free  margin  of  Poupart's  ligament  in 
the  periosteal  incision  on  the  postero-superior  aspect 
of  the  bone,  thus  closing  the  canal.  (Fig.  7.) 

As  already  mentioned,  the  closure  thus  obtained  is 
less  secure  than  that  resulting  frOm  the  bone  suture 
method.  Further,  if  the  periosteal  incision  be  made 
too  lone:,  or  the  anterior  lip  be  raised  as  far  as  it 
necessarily  has  been  in  the  illustrations,    the  result 


Fig.  7. — Suture  knots  tied  on  anterior  (outer)  aspect 
of  anterior  lip  of  periosteal  incision,  thus  lodging  the 
free  margin  of  Poupart's  ligament  in  the  periosteal 
incision.  N.B. — In  Figs.  6  and  7  the  periosteal  lip 
or  flap  is  necessarily  represented  as  raised  too  exten- 
sively, and,  therefore,  too  long. 

7.  Bottini,  Centralbl.  f.  Chir.,  1894. 

8.  Chaput,  Bull,  de  la  Soc.  de  Chir.,  No.  5. 

9.  Ruggi,    Methodo-Operativo   Nuovo   par  la   Cura 
Radio  ah  dell*  Ernia  Crurale. 

10.  Nasi,  La  Clinica  Chirurgica,  1900,  vol.  1. 

11.  Parlavecchio,  //  Policlinico  Sessione  Chirurgica. 
fasc.  6,  1900. 

12.  Buonamici.  Hildebrand  :  Jahresbericht,  1901. 
Gordon,  British  Medical  Journal,  June,  1900. 
Kraske,  Deut.  med.  Woch.,  1893. 
W.  Cheyne,  Lancet,  1892. 
Saltzer,  Centralbl.  f.  Chir.,  1892. 
Prokupin,  Hildebrand  :    Jahresbericht,  1898. 

18.  Schwartz,  Centralbl.  f.  Chir.,  1893. 

19.  Davis.  Ann.  of  Surg.,  1896. 

20.  Packard,     Trans.    Amer.    Surg.    Assoc,     1895, 
vol.  xiii. 

21.  Roux,  Anjou  Mtd.,  No.  2  ,   Hildebrand  :  Jahres- 
bericht, 1900. 


13- 
14. 
IS- 
16. 

17. 


Society  fop  the  Relitf  of  Widows  and  Orphans  of  Medical  Men. 
i  During  the  past  year  twelve  new  members  were 
1  elected,  three  died,  and  three  resigned,  the  number  of 
I  members  being  298.  Two  widows  and  six  orphans 
!  applied  for  reliei,  three  widows  died,  and  one  orphan 
j  became  ineligible.  At  the  end  of  the  year  fifty-three 
widows  and  fifteen  orphans  were  in  receipt  of  half- 
yearly  grants.     A  sum  of  £3.299  10s.  was  distributed 

•  during   the   year,   and    the   expenses   were    £246.     At 
j  Christmas  a  present  was  made  to  the  widows  and  or- 

•  phans  amounting  to  £583. 


]aji,  6,  1004. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press.    5 


A   PLEA  FOR  THE 

MORE   THOROUGH   STUDY 

OF 

THERAPEUTICS-   (a) 

By  DENNIS  VINRACE,  M.R.C.S.,     L.SJt 
As  I  do  not  wish  it  to  be  thought  that,  in  en- 
deavouring   to   emphasise    the    importance    of    a 
thorough     study    of     therapeutics     as     an     ele- 
ment in  the  medical    curriculum,  I    am   trying    to 
forte  an  already  open  door,  I  should  like  in  the 
fiist  instance  to  say  a  lew  words  as  to  the  present 
attitude  of  the  public    towards  medical   matters. 
it  is  generally  supposed  that  we  are  living  in  a 
highly  scientific  and  somewhat  sceptical  age,  and 
nowadays  people  are  apt  to  subject  everything 
to  the   touchstone  of  reason,  and  are  no  "longer 
•z  to  take  anything  on  trust.     Broadly  speak- 
ing, ihi-s  view  is  doubtless  largely  correct ,    but, 
enough,  in  the  sphere  of  medicine  Hi  is 
tight  "   of  reason,    to   use    Bacon's   famous 
;.  is  less  generally  applied.     The  day  of 
wireless  telegraphy,  of  Ron t gen  rays,  and  number- 
'her  scientific  marvels  is  also  a  period     in 
i    Ihe    crudest    advertisements    of    worthless 
ims  will  open  the  popular  purse-strings  to  an 
if   which  probably  has  never  been  equalled. 
<ursc,  medical  quackery  is  no  new  thing*     It 
\    almost    seem,  indeed ,    that    there   is   some 
rums     instinct     which     induces     otherwise 
ns  to  reject  what  is  capable  of  proof  in 
what  is  marvellous  and  beyond  the  reach 
ni  reason,  so  that,  to-day  perhaps  more  than  ever, 
the  rried  and  reasoned  formulae  of  the  Pharma- 
ia  arc  passed  bv  ;  the  mysterious  concoctions 
Od   i he  quack  drug-vendor    are  accepted   with   a 
childlike  faith  which  would  be  amusing  if  it  was 
not  also  pathetic.     At  the  present  time  it  is  im- 
bte    to    take    up   any    popular   newspaper  or 
magazine  without  being  faced  by  pages  of  quack 
remedy  advertisements,   which  seem    to  grow  in 
audacity  from  day  to  day,     It  is  clear,  then,  that, 
pan  passu  with    the  great    advances  which  have 
been  made  of   late   in    the   regions   of   legitimate 
medicine,  there  has  been  an  even  greater  tendency 
on  the  part  of   the  public   lo  have  resort   to  the 
Uianry  of  the  compounder  of  quack  drugs, 
What    is    the   explanation    of    tins    paradoxical 
of  aft  airs  ?     The  natural    tendency   of   the 
popular  mind  to  run  after  new  and  strange  things 
will  not  fully  account  for  it,  for  it  is  improbable 
the  present  generation  is  more  credulous  than 
:essors.     No,    the   explanation    must    be 
sought  elsewhere,  and  I  would  ask  whether  the 
ss  of  the  quack  and  the  growing  habit  of  sell- 
menl  and  consulting  the  chemist  or  the  herbalist 
may  not  to  some  extent  be  the  fault  of  the  medical 
i  itself.     Is  it  not  possible  that  there  is 
defect    in    the    present    system    of    medical 
Training  which  accounts  for  this  willingness  on  the 
p.iri  of  the  public  to  trust  their  health  and  their 
BVW  to  unqualified  persons  ?     In  my  opinion,  the 
UOn  of  this  problem  is  to  be  iound  ,  to  some 
.1    at    any    rale,    in    the    rather   subordinate 
don  which  has  been  accorded  to  the  study  of 
rape u tics  in  the  training  of  medical 
Anatomy 4   physiology,  and  pathology  have 
tied  so  much  attention  that  there  has  been  a 
eve  therapeutics  somewhat  less  than 
ition  which  it  deserves. 
To  the  average  general  practitioner  a  profound 

(*t    I  he  Tner*ptm  ileal  dotristy,  i>ei:*mtjt*r  SUad,  U*j3. 


acquaintance  with  anatomy  or  a  deep  knowledge 
of  bacteriology  is,  I  submit ,  far  less  really  essential 
than  a  sound  working  familiarity  with  thera- 
peutics. Of  what  avail  is  it  that  he  can  locate  all 
the  component  parts  of  the  human  organism, 
down  to  the  minutest  detail,  or  that  he  can  deter- 
mine the  character  of  a  malady  with  pathological 
accuracy,  if  he  has  not  at  his  fingers*  ends  the 
remedial  measures  which  each  particular  condition 
demands,  and  if  he  is  not  personally  able  to  dis- 
pense the  necessary  drugs,  or  at  any  rate  possesses 
a  sound  knowledge  of  the  nature  and  the  com- 
binations into  which  they  can  most  advantageously 
be  formed  ?  It  is  as  if  a  man  should  go  into  battle 
with  a  gun  of  admirable  workmanship,  but  lack 
the  knowledge  to  arrange  the  ammunition  which 
alone  could  make  it  an  elective  weapon. 

Very  briefly  I  will  deal  with  two  phases  of  this 
question — the  training  received  by  medical 
students,  and  the  attitude  towards  practical 
therapeutics  adopted  by  the  average  qualified 
man,  I  have  recently  looked  into  the  examina- 
tion papers  set  by  the  principal  qualifying  bodies, 
and  I  must  admll  that  I  found  that  more  attention 
appeared  to  be  paid  to  the  practical  side  ol  thera- 
3  than  in  the  period  when  I  was  myself  a 
student.  On  the  whole,  however,  it  was  obvious 
that  to  pass  their  examinations  students  must 
still  spend  by  far  the  greater  part  of  their  time  on 
anatomy,  physiology,  pathology,  &e,p  t  he  rape  u- 
comparatively  unimportant.  The 
natural  consequence  is  that  practical  therapeutics, 
being  of  little  iielp  in  the  securing  ol  degrees,  is  apt 
bo  he  rather  neglected.  Now,  I  contend  that 
throughout  the  student's  career  the  value  of  a 
thorough  knowledge  of  therapeutics  and  pharma- 
cology Ought  to  be  kept  constantly  before  him, 
If  it  be  true  that  in  their  student  days  medical 
men  are  not  led  to  attach  sufficient  importance  to 
therapeutics,  one  would  naturally  expect  to 
find  them  in  their  after  years  continuing  to  some- 
what cold-shoulder  this  branch  of  their  calling. 
And  this,  I  contend,  is  in  fact  the  case. 

Let  me  take  two  points — the  tendency  to  neglect 
minor  ailments,  and  the  decadence  of  dispensing. 
In  regard  to  the  first,  I  cannot  but  think  that 
medical  men  nowadays  are  too  anxious  to  fly  at 
high  game.  A  mere  sore  throat  or  tooth -ache 
hardly  seems  worthy  of  their  serious  consideration, 
and  yet  it  is  these  little  matters  which  should  form 
one  of  the  most  constant  and  reliable  features  in 
the  average  doctor *s  practice.  The  result  is  that 
people  with  minor  ailments  are  more  and  more 
getting  into  the  way  of  consulting  the  chemist 
when  they  have,  say,  a  headache  or  an  attack  ol 
indigestion,  or  of  doctoring  themselves  with  the 
catch-penny  remedies  advertised  by  the  score  m 
every  popular  periodical.  And  this  is  really  the 
thin  end  of  the  wedge.  When  a  person  finds  thai 
his  toothache  has  vanished  under  the  attentions 
of  Mr,  Jones  the  chemist,  or  after  a  dose  of  So* 
and-so's  "Pain  Destroyer/'  he  is  apt  to  argue  that, 
after  all,  a  medical  man  can  often  very  well  be 
dispensed  with.  In  course  of  time  it  is  not  only 
for  petty  maladies  that  he  seeks  relief  in  these  p 
Even  when  he  has  a  more  serious  affection  lu- 
applies  to  his  old  allies  for  assistance,  and  another 
patient  is  Inst  to  the  qualified  man.  If  medical 
men  devoted,  proportionately.,  as  much  time  and 
care  to  the  treatment  of  the  smaller  ills  of  life  as  th^y 
would  to  a  case  exhibiting  interesting  or  unusual 
features,  there  can  be  little  doubt  that,  by  reason 


6     The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


Jan.  6,  1904. 


of  their  superior  skill  and  knowledge,  they  could 
very  largely  overcome  the  competition  of  the 
chemist  and  the  drug-vendor.  It  is  worthy  of 
note  in  this  connection  that  considerable  classes 
of  persons,  such  as  chemists,  manicurists,  chiro- 
podists, and  barbers  who  profess  to  cure  ailments 
of  the  hair  and  scalp,  derive  a  large  part  of  their 
livelihood  from  treating  the  kind  of  minor  maladies 
which  doctors  too  largely  despise. 

Turning  now  to  the  question  of  dispensing,  I 
feel  convinced  that  it  is  very  unfortunate  that  the 
custom  of  medical  men  acting  as  their  own  dis- 
pensers is  going  rapidly  out  of  fashion.      My  ideas 
may  be  old-fashioned,  but  I  am  satisfied  that  the 
old    system   has   several   commendable   features. 
By  dispensing,  a  medical  man  acquires  a  mastery 
over  the  qualities  and  properties  of  drugs  which  no 
amount  of  theoretical  study  can  ever  give  him. 
He  is  further  able  to  ensure  that  his  prescriptions 
are  accurately  prepared  and  compounded  of  good 
materials,  and  he  is  thus  in  a  better  position  to 
secure  satisfactory   results,   and  is  consequently 
strengthened  against   the  rivalry  of  the  chemist 
and  the  quack.  But  it  is  not  only  actual  dispensing 
which  is  going  out  of  use  among  medical  men. 
Even  the  art  of  writing  prescriptions  seems  to  be 
on  the  wane.     More  and  more,  medical  men  seem 
to  be  coming  to  depend  upon  the  wholesale  drug- 
gists.    At  the  present  moment  the  large  wholesale 
firms  prepare  medicaments  after  formulae  of  their 
own  in  absolutely  bewildering  number  and  variety, 
and,  as  supply  is   governed   by  demand,  one  is 
forced  to  conclude  that  doctors  must  be  very  largely 
availing  themselves  of  this  easy  and  simple  means 
of   providing  medicine  for  their  patients  with  the 
least  possible  trouble  to  themselves.     No  doubt, 
many  of  these  preparations  are  excellently  adapted 
to  their  purpose,   but   I   cannot  think  that  this 
dependence    of  medical    men  on  compounds  in 
the     preparation    of     which     they     have      had 
no  part,  and  of  the  composition  of  which  they  have 
little  or  no  accurate  knowledge,  is  a  healthy  sign 
of  the  times.     If  the  present  tendency  continues 
to  increase,  it  looks  as  if  a  time  will  come  when 
medical  men,  as  far  as  the  giving  of  remedies  is 
concerned,  will  be  little  more  than  agents  for  the 
great   drug   firms.     Why,   I   may   ask,   should   a 
doctor  abdicate  one  of  his  most  important  func- 
tions in  this  remarkable  way  ?  Surely  if  he  has 
a   thorough  knowledge  of  practical   therapeutics 
and  pharmacology  he  should  be  able  to  dispense, 
or    at    least     prescribe,    preparations     quite    as 
efficacious  as  any  of  those  which  are  sold  by  the 
wholesale  chemists.     In  so  doing,  apart  from  the 
financial  saving,  he  would  have  full  control  over 
the  nature  of   the  medicaments   supplied  to    his 
patients  and  a  greater  power    of    varying   them 
to  meet  individual  requirements. 

There  is  another  point  in  this  connection  to 
which  I  should  like  to  draw  attention.  Most  of  the 
reputable  wholesale  houses  supplying  the  profession 
make  a  point  of  stating  that  their  specialities  are 
not  supplied  to  other  than  medical  men,  and  no 
doubt  this  statement  is  quite  honestly  made.  I 
think,  however,  that  most  of  those  whom  I  am 
addressing  will  have  encountered  instances  in 
which  these  preparations  have  passed  through  the 
hands  of  retail  chemists  direct  into  the  possession 
of  members  of  the  public.     Some  of  these  speciali- 


panied  that  they  are  intended  to  be  purchased! 
without  the  intervention  of  a  doctor.  The  pro- 
prietors of  some  of  these  nostrums  go  so  far  as  to- 
state  in  plain  terms  that  a  medical  man  need  not 
be  consulted,  so  that  I  think  it  will  be  agreed  that 
there  is  already  an  appreciable  general  circulation 
of  drugs  which  should  properly  only  be  administered 
through  the  medium  of  a  professional  man. 

Now,  if  this  is  the  case  already,  what  may  be 
expected  to  take  place  in  the  not  distant  future  ?• 
If  the  laity  is  given  reason  to  believe  that  t he- 
remedies  which  they  obtain  from  their  doctors  are 
largely  procured  ready-made  from  the  manufac- 
turers, they  may  begin  to  ask  why  they  should  not 
be  able  to  procure  them  for  themselves  without 
the  preliminary  need  for  a  medical  fee,  and  it  is- 
possible  that  many  wholesale  firms  may  find  it 
worth  their  while  to  put  their  goods  openly  on  the 
market,  even  at  the  risk  of  losing  part  of  their 
professional  connection.  Surely  this  is  a  considera- 
tion which  might  make  medical  men  pause  before 
further  encouraging  the  wholesale  chemists  in  the 
production  of  preparations  according  to  formulae- 
of  their  own. 

"  Upon  all  these  grounds  I  wish  to  urge  that  the 
claims  of  practical  therapeutics  should  be  paid 
more  attention  than  they  have  received  in  the 
past.  If  I  might  be  allowed  to  make  a  few  con- 
crete  suggestions,  they  would  be  : — 

That  each  medical  student  should  dispense  at 
the  hospital  for  an  hour  a  da}'  for  at  least  three 
months. 

That  the  use  of  stock  mixtures  and  printed 
formulae  at  hospitals  should  be  reduced  to  a 
minimum. 

That  there  should  be  Professors  of  both  practical 
pharmacy  and  therapeutics,  the  former  to  concern 
himself  with  the  art  of  compounding  drugs  in  the 
most  eificient,  agreeable  and  convenient  manner,, 
while  the  latter  would  instruct  as  to  the  action  ot 
medicine  in  health  and  disease,  explain  the  manner 
in  which  one  drug  may  aid  another,  and  describe 
the  action  of  drugs,  both  physiologically  and 
therapeutically. 

In  conclusion,  I  may  perhaps  be  excused  for 
saying  that  I  feel  I  owe  much  to  the  fact  that, 
when  I  was  Resident  Medical  Officer  at  the  Golden 
Square  Throat  Hospital,  the  paramount  import- 
ance of  therapeutics  was  indelibly  impressed  on  my 
mind  by  the  teaching  and  example  of  my  dis- 
tinguished friend  Dr.  Prosser  James.  On  the 
clearer  realisation  of  the  principles  I  advocate  by 
the  profession  at  large,  I  believe  that  the  future 
prosperity  and  utility  of  its  members  must  largely 
depend. 

parte  Clinical  Xecture. 

ON 

SPONDYLITIS    OF    INFECTIVE 
ORIGIN. 

By  Dr.  L.  CHEINISSE, 

Ancien-Interne  des  Hopitaux  de  Montpellier. 


[FROM     OUR    PARIS    CORRESPONDENT.] 

Vaguely  recognised  towards  the  middle  of  the 
nineteenth  century  by  Chassaignac,  who  described 
acute    osteomyelitis    under    the    vivid    term    of 

"  typhus  of  the  limbs,"  the  infective  origin  of  the 

ties  also  are  even  advertised  in  the  lay  Press,  and  i  inflammatory  diseases  of  the  bones  has  since  teen 
others  make  it  clear  from  their  format  and  the  J  amply  demonstrated  by  bacteriological  research, 
elaborate  instructions  by  which  they  are  accom-  j  It  is  thanks  to  bacteriology,  indeed,  that  we  are 


ORIGINAL  COMMUNICATIONS. 


Tvrn  M>dtcal  Press     7 


enabled,   in   addition    to   the  acute  osteo- myelitis 

of  children,  due  to   ordinary  pyogenic  organisms, 

to  recognise   other  forms  of  osteomyelitis  which 

result  from  the  most  varied  infections,  localised 

:n  a  particular  part  of  the  osseous  system. 

Amoni*   these  osteo- myelitic  lesions  those  asso- 

tb  uphold  fever  have  specially  attracted 

the  attention  of  observers       Nevertheless,  although 

the  lesions  affecting  the  tibia?  and  ribs,  the  seats  of 

■  i  lection    of    typhoid  al    myelitis,    have    been 

known  tor  many  years,  the  same  cannot  be  said 

he    vertebral    localisations    of    typhoid    fever, 

which,  until  quite  recently,  hardly  found  men  Hon 

fa  the  numerous   works   in   French  and  German 

devoted  to  the  study  of  the  osseous  complications 

phoid  fever*     Out  of    144  cases  of  the  kind 
,   111  Dr.   Klein's  Thesis  (Kiel,   18961,  in 

one  is  reference  made  to  the  localisation  of 

Live  process  in  the  vertebrae*     This  case! 

uch  was  in  the  service  of  Dr.  Quincke ,  together 

valh  one  other  similar  case,  enabled  him  to  describe 

1a  [899,  under  the  name  of  spondylitis    typhosa, 

1  ptoms  which  make  their  appearance 

after  recovery  from  the  attack  of  typhoid 

fever,    or    during     the    period    of    decline.     The 

aileeiion  is  characterised  by  intense  pain  situated 

la  the  lumbar  vertebrae,  with  fever,  swelling  of  the 

sensory  and  motor  troubles  in  the 

lower  liniL-     and   sometimes  also  of  the  bladder 

and  rectum. 

Since  )\i<  publication  of  Quincke's  monograph 
other  cases  of  the  kind  have  been  reported,  the 
total  number  amounting  to  seven  observed  in 
Germany,  <  hmicke  mentions  that  similar  cases 
had  been  noted  in  the  United  States,  Gibncy 
regarding  the  disease  as  of  the  nature  of  a  peri- 
1  as  a  neurosis,  These  cases 
appear,  indeed,  10  be  tolerably  frequent  in  America, 
whence  the  name  M  typhoid  spine/'  Had  the 
Kiel  professor  taken  the  trouble  to  look  up  the 

:n  literature  of  the  subject,  he  would  have 
found  that  cases  of  the  kind  had  already  been 
described  by  PaUaxti  and  others  in  France.  In 
■order  to  throw  light  upon  the  history  of  this 
talemtiflg  affection  I  have  gone  into  the  subject 

thoroughly, 
The  question  arises  whether  typhoid  fever  is 
the  only  disease  which  is  liable  to  localise  itself 
in  the  vertebral  column.  In  other  words ,  does 
there  exist,  side  by  side  with  typhoid  spondylitis, 
and  apart  from  ordinary  spondylitis  of  the  tuber- 
culous and  syphilitic  varieties,  other  forms  of 
infective  spondylitis  ?  Certain  anatomo-bacterio- 
logical  observations  appear  to  suggest  a  reply  in 

affirmative.  Frankel's  researches  on  bone 
marrow  in  infectious  diseases  arc  specially  in- 
teresting irom  this  point  of  view.  He  discovered 
Eberth's  bacillus  in  the  marrow  of  the  vertebra? 
-of  patients  who  had  succumbed  to  typhoid  fever 
tn  every  instance.  Nay  more,  in  the  case  of  a 
girl  who,  in  the  course  of  an  attack  of  enteric 
fever,  and  but  a  few  days  before  death,  developed 
pneumonia,  Frankel  was  able  to  demonstrate  the 
presence  in  the  spinal  marrow  of  the  diplococcus 
alongside    of    Eberth's    bacillus.     This    discovery 

ced  him  to  extend  his  researches  to  other 
tnaladics  than  typhoid  fever.  In  the  course  of 
these  further  investigations,  he  revealed  the 
presence  of  the  diplococcus  in  the  marrow  of 
persons  who  had  died  of  pneumonia,  of  the  strepto- 

is  in  cases  of  erysipelas,  pulmonary  abscess 
diphtheria,  and  of  the  Staphylococcus  pyogenes 


aureus  in  cases  of  phlegmon  and  various  forms  of 
suppuration. 

The  presence  of  these  organisms  in  the  marrow 
of  the  vertebra?  gives  rise  to  a  whole  series  of 
pathological  changes,  e.g.,  hemorrhages,  fibrinous 
exudations,  localised  necrosis  and  the  like.  Anato- 
mically the  bone  marrow  of  the  vertebrae  shows 
itself  to  be  as  liable  to  the  influence  of  infective 
agents,  whether  general  or  local,  as  the  spleen* 
The  analogy  is  the  more  complete,  seeing  that  the 
splenic  localisation  of  the  infective  process,  like 
the  vertebral  manifestations,  exhibits  a  like  ten- 
dency to  spontaneous  resolution,  and,  in  contrast 
to  affections  of  the  long  bones,  only  exceptionally 
culminates  in  suppuration,  the  difference  being 
no  doubt  due  to  the  comparatively  greater  vascu- 
larity of  the  marrow  and  the  spleen. 

However  this  may  be,  it  is  obvious  that  although 
the  centres  of  disease  in  the  depths  of  the  vertebral 
marrow  are,  as  a  rule,  so  small  as  to  subside 
without  giving  rise  lo  symptoms  accessible  to 
clinical  investigation,  they  may,  in  rare  cases, 
determine  more  or  less  grave  symptoms.  In  such 
cases  we  have  infective  spondylitis  proper! 
called.  Typhoid  spondylitis  is  unquestionably 
one  of  the  most  typical  forms,  but  other  van 
have  been  observed. 

Quite  recently  Quincke  published  two  very 
characteristic  examples  thereof.  Case  I  was 
that  of  a  man,  a?t,  46,  who,  about  six  weeks  after 
the  onset  of  an  attack  of  pneumonia  of  average 
severity  and  running  the  usual  course,  suddenly 
complained  of  acute  pain  in  the  lumbar  region  of 
the  spinal  column,  not  accompanied  by  any  rise 
of  temperature.  Admit  ted  to  hospital,  he  re- 
mained an  inmate  (or  upwards  of  five  months, 
on  account  of  well-marked  spondylitis,  which 
kit,  after  recovery,  some  swelling  of  the  spinous 
processes  of  the  second  and  third  dorsal  vertebra*. 
The  hypothesis  of  the  process  being  tuberculous 
could  be  discarded  on  account  of  the  absence  of 
any  rise  of  temperature,  and  of  the  absence  of 
any  pulmonary  disease  and  hereditary  ante- 
cedents, and,  on  the  other  hand,  there  was  no 
history  of  traumatism.  The  author,  therefore, 
arrived  at  the  conclusion  that  it  was  a  case  of 
pneumococcic  spondylitis.  In  the  other  case,  a 
farmer,  also  mt.  46,  was  admitted  to  hospital  with 
right -sided  empyema,  which,  ten  days  previously, 
had  burst  into  the  lungs  with  expectoration  of 
pus.  Several  ribs  were  resected  and  the  pleura 
opened,  whereupon  the  expectoration  of  pus 
considerably  diminished,  and  in  about  six  weeks 
the  patient,  who  had  meanwhile  gained  twenty- 
five  pounds  in  weight,  was  discharged.  Some 
weeks  later  he  began  to  complain  of  pain  in  the 
lumbar  region.  The  pain  was  but  slight  when  he 
was  lying  down,  but  became  very  severe  on  the 
slightest  movement  or  on  pressure,  so  that  he  was 
readmitted.  Investigation  revealed  the  existence 
of  some  rigidity  of  the  spinal  column,  with  tender- 
ness on  pressure  over  the  lumbar  spinal  processes, 
especially  over  the  third  lumbar  vertebra.  In 
the  left  lumbar  region,  just  above  the  iliac  crest 
and  about  three-quarters  of  an  inch  from  the 
spinal  processes,  a  swelling  the  size  of  a  goose's  egg 
was  perceived.  An  exploratory  puncture  did 
not  give  issue  to  pus,  and  the  patient  was  allowed 
to  go  home  after  fitting  him  with  a  piaster  jacket* 
As  this  patient  was  suffering  at  the  time  from 
1  chronic  bronchitis,  it  was,  of  course,  possible  that 
1  he    had    Pott's   disease,  but,    judging    from  the 


8     The  Medical  Press. 


SPECIAL  ARTICLES. 


Jan.  6,  1904. 


subsequent  history  of  the  case,  supplied  by  his 
medical  man — the  symptoms  having  cleared  up  in 
the  course  of  a  few  months — this  hypothesis  cannot 
be  substantiated.  Dr.  Quincke  therefore  con- 
cluded that  the  symptoms  were  the  sequel  of  the 
empyema,  and  since  the  pleural  exudation  was 
rich  in  streptococci,  he  inclined  to  the  view  that 
the  vertebral  affection  was  of  streptococcic 
origin. 

It  is  obvious  that  the  two  cases  just  briefly 
related  present  considerable  analogy  with  cases 
of  typhoid  spondylitis.  The  severity  of  the  pain, 
the  swelling  of  the  soft  parts,  and  the  more  or  less 
persistent  rigidity  of  the  affected  segment  of  the 
spinal  column  seem  to  point  to  implication  of  the 
periosteum  and  ligaments,  and  to  justify  the 
name  "  perispondylitis  "  given  to  it  by  Gibney. 
If  we  add  the  slight  tendency  to  suppuration  and 
the  predilection  of  the  morbid  process  for  the 
lumbar  region,  we  have  a  group  of  symptoms 
common  to  all  varieties  of  spondylitis. 

It  may  be  conceded  that  Quincke's  cases  alone 
would  hardly  suffice  to  establish  the  existence  of 
infective  spondylitis.  But  apart  from  the  fact 
that  they  fit  in  very  well  with  the  bacteriological 
results  obtained  by  Frankel,  it  is  only  fair  to  add 
that  other  clinical  observations  tend  to  confirm 
this  view.  In  the  course  of  the  discussion  at  the 
Medical  Society  of  Kiel  on  one  of  Quincke's  cases, 
two  other  cases  were  mentioned,  one  following  an 
attack  of  pneumonia  and  one  after  scarlatina. 

It  would  be  a  mistake  to  suppose  that  the  Kiel 
professor  was  the  first  to  call  attention  to  these 
vertebral  manifestations  in  association  with  in- 
fective diseases  other  than  typhoid  fever.  We 
have  only  to  refer  to  Gibney 's  paper  on  typhoid 
spine  to  see  that  in  the  discussion  to  which  the 
paper  gave  rise  Shaffer  stated  that  he  had  met 
with  similar  morbid  incidents  not  only  after  typhoid 
fever,  but  also  after  scarlet  fever  and  measles. 
.  If,  in  his  practical  remarks  on  the  subject, 
Quincke  thought  it  desirable  to  advise  the  avoid- 
ance during  convalescence  from  infective  diseases 
of  all  risk  of  traumatism  and  over-exertion  of  the 
spinal  column,  the  fact  remains  that  fourteen 
years  before,  Shaffer  made  use  of  almost  the  same 
words  in  discussing  the  influence  of  "  excessive 
exercise  or  a  direct  blow  or  fall  after  an  acute 
fever." 


Special  articles* 

BRITISH    SANATORIA    FOR    CONSUMPTION.— 
XXVII. 


BY    OUR    SPECIAL    MEDICAL   COMMISSIONER.] 


OVERTON  HALL  SANATORIUM.BOURNEMOUTH. 
Overton  Hall  is  a  large  villa  residence  so  con- 
structed and  adapted  as  to  meet  in  some  measure  the 
requirements  of  a  small  private  sanatorium  for  con- 
sumption. Its  situation  is  by  no  means  ideal,  for  it  is 
on  the  north  side  of  the  busy  Bournemouth  tram-route, 
Poole  Road,  from  which  it  ls  only  separated  by  a  com- 

f>aratively  small  garden.  This  location,  while  doubt- 
ess  convenient  in  many  ways,  has  many  serious  draw- 
backs, for  it  lacks  in  quietness  and  privacy,  and  in 
summer  months  cannot  be  free  from  dust.  The  close 
proximity  of  other  residences  is  also  a  disadvantage. 
The  institution  was  first  established  by  Dr.  Pott,  but 
is  now,  as  we  understand,  in  the  hands  of  Dr.  Stein. 
The  building  has  an  attractive  appearance.  It  is 
built  of  red  brick,  and  forms  a  hollow  square  minus  the 
north  side.  The  extensive  south  front  of  some  80  ft. 
provides  a  series  of  pleasant  rooms  for  the  patients. 


Short  wings  diverge  from  the  two  corners.  Between 
these  projecting  ends  there  is  a  lofty  and  wide  verandah, 
which  communicates  with  the  lower  bedrooms  and  is- 
provided  with  glass  screens,  and  has  glass  windows  in 
its  roof  for  ventilation.  This  structure  seems  to  be 
much  used  by  patients  as  a  resting  shelter,  but  we 
should  imagine  it  is  in  danger  of  becoming  a  kind  of 
all- the-y ear-round  "  winter  garden."  Above  the 
verandah  is  a  partially  roofed  over  balcony.  There  is 
a  good  corridor-hall  running  the  whole  length  of  the 
house,  and  affording  a  common  ground  where  "  the 
patients  pass  the  evening  in  conversation  and  reading 
the  daily  papers." 

Many  of  the  bedrooms  are  good,  although  by  na 
means  coming  up  to  the  hygienic  standards  set  by 
some  recent  sanatoria.  The  rooms,  indeed,  have  too 
"  homely  "  an  aspect.  As  far  as  we  could  see,  every 
care  is  taken  to  maintain  absolute  cleanliness.  The 
furniture,  mostly  of  mahogany,  is  more  elaborate  than 
is  usually  seen  in  sanatoria.  There  are,  of  course,  no- 
fixed  carpets,  but  a  plentiful  supply  of  rugs  which, 
considering  the  site  and  size  of  the  sanatorium,  must  be 
great  dust  collectors  and  require  considerable  labour 
to  keep  clean. 

The  wings  of  the  building  contain  a  number  of  bed- 
rooms smaller,  however,  than  those  on  the  south  side. 

Heating  is  by  means  of  open  fires.  Lighting  is  by 
electricity.  The  sanitary  arrangements  appear  to  be 
good. 

The  grounds  are  very  limited,  being  only  about  one 
and  a  half  acre  in  extent,  but  they  are  provided  with 
various  "  sun  traps  "  and  revolving  shelters. 

Treatment  is  conducted  in  accordance  with  the  now 
generally  recognised  hygienic  principles.  The  sana- 
torium is  only  intended  for  early  cases.  For  such 
patients  as  are  suited  for  Bournemouth,  Overton  Hall 
offers  many  advantages.  The  public  gardens  and  sea. 
front  can  be  readily  reached,  and  undoubtedly  the 
electric  cars  offer  a  ready  means  of  locomotion  which, 
wisely  or  not,  is  certainly  largely  made  use  of.  ■ 

For  subjects  disliking  the  routine  and  restraints  of 
institutional  life,  and  desiring  the  comforts  and  con- 
veniences of  a  private  house,  this  establishment  has 
distinct  attractions. 

There  is  an  excellent  resident  matron  and  a  gooA 
staff  of  attendants. 

The  terms  are  from  four  to  five  guineas. 

Overton  Hall  is  only  a  few  minutes'  walk  from  West 
Bournemouth  Station,  and,  as  already  indicated,  the 
electric  cars  pass  the  gates. 

The  National   Sanatorium   for  Consumption  and- 

Diseases  of  the    Chest,  Bournemouth. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, So  much  has  been  done  during  the  last  five 

years  to  bring  the  National  Sanatorium  structurally 
up  to  date  that  we  must  take  exception  to  the  state 
ment  of  your  Special  Commissioner  that  "  it  cannot 
claim  to  rank  high  among  modern  sanatoria."  ( 1)  The 
wards  and  corridors  are  very  well  ventilated,  the  old 
windows  being  replaced  bv  double  casements  and  fan- 
lights, the  wards  on  the  ground-floor  haying,  in 
addition,  openings  into  corridor,  as  described  in  your 
article  in  one  ward  only.  (2)  The  whole  of  the  sanitary 
arrangements  have  been  rebuilt.  (3)  Electric  light  has 
been  installed  all  over  the  building  and  shelters. 
(4)  The  dining-rooms  each  have  four  double  casement 
windows.  (5)  The  partition  between  the  day-room 
and  the  corridor  has  been  removed,  thus  admitting 
more  light  and  free  circulation  of  air  throughout  the 
building. 

The  grounds  are  three  acres  in  extent.  There  is 
accommodation  now  for  seventy-two  patients.  Plans- 
for  an  additional  extension  have  been  revised  and  will 
provide  for  ten  to  twelve  new  beds.  There  are  now  six 
nurses  working  under  the  matron. 

Although  one  cannot  expect  to  alter  an  existing 
building  so  that  it  will  have  quite  the  same  appearance 
as  one  of  the  modern  sanatoria,  yet  the  alterations- 
carried  out  here  have  to  a  great  extent  brought  the 


»av    £    1^4 


TRANSACTIONS  OF  SOCIETIES. 


TBS  Medical  Pi  ess.     9 


satstttrioo  into  "  Accordance  with  modern  principles  of 
saoitjrram  construction," 

I  arr  LTB  truly 

(A,  Geo!  Eyre  Harris,  M.D.Dub. 
[Wear?  glad  to  insert  the  above  statements,  which 
ctrtaisly  show  that  no  pains  have  been  spared  to 
At  tint  at  hi^h  a  standard  as  may  be  possible  under 
eibtuy  conditi»*ns~  Our  Commissioner  will  re  ply  in 
■ 
The 
LltM 
ift* 


transactions  of  Societies. 


£TY   FOR    THE    STUDY    OF    DISEASE     IN 
CHILDREN. 
Meeting  held  December  iith. 


Ujl  Sydney Stephenson,  RR.C.S., 

-• 


in  the  Chair. 


'r    A.  Monson  showed  an 

ABDOMINAL   CASE    FOR   DIAGNOSIS, 

The  patient  was  a  hoy,  *t.  y.  who  had  suffered  froman 
istick  of  nephritis,  accompanied  by  general  *  edema, 
albuminuria,  and  tube  caste-  After  recovery  he  was 
seat  to  a  convalescent  home,  and  there  a  lump  was 
discovered  in  the  left  side  of  the  abdomen,  situated 
hm  down.  The  boy  said  he  had  been  conscious  0/ 
-ome  thing  movable  there  for  six  months,  Dr.  Monson 
found  a  mass  in  the  left  iliac  fossa  which  was  fixed, 
and  a  part  above  which  was  movable.  He  believed 
the  movable  portion  of  the  tumour  was  a  floating 
kidney,  which  might  possibly  have  become  twisted 
*>  as  to  develop  the  renal  symptoms  above  described. 

Dr.  Cax'TLEY  thought  the  lump  was  more  or  less 
fad,  that  the  attack  of  nephritis  was  probably 
unconnected  with  it,  and  that  the  mass  was  possibly 
tvbercnlous. 

Dr.  Percy  Lewis  (Folkestone)  recalled  a  similar 
tamoar  mass,  leading  to  intestinal  obstruction,  which 
limvcd  to  be  a  dermoid  cyst. 

Dr.  Guthrie  thought  there  was  a  movable  kidney 
m  the  left  side,  tend  that  the  swelling  below  was 
probably   tuberculous. 

Mr.  Arnold  Lawson  showed  a  case  of 

EXOPHTHALMIC  GOITRE 

it  a  girl,  ;rt.  12.  The  physical  signs  were  all  well 
marked.  The  chief  interest  oi  the  case  lay  in  the  ex- 
treme youth  of  the  patient,  very  few  cases  of  Graves' 
tlt&ease  at  such  an  early  age  having  been  recorded. 
So  cause  could  be  assigned  for  the  onset  of  the  disease, 
The  child's  health  had  been  excellent  previously,  and 
tkere  was  no  family  history  of  insanity  or  nervous 
itftea&e.  The  constitutional  effect  of  the  illness  on 
the  child  was  very  slight,  although  the  disease  had  been 
m  progress  for  over  twelve  months, 

Dr.  Robert  Hutchison  referred  to  a  case  he  had 
seen  in  a  child  of  eight  years,  and  asked  if  there  were 
any  affection  of  the  pelvic  organs,  and  if  early  men- 
struation  had  occurred.  The  association  of  pelvic 
disorder  in  women  with  Graves*  disease  was  a  subject 
more  worthy  of  study, 

som  referred  to  the  case  of  a  child  of  twelve 
*!w  developed  this  infect  ion  after  an  attack  ol  influenza. 
la  reply  Mr.  Lawson  said  he  had  not  examined  the 
yclvic  organs,  but  the  menses  had  not  commenced. 
Th#&  was  no  definite  neurotic  element  about  the 
dttl, 

Dr.  E,  R  B%umann  showed  a  boy,  set.  /.  suffering 
from  media--  Last  July  he  suffered  from  acute 

rheumatism,  complicate  1  by  endocarditis  and  peri- 
carditis. In  September  pumuess  of  the  face  and 
ascites  developed.  There  was  found  to  be  a  large 
lim  and  an  enlarged  heart.  The  abdomen  had  been 
upped  several  times,  but  the  evacuation  oi  the  fluid 
flfcde  no  d ifference  in  the  venous  dilatation  oi  the  neck. 
Examination  by  the  X  rays  threw  no  further  light  on 
lie  case.  In  view  of  the  history  and  the  clinical 
jymptoms,  a  diagnosis  of  adhesive  mediastinius  had 
ben  made,    The  bov 


v's  general  health  was  good. 

CASE    Or    DISPLACE MENT    OF    THE    THYROID. 

roe  Carpenter  showed  a  girl,  at,  16,  with  a 


tumour  at  the  root  of  the  tongue,  which  was  acci- 
dentally discovered.  The  mass  was  probably  a  der- 
moid in  connection  with  the  thyrivglossal  duct.  The 
thyroid  gland  could  not  be  felt  in  the  neck,  and  the 
possibility  of  the  lingual  swelling  being  a  misplaced 
thyroid  was  suggested* 

Mr,  Jajfhey  thought  the  swelling  occupied  the  site 
of  the  thyro-Lingual  duct. 

Dr.  Frank  Collie  said  he  had  known  the  pa  ticnt 
for  four  years,  and  until  one  and  a  half  years  ago  there 
was  no  question  of  any  swelling.  At  the  latter  time 
she  began  to  menstruate,  and  two  months  later  a  pro- 
minence developed  in  the  region  of  the  chin,  which 
might  have  been  due  to  the  effort  to  get  a  freer  passage 
of  air.  Two  well-known  specialists  in  throat  diseases 
had  seen  the  case,  and  agreed  that  it  was  probably 
a  case  of  displacement  of  the  thyroid  on  to  the  dorsum 
of  the  tongue.  As  the  child  suffered  no  inconvenience, 
he  advised  that  it  should  be  left  alone, 

Dr*  Carpenter  also  showed  a  case  of  congenital 
heart  disease,  and  a  case  oi  cirrhosis  of  the  lunc. 

THE    AFTER-EFFECTS    OF    ROLYNI 

Dr.  Leonard  Guthrie  showed  a  boy,  ^t.  12 1  who 
seven  years  previously  had  suffered  from  a  severe 
attack  "of  polyneuritis  of  uncertain  origin.  At  the  end 
of  three  months  he  had  completely  recovered,  save 
1  that  the  knee-jerks  were  absent,  and  there  was  a 
j  tendency  to  contraction  of  the  tend  a  Achillis  on  both 
sides.  He  had  been  admitted  into  hospital  during  the 
present  year  suffering  from  a  well-marked  condition 
oi  talipes  equino-varus,  for  which  tenotomy  had  been 
I  performed,  with  improvement  of  the  walking  powers. 
At  present  he  showed  a  condition  of  pes  cavns  on  both 
sides,  strongly  resembling  that  of  Friedreich's  disease, 
but  without  ataxy.  The  knee-jerks  were  absent,  the 
muscles  of  all  the  extremities  were  small,  but  there  was 
no  paralysis.  He  was  somewhat  deficient  mentally. 
After  excluding  other  possible  causes  of  the  condition, 
such  as  spastic  paraplegia,  Dr.  Guthrie  concluded  that 
the  case  illustrated  the  after-effects  of  polyneuritis. 

Dr.  James  Taylor  agreed  with  the  diagnosis,  and 
suggested  that  there  had  been  six  years  ago  some 
general  toxic  condition.  This  had  not  only  aflected 
the  peripheral  nerves,  but  also  the  anterior  horns  of 
the  cord  and  the  highest  cerebral  centres.  This  had 
caused  the  impaired  mental  condition  which  was  now 
present, 

Dr,  Fletcher  Beach  thought  that  there  was  de- 
fective moral  control,  probably  the  result  of  the  early 
illm 

Dr.  Guthrie  also  showed  a  girl,  at.  n,  with  physical 
signs  which  he  regarded  as  those  of  aortic  valvular 
disease,  with  stenosis*  The  maximum  of  the  intensity 
of  the  murmur  was  in  the  second  left  intercostal  space. 
Dr,  Theodore  Fisher  said  that  disease  of  the  aortic 
valves,  either  congenital  or  acquired,  was  not  so  rare 
as  was  usually  supposed.  A  variety  of  lesions  affect- 
ing the  aortic  valves  was  found  on  post  mortem  ex- 
amination. Various  diagnoses  as  to  the  cardiac  con- 
dition were  given  by  members,  including  mitral  disease, 
aortic  regurgitation  with  presystolic  thrill  and  murmur 
(Mmfs  murmur),  pulmonary  valvular  disease,  and 
patent  ductus  arteriosus. 

Mr,  J.  W.  Thomson  Walker  showed  a  dermoid  cyst 
which  he  had  removed  from  the  front  01  the  sternum 
in  a  girl,  at.  5.  Since  infancy  a  small  round  swelling 
'.en  observed,  which  had  increased  to  the  sise 
of  a  large  horse-chestnut.  It  was  easily  dissected  out. 
On  microscopic  examination,  hair  follicles,  sebaceous 
glands,  and  sweat  glands  were  easily  recognised, 

Mr.  Douglas  Drew  showed  a  specimen  ot  tuberculous 
caries  of  the  upper  dorsal  spine,  with  an  abscess  pressing 
on  the  bifurcation  of  the  trachea-  The  patient  was  a 
child.  ;et,  5,  who,  while  under  treatment  for  spinal 
disease,  developed  some  difficulty  in  breathing,  which 
at  times  became  rather  urgent.  One  of  these  seizures 
proved  fatal  from  asphyxia.  The  upper  dorsal  ver- 
tebra were  found  to  be  extensively  diseased,  and  there 
was  a  large  thick- walled  abscess  pressing  on  the  trachea 
and  bronchi. 

Dr,  George  Carpenter  showed  a  specimen  of  a 
lung  removed  from  an  infant,  $  months  old.     The  lower 


10    The  Medical  Press.  TRANSACTIONS  OF  SOCIETIES. 


Jan.  6,  1904. 


lobe  of  the  left  lung  was  cystic,  the  largest  cyst  being 
the  size  of  a  small  orange.  It  was  probably  6f  con- 
genital origin,  and  akin  to  the  cysts  found  in  the  kidneys 
and  spleen.  During  life  the  prominent  feature  was 
dextrocardia. 

Mr.  Albert  Carless  read  a  paper  on  some  cases  of 
"  Lymphangeiomata,"  which  was  discussed  by  Mr. 
Douglas  Drew  and  Mr.  Thomson  Walker. 


NORTH     OF     ENGLAND     OBSTETRICAL     AND 

GYNECOLOGICAL  SOCIETY. 
•^Meeting  held  at  Manchester,  Friday,  Decem- 
ber i  8th,  1903. 


l  Dr.  J.  E.  Gemmell,  President,  in  the  Chair. 

Card  Specimens. 

Mr.  Stanmore  Bishop. — A  series  of  specimens  of 
hydro-  and  pyo-salpinx,  a  fibroid  uterus,  proliferating 
papillomatous  cysts  of  the  ovary. 

Dr.  W.  E.  Fothergill. — Ectopic  gestation,  pyone- 
phrosis   following  movable  kidney. 

Dr.  J.  H.  Willett. — Tubal  mole  in  process  of  ex- 
trusion. 

Dr.  Lloyd  Roberts. — Ovarian  cyst  with  twisting 
of  the  pedicle. 

Dr.  W.  Walter. — Fibro-myomata  of  uterus. 

Professor  W.  J.  Sinclair  (Manchester)  showed  glass 
drainage-tubes  used  in  vaginal  hysterectomy.  He  had 
devised  these  because  he  was  not  satisfied  with  ordinary 
rubber  ones,  which  were  apt  to  become  choked  by 
fibrous  clot.  The  glass  tube  resembled  a  short  narrow 
test  tube  with  a  very  wide  flange,  and  it  was  per- 
forated by  several  rows  of  holes.  It  could  be  washed 
out  with  normal  saline  solution  and  kept  clear  of  clot. 

Dr.  Arnold  Lea  (Manchester)  said  he  had  had  per- 
sonal experience  of  the  tubes,  and  they  had  all  the 
advantages  claimed  for  them. 

Dr.  J.  B.  Hellier  (Leeds)  related  a  case  of 
Septate  Uterus  and  Vagina;  Labour  Obstructed 
by  the  Vaginal  Septum.  

She  had  had  only  one  child,  and  when  the  medical 
attendant  arrived  to  conduct  the  labour,  he  found  both 
feet  contained  in  a  sort  of  pouch  on  the  left  side  of  the 
vagina.  This  pouch  appeared  to  be  closed  below, 
and  the  feet  were  ultimately  extracted  from  it  and 
delivery  completed,  the  perinaeum,  however,  being 
lacerated.  The  latter  was  sutured,  but  did  not  heal, 
so  the  patient  was  sent  to  Dr.  Hellier,  who  thus  ob- 
tained the  opportunity  of  examining  the  conditions 
under  anaesthesia.  He  found  a  broad  fundus  uteri 
witha  depression  in  its  centre  ;  a  single  os  externum, 
within  which  was  a  well-marked  septum  dividing  the 
cavity  of  the  uterus  into  two  halves  of  equal  length  ;  a 
well-formed  vaginal  septum  of  fleshy  consistence,  which 
was  deficient  above  in  front  of  the  os.  The  two  halves 
of  the  vagina  were  open  above  and  below.  The  septum 
was  excised. 

Dr.  Blair  Bell  (Liverpool)  read  notes  of 

An  Unusual  Case  of  Ectopic  Gestation. 

The  patient  was  a  single  young  woman  with  a  long 
history  of  "indigestion"  and  "bilious  attacks."  For 
several  days  she  had  had  repeated  attacks  of  severe 
abdominal  pain,  but  persisted  in  going  about  as  usual 
and  in  declining  to  see  a  doctor,  as  she  attributed 
this  pain  to  "  indigestion."  Ultimately  Dr.  Bell  saw 
her,  and  found  that  menstruation  had  always  been 
profuse,  and  that  a  supposed  period  which  had  con- 
tinued for  ten  days  (unusual  for  her)  was  just  "  going 
off."  Rectal  examination  was  negative,  but  there 
were  rigidity  and  tenderness  of  the  right  iliac  fossa. 
The  pulse  was  slow  and  the  temperature  low.  It  was 
considered  that  there  was  probably  appendicular 
trouble  with  impending  gangrene  or  perforation, 
so  laparotomy  was  performed.  Much  blood  was 
found  in  the  abdominal  cavity  and  the  cause  of  the 
illness  revealed  rf  The  right  pregnant  tube  was  removed, 
leaving  the  ovary  intact.  The  entire  length  of  the 
vermiform  appendix  was  adherent  to  the  back  of  the 
caecum,  so  it  was  freed  and  removed  also.     Dr.  Bell 


remarked  that  had  the  appendix  been  normal  he 
would  have  removed  it  in  any  case  to  prevent  any 
chance  of  disclosures  in  the  future.  The  patient  re- 
covered perfectly,  and  has  since  been  free  from 
"  bilious  attacks." 

Dr.  J.  H.  Willett  (Liverpool)  read  a  pathological 
report  on  the  specimen  removed  by  Dr.  Blair  Bell,  and 
showed  lantern  slides  of  sections  made  from  it.  The 
remarkable  point  about  it  was  the  extreme  and  uni- 
versal thinning  the  tube  had  undergone. 

The  President  inquired  if  there  was  any  acknow- 
ledged menstrual  irregularity  ? 

Dr.  Arnold  Lea  asked  whether  there  had  been  any 
indications  of  attacks  of  appendicitis  in  the  past. 
Could  the  condition  be  attributed  to  adhesions  round 
the  appendix  ?  Dr.  Hellier  commented  on  the  ad- 
visability of  removing  a  healthy  appendix.  Professor 
Sinclair  favoured  the  view  that  an  attack  of  appen- 
dicitis might  predispose  to  tubal  disease,  and  related 
a  case  in  support  of  his  statement.  Dr  Garner 
(Preston)  and  Dr.  Fingland  (Liverpool)  having 
spoken,  Dr.  Bell  replied.  He  said  there  was 
no  evidence  of  the  spread  of  inflammation  from  appen- 
dix to  tube  in  this  case.  The  two  conditions  were  quite 
distinctly  independent  of  one  another. 

Dr.  W.  K.  Walls  (Manchester)  detailed  a  case  of 
"  Severe  metrorrhagia  in  a  girl,  set.  14."  Ergot  proved 
valueless,  so  the  uterus  was  curetted,  the  cervix 
beingjso  patulous  that  it  was  scarcely  necessary  to  use 
dilators.  A  very  large  number  of  long  thick  strips 
were  removed.  The  condition  was  cured  after  this  had 
been  carried  out. 

Dr.  Lloyd  Roberts  said  that  in  such  cases  ergot 
was  of  little  use,  iron  and  purgatives  being  more 
beneficial.  Local  applications  of  iodine  used  to  cure 
before  curetting  became  fashionable,  but  the  latter  had 
been  the  best  treatment  in  this  case. 

Professor  W.  J.  Sinclair  said  that  the  pathology 
in  such  a  case  was  mere  guess-work,  although  it  might 
perhaps  have  been  possible  to  ascertain  some  possible 
ovarian  change.  Was  the  uterus  smaller  in  size  a  few 
periods  after  the  curetting,  or  larger  ?  He  suggested 
the  possibility  of  some  sexual  element,  and  mentioned 
a  case  in  which  bleeding  had  ceased  after  marriage. 

Dr.  W.  Walter  considered  that  the  cause  of  the 
trouble  had  been  in  the  uterus,  as  the  curetting  had 
cured  the  bleeding. 

Dr.  W.  E.  Fothergill  suggested  some  develop- 
mental error  as  a  possible  cause.  He  instanced  the 
irregular  profuse  menstruation  met  with  just  after 
puberty,  and  said  that  Dr.  Walls'  case  might  be  an 
exaggeration  of  an  ordinary  type  of  case.  At  puberty 
there  occurred  an  increase  in  blood-vessels  and  muscu- 
lar Cfibres.  If  the  latter  were  defective  or  late  in 
appearing  haemorrhage  would  occur,  and  ergot  would 
not  control  it,  because  there  were  no  muscular  fibres 
for  it  to  act  upon.  The  same  cause  was  in  action  at 
the  menopause. 

Dr.  J.  J.  O' Hag  an  (Gars  ton)  said  that  possibly  a 
small  fibroid  which  had  escaped  detection  might  have 
accounted  for  the  bleeding.  He  had  known  this  to 
be  the  case  in  an  older  girl. 

*The  President  and  Dr.  Hellier  having  spoken.  Dr. 
Walls  said,  in  reply,  that  haemophilia  and  a  small 
fibroid  had  been  excluded,  and  the  sexual  element 
had  not  been  inquired  into.  The  curettings  were  about 
an  eighth  of  an  inch  in  thickness,  but  the  microscopical 
examination  did  not  reveal  any  increase  in  the  blood- 
vessels. At  the  same  time  he  thought  that  Dr. 
Fothergill's  explanation  of  why  ergot  failed  in  these 
cases  would  stand  criticism. 


LIVERPOOL  MEDICAL  INSTITUTION. 
Meeting  held  December  17TH,  1903. 


Rushton  Parker,  Esq.,  B.S.,  F.R.C.S.,  President,  in 
the  Chair. 


Mr.  Thelwall  Thomas  exhibited  receptacles  for 
dressings  designed  by  him  to  facilitate  the  carrying 
out  of  aseptic  surgery  in  private  practice.    The  boxes 


J&.  6,   1904. 


FRANCE, 


The  Medical  Press.     II 


ire  rectangular,  the  hd  placed  underneath,  and  let  in  in 
s»cb  a  way  that  when  the  box  rests  on  a  flattened 
surface  dust  cannot  enter  1    the  sides  have  perforated 
and  miss  M  slides.     They  tit  into  a  large  steam 
^r,  and  each  box  will  hold  the  necessary  dress- 
ing*,  bandages,  sheets  of   sterilisahle  waterproof    ma- 
covered   with   thick   muslin,   and    two  specially 
.  fwns.     A  dark  mackintosh  cloth  case  fits 
over  the  box  for  transportation. 

The  President  said  the  boxes  shown  were  by  far 

tin  most  convenient  and  suitable  ones  he  had  seen* 

[)r  Gordon  Gullan  showed  a  lad,  set,  18.  suffering 

morbus  c^mleus.     He  was  able    to   follow 

trade  as  a  watchmaker*     There  were  signs  of  enlarge- 

oi  the  right  heart,  with  obstruction  t>f  the  pul* 

moaary  artery,   and    probably  a  patent  ductus  arte- 

Dr,  Gull  an  also  reported    two  cases  of  cretinism  in 
one  patient   being  shown.     Both  were 
One    was    improving    under    thyroid  ; 
!ier  had  shown  no  Improvement. 
Hubert    Armstrong  referred    to   the   rial 
n   death  in   congenital   heart   disease,    and    men- 
!  two  cases  in  his  own  experience,  one  a  baby,  and 
icr  3  bov  of  twelve. 

■mo  Walker  showed  a  woman,  art.  40,  with 
tii-  atrophy  and  dnuhlc  third  nerve  paralysis. 
*  history  of  "  inflammation  of  the  bowels  " 
ears   previously,   with   vomiting   and    headache, 
were  "probably  due  to  a  basal  syphilitic 
implicating    the    affected    nerves    in    the 
icular  space  and  the  chiasma,     Mr,  Walker 
it  was  a  rare  case,  and  had  only  occurred  once  in 
'■*  nts  seen  at  St*  Foul's    Kye   and  Ear  Hos- 
pital 1  a  the  present  year.     Some  power  was  returning 
rcurial     inunction     and     potassium     iodide 
intern  • 
Mr,  George  G.  Hamilton  read  a  paper  upon 

RAPID    PARAPLEGIA, 

ted  a  case,  which  will  be  published  in  full  later. 
In  commenting  upon  the1  condition  he  thought  Am- 
•  >a  might  usefully  turn  upon  the  following  con- 
ditions —Traumatic  neurasthenia,  meningitis,  spinal 
o-rmorrhage,  Landry's  paralysis,  peripheral  nerves, 
palates.  In  this  particular  case  the  post -mor- 
tem revealed  a  hemorrhagic  myelitis. 

Dr.  k.  E,  Glynn  had  examined  the  spinal  cord  and 
rerebr  <nm;i]  fluid,  and  had  found  no  evidence  of 
hacterial  infection. 
IT.  W.  B  Warrington  said  many  cases  of  so-called 
myelitis  were  really  due  to  softening  of  the  cord 
following  syphilitic  arterial  disease,  but  the  different 
ml  diagnosis  was  difficult.  He  suggested  that  a  sy- 
phiEtlC  history,  the  spread  of  the  in  mi  one 

ner,  with  the  Brown-Scquarrf  features, 
I  help,  and  quoted  two  oases  in  which  this  symptom - 
complex  was  present.  Primary  haemorrhage  into 
the  cord  was  extremely  ran  It  was  important 
to  recognise  a  syphilitic  origin  for  its  guide  to  treat- 
meat. 

Dr*.  T.  R.  Glynn,  Raw,  Carter,  and  Barr  spoke,  and 
Mr  Hamilton  replied. 


favour  of  the  revival  of  the  practice  in  certain  cardiac 
and  pulmonary  diseases. 

A  discussion  took  place  on  this  paper  also, 

jfrance* 

[from   our  own  correspondent.] 


RK  MEDICAL  AND  SURGICAL  SOCIETY. 
held   Wednesday,    [>ec ember  oth,   1903, 


or    Henry   Corby,    M,D,.    in    the    Chair. 


Pr'ifkssor  Corby  read  a  paper  on 

VSES   OP    THE    PLACENTA    CAUSIXG    ABORTION, 

specially    with    fatty    degeneration    of    the 
nta,  and  the  occurrence  of  apoplectic  lobules  or 
due  to  effusion  of    blood  in  the  placental  ti 

!  a  typical  specimen  of  this  Utter  condition, 
-ion  on  the  paper  followed. 
E>«  J.  O'Connor  read  a  paper  en 

T  ION  OF  BLOOD-LETTING   IN  ACUTE  PULMONARY 
^SES, 

id  winch  he  argued  that  the  practice  of    venesection, 

out  of  fashion,  might  be  employed 

intage  in  many  cases  of  this  description,  and 

•  of  the  best  authorities  were  now  in 


Paris,  Jtnuafs  Bui,  iflOk 
Renal  Opotherapy. 

At  the  meeting  of  the  Academie  de  Medecine,  M. 
Tenault  read  a  paper  on  the  treatment  of  chronic 
albuminuria  by  opotherapy,  in  which  he  related  the 
cases  of  three  patients  Buffering  from  Chronic  Bright* a 
•  .  interstitial  nephritis  and  cardiac  albuminuria 
:ively,  who  were  treated  with  macerated  pork 
kidneys.  The  albuminuria  disappeared  completely, 
and  the  quantity  of  urine  excreted  became  normal* 

The  administration  oi  the  remedy  should  not  e&ceed 
ten  days,  after  which  it  shoul  -uded  fnr  four 

Of  five  days. 

Tinea  Tonsurans, 

The  treatment  of  this  troublesome  affection  is 
varied  and  frequently  exhausts  all  the  microbicides 
known. 

Professor  Charmed  counsels  as  general   treatment, 
outdoor  exercise,  sea  air,  tonics  in  the  form  of  glycero- 
phosphates, arsenic,  cod-liver  oil,  &e,     As  local  treat- 
ment, d epilation  of  the  patches  three  or  four  times  in 
the  course  ot  the  disease.     As  application,  pure  acetic 
acid  painted  on  the  part  by  a  pencil  made  of  a  piece  of 
cotton  wool  on  a  stick,  and  rubbed  gently  in  followed 
by  drying  with  a  bit  of  soft  cotton,    A  certain  amount 
of  inflammation  bordering  on  vesication  is  the  conse- 
quence, but  in  ten  days  the  part  resumes  its  normal 
appearance.     Other    agents    may    be    tried,    however, 
as    liquid    ammonia,    crot.ni    nil,    tincture    of    iodine, 
essence  of  winter  green  in  ether  (1   in   3).     Twice  a 
week  the  whole  head  is  rubbed  with  ;  — 
Proof  spirit,  gx. 
Spirit  of  lavender,  3iv. 
Bichloride  of  mercury,  grs,  xii. 
Tincture  of  cantharides.  3iv, 
Hydrate  of  chloral,  5i. 
Psoriasis. 

Professor  Renault,  of  Paris,  in  his  local  treatment 
of  psoriasis  employs  but  one  or  other  of  the  three 
following  agents  after  the  squama?  have  been  removed 
by  baths  ; — Oil  of  cade,  pyrogallic  acid,  and  chry- 
sophanic  acid.  The  first  preparation  he  mixes  with 
glycerine  and  starch  thus  : — Cade  oil,  $i  ;  glycerine, 
5iii  ;  starch.  3ii ;  to  be  rubbed  night  and  morning. 
If  this  preparation  has  the  advantage  of  being  sure 
in  its  action  and  non-toxic,  it  has  the  inconvenience 
of  provoking  a  certain  amount  of  irritation  and  of 
smelling  disagreeably.  Pyrogallic  acid  is  odourless, 
but  produces  black  stains,  and  cannot  be  used  except 
in  circumscribed  patches.  The  same  might  be  said 
of  chrysophanic  acid,  which,  although  very  efficacious. 
presents  certain  disadvantages  ;  it  gives  a  violet  colour 
to  the  teguments  and  yellow  to  the  hair,  and  produces 
local  erythema  and  sometimes  bilateral  conjunc- 
tivitis. Bearing  ail  these  points  in  view,  preference 
should  be  given  to  oil  of  cade. 

The  internal  treatment  should  be  essentially  ar- 
senical. In  some  countries  great  confidence  is  given 
to  large  doses  of  iodide  of  potassium,  but  M.  Renault 
does  not  see  what  use  it  can  be  in  psoriasis. 


The  site  of  twelve  acres  in  South  London,  presented 
by  the  Hon,  W.  F.  D.  Smith,  for  the  new  buildings  of 
King's  College  Hospital,  has  been  supplemented  by  a 
gift  of  £1.000  from  the  firm  ot  Messrs,  W.  H.  Smith  and 
Son,  and  the  promise  of  a  similar  amount  next  year. 


12     Ths  Medical  Press. 


AUSTRIA. 


Jak.  6.  1904. 


Germany 

[from  our  own  correspondent.] 


Bwlmx,  January  2nd,  1904. 
At  the  Medical  Society  Hr.  Lassar  spoke  on 
Inoculation   Experiments     on  Anthropoid  Apes 

with  Syphilitic  Virus. 
He  said  that  twenty  years  ago  he  had  inoculated 
animals  with  syphilis,  but  his  experiments,  like  those 
of  others,  had  had  negative  results.  Roux  and 
Metschnikoff  had  more  recently  experimented  with 
highly  developed  apes,  and  he  himself  had  inoculated 
a  chimpanzee  four  or  five  years  of  age,  which  had 
been  healthy  and  lively  in  confinement.  The  patient 
from  whom  the  virus  had  neen  taken  had  been  inoculated 
whilst  being  tattooed  on  the  arms,  and  at  thf  time 
the  material  was  taken  had  swelling  of  the  glands 
and  an  amphora.  The  inoculation  was  done  on 
October  22nd,  and  on  several  places  in  the  skin.  No 
local  reaction  took  place.  After  a  fortnight,  however, 
infiltrations  appeared  over  both  eyebrows;  these  speedily 
broke  down,  and  the  part  took  on  the  appearance  of 
a  chancre.  These  sores  showed  scarcely  any  tendency 
to  heal,  and  were  even  now  almost  unchanged.  A 
little  higher  on  the  head,  about  the  middle  of  the  fore- 
head, appeared  what  must  be  called  a  papula.  Other 
phenomena  appeared  at  a  distance  from  the  inocula- 
tion spots.  Roundish  patches/  raised  at  the  edge 
and  depressed  in  the  centre,  appeared  on  the  palms 
of  the  hands  and  soles  of  the  feet  and  around  the 
anus.  At  the  same  time  the  hair  got  light  in  patches 
as  in  the  human  subject. 

The  symptoms  were  beginning  to  appear  less  marked 
than  at  first.  As  such  animals  did  not  breed  in  cap- 
tivity, the  carrying  out  of  such  experiments  was 
rendered  more  difficult.  A  second  ape  was  inoculated 
from  the  first  on  December  1st,  but  the  animal  was 
already  suffering  from  tubercle  of  the  intestines.  At 
the  site  of  the  inoculation  a  weakened  form  of  in- 
fection could  at  most  be  determined. 

At  the  Society  of  Charite  Physicians  Hr.  Kraus,  in 
showing  a  case  of 

Carcinoma  of  the  (Esophagus, 
described  the  recent  methods  of  diagnosis  in  disease 
of  the  oesophagus  and  diverticula,  and  explained  the 
various  methods  of  Rdntgen  illumination,  both  in  the 
direct  and  oblique  directions,  illumination  by  means  of 
sounds  and  the  bolus  process,  and  showed  illustrative 
plates.  One  photograph  was  of  special  interest,  that 
of  a  case  of  diaphragmatic  hernia  where  the  shadow 
of  a  sound  filled  with  mercury  was  seen  curving  bolow 
the  diaphragm,  and  was  observed  to  twist  round  several 
times  in  the  stomach. 

Hr.  Rectezeh  showed  a  case  of 

Glandular  Tuberculosis 
with  an  interesting  history.  The  tumours,  which 
were  the  size  of  the  adult  head  and  lay  over  the  ribs, 
were  of  diagnostic  interest.  Pseudo-leukaemia,  Kun- 
d  rat's  malignant  lymphoma,  and  the  tumour-like 
form  of  lymph  gland  tuberculosis  were  to  be*  con- 
sidered. /The  first-named  disease  could  be  excluded 
by  the  rapid  course  (development  of  the  tumours  in 
a  few  montns),  the  condition  of  the  blood  ^absence  of 
relative  lymphocytosis,  presence  ^ot  polynuclear  leuco- 
cytosis  at  the  time  of  relapsing  feverish  attacks),  the 
lymphoma  malignum  of  Kundrat,  by  the  absence  of 
excessive  malignancy  and  of  the  characteristic  histo- 
logical form.  Thus  there  remained  only  lymph  gland 
tuberculosis,  and  in  favour  of  this  were  hereditary 
taint,  tuberculin  reaction  (very  uncertain,  however), 
the  whole  "  habitus  "  of  the  patient,  the  richness  of 
the  pleural  exudation  in  lymphocytes,  and  the  histo- 


logical characteristics.  The  prognosis  as  regarded 
fife  was  unfavourable,  as  the  great  loss  of  fluid  was 
of  importance,  quite  independent  of  the  pressure,  which 
wonld  lead  to  permanent  injury  to  the  heart  and  lungs. 
Treatment  had  to  be  limited  to  good  nursing  and 
timely  removal  of  the  fluid. 

Hr.  Steyrrr  related  a  case  of 

Unilateral  Polyhydruria. 
The  case,  which  was  carefully  observed,  was  that  of  a 
woman  with  bilateral  pyelitis,  in  which  catheteri- 
sation  of  the  ureters  was  employed.  At  the  moment 
of  the  introduction  of  the  catheter  into  the  left  side 
there  was  an  increase  in  the  urine  issuing  from  the 
right  side  up  to  double  in  the  unit  of  time,  which 
was  the  opposite  of  what  occurred  when  the  catheter 
was  introduced  on  the  right  side  and  the  urine  from 
the  left  kidney  measured. 

The  molecular  concentration  of  the  urine  reckoned 
from  the  freezing  depression  was  lowered  by  more 
than  half,  as  compared  with  earlier  samples.  In  a 
short  time  the  original  condition,  both  as  to  flow  and 
degree  of  concentration,  was  restored.  The  interest 
of  the  case  lay  in  this — that  when  one  kidney  was 
irritated  (catheter)  the  other  kidney  responded  with 
polyhydruria,  something  which  had  not  yet  been 
explained. 


Austria. 


[from  our  own  correspondent.] 

Vinnu.  January  2nd,  1904. 
EXPERIMENTS  WITH    NEW  DRUGS. 
Aristochin. 

Strass  has  published  the  results  of  the  experiments 
conducted  with  new  drugs  at  the  Wieden  Hospital. 
According  to  his  report  aristochin  has  been  used  in 
15  cases  where  quinine  was  indicated  with  excellent 
results.  Aristochin  is  a  neutral  carbonic  ester  salt  of 
quinine,  almost  tasteless,  and  easily  borne  by  the 
stomach,  which  agrees  with  the  manufacturers'  des- 
cription. 

The  first  case  is  an  insurance  agent,  aet.  2S,  suffering 
from  neuralgia  nervi  superorbitalis  trigemini,  as 
severe  matutinal  paroxysms.  The  dose  ranges  from 
0*25  to  0*5  gramme,  or  5*1  to  77  grs.  In  this 
case  one  gramme  doses  were  given  with  speedy  relief; 
no  recurrence  after  five  days'  treatment. 

It  was  used  with  excellent  effect  in  dyspeptic 
phthisical  cases  where  quinine  could  not  be  borne. 
It  was  equally  serviceable  in  gastric  disturbance,  when 
chlorosis,  anaemia,  and  cephalalgia  were  present.  It 
is  free  from  that  annoying  symptom,  quinine  deafness  ; 
neither  has  vertigo  been  observed,  which  is  not  un- 
common to  quinine. 

Strass  thinks,  however,  that  aristochin  has  no  special 
advantage  over  the  sulphate  of  quinine  beyond  the 
taste  and  ringing  in  the  ears.  He  quite  believes 
Swoboda  may  have  obtained  excellent  results  with 
its  use  in  children  for  whooping-cough,  &c,  &c. 
Aspirin. 

Aspirin  was  used  in  40  cases.  This  is  a  salicylic 
salt  with  hydrogen  atoms  from  the  acetal  group.  It 
was  used  in  articular  rheumatism  as  well  as  muscular 
in  the  acute  forms  with  beneficial  results.  Ischia 
and  lumbago  rheumatica  were  equally  relieved,  while 
plenritis  and  pericarditis  with  a  similar  origin  were 
greatly  benefited.  The  dose  ranges  from  0*5  gramme 
to  i*o  gramme  five  or  six  times  a  day.  He  can  discover 
no  special  advantage  that  aspirin  has  over  the  sali- 
cylate of  soda,  except  the  absence  of  the  uncomfortable 
physiological  effect,  although  this  must  be  affirmed 
with  caution,  as  he  met  with  oedema  of  the  face  in  a 


Jix.  6,  1904, 


THE  OPERATING  THEATRES.       Tm  mmCAL  FMtss.    I3 


Iconic,  a^t,  10,  who  had  been  treated  with  5;  patnmcs 
of  aspirin  far  acute  articular  rheumatism.  A  similar 
«q&ela  is  reported  by  Hirschberg,  Others  recognise 
red  patches  on  the  head,  face*  #c>  but  not  on  the 
trunk,  raedrug  is  contra-indicated  in  phthisical  fever, 
m  it  favours  haemoptysis.  On  the  other  hand  aspirin 
has  been  success billy  used  in  gastro-enteritis  and 
icterus  catarrhal  us  of  doubtful  etiology, 
Hedoxal. 
Hedonal  was  used  on  40  patients  as  an  hypnotic 
wtoch  belongs  to  the  series  of  urethane.  The  greatest 
number  of  cases  were  pulmonary  and  cardiac  and  a 
few  su  tiered  from  neuritis  and  neurasthenia.  The 
^s  1  era  mm©  to  it  gramme.  The  best  effects 
ire  obtained  in  cases  ot  agrypnia  or  pcrvigilUuni, 
Trie  act  10 a  of  hedonal  in  cardiac  diseases  is  intensified 
&?Uie combination  of  strophanthine  codeia  in  phthisical, 
ajifl  bromideo  in  the  neurasthenic  cases.  When  given  in 
chrome  alcoholism  or  multiple  nen ntis  with  anaemia, 
it  produced  excitation  and  determined  trie  blood  to 
the  head,  which  soon  caused  the  patient  to  refuse  the 
drug. 

Mesotan, 
Mesotan  is  a  clear,  yellow,  oily  fluid,  soluble  in 
akahol  and  ether,  and  readily  aosorbed  by  the  skin, 
It  can  be  detected  in  the  urine  a  few  hours  after  ad- 
I ration  by  the  presence  of  salicylic  add  and 
chlnride  of  iron  reaction.  It  is  applied  externally  mixed 
with  an  equal  quantity  of  olive  oil  with  a  brush  twice 
or  three  times  a  day.  It  is  indicated  in  all  cases 
demanding  salicylate  treatment.  It  is  efficacious  in 
rheumatic  ptauitfft,  £tc„  as  well  as  acute  articular 
ilisease.  Ischial  lumbago,  dfec,  Ac,  are  equally 
relieved  by  producing  an  artificial  hyperemia  on  the 
surface,  as  fomentations,  thermophores,  or  cupping 
£k"ses,  Mesotan  can  be  well  recommend  ed  for  this 
action,  requiring  no  drug  internally,  unless  a  tonic 
srrch  as  the  compound  tincture  of  quinine  He  has  not 
tooad  any  injury  to  the  kidneys,  although  it  operates 
very  favourably  on  the  heart.  Mesotan  is  useless  in 
cases  of  arthritica  urica  and  dciormans,  as  well  as 
gonorrhea  and  neuntis.  He  had  two  cases  followed 
by  erythema  and  other  purple  rashes.  Its  use  is 
principally  confined  to  the  rheumatic,  and  may  be 
Vfel  where  aspirin  fails.  A  few  drops  rubbed  on 
u> the  chest  of  a  phthisical  patient  at  night  will  produce 
*  flood  of  perspiration  in  a  very  short  time — hence  the 
injury.  The  drug  should  not  be  used  constantly 
I  eujht  or  ten  days, 

THEiZis 

rhcojin,    from    theophylin,   is   a  synthetic    body  of 

the  xanthin  series,  and    has   been  recommended  as  a 

diuretic     This    was    administered    to    35    patients   in 

cat  conditions.     Every  practitioner  knows  how 

s  to  obtain  the  desired  effect  when  a  diuretic 

1*  wm ted .     As  a  rule  every  drug  is  tried  in  succession 

with  the  hope  that  the  next  will  meet  with  more  success 

(aan  the  preceding  one;  but,  alas!   with  no    better 

result.    This     was     the    disappointment     that     befel 

1  in  the  first  experiments.     Further  examination 

Eton  of  Cases  prove;  1     that  it  was  efficacious 

as  a  diuretic  and  antihydropic,  when  no  disturbance  of 

the  cardiac   organ  was   present,   or  when    the   blood 

pressure  was  not  abnormal y  low.     When  the  cardiac 

ipparaius  was  deficient  or  the  arterial  pressure  low 

no  advantage  can  be  obtained  with  the  drug.     If  the 

ovulation   be   improved    and    the    tension   increased 

u  resis  wi  U  rapid  ly  rise  fro  m  5  00  en  b  ic  cen  1 1  metres 

jt  none   to  an   elimination  of    1,500  or   3,000  cubic 

■metres,     Hence    a   short    course    of    digitalis    or 


digitalis  during  the  administration  of  theozin  caused 
the  quantity  of  urine  to  fall  from  2,000  or  3,000  cubic 
centimetres  to  1,000  cubic  centimetres  in  one  day  ; 
hence  it  is  concluded  that  in  all  cases  of  eomgten 

the  blood  pressure  must  also  be  considered 
before  the  drug  is  successful.  In  vitium  cordis,  theoztn 
is  equally  useless.  (Partner's  tonometer  was  used  in 
every  experiment,  by  which  it  was  found  that  when  it 
measured  70  or  So  millimetres  of  mercury  theozia 
had  no  effect  on  the  renal  secretion.  If  four  or  five 
times  this  pressure  could  be  maintained,  the  quantity 
of  urine  was  correspondingly  increased.  With  this 
object  in  view,  Schliesinger  has  combined  the  dose  of 
11  (o"2  to  ro  gramme)  with  an  infusum  herbae 
adonis  vemalis  (5  in  150  strength),  and  obtained  the 
exciting  effect  of  the  drug.  Minkowski,  labouring 
under  the  same  difficulty,  combined  theoziu  with 
hedonal  and  obtained  the  exciting  effect  also.  Of  the 
two  the  infusum  herbar  adonidis  is  the  better.  Schlie- 
singer supports  his  application  by  quoting  Beehterew's 
experiments  with  adonis  vemalis,  that  it  is  an  anti- 
convulsive. There  are  many  cases  where  azurin  or 
the  acetate  of  potash  will  be  equally  beneficial  in 
practice. 


XCbe  ©perattng  Cbeatres. 

NORTH-WKST    LONDON    HOSPITAL. 
Appendicitis. — Mr,  Mayo  Collier   operated  on  a 
case  of  appendicitis  with  features  of  some  interest. 
The  patient  was  a  young  man,  seL  19.  who  during  t he- 
last  eighteen  mouths   had   had   five  attacks  of  pain 
in     the    lower    abdomen,    accompanied     by    sickness, 
indigestion  and  fever.     These  attacks  were  diagnosed 
by  Drr  Richardson,  of  Gosport,  as  appendicular  j  he 
requested  Mr.  Collier  to  admit  the  case  into  the  North- 
West   London    Hospital   and   operate.     On   admission 
to   hospital   the  condition  of   the  patient   was  quite 
satisfactory,  some  two  months  having  elated  since 
the  last  attack.     On  examination  of  the  abdomen,  in 
the  ri^ht  iliac  region,  Mr+  Collier  said  he  could  make 
out  a  distinct  thickening  of  the  appendix,  which  ap- 
parently   was    movable,    and    its    surroundings    were 
free  from  trouble,     He  decided  to  operate.     He  made 
an  incision  along  the  outer  border  of   the  rectus  in 
the   usual    position.     On   opening    the   abdomen    the 
appendix  was   easily   found*   freely  movable,   without 
adhesions,   and   with   apparently  a   perfectly   healthy 
peritoneal    covering,     There    were    several    distinctly 
enlarged  glands  in  the  mesentery  of  the  appendix:,  but 
these    were    freely    movable,    ant  I    of    normal    colour. 
The  appendix  itself  was  extremely  interesting,   in  so 
far   as  it   was  absolutely  stiff  and  rigid,   resembling 
almost,  as  Mr,  Collier  pointed  out,  a  miniature  penis. 
It  was  thickened  and  hard  close  to  the  attachment  ol 
the  caput  caecum  coli.     Alter  dividing  the  inesenhrv 
of    the    appendix  and    removing  the    affected  glands 
Mr     Collier    made    a    transverse   incision    through    the 
peritoneum  covering  the  appendix    about  half  an  inch 
Hun    the    caput    caecum    coli;    having    divided      the 
peritoneum    and    muscular    coat,     he     ligature  1     the 
appendix    and     removed    it.     After    disinfecting    the 
lumen  of  the  stump  with  pure  carbolic  acid,  he  replaced 
the  cuff  of  peritoneum,  and  sewed  it  with  continuous 
sui  urns     over     the     stump.     The    mesentery     of     the 
appendix    was    next    brought    together    with    a    fine 
continuous   suture  ot  silk,   and   the   abdomen   closed. 
Mr.  Collier  said  he  preferred  to  close  the  abdomen  by 
first   uniting  the   peritoneum  by  interrupted   sutures. 
The  sheath  ot  the  rectus  and  sheath  ot  the  abdominal 
muscles  were   next   united,  and    lastly    silkworm -gut 
is  before  commencing  theoZin  will  accom-     sutures  were  passed    through,  including    skin,  fibrous, 
U)C  desire  J  effect.      Again,  the  abstraction  of  the  !  and    muscular    tissue.     Mr.    Collier    said    the    hue    of 


14    Ths  Medical  Press. 


LEADING   ARTICLES. 


Jan.  6,  1904* 


incision  adopted  was  more  satisfacory  than  one  more  Rrohtered  for  Transmission  Abroad. 

external,  because  it  allowed  free  exploration  and  mani-  flftg  AeMcal  DreSS   ait&   GfrCUlar, 

Infw  r°Mthf   tPP/ndlX  ^  iU   *U™Qndin*S'   ami    Published  every  Wds^nta^  Price  6d.      Post  free,  5jd, 
was  less  liable  to  be  followed  by  ventral  hernia.  ,  AUVKifcTMRMfflrw 

This  case  made  an  uninterrupted  recovery  without  ADVBETwBMBHT*. 


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TEbe  /BeMcal  press  and  Circular. 


a  single  bad  symptom. 

Wiring  Fractured  Patella. — Mt.Collibr  operated 
immediately  after  on  a  case  of  fractured  patella  of 
four  days*  standing.  He  said  that  lately  he  had 
operated  on  quite  a  number  of  these  cases  with  most 
satisfactory  results,  and  he  looked  upon  the  operation 
as  one  of  perfect  safety,  unless  under  most  exceptional 
circumstances.  The  present  patient,  a  young  man, 
aet.  24,  had  tripped  up  in  the  street  on  a  piece  of  orange 
peel,  and  on  admission  to  hospital  separation  of  the 
fragments  was  so  slight  that  at  first  the  iact  of  the 
fracture  could  not  easily  be  ascertained.  The  joint 
was  considerably  distended,  probably  with  blood. 
Mr.  Collier  made  a  longitudinal  incision  over  the 
patella  down  to  the  tubercle  of  the  tibia,  and  having 
drilled  the  broken  fragments,  brought  them  into 
position  with  a  stout  silver  wire.  The  joint  was  opened 
by  a  longitudinal  incision  external  to  the  patella, 
the  blood  evacuated,  and  the  joint  carefully  cleaned 
with  hot  saline  solution.     Every  possible  precaution 

was  taken  before,  during  and  after  the  operation  to  ^==^?^^^^^= 

avoid  sepsis.     The  parts  were  adjusted,  and  the  patient 
removed  to  bed.  after  a  splint  had  been  applied.  t        THE  THEATRE   FIRE  AT   CHICAGO. 

The  subsequent  history  of  this  case  *ras  unfortun-  (  Ox  December  30th,  a  tragedy  of  appalling 
ately  most  disastrous.  Forty-eight  hours  after  the  character  was  enacted  at  the  Iroquois  Theatre  in 
operation  the  edges  of  the  wound  and  the  stitches  were  j  Chicago>     During  a  performance  of  "  Bluebeard," 

ZfZ      /•  an.   angry;,  tbf,  temPerature  ™e  to '°u2° ' ,  when  the  audience  was  composed  mainly  of  women 
and  the  patient  was  evidently  suffering.     The  stitches  1       ,       .. ,  ^      t     1  *.  *xl       ±  j 

were  removed  and  bloody  pus  issued  from  the  wound.  '  a»d  Cnulldren>  a  *?  brokf '  0Ut    °n    he  Staf '  ™d 
The  joint  was  apparently  free  from  infection.     Twenty-   the  asbestos  curtain  could  not  be  lowered.     The 


SALUS  POPULI  SUPREMA  LEX 


WEDNESDAY,  JANUARY  6,  1904. 


four  hours  later,  however,  it  was  evident  that  the  joint 
was  affected,  necessitating  free  opening  up  and  drainage 
Things  mended  for  a  short  time,  but  it  was  plain  that 
fresh  trouble  was  in  store.  The  whole  thigh  became 
swollen  and  painful,  as  the  planes  of  fascia  between  the 
muscles  had  become  infected,  necessitating  a  further 


house  was  in  darkness  and  a  blind  panic  ensued,  in 
the  course  of  which  many  hundreds  of  persons  met 
with  their  deaths.  The  exact  number  is  even  yet 
not  definitely  known,  but  there  is  reason  to  believe 
that  the  death  roll  will  reach  a  total  of  six  or  seven 
hundred.  By  an  irony  of  fate  the  building  is  of  the 


extensive  operation     Mr.  Collier  said  that  the  only ,  most  modern  foeprooi  construction,  and  we  are 
hTSS Tn"?         fect'°nfw?1?  the  previous  operation   forced  conciusion  that  the  terrible  fatalitv 

ne  naa  done  for  removal  of  the  appendix,  yet  at  this  ■  _  ,,..,,.  ,     " 

operation  the  peritoneum  was  apparently  perfectly  j  was  due  not  to  the  ***  ^self ,  but  to  its  secondary 
healthy,  and  no  pus  by  any  possibility  could  have  effects  of  panic  and  suffocation.  At  present  the 
gained  admission  to  the  instruments  or  hands  of  the 
operator,  as  none  was  present.  The  pathological  con- 
dition of  the  appendix  was  a  small  heaUng  ulcer  with 
much  thickening  and  engorgement  of  the  lymphoid 
tissue  of  the  process.  He  had  been  careful  to  avoid 
handling  the  removed  appendix  or  stump.  His 
assistant  at  the  operation  for  appendicitis  was  not  the 


cause  of  the  catastrophe  is  undergoing  rigorous 
investigation.  The  city  coroner  is  holding  an 
inquiry.  A  clear  indication  of  the  nature  of  some 
of  the  issues  that  will  be  raised  may  be  gathered 
from  the  published  list  of  points  to  which  the 
attention  of  the  jury  will  be  specially  directed. 
They  are  briefly:  (1)  Were  the  steel  doors  locked 


same  as  the  one  for  the  next  operation,  yet  by  some       ,        A,  **        1  ,  w  N  „,       ..  , 

™«a„«  ;«*<>,»♦  ~„  j  *~      *l  *i  when  the  outbreak  pecurred  ?  (2)  Were  those  doors 

means  infection  was  conveyed  from  the  apparently  ,  ,     _       ,  ,  .*   ,  v  •«« 

innocent  peritoneal  cavity  to  the  cut  surface  of  the  opened  promptly  by  the  attendants  ?  (3)  Why  was 

knee-joint.     He  thought  that  everyone  must  regret  the  lt  impossible  to  lower  the  asbestos  curtain  ?  (4) 


unfortunate  result  of  this  seemingly  simple  operation, 
and  he  considered  that  it  would  be  as  well  for  surgeons 


Why  was  no  provision  made  to  prevent  the  lights 
in  the  flies  from  igniting  the  curtains  ?  (5)  Why  were 


a    second  patient   immediately    after   operating 
appendicitis. 


to  be  warned  by  the  result  of  this  case  not  to  operate  on  ;  the    doors    shut  and  the  people  urged   to  remain 

*or!  seated  ?  There  appear  to  have  been  ample  exit 
doors  which  were  not  available  to  the  panic-stricken 
audience,  for  what  reason  remains  to  be  disclosed. 
It  is  clearly  of  no  use  to  insist  upon  safeguards 
against  fire  if  they  are  not  systematically  super- 
vised and  tested.  An  asbestos  curtain  that  cannot 
be  lowered  is  worse  than  no  fireproof  curtain  at  all, 
since  it  furnishes  a  feeling  of  false  security.  It  has 
been  stated  that  the  obstacle  to  the  descent  of  the 
curtain  was  the  wire  on  which  the  "  Queen  of  the 
Aerial  Ballet  "   flew  out  over  the  heads  of  the 


Princess  Henry  of  Battenberg  has  headed  a 
subscription  list  which  has  been  started  w»th  the  object 
of  raising  the  £18,000  necessary  for  extensive  recon- 
struction works  and  additions  to  the  Royal  Isle  of 
Wight  Infirmary  and  the  County  Hospital. 


The  North-Eastern  Hospital  for  Children,  Hackney 
Road,  has  received  a  donation  of  £100  from  Lord 
Amherst  of  Hackney  in  reduction  of  j  the  deficit  of 
£1,100  carried  forward  from  1903. 


LEADING    ARTICLES, 


Fiom    various    statements    it    appears 
escapes  were  defective,  control  of   extra 
tire  exits  non-existent    owing    to    the   absence  or 
fusion  of  a  special  attendant,  and  other  avoid- 
able sources  of  clanger  present.     The  Lesson  to  the 
American  people  is  indeed  a  terrible  one,  Slid  it  i-^ 
to  be  hoped,  as  it  is  to  be  believed,  that  this  fearful 
holocaust   will   bring   increased   safely    to   future 
us  of  American  sightseers.    The  calamity, 
moreover,  conveys  its  lessons  to  th<  whole  civilised 
world      Among  great  disasters  of  the  kind  may  be 
mentioned  one  at  St.  Petersburg   in  it  836,  with   a 
't  Hoo  lives  ;   in  1845  at  Canton,  China,  1^70 
in    1846,    Quebec,    200    lives;     in     tK;_\ 
Tientsin,    Hoo  live-  Brooklyn,  400  lives  ; 

in  1 8$ 3 ,,  Moscow ,  3 00  li ves  ;  in  1883,  Berv i t zc h c  w , 
ives  ;   m  iSu?,  Quant  on,  230  lives,  with  many 
^mailer  losses.     The  United  Kingdom  has  hitherto 
I  a i thou l  any  greater  disaster  than  that  of 
r  in  1887,  when  127  lives  were  lost  ;   others 
<went  Garden  in  180^,25  lives  ;    iheCobourg 
16  lives;    the  Hebrew  Club  in   i « X 7 h   17 
livr*  ;   and  Gateshead  in   1KK1,  24  lives.     For  all 
this   comparative    i  mm  unity    we  should    hesitate 
uorse  the  complacent  attitude  of  the  Press 
in  various  pans  of  the  country.     We  have  little 
non  in  stating  our  opinion  that  many  of  the 
<  s  in  the  United  Kingdom  would,  in  the  event 
■1  fire,  become  veritable  death-traps.    Even  in  the 
Metropolis,  where  the  fire  supervision  of  the  Lorn  ion 
Count v  Council  of    theatres  and    music-halls    ha^ 
vigorous,  much  remains    10   be  done.     There 
res  in  London  at  the  present  moment  that 
ructuralJy  defective  as  to  constitute  a 
menace  to  the  safety  ot  the  public.     Only 
recently  has  the  whole  burden  of  responsibility  in 
matter  been  shifted  on  to  the  shoulders  of  the 
Com    iL     The  result  of  that  change  was 
ral  well-known  theatres,  because 
v ere  unable  to  face  the  outlay  deemed  neces- 
be  County  Council  to  render  them  reason- 
ably sale.     The  inevitable  conclusion  is  that  until 
in  a  year  or  two  these  theatres  were  a  danger  to 
the  public.     There  can  be  no  doubt  that  the  terrible 
catastrophe  at  Chicago  will  greatly  strengthen  the 
lunds  of  the  County  Council  and  of  kindred  licens- 
ing bodies  all  over  the  Dnited  Kingdom  in  their 
structural  control  of  places  of  public  amusement. 
It  would  be  interesting  to  learn  in  how  many  of  our 
,     music-halls    at    the     present 
Stouten t    fireproof    curtains    are    prevented    tmm 
tiding  by  the  fixing  of  wires  for  the  flight  of 
ial  queens,"     Nothing  can  be  done  by  official 
fry -tows    to   regulate  panic,  but  at  the  same  time 
4  escape  must  be  kept  clear  of  obstacles 
very  means  of  prevention  provided  that  can 
ised  by  the  art  of  man 


The  Medical  Press.     15 


SANITARY  REFORMS. 

The  decision  of  the  Court  of  A Appeal,  delivered 

1       in  the  case  of  the  King    (Rural 

d  of  Ballycastle;  against   the  Irish 

J  Government  Board,  is,  we  fear,  calculated 

to  interfere  withsanitarv  reforms  through- 

Otmtry,     The  importance  of  the  issue  at 


slake  brought  the  case  into  the  Court  of  Appeal, 
and  now,  after  eighteen  months'  litigation,  iln. 
principle  for  which  the  Irish  Local  Government 
Board  fought  has  been  condemned  unanimoi^lv 
by  judges  whose  names  command  respect,  so  that 
the  decision  may  be  accepted  as  the  correct  inter- 
tion.on  the  question  before  them, of  the  Public 
Health  Act,  Our  readers  are  familiar  with 
the  fact  that  there  are  many  districts  throughout 
the  country  in  which  sanitary  relorms  are  required* 
and  that  one  of  the  first  steps  in  that  direction  is  an 
abundant  supply  of  good  water.  In  many,  if  not 
the  majority,  of  such  districts  the  valuation  of  the 
property  is  so  small  that  a  tax  sufficient  to  bear  the 
expense  of  the  introduction  of  a  water  supply 
cannot  be  imposed  which  the  inhabitants  could 
pay  without  undue  hardship.  Under  such  cir- 
cumstances the  Local  Government  Board  have 
been  hVthe  habit  of  extending  the  area  of  taxation 
until  a  valuation  was  reached  that  could  be  taxed 
without  levying  a  too  heavy  rate  on  the  people  I 
The  Board  claimed  that  they  had  the  right  to  put 
the  charge  anywhere  they  liked,  short  of  the  entire 
district,  ana  that  they  alone  had  the  right  to  deter- 
mine that  question,  It  was  considered  necessary 
by  the  sanitary  authorities  and  the  Local  Govern- 
ment Board  inspectors  that  the  village  of  Cashen- 
dall,  of  some  400  inhabitants,  should  be  provided,. 
with  waterworks,  but  the  Ballycastle  Rural 
Council  refused  to  take  the  necessary  steps  to  carry 
ouL  the  work.  As  a  result  the  Board,  considering 
the  work  necessary,  issued  a  sealed  order  in 
September,  1002,  to  the  effect  that  the  entire  rural 
district,  with  the  exception  of  Rathlin  Island  and 
the  town  of  Ballycastle,  be  taxed  as  a  contributing 
area.  The  council  contended  that  the  Board  had 
no  power  under  the  Local  Government  Act  to  put 
a  rate  to  cover  special  sanitary  expenses  on  a  larger 
district  than  would  be  included  in  the  contributory 
area  under  the  Public  Health  Act,  namely,  the 
place  in  which  and  for  whose  benefit  the  scheme 
was  adopted,  They  supported  this  contention  by 
proving  that  when  on  a  previous  occasion  the  Board 
had  made  similar  expenses  Union-at -large  cha: 
j hey  subsequently  got  an  Act  of  Parliament  validat- 
ing the  orders,  and  that  this  showed  that  the  Board 
were  themselves  conscious  that  they  had,  in 
making  general  orders  of  the  nature  now  com- 
plained Of,  exceeded  their  jurisdiction.  The  Lord 
Chancellor  gave  it  as  his  opinion  that  "  He  could 
not  see  that  Section  2  of  the  Public  Health  Act  of 
iqoq,  which  enacted  that  the  Local  Government 
Board  might,  with  the  consent  of  the  Rural  District 
Council,  determine  that  the  whole  district  should 
be  the  area  of  charge,  had  much  bearing  on  the 
question  there,  but  it  indicated  that  in  Ihe  opinion 
of  the  Legislature  the  Board  had  not  power  under 
the  Act  of  1878  to  make  the  whole  area  of  charge.1 
Lord  Justice  Fit  ^gibbon,  in  concurring,  said  it  was 
"  perfectly^clear  that  the  Local  Government  Board 
order  was  one  of  excessive  jurisdiction.5*  Thus 
rural  sanitary  progress  in  Ireland  is  practically 
arrested  until  fresh  legislative  powers  are  con- 
ferred on  the  Local  Government  Board,  for  Lt  is 
hopeless  to  appeal  to  rural  authorities  lo  enforce 


16     The  Medical  Press.  NOTES    ON    CURRENT    TOPICS. 


Jam.  6.  1904. 


sanitary  measures  the  value  of  which  they  have 
never  realised. 


THE  DRAFT  BILL  FOR  THE  REGISTRATION 

OF  NURSES. 
!  There  is  only  one  way  out  of  the  confusion  that 
prevails  in  the  nursing  profession,  where  good  and 
bad,  desirable  and  undesirable,  trained  and  un- 
trained persons  are  inextricably  mixed  up.  That 
way  is  by  State  registration.  The  nurses, 
actuated  by  pressure  from  within  and  from  with- 
out their  ranks,  have  gradually  established  a 
definite  system  of  qualification,  namely,  a  three 
years'  course  of  training  at  a  recognised  general 
hospital,  and  it  is  essential  that  women  who  have 
obtained  a  certificate  of  efficiency  after  this  period 
of  probation  should  be  readily  distinguished  from 
those  who  have  not.  It  is  due  to  them  in  virtue 
of  their  attainments,  it  is  due  to  medical  men 
who  employ  them,  and  it  is  due  still  more  to  the 
public  whom  they  seek  to  serve.  It  is  beyond 
dispute  that  many  incompetent  persons,  some 
attached  to  institutions  and  some  acting  on  their 
own  account,  found  their  principal  claim  to  the 
title  of  "  nurse  "  on  the  possession  of  a  cap  and 
apron,  and  though  there  is  doubtless  a  sphere  of 
usefulness  for  such  persons  in  attendance  on  old 
people  and  some  chronic  cases,  it  is  most  important 
that  in  acute  cases,  where  delicate  manipulations 
and  skilled  observations  have  to  be  made,  the 
medical  practitioner  should  be  able  to  rely  on 
obtaining  a  competent  assistant.  For  these 
reasons  the  State  registration  of  nurses  commands 
our  ready  sympathy.  Now,  in  order  to  attain  this 
object  the  Society  for  the  State  Registration  of 
Nurses  have  drafted  a  Bill  which  they  have  put 
forward  for  discussion,  and  we  think  we  shall  be 
rendering  them  service  by  offering  some  criticisms 
on  points  that  strike  us.  The  first  of  these  is  that 
the  Bill  has  not  been  drawn  up,  as  it  should  have 
been,  by  an  expert  Parliamentary  draughtsman. 
Men  who  devote  their  time  to  work  of  this  kind 
know  all  the  tricks  of  the  trade,  and  they  know 
how  to  guard  against  loopholes  being  left  by  which 
the  provisions  of  an  Act  may  be  rendered  nugatory. 
Now,  had  this  been  done,  we  feel  sure  that  some 
attempt  would  have  been  made  to  define  the  word 
4t  nurse."  We  have  all  of  us  had  to  accept  the 
word  as  we  found  it,  and  to  the  medical  and 
nursing  world  the  name  conveys  a  specific  meaning. 
To  the  public,  however,  this  is  not  so.  A  nurse  is 
a  person  who  lives  in  the  nursery  and  looks  after 
the  children  ;  the  person  who  looks  after  them 
when  they  are  ill  is  a  "  hospital-nurse."  We  do 
not  propose  that  this  term  should  be  adopted,  but 
we  suggest  that  either  the  word  "  nurse  "  should 
be  defined  and  its  scope  limited,  or  that  the  words 
"of  the  sick"  should  be  added  in  brackets. 
Another  difficulty  arises  from  the  Midwives  Act 
creating  a  sub-order  of  sick-attendants,  and  it  is 
necessary  that  nothing  in  the  Act  should  give  a 
nurse  a  colourable  commission  to  act  as  a  midwife. 
We  notice  that  an  attempt  is  made  to  introduce 
the  term  "  registered  nurse  "  later  in  the  Act,  and 
that   it   is   proposed   (by   implication)    that    the 


initials  R.N.  should  be  used  after  the  name. 
Can  it  have  struck  the  framers  of  the  Act  that 
these  initials  are  already  sacred  to  the  Senior 
Service  ?  We  think  not,  or  they  would  have 
known  that  every  Service  member  in  the  House 
would  oppose  it.  We  think  that  there  is  much  to 
be  said  for  two  distinctive  initials  being  used  to 
designate  the  nurses  on  the  Register,  but  R.N. 
will  not  do.  The  next  point  that  we  would  deal 
with  is  the  constitution  of  the. Council.  Let  them 
take  warning  from  the  condition  of  the  General 
Medical  Council  and  be  chary  as  to  how  far  they 
secure  representation  for  privileged  bodies.  Why 
should  not  the  seats  be  filled  by  representatives  of 
the  people  who  pay  for  its  support — the  nurses 
themselves  ?  We  see  no  earthly  reason  for 
securing  seats  to  three  past  or  present  hospital 
matrons  appointed  by  the  Matrons'  Council  of 
Great  Britain  and  Ireland.  This  Matrons*  Council 
is  a  new  body,  and  in  ten  years'  time  may  not 
exist,  or  may  be  merged  into  some  other  society. 
Let  the  right  to  seats  be  as  free  as  possible  to  those 
whom  the  nurses  think  will  best  voice  their  own 
views.  There  are  several  verbal  alterations  that 
it  would  take  too  long  to  deal  with,  but  we  must 
draw  attention  to  the  power  that  it  is  proposed  to 
give  the  Council  to  strike  a  nurse's  name  off  the 
Register  (why  "  Roll "  in  one  place  and  "  Register  " 
in  another  ?)  for  disobeying  the  regulations  of  the 
Council  or  other  misconduct.  The  italics  are  our 
own.  This  power  is  far  too  wide,  and  as  it  is 
possible  that  it  may  be  exercised  by  a  Committee 
of  three  persons  it  would  open  the  door  to  much 
that  might  be  most  undesirable  in  the  way  of 
personal  bias.  The  misconduct  should  be  specified. 
We  wish  the  Bill  well  in  its  aims  and  general 
scope,  but  there  must  be  considerable  pruning 
and  trimming  before  it  would  be  safe  or  wise  to 
allow  it  to  appear  on  the  Statute  Book. 


Doted  on  Current  Copies* 

Patent  Medicine. 
A  lecture  of  considerable  interest  and  import- 
ance to  the  medical  profession  was  recently  delivered 
by  Dr.  Robert  Hutchison,  at  the  London  Hbspital, 
on  the  prevalence  of,  and  the  abuses  ari  iing  from, 
the  use  of  so-called  patent  medicines  by  the  public. 
This  is  a  subject  to  which  The  Medical  Press  and 
Circular  has  frequently  directed  attention.  It 
is,  to  say  the  least  of  it,  a  scandal  that  the  patent 
laws  should  be  so  twisted  away  from  their  original 
purpose  that  any  fraudulent-minded  individual 
is  enabled  to  pose  before  the  public  as  an  inventor 
and  to  raise  some  combination  of  drugs — parhaps 
harmless,  or  perhaps  the  reverse — to  a  level  with 
the  invention  of  practical  and  of  scientific  minds 
in  the  eyes  of  the  general  public.  The  essential 
of  a  patent  of  any  kind — we  use  the  word  in  its 
correct  sense — are,  first,  that  it  shall  be  original, 
and  secondly,  that  such  a  description  of  it  s.iall  be 
placed  on  record  that  a  person  of  sufficient  intelli- 
gence can,  as  soon  as  the  law  permits  him  to  do  so, 
reconstruct  from  the  description  filed  the  particu- 
lar   article    patented.     For    some    extraordinary 


}UI.    6,     Ti*H. 


NOTES    ON    CURRENT    TOPICS. 


The   Medical  Press.     17 


reason,  il  is  quite  apparent  that  neither  of  these 
renditions  need  be  fulfilled  by  the  patentee  of  a 
so-called   patent   medicine.     There  is   nothing   to 

:>.  him  to  show  that  his  nostrum  is  original, 
and,  far  worse,  there  are  no  attempts  made  to  compel 
Wim  to  file  a  fill!  specification  of  its  contents. 
That  these  obligations  might  at  times  be  allowed 
to  go  by  default  in  the  interests  of  humanity  is 
possibly  very  proper — if  a  case  of  such  a  kind  could 

—but  that  such  exemptions  should  be  per- 
mitted in  order  to  facilitate  imposture,  when  they 
ait  denied  to  the  bond  fide  inventor,  does  not  seem 
lobe  cither  good  or  fair  policy  Its  results  are 
obvious  to  every  practising  physician  and  to  every 
pharmaceutical  chemist,  A  shoal  of  harpies  pick 
out  each  one  his  particular  nostrum,  give  it  its 
fascinating  title,  pay  the  necessary  fees,  and 
launch  it  on  the  sea  of  commerce  with  the  pos- 
n  of  a  Government  stamp,  and  the  implied 
nunendaticra  to  many  simple  folk  that  it  is 
thereby  vouched  for  and  g  uaran  teed  by  Governing  11  t . 
As  Dr.  Hutchison   says,  persistent  and  audacious 

I  tising  precedes  and  follows  the  advent  of  the 
compound  with  the  object  of  creating  in  the  minds 

..■  public  an  exaggerated  dread  of  disease  and  an 

ral  idea  of  the  value  of  the  vaunted  remedy. 
Even'  right-minded  man  condemns  journals  and 
newspapers  who  publish ,  for  the  sake  of  gain, 
immoral  and  filth v  advertisements  ;  when  will  they 
abo  see  I  hat  for  Government  to  directly  aid  the  sale 

i latent  medicines  M  for  revenue  purposes — as 

present  done — is  a  very  similar  procedure  ? 


College  of  Physicians  for  examination-  A  little 
earlier  than  this  we  find  a  certain  Arthur  Dee 
punished  for  advertising  medicines  to  cure  ail 
diseases,  and  one  Foster  for  selling  a  powder  to 
cure  chlorosis,  while  a  person  named  Hunt  was 
put  in  the  pillory  for  putting  bills  in  the  streets  for 
the  cure  of  diseases,  The  proprietors  of  various 
"  pink  pills  "  and  "  safe  cures  '*  have  reason  to 
congratulate  themselves  that  they  did  not  live 
two  or  three  hundred  years  ago,  though  the  public 
of  to-day  have  not  the  same  reason  to  be  grateful. 


Action  for  Malpraxie. 
Ir  is  not  generally  known  that  the  right  of  a 
patient  or   his   representatives    to   an    action    for 
mal  praxis  against  an  unskilful  physician  has  been 
recognised  as  far  back  as  the  days  of  Ancient  Greece 
and  Rome.     Yet  we  find  one  of  the  first  recorded 
cases  occurring  at  Ephcsus,  when  a  certain  physi- 
iiamed  Glaucus  was  condemned  to  death  by 
the  cross  because,  having  left  a  patient  in  order  to 
go  to  the  theatre ,  the  patient  imprudently  partook 
"id  during  his  absence,  and  died.     In  Rome 
there  were  stringent  taws  punishing  carelessness  or 
ignorance  on  the  part  of  the  physician,  but  they 
seem  not  to  have  been  rigorously  enforced,  for  we 
find  Pliny  complaining  that  to  a  doctor  alone  is  it 
permitted    to    slay    with    impunity.     According 
to  ancient  Germanic  law,  a  physician  before  at  tend- 
ing a  patient  had  to  guarantee  an  indemnity  in  case 
be  was  not  successful.     If  he  wounded  a  free  man 
ift  hurt  while  bleeding  him  he  had  to  pay  the 
sum  of  one  hundred  and  fifty  golden  ducats,  while, 
it  the  patient  should  die,  the  physician  became  the 
>>f  the  family,  who  could  deal  with  him 
as  they  t  ho  u  gfa  t  fi  t .    In  Frc nc h  law  f  ro  m  t  h e  M id  d I e 
am  finds  various  references  to  the  ha- 
il men,  and  there  are  many  records 
r  mal  praxis  whir  h  sh  nv  that  in  the  main 
the  d  h^ld  w^re  the  sim?  as  th3g™  now  in 

In  England  under  the  Stuarts  severe 
measures  were  often  used  against  quacks  and 
nostrum-dealers,  and  in  the  reign  of  James  X.  the 
magistrates  of  the  City  of  London  were  ordered  to 
hale  all.  empirics  before  the  Censors  of  the  Royal 


Bacteria  and  Cold, 
It  has  long  been  held  that  exposure  to  pro- 
longed cold  is  fatal  to  most  pathogenic  bacteria, 
and  in  particular  to  the  typhoid  bacillus.  While 
it  was  known  that  a  short  exposure  even  to  intense 
cold,  such  as  that  of  liquid  air,  was  insufficient  to 
do  more  than  inhibit  their  growth,  yet  many 
observations  had  gone  to  show  that  when  bacteria 
were  exposed  for  days  or  w,seks  to  a  temperature 
below  freezing  point,  they  died.  In  an  exhaustive 
examination  of  the  ice  supply  of  Boston  made 
some  years  ago  by  Drs.  Sedgwick  and  Winslow 
this  view  was  borne  out,  and  these  investigators 
came  to  the  conclusion  that  ice  more  than  three 
weeks  old  was  sanitarily  as  safe  as  well  tillered 
water.  Some  recent  epidemics  have,  however, 
shown  facts  startlingly  at  variance  with  the 
accepted  views,  and  of  great  importance  to  public 
health,  particularly  in  America,  where  the  con- 
sumption of  ice  is  much  greater  than  here.  In  the 
case  of  the  St.  Lawrence  epidemic  which  occurred 
twelve  months  ago,  the  outbreak  started  with  the 
consumption  of  ice  from  a  certain  ice-house  where 
it  had  been  stored  for  eight  months.  Tne  water 
supply  and  food  were  above  suspicion,  and  the 
ice  was  made  the  chief  object  of  investigation. 
Very  simple  culture  experiments  were  sufficient 
to  establish  the  presence  of  both  typhoid  and  colon 
bacilli,  showing  unquestionably  the  presence  of 
sewage  contamination.  Further  inquiry  elicited 
the  fact  that  at  the  time  the  ice  was  forming  the 
previous  winter  there  had  been  a  few  cases  of 
typhoid  in  its  vicinity.  There  seems  no  reason  to 
doubt,  then,  that  whether  it  be  unsuual  or  not 
typhoid  bacillus  has  the  power  of  resisting  low 
1  rature  for  many  months* 


The  Religion  of  Poor-law  Norses. 
1'nvERTY  knows  no  religion,  as  it  spares  no  rank. 
Among  the  host  of  human  wreckage  to  bt?  found 
within  the  shelter  of  the  Poor-law  of  the  United 
Kingdom  are  representatives  of  every  kind  of 
religious  belief  and  unbelief.  Tnis  diversity  of 
forms  of  worship  is  so  characteristic  of  the  national 
1  character  that  it  has  become  recognised  on  the 
Continent  in  the  proverb  that  "Tae  British  are  a 
nation  of  many  religions  and  one  sauce/'  The 
inevi tabic  in  this  respsct  has  been  hitherto  wisely 
accepted  by  the  Local  Government  Board  in  their 
Poor-law  administration.  Officials  have  been 
selected  regardless  of  their  religious  beliefs,  and 
opportunities  provided  for  bringing  services  of 
various  kinds  as  far  as  possible  within  the  reach  of 
the  Poor-law  population ,  whether  administrative 


18      The  Medical  Press. 


NOTES    ON    CURRENT    TOPICS. 


Jan.  6,  1904. 


or    pauper.     In    the    course    of    time,    however, 
boards  of  guardians  are  apt  to  forget  the  traditions 
and  principles  that  have  guided  their  predecessors. 
That  appears  to  have  been  the  case  at  Eccleshall, 
where  the  question  of  religious  tests  has  been  raised  1 
in  an  acute  form  as  regards  the  Poor-law  nurses. 
It    appears    that    the    superintendent    of   nurses  1 
declined  to  obey  the  order  of  the  guardians  to  attend 
divine  service  on  Sunday  morning.     Her  refusal 
was  simply  a  matter  of  conscience,  as  she  had  on 
several  occasions  attended  the  service  voluntarily. 
The  guardians  after  some  heated  discussion  referred  1 
the  matter  to  the  Local  Government  Board.      It 
would  be  inconceivable  that  any  answer  could  be  i 
returned  from  the  central  authority  other  than  ' 
that  any  Poor-law  official  is  entitled  to  decline 
attendance  at  a  religious  service  not  in  accordance 
with  his  own  views. 


in  Prohibition  districts,  in  quantities  from  a. 
J  drachm  to  an  ounce  or  more,  its  toxicity  is,  as 
I  the  above  description  shows,  very  considerable  and 

dangerous. 


Poisoning  by  Methyl  Alcohol.  , 

We   have   noticed   in   many   medical   journals  , 
recently,  particularly  in  our  American  exchanges,  j 
a  number  of  cases  of  poisoning  reported  as  due  to 
Jamaica  ginger.     In  fact,  this  apparently  harm-  | 
less  article  of  diet  has  come  to  be  regarded  with  so 
much  suspicion  that  we  understand  there  are  at 
present  several  law-suits  pending  in  which  damages 
are  claimed  against  ginger  manufacturers  for  alleged 
poisoning.     In  every  case  reported  the  symptoms 
followed  on  the  drinking  of  a  spirituous  essence  of 
the  ginger,  but  were  of  varying  severity.     In  mild 
cases  there  were  no  further  symptoms  than  a  certain 
amount  of  gastro-enteritis,  while  in  more  severe 
cases  there  was  partial  loss  of  sight  and  even  com- 
plete and  permanent  blindness,  and  in  very  severe 
cases  blindness  was  soon  followed  by  coma  and 
death.     About  the  same  time,  however,  as  these 
cases  of  alleged   ginger-poisoning  were  occurring, 
there  were  a  number  of  other  cases  of  poisoning 
reported    with    exactly    similar    symptoms.     For 
them  different    substances  were  blamed,  lemon 
extract,  essence  of  peppermint,  Columbian  spirits, 
bay  rum,  and  finally  methyl  alcohol.     Dr.  R.  H   ' 
Main,  of  Berry,  Illinois,  who  reports  a  case  of  his  | 
own  and  collates  the  references,  (a)  has  not  much 
trouble  in  showing  that  in  all  probability  the  com-  j 
mon  feature  in  all  the  cases  was  the  presence  of  I 
methyl   alcohol,   which   is   often   substituted    for  | 
methyl  alcohol  in  the  preparation  of  culinary  and  j 
medicinal  essences.     The  only  reason  that  it  has 
not  long  ago  been  tabooed  is  apparently  the  fact 
that  its  effects  are  very  varying  in  different  indi-  • 
viduals.     "  Suppose,"  quotes  Dr.  Main  from  Dr.  ' 
Casey  Wood,  "  six  men  consume  equal  quantities  \ 
of   any   liquor   containing,  say,   eight   ounces   of 
methyl  alcohol,  one  of   them  will  probably  die 
within  forty-eight  hours  of  marked  intestinal  and 
-cerebral  symptoms  ;    one  other  will  be  very  ill, 
but  recovering,  will  become  totally  blind  in  a  few 
weeks,  while  the  other  four  will  suffer  as  from  a 
drunken  orgie  with  ordinary  alcohol."     Taken  in 
the    small    quantities    used    in    cooking,    methyl 
alcohol  is  probably  innocuous,  but   taken   as  it 
frequently  is  in  the  so-called  "  dry  towns  " — i.e., 


The  Dangers  of  Coke  Fires. 
In  these  days  of  progress  it  is,  indeed,  quite  the 
exception  to  find  a  main  road  within  the  Metro- 
politan area  which  is  not  in  the  hands  of  some  con- 
tractor or  other.     Here  it  is  the  electrification  of 
j  a  tram  route,  and  there  it  is  the  repair  or  adjust- 
,  ment  of  one  of  the  many  systems  of  pipes  with 
which  the  great  city  is  literally  honeycombed  only 
j  a  few  feet  below  the  surface.    The  lot  of  the  many 
workers    engaged    upon    these    tasks    varies,    of 
necessity,   with    the   exigencies   of    the   weather. 
Cold  and  other  hardships  are  comparatively  easy 
to  endure  as  long  as  the  body  is  engaged  in  active 
work.     It  is  otherwise,  however,  with  those  whose 
duties  are  to  guard  the  works  at  night.     They 
cannot  perambulate  the  field  of  labour  the   whole 
night  long,  and,  therefore,  some   provision   must 
be  made  for  their  shelter  and  warmth.      At  best„ 
this    usually    consists    of   a    three-sided    wooden 
erection    in    which,    sentinel-fashion,    the    lonely 
night-watchman  sits  before  a  coke  fire,  and,  as  long: 
as  the  fumes  are  not  blown  into  his  box,  he  is  fairly 
comfortable  ;  but  the  wind  does  not  always  blow 
from  the  same  quarter  all  through  the  night,  and 
then  the  whole  concern  has  to  be  moved  with  much 
labour.     At  other  times  the  shelter  is  made  up  of 
a  wall  of  bricks  covered  by  a  tarpaulin,  which  is 
often  devoid  of  any  means  of  ventilation,  so  that 
the  interior  quickly  becomes  fouled   by  fire-  or 
tobacco-smoke  and    the  emanations  from  sundry 
oil-lamps.     The  recent  death  of  one  of  these  men 
shows  that  a  distinct  danger  exists  in  the  present 
means  of  accommodation.     The  medical  evidence 
at  the  inquest  was  that  the  deceased  was  overcome 
by  the  fumes  from  the  stove,  and  falling  forwards 
in  an   unconscious  state,  had  been  burned.     It 
should   not    be   impossible    to   provide    movable 
"  sentinel -boxes  "  so  that  they  could  be  turned  in 
accordance  with  the  direction  of  the  wind,  for, 
not  unfrequently,  they  are  so  placed  as  to  render 
any  change  in  position  a  physical  impossibility. 


(«)  Amtrican  Medicine,  September  5th,  1003. 


The  Function  of  Maternal  Milk. 
To  the  student  of  comparative  anatomy  few 
things  are  more  interesting  than  the  manner  in 
which  the  needs  of  the  young  growing  organism 
are  provided  for.  We  are  so  accustomed  to  regard 
milk  as  the  natural  food  for  the  young  of  the  higher 
animals,  including  man,  that  its  true  function  and 
properties  in  this  respect  are  apt  to  be  forgotten. 
A  valuable  paper  upon  the  subject  has  recently 
been  read  by  Dr.  H.  Dwight  Chapin  at  the  Pedia- 
tric Section  of  the.  New  York  Academy  of  Medicine, 
in  which  the  idea  is  expressed  that  maternal  milk, 
in  addition  to  nourishing  the  offspring,  actually 
assists  in  the  development  of  the  infantile  stomach. 
In  reviewing  the  various  forms  of  the  alimentary 
canal  from  the  standpoint  of  comparative  anatomy r 
Dr.  Chapin  finds  that  in  the  kangaroo  a  consider- 
able change  takes  place  in  the  digestive  tract 
during   the   period  of  suckling.     The  distinctive 


J*Jf.  6,  1904. 


NOTES    ON    CURRENT    TOPICS. 


Thk  Medical  Press. 


19 


composition  of  colostrum,  as  compared  with  the 
milk  which  is  later  secreted,  is  well  known,  and 
Una  fluid  has  been  credited  with  possessing  certain 
properties  by  which  the  immature  gastric  mucous 
membrane  is  prepared  for  the  stronger  material  to 
tallow.     It  is  suggested  that  maternal  milk  con- 
tains proteids,  the  function  of  which  is  to  provide 
imminent  capable  of  easy  absorption   at   a  time 
the  stomach  is  not  in  a  condition  lo  under-, 
ake  proper  digestion.     Ah  the  infant's  digestive 
1  become  further  developed,  longer  intervals 
en  the  feedings  are  rendered  necessary.     The 
>.tl  adaptation  of  the  mother's  milk  and  the 
secretions  of  the  child's  gastrointestinal  trai 
alio    sinking.     From     these    observations,     Dr, 
n eludes  thai  a  rigid  adherence  to  any 
icular   rule   for   infant    feeding   will   only   be 
•hi    with    disaster.     The   whole   state   of    the 
jafant  's  digestive  powers  must  be  taken  carefully 
consideration,   and  something   more    than   a 
izard   mixing  of  milk  with  some  diluent   is 
required, 

Diphtheria  Antitoxin  in  Private  Practice. 
The  use  of  antitoxin  in  the  treatment  of  diph- 
theria is  at  the  present  day  so  well  established   that 
there  is  no  longer  any  need  lo  adduce  statistical 
rvidence  in  its  favour.     Nevertheless,  the  mortality 
-  still  90  high, if  judged  from  official  figures, 
that  one   must   question  whether  mere  statistics 
give  at  all  a  favourable  enough  opinion  of  its  merits, 
The  average  practitioner,  indeed,  is  rarely  con vi need 
t  a  certain  method  of  treatment  by  a 
mathematical     comparison     of     mortality     rates, 
for  he  is  a  practical  man,  and  be  judges  from  his 
experience,  and   from   what   his  neighbours 
tet!  him  of  theirs.     It  is  fortunate  that  this  was  his 
merhod   of   forming   an   opinion   in    the   case   of 
■  ria  antitoxin,  for  if  lie  had  proceeded  other- 
wise, he  would  not  have  been  so  likely  to  come  to  a 
t    decision.     Judging    from    official    figures 
supplied  by  various  health  authorities,  the  mor- 
rate  in  diphtheria  is  still  somewhat  over  ten 
eat     In  America,  different  States  and  cities 
ei ve  returns  varying  from  seven  to  fourteen  per 
many  the  figure  stands  still  higher, 
between   sixteen  and   seventeen,     In    England   a 
lair  average   would    be    about    fit  teen    per   cent. 
l  comparing  these  official  rates  with 
ihe  results  in  private  practice,  Dr.  Zahorsky,  of  St, 
Louis,  has  just  made  inquiries  (a)  from  twelve  oi  the 
leading  physicians  in  that  city,  whose  practice  lies 
children.     Among    1,610   cases   of 
^eria  attended  by  these  gentlemen  during  the 
five  years,   there   have  only  been    24  deaths, 
ing  a  mortality  percentage  of   1*5.     This  con- 
trasts so  markedly  with  the  total  returns  we  have 
ed    that  one  cannot  help  questioning  whether 
treatment  is  as  widely  adopted    as 
wc  are  wont  to  believe,  and  as  it  unquestionably 
"  es.     Granting  that  the  St.  Louis  physicians 
in  advantage  over  the  average  practitioner 
m  that  their  practice  lies  probably  among  the  better 
Wt  and  that  therefore  they  see  patients  earlier 

Iff)  Mr  ii  mi  JTftM,  December  5th,  1903. 


in  the  disease,  nevertheless  the  difference  of  results 
is  still  too  large  to  be  easily  explained.  The  success 
of  these  twelve  gentlemen,  however,  is  very  en- 
couraging, and  it  should  be  the  aim  of  every 
practitioner  to  assimilate  his  figures  to  theirs. 


An  Epidemic  of  Pseudo-Babies- 
What  at  first  sight  appears  to  be  a  terrible 
outbreak  of  rabies  has  taken  place  at  Madrid,  there 
being  no  less  than  twenty  persons  reported  to  be 
suffering  from  hydrophobia.  Among  the  number 
is  a  man  who  was  bitten  by  his  son,  who  had  him- 
self contracted  the  disease  from  the  bite  of  a 
schoolfellow.  No  mention  is  made  of  one  or 
several  mad  dogs,  and  on  investigation  of  the 
i  instances  it  becomes  evident  that  although  the 
alleged  outbreak  owed  its  origin  to  one  or  two 
possibly  genuine  cases  of  hydrophobia,  the  other 
cases  are  in  all  probability  of  the  nature  of  imita- 
tive hysteria  or  "  hydrophobia  by  suggestion/* 
especially  in  view  of  the  benignity  of  the  affection. 
It  used  to  be  believed — indeed,  the  belief  is  still 
very  generally  entertained  by  the  non-medical — 
that  fear  may  per  £4  engender  hydrophobia,  and 
instances  have  been  placed  on  record  in  which 
this  pseudo- hydrophobia  actually  proved  fatal. 
It  is  obvious  that  the  supervention  of  grave 
symptoms  in  such  cases  must  be  due  to  complica- 
tions, as,  for  instance,  to  meningitis  or  other  acute 
cerebral  disease.  Morbid  scare  is  very  epidemic 
in  its  incidence,  and  in  presence  of  a  hydrophobic 
scare  many  persons  of  unstable  nervous  equili- 
brium forthwith  develop  symptoms  which  pass 
muster  lor  hydrophobia  just  as  every  rise  of 
temperature  and  every  malaise  is  ascribed  to 
influenza  when  that  disease  happens  to  occupy  the 
minds  of  men,  Now  hydrophobia  is  usually  con- 
sidered to  be  so  inevitably  fatal  a  disease,  once  it 
admits  of  diagnosis,  that  the  fact  of  recovery 
belies  the  diagnosis.  The  mental  excitement  and 
physical  depression  which,  in  certain  subjects, 
follow  the  bite  of  a  dog  are  eminently  calculated 
to  Jan  into  activity  any  latent  meningeal  or  cere- 
bral weakness.  At  the  same  time,  an  error  of 
diagnosis  ought  not  to  be  possible  in  regard  to  the 
merely  hysterical  phenomena. 


More  Light. 
Tennvson's  infant  crying  for  the  light  would 
have  had  his  appetite  surfeited  had  he  lived  in 
these  days,  for  rays  and  radiating  substances  suc- 
ceed one  another  with  bewildering  rapidity-  The 
people  who  have  so  pertinaciously  clung  to  belief 
in  thought-transference  must  be  greatly  comforted 
when  they  read  every  six  man  t  lis  of  some  new  iind 
unsuspected  emanations  from  things  organic  and 
inorganic.  Thedayof  their j  us  tifi  ea  t  ion  seems  to  be 
at  hand.  The  latest  thingin  rays  again  comes  from 
France,  M.  Blondlot,of  the  University  of  Nancy, 
having  discovered  them  proceeding  from  the  human 
muscles  and  nerves.  In  compliment  to  the  town 
that  provides  him  with  his  chair  he  has  called  them 
the  N-rays,  and  he  finds  that  they  can  pass  through 
black -pa  per,  aluminium,  and  several  other  sub- 
stances.      If  this  discovery  is  confirmed  by  other 


20    Thb  Medical  Prbss. 


NOTES    ON    CURRENT    TOPICS. 


Jan.  6,  1904. 


physicists  and  physiologists,  a  very  extensive 
field  will  be  opened  up  for  further  research,  for  an 
entirely  new  method  of  studying  the  action  of  the 
nervous  system  in  health  and  disease  will  be  avail- 
able. "  Functional  "  nervous  diseases  have  been 
equally  the  puzzle  and  bane  of  physicians  almost 
since  medicine  recognised  a  nervous  system  as 
existing,  and  one  can  have  little  doubt  but  that 
these  are  due  to  minute  molecular  changes  in  the 
neuron.  If  the  N-rays  given  off  by  the  nerves  are 
found  to  throw  any  light  on  these  conditions,  one 
can  only  hope  that  M.  Blondlot  will  receive  the 
Nobel  Prize  next  year,  asFinsen  and  the  Curies 
have  this,  for  he  will  have  helped  to  remove  one  of 
the  greatest  disabilities  under  which  the  science  of 
medicine  at  present  works. 


A  Pioneer  Association. 
The  twelfth  annual  meeting  of  the  Liverpool 
Ladies'  Sanitary  Association  reminds  one  that  the 
excellent  example  set  in  the  Northern  city  has  not 
yet  been  followed  by  ladies  elsewhere  as  it  might 
have  been.  The  objects  of  the  association  are  to 
encourage  and  develop  sanitary  work,  to  rouse 
public  interest  in  the  necessity  for  preventing 
disease,  and  to  raise  the  moral  tone  of  the  popula- 
tion by  improving  their  surroundings.  For  these 
purposes  the  services  of  the  ladies  of  the  town  are 
enlisted  and  organised,  and  the  value  of  the  un- 
official aid  thus  rendered  to  the  cause  of  public 
health  cannot  well  be  over-estimated.  Apathy 
among  the  people  themselves  is  almost  a  greater 
drag  on  sanitary  progress  than  misdirected  zeal, 
and  an  association  of  this  kind  combats  both  these 
social  difficulties.  The  association  trains  health- 
lecturers  and  children's  nurses,  and  itself  delivers 
a  number  of  free  lectures  on  questions  of  health. 
The  Chairman  of  the  association  is  a  clergyman 
and  thus  the  co-operation  of  religion  with  sanitary 
reform  is  secured,  to  the  great  advantage  of  both. 
It  is  to  organisations  of  this  character  that  one 
must  look,  far  more  than  to  Acts  of  Parliament 
and  by-laws  of  local  authorities,  to  diffuse  know- 
ledge among,  and  gain  the  adherence  of,  the  people 
themselves ,who,  after  all,  are  the  ones  to  be  reached. 
Combinations  of  the  ladies  of  all  towns  and  large 
districts  modelled  on  the  lines  of  the  Liverpool 
Ladies'  Sanitary  Association  could  work  wonders 
in  the  slums  and  alleys,  for  does  not  the  hand  that 
rocks  the  cradle  rule  the  world  ?  The  only  ob- 
jection to  the  association  is  its  name.  "  Sanitary  " 
always  suggests  "  drains,"  and  drains  are  objects  of 
popular  contempt  and  derision.  Could  not  some 
more  sympathetic  title  be  devised  ? 


The  Plumbers'  Company  and  Registration. 
The  question  of  the  registration  of  plumbers  is 
fast  assuming  a  position  of  importance  in  practical 
politics.  It  is  one  that  concerns  the  public  health 
in  no  small  degree,  inasmuch  as  a  great  deal  of  the 
sanitary  comfort  and  safety  of  the  citizen  lies  in  the 
hands  of  the  plumber  who  controls  his  water  supply, 
his  drains,  and  many  details  of  his  internal  domestic 
architecture.  The  influential  Plumbers'  Company 
— an  ancient  London  body — have  for  many  years  j 


past  worked  steadily  with  a  view  of  obtaining 
from  Government  compulsory  powers  of  registra- 
tion of  all  plumbers.  During  the  past  year  they 
have  presented  a  petition  to  Parliament  in  favour 
of  the  proposed  registration  signed  by  3,500 
master  and  operative  plumbers.  The  wish  to 
obtain  good  work  from  known  and  responsible 
workmen  is  laudable  enough,  but  there  are  other 
things  to  be  considered  in  the  interests  of  the  public. 
There  is  the  question,  for  instance,  whether  the 
establishment  of  a  combined  monopoly  controlled 
by  the  Plumbers'  Company  would  not  raise  prices 
of  plumbing  work  unduly.  Then  the  reflection 
arises:  why  should  not  carpenters  and  cabinet- 
makers and  a  number  of  other  skilled  workmen  be 
controlled  in  a  similar  manner  ?  In  short,  the 
registration  proposals  of  the  Plumbers'  Company 
involve  issues  of  such  general  and  special  import- 
ance that  we  propose  at  an  early  date  to  discuss 
them  somewhat  fully. 


Cures -Ancient  and  Modern. 
That  the  appetite  of  the  public  for  marvellous 
"  cures  "  grows  with  feeding  may  be  assumed  from 
the  unceasing  supply  of  novelties  of  the  kind  that 
are  "  boomed  "  in  the  daily  newspapers.  One  day 
we  are  assured  tht  a  maniac  suffering  from  violent 
dementia  was  "  cured  "  after  an  hour's  isolation  in 
a  blue  room,  and  another  grew  peaceful  after  a  day 
in  a  violet  room.  To  restore  reason  to  the  degen- 
erate brain  of  a  "  dement  "  is  a  task  left  to  the 
omnipotent  journalist,  for  it  has  long  ago  been 
abandoned  as  hopeless  by  the  medical  profession. 
An  amusing  instance  of  re-discovery  of  an  old 
form  of  treatment  has  recently  gone  the  rounds  of 
the  Press  in  the  shape  of  the  "  hot  water  cure  "  for 
typhoid  fever.  A  leading  journal  gravely  writes 
that  it  is  one  of  the  latest  "  cures,"  and  that  it  has 
recently  been  tried  at  the  London  Hospital.  The 
reduction  of  febrile  temperatures  by  the  continuous 
bath  has  been  before  the  profession  for  the  last 
half-century  or  more.  At  one  time  the  method 
was  extensively  used  in  the  treatment  of  typhoid 
and  scarlet  fevers,  and  of  hyperpyrexia  generally. 
To  the  modern  journalist  nothing  is  sacred.  He 
seems,  however,  to  be  deriving  a  good  deal  more 
"  copy  "  from  the  hospitals  than  he  is  entitled  to 
in  the  ordinary  course  of  his  occupation.  The 
hospital  authorities  would  do  well  to  keep  a  tighter 
hand  on  the  information  conveyed  to  journalists. 


A  Case  of  Hellebore  Poisoning. 
A  good  deal  of  scientific  interest  is  attached  to 
the  case  of  an  old  army  pensioner  named  Davis 
at  Sackville  College,  East  Grinstead.  An  inquest 
was  held  on  December  22nd  last  by  Mr.  G.  V. 
Benson,  the  East  Sussex  coroner,  and  resulted  in  a 
verdict  of  accidental  death  through  poisoning 
by  hellebore.  Deceased  was  suffering  from  pains 
in  the  stomach  and  went  to  his  room  with  the  inten- 
tion of  taking  some  liquorice  powder.  Half  an 
hour  later — at  seven  in  the  evening — he  returned 
saying  he  had  taken  hellebore  in  mistake  for 
liquorice  powder.  He  then  went  to  a  chemist, 
whose  shop  he  reached  about  7.30.     He  was  advised 


W4- 


SPECIAL  CORRESPONDENCE. 


The  Medical  Press.     21 


to  go  to  a  doctor,  and  walked  away  looking  **  as 
if  nothing  were  the  matter  with  him/1  Shortly 
afterwards  he  was  found  in  a  helpless  condition 
in  i he  road  and  taken  home,  where,  alter  violent 
p.iin  and  convulsion , he  died  at  a  quarter  past  eight. 

ninately  medical  aid  was  not  available.  In 
October  last  deceased  bought   the  hellebore  at  a 

i  hemist's  for  the  purpose  of  making  an  oint- 
ment to  allay  an  irritation  of  the  skin.    The  hellc- 

liquorice  powder,  and  some  Epsom  salts  were 
fccpi  together  in  a  tin.  Black  hellebore  or  Christ- 
[jus  rose  is  used  by  horticulturists  as  a  vermifuge 
aod  insect  killer.  Although  so  deadly  a  poison  it  is 
DOl  >>n  the  schedule,  and  the  chemist  who  sold  the 
drug  acted  in  a  praiseworthy  manner    in  entering 

dein  his  poison  book.  His  wisdom  in  selling 
(be  hellebore,  however,  may  be  called  m  question, 
as  well  as  the  casual  way  in  which  the  old  man 
was  referred  to  a  doctor  on  stating  his  mistake. 
Poisoning  bv  hellebore  is  extremely  rare,  so  that 
the  data  of  the  above  case  will  be  of  value  to 
toxic  ologists* 


The  Contagiousness  of  Alopecia  Areata. 

Many  disputes  have  arisen  concerning  the 
ongin  of  that  form  of  baldness  known  as  alopecia 
areata,  or  the  area  CelsL  Though  no  actual 
specific  micro-organism  has  been  discovered  in 
connection  with  the  disease,  yet  there  are  many 
who  firmly  believe  that  it  is  a  bacterial  affection, 
and,  now  and  then ,  cases  are  brought  forward  which 
seem  to  uphold  the  theory.  Others,  on  the  con- 
trary, maintain  that  the  cause  lies  in  the  nervous 
system,  and  that  the  tall  of  hair  is  due  to  trophic 
influences  acting  through  the  peripheral  nerves.  It 
is  w^U  known  that  a  sudden  and  severe  mental 
emotion  may  produce  this  form  of  alopecia  with 
great  rapidity,  such  as  could  not  very  well  be 
supposed  to  result  irom  the  action  of  a  germ. 
If.  L  Jacquet.  one  of  the  champions  of  the  trophic 
tnfOffy,  QOt  so  very  long  ago  traced  the  develop- 
lie  disease  to  carious  teeth,  believing  that 
the  irritation  thus  set  up  produced  a  sort  of  reflex 
alopecia.  The  same  observer  has  recently  re~ 
corded  i>  the  results  of  one  hundred  separate 
attempts  to  inoculate  the  disease  upon  healthy 
pt,  The  subjects  experimented  upon  included 
five  of  his  pupils  at  the  Hopitai  Saint- An  toine  and 
himself,  upon  whom  If.  Sabouraud  personally  con- 
ducted the  inoculation.  The  material  derived 
trom  scraping  the  margins  of  the  bald  patches  was 
inserted  by  means  of  a  hollow  needle  directly  into 
the  hair- follicles  of  the  normal  scalps.  In  the  case 
of  If.  Jacquet,  he  purposely  abstained  from  all 
toilet  of  the  scalp  lor  forty-eight  hours ,  in  order  to 
give  the  supposed  parasite  full  chance  of  finding 
i  table  nidus  for  its  growth.  All  the  expert- 
men  is  were  entirely  negative.  Though  not,  of 
course,  absolutely  conclusive  evidence  against  the 
:  contagion,  these  facts  cannot  be  said  to 
in  at  it  very  strongly. 


renders  that  work  of  especial  interest  to  the  medical 
profession.  The  sale  of  engravings  of  the  picture 
has  been  enormous,  with  the  inevitable  result  that 
the  English  market  has  been  swamped  by  a  flood 
of  copies  "  made  in  Germany/*  We  have  been 
asked  to  warn  our  readers  against  this  unfair  substi- 
tution. The  effectual  safeguard  against  any  such 
fraudulent  practice  is  to  bear  in  mind  that  the 
genuine  copyright  engraving  of  Mr.  Fildes*  picture 
is  published  by  Messrs.  Thos.  Agnew  and  Sons,  of 
39B,  Old  Bond  Street,  London,  W. 

PERSONAL. 


Mr,  Joseph  T,  Fry  has  made  a  Christmas  gift  of 
£t(ooo  to  the  Bristol  General  Hospital. 

Farl  Howe,  as  Chairman  of  the  Birmingham 
Triennial  Musical  Festival,  was  able  to  hand  over 
nearly  £itooo  to  the  General  Hospital  of  the  town 
mentioned  as  the  profits  of  the  recent  festival. 

Dr.   Chantemesse  has  been  appointed    Inspector- 

General  of  Sanitation  in  Paris,  in  succession  to  the  late 

Professor    Proust,     Dr.    Chautemesse,    it    need    hardly 

Ided,  is  a  bacteriologist  of  note,  who  has  mad-    1 

special  studv  Of  cholera  and  typhoid  fever, 

ES  of  handsome  presentations  were  made 
recently  at  the  Vc-lingwm  County  School  to  Dr.  Glan- 
ville  Morris,  Medical  Officer  of  the  Maerdy  Collieries 
District*  by  admiring  friends  and  patients. 

At  the  next  meeting  of  the  Incorporated  Society  oJ 
Medical  Officer*  of  Health,  to  be  held  in  London  on 
Friday.  January  Hth.  Dr.  J.  Spottiswoode  Cameron 
will  open  a  discussion  on  Sophistication  of  Foods, 

His  Majesty  thi    I  ^ntciuusly  appointed  to 

the   Fourth  Class  of  the  Royal  Victorian  Order  Mr. 
Harold    Boulton,    honorary     treasurer    of    the    Queen 
ria's  Jubilee  Institute  for  Nurses. 


The  strong  human  note  struck   by   Mr.   Luke 
1  in  his  well-known  painting  of "  The  Doctor  " 

(*»  La  Pr****  Medical*,  December  12th,  1OT3L 

1 


Special  correepon&euce, 

[FROM    OlTR    OWN    CORRESPONDENT /) 

BELFAST, 
EtaurpMBNT  ov  Queen's  College. — A  strongly- 
worded  memorial  has  been  sent  to  the  Chief  Secretary 
fof  Ireland  bv  the  Council  of  the  Belfast  Natural 
History  and  Philosophical  Society,  calling  the  attention 
of  the  Government  to  the  urgent  need  of  increasing  the 
provision  tor  scientific  teaching  and  research  in  Queen's 
College.  Belfast.  Thev  state  their  belief  that  the  need 
of  Belfast  is  greater  than  ever,  and  may  be  dealt  with 
quite  apart  from  the  long-delayed  settling  of  the 
general  university  question. 

The  Consumption  Question. — At  the  monthly 
meeting  of  the  Belfast  Corp >ra lion  on  the  1st  inst*,  a 
report  was  presented  bv  the  Medical  Superintendent 
Officer  of  Health  on  the  prevalence  and  proper  treat- 
ment of  consumption  in  the  city*  From  1*03  to  igoj 
the  deaths  from  consumption  varied  from  97?  *o  H32 
vear,  on  the  whole  showing  a  tendency  to  de- 
crease in  proportion  to  the  population,  and  being  about 
one-seventh  Oi  the  total  number  of  deaths  - 
The  estimates  of  the  total  number  of  consumptives  in 
the  city  at  any  one  time  vary  from  2,000  to  4,000, 
I  The  report  goes  on  to  recommend   the  provision   oi 

open-air  shelters  in  the  neighbourhood  oi  the  cr 
J  mild  case*,  anil  a  sanatorium  for  more  advanced  cases, 
,  This   latter,    if   built   of   brick,    to   accommodate    too 

I  patients,  would  coat  £25,000  to  { 30.000  to  erect,  and 
to  maintain  would  cost  {50  to  {60  per  bed  per  annum. 
Wooden  buildings,  however,  could  be  erected  in  Mocks* 


22 


Thb  Mbdical  Press. 


CORRESPONDENCE. 


Jan.  6,  1904. 


each  capable  of  holding  twenty  patients,  at  a  cost  of 
£1,000  each  block,  and  the  cost  of  such  a  sanatorium 
for  100  patients,  with  administrative  block  complete, 
would  be  about  £8,000.  The  necessity  for  great  care  in 
the  choice  of  a  site  is  dwelt  upon.  Compulsory  noti- 
fication of  cases  is  advocated.  Since  last  May  the 
Belfast  Dispensary  officers  have  voluntarily  and 
gratuitously  notified  cases,  143  in  all,  and  in  every 
instance  the  house  where  the  patient  lived  was  visited 
by  one  of  the  female  sanitary  inspectors  and  advice  and 
instruction  given.  The  report  will  be  considered  in 
detail  at  a  future  meeting  of  the  Corporation  in  com- 
mittee. 

Health  of  Belfast. — The  health  of  the  city  seems 
to  have  been  remarkably  good  during  the  past  year, 
the  death-rate  for  1903  being  only  19*8  per  i.ooo,  the 
lowest  on  record.  From  typhoid  the  death-rate  was 
38  per  1,000,  the  lowest  since  1888,  when  it  was  3*3. 
In  1898  it  rose  to  188.  From  zymotic  diseases  the 
death-rate  was  2*2  per  1,000,  the  lowest  for  sixteen 
years,  with  the  exception  of  1900,  when  it  was  2*1. 
Typhoid  shows  a  marked  decrease  last  month,  but 
whooping-cough  and  scarlatina  are  both  very  prevalent. 
In  the  last  four  weeks  there  were  notified  75  cases  of 
scarlatina,  48  typhoid,  48  erysipelas,  23  diphtheria,  20 
simple  continued  fever,  9  small-pox,  5  membranous 
croup,  4  puerperal  fever,  and  3  typhus. 

Correspondence* 

[We  do  not  hold  omraelves  responsible  for  the  opinions  of  <mr  corres- 
pondents. J 

VIVISECTION. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — When  I  wrote  to  you  the  letter  you  were 
good  enough  to  publish  December  9th  on  Vivisection, 
the  question  of  interest  seemed  to  me  to  be  to  ascertain 
what  evidence  could  be  given  by  any  of  your  readers 
of  their  own  personal  experience  in  vivisection  as  a 
source  of  useful  practical  knowledge.  Most  of  us 
who  take  any  interest  in  medical  education,  and  in 
the  value  of  vivisection,  know  pretty  well  what  the 
great  men  of  the  past  learnt  from  it.  We  do  not  want 
any  references  to  this  kind  of  evidence,  one  way  or 
the  other.  We  want  an  answer  to  the  simple  question, 
"  What  have  you  learnt  from  vivisection,  you  yourself, 
from  your  own  experiments  first,  and  from  what  you 
have  seen  others  do  next  ?  " 

We  know  too  well  how  sentiment  is  often  an  anta- 
gonist to  research  and  progress,  whether  it  be  religious 
sentiment  or  dread  of  pain,  or  any  other  of  those 
peculiarities  in  the  nature  of  human  beings  which  we 
cannot  dislike  or  despise,  and  which  we  must  often 
admire  and  respect.  Cruelty  is  a  low,  mean,  despicable 
trait  in  a  man's  or  woman's  character,  and  we  are 
justified  in  observing  how  we  give  it  liberty  to  do  harm. 

I  see  no  such  trait  in  the  character  of  the  great 
physiologists  and  anatomists  of  the  past ;  such  men 
as  William  Harvey,  the  Hunters,  and  later  Pasteur, 
Charcot,  and  some  who  have  done  much  in  the  study 
of  disease.  Personally,  I  dislike  and  distrust  vivi- 
section as  a  method  of  research.  The  dissecting  room 
and  the  post-mortem  room  have  always  appeared  to  me 
to  be  the  most  certain  and  satisfactory  fields  for  laying 
the  best  foundation  for  good  practical  knowledge. 
To  watch  the  capillaries  of  a  frog's  foot  or  a  fish's 
tail  is  not  cruel,  or  need  not  be,  and  it  is  certainly 
interesting,  and  if  the  anti-vivisectionists  only  ask 
for  care  that  there  is  no  pain  or  cruelty  inflicted,  we 
cannot  think  them  wrong.  But  to  go  back  to  the 
question  of  interest,  I  have  not  found  vivisection 
reliable,  and  I  will  give  an  instance  of  this.  Many 
years  ago  when  I  had  the  direction  of  the  post-mortem 
room  and  the  teaching  of  pathology  in  one  of  our 
hospitals,  my  friend,  the  lecturer  on  physiology,  brought 
into  my  room  a  rabbit  that  he  had  been  lecturing  on, 
to  show  how  the  division  of  the  sympathetic  on  the 
left  side  affected  the  temperature  of  the  ear,  the  con- 
dition of  the  left  iris,  and  other  peculiarities  related 
i  n  works  on  physiology.     I  thought  the  kindest  thing 


to  do  was  to  have  the  poor  creature  killed,  and  I 
put  it  aside  after  proper  cleaning  in  pure  alcohol  to 
dissect  it.  I  was  rather  amused  to  find  that  so  far  as 
the  sympathetic  ganglion,  which  lies  deep  in  the  neck 
close  to  the  pneumogastric  and  phrenic,  was  concerned, 
it  had  not  been  reached  by  the  section  made  by  my 
friend,  and  not  even  approached,  and  consequently 
I  was  rather  led  to  think  that  there  was  not  much 
reliance  to  be  placed  upon  that  kind  of  physiology,  or 
upon  those  who  believed  in  it. 

It  seems  to  me  that  if  we  disturb  in  the  slightest 
degree  the  natural,  harmonious,  and  most  complicated 
relations  of  the  parts  of  a  living  creature  by  even  the 
slightest  injury  or  influence,  we  cannot  be  certain  of 
what  we  observe,  particularly  when  the  work  we  are 
doing  is  outside  the  simplest  physical  science.  It  * 
was  with  interest  that  I  tried  to  find  out  what  Charcot 
learnt  from  vivisection  compared  with  pathology. 
Disease  has  always  seemed  to  me  to  be  of  infinitely 
greater  value  to  physiology  than  any  but  pathologists 
can  realise.  When  the  lecturer  on  physiology  at  any 
of  our  schools  is  not  a  good  pathologist  and  good 
anatomist,  in  my  opinion  he  cannot  be  a  good  teacher 
of  physiology. 

Let  us  not  misdirect  the  studies  of  our  students, 
considering  how  short  a  time  they  have  to  learn  what 
they  ought  during  student  life,  from  the  practical, 
useful,  and  absolutely  necessary  knowledge  they  should 
acquire  to  fit  them  for  the  work  they  are  preparing 
for. 

I  am,  Sir,  yours  truly, 

Robert   Lee. 

[The  fallacy  of  non-division  of  the  sympathetic 
ganglion  in  the  experiment,  assuming  division  to  have 
been  the  intention  01  the  experimenter,  and  further, 
that  the  objective  signs  mentioned  were  present, 
surely  iurnished  data  lor  revising  former  recorded  ex- 
periments— and  in  that  way  justified  the  experiment, 
provided  always  that  the  fallacy  came  to  the  experi- 
menter's knowledge. — En.] 

"  CURES "     FOR    CONSUMPTION. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — The  editorial  paragraph  on  the  above-named 
subject  in  your  issue  of  to-day,  December  *:oth,  serves 
to  remind  us  that  we  have  never  had  any  final  report 
from  Colonel  le  Poer  Trench,  with  regard  tJ  the  in- 
vestigation into  the  nature  of  the  "  Lacnanthcs  Cure,"" 
of  which  two  or  three  years  ago  he  made  himself 
champion.  In  the  interest  of  science,  of  the  public, 
and  perhaps  as  a  contribution  to  the  history  of  popular 
medical  errors  and  delusions,  it  is  important  the  story 
of  this  "  cure  "  should  be  fully  told  ;  whilst  in  justice 
to  the  medical  profession,  against  whom,  as  a  body, 
wild  charges  of  persecution  for  selfish  ends  were  made 
by  advocates  of  the  "  cure,"  it  is  desirable  these 
charges  should  be  substantiated  or  withdrawn. 
I  am,  Sir,  yours  truly, 

H.  S. 

Decembtr  30th,  1903. 

[Our  correspondent  has  drawn  attention  to  a  point 
of  importance.  The  subject  should  not  be  permitted 
to  lapse  into  the  No-man's  Land  of  the  unknown  and 
the  uninvestigated,  which  already  forms  the  abiding 
place  of  too  many  "curers"  of  grave  and  incurable 
disease. — Ed.] 


"A   NEW   TREATMENT   FOR   BOILS." 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — The  idea  of  injecting  one  or  more  litres  of 
oxygen  gas  subcutaneously  for  the  cure  of  boils  and 
carbuncles  related  by  your  French  correspondent  in 
The  Medical  Press  "and  Circular  for  December 
16th  is  only  an  extension  of  the  "  oxygen  treatment," 
and  open  to  the  same  general  objections  of  inconven 
ience  and  expense. 

I  have  had  considerable  experience  of  the  treatment 
of  boils,  in  myself  and  others,  and  I  can  certify  that 
if  the  boil  be  treated  at  the  onset  by  removing  the 


Jtv-  ft,    19Q4, 


OBITUARY. 


The  Medical  Pbess,     23 


the  point  of  a  scalpel,  squee zing  out   the 

mi  nut*  quantity  of  pits   therein   contained,   and   then 

cauterising  the  interior  ol  the  small  cavity  with  pure 

ittc  and,   that  boil  will  never  go  any  further,     I 

r  seen  this  treatment  tail,  ami  I  have  applied 

I  instances, 

1  bare  n  lumever,  that  if  the  applic; 

delayed  until  the  boil  has  attained  the 

nsions,  say,  of  a  cherry,  its  success  is  less  certain, 

nera  evince  a  di^hke  to  opening  these 

>ns,  but  from  personal  experience— 

red  prior  viiiiL  the  abortive  method  — 

testify    to    I  -t    which    Jree    mo 

►"I  by  free  curetting  "t  the  sloughing  tissues  and 
the  free  application  on  a»  ad,  affords-      I  0Oa> 

I  myself,  moreover,  that  by  such  means  the  dura- 
whatever  its  dimensions,  is  materially 
method  is  so  simple   and  *o   certain 
■rised  it  is  not  more  generally  adopted* 
I  am,  Sir,  rotus  truly, 

\i  1  Kjo  S  1  ,v&v>  MJX 


I  ATION  TO  \  PERTHSHIRE  SURGEON. 


Dr,   David   Halket  Stirling,  ol  Perth,    who    has 
WCttilJ  jubilee  as  a  member  oj    the 

medical   profess  aed    l>v    the    Perth- 

Branch  of  the  British  Medical   Association  and 
with  his  portrait,  a  striking  likeness,  painted 
lr,  C  Sellar  R.S.W,     A  photograph  ol  the  picture 
ared    by  Mr.  Mercer— of    the   Raebura 
Princes  Street— for  the  subscribers,  and  will  be 
table  to  Dr.  Stirling's  many  friend?       Mi     tjiove- 
t   has  been  confined  entirely  to   the  medical   po- 
re courtesy    oi     the    Dundee   Advertiser 
the   sketch   oi    the   pre- 
sentation picture.     Dr.  Stirling  graduated  as  MJX  of 
the  University  Of  Edinburgh.     During  a  Jong  and  dis- 
tinguished career  he  had  »nlled   uumezo  irable 

ns   both  in  a   |  ,  civil  capa< 

The  honour  and  affection   testified    to  so  cordially  by 
bis  medical   brethren    are   faithfully   reflected    I 
unusually  wide  circle  of  friends  and  acquaintances  in 
the  world  thai  is  outside  his  purely  professional  life. 


©bltuar& 


DK,    CHARLES     1      MOORE, 
We  deeply  regrei  ace  the  death  of  one  of 

lht '  •  sing  member  of  the 

w«"eal     ;  in     Ireland,     Charles    1".     Moore 

■listed  tie  medical  profession  in  Dublin  through  the 
medium  of  the  Apothecaries'  Hall,  in  1*45.     In  1844 


he  became  a  Licentiate  of  the  Royal  College  off  Surgeons 
and  an  MD.  of  Glasgow  University,  and  in  1865  he 
passed  the  necessary  examinations  for  the  i 
of  the  Royal  College  of  Surgeons  in  Ireland.  Dr. 
Moore  has  thus  been  a  member  1  ri  the  medical  profession 
for  some  sixty  and  odd  years,  and  in  spite  of  his 
age  a  fortnight  ago  was  still  discharging  his  duties 
as  certifying  factory  surgeon  for  the  Dublin  district. 
The  late  Dr.  Moore's  life  was  a  busy  one.  Early  in 
his  career  he  served  as  slop's  surgeon,  and  for  several 
years  was  a  senior  surgeon  in  the  Peninsular  and 
it  a)  Steam  Packet  Compay's  service.  After  he 
had  given  up  a  sea  life,  he  settled  in  Dublin,  where  for 
many  years  he  held  the  post  of  medical  officer  of 
health  to  the  No,  3  Smith  City  Dispensary,  In  addition, 
he  was  a  visiting  physician  to  Cork  Street  Fever 
Hospital,  medical  inspector  of  seamen  for  the  Port 
of  Dublin,  and  certifying  factory  surgeon  for  the  Irish 
Metropolitan  District,  Dr.Moore  devoted  much  at  ten 
from  the  outstart  of  his  career  to  sanitary  science, 
and  contributed  several  articles  to  the  medical  journals 
on  subjects  relating  to  the  public  health.  Duriu 
time  at  sea  he  acquired  much  information  regarding 
tropical  epidemic  diseases,  and  this  knowledge 
materially  assisted  him  in  discharging  his  duties 
in  Dublin  in  connection  with  the  inspection  of  seamen, 
and  widened  his  opinions  on  the  imp< usance  of  pre- 
ventive medicines.  Dr.  Moore  always  took  a  keen 
interest  in  the  work  of  the  Public  Health  Secti- 
the  Royal  Academy  of  Medicine  in  Ireland,  of  which 
section  he  was  at  one  time  President,  and  in  the  work 
of  the  Sanitary  Association  and  the  Society  for  the 
Prevention  of  Tuberculosis,  In  his  private  life  Dr, 
Moore  won  the  regard  and  affection  of  ail  with  whom 
he  came  in  contact,  and  many  will  learn  with  sorrow- 
that  he  has  passed  away  to  join  the  numerous  colleagues 
aild  friends  whom  he  had  seen  precede  him. 

LIELI    COl  ONKL  EDWARD     Rl'SSEU,    CREE, 
R.A.M.C. 
With  regret  we  announce  the  death  of  Lieut, -Colonel 
Edward  Russell  Cree,  K.A.M.f.,  on   December  291I1,  ol 
heart   failure,   at    Wokingham.     The  sun  of  the   late 
Edward  Hodges  Cree.  Ins  pec  tor- General  of  Ho>: 
and  Fleets,  R,N\,  he  jollied  the  Army  as  a  surgeon  m 
becoming  surgeon-major  twelve  years  later,  and 
lieu  tenant -colonel  in  1900.     Lieut. -Colonel  Cree  stt 
m  the  Soudan  campaign  in  iSS;,  and  was  present  in  the 
engagements  at   Hasheen  and  the  Tofrek  Zariba,  and 
at  the  destruction  of  Temai,  receiving  the  medal  with 
two   clasps  Lin  !    the    Khedive's    Star.      In    the    South 
African  War  he  again  saw  service  in  t8go  and  1900.  anil 
took  part  in  the  relief  of  Ladysnuth,  being  mentioned 
in  despatches.     Lieut. -Colonel  Cree  was  4>  years  of  age. 


DR,     ROBERJ       [AMES     BLAIRdTNYNGHAME. 

By  the  death  ol  Dr.  Robert  James  Blair-Cuin  n  . 
name,  of  Cruuan.  Perthshire,  who  died  last  week  at 
Rothesay  Place,  Edinburgh,  a  prominent  Scotchman 
has  been  lost  to  the  profession,  lie  was  born  in  184 1, 
and  was  educated  at  the  University  of  Edinburgh,  and 
in  London,  Berlin,  Prague,  and  Vienna. "  He  took  the 
M.D.  decree  at  Edinburgh  in  180?,  when  he  was  Gold 
Medallist  in  Forensic  Medicine ;  was  admitted  a 
Fellow  of  the  Royal  College  of  Surgeons,  Edinburgh,  in 
and  a  member  of  the  Royal  College  of  Physicians, 
Edinburgh,  in  18;;,  He  was  President  of  the  Royal 
je  of  Surgeons.  Edinburgh,  in  iSoj.  while  he 
Mien  President  of  the  Royal  Medical  Society  of 
Edinburgh,  of  which  he  was  a  member,  Dr,  Blair- 
Cunynghame  was  also  a  Fellow  of  the  Royal  Society  of 
Edinburgh,  and  a  member  of  several  learned  Societies 
in  the  Scottish  capital. 

Mount  Vfrnon  Hospital  for  GonsttinpUOD, 
Dr.  Arthur  Newsholue  will  deliver  the  Inaugural 
Address  in  connection  with  the  Post-Graduate  Lei  1 
and  Demonstrations  at  the  Mount  Vernon  Hospital 
for  <  onsumptLOD  and  Diseases  of  the  Chest,  7  Fitzroy 
Sptan\  \\ '..  to-morrow  (Thursday),  at  5  p,m.  The 
subject  will  be  "  Public  Preventive  Measures  against 
Tuberculosis  in  Relation  to  the  Medical  Practitioner." 


The  Medical  Press.       LITERARY  NOTES  AND  GOSSIP. 


Jan.  6,  1904. 


Xiterarg  notes  an&  Gossip. 

The  Sketch  in  its  current  number  has  an  illustrated 
article  on  New  York's  floating  hospital   for   "  slum  " 

children,  "  Number  One." 

*  *     *  * 

The  Builder  for  December  has  an  interesting 
leader  on  "  The  Sanatorium  Question,"  in  which  our 
point  is  emphasised  that  "  as  sanatoria  are  being 
built  all  over  England,  it  is  essential  that  the  great- 
est care  should  be  exercised  in  planning  them  on 
the  most  economical   and  effective  lines." 

*  *     * 

We  are  informed  that  both  his  Majesty  the  King 
and  his  Royal  Highness  the  Duke  of  Connaught  have 
been  graciously  pleased  to  accept  copies  of  Captain 
St.  Leger's  "  War  Sketches  in  Colour,"  just  published 
by  Messrs.  Adam  and  Charles  Black. 
J  *     *     * 

The  list  of  medical  men  who  have  tried  their  hands 
at  novel-writing  is  now  of  considerable  length.  The 
latest  recruit  is  Major  Greenwood,  M.D.,  LL.B.,  who 
is  announced  as  having  a  novel  in  hand.  His  book 
"  The  Law  Relating  to  the  Poor-law  Medical  Service  " 
is  now  being  advertised  in  the  medical  press.  Messrs. 
Bailliere,  Tindall  and  Cox  are  the  publishers  of  it. 

*  *     * 

A  very  interesting  historical  MS.  catalogue  has  been 
presented  to  the  Library  of  Owens  College  by  Mr.  J. 
Joseph  Jordan.  It  is  the  catalogue  of  the  anatomical 
preparations  in  the  museum  of  the  Mount  Street  School 
of  Medicine  belonging  to  Joseph  Jordan.  Many  of  the 
specimens  were  mounted  by  Ms  nephew,  James 
Stephens.  The  number  of  specimens  carefully  de- 
scribed and  catalogued  is  over  1,000.  It  is  evident 
that  even  in  tne  earlv  davs  of  medical  studies  in  Man- 
chester the  Mount  Street  School  was  exceptionally 
well  provided  with  museum  specimens.  Many  of  these 
are  now  in  the  Anatomical  Museum  of   Owens  College. 

*  •     * 

Dr.  Ernest  Graham  Little's  article  on  "  Health 
Resorts  of  South  Africa  "  and  Mr.  Creswicke's  "  South 
Africa  and  its  Future  "  are  both  peculiarly  opportune 
at  the  present  moment,  and  may  be  consulted  by 
medical  men  with  advantage. 

♦  •     ♦ 

The  forthcoming  number  of  the  British  Journal  of 
Inebriety,  edited  by  Dr.  T.  N.  Kelynack,  the  hon.  secre- 
tary of  the  Society  for  the  Study  of  Inebriety,  will 
contain  in  extenso  Professor  [G.  Sims  Woodhead's 
Lees  and  Raper  Memorial  Lecture  on  "  Recent  Re- 
searches on  the  Action  of  Alcohol  in  Health  and  Sick- 


The  Ophthalmoscope  is  one  of  the  new  special  medical 
journals,  of  which  this  country  now  possesses  a  fair 
number,  although  bv  no  means  so  well  provided  as 
Germany,  the  United  States,  and  other  foreign  coun- 
tries. Under  the  able  editorship  of  Mr.  Sydney 
Stephenson,  the  well  known  ophthalmic  surgeon, 
the  newcomer  promises  to  become  a  veteran,  at  any 
rate,  if  careful  editing  can  ensure  success.  A  special 
feature  of  the  Ophthalmoscope  is  the  "  Notes  and 
Echoes,"  which  give  a  delightful  summary  of  current 
events  of  interest  in  the  ophthalmic  world.  They  are 
evidently  written  currente  calamo  by  a  pen  of  literary 
merit,  although  here  and  there  we  note  a  sign  of  haste. 
That    drawback,    however,    seems    inseparable    from 

almost  all  forms  of  journalism  nowadays. 
*     *     * 

The  two  following  paragraphs  are  culled  from  the 
Ophthalmoscope  :— The  limitations  of  modern  surgery 
are  well  illustrated  by  the  position  of  affairs  with  regard 
to  so  common  and  so  disastrous  a  malady  as  trachoma. 
In  spite  of  the  enormous  amount  of  painstaking  re- 
search that  has  been  bestowed  upon  that  disease  of 
recent  years,  it  can  hardly  be  said  that  we  are  any 
nearer  the  ultimate  pathology  of  that  particular  morbid 
process  than  we  were  a  generation  ago.  The  main 
advances  have  been  in  prevention,  and  perhaps  the 
greatest  stride  ahead  is  the  striking  and  interesting 


fact   that  "  granular  lids  "  can  be  cured  by  exposure  to 
focus- tubes — alias  X-ray  treatment — and  to  a  "high 

frequency  "  brush  discharge. 

*  *     * 

Here  in  the  United  Kingdom  the  virtue  of  the 
scientific  investigator  is  for  the  most  part  his  sole 
reward.  They  manage  that  sort  of  thing  better 
abroad — at  least,  so  we  gather  from  a  recent  official 
announcement  by  the  Hungarian  Minister  of  the 
Interior,  of  a  prize  of  100,090  marks  for  the  best  essay 
upon  the  pathology  and  treatment  of  trachoma.  To 
be  successful  essays  must  show  a  tangible  advance  along 
one  of  the  two  indicated  lines.  The  prize  may  be 
divided.  Essays,  which  may  be  in  any  language,  must 
be  sent  in  by  the  end  of  1004.  A  step  of  this  kind 
might  well  be  imitated  by  His  Majesty's  Government. 
Let  us  say,  under  the  patronage  of  King  Edward  VII., 
half  a  dozen  prizes  of  ^2,000  each  were  offered  for  the 
best  essays  on  scarlatina,  comparative  tuberculosis, 
trachoma,'  malignant  tumour,  rheumatism,  and 
measles,  would  there  not  be  a  field  of  possibilities 
opened  up  of  untold  value  to  our  fellow-countrymen  of 
the  present  and  of  future  generations,  not  to  mention 

mankind  at  large  ? 

*  *     * 

Among  the  note-books  and  diaries  that  come  round 
each  year  with  Christmas  tide  we  may  especially 
mention  Messrs.  Scott  and  Bowne's  as  being  a  neat 
and  handy  little  volume  for  the  waistcoat  pocket. 
Our  old  friends,  Messrs.  Burroughs  and  Wellcome,  are 
as  usual  to  the  front  with  a  thoroughly  up-to-date 
visiting  list  for  general  practice,  and  an  appointment 
book  for  consultants.  The  amount  of  intormation 
condensed  in  the  literary  matter  of  these  volumes  is 
simply  astonishing  and  does  credit  to  the  compilers. 
Knowledge  sends  a  handsome  crown  octavo  "  Diary 
and  Scientific  Handbook  for  1004."  It  contains  a 
blank  sheet  for  every  day  in  the  year,  with  the  usual 
tables  for  accounts,  and  so  on,  and  is  prefaced  by  a 
number  of  valuable  scientific  articles.  It  is  handsomely 
bound,  and  admirably  fitted  for  the  library  table. 
It  is  well  worth  the  three  shillings  at  which  it  is  sold. 

•  *     * 

A  new  and  seemingly  valuable  prophylactic  addition 
to  the  equipment  of  a  fireman  has  been  introduced 
and  is  illustrated  in  the  current  number  of  The  Tatler. 
It  is  a  protective  water  spray  which  completely  en- 
velopes the  operator.  With  nippers  on  his  nose, 
special  smoke  glasses  for  the  eyes,  an  oxygen  bag 
supplying  the  mouth,  and  a  surrounding  spray  of 
water  effective  advance  has  been  made  towards 
successful  fighting  of  the  flames. 

•  •     • 

The  Illustrated  London  News  in  its  last  issue  fur- 
nishes amusing  illustrations  of  Dr.  Lauterwasser's 
method  of  dealing  with  consumption  by  burying 
patients  in  shallow  "  graves,"  and  sleeping  out  of 
doors  on  the  grass.  Even  the"  hut  system  "is  to  be 
superseded.  The  craze  for  novelty  in  the  treatment  of 
tuberculosis  seems  to  justify  any  extravagance. 

*  *     * 

■■  Proposed  Sterilisation  of  Certain  Mental  and 
Physical  Degenerates  "  is  the  title  of  a  work  by  Dr. 
R.  R.  Rentoul,  which  is  being  published  by  the 
Walter  Scott  Publishing  Co.,  Newcastle  and  London. 

*  *     * 

A  valuable  study  of  the  so-called  "  plague  "  which 
devastated  the  metropolis  in  the  seventeenth  century 
appears  in  Sir  Walter  Besant's  posthumous  work. 
'-'■  London  in  the  Time  of  the  Stuarts,"  which  Messrs 
Adam  and  Charles  Black  have  just  issued. 

The  New  Coarse  of  Pott-Graduate  Lectures. 

The  new  course  of  Post-Graduate  lectures  of  the 
Mount  Vernon  Hospital  for  Consumption  and  Diseases 
of  the  Chest,  7,  Fitzroy  Square,  W.,  will  be  opened  by 
an  address  by  Dr.  Arthur  Newsholme,  on  "  Public 
Preventive  Measures  against  Tuberculosis  in  Relation 
to  the  Medical  Practitioner."  The  meeting  is  open 
to  all  interested  in  the  subject,  and  the  lecture  and 
demonstrations  are  free  to  all  medical  practitioners 
and  students  of  medicine. 


JA*. 


MEDICAL    NEWS. 


Tun  Meuical  Pressi     25 


Xaboratorg  notes* 

-TABLOID "     HYDRARGYRI    PERCHLORIDI 
1-32,      ET  POTASSII   IOD1D1.  GE.  ^*- 
srs.  Burroughs    and    WwXCOUB  have  added 
1L*ir  list   of   »  tabloids  M    one    that   will   be   found 
especially  convenient.     As  everyone  knows,  in  cases 
requiring     treatment    bv    mercury     perchloride    and 
,.nun  iodi  lallv  necessary  to  continue  the 

ition  of  the  combination  with  regularity  for 
time,         Tabloid  "   Hydrarg.   Ferchlor.   gr.   1-32 
_r.  2|  has  therefore  been  introduced 
rovide  a  trustworthy  means  oi  carrying  out  the 
imcnt    when    small    doses    are    required.     When 
necessary,  "  Tabloid  "  Hydrarg,  Per 
U*.  1-16  et  Potassu  lodidi,  gr.  5,  Which  has  been  issued 
for  IODIC  time  past,  may  be  prescribed. 

FRY'S  COCOA  AND  Ml LIC 
This  preparation  by  J,  S.  Fry  and  Sons.  Bristol 
highly  mjUitkmfl  oompotrnd  Of  cocoa  and  sweetened 
milk,*  and  very  convenient  and  concentrated 

It  is  free  Irom  the  least  trace  of  rancidity  and 
after  il  had  been  kept  open  for  a  considerable   time  in 
aboratory,   we    found    that  il   had  not  undergone 
t ion  whatever* 

•,e  have  obtained  the  following  results  : 
Mure,  22.0  ; 
Mineral  matter,  2,0  ; 
Albuminoids  io*0  ; 
Fat,  1 2.0; 

Sugar,  by  difference,    54.0. 
"  A  careful  search  for  poisonous  metals  proved  their 

^ence, 
-ults  it  is  plain  that  this  preparation  is  a 
cent  rated  food  of  great  value,  which  keeps 
well  even  when  the  tin  has  been  open  tor  a  I 1  nisiderabie 
id  Lime, 


iHebloU  #cto0- 


TIM  New  Appointments  at  Br,  Steevena'  Hospital 

The  Board  of  Dr,  Steevens'  Hospital  met  on  Decenv 

r  >^nd,  to  till  the  posts  of  visiting  physician,  gyna^co- 

and    house    surgeon,     The    physiciancy    was 

in    the    regretted    resignation    of    Dr. 

Henry  <     I  weedy,    due    to    ill -health.      Dr,  Tweedy 

been  connected  with  the  hospital  for  many  years, 

and    his    resignation    was    deeply    regretted.        The 

ecologistship  was  vacant   by   the  election  of  Dr. 

ugs  Tweedy  to  the  Mastership  of  the   Rotunda 

Hospital,  an  appointment   to  which  we  have  already 

rod    m    these    columns.       The    election    resulted 

m   the  appointment    of     Dr.   T.    P.  C    Kirkpa trick, 

tant  Physician  to  the  post  of  physician  ;  and  of 

Dr.  Henrv  Jctlett,  a  former  assistant   master  of  the 

nda  Hospital,  to  the  post  of  gynecologist  ;  and 

of  Or,  Blacklev  to  the  post  of  house  surgeon.     At  the 

same  meeting  Mr.  R.  L.  Swan,  F.R.C.S.  was  co-opted 

a  Governor  of  the  Hospital. 

Epileptic  Colony. 

The    Asylum*    Committee  of   the   London  County 

orted  that  the  epileptic  colony  on 

m    provided  accommodation 

lor  866  male  and  ?H  female  patients,     They  had  trans- 

I   from   the  other  asylums  all   the  male  epileptics 

luitabte  cases  for  the  colony  and  had  a  few 

,<:ies  remaining.     These  they  proposed  to  use  for 

die  reception  of  private  male  patients,  their  experience 

fhe    private    accommodation    elsewhere 

Log  convinced   them   that  a  moderate  charge  was 

reciated  by  a  class  of  people  who  were  unable 

k>  pe  trges  of  private  institutions,     The 

to  be  charged  would  be  i8s,  id.  and  2  is.  a  week. 

Death  under  Ether, 

i .   Francis  Taylor,   of  Poliard 
oats,  has  died  while  under  the  influence  of  an 


anaesthetic,  administered  for  the  purpose  of  an  opera- 
tion.    When    he   arrived    home    nn    furlough   recently 
he  was  suffering  from  a  swelling  in  the  neck,  apparently 
i  by  a  bad  tooth.     On  the  t/th  inst.  a  doctor  was 
in.  whu    found  Taylor    in    a    serious   condition. 
It  was  necessary  to  do  something  at  once,  and  ether 
was  administered.     At   first    the   deceased    man   took 
the  ether  badly.  I  nit  IOOO  afterwards  he  quietened  down. 
It   was  then  thought  advisable  to  draw  a  tooth,  but 
before  the  instrument  could  he  got  into  his  mouth  his 
breathing    suddenly    stopped.     The    (  oroner's     jury 
agreed  that  death  was  due  to  misadventure. 
Memorial  to  the  late  Dr.  John  Man  ley. 
On   December   i<Sth   a   marl  t   the  late  Dr. 

John  Manley,  formerly  medical  officer  for  the  borough 
of  West  Bromwieh,  and  chairman  of  the  Free  Library 
Committee,  which  has  been  placed  in  the  central 
reading  room.  High  Street,  as  s  permanent  memorial 
of  the  services  rendered  to  the  town  by  him,  was 
unveiled  in  the  presence  of  a  numerous  company  by 
Alderman  H,  Hartland,  who,  OS)  behalf  of  the  sub- 
scribers, handed  it  over  to  Councfllox  \.  G,  Furley 
(Mayor),  Underneath  the  bust  is  the  following  in- 
scription: t4  John  Manley,  Esq.,  J, P.,  member  of  the 
Free  Library  Committee  from  1875  to  1902,  and 
chairman  of  the  above  1891  to  tgo2  ;  \j  years  medical 
officer  of  health  for  West  Bromwich.  A  tribute  of 
admiration  and  respect  from  a  number  of  his  personal 
friends.  Bom  1827,  died  January,  1902."  Tht 
of  the  butt,  which  is  the  work  of  Mr.  Hopkins,  oi  West 
Bromwich  School  of  Artr  has  been  defrayed  bv  sub- 
scriptions. 

London  School  of  Tropical  Medicine 
Of  the  students  of  the  above  school  who  presented 
tin -mselves   for   the  examination   at    the   end    oi    the 
October-December,    TQ03,  Session,   the  following   have 
passed  : — Dr.   A.    E.    Horn   (Colonial   Service!,    Dr.    A 
H.  Barclay  (Foreign  Office).  Major  Wilson,  (R.A.M 
MB.  Ac  .  Dr.  W.  J.  Radford   (Foreign  Office),  passed 
with  distinction  ;  Dr.  D.  Cowin  (Colonial  Service),  Dr. 
J.  E.  Mitchell,    Dr.  S.  G.  Ranaday.    Dr.  C,  H.  Allan 
(Colonial  Service),  Dr.  J.  T.  Cart&ya,  Dr.  F  A.  Baldwin 
(Colonial  Service),  Dr.  T.  F.  G.  Mayer  (Colonial  Service), 
Dr,  F.  C.  Sutherland,  and  Dr.  Guy  Ruata. 

Here  Small  pox  In  London. 
It  was  reported  to  the  Public  Health  Com  mitt- 
the   Stepney  Borough   Council   last  Friday,  that    three 
cases  of  small-pox  had  broken  out  in  Mile   Bod   since 
Christmas   Day,     Every   precaution  was  being  taken 
to  prevent  the  spread  of  the  disease,     Mile  End   b 
so     notoriously     anti- vaccinationist     a     district,     the 
occurrence  there  ,,f  small-pox  is  of  more  than  ordinary 
significance. 

Medical  Sickueaa  and  accident  Society. 
The  usual  monthly  meeting  of  the  Medical  Sickness, 
Annuity  and  Life  Assurance  Society  was  held  at  410, 
Strand,  W.C.,  on  December  i£th.  There  were  present 
Dr.de  Havilland  Hall  (m  the  chair),  Dr.  St.  Clair  B. 
Shad  well,  Mr.  J.  Brindley  James,  Dr.  Fredk.  S. 
Palmer.  Dr.  M,  Greenwood,  Dr.  J.  W.  Hunt,  Mr.  H. 
P  Svmonds,  Mr.  F.  S.  Edwards.  Dr.  F.  J.  Allan, 
Dt.  VV.  Knowsley  Sibley,  and  Dr.  J,  B,  Ball.  The 
accounts  for  the  eleven  months,  ending  in  November 
bat,  show  tnat  the  Society  had  in  that  period  secured 
more  new  members  than  in  the  previous  twelve  months, 
and    it   seems    i  1    the  steady  increase    in    the 

number  of  applicants  for  membership  that  the  ad* 
vantages  which  the  Soci-  to  members  of  the 

profession  are  becoming  more  widely  known.  The 
amount  paid  away  in  Sickness  claims  is  less  than  in 
the  corresponding  period  of  last  year,  and  then  is 
every  reason  to  hope  that  the  result  of  the  quinquennial 
valuation  oi  the  Society's  business,  now  m  progress, 
will  show  that  an  ample  margin  exists  after  providing 
for  all  liabilities.  Prospectuses  and  all  particulars 
on  application  to  Mr.  F.  Addis  cot  t  Secretary,  Medical 
Sickness   and    Accident    Society,    $5,   Chancery    l.ane. 

London!  w.c. 


26        The  Medical  Peess.         NOTICES    TO    CORRESPONDENTS. 


Jan.  6,  1904. 


JUrtictB  ta 
^oxxtBfoxtbtntBf  Shxrrt  %tttzt*t  &c 

09*  Correspondents  requiring  a  reply  in  this  column  are  particu- 
larly requested  to  make  use  of  a  distinctive  signature  or  initial,  and 
avoid  the  practice  of  signing  themselves  "Reader,"  "Subscriber," 
"Old  Subscriber,"  60.  Much  contusion  will  be  spared  by  attention 
to  this  rule. 

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

Original  Articles  or  Letters  intended  for  publication  should  be 
written  an  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

Reprints.— Reprints  of  articles  appearing  in  this  journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

APPRECIATION. 
A  Subscriber  at  Sheffield  in  remitting  his  annual  subscription  this, 
week  writes :— *f  I  always  enjoy  reading  you »■  journal  in  my  brougham ; 
it  is  not  too  big  nor  overloaded  with  a  lot  of  theoretical  rubbish.      I 
greatly  appreciate  its  crisp  style." 

A  Glasgow  correspondent  writes  by  same  po9t :— "I  like    you* 

journal  so  much  that  I  introduced  it  to  my  friend  Dr. ,  who  said 

he  would  like  to  become  a  subscriber." 

Such  messages  of  appreciation  are  greatly  esteemed  and  help  to 
lubricate  the  wheels  of  medical  journalism,  preventing  them  fiom 
■clogging. 

N.  T.  B,  Y.— Our  correspondent  is  thanked  for  his  suggestion, 
which  shall  be  acted  upon. 

Excelsior.— From  inquiries  which  we  have  made  into  the  matter, 
our  answer  must  be  in  the  negative. 
Western.— Yes. 

8ANATORIUMS  OR  SANATORIA. 
Much  difference  of  opinion  exists  as  to  the  proper  plural  of  the 
-word  sanatorium,  some  preferring  a  frankly  English  plural— sana- 
toriums— others  voting  for  sanatoria.  Since  the  word  is  of  Latin  ex- 
traction it  may  not  be  without  interest  to  know  that  the  secretary  of 
the  French  Academy,  the  great  authority  in  the  matter  of  ortho- 
graphy, has  decided  in  favour  of  the  former,  he  having  discovered  a 
number  of  French  words  terminating  in  '  urn'  which  form  their 
plural  bv  the  addition  of  an  '  s.'  Possibly  this  decision  may  assist  us 
in  deciding  which  form  to  adopt. 

FJI.C8.Edin.,  writes:— "Can  any  one  of  your  readers  give  me 
some  information  as  to  the  prospects  of  starting  general  practice  in 
Western  Australia  ?  Where  could  I  find  a  description  of  the  climate, 
and  other  details  of  the  Colony  ?" 

EMOLUMENT. 
A  Board-School  girl,  asked  to  define  the  term  emolument,  described 
it  as  M  A  soothing  medicine  "—nor,  pace,  the  professor  of  materia 
-medica,  was  she  very  wide  of  the  mark. 

W.  B.  R.— The  so-called  ••  acrodynic  erythema,"  a  term  applied  to 
the  patchy  red  spots  you  describe  on  your  patient's  palms  and 
soles  is  now  usually  ascribed  to  a  toxic  action  on  the  ocrd.  It  is  diffi- 
cult to  name  any  satisfactory  therapeutic  plan  of  treatment,  but 
there  are  two  modern  methods,  namely,  hot-air  baths  and  "  high 
frequency ''  electrical  currents,  which  certainly  would  be  worthy  of 
trial.    Drugs  have  little  influence  upon  the  condition. 

Dr.  Wallwood.— No  "  characteristic  organism  of  cancer  "  has  yet 
been  isolated.  The  bacteriology  of  cancer,  so  far,  has  proved 
negative 

Dr.  Ahrik  Sinoh  (Lafurwal)  is  thanked  for  his  communication, 
which  is  reserved  for  future  reference. 


^SSlrHL^V^Kr  "W*.  °Lth€  ^^^  Hospital  for  the  year 
1902-03.  Dm.  Jellett  and  Earl— Sarcoma  of  the  Vagina  with  notes  on 
a  ^'^  ^ibits  b>'  card.-Dr.  W.  J.  Smylv-PapiTlomatous  ovaries. 
—The  President  1.  Pyo-salpinx  (four  specimens).  2.  Large  Intra- 
ligamentous Fibro  myoma.    8.  Interesting  Ovarian  Cysts. 

Medical  Graduates'  College  and  Polyclinic  (22  Chenies  Street. 
W.C.).— 4  p.m.  Mr.  A.  Lawson— Clinique.     (Eye.) 

**^,~  „      Thursday,  January  14th. 

At  20]Hanover  Square,  W\,  at  8  p.m.  A  paper  will  be  read  by  Dr. 
Mendes  de  Leon,  on  •«  A  hitherto  not  sufficiently  recognised  source 
of  infection  during  operations."  The  President  will  deliver  his  Vale- 
dictory  Address. 


JlppohttnuniB. 


,  C.M.Qlasg.,  Medical  Officer  to 


Bush.  James  Paul,  M.R.C.S.,  L.S.A., 

the  Bristol  Post-Office. 
^R"*L^  Charles,  L-»  C.P.Lond,,  M.R.C.S.,  Medical  Officer  to  the 

Bristol  Dispensary. 
Folkjr,  H.  H,  M.R.C8..   L.R.C.P.Lond.,  Certifying  8urgeon  under 

the  Factory  Act  for  the  Hanley  District  of  the  county  of  Stafford. 
Gilford,  Sidney,  M.B.,  Ch.B.Edin.,  HouseSurgeon  to  the  Paddington 

Green  Children's  Hospital. 
Holland,  Eardlry,  M.R.C.S.,  L.R.C.P.Lond.,  House  Phvsician  to 

the  Paddington  Green  Children's  Hospital. 
Houseman,  Edward  A.,  B  A.,  MB.,  S.C.Cantab.,  Medical  Officer  to 

the  East  Indian  Railway. 
Ishrrwood,  F.,  L.R.C.P,L.R.C.S.Edin.,  L.F.P.S.Glasg.,  Certifying 

Surgeon  under  the  Factory  Act  for  the  Cockermouth  District  o 

the  county  of  Cumberland. 
Lamport,  Ethel  Frances,  M.D.Brux.,  L.S.A  ,  Public  Vaccinator  for 

the  Isle  of  Dogs  district  of  Poplar. 
McNabb,  H.  Horsman,  M.D.Vict.,  Assistant  Honorary  Surgeon  to  the 

Manchester  Royal  Eye  Hospital. 
Moors.  Leonard  a.,  L.R.C.P.Lond.,  M.R.C.S.,  Medical  Officer  to  the 

Bristol  Dispensary. 
Stanley,    John    Douglas,   M.D.Edin.,    M.R.C.P.Lond.,    Honorary 

Physician  to  the  Birmingham  Children's  Hospital. 
Thompson,  William  Fookes  M  D.,  O.M.Edin.,  Medical  Officer  for  the 

Northpetherwin  District  by  the  Launceston  (Cornwall)  Board  of 

Guardians. 
Turner,  H.  N.,  M.B.,  B.S.Glasg.,  Certifying  Surgeon  under  the  Fac- 
tory Act  for  the  Castle  Bytliam  District  of  the  county  of  Lin- 
coln. 
Wade,  Henry,  M.B.,  F.R.CS.Edin.,  Conservator  of  the  Museum  of 

the  Boyal  College  of  Surgeons,  Edinburgh. 
Walker,  J.  D  ,  M.B.,MjS.Aberd.,  Certifying  Surgeon  under  the  Fac- 
tory Act  for  the  Shaftesbury  District  of  the  county  of  Dorset. 
Williams,  S.  R.,  M.R.C.8.,  L.R.C.P.,  Clinical  Assistant  at  the  Chelsea 

Hospital  for  Women. 


^Ueiing*  of  the  Societies,  %tttwct&f  &c. 

Wednesday,  January  6th 

Obstetrical  Society  or  London  (20  Hanover  Square,  W  ).-— 8  p.m. 
Specimens  will  be  shown  by  Dr.  R.  H.  Bell  and  Mr.  J.  D.  Malcolm. 
8hort  Communications— Dr.  V.  Bonney— Pyometra  in  One  Half  of  a 
geptate  Uterus.— Dr.  A.W.W.'Lea— Abscess  of  the  Uterus.  Paper— Dr. 
H.  R.  Spencer— Fibro-myoma  of  the  Intra-abdominal  Portion  of  the 
Round  Ligament  of  the  Uterus. 

Medical  Graduates'  College  and  Polyclinic  (22  Chenies  Street, 
W.C). — *  p.m.    Mr.  P.  J.  Freyer— Clinique.     (Surgical.) 
Thursday,  January  7th. 

Medical  Graduates'  College  and  Polyclinic  (22  Chenies  Street, 
W.C.).— 4  p,m.    Mr.  Hutchinson.     Clinique.    (Surgical.) 
Friday,  January  8th. 

The  Incorporated  8ociety  of  Msdical  Officers  op  Health  (9 
Adelphi  Terrace,  Strand,  W.C.).— 7.80  p.m.  Council  Meeting.  Paper 
—Dr.  J.  Spottiswoode-Camerou— The  Sophistication  of  Foods. 

Clinical  Society  ok  London  (20  Hanover  Square,  W.).  -8.30  p.m 
Papers— Sir  Dyce  Duckworth  and  Prof.  H.  Marsh— A  Case  of 
Pneumococcal  Peritonitis  —Dr.  F.  Taylor— A  Case  of  Pneumococcal 
Peritonitis.— Dr.  8.  Phillips— A  Case  of  Fihroid  Disease  of  the  Pan- 
creas with  Calculi,  accompanied  by  Jaundice  and  subsequently  by 
Diabetes,  Laparotomy,  Relief  of  Symptoms.  Death. 

Royal  Academy  op  Medicine  in  Ireland.    Section  of  Obstetrics. 


Ancoats  Hospital,  Manchester.— Resident  House  8urgeon.  Salary 
£100  per  annum,  with  board,  residence,  &c.  Applications  to 
Sami  Baron,  Secretary. 

City  of  London  Lying-in  Hospital,  City  Road,  B.C.— Surgeon- 
Accoucheur.  Salary  £100  per  annum.  Applications  to  R.  A. 
Owthwaite,  Secretary. 

Department  of  Medicine,  Yorkshire  College,  Leeds.— Junior  Demon- 
strator of  Pathology.  Salary  £120  per  annum.  Applications  to 
the  Registrar. 

Metropolitan  Asylums  Board.— Vale  Assistant  Medical  Officer.  Salary 
£150  per  annum,  with  rations,  lodgings,  attendance,  and  washing. 
Applications  to  the  office  of  the  Board,  Embankment,  E.C. 

Royal  Victoria  Hospital,  Bournemouth.— House  Surgeon.  Salary 
£110  per  annum,  with  board  and  lodging.  Applications  to  the 
Chairman  of  Committee. 

6t.  Mary's  Hospital  Medical  School,  Paddington,  W.— Demonstra- 
tor o'  Physiology.  Salary  £160  per  annum.  Applications  to  H. 
A.  Caley,  M.D.,  F.R.C.P.,Dean. 

Staffordshire  General  Infirmary,  Stafford.— Assistant  House  Surgeon. 
Salary  £50  per  annum,  with  board,  lodging,  and  washing.  Appli- 
cations to  the  House  Surgeon. 

Tiverton.  Devonshire,  Infirmary  and  Dispensary.— House  Surgeon 
and  Dispenser.  Salary  £80  per  annum,  and  all  found.  Applica- 
tioiis  to  Arthur  Fisher,  Hon.  Secretary. 

Wolverhampton  Eve  Infirmary.— House  Surgeon.  Salary  £70  per  an- 
num, with  rooms,  board,  and  washing.  Applications  to  the  Sec- 
retary. 


girths. 


Edmonds.— On  Dec  28th,  at  Manor  House,  Inverleith  Avenue,  Streat- 

ham,  S.W.,  the  wife  of  C.  J.  Ernest  Edmonds,   L.R.C.P.Lond,. 

M.R.C.S.Eng.,  of  a  daughter. 
Harneis  —On  Dec.  31st,  at  186  Amhurst  Road,  the  wife  of  T.  W. 

Morcom  Harneis,  M.R.C.S.,  L.R.C.P.,  of  a  son. 
Jellett. — On  Jan.  3rd,  at  61  Lower  Mount  Street,  Dublin,  the  wife  of 

Henry  Jellett,  M.D.,  of  a  daughter. 


feailts. 


Bartkls.— On  Dec!  21st.  at  West  Kensington,  of  acute  bronchitis,  Dr. 
Bartels,  formerly  of  Cambridge  and  Clapham,  aged  83. 

Elliot*.— On  Dec.  28rd,  at  115  Ladbroke  Grove,  W.,  Mary  Christian 
Elliott,  widow  of  the  late  Captain  John  Bardoe  Bowes  Elliott, 
J.P.,  and  daughter  of  the  late  Dr.  James  Corbet,  J.P.,  aged  60. 

Hunter.— On  Dec.  28th,  at  146  Lavender  Hill,  Frederick  Hunter, 
M.R  C.S.,  L.R.C.P.,  Ac.,  the  loviug  and  beloved  husband  of  Caro- 
line Ida  Hunter. 

Sugden.— On  Dec.  30th.  at  Buckfastleigh  S.  Devon.  D'Arcy  Sugden, 
M.R.C.S  Eng.,  L.R.C.P.Lond.,  third  son  of  the  late  William  Sug- 
den, of  Bath. 


Mk  g|Ufal 


km    ami    iTtrrnlar. 


^SALUS    FOPULI    SUPEEMA    LEX-* 


Vol.  CXXVIIL 


WEDNESDAY,    JANUARY     13,    1904- 


No,    2. 


Original  Communication** 
THE    HYGIENI^TREATMENT 

OF 

CONSUMPTION,  («) 

By    T.    N.    KELYNACK,    M.D.,    M.R£P,t 

to  the   Mount    Vernon    Hospital   far  Consumption    and 
orl  live  Chest,  Hampstend  and  North  wood,  Lai  ad  on. 


A  rational  conduct  of  the  hygienic  treatment  nf 
consumption  must  be  based  on  a  sound  knowledge  of 
of  the  a  Section  and  wide  experience  of 
rnptomatology. 
There  seems  a  danger,  at   least  in  some  quarts! 
asiummg  that  in  the  so-called  "  open-air  "  method  we 
have  discovered  a  "  specific  "  treatment  of  consumption 
which,  irrespective  of  accurate  information  regarding 
its  pathology  or  satisfactory  interpretation  of  clinical 
may  nevertheless  secure  arrest  of  the 
disease  and  perfect  restoration  to  health 

It  1  ry  that  '-very  effort  should  be  made 

1  edit  being  brought  upon  a  system  which 
offers  the  best-known  means  of  satisfactorily  coping  with 
pulmonary  tuberculosis, 

^Th  itel    principles    underlying  the    hygienic 

management  of  consumptives  arc  : — 

i.   The   removal  of  the  patient    from   the  sphere  of 
action  of  the  causal  influences  of  the  disease. 

!  . !  lishment  of  such  conditions  as  will  allow 

Of   the  development  of  reparative  processes  and  the 
evolution  of  the  highest  powers  of  resistance* 

A  ml  to  this  end  experience  and  experiment  have 
abundantly  testified  that  the  following  factors  are  of 
importance;  —  i.  A  continuous  open-air  life 
under  natural  conditions*  2.  Free  exposure  to  sun- 
light-  v  Carefully  regulated  rest.  4*  Graduated' 
\ ant  dietary*  6.  Strict  compliance 
with  all  hygienic  requirements.  7.  Constant  medical 
supervise 

TtfL  EVOUJTIQK  of  Tuberculosis, 

Bel  tg  to  consider  the  various  ways  in  which 

the  hygienic  treatment  of  consumption  is  being  carried 

irtieularly  in  this  country  at  the  present  tnm.it 

may  !>le  to  consider  rnent  the  eoudi- 

which  have  led  to  the  invasion  of  the  human  by 

the  tubercle  bacillus* 

ft  would  be  as  useless  to  romance  as  to  the  manner  m 
which  the  first  primitive  man  fell  a  victim  to  the  attack- 
ing microbe  as  to  attempt  an  explanation  of  the  origin 
its  human   parasite,   but   from  a  study  of  such 
glimpses  of  the  life  of  prehistoric  man  as  have 
rcvealH  by  much  patient  and  painstaking  research  we 
II  events  gain  some  idea  of  the  stow  develop - 
rvental   influences  and  the  evolution 
i-»(  actual  tissue  conditions  which  have  rendered  man 
iliarly   prone  to  tuberculous   invasion.      It   seems 
that  among  civilised  people  under  con- 
dition* such,  for  instance,  a*  exist  in  this  countrv  and 


lit  delivered  In  cttnnci.tion  with  the  Post* 
CenLj-.il  '  ML -L'ulUMit  Department  0*  Mount 

L  ifl  I  ."II 


America  that  half  the  community  have  or  have  had 
some  form  of  tuberculosis,  (a) 

Post-mortem  investigations  certainly  clearly  show 
that  something  like  JO  per  cent,  of  individuals  present 
evidences  of  having  been  the  subjects  of  a  tuberculous 
infection*  (h) 

Primitive  people,  as  far  as  can  be  ascertained,  when 
living  a  free  and  nomadic  life  show  but  little  suscepti- 
1. 1 1  u  v  to  tuberculosis.  Wild  animals  rarely  sutler* 
And  even  certain  animals  which  are  experimentally 
susceptible  to  tuberculosis  only  exceptionally  contract 
it  spontaneously. 

On  the  Other  handr  natives  subjected  to  so-called 
influences  of  civilisation  are  peculiarly  prone  to  develop 
phthisis,  and  oftentimes  show  but' feeble  powers  of 
resistance  to  a  tuberculous  invasion. 

Domesticated   animals,  as   is   well  known,    manifest 
marked     susceptibility*     Captive     monkeys     are     fre- 
quently   affected,     and     the     disease     is     widespread 
among  cattle  and  fowl,  and  is  met  with  also  in  pigs, 
rats,  horses  and  sometimes  sheep. 

Primitive  man,  as  far  as  we  can  ascertain,  enjoyed 
with  the  free  living  animals  a  high  degree  ot  resistance 
to  tuberculosis. 

There  is  reason  to  believe  that  at  least  in  most  Euro- 
pean countries  the  progress  ot  Western  civilisa- 
tion has  been  accompanied  until  recent  times  h 
increase  in  consumption*  It  is  well  tO  remember  that 
the  Greeks  and  Romans  and  Arabs  practised  the 
hygienic  life  to  a  greater  extent  than  is  passible  for 
most  of  us  at  the  present  time,  for  they  both  by  day  and 
night  were  probably  exposed  to  a  more  abundant  supply 
of  fresh  air  than  is  now  possible  in  our  country  with  its 
crowded  cities  and  densely  populated  districts. 

It  is  neither  possible  nor  desirable  to  return  to  the 
habits  and  customs  oi  primitive  man,  but  it  is  at  least 
reasonable  to  inquire  it  iu  the  process  of  civilisation  we 
have  not  departed  from  desirable,  natural,  and  health- 
maintaining  procedures* 

Primitive  man  was  no  doubt  much  of  a  vagabond, 
but  he  was  at  all  events  mainly  engaged  in  pursuits 
necessitating  an  open-air  existence.  He  was  freely 
exposed  to  the  beneficial  influences  of  sunlight  and  other 
natural  forces*  Hts  exercise  and  rest  were  directed 
and  governed  chiefly  by  the  exigencies  of  creative 
needs.  He  had  to  work  for  Ms  food.  It  is  certain  he 
did  not  allow  his  sanitary  requirements  to  be  arranged 
by  an  unknown  medical  officer  of  health,  neither  did  he 
consult  his  physician  on  the  desirability  of  fashioning 
his  life  in  accordance  w^ith  hygienic  principles. 

I  do  not  wish  to  be  misunderstood.  I  do  not  advo- 
cate a  return  to  barbarism,  but  we  must  all  recognis-.*, 
I  think,  in  studying  such  a  disease  as  consumption,  the 
necessity  of  availing  ourselves  of  the  light  which  the 
teaching  of  evolution  is  capable  of  affording. 

To  sum  up.  therefore,  we  may  say— Most  healthy 
individuals  possess  vigorous  powers  of  resistance 
to  tuberculosis.  The  maintenance  of  a  high  stan- 
dard   ot    personal    hygiene  aSords   the    best  security 

(a)  Consult  " TubdfeiiLoti».,J  By  Norman  Bridge,  A.M.,  M. i». 
fjODilon  ,&£-.,  1903* 

(b)  tUn»an»,  A„  "  Bodily  Conditions  Resist  in u  Phthisi*."* 
Medial  OtnmleU,  April.  11W& 


28    The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


Jan.  13,  1904. 


against  infection.  The  protective  agencies  of  the  body 
are  manifold,  but  their  efficiency  can  only  be  secured 
by  systematic  compliance  with  natural  law.  We  do  not. 
of  course,  deny  the  immense  importance  of  an  inherited 
or  acquired  susceptibility,  but  probably  we  are  not 
going  too  far  in  suggesting  that  the  perfectly  healthy 
individual  enjoys  an  almost  absolute  immunity  to 
tuberculosis. 

Details    of    Sanatorium    Treatment. 

It  is  now  generally  admitted  that  the  hygienic  treat- 
ment of  pulmonary  tuberculosis  can  be  most  effectively 
carried  out  in  a  specially  designed  and  definitely  con- 
ducted institution.  Hence  the  term  "  hygienic  treat- 
ment "  may  well  be  replaced  by  the  title  of  "  sana- 
torium management,"  but  unfortunately  it  is 
necessary  to  say  the  latter  does  not  always  altogether 
include  the  former. 

I  have  recently  visited  a  number  of  excellent  sanatoria, 
and  have  been  much  struck  by  the  wide  differences  in 
methods  and  procedures.  Considerable  divergence  in 
practice  exists,  and  great  variation  in  the  conduct  of  all 
important  details  is  everywhere  conspicuous.  No 
doubt  at  a  time  when  much  in  regard  to  so-called 
sanatorium  treatment  is  in  an  experimental  stage,  a 
certain  variety  in  practice  is  not  only  permissible,  but 
even  desirable,  but  it  is  of  the  greatest  importance  that 
in  this  very  special  line  of  medical  work  an  open  mind 
should  be  maintained,  and  a  strict  scientific  spirit 
upheld,  and  all  faddist  and  quackish  narrowing  of 
outlook  avoided. 

Almost  of  necessity  most  physicians  -  engaged 
in  sanatorium  practice  are  more  or  less  isolated, 
and  to  a  great  extent  deprived  of  contact  with 
medical  centres.  It  seems  to  be  most  desirable 
that  public  sanatoria,  at  least,  should  not  be  left 
to  the  sole  care  and  discretion  of  resident  officers, 
but  should  always  be  furnished  with  a  visiting 
staff.  At  the  present  time,  when  sanatoria  are 
springing  up  all  over  the  country,  it  would  be  well  if 
some  means  could  be  found  whereby  greater  co-opera- 
tion and  combination  in  scientific  work,  and  compari- 
son of  clinical  procedures  and  results,  could  be  secured. 
A  study  of  the  reports  of  the  various  British  sanatoria 
will  furnish  abundant  evidence  of  the  need  for  some 
such  combine,  [a) 

In  the  carrying  out  of  an  effectual  hygienic  treatment 
of  consumption  among  the  poor,  I  believe  some  such 
comprehensive  scheme  as  we  are  endeavouring  to  pro- 
vide in  the  case  of  Mount  Vernon  Hospital  is  absolutely 
necessary. 

1.  A  central  out-patient  department  for  the  selection 
of  suitable  cases  for  admission  to  the  hospital  and  sana- 
torium, the  treatment  ot  patients  who  cannot  obtain 
admission  to  any  suitable  institution,  and  the  periodical 
inspection  of  those  who,  having  undergone  sanatorium 
treatment,  have  returned  home  or  recommenced  work. 

2.  A  hospital  maintained  on  sanatorium  lines,  near 
the  city,  where  acute  cases  may  be  readily  [admitted, 
and  doubtful  ones  watched  and  thoroughly  investigated. 

3.  A  country  sanatorium,  where  carefully  selected 
cases  may,  under  strict  medical  control,  careful  nursing, 
and  perfect  hygienic  conditions,  be  directed  to  a 
practical  recovery. 

It  is  also  very  necessary  that  a  suitable  home  for 
incurable  cases  should  be  included  in  such  a  scheme. 
For  children,  a  special  institution,  preferably  by  the 
sea-side,  is  desirable.  And  for  many  consumptives  it 
must  be  remembered  that  return  to  town  life  means 
almost  inevitably  reinfection  or  recrudescence  of  the 
slumbering  disease.  For  such,  a  hygienically  conducted 
colony  seems  the  only  solution. 

In  some  cities  it  is  possible  to  render  real  benefit  by 
providing  a  home  officer  who  visits  bedridden  cases  and 
patients  who,  because  of  weakness  or  other  disability, 
are  unable  to  attend  the  out-patient  department. 
By  such  service  much  suffering  is  relieved  and  friends 
can  be  educated  regarding  the  best  means  of  preventing 
the  propagation  ot  the  disease.  It  is  much  to  be  de- 
sired that  a  larger  number  of  nurses,  especially  those 
whose  duty  brings  them  into  contact  with  the  poor, 

(«)  See  Series  of  Special  Articles  on  "  British  Sanatoria  for  Con- 
sumption/' Thb  Mbdical  Press  asd  Circular,  July  8th  1003,  et.  seq. 


should  be  trained  in  the  details  of  the  hygienic  treat- 
ment of  consumption. 

It  is  not  my  purpose  to  dwell  on  the  most  important 
matter  of  the  selection  of  cases  for  hygienic  treatment, 
although  the  utter  insufficiency  of  sanatorium  accom- 
modation for  the  poor  in  this  country  at  the  present 
time  makes  this  subject  one  of  pressing  importance. 
I  have  discussed  it  elsewhere,  (a) 

Time  will  not  allow  me  to  dwell  at  length  on  the 
various  factors  in  the  hygienic  treatment  as  now  con- 
ducted in  the  best  sanatoria.  I  can  only  touch  on 
some  of  the  more  conspicuous  features. 

The  Open-Air  Life. 

Free  access  to  fresh  air  and  sunlight  forms  the  most 
essential  factor.  Such  can  be  best  attained  by  secur- 
ing an  out-of-door  life.  Generally  speaking,  climate  is 
mainly  of  importance  in  so  far  as  it  allows  of  an  un- 
restrained life  in  the  open.  Dr.  R.  W.  Philip,  as  far 
back  as  1898,  (b)  contended  that  phthisis  may  be 
treated  with  approximately  equal  success,  or  want  of 
success,  in  all  climates,  according  as  ttye  larger  indica- 
tions for  treatment  are  fulfilled  or  overlooked. 

Experience  has  fully  justified  his  statement  that, 
"It  is  a  comforting  doctrine,  and  economically  re- 
assuring, that  the  tuberculous  patient  of  whatever 
country  or  race  can  be  suitably  treated  not  far  from  his 
own  home." 

The  various  reputed  climatic  factors  have  been  much 
discussed,  (c)  Doubtless  several  are  of  considerable 
moment,  but  concisely  summarised  they  are  all  mainly 
of  importance  in  so  far  as  they  encourage  the  patient 
to  live  the  open-air  life. 

Rest  and  Exercise. 

The  consideration  of  arrangements  for  rest  and 
exercise  must  not  be  separated,  as  is  so  often  the  case. 
The  right  apportioning  forms  one  of  the  most  difficult 
and  responsible  of  the  duties  of  a  medical  man  directing 
the  hygienic  treatment  of  a  consumptive. 

We  are  all  acquainted  with  Hilton's  wonderful  classic 
on  "  The  Therapeutic  Influence  of  Rest,  and  the 
Diagnostic  Value  of  Pain,"  and  although  much  of  its 
application  is  directed  to  surgical  work,  the  principles 
there  laid  down  are  almost  equally  serviceable  in  the 
practice  ot  medicine,  and  have  particular  bearing  on 
the  management  of  consumptives.  Almost  every  case 
of  pulmonary  tuberculosis,  at  least  until  carefully 
studied  in  all  its  bearings,  should  be  submitted  to  rest. 
It  is  a  general  rule,  and  I  think  a  very  good  one  in  most 
institutions,  to  keep  the  patient  altogether  in  bed  for 
the  first  few  days.  Rest  is  not  only  valuable  as  a  means 
of  conserving  energy,  but  also  because  it  is  capable  of 
exercising  a  beneficial  psychological  action.  Absolute 
rest  in  the  recumbent  position  is  of  the  utmost  import- 
ance for  all  acute  cases,  for  it  gives  the  greatest  possible 
measure  of  immobility  to  the  thoracic  wall  over  the 
affected  portions  of  the  lungs.  Abundant  sleep,  it  must 
be  remembered,  is  one  of  the  most  natural  means  of 
securing  perfect  rest  to  mind  and  body. 

But  while  local  and  general  rest  play  an  important 
part  in  securing  the  establishment  of  reparative  pro- 
cesses, and  when  wisely  directed  go  far  to  restore  mental 
force  and  bodily  vigour,  I  am  convinced  that  judi- 
ciously selected  and  wisely  applied  exercise  stands  in 
the  very  forefront  of  natural  agencies  which  may  assist 
greatly  in  conducting  many  consumptives  back  to 
healthy  life. 

Ail  exercise  should  only  be  undertaken  under  strict 
medical  direction.  Much  harm  is  undoubtedly  done 
by  the  unregulated  wandering  of  patients  in  an  early 
stage  of  the  disease.  The  uncontrolled  exercise  in- 
dulged in  by  many  incipient  cases  sent  to  convalescent 
homes  not  infrequently  seriously  aggravates  the  con- 
dition.    The  temperature  is  a  valuable  guide  in  con- 


fa)  Kelynack.  T.  N. 
flurvi  ~  ...  • 

<*> 
Treatment 
23rd,  1898. 


Open-Air  Treatment  in  Great  Britain:  a 


er  and  a  Criticism."— Hospital,  April  26th,  1903. 
Philip,  R.  W.t  "On  the  Universal  Applicability  of  the  Open-, 
tment  of  Pulmonary  Tuberculosis."— Brit.  Med.  Journ.,  Ji 


Air 
July 


(e)  Among  recent  workt  consult  ••  Handbook  of  Climatology,"  by 
Dr.  Julius  Harm.  English  translation  by  Robert  De  Oourcy  ward. 
New  York:  1903:  and  "The Geography  of  Disease,"  by  Frank  G. 
Clemow.    Cambridge  :  1903. 


Jjtx.  15,  1904, 


ORIGINAL  COMMUNICATIONS, 


The  Medical  Press,    29 


siderutg  the  qualitative  and  quantitative  features  of 
ise. 

safest,  surest,  and  most  scientific  form 
•-rcise  for  the  convalescing  consumptive  is  regu* 
la  ted  walking- 

length,  speed,  and  character  of  the  walk  must  be 

carefully  graduated  by  the  physician,  who  must  make 

&  thorough  individual  study  of  each  case.     By  carefully 

Mted  walks  much  may  be  accomplished  in  the  way 

ic  expansion. 

V jji ous  forms  of  respiratory  exercises  have  been 

advocated*  but  much  judgment  is  necessary  to  avoid 

ondesirable  or  actually  prejudicial   results   unless   the 

ises  be  always  conducted  under  medical  super- 

Hydrotherapeutic  Measures. 
Most  jaded  and  weary  workers  have  experienced  the 
bracing  and  revivifying  effects  of  a  cold  dip  or  tepid 
hftlb. 

I  need  not  stay  to  remind  you  01  the  physiological 
action  of  hydrotherapeutic  measures  on  the  cardio- 
vascular apparatus  and  cutaneous  functions,      n 

Bui  what  is  undoubtedly  one  of  the  most  useful 
hygienic  measures  in  health  should  not  be  discarded  in 
<uch  a  pathological  state  as  pulmonary  tuberculosis, 
Of  course,  the  form  of  bathing  must  be  made  to  fit  the 
case. 

In  some  of  the  newer  sanatoria  elaborate  arrange- 
menu  have  been  made  for  various  forms  of  spray  and 
Aoochc  baths, 

t  believe  a  judicious  application  of  hydrotherapeutic 
measure*  is   likely   to   prove   of  much  benefit   in   the 
^etnent  of  phthisical  cases. 

baths  are  useful   mainly   for  their  general 
tome  action. 

Dietary. 
k  deferences  of  opinion  still  exist  in  regard  to  the 
number  of  the  meals,  character  of  the  food,  and  manner 
preparation  and  presentation,  best  suited  to  the 
nreds  of  the  consumptive. 

lathis  country  forced  feeding  is  fortunately  not  ear- 
ned out  m  such  drastic  fashion  as  has  been   tolerated 
abroad.     It  is,  however,  necessary  that  the  diet  should 
;  umlaut  and  highly  nutritious. 
hi  sume  sanatoria  in  this  country  the  medical  officer 
personally  superintends    the  distribution  of  all  food* 
The  food  given  is  is  some  institutions  carefully  weighed 
II  partaken  of  charted. 
Kl  EDOSl  be  remembered  that  mere  increase  in  weight 

e  is  not  necessarily  a  favourable  indication. 
In  not  a  few  instances  where  rapid  addition  to  the 
bodily  weight  is  made,  it  is  speedily  lost  on  the  patient 
fearing  the  sanatorium. 

Much  of  the  difficulty  of  adequately  dealing  with 
many  of  the  cases  which  attend  as  out-patients  arises 
Irom  the  fact  that  they  are  insufficiently  or  improperly 
fed. 

some  towns  and  cities  the  plan  followed  by  the 
iurgh  Vic  tuna  Huspital  might  well  be  adopted* 
^ant  "  patients  are  admitted  as  "day  boarders," 
■tary.  and  other  benefits  of  the 
institution    throughout    Lhe    day,    returning    home    to 
?teq>,    Some  such  arrangement  might  go  far  to  mini- 
mise the  suffering  now   resulting   irom   the   enormous 
pressure  on  some  sanatoria,  where  cases  have  frequently 
to  wait  for  five  or  six  months  before  admission   is 
possible. 

The   Insufficiency    of    Sanatoria    for    tub 

Consumptive. 
Much  difficulty  is  now  being  experienced  in  providing 
mean*  for  the  application  of  efficient  hygienic  measures 
in  the  treatment  of  the  consumptive  poor*     It  has  been 
recently  estimated  by  Dr.  Shirley  Murphy  that  in  the 
administrative  County  of  London  over  7,500  persons  die 
phthisis  annuaHy  ;     and  Dr.   Alfred   HUlier  has 
calculated  that  the  hospital  and  infirmary  expenditure 
for  consumptive  patients  in   London  alone  probably 
exceeds  £100,000  a  year. 
The  common  but  pernicious  system  which  prevails  of 
in  introduction  by  ii  subscriber's  letter  is 
little  short  of  inhuman  and  altogether  unscientific. 


The  insufficiency  of  sanatoria  makes  it  necessary  to 
keep  patients  seeking  aid  and  yet  requiring  immediate 
attention  watting  for  rive  months  or  more,  which 
means  that  valuable  time  and  strength  are  lost  just  at 
that  period  when  the  greatest  assistance  might  be 
rendered. 

The  case  of  the  indigent  consumptive  was  probably 
never  more  pitiable.  High  hopes  for  relief  are  being 
raised  only  too  frequently  to  be  quenched  by  the  un- 
fortunate condition  of  circumstances  which  might  and 
should  be  altered. 

It  is  not  for  me  to  enter  now  into  a  discussion  on  this 
very  wide  arid  difficult  question  of  ways  and  means 
for  the  adequate  provision  of  hygienic  necessities  for 
the  treatment  of  the  consumptive  poor.  It  is,  how- 
ever, becoming  abundantly  clear  that  collective  public 
afltkm  must  be  taken,  lor  only  by  securing  efficient 
treatment  of  the  indigent  consumptive  can  we  hope  to 
secure  means  for  prota  ting  all  sorts  and  conditions  of 
men  and  women  from  joining  the  ranks  of  the  tuber- 
cidmis   sufferers. 

The  revelation  of  the  l  1  I  of  hygiene  has  pointed 
out  a  way  whereby  many  of  the  ills  to  which  it  was 
supposed  flesh  was  heir  may  be  escaped  ;  and  medical 
science  has  now  conclusively  shown  that  such  hygienic 
measures  may  also  furnish  means  for  the  arrest  of 
disease,  and,  at  least  for  the  consumptive,  a  means  of 
relief  has  been  secured  in  what  we  are  now  accustomed 
to  term  sanatorium  treatment.  It  only  remains  for 
us  to  apply  our  knowledge  in  accordance  with  the 
principles  of  scientific  medicine  and  the  dictates  of  a 
sound  common  sense. 


NOTES   ON  A  CASE  OF 

PERFORATION     IN     TYPHOI D 

FEVER, 

By  HENRY  C  UKURY,  M.D..  F.R.CJ'.  I,, 

Phwician   to  Sir  Pttriek     rain's    UoHpital,   Vtfttlf    Physician     to 
Cork  StTMt  Fever  Hoiftad,  4c*, 

AND 

WILLIAM    TAYLOR.    M.B.,     K.RX.S.L. 
Stuxvon     to    the    Meath    H**|>ita!   and  Co,     llnbLm     iiinmiiu-y  ; 
Surgeon  to  Cork  Street  FWcr  H  wpital,  &e. 

J,  H.,  aH.  *t,  was  admitted  to  Cork  Street  Fever 
Hospital  on  August  4th.  1003.  He  was  an  ambulatory 
case  of  typhoid  fever,  and,  in  consequence,  we  were 
unable  to  find  out  how  long  he  had  been  ill,  but  from  his 
own  account  we  considered  it  was  about  his  twelfth 
day  of  fever.  In  reality  he  had  probably  been  ill  three 
weeks  or  more. 

He  appeared  to  be  quite  a  mild  case,  and  when  seen 
the  morning  after  admission  presented  absolutely  no 
bad  symptom.  Though  a  thin*  spare  subject  his 
aspect  was  good.  The  abdomen  was  flat,  the  tongue 
moist  and  not  very  dirty.  There  were  a  few  rhonchi 
m  the  lungs,  the  heart  was  sound,  the  bowels  moving 
moderately,  and  the  appearance  of  the  motions  satis- 
factory. His  temperature  was  moderate,  varying 
between  ior2°  and  tor 8°  morning  to  evening  ;  the 
pulse  quiet,  between  84  and  96.  there  was,  therefore, 
no  cause  for  alarm  in  his  condition,  However,  the 
next  morning — the  second  after  admission — at  7.45  a.m., 
he  complained  of  a  severe  pain  in  the  abdomen.  Dr. 
Sandes,  one  of  the  assistant  resident  medical  officers 
of  the  hospital,  saw  him  ;  the  pulse  was  then 
quiet.  T  must  acknowledge  the  splendid  way  in 
which  Dr,  Sandes  looked  after  and  managed  the 
case  throughout,  for  as  the  resident  medical  officer 
was  away  for  his  holidays.  Dr.  Sandes  had  the 
entire  responsibility.  At  9  o'clock,  pain  continuing 
and  increasing,  he  was  given  i  gr.  morphia  hypodermt- 
cally  ;  the  pulse  was  *nll  quiet— under  100.  At  about 
12  o'clock,  when  I  saw  him,  it  had  risen  to  120  ;  he  had 
a  drawn,  anxious  look,  the  abdomen  was  full  and 
slightly  distended  ;  it  was  very  tender  on  pressure, 
tympanitic,  but  liver  dulness  present.  It  was  ap- 
parent that  perforation  had  taken  place,  and  Mr.  Wra, 
Taylor,   the  surgeon    to    the  hospital,    was  asked  to 


3°    The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


Jan.  13,  1904. 


intervene.  By  the  time  Mr.  Taylor  could  be  got,  and 
was  able  to  be  at  the  hospital,  it  was  3.30  o'clock. 
Everything  being  in  readiness,  the  operation  was  com- 
menced, seven  and  a  half  hours  after  the  occurrence 
of  perforation,  but  by  this  time  the  patient's  condition 
had  greatly  changed  for  the  worse,  and  the  pulse-rate 
had  risen  to  1 50  or  over. 

Mr.  Taylor's  Account  of  the  Operation. 
When  seen  by  me  at  3.30  p.m.  the  condition  was 
most  unpromising.  The  pulse  was  1 50  to  the  minute  ; 
small,  thready  and  irregular.  The  tacies  was  ty- 
pical of  a  peritoneal  catastrophe.  The  respirations 
were  over  fifty  a  minute.  The  abdomen  was  distended, 
motionless,  rigid  and  tender  all  over.  Though  his  con- 
dition was  most  unfavourable  for  operation,  I  con- 
sidered myself  morally  bound  to  give  him  whatever 
chance  surgery  offered.  The  skin  of  the  abdomen  was 
quickly  cleansed  and  the  abdomen  freely  opened,  under 
light  ether  anaesthesia,  through  the  right  rectus  muscle, 
The  intestines  were  allowed  to  prolapse  into  warm 
towels.  The  perforation,  which  was  a  small  one,  was 
easily  found  about  fifteen  to  twenty  inches  from  the 
ilio-caecal  junction.  The  opening  was  closed  by  en- 
folding it  with  a  purse-string  suture,  over  which  a 
continuous  Lembert  suture  of  fine  silk  was  placed.  A 
second  ulcer  which  seemed  just  about  to  perforate, 
some  twelve  or  fourteen  inches  higher  up,  was  also 
enfolded  with  a  purse-string  suture.  While  I  was 
dealing  with  the  intestine,  my  assistant,  Dr.  Sandes, 
was  washing  out  the  abdominal  cavity  with  warm 
saline  solution.  Having  then  got  the  intestines  free 
of  the  septic  fibrin  with  which  they  were  covered,  and 
the  general  peritoneal  cavity  as  thoroughly  cleaned 
as  the  condition  of  the  patient  permitted,  the  intestines 
were  returned,  and  the  edges  of  the  wound  approxi- 
mated by  through-and-through  sutures  of  silkworm- 
gut.  Several  pints  of  warm  saline  solution  were  left 
in  the  abdominal  cavity.  The  operation  from  start 
to  finish  occupied  about  twenty-one  minutes,  and  the 
patient  was  returned  to  bed  with  a  pulse  of  much  the 
same  rate  as  before  we  started. 

Dr.  Drury's  Account  Continued. 

Subsequently,  great  interest  attaches  to  the  struggle 
to  keep  the  patient  alive,  and  the  very  highest  credit 
is  due  to  Dr  Sandes  and  the  nurses,  by  whose  un- 
remitting attention,  day  and  night,  success  in  this  en- 
deavour was  attained.  The  measures  used  were 
nutrient  enema ta,  saline  enema ta,  hypodermic  in- 
jections of  morphia,  strychnine  and  digitalin.  The 
heart,  which  was  flickering  at  the  rate  of  1 50,  was  thus 
kept  going,  and  by  the  fourth  day  after  the  operation 
it  had  gradually  strengthened  in  force  and  diminished 
in  frequency  to  100. 

Owing  to  his  enfeebled  and  febrile  condition,  together 
with      the      effect    of    the    ether     administered    for 
anaesthesia,   the    lungs    became      greatly    filled    up 
with    bronchitic   fluid,  and  there     were   moist    rdles 
ail    over    the  chest.       It     was    therefore   necessary, 
in    spite  of    the    operation,   to  keep  him  constantly 
moved      from       one      side      to     the      other.      His  ! 
fever     still     continued     at      high    range,     but     his  I 
general      condition       steadily      though       gradually  1 
improved.     The    lungs    slowly    cleared,     the    heart  1 
became      stronger      and    less     frequent    in     action,  I 
and  at  the  end  of  a  week  after  the  operation  the  tem-  j 
perature  reached  and  remained  at  normal — i.e.,  nine 
days  after  admission,  or  seven  days  after  operation.      | 

On  the  removal  of  the  stitches  from  the  abdominal  ' 
wound,  which  had  apparently  closed  all  right,  it  was  ' 
found  there  was  an  abscess  in  the  deeper  parts  of  the  | 
incision,  due,  no  doubt,  to  its  infection  by  the  faecal 
material  which  had  escaped  from  the  perforated  bowel.  I 
The  whole  wound  then  suppurated  and  sloughed,  1 
By  Dr.  Sandes'  constant  attention  this  was  got  into  a  ' 
healthy  condition  and  brought  together  without  having  ( 
infected  the  general  peritoneal  cavity.  This  suppura- 
tion was  accompanied  by  a  mild  fever  of  hectic  type,  I 
which  came  on  about  a  week  after  the  enteric  fever  ' 
had  ended,  and  which  lasted  for  another  week.  In  | 
spite  of  this,  he  convalesced  steadily,  but  lest  this  fever  \ 
should  have  any  connection  with  his  enteric,  we  were 


careful  not  to  take  any  liberties  with  his  diet,  so  it  was 
not  till  this  fever  had  ended — and  fifteen  days  after 
what  we  considered  as  the  enteric  fever  was  over — that 
he  was  given  some  solid  food  in  the  shape  of  bread 
crumb.  This  agreed  well,  and  very  cautiously  other 
additions  were  made,  but  nothing  stronger  than 
a  lightly  boiled  egg  had  been  given  up  to  the  beginning 
of  September.  It  will  be  remembered  he  was  ad- 
mitted on  August  4th. 

On  the  evening  of  September  2nd,  twenty-eight 
days  after  operation,  he  complained  of  pain  in  the 
abdomen.  Nothing  abnormal  could  be  found  except 
some  tenderness  all  over  the  retracted  abdomen.  The 
pulse  and  temperature  remained  unchanged,  and  the 
bowels  had  moved  twice  naturally ;  there  was  slight 
emesis  with  retching,  and  the  breathing  was  costal. 

The  next  day  pain  was  still  complained  of,  but 
nothing  fresh  was  made  out,  except  that  the  abdomen 
was  slightly  fuller,  and  the  bowels  had  not  moved. 

On  the  third  day  the  abdomen  was  decidedly  fuller, 
there  was  still  dull  continuous  pain.  One  drachm  of 
castor  oil  produced  a  very  small  motion,  but  there  was 
no  other  relief. 

On  the  fourth  day  there  was  still  pain,  the  patient 
again  looked  wretchedly  ill ;  the  abdomen  was  mani  • 
festly  distended.  Up  to  this  the  pulse  and  temperature 
had  remained  normal,  but  now,  though  the  tempera- 
ture still  remained  normal,  the  pulse  had  risen  to  116. 
The  bowels  had  not  moved.  Mr.  Taylor  was  again 
asked  to  see  him,  and  while  present  an  enema  was 
given  which  was  returned  unchanged.  He  at  once 
resolved  to  open  the  abdomen  again,  and  endeavour  to 
undo  the  cause  of  obstruction. 

Further  Notes  by  Mr.  Taylor. 

Second  operation,  4i  weeks  after  suturing  perfora- 
tions.— When  seen  by  me  he  presented  all  the  appear- 
ance of  acute  intestinal  obstruction.  He  was  then 
vomiting,  and  complained  of  severe  spasms  of  pain  ; 
the  expression  was  anxious,  the  abdomen  generally 
distended,  and  constipation  was  then  absolute.  An 
enema  produced  no  effect,  The  abdomen  was  again 
opened,  when  the  intestines  were  found  extensively 
matted  to  each  other  and  to  the  abdominal  wall.  With 
considerable  difficulty,  on  account  of  the  density  of  the 
adhesions,  a  separation  was  effected.  The  obstruction 
was  evidently  due  to  sharp  angulation,  the  result  of 
adhesions,  as  no  distinct  band  was  found  producing 
constriction  at  any  point.  Two  very  distended  coils 
were  evacuated  of  their  contents,  and  the  abdominal 
wound  again  closed.  The  time  occupied  was  about 
forty  minutes.  Unfortunately  the  poor  fellow  never 
rallied,  and  sank  about  ten  or  twelve  hours  later. 

This  most  unfortunate  result  is  much  to  be  deplored, 
for  the  operation  Mr.  Taylor  performed  during  the 
course  of  the  fever  was  really  successful ;  it  prolonged  the 
patient's  Ufe  for  four  and  a  half  weeks,  and  having 
been  undertaken  during  the  course  of  the  fever,  such 
a  result  is  rare. 

The  post-mortem  showed  that  the  obstruction  was 
in  no  sense  due  to  the  sutures  in  the  gut.  These 
completely  closed  the  perforation,  and  there  was  no 
leakage.  In  fact,  the  only  evidence  we  could  get  of  the 
site  of  perforation  was  the  presence  of  the  silk  sutures. 
Healing  over  the  two  sutured  areas  was  perfect. 
Where  precisely  the  obstruction  occurred  could  not  be 
seen,  as  the  adhesions  had  been  broken  down  at  the 
second  operation.  But  inside  the  bowel  a  most  in- 
structive and  one  of  the  most  important  observations 
from  a  physician's  point  of  view  was  made,  namely, 
that  there  "were  numerous  large  ulcers  still  present — in 
the  processs  of  healing,  it  is  true,  but  not  by  any  means 
healed.  They  were  variable  in  size,  some  large  and 
surrounded  by  a  raised  margin.  A  very  few  appeared 
to  have  healed,  but  the  majority  were  still  open. 
That  is,  we  found  open,  healing  ulcers,  more  than  three 
weeks  after  the  enteric  temperature  had  reached  the 
normal  level ;  and  the  appearance  of  these  ulcers 
was  such  as  to  lead  us  to  conclude  that  it  would  have 
required  at  least  another  week  or  fortnight  to  complete 
their  repair.  In  other  words,  the  ulcers  would  not 
have  healed  till  four  or  five  weeks  had  elapsed  from 
the  termination  of  the  fever. 


: 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press.    31 


A\  UNUSUAL  CASE  OF 

PSE  U  DARTH  ROSIS 

ier   the    care    of    Pkofessor    RAY,    M.D., 

Sune**";  10  The  OifU  Bovpttal*  Albert;  Profeswr  of  Medicine  In  the 
t~uiv  entity  of  Algiero. 

I   J.LY    REPORTED   FOR    THE     "  MEtMCAt    PftSSS 
Mi;       A      CaBANSS,     HOUSE 
SCRGEQN\] 

This   case  is  of  some   interest  in    view  of   the 

history  and  the  tact  of  its  being  a  case  of  infantile 

pseudarihrosis,    this    lesion    being    comparatively 

n  •.  hi  Id  hood,  especially  in  respect  of  the  upper 

Limb. 

The  patient  is  an'Arab,  set,  18,  who  was  admitted 

on  October  iSth,  tQQ3\  with  the  ioj  lowing  history  \ — 

When   two  years  of  ageThe  met  with  an  accident 

left  him  with  a  fracture  of  the  left  humerus. 

As^k    was  far  removed  from  civilisation  the  injury 

nded  to  by  the  tribal  bone-setter  who  fixed 


the  limb  by  means  of  a  plate  oi  leather,  softened 
Oil.  This  was  moulded  to  the  upper 
and  reinforced  by  lour  wooden  splints,  which 
were  maintained  in  position  by  four  bands,  twi 

ihion.     The    bone-setter    visited   the 

it  twice  a  week  and,  as  union  was  delayed,  he 

tpparatua  on  each  occasion,  more 

btly.     At    tin.    expiration  of  about    two 

rigorous  treatment  the  skin  over  the 

ired  bone  became  gangrenous      <  >n  the  outer 

nf  the  arm  lh<    tissues  broke  down,  creating 

i  of  continuity  through    which  three  frag- 

eliminated,    The  first  mea 
nee  baches  in  length  and   the  two  others, 
other  one  and  a  half  inches,  in 

tuedicine  man  '*  thought  it  j 
ible  to  remove  the  apparatus,  and  the  wound, 


which  discharged  pus  freely,  ultimately  healed  in 
some  forty  days. 

Last  October  he  was  admitted  to  the  hospital 
with  a  fractured  clavicle.  This  injury  presented 
no  particular  interest,  but  the  condition  of  the  arm 
on  the  injured  side  a  I  traded  at  ten  lion.  The 
photograph  shows  the  condition  of  the  limb  when 
he  contracted  the  muscles,  causing  displacement  of 
the  unconsolidated  fragments.  The  upper  arm 
hung  flail  dike,  it  was  markedly  atrophied,  the 
muscles  were  much  thinner,  and  it  was  somewhat 
shorter  than  the  right  arm.  The  bone  was  plainly 
broken  right  across,  and  underneath  the  skin  could 
be  felt  (the  muscles  being  in  a  state  of  contraction) 
a  marked  projection  formed  by  the  pulling  for- 
wards and  slightly  inwards  oi  the  two  broken  ends 
of  the  humerus.  The  site  of  the  fracture  was 
exactly  at  the  junction  of  the  lower  fourth  with  the 
upper  three-fourths  oi  the  bone. 

The  skiagram  shows  that  the  thickness  of  the 
upper  fragment  has  undergone  considerable  diminu- 


tion for  a  distance  of  some  four  inches  above  the. 
fracture.  The  lower  fragment  appears  to  be  of 
normal  size.  The  1069  Of  substance  on  the  part  of 
the  u ppe r  portion  of  the  bone  is  no  doubt  due  to 
the  elimination  ol  the  three  sequestra  mentioned 
above,  rather  than  lo  any  actual  atrophy. 

On  examination,  one  could  feel  very  distinct h 
a  strong  fibrous  band  connecting  the  two  ends, 
very  resistent  in  spit-.-  ol  its  suppleness.  The  triceps 
is  well  formed  but  the  biceps  is  underdeveloped. 
Contraction  of  these  muscles  tends  h.  brinfi  the 
elbow  nearer  to  the  shoulder,  and  at  the  same  time 
there  is  a  slight  curving  of  the  arm,  wilh  the 
concavity  forwards.  As  far  as  fine  could  make  out 
there  were  do  adhesions  between  the  periosteum 
and  the  neighbouring  muscles,  and  the  atrophied 
condition  oi  the  tissues  rendered  it  possible  to 
delineate    the    parts    very   easily,     there    WC5   no 


32    Ths  Mbdical  Press. 


ORIGINAL  COMMUNICATIONS. 


reason  to  suspect  any  interposition  of  muscle  be- 
tween the  fragments. 

The  patient  absolutely  refused  to  allow  anything 
to  be  done  with  the  view  of  restoring  the  continuity 
of  the  bone,  and,  having  regard  to  the  tenuity  of 
the  upper  fragment  of  bone,  it  is  doubtful  whether 
surgical  intervention  would  have  given  a  satis- 
factory result.  He  stated,  moreover,  that  he  was 
able  to  carry  about  his  basket  of  trinkets  (he  is  a 
pedlar)  on  this  arm  without  pain  or  difficulty,  and 
could,  when  necessary,  lift  comparatively  heavy 
weights  with  that  arm. 

The  case  appears  to  me  to  be  of  interest,  seeing 
that  it  is  one  of  pseudarthrosis  happening  in  infancy, 
a  rare  occurrence,  since  the  statistics  compiled  by 
D'Arcy  Power,  an  English  surgeon,  only  comprise 
nine  cases  in  which  the  lesion  involved  the  humerus. 

With  respect  to  the  causation  of  the  lesion  it  is 
clear     enough  —  viz, 


Jaw.  13,  1904. 


instance.  Some  of  the  latter,  according  to  Unna, 
might  act  by  influencing  metosis.  Of  recent 
years  science  had  placed  at  our  disposal  various 
agencies,  such  as  the  X-rays,  Finsen  light,  radium, 
and  high  frequency  currents,  which  act  on  the 
tissue  elements  in  and  beneath  the  epidermis  ; 
the  present  paper  deals  with  the  first  two  only. 
His  earlier  work  with  the  X-rays  had  been  greatly 
hampered  by  the  spring  interrupter  used,  and  it 
was  only  on  the  introduction  of  the  mercurial 
interrupter  that  he  had  had  favourable  results. 
In  using  X-rays  the  treatment  required  to  be 
carefully  supervised,  and  the  exposures  suspended 
on  the  slightest  sign  of  reaction  showing  itself. 
It  was  of  great  importance  to  screen  healthy  parts 
from  the  effects  of  the  rays,  as  they  caused 
baldness,  the  hair,  however,  growing  again 
after    the    treatment    was    stopped.     The    best 


clear     enough  —  viz..    undue     pressure      applied   j-  *  *.     u-  u  *      1     «wowyyw.     urc    wai, 

directly  over  the  seat  of  the  fracture,  the  prILc* '  * StanCe  **  wh'ch  to  PIaCe  the  •tube  was  from,  f°ur 
of  deutched  fragments  of  bone,  which,  by  their  i  to.s«'nches  i  he  usually  gave  six  exposures  of  five 
displacement,  probably  in  a  transverse  direction,  I  ™nutes  °n  f<?r  ***•  of  *h*  wef  ;  A  moderate 
tended  to  prevent  proper  coaptation  and  exerted1^6*  of  reactlon  ?"  not  ^T^l  "  lt  showed 
dangerous  pressure  from  within  outwards  on  the  ■ *»*  ^e  rays  were  taking  effect,  but  it  was  gener- 
neighbouring  tissues,  ultimately  causing  a  limited .  ally>  on  the  whole'  ""f  to  ,nter™P* ««.  treatment 
area  of  necrosis  through  which  they  escaped.  I  as  soon  as  any  reaction  manifested  itself.     He 

The  production  of  the  pseudarthrosis  necessarily  I  ^d  sefn  burns  occur  V1  ,luPus\ rodent  ulcer'  and 
interferes  very  considerably  with  the  functional !  fav.us>  but  nTot  in  mvcosls.  fungoides. 
utility  of  the  elbow.  When  the  triceps  and  biceps  I  Lupus.— It  was  sometimes  advisable  to  supple- 
are  contracted  to  their  maximum  extent  the  angle  ment  the  X"ray  treatment  of  lupus  by  painting 
formed  by  the  two  fragments  of  the  humerus  is  • wlth  Pure  carbouc.  especially  when  progress 
approximately  equal  to  the  articular  flexion,  and  I  seemed  rather  slow.  In  some  cases  reaction 
when  thus  contracted  the  elbow-joint,  which  is  occurred  almost  at  once  ;  in  others  it  might  be 
brought  much  nearer  the  shoulder,  merely  serves  !  delayed     for  weeks.     Hard  tubes  were  generally 


to  maintain  the  forearm  in  a  direction  parallel  to 
that  of  the  upper  arm,  and  it  is  in  this  position  that 
the  patient  is  enabled  to  make  use  of  his  maximum 
muscular  power. 
The  case  is  almost  on  all  fours  with  that  men 


less  active  ;  soft  tubes,  with  a  three-inch  spark, 
were  more  effective,  and  not  more  likely  to  cause 
burns.  He  had  noticed  that  the  weather  had 
considerable  influence  on  the  occurrence  of 
reaction,  which  was  most  likely  to  take  place,  and  to 


of  the  eliminated  sequestra  or  whether,  on  the 
other  hand,  it  was  due  to  an  atrophic  process 
consequent  upon  interference  with  the  vascular 
supply.  Had  the  patient  allowed  us  to  operate 
I  should  have  thought  it  desirable  to  effect  grafts 
of  bone  in  order  to  compensate,  as  far  as  might  be, 
the  actual  loss  of  a  tissue. 


tioned  by  Schwertzel,  it  being  possible  to  bend  the  to  be  of  severe  type,  on  cold,  raw  days.  Possibly 
elbow  to  a  right  angle  without  causing  the  patient  I  other  meteorological  conditions  might  affect  it 
any  pain  ;  it  would  have  been  an  interesting  j  also,  just  as  one  sometimes  saw  simultaneous 
experience  to  endeavour  to  bring  the  fragments  rises  of  a  number  of  temperatures  in  a  hospital 
into  close  apposition,  but  the  success  of  our  inter-  ward  under  certain  climatic  conditions  ;  but 
vention  would  depend  in  great  measure  upon  1  apart  from  cold,  he  could  not  say  what  these 
whether  the  diminution  in  size  of  the  upper  frag-  were.  In  eighteen  months  he  had  treated  133 
ment  was  due  to  the  loss  of  bone  tissue  in  the  shape  !  cases  of  lupus,  30  of  favus,  21  of  rodent  ulcer„ 
'   -'        -•    •      -    -  12  of  sycosis,  and  2  of  mycosis  fungoides.     Some 

of  the  lupus  cases  were  partially,  and  other 
exclusively,  healed  by  light,  the  rest  by  X-rays 
alone.  He  could  not  give  statistics  of  cure,  as 
nearly  all  were  out-patients,  and  many  discon- 
tinued attendance,  but  he  could  certainly  .say 
that  all  who  persevered  received  material  benefit. 
In  lupus  all  the  methods  of  treatment  hitherto 
in  vogue  had  had  the  disadvantage  that  while 
the  centre  of  the  patch  healed,  the  disease  spread 
at  the  periphery.  Under  X-rays  this  was  not 
the  case  ;  where  nodules  reappeared  they  often 
did  so  in  the  centre  of  the  patch.  In  lupus  the 
soil  had  to  be  reckoned  with,  and  cases  in  which 
the  skin  was  soft,  pale  and  tender,  in  persons  of 
strumous  constitution,  were  likely  to  react  early, 
and  did  not  offer  so  good  a  chance  of  cure.  But 
even  in  these  the  treatment  at  least  reduced  the 
size  of  the  lupus  patch,  and  allowed  of  other 
means  being  more  effectually  employed.  Dr. 
Jamieson  then  raised  the  question  whether  the 
treatment  could  induce  tubercle  to  break  out  in 
other  organs,  instancing  the  case  of  a  patient  who, 
after  having  undergone  a  course  of  X-rays  for 
lupus,    developed    tuberculous    peritonitis,    and 


THE  TREATMENT  OF  VARIOUS  FORMS  OF 

CUTANEOUS   DISEASE 

BY  THE 

X-RAYS  AND  LIGHT,  (a) 

By    ALLAN  JAMIESON,  M.D.,  F.R.C.P.Ed., 

Physician  for  Diseases  of  the  Skin,  the  Royal  Infirmary,  Edinburgh. 

The  author  first  drew  attention  to  the  fact 
that  when  structurally  intact  the  epidermis  was 
highly  impermeable,  while  if  diseased  and  therefore 
porous,  it  might  absorb  unduly  remedies  applied 
to  it.  Hitherto  our  means  of  acting  on  the  deeper 
parts  of  the  skin  had  either  been  caustics  or 
agents  which   occasioned   irritation   in   the   first 

(a)  Abstract  of  Paper  read  before  the  Edinburgh  Medico-Chirurgical 
Society,  on  January  8th,  1901.    For  discussion  see  page  36. 


1904. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Fuss.     33 


second  scries  of  exposures,  an  abscess 
near  the  hip.  He  concluded  that  there  seemed 
no  rt  :  hat  the  sequence  was  other 

tbOD  accidental.     The  Finsen  light  acted  best  in 
i    patches   or   nodules     situated     over   bony 
eminences,   which    permitted    of    the    part    being 
blanched.     The  process  was  slower ,  less  effective, 
andcaused  no  burns.  The  lamp  he  used  worked  at 
ten  amperes,  but  by  increasing  to  eighteen  amperes 
he  had  got  better  results.     He  had  tried  applying  ' 
adrenalin  previous  to  using  the  Finsen  light,  but 
iliii  do(  think  the  results  justified  the  extra  expense. 
RmUtit  ulcers  were  uniformly  benefited,  the  hard 
margins  receding  and  healthy  epithelium  advancing 
over  the  ulcer.    The  less  the  bones  and  periosteum 
exposed    the   better    were    the    results.     In 
forms  of  cancer  the  effects  were  not  so  good, 
and  lie  had  seen  epitheliomata  progressing  while 
the  rays  were  being  used.  Bad  cases  of  rodent  ulcer 
were  the  better  for  a  preliminary  scraping  and 
it   with  chromic   acid   before   being  sub- 
jected to  X-rays.         The  permanency  of  cure  in 
CAM  was  doubtful,  and  relapse  olten 
took  place  after  apparent  healing. 

-Only  intractable  cases  had  been 
treated,  and  in  all  the  hair  fell  out,  and  the 
pustules  disappeared.  Unless  all  the  disease 
wa*  got  rid  of  relapse  was  very  likely  to  take 
place. 

In  fav us  the  result  of  the  rays  was  to  remove  ail 
the  hair  and  leave  a  smooth  polished  surface,  on 
which  healthy  hair  again  grew.  An  aggregate 
exposure  of  an  hour  or  more  was  required  for 
this.  There  was  no  great  tendency  to  reaction 
10  this  disease. 

In   mycosis  fungoides  the  X-rays     constituted 

the  sole  means  of  arrest  known.     The  case  which 

he  had  published  some  eighteen  months  ago  still 

umed   well,   but   some   nodules   had  recently 

developed  on  parts  of  the  skin  which    had  never 

been  subjected   to   X-rays,     As  to   the  mode  of 

m  ot  the  rays  in  cutaneous  diseases,  it  was 

nit    due    to    any  bactericidal    effect.     Though 

is  could  be  cured,  it  was  only  by  removing 

the   hair    and    destroying    the    nidus     on    which 

the  staphylococci  grew  t  the  vitality  of  the  organisms 

themselves  being  scarcely  diminished,      In  fav  us, 

the  rays  were  merely  an  effective  e  pi  la  ting 

agent.     Possibly    they     promoted     metosis,    and 

in  malignant  cases  it  seemed  that  they  recalled 

aberrant  cells  to  the  normal  ;  how  so,  was  quite 


THE 

PATHOLOGY  OF   CHRONIC 
ALCOHOLISM,  (a) 

By  WILLIAM  FORD  ROBERTSON,  M,D., 

P  irhold^iit  to  the  Scottish  Asylum*  Board: 

The  author  said  he  proposed  to  consider   the 

inimical  action  of  alcohol,  firstly,  upon  the  tndi- 

ad    secondly,  upon  the  race.     The  essen- 

involved  in  a  scientific  conception  of  the 

nature   of   disease    was    that   of   a    vital    process 

response    to    a    harmful    stimulus. 

Dtse<  be  denned  as  a  chemico- vital  re- 

•    to   an    inimical    force   which   had    broken 

_lh  the  first  line  of  defence  of  the  organism. 

Alcohol^  when  brought  in  contact  with  the  living 

(«0  Atistraet  of  l'*per  read  before  ttuj   Society  for  the  Study  of 
fnehri*i>,  January  12th,  J*M. 


body,  readily  passed  the  first  line  of  defence  and 
was  capable  of  acting  as  an  inimical  force.  After 
having  briefly  recalled  the  main  facts  regarding  the 
general  or  physiological  action  of  alcohol,  he 
referred  to  the  experimental  and  other  observa- 
tions, which  showed  that  alcohol  could  have  an 
extremely  injurious  effect  upon  the  early  stages  <>i 
development.  The  experimental  investigations 
of  various  workers  had  also  clearly  demonstrated 
that  chronic  alcohol  poisoning  had  a  very  harm  Jul 
action  upon  the  defensive  mechanism  of  the  body, 
or  upon  immunity.  This  was  a  fact  of  great  im- 
portance, and  it  served  to  strengthen  the  convic- 
tion that  many  had  long  had  that  the  lesions  which 
occurred  in  cases  of  chronic  alcoholism  in  the 
human  subject  owed  their  severity  and  multi- 
plicity to  various  forms  of  bacterial  toxemia.  He 
believed  that  those  secondary  toxaemias  were  really 
the  chief  cause  of  the  pathological  changes  in  these 
cases.  In  addition  to  the  weakening  of  the  general 
immunity,  there  was  an  impairment  of  the  local 
defences,  especially  in  the  upper  portion  of  the 
alimentary  tract,  by  the  direct  action  of  the 
alcohol.  The  chronic  catarrhal  changes,  at  first 
due  to  the  action  of  the  alcohol,  became  intensified 
by  bacterial  action,  and  a  condition  of  chronic 
toxic  infection  from  the  alimentary  tract  was 
gradually  established.  Consequently  the  indi- 
vidual gradually  developed  various  other  dts- 
orders,  located  in  accordance  with  his  powers  of 
resistance  and  various  accidental  circumstances, 
After  referring  to  the  special  forms  of  chronic 
alcoholism,  he  briefly  enumerated  some  of  the  more 
important  morbid  changes  that  occurred,  and 
showed  a  number  of  illustrative  lantern  slides. 
He  especially  directed  attention  to  the  severe 
chronic  catarrhal  changes  that  could  always  be 
shown  to  be  present  in  the  alimentary  tract. 

Coming  next  to  the  inimical  action  of  alcohol 
upon  the  race,  he  asserted  the  right  of  pathology 
to  deal  with  the  question.  Pathology  dealt  with 
abnormal  phenomena  of  celHife,  Mainly  through 
the  magnificent  embryological  work  of  Dr.  J. 
;  Beard,  the  processes  concerned  with  phylogenetic 
evolution  had  recently  been  brought  into  harmony 
with  the  cellular  doctrine.  Abnormal  phenomena 
of  phylogenetic  evolution,  as  well  as  those  of  onto- 
genetic evolution,  therefore,  now  fell  within  the 
I  province  of  pathology.  He  thought  that  the 
1  truth  regarding  the  effect  of  widespread  alcohol 
poisoning  upon  the  race  had  not  yet  been  grasped. 
The  subject  was  really  a  part  of  the  general  ques- 
tion of  the  biological  significance  of  disease,  and  as 
such  he  wished  to  consider  it.  In  the  results  of 
Dr.  Beard's  work  they  had  the  foundations  for  a 
purely  biological  pathology  which  had  hitherto 
been  only  a  desideratum.  He  shortly  stated  the 
main  facts  that  Dr.  Beard  had  elucidated  regarding 
the  continuity  of  the  germ -cells  and  the  place  and 
time  of  origin  of  the  embryo.  Dr,  Beard  had  also 
shown  that  the  mode  of  metazoan  development  was 
really  that  of  an  antithetic  alternation  of  genera- 
tions, and  mat  there  was  thus  one  primitive  mode 
of  reproduction  for  the  whole  of  organic  nature. 
He  pointed  out  some  of  the  important  corollaries 
of  this  new  doctrine  of  development,  and  showed 
that  it  did  not  confirm  Weismann's  hypothesis,  as 
some  seemed  to  imagine,  but  rendered  it  super- 
fluous and  proved  it  to  be  in  many  respects  at 
variance  with  the  facts.  They  were  now  enabled 
to  separate  entirely  the  line  of  phylogenetic  evolu- 
r  tion     from     ontogenetic      evolution.        Offspring 


34    The  Mbdical  Press. 


SPECIAL  ARTICLES. 


Jan.  13,  1904. 


inherited  nothing  from  their  parents.  The  distinc- 
tion between  inborn  and  acquired  character  was 
really  an  artificial  and  useless  one,  and  existing 
definitions  could  be  shown  to  be  erroneous.  He 
next  discussed  the  causes  of  genetic  variation  in 
the  light  of  the  facts  of  modern  embryology  and  of 
evidence  drawn  from  other  sources.  He  contended 
that  the  generally  accepted  view  that  conjugation 
of  germ-cells  is  a  cause  of  genetic  variation  was 
entirely  unproven,  and  probably  erroneous  ;  and 
that  the  real  cause  of  such  variation  was  the  action 
of  a  changed,  and  especially  an  inimical,  environ- 
ment upon  the  germ-cells.  He  referred  to  the  re- 
markable observations  of  De  Vries  upon  the 
mutations  of  Oenothera  Lamar  ckiana,  and  con- 
tended that  these  mutations  were  typical  of  what 
occurred  in  animals  under  the  influence  of  new  or 
inimical  environmental  conditions.  Some  of  the 
mutations  of  this  plant  were  adapted  to  their  new 
environment,  others  were  not.  If  organisms  were 
perfectly  adapted  to  their  environment  there  would 
be  no  disease.  This  state  was  approximated  to  by 
many  of  the  lower  animal  forms  and  plants  living 
in  natural  conditions ;  when  brought  into  a  new 
environment  they  quickly  manifested  lack  of 
adaptation  to  it.  Their  effort  was  towards  adap- 
tation to  the  new  conditions,  and  this  they  at- 
tempted to  achieve,  firstly,  by  somatic  variation, 
and  secondly,  by  genetic  variation.  Some  of  the 
descendants  were  better  adapted  to  the  new  con- 
ditions, but  this  advance  was  only  achieved  at  the 
cost  of  the  production  of  other  individuals  who 
were  less  adapted.  These  were  more  liable  to 
succumb  under  the  action  of  the  inimical  forces  in 
their  environment.  This  principle  was  exem- 
plified in  the  fate  of  some  of  the  mutations  of 
(Enothera  Lamar  ckiana.  Imperfect  adaptation  to 
environment  entailed  somatic  and  genetic  varia- 
tion, and  an  increased  incidence  of  disease  in  a 
certain  proportion  of  the  descendants.  He  main- 
tained that  in  this  country  alcohol  was  at  the 
present  moment  one  of  the  most  potent  causes  of 
genetic  variation,  as  it  was  unquestionably  of 
somatic  variation,  and  that  the  incidence  of 
diseases  dependent  upon  defective  resisting  power 
on  the  part  of  the  individual  was  thereby  enor- 
mously increased.  If  these  views  were  in  accord 
with  the  facts,  it  was  plainly  the  duty  of  a  nation 
to  do  everything  in  its  power  to  remove  from  its 
environment  every  inimical  condition  to  which 
there  was  imperfect  adaptation.  He  entirely 
dissented  from  the  doctrines  of  the  Read  school  in 
regard  to  the  importance  of  "  alcohol  and  disease  " 
as  causes  of  human  evolution. 


Clinical  flotea. 


came  on  somewhat  later  ;  he  then  laid  down  for  ajfew 
hours  and  died  quietly. 

The  post-mortem  showed  some  amount  of  inflam- 
mation of  stomach  and  intestine,  the  spleen  was  large 
and  very  soft,  and  the  gall-bladder  full  of  green  bile. 

The  fatal  result  was  attributed  to  the  patient  not 
having  drunk  freely  of  whey,  a  precaution  it  was  cus- 
tomary to  advise  for  all  who  took  the  hellebore.  There 
is  also  a  record  of  two  persons  who  took  hellebore 
root  in  cyder  by  the  advice  of  a  quack.  Three-quar- 
ters of  an  hour  after  taking  this  dose  violent  symptoms- 
came  on  without  exciting  suspicion  as  to  the  cause,  so 
that  one  man  took  a  second  dose  of  the  cyder ;  vomiting, 
delirium,  convulsions  and  death  soon  followed.  The 
post-mortem,  sixteen  hours  after  death,  showed  the 
lungs  engorged  with  blood  and  the  mucous  membrane 
of  the  stomach  and  intestines  blackish  and  almost  in  a 
state  of  gangrene. 

These  cases  were  communicated  manv  years  ago  by 
M.  Ferary  to  the  Societe  Medicale  d'Emulation  at  Paris. 

Special  articled. 

BRITISH    SANATORIA    FOR    CONSUMPTION.— 

XXVIII. 

[by  our  special  medical  commissioner.] 


POISONING  BY  BLACK  HELLEBORE. 
By  John  C.   Thorowgood,  M.D.,  F.R.C.P. 

Interest  attaches  to  the  black  hellebore  as  being 
the  first  recorded  purgative.  Melampus,  1400  years 
B.C.,  is  said  by  its  use  to  have  cured  the  daughters  of 
Praetus  of  madness. 

As  an  emmenagogue  and  purgative  the  tincture  of 
hellebore  has  often  been  used  in  past  years,  and  this 
tincture  found  a  place  in  the  last  issue  of  the  London 
"  Pharmacopoeia,"  the  dose  being  30  to  60  minims. 

Morgagni  has  recorded  a  case  where  half  a  drachm 
of  the  extract  was  taken,  causing  death  in  sixteen 
hours.  The  patient,  a  man,  aet.  50,  had  been  under 
treatment  for  melancholia,  and  on  departure  from  the 
hospital  he  took  half  a  drachm  of  extract  of  hellebore. 
Active  purgation  with  vomiting  and  abdominal  pain 


MUNDESLEY  SANATORIUM,  NORFOLK. 

The  Mundesley  district  of  Norfolk,  as  many  a  visitor 
knows,  is  peculiarly  attractive  in  summer  time.  The 
climate  is  then  well  suited  to  the  needs  of  many  a  tuber- 
culous invalid.  There  is  much  sunshine,  but  little 
rainfall,  a  clear  and  dry  atmosphere,  and  air  that  is 
well  characterised  as  bracing.  In  the  winter  and 
spring  it  must  be  admitted  there  are  drawbacks,  but 
experience  seems  to  show  that  at  all  times  of  the  year 
a  wisely  directed  medical  supervision  may  secure  bene- 
ficial results. 

The  Mundesley  Sanatorium  was  specially  designed 
for  the  treatment  of  consumptive  cases,  and  opened  at 
♦he  end  of  1899  under  the  care  of  Dr.  Burton-Fanning 
and  his  cousin.  Mr.  W.  J.  Fanning,  the  former  as 
visiting  physician,  the  latter  being  resident  medical 
officer.  Recently  the  institution  has  passed  into  the 
hands  of  Dr.  Noel  D.  Bardswell,  who  acts  as  resident 
physician,  while  Mr.  J.  E.  Champman  assists  as  clinical 
pathologist. 

The  sanatorium  is  situated  about  a  mile  from  the  sea 
and  a  similar  distance  from  the  railway  station,  in  a 
somewhat  isolated  position.  It  is  built  on  the  southern 
slope  of  a  sparsely  fir-clad  ridge  which  runs  east  and 
west,  and  is  protected  to  some  extent  from  the  pre- 
vailing winds  on  the  north,  north-east,  and  north-west. 

On  the  south  the  outlook  is  over  rather  uninteresting 
and  slightly  undulating  agricultural  country.  On  the 
east  side  lie  the  Mundesley  golf  links. 

The  soil  is  of  sand,  which  extends  to  a  depth  of 
180  ft.,  when  chalk  is  reached. 

The  building  is  of  wood,  but  is  attractive  and  com- 
fortable. The  patients  are  accommodated  on  the 
south  side  of  the  ground  and  first  floors.  Some  of  the 
servants'  quarters  are  in  attics.  The  dining  and 
drawing-rooms  are  on  the  ground-floor.  The  corridors, 
8  ft.  wide,  are  covered  with  linoleum,  and  run  the  whole 
length  of  the  building.  The  chief  entrance  is  at  the 
east  end.  The  patients'  rooms  are  well  appointed. 
I  Heating  is  effected  by  radiators,  which,  however,  do 
I  not  seem  very  satisfactory.  Some  of  the  rooms  have 
open  fireplaces.  Lighting  is  by  electricity.  A  veran- 
dah extends  along  the  whole  of  the  front  of  the  building. 

The  grounds  are  thirty  acres  in  extent  and  contain 
various  conveniently  placed  and  well-designed  shelters. 

As  far  as  we  could  gather,  the  general  management 
and  daily  routine  were  in  accordance  with  modern  re- 
quirements. Considerable  attention  is  paid  to  diete- 
tics. 

A  bungalow  near  the  main  building  accommodates 
several  patients. 

At  the  time  of  our  visit  a  very  simple  form  of  shelter 
accommodated  two  cases  of  working-class  patients, 
who,  in  return  for  free  treatment,  were  submitting  to 


]**»  tj  1904- 


TRANSACTIONS  OF  SOCIETIES. 


THJt   MEDICAL   PltESt,      35 


careful  investigations  respecting  dietetic  procedures* 
Sane  interesting  experiments  were  proceeding  on  the 
influence  of  a  vegetarian  diet  in  the  maintenance  of 
nutrition  in  the  phthisical* 

Verv  careful  clinical  records  arc-  kept  of  every  case, 
ami  much  valuable  scientific  data  is  being  collected. 

The  patients  are  allowed  opportunities  for  carefully 
regulated  exercise,  but  we  were  surprised  to  rind  that 
poll  was  not  interdicted, 

An  attempt  was  recently  made  to  deal  with  cases 
belonging  to  the  working-class  in  a  separate  building  at 
Mundesley  at  the  remarkably  low  rate  oi  17s.  a  week  ; 
but  we  were  informed  that  the  experiment  did  not 
[if uve  a  success  and  has  been  abandoned. 

The  terms  at  the  Mundesley  Sanatorium  are  five 
guineas  a  week,  inclusive  of  everything  except  personal 
rv,  stimulants,  extra  nursing,  and  special  invalid 
1  lie  is.  Mundesley  is  a  terminus  of  the  Great  Eastern 
and  Midland  and  Great  Northern  Joint  Railways. 
Carriages  by  arrangement  will  meet  patients  on  their 
arrival. 

,'  The  Medical  Press  and  Circular, 

—The  question  raised  by  Dr*  Eyre  Harris  in 
last  issue,  as  to  the  possibility  of  modifying  the 
old -fashioned  hospitals  for  chest  diseases  and  ancient 
institutions  for  the  treatment  of  pu!monarv  tuberculous 
to  meet  the  stnet  requirements  of  sanatorium  life  as  m>w 
understood,  1-*  one  of  great  importance  and  should  be 
in    ill  its  bearings  by  those  responsible  for  the 

set  of  these  establishments.  It  has  been  my 
to  point  out  in  the  articles  on  the  various  British 

•uria  for  consumption  which  1  have  contributed 
ur  pages  that  these  are  of  M  all  sorts  and  condi* 
halts, rt  some  suffering  from  structural  deficiencies,  win  I 

ra  lack  in  efficient  management.      It  is  very  doubt- 

if  is  not  false  economy  to  attempt  extensive  altera- 
tton  of  the  ancient  to  tit  the  fashion  of  the  modern. 
Certainty  in  the  case  of  many  of  our  hospitals  no 
amount  of  alteration  will  enable  these  institutions  to 
supply  what  are  now  consider  leaic  necessities. 

I  am  still  of  opinion  that  the  Committee  id  Management 
(rf  the  National    Sanatorium  at  Bournemouth  should 

fcder  whether,   instead    of   providing   such    fqi 

lions  as  are  con  tern  plated  on  the  present  very 
limited  site,  it  would  not  be  wisest  to  recognise  that  no 

int  of  alteration  can  modernise  an  establishment 
bunded  as  far  back  as  1 855  ;  steps  should  betaken 
to  provide  an  establishment  where  the  "  open -air  " 
method  can  be  applied  in  their  entirety  in  accordance 

tie  best  knowledge  of  the  day. 

Ai  I  was  careful  to  point  Ottt  manv  valuable  improve- 
ments have  been  carried  out  at  the  National  Sanatorium 


in  the  peritoneum  and  large  intestine.  The  appendix 
was  found  to  be  constricted  at  the  base,  dilated,  and 
full  of  mucus  above  ;  it  was  ligatured  and  removed* 
There  was  some  thin,  turbid,  and  dark-coloured  fluid 
in  the  peritoneal  cavity ,  but  no  adhesions  were  found, 
nor  was  there  any  evidence  of  the  perforation 
viscus.  A  culture  oi  the  fluid  showed  pure  specimens 
of  the  pneumococcus,  the  presence  of  which  was  con* 
firmed  by  an  inoculation  test.  Three  days  later  hiccough 
and  abdominal  pain  supervened,  and  10  c.c>  of  No.  1 
antipneumococcic  serum  were  injected*  On  March  6th» 
the  injection  was  repeated.  Signs  of  fluid  at  the  left 
base  appeared j  and  on  March  20th  pus  was  found  on 
exploration,  resection  of  part  of  the  ninth  rib  being 
1  rued  the  ne^t  day*  when  twelve  ounces  of  sour- 
smelhng  pus  were  evacuated.  The  further  progress 
of  the  case,  though  slow,  was  uneventful.  The  sudden 
onset  and  rapid  and  grave  development  of  the  peritoni- 
tis clowh  coi responded  with  what  is  observed  in  pneu- 
moceoccic  inflammations  elsewhere. 
The  President  also  communicated  a  case  oi 

PNEUMOCOCCAL    PERtTONlTlS 

in  a  sir],  a*t.  H,  who  was  admitted  under  Ins  care  into 
Guy's  Hospital  on  November  19th,  IOO|.  On  the  ioth, 
abdominal  pain  set  in.  followed  by  a  rigor,  and  two 
days  I  at  er  si  gns  of  pn  en  monia  de  v  el  oped .  On  ad  missi  o  n , 
the  abdomen  was  distended  and  tender,  moving  very 
little  on  respiration,  while  physical  signs  of  consolida- 
te n  at  both  bases  behind  were  present.  Some  herpetic 
vesicles  were  seen  at  the  base  of  the  nose.  Mr*  Lucas 
performed  laparotomy,  and  a  quantity  oi  odourless  pus 
together  with  masses  of  lymph  was  removed.  The 
cavity  was  irrigated  with  hot  saline  solution  and 
drained.  The  pneumonia  on  the  right  side  cleared  up, 
but  on  the  left  side  physical  signs  of  empyema  mani- 
fested themselves,  and  on  the  a^tb  six  ounces  of  pus  were 
withdrawn,  resection  of  a  portion  of  rib  being  performed 
lour  days  later,  when  more  pus  was  evacuated*  Culti- 
vations taken  by  Dr-  Eyre  from  the  peritoneal  pus 
gave  a  pure  growth  of  the  pneumococcus  ;  those  taken 
from  a  second  collection  in  the  left  iliac  iossa,  which  was 
incised  on  December  nth.  a  growth  of  pneumococcus 
associated  with  the  staphylococcus  aureus.  Cultivations 
from  the  pus  aspirated  from  the  chest  were  sterile, 
but  under  the  microscope  showed  badlv  staining  diplo- 
OOCCi,  and  empty  capsules,  characteristic  of  a  pneu  mo - 
ooock  empyema.  The  c h ild  was  making  good  progress , 
Dr.  Taylor  discussed  the  question  oi  the  seat  of  primary 
infection  which,  he  thought,  was  shown  by  the  sequence 
of  events  to  be  the  lung,  and  the  peritonitis  and 
empyema  he  considered  were  secondary* 

Mi1.  Stanley  Boyd  referred  to  the  case  oi  a  woman. 
fi.  »6,  whom  he  had  operated  upon  for  symptoms  oi 
MBM^^.'^d^l^dM  aUemprareTow'l'Zg  [  Pf"'™^;  ««*  pint*  oi  odourless  pa.  U^WUM 
made  lo  secure  a  hi*.!  ,U*Urd  of%c,  „   I    *;™^^Z^«^*?ST<^J^ 

must  continue  to   hold   to  my   former  opinion  as  ex- 
pressed by  Dr.  Harris  himself, "thai  "  one  cannot  expect 


ter  an  existing  building  so  that  it  will  havo  quite 
Line  appearance  as  one  of  the  modern  sanatoria/ 
I  am*  Sir,  yours  truly. 
Special  Medical  Commissioner. 


transactions  of  Societies. 


CLINICAL  SOCIETY  OF  LONDON 
Meeting    Held    Friday,    January    8th, 


I>r.    Frederick    Taylor,    President, 


1004. 

the    Chair, 


Sin    [>yce    Duckworth    and     Prafemor    Howard 
I  notes  of  a  case  of 

PN E U MOCOCC A L    PER ITO N tT IS. 

itient,  a  woman,  art.  17,  was  seized  with  head- 

generalised  pains  and  a  rigor  on  February  zi  th, 

The  temperature  was  lounri   to   be  104  2  on  the 

following  day\   and  symptoms  of   general   peritonitii 

WidaTs  reaction  was  negative,  and  a  large, 

polvnudear  leukocytosis  was  present.     On  March  2nd, 

Mr  Vfarsh  and  Mr,  Bowlby  saw  the  case,  and  a  diagnosis 

">!  typhlitis  with   some  general  peritonitis  was  made* 

Mr  Marsh  operated,  and  signs  of  inflammation  were  seen 


obtained.  The  abdomen  WM  distended  in  a  peculiar 
fashion  and  moved  with  surprising  ease.  No  informa- 
tion was  forthcoming  at  the  time  oi  operation  as  to  the 
primary  origin  of  the  disease. 

Dr.  J.  H.  Bryant  alluded  to  three  cases  of  pneu- 
QKJOOCCfc  peritonitis  which  he  had  published  in  tool,  in 
which  the  primary  point  of  infection  was  the  peritoneum. 
He  considered  that  an  alimentary  origin  was  not  at  all 
improbable,  especially  as  the  pneumococcus  might  be 
found  in  ihe  throats  of  healthy  individuals.  He  called 
attention  to  the  tact  that  abdominal  pain  was  fre- 
quently complained  ol  in  pneumococcal  pneumonia 
and  he  thought  that  the  adhevons  sometimes  found 
post-mortem  between  the  lung  and  the  diaphragm 
might  account  for  this, 

Dr+  J.  FaWCXTT  stated  that  in  182  fata!  cases  of  lobar 
pneumonia  occurring  in  GnyTs  Hotpital  during  the  last 
five  years,  in  which  autopsies  had  been  made,  five 
only  showed  au\  of  infection  of  the  peritoneum , 

am)  t!iis  was  very  slight.  The  conclusion  to  be  derived 
was  that  in  pneumococcal  peritonitis  the  infection  was 
generally  primary  in  the  peritoneum. 

Dr.  \V.  La  no  00  n -Brown  referred  to  a  case  of 
pneumococcal  empyema  in  a  girl,  at,  IO,  in  whom  signs  of 
fluid  appeared  in  the  abdomen  and  right  knee-joint. 
The  abdomen  was  not  opened t  as  the  condition  cleared 
u\k     He  considered  that  this  was  probably  a  case  of 


36    Th»  Medical  Prbss.         TRANSACTIONS  OF  SOCIETIES. 


Jaw.  13,  1904. 


pneumococcal  peritonitis  which  got  well  without 
surgical  interference. 

Mr.  C.  H.  Golding-Bird  said  that  although  a  tuber- 
culous appendicitis  was  known,  yet  pneumococcal 
appendicitis  was  not,  as  yet,  recognised.  He  thought 
that  there  were  many  points  in  Mr.  Marsh's  case  which 
might  justity  the  latter  description. 

Dr.  J.  Eyre  felt  sure  that  if  bacteriological  examina- 
tions were  made  more  frequently  than  they  were  the 
pneumococcus  would  be  more  often  found.  He  called 
attention  to  one  curious  property  possessed  by  the  pus 
from  these  cases,  namely,  its  tendency  to  auto- 
sedimentation,  the  upper  layers  soon  becoming  clear. 
He  thought  that  such  a  simple  test  might  be  found  of 
assistance  at  the  time  of  operation.  He  also  pleaded 
for  the  importance  of  performing  animal  inoculation 
experiments  as  a  confirmatory  test  for  the  presence  of 
the  organism. 

Dr.  Herbert  French  read  notes  of  a  case  under  the 
care  of  Mr.  Newton  Pitt,  in  which  he  had  performed  the 
autopsv.  Acute^peritonitis  with  consolidation  of  one 
base  were  found.  He  thought  that  the  cases  might  be 
divided  into  two  groups,  one  where  the  infection  is 
directly  into  the  peritoneum,  and  another  in  which  the 
organisms  get  into  the  blood  and  so  disseminate 
themselves. 

Sir  Dyce  Duckworth,  in  replying,  said  that  he 
thought  that  pneumococcal  peritonitis  might  exist  in 
varying  degrees  of  virulence.  The  improvement  in  his 
case  after  the  use  of  the  serum  was  certainly  post,  if  not 
propter,  hoc. 

Professor  Marsh  replied  that  he  was  unable  to  state 
whether  the  case  was  one  of  primary  appendicitis.  He 
thought  that  to  the  list  of  conditions  which  may  imitate 
appendicitis  pneumococcic  peritonitis  must  be  added. 

The  President,  in  replying,  said  that  the  presence  of 
an  extra-peritoneal  abscess  containing  pneumococci 
in  association  with  another  organism  was  an  interesting 
feature  in  his  case. 


EDINBURGH  MEDICO-CHIRURGICAL  SOCIETY. 
Meeting  held  January  8th,  1904. 


Mr.  John  Chiene,  President,  in  the  Chair. 
Dr.  Wm.  Allan  Jamieson  read  a  paper  on— - 

THE  TREATMENT  OF  SKIN  DISEASES  BY  X-RAYS,  &C., 

an  abstract  of  which  will  be  found  on  page  32. 

Dr.  Norman  Walker,  in  the  discussion  that  followed, 
said  it  was  very  important  to  consider  each  case  on  its 
own  merits,  especially  as  to  the  duration  of  the  sittings. 
For  example,  in  a  working-man  it  was  better  to  give  a 
long  exposure  in  one  or  two  sittings ;  a  burn  resulted, 
but  the  cure  was  not  interfered  with,  and  the  patient 
could  go  on  with  his  work  while  the  burn  was  healing. 
In  this  method  telangiectases  were  often  produced  in 
the  scar,  but  this  was  of  minor  importance,  as  they 
could  be  easily  treated  by  electrolysis  later  if  desired. 
Again,  in  patients  who  could  not  attend  daily  over 
long  periods,  and  who  at  the  same  time  did  not  wish 
to  have  burns,  ten-minute  exposures  at  intervals  of 
ten  or  twelve  days  might  be  tried,  and  a  cure  could 
ultimately  be  attained  in  this  way.  In  rodent  ulcer, 
if  the  case  were  seen  early,  it  was  always  a  question 
wnether  excision  should  not  be  preferred  to  X-rays ; 
he  thought  it  should.  It  was  always  difficult  to  say 
when  treatment  should  be  stopped,  as  after  apparent 
cure  relapse  was  often  seen.  When  once  a  rodent 
ulcer  had  attacked  the  cartilages  the  outlook  was  not 
nearly  so  good.  As  to  other  skin  diseases  on  which 
the  X-rays  had  been  tried,  they  might  be  divided  into 
those  in  which  there  was  reason  for  supposing  that  the 
treatment  would  succeed,  and  those  in  which  its  use 
had  been  found  accidentally.  In  hypertrichosis  he 
considered  that  the  margin  between  permanent  de- 
struction of  the  hair  follicles  and  sloughing  of  the  skin 
was  too  small  for  safety,  and  that  therefore  the  treat- 
ment was  not  to  be  recommended.  In  favus,  which 
he  looked  upon  as  practically  incurable  by  other  means, 
the  method  was  the  best  at  our  disposal.     In  ringworm 


he  did  not  advise  it,  unless  there  was  some  especial 
reason  for  hurrying  on  a  cure.  In  these  diseases  and 
in  sycosis  it  acted  solely  because  of  its  efficient  epilatory 
action.  He  had  used  X-rays  in  the  treatment  of  an 
extensive  case  of  warts  of  the  scalp  with  great  benefit  ; 
the  growths,  which  numbered  about  200,  disappeared 
after  seven  or  eight  sittings.  In  psoriasis,  though  the 
lesion  was  improved,  the  results  on  the  whole  were  not 
so  good.  He  had  not  tried  it  in  eczema,  nor  did  he 
propose  doing  so.  A  word  of  caution  as  to  tubes 
bursting  was  needful ;  they  should  be  wrapped  in  gauze 
to  minimise  the  risk  of  glass  splinters  flying  about. 
There  was  no  evidence  that  X-ray  treatment  caused 
dissemination  of  tuberculosis ;  in  Wilde's  series  of 
eighty  cases  of  lupus  two  died  of  phthisis,  probably 
quite  an  accidental  proportion.  His  experience 
rather  was  that  the  general  health  of  the 
patients  improved  under  treatment.  Dr.  Wilde, 
of  Manchester,  was  able  to  compare  all  methods 
of  treatment,  and  found  that  with  X-rays  he 
had  75  per  cent,  of  cures,  withFinsen  light  74  per  cent., 
and  with  the  London  Hospital  lamp  24  per  cent. 
Dr.  Walker  did  not  therefore  think  it  was  justifiable 
to  replace  their  small  lamp  by  the  expensive  Finsen 
one,  seeing  that  the  results  were  not  better  than  with 
the  X-rays.  He  strongly  urged  that  to  save  all  methods 
of  electrical  treatment  from  falling  into  disrepute  they 
should  be  kept  in  the  hands  of  scientific  physicians  and 
not  exploited  by  quacks,  companies  \  and  electrical 
institutes.  Not  less  strongly  did  he  assert  that 
despite  the  brilliant  results  got  in  malignant  disease, 
all  such  cases  should  be  treated  surgically  if  they 
were  got  early,  and  X-rays  looked  upon  as  a  "secondary 
resource  only. 

Dr.  Dawson  Turner  gave  statistics  of  the  cases  he 
had  treated  during  the  past  six  months.  Of  twenty- 
three  of  rodent  J  ulcer,  seven  were  cured,  twelve  im- 
proved, and  four  died.  Of  forty-two  of  lupus,  eighteen 
were  cured  and  twenty-four  improved  ;  of  three  of 
cancer  of  the  cervix,  two  were  improved  and  one  died  ; 
of  thirty-five  of  tuDerculous  glands,  twenty  were 
cured,  twelve  improved,  and  three  not  improved  ; 
of  six  of  tuberculous  joints,  one  was  cured,  three  im- 
proved, and  two  not  improved  ;  of  twelve  of  epithe- 
lioma of  mouth,  four  were  improved,  eight  not  im- 
proved ;  three  cases  of  sarcoma  were  improved  ;  of 
nineteen  of  scirrhus  of  the  breast  eight  were  improved, 
eleven  not  improved.  Sarcoma  yielded  much  more 
readily  than  carcinoma  ;  an  extensive  fibro-sarcoma  of 
the  frontal  bone,  which  had  mechanically  caused  com- 
plete blindness  for  four  years,  had  diminished  so 
greatly  as  no  longer  to  interfere  with  vision  in  eleven 
sittings.  An  ulcerated  scirrhus  had  healed,  and  re- 
mained so  for  a  year.  As  to  voltage,  it  must  be  high 
enough  to  carry  the  current  through  the  tube ;  the 
more  amperes  got  through  the  better.  The  length  of 
exposure  varied  inverselv  as  the  square  of  the  distance 
of  the  tube.  For  superficial  lesions  a  soft  tube  should 
be  used,* for  deeper  ones  a  hard  tube.  He  thought 
that  there  was  some  reason  to  fear  metastasis  in 
malignant  disease,  as  he  had  seen  a  scirrhus  develop 
in  a  healthy  mamma  after  a  scirrhus  in  the  other  breast 
had  been  healed  by  X-rays. 

Dr.  Fraser  (Dundee)  thought  that  the  more 
aberrant  the  tissue  cells  were  the  greater  was  the  effect 
of  the  rays.  Their  bactericidal  action  was  less  im- 
portant ;  they  altered  the  nutrition  of  the  cells  in  some 
way  and  laid  them  more  open  to  other  treatment. 
Soft  tubes  caused  more  irritation  than  hard  ones,  their 
effects  being  redness,  swelling,  loosening  of  hairs, 
pigmentation,  blistering,  and  sloughing.  The  factors 
influencing  the  results  were  the  strength  of  the  current, 
the  hardness  of  the  tube,  the  distance,  the  duration  of 
exposure,  the  state  of  the  skin,  and  the  individual 
reaction  ;  he  had  not  noticed  that  weather  had  any 
effect.  In  lupus  and  rodent  ulcer  the  abnormal  cells 
were  destroyed,  the  growth  of  healthy  fibrous  tissue 
stimulated,  and  the  natural  epithelium  favourably 
influenced.  In  favus  his  results  had  been  good.  In 
scirrhus,  large  rodent  ulcers,  and  sarcoma  he  had 
noted  a  marked  analgesic  action  even  where  no  healing 


J*&  S3-  ' 


TRANSACTIONS  OF  SOCIETIES. 


The  Medical  Pbess.     37 


In   lupus  erythematosus  his  result 
scars  being  soft  and  not  contracting, 
-  iv  common. 
IG  (Dundee)  alluded   to  the  success  he  hail 
tting  mycosis  fungoides  bv  X-ravs,  and 
GAXDJKBt    to   their  applicability   to  hyper- 
trichosis, in  which,  he  thought,  the  margin  of   safety 
was  Jar; ..-r  fh  01  l>r.  Norman  Walker  had  represented  it 

ROY  FJtfY  OF  MEDICINE  IN  IRELAND. 

Section  of  Obstetrics. 


Mf.ETI.SG  HELD    FRIDAY,    NOVEMBER   27  TH,    IQOJ* 

Hie  President,   Ok    A.  Smith,  in  the  Chair, 


D*-  Shyly  showed  an  interesting  fibro-cyst  of  the 

uteres  and  a  sarcomatous  tumour  which  occurred  at 

at  of  operation  six  years  after  an  ovariotomy. 

The  President  showed  a  specimen  of  tubal  preg- 

ngulated  by  torsion  of  the  pedicle, 

roposed,  and  Dr,  Kton  seconded,  that 
-est  thanks  of  the  Section  be  accorded  to  the  out- 
doing President  (Dr.  Smyly), 
The  President  then  read  his  address  on 

THE    EFFECT   OF    THE    M  JO  WIVES*  ACT   OF    IQ02    ON    IRISH 
TRAINING     INSTITUTIONS     AND     NURSES. 

a  fall  report  of  which  appeared  in  our  issue  lor  December 
9ttY     [n  th*  discussion  of  the  address  which  followed  , 
weedy  proposed  a  vote  of  thanks  to  the  President 
for  his  able  address.     M  I  wish  also  to  convey  my  con- 
5  to  him,"  he  said, J*  for   the  high  position  in 
1  he  has  been  placed  as  head  uf  the  Obstetrical 
the  Royal  Academy  of  Ireland  by  a  unani- 
mous vote.     In  reference  to  the  Hid  wives'  Registration 
I  iear  that  our  profession  cannot  be  held  blameless 
>ent  condition  of  affairs.     When  it  became 
Apparent    to    everyone    that   rightly   or    wrongly    the 
English  public  intended  to  have  the  Bill  as  it  at  present 
Stands,  there  was  no  unanimity  of  opinion  among  our 
ikmal  brethren  here.     Dr.  Smyly  alone,  so  far  as  I 
loom,  held  consistent  views,  and  urged  the  importance 
Oi  having   Ireland  included  in  the  benefit  of  the  Act. 
c   until  the  Bill  had  almost  become  a  law 
in  authority  in  the  Rotunda  aroused  them- 
btain  certain  privileges  for  the  chartered 
Mis  Ol  Dublin,     These  privileges,  I  understand, 
1  to  the  year  1905,  and,  such  as  they  are,  we 
share  them  in  common   with    every    '  handy  woman  ' 
m  England,     After  1905,  women  who  wish  to  practise 
midwifery  in  England  will  have  to  pass  a  State  exa- 
mination ;     before     presenting     themselves     for     this 
certain  conditions  will  have  to  be  fulfilled,  which  render 
«  impossible  for   Irish  nurses  to  enter  for  it     The 
Rotunda  is  the  largest  hospital  of  its  kind  in  the  three 
loms;     170   women   have   crossed    the   water    to 
nurses  within  the  past  five  years  ;  that  in 
1  trident  proof  of  the  value  attached  to  our 
tales.       Vet    this   miserable     rule     of     having 
'tend     a     woman     for      ten     days     after     con* 
eat     absolutely     makes     it     impossible    for  our 
lOalify.      It  is  a  lact  of  common  knowledge 
that  I  in  women  in  the  Rotunda  only  spend 

eicht  days   ha   the  institution  ;  and,  consequently,   the 
woman*'    in     the   English   villages,  who  has 
fed   through   her   twenty   conductions,   and   has 
l  for  ten  days    in    each  case,    will    be  adjudged 
worthy  to  present  herself  for  examination  than 
If  we  atjree  on  some  common  course  of  action 
vet  shall  mjrelv   succeed   in   getting   the   Privy  Council 
let  the  rules  that  at  present  exist  ;  and  I  hope  that 
we  leave  this  evening  some  resolution  will  be 
hat    will   be  the  means  of  removing  the  Ln- 
nearly  threatens  us." 
Or  Kidd,  in  proposing  *'  That  in  the  opinion  of  the 
Obstetric  Section  of  the  Royal  Academy  of  Medicine 
in  Ireland,  any  woman   holding  the  nursing  certificate 
bfei  Chartered    maternity   hospitals  shall  be 
"turned  to  have  complied  with  the  rules  of  the  Central 
Board    regulating    the   course   of   training 


of  'pupil  midwives/  and  shall  be  eligible  to  present  her- 
self for  the  examination  of  the  Central  Midwives  Board," 
said;  "  After  the  very  able  address  we  have  heard  from 
our  President  my  task  is  an  extremely  easy  and  pleasant 
one.  In  this  resolution  which  you  have  just  heard, 
I  think  there  is  nothing  contentious  to  a  member  of 
'bstetric  Section  of  the  Royal  Academy  of 
Medicine.  Professor  Smith  pointed  out  very  clearly 
the  difference  which  exists  between  the  training  1  »f 
midwives  here  in  Ireland  and  that  which,  under  the 
terms  of  the  Act,  would  entitle  the  ordinary  midwife  in 
1  I  to  present  herself  for  examination  by  the 
Central  Midwives*  Board.  Dr.  Tweedy  mentioned 
that  eight  days  was  the  recognised  number  of  days 
spent  by  a  patient  in  the  maternity  of  the  Rotunda 
Hospital;  I  believe  that  nine  days  is  the  number  at 
the  Coombe  ;  but  any  person  who  has  had  experience 
koOWS  the  extreme  difficulty  there  is  in  keeping  that 
GlASfl  of  patient  in  hospital,  even  for  so  short  a 
tittle.  With  regard  to  the  allocating  of  twenty 
conductions  to  each  nurse,  I  think  that  instead  of 
doubling  the  size  **i  our  hospitals  we  would  have  to 
double  the  number  of  births-  Dr+  Tweedy  has  pointed 
out  that  no  less  than  i;o  midwives  who  were  trained 
in  the  Rotunda  hospital  during  the  last  five  years 
went  o%er  to  practise  in  England-  I  think  that  if 
this  point  were  brought  prominently  forward  it  is 
the  one  and  sole  proof  needed  to  show  the  estimation 
in  which  the  diploma  of  the  Rotunda  Hospital  is  held 
in  England.  With  regard  to  the  clause  which  gives 
us  two  or  three  years*  grace,  it  really  reduces  the  nurses 
who  have  received  the  certificate  of  the  Rotunda  or 
I  the  Coombe  to  the  level  of  the  ■  handy  women  *  in 
England.  I  think  that  if  this  resolution"  be  adopted, 
and  if  pressure  be  brought  to  bear  on  the  Privy  Council 
I  to  alter  the  rules  so  as  to  allow  the  admission  of  our 
I  trained  nurses  to  the  examinations  of  the  Central 
!  Midwives'  Board,  we  should  succeed  in  getting  justice 
done  to  the  chartered  hospitals  of  Dublin." 

Dr.  Jellett,  in  seconding  '±jt+  Kidd's  resolution, said 

I  "  thai  he  would  like  to  point  out  that  the  present  dim* 

i  cully  of  the  Dublin  hospitals  was  brought  about  not 

:  by  the     provisions  of  the  Midwives*  Act,  but  by   the 

regulations  <>f  the  Central  Midwives*  Board  sanctioned 

l,e   Privy  Council;   and    that   it  was4    therefore, 

possible  to  overcome  it.  as  these  regulations  could  be 

changed.     There  was  not   the  least  occasion  for   the 

Dublin  hospitals   to  lose  heart.     If  the  proper  stand 

were   made,    the   changes  were  sure    to    be    effected. 

The    present     regulations        practically    prohibit    the 

training   of  nurses  in   Ireland   for    English   districts. 

1  Now     there     are     two     ways     out    of     the    present 

difficulty     open     to      the      Irish      hospitals.       They 

can     claim     either     that     their     examinations     are 

recognised   as   equivalent   to   the   examination   of   the 

1  Central  Midwives'  Board,  or  that,  in  the  terms  of  the 

resolution,  the  certificates  of  the  Irish  hospitals  shall 

be  taken  by  the  Central  Midwives'  Board  as  evidence 

;  of  sufficient  training,  though  this  would  seem  to  be  self  - 

]  evident  to  anyone,  1 1  was  interesting  to  note  the  attitude 

of  the  promoters  of  the  different  Bills  towards  the  Irish 

hospitals  in  the  past  and  at  present.       (The  speaker 

then  read  some  correspondence  which  passed  between 

the  College  of  Phvsicians  and   the  promoters  of   the 

Midwives'  Bills  of'tooo  and  1902.)     When  the  Bill  o1 

1900  was  before  Parliament,  Mr.  Heywood  Johnston 

expressed    a    willingness    to    accept    an     amendment 

recognising  the  examinations  of  the  Irish  hospitals  as 

1  equivalent   to    the   examination   of   the   Central   Mid* 

wives'  Board.     When  the  Bill  of  1902  came  forward, 

he  refused  to  accept  such  an  amendment,  but  at  the 

same  time  disclaimed  any  hostility  to  the  Irish  hospitals. 

,  and  stated  that  in  his  opinion  the  Bill  would  not  injure 

I  them.     Now   that   the  Bill  is  law,   the  first  act  of  a 

Board  largely  controlled  by  the  promoters  of  the  Bill 

is   to  draw  up  rules  which  effectually  exclude   Irish 

nurses.         He     had      written      to      Dr.     Sinclair,     a 

member     of     the     Board,    and     asked     him     what 

would     be     the     position     of     an     Irish    nurse    who 

applied    to   be   admitted   to    the   examination   of   the 

i  Board,  and  said  ;— "  I  have  been  a  pupil  midwife  for 


38     Thb  Medical  Press.        TRANSACTIONS  OF  SOCIETIES. 


Jan.  13,  1904. 


six  months  at  one  of  the  Dublin  Incorporated  hospitals. 
During  that  time  I  have  attended  a  regular  course  of 
instruction  ;  I  have  watched  some  300  to  400  de- 
liveries ;  I  have  personally  assisted  at  some  20  to  30 ; 
I  have  personally  conducted  some  three  or  four;  I 
have  watched  some  600  to  800  women  during  their 
puerperium  ;  and  I  have  personally  nursed  some  20 
to  30.  I  have  passed  the  examination  of  the  hospital.' 
Dr.  Sinclair,  in  reply,  had  stated  that  the  Board  had 
said  that  it  was  bound  by  the  Privy  Council  rules, 
but  that  he  considered  that  the  Irish  hospitals  had  a 
substantial  grievance  which  called  for  removal.  What 
were  they  going  to  do  ?  The  resolution  of  the  Academy 
must  be  backed  unanimously  by  the  hospitals,  by 
the  Royal  Colleges,  and  by  extraneous  opinion,  and 
then  it  could  not  tail.  The  Central  Midwives' 
Board  was  undoubtedly  a  powerful  body,  but  when  it 
went  too  far  it  could  be  pulled  up  by  the  Privy  Council 
as  had  been  done  before.  Of  the  present  regulations 
some  were  good  and  some  were  bad  ;  and  it  was  a 
curious  fact  that,  as  was  commonly  hinted,  almost  all 
the  good  regulations  were  recommended  by  a  minority 
ot  the  Board,  were  refused  by  the  majority,  and  were 
finally  forced  on  the  majority  by  the  Privy  Council. 
In  other  words  the  majority  report  was,  to  a  very  large 
extent,  rejected  by  the  Privy  Council,  and  if  the  Privy 
Council  had  compelled  the  Central  Board  to  change 
their  regulations  once,  it  could  make  them  do  so  again. 
But  to  succeed  there  must  be  absolute  unanimity 
between  the  Dublin  hospitals.  The  worst  enemies  of 
these  hospitals  could  not  accuse  them  of  over  zeal  in 
their  own  behalf  in  the  past." 

Dr.  Smyly  :  "  The  resolution  I  have  to  propose  is  one 
of  great  importance  to  our  country  and  profession, 
and,  therefore,  should  arouse  the  most  intense  feelings 
of  patriotism  and  professional  esprit  de  corps.  It  is 
that  this  Midwives'  Act  should  be  extended  to  Ireland. 
For  many  years  I  have  felt  it  to  be  a  very  desirable 
Act  both  for  England  and  Ireland,  and  at  first  I  worked 
with  some  energy  for  its  passing  ;  but  when  I  found 
that  Ireland  was  excluded  from  the  Act,  and  that 
we  were  excluded  from  all  the  benefits  of  it,  it  seemed 
to  me  that  we  should  suffer  a  double  wrong — we  not 
only  get  nothing  ourselves,  but  we  are  deprived  of  our 
present  privileges.  I  think  this  Act  would  be  of 
benefit  to  us  in  three  ways.  First,  to  poor  lying-in 
women  in  Ireland.  It  has  been  said  to  me  often  that 
we  did  not  want  the  Midwives'  Act  over  here  when  we 
have  a  Poor-law  that  provides  midwifery  for  neces- 
sitous women.  I  give  my  opinion — it  has  been  formed 
from  some  experience  among  the  poor  of  Dublin  and 
elsewhere,  and  not  founded  on  statistics,  so  it  may 
clash  with  and  be  different  from  the  opinion  of  other 
people.  But  it  is  my  opinion  that  in  the  poorer  parts 
the  lying-in  women  are  not  attended  by  trained  nurses, 
but  by  ignorant  women  who  have  no  training  whatever, 
and  are  popularly  known  as  '  handy  women.'  I  am 
sure  we  can  all  remember  instances  in  which  injuries  have 
been  done  by  these  women.  No  women  will  be  allowed 
to  practise  midwifery  again  without  certificate — that 
is,  in  England.  If  the  Bill  extended  to  Ireland  the 
effect  would  be  that  these  poor  women  would  be 
attended  by  trained  nurses.  However  superficial  such 
training  might  be,  she  would  at  least  have  learnt  the 
use  of  antiseptics,  the  methods  of  cleanliness,  the 
prevention  of  puerperal  fever,  &c,  and  she  would 
know  when  to  send  for  a  doc  tor.  If  under  the  Midwives' 
Act  a  nurse  meet  with  a  case  of  malpresentation, 
haemorrhage,  and  so  on,  and  she  does  not  send  for  a 
doctor,  she  is  liable  to  have  her  name  erased  from  the 
midwives'  roll.  If  guilty  of  drunkenness,  or  im- 
morality, she  would  be  liable  to  punishment.  How 
does  this  Bill  affect  the  medical  profession  ?  The 
midwives  have  to  send  for  a  doctor  if  anything  is 
going  wrong,  and  this  entails  a  lot  of  work  for  doctors 
which  they  might  otherwise  not  have  got.  And  as 
midwives  are  compelled  by  Act  under  the  County 
Councils  to  send  for  the  doctor,  I  believe  the  people  who 
compel  the  sending  for  the  doctor  will  have  to  pay  him  ; 
but  this  is  not  quite  dear.  The  third  reason  why  the 
extension  would  be  beneficial  to  us  is  that  of  the  gTeat 


training  schools  here.  If  we  fail  in  our  appeal  to  the 
Central  Board  and  to  the  Privy  Council,  we  shall  be  in 
an  unfortunate  condition,  and  the  Rotu  ida  will 
receive  a  very  great  blow.  If  we  had  united  to  get 
the  Act  extended  to  this  country,  we*  should  have  had 
our  representatives  on  the  Central  Board,  and  their 
rules  would  not  have  passed  in  their  present  form.  As 
this  resolution  appeals  generally  to  the  profession  in 
Ireland,  I  propose  that  a  copy  of  it,  if  passed,  be  sent 
to  the  authorities  of  the  Irish  Medical  Association." 

Dr,  Horns  said  "  we  had  to  go  back  some  twelve  or 
fourteen  years  since  this  Bill  was  proposed,  and  ask  who- 
were  its  promoters.  Not  the  medical  profession,  but  a 
lay  society  and  Mr.  |Heywood  Johnston.  The  Obstetric 
Section  of  the  Royal  Academy  of  Medicine  had  the  Bill 
under  discussion.  When  it  came  before  us  it  was  said 
it  did  not  affect  us  at  all ;  it  was  a  Bill  for  England  and 
Wales.  We  thought  our  poor  people  in  this  country 
well  nursed  indeed,  for  we  had  the  Coombe  and  the 
Rotunda  Hospitals,  which  were  sending  out  nurses  all 
over  the  country.  A  second  attempt  was  made  to> 
carry  the  Bill,  but  it  was  still  resisted  by  the  profession, 
as  against  their  rights.  A  third  time,  it  becomes  law. 
It  is  because  it  is  law  that  I  feel  justified  in  saying  that 
it  should  be  extended  to  Ireland*  However,  there  may 
be  some  difficulties  about  its  extension  to  Ireland. 
Dr.  Smyly  has  mentioned  one  very  important  point- 
How  will  the  medical  men  receive  it  ?  How  will  the 
County  Councils,  if  they  find  they  have  to  pay  the  costs  i* 
I  do  not  think  that  a  trained  nurse  will  go.  say. 
to  the  Arran  Isles  for  a  salary  of  £1 5  a  year.  However, 
the  meeting  very  properly  decided  that  the  resolution 
ought  to  go  before  the  Irish  Medical  Association  in 
order  that  the  prolession  may  give  their  opinion  on  it.  I 
wrote  the  other  day  to  the  secretary  of  the  Midwives" 
Board,  asking  for  explanations,  first  as  to  the  nurses' 
certificates  in  training,  and  those  to  come  afterwards. 
I  got  areply  stating  that  my  letter  would  be  laid  before 
the  Board  in  due  course.  There  is  no  necessity  for 
action  until  they  say  they  cannot  receive  our  certi- 
ficates. If  they  do  not,  I  think  this  Bill  ought  to  be 
extended  to  Ireland,  but  with  very  decided  amendments. 
I  think  that  in  centres  like  Dublin  and  Belfast  the 
right  should  be  reserved  for  nurses  to  train  just  as  at 
the  present  time,  for  it  is  only  in  big  clinical  centres 
that  attendance  should  be  recognised,  and  certificates- 
given." 

The  resolution  was  put  to  the  meeting  and  unani- 
mously adopted. 

Dr.  Stephens  proposed  that  the  resolution  of  Dr, 
Kidd,  which  was  seconded  by  Dr.  Jellett,  re  the 
chartered  hospitals,  should  be  sent  to  the  Central 
Midwives'  Board,  and  to  the  Privy  Council.  On 
account  of  some  remarks  of  Drs.  Tweedy  and  Jellett. 
he  would  like  to  state  that  his  Board  had  been  willing 
to  co-operate  with  Rotunda  Hospital,  and  had  sent  a 
communication  to  the  Board  of  that  hospital  which 
had  not  received  any  reply.  He  added  that  his  Board 
would  be  only  too  happy  to  act  with  the  other  hospitals, 
for  it  was  only  by  united  action  they  could  hope  to 
prosecute  their  claim  successfully.  He  was  there  on 
behalf  of  his  Board  to  join  in  anv  resolution  they 
might  adopt,  and  he  was  heartily  in  agreement  with 
the  opinions  of  the  meeting. 

Dr.  Barry  seconded  the  resolution,  and  thought  it 
was  one  that  should  be  accepted  without  hesitation, 
for  it  was  no  more  than  justice  that  they  should  have 
good  nurses  not  only  here  but  across  the  water.  The 
united  action  of  the  hospitals  would  be  bound  to  get 
them  what  they  wanted,  not  as  a  favour  but  as  a  right. 

The  resolution  was  adopted  and  the  Section  ad- 
journed.   

SOCIETY    FOR    THE    STUDY    OF    INEBRIETY* 
Meeting  held  in  the  rooms  of  The  Medical  Society 

of  London.  Tuesday,  Januarv  12th,  1004. 
H.  Campbell,  M.D.,  F.R.C. P.,  President,  in  the  Chair. 
W.  Ford  Robertson,  M.D.,  Pathologist  to  the 
Scottish  Asvlums,  opened  a  discussion  on  "  The 
Pathology  of  Chronic  Alcoholism,"  and  illustrated  his 
paper  (an  abstract  of  which  will  be  found  on  page  33) 
by  lantern  slides. 


J**.  tj.  1904- 


GERMANY, 


The  Medical  Press,     39 


XOKTH-EAST  LONDON  CLINICAL  SOCIETY. 
A  VEiTMc.  of  this  Society  was  held  at  the  Totten- 
ital  on  January  7th,  at  4  p»m+1  the  President, 
Dr.  J.  Hunt,  being  in  the  Chair.     Dr.  A,  J-  Whiting 
a  case  of  angioneurotic  rede  ma  in  a  female 
Areas  of  spastic  <  edema  had  developed 
themselves  over  different  parts  of  the  body,  including 
the  pharays.     The  affection  was  ;n  no  way  dependent 
Bpoo  any   error   in   diet.     The   treatment   of   the   case 
isiderable   discussion,    manv    members   ex- 
pressing the  view  that  some  derangement  of  the  gastro- 
;nal  canal  would,  in  all  probability,  play  an  im- 
11 1   part    in  the  production  of    the  disease,    while 
n  maintained  thai  the  disorder  had  its  origin  m 
1  vasomotor  neurosis.      (2)  A  case  of  lymp  hade  noma 
ia  a  boy,  Bet.    14       The  bilateral  glandular  swellings 
t  neck  at  one  time  obstructed  the  respiration*     He 
lad  materially  improved  under  the  administration  of 
took  and  cod-liver  oiL     Dr*  R,  Murray  Leslie,  under 
care  the  boy  was  at  one  time  as  an  in-patient, 
*ered  that  the  condition  was  both  clinically  and 
logically  distinct  from    tuberculosis,  with  which 
it  wa*  often  confounded,  and  that  its  mode  of  spread 
resembled  that  ol  the  sarcomata.     Dr.  Norman 
1  showed  a  case  of  lichen  planus  in  a  married 
n,  **t    31,  illustrating  the  lichenoid  transforma* 
tion  c»f  scratch- marks*     Her  condition  was  improving 
ly  under  the  administration  of  arsenic  internally 
be  local  application  of  a  creoUn  lotion. 


frauce. 


[from   our  own   correspondent,] 


Paris,  Jmiwy  10th,  IMA, 
Opotherapy  in  Renal  Disease, 

10 ned  last  week.  M.  Renaut,  of  Lyons,  made  a 
tii m  at   the  Academic  de  Medicine  on   the 
a  lion  of  the  treatment  of  renal  opotherapy  to 
ilbummuna,  and  on  account  of  its  importance  we  give 
detailed  thum*?. 
This  treatment,  he  said,  applied  to  patients  suffering 
renal  insufficiency,  constitutes  the  most  active 
the  most  efficacious  of  all  proposed  up  to  I  he  present 
t.     Better   than   any   other   known   means,    it 
the    kidney,    practically  annulled    by    uraemic 
i  .    it  acts  rapid ly  and  surely,  exercising  intense 
Lie  effects  ;   when  sufficiently  prolonged,  it  brings 
r  1  nary  secret  inn  to  its  normal  quantity  and  main- 
tains it  (here.     The  method   has  the  ail  vantage  over 
most  others  m    the   fact   that   it   surely   reduces   the 
ilbiimm  emitted    by  an    insufficient    kidney  and   re- 
turn to  the  latter  its  full  activity. 

It  can  even  cause  the  albumin   to  disappear  for  long 

penods,  giving  a  chance,  by  the  prolonged  functional 

ha  favour  the  restoring  of  the  renal  epithelium, 

It  is  also  a  first  class  antitoxic  method,  and  one  which 

30  way  destroyed  by  its  passage  through  the  dige*- 

1/vt  tract,  a  very  important  point, 

fcO  its  BtOdfi  of  administration  Professor  Renaut 

afreet  every  day,  one,   two,  or  three  pork   kidneys. 

,ed     m     a   mortar,    a     pint     of     salt     water     is 

Alter  four  hours  the  water  is  decanted  and 

the    patient    in    three    or   four   doses    in 

twenty-four  hours*   The  treatment  is  followed   for  ten 

Jan  and  a  rest  of  four  Of  live  days  is  ordered,  after 

-Miidi  the  treatment  is  recommenced. 

fk  have  here,  concluded  M*  Renaut,  a  therapeutic 
method  which  should  be  currently  employed  at  the 
Hymning  of  all  cases  of  nephritis,  without,  however, 
ROM  ither  means  known  and  put  into  prac- 

1L  Dieulafoy  confirmed  the  report  of  his  colleague 

tag  that  he  had  warded  off  more  than  once  acute 

OTMnk  attacks  by  the  ingestion  of  raw  kidneys,  while 


Professor  Ca^saet,  of  Bordeaux,  employed  with  com- 
plete  success  the  same  treatment  (daily  ingestion  of  raw 
kidneys)  in  a  case  of  suppuration  of  the  kidney  Inuri 
renal  calculus* 

Antithermjcs  in  Typhoid  Fever, 

As  everyone  knows,  the  treatment  of  typhoid  fever 
has  varied  according  to  the  experience  of  the  practi- 
tioner* While  some  give  every  confidence  to  quinine, 
others  prefer  antipyriue,  and  still  others  pyramid -n, 
which  they  say  possesses  none  of  the  inconveniences 
of  the  two  former,  Naturally  those  antithermics 
receive  only  their  full  application  where  cold  bath 
not  or  cannot  he  accepted  by  the  patient.  To  the  -"above 
list  a  new  agent  lias  just  been  added  which,  if  reports 
are  true,  would  seem  to  give  particular  satisfaction. 
Cryogenine,  according  toM.  H orioles,  of  the  Mont  pettier 
Academic  'de  Medicine,  possesses  real  advantages, 
especially  in  the  treatment  ol  typhoid  fever  in  children. 

In  spite  of  baths  and  quinine  associated  with  anti- 
pyrincthe  temperature  in  a  case  which  he  was  attending 
rose  persistently  for  ten  days.  Given  in  the  dose  of 
ten  grains  every  four  hours  the  temperature  fell  each 
time  on  aivl  1  half  degrees,  and  during  the  whole 
period  of  The  malady  cryogenine  was  constant  in  its 
effects.  A  short  time  after  its  administration  the 
patient  perspired  freely,  but  no  intolerance  of  the  drug 
Wll  noticed. 

Syphilis  in  the  Infant 

According  to  M.  Schwab,  injections  of  biniodide  oi 
mercury  in  a  watery  solution  are  superior  to  all  the 
other  classical  methods,  and  the  hypodermic  treatment 
should  take  the  place  in  the  treatment  of  infantile 
svphilis.  Without  danger  it  seems  particularly  ethta- 
cious,  rapid,  ami  certain,  The  average  dose  should  be 
from  one  to  two  milligrammes  given  each  day  for  ten  or 
fifteen  days,  and  then  suspended  for  a  similar  number 
of  days  when  a  new  series  of  ten  injections  should  be 
made. 

His  formula  is  as  follows  :  — 

Biniodide  of  mercury,  o'oj 

Iodide  of  sodium*  0*05 

Distilled  water,  10  gr.  (cubic  cen  timet  re ), 

This  solution  contains  5  millig.  of  mercury  per  cubic 
centimetre  (Pravaz  syringe)  ;  %  divisions  of  the 
syringe  representing  1  millig.  should  be  injected  into 
the  lumbar  return.  It  is  generally  recommend  1 
make  the  injection  into  the  muscles,  but  the  subcu- 
taneous cellular  tissue  presents  no  inconvenience. 

The  same  aqueous  solution  of  biniodide  of  mercury 
is  very  efficacious  in  syphilis  of  the  adult,  but,  of 
.zinirse,  in  much  larger  doses,  6  to  S  centigrammes  every 
five  days* 

Germany. 

[from   gdr  own   correspondent.] 


BwLltt.  January  flth,  tfloi. 
Ar  the  Society  fur  innere  Mediztn  Hr.  A.  Loewy  gave 
an  address  on 

The  Actions  of  High  and  Sea   Climates  on 

the  Organism. 
Although   the  action  of  the  former  had   frerjuentty 
been  the  subject  of  investigation  during  recent  y 
that  of  sea  climates  had  never  been  properly  estimated. 
The  speaker,  along  with  Dr.  Fran*  Mutter,  had  carried 
out  investigations  on  the  climates  of  Westerland  and 
Sylt  as  to  the  efteci  on  tissue  change  in  three  individuals, 
J  and  the  report  embraced  the  results  then  obtained,  and 
also   the  results  of   his  earlier  investigations  on   high 
(  climates* 
I      A  high  climate  acted  stimulatingly,  it  increased  the 


40     Thb  Medical  Press. 


AUSTRIA, 


Jan.  13,  1904* 


activity  of  the  heart,  the  respiration,  and  tissue  change. 
Even  when  the  body  was  at  rest  the  pulse-rate  was 
higher  than  at  the  sea  level,  as  also  the  frequency  of 
respiration  and  the  volume  of  inspired  air.  With 
muscular  exertion,  also,  all  these  processes  were  at  higher 
values  than  on  lower  levels.  These  increases  were  higher 
according  to  the  height  and  especially  in  proportion  to 
the  excitability  of  the  individual,  but  they  were  also  of 
a  transient  nature:  they  fell  after  some  days  or  weeks 
— they  did  not  depend  on  the  rarity  of  the  higher  air. 
Other  factors  must  also  be  taken  into  consideration — 
intense  isolation,  rapid  movements  of  air  and  tempera- 
ture. In  contrast  to  this,  however,  was  the  action  of  a 
high  climate  on  blood  formation,  which  was  permanent, 
that  is,  acting  as  long  as  residence  in  the  high  climate 
lasted,  and  dependent  directly  on'the  rarefaction  of  the 
air.  An  actual  stimulation  of  blood  formation  must  be 
conceded,  for  the  increase  in  the  total  haemoglobin 
constituents  could  be  confirmed  by  the  speaker,  and 
it  could  be  determined  that  the  medulla  of  bones  of 
animals  of  high  altitudes  was  richer  in  blood  cells  than 
the  marrow  of  similar  animals  on  the  lower  planes, 
and  represented  red  marrow  as  compared  with  the  fatty 
marrow  of  the  latter  animals. 

As  regarded  two  of  the  individuals  experimented  on, 
it  was  shown  that  the  sea  climate  also  stimulated  tissue 
changes,  one  much  more  than  the  other,  but  for  a 
shorter  time,  the  other  less  but  more  lastingly.  The 
third  person  showed  no  increase.  The  increase  began 
even  on  the  second  day  of  residence,  and  before  there 
could  be  any  direct  effect. 

It  was  worthy  of  note  that  in  the  case  of  the  speaker, 
both  high  and  sea  climates  increased  tissue  changes, 
but  with  Muller  the  high  climates  had  no  distinct  effect. 
There  were  therefore  individual  differences  in  regard  to 
such  action. 

The  stimulating  effects  of  sea  and  high  climates  must 
be  looked  upon  as  specific  actions,  as  the  individual 
factors,  the  total  of  which  caused  them,  but  which  could 
not  be  caused  by  any  of  them  individually. 

In  any  case  sea  and  high  climates  were  by  no  means 
indifferent  curative  agents ;  they  stimulated  and  should 
be  employed  with  caution  when  conditions  of  excite- 
ment were  already  present.  Individualisation  was 
to  be  desired,  as  they  did  not  act  on  all  individuals 
alike,  rather  one  would  be  more  active  in  one  case  and 
another  in  another.  For  any  regular  rules  to  be  laid 
down  in  this  respect,  however,  further  investigations 
were  necessary. 
At  the  Medical  Society  Hr.  Hollander  spoke  on  the 
Treatment  of  Primary  Sores, 
the  communication  being  a  preliminary  one.  He  spoke 
on  the  endeavours  that  had  been  made  to  prevent  the 
outbreak  of  syphilis  by  cutting  out  or  destruction  of  the 
primary  sore.  Only  rarely  had  any  result  been  seen 
from  it.  Moreover,  one  could  not  always  say  from  the 
character  of  the  sore  that  it  was  not  a  simple  ulcer. 
For  this  reason  statistics  were  comparatively  worth- 
less, and  only  such  were  of  value  as  were  based  on  a 
large  series  of  cases. 

In  tne  belief  that  contactless  hot  air  cauterisation 
effected  a  decidedly  deeper  action  than  Paquelin  or 
the  hot  iron,  he  had  employed  hot  air  cauterisation  in 
59  cases  of  primary  sore.  Of  the  number  15  became 
syphilitic,  44  were  spared,  22  of  these  had  remained 
well  over  a  year,  12  more  than  6  months,  3  acquired  a 
re-infection. 

If  one  had  cauterised  a  sore  with  hot  air  and  tried 
to  scrape  off  some  of  the  slough  with  the  sharp  spoon, 
nothing  came  away.  If  the  sore  were  a  soft  ulcer, 
however,  a  bleeding  wound  would  be  left  from  the 
curetting.     This  differential  ^sign  the  speaker  looked 


upon  as  positively  typical,  and  he  included  only  those 
cases  that  had  the  characteristic  hard  surface.  He 
believed  that  by  this  method  a  larger  number  of  cases 
could  be  saved  from  general  infection  than  in  any  other 
way. 


Bustrla- 


[from  our  own  correspondent.] 


Virxka,  January  9th,  1904. 
Sensational  Paralysis. 
Urbantschitsch  read  an  exhaustive  paper  to  the 
Gesellschaft  der  Aerzte  on  the  subject  of  perverted 
sensation  aad  its  remote  effects  through  the  reflex 
system  on  the  motor  nerves.  To  illustrate  his  subject 
he  quoted  cases  of  catarrh,  polypi,  and  simple  thicken- 
ing of  the  middle  ear  producing  paresis  and  even 
paralysis  of  an  entire  motor  region.  The  sensation  of 
calculating  weight  is  not  an  uncommon  occurrence  in 
aural  disease.  A  finer  disturbance  is  frequently 
observed  in  the  arm  while  writing,  and  the  tongue  in 
speech.  He  gave  fifty  examples  of  the  former  from 
tamponing  ;  in  eleven  cases  the  paralyses  were  greatly 
aggravated  by  laying  the  middle  ear  space  quite  open, 
and  then  applying  the  tampon.  Writing  and  speaking 
were  the  tests  regularly  applied  in  carrying  out  these 
observations.  In  one  of  these  cases  the  patient 
became  utterly  unaole  to  write  at  all,  although  a  good 
penman  when  in  health.  As  soon  as  the  tampon  was 
withdrawn,  speech  and  power  of  writing  would  return. 
Out  of  the  fifty  cases  experimented  on  with  the  tampo  n 
pressure,  thirteen  were  affected  in  speech  as  the  earliest 
manifestation,  and  particularly  in  attempting  to 
pronounce  the  letter  "  s,"  and  in  this  respect  the 
condition  very  much  resembles  aphasia. 

The  motor  reflex  may  also  be  associated  in  the  most 
deceptive  manner  as  apoplectic  attacks,  which  will 
certainly  increase  the  attendant's  alarm.  Proper  atten- 
tion to  the  ear  will  immediately  relieve  the  excitement, 
which,  he  considers,  fully  testifies  to  the  reflex  func- 
tional character  of  the  disorder. 

From  these  facts  he  reasoned  that  the  same  results 
were  obtained  from  similar  influences  on  the  mucous 
membrane  of  the  nose,  mouth,  &c,  which  need  not 
be  confined  to  the  motor  sphere,  but  may  be  passed 
on  to  the  damage  of  other  sensations,  such  as  t  aste, 
smell,  temperature,  &c.  He  found  that  cocainising 
the  mucous  membrane  before  applying  the  tampon 
abolished  the  consequent  disturbance,  another  fact 
which  proved  to  his  mind  that  the  morbid  changes 
were  of  a  reflex  nature. 

Etiology  of  Emphysema. 
Golubow,  of  Moscow,  in  describing  the  history  of  a 
case  of  emphysema  arising  from  an  aneurysm  of  the 
adrta  said  that  in  this  case  chronic  tracheitis  followed, 
with  a  consequent  emphysema  of  the  lung.  The 
true  etiology,  however,  of  this  disease  was  due  to  a 
congenital  anomaly  in  the  cartilages  of  the  ribs.  If 
the  number  attached  to  the  sternum  were  reduced  to 
three  or  four,  leaving  seven  or  six  of  the  ribs  attached 
by  cartilaginous  union  at  the  lower  part  of  the  c  hest, 
the  lung  thus  protected  would  in  all  probability  be 
emphysematous. 

Prostate  Gland. 
Englisch  again  presented  an  exhaustive  mono- 
graph on  urologic  pathology,  in  which  his  results 
differ  somewhat  from  other  authors,  in  acting  upon 
the  supposed  valves  at  the  neck  of  the  bladder,  or 
rather  the  folds  in  the  bladder  itself,  which,  according 
to  Fritsch,  was  caused  by  an  atrophy  in^the  muscular 
wall  of  this  viscus.  Englisch  divides  these  so- 
called  valves  into  two  classes :  First,  a  small  prostate 


JAX.    IJ.    I904. 


THE  OPERATING   THEATRES.        Tint  Medial  Press.    41 


bain  g  deeply  em  bedded  a  ud  d  war f  ed  i  n  i  t  s  grow  t  h  ;  and 
second  a  prostate  which  has  degenerated  organically 
iticm  is  normal.     He   srives  a  history   of 
1,-47  rases  which  he  has  examined,  and   among    them 
found    100  dwarfed    glands.     In    his    tabular   arrange- 
ment,  the  pathological   anatomy  is  divided   into   two 
rirst.  where  the  valve  does  not  involve  any 
Oil   #>f   the    tissue   of    the   prostate      itself,    but    i* 
ikeii    up   bv   a    fold    of   mucous   membrane, 
he  designates  "  valvula  mucosa."  or  where  the 
membrane  and  a  ring  of  ftbttBflil  tsssne  is  i  ■ 
up  to  form  what  he  calls  "  vatvula  museularis/*     The 
teetmd    group    comprises     a    valvular    arrangement 
\\   out  of  the  substance  of  the  prostate  itself, 
he  names  "  valvula  musculo-glandularis."     The 
■jsaptmuatology    of    the  small  prostate  resembles  in 
detail    that  oi    the  enlarged    prostate,  parti  cu- 
in   adults   after   puberty,    where  enuresis    i£ 
most   troublesome  symptom   we   have   to   deal   with, 
Efac  this     morbid  condition  he  recommends  the  i(  in- 
aa  epidu  rales  "  of  Kathehn,  which  he  has  fount  I 
peedy  and   effectual   manner.     He  has  not 
met  with  that  success  that  manv  other  authors  record 
Uevtng    enuresis     by   removing    the    patient     to 
tab     He   has  found    in   several   cases,    however, 
many  of  them  have  been  relieved  by  thesectioalta 
,tion  and  destroying  the  pseudo-valve.      Others 
have  succeeded  in   the  same  manner  by  the  sectio  peri- 
nealis.     In  cases  of  atrophv  of   the   prostate   arising 
from  senile  cachexia  or  inflammation,  he  gives  very 
to  encourage  the  hope  of  any  successful  treat  m<-i  it 
mse  of  the  atrophy  should  be  relieved  as  much 
is  possible  by  removing  all  foreign  matter,  and  fre- 
quently cathetensing  to  prevent  complications  ari-m. 
I  kidneys. 


Ttbc  Operating  Gbeatres. 

i;rY  S   HOSPITAL. 

jeation  for  Hoi/r-Gi.ass  Constriction  ok  the 
Stomach. — Mr.  Akui  tunot  Lane  operated  on  a  case 

tstrfcticm  of  the  stomach  at  some  distance  from 
ttw  pylon*  ia!   the  stomach  was  divided 

into  two  pa  mal  size,  that  forming  the  cardiac 

being  much  larger  than  that  forming  the  pyloric  portion. 
The  patient,  a  woman,  a?t,  50, had  suffered  Inunsyiii' 
ptoms  of  g.i  omfort  for  many  year:,,  and  within 

the  last  few  years  she  had  been  troubled  also 
with  vomiting.  She  had  restricted  her  diet  and  lost 
flesh  very  considerably.  Her  stomach  walls  could  be 
felt  distinctly,  and  in  the  situation  of  the  constriction 
*  hard  Cicatricial  mass  could  be  felt  which  was  attached 
to  the  under  surface  of  the  liver  in  the  position  of  the 
•Udder  ,  indeed,  this  mass  had  previously  been 
a  contracted  gall-bladder  which  had  become 
adherent  to  the  stomach  and  had  produced  the  gastric 
wro  atoms  of  which  she  complained.  The  front  of  the 
*Hima>  posed  bv  a  vertical  incision  through 

the  anterior  abdominal  wall  ;  the  stomach  was  then 
*M  constricted  in  the  manner  already  described, 
The  constriction  was  due  to  the  healing  of  a  gastric 

vhose  base  had  also  become  attached  to  the  under 
inrface  of  the  liver  and  gall-bladder.  As  far  as  could 
be  judged  by  the  appearance  of  the  cicatrix  the  ulcer 
had  been  a  simple  one,  and  there  was  nothing  to  suggest 
any  cancerous  infection.     The  aperture  of  communica- 

ttween  the  two  portions  of  the  stomach  was  very 

indeed,   am*   only    permitted    the   introduction 

through  it  1.      A  vertical  transverse  in- 

/was  made  through  the  stricture  and  through  the 
stomach  on  either  side,  so  that  a  large  aper- 
ommumcation  was  established  between   toe 


two  portions  of  the  stomach.  The  edges  of  the 
incision  were  brought  together  in  such  a  manner  as  to 
restore  the  functions  of  the  stomach  completely.     Mr. 

>aid  this  case  illustrated  the  difficulty  of  differen- 
tiating between  an  inflamed  gall-bladder  attaching  and 
interfering  with  the  lumen  and  functions  of  the  stomach, 
and  a  primary  ulceration  of  the  stomach  which  becomes 
attached  to  the  gall-bladder  and  interferes  with  Us 
function,  while  it  also  materially  affects  the  form, 
utility  and  function  of  the  stomach.  Such  conditions, 
he  thought,  could  be  differentiated  from  out*  another 
only  by  a  careful  inquiry  into  the  history  t>f  the  patient 
and  by  the  skilful  employment  of  one's  tinkers.  The 
progress  made  by  the  patient  was  excellent.  Siu-  lost 
her  pain,  nausea  ami  sickness,  and  rapidly  put  on  M---h. 
Pancreatic  Cyst. — The  same  surgeon  operated 
upon  a  case  of  pancreatic  cyst  in  a  woman,  set,  about  ;;. 
The  patient  had  suflered  from  a  lump  in  her  abdomen 
for  between  two  and  three  years.  It  had  interfered 
very  much  with  her  comfort,  preventing  her  from 
wearing  her  corsets,  producing  indigestion  and  constipa- 
tion, both  of  which  had  required  much  treatment  tot 
their  alleviation.  At  one  time  she  consulted  a  physi- 
cian, who  informed  her  that  the  lump  in  the  left  ssde 
of  her  abdomen  was  produced  by  the  accumulation  of 
farcal  matter  in  her  large  bowel,  and  advised  m 
and  various  manipulations,  which  he  himself  undertook 
to  apply  ill  doing  this  he  used  much  force.  She  felt 
the  lump  f subside  suddenly  during  the  process, 
when  she  was  informed  she  was  cured,  The  »oh 
cure  was  followed  by  much  I   pain,   nausea 

and  tenderness,  which  lasted  for  several  days.  As  she 
did  not  pass  the  masses  of  hard  farces  which  she  was 
led  to  suppose  had  produced  the  lump,  and  as  the  pro- 
cess of  cure  was  followed  by  so  much  di  scorn  for  I 
did  not  consult  that  physician  again.  The  lump  vary 
soon  returned  in  the  same  situation  and  became  bigger 
than  it  had  been  before.     The  large  bulk  of  the  toi 

miateil  on  the  left  of  the  middle  line, extending 
upwards  under  the  stomach  and  ribs,  backwards  into 
the  loin,  downwards  below  the  level  of  the  umbilicus, 
while  it  projected  across  the  middle  line  of  the  abdorm.n 
to  the  right  about  two  fingers'  breadth.  The  lower 
part  of  the  kidney  could  be  felt  on  its  posterior  mm 
and  the  cyst  and  kidney  appeared  to  be  intimately 
united,  A  distinct  thrill  could  be  felt  in  the 
An  incision  was  made  along  the  outer  margin  of  the 
erector  spina;,  the  kidney  was  displaced  inwards,  and 
an  incision  was  made  into  the  bulging  cyst  in  this  situa- 
tion. The  contents  of  the  cyst  were  evacuated  and  a 
drainage-tube  introduced  and  fixed  in  position.  From 
the  history  of  the  case  it  seemed  very  probable.  Mr. 
Lane  said,  that  the  cyst  wall  had  been  ruptured  in  the 
process  of  manipulation,  and  that  the  fluid  had  been  dif- 
fused through  the  general  peritoneal  cavity  and  gradu- 
ally absorbed.  The  contents  of  the  cyst  which  were 
evacuated  at  the  time  of  the  operation  in  no  way 
differed  from  those  which  are  usually  present.  The 
diagnosis,  he  pointed  out.  lay  between  pancreatic  cyst 
and  hydronephrosis*  which  involved  the  pelvis  of  the 
kidney  only,  and  left  the  secreting  substance  of  the 
organ  unaltered. 

We  have  received  the  following  from  the 
Colonial  Office  :— "  Disquieting  reports  having 
appeared  in  the  Press  as  to  an  outbreak  of  yellow 
fever  in  Jamaica,  the  Governor  of  that  Colony  has 
telegraphed  that  since  the  death  of  an  officer  from 
this  disease,  which  he  reported  on  November  19th 
last,  no  case  has  occurred,  and  that  the  state  of 
health  in  the  island  is  most  satisfactory/1 


42    The  Medical  Press. 


LEADING  ARTICLES. 


Jan.  13.  1904. 


RMISTESBD    FOR   TRANSMISSION    ABROAD. 

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"  SALUS   POPULI  SUPREMA  LEX." 


WEDNESDAY,  JANUARY  13,  1904. 


PHARMACOPCEIA  REVISION. 
One  of  the  important  events  of  the  past 
year  was  the  publication  by  the  Pharmacopoeia 
Committee  of  the  General  Medical  Council  of  a 
"  Digest  of  Researches  and  Criticisms,"  prepared 
for  them  by  William  Chattaway,  F.I.C.,  Superin- 
tendent of  the  Society  of  Apothecaries.  The 
"  Digest,"  as  some  of  our  readers  are  doubtless 
aware,  covers  the  various  researches  and  criticisms 
that  have  appeared  between  the  years  1899 
and  1902.  Most  of  the  quotations  are  taken  from 
the  Pharmaceutical  Journal,  the  Chemist  and 
Druggist,  the  British  and  Colonial  Druggist,  and  the 
American  Journal  of  Pharmacy.  Another  source 
of  information  is  the  valuable  series  of  investiga- 
tions recently  carried  out  in  the  Research  Labora- 
tories of  the  Pharmaceutical  Society  at  the  in- 
stance of  the  General  Medical  Council.  In  this 
case,  however,  full  details  are  not  supplied,  as  they 
had  already  been  reported  direct  to  the  Council. 
The  "  Digest  "  comprises  some  seventy  closely- 
printed  pages  of  weighty  matter,  and  so  far  as  we 
have  examined  it,  contains  brief  yet  adequate 
accounts  of  almost  every  criticism  or  research 
bearing  on  the  varied  collection  of  substances  con- 
tained in  the  "  Pharmacopoeia."  The  importance 
of  this  work  to  the  medical  profession  can  hardly 
be  over-estimated,  when  we  take  into  considera- 
tion the  fact  that  the  whole  of  its  progressiveness 
must  depend  ultimately  on  the  proper  appreciation 
of  fresh  facts.  On  this  point  Mr.  Chattaway  says  : 
"  I  think  it  is  clear  that  of  the  large  number  of 
researches  published  many  new  facts  may  be  taken 
as  fairly  well  established,  and  available  for  use  in 
a  new  edition  of  the  '  British  Pharmacopoeia.'  On 
the  other  hand,  it  is  equally  clear  that  there  are 
many  cases  where  revision  and  confirmation  are 
desirable  before  new  processes  can  be  regarded  as 
sufficiently  well  established  to  warrant  their 
official  recognition."  This  comment,  wide  though 
it  be,  will,  we  feel  confident,  be  found  fully  justified 


on  a  careful  perusal  of  the  "  Digest,"  in  which  the 
criticisms  dealing  with  the  botany  of  the  "  Pharma- 
copoeia "  are  but  few,  as  might  have  been  expected, 
seeing  that  such  well-equipped  experts  as  Mr.   E. 
Morell  Holmes   and  Sir  William  Thiselton-  L>yer 
were  engaged  in  advising  the  Council  on  these  points. 
The    "  Digest  "    contains    suggestions    by    many 
well-known  pharmacists  for  improvements  in  the 
manufacture  of  many  valuable  preparations,  as  well 
as  for  the  improvement  of  methods  of  assay  and 
tests  for  impurities.     It  forms,  again,   a  handy 
compendium  of  reference  to  the  pharmaceutical 
progress  during  the  past  three  years,  and  from  that 
point  of  view  should  be  of  considerable  use    to 
pharmacists  generally.     We  understand  that  it  is 
obtainable  by  post  from  the  offices  of  the  General 
Medical  Council  for  a  merely  nominal  sum.     It 
seems  a  pity  that  a  more  durable  style  of  binding 
was  not  adopted,  as  the  copy  which  we  have  re- 
ceived is  bound  in  a  thin  paper  cover  which  would 
hardly  survive  even  a  moderate  amount  of  use. 
We  congratulate  the  compiler  of  the  "Digest," 
Mr.  C.  G.  Moor,  on  the  manner  in  which  he  has 
carried  out  his  task,  and  believe  that  the  facts  he 
has  collected  will  prove  of  great   value   to    the 
Pharmacopoeia  Committee  when  they  have  before 
them    the    important    question    of    preparing  a 
new  edition  of  our  national  text-book  of  pharmaco- 
logical lore.    It  is  an  open  secret  that  the  "  Digest  " 
contains  many   references   to   his   standard  work 
on    the  "  Purity  of  Foods  and  Drugs." 

THE  CONSUMPTIVE  AT  HOME. 
While  the  immense  value  of  the  sanatorium 
and  other  forms  of  open-air  treatment  for  con- 
sumption is  daily  becoming  more  fully  recognised, 
it  must  be  remembered  that,  as  yet,  these  methods 
are  available  only  for  a  comparatively  small  pro- 
portion of  the  total  number  of  cases  of  the  disease. 
We  have  not  yet  arrived  at  the  time  when  muni- 
cipal sanatoria  will  be  provided  for  the  poorer  class 
of  consumptives  inhabiting  their  respective 
boroughs,  but  there  are  indications  that  this  is  the 
direction  in  which  the  therapeutic  progress  in  pul- 
monary phthisis  will  ultimately  be  made.  In  the 
meantime,  it  is  obvious  that  the  immense  majority 
of  tuberculous  patients  must  be  treated  in  their 
own  homes,  under  circumstances  which  must  often 
militate  considerably  against  restoration  of  the 
lung- tissue.  It  is  little  to  be  wondered  at,  some- 
times, that  such  patients,  seeing  the  impossibility 
of  carrying  out  the  directions  of  the  physician  with 
regard  to  the  hygienic  arrangement  of  the  bed- 
room, the  necessity  for  suitable  and  sufficient 
nourishment,  and  other  details  in  the  management 
of  their  cases,  are  apt  to  lose  heart  in  themselves 
and,  what  is  equally  bad,  confidence  in  their 
medical  attendant,  and  relax  the  very  precautions 
they  had  at  first  promised  faithfully  to  observe. 
How  is  it  possible  to  treat  tuberculosis  efficiently 
under  conditions  of  extreme  poverty,  gross  over- 
crowding, or  bad  sanitary  '  conditions  ?  The 
problem,  indeed,  seems  hard  to  solve,  and  yet  a 
good  deal  may  be  accomplished  by  the  dissemi- 
nation of  knowledge  respecting  the  need  for  the 


)»y.    tjt    I9Q4- 


LEADING    ARTICLES, 


The  Medical  Pres^      43 


disinfection  of  sputa,  properly  lighted  and  venti- 
feted  acid    strict    cleanliness*     Professor 

has  recently  called  alien  lion  to  this 
I  aspect  of  the  tuberculosis  question,  and 
laid  stress  upon  three  essential  points  in  the 
fueiit  of   the  consumptive  at  home.     In  the 
lace,  the  necessity  for  an  earlier  recognition 
of  the  disease  is  urged,  and,  provided  that   the 
it  will  only  seek  medical  advice  before  definite 
puln  mptoms  have  supervened,  it  should 

aot  be  difficult  after  a  thorough  systematic  phy- 
sical examination  to  enlist  the  intelligence  of  the 
patient  himself  in  his  condition  and  invite  his  co- 
operation in   battling  with   the    tendency   to    the 
disease,  and  in  overcoming  the  first  onslaught  of 
fhe  tubercle  bacillus.     When  physical  signs  have 
appeared.    Professor    Osier    pleads    for    a    more 
\[  management  "  of  the  early  cases.     It 
is  here    that    real  practical  difficulties  arise,  for, 
er  willing  and  anxious  the  patient  may  be  to 
subdue  the  affection,   neither  he   nor  his   friends 
may  show  much  disposition  to  upset  the  arrange- 
ments of  the  home  by  providing  freer  ventilation 
than  that  to  which  they  were  formerly  accustomed, 
the  patient's  confidence  is  gained— -and  this 
1*  .*  most  important  point — the  hope  of  recovery 
will,  m   the   majority  of  cases,  prove  a  sufficient 
til  as  by  which   he  may  overcome  objections 
and  other  temporary  obstacles  in  the  way  ol  the 
successful  carrying  out  of  the  plan  of  treatment, 
her  sim  qud  non  in    the   home-cure  of  con- 
sumption is  persistence,  without  which  any  system 
■en  tics    will     tail.      In    only     too    many 
uces  is  it  seen  that  the  good  effect  wrought 
rtatment  is  undone  at  night  by  sleeping  in 
and   overcrowded    rooms.       Intermittence, 
whether  nightly  or  at  longer  intervals,   must  be 
ns!v    guarded    against,  and  this  more  cspe- 
ol  improvement  arc  manifest. 
Be  regard  be  paid  to  these  essentials  in   the 
at   of    tuberculosis,    the   lot   of    the 
ive  wh",  from  lack  of  accommodation  or 
means,   is  deprived   of   the   advantages   of  sana*  I 
'i>mim   life    should   be   rendered   more  endurable  , 
and  his  outlook  somewhat  brighter. 


SCIENTIFIC     AND    MEDICAL    EDUCATION, 

Ir  is  natural  that  there  should  be  considerable 
foment  on  the  question  of  the  proper  place 
tning  in  the  curriculum  of  a  medical 
at.     There    arc    certain    sciences    which    by 
nseni  must  form  a  part  ot  any  proper 
medical  education,   and   others  whose 
m  that  connection  is  more  or  less  debatc- 
lu    the    first    class    must    be    placed    such 
of  study  as  anatomy,   physiology,  and 
main  truths  form  the  basis  of  any 
r  medicine.      In  the  second, 
mention  what  are  often  called  the  pre- 
liminary medical  sciences,  Mich  as  biology,  botany, 
X<>  question  regarding  the  protes- 
ts caused  so  much  difficulty  as  that 
1  ice  to  be  attached  to  these  subjects, 
Medical  Council,  by  its  dealings 
Royal  Colleges,  has  allowed  it  to  appear 


that  considerable  individuality  of  action  by  the 
different  licensing  bodies  will  be  tolerated*  With 
this  subject,  however,  it  is  not  our  intention  to 
just  now,  but  rather  with  the  position  in  the 
medical  curriculum  of  what  we  may  call  the  essen- 
tial medical  sciences,  and,  in  particular,  anatomy 
and  physiology.  This  matter  has  recently  been 
considerably  discussed  in  medical  circles,  and 
especially  in  the  Universities  ol  Dublin  and  Edin* 
burgh.  It  appears  thai  in  both  these  schools  it  is 
now  the  custom  for  students  to  begin  their  attend- 
ance at  hospital  in  the  same  winter  as  they  begin  to 
dissect  and  to  attend  lectures  in  physiology.  In 
both  places,  as  might  be  expected,  hostile  criticism 
is  heard.  It  will  be  remembered  that  in  his  opening 
address  to  the  Yorkshire  College  Medical  Depart- 
ment ,  Professor  Schafer  held  up  the  Edinburgh 
School  as  the  drunken  helot  to  modern  medical 
Sparta— the  example  of  how  things  ought  not  to  be 
done.  Instead  of  starting  the  study  of  medicine 
at  the  same  time  as  he  starts  that  of  physiology 
and  anatomy.  Dr.  Schafer  thinks  that  the  student 
should  complete  his  study  of  the  latter  subjects 
before  the  former  is  begun,  and  he  emphasises  the 
crudeness  which  necessarily  results  from  attempt- 
ing both  branches  together.  We  think  that  there 
is  often  a  tendency  to  over-estimate  the  educa- 
tional value  of  a  purely  scientific  training,  and,  in 
consequence,  to  neglect  the  humaner  studies,  and, 
indctd,  we  agree  with  one  of  Professor  Schafer's 
severest  critics  that  lf  there  is  no  more  narrow- 
minded  man  than  he  whose  education  has  been 
exclusively  scientific.  The  years  before  the  medi- 
cal curriculum  is  commenced  should,  therefore,  in 
an  ideal  course,  be  devoted  to  the  broadening  of 
the  mind  by  extra -scientific  studies,  and  especially 
by  the  study  of  such  subjects  as  philosophy/* 
Nevertheless,  we  think  that  Professor  Schafer's 
main  contention  is  right,  and  that  any  attempt  to 
learn  medical  and  surgical  practice  without  a 
proper  grounding  in  anatomy  and  physiology  must 
result,  if  it  results  in  anything  but  the  accumu- 
lation of  an  undigested  mass  of  useless  facts r  in 
the  crudest  empiricism.  The  student  who  has 
never  dissected  can  learn  nothing  from  watching  a 
surgical  operation,  or  from  hearing  a  clinique  on, 
let  us  say,  pneumonia.  To  him,  the  lung,  the 
bronchi,  the  alveoli,  and  the  pleura  are  only 
names,  and  quite  meaningless.  Even  the  most 
painstaking  teacher  cannot  stop  to  explain  every 
technical  term  he  uses,  and  in  the  actual  condition 
of  affairs  at  Dublin  and  Edinburgh  to-day  he 
would  not  only  have  to  do  this,  but  to  spend  his 
time  in  elementary  explanations  of  the  simplest 
anatomical  and  physiological  facts,  if  the  first -year 
student  is  to  learn  anything  from  his  teach- 
ing. The  result  at  present  is  that  the 
average  student  soon  finds  he  is  not  learning 
anything  of  value  and  he  gets  into  the  habi 
neglecting  hospital  attendance,  or,  on  the  other 
hand,  if  the  wards  interest  him,  he  neglects  his 
dissecting.  The  cessation  of  attending  hosi 
would  be  in  itself  innocuous,  were  it  not  that  the 
habit  thus  formed  is  likely  to  persist  during  the 
later  years  of  the  student's  course,  when  hospital 


44     The  Medical  Press.         NOTES    ON    CURRENT    TOPICS. 


work  should  be  the  one  important  thing.  We 
fear  it  is  impossible  to  prevent  some  overlapping 
of  the  work  in  the  wards  and  in  the  dissecting- 
room,  but  at  least  one  winter  should  be  kept  free 
from  hospital  interruption.  At  the  same  time  we 
think  it  only  fair  to  Dublin  and  Edinburgh  to 
point  out  that  there  is  much  to  be  learnt  from  an 
early  experience — what  was  described  in  Albert 
Smith's  day3  as  "walking  the  hospitals."  In 
that  way  there  is  an  everyday  acquaintance  to  be 
acquired  with  the  features  of  disease  that  is  often 
wanting  in  the  highly  qualified  and  theoreti- 
cally perfect  product  of  modern  medical  educa- 
tion. It  seems  not  improbable  that  the  pendulum 
has  swung  too  far  in  the  direction  of  theoretical  as 
against  practical  education. 


notes  on  Current  ttoptca* 

Historical  Medical  Exhibition. 
An  exhibition  of  a  novel  and  attractive  kind  is 
announced  to  take  place  shortly  in  London.  It  is 
nothing  less  than  a  comprehensive  historical  exhi- 
bition of  rare  and  curious  objects  relating  to 
medicine,  chemistry,  pharmacy,  and  the  allied 
sciences  bearing  upon  "  the  science  and  art  of 
healing  throughout  the  ages."  Messrs.  Burroughs 
Wellcome  and  Company  have  organised  this  most 
interesting  project  as  an  appropriate  means  of 
celebrating  the  lapse  of  a  quarter  of  a  century 
since  the  foundation  of  their  firm.  They  announce 
that  the  exhibition  will  be  strictly  professional  and 
scientific  in  character,  and  they  ask  the  co-opera- 
tion of  medical  men  throughout  the  United 
Kingdom.  It  is  with  great  pleasure  that  we  draw 
the  attention  of  our  readers  to  the  matter,  and  we 
cordially  invite  them  to  intimate  either  to  the 
Editor  of  The  Medical  Press  and  Circular  or 
to  Messrs.  Burroughs  Wellcome  and  Company 
direct  their  willingness  to  loan  any  objects  of 
interest,  such  as  interesting  old  books,  manuscripts, 
ancient  medical  relics,  surgical  instruments,  or,  in 
short,  anything  rare  and  curious  appertaining  to 
things  medical.  In  the  rush  and  hurry  of  modern 
professional  life  it  is  well  to  be  reminded  that  we 
of  to-day  depend  to  no  small  extent  for  our 
knowledge  upon  the  evolution  of  a  buried  past. 
A  survey  of  history,  moreover,  enforces  the  lesson 
that  the  underlying  principles  of  medicine  and 
surgery  are  eternal,  however  much  the  surface 
eddies  of  form  and  fashion  may  change. 


Koch's  Birthday. 
The  sixtieth  anniversary  of  the  birthday  of 
the  discoverer  of  the  tubercle  bacillus  is  being 
celebrated  in  Germany  by  the  issue  of  a  festival 
number  of  the  Deutsche  medizinische  Wochenschrift, 
to  which  many  of  the  leading  pathologists  of  this 
country  and  the  Continent  are  contributing 
articles.  The  public  celebration  will  have  to  be 
postponed,  as  the  protagonist  himself  is  away  in 
Rhodesia,  working  for  the  second  time  at  rinderpest 
for  the  Colonial  Government,  and  even  on  his 
return,  with  a  characteristic  dislike  of  fuss  and 
pomp,  he  has  insisted  that  only  past  and  present 


Jan.~i3,  1904. 


assistants  shall  be  present  at  the  gathering.  It 
is  interesting  now  that  the  great  savant's  name 
is  again  *to  the  fore  to  note  that  there  are  indica- 
tions that  he  has  modified  the  opinion  that  startled 
the  world  so  much  when  he  enunciated  it  at  the 
Tuberculosis  Congress  three  years  ago.  Till  then 
it  had  been  actively  assumed  that  human  and 
bovine  tuberculosis  were  both  due  to  the  same 
species  of  tubercle  bacillus,  and  many  important 
regulations  had  been  founded  on  that  assumption. 
When  Koch,  himself  the  sponsor  of  the  tubercle 
bacillus,  announced  that  the  diseases  were  due 
to  different  organisms,  the  ground  under  the  feet 
of  hygienists  seemed  to  be  cut  away.  It  is  not  too 
much  to  say  that  in  no  country  except  Germany 
has  this  view  been  accepted,  and  all  subsequent 
work  in  this  country,  especially  Professor 
Hamilton's,  has  tended  to  negative  Koch's  dictum. 
A  book  on  the  prevention  of  consumption  just 
published  has  been  revised  and  criticised  by  Koch, 
who,  although  not  the  author  of  the  work,  has 
thus  made  himself  responsible  for  the  opinions 
expressed  in  it.  The  section  dealing  with  the 
communicability  of  bovine  tuberculosis  to  man 
discusses  the  question  very  fully,  and  concludes 
that  the  question  is  still  sub  judice,  and  not,  as 
one  had  hitherto  supposed,  une  chose  jugt'e — from 
Koch's  point  of  view.  For  those  of  us  who  admire 
the  great  work  that  he  has  done  for  bacteriology, 
but  who  were  not  prepared  to  follow  him  in  his 
latest  developments,  this  modification  of  Koch's 
view  will  be  very  acceptable. 


Massage  of  the  Heart. 

The  sensational  feat  accomplished  by  Mr. 
Arbuthnot  Lane  in  restoring  animation  by  massage 
of  the  heart  in  a  patient  who  had  apparently 
died  during  an  operation  for  appendicitis  performed 
under  ether  is  still  fresh  in  the  minds  of  those 
who  read  of  it.  Several  Continental  surgeons 
have  attempted  massage  of  the  heart  under 
similar  circumstances  ;  they  have  generally  opened 
the  thorax  and  pericardium  and  squeezed  the 
heart  with  the  hand.  None  of  these  have  been 
successful,  and  Batelli,  who  has  tried  the  same 
manoeuvre  on  dogs,  has  not  had  encouraging 
results,  for  all  his  animals  died  within  a  few  days, 
even  it  their  immediate  resuscitation  was  accom- 
plished. Boucart  has  been  making  further  experi- 
ments on  dogs,  but  his  method  is  to  massage  the 
heart,  not  directly  through  a  wound  in  the  chest, 
but  mediately  through  a  laparotomy  incision. 
The  animals  were  anaesthetised  with  chloroform 
till  syncope  occurred ;  then  tracheotomy  was 
performed,  and  artificial  respiration  begun.  A 
median  incision  was  promptly  made  through  the 
abdominal  walls,  the  hand  introduced  and  slipped 
up  over  the  stomach,  and  the  heart  defined 
through  the  relaxed  diaphragm.  The  fingers 
then  seized  the  heart  and  gentle  rhythmical 
compression  was  made  till  spontaneous  contrac- 
tions of  the  organ  itself  were  felt  to  be  setting  in. 
The  heart  was  apt  to  slip  up  into  the  chest  during 
the  manipulations,  and  when  this  occurred  care 


J»s.  i  j.  1904. 


NOTES    ON    CURRENT    TOPICS. 


had  to  be  exercised  not  to  squeeze  the  bronchi 
and  interfere  with  respiration.  Bon  cart's  results 
were  decidedly  encouraging,  (or  of  four  dogs  on 
which  he  experimented  one  recovered  completely 
having  been  dead  apparently  for  ten  minutes. 
Another  recovered ,  but  died  the  next  day  from 
ideni a  oi  the  lungs,  due  probably  to  liquid 
chloroform  being  inhaled  by  mistake  ;  a  third 
regained  cardiac  motion ,  but  respiratory  move- 
ments did  not  follow  ;  and  a  fourth  died  through 
the  heart  compressing  the  bronchi,  during  in- 
version of  the  animal.  Considering  the  number 
JqI  deaths  annually  from  chloroform  syncope  ( 
and  the  poverty  of  our  resources  in  treating 
its  thus  intoxicated,  sub-diaphragmatic 
massage,  heroic  though  it  sound,  may  be 
unct  service  as  a  last  resource. 
Bed  Books. 
A.n  interesting  discussion  is  now  proceeding  in 
a  ontempDrary  on  the  merits  and  perils  of  reading 
m  bed.  It  is  a  matter  on  which  a  medical  adviser 
is  not  infrequently  consulted.  As  with  most 
matters  concerned  with  individual  needs  much 
discretion  and  a  wise  discrimination  is  necessary 

»  judicious   direction   can   be   safely   given* 

B?d  books  are  oiten   bad  books,  but   to  condemn 
a  habit  before  studying  all  the  conditions  which 
given   rise   to    its   establishment,    and    the 
various  circumstances  under  which  it  is  conducted, 
*e  and  unscientific.     To  many,  read- 
ing in  bed  eames  as  a  solace  and  comfort  after  the 
jrimils  of  the  day,  and   in  the  land  of  fiction 
tmtiy  a  weary,  worried  struggler  finds  rest  and 
n>ration.     But   to    n>t   a   few    the   nocturnal 
i  Is  pernicious  and  capable  of  working  much 
damage,     Wisely  selected  reading  may  serve  as  a 
mg  soporific  and    desirable    sedative,  but  a 
reckless  trespiss  intz>  certain  types  of   so-called 
fiteratare  is  productive  of  nothing  but  evil.    The 
£Ot  oi  success  in   this,  as  in  so  many  other 
matters,   must    depend    upon   our   knowledge  of 
action   and    re -action.       The     man    who    is    not 
absolutely  M  fit ■'  both  in   mind    and  in  body  had 
r  consult  his  physician  if  he  wishes  either  to 
commence  or  to  continue  reading  in  bed. 


The  Medical  Press,     45 

is  not  given  to  excessive  lachrymal  secretion,  and 
even  the  fashionable  ladies'  physician  does  not 
usually  display  tearful  tendencies.  We  can  only 
imagine  that  Dr.  Kenealy  is  referring  to  physio- 
logists and  artists  of  her  own  sex,  and,  concerning 
such,  ignorance  is  doubtless  bliss.  We  fear  but 
little  good  will  result  from  such  extravagant  pre- 
sentations as  that  to  which  we  have  felt  it  desirable 
to  draw  attention.  The  abuse  of  the  corset  is  only 
too  prevalent,  and  in  the  initiation  of  many  morbid 
conditions  it  probably  plays  an  important  part, 
and  certainly  often  does  much  to  hamper  physical 
development.  But  in  spite  of  the  lachrymation  of 
female  physiologists,  it  is  well  to  remember  that 
both  experience  and  experiment  afford  evidence 
that  a  wise  use  of  corsets  is  sometimes  advan- 
tageous. Tight4acing  stands  condemned  on  all 
counts,  but  there  are  sound  physiological  reasons 
for  the  rational  adoption  of  some  form  of  thorarico- 
abdominal  support, 


The  Curse  of  Corsets. 

Dress  is  the  charity  which  cover eth  multiple 

jus  deficiencies  in    the  feminine    form    that 

mere  man  in  his  ignorance  once  designated  divine. 

Wc  do  not  venture  on  such  a  statement  as  the 

result  of  our  own  experience  or  experiment*     It  is 

the    verdict    of    Dr.    Arabella    Kenealy,    clearly 

drafted    in    the    serious    pages    of    this    month's 

Ukmik    Century.     All    minds    are    now    being 


Camps  for  the  Tuberculous. 

The  New  York  Board  of  Health  has  given  a  good 
example  in  regard  to  the  provision  of  accomnv  na- 
tion for  the  out -door  treatment  of  the  victims  ol 
tuberculosis.  A  tract  of  land,  of  ample  dimensions, 
at  a  reasonable  distance  from  the  City  and  other 
inhabited  places,  and  at  a  certain  altitude,  has  been 
selected  and  on  it  are  to  be  erected  a  number  of 
tents,  furnished  with  the  strictly  necessary  furni- 
t  ure  and  even  some  t  lung  more.  1 1  is  con  tempi  a  ted 
that  each  tent  will  accommodate  two  or  three 
persons,  but  single  tents  will  be  available  for 
persons  in  a  position  to  pay  a  small  additional  sum. 
We  have  over  and  over  again  insisted  on  the  fact 
that  this  plan  is  the  only  one  that  will  enable  us  to 
bring  the  open-air  treatment  within  reach  of  the 
tuberculous  masses.  The  costly  instil utions  which 
have  so  far  been  the  rage  are  filled  for  the  most  part 
with  persons  whose  claims  to  admission  consist 
merely  in  their  pitiable  condition— those,  in  fact, 
for  whom  the  open-air  or  any  other  treatment  can 
do  Little  or  nothing.  These  tents  can  be  fitted  up 
for  about  £i$  each,  and  are  easily  moved  as  occa- 
sion may  require.  There  is  no  reason,  not  even 
that  of  expense,  why  every  district,  rural  as  well  as 
urban,  should  not  have  its  open -air  camp.  If  the 
expense  be  kept  down,  such  a  camp  might  even 
be  made  to  cover  its  cost  of  maintenance.  Official- 
ism appears  to  be  wedded  to  bricks  and  mortar, 
but  the  system  will  have  to  be  modified  under 
penalty  of  the  method  of  treatment  falling  into 
discredit. 


Dunbar's  Antitoxin  in*Hay  Fever. 
When    Professor    Dunbar    intimated    1 


aeatific  study  of  influences  making     betieved  this  distressing  complaint  was  due,  not,  as 
ion.      Th*>     *'  IaH\/     mpHiral  "      u_j    i~_ .+ .1 *  ..  '.         * 


deterioration.     The    "  lady    medical 

finds  that  decadence  originates  in  **  the  curse  of 

"  The     average     woman,     clothed     as 

•a  clothes  her,  presents,  1  confess,  an  exterior 

pleasing   to    our    artificial    and    acquired    tastes, 

tfted — alas  I     She    is    that    to    make    the 

■logist    and     artist    weep.**     The     average 

logtst,  as  far  as  we  are  acquainted  with  him,  j  Felix    S&mon 


had  been  previously  supposed,  to  the  mechanical 
irritation  of  pollen  from  plants,  but  1 
actual  toxin  resident  in  the  pollen-grains,  it  wis 
hoped  that  the  antitoxic  serum  he  presented  a 
result  ot  his  experiments  would  inaugurate  a  new 
era  in  the  treatment  of  this  refractory  disease. 
The  early  trials  of  the  serum  in  this  country  by  Sir 
were    decidedly    hop:*fuL     Fuller 


46     The  Medical  Press.  NOTES    ON    CURRENT    TOPICS. 


Jan.  13,  1904- 


trials  did  not  bear  out  the  most  sanguine  expecta- 
tions formed,  but  now  that  the  results  of  last 
summer's  experiments  with  the  serum  on  both  sides 
of  the  Atlantic  have  been  published  there  is  good 
reason  for  the  belief  that  a  distinctly  hopeful 
direction  has  been  taken  by  Dunbar's  departure. 
Dr.  McBride  in  Scotland  has  reported  several 
cases  which  gave  similar  results  to  those  of  Dunbar 
and  Semon,  and  the  suggestion  is  that  all  are  not 
successful  because  the  various  particles  causing  the 
catarrh  act  by  virtue  of  different  toxins.  If  this 
be  so  it  is  not  to  be  expected  that  the  same  anti- 
toxin will  be  successful  in  each.  Dr.  McCoy,  in 
the  New  York  Medical  Journal,  publishes  fifteen 
cases  treated  with  satisfactory  results,  six  of 
them  being  detailed  in  full.  McCoy  treated  his 
cases  by  applying  the  serum  with  a  pipette  to  the 
conjunctival  mucous  membrane  and  to  the  nasal 
passages.  Quite  small  doses,  one  to  four  drops, 
were  instilled  several  times  a  day  and  the  effect 
was  immediate  and  complete.  The  diagnosis  was 
fully  established  before  commencing  the  treatment, 
and  none  but  patients  who  suffered  periodically 
were  selected  for  trial.  It  is  to  be  hoped  that 
larger  quantities  of  the  serum  may  be  available 
before  next  spring  so  that  by  extension  of  the 
experiments  some  definite  decision  may  be  arrived 
at. 


"Homocea,  Limited/' 
It  is  evident  that  our  much-advertised  friend, 
"  Homocea,"  however  much  it  may  have  succeeded 
in  "  touching  the  spot,"  has  not  succeeded  in  at 
the  same  time  touching  the  almighty  dollar  in 
quite  the  manner  expected  by  its  proprietors  and 
shareholders.  The  history  of  the  company — 
"  Homocea,  Limited  " — is  a  curious  one.  In  1897 
it  purchased  the  patents  and  trade  marks  of 
"  Homocea "  for  the  sum  of  £141,000,  a  sum 
which,  according  to  the  company's  counsel,  was 
"  a  great  deal  too  high."  In  1897,  tlie  company 
paid  a  dividend  on  their  preference  shares,  but 
since  then  have  paid  no  dividend  of  any  kind. 
The  sole  present  assets  of  the  company  are  the 
aforesaid  trade  marks  and  patents,  and  the  good- 
will of  the  business,  and  as  these  do  not  appear  to 
be  at  the  present  time  very  negotiable  articles, 
the  wisdom  of  reducing  the  capital  from  a  quarter 
of  a  million  to  £60,000  has  become  evident. 
Accordingly,  the  company  in  December  last  pre- 
sented a  petition  for  the  sanction  of  the  Court  to 
the  proposed  reduction.  The  learned  judge  had 
apparently  no  difficulty  in  deciding  that  the 
above-mentioned  assets  do  not  represent  value  for 
a  quarter  of  a  million,  and  sanctioned  the  reduction. 
We  cannot  say  that  we  view  the  tribulations  of 
such  companies  with  sympathetic  eyes,  nor  should 
we  greatly  grieve  if  other  similar  companies 
followed  a  like  course.  The  "  Homocea  "  share- 
holders must  have  known  when  they  purchased 
shares  that  the  business  by  which  they  hoped  to 
earn  a  dividend  was  one  which  throve  on  the 
credulity  of  the  times,  and  if  they  find  that  that 
credulity  leads  people  into  another  shop  than 
theirs   they   cannot   complain.  kWe   notice   that 


there  is  at  present  an  arrear  of  dividend  to  the 
preference  shareholders  amounting  to  over  £19,000, 
and  if  these  unfortunate  people  ever  see  their 
money  we  shall  be  much  surprised.  They,  at  any 
rate,  received  one  dividend,  the  ordinary  share- 
holders never  received  any. 


A  Forgotten  Physician. 

It  is  seldom  remembered  that  the  originator  of 
the  "  Higher  Criticism"  of  the  Hebrew  Scriptures, 
and  thereafter  of  "  Higher  Criticism  "  in  general, 
was  a  professor  of  medicine.  Jean  Astruc,aman 
of  much  distinction  in  his  time,  was  born  in  1684, 
and  eventually  held  chairs  at  Toulouse,  at  Mont- 
pellier,  and  at  Paris.  He  was  a  man  of  wide  learn- 
ing, both  in  the  medical  sciences  and  in  letters,  and 
as  a  teacher  he  had  a  European  reputation.  A 
voluminous  writer,  his  most  important  book  in  the 
sight  of  his  contemporaries,  was  entitled  "De  mortis 
venereis  libri  sex/*  which  enjoyed  great  vogue  and 
was  translated  into  English.  The  apparently 
inconspicuous  book,  but  for  which  Astruc  would 
long  ago  have  been  forgotten,  is  a  small  monograph 
which  was  probably  regarded  by  its  author  as  a 
mere  bagatelle.  The  "  Conjectures  sur  les  mhnoires 
qui  ont  servis  d  Moise  pour  icrire  la  Genlse  ' '  is  an 
epoch-making  work  in  the  history  of  literary 
criticism,  and  is  so  merely  by  the  clue  which  served 
Astruc  to  distinguish  one  author  from  another. 
In  certain  passages  in  the  Book  of  Genesis,  and 
particularly  in  the  account  of  the  Creation  in  the 
first  two  chapters,  the  Deity  is  described  as 
Elohimy  while  in  others  the  word  Johveh  is  used. 
The  transition  from  one  passage  to  the  other  is 
always  abrupt,  and  Astruc  pointed  out  the  strong 
probability  that  they  were  written  by  different 
hands.  It  is  beyond  our  sphere  to  discuss  questions 
of  literary  criticism,  but  it  is  interesting  to  note 
that  the  sole  originator  of  what  is  rightly  called 
scientific  criticism  was  himself  a  medical  man, 
and  a  scientific  writer  of  no  small  repute.  At  the 
same  time  it  is  passing  curious  that  the  pioneer  in 
such  a  subject  should  have  been,  not  a  scholar,  but 
a  specialist  in  venereal  disease. 


Compressed- Air  Illness. 

The  affection  which  goes  by  the  name  of  caisson- 
disease  is,  like  divers'  paralysis,  seen  in  workers 
under  conditions  of  greatly  increased  atmospheric 
pressure.  The  most  characteristic  symptoms  are 
those  of  dyspnoea,  vertigo,  pains  in  the  joints, 
cramps,  and  a  rapid  pulse.  The  venous  blood 
obtained  by  venesection  has  been  observed  to  be 
arterial  in  colour.  But,  since  these  morbid 
phenomena  invariably  appear  when  the  men 
return  to  the  ordinary  pressure  of  the  air, — i.e., 
after  decompression,  the  disease  might,  with 
propriety,  be  known  by  the  name  of  decompressed- 
air  illness.  The  pathology  of  the  condition  was 
thought,  at  one  time,  to  be  due  to  mechanical 
congestion  of  the  central  nervous  system,  and 
especially  of  the  spinal  cord.  This  theory  has  been 
disproved  by  Paul  Bert,  and,  more  recently,  by 
Drs.  Leonard  Hill  and  J.  J.  R.  Macleod  (a).  These 
observers  have  found  that  no  change  in  the  mean 

(a)  Journal  0/  Hygiene.  October,  1903. 


NOTES    ON    CURRENT    TOPICS. 


Thr  Medical  Press*    47 


sure  occurred  during  compression  of 
air  in  a  chloralised  rabbit;  nor  in  a  frog's  web  or  a 
bat's  wing.  The  conclusions  arrived  ai  by  modern 
research  are  that  caisson -sickness  is  due  to  the 
escape  of  bubbles  of  gas  from  the  blood  vessels  and 
bodv  d  decompression.     The  gases  of  the 

atmosphere,  having  been  absorbed  into  the  blood, 
are  again  given  up  when  the  pressure  under  which 
iky   have    been    dissolved    is    withdrawn.     The 

>  under  these  circumstances  may  be  compared 

open  soda-water  bottle  in  a  state  of  efferves- 
cence, The  different  symptoms  produced  depend 
upon  ing  localities  of  these  air-emboli*     It 

h  found  that  young  men  generally  escape  the 
<lisease  on  account  of  the  elasticity  of  their  tissues 

greater  facilities  for  collateral  circulation. 
Dts,  Hill  and  Macleod  consider  that  the  length  of  the 

I  of  decompression  is  one  of  the  most  impor- 
tant factors  in  preventing  this  troublesome  malady. 
They  believe  that  by  working  in  short  shifts  of  not 
longer  than  four  hours  and  by  allowing  sufficient 
ame,  about  two  hours,  lor  decompression,  the 
disease  may  be  avoided  altogether. 


to  abstain  from  gathering  its  spoil  from  such 
sources.  Only  rarely,  however,  does  it  err  in  this 
respect. 


Poisoning   by   Honey, 

Fkum   a   case    narrated    in    the   Guy's   Hospital 
G&utUt  it  would  appear  that  honey  is  not  always 
Lb£  delectable  article  which  it  is  supposed  to  be. 
shortly    alter    pan n king    of   some    fresh    country 
was  affected   with   urticarial   sym- 
ptoms, the  larynx  becoming  oedema  tons  and  the 
ttions  hurried.     Fortunately,   the  condition 
deared  up  alter  a  prompt  purgative.     From  time 
ime   there  have   been   reported  instances  of 
I  poisoning  from  the  consumption  of  honey, 
,.t  of  which  was  known  to  and  described  by 
iphon,  who  relates  how   that  certain   Greek 
withers  were  seized   with   vomiting  and  sickness 
:iUcr  partaking  freely  of  the  honey  gathered  in 
liir  neighbourhood    of    Trebizondc.     In    a    paper 
read  by  Dr.  J.  C.  Thresh  (a)  before  the  Pharma- 
ceutical Society,  some  information  was  given  with 
regard  to  the  nature  of  the  poison.     According  to 
Dt,    Stockman,    of    Glasgow,    who    examined    an 
ethereal  extract  of  this  honey  physiologically,  the 
active  substance   was  slated   to  be   u  a  narcotic 
acting  very  markedly  on   the  respiratory 
In  other  cases,  gelsemium  has  been  found 
impregnating  the  honey,  the  consumption  of  which 
Siren  rise  to  all  the  symptoms  of  poisoning  by 
that  drug,  such  as  giddiness,  cardiac  weakness,  and 
temporary  amaurosis.     Death  has  even  occurred 
under  these  circumstance^  though,  happily,  such 
an  event  is  extremely  rare.     Severe  pruritus  has 
lln  been  observed  to  follow  the  eating  of  honey 
iiilnunating  in  the  outbreak  of  an  erythematous  or 
urticarial  eruption,     The  obvious  explanation  of 


The  Significance  of  Albumosee. 
The  nature,  plurality,  and  separation  of  the 
intermediate  substances  between  the  albumins,  on 
the  one  hand,  and  the  peptones,  on  the  other,  form 
no  small  corollary  to  the  chapter  in  the  physiology 
of  digestion.  When  one  or  more  of  these  bodies 
appears  in  the  urine  there  is  an  added  interest 
attaching  to  it  from  the  clinical  standpoint.  That 
variety  known  as  the  albumose  of  Bene e- Jones, 
first  described  by  that  observer  in  1848,  and 
possessing  the  characteristic  heat -react  ion,  is  now 
definitely  associated  with  a  rare  affection  of  the 
bone-marrow  which  bears  the  name  of  myelopathic 
albumosuria  (Bradshaw).  The  albumosuria  de- 
scribed by  Professor  Teissier,  of  Lyons,  a  year  ago, 
t  with  especially  in  severe  forms  of  chronic 
nephritis,  and  this  kind  of  albumose  is  soluble  in 
nitric  acid.  In  addition  to  these  two  varieties, 
M,  Fiery  (a),  of  Lyons,  has  recently  described  ft 
third,  the  clinical  significance  of  which  is  less  defi- 
nite, as  it  is  seen  in  very  diverse  pathological  con- 
ditions. It  can  be  recognised  by  a  special  test^ 
that  of  Jacquemet,  which  consists  of  first  getting 
rid  of  any  albumin  which  may  be  present  by 
acidification,  boiling,  and  filtration,  and  then,  when 
cool,  of  mixing  the  urine  with  one-third  of  its 
volume  of  sulphuric  ether.  This  is  shaken,  and 
the  tube  is  then  left  for  a  quarter  of  an  hour  in  the 
vertical  position,  when,  if  this  form  of  albumose  be 
present,  a  gela Uniform  clot,  like  a  plug,  will  appear 
upon  the  surface  of  the  liquid.  This  +H  ether- 
albumose  "  is  found  in  the  urine  of  many  normal 
individuals,  and  also  in  most  of  the  infectious 
diseases,  as  well  as  in  chronic  nephritis.  Seeing 
that  this  body  is  present  under  such  varied  con- 
ditions, its  true  pathological  significance  has  yet 
to  be  determined. 


. 


these  untoward  manifestations  is  that  the  par 
iicular  sample  of  honey  has  been  gathered  by  the 
bee  from  a  poisonous  flowering  plant,  for,  notwith- 
standing the  gaudiness  of  the  bloom  and  its  richness 
be  syrupy  liquid,  the  melliferous  insect  can 
hardly  be  expected,  even  by  fcf,  Maeterlinck,  to 
possess  sufficient  powers  of  discrimination  always 


The  Surgery  of  Typhoid  Perforation. 

Elsewhlrk  in  our  columns  (page  29}  we 
publish  an  account  of  a  most  interesting  report  of 
operation  for  perforation  of  the  bowel  in  enteric 
fever*  The  case  is  both  suggestive  and  instructive 
in  the  highest  degree.  The  patient,  a  youth  of 
twenty-one  years,  was  admitted  to  the  Cork  Street 
Fever  Hospital  in  Dublin,  under  Dr.  H.  C.  Drury, 
suffering  from  a  mild  attack  of  enteric  fever, 
apparently  of  twelve  days'  duration,  but  in  all 
probability  the  disease  had  been  going  on  for  three 
weeks  or  more.  One  morning  he  complained  of 
severe  pain  in  the  abdomen,  and  it  was  evident 
that  perforation  of  the  bowel  had  taken  place, 
Seven  and  a  half  hours  after  the  occurrence  of  that 
accident  he  was  operated  upon  by  Mr. ^William 
Taylor.  At  that  time  the  patient  was  in  a  state 
of  collapse t  and  apparently  dying.  A  small  per- 
forated ulcer  "was  sutured,  another  ulcer  on  the 
point  J?f  ulceration  also  sewn  "up,  the  intestines 
cleansed,  and  the  wound  closed.  On  the  fourth 
day  after  operation  the  pulse  had  dropped  from 
{«)  Lytm  Mtttittl*  October  Utht  itttf. 


48    The  Medical  Press.  NOTES    ON    CURRENT    TOPICS. 


Jan.  13,  1904. 


1 50  to  1 00.  At  the  end  of  seven  days,  temperature 
had  dropped  to  normal.  Twenty-eight  days  after 
operation  pain  commenced  and  the  patient 
gradually  grew  worse,  with  constipation,  so  that 
next  day  a  second  operation  was  performed. 
Extensive  adhesions  were  found,  and  the  gut  was 
bent  at  a  sharp  angle.  The  patient  gradually 
sank  after  the  second  operation.  The  results  of 
this  case  are  brilliant  and  encouraging,  for  clearly 
the  patient  recovered  from  the  original  operation 
performed  for  relief  of  typhoid  perforation  under 
the  most  desperate  and  unfavourable  circum- 
stances that  could  well  be  conceived. 


Faecal  Accumulation. 
Most  physicians  of  experience  have,  at  one  time 
or  another,  been  astonished  at  the  degree  of  faecal 
accumulation  which  may  occur  without  the 
patient  paying  any  attention  to  the  condition. 
In  some  cases,  most  commonly  in  chlorotic  young 
women,  the  patient  denies  that  there  has  been  any 
constipation,  and  can  hardly  be  persuaded  that 
there  is  a  mass  of  faeces  in  the  intestine.  On 
suitable  treatment,  however,  she  is  very  often 
startled  at  the  discovery  of  the  enormous  masses 
which  were  in  reality  present.  Few  cases  of  faecal 
accumulation  can,  however,  parallel  that  recently 
recorded  in  one  of  our  contemporaries.  The 
patient,  an  elderly  man,  showed  such  swelling  of 
the  abdomen  that  the  girth  was  increased  from  a 
normal  thirty-two  by  no  less  than  twenty  inches, 
and  the  percussion  note  over  the  entire  belly  was 
dull.  The  constitutional  symptoms  were  severe — 
high  temperature,  pulse-rate,  rigors.  Neverthe- 
less, defaecation  had  taken  place  regularly  once  or 
twice  a  day.  After  treatment  by  enemata  and 
castor  oil,  the  temperature  and  pulse-rate  dimi- 
nished, and  in  the  course  of  a  week  as  many  as 
171  large  stools  were  passed.  As  in  most  such 
cases,  all  symptoms  of  auto-intoxication  dis- 
appeared when  the  intestine  was  thoroughly  cleared 
^4  its  contents. 


A  National  Laboratory  of  Hygiene. 
Those  of  us  who  are  continually  pressing  fdr 
more  open  and  liberal  State  recognition  of  scientific 
research  and  investigation  of  health  problems 
will  feel  our  mouths  water  when  we  read  of  the 
beautiful  National  Laboratory  of  Hygiene  which 
is  being  built  at  Washington,  and  is  now  nearly 
completed.  This  laboratory  was  provided  for 
by  a  special  Act  of  Congress,  and  will  be  under  the 
Department  of  the  United  States  Public  Health 
and  Marine  Hospital  Service.  It  will  be  directly 
controlled  by  an  advisory  board,  consisting  of  the 
Director] ?oi  [the  Laboratory,  five  members^ap- 
pointed  by  the  Surgeon-General  of  the  Public 
Health  and  Marine  Hospital  Service,  and  three 
specialists  nominated  by  the  Army,  Navy,  and 
Bureau  of  Animal  Industry.  Hygiene,  though 
the  prime  object  of  the  laboratory,  will  not  be 
exclusively  dealt  with,  for  there  are  to  be  depart- 
ments for  making  investigations  in  pathology  and 
pharmacology,  as  well  as  in  chemistry  and  bacterio- 
logy.    Each  of  these  departments  is  to  be  under 


the  management  of  a  chief  who  has  special 
knowledge  and  skill  in  the  work  that  the 
clepartment  investigates,  but  he  is  always  to 
keep  in  view  the  bearing  of  the  researches  on 
public  health  problems.  The  results  arrived  at 
are  to  be  published  periodically  in  bulletins,  and 
these  should  contain  material  of  the  greatest 
value  and  importance,  as  under  such  direction 
systematic,  as  opposed  to  sporadic,  effort  can  be 
organised  and  moulded  to  the  same  ends.  One 
of  the  principal  duties  of  the  laboratory  will  be 
to  manufacture  anti-diphtheritic  serum  of 
guaranteed  efficacy,  and  the  direction  will  be 
responsible  for  the  supervision  of  the  antitoxic 
sera  produced  by  private  firms.  In  America 
many  firms  produce  low-grade  and  unreliable 
sera — a  curse  we  are  fortunately  free  from  in  this 
country — and  great  discredit  is  brought  on  serum- 
therapy  thereby.  In  the  future  this  unsatis- 
factory condition  of  things  will  be  impossible. 
Are  we,  who  have  a  Prime  Minister  who  openly 
sympathises  with  our  own  professional  aspira- 
tions, to  be  the  last  nation  to  have  State-supported 
research  laboratories  ? 


Extract  of  Meat  and  Yeast.  _ 
A  lurid  light  was  shed  on  some  brands'of  meat 
extract  at  Liverpool  Police  Court.  David  Pearson,, 
trading  as  the  Anglo-American  Food  Company, 
was  summoned  for  selling  extract  of  beef  containing 
about  half  its  weight  of  yeast  extract.  Mr. 
Trubshaw  (who  prosecuted  on  behalf  of  the  Liver- 
pool Corporation)  said  there  was  a  label  on  the 
bottle  intimating  that  the  contents  were  extract 
of  beef,  consisting  solely  of  the  juice  of  the  finest 
beef  ;  but  upon  an  analysis  the  sample  was  found 
to  contain  half  its  weight  in  yeast  extract,  a  sub- 
stance imported  from  Germany.  Defendant  was 
fined  £$  and  ^10  10s.  costs.  This  conviction  is  of 
special  interest  to  The  Medical  Press  and 
Circular,  as  the  fraudulent  substitution  of  yeast 
for  meat  extract  was  first  pointed  out  in  the 
columns  of  this  journal. 


The  South  African  Medical  Congress  has 
initiated  a  movement  for  the  formation  of  an 
association  for  the  prevention  of  consumption  and 
other  forms  of  tuberculosis.  The  opinion  has  been 
expressed  in  Natal  that  consumptives  in  an 
advanced  stage  of  the  disease  should  be  prevented 
from  entering  South  Africa,  and  it  is  stated  that 
twenty  years  ago ,  consumption  was  practically 
unknown  in  that  country,  but  has  now  become 
a  serious  danger  to  "the  immunity.  Protection 
of  the  kind  suggested  merits  serious  consideration. 


The  Court  of  Governors  of  Christ's  Hospital  on 
Wednesday  approved  unanimously  the  recom- 
mendations of  the  Site  Committee  in  favour  of  dis- 
posing  of  the  remaining  part  of  the  site  to  the 
Government  for  the  purpose  of  the  Post  Office. 
This  decision  means  that  Christ's  Hospital  will 
receive  ^23,000  a  year  in  perpetuity.  It  also 
means  that  St.  Bartholomew's  will  have  to  look 
elsewhere  for  an  extension  of  its  ground  area. 


iy    T9Q4- 


SPECIAL   CORRESPONDENCE. 


The  Medical  Press.     4<] 


fr  is  announced  that  a  new  Pasteur  Institute  has 

been  established  at  New  Orleans,  where  the  anti- 

■■nt  will  be  carried  out  without  lay 

expens  fthe    patients.     The    success    of    the 

lal  Paris  Institute  renders  the  establishment 

centres  of  treatment  highly  desirable, 


There   were  twenty-six  sufferers   from  small- 

poaffemaining  under   treatment    on    Friday  noon 

e  Ix>ng  Reach  Small-pox  Hospital,  Darfford, 

This  amount  of  infection  points  to  a  persistence  of 

Usease  in  London  that  must  arouse  a  certain 

lht  of  apprehension. 

The  Food  Test  Commission,  appointed  by  the 

Government,  reports  that  the  use  of 

i. id  in  food  is  seriously  injurious  to  health 

importance  of  this  conclusion  is  obvious  and 

universal. 


The  death  is  announced  at   Munich  on  Tuesday 
5th  inst.,  of  Professor  Karl  von   Zittel,  the 
us  palaeontologist  and  author  of  the  well- 
1      Manual  of  Paleontology." 


In  the  recent  rout  of  the  Mullah  by  General  Egarton 

m  Somahland,  we  regret  to  announce  the  death  of  a 

sing    young  officer,  Lieutenant   Joseph  Raboteau 

Wfllaud.  M.B.,   who  bee  a  me  lieutenant  in  the  Royal 

Army  Medical  Corps  in  June,  1891,  and  was  attached 

ki  King's  African   Rifles.     He  had  not  been  pre- 
un  active  service. 


E'k  Herbert  Owen  Taylor  was  presented  last 
imA  with  a  handsome  testimonial  from  the  Not  ting- 
am  Police  Force,  lo  which  he  has  acted  as  surgeon  for 
past   thirty   years. 

The  Lambeth  Guardians  last  week,  out  ofhfty-nve 
applicants  fr<mi  whom   to  select  a  medical  officer  for 
ieir  schools  at  West  Norwood,  chose  a  Carmarthenshire 
dy#  Miss  N.  V.  Johnson,  the  only  lady  candidate* 

THE  Jate  Sir  Robert  Martin  Craven,  F.R.C.S,,  at  one 
Mme  Sherifl  of  Hull  and  President  of  the  Centra!  Hull 
Conservative  Association,  has  left  property  oi  the  gross 
value  <i.   Including  net    personalty  estimated 

Mr,  H.  C.  Shan* 4  M.R.C.S.Eng,,  L.R.CP.Edin.,  who 
:tly    re  tired  from  his  position  as  medical  officer  of 
the  York  UltiOO  Workhouse,  has  been  presented  by  the 
fecials  of    that    institution   with  a   handsome    testi- 

Mr.  Alfred  James  Barker,  M.D.  St.  And,,  late  of 
tanlieu   Villas.    Green   Lanes.    X.p    who   has   recently 
u\  practice  on  account  of  advancing  age,  has 
resented  with  an  album  and  purse  by  his  numer- 
itieiits  and  friends* 

The  opening  clinical  lecture  of  the  spring  session  at 

!on  post-Graduate  College,  Tottenham 

Hospital,  will  he  t;iven  by  Dr.  T.  Gilbart  Smith  on 

iry    14th.    at    4.30    p.m.     The    subject    will    be 

Points  in  the  Diagnosis  of  Fluid  in  the  Chest/* 

Dr.   B.  Symes-Thompsgx,   Greshani     Professor    of 
vfU  deliver  a   course   of    four   lectures  at 


Gresttatti  College,  Basinghatl  Street,  London,  101  "The 
Evolution   oi    Plants,    Animals  and   Man/'     The   first 
Lectttie   will  be  delivered   mi  the  19th  mst..  at  6   [MR, 
"irse  being  free. 

The   course   of   lectures   at    the    HuspitaJ    lor   t  is,,. 
sumption  and  D  t   the  Chest  Jor  igo4  will  be 

opened  by  Sir  Richard  Douglas  Powell,  Hart.  M.D,,  by 
an  address  6n  foreign  bodies  in  the  bronchi,  on  January 
27th ,  at  Jour  p.m.  The  lectures  are  free  to  qualified 
practitioners  and  tu  students  of  medicine. 


The    second    Hunterian    Society's    lecture    will    be 
delivered  by  Mr.  Anthony  Bowlby,  CM.i...  on  Wt 

nght,  at  S.30  p  in.  The  subject  will  be  "  Wuii  . 
its  Cbnical  Significance  anrl  Importance  in  Diagnosis. n 
All  members  oi  the  medical  profei  invited  to 

a  t  tend . 


Dr.  Mendes  de  Leon,  of  Amsterdam,  will  read  a 
paper  before  the  British  G>  narcological  Soetel  I 
murrow  (Thursday)  evening,  at  8  p,m.,  to  whicD  meeting 
all  practitioners  are  cordially  invited.  The  subject  oi 
the  paper  will  be,  "  A.  Hitherto  not  Sufficiently  Recog- 
nised Source  of  Infection  during  Operations," 


Dr.  William  C.  Neville,  F.R,C.P.U>  formerly 
assistant-physician,  Coombe  Hospital  and  Lecturer 
in  Midwifery,  Carmichael  Schhool  of  Medicine,  has  been 
appointed  Pathologist  to  the  Rotunda  Hospital.  Dn 
Neville  is  well  known  in  the  obstetrical  world  as  Hie 
inventor  of  the  axis -traction  forceps  which  bears  his 
name. 


In  the  presence  of  a  large  assembly  at  St, Augustine's 
Church  on  Saturday  the  9th  instant,  Mr.  Harold 
Spender  was  married  to  Miss  Violet  Hilda  Schuster, 
only  daughter  of  Dr+  Ernest  Schuster  and  Mrs,  Schuster 
ol  Harrington  Gardens.  Mr,  Spender  is  a  well  known 
editor  of  London,  and  son  of  the  late  Hr  Kent 
Spender,  of  Bath* 

Special  Corrcspon&ence, 


[from  our  own  correspondents 
BELFAST. 
The  Milk  Supply* — The  question  of  pure  milk  and 
huw  to  obtain  it  has  been  brought  prominently  before 
the  public  by  the  very  generous  offer  made  by  Dr. 
and  Mrs.  Henry  O'Neill  to  the  Public  Health  Committee 
of  the  Corporation,  The  offer  was  one  of  /joo  to  en- 
courage the  establishment  of  a  milk  sterilisation  depot 
in  Belfast,  but  it  had  to  be  declined,  as  the  Corporation 
lack  the  necessary  legal  power  to  establish  such  a  depdt. 
An  able  article  in  the  Northern  Whig  advocates  the 
adoption  of  *'  measures  by  which  the  milk  may  be  pro- 
duced in  such  a  way  that  it  may  be  used  with  confi- 
dence by  the  public  without  any  necessity  for  its  being 
pasteurised  or  sterilised/'  The  measures  proposed  are 
(t)  regular  inspection  of  the  cows,  with  testing  for 
tubercle  ;  [2}  sanitary  byres  ;  (j)  cleanliness  in  all  de- 
partments ;  {4)  regular  medical  examination  ol  the 
milkers  and  other  dairy  workers  ;  (5)  rapid  cooling  of 
the  milk  ;  (6)  delivery  of  the  milk  in  sealed  cans  or 
buttles,  The  dairy  of  Mr*  Sonensen,  of  York,  who  has 
proved  that  a  business  worked  on  these  lines  can  be  a 
thorough  commercial  success,  is  described  at  length. 
It  is  to  be  hoped  Belfast  enterprise  will  take  the  hint. 

ri.-pnx  — A  case  of  small- pox  occurred  eark 
week  m  Newtowuards.  the  patient  being  a  young  man 
from  Glasgow  visiting  co*  Down  cm  his  holidays. 
Two  more  cases  occurred  later  in  the  week  m  Belfast, 
and  it  is  to  be  feared  that  others  will  follow,  as  one 
of  the  cases  was  discovered  in  a  crowded  house  in 
of  the  worst  slums  of  the  city,  where  the  patient 
{a  child)  had  been  ill  some  days, 


50     The  Medical  Press. 


OBITUARY. 


Correspondence. 


{We  do  not  hold  cmnelves  respoaiible  for  the  opinions  of  omr  corres- 
pondents.) 


grist  of  any  solid  value. 

Charcot,  says  Dr.  Lee,  were  all  honourajrfr,  humane 

physiologists  ;  are  the  men  now  living  whe^re  devoting 

their  lives  to  scientific  investigation 

character  to  their  great  dead  masters, 

less  convinced  of   the  necessity  for  experimentation 

on  animals  in  the  pursuit  of  new  truths 

Dr.  Lee  asks  practitioners  what  they  flHye  learnt 
from  vivisection  themselves,  from  their  owrT^UJeri 


Jan.  13,  1904. 


VIVISECTION. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — Dr.  Robert  Lee's  second  contribution  does 
not,  to  put  it  mildly,  carry  the  question  much  further, 
whilst  it  unfortunately  is  painfully  suggestive  of  the 
attitude  of  one  who  is  willing  to  wound  and  yet  afraid 
to  strike.  The  keynote  of  the  letter  is  to  be  found  in 
the  sentence :  "  Personally,  I  dislike  and  distrust 
vivisection  as  a  method  of  research."  This  is  an  in- 
teresting confession,  but  hardly  of  any  value  save  to 

the  mill  of  the  an ti -vivisection  fanatic,  where  a  mere       ,  _  „ ,  __,  _  __..  _.J 

empty  husk  to  grind  is  welcomed  in  the  ahs€ji*r-t,f  I  ««Un  year,  He  was  educated  at  the  University  of  Edin- 
"  -•-      -  Harvey,  the  Hun tflOflSfbGW  I  f^HKl  »--—-■--«--*»- 


17th,  1903,  after  a  lingering  illness  following  an  attack 
of  influenza  contracted  last  winter.  The  deceased 
was  born  in  the  year  1840,  and  received  his  medical 
education  at  Dr.  Steevens'  Hospital,  Dublin,  where  he 
qualified  in  1865.  In  the  following  year  he  was 
appointed  assistant  resident  medical  superintendent  of 
the  District  Lunatic  Asylum,  Downpatnck,  and  in  1S72 
resident  medical  superintendent  of  the  District  Lunatic 
Asylum,  Waterford.  In  1874  he  became  resident 
medical  superintendent  of  the  District  Asylum,  Ballin- 
asioe,  which  post  he  held  until  the  time  of  his  death. 

MR.  JOHN  KNOWSLEY  THORNTON. 
It  is  with  much  regret  that  we  announce  the  death  of 
Mr.   John   Knowsley  Thornton,  of  Hildersham   Hall, 
Cambridge,  on    Sunday,  at  his  residence,  in  his  fiity- 


5  wnc  f  are  a  e vo  u  n£     ™« -«. .  j 

much  uUcQQf'i-in  L  ^w  Sama 

ers,tnd  aWWyl^JMf 

r    ex4**ri rotation     He  wis  1 


ments  first,  and  from  what  they  have  seen  others  UtT  ***-HflTPeace  for  Cambridgeshire,  was    the  author  of 


next  ?  Practitioners  are  not  called  upon,  and  virtu- 
ally never  do  perform  experiments  upon  animals  ;  they 
need  to  learn,  and  do  learn  only  from  the  work  of 
others ;  research  directed  to  results  of  importance 
absorbs  the  whole  energy  of  the  worker ;  no  practi- 
tioner attempts  it.  As  to  what  a  practitioner  may 
have  learnt  from  what  he  has  seen  others  do,  this  must 
depend  upon  the  time  spent  in  laboratories  and  the 
experiments  there  observed.  A  year  might  be  passed 
in  such  observation  in  one  direction  without  any 
result  to  record,  except,  perhaps,  some  of  negative 
quality ;  but  it  does  not  at  all  follow  that  mere  nega- 
tive results  were  valueless,  or  that  valuable  positive 
results  had  not  been  achieved  elsewhere.  What  can 
be  the  value  of  any  practitioner's  evidence  in  this 
direction  is  hard  to  guess,  but  one  must  suppose  it  is 
quite  clear  to  Dr.  Robert  Lee. 

I  am,  Sir,  yours  truly. 

An   Obscure   Practitioner. 
January  7th,  1904. 


he  took  the  M.B.  and  CM.  degree  in  187 1. 
At  Ef^uJ|h  he  acted  as  house  surgeon  in  the  Royal 
Infirmary,  bM  in  London  was  consulting  surgeon  to 
maritinyree  Hospital  for  Women  and  Children. 
lit'  ^rdSvenor  and  New  Hospitals  for  Women, 
'formerly  President  of  the  Medical  Society  of 
London.  a#l/ras  also  a  Fellow  of  the  Royal  Medical 
Society  ol  ^Edinburgh,  and  of  many  other  learned 
:£lies^Mr.  Thornton,   who  held  the   Commission. 


©bituanx 

MR.  JAMES  BOWYER  BAKER. 
The  death  is  announced,  in  his  seventy-first  year,  in 
London,  of  Mr.  James  Bowyer  Baker,  Brigade  Surgeon, 
retired,  of  the  Army  Medical  Staff.  The  fourth  son  of 
the  late  Rev.  W.  L.  Baker,  M.A.,  of  Hargrave,  North- 
amptonshire, he  received  his  professional  education 
at  Guy's  Hospital,  and  being  admitted  a  member 
of  the  Royal  College  of  Surgeons,  England,  in  1854,  he 
joined  the  Army  Medical  Service  in  May,  1857,  and 
served  with  the  expeditionary  force  in  the  North  of 
China  in  i860,  for  which  he  had  the  medal.  He  was 
placed  on  the  retired  list  in  1882. 


DR.  R.  M.  TAGERT. 
We  regret  to  announce  Jthe  death  of  Dr.  R.  M. 
Tagert,  at  his  residence,  Kingstown,  on  December  27  th, 
He  took  the  degree  of  M.D.  of  the  University  of  Glasgow 
in  1837  and  in  1845  became  F.R.C.S.  He  was  formerly 
medical  officer  to  the  union  workhouse  and  dispensary 
at  Carrickmacross,  also  to  Farney  Baronial  Fever  and 
General  Hospital.  He  was  the  oldest  medical  man  in 
the  county  of  Dublin,  where  he  had  secured  universal 
respect  and  esteem.  At  the  time  of  his  decease  he  had 
reacned  the  patriarchal  age  of  ninety-one  years. 

MR.  R.  V.  FLETCHER. 
With   regret   we  record   the  death  of  Mr.    R.   V. 
Fletcher,     resident    medical    superintendent    of    the 
District   Asylum,   Ballinasloe,   Galway,   on   December 


various  medical  works.  He  was  twice  married,  his 
first  wife  being  Eleanor  Phillipa,  eldest  daughter  of 
Captain  Paterson,  of  Castle  Huntley,  N.B.  She  died 
in  1886,  and  in  1892  he  married  the  Hon.  Mary  Agnes, 
youngest  sister  of  the  present  Lord  Windsor,  First 
Commissioner  of  Works,  and  daughter  of  the  late 
Hon.  R.  Windsor-Clive,  M.P. 

SAMUEL  THOMAS  BADGER,  M.R.C.S.,  L.S.A. 

After  a  long  illness,  Samuel  Thomas  Badger, 
M.R.C.S.,  L.S.A.,  passed  away  at  his  residence,  Knowle, 
near  Birmingham,  at  the  ripe  age  of  eighty-four. 
The  deceased,  who  was  well  known  and  highly  res- 
spected,  not  in  medical  circles  alone,  but  by  a  large 
number  of  friends  and  acquaintances,  spent  nearly  the 
whole  of  his  life  in  Birmingham.  The  deceased  leaves 
a  widow  and  three  sons.  One  of  his  sons  is  head  master 
of  King's  School,  Peterborough,  another  is  practising 
as  a  surgeon,  and  the  third,  the  Rev.  G.  E.  Badger,  is 
the  vicar  of  Bishop  Ryder's  Church,  in  Birmingham. 

SURGEON  W.  T.  KEY. 
The  death  is  announced  of  Surgeon  W.  T.  Key,  of 
Wyke  Regis,  at  the  age  of  fifty-six.  He  commenced 
practice  in  Wyke  in  1898.  An  Army  Medical  Reserve 
officer  and  a  Surgeon-Captain  in  the  City  of  London 
Artillery  for  many  years,  he  became  attached  to  the 
military  staff  of  the  National  Artillery  Association  and 
attended  the  annual  camp  meetings  of  the  Association 
at  Shoeburyness  on  many  memorable  ocasions. 


DR.  CHARLES  EDWARD  SAUNDERS. 
We  regret  to  learn  of  the  death  at  Nice  of  Dr.  Charles 
Edward  Saunders,  who  will  be  remembered  in  Sussex 
as  the  Medical  Superintendent  of  the  Haywards  Heath 
Asylum  for  a  period  of  about  twelve  years.  Under  his 
able  administration,  the  East  Sussex  County  Asylum 
attained  a  high  degree  of  efficiencv  and  completeness, 
and  his  genial  personality  will  ever  remain  a  pleasant 
memory  to  his  many  friends  both  in  the  medical  pro- 
fession and  outside  it.  He  was  greatly  respected 
among  the  fraternity  of  Freemasons.  Dr.  Saunders 
went  to  London,  and  devoted  his  attention  chiefly  to 
sanitary  work.  He  was  the  medical  officer  of  health 
for  the  Herts  and  Middlesex  Combined  District,  and 
became  hon.  secretary  of  the  Society  of  Medical  Officers 
of  Health.  He  was  a  brother  of  the  late  Dr.  Sedgwick 
Saunders,  medical  officer  of  health  for  the  City  of 
London.  Dr.  Saunders  was  appointed  Medical 
superintendent  of  the  Havwards  Heath  Asylum  in 
succession  to  the  late  Dr.  Wiliams,  and  after  twelve 
years'  devoted  service  there  he  retired  on  account  of 
failing  health  in  1900.  The  late  Dr.  Saunders  was 
fifty-nine  years  of  age.  He  was  educated  at  Cheltenham, 


J*JL  ij.  t9Q4- 


MEDICAL    NEWS. 


Thb  Meuical  Press*     51 


asd  was  &LRX.S.  England,   1S64  ;      M.B.   (Honours) 

M       ig«55  ;      M.D..     Vberdcen,     1866;    D.RH, 

iamb..  1875  {St.  Thomas's),     He  wrote  several  works 

and  was  a  frequent  contributor  to  me; 1 veal  journals 

and  reports*  

DR.  FRIEDRICH  JOLLY. 
ItiL  death  of  the  eminent  professor  of  psychiatry 
and  uervons  diseases  in  the  University  of  Berlin.  Dr. 
nch  Jolly  is  announced.     The  learned  Professor 
wms  bora  at  Heidelberg  in  1844*  and  occupied  pi 

rs  at  WOribufg  and  at  Strasburg  before  he 

He  was  one  of  the  leading 

in  specialists  in  his  own  subject,  and  was  director 

be    University   Clinical    Hospital   for   Mental   and 

Nervous    Diseases,   as   well   as   president   of    various 

• 


Aebtcal   Hews. 

Royal  College  of  Surgeons  of  England, 
The   following  is   the  official   lee t tire  arrangements 
tot  the  fi»t  quarter  of  the  current  year  at  this  college  :■ — 
Htinterian    Lectures. — February     i;th.     t/tb,    and 
lh«>    After-Effects    of    Head    Injuries.**    by 
T.  Cnsp  English      On  February  22nd,  24th, 
Professor  Arthur  Keith  will  deliver  a  course 
The  Structure  and  Evolution  of  the  Auricles  of  the 
1  of  a  competent  Valvular  Mechanism  round 
their    great    Venous    Orifices."     On    February    29th. 
1  and.  and  ith,  Professor  L.  B.  Rawhng  will  de- 
liver a  course  on   "  Fractures  of  the  Skull,  including 
thologv.  Complications  immediate  and 
On  March  7th,  QthP  and  1  tth, 
i  r  \.  \V.  Ifayo  Robsou  one  on  gf  The  Surg* 

Tire    ^rns     and    Gale    Lectures    will     be  delivered 

14th  by  Percy  J*  Cammidge,  Esq.,  M.B.,  on 

"  The  Physiology  and  Chemist  1  Pancreas."  and 

irch  t6th,  by  J.  Herbert  Parsons,  Esq.,  F.R.C.S., 

otj  "  The  Neurology  of  Vision.*' 

The   Erasmus    Wilson   Lectures.— On  March   21  st, 

and   2Cth,   by   E.  M.  Corner.   Esq.,  F.R.C.S.,  on 

v  e    f  1 .1  n  grew  »us    Processes    (Necroses) 

rr.  the  Alimentary  Tract.** 

The  Plumbers'  Registration  BUI. 

December    zgth    last,    a  meeting  of    registered 

in  Loudon  was  held  at  the  Memorial  Hall  for 

urpose  of  the  annual  election  of  members  of  the 

London  Registration  Committee*  Mr.  Charles  Hudson. 

ftst -master  of  the  Worshipful  Company*  being  in  the 

It  was  stated  that    there  are   now  upon  the 

me  12,000  or  13,000  masters  and  operatives 

t  was  announced  that  a  petition  to  Parliament  was 

of   preparation    in  favour  of   the  national 

ration   of   plumbers,   on   lines   approved    by    the 

-rumen!  Board,  as  a  means  of  distinguishing 

vorKmcn. 

Prosecution  of  an  Unqualified  Practitioner 

Jaue?  Charles  Ai>v,  a  coloured  man,  carrying  on  a 

medical  practice  at    95  Warde  Avenne,  Fulham,  was 

veek  summoned  under  the  Medical  Acts  o I   | 

1 886    for    unlawfully    using    the    description    of 

tor,"       U.RX.P.,        **  L.R,C.S.Edin..       1878." 

It  appeared   that  the  defendant  held   the  degrees  of 

'.[>.  and   L.RX.S.Edin.    in     1878.       Towards  the 

d  1895  he  brought  a  libel  action  against  a  rews- 

and    from    what    transpired    at    the    trial,    the 

al  Councd  struck   his  name  off  the  Register  for 

amous  conduct."     En  January,   i.KuS.  be  was  con- 

]  at  the  Central  Criminal  Court,  and  sentenced  to 

seven  years1  penal  servitude.     In  April,   1903,  he  was 

sod  on  ticket -of -leave.        Recently  it  came  to  the 

knowledge  of  the  police  that  the  defendant  had  set  up 

.al  practitioner  at  Fulham  and   they  com- 

rite*!  with  the  Medical  Defence  Union.     Among 

the  evidence  was  the  following  certificate  : — M  I  certify 

Mr.  Tyrell  is  suffering  from  a  bad  attack  ol  influ- 

aud  a  few  days'  rest  would  greatly  aid  in  his 

ned.  James  C.  Ady.  LR.C.P,  L.K 

Outside  the  house  were  two  brass  plates 

rhe  defendants  name  and  qualifications  thereon, 

and  tu   the  window   was  a   card    bear ing   the   words 


"  Institute    of    Eclectic    Medicine — Medical    Supcrin- 
tendant,    f>r,   Ady,   L.R.C.P.,   L.R.C.S.Edin.,   ex-Med. 
Reg,*'     A  penalty  of  £20,  with  ten  guinea*  costs,  or  two 
months*  imprisonment  with  hard  labour  was  Imp 
Royal  College  of  Burgeons  in  Ireland 

The  Annual  Charter  Dinner  will  be  held  at  the 
College  on  Saturday,  February  13th,  [004.  His 
Excellency  the  Lord  Lieutenant  has  graciously  ac- 
cepted the  invitation  of  the  president  and  council  to 
be  present.  Fellows  desirous  of  being  present  should 
send  their  names,  and  those  of  any  guests  they  may 
wish   invited  to  the  Registrar. 

Small-pox  Ships  for  Bale. 

At  a  meeting  of  the  Met  mp.  J  Han  Asylums  Board 
yesterday,  the  Hospital  Committee  recommended  that 
the  small- pox  hospital  ships  Atlas,  Cast&lia.  and  the 
Endvmion  be  sold,  as  they  were  required  no  longer  for 
isolation  purposes.  Several  members  at  once  raised  a 
question  of  the  safety  of  selling  the  vessels,  considering 
that  they  were  saturated  with  the  germs  of  small- pox, 
and  would  in  all  probability  be  a  source  ot  inle> 
The  Chairman  of  the  Board  assured  the  members  that 
the  vessels  had  been  thoroughly  disinfected,  and  from 
the  report  ol  the  medical  officer  of  the  Port  of  London 
on  the  subject  there  was  no  fear  ol  infection 
amendment  to  refer  the  matter  back  for  another  report 
from  the  medical  officer  was  rejected,  and  the  reoom- 
mendation  adopted.  One  member  suggested  ami' 1st 
loud  laughter  that  they  should  be  offered  to  the  Russian 
Government  as  an  addition  to  that  country's  navy. 
Royal  City  of  Dublin  Hospital 

The  annual  election  for  Resident  Medical  Officer 
will  be  held  on  January  ^6th.  Applications  to  be  sent 
on  01  before  the  2U1Y  to  Mr.  G.  Jameson  Johnston* 
RK,C.S..  Hon,  Sec.  Medical  Board. 

The  Late  Dr.  0.  F.  Moore 

At  the  last  meeting  of  the  Council  of  the  Dublin 
Sanitary  Association  the  following  resolution  was  unani- 
mously adopted  ; — "  That  at  this,  the  first  meeting  of 
the  Council,  since  the  lamented  death  of  Dr.  Charles 
Frederick  Moore,  the  Council  hereby  give  expression 
to  the  very  deep  regret  felt  by  them  for  the  loss  of  so 
highly- valued  a  colleague.  Dr.  Moore  was  one  ol  the 
principal  founders  oi  the  Association,  and  for  many 
years  took  an  active  part  in  the  transactions  of  its 
business,  and  recently  filled  toe  office  of  president. 
His  in ti male  knowledge  of  the  subject,  his  excellent 
business  capacity,  amiaole  disposition,  and  conciliatory 
mainer  conduced  to  his  rendering  valuable  service  to 
the  cause  of  sanitary  science.  The  Council  deeply 
sympathise  with  his  bereaved  family. 

International  Congress  of'  Otology 

It  is  announced  that  the  International  Congrc 
Otology  will  hold  its  seventh  congress  at  Bordeaux, 
August  tst  to  4th,  1904.  under  the  patronage  of  tne 
French  Minister  of  Public  Instruction.  The  following 
subjects  are  proposed  for  discussion  :  1.  The  choice  of 
a  simple  and  practical  acoumetric  formula,  to  be  intro- 
duced by  Professors  PoliUcr.  Gradenigo,  and  Delseaux; 
3.  The  diagnosis  and  treatment  of  suppuration  of  the 
labyrinth,  to  be  introduced  by  Drs.  Brieger,  von  £ 
and  Dundas  Grant  ;  3.  Technique  of  the  opening  of 
brain  abscess  of  aural  origin,  and  after  treatment,  to  be 
mtroduced  by  Drs.  Knapp.  Sehmiegelow  and  Botey. 
The  Lenval  prize,  in  recognition  of  the  greatest  pro- 
gress achieved  in  the  practical  treatment  of  affections 
of  the  auditory  apparatus  during  the  interval  between 
two  sessions  of  the  Congress,  or  to  the  inventor  of  an 
easily  portable  apparatus  capable  of  markedly  im- 
proving the  hearing  of  deaf  persons,  will  be  awarded 
during  the  Congress.  The  jury  consists  of  Professor 
Politser  of  Vienna  (President)/ Dr.  Benni  of  Warsaw, 
Dr.  Gell6  oi  Paris,  Dr.  Urban  Pritchard  of  London, 
Professor  St.  John  Roosa  of  New  York,  Professor 
K  ire  her  of  Wurzburg,  Professor  Grassi  of  Florence. 
and  Professor  E-  J.  Moure,  of  Bordeaux.  The  prise 
consists  of  the  interest  on  3,000  francs,  accumulated 
during  the  interval  between  two  sessions  of  the  Con- 
gress. Candidates  must  send  in  a  statement  of  their 
claims  to  Dr.  E.  J.  Moure,  President  of  the  Organising 
Committee,  Cours  du  Jardin  Public,  25  bis,  Bordeaux, 
before  July  1st,  1904, 


52 


The  Medical  Pxess. 


NOTICES    TO    CORRESPONDENTS. 


Jan.  13.  1904. 


Jtoticw  to 
ftorrcspontonts,  $\iovt  %ttttx»t  &c 

Jse^*  Corrxspondrnte  requiring  a  reply  in  this  column  are  particu- 
larly requested  to  make  use  of  a  dUtinctitx  signature  or  initial,  *nd 
avoid  the  practice  of  signing  themselves  "Reader/*  "  Subscriber, " 
••Old  Subscriber,"  6c.  Much  oonfusion  will  be  spared  by  attention 
to  this  rule* 

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

Original  Articles  or  Letters  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

Reprints.— Reprints  of  articles  appearing  in  this  journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

Public  Health  Diplomat*.— A  valnable  report  upon  the  question 
of  the  physical  improvement  or  degeneracy  of  the  population,  from 
the  Anthropometric  Committee  of  the  British  Association,  will  be 
found  in  the  Proceedings  of  the  Association,  published  in  the  year 

)&&.  A  perusal  of  the  evidence  therein  contained  will  show  that 
'*•  •  town-life  "  «o  called  isnot  deleterious  to  the  race. 

A  CANDIDATE'S  HUMOUR. 

Tub  Examiner  :  Now  sir,  which  is  the  best  way  to  re-establish  the 
circulation  ? 

Candidate  :  That  is  the  duty  of  the  police,  sir. 
(Referred  for  six  months.) 

Poct -Graduate. — Our  correspondent  is  thanked  for  his  letter.    He 

ill  receive  a  private  note  in  the  course  of  a  few  days. 

Dr.  I.  Watsob.— The  Medical  and  Dental  Defence  Union  of  Foot- 
land  has  no  connection,  so  far  as  we  know,  with  the  Medical  Defence 
Union,  Ltd.,  London.    Apply  to  the  Secretary  of  the  latter. 

General  Practitiohrr  (Leeds).— We  think  that  a  better  course 
would  have  been  to  have  sent  a  friendly  note  drawing  attention  to  the 
facts  without  attributing  any  motive.  Had  this  been  done  our  cor- 
respondent would  probably  have  received  a  friendly  reply,  together 
w  ith  a  full  explanation  of  the  circumstances  of  the  case. 

I  Tr  Quoqur.— There  is  no  ethical  rule  upon  the  sublect.  beyond  that 
which  guides  the  action  of   one  gentleman  in  his  dealings  with 
another. 
A  Barristkr.— Your  letter  is  unavoidably  crowded  out. 


Meetings  of  the  gocuties,  'gutvxts,  iet. 

Wednesday,  January  13th. 

Huntrriak  80CIBTT  (London  Institution.  Pinsbury  Circus.  EC). 
-8  p.m.  Council  Meeting.  8.80  p.m.  Mr.  A.  Bowlby— Pain,  its 
Clinical  Significance  and  Importance  in  Diagnosis.  (Second  Hunterian 
Lecture. ) 

80UTH-WBBT  London  Medical  Society  (Boliogbroke  Hospital, 
Wandsworth  Common).— Mr.  J.  H.  Targett— The  Causes  of  Uterine 
Haemorrhage. 

Dermatological  8ocibtt  or  London  (11  Chandos  8treet,  Caven- 
dish Square,  W.)  —6.16  p.m.    Demonstration  of  Cases  of  Interest. 

Medical  Graduates'  College  and  Polyclinic  (22  Chenies  8 tree t, 
W.C.).— 4  pjn.  Mr.  J.  Berry— Olinique.  (Surgical.)  6.16  p.m.  Dr. 
W.  Carr—  infant  Feeding. 

Thursday,  January   14th. 

British  Gynecological  Society  (20  Hanover  Square,  W .)  .—8  pjn. 
Paper— Dr.  M.  de  Leon  (Amsterdam)— A  hitherto  not  sufficiently 
recognised  Source  of  Infection  during  Operations.  The  President- 
Valedictory  Addre*.    (All  practitioners  will  be  welcome.) 

North  London  Medical  and  Chiruroical  Society  <Gt.  Northern 
Central  Hospital,  HoUoway  Road,  N.).— 9  p.m.  Discussion  on 
Recent  Methods  of  Inducing  Anesthesia  fopened  by  Dr.  J.  P.  Silk). 

Medical  Graduates'  College  and  Polyclinic  (22  Chenies  Street, 
W.C.).— 4  pjn.  Mr.  Hutchinson— Clinique.  (Surgical.)  6.16  p.m. 
Dr.  P.  Stewart— Myopathies. 

Mount  Vernon  Hospital  roa  Consumption  and  Diseases  op  the 
Chest  (7  Fit«roy  Square,  W.).— 5  pjn.     Dr.  J.  E.  Squire-Pulmonary 
Cavities— I.,  Signs  (Illustrated  by  cases).    (Post-Oiaduate  Course,) 
Friday,  Jakuary  16th, 

Epidemiological  Society  op  London  (11  Chandos  Street,  Caven- 
-dish  Square.  W.).-8.30  pjn.  Discussion  on  Sleeping  Sickness  (opened 
by  Dr.  L.  Sambon). 

Society  for  the  Study  of  Dhusasr  in  Children  (11  Chandos  Street, 
W  ) .— 5  p.m.  Cases  and  Morbid  Specimens  will  be  shown  by  Dr.  E. 
Pritchard,  Mr.  Brickdale,  and  Dr.  G.  Carpenter.  5.80  p.m.  Papers 
—Dr.  D.  McKenzie  (Leytonstone)— A  Fatal  Case  of  Streptococcus 
Poisoning  following  Measles  in  an  Infant.— Mr.  J.  H.  Evans— The 
.Relation  of  Certain  Extra  and  Intra -cranial  Haemorrhage  in  the  New- 


born.—Dr.  G.  Chaffey  (Brighton)— Sequel  of  "the  Case  of  Extreme 
Wasting  shown  at  the  Provincial  Meeting  at  Brighton. 

Medical  Graduates'  College  and  Polyclinic  (22  Chenies  Street. 
W.C.).— 4  p.m.    Dr.  J.  Horne-Clinique.     (Throat.) 
Tuesday,  January  19th. 

Therapeutical  8ociett  (Apothecaries'  Hall.  Blackfriars.;  4  p.m. 
Professor  Farmer  will  describe  Some  Recent  Investigations  on 
Cancer.— Papers— Dr.  T.  N.  Kelynack— Some  Points  in  the  Hygienic 
Treatment  of  Pulmonary  Tuberculosis.— Dr.  Gray  Duncanson  —  The 
Therapeutic  Value  of  Suprarenal  Gland  Products. 


&ppomtmtntz. 


Brown,  Thomas,  M.B.,  Ch.  B.Vict.,  Resident  Medical  Officer  to  the 
Public  Dispensary,  Leeds. 

Carvbll,  John  Maclean  M.R.C.8.,  L.&A.Lood.,  Registrar  to  the 
Central  London  Throat  and  Ear  Hospital. 

Dtrr,  Sydney  Reginald.  M.D.Brus.,  M.R.C&,  L.R.C.P.,  LJ3.A  f 
D.P.H.Lond.,  Senior  Medical  Officer  to  H.M.  Prison,  Dartmoor. 

Irwin,  8.  T.,  M.B.,  Oh.B.R.U.1.,  Junior  House  Surgeon  at  St. 
Peter's  Hospital  for  Stoue,  Covent  Garden.  London. 

Jones,  A.  Webb,  F.R.C.S.,  Honorary  Surgeon  to  the  Women's  Wards, 
Alexandria  Government  Hospital. 

Maunder,  Percy  R„  M.D.Durh.,  L.R.O.P.Lond,,  M.R.C.8.,  L.8.An 
Medical  Officer  to  Stafford  Prison. 

Mi' dib.  R.  F.,  M.B..  M.*.Edin.,  Certifying  Furgeon  under  the  Fac- 
tory Act  for  the  Lady  bank  District  of  the  county  of  Fife. 

Pricb,  D.,  L.R.CP.Lond.,  M.R.C.S.,  Certifying  Surgeon  under  the 
Factory  Act  for  the  Works  of  Messrs.  Boyd  and  Co.,  Castle  Carey, 
in  the  county  of  Somerset. 

Smith,  John  M..  M.D.Glaar.,  D.P.H.R.C.P.Edin.,  Medical  Officer 
for  No.  1  District  of  the  Cheltenham  Union. 

Vaughan,  Ethel  Mat,  M.D.Lond.,  Assistant  Physkian  to  the  De- 
partment for  Diseases  of  Women  at  the  Royal  Free  Hospital. 

fJaranrit*. 

Bethnal  Green  Infirmary.— Assistant  Medical  Officer.  Salary  £100 
per  annum,  with  furnished  apartments,  board,  and  washing.  Ap- 
plications to  the  Medical  Superintendent  of  the  Infirmary,  Cam- 
bridge Road,  N.E. 

Cheltenham  General  Hospital.— House  Surgeon.  Salary  £80  per 
annum,  with  board  and  apartments.  Applications  tou.  T.  Oar- 
rington,  Esq.,  Honorary  Secretary  and  Treasurer. 

Leicester  Infirmary.— Assistant  House  Surgeon.  Salary  £80  per 
annum,  with  board,  apartments,  and  washing. ,  Applications  to 
the  Secretary.  24  Friar  Lane,  Leicester. 

Lincoln  County  Hospital.— Senior  Male  House  Surgeon.    Salary  £100 

Sr  annum,  with  board,  lodging,  and  washing.  Applications  to 
e  Secretary,  2  Bank  8treet,  Oncol n. 

Liverpool  Stanley  Hospital.— Second  House  Surgeon.  Salary  £80 
per  annum,  with  board,  residence,  and  washing.  Applications 
immediately  to  the  Chairman  of  the  Board. 

Norfolk  and  Norwich  Hospital.— Lady  Superintendent.  Salary  £100 
per  annum,  with  apartments,  board,  and  laundry.  Application! 
to  the  oecretary. 

Rochdale  Infirmary.— Resident  Medical  Officer.  Salary  £100  per  an- 
num, with  board,  residence,  and .  washing.  Applications  to  the 
Hon.  Sec.,  B.  W.  8haw,  Esq.,  8outhfleVJ,  Rochdale. 

Stamford,  Rutland,  and  General  Infirmary.— House  Surgeon*  Salary 
£100  per  annum,  with  board,  lodging,  and  washing.  Applica- 
tions to  V.  G.  8tapleton.  Secretary,  the  Infirmary,  Stamford. 

Tiverton,  Devonshire,  Infirmary  and  Dispensary.— House  Burgeon 
and  Dispenser.  Salary  £80  per  annum,  and  all  found.  Applica- 
tions to  Arthur  Fisher,  Hon.  Secretary. 

West  Ham  and  East  London  Hospital,  8tratford.  E.— Resident  Medi- 
cal Officer.  Salary  £120  per  annum,  with  board,  residence,  4c. 
Applications  to  the  Secretary. 

Wolverhampton  Eye  Infirmary.— House  Surgeon.  Salary  £70  per  an- 
num, with  rooms,  board,  and  washing.  Applications  to  the  Sec- 
retary. 

girths. 

Abercrombir.— On  Jan.  6th,  at  28  Upper  Wimpole  Street,  London, 

the  wife  of  John  Abercrombie,  M.D.,  of  a  son. 
Haywaro.— On  Jan.  8th,  at  65  blert  8treet  Abingdon,  the  wife  of 

M.  Cecil  Hayward,  M.A.,  M.B.,  of  a  daughter. 
K  ennedy.— On  Jan.  6th,  at  Plaistow,  E.,  the  wife  of  Angus  Kennedy, 

L.R.C.P.,  M.R  C.8.,  L.8.  A.,  of  a  son. 
W a  cm— On  Jan.  6th,  at  Waicote, Winchester,  the  wife  of  Cyril  Wace, 

F.R.C.S.,  of  a  daughter. 


4ftatriagts. 


Jones— Jay.— On  Jan.  7th,  at  the  Parish  Church,  Busbey,  the  Rev. 
Cyril  Leslie  Jones,  M.A..  Marske-by-the-Sea,  |seoond  son  of  H. 
Leslie  Jones,  M.D.,  FJt.C.S.I.,  to  Violet  Mary,  second  daughter 
of  the  late  James  A.  Buchanan  Jay,  of  Hereford,  and  Mrs.  Jay, 
Bushey. 

Trllet— Little.— On  Jan.  6th.  at  St.  Andrew's  Church,  Penrith, 
William  Edward  Tellet,  M.D.,  Paisley,  to  Charlotte  Edith, 
daughter  of  William  Little,  of  Hutton  Hall,  Penrith,  Cumber- 


Wrlcu— Laee.— On  Jan.  6th,  at  St.  Peter's,  Cherteey,  Walter  Bar- 
rows, M.R.C.S.,  US.  A.,  elder  surviving  son  of  the  late  Thomas 
Welch,  of  Brighton,  to  Alethea  Emily,  only  daughter  of  the  late 
James  W.  Legg,  of  Ely.  and  Mrs.  Legg,  of  Chertsey. 


Braihe. 


Hemstrd.— On  Jan.  5th,  at  Bath,  Maria  Ann,  widow  of  Henry  Hem- 
sted,  F.R.O.8.,  of  Newbury,  Berks,  in  the  90th  year  of  her  age. 

Smart.— On  Jan.  7th,  at  Kingfleld.  Rye,  Sussex.  Elisabeth  Atkinson, 
widow  of  the  late  Thomas  William  Wake  Smart,  M.D.,  of  Cran- 
borne,  Dorset. 


Mt&ml  Wtm  audi   €\ta\m. 


GO 


"SALTJS    POPULI    SDPREMA    LEX-1 


Vol,  CXXVIIL 


WEDNESDAY,    JANUARY     20,     1904, 


No.    3. 


Clinical  Xccturc 

OX 

ENDOCARDITIS,    (a) 

By  JOHN   HILL  ABRAM,  M.D.LoncL, 

14D  %&  the  Rujrii  infirmary  ,   Lrctnrer  on   <  Uokftl  M«li«ine, 
Univtnllf  of  Livtrpooh 

Is  the  last  few  weeks  two  pa  dents  have  died  in 

ranis  from  heart  disease,  and  the  result  of  the 

lem   examinations    has  led   me   lo  bring 

;r     notice   the    subject    or  endocarditis 

in  general. 

I  wish  to 

is,  due  to  the  chronic  process  of  atheroma 

tog  the  aortic  valve- and  associated   or6an,sm 


factors  have  to  be  considered,  the  virulence  of  the 
organism,  and  the  resistance  of  the  host. 

In  clinical  work  the  varying  virulence  of  the 
Organism  is  difficult  to  gauge,  but  the  resistance  of 
the  host  is,  we  know,  impaired  by  exhaustion, 
physical  or  mental,  excesses  of  all  kinds,  chronic  or 
acute  disease,  and  in  the  particular  form  of  disease 
we  are  considering  by  previous  damage  to  the 
valves. 

Some  infective  diseases  play  a  preponderating 
part  in  the  causation  of  endocarditis;  acute 
rheumatism,     scarlet     fever,    chorea,    pneumonia, 

-omia;    and     less     often    gonorrhoea,    typhoid, 
put  on  one  side  to-day  the  valvular   lur>erele ;  and  others  still  more  rarely,  as  an thr. 
:c  chmnic   process  of  atheroma.    Il   ls  rarc   lfl   m>'  experience    to  find    the  specific 

Lf«t    the    pneumococcus ;    much  more 


iilar  affection  of  the  aorta.    I  propose  to   commonly  we  find  the  common  pyogenic  cocci, 
imply  what  I  may  be  allowed  to  call  true       ln  Edith  c->   one  of    the   cases  before  you,  the 
tndv  Endocarditis    is    usually    classified    fatal  acutc  condition,  though  postpneumonic,  was 

and  malignant,  or  ulcerative,  and  it  has    stlovv^  during  life  to  have  been  due  to  a  secondary 
loot  been  taught  that  the  latter  variety  is  infective     streptococcal  infection , 

broad  an  atomic*]  differences  between  ihesr  *,„,!"  ^f™**   !?''  t^T  **  ■bcfare  W>  Whicb 
km  may  be  briefly  given  as  laid  down  in  former    £™^^  streptococci 

Years  — 


Vitiations      |,      Sun  11. 


Mttltgnutt, 
Exuberant. 


have  been  obtained  in  pure  culture  from  the  valves, 
I  have  long  though ty  therefore,  thai  these  various 


affections  damage  nutrition,  and  allow  in  the  firs! 
/  Auricular  surface  .  Both  surfaces  and  instance  the  entrance  of  the  pyogenic  cocci,  and 
)     of  mitral  v.  I  on  to  wall  of  cavi-  in  the  second  place  their  attack  upon  the  valves, 

'  Ventricularsurlacc     ties    and    aorta         In  this  way,  mo,  I  should  explain  the  action  of 


ot  aortic  v. 


and     aorta 

heart.     Bright  *s  disease  as  a  cause  of  true  endocarditis. 

You  will  readily  see,  from  what   I  have  said  and 


Ulcerations, 


No      micro-organ- 
ism*  present. 


valves/  periora- ^hearts  befon syou,  that  In  the  si ric l  pathological 
lions  of  valves,  sense  no  distinction  can  be  drawn  any  longer  De- 
nature oi  chor-  tween  simple  and  infective  endocarditis.  Both 
dae  tendinae.  are  mycotic,  and  although  at  their  extremes  the 

Mi  i..  .  .-anisms  anatomical  differences  are  marked,  yet  numerous 
present.  intermediate  grades  link  these  extremes  together, 

In  bar  rorm  of  disease  has  so  much  work        Nevertheless,  when   we   approach    the   question 

taendone    with    regard    to    the    relationship    of   from  the  clinical  standpoint  we  must  retain  the  old 
organisms  to  the  lesion,  and  the  outcome  of  the   classification 

writ  of  Observers,  too  numerous  to  name,  has  been        Simple  endocarditis  is  most  commonly  seen  with 

tetroy   any   pathological    difference    between   acute   rheumatism      A    good    example   of   recent 

,md  malignant  endocarditis.  rheumatic  endocarditis  wasonly  sent  out,  recovered , 

It  may  be  said  with  certainty  that  endocarditis,   from  X  ward  in  October,  a  boy  who  had  been  left* 

te  exception   I  have  made,  is  mycotic  in   in  my  charge  by  Dr.  Caton,  on  his  retirement  from 

the  Infirmary,     The  important  point  here  is  the 
In  (he  simplest    type  of  endocarditis  with   the  early  recognition  of  the  development  of  the  heart 
features   tabulated    above,  organisms  of   various    trouble. 

lands  ha vit  been  found,  morphologically  identic  il       It    is,  in    my   opinion,  an   extremely    difficult 

ft'ith  those  found  incases  with  the  most  advanced    problem.     Symptoms   are   very  indefinite;     pra?- 

id]  changes.     Why,  then,  you  will  ask,  do   cordial  pain,  palpitation,  an  added  degree  or  two 

the  cases  vary  so  widely  in  their  clinical  course  ?      .of  temperature,  an  accelerated  pulse-rate.     These 

The  answer,  no  doubt,  is  that  in  all  cases  two  'mav  **  due  to  the  original  complaint  and  can  have 

. but  little,  if  any,  diagnostic  weight. 

Lecture  delivered  »t  the  Liverpool  Roy*I  Infirmary,  I       ^  careful    physical   examination   must    be   made 

regularly,    daily,    in   all     cases    where   a    cardiac 


,£ 


54    The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


Jan.  20,  1904. 


complication  is  at  all  likely — e.g.,  rheumatic  fever 
and  scarlet  fever.  As  I  told  you  in  a  previous  lec- 
ture on  chest  symptoms,  a  physical  examination 
alone  permits  of  a  definite  diagnosis. 

What  points  will  help  us  ?  In  the  usual  mitral 
form  the  first  sound  loses  its  sharp  character,  and 
becomes  dull  and  muffled.  Dr.  Caton  has  suggested 
that  this  implies  the  loss  or  weakening  of  the  valvu- 
lar element,  and  the  predominance  of  the  muscular 
element. 

Later  a  systolic  murmur  may  develop  at  the 
mitral  area,  less  often  at  the  aortic  area,  and  still 
more  rarely  a  diastolic  bruit,  which  more  com- 
monly is  added  to  the  systolic  murmur. 

The  pulmonary  second  sound  in  the  common 
mitral  type  becomes  accentuated. 

Less  noteworthy  is  a  diffusion  of  the  apex  beat. 

Enlargement  of  the  heart  is  rarely  present  in  the 
early  stage,  and  is  suggestive  rather  of  myocardial 
weakness  than  a  secondary  result  of  regurgitation. 

The  differential  diagnosis  has  to  be  attempted 
from  accidental  murmurs  in  the  strict  sense,  and 
from  the  murmurs  of  relative  incompetence. 

Where  there  is  no  enlargement  of  the  heart,  no 
accentuation  of  the  pulmonary  second  sound,  with 
a  bruit  de  diable  in  the  neck,  and  a  systolic  murmur 
loudest  at  the  pulmonary  area,  then  in  the  presence 
of  marked  anaemia  a  diagnosis  of  accidental 
or  haemic  murmur  is  probably  sound,  especially 
when  no  usual  cause  for  endocarditis  is  present. 

Unfortunately  this  matter  is  rarely  so  simple. 

A  disease  which  may  give  rise  to  endocarditis 
may  attack  an  amemic  patient,  nay,  acute  rheu- 
matism generally  produces  anaemia.  Again  in 
anaemia  and  in  myocarditis  relative  incompetence 
may  arise  from  weakness  of  the  muscular  ring,  or 
dilatation  of  the  ventricle,  or  even  spasm  of  the 
papillary  muscles.  In  these  latter  cases  increase 
of  the  cardiac  dulness  will  be  present,  and  the 
pulmonary  second  sound  accented. 

The  second  sound  is  rarely  so  much  accented 
as  in  endocarditis,  the  cardiac  impulse,  on  the  other 
hand,  is  weaker,  and  the  pulse  smaller  and  often 
irregular. 

I  am  inclined  to  lay  stress  on  the  character  of 
the  first  sound  in  endocarditis,  prolongation  and 
muffling;  in  relative  incompetence  of  the  mitral 
valve  it  becomes  short  and  sharp. 

The  character  of  the  murmur  is  of  no  assistance  ; 
4  the  time  may  help  ;  a  diastolic  accidental  murmur 
is  exceedingly  rare.  I  can  only  add  that  in  some 
cases  a  diagnosis  cannot  be  made  with  certainty, 
although  I  think  it  should  always  be  attempted. 
A  pericardial  murmur  is  readily  differentiated,  the 
superficial  to-and-fro  scratching  character,  the  time 
not  strictly  synchronous  with  the  heart  sounds/with 
the  further  points,  greatest  intensity  on  the 
auriculo- ventricular  line  and  on  increased  pressure 
with  the  stethoscope,  make  a  ready  recognition 
possible. 

Pleuro-pericardial  murmurs  do  not  affect  the 
size  of  the  heart  or  alter  the  heart  sounds,  and  are 
best  heard  along  the  edge  of  the  cardiac  dulness. 
Two  examples  of  this  last  murmur  are  at  present  in 
Clarence  ward. 

Primary  acute  endocarditis  usually  attacks  the 
mitral  valve  ;  it  may  resolve,  but  very  frequently 
leads  to  permanent  damage.  Death  is  never  the 
direct  result  of  the  endocarditis. 

Severe  endocarditis  I  have  never  seen  except  in 
association  with  chronic   disease  of   the   valves, 


hence  in  the  vast  majority  of  cases  the  diagnosis  of 
valvular  disase  is  readily  made. 

However,  in  some  cases  which  have  been  recorded, 
the  local  heart  changes  have  been  a  post-mortem 
finding.  In  the  case  of  Edward  H.,  the  tem- 
perature for  the  last  ten  days  of  his  life  was  normal, 
the  hematuria  and  albuminuria  were  thought  to 
be  due  to  the  salicylates  he  had  received  for  his 
rheumatism.  However,  the  appearance  of  cu- 
taneous haemorrhages  and  abundant  leucocytes 
in  the  urine  made  the  diagnosis  only  too  obvious  ; 
he  died  suddenly  before  a  blood  examination  could 
be  made.  (Aortic  regurgitation.)  In  both  malig- 
nant and  septic  endocarditis  we  meet  fresh  sym- 
ptoms— marked  fever  of  varying  type,  multiple 
embolisms,  haemorrhages  into  the  skin  and  retina, 
enlarged  spleen,  haemorrhagic  nephritis. 

Lit  ten  describes  a  form  of  endocarditis  practi- 
cally identical  with  the  usual  septic  type  as  regards 
symptoms,  but  with  three  pointsof  difference — it  is 
due  to  rheumatism,  it  runs  a  course  of  weeks  and 
months,  and  the  infarcts  never  suppurate. 

Dr.  Glynn  taught  me  years  ago  that  a  chronic 
form  of  ulcerative  endocarditis  occurred,  and  I 
have  seen  several  cases  in  my  practice. 

Edith  C,  one  of  the  cases  before  you,  ran  a 
course  of  over  two  months  ;  now  this  was  due  to 
streptococcus  infection,  yet  no  infarcts  suppurated, 
and  there  was  no  history  of  rheumatism. 

Hence,  while  accepting  Litten's  statement  as  to  a 
malignant  endocarditis  due  to  rheumatism,  we 
must  remembeV  that  similar  cases  occur  where 
rheumatism  cannot  be  traced  and  in  which  ordinary 
organisms  are  found. 

Finally,  we  have  ordinary  types  of  severe  endo- 
carditis, which  are  given  in  your  text-books — 
typhoid  and  septic.  Others  can  be  manufactured, 
where,  for  instance,  the  heart  symptoms  are  promi- 
nent, "  cardiac  type  "  ;  nervous  symptoms  promi- 
nent, "  cerebral  type."  The  gain  thereby  is 
infinitesimal. 

You  will  see,  gentlemen,  that  I  practically  work 


Simple  endocarditis 
Malignant  { 


acute 
chronic 


(     typhoid 
I     pyaemic 


It  may  be  that  as  time  goes  on  we  shall  be  able  to 
find  during  life  the  infective  agent  at  work  in 
individual  cases,  and  research  may  then  provide 
us  with  the  necessary  antidote. 

It  is  an  important  quest,  for  all  forms  of  malig- 
nant endocarditis  tend  towards  a  fatal  termination : 
Of  Litten's  20  cases,  19  died  ;  and  the  twentieth  was 
in  a  bad  way  at  the  date  of  his  paper.  This  is 
the  common  experience. 

NOTES  ON  A  CASE  OF 

ENTERIC    FEVER, 

WITH    SYMPTOMS  CLOSELY  RESEMBLING 

THOSE  OF  PERFORATION.— RECOVERY 

WITHOUT  PERFORATION. 

By  R.  TRAVERS  SMITH,  M.D.Univ.Dub., 

F.R.C.P.I., 

Visiting  Physician   to  the  Richmond,  Whitworth,  and  Hardwicke 
Hospitals,  Dublin. 

R.D.,  aet.  56,  a  compositor  by  occupation,  was 
admitted  to  the  Hardwicke  Fever  Hospital  on 
March  7  th,  1903.  He  complained  of  having  been 
ill  for  two  weeks,  during  the  latter  of  which  he  was 
confined  to  bed.  He  had  not  seen  a  doctor  before 
admission,  but  had  treated  himself  by  consuming 


fist,  *>,  1904, 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Panss.     55 


targe  quantities  of  whisky,  in  the  remedial  value 
jicb  he  bad  a  confirmed  belief.     On  examina- 
tion be  proved  to  be  an  unequivocal  case  of  enteric 

of  considerable  severity.     I  shall  refrain  from 

,'ing  his  symptoms j  as  they  were  the  ordinary 
ones  of  enteric  fever  in  the  third  week ,  except  to 

sit  the  blood  gave  an  unusually  pronounced 
Widal's  reaction.  Dr.  Earl ,  who  examined  the 
blood,  stated  that  in  performing  this  test  with  a 
dilution  of  1  in  50,  the  typhoid  bacilli  were 
markedly  agglutinated  by  the  time  he  had  focused 
preparation  under  the  microscope.  Despite 
the  patient's  occupation,  no  signs  of  lead  poisoning 

present,  nor  had  he  ever  suffered  any  of  its 
symptoms. 

Till  the  sixth  day  after  admission  to  hospital,  or 

ximately  the  end  of  the  third  week  of  his 

\  R.  D.  remained  in  much  the  same  condition. 
Un  that  day,  at  9.30  a.m,,  he  complained  of  pain  in 
the  right  iliac  fossa  and  hypogastrium,  after  which 
bowels  moved,  and  vomiting  occurred.  On 
*fing  the  patient  less  than  an  hour  later  I  found 
that  his  temperature  had  risen  from  102°  (its 
average  on  previous  mornings,  to  104  ;  the  pulse 
was  &4  ■  the  respirations  28.  The  abdomen  had 
become  rigid,  was  not  distended,  and  not  tender 
unless  sufficient  force  was  used  to  overcome  the 
rigidity  of  its  wall  in  the  right  iliac  fossa.  Liver 
0  ulness  was  present  ;  elsewhere  the  abdominal 
resonance  was  not  uniform.  The  general  aspect  of 
the  patient  was  somewhat  altered  for  the  worse, 
He  still  complained  of  the  pain,  Having  ascer* 
tiined  these  points,  the  diagnosis  of  perforation 

: artfully  considered.  In  the  light ,  however, 
of  a  pulse-rate  little  if  any  above  its  average 
morning  frequency,   and   in   the   absence  of   any 

itions  of  collapse,  despite  the  onset  of  pain, 
rigidity  and  tenderness  in  the  right  iliac  region,  I 
wis  unable  to  form  a  sufficiently  positive  opinion 
to  warrant  the  recommendation  of  an  operation, 
so  determined  to  watch  the  case  a  little  longer. 
Vll  iood  was  prohibited  except  sips  of  water,  but 
DO  morphia  was  given,  An  hour  later  the  abdo- 
men presented  the  same  signs  exactly  ;  the  pain 
The  pulse  had  increased  by 
lour  beats  (to  88 j,  the  temperature  had  fallen  one 

e  (to  1030).  Two  hours  later  still,  all  pain 
had  gone,  the  pulse  was  82,  At  6-30  p.m.  (seven 
hours  alter  the  onset  of  pain  ,  the  p  .ticnt  expressed 
himself  and  looked  much  better      He  had  sweated 

isely,  the  bowels  had  just  moved,  the  motion 

being  free  from  blood.     The  pulse  had  fallen  to  78, 

and  the  temperature  had  been  recorded   1006°  a 

time    previously.     The    abdomen    was    less 

Otherwise    the    same    as   in    the    morning. 

•rdingly    progress    was    deemed    satisfactory, 

more  particularly  as  no  morphia  had  been  given 

iask  the  symptoms  of  spreading  peritonitis,  for 

carctul  watch  was  being  kept. 

An  hour  la  1  ■  p.ra*)  the  scene  changed. 

R.  D.  was  suddenly  seized  with  violent  pain  in  the 

iliac  region.     He  vomited  some  bilious  fluid* 
mg  hospital  I  found  the  patient  in  great 
[om  pain.     His  aspect  was  one  of  suffer- 
ing, indeed,  it  was  evident  from  a  glance  that  a 
marked  change  for  the  worse  had  set  in— in  fact, 

fie  was  m  a  condition  of  collapse.     His  tern- 
«re  had  fallen  to  96 \  his  pulse  had  become  ' 

itidly  fast  and  reached  its  maximum  of  140  in 

ourse  of  two  hours.  He  lay  on  his  back  with 
*Us  knees  drawn  up.     On  examining  the  abdomen 

11  found  not  to  be  distended,  but  extremely 


rigid.  Tenderness  was  more  marked  in  the  right 
iliac  fossa  than  it  had  been  in  the  morning,  con- 
siderable pressure  being  required  to  overcome  the 
rigid  muscles.  Liver  dulness  was  present  over  a 
smaller  area  than  had  been  observed  in  the  morn- 
ing, the  probable  result  of  the  presence  of  distended 
intestines  beneath  a  rigid  abdominal  wall,  The 
breathing  was  rapid  and  almost  entirely  thoracic. 
The  diagnosis  of  perforation  was  now  irresistible. 
I  therefore  recommended  immediate  operation  to 
the  patient,  who,  though  quite  clear  in  his  mind, 
refused.  It  was  urged  upon  him  that  it  was  the 
only  chance  of  saving  his  life,  to  which  he  replied 
that  he  would  rather  die  than  undergo  an  opera- 
tion. The  lapse  of  half  an  hour  and  the  con- 
tinuancc  of  his  pain  during  the  time  did  not  shake 
his  determination.  Under  these  circumstances  I 
ordered  a  quarter  grain  of  morphia  hypodermic  ally, 
and  the  continued  abstinence  from  all  food  except 
sips  of  water,  feeling  at  the  time  that  the  case  was 
hopeless,  The  night  was  passed  in  comparative 
freedom  from  pain  and  with  a  considerable  amount 
of  sleep. 

At  4  a.m.,  temp.  104' 3*,  resp.  36,  pulse  96. 

At  5,30  a.m.,  temp.  103' 8°,  resp.  24,  pulse  too. 

At  8  a.m.,  temp.  ior8°,  resp.  zSt  pulse  112. 

These  observations  go  to  show  the  fluctuations 
of  temperature  and  pulse- rate  which  may  occur  in 
such  cases,  and  it  was  noticed  that  as  the  former 
tended  to  fall  the  latter  tended  to  rise  in  frequency, 
and  vice  versa.  On  seeing  the  patient  on  my 
morning  visit  following,  though  the  temperature 
was  no  longer  at  a  point  indicative  of  collapse  and 
the  pulse  was  slower,  he  seemed  worse  in  other 
respects  than  on  my  visit  the  night  before.  His 
tongue  and  mouth  were  dry,  voice  extremely  weak, 
muscles  tremulous,  prostration  marked.  His 
general  appearance  looked  most  unfavourable. 
The  abdominal  physical  signs  were  as  they  had 
been  twelve  hours  before  ;  the  pain,  however,  was 
less  acute.  No  urine  had  been  passed  for  at  least 
twelve  hours,  yet  the  suprapubic  region  was 
resonant.  This  retention  persisted  for  twelve 
hours  longer  without  causing  distress  or  signs  of 
bladder  distension,  at  the  end  of  which  time  urine 
was  passed  naturally  ;  unfortunately  the  quautity 
passed  was  not  measured.  During  the  next  three 
or  four  days  the  patient  lay  in  a  truly  critical  state. 
Vomiting  occurred  several  times  daily,  increasing 
his  exhaustion.  Pain  became  severe  from  time  to 
time.  The  abdomen  did  not  become  distended  or 
generally  tender.  The  pulse,  prone  to  fluctuation, 
on  the  average  remained  about  90,  very  weak  and 
small.  Pyrexia  continued  much  as  before  the 
onset  of  the  abdominal  complication. 

R.  D.  now  began  to  improve  steadily t  though 
pyrexia  continued  for  nearly  a  fortnight.  As  the 
uy  and  tenderness  of  the  abdomen  disappeared 
a  persistent  ill -defined  swelling  in  the  right  iliac 
fossa  could  readily  be  detected.  This  tumefaction 
(almost  certainly  the  result  of  local  peritoneal 
thickening  and  matting)  was  still  evident,  though 
less  distinctly  so,  when  the  patient  left  the  Hard- 
wicke  Hospital  on  April  29th.  No  peritoneal 
abscess  had  formed.  A  few  weeks  after  his  dis- 
charge the  patient  was  in  his  usual  health. 

A  few  words  concerning  the  treatment  of  the  cat  e. 
Morphia  was  of  necessity  given  to  relieve  bad  pain, 
opium  stupes  gave  relief  when  pain  was  less 
intense.  The  choice  of  diet,  of  course,  caused  the 
greatest  anxiety  and  difficulty,  For  twenty-six 
hours  after  the  onset  of  pain  nothing  was  given  per 


56    Thb  Mxdical  Press, 


ORIGINAL  COMMUNICATIONS. 


Jan.  20,  1904- 


mouth,  except  sips  of  water.  Then  dilute  pepto- 
nised  milk  was  given,  two  teaspoonfuls  every  hour 
at  first,  and  gradually  increased.  Next  a  little 
raw  meat  juice  and  panopeptone  were  allowed. 
Even  this  meagre  amount  of  food  was  not  all  re- 
tained by  the  stomach.  Nutrient  enemata  were 
tried,  but  appeared  to  irritate  the  rectum  and 
produce  iliac  pain  ;  in  fact,  the  patient  developed 
such  a  terror  of  them  that  they  were  stopped  after 
a  few  had  been  given.  For  three  days  after  the 
urgent  abdominal  symptoms  the  bowels,  pre- 
viously regular,  remained  confined.  A  small 
enema  of  castor  oil  was  given  and  produced  a 
satisfactory  fluid  motion.  From  that  time  the 
bowels  moved  spontaneously  every  day,  the  move- 
ment being  preceded  and  accompanied  by  abdo- 
minal pain  as  a  rule.  The  origin  of  this  pain  was 
most  probably  some  dragging  upon  adhesions. 

Conclusions. — Though  the  existence  of  a  per- 
foration in  this  case  cannot  be  asserted  positively, 
it  is  my  own  opinion  that  such  did  occur.  The 
following  solution  of  the  clinical  phenomena 
appeals  most  to  me.  In  the  first  instance  a  mild 
and  limited  peritonitis  developed  from  inflam- 
matory extension  through  the  wall  of  the  bowel, 
hence  the  preliminary  pain  without  much  con- 
stitutional disturbance.  The  subsequent  onset 
suddenly  of  violent  pain  accompanied  by  well- 
marked  collapse,  as  indicated  by  subnormal  tem- 
perature, rapid  pulse,  cold  sweating,  &c,  coincided 
with  the  occurrence  of  perforation.  Further,  peri- 
tonitis now  developed,  but  did  not  become  gene- 
ralised owing  to  the  existence  of  the  following 
favourable  conditions  at  the  time  of  perforation  : — 

1.  The  bowels  were  comparatively  empty,  no 
food  having  been  given  for  ten  hours  previously, 
and  two  motions  having  passed  from  them  in  that 
time. 

2.  Some  adhesive  peritonitis  was  already  present 
which  retarded  the  escape  of  intestinal  contents, 
and  limited  the  range  of  movement  of  the  per- 
forated portion  of  the  intestine. 

3.  The  subsequently  continued  abstinence  from 
food  and  the  administration  of  morphia  also  played 
their  part  in  limiting  the  movement  of  the  intestine. 

Finally,  I  would  say  that  if  the  above  case  was 
really  one  of  perforation,  it  is  interesting  as 
exemplifying  what  is  known  to  happen  rarely, 
namely,  spontaneous  recovery  after  this  complica- 
tion. If  it  were  not  a  case  of  perforation,  it  is  none 
the  less  interesting  as  being  illustrative  of  the 
impossibility  of  making  certain  of  a  correct  dia- 
gnosis when  all  the  classical  early  symptoms  of 
perforation  can  be  so  closely  imitated  by  some  other 
condition. 

The  lesson  which  certainly  should  not  be  learnt 
from  the  case  is,  that  it  is  justifiable  to  postpone 
operation  when  one  has  sufficient  grounds  for 
thinking  that  a  perforation  is  probably  present. 

I  am  indebted  to  my  late  resident  pupil,  Miss 
Ovenden,  for  many  careful  observations  and  notes 
upon  this  case. 


CERTAIN    POINTS    IN   THE    DIAGNOSIS     ' 

OF  I 

FLUID  IN   THE  CHEST,   (a)     | 

By  T.  GILBART  SMITH,  M.A.,  M.D.,  F.R.C.P., 

Physician  to  the  London  Hospital.  , 

In  spite  of  the  fact  that  pleurisy  was  so  com- 

(a)  Abstract  of  Opening  Clinical  Lecture  of  the  Spring  Session  of 
the  North-East  London  Postgraduate  College,  delivered  at  the 
Tottenham  Hospital  ,on  Thursday,  January  14th. 


monly  met  with,  nothing,  perhaps,  was  easier  than 
to  fail  to  diagnose  it  when  present,  or  vice  versd. 
Our  mistakes  in  this  respect  were  often  far  more 
interesting  than  our  correct. diagnoses !  The  in- 
formation derived  from  text-books  about  pleurisy 
would  lead  one  to  suppose  that  it  was  a  very 
distinct  affection,  but  at  the  bedside  many  of  the 
characteristic  signs  were  often  found  wanting. 
For  instance,  in  a  case  of  pleurisy  with  effusion 
we  should  expect  to  find  immobility  of  the  ribs 
on  the  affected  side,  and  on  palpation,  vocal 
fremitus  would  be  absent.  But  definite  signs  axe 
very  often  wanting.  One  of  the  most  important 
clinical  tests  was  the  sensation  conveyed  to  the 
hands  of  expansion  of  the  chest  wall,  a  slight 
difference  in  movement  being  readily  appreciated 
in  this  manner.  Obliteration  of  the  intercostal 
spaces  and  bulging  of  the  ribs  were,  comparatively 
speaking,  seldom  seen  nowadays,  as  the  cases 
generally  came  under  observation  earlier.  It  was 
very  difficult  to  obtain  vocal  fremitus  in  women 
owing  to  the  lack  of  resonance  in  their  voice,  so 
that  as  an  aid  to  diagnosis  it  was  not  always  a 
trustworthy  guide.  The  ordinary  method  of  placing 
the  whole  palmar  surface  of  the  hand  flat  upon 
the  chest  was  open  to  several  objections,  and  he 
considered  that  the  ulnar  surface  of  the  hand 
was  better  for  detecting  vocal  fremitus,  and  for 
limiting  the  areas  over  which  it  could  be  felt. 

The  real  difficulty  lay  in  the  fact  that  one  was 
apt  to  mistake  fluid  for  solid  lung,  and  vice  versd. 
Here,  again,  the  presence  or  absence  of  vocal 
fremitus  was  not  sufficient  alone,  as  in  conditions 
where  there  was  a  blockage  of  the  bronchial  tubes > 
vocal  fremitus  might  be  absent,  even  when  there 
was  no  fluid.  The  presence  of  tubular  breathing 
over  an  effusion  might  lead  to  the  erroneous 
supposition  that  solid  lung  was  present.  In 
purulent  effusions  the  breathing  was  apt  to  assume 
a  tubular  character,  as  was  also  the  case  when 
the  lung  was  compressed  by  a  quantity  of  fluid, 
simple  or  purulent,  or  a  portion  of  it  congested. 
This  was  the  class  of  cases  most  likely  to 
mislead. 

The  physical  signs  of  fluid  in  children  were 
especially  deceptive.  An  absence  of  breath 
sounds  was  generally  held  to  indicate  the  presence 
of  fluid,  while  definite  tubular  breathing  was  by 
no  means  universally  present  in  cases  of  pneu- 
monia. Another  condition  which  was  prone  to 
mask  the  physical  signs  was  that  of  emphysema> 
as  in  such  cases  the  results  on  percussion  would  be 
very  misleading.  Absent  voice-sounds  and  vocal 
fremitus  should  especially  suggest  the  presence 
of  fluid.  The  position  of  the  heart's  apex  should 
also  be  borne  in  mind,  particularly  in  effusions  upon 
the  left  side,  as  any  displacement  of  this  was  a 
most  valuable  sign.  The  number  of  cases  in 
which  one  found  trouble  at  the  bases  of  the  lungs 
was  very  great.  Most  mistakes  were  made, 
perhaps,  when  there  was  old  mischief  at  the  base 
associated  with  an  effusion.  Difficulty  was  also 
experienced  when  fluid  was  found  together  with 
pneumonia,  especially  when  the  former  was  only 
slight  in  amount. 

The  question  as  to  the  nature  of  the  fluid 
present  often  presented  great  difficulty.  Rigors 
were  not  always  associated  with  purulent  effusions, 
nor  was  the  temperature  invariably  raised.  In 
fact,  there  might  be  considerable  pyrexia  with  a 
simple  effusion.  One  sign  was  really  of  value, 
namely,  clubbing  of  the  fingers  ;  but  even  here, 


JhX*  JO*    1004. 


ORIGINAL  COMMUNICATIONS.         The  Medical  Prbss,    57 


care  was  needed  in  ascertaining  the  exact  duration  i  chloroform  ami  ether  in  the  following  proportions  ; 
of  this  symptom  and  its  relation  to  any  existing  |  Ethyl  chloride,  1;  per  cent.  ;  chloroform,  35 "89  per 
phthisical    condition.     His    experience    was    that    cent.  ;    ether.  47 ^10  per  cent.     Dr.  George  Ko; 


i  exaggerated  the  voice- sounds,  Whispered 
pectorilwjuoy  was  generally  supposed  to  be  lost 
1  purulent  effusion.  Another  condition  in 
w  hieh  there  were  several  small  localised  collections 
of  pus  forming,  as  it  were,  "  pus- tight  "  compart- 
ments was  very  difficult  to  diagnose. 

considered  that  sufficient  use  was  not  made 
:ie    exploring    needle    in    diagnosis.     It    was 
important  to  insert  this  boldly  and  in  the  right 
plice.     The   best   spot,    he  believed,   was   at  the 
tower  extremity  of  a  line,  one  and  a  half  inches 
drawn   vertically  downwards  from  a  point 
ay    between    the    twT0    spots    marking    the 
position  of  the  angle    or    the    scapula  when  the 
arm  was  down  by  the  side,  and  when  it  was  ra- 
the head,     This  site  was  sufficiently 
fctr  out  to  avoid  the  lung  and  high  enough  up  to 
escape  the  diaphragm,  while,  at  the  same  time, 
is  sufficiently    low    to    jxrmit    of    the    easy 
escape  of  fluid,  and  also  to  allow  of  subsequent 
Ljige^    should    this    be    found    necessary.     In 
advanced  phthisis  the  removal  of  pus  was  seldom 
indicated  *    except    to    relieve    urgent    dyspneea. 
:  better  success  had  attended  the  operative 
treatment  of  empyema! a  by  resection  of  a  portion 
he   rib,    this   being   a   far   more   satisfactory 
id  of    dealing  with   the   affection   than   the 
rtion  of  a  tube  between  the  ribs.     Flat 
tubes  of  silver,  such  as  those  devised  by 
Turner,  were  often,  however,  of  great  advantage. 
The  use  of  ether  during  all  such  operations  was 
almost  always  contra  indicated. 


ME  OF  THE 

NEWER    ANAESTHETIC 
AGENTS,  (a) 

r  PERCY  •     K1RKPATRICK.  M.D.. 

Ani:s£k*li*t  to  the  Dental  Hospital  of  IrriuxL 

of   the  history  and   literature  of  the 

one  cannot   help  being 

§iruck  with  the  fact  that  many  of  the  great  advances 

been  mad'-  m  the  art  of  the  administration 

of  these  drugs  have  occurred  in  connection  with  their 

;ery-     It  was  a  dental  surgeon,  Mr. 

Wi  cuv,  who  iirst  used  nitrous 

rargical  purposes  in  the  year  1844  ;    it  was 

vaectiou  with  dental  .surgery  that  the  adimms- 

n   of    nitrons   oxide   and   oxygen   was   perfected* 

wind:  ruesthetists  to  recognise 

ajiT-sthetk   effects  a!  nitrons  oxide  as  die- 

trom    tho<  tphyxia,  and,  again,    the 

>i  dental   surgery   have  taught  us   the  use 

tat    valuable    sequence,    nitrous    oxide-    gas  and 

When    we    consider    I  Ls   it    will    not 

I    at  1  the    present    time    the 

D  anaesthetic  research  and  experimental 

5  m  connection  with  the  administi 

lo  title  ol  ny,  of  the 

ana  about   to  consi  be  looked 

,,  new— it   is  ml  r  combination   and 

tseihud   nf    their    use    wmch  merit    that    descripi 


number  of  The  Mr  pic.vi.  Pki;ss  and  Circular,  (a) 
speaks  of  it  as  follows  :  tJ  Meyer,  who  introduced  the 
drug,  and  has  extensively  uned  it.  recommends  that 
■dmiaifl tared  by  an  Ksmarehs  mask,  which  is 
covered  with  a  doubly  folded  piece  of  sterilised  gauze 
and  a  piece  01  oiled  silk,  the  latter  having  an  opening 
of  the  size  of  half  a  crown  in  the  centre.  The  drug 
should  be  given  as  chloroform,  drop  by  ctam. 
patient  quickly  recovers  lrom  its  effects ;  indeed,  he 
has  never  been  deeply  narcotised,  for  his  reflexes  have 
not  been  abolished/'  This  drug  appears  to  somewhat 
resemble  in  composition  what  is  known  as  Schlei 
No.  1  mixture,  and  consists  of  2  ]>arts  if  ethvi  chloride, 
4  j.;in>  of  chloroform,  and  12  parts  ot  sulphuric  ether. 
F.  von  Winckle  (b)  has  contrasted  its  eliects  in 
hundred  cases  with  those  of  pure  ether  ana-sthesia. 
Vomiting  occurred  in  67  per  cent,  of  the  cases  as  con 
tntsted  with  5;  nL  in  ether  cases,  and  in  ten 

cases  untoward  symptoms  occurred  which  made  it 
necessary  to  have  recourse  to  other  means  of  guises* 
thesia. 

—Dr.  T.  Eastman,  of  Bournemouth,  has 
published  a  paper  (e)  on  the  use  of  thisdrugP  which  be 
stales  ti»  lie  a  pure  and  definite  ether  obtained  by  the 
reaction  of  hydrochloric  acid  on  mixed  ethytic 
and  met  hylic  alcohols  distilled  together,  the  vapours 
being  condensed  under  pressure  and  purified.  It  is  a 
pure  Bad  constant  chemical  product,  and  is  not  subject 
to  decomposition  when  exposed  to  li^ht.  Dr.  J 
ni.m  administered  the  drug  by  means  of  a  Lobjois' 
inhaler  in  a  number  ol  cases  with,  as  he  Mys,  very  satis  * 
factory  results  j  he  does  not,  however,  give  us  anv 
figures  ai  to  the  time  it  takis  tG  induce  antes  t' 
or  of  the  time  available  for  operation  alter  induction. 
He  states,  however,  that  the  anaesthesia  can  be  pro- 
longed at  will  by  means  of  a  mouth  OT  nasal  tube,  and 
quotes  the  case  of  a  woman,  tet.  27,  who  inhaled  20  cc 
for  the  extraction  of  eighteen  teeth.  There  were  no 
rellexes,  and  the  aiuesthesia  was  prolonged  for  eight 
minutes  by  means  of  the  metal  tube.  The  patient 
tame  round  three  minutes  after  withdrawing  (heart. es- 
thetic, was  not  sick,  felt  nothing,  and  walked  home 
half  an  hour  after  the  operation.  In  Ins  early  cases 
he  had  several  failures,  but  after  discovering  the 
delect  he  has  not  had  a  single  case  where  anaesthesia 
w:i>  not  extremely  satisfactory.  1  have  used  the  drug 
myself  in  several   cases,   but   with  indifferent   results. 

veral  cases  I   failed  to  get  any  anaesthesia;    in 
others  the  ia  was  only  moderately  good 

in  one  case  the  result  was  excellent.  -This  was  the  case 
of  a  girl,  a*tT  14,  who  was  operated  on  for  tooth  ev- 
traction.  in  whom  anaesthesia  was  induced  in  forty-ri^ 
seconds,  and  who  gave  an  available  operative  anaes- 
thesia of  two  minutes!  and  made  a  good  recovery  with- 
out sickness*  This  leads  ine  to  think  that  my  \Vant  of 
success  in  the  Other  oases  may  have  been  due  to  my 
own  want  of  • xperienee  in  the  use  of  the  drug  rather 
than  any  fault  in  the  drug  itself,  The  regulation  of 
the  air  vaJve  in  the  inhaler  requires  some  experience, 
hope  at  some  luture  date  to  make  a  further  trial 
of  it.  The  Chief  advantage  in  the  drug  would  appear 
to  be  that  it  is  pissible  to  prolong  the  anaesthesia 
by  means  of  the  mouth  tube  during  the  operation ,  but 
must  remember  that  unpleasant  after- 

i   are  much   more   frequent   after  prolonged  ad- 
ministration-. 

Bromide  of  Ethyl   (C..HfiBr)  is  a  drug  which,  though 
lensively  used,  and  of  which  the 
literature  is  voluminous,  I  have  no  practical  experience, 
With  Continental  anaesthetists   it    appears    to   occupy 


ill  not  permit  n  ihug 

-1""*  "J    vrrl-muchih,  ^oiti^o^de^asdoee^ 

them,    I  }  i . . I z . 

in  the  um  i  mam  Frb»  akii  Ctae*  lah,  October  «btb,  1903,  f 

paper  wmkM,  Or.  liejei  Tun  Mni 

I    have  no  experience;     it     tt>«  drttn  almoai   exclualv^y  in  opeiatiowt  requiring  g« 
1  ol  ethvl  chloride 


ita  Brandt  ot  the  Bhtwh  Lteuial 


,  January  UK  1003,  CI. 
horn*  pure  54, 
April  ihth,  1 


><L  Jour» 


5$    Thb  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


Jan.  20,  1904. 


this  country.  It  is  used  very  largely  for  dental  opera- 
tions, and  as  a  preliminary  to  ether.  In  Professor 
Kocher's  clinic  at  Berne  it  is  almost  constantly  used 
for  the  latter  purpose,  and  with,  I  am  told,  excellent 
results.  In  this  connection,  Professor  Kocher,  writing 
to  Dr.  William  Huggard  (a)  under  the  date  of  May  13th, 
1903,  says :  "  Nearly  always  I  give  bromethyl  first 
and  ether  afterwards.  I  am  very  satisfied  with  the 
rapid  anaesthesia  I  get  from  it ;  I  have  never  had  any 
death,  nor  even  disagreeable  symptoms.  We  give 
from  15  to  30  grammes  at  the  time  (tor  one  dose). 
Only  with  very  weak  and  anaemic  people  I  prefer  giving 
ether  fr«m  the  beginning."  Dr.  A.  Brown  Kelly,  (b) 
in  the  British  Medical  Journal,  states  that  after  an 
administration  of  from  fifty  to  eighty  seconds  one 
can,  as  a  rule,  reckon  on  one  to  two  minutes  insen- 
sibility in  patients  under  four  years  of  age,  and  some- 
what less  in  those  older.  With  respect  to  after-sick- 
ness, the  statistics  of  different  observers  differ  very 
considerably,  as  much  as  from  1  in  400  to  66  per  cent. 
Muscular  relaxation  is  often  not  complete,  and  a  gag 
must  be  inserted  before  the  administration  in  cases 
of  mouth  operation.  A  considerable  number  of  deaths 
have  been  recorded  irom  the  use  of  this  drug,  but  it  is 
stated  that,  if  a  pure  drug  is  used  and  proper  precau- 
tions taken,  in  short  administrations  it  is  practically 
safe.  The  drug  is  peculiarly  liable  to  undergo  decom- 
position when  exposed  to  light  or  air.  Mr.  J.  P.  Gil- 
mour,  in  the  Pharmaceutical Journal,  {c)  says:  "  During 
the  past  three  years  I  have  examined  fifty  specimens 
of  bromide  of  ethyl  (bromethane)  for  Dr.  A.  B.  Kelly, 
with  the  following  results  :  Thirty  samples  (60  per  cent.) 
were  utterly  unfit  for  anaesthetic  purposes  owing  to 
the  presence  of  impurities,  due  either  to  contamination 
during  the  process  of  manufacture,  or  to  decomposition 
by  reason  of  age,  presence  of  moisture,  or  exposure  to 
light."  Dr.  Kelly,  however,  states  that  now  Messrs. 
Duncan  and  Flockhart  are  able  to  supply  an  abso- 
lutely pure  preparation.  As  I  stated  before,  I  have 
had  no  personal  experience  of  the  use  of  this  drug, 
but  am  inclined  to  think  that  in  view  of  the  facts  I 
have  mentioned  it  is  not  likely  to  replace  the  use  of 
nitrous  oxide  in  this  country. 

Chloride  of  Ethyl  (C2H8C1)  is  a  colourless  mobile 
liquid  which  boils  at  a  temperature  of  1250  C.  The 
late  Sir  Benjamin  Richardson  (i)  in  1867  experimented 
on  a  rabbit  and  a  pigeon  with  it,  but  its  use,  until  quite 
recently,  must  have  been  very  restricted.  Rotten- 
stein,  (e)  in  his  work  on  anaesthetics,  merely  refers  to  it 
as  a  local  anaesthetic ;  Hankel.  (/)  in  his  handbook  on 
inhalation  anaesthesia,  does  not  refer  to  it  at  all ;  and 
Dastre  (g)  refers  to  it  in  the  following  terms:  "The 
ether  chlorhydrique,  or  the  chloride  of  ethyl,  C2H5C1, 
has  been  tried  several  times  by  Flourens,  Tracy,  Babri, 
Harless  and  Heyfelder.  It  boils  at  n°C.  ;  at  150  C. 
it  is  a  colourless  gas.  It  is  without  interest."  Buxton, 
Underwood  and  Probyn-Williams,  in  the  latest  edition 
of  their  text-books,  where  they  refer  to  it  at  all,  do  so 
as  a  locaranaesthetic  only.  Hewitt  (h)  devotes  a  page 
only  in  his  book  to  it,  quoting  mainly  from  the  papers  of 
McCardie.  I  mention  these  facts  to  show  you  how 
recent  is  the  introduction  of  this  drug  into  the  general 
practice  of  anaesthetists.  Though  this  is  so,  we  have 
no  reason  to  complain  of  its  neglect  at  the  present 
time,  for  during  the  last  two  years  quite  a  number  of 
papers  have  been  published  dealing  with  its  properties 
and  uses.  Foremost  among  English  writers  we  must 
place  McCardie,  of  Birmingham. 

Owing  to  its  extreme  volatility,  the  drug  is  very 
rapidly  absorbed  and  eliminated  from  the  system, 
and  this  rapidity  of  elimination  is  a  factor  of  con- 
siderable importance  in  its  safety  as  a  general  anes- 
thetic.    In  deep  narcosis  the  pulse  appears  to  become 


(a)  Lanctt.  September  12th,  1903,  page  744. 

(b)  Brit.  Med.  Journ.,  August  30th.  1902. 

(c)  Pharm  Jour*.,  June  7th,  1902.  page  490. 

(d)  Med.  Times  and  liaz.,  December,  1867,  page  693. 
ie)  "  Traite  <V Anesthesie  Chirurgicale.''    Pans,  1880. 

r  n  ••  Handboch  der  Intaalatiooi-Anasthetiea.      Leipzig,  1898. 

(g)  "  Les  Anesthesiquea  Phyaiologie  et  Applications  Chirurgieales.' 

(A)M  Anaesthetics  and  their  Administration."  London,  1901. 


somewhat  slower  than  normal,  but  remains  quite 
regular.  The  respiratory  movements  are  increased  in 
both  frequency  and  depth,  and  the  colour  improved 
as  a  result  of  this  and  of  an  accompanying  vaso- 
dilatation. Authorities  differ  as  to  the  effects  on  the 
heart,  but  the  weight  of  evidence  appears  to  show 
that  there  is  not,  at  all  events,  any  marked  circulatory 
depression.  According  to  Seitz  (a)  the  death-rate  is 
i  in  16,000  administrations,  as  contrasted  with  i  in 
8,000  cases  of  ethyl  bromide  ;  he  places  it  as  the  safest 
anaesthetic  next  to  nitrous  oxide.  Since  its  reintro- 
duction,  very  many  forms  of  apparatus  have  been  de- 
vised for  its  administration,  but  an  ordinary  Ormsby 
inhaler  is  perhaps  as  suitable  as  any.  Luke's  inhaler  is 
perhaps  the  most  simple,  consisting  as  it  does  of  an 
ordinary  face-piece  with  bag  and  angle-mount  attached, 
similar  to  that  of  the  Clover,  with' the  exception  that 
the  angle-mount  is  pierced  by  a  hole  to  enable  one  to 
introduce  the  drug  into  the  bag  while  the  mask  is  in 
position,  the  hole  being  afterwards  stopped  by  a  box- 
wood plug.  Whatever  apparatus  is  used,  total  ex- 
clusion of  air  during  the  administration  should  be 
aimed  at,  for  there  is  sufficient  oxygen  in  the  air  in  the 
bag  and  the  lungs  to  prevent  cyanosis  before  anaes- 
thesia is  obtained.  Concerning  the  use  of  chloride  of 
ethyl  in  dental  cases,  McCardie  (6)  gives  the  following 
figures  : — Single  dose  from  3  to  8  c.c,  Ormsby 's  in- 
haler, seventy-seven  cases.  Average  duration  of 
induction,  50*9  seconds  ;  average  duration  of  anaes- 
thesia, 71*3  seconds.  Longest  case  of  induction,  2\ 
minutes ;  longest  case  of  anaesthesia,  z\  minutes. 
Shortest  case  of  induction,  20  seconds  ;  shortest  case 
of  anaesthesia,  3  seconds. 

Vomiting  is  stated  to  occur  more  frequently  than 
after  nitrous  oxide,  but  it  is  not  persistent,  and 
headache  is  frequent.  McCardie  sums  up  the 
position  as  follows  :  "In  regard  to  ethyl  chloride  in 
dental  work  it  is  not  to  be  preferred  to  nitrous  oxide 
for  routine  use.  It  is  of  advantage  in  cases  where  the 
prolonged  methods  of  administration  are  not  available. 
By  giving  a  full  dose  of  the  drug  one  can  always  be  sure 
of  one  and  a  half  minutes'  anesthesia.  By  reason  of  the 
portability  of  the  apparatus  and  the  quickness  of  the 
phases  of  narcosis,  ethyl  chloride,  when  administered 
from  an  Ormsby  inhaler,  is  an  ideal  anesthetic  for 
short  operations  in  country  practice."  In  the  case 
of  children  the  drug  is  likely  to  be  oi  very  great  value  ; 
all  observers  appear  to  agree  that  they  are  particularly 
suitable  subjects  for  its  administration.  The  chiet 
drawback  at  present  to  its  use  is  the  after-sickness, 
and  it  is  on  this  point  that  we  require  further  infor- 
mation, which  can  only  be  derived  from  patient  and 
close  observation  of  a*  number  of  cases.  It  mav  be 
that  such  observation  will  lead  to  the  discovery  of  the 
cause  of  this  phenomenon  and  the  means  of  avoiding  it, 
and  if  it  does  so,  I  believe  that  chloride  of  ethyl  will  in 
the  future  take  a  very  high  place  among  our  general 
anaesthetics. 

Quite  recently  Hewitt  has  introduced  a  method  of 
giving  chloride  of  ethyl  and  nitrous  oxide  gas  mixed, 
which  promises  to  give  very  gdod  results.  I  think  the 
best  way  that  I  can  describe  this  method  to  you  is  to 
quote  the  words  of  Dr.  Hewitt,  in  which  he  described 
it  at  the  annual  meeting  of  the  British  Dental  Asso- 
ciation last  June.  Hewitt  (c)  says  :•-—"  In  order  that 
this  method  may  be  thoroughly  understood,  it  is 
necessary  to  recapitulate  certain  facts  concerning 
nitrous  oxide,  to  which  I  drew  attention  many  years 
ago.  If  a  full  two-gallon  bag  of  the  pure  gas  be  taken, 
if  an  accurately-fitting  face-piece  and  efficient  valves 
be  used,  if  two  or  three  expirations  be  allowed  to 
escape  through  these  valves,  and  if  the  valves  be  then 
thrown  out  of  action  and  the  remaining  quantity  ol 
nitrous  oxide  be  breathed  backwards  and  forwards, 
anaesthesia  with  a  minor  degree  of  asphyxia  will 
ensue  with  a  rapidity  varying  with  the  type  of  subject. 
!  Thus,  while  this  particular  method  01  an«xsthetisiu,u 
!  by  nitrous  oxide  would  in  the  case  of  a  tall,  powerfully 


(a)  Jjancft,  April,  1903,  page  953. 
C6)  lAncet,  April,  1903,  page  954. 
(<•)  lirit.  Dent,  Journ.,  September,  1908,  page  615. 


Jajt,  3Q»  I9°4. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press.    59 


I 


built  man  take  about  a  minute  and  a  half  to  produce 

anasthesM,  and  whilst  the  anaesthesia  would  be  un- 

r  imticeable  asphyxial  symptoms,  the  same 

■aid,  in  the  case  of  an  anaemic  young  woman 

itatuie,  indi  il  hesia  in  about  forty -five 

seconds,  and    the  anaesthesia  would   be  accompanied 

stertor,   epileptiform   spasm,   or   both 

Now,    supposing    we    wish    to 

iice  a  similar  anaesthetic  effect  in  each  case,  and 

(dure,  so  far  as  the  escape  of 

mo  or  three   expirations   is   concerned,    remains   the 

wc  shall   find    that   our  object   may  be  readily 

-ulatiiig  the  quantity  of  nitrous  oxide 

present  in  the  bag,  a  full  bag  being  required 

thoric  or  .:id  two-th 

i;iK,  or  even    one- third  of  a  bag  being  advisable 

vsieal  scale  to  the  feebly  nourished 

an.Tniu  t. htld,  ' 

ire    the    considerations    winch    underlie    the 

hw.l  we  are   about   to  discuss,  which  aims  at  pro- 

ig  a  partial  anaesthesia   with  a  Limited  quantity 

nitrous  oxide,  eliminating  all  asphyxial  symptoms, 

Iding  ethyl  chloride  that   the    partial 

thesis  is  replaced  by  the  deep  anesthesia  of  the 

latter  drug,     In    order    to   effect    this    the    following 

clime   is   adopted.     An    ordinary  two-gallon   gas- 

!  tilled  aboul    Ihrec-quarters  lull  for  the  average 

i!     and    then    detached    from    the    gas    bottles; 

a  itnall  glass  tube  charged  with  from  3   10  5  c,c+  «i 

3f  of  ethyl   is   now  fixed   by  a  piece  of  rubber 

tllbtag  to  the  stop-cock  at   the  bottom  of  the    gas-bag. 

The   i  j^  accurately  adjusted  to  the  patient, 

1  permitted  to  inspire  gas  and  expire  through 

r  three  breaths*     The 

then  thrown  out  of  actum  and    the  patient  permitted 

to  rebreathe   the    gas.     In  about  twenty  seconds   the 

stap-f  '  iwd  and  the  chloride  or    ethyl  Intro- 

;  into   the  bag.      The   patient   now   breathes   the 

vapour  ol  chloride  ol  ethyl  mixed  with  nitrous  oxide 

uesthesia  is  complete.     The  time  which  it  takes 

Bo  mduee  ttiii  anesthesia  varies,  but  it  is  stai 

shorter   than  that   which  would  be  necessary   to 

im'ar  state  of    anaesthesia  by  either   agent 

separately.     Hewitt  has  given  us  no  record  of  actual 

so  I  am  not   able  to  contrast   it  wih  the  figures 

given  you  for  somnoform  and  chloride 

□  administrations  some  days  ago 

If  the  following  hgures: — 

rage     time    of    administrate!  seconds ;  | 

e  of  anaesthesia,  66*3  sen 
Ten  of   these   case   were   boys  of    the    average  aga 
1  his  is  not  at  ail  as  good  as  McCan 
t  with  chloride  of  ethyl,   lint  it   must  be  remem- 
that    they    were   my   first   cases,    and    my  first 
nem  -.bod.  and    1  have  no   doubt   very 

.ureal  1y  improve  my  results,     The 
KceUent  ;  there 
>  cyanosis  or  jactitation,  and  rarely  any  phonation, 
Miarkable   fact  in  view  of  the  number  of  young  ' 
buys  in  the  1  he  absence  of  cyanosis 

ition,    Nvith    their    accompanying    swelling, 
lity  of  the  parts  about  the  mouth, 
dm   importance  to  the  operator, 
is  thus  given  every  facility  U  -  imputations 

me  of  my  patients  appeared   to 
nee     the    slightest    difficulty    in      taking      the  { 
Ifi&thetic,  and  in  no  case  was  there  .  Jing 

ine  administration,  though  1  must  admit 
none  of  the  so- caller)  bad  subjects  in  the 
a  rule   the  recover;  t,  though 

imple  1  Mtrous  oxide 
t  he  pa  tie  11 1  s    were,     however,    a  b  I 
walk  into  the  recovery  room  within  two  or  three  minutes  \ 
termination   of  the  operation.      Fhrce  patients 
ittle    time    alter     recovery,    but     this 
tig  \*a*  not  attended  with  any  distressing    svm-  ( 
prostration.     On  the  whole,  "the 
good  as  that 
thesia.      \t   present 
■  ak  with  any  th 


as  to  the  question  of  the  safety  of  the  method,  but 
this  much  I  can  say.  that  in  none  of  my  cases  did  I 
see  any  symptom  which  gave  rise  to  the  least  alarm, 
and  Hewitt  has  had  the  same  experience  with  his 
cases.  The  method  has  the  advantage  of  bein^ 
to  carry  out,  the  apparatus  simple  and  inexpensive, 
and  the  drug  not  costly.  The  signs  of  anaesthesia  which 
1  found  most  trustworthy  were  a  slightly  snoring  re- 
spiration, fixity  of  the  eyeballs,  marked  diminution  if 
not  complete  loss  of  the  conjunctival  and  corneal 
reflexes,  and  general  flaccidityof  the  voluntary  muscles. 

I  do  not  know  of  any  previous  record  of  the  com- 
n  of  these  drugs,  but  ethyl  bichloride,  or  ethylene 
dichlonde,  as  it  was  called,  was  used  by  both  Clover 
(a)  and  McLeod  (h)  as  far  back  as  18  Mo.  Clover 
records  quite  a  number  of  cases  in  which  he  used  it 
■"(  both  major  and  minor  operations, 

I  have  endeavoured  to  give  vou  a  brief  description 
of  the  use  of  sonie  of  the  newer  methods  of  inducing 
ana-sthesia  for  dental  purposes,  relying  chiefly  on  my 
own  experience  where  that  was  available,  and  supple- 
mentiug  it  by  that  of  others  wrhere  my  own  was  de- 
ficient, I  have  coiitiiied  my  remarks  to  those  methods 
which  for  their  own  use  do  not  necessarily  demand  the 
assistance  of  a  skilled  anaesthetist  in  addition  to  the 
Operator,  as  I  considered  that  these  methods  would  be 
01  more  interest  to  the  majority  ot  my  hearers*  I 
firmly  bebeve,  as  indeed  my  position  would  enforce 
tue  to,  that  the  best  results  in  Operations  under  ana *- 
Cfiri  only  be  attained  when  the  operator  can 
give  his  undivided  attention  to  the  operation,  and  the 
!  care  of  the  anaesthesia  is  entrusted  to  a  skilled  anaes- 
thetist, but  I  also  quite  recognise  that  tlie  exigencies 
of  practice  often  render  this  desirable  ideal  unattain- 
able* In  n  very  large  majority  of  dental  operations 
I  believe  that  the  nasal  method  of  administering 
nitrous  oxide  gives  us  the  very  best  results  for  both 
patient  and  operator,  whether  the  operation  be  long 
or  short,  but  this  method  necessitates  the  assistance 
of  an  a.na."Sthetist,  and  one,  too*  who  has  had  con- 
siderable practice  in  its  use,  if  good  results  are  to  be 
attained,  and  consequently  I  have  not  touched  on  it 
in  this  paper, 

Death  Under  Ether. 

At  Shelley  on  the  1  jth  inst.,  an  inquest  was  conducted 
by  the  Coroner  on  the  body  of  a  single  woman,  of  Town 
End,  Shelley,  near  Hudderstk-kL  The  evidence  showed 
that  the  woman  had  undergone  an  operation  six  months 
ago  for  tumour  of  the  breast,  She  consented  to  another 
operation,  and  in  both  instances  ether  was  administered. 
There  were  no  signs  of  fainting  at  the  first  operation, 
and  on  Monday  it  took  about  ten  minutes  to  get  her 
under  the  influence  of  the  ether,  which  was  administered 
by  Dr.  Smith,  of  Middles  low  11.  while  the  operation  was 
performed  by  Dr.  Nesfield,  of  Shelley,  The  latter 
stated  that  his  attention  was  drawn  to  the  woman's 
condition  as  be  was  about  bo  stitch  the  wound  up. 
Artificial  respiration  was  resorted  to,  fcjnt  without 
avail.  The  cause  of  death  was  sudden  failure  of  the 
.  .n  which,  is  his  opinion,  was  due  to  the 
ether.  returned  a  verdict  of  "  Misadventure," 

French  Congress  of  CUmatotherapy  and  Hygiene  of  Town*, 

The  first  i  ongreso  will  be  held  at  Nice,  during  the 
Faster  vacation,  from  April  4th  to  9th,  Professor 
Chan  tern  esse  has  been  named  President  ;  the  Vice- 
tents  are,  Professor  Renaut,  Lyon;  Professor 
Grass*  t,  MootpeJtter ;  Professor  Calmette,  UUe;  Dr. 
Balestre,  Nice.  The  discussions  will  bear  on  five 
questions: — (i)  the  climate  of  the  French  Me- 
ranean  coasl  (2)  adaptation  of  the  individual  to 
climate;  (3)  influence  of  the  French  Mediterranean 
coast  climate  on  tuberculosis  and  tuberculous  patients  . 
1  ■  Ii!i  >  and  critical  discussion  on  the  special 
ions  required  in  order  to  benefit  by  this  influence  ; 
(a)  treatment  of  such  patients  at  their  homes  .  (c) 
treatment  of  such  patients  under  supervision,  sanatoria 
for  patients  in  easy  circumstances  ;  establishments  for 

(0)  Lecture  an  Etfalrlett  BHh  M'tt.  Journ.t  Maj,  |£SQ> 

!**.'#  797. 
i,'.)  1    ►mi,iri[U  on  AnirrtheUe,  HriL  At  ft.  /MJr*»j  May,  Ifctffl,  jnga  380. 


6o     The  Medical  Press.  OUT-PATIENT  DEPARTMENTS. 


Jan.  20,  1904. 


the  treatment  of  poor  patients  suffering  from  scrofula 
or  pulmonary  tuberculosis  ;  (4)  the  influence  of  climate 
on  the  French  Mediterranean  coast  on  rheumatism, 
and  on  those  subject  to  rheumatism  ;  (5)  disinfection 
of  towns.  Great  travelling  facilities  in  France  and 
abroad  will  be  granted  to  members  of  the  Congress 
and  their  families.  The  hotel  prices  at  Nice  will  be 
reduced  in  their  favour  and  may  be  ascertained 
beforehand.  Full  particulars  will  be  furnished  on 
application  to  Dr.  Herard  de  Besse,  Secretary-General 
of  the  Congress,  Beaulieu-sur-Mer.  The  members  of 
the  executive  committee  for  England  are  :  Dr.  G.  H. 
Brandt,  Nice ;  Dr.  Johnston  Lavis,  Beaulieu ;  Dr. 
MacDougall,  Cannes  ;  Dr.  Price  Mitchell,  Monte  Carlo  ; 
Dr.  Stanley  Rendall,  Mentone. 

XTbc  ©inpatient  Dcpartm  ents 

LEICESTER  INFIRMARY. 
•   Case  of  Pulmonary  Osteo- Arthropathy. 
By  Robert  Sevkstre,  M.D., 
Assistant  Physician,  Leicester  Infirmary. 

The  patient,  Joseph  C,  at.  19,  at  work  in  the  shoe 
trade,  presented  himself  in  the  Out-patient  Department, 
and  was  admitted  into  the  Leicester  Infirmary  in  May, 
1903.  When  a  child  of  seven  he  had  the  measles, 
which  was  complicated  by  a  severe  attack  of  bronchitis  ; 
since  then  he  has  had  a  cough,  which  in  the  summer 
gives  him  no  trouble,  but  in  the  winter  is  always  severe. 
Four  years  ago  he  states  that  he  had  pleurisy  on  the 
left  side  of  his  chest,  and  about  the  same  time  he 
expectorated  some  blood.  At  different  times  since 
then  there  has  been  haemoptysis,  but  not  in  any  large 
quantity.  During  the  last  two  years  the  character 
of  the  cough  has  changed,  coining  on  in  paroxysms, 
especially  after  meals,  and  accompanied  with  the  ex- 
pectoration ot  a  thin,  green  fluid  of  an  unpleasant 
smell — at  times  amounting  to  half  a  cupful.  In  the 
autumn  of  1901  he  dislocated  the  left  patella  ;  the 
joint  became  swollen,  and  never  resumed  its  natural 
size.  In  August,  1902,  he  noticed  a  little  stiffness  and 
swelling  about  the  right  knee-joint,  and  in  the  following 
October  he  was  laid  up  in  bed  for  about  one  week  with 
What  he  calls  an  attack  of  rheumatism.  His  limbs 
ached  and  he  felt  feverish,  aad  the  wrist-joints  and  some 
of  the  phalangeal  joints  of  the  fingers  became  stiff 
and  swollen,  but  there  was  very  little  pain.  During 
the  next  few  months  his  general  condition  improved, 
but  the  condition  of  the  affected  joints  and  the  cough, 
with  its  expectoration,  did  not  materially  alter.  His 
past  history  had  been  uneventful,  and  he  denies  lues. 
Other  members  of  the  family  are  healthy. 

When  admitted  into  the  Infirmary  he  presented 
the  appearance  of  a  tall,  spare  youth,  having  a  pale  but 
healthy  colour.  The  tongue  was  clean.  The  wrist- 
joints  and  the  first  phalangeal  joints  of  the  fingers  were 
swollen  and  stiff,  so  that  the  hand  could  not  be  tightly 
closed.  Both  knee-joints  contained  fluid,  the  left 
more  than-the  right.  There  was  no  pain,  and  the  skin 
over  the  affected  joints  presented  nothing  unusual. 

The  ends  oi  the  fingers  and  toes  were  clubbed  and  a 
little  congested  in  appearance,  and  he  says  he  does 
not  remember  the  time  when  his  fingers  were  different 
from  the  thickened  and  rounded  condition  in  which 
they  are  at  present.  Cough  comes  on  in  paroxysms, 
usually  in  the  morning  and  after  meals,  with  expectora- 
tion of  a  faint  mortar-like  smell,  greenish-yellow  in 
colour,  not  very  tenacious,  and  devoid  of  air  ;  in  quan- 
tity about  three  ounces  a  day.  On  examining  the 
sputum  no  tubercle  bacilli  were  found. 

On  inspection  of  the  thorax  it  was  seen  that  the  left 
side  was  contracted  and  flattened,  with  diminished 
movement  on  respiration,  and  that  the  spine  showed 
a  lateral  curve  to  the  right  in  the  lower  dorsal  region. 
The  vocal  vibrations  on  the  right  side  were  felt  nor- 
mally ;  on  the  left  they  were  diminished  in  the  upper 
part  of  the  chest,  and  in  the  lower  part  of  the  lateral 
region  and  at  the  base  were  barely  perceptible.  The 
percussion  note  was  hyperresonant  on  the  right  side, 
much  diminished  on  the  left,  and  below  the  level  ot 
the  angle  oi  the  scapula  it  was  dull.     The  breath  sounds 


on  the  right  side  were  exaggerated  with  a  few  r&les  at 
the  base  ;  on  the  left  side  in  the  upper  part  they  were 
diminished  and  moist  rdles  were  added  ;  over  the  dull 
area  they  were  feeble,  and  just  below  the  angle  of  the 
left  scapula  bronchial  in  character.  The  physical  signs, 
however,  on  the  left  side  of  the  chest  varied  from 
time  to  time,  the  variation  being  dependent,  probably, 
upon  the  amount  of  secretion  present  in  the  bronchial 
tubes.  For  instance,  at  one  examination  along  the 
lower  part  of  the  inner  border  of  the  left  scapula, 
cavernous  breathing  with  consonating  r&Us  and  pec- 
toriloquy were  audible.  The  apex  beat  of  the  heart 
was  situated  in  the  sixth  left  interspace  in  the  anterior 
axillary  line.  The  sounds  of .  the  heart  at  the  apex 
were  regular  and'  clear ;  in  the  pulmonary  area  a 
faint,  rough  ending  was  heard  to  first  sound,  which  was 
most  marked  on  expiration.  The  pulse-rate  was 
seventy-eight,  regular  and  of  good  volume.  Nothing 
abnormal  was  found  on  examining  the  abdomen. 
The  urine  contained  no  albumin  or  sugar.  The 
patient  was  placed  on  a  full  diet  with  cod-liver  oil  and 
malt.  He  was  allowed  to  be  in  the  grounds  of  the 
Infirmary  as  much  as  possible. 


After ,  the  first  week  of  his  stay  in  the  Infirmary 
he  had  creosote  vapour  baths  given  every  other  day, 
the  quantity  of  the  vapour  and  the  duration  of  his  stay 
in  it  being  gradually  increased.  Under  this  treatment 
he  improved  considerably ;  the  temperature,  which 
was  slightly  raised  on  admission,  fell  very  soon  to 
normal ;  the  swelling  and  stiffness  gradually  disappeared 
from  the  wrists  and  fingers,  and  the  fluid  from  the  knee- 
joints  almost  disappeared,  a  little  remaining  in  the  left  ; 
the  expectoration  lost  its  offensive  character,  but  the 
quantity  did  not  diminish  to  any  great  extent,  re- 
maining about  \\  oz.  daily.  The  gain  in  weight  was 
3  lb.  The  physical  signs  in  the  chest,  however,  did 
not  materially  alter.  Since  his  discharge  in  July, 
1903,  his  condition  has  remained  much  the  same. 
The  expectoration,  he  says,  amounts  to  about  2  oz. 
daily,  and  he  gets  it  up  in  about  five  minutes  when  it 
bothers  him  most  ;  at  times  it  is  slightly  offensive, 
and  is  occasionally  streaked  with  blood.  The  joints 
have  given  him  no  further  trouble. 

Remarks. — The  physical  condition  of  the  lungs  calls 
for  no  special  comment ;  the  signs  indicated  that  there 
was  a  condition  of  bronchiectasis  in  the  lower  lobe  of  the 
left  lun^.  It  is  difficult  to  say  what  part  the  creosote 
vapour  baths  played  in  the  amelioration  of  the  patient's 
symptoms.     During  the  inhalation  of  the  vapour  the 


J  AS,   3Q»    1904 


TRANSACTIONS  OF  SOCIETIES. 


Thk  Medicai.  Press.    01 


greater  portion  of  the  daily  quantity  of  the  expectora- 
M$M  brought   up  1     the   quantity   itself   was   not 
materially  altered,   but   the   unpleasant  smell  disap- 
peared.    It   seems   probable    that    this   alteration    in 
character  bore  some  relation  to  the  great  improvement 
th&i  look  place  in   the  affected  joints.     The  improve- 
ment itx  his  appetite  may  have  been  partly  due  to  the 
of  the  creosote,  and  partly  to  the  fact  that  he  was 
1  doors  the  greater  part  of  the  day.      Whether 
lass  of  case,   in  which  joints  become  affected  in 
d«sse  of  the  chest,  disease  which  is  always  chronic 
ippnrative,   merits  a  description  as  a 
ijiitjiKt  clinical  entity  is  very  much  to  be  doubted.      It 
re  probable  that  the  condition  of  the  joints 
a  a  complication  dependent  on   some   infective  eon- 
«NtJon  within  the  chest  ;   that  it  is  an  infective  arthritis 
liable  to  that  met  with  in  other  morbid  states. 

Special  Hrtlclcs, 

BRITISH  I  >RIA    FOR    CONSUMPTION.— 


[bv  our  special  medical  commissioner.] 

I  ELD  PARK  SANATORIUM,  POKES- 
DOWN  ,  BOU RN EMOUTH  ■ 

Park    has    had    a    somewhat    varied 

an  old  one,   but  the  present 

parently     the    work    of 

Ms  evidence  that  it  was 

to    serve    as    an    attractive    and 

tial    hotel,     Before    completion    as 

have  undergone  a  metatnorph 

ritun*     In  1809  ibe  establish- 

control  of  Dr.  Denton  Johns,  who 

1  nnsequenceot  ibli  th  the  lay 

succeeded  by  Dr,  Davi<l  Thomson. 

-'.mii  i>   11.. v.,  we  understand,    in  some  way 

\    Sanatorium,  near  Walling- 

the  senior  resident  physician* 

II.     M.     Bullock,    as    junior 

physician  and     bacteriologist,     while     Dr. 

the    visiting    physician,    and 

vler  lor  rhe  general 

ark  Sanatoriun 

situated  at  Pokesdown,  some  three 

m    either    Central    Bournemouth  or  Christ  - 

[1   is  on  a  slight  eminence  overlooking  the 

tid  is  some  fioo  yards  from  thi 

rid  and  Hint  gravel. 

re  about   u  1  ground  studded  with 

beech,    chestnut  and  oak.     The  lawns 

we  pa  ve  and    the   shrubberies  and 

Uavc  been  conveniently  arranged* 

1  lately,  however,  the  establishment  is  being 
rapidly  surrounded  by  new    buddings,  and  the  adjacent 
piiie-itudded  country  is  now  succumbing  to  the  destruc- 
tive irresistible  builder. 
The  Inn  ch  is  of  modern  appearance 

in  many  ways  well  adapted  tt> 

'..  although   tar  removed    from*  the 

simplicii  vacated    by    Dr. 

1 1,    anil    tO    a    great    measure    exemplified    at 

jdding  faces  south  by  south-west.     The  venti- 
lation anil   sanitation  and   general  construction  have 
bittl  wisely   arranged.      The   rooms   are  of  good   size, 
ovided    with    much    window   space. 
There  are   open  In   not  a  few  cases  the 

bedrooms  open  on  to  a  verandah  or  balcony. 

rs  are  fine  and  stylishly  decorated  and 
are   well    ventilated  and  are 
ta  Armed  by  hot -water  pipes. 

There  are  three  storeys,  the  ground-floor  with 
admim&trattve  quarters,  reception  and  dining-rooms, 
the  upper  floors  reserved  fur  patients,  while  the  attics 
ire  used  by  servants.     There  is  an  electric  lift. 

a  inn  is  assisted  by  electric  fan  extractors. 
There  is  a  good  supply  of  baths.  The  sanitary  require- 
ments appear  to  be  "excellent.     The  whole  establish- 


ment is  lit  by  electricity.     Heating  is  provided  for  both 
bv  open  grates  and  hot-water  pipes. 

'The  sanatorium  possesses  its  own  laundry,  disin fee- 
tor,  and  electro-therapeutical  equipment. 

Accommodation  is  provided  for  forty-five  patients. 
We  had  the  privilege  of  dining  with  the  patients  and 
observing  something  of  the  general  routine  of  manage- 
ment. . 

Treatment  is  conducted  on  the  now  generally  estab- 
lished hygienic  lines.     Dr.  Frank  Fowler,  who  has  him- 
self  undergone   treatment   at    Hailey,    resides  in  the 
sanatorium    with    his   Wife    and    exercises   a   constant 
i\  supervision. 

In  the  grounds  are  seventeen  admirably  designed 
and  attractive-looking  kiosks  or  chile  ts,  each  simply 
furnished  with  couch  and  table,  and  ntted  with 
elect nc  light.  Here  the  patients  arc  supposed  to  spend 
thfiif  time  when  not  at  meals  or  taking  exercise.  These 
shelters  are  well  placed  and  so  constructed  as  to  allow 
Oi  exposure  to  air  and  sunlight,  and  yet  secure  pro- 
tection from  winds. 

The  fees  are  from  lour  to  five  guineas  a  week. 
ling  lo  accommodation,  and  are  inclusive  of 
medical  attendance  and  ordinary  nursing.  There  are 
a  few  rooms  at  three  guineas.  Patients  whose 
condition  renders  it  necessary  to  have  their  meals 
served  in  their  rooms  are  charged  one  mnuea  a  week 
rixtra.  and  caftCS  moiling  a  special  nurse  must  pay  ner 
fees  and  board,  UCOhd  is  only  allowed  when  e*] 
ally  prescribed,  and  must  be  paid  for  by  the  patient. 

the  sanatorium  is  within  three  mil'  r  Bourae- 

itral  or  Christchurch   stations,    at    each  of 

which  cabs  meet  all  trains.     Boscombe  and  Pokeedown 

rather  nearer,  but  fast  trams  do  not  usually 

stop  at  these. 

The  lelefcrahic  address  is  "  Sanatorium,  Pokesdown. 
and  the  telepln  ;  'ourcemouth. 

transactions  of  Societies. 

Ri  >Y AL  ACADEMY  OF  MEDICINU    IN  IRELAND, 
(Section  of  Obstetrics-) 


Dr.  A.  J.  Smith.  President,  in  the  Chair. 

The  Section  met  in  the  Royal  College  of  Physicians 
on  January  Hth,  1904- 
hr    PUXXFOY  read  the  report  id    the  Rotunda  Hos- 
pital for  the  year  [902-03, 

Sir  Arthur  Macau  proposed,  and  Dr.  W,  J.  SMYLV 
seconded  .that  the  discussion  of  the  report  be  poal  p 
until  the  next  meeting  of  the  Section.     The  resolution 
wmA  unanimously  carried. 
The  following  specimens  were  ftfco  shown  :• — 
Dr.  Purefoy. — Fibroid  uterus  removed  by  supra- 
vaginal amputation. 

Dr.    Tweed  v.— (t|  Diseased   tubes  with  enlarged 

Ovary,   removed    by   bisection   of   uterus   and    vagina! 

hysterectomy.     (2)'  Cystic  implantation    tumour    re* 

I   from'  abdominal  scar,   the  result  of  a  tormer 

ovariotomy, 

THERAPEUTICAL  SOCIETY. 


Meeting  held  December  2-nd,  1903- 


Dr.  Dixon  described  the  action  ot  drugs  upon  the 
pulmonary  vessels.  The  experiments  were  undertaken 
conjointly  with  Professor  Brodie,  and  consisted  in  the 
artificial  perfusion  of  the  lungs  outside  the  body.  He 
hrst  showed  that  these  vessels  have  no  nerve  supply,  and 
hence  drugs  which  produce  vasoconstriction  on  ordinary 
systemic  vessels  have  no  effect  on  those  of  the  lungs. 
The  action  of  drugs  on  these  vessseis  was  divided  into 
three  groups.  Group  t,  represented  by  pilocarpine, 
adrenalin,  physostigmine  and  digitalis,  all  of  which  act 
Ml  peripheral  nerve  endings  and  therefore,  whilst 
producing  marked  constriction  of  systemic  vessels, 
have  no  action  on  the  pulmonary.  Group  2,  drugs 
acting  directly  on  muscle,  such  as  barium,  calcium, 
veratrin,    &c.~    These     produce     constriction    of    all 


62     The  Medical  Press. 


GERMANY. 


Jan.  20,  1904. 


-vessels  throughout  the  body,  including  those  of  the 
lungs.  Group  3,  drugs  producing  vaso-dilatation. 
These  were  represented  by  nitrites  and  caffeine.  Both 
produce  very  decided  vaso-dilatation  of  systemic 
and  lung  vessels,  and  must  therefore  act  directly  on 
muscle.  In  conclusion,  Dr.  Dixon  described  how 
injection  of  such  substances  as  digitalis  or  adrenalin 
gave  rise  to  marked  pulmonary  congestion. 


LIVERPOOL  MEDICAL  INSTITUTION. 
Meeting  held  January  7,  1904. 


Rushton  Parker,  Esq..  B.S.,  F.R.C.S.,  President 
in  the  Chair. 

Dr.  A.  S.  Grunbaum  showed  an  experiment  to 
demonstrate  the  hemolytic  action  of  radium  rays  on 
red  blood  corpuscles. 

Dr.  Stenhouse  Williams  exhibited  and  described 
a  new  ethyl  chloride  inhaler.  Given  by  his  method 
the  patient  was  under  in  50  seconds,  the  anaesthesia 
being  maintained  with  ether.  He  had  found  it  very  useful 
in  alcoholic  subjects. 

Dr.  F.  W.  Bailey  had  noticed  that  patients  fre- 
quently came  out  of  the  ethyl  chloride  anaesthesia 
before  ether  anaesthesia  was  induced. 

Sir  William  Banks  and  the  President  also  spoke. 

Mr.  R.  C.  Dun  read  notes  of  a  case  of  congenital 
hydronephrosis,  due  to  stricture  of  the  ureter  at  its 
junction  with  the  renal  pelvis.  The  chief  point  of 
interest  lay  in  the  fact  that  the  abdominal  tumour  was 
principally  on  the  left  side,  and  was  not  palpable  in  the 
right  loin.  The  diagnosis  of  left  hydronephrosis  was 
made.  On  peforming  nephrectomy  through  an  inci- 
sion on  the  left  side,  a  normal  left  kidney  and  ureter 
were  exposed.  The  tumour,  which  proved  to  be  a 
hydronephrosis  of  the  right  kidney,  lay  in  front  of  the 
left  kidney,  and  was  readily  removed.  Recovery  was 
uneventful.  A  congenital  displacement  of  the  right 
kidney,  either  to  the  middle  line  or  into  the  loin  of  the 
opposite  side,  probably  explained  the  abnormal  posi- 
tion of  the  hydronephrosis. 

Dr.  Blair  Bell  and  the  President  commented 
upon  the  case. 

Dr.  C.  Thurston  Holland  read  a  note  on  the  X-ray 
diagnosis  of  kidney  stones  ;  he  laid  special  stress  on 
the  necessity  in  making  a  negative  diagnosis  of  taking 
the  X-ray  whilst  the  breath  was  held.  Also  the  im- 
portance of  obtaining  a  plate  showing  differentiation  of 
the  shadows  of  the  soft  structures  lying  between  the 
iliac  crest  and  the  lower  ribs.  The  note  was  illustrated 
by  a  series  of  lantern  slides  showing  stones  in  situ,  and 
also  the  type  of  negative  to  be  aimed  at. 

Drs.  W.  Carter,  Chas.  Macalister,  and  Alexander 
spoke,  and  Dr.  Holland  replied. 

Dr.  C.  Brown  exhibited  an  old  note-book  containing 
notes  on  Dr.  John  Rutherford's  clinical  medical  lec- 
tures delivered  in  Edinburgh  in  1749,  and  read  a  paper 
on  the  subject.  After  giving  an  account  of  Edinburgh, 
the  medical  school,  and  Dr.  Rutherford,  he  referred  to 
the  total  absence  of  anything  like  scientific  observation 
in  medicine,  but  pointed  out  that  the  rate  of  mortality 
in  Dr.  Rutherford's  wards  was,  under  the  existing 
circumstances,  not  at  all  a  discreditable  one.  Dr. 
Cassels  Brown  gave  details  of  the  treatment  adopted  in 
cases  of  anaemia,  rheumatism,  ague,  phthisis,  syphilis, 
cardiac  disease,  and  hydrophobia,  and  in  conclusion 
remarked  that  while  the  medical  profession  had  ad- 
vanced scientifically  to  an  enormous  extent,  it  had 
not  advanced  equally  in  other  directions.  He  sug- 
gested that  more  attention  should  be  given  to  the  teach- 
ing of  practical  therapeutics,  and  advocated  a  modified 
return  to  the  culture  of  the  old-time  physician.  The 
President,  Sir  William  Banks,  Dr.  Grunbaum  and  Dr. 
Logan  spoke,  and  Dr.  Cassels  Brown  replied. 


Clams  and  Typhoid. — An  outbreak  of  typhoid  fever 
has  occurred  in  the  district  of  the  Strood  Rural  Dis- 
trict Council,  Rochester,  through  the  patients  having 
eaten  clams.  The  Council  has  issued  notices  warning 
persons  against  using  this  kind  of  shell-fish. 


France. 

[from  our  own  correspondent.] 


PARIS.  January  16th,  1904. 
Treatment  of  Cancer  by  Adrenalin. 

Dr.  A.  Rodin,  who  has  been  making  a  special  study 
of  adrenalin  in  its  effects  on  cancer,  reports  that,  in 
cancer  of  the  rectum,  from  thirty  to  sixty  drops  in  a 
tablespoonful  of  water,  of  the  solution  of  1 — 1,000, 
applied  daily  to  the  parts,  removed  the  oozing  from  the 
anus  and  diminished  for  a  time  the  volume  of  the 
cancerous  granulations.  The  external  cancerous  ulcers 
became  pale  under  its  effect,  diminished  in  volume,  and 
the  progress  of  the  affection  was  retarded. 

Combined  with  quinine  and  beer-yeast,  adrenalin 
seemed  to  prevent  relapses  after  ablation. 

A  woman  was  operated  on  at  Lyons  for  cancer  of  the 
uterus,  total  ablation,  in  1901.  The  operation  was  in- 
complete.and  a  rapid  return  of  the  disease  was  expected. 
The  patient  was  submitted  to  the  following  treatment  ; 
During  five  days  she  was  given  five  grains  of  quinine 
twice  a  day ;  the  five  following  days  she  took  a  tea- 
spoonful  of  beer-yeast  each  morning,  when  she  returned 
to  the  quinine  for  another  five  days,  and  so  on  during  a 
month.  After  this  period  she  was  ordered  to  suspend 
the  treatment  five  days,  after  which  to  recommence. 
A  year  afterwards  adrenalin  was  added  to  the  treat- 
ment, five  to  ten  drops  of  the  1 — 1,000  solution  was 
given  morning  and  evening.  The  patient  continues  to 
be  in  excellent  health. 

Another  patient  operated  on  three  times  in  the  interval 
of  a  few  weeks  lor  cancer  of  the  breast,  which  returned 
each  time  immediately,  was  treated  in  a  similar  manner, 
and  no  relapse  took  place. 

The  Hypodermic  Treatment  of  Syphilis. 

As  mercurial  injections  in  the  treatment  of  syphilis 
constitute  a  convenient  and  very  effective  treatment 
of  the  specific  disease,  it  may  be  well  to  indicate  the 
different  points  of  election  for  the  insertion  of  the 
needle  according  to  different  authors. 

1.  The  point  preferred  by  Barthelemy  is  situated  on 
the  middle  of  a  line  running  from  the  antero-superior 
iliac  spine  to  the  upper  extremity  of  the  fissure  of  the 
nates,  corresponding  to  the  external  border  of  the 
gluteus  maximus. 

2.  The  "  point  of  Galliol,"  two  fingers'  breadth  above 
the  great  trochanter,  at  the  intersection  of  a  horizontal 
line  drawn  at  this  point  and  a  perpendicular  line  run- 
ning parallel,  but  at  a  distance  of  two  inches,  to  the 
groove  of  the  nates. 

3.  The  "  point  of  Smirnoff,"  a  finger's  breadth 
behind  the  upper  part  of  the  great  trochanter. 

4.  The  "  point  of  Fournier,"  corresponding  to  the 
upper  third  of  the  buttock. 

The  needle  should  never  be  planted  into  the  middle 
of  the  gluteal  region,which  constitutes  a  dangerous  zone 
on  account  of  possible  wounding  of  the  nerves  or  vessels, 
nor  in  the  inferior  portion,  on  which  the  patient  sits. 


Germany. 

[from   our  own   correspondent.] 

BuLLur,  January  16th,  1904. 
At  the  Society  for  innere  Medizin,  Hr.  Litten  showed 
the  preparations  and  related  the  following  case  of 
Two  Different  Kinds  of  Malignant  Tumour  in  the 
Same  Person. 
A  woman,  aet.  73,  suffered  from  melano-sarcoma  of  the 
choroid  that  had  developed  so  that  it  could  be  seen, 
for  the  eye  could  not  be  illuminated  on  account  of  a 
complete  opacity  of  the  cornea.     Besides  this  primary 


JaX.  >i. 


AUSTRIA. 


Thb  Medical  Press,    63 


melaao  sarcoma  of  the  retina,  with  exudation  so  that 

the  membrane    was  raised    up,    it    was  attached  only 

it  the  uptjc  paptlla.  and  there  was  carcinoma  of  the 

*rall -bladder  that  could  be  felt  on  the  liver  as  a  hard 

Wule  the  st*e  of  a  walnut.     As  a  rule,  metastases  of 

mcto^afO)mawert>mct  with  as  bulky  tumours  m  the 

At  the  autopsy  the  gall-bladder  was  found  dis- 

i-ndcd  and  containing  a  large  calculus,  by  which  the 

was  divided  into  two  parts*,   The  stenosis  was 

in  aiknu-sarcoma* 

The  speaker  had  also  seen  a  second  case  of  melano- 

I  of  the  choroid  without  metastases  in  a  case  of 

anarmia.     [n  ]*8S.  he  had  demonstrated  to 
the  Society  a  case  he  had  had  under  observation  for 
hud  a  half  years.     In   1884  enucleation  had  been 
performed,    but   advised   long   before-     A    few   weeks 
fata  an  enormous  tumour  of  the  liver  and  spleen  was 
The  man  had  had  the  melanosis  for  five  years. 
Here  were  fluctuating  spots  from  which,  by  puncture, 
ofoured   contents  were   evacuated.     There  was 
i^lanuna.     According  to  Hirsehberg*s  statements, 
paucnts  with  melano-sarcoraa  of  the  choroid  who  re- 
mained free  four  to  five  years  after  enucleation  were 
lobe  looked  upon  as  cured.     Hut  Paul  Guttmann  had 
n  a  patient  in  iS;o  with  retro-bulbar  sarcoma  that 
had  driven   the   bulb  well   forwards*     Operation  was 
deferred,  and  later  on  the  tumour  shrank  so  that  the 
exophthalmos  disappeared.     Thrrty  years  after  meta- 
tumours   appeared,  from   which   the   man   died. 
ier  case  was  recorded  in  which  met  is  tases  recurred 
after  ten  yean.    It  was  not  safe,  therefore,  to  prophesy, 
Hr-  Westenhoefler  reported  a  case  of 

ous  Rupture  of  a  Carcinomatous  Ijver. 

hver  weighed  3,000  grammes,  and  had  numerous 

memis  ruptures  on  the  surface,  through  which  the 

carcinomatous  masses  projected. 

H'   5t«a  ^cd  of  the  case  that  it  was  one  of 

d  carcinoma  of  the  stomach,  and  that  the  disease 

feveloped   in   the   liver  secondarily.      During   the 

thul  day*  ol  the  patient's  life,  there  was  rapid  loss  of 

strength  with  black  vonitt,  so  that  death  was  attributed 

t«i   mternal    hemorrhage.     Bleeding    had    never    been 

when    the  stomach    was  washed  out. 

The  reason  was  that  the  motility  of  the  stomach, was 

1  that  the  blood  was  never  detained. 

but  expelled  immediately. 

At  the   Derma tologicat   Society >    fir,   P,  Strassmann 
ed  a  case,  previously  shown,  of 

NGREKES    OF   THE    Si 

II  orcii inscribed  gangrenous  patches  had  appe 

authoritatively  declared 
to  be  tuberc  uli  his  or  pa  fa  -tuberculous.     A  histological 

ittltJOQ    had     11*  >t    negatived    this    view.     Total 

pation  had  111  consequence  been  performed  on  the 

«t.  The  appearance  of  recurrences  gave  rise  to 
*n  "pinion  that  they  were  multiple  neurotic  necroses. 
The  patient  waa  therefore  carefully  watched,  and  proof 

p.ed  that  the  skin  necroses  were  caused  by  the 
application  of  zinc  chloride  by  the  patient  herself,  At 
ihe  same    time,    shght    stricture   of    the    rectum    was 

jsed,  the  cause  of  which  could  not  be  determined. 

iiat ient  left  the  hospital  and  entered  the  Urban 
Hospital,  where  the  medical  officers,  knowing  nothing 

r  previous  history,  performed  laparotomy*  Ex- 
tirpation of  the  rectum  was  earned  out  at  the  same 
time.  In  the  discussion  it  was  mentioned  that  the 
pit  ient  made  the  confession  in  consequence  of  a  sugges- 
tion, in  the  belief   that   her  case  would    thereby   be 

red  more  interesting,  They  had  not  been  able  to 
produce  similar  necroses  by  cnlonde  of  zinc.  In  Other 
wiyb  the  patient  was  tuberculous.  The  speaker 
observed  that  an  explanation  of  the  patient's  behaviour 


was  made  clearer  by  the  assumption  of  sadistic  sensa- 
tions. 

The  O,  Zciisch.  /,  Chtr.  has  a  paper  (Festschrift  fur 
Esmarch)  on  the  question  of 
Operations    for    Tubercle    of    the    Peritoneum, 

Soon  after  the  surprise  piven  by  K6nig  nearly  twenty 
years  ago,  when  he  declared  that  tuberculous  perito- 
nitis, up  to  then  considered  to  be  a  fatal  disease,  was 
amenable  to  simple  laparotomy,  experiences  began  to 
pour  in  as  numerous  as  mushrooms  after  rain. 
Those  who  read  them  had  lo  conclude  that  m  abdo- 
minal section  we  had  an  infallible  cure  for  tuberculous 
peritonitis.  Only  cases  that  recovered  were  published. 
Afterwards,  however,  when  material  from  large  insti- 
tutions came  to  hand,  it  was  seen  that  deaths  still  took 
place,  but  much  less  frequently  than  formerly.  Then 
some  rejected  opera ti mi  is  dangerous.  Internal  treat- 
ment also  showed  good  results.  The  author  pro- 
pounds the  question  whether  we  should  treat  the  disease 
by  operation,  and  holds  that  we  should  in  cases  of  the 
chrome  exudative  form,  operation  not  being  too  early 
resorted  tu.  and  m  cases  m  which  a  primary  lesion  exists 
in  the  tubes  which  can  be  treated  at  the  Japarotomv, 
Whether  operation  should  be  performed  in  all  cases  is 
doubtful,  and  a  decision  can  only  be  reached  through 
further  observations.  The  counter-current  has  brought 
some  good  with  it  in  that  it  is  opposed  to  indiscrimi- 
nate operation.  The  writer  has  shown  elsewmerc  that 
tuberculous  peritonitis  is  a  disease  that  has  a  tendency 
to  recovery,  that  tfafa  tendency  can  be  supported  m 
suitable  cases  and  at  a  suitable  stage  in  its  course  by 
laparotomy,  and  this  is  a  view  that  is  gradually  making 
way. 


austrta. 


[froh  our  own  correspondent,] 

ViKNSA,  January  0th,  IttM* 

Appendicitis. 

Under  this  title  Zahradnicky  gave  an  historical  ac- 
count of  several  operations  for  appendicitis,  necrosis, 
txc,  or.  in  other  words,  a  year's  practical  work  in  which 
,  li.  in-  lirgely  bulked. 

In  thirteen  cases  operated  on.  seven  were  of  a  chronic 

recurring  nature,  all  of  which  recovered  rapidly  after 

the   operation,     The  symptoms  were  mostly  confined 

to  the  disturbances  in   the  ahmentary  tract,  due  to 

on,  <&c 

The  other  six  were  operated  on  immediately  the 
diagnosis  was  made.  In  two  of  the  cases  there  were 
intraperitoneal  abscesses ;  one  of  these  died  from  sepsis. 

In  his  criticism  of  injury  to  the  abdomen  he  considers 
earlv  interference  &«  D  save  life  ;  even  though 

the  injury  be  a  very  simple  one  no  time  should  be 
lost  in  performing  laparotomy.  This  late  action  in 
slight  cases  is  deeply  to  be  regretted  by  most 
surgeons,  and  is  the  most  fruitful  cause  of  the 
greatest  number  of  the  cases  operated  on,  while  tne 
most  serious  are  more  successful  owing  to  early 
operation, 

Zahradnicky  is  a  sealous  devotee  of  medullary 
anaesthesia  and  loudly  praises  the  many  advantages 
obtained  from  this  form  of  narcosis. which,  he  maintains, 
are  far  superior  to  the  usual  practice  of  general  narcosis. 
He  recorded  300  cases  on  which  he  had  operated  with 
this  form  of  anesthesia.  One  of  these  cases  deserves 
special  notice.  A  girl,  ait,  1 3.  suffered  from  hip  disease, 
which  had  to  be  resected  to  remove  the  ost  corny  eli  tic 
material,  and  for  this  reason  a  combination  of  the  general 
and  medullary  anaesthesia  was  practised.  Within 
twenty-eight    hours   after   the   operation    the   patient 


64    Thb  Mboical  Press, 


THE    OPERATING    THEATRES. 


Jan.  20,  1904- 


died.     The  result  of  the  post-mortem  attributed  death 
to  the  use  of  the  chloroform. 

Jaroslav  Hausman  said  he  preferred  Bier's  anaes- 
thesia in  operation  on  the  vulva,  vagina,  perineum  and 
inguinal  regions.  He  has  applied  it  in  eighty  of  his 
operations  and  only  met  with  one  case  that  gave  any 
sign  of  collapse.  This  was  a  case  of  pronounced 
obesity  with  arterio-sclerosis,  for  which  the  uterus  was 
enucleated. 

Tabes  Dorsalis. 

Rohac  reported  three  cases  of  tabes  dorsalis  which 
recovered  by  indifferent  treatment.  One  of  the  cases  was 
in  the  paralytic  stage  of  the  disease  and  was  considered 
hopeless  according  to  Romberg's  experience.  The 
usual  course  had  been  gone  through  before  this  fatal 
form  of  the  disease  had  set  in  without  any  apparent 
effect  on  the  progress  of  the  morbid  phenomena.  The 
case  was  finally  put  aside  as  incurable,  but  to  the  surprise 
of  all  recovered,  and  walks  about  quite  well ! 

The  next  case  he  gave  the  history  of  was  first  seen 
in  1 89 1,  when  total  paraplegia  was  stated  to  be  present 
with  paralysis  of  the  bladder.  He  came  to  hospital  for 
treatment.  Though  the  case  was  considered  hopeless  he 
was  allowed  to  remain  with  probably  a  placebo.  After 
fourteen  days  the  patient  began  to  improve,  and  in  six 
weeks  he  went  home  on  his  own  feet  without  even  a 
crutch.  No  return  of  the  trouble  has  been  observed 
since.  The  third  case  had  a  similar  history. 
Calcareous  Vessels. 

Pelnar  next  gave  the  Society  a  long  history  of  an 
alcoholic  patient,  aet.  67,  who  was  described  as  of  a 
healthy  family.  He  complained  for  years  of  headache, 
vertigo,  pain  in  the  feet,  burning  in  the  soles,  general 
weakness,  dulness  of  vision,  and  sluggish  perception  or, 
in  short,  a  state  of  meiopragia. 

The  objective  symptoms  were  an  extensive  calcifica- 
tion of  the  vascular  system,  accentuation  of  the  second 
cardiac  sounds,  no  hypertrophy  of  the  heart,  increased 
vascular  pressure,  and  albumin  in  the  urine.  The 
pulse  was  quite  imperceptible  along  many  of  the  arteries, 
but  in  spite  of  this  no  obliteration  or  endarteritis  could 
be  perceived,  as  the  process  was  so  diffuse  without 
trophic  disturbance.  It  seemed  to  assume  a  form 
of  atheroma  without  involving  the  aorta  or  the  splanch- 
nic region. 

fnmgan?. 

[from    our    own    correspondent.] 

Budapest,  January  16th,  1904. 
At  a  recent  meeting  of  the  Budapest  Royal  Society 
of  Physicians  and    Surgeons   Dr.    Dollinger,    Professor 
of  Surgery  in  the  University,  read  an  interesting  paper 
on  the 

Operative  Relief  of  the  Lung  Compressed  by 
Pseudo-Membranes  due  to  Chronic  Pyo- 
pneumothorax, 
of  which  I  give  the  following  abstracts : — In  the 
incipient  stages  of  this  disease  surgeons  have  usually 
followed  the  Rstlander-Letievant  method,  and  removed 
portions  of  ribs  corresponding  to  the  area  of  the  pyo- 
pneumothorax, while  in  case.s  of  greater  severity, 
if  necessary,  all  the  ribs  and  the  parietal  layer  ot  the 
pleura  were  removed.  The  sott  parts  of  the  thorax 
were  pressed  close  to  the  lung  and  adhered  to  it ; 
while  the  lung  proper  remained  in  its  compressed 
state.  In  1894  Delorm  first  attempted  to  get  rid  of 
the  pseudo-membrane  enveloping  the  lung  and  binding 
it  down.  This  attempt  was  followed  by  success,  so 
that  in  1 896,  at  the  Congress  of  French  Surgeons,  he 
was  enabled  to  bring  forward  twenty  cases  ot  the  kind, 
partly  his  own,  and  partly  those  of  others  who  had 


ollowed  his  method.  Among  these  cases  seven  proved 
successful.  The  patient  whom  Dollinger  showed 
suffered  from  adhesions  in  the  region  of  the  fourth 
intercostal  space,  5  cm.  outwards  from  the  sternum  in 
the  left  half  of  the  thorax.  This  happened  in  December,. 
1899,  and  although  this  soon  subsided,  the  patient 
had  another  attack  in  January,  1900.  followed  by 
plcuritis,  the  purulent  exudation  breaking  through 
the  intercostal  space.  It  was  in  this  state  that  he 
sought  advice  at  the  Klinik  in  April,  1900,  when 
he  had  already  a  pyo-pneumothorax,  which  filled 
the  greater  part  of  the  left  half  ot  the  chest,  and  which 
communicated,  through  the  above-mentioned  fistula 
with  the  surface.  Dr.  Dollinger  performed  the  Delorm 
operation.  Through  one  incision  he  cut  away  the 
third  and  fourth  ribs,  this  incision  commencing  just 
outside  the  sternum,  on  a  level  with  the  second  inter- 
costal space ;  thence  he  passed  outwards  for  about 
10  cm.,  bringing  the  incision  perpendicularly  as  far 
as  the  second  intercostal  space,  and  passed  parallel 
to  this  as  far  as  the  sternum.  This  incision  went 
through  all  the  soft  parts,  through  the  pectoralis 
muscle  and  the  intercostal  space,  in  front  of  the  axillary 
Une  corresponding  to  the  perpendicular  line  he  had 
made  across  the  ribs.  In  this  way  be  made  a  movable 
flap  comprising  the  fourth  and  fifth  ribs.  This  door 
was  strengthened  by  the  sternumjside,  and  could  be 
opened  after  having  broken  through  the  cartilages 
of  the  ribs.  One  could  then  see  clearlv  into  the  chest. 
Alter  removing  the  pus,  it  was  evident  that  the  lung 
was  compressed  towards  the  middle  line,  so  that  it 
only  reached  to  the  edge  of  the  sternum ;  the  lung, 
moreover,  was  bound  down  by  a  1  cm.  thick  pseudo- 
membrane,  which  Dollinger  readily  removed.  The 
lung  then  expanded  in  the  open  chest,  and  entirely 
filled  it  down  and  backwards.  Suppuration  continued 
about  five  weeks,  but  during  the  first  days  of  this  period 
the  fistula  healed,  and  at  present  over  all  places  of 
the  pneumothorax  one  can  hear  respiration.  Dulness 
is  present  only  over  the  lowest  part  of  the  chest,  where 
thick  pseudo-membranes  still  exist.  The  same  opera- 
tion was  performed  by  Dollinger  on  another  patient,, 
aet.  45,  who  had  suffered  for  five  years  from  pyo- 
pneumothorax. This  patient  had  been  operated  upon 
by  three  surgeons  without  result.  In  this  case  the 
removal  of  the  pseudo-membranes  was  not  quite  as 
successful,  and  therefore  the  lung  could  not  expand 
so  completely ;  consequently,  the  suppuration  did 
not  cease  after  the  operation.  In  such  a  patient  the 
best  course,  perhaps,  would  be  to  perform,  either 
immediately  or  later,  the  Schede  operation. 


TEbe  ©peratino  Cbearres. 

KING'S  COLLEGE  HOSPITAL. 
Excision  of  the  Upper  Part  of  the  Rectum 
(Kraske's  Method). — Restoration  of  Canal. — Mr. 
Carless  operated  on  a  woman,  at.  41,  who  had 
suffered  from  occasional  haemorrhage  from  the  rectum 
for  some  months,  and  from  a  mucous  discharge  for 
about  six  months.  She  had  experienced  a  good  deal 
of  pain  lately,  and  the  haemorrhage  had  been  more 
marked.  There  was  no  pain  on  action  of  the  bowel,  but 
a  good  deal  of  opening  medicine  was  required.  The 
face  was  pallid  and  anaemic,  and  she  had  recently  lost 
weight.  On  examination,  a  growth  with  everted  edges 
could  be  detected  two  or  three  inches  from  the  anus  ; 
it  was  nearly  annular,  but  a  small  portion  of  the  mucous 
membrane  on  the  posterior  aspect  was  free.  The 
growth  was  hard  but  freely  movable,  and  there  was  no 
evidence  of  secondary  infiltration  of  glands  or  of  secon- 
dary deposit  in  the  liver  ;  it  was  therefore  a  favourable 


JaX.  *>,  1904, 


JHE  OPERATING  THEATRES.        t™  m.d,caL  r„S5.    65 


ease  far  Kraake  *  operation.  The  patient  was  placed 
on  the  UtJe  face  downwards,  and  with  the  pelvis  some- 
what raised.  An  incision  was  made  from  just  below 
pof  the  coccyx  in  ihe  middle  line  upwards  as  far 
ai  the  base  of  the  sacrum.  The  soft  parts  were  stripped 
back  from  the  bone  mainly  on  the  left  side.  The 
coccyx  was  then  removed,  as  also  the  left  lateral 
margin  of  the  sacrum-  the  incision  in  the  bone  skirting 
the  third  left  sacral  foramen.  The  tissues  were  then 
opened  tip  and  the  rectum  exposed.  With  a  little 
the  finger  was  passed  round  the  bowel  below 
the  peritonea]  reflection.  By  a  little  dissecting  the 
growth  was  now  isolated,  a  procedure  which  necessi- 
tated the  opening  of  the  pentoneal  cavity   through 


pathologist  reported  that  the  enlarged  glands  in  the 
meso-rectum  were  merely  inflammatory. 
HOSPITAL     FOR     SICK     CHILDREN.     GREAT 
ORMOND  STREKT, 
Operation  for  Strangulated  Inguinal  Hernia 
jn    an   Infant,   mt.   Three  Weeks.— Mr.    Kellock 
operated  on  a  male  child,  Let.  J  week*,  the  subject  of  a 
strangulated  right  inguinal  hernia.     Even  for  its  age 
it  was  an  undersized,  wasted  child.     The  history  was 
that  soon  after  birth  a  hernia  had  been  discovered  in 
the  right  inguinal  region,  which,  up  to  the  day  previous 
to   operation  had   been   reducible.     On    that  dav  all 
to  reduce  it  had  been  unsuccessful  and  the  child 
had  been  in  some  pain  and  had  been  sick.     He  had 


Douglas's  pouch,      No  yiscus  escaped,   but   a  strip  of     been  fed  onlyhv  the  breast.   On  examination,  a  tense 


sed  gauze  was  introduced  to  protect  the  cavity 

prevent  any  protrusion.      It  was  then  easy  to  still 

*  the  growth,  as  also  the  glands  in  the  meso- 

tm,  which  were  enlarged.     The  mcso-rectal  tissues 

now    nipped   through  with  st .  i  1  bleeding 

v  secured  by  ligature,  Sterilised  tapes  were  tied 
i  the  bowel  above  and  below  to  act  as  clamps,  and 

■-eased  po  r  t  io  n  o  i  In  ^  u  e  I  was  re  moved  *     A  f  t  e  r  t  h  e 


rounded  swelling  was  found  occupying  the  usual  situa- 
tion of  right  inguinal  hernia.  It  readied  downwards 
a  short  distance  intu  the  scrotum  :  the  testicle  could 
not  be  felt  below  it,  but  it  was  thought  that  the  organ 
could  be  distinguished  In  the  lower  end  of  the  henna 
the  child  was  also  the  subject  of  a  rather  tight  phimosis, 
After  the  parts  had  been  cleansed  as  far  as  possible,  an 
oblique  incision  was  made  over  the  swelling  and  deep- 


>icedi!is  had  been  stopped,  it  was  found  that  the  pur-     cned  until  the  sac  of  the  hernia  was  reached  ;  the  latter 


i if  bowel  above  and  below  could  tie  approximated* 

but  before    affecting    this    the   peritoneal    cavity    was 

dosed.     An  incision  was  made  over  the  anterior  aspect 

turn  allowing  an  edge  of  the  peritoneum  to 

utted  up.  and  this  was  carefully  stitched  to  the 

nor  margin  of  Douglas *s  pouch.     Thus  the  peri- 

h  cavity  was  dosed  off.     This  transverse  cut  in 

r      neum  was  made  about  an  inch  and  a  half 

9t  the  section  of  the  bowel.     Approximation  of  the 

anal  and  upper  portions  of  the  tube  was  now-  effected  by 

Deans  oi  a  Murphy's  button,  but  a  good  deal  of  over- 

iQg  was  required  to  make  good  the  lower 

segment,  the  muscular  wall  of  which  had  been  torn  in 

I  freeing  it  at  an   earlier  stage  of  the  operation.      No 
Attempt  was  made  to  close  the  wound  in  the  soft  tissue, 
was  packed   with   gauze  and    the  patient   sent 
10  bed.     Mr.  Carless  pointed  out  that  he  had  not 
wider  la  ken  a  preliminary  colotomy  in  this  case  as  he 
had  every  hope  of  resti in ng  the  continuity  of  the  canal. 
In  his  opinion  colotomy  was  valuable  in  cases  that 
could  not  be  dealt  with  by  excision  or  as  a  preliminary 
:ision  where  the  anal  segment  of  the  bowel  had 
removed,  as  under  these  circumstances  the  anus 
resulted  was  almost  certain  to  be  either  contracted 
or  so  patulous  that  the  patient  had  no  control.    He  had, 
it  to  save  the  nvr\i.^    going  to 
limiting  the  part  of  the  sacrum  that 
&  removed,  and   he  hoped  that  at  any  rale   a  partial 
he  segment*  united  by  the  Murphy's  button 
Old  result,  as  thereby  a  much  better  issue  would  be 
Attained.     The   a  Iter- his  ton-    of    this   case    has    been 
interesting*     The  union  of  the  two  segments  was  not 
giving  way  in  three  spots,  and  for 
some  time    the   whole   ot    the   patient's    feces    passed 
through  the  wound-     The  button  was  set  free  about 


was  rather  dark  in  colour  and  vrty  tense,      <  hQ  Opening 
it  was  found   to  contain  no  fluid,  but  a  coil  of  small 
found  lying  immediately  in  i  Hi  its 

inner  surface.  The  opening  in  the  sac  was  enlarged 
upwards,  and  the  bowel  drawn  out  ami  examined  .  it 
was  discovered  to  be  a  piece  of  small  intestine  about 
two  inches  in  length  in  a  fairly  satisiactory  condition, 
-howing  well-marked  signs  of  constriction,  both 
above  and  below.  With  a  little  difficulty  it  was  found 
urn  the  bowel  to  the  abdomen  without 
making  any  incision  at  the  constriction  ;  it  was 
apparent  that  the  testicle  wis  contained  in  the  sac  of 
the  hernia,  which  was  therefore  divided  transversely 
about  an  inch  below  the  external  abdominal  ring,  the 
part  dissected  up,  ligatured  by  transfixion  and 
removed.  A  small  portion  of  the  lower  part  was  also 
re  moved  a  ntl  t  he  t  n  i  i  <  I  e  re  t  u  r  n  ed  to  the  scrotum.  One 
silk  stitch  having  heen  passed  through  Ponpart'a 
ligament  and  the  edge  of  the  conjoint  tendon  approxi- 
mating the  walls  of  the  inguinal  canal,  the  wound  was 
dosed  by  a  continuous  horsehair  suture  and  a  dressing 
r  ojiodion  and  gauze  applied.  Mr.  Kellock  remarked 
on  the  early  age  of  the  little  patient  for  such  an  opera- 
tion .  he  said  that  strangulated  inguinal  hernia  was  not 
very  rare  in  infants,  and  probably  only  differed  from 
the  same  condition  in  later  life  in  the  greater  difficulties 
of  the  operative  treatment.  The  difficulty  of  getting 
the  region  perfect ly  clean  in  the  first  place  is  great.  The 
hernia  is,  as  in  this  case,  very  often  marked  by  a  total 
absence  of  fluid  in  the  sac,  rendering  the  greatest  ot 
fare  necessarj  in  Opening  it.  In  this  case,  lie  said,  the 
returning  Of  the  bowel  to  the  abdomen,  so  often  a  matter 
of  considerable  difficulty,  was  comparatively  easy. 
He  also  pointed  i>ut  the  fact  that  the  hernia  was  of  the 
congenital  variety,  rendering  it  necessary  to  divide  the 


day.  and   was   removed    through   the  anus,     sac  of   the   hernia   transversely    before    removing  any 
The  opening  in  the  line  of  union  have  gradually  closed,     portion  of  it.      He  thought  the  dressing  which  had  been 


'.eeks  niter  the  operation   the  patient  ' 
prt    tut  urn,    the   sensation    of 
normal  and  the  sphincteric  control  of  which 
present  time  (about  eight  weeks 
*mce  operation*  the  wound  is  contracting  rapidly,  the 
ttnua  imitation   with   the   bowel   <-  almost  closed,  aud 
;alnnfs    motions   pass   almost   entirely    by   their 
natural  passage.     In  all  probability  the  complete  con- 
tinuity ol  the  canal  may  be  evpected  when  the  sacral 
i  is  sealed. 

The  growth  is  a  CO*  umnar-celled  carcinoma,  but  the 


' 


applied — namely,  collodion  and  gauie  a!*ove  without 
wool  or  bandages,  was  the  best  calculated  to  keep  the 
ucmnd  clean  because  owing  to  the  sue  of  the  child  it 
would  be  practically  impossible  to  keep  a  larger  dressing 
from  becoming  soiled.  He  also  pointed  out  that  con- 
sidering the  operation  had  not  been  a  long  one.  and  the 
condition  easily  remedied,  the  prognosis  was  entirely 
favourable* 


Dr.  H*  W,  Beach,  of  Putney,  ha*  been  elected 
Medical  Officer  of  Health  for  Yarmouth.  He  was  one 
of  five  selected  candidates. 


66    Ths  Medical  Press. 


LEADING   ARTICLES. 


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"  SALUS   POPULI   SUPRElf  A  LEX." 


Jan,  20.  1904. 


WEDNESDAY,  JANUARY  20,  1904. 


THE  BRITISH  MEDICAL  ASSOCIATION  AND 
THE  GENERAL  MEDICAL  COUNCIL. 
We  have  carefully  watched  the  columns  of  the 
official  organ  of  the  Biitish  Medical  Association 
during  the  past  few  months  for  some  explanation 
of  the  reasons  which  led  that  body  to  formu- 
late a  demand  for  direct  representation  on  the 
General  Medical  Council,  but  up  to  the  present 
little  information  has  been  given.  It  appears 
that  a  resolution  was  passed  last  July  begging  that 
in  any  future  legislation  affecting  the  constitution 
of  the  General  Medical  Council,  direct  representa- 
tion in  proportion  to  its  members  should  be  given 
to  the  British  Medical  Association.  We  confess 
we  can  see  Ifttle  justification  for  such  a  proposal,, 
and  we  do  not  believe  for  a  moment  that  it  will 
be  seriously  considered  by  Parliament.  It  is  true 
that  the  great  majority  of  medical  men  in  these 
islands  are  members  of  the  British  Medical  Asso- 
ciation, which  is  therefore,  in  the  widest  sense, 
representative,  and  has  on  many  occasions  voiced 
the  opinions  of  the  profession  with  dignity  and 
force.  But  we  do  not  see  that  the  individual  prac- 
titioner who  is  a  member  of  that  Association  has 
any  just  claim  to  greater  representation  in  the 
General  Medical  Council  than  the  individual 
practitioner  who  is  not  a  member.  At  present  a 
member  of  the  profession  has  his  interests  repre- 
sented in  two  ways.  He  has  first,  the  direct  re- 
presentative or  representatives  for  whom  he  votes, 
and  he  is,  in  addition,  represented,  though  in- 
directly, by  the  nominee  of  university  or  cor- 
poration from  which  he  holds  his  diploma.  Why 
should  the  individual  practitioner  be  entitled 
to  get  further  representation  by  merely  joining 
the  British  Medical  Association  ?  Whatever  steps 
may  be  necessary  to  secure  a  greater  direct  re- 
presentation of  the  profession — and  we  have 
always  urged  reform  in  this  direction — we  do 
not  think  the  object  aimed  at  will  be  gained  by 
endowing  the  members  of  the  British  Medical 
Association    with    a    representation    refused    to 


others.  Again,  if  the  claims  at  present  made  be 
at  all  admitted,  the  difficulty  at  once  rises  as  to 
where  to  draw  the  line.  If  one  voluntary  society 
be  entitled  to  direct  representation,  why  not 
another  ?  The  British  Medical  Association  is 
the  most  powerful  medical  corporation  in  England, 
but  the  Irish  Medical  Association  occupies  a 
similar  position  in  Ireland.  Indeed,  in  one  sense, 
it  has  a  stronger  claim  to  represent  its  members 
in  public  matters,  since  its  primary  work  is  in  the 
field  of  medical  politics,  while  the  British  Medical 
Association  is  primarily  a  scientific  body,  and 
only  by  an  after- thought  political.  Similar  argu- 
ments might  be  made  use  of  on  behalf  of  the 
Medical  Defence  Union,  and,  indeed,  any  other 
medical  society  strong  enough  to  make  its  voice 
heard.  Unique  as  the  position  of  the  British 
Medical  Association  may  at  first  sight  appear,  we 
believe  that  it  would  be  a  very  dangerous  pre- 
cedent to  give  any  voluntary  association  of 
medical  men  power  to  govern  those  who  are  not 
members  of  that  Association.  And,  indeed,  we 
do  not  think  that  the  Association  would  be  at  all 
wise  to  take  on  the  proposed  responsibility.  Hs 
work  is  already  becoming  too  unwieldy  for  the 
most  efficient  management,  and  any  further  plan 
to  withdraw  energy  from  the  pursuit  of  its  scientific 
objects  is,  at  the  least,  of  questionable  wisdom. 
The  resolution  we  have  discussed  is  at  present 
under  the  deliberation  of  the  divisions,  and  it  is 
with  satisfaction  we  note  that  such  an  important 
body  as  the  Dublin  Division  has  already  expressed 
its  unqualified  and  unanimous  condemnation. 
It  need  hardly  be  added  that  the  adequate  repre- 
sentation of  the  whole  profession  on  its  governing 
body  —  a  much-needed  reform — stands  on  an 
entirely  different  basis  from  the  proposal  to  add 
another  class  interest  to  those  that  at  present 
constitute  one  of  the  most  autocratic  and  irre- 
sponsible public  bodies  in  the  United  Kingdom. 

ALCOHOLISM  AND  RACIAL 
DETERIORATION. 
The  so-called  alcohol  question  is  receiving  much 
attention  in  relation  to  the  alleged  deterioration  of 
our  people.  It  is  to  be  hoped  that  the  Govern- 
ment inquiry  now  in  course  of  initiation  will  pro- 
cure trustworthy  evidence  on  this  matter.  Con- 
siderable discussion  has  taken  place  respecting  the 
contentions  of  Dr.  Archdall  Reid  that  alcohol,  like 
disease,  is  the  cause  of  an  evolution  protective 
against  itself.  Nature,  it  is  true,  works  for  the 
elimination  of  the  drunkard  ;  but  the  practical 
conclusion  of  Dr.  Reid's  argument,  as  stated  in 
the  current  number  of  the  British  Jqurnal  of 
Inebriety,  will  shock  the  humanitarian  sensibilities 
of  many  :  "  We  have  no  real  choice  between  the 
reformer's  method  and  Nature's  method.  The 
reformer's  method  has  long  been  out  of  court. 
Whether  we  help  or  resist,  Nature  will  do  her  work. 
If  we  help,  she  will  do  it  quickly  and  with  mercy  ; 
if  we  resist,  she  will  do  it  slowly  and  with  infinite 
cruelty."  Doubtless,  while  there  is  much  that  is 
repellent  in  such  a  view,  there  is  also  much  that  is 
peculiarly  attractive  to  the  superficial  scientific 


J  as**  .20.   I 


LEADING   ARTICLES, 


The  Medical  Press.     67 


tatalist.  Not  a  lew,  however,  hold  that  what  is 
illy  wrong  cannot  be  scientifically  right- 
And  now  Dr.  Ford  Robertson,  the  distinguished 
pathologist  to  the  Scottish  Asylums,  has  taken  up 
the  sca-mirk  cudgels,  and  at  the  last  meeting  of 
the  Society  for  the  Study  of  Inebriety,  argued  that 
the  Keid  school  had  founded  their  argument  on  an 
insecure  and  even  false  foundation.  Dr.  Robert- 
vm  holds  that  the  distinction  between  inborn  and 
acquired  characters  is  really  an  artificial  and  us 
one,  and  if  such  can  be  substantiated,  Di\  Reid's 
structure  collapses  like  a  pack  of  cards.  Certainly , 
many  careful  observers  will  be  inclined  to  agree 
with  Dr.  Robertson  that  at  the  present  time  one 
potent  causes  of  genetic  variation 
depends  upon  the  action  of  alcohol,  and  probably 
majority  will,  whatever  theoretical  support 
nay  be  inclined  to  give  to  Dr.  Reid's  theories, 
agree  with  Dr.  Robertson's  practical  advice  that  it 
is  the  duty  of  the  State  to  remove  from  the  en* 
nronment  of  its  people  every  mimical  condition  to 
which  there  is  imperfect  adaptation.  The.  tem- 
Euestion,  thanks  to  the  researches  of  many 
scientific  investigators  and  the  work  of  such  bodies 
as  the  Society  for  the  Study  of  Inebriety,  is  now 
no  longer  the  battlefield  for  vulgar  fanatics 
and  irresponsible  cranks,  but  one  concerned  with 
the  highest  interests  of  our  people,  and  offering 
oppurt unities  lor  study  of  the  most  serious  and 
important  of  biological  and  ethical  problems,  The 
question  is  one  which  no  medical  man  can  now 
afford  to  neglect- 


nroui 

which 
peram 


KOPLIK'S    SPOTS    IN    MEASLES. 
Measles  is  a  disease  to  which  the  public  are 
apt  to  attach  but  scant  importance.     It  is  exceed  - 
v  common  and  widely  distributed  ;  generally 
mild  and  of  low  fatality.     Almost  everybody  has 
had  1  (  childhood,  and  most  people  regard 

it  as  one  oi  the  inevitable  incidents  of  the  early 
vear*  oi  life.  To  them  it  ranks  with  teething  and 
i  nation  as  one  of  the  drawbacks  to  the  pleasure 
of  having  children.  And  yet  measles  demands 
an  annual  toll  of  human  life  as  great  as  all  the 
scheduled  dangerous  infectious  diseases  put  to- 
gether The  promoters  of  Public  Health  Acts 
did  not  urge  its  inclusion  among  the  compulsorily 
notifiable  diseases,  presumably  because  oi  the 
inking  any  steps  to  limit  its  spi 

ugh  the  mere  fact  of  making  it  notifiable 
would  have  had  a  considerable  influence  in 
drawing  attention  10  its  being  something  far 
more  serious  than  a  mere  puerile  ailment.  But 
the  disease  has  proved  so  refractory  to  preventive 
measures  that  one  large  town,  in  which  compulsory 
notification  had  been  in  force  for  some  years  by 
nl  order,  decided  the  other  day  that  the 
.unnunt  of   good   that   resulted   from   notification 

so  problematical  that  they  withdrew  the 
obligation  to  notify.  Now,  in  what  does  this 
difficulty  in  dealing  with  measles  consist  ?  There 
are  two  contributory  factors.  One  is  the  ex- 
tremely generalised  character  of  the  influences  that 
tend  to  produce  the  disease  in  individuals,  and 
the  other  is  the  difficulty  of  early  diagnosis*     The 


first  of  these  is  beyond  our  ken  at  present, 
but  to  the  second  we  would  like  to  direct 
attention,  The  first  symptoms  of  measles  arc 
no  more  than  those  of  a  feverish  cold — a  little 
bronchial,  nasal,  and  conjunctival  catarrh  accom- 
panied by  pyrexia.  Unless  he  has  particular 
reason  to  suspect  measles,  the  practitioner  hesitates 
to  turn  the  house  upside  down  and  isolate  every 
case  of  febrile  catarrh  that  he  is  called  on  to  attend  ; 
such  a  procedure  causes  great  domestic  upset, 
and  does  not  tend  to  enhance  his  reputation 
when  it  turns  out  (as  it  frequently  does)  that  his 
suspicions  are  unfounded.  The  usual  plan  is  to 
wait  till  the  fourth  day  to  sec  if  a  rash  appears, 
though  if  it  does  it  generally  happens  that  the 
harm  has  been  done,  and  the  other  children  in  the 
house  have  been  infected.  The  early  diagnosis 
of  measles,  then,  is  a  great  desideratum.  It 
seems  curious  in  this  connection  that  the  lesions 
of  the  buccal  mucous  membrane  known  as  Koplik's 
spots  should  not  have  received  wider  recognition 
than  has  been  accorded  to  them.  These  spots 
were  first  definitely  described  by  Filatow  in  tHg$t 
although  it  is  possible  that  Flindt  may  have  in- 
dicated the  same  changes  in  his  paper  published* 
in  1880.  The  subject  was  not  taken  up  till  1896, 
when  Koplik,  of  New  York,  wrote,  in  the  u  Archives 
oi  Pediatrics,'*  an  account  of  them,  which  differed 
somewhat  from  that  of  Filatow,  but  was  un- 
doubtedly intended  to  apply  to  the  same  lesions. 
At  all  events,  Koplik's  name  came  to  be  associated 
with  the  disco  very,  and  for  good  or  evil,  Koplik's 
spots  seem  likely  to  take  rank  with  other  epony- 
mous pathological  phenomena  in  the  nomen- 
clature of  the  future.  These  spots  are  described 
by  different  observers  as  white,  bluish-white,  and 
bright  redt  the  truth  seeming  to  be  that  they  are 
all  three  colours  at  different  stages  ;  red  at  first, 
then  white  with  a  red  areola  around,  and  finally 
bluish- white  in  the  centre,  white  in  the  periphery, 
and  surrounded  by  a  ring  of  injected  mucous 
membrane.  As  to  their  site  there  is  no  dispute. 
Most  commonly  they  are  found  in  the  buccal 
mucous  membrane  opposite  the  molar  teeth, 
but  they  may  also  occur  in  the  inside  of  the  lips 
and  on  the  palate.  The  area  they  cover  varies  from 
a  mere  point  to  the  size  of  a  silver  penny-piece. 
Now  the  important  clinical  point  with  regard  to 
these  spots  is  that  they  appear;  as  a  rule,  within 
twenty-four  hours  of  the  initial  catarrhal  sym- 
ptoms, and  thus  are  visible  two,  three ,  and  some- 
times four  days  before  the  appearance  of  the 
rash.  They  are  peculiar  to  measles  ;  they  are  not 
found  in  scarlet  fever,  rotheln,  or  any  other 
disease.  They  are  characteristic  in  appearance 
and  position  ;  they  can  be  easily  differentiated 
from  thrush,  stomatitis  and  adherent  milk-curd. 
Here,  then,  we  have  a  most  valuable  means  for 
aiding  early  diagnosis.  Observers  who  have 
systematically  watched  for  these  spots  have 
seen  them  in  00  to  100  per  cent,  of  the  cases 
that  subsequently  proved  to  be  measles,  and 
this  has  been  the  case  in  England,  America, 
Germany,    and    Austria.     The   latest  to    publish 


68      Thk  Mbdical  Press.         NOTES    ON    CURRENT    TOPICS. 


Jan.  20.  1904. 


his  results,  M.  Marvasse,  in  Die  Heilkunde,  dis- 
covered them  in  forty-five  out  of  forty-eight 
consecutive  cases,  and  this  is  rather  below  than 
above  the  average  of  previous  observers.  We 
think  that  this  clinical  phenomenon  cannot  be 
too  widely  known,  for  its  early  recognition  may 
save  many  a  case  from  the  personal  infection  of 
measles.  It  certainly  adds  a  weapon  of  great 
power  to  the  practitioner's  armamentarium,  a 
weapon  that  has  been  sadly  needed  in  the  past. 


notes  on  Current  topics. 


Dublin  Hospitals  and  "Poor"  Patients. 

Our  contemporary,  the  British  Medical  Journal, 
does  not  appear  to  have  a  very  correct  knowledge 
either  of  the  position  which  the  Dublin  hospitals 
occupy  with  regard  to  the  community  at  large,  or 
of  the  source  of  their  funds.  A  medical  man, 
who  rather  thinly  veils  his  identity  under  the 
initials  "  W.  H.N.,"  writes  to  our  contemporary  to 

complain  that  he  sent  a  child  suffering  from  j I  sof  tness  ^ves  way  to  brittleness 
intussusception  to  a  Dublin  hospital,  and  that  it 
was  refused  admission.  He  then  wrote  to  the 
secretary  of  the  hospital  to  complain,  and  getting 
no  answer  stigmatises  the  Dublin  hospitals  as 
frauds    on    the    charitable    public,    because    they 


admitted,  it  would  not  explain  the  phenomenon 
under  investigation.  In  fact,  what  happens  with 
the  hair  is  the  very  reverse  of  becoming  brittle, 
for  when  a  hair  is  soaked  in  soap  solution  for 
some  time  it  becomes  soft,  and  it  is  this  softness, 
and  not  any  imagined  brittleness,  which  makes 
the  hair  easy  to  cut.  A  few  simple  experiments 
are  sufficient  to  settle  the  question.  If  three 
separate  hairs  are  taken  for  purposes  of  examina- 
tion, and  after  soaking  one  in  water,  another  in 
soap  and  water,  and  leaving  the  third  untreated, 
are  examined  under  a  microscope,  certain  facts  are 
observable.  The  hair  which  has  been  lying  in 
water  has  become  somewhat  swollen,  and  cuts 
with  a  clean  section  as  compared  with  the  broken 
or  frayed  edge  shown  on  cutting  the  untreated 
hair.  Further,  the  soaped  hair  is  much  swollen, 
and  cuts  with  great  ease,  showing  a  perfectly 
clean  section.  The  fact  is,  then,  that  alkalis 
soften  such  structures  as  hair  and  epidermal 
thickenings,  and  it  is  only  on  drying  that   this 


Pig-Sticking  Extraordinary. 
One  of  the  curiosities  of  surgical  literature  is  a 
pig-sticking  story  just  come  to  hand  in  an  Indian 


contemporary.  An  officer,  wnile  pig-hunting, 
are  unwilling  to  receive  poor  patients  who  do  1  came  up  to  a  pig  and  succeeded  in  sticking  it, 
not  bring  grist  to  their  mill.  To  his  letter  our  |  only  to  have  the  spear  immediately  jerked  out  of 
con tempoiary  appends  the  note  that  "  it  is  under-  ,  his  hand.  As  the  spear  fell  to  the  ground  it 
stood  that  the  Irish  hospitals  object  to  receive .  became  free  of  the  pig,  and,  in  the  rebound, 
pauper  patients,"  and  that  "  as  the  Dublin !  pierced  the  pony's  shoulder.  The  point  entered 
hospitals  are  almost  entirely  supported  by  the  under  the  near  shoulder,  pierced  the  chest  wall 
State  grant,  they  have  not  much  to  do  with  the ,  between  the  tenth  and  eleventh  ribs  and  pro- 
charitable  public."  We  do  not  profess  to  know  truded  through  the  saddle.  It  then  pierced  the 
the    source    of    our    contemporary's    information   left  buttock  of  the  rider  about  the  middle  of  the 


regarding  the  Dublin  hospitals,  but  we  would 
point  out  first  that  no  Dublin  hospital  refuses  a 
patient  who  is  a  fit  subject  for  charitable  relief 
and  for  hospital  treatment  if  it  has  a  bed  vacant 
in  which  to  place  the  sufferer.     Secondly,  that, 


thigh,  and  emerged  behind  the  great  trochanter, 
finally  coming  to  rest  behind  the  shoulder.  The 
pony  luckily  stopped  dead  still,  and  was  held 
while  the  shaft  of  the  spear  was  divided  and  the 
parts    drawn    out.     Nine    inches    of    blade    and 


as  unfortunately  the  State  grant  is  insignificant  twenty-one  inches  of  shaft  had  pierced  the  rider, 
in  proportion  to  the  needs  of  the  hospitals,  even  I  while,  in  addition,  three  feet  of  torn  bamboo 
with  the  very  large  sums  annually  subscribed  by  I  handle  had  passed  into  the  pony.  The  thigh 
the  charitable  public — a  source  without  which '  wound  was  superficial,  no  important  structure 
most  of  the  hospitals  might  close  their  doors —  '  being  injured,  and  healed  rapidly.  The  pony,  un- 
many  patients  have  to  be  turned  away  for  want !  fortunately,  developed  pneumonia  and  died, 
of  accommodation.  I  The  case  is  interesting,  as  the  writer  justly  re- 

j  marks,  not  only  as  showing  the  vagaries  of  a  spear 


The  Physiology  of  Shaving. 


in  a  very  few  moments,   but   as  demonstrating 


It  is  curious  how  content  we  are,  day  after  day, ,  that  such  a  wound   need  not  become  septic   if 


to  use  the  shaving-stick  without  a  knowledge  of 
its  method  of  action.  We  do  not  know  for  how 
many  generations  it  has  been  the  custom  to  aid 
the  razor  by  soap,  yet  it  would  appear  that  the 


properly  treated  at  the  time. 


The  Dangers  of  the  Bath. 
Happy  were  the  days  before  we  knew  anything 
modus  operandi  of  the  lather  was  never  explained.  ]  of  bacteria  and  their  habits  of  life.     In  the  good 


We  are  all  empirics  in  our  shaving,  and  a  rational 
basis  of  our  practice  is  for  most  of  us  yet  to  seek. 
Happily,  a  writer  in  one  of  our  contemporaries  has 
come  to  our  relief,  and,  late  as  it  is,  has  reduced 
the  action  of  soap  on  hair  to  the  sphere  of  natural 
law.  $  It  appears  that  the  ordinary  haphazard  ex- 
planation that  soap  extracts  oily  matters,  and 
thus  renders  the  hair  brittle,  is  worse  than  merely 
erroneous,  for  not  only  are  the  premisses  false  and 
the  conclusion  illicit,  but  even  were  the  conclusion 


old  days  we  read  our  letters  at  the  breakfast- table 
— as  some  of  us  do  still  in  spite  of  the  warnings 
of  one  of  our  contemporaries — without  any  thought 
of  the  unseen  foe  which  adhered  lightly  to  the 
envelope  that  we  dropped  carelessly  on  the 
buttered  toast.  We  drank  our  milk  without  any 
thought  of  suppurative  mammitis  to  turn  it  to 
curds  in  the  mouth.  We  slaked  our  thirst  at  the 
wayside  brook  without  caring  that  a  case  of 
typhoid  fever  had  been  treated  on  its  banks  a 


J  AX  33,   tg©4. 


NOTES    ON    CURKENT    TOPICS. 


few  hundred  yards  away*  Nowadays  we  do  none 
of  these  things,  for  we  know  that  the  bacillus  is 
larking  everywhere   to  catch   us   unawares.     We 

ot  used  to  guarding  against  the  enemy  which 
ran!  to  enter  our  mouths  with  any  uncon- 
sidered  trifle  of  food  or  drink,   and   we   thought 

in  doing  so  we  kept  sufficient  watch.  It 
seems  that  we  were  wrong,  for  the  latest  strong 


Thr  Medical  Press,     69 


short  life.  The  association  of  good  teeth  and 
hair,  though  frequently  commented  upon,  has 
not  so  far  raised  the  conjecture  that  their  decay 
and  deficiency  may  be  correlated, 


Public  Night  Shelters. 

The  misery  and  hardships  endured  by  thousands 

arr.     01    individuals    who    are    compelled     to    wander 

held  captured  ist  of  all  things,  our  morning  tub,     through  the  streets  of  the  metropolis  at  night  can 

Surgeon-Major  Beevor,  in  a  recent  paper,  (&)  dis-    on^     ^  adeauatclv  ilescritwl  Uv  th^,,  **,k^  krt™ 


caters   the   whole   question   of   typhoid   infection 
iforo  bath  water,  and  shows  without  much  diffi- 
l he  great  ease  with  which  bacteria  may  gain 
access  to  the  mucous  cavities  during  immersion. 
During  the  rainy  season  in  India  the  water  supply 
1  nurse,  specially  liable  to  bacterial  con  .t  ami  na- 
il is  impossible  to  protect  it  from  inflow 
ot  surface  water.     Now  the  rainy  season  coincides 
with,  the  enteric  season,  and  it  is  likely  enough  that 
a  use  of    the  increase  of  enteric  fever  at  that 
period  of  the  year  is  due   to  an  excess  of  surface 
water  finding  its   way  into   the  supply-tanks.     It 
is  obvious  that  water  which  is  open  to  suspicion 
Id    never    be     used     for    drinking    purposes 
without  bulling,  and  Surgeon-Major  Beevor  is  right 
ing  greater  caution  in  the  bath  than  is  ' 
monly  observed. 

Alopecia  and  Dental  Caries, 
The  relationship  between  alopecia  and  dental 
caries  is  not,  at  first  sight,  particularly  obvious  ; 
nevertheless  when  the  facts  of  the  correlation  of 
growth  are  borne  in  mind,  a  possible  explanation 
he  discovered  which  does  not  involve  either 
(ation  or  bacillary  infection.    It  has  been 
-ved    that   certain    malformations    very   fre- 
Btly  co-exist  for  which  no  cause  can  be  assigned. 
Animals   which   present    the   most   abnormal   ap^ 
pearances    in    their    teeth    are    likewise    most    ab- 
normal in  their  dermal  coverings.     The  narwhal 
ts  a  good  example  of  this  peculiar  association  of 
abnormality  of  teeth  with  specialised  integument, 
having  a  hairless  body,   thick  deposit  of  subcu- 
»us  fat  or  blubber,  an  enormously  developed 
tusk,    with   an   undeveloped   or   rudimentary 
I   tusk.     The  facts  which  led   M.    L.   Jacquet 
to  ascribe   baldness    to   the   presence   of   carious 
teeth,  together  with  the  general  impression  which 
1  that  young  people  sutler  more  in  this  respect 
than  was  formerly  the  case,  suggests  that  a  modi- 
oli of  our  epithelial  structures  may  be  taking 
r  which  may  best   be  described  as  an  asso- 


only  he  adequately  described  by  those  who  have 
actually  experienced  them.  The  cry  of  the  home* 
less  and  shelterless  is  one  to  which  many  philan- 
thropic agencies  have  respsnded,  and  yet  then 
numbers  seem  scarcely  diminished.  The  Salva- 
tion Army  authorities  early  recognised  their  re- 
sponsibilities in  this  direction,  and  the  outcome  of 
their  labours  is  nightly  appreciated  by  a  host  of 
destitute  and  outcast  men  and  women.  The 
suggestion  recently  made  by  Mr  G.  J.  Cooper, 
Eiian  of  the  Public  Health  Committee  of  the" 
London  County  Council,  that  the  municipality 
should  provide  night  shelters  on  somewhat  similar 
lines  available  for  those  who  are  unable  to  afford 
even  a  sixpence  for  a  bed  is  oru-  which  should  be 
commended  for  the  consideration  of  that  august 
body  as  likely  to  meet  a  real  and  growing  need 
among  the  very  poorest  of  the  citizens  of  London. 
The  regulations  controlling  the  management  of 
those  already  in  existence  were  passed  by  the 
Conned  without  objection,  even  though  theii 
gienic  conditions  were  not,  perhaps,  always  of  the 
most  first -class  description.  But  there  is  no 
reason  why  certain  buildings,  such  as  warehouses, 
could  not  be  adapted  to  this  beneficent  purpose! 
or  Other  and  cheaper  structures  built  of  a  more 
sanitary  nature  which  would  meet  all  the  necessi- 
ties of  the  case.  Strict  supervision  would,  of 
course,  have  to  be  exercised  with  regard  to 'the 
arrangements  for  sleeping  and  for  disinfecting 
beds  and  couches.  The  nightly  visit  of  a  sanitary 
inspector  might  be  of  assistance  in  detecting  some 
of  the  more  acutely  infectious  diseases,  and  any 
such  cases  could  be  promptly  referred  to  a  medical 
man.  The  idea  of  making  any  profit  over  the 
undertaking  is,  as  Mr.  Cooper  sagely  remarked, 
out  of  the  question. 

Apparent  Improvement   in   Disease 

Symptoms. 
Few   phases   of   disease    are    more   mysterious 
to  the  lay  mind  than  those  periods  of  remission 
which  occur  from  time  to  lime  during  its  co 


piace,  wmen  may   best    be  described  as  an  asso-     ^  ^  ^  wav  uunog  us  course. 

dated  epidermal  degeneration,  manifesting  itself1  At  such  ,imes  .rhe  Patient  be£in?  to  take  gr 

Hal    caries    anri     air.™^       rk.  :  I  liberties  with  himself,  and  the  hopes  of  hts  friends 

are  falsely  raised  by  the  transitory  improvement. 
But   after  the   calm  comes    the  storm.     The  old 


and    alopecia,     The    cause    of  ' 
1  doubt  to  be  found  in  the  fact  | 
for  some   generations  cooking  has  rendered 
ugh    mastication    less    necessary,    and     thai 
th  are  Co  rjy  atrophying  isuse, 

sisting   the  ravajk" 
ns      correspondingly      diminishing, 
theory  calls  attention  to  a  possible 
lo  attend  to  the  teeth, 
riy  the   milk  teeth,  which  are   too  often 
:ted    on     aocounl     of     their    comparatively 


I 


svm;<  turn    unabated,    and    seem    to    have 

gathered  fresh  strength  by  their  tempo, 
ance.  Many  diseases  of  the  nervous  system  arc 
characterised  by  these  periods  of  remission,  inso- 
much that  the  very  fact  has  been  utilised  as  a 
prognostic  mgn,  though,  in  many  cases,  it  beco 
a  matter  of  do  small  difficulty  to  gauge  accurately 
the  course  of  events  pursued  by  the  malady. 
From  the  point  of  view  of  treatment  the  question 
is  one  of  great  importance,  pathologic*] 


70     The  Medical  Press.  NOTES    ON    CURRENT    TOPICS. 


Jan.  20,  1904. 


changes  may  be  in  progress,  hidden,  perhaps, 
from  the  patient,  and  even  veiled  from  the  per- 
ception of  the  physician,  during  the  time  that  the 
intensity  of  the  symptoms  has  abated.  That 
such  a  condition  of  affairs  may  be  met  with  in  acute 
appendicitis  has  been  recently  pointed  out  t>y 
Sir  William  H.  Bennett,  (a)  who  has  shown  that 
a  sudden  fall  in  the  temperature,  together  with  a 
diminution  of  the  pulse-rate,  may  occur,  and  the 
patient  may  express  himself  as  much  more  com- 
fortable ,  while  the  state  of  the  appendix  is,  neverthe- 
less, going  steadily  from  bad  to  worse.  This  fallacious 
sign  of  improvement  was  accompanied,  in  the  case 
of  a  boy  of  fifteen,  by  gangrenous  inflammation  of 
the  appendix,  which  was  removed  by  operation. 
The  cessation  of  pain  and  the  apparent  ameliora- 


te sell  tobacco  to  boys  under  sixteen,  through 
Parliament.  The  various  organisations  which 
have  the  "  anti-smoking "  cause  at  heart  are 
becoming  more  and  more  active,  the  International 
Cigarette  League  having  600  branches  and  21,200 
members  in  this  country  alone.  A  badge  is 
worn,  and  a  member  caught  smoking  on  the  sly 
is  set  upon  by  his  comrades  and  deprived  of  his 
insignia.  These  Leagues  are  nothing  if  not 
militant,  and  so  long  as  they  confine  their  activities 
to  looking  after  the  youngsters  and  not  making 
themselves  ridiculous  they  are  to  be  commended. 


Erythema  Scarlatiniforme  Desquamativum 
Recidivans. 
One  is  not  surprised  to  find  that  the  description 
tionof  the  symptoms  was  due,  in  reality,  to  septic  'of  an  affection  with  this  ponderous  designation 


intoxication  from  the  focus  of  disease.  Sir  William  conies  from  the  pen  of  Kramsztyk,  and  is  to  be 
Bennett  also  points  out  that  a  sudden  drop  in  the  found  in  the  Dermatologische  Zeitschrift.  But  in 
temperature  is  not  infrequently  the  precursor  of  sPite  of  its  forbidding  title  the  disease  is  one  that 
gangrene  in  appendicitis,  so  that  such  a  fall  is  claims  very  careful  consideration,  for  though  the 
often  to  be  interpreted  as  a  signal  of  danger.  ,  condition  is  rare,  its  recognition  would  save  one 

1  from    an     unfortunate  error    if    one  came   upon 

Juvenile  Cigarette-Smoking.  .it     unawares.       Relapsing     desquamative     scar- 

Sir  Walter  Raleigh  has  much  to  answer  for,  I  iatiniform    erythema,    as    its    name    implies,    is 


probably  more  than  most  of  the  characters 
described  in  his  "  History  of  the  World."  For 
did  he  not  introduce  into  Europe  the  weed  that 
has  been  the  source  of  more  theoretical  discord 
and  practical  solace  than  any  other  substance 
except  alcohol  ?  It  would  hardly  be  too  much 
to  say  that  of  the  physiological  and  pathological 
effects  of  tobacco-smoking  we  know  next  to  nothing, 
which,  considering  the  enormous  quantity  of 
tobacco  that  is  annually  consumed  in  Europe — 
7,000,000,000  cigarettes  are  smoked  in  England 
alone  every  year — argues  that  it  cannot  be  such 
a  deadly  poison  after  all.  Nicotine  is  debited  by 
the  non-smoker  with  all  the  vices  outside  the 
decalogue,  but  the  proportion  of  nicotine  in  the 
modern  light  tobaccos  is  almost  negligible.  Such 
effects  as  are  produced  are  probably  far  more 
due  to  other  empyreumatic  substances,  so  complex 
as  to  mock  the  efforts  of  the  analyst,  but  the 
blessed  word  "  nicotine  "  still  bears  the  brunt  of 
the  objurgatory  onslaughts  of  tobacco-detractors. 
The  chief  disability  that  tobacco-smoking  has 
been  demonstrated  to  place  its  adherents  under 
is  a  slight — very  slight — loss  of  muscular  power, 
but  this  is  so  infinitesimal  that  it  is  hardly  worth 
considering.  Intemperate  smokers  sometimes 
suffer  from  temporary  cardiac  palpitation,  and 
more    or    less    chronic    pharyngitis    with    hyper 


an  affection  whose  cutaneous  appearance  is  that 
of  a  punctate  erythema  like  that  in  scarlet  fever, 
while  it  further  apes  that  disease  by  being  fol- 
lowed by  desquamation.  In  fact,  its  diagnosis 
presents  great  difficulty,  unless  the  patient  has 
had  former  attacks.  The  throat  and  tongue 
lesions  that  are  so  characteristic  of  scarlet  fever 
form  a  useful  means  for  differentiating  between 
the  diseases,  but  in  mild  scarlet  fever  the  fauces 
and  tongue  may  be  so  slightly  affected  that  too 
much  reliance  must  not  be  placed  on  their  aid. 
Even  the  course  of  the  disease  will  not  always 
decide  the  point,  as  otitis  media  and  even  nephritis 
have  been  noted  as  sequels  of  desquamative 
erythema.  The  only  certain  guide  to  a  correct 
interpretation  of  the  symptoms  is  to  be  found  in 
the  occurrence  of  previous  attacks.  In  the  three 
cases  reported  by  Kramsztyk,  one  had  had  no 
less  than  nine  attacks,  and  the  other  two  had 
had  two  and  three  respectively.  The  conditions 
would  seem  to  be  a  general  infection  of  a  similar 
nature  to  the  other  exanthemata,  not  merely  a 
local  skin  affection  as  has  been  thought.  There 
has  been  but  little  attention  paid  to  desquamative 
erythema  in  this  country,  and  probably  most 
medical  men  have  not  met  with  instances  of  it 
in  their  practice.  It  is  well,  however,  to  be  on 
one's  guard,  for  the  diagnosis  of  scarlet  fever  is 


trophy  of    the    adenoid    tissue    of    the    posterior  i  puzzling  enough  without  this  added  terror  lying 
pharyngeal  wall  is  common.      Beyond  these    it  in  wait  ^  catch  one  tripping. 

is  extremely  difficult  to  trace  any  physical  derange-  j  

ment  to  tobacco,  except  the  rare  tobacco-amblyopia. 
The  worst  results  of    smoking    are    undoubtedly  . 


Contaminated  Shell-Fish. 

The  dangers  of  eating  raw  shell-fish,  not  only 
moral,    over-indulgence    of    the  habit  tending  to  !  oysters,  but  mussels,  whelks,  et  hoc  genus  omne, 


produce  contentment,  inertia,  and  lethargy  in 
its  devotees.  It  is  really  for  these  reasons  that 
juvenile  smoking  should  be  discouraged,  and  the 
British  Anti-Tobacco  League  may  do  some  good 
if  they  get  their  Bill,  proposing  to  make  it  an  offence 

(c)  Lnnrtt,  January  2nd,  1904. 


has  been  several  times  mentioned  in  these  columns, 
and  now  comes  an  authoritative  pronouncement  on 
the  subject.  It  takes  the  form  of  an  interim 
report  by  the  Royal  Commission  on  Sewage 
Disposal,  which  has  been  sitting  for  some  years. 
The  report  is  clear  and  emphatic  as  to  the  possi- 


JsK.  *j,  1004 


NOTES    ON    CURRENT_TQPICS.         Tm  Meimcal  PRltss. 


bility  of  contaminated  shell-fish  being  the  cause 
of  enteric   fever   and  other  illnesses   in   man  ;   in 
rt  or  this  opinion  they  refer  to  the  disastrous 
consequences  that   followed   the  Consumption  of 
oysters— the  only  article  of  diet  that  the  guests 
ate  in  common — after  the  mayoral  banquets  at 
Winchester     and     Southampton     in     1903.     This 
□     is     supported     by     much      evidence, 
especially  that  of  the  medical  officers  of  health  of 
Brighton,  Yarmouth,  Southend  and   Manchester, 
t  om  mission  is  equally  clear  as  to  the  remedy — 
are  strongly  of  opinion  that  the  only  way 
uich  this  evil  can   be  effectively  dealt  with 
placing  tidal  waters  under  the  jurisdiction 
me   competent   authority/*     The    authority 
is  the  Kivers  Board,  the  local  body  which 
now  administers  the  Rivers  Pollution  Prevention 
Glad   as  one  is   to   hear  a   good   principle 
phatically  stated,  one  cannot  help  regretting 
that  the  proposed  new  powers  are  not  to  be  con- 
ierred  on  the  local  sanitary  authority,  for  not  only 
•  ase- prevention  their  function,  but  they  have 
a  trained  expert  to  advise  them  on  these  matters, 
which  the  Rivers  Board  has  not.     In  the  absence  of 
such  advice,  the  Rivers  Board  could   not  be  ex- 
pected intelligently  to  anticipate  and  deal  with 
all  the  sources  of  danger  that  might  arise.     To 
medical  men  the  remarks  of  the  Commission  on  the 


71 


From  the  morevmaterial  amT  hygienic  standpoint 

there  is  much  to  be  said  in  favour  of  the  suggestion 

which   has   been   made   to   allow  smoking  in  our 

public     rearlin^-rooms.     As    a     disinfectant,     the 

funics    of    tobacco    would    possibly    be    useful  in 

toting  many  forms  of  infectious  complaints, 

the    concession,  if  adopted,  would    be  one 

which  would  be  appreciated  by  large  numbers  of 

the   working-classes.     The   chief   objection   seems 

to    be    one    of    accommodation,    for,    obviously, 

rate   news-rooms    lo    those   already   provided 

would  reqi  built,  and,  on  grounds  ot 

alone,  the  idea  might  have  to  be  abandoned 
in  certain  districts.  Special  precautions  would 
have  to  he  taken  and  strict  rules  enforced  with 
regard  to  spitting, but  if  should  not  be  a  matter  of 
difficulty  to  provide  fixed  receptacles  which  might 
serve  the  double  purpose  of  ash-tray  and  spittoon. 
An  object-lesson  as  to  the  proper  disposal  of 
sputum  would  thus  be  constantly  before  the  public. 

Education  by  Suggestion. 

Mr,  Hamilton  Arch  (bald  has  been  conducting 
a  series  of  experiments  on  school -children  with 
the  idea  of  showing  how  much  can  be  done  in  the 
way  of  teaching  children  by  suggestion.  Under 
the  influences  brought  to  bear  large  numbers 
of    children    were    induced     to     believe    (or    say 


significant.    Hitherto  the  presence  of  Banff  us 

ioli  communis  in  shell-fish  has  been  regarded  as 

nee  of  contamination,   but  Dr,  Houston,    at 

the    Commissioners'     bidding,     examined     ipoo 

us  beds  and  layings,  and  found 

that  from    nearly    all,   including  those    from   ob- 

-:v    pure    sources,  that    organism    could    be 

obtained  by  culture.     The  oysters  from  the  more 

bo]  sources,  as  a  rule,  showed  a  larger  number  of 


help  that  may  be  expected  from  bacteriology  arc  j  they    believed)    quinine    was    tasteless,    eau    de 

Cologne  did  not  smell,  and  such-like  absurdities. 
Of  course,  Mr.  Archibald's  idea  was  not  to  impress 
such  nonsense  on  the  young  mind,  but  only  to 
see  how  far  the  process  could  go  in  dealing  with 
children.  It  is  difficult  to  make  out  what  was 
gained  by  the  experiments  except  a  demonstration 
of  the  well  -  known  fact  that  the  psychological 
attributes  of  a  collection  of  individuals  is  not 
the  sum   of   the   psychological   attributes  of  the 


bacilli   than    those    from    pure    sources,    and    the  j  component    individuals,    and   of   the   even    better 


iggest  that  it  may  be  possible  in  the 
hrtnre  to  establish  a  quantitative  test,  but  in  the 
time  the  significant  remark  is  made  that 
"results  ot  bacteriological  examination  must  be 
interpreted  in  the  light  of  topographical 
observations/' 

Smoking  in  Reading-Rooms. 
QriOlts  differ  considerably  with  regard  to  the 
[    produced    upon    the    mental    faculties    by 
m^  whilst  engaged  in  reading,    Manystudcnts 
:  1  hut  1  he  habil  is  01s  tracking,  and  one  which 
i  r ked  I y  t  he  po \v e r  of  Co ncen  t ra t  i on ,     On 
-   believe  just   as  strongly 
that  il   renders    the   perceptive    faculties    keener, 
ami  actually  enables    them    to    do    better   work, 
largely  a  matter  of  custom,     If  it  be  granted 
that  smoking  may  sometimes   be  an   undesirable 
-lpamment  of  hard  study,  it  is  quite  other- 
where light  reading  tor  purposes  of  iccreation 
The  subtle  aroma  of  the  fragrant 
d  seems  then  13  lend  enchantment  to  the  plot 
and  increased  vividness   to   the  scene,   while   the 
!:ng  wreaths  of  smoke  become  transformed 
ULtQ  vm table  garlands  ready  to  weave  themselves 
heads    oi    our    favourite    characters. 


known  one  that  some  children  will  say  anything 
they  arc  expected  to  say.  It  is  to  be  sincerely 
hoped  that  such  a  method  of  instruction  will  find 
no  place  in  our  educational  system.  Hypnotic 
suggestion,  or  quasi-hypnotic  suggestion,  is  likely 
bo  prove  gravely  deleterious  to  weak  and  unstable 
minds,  and  the  object  of  education  should  be 
to  educate,  to  bring  forth,  the  powers  latent  in 
the  mind,  not  to  stuff  it  with  suggestions 
good,  bad,  or  indifferent.  The  only  legitimate 
way  in  which  suggestion  may  be  employed  is  bv 
the  example  of  the  teacher's  own  conduct,  but 
to  introduce  even  beneficial  knowledge  by  the 
exercise  of  suggestion  to  enthralled  children  1- 
only  deplorable  in  its  stupidity,  but  positively 
baneful, 


Voluntary  Cardiac  Inhibition. 

The  power  of  directly  controlling  the  action  ot 
the  heart  is  a  rare  attainment  possessed  by  a  few 
individuals  only.  It  is  generally  supposed 
that  this  ability  is  entirely  dependent  upon  the 
*th  of  the  will,  the  exercise  of  which  is  known 
to  influence  many  of  the  bodily  functions.  Some 
physicians  have  been  enabled  to  inhibit  voluntarily 
their  own  cardiac  action,  but  recognising  that  the 


F  72    The  Medical  Prkss.  NOTES    ON    CURRENT    TOPICS. 


Jan.  20,  1904. 


practice  is  not  unattended  by  danger,  have 
wisely  abstained  from  exhibiting  this  strange 
power.  The  presence  in  this  country  of  a  certain 
Hindoo  Mahatma,  who  is  accredited  with  the 
power  of  thus  directly  producing  complete  cardiac 
inhibition,  has  naturally  aroused  considerable 
sensation  in  the  public  Press.  The  practice,  how- 
ever, is  assiduously  cultivated  by  many  of  the 
Indian  jugglers  and  "  holy  men."  Any  power  by 
which  man  is  enabled  to  exert  a  mysterious  in- 
fluence over  himself  or  others  at  once  renders  that 
individual  an  object  of  reverence  to  the  super- 
stitious Easterns,  who  believe  him  to  be  in  touch 
with  the  supernatural.  The  effect  upon  the  heart 
produced  in  this  way  is,  in  all  probability,  due  to 
increased  inhibition  through  the  vagi.  It  is  well 
known  that  tumours,  or  other  morbid  conditions 
affecting  these  nerves,  may  inflaence  the  rate  of  the 
heart-beat  considerably,  as  in  the  celebratedCzermak 
of  Prague,  who,  by  pressing  upon  a  cervical  tumour, 
was  able  to  slow  his  heart  at  will.  The  case  of 
the  late  Lieut. -Colonel  Townsend  is  an  instance  of 
the  possession  of  a  similar  power,  but  he  did  not, 
according  to  Fothergill,  kill  himself  by  the  too 
frequent  repetition  of  the  inhibitory  process.  It 
is  far  more  common  to  meet  with  cases  in  which 
a  slight  degree  of  slowing  of  the  heart's  action  may 
be  observed  during  intense  thought,  the  passing  of 
a  strong  emotion,  or  the  endurance  of  great  phy- 
sical pain,  when  the  effect  may  be  said  to  differ 
little  from  an  ordinary  reflex. 


The 


Criminals  and  Union  Infirmaries. 

We  desire  to  draw  the  attention  of  the  public 
to  a  development  under  the  General  Prisons 
Board  that  is  pregnant  with  evil  for  all  union 
infirmaries.  By  a  new  rule,  convicts  who  are  ill, 
especially  if  near  the  expiration  of  their  term  of 
penal  servitude,  can  be,  and  are,  removed  to 
union  infirmaries,  where  five  shillings  a  week  is 
paid  for  their  keep.  The  following  example  of 
this  came  before  the  Mountmellick  Board  of 
Guardians.  On  December  26th  last  the  governor 
of  Maryborough  prison  sent  for  the  Mountmellick 
ambulance  to  convey  a  convict  from  the  prison 
to  the  union  infirmary,  the  Prison  Board  paying 
five  shillings  a  week  for  his  keep.  This  convict 
patient,  one  Costelloe,  had  been  thirty-nine  years 
in  the  U.S.A.  ;  he  was  convicted  of  forgery  com- 
mitted in  Wexford,  he  was  in  bed  for  the  past  year, 
and  was  within  a  few  months  of  the  expiry  of  his 
term.  That  a  sick  convict  should  get  proper 
medical  advice  and  medicines  goes  without  saying, 
but  that  advice  and  medicine  should  be  provided 
within  the  gaol  infirmary.  During  the  past  ten 
years  the  medical  profession  and  the  public  have 
been  working  harmoniously  together  to  make  the 
workhouse  infirmary  less  distasteful  to  the  poor, 
particularly  in  country  places.  It  has  been  sug- 
gested to  remove  them  from  the  workhouse  where 
possible  and  call  them  district  hospitals.  Every- 
body confesses  that  an  infirmary  in  each  union 
for  the  treatment  of  accidents  and  infectious 
diseases  is  most  desirable.  The  action  of  the 
Prisons  Board  will  check  this  movement,  and  will 
accentuate  the  old  objections  to  the  infirmaiy. 


Non-Surgical  Treatment  of  Floating 
Kidney. 
When  the  risk  of  surgical  procedures  has  been 
so  greatly  reduced  as  it  has  been  in  the  last  decade 
or  two,  there  is  a  natural  temptation  on  the  part 
of  medical  men  to  call  in  the  surgeon  to  trouble- 
some cases  that  do  not  yield  early  to  medical  * 
treatment.  The  recognition  of  a  movable  kidney 
as  the  cause  of  many  elusive  but  distressing  sym- 
ptoms, and  the  difficulty  of  effectively  dealing  with 
the  condition  when  diagnosed,  have  led  to  many 
operations  for  fixing  the  kidney  to  the  posterior 
abdominal  wall  by  one  method  or  another.  It 
cannot  be  said  that  the  success  of  these  procedures 
has  been  as  great  as  was  at  first  anticipated,  and 
many  patients  have  been  disappointed  after  having 
undergone  a  severe  operation  to  find  the  old  con- 
dition return  again  in  a  year  or  two's  time.  Fixing 
the  kidney  by  external  bands  and  pads  is  usually 
an  unsatisfactory  process ;  though  it  answers  well 
enough  in  some  cases,  in  the  majority  it  gives  but 
slight  relief.  Aaron,  of  Detroit,  writing  from  an 
experience  of  442  cases,  attributes  the  non-success 
of  this  method  to  want  of  accuracy  in  the  making 
and  fixing  of  the  belts.  He  maintains  that  the 
proper  shape  and  size  of  the  belt  can  only  be 
determined  by  the  physician,  whereas  in  practice 
it  is  usually  left  to  the  instrument  maker.  He  says 
that  no  trouble  is  too  great  to  be  taken  in  mapping 
out  the  position,  range  of  movement,  and  relations 
of  the  kidney,  and  that  when  this  is  done  belt  after 
belt  (if  necessary)  must  be  made  till  the  indica- 
tions are  exactly  fulfilled.  Aaron  himself  inflates 
the  colon  with  gas  to  make  sure  that  there  is  no 
coloptosis,  and  even  takes  a  model  of  the  abdomen 
with  pliable  lead  to  obtain  the  exact  shape  of  the 
lower  edge  of  the  kidney — the  spot  where  the 
greatest  pressure  should  come.  By  taking  all 
these  [precautions  and  getting  a  band  that  uni- 
formly compresses  the  lower  abdomen,  with  a  pad 
pressing  ^the  displaced  organ  upwards  and  back- 
wards, he  claims  to  have  cured  215  cases  out  of  442, 
whilst  168  improved,  and  59  were  either  not  re- 
lieved or  passed  from  observation.  If  by  adopting 
his  methods  similar  results  are  obtained,  a  great 
many  disappointing  operations  may  be  avoided. 


Infectivity  of  Acute  Rheumatism. 
Taken  in  connection  with  the  recent  researches 
of  Dr.  Ainsley  Walker  and  others  into  the  causation 
of  acute  rheumatism  and  the  study  of  a  supposed 
specific  organism,  it  is  important  to  note  every 
occurrence  of  the  disease  where  there  appears  to  be 
a  direct  infection  from  one  patient  to  another. 
Just  as  formerly  in  the  case  of  pneumonia  the 
apparent  rarity  of  infection  was  made  an  argument 
against  the  doctrine  of  bacterial  origin,  so  nowadays 
with  acute  rheumatism.  Nevertheless,  there  are 
on  record  several  instances  of  outbreaks  of  the 
disease  impossible  to  explain  by  any  other  hypo- 
theses. One  of  the  best  instances  we  have  seen  is 
that  recently  reported  by  Mr.  Sydney  Hawthorne, 
of  Murree,  U.S.A.,  (a)  in  which  no  less  than  six 

(a)  British  Medical  Journal,  December  2«,  1908. 


Jam,  30,   1904- 


SPECIAL  CORRESPONDENCE, 


Thx  Medical  P*ess       73 


members  of  one  family  were  struck  down  one  after 
the  other  by  acute  rheumatism.  The  diagnosis 
was  not  open  to  question ,  as  it  was  made  in  some 
of  the  cases  independent! y,  by  himself  and  by  two 
other  physicians.  Nor  was  the  cause  apparently 
iay  common  condition  other  than  in  fee Lion  t  such 

•d  or  damp,  since  the  outbreak  occurred  in 

t he  middle  of  prolonged  d ro u gh I .     We  d raw  alten- 

[f.  Hawthorne's  cases  because  we  believe 

that  in  the  investigation  of  the  etiology  of  dis 

epidemiological  study  must  go  hand  in  hand  with 

notogical,  ajid  while  the  latter  must  remain 

pally  in  the  hands  of  laboratory  workers,  the 
former  is   the   special   field  of   the   general   prac- 

icr. 


PERSONAL. 


Mrs.  Jane  Gabriel  has  presented  £1,000  to  Charing 
Crow  Hospital  to  endow  a  bed  in  memory  of  her  hus- 
the  late  Mr.  Arnold  Gabriel. 


the  next   meeting  of  the  Royal  Microscopical 
ty,  on  Wednesday,  January  20th,  at  8  p.m.,  Dr. 
Woodward  will  deliver  hh  Residential  Address  on  the 
Evolution  of  Vertebrate  Animals  in  Time, 


Wc  regret  to  announce  the  death  of  Mrs.  Allingham, 
J  Mr,  H.  W.  Alhngham,  RR.CS>,  of  Grosveuor 
VV\,  and   the  Orchard,  Marlow,  Surgeon  lo  I  lis 
Majesty  \  Household,  at  Marlow  on  Wednesday  last* 

J-  W.  Taylor,  F.R.C.S.,  Professor  of  Gyn 
m  the  Birmingham   University,  has  been  elected 
Prudent  of  the  British  Gynaecological  Society,     Full 
1  office-bcarera  elected  on  Thursday  last  will  be 
t  ui  our  news  columns. 


Im-hing  his  recent  visit  to  Chatsworth,  His  Majesty 

Aing   was    attended    by   Dr.    £,    M.    Wrench,   of 

Easlow,     Before  leaving  the  district,  the  King  calif < I 

M  Ur.  Wrench's  house,  and  left  with  him  a  diamond 

pm  And  Other  sou  Ins  Royal  patient. 

The  retirement  is  announced  of  Dr.  J.  S.  Wall  bridge, 
«  Medical  Department  of  British  Guiana,  on 
on    after    twenty-seven     years'  service    in  that 

Goiaay,    Rib  district  will  be  taken  over  by  Dr.  J,  E.  A. 

Fergusern,  who  has  had  charge  oi  the  Bet  field  District. 

Process  Christian  (the  President),  accompanied 

Jincess  Vic  ton  a  of  Schles  wig- Hols  tein,  visited  the 

I  Free  Hospital,  Gray's  Inn  Road,  on  Wetlm  - 

nuxm  last,  and  distributed  the  presents  from  the 

'mas  tree  which  she  had  provided  for  the  patients 

tod  nurses. 


0?f  January  7th.  at  St.  John's,  Worcester,  an  illu* 
rmnated  congratulatory  address  and  a  silver  tray  were 
presented  to  Dr,  and  Mrs.  Polsmi.  The  tray  bore  the 
mucriplion  :  N  Presented  to  Dr.  and  Mrs.  J.  Ronald 
Poison  upon  the  occasion  of  their  marriage,  February 
1903,  by  friends  and  pa tj cuts  of  Dr.  Poison.  *  I 
was  sick,  and  ye  visited  me/  *' 


last  Thursday  delivered  the  first  of  a  series  of  six 
lectures  on  "Medical  Jurisprudence M  at  the  Old  Hall, 
Lincoln's  Inn,  under  the  auspices  of  the  Council  of 
Legal  Education.  The  next  lecture  of  the  series,  to  be 
dehvere.1  on  January  21st,  will  have  as  its  subject* 
"  Birth  in  Relation  to  Civil  and  Criminal  Law." 


We  are  glad  lo  be  able  to  announce  that  the  long 
drawn  out  Scotch  quarry  dispute  has  at  last  been 
settled  by  the  reinstatement  of  Dr.  Lachlan  Grant  as 
medical  officer,  and  the  return  of  the  quarriers  to  their 
work.  The  case  stands  out  from  all  others  on  account 
of  the  prolonged  stand  the  men  made  for  their  medical 
fend  their  unswerving  determination  never  to 
return  lo  their  work  until  justice  had  been  done  to  him. 

Special  correspondence, 

[from  our  own  correspondents.] 
SCOTLAND. 


J  Waldo,  Coroner  for  the  City  of  London, 


Edinburgh  Royal  In  fir  mar  y, — During  the  year  that 
has  just  gone  by  important  changes  have  been  made  in 
the  regulations  of  this  institution,  and  in  that  in  which 
we  have  now  entered  it  seems  as  though  a  continuance 
of  the  reforming  spirit  will  effect  still  further  alterations, 
and  indirectly  may  have  an  important  influence  on  the 
rsity  and  whole  medical  school.  Hitherto  the 
tenure  of  office  of  the  physicians  and  surgeons  has  been 
limited  to  a  period  of  fifteen  years  without  any  age 
limit,  and  the  vacancies  occurring  have  been  filled  up, 
almost  as  a  matter  of  routine,  from  the  assistant  staff. 
Last  summer  the  managers  decided  that  for  this  arrange* 
id.  which  t&ey  fixed  &l  sixty,  should  be 
substituted  ;  they  also  arranged  that  the  senior  assistant 
surgeon  and  physician,  under  whose  care  the  wards 
reserved  for  the  teaching  of  women  were  placed,  should 
henceforth  rank  as  full  surgeon  and  physician.  The 
rule  was  passed  without  consultation  with  the  staff,  and 
called  forth  considerable  opposition  from  the  latter, 
and  +  as  a  result  of  the  action  which  the  staff  took,  the 
rule  was  so  far  modified  that  the  age  for  retiring  was 
fixed  at  sixty -five  instead  of  sixty  years.  The  rule 
applied  to  the  assistant  staff  and  to  such  of  the  physi- 
cians and  surgeons  as  had  not  yet  entered  the  second 
live  years  tH  their  fifteen-year  period.  The  University 
Professors,  fcOO,  were  exempted  from  the  operation  of 
the  rule,  and  as  three  holders  of  chairs  act  as  physicians, 
two  as  snrgeuns,  and  one  as  a  gynaecologist,  a  not 
inconsiderable  proportion  of  the  staff  are  thus  placed  at 
some  advantage  as  compared  with  their  less  fortunate 
colleagues.  At  the  annual  meeting  of  the  Court  of 
Contributors,  held  on  January  4th,  when  the  report  of 
the  Infirmary  was  submitted  for  approval  a  motion— 
M  That  in  the  public  interest  the  age  limit  enacted  by 
the  managers  for  the  ordinary  physicians  and  surgeons 
be  made  to  apply  as  well  to  the  physicians  and  surgeons 
of  the  institution  nominated  by  the  University*' — 
was  carried  by  46  votes  against  23,  in  favour  of  re- 
mi t ting  the  question  to  the  managers  for  consideration 
and  report  next  year.  The  meetings  of  the  Court  of 
Contributors  are  usually  purely  formal,  and  not  largely 
attended,  and  it  was  probably  a  surprise  to  many  of 
entitled  to  vote  at  them  to  learn  how  great  the 
power  of  the  Court  is,  tor  it  seems  that,  according  to  the 
Infirmary  Act  of  iS;c>,  the  managers  are  bound  to  give 
effect  to  their  recommendations.  This  point,  however, 
is  somewhat  uncertain,  ami  it  must  be  left  to  the 
lawyers  to  decide  which  oi  two  clauses  in  the  Act,  one 
of  which  provides  that  the  managers  *'  may  adopt  ** 
recommendations  of  the  Court,  and  the  other  of  which 
empowers  the  Court  to  alter  or  make  new  statutes* 
applies  in  the  present  instance.  The  Committee  of 
the  Contributors,  whose  duty  it  is  to  examine  the 
managers*  report  and  to  report  thereon  to  the  adjourned 
meeting  of  the  Court  of  Contributors  to  be  held  on  the 


74     Thb  Mspkal  Press. 

1 8th  inst,  deal  with  the  matter  in  these  words: — 
"  At  the  meeting  of  Contributors  held  on  January  4th, 
a  motion  was  carried  which  enacted  a  new  rule  putting 
the  Professors  who  hold  wards  on  the  same  footing  as 
regards  an  age  limit  as  the  medical  and  surgical  officers 
who  would  be  affected  by  the  new  rule  framed  by  the 
managers.  That  new  rule,  although  referred  to  in  the 
motion  as  to  an  age  limit  for  Professors,  and  therefore 
possibly  by  implication  approved  of  by  the  Court  of 
Contributors,  has  not  been  formally  sanctioned  by  the 
Court,  and  technically  it  may  be  open  to  question 
whether  the  rule  as  to  the  Professors  was  in  order  in 
being  passed."  The  appointment  of  a  Joint  Committee 
of  the  managers  ana  Contributors  to  consider  this 
difficult  and  delicate  question  is  suggested,  its  serious 
importance  requiring  ample  time  for  deliberate  con- 
sideration. In  this  position,  therefore,  the  matter  rests 
at  present,  and  pending  the  decision  of  the  adjourned 
meeting,  its  discussion  may  be  postponed. 

Annual  Report  of  the  Royal  Infirmary. — The 
total  number  of  in-patients  treated  was  10,484 — an 
increase  of  523,  the  death-rate  being  7*2  as  against 
8.3  last  year,  and  the  cost  of  maintenance  per  occupied 
bed  £64  is.  3}d.,  a  decrease  of  £1  os.  7d.  The  ordinary 
income  was  ^32,685,  an  increase  of  £64  ;  the  ordinary 
expenditure  £47,600,  an  increase  of  £407.  The 
difference  was  met  from  the  extraordinary  income  of 
j£47,oo2.  The  bathing  department  was  opened  in 
February,  and  by  September  30th,  1.636  baths  of  various 
description  had  been  given,  supplying  a  want  long  felt. 
Fire  escape  staircases  had  been  completed  in  all  the 
medical  blocks,  and  those  on  the  surgical  side  improved. 
One  of  the  fire-brigade  is  now  constantly  on  duty  in 
the  infirmary.  The  Eye  and  Ear  and  Throat  pavilions 
are  now  occupied,  the  additional  sixty  beds  thus  afforded 
completing  the  extension  scheme  begun  thirteen  years 
ago.  The  wards  set  free  provide  additional  accom- 
modation for  female  cases,  and  a  much  improved  skin 
and  electric  department  are  being  arranged  for.  The 
report  then  states  the  new  rules,  referred  to  above. 
In  the  report  of  the  Contributors  on  the  above  report 
the  only  clause  of  importance,  apart  from  that  dealing 
with  the  age  limit,  is  one  requesting  information  from 
the  managers  on  the  proposal  to  institute  wards  for 
mental  cases,  and  hoping  that  the  matter  will  be  dealt 
with. 


CORRESPONDENCE. 


Jan.  20^1904. 


Correspondence- 

[We  do  not  hold  ovnelves  respoutibl*  for  the  opinions  of  our  corres- 
pondent*] 


BELFAST. 

Belfast  Corporation. — At  a  meeting  of  the  Public 
Health  Committee  of  this  Corporation  last  week,  Dr. 
James  Graham  resigned  the  chairmanship  of  the  com- 
mittee, which  he  has  held  for  thirteen  years,  and  also 
his  membership  of  the  committee.  Speeches  were 
made  expressing  the  sorrow  of  his  colleagues  at  his 
retirement,  and  referring  to  his  genial  and  kindly 
disposition.  These  compliments  were  well  deserved, 
but,  unfortunately  for  the  City,  it  is  not  geniality  and 
kindness  which  are  now  required  in  the  Public  Health 
Department.  What  we  badly  need  are  the  qualities 
that  have  made  Lord  Kitchener  so  successful,  and  until 
we  get  someone  who  is  at  least  a  faint  likeness  to  that 
type,  we  must  expect  municipal  jobbery  and  corruption 
to  flourish,  and  with  them  the  typhoid  bacillus. 

The  Food  and  Drugs  Act. — An  interesting  prose- 
cution under  this  Act  took  place  at  Ballymena  last 
week,  which  has  attracted  much  notice.  The  defen- 
dant was  nominally  a  tradesman  in  the  town,  but  in 
reality  the  action  was  against  a  large  Glasgow  manu- 
facturing firm,  who  supplied  the  article  in  question, 
known  and  sold  as  "  cooking  fat."  This  was  admitted 
to  be  a  manufactured  article,  containing  about  20  per 
cent:  cottonseed  oil.  The  inspector  of  foods  and  drugs 
withdrew  the  "  injurious  to  health "  clause  in  the 
summons.  One  of  the  partners  in  the  Glasgow  firm 
testified  that  they  had  manufactured  cooking  fats  for 
thirty  years,  and  sold  them  under  various  names,  and 
that  last  year  they  used  no  less  than  twelve  thousand 
tons  of  cottonseed  oil.  After  several  experts  had  been 
heard,  the  Bench  dismissed  the  case,  holding  that  the 
Act  had  not  been  contravened. 


THE  HOME  OFFICE  AND  THE  MEDICAL  PRO- 
FESSION. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — I  wisn  to  call  your  attention  to  a  recent 
correspondence  between  the  Criminal  Department  of 
the  Home  Office  and  Mr.  Collinson,  the  Secretary  of 
the  Humanitarian  League,  and  to  draw  some  conse- 
quences therefrom.  The  principles  involved  in  the 
final  answer  of  Mr.  Chalmers  are  not  new.  They 
appeared  in  the  Fortnightly  Review  for  September, 
1899,  in  an  article  evidently  from  the  pen  of  an  official ; 
but  as  it  was  anonymous  sufficient  attention  was  not 
paid  to  it.  The  present  case  was  as  follows  : — In 
the  year  1899  an  Act  of  Parliament  was  passed  which 
rendered  it  illegal  to  sentence  any  child  to  imprison- 
ment followed  by  detention  in  a  reformatory.  In  1903 
the  magistrates  at  Bishop  Auckland  sentenced  a  boy 
named  William  Ferguson  to  imprisonment  followed 
by  detention  in  a  reformatory.  They  seem  to  have 
discovered  their  blunder  very  speedily  and  informed 
the  Home  Secretary,  who  thereupon  remitted  the 
remainder  of  the  imprisonment  (the  sentence  having 
been  for  a  month),  and  directed  the  boy  to  be  sent  to 
the  reformatory  at  once.  The  illegality  of  this  sen- 
tence does  not  seem  open  to  question.  I  do  not  know 
what  term  the  boy  actually  spent  in  prison,  but  sup- 
posing it  to  have  been  forty-eight  hours,  a  sentence  of 
forty-eight  hours'  imprisonment  followed  by  three 
years'  detention  in  a  reformatory  would  have  been  as 
illegal  as  that  actually  passed. 

Mr.  Collinson  having  called  attention  to  the  illegality 
— the  combination  of  imprisonment  and  detention  in  a 
reformatory  being  illegal,  irrespective  of  the  actual 
duration  of  either  or  both  punishments — Mr.  Chalmers 
ultimately  repUed  on  behalf  of  the  Home  Secretary 
that  questions  of  legality  could  only  be  decided  in  a 
court  of  law,  whereas  the  Home  Secretary's  function 
was  to  advise  the  King  with  regard  to  the  exercise 
of  his  prerogative  of  mercy,  which  prerogative  had 
been  exercised  by  shortening  the  duration  of  Ferguson's 
term  of  imprisonment.  (Notwithstanding  this  shorten- 
ing, tne  punishment  which  is  being  inflicted  under  the 
authority  of  the  merciful  Home  Secretary  is,  as  already 
intimated,  in  excess  of  what  the  law  permits.) 

Of  course,  after  this,  the  Criminal  Department  of 
the  Home  Office  should  not  be  regarded  as  in  any  sense 
a  Court  of  Criminal  Appeal.  It  does  not  concern 
itself  with  questions  of  law  or  justice.  Its  function  is 
merely — taking  the  sentence  as  it  finds  it,  and  without 
inquiring  into  the  legality  either  01  it  or  of  the  trial 
which  resulted  in  it — to  consider  whether  there  are 
grounds  for  showing  mercy  to  the  prisoner  and  remit- 
ting the  sentence,  either  wholly  or  in  part.  Now,  this 
being  so,  of  what  use  is  legal  knowledge  on  the  part 
of  the  permanent  officials  ?  Why  should  they  be 
selected  (chiefly,  at  least)  from  the  members  of  the 
legal  profession  ?  Questions  of  law  are  quite  outside 
the  Home  Secretary's  province,  and,  it  may  be  added, 
that  if  any  question  of  law  did  accidentally  arise,  there 
are  high  legal  functionaries  whom  the  Home  Secretary 
could  always  consult  free  of  charge.  Knowledge  of 
law  is  no  guide  in  the  exercise  of  mercy..  But  one  of 
the  strongest  grounds  for  merciful  interposition  is  the 
mental  condition  ot  the  prisoner,  which  may  vary  irom 
perfect  responsibility  to  complete  insanity  (or 
idiocy),  with  a  different  degree  of  culpability  at  every 
stage.  Who  ought  to  advise  the  Home  Secretary 
as  to  the  exercise  of  mercy  in  such  cases  ?  Certainly 
not  a  barrister,  who  may  be  prejudiced  in  favour  ot  the 
legal  view  of  insanity  which  is  scouted  by  the  medical 
profession,  or  may,  at  least,  be  apprehensive  of  under- 
mining this  legal  view  by  the  too  frequent  exercise 
of  mercy  towards  persons  who  are  legally  sane.  The 
best  advisers  for  the  Home  Secretary  in  such  cases 
would  be  qualified  medical  gentlemen  who  had  paid 
special  attention  to  the  subject  of  mental  deficiency 


JXtLMXy^JiXn^ 


OBITUARY, 


Thk  Meoical  Press*     75 


and  disease.     And   another   kind   ol   case   frequently 
occurs  in  which  the  services  of  permanent   medical 
officials  would  be  equally  valuable.   Take,  for  example, 
the  famous  Jlaybrick  case.     We  do  not  know  what 
rpfidicat   gentlemen    the    Home    Secretary    consulted, 
lo  not  know  what  statement  of  the  case  was  laid 
re  them,  or  whether  they  were  left  to  read  such 
newspaper  reports  as  they  happened  to  have  in  their 
;    and  we  do  nut  know  how  their  opinions 
nd  whether  they  were  of    a  positive  or 
ot  doubtful   character.     Now/ although   it    would    be 
8iwte»  table  to  have  such  questions  settled  by  one  or 
man  permanent  officials,  their  services  would  otherwise 
of  the  utmost  value.     They  would   know  the 
names  of  the  specialists  whose  opinions  should  be  ob- 
tain*! m  such  a  case  as  that  before  them.  They  would 
*e  that  a  full  and  correct  statement  of  the  evidence 
Qg  on  the  medical  issues  was  sent  to  every  doctor 
who  was  thus  consulted.     They  would  be  able  to  ex- 
plain the  meaning  of  each  reply  received,  which  in  some 
might     contain     enough      technical     language 
Do  puizle   the    Home    Secretary    and    his    assistants  ; 
they  would  also  be  able  to  point  out  whether  any 
..it  ihe  doctor*   had   m  in  taken  the  evidence  or  based 
Opinion   (wholly   or  in  part)  on  matters  which 
not  in  evidence.     The  present  system  affords  no 
;ty  that  any  of  these  things  will  be  done. 
I  therefore   maintain    that    the   highest  officials  in 
this  department  should  not  be  barristers,  but  members 
e   medical    profession.     The    Home   Secretary   is 
i  more  concerned   *ith   medical  than  with  legal 
questions,  ami  as  regards  the  tatter,  he  is  abundantly 
irith  extern  assistance. 

1  am.  Sir,  yours  truly, 

A  Barrister. 
[The  clear  and  powerful  enunciation  of  our 
correspond  cut  calls  attention  to  a  matter  upon  tfttich 
tbe  mil  weight  of  medical  authority  has  never  been 
adequately  expressed,  For  centuries  past  law  has 
tailed  to  understand  medicine.— Ed. J 


age,  had  held  the  post  of  medical  officer  since  tS/i  or 
1872,  and  was  greatly  interested  in  all  movements  for 
the  welfare  of  the  town.  Of  late  years  he  had  retired 
from  general  practice,  although  he  continued  to  carry 
out  his  official  duties,  Deceased  leaves  a  widow  and  a 
son  and  daughter,  the  former  being  Mr.  C.  A.  S.  Gar- 
land, a  barrister  on  the  Western  Circuit,  and  Recorder 
ot  Winchester, 


©bttuarp. 

HENRY   BOYD  CARDEW.   M.R.CS.PEm.. 

L.R.C.P.  LONt>. 

Wk  regret    to   announce    the   death   of   Mr.    Henry 

!  Cardew,  of  Cheltenham,  at  the  early  age  of  thirty- 

-hort  illness.     He  was  the  elder  son 

1  M  .1,  '■■[ -1  ..iP  ril  Henry  Cardew,  a  retired  officer  ot  the. 

Artillery,      Upon  leaving  Cheltenham   College, 

early  education  was  received,  he  entered  at 

■.■.rih'.-loTut  w's  Hospital  and  eventually  took  the 

d  the  Royal  College  of  Surgeons  of  England 

and  the   Royal  College  of  Physicians  of    London  in 

Returning     to     Cheltenham     he     commenced 

a  practice  in  1894.    But  he  continued  for  several 

later  10  hold  the  position  of  honorary  medical 

officer  to  the  b ranch  dispensary  of  the  hospital  and  t<  the 

He  was  married  in  1895  to  Miss  Agnes 

-■-,  third  daughter  of  the  late  Mr,  Thomas  Moore. 

f  Blackheath.  and  leaves  a  widow  and  four 

daughters.     The  deceased  was  a  well-known  figure  in 

ithletie  and  social  world,  and  his  early  death 

will  be  the  cause  of  wide-spread  regret. 


SIR  WILLIAM  RAYMOND   KYNSEY,  M.D.,   J.P., 
CM.G. 
Sir  William  Raymond  Kynsey,  late  Principal  Civil 
Medical  Officer  and  Inspector  General  of  Hospitals  in 

Ceylon,  died  at  his  residence,  Courtenay  House,  Hor- 
sham, on  Monday  week,  in  the  sixty*fourth  year  of  his 
age.  Son  of  the  late  Dr,  Thomas  Brett  Kynsey,  M.D., 
J,  P.,  of  A  thy,  co.  Kildare.  he  was  born  in  1840,  was 
educated  at  Trinity  College,  Dublin,  and  was  admitted 
a  Licentiate  of  the  Royal  College  of  Surgeons.  Ireland, 
in  1861,  and  of  the  Royal  College  ot  Physicians,  Ireland, 
the  following  year.  He  joined  the  Medical  Service  of 
the  Army  in  September,  1863.  and  served  in  the 
Ashantee  War  of  1873-4.  when  he  was  present  at  the 
capture  of  Coomassie,  for  which  he  had  the  medal. 
In  1875  he  was  placed  on  half -pay  on  appointment  as 
Principal  Civil  Medical  Officer  in  Ceylon,  and  in  1S8G 
after  having  been  admitted  a  member  in  t&SO, 
elected  a  Fellow  of  the  Royal  Co  Siege  of  Physicians, 
Ireland.  He  held  his  official  appointment  in  Ceylon 
until  1 899,  and  while  resident  there  rilled  various  other 
offices,  including  that  of  a  member  ot  the  Legislative 
Council,  a  Magistrate,  a  visitor  of  the  gaols  of  the  Island, 
and  a  Municipal  Councillor  of  Colombo.  He  was 
decorated  with  the  C.M.G.  in  18S8,  and  was  Knighted 
in  1897.  Sir  W.  Kynsey  married,  in  t866>  Isobel  Keith. 
daughter  of  the  late  Captain  J.  K.  Jolly,  of  the  East 
India  Company's  Service,  of  Fari eland,  Kandy,  Ceylon. 


DR.  DETWEILER,  OF   K  RON  BERG. 
telegram  from  the  Berlin  correspondent  of  the 
Standard,   announces    iha   death   of   Privy   Councillor 
Dr.  Peter  Detweder,  who  died  suddenly,  at  Kronberg, 
aged  I  he   deceased   was    well   known   in 

connection  with  his  open-air  treatment  of  tuberculosis. 


LIEUTENANT  J.  K.  WELLAND,  R.A.M.C. 
We  deeply  regret  the  death  of  a  promising  member 
of  the  Royal  Army  Medical  Corps  in  the  recent  battle 
at  Jidballi  in  Somaliland  briefly  referred  to  last  week. 
Lieutenant  Wei  land  was  one  of  three  officers  killed  at 
that  engagement,  and  no  further  particulars  have  as 
yet  reached  home  other  than  that  he  was  killed  by  a 
spear  thrust.  Lieutenant  Wei  land  graduated  in 
Dublin  University  in  the  year  1900,  and  entering  the 
Royal  Armv  Medical  Corps  was  shortly  after  sent  to 
Somaliland  where  he  served  with  the  o'th  Batallion  of 
the  King's  African  Rifles.  Last  year  he  was  invalided 
hut  returned  again  to  Somaliland  in  the  autumn. 
Welland  was  a  well-known  athlete  during  his  student 
career  in  Trinity  College,  and  stroked  the  Dublin 
University  eight  on  many  occasions,  notably  in  their 
contest  with  the  Pennsylvania  crew  in  tooi.  He 
leaves  a  widowed  mother  to  whom  we  offer  our  deep 
sympathy. 

Society  for  Belief  of  Widow*  and  Orphans  of  Medical  Men. 
At  the  quarterly  courL  of  the  directors  of  this  society, 
held  on  Wednesday  last,  the  president,  Mr.  Christopher 
Heath,  in  the  chair,  three  new  members  were  elected, 
and  Hie  death  of  a  member  reported.  There  wen;  no 
fresh  applications  t«»r  grants.  It  was  resolved  to  dis- 
tribute £1.315  among  the  53  widows,  15  orphans,  and 
4  recipients  from  the  Copeland  Fund,  now  m  receipt  ot 
grants.  A  sum  of  £5 So  had  been  given  at  Christmas  as 
a  present,  £10  each  to  53  widows.  £$  each  to  t2  orphan*, 
and  £s  each  to  the  4  orphans  on  the  Copeland  Fund. 
The  expenses  of  the  quarter  were  £??   12s.  6d. 


The  increasing  use  of  oxygen  for  medical  purposes 
renders  it  desirable  lor  every  practitioner  to  have  an 
address  at  hand  to  send  to  incase  of  emergency.  The 
well-known  makers  tit  oxygen,  Messrs.  Brin  and  Co., 
who  may  indeed,  be  called  the  pioneers  of  that 
particular  trade,  have  issued  a  remarkably  neat  lit  tie 
pocket  diary  which  contains  their  new  address.   Much 


DR.  E.  C.  GARLAND. 

1 11 1  such  J  en  death  was  announced  on  the  10th  ins  taut 
OJ  Dr.  1%,  C.  Garland,  the  Medical  Officer  of  Health  tor 
tbe  borough  ol  Yeovil,  He  had  attended  a  meeting  of 
the  Town  Council  in  the  afternoon,  and  was  afterwards 
rig  in  the  Municipal  Offices,  when  he  was  taken 
ill  He  was  carried  home  in  a  cab,  and  expired  shortly  |  useful  information  as  to  oxygen  is  appended  to  this 
itterwards.     Deceased,  who  was  sixty-nine  years  of     handy  little  book. 


76    Thb  Medical  Press. 


LITERATURE. 


Jan.  20.  1904. 


Xtterature. 


VON    NOORDEN    ON    THE    PATHOLOGY    AND 

THERAPY    OF    DISEASES    OF    METABOLISM 

AND  NUTRITION,  (a) 

These  little  monographs  constitute  a  most  welcome 
addition  to  the  library  of  the  physician.  They  are 
clearly  and  boldly  written,  are  the  result  of  prolonged 
scientific  work  and  contain  much  that  is  new,  and  in 
places  even  revolutionary.  The  monograph  on  nephri- 
tis is,  perhaps,  the  most  interesting,  and  in  it  the  writer 
calls  in  question  almost  all  the  usually  accepted 
notions  on  the  therapy  and  treatment  of  this  serious 
organic  disease.  The  translator  has  done  his  work 
well,  although  here  and  there  the  book  is  disfigured 
by  mistakes.  It  is  by  no  means  easy  to  say  how  many 
of  these  are  intentional  and  how  many  accidental. 
On  the  same  line  we  find  the  two  remarkable  words, 
"edema"  and  "  perenchymatous."  It  may  be  that 
both  are  intentional,  as  we  understand  that  the 
new  American  system  of  orthography  sanctions  the 
use  of  the  word  "  edema,"  while  the  American  mode 
of  phonation  sanctions  the  use  of  the  word  "  peren- 
chymatous."  If,  however,  the  mispelling  of  these 
and  other  words  is  intentional,  so  far  as  the  American 
editor  is  concerned,  we  must  protest  against  English 
publishers  publishing  in  their  own  name  such  American 
works  as  are  written  in  Americanese  without  first 
translating  them  into  English. 

This  condemnation  of  a  practice  which  is  becoming 
too  common  must  not  be  read  as  an  unfavourable 
criticism  of  these  little  monographs.  So  far  from 
regarding  their  subject-matter  unfavourably,  we 
cordially  recommend  them  to  medical  men,  as  they 
will  enable  the  latter  to  review  from  an  entirely  new 
standpoint  their  ideas  on  the  subjects  of  which  the 
books  before  us  treat. 


HOME  NURSING  (a) 
Very  appropriately,  indeed, "  This  Book  is  Dedicated 
to  all  Women  who  are  Desirous  of  Alleviating  the 
Sufferings  of  their  Fellow-Creatures. M  As  the  author 
tells  us,  the  volume  was  "  written  in  the  hope  that  it 
may  be  of  service  in  guiding  an  untrained  nurse  in  her 
I  duties  when  administering  to  the  sick  and  dear  ones  at 
home."  On  this  account  the  endeavour  has,  of  course, 
been  made  according  to  the  author's  discrimination  "  to 
state  all  those  facts  which  a  lay  person  should  know  if 
she  desires  to  be  efficient  in  home  nursing.  At  the 
same  time,  care  has  been  taken  not  to  burden  her  with 
superfluous  knowledge."  It  is  needless  to  add  that 
the  author's  self-imposed  task  is  one  of  exceptional 
difficulty — one  which  no  two  members  of  the  profession 
would  be  at  all  likely  to  carry  out  along  strictly  parallel 
lines  ;  and,  accordingly,  one  regarding  the  merits  of 
whose  accomplishment  as  now  placed  before  all  readers, 
no  two  would  be  likely  to  form  opinions  strictly  coin- 
cident. The  chapters  are  ten  in  number  :  "  Home 
Nursing,"  "  The  Sick  Room,"  "  Sick-Room  Regime," 
"  Elementary  Human  Anatomy  and  Physiology," 
"  Some  Diseases  and  their  Nursing,"  &c.  The  author 
writes  clearly  and  concisely,  and  gives  a  good  deal  of 
sound  common-sense  advice.  Needless  to  say  that 
the  net  resultant  value  of  the  book  will  depend  largely 
on  the  individual  hands  in  which  it  is  placed  ;  on  the 
collateral  circumstances  and  environments,  &c,  etc. 
We  think  that,  upon  the  whole,  however,  the  author  has 
done  his  part  well.  There  are  fifteen  illustrations,  and 
an  index. 


MUTER'S  ANALYTICAL  CHEMISTRY,  (b) 

The  ninth  edition  of  this  work,  which  must  be  re- 
garded as  the  most  valuable  one  of  moderate  price  for 
the  use  of  students,  has  been  brought  well  up  to  date 
and  will  continue  to  be  one  of  the  most  widely  used 
books  by  pharmaceutical  students. 

It  is  really  astonishing  to  note  the  enormous  amount 
of  information  that  has  been  collected  in  a  book  of  handy 
size.  After  a  detailed  search  we  can  hardly  find  any 
article  of  consequence  on  which  there  is  not  useful  and 
up-to-date  information.  In  addition  to  this,  the  facts 
dealt  with  are  not  presented  in  such  a  manner  as  to 
require  isolated  feats  of  memory,  but  follow  in  a  logical 
and  understandable  manner  so  that  the  students'  ideas 
and  capacity  are  enlarged  as  he  proceeds. 

We  can  find  very  little  that  calls  for  criticism  in  the 
book,  excepting  some  of  the  illustrations.  Those  which 
are  intended  to  give  an  idea  of  the  various  urinary 
deposits  are  by  no  means  distinct  and  appear  to  have 
been  damaged,  and  the  author  would  do  well  to  replace 
them  in  the  next  edition. 

The  only  other  point  to  which  exception  can  fairly 
be  taken  is  the  author's  very  brief  treatment  of  the  im- 
portant subject  of  water  analysis.  Such  treatment  is 
undoubtedly  likely  to  produce  in  the  mind  of  the  student 
an  impression  that  the  subject  is  one  which  may  be 
mastered  in  a  few  days,  and  is  not  a  subject  which 
requires  years  of  patient  study.  A  little  less  than  a 
page  is  devoted  to  the  interpretation  of  results,  which  is 
so  inadequate  that  it  would  have  been  better  omitted 
altogether,  or  a  statem<  nt  might  have  been  added 
showing  the  impossibility  of  treating  the  subject  in 
the  space  at  the  author's  disposal. 

With  this  exception  we  have  nothing  for  the  work 
but  unqualified  praise,  and  feel  assured  that  this  edition 
will  meet  the  success  that  so  useful  a  work  deserves. 

(a)  "  Clinical  Treatises  on  the  Pathology  and  Therapy  of  Disorders 
ot  Metabolism  and  Nutrition."  By  Dr.  Carl  von  Noorden.  8enior 
Physician  to  the  City  Hospital,  Frankfurt.  Authorised  American 
Edition.  Translated  under  the  direction  of  Boardman  Reed,  M.D. 
Part  I.,  Obesity.  Part  II.,  Nephritis.  Part  III..  Membranous 
Catarrh  of  the  Intestines.    New  York  :  E.  B.  Treat  and  Co.    1903. 

(0)  "A  Short  Manual  of  Analytical  Chemistry."  By  Dr.  J. 
Muter.  P.I.C.,P.R.d.E.,  *c.  Pp.  250,  with  66  illustrations.  Demy 
8ro,  price  do.  net.    London:  Bailliere,  Tindall  and  Cox. 


MANUAL    OF    PRACTICAL    ANATOMY.    (6) 

Even  such  a  finite  science  as  anatomy  undergoes  a 
process  of  development,  otherwise  no  fresh  edition 
would  be  necessary,  mere  reprints  sufficing  for  all 
requirements.  On  the  one  hand  there  is  a  process  ot 
evolution  which  finds  expression  in  the  elimination  of 
unimportant  details  and  superfluous  verbiage  ;  on  the 
other  our  conceptions  in  regard  to  the  anatomical 
relationships  of  tissues  and  viscera  are  modified  and  the 
text  embodying  those  conceptions  has  to  be  remoulded. 
Both  these  processes  have  been  at  work  in  the  gestation 
of  the  volumes  now  before  us,  with  results  which  we 
doubt  not  will  be  to  the  advantage  of  the  student. 

It  is  a  matter  for  congratulation  that  anatomists  are 
getting  to  recognise  the  line  of  demarcation  between 
what  we  may  call  academical  anatomy  and  the  practical 
details  which  alone  are  likely  to  prove  of  service  to  the 
future  practitioner — physician  or  surgeon  as  it  may 
be.  The  method  of  investigating  the  relationship  of 
the  internal  organs  by  the  aid  of  frozen  sections  has 
yielded  brilliant  and  unexpected  results,  of  which  full 
advantage  has  been  taken  by  the  author.  There  too. 
the  anatomist  exercises  a  freer  hand  in  describing 
these  relations  since,  in  respect  of  the  hollow  viscera 
at  any  rate,  they  vary  within  tolerably  wide  limits  in 
the  human  organism  in  deference  to  physiological 
circumstances,  and  it  is  obviously  absurd  to  invite  the 
student  to  study  one  facet  of  the  subject  to  the 
exclusion  of  the  others,  in  other  words,  the  tendency 
is  to  make  anatomy  a  vital  rather  than  a  merely 
cadaveric  study.  In  this  direction  radiography  has 
contributed  its  quota  of  actual  observation  and  is 
likely  to  extend  its  sphere  of  usefulness  in  the  near 
future. 

One  noteworthy  feature  in  this  edition  is  the  dis- 
appearance of  many  old  friends  in  the  shape  of  illustra- 
tions, some  of  which  were  more  or  less  mouldy  wit.i 
age.  Their  successors  are  unquestionably  superior 
from  an  artistic  as  well  as  from  an  anatomical  point  of 
view,  much  of  the  credit  being  due  to  Mr.  J.  T.  Murray, 
who,  as  the  author  observes,  has  obtained  an  almost 
unrivalled  reputation  in  the  treatment  of  anatomical 
subjects.     The  result  of  the  collaboration  is  a  work 


(a)  "  Home  Nursing."  By  Bernard  Myers,  M.D..  O  M„  M.B.C.S., 
L.R.CP. :  etc,  Lecturer  and  Surgeon  to  8t.  John  Ambulance  Associ- 
ation. London  Bailliere,  Tindall  and  Cox.  1903.  Crown  Sro.,  pp. 
181.    Price2s.6d.net. 

(b)  " Manual  of  Practical  Anatomy."  By  D.  J.  Cunningham. 
M.D.Edln.  and  Dublin,  D.Sc.,  LL.D.,  D.C.L.Oxon.,  F  R.8.,  Pro- 
fessor of  Anatomy  in  the  University  of  Edinburgh.  Ac  Third 
Edition,  2  vols.    Edinburgh;  Young  J.  Pentland.    1903. 


Ja*  JQ.   IgH- 


MEDICAL    NEWS. 


The   Medical  Pkrss, 


',7 


wistcn  will  perpetuate  the  fame  oJ  its  author  and  cotn- 
tention  of  students. 


/DeOfcal   Hews. 


inquiry, 


Visitation  at  Queen's  College,  Gal  way. 

tsrtatlDM  oi  the  Queen's  College,  Gahvay,  was 

iv  last.     The  visitors    attending  were 

i  Clonbrock,   K  P.  (in  the  chair)  ; 

th*  Right  Rev,  the  Lord  Bishop  of  Tuam.  the  Right 

■i  Westmeato,  Sir  A.  V,  Macan.  Pre- 

il  College  of   Physicians,    Ireland  ; 

Sai  Lambert  H.  Grmsby,  President  oi  the  Royal 

trgeons,    Ireland.     The  President  of   the 

\uderson,   LL.D.,  and  other 

>rs  attended.    The  principal  business  which  was 

brought  before  the  visitors  was  an  appeal  by  Professor 

gainst  the  decision  oi  the  College  Council  in  the 

i  he  had  brought  forward  in  that  the  Roman 

Citbonc  students  of  the  College  had  been  sent  tracts 

i  tea  tan  t    clergyman.     The    College    Council 

.1  to  accede  to  Professor  Pyes  request  for  an  in* 

the  circumstances.     Professor  Pye,  ha 
:i  in  favour  of  his  apical,  the  President  said  that 
&se  had  occurred  in  Decern bcr,  and  that  there  had 
been  no  repetition  of  it.  and  that,  moreover,  the  clergy- 
had  distributed  the  tracts  had  undertaken 
tot  to  Lgain*     Under   the   circumstances,   and 

t;g  the  expression  <d  disapproval  from  the 
iessor  Pye  withdrew  his  appeal  for  a  public 
We  are  glad  that  he  consented    to  such  a 
Religiuus  animosity  is  quite  sufficiently  keen 
land   without    professional    men    lending    them- 
selves to  its   aid.     We   have   no   sympathy   with   or 
, .-al  tor  any  form  of  proselytising  by  any  religion, 
bat  the  tact  cannot  be  overlooked  that  conscientious 
men  of  every  religion  often  consider  it  to  be  their  duty 
to  attempt  to  proselvtisc.      Such  attempts  cannot  be 
l*rmti!ed  to  be  made  on  those  who  are,  or  may  be, 
uaduly  prone  to  be  affee  ted  by  them,  although  the  more 
stftjog-rtunded  are  quite  capable  of  looking  after  them- 
Fur   this  reason   Professor  Pye  s  protest  was 
most  proper,    though   a  public    inquiry  into  such   an 
Lt  would   have  been  out  of  place.     The  visitors 
proceeded    to  inspect     the   laboratory,    museum, 
her  parts  ol  the  College.     They  then  returned 
i  urination   hall,   when    Lord   Clonbrock,  the 
>an,   said    that    the   visitors   were   unanimously 
ttion  that  everything  was  in  extremely  good  work- 
lei  tn  all  the  departments,  considering  the  limited 
*pacc  at  present  available.     The  chairman  also  stated 
thai  it  was  the  unanimous  opinion  of  the  visitors  that, 
u  their  was  no  Chair  of  Pathology  in  the  College,  the 
cnoacil  should  make  arrangements  for  the  appointment 
mi  table  lecturer  in  pathology,  who  should  devote 
ie  of  his  time  to  the  subject. 
Pharmaceutical  Society  of  Great  Britain. 
An  educational  meeting  will  be  held  in  London  in 
the  Lecture  Theatre  on    Wednesday,    January  20th, 
1/ clock,     (1.)  "  University  Education  for  Phar- 
matists.*'     By    Professor   R.    B,    Wild,    M.D..    M.Ch- 
"Concurrent    Curricula."'     By     H.     Whippell 
Gadd. 

A  London  "  Herbalists  "  Bueineaa 

J  Ethel  Lardent  and  Ada  Booth  were  found  guilt  y 

of  being  concerned  together  in  performing  an  illegal 

uon  on  a  woman  named  Mitchell,  and  were  each 

*rntcnced  to  five  years'    penal  servitude.     The  male 

pnsoner  carried  on  the  business  of  a  herbalist  in  South- 

wark  Park  Road,  and  it  was  stated  that  the  police  had 

received  numerous  complaints  as  to  what  went  on  at 

the  premises.    The  jury  recommended   the  prisoners 

rey  tin  the  ground  that  the  woman  upon  whom 

the  operation  was  performed  was  an  accomplice, 

University  Candidates  for  the  Army. 

I  scheme  recommended  by  the  Advisory  Board  of 

Military  Education  and  approved  by  the  Secretary  of 

Sutc  fur  War  has  been  published  by  the  War  Office 

<Ung   the   appointment   of   candidates   from    the 

universities  to  commissions  in  the  regular  forces,     The 


scheme  will  come  into  operation  19  September  next. 
Its  object  is  to  attract  this  class  of  candidates  into  the 
army  by  doing  away  as  far  as  possible  with  tti< 
advantage  under  which  university  candidates  who 
have  completed  their  university  career  by  taking  a 
at  present  labour  in  having  to  enter  the  army  at 
a  later  stage  than  men  who  are  not  university  graduates. 
The  great  importance  of  this  announcement  to  Varsity 
obvious. 

British  Gynaecological  Soci sty. 

At  tin-  annual  meeting  of  this  Society  on  Thursday 
Last,    January    14th,    the   election   of    the  officers  and 
I  resulted  in  the    following  appointments.     The 
k  indicates  the  new  officers  :  — 

Hon.  President^ R.  Barium  M.D.,  F.R.CP.  (East- 
bourne). 

l'n  1 j 4#itf.— *  Professor  J.  W.  Taylor,  M.D..  F.R.CS, 
(Birmingham). 

it, — E.  Stanmore  Bishop,  F.R.CS. 
(Manchester).  Protestor  Murdoch  Cameron,  M.l>, 
(Glasgow),  *F,  B.  Jessett,  F.R  <  I  ondon),  *Sir  A,  V. 
Macan,  M.D,,  P.R.CPJ,  (Dublin),  H.  Macnaughton- 
[ones,  M.D.,  F.R.CS.  L  (London),  J,  A.  MansHI- 
Moullin,  M. A.,  MB.  M.R.C.P.  (London),  Christopher 
Martin,  M.B.,  CM,,  F.R.CS.  (Birmingham),  F.  F. 
Schacht,  B.A,.  M.D.  (Loudon).  Professor  Alfred  Smith, 
M.B.,  F.R.C.S.I..  (Dublin),  *Heywood  Smith.  M,A  . 
MJ>..  M,R.t,R  (London),  *W.  D.  Spanton,  F.R.CS. 
(Hanley),  *W.  Travers,  M,D.,  F.R.CS,  (London). 

Treasurer. — W.  H.  Sumon,  M.D.,  F.F.P.3.  (Lon  *on). 

Council.—  G.  R.  Carter.  M.R.CP.T.  (London),  Eber 
Chambers.  M.D..  M.R.CS.  (London),  R.  J.  Colenso. 
M.A..  M.D.  (London).  Sir  J.  H.  Croom,  M.D..  F.R.S.E.. 
F.R.CP.,  F.R.CS.E.  (Edinburgh),  T.  M.  Dolan,  M.D„ 
F.R.CS.  (Halifax).  *W-  Duncan,  M.D.,  F.R.CS. 
(London),  F.  Edge,  M.D.,  M.R.CR  (Wolverhampton), 
*G.  Elder,  M.D.  (Nottingham),  *T,  J,  English,  M.D. 
(London),  Bedford  Fenwiek,  M.D..  M.R.C.P.  (London), 
*J,  Haig  Ferguson.  MJX,  RIICR  (Edinburgh), 
Clement  Godson,  M.D,.  M.R.C.P.  (London).  Arthur 
Helme,  M.D.,  M.R.C.P.  (Manchester),  James  Jardine, 
M.B.,  CM.  (Richmond),  Henry  Jellett,  M.D.,  F.R.CP. I. 
(Dublin),  *j.  MacPherson  Lawnc,  M.D.  (Weymouth)* 
*R.  P.  Ranken  Lyle,  M.D.  (Newcastle-on-Tyne),  *S. 
Lloyd.  M,D.  (London),  *J.  Padman,  M.R.CS.  (London), 
Mayo  Robson,  F-R-C.S.  (London),  Charles  Ryall. 
F.R.CS.  (London),  R.  TV  Smith.  M.D.,  M.R.C.P. 
(London).  Herbert  Snow,  M,D.  (London),  *H.  F, 
Vaughan- Jackson,  M.R.CS.,  L.R.CP.  (Potter's  Bar). 

Editor  of  the  Journal— J.  J-  Macan,  M.A„  M.D. 
(London). 

Hon,  Secretaries.—]*  H,  Swan  ton,  M.A*,  M.D. 
( London h  S.  Jervois  Aarons,  M.D.  (London,) 

Auditors.— C.  H.  Bennett,  M.D.  (London),  F.  A- 
Purcell,  M.D,  (London.) 

Trustees  of  the  Property  of  the  Society. — G.  Granville 
Bantock,  M.D,,  K.  S.  Fancourt  Barnes,  M.D.,  F,R.S.R., 
Clement  Godson,  M.D.,  M.R.C.P. 

Industrial  Diseases  Dae  to  Poison. 

The  first  of  a  series  of  lectures  on  M  Public  Health  " 
was  given  in  the  Library  of  the  Owens  College.  Public 
Health  laboratory,  Manchester,  by  Professor  Thomas 
Oliver,  of  Newcastle-on-Tyne.  The  subjett  was  in- 
dustrial diseases  due  to  certain  poisonous  fumes  or 
gases,  and  the  lecturer  dealt  principally  with  tnOSS 
caused  by  phosphorus,  bisulphide  of  carbon,  carbon 
monoxide,  and  sulphuretted  hydrogen.  Dealing  with 
phorus  poisoning  in  match  manufactories,  he 
pointed  out  that  after  making  extensive  inquiries 
about  six  years  ago  he  had  to  report  to  the  Home  Office 
that  absolute  immunity  from  that  poisoning  could  not 
be  guaranteed  so  long  as  wdiite  phosphorus  was  used. 
Such  poisoning  had  now  considerably  diminished, 
and  match  making  had  ceased  to  be  a  dangerous  trade 
by  the  substitution  of  a  less  harmful  material  for  white 
phosphorus.  Speaking  of  poisoning  by  sulphuretted 
hydrogen,  he  said  he  did  not  think  members  oi  thi- 
medical  profession  were  sufficiently  alive  to  the  d 
of  inhaling  it,  and  instanced  several  cases  in  which 
death  had  resulted  almost  instantaneously  from 
inhalation. 


78    Thk  Medical  Pbess.       NOTICES    TO    CORRESPONDENTS. 


Jan.  so,  1904. 


Jtotices  to 
(ttorospontettts,  $hort  %tttxx&,  Sec 

WttT  Correspondents  requiring  a  reply  in  this  column  are  porticu 
larly  requested  to  make  use  of  a  distinctive  signature  or  initial,  and 
avoid  the  practice  of  signing  themselves  "Reader,"  "Subscriber," 
"Old  Subscriber,"  Ac.  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

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

Original  Articles  or  Letters  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

Reprints.— Reprints  of  articles  appearing  in  this  journal  can  be  hud 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

"THE  PU ARMACOP02IA    DIGEST." 
To  the  Editor  of  The  Mbdical  Press  and  Circular. 

Dear  Sir,— Kindly  allow  me  to  correct  a  slip  in  the  last  paragraph 
of  your  editorial  appearing  in  your  issue  of  January  ISth,  in  which 
you  refer  to  me  as  compiler  of  the  digest  recently  prepared  fcy  Mr. 
Wm.  Chattaway  for  the  Pharmacopoeia  Committee  of  the  General 
Medical  Council.  I  gave  Mr.  Chattaway  assistance  in  collecting  and 
arranging  references,  but  there  my  responsibility  ends. 

I  am,  yours  obediently. 

C.  G.  Moor. 

[The  error  on  the  part  of  the  writer  of  the  leader  was  obvious. 
He  had  already  alluded  to  Mr.  Chattaway  as  the  author  of  the 
••  Digest,"  and  intended  simply  to  mention  Mr.  Moor  s  Itook  on 
"Standards"  as  one  cf  the  secondary  sources  of  information.— Ed. 
Mbdical  Pribs  and  Circular.] 

Mr.  J.  8.- The  X-rays  are  more  generally  employed  in  the  treat- 
ment of  disease  in  America  than  in  this  country,  and,  for  example, 
according  to  one  authority  acne  is  more  effectively  treated  by  this 
method  than  by  any  other. 

Pensator.— The  MS.  which  our  correspondent  submits  for  approval, 
while  dealing  with  important  truths,  is  still,  we  think,  more  adapted 
for  a  student's  journal  than  for  our  columns. 

EXAMINATION  FOR  THE  "CONJOINT." 

"  Name  the  bones  of  the  skull."  The  candidate,  hesitating,  stammers, 
••  Excuse  me.  sir,  it  must  be  my  nervousness.;  but  for  the  life  of  me  I 

can  t  remember  a  single  one Yet  I  have  them  all    ...     in  my 

head. ' 

F.R.C.8.— Our  correspondent's  letter  has  been  handed  on  to  the 
writer  of  the  article  as  requested. 

Miss  K.  (Glasgow).— We  have  been  unable  to  trace  the  report  in  our 
columns. 

Dr.  S.  F.  W.  (Paris).— The  request  you  make  is  not  exactly  in 
accordance  with  our  editorial  capacity,  but  we  have  handed  your 
letter  to  a  practitioner  who  is  in  a  more  likely  position  to  concede  the 
favour  you  ask. 

Smilax  (Ealing).— We  hold  it  to  be  the  duty  of  every  medical  man 
to  become  a  member  of  one  of  the  Defence  Societies  The  Medical 
Defence  Union  is  the  oldest  of  those  admirable  institutions,  but.  the 
choice  between  that  and  the  others  must  be  left  to  your  own 
judgment. 

Hospital  Reformer  (Leicester).— The  Hospital  Sunday  Fund  wields 
a  vast  power  over  hospitals  by  its  method  of  making  grants,  subject 
to  certain  conditions.  The  chief  objection  to  this  method  would  be 
removed  if  the  reasons  for  the  conditions  were  clearly  stated  in  each 
individual  case.  At  present  the  complaint  is  not  infrequently  made 
that  the  demands  are  arbitrary  and  indefensible.  As  1  he  administra- 
tors of  public  charity  the  principles  of  the  Sunday  Fund  should  be 
clearly  laid  down,  and,  if  necessary,  some  sortof  arbitration  be  obtain 
able  where  the  jnstice  or  expediency  of  its  decisions  it*  called  in 
question. 


Jlppointmems. 


Barker,  F.  J.,M.B.,  C.M.GIasg.,  Clinical  Assistant  to  the  Chelsea 

Hospital  for  Women. 
Barwsll,  Harold,  M.B.Lond.,  F.R.C.S.Eng  ,  Assistant  Purgeon  to 

the  Metropolitan  Ear,  Nose,  and  Throat  Hospital,  Grafton  Street, 

Fit  sroy  Square. 
Bonnet,  W.  P.  Victor,  M  S  ,  M.D.Lond..  F  R.C.S.Eng.,  M.R.C.P. 

Loid.,  Lecturer  in  Practical  Midwifery  in  the  Middlesex  Hospital 

Medical  School. 
Candler,  George,  B.A.Cantab.,  L.R.C.P.Lond.,  M.R.C.S.,  L.S.A., 

Medical  Officer  and  Public  Vaccinator  for  the  Black  Torrington, 

Bradford,  and  Cookbury    Districts  of  the    Holsworthy  Union 

(Devon). 
Emanuel,  J.   G.,    M.D.Lond.,   M.B.,   Ch  B.Birm.,    M.R  O.P.Londi. 

Phywician  to  Out-patients  at  the  Birmingham  and  Midland  Free 

Hospital  for  Sick  t  hildren. 
Graft,  Lachlan  M.  D.,  CM.  Edin.,  re -appointed  Medical  Officer  to  the 

Ballachulish  Quarriers"  Medical  Club,  vice  A.  Dingwall  Kennedy, 

M.B.,  Ch.B.Glasg.,  resigned. 


Grby-Edwards,  H.,  M.B.,  B.Ch.Dub.,  Honorary  Ophthalmic  Surgeon 

to  the  Carnarvonshire  and  Anglesey  Infirmary. 
Lister,  W.  T.,  B.A.,  M.B..  B.C.,  F.R.C  S.,  Assistant  surgeon  to  the 

Royal  London  Ophthalmic  Hospital,  City  Road,  E.G. 
Mackbkur,  E.  G.,  M.B.Toronto,  Clinical  Assistant  to  the  Chelsea 

Hospital  for  Women. 
Mil  ward,  F.  Victor,  B.A.,  M.B.,  B.C  Cantab.,  F.R.C  8.  Ed  g.,  Surgeon 

to  Out-patients  to  the  Birmingham  and  Midland  Free  Hospital  for 

Sick  Children. 
Norman,  R.  H.,  M.D.Lond.,  B.8..  M.R.C.S.,  L.R.C.P  Lond  ,  Assistant 

Anaesthetist  to  the  Great  Northern  Central  Hospital. 
Price,  E.  O.,  M.D.,  C.M.Edin.,  Honorary  Medical  Officer   to  the 

Carnarvonshire  and  Anglesey  Infirmary. 
Stamm,  L.  E  .  M.D.,  B  A.,  B.Sc  Lond.,  Medical  Officer  to  the  British 

Home  and  Hospital  for  Incurables,  8treatham  Common,  S.W. 
Thornton,  Bertram,  M.R.C.8  ,  L.R.C  P.Lond.,  J.P.,  Medical  Officer 

of  Health  of  the  Borough  of  Margate. 


Bradford  Poor-law  Union.  —  Resident  Assistant  Medical  Officer. 
Salary  £125,  with  rations,  apartments,  and  washing.  Applications 
to  Geo.  M.  Crowther,  Clerk  to  the  Guardians,  22  Manor  Row, 
Bradford. 

Clogher  Union.— Medical  Officer.  Salary  £70  per  annum,  with  regis- 
tration and  vaccination  fees;  also  to  act  as  Medical  Officer  of 
Health  at  a  salary  of  £10  10s.  per  annum.  Immediate  application 
to  Thomas  Turner,  Clerk  of  Union.     (8ee  advt.) 

Darenth  Asylum  (Training  School  and  Industrial  Colony),  near 
Dart  ford,  Kent.— Medical  Superintendent.  Salary  £000  per 
annum,  together  with  unfurnished  house,  coals,  light,  washiug, 
mi  k,  and  vegetab'es.  Applications  to  T.  Duncombe  Mann,  Clerk 
to  the  Board. 

Dr.  Steevens'  Hospital,  Dublin.— Assistant  Physician  and  an  Assistant 
Surgeon.    Applications  to  the  Secrotary.    (See  advt.) 

Dr.  Steevens'  Hospital,  Dublin  —Anaesthetist.  Applications  to  the 
Secretary.    (See  advt  ) 

Gorey  Union.— Medical  Officer.  8alary  £120  per  annum,  with  registra- 
tion and  vaccination  fees ;  also  to  act  as  Medical  Officer  of  Health 
at  a  salary  of  £15  a  year.  Applications  to  R.  Creighton,  Clerk  of 
Union.    (See  advt.) 

Liverpool  Dispensaries.  -Head  Surgeon.  Salary  £200  per  annum  with 
board  and  apartments  Applications  to  Sam.  B.  Leicester.  Secie- 
tary,  60  Vauxhall  Road,  Liverpool. 

Locum  Tenens  to  do  duty  as  Dispensary  Medical  Officer,  Ac.  Salary 
£3  3s.  per  week  all  found.  Applications  to  Dr.  M.  F.  Brady, 
Carnew,  Co.  Wicklow.    (See  advt.; 

Leeds  Public  Dispensary.  -Junior  Resident  Medical  Officer.  Salary 
£100  per  anuum,  with  board  and  lodging.  Applications  to 
Secretary  of  the  Faculty. 

Leicester  Infirmary.— Assistant  House  Surgeon.  Salary  £80  per 
annum,  with  board,  apartments,  and  washing.  Applications  to 
the  Secretary,  24  Friar  Lane,  Leicester. 

Norfolk  and  Norwich  Hospital.— Lady  Superintendent.  Salary  £100 
per  annum,  with  apartments,  board,  and  laundry.  Applications 
to  the  decretory. 

Royal  Buckinghamshire  Hospital,  Aylesbury.— Resident  8urgeon. 
Salary  £100,  with  board  and  furnished  apartments.  Applications 
to  Geo.  Fell,  Secretary,  Rickford's  Hill,  Aylesbury. 

St.  Mary's  Hospital,  Paddington,  W.— Casualty  Physician.  Salary 
£75  per  annum     Applications  to  Thomas  Ryan,  Secretary. 

York  County  Hospital.— House  Physician.  Salary  £100  per  annum, 
with  board,  residence,  and  washing.  Applications  to  Frederick 
Neden,  Secretary  and  Manager,  York. 


^Meetings  of  the  goaeties,  JUtlmes,  Stc. 

Wednesday.  January  20th 

Royal  Microscopical  Society.— (20  Hanover  Square.  W.).— 8pm. 
Presidential  Address :  On  the  Evolution  of  Vertebrate  Animals  is 
Time. 

Pharmaceutical  8ociety  of  Great  Britain  (17,  Bloomsbury  Square, 
W.C.).  3  p.m.  Educational  Meeting.  Papers:— Prof.  B.  B.  Wild: 
University  Education  for  Pharmacists.  Mr.  H.  W.  Gadd— Concurrent 
Curricula. 

Thursday,  January   21st. 

Mount  Vernon  Hospital  for  Consumption  and  Diseases  ok  the 
Chest  (7  Fitsroy  Square,  W.).— 5  p.m.  Dr.  J.  E.  Squire— Pulmonary 
Cavities  —  II.,  Treatment  (illustrated  by  cases).  (Post-Giadoate 
Course.) 

Friday,  January  22nd. 
Clinical   Sociktt  of  London  (20  Hanover  8quare,  W.).-8  p.m, 
Exhibition  of  Clinical  Cases  followed  by  Discussion.    Patients  wi  1  be 
in  attendance  from  8  p.m.  to  9  p.m. 

Monday,  January  25th. 
Odontolooical  Society  of  Great  Britain  (20  Hanover  Square,  W.). 
—8  p.m.      Casual  Communications— Mr.  Sefton  8ewill,    L.R.C.P., 
M.R.C.8. ,  L.D.S.Eng.    A  paper  will  be  read  by  Mr.  F.  J.  Bennett, 
M.R.CS.,  L.D.S.Eng. 


geailt*. 


Maxfibld.— On  Jan  16th,  at  Ealing,  Middlesex,  'the  wife  of  James 
Morris  Maxfield,  Admiralty,  and  daughter  of  the  late  J.  H.  Simp- 
son, M.D.  Cantab..  Pontefract. 

Merry  weather.— At  Gorakhpur,  India,  of  congestion  of  the  longs, 
Percy  William,  second  son  of  the  late  Dr.  Merryweather,  of  Guis- 
borough,  Yorkshire,  age  37. 

Williamson.— On  Jan.  15th,  at  Southsea,  Marv,  relict  of  John 
Williamson,  Esq.,  M.D.,  of  Graham's  Town,  S.  Africa. 


"SALUS   POPULI    SUPREMA    LEX" 
VauCXXmh  WEDNESDAY,    JANUARY    27.    1904- 


:'    _ , 

APPEARANCE    OF    A 

FOLLOWING  Tin; 

REMOVAL    OF    TONSILS    AND 
ADENOIDS. 

By  WYATT  WINGEAVE,   M.D.Durh., 

Pnni~i*n    to    Hie  Out  ml  Lnnrioii  T.m»nt   «ml   Ear  Hospital;  Prai^ 
qftfa*  British  Lmryn^.knfi«-:il.    RhmoIo*K-»t.  and  OtologiunL 

rsMTfON  to  the  incidence  of  a  rash  following 
these  now  popular  operations  was  first  drawn  by 
the  writer  in  May,  1901,  [a)  when  twenty-six  eases 


and   (Dianto. 


No.    4- 


®rtginal  Com  mun  teat  ions. 


RASH 


the  second  or  third  day  (48  instances  ;  five  times 
it  occurred  on  the  fourth,  once  on  the  fifth,  twice 
on  the  sixth,  twice  on  the  seventh,  and  once  on 
the  thirteenth  day. 

Its  duration  was  generally  between  two  and  tour 
days,  the  maximum  being  eight  days,  of  which 
there  were  two  examples 

The  character  was  decidedly  polymorphous  in 
its  grouping  ;  the  spots  were  bright  red,  discrete 
yet  often  crowded,  with  and  without  erythematous 
swelling.  The  parents'  own  descriptive  words  are 
recorded  in  some  of  the  cases,  and  these  fairly 
represent  the  appearance  of  those  which  were 
personally  inspected.  In  one  case  only  was  it 
urticarial. 

As  to  distribution,  it  was  found  chiefly  upon  the 
^  Tri  chest    and    abdomen ,    sometimes    involving    neck, 
we   reported   as   having   been   seen   during   tto.ctot   *m    "™  extremities-in   fact,   the  whole 
:  of  seven  years.      The  interest  and  import;   ^   T^^sTcases  there  was  considerable  itching. 

SftiSA  m   specific, 

observations    are    now    given    with    the    hope    of      ^^^  which  were  personally  inspected,  or 
throwing  further  light  upon  the  matter  1#.  ;g*  ^^ation    was    given    by    their    medical 

The  patients,  as  before,  were  seen  on  the  eighth  \^^~^\Z  exception,  the  temperature 
d.vaitertheoperation  of ,incaseof  non-aUendance ;  ;J™^CS  ,01'  F  at  any  time,  and  only  re- 
their  parents  reported  that  they  were  detained  at   did  not  exceea  10^  r .  ^  ,  The 

hon/on  account  of  a  rash  which  they -thought  '"""Jlv   P<lif    noT    exS  ^5-      The 


"might    be     something     catching."       Whenever 
possible,  however,  the  case  was  personally  investi- 
gated.   Some  of  the  cases    were    brought  during 
tirst  week  when  the  rash  was  developing. 
So  far,  the  search  has  afforded  thirty -five  addi- 
tional cases,  occurring  in  about  2,000  operations,  a 
proportion  which  fully  confirms  the  belief  originally 
rsscd     that     systematic     examination    would 
probably  reveal  a  greater  frequency  than  was  then 
recorded. 

The  following  list  gives  a  present  total  of  61  cases, 
including  the  original  2U.    In  analysing  it  the  prin 


majority  did  not  exceed  99*5-  Thcrc  was 
in  many  an  appreciable  degree  of  malaise  and 
irritability,  some  slight  vomiting,  a  dryness  of 
skin  and  "  hot  head/'  but  no  marked  or  severe 
constitutional  disturbance.  They  were  generally 
reported  as  being  well  and  lively,  and  but  for  the 
rash,  no  anxiety  would  have  been  felt. 

None  afforded  evidence  of  albumin   or  globulin 
in  the  urine. 

Bacteriologkai  t\  m$  were  made  in  most 

»t  the  cases,  the  prevailing  micro-organisms  p 
ine   to  be  diplococci,  staphylococci,  and  strepK- 


.deluding  the  original  26.    In  analysing  it  the  prin-  •  »s  » y ;heirrorder  o£  frequency,  and  no  evidence 

d  features  wiU  first  be  discussed  «^^\^J£mS~9  specific  micro-organism, 
dime  cases  possessing  special  points  of   interest  "^^J,    ica{  examinations   showed   a  distinct 
will  then  be  treated  indi v. dually.  leucocvtosis   but  not  more  marked  than  in  those 

-The   youngest    patient   was    .4  ^^^s    ^cocjto  .  whitc  ^ 

while  the  oldest  was  23   y»»  °<  *&-  *f  ^atnef  barely  exceeded  10  000  per  c.mm.      At  the  early 
number  being  under  »  .*.,  2,  under  5 ,  and  ,««*  «  ^  tQ  ei"  hth^ay  a(ter  operation)  the 

-'>  between  5  and  mononuclcatcd      lymphocyte      type     were     very 

-With   regard   to   sex,    females   strikingly  ™?™™t  ,atcryonP  after  the  first  week,  multi- 
predominated,  in  the  proportion  of  40  to  16  males    m    ,  ar'leuwcvtes  beCame  relatively  more  mime- 
figures   which   do   not   conform    to   the   relative  nuciear  ieu«*-> 
numbers  of  the  sexes  operated  upon.  rm,> 

Saturt  of  Operation.— In  27  cases  both  tonsils        Remarks  on  Cases  of  Special  Interest. 
and  adenoids  were  removed  j  in  22,  adenoids  only  ;  ».—•'•»  wt^kp 

ind  in  1  -    tonsils  only  No-  3-— Had  a  temperature  of  102    F.  for  twelve 

flflSA.-The  rash  appeared  for  the  most  part  on   hours,  but  with  no  other  sign  of  constitutional 

— — ; 1  disturbance. 

U>  "Toniiiiotomy  Bw-h."   Bi ■  Wy»«  winjrravf,  u.u.   Lamctt.       No    ;_  developed  diphtheria. 


tto     The  Medical  Prbss. 


ORIGINAL  COMMUNICATIONS. 


Jan.  27,  1004. 


No.  8. — Was  scarlet  fever. 

No.  11. — Patient  was  suffering  with  chronic 
suppuration  of  middle  ear  at  the  time  of  operation, 
and  developed  scarlet  fever. 

Nos.  15  and  17. — Also  subjects  of  chronic 
middle  ear  suppuration. 

No.  24. — Scarlet  fever. 

No.  28. — The  only  case  of  urticaria. 

No.  32. — The  tonsils  sloughed,  were  very  painful, 
and  did  not  heal  until  the  fifteenth  day  after 
operation. 

No.  34. — Rash  persisted  till  the  fourteenth  day, 
but  patient  seemed  quite  well  in  other  respects 
and   there  was  no  "  peeling." 

No.  35. — Turbinotomy  was  performed  at  same 
time,  and  there  was  some  slight  febrile  disturbance, 
temperature  being  ioo°  for  two  days. 

Nos.  37  and  40. — Operation  was  followed  by 
acute  suppuration  of  cervical  glands. 

No.  43. — Developed  scarlet  fever. 

No.  44. — Diagnosed  as  surgical  rash  by  own 
medical  attendant .  Temperature  1  oo*  5  °  f or  twenty- 
four  hours. 

No.  48. — Was  thought  to  be  scarlet  fever  by 
own  medical  attendant,  but  when  seen  on  the 
eighth  day  after  operation  was  quite  well,  free 
from  rash,  and  no  "peeling." 

No.  49. — Subject  of  chronic  suppurating  middle 
ear. 

No.  50. — Followed  by  acute  suppurating  middle 
ear. 


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ypMARursi 


No.  const-  dist- 

Infl.   eerr.    glands, 
acute. 

Convulsion*. 
Acutely      inflamed 
eerr.  glands. 


Scarlatina. 

T.  100.  Diag.  as 
surg.  raah  by  his 
med.  attendant. 

Itching  1 


like  measles  1  everywhere 
except  abd. 


minute 
papules 


all  over 
body 


8c.  fever  6  years  ago. 
Itched. 

Diag.  by  own  doctor 
as  scarlatina.  No 
const,  dist. 

Ch-  supp.  mid.  ear, 
feverish. 

Acute  supp.mid.ear- 

8c-  fever  8  years  pre- 
viously. Slough 
on  tonsil. 


Had  measlesJtcning 
No.  const,  dist    Se- 
vere general  jaun- 
dice. 
Had  so.  fever. 

No     const,      dist, 

marked  itching. 
Measles  12  mo-  ago. 


Bemoved  to  oba. 
ward  of  fever  hoe., 
suspected  sc>  fev<, 
no  const,  signs, 
tonsils  healed 
well,  no  deeq. 

Slight  malaise,  no 
other  const,  dist.,. 
no  desq. 

Nooonst.  diet. 


No.  51. — The  tonsils  sloughed,  and  did  not  heal 
until  fifteenth  day. 

No.  54. — There  was  severe  general  jaundice  with 
slight  malaise,  only  lasting  fourteen  days. 

No.  59. — Removed  to  observation  ward  of  fever 
hospital  as  suspected  scarlet  fever,  but  did  not 
develop  any  serious  constitutional  signs.  There 
was  delay  in  tonsil  healing. 

It  will  be  seen  that  there  were  four  cases  of  un- 
equivocal scarlet  fever,  one  of  diphtheria,  and  two 
in  which  scarlet  fever  was  at  first  suspected  but 
not  confirmed.  In  these  instances  infection  had 
doubtless  already  occurred  before  the  operation. 
In  one  of  them  it  was  afterwards  discovered  that 
the  patient's  sister  was  also  attacked  at  about  the 
same  time. 

The  occurrence  of  such  a  complication  strongly 
suggests  the  expediency  of  allowing  an  interval  of 
one  or  two  weeks  to  elapse  between  the  diagnosis 
and  the  removal  of  an  acutely  inflamed  tonsil. 
Not  that  the  operation  itself  under  such  conditions 
is  necessarily  associated  with  exceptional  risk  to 
the  patient,  but  rather  in  consideration  for  others. 

Since  in  most  cases  of  adenoids  and  enlarged 
tonsils  the  submandibular  and  cervical  lymphatic 
glands  are  prominent,  it  was  not  surprising  that 
they  showed  further  signs  of  activity  by  an  in- 
creased thickening  and  tenderness,  extending  in 
three  instances  to  acute  suppuration. 
.  The  healing  of  the  tonsil  wounds  was  consider- 
ably delayed  in  three  cases,  while  acute  suppura- 


Jam.  27,  1904, 


ORIGINAL  COMMUNICATIONS. 


Tee  Medical  Press.     81 


tion  oi  the  middle  ear — a  by  no  means  unusual 
<xjm plication  when  nasal  douching  played  so  con- 
spicuous apart  in  the  after-treatment — was  present 
in  one  instance  only. 

While  these  clinical  details  may,  perhaps,  help 
to  throw  a  little  more  light  upon  the  pathology  of 
-ubject,  it  must  be  frankly  admitted  that  they 
do  not  cany  us  much  nearer  a  satisfactory  explana- 
tion than  is  already  embraced  in  the  familiar  term 
.ical  rash/'  and  any  interpretation  must 
obviously  be  influenced  by  the  particular  aspect 
tan  which  the  tMe  played  by  these  lymphoid 
structures  is  viewed. 

The  view  that  this  rash  is  solely  due  to  bromides, 
alkylates,     or  other   drugs   may  now  justly  be 
excluded,  but  the  evidence  strongly  suggests  that 
the  lymphoid  tissues  of  this  region  possess  a  some* 
what  high  degree  of  vulnerability  when  disturbed, 
since  operative  treatment  or  any  interference  with 
the  continuity  of  their   surfaces   seems   to  favour 
the  entrance  of  bacteria  or  their  toxins ,  which,  in 
tum,  give  rise  to  a  dermatitis,  with  or  without 
constitutional  disturbance,  (a) 
Whether    the    invasion    be    clue    to    (1)    purely 
mechanical  causes,   to   (2)  interference   with   the 
ib1  phagocytic  duties,  or  (3)  to  inhibition  of  a 
probable  alexinc  l unction,  are  points  for  considera- 
tion.   It  is,  however,  important  to  note  that  there 
is  no  suggestion  of  an  epidemic  character  in  the 
grouping  of  the  cases,  since  very  wide  intervals  of 
dapscd  between  them,     Further,  there  is  no 
special  reason  for  associating  the  rash  with  infec- 
lj.  iq  at  the  time  of  operation,  since  every  reasonable 
atkua  with  regard  to  cleanliness  of  hands  and 
instruments  was  employed. 

That  these  lymphoid  structures  are  specially 
prone  to  coincidental  and  sympathetic  activity  is 
well  shown  in  the  prominent  part  which  they  play 
rations  infective  fevers.  This  aspect  has  re- 
cently been  emphasised  by  Dr,  FL  K.  Biss  (h)  in  a 
suggestive  article  dealing  with  the  inter- 
relationship of  tonsil  inflammation,  scarlet  fever, 
And  diphtheria. 

Has  this  particular  rash  any  relation  to  scarlet 
fever  ?     Is  it  a  *+  borderland  "  or  modified  type  of 
scarlet  fever  ?     Unfortunately  questions  as   to  a 
possible  immunity  from  scarlet  fever  or  measles 
were   not    systematically    noted.     In    four    cases, 
however,    there   is   record   of  the  patients  having 
suffered  with  scarlet  fever  and  two  from  measles. 
it  the  rash  may  be  the  result  of  septic  absorp- 
tion through  the  often  large  area  of  this  operation 
wound  is  not  at  all  unlikely,  considering  the  un- 
nic  homes  and  surroundings  of  most  of  our 
OTt-paiientB  .    in  fact,  it  is  remarkable  that  septic 
complications  are  so  lew.     Still   the  rash   is   not 
ied   to  such,   for  one   occurred   in   our  own 
wards,   and   one   in   private   practice,   where    the  i 
and    after-treatment   were   under   the 
Uvourable  conditions. 
The  occurrence  of  so  large  a  proportion  of  rash 
^ses  between  the  age  of  five  and  ten  is  doubtless 
flue  to  that  period  being   the  one  during  which  ' 
Operations  fox  adenoids  and  tonsils  are  most  fre- 
quently performed,, 

In  conclusion,  it  may  be  advanced  that  a  rash 
may  occur  as  a  sequel  to  the  removal  of  adenoids 
or  tonsils ;     that,   from   the   absence  of   signs  of 

» Uft,  It '-it.  Mrrt.  Jotim,f  May,  1003. 
'      Uw.  Fi-racr,  /.<m£'rf,  Jatmary.  190J,      Both 


constitutional  disturbance  and  from  its  atypical 
characters  it  may  reasonably  be  assumed  to  be 
non-specific.  But  that  assumption  does  not 
relieve  the  responsibility  for  taking  precautions. 

It  may  be  further  urged  that  since  enlarged  or 
inflamed  tonsils  may  be  the  earliest  evidence  of  a 
specific  infection,  their  removal,  unless  otherwise 
urgent j  should  be  postponed  pending  observation. 


Jamiury.  190  J,      Both 
-lorn. 
Icrlaodi  of   Dipntbfri*  and  Bcarltt   Fe*dr."     %  II.  J* 
a™.  X.b.   Uncet,  November  Tin,  190& 


THE  MODERN  SURGERY  OF 
THE  PROSTATE,  (a) 

By  Sir  WILLIAM  MITCHELL  BANKS,  M,D+t 

F.RX+St, 

CoDtultioff  Surgeon  Lit  orpool  Eoj»l  Infirmary  »  Ao. 
The  lecturer  first  described  a  typical  case  of 
acute  prostatic  retention  with  its  generally  dis- 
astrous termination  alter  the  treatment  in  vogue 
when  he  began  practice  t  and  eulogised  the 
work  of  Sir  Henry  Thompson,  which  had  com- 
pletely revolutionised  the  whole  conduct  of  urinary* 
surgery.  Passing  over  Bottini's  treatment  by 
the  electric  cautery,  as  one  of  which  we  have  no 
practical  experience  in  this  country (  he  recalled 
the  work  of  McGilltoi  Leeds,  with  which  he  was 
well  acquainted.  Had  not  death  cut  short  the 
labours  of  this  very  admirable  surgeon,  he  would 
almost  certainly  have  still  further  advanced  the 
surgery  of  the  prostate,  His  method  of  attacking 
the  gland  from  above  by  means  of  suprapubic 
cystotomy  showed  a  fine  combination  of  courage 
and  originality,  The  mortality  from  hemorrhage 
and  sepsis  was,  however,  severe  and  the  operation 
did  not  gain  ground.  When  Freyer  made  public 
;  his  operation  it  was  so  novel  in  its  character  and  so 
I  opposed  in  appearance  to  anatomical  possibilities 
that  many  persons  would  not  believe  that  it  could 
be  done,  and  he  himself  was  one.  But  he  ventured 
frankly  to  say  that  this  would  not  have  occurred 
if  at  the  outset  it  had  been  clearly  pointed  out  that 
there  was  no  comparison  between  the  normal 
anatomical  prostate  and  the  pathological  adeno- 
matous prostate.  But  ihe  attempt  made  to 
deprive  him  of  the  credit  due  to  him  by  saying  that 
his  operation  was  simply  that  oi  McGill  was  very- 
paltry. 

The  writer  saw  McGill's  specimens  and  patients 
some  fourteen  years  ago,  and  it  was  plain  that  his 
operation  was  mere  nibbling  in  the  effort  to  get 
away  as  much  as  possible  of  the  gland,  and  that 
by  means  of  instruments,  Freyer1  s  operation  is 
done  with  the  avowed  object  of  removing  the  whole 
gland  bodily  by  enucleating  it  with  the  finger, 
even  if  the  prostatic  urethra  had  to  go  too. 

He  referred  to  Ihe  magnificent  specimens  ex- 
hibited that  night  by  Mr.  Freyer  and  to  bis 
mortality  of  to  per  cent.K  a  low  mortality  con* 
sidering  what  was  done,  and  the  age  and  the  condi- 
tion of  the  patients  to  whom  it  was  done. 

Allusion  was  made  to  the  operation  of  Parker 
Sims,  by  which  the  gland  was  removed  by  the 
perineal  route,  an  operation  which  doubtless 
promised  a  better  drainage  than  by  the  supra- 
pubic, but  which,  although  apparently  making 
great  way  in  America,  had  so  far  not  been  exten- 
sively used  in  this  country. 

fa)  Abstract  of  brief  Paper  introducing  di*cu«tGti  on  the  •ab- 
ject At  the  Liverpool  Medial  Institution,  Jinu*ry  SlBt,  1904. 


82    The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


Jan.  27.  1904- 


Coming  to  the  question  of  double  castration, 
while  admitting  the  direct  effect  of  the  removal  of 
the  testes  in  diminishing  the  prostate,  he  never 
could  bring  himself  to  do  it,  and  he  was  glad  to 
think  that  its  own  inherent  defects  and  Freyer's 
operation  would,  ere  long,  render  it  a  thing  of  the 
past. 

He  regretted  very  much  that  Mr.  Reginald 
Harrison's  excellent  attempt  to  accomplish  by 
the  safe  and  easy  operation  of  vasectomy  any 
good  that  had  been  done  by  castration  had  not 
proved  as  successful  as  he  could  have  wished. 
With  regard  to  his  own  experience  in  this  depart- 
ment of  surgery,  it  all  went  to  show  that  early 
treatment  was  the  real  line  upon  which  efforts 
should  be  made.  So  soon  as  a  man  showed  any 
symptoms  of  enlarged  prostate,  and  so  soon  as  his 
surgeon  found  that  he  did  not  completely  empty 


like  carrying  coals  to  Newcastle  for  a  Frenchman  or 
Dutchman  to  come  to  the  land  of  Lister  and  address 
there  a  Society  which  counts  among  its  members 
so  very  many  distinguished  surgeons  whose  results 
speak  for  themselves. 

For  years  past  we  have  sterilised  our  hands,  our 
instruments,  the  field  of  operation,  and  everything  that 
is  necessary  for  its  performance  ;  new  methods  of 
sterilisation  and  new  apparatus  are  being  introduced 
nearly  every  day.  During  the  last  five  or  six  years 
no  less  than  thirty  papers  have  appeared  dealing  merely 
with  the  way  we  should  sterilise  our  hands  ;  so  it  would 
really  seem  as  if  nothing  has  been  left  unsaid  or  undone 
as  far  as  this  question  is  concerned.  In  fact,  since 
Robert  Koch's  investigations  in  1878  on  the  etiology 
of  wound  infections,  we  have  become  thoroughly  con- 
vinced that  such  infection  occurs  only  from  contact, 
and  we  have  sterilised  everything  that  is  likely  to 
approach  the  wound. 

In  some  few  publications  stress  has  been  laid  on  the 
possibility  of  air  infection,  and  it  has  seemed  some- 


v»ie  ui~aa**~    „^*  „r>~„   ~  ,«v»*    fu„*  *«««   *r\  ^raur  rvff     pussioiuty  01  air  lmecuon,  ana  n  nas  seemea  some- 
H      "^  Z^l^LT^'u  ?Xt°*    &•  as  fr  the  whole  theory  of  the  great  Lister  might 


his  water  at  night  with  the  biggest  soft  catheter 
he  could  pass. 

A  silly  phrase — "entering  upon  catheter  life" — 
had  done  a  great  deal  of  mischief  by  inducing  many 
to  believe  that  this  was  entering  a  kind  of  hell  upon 
earth,  the  tortures  of  which  were  brought  on  by 
the  use  of  the  catheter.  The  second  point  was  the 
prompt  use  of  prostatotomy  in  certain  cases. 
When  a  man  having  symptoms  of  a  big  prostate 
suddenly  gets  retention,  and  where  it  is  clear  that 
instruments  of  any  kind  can  only  be  passed  with 
difficulty  and  suffering,  and  that  the  retention  of  a 
catheter  cannot  be  tolerated,  the  following  pro- 
ceeding has  been  promptly  adopted  by  the  writer 
with  the  greatest  success  in  obtaining  not  only  a 
relief  from  the  immediate  danger  but  a  complete 
and  permanent  cure. 

With  the  patient  in  the  lithotomy  position  the 
membranous  urethra  is  opened.  The  floor  of  the 
prostatic  urethra  is  deeply  incised,  and  the  cut 
should  go  right  up  into  the  bladder  so  as  to  split 
any  valve-like  third  lobe  or  a  cervix-like  protrusion. 
Next  the  prostatic  urethra  should  be  dilated  to  the 
utmost  with  the  finger  and  the  biggest  possible 
glass  tube  inserted  and  worn  at  least  for  a  month. 

It  may  be  said  that  every  surgeon  in  an  urgent 
case  does  a  urethrotomy  and  drains  the  bladder ; 
so  he  does,  but  he  does  not  split  the  lower  lobe  of 
the  prostate  as  described,  nor  does  he  forcibly 
dilate  the  prostatic  urethia  and  keep  it  dilated 
afterwards. 


A     SOURCE      OF      INFECTION 

DURING   OPERATION 

HITHERTO    NOT     SUFFICIENTLY 

RECOGNISED,  (a) 

By  MENDES  DE  LEON,  M.A.,  M.D., 
of  Amsterdam. 
Mr.  President  and  Gentlemen, — I  must  begin  by 
apologising  for  having  to  speak  in  a  language  which  is 
not  my  own,  and  therefore  not  as  easily  and  as  fluently 
as  those  you  are  accustomed  to  hear.  In  the  second 
place  I  must  apologise  for  calling  your  attention  to  a 
question  that  is  not  entirely,  or  at  all  events  not 
specially,  gynaecological .  Surgery  has,  however,  nowa- 
days taken  such  an  important  place  in  therapeutics 
and  especially  so  in  gynecology,  that  the  question  of 
antisepsis  and  asepsis  can  never  be  entirely  devoid  of 
interest,  though  it  may,  as  you  say  in  England,  seem 

(«)  An  Address  delivered  before  the  British  OyiifieLolojrical  Societv 
'he  Annual  Meeting  on  January  14th,  1904.  «**■«> 


be  thrown  over  and  forgotten.  The  idea  that  the  mi- 
crobes of  the  air  might  play  a  more  important  part  in 
wound  infection,  than  most  of  us  were  inclined  to  think, 
occurred  to  me  by  mere  chance  in  the  following  way : 
About  a  year  ago,  while  speaking  to  a  friend  who  was 
standing  with  his  face  lit  up  by  rays  of  sunlight  coming 
through  a  small  hole  in  the  window  curtain,  I  noticed 
that  of  the  thousands  of  little  particles  of  dust,  dancing 
in  the  sunlight,  the  majority,  wnile  this  gentleman  was 
speaking,  travelled  in  a  direction  opposite  to  the  sun- 
rays,  that  is  to  say,  from  the  mouth  towards  the  window. 
At  first  I  thought  that  the  direction  given  to  these  little 
particles  of  dust  was  due  to  merely  his  speaking,  but  on 
approaching  him  and  putting  my  hand  near  his  mouth 
I  felt  it  moist.  I  therefore  concluded  that  the  phe- 
nomenon was  caused  by  little  particles  of  saliva  pro- 
jected from  his  mouth  in  the  act  of  speaking.  We 
know  that  some  people,  when  speaking,  have  the  very 
disagreeable  habit  of  spraying  saliva  about  from  their 
mouth,  and  sometimes  we  can  even  feel  it  on  our  faces 
and  hands  ;  but  it  is  easily  proved  that  this  discharge 
of  saliva  is  far  more  common  than  has  been  recognised, 
that  perhaps  everyone  in  speaking  emits  more  or  less. 
If  we  place  a  looking-glass  at  a  distance  of  25  to  30 
centimetres  from  the  mouth,  after  speaking  a  few  words 
in  its  direction  we  can  see  that  the  whole  surface  of  the 
glass,  or  a  great  part  of  it,  is  spread  over  with  small  drops 
of  saliva. 

Now,  every  surgeon  is  obliged  to  speak  during  an 
operation  ;  and  it  is  therefore  evident  that  drops  of 
saliva  such  as  I  refer  to  must  find  their  way  into  the 
wound  when  we  are  operating,  and  the  question  arises 
whether  this  is  dangerous  to  the  patient,  and  likely 
to  cause  infection  of  the  wound. 

I  felt  sure  that  this  was  the  case  and  decided  to  in- 
[  vestigate  the  matter  more  closely.  Whilst  occupied 
with  my  experiments  I  consulted  the  literature,  and 
i  found  the  old  saying  true  that  there  is  nothing  new  under 
I  the  sun.  This  question  had  been  investigated  by  others, 
before  me,  though  I  was  not  aware  of  it,  perhaps  because 
what  had  been  written  and  said  about  it  was  in  hygienic 
and  bacteriological  works,  or  in  meetings  of  societies  on 
those  lines,  rather  than  in  connection  with  surgery  or 
gynaecology.  Flugge  was  the  first  to  point  out  the 
danger  of  small  drops  of  saliva  sprayed  into  the  air, 
which  occurred  to  him  whilst  he  was  investigating 
the  question  of  the  ventilation  of  sick  and  invalid 
rooms,  and  he  pointed  out  the  risk  of  infection  from 
tuberculosis  and  other  kinds  of  disease  in  this  way. 
Huebener,  who  was  at  that  time  assistant  to 
Micholitsch,  hearing  of  the  researches  of  Flugge,  thought 
the  same  danger  might  apply  to  operating,  and  by  per- 
sonal experiments  demonstrated  that  in  speaking  many 
drops  of  saliva  were  projected  into  the  air,  and  might 
easily  pass  into  the  wound  during  operation.  Having 
rinsed  his  mouth  with  a  culture  of  the  Bacillus  prodigi- 
ostis,  he  spoke  on  to  agar  plates  prepared  for  the 
experiment,  and  in  twenty-four  to  thirty-six  hours  a 
multitude  of   red  colonies  were  distinctly  visible  upon 


Jaw.  27.  1904. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Prhss. 


I  Lates*     This  could  not  be  due  to  anything  else  than 
I  rops  of  saliva  which  had  left  his  mouth  in  speaking. 
These    experiments  and    researches,    though    impor- 
tant .  did  not  seem  to  me   to  he  conclusive  as  to  the 
biltty  of  infection,  because  saliva  aught  reach  the 
wound  without  causing  infection*     I  therefore  wished 
^t  ermine  what  forms  of  microbes  leave  the  mouth 
in  the  saliva,  and  if  possible  what  number  of  them. 
That   the  human  mouth  is  a  great  focus  ot  infection 
has  been  abundantly  proved  by  hygienists.  and  very 
by   members  of  odontological  societies 
and  dentists  in  England  and  elsewhere.     Miller,  one  of 
in    Berlin,    found    twenty- two 
sorts  of  germs  or  microbes  in  the  saliva,  and 
;uj  Goad  by.  of  London,  and  others  have  traced 
of  local  diseases,   even  alveolar  abscesses, 
(Bfteiti  myelitis,   periostitis,   fistula,  and  septic 

n  the  lungs  and  digestive    tract  to  microbes 
the  saliva*  or  at  any  rate  in  the  mouth. 
But  what   I  wished  to  investigate  especially  was  not 
that,  but  how  much  of  the  saliva  leaves  the  mouth  in 
speaking.       My  experiments  were  carried  out  in  the 
I  had  some  agar  plates  prepared  in 
Huebener's  way.  but  instead  of  rinsing  ray  mouth  with 
the  Bacititts  prodi£iosus  as  he  had  done— and  I  wa> 
experimenting   myself  before  I  knew  of  his  work — I 
spoke   on    to    the   plate  in   the  ordinary  way*     The 
amenity  was   to  shut  out   the  microbes  of   the  air, 
number*  ot  winch    we  know  are  suspended  in  the  air 
to  any  room,  and  especially  in  that  ot  a  laboratory*  To 
exclude   these  microbes  I  had  a  box  made  with  an 
opening  about  as  large  as  the  mouth  on  its  upper  side, 
and  a  sliding  drawer  at  its  base  ;     having  carefully 
-sterilised  the  apparatus  I  opened  this  sliding  drawer, 
put  one  of  my  agar  plates  upon  it,  and  shut  it  immedi- 
ately*  sq   that    I   could    be   sure   there   were   no  aerial 
lies  m  the  box.     f  had  previously  got  my  assistant 
to  write  down  all  the  words  I  had  spoken  at  an  opera  tton 
these  words  I  repeated  into  the  box  through  the  open- 
ing in  the  direction  of  the  plate,  and  of  these  plates  I 
WOm  show  you  one.     The  very  small  colonies  which  you 
can  see  on  the  plate  are  streptococci,  every  one  of  them  ; 
the  larger  whitish  ones  are  diplococci.  and  the  yellow 
staphylococci.     Now  these  plates  prove  that  when 
we  speak  microbes  are  emitted  from  our  mouths,  and 
tf  we  are  operating  those  microbes  will  tie  projected 
ound.     In  fact,  in  speaking  while  operating 
emit  multitudes  of  most  dangerous  and  infectious 
ns,  which  are  a  source  of  real     danger,     I   have 
•d r  sorts  of  these  germs  in  every  one  of  several 
bund  red    experiments    I    performed,    that    is    to    say, 
•cocct,    staphylococci,   diplococci,   and   an  aerial 
microbe  not  of  so  much  danger  in  wounds  as  the  others. 
-     gentlemen,   I  wished   to  determine  not  only 
sorts  of  germs  emitted,  but  also,  though  mathem- 
atical accuracy  was  out  of  the  question,  to  find  out 
1  nearly  as  possible  how  many  of  these  germs  were 
.ted   into   the   field   of  operation.     1   show   you 
I   these  plates  on  which  instead  of  agar   I 
spread  out  about  half  a  dozen  of  the  usual  cover  slips, 
fxjkeinio  the  box  against  them  in  the  same  way, 
On  those  cover  slips  1  found  a  number  of  small  drops  of 
h  I  stained  in  the  usual  way  and  examined. 
OH  a  surface  of  about  2.000  micro-millimetres  I 
(40  germs  of  the  forms  already  mentioned,  and  , 
easily  countable.     One  little  drop  of  saliva  measured,  ' 
as  near  as   possible,    on    the    surface,    02.500    mil 
1U1II1  metres.     This  multiplied  by   140  and  divided  by 
i,  J75  microbes  for  one  drop  of  saliva*      In 
vords  you   will  certainly  emit  at   least  , 
tlva,  and  1  am  sure,  gentlemen,  each  of  ' 
ill  speak  at  least  *KX>  words  even  in  an  operation 
a  quarter  of  an  hour.     So  if  we  multiply 
?$  by  60,  we  may  assume  that    nearly 
a  quarter  of  a  million  dangerous  microbes  fall  into  the 
j'h    To  meet   the  possible  objection    that    I 

.«.    diplococci*    and    staphylococci    may    be 

TOt,  because  we  know  that  sometimes  streptococci 

indent  at  all,    I    thought  it   well   to  go  a 

Uier,  and  study  the  virulence  of  the  streptococci 

er  rnicrolies  from  my  own  mouth.     I  therefore 

ta'l  them  cultured,  and  I  inoculated  about  sixty  animals 


— that  is  to  say,  41  guinea-pigs,  15  white  mice,  and  5 
rabbits.  Of  these,  8  guinea-pigs  and  to  white  mice 
died.  The  inoculations  were  made  into  the  peritoneum 
and  subcutaueously,  and  the  sections  after  death 
showed  that  the  animals  died  of  peritonitis  ;  the  mi- 
crobes were  found  in  the  liquid  exudation  from  the 
peritoneum  as  well  as  in  the  liver  and  heart.  I  am* 
therefore,  absolutely  sure  that  the  deaths  were  due  to 
the  inoculation*  Two  of  the  rabbits  died  also*  but  as 
their  death  occurred  two  months  after  the  inoculation 
I  did  not  think  it  right  to  attribute  their  death  to  that 
cause.  From  these  animals  I  obtained  pure  cultures 
of  the  microbes  upon  gelatine,  milk,  potato*  and  blood- 
agar,  and  there  was  not  the  slightest  doubt  that  they 
were  the  staphylococci  and  streptococci,  the  germs* 
which  cause  suppuration  and  inflammation. 

It  now  seemed  to  me  proved  that  we  are  continually 
risking  infection  of  wounds  when  we  operate,  and  I  felt 
it  of  the  greatest  importance  to  find  out  how  we  might 
prevent  such  infection.  When  I  consulted  the  litera- 
ture oi  the  itabj ect  I  found  that  in  this  direction  nothing 
adequate  had  been  attained-  The  most  reasonable 
advice  that  had  been  given  was,  to  abstain  from 
speaking  at  all.  But,  as  1  have  already  said*  this  is 
practi tally  impossible.  Every  surgeon  must  admit 
that  whenever  he  operates  he  not  only  speaks,  but 
speaks  a  good  deal ;  some  surgeons  speak  all  the  time* 
and  often  with  the  face  very  near  the  field  of  operation. 
It  is  true  that  sometimes  the  mouth  is  averted,  but 
very  often  they  speak  directly  into  the  wound*  More- 
over, the  more  difficult  the  operation,  the  more  excited 
and  agitated  the  operator  becomes,  and  the  more  and 
the  louder  he  talks,  while  if  he  have  a  stupid  assistant 
or  stupid  nurses,  or  both,  he  cannot  help  talking  harder 
and  more  excitedly  than  when  everything  goes  smoothly 
and  calmly.  Ami,  of  course*  the  louder  and  the  more 
rapid  the  talking,  the  greater  the  number  of  microbes 
which  are  emitted  into  the  wound,  or,  at  any  rate,  into 
the  air  round  the  wound.  I  do  not*  however,  wish  to 
submit  to  you  merely  my  own  experience.  During  the 
last  six  or  seven  operations  which  I  have  done  I  asked 
one  of  my  assistants  to  note  exactly  how  many  words 
I  had  spoken  and  what  1  had  said.  I  also  asked  some 
of  my  surgical  friends  to  do  the  same,  and  six  of  them 
were  kind  enough  to  comply,  and  answered  my  ques- 
tions. The  first  of  these  spoke  85  words,  another  24a* 
another  200.  another  226,  and  another  144  words,  while 
number  six  spoke  246.  And  we  must  remember,  in 
the  first  place,  that  these  numbers  are  minima  ;  what 
the  assistants  said  was  not  noted,  and  every  assistant 
has  occasionally  to  answer  a  question  or  instruction 
addressed  to  him.  In  the  second  place,  many  words 
must  have  been  indistinctly  heard  or  forgotten  and, 
therefore,  not  noted  down.  In  the  third  place,  I  have 
00  lnubt  that  some  of  these  gentlemen,  under  the 
conditions  1  imposed*  spoke  less  than  they  usually  do. 
One  of  them  *ns  honest  enough  to  write  to  me  and  say 
that  it  was  impossible  for  him  to  continue  operating  in 
this  way  .  being  obliged  to  abstain  from  speaking  was 
such  a  strain  that  it  made  him  nervous;  and  that  as  a 
rule  he  spoke  four  times  as  much  as  when  he  was 
conducting  the  experiment  I  asked  him*  So  the  advice 
not  to  speak  during  an  operation  is  all  very  well,  but 
practicallv  it  would  be  quite  impossible  to  carry  it  out* 

and  method  suggested  to  prevent  the  infects 
wounds  from  talking  is  by  rinsing  and  so  Sterilising 
the  mouth  with  an  antiseptic.  But  we  know  that  to 
sterilise  the  mouth  properly  we  should  have  to  use  a 
solution  of  sublimate,  and  the  buccal  mucous  membrane 
is  too  delicate  to  allow  this.  Many  experiments  indeed 
have  been  made  in  this  direction,  especially  by  the 
odonlological  branch  of  the  profession,  and  I  tried 
several  ot  those  which  they  recommend*  There  is  a 
prescription  by  Miller  of  a  solution  containing  benzoic 
acid  and  saccharine  which  I  tried,  but  the  only  effect 
it  had  was  to  produce  much  more  saliva  in  my  mouth 
than  under  ordinary  circumstances.  I  also  experi- 
mented with  my  plates  when  using  this  substance,  and 
found  on  them  the  same  germs  as  before.  The  more 
liquid  part  of  the  saliva  contains  multitudes  of  strep  to* 
which  are  the  worst  of  the  lot.  I  also  tried  odol 
and  other  well-known  washes,  but  none  of  them  had 


JM-Thb  Medical  Press, 


CLINICAL  RECORDS. 


any  effect  at  all  in  diminishing  the  number  of  organisms 
which  were  emitted  in  speaking.     I  therefore  concluded 
that  the  only  way  of  preventing  this  danger  was  to 
adopt  mechanical  means  ;    that  is  to  say.  to  try  to 
prevent  in  a  mechanical  way  any  saliva  leaving  the 
mouth,  and  carrying  microbes  into  contact  with  the 
wound.      Huebener  and  others  have  employed  masks 
with  this  object,  and  perhaps  some  gentlemen  here 
present  have  also  done  so.     The  masks  are  made  some 
•of  single,  and  others  of  double  gauze,  and  I  experi- 
mented with    both  kinds  in   the   same  way    I    have 
already  described.     Speaking  in  front  of  the  plates 
with  a  single  gauze  mask  on  resulted  in  75  colonies  of 
microbes  on  the  plate,   among  which   there  were  39 
of  streptococci ;    with  double   gauze   there   were   21 
colonies.     Of  course  with  the  double  gauze  masks  the 
number  of  microbes  which    found  their  way  outside 
was  much  less,  but  in  both  cases  there  were  far  too 
many.     Finally,  I  concluded  that  the  best  way  to  pre- 
vent these  microbes  doing  any  harm  by  escaping  into 
the  air  was  to  shut  the  mouth  off  with  cotton  wool, 
because  we  know  that  cotton  wool  is  the  most  certain 
way  of  excluding  microbes.     The  difficulty  was  to  find 
means  of  keeping  the  cotton  wool  before  the  mouth 
while  operating  without  causing  inconvenience,  but  I 
devised  this  very  simple  little  apparatus,  which  seems 
to  me  to  answer  the  purpose  in  a  very  efficient  way. 
It  is   a  respirator,   and  between  double  metal  plates, 
each  of  which  is  perforated  with  small  holes,  there  is 
room  for  a  small  quantity  of  wadding,  which  is  quite 
sufficient  for  the  purpose.     After  it  has  been  inspected 
I  will  put  it  on,  and  you  will  find  that  it  does  not 
interfere  with  speech,  that  can  be  easily  heard,  though 
it  does  prevent  the  exit  of  dangerous  microbes  from  the 
m??Xl  i    I  show  vou»  more°ver,  one  of  the  agar  plates 
which  has  been  spoken  upon  through  this  mouth-piece, 
and  you  can  easily  prove  for  yourselves  that  not  a  single 


Jan.  27,  1904* 


assured  me  it  was  not  faecal.  His  general  health  was 
good.  I  administered  chloroform,  and  but  for  a  slight 
amount  of  struggling  during  the  narcotic  stage,  all  went 
well.  Colotomy  in  the  right  inguinal  region  was  being 
performed,  and  towards  the  close  of  the  operation, 
after  about  twenty  to  thirty  minutes'  inhalation,  a 
quantity  of  faecal  fluid  was  regurgitated.  This  occurred 
without  any  effort  during  absolutely  quiet  breathing 
and  well  contracted  pupils.  The  face  had  been  all 
through  the  administration  turned  towards  the  right 
side,  but  the  amount  of  regurgitated  fluid  was  more 
than  enough  to  flow  from  the  angle  of  the  mouth,  and 
a  quantity  of  it  was  immediately  drawn  into  the  trachea. 
The  face  immediately  turned  blue,  the  inhalation  was 
stopped,  the  head  lowered,  and  means  of  resuscitation 
persevered  with,  during  which  the  operation  was  com- 
pleted. The  pupil  remained  contracted  until  after 
artificial  respiration  was  begun.  Pulse  and  respiration 
failed  absolutely  about  three-quarters  of  an  hour  after 
the  regurgitation  of  the  faecal  fluid,  the  blueness  of  the 
face  having  deepened  as  each  inspiration  carried  the 
fluid  into  the  smaller  bronchioles. 


colony  of  microbes  has  been  developed  upon  it.  I 
repeated  this  experiment  several  times,  to  make  sure, 
but  always  with  the  same  result.  One  or  two  colonies 
•sometimes  could  be  seen  on  the  plate,  but  I  satisfied 
myself  that  they  could  only  have  come  there  through 
air  infection,  for  there  must  have  been  a  few  moments 
<lunng  which  the  slide  was  exposed  to  the  air  before  the 
drawer  could  be  pushed  back  again. 

The  conclusion  which  I  desire  to  bring  before  you  is, 
that  where  we  take  so  much  trouble  in  sterilising  our 
hands  our  instruments,  and  the  whole  area  of  operation 
as  well  as  the  room  in  which  it  is  done,  and  everything 
which  comes  near  the  patient,  we  ought  not  to  neglect 
tins  simple  precaution  against  the  risk  of  which  I  have 
oeen  speaking,  for  I  hope  I  have  been  able  to  convince 
you  that  it  is  a  real  danger,  and  it  may  be  as  great  a 
source  of  infection  as  those  which  we  habitually  guard 

I  have  to  thank  you.  Mr.  President,  for  allowing 
me  the  opportunity  of  explaining  this  little  matter  at 
wnicn  I  have  been  working,  and  you,  gentlemen,  for 
having  so  kindly  and  attentively  listened  to  me.  I 
^y™ent10nthatlhave  Placed  under  the  microscopes 
on  tne  table  slides  containing  micrococci  and  diplococci 
which  I  cultivated  from  the  inoculated  guinea-pigs, 
as  well  as  others  directly  sown  by  speaking. 

Clinical  iRecor&s. 

AN^STHESIA  DURING  OPERATION  FOR  TWO 
£ASES  OF  ACUTE  INTESTINAL  OBSTRUC- 
TION.—A  LESSON. 

By  Victor  G.  L.  Fielden,  M.B., 
SenwrAnwithetist  to  the  Boyal  Victoria  Hospital.  Belfast ;  Anes- 
thetist to  the  Ulster  Hospital  for  Children  and  Women  : 
and  to  the  Belfast  Ophthalmic  Hospital. 


This  unhappy  case  naturally  set  me  thinking,  With 
a  view  of  avoiding  a  repetition  in  any  future  case. 
Vomiting  is  frequent  enough  during  or  after  the  adminis- 
tration of  an  anaesthetic,  but  in  these  cases  the  epi- 
glottis completely  closes  the  respiratory  tract,  and  the 
vomited  matter  cannot  enter  unless  it  is  allowed  to 
remain  in  the  mouth  or  pharynx  until  the  glottis  opens 
during  the  next  deep  inspiration.  Regurgitation,  on 
the  other  hand,  as  happened  in  my  case,  is  the  passage 
of  fluid  from  a  more  or  less  filled  stomach  without  effort, 
and  whilst  the  patient  is  breathing  normally,  and 
whilst  the  glottis  is  open.  We  have  no  means  of 
knowing  the  amount  of  the  contents  of  the  stomach,  for 
even  if  the  patient  has  "  vomited  "  just  prior  to  the 
operation,  he  may  not  have  emptied  his  stomach :  con- 
sequently there  is  an  unknown  quantity  there.  Again, 
the  necessary  manipulation  of  the  intestine  increases 
peristalsis.  (I  have  frequently  seen  a  surgeon  demon- 
strate increased  peristalsis  by  lightly  tapping  with  an 
instrument  a  coil  of  bowel  which  he  had  withdrawn 
through  an  abdominal  wound.)  If,  then,  the  surgeon's 
handling  of  the  bowel  increases  the  peristaltic,  or  in 
the  case  of  obstruction,  the  so-called  anti-peristaltic, 
action  more  or  less  of  the  intestinal  contents  are  re- 
turned to  the  stomach  and  the  unknown  quantity  is 
increased  thereby  until  possibly  it  contains  such  an 
amount  that  it  expels  more  or  less  by  the  only  possible 
route — the  oesophagus. 

With  this  reasoning  I  decided  that  it  should  be  a 
routine  practice  for  anaesthetists  to  wash  out  the 
stomach  of  intestinal  obstruction  cases*  no  matter 
whether  the  patient  had  recently  vomited  or  not.  Two 
days  ago  I  had  an  opportunity  of  carrying  out  my 
views  with  the  best  possible  results.  Notes  of  this  case 
I  briefly  record — 

Case  II.— On  January  10th,  1004,  I  was  called  to 
the  Royal  Victoria  Hospital  to  anaesthetise  a  man, 
aet.  35,  upon  whom  laparotomy  was  to  be  performed  for 
acute  intestinal  obstruction.  *  He  had  vomited  faecal 
fluid  several  times  during  the  morning,  but  I,  imme- 
diately on  my  arrival,  set  about  washing  out  his 
stomach.  It  contained  a  good  quantity  of  faecal  fluid 
which  was  syphoned  off  and  the  viscus  washed  out  with 
two  or  three  quarts  of  water.  Half  an  hour  or  more 
elapsed  before  he  was  put  upon  the  table,  and  although 
he  had  not  vomited  in  the  meantime,  I  deemed  it 
advisable  to  pass  the  stomach-tube  again,  although  he 
had  been  given  nothing  in  the  meantime.  I  was  some- 
what surprised  to  find  nearly  half  a  pint  of  faecal  fluid 
syphon  over.     I  washed  him  out  with  a  quart  of  water, 


*ni  £  ♦•  ♦  Wmg    n°         may    pr0ve    mstructive    to     and  then  proceeded  to  give  chloroform.     The  operation 
aesmetists  :~~~  for  the  relief  of  the  obstruction  was  followed  by  appen- 


Case  I.— On  April  28th,  1903,  I  was  asked  to  give 
chloroform  to  a  gentleman,  aet.  63,  who  was  suffering 
from  acute  intestinal  obstruction.  He  had  been 
brought  to  a  private  hospital  that  same  morning,  and 
had    vomited    once   after   admission,    but    the   nurse 


dicectomy,  the  duration  of  the  administration  being 
seventy-two  minutes.  Not  once  was  there  the  slightest 
trouble,  and  he  did  not  vomit  again  till  sixteen  hours 
later,  when  he  brought  up  a  little  which  the  nurse  in- 
formed me  was  not  fiecal. 


Jax.  rr,  1904 


TRANSACTIONS  OF  SOCIETIES. 


Thb  Medical  Puss,     85 


{Transactions  of  Societies* 


CLINICAL  SOCIETY  OF  LONDON, 

\l    Evening    held    Friday,    January 

1904. 


Dr.  Frederick  Taylor,  President,  in.  the  Chair, 


Dr.  F,  Parkes  Weber  showed  two  cases  of 

DIFFUSE    LIPOMATOSIS. 

nrst  case  was  that  of  a  single  woman,  jet.  34.  who 

ated  typical  diffuse  bpomata  below  the  lower  jaw, 

on  the  upper  arms,  and  on  each  side  0/  the  front  of  the 

tfcorax.     She   had    always   enjoyed   good   health,    and 

was  not  excessively  fat.     There  was  no  evidence  of  any 

disease  oi  the  thoracic  or  abdominal  viscera  or  of  the 

nervous  system.     The  thyroid  gland  could  be  felt  and 

ntly  not  abnormally  small.     The  condition 

aid  been  noticed   for  about  two  years,  and  was  tin- 

raxiated  with  pain*     She  had  been  treated  by  thyroid 

The  second  case  was  that  of  a  man*  set.  $2, 

*hrc  was  formerly  a  carman.     The  lipoma  tous  masses, 

neck,  arms,   and  pubic  region,  first 

red  in  tS6S,  following  an  injury.     There  had  been 

general  wasting,  in  connection  with  which  it  was 

nggested  that  there  might  be  some  cirrhotic  change  in 

er.     The  development  oi  ascites  had  sometimes 

ban  observed  m  cases  of  difluse  lipoma  with  general 

wasting, 

V.  E,  Garrod  exhibited  a  boy,  ttt  IOj  With  a 

TUMOUR   OP    THE    LIVER. 

it  rinst  seen  in  August,  1903,  he  was  said  to  have 

fti&ng    tor  a   year,   and   to   have   had   pain  and 

1    the  left  side.     The  liver  was  then  much 

and  reached   below  the  umbilicus.     It  was 

orait  and  not  lender.     One  large  and  several  smaller 

swellings  were  felt  on  the  surface  of  the  right  lobe  near 

margin,  which  were  hard  and  yielded  to 

ation.  The  lymphatic  glands  in   the  Week  were 

There  was  double  dacryocystitis  with  con* 

fanctivitis,  and  interstitial  keratitis  more  marked  in 

ye.     There  were  no  changes  in   the   fundi. 

were  badly   formed,    but   were  not   charac* 

c  of  congenital  syphilis.     He  had   taken  i& 

Msstum  almost  continuously.     It  was  thought 

that  the  tumour  was  probably  of  a  gummatous  nature, 

ie  diagnosis  of  hydatid  had  also  been  advanced. 

hanges  had  been  observed. 

Dr.  G.  k.  Sutherland  thought  that  the  hardness  of 

the  mass,  as  well  as  the  presence  of  old  k era titis,  strongly 

Led  gum  mat  a.     He  inquired  if  mercury  had  been 

•  ved  at  all  in  the  treatment. 

nt  asked  if  there  had  been  pyrexia  at 
me. 
Dr.  Garrod  replied  that  the  boy  had  taken  a  small 
qustity  of  mercury  some  months  previously,  but  that 
he  intended    to  put   him   upon   a   course  of    the   drug 
together  with  the  iodide.     There  had  never  been  any 
lever, 
Mr  W,  H.  B.  Brook  (Lincoln)  showed  a  case  of 
I  paraplegia  dce  to  caries  of  the  mid-dorsal 

vertebra, 
rhich  the  operation,  of  cos  to -transversectomy  had 
txen  performed  with  complete  recovery.     The  patient 
was  a  youth,  at.  18,  the  notes  of  whose  ease  had  been 
read  before  the  Society  in  March,  1903.     The  fact  that 
vtieni  had  undertaken  a  railway  journey  of  over 
»oe  hundred  miles  was,   in  itself,  sufficient  evidence  of 
the  completeness  of  his  recovery. 
Mr.  LawrieH;  McGaVin  considered  that  the  thanks 
c  Society  were  due  to  Mr.  Brook  for  bringing  the 
before  its  notice,   and   congratulated   him  upon 
tocfa  a  successful  issue. 

Mr  J  showed  (1)  a  case  of  chronic  perios- 

titis (syphilitic)  in  a  man,  set.  28,  affecting  the  lower 
ends  of  both  femora.  A  skiagram  was  shown  to  illus- 
trate the  condition.     (2 }  A  case  of  ununited  fracture  of 


radius  and  ulna  m  a  man,  .ct.  74.  which  had  existed 
for  a  period  of  thirty-eight  years.  The  accident  was 
a  compound  one,  and  when  first  seen  he  was  advised 
amputation,  but  he  refused.  (3)  A  boy.  a?t,  13,  with 
symmetrica!  swellings  on  the  lower  jaw.  He  was  also 
the  subject  of  congenital  syphilis, 

Mr.  Harold  S.  Barwell  thought  that  the  condition 
was  one  of  dentigerous  c\ 

Mr.  Walter  G.  Spencer  exhibited  a  boy#  set,  io> 
with  bilateral  enlargement  of  the  testicles.  Both 
testes  were  swollen  to  about  adult  sixe,  and  hrmry 
elastic,  but  nut  tender  ;  the  right  was  rigid  and  enlarged, 
the  left  less  so,  \  sinus  existed  over  the  front  of  each 
testis  which  had  ceased  to  discharge  pus,  and  ftppca*ed 
to  be  healing.  The  patient  did  not  present  any 
further  signs  of  past  or  present  disease.  \u  indefinite 
family  history  suggested  both  tubercle  and  syphilis. 
He  had  been  under  observation  for  three  weeks,  and 
was  treated  with  mercury  internally  and  locafly,  with 
a  little  iodide. 

Mr.  Anthony  A.  Bowlby  thought  that  the  fact  of 
there  having  been  previous  suppuration  was  in  favour 
of  tubercle, 

Mr.  Raymond  Johnson  said  that  the  presence  of 
sinuses  111  front  oi  the.  testes  suggested  that  the  din 
began  in  the  body  of  the  organ,  which  was  rather  more 
common  in  s%'philis,  but  in  view  of  the  conversion  oi 
the  whole  gland  into  a  hard  mass,  he  agreed  that  the 
case  w+as  one  of  tubercle. 

Mr,  Percy  Paton.  in  the  absence  of  Mr.  Spencer, 
said  that  he  believed  that  the  latter  was  inclined 
towards  a  diagnosis  of  tubercle. 

Dr.  Frederick  E.  Batten  showed  a  little  girl,  at.  5, 
the  subject  of  complete  ophthalmoplegia  externa 
with  blnuhu  ss  of  acute  onset.  Thirteen  weeks  before 
admission  to  hospital  the  child  had  whooping-cough, 
from  which  she  recovered,  and  was  weU  in  about 
six  weeks.  Two  weeks  before  admission  the  child  had 
headache,  pain  in  the  abdomen  and  across  the  shoul- 
ders t  there  was  no  vomiting.  One  week  before 
admission  the  mother  noticed  that  the  child  could  not 
see  and  the  child  asked  her  mother  to  bring  a  candle 
because  it  was  dark.  At  the  same  time  it  was  noticed 
that  the  pupils  were  very  large,  and  she  could  not  move 
the  eyeballs.  There  was  no  loss  of  consciousness,  no 
Istons.  On  admission,  the  child  was  well  nour- 
ished, intelligent,  and  suffered  no  pain.  There  was 
no  ptosis,  but  complete  ophthalmopleeia,  with  a  slight 
divergent  strabismus.  The  pupils  were  widely  dilated, 
and  did  not  react  to  light.  There  was  complete  blind- 
ness. There  was  slight  optic  neuritis,  moro  marked 
in  the  nght  eve  than  the  left.  There  was  ne  weakness, 
of  the  muscles  of  the  face,  tongue,  palate,  or  limbs. 
The  child  walked  with  the  unsteadiness  of  a  blind 
person,  and  there  was  a  very  slight  mco-ordi nation  of 
the  movement  oi  the  right  arm.  All  the  deep  reflexes 
were  abolished.  The  superficial  reflexes  were  present. 
The  plantar  reflex  gave  a  variable  response  sometimes 
definitely  flexor,  at  other  times  a  typical  skin  extensor 
response  was  elicited.  Within  a  week  after  admission 
the  movement  of  the  eyes  had  greatly  improved,  but 
the  pupils  remained  dilated,  and  there  was  no  return 
of  vision.  Fourteen  days  after  admission  the  an 
menta  of  the  eyes  had  become  normal,  the  pupils  were 
no  Jonger  so  dilated,  and  the  optic  neuritis  was  much 
less  There  was  no  return  of  vision,  and  the  knee-jerks 
still* remained  absent.  While  m  the  hospital  there  was- 
no  rise  of  temperature,  no  headache,  no  vomiting,  and 
the  child  was  generally  bright  and  intelligent.  It  wu 
suggested  that  the  case  was  one  of  poho-enccphaht^ 
inferior  ejecting  the  oculo-motor  nuclei  and  the  lower 
visual  centres. 

Mr,  Lawrie  H.  McGavin  showed  a  married  woman 
with  complete  absence  of  the  phalanges  of  the  left 
hand.  The  patient,  who  was  the  sole  member  of  her 
family  affected  by  any  bodily  deformity,  was  healthy 
,n  other  respects.  The  skiagram  showed  that  the 
whole  of  the  phalanges  had  been  suppressed,  the 
metacarpal  bones  also  revealing  deformities.  The  case 
was  a  good  example  of  the  value  of  even  a  portion  ot 


86    Thb  Mbdical  Press, 


TRANSACTIONS  OF  SOCIETIES. 


the  thumb,  as  the  patient  had  brought  up  a  family  of 
"five  children  and  had  made  all  their  clothes  herself  ! 


Jan.  27 »  1904. 


fejMr.  Raymond  Johnson  showed  a  man,  aet.  28,  with 
a  translucent  cystic  swelling  of  root  of  nose.  The 
condition  was  first  noticed  about  three  years  ago.  No  I 
cause  could  be  assigned,  and  it  had  slowly  increased 
without  pain.  The  cyst  gave  a  well-marked  sense  of 
fluctuation,  and  its  tension  appeared  to  be  quite  con- 
stant. It  was  possible  that  it  was  jf  parasitic  origin. 
The  President  asked  what  form  of  parasitic  disease 
was  suggested. 

Mr.  Horrocks  Openshaw  considered  that  the  con- 
dition was  one  of  meningocele. 

Mr.  Douglas  Drew  thought  that  an  exploratory 
puncture  of  the  cyst  might  be  undertaken  with  aseptic 
precautions  in  order  to  confirm  the  diagnosis. 

Dr.  Arthur  E.  T.  Longhurst  inquired  what  form 
of  treatment  would  be  adopted. 

Mr.  Raymond  Johnson  replied  that  the  extreme 
translucency  of  the  swelling  rather  pointed  to  the  pre- 
sence of  a  dermoid,  and  that  it  would  be  better  to 
incise  the  cyst,  and,  if  possible,  remove  it. 

Mr.  R.  Johnson  also  showed  a  man,  aet.  47,  the 
subject  of  multiple  aneurysm,  in  whom  an  aneurysm 
of  the  right  brachial  artery  was  removed  by  operation 
.  in  July,  1902.  Eighteen  months  afterwards,  the  other 
aneurysms  situated  on  the  left  brachial  artery,  at  the 
bend  of  the  elbow,  and  on  the  left  popliteal  artery,  had 
remained  in  precisely  the  same  condition. 

Dr.  Wilfred  Harris  exhibited  two  cases  of  post- 
diphtheritic bulbar  paralysis.  Both  the  patients  were 
young  women,  aet.  25  and  29  respectively.  The  elec- 
trical reactions  showed  considerable  diminution  to 
faradism  in  the  paralysed  muscles. 

Mr.  Charles  R.  Keyser  showed  (1)  a  case  of  con- 
genital elevation  of  the  shoulder  in  a  girl,  aet.  9. 
There  was  no  history  of  injury  or  paralysis,  nor  was 
any  other  member  of  the  family  affected  by  any  bodily 
deformity.  There  was  no  muscular  paresis,  and  the 
X-rays  did  not  show  anything  abnormal.  (2)  A  case  of 
congenital  absence  of  the  fibula;  in  a  male  child, 
aet.  2 J.  There  was  bilateral  talipes  valgus  and  only 
four  toes  on  each  foot. 

Mr.  C.  Gordon  Watson  exhibited  two  cases  of 
osteitis  deformans  in  a  man,  aet.  73,  and  a  woman, 
aet.  53,  respectively.  In  the  first  case,  the  left  femur 
and  the  skull  were  principally  affected,  while  in  the 
second,  the  left  tibia  was  chiefly  involved. 

Mr.  William  H.  Battle  showed  a  case  of  fracture- 
-dislocation  of  the  upper  cervical  spine  in  an  adult 
without  symptoms.  The  patient  was  a  man,  aet.  56, 
who  had  fallen  down  a  staircase  a  month  before  admis- 
sion to  hospital.  A  skiagraph  showed  a  fracture  of  the 
axis  with  displacement  forwards  of  the  atlas  and  axis 
from  the  spine. 

Mr.  Edred  M.  Corner  showed  (1)  a  case  of  fracture 
of  both  pedicles  of  the  atlas  ;  and  (2)  a  case  of  frac- 
ture of  the  body  of  the  fifth  cervical  vertebra.  In 
both  cases  a  considerable  interval  elapsed  before  the 
patients  came  to  the  hospital,  and  in  neither  were  there 
any  paralytic  or  sensory  symptoms.  Mr.  Corner  con- 
sidered that  Mr.  Battle's  case  and  his  first  one  might  be 
termed  reasonably  frequent  fractures,  and  that  if 
■skiagraphs  of  the  spine  were  taken  in  all  cases  of 
severely  sprained  necks,  a  large  proportion  of  them 
would,  in  all  probability,  reveal  the  presence  of  a 
fracture. 


Prof.  McWeeney  said  out  of  many  hundreds  of 
autopsies  which  he  had  made  he  found  but  one  horse- 
shoe kidney,  which  was  situated  much  lower  down 
than  usual  ;  in  fact,  the  connecting  isthmus  lay  over 
the  sacro-iliac  synchondrosis. 
j  deformity  of  liver. 

1  The  President  showed  a  liver  with  deformity 
probably  produced  by  tight  lacing.  A  portion  of  the 
right  lobe  close  to  the  right  side  of  the  gall-bladder 
was  turned  right  over  so  as  to  come  in  contact  with 
the  upper  surface  of  the  liver. 

paraffin  method  of  embedding. 
Prof.  McWeeney  showed  an  adaptation  of  the 
paraffin  method  of  embedding  tissues  suitable  for 
class  purposes.  The  sections  were  cut  in  chains, 
floated  off  in  convenient  lengths  as  usual,  and  taken 
up  on  thin  sheets  of  mica,  to  which  they  were  caused 
to  adhere  by  capillary  attraction.  The  mica  sheets 
were  cut  up,  and  the  divisions,  each  bearing  a  section, 
given  out  to  the  class.  After  removal  of  the  paranin 
as  usual,  the  students  stained  and  mounted  the  sections 
which  adhered  throughout  to  the  mica,  and  were 
mounted  in  balsam  along  with  it.  Exhibitor  owed 
his  acquaintance  with  this  useful  method  to  his  friend 
Professor  Coffey,  who  had  acquired  it  in  Held's  labora- 
tory. 

ringworm. 
Prof.  McWeeney  showed  sections  of  ringworm- 
hairs  prepared  by  the  paraffin  method,  and  adapted 
by  the  mica  method  for  distribution  to  a  class.  They 
showed  the  characters  of  the  several  forms  of  ringworm, 
especially  the  microsporon,  and  their  relation  to  the 
hair  shaft  and  root  sheath.  The  microsporon  spores  in 
the  Irish  cases  he  had  studied  gave  notably  larger 
measurements  than  those  usually  recorded — 4  to 
6  mikra,  instead  of  2  to  3  mikra  as  generally  given.  He 
also  showed  young  microsporon  plants  grown  from  single 
spores  on  "  French  proof  agar,"  as  well  as  in  epidermic 
scales.  The  acladium  form  of  branching  and  ectospore 
formation  were  well  seen  in  the  hanging  drop  cultures. 
For  staining,  he  had  found  Heidenhain's  iron-haema- 
toxylene  after  formol-vapour  fixation  most  useful. 
The  nuclei  of  the  young  mycelium  were  well  seen  under 
high  powers.  He  had  it  in  contemplation  to  under- 
take a  comparative  study  of  Irish  skin-fungi  by  th^ 
methods  he  now  outlined — viz.,  isolation  of  individual 
spores  and  culture  on  French  proof  agar. 
endometritis. 


Dr.   Neville  exhibited  photographs  made  by  Dr. 
Wigham  of  various  varieties  of  endometritis. 


cancer  of  ovary. 


Dr.  Neville  showed  macroscopic  and  microscopic 
sections  of  cancer  of  the  ovary. 


BRITISH  GYNAECOLOGICAL  SOCIETY. 
Meeting  held  Thursday,  January  14TH,  1904. 


Dr.    Heywood   Smith,    President,    in   the  Chair. 


JROYAL  ACADEMY  OF  MEDICINE  IN  IRELAND. 

Pathological  Section. 

Meeting  held  Friday,  January  15TH,  1904. 


The  President,  Dr.  Earl,  in  the  Chair. 


horseshoe  kidneys. 
The  President  and  Dr.  Travers  Smith  showed 
tuberculous  suprarenal  bodies  and  a  horse-shoe  kidney, 
.  from  a  case  of  Addison's  disease. 

The  President  also  exhibited  a  second  horse-shoe 
kidney. 


This  being  the  Annual  Meeting  of  the  Society,  in 
the  unavoidable  absence  of  the  treasurer,  Dr.  William 
Travers,  his  report  and  balance-sheet  for  the  year  1903 
were  read  by  the  senior  secretary,  Dr.  Swan  ton,  and 
on  the  motion  of  Mr.  Bowreman  Jessett,  seconded  by 
Dr.  George  Elder,  were  unanimously  adopted,  with  an 
expression  of  regret  at  his  resignation,  earnest  hope  for 
his  complete  recovery,  and  the  thanks  of  the  Society 
to  him  for  his  past  services.  The  report  of  the  Editor 
of  the  Journal  of  the  Society  having  been  read  by 
Dr.  J.  J.  Macan,  it  was  adopted  on  the  motion  of  Dr. 
Macnaughton-Jones,  seconded  by  Dr.  Macpherson 
Lawrie,  and  a  vote  of  thanks  to  Dr.  Macan  in  apprecia- 
tion of  the  efficiency  of  his  work  was  unanimously 
passed,  together  with  a  vote  of  thanks  to  Drs.  Purcell 
and  Bennett  for  their  services  as  auditors.  The  officers 
of  the  Society  for  the  current  year  were  then  elected,  a 
complete  list  of  which  appeared  in  our  last  issue. 


J*s.  ij,  1904- 


TRANSACTIONS   OF  SOCIETIES.  Tmt  Medical  Press.    8? 


The  President  exhibited  the  modification  of 

BOSSES  INSTRUMENT  FOR  DILATING  THE  CERVIX    CTERI, 

tie  vised  by  Frommer,  and  « It  mo  nitrated  the  ease  with 

Which  any  one  or  more  of  the  eight  blades  could  be 

bo  that  it  was  possible  instead  of  commencing 

:nn  with  the  linger  to  begin  the  process  with 

three  blades  only  and  complete  it  with  the  eight.     The 

action  was  controlled  by  a  screw,  and  the  exact,  amount 

sion  was  indicated  on  a  dial  on  the  handle. 

risi    of    Lacerating    the    cervix    was    materially 

darimshed  by  having  eight  blades  instead  of  four, 

Mevdes  de  LGgn,  of  Amsterdam,  then  gave  an 

fce  of  infection  during  operations  hitherto 

NOT    SUFFICIENTLY    RECOGNISE!*. 

will  be  found  on  page  S2. 
r    deb  very    of     the  address,     the    President 
t    suri      the  Fellows  would    wish    to  thank 
Icndes  dc  Leon  for  his  very  valuable  and   inter- 
Lper.      The  effect  of  habit  and   temperament 
as   very   remarkable.     Some  wen 
ng    nearly    the    whole    time  ;      others,    and    he 
i.t    the    best    operators,    conducted    their    work 
at  all,     He  thought   the   upshot  of 
-ments  was  thai   they  should 
the     ope  rating    table    except'  when    it    was 
rtBOhitely     necessary.      Dr.     Maenaughlnn- Jones    had 
recetith   read  a  paper  which   would   be  interesting  to 
"    they  had  just  heard,  as  it  was 
ijm  a  kindred  subject— the  care  of  the  mouth  and 
.   m  u  h    neglected  source  of  infection,   prior  to 
:toat  upon  the  pelvic  viscera. 

pressing  his  appre- 
ciation of  the  interesting  paper 
ol  Dr.  Mendes  de  Leon,  and  the 
perimenti  with  which  he  had 
illustrated     it,     said     that     he 
ibted  i!  Wi   '"iildever  arrive 
at    a    perfectly    ideal     asepsis. 
There   were    so   many    possible 
Of     the     admission    of 
infective  germs  In  the  surround  - 
rngs     of     the     operation  —  the 
patient,  the   surgeon,  the    assis- 
tants,    the     nurses,     the    appli- 
es,   and    the   operative  tract 
Bit    before,  during,   and  after 
an   operation — that  all  we  con  Id 
the    best    hope    for  was   to 
reduce  to   the    lowest    minimum 
the  elements  of  risk  which  must 
always  be    present,    no    matter 
what   our   precautions.      It    was 
this  striving  for  perfection  that 
tided    the    best   security    for 
tmt      patient,       and      no      effort 
tttch  as  that   advocated    h\ 
Mendes     de     Leon    should     be 
I   |  II  ~  ■  ridiculed     or    treated     lightly, 

Abroad    iu  some   Ultnik*    linen 

fcaps  were    worn,  and    also    sacs 
ft  *  co  v er  the  1 tcao  I .    As  to  silen  ce, 
speaking     for    himself,    nothing 
fi%  irritated     him     more     than    un- 

necessary talk  during  an  opera - 
lion,  but  he  supposed  that  this 
tendency  varied  with  the 
nationality  of  the  operator. 
The  great  desideratum  was 
silence  during  an  operation,  and 
only  such  speech  as  was  in- 
dispensable. The  demonstration 
which  they  had  seen  left  no 
room  for  argument  as  to  the 
practical  consequences  which 
resulted  from  speaking  over  the 
wound,  but  fortunately  they  did 
not  seem  to  result  in  any  very 
serious  effects  on  the  patient, 
min unity  of  our  graver  operative  procedures, 
only  saved  one  patient  in  a  thousand  on 


whom  we  operated  from  any  evil  consequences  ot 
salivary  infection,  it  was  our  duty  to  take  every  pre- 
caution to  prevent  that  risk.  He  could  not  say  how 
the  mouth-mask  shown  could  be  worn  during  a  pro- 
longed operation  without  inconvenience  to  the  operator, 
but  he  would  himself  try  it  in  order  to  ascertain  this' 
Dr.  Herbert  Snow  had  great  pleasure  in  seconding 
a  vote  of  thanks  to  Dr.  Me  rules  tie  Leon  for  his  most 
interesting  account  of  the  experiments  he  had  carried 
out  with  such  care  and  perseverance.  All  progress 
towards  asepsis  was  merely  relative,  and  whatever  the 
danger  of  the  emission  of  smalt  particles  ol  saliva  might 
be.  the  breath  passing  through  the  nasal  cavities  and 
month  must  be  extensively  loaded  with  microbes,  and 
OOW  infection  from  that  source  could  be 
possibly  excluded.  Drops  of  perspiration  were  another 
danger.  As  the  experiments  of  Lockwood.  among 
others,  hat!  shown,  absolute  sterilisation  could  not  be 
secured.  Whatever  was  done,  some  microbes  would 
be  implanted  on  the  wound.  If,  however,  the  tissues 
were  in  anything  like  a  healthy  state,  aud  if  the  nun 
of  pathogenic  germs  coming  in  contact  with  the  wound 
were  relatively  small,  there  would  not  be  any  serums 
trouble.  It  would  be  interesting  to  know  whether, 
before  adopting  the  precautions  described,  Dr.  de  Leon 
had  experienced  disasters  from  undetected  causes, 
which  had  not  occurred  since  those  precautions  had 
been  taken. 

Dr.  Mm  eHERsox  Lawrie  expressed  his  sense  of  the 
great  interest  of  the  results  arrived  at  by  Dr.  Mei 
de  Leon,  but  concurred  with  Dr.  Snow  in  thinking 
that  the  breath  of  the  operator  might  also  be  a  fertile 
Huiirce  of  infection,  and  thought  that  the  nostrils  should 
be  guarded  as  well  as  the  mouth  if  it  weredesira 
r  the  latter. 

Dr.  Bedford  Fen-wick  said  that  the  paper  they  bad 
heard  was  of  great  practical  as  well  as  theoretical  value, 
though  the  author  had  confined  himself  to  the  effects 
:h.  M any  \ears  ago  his  (Dr.  Feivwick's)  father 
made  some  original  researches  upon  the  effect  of  I  he 
saliva  in  health  and  disease,  which  at  the  time  attracted 
attention,  ami  in  that  work  he  had  been  privileged  to 
ajaUt.  They  had  found  that  in  all  healthy  people  the 
saliva  contained  a  large  amount  of  sulphocyamde  of 
potassium,  and  was  therefore  powerfully  antisi 
He  coutd  not  therefore  agree  with  Dr.  de  Leon  in 
attributing  more  importance  to  the  saliva  than  ti 
breath  ;i*  a  vehicle  of  micro-organisms,  but  thought, 
with  Dr.  Macpherson  Lawrie,  that  as  a  source  of  in- 
fection the  nose  was  as  important  as  the  mouth. 

Dr.   W.  J*  SHYLY  having  made  a  few  remark 
appreciation. 

Dr.  Mendes  de  Leon,  in  reply,  said  that  m  regard 
to  the  amount  of  talking  during  operation,  Dutchmen 
had  not  the  same  temperament  as  Irishmen,  French,  or 
Italians,  and  were  generally  supposed  to  take  things 
very  quietly  ;  yet  even  men  who  said.  "  Well,  my 
friend.  I  will  do' what  yon  ask  me.  but  it  will  be  of  no 
use  hecause  I  do  not  talk  at  all  during  operations/' 
nevertheless  sent  him  protocols  of  2CO  to  300  words 
spoken  over  the  wound.  Though  300  words  might 
seem  a  very  large  number,  they  might  easily  be  s.ml 
during  an  operation  that  did  not  take  more  than  fii 
minutes.  As  a  characteristic  incident  he  might  tell 
them  that  one  of  the  best  Surgeons  in  Amsterdam,  who 
habitually  took  extraordinary  precautions  against 
sepsis,  noticing  that  an  etherised  patient  seemed  to  be 
about  to  vomit,  cried  out  with  great  energy,  "  Lock- 
out, she  is  going  to  vomit,  and  if  you  are  not  careful 
she  will  spit  into  the  wound  M — the  very  thing  that  he 
was,  without  knowing  it,  doing  himself.  Absolute 
asepsis  was  not,  perhaps,  obtainable,  but  every  possible 
precaution  should  be  taken,  especially  when  so  Ca 
the  one  he  had  suggested.  Before  he  brought  bis  mask 
before  the  profession,  he  had  used  it  for  several  weeks 
during  many  operations,  some  of  them  lasting  from  an 
hour  to  an  hour  and  a  half>  and  he  could  assure  Dr. 
Macnaugh  ton -Jones  that  it  did  not  cause  the  slightest 
discomfort.  The  instrument  was  very  easily  adjusted, 
and  did  not  interfere  with  audible  speech  as  he  would 


88    The  Mbdical  Press* 


TRANSACTIONS  OF  SOCIETIES. 


Jan.  27.  1904. 


now  show  them  (demonstration).  In  regard  to  the 
danger  of  germs  being  disseminated  into  the  air  from 
the  nostrils,  as  insisted  on  by  Dr.  Lawrie  and  others, 
he  did  not  deny  the  possibility,  but  was  not  convinced 
of  the  danger  ;  the  pathogenic  germs  he  had  demon- 
strated in  the  saliva  had  not  been  found  in  the  healthy 
nose,  though  streptococci  had  no  doubt  in  ozaena  and 
similar  inflammations  been  found  there.  He  was 
absolutely  convinced  that  the  microbes  emitted  with 
the  voice  were  conveyed  by  the  saliva,  and  not  merely 
by  the  breath,  as  suggested  by  Dr.  Fenwick,  for,  in 
spite  of  repeated  trials,  he  had  never  obtained  any 
colonies  upon  his  agar  plates  simply  by  breathing  upon 
them.  He  had  not  been  disappointed  at  this,  as  he 
knew  that  it  was  the  saliva  that  caused  peritonitis 
in  the  inoculated  animals.  Pathogenic  germs  might 
possibly  be  emitted  from  diseased  lungs,  but  his 
experiments  proved  that  they  had  been  conveyed  by 
the  saliva  on  to  the  agar  plates,  upon  which  they  had 
caused  definite  colonies.  If  every  streptococcus  or 
staphylococcus  that  fell  into  a  wound  caused  infection, 
the  effect  of  a  quarter  of  a  million  of  such  would  be 
terrible  to  contemplate  ;  but,  fortunately,  this  was  not 
the  case,  and  surgeons  now  had  very  good  results,  especi- 
ally in  gynaecology.  We  should,  however,  aim  at  the 
lowest  possible  mortality,  and  as  the  mysterious  deaths 
that  occasionsally  occurred  in  the  practice  of  even  the 
most  distinguished  operators  might  be  due  to  some 
such  cause  as  he  had  pointed  out,  the  admission  of  such 
a  possibility  and  steps  to  guard  against  it  could  only 
be  beneficial. 

A  cordial  vote  of  thanks  to  Dr.  Mendes  de  Leon 
having  been  carried  by  acclamation, 

The  President,  Dr.  Heywood  Smith,  then  delivered 
his 

valedictory  address, 
reviewing  the  work  done  by  the  Society  during  his  year 
of  office.  He  first  referred  to  the  many  interesting 
specimens  shown,  and  cases  narrated,  and  instruments 
exhibited.  Of  the  many  valuable  papers  read  before 
the  Society,  of  which  by  no  means  the  least  interesting 
was  that  brought  before  the  Society  that  night  by 
Dr.  Mendes  de  Leon,  might  be  mentioned  the  one  by 
Dr.  Macnaugh ton-  Jones  on  "  The  Importance  of 
Attention  to  the  Condition  of  the  Mouth  and  Teeth  at 
Operations  on  the  Pelvic  Viscera  "  ;  on  "  Intestinal 
Obstruction  After  an  Operation  for  Ectopic  Gestation," 
by  Mr.  Jessett.  Dr.  Routh  read  a  paper  on  "  Some 
Directions  and  Avenues  Through  which  Cancer  may 
Possibly  be  More  Successfully  Treated  and  Perhaps 
Cured."  Dr.  Mansell  Moullin  read  a  paper  on  "  Haema- 
tocolpos  and  Haematometra."  Professor  Taylor  (the 
learned  President-Elect)  gave  a  valuable  paper  on 
"  Lacerations  of  the  Cervix  and  their  Consequences." 
Dr.  Bedford  Fenwick  opened  an  interesting  discussion 
on  "  The  Treatment  of  Stenosis  by  Incision  "  ;  and 
Dr.  Mendes  de  Leon  has  given  to-night  a  most 
instructive  paper  on  "A  Hitherto  not  Sufficiently 
Recognised  Source  of  Infection  During  Operations. 
[All  of  these  papers  have  appeared  in  the  columns  of 
The  Medical  Press  and  Circular.]  He  next  referred 
to  the  Journal  of  the  Society,  so  ably  conducted  by  its 
Editor,  Dr.  Macan,  which  contained,  besides  an  accurate 
report  of  the  Transactions,  many  very  valuable  original 
communications  and  the  Summary  of  Gynaecology, 
including  obstetrics,  exhibiting  a  most  painstaking  and 
laborious  effort,  and  keeping  the  gynaecologist  fully 
up  to  date  with  the  progress  of  the  speciality  all  over 
the  world.  Dr.  Heywood  Smith  next  touched  on  the 
altered  attitude  of  the  Society  towards  the  admission 
of  medical  women  to  the  Fellowship,  and  on  the  estab- 
lishment of  an  examination  for  gynaecological  and 
maternity  nurses.  With  regard  to  the  former,  he 
remarked  that  the  Articles  of  Association  and  the  by- 
laws of  the  Society  were  originally  drawn  up  with  the 
distinct  view  of  the  admission  of  medical  women  as 
well  as  medical  men  to  the  Fellowship,  but  a  small 
minority  of  Fellows,  although  they  joined  the  Society, 
yet  were  opposed  to  that  idea,  and,  making  their  influ- 
ence felt,  frustrated  in  that  direction  the  principles  of 
the  Society.  Several  important  meetings  on  the 
ubject,  however,  had  been  held,    and  he  gave  credit 


where  it  is  due  by  stating  that  several  members  of  the 
opposing  minority,  when  they  saw  the  manifest  feeling 
of  the  Society  on  the  subject,  withdrew  their  opposition, 
and  aided  the  Society  in  so  altering  their  rules  as  to 
make  the  election  to  the  Fellowship  simpler,  while  at 
the  same  time  safeguarding  its  interests  with  regard  to 
the  eligibility  of  any  particular  candidate.  The  estab- 
lishment of  a  periodical  examination  for  nurses,  gynaeco- 
logical and  maternity,  was,  he  remarked,  fully  ex- 
plained in  his  Inaugural  Address  a  year  ago.  It  would 
suffice  now  to  state  that  such  examinations  have  been 
carried  out  by  their  Board  of  Examiners  quarterly ; 
that  the  examinations  have  consisted  of  written  papers, 
the  questions  for  which  have  been  published  from  time 
to  time  in  the  Journal,  and  a  vivd  voce  examination,  in 
which  the  examiners  had  been  aided,  as  to  practical 
work,  by  several  matrons  of  hospitals,  who  willingly 
gave  their  help  in  this  matter.  Examiners  have  been 
well  pleased  with  the  high  standard  of  the  knowledge  of 
their  profession  shown  by  the  majority  of  the  candidates 
so  far  as  to  work  done  during  the  past  year.  But  he 
wished  to  draw  attention  to  the  cases,  five  in  number, 
of  sclerosis  of  the  ovary  that  have  been  brought  forward 
as  indicating  a  field  for  further  investigation  and 
research.  And,  first  of  all,  he  thought  the  ground 
should  be  cleared  as  to  the  etiology  of  the  disease, 
whether  it  is  a  "  cirrhosis  "  or  "  sclerosis,"  and  then 
proceed  to  map  out  the  leading  symptoms  with  the  view 
to  a  correct  diagnosis,  and  thence  to  the  prognosis  and 
treatment.  His  own  view  was  that  they  represent  two 
separate  conditions ;  the  specimens  brought  before  the 
Society  during  the  year  tend  to  confirm  this  position. 
In  cirrhosis  we  find  the  interstitial  stroma  first  of  all  the 
seat  of  an  inflammatory  process  and  afterwards  so 
contracting  as  to  render  the  envelope  convoluted,  so 
that  it  presents  an  appearance  not  unlike  the  convolu- 
tions of  the  brain,  whereas  in  sclerosis  it  is  the  envelope 
that  is  the  chief  seat  of  the  abnormal  thickening  and 
induration,  leading  (as  also  in  the  case  of  cirrhosis)  to 
contraction  of  the  organ  and  to  consequent  dysmenor- 
rho?a.  Dr.  Heywood  Smith  passed  in  review  the  deaths 
of  Fellows  during  his  year  of  office,  and  concluded  his 
address  by  congratulating  the  Society  on  having'elected 
as  his  successor  so  distinguished  a  Fellow  as  Dr.  John 
William  Taylor,  M.Sc,  Professor  of  Gynaecology  in  the 
University  of  Birmingham,  and  Surgeon  to  the  Bir- 
mingham and  Midland  Hospital  for  Women.  Pro- 
fessor Taylor,  he  added,  was  renowned  not  more  for  his 
operative  skill  than  for  his  accuracy  of  diagnosis,  the 
thoroughness  of  his  research,  and  the  value  of  his 
published  works  ;  and  he  was  convinced  that  the 
Society,  in  thus  electing  him  President  for  the  ensuing 
year,  had  taken  a  step  that  could  but  result  in  the 
furtherance  of  the  objects  for  which  it  was  founded. 

Professor  John  W.  Taylor,  the  President-Elect,  said 
that  it  was  to  him  a  great  pleasure  to  propose  a  vote  of 
thanks  to  the  President,  not  merely  for  the  Valedictory 
Address  they  had  just  heard,  but  for  his  admirable  con- 
duct in  the  Chair  during  the  past  year.  Of  all  the 
original  Fellows  of  the  Society  he  believed  that  none 
had  been  a  more  constant  attendant  at  their  meetings, 
or  had  the  interests  of  the  Society  more  closely  at  heart 
than  Dr.  Heywood  Smith,  and  no  one  could  fail  to 
appreciate  the  patience,  wisdom,  and  courtesy  with 
which  he  had  discharged  the- onerous  duties  of  the  office 
of  President  of  the  Society,  while  all  would  join  in  cordial 
wishes  that  he  might  long  be  spared  to  take  part  in  their 
proceedings  and  give  them  the  benefit  of  his  presence 
and  counsel. 

The  vote  of  thanks  having  been  carried  by  accla- 
mation, Dr.  Heywood  Smith,  in  acknowledging  it, 
expressed  the  pleasure  it  had  been  to  him  to  serve  the 
Society. 

LIVERPOOL  MEDICAL  INSTITUTION. 
Meeting  held  Thursday,  January  2ist,  1904. 

James  Barr,  M.D.,  F.R.C.P.,  President,  in  the  Chair.. 

CEREBRAL  TUMOUR.— CEREBRAL  THROMBOSIS. 

Dr.  Warrington  read  a  note  on  a  case  of  cerebral. 


JiK.  aj.  1904. 


TRANSACTIONS  OF  SOCIETIES.  Th,  iumt.au  p.,-.    89 


thrombosis  clinically  ^characterised  by  total  aphasia, 
but  with  retention  of  consciousness*     The  necropsy 
■J  thai  I  he  softening  had  occurred  in  the  region  of 
distribution  of  the  middle  cerebral  artery,  and  that  it 
n  great  part  limited   to  the  lower  frontal  con- 
cern poro -sphenoidal  and  angular    gyros  on 
left  side. 
D!\  Warrington  also  gave  an  account  of  a  case  of 
ral  tumour,     The  initial  symptoms  were  loss  of 
retollection,    hallucinations    of  'smell    and    attack    of 
pallor,  with  erection  of  hair  on  the  left  side  of  the  face. 
later  the  classical  symptoms  of  tumour  cerebri  deve- 
being  ushered  in  by  an  apoplectiform  attack  in 
1  consciousness  was  lost   for  nine  days,     An  ex- 
ploratory operation  was  performed   by  Mr+   Rush  ton 
rVker,    the    Rolandic    area    was    exposed,    revealing 
odetna  of  the  sub-arachnoid  tissue  and  softness  of  the 
but  no  tumour  or  even  marked  tension  of  the 
1*101.     The  operation  afforded   marked    though   tem- 
r\  relief  to  the  patient,  who  died  four  months  Liter. 
/   a   tumour  was  found  occupying   the 
tool  ganglia  and  hippocampus  major. 

>n    Parker  said   that   the  operati- 

was  done  chiefly  with  the  view  to  relieve 

1  supposed  to  he  the  cause  of  the  optic  neuritis. 

1  01  bone  removed  was  replaced  m  fragments. 

ad  healed  by  first  intention,  and  the  patient's 

was    restored    and  preserved.      The  patient 

rly  four  months  after  the  operation,  and  un- 

ibtedly  his   life  was  prolonged  and  the  progress  of 

!  tumour  found  after  death  was  greatly  diminished. 

u.tiAM   Banks  then  read  a  paper  on 

THE    MODERN    SURGERY    OF   THE    PROSTATE, 

i  Abstract  of  which  will  be  found  cm  page  8i. 
Mr   J-'rever  congratulated  Sir  William  Banks  upon 
tally  practical  paper,  and  endorsed  what  had 
respecting  the  admirable  work  of  Sir  Henry 
i     for  the  use  of  the  soft  rubber  catheter, 
f ether  with  washing  out  of  the  bladder*  was  a  very 
at  advance  in   the  treatment  of  enlarged  prostate. 
Freyer  briefly  referred   to   the  various  operative 
-  which  had  from  time  to  time  been  advo- 
ated  in  dealing  with  an  enlarged  prostate.     He  par- 
mentioned  castration,  and  as  illustrating  the 
neb  a  procedure,  exhibited  a  prostate 
nch  he  had   removed   from  a  patient    upon  whom 
had  been  performed  five  years  previously. 
Mr.  Fteyer  Iben  dealt  with  the  anatomy  of  the  prostate, 
Ahtth,  he  said,  consisted  of  two  separate  portions  held 
v  a  fibrous  capsule*  the  whole  being  enclosed 
m  i  iteath  formed  by  the  recto-vesical  fascia,  much  in 
vay  as  the  rind  encloses  the  edible  portion  of 
4fl  orange.     In   enucleating  a  prostate   the  gland   is 
iie  recto-vesical  sheath,  and,  as  the  pros- 
plexus  of  veins  is  for  the  most  part  embedded  in 
tte  I  i\   sheath,   there   should   not   be   much 

taiorrhage    during    the   operation.       He    laid    great 
upon  the  importance  of  ascertaining  as  far  as 
condition  of  the  kidneys  before  attempting 
<nuc leatton.    for    in    long-standing    prostatic     trouble 
was  always  a  danger  of  suppression  of  urine,  quite 
from    the    result  of  operative  interference.     If 
om  were  more  carefully  selected  and  better  prepared 
'ion  the  mortality  in  future  would  be  less* 
i  reyer  finally  described  in  detail  the  various  steps 
Mpcratiou. 
Mr   Reginald  Harrison  said  he  would  confine  his 
ttnarioi  to   the  influence  that  supra -pubic  prostatec- 
as  illustrated   by  Mr,   Freyer's  cases  would   be 
"My  to  have  on  the  operative  treatment  of  stone  in 
iUder,  complicated  with  such  a  degree  of  pros- 
enlargement  as  to  render  the  patient   incapable 
:  loHj  emptying    bis  bladder  or  of  doing  so  with  a 
In  such  cases  the  expectancy  of  a  recurrence 
after  its  removal    either    by" crushing  or  by 
botomy  was  very  great.      In  fact,  under 
toe*  conditions   the   obstructing  prostate    might   be 
,e*anitti  as  the  principal    lac  tor  mi    the   formation  or 
MbQttlion  of  stone.     He  quoted    examples  where,  j 
iapaxy    had    been    employed    on    repeated  ' 


I  occasions  for  recurrence  of  bladder  stone,  the  concur- 
rent removal  of  both  stone  and  prostate  had  been 
foUowud  by  the  complete  and  permanent  recovery  of 
the  patient  in  the  fullest  sense  of  the  term.  He  ex- 
hibited a  stone  and  prostate  which  he  had  removed  the 
previous  day  from  a  patient  who  had  undergone  supra- 
pubic  lithotomy  six  months  previously.  He  thought 
there  were  many  cases  where  the  stone  and  prostate 
should  be  removed  as  a  primary  operation.  In  fact, 
he  had  done  so  in  several  instances  with  excellent 
results.  He  said  this  without  any  prejudice  to  litho- 
tapaxy,  which  he  regarded  as  the  best  and  safest  opera- 
tion in  uncomplicated  cases  of  stone  or  where  co-exist- 
ing prostatic  symptoms  were  not  pressing.  He  did 
not  think  the  combined  operation  increased  the  risk. 

Mr.   Robert  Bickersteth  spoke  of  the  - 
great  difficulty  m  removing  a  small  and  hard  prostate, 
and     asked     Mr.    Freyer  whether  in   his  suprapubic 
operation  he  had  ever  failed  in  an  attempt  to  enucleate 
one  of  these  prostates* 

Mr.  Kewbolt  mentioned  three  cases  in  which  he  bad 
Operated  by  the  suprapubic  method,  twice  successfully, 
the   third  patient  dying  from   uraemia, 

Mr.  Douglas  Crawford  thought  that  in  future  the 
operation  would  be  performed  earlier  while  the  pros- 
tate  was   comparatively   small       He    had    not    been 

I  satisfied  with  his  results  from  castration, 

Mr,  Rushton  Parker  said  he  could  confirm  Mr. 
Freyer's  description  of  the  so-called  third  lobe,  as  being 
an  integral  part  of  one  of  the  lateral  lobes. 

Mr.  Thelwall  Thomas  spoke  in  favour  of  the  peri- 
neal route,  and  laid  when  the  enlargement  was  not 
very  great  the  prostate  could,  after  free  division  of  the 
capsule,  be  as  readily  enucleated  as  by  the  supra- 
pubic method;  this  latter  method  he  considered  more 
applicable  when  there  was  considerable  prostatic 
enlargement. 

Mr.  Pall  said  his  experience  of  complete  enucleation 
of  the  prostate  was  limited  to  one  case,  a  gentleman. 
a?t  70.     The  power  of  urinating  had  subsequently  been 

I  normal.  He  said  he  was  a  firm  believer  in  the  value  of 
eatheterism  in  prostatic  retention,  In  many  cases 
nothing  more  was  required,  but  in  some  a  period  came 
when  operative  interference  was  necessary.  As  re- 
gards double  castration,  he  congratulated  Sir  William 
Banks  on  never  having  done  it.  In  his  experience  the 
advantages  claimed  for  it  and  for  vasectomy  had  not 
been  fulfilled . 


CORK     MEDICAL     AND     SURGICAL     SOCIETY 
Meeting  held  Wednesday,  January  t  3th,  1904, 

J.  Cotter,  M.P.,  F.RX.S.L,  President,  in  the  Chair 

The  Chairman  read  notes  of  intestinal  obstruction 
occurring  in  a  woman,  a?L  49,  the  result  of  carcinoma 
of  the  hepatic  flexure  of  the  colon,  and  exhibited  the 
growth*  The  growth  was  excised,  and  the  free  ends 
of  the  intestines  sutured  together,  but  the  patient  died 
111  twenty-four  hours. 

Dr.  T«  Gelston  Atkins  showed  two  ovarian  tumours, 
both  occurring  in  patients,  act.  23.  and  neither  of  them 
giving  rise  to  any  symptoms  whatever  except  some 
nausea,  aggravated  by  movement,  though  one  tumour 
was  of  considerable  size,  Both  patients  recovered. 
Dr.  Atkins  also  read  notes  of  two  cases  of  hystero- 
salpingo-oophorectomy.  One  patient  was  a  married 
woman,  *t  3$,  and  on  vaginal  examination  pus  was 
found  welling  from  the  uterus.  A  laparotomy  was 
performed,  and  an  abscess  found  in  each  ovary,  pro- 
bably due  to  puerperal  infection*  A  peculiar  feature  of 
the  case  was  that  each  abscess  opened  directly  into 
the  uterus,  the  uterus  itself  and  the  Fallopian  tubes 
being  healthy.  The  patient  made  a  good  recovery. 
The  other  patient  was  aet.  53,  and  suffered  from  carci- 
noma of  the  uterus  and  ovaries.  The  diseased  organs 
were  removed,  but  the  patient  gradually  saak  and  died 
in  seven  days  from  cardiac  failure.  She  had  suffered 
for  years  from  tachycardia*  and  her  pulse  before  the 
operation  was  never  below  150,  and  after  the  operation 
never  below  160,     The  diseased  organs  were  shown. 


9°     The  Mbdical  Press. 


GERMANY. 


Jan.  27.  1904. 


Dr.  N.  Henry  Hobart  read  notes  of  a  successful 
case  of  Caesarean  section.  The  patient  was  a  primi- 
para,  aet.  24 ;  height,  4  ft.  6  in.,  and  the  subject  of 
lateral  curvature.  The  external  conjugate  diameter 
measured  5 J  in.,  and  the  true  conjugate  slightly  over 
3  in.  The  child  was  delivered  by  the  feet  (the  head 
being  fixed),  6}  minutes  from  the  commencement  of 
the  operation.  The  uterus  was  flushed  with  saline 
solution  and  then  sutured.  The  patient  made  a  good 
recovery  and  the  child  also  lived. 

jfrance. 

[from  our  own  correspondent.] 


Paris,  January  24th,  1904. 
ACETONURIA  INCHIEDREN. 

Periodical  vomiting  in  children  is  frequently,  accord- 1 
ing  to  Professor  Marfan,  connected  with  acetonemia 
indicating  a  disturbance  in  nutrition.  A  link  in  the 
chain  of  the  oxyo\ation  of  albuminoids  of  which  the 
ultimate  term  was  water  and  carbonic  acid,  acetone 
was  accompanied  by  a  number  of  other  products,  such 
as  lactic  acid,  oxalic,  acetic,  formic,  and  butyric  acids.  It 
had  been  suggested,  and  with  some  reason,  that  acetone 
was  produced  by  a  disorder  in  the  hepatic  functions. 

Acetonuria  being  remarked  in  diabetes  and  the  coma 
of  glycosuria,  a  considerable  amount  of  gravity  was 
attributed  to  its  presence,  but  it  existed  also  in  auto- 
intoxications of  intestinal  origin,  typhoid  fever,  cancer 
and  certain  cases  of  inanition. 

In  all  these  affections  and  conditions  the  digestive 
tract  was  compromised.  In  children  there  existed  a 
rather  rare  syndroma  characterised  by  periodic  attacks 
of  vomiting  accompanied  by  absolute  constipation  in 
otherwise  healthy  children.  The  vomited  matter 
contained  acetone,  and  the  breath  had  a  special  odour 
resembling  chloroform  or  apples,  yet  the  gravity  of 
the  case  depended  on  the  malady  and  not  on  the  acetone ; 
but  in  acute  affections  the  convalescence  should  be 
watched,  as  the  patient  might  be  considered  as  liable 
to  arthritism. 

Physicotherapy. 

When  in  Paris  those  who  are  interested  in  physico- 
therapy would  do  well  to  visit  the  Institute  of  Dr. 
Joseph  A.  Riviere,  No.  25  Rue  des  Mathurins,  near 
the  Opera.  Dr.  Riviere  has  devoted  his  professional 
life  to  the  improvement  and  development  ot  this  branch 
of  medical  science,  and  was  the  first  to  attempt  the 
combination  in  one  establishment  of  the  latest  and  most 
perfected  apparatus.  Many  of  these  are  his  own  in- 
ventions, as  may  be  seen  from  the  following  enumera- 
tion of  the  leading  departments  of  his  institute.  Electro- 
therapy :  Every  model  of  high  frequency  apparatus 
Hydrotherapy :  Nauheim  baths,  Riviere's  massage 
under  water,  and  carbonic-acid  baths.  Thermo- 
therapy.  Vibrotherapy.  Mecanotherapy.  Hydro- 
and  aero-massotherapy.  Obesity :  apparatus  Riviere. 
Phototherapy :  Finsen  apparatus,  Riviere's  electric 
light  baths  and  reflecting  apparatus,  treatment  of 
pulmonary  tuberculosis  by  means  of  intense  luminous 
clusters.  Aerotherapy.  Radiography.  Radioscopy. 
Kinesitherapy  and  gynaecological  electrotherapy. 

It  will  be  seen  by  an  inspection  of  his  institute  and 
from  the  articles  he  has  contributed  to  various  publi- 
cations, and  by  the  reports  of  his  addresses  before 
medical  conventions,  that  Dr.  Riviere  has  anticipated 
many  of  the  recent  experiments  in  treatment  of  can- 
cerous and  obstinate  tumours.  I  may  mention  here 
his  paper  read  before  the  International  Medical  Con- 
gress of  Electrology  and  Raliology  at  Paris  in  1900  ; 
his  communication  to  the  Fourteenth  International 
Medical  Congress  at  Madrid  in  1903  ;  and  nis  address 
to  the  Academie  Nationale  de  Medicine,  at  Paris,  on 


December  8th,  1903.  In  recognition  of  these  services 
Dr. Riviere  received  last  October  the  Chevalier  decora- 
tion of  the  Legion  d'Honneur  ;  and  on  this  occasion  a 
banquet  was  given  to  him  by  many  members  of  the 
profession,  including  Professor  Lance  reanx,  President 
of  the  Academy  of  Medicine. 

Germans. 

[FROM     OUR     OWN    CORRESPONDENT.] 


Bkelih,  January  23rd,  1004. 
The  Genesis  of  Syphilitic  Gummata. 
A  case  published  in  the  Deut.  nud.  Woch.  by  Dr. 
Kulisch,  of  Halle,  is  interesting  from  an  etiological 
point  of  view  as  regards  the  origin  of  gummata.  In 
this  case  a  gumma  formed  at  the  point  when  hydrarg. 
salicyl.  was  injected.  In  November,  1895,  the  patient 
was  treated  in  Russia  for  an  ulcer  on  the  penis  that 
healed  rapidly. 

As  no  further  symptoms  developed,  he  married  in 
July,  1896.  Soon  afterwards,  however,  mucous 
plaques  appeared  on  the  palate,  tongue,  and  lips,  for 
which  local  treatment  was  applied,  and  internally 
potassium  iodide  was  given  and  mercury  salicylate  by 
injection  into  both  gluteal  regions.  In  May,  1897,  tne 
patient,  who  was  then  act.  about  30,  consulted  the 
writer  on  account  of  his  wife,  who  had  given  birth  to  a 
dead  decomposing  syphilitic  foetus  at'  the  eighth 
month.  On  examination,  luetic  plaques  were  found 
on  both  tonsils,  numerous  pigmented  patches  on  the 
trunk,  and  several  painless  nodules  in  the  gluteal 
musculature  of  both  sides.  Under  a  course  of  local 
nunction  of  four  weeks,  recovery  took  place,  and 
another  course  of  three  weeks  was  carried  out  six 
months  afterwards.  In  May,  1899,  there  were  scaly 
papules  on  the  glans  penis,  weeping  papules  on  the 
scrotum,  and  large  pustulous  syphilides  on  both  legs. 
These  symptoms  also  disappeared  under  potassium 
iodide  internally  and  an  inunction  course  of  several 
weeks.  In  December,  1899,  the  patient  again  came 
under  treatment  for  a  solitary  gumma  situated  in  the 
eft  gluteal  muscle,  with  commencing  softening  and 
spontaneous  rupture  in  some  spots.  After  a  month's 
treatment  healing  took  place  with  central  funnel-shaped 
contraction.  At  the  end  of  June,  1900,  there  was  an 
ulcerating  gumma  on  both  fauces,  and  one  on  the  right 
buttock.  Both  receded  after  a  three  weeks'  inunction 
course,  and  potassium  iodide  internally,  and  the 
patient  went  abroad  again.  Ten  weeks  later  he  re- 
turned with  a  tumour  in  the  same  spot ;  the  skin  over 
the  tumour  was  perforated  in  some  places,  and  secre- 
tion was  taking  place.  This  condition  also  dis- 
appeared after  several  weeks  of  treatment,  so  far  that 
in  the  circumference  of  a  central  contraction  an  abso- 
lutely painless  tumour,  the  size  of  an  apple,  remained. 
In  June,  1901,  the  patient  returned,  as  the  tumour  had 
grown  and  had  broken  out  in  the  same  places.  The 
growth  was  now  punctured,  and  the  mass  scraped  out. 
This  was  shown  microscopically  to  be  detritus  and  cells 
undergoing  fatty  changes,  and  chemically  mercury 
was  found  to  be  present.  As  surgical  treatment  was 
declined  on  the  part  of  the  patient,  specific  treatment 
was  again  begun.  After  six  weeks'  treatment  some 
induration  was  still  present.  Up  to  May,  1902,  there 
was  no  relapse,  and  the  patient  was  in  good  health. 
In  the  foregoing  case  it  must  be  remarked  that  even 
after  the  lapse  of  five  years,  remains  of  the  early  hydrarg. 
salicyl.  injection  were  still  present  in  the  musculature. 
These  injections  had  caused  inflammatory  symptoms 
at  the  point  of  injection,  and  had  started  chronic 
changes  in  the  muscular  tissues  that  had  formed  the 
substratum  for  the  laterjtertiarydisease.     Theexciting, 


JhS.   27t    1504- 


THE  OPERATING   THEATRES.        The  Medical 


causes  Kb*  this  tertiary  disease  wore  the  very  late  specific 
primary  treatment  and  the  irregular  mode  of  life  of  a 
traveller. 


Hustrta, 


[from  our  own  correspondent,] 

VivxxAt  Januarv  i!3fflt  11)04* 

Stenosis    of    the    Left    Pulmonary    Artkkv. 
Jellinex  brought  before  the  Society  a  patient  with 
all  the  symptoms  ol  stenosis  of   the  left  pulmonary 
The  patient,  an.  28 ,  was  taken  ill  in  April, 
vi th  inflammation  in  the  left  side,  involving  the 
.ragm  and  lower  part  of  the  lung,  evidently  of  a 
tuberculous  nature.     At  present  there  is  great  shrinkage 
;n  the  left  side  of  the  chest,  and  percussion  is  generally 
Heart  is  two  fingers' breadth  displaced 

»to  the  left  ;    apex  beats  strong  and  a  finger's  breadth 
outride  the  left   mammary  line  over  the  mitral  and 
mcuspid    valves.      A  systolic  murmur  wma  distinctly 
Jieafd  both  in  front  and  behind  the  ruler -scapular  space* 
The  second   sound  was  greatly  accentuated,  both  to 
sghi  and  touch.     The  radial  pulse  had  nothing  par- 
iicutar  to    note,   with  a    tension  of    no   mm.     There 
«as  no   positive   venous  pulse    to   be  observed,   nor 
ition  of  the   heart.     Examination   of   the   sputa 
led  tuberculous  bacilli.     The  Rontgen  rays  con- 
tused the  displacement  to  the  left  of  the  mediastinum. 
The  whole  resembled  an  indurated  left  side  pleuntis. 
Localisation  of  the  loud  systolic  murmur  and  the 
Absence  of  the    usual  phenomena  were  in  favour  ol   ■ 
mitral  or  tricuspid  insufficiency-  Against  the  possibility 
of  aortic  stenosis  or  aneurysm  was  the  condition  of  the 
pulse,  the  appearance  of  the  diaphragm  and  general 
peruus&ion       I  he  symptoms  generally  confirmed   the 
nOBftt  that  a  stenosis  existed  in  the  left  pulmonary 
artery, 

I  HEMATURIA  FOLLOWING  ULCERATIVE  TUBERCULOSIS 
OF  THE  KlDNEVS, 
Schmidt  exhibited  a  male  patient,  act,  3J.  who  was 
confined  to  his  bed  on  November  3rd.  After  carrying 
4  heavy  load  upstairs  he  suddenly  complained  of  great 
pain  in  the  right  testicle,  which  radiated  down  the 
tnsuie  of  the  leg  and  upwards  over  Poupart's  ligament. 
<>nc  hour  after  he  urinated  pure  blood.  According  to 
the  history  nothing  in  the  uropoietic  system  could 
account  for  this  phenomenon  as  there  was  no  previous 
liance  in  the  emission  of  urine,  pain  in  the  renal 
region,  nor  any  deviation  in  the  constituents  of  the 
untie,  which  was  normal  in  quantity.  The  objective 
1: nation  was  against  tuberculosis,  while  the  family 
ry  gave  nothing  to  support  thai  suspicion.  A 
initial  diagnosis  and  exploration  of  the  blood  with 
pain  in  the  right  side  of  the  testicle  was  at 
issumed  to  be  hyperesthesia  with  possible  right 

k renal    hemorrhage,    which   was    confirmed    with    the 
cope,     There  was  no  tumour  or  enlargement  to 
Steeled,    while   nephrolithiasis   could    scarcely   be 
lined   without  some  pri  tial   prodroma. 

After  turther  exclusion  it  was  concluded  that  the  ease 
Itaa]  papillary  tuberculosis  of  an  ulcerative  form, 
ttfirm  thtSi  tuberculin  o(  the  old  style  was  injected. 
cuaunencing  with  0001  gramme  without  any  appro- 
fl  ;    later  0003  was  injected,  which  com- 
menced to  show  signs  of  activity  after  twenty-four 

a  as  confined  to  bed  and  treated  with 
adrenalin,  tanmu,  fta,  up  to  November  joth,  when  it 
tesolved  to  extirpate  the  right  kidney,  which  was 
iHy  accomplished. 

cal  examination  of  the  kidney  proved 
l*  a  disseminated  form  of  tuberculosis,  where 


small  groups'of  greyish  tubercle  was  scattered  through- 
out different  parts  of  the  cortex*  There  was  also  a 
caseous  degeneration  at  the  mucous  orifices  in  the 
pelvis  of  the  kidneys, 

Schmidt  thought  this  was  an  important  case  to  guide 
us  in  manv^of  those  obscure  and  sudden  attacks  of 
hematuria  whose  etiology  was  doibthd  and  tuber cu* 
losis  suspected. 

•  Schlesinger  reported  another  case  of  renal  h^mor* 
rhage  for  which  he  extirpated  the  left  kidney,  and  found 
on  examining  it  a  small  tumour  not  much  larger  than» 
a  pea,  but  of  a  carcinomatous  nature, 

TLbc  ©perattufl  dbeatres- 

I  .UN  HON  HOSPITAL. 
^Cholelithiasis. — Empyema. — Excision  of  Gall- 
Bladder. — Mr,  F,  Eve  operated  on  a  woman,  a?t,  36, 
who  had  been  suffering  for  eighteen  years  from  at  tacks  ol 
so-called  digestive  trouble,  several  attacks  of  pain 
referred  mainly  to  the  epigastrium,  associated  with 
vomiting ;  on  one  occasion  she  was  slightly  jaundiced. 
There  had  been  a  severe  attack  of  pain  a  few  days 

1  before  admission  and  pyrexia,  the  temperature  being 
about  102*5,  but  no  jaundice,  Ttiere  was  tenderness 
below  the  ninth  costal  cartilage  on  the  right  side  and 
part  "of a the  rectus  on  the  same  side  was  extremely  con- 
tracted with  resistance  beneath  it.  Cholehth 
and  empyema  of  the  gall-bladder  was  diagnosed,  but 
Mr.  Eve  pun  ted  out  that  it  was  impossible  to  give  a 
definite  opinion  from  physical  examination  without  an 
anaesthetic,  owing  to  the  tonic  contraction  of  the 
abdominal  muscles.  The  resistance  beneath  the  upper 
part  of  the  right  rectus  was,  he  thought,  just  as  likely 
to  be  a  Riedel's  lobe  as  an  enlarged  and  thickened  gall- 
bladder, An  incision  was  made  in  the  usual  situation, 
and  this  exposed  a  Riedel's  lobe  extending  down 
tO  midway  between  [the  costal  margin  and  the  um- 
bilicus, On  raising  it  the  gall-bladder  seemed  to  be 
situated  entirely  beneath  it  and  surrounded  by  ad- 
hesions to  the  omentum  and  stomach.  These  were 
separated  with  the  linger  ;  the  gall-bladder  was  found 
to  be  distended,  and  Its  walls  much  thickened.  It 
was  aspirated, f  and  pus  drawn  out;  it  was  then 
incised,  many  stones  were  removed,  and  the  cystic 
duct  appeared  to  be  obliterated.  The  thickened  gall- 
bladder was  therefore  removed  and  a  ligature  placed 
on  its  proximal  end.  The  peritoneum  was  too  thickened 
to  allow  a  flap  being  formed  to  cover  the  stump.  The 
operator's  and  assistant's  hands  were  now  cleans*  d 
before  exptoring  the  condition  of  the  common  duct. 
The  foramen  of  Wins  low  was  found  to  be  closed  by 
adhesions  which  gave  way  to  the  finger.     The  gastro- 

■  hepatic  omentum,  which  was  greatly  thickened  and 
shortens  I,   was  brought   to   the  surface   by  the    linger 

.  beneath  it;  a  stone  was  felt  at  its  upper  part ;  this  was 
cut  dowH  upon,  excised  and  removed  ;  it  was  found 
to  occupy  the  cystic  duct  011  its  junction  with  the  com- 
mon duct,  the  latter  being  clear.  The  small  incision 
was  closed  by  suture,  a  drainage-tube  fitted  with  gauze 
was  carried  downwards  towards  the  hilum  of  the  liver, 
and  packed  round  with  gauze,  and  the  abdominal  w 

1  closed  with  the  exception  til  an  Opening  in  the  centre 
for  the  dramage-tube.  The  entire  operation,  which 
was  well  borne,  lasted  one  hour,  Mr,  Eve  said  that 
the  case  emphasised  many  facts  of  clinical  importance, 
When  a  patient  presented  herself  with  hepatic  colic 
and  a  rounded  swelling  moving  with  respiration  was 
felt  in  the  region  of  the  gall-bladder,  it  was  usually 
assumed  that  it  was  the  gall-bladder  ;  in  a  majority 
of  instances,  however,  the  swelling  was  a  Riedel's  lobe, 
for  in  cholelithiasis  the  gall-bladder  was  more  often. 


92    The  Medical  Pi  ess. 


SPECIAL   ARTICLES. 


Jan.  27.  1904- 


contracted  than  distended  ;  the  contraction  of  the  ab- 
dominal muscles  prevented  a  minute  examination  of 
the  swelling,  except  under  an  anaesthetic.  Again,  pain 
referred  to  the  epigastrium  and  sometimes  to  the  left 
costal  margin  might  lead  to  the  diagnosis  of  a  gastric 
affection,  were  it  not  borne  in  mind  that  when  the 
stomach  is  adherent  to  the  gall-bladder  the  pain  is 
usually  referred  to  the  above-mentioned  locality,  and 
not  to  the  right  hypochondrium  and  right  shoulder- 
blade.  He  believed  that  when  the  gall-bladder  was 
greatly  thickened,  suppurating,  and  its  duct  probably 
obliterated,  the  organ  was  not  only  obsolete,  but  might 
prove  a  source  of  danger  to  the  patient,  and  its  presence 
retarded  convalescence ;  he  therefore  removed  it, 
provided,  as  in  this  case,  there  was  no  evidence  of 
obstruction  to  the  common  duct,  but  even  if  there  were, 
the  common  duct  could  be  opened  and  drained  by  a 
tube  sewn  to  the  margin  of  the  incision.  Another 
point  of  interest  in  this  case,  he  said,  was  the  very 
great  thickening  and  shortening  of  the  gastro-hepatic 
omentum,  which  rendered  the  structures  within  it 
almost  unrecognisable  ;  its  section  was  homogeneous, 
like  brawn.  These  cases,  he  thought,  almost  invariably 
did  well,  owing  to  the  fact  that  the  "  kidney  pouch," 
in  which  the  trouble  occurs,  is  practically  shut  off  from 
the  rest  of  the  peritoneal  cavity.  The  complication 
most  to  be  feared,  he  considered,  was  pre-operative 
infective  cholangitis,  followed  by  hepatic  abscess. 
In  operating  on  septic  conditions  of  the  abdomen, 
care,  he  pointed  out,  should  be  taken  to  thoroughly 
cleanse  the  hands  and  to  obtain  clean  instruments 
before  exploring  any  uninfected  region  of  the  abdomen 
within  the  neighbourhood,  this  being  often  necessary. 


Special  articles. 

CONSUMPTION.  - 


BRITISH  SANATORIA    FOR 
XXX. 


[by  our  special  medical  commissioner.] 


ALDERNEY  MANOR  SANATORIUM,  PARK- 
STONE,  BOURNEMOUTH. 

Much  discussion  has  recently  taken  place  as  to  the 
best  form  of  sanatorium  for  the  consumptive,  and 
much  can  be  said  in  favour  of  the  "  separate  or  chalet 
system."  Dr.  Johns'  sanatorium  is  an  excellent 
-example  of  a  small  private  institution  worked  on  the 
■"  hut  "  method,  and  well  exemplifies  the  merits  and 
difficulties  of  such  an  arrangement. 

Dr.  Johns  has  had  a  comparatively  extensive  ex- 
perience of  sanatorium  management  in  Bournemouth 
and  its  immediate  neighbourhood.  In  1896,  he  com- 
.  me  need  "  open-air  "  treatment  at  Sunny  Mount,  a 
small  house  at  Meyrick  Park.  Later  he  transferred  his 
patients  to  Stourfield  Park  Sanatorium,  which  was,  as 
regards  structure,  practically  a  large  hotel.  Quite 
.'recently  he  has  developed  Alderney  Manor. 

The  present  sanatorium  is  well  situated  about  three 
miles  from  Bournemouth  at  an  elevation  of  2 10  ft.,  and 
tin  open  country.  The  site  is  to  all  intents  and  purposes 
a  clearing  of  about  30  acres  in  the  midst  of  a  pine 
'forest.  The  estate  consists  of  600  acres  of  pine  woods 
and  heather-covered  land.  Many  thousands  of  acres 
•of  open  country  surround  the  estate.  The  New  Forest 
is  near  at  hand ;  the  River  Stour  can  be  easily  reached ; 
.and  the  sea  is  not  far  distant. 

As  already  indicated,  the  sanatorium  is  laid  out  on 
•the  "  hut  system."  The  huts,  single  or  double,  are 
•one-storeyed  buildings  throughout.  Neither  veran- 
dahs nor"  liegehallen  "  are  provided.  An  absolutely 
•open-air  existence  is  insisted  on. 

The  sleeping  huts  are  built  of  galvanised  iron,  lined 
with  compo  or  match-boarding,  and  interlined  with  felt. 
In  some  cases  the  matching  is  covered  with  "  salubra." 
"The  furniture  is  of  the  simplest  and  has  been  specially 


designed  to  be  non-dust-collecting.  The  windows  are 
large  and  numerous,  and  so  arranged  that  the  patient 
can  always  be  provided  with  a  thorough  current  of 
air,  and  yet  be  protected  from  draught. 

One  corridor-building  containing  several  apartment? 
has  been  reserved  for  ladies,  and  here  the  exposure  to 
fresh  air  is  not  so  complete,  although  there  is  still  good 
ventilation,  a  window  being  opposite  each  door,  and 
the  bedrooms  placed  only  on  one  side  of  the  corridor. 

The  dining-room  is  an  excellent,  airy,  well-lighted, 
and  cheery  room,  standing  by  itself  with  windows  on 
three  sides. 

Dr.  Johns  devotes  himself  entirely  to  the  conduct 
of  his  colony.  Every  case  receives  close  personal 
attention.  The  following  points  are  particularly 
observed : — 

1.  The  patient  breathes  fresh  air  at  all  times,  day 
and  night. 

2.  A11  abundant  diet  of  mixed  foods  is  provided  and 
in  some  cases  judicious  "  over- feeding  "  is  enforced. 
Prizes  are  given  to  those  who  increase  most  in  weight. 

3.  Exercise  and  rest  are  systematically  regulated, 
according  to  individual  necessities. 

4.  The  patients  are  wholly  in  the  charge  of  the  doctor, 
supported  by  a  staff  of  trained  nurses.  The  feeding, 
which  forms  a  conspicuous  part  of  the  treatment,  is 
personally  superintended  by  the  doctor,  who  presides 
at  all  meals. 

Dr.  Johns  informed  us  that  he  finds  much  benefit 
results  from  the  judicious  use  of  the  "  sun  bath."  An 
old  walled-in  garden  forms  an  excellent  exercise 
ground  and  an  admirable  "  sun  garden  "  for  gentle- 
men. Another  "sun-bath"  has  been  formed  for 
ladies.  In  these  so-called  "baths"  patients  lie 
completely  exposed  to  the  light  and  heat  rays  of  the 
sun,  even  at  such  times  of  the  year  when  most  persons 
are  unpacking  their  winter  apparel. 

Extensive  provision  is  made  for  the  comfort  and 
amusement  of  the  patients.  There  are  two  croquet 
lawns,  sea-bathing  may  be  enjoyed  under  medical 
supervision,  and  salmon  and  other  fishing  may  be 
indulged  in,  and  even  a  fair  amount  of  shooting  is  avail- 
able. 

We  were  surprised  to  find  a  band-stand  on  the 
grounds,  which  we  learnt  was  sometimes  used  by  the 
musicians  from  a  neighbouring  village. 

There  are  good  stables,  and  patients  may  keep  their 
own  horses  if  they  so  desire.  Arrangements  have  been 
made  whereby  gentlemen  may  gain  experience  in  the 
management  of  landed  property,  and  so  secure 
knowledge  which  may  equip  them  for  a  useful  outdoor 
occupation. 

It  will  perhaps  be  of  interest  to  quote  from  a  copy  of 
the  Rules  as  presented  to  every  patient  : — 

44  1.  Patients  are  requested  to  expectorate  only  in 
the  receptacles  specially  provided  for  the  purpose. 
They  must  never  spit  on  the  ground,  or  in  their  hand- 
kerchiefs, as  by  these  means  the  disease  is  spread. 
Flasks  are  provided  for  patients  when  out  walking. 

44  2.  As  it  is  essential  that  patients  should  breathe 
only  pure  air  continually,  they  should  not  frequent  any 
place  of  public  resort.  Whilst  under  treatment  they 
are  expected  to  take  only  such  exercise  as  is  prescribed 
by  the  doctor,  and  they  are  requested  not  to  go  into 
the  town,  ride  in  public  vehicles,  or  enter  houses  or 
shops  without  his  permission. 

44  3.  For  the  same  reason  patients  are  asked  not  to 
congregate  in  each  other's  rooms  or  huts. 

44  4.  Patients  must  rest  at  least  one  hour  before 
every  meal. 

44  5.  It  is  considered  much  better  for  the  patients 
not  to  see  visitors  except  very  occasionally.  The 
doctor  will  be  obliged  if  patients  will  make  this  clear 
to  their  friends. 

44  6.  The  food  is  specially  ordered  to  assist  the  cure  of 
the  patient  in  the  shortest  period.  The  patient  should, 
therefore,  exert  every  power  of  will  to  eat  the  quantities 
prescribed  by  the  doctor. 

44  7.  During  the  season  shooting  will  be  allowed  in 
the  woods,  Tuesday  mornings,  Thursday  and  Saturday 
afternoons.  Shooting  will  not  be  allowed  at  any  other 
time,  either  in  the  field  or  near  any  building. 


Jaw.  j;.   1904. 


LEADING   ARTICLES. 


The  Medical  Press.     93 


Patients  must  be  in.  bed  by  9-3*>*     All  lights  to 
be  extinguished  at  10,30/* 

The  administrative  part  of  the  sanatorium  consists 
of  a  quaint  old  building,  the  Manor  House,  built  alter 
the  early  English  Style,  and  here  Dr.  and  Mrs.  Johns 
and  the  other  members  of  the  staff  reside.  The  bells 
of  all  the  sleeping  huts  and  from  the  head  nurse's  room 
ring  in  the  doctor's  bedroom. 

It  must  be  admitted  that  the  general  view  of  the 
sanatorium  is  peculiar  and,  architecturally,  not 
altogether  pleasing  ;  but  if  aesthetic  considerations 
have  been  ■■•!,    rigorous    insistence    has    been 

made  on  the  importance  of  securing  the  maximum  of 
exposure  to  open  air. 

The  drainage  system  is  connected  with  the  newly-con- 
structed main  sewer*     The  water  comes  from  the  Poole 
Water  Supply  Company,     Heating  is  provided  (or  by 
crsky's  stoves,  which  burn  anthracite, 
vmmcitjation  is  available  for  above  twenty-five 
nts. 

The  fees  are  four  guineas  a  week,  inclusive  of  medical 
attendance,  the  only  extras  being  personal  laundry. 
wine  or  spirits,  medicine,  and  special  nursing* 

The  sanatorium  is  not  readily  accessible*  It  is  about 
twrnty-hve  minutes'  walk  from  Constitution  Hill  on 
the  Bournemouth  to  Poole  tram  route*  Parks  tone 
;  ta  two  miles  distant,  white  Bournemouth  is 
three  miles  away.  A  carriage  can  always  meet  patients 
by  appointment, 


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"  5ALUS  POPOLI  SUPREMA  LEX  " 


WEDNESDAY,  JANUARY  27,  1904. 


ST.  BARTHOLOMEW'S  HOSPITAL. 
The    question    of     the    reconstruction    of     St. 
Bartholomew's  Hospital,  which  has  been  before 
the  public  for  so  long  a  time,  appears  to  be  on  the 
point   of   settlement.     The   possibility   of   an   ex- 
tension of  area  00    the  present  site  has  been  pre* 
eluded  by  the  purchase  by  the  Post  Office  of  the 
whole  of  the  ground  rendered  vacant  by  the  re- 
moval of  Christ's  Hospital  School  to  more  salu- 
brious country  quarters.     The  authorities  of  the 
Hospital,   both    medical   and    noti- medical ,    ha%'e 
upon    a     course  of  action,   the  details    to 
discussed   at     a    Mansion    House  meeting    on 
26th.     The  main  feature  is  the  removal  from 
the  present  site  of  all  but  strictly  hospital   build- 
ings, such  as   the  medical   school,  nurses*  home, 
and  other  administrative   and   official   orhces,   ail 
ft  which  would  be  located  at  a  convenient  distance. 
In  this  way  the  present  site  could  be  devoted  to 


wards,  operating  theatres,  out-patient  rooms, 
clinical  laboratories,  and  so  on.  This  way  out  of  the 
wood  is  fairly  obvious,  but  surely  it  can  be  hardly 
less  costly  than  would  have  been  the  prompt 
purchase  of  the  vacant  Christ's  Hospital  site. 
The  value  of  the  present  site  of  St*  Bartholomew's 
is,  roughly  speaking,  about  a  million  pounds* 
The  appeal  about  to  be  made  to  the  public  is  for 
some  £500,000  for  reconstruction,  and  to  that 
will  probably  be  added  some  £350,000  for  the 
purchase  of  an  auxiliary  site  and  the  con- 
struction of  extra-hospital  buildings,  There 
is  little  doubt  that  the  -money  asked  for  will  be 
forthcoming,  although  at  the  same  time  it  is 
equally  certain  that  the  absorption  of  so  large 
a  charitable  public  gift  must  necessarily  tem- 
porarily diminish  the  resources  of  other  medical 
charities.  Few  will  dispute,  however,  the  desira- 
bility of  placing  St.  Bartholomew's  Hospital  on 
a  level  with  the  highest  modern  standards  of 
scientific  hospital  construction  and  adminis- 
tration. Let  St.  Bartholomew's,  a  national 
institution,  be  second  to  none  in  its  completeness 
of  equipment  on  all  points*  The  mere  profusion 
of  expenditure,  it  need  hardly  be  pointed  out,  is 
by  no  means  a  necessary  index  to  the  attain- 
ment of  a  high  ideal  of  perfection.  In  all  walks 
ol  life  success  is  most  likely  to  result  from  prudent, 
cautious  and  well-informed  counsel  and  con- 
sideration. In  the  Steps  hitherto  taken  with 
regard  to  St.  Bartholomew's  Hospital  we  venture 
to  think  that  two  defects  have  been  conspicuous, 
namely,  the  withholding  of  evidence  on  which 
decisions  have  been  made,  and  the  strong  par- 
tisan nature  of  conflicting  proposals*  The  report 
of  the  first  Mansion  House  Committee  was  a 
document  unworthy  of  the  administrators  of  a 
great  public  trust.  The  views  of  the  medical 
staff  of  the  hospital  were  revealed  to  the  public 
by  the  enterprise  of  a  private  individual.  The 
proposal  of  Sir  Henry  Burdett  to  build  a  large 
modern  hospital  has  been  rejected*  There 
may  be  excellent  grounds  for  all  thai  has  been 
done,  but  our  contention  is  that  the  public  should 
be  fully  informed  of  every  argument  "  pro  and 
con/'  bearing  upon  every  fresh  development  and 
every  fresh  decision.  From  this  standpoint  we 
maintain  that  the  question  of  "  partial  removal  " 
has  never  been  adequately  discussed  by  the 
authorities  of  St.  Bartholomew's,  The  Mansion 
House  Committee  dismissed  the  maMer  curtly 
and  contemptuously,  The  medical  stall,  in  their 
latest  report,  condemn  the  proposal  in  general 
terms,  but  a  problem  of  that  kind,  although  it 
may  be  thereby  shelved,  remains  unsolved,  A 
business  man  has  detailed  reasons  for  all  he  says 
and  does,  and  there  is  no  reason  for  any  other 
attitude  on  the  part  of  the  business  men  who  have 
been  entrusted  with  the  management  of  the 
greatest  medical  charity  in  the  Kingdom*  The 
present  site  could  be  sold  for  about  a  million,  and 
out  of  the  purchase  money  a  palatial  building  and 
grounds  could  be  secured  in  the  suburbs  of  London, 
while  enough  accommodation  could  be  left  behind 
in  Smithfteld  for  the  needs  of  the  day  population 


94    The  Medical  Press. 


LEADING   ARTICLES. 


Jaw.  27,  1904. 


of  the  City.  The  "  Blue  Coat  "  boys  have  been 
moved  into  the  country  for  the  sake  of  purer  air. 
If  that  be  desirable  for  schoolboys  it  is  surely  far 
more  necessary  for  invalids.  The  tendency  of 
medicine  is  to  trust  more  and  more  to  country 
air.  It  is  questionable  whether  the  surgeon  of  the 
future  will  sanction  serious  operations  in  a  town 
environment.  If  all  tuberculous  diseases  were 
henceforth  declined  at  St.  Bartholomew's,  con- 
siderable relief  to  the  hospital  accommodation 
would  speedily  follow.  Yet  what  conscientious 
surgeon  would  keep  tuberculous  patients  in  the 
City  when  he  could  send  them  to  an  airy  suburb 
or  to  the  country  ?  Then,  again,  the  London 
University  has  made  a  bid  for  the  centralisation 
of  medical  teaching.  Until  the  issue  of  that 
movement  is  indicated  the  wisdom  of  founding  a 
costly  medical  school  in  the  heart  of  London  may 
well  be  questioned.  It  may  be,  as  we  have  already 
said,  that  the  balance  of  argument  may  be  in 
favour  of  retention  of  the  ancient  site  by  St. 
Bartholomew's.  We  maintain,  however,  that 
the  grounds  of  objection  to  a  scheme  of  partial 
removal  have  never  been  adequately  presented 
to  the  public.  The  demand  for  half  a  million  or 
more  should  be  accompanied  with  a  minute 
statement  as  to  the  why  and  wherefore  of  i t sides tina- 
tion,  with  the  fullest  and  most  precise  information 
as  to  the  action  of  the  Hospital  authorities  through- 
out the  whole  of  the  somewhat  complicated 
recent  proceedings  with  regard  to  the  reconstruc- 
tion proposals. 


PHTHISIOPHOBIA. 
During  the  last  few  months  we  have  been  able 
to  furnish  a  series  of  unbiassed  reports  on  various 
British  sanatoria,  each  account  being  the  out- 
come of  a  special  visit  by  our  Special  Medical 
Commissioner.  A  study  of  these  articles  will 
make  clear  the  widespread  influence  of,  what 
we  may  speak  of  as,  institutional  effort  in  the 
arrest  of  pulmonary  tuberculosis,  and  a  mitiga- 
tion of  the  evils  attendant  on  such  disease.  Both 
public  and  professional  attention  in  almost 
every  part  of  the  country  is  being  focussed  on 
this  matter  by  the  rapid  uprising  of  extensive, 
and  often  elaborate,  and  sometimes  even  palatial, 
establishments  for  the  care,  and,  it  is  to  be  hoped, 
the  relative  cure,  of  the  consumptive.  Public 
notices  meet  the  eye  at  almost  every  turn  warn- 
ing of  the  danger  which  arises  from  the  expectora- 
tion of  an  ignorant  and  neglectful  consumptive. 
The  greater  the  warning  the  more  conspicuous 
appears  the  danger.  The  ordinary  layman  is 
oftentimes  much  perplexed  at  the  seeming  con- 
tradictions of  medical  directions,  and  certainly, 
in  regard  to  the  advice  respecting  tuberculosis  he 
may  well  stand  in  perplexity  and  linger  in  doubt. 
Amidst  conflicting  voices  it  is  hardly  to  be 
wondered  at  that  a  condition  conveniently  de- 
signated "  phthisiophobia' '  is  wont  to  be  developed. 
The  more  unknown  and  ill-defined  the  danger  the 
greater  is  the  fear.  The  declarations  of  not 
a  few  would-be  leaders  of  medical  thought  and 
hygienic  progress  have  recently  gone  far  to  bring 


about  conditions  which  are  in  imminent  danger 
of  acting  prejudicially  on  the  consumptive.      We 
venture  to  think  that  the  time  has  come  when 
medical    men    should    take    a    part   in    securing 
measures  which  may  allay  the  alarm  of  the  public, 
rather  than  foment  a  tendency  to  panic  which  must 
necessarily  mean  paralysis  in  action  and  poverty 
in  thought.      In  many  quarters  there   exists  an 
exaggerated  fear  of  the  presence  of  the  consump- 
tive.    This  would  appear  to  be  particularly  the 
case  in  certain  districts  of  America,  and  has   pro- 
bably arisen  from  an  ill-regulated  and  somewhat 
precipitate  action  of  officials,  whereby  a  declaration 
was  recently  issued  stating  that  pulmonary  tuber- 
culosis was  a  dangerous  contagious  disease,  and  im- 
migrants or  aliens  so  afflicted  must  be  debarred  from 
all  ports  of  the  United  States.  It  is  to  be  hoped 
that  no  such  reckless  views  will  receive  approval 
in  this  country  until  at  least  we  have  secured 
scientific  evidence  and  sound  clinical  experience 
warranting  such  action.   In  the  State  of  New  York 
official  phthisiophobia  has  developed  to  such  an  ex- 
tent that  it  would  now  appear  to  be  difficult  to  pro- 
vide   for  the  suitable  establishment  of  sanatoria 
in  the  vicinity    of     a    community.      It    is     well 
that  we   should   do    our  utmost    to   discourage 
action  merely  based  on  the  selfish  element  of  fear. 
Even   now   those   engaged   in   the   treatment  of 
phthisis  know  that  the  development  of  what  we 
may  call  a  State  phthisiophobia  is  in  danger  of 
staying  progress.     Widespread  fear  of  consump- 
tion prevails  among  many,  and  in  certain  circles 
there  is  likelihood  of  a  consumptive  being  shunned 
as  a  leper,  and  treated  as  an  outcast  from  society. 
In  the  anti-tuberculosis  crusade  which  is  being 
so  actively  carried  on  in  Europe,  and  particularly 
in  this  country,  there  is  the  utmost  need  for  wise 
discernment,    close  observation,    strict  scientific 
procedure,  and  every  movement  likely   to   induce 
panic  must  be  strenuously  resisted.     After  close 
study  of  the  expressions  of  recent  opinion  and  a 
careful  investigation  into  the  conduct  of  measures 
designed  to  arrest  tuberculosis,  we  have  no  hesita- 
tion in  warning  against  the  well-meant  but  in- 
judicious and,  we  venture  to  add,  ignorant  ad- 
vocacy  of    certain   repressive   procedures   which 
have  their  origin  in  personal,  public,  and,  we  are 
sorry   to    add,    professional    phthisiophobia.     To 
all  such  fear-fanned  fanatical  agitations  we  can 
only  oppose  the  firm  force  of  sound  education. 


PARATYPHOID  FEVER. 
If  there  be  one  disease  which,  from  its 
prevalence,  its  importance,  and  its  protean 
character  presents  a  host  of  difficulties  to 
the  physician,  that  disease  is  typhoid  fever. 
Other  diseases  have  their  own  intricacies  and 
present  their  own  puzzles,  but  none  are 
quite  so  alluring  and  evasive  as  typhoid  fever. 
Its  insidious  onset,  its  erratic  course,  its  equivocal 
symptoms,  its  startling  surprises,  its  high  fatality, 
all  combine  to  make  it  at  once  the  bane,  the 
bugbear,  and  the  stumbling  block  of  the  prac- 
titioner of  medicine.  A  most  unfortunate  change 
was  made  in  the  nomenclature  of  the  disease  by 


l«x,  t]t  t<x>4- 


NOTES    ON    CURRENT    TOPICS, 


The  Medical  Press.     95 


the  substitution  of  "enteric  lever"  for  the  old'  i  the  specific  part  played  by  Bacillus  enteritidis  in 
tune  '*  typhoid  lever  "—  a  substitution  that  has  J  the  production  of  the  disease,  and  it  also  helps 
moreover,  become  fixed  in  the  popular  mind  by  !  to  explain  why  Widal's  reaction  is  not  given 
repeated  perusal  oi  the  casualty  lists  during  j  by  all  cases  *of  (apparent)  typhoid  fever,  The 
the  South  African  War,  "Typhoid  fever"  may  ,  presumption  is  that  the  latter  cases  are  not 
have  been  good,  but  it  was,  at  least,  non-  examples  of  typhoid  fever  proper,  but  of  para- 
committal  as  regards  the  pathology  of  the  disease,  typhoid  fever,  Now  this  latter  disease^  closely 
whilst  "enteric  tcvcr"  more  than  suggests  that  resembling  typhoid  fever  as  it  does  at  the  bed- 
it  is  an  affection   of    the   aliment ary    tract,   and    side,  is,  as  a  rule,  a  milder  affection,  and  though 


,,]  thai  alone.     Had  the    nosologist  waited  before 

cuing    the    disease    he    would    have    had    to 

confess  that  typhoid  lever  is  an  infective  process 

IB  which  the  specific  bacilli  pass  into  the  blood- 

ii  trom  the  intestine  and  reach  many  01 
important     viscera  ;     and,     moreover,     that     the 
characteristic  phenomena  of  the  disease  are  due 
be  pathological  changes  thus  brought  about. 
Sqvs  this  is  far  more  than  a  mere  academic  con- 
lention.    It  involves  Ihe  wThole  conception  of  the 
nature  of   the  process   which  we  indicate  by  the 
typhoid    fever,     This    process    is    complex, 
nd  its  real   complexity    is   only    just   beginning 
to  appear.     For  typhoid  fever  is  now  known  to 
comprise  at  least  two  distinct  processes,  and  the 
ibihty  is   that  even  more   may  be   differen- 
tiated as  the  study  of   the  question  progresses. 
The     Bacillus     typhosus,    which    held      rank     in 
the  bacteriological  hierarchy  as  one  of  the  specific 
disease-producing  bacteria, has  been  found  not  to 
be  the  causal  organism  in  all  that  group  of  cases 
that  now  rank  as  typhoid   lever,   for  in  quite  a 
number  oi  cases  recently  not  only  has  Bacillus 
typhosus  not  been  found,  but  other  organisms  of 
the  Bacillus   enteritidis    or    Gartner   group    have 
been  discovered  in  such  situations  and  in  such 
numbers  that  there  can  be  little  doubt  they  play 
a  leading  tole  in  the  disease -process.      The  typhoid 
haciJJus  stands  at  the  far  end  of  a  long  series  of 
organisms  closely  allied  to  Bacillus  coli  communis, 
and  one  or  more  of  these  intermediate  forms  has 
been  demonstrated  in  several    different    cases  as 
the  predominant   factor.     Three  interesting  pro- 
blems   arise.     First,   are     all    the  Gartner    bacilli 
that  have  been   found  in   these  cases  genetically 
the   same  ?     Secondly,    is    the    typhoid    bacillus 
I  specialised  Gartner  bacillus  ?     And,  thirdly, 
***  the   cases   of   disease   in   which    the   Gartner 
***cillus  occurs  different  in  their  clinical  features 
^m  those  in  which  the  typhoid  bacillus  occurs  ? 
bo  this  third,  and  very  important,  question 
hat    vvc  address  ourselves.      Paratyphoid   fever, 
L*  *t  has  been  called,  is  a  disease  that  has  many 


it  may  run  a  long  course  it  generally  tends  to 
recovery.  Moreover,  attention  has  been  directed 
several  times  lately  to  cases  in  which  after  death 
from  clinical  typhoid  no  changes  have  been  found 
in  the  lymph -follicles  of  the  intestine,  and  the 
suggestion  has  been  made  by  Luksch  that  these 
cases  belong  to  the  M  paratyphoid  "  group,  and 
that  not  only  do  these  cases  differ  from  typhoid 
fever  clinically  and  bacterioiogicaliy,  but  that 
they  present,  in  some  instances  at  all  events,  dis- 
tinctive gross  morbid  phenomena.  The  further 
elucidation  of  these  questions  will  be  awaited 
with  much  interest,  as  they  involve  points 
not  only  of  the  highest  scientific  interest  but  of 
the  greatest  practical  importance.  If  typhoid 
ti\cr  prove  to  be  a  name  applied,  not  to  a  homo- 
geneous disease,  but  to  a  heterogeneous  collection 
of  closely-allied  diseases,  the  explanation  of  much 
that  is  at  present  involved  in  obscurity  will  be 
forthcoming.  For  the  present  it  may  be  said  with 
some  conviction  that  paratyphoid  fever  has 
established  its  claim  to  recognition  as  a  distinct 
entity  ;  but  that  is  all.  What  its  features  are, 
and  what  it  may  include,  remain  to  be  worked 
out.  Perhaps  one  of  the  most  striking  develop- 
ments will  be  an  explanation  of  the  relapse.  We 
feel  ourselves  that  no  solution  of  this  problem 
would  be  so  satisfactory  as  that  which  demon- 
strated that  the  relapse  in  typhoid  fever  was  due 
to  fresh  infection  of  the  patient's  tissues  by  a 
different,  but  closely- allied,  bacillus  from  that 
which  caused  the  original  disease.  The  laurels 
of  Jcnner  and  Stewart  await  the  investigators  o£ 
paratyphoid  fever. 


1*etes  on  Current  topics. 

An  Age-Limit  to  Medical  Appointments. 1 
The   Court  of  Contributors   to   the   Royal   In- 
firmary, Edinburgh,  have  recently  very  definitely 
asserted  their  authority  by  imposing  an  age-limit 
of  sixty-five  on  professors  in  the  University  wmo 


have  also  charge  of  wards  in  the  I  nfinnary.  The 
clmical  features  in  common  with  typhoid  fever  ;  i  decision  was  the  natural  sequence  to  a  former 
cr-'&tinued    pyrexia,    rose-spots,    enlargement    of  |  decision  of  the  Board  of  Management,  which  im- 


je   Spleen,  diarrhoea,  and  haemorrhage  from   the 

!     have  all  been  noted.     On  the  other  hand, 

^Eglutiuati'jfi  <>i   cultures  of  typhoid  bacilli  does 

t  occur  when   the  blood  scrum  of   the   patient 

l*  t>tt>\ight  into    contact    with    them.      But — here 

the    important    point — the    blood    from    these 

Sfc&    does  agglutinate  various  strains  of  Gartner 

Bacilli       It,    therefore,    contains    agglutinins,    not 

;  »ecitic  agglutinins  of  Bacillus  typhosus,    but 


the 


poses  a  similar  age-limit  on  the  ordinary  physicians 
and  surgeons  to  the  Infirmary,  omitting  the  Uni- 
versity professors.  The  new  rule  is  bound  sooner 
or  later  to  give  rise  to  difficulties,  inasmuch  as 
there  is  no  age-limit  in  the  University,  nor  any 
obligation  to  compel  a  professor  who  is  retired 
at  the  Infirmary  at  the  same  time  to  vacate  his 
Chair  in  the  University.  Consequently,  a  pro- 
fessor who  has  passed  sixty-five  will  find  himself 


varieties  of  Bacillus  enteritidis.    in  the  position  of  teaching  his  students  without 
*s*     it  cannot  be  denied,  is  strong  evidence  of  ,  the  power  oi  giving  them  the  necessary  clinical 


96     The  Medical  Press.         NOTES    ON    CURRENT    TOPICS. 


Jan.  27,  1904- 


instruction.  As  to  the  advisability  of  an  age-limit 
in  hospital  appointments,  opinions  will  doubtless 
differ.  Many  instances  can  be  brought  up  to 
•show  the  tendency  of  men  to  cling  to  their  posts 
even  after  they  are  physically  or  mentally  in- 
capable of  discharging  the  duties  of  them ;  and, 
similarly,  many  instances  could  be  brought  up  in 
which  compulsory  retirement  at  a  fixed  age  would 
lead  to  the  loss  of  the  best  men.  The  system  in 
vogue  in  many  universities  of  electing  a  man  for 
a  term  of  years,  with  power  to  re-elect  him  if  it  is 
•considered  advisable,  is,  to  our  mind,  the  best 
method  that  can  be  obtained,  as,  if  it  is  carried 
out  as  its  originators  intended,  the  man  who  is 
past  his  work  will  be  as  eftectually  removed  as  he 
would  be  by  an  age-limit,  while  the  capable  man 
will  be  left  to  discharge  his  duties.  At  the  same 
time,  we  of  course  recognise  the  personal  difficulty 
that  often  arises  to  the  shelving  of  a  man  who  may 
perhaps  be  more  or  less  dependent  on  his  appoint- 
ment for  his  livelihood. 


Microbes  as  Instruments  of  Warfare. 
Some  interesting  discussions  and  reminiscences 
have  been  called  forth  by  the  rumour  which  was 
■current  a  few  weeks  ago  that  the  Macedonians 
had  decided  to  make  use  of  virulent  plague 
cultures  in  their  fight  against  the  Turks.  It  is 
very  doubtful  whether  plague  bacilli  could  be  of 
any  avail  if  used  by  the  particular  method  sug- 
gested— infection  of  the  water  supply.  The  life 
history  of  the  microbe  in  question  is  not  yet 
sufficiently  known  to  say  whether  plague  is  at  all 
a  water-borne  disease,  but  it  is  unlikely  to  be  so  to 
such  an  extent  as  to  render  possible  the  poisoning 
of  the  water  supply  of  a  great  city.  It  is  above  all 
things  a  dirt  disease,  but  it  is  too  soon  to  dogmatise 
regarding  its  methods  of  spreading.  The  use  of 
micro-organisms  in  warfare,  though,  of  course,  at 
the  present  day  contrary  to  the  methods  of 
civilised  nations,  has  always  been  practised  among 
uncivilised  peoples,  and  still  more  by  civilised 
in  their  attempts  to  exterminate  uncivilised  peoples. 
One  of  the  commonest  means  of  poisoning  weapons 
was  dipping  their  points  in  putrefying  material 
with  the  view  of  producing  a  septic  wound.  In 
the  English  suppression  of  rebellions  in  Ireland 
in  Elizabethan  times  thousands  of  the  natives 
were  swept  away  in  epidemics  accidentally  intro- 
duced, and  the  same  thing  occurred  at  a  later 
period  among  the  Red  Indians  of  North  America. 
As  late  as  the  Napoleonic  wars  terror  was  spread 
through  the  North  of  France  by  the  rumour  that 
England  was  about  to  attempt  to  introduce  plague 
to  those  regions.  An  interesting  document  re- 
lating to  this  has  just  seen  the  light  in  Paris.  It  is 
a  circular  addressed  to  the  officials  of  the  Channel 
ports  by  the  Naval  Commissary  at  Boulogne, 
stating  that  the  English  Government  waj 
about  to  throw  upon  the  French  coasts  several 
hundred  bales  of  wool  collected  in  a  country 
where  plague  was  raging.  It  goes  on  to  give  strict 
directions  as  to  the  destruction  of  any  such  bales. 
The  story  had,  of  course,  no  foundation  in  fact, 
and  is  about  as  near  the  truth  as  many  of  the 


tales  commonly  believed  in  England  at  the  same 
period  concerning  the  character  of  Napoleon. 


One-Sided  Reciprocity. 
Thanks  to  the  mandamus  of  the  Privy  Council 
we  have  a  reciprocity  understanding  with  the 
Italian  Government  in  virtue  of  which — and  very 
much  against  the  desire  of  the  General  Medical 
Council — Italian  graduates  are  admitted  to  re- 
gistration in  this  country.  That  formality  having 
been  complied  with,  at  the  moderate  and  in- 
clusive fee  of  five  pounds,  the  same  as  for  British 
registrants,  the  Italian  physician  has  the  run  of 
the  country.  He  acquires  a  medical  status  in 
that  he  can  sue  for  fees — whatever  that  maybe  worth 
— and  can  tender  evidence  in  a  court  of  law  at  the 
risk  of  being  heckled  by  a  hostile  counsel,  over 
whom,  however,  a  foreigner  has  the  advantage 
that  he  need  not  understand  an  embarrassing  ques- 
tion unless  convenient.  In  return  for  all  these 
privileges,  British  practitioners  are  entitled,  or 
are  at  any  rate  allowed,  to  exercise  their  calling 
in  Italy.  It  would  seem,  however,  from  a  state- 
ment made  a  few  days  ago  in  the  Italian  Chamber, 
that  foreigners  are  entitled  to  practise  only  among 
their  fellow-countrymen ;  in  other  words,  the 
privilege  conceded  to  them  is  narrowly  hedged  in. 
This  is  hardly  reciprocity  on  all  fours,  and  re- 
ciprocity, as  the  Irishman  said,  must  not  be  all  on 
one  side.  If  strictly  interpreted,  the  British  prac- 
titioner would  not  be  justified  in  prescribing  for 
citizens  of  the  United  States,  since  they  are  not 
under  the  same  flag,  still  less  for  a  native  Italian. 
Admitting  that  in  all  probability  no  British  prac- 
titioner is  very  keen  on  ministering  to  the  medical 
requirements  of  the  natives,  seeing  that  they,  for 
the  most  part,  pay  the  smallest  fees,  the  question  of 
principle  remains.  We  heartily  approve  the  idea 
of  reciprocity :  indeed,  the  prohibition  of  the 
foreign  practitioner  who  only  aspires  to  treat  his 
own  countrymen  is  the  reductio  ad  absurdam  of 
protectionism,  and  marks  a  big  step  backwards 
compared  to  the  intelligent  eclecticism  of  the 
Middle  Ages.  Nevertheless,  we  would  urge  upon 
the  General  Medical  Council  in  future  to  scheme  to 
do  what  it  can  to  secure  real  reciprocity,  and  not 
to  exchange  the  whole  for  the  part. 


Diphtheria  Antitoxin  as  a  Prophylactic. 

It  has  long  been  the  custom  with  those  who  best 
know  the  value  of  antitoxin  in  the  treatment  of 
diphtheria  to  make  use  of  the  serum  as  a  prophy- 
lactic among  those  exposed  to  the  disease.  For 
instance,  most  physicians,  in  diagnosing  diphtheria 
in  one  child  of  a  family,  are  in  the  habit  of  treating 
the  other  children  with  small  doses  of  antitoxin, 
with  a  view  to  producing  immunity.  And  when 
a  case  of  diphtheria  appears  in  a  ward  of  a 
children's  hospital,  it  is  usual  to  adopt  the  same 
course  in  regard  to  the  other  children  in  the  ward. 
In  some  hospitals  it  has,  however,  become  the 
habit  to  go  further,  and  to  use  antitoxin  systema- 
tically on  all  children,  whether  diphtheria  is  known 
to  be  present  or  not.  In  particular  is  this  the  case 
in  the  Boston  Children's  Hospital,  and  the  Hospital 


Jan.  :-■    1904 


NOTES  ON  CURRENT  TOPICS.         Ths  Medical  Pkbss.    97 


tor  Sick  Children  in  Toronto,  and  Dr.  Graham,  in 
a  recent  paper,  {a)  publishes  observations  of  great 
importance  made  in  the  latter  hospital.  It 
appears  that  for  many  years  this  institution,  which 
<1oes  not    receive  infectious  diseases  of  any   sort, 

never  quite  free   from  diphtheria,  and  it  is 

calculated  that  on  an  average  there  were  annually 

no  less  than  eighty  four   cases,     Commencing  in 

(90af    JOO    units    of    antitoxin    were    given 

regularly  to  each  child  every  three  weeks,  with  the 

it  that  during  the  ensuing  six  months  there  was 
not  in  the  wards  a  single  case  of  the  disease  This 
record  is  the  more  remarkable  since  both  a  doctor 
and  a  nurse  suffered  from  diphtheria,  and  though 
thevwent  about  for  several  days  before  a  diagnosis 
was  made  no  child  became  affected.  Dr.  Graham's 
production  of  immunity  is  so  striking  in  its  success 
thai  it  ought  to  go  far  to  establish  similar  methods 
of  procedure  in  other  hospitals  for  children  where 
ii  is  found  difficult  to  keep  free  of  diphtheria, 

"The  Mystery  of  Sleep  " 

Divines   rush   in   where   physiologists   fear    to 

,t  it  only  physiologists  were  not  so  intent 

011  studying  the  phenomena  of  sleep  they  would 

hat  there  was  really  no  need  for  study  at  all. 

clear   as   daylight.     The    Rev 


divine-  mercy/'  Most  alienists  will  be  disposed 
to  agree  with  the  last  statement,  so  far,  at  least, 
as  it  asserts  that  the  mercy  is  unappreciated  by 
the  sufferer.  It  is  little  less  than  extraordinary 
that  pseudo-philosophic  froth  of  this  kind  can 
be  stirred  up  by  the  eccentric  antics  of  twentieth- 
century  divines,  and  one  feels  that  the  reverend 
doctor  would  rind  his  views  expressed  in  certain 
papers  by  Lowell  that  are  called  by  a  name 
resembling  Dr.  Bigelow's  own,  in  which  we  are 
told   that — 

■■  A  merciful  Provide nue  taManed  us  holler 
J  it  order  we  might  our  principle!!  s waller/* 


A  New  "Trust." 

People  are  fond  of  sneering  at  medical  etiquette, 
and  the  laws  written  and  unwritten  by  which  we 
bind  ourselves  in  our  relations  with  them  and 
with  each  other.  If  they  would  only  take  the 
trouble  to  inquire  they  would  find  that  the  des- 
pised u  etiquette  M  is  framed  far  more  in  their 
own  interests  than  in  ours,  and  that  the  greatest 
sufferers,  were  these  self-imposed  restraints  re- 
moved, would  be  themselves,  Do  they  realise, 
one  wonders,  the  abnegation  that  is  placed  on 
the  author  of  a  discovery  in  medicine  by  being 
obliged    to  deny   himself   all    private   property  in 


Everything    is    as    vieai     &*    uajr*i£iiL*      *«*-     *.^  . .     uuiigcu    *.«-»    uw*j    ■■■■■wyiTMi    i«-    r,*,«*«    r*~* v     -— 

Dr.  Bigelow  has  plumbed  the  depths  of  sleep,  and    his  discovery  ?     Musicians  and  waiters  have  their 


has  initiated  us  into  its  mysteries.  After  reading 
his  book  no  one  need  interest  himself  in  such  de- 
tails as  whether  the  cerebral  arteries  contract  or 
sleep,  why  blood- pressure  falls,  and 
bow  it  is  that  voluntary  nervous  activity  passes 
into  abeyance.  Sleep  has  generally  been  assumed 
to  be  a  device  for  giving  tired  Nature  rest,  and 
affording  the  tissues  an  opportunity  for  recupera- 
tion. This  assumption,  however,  amounts  more 
or  less  to  rank  blasphemy,  according  to  Dr.  Bige- 
low, for  it  suggests  that  the  Creator  has  fashioned 
us  so  imperfectly  that  we  need  to  make  up  for  the 
deficiencies  by  wasting  precious  time  in  sleep. 
Other  created  bodies  need  no  rest  ;  the  planets 
whirl  ceaselessly  in  their  appointed  spheres,  and 
BSD  never  takes  a  day  off.  No,  the  need  of 
sleep  is  moral,  not   physical  ;    slumber  gives   to 


copyrights  ;  inventors  their  patents  ;  business 
men  their  trade-marks  ;  the  doctor— nothing. 
If  people  wish  to  go  into  the  question  how  this 
benefits  them,  let  them  pay  attention  to  the  outcry 
that  is  being  raised  on  the  other  side  of  the  Atlantic 
by  the  proposed  amalgamation  of  three  firms  to 
tnrm  an  "  antitoxin  trust/'  Commercialism  rules 
stronger  among  our  fellow  Anglo-Saxons  than  it 
does  among  ourselves,  and  these  firms  see  that 
by  a  judicious  arrangement  they  may  increase 
the  profit  on  the  sale  of  antitoxin,  of  winch  they 
have  the  monopoly  of  manufacture,  by  a  hundred 
per  cent.  Trusts  of  this  kind  are  considered 
legitimate  commercial  enterprises  when  they 
affect  soap,  sugar,  or  tooth- picks,  but  when 
they  touch  medicinal  remedies  they  become 
■■«  iniquitous/1     Now   that     the  American    public 


(he  soul  the  opportunity  of  a  little  jaunt   to  the  j  arc      alive    to     what     monopolies     in     remedies 


spirit-world.     There  it    has    the    opportunity 
reeling  other  (temporarily)  disembodied  souls,  and 
of  communing  with   the   spirits  oi  the  great 
dead.      From  this  period  of  refreshment  the  soul 
returns  rejuvenated,  for  do  we  not  find  the  morn- 
H  the  time  of  greatest  spirituality  ?     "  It  is  then 
that    we  feel  the  charms  of  Nature  most  keenly, 
'tat    we  are  most  disposed  to  extenuate  tin- 
ct*Qtiuci  of  friends  and  neighbours/'     Some  break- 
kst-tables  lbat  one  k^ows  do  not  always  exhibit 
these   admirable  traits  ;   perhaps  the  souls  of  these 
lilies  go  to  other   than  Elysian  fields    during 
llle  night- time,     The  same  soul- vagaries    happen 
in  lunacy.     The  madman  is  brought  to  his  con- 
ation by  *'  inordinate  ambition,  vanity  or  greed/' 
m^    the  removal  of  the  soul  from  the  terrestrial 
busk    •  *  resembles    the  operation  of    sleep,     and  is 
1  real   and    usually    unappreciated    evidence    of 

(a)  CVnuidta*  i*rm?tiiM>fi*rp  December,  190&. 


of  real  value  would  mean  to  them,  it  may  be  hoped 
that  they  will  be  a  little  less  inclined  to 
favour  the  unblushing  quackery  that  flour- 
ishes    in    their  midst,   to   the  great  profit  of  the 

j  charlatan  and  the  great  loss  of  the  people.  One 
cannut   refrain   from   quoting   the  following   from 

I  a  contemporarv  that  writes  on  the  antitoxin 
trust  :_*'  With  a  cynical  effrontery  which  would 
be  impossible  in  any  other  country,  they  have  an- 
nounced their  determination  to  enter  on  this  traffic 
in  human  life  without  further  delay/'  Quite  so, 
but  what  is  sauce  for  the  goose  is  sauce  for  the 
gander,  and  little  as  one  sympathises  with  the 
antitoxin  trust,  it  will  at  least  deal  in  wares  that 
are  of  value  and  will  save  life,  which  is  more  than 
can  be  said  for  those  rogues  who  at  present  fatten 
on  the  credulity  of  their  fellows.  The  antitoxin 
trust  will  do  nothing  but  good  it  it  brings  home 
to  our  trans- Atlantic  cousins  the  danger  of  placing 


98    The  Medical  Press.  NOTES    ON    CURRENT    TOPICS. 


Jan.  27,  1904. 


their  health  requirements  in  the  hands  of  selfish 
and  irresponsible  individuals. 

Adrenal  Haemorrhage- 

The  functions  and  pathology  of  the  suprarenal 
capsules  have  long  proved  an  attractive  subject 
for  pathological  research.  The  connection  of 
these  glands  with  that  mysterious  malady,  Ad- 
dison's disease,  has,  no  doubt,  given  added  zest 
to  the  work,  but,  apart  from  this  affection,  there 
are  other  conditions  of  the  adrenal  bodies,  notably 
haemorrhage,  the  pathology  of  which  is  but  little 
understood.  Four  cases  of  adrenal  haemorrhage 
have  been  recorded  by  Dr.  Leonard  S.  Dudgeon,  (a) 
in  whose  paper  the  whole  subject  is  discussed.  All 
the  cases  occurred  in  young  children  under  the  age 
of  seven.  Perhaps  the  most  striking  point 
associated  with  the  condition  is  that  it  is 
seen  in  the  most  varied  diseases,  and  this 
has  also  been  noticed  by  other  observers. 
Some  of  the  cases  commence  acutely,  simulating 
the  onset  of  a  specific  fever,  and,  from  the  fact 
that  purpura  is  sometimes  met  with,  the  question 
has  even  been  raised  as  to  whether  they  are  not 
in  reality  an  abortive,  fulminating  form  of  small- 
pox. The  bacteriology  of  the  affection  is  by  no 
means  constant,  as  the  pneumococcus  has  been 
found  in  the  blood  and  the  suprarenal  glands  in 
one  case,  while  in  others  septic  organisms  were 
discovered.  The  cause  of  the  haemorrhage 
appears  to  be  as  varied  as  its  pathology.  Some 
cases  are  definitely  connected  with  traumatism, 
while  others  are  associated  with  gastro-intestinal 
disturbances.  It  has  also  been  observed  in  the 
new-born  and  in  certain  diseases  of  the  blood. 
All  degrees  of  haemorrhage  are  met  with  in  the 
adrenals,  from  the  minute,  punctate  spots  to 
the  condition  in  which  the  glands  are  converted 
into  veritable  "  blood-sacs."  In  other  instances, 
the  medulla  bears  the  brunt  of  the  affection, 
the  cortical  portion  remaining  quite  normal.  The 
relation  of  suprarenal  haemorrhage  to  Addison's 
disease  and  to  purpura  is  not  yet  settled,  nor  are 
the  clinical  signs  definite  enough  to  render  a 
•diagnosis  of  the  condition  possible  during  life. 

Eruptions  Simulating  Scarlatina. 

The  short  article  in  last  week's  Medical  Press 
and  Circular  on  if  Erythema  Scarlat  ini  forme  " 
was  probably  of  interest  to  many  of  our  readers, 
for  we  have  had  communications  that  certainly 
lead  us  to  conclude  that  cases  similar  to  those 
described  by  Kramsztyk  have  occurred,  and 
have  been  reported  on  in  this  country.  About 
ten  years  ago  there  was  an  epidemic  in  the 
West  of  London  which  led  to  Dr.  Robert  Lee 
addressing  a  letter  to  the  Chairman  of  the 
Sanitary  Committee  of  the  Fulham  Council  on 
the  subject  ;  and  this  letter  was  published  in  the 
British  Medical  Journal  in  November,  1894. 
The  Lancet  published  an  article  under  the  title, 
"  Scarlet  Fever  and  its  Congeners  "  (October 
13th,  1894),  in  which  it  was  stated  that  Dr.  Lee 
gave  "  an  instructive  description  of  some  cases 

(a)  Amtr.  Jvvrn.  Med.  Sci.,  Jannaiy,  1904. 


which  recently  happened  in  that  parish  (Fulham), 

and  which  simulated  scarlet  fever."      Appended 

to  Dr.  Lee's  communication  was  a  letter  from 

Sir  Samuel  Wilks,  and  another  from  Sir  George 

Johnson,     which  show  that  the  subject  was   of 

interest  to  them.     On  December  12th,   1896,   in 

the  British  Medical  Journal,  Dr.  Lee  made  a  further 

report  on  these  cases,  and  others  that  later  came 

under  his  observation.    In  the  second  report  Dr.  Lee 

gives  a  full  account  of  a  malady  which  appears  to 

be  absolutely  identical  with   that   mentioned   in 

our  article  on  Kramsztyk's  cases,    and  we    think 

that  precedence  must  be  claimed  for  Dr.  Lee  in 

the  observation  and  recording  of  such  cases,  and 

the ,  distinct   difference   between    them   and    true 

scarlatina.     Dr.   Lee's  remark   "  that    the  whole 

subject    of    the    pathology    of   eruptions    is    one, 

,  however,  which  requires  more  investigation  than 

!  it  has  yet  received,"  will  be  concurred  in  by  many  ; 

j  and  it  is  certainly  one  of  very  great  interest  to 

!  those  who  are   required   to  diagnose  and   notify 

!  accurately,  for  as  we  concluded  our  article,  "  the 

'  diagnosis    of    scarlet    fever    is    puzzling    enough 

,  without  this  added  terror  lying  in  wait  to  catch 

;  one    tripping."     The    irritation    of    the    skin    by 

'bacterial   action,   direct   or   indirect,     is     a    self- 

1  evident   fact,   and   whatever   the   ultimate   causa 

causans  may  be,  Dr.   Lee's  clinical    instinct   has 

'  detected  a  pathological  relationship  of  considei  - 

able  suggestive  value. 


Obstructive  Self-immolation. 
The  brilliant  discoveries  of  Dr.  Manson  and  his 
co-workers  in  the  domain  of  the  prophylaxis  of 
malarial  fever  are  beginning  to  bear  fruit,  and  the 
French  Government   has   taken   steps   to  enforce 
j  certain    measures   with    the    object    of   rendering 
several  districts  of  Algeria  less  malarial.     Active 
opposition  has  been  offered   to  the  execution  ol 
the  decree  by  several   Algerian  practitioners  on 
I  the   ground    that    the  conclusions  arrived   at   by 
Dr.  Manson  and  his  school  arc  erroneous  and  only 
apply,  at  most,  to  one  or  two  comparatively  in- 
significant forms  of  malarial  fever.     Drs.  Treille 
and    Legrain    have   enlisted    the   support    of    the 
medical  practitioners  of  a  Paris  society,   where  a 
vote  adverse   to  the  new  departure  was  carried 
unanimously.     The   most   remarkable   feature   of 
the  discussion  is   that     these  gentlemen,    strong 
in  their  scepticism,  demand  that  the  experiment 
of    communicating    malaria    by    mosquito    bites 
shall  first  be  tried  on  themselves,  and  they  solemnly 
undertake  not  to  take  quinine  or  other  medica- 
ment which  might  jeopardise  the  success  of  the 
experiment.     To  make  the  offer  more  ridiculous 
the  editor  of  a  local  newspaper,  not  a  meoical 
man,  seeks  to  attain  notoriety  by  insisting  that 
he   also   must    be   experimented    upon,   and    the 
(  Paris  society  actually  endorsed  these  pretensions. 
\  Of  course,  the  offer  is  only  a  feeble  imitation  of 
the  experiment  carried  out  by  the  Paris  practi- 
;  tioner  who  attained  brief  notoriety  by  inoculating 
!  himself  with  bovine  tuberculosis,  and  it  is  hardly 
necessary  to  point  out  that  one  or  two  observations 
'  on  individuals  would  prove  nothing  either  way  in 


Jan  *;,   1904- 


NOTES  ON  CURRENT  TOPICS. 


view  of  the  countless  experiments  upon  which 
the  present  teaching  is  founded*  It  is  as  if  a 
practitioner  declined  to  make  use  of  anti-diphtheria 
serum  until  he  had  contracted  the  disease  and 
been  cured  thereby.  The  tribe  of  "  ant  is  "  is 
evidently  no l  limited  to  Great  Britain, 


The  Supply  of  Foisonous  Alkaloids  by 
Chemists . 

An  in  teres  ting  trial  has  just  been  under  con- 
sideration by  the  Paris  tribunals.  A  vi 
maker,  who  narrowly  escaped  death  in  conse- 
quence of  the  abuse  of  morphine  and  cocaine, 
brought  an  action  to  recover  damages  from  five 
retail  chemists,  whu,  it  is  alleged,  supplied  him 
without  hesitation  with  the  toxic  alkaloids  in 
powder  form  as  well  as  in  solution  for  hypodermic 
infection.  Now,  under  the  French  law,  no  chemist 
n titled  to  dispense  a  poisonous  substance 
except  on  medical  prescript  ton,  with  which  the 
plaintiff  was  not  provided,  The  defence  was  that 
the  substances  in  question  were  not  poisons  within 
the  meaning  ot  the  law,  but  the  expert  appointed 
by  the  court  easily  ais posed  of  this  contention. 
The  tribunal  w*as  urged  to  decide  against  the 
defendants  *»n  the  ground  that  by  acting  as  they 
had  done  they  rendered  nugatory  the  precautions 
imposed  by  law  in  favour  of  the  public.  The 
judges  have  postponed  their  decision,  the  Phar- 
maceutical Syndicate  having  asked  to  be  heard 
<m  behalf  o!  the  defendants,  but  it  is  to  be 
hoped  that  no  technical  objection  will  be  invoked 
to  perpetuate  a  practice  which  is  unquestionably 
position  to  the  public  inter 


Typhoid  Fever  and  "Water  Supply* 

IfTE  connection  of  typhoid  epidemics  with 
contaminated  water  supply  is  so  well  known 
that  it  seems  almost  superfluous  to  draw  attention 
to  yet  another  epidemic  due  to  this  cause.  But 
the  history  of  a  recent  outbreak  at  Lowell,  Mass., 
is  unusually  interesting,  since  not  only  the  source 
but  the   actual   pieriod   of  contamination   an 


99 


the  defect,  a  certain  degree  of  admixture  had  taken 
place.  Within  a  few  days,  a  large  number  of 
cases  of  gastroenteritis  occurred  in  the  districts 
supplied  by  the  polluted  mains.  Within  a  few 
weeks  typhoid  fever  made  its  appearance  in  the 
same  districts,  and  whereas  only  four  cases  were 
reported  in  July,  in  August  there  were  one 
hundred  and  thirty-six,  and  in  September  thirty- 
eight,  No  immediate  bacterioscopic  examination 
of  the  water  was  made,  but  ten  days  after  the 
pollution  took  place  Bacillt4s  colt  were  found  in  the 
water.  The  epidemic  emphasises  again  the 
moral  that  no  caution  is  too  great  in  guarding 
against  an  impure  water  supply. 


The  Therapeutics  of  Precious  Stones. 

Precious  stones  have  at  all  times  and  amonc, 
all  peoples  been  reckoned  among  materials  to  be 
most  carefully  prized  and  safe-guarded.  The 
Kerns  ot  primitive  races  seem  to  have  been  at 
first  valued  for  their  supposed  heating  and  pro- 
tective virtues*  Civilised  people,  on  the  other 
hand,  have  used  them  chiefly  for  purposes  of 
personal  adornment.  Precious  stones  are  chiefly 
distinguished  by  their  transparency,  lustre,  hard- 
ness, colour,  specific  gravity,  electric  properties, 
refractive  power,  and  symmetrica!  crystal  form. 
The  more  important,  arranged  in  their  order  of 
hardness,  are  diamond,  ruby,  sapphire ,  chryso- 
beryl,  topaz,  spinel,  emerald,  zircon,  garnet, 
cordierite,  tourmaline,  quartz,  chalcedony,  opal, 
turquoise,  nephrite,  lapisdazuli,  malachite  and 
amber.  With  the  results  of  recent  investigations 
into  radio-activity  and  force -rays  facing  us,  it  is  of 
interest  to  inqure  if,  after  all ,  precious  stones  may 
not  be  capable  ot  exerling  Iherapeutic  influence 
Of  one  thing  there  can  be  little  doubt,  namely, 
that  gems  now  as  in  the  past,  and  as  in  all  pro- 
bability will  be  the  case  throughout  the  future, 
exercise  a  more  or  less  marked  action  in  initiating 
and  maintaining  emotional  conditions  and  direct- 
ing l  he  pi  ay  o  f  psy  c  ho  1  o  g  ica  1  processes .  T  he  as  t  u  t  e 
I  physician    need    not    altogether    neglect    the    part 


curately  ascertained.     Lowell,  which   is  a   manu 

factoring   town  of   about    one   hundred    thousand     taken  by  Eems  in   the   kaleidoscopic  variation  of 

inhabitants,   is   situated   on    the  Merrimac   River,  ;  human  sentiments,  and  the  evolution  of  personal 

and  has  a  double   water  supply,       One      source,  1  sympathies. 

used   only    for     industrial     purposes,     is     drawn  [ 

directly  from  the  river,  which  a  few  miles  up   re-  1 

cet%*es   the  sewage  of  Manchester,    The  other,  for 

banking    purposes,    and    more    recently    laid    on, 


The  Penalties  of  Malpraxis  in  Germany. 

There  is  no  country  in  Europe  where   the  in 
is  drawn  from  a  system  of    driven  wells,  and  is  o!  I  dividual  enjoys  so  much  personal   freedom  as  in 
I   quality.     There   is    no   connection    between  ;  England,  and  we  are  accustomed   to  regard  this 
"he  two  systems  except   at  one  point,  where,  in  I  feature  of  our  national  life  as  one  of  the  greatest 


case  the  river  reservoirs  should  be  exhausted 
by  a  sudden  demand  in  case  of  tire,  the  well 
w<uer  has  to  supply  the  deficiency  The  connec- 
tion is  guarded  by  "  flapper"  valves,  which  are 
supposed  to  prevent  any  flow  from  the  river 
system  to  the  other.  On  JuJy  18  lb,  1903,  * 
Urge  fire  occurred,  and  the  valves  opened.     Some 


of  our  birthrights.  We  trust  it  will  be  long, 
indeed,  before  the  individual  medical  man  in 
this  country  will  be  l'cribbTd,  cabin'd,  and  con- 
fined," as  he  is  already  in  some  countries  on  the 
Continent.  For  instance,  in  Germany,  there  is  by 
law  the  severest  punishment  for  inattention  to 
certain     more    or   less    useful    rules    of    practice. 


hours  after  the  demand  ceased,  it  was  discovered  j  Among  these  we  find  that  in  case  a  medical  man 
that  the  valves  were  stuck  open  and  that  the  I  neglects  to  suture  a  ruptured  perineum,  he  is 
nver  water  was  passing  into  the  well  water  mains,  liable  to  be  mulcted  by  the  courts  to  the  tune  of 
Though   immediate  steps  were    taken    to   remedy  ]  nine    hundred    marks    (about    forty-five    pounds 


100     The  Medical  Press.  NOTES    ON    CURRENT    TOPICS. 


Jan.  27,  1904. 


sterling),  to  undergo  three  years'  imprisonment, 
and  to  pay  compensation  to  the  patient.  Now 
there  is  undoubtedly  a  universal  consensus  of 
gynaecological  opinion  in  favour  of  immediate 
union  of  ruptured  perineum,  and  though  there 
may  be  few  instances  where  it  is  advisable  for  the  sur- 
geon to  adopt  other  than  the  customary  procedure 
in  regard  to  a  particular  lesion,  yet  the  decision 
must  lie  with  himself,  and  his  responsibility 
should  be  to  his  patient,  to  the  opinion  of  his 
professional  brethren,  and  to  his  own  conscience. 
It  is  obvious  that,  if  interference  by  the  State  in 
the  details  of  medical  treatment  be  permitted  in 
one  instance,  there  is  no  logical  limit  to  such 
compulsion,  and  whatever  be  the  merits  of  demo- 
cratic government,  discernment  and  wisdom  in 
medical  treatment  are  not  likely  to  be  among 
them. 


Life  Insurance  Examination  Fees. 
The  general  tendency  to  cut  down  medical  fees 
has  long  been  a  growing  evil  in  professional  life. 
In  many  ways  medical  men  are  themselves  to 
blame,  because  they  have  set  the  example  by 
placing  their  services  at  the  disposal  of  the  com- 
munity on  a  scale  of  remuneration  that  is  simply 
degrading.  The  evils  of  rivalry  in  an  overcrowded 
profession  are  heightened  by  the  competition  of 
the  hospitals,  and  by  the  incessant  inroads  of  an 
ever-increasing  army  of  unqualified  practitioners 
and  quacks,  whom  there  is  no  law  to  restrain. 
Some  of  the  less  important  life  insurance  offices 
are  now  reducing  their  fees  to  half  a  guinea. 
Is  it  too  much  to  hope  that  medical  men  will 
stand  by  each  other  and  refuse  this  reduction  ? 
As  it  is,  a  guinea  is  small  enough  remuneration 
for  a  highly  skilled  and  responsible  medical  exa- 
mination, including  a  report  of  the  urine.  Here 
in  the  United  Kingdom  the  insurance  offices  have 
no  difficulty  in  obtaining  the  services  of  men  of 
the  highest  skill  and  absolute  integrity  at  a  fee  of 
one  guinea  per  examination.  It  will  be  an  ex- 
ceedingly unwise  step  on  the  part  of  the  offices 
if  they  invite  the  entry  of  inferior  men  by  a 
reduction  of  the  scale  of  fees.  In  the  United 
States  rumour  persistently  maintains  that  insur- 
ance frauds  are  connected  with  this  class  of  medical 
examinations  in  a  way  that  we  are  happy  to  think 
is  practically  non-existent  among  British  practi- 
tioners. 


a  preventive  of  disease.  Cases  of  lead-poisoning 
have  been  traced  to  the  dissemination  of  fine 
metallic  particles  emanating  from  the  mat  after 
long-continued  friction  against  the  boots  of  a 
pottery-worker,  and  this  among  persons  in  whom 
it  was  shown  that  infection  from  every  other 
source  was  precluded.  Tubercle  and  tetanus 
bacilli,  to  say  nothing  of  the  bowel-organisms  of  the 
horse,  would  be  found  in  the  dust  thus  harboured, 
coming,  as  it  does,  from  road  soil  where  it  is  known 
that  these  organisms  flourish.  There  is  one  par- 
ticularly objectionable  practice  unavoidably  con- 
nected with  the  use  of  door-mats,  namely,  their 
beating  or  shaking  in  the  front  precincts  of  the 
house  or  upon  the  public  highway.  The 
unwholesome  clouds  of  dust  thus  raised  often 
settle  again  in  the  hall  or  passage,  or  are  blown 
into  rooms  through  the  open  windows.  A  worse 
nuisance  is  created  when  the  only  available  space 
for  shaking  is  the  pavement,  especially  in  the  early 
morning  during  the  busy  hours  of  passenger  traffic. 
Many  of  the  Metropolitan  boroughs  have  recog- 
nised the  danger  of  this  unwholesome  practice, 
and  have  prohibited  the  beating  of  door- mats  after 
a  specified  time  in  the  morning.  For  the  infringe- 
ment of  this  by-law  a  fine  of  five  shillings  has 
been  recently  imposed  at  the  Thames  Police  Court, 
and  it  would  be  well  if  the  law  regarding  the  matter 
were  more  rigorously  enforced. 


The  Hygiene  of  the  Door-Ma  . 
Until  the  time  comes  when  street-mud  shall  be 
no  more,  so  long  will  the  door-mat  continue  to  be 
a  household  necessity.  The  thoughtless  indi- 
vidual who  omits  to  remove  the  superfluous  dirt 
from  his  foot-gear  in  the  manner  that  custom  has 
dictated  is  the  terror  of  the  careful  housewife  and 
an  unconscious  object  of  execration  on  the  part 
of  the  domestics.  We  are  not  aware  that  a  bac- 
teriological examination  of  the  dried  mud  ob- 
tained from  a  door-mat  has  been  specially  made, 
but  from  the  sanitary  point  of  view  there  is  no 
doubt  that  this  article  is  quite  as  often  a  cause  as 


The  Silent  Operator. 
The  surgeon  of  the  future,  if  he  is  to  keep  in 
touch  with  the  findings  of  bacteriology,  will  indeed 
be   a   strange   creature.     He   is   already   clad  in 
sterilised  garments,  and  has  his  hands  sterilised 
by  minute  and  formal  ablutions.     Some  operators 
work    in    sterilised    gloves.     Others    cover    their 
heads  with  caps  and  their  beards  with  bags,  in 
order  to  prevent   the  chance  falling  of  bacteria 
from  these  hairy  lurking  places  upon  the  wound. 
Now    an     Amsterdam  surgeon  comes  along  and 
says  that  every  time  we  speak  we  unconsciously 
emit  a  huge  spray  of  saliva  which  is  charged  with 
the  harmful  micro-organisms  that  are  found  in 
enormous  numbers  in  every  human  mouth,  healthy 
or  otherwise.     He  more  than  suggests  that  some 
of  the  mysterious  bad  results  of  modern  operative 
surgery   may   be    explained   in    that   way.    The 
truth  of  his  conclusions  was  proved  experimentally 
by  talking  into  a  box  containing  prepared  plates 
from  which  numerous  colonies  of  bacteria  were 
afterwards  cultivated.     Every  surgeon,  even  the 
most  taciturn,  speaks   150  to  200  words  in  the 
course  of  a  short  operation,  lasting,  say,  a  quarter 
of  an  hour.     Other  surgeons,  again,  talk  incessandy 
right     through     an     operation.      It    would     be 
almost  impossible  for  a  surgeon  to  avoid  speaking 
during    an  operation.      The     suggested    remedy 
is    to    wear    a   sort    of    cotton    wool   respirator 
which  permits  of  audible  speaking,  but  filters  off 
the  bacteria.      At  the  same  time,  it  is  only  fair 
to  add  that  many  talking  surgeons  have  achieved 
a  fine  record  of  success  in  their  operative  work. 


]ui.  a;.  IQQ4- 


LRTYR. 


The  Medical  Press,     I  CI 


PERSONAL. 


J}r.  James  Mil  ward,  who  has  been  in  the  Poor-law 

Medical  Service  since  the  year  1867,  has  resigned  his 
position  as  Medical   Officer  to  the  east  district  of  the 

-Cardiff  lTt-  

DtL  W.  ]\pf  Sinclair,  Professor  of  Obstetrics  and 

Gynecology  in  Owens    College,  Manchester,  has  been 

elected  President  of  the  North  of  England  Obstetrical 

and  Gyu analogical  Society. 


Dr.  J  AS*  Bmir,  Physician  to  the  Liverpool  Royal  In- 
firmary, Lecturer  on  Clinical  Medicine  in  Liverpool 
VniverMtv,  has  been  elected  Presidentof  the  Liverpool 
Medical  Institution  for  the  current  year. 


A    MEDICAL   MARTY  R. 
THE  LATE  DR.  W.  J.  CONEYS,  OF  ROUNDSTONE, 


January  21st,  the  Lord  Rector  of  the  University 
of  Edinburgh,  the  Right  Hon.  Sir  Robert  Fin  lay, 
MJ\t  delivered  an  address  to  the  students  of  the  Uni- 
Tersity  in  the  M'Ewan  HaU  in  his  capacity  of  Lord 
Rector  of  the  University. 


Dr*  Jobs  Hay,  formerly  Assistant  Physician  to  the 

Stanley  Hospital.   Liverpool,   has  been  appointed  One 

oi  the  Physicians  of  the  hospital,  in  succession  to  Dr. 

J   Lloyd  Roberts,  who  has  been  elected   to  a  similar 

100  at  the  Royal  Southern  Hospital 

Professor  Ro&f.rt  B.  Wild's  important  address 

University  Education   for  Pharmacists*'  appears 

m  the  current  number  of  the  Phartnaceutntil  Journal, 

and  should  recsive  the  attention  of  all  interested  in 

the  evolution  of  the  pharmacist  -graduate. 


I 


The  Earl  ot  Derby.  K.G.,  as  Chancellor  of  the  Uni- 
versity of  Liverpool,  a  few  days  ago  headed  a  deputa- 
tion to  the  City  Council,  which,  in  reply;  granted  a  sum 
',000  to  the   University  during   the  year   1904, 
rocb  sum  to  be  paid  out  ot  the  city  rate. 

On  Thursday.  January  7O1,  a  bronze  statue  of  heroic 


It  is  with  deep  regret  that  we  announce  the  death 
of  Dr.  \V\  J.  Coneys,  medical  officer  of  Roundstone 
dispensary  district,  Clifden  No.  t  Union.  This  great  area 
is  worked  by  two  medical  officers,  whose  physical 
strength  is  taxed  to  the  utmost  in  t^eir  attempts  to 
fulril  their  duties  among  a  ver>  poor  population,  the 
majority  of  whom  have  no  idea  of  cleanliness,  who 
believe  that  K  muck  is  luck,"  and  whose  cabins  are 
foci  of  dirt  diseases.  Amid  such  surroundings  Dr. 
Coneys  worked,  and  fearlessly  encountered  all  risks. 
But  he.  no  more  than  any  other  medical  officer,  was 
immune  to  that  dreadful  fever,  the  fear  of  which  111 
the  west, where  it  is  so  common, parts  wife  from  husband 
and  mother  from  child.  It  became  Dr.  Coneys' 
duty  to  visit  typhus  in  one  of  those  wretched  hovels, 
in  which  escape  from  infection  is  impossible,  and  the 
duly  was  heroically  undertaken  and  his  life  given  for 
his  patient, 

A  few  days  before  his  death  he  wrote  to  Dr.  Kinkead, 
of  Gal  way,  a  description  of  the  duties  he  had  to  perform 
in  this  case — duties.be  it  noted,  not  obligatory  to 
office,  but  solely  imposed  upon  him  by  feelings  of  hu- 
manity* His  patient  died,  and,  tn  his  own  words, 
"  I  could  not  get  a  man  for  love,  whisky,  or  money, 
to  help  me,  and  I  was  obliged  to  coffin  the  corpse, 
along  with  the  nurses  and  another."  Dr.  Coneys* 
sad  death,  following,  as  it  does,  on  those  of  Dr.  Kean. 
of  Arran,  and  Dr,  Conroy,  of  Spidda! — three  deaths 
within  three  years  in  the  county  Gal  way  alone — 
shows  full  well  that  great  as  are  at  times  the  dangers 
associated  with  a  soldier's  life,  the  dangers  which 
surround  the  medical  soldier,  who  fights  disease  and 
death,  are  atifl  % reat er ,  Wh 0  can  d eny  t ha 1 1 he  b ra very 
shown  is  also  greater  far  ?  There  are  thousands  of 
men  who  will  face  death  bravely  when  spurred  on  by 
the  surroundings  of  the  moment  and  the  glamour 
that   will  always  surround   physical  courage,  but   the 


s  unveiled  of  the  late  Hunter  Holmes  McGutre     number  of  men  win.  will  in  cold  blood  shake  hands  with 


ipital  Square,  Richmond,  Virginia,  the 
bjgiiiature  of  the  Commonwealth  having  passed  a  Bill 
authorising  its  being  placed  there,  in  close  proximity 
to  that  of  his  beloved  leader,  Stonewall  Jackson. 

The  Gloucestershire  County  Council  has  appointed 

Dr.  J  Middleton  Martin,  the  County  Medical  Officer  of 

Health  and  the  Medical  Officer  of  Health  of  the  Stroud 

t,  Executive O thee r  under  the  Midwives  Act  at  a 

rj  of  £105  per  annum  and  out-of-pocket  expenses. 

. 

Di.    Skgyll-Rorsrtson  will    shortly  leave  Edin- 
burgh to  reside  in  Jersey.     He  was  appointed  Lec- 
iQ  Ophthalmic  Surgery  in   the  Edinburgh  Royal 
Infirmary  in  1890,  about  the  period  when  he  published 
trches  in  the  eye  conditions  in  various 
nme  dfeeaet,  notably  the  "  Argyll* Robertson  "  pupil 
tot  ataxy.       He  graduated  at  St,  Andrews 
m  1 9 f 7 ,     He  has  always  been  a  notable  athlete,  and  is  a 
be*  of  the  Royal  Bodyguard  of  Scottish  Archers. 

Cremation  Statistics. 

In  his  report  to  the  Municipal  Council  of  Paris  M. 

Ranvier '-stales  that  there  are  twenty-eight  crematoria 

iti  Italy,  mx  in  the  United  States,  nine  in  Great  Britain, 

ngnt  in  Germany,  lour  tn  Switzerland,  three  in  France, 

fttH  Rouen),  and    two  in  Sweden,   while 

Denmark,  Canada,  Argentina, and  Australia  each  po&eas 

one.    France  occupies  the  hrst  place  in  the  matter  of 

raauom,    From  August,   tflSq.  i<i  the  end  of  n>>i 

JJJ7I  bodies  of  persons  who  had  died  in  the  hospitals, 

1,999 private  individuals,  and  20,178  stillborn  children 

wm  cremated.     The  United  States  comes  next,  with 


death,  when  it  presents  its  dread  form  shorn  of  the 
trappings  that  serve  tn  hide  it  from  the  excited  brain, 
are  but  few,  and  many  of  ttiem,  we  are  glad  to  think, 
are  found  in  the  ranks  of  the  medical  profession.  The 
question  will  arise,  Why  is  it  that  men  voluntarily 
undertake  such  risks  ?  If  they  safely  pass  through 
the  danger  no  one  wots  of  its  existence,  and  the  thanks 
thev  receive  are  small,  flf  they  fall  victims  to  their 
generous  actions,  a  momentary  enthusiasm  is  created, 
men  congratulate  one  another  that  the  wot  Id  still 
possesses  silent  heroes,  and  that  is  alL  No  bonds  of 
official  duty  can  compel  a  man  to  actions  such  as  those 
of  IV  Coneys  and  his  assisting  nurses,  but  when  the 
silent  calls  of  humanity  hint  that  there  is  work  to  be 
done,  there  are  few  members  of  the  medical  profession, 
and.  we  are  glad  to  think,  still  fewer  members  of  the 
Irish  Poor-law  Medical  Service,  who  do  not  respond. 
When  will  the  public  at  large  understand  that  what 
humanity  in  the  abstract  demands  must  be  paid  for 
by  humanity  in  the  concrete  ?  Is  it  right,  is  it 
honest,  to  call  for  a  man  to  take  up  duties  such  as  those 
of  the  Poor-law  Medical  Service,  duties  which  never 
end  in  glory,  though  they  may  often  lead  to  the  grave, 
only  to  reward  him  for  the  discharge  of  those  duties  by  a 
miserable  pittance,  to  refuse  him  the  means  of  reo 
iug  his  health  from  lime  to  time,  and  often  to  leave 
after  his  death  his  immediate  relatives  in  poverty? 
Medical  men,  like  their  fellows,  have  their  duty  to 
humanity  to  discharge,  and  humanity  has  its  duties 
to  discharge  to  medical  men.  It  may  seem  a  useless 
sacrifice  that  a  living  man  should  lose  his  life  in  order 
that  a  dead  one  may  be  buried,  but  such  deeds  serve 
to  show  to  each  one  his  duties.  It  may  even  be  that 
they  may  also  serve  to  bring  out  of  its  present  seclusion 
into  prominence  that  other" da tv  to  which  we  have  re 
f erred — the  duty  of  humanity  to  medical  men. 


102     Thb  Medical  Press. 


CORRESPONDENCE. 


Jan.  27,  1904* 


Special  Correspondence. 


(from  our  own  correspondents.] 


SCOTLAND. 


Spread  of  Small-pox. — Small-pox  still  continues  to 
spread  in  Scotland,  and  scarce  a  day  passes  without 
a  case  being  reported  in  some  new  locality.  In  Glasgow 
on  the  2 1st  inst.,  there  were  under  treatment  235  cases, 
the  death-roll  up  to  that  date  being  36.  In  the  Coat- 
bridge district  27  cases  have  broken  out.  A  case  has 
also  been  found  in  a  lodging-house  in  Leith,  and  there 
the  corporation  took  the  wise  step  of  offering  2s.  6d. 
to  every  inmate  of  a  common  lodging-house  who 
would  submit  to  be  vaccinated.  Several  cases  of  the 
disease  have  also  occurred  in  Edinburgh,  one  in  the 
person  of  a  Christian  Scientist,  who  seems  to  have,  been 
visiting  among  the  sick  in  Glasgow.  He  had  had  the 
disease  on  him  for  several  days  before  being  admitted 
to  hospital,  and,  unfortunately,  succumbed  to  it.  The 
disease  has  also  broken  out  in  the  navvy  huts  in  con- 
nection with  the  construction  of  the  Ayr  and  Girvan 
Railway,  in  Hamilton,  in  Perthshire,  in  Lochgelly,  in 
Upper  Renfrewshire,  and  in  Cambuslang,  Govan, 
Greenock,  and  Paisley. 

.    Edinburgh  University  Rectorial  Address. — Sir 
Robert  Finlay,  Lord  Rector  of  the  University,  deli- 
vered (or  attempted  to  deliver,  for  the  students  took 
good   care   that  no  single  sentence  of  it  should   be 
audible)  his  Rectorial  Address  in  the  MacEwan  Hall, 
on    the    21st   inst.,    his   subject    being    International 
Arbitration.     The  undergraduates  behaved  exceedingly 
badly,  their  conduct  recalling  the  very  worst  days  of 
the  era  which  all  had  hoped  was  ended  with  the  birth 
of  the  Students'  Representative  Council.     Apparently, 
however,  the  body  has  lost  the  respect  of  the  students, 
or  is,  at  least,  quite  incapable  of  dealing  with  such  an 
organised  exhibition  of  vulgar  rowdyism  as  disgraced 
Thursday's  meeting.     Great  latitude  is  allowed  to  the 
students    on    the  occasion  of  the  Rectorial  Address, 
but  their  conduct    on    this   occasion   has    met    with 
universal  reprobation.     It  is  sincerely  to  be  hoped  that 
the  Students'  Representative  Council,  or  the  Senatus, 
will  offer  some  apology  to  Sir  Robert  Finlay  and  to 
the  Chancellor,  Mr.  A.  J.  Balfour,  for  the  discourtesy, 
amounting  at  one  part  of  the  procedings  to  deliberate 
insult,  which  was  shown  them,  and  also  to  the  people 
of  Edinburgh  for  the  discredit  which  such  behaviour 
casts  on  the  city.     It  is  very  generally  felt  that  scenes 
like  those  of  Thursday  will  make  it  difficult  for  the 
students  to  get  any  respectable  man  to  occupy  the 
post  of  Lord  Rector,  and  they  will  certainly  close  the 
purse  -strings  of  many  who  would  otherwise  have  felt 
disposed  to  respond  generously  to  an  appeal  for  funds 
to  extend  the    University   Union  which   was    issued 
broadcast    only    a    few    days    before    the    Rectorial 
Address. 

Edinburgh  Royal  Infirmary. — The  question  of 
an  age-limit,  to  which  reference  was  made  last  week, 
and  which  .was  supposed  to  have  been  definitely 
settled  by  the  managers,  was  again  thrown  into  the 
melting-pot  by  the  action  of  the  Court  of  Contributors 
at  the  adjourned  meeting  on  the  18th  inst.  It  will  be 
remembered  that  at  an  earlier  meeting  a  motion  ex- 
tending the  operation  of  the  age-limit  to  the  Professors 
holding  wards  was  carried,  while  the  committee  of 
Contributors  recommended  to  the  adjourned  meeting 
that  the  whole  matter  should  be  delayed.  Accord- 
ingly a  motion  delaying  approval  of  the  new  rule 
(i.e.,  an  age-limit  for  ordinary  physicians  and  surgeons 
only)  and  remitting  to  a  committee  of  the  Contributors 
and  Managers  for  consideration  and  report  was  carried. 
It  will  be  a  thousand  pities  if  so  excellent  a  principle  as 
the  age  limit  be  departed  from,  and  we  sincerely  hope 
that  some  agreement  will  be  arrived  at  for  the  im- 
partial application  of  the  rule. 

BELFAST. 
The     Proposed     Consumption     Sanatorium     at 
Whiteabbey. — The  proposed  purchase  of  the  Abbey, 
a  large  old  country  house  about  five  miles  from  Belfast, 


on  the  north  shore  of  Belfast  Lough,  is  being  vigorously 
protested  against.     At  a  public  meeting  in  Whiteabbey, 
most  of  the  leading  residents  of  the  neighbourhood 
l  were  present.     They  protested  on  the  grounds   that 
!  the  site  was  unsuitable  for  the  purpose,  being  a  cold 
j  clay  soil,  that  the  cost  of  adapting  the  old  building  to 
I  its  new  purpose  would  be  so  great  as  to  add  largely  to 
the  rates,  and  that  the  close  proximity  of  the  house 
and  grounds  to  a  large  manufacturing  village  such  as 
Whiteabbey  is,  would  be  a  source  of  danger    to   the 
latter.     A  Local  Government  Board  inquiry  into  the 
proposed  scheme  was  held  in  Belfast  last  week,  and  at 
this  inquiry  the  objectors  to  the  scheme  were  strongly 
represented.     The  lands  of  the  Abbey  extend   to  33 
acres,  and  would  accommodate  150  to  200  patients  in 
huts,  according  to  Dr.   Richard  Purdon,  one  of  the 
physicians    to    the    Forster   Green    Sanatorium,    who- 
expressed  general  approval  of  the  scheme.     The  soil  is 
said  to  be  12  to  14  inches  in  depth,  and  under  it  is  a 
red  retentive  clay  mixed  with  gravel.     It  was  said  that 
there  would  be  no  difficulty  in  draining  it  properly, 
but  there  seems  little  doubt  that  at  present  it  is  deci- 
dedly damp.     Dr.  McKisack,  a  visiting  physician  to 
the  Koyal  Victoria  Hospital,  said  that  he  had  inspected 
the  grounds  and  found  rushes  growing  on  the  lawn, 
and  that  when  he  stepped  from  the  raised  avenue  to 
the  ground  below  he  found  he  was  -walking  in  surface 
water.     In  two  places  he  excavated  and   found  red 
retentive  clay  in  one  at  six  and  the  other  ten  inches 
from  the  surface.     He  was  of  opinion  that  the  site  was 
most    unsuitable    and    unhealthy    for    consumptives. 
Dr.   Manley,  a  local  practitioner,  was  also   strongly 
opposed  to  the  site,  believing  it  to  be  too  damp  and 
relaxing.     On  the  whole,  the  weight  of  medical  opinion 
is  decidedly  against  the  scheme,  but  it  remains  to  be 
seen  what  decision  the  Local  Government  Board  will 
come  to  in  the  matter. 

Small-pox  in  Belfast. — As  predicted  n  this 
column  a  fortnight  ago,  there  has  been  a  decided 
increase  in  the  number  of  small-pox  cases.  It  was 
mentioned  then  that  a  child  had  been  found  in  a 
crowded  house  in  a  very  poor  locality.  The  parents 
of  that  child  and  an  old  woman  who  nursed  her  have 
since  developed  the  disease,  and  fresh  cases  are  now 
occurring  daily.  Some  of  these  are  cases  which  have 
a  clear  history  of  having  been  in  contact  with  previous 
cases,  but  others  are  now  coming  in  from  almost  all 
parts  of  the  city,  showing  that  the  infection  is  widely 
diffused. 


Correspondence. 


I  We  do  not  hold 
Correspondents.] 


ourselves  responsible  for  the  opinions  of  our 


"  KOPLIK'S  SPOTS  IN  MEASLES." 
To  the  Editor  of  The  Medical  Press  and  Circular- 
Sir,  —in  an  article  under  this  heading  in  your  issue 
for  January  20th,  1904,  you  observe  : — "  The  early 
diagnosis  of  measles,  then,  is  a  great  desideratum.  It 
seems  curious  in  this  connection  that  the  lesions  of  the 
buccal  mucous  membrane  known  as  Koplik's  (not 
'Koplik')  spots  should  not  have  received  wider 
recognition  than  has  been  accorded  to  them.  These 
spots  were  first  definitely  described  by  Filatow  in 
1895,  although  it  is  possible  that  Flindt  may  have 
indicated  the  same  changes  in  his  paper  published  in 
1880.  The  subject  was  not  taken  up  till  1806,  when 
Koplik,  of  New  York,  wrote,  in  the  *  Archives  of 
Pediatrics  '  an  account  of  them  which  differed  some- 
what from  that  of  Filatow,  but  was  undoubtedly 
intended  to  apply  to  the  same  lesions.  At  all  events, 
Koplik's  name  came  to  be  associated  with  the  dis- 
covery." „  . 
It  appears  to  me  that  Koplik's  "discovery  & 
nothing  new.  All  close  observers  of  measles  for  genera- 
tions have  recognised  the  fact  that  the  rash  of  the 
disease  shows  itself  as  early  as  the  second  day  of  in- 
vasion on  the  palate  and  buccal  mucous  n*embF*?*; 
"  Koplik's  spots  "  are  the  papules  of  measles  ^J*™* 
by  their  situation  on  a  mucous  membrane.    w"«n* 


Writing: 


in   1 891,   five  years   before   Koplik's   £*  discovery, 


JaK.  »/,  1904. 


CORRESPONDENCE. 


The  Medical  Press.     I<>3 


quoted  Dr.  Hilton  Fagge  on  this  point.     Describing 

the  stage  of  invasion  of  measles,  I  wrote  as  follow*  :  — 

second  day  an  tfflvrescvnct  may  spread  over 

the  skin,  leading  to  a  wrong  diagnosis' oi  scarlatina. 

dental  rash  may  also  simulate  urticaria  be- 

caoie  of   the  itchiness  which  accompanies  it.     It  is, 

thema tenia    in    character.     About    this 

th&r*  according  to  Dr.  Hilton  Fagge,  an  erup- 

uon  of  scattered  points  and  spots  may  be  seen  over  the 

as  membrane  of  the  soft  palate/* — "  Eruptive  and 

Lnued    Fevers/'     Dublin;    Fannin  and  Co.     1S92* 

Pin 

la  his  monograph  on     'Measles"   in    the    second 

«e    of    the    English    edition    of   Von    Ziern 

lopfdia  of  the  Practice  of  Medicine/'  published 

;  1  twenty-one  years  before  Kophk's     discovery  "), 

iisr   of   Leipzig,  gives  a  detailed  account  of  the 

a^eirances  described  by  Filalow  and  Koplik,  as  he 

them  on  the  palatal  mucous  membrane,  the 

cons     membrane,     and     the     conjunctiva. 

le  Thomas  does  not  recognise  the  perfect  justice  of 

'*rm  "  exanthem  of  the  mucous  membrane/'  he 

::£ly  concedes  that*    since    the  peculiarities  of  the 

prec  membrane  are  unmistakable, 

[Ota  ftof  need  to  be  so  precise  in  one's  application 

ion  of  the  exanthem  of  measles  here  as 

upon  the  outer  skin,  since  not  its  form,  but  its  mere 

appearance  at  all,  is  of  any  significance  in  regard  to  a 

losia, 

I  am,  Sir,  yours  trulv. 
iHn  Ww,  Moore,  M.D.Dub.,  F.R.C.P.L 
llliaru  Square  West,  Dublin, 
itury  20th,  1004. 


OPECIA  AND  DENTAL  CARIES. 

0  tkc  Editor  af  The  Medical  Press  and  Circular. 
— M.  L.  Jacquct's  observations,  upon  which  you 
comment  in  your  issue  of  January  20th,  are  interesting 
ntal  pathologists  and  dental  surgeons.     It  must 
borne  m  mind  that*  once  calcined,  the  hard 
the  teeth — enamel  and  dentine— are  physlo- 
ilfy  unalterable  ;    they  can  be  affected  only  by 
agents.     The    main    predisposing    cause    of 
ones  is  formed  by  innate  structural  defects,  especially 
-  enamel.     Few  sets  of  teeth  in  civilised  man  are 
t&  be  discovered  absolutely  free  from  inherent  weak- 
nesses, whilst  in  great  numbers  the  enamel  and  dentine 
show  large  areas  of  ill-  formed  tissue  in  many,  if  not  all, 
e  members.     The  onset  and  progress  of  caries  are 
ifuvemed  mainly  by  defects  of  the  tissues,  the  other 
cause  being  vitiation  of   the  secretions  due   to 
neglect  or  disease  by  which  acid  fermentation  in  the 
1   lodging  upon   the   teeth   is   encouraged.     That 
<anes  is  especially  noticeable  in  circumstances  sugges- 
erf  correlation  with  alopecia  is  certainly  not  my 
rtcace,  nor,  so  far  as  published  writings  ^o,  is  it 
the   experience    of    dental    pathologists,     Degenerate 
bair  is  not  a  constant  accompaniment  of  degenerate 
teeth,  albeit  they  are  equally  dermal  appendages,  and. 
presumably,  subject  to  similar  hypoplastic  influences 
•  ruent,     If  a  patient's  powers  of  masti- 
cation are  seriously  interfered  with  by  dental  caries 
fall  physiological   apparatus   becomes  so    far  handi- 
cap]) 1  .  t  he r  f  ac  t o rs  exi st  i  t  is  possi  ble  th i s  may 
lead  to  a  state  of  general  malnutrition.     Such  debility 
1  no  doubt  show  itself  locally  in  the  hair  follicles 
with  Waiting  alopecia,  and  111  *uch  a  case  caries  would 
certainly  constitute  a  contributory  cause  1   so  that  m 
iome  instances  there  might  be  traced  between  these 
diseases  a  connection  hardly  less  close  than  M,  Jacquet 
iggests,  although  not  quite  of  the  same  kind. 
I  am,  Sir,  vours  truly, 

M,R.C.S>+  L.D.S. 
January  22nd,  1904. 


Office  appears  to  have  treated  the  medical  profession 
with  more  deference  (as  regards  one  class  oi  cases  to 
which  I  referred)  than  it  does  now.  In  support  of  this 
statement  I  shall  quote  the  terms  of  a  free  pardon 
granted  to  one  Edward  M'Quirk,  in  the  year  1769,  from 
the  Annual  Register  of  that  year.  M'Quirk  had  given 
a  man  named  Clarke  a  blow;  apparently  unprovoked, 
during  an  election  not,  and  the  main  question  was 
whether  Clarke  had  died  of  the  blow  (I  omit  M'Quirk  s 
1)  :  — 
Whereas  a  doubt  has  arisen  in  our  Royal  breast 
concerning  the  evidence  of  the  death  of  George  Clarke, 
from    the    representations   of   Wm,    Bromneld,    1 

on.  and  Solomon  Starling,  apothecary,  both  ot 
whom  as  it  has  been  represented  to  us  attended  the 
deceased  before  his  death  and  expressed  their  opim 
that  he  did  not  die  of  the  blow  he  received  at  Brentford  ; 
and  whereas  it  appears  to  us  that  neither  of  the  said 
persons  were  produced  as  witnesses  upon  the  trial, 
though  the  said  Solomon  Starling  had  been  examined 
before  the  Coroner,  and  the  only  person  called  to  prove 
that  the  death  of  the  said  George  Clarke  was  occasioned 
by  the  said  blow  was  John  Foot,  surgeon,  who  swore 
that  he  never  saw  the  deceased  until  after  his  death, 
we  thought  it  fit  to  refer  the  said  representations, 
together  with  the  report  oi  the  Recorder  of  our  Uty 
of  London  nf  the  evidence  given  by  Richard  ana 
William  Beale  and  the  said  John  Foot  at  the  trial  oi 
the  said  Edward  M'Quirk  lor  the  murder  of  the  said 
Clarke,  to  the  master  wardens  and  the  rest  ot  tne 
examiners  of  the  Surgeons'  Company,  commanding 
them  likewise  to  take  such  further  examination  ot  the 
said  persons  so  representing  and  of  the  said  John  tool 
as  they  might  think  necessary,  together  with  the 
premisses  above-mentioned,  to  form  and  report  to  us 
their  opinion  whether  it  did  or  did  not  appear  to  them 
that  the  said  George  Clarke  died  in  consequence  ot 
the  blow  which  he  received  in  the  not  at  Brentford  on 
the  8th  of  December  last.  And  the  said  Court  of 
Examiners  of  the  Surgeons'  Company  having  there- 
upon reported  to  us  their  opinion  that  it  did  not 
appear  to  them  that  he  did.  we  have  thought  it  proper 
to  extend  Our  Roval  mercy  to  him,  the  said  Edwwd 
M'Quirk,  and  to  grant  him  our  l^e  pardon  for  the 
murder  of  the  said  George  Clarke,  of  which  he  has  been 
found  guilty/' 

NTow  compare  this  with,  for  instance,  the  wU-knomm 
Mav brick  case.  In  that  case  the  Home  Secretary  is 

known  to  have  taken  the  opinions  of  several  medical 
gentlemen,  but  the  names  of  those  consulted  and  the 
manner  to  which  they  were  divided  in  opinion  has 
never  been  published.  Further,  we  do  not  know  what 
Statement  oi  the  evidence  was  laid  before  them 
and  whether  any  new  facts  were  communi- 
cated to  the  Home  Office  as  to  Mr,  May* 
brick's  habit  of  dosing  himself  or  of  the  causes 
to  which  he  himself  asenbed  his  illness  were  laid  betore 
them.  But  perhaps  the  most  important  dinerence  is 
that  the  Home  Secretary  did  not  consult  any  repre- 
sentative medical  body  or  empower  them  to  put  ques- 
tions to  the  medical  witnesses  which  might  have  tended 
to  bring  out  the  relevant  facts  much  more  dearly  than 
the  questions  put  to  them  by  counsel.  In  a  case  ot 
this  kind  the  weight  of  medical  opinion  received  by 
the  Home  Office  might  very  probably  depend  alto- 
gether on  the  official  who  selected  the  doctors  to  be 
consulted.  The  improvising  of  a  medical  Court  ot 
Appeal  by  the  Home  Secretary  for  the  occasion  is  as 
objectionable  as  the  improvising  of  a  legal  Court  ot 
Appeal  or  a  Police  Court  of  Appeal —though  any  c>l 
these  might  possibly  do  better  than  the  officials  if  left 
to  themselves. 

I  am,  Sir,  yours  truly, 

A  Barristkr. 


'    HOME  OFFICE  AND  THE  MEDICAL 
PROFESSION. 

To  tte  Editor  of  The  Medical  Press  and  Circular. 
Sir,— Referring  to  your  comment  on  my  previous 
te   that   at    one    time    the   Home  \ 


[The  moral  and  circumstantial,  apart  Irom  the 
scientific,  evidence  in  Mrs.  Maybricks  case  was 
overwhelming.  The  wile's  intrigue,  the  quarrels,  the 
purchase  of  the  poison,  the  finding  of  arsenical  papers 
in  the  bedroom,  and  other  facts  pointed  to  an  absolu- 
tely clear  conclusion. — Ed.] 


104 


Thx  Medical  Pxbss. 


CORRESPONDENCE. 


THE  MISSING  LINK. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — May  I  ask  from  any  of  your  correspondents, 
so  much  prejudice  and  incredulity  existing  in  the 
public  mind,  and  more  especially  the  clerical  portion, 
as  to  the  truth  or  otherwise  of  man's  evolution  from  a 
lower  type  of  animal  on  account  of  the  great  intel- 
lectual gap  between  the  two — whether  the  idea  of  the 
origin  of  language  (I  use  "  language  "  in  its  broadest 
sense,  i.e.,  hieroglyphic  or  phonetic)  has  been  advanced 
to  account  for  this  ? 

It  must  appear,  I  submit,  fairly  evident  that  language 
in  its  earliest  dawn,  or  rudimentary  stage,  would  or 
might  commence  so  complete  a  change  in  the  environ- 
ment of  sentient  existence,  owing  to  the  creation  of  a 
medium  for  interchange  of  ideas,  as  in  the  process  of 
time  sufficiently  to  account  for  the  intellectual  breach 
between  man  and  the  anthropoids.  I  shall  be  glad, 
therefore,  if  you  will  allow  me  to  submit  to  your  readers 
the  following  considerations  : — 

i.  It  must  be  self-evident  that  the  art  of  language 
did  at  some  epoch  more  or  less  remote  have  a  beginning, 
and  this  independent  of  the  hypothesis  whether  man 
has  from  all  time  been  a  distinct  and  separate  species. 

2.  It  may,  I  think,  be  fairly  surmised  that  in  the 
most  remote  period  of  man's  history,  assuming  him 
from  the  first  a  distinct  species,  that  there  need  not 
necessarily  be  at  the  period  in  question  any  consider- 
able degree  of  intellectual  difference  between  man  and 
a  lower  animal,  because  the  means  of  exercising, 
developing,  and  consummating  the  faculties  are  not 
sufficiently  advanced  or  properly  in  vogue. 

3.  Assuming  the  correctness  of  this  surmise,  it 
seems  reasonable  to  suppose  that  the  improvement 
between  man's  intellect  at  the  present  compared  to 
his  first  appearance  in  Creation  can  only  find  its 
equivalent  in  the  development  of  language. 

4.  I  have  already  surmised  that  the  mental  faculties 
of  man  at  his  most  remote  period  need  not  far  exceed 
that  of  a  lower  animal ;  hence  it  would  seem  that  the 
intellectual  gap  in  man's  individual  history  may  be 
equal  to  the  gap  which  now  exists  between  man' and 
the  anthropoids. 

I  should  be  glad,  therefore,  to  ascertain  if  any  of  your 
correspondents  think  these  considerations  worthy  of 
notice,  or  if  they  carry  any  weight,  as  it  appears  to  me 
that  so  far  from  tne  breach  in  intellect  being  a  point 
against  Darwin's  theory,  it  is  what  one  should  expect. 
I  am,  Sir,  yours  truly, 

Clement  H.  Sers. 
.Preston  Drove,  Brighton,  Jan.  22nd,   1904. 


DOCTORS  v.  BARRISTERS  AND  SOLICITORS. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — I  have  often  wondered  why  medicals  are  such 
fools  in  giving  so  much  service  for  nothing,  and  in 
accepting  as  a  working  basis  the  idea  that  it  is  better 
-'  to  throw  a  sprat  to  catch  a  mackerel  "  than  to  act  in 
an  honest  businesslike  wav.  The  above  views  are 
revived  by  studying  the  Midwives  Act,  in  which  no 
provision  whatsoever  has  been  made  for  paying  medi- 
cals called  in  ;  and  by  looking  into  the  Poor  Prisoners' 
Defence  Act,  1903,  in  which  Parliament  has  enacted 
as  follows  : — 

"  Section  I.  (1)  When  it  appears,  having  regard  to 
the  nature  of  the  defence  set  up  by  any  poor  prisoner 
....  that  it  is  desirable,  in  the  interests  oi  justice 
that  he  should  have  legal  aid  in  the  preparation  and 
conduct  of  his  defence  and  that  his  means  are  insuffi- 
cient to  enable  him  to  obtain  such  aid,"  the  Justices, 
or  the  Judge,  or  the  Chairman  of  Quarter  Sessions, 
4f  may  certify  that  the  prisoner  ought  to  have  such 
legal  aid,  and  thereupon  the  prisoner  shall  be  entitled 
to  have  solicitor  and  counsel  assigned  to  him." 

Under  the  above  Act  the  Secretary  of  State  has 
issued  the  following  rules  : — Solicitor's  fee,  from  £2  2s. 
to  £5  ;  travelling  expenses  (for  self  and  clerk)  ;  counsel's 
f<*,  &  3s.  6d.  to  £1  5s.  6d. 

Now,  Sir,  we  must  congratulate  our  legal  brethren 
for  having  such  an  Act  passed.  Each  year  the  legal 
profession  is  making  itself  more  and  more  felt  in  public 


Jan.  27,  1904. 


importance  ;  while  the  doctors — well,  they  can  sue 
persons  for  using  certain  medical  "  titles,"  and  allow 
a  Midwives  Act  to  pass  without  a  single  proviso  such 
as  is  in  the  Poor  Prisoners'  Defence  Act.  It  has  been 
stated  that  about  £1,000,000  per  annum  will  be  re- 
quired to  cover  the  fees  under  this  Act.  Let  everv 
medical  obtain  a  copy,  and  make  a  close  study  of  it. 
Then  perhaps — I  use  the  word  perhaps — they  will  lay- 
aside  their  petty  jealousies,  in  tongue  and  backbiting, 
and  work  as  men  entitled  to  payment  for  services. 
Doctors  evidently  prefer  "  to  take  their  licking  lying 
down." 

I  am,  Sir,  yours  truly, 

Robert  R.  Kentoul. 
Liverpool. 


ERYTHEMA  SCARLATINIFORME. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — In  your  article  on  "  Erythema  Scarlatini- 
forme  Desquamativum  Recidivans,"  you  make  the 
remark  that,  "  There  has  been  but  little  attention  paid 
to  desquamative  erythema  in  this  country,  and  pro- 
bably most  medical  men  have  not  met  with  instances 
of  it  in  their  practice."  May  I  direct  your  attention 
to  a  communication  I  made  to  the  British  Medical 
Journal  in  November,  1894,  and  to  an  article  in  the 
Lancet,  "  Scarlet  Fever  and  its  Congeners,"  October 
13th,  1894;  and  to  another  communication  to  the 
British  Medical  Journal,  December  12  th,  1806?  Copies 
of  the  two  last  I  send  you.  The  question  of  patho- 
logical interest  in  such  cases  is  the  depth  to  which  the 
skin  is  affected.  Why  the  skin  should  peel  in  some 
cases  and  only  effloresce  in  others  is  an  interesting  one. 
I  am  glad  to  see  that  some  attention  is  being  given  to 
this  subject,  though  I  am  sorry  that  we  wait  till  it 
comes  from  Germany  or  some  other  source. 

You  conclude  your  article  :  "  It  is  well,  however, 
to  be  on  one's  guard,  for  the  diagnosis  of  scarlet  fever 
is  puzzling  enough  without  this  added  terror  lying  in 
wait  to  catch  one  tripping  "  ;  and  this  confirms  the 
opinion  expressed  at  the  end  of  my  communication  to 
the  British  Medical  Journal :  "  The  chief  point,  how- 
ever, to  which  we  ought  to  give  attention  is  to  be  care- 
ful not  to  mistake  this  malady  for  either  diphtheria  or 
scarlatina,  as  is  very  liable  to  be  done." 
I  am  Sir,  yours  truly, 

Robert  Lee. 

West  Kensington,  Jan.  21st,  1904. 

[Dr.  Lee's  claim  to  originality  in  the  interesting  con- 
dition alluded  to  appears  to  rest  on  a  solid  basis.  We 
hope  to  publish  a  short  risunU  of  his  work  on  the 
subject. — Ed.] 


ST.  BARTHOLOMEW'S  HOSPITAL. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — The  number  of  beds  which  the  Governors  wish 
to  accommodate  on  the  6J  acres  available  in  Smithfield 
is  about  700,  at  about  45  square  yards  per  bed,  whereas 
100  square  yards  per  bed  is  the  minimum  laid  down  by 
recognised  authorities. 

In  order  to  contrast  the  value  of  the  Governors' 
scheme  for  rebuilding  on  the  Smithfield  site  with  that 
of  the  alternative  scheme  for  the  suggested  removal  to 
the  suburbs,  the  following  figures  will  prove  convinc- 
ing :— 

St.  Bartholomew's  Scheme. — The  value  of  the  6J  acres 
at  present  owned  by  the  Hospital,  based  on  the  rate  at 
which  the  adjoining  land  has  lately  been  acquired  by 
the  General  Post  Office,  is  approximately  £1,040,000. 

The  total  cost  of  rebuilding  on  the  present  site,  so 
far  as  can  be  ascertained  at  the  present  time,  would  be 
at  least  £500,000  for  the  buildings  and  £240,000  for 
the  land  recently  acquired,  making  an  estimated  total 
of  £740,000. 

Alternative  Scheme. — A  perfectly  equipped  hospital 
for  700  beds,  providing  the  necessary  100  square  yards 
per  patient,  could  be  erected  in  a  suitable  position  in 
the  suburbs  for  £675,000,  including  the  cost  of  land. 
This  outlay  would  be  met  by  the  sale  of  the  land  in 
Smithfield,  amounting  to  over  a  million  sterling,  and 
would  leave  a  balance  in  the  hands  of  the  Governors 


IQ04- 


LITERATURE. 


JHK     M£t  HAT       PKFV.        105 


tb 

mi 
tb. 


amounting    to    about  >>,    which,    if    properly 

it.  would  increase  the  revenue  o* 

it  £15,000  per  annum* 

ll  1  'ate  for  Sir  Trevor  Lawrence  to  justily 

ill  the  Governors  to  invoking  such  a  powerful 

fltiencc  as   the   Mansion   House  Fund   111  support  of 

m  appeal  lor  £$qq  000,  winch  must  have  the  effect 

istuog  the  urgent  appeals  of  poorer.  M  nut  more 

u.ispuals« 

I  am,  Sir,  yours  truly, 

Albeht  \\\  Moore. 
London,    EX. 
.•-going  letter  15  reproduced  from  the  Daily 
..-,    .  ;tli.      Ii    $0   itrongl}    1  "H firms  our 
ith  regard  to  "partial  removal''  that  we 
0.  —  En\] 


BRITISH     MEDICAL    ASSOCIATION 

R  EPR  ESENTATI  <. )  X 

t  Edttow  of  The  Medical  Press  and  Circular. 

-With  reference  to   your  leading  article  Which 

»red   in   The  Medical   Press   and  Circular  o 

ry    201  h«    I    would    point    out    that    the    British 

t ion  has  not  formulated  a  demand  for 

.  tatiun  on  the  General  Medical  Council. 

be  annual  representative  meeting  heM  at  Swansea 

i.ir  a  resolution  Vas  passed  by  trie  representative 

ag  :    "  That  a  petition  be  pr<  the  Privy 

ng    thai    in    any    future    legislation    the 

latum  be  directly  represented  on 

-iical  Council  in  proportion  to  its  magni- 

n tentative  character/' 

reWuLion    Wds    passed    f<>r    reference    to    the 

i*.  remains  to  be  seen  what  the  decision  Of  the  divi- 
Tid  pending  such  information  the  British 
■  al  Association  ha?>  uot   moved  in   the  direction 
voxtld  imply. 

1  am,  Sit,  yours  truly, 
(Signed)  Gun  Ell  is  ton, 

»  General  Secretary. 

In*  British  Medical  Association, 
42n   Strand,   W.C 


It  is  an  alarming  condition,  but  readily  yields  to  hot 
stations  and  active  purgation.  We  are  please.)  60 
note  that,  in  speaking  of  the  care  of  the  breasts  during 
pregnancy,  Dr.  Vincent  absolute!}  warns  against  the  use 
of  spirituous  applications,  whith  tend  to  cause  fissures 
and  excoriations.  In  this  connection  he  refers  to 
own    "  Pn  Corset    Belt"    as    being    not    only 

supporting  but  allowing  for  freedom  of  movement  at 
Ime-     He  appear  to  favour  mixed 

in  those  cases  where  the  milk  Hup] 
"  In  the  interests  of  the  mother  it  is  unfair  to  advise 
her  to  continue  nursing  when  evidence    ol    the  stress 
is  present.'"     (P.  53.) 

In  speaking  of  infant   fearffetg  by  Otto  means  than 
that  of   mothers  milk,    the    author  very  wisely  dis- 
tinguishes between    what    he   calls   " substitute "   aw.] 
feeding.     The   former  he   regards  as  the 
hich    the  irt!ant  is  supplied   With   milk 
from  another  woman,  or  from  some  other  animal  after 
'  atioo  to  adapt  it  to  the  infant's  digestion,"  the 
latter  he  defines  as  the  mode  "  by  which  an  infant  is  fed 
on   preparations   artificially  manufactured   from   milk 
01  From  other  products,"  Avery  interesting  account  is 
given  of  the  laboratory  methods  of  modifying  milk  in 

rdanoe   With  physicians     prescriptions' of  wfcfc 

number  of  typical  examples  are  supplied  in  The  text. 
Artificial  feeding  3s  condemned,  and  the  bulk  of  the 
DM   the  market  are  strongly  depreciated, 
The  g3  hey  one  and  all  1  their  "  facility 

for  use."     (P.    no.)     They  are  also  readily  digested, 
but  this  is  largely  due  to  "their  containing  s"n  small  an 
amount  of  food  material.    Their  danger  lies  in  the  tact 
disorder;  arising  frjm  imperfect  feeding  escape 
tor  a  long  J nn «-  the  notice  o(  the  parent.     Such  children 
art  pallid,  flabby,  and  listless.  In  other  words  tiny  lack 
I  resistance  against  disease.     The  author  has  struck  the 
right  not*?  here,  and  the  sootier  the  profession     1  large 
es  the  facts  the  better.     The  market   is  Hooded 
with  infants'  foods,  all  more  or  less  calculated  to  pro- 
duce rickets,  and  other  nutrition  diseases,  and  the  banish- 
I  ment  of  them  from  our  nurseries  would  lie  an  iucafcul- 
I  able  gain  to  the  developing  race. 

The  chapter  on  the  heating  of  milk  is  pregnant  with 
important  facts.  As  Dr.  Vincent  point*  out,  the  prime 
object  to  he  aimed  at  is  a  pure  milk  supply,  for  "  milk 
containing  pathogenic  bacteria  is  contaminated  P 
whether  heated  or  unhealed,"  (P.  135.)  Jlie  objec- 
tions to  milk  sterilisation  are  carefully  detailed,  and  no 
one  who  gives  this  matter  attention  "can  fail  to  be  im- 
pressed by  the  fact  that  what  we  want  is  not  a  sten1 
milk  supply  at  second  hand,  hut  one  which  is  abso- 
lutely pure  as  drawn  from  the  cow,  This  mean*  careful 
feeding  and  housing  as  well  as  cleanly  manipulation  of 
the  milk  both  while  being  drawn  off  and  during  its 
storage  and  trans  port. 

The  later  chapters  in  the  book  treat  of  the  chemistry 
of  infantile  digestion,  the  normal  development  of  the 
infant  and  nutrition  disorders,  including  ricket-  and 
scurvy,  The  concluding  chapter  gives  a  brief  but 
atri  king  account  of  infantile  mortality  as  shown  by  the 
registrar's  report  for  various  large  English  towns. 
On  page  2 86  we  find  the  following  noteworthy  sentence, 
which  we  quote  for  the  benefit  of  our  readers  :  "  frlos- 
pitals  for  the  treatment  of  diseases  of  nutrition  in 
infants  need  to  be  established  in  every 
district/*  We  heartily  add  our  assent  to  these  im- 
portant words,  and  trust  the  day  may  soon  come  when 
such  institution*  will  be  an  established  fact. 

Wfl  have  read  this  work  with  pleasure  and  not  a  little 

profit*     It  covers  the  ground  in  a  very  interesting  and 

yet  comprehensive  manner.     The  author's  style  is 

and  instructive,  while  the  numerous  tables  supplied  will 

writer  refers   to   a   condition   which   he   has     termed  i  be  found  useful  for  reference  many  of  them,  indeed tbeing 


Xtterature. 


■■ajTRITION    OF    THE  INFANT,  (a) 

Till  literature  of  infant  feeding  grows  apace.     The  I 
importance  of  the  subject  cannot   be  over-estimated, 
we  1  eel  certain  that  it  is  impossible  to  write  too 
isequently  we  hail  the  present 
with  satisfaction  as  it  is  an  addition  to  our  already 
cant)  knowledge  of  the  management  of  infant  life.  I 
book  is  the  outcome  of  the  author's  personal  dis-  ' 
taction  with  the  modes  of  infant  feeding  in  vogue 
uts   country.     The  work    has   as    its    basis    the 
m  baa  of  Rotch,    than   whom  there  is  no  greater 
.  Authority  on  the  subject. 
The  opening  chapter  deals  with  the  composition  of 
human  Uii  id  milk.     With  regard  to  colostrum 

tothor  maintains  that  no  great  advantage  is  to  be 
1  a  the  ingestion  of  colostrum,  ami  states  that 
turbanccs  ot  digestion  during  the  first 
of  life  are  due  to  the  excessive  amount  present  in  | 
I  milk.     He  states  later  on  (p.  J7)  that  it  is  ! 
i^us  mistake  to  allow  the  infant  to  take  freely  of 
the  colostrum   when   this  is  plentiful.     The  chemical 
composition  of  colostrum  indicates  that  anything  but   1 
HBB   ainnimt    seriously     disturbs     the    infant.     The 
vperience  does  not  uphold  the  ordinary  view 
early  suckling  aids  and   stimulates  uterine  oon- 

»irjc 
to  dealing  with   the  complications  of  lactation  the 


UmphangiUs  mamma-,  in  which  we  have  an  inflam- 
o.ihhtionof  thesuperhcia!  structures  of  thegland. 


>n  of  the  Intuit/1  liy  LUlpJi  Vincent.  M.D., 
K.K.C  P  ,  t'hyiiuian  to  the  Infant*  Hospital,  late  Senior  Resident 
WfdiaJ  ifctk+r,  Vki**"  Ch»rlolU'»  Lying-in  Hunpkal.  i'\*.  3121,  with 
Slfaffntifonft.  Deny  avo,  It*.  *d.  net.  London:  Dailliert,  Tinrlnil 
wwlCut.  1904. 


quite  inaccessible  save  to  those  who  are  familiar  with 
German  The  subject  of  infant  feeding  has  not  as  yet 
received  the  attention  it  deserves  in  this  country,  and, 
accordingly  we  welcome  this  book  from  the  pen  1 
Knglish  physician  all  the  more  eagerly.  It  deserves 
to  be  widely  read  by  general  practitioner*  as  well  as  by 
those  who  make  pediatrics  their  special  study. 


io6      The  Medical  Press. 


MEDICAL    NEWS. 


Jan.  27,  1004. 


TOLDT  ON  HUMAN  ANATOMY,  (a) 
We  have  received  the  first  volume  of  the  English 
translation  of  this  fine  work,  and  are  greatly  pleased 
with  the  manner  in  which  it  has  been  reproduced. 
The  original  is  a  work  of  much  value,  and  one  which 
will  well  repay  the  cost  of  translation.  Dr.  Paul, 
who  Is  responsible  for  this  difficult  task,  has  succeeded 
admirably,  and  may  be  said  to  be  among  the  few 
translators  who  have  made  additions  to  the 
original  without  impairing  the  value  of  the  book. 
His  additions  are  of  considerable  value,  especially 
to  those  who  are  not  skilled  in  foreign  nomenclature. 
As  is  well  known,  in  many  instances  foreign  nomen- 
clature differs  to  a  marked*  extent  and  in  a  very  con- 
fusing manner  from  English  nomenclature,  and  the 
translator  has  overcome  this  difficulty  by  placing  the 
English  term  and  its  foreign  equivalent  side  by  side. 
For  this  reason,  the  book  is  not  only  an  Atlas  but  a 
glossary  of  anatomical  terms  and  their  equivalents. 

The  drawing  of  the  different  bones  is  admirable, 
and  leaves  little  to  be  desired  save  in  a  few  instances, 
where  a  larger  drawing  might  have  been  of  more  value, 
It  is  intended  to  publish  the  Atlas  in  six  sections, 
of  which  the  book  before  us  is  the  first.  If  no  unfore- 
seen delay  occurred,  it  was  intended  to  complete  the 
issue  within  the  year,  but  as  only  one  further  instalment 
has  so  far  reached  us,  we  fear  that  the  inevitable 
printer's  delay  has  occurred.  We  can  cordially  recom- 
mend the  Atlas  to  both  students  and  medical  men. 

©bttuan?. 

FRANKLEN  GEORGE  EVANS.  M.R.C.S.,  Eng., 
L.S.A. 
We  regret  to  announce  the  death  of  Mr.  Franklen 
George  Evans,  on  January  17th,  after  an  attack  of 
apoplexy  in  his  seventy-seventh  year.  Deceased  was 
the  son  of  Edward  Evans,  at  one  time  the  only  surgeon 
in  Cardiff,  when  the  population  was  numbered  only  by 
a  few  thousands.  Mr.  Evans  received  his  medical 
education  at  St.  Bartholomew's  Hospital,  and  in  1849 
qualified  as  M.R.C.S.Eng.,  and  L.S.A.  After  being 
house  surgeon  to  the  Cardiff  Infirmary,  he  was  ap- 
pointed surgeon  to  the  Pentyrch  Colliery  and  Iron- 
works, and  to  the  Melingriffith  Tinplate  Works.  Mr. 
Evans  was  at  the  time  of  his  death  chairman  of  the 
Rhymney  Railway  Company  and  a  director  of  the 
Pontypridd  Waterworks  Company,  as  well  as  of 
many  other  large  industrial  concerns.  Much  of  his 
spare  time  was  devoted  to  the  study  of  astronomy, 
and  he  was  a  Fellow  of  the  Royal  Astronomical  Society. 
A  few  years  ago  he  presented  to  the  Cardiff  Corporation 
a  large  and  valuable  astronomical  telescope.  Mr. 
Evans  was  twice  married,  his  second  wife  being  a  grand- 
niece  of  Mrs.  Wyndham  Lewis,  who  subsequently  be- 
came the  Countess  of  Beaconsfield.  He  retired  from 
active  practice  twenty  vears  ago. 

MR.  JONATHAN  WILLIAMS,  J. P. 
The  death  is  announced  of  Mr.  Jonathan  Williams, 
J. P.,  of  Bargoed,  at  the  age  of  66.  Deceased  had  been 
engaged  in  practice  at  Bargoed  for  the  last  30  years. 
He  was  chairman  of  the  first  Parish  Council  for  Gelli- 
gaer,  and  in  1894  was  placed  on  the  Commission  of 
the  Peace  for  the  Caerphilly  Lower  Division.  The 
deceased  gentleman  owned  a  colliery  at  Bargoed,  he 
was  a  director  of  the  Rhymney  and  Aber  Valleys  Gas 
and  Water  Company,  and  chairman  of  the  Income 
Tax  Commissioners  for  the  district.  He  leaves  behind 
a  wide  circle  of  friends  and  acquaintances. 

Beri-Beri  at  Lorenxo.- 
News   from   Lorenzo  Marques  states   that   several 
cases  of  beri-beri  have  broken  out  there,  seventeen 
negroes  and  three  white  people  having  already  died 
from  the  terrible  plague. 


(a)"  An  Atlas  of  Human  Anatomy  for  StudenU  and  Physicians." 
By  Carl  Toldt,  M.D.,  Professor  of  Anatomy  in  the  University  of 
Vienna;  assisted  by  Alois  Dalia  Rosa,  M.D.  Translated  from  the 
Third  German  Edition  by  M.  Eden  Paul.  M.D.Brux.,  M.R.CS.Eng., 
L.R  C.  P.  Lond .  First  Section  :  A.  The  Regions  of  the  Human  Body ; 
B.  Osteology.  Figs.  1  to  377,  and  Index.  London  :  Kebman.  Ltd. 
1903.    Pp.  100. 


laboratory  notes. 

CADBURY'S  COCOA  ESSENCE. 
It  is  many  years  since  we  analysed  the  various  cocoas 
then  before  the  public,  and  we  think  it  desirable  for 
the  public  health  to  ascertain  from  time  to  time  in  the 
laboratory  whether  manufacturers  are  keeping  up  to 
original  standards.  To  this  end  we  have  submitted 
samples  of  this  well-known  cocoa  to  a  careful  analysis, 
with  the  following  results  : — 

Moisture,  34  ;  nitrogen,  3*25  ;  albuminoids,  20*31  ; 
inorganic  salts,  4*4;  cold  water  extract,  184;  and 
cocoa  butter. 

The  inorganic  salts,  amounting  to  4*4  per  cent,  on 
treatment  with  water,  yields  1*4  per  cent,  of  soluble 
ash,  and  30  per  cent,  of  insoluble  matter.  This  latter 
contained  the  due  proportion  of  alkaline  salts  that  are 
found  in  pure  cocoa  that  has  not  undergone  any  treat- 
ment with  chemicals.  The  cold-water  extract,  184, 
is  sufficient  evidence  that  no  soluble,  diluent,  such  as 
sugar,  has  been  added,  and  the  microscopical  examina- 
tion proved  the  absence  of  foreign  starch,  which  is  so 
often  added  in  enormous  quantities  in  cheap  cocoa. 
The  cocoa-butter  {oleum  theobromatis)  is  present  in  due 
proportion.  The  natural  bean  contains  something 
like  so  per  cent,  of  cocoa-butter,  and  this  quantity  is 
too  great  to  enable  cocoa  to  be  presented  in  a  powdered 
form  in  the  process  of  manufacture,  therefore  a  part  of 
this  is  removed  by  pressing  the  beans  heated  to  a 
suitable  temperature,  and  this  method  is  much  more 
to  be  commended  than  that  of  adding  diluents,  such 
as  starch,  sugar,  or  dried  albuminoids  from  milk. 
The  figures  obtained  agree  well  with  the  "  Standards 
of  Purity  in  Food  and  Drugs,"  recently  published  by 
Mr.  C.  G.  Moor,  M.A.,  F.I.C.,  and  the  aroma  and 
flavour  leave  nothing  to  be  desired. 

We  have  pleasure  in  laying  before  our  readers  the 
foregoing  evidence  that  the  cocoa  essence  manufac- 
tured by  Messrs.  Cadbury  Bros,  is  free  from  all  admix- 
tures ;    pure  and  genuine  in  the  highest  sense. 

Cadbury's  Milk-Chocolate. — We  have  also  exa- 
mined a  sample  of  the  milk-chocolate  prepared  by  the 
same  manufacturers,  and  find  on  analysis  that  the 
article  is  of  the  same  excellent  quality  as  their  cocoa. 
THE  DETECTION  OF  YEAST  EXTRACT  AS  AN 
ADULTERANT  OF  MEAT  EXTRACT. 
While  the  test  published  in  the  Pharmaceutical 
Journal  of  October  10th  gives  satisfactory  results  in 
cases  of  substitution  of  yeast  extract  for  meat  extract, 
or  gross  adulteration  of  one  with  the  other,  it  is  not  so 
suitable  for  the  detection  of  small  admixtures  of  the 
former.  The  author  of  the  process  above  referred 
to  has  now  worked  out  a  method  by  which 
one  is  enabled  to  detect  an  admixture  of  as  little  as 
1  per  cent.,  and  this  may  act  as  an  efficient  corrective 
to  the  temptation  which  dealers  will  feel  to  work  oft 
by  degrees  stocks  of  yeast  extract  masquerading  as 
genuine  meat  extract,  which  are  known  to  have  been 
hurriedly  withdrawn  from  the  market  since  the  test  was 
published.  If  the  sample  gives  doubtful  or  negative 
results  by  that  test,  but  is  still  open  to  suspicion,  take 
from  3  to  6  grammes  and  dissolve  in  3  or  6  c.c.  water 
(according  to  quantity  taken)  ;  add  to  this  sufficient 
spirit  (methylated  will  answer  the  purpose)  to  throw 
down  all  that  is  insoluble  in  alcohol.  After  vigorous 
shaking  separate  the  insoluble  residue  by  decanting  or 
filtering,  dissolve  this  residue  in  60  c.c.  water,  filtered  if 
necessary  and  proceed  as  before.  If  yeast  extract  is 
present  the  characteristic  bluish-white  precipitate  will 
be  thrown  down  on  boiling  with  the  modified  Fehling's 
solution,  and  may  be  collected  and  weighed. 

fflebtcal  Hews. 


Society  of  Members  of  the  Royal  College  of  Surgeons  in 
England. 

A  Council  meeting  of  this  Society  was  held  at  20, 
Brunswick  Square,  London,  W.C.,  on  January  12th, 
Mr.  Joseph  Smith  being  in  the  chair.  The  following 
resolutions  were  unanimously  agreed  to: — 1.  "That 


MEDICAL    NEWS. 


1EOICAL 


RESS.       107 


this  council  considers  the  reply  oi  the  College  Council 

10  the  resolutions  passed  at  the  Last  annual  meeting  of 
Fellows  and  members  to  be  most  unsatisfactory. 
HmviuM  regard  to  the  repeated  refusal  to  accede  to  the 
wishes  of  the  members  as  expressed  in  meetings  to 
whu.Ii  they  have  been  specially  summoned,  this  council 
^TTiphatic-ally  repudiates  the  claim  of  the  College 
Council  to  represent  the  members,  and  further  declares 
its  determination  not  to  abate  its  efforts  to  obtain 
adequate  representation  for  the  great  majority  of  the 
body  corporate. "  2.  "  That  this  council  desires  to 
call  attention  to  the  inexpediency  of  appointing  a  com- 
mittee to  deal  with  the  relations  of   the  medical  pro* 

to  the  coroners*  courts  composed  exclusively 

of  these  who  are  seldom  brought  into  contact  with  those 

courts  and  would  suggest  the  addition  to  the  committee 

nt  some  Fellows  or  members  outside  the  College  Council 

ial  knowledge  of  the  mattes 

Lectures  In  Medical  Jurisprudence. 

January   14th,  Dr»  R  J.  Waldo,  coroner  for  the 

m  London,  delivered  the  first  of  a  series  of  six 

lectures  on    medical   jurisprudence   at    the    Old    Hall, 

In's  Inn.  under   the   auspices   of    the  Council  of 

hspl  Education,     The  subject  of  the  first  lecture  was 

Medical  Man  as  Witness/4     At  the  outset  the 

abilities  attached  to  the  registration  of 

medical  men  were  dealt  with.     A  medical  man  might 

pve  evidence  either  as  a  common  witness  \*>  E&etS  or 

11  in  expert  in  matters  of   deduction  and  experience  . 
Uy  and  wherefore  of  conflicting  medical  evidence 

vol  next  discussed  at  some  length  and  reasons  were 
to  show  how  cam  I  id  and  skilful  men  could  con* 
tiadici  eacb  other  in  court  without  sacrifice  of  honesty. 
Ihr  illustration  of  this  point  was  taken  from  "  railway 
!  accidental  injury  in  which  the  widest 
pinion  often  prevailed.     The  ending  of 
tittgalioa  was  often  attended   by  a  speedy  recovery 
the  patient.     Quite  as  great  or  greater 
iices  existed  amongst  lawyers,  as  proved  by  the 
taj  of    decisions,  time  after    time,  in  ancces 
is,  until  the  House  of  Lords  was  reached.      The 
rtant  question  of  personal  privilege  was  discussed 
usiderable  length  and   the  illustrations  included 
ccent    appeal  of  a  provincial  head   constable   to 
i[>(  local  medical  men  for  information  likely  to  identity 
Sender  in  .1  case  Of  infanticide.      A  medical  witness 
awer  fully  in  a  witness-box  if  required  to 
by  the  court,  except  where  by  so  doing  he  would 
intntmnate  himself.     Ln  ordinary  life,   however,  any 
t  professional  secrets  might  involve  an  action 
w      The  unwritten  law  of  the  medical  profession 
appeared  to  be  that  there  was  no  obligation  to  reveal 
Anything  that  come  under  their  notice  short  of  murder 
.vest    criminal    charges.     This    professional 
lied  from  the  earliest  times,  as  shown  by  the 
j  of  Hippocrates,  the  substance  of  which  wafl  BtiU 
pted  111  the  declaration  Of  the  Scotch  medical  gradu- 
ate.    The  lecturer   concluded  with  an  analysis  of   the 
J   evidence  and   some  ol    the 
points    concerned     iu      the    medical    examination  of 
prisoners. 

Society  for  Belief  of  Widows  and  Orphans  of  Kedloal  Men 
•ariehi  v  Conxl  of  the  Directors  oi  the  Society 
1   Wednesday,  January  1  }th,  Mr.  Christopher 
Heath,  the  president,  'be iutf  in  the  chair.     Three  new 
members  were  elected  and  the  death  of  a  member  re- 
ed.    It  was  resolved   to  distribute  £1,513  among 
}  Widows.   1$  orphans,  and  4  recipients  from  the 
Copland  Fund,   now  in  receipt  of  grants,      A  sum  of 
liiven  at  Christmas  as  a  present  — -mo  each 
widows,  £3  each  to  \l  orphans,  and  £5  each  to  the 
4  orphans  ot  The  Copeland  Fund,      The  expenses  of 
the  quarter  were  £77  ws.  6*3 

loyal  British  Horses'  Association- 

m-ECUl  general  meeting  of   this  Association  will 

Ik:  held  al  the  rooms  of  the  Medical  Society  of  London, 

feet,  Cavendish  Square.  W-.  on  Tuesday* 

February  ;nd,  1904.  at  4  p.m  ,  tor  the  purpose  of  con- 

:  .ft  of  a  Bill  upon  the  State  registration 

aursea,  which  will  he  submitted  to  the  meet- 


ing ;  and  any  amendments  that  may  be  proposed 
thereon.  The  following  resolution  will  be  proposed  :  — 
"  That  the  draft  Bill,  as  amended,  be  approved  and 
that  the  Executive  Committee  be  directed  to  take  such 
steps  as  they  may  think  necessary  to  have  it  submitted 
to  Parliament." 

City  Hospital  for  Diseases  of  the  Skin  and  Cancer.  Dublin, 

The   new   quarters    of   this    hospital    were   formally 

opened  by   the   Right   Hon.   T.  C  Harrington,   M.R\ 

Lord  Mayor  of  Dublin,  on  Friday,  the  23nd  inst.     The 

meeting  was  large  and  representative,  and  an  urgent 

appeal  for  sufficient  funds   to  allow  the  Governors  to 

establish    fifteen    beds    for  acute    cases    was.    we   have 

r  eas<  i  u  to  bel  ie  ve ,  ge  nero  us  I  y  reft] » ..  n .  I  ed  to .    T  he  a  1 1  ern\  - 

ances    registered    during    the    year    numbered    5*468. 

Qg  an  increase  of  1. 025  over  all  previous  years. 

ight  department  is  well  equipped,   and  at  very 

considerable    expense,     A    short    demonstration    was 

given  by  the  medical  staff  of  the  Finsen  Light,  X-rays, 

High  Frequency  Currents,  and   Radium. 

Institute  of  Medical  Selene  as, -London  University  Appeal 
Thi    following  letter  has  been  addressed  to  the  Earl 
of  Koscbery,  Chancellor  of  the  University  of  London  :  — 
My  Lord, — We  have  observed  with  satisfaction  that 
the  Senate  of  the  University  of  London  have  latclv 
issued   an   appeal   for   funds   to   build   and   endow   an 
Institute  of  Medical  Sciences  under  the  control  of  the 
I   mversity.      The  positions  which  we  severally  hold  m 
connection  with  the  general  hospitals  of  London  and 
their  medical  schools  have  compelled  us,  especially  of 
late,  to  give  the  proposal  that  the  University  should 
undertake   the  teaching  of   the  preliminary  scientific 
subjects  of  the  medical  curriculum   the  most  serums 
consideration.     We  are  convinced  that  the  adoption  of 
the    recommendation    of    the    Royal    Commission    in 
favour  of  the  concentration  of  the  teaching  of  these 
subjects  in  one  or  more  centres  has  become  a  matter  of 
urgent    necessity,    lo    the    interests    alike    of    medical 
education,  of  the  hospitals,  and  the  medical  schools. 
We  are.  my  Lord,  yours  faithfully. 
Sandhurst. 
Chairman  of  the  Weekly  Board,  Middlesex  Hospital. 
Trevor  Lawrence. 
Treasurer,  St.  Bartholomew's  Hospital, 
H+  Cosmo  Bonsor, 

Treasurer,  Guys  Hospital* 
Sydney  Holland.' 

Chairman.  London  Hospital. 
j.  G.  Wainuru.ht, 
I  reasurer,   St.  Thomas's  Hospital. 

Timothy  Hoi  mes, 
Treasurer,  SL  George's  Hospital. 

H.    A,    HftRBEN, 

Chairman,  St.  Mary**  HospitaL 
Thos.  Percy  Borhett. 
Chairman,  Charing  Cross  Hospital. 

J.  Wolfe-Barry, 

Chairman,  Westminster  HospitaL 

A   large  sum  1*  required   to  carry  out  the  scheme. 

The   Hoii,   Treasurers  of   the   Appeal   Fund   are   J.    K. 

Fowler,  Member  oi  the  Senate,  and  H*  T.  ButHu,  Dean 

of  the  Faculty  ol  Medicine,  35,  Clarges  Street.  W- 

Liverpool  Medical  Institution 
At  the  annual  meeting  held  on  Thursday.  January 
tith,  *</>4.  the  following  list  of  office  bearers  and 
members  of  council  was  adopted,  viz,. — President : 
•James  Barr.  Vice-Presidents  :  H.  Briggs,  G.  W. 
Sleeves,  *J+  R<  Logan,  and  *J>  Wiglesworth.  Trea- 
surer :  T+  H.  Bicker  ton.  General  Secretary  :  *F*  C. 
harkin.  Secretary  to  the  Ordinary  Meetings  :  *R.  W, 
Murray,  Secretary  to  the  Pathological  Meetings  ; 
*W>  B.  Warrington.  Editor  of  the  Journal  :  *F.  H. 
Barendt*  Librarian  ;  *A.  S+  Grunbaum*  Council  : 
•H.  Adcock.  *J.  Bark.  *H.  A.  Clarke,  A.  Fisher,  F.  T, 
Paul.  J.  Pinkerton,  *W.  Fingland,  *A>  G.  Gutlan, 
*U  Monsarrat.  *J.  Hay,  *R.  Parker,  and  *  Edgar 
Stevenson.  Those  marked  (*}  did  not  hold  the  same 
office  last  year* 


io8      The  Medical  Pbkss.       NOTICES    TO    CORRESPONDENTS. 


Jan.  27,   1904. 


Sottas  ta 
<&otxt&vovibtvAst  Short  %sttsx&,  Stt. 

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^ettnge  of  the  goocttee,  Qutvxts,  to 

Wednesday.  January  27th. 
Huntkrian  Society.— (London  Institution,  Finsbury  Circus,  E.C.)— 
3  30  p.m.     Pathological  Evening. 

Medical  Graduates'  College  and  Polyclinic  (22,  Chenies  Street, 
W.C.).-4  p.m.  Mr.  P.  Paton  :  Olinique.  (Surgical)  5.15  p.m. 
Dr.  W.  Carr :  Infant  Feeding. 

Thursday,  January  28th. 

OPUTHALMOLOGICAL   SOCIETY    OK   THE  UNITED   KINGDOM   (11   ChandOS 

Street,  Cavendish  Square,  W.).— 8  p.m.  Cases  will  be  shown  by 
Mr.  G.  W.  Thompson,  Mr.  E.  T.  Collins,  Mr.  G.  W.  Roll,  Mr.  S.  J. 
Taylor,  Dr.  L.  Werner,  and  Dr.  D.  Mowat.  8.30  p.m.  Papers:— 
Mr.  A.  H.  Jessop :  Cases  of  Ptosis.— Mr.  G.  BrooksDank-Jaraes :  A 
Plan  of  Treatment  in  some  Cases  of  Asthenopia. — Mr.  W.  M.  Beau- 
mont :  A  Note  on  the  Eye  Symptoms  of  Rheumatoid  Arthritis  with 
a  Special  Reference  to  the  Field  of  Vision.— Major  Maynard  and 
Dr.  L.  Rogers :  Pulsating  Exophthalmos  due  to  Dilatation  and 
Dropsy  of  the  Optic  Nerve,  accompanying  Internal  Hydrocephalus. 
— Mr.  J.  R.  Lunn :  Notes  of  a  Case  of  Tuberculosis  of  the  Choroid. 

Medical  Graduates'  College  and  Policlinic  (22,  Chenies  Street, 
W.C).— 4  p.m.  Mr.  Hutchinson :  Clinique.  (Surgical.)  5.15p.m. 
Mr.  L.  Cheatle :  Operations  for  Cancer  of  the  Tongue  and  Nasolabial 
Regions. 

Mount  Vernon  Hospital  for  Consumption  and  Diseases  op  the 
Curst  (7  FUzroy  Square,  W.).— 5  p.m.  Dr.  G.  Johnston :  Fibrosis  of 
the  Lunirs,  I.  (with  cases).    (Post-Giaduate  Course. ) 

St.  John's  Hospital  por  Diseases  op  the  Skin  (Leicester  Square, 
W.C.).    6.15  p.m.     Dr.  M.  Dockrell :  Syphilis.  (Chesterfield  Lecture.) 


Friday,  January  29th. 

British  Laryngological,  Bhinological,  a»d  Otologic al  Associa- 
tion (II,  Chandos  Street.  Cavendish  Square.  W.).— Cases  will  be 
shown  by  Dr.  Kelson,  Dr.  W.  Wingrave,  Dr.  A.  Wylie,  Mr.  M.  Collier, 
and  Mr.  Stuart-Low.  The  President :  Annual  Address.  Communica- 
tion -  Mr.  M.  Collier. 

Medical  Graduates' College  and  Polyclinic  (22  Chenies  Street,  - 
W.C.).-4p.ra.    Dr.  H.Tilley:    Clinique.    (Throat.) 

Thursday,  February  4th. 
Rontgen   Society   (20,    Hanover   Square).- 8.30  p.m.      Ordinary 
General  Meeting.  Discussion  upon  the  "  Production  of  Photographic 
Reversal  through  the  Action  of  Various  Radiations." 


Jlppointmcnis. 

Boyton,  A.  J.  H„  M.R.C.8.,  L.R.C.P.Lond.,  Certifying  Surgeon  under 

the  Factory  Act  for  the  Watlington  District  of  the  county  of 

Oxford. 
Butterworth,  Rupert,  M.B.0antab.,  House  Physician  to  the  Derby- 
shire Royal  Infirmary. 
Coleridge,  A.,  M.R.C.8.,  L.R.C  P.Lond.,  8enior  Resident  Medical 

Officer  at  the  Mount  Vernon  Consumption  Hospital,  Hampetead. 
Condbll,  A.  P.,  M.D.,  Clinical  Assistant  to  the  Chelsea  Hospital  for 

Women. 
Donald,  C.  W.,  M.B.,  F.R.C  8. Ed..  Assistant  Honorary  Physician  to 

the  Cumberland  Infirmary,  Carlisle. 
Evans,  J.  Howell.  M.B.,  M  Ch.Oxon.,  F.R.C.8.Eng.,  Registrar  to  the 

Chelsea  Hospital  for  Women. 
Goodwin.  Robert,  M.D.,  Clinical  Assistant  to  the  Chelsea  Hospital 

for  Women. 
Hardy,  Percy,  M.R.C.8.,  L.R.C.P.Lond.,  Assistant  House  Surgeon 

to  the  Derbyshire  Royal  Infirmary. 
Higiit,  John,  M.D.  Olas.,  D.P.H.,  Medical  Officer  of  Health  of  Burgh 

of  Prestwick,  Ayrshire. 
Jones.  H.  Buckland,  M.B.,  M.Ch.  Edin..  Assistant  Surgeon  to  the 

Metropolitan,  Ear.  Nose,  and  Throat  Hospital. 
Kirkby,  Walter,  LR.C.P.,  L.R.C.8.,  L.F.P.S.Glas.,  Medical  Erarainer 

of  Recruits  for  the  Glamorgan  Imperial  Yeomanry  in  the  Maesteg 

District. 
Mummery,  J.  P.  Lot  km  art,  B.C  Cantab.,  F.R.C.S  Eng.,   Assistant 

Surgeon  to  St.  Mark's  Hospital  for  Fistula  and  other  Diseases 

of  the  Rectum,  City  Road,  London,  EC. 
Phillips.  Jambs,  FR.C.8Ed.,  Honorary  6  urge  on  to  the  Bradford 

(Yorks)  Children's  Hospital. 
Rose,  Thomas,  M.R.C.8..  L.R.C. P.Lond;,  Resident  Medical  Officer  to 

the  Chelsea  Hospital  for  Women. 


SJatanritB. 


Corporation  of  Manchester.  —  Monsall  Fever  Hospital.  —  Fourth 
Medical  Assistant,  Salary  £100  per  annum,  with  board,  lodgings, 
and  washing.  Applications  to  the  Chairman  of  the  Sanitary 
Committee,  Public  Health  Office,  Town  Hall,  Manchester. 

Hampetead  General  Hospital.— Resident  Medical  Officer,  Salary  £120 
per  annum,  with  rooms,  coal,  and  gas.  Applications  to  George 
Watts,  Secretary. 

North  Riding  Infirmary,  Middlesbrough,  Yorkshire.  —  Assistant 
House  8urgeon.  Salary  £75  per  annum,  with  bed  board,  and 
washing.    Applications  to  Angus  Macpherson,  Secretary. 

Poplar  Union.— Medical  Officer,  Salary  £.120  per  annum.  Applica- 
tions to  G.  Herbert  Lough,  Union  Offices,  45,  Upper  North 
Street,  Poplar,  E. 

York  Dispensary,— Resident  Medical  Officer,  Salary  £120  per  annum, 
with  board,  lodging,  and  attendance.  Applications  to  W.  Draper, 
Esq.,  De  Grey  House,  York 


jBirtkB. 


Charles.— On  January  20,  at  Pelsall,  Staffordshire,  the  wife  of  J.  R. 

Charles,  M.D.,  M.R  C.P.,  of  a  son. 
May.— On  January  20th,  at  Ivanhoe,  60,  Archers  Road,  Southampton 

the  wife  of  Henry  J.  May,  M.B..  B.C.  (Cantab.),  of  a  daughter. 
Williams.— On  January  19th,  at  Bryn  Derw.  Penarth,  the  wife  of 

W.  Williams,  M.A.,  M.D.,  D.P.H.,  County  Medical  Officer,  of 

a  son.  n 

Yeld.— On  January  22nd,  at  15,  Gloucester  Road,  Regent's  Pork,  the 

wife  of   Walter  H.    Yeld,  M.R.C.S.Eag.,  L.R.C. P.Lond.,   of  a 

daughter. 


<4&atriage5. 


Tea  ill-Thompson  —  Bell.  —  On  January  20th,  at  Christ  Chur3h, 
Lancaster  Gate.  W.,  W.  D.  Traill-Thompson,  M.B.,  BCh.. 
Knottsall,  Wembley,  second  son  of  G.  Thompson,  Esq.,  late 
Inspector  General  of  Education,  C.P  India,  to  May,  second 
daughter  of  the  late  C.  beymour  Bell,  Esq.,  Carlton  Hall,  Yorks. 


§  tatluf. 

Boulton.— On  January  20th,  at  Ingham,  nr.  Lincoln,  Mary  E. 
Boulton,  wife  of  George  S.  Boulton,  M.R.C.8.,  aged  56. 

PAIN.^-On  December  8th,  at  C  M.8.  Hospital.  Old  Cairo,  Ethel 
Blanche,  the  wife  of  E.  Maynard  Pain,  Esq.,  MB,,  Ch.M. 

Williamson.— On  January  15th,  at  Southsea,  Mary,  relict  of  John 
Williamson,  Esq.,  M.D.,  of  Orabamstown,  8.  Africa,  and  third 
daughter  of  Thos.  Stringer,  Esq.  J.P.,  of  Sycamore  HUL 
Macclesfield,  aged  67.    South  African  papers,  please  copy. 


Ito  ffidkxA  Wxm  m&   feutot 


"BALUS    POPULI    S0PREMA    LEX-1 


Vol,  CXXVIIL 


WEDNESDAY,    FEBRUARY     3.    1904.  No.    5. 


a  Clinical  lecture 

ON 

SOME    PNEUMONIAS, 

Deuve&ed   at  the  Westminster    Hospital 

Bv  WILLIAM  MURRELL,  M.D.,   F.R.C.R, 
+n  ro  tht  Hospital,  Joint  Lecturer  on  Medicine,  *nd  Lecturer 
ob  Clinical  Medn  Am . 

te  lobar  pneumonia  is  a  fairly  common  disease, 
tom  picture  of  which   is  readily  recognises. 
patient  is  usually  a  young  man  who  gives  a  definite 
exposure  to  cold  and  wet.     The  onset  is 
m    '.here  is  a  rigor  of  some  intensity,  the  tempera- 
ture is  10 y  or   104",   the  pulse-rate    lao,  whilst   the 
ijicy  of  respiration  is  notably  increased.     There 
ts  acute  pun  in  the  side,  not  from  inflammation  of  the 
l«ag  itself,  but  from  the  accompanying  pleurisy.     The 
:t  feels  very  ill  and  readily  takes  to  his  bed,  the 
Uce  wean  an  anxious  expression,  and  is  flushed  often 
n  the  side  corresponding  to  the  seat  of  the  disease, 
aogb  is  short  and  hard,  and  the  expectoration,  at 
ihsent,    is   soon       rusty**    or    "greengage"    in 
The  skin   is  dry  and  pungent,  thirst  is  a 
jrtjinment  symptom,  and  there  are  pains  in  the  limbs. 
There  is  also   a   rash,    the   herpes   labialis  or   herpes 
seen  on  the  upper  bp  either  at 
lie   mouth   or   just    under  one  or  other 
ril.  but  it  may  l>e  on    the  cheek,  chin  or  jaw.      It 
I  that  the  patt ;  es  is  on  the  same  side  as 

ing  involved,  but  this  is  not  always  the  case.     In 
pneumonia  there  may  be  double  herpes*  but 
r    an    invariable    rule.     Inequality    of    the 
pupils  is  not  uncommon  in  pneumonia,  the  dilated  pupil 
§  usually  on  the  a  tie  tied  side,     The  dilatation  of 
the  pupil  is  due  to  irritation  of    that  portion  of  the 
ahetic  which  acts  as  the  pupil  dilator,    Usually 
the  herpes  and  the  dilated  pupil  are  on  the  same  side, 
but  here  again  exceptions  are  not  uncommon,     Herpes 
not  peculiar  to  pneumonia,  and  often  occurs 
ilt  01  a  febrile  cold  or  of  gastric  disturbance. 
Herpes  is  attended  with  elevation  of  temperature,  and 
u  is  not  always  easy  to  distinguish  herpetic  fever  from 
pneumonic  fever,     Cases  are  from  time  to  time  seen  of 
ted  pneumonia  without  physical  signs,  there  being  a 
rwidea  Ottset,  a  sharp  rise  of  temperature,  wTith  ter- 
mination :  uid  other  symptoms  closely  simu- 
lating pneumonia.      It  will  be  found  in  most  of  these 
cases  that  herpes  labialis  is  present ,  and  that  they  are 
examples  of  herpetic  fever.      It  is  not.  however,  every 
ol  herpes  m  tended  with  elevation  of  tern- 
ttrre.     We  recently  had  in  the  wards  a  girl.  a?L  1 1, 
:rom   Todd's   paralytic   chorea,   whose   tern- 
perature  taken  every  four  hours  was  always  normal, 
iped  herpes  on  buth  sides  of  the  lower  lip 
th  Listed  seven  days.     There  was  no  pneumonia. 
do  disturbance  of   temperature.     The 
herpes  in  inflammation  of  the  lungs  sometimes  makes 
:  pearance  on  the  tonsil  and  pharynx,  and  I  have 
ra  a  case  of  this  description,  in  a' child,  diagnosed 
lUt'tcuious  meningitis,     An  attack  of  acute  lobar 
'riusua  usually  terminates  by  crisis,  indicated  not 
by  a  sudden  fall  in  temperature  but  bv  an  attack 


of  diarrhea  or  profuse  sweating,  and  a  subsidence  of  all 

ite  symptoms.  The  critical  period  is  said  to  be 
the  fifth  day,  but  the  statistics  of  the  Westminster 
Hospital  show  that  it  is  commoner  on  the  sixth  dav 

11  the  tilth,  and  still  more  frequent  on  the  seventh- 
As  a  matter  of  expediency  it  is  safer  to  prognosticate 
that  the  crisis  will  be  about  the  eighth  day*  beyond 
which  it  is  not  likely  to  be  postponed.  In  termination 
by  crisis  there  is  not  uncommonly  a  pseud o -en sis,  or 
temporarv  fall  in  temperature,  before  the  actual  crisis, 
and  a  post-critical  rise  is  frequently  seen.  When  the 
termination  is  by  lysis  it  is  spread  over  a  couple  of  days 
or  more,  usually  the  seventh  and  eighth. 

With  regard  to  the  bacteriology  of  the  disease, 
Frankel's  pneumococcus  W  diplococcus  is  the  essential 
organism.  It  is  commonly  spoken  of  as  the  diplococcus 
pneumoniae,  but  the  tern  streptococcus  lanceolatus  is 
someti  It  is  not  always  pathogenic,  and  is 

present  In  the  saliva  and  nasal  secretions  of  many 
healthy  people.  As  a  rale,  it  exerts  no  morbific  in- 
fluence, but  when  the  resistive  powers  are  lowered  by 
exposure  to  cold  and  wet,  or  other  depressing  agencies, 
it  attacks  the  lungs  and  the  patient  gets  pneumonia. 
The  microscopical  examination  of  sputum  for  deter- 
mining the  diagnosis  of  suspected  pneumonia  is  not 
ntely  certain,  for  the  observation  is  complicated 
by  the  fact  that  diplococci  are  frequently  present  in 
the  month  m  large  numbers.  When  pneumococci  are 
oblaincd  from  the  mouths  of  healthy  individuals  the 
virulence  is  not  so  high,  nor  can  it  be  so  easily  in- 
creased *s  when  they  are  derived  from  pathological 
lesions,  A  more  trustworthy  test  is  that  afforded  by 
inoculation,  for  the  oral  diplococci,  if  present,  are 
usually  too  few  or  not  sufficiently  virulent  to  produce 
effects,  Moreover,  diplococci  are  not  uncommonly 
found  in  the  lungs  of  healthy  persons,  Frankel's 
pneumococcus  is  responsible  for  a  good  many  morbid 
manifestations  In  addition  to  acute  lobar  pneumonia, 
it  may  g;ve  rise  to  pneumococcic  arthritis,  often  mis- 
taken for  acute  rheumatism,  to  pleurisy  and  empyema. 
endocarditis  and  pericarditis,  salpingitis  and  peri- 
tonitis, Otitis  media  with  cellulitis  and  the  formation 
ol  multiple  abscesses,  meningitis,  and  many  other 
forms  id  disease  Pneumococcic  tonsilitis  is  a  con- 
dition often  accompanied  by  rusty  expectoration,  a 
point  worth  remembering  in  connection  with  di&gni 
The  pleurisy  which  accompanies  pneumonia  is  pneumo- 

tn  origin.  It  is  now  recognised  that  the  diplo- 
bocciifl  may  enter  through  the  lungs  and  produce  remote 
effects  without  causing  pneumonia.  Fried  lander's 
pneumobacillusisnot  the  essential  cause  of  pneumonia, 
although  frequently  found  in  connection  with  it.  It 
dors  not  stand  in  the  same  relation  to  pneumonia  that 
the  tubercle  bacillus  does  to  phthisis,  although  in  some 

of  pneumonia  Friedlander's  bacillus  is  present 
whilst  Ir.iiik'  1  s  pueumococcus  is  absent. 

Weieliselbaum,  "'f  Vienna,  as  a  result  of  an  examina 
tien  of  129  cases  of  pneumonia*  found  Frankers  diplo- 
coccus  in  94  and  Friedlander's  pneumococcus  in  only  9. 
It  is  probable  that  several  varieties  of  pneumococcus 
exist.  Foa.  described  two  distinct  varieties.  One  he 
calls  dimply  the  pneumococcus,  whilst  the  other 
he    names    meningococcus.     He    found    that    rabbits 


110    The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


Feb.  3.  1904 


immunised  against  the  pneumococcus  were  not  immu- 
nised against  the  *  meningococcus,  and  vice  versd. 
Various  strains  of  pneumococci  differ  much  in  their 
virulence.  Certain  lesions  will  occur  with  some  varie- 
ties and  not  with  others  ;  for  example,  with  some 
broncho-pneumonia  is  produced,  whilst  with  others 
acute  lobar  pneumonia. 

There  is  often  a  mixed  infection,  and  in  some  cases 
classed  as  pneumonia,  streptococcus  pyogenes  and 
staphylococcus  pyogenes  aureus  have  been  the  pre- 
valent organisms.  Other  organisms  found  in  connec- 
tion with  pneumonia  are  those  characteristic  of  in- 
fluenza, enteric  fever,  and  diphtheria.  In  an  outbreak 
of  epidemic  pneumonia  at  Middlesbrough,  Klein  was 
unable  to  discover  either  the  diplococcus  of  Frankel  or 
the  pneumococcus  of  Friedlander,  but  found  instead  a 
distinctive  bacillus,  a  mobile  rod-shaped  microbe.  It 
is  clear  that  whilst  one  organism  is  most  frequently 
found  associated  with  pneumonia  there  are  others 
capable  of  producing  a  closely  allied  if  not  identical 
condition.  If  is  often  said  "  no  pneumococci  no 
pneumonia,"  but  it  is  doubtful  if  this  statement  is 
correct.  In  an  apparently  typical  case  of  acute  lobar 
pneumonia  recently  in  the  wards,  the  rusty,  viscid 
expectoration  was  examined  many  times,  but  no  diplo- 
cocci  were  found.  It  is  possible  that  cocci  may  have 
been  present  in  some  of  the  expectoration,  but  they 
were  absent  in  the  specimen  examined.  A  similar 
experience  is  met  with  in  phthisis,  for  although  there 
may  be  abundance  of  bacilli  in  the  lungs  the  specimen 
examined  may  have  come  from  the  larynx  or  nasal 
passages. 

The  treatment  of  asthenic  pneumonia  presents  many 
points  of  interest.  The  patient  is  knocked  down  by 
the  severity  of  the  blow,  and  readily  takes  to  his  bed, 
it  being  rare  to  meet  with  "  ambulatory  "  cases,  such 
as  are  seen  in  enteric  fever.  If  the  tongue  is  foul  it  is  a 
good  plan  to  begin  with  a  dose  of  calomel,  three  grains 
for  a  private  patient  and  ten  grains  in  hospital  practice. 
The  diet  should  consist  of  three  pints  of  milk — five 
ounces  every  alternate  hour — or  two  pints  of  milk  and 
one  of  beef-tea  in  the  twenty-four  hours.  If  there  is  no 
expectoration,  or  if  it  is  scanty  and  viscid,  three  drops 
of  antimonial  wine  may  be  given  every  two  or  three 
hours.  The  antimonial  treatment  is  indicated  chiefly 
in  the  very  early  stage  of  the  disease,  when  the  skin  is 
hot  and  dry  and  the  expectoration  tenacious.  After 
the  first  twenty-four  hours  five  grains  of  carbonate  of 
ammonium  may  be  given  in  milk  every  four  hours.  In 
cases  of  delayed  resolution,  five  grains  of  carbonate  of 
ammonium,  ten  grains  of  chloride  of  ammonium,  and 
five  of  iodide  of  potassium  every  four  hours  in  an  ounce 
of  water  flavoured  with  a  drachm  of  liquid  extract  of 
liquorice  and  fifteen  minims  of  spirits  of  chloroform, 
will  be  found  useful.  If  the  pain  in  the  side  is  acute, 
linseed  meal  poultices,  hot  fomentations,  equal  parts  of 
extract  of  belladonna  and  glycerin,  iodine,  or  a  chloro- 
form poultice  may  be  applied.  If  the  heart  shows 
signs  of  failing,  two  drachms  of  freshly  prepared  in- 
fusion of  digitalis  every  four  hours,  or  a  hypodermic 
injection  of  i-2oth  grain  of  strychnine  will  do  good. 
When  there  is  much  dyspnoea  with  commencing 
cyanosis,  copious  inhalations  of  oxygen  usually  afford 
temporary  relief.  If  the  crisis  is  unduly  delayed,  a 
.single  dose  of  an  ounce  of  Warburg's  tincture,  either 
by  mouth  or  rectum,  may  determine  it.  Stimulants 
usually  have  to  be  given  freely,  and  old  liqueur  brandy 
will  be  found  the  best,  the  ordinary  "  three  star " 
being  of  little  value  for  this  purpose.  Very  old  brandy, 
which  consists  of  various  forms  of  ether  and  is  of  com- 
paratively low  alcoholic  strength,  commands  a  high 
price,  and  the  1823  and  1821  vintages  are  not  readily 
obtainable.  Champagne  is  another  good  form  of 
stimulant,  but  it  must  be  of  some  age  and  standing,  for 
immature  wine  is  of  little  value.  Delbeck  1893  is  a 
light  champagne,  and  I  often  have  given  a  bottle  in 
the  twenty-four  hours  when  the  pulse  is  weak  and 
running.  The  ordinary  half-bottle  of  champagne 
holds  13  oz. 

The  treatment  of  pneumonia  by  means  of  an  anti- 
pieumoccocic  serum  hardly  falls  within  the  range  of 


practical  therapeutics.  The  late  Dr.  J.  W.  Washbourn 
was  the  first  to  immunise  a  horse,  and  to  obtain  suffi- 
cient serum  for  the  treatment  of  cases  of  pneumonia. 
The  serum  was  of  such  potency  that  0*03  cc.,  when 
mixed  with  ten  lethal  doses  of  living  pneumococci  and 
the  mixture  injected  into  the  peritoneal  cavity  of  a 
rabbit,  prevented  death.  Several  cases  of  pneumonia 
were  treated  with  the  serum  with  satisfactory  results, 
but  subsequent  observations  showed  that  clinically  it 
was  of  little  value.  Mennes  obtained  a  protective 
serum  from  horses  and  Pane  one  from  donkeys,  but 
they  have  not  come  into  general  use.  It  is  probable 
that  they  are  antibacterial,  but  not  antitoxic. 

Secondary  or  Intercurrent  Pneumonia  engrafted 
on  some  other  pre-existing  disease  is  more  common  than 
the  acute  lobar  form.  It  may  supervene  insidiously 
on  various  disorders,  such  as  influenza,  diphtheria, 
enteric  fever,  small-pox,  erysipelas,  and  puerperal 
septicaemia.  In  these  cases  the  symptoms  are  but 
slightly  pronounced  and  the  inflammation  steals  upon 
the  lung  and  does  irrevocable  injury  without  giving  any 
notice  of  its  presence  except  such  as  may  be  gathered 
by  a  careful  and  systematic  examination  of  the  chest. 
It  is  not  a  common  accompaniment  of  bronchitis, 
phthisis,  or  pleurisy,  but  it  frequently  ends  the  scene 
in  carcinoma  and  chronic  affections  of  the  kidneys  and 
of  the  nervous  system.  Influenza  in  some  epidemics  is 
commonly  accompanied  by  pneumonia,  and  this i  was 
the  case  in  the  outbreak  in  1889-90.  The  soil  of  the 
influenza  bacillus  appears  to  be  favourable  to  the 
growth  of  the  pneumococcus.  Pfeiffer's  bacillus  may 
be  found  alone  or  in  association  with  pneumococcus  or 
streptococcus  pyogenes  or  both.  The  type  of  in- 
fluenzal pneumonia  is  broncho-pneumonic  with  acute 
interstitial  changes.  There  is  no  initial  rigor  and 
expectoration  may  be  absent,  or,  if  present  of  the 
muco-purulent  rather  than  the  rusty  variety.  The 
physical  signs  may  not  be  detected  for  some  days,  i and 
the  dulness  is  usually  patchy  or  scrapy.  and  not  con- 
fined to  the  base  or  to  one  lobe.  Not  uncommonly 
there  is  a  gradual  diffusion  of  the  inflammationt^ 
out  the  whole  of  one  or  both  lungs.  These  cases 
are  prolonged  and  tend  to  terminate  by ysis 
ratheV  than  by  crisis.  Prostration  is  a  Prominent 
feature,  and  alcoholic  stimulants  have  to  be 
administered  freely.  Death  not  infrequently  super- 
at  an  early  stage  of  the  disease.  Enteric 
is  another  common  form  of  secondary 
pneumonia.  In  every  case  of  pneumonia  "»«"*»"* 
to  consider  whether  the  disease  is  primary  or  secondary, 
and  if  secondary  if  the  primary  disease  »  ^enc.  tt 
makes  all  the  difference  not  only  in  P*>f^»™  " 
treatment.  I  have  known  a  patient  treated  for  acute 
looar  pneumonia  for  days  without  the  sughtest  sus 
picion  that  it  was  secondary  to  typhoid  fever,  and  that 
at  a  stage  when  there  was  a  characteristic  foseolar  rash 
on  the  abdomen.  The  patient  had  beenfed  on^ops 
and  steaks,  and  died  of  perforation.  Some  cases  01 
enteric  fever  practically  begin  with  Pneumom*  •„ ^ 
is,  the  symptoms  from  the  first  are  those  of  inflam- 
mation of  the  lungs,  and  it  is  not  until  later  that  the 
true  nature  of  the  disease  is  suspected.  In  case  01 
doubt  it  is  essential  to  diet  the  patient  on  the  sup- 
position that  he  has  enteric.  An  acute  pneumonia  wiU 
So  well  on  three  pints  of  milk  a  day,  whilst  an  enteric 
case  will  certainly  do  badly  on  a  solid  dietary,  in 
many  cases  of  enteric  the  symptoms  of  pneumonia  are 
not  observed  until  the  second  or  third  week,  and  even 
then  the  pain  and  rusty  expectoration  are  commonly 
absent.  Frequently  the  complication  is  recogwsea 
only  by  the  dyspnoea,  the  increased  elevation  ot  tem- 
perature, and  the  by  no  means  pronounced  physical 
f- t_   j.i_« i~-:*..   n4   /•ogm    th«»   nneumonia  is 


venes 
pneumonia 


the   pneumonia 
others    the   enteric 


signs.     In  the  majority   of   cases 

pneumococcic   in   origin,    but   in   v - 

bacillus  is  detected  in  the  expectoration,  and  sometimes 
in  addition  streptococci  are  found.  The  term  -!  tyPh0_"| 
pneumonia"  is  frequently  applied  to  patimts  wno 
present  a  "  typhoid  "  condition,  and  it  must  not  be 
regarded  as  synonymous  with  enteric  pneumonia. 
Diphtheritic,  plague,  and  erysipelatous  pneumonias 
are  well-known  varieties  of  the  disease.    The  usual 


Fes,  J,  1904. 


ORIGINAL  COMMUNICATIONS, 


Tm  Medical  Press.    HI 


complication  of  diphtheria  in  this  connection  is  broucho- 
pneumonia,  due  not  to  the  Klebs- Loftier  bacillus  but  to 
pyogenic  cocci  taken  in  during  respiration.  Erysipe- 
latous pneumonia  may  occur  m  the  course  of  erysipelas 
migrans,  the  inflammation  affecting  iirst  the  skin,  then 

mucous  membranes,  and  finally  spreading  to  the 
It  is  a  good  example  of  migratory  or  wander- 
ing pneumonia.  Convalescence  is  likely  to  be  pro- 
longed and  attended  with  much  prostration.  Pneu- 
monia may  occur  in  connection  with  pulmonary 
aspergillosis,  although  the  pulmunary  symptoms  are 
usually  more  closely  allied  to  tuberculosis,      In  actino- 

>is,    portions    of    the    lung    are   converted   into 

'  fibrous  material  having  an  irregular  interlobular 
distribution.  In  pulmonary  anthrax  there  is  a  con- 
dition allied  to  pneumonia,  the  lungs  on  section  being 
congested  and  edematous  with  large  extravasations  of 
blood, 

It  is  probable  that  in  the  majority  of  cases  secondary 
pneumonia  is  a  purely  local  inflammation  due  to  the 

1  si  the  specific  poison,  and  not  differing  essentially 
from  inflammation  of  other  organs  and  structures  due 
to  the  same  cause. 

Latent  oa  A  sthenic  Pneumonia, — These  are  cases  in 

which  the  characteristic  symptoms  of  the  disease  are 

absent  or  are  masked  by  other  clinical  phenomena.      In 

flderiy  people  there  is  no  initial  rigor,  and  the  presence 

of  the  disease  may  be  revealed  only  by  the  prostration, 

headache  and  delirium,  none  of  the  usual  symptoms 

**i  invasion   being  observed.     The  cough  and  expec- 

>n  may  be  absent,  and  the  latter,  if  present,  may 

1  prtMmt  the  characteristic  appearance  and  may 

be  simply  viscid  or  puriform.     The  flushed  face  is  not 

common  and   the  face  is  commonly  pale  and  sunken, 

present,  but  is  rarely  highl     This  elevation  of 

temperature,  however,  is  sufficient  to  put  the  observer 

l  Kuan!,  tor  pneumonia  is  one  of  the  few  febrile  dis- 
orders from  which  old  people  suffer.  Most  cases  of 
wcondary  pneumonia  tend  to  assume  an  asthenic  type. 
There  is  intense  prostration  with  great  depression  of 
the  nervous  centres.  This  variety  is  often  met  with 
ta  people  who  are  alcoholic,  and  in  them  the  prognosis 
is  grave.     Death  may  occur  early,  and  in  cases  of  re- 

ry  convalescence  is  prolonged.  Cheyne -Stokes 
respiration  is  a  bad  sign,  and  marks  the  beginning  of  the 
end.  Stimulants  are  indicated,  and  it  is  in  this  variety 
that  musk  is  moat  likely  to  do  good.  It  should  be 
administered  in  four-grain  doses  in  pill  every  four  hours, 
ive  remedy,  and  at  one  time  cost  2s.  6d, 
a  grain,  but    is    now  cheaper,     Sumbui  has  been  pro- 

3  as  a  substitute,  but  has  not  the  same  thera- 
peutical action. 

Cardiac  Pnevmonia  is  a  common  disease,  although 
tome  writers  seem  to  doubt  its  existence,  and  speak  of 
it  as  a  condition  of  hyperemia  or  congestion.  It  is  a 
nut  uncommon  complication  of  mitral  stenosis,  peri- 
carditis, and  fatty  degeneration.  The  temperature 
rises  suddenly,  there  is  a  short,  dry,  hacking  cough,  the 
toration  is  rusty,  and  line  crepitation  is  heard 
ner  one  or  both  lungs.     At  the  autopsy,  in  addition  to 

Cionary  infarcts,   haemorrhage,    extravasation,   and 
Us&ttea   are  found,     A  girl,  aet,  so,  was  recently 
admitted   with   acute  rheumatism   followed    by  endo- 
carditis (mitral   regurgitation!    and   pancarditis   with 
ion,     A  week  later  there  was  a  sudden  rise  of  tem- 
perature, and  the  patient  was  found  to  have  fine  crepi- 
tation at    the   base   of   both   lungs    posteriorly,    mure 
i  on  the  right  than  on  the  left.     There  was  no 
the  cough   was   slight   and   hacking,   whilst   the 
ion  was  rusty  and  streaked  wilh  blood.     No 
ttibcrcU-  bacilli  were  present,  and  the  organisms,  which 
were  not  numerous,  consisted  for  the  most  part  of  short, 
thick  bacilli,  and  of  cocci  in  pairs,  but  not  resembling 
die  oiplococcus    pneumonia*.     There    was  a   crisis  on 
ventb  day,  but  the  patient   died  a  month  after 
adiaissiou  of  acute  endocarditis   not  septic  in  origin, 
treatment  of   these   cases  in  which    there   is  a 
damaged  heart  as  the  result   of  rheumatic  fever  re- 
quires  tn uch  care .     A n t .j  m om al  wine  m ay  be  useful,  but 
t«u  or  fifteen  minims  of  solution  of  hydroehlorate  of 
apomnrphine  by  mouth  every  three  hours  gives  better 


results,  chiefly  by  promoting  expectoration.  Counter- 
urn  over  both  bases  should  not  be  neglected. 
Stimulants,  especially  in  the  form  of  champagne  and 
old  brandy,  are  indispensable,  and  when  the  heart 
shows  signs  of  failure  and  the  pulse  is  frequent,  irregular 
uermittent,  half -on  nee  doses  of  freshly  prepared 
infusion  of  digitalis  every  three  hours,  with  hypodermic 
injection  of  i-aoth  grain  of  strychnine,  are  useful. 

Traumatic  and  Contusion  Pneumoni a. —Traumatic 
pneumonia  is  the  natural  sequence  of  penetrating 
wounds  of  the  lung.  It  differs  from  idiopathic  pneu- 
monia in  exhibiting  very  little  tendency  to  diffuse  itself 
through  the  lung.  It  shows  no  predilection  for  the 
base,  an  J  as  a  rule  is  strictly  localised.  It  is  asthenic  in 
type,  and  is  accompanied  by  active  febrile  disturbance. 
It  may  terminate  m  abscess,  but  usually  the  lung 
exhibits  a  remarkable  power  of  recovery  from  even 
extensive  injury  - 

Contusion  pneumonia  may  follow  blows  on  the 
chest- wad  or  falls,  It  was  at  one  time  considered 
doubtful  whether  external  violence,  short  of  lung 
laceration,  was  capable  of  producing  pneumonia*  but 
the  fact  is  now  established  that  inflammation  of  the 
lung  having  all  the  characters  of  acute  lobar  pneumonia 
may  ensue.  This  is  a  matter  of  importance  in  con- 
nection with  claims  against  accident  insurance  com- 
panies. If  a  person  meets  with  an  accident  and  sub- 
sequently dies  of  pneumonia  it  is  not  always  easy  to 
say  whether  the  condition  of  the  lungs  is  primary  or 
secondary  to  the  injury.  It  is  probable  that  in  some 
cases  a  blow  on  the  chest  lowers  the  vitality  of  the 
subjacent  portion  of  the  lung,  whilst  a  subsequent 
exposure  to  cold  or  wet  determines  the  onset  of  the 
K.  A  street  scavenger,  art.  31.  was  admitted  to 
the  hospital  having  been  knocked  down  by  a  hansom 
cab,  the  wheel  of  which  passed  diagonally  over  the 
lumbar  region  and  the  left  side  of  the  chest.  On  ad- 
mission, lie  was  not  collapsed,  and  there  was  no  evidence 
of  fracture  of  the  nbs  or  injury  to  the  liver.  The  urine 
was  smoky  m  appearance,  and  as  the  patient  had  been 
in  South  Africa  it  was  examined  for  bilharzia,  but 
nothing  was  found.  On  the  day  following  the  injury 
a  patch  of  fine  crepitation  was  detected  near  the  angle 
of  the  scapula  on  the  injured  side.  There  was  no  rigor 
and  no  elevation  of  temperature.  The  same  night  the 
patient  commenced  coughing,  and  the  expectoration 
was  rusty  in  character,  The  crepitation  persisted  for 
some  days.  There  was  no  herpes,  and  no  pleuritic 
ertusion,  and  the  patient  made  a  good  recovery. 

Septic  or   Streptococcic  Pneumonia.— The  term 
"  septic  Tt  is  sometimes  applied  to  cases  of  pneumonia 
originating  in   bad  sanitary  conditions,  especially  ex- 
posure to  sewer  gas.     A  true  septic  pneumonia  may 
I  arise  in  connection  with  a  wound  or  trivial  abrasion, 
I  and  the  entrance  into  the  system  of  either  streptococci 
I  or   staphylococci   or   both.     A    patient   admitted    for 
.  pneumonia  is  found  to  have  an  abrasion  on  the  ringer. 
,  There  is  no  tenderness  of  the  lymphatics,  and  there  are 
;  no  enlarged  glands  in  the  axilla.     There  is  no  cough 
1  or  expectoration,  the  physical  signs  are  not  those  of 
acute  lobar  pneumonia,  and  there  is  no  crisis.     The 
condition   of   the   lung  is   apparently   secondary,    but 
I  there  is  nothing  to  connect  it  with  the  wound.     The 
temperature  is  high,  but  not  hectic  in  type.     Anti- 
streptococcic serum  does  no  good,  and  an ti -staphylo- 
coccic serum  is  equally  inefficacious.     There  are  fre- 
quent shiverings,  a  very  rapid  and  feeble  pulse,  with 
profuse  perspirations,  and  death  ensues  by  asthenia. 
At  the  autopsy  a  general  py acinic  condition  is  found,  and 
cultures  show'  a  mixed  infection,  probably  having  its 
origin  in  the  wound .     These  cases  are  often  extremely 
pawling.     Some  writers  limit  the  term  septic  to  post - 
operation  pneumonias  in  which  there  is  absorption  of 
septic  material  from  open  wounds.     Cases  of  parturient 
pneumonia  come  within  this  category-     Septic  pneu- 
monia following  pregnancy  is  not  especially  fatal,  but 
the  prognosis  of  idiopathic  pneumonia  both  in  pregnant 
and  parturient  women  is  extremely  bad-     In  many 
cases    of   septic   pneumonia    both    pneumococci    and 
streptococci  are  found  111  the  expectoration.     When  the 
streptococcus  infection  predominates  the  onset  is  less 


112    The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


Feb.  3,    1904. 


abrupt  than  in  the  pneumococcic  form,  but  the  fever  is 
of  a  hectic  type,  and  there  may  be  a  succession  of 
rigors.  The  physical  signs  are  usually  few  and  doubt- 
ful, and  there  may  be  little  or  no  dulness  on  percussion. 
If  the  inflamed  lobules  are  near  the  surface  moist 
sounds  may  be  audible.  The  most  notable  feature  is 
the  long  duration,  with  the  shifting  character  of  the 
physical  signs.  Termination  is  usually  by  lysis,  and 
convalescence  is  as  prolonged  as  in  enteric  fever. 

Anjesthetic  Pneumonia. — This  occurs  most  fre- 
quently after  the  administration  of  ether, but  is'occasion- 
ally  seen  after  chloroform.  Ether  pneumonia  may  be 
due  to  the  irritation  produced  by  the  anaesthetic  itself, 
by  exposure  of  the  patient  to  cold,  especially  in  abdo- 
minal explorations,  and  possibly  in  some  cases  from  the 
.  use  of  a  contaminated  mouth-piece.  It  has  been 
suggested  that  prior  to  the  administration  of  the 
anaesthetic  the  mouth,  throat,  and  nasal  passages 
should  be  rendered  aseptic  by  the  use  of  a  mouth-wash 
and  gargle.  The  symptoms  of  pneumonia  may  make 
their  appearance  in  from  five  to  seven  hours  after  the 
operation,  or  they  may  be  postponed  for  some  days. 
The  mortality  in  cases  of  ether  pneumonia  is  said  to 
be  about  50  per  cent.,  whilst  in  chloroform  pneumonia 
it  is  higher. 


THE 

DIAGNOSIS  AND  INDICATIONS 

FOR  OPERATION  IN 

ACUTE  APPENDICITIS,  (a) 

By    W.    RUSSELL,    M.D.Ed.,    F.R.C.P., 

Assistant  Physician,  Royal  Infirmary,  Edinburgh,  Ac. 

In  his  introductory  remarks  Dr.  Russell  alluded 
to  the  seeming  paradox  that,  while  each  of  us 
relied  in  practice  on  his  individual  experience, 
this  individual  experience  was  of  little  value  as 
compared  with  collective  experience.  For  twenty- 
one  years  the  appendix  vermiformis  had  been 
recognised  as  the  great  cause  of  trouble  in  the 
caecal  region,  and  concomitantly  therewith  the 
terms  perityphlitis  and  typhlitis  had  almost 
dropped  entirely  into  disuse,  some,  indeed,  being 
inclined  to  deny  that  such  conditions  existed. 
Nevertheless,  Dr.  Russell  thought  that  in  a  small 
percentage  of  cases  the  caecum  was  primarily  at 
fault.  He  had  three  bad  cases  of  perforation  of  a 
faecal  ulcer  of  the  caecum,  and  one  of  perity po- 
litic abscess,  in  which  there  was  proof  that  the 
vermiform  appendix  was  not  involved.  In  ap- 
proaching the  question  of  diagnosis,  it  was 
necessary  to  have  a  clear  conception  of  the  con- 
ditions which  favour  the  occurrence  of  the  disease, 
and  the  essential  points  in  its  varying  intensity. 
He  thought  that  the  anatomical  conditions  of 
the  appendix,  especially  the  length  of  the  meso- 
colon, were  of  importance  in  predisposing  to  the 
disease.  The  mesocolon  contained  the  vessels 
of  the  appendix,  though  in  women  there  was  an 
additional  vascular  supply  (which  might  account 
for  the  lesser  frequency  of  appendicitis  in  females), 
so  that  its  length  might  have  some  effect  on  the 
ease  with  which  the  blood  supply  was  interfered 
with.  Again,  variations  in  the  length  and  position 
of  the  appendix,  and  variations  in  the  ratio  of  its 
calibre  and  length  to  the  lumen  of  the  caecum, 
might  make  some  appendices  more  liable  than 
others  to  defective  drainage.  Appendicitis — 
catarrhal,  ulcerative,  perforative,  or  gangrenous — 
was  most  likely  to  occur  when  the  organ  was 
sickle-shaped,  and  had  a  short  mesentery.  Some 
persons,  in  fact,  had  appendices  which,  from  their 


(a)  Abttmct  of  Paper  to  introduce  discussion  on  subject  at  the 
Edinburgh  Medico-Chirurgical  Society,  January  20tb,  1904. 


anatomical  peculiarities,  were  bound  to  give  trouble, 
sooner  or  later.  Interference  with  the  drainage 
of  the  appendix  played  an  important  part  in 
determining  inflammation.  The  bacillus  coli, 
though  not  the  only  organism,  was  that  usually 
present  in  appendicitis,  and  its  virulence  varied 
greatly  in  different  cases.  It  was  exalted  by  any 
morbid  condition  of  the  intestine — diarrhoea, 
constipation,  or  obstruction.  It  must  be  remem- 
bered that  the  drainage  of  the  appendix  could  be 
interfered  with  by  its  being  blocked  by  a  catarrh 
of  the  caecum,  or  the  blockage  might  be  wholly 
or  partially  due  to  faecal  concretions,  which  were 
especially  frequent  in  the  fulminating  types.  In 
very  rare  cases  appendicitis  had  been  caused  by 
a  gall-stone  occluding  the  appendix.  Before 
discussing  the  symptomatology  of  an  acute  attack, 
the  speaker  referred  to  "  appendicular  colic/' 
in  which  transitory  symptoms  of  appendicitis 
recurred  at  intervals,  but  no  local  signs  could 
ever  be  made  out.  He  thought  that  such  a  con- 
dition must  be  recognised  ;  it  seemed  to  be  due 
to  the  engagement  of  a  faecal  mass  in  the  mouth 
of  the  appendix,  and  disappeared  after  a  dose  of 
castor  oU.  This  appendicular  colic  may,  or  may 
not,  go  on  to  appendicitis.  The  symptoms  of 
such  appendicitis  were  common  to  other  diseases. 
As .  to  pain,  he  thought  that  too  much  stress 
might  be  laid  on  its  seat ;  it  was  often  general, 
around  the  umbilicus,  or  referred,  and  was,  es- 
pecially when  associated  with  cutaneous  hyper- 
esthesia, very  often  misleading.  Deeply-seated 
tenderness,  on  the  contrary,  was  the  key  to  all 
abdominal  diagnosis,  and  though  the  tension  of 
the  abdominal  muscles  might  make  it  difficult  to 
elicit,  careful  deep  palpation  would  overcome  thisr 
and  enable  us  to  detect  the  painful  diseased 
appendix.  Sometimes  it  could  be  most  readily 
made  out  by  rectal  examination,  when  it  dipped 
down  into  the  pelvis  instead  of  being  an  abdo- 
minal organ.  He  did  not  dwell  on  the  other 
symptoms  of  appendicitis — the  vomiting,  mus- 
cular rigidity,  pulse  rate,  temperature,  appearance 
of  shock,  &c.  The  diagnosis  depended  upon 
individual  skill  in  eliciting  the  essential,  and  dis- 
tinguishing it  from  the  non-essential.  Deep- 
seated  tenderness  was,  he  repeated,  the  safest 
guide. 

Indications  for  Operation. — At  the  outset 
of  this  consideration,  two  schools  had  to  be  faced — 
the  radical  school,  represented  in  America  and 
France  ;  the  conservative  school,  represented  in 
Britain,  France  and  Germany.  If  Lequen's 
aphorism,  "  toute  appendicite  doit  £tre  operee 
a  temps,"  were  accepted,  the  position  was  simple, 
and  there  was  nothing  to  discuss.  The  chief 
argument  of  those  who  held  the  radical  view  was 
that  in  every  case  there  was  great  danger  of  per- 
foration, and  that  this  danger  could  never  be 
foreseen.  The  opinions  of  the  conservative  school, 
as  represented  by  Treves,  Talamon,  Hawkins, 
and  Nothnagel,  were  then  quoted.  Statistics 
showed  that  about  90  or  95  per  cent,  of  cases  of 
acute  appendicitis  recovered.  Thus  Furbinger 
had  had  120  cases  with  a  mortality  of  1  ;  Gutt- 
mann,  a  recovery-rate  of  91-92  per  cent.;  Cursch- 
mann,  a  recovery-rate  of  96  per  cent.  ;  Sahli  had 
had  a  series  of  453  cases  with  a  mortality  of 
4-5  per  cent.,  and  only  nine  cases  treated  surgically. 
In  another  series  of  7,213  cases,  of  which  over 
6,000  were  operated  upon,  about  8  per  cent. 
died.     In    the    Edinburgh    Royal    Infirmary,  ol 


Feb    J,    ; 


ORIGINAL  COMMUNICATIONS, 


The  Med  it  vt  Press.    113 


consecutive  cases  treated  in  the  medical 
wards,  169  were  cured,  7  relieved,  29  died,  and 
the  rest  were  transferred  to  the  surgeons  The 
supreme  question  at  the  outset  oi  even,'  case  was  : 
Is  the  appendix  rapidly  about  to  perforate  or 
to  become  rapidly  gangrenous  ?  The  chance 
was  about  nine  to  one  against  this,  but  the  res- 
ponsibility of  deciding  which  was  the  one  case 
very  ten  that  would  require  operation 
was  none  the  less,  perhaps  more,  onerous  on  this 
account.  He  had  come  to  the  following  con- 
clusions as  to  operation  : — (11  In  an  acute  attack 
which  has  been  preceded  by  one  or  two  mild  ones 
immediate  operation  should  be  advised,  because 
probably  the  anatomical  condition  of  the  appendix 
mis  such  as  to  render  it  liable  to  become  inflamed, 

ases  in  which  there  was  an  early  rigor  should 

aerated  on  at  once,  (3)  Fulminating  cases 
of  course  required  immediate  operation.  There 
remained  over,  however,  the  great  balance  of 
acute  cases  ;  in  these  medical  treatment  might 
first    be     adopted.     Purgatives     he     never     now 

j red  to  give.  Pain  should  be  relieved  by 
-bag.  The  question  of  giving  opium 
arose  ;  Nothnagel  thought  it  should  only  be 
administered  to  relieve  pain,  and  that  a  call  for 
ntinued  use  indicated  operation.  He  knew 
that  it  masked  symptoms  to  some  extent,  but 
not  so   much,    he    thought,   as   to    forbid   its   use 

-iitely*     He    preferred    belladonna,    however, 

!i    only    alleviated    the    spasm.     He    was   in* 

dmed    to    commend     lavage    of    the    bowel,    as 

ised    by    Bourget,   of    Lausanne,     How    long 

Id  medication  be  continued,  and  what  arc 
the   indications    for   operation  ?     As    to    this,    he 

jht  that  u    continued  pain  was  an  indication, 
ited  to  a  severe  inflammation  and  block- 
recurrent  spasmodic  pain  showed  that 

appendix  was  rrnt  draining  itself,  and  should 
be  removed  ;  j)  if  the  pain  is  severe,  but  the  other 
trmptoms  mild,  we  should  be  on  our  guard  ;  (4) 
the  leucocyte  count  gave  little  help  in  cases  of 
gangrene  ;  here  deep  palpation  was  of  great  value  ; 

1  less  acute  cases  increasing  temperature,  pulse, 
and  leucocytosis  indicated  operation  j  6)  obvious 
evidence    of     peritoneal     infection    was     also     an 

ation.       He    summarised    his   paper    as    fol- 
-Bear  in  mind  variations  in  the  anatomy 

Ike  appendix,  Consider  the  question  ol 
drainage  of  the  appendix  into  the  caecum,  Ap- 
pendicular colic  is  a  danger  signal.  Deep  pal- 
pation is  of  paramount  importance  in  all  ab- 
dominal diseases,  and  the  site  of  pain  as  shown 
bj  it  out  best  guide.  From  statistics,  it  seems 
that  95  jier  cent,  of  patients  recover.  All  cases 
beginning  with  rigors  should  be  operated  upon  ; 
also  all  second  attacks.  Fulminating  cases  have 
only  deep  tenderness,  little  local  reaction.  Medical 
treatment  should  not  be  continued  for  more  than 
twenty-four  to  forty-eight  hours,  unless  there  is 
improvement.  Continuance  of  symptoms  and 
increasing  leucocytosis  indicate  operation 


PiOF&asoR  Howard  Marsh,  F.R.C.S,,  delivered  Ins 
jural  lecture  as  Professor  of  Surgt-ry  at  theUniversi  1  y 
onbridge    last     Friday,  and    met    with   a  most 
!  reception  in  the  anatomical  lecture-room. 

She    new    Anglo-American    hospital    at    Gheztreh, 

Egypt,  Wit  last  week   by  Lady  Cromer.     The 

.700  has  been  subscribed  (or  the  erection  <>f 

uifdmg,    the   principal   donor   bemg    Sir    Ernest 

CukL,  who  contributed  £5,000, 


MODERN 
PHYSICAL   THERAPEUTICS,  (a) 

By   W.  S.   HEDLEY,  M.D., 

FhysioUn  in  charge  ot  the  Elect  riad  Department,  London  Hospital. 

He  first  referred  to  Professor  Dewar's  dis- 
covering the  presence  of  helium  when  examining 
the  gases  collected  over  the  King's  Bath  at 
(  Bath,  and  to  the  (act  that  Sir  W.  Ramsay  and 
Mr.  Soddy  had  seen  the  spectrum  of  helium 
develop  in  a  vacuum  tube  into  which  nothing 
but  the  radiation  and  "emanation"  of  radium 
had  been  admitted.  In  other  words,  radium 
;  develops  helium  by  a  spontaneous  change.  Thus 
a  sample  of  the  deposit  from  the  Royal 
Bath  was  found  to  contain  radium  in  appreciable 
1  quantity.  It  therefore  seemed  possible  that  a 
i  substance  undergoing  such  constant  change  and 
disintegration  as  does  an  atom  of  radium  might 
fling  off  from  itself  something  that  might  endow 
the  water  with  therapeutic  value.  Such  sub- 
stance being  in  a  '*  nascent  *'  form  might  help  to 
explain  the  comparative  inefficacy  of  the  waters 
of  certain  springs  when  removed  from  their 
source  ;  and  the  same  fact  might,  perhaps,  supply 
a  reason  for  the  recognised  difficulty  of  making 
successful  artificial  imitations  of  the  waters  of 
mineral  springs.  The  radiations  of  radium  were 
then  considered,  the  "  Alpha  "  rays  being  shown 
on  the  spinthariscope,  and  those  from  polonium 
on  the  sine  screen.  The  bactericidal  properties 
and  therapeutic  applications  of  radio-active 
substances  were  then  considered,  and  '*  appli- 
cators"  lav  throat,  nose  and  gyna»co logical  work 
were  shown,  as  well  as  thorium,  pitchblende,  and 
other  plasters,  kindly  made  up  bv  Mr.  Martindale 
ior  the  occasion.  The  "  N  "  or  Blondlot  rays 
were  then  discussed,  their  place  in  the  scale  being 
apparently  between  the  infra-red  and  the  shortest 
Wave  length  of  the  Herts ian  waves.  They  seem 
to  bridge  the  gap  between  electrical  action  and 
radiant  energy.  F'rofcssor  Charpentin  had  shown 
that  these  rays  are  emitted  from  nervous  tissue 
in  proportion  to  its  quantity,  its  physiological 
ity,  or  its  mjmy  It  would  seem  thfrl  des- 
tructive decomposition  of  the  tissue,  whether 
physiological,  as  in  generation  of  nei . 
energy,  or  what  may  be  called  pathological,  as 
in  the  case  oi  herring  brine  p  is  a  source  of  H<  N  *k 
rays.  It  is  rumoured  thai  radium  is  soon  to 
find  a  rival  in  the  destructive  distillation  of 
herring  brine  ;  at  least,  this  and  guano  are  now 
being  experimented  upon  as  a  source  of  radio- 
activity. 

The  therapeutic  action  of  heat  was  then  dealt 
with,  as  well  as  light  of  various  colours,  and  the 
necessity  for  the  use  ..I  the  act  i  no  meter  to  secure 
definite  and  accurate  dosage.  The  important 
measurement  of  the  quality  and  quantity  of 
X-rays  was  also  insisted  upon,  and  a  new  method 
was  demonstrated  oi  ascertaining  by  measuring 
this  on  a  milliamperemetcr,  the  rectified  current 
passing  through  a  focus  tube  ;  also  by  the  radio- 
chronometer.  High  J  requeue  y  currents  were  con- 
sidered, and  a  tendency  noticed  to  desert  the 
methods  of  the  condensation  couch  and  auto- 
conduction  for  bipolar  efffuvation — the  latter 
being  demonstrated.  The  fatal  effects  of  high- 
frequency  currents  on  the  lower  animals  was  then 
referred  to, 

{a)     Aliutrart  or  Paper  rend  before    th«   BfthrrtilOfcteal   Socittv. 

.fi<,ii..ry  *  KM !."'-!. 

D 


H4    Thb  Medical  Press.   THE  OUT-PATIENT  DEPARTMENTS. 


Feb,  $r  1904, 


THE    CLINICAL    IMPORTANCE 

OF     THE 

LYMPHATIC    GLANDS 

CONTAINED  IN  THE  THICKNESS  OF  THE 

CHEEK. 

By    M.    TRENDEL,    M.D., 

Professor  at  the  University  ol  Tubingen. 

The  existence  of  lymphatic  glands  in  the  thick- 
ness of  the  cheek  was  shown  some  time 
since  by  Poncet,  of  Lyons,  who  demonstrated 
their  frequent  existence  and  described  their 
exact  situation.  Briefly  stated,  these  glands  may 
be  divided  into  three  groups — (1)  a  maxillary  or 
supra-mandibular  group,  consisting  of  one  or 
two  glands  which  lie  between  the  facial  artery 
and  vein  at  the  anterior  margin  of  the  masseter 
muscle  ;  (2)  a  buccinator  group,  situated  on  the 
external  surface  of  the  buccinator  muscle, 
more  rarely  in  its  thickness,  or  even  between 
the  muscle  and  the  buccal  mucous  membrane, 
just  below  the  level  of  a  line  drawn  from  the 
labial  commissure  to  the  lobule  of  the  ear.  This 
group  may  be  subdivided  into  two,  an  anterior 
group  situated  a  finger's  breadth  from  the  labial 
commissure  (commissural  glands)  between  the 
artery  and  the  vein,  and  a  posterior  group  behind 
the  vein,  at  the  front  of  the  masseter,  not  far 
removed  from  the  meatus  of  Steno's  duct ;  (3) 
a  superior  maxillary  group  of  less  frequent 
occurrence,  consisting  in  glands  included  in  the 
naso-labial  fold  on  a  level  with  the  lower  border 
of  the  orbit  at  the  internal  palpebral  angle. 

The  anatomical  accuracy  of  this  distribution 
is  confirmed  by  clinical  observation.  I  have 
notes  of  seventeen  observations  (two  of  them 
already  published  by  Kuttner)  from  von  Bruits' 
clinic  ;  in  nine  of  these  the  supra-mandibular 
glands'  were  involved,  and  in  eight  the  buccinator 
glands,  the  lesion  being  cancerous  in  twelve  and 
tuberculous  in  the  others. 

As  a  matter  of  fact  chronic  adenitis  is  usually 
due  to  cancer  or  tuberculosis,  and  even  acute 
suppurating  adenitis  is,  in  many  cases,  tuber- 
culous, though  sometimes  consequent  upon 
infection  from  carious  teeth,  tonsillitis,  erysi- 
pelas, &c. 

Out  of  eighty-four  cases  which  I  have  found  in 
the  literature  of  the  subject,  in  twenty-five  the 
initial  lesion  was  cancer  (cancer  of  the  nose, 
lower  lip,  cheek,  temple,  parotid  or  superior 
maxillary  alveolus),  while  in  fifty-nine  the  point 
de  depart  was  an  acute  or  chronic  inflammatory 
lesion  of  the  face.  I  may  add  that  the  buccinator 
glands  were  involved  in  forty-six  (nine  cancer, 
thirty-seven  tuberculous,  or  simple  inflammatory 
lesions) ;  the  supra-mandibular  glands  in  thirty- 
seven  (sixteen  cancers,  twenty-one  inflammatory 
affections),  and  once  the  sub-orbital  glands, 
following  facial  erysipelas. 

These  figures  suffice  to  prove  that  adenitis  of 
the  cheek  is  not  merely  a  pathological  curiosity, 
and  that  it  is  worthy  of  being  looked  for  even 
though  it  never  results  in  the  formation  of  large 
tumours  or  chains  of  enlarged  glands,  such  as  wc 
meet  with  in  the  neck  and  submaxillary  region. 
Cheek  adenitis  rarely  exceeds  the  size  of  a  pea, 
or  at  most  of  a  nut.     Its  consistence  and  mobility 


vary  according  to  circumstances,  e .£.,  its.  situation 
and  its  period  of  evolution.  Cancerous  and 
tuberculous  glands  in  the  cheek  may  remain  for 
a  long  time  as  hard  indolent  nodules,  perceptible 
on  pinching  up  the  thickness  of  the  cheek  between 
the  fingers.  To  make  sure  of  finding  them  when 
present,  it  is  desirable  to  carry  out  the  exploration 
with  one  finger  inside  the  mouth,  and  in  every 
case  of  epithelioma  of  the  face  this  method  should 
be  resorted  to,  carrying  the  search  into  the  sub- 
maxillary and  submental  zones,  as  well  as  the 
cheek. 

Later,  the  tuberculous  gland,  sometimes  also 
the  neoplastic  gland,  spreads,  becomes  adherent r 
invades  the  skin  and  ulcerates.  In  acute  adenitis 
the  suppurating  gland  soon  opens  externally,  and 
is  accompanied  by  very  considerable  tumefaction 
of  the  cheek.  These  inflamed  glands  almost 
invariably  open  on  the  external  surface  of  the 
j  cheek,  and  in  the  rare  instances  of  an  opening 
through  the  buccal  mucous  membrane,  the  glands 
affected  are  those  exceptionally  situated  on  the 
I  buccal  surface  of  the  buccinator  muscle. 

When  it  has  reached  this  stage  the  diagnosis 
presents  some  difficulty.  It  is  highly  probable 
that  many  so-called  scrofulous  or  tuberculous 
ulcerations  of  the  cheek  were  originally  of  the 
nature  of  adenitis.  We  cannot  be  sure  thereof 
unless,  indeed,  we  disco ver  the  remains  of  glandular 
structure  on  the  walls  of  the  excised  abscess,  an 
observation  by  no  means  easy  to  make.  Certain 
fistula?  of  the  cheek  surrounded  by  a  skin,  dull 
violet  in  hue,  and  presenting  a  close  resemblance 
to  a  tuberculous  lesion,  may  be  simply  due  to 
dental  lesions,  as,  for  example,  necrosis  of  a 
stump  in  the  upper  jaw.  In  such  event  it  is 
obvious  that  curettage  or  excision  will  be  useless, 
and  if  the  carious  stump  be  removed  the  fistula 
will  heal  by  itself. 

The  treatment  of  adenitis  of  the  cheek,  properly 
so-called,  is  simple  enough.  A deno -phlegmons 
should  be  opened  through  the  cheek  except  in 
the  rare  instances  of  a  submucous  collection  of 
pus.  If  tuberculous  they  should  be  scraped  or 
removed  in  toto.  Lastly,  cancerous  glands  should 
be  removed  at  the  same  time  as  the  original 
growth  if  we  wish  to  do  a  complete  operation,  and 
for  this  purpose  the  exploration  of  the  cheek 
should  never  be  omitted  in  presence  of  facial 
epithelioma.  The  removal  of  these  glands  should 
be  effected  through  incisions  as  short  as  possible, 
and  made  horizontally  in  order  to  avoid  wounding 
branches  of  the  facial  artery  or  damaging  Steno's 
duct. 


XCbe  ©inpatient  Departments* 

GREAT   NORTHERN    CENTRAL   HOSPITAL. 

Medical  Cases 

Under  the  care  of  Dr.  H.  W.  Syers. 

Case  I. — A  man,  jet.  55,  suffering  from  a  general 
eruption,  especially  marked  on  the  face.  The  first 
glance  at  the  patient  gave  the  impression  that  he  was 
suffering  from  variola.  The  forehead  was  covered  with 
i  papules  of  the  size,  shape,  and  colour  of  those  usually 
characteristic  of  small-pox.  The  whole  body  was  more 
or  less  covered  with  similar  spots,  which  were  also  well 
developed  on  both  wrists.  It  was  clear  that  the  case 
was  one  of  very  severe  secondary  syphilis,  for  further 
examination  revealed  the  fact  that  the  patient  was 
suffering  from  a  chancre,  and  also  that  the  rash  was, 
to  a  certain  extent,  polymorphic,,  erythema,  staining,. 


Feb.  3>  1904* 


SPECIAL  ARTICLES, 


The  Medical  Press.     115 


and  some  pusf  illation  being  present  contemporaneously 
with  the  papular  rash. 

Dr  Syrrs  observed  that  he  had  known  cases  in  which 
this  form  of  secondary   syphilis  had  been  diagu 

ill-pox.     He  also*  remarked   that,   in  his  opinion. 

taneous  syphilide  was  always  indicative  of  a  very 

severe,  even  malignant,  clinical  type  of  the  disease.      In 

thr  present  case  this  was  so,  for  the  general  health  oJ 

The  patient  was  gravely  impaired,  and  he  was  much 

rm&cia r 

Case  IL — A  girl,  act.   17.     This  case  was  diagnosed 

01  diabetes  melhius  from  the  facial  aspect  and 

general  condition  of  the  patient.  There  was  no  obvious 

tmse  Tor  the  disease,  which  had  manifested  itself  eight 

neflifo  hesvmptoms  first  noticed    being 

thirst  and  diuresis.     Physical  examination 

he  fact  that  latent  phthisis  was  present  ;    in 

ra-seapular  region  the  note  on  percussion  was 

"  d,  arid  on  auscultation  a  few  crackles  were 

t  immediately  after  the  patient  coughed. 

Syer*  called  attention  to  the  latency  of  the  pul- 

condtUon  :  there  was  do  cough  or  other 

rase.      Tins  us   not  unusual  111  cases  of 

! "h-    physiognomy  was  strongly  suggestive 

face  was  thin  and  the  features  them- 

nplexion  rather  yellow  and  inclined 

1  there  was  a  faint  acetone  odour  in  the 

Tut.  in  us  Lies  of  the  upper  part  of  the  chest  were 

yjmc'A  led,    the   clavicles    and    the    ribfl 

►minent.     Dr.     Syers    remarked     that     the 

disease  in  young  people  was  very  un- 

uvoorabic,  dial  1  nearly  always  supervening 

ruparaf  tvely  early  stage  of  the  illu- 

,    ftL — A   middle-aged   man  came  complaining 

ss  of  the  soles  of  the  feet,  but  worse 

The  left  sole  was  found  to  be  the  seat  of  a  perforating 

mi  a  somewhat  advanced  stage  ;    it  was  situated 

lie  metatarsal  bums  and  was  as  large  as  a  half- 

o.     Trie   ulcer  on   the   right   sole   was   in   a   less 

i.mdition,  ms  had  existed  for  some 

re  the  patient 

ited  out  that  in  all  probability  the  case 

,ne  of  locomotor  ataxy  ;    no  knee-jerk  could  be 

■  diner  side,  the  pupils  reacted  to  accommo- 

.1  not  to  light,  and    on    standing  with  the 

tn\  together  the  patient  at  once  began  to  sway,  and 

Hen  had  he  tint  been  supported.     There 

...  Lightning* pains  in  the  limbs,  and  no  inco-ordina- 

o(  movement  of  the  upper  extremities  could  be 

made  out. 

Special  Articles. 

BRITISH    SANATORIA    FOR    CONSUMPTION.— 
XXXI. 


[BY     OUR     SPECIAL     MEDICAL      COMMISSIONER.] 

THE  ROYAL  NATIONAL  HOSPITAL  FOR  CON- 
SUMPTION,  VI.NJNdK,  ISLE  OF  WIGHT, 
VSM  Royal  National  Hospital  for  Consumption  and 
i  the  Chest  was  founded  mainly  through  the 
,ns  of  the  late  Dr,  Arthur  Hill  Hassall  in  1867, 
The  original   block,   accommodating  twelve  ^patients, 
was  opened  in    1869.     The  last  of  the  eleven  blocks,  of 
nstitution  at  present  consists,  contains  rooms 
lor   twenty- one  cases,    and  was  completed   in   1889. 
the  hospital  now  forms  an  imposing  series  of  houses, 
accommodation  for  i  54  patients,  ninety-two 
>ms  being  available    for  men  and  sixty-two  for 
*<imen. 
The  hospital  is  admirably  situated  in  the  sheltered 
■  id  Underciiff,  about  a  mile  west  of  Ventuor, 
iiu!  overlooking  the  English  Channel.     This  district  of 
!c  of  Wight  has  long  been  noted  for  its  suitability 
lor    many     chest     cases,     and     although     recent     ex- 
;    sanatorium    life   in    various  parts  of   the 
British   Isles   has   gune   far   to   modify   Opinion   on    the 
special  advantages  of  particular  climates  in  the  manage- 
ment of  phthisical  cases,  it  must  be  admitted  that  the 


Vent  nor  district  presents  not  a  few  advantages.     The 
Lai  is  well  protected  on  the  north  by  trees,  a  well- 
1  wooded  slope,  green  sand  cliffs  and  lofty  chalk  downs  ; 
it  is  also  sheltered  to  some  extent  on  the  east  and  west, 
but  to  the  south  it  lies  open.      It  is  only  som»:  three 
red  yards  from  the  sea,  and  its  elevation  is   but 
eighty    feet*     The   soil   is   mainly  sandy*     There   are 
about  twenty-two  acres  of  ground.     Generally  speak- 
ie  climatic  conditions   may  be  characterised   as 
mild  and    humid,    with   considerable   sun   and   a   com- 
paratively small  amount  of  rainfall.     Many   find   the 
place    relaxing.     Some    consider    the   district    unsatis- 
factory  for   throat   c 

The  institution,  although  it  still  retains  its  name  of 
'hospital/1  has  for  long  occupied  a  prominent  position 
I  pioneers  in  the  application  of  hygienic  methods. 
As  far  as  possible  it  is  conducted  on  modern  sanatorium 
hues.  For  many  years  great  insistence  has  been  made 
on  open-air  procedures,  The  hospital  has  been  1 U  signed 
mil  constructed  00  the  separate  principle;  each 
patient  is  supplied  with  a  sleeping  apartment*  There 
are  eleven  blocks  ;  most  of  them  have  been  erected  by 
private  friend,-,  and  practically  form  separate  and 
complete  houses  ;  each  bears  a  distinct  name,  usually 
that  of  the  donor  or  some  relative  whose  name  is  asso- 
ciated therewith  M  111  memoriam  "  All  the  blocks 
are  connected  by  a  spacious  subway.  Each  block  is 
well  constructed  of  brick  and  stone  and  is  slated* 
There  is  a  covered  verandah  along  the  ground  floor, 
and  covered  wooden  balconies  to  all  but  the  topmost 
storeys.  The  patients*  apartments  are  all  on  the  south. 
The  ground -floor  is  used  for  day  rooms.  The  adminis- 
trative block  is  No*  9.  and  has  a  large  and  elegant 
dining-hall,  pleasantly  decorated  and  well  lighted, . 
and  with  a  convenient  stage  for  entertain  men  ts.  There 
is  also  a  large  orchestron  and  portrait  «f  Dr,  Hassall, 
1  he  founder  of  the  hospital.  The  men  and  women 
dine  together*  but  at  separate  tables,  and  it  is  only  in 
the  dining-hall  or  at  chapel  that  the  sexes  are  supposed 
to  have  any  opportunity  of  communication.  Jn 
the  grounds  there  is  a  sharply-de fined  dividing  line. 
No.  9  block  contains  consulting  rooms,  dispensary, 
board  room,  medical  officers'  quarters  and  kitchen. 
The  newest  portion  of  the  hospital  is  the  Bat  ten  berg 
block.  No*  tt,  which  is  thoroughly  modem,  with  its  teak 
floors  and  staircases, walls  of  Parian  cement  and  rounded 
,  well-designed  doors  and  windows  and  wide 
oe*  of  iron  sufficiently  wide  to  allow  a  bed  to  be 
wheeled  out  01  to  them. 

Nowadays  the  open-air  method  is  strictly  carried 
ant  There  are,  however,  elaborate  arrangements  for 
the  collection  of  impure  air  and  the  admission  of  warmer 
air.  Heating  is  by  steam  pipes  and  radiators.  Electric 
lighting  is  employed  in  all  parts. 

The  following  are  among  the  rules  : — 

"  Patients  shall  rise  at  8  a.m.,  and  go  to  bed  at  9  p.m.* 
lights  to  be  all  extinguished  half  an  hour  after  retiring. 

•*  The  hours  for  meals  are  :  Breakfast.  8.30  a.m.  ■ 
dinner,  1  p.m.;  lea,  ;  p.m.  ;  supper,  8  p,m.  These 
hours  must  be  punctually  observed,  and  no  one  must 
be  absent  from  any  meal  without  the  sanction  of  the 
ut  medical  officer. 
I 'atients  are  strictly  forbidden  to  enter  public  houses, 
OT  Otnar  places  where  intoxicating  liquors  are  sold, 
nr  to  partake  of  any  liquor  not  ordered  and  provided 
h\  the  hospital  authorities.  Summary  dismissal  will 
be.  incurred  by  infringement  of  this  rule, 

"  Patients  are  prohibited  from  bringing  into  the  hospi- 
tal, or  receiving  from  without,  any  article  of  food  or 
drink. 

"  Smoking  is  permitted  in  the  lower  terraces  and  in  the 
shelter  provided  there,  also  on  the  walks,  but  only  at 
times  sanctioned  by  the  resident  medical  officer. 

"  Card-playing  and  gambling  of  every  description  is 
strictly  prohibited/' 

Open-air  treatment  is  systematically  enforced.  Strict 
hygienic  precautious  are  taken;  and  as  far  as  possible, 
the  patients  are  instructed  in  the  conduct  of  a  healthy 
life.  Baths  are  employed,  and  those  in  the  newer 
blocks  are  good.  Various  drugs  are  employed  as  re- 
quired.    There  is  a  good  dispensary  and  a  very  capable 


Ii6    Thb  Mbdical  Press.        TRANSACTIONS  OF  SOCIETIES. 


lady  dispenser,  who  also  acts  as  recorder  of  the  mete- 
orological observations.  There  is  a  general  superin- 
tendent and  a  chaplain,  who  are  non-resident,  and  a 
resident  medical  officer  and  three  assistant  medical 
officers,  a  matron,  and  staff  of  eighteen  nurses.  The 
honorary  medical  staff  consists  of  five  consulting  phy- 
sicians, four  "  physicians  in  London,"  three  "  physi- 
cians in  Ventnor,"  one  local  surgeon,  and  there  are  also 
two  analysts. 

The  institution  is  directed  by  a  somewhat  com- 
plicated series  of  committees,  which  meet  in  London  and 
Ventnor. 

The  hospital  opens  its  doors  to  all  applicants  without 
distinction  of  creed  or  sect.  Cases  are  received  from 
all  parts  of  the  United  Kingdom.  Over  19,000  patients 
have  been  admitted.  Cases  eligible  for  admission  are 
those  which  are  in  an  incipient  or  early  stage  of  disease 
or  arrested  if  in  the  later  stages.  Patients  must  be 
necessitous,  and  not  in  a  position  to  defray  the  entire 
cost  of  maintenance  and  medical  treatment,  but  not 
in  receipt  of  parochial  relief.  Applicants  for  ad- 
mission must  be  provided  with  a  letter  of  recommenda- 
tion from  a  governor  and  a  medical  certificate,  and  if 
admitted  will  be  required  to  pay  ten  shillings  a  week.  We 
recommend  a  careful  study  01  the  last,  or  thirty-fourth, 
annual  report,  which  contains  much  matter  of  interest, 
including  a  valuable  report  on  the  mortality  in  England 
and  Wales  from  pulmonary  phthisis  and  other  diseases 
of  the  respiratory  system,  by  Dr.  John  Tatham.  of 
the  Registrar-General's  Office,  Somerset  House.  The 
report  is  well  illustrated,  and  we  commend  its  perusal 
to  all  medical  men  who  desire  to  send  cases  to  the 
Royal  National  at  Ventnor. 

{Transactions  of  Societies. 


EDINBURGH  MEDICO-CHIRURGICAL  SOCIETY. 
Meeting   held   January   20TH,    1904. 


Mr.  Chiene,  President,  in  the  Chair. 


The  meeting  was  devoted  to  a  discussion  on  the 

DIAGNOSIS     AND      INDICATIONS     FOR     OPERATION      IN 
ACUTE    APPENDICITIS, 

which  was  opened  by  a  paper  by  Dr.  W.  Russell,  an 
abstract  of  which  will  be  found  on  page  112. 

Mr.  J.  M.  Cotterill,  speaking  from  the  surgical 
standpoint,  said  that  the  difficulty  was  to  dia- 
gnose the  exact  condition  of  the  appendix,  the  pos- 
sibilities being  so  many,  and  often  complicating  one 
another.  The  three  cardinal  symptoms  were  pain, 
tenderness,  and  rigidity  of  the  abdominal  walls. 
Pain  was  usually  first  in  the  right  iliac  fossa,  then  um- 
bilical, and  in  a  few  hours  appendicular  once  more. 
Pain  increasing  after  thirty-six  hours  indicated  block- 
age, perforation  or  gangrene.  He  deprecated  the 
use  of  opium  ;  pain  so  severe  as  to  require  a  narcotic 
was  a  reason  for  surgical  intervention.  Gradual 
diminution  of  pain  generally  meant  improvement ; 
its  sudden  disappearance,  gangrene,  especially  if  the 
other  symptoms  continued,  in  which  case  a  cessation 
of  pain  was  a  very  bad  sign.  Pain  associated  with 
frequency  ot  micturition  generally  indicated  that  the 
appendix  was  in  the  pelvis.  As  to  deep  tenderness, 
care  must  be  exercised  in  palpation  lest  rupture  be 
caused.  Rigidity  of  the  right  lower  quadrant  of  the 
abdomen  was  usually  progressive  ;  it  was  not,  how- 
ever, a  very  early  symptom.  Spread  of  rigidity  was 
a  sign  of  peritonitis.  Vomiting  was  a  very  common 
initial  symptom  ;  if  it  continued  after  the  first  twelve 
hours  that  was  a  bad  sign.  While  constipation  was 
the  rule,  uncontrollable  diarrhoea  might  be  met  with. 
Along  with  vomiting,  diarrhoea  was  unfavourable. 
If  obstruction  and  tympanitis  were  present  the  case 
was  usually  past  surgical  measures.  A  moderate 
temperature  of  1020  or  1030,  falling  on  the  third  or 
fourth  day,  was  favourable  ;  a  fall  with  a  rapid  pulse 
was  the  reverse,  while  a  high,  remitting  temperature 
usually  indicated  sepsis.  He  looked  on  the  pulse  and  the 
nature  of  the  vomiting  as  the  most  trustworthy  signs'; 


Feb.  3,  1504. 

rtt!Lcrig0rS  meant  «an^ene  or  perforation  ;  leuco- 
cytosis  was  suggestive,  but  not  conclusive.  The 
iSZul***  alS°  a  helP'  lt  was  <&**  imposs  ble  to 
l^er  L^HPtUre'SinCe  aU  the  bad  symptoms  develop^ 
Thf  k  w     in    V"*"*****  of    rupture  or  gangreV 

2T££  '  wS°H0r  0perati°n  were  :  (OMmu- 
ing  cases,  which,  however,  were  rare;    (2)  in  acute 

cases  vomiting  after  the  first  twelve  hours,  pulse  of 
100  or  over,  falling  temperature  without  general  im- 
provement,  sudden  cessation  of  pain.  Delay  miKht 
be  safe  in  cases  of  gradual  onset,  with  tumour,  and 
with  slow  pulse.  The  mortality  in  surgical  cases  was 
2l  Kfr  °f,nt'  The  most  imP<>rtant  question  was 
whether  all  cases  should  not  be  operated  on  within 
twenty-four  or  thirty-six  hours,  irrespective  of  their 
seventy.  This  could  onlv  be  decided  by  a  statistical 
determination  of  the  risks  attending  early  operation 
tor  which  materials  were  as  yet  wanting.  If  the  mor- 
talitv  was  no  higher  than  bv  the  expectant  method 
then  undoubtedly  all  cases  should  be  treated  surgically! 

Dr.  Haldane  discussed  the  medical  treatment  shortly. 
He  advised  calomel  and  salol  as  an  intestinal  anti- 
septic m  the  early  stages.  Leeches  relieved  the  pain 
effectually,  and  so  did  hypodermic  injections  of  strych- 
nine. 

Mr.  Crawford  Renton  (Glasgow)  divided  acute 
appendicitis  into  three  groups  of  cases  : — (1)  Ordinary 
catarrhal,  unaccompanied  by  swelling  ;  (2)  acute  cases 
with  swelling,  which  might  resolve  or  suppurate ;  (3) 
perforating  cases.  Catarrhal  cases  might  about  the 
fifth  or  sixth  day  give  rise  to  exudation  or  become 
gangreneous,  therefore  the  risk  of  this  happening  was 
greater  when  catarrhal  cases  were  allowed  to  go  over 
the  third  day.  Ought  this  risk  to  be  run  ?  Personally, 
Mr.  Renton  inclined  to  remove  the  appendix  earlv, 
even  in  catarrhal  cases  ;  if  they  were  not  seen  till 
after  the  third  day,  tailing  urgent  symptoms,  he  pre- 
ferred waiting  till  the  quiescent  period.  It  was  most 
important  to  watch  the  pulse  and  temperature, 
especially  about  the  fifth  and  sixth  day,  when  perfora- 
tion or  suppuration  was  most  likely  to  occur.  When 
a  patient  once  had  an  attack  of  catarrhal  appendicitis 
he  thought  he  ought  never  to  be  allowed  out  of  bed 
without  being  operated  on.  Leucocytosis  he  thought 
a  valuable  addition  to  the  other  signs. 

Dr.  J  ames  Ritchie  said  that,  apart  from  cases  he  had 
had  operated  on,  he  had  only  had  one  death,  so  that  his 
views  as  to  the  severity  ot  the  disease  must  be  different 
from  a  surgeon's,  who  saw  only  the  worst  cases. 
Appendicular  colic  was  in  reality  often  a  catarrh  ot 
the  colon  or  oecum.  The  diagnosis  of  appendicitis 
might  be  very  easy  or  very  difficult;  it  was  very  essentia 
to  examine  the  whole  of  the  abdomen.  As  diagnostic 
difficulties,  he  mentioned  cases  ot  colitis,  gastric 
catarrh  with  rheumatism  of  the  abdominal  parietes, 
and  perforation  of  the  stomach  with  passage  ot  the 
gastric  contents  into  the  pelvis.  Fulminating  cases, 
and  cases  attended  with  sudden  pain  and  shock,  should 
certainly  be  operated  on  ;  quiescence  of  the  symptoms 
was  often  very  deceptive.  Opiates  ought  only  to  be 
given  after  a  definite  decision  as  to  whether  or  not 
operation  was  required  had  been  come  to.  After 
recovery,  if  there  was  absolutely  no  tenderness  re- 
maining, he  did  not  think  operation  was  indicated. 

Mr.  Caird  thought  they  could  best  understand  the 
symptoms  of  appendicitis  by  comparing  them  with 
affections  of  other  parts  of  the  intestine.  They 
were  very  much  the  same  as  that  following  strangulation 
of  a  knuckle  of  colon,  involving  only  a  part  of  its 
circumference,  and  not  causing  mechanical  obstruction. 
In  the  same  way  other  cases  of  appendicitis  might  be 
compared  with  partial  occlusions  of  the  intestine  by 
swelling  and  the  presence  of  a  foreign  body.  In  anV 
case,  whether  the  affection  was  of  the  appendix  or  of 
another  part  of  the  intestine,  the  result  was  a  localised 
paralysis  of  the  bowel  which  gave  rise  to  the  sym- 
ptoms. The  diarrhoea  which  was  sometimes  met 
with  was  comparable  to  that  accompanying  strangu- 
lated hernia,  and  was  due  to  the  emptying  of  the  bowel 
below  the  lesion.     Pain  referred  to  the  urethra,  with 


IQ04- 


TRAXSACTIONS  OF  SOCIETIES. 


*l  micturition,  was  probably  as  a  rule  reflex, 

might  be  due  m  some  cases  to  the  appendix 

•  lipping  down  into  the  pelvis.     As  to    the  question  of 

EiOU,  he  point  eel  ou  t  that  recovery  always  meant  a 

L'ed  appendix,  though,  to  be  sure,  dense  adhesions 

I  to  some  extent   protect  against  future  perfora- 

He  gave   details   of   several   cases  illustrating 

'  ski  pies  of  operation.     As  to  the  question  of  early 

um  in  all  attacks,  the  point  on  which  information 

wis  needed  was.  How  many  patients  have  one  attack, 

nut  no  more  ? 

Or.  Burn  Murdoch  gave  a  lyiiopais  of  the  sym*  j 

on  which  he  relied  for  diagnosis,  and  alluded  | 

illy  to  the  difficulty  in  distinguishing  append i-  , 

in  some  cases.     He  thought  there 

perityphlitis   and     typhlitis 

Vs    to    the     indications     for   operation,    he  ' 

only  say  that  he  had  never  had  a  case  treated 

ally  but  that  he  was  glad  afterwards  for  having 

he  had  often  regretted  delaying  opera - 

Speaking  generally,  he  was  becoming  more  and 

favourable  to  early  operation  as  years  went  on, 

-  own  experience  single  attacks  were  rare,  and 

common, 

IE*  said  he  proposed  to  limit  his  remarks  to 

appendicitis  in  children.     He  very  seldom  had  operated 

patients  in  the  intervals,  for,  as  a  rule,  the 

itack  was  very  serious.    His  rule  was  always  to 

-•'   in   a  definite   acute   appendicitis   in   a   child. 

Fulminating  and  acute  cases,  the  latter  rapidly  going 

suppu  rat  ion,  were  relatively   very   common   in 

n,    catarrhal    appendicitis    being    much    rarer, 

The  chief  guide  was  $uddcnn*$s  of  onset*     Pain  in  the 

men    and    vomiting,    and    especially    persistence 

Ol  vomiting,  were  most  important  indications.     Next 

rn  lie  placed  the  pulse,  not  so  much  its  rate,  which 

wat  OS  r  1 20 1  as  Us  character.      The  tempera- 

,\s  little  guide.      As   lo  the  examination  of  the 

men,  pain   and   resistance  were  difficult  to  1 

nation  should  be  carried  out  under 
hetic.     The    conditions     usually     mistaken 
nh  other  were  intussusception  and  appendicitis, 
fnptoms  were  really  different  j    in  lntussus- 
patient  was  quiet  and  happy  in  the  intervals, 
•pendicitis   miserable    the  whole    time.  Ex- 
under    chloroform    would    never    fail    to 
tumour  in   intussusception,  while  in  appen- 
Ineas  could  usually  be  made  out  per  rectum. 
uklren  early  operation  within  twenty-four  hours 
native  :    by   iorty-eight    hours  the  case  was 
His' rule  was  to  operate  on  every  case 
ate  onset  in  which  any  symptom  persisted* 
lisease  was  rare  in  the  period  Or  tirst  dentition, 
diierential  diagnosis,  the  conditions  which  were 
likely  to  give  rise  to  error  were  peritonitis  from 
eons    tuberculous    glands,    abdominal 
ith   an  acute    exacerbation  of    some    kind, 
inflammatory  conditions  of  the  base  of  the  right  lung 
leura,   pneumococcal  peritonitis,  and  strangula- 
tion ol  a  Iffeckel'i   diverticulum, 
Dr.  A.FFLECK  reminded  the  Society  of  a  discussion  mi 
ich  had  taken  place  there  eleven 
sis  was  not  always  easy  ;  in  his  opinion 
two  principal  causes  ot  fallacy  were  enteric  fever 
tuberculous  peritonitis.      He  had  seen  many  1 
*ith quite  latent  symptoms  in  which  the  patients  had 
I  about  for  several  days  after  the  onset  of  sy (ti- 
de had  ever  seen  recover  had 
been  .ture,   the  appendix  being  gangrenous 

-n  full  of  pus  at  the  time  of  the  opera - 
M.ceedecl   first   by  pneumonia,  and 
thereafter  bv  general  septicemia, 

1  referred  to  the  value  of  the  glycogen 
reaction  as  a  guide  lo  the  occurrence  of  suppuration. 
Dr.  Russet  l  replied  lo  the  discussion. 

The  Duke  of  Maklborough  has  consented  to  take 

•  hair  at  a  meeting  at  the  West  India  Committee 

ftooras,  on  Tuesday,  March  3th.  at  3.45,  when  a  paper, 

rated  by  limelight  lantern,  on  '*  Tropical  Diseases" 

wtSl  be  read  by  Sir  Patrick  Mansom 


Tag  Medicax  Press.     HJL_ 

WEST  LONDON  MEDICO-CHIRURGICAL 
CtETY. 

Clinical  Meeting  meld  Friday,  January  8th,  1904. 


The  President,  Dr.  Seymour  Taylor,  in  the  Chair, 


Dr.  Leonard  C,  Dobson  showed  a  case  of 

LVMP  HQ-S  A  RC  OKA . 

The  patient,  a  man,  aH.  44,  had  suffered  a  year  from 
severe  pains  in  the  left  occipital  region,  followed  by 
enlargement  of  the  cervical  glands  on  the  same  side, 
those  on  the  right  side  becoming  enlarged  some  three 
months  later.  Three  months  after  he  complained  of  a 
bloody  discharge  from  the  pharynx  accompanied  by 
some  "fleshy  lumps/'  and  rapidly  lost  weight,  tie 
attended  the  out-patient  throat  department  of  the 
hospital  in  November,  iooj.  Up  to  that  time  the 
glands  were  more  than  twice  their  present  size,  and  he 
large,  soft  growth  occupying  the  position  of 
Luschka's  tonsil,  which  bled  profusely  on  examination, 
and  broke  down  on  the  slightest  pressure.  There  was 
no  his  1  I  110  other  glands  in  the  body 

were  enlarged*  The  case  was  referred  lo  Mr.  C  his  holm 
Williams  lur  treatment,  and  under  two  exposure 
the  X-rays  weekly  had  improved  o  nsuierabty.  The 
diagnosis  had  at  first  been  lymph -adenoma  with 
lymphoid  growth  in  the  pharynx,  but  the  fact  that 
i.i<  no  other  enlarged  glands  in  the  body,  the 
persistent  loss  of  weight,  and  the  nature  of  the  pharyn- 
geal tumour  seemed  to  point  to  lymphosarcoma  as 
the  true  solution, 

Mr.  E.  Percy  Paton  considered  it  unfortunate, 
(hough  unavoidable,  that  no  microscopical  examina- 
I  lion  had  been  possible  to  iletermine  the  nature  of  the 
growth  in  the  pharynx.  Should  it  be  really  lympho- 
sarcoma* it  should  not  be  forgotten  that  in  such  cases, 
quite  apart  from  treatment,  there  was  frequently  great 
variation  (rum  time  to  time  in  the  size  of  the  growths. 

Mr,  G.  A.  Gamy  Simpson  showed  a  patient  in  whom 
he  had  ligatured  the  internal  saphenous  vein  for  old- 
slandiug  varix  complicated  by  thromhosis.  The  vein 
was  ligatured  close  to  the  saphenous  opening,  and  in 
addition  two  masses  of  thrombosed  veins  were  lied 
above  and  below  without  removal  of  the  intervening 
portion.     The  result  has  been  highly  satisfactory* 

Mr.  McAdam  ECCXXS  I  niyra  tula  ted  Mr.  Garry 
Simpson  on  the  eminently  satisfactory  result  in  his 
case.  He  considered  that  in  cases  of  venous  throm- 
bosis the  vein  at  the  actual  site  of  the  phlebitis  should 
not  be  disturbed,  but  ligature  of  the  inte-rnal  sapheua 
ro  the  saphenous  opening  was  quite  justifiable, 
ally  with  a  view  to  the  prevention  of  detachment 
and  movement  of  clot, 

Mr,    E.    Percy    Paton    thought    that    the    course 
followed  by  Mr.  Garry  Simpson  was  clearly  jus tihed 
by  the  result. 
*  The  President  showed  a  case  of 

SARCOMATOSIS    CUTIS 

in  a  man,  fet  St,  The  patient  complained  chiefly  of 
cough,  which  was  not  accompanied  by  expectoration- 
or  night  sweats.  On  further  examination,  tracheal 
stridor  was  noted,  and  the  cough  had  the  brassy 
character  associated  with  pressure  on  the  respiratory 
tract.  On  physical  examination  of  his  chest  nothing 
further  than  distinct  increase  of  the  breath  sounds 
and  vocal  fremitus  and  resonance  on  the  right  side 
could  he  detected.  Laryngoscopic  examination  showed 
nothing  abnormal*  On  the  trunk  numerous  tumours— 
Upwards  of  forty — were  to  be  seen.  They  varied  in 
size  from  that  of  a  pea  to  that  of  a  small  orange,  most 
being  about  ine  size  of  a  small  walnut.  The  smallest 
were  ivi  inherent  to  the  skin,  but  very  soon  the 
cutaneous  structures  appeared  to  be  involved,  and  a 
few  of  the  larger  had  come  to  the  surface  and  prcseuted. 
a  granular  duU  red  surface,  dry  and  free  fooifi  mis 
exudation  or  discharge.  The  head,  neck,  and  IS 
were  free  from  growths.  The  diagnosis  lay  between 
mycosis  fungotdes  and  multiple  sarcoma  of  the  skin, 
I Fiit  in  view  of  the  fact  that  there  has  been  no  antecedent 
skin  disease  as,  e.g.,  eczema,  Dr.  Taylor  was  inclined  to 
'  the  latter  opinion.     No  primary  source  r.ther  than  the 


Il8    Ths  Medical  Psess. 


TRANSACTIONS  OF  SOCIETIES. 


Feb.  3.  1904- 


probable  intrathoracic  new  growth  had  been  discovered. 

Mr.  E.  Percy  Paton  referred  to  three  similar  cases 
which  he  had  seen.  In  each  of  these  the  primary 
growth  appeared  to  be  in  the  testis,  and  in  each  extra- 
ordinary rapid  increase  in  size  of  the  skin  tumours  was 
a  marked  feature. 

Dr.  Arthur  Whitfield  believed  that  the  case  was 
not  one  of  mycosis  fungoides.  He  thought  it  probable 
that  the  case  was  one  of  primary  sarcomatosis  cutis,  a 
very  rare  disorder,  but  that  all  possible  situations  for  a 
primary  growth  should  nevertheless  be  investigated, 
as  he  remembered  a  case  in  which  somewhat  similar 
growths  were  proved  after  death  to  be  metastases  from 
an  insignificant  prostatic  tumour  of  carcinomatous 
type. 

The  President  showed  a  girl,  aet.  19,  who  had  been 
under  his  care  in  hospital  for  eight  weeks.  She  was 
sent  in  as  a  case  of  advanced  phthisis,  and  was  ex- 
tremely emaciated  on  admission,  her  weight  being  just 
over  four  stones.  No  evidence  of  tuberculosis  or  other 
organic  affection  was  discovered,  and  the  case  was 
recognised  to  be  one  of  anorexia  nervosa  as  described 
*nd  figured  by  Gull  and  others.  The  treatment  con- 
sisted of  careful  dieting,  at  first  by  means  of  the  nasal 
tube,  as  food  was  systematically  refused,  and  later  by 
giving  small,  easily  digestible  meals  at  frequent  intervals. 
In  addition,  cod-liver  oil  was  given  in  teaspoonful 
-doses  thrice  daily.  Improvement  was  steady  and  con- 
tinuous, and  when  she  left  hospital  she  had  improved 
immensely  in  appearance  and  in  general  strength,  and 
had  gained  very  considerably  in  weight. 

Dr.  Rice  Oxley  referred  to  several  similar  cases 
which  had  been  under  his  care.  They  were  all  oi  a 
distinctly  *'  nervous  "  type  ;  they  all  ran  a  long  course  ; 
and  in  all  careful  dieting,  together  with  massage  and 
•electricity,  eventually  effected  a  cure. 

Dr.  Leonard  C.  Dobson  suggested  the  use  of  high- 
frequency  electrical  currents  in  the  treatment  of  this 
and  similar  cases,  especially  if  skilled  massage  were 
unavailable. 

Mr.  A.  V.  Hamilton  (for  Mr.  C.  B.  Keetley)  showed 
a  child  with  tuberculous  disease  of  the  spine,  presenting 
two  foci  of  disease  with  angular  curvature — one  in  the 
cervical  and  the  other  in  the  dorso-lumbar  region. 

THE  LARYNGOLOGICAL  SOCIETY  OF  LONDON. 
Meeting  held  Friday,  January  15TH,  1904. 


The  President,  Dr.  P.  McBride,  in  the  Chair. 


Dr.  W.  H.  Kelson  showed  (1)  a  case  of  deformity  of 
fauces  in  a  woman  ;  (2)  a  case  of  epithelioma  in  the 
cricoid  plate  region  in  a  woman,  aet.  30. 

Dr.  A.  Logan  Turner  showed  a  case  of  affection 
of  the  palate  and  larynx  in  a  man.  The  patient  suf- 
fered from  oedema  and  infiltration  of  the  uvula,  left  half 
of  the  soft  palate  and  left  lateral  wall  of  the  pharynx. 
There  was  infiltration  of  the  epiglottis  and  both  aryte- 
noid regions.  He  considered  the  condition  analogous 
to  certain  cases  which  Sir  Felix  Semon  had  shown 
at  the  previous  meeting. 

The  case  was  discussed  by  Dr.  P.  McBride,  Sir 
Felix  Semon,  and  Dr.  Dundas  Grant. 

Mr.  Atwood  Thorne  showed  a  case  of  malignant 
disease  of  the  nose  in  a.  man,  aet.  70. 

Mr.  H.  B.  Robinson  showed  (1)  a  case  of  syphilitic 
necrosis  of  the  sphenoid  bone  ;  (2)  a  case  of  left  ab- 
ductor paralysis  in  a  male,  aet.  31  ;  (3)  a  case  of  sy- 
philis of  the  posterior  part  of  the  tongue  and  posterior 
pharyngeal  wall. 

Dr.  L.  H.  Pegler  showed  a  case  of  crumpled  septum 
in  which  he  had  erased  the  hard  structures  four  years 
ago,  and  in  which  the  intact  mucous  perichondrium 
remained  unstiffened. 

Mr.  P.  de  Santi  showed  (1)  a  case  of  laryngeal  ver- 
tigo ;  (2)  a  man  with  tertiary  syphilis  of  the  larynx 
-causing  stenosis,  on  whom  thyrotomy  had  been  per- 
formed four  years  ago  with  satisfactory  results. 

Dr.  StClair  Thomson  showed  (1)  a  case  of  com- 
plete paralysis  of  the  left  vocal  cord  in  a  woman,  aet.  36  ; 
<2)  and  (3)  cases  of  bleeding  polypus  of  the  septum. 

Mr.  H.  T.  Butlin  showed  a  specimen  of 


epithelioma   of   the   cricoid    plate   and    of   the 

oesophagus 
removed  by  operation.  The  patient  was  a  man,  aet.  44, 
with  a  large  smooth  red  tumour  at  the  back  of  the 
larynx,  almost  confined  to  the  left  side,  involving 
the  whole  of  the  ary-epiglottic  fold,  but  not  encroaching 
to  any  extent  on  the  interior  of  the  larynx.  There  was 
a  very  large  mass  of  glands  on  the  left  side  of  the  neck 
so  intimately  associated  with  the  sterno-mastoid  that 
their  removal  could  only  be  carried  out  by  removing 
almost  the  whole  of  the  muscle.  The  disease  had 
started  ten  months  previously  as  a  curious  catch  in 
speaking.  For  four  months  there  was  a  difficulty  in 
swallowing,  and  when  first  seen  by  Dr.  Butlin  the 
patient  could  only  swallow  with  pain,  and  the  voice 
had  just  become  husky.  The  age  and  immense 
strength  of  the  patient,  and  the  fact  that  Professor 
Gluck's  successful  operations  for  what  would  have 
appeared  to  be  hopeless  conditions  of  malignant  disease 
of  throat  and  neck,  induced  him  to  put  the  matter 
before  the  patient,  who  decided  in  favour  of  operation. 
An  extremely  extensive  operation  had  to  be  performed, 
necessitating  removal  of  the  whole  internal  jugular 
vein,  the  glands  of  the  neck,  and  the  whole  of  the 
sterno-mastoid  muscle  on  that  side.  The  patient 
made  an  excellent  recovery,  but  within  two  months 
the  disease  had  recurred.  He  had  operated  on  another 
case  of  the  same  sort,  but  within  a  week  the  patient 
died  suddenly  from  profuse  haemorrhage,  probably  from 
the  carotid. 

The  case  was  discussed  by  Dr.  McBride,  Sir  Felix 
Semon,  and  Dr.  Watson  Williams. 

Mr.  F.  C.  Shrubshall  (for  Dr.  P.  Kidd)  showed  a 
patient  suffering  from  a  tuberculous  outgrowth  from 
the  anterior  end  of  the  left  vocal  cord. 

Dr.  Dundas  Grant  showed  (1)  a  case  of  sessile 
fibromata  at  the  anterior  extremity  of  the  left  vocal 
cord  partially  removed  by  means  of  forceps  and  com- 
pletely extirpated  by  the  galvano-cautery  ;  (2)  a  case 
of  atrophy  and  collapse  of  alae  nasi  treated  by  means  of 
a  subcutaneous  injection  of  paraffin.  A  note  of 
warning  was  sounded  by  some  speakers  as  to  the  dan- 
gers that  might  accrue  after  the  injection  of  paraffin  ; 
(3)  photographs  of  a  case  of  flat  and  sunken  nose  treated 
by  paraffin  injections. 

Mr.  Hunter  Tod  showed  a  case  of  soft  fibroma  of 
the  left  vocal  cord  in  a  woman,  aet.  31  ;  (2)  a  case  of 
sarcoma  of  the  post-nasal  space  probably  involving: 
the  ethmoidal  region,  with  enlargement  of  the  cervica 
glands  on  the  right  side  in  a  man,  aet.  51.  The  general 
expression  of  opinion  was  that  operation  was  imprac- 
ticable. 

Dr.  Watson  Williams  showed  a  man,  aet.  42,  with 
an  interlaryngeal  new  growth. 


THE  SOCIETY  FOR  THE  STUDY  OF    DISEASE 

IN    CHILDREN. 

Meeting  held  January  15TH,  1904, 


Dr.  Porter  Parkinson  in  the  Chair. 


Dr.  Eric  Pritchard  showed  a  case  of  transposition  of 
the  viscera  in  a  girl,  aet.  12.  The  heart,  liver, 
stomach,  and  spleen  were  transposed.  The  child  had 
been  delicate  since  birth,  and  had  at  one  time  been 
treated  for  enlargement  of  the  spleen,  owing  to  the 
liver  having  been  mistaken  for  that  organ.  In  reply 
to  questions.  Dr.  Pritchard  said  the  girl  was  undoubtedly 
deficient  mentally,  and  that  he  would  have  a  skiagram 
taken  to  see  whether  the  aortic  arch  was  on  the  right  side. 

Dr.  Pritchard  also  showed  a  case  of  congenital 
absence  of  the  left  arm  in  a  girJ,  aet.  15.  The  stump 
ended  about  two  inches  below  the  elbow  in  a  small 
excrescence,  which  presented  the  appearance  of  a 
rudimentary  thumb  provided  with  a  nail.  He  re- 
garded the  case  as  one  of  arrested  growth  during  an 
early  stage  of  development  by  a  fibrous  band  which 
partially  strangulated  the  growing  extremity. 

Dr.  Hawthorne  said  that  there  were  many  cases 
which  presented  processes  in  the  stump  ;  he  had  seen 
at  least  two  in  which  there  were  processes  that  might 


Ttb,   %  igo4. 


I*  claimed    to  be    digits.       In     one     of   these  there 
wen?  rive  processes, 

&  H.  Tt  bey  showed  a  case  of  sarcoma  with 
hrv    deposits  in  a  boy,   set.   2J.     Seven  weeks 
received  a  knock  on  the  left  leg. 
afterwards   the  muther  noticed   a   swelling 
which  was  poulticed.     Three  igo  he  was 

again  struck  on  the  same  teg,  and  also  fell,  striking  his 
head.     He  now  presented  a  definite  tumour  over  the 
ttachod  to  the  fibula,  and  a  smaller  tumour 
the  right  parietal  bone.     The  left  inguinal  and 
lands  formed  a  large  adherent  mass,  but  were  not 
Tender*     In  i83q  Mr.  Tubby,  in  a  paper  published  In 
■',    had   pointed   out    the   direct   relation    oi 
traumatism  to  sarcoma  of  bone,  ami  he  thought   this 
now    generally    accepted.     The  growths  on  the 
I  head  both  followed  a  direct  injury.     He  thought 
/might  be  looked  on  as  separate  local  outbreaks  of 
It sord  er.     The  occ  urren  c  e  o  f  py  re  xi  al  a  t  tac  ks 
visual  unknown  in  cases  of  rapidly-growing  saro»in;i. 
1  might    complicate    the   diagnosis.     He    had    seen 
of  sarcoma  of  the  lower  end  of  the  femur  in  a 
J3.  where  the  temperature  reached  102°  F., 
iad  led  a  colleague  to  believe  that  it  was  a  case  of 
periostitis.       This     was     disproved     by    in- 
cision.    In  the  present  case  operative  treatment  was 
rot  available  owing   to    the   implication  of  the  glands. 
Mr  Lock  hart  Mummery  suggested  that  the  primary 
jnmh  might  have  been  in  the  glands  of  the  pelvis 
without  giving  any  external  signs. 
Mr    IYbby  also  showed  a  case  of  congenital  dis- 
on  of   the  fifth  cervical  vertebra  in  an  infant  of 
iths*     The  deformity   was   noticed   the  day 
after  a  normal   birth.     No  symptoms  had   been  ob- 
•  i    until   a   week   ago,    when    vomiting   occurred 
*oreraJ  limes  a  day.     At  the  base  of  the  neck  there 
was  a  sharp  bony  prominence,  which  corresponded  to 
ifthcervica  a     The  summit  of  this  process 

*m  formed    by    the   left    articular  process,   and    the 
is  process  could  be  felt  to  the  right  of  it.     On 
il    examination,   a   depression   could   be   felt 
the  affected  vertebra.     There  was 
afeii  ajogenital  scoliosis,  the  curve  being  to  the  right 
sal  region,  and  to  the  left  in  the  lumbar. 
•  ti genital  deformity  present  was  the  absence 
Tillages  of  the  nfthto  the  eighth  ribs  on 
ide  of  the  chest.     There  were  no  evidences  of 
Mr,  Tubby  regarded  the  case  as  one  of  dis- 
>n  of  the  vertebra. 
Dr.  Efttc  Peitch*ro  showed  a  specimen  of  congenital 
malformation  oi  the  heart. 

Dr.  T  M  PoRTBsctTB  Bhickdale  (Bristol) sho we 

following  specimens  :—  ( 1 J  Two  examples   of  congenital 

diltlation  of  the  ureters  and  hydronephrotic  kidneys, 

!iy  of  the  bladder  ,  and   {2)  two  sped* 

ot  tuberculous  ulceration  of  the  stomach. 

Dr.  George  Carpenter  showed  a  specimen  of  con- 

of  the  lung. 
Mr,  T  Howell  Evans  read  a  paper  on  I  he  relation  of 

CEHTAIN     EXTRA'    AND     INTRACRANIAL    HEMORRHAGES 
IN  THE  NEW-BORN. 

hat  these  hemorrhages  were  dependent 
lowing    factors;—  (1)     Irregularity    in     the 
Ling  of  the  Icetal  head  ;   {1)  this  irregularity  arises 
he  presence  of  accessory  sutures  in  the  situations 
tain    extracranial   Vessels   anastomose    with 
tracraniai  vessels;    and   (\)   the   rise  of  blood 
rs  during  the  react  ionarv  period, 
iii' I  is  recovering  from  the  birth"  trauma. 
he  noted  I he   facts   that 
ih«c  hemorrhages  occur  in  non-instrumental  labours, 
iiritly  in  breech  as  in  vertex  presentations, 
approximately  the  same  frequency  as  the 
accessory   sutures    referred    to.     In    a    normal    fcetal 
*lrtill  the  anastomosing  occipital  and  meningeal  vessels 
-xre  secure  from  Injury,  butwdienthe  accessory  sutures 
are  present  irregular  moulding  occurs  at  them  and  the 
b   lacerated.     The   author   illustrated    these 
anatomical  irregularities  and   the  allied   conditions  in 
Mtbropoid  apes  by  a  series  of  lantern  slii 
Dr.   m  tHLRLAND  said  that  this  subject  was  of  ex- 
interest  to  physicians  and  surgeons,  and  that  he 


TRANSACTIONS  OF  SOCIETIES.       Tmt  M,n,CAL  PrM3.    tVj 


considered  Mr.  Evans'  paper  uas  a  most  suggestive  one. 
Thev  met  with  cases  described  as  birth  palsies,  in 
which  the  labour  was  normal,  neither  too  prolonged 
nor  loo  rapid,  and  it  was  difficult  to  understand  how 
stich  cases  were  explained   by   the  ordinary  pressure 

Dr.  Hawthorne  said  that  any  theory  which  was 
to  account  fur  these  cases  of  intracranial  hemorrhages 
must  take  cognisance  of  the  fact  that  tbey  occurred 
in  cases  which  had  not  been  subjected  to  any  undue 
pressure,  some  cases  occurring  in  infants  born  at  the 
seventh   month. 

Dr.  W.  C  Chaffev  (Brighton)  read  a  paper  on 

THE  SEQUEL  OF  A  CASE  OF  EXTREME  WASTING. 

shown  at  a  meeting  in  July  last.  The  patient  was  a 
boy.  act.  10,  who  was  extremely  wasted,  refused  all 
solid  food,  but  drank  two  and  a  half  pints  of  milk 
daily,  and  presented  no  objective  signs  of  cerebral 
disease.  The  case  had  been  regarded  by  most  of  the 
members  as  one  of  hysteria.  In  October  he  developed 
bedsores,  had  attacks  of  headache  with  screaming, 
and  tonic  contractions  appeared  in  the  extremities* 
These  and  other  symptoms  fed  to  a  diagnosis  of  tumour 
cerebri  or  meningitis.  At  the  necropsy  there  was  found 
to  be  chronic  meningitis,  chronic  hydrocephalus,  and 
an  endothelial  tumour  about  the  size  of  a  *alnut 
attached  lightly  to  the  posterior  aspect  of  the  right 
optic    thalamus, 

Dr,  Carpenter  said  he  believed  that  not  only  might 
new  growths  be  started  by  traumatism,  hut  also  other 
diseases,  such  as  tuberculous  meningitis,  pneumonia, 
and  pleurisy. 


BRITISH  BALNEOLOGICAL  AND  CLIMATO^ 
LOGICAL  SOCIETY, 

An  Ordinary  Meeting  was  held  at  20  Hanover 
Square,  W-,  on  Wednesday,  January  20th,  at  8. 30  p.m.. 
the  President,  Dr.  Alfred  Street,  in  the  Chair, 

A  paper  was  read  and  a  demonstration  given  bv 
Dr.  W\  S,  HEDuvon  "  Physical  Therapeutics/1  an 
abstract  of  which  will  be  found  on  page  nj. 

The  President  said  he  was  particularly  struck  by 
the  judicial  moderation  of  the  claims  put  forward, 
and  inquired  whether  investigation  had  yet  been  made 
of  the  radio-activity  of  sea-water,  and  why  the  healing 
of  an  ulceration  caused  by  radium  sometimes  took  so 
long  as  six  months.  He  asked  for  information  as  to 
the  activity,  applicability,  and  mode  of  using  the 
plasters  containing  thorium  and  pitchblende,  which 
wTere  shown  by  Dr+  Hedlev. 

Dr,  Svmes  Thompson  drew  attention  to  the  value 
of  the  instruments  described,  by  which  the  quantity 
and  quality  of  the  forces  evolved  were  estimated  as 
likely  to  add  greaLly  to  the  precision  of  X-ray  thera- 
peutics. 

Dr.  Sansom  narrated  his  experience  of  the  high 
frequency  current  at  Aix,  and  how  a  great  authority 
then-  tin  night  little  of  them.  We  ought  to  be  very 
careful  to  differentiate  between  the  subjective  and 
the  objective.  There  was  much  of  glamour  abo  ut 
electricity,  but  the  radium  discovery  was  very  potent 
for  good  and  taught  us  that  there  Vas  much  yet  to 
learn. 

Dr.  Herschell  said  thai  he  could  not  agree  with 
Dr.  Sansom  that  the  results  of  high  frequency  appli- 
cations were  mainly  due  to  suggestion.  In  addition 
in  the  effect  upon  the  metabolism  of  the  body,  which 
might  be  disputed,  if  we  administered  the  current  from 
the  small  solenoid  with  a  spark  gap  in  the  circuit  wr 
should  obtain  muscular  contractions  equaling  those 
produced  by  the  induced  current  or  by  the  Morton 
current.  There  could  be  no  suggestion  about  that. 
the  effect  upon  haemorrhoids  also  was  a  visible  one  ; 
if  we  saw  a  pile  of  an  inch  in  diameter  shrink  to  half 
the  size  as  the  result  of  two  or  three  applications  of  a 
condenser  electrode  we  must  perforce  credit  the 
evidence  of  our  own  senses.  And  it  was  difficult  to 
understand  how  such  a  result  could  be  brought  about 
in  any  other  way  than  by  the  direct  action  of  the 
current  upon  the  tissues. 

Dr,  Groves  fCarisbruoke)  said  he  had  gathered  that 


120    Thb  Medical  Press. 


FRANCE. 


Feb.  3,  1904. 


the  X-ray  and  high  frequency  currents  were  powerful 
and  dangerous  agents,  about  the  action  of  which  very 
little  was  actually  known  by  some  of  those  who  practise 
this  form  of  therapeutics.  He  thought  that  careful 
experiments  should  be  made  in  public  institutions  by 
scientific  men,  and  any  positive  results  obtained  by 
them  given  to  the  profession. 

Dr.  Braithwaite  wished  to  know  whether  the  effect 
of  high  frequency  currents  in  rheumatoid  arthritis  is 
due  to  general  tonic  effect  on  the  patient  or  to  an  effect 
on  the  specific  cause  of  rheumatoid  arthritis. 

Dr.  Septimus  Sunderland  asked  what  effect  was 
produced  on  cheloid  growth  in  scar-tissue  by  the  X-rays, 
Finsen  light,  and  radium. 

Dr.  Leonard  Williams  and  Dr.  Gage  Brown  made 
remarks. 

In  reply,  Dr.  Hedley  could  not  refer  to  any  experi- 
ments demonstrating  the  radio-activity  of  sea-water. 
He  thought  the  ulceration  produced  by  radio-active 
bodies  was  the  same  in  its  clinical  character  and  patho- 
logy as  that  of  X-ray  burns.  The  therapeutic  uses  of 
high  frequency  currents  had  never  been  tested  under 
really  experimental  conditions,  but  there  was  no  possible 
doubt  as  to  their  physiological  effects  upon  the  "  re- 
spiratory combustions,"  urine,  blood,  and  blood  pres- 
sure, &c. 


NORTH  OF  ENGLAND  OBSTETRICAL  AND 
GYNECOLOGICAL  SOCIETY. 

At  the  conclusion  of  the  annual  meeting  for  the 
election  of  office-bearers,  held  in  Owens  College,  Man- 
chester, 

Dr.  A.  Stokes  read  the  notes  of  a  case  of 
eclampsia,  with  fatal  result. 

A  discussion  followed,  in  which  the  President,  Drs. 
Briggs,  Martin,  Croft,  Nesfield  and  J.  Garner  took 
part,  after  which  Dr.  Stokes  replied. 

Dr.  A.  Donald  (Manchester)  read  a  paper  on — 

CHRONIC     ENDOMETRITIS     AND     CHRONIC     METRITIS      IN 
VIRGINS. 

He  dealt  with  affections  of  the  endometrium  and 
mesometrium  occurring  apart  from  the  usual  infective 
causes  (sepsis,  gonorrhoea,  &c).  The  paper  was  based 
on  a  series  of  forty  cases  which  had  been  carefully  ob- 
served. Attention  was  specially  directed  to  one  group 
of  cases,  which  were  characterised  by  the  association 
of  these  three  conditions: — (1)  Small  or  infantile 
cervix ;  (2)  acute  flexion,  forwards  or  backwards  ; 
(3)  enlargement  of  the  uterine  body.  The  symptoms 
in  these  cases  were,  in  the  order  of  frequency  :  (1)  pain 
or  dragging  sensation  in  one  or  both  iliac  regions,  or 
pain  generally  in  the  lower  zone  of  the  abdomen 
(in  thirty-six  out  of  forty  cases)  ;  (2)  dysmenorrhcea 
(in  thirty-three  out  of  forty  cases)  ;  (3)  leucorrhoea 
(in  thirty-one  out  of  forty  cases)  ;  (4)  menorrhagia  or 
metrorrhagia  (in  sixteen  out  of  forty  cases);  and  (5) 
remote  or  nervous  symptoms.  In  a  large  proportion 
of  the  cases  the  uterine  mucosa  was  much  thickened. 
The  uterine  cavity  showed  an  increase  in  length  of 
from  a  quarter  to  one  and  three-quarter  inch, 
and  the  mesometrium  was  sometimes  considerably 
thickened.  Microscopic  examination  of  the  mucous 
membrane  removed  showed  great  increase  in  glands  or 
in  inter-glandular  stroma,  or  both.  Remarks  were 
made  as  to  the  etiology  and  treatment  of  the  condition. 

The  paper  was  discussed  by  Drs.  Lloyd  Roberts, 
Arnold  Lee,  W.  E.  Fothergill,  Stokes,  Richardson, 
and  the  President. 

Dr.  Donald  replied. 

The  list  of  office-bearers  elected  at  this  meeting  will 
be  found  under  the  heading  of  "  Medical  News." 


ULSTER  MEDICAL  SOCIETY. 

Meeting  held  in  the  Medical  Institute,  Belfast, 

January  2ist,  1904. 


Dr.  John  Campbell,  F.R.C.S.,  President,  in  the  Chair. 

the  question  of  smoking  at  meetings. 
It  was  proposed  by  Dr.  A.  B.  Mitchell,  and  seconded 
by  Professor  Lindsay,  that  the  practice  of  smoking  at 


the  general  meetings  of  the  Society  be  discontinued. 
After  an  amusing  debate,  in  which  the  painful  sym- 
ptoms induced  in  some  of  the  weaker  brethren  by  an 
evening  spent  at  a  meeting  where  many  men  were 
smoking  were  vividly  described,  the  motion  was  passed 
by  a  fair  majority. 

Dr.  W.  B.  McQuitly  showed  a  case  of  muscular 
dystrophy,    and 

Dr.  Fullerton  an  anomalous  case  of  the  same  disease 
affecting  one  arm  only. 

Dr.  Robert  Campbell  showed  two  cases  illustrating 
the  effect  of  surgical  treatment  in  obstetrical  paralysis. 

Dr.  H.  L.  McKisack  showed  films  from  the  urine 
of  a  case  of  tuberculosis  of  the  kidney,  showing  casts 
of  tubercle  bacilli. 

Dr.  R.  J.  Johnston  read  a  paper  on 
normal  and  abnormal  mobility  of  the  kidney, 
based  on  an  examination  of    the  mobility  or  otherwise 
in  a  series  of  about  250  gynaecological  cases,  in  which 
he  had  studied  this  point. 

The  paper,  which  led  to  an  interesting  discussion, 
will  be  published  later. 

Dr.  Thos.  Carnwath  and  Dr.  RobertJWatson,  both  of 
Belfast,  were  elected  members  of  the  Society  at  this 
meeting. 

f  ranee. 

[from  our  own  correspondent.] 

Paris,  January  Slat,  1901. 
Pneumonia  in^Children.^H* 

Nothing  is  general ly^more  difficult,  said  M.  Variot, 
than  the  diagnosis  of  pneumonia  in  children.  The 
classics  say  that  it  is  a  rare  affection,  that  broncho- 
pneumonia was  more  generally  observed.  The  fact 
was  true  for  broncho-pneumonia,  but  not  absolutely 
exact  as  regarded  pneumonia,  which  often  passed 
unperceived. 

A  child,  aet.  10,  entered  the  hospital  for  supposed 
typhoid  fever ;  high  temperature,  prostration,  loaded 
tongue,  diarrhoea  ;  the  symptoms  were  all  those  of 
typhoid.  Examination  of  the  lungs  revealed  sub- 
crepitant  rdles  at  the  base.  However \ by  percussion 
M.  Variot  discovered  a  dull  zone  at  the  apex  of  the 
right  lung  and  behind  which  awakened  his  attention ; 
nevertheless,  the  treatment  ordered  was  that  of  typhoid 
fever  :  baths  at  86°  every  three  hours  as  long  as  the 
temperature  remained  above  102 °,  and  quinine  given 
by  the  mouth. 

On  the  sixth  day  the  fever  fell  suddenly,  and  at  the 
same  time  the  signs  of  pneumonia  became  evident, 
souffle  and  fine  sub-crepitant  rdles. 

In  commenting  on  the  case,  Dr.  Variot  said  that  in 
such  cases  the  signs  afforded  by  auscultation  were 
very  uncertain  ;  pneumonia  in  children  attacked  the 
centre  of  the  lung,  and  as  a  large  layer  of  healthy 
tissue  separated  it  from  the  ear,  nothing  very  abnor- 
mal could  be  heard.  Weyle,  of  Lyons,  claimed  he  had 
discovered  a  new  sign  of  pneumonia  :  absence  of  ex- 
pansion of  the  chest  in  inspiration  on  the  affected 
side  ;  but  that  sign  was  inconstant  and  could  be  found 
in  other  affections.  The  radioscope  constituted  a 
much  better  means  of  diagnosis,  as  the  diseased  part 
was  represented  by  a  shadow  on  the  screen. 

Practitioners,  in  presence  of  pneumonia  in  children, 
should  eliminate  from  their  mind,  by  careful  and  re- 
peated percussion  of  the  lung,  the  idea  of  typhoid  fever. 
The  same  prudence  should  be  observed  with  menin- 
gitis, a  malady  which  naturally  threw  a  family  into 
despair.  It  was  true  that  meningitis  could  succeed 
pneumonia  as  purulent  pneumococcic  meningitis,  but 
it  was  a  very  rare  affection,  and  was  always  fatal. 
On  the  other  hand,*  pneumonia  was  a  very  benign 
affection  in  children.   ,  .^ 


Fmw.   \ 


GERMANY. 


The  Medical  Press.    12 i 


Antisvfhilitic  Injections, 
Huile  gnse: 

Punned   mercury,  40  grammes  j 
Lanoline  (sterilised),   1 2  grammes  ; 
Vaseline  [ sterilised ).    1  3  grammes  ; 
Oil  of  vaseline,  35  grammes, 
1    1  lie  mixture  before  using  ;    two  drops  injected 
Bteey  vbt  or  eight  days. 

Abuse  of  Vaginal  Injections. 

Professor     Lucas  '  MERE     has      for     many 

years  protested  against  the  abuse  of  vaginal  injections, 

la  a  normal  confinement,  when  the  uterine     won  in  I 

md  the  vagina  have  been  properly  disinfected,  further 

were   needless.     Ordinary    leucorrhcea    was 

not  septic  -    it  resulted  onlv  from  uterine  congestion, 

»bkn  was  frequently  cured  by  scarification  of  the  os 

and  the  administration  of  iodide  of  potassium. 

During  pregnancy,  vaginal  injections  might  provoke 

tiJe  at  the  time  of  deli  very  the  professor 

tied    only  one  injection  of  a  strong  solution  o! 

\fter   delivery   the   patient   should    not 

(»e  touched,     li  '(>gv    M.  Champouniere  CXiti- 

also  the  abuse  of  injections  which  irritate    the 

plexus,     Among  the  agents  used  he  preferred 

onsof  phemc  acid,  oxygen  water  (3  or  4  volumes), 

permanganate    ol     potash,   1-2,000,  alkaline  solutions, 

-  [camomile,  walnut  leaves,  oak  bark,  tannin, 

tn  the  healthy  woman  no  injii  tiOD  should  be  used  -t 
they  were  an  obstacle  to  impregnation,     Against  leticor- 
alkalmc  injections  to  correct  the  acidity  should 
r  escribed, 

t.  M.  Lucai-Chaniponniere  said  that 
vaginal  injections  should  be  regarded  as  a  medical 
treatment,  and  never  become  a  part  of  the  toilette  of  a 
woman, 

tSTHSatA  by  Cocaine  and  Adrenalin. 
One  of  the  most  useful  applications  of  the  extract  of 
tU  suprarenal  capsules,  says  M.  Foisy.  consists  in  the 
possibility    of    obtaining    anesthesia    and    absence    of 
hemorrhage  by  its  association  with  cocaine  as  follows  — 
of  cocaine  (1-200)..  jo  grammes. 
Solution  of  hydrochLof  adrenalin  { i-i.OQO)  lodrops. 
la  the  case   of   large   incisions   ^anthrax,   suppurating 
adenomata)   the  entire  following  mixture  may  be  era- 
i  : — 

,tion  of  coi  zoo),  20  grammes. 

Solution   »ji   adrenalin   (i-i.ooo),    3  drops. 

whitlow  or  boil : — 
Solution  of  cocaine  (i-ioo),  1  gramme, 
Solution  of  adrenalin,  4  drops. 
To  avoid  any  accident  it   is  necessary  to  place  the 
patient  in  the  horizontal  position.     The  first  injection 
id  tic  made  in  the  line  of  the  incision  and  into  the 
One    or     two     Pravaz    syringes    suffice       The 
le  is  withdrawn  and    inserted    more  deeply,   and 
fringes   may   be  necessary  for  the  in- 
UCratioo  of  the  cellular  tissue,  and  finally,  one  or  two 
ig«l    are  injected  into  the  abscess. 
A*  (fleet   of   the  injection,    the  redness  of   the  skin 
pears    ver  :.,    a    well-marked    whiteness 

taking  its  place,  In  three  tir  four  minutes  the  anjes- 
I  u  complete.  The  incision  should  be  made  layer 
Uyer ;  transfixion  with  the  bistoury  should  be 
ted.  \<  the  incision  is  almost  bloodless,  care 
lid  be  taken  to  ascertain  if  any  vessel  needs  pinch- 
op,  oi  her  wise  secondary  hemorrhage  might  occur. 
TOW  loeidenta  as  pallor,  vertigo,  or  syncope  it 

make  the    patient  keep  the  recumbent 
tiou  several  hours  after  the  operation. 
By  anesthesia,    adds  M,    Foisy,   obtained    by    this 
method  one  can   operate  without   pain   on   whitlows, 
nrax,  abscesses,  anal  fistula,  &c- 


Germans. 

[I  ROM     OUR     OWN     CORRESE0NDENT.] 

Bsrux,  January  Stab,  1004, 

The  Treatment  of  Epilepsy  with  Bromide  of 
Sodium  and  Withdrawal  of  Chloride  of  Sodium, 
\  notice  of  a  paper  on  this  subject  by  C.  Madiert 
appears  in  the  Deut,  wrd*  Zcitimg  of  January  t8th* 
This  form  of  treatment  has  now  been  carried  out  in 
different  institutions  for  ftto  Of  three  vears,  and  the 
mode  is  based  on  the  assumption  adopted  by  To 'do  use 
and  Richet,  that  a  much  larger  quantity  of  common 
salt  is  used  than  is  required  by  the  system,  and  that 
the  excess  prevents  the  due  sedative  action  of  the 
bromine  salt  so  that  unnecessarily  large  doses  of  the 
latter  have  to  be  given  to  produce  a  decided  effect. 
It  is  claimed  that  only  about  two  grammes  of  the 
sodium  salt  are  required  daily  in  place  of  the  fourteen 
grammes  usually  made  use  of.  In  the  case  of  twenty 
epileptics  who,  in  spite  of  bromine  treatment,  bad 
attacks  almost  daily,  experiments  were  made.  They 
each  received  too  grm,  milk.  300  grm>  of  meat,  300  gnu. 
of  potatoes,  20O  grm.  of  flour,  2  eggs,  50  grm,  of  sugar, 
10  of  coffee*  and  40  of  butter.  The  nutrient  value  of 
the  diet  was  2,700  calorics.  It  was  well  borne  for 
months.  Besides  this,  4  gmi,  (later  2)  of  bromide  of 
sodium  were  given.  It  is  stated  that  the  results  corre- 
sponded to  the  hypothesis,  the  attacks  diminishing  both 
in  number  and  severity,  The  special  diet  without  the 
bromine,  however,  showed  no  beneficial  influence* 
Bahrit  also  made  experiments.  He  left  out  the  meat, 
and  replaced  the  sodium  chloride  of  the  bread  by 
sodium  bromide,  a  change  which  was  w^ell  borne  by 
the  patients  ;  3  grm.  of  sodium  bromide  were  added 
to  300  to  400  grm .  of  bread,  T  he  results  in  twenty-eight 
persons  were  remarkable  ;  86  per  cent,  of  thetn  lost 
their  attacks  'completely,  and  in  the  remainder  they 
were  fewer  and  less  severe. 

The  writer  gave  a  modified  Balirit  diet— 14 ti  litres 
oi  nulk,  40  to  50  grm,  of  butter,  300  to  400  of  bread  and 
fruit  of  a  nutritive  value  of  2,300  to  2,400  calorics, 
Tjiis  was  given  to  eighteen  patients  with  slight  modifi- 
cations with  good  effects.  In  order  to  suit  various  appe- 
tites and  to  vary  the  dose  of  bromide,  three  sorts  of  bread 
were  baked,  one  containing  £  gnn*  of  bromide  to  the 
too  grm.  of  bread,  one  with  4  grm,,  and  one  with  1  grm. 
iwever,  the  diet  could  not  be  carried  out  strictly 
for  months  together,  one  consisting  mainly  of  vegetables 
and  with  very  little  meat  was  adopted,  and  with  mil 
harm  to  the  treatment.  As  regarded  results,  a  much 
more  intensive  action  oi  the  bromide  was  visible,  a 
much  smaller  dose  was  required  than  formerly,  and 
the  undesirable  bye-effects  were  avoided.  The  action 
nn  Lhe  disease  also  was  more  favourable.  Patients  who 
before  had  a  monthly  attack  remained  quite  free  after 
six  months.  He  considers  that  the  treatment,  which, 
however,  can  only  be  property  and  thoroughly  carried 
out  in  an  institution,  has  much  to  recommend  it. 
At  the  Medical  Society,  Hr,  Plehn  showed  a  case  of 
Le  net  MiA, 
patient  was  admitted  into  the  City  Hospital 
on  October  30th,  for  a  pain  in  the  left  leg  that  he 
had  had  for  ten  days.  He  had  ascites,  swelling  of  the 
and  spleen,  slight  glandular  enlargement,  gingivi- 

,  us,  retinal  hemorrhage,  and  leuca?mic  changes  in  the 
blood  ;  besides  this,  he  had  a  rather  large  retro-pcri- 
tcmeal  hematuria.  After  getting  worse  at  first,  he 
soon  improved.  The  original  myelogenous  mixed-celled 
leucaemia  improved,  so  that  at  the  lime  only  slight  blood 
changes  remained.     All  the  changes  in  the  organs  had 

I  disappeared  except  a  slight  remaining  enlargement  of 


122    The  Medical  Press. 


AUSTRIA. 


the  spleen.  Such  remissions  in  the  course  of  the  disease 
were  very  rare.  The  treatment  made  use  of— injection 
of  arsenic — he  did  not  think  responsible  for  them. 

Hr.  Kohn  had  seen  such  remissions  twice,  and  did 
not  think  they  were  due  to  treatment.  In  one  case 
the  remission  lasted  six  months,  and  then  the  disease 
proved  rapidly  fatal.  In  another  case  the  improve- 
ment lasted  ten  years,  but  the  latter  was  a  chronic  case. 


Feb.   3,    1904. 


HuBtrta. 


(from  our  own  correspondent.] 


Vknna,  January  31ft,  1904. 
Aneurvsma  Spurium. 

Stutzer  showed  pathological  preparations  to  the 
Gesellschaft  der  Aerzte,  where  an  exostosis  from  the 
femur  led  to  a  false  diagnosis. 

Wernlechner  related  a  similar  experience  where  a 
•coagulum  in  the  vessel  over  the  exostosis  compelled 
him  to  amputate  the  limb.  In  the  early  part  of  treat- 
ment the  aneurysm  was  perfectly  distinct,  but  when 
the  blood  coagulated  in  the  cavity  the  whole  vessel 
^solidified,  closing  up  the  arterial  circulation.  No  pulsa- 
tion could  be  detected,  and  from  the  hardness  of  the 
neoplasm  it  was  concluded  that  an  osteosarcoma  was 
the  cause  of  the  obliteration. 

Cerebral  Angio-Sarcoma. 

Moszkowicz  followed  with  a  few  cases  of  some  interest 
to  the  Society.  The  first  was  a  joiner,  aet.  28,  from 
whom  he  had  removed  an  angio-sarcoma  from  the 
cerebrum,  leaving  an  opening  in  the  frontal  bone  of 
6  by  7  centimetres,  which  he  had  covered  with  a  cellu- 
loid plate. 

He  exhibited  a  tailor,  aet.  39,  whom  he  had  resected 
at  the  first  and  fourth  rib  on  the  left  side  for  peri- 
pleuritis. 

He  next  showed  a  test  tube  for  centrifugal  work  in 
■securing  sediment  by  means  of  attaching  two  drainage- 
tubes. 

Chloroma. 

Hitschmann  reported  the  history  of  a  case  of  chloroma 
affecting  the  skin  and  buccal  region.  From  the  right 
tonsil  spread  a  neoplasm  having  all  the  appearance  of  a 
sarcoma.  Immediately  after  this  a  few  disseminated 
patches  appeared  on  the  body,  first  on  the  breast,  next 
on  the  face,  and  subsequently  on  the  extremities.  These 
patches  were  of  an  efflorescent  green  colour,  and  were 
observed  on  the  conjunctiva  of  the  eye  as  well  as  the 
bulbus  itself. 

A  careful  examination  of  the  blood  showed  an  increase 
in  the  number  of  the  leucocytes;  at  a  later  period 
lymphaemia  poikilocytosis  and  polychromophilia. 

The  post-mortem  revealed  a  large  accumulation  of  a 
greenish  deposit  diffused  over  the  body,  which  seem- 
ingly had  taken  its  origin  in  the  tonsils,  as  it  was  found 
under  the  mucous  membrane  of  the  fauces,  nose, 
throat  and  bronchi.  The  glands  of  the  neck  and 
mediastinum  were  as  green  as  grass  by  infiltration. 
Canities  Prematura  et  Alopecia  Areata  Cured 
by  r6ntgen  rays. 

Karl  Ullmann  showed  two  patients  whom  he  had 
successfully  treated  for  premature  grey  hair  or  poliosis, 
which  is  supposed  to  be  more  correctly  described  under 
the  term  canities,  which  is  simply  an  atrophy  of  the  hair 
pigment. 

The  first  was  a  young  man,  aet.  28,  who  had  always 
been  healthy,  but  ten  years  ago,  when  only  eighteen, 
he  found  himself  becoming  grey-haired,  although  the 
growth  was  of  the  usual  or  normal  thickness.  About 
the  beginning  of  1903  the  hair  began  to  fall  out  in  great 


quantities  without  any  attributable  cause.  This 
denudation  confined  itself  to  the  middle  of  the 
head.  As  an  experiment  the  R6ntgen  rays  were 
applied  for  fifteen  minutes  on  two  occasions 
within  a  week,  but  to  the  horror  of  the  patient  this 
seemed  to  aggravate  the  disease,  as  another  denudation 
occurred,  leaving  the  patient's  head  as  bare  as  the 
palm  of  the  hand. 

A  few  weeks  after  the  hair  had  aU  fallen  off,  a  fine, 
soft  crop  of  black  hair  commenced  to  appear,  and 
by  June  he  had  a  profuse  head  of  hair.  Ull- 
mann concluded  that  there  was  no  doubt  about  the 
efficacy  of  the  rays  in  stimulating  the  growth  of  hair  as 
well  as  inducing  the  formation  of  pigment,  which  he 
endeavoured  to  prove  by  another  case  of  alopecia 
areata. 

Bilateral  Tubal  Pregnancy. 
Emerich  Ullmann  related  the  history  of  a   patient, 
aet.  29,  who  on  February  26th,  1903,  was  operated  on 
for  tubal  pregnancy  on  the  left  side. 

In  July,  1903,  symptoms  again  showed  that  tubal 
pregnancy  had  occurred  on  the  right  side.  By  the  end 
of  September  this  suspicion  was  confirmed  and  an  opera- 
tion performed,  removing  both  uterus  and  right  ovarian 
tube  with  the  foetus.  The  patient  is  now  well. 
Growths  in  Frontal  and  Maxillary  Sinuses. 
Weil  showed  Ron t gen  photograms  of  the  maxillary 
and  frontal  sinuses,  both  before  and  after  treatment 
with  sulphate  of  lead.  He  first  fills  the  sinus  with  the 
powder,  which  prevents  further  thickening  of  the 
mucous  membrane  or  increase  of  any  growth  present, 
which  he  contends  is  the  most  simple  and  conservative 
way  of  treating  these  cavities  and  thus  obviating  a 
radical  operation. 

Chiari  observed  that  he  recently  treated  an  empyema 
of  the  maxillary  sinus  with  an  iodoform  plug,  with  an 
excellent  result.  The  progress  of  the  disease  and  treat- 
ment was  watched  with  the  Rontgen  rays. 
Enterostomy. 
Eiselsberg  gave  the  Society  a  detailed  history  of  52 
cases  of  lateral  anastomosis  of  the  bowel  with  1 3  deaths  ; 
8  of  the  cases  were  unilateral  with  one  death  ;  and  14 
were  total  "  Auschaltung  "  of  the  bowel  with  3  deaths. 
Of  39  cases  with  lateral  anastomosis  14  died  within  a 
year  after  the  operation  ;  4  cases  are  still  under  obser- 
vation, and  two  have  quite  disappeared.  The  re- 
mainder range  from  one  to  four  years,  three  of  whom 
were  certainly  carcinomatous.  The  operations  were 
performed  on  account  of  neoplasms  in  35  cases  ;  acute 
ileus  in  8  cases  ;  tuberculosis,  21  ;  acute  appendicitis, 
4  ;  and  8  times  for  fistula.  In  summing  up  his  results 
he  said  inoperable  cases  where  anus  praeternaturalis 
isTnecessary,  later  entero-anastomosis  is  the  best.  It  is 
also  preferable  where  an  antecedent  operation  is  neces- 
sary in  cases  of  fistula.  The  unilateral  operation 
is  usually  more  severe  'and  more  prolonged  than 
theftlaterai  operation,  neither  does  it  give  the  free- 
dom desirable.  When  the  bowel  is  fully  separated 
most  satisfaction  will  be  obtained,  although  this  is  the 
longest  and  most  severe  of  all  the  performances,  but 
iSjthe  sovereign  remedy  for  such  affections, 
gin  the  discussion  Schnitzler  said  that  he  always 
performed  the  lateral  anastomosis  by  using  one  of 
Mosetig's  double  closing  tubes,  which  was  a  protection 
for  the  contents  of  the  bowel  in  the  separated  portions. 
He  related  another  case  of  obliteration  between  ileum 
and  caecum  from  tuberculous  ulceration.  After  the 
operation  the  pain  was  very  great,  which  necessitated 
another  operation  to  resect  the  obstruction  which 
appeared  j^ to  be  the  cause  of  the  pain,  owing  to  the 
peristaltic  action  dragging  on  trie  affected  part. 
After  resection  the  patient  was  quite  well. 


Feb.  h  *904 


OPERATING    THEATRES. 


T«e  Medical  Press,      123 


UUmaaa  said  he  had  performed  the  total  operation 
five  times  with  disastrous  results,  not  one  of  the 
patients  surviving.  They  either  died  through  the 
operation  or  from  the  disease. 

Eisetsber.  •■    had    not    confirmed    nor    seen 

Mosetig**  method  tried  on  animals. 


TLbc  ©perattno  afoearres, 

VS    HOSPITAL. 

Excision  of  Large  Vascular  Tumours. — Mr, 
Clem  est  Lucas  operated  on  a  female  child,  act.  seven 
months,  who  had  been  admitted  for  a  swelling  on  the 
ngbt  side  of  the  head-  The  patient  was  a  healthy- 
kxiking  baby  who  had  enjoyed  good  health  from  its 
birth.  When  the  child  was  born  she  had  a  red  mark 
on  the  same  side  of  the  head,  and  in  the  same  place. 
It  was  then  as  large  as  a  sixpence  :  it  was  not  raised 
above  the  skin,  but  the  hair  on  it  did  not  grow.  The 
parents  had  brought  her  to  the  hospital  when  she  was 
tive  weeks  old,  when  the  red  mark  was  burnt  out  and 
tfae  wound  strapped  up.  When  the  strapping  was 
removed,  the  place  looked  sore  ;  this  soreness  gradually 
disappeared,  but  afterwards  the  place  looked  the  same 
as  before,  and  the  red  mark  got  gradually  larger  and 
became  raised  from  the  surrounding  skin  ;  it  continued 
to  swell  ami  extend  till  about  four  months  before  the 
present  time.  On  examination,  the  swelling  was  now 
about  an  inch  and  three-quarters  long  and  an  inch  in 
breadth,  and  was  situated  over  the  parietal  region  , 
it  was  soft  and  fluctuating, and  its  edges  were  definite, 
there  being  a  red  mark  in  its  centre  ;  its  surface  was 
>h»nv  and  dry-looking,  and  no  pain  was  felt  on  its  being 
manipulated.  The  patient  having  been  anaesthetised 
with  chloroform,  an  elliptical  mciaion  was  made 
OTTOtt&dittg  the  coloured  area.  The  skin  was  dissected 
backwards  for  some  distance  on  either  side  over  the 
of  the  na?vus  until  well  beyond  its 
margin.  In  this  way,  there  being  often  a  kind  of  fibrous 
jimitation  to  a  cavernous  navus,  fewer  vessels,  Mr.  Lucas 
painted  out,  are  met  with  than  if  the  na-vus  is  by 
accident  encroached  upon  by  incision,  The  feeding 
vwaeiican  very  readily  be  controlled  by  finger  pressure 
against  the  bone  till  their  ends  are  secured  by  forceps 
And  ligatured.  The  na-vus  being  isolated  on  all  sides 
was  finally  dissected  up  from  its  attachment 
to  the  pericranium  and  removed.  Having  com- 
I  the  hemorrhage,  Mr.  Lucas  brought 
together  the  scalp,  but  only  with  considerable  difficulty, 
Q*ifl|  to  the  large  surface  removed.  In  order  to 
lender  the  scalp  more  movable,  it  was  detached  still 
further  from  the  subjacent  parts,  and  it  was  then  found 
thai  with  the  aid  of  strong  salmon -gut  ligatures  the 
«dge*  could  be  approximated. 

The  second  case  was  that  of  a  rapidly  spreading 
n*vus  ol  the  scalp,  eyelid,  ear  and  face,  where  it  waa 
absolutely  nect  do  something   to  prevent  its 

rapid  growth.  The  patient  was  a  male  child,  set.  six 
month*,  who  had  been  born,  with  a  red  mark  on  its 
forehead  about  the  sue  of  a  pea  ;  the  mark  was  situated 
to  the  right  of  the  an  tenor  fontanelle.  It  spread 
rapidly,  soon  reaching  to  the  back  of  the  ear  and  down 
lie  right  eye,  on  to  the  cheek,  and  also  towards 
the  ftose,  and  across  the  middle  line  of  the  forehead* 
A  place  on  the  back  started  at  the  same  time,  and  was 
at  first  the  size  of  a  pin's  head,  but  this  also  spread 
rapidly  bo  that  nam  it  is  six  inches  from  above  down- 
wards and  about  five  inches  at  its  base  ;  it  is  situated 
4>ver  tht  scapular  region.  The  little  patient  was  per- 
fectly healthy  m  all  other  respects.  In  these 
^es  Mr,  Lucas  relies  on  galvanic  cautery  puncture 
^  a  primary  measure  to  prevent  the  spreading. 
The  patient    being    under    an    anaesthetic,   a    series 


of  deep  punctures  were  made  along  the  margin  of  the 
growth  about  an  eighth  of  an  inch  apart  ;  they  were 
carried  through  the  cellular  tissue  down  to  the  deep 
fascia.  Any  tendency  to  bleed  was  stopped  by  reduc- 
ing the  heat  of  the  cautery  so  as  to  make  a  black  eschar* 
The  apertures  thus  made  along  the  margin  of  the  growth 
were  then  filled  in  with  iodoform  powder,  dry,  antiseptic 
gauze  being  applied  over*  In  this  way*  Mr,  Lucas 
said,   suppuration   is   reduced    to   a   minimum. 

He  remarked  that  these  two  methods— excision  and 
cautery — he  entirely  relies  upon  for  the  cure  of  all 
nxvi.  Although  he  considered  the  galvanic  wire 
cautery  to  be  the  more  convenient,  yet  a  pointed 
Paquelin's  cautery  is  often  more  easy  to  carry  about, 
and  when  neither  of  these  is  available  the  homely 
skewer  heated  in  the  tire  serves  equally  well  for  cautery 
puncture,  or  even  a  straight  paper  file  will  serve  the  pur- 
pose heated  in  the  fire,  the  wooden  handle  of  which 
protects  the  surgeon's  hand  from  injury,  He  pointed 
out  also  that  there  was  still  hesitation  among  many 
m  employing  excisions  for  the  very  largest  na^vi,  some 
Of  which  may  occupy  a  large  part  of  the  cellular  tissue 
of  a  limb  ;  in  these  cases  he  himself  operates  succes- 
sively on  considerable  portions,  leaving  each  successive 
part  to  heal  before  subjecting  the  patient  to  a  second, 
third,  fourth,  or  fifth  operation.  He  mentioned  a 
recent  case  which  had  just  left  the  hospital,  in  which 
he  excised  in  three  operations  a  large  subcutaneous 
nasvus  a tiecting  the  lower  eyelid,  nose  and  cheek  ; 
the  first  operation  was  carried  out  in  a  vertical  direc- 
tion, leaving  the  scar  on  the  side  of  the  nose  ;  the  second 
and  third  were  carried  out  horizontally  on  the  eyelid 
and  cheek,  so  as  to  leave  the  scars  corresponding  to  the 
upper  margin  of  the  superior  maxilla.  The  result 
was  very  satisfactory,  the  scarring  following  these 
lines  not  being  very  noticeable,  whilst,  on  the  other 
hand,  the  uevui  before  removal  was  most  disfiguring. 
Again,  in  a  case  wnieh  he  completed  last  autumn,  he 
removed  by  excision  in  seven  operations  an  enormous 
uavit-lipoma  of  a  pendulous  character  extending  from 
the  buttocks  to  the  foot,  completely  curing  the  patient 
of  a  tremendous  disfigurement.  He  remarked  that 
the  cautery  was  of  chief  use  in  the  red  capillary  BJBvi, 
which  are  apt  to  spread  rapidly,  whereas  excision  is 
more  applicable  to  the  subcutaneous  cavernous  form 
01  to  the  mixed  form. 

CHELSEA  HOSPITAL  FOR  WOMEN, 

Abdominal  Hysterectomy  for  Myoma. — Dr* 
Arthur  Giles  operated  on  a  single  woman,  at.  JO, 
who  had  been  under  the  care  of  Dr,  Gordon  Hull. 
Her  principal  symptoms  were  weight  in  lower  part  of 
the  abdomen,  severe  pain  in  the  left  iliac  region,  ami 
irritability  of  the  bladder,  causing  frequency  of  mictu- 
rition. She  was  unable,  in  consequence  of  these  dis- 
turbances, to  follow  her  occupation.  There  had  been 
no  alteration  in  the  characters  of  menstruation  except 
that  the  pain  on  the  left  side  was  then  aggravated. 
On  examination,  a  hard,  rounded  tumour  was  felt, 
which  appeared  to  involve  the  left  side  of  the  uterus  T 
the  uterine  cavity  was  deflected  towards  the  right, 
The  patient  was  very  anxious  to  be  relieved  of  her 
tumour,  and  an  operation  was  undertaken  accordingly. 
08  opening  the  abdomen  it  was  found  that  the  tumour 
originated  in  the  left  cornu  of  the  uterus,  displacing 
the  left  Fallopian  lube  to  a  considerable  extent.  It 
was  the  size  of  a  large  orange.  The  rest  of  the  uterus 
wwk  not  affected,  and  the  right  tube  and  ovary  were 
normal,  A  supra- vaginal  hysterectomy  was  performed. 
The  operation  presented  no  special  diihcultu-s,  and  fchfl 
abdominal  wound  wa>  dosed  in  the  usual  way.  Dr. 
Giles  remarked  thai  pain  was  not  a  conspicuous  sym- 
ptom of  uterine  fibroids  ;  when  present  it  was  due 
either   to  pressure  or  to  some  complication,  such  as 


124     The  Mbdical  Press. 


LEADING   ARTICLES. 


Feb.   3,   1904- 


localised  peritonitis  or  disease  of  the  appendages.  In 
this  case  the  pain  was  due  to  compression  of  the  left 
ovary  between  the  tumour  and  the  wall  of  the  pelvis. 
The  bladder  irritation  arose  from  the  fact  that  the 
tumour  had  developed  anteriorly  as  well  as  laterally. 
It  was  a  case  in  which  the  choice  in  the  matter  of 
operation  lay  between  hysterectomy  and  myomec- 
tomy. The  latter  procedure  was  best  adapted  for 
tumours  situated  on  the  anterior  or  posterior  walls  of 
the  uterus  ;  it  was  not  usually  suitable  for  tumours 
arising  in  the  cornua,  because  removal  of  a  tumour  in 
this  position  left  the  uterus  greatly  distorted.  On  this 
account  hysterectomy  was  performed  in  this  case. 
It  had  been  shown  by  the  statistics  of  a  former  registrar. 
Dr.  Crewdson  Thomas,  that  there  was  a  very  definite 
advantage  obtained  by  leaving  one  or  both  ovaries  in 
a  young  woman,  as  the  disadvantages  of  an  artificial 
menopause  were  thereby  lessened.  In  the  case  of  a 
patient,  set.  45  or  more,  the  removal  of  both  ovaries 
made  comparatively  but  little  difference  in  the  con- 
valescence. In  the  present  instance  it  was  possible  to 
leave  the  right  ovary.  The  left  appendages,  although 
healthy,  had  to  be  removed  owing  to  their  position, 
as  they  virtually  arose  from  the  tumour. 

The  patient  made  an  uneventful  recovery,  and  left 
the  hospital  on  the  seventeenth  day  after  operation. 


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"  SALUS   POPULI  SUPREMA.LEX." 


WEDNESDAY,  FEBRUARY  3,  1904. 


RADIUM   AND   CANCER. 
>  The    importation    of   radio-active    forces   into 
modern  medicine  constitutes  one  of  the  most  recent 
as  well  as  one  of  the  most  fascinating  chapters  of 
modern  science.  The  discovery  of  the  Rontgen  rays 
placed  in  the  hands  of  surgeons  and  of  physicians 
a  powerful  additional  weapon  of  exact  diagnosis. 
Before  long  it  was  discovered  that  the  emanations 
from  the  active  Crookes*     tube  used  to  produce 
the  X-rays  were    possessed  of   therapeutic    pro- 
perties.    So  far  as  malignant  growths  are  con- 
cerned   exposures    to    the    live    focus    tubes    are 
found  to  promote  healing  of  ulcerating  carcino- 
matous surfaces   and   to  relieve  pain,   although 
they  do  not  cure  the  disease.     Applied  to  recurrent 
nodules  after  operation  numerous  cases  have  been 
recorded  in  which  the  secondary  local  recurrences 
have  disappeared  and  sometimes  been  warded  off 


indefinitely.  Many  cures  of  superficial  epithe- 
liomata  have  been  reported,  as  well  as  of  rodent 
ulcers.  The  usefulness  of  the  X-ray  tube  in 
malignant  growths,  then,  appears  to  be  distinctly 
limited.  A  field  of  richer  promise,  however,  is 
to  be  found  in  radium,  that  wonderful  radio- 
active substance  whose  therapeutic  properties, 
as  yet  in  their  infancy,  are  being  investigated 
by  many  eager  inquirers  in  various  parts  of  the 
world.  A  few  weeks  since  news  came  from  Vienna 
that  an  epithelioma  inside  the  cheek  had  been  cured 
by  the  application  of  radium.  Before  that  time, 
so  long  back,  indeed,  as  May,  1903,  brilliant 
results  had  been  attained  in  our  own  country  by 
Mr.  Mackenzie  Davidson,  the  well-known  inventor 
of  an  exact  system  of  X-ray  localisation.  In 
the  year  mentioned,  by  the  application  of  radium 
he  succeeded  in  curing  several  cases.  The  first, 
one  of  external  rodent  ulcer  of  the  nose,  healed 
up  in  about  a  couple  of  months,  and  showed  no 
signs  of  recurrence  five  months  later.  The  second 
case  was  a  patch,  the  size  of  a  sixpence,  of  verrucose 
tuberculosis  of  the  skin  of  the  hand.  The  lesion 
disappeared  after  seven  applications  of  radium, 
and  with  one  slight  recurrence  was  completely 
cured.  The  third  patient  suffered  from  "  rodent 
cancer  "  of  the  nose,  and  was  cured  with  nine 
applications.  The  most  brilliant  of  Mr.  Davidson's 
cases  was  that  of  an  extensive  epithelioma  of  the 
face.  The  whole  of  one  cheek  was  destroyed, 
the  tongue  and  teeth  being  bare,  the  lips  partially 
gone,  the  tongue  foul  and  discharging,  the  hard 
and  soft  palates  invaded.  After  several  months' 
treatment,  the  discharge  has  been  rendered  in- 
offensive and  sterile,  speech  has  been  recovered, 
and  extensive  cicatrisation  has  taken  place.  The 
patient  appeared  to  be  on  the  high  road  to  recovery, 
but  in  any  event  it  is  clear  that  the  course  of 
the  epithelioma tous  process  was  profoundly 
modified,  if  not  finally  arrested.  That  result 
is  sufficiently  encouraging  to  instil  fresh  hopeful- 
ness into  the  energy  of  the  many  workers 
who  are  in  quest  of  the  key  to  that  most  baffling 
of  all  medical  problems,  namely,  the  etiology 
and  the  cure  of  malignant  new  growths.  One 
suggestion  thrown  out  by  Mr.  Mackenzie  Davidson 
is  worthy  of  careful  consideration.  Twice  during 
the  treatment  of  the  last  mentioned  of  the  above 
cases  a  more  than  usually  prolonged  application 
of  the  radium  was  followed  by  a  kind  of  erysi- 
pelatous rash,  and  a  "reaction"  temperature 
running  up  as  high  as  105  °  F.  In  the  remission 
following  each  of  these  reactionary  periods  there 
was  a  distinct  improvement  of  the  local  condition. 
Mr.  Davidson,  in  an  article  published  in  the 
British  Medical  Journal,  observes  : — "  It  seems 
fairly  clear  that  the  radium  radiations  produce 
profound  changes  in  rodent  cancer,  and  that 
absorption  of  the  altered  products  leads  to  the 
blush  that  so  often  follows  the  application  of 
radium  in  this  disease  ;  and,  if  the  exposure  has 
been  too  long,  then  the  blush  may  be  succeeded 
by  a  severe  inflammation  resembling  erysipelas. 
There    seems    a    possibility    that    the    products 


Fib,  }.  1904, 


PICLES. 


The   Medical  Press.     125 


absorbed  may  act  as    antitoxins.       There    is  no 
evidence,  meantime,  thai  this  is  so.     It  is  obvious 
thai  vath  a  large  surface  care  must  be  taken  not 
to  over-expose   the    parts  to    radium,    otherwise 
serious  constitutional  disturbances  may  be  pro- 
duced."    Radium    appears    to    have    little   or   no 
effect  when    applied    to    carcinoma    through    the 
unbroken  skin*     That  it  is  capable   of   exercising 
a  profound  effect  upon  some  of  the  morbid  cell 
processes  in  malignant  neoplasms  can  no  longer 
be   doubled,     Modern    science    travels    fast,    and 
it  may  reasonably  be  hoped  that  the  glimmering 
nescience    of     to-day    will    be    replaced    by    the 
brilliant  and  adequate  knowledge  of  to-morrow. 
Meanwhile  the  thanks  ot  the  community  are  due 
10  the  patient  and  devoted  labours  of  those  who, 
like  Mr.  Mackenzie  Davidson,  throw  the  search- 
light of  scientific  method  into  the  dark  recesses 
of  the  unknown. 


THE  PRODROMATA  OF    THI      V>\ XHOSES 
AND  THEIR  MEANING. 

To  the  psychiatrist  and  neurologist,  as  well  as 

to     the    general     practitioner,   any   authoritative 

statement  bringing  fresh  evidence  in  support  of 

ascertained    facts   on    psychiatry   cannot    fad  [to 

be    welcome.     The   importance    of    a    knowledge 

of  the  pfodromata  of  so  serious  an  event  as  an 

attack  "t    insanity     cannot    be    too    assiduously 

,ied  out.     This  we  arc  constantly  reminded  of 

bv  the  asylum  physician,  as  doubtless  in  numerous 

cases  which  finally  find  their  way  to  mir  asylums, 

recognition    and    importance   of    the    pro- 

sufficiently  recognised,  the  mental 

attack     might    often     be     prevented.        A    most 

interesting      and      important      paper      by      Dr+ 

read  on    this  subject  at   the    last 

nttttirm  oi   the  Scottish  Division  of   the  Medico- 

Psychological   Association,   in   which    the   author 

importance  of  recognising  that  attacks 


special  sense  functions^  which  he  attributes  to  a 
failure  of  nutritive  and  dynamic  energising  of  the 
higher  cortical   cells.     If  the  sensory    system    is 
hereditarily  weak,  or   exhausted,   or   starved,  or 
poisoned,  then  the  mental  centres  that  it  keeps 
going  must  soon  exhibit  disturbance.     Hence  the 
common  sequence  of  sensory  neuroses  and  melan- 
cholia.     Among  the  motor  disturbances  discussed 
are   general   convulsions,   followed   by   attacks  of 
acute  insanity  ;  localised  twitchings  arc  common, 
but   the   most  marked   and   characteristic   motor 
prodromata  of  infinity  consist  of  changes  in  the 
facial  and    eye   expressions.     Among    the    other 
disturbances     enumerated     are      insomnia,     cir- 
culatory,   nutritive    and    digestive    disturbances, 
and    menstrual   derangements,    and    Di\   Clouston 
contends    that    a    general    consideration    of    the 
character  and   frequency  of  such  facts  from  the 
physiological    and   pathological,    as   well   as   from 
the  clinical,  point  o\  view    leads  to  the  inevitable 
conclusion  that  an   attack   ol   mental   disease   is 
commonly  not  a  simple  or  localised  phenomenon, 
but  that  they  show  the  solidarity  of  action  of  the 
whole  brain  and  of  the  whole  of  the  nerve  centres 
in  the  cord,  and  the  special  ganglia  of  the  organic 
systems  of  the  body,  that  they  seem  to  point  to 
the  fact  that  the  lower  parts  of  the  sensory  appa- 
ratus very  often  break  down  before  the  mental 
apparatus  in  the  highest  regions]  and  prove  the 
mental  cortex  to  be  the  centre  of  the  organism 
and  ideologically  its  end,  and  that  the  whole  class 
of    ll  mental   disease  M    should   be    regarded    and 
treated,  not  as  local  disturbances,  but  as  wide- 
spread departures  from  the  normal  physiological 
condition    of    the    whole    organism.     Space    fails 
us  in   referring   further  to   Dr.   Houston's   paper, 
which  contains  many  other  interesting  points  not 
here  touch- id  on,     It  gives  a  fresh  impetus  to  the 
study  of   the   pathology  of    mental    disease,  and 
demonstrates  the  importance  of  a  careful  study 
of  all  the  organs  as  well  as  the  brain  and  spina ' 


i  ni,nU!  d^bS:ecSScSnP!SS^t1S  ^.--d  also  of  bacteriology,  in  connection  with 
not  mental   in  character  ,  ana   rnai   u  is  |         .  n_     ^i„..„*„„    h,.   ™,    manv 

equally  true  that  in  neurology  the  tact  has  not   mental   d.scase. 
'  d  sufficient    attention;  that   all  sorts  of   !«««    oceasioi  . 
vasomotor  and  motor  symptoms  may  bejph*«»  and  other  Ph-V 


Dr.    Clouston    has    on    many 

£1,  |»  i™  ""  *  *-  ^s";;  mrTnCr    occasions    emphasised     the     relation    of 

attracted   ftofficwt    *tt**tKmi  that    all    sorts   ol  d  insanity, 

smsnrv    vawntotor  and  motor  symptoms  may  be  Pnin,M!'  dim  uulcl   r")31^  - 

Ncrittm,  %asomotor  ana  y     r    ^        7  doubt  that  certain  disturbances  of 

rr  nrekides  tn  an  attack  of  insanity  and  not  *»u  LtlCicr  *a  IHJ  M1-    u  *     w„ 

iric  nitre  pitiuMLs       *  j  other   of    the     systems     mentioned    by 

ue  neuroioB»  exist    prior   to    the    development   of   the    mental 

mman  c„flPHne  from  an  unusual  form  o.   head-  <™«    I  '  ,  -_r^      A      ,-cu     *,. 


woman  suffering  from  an 

**e.      with     anorexia,     insomnia,     and     obscure   symptoms 

prcesthetic  sensations,  ottcn  misses  the  real  point  |  elicit, 


although    often     most    difficult    to 
the    relatives    and    even     the   family 


1W  he  do«  not  realise  that  such  I  physician  constantly  incline  to  view  the  menta 
ine   case  oecaust  v,.„K„r  'as  wholly   apart   from   any   physical   symptoms 

„,  in  tins  particular  pat.ent.  . higher- ■  JJ  w™£      J,        fc  ,&&£    priof  to   the 

WrtSc^l  .n  oriBin    and  mav  mean  an  attack  of  F*  pauem   nwiy    uavo  f 

^SmUSr, I V«k,  ,1  nithiag  can  be  done  to  I  development  of  mental  symptoms. 
Test  ^heir  course.     Discussing  sensory  symptoms, 

!  boids  that  in  addition  to  the  various  forms  ol  TUBERCULOSIS  IN  IRELAND, 

^dEtches  which  are  most  commonly  met  with  |      jT   has   nowadays   become   a   truism    lhat    the 
an^n,E>  there  arc  other  sensory  symptoms  [battie    x%ith   consumption   is   one^  quite   as    much 

■;.* "in   Ot   of'  paresthesia   not   confined    to    the 


hca^.     namely,  spinal   pains    and   visceral   pains 

**4c^    frequently    precede    attacks    of    insanity; 

that    the    sensory    prodromata    of    mental 

^H'^Sl.may    take    the    form    of    disturbance    of 


for  the  layman  as  for  the  medical  man,  The 
function  of  the  latter  is  chiefly  advisory,  both 
as  regards  his  particular  patient,  and  more  gener- 
ally as  regards  the  health  of  the  community.  It 
is  "the  physician's  duty  to  instruct    the  public  in 


126    The  Medical  Press. 


NOTES  ON  CURRENT  TOPICS. 


Feb.   3.   1904. 


hygienic  matters,  and  in  the  case  of  tuberculosis, 
at  any  rate,  it  is  satisfactory  that  the  intelligent 
interest  of  the  public  has  been  aroused.  Under 
the  circumstances  the  struggle  against  the  disease 
has  become  a  prolonged  campaign,  and,  as  often 
happens  when  but  little  apparent  progress  is 
being  made,  a  certain  weariness  of  conflict  appears. 
So  much  is  being  said  and  written,  both  in  lay 
and  medical  papers,  that  it  is  often  with  something 
approaching  a  sense  of  duty  rather  than  real 
interest  one  returns  to  the  subject.  This  being 
so,  it  is  with  a  peculiar  pleasure  that  one  finds 
any  contribution  to  the  literature,  where  either 
through  intrinsic  importance  of  the  views  held, 
or  because  of  some  freshness  of  utterance,  the 
reader  is  at  once  interested  in  spite  of  himself. 
On  both  these  points  we  commend  the  paper 
contributed  to  the  current  number  of  Tuberculosis, 
by  Dr.  Alfred  Boyd,  the  Honorary  Secretary  of 
the  Dublin  Branch  of  the  National  Association  for 
the  Prevention  of  Tuberculosis.  In  discussing 
the  present  position  of  the  problem  in  Ireland, 
he  states,  as  tersely  as  it  is  possible  to  do,  the 
facts  and  figures  of  the  past  few  years,  contrasting 
the  rates  of  incidence  and  mortality  with  those  of 
England  and  Scotland.  It  is  discouraging  to 
those  particularly  interested  in  the  Irish  aspect  of 
the  question  to  find  that  while  the  death-rates 
from  tuberculous  diseases  in  England  and  Scotland 
have  during  the  past  forty  years  been  reduced  by 
about  one-half  and  one-third  respectively,  the 
death-rate  in  Ireland  shows  a  slight  increase. 
It  is  curious  that  whereas  the  Irish  rate  is  now 
the  highest,  in  1864  it  was  by  far  the  lowest.  In 
an  agricultural  population,  such  as  in  the  main 
is  that  of  Ireland,  it  ought  to  be  easier  to  arrange 
life  on  hygienic  principles  than  in  an  industrial 
population.  But  we  must  bear  in  mind  the  fact 
that  in  the  Irish  peasant's  cabin  over-crowding 
is  the  rule,  and  ventilation,  once  the  door  has  been 
shut  for  the  night,  is  unknown.  If  anything  will 
counteract  the  evils  of  such  habits,  and  tend  to 
ameliorate  the  sanitary  conditions  of  the  people, 
it  is  the  persistence  of  such  efforts  as  Dr.  Boyd 
tells  us  are  now  being  made  under  the  auspices  of 
his  Branch.  "  Much  is  being  done  to  educate 
the  people  in  matters  of  general  hygiene.  This 
subject  is  now  taught  in  the  Roman  Catholic 
Theological  College  at  Maynooth,  and  in  several 
of  the  Training  Colleges  for  National  School 
Teachers  ;  the  influence  of  such  teaching  on  the 
students  in  these  colleges  should  in  time  show 
itself  in  an  improvement  in  the  hygienic  state  of 
the  towns  and  villages,  in  the  life  of  which  the 
clergy  and  teachers  are  so  important  a  factor. 
Hygiene  is  also  being  taught  by  the  itinerant 
lecturers  under  the  Technical  Instruction  branch 
of  the  Department  of  Agriculture  and  Technical 
Instruction."  As  regards  the  treatment  of  the 
disease  itself,  we  find  that  in  seventy-two  Union 
infirmaries — nearly  half  the  total  number — there 
is  now  separate  accommodation  for  cases  of  con- 
sumption, and  it  is  likely  that  much  greater 
enterprise  will  soon  be  shown  by  the  Poor-law 
authorities.     In  Dublin  itself,  much  remains  to 


be  done.  The  question  of  making  phthisis  a 
notifiable  disease  is  still  under  discussion,  and 
though  it  has  been  stated  that  it  is  at  present 
optionally  notifiable,  no  step  has  ever  been  taken 
by  the  sanitary  authority  to  invite  the  co-operation 
of  the  profession  in  Dublin.  No  attempts  are 
made  to  prevent  spitting  in  the  streets,  and  but 
little  in  public  conveyances.  The  Medical  Officer 
of  Health  has  again  and  again  urged  the  ad- 
visability of  providing  bacteriological  examination 
at  public  expense,  but  the  Corporation  remains 
inert.  The  existing  institutions  for  the  treatment 
of  consumption  in  Dublin,  while  doing  admirable 
work  as  far  as  their  resources  permit,  are  quite 
insufficient.  In  fact,  for  the  very  poor  there  is 
at_  present  practically  no  provision  outside  the 
Union  infirmaries.  While  the  position  in  Ireland 
is  still  very  grave,  yet  there  are  undoubted  hopeful 
signs  in  the  awakening  of  public  opinion  and 
the  enlightened  action  of  many  public  bodies. 
With  determined  reform  along  the  lines  laid 
down  by  Dr.  Boyd,  there  is  no  reason  why  the 
death-rate  from  tuberculosis  in  Ireland  should 
not  be  materially  reduced  in  the  next  few  years. 


ttotes  on  Current  Goptcs. 

St.  Bartholomews  Hospital* 
The  meeting  of  the  Governors  of  St.  Bartholo- 
mew's Hospital  at  the  Mansion  House  last  week 
in  furtherance  of  the  appeal  for  funds  for  rebuilding 
on  the  present  site  resulted  in  a  preliminary  sub- 
scription  list   of   ^40,000.     There   is   reason   for 
congratulation  on  this  result,  as  showing  the  prac- 
tical sympathy  of  the  public  for  this  ancient  and 
noble  charity.    At  the  same  time  it  cannot  be  said 
that  any  of  the  speeches  advanced  any  conclusive 
grounds  against  the  adoption  of  a  partial  removal 
scheme,  whereby  the  necessity  of  an  appeal  to  the 
public  would  have  been  rendered   unnecessary. 
The  sale  of  the  present  site  would  have  enabled  the 
authorities  concerned  to    have    built  a    palatial 
hospital  in  a  healthy  suburb,  and  at  the  same  time 
to  have  left  behind  ample  out-patient,  casualty, 
and  medical  school  accommodation.     The  argu- 
ments advanced  by  speakers  were  founded  mainly 
on  sentiment.     Sir  Trevor  Lawrence  remarked  that 
removal  would  not  only  make  a  great  difficulty  in 
the  treatment  of  patients,  but  it  would  absolutely 
destroy  the  medical  school.     Why  it  should  be 
more  difficult  to  treat  a  sick  patient  at  Hampstead, 
say,  than  in  Smithfield  is  not  clear,  remembering 
that  the   great   majority  of   St.    Bartholomew's 
patients  are  drawn  from  the  provinces  and  from 
outlying  London.     If  the  medical  school  be  threat- 
ened by  removal  of  the  hospital  wards,  it  is  well 
to  bear  in  mind  the  infinitely  greater  jeopardy 
arising    from    the    centralising    proposals  of  the 
University  of  London.     The  Bishop  of  London 
observed  that  the  proposal  to  remove  the  hospital 
would  be  supported  by  some  people  just  as  would 
a  similar  suggestion  with  regard  to   St.  Paul's 
Cathedral.    The  analogy,  however,  is  hardly  sound. 
St.  Paul's  is  built  for  healthy  citizens,  and  St. 
Bartholomew's  for  the  sick  and  ailing.  Moreover, 


Feb 


many  City  churches  are  deserted,  and  have  plainly 
outij  c   function,  while  others  have  been 

removed  into  the  country.     In  short,  the  Bishop 
could  not  have  advanced  an  aptcr  illustration  .."] 
the  desirability  of  sacrificing  sentiment   to  reason 
as  regards  the  retention  ol  effete  institutions  on 
the   site   of    their    former    usefulness    instead   of 
removing  them  to  fresh  centres  of  activity.     Mr, 
John  Tweedy  said  removal  of  St,  Bartholomew's 
d  be  not  only  a  calamity  but  a  disgrace  to  the 
Of     London.     Dr.  Gee   argued   that     if   the 
mors  listened    to    critics    who    put    forward 
mt  schemes  the  result  won  id  be  the  disinte- 
gration and    destruction    of    the    II capital,     We 
ire  to  think,  however,  that  strong  expressions 
anion  of  that  kind  cannot  take  the  place  of 


.NOTES  OX  CURRENT  TOPICS.  Thb  Mrd,cal  p„ss. 


127 


may  press  in  individual  cases,  are  such  as  they 
themselves  are  responsible  for,  There  will  always- 
be  grit  m  the  axles  of  the  best-oiled  wheels,  but  the 
coach  must  be  driven  on  nevertheless, 


The  Late  Dr.  George  Salmon, 
In'  common  with  our  lelbws  in  other  fields  of 
science  and  learning,  we  this  week  deplore  the 
death  of  Dn  George  Salmon,  Provost  of  Trinity 
College,  Dublin.  To  few  men  has  it  been  given 
to  make  a  world-wide  reputation  in  two  such 
distinct  branches  of  study  as  mathematics  and 
divinity,  yet  of  Salmon  this  may  truly  be  said. 
It  is  a  great  deal  more  than  a  generation  ago  since 


lus  publication  of  "  Conic  Sections  "  raised  him  at 

tncing  argument  in  so  important  a  'matter.    °^ce   *°   fhe    foremost   rank   of   mathematicians, 
Several   London   daily   newspapers    have   made  a 

ig    stand   in   favour  of    a    more   economical 

ne  of  partial  removal.     Some  pointed  qucs* 
tions  bearing   upon  the  point  were  raised  by  a 

eroofj  and  inadequately  answered. 


Notifications  and  Erroneous  Diagnoses. 
The    action    recently    tried    before    Mr.    Justice 
Itham,  in  which  Dr.  William  Gould  was  sin   I 
la  mages  for  Certifying  a  child  as  having  small- 
pox, was  really  suffering  in  mi  chicken- 
pox,  should  encourage  practitioners  to  have  the 
courage  of  their  opinions.     The   plaintiff   was   a 
dressmaker  and  she  claimed  that  her  business  had 
been  rumed  by  the  report  that  she  had  had  a  case 
All-pox  in  the  house.  No  one  can  help  sym- 
pathising with  a  person  placed  in  this  unfortunate 
ton,  but  the  blame  must  be  placed  on  the  state 
nfl  the  law  and  an  unhappy  conjunction  of  circum- 
stances, nut  on  the  doctor,     Dr.  Gould  is  to  be 


where  he  established  himself  permanently  by  other 
works  which  soon  followed— "  Higher  Algebra/* 
" Higher  Plane  Curves/*  "  Analytical  Geometry  of 
Three  Dimensions."  These  books  were  at  once 
recognised  as  epoch  making  in  higher  mathc- 
:»d  were  translated  into  every  European 
language.  It  is  passing  curious  that  as  text- 
books they  are  still,  after  forty  years,  in  universal 
use.  For  the  past  fifteen  years  tit'  had  ruled  over 
his  College,  where  he  had  been  regarded  almost 
with  reverence  by  those  under  his  sway,  i  H 
unfailing  courtesy,  of  delicious  humour,  of  massive 
teaming,  of  incredible  modesty,  and  withal  one 
of  the  strongest  of  men  in  character  and  will,  he 
had  these  traits  that  ensure  both  respect  and  love. 
His  toss  to  Dublin  University  is  incalculable,  for 
never  in  her  history  were  calm  judgment  and 
inflexible  strength  such  as  his  more  necessary. 
To  our  own  profession  he  was  bound  by  warm 
ties,  not  only  as  the  head  of  a  College  possessing 
a  great  medical   school,   but   by   bis  accepting  a 


ily  congratulated  on  having  come  scathlcss    , 
out  ol  the  trial,  and  secured  a  verdict  exonerating    £*   ??*„**>     he   Honorary   Fellowship  of  the 
him  from   any   suspicion  of   blame.     We  are   all    R°yai  CoUx^  °l  Ph^1Giails  «n  ™™*- 


fallible,  and  the  power  of  making  a  correct  diagnosis  ' 
does  not  always  lie  within   human  capacity  ;  the 
best  a  man  can  do  is  to  arrive  at  the  decision  that 


Cancer  and  Morphology, 

The  recent  researches  which  have  been  under- 
lie to  best  accord  with  the  phenomena  that  he    taken   in   connection   with   cancer   have   resulted 


observes,     Having  done  this,  he  has  no  option  10 

the  case  of  infectious  disease  ;    he    is  bound  to 

notify  the  case,  whether  he  wishes  to  or  not.     The 

asibility  entailed  by   his  decision   passes  out 

IS  hands.     In  the  case  under  notice  Dn  Gould 

itted  in  his  pleadings  that  his  diagnosis  had 

not  been  confirmed  by  the  subsequent  progress 

te  case,  but  that  he  had  performed  his  duty 

when  he  informed  the  sanitary  authorities  of  his 


in  the  discovery  of  cancer  cells  in  fish,  It  is 
not  so  very  long  ago  that  a  distinguished  pathologist 
asserted  that  the  disease  was  peculiar  to  the 
human  species,  an  assertion  shortly  afterwards 
discredited  by  the  results  of  a  careful  inquiry 
into  the  occurrence  of  cancer  in  the  lower  animals, 
which  results  have  now  been  supplemented  by 
the  present  discovery.  This,  while  it  does  not, 
so   far    as    can    be    seen,   enlarge    the  scope  for 


diagnosis.     A   medical   man  in  one  of  the   large    treatment,  seems  feo   throw  some  light  upon  the 
U  wai  lately  prosecuted  and  fined  for  failing  I  morphology  of  the  disease,  and  tends  rather  to 


lify  a  case  of  infectious  disease  with  regard  to 

which  he  denied  that  he  had  made  up  his  mind, 

but  of  which  he  had  spoken  to  the  relatives  as 

being  possibly  one  of   scarlet   fever.     With  the 

hard  legal  obligation  laid  on  him  the  practitioner 

lias  no  alternative  but  to  notify  to  the  best  of  his 

ability K  and  it  will  be  well  for  people  to  grasp  the 

hat  it  is  they  who  make  the  laws  of  the  land, 

-ind  that  any  disabilities  that  they  suffer  through 

its  being  carried  into  effect,  however  hardly  they 


support  the  view  which  has  from  time  to  time 
been  expressed  that  certain  embryonic  cells 
possess  spermatic  properties*.  Haeckel's  pro- 
nouncement that  the  individual  in  his  life  epito- 
mises the  "  form -modifications  M  undergone  by 
the  successive  ancestors  of  the  species  in  the  course 
of  their  historic  evolution,  may  be  held  to  explain 
the  genesis  of  those  cells.  If  the  latter  are  rem- 
nants of  bygone  ages,,  it  is.  not  unreasonable  to 
anticipate    that    with    the    increase    of    medical. 


128    The  Mrdical  Press* 


NOTES  ON  CURRENT  TOPICS. 


Feb.  3,   1904. 


science  and  the  consequent  preservation  of  the 
physically  unfit,  in  defiance  of  the  law  which 
leads  to  the  advancement  of  all  organic  beings, 
namely,  "  To  multiply,  vary,  and  let  the  strongest 
live  and  the  weakest  die,"  there  will  be  a  still 
further  increase  in  the  number  of  cancer  cases. 
It  may,  however,  be  that  the  improved  conditions 
under  which  we  live  will  result  in  such  a  strengthen- 
ing of  the  resistance  of  the  tissues  that  the  parasitic 
cell  can  no  longer  make  encroachments  upon  them. 
Prof.  Ro swell  Park,  of  New  York,  stated  five 
years  ago  that  the  death-rate  from  cancer  was 
increasing  at  such  a  pace  that  if  for  the  next 
ten  years  the  relative  death-rates  were  maintained, 
in  1909  there  would  be  more  deaths  in  the  State 
of  New  York  from  cancer  alone  than  from  con- 
sumption, small-pox,  and  typhoid  fever  combined. 


must  be  thoroughly  dealt  with  in  the  same  manner 
if  an  early  and  complete  cure  is  to  be  effected. 


Gonorrhoea!  Infection  in  the  Female. 

A     somewhat     unsavoury,     but     nevertheless  j  salinVsolu^ 


Pulmonary  CEdema  and  Serum  Injections. 
A  chronic  condition  of  oedema  at  the  bases  of 
the  lungs  is  one  encountered  in  the  course  of 
many  affections,  accompanied  by  long-continued 
pulmonary  congestion  of  cardiac  insufficiency, 
notably  in  chronic  renal  disease,  when  the  heart 
has  begun  to  fail.  The  occurrence  of  an  acute 
oedema  of  the  lungs  is  less  often  met  with,  and 
fortunately,  for  it  is  a  very  grave  condition. 
MM.  Achard  and  Paisseau,  at  a  recent  meeting  of 
the  Societe  Medicale  des  Hdpitaux,  described  an 
autopsy  they  had  performed  in  such  a  case.  The 
patient  was  a  woman  who  had  undergone  an 
operation  for  hysterectomy,  and  secondary  internal 
haemorrhage  had  supervened.  In  order  to 
combat  this,  a  subcutaneous  injection  of  normal 


highly  important  point  has  been  brought  forward  |  inserted  ^^  the  skin  ^  ten  htm  fa  ^ 
by  Dr.  Antra,  of  Guatemala,  who,  as  Government  j  course  of  twent  four  hours  si  of  pulmonar^ 
examiner   of   prostitutes,  has  gained  a  wide  ex-  j  oedema  be^  t0  to  which  ^  rd  ' 

penence  of  venereal  disease  in  Central ^  America.  {  succumbed>  and  the  characteristic  lesions  were 
It  has  always  been  assumed  and  taught  that  gonor- ,  found  m  the  x  after  death     There  fa 

rhoeal  infection  was  conveyed  to  the  female  by  the  ■  addition,  alterations  in  the  epithelial  cells  lining 
introduction  of  the  gonococcal  pus  into  the  vagina, ,  the  renal  tubules     To  what  the  feal  cauge  q{  ^ 

and  that  the  first  symptoms  of  the  disease  «-  polmonary  <adema  wa.  due  in  this  ca»  fa  a  matter 
curred  in  connection  with  that  tube.  The  vagi-  \  o{  some  uncertaint  The  authors  were  indined 
nitis  thus  initiated,  one  has  been  accustomed  to  j  to  attribute  it  not  „  much  to  the  chloride  of 
think  spread  to  the  urethra  and  vulva,  and,  if  not  |  .odium  in  the  injection,  as  to  its  mere  bulk, 
cured  by  strong  and  early  measures  to  he  uterus.  AUerations  in  the  re„al  epithelium  have  been  pro- 
The  disastrous  results  of  gonorrhoea!  endome-  duced  experimentally  by  the  subcutaneous  in- 
tntisand  its  intractable  nature  are  too  well  known  \  jection  of  saline  tfAntim  m  rabbi  but  whether 
to  need  comment.  But  Dr.  Antra  holds  that  the  ,  a  coaditioa  of  pulmonary  ^ma  might  be  similarly 
primary  infection  occurs  in  the  cervix  uteri,  and  caused  te  stiu  undetermined.  It  is  conceivabie 
that  it  is  only  when  this  structure  has  become  in     that  d  mi  ht  ^  from  the  use  of  solutions 

flamed    that    the    vagina   suffers     the   discharge  I  of  usd  tonici      to  that  of  the  Uood  ^  m 

passing  into  it  from  the  external  os.     Dr.  Antra  .  r  e  such  „  the  mjection  of  air  when  the 

first  noticed  that  all  women  with  vaginitis  and  fluid  „  lntroduced  directl  '  mto  the  circulation> 
urethritis  suffered  ako  from  cervical  inflammation, ,  h         M  .,  wd,  ^  ^  attended  ^  fatal 

and   subsequently    his    attention    was    drawn    to  I  resu]ts      Thc  case,  such  as  the  one  quoted,  shows 

the  fact  that  many  women  who  were  quarantined  .  f.    ,    i™~<;™i  ^e  ™^,.«  ;«;^*;~«„  ~ _~ii  .  ««» 

.     ,        ,    J      .  .  t        ,    n  .   .  .         ,1  that,  beneficial  as  serum  injections  generally  are, 

for  cervical  endometritis  developed  vaginitis  and    0rtW,    _   »•  „   „.  i^»#.  ;„  ^  :^a  :    Zu  •       I 
A,    .A.    .  A         ..    lL       .     ,    A  .   .        lL    i  some  caution,  at  least,  is  required  in  their  use. 

urethritis  later.     He  then  took  to  examining  the 

discharge  from    the    cervix   in    such   cases,   and  j  # 

found  the  gonococcus  of  Neisser  both  by  staining  Typhoid  Fever  among  the  Chinese, 

and  culture.  His  final  observations  were  made  \  Among  the  various  external  factors  which 
on  154  women  suffering  from  first  attacks,  and  in  l  influence  the  incidence  and  character  of  disease, 
all  these  he  found  the  specific  organism.  The  ;  none>  perhaps,  are  so  interesting  or  so  little  under- 
therapeutical  deduction  from  these  facts  is  that  stood  as  topographical  conditions.  Climate,  race, 
our  recognised  systems  of  treatment  have  been  and  national  habits  and  customs  are  known  to 
far  from  sufficient,  and  as  the  early  treatment  of  '  render  in  the  same  malady  certain  symptoms 
the  affection— which,  unfortunately,  is  far  from  \  prominent,  and  to  obscure  others.  Typhoid  fever 
being  confined  to  the  class  of  women  of  whom  is  a  disease  which  is  powerfully  affected  by  locality. 
Dr.  Antin  treats— is  of  the  greatest  moment,  it  ^r-  James  Cantlie  (a)  has  shown  that  in  China 
will  be  well  in  the  future  to  examine  the  cervix  its  type  differs  somewhat  from  that  seen  in  Western 
carefully.  It  is  generally  admitted  now  that  un-  (  countries.  Taken  on  the  whole,  the  disease  is 
less  energetic  and  severe  measures  are  adopted  not  common  among  the  Chinese,  but,  owing  to 
at  the  outset,  very  grave  complications  may  the  absence  of  accurate  statistics  extending  over 
follow,    and    that    to    treat  gonorrhoea!  vaginitis    a    sufficiently    long    period,    actual    figures   are 


with  mild  antiseptic  irrigations  is  to  play  with  the 
fire.  The  best  method  is  to  anaesthetise  the  patient 
and  apply  strong  antiseptics  directly  to  the 
inflamed  parts,  and  in  all  future  dealings  the  cervix 


difficult  to  procure.  The  Chinese  method  of 
preparing  food  would  seem  to  be  responsible  for  the 
comparative  immunity  which  they   enjoy  from 

(a)  Practitioner,  January*  1904. 


Fts,  j,  1904, 


NOTES  ON  CURRENT  TOPICS. 


The  Medical  Press.     129 


enteric  fever.  Practically  all  the  water  consumed  regulate  exactly  the  amount  and  tension  of  the 
by  them  is  boiled  before  drinking,  either  in  the 'evolved  gas.  In  advanced  disease  and  de- 
bras  of  tea  or  in  the  shape  of  congee-water,  which   hilitated  subjects  its  practice  is  certainly  contra- 

ter  in  which  rice  has  been  boiled.   Vegetables   mdlcated> 
are  invariably  cooked,  and  little  milk  is  drunk. ! 
It   is  seen,   therefore,    that   the    most   important 
liiinnds  of  infection  of  the  disease  are  eliminated 


The  Health  of  Hospital  Residents* 
The  stale  of  the  general  health  of  the  resident 
Europeans  appear  to  contract  typhoid  in  China  staffs  in  our  hospitals  "»  well  known  to  be  liable 
with  greater  relative  frequency,  perhaps  because  1 to  considerable  deterioration  during  their  terra  of 
they  do  not  always  adopt  the  native  methods  of ' o0*€e*  unless  special  precautions  are  taken  to 
preparing  and  cooking  food.  On  the  other  hand,  avoid  il-  There  are  many  causes  which  combine 
the  case-mortality    is    much    higher    anion*?    the   ut  make  il  difficult  *or  a  resident  medical  officer 

nese  than  among  Europeans,  but,  here  again,  or  h°use-surgcon  to  keep  himself  thoroughly  w  fit." 
difficulties  arise  through  lack  oi  statistics.     The  Thc  sense  of  responsibility,  which   is  apt  to  weigh 

us  of  the  different  missionary  societies  deal  lmdlll>'  nV°n  the  newly-appointed  resident,  the 
less  with  medical  cases,  as  a  rule,  than  with  surgery  con^ant  contact  with  disease,  both  in  the  wards 
muI  AnhftiBimAUiM    —  *w_  -^,jj— .  ..... —  i_  r_^  and  in  the  out-patient  department,  the  disturbed 


and  ophthalmology,  as  the  natives  seem  to  prefer 

their  own  doctors  fur  ordinary  medical  complaints. 

The  "  typhoid  state  "  is  said  to  be  rarely  seen  in 

Chinese,    and    real    epidemic    forms    of    the 

are    almost    unknown T    though    sporadic 

occut  from  time  to  time. 


The  Bisks  of  Gastric  Inflation 
amplest   form  of   intragastric   technique, 


rest  at  night,  and  the  limited  amount  of  open-air 
recreation,  all  conspire  to  undermine  the  health 
of  any  but  the  most  robust.  In  nine  cases  out  of 
I  ten  it  is  the  resident  himself  who  is  to  blame  by 
deliberate  neglect  of  regular,  if  brief,  daily  exer- 
cise in  the  open  air,  for  there  is  nothing  like 
complete  absence  from  the  scenes  of  work  to 
remove  the  feeling  of  being  always  on  duty  which 
is   apt    to   develop   into   a   veritable    fixed    idea. 


and,  next   lu  lavage,  the  one  earliest  learnt  by  the  tl,^  ;e  w™*  A  j   *.      ^    %  ■       ,     ♦,  *L- 

,    ,     ,     ,        ,-  fc-  '  rZ    \  ^     ■        There  is  more  excuse,  perhaps,  for  laxity  in   this 

nt  of  medicine,  is  that  ot  artificially  inflating   ™™-t  ;~  *u~  ^^     t \u    .       tt      L       -.i        * 

.      -  .  .  y         <**    h  respect  in  the  case  of  the  smaller  hospitals,  where 


[be  stomach  with  gas  in  order  to  delimit   its  boun 
dines  or   to  demonstrate  the  position  or  immo 


the  resident  staff  is  limited  to  one  or  two,  but  in 
(very    large    institution    with    a    medical    school 


■    suspected    tumour.     No   special    ap-  atlached    il   is  quite  possible   for  those  holding 


piirams  is  required  for  this  purpose,   all   that   is 

try  being  the  administration  of  a  measured 

quantity  of  bicarbonate  of  soda  followed  by  some 


house  appointments  to  get  "  off- lime  "  daily, 
except  under  circumstances  of  great  pressure. 
Some  interesting  statistics  bearing  on  the  subject 


vt«rubk   acid  salt ,  such  as  the  tartrate  of  potas-  have  hwn  b         ht  %Q  hht  by  ^V  R,  S.  Emcr- 

'7,   The  effects  can  be  then  carefully  watched,  sorip  o£  the  B<moa  CUy  Hospital,  in  which  it   19 

and  the  position  of  the  stomach  accurately  noted.  clearly  Seen  that  the  heaUh  and     enera1  fitDess  of 

1  a  general  rule  the  method  is  devoid  of  pam  or  the    T^dent   bear   a  chstmcl  relatioilsmp  t0  the 


wenience   to   the  patient,   and   is   frequently   amount  of  exercise  taken.  Tonsillitis,  or  -  hospital 
of  great  assistance  in  arriving  at  a  correct  diagno-   *nrP    rh™i  »  _-   Mlp   mnc+ .  ™mrtlftn    ,;im_t  «n 


assistance  in  arriving  at  a  correct  diagno-   ^e    throa^  was   ^'m^'^^^^tM 

ls  ol   certain   morbid    conditions   of    the   organ. '  both  the  medical  and  surgical  side,  while  influenza, 

That  the  practice  of  inflation  may  not  be  alto- 1  furunculosis,  and  septic  complaints  added   their 

ler  without    danger   is   shown   by   Dr.   Moses  j  quota   to   the   list   of   minor  illnesses.     Since   thc 

Behind,     ^     of   Philadelphia,   who   relates    three   Introduction  of  the  gymnasium  and  the  swimmmg- 


cases  in  which  its  performance  was  followed  by 
death,  All  the  patients  were  over  fifty  years  of 
age,    Thc  first  died  from  hemorrhage,  a  chronic 


bath  as  part  of  the  residential  equipment  of 
hospital  colleges,  the  health  of  house-officers  has 
materially  improved,  and  for  their  own  sake,  as 


gastric  ulcer  being  found  at  the  autopsy.     In  thc   wcll  as  that  of  their  patients,  It  behoves  them  to'usc 
I  case,  one  ot  carcinoma  of  the  lower  end  of  I  the    opportunities    provided    for    systematic    re^ 
ihc  (esophagus  and  cardiac  end  of  the  stomach, '  creation, 
death  resulted  from  prostration,  while  in  the  third  ' 


ance  the  fatal  issue  was  directly  attributable  The  Teaching  of  Hygiene  and  Temperance. 

it  dilatation  of  the  lower  part  of  the       We  have  received  a  copy  of  a  petition  which  is 

QSOpbagus  being  discovered  at    the  post-mortem,   being  sent  to  the  registered    medical  practitioners 

1  all  cases  carbonic  acid  gas  was  employed  in   o(  Great    Britain   and   Ireland  for  signature,  and 

*  usual  manner,  and  each  one  complained  of  a    which  deals  with  a  matter  of  considerable  prac- 

sense    ot    oppression     shortly     afterwards.     One  |  Ucal  importance  to  the  State  in  general,  as  well  as 

sinking  point  is  the  great  diversity  oi  ihe  lesions    o(  deep  interest  and  concern  to  the  medical  pro- 

discovered  after  death,  but  it  is  noteworthy  that    fession\     The  objecl  ol  rhc  pctltion  is  lo  endeavour 

m  two  cases  there  was  disease  affecting  the  lower  |  to  seCure  thal  cvcrv  child  in  our  nalional  schools 

<md  ot   the  esophagus  and  cardiac  extremity  of   shall   obtain   some 'instruction   in    the   rudiments 

the  stomach,   which  would   thus  appear   to  con-    0f  the  simpler   rules   of   health   and    temperance. 

ihtate  1  '■  dangerous  area."     Thc  chief  drawback   The   petition   draws   attention    to   the   great   fan- 

inflation  in  gastric  disorders  is  the  inability  to  j  portance  of  such  instruction  as  a  means  of  leading 

(ft)  jr«d.  AT*ift,  December  19th.  lwis.  j  children  to  appreciate  at  their  true  value  cleanli- 


*3°    Ths  Medical  Prbss- 


NOTES  ON  CURRENT  TOPICS. 


Feb.  3,  1904. 


ness,  personal  hygiene,  food,  drink,  &c.  It  also 
draws  attention  to  what  is  being  already  done 
in  this  direction  in  the  Army  schools,  in  many  of 
the  colonies,  and  in  the  United  States,  as  well  as 
in  some  schools  in  Great  Britain  and  Ireland. 
In  the  opinion  of  the  promoters  of  the  petition, 
such  instruction  should  be  compulsory  and  given  by 
competent  teachers,  who  must  have  themselves 
received  adequate  instruction  in  these  subjects. 
The  Medical  Press  and  Circular  has  ever 
striven  hard  to  impress  on  its  readers  the  necessity 
for  every  medical  man  endeavouring  by  precept 
-and  example  to  inculcate  among  his  patients 
^and  the  public  generally  the  principles  of  hygiene. 
At  the  present  time,  when  so  much  attention  has 
been  drawn  to  the  necessity  for  the  improvement 
of  the  national  physique,  the  circulation  of  the 
petition  is  especially  wise,  and  we  trust  that  every 
member  of  the  profession  who  has  not  already  done 
-so  will  add  his  name  to  those  already  at  its  foot. 

Pulmonary  Osteopathies 

The  association  of  clubbing  of  the  finger-tips 
with  chronic  pulmonary  congestion  has  long  been 
known,  so  that  the  possibility  of  similar  changes 
from  the  same  cause  on  a  more  extensive  scale 
excites  interest  rather  than  surprise.     According 
to  Dr.  H.  E.  Symes-Thompson,  (a)  the  salient  feature 
•iof  this    "  hypertrophic    pulmonary  osteo-arthro- 
pathy  "  is  more  or  less  symmetrical  enlargement 
•of  the  bones  and  joints,  and  sometimes  also  of 
the  soft  parts,  more  particularly  in  the  extremities. 
The  pathological  anatomy  of  this  curious  con- 
stitutional    disturbance    is    of    less    immediate 
general  interest  than  its  causation,  and  it  happens 
that  this  is  largely  a  matter  of  hypothesis.     It 
is  said  to  be  commoner  in  males  than  in  females, 
and  is  more  frequently  met  with  between  thirty 
and  forty  years  of  age.     Although  in  the  majority 
of  instances  the  affection  was  consequent   upon 
chronic  suppuration  in  the  chest,  it  is  sometimes  met 
with  in  association  with  other  protracted  morbid 
states,  as,  for  instance,  in  congenital  heart  disease. 
It  is  surmised  that  the  changes  in  the  ossedus 
system    and    joints  are  brought    about    by  the 
presence  in  the  blood  of  certain  undefined  toxins, 
some  of  which  are  fixed  and  others  volatile.     The 
latter  should  normally  be  got  rid  of  through  the 
lungs,  the  fixed  toxins  being  destroyed  by  the 
liver.     If  this   hypothesis  be  correct,  it  follows 
that  the  presence  of  a  toxic  focus  in  the  lungs  is 
not  essential  to   the   production  of  osteopathy. 
Many  obscure  points  remain  to  be   worked   out 
before  we  can  hope  to  grasp  the  pathology  of 
these  far-reaching  changes,  and  the  author  deserves 
praise   for   his    courage    in   tackling    a    problem 
presenting  so  much  difficulty.     As  was  pointed 
out  in  the  discussion  to  which  Dr.  Symes-Thompson's 
paper  gave  rise,  these  changes  are  not  always,  or 
even  often,  met  with  in  association  with  chronic 
pulmonary  disease,  so  that  there  must  be  some 
independent   factor   to    explain   their   incidence. 
Various  forms  of  chronic  intoxication  have  been 
invoked  to  explain  the  lesions  of  that  ill-under- 

Roval  Medical  and  Chirurgictl  Society,   January  12th,  1904. 


stood  group  of  lesions  known  en  bloc  as  rheu- 
matoid arthritis,  and  intoxication  of  pulmonary 
origin  may  in  certain  subjects  be  the  determining 
factor. 


Tuberculous  Infection  of  the  Tonsils. 
The  importance  of  the  lymphoid  tissue  of  the 
pharnyx  and  adjacent  regions  as  a  possible  channel 
of   infection   by    means    of   which    the    tubercle 
bacillus  gains  access  to  the  system,  can  hardly 
be    over-estimated.     The    early    eradication    of 
adenoid  vegetations  in  young  children  is  freely 
justified  when  viewed  from  this  standpoint  alone. 
The  peculiar  susceptibility  of  the  tonsils  in  this 
respect  is  especially  noteworthy,  as  experimental 
observation  has  abundantly  proved   their  capa- 
bility to  act  as  channels  of  infection,  not  only  for 
the  ordinary  septic  organisms,  but  also  for  patho- 
genic ones,  including  the  tubercle  bacillus.    Pri- 
mary tuberculosis  of  the  tonsils  unassociated  with 
lesions  elsewhere,  is  exceedingly  rare,  as  has  been 
pointed  out  by  Koplik,  (a)  of  New  York,  but  the 
same  observer  considers  that  the  tonsil  may  be 
the  seat  of  infection  in  certain  cases  of  tubercu- 
losis of  the  cervical  lymphatic  glands.     Dr.  George 
B.  Wood,  (6)  of  the  University  of  Pennsylvania, 
has  collected   1,354  cases  from  the  literature  in 
which    the    tonsils   were   examined    for   primary 
tuberculosis,  with  the  result  that  positive  data 
were  obtained  in  seventy-three — i.e.,  in  54  per 
cent.     Secondary  tuberculosis  is  somewhat  more 
frequent,  and  the  opinion  of  Schlesinger  is  quoted 
to  the  effect  that  in  pulmonary  phthisis  tubercu- 
losis of  the  tonsils  is  almost  always  co-existent. 
The  presence  of  the  latter  can,  as  a  rule,  only  be 
detected    by    microscopic    examination,    as    the 
deposits  of  tuberculous  material  is  situated  deeply 
in  the  tonsillar  substance.     One  clinical  proof  of 
importance  is  always  brought  forward,  namely, 
that  in  tuberculous  cervical  adenitis  the  posterior 
submaxillary  is  generally   the  first  gland  to  be 
affected,  and  as  the  efferent  lymph- vessels  of  the 
tonsil  lead  into  this  gland  anatomical  evidence  of 
the  continuity  of  the  path  of  infection  is  thereby 
furnished. 


Irish  Maternity  Hospitals  and  the 
Midwives  Act. 

We  are  pleased  to  learn  that  the  representatives 
of  the  Belfast  Maternity  Hospital  have  joined  in  the 
protest  of  the  Dublin  Hospital  against  the  extra- 
ordinary regulations  which  have  been  adopted  by 
the  Central  Midwives  Board,  with  the  result  of 
rendering  every  Irish  trained  nurse  ineligible  to 
offer  herself  for  examination  and  certification  in 
England.  At  a  meeting  of  the  staff  of  the  Belfast 
Maternity  Hospital,  the  following  resolution  was 
adopted  and  entrusted  to  Professor  Byers  for 
presentation  to  the  President  of  the  Central  Mid- 
wives  Board.  "  That  the  Central  Midwives  Board 
be  requested  to  alter  their  rules  so  that  any  woman 
attending  '  The  Incorporated  Belfast  Maternity 
Hospital*  shall  be  deemed  to  have  complied  with 

(a)  Anur.  Joum.  Med.  Sci.,  November,  1903. 

(b)  Univ.  Penn.  Med.  BtUl.,  December,  1904. 


Fii.  J.  1904- 


PERSONAL. 


Thb   Medical  Press.     13 1 


their  regulations  in  reference  to  the  training  of 
hospital  midwives,  and  shall  be  eligible  to  present 
herself  for  the  examination  of  the  Central  Mtdwivcs 
Board.**  This  resolution  has  been  somewhat 
loosely  drafted,  but  its  meaning  is  nevertheless 
dear/  It  cannot  be  expected  that  every  woman 
m  attending  "  a  midwifery  hospital  can  be  regarded 
ashaving  rec  ei  ved  a  sui  t abl  e  t rai  n  i  ng ,  i  t  i  l  the  wo  m  an 
tthn  has  taken  her  full  course  at  the  hospital  and 
passed  the  examination  held  by  the  staff  who  can 
claim  the  right,  and  whose  claim  must  be  granted, 
We  cannot  help  thinking  that  the  Central  Midwives 
Board  must  be  very  nearly  on  the  point  of  recog- 
nising that  it  has  "placed  itself  in  an  impossible 
position  by  recognising  midwife-trained  nurses, 
vfetk  at  the  same  time  automatically  excluding 
nurse  trained  in  the  great  Irish  maternity 

hospitals.  — ■ 

Scarlet  Fever  Prevalence  and  Isolation. 
TifE  relationship  between  modern  preventive 
medicine  and  infectious  diseases  is  one  of  the  most 
important  of  scientific  problems.  In  every 
communicable  disease  the  application  of  sanitary 
measures  of  notification,  isolation,  and  disinfection 
have  been  followed  by  a  satisfactory  lessening  of 
incidence,  In  scarlet  fever,  however,  the  disease 
nm  only  holds  its  own,  but  appears  to  gather  in 
strength  in  spite  of  all  the  efforts  of  sanitarians* 
It  becomes  necessary,  therefore,  to  search  out 
diligently  for  the  weak  spots  in  the  armour,  for 
the  control  ol  scarlet  fever  is  certainly  within  the 
compass  of  modern  preventive  science,  At  an 
cariv  period  wTe  propose  discussing  the  whole 
question  exhaustively,  and  meantime  we  cordially 

a  the  co-operation  of  our  readers  in  approach- 
ing the  subj ect .  Mr,  Co rbet ,  the  Med  i c al  6 fficer  o f 
Kidderminster,  aptly  remarked  in  the  course  of 
in  able  report,  which  is  noticed  elsewhere  in  our 
columns  — "Although  it  might  be  said  that 
hospital    isolation    is    not    completely    successful, 

ts  far  as  yet  known,  isolation  and  disinfection 
*tre  the  only  practical  means  for  minimising  the 
spread  of  the  malady." 


68    the    enormous    sum   of    almost  I  ^  the  President  «r  Magdalen  College.  Oxford 
nil  be  required,    This  sum  will,  however,  I  T*  H*  ^Varren)-  ^^_ 


The  Richmond  Asylum. 
T>n:  report  of  the  Finance  Committee  on  the 
estimates  for  the  ensuing  year  have  been  presented 
to  the  board  of  the  hospital.     They  show  that  to 
meet  all 

DOO  will 

tc  not  alone  the  Richmond  Hospital  but  also 
the  new  auxiliary  at  Port  nine,  and  a  suitable 
allowance  for  an  estimated  increase  of  150  patients 
during  the  year.  The  report  shows  that  since 
1894  the  number  of  lunatic  patients  in  the  Dublin 
district  has  increased  by  i,ooo.  We  are  glad  to 
note  that  the  report  bears  testimony  to  the 
admirable  manner  in  which  the  Resident  Medical 


PERSONAL. 


Mr.  George  Philip  Francis.  L.K.C.S.Edin.* 
L.A.H.Dub*.  of  Brecon,  has  been  placed  upon  the  com- 
mission ol  the  peace  for  Breconshire. 

The  Lett  so  mi  an  lectures  of  the  Medical  Society  of 
London  will  be  delivered  by  Mr.  C  B.  Loekwood  on 
Monday  evenings,  February  tst,  15th-  and  29th'  at  $ 
p.m..  qpOO     Aseptic  Surety  in  Theory  ami  Practice." 

Dr.  J.  Kingston  Fowtler  will  deliver  a  lecture  at 
Brampton  Hospital  to-day*  the  subject  being 
**  The  Treatment  of  Thoracic  Aneurysm  by  Gelatin 
Injections."  

On  Thursday  of  the  present  week,  Dr,  F.  J.  Waldo, 
Coroner  of  the  City  of  London,  will  deliver  a  lecture 
on  the  "  Medico- Legal  Relations  of  Insanity*'  at  the 
Old  Hall,  Lincoln's  Inn,  London. 


Dr.  George  Thin,  of  Harley  Street,  who  died  at  Nice 
on  December  27th ,  leaving  estate  of  £29,97  5  >  bequeathed 
tn  the  Royal  Society  of  London  and  the  Royal  Medical 
and  Chirurgical  Society  £\oo  each,  and,  on  the  death 
of  Mrs.  Thin,  £iqo  each  to  the  Middlesex  Hospital  and 
the  Edinburgh  Royal  Infirmary. 

Sir   William    MacEwen,   M.D+,   F,R.S.,   will  visit 

j  Cardiff   and  deliver  an   address   to    the   local   medical 

I  society  on    Friday   afternoon    next.     Sir   William    is 

Regius    Professor   of    Surgery   in    the    University   of 

Glasgow,  and  Surgeon    in   Ordinary    to    His  Majesty 

the  King  in  Scotland* 


Mr.  G.  P.  Rugg,  M.D.Aberd.,  L.R.C.P.Lond,, 
M.R.C.S.Eng,,  who  has  been  the  medical  officer  of 
the  British  Home  and  Hospital  for  Incurables  at 
Sireatham,  London,  S.W..  for  more  than  twenty-four 
years,  recently  received  from  the  patients  and  nursing 
staff  of  the  home  a  silver  howl. 


Ma.  C  F.  Sutton,  M.R.CS.Eng*.  was  recently  pre 
sented  by  his  patients  and  friends  with  a  silver  soup 
tureen,  together  with  a  silver  tea  and  coffee  service  and 
tray,  as  a  token  of  esteem  on  his  retirement  from 
practice  after  nearly  forty  years"  residence  at  Holmes 
Chapel,  Cheshire.  

At  the  fifth  annual  dinner  of  the  University  College 
Colston  Society,  held  tn  the  large  hall  of  the  College  at 
Bristol  im   January   21st,    Mr.   Henry   Hobhouse  pre 
sided  and  the  principal  speakers  were  Sir  John  Gorst 

(Mr, 


On  January  14th,  Alderman  Graham,  M.D.,  presided 
(or  the  last  time  over  the  Public  Health  Committee 
wh':n  a  special  resolution  was  passed  expressive  of 
the  great  loss  the  City  of  Belfast  and  its  council  had 
sustained  by  the  retirement  of  Dr.  Graham.  Dr,  J. 
King  Kerr  has  been  since  appointed  chairman  of  the 
Committee.  

Dr.  D.  C.  Llovo  Owen,  Consulting  Surgeon  to  the 


Superintendent,  Dr.    Conolly  Norman,  discharges  j  Birmingham  and  Midland  Eye  Hospital,  and  Honorary 
his  duties  with  regard  to  the  management  of  the  \  Ophthalmic    Surgeon    to    the   General  Hospital   Bir- 


institution. 


li  is  announced  that  His  Majesty  the  King  has 
consented  to  open  the  new  I'niversity  buildings  at 
Cambridge  early  in  March. 


mingham,  has  resigned  his  membership  of  the  Spectacle 
Makers'  Company  in  consequence  of  the  action  of  the 
company  in  instituting  an  examination  and  issuing  a 
Certificate  in  sight  testing,  an  action  of  which  Dr. 
Lloyd  Qw«t\  disapproves. 


132     Tbi  Medical  Pibm. 


SPECIAL  CORRESPONDENCE. 


Fbb.  3,  1904. 


Special  correspondence* 

[FROM   OUR   OWN   CORRESPONDENTS.] 

SCOTLAND. 

Scottish  Poor-law  Medical  Officers'  Associa- 
tion. —  From  the  annual  report  which  was 
adopted  at  the  meeting  of  this  Association 
on  January  22nd,  it  would  seem  that  the 
efforts  of  the  organisation  to  better  the  position 
of  its  members  are  being  attended  with  some  degree  of 
success.  The  Association's  attempts  to  improve  the 
status  and  prospects  of  the  Poor-law  medical  officers  by 
legislation  have  so  far  not  led  to  any  definite  results, 
the  Bill  introduced  by  Mr.  Wason,  M.P.,  not  having 
reached  a  second  reading.  Allusion  is  made  to  the 
unsatisfactory  state  of  matters  shown  by  the  return 
of  medical  officers  discharged  by  parish  councils  ;  the 
return  was  quoted  in  this  column  some  months  ago. 
Regular  advertising  in  the  medical  papers  has  induced 
many  applicants  for  posts  in  the  Highlands  and  islands 
to  communicate  with  the  secretary  before  proceeding 
with  their  candidature,  and  in  nearly  every  case  the 
result  was  that  the  application  was  not  pursued.  The 
lack  of  teprit  de  corps  displayed  by  some  of  the  medical 
women  who  have  taken  these  posts  is  deplored  by  the 
Association.  A  list  of  vacant  parishes  is  given,  with 
the  reasons  for  which  the  previous  holder  of  the  office 
of  medical  officer  had  to  resign  or  was  dismissed.  The 
Association  numbers  350  members,  less  than  one-half 
of  the  Poor-law  doctors  in  Scotland,  to  whom  an  appeal, 
in  which  we  strongly  concur,  is  made  to  join  the  Asso- 
ciation. 

Disturbances  at  the  Edinburgh  University 
Rectorial  Address. — In  the  sequel  to  the  disgraceful 
rowdyism  which  characterised  the  behaviour  of  the 
students  at  Sir  Robert  Finlay's  address  last  week,  two 
of  the  principal  offenders  were  called  before  the  Principal 
and  Dean's  committee,  and  were  rusticated  for  two 
years.  The  sentence,  though  severe,  is  not  unmerited, 
and  will  do  more  than  much  lecturing  to  show  the  under- 
graduates that  there  is  a  limit  to  folly,  which,  when 
overstepped,  brings  unpleasant  consequences  in  its 
train.  The  Senatus  are  understood  to  have  had  the 
whole  question  of  rowdyism  under  consideration  at 
a  subsequent  meeting,  and  have  resolved  to  take  steps 
to  put  down  this  nuisance  in  the  classes.  It  is  stated 
that  strong  disapproval  of  the  tone  of  the  Student — 
the  University  magazine — was  expressed  at  that  meet- 
ing. A  special  meeting  of  the  Representative  Council 
was  held  on  the  26th,  at  which  a  series  of  more  or  less 
self-condemnatory  motions  were  carried  with  but  little 
opposition.  After  apologising  for  the  uproar,  it  is 
suggested  that  the  students'  concerts,  at  present  pre- 
ludes to  the  address,  should  be  discontinued,  that  seat- 
ing arrangements  should  be  altered  so  as  to  admit  of 
more  effective  "  policing,"  that  the  professors  should, 
the  day  before  such  a  gathering,  point  out  to  the  stu- 
dents the  propriety  of  good  behaviour,  finally,  one  of 
the  council,  who  acted  as  a  ringleader,  is  called  upon  to 
resign  his  seat.  For  ourselves,  we  feel  most  strongly 
that  it  is  not  a  question  of  merely  suppressing  the  row- 
dyism which  characterises  public  students'  functions, 
but  of  doing  away  with  the  general  insubordination 
and  noise  which  disgrace  many  of  the  class-rooms  from 
year's  end  to  year's  end.  The  first  year's  arts  and 
medical  students  are  the  worst  offenders,  and  if  half  a 
dozen  of  the  ringleaders  in  each  faculty  were  rusticated 
early  in  their  career  it  might  induce  them  to  give  up 
professions  for  which  they  are  obviously  unfitted,  and 
leave  the  University  in  peace — neither  would  be  losers 
by  the  change. 

BELFAST. 

Belfast  Lough  Foreshore  Nuisance. — A  Local 
Government  Board  Inquiry  into  this  subject  was  opened 
in  Belfast  last  week,  which  greatly  interests  medical 
men.  The  city,  as  most  people  know,  is  situated  just 
where  the  River  Lagan  flows  into  the  Lough,  and,  as 
happens  in  all  such  places,  there  are  great  stretches  of 
mud  flats  at  the  head  of  the  Lough,  covered  by  the 
tide  at  high  water.     Though  thousands  of  acres  have 


been  reclaimed,  many  thousands  more  remain,  and  at 
every  high  tide  are  irrigated  with  the  liquid  sewage 
of  the  city,  which.as  the  tide  fails,  emits  anything  but  a 
savoury  odour,  especially  if  the  sun  happens  to  shine  on 
it.  Some  years  ago  Professors  Letts  and  Lorrain 
Smith,  of  Queen's  College,  investigated  the  cause  of 
the  smell,  which  is  uncommonly  "  full  flavoured." 
They  found  it  was  due  to  the  decomposition  of  a  green 
sea-weed,  Viva  latissima,  which  flourishes  in  great 
abundance  on  the  mud  banks,  and  which,  containing 
a  high  proportion  of  sulphur  in  its  composition,  gives 
off  great  quantities  of  sulphuretted  hydrogen  as  it 
decavs.  It  might  be  thought  that  the  inhabitants  of  the 
districts  around  the  Lough,  growing  up  in  an  atmosphere 
so  flavoured,  would  become  acclimatised,  but  it  is  only 
since  1890,  or  so,  that  it  has  become  troublesome, 
the  cause  generally  assigned  being  the  introduction 
of  the  "  main  drainage  system  "  at  that  time.  Some 
idea  of  the  quantity  of  weed  may  be  inferred  from  the 
fact  that  during  the  summer  and  autumn  months  of 
1900  and  1 90 1  the  District  Council,  which  took  the 
matter  up  on  the  co.  Down  side  of  the  Lough,  caused 
about  420  tons  to  be  removed  each  day.  Dr.  Donnan, 
Medical  Officer  of  Health  for  Holywood,  stated  in  his 
evidence  that  the  nuisance  was  both  objectionable 
and  injurious  to  health.  The  amount  of  sulphuretted 
hydrogen  is  so  great  that  silver  is  quickly  blackened. 
Dr.  Chas.  O'Neill  and  Dr.  Thos.  Greenfield  Corro- 
borated Dr.  Donnan's  evidence.  Dr.  Letts  (Professor 
of  Chemistry  in  Queen's  College,  Belfast)  gave  a  most 
interesting  account  of  his  experiments,  carried  out  to 
ascertain  the  cause  of  the  nuisance.  It  appears  that 
the  septic  tank  treatment  of  sewage;  which  is  being 
tried  in  Belfast,  results  in  the  production  of  nitrates 
in  abundance,  and  on  these  nitrates  the  seaweed 
flourishes.  To  render  the  sewage  less  nutritious  to  the 
weed  it  will  therefore  be  necessary  to  submit  it  to 
further  treatment,  though  what  that  will  be  has  not 
been  decided.  As  to  the  immediate  lessening  of  the 
nuisance,  Dr.  Letts  thinks  that  much  might  be  done 
by  the  prompt  removal  of  the  weed  as  soon  as  it  begins 
to  accumulate  in  April,  instead  of  waiting  till  it  is  at 
its  greatest  luxuriance  from  July  to  October.  The 
inquiry  has  been  adjourned  till  February  25th. 

Forster  Green  Hospital  for  Consumption, 
Belfast. — At  the  annual  meeting  of  this  hospital, 
held  last  week,  the  medical  report  was  read  by  Dr. 
Howard  Sinclair.  During  the  past  year  186  in-patients 
were  treated  for  periods  varying  from  ten  days  to  nine 
months.  The  average  stay  in  the  hospital,  which  is 
really  a  fresh-air  sanatorium,  is  not  given,  but  is 
apparently  about  two  and  a  half  months.  The  report 
dwells  at  length,  as  it  has  done  every  year  for  eighteen 
years,  on  the  necessity  for  early  treatment.  It  also 
mentions  that  the  hospital  grounds  would  accommodate 
ten  times  as  many  patients  as  there  are,  but  owing 
to  lack  of  funds  they  cannot  be  utilised. 

Belfast  Hospital  for  Sick  Children. — At  the 
annual  meeting  of  this  hospital  the  medical  report 
stated  that  during  the  year  826  children  had  been  treated 
in  the  wards,  and  328  operations  were  performed.  In 
the  extern,  5,377  new  cases  were  treated,  and  304 
operations  were  performed.  In  the  excellent  con- 
valescent homes  connected  with  the  hospital  201 
patients  were  treated. 

Small-pox  in  Belfast. — Three  new  cases  were 
reported  last  week,  bringing  the  total  number  of  cases 
since  the  beginning  of  the  outbreak  to  about  thirty. 


German  Dentist  for  the  Korean  Emperor. 

We  understand  the  following  notice  has  been  pub- 
lished at  Berlin  :— "  H.M.  the  Emperor  of  Korea 
desires  to  engage  a  German  dentist  for  a  period  of  two 
years.  Terms  :  300  yen  monthly.  Expenses  allowed  : 
Lodging,  30  yen;  travelling  expenses,  1,000  yen; 
for  instruments,  4,000  yen  ;  for  establishing  a  labora- 
tory, 50  yen.  One  yen  equals  two  marks  (or  shillings). 
A  consultation  once  a  week  at  the  Palace.  Two 
months'  leave  granted  annually,  and  private  practice 
allowed.     Knowledge  of  English  or  French  essential. 


Feb.  3*  *9&^ 


LABORATORY  NOTES. 


Thb  Medical  Press,     133 


Gorrespoit  Deuce* 


l*>  do   uol   hold    Quincke*    rf^potiHlhle  for  di*  opinion n  of  our 

KQPLIK'S  SPOTS  IN  MEASLES. 

f  The  Medical  Press  and  Circular 

Sir—  The  claims 

t  morbid 

10  decide,  tor  the  reason   1  hat  probably  every  clinical 

event  in  disease  has,  at  some  time  or  another,  attracted 

of  at   least  one  physician.     No  one  would 

y  Darwin  the  credit  that  is  hift  due  because  the  ques- 

ic  evolution  had  been  agitating  mens  minds 

v  a  long  year  before  the  "Origin  of  Species  " 

•■published,  nor  because  Dr.  Alfred  Russell  Wallace 

had  practically   arrived    at    Darwin's   conclusions  at 

the  same    time  as    Darwin    himself,     Jenner's 


ERYTHEMA  SCARLATINIFORME. 

r« j  thr  Edit, >r  of    1  H b   M e Die IL  Press  and  Ci rc r I .\ R 

S  tit,— Dr.     Robert     Lee's   letter   in    vour  issue    ot 

January    2;th    with    reference    10   desquamative    and 

non-desquamative  erythema  is  of  much  interest  to  me 

personally  because  of  its   relation    to  a   general    law 

iCAL  rRESS        o  UicuLAR.     ^ffotf  bv  m  m   ,  S90  under  the  name  of  excretory 

of  individual,  to  pnlj  m  ttie     irritation.     I    then    ventured    to  claim    that  to 

i^^w,'1""-:  "SSfi     dermatitw  a,  one  01  a  eerie*  of  inflammations  of  various 

excretory  organs — ?.%..  skin,  kidney,  intestine,  bronchi. 

The  common  bond  between  these  symptomatic  e 

rory  disturbances  is  the  irritant,  which  may  be  chemical, 

or  of  unknown  tissue  origin.     Instances  of 

each  origin  may  be  found  in  mercury,  enteric  fever  and 

gont,    which   may   either  dire  irectly  inflame 

any  of  the  excretory  nutlets  of  the  body  and  give  rise 

to  diarrhoea,  nephritis,  bronchitis, dermatitis,  and  soon. 

In  fact,  the  application  of  the  general  law  of  excretory 

werk  on   the   differentiations   of   typhoid    fever   from     imlaUoil  wilI  he  found   to  furnish  a  satis  factory  ex 

tvnhiH  remains   classical,   although    for   time    half   a  '»■._-.:. i.w.l^. .,  .7^*'^  e* 


typbtts  remains   classical,   although   for  quite   half   a 

t>efore  he  published   his  results  observers  in 

soar  countries  had  been  seeking  to  establish  the  same 

ctton.  -    of  enduring  work  springs  folly 

from  the   brain  of  the  thinker    like    Athene 

head  of  > 

ccurrence  of  lesions  of  the  mucous  membrane 

e  mouth  and  palate  in  measles  has  been  mentioned 

by  writers  for  many  years.     Trousseau   says   that   the 

raucous  membranes  of  the  respiratory  tract    and  con- 

ihe  presen  imn  on  the  first 

and    that    the    disease    is    "  inscribed  "    on    the 

g,  tonsils,  and  velum  palati  before  the  appear- 

tan  them  of  the  skin.     Similar  statements 

Je  by  other  writers,   Ringer  being,  perhaps,  the 

finite  white  patches.     He,  however, 

nftned  them   to  tl  and  inside  of  the  lips.      1 

D01  of    referring    in    Professor 

rticle   111    \nn    Ziem  vclopacriia  "  of 

but  I  do  not  think  that  his  description,  however 

urate,  would   invalidate   the  general  argument  of 

ler,    namely,    that    since    the    publication    of 

and     Kophk's    respective    papers    general 

attention   was  not   directed    to   the  almost    universal 

occurrence   and   practical  importance  of  these  lc-i 

Those  ol  us  who  have  had  much  to  do  with  the  health 

r ttmmnnities  of  children  have  found  Koptik's  spots 

whatever  their  lecture  designation  may  be)  of   the 

atesi  help  in  the  early  diagnosis  of  measles,  and   I 


planation  of  the  phenomena  of  many  morbid  conditions, 

So   far  as   Dr*   Lee's  desquamative  erythema   is  con- 
cerned, it  supplies  a  rational  qpusa   camans  for    his 
original  and  acute  observation    of    what  is 
S   symptomatic  condition. 

I  am.  Sir,  yours  truly, 
Grosvenor  St.,  London,  W*  David    Walsh. 

ALOPECIA    AND    DENT  A  I-  CARIES. 

htor  of  The  M epical  Press  asd  Circular 
Sir,  —  The  letter  of  your  correspondent,  "  M.R.C.S,,'" 
ui  yOttf  issue  ol  the  jpth,  on  dental  caries  and  alopecia, 
seems  to  me  to  be  based  upon  a  somewhat  out-of-date 
pathology.  Nowadays  it  is  pretty  generally  agreed 
that  most  forms  of  alopecia,  no  less  than  of  dental 
caries,  are  due  to  bacterial  invasion.  The  tissues  of 
some  individuals  are  men-  resistent  to  the  adverse 
eftects  of  such  invasion  than  those  of  others.  Early 
degeneration  means  simply  lessened  resistance  to 
adverse  conditions,  due  either  to  inherited  or  acquired 
weakness  of  individual  constitution.  The  hair  and  the 
teeth  of  pel  ■■!   resistance  will  survive  fl 

years  of  partial  damage.  On  the  other  hand,  early 
degenerates,  as  we  call  them,  toss  both  teeth  and  hair  at 
a  premature  age,  Why  ro  out  ot  the  way  to  find  less 
simple  explanations  ?  Again,  the  statement  that  the 
solid  constituents  of  the  teeth,  once  deposited,  undergo 
no  further  change,  appears  to  me  to  be  a  pure  assump- 
tion,    He  would   be  a    bold   physiologist   who   would 


they  deserve,  lor  instead  of  speaking  authorita- 

iheni  m  his  classical  work.   "  Eruptioj; 
vers,"   he  quoted  a  not    ven    lull 
"  from   Dr.    Hilton    Fagge's   I k      it    5ij     [ohn 


laboratory  ttotes. 

M  1  IXBIRYS     MILK     FOOD    CHOCOLATE, 

e  examined  a  sample  of  this  Milk  Chocolate, 


shad  been  convinced  ot  th  ■  :  these  pheno-    wittl  the  Allowing  results  :  — 


rl  them  himself  and 
it  the  assistance  they  render  m  diagnosis  : 
improbable  that  these  spots  are  the  homo- 
toe   cutaneous    eruption,      1  hev    OCCur   con- 
ably   earlier;     thev    have   a   definite    relation    to 
kin   Structures,    and    they   are   explicable  on   other 
"  ,     If    one    examines    the    buccal    mucosa    in 
one  finds  it  generally  injected  and  inflamed, 
g  through  the  reddened  mucosa  one  Hnds  white 
namely,    the    papilhe,    just    as    one    sees    the 
lie  scarlet  fever  tongue  showing  through  the 
The  mucosa  over  the  papilla?  being  rubied  and 
tltwi   by   the    teeth   or   other    contiguous  structures 
ndl  to  necrose,  or  one  enlually  where  some 

date  spe< '  n.  little 

lum  with  a  margin    <4  inflamed    mucous    ment- 
al. 
over  the  "a  "  m  Koplik,  perhaps 
Km   transferred    it    inadvertently     from    that    ■ 

ifs  name,  Knospil  having  written  on  the  same 
tut     the     same     time     (Frag,   wtd.    U'ocA.,  I 
♦  1).  I  am.  Sir,   vou is  truly. 

Hubert  Ej  J.  Btss. 
Easttxmme,  Jan.  30th,   1904.  ' 


Moisture,    Q'76; 

Albumenoids,  5  44  ; 

Fat,  jo'28  ; 

ral  matter,    rq  : 

I  old  water  extract,  hizo. 
This  is  an  excellent  example  of  a  palatable  sweetmeat, 
iree  Irom  all  Objectionable  additions  and  of  real  nut ri- 
alne.  It  contains  a  very  high  proportion  of 
nourishment  in  a  convenient,  pleasant,  and  portable 
form  and  is  very  suitable  for  travellers,  expeditions,  tVc. 
Some  of  the  cheaper  forms  of  chocolate  are  loaded  with 
the  husk  or  fibre  of  the  cocoa  beanH  this  is  not  the  case 
with  the  article  in  question.which  is  of  very  fine  quality, 
and  may  be  given  to  children  with  tre^utmost  confi- 
dence. 


'TABLOID"  ZINC  VALERIANATE,  Gr.  2 
(0*13  gm.). — (Burroughs  Wellcome  &  Co.) 
The  nauseous  nature  ol  zinc  valerianate  renders  it 
unacceptable  to  the  patient  in  its  crude  lorm.  In  the 
shape  of  the  tabloid,  however,  it  is  possible  to  present 
this  drug  in  such  a  condition  that  it  can  be  taken  by  the 
most  fastidious  patients  without  difficulty.  Zinc 
valerianate,  made  up  into  pills  in  the  Ordinary  way, 


134     Th*  Medical  Prbss. 


MEDICAL  NEWS. 


Feb.  3,  1904. 


is  liable  to  become  hard.  The  volatile  constituent, 
moreover,  usually  permeates  the  coating,  and  renders 
the  pill  extremely  distasteful.  The  tabloid  zinc 
valerianate  obviates  these  objections  as  far  as  possible, 
and  should  be  useful  to  practitioners  prescribing  the 
drug.  The  salt  employed  is  of  exceptionally  high 
quality,  and  the  tabloid  product  disintegrates  promptly 
on  reaching  the  stomach. 

"  DARTRING  LANOLINE  "  TOILET  SOAP. 
We  have  tried  this  excellent  soap  and  find  that 
"  Dartring  Lanoline  "  Toilet  Soap  satisfies  the  require- 
ments of  a  perfect  soap.  It  claims  to  be  an  efficient 
detergent,  while  containing  no  free  alkali,  and  not  to 
deprive  the  skin  of  its  natural  protective  oil.  It  is  a 
true  superfatted  soap  for  an  excess  of  genuine  "  Dart- 
ring  Lanoline  "  above  that  necessary  to  secure  complete 
saponification  is  present.  We  have  no  hesitation  in 
saying  that  this  soap  is  most  excellent  for  toilet  pur- 
poses. 

flew  JnstrumentB* 

THE  REPELLO  CLINICAL  THERMOMETER. 

We  have  received  a  most  ingenious  clinical  ther- 
mometer from  Mr.  G.  H.  Zeal,  of  Turnmill  Street, 
London,  E.C.  It  is  a  "  thirty-second  "  thermometer 
•which  can  be  set  in  an  instant  without  shaking.  The 
method  whereby  the  mercury  scale  is  restored  to 
normal  or  to  the  desired  degree  below  normal  is  simple. 
At  the  top  end  of  the  tube,  opposite  to  the  ordinary 
mercury  registering  bulb,  is  a  second  small  round 
flattened  bulb  connected  with  a  short  column  of 
mercury.  After  the  thermometer  has  been  taken  from 
the  patie  nt's 
body  and  the 
temperature 
read  the  small 
top  bulb  is 
pressed  between  __ 
the  fingers  and  m 
the  mercury  ex-  ^^^^m 
pands.  The  re-  *^ ^^B 
suit  is  that  the  ) 

mercury-re  g  i  s  - 
tering  in  d  e  x 
column    at    the 

lower  end  of  the  tube  is  immediately  forced  back 
into  position  by  an  air  gap  which  is  provided  in  the 
central  tube  between  the  two  mercury  bulbs.  The 
old-fashioned  way  of  shaking  down  the  mercury 
into  position  has  always  proved  tedious  and  a  fruit- 
ful source  of  damage  to  these  delicate  instruments. 
If  Mr.  Zeal's  invention  stands  the  test  of  practi- 
cal experience,  as  it  promises  to  do,  he  will  have  con- 
ferred a  distinguished  service  upon  both  medical 
men  and  nurses,  not  to  mention  patients. 

AeMcal  View*. 


Lectures  on  Medical  Jurisprudence. 

On  January  21st,  the  second  of  a  course  of  lectures  on 
medical  jurisprudence  was  delievered  by  Dr.  F.  J. 
Waldo,  coroner  for  the  City  of  London,  at  the  Old  Hall, 
Lincoln's  Inn.  The  lecturer  dealt  with  fl  Live  Birth 
in  Relation  to  Civil  and  Criminal  Law,"  a  subject  of 
great  importance  to  lawyers.  The  consideration  of 
live  birth,  he  said,  was  naturally  divided  into  two 
classes — namely,  those  which  affected  either  civil  cases 
of  inheritance  or  criminal  cases  of  infanticide.  In  both 
the  evidence  that  established  the  fact  of  live  birth  was 
identical.  The  medical  view  of  live  birth  differed  from 
the  legal.  The  medical  man  demanded  proof  of  the 
establishment  of  circulation  and  of  respiration  even 
when  the  child  had  not  been  born  into  the  world.  In 
this  way  crying  was  one  of  the  most  satisfactory  proofs 
of  respiration  and  hence,  to  the  medical  mind,  of  live 
birth.  The  law,  on  the  other  hand,  was  content  with 
the  faintest  sign  of  vitality,  provided  the  child  was 


fully  born  into  the  world,  as  establishing  the  fact  of  live 
birth.  The  tremor  of  a  muscle  or  the  quiver  of  an 
eyelid  might  be  sufficient  evidence  of  live  birth  from 
the  legal  point  of  view.  The  positive  signs  of  five 
birth,  as  laid  down  by  Casper,  were  next  discussed,  and 
the  crucial  point  of  viability  or  the  capacity  of  a  child 
to  survive  birth  was  treated  at  some  length.  The  re- 
maining lectures  of  the  course  will  be  delivered  on 
subsequent  Thursdays.  They  deal  with  death  in  its 
medico-legal  relations,  insanity,  and  poisons. 

Scarlet  Fever  at  Klddermiaittr. 

Mr.  D.  Corbet,  medical  officer  for  Kidderminster, 
reports  that  the  death-rate  last  year  was  1676  per 
1,000,  or,  subtracting  the  deaths  of  non-residents  regis- 
tered at  the  workhouse  and  infirmary,  14*57.  There 
had  been  590  notifications  of  scarlet  fever  in  1903,  and 
one  death,  against  185  cases  and  one  death  in  1902. 
Dr.  Corbet  says  the  disease  has  been  prevalent  through- 
out the  year.  Many  of  the  cases  had  been  mild,  and 
the  carelessness  often  observed  in  these  instances  con- 
tributed very  much  to  its  spread.  No  part  of  the 
borough  had  been  exempt  from  the  disease,  neither 
had  Kidderminster  been  alone  in  this  experience,  for 
Stourport  and  Bewdley  and  the  rural  district  of 
Kidderminster  had  sent  an  unusual  number  of  cases  into 
the  borough  hospital.  Their  experience  indicated  that 
they  were  passing  through  one  of  those  recurrent 
periods  when  from  conditions  at  present  unknown 
there  was  a  widespread  susceptibility  to  the  infection, 
or  an  extra  degree  of  infectiveness  in  the  germs  of  the 
disease.  Although  it  might  be  said  that  hospital 
isolation  is  not  completely  successful,  yet,  as  far  as  yet 
known,  isolation  and  disinfection  were  the  only  prac- 
tical means  for  minimising  its  spread.  Further,  it 
must  be  admitted  that  many  lives  have  been  saved, 
and  certainly  much  sickness  prevented,  so  that  they 
had  a  diminution  of  deaths  from  the  disease.  All  the 
elementary  schools  had  been  disinfected  several  times 
in  the  year  and  other  precautions  taken.  The  report 
of  the  sanitary  inspector,  Mr.  Cowderay,  has  been 
issued  with  that  of  the  medical  officer,  and  gives  much 
information  on  the  work  done  in  his  department 
during  1903.  It  is  stated  that  the  rainfall  of  1903  was 
32-49  inches,  compared  with  an  average  for  the  past 
ten  years  of  21*43. 
North  of  England  Obstetrical  and  Gynecological  Socitty. 
At  the  annual  meeting  of  this  Society,  held  at  Owens 
College,  Manchester,  the  following  were  elected  office- 
bearers for  the  ensuing  year  : — 

President:  W.  J.  Sinclair,  M.D.  Vice-Presidents: 
S.  Buckley,  M.D.,  W.  Walter,  M.D.,  H.  Briggs,  F.R.C.S., 
T.  B.  Grimsdale,  M.B.,  J.  B.  Heilier,  M.D.,  A.  C.  F. 
Rabagliati.  M.D.,  Sinclair  White,  M.D..  Richard 
Favell,  M.R.C.S.  Members  of  Council :  W.  E. 
Fothergil,  M.D.,  A.  T.  Helme,  M.D.,  A.  Hopkinson, 
M.B.,  S.  Nesfield,  M.D.,  D.  Lloyd  Roberts,  M.D., 
J.  P.  Stallard,  M.D.,  J.  M.  H.  Martin,  M.D.,  J.  E. 
Gemmell,  M.B.,  E.  T.  Davies,  M.D.,  P.  Edwards, 
L.R.C.P.,  R.  Humphreys,  M.B.,  J.  McClelland.  M.D., 
A.  M.  Patterson,  M.D.,  J.  N.  Cregeen,  L.R.C.P.,  J. 
Braithwaite,  M.D.,  C.  Richardson,  M.R.C.S.,  C.  J. 
Wright,  M.R.C.S.,  A.  E.  L.  Wear,  M.D.,  Percival  E. 
Barber,  M.R.C.S.,  J.  W.  Martin,  M.D.,  Robert  Gordon, 
M.D.  Hon.  Treasurer:  E.  Octavius  Croft,  M.D. 
Hon.  General  Secretary :  Arthur  J.  Wallace.  M.D. 
Hon.  Local  Secretaries :  John  Scott,  M.D.  (Manchester). 
A.  Stookes,  M.B.  (Liverpool).  Walter  Thompson, 
F.R.C.S.  (Leeds),  Sidney  Barber,  M.R.CS.  (Sheffield). 
Death  of  Henry  Edward  Haycock,  MB.0.8. 
We  regret  to  announce  the  death  of  Mr.  Henry 
Edward  Haycock,  of  Alfreton,  Derbyshire.  Deceased 
was  educated  at  St.  Bartholomew's  and  Durham,  and 
took  the  M.R.C.S.Eng.  in  188 1,  and  the  L.R.C.P.Ed.  in 
1882.  He  held  the  post  of  Medical  Officer  and  Public 
Vaccinator  for  the  Codnor  Park  and  Bashford  Union. 
His  death  took  place  at  the  early  age  of  45.  *nd  was 
due  to  an  attack  of  pneumonia.  A  public  funeral 
took  place  on  January  28th,  and  was  attended  by 
a  great  and  sympathetic  concourse  of  residents  in  the 
neighbourhood. 


Feb.  3.  to°4- 


MEDICAL  NEWS, 


The  Medical  Press.     135 


Health  in  the  School. 
Vt  a  recent  meeting  of  the  Kidderminster  Education 
ttee,  Alderman   Parry  presiding,   a  report   was 
n?ad  from  Dr.  Dudley,  who  had  vi sited  all  the  schools 
uruler  the  committee.     A  very  serious  defect  in  some 
the  schools  was  the  very  inadequate  area  of  the  play- 
unds.     The  value  of  proper  space  for  the  purpose 
not     be    over-estimated.      Physical     education 
in  importance  with  mental  and  moral  education, 
the  two  latter  largely  depended  on   the  former, 
mever  practicable,  all  physical  education  should  be 
t  of  doors.     During  play-time  the  flushing  ot    tin 
acbuol-rooms   with    fresh   air   should    be   carried   out* 
Great  importance  was  now  being  attached  to  the  sub- 
ject of  physical  deterioration  ;   and    the    fundamental 
■tii  for  securing  health,  on  which  every  child 
kiaokl  he  educated,  appealed  to  him  to  be  0)  proper 
n   infancy.    (2)   pure   air   by   day   and   night, 
. .  nt   physical  exercise,  and  (4)  knowledge  of 
ace  of  alcohol.     His  attention  had 
a  to  testing  defective  eyesight  in  the  schools, 
to  wes  of  deafness,  and  other  ailments.     The  coin- 
tee  considered  the  report  a  valuable  one.  and  it  was 
that    the   recommendations   should    be   duly 
A  number  of  matters  on  the  agenda  were 
th  seriatim, 

TAe  State  Registration  of  Nurses. 
Bill    promoted    by    the   Society    for    the   State 
oration  of  Trained  Xurses  has  been  finally  adopted, 
will  be  introduced  into  Parliament  in  the  forth- 
Mon  by  Dr.  R.  Farquharson.     The  following 
of   Parliament  have  consented   to  back  the 
Bill  — Sir    rhomae  Wright  son,  Sir   lames    foicey, 

Baity    Tuke,    Mr.    Haldane,    K.C4    Mr,    Hugh 

nith.  Mr.  R.  C.  Munro-Ferguson,  Mr,  H.  J. 

W.  Black,  Mr,  C   E.  H.  A,  Colston, 

H    Trelawney    live,    K.C,   an<l    Dr.    Edward    C. 

At    a    meeting    of    the    Central    Hospital 

Ion,  held  at  St.  Thomas's  Hospital  on 

Tutfclay  last,  the  following  resolution  was  passed  ; — 

flat  this  council  is  opposed  to  any  State  registration 

>i  nurses,  and   that  steps  be  taken  on  behalf  ol  the 

ctrtmcil  to  oppose  any  Bill  in  Parliament  having  such 

ior    its   object/*     Representatives   of   the 

ng   hospitals   were   present    at    the   meeting  : — 

rtftrtholom-ew's.     St.     Thomas's,     Guy's,     King's 

c    London,  Middlesex,  Royal  Free,  St.  Geor 

Si.  MaryV  University  College,  and  Westminster. 

Death  from  "  Laboratory  "'  Plague. 

Thl  Frankfurter  Zeitung  publishes  a  telegram  from 

St  Petersburg  stating  that  in  addition  to  Dr.   Wtch- 

vAevitch,    the    director    of    the    laboratory     in     Fort 

\ie*&nder  I.  at  Kronstadt,  who  recently  died  of  plague 

i;ted    during    experiments    with    living    plague 

■  ultures.  two  assistants  have  now  been  seized  with  the 

.lipase. 

The  Drapers  School. 
Da.  Houan,  medical  officer  of  health,  was  granted  an 
irder  lately  at  Tottenham    Pojice  Court    to    inspect 
the  Drapers    School,   where  he  said   the  sanitary  in- 
spector had  Wen  refused  admission. 

London  Smallpox  Statistic*. 
Aecajtmv&  to  the  official  return  <>f  the  Metropolitan 
Board,  only  nine  cases  of  small-pox  had    been 
d  during  the  fortnight,  as  compared  with  fifteen 
11  the  previous  fortnight.     The  total  number  of  small* 
s  remaining  under  treatment  in  the  hos- 
<vas  twenty -four,  being  a  decrease  of  one  on  the 
preceding  fortnight.     The  total  number    under  treat- 
in  the  corresponding  fortnight  oJ  [903  was  882, 
Keileal  Prizes  of  the  Paris  Academy  of  Sciences. 
I  ml  h* i  oJ  prizes  which  will  be  awarded  by  the  Pans 
amy    oi    Sciences   during    1904   and    subsequent 
has  now    been    published.      The 
vary     from     200     francs     to     loo.orjo    francs. 
Hie    following    are    those     connected     with    medical 
I*rix    Montyon  -      Three     prizes     of     2,500 
ies  in    therapeutics   and    improve- 
ments in  medicine  and  surgery.     Prix  Barbier  ;    2,000 


francs  for  a  valuable  discovery  in  medicine,  surgery, 
pharmacy,  or  medical  botany.  Prix  Bryant  :  100,000 
francs  ior  a  discovery  relating  to  the  cure,  etiology,  or- 
prophylaxis  of  Asiatic  cholera,  Prix  Mege  :  10,000 
francs  lor  the  continuation  and  completion  of  the  work 
of  M.  Mege  on  the  causes  which  have  hindered  or  pro- 
moted the  progress  of  medicine.  Prix  Leconte  ;  50,000 
francs  for  newr  and  important  discoveries  in  mathe- 
matics, physics,  chemistry,  natural  history,  and 
t  1 1 « 1 1  ca  I  sci en c es .  Pn  x  S erres  ;  7,5 00  1  rancs  " for  t he 
beal  v\uik  on  embryology,  applied  as  much  as  possible 
to  physiology  and  medicine.  Prix  Dusgate  ;  2,500 
francs  for  the  best  work  on  the  diagnostic  signs  of  death 
and  on  the  prevention  of  premature  burial.  Prix 
Parkin  :  3,400  1  rancs  for  researches  on  the  curative 
effect!  ot  carbon  m  its  various  forms,  and  particularly 
in  the  gaseous  form  in  the  treatment  ot  cholera,  h 
and  other  diseases.  Prix  Chaussier  ;  10,000  francs  for 
the  best  work  on  legal  medicine  or  practical  medicine 
which  has  appeared  for  tour  years.  Prix.  Lacaze  : 
to,ooo  francs  for  works  or  memoir!  which  have  ad- 
vanced physiology. 

PASS  UBTS, 
The  Indian  Medical  Service. 
The  following  were  the  successful  candidates  at  the 
Indian  Medical  Service  examination,  held  on  January 
19 tii,  and  inur  following  days  : — 


Marks. 

Marks, 

H.  B.  Drake 

■   3p51  5 

H.  Watts;   . . 

..     J.Xio, 

Hodnon 

J.    A  iu  lei-.  11 

..  2,800 

W.  S.  McGilhvrav . 

.    3,046 

W.  S.  Fin!  ay  son 

-709 

w.  GilHtt    ■  . 

♦    2,991 

H.       E.       Stranger- 

W.  F.  Brayne 

Leathes  . . 

, .  2,792 

M.  S.  Irani . . 

■    2,«99 

E,  A,  Roberts 

..  2-789 

S.  W.  Jones  ■ 

>    2,882 

G   G.  Hirst.. 

-   *.777 

W.  Tarr      . . 

,   7374 

M.   J.  Quirke 

..   2,753 

C.  H.   Barbar 

.  2,867 

|.  M,  Holmes 

, .    2,684 

W.  T.  McCoweu;    . 

-    ^8J9 

M.  F.  White 

.,    2,666 

1.  D.  Jones.  . 

♦   2.834 

Forty-two  candidates  (of  whom  26  had  University 
degrees)  competed  ior  20  vacancies. 

tioeicty  of  Apothecaries  of  London 

I  hk  following  candidates  have  passed  during 
January  in  : — 

Sur$erv—  R.  S.  Dollard,  P.  Elias,  B.  C.  Ghosh. 
F.  W.  Higgs,  W.  G.  Kinton,  J,  W.  Watson. 

Atafo***.~-W.  V,  Braddon,  F,  H.  Hand,  J.  D.  Keir, 
W,  G.  Kinton,  E.  H.  Price,  A.  Rogers,  A*  Turner. 
S.  Zweiback. 

Forensic  Medicine.— F,   H.   Hand,    W.  G.   Kinton, 

A.  Turner. 

MmHfery.— H.  Archer,  C  H.  J.  Fagan,  W.  S. 
Lewis,   P,  B.  Whiting  ton. 

The  Diploma  of  the  Society  was  granted  to  the 
following  :— W.  V,  Braddon,  R.  S.  DoUard,  P.  Ellas. 

B.  C.  Ghosh.  J.  D.  Keir,  W.  S.  Lewis,  and  A.  Turner, 

Trinity  College.  Dublin . 

Ar  the  examination*  during  Hilary  Term.  1904.  *ha 
following  candidates  passed  L— ■ 

Anatomy  and  Institute  of  Medicine.—  William  G. 
Harnett  and  Willtam  C.  MacFetridge.  equal ;  Joseph  H. 
Elliott  and  Robert  E.  Dunn,  enual. 

Physics  attd  Chemistry.  — Wilbam  F.  Casey,  Willuim 
F.  Samuels.  Hercules  j,   Knox. 

Botany  and  Zoolog v.— James  C.  C.  Hogait,  Rupert 
MaKtH,  Robert  L.  Lee.  Denis  J.  Stokes  ;  Alexander  K. 
Cosgrave  and  John  H.  Morton,  ecpial  ;  John  A.  L, 
Hahn,  William  F.  Casey. 

Find  Examination:*  Section  A.—  George  MacU 
Millar.  Howard  English,  Charles  R.  Morns,  Benjamin 
johnaon.  George  E.  Nesbitt,  Montgomerv  D.  Ferguson. 
William  R.  Galwey,  William  G.  Harnett,  Hercules  J. 
Knox. 


THt  South  African  Medical  Congress,  after  a  Jong 
interval  has  just  concluded  its  sixth  meeting  at  Cape 
Town.  The  President  was  Dr.  E.  Sinclair  Stevenson,  a 
well-known  Cape  rowfl  practitioner,  and  a  former 
President  of  the  Medical  Council. 


136     The  Medical  Puss.        NOTICES  TO  CORRESPONDENTS. 


JUrtitt*  to 
dorospmttetti*,  Short  fetters,  &t\ 

J9~  Correspondents  requiring  a  reply  in  this  column  are  particu- 
larly requested  to  make  use  of  a  dittinctivt  signcUurt  or  initial,  and 
avoid  the  practice  of  signing  themselves  "Reader,"  "Subscriber," 
••Old  Subscriber,"  &c.  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

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

Reprints— ReprinU  of  articles  appearing  in  this  journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

Original  Articles  or  Letters  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
srith  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

Miss  J.  W.  Power  is  referred  to  the  paragraph  which  appears  at 
the  head  of  this  column  weekly ;  her  letter  was  dul  v  received  at  the 
London  Office  the  day  the  journal  is  "put  to  press, "  and  was  referred 
back  to  the  Dublin  Office  to  be  dealt  with  in  the  ordinary  way,  hence 
its  non-appearance  in  present  number. 

Laranaoas  (Jamaica).— Your  inquiry  is  an  apt  one.  Alien  immi- 
gration  proceeds  apace  in  the  United  Kingdom,  where  the  only  ground 
of  exclusion  is  actual  infection  with  some  deadly  complaint.  Even  in 
that  case  the  exclusion  simply  resolves  itself  into  detention  under  ob- 
servation in  an  infectious  hospital  at  the  port  of  entry.  In  this  way 
the  United  Kingdom  has  become  the  happy  hunting-ground  of  a  vast 
horde  oi  aliens,  who  undersell  the  native  workmeu  and  furnish  an  un- 
due proportion  of  criminals.  Political  economists  tell  us  that  in  the 
long  run  the  nation  is  the  gainer  by  the  influx  of  cheap  alien  labour. 
It  is  a  question,  however,  whether  the  price  paid  for  such  an  advan- 
tage may  not  be  too  great.  In  the  case  of  Jamaica  it  should  be 
possible  to  devise  and  enforce  stringent  laws  for  the  exclusion  of  un- 
desirable aliens.  We  shall  be  glad  to  learn  if  any  such  laws  are  in  ex- 
istence. 

M.  S.  G.  F.— Under  the  new  London  University  scheme,  professorial 
chairs  will  probably  fce  founded  at  all  the  constituent  medical  colleges 
At  present  only  the  lecturers  in  the  medical  schools  of  University 
and  King's  Colleges  are  able  to  call  themselves  "  Professors." 

Spes.— The  question  was  so  fully  discussed  in  our  columns  a  year 
ago,  that  we  must  decline  to  reopen  it  at  present. 

THE  LATE  DR.  CONEYS.— A  CORRECTION. 

Owing  in  part  to  the  necessarily  hastily  written  note  which  we 
received  from  our  Western  correspondent  regarding  the  sad  death  of 
Dr.  Coneys,  an  omission  occurred  in  our  obituary  which  calls  for 
correction.  In  eulogising  the  devotion  and  self  sacrifice  of  Dr. 
Coneys,  we  omitted  to  make  any  mention  of  a  man,  a  member  of  his 
own  profession,  who  nobly  stood  by  him  in  his  last  illness.  Dr 
Gorham,  of  Clifden,  nursed  Dr.  Coneys  devotedly  through  his  illness' 
He  sat  with  him  for  three  nights  before  his  death,  and  when  the  end 
came  and  Dr.  Coneys'  servants  and  friends  fearing  infection  would 
not  approach  the  sick  room,  Dr.  Gorham,  with  the  assistance  of  the 
nurses,  was  obliged  to  himself  place  Dr.  Coneys  in  hi8  coffin. 

Dr.  Eoger  (Budapest)  is  thanked  for  his  communication. 

Dr.  Barr  (Uverpool).-Ypur  paper  on  "Prognosis  in  Heart 
Disease    is  marked  for  early  insertion. 

Mr.  H.  Watson.— It  is  a  question  for  a  transfer  agent  to  decide 
rather  than  for  an  editorial  opinion.  We  would  advise  vou  to  consult 
Messrs.  Wilson  and  Son,  of  Charles  Street,  St.  James',  or  Mr.  Needes 
of  the  Adelphi,  London. 

Jfoetings  of  the  goortus,  JccturcB,  &t. 

LONDON. 
Wednesday,  Pbbruary  3rd. 

Obstetrical  Society  of  London  (20,  Hanover  Square,  W )  - 
3  p.m.  Annual  Meeting  Specimens  :-Mrs.  Scharlieb/  Unruptured 
Tubal  Gestation.-Dr  Rkcker:  Deciduoma  Malignum.-Dr.  SiggT: 
Primary ;  Carcinoma  of  Fallopian  Tube.  The  President  (Dr  MaJins 
of  Birmingham) :  Annual  Address.  ««ins, 

Medical  Graduates'  &>™m*  and  Polyclinic  (22,  Chenies  Street, 
XjnJ'u  /iP,DU  2Lr,J  Clarke:  Clinique.  (Surgical.)  5.15  p.m 
Dr.  T.H.Green:  The  Treatment  of  Pneumonia.  P 

„      Thursday,  Fbbruaby  4th. 
Neurological  Society  ok  tub  United  Kingdom  (11,  Chandos  Street 

Rontorn  Society  (20,  Hanover  8quare,  W.).-8  30  p.m  Discussion 
JiSSB^  'throughThe  SSSft 

Cnmn  I™°vI,aH08p,TiL»'0R  Consumption  and  Diseases  of  the 
hSt £'Sif^y  ;?3uare»  JH-6  Pm-  Dr-  G-  Johnston  :  Fibrosis  of 
the  Lungs,  II.  (with  cases).    (Post-Graduate  Course.) 

W  G»  -2u2  ^PITALtwR  2""^?  °5  ™*  SKIlf  (Leicester  Square. 
UctureT?        P  M*    Dockrell:      8yphylk.      (Chesterfield 

M^edi^lGraduates;  College  and  Polyclieic  (22,  Chenies  Street. 
5;  *  '7^  £  B.Mr*  Hu,t£h"180n ;  Clinique.  (Surgical.)  5.15  p.m. 
Mr.  E.  Clarke :  Errors  of  Refraction,  their  Diagnositfand  Treatment 


Feb.  3,  1904. 


Friday,  February  5th. 


ur       «.        --  r  R1UA T t  F « wm> art  atn. 

iZ^^VJ^1^11^^10^  ^Tcf°B^aU?TST,1,ary' 


Greenwich  Road,  S.E.).     8.45  p.m. 
Treatment  of  Appendicitis. 

Medical  Graduates'  College  and  Polyclinic  (22,  Chenies  8t>«* 
W.O.)—4  p.m.    Dr.  E.  Waggett :  Olinique.    (Ear.)  ***• 

DUBLIN. 

Royal   Academy   of   Medicine   (Obstetric    Section). -Adjournal 

&SE&"u0BS  I1ntore8t!n?  <**<*  occurring  in  the  practkTof 

l^D^^frS^L  t0r^  MV«n  Y?*8  endin?  3l8t  December 
1903 ,  Dr.  Alfred  Smith :— Tuberculous  Ulceration  of  the  Cervix  with 

KSS?J5acT"  fcPecimfD>-  Dr.  Alfred  Smith  :-Utenu wnWeTbv 
Panhysterectomy  containing  a  large  sessile  polypus.         reraovea  V 


^atmidw. 


Y<WlliHJlPen5rf/,r?€,lde,Lt  Medical  OtBcer,  Salary  £120  a  year 
with  board,  lodging,  and  attendance.  Applications  to  W.  Drawr' 
Esq.,  De  Grey  House,  York  ^•hw. 

TheJ?S?ip8te,ld  GeDem!  H<*Pit*l.-Re«ident  Medical  Officer,  8altrr 
Geo^Wa^^t^f^i'0^•andgm,•      Appln.atlon.tJi 

North  Hiding  Infirmary,  Middlesbrough,  Yorkshire.  -  Assistant 
House  Surgeon  Salary  £75  per  annum,  with  bed.  boardTtSd 
washing.    Applications  to  Angus  Macpherson,  Secretary^ 

Ancoats  HospiUl,  Manchester. -Resident  House  Physician.  Salarv 

^rB^^Secretary.50^'  ******'  te       ^P^kTS 

^^SS?1^^6"8^68  ~Asiif tlnt  8u»?«on.  8»Ury  £100  per  annum, 

with  board  and  apartments.    Applications  to  8am.  B.  Leicester 
Inverness  District  Boaid  of  Lunacy.-Medical  Superintendent  torthe 

1*™I?T  *W  A8?,UKm*  *fty  £60°  T»r  annum,  with  fret 
house.  fire,  Hght.  vegetables,  and  keep  of  one  horse.  Applies- 
tions  to  Messrs  Anderson  and  8haw,  Solicitors,  Inverness 

Bamwood  House  HospiUl  for  Mental  Diseases.  GjoucesterT-Junior 
Assistant  Medical  Officer,  Salary  £150  a  year1,  wUh Tbiar^T. 
Applications  to  the  Medical  Superintendent. 

County  Asylum,  Prestwich,  Mancnester.-Junior  Assistant  Medical 
Officer,  Salary  £150  per  annum,  with  board,  furnished  apart- 
ments, and  washing.    Applications  to  the  Medical  Superioteo^- 

London  County  Asylum,  Horton,  Epsom  -Junior  Assistant  Medical 
Officer,  Salary  £150  per  annum,  with  board,  furnished  apartment* 
and  washing.  Immediate  Application  to  R.  W.  Partridge,  Clerk 
of  the  Asylums  Committee.    (See  Advt ) 

Richmond  District  Asylum,  Dublin.— Two  Clinical  Assistants,  Salan 
T60  .P**  .annum,  with  furnished  apartments  and  full  rations. 
Applications  to  Conolly  Norman,  Medical  Superintendent 
(see  Advt.) 


S^VointmmiB. 


BiLLMORE,CiiARLEs  Cecil,  L.R.C.P.,  L3.C.S.Edin..  L.F.P.S.GU*. 

ril^th^^^  an<1  K(UmOUth  **«**& 

Gartrbll.  John  Herbert,  L.D.S.Eng.,  Honorary    Dental   Surgeon 
«*■«?%?  *n  ^^  iipnuvy  and  Dispensary,  Penxance. 
Harmer,  WD.,  M.C.Camb.,  F.R.C.aEng!/8urireon  to  the  Metro- 

politan  Hospital,  Kiogsland  Road,  N.E.      OUrgeon  w  cne  Metr°- 
Hay  Joiik,  M.D.  Ch.B.fict.,M.R.C.8.t  L.D.S.Eng.,  M.RCPLo,h1, 

Physician  to  the  Liverpool  Stanley  Hospital 
Heilborn,  W.   E.,  M.B.,  B.C.  CanUb.,  Honorary  Assistant  Matin*) 

Officer  to  the  Bradford  Children^  HoSSSST^  A88,8tant  **** 
Hern,   George ,     L.R.C  S.Lond.,     M.R.C.S.,    L.D.S.Eng.,    Dentil 

Surgeon  to  the  Royal  Dental  HospiUl  of  London. 

l&^^^^^P'f:^  L-R-C.P.Lond..  »  Medicri 
Keferee  under  the  Workmen's  Compensation  Act,  1897  and  1900, 

?£l^CHfH  thKeM0rpe5hDan?  B1^'  North  ShUlds.wS 
ClS?        m'  »ndBellingham  Districts  in  County  Court 

P0ESjJ^;?f^,,«^?'BrSt-'  M.R.C.S.,  F.R.C.P.Lond.,  Clinical 
Assistant  to  the  Chelsea  HospiUl  for  Women. 

PRAU»Jt:DALLA8»M-1>-I>wb..P.i«.i;.8.L.  Certifying  Surgeon  under 

hJIm      1     li!1  «or  the  Dublin  District  of  the  county  of  Dublin. 

f^ri  p^T'   ^A***1;.    Additional  EEaminef  in  CUnical 

Surgery,  Edinburgh  University. 

a0l'fcJii^R"C-^M-RiC-a-»*fl0U8e  Su**°n  <»  ^he  Hastings, 
St.  Leonards,  and  East  Sussex  Hospital.  ««*"«6«>. 

toAS^A8KwR/£8-'  L^C-?»  Honorao- Medical  Officer  to  the 
Newton  Abbot  (Devon)  Hospital 

WA  to?hpASiS,  ?fiAV  M:D-  BCCantab.,  Honorary  Medical  Officer 
to  the  Budleigh  Salterton  (Devon)  Cottage  HospiUl. 

MetropoliUn  HospiUl,  Kingsland  Boad,  N.E. 


girths- 


BA1^I^ITV,k~"0"#  JVSfry  2?th'  at  the  *•  N-  HospiUl,  Haslar, 
a  dffite?.        e  fc  8urjfeon  P-  W-  Bassett-amith,  »Jf.f  of 

BRBXD.-^,  January  28th,  at  43,  Campden  Hill  Court,  Kensington, 
W.,  the  wife  of  William  A.  Brend,  mTb.,  of  a  son. 


gtttltB. 


C,IAHa^n*^nwtYT*>;  ??Kth'  l9W*Tat J1'™  '^dence.  The  Pines, 
iiampton  Wick,  E.  J.  Chapman.  LL.D.,  P.H.D. 

D°VSi^>iLvJ,V,Kar^  !ithV  ^  at  'ArdesUe,  Northwood, 
^^eX,J°u1n£?Sben  ^^wnt  Dove,  M.B.,  is.Lond.,  Ute 
of  Pinner,  in  his  67th  year. 

j3T;~m5  JM5»2r»^tt  ^ Upper  KeonlMton  Lane,  ML 
John  8klney  Albert  Wright,  L.k.C.K7  L.M.Edin.,  L.S.A.,  aged 
04  years. 


Z\\t   Medical   Wxm   mi   €itmht 


Vol.  CXXVIII. 


"8AL08    POPULI    SUPREMA    LEX-" 


WEDNESDAY,    FEBRUARY     10,    1904.        No.   6. 


DERMOIDS  : 
OVARIAN    AND   PELVIC, 

Delivered    at  the   Samaritan  Free  Hospital 

Ion  Thursday,  November  $THt  1903. 
By  ALBAN  DORAN,  FJR.C.S,, 
Surgeon  to  the  Hospital. 
For  practical  purpose  the  characters  of  an 
ovarian  dermoid  arc  well  known.  We  are  all 
aware  that  they  are  cystic  tumours  containing 
greasy  fluid,  felted  hair,  bone,  teeth,  skin  and 
moie  complicated  structures*  On  the  theories, 
m  rather  doctrines,  which  profess  to  explain  their 
origin  we  need  not  dwell,  I  only  mention  them 
because  patients  and  their  friends,  hearing  about 
the  bones  and  teeth,  not  rarely  ask  questions, 
and  expect  an  explanation.  M  Parthenogenesis  *' 
is  no  explanation,  but  simply  reminds  us  that 
dermoid  cysts  may  be  found  in  little  girls;  the 
term  should  be  limited  to  a  phenomenon  seen  in 
certain  insects  where  an  unimpregnated  female 
may  produce  fertile  ova,  the  produce  of  which, 
however,  are,  I  understand,  sterile  unless  impreg- 
nated. 4t  Foetal  inclusion "  is  open  to  much 
objection,  as  is  "  the  inherent  formative  power  of 
the  ovar 
Wt  cannot  really  explain  why   dermoids  grow, 

»but  we  can  often  manage  to  treat  them  very 
factorily.  Knowing  what  they  are  like,  we 
must  bear  in  mind  some  of  their  relations  and 
associations. 
First,  granting  that  we  have  to  do  with  a 
dermoid  diagnosed  by  palpation,  or  even  actually 
exposed  at  an  operation,  we  must  remember  not 
only  that  the  great  majority*  of  abdominal  dermoid 
tumours  are  ovarian,  but  also  that  a  dermoid 
tumour  found  in  the  abdomen  quite  separate 
ton  the  uterine  appendages  may,  nevertheless, 
be  of  ovarian  origin.  Hence  it  is  of  great  im- 
portance when  such  a  tumour  is  discovered  to 
v  up  the  uterus  and  examine  its  appendages 
with  care.  The  chances  are  that  in  such  a  case 
a  stump  will  be  found  replacing  one  ovary  and 
tube,  in  other  words,  the  dermoid  was  of  ovarian 
origin,  but  has  twisted  itself  off  its  pedicle.  It 
usually  adheres  to  the  great  omentum,  that 
interesting  serous  fold  which  the  modern  school 
of  surgery  has  learnt  to  utilise  so  freely.  It 
will  establish  collateral  circulation  and  relieve 
itea  when  stitched  to  the  parietal  peritoneum 
tain  cases  of  cirrhosis,  it  will  guard  the  general 
peritoneal  cavity  if  sewn  to  the  abdominal  wound 


a  Clinical  Xecture 


under  a  diseased  gall-bladder  which  requires  drain- 
age, but  is  too  contracted  to  be  fastened  safely  to 
the  parietes,  and  it  will  greatly  fortify  the  repair 
of  plastic  wounds  in  surgical  operations  on  the 
stomach  and  intestines,  The  fostering  qualities 
of  omentum  adherent  to  cysts  detached  from 
their  original  blood  supply  suggested  the  utilisa- 
tion of  that  process  of  peritoneum  for  surgical 
purposes. 

In  a  case  of  this  kind,  I  repeat,  the  uterus 
should  be  carefully  examined,  not  only  to  see  if 
the  appendages  be  wanting  on  one  side,  but  when 
this  condition  is  detected  to  ascertain  the  state  of 
the  opposite  ovary,  for  ovarian  dermoid  disease  is 
often  bilateral. 

Yet  we  hear  that  an  abdominal  or  pelvic 
dermoid  may  be  non-ovarian.  This  is  quite  true, 
for  it  has  been  found  in  a  male,  and  not  as  a 
homologue  of  an  ovarian  tumour — in  plainer 
words,  not  as  a  tumour  of  the  testicle.  We  need 
not  dwell  on  dermoid  elements  in  the  testicle, 
as  they  are  clinically  very  different  from  ovarian 
dermoids.  The  possibility  of  a  cystic  abdominal 
tumour  in  a  male  being  dermoid  should  be  borne 
in  mind  in  these  days  when  surgeons  are  always 
ready  to  extirpate  any  removable  tumour.  In 
Ord  and  SewelTs  case  a  robust  young  country 
gentleman  suffered  from  an  abdominal  swelling. 
On  tapping,  two  pints  of  thick,  greasy  fluid  con- 
taining hairs  came  away.  The  patient  died  in  a 
few  days,  and  a  retro -peritoneal  dermoid  was 
found  firmly  united  to  the  bladder  and  rectum. 
Wilks  and  Curling  report  another  instance  where 
a  pelvic  dermoid  existed  in  a  man,  a^t.  21.  It 
pressed  into  the  rectum  and  was  tapped,  two 
pints  of  oily  fluid  coming  away.  Eight  years  later 
a  calculus  was  removed  by  lithotomy  ;  it  had  a 
nucleus  of  hair.  Thus  a  dermoid  abdominal  or 
pelvic  tumour  may  develop  in  a  male  ;  other 
cases  besides  those  quoted  have  been  recorded. 
In  these  days  a  doubtful  cyst  is  explored,  not 
tapped  ;  the  escape  of  dermoid  fluid  into  the 
peritoneal  cavity  is  obviously  dangerous. 

The  non-ovarian  retro -peritoneal  tumour  is, 
however,  much  more  frequent,  or,  rather,  less 
rare,  in  women  than  in  men.  It  burrows  very 
deeply  in  the  pelvis  and  may  he  anterior  to  the 
uterus,  or  between  it  and  the  rectum,  or  com- 
pletely behind  the  rectum,  in  which  case  it  causes 
the  perineum  to  bulge  freely,  and  has  been  removed 
through  an  incision  between  the  rectum  and 
coccyx,  This  kind  of  dermoid  is  sometimes  first 
recognised  by  the  discharge  of  hair  and  grease 
from  the  rectum  or  in  the  urine. 

Retro-peritoneal  no n -ovarian  dermoid  is,  how- 
ever, exceedingly  rare,  many  recorded  cases  being 


138    Thx  Medical  Prbss. 


ORIGINAL  COMMUNICATIONS. 


Feb.  10,  1904. 


doubtful,  or,  more  correctly  speaking,  instances 
of  ovarian  dermoids  transplanted  to  the  omentum. 
Returning  to  genuine  ovarian  dermoids,  the  most 
important  question  in  respect  to  their  characters 
is,  Are  they  innocent  or  malignant  ?  It  is  now 
known  that  true  pathological  malignant  degenera- 
tion of  this  kind  of  tumour  is  quite  exceptional, 
and  occurs  late  in  the  development  of  the  growth. 
But  the  dermoid  tissue  not  rarely  implants  itself 
on  the  peritoneum  outside  the  cyst  wall ;  this 
prejudicial  change  is  constant  in  a  form  of  dermoid 
mainly  solid,  named  teratoma. 

Dermoid  cyst  of  the  ovary  proper  is  a  very 
common  tumour.  I  have  operated  in  this  hospital 
on  five  cases  during  the  past  summer.  The 
percentage  of  dermoids  in  relation  to  other  ovarian 
tumours  is  much  higher  than  was  once  supposed, 
for  mixed  adenomatous  and  dermoid  multilocular 
cysts  are  quite  frequent.  Only  last  month  I 
removed  a  large  cystic  tumour,  emptying  during 
the  operation  several  pints  of  typical  ovarian 
fluid,  free  from  dermoid  elements,  from  a  cyst 
larger  than  its  fellows  ;  afterwards  grease  and 
hair  were  found  in  some  of  the  lesser  cavities. 
Such  an  experience  is  common  in  ovariotomy. 
Ovarian  dermoids  proper  are  rarely  multilocular, 
and  nearly  always  pedunculated,  which  is  for- 
tunate, as  enucleation  would  involve  risk  of 
escape  of  septic  grease.  They  are  often  bilateral, 
so  that  it  is  always  necessary  to  make  sure  of 
the  condition  of  the  opposite  ovary  when  an 
ovarian  dermoid  is  removed. 

This  frequency  of  bilateral  dermoid  disease  is 
specially  important  to  bear  in  mind  in  cases  under 
puberty.  Ovarian  cysts  in  children  are  nearly 
always  dermoid,  so  when  a  cyst  is  diagnosed  in  a 
child  the  possibility  that  both  ovaries  may  require 
removal  must  not  be  overlooked,  and  the  con- 
sequences of  double  ovariotomy  must  be  explained 
to  the  patient's  friends, 


An  ovarian  dermoid  forms  a  tumour  of  small 
and  moderate  size,  usually  occupying  the  middle 
of  the  abdomen  up  to  or  above  the  umbilicus. 
A  very  large  dermoid  is  often  compound,  the 
main  loculi  being  freed  from  dermoid  elements, 
but  this  is  not  a  matter  of  much  clinical  import. 
There  will  be  resonance  in  the  epigastrium  and 
flanks.  Free  fluid  in  the  peritoneal  cavity  is  very 
unusual,  just  as  in  uterine  fibroid  disease.  In 
cases  of  glandular  ovarian  cyst  this  condition 
is  not  rare  ;  in  fibroma  of  the  ovary  (which  has 
been  taken  for  a  dermoid  when  very  soft)  it  is 
frequent,  and  in  free  papilloma  or  malignant 
disease  of  the  ovary  constant. 

A  dermoid  ovarian  tumour  may  fluctuate 
quite  distinctly,  but  as  a  rule  fluctuation  is  obscure, 
and  there  is  a  doughy  feeling  on  palpation.  Above 
all,  irregular  degrees  of  consistence  in  different 
parts  of  the  tumour  are  very  characteristic  in 
most  dermoids.  It  may  feel  tense  high  up,  hard 
on  one  side,  almost  spongy  on  the  other,  doughy 
below,  and  so  forth.  When  a  mass  of  bone  can 
be  felt,  diagnosis  is  practically  certain.  A  true 
included  monstrous  foetus  never  lies  in  a  movable 
cyst  and  well  up  in  the  abdomen  ;  a  retained 
extra-uterine  foetus  in  a  sac  is  associated  with 
conditions  in  the  pelvis  and  disturbances  of  the 
catamenia  which  are  not  to  be  detected  in  a  case 
of  uncomplicated  dermoid,  whilst  a  norma) 
uterine  foetus  should  never  be  taken  for  bone  in  a 
dermoid  cyst.  As  a  rule,  I  find  that  bony  plates 
in  ovarian  dermoids  are  not  to  be  detected  by 
palpation,  even  though  plenty  may  be  found  in 
the  tumour  after  or  during  its  removal. 

An  ovarian  dermoid  is  quite  movable  at  first, 
and  on  pelvic  exploration  the  uterus  is  nearly 
always  far  back,  behind  the  lowest  part  of  the 
tumour,  which  comes  down  to  the  level  of  the 
pelvic  brim,  if  not  lower.  These  relations  are, 
I  however,  by  no  means  constant.     Occasionally, 


Ovarian  dermoids  are  met  with  in  women  of ,  as  in  a  case  where  I  operated  here  last  month1 
all  ages  ;  children,  young  girls,  parous  subjects, !  the  entire  uterus  lies  forward,  pushed  upwards  by 
elderly  virgins,  and  old  women  who  have  borne  the  dermoid  which  comes  down  into  Douglas's 
children.     In  age  they  appear  sometimes,  as  in  pouch. 

a  case  which  I  shall  relate,  to  lie  latent,  but  I  When  very  small,  a  dermoid  not  rarely  lies 
have  removed  large  dermoids  in  an  active  state  altogether  in  the  pelvis,  and  occasionally  remains 
of  development  from  old  patients.  there   even   after   attaining   a   considerable  size. 


There  are  four  clinical  features  of  special 
interest  in  relation  to  the  common  ovarian  dermoid. 
(1)  If  diagnosed  early,  ovariotomy  proves  easy 
and  highly  successful.  (2)  Twisting  of  the  pedicle 
and  worse  complications  are  very  frequent. 
(3)  Association  of  an  ovarian  cyst  with  pregnancy, 
labour,  and  the  puerperium  is  specially  serious 
when  the  tumour  is  dermoid.  (4)  Neglected  der- 
moids cause  dangerous  and  intractable  compli- 
cations. 

Early  diagnosis  of  an  ovarian  dermoid  is  one  of 
the  greatest  services  which  a  doctor  can  render  to 
a    patient,    and    if    the    tumour   be    successfully 


Diagnosis  is  not  always  easy,  but  occasionally 
the  doughy  feeling  is  very  evident  on  bimanual 
palpation.  A  pelvic  dermoid  is  a  distinct  source 
of  danger  in  young  married  women,  as  it  will 
obstruct  labour,  and  may  rupture,  especially 
should  obstetrical  operations  be  necessary. 

But  complications  often  set  in  early.  Ovarian 
dermoids  are  particularly  liable  to  torsion  of  the 
pedicle,  intra-cystic  haemorrhage  (very  rarely 
serious),  adhesions  due  to  irritation  and  inflam- 
mation of  neighbouring  peritoneum,  septic  in- 
fection of  the  contents  and  escape  of  the  contents 
from  the  cyst  cavity,  either  through  rupture  of  the 


removed  cure  is  complete,  for  a  dermoid  is  not  cvst  wall  or  by  processes  which  allow  hair  or  bone 
pathologically    malignant,    so    there    will    be    no  1  to  grow  through  the  wall. 

recurrence  in  the  pedicle.     The  tumour  has  not,  |      Even   very  early  in  its  history  a  dermoid  is 
in  such  a  case,  contracted  adhesions,  its  pedicle  j  often  tender  to  touch,  a  fact  which  aids  in  diagnosis. 


is  rarely  broad  and  usually  narrow,  and  above 
all,  none  of  the  contents  have  escaped  into  the 
peri  .oneal  cavity,  nor  has  bone  or  hair  worked 
its  way  into  the  bladder  or  rectum.  Even  twisted 
pedicle,  so  frequent  in  dermoids,  at  first  facilitates 
the  operation,  the  ovarian  vessels  being  usually 
plugged.  If  operation  be  delayed  serious  effects 
may  arise  from  this  complication. 


A  history  of  a  very  sharp  attack  of  pain  is  not 
rare,  while  very  often  the  patient  complains  that 
she  has  suffered  from  dull  pain  for  several  days. 
The  sharp  pain  means  acute  torsion  of  the  pedicle ; 
the  dull  pain,  if  observed  by  a  medical  attendant  to 
be  free  from  rise  of  temperature,  signifies  slow 
torsion.  The  latter  complication,  much  the  more 
frequent,  is,  however,  often  associated  with  local 


io.   1904, 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press,    139 


peritonitis,  and  in   lhat  case   there  will  be  more 
or  less  feverishness.     I  once  observed  both  forms 
of  torsion  in  a  patient  under  my  care  here  with 
double  ovarian   dermoid   disease.     She   had   been 
subject    to  abdominal   pains  difficult    to  localise. 
After  passing  a  motion  she  felt  the  most  intense 
pain  in   the  abdomen,  and   I   found   her  moving 
about   her  bed   in   great   agony,   with    free,   cold 
perspiration.     On  operating,  the  right  ovary  was 
3   converted   into   a   big   tumour,   extremely 
hvid  and  full  of  grease.     Its  pedicle  was  tightly 
twisted,    with    turgid    veins    and    a    large    empty 
artery.     The  opposite  ovary  formed  a  yet  larger 
dermoid  tumour  with  its  pedicle  atrophied  through 
ok  torsion.     The  patient  on  recovering  from 
the   anesthetic,    declared    that    she   felt    extreme 
relief  as  all  pain  was  gone  ;  this  is  not   the  rule 
diately   after  an   ovariotomy,   but    the  pain 
caused   by   the  ligatures  on   the  "pedicle  was   rc- 
Uttvely  so  slight  as  compared  with  the  sufferings 
due  to  torsion  that  the  patient  hardly  perceived  it. 
Septic   changes  in    the   contents  oJ   a   dermoid 
are    frequent,    and    in    non -puerperal    cases 
sually  due  to  the  bacillus  coli  entering  at  a 
point    on    the    wall    where    there    are    adhesions. 
They    add     to    the    risk    of    complications    after 
lotomy. 
Pregnancy  involves  yet  greater  risks,  and  in  the 
puerperium    worse   germs    than    the    bacillus  coli 
infect  the  cyst.     We  sec  a  great  deal  oi  the 
is  of  pregnancy  complicating  ovarian  tumours 
iospital,    and    dermoids    specially    cause 
ble.     The     complications     above     described, 
particularly  torsion,  are  very  apt  to  occur  during 
pregnancy. 
There  can  be  no  doubt  that  the  tumour  is  more 
(diced    than    the   pregnancy,    for    torsion    of 
the  pedicle,  even  when  actite,  does  not  necessarily 
cause  abortion  ;  delivery  may  be  perfectly  normal, 
provided    lhat    the   tumour  be  above    the   pelvis, 
<    the  puerperium  may  proceed  normally  as 
far  as  the  uterus  and  general  system  are  concerned, 
iugh   the  cyst  is  at   the  same  time  becoming 
cd 
The     treatment     of     pelvic     dermoids    during 
delivery  is  a  grave  matter,  which  we  cannot  fully 
discuss     at     present.     Ovariotomy     through     an 
abdominal      incision      is      probably      the     safest 
ided     there    be    both'  a    competent 
1  tor  and  satisfactory  nursing  and  appliances 
b&nd.     Opening   the  cyst  through    a    vaginal 
gunds  simple,  but  after  clearing  away  the 
stents,    often    mixed    with    much    hair, 
the  cyst  wall  may  be  lorn  off  in  part  as  it  is  drawn 
down,  so  that    the    remainder  of  the  tumour  with 
the   pedicle    unmatured    will    slip   back    into    the 
peritoneum.     Dangerous    hemorrhage    and    peri- 
toneal infection  will  ensue.     It  has  been  suggested 
Thar  the  experienced  obstetrician,  who  has  never 
done  an  ovariotomy,  had  better,  in  such  a  case, 
make  an    abdominal   incision    and    draw  up    the 
>ur  above  the  pelvic  brim,  closing  the  wound, 
delivering    the   woman,    and    then    preparing    her 
tor  operation  after  the  puerperium. 

These  considerations,  however,  are  mainly 
obstetrical  and  too  much  open  to  grave  debate  to 
be  suitable  for  this  lecture.  As  a  rute  the  dermoid 
does  not  prejudice  gestation,  but  is  liable  to  com- 
plications during  pregnancy,  and  is  much  exposed 
to  infection  in  the  puerperium.  Experience 
teaches  us  that  the  removal  of  the  dermoid  during 
.nancy  is  not  dangerous,  whilst  abortion  does 
not  necessarily  follow  the  operation,  and  should 


it  ensue  it  hardly  interferes  with  recovery.  But 
experience  likewise  reminds  us  that  the  risk  of 
ovariotomy  is  greatly  increased  when  the  cyst 
and  its  greasy  oon  tents  have  undergone  puerperal 
infection.  On  that  account  we  should  strongly 
advise  a  pregnant  patient,  who  has  an  ovarian 
cyst,  to  have  the  tumour  removed  during  preg- 
nancy. Should  she  refuse,  she  should  be  kept 
in  bed  after  the  puerperium,  and  not  allowed  to 
rise  before  the  operation  is  performed. 

The  spilling  of  grease,  often  mixed  with  hair,  into 
the  peritoneal  cavity  may  necessitate  flushing 
with  saline  solution,  or  free  i4  toilet  "  with  pads, 
but  such  manipulations  increase  the  chances  of 
abortion.  Hence  a  small  dermoid  is  best  ex- 
tracted entire  through  a  free  incision  in  the 
middle  line,  whilst  if  large,  great  pains  must  be 
taken  to  prevent  grease  escaping  into  the  abdo- 
men when  the  cyst  is  opened.  A  trocar  and 
cannula  are  quite  useless  unless  the  fluid  in  the 
cyst  is  thin  and  abundant. 

In  my  own  practice  I  have  detected  chronic 
torsion  of  the  pedicle  with  dense  adhesions  in 
six  cases  of  ovariotomy  on  dermoids  diagnosed 
(as  tumours  at  least)  before  a  recent  pregnancy, 
The  patients  recovered,  though  the  operation 
was  always  difficult,  save  in  one  very  bad  and 
neglected  case  of  puerperal  infection  with  foetid 
fluid  in  the  cyst  and  close  adhesions  to  large  and 
small  intestines.  In  conclusion,  I  will  relate  a 
case  where  I  operated  in  this  hospital  last  spring, 
on  a  patient  who  had  been  delivered  of  twins  two 
years  previously*  Labour  was  on  that  occasion 
impeded  by  the  tumour,  which  occupied  part 
of  the  pelvic  cavity,  rising  into  the  left  iliac  fossa. 
Once  more  the  patient  became  pregnant  and  labour 
was  induced  at  the  sixth  month,  nine  months 
before  I  performed  ovariotomy.  I  found  a  small 
heavy  dermoid  of  the  left  ovary  full  of  fat  and 
felted  hair,  strongly  adherent  to  the  uterus  and 
rectum  ;  the  right  ovary  was  dermoid  and  required 
removal.  Convalescence  was  rapid,  but  the  case 
is  instructive  as  showing  how  a  dermoid  cyst  may 
imperil  labour,  and  may  itself  be  endangered  by 
the  processes  of  gestation 

Neglected  dermoids  were  once  very  often  seen 
in  hospitals.  When  1  was  house-surgeon  at 
St,  Bartholomew's,  in  1871 1  I  saw  tiro  women, 
one  almost  a  child,  with  pus  and  hair  discharging 
from  the  bladder  and  rectum.  Occasionally  such 
cases  are  witnessed  at  the  present  day  in  patients 
who  dread  operative  measures.  Excision  of 
part  of  the  bladder  or  of  intestine  may  be  necessary  > 
whilst  in  some  cases  the  dermoid  elements  cannot 
be  thoroughly  extirpated.  When  the  rectum 
is  damaged  by  the  separation  of  dense  adhesions 
during  the  removal  of  an  old  dermoid,  it  is  often 
advisable  to  drain  by  the  vagina,  and  to  sew  the 
broad  ligament  to  the  peritoneum  of  the  posterior 
part  of  the  pelvis  and  upper  portion  of  the  rectum 
above  the  seat  of  injury,  In  this  way  the  peri- 
toneal cavity  is  cut  off  from  a  focus  of  deadly 
infection  ;  abdominal  drainage  is  untrustworthy  in 
such  a  case. 

Under  circumstances  not  clearly  understood, 
small  pelvic  dermoids  may  lie  latent  for  years 
and  fail  to  contract  adhesions.  I  removed  a 
tumour  of  this  class  last  summer  from  an  old  lady, 
aH,  63,  in  a  nursing  home,  and  the  results  were 
satisfactory.  Most  probably  growth  is  arrested 
in  these  cases  by  plugging  of  the  vessels  in  the 
long,  narrow  pedicle  of  the  heavy  little  tumour, 

D 


14°   Thb  Mbdical  Prbss. 


ORIGINAL  COMMUNICATIONS. 


Feb.  io,  1904. 


SOME     CASES 

OF 

LYMPHANGIOMA. 

By  ALBERT  CARLESS.  M.S.Lond.,  F.R.C.S.. 

Professor  of  Sargery  in  King's  College,  London ;  and  Surgeon  to  King's 
College  Hospital,  Ac. 

It  has  fallen  to  my  lot  to  treat  a  number  of  these 
growths  during  the  last  few  years,  and  inasmuch  as 
their  characters  and  peculiarities  are  none  too  clearly 
described  in  text-books,  and  my  cases  have  ranged 
over  most  of  the  different  types  assumed  by  them,  it 
has  seemed  worth  while  picking  out  some  of  the  more 
characteristic  so  as  to  give  an  idea  of  the  whole  subject. 

It  is  a  little  difficult  to  draw  an  exact  line  of  demarca- 
tion around  growths  which  should  merit  the  title  : 
between  them  and  the  lymphangiectases  a  somewhat 
large  group  exists,  of  which  it  is  almost  impossible  to 
say  to  which  class  one  should  assign  the  individual 
members.  Theoretically,  one  looks  on  a  lymphangioma 
as  a  tumour  built  up  of  newly-formed  lymphatic  vessels, 
whether  or  not  they  retain  their  tubular  characters, 
whilst  the  lymphangiectases  are  conditions  due  to  the 
distension  of  pre-existing  lymphatics,  and  the  latter 
are  usually  associated  with  interstitial  overgrowth  of 
the  tissues  involved,  constituting  in  the  extremities 
conditions  akin  to  elephantiasis.  The  difficulty  in  par- 
ticular arises  with  the  unilocular  or  multilocular  cysts 
which  form  the  majority  of  cases  known  as  cystic 
hygroma ;  whilst  the  term  lymphangioma  is  usually 
applied  to  these,  it  is,  to  my  mind,  quite  an  open  ques- 
tion whether  it  is  strictly  merited. 

I  propose  to  lay  before  you  the  characters  of  five 
cases.  Of  these  one  was  purely  cutaneous  ;  two  in- 
volved skin  and  subcutaneous  tissue ;  three  were 
typically  cystic ;  and  the  last  was  a  solid  growth,  but 
covered  by,  and  associated  with,  a  marked  cutaneous 
development. 

Case  1. — The  patient  was  a  child,  act.  under  1 2  months, 
of  poor  physique  and  badly  nourished.  It  was  affected 
by  a  patch  of  lymphangioma  to  us  tissue  upon  the  temple, 
the  size  of  a  shilling  or  a  little  more.  It  presented  the 
typical  appearance  of  what  may  well  be  termed  a 
lymphatic  n&vus.  The  patch  was  of  brownish-yellow 
colour  ;  the  surface  was  slightly  irregular  and  papilla  ted, 
and  on  examination  with  a  lens  one  could  see  that  each 
of  the  enlarged  papules  of  the  skin  was  the  seat  of  a 
dilated  lymphatic  covered  with  epithelium.  There 
were  a  few  enlarged  blood-vessels  in  the  neighbourhood. 
As  the  condition  was  not  increasing  in  size,  and  as  the 
child's  nutrition  was  peculiarly  defective,  I  advised  that 
it  should  be  carefully  watched  and  not  dealt  with  at 
the  time  ;  any  increase  would  determine  active  treat- 
ment, in  the  shape  either  of  destruction  by  the  actual 
cautery  or  excision. 

In  the  third  and  fifth  of  the  cases  here  recorded,  a 
similar  condition  was  present  in  association  with 
deeper  lymphangioma  to  us  manifestations,  but  was 
spread  over  a  much  more  extensive  surface.  Not 
infrequently  patients  scratch  and  irritate  the  affected 
areas,  giving  rise  to  a  flow  of  lymph  from  the  surface, 
and  perhaps  followed  by  attacks  of  inflammation, 
which  may  lead  either  to  extension  or  to  cure. 

This  lesion  is  sometimes  associated  with  a  condition 
in  which  the  lymphatics  are  distended  to  such  a  degree 
as  to  constitute  vesicles  as  large  as  half  a  pea,  but  the 
latter  may  also  occur  without  the  former.  These 
lymphatic  varices  are  by  no  means  uncommon,  and  are 
best  treated  by  simple  extirpation  if  they  be  few  in 
number,  or  by  opening  them  and  cauterising  the  ex- 
posed surface.  A  very  good  illustration  of  this  "  lymph- 
angioma circumscriptum "  appeared  in  the  British 
Medical  Journal  on  June  3rd,  1893. 

Lymphangiomata  of  the  subcutaneous  tissues  similarly 
present  themselves  under  two  chief  manifestations — 
vii.,  the  tubular,  and  the  cystic  or  cavernous.  In  the 
former,  as  in  the  haemangiomata.  the  newly-formed 
vessels  remain  as  capillaries,  and  constitute  soft,  pulpy 
or  spongy  swellings,  which  can  sometimes  be  reduced  in 
size  on  pressure.     In   the   cavernous   type,   cysts  of 


greater  or  smaller  size  are  found,  associated  or  not  with 
the  spongy  tissue  just  mentioned,  and  filled  with 
lymph,  to  which  a  greater  or  less  quantity  of  recent  or 
old  blood  is  not  infrequently  added.  On  the  whole, 
one  is  inclined  to  think  that  the  purely  cavernous 
without  admixture  of  spongy  tissue  is  more  frequently 
seen.  As  an  illustration  of  this,  the  following  case 
may  be  noted  : — 

Case  2.— D.  M.  S.,  aet.  5,  admitted  to  King's  College 
Hospital  on  September  9th  last  for  a  cystic  swelling 
situated  in  the  lower  part  of  the  right  cheek  and  upper 
part  of  the  neck.  It  had  only  been  noticed  three 
months  previously,  but  during  the  month  preceding 
her  admission  it  had  increased  in  size  very  considerably. 
It  extended  upwards  as  high  as  the  external  auditory 
meatus,  downwards  to  the  level  of  the  thyroid  car- 
tilage, backwards  to  the  anterior  border  of  the  sterno- 
mastoid,  and  forwards  nearly  as  far  as  the  middle  line. 
The  swelling  was  tense  and  elastic,  apparently  locu- 
lated,  and  the  skin  over  it  was  normal  and  moved 
freely  ;  the  growth  appeared  to  be  more  or  less  attached 
to  deeper  structures.  The  limits  of  the  swelling  were 
quite  sharply  defined,  and  it  was  obviously  of  a  cystic 
nature.  It  was  operated  upon  on  September  nth, 
and  on  incision  proved  to  be  a  thin-walled  multilocu- 
lated  cyst,  containing  serum  mixed  with  blood,  which 
from  its  colour  had  been  extravasated  into  it  some 
little  time.  The  various  loculi  penetrated  deeply 
among  the  structures  of  the  neck,  and  were  in  close 
proximity  to  the  vessels;  the  lingual  and  facial 
arteries  projected  into  the  cavity,  and  were  only 
separated  from  it  by  the  endothelial  lining.  One 
loculus  ran  up  under  cover  of  the  mandible  into  the 
pterygoid  region.  It  was  impossible  to  dissect  out 
in  its  entirety  the  whole  of  the  lining  wall,  and  hence 
those  portions  which  could  not  be  thus  dissected  away 
were  well  scraped  with  a  sharp  spoon.  The  wound 
was  closed  with  a  continuous  suture  and  healed  by 
first  intention. 

I  look  on  this  growth  as  a  pure  cystic  lymphangioma, 
though  why  it  appeared  in  this  situation,  and  why  it 
developed  so  suddenly  and  rapidly,  it  is  impossible 
to  say.  Its  definite  limitation  rendered  it  very  suitable 
for  treatment  by  operative  measures.  Not  a  few 
growths  ordinarily  termed  cystic  hygroma  are  of  this 
type  ;  they  are  perhaps  more  often  composed  of  a 
congeries  of  smaller  cysts  than  of  a  single  one,  but  they 
are  frequently  quite  amenable  to  operative  treat- 
ment. It  is  by  no  means  unusual  to  see  a  haemangio- 
matous  element  also  present,  and  this  association 
may  explain  why  the  fluid  contained  in  them  is  stained 
or  mixed  with  blood.  In  one  instance  which  I  saw 
years  back  under  the  care  of  Lord  Lister,  it  was  possible 
to  reduce  the  size  of  the  mass  by  pressure  to  a  con- 
siderable extent,  and  as  soon  as  the  compressing 
force  was  removed  the  tumour  swelled  up  to  its  former 
dimensions. 

Quite  distinct  in  their  features  from  ttiis.  although 
still  cavernous  lymphangiomata,  are  the  next  two 
cases. 

Case  3. — H.  G.,  a  boy,  aet.  6,  came  under  my  care  at 
St.  John's  Hospital,  Twickenham,  about  two  years  ago. 
He  was  the  subject  of  a  large  cystic  swelling  on  the  left 
side  of  the  posterior  thoracic  and  abdominal  walls. 
This  had  existed  from  birth,  but  had  increased  in  size 
rapidly  during  the  previous  few  months.  The  mass 
extended  from  the  mammary  line  in  front  nearly  to 
the  middle  line  behind  ;  from  above  downwards  it 
was  about  four  inches  in  diameter,  and  projected  out- 
wards to  such  an  extent  that  it  resembled  in  size  a 
large  cocoanut.  Several  cysts  could  be  detected,  but 
the  main  loculus  was  of  considerable  dimensions. 
The  skin  covering  the  mass  was  adherent  to  it,  and  in 
part  the  seat  of  a  cutaneous  lymphangioma  resembling 
that  described  in  Case  1.  The  growth  appeared 
to  be  more  or  less  fixed  to  the  thoracic  parietes.  I 
dealt  with  it  in  two  operations.  In  the. first  the  in- 
cision was  a  straight  one  placed  across  the  centre  of 
the  mass,  and  extending  from  an  inch  and  a  half  ex- 
ternal to  the  left  nipple  obliquely  downwards  and  back- 
wards nearly  to  the  middle  line  behind  just  above,  then  to- 


F*fc  to,   1904* 


ORIGINAL  COMMUNICATIONS. 


Tub  Medjcal  Press,    141 


thctopof  the  sacrum.  The  main  cyst  was  thereby  01 

and  found  to  contain  serous  fluid.     Many  other  cysts 

were  present,  but  in  addition  to  this  was  a  considerable 

lity  of  a  soft  spongy  tissue  which  ooied  lymph 

when  cut  into,  and  was  much  of  the  same  character 

as  the  soft  spongy  hemangioma  tous  tissue  found   in 

..rdinary  n&vi.    This,  together  with  the  lining  wall  of  the 

main  cvst  and  the  greater  portion  of  the  atfected  skin, 

was  dissected  away  ;    but  it  was  found  that  the  soft 

id  tissue  extended  into  and  had  infiltrated   the 

superficial  muscles  covering  the  thorax  and  abdomen, 

ad  il  was  necessary  to  encroach  on  these  to  a  eon- 

nukrable  extent  in  order  to  get  clear  of  the  growth. 

There  was  a  good  deal  of  bleeding  in    this  procedure, 

ami  therefore   it  was   thought  wise   not    to  attempt 

<tal  extirpation  of  the  outlying  portions  of  the 

towards  the  middle  line.     The  patient  recovered 

ily    well,    and     some      time      later    a     second 

ion     was     undertaken      111     order     to     remove 

the  remains  of  the   tumour,   which   had   once  again 

started  growing.     This   time  one  made  a  curved  in- 

"Xtending  from  the  upper  end  of  the  scar  to  nearly 

wer.  and  reaching  back  as  far  as  the  middle  line* 

This  large  flap  was  dissected  up,  and  all  the  remaining 

cis  of   the  growth  were  removed.     The  wound 

Created   by   first   intention.     I  saw  the  patient  a  few 

Trwks  back — i.e.,    eighteen    months   after    the   second 

operation*  and  found  that  the  condition  was  perfectly 

satisfactory  :  there  was  no  si^n  of  any  recurrence,  and 

the  skin  only  in  one  spot  showed    evidence  of   the 

preceding     lymphangioma toua    condition    which    had 

involve-;!  it* 

r  4  was  a  less  satisfactory  one  of  a  similar  type, 
■:h.   however,  a  fatal  issue  ensued  in  spite  ofex- 
tenii ve   in  ler f erence . 

M.  K.  act  3  days,  was  admitted  to  King's  College 
Hospital  under  Mr.  Rose  on  March  3rd,  1902,  with  a 
large  lling  beneath  the  left  side  of  the  jaw, 

extending  from  the  symphysis  menti  to  the  mastoid 
process*  The  skin  was  not  adherent  over  the  mass, 
and  several  distinct  cysts  could  he  made  out.  The 
growth  increased  rapidly  in  size,  several  of  the  cysts 
appearing  to  merge  into  one  another  under  observa- 
tion, and  the  mass  soon  began  to  project  further  back- 
wards behind  the  sterno- mastoid.  On  March  10th 
Mr.  Rose  operated,  making  an  incision  more  or  Jess 
parallel  with  the  ramus  of  the  jaw  over  the  more  pro- 
minent cysts.  The  skin  was  separated  from  them, 
lad  the  cysts  opened*  They  contained  yellow  serous 
liuid  and  a  substance  of  jelly-like  structure,  probably 
due  to  coagulation  of  the  lymph  in  situ.  The  greater 
part  of  the  mass  was  removed  and  its  pedicle  ligatured. 
The  wound  was  closed  and  the  child  did  well,  but  the 
aotes  state  that  on  March  SOth.  before  the  child  was 
irged,  the  tumour  under  the  chin  was  again 
lencing  lo  enlarge,  The  fluid  contained  in  the 
reported  by  Dr.  Griinbaum  to  contain  0*4 
percent,  ot  albumen.  The  wall  of  the  cysts  was  com- 
posed  of  connective  tissue,  in  parts  undergoing  myxo- 
matous degeneration  ;  the  cyst  cavity  was  not  lined 
by  epithelium.  The  solid  material  in  the  cysts  was 
said  to  be  organising  fibrin. 

The  child  was  admitted  a  second  time  under  my 
care  a  few  months  later.  The  growth  had  then  at- 
tained considerable  dimensions,  extending  under  the 
chinas  a  projecting  rounded  mass,  and  also  occupying 
bath  triangles  of  the  neck.  The  child's  nutrition  had 
hy  this  time  begun  to  surfer,  and  although  operation 
was  essential,  one  was  a  little  afraid  as  to  what  the 
result  would  be,  A  large  incision  was  made,  extending 
the  whole  length  of  the  lateral  aspect  of  the  neck,  and 
it  was  early  seen  that  the  sterno -mastoid  w-as  exten- 
sively invaded  by  the  growth,  and  that  removal  of  its 
fcneos  m  a  portion  of  its  extent  was  required 
—in  fact,  there  were  very  few  muscle-fibres  left  towards 
the  centre.  The  growth  had  also  attacked  the  parotid 
gland,  and  its  removal  from  this  region  necessitated 
the  division  of  a  portion  of  the  facial  nerve.  In  spite 
of  the  very  extensive  dissection,  it  was  impossible  to 
remove  the  whole  mass,  especially  under  the  chin. 
When  the  operation  was    finished     the  whole  of   the 


deeper  structures  of  the  neck  were  laid  bare,  and  one 
had  to  place  the  skin-flap  down  on  the  internal  jugular 
vein  with  no  other  structure  intervening.  In  spite 
of  all  things,  the  wound  healed  satisfactorily,  and  the 
child  was  sent  out  of  hospital  ,  but,  unfortunately,  the* 
side  of  the  face  remained  partially  paralysed. 

The  ultimate  result  was  that  the  tumour  grew  once 
again,  burst  through  the  skin,  and  became  infected, 
hild  was  admitted  to  hospital  for  a  third  time  on 
January  ioth.  1903,  and  died  of  septic  absorption* 

The  most  important  feature  in  each  of  these  two 
cases  is  the  tendency  obviously  existent  in  them  to 
infiltrate  surrounding  structures.  The  sterno -mastoid 
in  one  case,  and  the  superficial  abdominal  muscles  in 
the  other,  had  been  invaded,  and  their  tissues  infiltrated! 
and  destroyed  ;  the  parotid  gland  in  Case  4  had  also 
been  attacked.  In  the  former  case  the  parti  involved 
were  of  less  importance,  and  therefore  could  be  freely 
dissected  away  ;  but  when  the  deeper  tissues  of  the 
neck  are  afiected,  serious  results  may  follow,  and  life 
itself  may  he  destroyed.  This  tendency  to  invade 
and  infiltrate  has  been  noticed  by  other  observers, 
and  must  ever  be  kept  in  mind  in  advising  as  to  treat- 
ment. The  tissue  is  plainly  of  a  lowly  organisation, 
and  it  is  quite  an  open  question  whether  there  is  not  seme 
added  sarcomatous  element  present*  A  similar  in- 
stability of  the  haemangiomata  has  also  been  noticed. 

Mi.  Bet  ham  Robinson  related  a  case  somewhat 
similar  in  winch  the  parotid  region  was  invaded  by  a 
growth  of  this  nature,  though  there  it  was  simply  cystic 
and  not  of  the  spongy  type.  An  operation  was  under- 
taken, but  only  a  portion  could  be  removed*  The 
growth  recurred,  and  the  child  subsequently  died 
of  asthenia  ("  Path.  Soc*  Trans,,"  1896),  Mr*  Spencer 
has  also  reported  to  the  Medical  Society  a  case  of 
diffuse  lymphangioma  of  the  lower  extremity,  and 
has  referred  to  some  others  of  a  similar  type  ;  but  they 
do  not  seem  quite  lo  fall  into  line  with  cases  such  as  2 
have  referred  tot  and  are  more  like  diffuse  lymphan- 
giectases  (*J  Med.  Soc.  Trans.,*'  1892,  p.  133 J.  Zuccaro 
[Putilm  Msdti  0,  1894,  Nos.  8  and  9)  also  relates  a  case 
oj  ,h tins  ecys tic  disease  of  this  type  in  the  upper  arm 
and  thorax  of  a  child  seventeen  days  old,  where  the 
connective  tissue  was  riddled  with  cysts,  and  gives  a 
careful  account  of  the  histology.  Complete  removal 
was  impossible,  and  death  occurred  as  the  result  of 
septic  processes  starting  in  the  wound,  which  could 
not  be  completely  closed.  Vautrin  (Revue  de  Chtrurgie^ 
1898.  p<  1,128)  relates  a  case  of  mesenteric  lymphan- 
gioma which  he  discovered  post-mortem,  The  growth 
had  invaded  the  muscular  tunics  of  the  stomach,  and 
was  surrounded  by  agglutinated  coils  of  intestine. 
He  emphasises  the  gravity  of  this  invasion,  and  looks 
on  it  as    analogous  to  that  of  a  malignant  tumour. 

Operations  for  partial  removal  must  therefore 
always  be  avoided,  if  possible,  hut  there  are  not  a  few 
I  cases  on  record  in  which  a  good  result  was  subse- 
quently obtained.  D'Arcy  Power  [BriL  Med.  ]aurn.* 
December  ath,  1897}  relates  one  in  which  spontaneous- 
disappearance  of  the  mass  occurred  subsequently, 
owing  to  an  attack  of  inflammation  in  the  part  left  be- 
hind ;  but,  as  one  has  indicated  by  the  cases  referred^ 
to  above,  this  inflammation  may  not  always  lead  to  a 
satisfactory  issue. 

Case  5. — The  last  case  I  have  to  describe  was  an 
interesting  one  in  which  there  was  a  solid  fatty 
growth  on  the  anterior  thoracic  wall,  adherent  to> 
the  skin  which  covered  it  in,  and  this  in  turn  was 
invaded  for  a  good  portion  of  its  extent  by  a 
cutaneous  lymphangioma  to  us  development,  similar 
in  characters  to  that  which  I  alluded  to  in  my  first 
case. 

The  child,  M.  S.,  was  a*t.  U,  and  the  growth  had  bee* 
noticed  since  she  was  two  years  old.  It  increased 
gradually  in  site,  but  gave  no' inconvenience  till  about 
two  and  a  half  years  previously,  when  she  was  operated 
on  by  Mr.  Stanley  Boyd  at  Charing  Cross  HospitaL 
The  mother  stated  that  there  was  no  sign  of  the  mass 
after  this  procedure,  but  that  it  commenced  to  grow 
again  shortly  afterwards.  On  her  admission  to  King's 
J  College     Hospital     in     August,     1901,      the     swelling 


142    Thi  Medical  Pkess. 


ORIGINAL  COMMUNICATIONS. 


Feb.  io.  1904. 


extended  vertically  from  the  second  to  the  fifth  rib  in- 
clusive, and  from  half  an  inch  to  the  right  of  the 
middle  line  to  well  into  the  left  axilla.  It  projected 
forwards  two  or  three  inches,  constituting  a  tumour 
rather  larger  than  a  fist ;  and  towards  its  lower  part 
could  be  seen  the  rudimentary  breast,  which  was  quite 
independent  of  it.  '  In  consistence  it  was  soft,  slightly 
tabulated  and  irregular  ;  freely  movable  on  the  deepei 
parts,  but  the  skin  was  adherent  over  it.  Enlarged 
veins  coursed  over  the  mass,  and  the  scar  of  the  former 
operation  ran  transversely  across  its  lower  border. 
The  skin  over  the  greater  part  of  it,  and  especially 
towards  the  axilla,  was  slightly  warty  and  papillated, 
resembling  in  colour  and  appearance  the  lymphan- 
giomatous  developments  already  described.  No  en- 
larged glands  were  to  be  felt  in  the  axilla,  and  the 
growth  was  quite  painless. 

The  whole  mass  was  subsequently  excised,  and  as  it 
encroached  somewhat  closely  upon  the  pectoral 
muscle,  which  looked  decidedly  infiltrated,  it  was 
thought  better  to  remove  the  sternal  portion  of  that 
muscle,  and  to  carry  the  incision  well  into  the  axilla, 
from  which  a  somewhat  enlarged  gland  was  removed. 

The  exact  nature  of  this  case  is  certainly  open  to 
discussion.  The  microscopic  report  as  to  the  cutaneous 
condition  merely  stated  that  it  was  a  papillomatous 
naevus  ;  but  looking  to  the  appearance  of  the  lesion 
before  removal,  the  total  absence  of  any  evidence  of 
circulating  blood,  and  the  entire  accordance  of 
characters  with  those  of  demonstrated  lymphatic 
naevi,  one  is  forced  to  the  conclusion  that  it  must  be 
placed  in  that  group. 

As  to  the  main  mass,  the  report  stated  that  it  was 
merely  fat,  and  that  no  lymphatic  or  hemangioma  to  us 
developments  were  present ;  it  was,  however,  a  large 
mass,  and  it  is  possible  that  the  portion  that  might 
have  demonstrated  its  dependence  on  a  lymphan- 
giomatous  origin  was  not  examined.  That  fibro- 
fatty  growths  are  associated  with  lymphangioma tous 
developments  cannot  be  doubted.  Mr.  Marmaduke 
Sheild  showed  a  child  to  the  Medical  Society  in  1893 
(•*  Med.  Soc.  Trans.,"  vol.  xvi.,  p.  305)  who  was  the  sub- 
ject of  what  he  supposed  to  be  a  congenital  fibro-fatty 
growth.  In  the  next  year's  "  Transactions  "  (p.  334)  the 
sequel  of  this  case  is  related.  An  acute  attack  of 
inflammation  supervened  in  the  growth,  which  became 
enormously  enlarged,  hot,  red,  and  oedema  tous,  and 
in  spite  of  careful  nursing  the  child  died.  On  post- 
mortem it  was  found  that  the  greater  part  of  the  growth 
consisted  of  solid  fibro-fatty  tissue,  but  that  towards 
the  axilla  it  merged  into  a  sponge-like  growth,  and 
finally  into  distinct  cysts,  the  size  of  peas  or  grapes, 
filled  with  yellow  serous  fluid.  Spontaneous  inflamma- 
tion had  occurred,  and  the  child  had  been  able  to  with- 
stand the  inflammatory  fever  and  exhaustion.  I  look 
on  my  case  as  akin  to  this,  but  that  the  transformation 
into"  a  cavernous  type  of  lymphangioma  had  not  been 
reached.  In  such  developments  one  sees  an  analogy 
to  the  lipomatous  conditions  which  are  sometimes 
.  found  associated  with  the  hscmangiomata. 


ALBUMINURIA 

IN  THE 

APPARENTLY    HEALTHY. (<0 

By  SAMUEL  WEST,  M.D.,  F.R.C.P., 
Physician  to  St.  Bartholomew's  Hospital. 

The  term  "  physiological  "  or  "  functional," 
as  applied  to  this  variety  of  albuminuria,  was  not 
to  be  commended,  as  it  begged  the  very  question 
'•which  it  was  desired  to  prove.  Moreover,  under 
ordinary  conditions  physiological  albuminuria 
<lid  not  occur,  and  when  it  did  it  was  a  transuda- 
tion, not  a  secretion.  The  greatest  importance 
was  to  be  attached  to  the  state  of  nutrition  of 
the  walls  of  the  capillaries,  and  also  to  the  presence 


■   (a)  Abstract  of  Paper  read  at  a  meeting  of  the  West  London 
Medico  Chirurgical  Society,  on  Friday,  February  5th,  1W4- 


or  absence  of  high  arterial  tension.  It  had  been 
stated  that  albumin  might  be  demonstrated  in 
the  urine  in  everyone.  This  was  not  strictly 
true,  but,  at  the  same  time,  if  an  ordinary  speci- 
men of  urine  free  from  albumin  as  recognised  by 
the  usual  tests  be  evaporated  down,  and  the 
residue  extracted,  a  trace  of  albumin  might  be 
found.  The  explanation  of  this  was  simple,  as  a 
certain  number  of  cells  from  the  urinary  tract 
were  generally  present  in  the  urine.  Except  in 
this  limited  sense,  albuminuria  was  never  physio- 
logical at  all,  but  always  pathological. 

The  cases  could  be  divided  into  three  groups  ; — 

(1)  post-renal,  or  accidental,  due  to  the  contamina- 
tion of  the  urine  from  the  geni  to-urinary  tract ; 

(2)  renal,  (a)  with  obvious  cause,  as  kidney  disease, 
(b)  without  obvious  cause  ;  (3)  pre-renal,  (a)  with 
obvious  cause,  as  in  fevers  or  heart-disease,  (b) 
with  no  obvious  cause.  It  was  the  albuminuria 
in  which  the  cause  was  not  obvious  that  the 
diagnosis  of  this  special  variety  was  made  by 
exclusion — always  a  difficult  matter.  With  regard 
to  the  post-renal  class  of  cases,  a  tiny  calculus 
in  the  kidney  might  lead  to  a  transient  albu- 
minuria or  hematuria,  and  nothing  else,  the  con- 
dition completely  clearing  up  with  the  passage 
of  the  stone.  Temporary  albuminuria  might 
also  be  due  to  the  passage  of  oxalic  acid  gravel, 
and  it  was  also  said  that  the  strongly  acid  urine 
of  acute  gout  might  likewise  give  rise  to  the  same 
condition. 

Many  different  names  had  been  given  to  this 
form  of  albuminuria.  Most  of  them  called  atten- 
tion to  some  particular  feature  of  the  complaint, 
or  indicated  its  causal  relationships,  such  as 
"  occasional,"  "  intermittent,"  "  remittent," 
"  cyclical,"  M  postural,"  "  dietetic,"  and  so  forth. 
All  these  might  be  met  with  during  the  con- 
valescence from  acute  Bright 's  disease.  The 
actual  frequency  with  which  the  condition  occurred 
had  been  variously  stated,  10  per  cent,  being  pro- 
bably the  approximate  figure.  Its  importance 
and  significance  varied  with  age.  It  had  been 
met  with  in  new-born  babies,  and  it  was  not 
infrequent  in  quite  young  infants,  in  which  class 
one  series  of  statistics  showed  that  it  was  present 
to  the  extent  of  40  per  cent.  This  was  rather 
high.  In  boys  at  school,  the  average  was  20 
per  cent.  Here,  the  cases  were  divisible  into 
two  groups:  those  who  were  florid,  full-blooded, 
and  with  good  pulse- tension,  and  those  in  which 
pallor  with  low  arterial  tension  was  a  marked 
feature.  The  practical  question  was  whether 
their  school  life  should  be  interfered  with.  He 
thought  that  each  case  must  be  judged  upon  its 
own  merits,  and  that  continuance  at  school  under 
medical  supervision  was  the  best  course  to  pursue. 
In  the  young  adult,  the  condition  became  of 
importance  with  regard  to  the  question  of  life- 
insurance,  or  of  entry  into  the  Services  or  large 
business  houses.  The  presence  of  albumin  at 
all  was  a  risk  which  the  insurance  office  was 
justified  in  declining  to  take. 

From  the  age  of  twenty-five  to  thirty  the  case- 
frequency  of  functional  albuminuria  was  lowest. 
The  gravity  of  the  condition  increased  almost 
pari  passu  with  every  year,  the  mortality  some- 
times working  out  at  nearly  double  that  of  healthy 
persons.  The  chief  crux  of  the  whole  question 
lay  in  the  difficulty  of  excluding  latent  disease 
of  the  kidneys,  especially  granular  kidney.  The 
curves  of  mortalitv  of  the  two  conditions  were 


Feb.   io.  J904. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press*     143 


close.  He  would  lay  down  as  a  general 
rule  that  any  albuminuria  which  was  accom- 
j>anied  by  arterial  thickening  was  an  indication  of 
some  granular  change  in  the  kidneys. 

The  practical  application  of  these  considerations 
with  regard  to  life-insurance  was  that  it  was 
advisable  to  reject  all  cases  oi  albuminuria  above 
the  age  of  forty*  to  load  heavily  those  be l ween 
■hirty-five  and  forty,  to  add  considerably  between 
the  ages  of  twenty- five  and  thirty*  and  to  post- 
pone and  watch  those  cases  occurring  from 
^cn  10  twenty-five.  If  arterial  thickening 
were  present  al  the  same  time,  one  should  n 
at  all  ages.  It  was  of  supreme  importance  to 
rccoejiise  that  albuminuria  was  never  physio- 
logical but  always  pathological,  though  not  . 
necessarily  renal. 


THE 
ALBUMIN 


ADVANCES  IN 
CHEMISTRY       OF 

AND    THEIR 

CLINICAL    IMPORTANCE  W 

By  G.  KLEMPERER,  M.D., 

Professor  of  Medicine,  Berlin  University, 

All  albuminous  bodies,  the  lecturer  said,  were 
but  fell  into  different  groups.  We 
distinguished  two  large  groups,  simple  and 
complex.  The  first  group  fell  into  three  divisions, 
the  albuminous,  the  globulins,  and  the  phosphor- 
albumins.  The  two  first- named  were  found  in 
albumin  and  also  in  blood  serum  ;  cell  protoplasm 
contained  only  globulin.  In  the  albumin  of  urine 
e  both  albumin  and  globulin,  but  in 
varying  proportions,  according  to  the  nature  of  the 
disease,  With  ammonia  sulphate  the  globulin 
was  only  precipitated  with  difficulty  ;  it  was 
large- grained.  For  this  reason  it  was  kept  back 
by  the  epithelium  in  the  milder  kidney  affections, 
and  principally  albumin,  the  finely  granular,  was 
excreted,  whilst  in  severe  kidney  lesions  more 
albumin  was  Jet  through.  The  phosphorus- con- 
taining albumin  (formerly  so-called  nuclc in-con- 
taining; resembled  the  caseous  material  that  fell 
tmm  milk  by  acidifying  and  was  present  in  yolk  of 
egg  and  in  vegetable  foods.  It  was  formerly 
believed  that  animal  and  vegetable  albumin 
were  identical. 

Amido -acids  were  always  given  off  from  these 
albuminous  bodies.  They  changed  later  into 
proprionic  acids,  butyric  acids,  valerianic  acids, 
and  succinic  acid,  The  amido-acids  were  divisible 
into  mo  n  amino -acids  and  di  a  mi  no  -  acids,  the 
former  acting  as  acids,  the  latter  having  basic 
properties.  To  the  former  belonged  amino- 
capronic  acids  (leucine,  aminolactic  acid  (alaline), 
tyrnsiTio,  and  Cystine,  Other  chemical  changes  of 
albumin  had  been  found,  heterocyclic  circles. 
These  simple  albuminous  bodies  combined  with 
"the  1  groups,  and  so  arose  the  complex  albu- 
minous bodies,  the  proteids.  They  belonged  to 
the  cell -nucleus,  and  were  therefore  also  called 
Quel  eo -pro  teids  ;  they  consisted  of  three  parts 
part  phosphorus,  one  part  nucleus,  one 
part  purin  substance.  The  latter  was  the  mother 
ince  of  uric  acid  and  of  xanthin.  Pentose 
was  also  contained  in  it.  By  pairing  with  dextrose, 
gluoosamum  was  formed  from  the  nucleo-protcid. 
Mucin  belonged  to  the  glyco- pro  teids  that  were 
peculiar    to    some    albuminous    bodies.     Finally. 


<«.'  Abiir»ct  of  Ail  ■  lira  del  tare  1  at  the  Medio  il  Society  ,  Berlin, 


the  proteids  combined  with  iron  chromate  prn- 
teid.  The  denaturised  albuminous  bodies  were 
to  be  considered  as  special  bodies* 

What  did  the  body  do  with  these  albuminous 
bodies  ?  They  underwent  hydrolytic  changes, 
were  albumosised  and  peptonised.  But  pep- 
tonisation  w+as  not  a  final  change  ■  peptone  was 
only  a  passing  step.  Peptone  had  disappeared 
from  the  stomach  after  four  hours;  only  amldo- 
acids  were  found  in  the  intestines.  Peptone 
was  not  generally  absorbed,  but  passed  on  into 
crystalline  albuminous  products,  which  were  ab- 
sorbed ,  and  from  which  the  organism  again  pre- 
pared the  albuminous  bodies.  Cohnheim  had 
shown  that  the  splitting  up  into  crystalline  bodies 
was  due  to  a  ferment  secreted  by  the  mucous 
surface  of  the  intestinal  walls,  which  he  called 
crepsine.  It  was  possible  also  that  a  part  of  the 
peptones  was  absorbed  as  such. 

Tins  new  doctrine  of  the  previous  splitting  up 
of  albuminous  bodies  before  absorption  had  caused 
a  complete  revolution  of  the  views  as  to  the  rela- 
tion of  albumin  to  internal  tissue  change.  We  must 
assume  that  the  albuminous  bodies  that  passed  on 
with  the  tissue  and  body  fluids  as  component  parts 
were  formed  synthetically  out  of  the  crystalline 
division- products  of  the  albumin  contained  in 
the  food,  and  that  therefore  the  body  itself  per- 
formed synthetic  functions. 

When  the  cell  structure  was  completed,  urea 
was  first  formed,  and  by  intermediary  tissue 
change.  As  a  rule  the  intermediary  products 
passed  away  quickly.  But  by  disturbances  the 
demolition  of  certain  cells  might  come  to  a  stand- 
still, and  thereby  a  number  of  diseases  might  be 
caused.  Among  these  was  a  rare  disease, 
alkaptonuria  (urine  of  a  black  colour,  especially 
when  alkaline)  ;  it  was  a  pronounced  family 
disease  There  was  also  amidooxyphcnylacetic 
acid,  which  the  ferment  readily  changed  in- 
to tyrosine  (paraoxyphenylaminoproprionic  acid). 
The  ferment  was  absent,  ho w ever,  occasionally ; 
then  the  demolition  came  to  a  standstill, 
when  we  found  the  above-named  material  in  the 
urine,  Cystinuria  also  belonged  here,  and  this 
was  also  a  family  disease  ;  here  the  ferment  neces- 
sary ior  the  demolition  of  the  cystine  was  absent. 

Diabetes  was  more  difficult  of  explanation, 
Here  the  sugar  formation,  the  remaining  at  a 
lower  stage  oi  decomposition,  was  a  chemical 
anomaly  Whence  came  the  sugar  ?  Not  from 
the  pentose  and  not  from  the  glucoamine.  It 
must  be  formed  from  the  albumin  itself,  from 
the  mono-  and  diami no-acids;  glycosis  arose  and 
remained  with  the  patient. 

Another  disease  was  the  adiposity  of  anaemia. 
Here,  without  doubt,  the  fat  developed  out  of  the 
albumin.       Fatty  acid  was  also  formed  from  (11 
as  also  oxybutyric  acid  out  of  the  fat. 

The  prostatic  group  of  albuminous  bodies  was 
connected  with  uric  acid  If  the  process  became 
stationary  at  this  stage,  we  had  the  symptoms  of 
gout. 

We  had,  then,  the  so*called  autolytic  processes 
in  the  body,  Acetolysis  occurred  when  some- 
thing in  the  organism  died  off  ;  a  better  name, 
therefore,  was  the  necrochemical  processes. 

The  Plague. 
L  HE  following  telegram  from  the  Officer  Administering 
the  Government  of  Mauritius  has  been  received  at  the 
Colonial  Office  : — "  For  the  week  ending  Jauuarv  z&th* 
28  cases  of  '"plague/  IS  fatal." 


144    Thb  Medical  Press. 


SPECIAL   ARTICLES. 


Feb.  to.  iqo4« 


Special  articles- 


BRITISH    SANATORIA    FOR    CONSUMPTION.— 
XXXII. 


[by  our  special  medical  commissioner.] 


WOODHURST  SANATORIUM,  DORKING. 
^As  our  series  of  articles  has  already  abundantly 
-shown,  there  is  no  dearth  of  excellent  sanatoria  for 
-consumptives  in  this  country.  In  almost  every  part 
of  the  British  Isles  well-equipped  and  wisely-managed 
institutions  are  now  available.  Indeed,  for  tne  wealthy 
sufferers  the  supply  is  in  serious  danger  of  altogether 
•exceeding  the  demand.  But  for  the  poor  the  case  is 
very  different.  For  the  pauper  class  adequate  hygienic 
treatment  is  sadly  lacking,  although  in  certain  dis- 
tricts efforts  have  been  made  recently  to  provide 
means  for  the  carrying  out  of  "  open-air  "  methods.  For 
4he  majority  of  these  State-maintained  consumptives 
the  ordinary  workhouse  infirmary  is  the  last  and  much- 
dreaded  resort.  While  it  is  only  right  to  acknowledge 
the  immense  prophylactic  service  rendered  by  these 
Poor-law  institutions,  it  is  necessary  to  remember  that 
for  the  greater  number  of  cases  these  infirmaries  are  un- 
suited  to  the  needs  of  the  phthisical.  The  hospitals  and 
sanatoria  supported  by  voluntary  contributions  or 
maintained  by  philanthropic  effort  are  inundated  with 
applicants.  Recently,  by  a  wise  combination  of  county, 
municipal,  and  individual  effort,  certain  establish- 
ments have  been  brought  into  being,  and  go  some  way 
to  meet  the  wants  of  the  comparatively  poor.  In  most 
cases  these  attempts  to  deal  with  the  needs  of  the 
indigent  phthisical  worker  have  been  somewhat  dis- 
appointing. To  secure  efficient  hygienic  management, 
considerable  expense  is  necessarily  incurred,  and  it  is 
exceedingly  difficult  to  provide  food  and  the  other 
requirements  of  "  natural  "  treatment  at  such  rates 
as  can  be  met  by  most  members  of  the  working  class. 
And  perhaps  the  sufferers  most  to  be  pitied  are  those 
young  females  who,  even  when  in  full  health,  can  barely 
earn  sufficient  for  daily  needs,  and  when  overtaken  by 
disease  are  dependent  on  the  support  of  relatives  or  the 
benevolence  of  friends.  It  is  to  meet  the  requirements 
of  this  class  that  the  sanatorium  at  Dorking  has  been 
established.  It  is  restricted  to  females,  and  accom- 
modation is  provided  for  sixteen  cases. 

Woodhurst  is  situated  on  Tower  Hill,  on  the  borders 
of  Dorking,  in  characteristic  Surrey  scenery.  The 
sanatorium  consists  of  a  commodious,  square,  tho- 
roughly well-built  and  good-looking  house,  origin- 
ally intended  for  a  private  residence.  By  slight 
adaptation  the  building  has  been  rendered  suitable  for 
its  present  purpose.  The  hall,  stairs,  and  landings  are 
extensive,  airy,  well-lighted,  and  allow  free  circulation 
of  air  throughout  the  establishment.  The  rooms  are 
large,  lofty,  well-placed,  and  with  good  windows.  In  most 
instances  three  or  four  patients  share  the  same  bed- 
room. There  are,  however,  certain  rooms  available,  if 
necessary,  for  single  patients.  All  parts  of  the  house 
appear  neat  and  clean,  and  present  evidence  of  know- 
ledge well  applied,  and  ever  active  thoughtful  manage- 
ment. The  dining-room  is  good,  and  there  is  reason- 
able accommodation  for  rest  and  recreation. 

The  grounds,  although  not  very  extensive,  are 
pleasingly  laid  out,  and  offer  facilities  for  graduated 
exercise  and  suitable  rest  in  the  open.  There  is  a  well- 
designed  shelter  open  on  all  sides,  and  here  some  of  the 
patients  spend  a  great  part  of  every  day.  The  grounds 
adjoin  the  famed  Glory  Woods,  which  are  some  forty 
acres  in  extent,  and  to  these  the  patients  have  free  access 
by  a  private  entrance.  A  small  but  ventilated  glass- 
house provides  accommodation  in  wet  weather. 

A  natural  system  of  ventilation  is,  of  course,  main- 
tained throughout.  Heating  is  provided  by  means  of 
open  fires. 

The  sanatorium  stands  in  its  own  grounds,  and  is 
separated  from  the  road  by  a  stone  wall.  The  soil  is 
sand  and  gravel.  The  house  and  its  grounds  are  pro- 
tected  and   yet  allow  of  free  exposure   to  sunlight. 


From  the  windows  of  the  house  and  from  certain  parts 
of  the  grounds,  extensive  views  of  very  beautiful  undu- 
lating country  can  be  obtained. 

Woodhurst  is  within  the  parish  of  Dorking  ;  the 
sewerage  is  good,  and  gas  and  water  are  provided  by 
the  town. 

At  the  time  of  our  visit  of  inspection  we  were  accom- 
panied by  the  visiting  medical  officer,  who  informed  us 
that  the  cases  were  treated  in  accordance  with  the 
generally  accepted  principles  of  modern  hygienic  treat- 
ment. No  special  or  exceptional  form  of  treatment  is 
employed. 

The  sanatorium  is  a  proprietary  one.  Although  a 
non-medical  management  cannot  be  considered  the 
best,  the  arrangements  in  the  present  case 
appear  to  provide  for  the "  needs  of  a  class  whose 
wants  are  too  apt  to  be  forgotten.  There  is  no 
resident  lady  doctor,  but  Dr.  Mary  McDougall, 
of  Croydon,  acts  as  visiting  medical  officer,  and  Dr. 
J.  D.  Rawlings,  of  Dorking,  attends  in  cases  of  emergency. 
The  nursing  isdirected  by  the  daughter  of  the  proprietor, 
Miss  Wright,  who  has  had  many  years*  experience 
of  general  nursing,  and  since  1898  has  devoted  her 
attention  entirely  to  the  nursing  of  consumptives,  and 
has  thus  had  considerable  experience  in  the  management 
of  these  cases. 

As  we  have  already  indicated,  Woodhurst  meets  a 
want  in  providing  a  sanatorium  for  female  cases  at 
comparatively  low  rates.  The  terms  are  from  one  and 
a  half  to  two  and  a  half  guineas  weekly,  according  to 
bedroom  accommodation,  but  drugs  and  laundry  are 
not  included. 

Dorking  may  be  reached  by  either  the  South  Eastern 
and  Chatham  Railway  or  the  London,  Brighton,  and 
South  Coast  Railway.  The  station  of  the  former 
is  the  most  convenient  for  patients,  but  is  a  mile  and  a 
quarter  from  the  sanatorium.  A  conveyance  is  pro- 
vided by  arrangement. 


CENTRAL  MIDWIVES  BOARD. 
At  a  meeting  of  the  Central  Midwives  Board  held  on 
January  28th,  1904,  Dr.  F.  H.  Champneys  in  the  Chair, 
the  following  business  was  transacted  : — 

1.  On  the  recommendation  of  the  Standing  Com- 
mittee, the  Board  adopted  three  sets  of  questions  to  be 
addressed  respectively  to  those  applying  for  approval 
or  recognition  in  the  following  capacities  :  (a)  Institu- 
tions applying  for  approval  of  their  certificate,  or  for 
recognition  as  approved  institutions  under  Section  C  1 
of  the  rules.  (6)  Registered  medical  practitioners 
seeking  recognition  as  teachers  under  Section  C  1  (3). 
(c)  Certified  midwives  applying  to  be  approved  for  the 
purpose  of  signing  Forms  III.  and  IV.  under  Section 
C  1  (2). 

2.  The  following  applications  for  recognition  as 
approved  institutions  under  Section  C  1  of  the  Rules 
were  granted  :  National  Maternity  Hospital,  Dublin : 
Edinburgh  Royal  Maternity  and  Simpson  Memorial 
Hospital ;   City  of  London  Lying-in  Hospital. 

3.  The  following  application  for  recognition  as  a 
teacher  under  Section  C  1  (3)  of  the  Rules  was  granted  : 
John  W.  Fordham,  jun.,  M.R.C.S. 

4.  A  letter  was  read  from  Dr.  E.  Hastings  Tweedy, 
the  Master  of  the  Rotunda  Hospital,  Dublin,  calling 
the  attention  of  the  Board  to  the  practical  impossibility 
of  pupil  midwives  trained  in  the  Rotunda  complying 
with  the  requirements  of  Section  C,  Rule  1,  Sub- 
section 1  (personal  conduction  of  twenty  cases),  and 
Subsection  2  (ten  days'  puerperium).  It  was  hoped 
that  the  curriculum  of  the  Rotunda  might  be  accepted 
as  an  equivalent  to  the  course  of  training  prescribed 
by  the  Rules,  or  that  such  exception  or  modification 
might  be  made  as  would  enable  the  Rotunda  nurses 
to  qualify  for  the  Board's  examination.  After  con- 
sideration of  the  subject,  it  was  unanimously  resolved  : 
"  That  having  considered  the  letter  addressed  to  them 
by  the  Master  of  the  Rotunda  Hospital,  the  Board 
regret  that  the  suggested  alterations  were  not  brought 
to  their  notice  before  the  Rules  were  sent  to  the  Privy 


Feb.  to.  1904* 


TRANSACTIONS  OF  SOCIETIES. 


The  Medical  Press,     145 


GwocjI.  as,  having  been  approved  by  that  body,  it  is 
impossible  for  the  Board  to  alter  them/' 

\  letter  of  similar  purport  was  read  from  Professor 

physician      to      the      Incorporated      Belfast 

Maternity   Hospital,  and  a  copy  of  the  foregoing  re 

tion  was  ordered  to  be  sent  in  reply. 

Alter  consideration  of  applications  for  certificates, 

ihe  names  of  1.040  women  were  passed  under  Section  2 

r.j  the  Act,  and  ordered  for  entry  on  the  Roll.    Ot  this 

total,   169  claimed   as  holding   the  certificate  of   the 

Obstetrical  Society  of  London,  14  that  of  the  Rotunda 

Hospital    36  that  oi  Queen  Charlotte's  Lying-in  Hos- 

t4   that   of   the   Glasgow    Maternity    Hospital, 

14  that  of  St.  Mary's  Hospital,  Manchester.  2  that  of 

the  Liverpool  Lying -in  Hospital,  1   that  of  the  Edin- 

Royal  Maternity  Hospital.  1  that   of  the  City  of 

u  Lymg -in  Hospital  and  699  were  admitted  as 

g  been  in  bond  fide  practice  for  one  year  prior  to 

July  jist.    1 

THE  STATE  REGISTRATION  OF  NURSES. 
A  geseru.  meeting  of  the  members  of  the  Royal 
bh  Nurses'  Association  was  held  last  week  in  the 
rooms  *ii  the  Medical  Society  of  London  to  consider 
ihc  draft  of  a  Bill  upon,  the  State  Registration  of 
Nuftes,  when  several  important  amendments  were 
made,  and  at  the  end  of  the  meeting  the  following  reso- 
lution was  passed  : — 

"That   the  draft   Bill,   as  amended,   be    approved, 
and  that  the  Executive  Committee  be  directed  to  take 
as  they  may  think  necessary  to  have  it  submitted 
icy  Parliament." 

1.  Three    registered    medical    practitioners     to     be 
appointed   for  terms  of   three  years.     Two  to  be  ap- 
pointed by  the  Lord  President  of  the  Council,  and  one 
1  appointed  by  the  British  Medical  Association, 
Three  persona  to  be  appointed  for  terms  of  three 
I  by  the  Lord  President  of  the  Council ,  one   to  re- 
present England*  one  to  represent  Scotland,  and  one  to 
reprwent  Ireland* 

3.  Three  representatives  to  be  appointed  for  terms 
ot  three  years,  one  to  be  appointed  by  the  medical 
Director  General  of  the  Navy  and  the  Medical  Director 
<Vmeral  of  the  Army  conjointly,   one   by   the   Royal 

isociation,  and  one  by  the  Queen  Victoria 
Jubilee  Institute  for  Nurses. 

4,  Five  fully-trained  nurses,  who  shall  be  matrons 
<it  lady  superintendents  of  hospitals  or  Poor-law 
infirmaries,  with  training  schools  attached,  to  be  elected 

i  rns  of  three  years,  one  to  be  elected  by  the  matrons 
and  lady  superintendents  of  Metropolitan  hospitals, 
one  to  be  elected  by  the  matrons  and  lady  superin- 
tendents of  Metropolitan  Poor-law  infirmaries,  one  to 
he  elected  by  the  matrons  and  lady  superintendents 
<d  provincial  hospitals,  one  to  be  elected  by  the  matrons 
and  lady  superintendents  ot  hospitals  in  Scotland,  and 
<>ne  to  be  elected  by  the;  matrons  and  lady  superinten* 
d&  in  Ireland. 
i  fuUy-traine  j  nurses  to  be  elected  for  terms 
<yt  three  years,  three  to  he  elected  by  nurses  on  the 
Register  who  are  resident  in  the  Metropolis,  one  of 
*lmm  shall  be  a  mental  nurse  and  one  a  fever  nurse, 
v  nurses  on  the  Register  who  are  resident  in  the 
provinces  and  Wales,  one  by  nurses  on  the  Register 
*ho  are  resident  in  Scotland,  and  one  by  nurses  on 
tlie  Register  who  are  resident  in  Ireland. 

GrausacttOitB  of  Societies. 

ROYAL  ACADEMY  OF  MEDICINE  IN  IRELAND. 
Section  of  Anatomy  and  Physiology. 


Meeting  held  in  the  Royal  College  of  Surgeons 
on  FRtttAY.   January  39TH.   1904* 


I  resident,  E,  H.  Taylor,  M.D„  F.R.C.S,,  in  the 

Chair. 

After  a  few  introductory  remarks  by  the  President, 

who  returned  thanks  for  his  election  to  the  position  of 

PfeuicBt  oi  the  Section. 

Or.  R_    Vr  kiss on   Stone y  read  a  paper,   entitled 


"  The  Anatomy  of  the  Pelvic  Fascia,  with  Special 
Reference  to  its  Surgical  Importance."  He  described 
a  new  method  of  demonstrating  the  connections  of 
the  visceral  pelvic  fascia*  by  hardening  the  subject  in 
formalin,  and  then  having  made  a  mesial  section  of  the 
pelvis,  dissected  the  prostate  and  bladder  out  of  their 
fascial  envelopes*  By  means  of  specimens  dissected 
in  this  way*  and  drawings  and  diagrams  made  from 
them,  he  showed  that  the  visceral  layer  of  pelvic 
fascia,  instead  of  dividing  into  three  layers  as  us p ally 
described,  really  gives  off  three  complete  sheaths,  two 
in  a  downward  direction  surrounding  the  prostate  and 
rectum,  and  one  in  an  upward  direction  surrounding 
the  bladder  ;  and  that  each  of  these  is  complete  in 
itself,  and  in  no  place  does  one  Layer  of  fascia  enter  into 
the  formation  of  more  than  one  of  these  three  sin 
He  also  pointed  out  that  the  visceral  layer  of  pelvic 
fascia  meets  the  urogenital  apparatus  at  the  vesico- 
prostatic  junction,  and  the  alimentary  canal  at  the 
junction  of  the  rectum  and  anal  canal. 

Sir  Thomas  Myles,  the  President,  Professor  Fraser, 
and  Prcifts^ir  Dtxon  spoke. 

Dr.  Harold  F  jungle  exhibited  a  dog  on  which  he 
had  performed  Pawlow's  **  gastric  fistula  **  operation, 
The  object  of  the  operation  is  to  produce  a  stomach* 
pouch  which  is  made  to  open  on  the  surface,  while  the 
remainder  of  the  stomach  is  left  to  perform  Us  digestive 
function  as  usual.  The  pouch  is  formed  in  such  a 
manner  as  to  retain  its  nervous  connections  intact. 
Some  ianteni  slides  were  shown  illustrating  the  opera- 

■  n  and  olhers  giving  the  results  of  experiments, 
which  showed  that  the  juice  secreted  by  the  stomach- 
pouch  varied  in  amount  and  rate  of  secretion,  corre- 
sponding with  the  results  already  published  by  Paw  low. 

The  President  and  Professor  Thompson  spoke. 

Dr,  Henry  M,  Johnston  gave  a  demonstration  on 
the  making  of  blood  films  by  n  new  method.  He 
also  showed  specimens  of  films  stained  and  unstained. 
Ihs  apparatus  is  exceedinglv  simple,  and  is 
already  in  the  hands  of  a  firm  of  instrument 
makers.  A  complete  account  of  this  apparatus  and 
method  will  shortly  be  published. 

The  meeting  then  adjourned. 


BRITISH  LARYNGOLOGICAL.    RHINOLQGICAL, 

AND  OTOLOGICAL  ASSOCIATION, 

Quarterly   Meeting    held    on    Friday,   January 

2QTH,    1004. 


Mr,  Bark,  of  Liverpool.  President,  in  the  Chair, 

Cases  Shown, 

Mr.  Mayo  Collier  showed  a  case  of  intermittent 
nasal  obstruction,  and  cases  illustrating  stages  of  pro- 
gressive deafness.  The  President  said  that  the  fore- 
going cases  would  be  discussed  in  connection  with  Mr. 
Mayo  Colliers  paper  later. 

Dr.  Kelson  showed  a  case  of  laryngitis  in  a  girL 

Dr.  Dundas  Grant  asked  if  there  were  any  signs  of 
hysteria,  and  remarked  the  enlarged  tonsils  and  ventri- 
cular band  phonation, 

Mr.  McDoUGALL  (Liverpool )  suggested  that  the 
tonsils  be  removed  and  thus  the  neurotic  element 
eliminated. 

Dr.  Kelson,  in  reply;  said  that  he  intended  removing 
the  tonsils  and  that  he  had  not  noticed  any  nervous 
tendencn^. 

Mr.  Stu art-Low  showed  a  series  of  cases  of 

AURAL  SEPSIS  TREATED  BY  MEANS  OF  KELVOLIN  VAPOUR, 

and  the  local  application  of  pure  kelvolin.  Mr.  Stuart* 
Low  said  that  it  would  be  agreed  that  bacteria  kept 
up  the  continuation  of  the  sepsis,  and  that  this  per- 
sistence is  aided  and  abetted  exceedingly  by  the 
pecubarly  intricate  anatomical  arrangements  pertaining 
to  the  tympanic  cavity  and  its  accessory  recesses. 
It  is  passing  strange,  therefore,  that  with  a  pathology 
clear  and  explicit,  as  established  by  brilliant  bacterio- 
logical research,  the  best  means  yet  arrived  at  to  combat 
bacillary  ravages  in  this  special  region  should  be  so 
ineffectual  when  put  to  the  test  in  actual  practice. 
After  trying  various  substances  very  exhaustively,  I 


146    Thb  Mbpical  Press,       TRANSACTIONS  OF  SOCIETIES. 


have  selected  kelvoiin,  a  chemical  product  prepared 
by  Messrs.  Hay,  Steven  and  Company,  manufacturing 
chemists,  Mary  Hill,  Glasgow,  as  the  best.  Kelvoiin 
is  a  dark-coloured  fluid  of  an  oily  consistency  and 
slightly  tar-like  odour.  It  contains  40  per  cent,  of 
the  homologuesof  phenol,  and  35  per  cent,  of  highly 
refined  neutral  products  from  coal  tar.  Kelvoiin  is 
prepared  from  highly  refined  materials  and  is  free 
from  resin  and  free  alkali.  Kelvoiin  is  a  very  powerful 
germicide :  the  staphylococcus,  the  streptococcus,  and 
anthrax  spores  are  all  easily  destroyed  by  it  even 
when  it  is  much  diluted.  It  has  the  further  great 
advantage  that  so  far  from  any  irritating  properties 
when  applied  to  the  tissues  it  has,  in  common  with 
the  phenols,  an  anaesthetic,  numbing  effect.  It  has, 
further,  a  softening  action  on  incrustations  and  con- 
siderable penetrative  power.  Kelvoiin  is  easily  vola- 
tilised, and  is  again  very  quickly  condensed  upon  any- 
thing held  in  the  vapour.  Kelvoiin  I  have  used 
extensively  during  the  last  few  months  on  many  cases 
of  suppurative  middle  ear  disease  in  various  varieties 
and  stages.  I  have  used  it  in  two  ways — first,  directly 
applied  by  means  of  cotton  wool  on  a  fine  probe  to 
granulations  on  the  tympanic  walls,  and  secondly,  as  a 
vapour.  The  vapour  treatment  I  have  found  most 
efficient  and  satisfactory.  I  drive  the  vapour  by  means 
of  an  inflator  into  the  external  auditory  meatus,  and  in 
this  way  it  is  forced  into  the  farthest  limits  not  only 
of  the  tympanum  and  attic,  but  backwards  into  the 
antrum  and  its  adjacent  cells,  and  downwards  and 
forwards  into  the  Eustachian  tube.  The  patient  plainly 
perceives  it  in  the  pharynx  when  the  passage  is  suffi- 
ciently patent.  I  also  force  the  vapour  up  the  Eusta- 
chian tube  through  an  ordinary  Eustachian  catheter 
inserted  through  the  nose,  and  thus  additionally  insure 
that  a  thin  layer  of  condensed  vapour  is  spread  over 
the  entire  interior  of  the  middle  ear  and  its  accessories. 
Preliminary  to  using  the  kelvoiin  as  just  described,  the 
interior  of  the  ear  must  be  prepared  for  the  vapour  by 
being  freed  from  all  discharges,  this  being  accom- 
plished by  most  carefully  and  thoroughly  mopping  it 
out  with  fine  light  probes  carrying  boracic  wool,  and 
in  fiis  way  the  surface  is  cleaned,  and  dried  for  the 
deposition  of  the  condensed  kelvoiin  vapour,  any 
granulations  being  touched  gently  and  lightly  with 
kelvoiin.  This  preparatory  process  is  not  complete 
until  aerial  inflation  by  the  Eustachian  catheter  and 
suction  by  means  of  Siegle's  pneumatic  speculum  has 
been  repeatedly  performed,  and  every  particle  of 
secretion  thus  blown  and  sucked  out  has  been  carefully 
removed  by  most  assiduous  and  painstaking  mopping. 

The  President  regarded  these  cases  as  very  satis- 
factory and  encouraging.  Dr.  Dundas  Grant  said 
that  he  was  favourably  inclined  to  the  method  and 
would  certainly  try  it  in  future.  It  seemed  a  valuable 
addition  to  the  aurist's  armamentarium.  Dr.  Vinrace 
could  not  concur  with  Dr.  Dundas  Grant,  and  wished 
to  know  if  this  method  had  ever  succeeded  where  the 
usual  treatment  had  failed  ?  Dr.  Jobson  Horne 
would  like  to  learn  something  of  the  bactericidal  powers 
of  kelvoiin  vapour.  Dr.  Kelson  said  the  cases  shown 
were  very  satisfactory.  He  would  like  to  know  if 
there  had  been  any  failures.  Mr.  Nourse  said  he  had 
been  very  much  impressed  by  the  ready  way  in  which 
cases  yielded  to  this  treatment  when  other  remedies 
failed. 

Mr.  Stuart-Low,  in  reply,  thanked  the  President 
and  Fellows  for  their  kind  reception  of  the  subject. 
All  the  cases  shown  had  been  under  the  usual  methods, 
some  for  years  before  coming  under  the  treatment. 
Two  of  the  cases  shown  were  Dr.  Jakins'  patients,  and 
both  were  instances  of  intractable  discharge.  Cultures 
were  always  taken  before  using  the  vapour,  and  then  it 
was  pushed  until  the  culture  was  negative.  There 
was  no  doubt  about  the  germicidal  power  of  kelvoiin 
vapour — even  the  staphylococcus  succumbed  to  its 
influence.  There  had  been  no  failures,  but  when 
many  granulations  were  present,  shielding  the  seat  of 
the  mischief,  the  treatment  was  necessarily  more  pro- 
longed. 

Mr  Stuart-Low  also  showed  a  case  of  nasal  polypi 


Feb.  10,   1904- 


m  a  boy,  set.  7.  Prof.  Hajek,  of  Vienna,  had  visited 
Dr.  Dundas  Grant's  clinic  and  seen  this  case.  He  had 
never  seen  polypi  in  so  young  a  subject  and  said  sar- 
coma was  likely. 

Dr.  Wylie  showed  a  case  of  primary  hard  sore  on 
the  Up  of  a  woman. 

Dr.  Jobson  Horne  said  such  cases  were  uncommon, 
but  he  had  seen  three  in  five  years.  Mr.  C.  Nourse 
remarked  on  the  difficulty  in  tracing  the  primary  in- 
fection often.  Dr.  Dundas  Grant  said  that  some- 
times the  primary  infection  was  on  the  tonsil  and  not 
interpreted  until  the  mucous  patches  appeared.  Dr. 
Jobson  Horne  said  one  of  his  cases  was  on  the  lip 
and  then  on  the  conjunctiva.  Both  at  the  casualty 
ward  of  St.  Bartholomew's  Hospital. 

Dr.  Wylie  showed  a  case  of  neoplasm,  probably 
malignant,  of  the  oesophagus,  causing  paralysis  of 
both  vocal  cords. 

Dr.  Lodge  (Bradford)  said  he  had  a  similar  case. 
Death  ensued  from  septic  pneumonia  after  perforation 
of  the  trachea.  Mr.  Bar  well  asked  if  abductor  para- 
lysis was  present  in  the  case.  Dr.  Jobson  Horne 
asked  the  situation  of  the  growth. 

Dr.  Wylie,  in  reply,  said  the  growth  was  in  the  very 
upper  part  of  the  oesophagus. 

Dr.  Wyatt  Wingrave  showed  a  case  of  laryngeal 
disease  (tuberculosis)  in  a  man.  a*t.  30. 

Mr.  Barwell  asked  if  anti-syphilitic  remedies  had 
been  given. 

Dr.  Wingrave  said  he  could  get  no  specific  history. 
He  was  going  to  use  anti-syphilitic  treatment. 

Dr.  Kelson  showed  a  case  of  eruption  on  the 
fauces. 

The  President  said  the  case  was  very  interesting 
and  might  be  a  mucous  tubercle.  Dr.  McDougall 
(Liverpool)  thought  the  case  syphilitic,  and  advocated 
intra-muscular  injections  of  mercury.  Dr.  Weight 
said  the  hypodermic  injections  of  arsenic  and  iron 
might  be  tried.  Dr.  Kelson  said  the  case  had  altered, 
and  at  first  looked  like  malignant  disease. 

Mr.  Barwell  showed  a  case  of  syphilitic  laryngitis. 

Dr.  Wylie  asked  the  dose  of  iodide  of  potassium 
given.  Dr.  Lodge  advocated  60  grains  of  iodide  of 
potassium  three  times  a  day.  Dr.  Dundas  Grant 
said  he  had  a  somewhat  similar  case  under  treatment 
now.  It  looked  like  a  solid  oedema.  Iodide  of  potas- 
sium failed,  but  mercurial  inunctions  did  good. 

In  replying,  Mr.  Barwell  said  that  he  gave  75 
grains  of  potassium  iodide  a  day,  but  he  was  going  to 
give  larger  doses.     He  did  not  think  it  was  oedema. 

The  President  showed  a  case  of  growth  in  the 
anterior  commissure  above  the  vocal  cords. 

Dr.  Wyatt  Wingrave  said  chiefly  innocent  growths 
spring  from  this  position.  Developmentally  there 
might  be  tags  left,  which  had  become  myxoedematous. 
He  suggested  a  microscopical  examination  of  the 
growths.  Dr.  Vinrace  thought  the  growth  had  been 
present  a  very  long  time.  Dr.  Jobson  Horne  had 
had  a  similar  case.  This  he  removed  with  a  double 
curette,  after  Krause's  principle.  Dr.  Lodge  had  had 
a  similar  case.  He  removed  it  with  a  snare  without 
exactly  seeing  what  was  being  done. 

The  President,  in  reply,  said  there  was  a  good  deal 
of  dyspnoea  occasionally.  His  experience  was  that 
fibromata  were  always  single,  while  papillomata  were 
often  multiple. 

Mr.  Mayo  Collier  read  a  paper  entitled 

LATENT  OR   INTERMITTENT   NASAL  OBSTRUCTION. 

He  said  that  this  affection,  although  extremely  common, 
had  been  overlooked  by  rhinologists.  To  this  con- 
dition he  attributed  many  of  the  more  chronic  and 
minor  ailments  found  in  the  throat,  nose,  and  ear,  and 
much  of  the  neurasthenia  and  dyspepsia  so  prevalent. 
In  enumerating  the  functions  of  the  nose,  stress  was 
laid  on  the  relations  of  respiration  to  digestion  and  the 
circulation.  In  pointing  out  the  relation  of  the  nose 
to  the  ear  a  diagram  was  exhibited  showing  the  develop- 
ments of  the  tubo-tympanum  from  the  nose  and  mouth 
cavity  formed  out  of  the  first  branchial  cleft.  A 
suggestion'was'thrown  out  that  the  nose  was  [the  safety 


Fia,  jo.  igoa. 


of  the  bram  by  acting  as  a  drain  to  the  arachnoid 
v.     Important  *  relations    between    the   eye,    ear, 
and  emotions  were  all  touched  upon,  and  Anally 
the  importance  of  continuous  nasal  respiration  was  in- 
sisted on. 

The  Pre^hent  thanked  Mr.  Collier,  and  said  thil 
the  discussion  on  the  paper  would  be  taken  at  the  next 
meeting. 


TRANSACTIONS  OFjOgETreg^T^lto^  P.**.     W 


NORTH  EAST  LONDON  CLINICAL  SOCIETY. 

MEETING   HELD    THURSDAY,    FEBRUARY  4TK,    1 904. 

Or.  J.  W,  Hunt,  President,  in  the  Chair, 

Dr.  Fred,  J.  Tresilian  showed  [i)  a  case  of  osteo* 

ma  of  the  superior  maxilla  m  a  girl.  art.   j  5,  in 

winch  the  antrum  was  involved-     A  partial  operation 

had  been  performed  five  years  ago.  and  since  th.it  time 

rowth  had  been  quiescent,     [2)  A  married  woman, 

-.  wiih  tertiary  syphilitic  ulceration  of  the  cheek 

date. 

Hr    G.    P  e    showed   an  infant,  aet.  s},   with 

enlargement   of    the   abdomen,    and    signs   of   general 

nLkets.     An    operation    had    been    suggested    to    the 

parents,  but  was  refused, 

Mr.  Herbert  Carson  considered  that  the  protrusion 

abdomen  was  due  to  tuberculous  peritonitis,  m 

of   the   fact    that    signs  of  rickets  were  present. 

He  thought   that   laparotomy  was  the  best  form  of 

treatment. 

Mr.  Carson   ex  hi  hi  ted   a  specimen   from   a   case  of 

ruptured  gastric  ulcer,     The  patient  was  a  girl,  a?t,  18, 

ad  suffered  previously  from  dyspepsia,  but  there 

had  heen  no  ha^matemests.     She  was  seized  with  abdo- 

aiBtl  pain    at  nine   o'clock  One  evening,  but  medical 

aid  was  not  summoned  until  the  next  morning.    Laparo- 

was  performed  eighteen  hours  after  perforation. 

being  moribund  at  the  time,  she  sank  under  the 

operation.     The    perforation    was    a   double   one,    the 

ulcers  being  situated  at  the  cardiac  end  of  the  stomach.  | 

President  remarked  upon  the  great  rarity  of 

-urremce  of  perforation  m  two  adjacent  ulcers, 

liggested  that  the  accident  had  happened  at  two 

separate  periods  of  time. 

Carson  replied  that  perforation  of  one  ulcer 
would  not  necessarily  relieve  tension  in  another,  as  on 
grating- table  the  stomach  was  generally  found 
to  be  distended,  even  after  perforation.  He  believed 
that  the  most  important  prognostic  factor  in  these 
cases  was  the  condition  of  the  stomach  at  the  time  of  J 
perforation  rather  than  the  interval  which  might 
elapse  between  that  event  and  the  operation. 

Dr.  A.   J,  Whiting  showed  three  cases  illustrating 

different  types  of  syphilis  affecting  the  nervous  system. 

la  one  of  them,  a  woman,  jet.  60,  the  symptoms  were 

Luge  I  y  spinal,  but  she  presented  one  very  remarkable 

clinical  feature,  namely,   that  her  pupils,   which  did 

not   react    to   light,   dilated  01  modation.     On 

closer  inspection,  a  flight  transitory  contraction  pre- 

to   the  dilatation  was  observed.     She  had  also 

•'Ticing  cataract  in  both  eyes, 

Mr.  R.  Philip  Brooks  remarked  that  the  presence 

ol  a  cataract  won  If  I  not  in  itselJ  influence  the  move- 

of  the  pupils. 

Dr.  Whiting  also  showed  a  married  woman,  »t.  35, 

the  subject  of   post -influenzal   ulnar  neuritis   on   the 

Dt  Arthur  E.  Giles  exhibited  specimens  of  some 
diseased  ovaries  which  he  had  removed  by  operation. 

Of  them  were  cystic,  and  in  both  the  pedicl- 

become    twisted.     The    pressure-effects    due     to    the 

:ty  of  one  of  them  hail  led   to  the  diagnosis  of 

by  the  patient's  medical  attendant.     The 

eucy    with    which    a    pro  lapsed    ovary    became 

:.-.  necessitating  its  removal,  was  pointed  out. 

THERAPEUTICAL  SOCIETY. 

At  a  meeting  of  this  Society  in  the  Apothecaries'  Hall, 
°fl  Ji  ',  Sir  W,  TnisELToN  Dyer,  President, 

tn  the  Ch;; 

Professor  j.  R  Farmer  read  a  paper  on 

SOME    NEW    DISCOVERIES    RESPECTING    CANCER. 

I'tid  that  of  the  two  theories  of  the  causation  of 


cancer  either  (t)  from  a  parasite  sporozoon.  or  U)  from 
Mra>  eels,  there  was  no  real  proof,  but  from  his 
investigations  with  Messrs.  Moore  and  Walker,  it 
appears  that  cancer  cells  differed  entirely  from  other 
ordinary  cells  of  the  body  in  their  development.  All 
soma  hen  dividing,  have  their  nuclei  split  into 

'■lute  number  of  longitudinal  rods  or  chroma 
somes,  while  the  chromosomes  of  reproductive  celts 
are  oval  or  ring-like  m  shape,  and  divide  in  a  transverse 
manner.  Further,  their  chromosomes  are  present  in 
halt  the  number  of  those  that  appear  in  somatic  cells. 
Now  cancer  cells  exactly  resemble  reproductive  cells  in 
heir  mode  oj  division,  and,  like  reproductive  cells,  have 
he  power  (>f  destroying  somatic  cells  in  contact  with 
tnem,  this  is  seen  in  the  embryo  sac  of  plants,  This 
heterotypic* mitosis  occurs  in  all  malignant  growths, 
but  is  never  found  in  benign  tumours.  Sometimes  the 
ordinary  somatic  cells  of  plants  change  into  repro- 
ductive cells,  and  the  causes  of  this  alteration  have  to 
be  ascertained  by  further  investigations.  The  fre- 
quent anomalies  observed  10  the  malignant  growths. 
while  they  obscure,  do  not  affect  the  existence  of  the 
characteristic  heterotypic*!  mitosis,  They  are  probably 
to  be  related  with  nutritional  and  other  disturbances 
that  are  known  to  similarly  affect  the  nuclei  of  normal 
tissues. 

Sir  William  Thiselton  i>Ver  thanked  the  author 
for  his  very  valuable  paper,  which  proved  how  useful 
the  science  of  botany  might  he  to  the  medical  profession. 

Dr.  Willi  considered  the  paper  to  be  a  most  import- 
ant one,  and  asked  whether  the  hcterotvpicai  division 
of   thr  a  as    found   in   less   malignant   diseases, 

such  as  rodent  ulcers  or  cartilaginous  and  thy  mid 
tumours,  J 

Dr.  Koi.lkston  said  that  cells  had  two  different 
functions— either  metabolic,  increasing  the  tissues,  or 
anabolic,  destroying  them  ;  and  that  when  cells  in- 
creased in  a  tumultuous  manner  they  became  destruc* 
tive  to  other  tissues,  as  in  malignant  disease.  He 
inquired  whether  the  heterotvpical  division  of  nuclei  was 
found  to  occur  tn  the  preliminary  stage  of  mammary 
cancer,  J 

Sir  H.  Beevor  said  that  Begonia  leaves  produced 
new  plants  when  bruised,  and  inquired  whether  the 
heterotvpical  division  was  found  in  their  cells,  He  said 
that  Sir  J.  Paget  considered  that  cancer  resulted  from 
embryonic  cells  remaining  in  certain  parts  of  the  body 
till  stimulated  to  increase, 

i'mfessor  Farmer  replied  to  the  questions,  saying 
that  the  cells  of  Begonia  did  not  show  the  heteroiypical 
division  eveo  when  bruised,  but  that  further  inves- 
tigation was  necessary, 

Dr.  T,  N.  Kelynack  read  a  paper  on 

SOME   POINTS    IN    THE    HYGIENIC    TREATMENT    OF    FUL- 
NONARY   TUBERCULOSIS, 

based  on  a  recent  inspection  of  many  of  the  British 
institutions  for  the  care  of  the  consumptive.  He  dealt 
with  the  evolution  of  the  modern  sanatorium,  and 
indicated  how  such  pioneers  as  Parrish,  Bodington. 
MacCormac,  and  B.  W,  Richardson  had  to  a  great 
extent  anticipated  the  modern  application  of  hygienic 
measures  in  the  treatment  of  phthisis,  Particular 
attention  was  drawn  to  the  pressing  need  for  a  syste- 
mattsed  hygienic  M  after-cure  M  of  consumptives.  It 
>o  shown  that  at  the  present  time  wide  differences 
exist  in  clinical  methods  employed  in  sanatoria,  and 
very  considerable  divergence  in  therapeutic  practice. 
It  was  urged  that  serious  effort  should  be  made  to 
secure  some  degree  of  scientific  uniformity  in  clinical 
procedure,  a  measure  of  combination  in  scientific 
investigation  ami  a  suitable  system  of  recording  returns 
which  would  allow  of  a  trustworthy  comparison  of 
In  such  a  special  form  of  medical  work  as 
sanatorium  management  it  is  most  desirable  that  a 
faddish  or  quackish  narrowing  of  outlook  should  be 
avoided,  and  a  strict  scientific  spirit  firmly  maintained. 
I  >r    j.  Gray  Duncanson  then  read  a  paper  on  the 

THERAPEUTIC   VALUE   OF  SUPRARENAL  GLAND  PRO- 
DUCTS. 

He  touched  briefly  on  the  anatomy  and  physiology 
of   the  suprarenal  gland,  its  medicinal  preparations  of 


148    The  Medical  Press. 


AUSTRIA. 


Feb.  10,  1904. 


various  forms,  dry  powder  preferred  for  continuous 
internal  administration  ;  liquid  extracts  suitable  for 
internal  and  hypodermic  use  ;  and,  thirdly,  prepara- 
tions containing  the  active  principle  of  adrenalin,  first 
isolated  by  Takamine,  a  Japanese  chemist,  who  gives 
for  it  the  empiric  formula  C^H^NO,.  This  is  sup- 
plied pure  or  in  solution  1  to  i,ooo»  by  Messrs.  Parke 
bavis  and  Company.  He  contrasted  this  solution 
•with  three  others  on  the  market.  He  then  gave  an 
account  of  the  application  of  these  substances  in  the 
routine  work  of  private  practice.  The  usefulness  of 
their  ischaemic  properties  in  ecchymosis  of  the  eyes  and 
other  conditions,  their  haemostatic  qualities  when 
applied  directly  to  a  bleeding  surface,  and,  lastly,  the 
value  of  adrenalin  preparation  in  arterial  haemorrhage, 
when  the  drug  does  not  in  the  first  place  reach  the 
bleeding  surface.  He  struck  a  note  of  warning  as  to 
the  administration  in  haemoptysis,  citing  cases  where 
the  pulse  became  hard  and  of  high  tension  with  con- 
tinued haemorrhage  ;  but  on  discontinuing  the  treat- 
ment the  pulse  softened  and  bleeding  ceased,  appli- 
cation by  means  of  the  spray  being  the  only  justifiable 
course  in  such  cases.  In  a  case  of  diabetes  mellitus, 
the  glycosuria  was  increased  while  taking  adrenal 
liquid,  but  decreased  on  stopping  its  administration. 
He  concluded  with  an  appeal  for  the  official  recognition 
of  suprarenal  preparations  as  therapeutic  agents. 

Dr.  Glass  ington  said  that  he  has  found  adrenalin  of 
great  service  in  dental  surgery,  when  haemorrhage  had 
occurred  from  the  gums,  and  he  proposed  a  vote  of 
thanks  to  the  author  for  his  valuable  and  interesting 
paper.     This  was  unanimously  agreed  to. 

CORK  MEDICAL  AND  SURGICAL  SOCIETY. 
Meeting  held  Wednesday,  January  27TH,  1904. 

J.  Cotter,  M.D.,  F.R.C.S.I.,  President,  in  the  Chair. 


The  President  read  notes  of  a  case  of  perforation 
of  the  intestine  successfully  treated  by  operation. 
The  patient  was  a  girl,  aet.  12,  suffering  from  tuber- 
culous peritonitis.  On  admission  to  hospital  she  was 
greatly  emaciated,  and  suffered  from  extreme  abdo- 
minal distension.  The  day  after  admission  the  abdo- 
men was  tapped,  and  a  large  quantity  of  pus  escaped. 
Next  day  the  abdomen  was  opened,  and  the  peritoneal 
cavity  found  full  of  pus,  having  a  faecal  odour,  while 
faeces  were  found  escaping  from  a  small  aperture  in 
the  transverse  colon.  The  peritoneum  was  studded 
all  over  with  tubercles.  The  aperture  in  the  colon 
was  sutured,  and  the  cavity  closed.  Healing  was  slow, 
owing  to  the  damaged  condition  of  the  peritoneum  and 
the  emaciated  condition  of  the  patient,  but  was  ulti- 
mately complete,  and  the  patient's  weight  increased 
in  nine  months  from  4  stones  to  7  stones  2  lb. 

Dr.  P.  T.  O'Sullivan  read  notes  of  a  case  of  pul- 
monary tuberculosis  treated  by  tuberculin.  The 
patient  was  a  young  woman,  aet.  21.  The  first  two 
injections  had  no  effect,  but  the  reaction  to  a  third 
injection  was  very  marked,  the  temperature  rising  to 
106*4°,  and  all  the  symptoms  being  aggravated.  Only 
the  greatest  watchfulness  saved  the  patient's  life  at 
this  stage.  On  the  other  hand  the  effect  of  the  injec- 
tion was  to  cause  the  entire  disappearance  of  tubercle 
bacilli  from  the  sputum.  No  permanent  advantage 
followed  the  treatment,  which,  even  with  the  improved 
serum  now  being  used,  is  of  very  doubtful  benefit. 

Dr.  Corby  showed  an  external  ear  which  he  had 
removed  from  a  man,  aet.  60,  for  epithelioma. 


East  Africa,  and  during  that  time  had  had  about  forty 
severe  attacks  of  malaria  and  five  attacks  of  black- 
water  fever.  A  disturbance  of  speech  remained. 
Sometimes  the  expression  for  his  ideas  was  not  to  be 
mastered,  and  sometimes  the  ideas  themselves  were 
absent ;  but  he  could  always  write  fluently  to  dictation. 
In  January,  1902,  the  patient  returned  to  Germany 
and  passed  through  an  attack  of  blackwater  fever  ;  this 
left  the  speech  still  worse.  A  similar  result  followed  a 
malarial  attack  in  September,  1903.  When  the  patient 
was  admitted  into  hospital  there  was  almost  complete 
loss  of  power  of  expression  as  well  as  of  repetition, 
but  his  power  of  writing  to  dictation  was  still  perfect. 
The  case  was  plainly  one  of  isolated  motor  aphasia 
from  disturbance  in  the  cortical  centre.  The  malaria 
was  got  rid  of  in  hospital,  the  aphasia  was  taken  in 
hand  by  Dr.  Gutzmann,  with  an  excellent  result. 

In  severe  acute  malarial  cases,  symptoms  of  local 
trouble  in  the  brain  were  not  uncommon,  such  as 
paresis,  fits,  haemianaesthesias,  and  coma.  These, 
however,  disappeared  with  the  attack.  In  the  present 
case  the  course  had  not  been  so  favourable,  but  this 
was  because  they  had  not  given  the  patient  quinine  at 
the  height  of  the  attack,  but,  following  an  earlier 
practice,  only  after  the  fever  had  subsided,  whereby  a 
permanent  embolism  had  taken  place  through  the 
malaria  parasites. 

Hr.  Gutzmann  remarked  on  the  case  that  when  the 
patient  was  first  handed  over  to  him  he  could  not 
repeat  words  pronounced  before  him  nor  answer  a 
question ;  but  he  could  write  from  dictation,  and 
could  also  read  well.  There  were  symptoms,  therefore, 
of  subcortical  aphasia.  It  was  specially  remarkable 
that  in  trying  to  repeat  sounds  and  syllables,  there  were 
spasms  in  the  voice  apparatus  as  in  stammerers. 
These  spasms  rendered  treatment  very  difficult,  and 
they  had  not  yet  quite  disappeared,  but  came  on  during 
inspiration.  For  the  rest,  the  practice  treatment  had 
had  good  results,  the  repeating  of  words  had  improved 
and  also  spontaneous  speech ;  but  there  was  still  a 
dread  of  speech. 


Germany 


[from  our  own  correspondent.] 


Bibldc,  February  6th,  1904. 
At  the  Society  for  innere  Medizin,  Hr.  Plehn  showed 
a  case  of 

Isolated  Motor  Aphasia. 
The  patient  was  a  man  who  for  eight  years  had 
been  a  colonial  secretary  in  the  German  possessions  in 


Austria- 


(from  our  own  correspondent.] 


ViBfH a,  February  6th,  1904. 
Lepra  Tubbro-Anasthetica. 

At  the  Gesellschaft  meeting,  Spiegier  exhibited 
a  boy,  aet.  16,  with  lepra  tubero-anaesthetica,  who  had 
come  from  Rio  de  Janeiro,  in  Brazil,  two  years  ago  to 
attend  school. 

His  abode  or  surroundings  had  no  connection  or 
semblance  of  lepra  to  induce  such  a  disease,  nor  did 
anyone  suspect  that  the  lad  suffered  from  that  affec- 
tion. Two  months  after  taking  up  their  residence  in 
the  city  the  mother  began  to  develop  red  patches  on 
both  arms,  which  were  quite  insensible  to  pinching  or 
stabbing  with  pins. 

When  closely  investigated  it  was  found  that  the  boy 
must  have  had  the  disease  some  five  years  prior  to  this 
time,  as  such  oval  patches,  with  elevated  portions  which 
were  also  insensible,  were  present  on  all  the  extremities, 
The  microscope  has  confirmed  the  bacilli,  which 
leaves  no  doubt  as  to  the  correct  diagnosis  of  the  case* 
He  now  purposes  the  application  of  the  Rontgen  rays  as 
the  most  rational  expectant  treatment,  which  will  be 
watched  with  great  curiosity. 

PSEUDO-LEUKiEMIA  OR  LYMPHO-SARCOMA. 

Stoerk  showed  the  members  a  few  specimens  of  ade- 
noid tissue  taken  from  the  intestines  of  different  patients 
to  prove  that  these  growths  are  neither  the  result  of 
leucocythaemia   nor  lympho-sarcoma,  but  somewhere 


Feb.  io.   1904- 


HUNGARY. 


The  Medical  Press.      1 49 


between  these  two  morbid  growths.  The  clinical 
phenomena  accompanying  this  adenoid  tissue  found  in 
the  intestine  atre  much  about  the  same  in  all  cases — vis.. 
Constipation  alternating  with  diarrhrra,  oedema  in  the 
lower  extremities,  universal  lymphatic  enlargement t 
colic,  causing  great  resistance  in  the  canal  associated 
with  blood  in  the  stools*  decubitus,  and  finally  death 
from  pneumonia. 

The  post-mortem  subsequently  reveals  the  hyper- 
plasia of  adenoid  tissue  in  the  primam  viam  as  a  white^ 
sponjL;  modular  tissue  having  sometimes  a  poly- 

poid attachment,  in  others  confluent  or  ulcerative. 
The  k  are  everywhere   enlarged,   and   stand 

ant  prominently,  not  even  excepting  the  spleen  and 
intercellular  tissues  of  hver  and  kidneys,  which  are 
usually   much   infiltrated.     The  ma  the    l^ng 

bones  is  always  found  in  a  red  condition. 

Stoerk  concluded  by  pointing  out  that  this  picture 
was  neither  pseudodeucjcytha^mia  nor  lympho-sar- 
coma,  but  a  transitional  form  which  had  not  yet  been 
dearly  classified. 

Bromoderm^  Tuberosum. 

Matfcnauer  next  presented  a  woman  with  bromo- 
derm! tuberosum  of  an  obscure  origin.  The  face  was 
qtiitt  covered  with  pustules  of  a  spongy  nature,  of  a  dark 
brown  colour,  having  a  white  vesicular  margin  rising 
irom  a  red  inflamed  surrounding.  The  urine  was  ex- 
amined and  found  to  contain  two  milligrammes  of  bro- 
in  every  970  grammes  of  the  urine.  This  patient 
can  gi\e  no  account  of  how  this  clement  was  taken  into 
the  body,  and  it  is  therefore  assumed  that  she  had  taken 
it  in  unconsciously  by  the  food  or  drink  in  daily  con- 
sumption. 

Neumann  agreed  with  the  diagnosis  of  the  pustules, 
and  remarked  I  ha  I  the  differential  diagnosis  of  brom- 
acne  was  readily  diagnosed  from  genuine  acne  by 
the  site,  Bromacne,  as  a  rule,  restricted  itself  to  the 
temporal  region,  while  acne  proper  was  more  diffuse, 
*hile  its  dark  vesicular  wall  usually  distinguished  it 
from  erythema  nodosum. 

Card [ac   Surgery, 

Wcinlcchner  concluded  the  sitting  by  giving  a 
long  paper  on  surgery  of  the  heart.  Briefly  sum- 
marised, he  said  injury  to  the  heart  by  needles,  pins,  or 
other  sharp  articles  passing  into  the  body  by  the 
osophagus  was  not  a  very  uncommon  occurrence,  and 
sifcould  always  be  provided  for.  The  usual  advice  of 
extracting  the  offending  substance  was  criticised, 
and  a  long  description  of  how  to  lay  the  heart  bare 
given.  His  method  11  to  insert  the  knife  between  the 
sixth  or  seventh  rib  outside  the  heart,  carry  the  in- 
cision  inwards  to  the  sternum,  then  up  the  outside  of 
sternum  as  high  as  required,  probably  to  the  third  rib, 
finally  outwards,  thus  making  a  flap  that  may  bedrawn 
forwards  as  a  hinge. 

Haiti  is  an  important  factor,  as  the  movement  of  the 
heart  lends  to  tear  or  aggravate  the  wound,  the  longer  it 

allowed  to  remain .  Th  ere  a  re  a  nu  m  ber  o  i  o  t  h  er  ar  t  i  cles 

lAylie  in  the  cardiac  muscle  foralong  time  without 

doing  much  harm  ;    even  needles  themselves  have  lain 

m  this  position  without  the  patient  experiencing 

any  discomfort,  and  bullets  or  other  pieces  of  metal  have 

been  known  to  lie  for  years  without  any  untoward  cir- 

imstance.  Her<  ur  cases  of  stabbing  wound*  in 

the  heart  ;  only  one  was  sutured  in  time  to  save  life, 
the  other  three  dying  in  forty-nine  hours  after  the 
injury.  Tin  adhesion  of  the  pericardium  to  the 
heart,  and  subsequently  uniting  with  the  thorax,  leads 
to  1  difficult  operation  of  resection  or  cardiolysis.  In 
many  cases  the  soft  tissues  only  become  involved, 
and  thus  often  produce  displacement.     Experiments  on 


animals  for  the  latter  defect  have  often  been  performed 
with  perfect  success,  These  experiments  have  even 
gone  so  far  as  repair  of  the  bicuspid  valve  with  perfect 
success.  We  are  told  that  nineteen  such  cases  have 
been  so  treated, 

!'  Medicals  as  Pirates,*' 

This  is  a  title  that  is  going  the  round  of  the  medical 
journals  in  Vienna  concerning  Dover,  irom  whom  we 
derive  Dover  powder.  For  the  information  of  their 
readers  they  tell  how  Dr.  Dover  discovered  Alexander 
Selkirk,  the  subject  of  "  Robinson  Crusoe."  Dr,  Dover 
was  born  in  Warwickshire,  a  pupil  of  Sydenham,  and 
took  his  degree  in  London,  but  seems  to  have  taken  to 
the  sea  immediately  after.  Later  he  Is  represented  as 
t  ,i]>r  imi  Dover,  sailing  from  Bristol  for  Spanish  ports 
hi  1709, 

About  this  time  he  lands  in  the  island  of  Juan 
Fernandez,  where  he  discovers  Alexander  Selkirk,  who 
had  been  left  on  the  island  four  and  a  half  years  pre- 
viously. The  latter  is  taken  on  board  and  given  charge 
of  one  of  the  craft.  After  this  the  town  of  Guayaquil  is 
assailed,  and  a  large  amount  of  booty  earned  on  board. 
Steering  along  the  Peruvian  coast,  then  round  the 
Horn,  and  across  the  briny  ocean,  he  reaches  England 
in  1711,  The  booty  realised  850,000  dollars,  the 
greater  portion  of  this  belonging  to  Dr.  or  Captain  (?) 
Dover,  With  this  handsome  dowry  he  retired  to  Lon- 
don, where  he  left  the  "  Ancient  Physician's  Legacy  " 
m   1733, 


Dun  gar?. 


[FROM    OUR    OWN    CORRESPONDENT.] 


Bmi«^  Fetmiwy  5th,  1904, 
The  Medical  Profession  and  Duelling, 

The  movement  against  duelling  is  increasing  in 
strength  and  importance  from  day  to  day.  Persons 
ol  every  rank  join  the  new  Union  of  NondueUists,  and  at 
present  they  number  nearly  six  thousand.  Recently 
also  members  of  the  medical  profession  have  entered  the 
Union,  and  they  are  obliged  not  only  to  abstain  irom 
duelling,  but  even  to  refuse  attendance  at  a  duel  when 
summoned. 
The  Care  of  Infectious  Patients  on  Railways. 

The  official  Journal  publishes  an  enactment,  edited 
by  the  Minister  of  Internal  Affairs,  according  to  which 
the  carrying  of  patients  suffering  from  cholera  pestis, 
or  from  declared  mania,  is  prohibited.  Those  suffering 
from  contagious  diseases,  which  are  not  so  acutely  con- 
veyable  to  other  persons,  will  be  allowed  to  sit  in  rail- 
way carriages  only  when  every  hygienic  precaution 
istaken,  Pat  ie  n  ts  s  ufferi  ng  from  sm  all-  pox ,  diphtheria, 
ttery,  typhoid,  lepra,  &c,  must  be  separated  in 
locked  cars,  and  these  must  be  furnished  with  the  signa- 
ture *'  infected  passengers,"  Patients  suffering  from 
whnoping-cough  can  be  admitted  into  ordinary  cars, 
but  they  must  be  separated  (within  the  car)  Irom  the 
healthy  passengers. 

Food   Poisoning, 

The  Orvosi  Httilap  reports  a  triple  case  of  fatalism, 
Dr,  Mirelli  was  summoned  to  a  family,  where  six 
hours  after  the  consumption  of  sausages  the  symptoms 
of  acute  enteritis  had  set  in,  with  general  malaise, 
nausea,  gastric  pressure,  vomiting,  slight  diarrhcea 
and  headache.  The  symptoms  of  specific  intoxica- 
appeared  thirty-six  hours  afterwards,  Sight 
troubles,  diplopia,  paralysis  of  the  upper  eyed  id ;  the 
secretion  having  ceased,  the  conjunctival  membranes 
became  dry  and  insensible,  pupils  dilated,  the  accom- 
modative power  was  gone,  dcglutitional  troubles  on 
account  of  paralysis  of  the  throat,  and  total  dryness  of  the 


150    The  Mbdical  Press. 


OPERATING   THEATRES. 


Feb.  10,  1904. 


mucous  membranes  were  the  further  consequences. 
Owing  to  the  latter,  speech  became  difficult,  followed 
by.  schuria;  retarded  pulse-beat  became  increasingly 
marked.  The  sensorium  was,  however,  always  normal, 
temperature  likewise.  Treatment  by  powerful  irriga- 
tion carried  out  through  nutritive  enemas  was  resorted 
to,  and  in  order  to  counteract  the  dryness  of  the  skin 
and  mucous  membranes  pilocarpin  was  administered 
subcutaneously. 

The  Phonendoscope  in  Medicine. 
Dr.  Erdos  is  of  opinion  that  this  instrument  will 
become,  with  time,  as  indispensable  to  the  physician 
as  the  knife  is  to  the  surgeon.  The  speedy  advance 
in  surgical  technique  has,  to  a  certain  extent,  obstructed 
the  field  of  internal  medicine,  and  it  is  undoubtedly 
owing  to  this  fact  that  medicine  has  need  of  good  and 
practical  instruments.  The  introduction  of  the  phonen- 
doscope into  practice  marks  a  distinctly  forward  move- 
ment, and  Dr.  Erdos,  having  made  extensive  experi- 
ments, has  arrived  at  the  conclusion  that  the  phonendo- 
scope will  be  found  most  useful  in  the  incipient  stage 
of  pulmonary  tuberculosis,  because  even  the  weakest 
rdles  can  be  heard  therewith,  and  sometimes  this  sym- 
ptom alone  is  sufficient  for  diagnosis,  which  is  an  im- 
portant advantage,  because  the  earlier  pulmonary 
tuberculosis  is  diagnosed  the  greater  the  probability 
of  cure.  Secondly,  he  has  found  the  phonendoscope 
to  be  of  great  service  in  cases  of  obese  women,  in  whom 
the  deep  fatty  pillow  renders  auscultation  impossible. 
Even  in  these  cases  the  phonendoscope  conveys 
clear  sounds  to  the  ears.  In  Austria-Hungary  the 
Bazzi-Binnchis  phonendoscope  is  generally  in  use 
(made  by  Martin  Wallach's  Nachfolger  in  Cassel, 
Germany).  This  instrument  has  the  great  advantage 
that  its  sensibility  regarding  the  conveyance  of  sounds 
can  be  regulated  according  to  the  acoustic  requirements 
of  the  physician. 


Operating  TEbeatre*. 

ST.  THOMAS'S  HOSPITAL. 
Nephrectomy  for  Hydronephrosis. — Mr.  Battle 
operated  on  a  married  woman,  aet.  about  35,  for  a 
tumour  in  the  right  side  of  the  abdomen,  which  was 
regarded  as  a  hydronephrosis.  Ten  years  before 
admission  the  patient  had  experienced  an  attack  of 
pain  in  the  right  side  of  the  abdomen,  which  had 
necessitated  treatment  in  a  hospital,  where  operation 
had  been  suggested  but  refused.  The  attack  was  a 
painful  one,  and  lasted  for  some  days,  but  was  not 
characteristic.  Three  years  afterwards  she  had  another 
attack  of  a  similar  character,  and  again  refused  opera- 
tion. Within  the  last  few  months  she  had  suffered 
from  some  pain  in  the  right  side  of  the  abdomen,  and 
had  noticed  swelling.  Dr.  Ecklin,  who  had  sent  the 
patient  to  Mr.  Battle,  considered  the  case  one  of 
hydronephrosis,  and  had  advised  the  patient  to  undergo 
operation.  The  woman's  general  condition  was  good 
and  the  amount  of  urine  regular  and  without  evidence 
of  disease.  On  examination  of  the  abdomen  a  large 
rounded  swelling  was  evident  in  the  right  side.  This 
distinctly  fluctuated  and  was  without  tenderness  or 
pain.  It  extended  from  the  iliac  fossa,  under  the  ribs, 
and  from  outside  the  umbilicus  into  the  kidney  region. 
The  patient  was  kept  under  observation  for  some  days, 
during  which  time  there  was  no  further  development  of 
symptoms  and  no  change  in  the  size  of  the  swelling. 
At  the  operation  an  oblique  lumbar  incision  was  made, 
as  is  usual  in  cases  of  nephrectomy,  and  the  kidney 
exposed.  The  tissues  immediately  over  the  kidney 
capsule  were  a  little  oedematous  and  adherent  to  the 
capsule,  but  not  forming  together  with  it  any  great 


thickness  of  envelope.  A  trochar  and  cannula  were 
passed  into  the  tumour,  and  the  contents  evacuated. 
These  consisted  of  a  very  large  quantity  of  brownish 
fluid,  containing  abundance  of  cholesterin,  of  which  six 
and  a  half  pints  were  collected.  The  opening  was  made 
larger  and  the  interior  of  the  cyst  explored,  its  exten- 
sion upwards  being  more  than  was  anticipated.  The 
cyst  was  now  separated  from  the  capsule  by  means  of 
the  finger  of  the  hand  cased  in  a  cotton  glove.  Its 
wall  was,  however,  so  very  thin  and  friable  that  this 
separation  was  a  matter  of  great  difficulty.  When 
forceps  were  placed  on  it  in  order  that  traction  might 
be  exercised,  it  tore  away  and  a  fresh  start  had  to  be 
made,  and  although  great  care  was  employed  in  the 
upper  part  towards  the  anterior  aspect,  the  peritoneum 
was  so  adherent  to  the  thin  capsule  that  an  opening  of 
some  size  was  made  into  the  peritoneal  cavity.  It  was 
found  that  the  separation  of  that  part  of  the  capsule  of 
the  tumour  which  extended  under  the  liver  was 
attended  with  some  haemorrhage,  but  at  no  other  part, 
not  even  in  the  neighbourhood  of  the  hilum,  was  there 
any  vessel  of  importance.  During  the  separation  two 
calculi  were  found  in  the  cyst,  both  oxalate  of  lime 
stones,  one,  the  smaller,  impacted  probably  at  the 
entrance  to  the  ureter,  whilst  the  other  appeared  to 
have  been  caught  at  the  entrance  of  a  dilated  calyx. 
Owing  to  the  haemorrhage  from  the  vein  on  the  under 
surface  of  the  liver,  some  clots  had  passed  into  the 
peritoneal  cavity,  and  some  were  removed  when  the 
hand  passed  through  the  opening  in  the  peritoneum, 
but  as  even  this  could  not  be  done  effectually  through 
an  enlarged  lumbar  wound  and  the  haemorrhage  con- 
tinued from  the  under  surface  of  the  liver  from  a  point 
which  was  inaccessible,  and,  moreover,  the  extent  of 
the  opening  into  the  peritoneum  could  not  be  gauged, 
Mr.  Battle  decided  to  make  another  opening  from  the 
front.  The  lumbar  wound  was  plugged  with  gauze,  and, 
the  patient  having  been  placed  on  her  back,  an  incision 
was  made  with  its  centre  at  the  level  of  the  umbilicus 
and  about  two  inches  to  the  right  of  it.  At  this  point 
the  rectus  sheath  was  opened  in  front,  the  muscle  re- 
tracted towards  the  middle  line,  and  the  peritoneal 
cavity  opened.  The  opening  in  the  peritoneum  was 
found  to  be  placed  between  the  hepatic  flexure  and 
the  liver,  and  was  of  considerable  extent ;  through 
this  the  vein  on  the  under  surface  of  the  liver  which 
was  bleeding  could  be  seen,  and  as  it  was  not  likely 
that  a  ligature  could  be  applied  at  the  depth  at  which 
this  was  situated,  even  if  the  forceps  would  have  held, 
plugs  of  gauze  in  strips  were  passed  down  to  it,  and 
pressure  made  over  the  bleeding  point,  the  ends  of  the 
plug  being  brought  out  through  the  lumbar  wound. 
The  opening  in  the  subhepatic  region  of  the  peritoneum 
was  closed  with  silk  sutures,  the  peritoneal  cavity 
cleansed  of  clots,  and  the  abdominal  wound  closed. 
Sutures  were  put  in  the  lumbar  wound  so  as  to  close 
the  anterior  part  of  it.  Towards  the  close  of  the  opera- 
tion it  was  considered  advisable  to  administer  two  pints 
of  saline  solution  into  the  veins.  Mr.  Battle  said  that 
the  operation  had  been  an  extremely  difficult  one. 
because  of  the  peculiarity  of  the  cyst  wall  and  capsule 
of  the  kidney.  In  this  instance  the  true  wall  of  the 
cyst  was  not  only  thin,  but  very  friable,  and  the  cap- 
sule outside  it  was  also  very  thin,  so  that  it  was  ex- 
tremely difficult  to  separate  the  two,  especially  in 
those  parts  where  the  distension  was  most  marked.  It 
seemed  as  if  not  only  had  there  been  but  little  hyper- 
trophy of  the  capsule,  but  as  if,  in  addition,  there  had 
been  some  slight  inflammatory  change  in  it  which  had 
rendered  it  more  easy  to  tear.  The  adhesion  of  the 
peritoneum  in  front  was  so  dense  that,  even  after  re- 
moval of  the  cyst  from  the  body  it  was  hardly  possible 


F&a.   ID*   1904. 


LEADING   ARTK 


The  Medical  Press.    15 1 


ripping  away  of  the  thin  portion  still 
iiihcfent  to  it.  The  presence  of  the  calculi,  he  thought, 
explained  the  origin  of  the  cyst,  complete  obstruction 
p|  the  ureter  having  occurred  with  suppression  of 
secretion  from  that  kidney.  The  presence  of  the 
calculi  also  accounted  for  the  definite  attacks  of  pain 
Irani  which  she  had  suffered,  but  it  was  not  possible 
to  be  certain  of  the  cause  until  these  were  found* 

The  plugs  were  removed  forty-eight  hours  later,  and 
the  patient  has  made  an  uninterrupted  recovery, 


Rmhhtxkii}  warn  TujiautMiiott  A  mo  aw, 

Cbe  flteDtcat  press  a  lib  Circular. 

HMM&od  **ety   Wediu-sday  morning,   Price  Bd«      WQtk   Irtc,   5jd. 
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HS     AND     MEDICAL     WITNESS 

vtain    changes    of    procedure    which    have 

taken  place  during  the  last  year  or  so  in  one  of  the 

poll  tan  Coroners*  Courts  demand  the  careful 

attention  of  the  medical  profession.     For  a  long 

time  past  it  has  been  notorious  that  the  London 

iy  Council  has  been  opposed  to  the  existing 

cd   whereby    the   Coroner   has   called   in   the 

medical  man  who  last  attended  the  deceased  p 

'  <»1  inquiry,  and  who  has  been  usually 
iiqmtcd  to  perform  the  post-mortem  examination, 
when  necessary.  Failing  any  medical  attendant, 
cither  regular  or  casual,  the  Coroner  has  usually 
called  in  some  medical  practitioner  in  hjs  disl 
In  cases  of  unusual  obscurity  there  has  never  been 
any  great  difficulty,  so  far  as  we  know,  in  obtaining 
any  additional  amount  of  expert  medical  and  other 
scientific  evidence  that  might  be  rendered  desirable 
by  the  exceptional  nature  of  any  given  case.  The 
Coroner  has  full  powers  in  the  calling  of  evidence, 
and  the  machinery  of  his  Court  is  so  absolutely 
individual  control  that  he  may  adjourn 
an  inquiry  month  after  month,  if  necessary,  for  the 
clearing  up  of  doubts  and  difficulties,  This  plan 
ttai  hitherto  answered  well  enough.  The  average 
medical  practitioner  is  able  to  bring  to  bear  upon 
1  dual  cases  a  common-sense  knowledge  that  is 
trained  to  the  close  weighing  of  essentials  in  the 
light  of  available  details.  Were  he  the  most 
ignorant  of  men,  his  views  as  to  the  probable 
cause  of  death  in  the  case  of  a  given  patient  who 
had  been  under  his  care  during  life  would  be  of  far 


more  value  than  the  opinion  of  a  laboratory  expert 
founded  upon  the  facts  of  a  post-mortem  examina- 
tion and  a  theoretical  knowledge  of  medical  prac* 
tice.  Yet  it  is  to  the  latter  that  Mr,  Troutbeck, 
the  Westminster  Coroner,  presumably  acting  under 
pressure  from  the  London  County  Council,  pins 
his  faith.  Cases  coming  within  Mr.  Troutbeck 's 
jurisdiction  are  no  longer  handed  over  to  the  local 
medical  men  immediately  concerned,  but  tr»  a 
quasi-official,  for  whose  existence  we  have  failed 
to  find  any  legal  warrant,  who  is  styled  *•  patholo- 
gist to  the  London  County  Council."  That  position 
is  filled  by  Dr.  Freyberger,  whot  although  assuming 
the  position  of  an  M  expert/'  we  understand  per 
forms  the  duties  at  a  far  lower  fee  than  that  de- 
manded by  men  whose  authority  is  usually  regarded 
as  "  expert/1  Indeed,  we  believe  one  of  the  con- 
siderations advanced  by  the  County  Council  in 
urging  the  employment  of  an  expert  is  the  economy 
effected  as  against  the  ices  paid  to  general  prac- 
titioners. After  all,  the  question  of  the  rate  of 
remuneration  is  a  matter  to  be  settled  by  the 
individual,  although  at  the  same  time  it  is  hard 
that  a  poor  profession  like  that  of  medicine  should 
suddenly  be  deprived  of  so  large  and  legitimate 
a  source  of  income  by  underselling — which  1 
or  may  not  be  defensible— on  the  part  of  their 
own  .cloth.  For  ourselves,  we  do  not  for  one  single 
moment  believe  that  the  public  will  gain  either  in 
.  or  in  purse  by  the  substitution  of  Coroners' 
s:i -called  w  experts  "  for  ordinary  medical  practi- 
tioners; on  the  contrary,  they  will  lose  heavily  by 
the  lessened  income  and  standing  of  their  privau 
medical  attendants.  We  have  not  a  single  word 
to  say  against  Dr.  Freyberger 's  private  or  pro- 
iessional  character  and  attainments.  His  pn 
invidious  position,  however,  renders  it  a  dutv  lo 
raise  a  sharp  and  decisive  protest  against  the 
system  of  which  he  is,  unfortunately  for  himself,  the 
first  exponent.  Some  weeks  ago  we  commented 
upon  a  case  in  which  a  baby  died  after  taking  a 
,+  teething  powder/'  The  medical  man  in 
attendance  thought  the  child  died  from  a  metallic 
irritant,  probably  antimony,  Dr.  Freyberger 
deposed  there  was  no  antimony  in  the  body  and 
on  his  evidence  a  verdict  of  death  from  natural 
causes  was  returned,  We  have  since  been  informed 
that  no  mention  was  made  at  the  inquest  by  Dr. 
Freyberger  of  the  common  cause  of  death  from 
"teething  powders/'  namely ,  the  presence  of 
perchloride  of  mercury  fronl  the  slow  conversion  of 
calomel  into  the  dangerous  corrosive  sublimate, 
tinder  these  circumstances,  we  submit  that  the 
general  practitioner  who  suggested  the  cause  ol 
death  to  have  been  a  metallic  irritant  was  likely 
to  be  nearer  the  truth  than  the  gentleman  who 
suggested  "  natural  causes"  for  fatal  convulsions. 
Then,  again,  as  regards  the  Whi taker  Wright 
inquest.  Medical  men  were  actually  present  at  the 
death,  medical  men  had  been  previously  in 
attendance  upon  deceased,  and  a  medical  man  was 
summoned  from  King's  College.  Mr.  Troutbeck f 
however,  in  his  wisdom,  summoned  none  of  these 
competent  medical  practitioners  to  the  inquest, 
but  handed  over  the    post-mortem  and  report  to 


152    Thb  Medical  Press. 


LEADING   ARTICLES. 


Feb.  io»  1904. 


Dr.  Freyberger.  There  is  nothing,  so  far  as  we 
know,  to  point  to  the  fact  that  a  chemical  analysis 
was  made  to  show  that  cyanide  of  potassium  was 
the  cause  of  death.  Corrosion  of  the  tongue  by 
cyanide  of  potassium  seems  to  be  an  almost 
inconceivable  occurrence.  Yet  that  objective 
fact  appears  to  have  been  prominently  advanced 
in  evidence.  On  the  whole,  we  are  inclined  to  think 
that  if  the  relatives  of  deceased  desire  a  re-opening 
of  the  inquiry  there  would  be  good  grounds  for 
making  a  demand  to  that  effect.  The  question 
of  death  from  natural  causes  is  not  to  be  disposed 
of  on  such  incomplete  and  dogmatic  assumptions 
as  those  which  appear  to  have  satisfied  Mr.  Trout- 
beck.  In  any  case  we  think  the  time  has  come 
when  the  question  of  medical  evidence  in  Coroners' 
Courts  should  be  threshed  out  in  the  full  light  of 
publicity.  Such  a  course  will  be  likely  to  place  the 
future  relations  of  the  public  with  the  County 
Councils,  the  Coroners  and  the  medical  profession 
upon  a  sounder  basis  than  that  brought  into  exist- 
ence by  the  recent  arbitrary  proceedings  of  the 
Westminster  Coroner. 


MEDICAL  ADVERTISING. 
It  is  certain  that  we  do  not  in  this  country  at  all 
understand  the  art  of  advertising  ourselves,  as  it  is 
practised  by  our  brethren  in  other  lands.  Our 
representative  associations  have  condemned  such 
very  wide  publicity  as  is  given  by  the  insertion  of 
signed  bulletins  in  the  newspapers,  even  where 
the  patient  is  a  person  of  public  importance. 
In  many  quarters  the  items  of  fashionable  intelli- 
gence which  relate  that  "Dr.  Blank  has  returned 
to  500  Dash  Square,  from  a  visit  to  Switzerland," 
or  that  "  Surgeon  Asterisk  has  left  town  for  ten 
days,"  are  also  condemned.  But  the  crimes  of 
Clapham  are  chaste  in  Martaban,  and  actions  that 
in  England  are  "  grossly  unprofessional,"  or 
perhaps  even  "  infamous,"  are  in  California  pecca- 
dilloes of  the  mildest  sort.  We  learn,  for  instance, 
that  a  professor  in  a  San  Francisco  medical  school, 
while  nominally  absent  from  home  on  his  summer 
holiday,  was  in  reality  on  tour  through  the  neigh- 
bouring States  in  the  capacity  of  what  we  can 
only  describe  as  an  operating  showman.  His  visit 
to  various  towns  seems  to  have  caused  all  the 
interest  usually  roused  by  a  travelling  circus,  and 
the  newspaper  clippings  have  been,  with  great 
kindness,  collated  and  published  by  his  admiring 
colleagues  in  San  Francisco.  We  quote  one  or  two 
of  these,  just  to  show  the  interest  taken  by  the 
intelligent  laity  of  the  Western  States  in  surgical 
affairs.  "  Sunday  morning,  about  9.30  o'clock, 
nearly  every  doctor  in  town  was  on  his  way  to  the 
County  Hospital  for  the  purpose  of  witnessing  the 
first  operation  in  the  county  with  cocain  anesthesia 
by  the  spinal  column."  It  is  further  stated  that 
"  the  reporter  was  present  and  witnessed  the 
operation  ;  when  the  hypertrophied  prostate  was 
removed,  each  piece  was  held  up  for  the  reporter's 
benefit."  "  The  professor  commenced  by  saying 
that  he  had  operated  on  more  than  one  thousand 
patients  without  one  fatality."  After  this  it  is 
disappointing    to    read    that    "Mr.    D was 


operated  upon  last  Sunday  by  Dr. ,  who  used 

his  celebrated  new  method  of  spinal  injection. 
The  operation  was  entirely  successful  as  far  as  the 

operation  part  goes,  but  D was  an  old  and 

weak  man  and  could  not  withstand  the  treatment." 
After  this,  the  greatest  sinners  in  the  profession 
at  home  may,  with  some  justification,  in  com- 
parison with  this  gentleman,  adopt  a  little  of  the 
mental  attitude  of  the  Pharisee  in  the  Temple. 

SIGHT-TESTING  BY  OPTICIANS. 
There  is  no  end  to  the  encroachments  that  are 
made  on  the  legitimate  sphere  of  the  medical 
practitioner  by  various  trades  and  individuals, 
and  strange  as  it  may  seem,  not  the  least  formidable 
and  insidious  of  these  come  from  those  whom 
one  regards  as  one's  allies  and  assistants,  rather 
than  as  one's  rivals.  Chemists  prescribe,  instru- 
ment-makers fit  boots  and  trusses,  and  spectacle- 
makers  test  the  vision,  all  without  reference  to  the 
medical  attendant.  It  is  strange  that  the  members 
of  these  worthy  trades  do  not  appreciate  the 
fact  that  they  depend  so  largely  on  the  recom- 
mendation of  medical  men  that,  from  the  point 
of  view  of  their  own  self-interest,  it  is  dangerous 
to  tamper  with  the  goodwill  of  those  to  whom 
they  must  ultimately  look  for  their  supply  of 
customers.  But  the  medical  profession  is  long- 
suffering,  and  experience  shows  that  a  policy  of 
pin-pricks  can  be  pursued  to  an  unprecedented 
degree  before  it  turns.  The  testing  of  vision  in 
slight  errors  of  refraction  does  not  present  any 
great  difficulty  to  those  acquainted  with  elementary 
optical  principles,  but  there  is  far  more  than  this 
in  the  procedure  of  the  intelligent  medical  practi- 
tioner. Vision-testing  with  him  is  only  one 
method  that  he  adopts  in  the  examination  of 
the  patient ;  it  is  not  his  be-all  and  end-all.  Very 
likely  he  may  suspect  a  defect  in  vision  to  be  the 
first  symptom  of  organic  or  functional  nervous 
disease;  or  it  may  suggest  albuminuria  or  diabetes; 
or,  again,  some  deep-seated  affection  of  the  eye, 
such  as  detachment  of  the  retina.  These  possi- 
bilities he  bears  in  mind,  and  he  proceeds  from 
an  examination  of  the  eye  to  test  the  urine,  to 
examine  with  the  ophthalmoscope,  or  to  try  the 
knee-jerks.  If  he  is  satisfied  that  the  defect  is 
due  to  a  mere  error  of  refraction  he  prescribes 
glasses  and  sends  the  patient  to  an  optician  to 
purchase  them.  It  may  be  that  he  adopts  this 
procedure  merely  as  a  tentative  measure  whilst 
he  is  still  uncertain  of  his  diagnosis,  and  if  the 
glasses  do  not  give  the  expected  relief,  he  examines 
the  patient  again  and  again  to  find  the  cause  of 
their  failure.  Now  all  this  can  only  be  done  by  a 
medical  man,  that  is  to  say,  done  efficiently,  in- 
telligently, and  to  the  patient's  best  interest 
It  is  no  defence  to  say  that  the  patient  cannot 
afford  the  medical  man's  fees  as  well  as  the  price 
of  the  spectacles.  Few  are  the  towns  now  in 
which  a  genuinely  poor  patient  cannot  obtain 
expert  ophthalmic  advice  gratis,  and  in  country 
districts  the  question  does  not  arise,  as  there  are 
no  opticians  and  no  ophthalmic  surgeons.  It 
cannot,  therefore,  be  laid  down  too  emphatically 


Feb,  io 


NOTES  ON  CURRENT  TOPICS. 


The  Mxihcai,  Press.     153 


that  the  testing  of  vision  is  a  medical  man's  work,    step      io     the    maturation     of     the     inductive 

and  a  medical  man's  only.  The  spectacle-  proof.  What  some  laboratory  -  workers  may 
maker  who  takes  on  himself  the  responsibility  have  needed  in  this  respect  has  been  supplied 
ci doing  so  is  on  a  par  with  the  prescribing  chemist,  for  them  by  the  novelist,  and  the  wonderful  con- 
and  his  business  deserves  to  be  tabooed  by  all  the  I  ceptions  of  Jules  Verne  and  Mr.  H,  G,  Wells  are 
practitioners  in  the  neighbourhood.  All  medical  threatening  to  become  the  commonplaces  of  the 
men,  of  course,  do  not  undertake  to  test  the  sight  '  present.     The  marvellous  heat-ray  of  the  latter 


with  lenses,  but  nowadays  there  are  very  few 
places  in  which  a  colleague  with  the  requisite  skill 
and  apparatus  does  not  reside,  To  him  the  patient 
can  be  sent.     Now,  foolish  and  ill-advised  as  it  is 

I  spectacle-maker  to  test  the  sight  on  his  own 
account,  it  is  a  far  more  serious  matter  when  the 
Company  from  which  he  receives  his  certificate 
support  him  in  his  pretensions.  This,  however, 
bat  the  Worshipful  Company  of  Spectacle- 
Makers  are  gravely  proposing  to  do.  This  ancient 
body  have  a  committee  sitting  to  inquire  whether 

raid  be  well  to  include  sight- testing  in  their 
examination  for  opticians,  and  to  advise  how  it 

I  best  be  carried  out  if  they  decide  to  institute 
it,  It  seems  that  by  their  Charter  the  Company 
the  privilege  of  conferring  some  right  of 
this  kind,  but  such  a  right  is  surely  an  anachronism 
in  lhe  twentieth  century,  when  all  that  sight- 
testing  involves  is,  or  should  be,  understood  by 
them.  If  the  Worshipful  Company  should  see 
vrell  to  authorise  their  diploma  tea  to  enter  on  this 
foolish  and  dangerous  course,  the  medical  pro- 
n  has  an  effective  counter*  There  is  more 
than  one  firm  now  that  will  supply  the  profession 
with  frames  and  lenses  at  trade  prices,  and  thus 
afluw  the  practitioner  not  only  to  charge  a  fee 
for  his  examination,  but  also  to  supply  the  patient 
with  spectacles  at  a  profit  on  the  article  itself. 
We  think  it  would  be  a  pity  if  this  became  at  all 
a  general  practice,  for  it  would  tend  to  lower  the 
status  of  the  profession,  and  it  would  introduce 
an  element  of  commercialism  which  would  be  apt 
to  conflict  with  a  disinterested  and  impartial 
opinion.  Still,  if  the  legitimate  province  of  the 
practitioner  is  invaded  with  the  sanction  and 
approval  of  the  authorities  in  question,  he  has  the 
remedy  in  his  own  bands,  and  it  will  be  well  for 
the  Spectacle-Makers'  Company  to  appreciate 
the  fact,  Ne  sutor  ultra  ctcpidam  ;  we  as  a  pro- 
fession are  willing  not  to  leave  ours,  and  it  is  for 

opticians  to  say  if  they  will  force  us  to  do  so. 
The  business  of  a  spectacle- maker  is  an  honourable 
and  worthy  one  ;  the  medical  profession  has  the 
highest  respect  for  it;  So  long  as  he  employs 
himself  in  his  appropriate  and  familiar  field  he 
will  receive  the  support  and  patronage  of  its 
members.  If  he  wishes  to  come  and  labour  in 
theirs,  they  will  know  how  to  act. 


romancer,  used  by  the  Martians  in  their  combats 
with  men,  may  not  yet  be  available  as  a  method 
of  practical  warfare,  but  rays  of  various  poten- 
tialities are  being  discovered  on  every  hand,, 
emanating  from  the  most  unlikely  objects,  and  in 
the  most  unlikely  places.  The  discovery  of  a 
fresh  set  of  rays  by  M>  Blondlot  was  noticed  in 
this  journal  at  the  beginning  of  last  month,  and 
already  workers  are  beginning  to  find  that  N-rays 
are  given  off  from  many  other  sources  than  the 
human  muscles  and  nerves,  M,  Meyer  has  found 
that  plants  and  vegetables  emit  them,  especially 
from  their  leaves,  branches  and  roots.  Mushrooms 
and  no  n  -c  hlo  ro  phy  llo  u  s  v  ege  t  ables  are  part i  c  ul  arl  y 
rich  generators  of  this  new  luminosity,  Stranger 
still  are  the  observations  of  M.  de  Lepinay,  for 
he  has  shown  that  the  N-rays  are  produced  by 
sonorous  vibrations.  He  has  been  able  to  exclude 
any  fallacy  from  rays  given  off  by  the  articles 
used  to  produce  the  sound— tuning- forks,  gongs,  and 
hammers — and  to  show  that  it  is  the  actual 
vibration  of  the  air  that  is  the  productive  agent. 
It  is  early  days  yet  to  test  the  therapeutical  pro- 
perties of  the  N-rays,  but  after  the  unexpected 
and  astonishing  uses  of  the  X-rays  and  Finsen 
light  one  is  prepared  for  almost  anything.  In 
the  W  tetter  kliniscke  Wochemchrift  a  case  of 
cesophageal  cancer,  treated  by  radium  passed 
down  in  a  capsule  at  the  end  of  a  bougie,  is  reported, 
and  whatever  else  may  have  happened  Professor 
Gussenbauer  has  been  able  to  feed  his  patient  by 
mouth  without  artificial  means.  The  science  of 
radiography  opens  up  vistas  of  treatment  which, 
without  being  unduly  sanguine,  promise  to 
strengthen  our  hands  most  materially. 


notes  on  Current  topics* 

N-Raye. 

It  is  often  stated  that  scientific  men  lack  imagi- 
nation ;  that  they  are  dry-as-dusts  and  sticklers 
for  accuracy  ;  that  they  lack  perception.  As  a 
fact,  the  want  of  imagination  is  a  fatal  bar  to 
the  achieving  of  eminence  in  science  or  in 
medicine      Its  possession,  indeed,  is  a   necessary 


Mrs,  Eddy's  Toothache. 
There  would  not,  in  the  usual  way,  be  any 
particular  cause  for  remark  on  the  fact  of  an 
American  lady  suffering  from  the  worst  of  "  human 
doles."  Toothache  is  an  affection  that  spares 
neither  the  highest  nor  lowest  in  the  land,  and 
its  agony  has  inspired  the  hand  of  the  greatest 
English  poet  and  the  Scottish  national  bard  to  set 
down  their  impressions  of  the  sensations  it  evokes. 
Undoubtedly  toothache  is  hard  to  bear,  and  its 
pangs  are  none  the  less  difficult  to  suffer  in 
silence  because  of  the  paucity  of  sympathy  that 
is  meted  out  to  the  victim.  Burns,  at  least, 
found  it  so,  Faith  can  go  a  long  way  in  curing 
hysterical  paralysis  and  pseudo -angina,  but  it  is 
very  difficult  to  believe  one  has  not  got  a  tooth- 
ache, when  one  feels  its  intolerable  throbbing, 
burning,  and  starting.  Of  course  the  Christian 
Scientist  knows  that  the  pain  is  all  im- 
agi  nary,  an  d  that  all  that  is  needed  i  s 
to  believe  that  one  has  not  got  a  tooth- 
ache,  and,   hey   presto  1   it  is  gone.     Mrs.   Eddy 


154    The  Medical  Press  . 


NOTES  ON  CURRENT  TOPICS. 


Feb.  io.  1904 


doubtless  tried  very  hard  to  believe  she  had  not 
got  it,  but  the  twinges  would  not  take  "  No  " 
for  an  answer,  and  eventually  she  was  constrained 
to   do   what  ordinary   people   do   under   similar 
circumstances — go  to  the     dentist.     The  dentist 
was  of  the  earth  earthy,  and  instead  of  telling  her 
to  go  home  whilst  he  practised  absent  treatment, 
betook  himself  to  his  forceps-case,  and  extracted 
the  offender.     Whether  Mrs.  Eddy  let  the  secret 
out  in  a  moment  of  thanksgiving  is  not  recorded, 
but  the  whole  of  America  soon  became  aware  of 
the  visit  and  its  result,  and  instead  of  congratulat- 
ing  her    on    the   happy    issue  out   of    her    ills, 
it    was    heartless    enough  to  accuse   her   of    in- 
consistency.    What  will  the  Christian  Scientists 
do    now  ?     They    had    to    acknowledge   recently 
that  the  infectious  diseases  did  not  fall  within 
the  scope  of  their  system,  and  now  (presumably) 
diseases  of  the  teeth  will  have  to  be  excluded  also. 
If  this  process  goes  on  they  will  soon  find  them- 
selves limited  to  the  treatment  of  neurotic  affec- 
tions,   where    every    therapeutical    plan    has    its 
successes   and   all   have   their   failures.     If   they 
manage  to  cure  a  few  of  the  sufferers  on  whom 
we  have  all  tried  our  hands  and  failed,  we  will 
not   grudge   them   their   triumph,   but   as   these 
sufferers  are  principally  people  who  do  not  want 
to  be  made  well,  one  fears  they  would  not  get 
many  thanks  for  their  pains. 


X-Rays  and  Uterine   Oaneer. 

It  is  generally  supposed  among  those  who  have 
not  devoted  special  attention  to  the  subject  that 
the  treatment  of  cancer  by  the  X-rays  is  only 
practicable  where  the  disease  is  situated  super- 
ficially.    Most  of  the  instances  reported  up  to  the 
present  have,  indeed,    been   cases  of  epithelioma 
or  rodent  ulcer  of  the  face,  and  but  few  attempts 
have  been  made  to  bring  the  rays  to  bear  on  any 
deep-seated    disease.     However,    as     far    as    the 
experience  given  by  such  attempts  goes,  there  is 
every  reason  to  hope  that  when  conditions  admit 
the  application  of  the  rays,  their  effect  will  be 
equally    satisfactory    wherever    the    disease    is 
situated.     That  the  difficulty  of  treatment  is  in 
the  main  a  mechanical  one  is  shown  by  the  success 
obtained  by  Mr.  Sinclair  Tousey,  of  New  York, 
in  applying  the  rays  to  several  cases  of  cancer  of 
the   cervix.     His   method   of   treatment  consists 
of  three   procedures.     He  first,   by   means  of   a 
speculum,  with  the  tube  placed  near  the  vulva, 
applies  the   rays  directly   to  the  cervix   and   the 
anterior  vaginal   wall.      A  primary  exposure  of 
five  or  six  minutes  was  given,  gradually  increasing 
up  to   about  twenty,  with,  of  course,  intervals 
for  the  tube  to  cool.     The  next  procedure  is  to 
treat  the  body  of  the  uterus  through  the  anterior 
abdominal  wall.     The  time  of  exposure  was  about 
nine  minutes,  distributed  over  the  lower  part  of 
the  anterior  abdominal  wall.     The  third  part  of 
the  treatment  consisted  in  the  application  of  the 
high    tension    discharge    by    means    of    vacuum 
electrodes.     A  current  strong  enough  to  produce 
a  four-inch  spark  was  used,  and  the  vacuum  tube 
was  moved  from  one  part  of  the  abdominal  wall 


to  another,  keeping  it  in  contact  with  the  skin. 
The  cases  treated  by  Mr.  Tousey  were  those  in 
which  surgical  treatment  had  been  impossible  or 
had  failed.  While  he  expressed  no  opinion  as  to 
the  possibility  of  a  disappearance  of  uterine 
cancer,  he  has  in  every  case  produced  a  sympto- 
matic cure.  Pain  has  disappeared,  the  discharge 
has  ceased,  the  offensive  odour  has  passed  away, 
and  the  tumour  has  decreased  in  size.  These 
results  are  so  encouraging  that  we  hope  to  see 
modifications  of  Mr.  Tousey's  methods  applied 
in  the  case  of  cancers  of  the  stomach  and  intestine. 

Pneumoooooio  Infections. 

Though  it  has  long  been  recognised  that  lobar 
pneumonia  is  a  part  of  an  acute  general  infection, 
and  not  merely  a  local  disease,  yet  there  has  not 
been  sufficient  attention  directed  to  the  other 
lesions  which  may  accompany  those  of  the  lungs. 
The  reason  of  this  is,  of  course,  sufficiently  obvious, 
for  of  the  local  lesions  the  pulmonary  almost  always 
predominate,  and  are,  as  regards  prognosis,  by 
far  the  most  important.  It  is  necessary,  however, 
for  a  fuller  knowledge  of  such  a  common  disease 
that  all  cases  of  pneumococcic  infection  elsewhere 
than  in  the  lungs  should  be  reported,  and  in  par- 
ticular is  this  so  where  post-mortem  verification 
of  the  condition  has  been  possible.  In  three  cases 
recently  published  (a)  from  Johns  Hopkins  Hos- 
pital, the  principal  concurrent  lesion  was  arthritis, 
though  other  serous  inflammations  occurred. 
It  is  curious  that  an  organism  such  as  the  diplo- 
coccus  of  pneumonia,  which  always  chooses  a 
mucous  region  for  its  primary  lesion,  should  affect 
the  serous  membranes  almost  exclusively  in 
secondary  infection.  The  joints  affected  are 
usually  the  larger  ones — shoulder,  elbow,  knee— 
and  the  symptoms  follow  each  other  in  the  dif- 
ferent parts  with  often  a  couple  of  days'  interval. 
In  two  of  the  cases  there  was  a  pneumococcic 
endocarditis,  and  in  two  of  them  meningitis. 
It  is,  of  course,  well  known  that  peritonitis  is  a 
common  pneumococcic  infection,  and  in  animals 
is  commoner  than  pneumonia.  The  more  we 
learn  about  such  diseases  as  pneumonia,  enteric 
fever  and  diphtheria  the  more  we  see  that  their 
names  only  represent  some  of  the  commoner  effects 
of  what  is  in  each  case  a  general  bacteriaemia. 


Osteopathy. 

This  strange  exotic  has  never  yet  taken  root  on 
our  shores,  though  in  America  it  flourishes  like 
the  green  bay-tree.  Perhaps  it  is  from  lack  of 
initiative  that  we  prefer  sticking  to  the  old 
quack  methods  for  curing  illnesses  that  the 
doctors  have  "  given  up  "  rather  than  try  new  ones. 
True  "  Dr."  Dowie  and  Mrs.  Eddy  both  have  a 
Uttle  band  of  adherents  in  this  country,  but 
(like  the  coney)  they  arc  a  feeble  folk,  and  not  very 
aggressive.  So  long  as  they  content  themselves 
with  practising  "  absent  treatment "  on  their 
friends  they  are  not  likely  to  do  much  harm— or 
good.  But  it  is  a  little  curious  that  this  par- 
ticular "  pathy,"  instituted  by  that  great  bene- 

(4)  John*  Hopkin*  Hospital  Bulletin,  November,  1903. 


Feb.  to.  fgo*- 


NOTES  ON  CURRENT  TOPICS, 


The   Medical  Press,     155 


factor  Di\  Still ,  has  not  come  to  steal  the  hearts 
oi  these  who  have  tried  homoeopathy,  hydropathy, 
and  what  they  like  to  call  **  allopathy/1  and  found 
them  wanting.  Osteopathy  takes  itself  very 
seriously  in  America ;  it  has  its  colleges,  its 
courses,  and  its  diplomas.  It  even  has  its  organs ; 
one  is  modestly  named  the  Osteopathic  World,  whilst 
the  other  adopts  the  presumptuous  but  more 
restricted  title  of  the  Journal  of  the  Science  of 
Osteopathy.     Osteopathy    seeks    to    remedy    that 

Ulfte  class  of  cases  where  medicine  is  useless 
and  surgery  does  not  apply,'*  This  large  class 
consists  of  those  in  which  the  free  and  natural 
flow  of  the  fluids  and  forces  of  the  body  is  inter- 
fered with  by  displacement  and  contraction  of 
the  parts,  and  somehow  or  other  the  cause  of  all 
the  trouble  in  these  cases  generally  centres  in 
die  spine.  So  the  doctor  of  osteopathy  con* 
cemrates  his  brain  power  (such  as  it  is)  on  finding 
nui  which  of  the  vertebrae  needs  treatment,  and 
it  appears  that  he  is  seldom  at  fault  in  discovering 
one  or  other  that  wants  attention .  Occasion  ally , 
however,  the  spinal  column  is  normal,  and  then  a 

twisted  rib  "  has  to  be  rectified.  Osteopathy 
has  been  defined  for  us  by  its  exponents  as  "  fixing 
up  what  is  out  of  fix,  with  a  full  and  comprehensive 
knowledge  of  the  human  body1*;  but  if  this  be 
its  function  one  fails  to  see  wherein  it  differs  in 
its  aims  from  those  of  the  modern  orthopedic 
surgeon.  The  hold  that  this  ridiculous  system 
has  in  some  States  may  be  judged  from  the  fact 
lhat  a  Bill  to  place  its  practitioners  on  a  legal 
tooting  was  only  thrown  out  of  the  Pennsylvania 
Legislation  recently  after  a  hard  fight,  and  its 
defeat  was  only  accomplished  finally  owing  to  the 
large  number  (24)  of  physicians  1hat  had  seats 
ill  the  House.  However  much  we  may  suffer 
tTum  unfair  competition  in  these  islands,  we  have 
vet  been  spared  the  "  particular  addition  "  of  the 
osteopath. 

Eridovenous  Medication- 

The  resources  of  the  art  of  therapeutics  are  not 
fc>  comprehensive  that  one  can  afford  to  neglect 
a  possible  extension  of  the  method  of  treat- 
ing patients  by  direct  introduction  of  drugs 
and  fluids  into  the  circulation,  Transfusion  ol 
saline  solution  is  the  only  attempt  at  all  widclv 
made  in  this  country  to  fulfil  this  indication,  and 
ig  frequently  only  used  as  a  last  resource. 
A  systematic  attempt  was  made  at  the  Bel- 
•  Hospital,  at  Glasgow,  about  two  years  ago 
to  bring  grave  cases  of  diphtheria  rapidly  under  the 

il  antitoxin,  by  injecting  the  serum  into  ' 
the  median  basilic  vein,  and  the  results  published 
uily    gave   ground    for   the  suggestion  made 
method  promised  a  greater  prospect  of 
recovery  than  the  usual  one  of  injection  into  the 
subcutaneous  tissue.     But  this  plan  of  treatment 
has  stopped  here,  except  in  a  few  isolated  cases 
Th.it    have    been    reported.     It    seems,    however, 
^at  it   may  have  a  wider  sphere  of  usefulness. 
Not  all  drugs,  by  any  means,  are  useful  for  endo- 
ws  injection,    and    in    proposing    to    employ 
a-ny  particular  one  it  is  well  to  consider  the  effect 


it  is  likely  to  have  on  the  blood  as  well  as  on  the 
more  remote  tissues.  Preparations  of  mercury, 
for  instance,  coagulate  the  blood  by  combination 
with  its  albumens,  and  although  intra-museular 
injections  of  mercurial  preparations  have  proved 
very  useful  in  syphilis,  it  is  not  without  risk  that 
they  can  be  injected  endovenously.  There  is  one 
drug  which  has  been  tried  and  reported  on  very 
favourably  in  this  connection,  and  that  is  atoxyl, 
an  organic  arsenical  compound.  Excellent  and 
rapid  results  have  been  obtained  in  neurasthenia p 
Graves'  disease,  chlorosis,  and  hysteria,  and  both 
in  combination  with  tuberculin  and  by  itself  it 
has  been  of  distinct  service  in  a  variety  of  tuber- 
culous affections.  It  is  claimed  by  German  writers 
that  the  method  is  absolutely  safe  if  strict  care  is 
taken  that  the  technique  of  the  operation  is 
asepticaJly  conducted,  and  that  no  air  is  injected 
with  the  fluid,  and  that  the  inner  coat  of  the  vein 
is  not  wounded.  One  physician  has  injected  into 
the  same  spot  in  the  same  vein  no  less  than 
fifty  times  in  succession.  It  will  be  interesting  to 
see  if  this  plan  comes  in  vogue  more  generally, 
for  as  a  means  of  bringing  a  patient  rapidly  under 
the  influence  of  a  drug  it  has  no  equal. 


The  Collection  of  House  Refuse- 

Thk  spirited  correspondence  that  has  been 
going  on  in  the  columns  of  the  Times  on  the  above 
subject  directs  attention  to  what  is  an  admitted 
evil,  especially  in  large  towns.  That  veteran 
reformer,  Sir  Henry  Thompson,  started  the  ball, 
and  Mr.  Mark  Judge  and  others  have  kept  it 
rolling.  The  time  which  most  local  authorities 
select  for  collecting  refuse  is  when  people  are 
abroad  in  the  streets,  and  when  the  dust  that  is 
scattered  by  the  collectors  can  get  into  as  many 
pen  pie's  mouths  and  noses  as  possible,  The 
method  they  employ  of  having,  in  many  cases, 
open  carts  for  the  reception  of  the  refuse  ensures 
that  the  greatest  practicable  quantity  of  dust 
shall  be  blown  about  the  thoroughfares  through 
w  hich  t  he  c  art  passes.  I  n  fact  * '  d  u  s  t-d  tst  r  i  b  ut  ing ' ' 
would  be  almost  as  appropriate  an  epithet  for 
their  methods  as  H  dust-collecting/'  In  these 
columns  a  few  weeks  ago  it  was  pointed  out  in  a 
leading  article  how  potent  a  means  for  disseminata 
ing  disease  dust  could  become,  and  the  remarkable 
drop  in  the  death-rate  that  followed  the  prolonged 
rains  of  the  last  two  summers  was  dwelt  on  as 
showing  how  directly  dust  is  responsible  for 
purveying  germs  to  articles  of  food  and  drink.  The 
local  authorities  who  collect  refuse  are  also  the 
sanitary  authorities,  and  if  they  show  so  little 
regard  to  the  most  elementary  requisites  of 
communal  health,  one  feels  inclined  to  cry  Quis 
cUStodi&t  ip$0t  custodes  ?  The  only  serious  argu- 
ment advanced  in  their  defence  is  the  old  one  of 
expense*  There  is  something  to  be  said  on  this 
score,  but  one  cannot  help  thinking  that  it  is  a 
penny  wise,  pound  foolish  policy  to  go  on  with 
the  present  disgusting  methods  rather  than  ask 
for  a  moderate  sum  from  the  ratepayers  1 1 
institute  an  effective  and  cleanly  plan.  The  idea! 
one  would  require  each  house  to  have  two  portable 


156    Thb  Medical  Press.         NOTES  ON  CURRENT  TOPICS. 


Feb.  io,  1904. 


covered  dust-bins  ;  one  to  be  used  by  the  servants 
while  the  other  was  taken  away  by  the  collectors 
in  carts  to  be  emptied  straight  into  the  destructor. 
The  ideal  time  for  the  round  would  be  the  early 
morning  before  people  were  astir,  and  this  ought 
to  be  easily  capable  of  arrangement,  *even"under 
the  present  system.  Till  people  take' the  matter 
up  for  themselves,  and  make  the  question  an 
active  one  at  the  time  of  municipal  elections, 
things  will  go  on  as  they  are.  And  what  they  are 
and  what  they  might  be  differ  toto  ccelo. 

The  Sale  of  Poisons. 

The  Whitaker  Wright  tragedy  has  appealed 
immensely  to  the  public  mind,  and  various  aspects 
of  this  remarkable  case  have  been  brought  forward 
to  emphasise  defects  in  our  legal  system  and  the 
management  of  our  courts  of  justice.  But  is 
there  not  a  greater  and  more  important  lesson 
to  hand  ?  Does  it  not  show  a  painful  laxity  in 
our  law  regulating  the  sale  of  poisons  that  a  man 
can  obtain,  without  inquiry,  as  many  tabloids 
of  potassium  cyanide  as  he  wishes  ?  A  chemist 
may  not  sell  a  drachm  of  laudanum  without 
elaborate  precautions,  but  the  photographer  can 
dispose  of  the  most  deadly  poisons  without  any 
restrictions.  It  is  remarkable  that  in  the  general 
chorus  of  discontent  with  many  arrangements 
brought  out  by  aspects  of  this  case,  that  this — the 
most  vital  and  important — should  have  escaped 
comment.  On  the  other  hand  it  may  be  urged 
that  it  would  hardly  be  conceivable  that  any 
scheme  of  legislation  could  prevent  a  determined 
man,  with  unlimited  resources  at  command,  from 
obtaining  a  supply  of  any  deadly  poison  he  might 
require.  For  that  matter,  any  man  of  average 
intelligence  who  possessed  an  elementary  know- 
ledge of  chemical  methods  might  readily  make 
his  own  cyanide  of  potassium.  In  this  way  we 
are  brought  back  to  the  familiar  aphorism  that 
it  is  impossible  to  make  men  moral  by  Act  of 
Parliament. 


Public  Health  Legislation. 

It  is  an  encouraging  sign  of  the  times  that  the 
Government  propose  to  introduce  a  Public  Health 
Bill  into  Parliament  this  session.  As  it  comes 
rather  late  in  the  King's  Speech  it  is  only  to  be 
expected  that  it  will  occupy  the  usual  rank  that 
public  health  proposals  enjoy  in  Parliament, 
namely,  that  of  third-  or  fourth-rate  importance. 
Still,  in  a  programme  concerned  with  no  large 
measure  of  acute  interest  it  may  have  a  better 
chance  of  being  discussed  and  passed  than  if  a 
number  of  big  Bills  were  being  introduced.  What 
the  Bill  will  actually  propose  to  effect  is  a  secret, 
but  there  are  three  matters  that  it  certainly  should 
deal  with.  The  first  of  these  is  security  of  tenure 
and  superannuation  allowances  for  medical  officers 
of  health  and  sanitary  inspectors.  It  is  a  gross 
anomaly  that  medical  officers  of  health  and  their 
subordinates,  outside  London,  should  hold  office 
practically  at  the  caprice  of  the  Council  they  serve, 
while  their  duties  to  the  community  are  constantly 
bringing    them    into    conflict    with    the    private 


interests  of  members  of  the  Council.  This  is  a 
crying  evil  and  calls  loudly  for  remedy.  Till 
medical  officers  are  secure  in  the  tenure  of  their 
posts,  slum-property  and  over-crowding  —  to . 
mention  only  two  evils — will  cqntinue  to  flourish. 
The  second  subject  urgently  calling  for  Parlia- 
mentary action  is  to  give  effect  to  the  recom- 
mendations of  the  Roy;ai  Commission  of  Sewage 
Disposal  with  regard  to, th& pollution  of  oyster 
beds.  It  has  been  pointed  out  in  these  columns 
that  the  recommendation  fails  in  an  essential 
particular,  namely,  in  not  proposing  to  delegate 
the  powers  needed  to  bodies  having  medical 
experts  to  advise  them.  This  fault  is  capable  of 
remedy,  but  the  public  control  of  shell-fish  sources 
is  a  pressing  need.  Finally,,  it  may  be  hoped 
that  the  Government  will  see  the  necessity  of 
adopting  the  suggestions  of  the  London  County 
Council  with  regard  to  the  registration  and  in- 
spection of  manufactories  of  aerated  waters. 
Dr.  Hamer's  report  to  the  Council,  published  last 
year,  disclosed  a  state  of  things  existing  in  the 
smaller  manufactories  of  these  beverages  that 
demands  prompt  and  effective  supervision.  The 
clauses  of  the  Bill  will  be  awaited  with  interest. 


The  Exploiting  of  Disease. 
A  correspondent  in  one  of  the  daily  papers 
has  drawn  attention  to  what  he  believes  is  a  grow- 
ing evil  of  the  present  day — namely,  the  eager 
desire  on  the  part  of  the  public  to  acquaint  them- 
selves with  the  mysteries  of  disease  from  the  most 
varied  aspects  and  in  its  most  sordid  details.  He 
laments  the  ready  gratification  of  this  morbid 
appetite  by  a  certain  section  of  the  Press,  and 
expresses  the  opinion  that  disease  may  be  itself 
produced  by  constantly  dwelling  upon  its  symptoms 
and  manifestations.  To  consider  the  latter  state- 
ment first,  it  is,  of  course,  possible  to  induce  sym- 
ptoms of  functional  nerve  disorders  by  auto- 
suggestion, for  this  process  is  well  known  to  play 
an  important  part  in  the  complex  nervous  mechan- 
ism of  the  hysterical.  In  this  capacity  it  is  much 
on  a  par  with  imitation,  which  often  powerfully 
influences  weak  minds.  The  so-called  "  epi- 
demics "  of  suicide  may  sometimes  be  traced 
back  to  one  notorious  example,  the  perusal  of  the 
details  of  which  has  upset  the  mental  balance  of  less 
stable  individuals.  Medical  students,  on  reading 
the  account  of  a  disease  in  a  text-book  of  medicine 
for  the  first  time,  occasionally  find  it  difficult  not 
to  believe  that  they  are  affected  with  the  very 
complaint  which  they  have  been  studying,  to  wit, 
the  familiar  example  in  fiction  of  the  man  who  was 
positive  that  he  showed  symptoms  of  every  disease 
under  the  sun,  with  the  exception  of  "  house- 
maid's knee."  With  regard  to  the  first  question, 
the  dissemination  of  knowledge  respecting  the 
prevention  and  modes  of  infection  of  tuberculosis 
cannot  be  otherwise  than  beneficial,  and,  though  it 
is  to  be  regretted  that  premature  accounts  of 
reported  "  cures  "  of  such  a  disease  as  cancer  are 
published  in  this  manner,  the  interest  thus  aroused 
should  contribute,  in  some  degree,  to  the  earlier 
diagnosis  of  these  malevolent  disorders.     We  are 


Feb.  ?o,  1904. 


PERSONAL, 


Thb  Medical   Press.     1 57 


glad  to  think  that  the  majority  of  newspaper 
readers  are  not  morbid -minded  and  are,  generally, 
only  too  ready  to  take  hints  and  learn  facts  about 
any  matter  which  threatens  the  health  of  the 
nation.      Omnia  puribus  pur  a. 


Guy's  Hospital  and  Charges  of  Neglect. 

The    Southwaxk    Guardians    have    formulated 

various  charges  of  neglect  against  Guy's  Hospital. 

The  case  that  gave  rise  to  these  recriminations 

was  that  of  a  patient  suffering  from  stricture  and 

retention    of    tirine,     He    was    attended    by    the 

m   in  charge,  and,  as  there  was  not  a 

cal  bed  available,  he  was  sent  in  a  cab  to  St, 

George's   Workhouse,  with  a  recommendation  for 

tadmission.  The  unfortunate  man  died  not  long 
afterwards.  The  authorities  of  Guy's  Hospital 
are  credited  with  a  u  vigorous  reply "  to  the 
guardians'  charge  of  neglect.  In  the  published 
newspaper  report  of  the  Treasurer's  comments 
admitted  that  the  ease  was  one  requiring 
admission  as  an  in-patient.  There  was  not  room, 
however,  and  the  Treasurer  suggests  that  the  public 
should  subscribe  to  enlarge  the  hospital  accom- 
itionr  It  would  be  more  to  the  point,  how- 
ever, to  state  if  all  the  patients  occupying  beds  at 
Guy's  are  persons  whose  means  are  sufficiently 
narrow  to  warrant  their  maintenance  by  a  public 
chanty.  Further,  whether  any  of  the  existing 
ward  accommodation  at  Guy*s  is  devoted  to  well- 
to-do  paying  patients.  Thirdly,  whether  some  of 
the  chronic  cases  under  treatment  Gould  not  be 
weeded  out  of  the  wards  to  make  room  for  others 
of  extreme  urgency.  Guy's  is  a  noble  charity, 
but  that  fact  does  not  make  it  perfect  or  place  it 
above  criticism.  The  ground  advanced  by  the 
authorities  that  as  Southwark  contributes  little 
the  fund*  of  the  hospital  it  is  therefore  not 
entitled  to  demand  for  relief  seems  to  us  to  be 
absolutely  beside  the  mark.  If  relief  were  to 
be  accorded  to  districts  in  proportion  to  their 
individual  subscription  then  Kensington  and 
Gmsvenor  Square  might  demand  to  fill  the  wards 
oi  Guy's,  On  the  contrary,  the  poorer  a  district, 
The  greater  its  claims  on  a  public  charity,  We 
cannot  think  the  system  of  a  hospital  perfect  if  a 
man  is  sent  away  from  the  gates  to  die  when  his 
life  might  be  saved  by  immediate  surgical  opera- 
tion. The  urgency  wards  of  Guy's  should,  in 
our  opinion,  be  at  once  extended  at  the  expense  of 
the  ordinary  ward  accommodation. 


"  Premature  Burial." 

The  curious  and  most  essential  feature  about 

so-called  H  premature  burial  "  is  that  it  has  never 

been  shown  to  exist.      To  form  societies  to  guard 

against  this   terrible    phantom    and    to    propose 

nation  against  it  is  more  IH  premature  "  than 

he  wildest  assumptions  and  random  statements  of 

ion-mongers.       The     literature     of    the 

voluminous;    but  when  subjected  to  a 

AvA  examination,   such   as  would   happen,  for 

were  the  statements  in  question  brought 

orward  as  evidence  in  a  court  of  law,  they  vanish 

i  smoke  into  thin  air.     The  many  instances  o* 


alleged  live. burial  were  examined  by  a  medical 
man  some  years  ago  in  a  little  book  published  by 
Messrs,  Baiiliere,  Tindall  and  Cox,  He  came  to 
the  deliberate  conclusion  that  no  case  of  the  kind 
had  ever  been  substantiated-  That  is  the  scien- 
tific attitude,  namely,  that  though  live-burial  is  not 
impossible  it  has  never  been  shown  by  incontro- 
vertible proof  to  have  occurred  in  any  one  single 
instance.  We  learn  that  a  society  established  with 
the  view  of  preventing  this  shadowy  danger  has 
drawn  up  a  draft  Bill  with  a  view  of  making  a 
personal  examination  of  a  dead  body  compulsory 
on  the  part  of  a  medical  man  before  he  grants  a 
certificate  of  death.  That  contention  will  doubt- 
less meet  with  the  approbation  of  most  members 
of  the  medical  profession. 


PERSONAL. 


The  Opening  Address  of  the  eighty-eighth  session  of 
the  Royal  Army  Medical  College  was  delivered  last 
week  by  Sir  William  Taylor  to  the  lieutenants  on  Pro- 
bation, 


Dr.  H.  K.  Anderson  has  been  appointed  University 
Lecturer  in  Physiology  in  the  room  of  Dr.  J.  H.  Langley. 
who  resigned  recently  on  appointment  to  the  Pro* 
fc  5  so  rial  Chair. 

Dr.  Alb  an  Dor  an  has  resigned  the  Editorship  of  the 
fumal  of  Obstetrics  and  GyntBCotoity  <j/  the  British 
Empire,  and  Dr.  T.  W,  Eden  has  been  appointed  to 
fill  his  place.  It  will  be  remembered  that  Dr.  Doran 
took  a  leading  part  in  the  establishment  of  the  journal 

Dr.  Samuel  Lloyd,  on  retiring  from  the  medical 
officership  of  the  St.  Giles*  Workhouse,  was,  on  Feb- 
ruary 3rd.  the  recipient  of  a  valuable  silver  salver,  in 
token  of  the  esteem  in  which  he  is  held  by  all  the 
Poor-law  officials  with  whom  he  had  been  brought  in 
contact. 


Mr.  Timothy  Holmes,  F.R.C.5.Eng.,  who  has 
recently  resigned  the  office  of  Treasurer  ol  St.  George's 
Hospital  will  be  entertained  at  a  complimentary  dinner 
at  the  Whitehall  Rooms  of  the  H6tel  Metropole  on 
Saturday ,  February  13th,  at  7  p.m.  The  Earl  of  Cork 
and  Orrery  will  preside. 

Sir  David  Palmer  Ross.  Surgeon -General  of  British 
Guiana,  who  has  been  seriously  ill  for  some  time  past, 
has  been  granted  leave  on  full  pay  until  March  zjXK 
His  duties  have  b^n.  taken  over  by  Dr,  J.  C.  P.  Widdup, 
one  of  the  Government  medical  officers,  who  becomes 
Acting  Surgeon -General. 

The  Annual  Oration  of  the  Hunterian  Society 
will  this  year  be  delivered  by  Dr.  J,  F.  Woods  at  the 
London  Institution.  Fins bury  Circus,  E.G.,  on  Feb- 
ruary 10th.  at  8,30  p.m.  The  Oration  is  open  to  all 
rs  of  the  medical  profession,  and  the  subject 
will  be  the  "  Psychic  Side  of  Therapeutics." 

Dr.  Sidney  Reginald  Dyer,  Medical  Officer  at 
Stafford  Prison,  has  been  appointed  Principal  Medical 
Officer  of  Dartmoor  Convict  Establishment,  Dr.  Dyer, 
who  went  to  Stafford  from  Wandsworth  Prison  in  1900* 
will  be  succeeded  at  Stafford  by  Dr.  Percy  Mander, 
Deputy  Medical  Officer  at  Wandsworth. 

Major  Morgan  has  vacated  his  appointment  as 
Medical  Officer  of  the  Duke  of  York's  School  and  has 


158      The  Medical  Press. 


CORRESPONDENCE. 


Feb.  10,    1904. 


returned  to  India.  Owing  to  his  efforts,  the  question 
of  the  removal  of  the  school  to  healthier  country 
quarters  has  been  carried  to  a  successful  issue.  This 
distinguished  service  to  the  Army  and  to  the  country 
certainly  deserves  public  recognition. 

The  late  Mr.  Powell  Williams,  M.P.  for  South 
Birmingham,  who  was  seized  recently  with  his  mortal 
illness  in  the  House  of  Commons,  was  married,  in  1870, 
to  a  daughter  of  Mr.  Bindley,  a  Birmingham  surgeon. 

Dr.  Argyll-Robertson,  Surgeon-Oculist  to  the 
King  for  Scotland,  was  the  guest  of  the  Cap  and  Gown 
Club  at  a  farewell  dinner  held  in  the  Royal  Hotel, 
Edinburgh,  on  January  30th.  Mr.  G.  W.  W.  Barclay, 
F.R.S.E.,  presided,  and  nearly  one  hundred  visitors 
were  present,  including  many  members  of  the  medical 
profession. 


Dr.  Henry  Richard  Kenwood,  Medical  Officer  of 
Health  and  Public  Analyst  of  the  borough  of  Stoke 
Newington,  has  been  appointed  Professor  of  Hygiene  at 
University  College,  London,  in  succession  to  the  late 
Professor  W.  H.  Corfield.  Dr.  Kenwood  was  Professor 
Corfield's  assistant  for  twelve  and  a  half  years,  and 
some  six  years  ago  was  appointed  assistant  professor. 


Mr.  John  Robertson,  M.D.,  B.Sc.Edin.,  until  re- 
cently Medical  Officer  of  Health  of  the  City  of  Sheffield, 
and  now  holding  a  similar  appointment  in  Birmingham, 
was  entertained  at  dinner  on  January  28th  by  members 
of  the  medical  profession  and  by  his  late  colleagues  on 
the  staff  of  University  College,  Sheffield,  and  presented 
with  various  pieces  of  rare  and  valuable  silver  ware. 


Special  Correspondence* 

[FROM   OUR   OWN   CORRESPONDENT.] 


SCOTLAND. 

Progress  of  Small-pox. — During  the  last  fortnight 
of  January  316  cases  of  small-pox  were  intimated  to 
the  Local  Government  Board.  The  counties  in  which 
cases  have  occurred  are  Lanark,  Ayr,  Stirling,  Renfrew, 
Banff,  Dumbarton,  Edinburgh,  Fife,  Kincardine, 
Linlithgow  and  Perth.  The  local  incidence  of  the 
epidemic  has  so  far  been  greatest  in  the  burgh  of 
Govan  (5*23  per  10,000  of  the  population). 

Aberdeen  Asylum. — The  directors  have  under 
consideration  the  question  of  completing  the  building 
scheme  undertaken  in  1892,  involving  the  reconstruc- 
tion of  the  main  building  and  the  erection  of  new  re- 
creation rooms.  A  good  opportunity  for  the  carrying 
out  of  the  work  is  offered  by  the  impending  removal 
of  one  hundred  of  the  patients  belonging  to  'the  city 
parish,  which  will  do  away  with  the  overcrowding  at 
present  existing,  and  facilitate  the  rebuilding  opera- 
tions. 

Glasgow  Royal  Infirmary  Reconstruction. — 
A  public  meeting  has  been  held  in  Glasgow  with  the 
object  of  furthering  the  raising  of  funds  for  this  object. 
The  idea  of  reconstructing  the  whole  building  has 
evolved  from  the  Diamond  Jubilee  scheme,  which  was 
restricted  to  the  front  block  only.  For  some  time 
difference  of  opinion  existed  as  to  the  advisability  of 
rebuilding  on  the  present  site,  but  the  general  view 
now  is  that  it  would  probably  be  difficult  to  get  a  better 
site  in  all  respects  than  the  present  one.  and  the  ques- 
tion is  now  beyond  the  reach  of  discussion.  The 
funds  in  hand  include  £86,500  ear-marked  for  the 
Jubilee  memorial  front,  and  of  the  £200,000  required 
to  complete  the  building,  £78,000  has  been  subscribed. 
At  the  close  of  the  meeting  it  was  announced  that 
another  £1,200  had  been  received,  and  a  committee 
was  appointed  to  promote  the  supplementary  fund. 

Morrison  Lectures. — The  present  course  of  Mor- 
rison Lectures  was  delivered  by  Dr.  John  Macpherson, 


Commissioner  in  Lunacy,  in  the  Hall  of  the  College  of 
Physicians,  of  Edinburgh  during  the  last  week  of 
January.  Taking  as  his  subject,  "  Variation  in  its 
Relation  to  the  Origin  of  Insanity  and  the  Allied 
Neuroses, M  Dr.  Macpherson  devoted  his  first  lecture  to 
the  laws  of  heredity,  the  extent  of  variation,  and  to  the 
phenomena  of  genetic  selection,  regression,  correlation, 
and  the  distribution  of  mental  characters.  He  adopted 
the  views  of  Wiessmann.  which  had  received  direct 
confirmation  from  Beard's  researches,  that  descent 
is  through  the  germ  cells  alone,  and  pointed  out  that 
the  view  that  a  child  inherited  directly  from  his  father 
was  a  cause  of  confusion  of  thought  about  the  matter. 
He  next  described  the  methods  ot  the  mathematical 
school  of  biological  investigators,  among  whom  Karl 
Pearson  is  so  prominent  a  figure,  and  showed  that 
psychical  characters  were  distributed  according  to 
the  same  curve  of  probability  as  physical  attributes. 
In  the  succeeding  two  lectures  the  idea  of  disease  as  a 
variation  was  elaborated ;  first,  the  conception  of 
monstrositities  of  various  kinds  as  variations  being 
illustrated,  and  then  the  analogy  being  extended  to 
idiocy,  epilepsy,  hysteria,  and  alcoholism.  These 
variations  had  neither  racial  nor  geographical  limita- 
tions ;  some  of  them,  like  monstrosity,  were  not  even 
limited  to  man,  but  occurred  in  the  lower  animals. 
Alcoholism  was  defined  as  a  variation  from  the  normal 
characterised  by  a  craving  for  artificial  mental  states 
produced  by  drugs.  In  conclusion,  the  lecturer  said 
that  recent  observations  referred  to  showed  that 
variation  fell  under  the  mathematical  theory  of  pro- 
bability, and  if,  as  he  thought  he  had  shown,  the 
neuroses  he  had  been  considering  were  constant  varia- 
tions, universally  distributed  throughout  mankind 
and  the  lower  animals,  and  hereditary,  they  could 
neither  be  due  to  chance  nor  to  environment,  but  to 
genetic  selection. 


Correspondence* 


[We  do  not  hold  ourselves  reepontible  for  the  opinions  of  our 
Correspondents.] 


ALOPECIA  AND  DENTAL  CARIES. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — The  authorities  upon  whom  "  Medicus  Senex  " 
relies  for  his  pronouncements  on  dental  physiology  are 
a  good  deal  more  out  of  date  than  mine  ;  in  fact,  they 
are  passed  senility  and  are  dead.  More  than  forty 
years  ago  the  late  Sir  John  Tomes,  the  first  dental 
physiologist  to  work  in  the  light  of  modern  science, 
overthrew  the  fancies  of  ancient  pathologists  by  his 
demonstration  of  the  true  character  of  the  hard  dental 
tissues.  Since  then,  no  physiologist  or  pathologist  with 
the  least  valid  claim  to  authority  has  questioned  the 
fact  that  enamel  and  dentine  are  incapable  of  physio- 
logical or  pathological  activity.  Enamel  contains  a 
barely  recognisable  trace  of  organic  matter ;  and  the 
basic  mass  of  dentine  is  almost  as  lowly  organised.  I 
quite  agree  with  "  Medicus  Senex,"  and  so  does  every 
dental  physiologist,  that  it  would  be  "  bold  to  affirm 
a  similar  fact  with  regard  to  bone."  Even  the  densest 
bone  has  a  free  permeating  vascular  supply,  whilst  the 
dental  tissues  have  none.  From  other  avascular  tissues, 
like  the  cornea  and  cartilage,  they  are  differentiated  by 
the  fact  that  they  contain  no  cell  elements  capable  of 
carrying  on  processes  of  nutrition.  The  physiology  of 
enamel  and  dentine  is  beyond  all  controversy  demon- 
strated, and  is  easily  demonstrable.  "  Medicus  Senex" 
will  find  the  whole  story  in  Sewill's  "  Dental  Anatomy 
and  Surgery,"  or  in  any  similar  book  of  the  day.  Once 
formed,  the  hard  dental  tissues  can  undergo  changes 
only  by  action  of  external  agents ;  to  suggest  the 
possibility  of  degeneration  in  enamel  and  dentine  is 
absurd.  The  tissues  are,  however,  often  badly  made, 
owing  to  interference  with  the  process  of  calcification ; 
and  this  may  show  itself  in  the  external  form  of  the 
teeth,  as  in  honeycombed  or  spinous  crowns,  or  in  the 
typical  syphilitic  teeth  of  Hutchinson.  These  latter, 
I  would  say  in  passing,  are  extremely  rare,  not  being 
present  in  more  than  1  per  cent,  of  affected  children, 


Feb.    10,  1904. 


NEW  BOOKS  AND  NEW  EDITIONS.    The  M,p.cai.  p^,    159 


although  other   malformed    teeth  are  often   mis  taken 
lor   them       ^    ilecadent    subject    may    have   defective 
J  tissues,  but  the  causes  have  ceased  to  operate 
ir  v    in    life      The    temporary    crowns    are    all 
c&lcitie-l  a*  birth,  and  by  this  time  the  first  permanent 
.  ■-.    incisors,    and    canines    are    far    advanced    in 
development.     Then,     again,     the    action    of    micro- 
'loes  not  in  the  least  resemble  the 
phenomena  of  disease*  affecting  vascular  tissues,  or  of 
stoic  nature.     Acid  is  the  agent  in  dental  canes, 
ttlC  acid  is  produced  by  fermentation  in  organic, 
matter,   of  course  due  to  organisms*     |The  organisms 
rate  in  the  dentinal  tubes,  and  are  always  found 
in  caries,  but  they  are  acting  as  external  agents 
and  noL  setting  up  a  pathological  process  such  as  occurs 
Igbly organised  structures.     The  analogue  to 
alnpecta  among  dental  diseases  would   be  premature 
■  f  the  permanent  teeth,     This  is  not  a  com- 
ic nor  a  characteristic  of  degenerates.     Slow 
Dg  of  the  alveoli  accompanied  by  suppuration — 
pyorrhea     areolaris — is     a     commoner     disease.     It 
occurs  mostly  in  mouths  singularly  free  trom  caries, 
-  by  nrt  means  a  disease  of  individuals  physically 
inferior.     This  malady  has  many  points  of  resemblance 
a  fact  which  was  noted  some  years  ago  in- 
iy   by   Mr,    Jonathan   Hutchinson   and    Mr. 
I  have  taken  some  space  in  these  explanations, 
and  I  trust  you.  Sir,  will  not  think  it  excessive,     I  admit 
that  the  pathology  of  the  teeth  la  the  last  thing  about 
practitioner  of  medicine  needs  to  be  fully  in- 
fnrmecL     It  is  impossible    for  any  man  to  be  a  walking 
1 1  in  of  the  whole   range  of  medical   science. 
But   I   would  suggest  that  the  solution  of  problems  of 
pathology  associated  with  the   teeth  is   not   likely   to 
•moled  by  writers  who  have  not  taken  paini  to 
make  themselves  properly  acquainted  with  the  funda- 
k  of  dental  physiology, 
1  Jin.  Sir,  yours  trulv. 
February  4th.    1904-  M,R.C,S„  L.D.S, 


THE  PATHOLOGY  OF  CUTANEOUS  ERUPTIONS. 

/  The  Medical  Press  and  Circular, 

Sir, — I  am  ^lad  to  see  that  Dr.  Walsh,  and,  1  hope, 

many  others,  regard  the  study  oi  cutaneous  disen 

1  very  different  way  from  that  in  which  it  was  regarded 

years    ago*     It    was  in    1865   that    I   1; 

1. 1  Professor  Hard)  and  Professor  Behier,  in 
that  the  term,  "dermatoses," 
special  sense  might  be  expanded   into 
"dermatitis/1  as  a  term  more  useful  to,  and  consistent 
English  pathology.     The  simple  fact  that  at  a 
hospital  it*  per  cent,  of  the  total  cases  came 
under  the  class  of  skin  diseases  was  perhaps   the  chief 
it  that  my  attention  was  directed  to  the  study  of 
cuUntfoos  disease.     It  seemed  to  me  far  more  import- 
ant t  the    causes  of   these  diseases   than   the 
minute  variations  presented  in  the  character  of  erup- 
tions;  and  that  in  the  treatment  of  such  cases  it  was 
lecessary  to  study  the  constitutional  causes 
of  ihem  than  to  deal  with  them^in    the  very    limited 
and   unscientific  method   that   seemed    to   have  been 
ip  to  that   time      Why  those  who    devoted 
•juld  have  been  regarded 
vnli  contempt  by  the  leaders  of  the  profession  is  easily 
rstood.     Happily  things  are  changing. 

I  am.  Slt,  yours  truly, 

Robert  Lee. 


THE     TEACHING     OF    HYGIENE    AND 
TEMPERANCE. 
f  Tue  Medical  Press  and  Circular. 
mr  — d  have  no  intention  of  raising  any  discussion 
r  merit*  oi  total  abstinence,  but  with  regard  to 
11   referred   to  in   your  annotation,   I   may 
he  allowed    tp    point   out   that   considerable  stress   in 
virion*  paragraphs  is  imposed   on    the   word    "  tern- 
pcrau-  I  think  that  it  would  be  interesting  to 

blow  the  definition  or  meaning  conveyed  by  the  peti- 
temperance  and  total  abstinence  nowadays 
ipoear  ^>  often  to  be  used  synonymously,       Supposing 
however,  the  latter  should  be  advocated  in  any  of  the  | 


schools*  I  would  suggest  the  statistics  in  support 
thereof  should  be  taught,  duly  qualified  with  regard  to 
their  uncertainty. 

Some  tune  ago  I  attempted  in  vour  columns  to  point 
OUl  to  asylum  officials  that  the  difficulty  of  deter- 
mining how  far  drink  played  its  part  as  a  factor  in 
determining  any  given  case  of  drink  as  a  cause  of  in- 
sanity was  so  complex  as  to  be  well  nigh  insuperable, 
and  I  may,  by  the  way,  refer  to  the  painful  and  iftnsa- 
tional  case  of  suicide,  which  lately  occurred  to  a  much- 
respected  lady  doctor  on  the  staff  of  a  London  hospital, 
whose  habits  were,  according  to  the  evidence,  un- 
doubtedly abstemious,  if  not  of  total  abstinence.  Now, 
sir.  I  venture  to  state  that  if  this  lady  hat!  hcen  other- 
wise asylum  statisticians  would  have  tabulated  the 
insanity  due  to  excess  of  drink.  On  the  other  hand. 
I  suggested  that  alo  hoi  under  s  >me  nervous  conditions 
might  tend  to  prevent  insanity  by  helping  to  maintain 
the  general  health.  So  I  submit,  teachers  cannot  be 
too  guarded  m  enunciating  dogmas  which,  if  viewed 
with  a  critical  eye,  may  turn  out  to  be  erroneous. 
I  am,  sir,  yours  truly, 

Clement    H.    Sees. 

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A  MEDICAL  MARTYR. 


THE  LATE  DR.  W.  J.  CONEYS,  OF  ROUNDSTONE. 

In  our  issue  for  January  27th,  we  gave  a  full  account 
of  the  heroic  devotion  to  duty  and  the  untimely  death 
of  this  practitioner.  He  had  to  visit  one  of  those 
wretched  hovels,  in  which  escape  from  infection  is 
almost  impossible.  His  patient  died,  and,  in  his  own 
words,  "  I  could  not  get  a  man  for  love,  whisky,  or 
money  to  help  me,  and  I  was  obliged  to  coffin  the 
corpse  along  with  the  nurse  and  another."  But  the 
duty  was  heroically  undertaken,  and  his  life  given  for 
his  patient.  He  in  turn  was  devotedly  nursed  by 
Dr.  Gorham,  of  Clifden,  and  when  the  end  came  and 
Dr.  Coneys'  servants  and  friends,  fearing  infection, 
would  not  approach  the  sick  room,  Dr.  Gorham,  with 
the  assistance  of  the  nurses,  was  obliged  to  himself 
place  Dr.  Coneys  in  his  coffin.  All  honour  to  such 
heroism. 


WILLIAM  DONALD,  M.D.ABERD. 
With  regret  we  announce  the  death  of  Dr.  William 
Donald,  at  Aberdeen,  on  January  x8th.  For  a  year  or 
more  he  had  suffered  from  a  painful  internal  malady, 
and  some  two  months  ago  it  was  found  necessary  to 
have  him  removed  to  Aberdeen  for  the  purpose  of 
undergoing  a  surgical  operation.  This  was  successfully 
performed,  and  for  a  time  it  seemed  as  if  recovery 
would  ensue,  but  he  ultimately  died  at  the  compara- 
tively early  age  of  51.  Dr.  Donald  was  the  eldest  son 
of  William  Donald,  M.D.,  Bogside  of  Eden,  Aberdeen- 
shire, and  graduated  at  the  University  of  Aberdeen  as 
M.B.  and  CM.  in  1873.  He  passed  the  next  few  years 
in  Banff,  whence  he  went  to  Colombo,  Ceylon,  where  he 
was  district  medical  officer.  Returning  from  Ceylon 
more  than  a  quarter  of  a  century  ago.  Dr.  Donald 
settled  in  Banff  and  in  time  made  for  himself  a  large 
practice.  He  held  various  local  appointments,  among 
others  those  of  visiting  surgeon  to  the  Chalmers 
Hospital,  and  certifying  surgeon  under  the  Factory  Act. 

^  DR.  OWEN,  M.D.,  M.R.C.S.,  L.S.A. 
We  regret  to  announce  a  sad  ending  to  a  busy  life 
on  the  last  day  of  January,  when  Dr.  Owen,  M.D., 
M.R.C.S.,  L.S.A.,  was  found  partially  dressed  at  the 
bottom  of  the  staircase  in  the  cottage  in  which  he  had 
resided  of  late  years.  His  groans  attracted  a  passer-by. 
who  burst  open  the  door,  to  find  the  doctor  as  stated 
above.  Help  was  sent  for,  but  before  one  of  his 
colleagues  could  come  he  was  dead.  Dr.  Owen,  who 
qualified  as  far  back  as  1867,  was  at  one  time  the  medical 
officer  of  the  whole  of  the  Bromyard  Union,  which 
comprised  thirty-two  parishes,  some  of  them  a  radius 
of  sixteen  miles  apart,  and  this  he  did  all  on  horseback. 

MR.  R.  E.  SMITH. 
Mr.  R.  E.  Smith,  the  village  surgeon  at  Finching- 
field,  and  medical  officer  to  the  Braintree  Union,  met 
with  his  death  on  February  3rd  from  the  kick  of  a  pony. 
On  the  previous  day  the  doctor  was  shooting  with  a 
party  at  Spain's  Hall,  and  the  host  (Mr.  A.  W.  Ruggles- 
Brise)  was  riding  a  pony,  from  which  he  dismounted  on 
coming  to  a  hedge,  and  the  animal  ran  through.  Dr. 
Smith  attempted  to  seize  the  bridle,  but  missed  it,  and 
as  the  pony  passed  him  it  kicked  out,  striking  the 
doctor  a  severe  blow  in  the  face,  rendering  him  tem- 
porarily blind  and  unconscious.  He  was  at  once 
attended  by  neighbouring  medical  men  and  by  a 
specialist  from  Cambridge,  but  he  succumbed  to  his 
injuries.  Mr.  Smith  was  medical  officer  of  Finching- 
field  and  look  the  L.R.C.S.I.  in  1894. 


dDe&tcal  Hews. 


150  Danish  Soldiers  Poisoned  by  Pork. 

The  poisoning  of  no  less  than  1 50  soldiers  is  reported 
from  the  garrison  of  Aarhus,  in  Denmark.  The  cause 
of  poisoning  is  probably  due  to  the  preparing  of 
pickled  pork  in  zinc  pans  which  were  insufficiently 
cleaned.  All  the  soldiers  to  a  greater  or  less  degree 
are  suffering  from  severe  gastric  intestinal  irritation. 
The  remaining  pork  has  been  sent  for  bacteriological 
examination. 

London  School  of  Medicine  for  Women. 

The  annual  meeting  of  the  London  (Royal  Free 
Hospital)  School  of  Medicine  for  Women  was  held  last 
week.  Mr.  Holroyd  Chaplin  presided.  The  report 
presented  by  the  council  showed  a  favourable  position 
as  regarded  the  entry  of  students,  and  also  as  regarded 
their  success  in  examinations.  At  the  University  of 
London  two  scholarships  and  two  gold  medals  had 
been  obtained  by  students  of  the  school.  In  the 
matter  of  hospital  appointments  also  the  outlook  was 
good.  Several  hospitals  and  infirmaries  had  for  the 
first  time  appointed  medical  women  to  resident  posts, 
and  at  the  Lambeth  Poor-law  Schools  a  woman  had 
been  selected  as  medical  officer  from  a  large  number  of 
candidates.  The  financial  position  of  the  school,  it  was 
pointed  out,  was  improved,  but  could  never  be  wholly 
satisfactory  until" the  debt  of  £5.000  on  the  buildings 
was  cleared,  and  it  was  strongly  urged  that  an  effort 


Fts*  iOp  1904. 


MEDFCAL  NEWS. 


The  Medical  Press.     161 


should  be  made  to  hnd  some  generous  donors  to  help 
in  this  by  larger  or  smaller  contributions*  Among 
those  elected  as  members  of  the  Association  were  Sir 
Victor  and  Lady  Horsley,  Lady  Lockyer,  and  Pro- 
fessor and  Mrs.  Ayr  ton 

Eecfl  at  Plague  Scarp. 
J  a  connection  with  the  death  of  two  Chinamen  in 
the  Seamen's  Hospital,  Greenwich,  last  month  in 
circumstances  giving  rise  to  the  suspicion  of  plague, 
the  Public  Health  Committee  of  the  London  County 
Council  reports  that  medical  investigation  shows  that 
the  men  died  of  influenza,  Two  other  cases  ol  sys- 
poaous  sickness  in  Limehouse  were  also  investigated 
■  '.r.  Canine,  who  was  satisfied  from  the  clinical 
symptoms  that  there  was  no  question  ol  plague  in 
either  insta: 

me  German  Birth-Bate. 
The"  steady   decrease   in   the  number  of   births   in 
my  during  the  last  few  decades  is  a  marked  and 
unsatisfactory    leature    of    the    social    and    economic 
uons  of   the  empire*     From    1870  to    t88o,   the 
number  of   births  was  40  for  every  thousand  inhabi- 
taats ;   during  the  following  decade  it  fell  to  38*2  per 
I    and  from  1890  to  1900  it  was  not  more  than 
per  1,000  or  about  as  much  as  during  the  Fifties. 
i  decrease,  however,  has  hitherto  been  compensated 
the  decrease  in  mortality.     From  1890  to  1900,  for 
the  death-rate  decreased  by  more  than  two 
I#ooo.     In   Berlin   the  decrease  in   the   birth-rate 
been   especially    marked,    the     total     number   of 
m  the  capital  being    1,700  less  in  1905  than  two 
years  ago.     The   actual    number   of    births   m    Berlin 
▼as  49,000  in  1903.  52,250  in  loot- — Standard, 
Four  Fatlents  Poisoned  at  a  Lunatic  Asylum. 
Four   female  patients  have  been  accidentally  poi- 
soned at   Portsmouth  Lunatic  Asylum.     It   has  been 
in  at  that  institution  to  "administer  soothing 
ch%s  to  violent  patients  when   there  is  a  danger 
they  will  get   beyond   control.     On  Wednesday 
•  Era tight  composed  of  bromide  of  potash  and 
ral  was  administered    to   four  female  patients  by 
ersoJ  Miss  Watson,  the  lady  doctor.     Two  hours 
were  all  four  taken  ill,  and,  in  spite  of  the 
unremitting  efforts  of   the  medical   staff   and    nurses, 
ol  the  women  died  that  night  and  the  other  two 
i.:i  Thursday.     The  cause  is  supposed  to  be  an  overdose 
oral.     Similar  draughts  had  been  administered  on 
fanner  occasions   with  satisfactory  results,  and  it  is 
stated  that  the  doses  given  to  the  four  women  were 
r  than  usual. 
Medical  Sickness  and  Accident  Society 

eetxng  of  the  Executive  1 

mitte€    OJ    the    Medical    -  Annuity,    and    Life 

iety  took  place  on  the  29th  ttlt>,  at    420 

Strand    \V  accounts  presented  show  that  the 

Imsiness  is  in  a  very  healthy  atate,  and  the 

report  for  1905  to  be  presented  to  the  mem  tiers  in  May 

next   Will    be    found    very   satisfactory.     Prospectuses 

ulars  of  Mr,    F.   Addiscott,   Secretary, 

ess  and  Accident  Society,  33  Chancery 

Lane,  London,  WC. 

Sewage  polluted  6 toll  Fish, 
llig  report  mi   the  public  health  of  the  City,  Dr. 
Ige,  the  medical  officer  of  health,  alludes  to 
report  of  the  Royal  Commission  on  Sewage 
I    and    Disposal    on    the   Contaminat3> 
r,    and    cordially  approves   of   the   pr- 
remedial  measures.     He,"  however,  considers  that  the 
lor  the  Thames  should  be  the  Corporation  as 
Authority  so  far  as  its  jurisdiction  over 
extend*.     Dr,  Gollingridge  proceeds  to  refer 
to  a  discovery  of  sewage-polluted  mussels  from  South 
The    dealers   in    Billingsgate    had    sold    the 
Is  in  accordance  with  instructions  received  from 
the  Pi  '  ompany,   namely,   to  caution  pur- 

for  t  hree  and  a  hal  ( or  f o  ur  minu  t  es . 
■  ited  a  notice  to  that  effect.     That 
was  a  m>i  ry  mode  of  dealing  with  the 

matter.     The  mussels  were  known  to  be  sewage  con- 
iated,  and  therefore  dangerous  to  health,  an 


no  circumstances  could  there  beany  sufficient  guarantee 
that  the  recemmendation  would  be  properly  earned 
out.  As  mussels  were  largely  imported  from  Holland 
at  this  season,  the  facts  were  brought  to  the  knowledge 
of  the  Board  of  Agriculture  and  Fisheries,  the  Local 
Government  Board,  the  Netherlands  Government,  and 
the  Fishmongers'  Company.  Since  then  three  cases 
of  enteric  fever  arising  from  mussels  purchased  in  the 
City  had  been  reported.  In  these  instances  the  mussels 
came  frcm  Hadleigh,  Essex,  The  proprietors  of  the 
layings  had  given  an  undertaking  to  sell  no  more 
Hadleigh  mussels  until  they  were  declared  free  from 

i  contamination*  The  Fishmongers'  Company  and  the 
Netherlands   Government    were    co-operating  with   a 

j  view  to  having  a  thorough  investigation  made  of  the 

I  conditions  under  which  mussels  were  cultivated  and 

f  exported  to  tins  country. 

Ventilation  on  Scientific  Principles. 

The  "  Boyle  "  system  of  ventilation  having  been 

:  successfully  applied  to  the  Spanish  Cortes,  Madrid,  it  is 

I  now    to   be   tamed   out.   by  direction   of   the   French 

Government,    for   the   %'entilation    of    the   Musce  du 

Louvre,  Paris.     It  is  also  proposed  to  apply  the  same 

system  to  the  Chamber  of  Deputies,  the  mechanical 

appliances    tried    in     that     building,     including     the 

"  Plenum,*'  having  proved  failures. 

Lead  in  Cream  of  Tartar, 

At  West  Ham,  Messrs.  Leverett  and  Frye,  Limited, 
grocers,  were  summoned  for  selling  cream  of  tartar 
ffhich  was  not  of  the  nature,  substance,  and  quality 
demanded.  On  December  22nd,  one  of  Dr,  Sanders* 
assistants  bought  a  quarter  of  a  pound  of  cream  of 
tartar  for  jd,  at  the  defendants'  shop.  Dr,  Dver 
(analyst)  said  that  the  sample  he  anaJvsed  contained 
lead  in  the  proportion  of  rather  more  than  one  grain  to 
the  pound.  The  effect  would  be  to  render  it  injurious 
to  the  health  of  anyone  who  consumed  it.  Mr,  Beck* 
for  the  defence,  said  that  no  one  suggested  that  the 
defendants  were  responsible  for  this  lead  in  the  cream 
of  tartar.  Its  presence  was  to  be  accounted  for  solely 
by  reason  of  the  mode  of  manufacture,  and  the  de- 
fendants were  merely  the  victims  of  the  foreign  manu- 
facturers. Mr.  Gillespie:  You  suggest  you  were 
iustified  in  selling  it  with  this  lead  in  ;  Mr.  Beck  ; 
Without  any  knowledge  that  we  were  selling  an  article 
containing  lead.  What  my  Friend  is  putting  up  is  the 
standard  of  the  1398  British  Pharmacopoeia,  Mr.  Beck 
added  that  in  the  new  Pharmacopoeia  cream  of  tartar 
was  referred  to  as  "  purified  cream  of  tartar."  Mr. 
Gillespie  said  he  did  not  suppose  for  a  moment  that 
the  defendants  wilfully  put  lead  into  this  cream  of 
tartar,  but  on  the  evidence  it  was  shown  that  its  pre- 
sence could  be  discovered  wjth  ordinary  precautions. 
He  imposed  a  fine  of  j£iq,  including  cos 

Inter  national  Congress  of  Dermatology, 

The  fifth  Intel  national  Congress  of  Dermatology 
will  be  held  at  Berlin  from  September  12th  to  17th, 
1904,  Prof c  lident     The  follow- 

ing questions  will  be  discussed  ;  (1)  Skin  afiectii  1 
anomalies  of  metabolism  ;  (2)  syphilitic  djseases  of  the 
circulatory  organs  ;  (3)  epithelioma  and  its  treatment  ; 
f4)  (it)  the  State  ol  matters  as  to  the  distribution  of 
!  its  repression  since  the  Leprosy  Conference 
of  1897  :  [b)  the  present  state  of  knowledge  as  to 
anaesthetic  leprosy*  All  communications  should  be 
addressed  to  the  General  Secretary,  Sanatatsrat  Dr, 
Qt  Rosenthal,  Putsdammerslrasse  121   g,   Berlin, 

Trinity  College.  Dublin, 

At  the  examinations  during  Hilary  Term,  1904*  **'».■ 
following  candidates  passed  : — 

Final' in  Mtdui/ try.  —Charles  J.  Coppiuger,  Keith 
U,  C,  Hallowes,  Richard  C.  Hallowes,  Henry  M.  Craw* 
ford,  William  M-  Wade,  Rev.  Richard  B,  Bryan. 
Cecil  J*  Wyatt.  David  C,  Pearson,  Owen  J,  Parry- 
Edwards,  Maurice  FitzGibbou,  Harold  T*  Marrabfe, 
Thomas  Wilson.  Hugh  Stewart,  Section  B, — John 
Cunningham.  Robert  Magill,  John  A.  SiMhorpe, 
James  H.  C.  Thompson,  Wilfred  L,  Myfes. 


1 62    The  Medical  Press- 


NOTES  ON  CURRENT  TOPICS. 


Feb. 


io,  1904. 


Jtotias  to 
HLoxtzzvoxtbtrdB,  $hxrrt  ICettars,  &c 

f^T  Ooeempoicdekts  requiring  a  reply  in  this  column  are  particu- 
larly requested  to  make  use  of  a  dUtinctivt  signaiwrt  or  initial,  and 
avoid  the  practice  of  signing  themselves  "Reader,"  "Subscriber," 
11  Old  Subscriber/'  60.  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

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

Reprints.— Reprints  of  articles  appearing  in  this  Journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

Orioinal  Articles  or  Lbttkrs  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

THE  HUMAN  HYMEN. 

This  structure  which  anatomists  term  the  hymen  has  proved  an 
almost  insoluble  problem  to  biologists,  and  in  human  affairs  has 
exercised  an  influence  over  religious  ritual,  legal  rights  and  social 
procedure  which  cannot  well  be  estimated,  and  is  impossible  to  express 
adequately.  Metchnikoff,  in  his  remarkable  work  on  "The  Nature  of 
Man,"  in  the  study  of  disharmonies  of  reproduction  points  out  that 
the  hymen,  the  physical  indication  of  virginity,  is  peculiar  to  the 
human  race.  It  is  alwent  in  the  anthropoid  apes,  and  even  in  the 
development  of  the  female  foetus  this  structure  appears  late,  evidently 
indicating  that  it  is  a  comparatively  late  acquirement.  No  one  has 
satisfactorily  explained  its  utility.  It  has,  of  course,  played  an  im- 
portant part  in  judicial  procedure,  and  much  moral  significance  has 
been  given  to  it,  but  as  far  as  can  be  ascertained  it  is  of  no  functional 
value.  In  certain  countries  it  is  regularly  destroyed  as  part  of  the 
toilet  of  young  children.  It  is  of  no  distinct  service  in  the  sexual 
progress,  and  may  even  prove  a  bar  to  marital  duties.  It  is  remark- 
able that  a  structure  which  has  no  great  ancestral  heritage,  is 
functionless  and  non-essential  to  sexual  union,  should  persist  in 
spite  of  its  almost  unavoidable  rupture  in  the  process  of  childbirth. 
It,  however,  affords  a  powerful  argument  against  the  transmission  of 
acquired  characters. 

Edinburgh.— A  short  paper  on  "The  Treatment  of  Phlegmasia 
Alba  Dolens "  reached  us  a  few  weeks  since  with  the  Edinburgh 
postmark  on  envelope,  but  no  name  attached  to  the  article.  We 
shall  be  glad  if  the  writer  will  kindly  communicate  with  us. 

Dr.  H.  R.  S.— The  supposition  is  a  common  one,  bat  the  similarity 
exists  in  name  only. 

AN  Anxious  Oms.— The  instrument  to  which  you  refer  is  an 
American  invention  styled  "  The  Massacon,"  the  object  of  which  is  to 
break  down  or  reduce  the  thickening  around  the  ossicles  in  middle 
ear  deafness  by  electro-massage.  The  instrument  was  introduced  to 
the  profession  in  this  country  at  the  Manchester  Congress  of  the 
British  Medical  Association  in  1902,  and  we  believe  success  has 
attended  its  use  in  certain  cases,  but  we  know  nothing  of  it  from 
personal  experience. 

H.  P.  P.— Try  radium  without  a  moments  loss  of  time— the 
malignant  growth  you  describe  is  within  easy  reach.  It  is  necessary, 
however,  to  make  sure  that  your  radium  is  of  the  best  quality. 

^ftcettngs  of  the  §oactiee,  %ttt\ms9  &c# 

Wednesday,  February  10th. 

Hunteriax  Society  (London  Institution,  Finsbury  Circus,  EX.). — 
8  p.m.  Annual  Meeting.  8.80p.m.  Dr.  J.  F.  Woods :  The  Psychic 
Side  of  Therapeutics.    (Huntenan  Oration.) 

D sb mato logical  SociKTT  of  London  (11,  Chandos  Street,  Cavendish 
Square,  W.)  .--5.15  p.ra.    Demonstration  of  Cases  of  Interest. 

South-West  London  Medical  Socirtt  (Bolingbroke  Hospital, 
Wandsworth  Common).— 8.45  p.m.  Sir  Felix  Semon  :  Some  Desultory 
Remarks  on  Topics  of  Professional  Interest. 

Medical  Graduates'  Oollbqk  and  Polyclinic  (22,  Chenies  Street, 
W.C.).— -4   p.m.    Mr.  B.  Harrison :   Clinique.     (Surgicai)    5.15  p.m. 
Mr.  J.  Poland :  The  Treatment  of  Congenital  Club-foot. 
Thursday,  Fbbruary  11th. 

Harvbian  Society  or  London  (Stafford  Rooms.  Titchborne  Street, 
Edgware  Road,  W.).— 8.30  p.m.  Papers  .—Mr.  E.  Owen  :  Appendix 
Access  in  the  Rectovesical  Pouch.— Mr.  E.  W.  Houghton  :  A  Case  of 
Intestinal  Obstruction  with  Gangrene  of  the  Caecum,  Recovery. 

British  Gynaecological  Society  (20,  Hanover  Square.  W.).— 8  p  m. 
The  President  (Prof.  J.  Taylor):  Inaugural  Address.  Papers  will  be 
read  and  specimens  shown  by  Dr.  G.  Atkins,  Dr.  W.  Duncan,  Dr; 
Macnaughton-Jones,  Dr.  Snow,  and  Mr.  Span  ton. 

Ophthalmoloqical  Society  or  tub  United  Kingdom  (11,  Chandos 
Street,  Cavendish  Square,  W.).— 8  p.m.  Cases  will  be  shown  by 
Mr.  A. Ogilvy,  Mr.  S.  Stephenson,  and  others.  8.30  p.m.  Papers:— 
Dr.  A.  Brown  :  Notes  on  a  Case  of  Gonorrheal  Conjunctivitis  in  an 
Adult  Treated  with  Peroxide  of  Hydrogen.— Mr.  J.  H.  Parsons :  On 
Congenital  Anterior  Staphyloma.— Major  H.  Smith,  I.M.3. :  (1) 
Light-blindness :  (2)  Lens  Couching. 

Medical  Graduates'  College  and  Polyclinic  (22,  Chenies  Street, 
w*.C.).— 4  p.m.  Mr.  Hutchinson :  Clinique.  (Surgical.)  6.15  p.m. 
Dr.  G.  Brodie :  The  Pathology  of  Uremia. 

Mount  Vernon  Hospital  for  Consumption  and  Diseases  op  the 
Chest  (7,  Fitxroy  Square,  W.).— 5  p.m.  Dr.  F.  P.  Weber :  The  Rela- 
tions of  Pulmonary  Tuberculosis  to  other  Diseases.  (Post- Graduate 
Course.) 


8t.  John's  Hospital  por  Diseases  op  the  Skin  (Leicester  Square. 

JtP-hlJ-S  wW-     J*'   U'   Dock"M:    *™>S»*  Diseases  o?Hab. 
(Chesterfield  Lecture.) 

Friday,  February  12th. 
,«**.  ,^?eIoeat,d    g0C1IeTT  op  Medical  Officers  op  Health 
&  ^*""V1»«^.  W.C.).-7,80  p.m.    Dr.  L.  Stephens: 
Physical  Culture  in  Elementary  Schools.  ^^^ 

HuNTERiAV  Society.— 7  pjn.    Annual  Dinner. 

CLni5iI,a%SS!fT  or  fy™>*  (*>.  Hanover    Square,    W.)-&» 

with  Calculi,  accompanied  by  Jaundice  and  subsequently  by  Diabetes. 
Laparotomy,  Belief  of  Symptoms,  Death. -Dr.  NTbalton :  Two  Cases 
of  Malignant  Anemia  due  apparently  to  Defective  Formation  of  the 
Bed  Blood-corpuscles  and  Associated  with  Caries  of  the  Teeth  aid 
Suppuration  of  the  Lower  Jaw.— Mr.  J.  J.  Clarke :  Notes  on  a  Case 
of  Ankylosis  of  both  Temporo-maxillary  Joints.— Mr.  E.  M.  Corner 
Cases  of  Primary  and  Secondary  Tuberculosis  of  the  Thyroid. 

Medical  Graduates'  College  and  Polyclinic  (22,  Chenies  Street, 
W.C.).-4p.m.    Mr. a  Stephenson:  Clinique.    (Eye.) 

Bamwopd  House  Hospital  for  Mental  Diseases,  Gloucester.-Junior 
Assistant  Medical  Officer,  Salary  £150  a  year,  with  board,  4c. 
Applications  to  the  Medical  Superintendent. 

Birkenhead  Union.— Resident  Assistant  Medical  Officer,  8alary  £120 
per  annum,  with  board,  washing,  and  apartments.  Applications 
to  John  Carter,  Clerk  to  the  Guardians,  Union  Clerk's  Offices 
Birkenhead.  ' 

Caraberwell  House  Asylum.— Second  Assistant  Medical  Officer,  8alary 
£150  per  annum,  with  board,  residence,  and  laundry.  Applica- 
tions to  Medical  Superintendent,  S3,  Peckham  Road,  London, 

Carmarthenshire  Infirmary.— Resident  Medical  Officer,  Salary  £100 
per  annum,  with  furnished  apartments,  board,  attendence,  fire 
gas.  and  washing.   Applications  to  Howell  Howell.  Secretary.     ' 

City  of  Sheffield.-- Second  Assistant  Medical  Officer,  Salary  £150  per 
annum,  with  board,  lodging,  and  attendance.  Applications  to 
H.  8ayer,  Town  Clerk,  Town  Clerk's  Office,  Town  Hall,  Sheffield. 

Joint  Counties  Asylum,  Carmarthen.— Junior  Assistant  Medical 
Officer,  Salary  £150  per  annum,  with  board,  furnished  apart- 
ments, and  washing.  Applications  to  Dr.  Goodall,  Medical 
Superintendent,  The  Asylum,  Carmarthen. 

Kettering  and  District  General  Hospital. —Resident  Medical  Officer, 
Salary  £80  per  annum,  with  board,  residence,  Ac.  Applications 
to  H.  T.  Berry,  Hon.  Sec.,  3,  High  Street,  Kettering. 

Macclesfield  General  Infirmary.— Junior  House  Surgeon,  Salary  £70 
per  annum,  with  board  and  residence  at  the  Institution. 
Applications  to  the  Chairman  of  the  House  Committee. 

Royal  Albert  Edward  Infirmary  and  Dispensary,  Wigan.- Junior 
House  Surgeon,  Salary  £80  per  annum,  with  board,  aparttnenta, 
and  washing.  Applications  to  W.  M.  Taberner,  General  Superin- 
tendent and  Secretary. 

The  Guest  Hospital,  Dudley.— Senior  Resident  Medical  Officer,  Salary 
£100  per  annum,  with  board,  residence,  attendance,  and  wash- 
ing.   Applications  to  the  Secretary. 

The  Royal  Waterloo  Hospital  for  Children  and  Women,  Waterloo 
Bridge  Road,  S.E.— Head  Dispenser.  Applications  to  the 
Secretary.    (See  Adrt.). 

Worcester  General  Infirmary. —House  Surgeon,  Salary  £70  per  annum, 
with  board  and  residence.  Applications  to  William  Stallard. 
Secretary,  Worcester  Chambers,  Pierpont  Street,  Worcester. 


Jlppointmcms. 

Berks  ford,   B.    ds    la    Poer,  M.D.Glasg..  Medical   Examiner  of 

Recruits  for  the  Montgomery  Imperial  Yeomanry  at  Oswestry. 
Corner,    Edred   M.,    M.B.,   B.8  Cantab.,    F.R,O.S.Eng.,  Assistant 

Surgeon  to  St.  Thomas's  Hospital. 
Fry,  W.  W.  B.,  M.B.,  O.M.Edin..  Medical  Examiner  of  Recruits  for 

the  Montgomery  Imperial  Yeomanry  at  Builth  Wells. 
Humphreys,  C.  E  ,  M.R.C.8  ,  L.S.A.,  Medical  Examiner  of  Recruit* 

for  the  Montgomery  Imperial  Yeomanry  at  Llanfalr. 
Jonbs,F.  F..  M.R.C.S.,  L.S.A.,  D.P  H.,  Medical  Examiner  of  RecruiU 

for  the  Montgomery  Imperial  Yeomanry  at  Llanfvllin. 
Kenwood.  H.  R.,  M.B.,  C.M.Edin.,  D.P.H.,  Professor  of  Hygiene  and 

Public  Health  at  University  College.  London. 
Murray,  J.,  M.B.,  C.M.GIassr-,  Medical  Examiner  of  Recruits  for  the 

Montgomery  Imperial  Yeoman  rv  at  Llaridrindod. 
Proctor,  Thomas,    M.R.C.S.,   L.R.'C.P.Edin.,  Medical  Officer   and 

Public  Vaccinator  for  the  Fifth  District  of  the  Chipping  Sodburv 

Union. 
Richardson,  F.  L.  C,  L.R  C.P.  and  8.Ediu.,  Medical  Examiner  of 

Recruits  for  the  Montgomery  Imperial  Yeomanry  at  Rhayader- 
8ALTBR,  F.  W.,  L.R. C.P.  and  S.Edin..  Medical  Examiner  of  Recruits 

for  the  Montgomery  Imperial  Yeomanry  at  New  Mills. 
Smith.  William  Robert.  M.D.,  B.S.Lond.,  F.R.C.S.Eng.,  Assistant 

Surgeon  to  the  Hospital  for  Women,  Nottingham. 


girths. 


Dawson.— On  February  4th,  at  32,  Wimpole  Street,  W..  the  wife  of 
Bertrand  Dawson,  MD.,  F.R.C.P.,  of  a  daughter. 

Smith  —On  February  5th,  at  Waldon  House.  Watford,  the  wife  of 
G.  Fiancis  Smith,  MR.CS.Eng.,  L.R.C.P.LoncL,  of  a  daughter. 


gatilts. 


Cheese.— On  February  7th,  at  Woodville  House.  Amersham,  Mary 
Jane,  wife  iof  John  Cheese,  and  only  child  of  Wm.  Macmkhatl, 
M.D.,  F.R.S.,  F.R.C.P.,  Physician  in  Ordinary  to  His  Majesty 
King  William  IY.,  and  Principal  Librarian  to  her  late  Majesty 
Queen  Victoria. 


Sit  ftlcilital 


km  mid   tfirotlnr. 


I 


"SALUS    FOPULI    SDPSEMA    LEX-' 


Vol.  CXXVIII.  WEDNESDAY,    FEBRUARY     17,    1904.        No.   7. 


I 


Original  Communications, 

THE  APPLICABILITY  OF 

RADIUM  IX   THE  TREATMENT 

OP  A 

CANCEROUS  THROAT, 

By  DAVID  WALSH,  M.D., 

tafer  phj-ftiiiwii,  Western  Skin  HofplUif,  London,  W, ;  late  Honorary 
iry,  B<mtgen  >whi>  ui  Lonrtoo,  .tec, 

Tti£  possibilities  opened  up  in  the  treatment  of 
a  ths  by  the  discovery  and  introduc- 
u  are  full  of  brilliant  promise      For 
ihc  moment,    however,   the    results     of     patient 
must  be  awaited  before  it  is  possible 
vith  certainty  as  to  the  exact  therapeutic 
value  of  this  wonderful  substance.     At  the  same 
; indently  be  asserted  that  we  have  in 
ii  an  agent  whereby  it  is  possible  to  modify 
irullv,  Lind  in  some  cases  apparently  to  cure, 
rodent  ulcers  and  epitheliomata. 
Eih  :,  reports  of  the  treatment  of  malig- 

nant disease  by  radium  have  come  from  America, 
notably  from"  Dr,  .Morton,  of  New  York,  In 
a  it  has  been  somewhat  extensively  used  for 
the  same  purpose.  Exner  and  Holzknccht  (a) 
used  it  in  cases  of  carcinoma  and  sarcoma, 
"with  results  that  are  so  far  satisfactory.11  An 
account  of  their  cases  was  read  before  the  Medical 
Society  ol  Vienna  on  June  26th,  1903.  The  fust 
case  was  that  of  a  man,  aet.  37,  who  had  undergone 
an  operation  for  mc I ano -sarcoma  of  the  humerus 
TUree  years  previously.  For  eight  months  he 
suffered  from  small  subcutaneous,  dark-coloured 
"es  near  the  seat  of  operation.  Mieroscopi- 
a  nodule  was  found  to  be  of  a  melano- 
saroaraatous  nature.  Radium  was  applied  to 
these  small   metastatic    nodules,   whi  ed  in 

I    to    )    Of  an  inch  in   diameter,      The 
method  of  application  was  to  enclose  the  radium 
m   a   small    india-rubber    capsule    with    a    mica 
windmw     The  capsule  was  then  fixed  to  the  skin 
by  means  of  a  strip  of  adhesive  plaster,  exactly 
the  nodule,  with  which  it  was  kept  in  contact 
tr.im   a  quarter  of    an   hour   up   to    twenty-five 
minute,     In    from    two    to    forty-eight    hours    a 
ititis  followed,  resembline,  the  X-ray  or  focus- 
tube    dermatitis.     Where     the     application     had 
lasted  less  than   fifteen   minutes  no   change  was 
i  in  the  nodule  at  the  end  of  a  fortnight.     On 
tber  hand,  in  those  nodules  which  had  been 
ted  for  a  quarter  of  an  hour  or  more  (up  to 
twenty-five  minutes)  there  was  either  a  marked 
diminution    or     disappearance    of    the     nodules. 

it,  December  20th,  11*03. 


New  nodules  developed  on  the  shoulders,  breast, 
and  left  upper  arm,  but  disappeared  beneath  the 
influence  of  the  radium,  their  former  site  being 
marked  by  a  flat  depressed  cicatrix. 

The  second  case  was  that  of  a  man,  set.  6i,  who 
was  Operated  on  for  an  epithelioma  of  the  cheek 
in  1888,  and  for  recurrences  in  1891  and  I 
On  May  1  rth,  1903,  he  was  found  to  have  an  ulcer 
the  size  of  a  shilling  at  the  right  corner  of  the 
mouth,  while  a  hard  tumour  the  size  of  a  small 
hazel-nut  could  be  felt  in   the  surrounding  tissue. 

I  Six  exposures  to  radium,  each  one  lasting  from 
fifteen  to  twenty-five  minutes,  were  followed  by 
shrinking  of  the  tumour  and  healing  of  the  ulcer, 
so  that  both  had  disappeared  bv  June  26th.     The 

I  patient,  however,  died  of  recurrence  within  a  few 

j  montli- 

hi  a  third  case  an  epithelioma  of  the  cheek,  the 
size  of  a  sixpenny  piece,  healed  after  three  applica* 
tions  of  radium,  This  patient  passed  out  of  obser- 
vation. 

In  the  United  Kingdom  brilliant  results  have 
been  obtained  by  Mr,  Mackenzie  Davidson,  MB.. 
the  well-known  inventor  <>l  an  exact  system  o!i 
X-ray  localisation.  A  brief  note  on  the  subject 
has  been  "recently  published  by  him,  (a)  His  first 
case  was  one  of  rodent  ulcer  on  the  right  side  of  the 
nose  in  a  woman,  aet,  69,  The  ulcer,  which  mea- 
sured  1    by  I  inch,  had    resisted  treatment,  both 

'  by  the  Fi  risen  light   and  by  the  X-rays.      Treat  - 

I  ment  by  radium  began  on  May  21st,  and  on 
June  t  lth,  after  four  applications,  "  the  ulcer  was 
practically  healed."     Five  months  later  there 

;been  no  recurrence* 

The  most  important  of  Mr.  Davidson's  cases  was 
an  extensive  rodent  ulcer  of  the  right  side  of  the 

!  face.  It  would  be  more  correct,  apparently,  to 
describe  the  condition  as  cancerous,  inasmuch  as 
the  surgeons  who  saw  the  patient  in  the  early 
s  stated  that  it  was  an  undoubted  case  of 
epithelioma*  When  first  seen,  the  whole  of  the 
check  had  been  destroyed  and  the  tongue  and 
teeth  were  laid  bare  ;    the  upper  and  lower  lips 

1  were  destroyed  to  within  an  inch  of  the  middle 
line  ;  the  tongue  was  foul,  and  there  was  an  oflen- 
discharge  from  the  whole  of  the  ulcerated 
surface ;  the  hard  and  the  soft  palates  were 
invaded  and  the  patient  could  not  speak.  Treat- 
ment began  on  July  30th,  and  continued  for  some 

I  months*     The  patient  can  now  speak,  the  tongue 

'  is  clean,  the  discharge  inoffensive,  and  cicatrisa- 
tion is  going  on  steadily.  The  disease,  according 
to  Mr.  Davidson,  "  has  been  arrested /'  and  a  com- 
plete   cure    may    reasonably    be    expected.     Full 

(*)  Brit.  Mid.  /mim.,  Hu*KJ  Mrd,  1WW. 


164    The  Medical  Press.  ORIGINAL  COMMUNICATIONS, 


Feb.  17,  1904. 


details  of  this  important  case  will  be  published 
later. 

Meanwhile,  it  is  clearly  a  matter  of  general 
interest  to  know  the  methods  of  application  and 
the  limitations  of  radium.  The  radium  is  most 
conveniently  used  in  the  form  of  the  bromide, 
and  should  be  of  good  quality.  The  small  glass 
tube  containing  the  salt  must  be  placed  directly 
in  contact  with  the  ulcerating  surface.  It  ap- 
parently is  of  no  use  if  applied  to  the  unbroken 
skin  surface  overlying,  say,  a  scirrhus  of  the 
mamma.  The  action  of  the  radium  is  strongest 
at  the  immediate  point  of  contact,  and  lessens  in 
power  according  to  the  distance  from  that  point 
of  contact.  The  radium  may  be  applied  for  a 
quarter  of  an  hour  or  more,  up  to  thirty  or  forty 
minutes,  but  the  length  of  application  should  be 
most  carefully  regulated  by  individual  results. 
A  reaction  occurs  usually  on  the  eighth  day  of 
treatment.  If  it  be  moderate  the  temperature 
runs  up  to  about  ioo°  F.,  and  the  patient  suffers 
little  general  disturbance.  On  the  other  hand,  if 
the  exposure  has  been  unduly  prolonged,  the 
temperature  may  run  up  to  1040  F.  or  even  higher, 
and  the  patient  be  attacked  by  vomiting  and 
other  distressing  symptoms.  In  one  of  Mr. 
Davidson's  cases  the  ulcerating  surface  became 
scarlet  and  erysipelatous-looking  during  a  period 
of  severe  reaction,  but  immediately  afterwards 
underwent  a  marked  local  improvement.  The 
suggestion  of  Mr.  Davidson  that  the  reaction  may 
be  due  to  the  formation  of  an  antitoxin  is  of  great 
interest. 

It  will  be  at  once  apparent  that  the  necessity  of 
direct  application  of  the  radium  to  the  tissues 
involved  in  the  malignant  process  must  for  the 
present  limit  the  field  of  applicability  of  radium. 
Still,  much  may  be  achieved  by  the  exercise  of  a 
little  patience  and  ingenuity  on  the  part  of  the 
operator.  Thus,  a  Continental  surgeon  (a)  has  treated 
malignant  stricture  of  the  oesophagus  by  passing 
bougies  armed  at  the  end  with  a  bulb  so  con- 
structed and  placed  as  to  bring  the  radium  in 
contact  with  the  stricture.  In  the  case  of  an 
epithelioma  inside  the  cheek  there  would  obviously 
be  little  difficulty  in  maintaining  contact  of  the 
radium  tubes  with  the  diseased  surface  for  any 
required  length  of  time.  It  is  far  otherwise, 
however,  when  one  has  to  deal  with  a  malignant 
invasion  of  the  palate  and  fauces,  when  the 
structures  are  in  a  state  of  constant  watchfulness 
to  respond  to  and  resent  reflexly  almost  all  kinds 
of  direct  stimulation.  To  keep  one  or  more 
small  glass  tubes  in  contact  with  various  parts  of 
the  reflexly  sensitive  and  excitable  soft  palate  and 
fauces  might  seem  a  priori  to  be  an  almost  hopeless 
task.  The  object  of  this  short  preliminary  com- 
munication is  to  show  that  it  is  quite  feasible  to 
treat  the  oropharyngeal  region  by  the  direct 
application  of  radium. 

A  patient  came  under  my  care  suffering  from 
early  but  rapid  malignant  invasion  of  the  upper 
throat.  At  first  I  tried  the  application  of  the  high 
frequency  current  of  the  X-ray  tube,  the  latter 
especially  to  the  glands  at  the  angle  of  the  left  jaw, 
which  were  slightly  enlarged  and  tender.  At  the 
same  time  I  devised  an  apparatus  whereby  the 
rays  from  the  focus- tube  could  be  projected  directly 
on  to  the  back  of  the  throat  by  means  of  a  flattened 
vulcanite  speculum.  Some  improvement  followed 
this  course  of  treatment,  but  not  long  after  its 


S)  A  fuller  reference  cannot  be  given  here,  as  the  report  hM  been 
Hiked  only  in  the  lay  Press  In  this  country,  and  awaits  scientiflo 
confirmation. 


commencement    I    made    some    inquiries    as   to 
radium  and  determined  to  try  that  agent. 

By  the  kindness  of  Mr.  Mackenzie  Davidson  I 
was  enabled  to  carry  out  the  treatment  under  his 
supervision.  He  most  kindly  and  generously 
placed  at  my  disposal  four  sealed  tubes,  each  con- 
taining five  milligrammes  of  pure  radium  bromide. 
These  tubes  were  fastened  at  the  end  of  a  curved 
holder  and  enclosed  in  a  covering  of  india-rubber 
extemporised  from  a  finger  stall.  The  throat 
was  then  cocainised  and  a  gag  inserted  between  the 
teeth.  A  light  thrown  into  the  mouth  by  a  mirror 
enabled  me  to  pass  in  the  radium  and  press  it  with 
precision  on  the  desired  part.  At  first  the  patient* 
showed  the  greatest  intolerance  of  contact  with 
the  foreign  body,  but  by  dint  of  perseverance 
it  was  found  possible  to  push  the  application 
sufficiently  to  give  from  a  quarter  of  an  hour  to 
half  an  hour,  or  sometimes  forty  minutes,  distri- 
buted on  various  parts  of  the  palate,  fauces  and 
pharynx.  As  a  matter  of  fact,  the  patient  some- 
times could  not  bear  the  contact  for  more  than  a 
few  seconds,  while  at  other  times  he  could 
tolerate  the  pressure  for  one  minute,  two,  and 
occasionally  three  or  four  minutes  together.  In 
estimating  the  time  of  application  allowance  had 
to  be  made  for  the  continual  stoppages,  while  the 
radium  holder,  and  in  many  instances  the  gag  also, 
were  removed  from  the  mouth.  Anyone  acquainted 
with  throat  work  will  realise  that  to  stoop  over  a 
patient  and  hold  an  instrument  in  position  under 
these  circumstances  demanded  a  good  deal  of 
patience,  especially  when  the  foe  tor  of  a  malignant 
throat  is  taken  into  consideration. 

The  parts  involved  were  the  left  tonsil,  which 
presented  a  sloughing  surface,  and  the  neighbour- 
ing pillars  of  the  fauces,  part  of  the  posterior 
pharyngeal  wall,  the  whole  soft  palate  on  the 
left  side,  which  showed  a  deep  sloughing  pond -like 
depression,  that  would  about  receive  the  tip  of  an 
average-sized  middle  finger.  The  left  palate  was 
paralysed,  so  that  the  uvula  was  drawn  over  to  the 
right  by  the  action  of  the  unaffected  muscle  of 
that  side.  The  uvula  was  partly  destroyed. 
The  process  had  superficially  attacked  the  right 
soft  palate. 

The  appearance  of  the  lesion  was  suggestive  of 
other  specific  mischief,  but  that  view  was  negatived 
— (a)  by  the  history  ;  (b)  by  the  opinion  of  various 
distinguished  authorities  on  the  throat  ;  (c)  by 
two  microscopical  examinations,  the  report  from 
which  was  detailed  and  emphatic. 

The  case  is  of  importance  inasmuch  as  it  appears 
to  be  the  first  in  which  radium  has  been  applied  to 
a  cancerous  throat.  It  would  be  premature  to 
give  in  this  place  an  account  of  the  results  of  this 
particular  line  of  treatment.  At  the  same  time 
one  may  be  perhaps  allowed  to  say  that  the  ordi- 
nary progress  of  that  terriblecondition,  epithelioma 
of  the  upper  throat  and  fauces,  has  been  pro- 
foundly modified,  if  not,  as  one  hopes,  even 
arrested.  Meanwhile,  I  have  thought  it  my  duty 
to  lose  no  time  in  publishing  the  fact  that  it  is 
possible  to  apply  radium  to  the  soft  palate,  the 
tonsils  and  the  posterior  pharynx.  Henceforth, 
medical  men  who  have  cases  of  malignant  disease 
of  the  upper  throat  and  fauces  will  know  that  it 
is  possible  to  apply  radium  to  the  seat  of  the 
disease.  Further,  in  .fairly  early  cases  there 
appears  to  be  a  prospect  of  cure. 

Since  the  above  was  written  a  patient  has  come 
under  my  care  with  an  epithelioma  of  the  tongue. 
He    had  been  for  several  months  abroad  under- 


Feb.  tft    *904« 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press.     165 


goi  rig  Dr+  Otto  Schmidt's  method f  based  on  his 
alleged  cultivation  of  a  parasite  of  cancer.  By 
inoculations  oi  increasing  virulence  of  scrum  or 
of  sterilised  cultures  at  is  hoped  to  obtain  im- 
•Tiunisatjon  against  cancer.  In  the  case  of  my 
patient,  in  spite  of  several  months  of  careful 
treatment  by  Dr.  Schmidt,  both  the  original 
growth  and  the  glands  of  the  neck  showed  a 
ly  increase  in  size.     He  has  now  placed  him 


against  infection  by  the  bacillus  coli,  the  surface- 
wound  became  infected  about  a  fortnight  after 
the  operation,  and  so  severe  was  the  attack  of 
cellulitis  caused  thereby  that  some  large  branches 
of  artery  in  the  epigastric  region  burst  out  bleeding 
on  two  occasions,  and  the  patient  was  near  dying 
from  secondary  haemorrhage.  As  it  is,  however, 
>mpletely  recovered. 
My  explanation  of  the  case  is  that,  some  indefi* 


self  in  my  hands  for  energetic  treatment  by  radium    nite  time  ago.  he  had  probably  had  a  mild  attack 
and  high  frequency  current  applied  to  the  tongue,  !  of  inflammation,  which  fixed  the  tip  of  a  long  and 


and  by  X-ray  and  high  frequency  to  the  enlarged 
glands* 


AN 


A  CASE  OF 

APPENDIX  ABSCESS 

IN   THE 

RECTOVESICAL  POUCH,  (a) 

By   EDMUND     OWEN,     F.R.CS., 

Consult inK  Surgeon  to  St.  Miuy'ft  HotpiUU. 

hntleman,  set  45,  was  sent  to  me  on  August 
last  with  a  history  of  intermittent  trouble 
with  defecation,  and  of  a  feeling  of  fulness  and 
weight  about  the  neck  of  the  bladder,  His  doctor 
wrote  that  last  May  the  patient  had  been  treated 
lor  obscure  abdominal  pains  which  were  centred 
in  the  hypogastric  region.  At  that  time  no  rectal 
examination  had  been  made,  but  when  the  prac- 
titioner had  recently  introduced  his  finger  into  the 
bowel,  he  had  found  a  tumour  which  felt  like  an 
enormously  enlarged  prostate  gland.  For  several 
years  the  patient  had  had  obscure  abdominal 
I,  and  he  had  become  dyspeptic  to  such  an 
extent  that  he  was  afraid  to  eat  meat.  Three 
months  pa  he  had  had  severe  pains  in  the 

hypogastric  region,  for  which  he  was  kept  in  bed. 
He  told  the  doctor  who  was  attending  him  that  he 
thought  he  must  have  got  appendicitis,  so  great 
was  his  distress.  But  the  doctor,  finding  that  there 
was  neither  swelling  nor  tenderness  in  the  right 
iliac  lo.ssa,  put  it  down  to  the  after-effects  of 
influenza,  and  applied  fomentations  over  the 
gastric  region.  When  the  acute  attack 
passed  off,  the  patient  was  able  to  resume  work, 
bat  he  was  very  miserable  and  depressed,  and  was 
steadily  losing  weight. 

finger  introduced  into  the  bowel  at  once 
came  upon  a  hard,  tender  swelling  at  the  base  of 
thf  bladder.  It  was  about  the  size  of  a  small 
hen's  egg.  It  was  not  prostatic,  but  it  was  close 
lie  prostate  gland ,  and  intimately  attached 
to  it. 

On  opening  the  abdomen  in  the  middle  line  and 
working  cautiously  among  coils  of  closely- 
adherent  intestine,  I  found  at  the  very  bottom  of 
the  recto -vesical  pouch  a  tightly -filled  abscess , 
the  walls  of  which  were  composed  of  the  rectum 


wandering  appendix  in  the  depths  of  the  pelvis, 
and  that  a  few  months  ago  there  was  recrudescence 
of  the  inflammation  with  severe  hypogastric 
pains,  and  with  the  formation  of  the  abscess. 

Had  he  been  operated  on  just  after  his  first 
attack  (whenever  that  was)  he  would  have  avoided 
the  grave  risks  which  were  inseparable  from  the 
more  serious  operation  The  appendix  was  not  in 
the  pelvis  originally  j  it  was  probably  dragged 
there  by  the  adhesions  which  formed  about  it  at 
the  time  of  its  first  inflammatory  attack,  and  if  it 
had  been  resected  as  soon  as  that  attack  had  passed 
off  there  would  have  been  no  intra- pel  vie  abs* 

The  more  that  I  see  of  appendicular  disease,  of 
the  danger  of  delay  in  operating,  of  the  compara- 
tively slight  amount  of  risk  which  the  early  opera- 
tion involves,  and  of  the  great  sense  of  relief  and 
freedom  from  anxiety  which  it  affords,  the  more 
fully  am  I  convinced  that  the  patient  had  best 
take  his  courage  in  both  hands  and  submit  to  a 
prompt  resection  after  a  first  attack. 


GLAUCOMA 

AND   THE 

GLAUCOMA  THEORIES,  (a) 

By  J.  V.  PATERSON,  F.Rr.S.,Edin, 

Dealing  first  with  the  normal  intra-ocular 
tension  and  the  escape  of  fluid  from  the  eye,  it 
was  pointed  out  that  the  aqueous  humour  was 
secreted  by  the  epithehum  in  the  ciliary  region, 
and  was  eliminated  by  the  so-called  *' filtration 
angle  "  between  the  iris  and  cornea)  and  to  a  less 
extent  by  the  vessels  of  the  iris.  An  outline  of  the 
experimental  work  done  in  investigating  the  ques- 
tion  of  the  exact  channels  of  outflow  was  given,  and 
a  number  of  slides  of  sections  of  human  and 
animal  eyes  demonstrated,  the  latter  to  show 
the  channels  by  which  Chinese  ink  was  eliminated 
after  injection  into  the  vitreous.  As  to  the  rate 
of  flow  through  the  eye,  Leber's  estimate  that  the 
fluid  in  the  anterior  chamber  was  renewed  every 
forty  minutes  seemed  rather  too  high  than  too  low  ; 


there  was  no  appearance  of  current  in  the  anterior 
chamber,  so  that  the  outflow  must  be  very  gradual 
behind,  the  prostate  below,  and  the  bladder  in  '  indeed.  The  intra-ocular  pressure  is  intermediate 
tront,  whilst  a  kinked  piece  of  the  colon  formed  between  the arterio-capillary  and  venous  pressures 
its  roof.  To  the  right  side  of  the  abscess,  and  — probably  about  25  mm.  Hg.  It  is  sub- 
firmly  glued  to  the  base  of  the  bladder,  was  the  ject  to  very  slight  variation  at  different  periods 
end  of  the  appendix,  inflamed  and  ulcerated.  I  and  is  not,  as  Hess  has  shown,  affected  by  accom- 

Having  removed  the  appendix,  and  having  I  modation.  It  can  never,  of  course,  exceed  that  of 
thoroughly  wiped  out  the  abscess-cavity  with  dry  ,  the  arteries  supplying  the  eyeball.  In  the  living 
swabs  of  absorbent  wool,  I  passed  a  very  large  |  eye  nothing  was  easier  than  to  see  bow  pressure 
drainage-tube  down  into  the  recto- vesical  pouch  with  the  finger  first  caused  collapse  of  the  veins, 
and  brought  the  other  end  out  a  little  below  the  I  then  venous  pulsation,  and  finally  arterial  pulsa* 


umbilicus 
Though   the   peritoneum    showed   itself    proof 


tfUudon,  February  llth,  190*. 


tion— the   latter   being   a  characteristic  of   glau- 
coma*    To  some  extent    the  intra-ocular  tension 


*)  Abttnct  o*  *  Paper  read  at  *  meeting  of  the   Harveian  Society         (*}  Ahetfact  of  Paper  read  before  the  Edinburgh  Medico-Chirurglual 


Society,  February  3  rtl,  1»W. 


166     The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


Feb.  17,  1904. 


ran  parallel  to  the  blood  pressure — a  fact  which 
had  been  demonstrated  experimentally  on  animals. 
Turning  to  glaucoma,  which  was  defined  as  a  state 
of  increased  intra-ocular  tension,  the  speaker 
said  he  did  not  propose  to  discuss  the  clinical 
features  of  the  condition.  Part  of  our  lack  of  know- 
ledge of  its  pathology  was  due  to  the  fact  that 
attempts  to  produce  it  artificially  in  animals  had 
met  with  little  success.  The  condition  might  be 
either  primary,  or  secondary  to  other  diseases  of 
the  eye.  A  number  of  slides  illustrating  sections  of 
eyes  affected  with  secondary  glaucoma  were  shown, 
and  the  mechanism  by  which  the  lesions  had  caused 
glaucoma  was  explained.  In  primary  glaucoma, 
however,  none  of  these  simple  mechanical  explana- 
tions were  adequate.  A  great  obstacle  to  the 
elucidation  of  the  pathology  of  the  disease  was  the 
fact  that  eyes  were  not  enucleated  at  an  early 
stage,  but  only  when  secondary  changes  had  set 
in.  The  morbid  appearance  of  ordinary  glauco- 
matous eyes  at  the  stage  at  which  enucleation  was 
performed  was  now  perfectly  well  known,  but  it 
was  quite  impossible  to  say  which  of  these  changes 
was  the  primary  cause  of  the  disease.  For  this 
reason,  until  by  some  fortunate  chance  a  glauco- 
matous eye  was  got  at  its  earliest  stage,  it  was  doubt- 
ful whether  histology  could  throw  any  further 
light  on  the  condition.  Slides  illustrating  the 
changes  in  glaucoma  were  then  shown,  and  the 
speaker  proceeded  shortly  to  discuss  the  various 
theories  of  glaucoma.  Von  Graefe  and  Donders 
thought  it  was  due  to  hypcrsecretion,but  this  view  is 
now  generally  abandoned.  Knies  had  ascribed  the 
condition  to  a  blocking  of  the  nitration  angle  by  an 
adhesive  inflammation  of  the  tissues  in  that  region, 
while  Weber  thought  that  a  similar  blockage  took 
place  in  consequence  of  swelling  of  the  ciliary  body. 
While  the  lesion  described  by  Knies  was  of  the 
greatest  importance,  it  could  only  be  regarded  as 
secondary,  since  it  was  absent  in  early  cases  of 
acute  glaucoma.  Priestley  Smith  supposed  that, 
especially  in  hypermetropic  eyes,  the  circumlental 
space  became  narrowed  by  the  growth  of  the  lens  ; 
that  any  swelling  of  the  ciliary  processes  might 
completely  obliterate  it  and  prevent  the  flow  of  fluid 
forwards,  and  that  in  consequence  the  root  of  the 
iris  would  be  pressed  forwards  and  occlude  the 
filtration  angle.  There  was  not,  however,  any 
direct  evidence  of  the  correctness  of  this  hypo- 
thesis. The  theories  of  Panas,  Abadie,  and  others 
were  passed  in  review,  and  shown  to  be  untenable 
or  inadequate.  The  speaker  laid  stress  on  the  fre- 
quency with  which  chronic  glaucoma  was  associ- 
ated with  general  vascular  changes,  and  thought 
that  while  undoubtedly  some  forms  of  eye  (hyper- 
metropic) were  predisposed  to  glaucoma,  while 
others  (myopic)  were  not,  a  careful  examination 
of  the  circulatory  system  by  modern  instruments 
for  investigating  blood  pressure  might  throw 
light  on  the  pathology  of  the  disease.  As  he  had 
already  said,  little  more  was  to  be  gained  from 
examinations  of  old  glaucomatous  eyes,  nor  from 
experiments  on  animals,  but  if,  as  he  was  informed, 
it  should  prove  to  be  the  case  that  domestic  pets, 
kept  under  highly  artincal  conditions — e.g.,  pam- 
pered lap-dogs — were  occasionally  the  subjects  of 
glaucoma,  it  might  at  some  time  be  possible  to  get 
an  eye  in  the  early  stage  from  this  source. 


A  Stratford  chemist  has  been  fined  £5  under  the 
Food  and  Drugs  Act  for  selling  cream  of  tartar  con- 
taining there-quarters  of  a  grain  of  lead  to  the  pound. 


SOME    RECENT    OPERATIONS 

PERFORMED  IN  THE 

ROTUNDA    HOSPITAL. 

By  E.  H.  TWEEDY,     F.R.C.P.I., 

Master  of  the  Rotunda  Hospital,  Dublin. 

•  The  following  cases  which  have  recently  been 
I  under  my  care  in  the  gynaecological  department 
!  of  the  Rotunda  Hospital  are  of  considerable  in- 
1  terest : — 

I       Case   I. — Mrs.    B was   admitted    suffering 

from  acute  pyosalpinx  of  the  left  tube.  On  the 
right  was  felt  a  hard  mass  of  cicatricial  tissue, 
I  the  remains  of  a  former  pyosalpinx,  for  the  cure 
.  of  which  an  abdominal  section  had  been  performed 
1  two  years  ago.  On  that  occasion  the  operation 
I  was  much  impeded  by  dense  adhesions  which 
I  prevented  the  disease  being  removed,  and  necessi- 
I  tatcd  the  mere  drainage  of  the  abscess  through 
!  the  vagina. 

Her  convalescence  was  prolonged  and  gave 
cause  for  much  anxiety,  and  this  history  warned 
me  against  attempting  a  similar  procedure. 

I  performed  a  posterior  colpotomy  instead,  and 
burst  into  the  tube  by  a  finger  inserted  through 
the  incision  :  washing  out,  curetting,  and  plugging 
the  cavity  completed  the  very  simple  operation, 
and  the  patient  left  the  hospital  with  a  normal 
temperature  and  cured  of  all  subjective  symptoms 
of  disease  within  a  fortnight. 

I  desire  to  strongly  urge  the  propriety  of  this 
treatment  in  all  cases  of  acute  pyosalpinx  ;  the 
cure  of  the  disease  follows  it  in  a  fair  proportion  of 
cases,  and  should  the  subsequent  microscopic 
examination  prove  the  disease  to  be  tuberculous  in 
origin  or  in  the  event  of  recurrence,  Landau's  very 
radical,  rapid  and  safe  operation  can  be  subse- 
quently undertaken. 

Case  II. — This  is  of  interest  to  me  as  being 
the  first  in  which  I  have  performed  the  operation 
of  symphysiotomy. 

Mrs.  M ,  a  delicate,  nervous  primipara,  was 

admitted  on  January  22nd,  in  the  early  stages  of 
labour ;   the  foetal  head  was  freely  ballotting  above 
the  brim,  the  conjugate  vera  measured  four  inches. 
j  In  spite,  however,  of  the  slight  degree  of  flattening 
i  of  the  pelvis  I  had  no  doubt  that  serious  difficult)' 
1  would  be  experienced  in  her  delivery.     I  was  led 
'  to  this  conclusion  by  adopting  the  device  recently 
1  so  cleverly  described  by  Dr.  Munroe  Kerr,  of  Glas- 
1  gow,   and   noting  by  its  means  the  serious  dis- 
proportion which  existed  between  the  fcetal  head 
and  the  pelvis. 

At  the  end  of  thirty-six  hours  the  membranes 
!  ruptured  during  a  vaginal  examination,  and  the 
1  os  was  fully  dilated.     In  six  hours  after  this  her 
pulse  had  risen  to  over  1 10,  the  lower  uterine  seg- 
ment was  greatly  stretched,  and  in  spite  of  a  large 
,  caput  having  formed  on  the  foetal  head,  it  had  not 
i  moulded    into    the    pelvis.      Forceps     was    now 
applied,  but  failed  in  its  object,  though  it  was 
withdrawn  and  applied  at  different  diameters  of 
I  the  skull. 

I  The  fcetal  heart  being  still  distinctly  heard,  there 
seemed  no  alternative  open  to  me  but  to  perform 
symphysiotomy.  Accordingly,  the  patient  was 
wheeled  into  the  theatre  still  under  an  anaesthetic, 
and  the  symphysis  was  divided  with  compara- 
tively little  difficulty,  and  no  complications.  The 
child  was  easily  extracted  by  forceps,  but  unfor- 


Fee, 


ORIGINAL  COMMUNICATIONS,  The  Medical  Press,    167 


tuuately  was  born  dead.  The  patient  has  made 
an  excellent  recovery,  which  would  have  been 
uneventful  save  lor  a  slight  attack  of  cystitis. 

Case  ///♦ — M.  T •,  who  had  been  operated 

an  two  years  previously  tor  an  ovarian  cyst,  was 
admitted  suffering  from  a  tumour  in  the  old  scar. 
On  this  being  excised  and  submitted  to  our  patho- 
logist, Dr,  Neville,  he  reported  that  it  consists  of 
implantation  tissue,  the  product  of  the  tumour 
previously  removed. 

Case  IV—  Mrs. 


R- 


apt.  31,  a  collier's  wife, 


was  admitted  with  a  history  of  deep  laceration  of 
the  tervix ;  her  last  confinement  had  occurred 
three  months  before  admission,  and  there  was 
nothing  to  lead  me  to  suspect  from  her  appearance 
and  from  that  of  the  lacerations  that  the  case  was 
one  of  malignancy.  The  suspicions  of  my  assistants 
tod  myself  were  first  aroused  to  the  true  nature  ol 
the  case  by  the  difficulty  experienced  in  preventing 
the  stitches  which  were  applied  from  cutting 
through,     A   small  piece  of   tissue  was  removed 

microscopic  examination,  and  Dr+  Neville 
having  pronounced  it  malignant,  a  vaginal  hyster- 
ectomy was  performed  next  day. 

The  disease  having  involved  the  vagina  it  be- 
came necessary  to  remove  this  structure  very 
treely.  This  ringing  of  the  vagina  complicated 
the  operation  to  no  little  extent,  and  the  bladder 

incised  during  the  subsequent  steps  of  the 
operation.  Clamps  were  applied  to  the  broad 
ligament,  and  the  transverse  incision  of  the  bladder 
was  brought  together  by  catgut  ligatures. 

The  patient's  convalescence  gave  cause  for  great 
anxiety,  as  practically  no  urine  was  voided  for  the 
forty-eight  hours  after  operation.  It  was 
difficult  to  determine  whether  this  was  a  case  of 
suppression,  or  the  result  of  occlusion  of  the  ureters 
by  the  catgut  sutures.  At  the  end  of  fifty  hours, 
quantities  of  blood-tinged  urine  came  away,  and 
this,  taken  in  conjunction  with  the  insatiable 
thirst  experienced,  the  dull  aching  over  the  loin, 
and  the  absence  of  any  pelvic  pain  inclines  me  to  the 
belief  that  suppression  and  not  mere  retention  was 
the  cause  of  her  trouble.     The  patient  is  still  in 

itaff  suffering  from  a  vesical  fistula,  which  I 
intend  to  operate  on  when  the  ulcerated  vagina 
resulting  from  the  pressure  of  the  clamps  has  been 
cured. 

Case  K.—J ,  W t  a  nervous  unmarried  woman, 

at,  4j,  was  admitted  suffering  from  severe  haemor- 
rhage, the  result  of  two  myomata,  the  size  of 
pigeons'  eggs,  situate  one  on  the  anterior,  and  the 
other  on  the  posterior  wall  of  the  uterus.  In 
this  case  I  performed  both  anterior  and  pos- 
terior coipotomy,  removing  the  tumours  by  a 
myomectomy*  and  leaving  the  uterus  intact.  Two 
gauze  drains  were  inserted  for  twenty-four  hours 
and  the  patient's  recovery  has  been  uneventful. 

Case  VL — Mrs.  ,  admitted  suffering  from 

pyosalpinx  on  the  right  side  ;  the  tube  was  greatly 
ited,  distended  to  the  diameter  of  one's 
thumb,  but  was  only  slightly  adherent  to  sur- 
rounding structures.  It  was  easily  removed  by  a 
rior  colpotomy  and  the  subsequent  history*  of 
the  patient  was  uneventful. 

Case   K//,— -Miss  Y was  admitted  to   the 

Kutunda  Hospital  suffering  from  painful  tumours 
it  either  sideoi  the  uterus, of  solid  consistencvand 
*}  closely  connected  with  that  organ  that  a 
diagnosis  of  multiple  myomata  was  made  by  my- 
self and  my  two  assistants. 


On  opening  the  abdomen  one  of  the  tumours 
came  into  view,  and  was  pierced  by  a  corkscrew 
without  the  escape  of  any  fluid  resulting.  On 
being  pulled  out  through  the  wound  it  was  seen  to 
consist  of  solid  ovarian  tumour  which  Dr.  Neville 
reports  as  being  a  very  remarkable  example  of 
cancer, 

On  the  other  side  the  tumour  proved  to  be  a  der- 
moid of  the  ovary.  The  patient  is  making  a  normal 
recovery,  but  I  am  much  exercised  in  my  mind  as 
to  the  propriety  of  performing  another  operation 
for  the  removal  of  the  uterus  and  broad  ligaments. 


PROGNOSIS     IN     HEART 
DISEASE,  (a) 

By  JAMES  BARR.M.D,,  KK.C  P  , 

President^  Liverpool  Medical  Institution  ;  Senior  Phj'ricteft.  Liver 
pool  ttoyal  Infirmary  ;  mhI  Lecturer  on  Ciliiica]  Medicine,  Liver 
pool  University. 

Mr,  Phesident  and  Gentlemen, — When  i 
undertook  to  deliver  an  address  on  the  above 
subject,  chosen  by  members  of  this  Society,  I  am 
afraid  I  did  so  with  a  light  heart,  but  since  I  began 
to  realise  the  difficulties  of  the  subject,  I  have 
wished  that  I  had  demurred  and  selected  another 
from  the  vast  domain  of  heart  disease  dealing 
with  hard  facts  as  we  find  them,  rather  than 
prospective  inferences.  The  subject  of  pro  gnu  sis 
is  one  which  was  wisely  and  well  cultivated  by  our 
forefathers,  but  in  the  present  day  so  many 
disturbing  influences  have  been  introduced  in  the 
form  of  new  methods  of  treatment  that  Nature 
does  not  now  get  a  fair  chance.  Moreover,  pro- 
gnosis is  not  very  profitable,  many  medical  men 
considering  that  sufficient  unto  the  day  is  the  evil 
thereof,  and  consequently  do  not  care  to  prophesy 
much  more  than  twenty- lour  hours  ahead.  It 
is  always  wise  never  to  prophesy  until  you  know 
what  is  going  to  happen.  Some  say  that  it  is 
always  the  unexpected  which  does  happen,  and 
so  are  careful  not  to  give  an  evif  prognosis  until 
the  end  is  near. 

The  public  often  insist  on  "  knowing  the  worst/* 
and  occasionally  they  are  quite  satisfied  when  they 
hear  it,  but  frequently  they  dispense  with  the 
services  of  the  man  who  has  given  a  fatal  pro- 
gnosis, and  call  in  someone  else  who  from  sheer 
ignorance  or  cupidity  may  promise  the  impos- 
sible. 

Personally,  I  think  it  is  always  right,  whether 
it  pay  or  not,  to  recognise  the  limits  of  our  art 
and  be  fairly  candid  to  the  friends,  if  not  to  the 
patient.  Many  a  good  fee  I  have  lost  through 
candidly  speaking  the  truth  ;  I  am  afraid,  theref*  ,ie, 
I  may  be  alluring  you  into  dangerous  paths 
where  you  may  incautiously  prove  your  own 
undoing.  However,  as  general  practitioners, 
in  all  cases  of  doubt  or  difficulty  you  can  throw 
the  responsibility  on  the  consultant,  though,  in 
my  opinion,  the  practitioner  who  sees  the  case 
from  day  to  day,  or  month  to  month,  or  maybe 
year  to  year,  is  in  a  far  better  position  to  form 
an  accurate  prognosis  than  the  consultant  who 
may  see  the  case  a  few  times. 

Fortunately,  for  one  case  where  yoti  have  to  give 
an  unfavourable  opinion  you  will  meet  with  a 
score  where  the  prognosis  is  good.     There  is  no- 

■it    An  Address  delivered  At    tb*  Soiitbport    Medical    Society, 


l68    The  Medical  Press.         ORIGINAL   COMMUNICATIONS. 


Feb.  17,  1904- 


other  organ  of  the  body  more  amenable  to  treat- 
ment than  the  heart,  or  more  capable  of  adapting 
itself  to  altered     circumstances,  and  there  is  no 
other  organ  the  affections  of  which  are  better 
understood  or    more    easily  recognised.     But  in 
order  to  make  a  fairly  accurate  prognosis  it  is 
absolutely  essential  that  you  should  have  a  clear 
conception  of  the  condition  of  the  organ.     You 
must  not  only  know  the  particular  lesion  affecting 
the  heart,  but  also  its  extent,  and  the  effect  which 
it  has  on  other  organs  of  the  body.     As  practical 
men  I  understand  you  wish  me  to  give  you  methods 
of  prognosis  which  can  be  applied  to  individual 
cases.     Now,  that  is  a  very  large  order,  and  one 
which  covers  a  very  large  scope  ;  I  must,  therefore, 
assume  that  you  are  all  well  versed  in  cardiac 
diagnosis,  and  can  form  an  opinion    as    to    che 
extent  of  the  lesion,  e.g.,  in  a  case  of  mitral  stenosis 
you  should  not  only  diagnose  the  lesion,  but  also 
form  an  opinion  as  to  the  size  of  the  orifice,  the 
condition  of  the  curtains,  and  the  state  of  the 
muscle,  the  condition  of  the  lungs,  the  right  side 
of  the  heart,  and  the  liver.     Well,  if  you  wish  to 
read    any   articles    on  prognosis   I   can  strongly 
commend  to  your  attention  the  very  able  address 
delivered  by  Sir  Dyce  Duckworth  at  the  meeting 
of  the  British  Medical  Association  in  Carlisle,  and 
published  in  the   British  Medical  Journal,  1896. 
Also  a  discussion  at  the  Brighton  meeting  of  the 
British  Medical  Association  on  a  paper  by  the 
late  Sir  Andrew  Clark,   "  On  Cases  of  Valvular 
Disease  of  the  Heart  known  to  have  existed  for 
over  five  years  without  causing  serious  symptoms  " 
(British    Medical   Journal,    February    5th,    12th, 
and  19th,  1887).     Among  those  who  took  part  in 
the  discussion  may  be  mentioned  Sir  W.  T .  Gairdner, 
Dr    Clifford  Allbutt,   Dr.   Bristowe,   Dr.   Leech, 
Dr    Frank  Donaldson,  and  Dr.  Thomas  Oliver. 
You  should  be  careful  not  to  come  under  the 
stricture  enunciated  by  Dr.   Bristowe  when   he 
said  :— "  As  to  treatment,   I   am  sometimes  in- 
clined to  think  it  is  a  pity  there  are  physicians ;  many 
persons  would  lead  a  happy  enough  lif  e  but  for  them. 
We  should  endeavour  to  keep  up  the  health  of 
the  patients,  and  enable  them  to  continue  useful 
members  of  society.     It  is  related  of  Dr.  Murchison, 
seven  or  eight  years  before  his  death,  that  he 
found  out  that  he  had  aortic  regurgitation.     He 
consulted  as  to  what  he  should  do,  and  he  deter- 
mined to  go  on  enjoying  himself  as  well  as  he 
could  under  the  circumstances.     It  is  certainly 
what  |I    should    endeavour    to    do,    and    it     is 
what  I  recommend  to   patients/'      To    a   large 
extent    I    agree  with    the    sentiments    here    ex- 
pressed,    but     I     consider     the     following     sen- 
tences  too    pusillanimous    to    be    worthy   of    an 
eminent   physician:    "Now   I   think   it  is   quite 
-time  enough  for  persons  to  discover  that  they  have 
heart  disease  when  they  begin  to  feel  the  effects 
of  it.     I  do  not  believe  that  I  have  heart  disease, 
I  certainly  hope  I  have  not,  but   under  no  cir- 
cumstances would  I  allow  Sir  Andrew  Clark,  or 
anyone  else,  to  examine  me  for    the  purpose  of 
finding  it  out." 

I  once  examined  a  man  for  insurance  who  did 
not  know  that  there  was  anything  the  matter 
with  his  heart,  but  he  had  a  very  atheromatous 
aorta  calcareous  aortic  cusps  with  moderately 
free  aortic  regurgitation,  a  hypertrophied  left 
ventricle,  and  marked  friction  from  white  patches 
and  early  cardiac  fibrosis.  He  only  lived  for 
about  a  couple  of  years  after  that,  but  I  have  no 


doubt  if  there  had  been  early  recognition,  a  good 
many  of  the  degenerative  changes  might  have  been 
obviated  by  a  careful  life. 

So  far,  gentlemen,  I  have  been  merely  beating 
about  the  bush,  but  I  hope  you  do  not  consider 
these  preliminary  remarks  uninstructive.  You 
may  think  that  I  am  afraid  to  grasp  the  nettle 
for  fear  it  may  sting  me,  or  to  come  to  close 
quarters  with  my  subject  for  fear  you  might 
discover  my  ignorance.  Whatever  may  be  the 
result  of  your  verdict  I  must  now  try  to  give  you 
my  personal  impressions  on  what  appears  to  me 
a  difficult  subject.  It  was  first  suggested  to  me 
that  I  should  give  an  address  on  the  prognostic 
value  of  cardiac  murmurs,  to  which  I  replied 
that  they  had  no  prognostic  value  except  the 
general  statement  that  as  a  rule  the  louder  the 
murmur  the  less  its  importance.  My  friend  and 
teacher,  Sir  W.  T.  Gairdner,  in  his  "Clinical 
Medicine/'  1861,  said: — "The  tendency  of  half 
instructed  auscultators  is  to  over-estimate  the 
importance  of  the  murmur,  as  a  fact,  and  to 
under-estimate  it  as  a  means  of  investigation  ; 
to  pay  too  much  attention  to  the  mere  existence 
of  the  sound,  and  too  little  to  the  circumstances 
in  which  it  occurs,  and  from  this  springs  another 
tendency  which  is,  to  take  too  grave  and  sombre 
a  view  of  cardiac  murmurs  generally,  and  es- 
pecially of  such  as  are  loud  and  obtrusive." 
This  is  as  true  to-day  as  when  it  was  written 
more  than  forty  years  ago. 

In  prognosis  •  you  have  to  carefully  weigh  the 
whole  of  the  factors  of  the  case,  and  not  confine 
your  attention  entirely  to  the  particular  lesion 
from  which  the  patient  may  be  suffering.  You 
must  take  into  account  the  age,  sex,  temperament, 
habits,  occupation,  and  hereditary  proclivities 
of  the  individual.  In  the  very  young  much 
depends  on  the  care  which  they  receive,  while 
in  the  degenerative  types  of  advancing  years 
hard  work  lessens  the  chances  of  life,  but  it  must 
be  clearly  understood  that  even  hard  work  is  not 
more  pernicious  than  a  life  of  luxury  and  indolence. 

Pericarditis. — In  ordinary  sero-fibrinous  peri- 
carditis the  prognosis  of  life  is  almost  invariably 
good.  Where  there  is  much  effusion  the  gravity 
is  considerably  increased.  If  the  pulse  become 
small,  weak  and  irregular,  the  fluid  should  be 
immediately  withdrawn.  When  the  urgency  of  the 
case  demands  aspiration,  do  not  delay  as  there  is 
always  a  great  risk  of  fatal  syncope.  In  some  of 
the  mildest  or  less  obtrusive  cases,  often  a  plastic 
gelatinous  lymph  is  poured  out,  which  glues  the 
two  surfaces  of  the  pericardium  together,  and  so 
the  ultimate  prognosis  in  such  cases  is  worse  than 
that  of  severe  cases,  where  a  coarse,  honey-combed 
effusion  of  lymph  takes  place.  In  this  latter 
variety  adhesions  are  less  likely  to  occur,  and 
both  the  serum  and  lymph  may  eventually  be 
absorbed.  These  forms  of  pericarditis  generally 
occur  in  children,  and  the  right  side  of  the  heart  is 
much  more  involved  than  the  left.  The  serum 
effused  gravitates  towards  the  back  and  lower 
part  of  the  sac,  and  this  prevents  adhesions,  while 
the  heart  is  floated  up,  and  thus  the  pericardial 
surfaces  in  front  of  the  heart  are  brought  into 
close  contact ;  the  adhesions  cripple  the  right 
heart,  and  its  development  does  not  take  place 
pari  passu  with  the  growth  of  the  child.  This 
becomes  more  marked  if  there  have  also  been 
endocarditis  involving  one  or  both  valves  of  the 
left  side  of  the  heart  which  demands  hypertrophy 


Fkb.  17.   ISO* 


THE  OUT-PATIENT   DEPARTMENTS.   The   Medical  Press.      169 


01  the  right  ventricle;  consequently  these  children    of  acute  rheumatism.     I  believe  that  endocarditis 
tardv  grow  up  to  adult  life,  and  the  younger  the    can   be  diagnosed  two  or  three  days  before  the 


criild  the  worse  the  ultimate  prognosis. 

Pericarditis    occurring    with    rena!    disease    is 

illy  a  terminal  affection,  and  almost  neces- 

lata!      Tuberculous     pericarditis     is     also 

usually  fatal,  but  I  have  a  boy  at  present  under 

my  care  who  has  had  pericarditis,  which  I  believe 

luberculotis.      After  two   tappings  there   has 

no  reaceumulation,  and  I  do  not  think  any  of 

•:ould  tell  by  examination  that  he  ever  had 


had  double  pleuritis  with  effusion,  and  now 
there  is  evidence  of  tuberculous  mischief  in  the 
in&gL  Hemorrhagic  pericarditis  is  associated 
Willi  tubercle  or  malignant  disease,  and  the  result  is 
usually  fatal,  Purulent  pericarditis  is  generally 
septic,  and  associated  with  serious  disease  in  other 

s  .  the  outlook  is  immediately  grave,  but 
tome  cases  have  recovered  after  incision  and 
drainage.  This  treatment  should  be  adopted  at 
the  earliest  possible  moment 


appearance  of  any  murmur  by  the  character  of 
the  first  sound  and  the  delay  in  the  transmission 
of  the  pulse.  Therefore,  everyone  who  takes  the 
trouble  to  carefully  watch  his  cases  of  rheumatic 
fever  has  ample  opportunity  of  limiting  or  lessen* 
ing  the  valvular  mischief  and  so  improving  the 
ultimate  prognosis. 

The    right    side    of    the    heart    usually  escapes, 
although   it   is   under  the   influence  of   the   same 


King  the  matter  with   his  pericardium.     He    poison,   because  its   valves  are   not  subjected   to 

much  strain,  hut  in  congenital  heart  disease  the 
reverse  happens,  as  during  intra- uterine  life  the 
right  side  has  the  greatest  amount  of  work  to 
perform. 

Infective  or  V Iterative  Endocarditis * — I  have  seen 
a  few  cases  of  infective  endocarditis  recover  even 
when  streptococci  were  found  in  the  blood,  but 
the  great  majority  succumbs  notwithstand- 
ing antistreptococcic  serum.  The  duration  is 
generally  about  six  or  eight  weeks,  but  some 
Pericardial  Adhesions.  —  I  take    a    much    more    chronic  cases  mav  last  a  twelvemonth,     I    have 


serious  view  of  ail  such  cases  than  is  generally 
adopted.     Partial   adhesions   are   no   doubt  com- 

:e  with  lair  Length  of  life,  but  when  the 
adhesions  are  so  marked  as  to  he  easily  diagnosed 
they  have  a  great  crippling  effect  on  the  heart 
the 'weak   right   ventricle   is  much  more    involved 

the  left,  and  the  trabecule  of  fibrous  tissue 


seen  one  case  of  infective  endocarditis  of  the  right 
ventricle  which  caused  an  aneurysm  on  each  main 
division  of  the  pulmonary  artery;  one  of  these 
ruptured,  causing  death. 

Acute  My044fflKti$.—ln  pericarditis  and  endo- 
carditis there  is  generally  more  or  less  involvement 
of  the  muscular  structure,  but  acute  myocarditis. 


with  such  general  diseases  as  diphtheria,  typhoid 
fever,  and  pyaemia,  In  the  former  disease  when 
the  action  is  rapid,  the  sounds  short  and  resembl- 
ing each  other  in  their  tic-iac  character,  and  t In- 
dian tolic  period  lessened  the  prognosis  is  very 
grave.  When  the  ventricles  arc  dilated,  the 
action  slow,  the  first  sound  very  short  and  the 
second  rapidly  succeeding  it — thus  indicating 
an  only  partial  ventricular  contraction — the 
prognosis  is  extremely  grave.  The  early  use  of 
antidiphtheritic  serum  neutralises  the  poison,  and 
lessens  these  effects  on  the  heart. 

In  typhoid  fever  cardiac  failure,  owing  to  acute 
degenerative  changes  in  the  myocardium,  is  one 
of  the  commonest  causes  of  death.  In  acute 
arsenical  poisoning  the  myocardium  often  suffers, 
and  may  cause  death.  The  same  may  be  said  for 
phosphorus  poisoning  and  pernicious  anaemia. 
(To    be    concluded    in    our    next 


penetrate  between   the  muscular  fibres    and  give  |  involving  a  grave  prognosis,  is  usually  associated 
rise   to    cardiac    fibrosis.     In    mediastino-pericar- ' 
<iitis  the  outlook  is  stil!    more  gra%*cp  as   in    such 
there   is    an    enormous    amount    of    fibrous 
icl   not  only    fixing    the   two   surfaces   of    the 
pericardium,    but    also    anchoring    the   heart    and 
involving    both    pleurae,     There    is    usually    als:> 
perihepatitis,    giving    rise    to    the    "  sugar-coated 
liver."     The    so-called    pulsus    paradoxus   which 
occurs  in  these  cases  I  look  upon  as  a  favourable 
as  it  is  evidence  that  the  respiratory  pump 
tsting  the  heart  in  carrying  on  the  circulation. 
There  is  also  often  in  these  cases  both  mitral  and 
spid   stenosis,   and   not    infrequently   pleural 
cflusion    and  ascites      It  is  only  with  great  care 
that   the  children   thus   affected — and   the    great 
majority    are    children — reach    twenty    years    oJ 
Their  growth  and  development  are  stunted. 
ilt    Endocarditis.    -In     simple    acute    endo- 
carditis associated   with  rheumatism   and  chorea, 
the    immediate    prognosis    is    almost    invariably 
favourable,    even   more   so    than   in    pericarditis, 
but  in  the  majority  of  eases  it  leaves  more  or  less 
iling  of  one  or  more  valves,  leading  to  chronic 
valvular  disease,  with  which  we  shall  deal  later 
on.     The  whole  of   the   fibrous  structure  is   vul- 
nerable to  the  rheumatic  poison,  but  the  valves  of 
the  left  side  of  the  heart  suffer  most  owing  to 
purely  mechanical  causes,   and  the  mitral  valve, 
D  is  subjected  to   the   greatest   strain,  sutlers 
most,     The    beading    and    vegetations    occur    on 
the  auricular  surface  ol   the  valve  just  when-  the 
brought  into  violent  apposition  ;  and  in 
the  aortic   valve  the  damage  occurs  on   the  ven- 
tricular surface,  not  at  the  edges  of  the  cusps,  but 
at  the  genu  or  bend  where  they  are  brought  into 
ble   impact   during   the    recoil   of    the   aorta. 
In  order  to  prevent  the  damage  or  limit  its  severity; 
it  15  absolutely  of  the  greatest   importance  that 
the  blood  pressure  should  be  kept  at  the  lowest 
1  We  level   compatible   with   life.     As   a   pro 


Jibe  ©inpatient  ©epartmeuts, 

WEST  LONDON  HOSPITAL 

Dermatohgical  cases    under    the  care  of 

l>r,  P.  S.  Abraham. 
I  Reported  by   I>r.  G,   N.   M  each  en  J 

Case  t.— Erythema  Iris,— The  patient,  a  woman, 
a*.  $&>  came  with  an  eruption  Oil  the  hands,  fore-arms, 
and  knees,  accompanied  by  considerable  irritation. 
She  had  been  subject  to  the  complaint,  mi  an)  aft  (at 
about  five  years  Her  father  died  of  phthisis,  and 
three  I. rot  hers  and  sisters  had  also  died  young  from 
M  bronchitis.*'  She  had  never  had  any  other  illness. 
The  attacks  were  generally  preceded  by  headache  and 
a  slight  feeling  of  malaise,  and  the  bowels  were  habi- 
tually constipated.     She  never  suffered  from  chilblains. 

On  inspection,  the  dorsum  of  the  hands,  both  sur- 
faces of  the  arms,  and  the  front  of  the  knees  were  seen 


to    present      numerous     annular,    concentric,    raised, 
erythematous   patches  about    the  size  of  a  sixi 
phylactic  against  valvular  mischief,  in  my  opinion  J  some  of  them   being  larger,       A  few  were   typically 


the  bV»od  pressure 9hou Id  be  kept  low  in  every  case  l  "  target-like,"     The  places  on  the  knees,  having  under- 


170    The  Medical  Press. 


SPECIAL   ARTICLES. 


Feb.  17.  1904. 


gone  involution,  were  less  characteristic.  The  patient 
was  of  a  decidedly  neurotic  disposition. 

This  case  illustrates  several  of  the  more  important 
points  met  with  in  the  erythemata  as  a  class,  namely, 
the  nervous  disposition  of  the  patient,  the  hyper- 
sensibility  of  the  cutaneous  capillaries  accompanied  by 
impaired  vasomotor  control,  and  the  habitual  con- 
stipation. The  latter  condition,  by  facilitating  the 
absorption  of  toxins  from  the  intestinal  canal,  has  been 
shown  to  favour  the  appearance  of  many  skin  erup- 
tions, notably  those  of  an  erythematous  or  eczema tous 
nature. 

The  patient  was  given  an  aperient  iron  mixture  and 
an  anti-pruritic  lotion  of  creolin  for  local  application. 

Case  2. — Unilateral  Lichen  Planus  Hyper- 
trophicus. — A  man,  aet.  24,  presented  himself  with 
an  eruption  limited  to  the  lower  part  of  the  outer  aspect 
of  the  left  leg.  The  history  was  that  he  broke  his  ankle 
about  a  year  ago,  and  he  believed  that  the  spots  began 
to  appear  around  the  seat  of  the  injury  a  few  weeks 
afterwards.  Irritation  had  been  considerable,  though 
not  intense.     His  general  health  was  unimpaired. 

The  lesions  consisted  of  several  discrete,  dark  red, 
slightly  scaly  patches  about  the  size  of  a  shilling,  raised 
above  the  surface  of  the  surrounding  skin,  which  was 
quite  healthy,  and  showed  a  distinct  heaping-up  of  the 
epithelium.  They  were  grouped  almost  in  a  line  parallel 
to  the  long  axis  of  the  limb,  and  were  situated  upon  the 
lower  third  of  the  outer  side  of  the  leg  and  the  ankle. 
The  opposite  limb  was  unaffected,  neither  were  any 
other  parts  of  the  body  covered  by  papules,  the  wrists, 
shoulders,  and  knees  being  perfectly  clear. 

The  chief  interest  of  this  case  lies  in  the  peculiar 
unilateral  distribution  of  the  lesions,  which  were  un- 
doubtedly those  of  hypertrophic  lichen  planus.  Super- 
ficially they  might,  perhaps,  have  been  mistaken  for 
syphilis,  especially  as  their  colour  was  of  a  somewhat 
"  coppery  "  hue,  but  this  criterion  of  the  nature  of 
cutaneous  eruptions  is  one  which  is  apt  to  be  very 
deceptive,  and  he  would  be  a  bold  physician  who  relied 
upon  colour  as  an  infallible  diagnostic  sign.  Taken 
in  conjunction  with  other  signs,  it  may  then  be  of  some 
use. 

With  regard  to  the  asymmetry  of  the  eruption,  it 
must  be  admitted  that  this  is  an  unusual  feature  in 
lichen  planus,  but,  recognising  that  the  disease  is 
most  probably  an  inflammatory  disorder  of  the  skin 
of  a  neuropathic  origin,  it  is  not  difficult  to  see  that 
in  this  case  the  previous  injury  to  the  limb  may  have 
been  sufficient  to  act  as  a  determining  factor  in  the  dis- 
tribution of  the  lesions  in  a  predisposed  individual. 
Generalised  outbreaks  of  the  disease  have  been  known 
to  follow  nervous  injuries,  and,  more  rarely,  a  limited 
eruption  has  appeared  in  the  course  of  the  distribution 
of  a  cutaneous  nerve.  It  is  to  the  latter  group  that 
the  present  case  would  appear  to  belong. 

The  patient  was  given  a  lotion  and  an  ointment 
containing  creolin  for  local  application. 

Case  3. — Dermatitis  Herpetiformis. — A  married 
woman,  aet.  38,  came  with  an  irritating  eruption  which 
she  stated  had  been  troubling  her  for  about  three 
months.  She  described  the  rash  as  beginning  "  with 
little  blisters,"  which  would  break,  leaving  a  sore, 
abraded  surface.  Around  the  "umbilicus  the  eruption 
was  likened  to  "  mistletoe-berries."  Her  general 
health  had  suffered  considerably  during  the  past  few 
weeks,  the  appetite  and  sleep  both  being  impaired. 

The  lesions  were  seen  to  consist  of  small  discrete 
vesicles,  some  of  which  had  been  severely  scratched, 
and,  consequently,  presented  some  blood  crusts  upon 
their  apices.  The  face,  arms,  and  to  a  slighter  extent 
the  chest,  were  affected.  A  group  of  vesicles  upon  the 
inner  side  of  the  left  wrist  had  run  together  and  had 
progressed  to  superficial  ulceration.  The  feet  were 
not  affected.  The  chief  subjective  symptom  was  that 
of  itching. 

The  diagnosis  of  dermatitis  herpetiformis  of  Duhring 
was  based  upon  the  character  and  grouping  of  the 
lesions,  which  were  fairly  symmetrically  distributed, 
upon  the  typical  history  of  their  mode  of  appearance, 
together  with  the  intense  pruritus  which  they  occa- 


sioned. The  disease,  which  is  distinctly  a  rare  one. 
is  generally  characterised  by  considerable  impairment 
of  the  patient's  general  health,  and  this  is  well  illus- 
trated in  the  present  case,  loss  of  appetite,  weakness, 
and  some  irritability  of  disposition  being  marked. 
Treatment  is  not  always  satisfactory,  the  affection  fre- 
quently showing  an  obstinacy  to  both  internal  and 
external  medication,  and  sometimes  becoming  chronic 
Relapses  are  also  common,  especially  if  the  patient 
gets  run  down  in  health. 

A  mixture  containing  iron  and  strychnine  was  pre- 
scribed, together  with  a  simple  anti-pruritic  lotion 
and  ointment. 


Special  articled* 

BRITISH    SANATORIA    FOR    CONSUMPTION.— 
XXXIII. 


[by  our  special  medical  commissioner.] 

THE  MALDON  SANATORIUM. 

It  is  doubtless  well  that  there  should  be  all  sorts 
and  conditions  of  sanatoria  for  phthisical  subjects, 
provided,  however,  that  each  makes  the  care  of  the 
patient  the  first  object,  and  maintains  a  course  of  treat- 
ment which  is  thoroughly  rational  and  based  on  a  clear 
recognition  of  hygienic  principles.  Much  in  the  in- 
stitutional treatment  of  consumption  must  still  be 
considered  to  be  in  the  experimental  stage.  It  is 
well,  therefore,  that  as  far  as  definitely  ascertained 
scientific  procedure  will  permit,  there  should  be  varia- 
tions in  detail  and  differences  in  non-essential  routine.  It 
is  necessary  to  remember  that  for  many  patients,  social, 
financial,  and  what  we  may  term  local  considerations 
must  be  allowed  to  control  to  a  great  extent  the  selec- 
tion of  a  sanatorium.  It  is  not  our  intention  at  the 
present  time  to  discuss  the  various  factors  which  go  to 
make  a  satisfactory  sanatorium,  but  it  is  necessary 
to  insist  that  medical  control  is  essential  The  domin- 
ant mind  in  every  establishment  should  be  that 
of  the  responsible  medical  attendant. 

In  our  present  series  of  articles  we  have  had  to  deal 
with  free  public  institutions,  sanatoria  built  and  main- 
tained by  co-operative  effort,  establishments  semi- 
public  and  semi-proprietary,  and  not  a  few  conducted 
purely  as  private  ventures.  Advantages  and  dis 
advantages  are  inseparable  from  any  method  of  con- 
trol, and  the  advising  medical  practitioner  must  exercise 
much  judicious  care  in  his  selection  of  an  establish- 
ment for  his  cases. 

Many  of  the  small  and  private  establishments  which 
adopt  the  title  of  sanatorium  are  really  hygienic  homes, 
rather  than  specially-constructed  buildings.  They, 
however,  in  many  cases  meet  a  real  need,  and  provide 
useful  education  in  the  application  of  natural  methods, 
and  oftentimes  the  results  appear  to  be  as  satisfactory 
as  those  attained  in  the  more  ambitious  and  very  ex- 
pensive new  sanatoria. 

The  Maldon  Sanatorium  is  an  example  of  the  small 
proprietary  hygienic  home.  Maldon  is  a  small  country 
town  and  agricultural  centre  in  Essex,  on  the  river 
Blackwater,  some  ten  miles  from  the  sea,  and  one  and 
a  half  hours'  journey  from  London.  Although  much 
of  the  country  in  the  immediate  neighbourhood  is 
low-lying,  Maldon  is  picturesquely  placed  on  the  hill 
and  its  slopes,  and  the  sanatorium  lies  at  one  extremity 
of  the  town,  fairly  well  elevated,  distant  from  the  high 
road,  pleasantly  secluded,  and  with  an  attractive  out- 
look. 

The  sanatorium  is  really  an  adapted  old  country 
house.  It  was  once  evidently  a  moated  grange,  and 
even  still  a  moat  filled  with  water  surrounds  a  consider- 
able part  of  the  house.  A  portion  of  the  building 
would  appear  to  be  some  three  of  four  hundred  years 
old,  while  other  parts  have  manifestly  been  added  in 
the  last  century.  The  whole  place  has  an  old-world 
aspect.  A  verandah  runs  along  the  south  side  of 
the  house. 

The  grounds  are  some  five  acres  in  extent,  well- 


FfJL  \jt  1904. 


SPECIAL  ARTICLES. 


The  Mepicai.  Peess,     171 

Dd [sheltered,  and  include  pleasant    gardens,  ,  but  the  boy  was  lame.     She  admitted  that  Dr.  Colohan 
orchard  Duthouse  premises.    Adjacent  is  a  farm,  while  ,  was  most  attentive  to  the  boy 

nng   country  offers  ample  opportunities!      The   boy's  sister  gave  evidence   to   the  effect   that 

Dr.  Colohan  had  himself  screened  the  knee,  that  he 


for  waita.  and  pleasant  drives  can  be  taken  in  the  dis 
tnct. 

T/ie  room*  are  old -fashioned,  but  clean  and  airy, 
simply  furnished,  and  six  contain  two  beds.  There 
is  anulher  room  available  for  a  single  case.  Some 
thirteen  or  fourteen  patients  can  be  accommodated. 
The  dining-room  is  ot  fair  size,  and  is  also  used  as  a 
recreation  apartment  when  the  patients  cannot  venture 
out  of  doom. 

T&ere  is  a  somewhat  elementary  shelter  in  the 
grounds,  and  additional  liegehallen  might  be  secured 
with  advantage.  The  meals  are  arranged  to  meet  the 
jieeds  of  the  class  of  patient  received.  Three  meals  a 
day  are  given,  and  at  each  a  pint  of  milk  is  supposed 
to  be  taken. 

Tnere  is  no  resident  doctor,  but  Dr.  W.  E,  Faeey, 
a  practitioner  in  Maidon,  attends  daily  and  at  such  other 


had  put  the  tube  u  against  the  sore/'  and  that  in  taking 
the  photographs  the  tube  was  two  or  three  inches  from 
the  knee, 

►  Mr*  Mil  ford  Lewis,  professional  X-rayist,  said  that 
he  considered  that  anything  less  than  six  inches  be- 
tween the  tube  and  the*  flesh  was  dangerous.  The  time 
of  exposure  with  modern  tubes  would  be  a  half  to  one 
and  a  half  minutes.  For  an  old-fashioned  instrument 
and  an  old  tube,  allowance  had  to  be  given. 

Dr.  W.  Haughton.  Surgeon  to  Stcevens  Hospital  and 
University  Demonstrator  of  X-rays  to  Trinity  College, 
said  that  the  ordinary  working  distance  was  from 
twelve  to  fourteen  inches,  He  usually  worked  at 
eighteen  inches  for  a  knee.  His  experience  was  that  if 
he  did  not  get  a  photograph  in  five  miuntes  he  would 
not  get  one  at  twenty-five,  and  he  habitually  began 


times  as  he  may  be  desired.     Miss  Wilson  superintends 

•:mg  and  general  management  of  the  patients  f  with  ari  **Posure  ot  one  mmule.     Any  tube  requiring 
and  is  assisted  by  a  probationer.  "    twenty-minutes     exposure  was    an    improper    tube    to 


The  establishment   is   evidently   conducted   with   a  I 
view  to  strict  economy,  but  as  far  as  structural  and  / 
^ther  conditions  will  aflow,  satisfactory  results  should 
be  attained. 

The  fees  are  £2  2s.  to  two  and  a  half  guineas  weekly, 
usive  of  wines,  drugs,  personal  laundry  and  "a 
laJ     nurse,     should     one     be     required/1 

-sanatorium  is  near  to  Maidon  East  Station, 
and  patients  should  avoid  being  taken  to  Maidon  West, 
which  is  over  a  mile  distant  and  at  the  other  side  of  the 
town. 

There  is  a  fairly  convenient  service  of  trains  from 
Liverpool  Street  Station  on  the  Great  Eastern  Railway, 
but  a  change  has  to  be  made  at  S  hen  field 
JuQttmn. 


THE  CALWAY  X-RAY  CASE. 
4  much  interest  and  importance  to  medical 
men  occupied  the  Law  Courts  in  Dublin  for  a  con- 
siderable portion  of  the  last  two  weeks.  The  action— 
tllagh  1%  the  President  and  Professors  of  Queen's 
College,  Galway  *  William  Haire.  of  New  Line,  Galway; 
and  Nicholas  W.  Colohan,  M.D  ,  the  Villa.  Galway  — 
was  one  in  which  Thomas  M'Cullagh,  an  infant,  suing 
through  his  lather,  sought  to  recover  damages  for 
personal  injuries  caused  by  the  alleged  negligence  of 
defendants  iu  the  use  of  certain  electrical  apparatus, 
Plaintiff's  claim  was  in  respect  of  injuries  alleged  to 
have  been  caused  by  the  Rontgen  rays  in  the  treatment 
of  an  injury  sustained  to  the  knee.  Defendants  denied 
the  acceptance  of  any  employment  as  to  the  treatment 
of  plaintiff,  or  that  there  was  any  negligence  or  un- 
skufolnefts  in  the  treatment  of  his  injuries. 

In  counsel's  opening  statement  it  was  alleged  that 
Ibt  boy,  who  had  got  a  needle  in  his  knee,  was  taken  to 
the  late  Dr.  ijuirke,  of  Galway,  for  treatment  in 
December,  1902.  This  gentleman  sent  him  to  be 
X-rayed  by  a  man  named  Haire,  mechanical  assistant 
to  the  Professor  of  Natural  Philosophy  in  the  Queens 
College.  Haire  took  a  photograph  which  did  not 
reveal  the  presence  of  the  needle.  Dr,  Quirke  then 
tctl  ill  and  the  boy  was  taken  to  Dr.  Colohan,  who 
again  sent  him  to  be  photographed.  Several  photo- 
graphs were  done,  and  during  the  time  they  were  taken 
dted. 
The  mother  of  the  boy  gave  evidence  to  the  effect 
that  the  boy  was  "  under  photograph  M  for  h;jl 
hour  at  a  time,  and  that  "  the  piece  of  metal  inside 
the  globe  became  red  as  burning  coal/'  The  child 
MM  treated  for  the  burn  in  the  Galway  Hospital,  and 
then  brought  to  Dublin  in  April,  1903,  He  was  first 
Uken  to  Mr,  Mc  \rdle.  IRIS.,  who  did  not  examine 
the  knee,  but  sent  him  to  Mr.  Milford  Lewis,  a  non- 
medical man,  who  makes  a  practice  of  X-ray  work. 
Mr,  Lewis,  however,  on  seeing  the  burn,  refused  to  take 
the  photograph.  The  mother  next  look  the  boy  to 
Mr,  Lentaigne,  who  took  the  boy  into  the  Mater 
if iseri cordis  Hospital,     The  sore  had  now  skinned  over, 


use.  Atl  low  tubes  were  liable  to  cause  inflammation 
ul  the  skin.  He  consid ered  that  X-rays  in  careful 
hands  were  not  dangerous. 

Dr,  R,  L.  Lane-Joint  gave  corroboratory  evidence, 
and  demonstrated  the  manner  in  which  an  X-ray 
examination  was  carried  out. 

I  if  the  defence,  counsel  urged  that  some  fifty  radio- 
graphs  had  been  taken  by  Haire  without  accident,  and 
that  therefore  Dr.  Colohan  was  justified  in  sending  the 
boy  to  him  for  examination,  A  medical  man  was  not 
an  insurer  nor  bound  to  effect  a  cure4  and  Dr.  Colohan 
had  acted  throughout,  as  was  admitted,  with  the 
interests  of  the  boy  at  heart. 

Mr,  Haire  then  gave  evidence.  He  admitted  that, 
owing  to  former  photographs  having  been  without 
result,  he  had  exposed  the  plate  for  thirty  minutes, 
but  stated  that  it  had  never  been  within  two  inches  of 
the  skin.  Dr.  Colohan  did  not  interfere  with  the  tube 
in  any  way  or  take  a  photograph  on  his  own  account. 
The  platinum  in  the  tube  never  became  red-hot. 

Dr.  H.Lewis  Jones,  Medical  Officer  in  charge  of  the 
Electrical  Department,  St.  Bartholomew's  Hospital, 
stated  that  he  had  examined  and  tested  the  tubes  used 
in  this  case,  and  found  little  sign  of  use.  and  no  sign 
of  wear  and  tear.  The  platinum  target  showed  no 
symptoms  of  injury.  With  the  coil  used  in  this  case 
the  minimum  distance  from  the  skin  to  the  globe  would 
be  eight  inches,  and  ten  minutes  would  be  a  reasonable 
exposure.  If  pain  was  felt  during  an  exposure,  he 
would  consider  something  wronp  cither  with  the  patient 
or  the  instrument. 

Mr,  Hall  Edwards,  Surgeon  in  charge  of  the  X-ray 
Light  Department  in  Birmingham,  had  seen  worse 
burns  than  the  present  one.  A  reasonable  working 
distance  would  be  about  ei^ht  inches.  On  being  shown 
a  plate  taken  of  the  boy's  knee,  he  considered  that  it 
was  a  good  one  and  could  not  have  been  taken  at  a 
distance  of  two  inches. 

Sir  Charles  Ball  and  Sir  Thornley  Stoker  also  gave 
evidence. 

Dr.  O'DonneU,  physician  to  the  Mater  Hospital,  said 
that  his  average  working  distance  was  about  six  inches. 
He  had  often  in  the  past  exposed  for  twcnty-iivr- 
minutes,  and  sometimes  for  thirty- five,  but  now  this 
time  was  greatly  shortened. 

Dr.  Colohan  gave  evidence  of  his  treatment  of  the 
child.  He  did  not  personally  know  anything  of  the 
use  of  the  rays,  but  had  sent  patients  previously  to 
Haire,  and  had  received  excellent  photographs.  He 
h&d  never  himself  rayed  the  child.  The  globe  wan  to 
the  best  of  his  belief  six  or  eight  inches  from  the  knee, 
and  the  exposure  from  twenty  to  twenty-five  minutes. 
The  globe  never  touched  the  boy's  knee.  One  photo- 
graph was  taken  which  showed  the  needle,  but  on 
making  another  effort  to  get  supporting  evidence  it 
could  not  be  se^n. 

Mr.  McArdle  gave  evidence.  He  considered  that 
the    machine   produced    in    Court    for   demonstration 


172    Thb  Medical  Press.        TRANSACTIONS  OF  SOCIETIES. 


Feb.  17,  1904- 


purposes  was  not  of  a  modern  type.  He  had  exposed 
his  own  hand  for  thirty-five  to  forty  minutes  at  a 
distance  of  four  to  six  inches  without  any  injury.  He 
had  ordered  the  boy  to  be  X-rayed  without  seeing 
the  sore,  as  the  X-rays  would  do  no  harm. 

Further  evidence  was  given,  and,  after  the  speeches 
of  counsel,  the  Judge,  in  his  charge,  put  certain  ques- 
tions to  the  jury.  These,  with  their  answers,  are  as 
follows  : — 

1.  Were  the  Queen's  College,  Galway,  and  Haire,  or 
one,  and  which  of  them,  employed  for  reward  to  photo- 
graph by  X-rays  in  December,  1902,  and  in  April,  1903  ? 
— Haire  was  so  employed.  College  was  not. 

2.  Was  the  sore  caused  by  the  rays  ? — Yes. 

3.  Were   the  rays  negligently  applied   as   regards  : 

(a)  Distance  ? — No.  (b)  Duration  of  each  exposure  ? 
— No.  (c)  Consecutive  multiplication  of  exposures  ? — 
No.     (d)  The  type  of  machine  ? — No. 

4.  Was  the  sore  caused  by  the  operation — (a)  Of 
December  15th  ? — Cannot  say  which,  (b)  Of  Decem- 
ber 23th  and  27th  ? — Cannot  say  which,  (c)  Aggra- 
vated by  those  in  April  ? — No. 

5.  (a)  Did  the  operations  of  Dr.  Colohan,  for  which 
Haire  is  not  responsible,  contribute  to  the  sore  ? — Yes. 

(b)  Did  the  operations  of  Haire,  for  which  Dr.  Colohan 
is  not  responsible,  so  contribute  ? — Yes. 

6.  (a)  Was  Haire  negligent  in  applying  the  rays  ? — 
No.  {b)  Was  Dr.  Colohan  negligent  in  applying  or 
superintending  ? — No. 

7.  Before  the  rays  were  applied  in  April,  was  (a)  Dr. 
Colohan  negligent  in  not  diagnosing  the  sore  as  caused 
by  X-rays  ? — No.     (b)  Was  Haire  so  negligent  ? — No. 

8.  (a)  Was  Dr.  Colohan  negligent  in  applying  the 
rays  in  April  after  the  sore  appeared  ? — No.  (b)  Was 
Haire  so  negligent  ? — No. 

9.  To  what  damage,  if  any,  is  the  plaintiff  entitled  ? 
— None. 

10.  (a)  Is  any  and  what  amount  of  such  damages 
attributable  to  acts  of  Dr.  Colohan  only  ? — Not  an- 
swered, (b)  Is  any  and  what  amount  thereof  attribu- 
table to  acts  of  Haire  only  ? — Not  answered. 

On  these  findings  a  verdict  was  entered  for  the 
defendants. 


Transactions  of  Societies. 


CLINICAL  SOCIETY  OF  LONDON. 
Meeting  held  Friday,  February  12TH,  1904. 


Dr.    Frederick   Taylor,    President,    in    the   Chair. 


Dr.  Sidney  Phillips  reported  a  case  of 
fibroid  disease  and   calculi  of  the  pancreas. — 

jaundice     and     subsequent     diabetes. — death 

from  coma. necropsy. 

The  patient  was  a  married  woman,  aet.  26,  who,  at 
Christmas,  1901,  began  to  suffer  with  epigastric  pain. 
In  February,  1902,  jaundice  appeared  with  absence  of 
bile  from  the  stools.  There  was  no  history  of  biliary 
colic.  An  exploratory  operation  was  performed  at  St. 
Mary's  Hospital  by  Mr.  Edmund  Owen  on  April  3rd, 
when  a  great  enlargement,  judged  to  be  non-cancerous, 
of  the  pancreas  was  found.  On  June  14th,  8  per  cent, 
of  sugar  was  present  in  the  urine,  and  six  months  later 
the  jaundice  entirely  disappeared,  but  the  diabetic 
symptoms  progressed.  On  January  25th,  1903,  she 
was  attended  at  her  home  by  a  medical  man  for  diabetic 
coma,  from  which  she  died  on  the  following  day.  A 
partial  autopsy  was  obtained.  The  pancreas  was 
much  enlarged  and  presented  a  considerable  degree  of 
fibroid  change  throughout,  with  numerous  small  calculi 
of  varying  size,  so  that  sections  of  the  organ  cut  gritty. 
Microscopically,  there  was  almost  complete  replace- 
ment of  pancreatic  tissue  by  fibrosis,  and  destruction 
of  the  islands  of  Langerhaus.  The  occurrence  of  the 
jaundice  was  explained  by  obstruction  of  the  common 


opening  into  the  duodenum  of  the  pancreatic  and  bile- 
ducts.  The  glycosuria  was  of  the  type  usual  in 
"  pancreatic  diabetes." 

Dr.  Norman  Dalton  inquired  whether  the  pancreas 
was  smaller  at  the  autopsy  than  at  the  time  of  opera- 
tion, and  pointed  out  that  its  diminution  in  size  was 
probably  analogous  to  that  of  a  cirrhotic  liver. 

Mr.  Leonard  A.  Bidwell  remarked  that  the  gall- 
bladder was  generally  distended  in  cases  of  chronic 
pancreatitis.  He  had  operated  upon  four  cases  of 
this  affection,  and  in  none  of  them  was  glycosuria 
observed  after  the  operation.  The  cause  of  the 
jaundice  in  the  present  case  might  have  been  due  to  a 
calculus  which  had  been  originally  impacted  in  the 
ampulla  of  Vater. 

The  President  asked  what  were  the  conditions  of 
the  motions. 

Dr.  William  Pasteur  referred  to  the  case  of  a  man 
recently  under  his  own  care  with  increasing  jaundice, 
which  suggested  cirrhosis  of  the  liver.  At  the  autopsy 
a  scar  was  found  exactly  opposite  the  orifice  of  the 
pancreatic  duct  in  the  duodenum.  All  the  ducts  in 
the  pancreas  itself  were  dilated,  but  there  was  no- 
fibrosis. 

Dr.  Sidney  Phillips  replied  that  there  was  always 
some  difficulty  in  estimating  the  size  of  the  pancreas. 
He  did  not  consider  that  there  was  any  evidence  of 
gall-stones  in  his  case,  and  he  believed  that  pancreatic 
calculi  were  quite  capable  of  producing  jaundice. 

Dr.  Norman  Dalton  narrated 

TWO   CASES   OF   MALIGNANT    ANJEMIA, 

due,  apparently,  to  defective  formation  of  the  red 
corpuscles,  and  associated  with  caries  of  the  teeth  and 
suppuration  of  the  upper  jaw.  The  first  case  was  that 
of  a  man,  aet.  21,  suffering  from  debility,  pallor,  anaemic 
bruits,  epis  taxis  and  other  haemorrhages,  and  vomiting. 
The  disease  lasted  only  eight  months,  and  there  was  no 
post-mortem.  There  was  no  enlargement  of  the  spleen 
or  lymphatic  glands.  The  interest  centred  in  the  urine, 
in  the  suppurative  lesions,  and  in  the  blood.  The 
urine  was  never  high-coloured.  The  teeth  were  carious, 
and  there  was  an  alveolar  abscess  which,  after  incision, 
left  a  sinus  in  the  hard  palate.  Otorrhoea  was  also 
present.  The  blood  showed  progressive  oligocythemia, 
the  red  discs  falling  from  1,200,000  per  c.mm.  on 
admission  to  393.720  three  months  later.  The  haemo- 
globin was  also  diminished,  and  there  was  marked 
leucopenia,  the  lymphocytes  being  in  excess  of  the 
polynuclear  cells. 

The  second  case  was  that  of  a  girl,  aet.  17,  who  had 
lived  in  extreme  poverty.  She  had  been  ailing  for 
some  time,  but  the  illness  only  became  acute  three 
weeks  before  she  was  admitted  to  King's  College 
Hospital,  where  she  died  five  days  later.  The  urine 
was  pale,  the  teeth  were  carious,  and  there  was  an 
abscess  in  the  upper  jaw  from  which  pus  was  constantly 
oozing.  The  blood  only  contained  816,000  red  cells 
per  c.mm.,  17  per  cent,  of  haemoglobin.  The  leucocytes 
numbered  3,500.  At  the  autopsy,  there  were  subserous 
and  submucous  haemorrhages.  There  was  no  free  iron 
in  the  liver,  and  the  red  marrow  was  fatty.  In  neither 
case  could  surgical  treatment  be  undertaken  on  account 
of  the  tendency  to  haemorrhage.  Dr.  Pasteur  had 
described  an  exactly  similar  case,  but  there  was  no 
suppurative  lesion. 

Dr.  William  Hunter  agreed  that  the  cases  corre- 
sponded in  a  remarkable  way  to  those  which  he  had 
described  as  "  septic  anaemia,"  which  had  been  pre- 
viously included  under  the  title  of  pernicious  anaemia, 
but  were  distinguished  therefrom  by  the  intense  degree 
of  anaemia,  the  presence  of  megaloblasts,  the  frequently 
associated  gastric  or  intestinal  symptoms,  the  absence 
of  the  haemolytic  changes  in  the  urine,  the  presence 
of  a  low  type  of  pyrexia,  the  absence  of  the  bone 
marrow  changes  generally  seen  in  true  Addisonian 
anaemia,  and  the  grave  prognosis  attached  thereto, 
unless   the  focus  of  suppuration  could   be  removed. 

Dr.  William  Pasteur  referred  to  the  case  which 
he  had  read  before  the  Society  last  November,  in  which 
haemolysis  was  excessive,  but  there  was  no  suppurative 


FEB,    J  J.   1904* 


TRANSACTIONS  OF  SOCIETIES. 


The  Medical  Pbess.     173 


lesion  He  therefore  concluded  that,  for  the  present, 
his  case  must  stand  a] 

Dr.  Leonard  S.  Dudgeon  inquired  if  streptococci 
were  present  in  the  blood  previous  to  the  injection  of 
anti -streptococcic  serum. 

Dr.  F,  Parkes  Weber,  understood  Dr.  Dal  ton  to  say 
that  sume thing  more  was  necessary  for  the  production 
of  ana  mu.  than  &epstt  atone. 

Dr,  Daiton  replied  that  he  considered  that  persons 
with  carious  teeth  were  always  in  danger,  because  at 
any  moment  am  unknown  factor  might  supervene  and 
convert  a  condition  of  simple  ill -health  into  a  malignant 
form  of  anemia  which  was  rapidly  fatal.  He  thought 
that  Dr.  Hunter's  phrase  of  septic  anaemia"  a  little 
unfortunate,  as  tending  to  cause  some  confusion  with 
the  true  Addisonian  anaimia,  in  which  a  special  form 
of  sepsis  occurred  on  the  tongue.  The  blood  in  his  case 
was  not  examined  for  streptococci. 

Mr.  J,  Jackson  Clarke  described  a  case  of  excision 
of  the  neck  of  the  lower  jaw  for  tempore- maxillary 
ankylosis.  The  patient  was  a  woman.  a3t.  35.  on  whom, 
tour  years  ago,  he  had  performed  this  operation  on 
both  sides  for  ankylosis  following  an  infection ,  pro- 
bably gonorrheal  in  origin.  She  could  now  separate 
the  edges  of  the  incisor  teeth  three-quarters  of  an  inch, 
and  could  masticate  with  comfort. 

Mr.  T.  Horkocks  Open  sh  aw  referred  to  cases  of 
his  own  in  which  he  had  resected  both  condyles  with 
results* 

Mr,  Openshaw  also  exhibited  three  cases  of  fracture 
of  the  bones  of  the  Jeg  treated  by  immobilisation  in 
Hoefttcke's  apparatus  and  a  modified  Hessing's  splint  - 
case  appliance. 

Mr,  Ed  red  M,  Corner  read  notes  of  two  cases  of 
primary  and  secondary  tuberculosis  of  the  thyroid 
gland.  In  the  first  case,  a  girl,  act,  9.  the  condition 
was  found  during  life,  an  abscess  in  the  right  lobe  and 
tits  leading  to  a  diseased  left  lobe  being  present. 
The  wounds  refused  to  heal  until  thyroid  extract  was 
administered.  The  child  died  seven  months  later 
ton  general  tuberculosis.  The  second  case  was  dis- 
covered post-mortem,  as  a  caseous  mass  in  the  right 
lobe  of  the  thyroid,  in  a  woman  who  had  died  of  pul- 
monary thrombosis  and  phthisis.  The  condition  was 
really  more  of  a  clinical  curiosity,  as  localised  tuber- 
Enkma  deposits  in  the  gland  were  extremely  rare. 

EDINBURGH  MEDICO-CHIRURCICAL  SOCIETY, 

Meeting  held  February  jrd,   1004, 

Professor  Chiene,  President,  in  the  Cham 


Mr.    Dowdek    showed    (1)    a    patient   after  severe 
it  ion  of  the  arm  ;    and  (2)  after  osteo-myeutis  of 
the  iihi a  and  secondary  infection  of  the  knee-joint. 

Mr.  Alexis  Thomson  showed  a  boy,  a?t,  1 1 ,  who  had 
sintered  from  infantile  paralysis  at  the  age  of  three. 
1  and  extensor  digitorurn  being  chiefly  affected, 
and  the  resulting  condition  being  one  of  talipes  equino- 
varus.     Double  division  of    the    tendo-Ychillis,    along 
with    transplantation    of    the    tendon    of    the    tibialis 
•  that  of  the  extensor  digitorurn,  had  led  to 
led  improvement. 
Ifr.  Scot  Ski  hying  showed    the  skull  of  a  patient 
exhibited   before   tfai  five  years  ago.  showing 

total  necrosis  of  the  frontal  bones  and  partial  necroses 
of  the  parietal  bones  from  syphilis. 
Dr.  Lovell  Gulland  read  a  paper  on 

THE  GLYCOGEN  REACTION  OF  THE  BLOOD. 

This  reaction  was  first  described  by  Khrlich  in  t&8$ 
m  occurring  in  pus*  but  later  research,  both  in  Germany 
and  Amer..  really  extended  its  range  of  useful- 

ness, although  so  far  it  had  been  somewhat  negh 
in  this  country.     The  technique   was  very  simple,    an 
air-dn  film    being  placed  on  a  drop  of  the 

staining  reagent  (iodine,  1  grain  ;  potassium  iodide. 
3  grams  ;  distilled  water,  too  c,c.)  on  a  slide,  and 
Lined  directly  with  an  oil  immersion  lens,  A 
white  light— daylight,  or  that  from  an  incandescent 
gas  burner — should  be  used,  as  the  reaction  Was  much 
\tm  easily  seen  by  yellow  light.     In  normal  blood  thc 


red   corpuscles  stain  orange  yellow,   the  leucocytes  a 
faint    lemon    yellow.     The    lymphocytes    are    almost 
k\  except  from  their  different  refractor  index  ; 
the  eosinophiles  can  always  be  made  out  on  account  of 
the  high  refractive  power  of  their  granules,  while  the 
polymorphonuclears   are   darker  on   account   of   their 
closely-set  granules.     Under  norm  U  urcmustauces  the 
neutrophils  polymorphonuclears  s  io%v  no  red  or  browTn 
slain,  but  a  certain  amount  of  extra-cellular  glycogen 
is  present  in  the  blood  plates.     This  is  very  variable  in 
different  diseases  ;  it  is  increased  in  diabetes  only,  and 
is  of  no  practical  importance  in  diagnosis.     A  positive 
reaction,  i.e.,  presence  of  glycogen  in  the  polymorpho- 
nuclear leucocytes,  is  often  of  great  diagnostic  value, 
The  reaction  is  occasionally  found  in  the  myelocyte* 
and  basophiles  (in  rare  cases  of  ieuka?mia),  but   prac- 
tically it  may  be  disregarded  except  when  occurring  in 
the  polymorphonuclears       In    these  all  glycogen  may 
give  rise  to  three  different  degrees  of  change — (i)  a 
brown    colour,    (2)    line    brown    granules,    (5)    coarse 
granules  wjth  peripheral  brown  masses  tike  pseudo- 
podia.     These  glycogen  granules  are  paraplastic,  and 
have    no    connection   with    the    ordinary   neutrophil*? 
granules,  which  are  simply  nodes  in  the  cytoplasmic 
reticulum;     if,     therefore,     the    former    assume    any 
dimensions,    they  can  no  longer  be  contained  in   the 
meshes  of  the  reticulum,  and  are  extended  towards  the 
periphery  (pseudopodia).     These  granules  do  not  con- 
sist of  pure  glycogen*  but  of  a  combination  of  glycogen 
with  proteid. "  They  are  not  found  in  the  cells  of  the 
bone   marrow,   but   are  more  abundant  in  emigrated 
leucocytes,  and  can>  therefore,  be  well  studied  in  films 
of  pus.     In  the  blood  the  percentage  of  cells  giving  the 
glycogen  reaction  varies  from  5  per  cent,  of  the  neutro- 
phile   leucocytes  upwrards,  and  if  after  looking  over 
two  or  three  hundreds  of  these  cells    no  glycogen    is 
iound,  the  reaction  may  be  said  to  be  negative.     The 
degree  of  the  reaction  varies  roughly  according  to  the 
severity  of  the  cause,  and  it  is  found  under  four  prin- 
cipal conditions — (1)  in  anemia,  (2)  in  severe  disturb- 
ances of  respiration,  (j)  in  toxamia,  (4)  in  suppuration. 
In  various  forms  of  anemia  it  may  be  well  marked, 
but  it  is  doubtful  whether  ana?mia  per  se  has  anything 
to  do  with  it.     It  is  not  of  any  diagnostic  importance 
in  this  disease.     Any  obstruction  to  the  respiration — 
cardiac  or  pulmonary  disease,  &c, — produces  it  ;    but 
as  soon  as  the  embarrassment  of  the  circulation  is  at 
an  end,  the  reaction  disappears.     In  toxic  conditions 
following   sepsis,    malignant   disease,    Ac,    it    is    also 
present.     In  none  of  these  conditions,  however,  is  the 
reaction  of  more  than  pathological  interest  :    its  great 
clinical  importance   is   its   constant   association   with 
suppuration.     Experimentally  it  has  been  produced  by 
the  injection  into  animals  of  staphylococci  and  strepto- 
cocci, the  bacilli  of  typhoid,  diphtheria,  and  anthrax, 
the  bacillus  pyocyaneus,  Ac,,  while  the  organisms  of 
tetanus  and  fowlcholera  give  negative  results.     Clini- 
cally, it  is  met  with  in  man  most  markedly  in  infections 
in  which  there  is  a  marked  exudation.     Thus  a  positive 
reaction  is  got  early  in  pneumonia,  and  disappears  with 
the  crisis.     It  is  also  found  in  cases  of  broucho-pneu- 
tnoiii.1,  but  not  in  bronchitis,  and  hence  may  serve  to- 
assist  in  the  diagnosis  between  the  two  conditions.     It 
is  also  found  in  empyema,   but  not   in  dry   or  serous 
pleurisy,  and  in  abscess  and  gangrene  of  lung.     It  is  a 
much  more  constant  accompaniment  of  all  advancing 
suppurative    processes    than    is    a    leucocytosis,    and 
generally  is  equal  in  amount  to  the  severity  of  the  con- 
stitutional disturbance.     The  sUe  of  the  abscess  does 
not    affect    it  ;     whenever  an   abscess   is  drained   the 
glycogen  reaction  goes,  only  to  return  if  drainage  be 
interfered  with.     It  does  not  occur  in  tuberculosis.     In 
gangrene  of  the  bowel,  peritonitis,  and  appendicitis  \\ 
is  a  better   test   than   leucocytosis.   and   even   than  a 
relatively  high  polymorphonuclear  count.     It   occurs, 
very  soon  after  the  onset  of  appendicitis  or  peritonitis — 
within  three,  twelve,  or  fifteen  hours. 
Dr.  Stuart  McDonald  read  a  paper  on 

A  CASE  OF  GENERAL  STREPTOTHRIX  INFECTION, 

At   the  outset   he  pointed  out   that   the   case  wa* 
almost  unique.     Most  of  the  records  showed   that  10. 


174    The  Mbpical  Press.        TRANSACTIONS  OF  SOCIETIES. 


Feb.  17,  1904. 


previous  cases  the  infection  had  been  local,  and  there 
had  been  difficulty  in  cultivating  the  organism.  In 
his  case  the  streptothrix  had  been  cultivated  quite 
readily,  and  inoculations  into  animals  had  given  posi- 
tive results,  so  that  it  had  been  easy  to  identify  it. 
He  hoped  to  show  that  it  bore  certain  suggestive  re- 
semblances to  tubercle.  Some  writers  referred  to  such 
cases  as  actinomyces  infection,  but  it  was  better  to 
reserve  the  name  for  the  specific  variety  actinomycosis. 
After  referring  to  the  literature  of  the  subject  the 
speaker  said  that  the  streptothrix  found  in  his  case 
seemed  to  be  identical  with  that  found  by  Eppinger 
in  the  pus  from  a  cerebral  abscess  in  a  patient,  who  also 
showed  pseudo-tuberculous  lesions  of  the  apices  of 
the  lungs  and  caseating  glands.  His  case  seemed  to 
be  the  only  one  which  had  so  far  occurred  in  this 
country  in  which  the  streptothrix  Eppingerii  had  been 
found.  The  patient's  history,  shortly,  was  as  follows  : 
A  woman,  aet.  65,  had  been  complaining  of  a  cough  for 
six  months,  and  had  been  for  five  weeks  confined  to  bed. 
There  was  no  expectoration.  On  admission  to  hospital 
she  was  drowsy,  temperature  99-8°,  pulse  112,  respira- 
tion 28.  There  was  consolidation  of  the  left  lung, 
paralysis  of  the  left  arm,  conjugate  deviation  of  the  eyes 
to  the  right,  and  increase  of  the  knee-jerks.  She 
became  comatose,  and  died  two  days  later.  As  bearing 
on  a  possible  source  of  infection,  it  was  noted  that  her 
house  was  opposite  a  stable  yard,  and  that  quantities 
of  chaff,  Ac,  were  always  blowing  about.  The  post- 
mortem revealed  recent  pleurisy,  and  an  appearance 
of  the  lung3  like  general  tuberculosis,  though  the  lesions 
seemed  more  pyaemic  than  tubercles  usually  are.  At 
the  surface  of  the  lung  some  of  them  had  actually 
broken  down  into  small  abscesses.  There  was  an 
abscess  in  one  kidney  and  pyelitis,  and  multiple 
abscesses  in  the  brain.  Cultures  from  the  abscesses 
gave  a  pure  growth  of  streptothrix,  very  like,  but  not 
absolutely  identical  with,  S.  Eppingerii.  Inoculation 
of  guinea-pigs  and  rabbits  showed  that  the  organism 
was  virulent  to  these  animals.  In  some  instances  it 
produced  lesions  like  those  of  pyaemia,  in  others  like 
those  of  tubercle.  It  may  be  that  by  using  an  attenu- 
ated culture,  changes  even  more  like  those  of  tubercle 
would  be  produced.  The  streptothrix  stained  by 
Gram's  method  ;  it  was  acid-fast,  like  tubercle,  and 
alcohol-fast.  Under  certain  conditions  the  cultures 
tend  to  give  rise  to  bacillary  and  coccal  forms  of  the 
streptothrix,  and  the  former  of  these,  being  acid-fast, 
in  many  instances  closely  resembled  tubercle  bacilli. 
As  to  the  lesions  in  the  organs,  the  chief  point  was  the 
amount  of  fibrinous  exudation,  which  in  some  places 
even  showed  signs  of  organisation.  The  paper  was 
freely  illustrated  by  lantern  slides,  microscopic  pre- 
parations, illustrative  cultures,  &c. 
Dr.  J.  V.  Paterson  read  a  paper  on 

GLAUCOMA  AND  THE  GLAUCOMA  THEORIES, 

which  will  be  found  on  page  165. 

Mr.  George  Berry  discussed  the  relations  of  the 
glaucoma  theories  to  treatment.  He  thought  opera- 
tions based  on  such  hypotheses  had  been  less  successful 
than  those  which  had  been  discovered  empirically. 
Clinical  investigation  of  the  arterial  system  had  not 
in  his  hands  led  to  any  very  definite  conclusions  on 
account  of  the  imperfections  of  the  instruments  in 
use  at  present. 

Dr.  George  Mackay  also  discussed  the  paper,  and 
Dr.  Paterson  replied. 

LIVERPOOL  MEDICAL  INSTITUTION. 
Meeting  held  Thursday,  February  4TH,  1904. 

James  Barr,  M.D.,  F.R.C.P.,  President,  in  the  Chair. 


hot-air  cautery. 
Dr.  Grossmann  gave  a  short  account  of  the  hot-air 
cautery  introduced  by  Dr.  Hollander,  of  Berlin,  and 
showed  a  modification  adapted  for  ophthalmic  surgery. 
He  had  employed  it  with  satisfactory  results  in  angioma 
of  the  lid,  in  corneal  ulcers  and"  similar  affections. 
He  considered  it  particularly  valuable  in  cases  of 
conical  cornea.     The  different  degrees  of  heat  could  be 


easily  regulated,  and  the  results  were  superior  to  those 
of  actual  cautery. 

chronic  poisoning  from  antimony. 
Dr.  Leslie  Roberts  exhibited  a  patient,  a  com- 
positor, suffering  from  chronic  poisoning  by  antimony 
and  lead.  The  symptoms  were  sweating,  tenderness  of 
palms  and  soles,  and  pains  in  the  muscles  of  arms  and 
back.  The  patient  had  given  up  work  on  account  of 
the  tenderness  of  the  fingers.  The  palms  were  pinkish- 
red,  and  drenched  with  perspiration.  Scattered  over 
them  were  small  flat  smooth  papules.  Microscopic 
examination  showed  the  rete  to  oe  hvpertrophied,  the 
sweat-ducts  much  dilated,  and  the  capillaries  congested. 
The  condition  of  the  palms  was  like  that  seen  in  some 
forms  of  arsenical  poisoning.  The  linotype  metal  was 
found  to  be  composed  of  tin,  antimony,  and  lead.  The 
urine  was  free  from  albumin,  but  contained  lead.  The 
man  had  not  suffered  from  colic.  The  plumbism  seemed 
to  have  been  modified  by  the  antimony. 

INTRA-VESICAL  SEPARATION   OF  THE   URINE. 

Mr.  Robert  Bickersteth  read  a  note  on  the  intra- 
vesical separation  of  the  urine  from  the  right  and  left 
ureters  as  an  aid  to  the  diagnosis.  He  showed  the 
"  separator  "  introduced  by  Dr.  George  Luys,  of  Paris. 
He  had  used  this  instrument  for  the  last  six  months, 
and  he  showed  specimens  of  separated  right  and  left 
urines,  which  proved  the  method  to  be  of  the  greatest 
utility.  The  bladder  is  washed  out  and  emptied  before 
passing  the  "  separator."  In  from  fifteen  to  twenty 
minutes  sufficient  urine  can  be  collected  from  each 
ureter  to  estimate  the  relative  efficiency  of  the  kidneys. 
A  general  anaesthetic  is  not  necessary,  for  after  the 
introduction  of  the  instrument  the  patient  should  be 
placed  in  the  sitting  posture. 

Mr.  Paul  endorsed  all  that  had  been  said  in  favour 
of  the  instrument.  In  one  case,  from  the  clinical 
symptoms  he  had  decided  to  operate  upon  the  right 
kidney,  but  fortunately  the  "  separator "  demon- 
strated that  this  was  the  better  kidney  of  the  two. 

Mr.  George  Hamilton  said  that  in  certain  cases  of 
renal  haematuria,  owing  to  the  blood  clotting,  the 
utility  of  the  instrument  might  be  limited. 

Mr.  Monsarrat  had  been  greatly  impressed  with 
the  value  of  the  instrument. 

PUERPERAL   SEPTICEMIA. 

Dr.  Nathan  Raw  read  a  paper  on  the  pathology, 
bacteriology,  and  treatment  of  puerperal  septicaemia, 
with  special  reference  to  the  value  of  antistreptococcic 
serum,  based  on  an  observation  of  sixty-one  cases. 
The  disease  in  no  way  differed  in  origin  and  in  symptoms 
from  that  of  any  other  infective  and  septic  process,  and 
was  not  peculiar  to  the  lying-in  state.  The  micro- 
organisms found  in  his  series  were  as  follows  : — 
Cases.  Micro-organisms. 

27     Streptococcus  pyogenes. 
6    Staphylococcus  aureus. 
13    Mixed  infections. 
11     Bacillus  coli  communis. 
1     Diphtheria. 
3     No  growth  of  organisms. 

Total  61 

It  was  of  the  highest  importance  that  before  the  serum 
was  employed  it  should  be  demonstrated  beyond  doubt 
that  the  infection  was  streptococcal.  This  could 
readily  be  done  by  staining  a  little  of  the  secretion 
from  the  uterus  or,  in  advanced  cases,  from  the  blood. 
It  was,  however,  difficult  to  recover  streptococci  from 
the  blood  unless  taken  from  a  vein  in  large  quantity, 
say  5  ex.,  and  then  they  were  not  always  found. 
His  experience  went  to  show  that  the  serum  was  of  the 
greatest  possible  value  in  pure  streptococcal  infections, 
if  employed  early  in  the  disease.  It  reduced  the  tem- 
perature and  the  pulse-rate,  and  the  patient  passed  into 
a  condition  of  quiet  and  sleep.  The  dose  he  employed 
was  20  ex.,  twice  or  thrice  daily,  and  continued  for 
several  days.  He  had  never  known  any  harm  or  bad 
symptom  arise  from  its  use,  if  obtained  from  a  trust- 
worthy manufacturer,  and  with  a  bacteriological 
guarantee  of  its  purity  before  use.  Table  I. — Total 
number  of  cases  under  observation,  61  ;  recovered.  32  ; 


TRANSACTIONS  OF  SOCIETIES.        The  Mescal  Pibss.     175 


die*!.  29  \  death  rate.  48  per  cent,  TabU  //.—Number 
treated  with  serum,  3;;  recovered,  24;  died.  13; 
death-rate,  36  per  cent.  Tabic  III. — Number  treated 
without  serum,  24  ;  recovered,  8  ;  died,  16  ;  death- 
rate,  60  per  cent  Several  patients  in  Table  III,  were 
Admitted  in  an  advanced  stage  of  the  disease,  when 
obviously  no  treatment  would  be  of  avail. 

Dr.  CiEMMti-L  said  he  had  not  felt  confidence  in  the 
serum  treatment,  mainly  because  he  feared  to  use  it 
utiles  he  kit  certain  that  the  specific  germ  was  in  the 
blood,  and  any  examination  of  the  blood  must  be  made 
frequently  and  a  sufficient  quantity  taken  from  a  vein, 
Even  sor  the  result  was  usually  negative,  and  the  pro- 
cedure alannmg*  The  presence  of  streptococci  in  the 
iochial  discharges  was  not  sufficient  indication  for  the 
ase  of  the  serum. 

Dr.  Hugos  had  frequently  used  the  serum,  but  had 
grave  doubts  as  to  its  real  utility.  If  the  benefits 
claimed  for  its  use  in  puerperal  septicaemia  were  un- 
doubted, it  should  also  be  of  great  value  in  surgical 
septicaemia  and  in  ulcerative  endocarditis. 

Dfe  Llewellyn  Morgan  pointed  out  that  as  no 
barm  had  come  to  any  patient  through  the  use  of  the 
serum,  and  as  in  many  cases  undoubted  good  had 
followed  its  use,  therefore  every  case  of  septicaemia 
should  be  given  the  chance  oj  the  possible  benefit. 

Dr.  E.  T,  Dayies  drew  attention  to  the  fact  that 
though  in  maternity  hospitals  puerperal  septicaemia 
was  seldom  or  never  met  with,  yet  the  incidence  of 
septic  infection  in  private  practice  remains  appallingly 
common,  thus  proving  that  private  practitioners  and 
midwives  do  not  pay  the  same  attention  to  surgical 
cleanliness  as  obtains  in  hospital  practice. 

Dr  Gkimsdale  said  the  practical  point  to  emphasise 
was  that  puerperal  fever  is  a  prevent  ible  disease,  yet 
it  is  at  present  more  prevalent  in  private  practice  than 
it  was  ihirtv  years  ago.  Most  importance  should  be 
ted  to  prophylaxis,  and,  secondly,  to  early  dia- 
gnosis. Early  diagnosis  and  efficient  local  treatment 
were  the  chief  elements  in  success. 

Dr  O' Flaherty  said  in  many  cases  the  source  of 
infection  was  to  be  found,  not  in  the  uterus,  but  in 
some  diseased  pelvic  organ,  which  had  been  injured 
during  labour. 

Df»  Grukbaum  observed  that  in  spite  of  the  relative 
feebleness  of  antistreptococcic  serum,  it  should  always 
be  given  when  the  clinical  symptoms  pointed  to  puer- 
peral septicemia,  whether  streptococci  were  found  or 
not.  The  administration  should  be  continued  for 
sometime  after  apparent  cure,  on  account  of  the  feeble 
immunisation  attainable  against  streptococci  by  man. 
Recent  improvements  in  the  manufacture  of  the  serum 
made  its  use  much  more  hopeful. 

THE  OTOLOGIC AL  SOCIETY  OF  THE    UNITED 

KINGDOM. 

Meeting  held  Monday,  February  ist,  1904. 


The  President.  Dr,  Thomas  Bare  (Glasgow),  in 
the  Chair. 

INTRODUCTORY   ADDRESS. 

Tke  President,  reviewing  the  work  of  the  last 
session,  remarked  on  the  tact  that  a  very  large 
portion  of  the  communications  dealt  with  suppurative 
diseases  of  the  ear  and  their  complications,  and  sug- 
gested that  the  Society  might  well  devote  a  part  of  its 
time  to  a  study  of  such  affections  as  sclerosis  of  the 
middle  ear,  diseases  which  mi^'ht  nut  directly  endanger 
life,  but  which  made  life  almost  unbearable,  It  would 
be  of  gmt  ail  vantage  to  otologists  to  have  authorita- 
tive guidance  as  to  the  comparative  utility  of  the 
numerous  methods  of  treatment  in  vo^ue, 

Mr.  C.  H.  Fagge  exhibited  a  specimen  of  iJ  atresia 
aons  congenita/*  The  tympanic  membrane,  ossicles 
and  osseous  meatus  were  absent  on  both  sides,  and  no 
cavity  resembling  a  mastoid  antrum  could  be  found. 

Dr.  Tilley  raised  the  question  of  the  possible  ab- 
sence of  the  antrum  in  adult  ears,  which  were  otherwise 
anatomically    normal. 

Dr,  MiLLTGAV  (Manchester)  read  a  paper  on  the 
etiology    and    treatment     of     labyrinthine    suppura- 


tion. The  invasion  of  the  labyrinth  from  the  middle 
ear  or  antrum  took  place  generally  through  the  fora- 
mina ovale  and  rotundum  and  the  external  s.c.  canal. 
Extensions  from  the  labyrinth  were  most  frequent 
to  the  cerebellar  fossa  by  way  of  the  internal  auditory 
meatus,  the  cochlear  and  vestibular  canals,  but  might 
reach  the  middle  cerebral  fossa  through  the  prominence 
of  the  s.s.c.  canal.  Facial  paresis,  vertigo,  loss  of 
bone  conduction,  and  deep-seated  pain  occurring  in  a 
case  of  middle  ear  suppuration  would  lead  to  a  sus- 
picion of  labyrinthine  suppuration*  Mixed  cases 
of  labyrinthine  and  intracranial  disease  (especially 
suppurative  meningitis,  extradural  abscess  and  cere- 
bellar abscess)  were  not  uncommon,  and  the  differen- 
tial diagnosis  would  depend  largely  on  examination  of 
the  outer  wall  of  the  labyrinth.  The  presence  of  optic 
neuritis  and  focal  symptoms  would  favour  a  diagnosis 
of  intracranial  abscess  ;  mere  M  pressure  M  brain  sym- 
ptoms, on  the  other  hand,  might  be  caused  by  simple 
meningeal  exudation  excited  by  the  labyrinthine 
disease.  Drr  Milligan's  paper  was  illustrated  by  cases, 
and  by  lantern  slides  of  the  temporal  bone. 

Discussion  of  the  paper  was  adjourned,  at  the  sug- 
gestion of  Mr,  Ballance,  to  the  next  meeting- 

Mr.  W.  H,  Kelson  showed  a  patient  with  a  cica- 
tricial condition  of  the  tympanum  and  meatus,  follow* 
ing  prolonged  suppuration  of  the  middle  ear.  On  ex- 
amination with  a  speculum  the  meatus  presented  the 
appearance  of  a  hollow  cone,  the  ear  being  free  from 
suppuration  and  the  other  one  normal.  Members 
present  advised  leaving  well  alone. 

Mr*  Hunter  Tod  showed  a  specimen  of  sarcoma 
removed  by  operation  from  the  external  meatus  of  a 
woman,  set.  67,  The  specimen  was  referred  to  ih<- 
Pathological  Committee, 

Mr.  Hugh  E<  Jones  exhibited  a  portable  surgical 
hand-motor,  designed  to  obviate  the  necessity  for 
carrying  about  an  electrical  accumulator.  The  motor 
will  be  made  for  sale  by  Messrs,  Mayer  and  Meltzer, 
who  have  fitted  it  with  their  patent  flexible  cable  and 
aseptic  hand -piece, 

Mr,  W\  G  Bull  showed  a  left  temporal  bone  obtained 
from  a  man,  set.  21+  Purulent  otorrha^a  twenty  years, 
no  intracranial  symptoms,  facial  paralysis  fourteen 
days,  complete  post  aural  operation:  bone  around 
tympanum  and  antrum  found  blackened,  and  an  open- 
ing into  the  Fallopian  canal  discovered.  Death  oc- 
curred three  days  after  operation  from  an  undetected 
cerebellar  abscess. 


ULSTER  MEDICAL  SOCIETY. 

The  fourth  general  meeting  of  the  Session  was  held 
in  the  Medical  Institute,  Belfast,  on  Thursday  evening. 
February  4th.  the  President,  Dr.  John  Campbell. 
RR.C.5,,  in  the  Chair, 

On  the  motion  nf  Dr,  Houston,  seconded  by  Dr. 
O'Neill,  a  motion,  recommended  by  the  Council 
of  the  Society,  was  passed  supporting  the  resolutions 
recently  sent  to  his  Majesty's  Government  by  the  Coun- 
cil of  Queen's  College,  Belfast,  urging  the  necessity  for 
the  better  equipment  of  the  college. 

Dr.  j.  C.  Marttn  (Portrush)  showed  a  pathological 
specimen  of  atheromatous  and  aneurysmal  condition  of 
the  abdominal  aorta  and  both  iliac  arteries.  The  man 
from  whom  the  specimen  was  taken  died  at  eighty - 
seven  years  of  age,  not  from  any  of  the  usual  termina- 
tions of  aneurvsm.  but  from  asthenia. 

Dr.  A.  B.  Mitchell,  F.R.C.S.L,  showed  a  case  in 
which  the  whole  of  the  right  clavicle  h&d  been  resected. 
There  was  very  good  movement  and  power  in  the  right 
arm. 

Da.  Mitchell  also  opened  a  discussion  on  the 
surgical  treatment  of  malignant  tumours  of  the  breast. 
His  paper  was  very  fully  illustrated  by  lantern  slides 
showing  the  anatomy  of  the  gland  and  the  histology 
of  some  of  the  tumours  operated  on.  and  by  photo- 
graphs of  some  of  his  cases  and  pathological  specimens. 
Dt.  Mitchell  said  that  he  had  tried  the  Rontgen  rays 
and  Daley's  fluid,  and  had  come  to  the  conclusion 
that  an  operation  was  the  best  treatment.  His  rule 
was  "  Operate — operate    early    (do  not  wait  till   the 


176    The  Medical  Press. 


GERMANY. 


Feb.  17.  1904 


tumour  is  painful) ;  operate  completely."  He  advo- 
cated the  removal  of  the  pectoralis  muscle,  not  so 
much  because  it  might  be  infiltrated  with  the  growth 
as  that  its  removal  enabled  him  to  clear  the  axillary 
and  other  lymphatic  glands  more  completely  away. 
He  sounded  a  note  of  warning  as  regards  the  age  of 
the  patient ;  it  had  been  taught  that  carcinoma  of  the 
breast  was  not  common  below  thirty  years  of  age. 
He  did  not  altogether  agree  with  this  teaching,  and 
not  only  had  he  found  such  malignant  tumours  below 
that  age,  but  he  had  found  excessive  malignancy  in 
such  as  did  occur. 

Professor  Sinclair,  F.R.C.S.,  said  he  agreed  with 
this  statement  as  regards  patients  below  thirty  years 
of  age.  He  also  had  lost  confidence  in  Ron t gen  rays 
and  Colley's  fluid  ;  the  latter,  some  time  ago,  he  had 
found  not  only  do  no  good,  but  do  absolute  harm. 
He  usually  preferred  a  Mitchell  Banks  operation,  and 
removed  the  sternal  part  of  the  pectoralis  major  to 
get  at  the  glands  in  the  subclavicular  triangle.  It  was 
very  necessary  to  remember  the  triangular  shape  of  the 
organ,  as  in  old  days  the  angles  of  the  mamma  were 
left  to  propagate  fresh  growth. 

Professor  Byers  was  very  pessimistic  with  regard 
to  the  treatment  of  malignant  tumours  of  the  breast ; 
he  had  only  seen  two  cures  in  the  course  of  twenty 
years'  practice.  He  thought  the  knife  was  the  best 
treatment,  but  a  very  poor  best ;  we  should  have  to 
learn  more  about  cancer  before  we  could  learn  to  treat 
it  successfully.  . 

Dr.  Kevin,  speaking  as  a  general  practitioner,  said 
he  generally  found  recurrences  in  eighteen  months. 
Dr.  Byers  had  proclaimed  himself  a  Jeremiah,  and  he 
(Dr.  Kevin)  was  Jeremiah  II. 

Dr.  Robert  Campbell,  F.R.C.S.,  agreed  with  Dr. 
Mitchell  in  always  removing  the  pectoralis  major,  in 
order  that  he  might  clear  away  the  lymphatic  glands. 

Sir  Wm.  Whitla  said  that  when  house-surgeon  in 
the  Royal  Hospital,  Belfast,  he  had  traced  a  number 
of  cases  treated  by  old  methods,  and  all  had  died  in 
years. 

Dr.  Mitchell  briefly  replied. 

ROYAL  ACADEMY  OF  MEDICINE  IN  IRELAND. 

Section  of  Obstetrics. 

Meeting  held  February  5TH,  1904. 


The  President,  Dr.  Alfred  Smith,  in  the  Chair. 

Dr.  Alfred  Smith  showed  a  uterus  removed  by 
panhysterectomy  containing  a  large  senile  polypus. 

Dr.  E.  H.  Tweedy  showed  two  dermoids,  and  one 
cancerous  ovary  removed  by  abdominal  section. 

The  adjourned  discussion  on  Dr.  Purefoy's  report  of 
the  Rotunda  Hospital  for  the  year  1902-03  then  took 
place.  Drs.  Tweedy,  Jellett,  Wilson,  FitzGibbon, 
Fitzgerald  and  the  President  spoke,  and  Dr.  Purefoy 
replied. 

The  meeting  then  adjourned. 

©ermang. 

[from  our  own  correspondent.] 

Bbrldv.  February  15th.  1904. 

At  the  Society  for  innere  Medizin  Hr.  Albu  showed 
Preparations  from  the  Intestinal  Tract. 

The  first  was  a  traction  diverticulum  of  the  duo- 
denum. The  patient  was  a  man  who  suffered  from 
violent  pain  in  the  upper  part  of  the  abdomen  and 
obstinate  constipation.  An  ulcer  of  the  duodenum 
and  stenosis  of  the  pylorus  were  diagnosed.  An  opera- 
tion was  performed,  at  which  it  was  ascertained  that 
the  pylorus  would  admit  a  finger.  Behind  the  pylorus 
was  a  hard  mass — peritonitic  bands.  Gastroenteros- 
tomy was  performed,  but  the  man  died  some  days 
afterwards  of  pneumonia.  The  autopsy  revealed  an 
ulcer  in  front  of  the  pylorus  ;  by  the  peritonitic  bands 
the  duodenum  was  dragged  forwards,  and  in  this  way 
a  diverticulum  had  been  formed. 


The  second  was  an  invaginated  tumour  of  the  small 
intestine.  The  patient,  a  man,  aet.  53,  who  had  always 
been  healthy  previously,  suffered  acute  pain  in  the  ab- 
domen for  four  or  five  days — with  diarrhoea.  Palpation 
revealed  a  movable  tumour  in  the  right  side.  There 
was  dulness  above  the  tumour,  which  disappeared, 
however,  on  inflation.  The  patient  was  transferred 
to  the  surgical  klinik,  where  high  fever  set  in,  and  an 
abscess  developed  in  the  right  side,  from  which  pus 
escaped  after  incision.  The  patient  died  shortly  after- 
wards. A  tumour  of  the  small  intestine  was  then 
found,  a  fibroadenoma,  which  had  undergone  necrosis 
at  the  circumference,  and  which  had  then  led  to  sup- 
puration. 

The  third  was  a  case  of  cancer  of  the  pylorus,  originat- 
ing in  an  ulcer.  The  patient,  a  man,  aet.  30,  was  sup- 
posed to  be  suffering  from  pernicious  anaemia.  On 
examining  the  blood,  however,  nothing  appeared  to 
justify  this  diagnosis,  and  Hr.  Albu  suspected  cancer  of 
the  stomach  to  be  the  cause  of  the  anaemia.  Opposed 
to  this,  however,  was  the  fact  that  no  motor  insuffi- 
ciency could  be  detected  in  the  stomach.  After  a 
fortnight  paralysis  of  the  left  facial  nerve  and  of 
the  left  upper  extremity  came  on,  which  improved  to 
some  extent  in  the  course  of  a  few  days.  Shortly  after- 
wards the  patient  died.  The  autopsy  showed  cancer 
of  the  pylorus  that  had  developed  on  the  base  of  an 
ulcer.  The  suspicion  of  cancer  was  therefore  justified, 
although  there  had  been  no  motor  insufficiency.  No 
clot  was  discoverable  in  the  brain  as  the  cause  of  the 
hemiplegia,  but  hydrocephalus  internus  and  a  diffuse 
fibrous  arachnitis. 

The  fourth  case  was  one  of  carcinomatous  ulcer  of 
the  pylorus,  not  deep,  but  rather  superficial.  The 
patient,  a  woman,  aet.  63,  had  never  been  ill,  and  had 
no  pain  in  the  stomach,  nor  haematemesis.  The 
microscope  showed  that  the  carcinoma  had  developed 
out  of  an  ulcer. 

Hr.  Litten  remarked  on  the  third  case  with  hemi- 
plegia, that  he  had  observed  a  similar  case  in  which 
hemiplegia  was  associated  with  carcinoma  of  the  py- 
lorus. The  brain  was  afterwards  examined  most 
carefully,  and  slight  cancerous  metastases,  that  might 
easily  have  been  overlooked,  were  found  to  have 
affected  the  ganglia. 

Experiments  with  Fluorescing  Substances. 

Professor  Tappeiner  and  Dr.  Jesioneh  related  some 
experiments  they  had  made  on  the  subject  in  a  recent 
number  of  the  Munch,  mtd.  Wochensch.  It  had  been 
shown  that  fluorescing  substances,  eosin,  fluorescin, 
acridine,  and  quinine,  among  others,  even  when 
diluted  to  a  millionth  part,  had  a  destructive  power  over 
low  organisms,  such  as  the  ciliated  epithelium  of  the 
frog,  and  that  they  had  the  property  of  destroying 
the  power  of  enzymes  and  toxins.  The  authors 
named  were  led,  therefore,  to  try  if  these  substances 
had  any  therapeutic  properties.  They  painted  diseased 
portions  of  skin  with  a  5  per  cent,  aqueous  solution  of 
eosin  and  then  exposed  the  part  for  a  long  time  to 
sunlight  or  the  light  from  an  arc  lamp.  Three  cases 
of  carcinoma  of  the  skin  so  treated  showed  striking  im- 
provement after  sixty,  fifty,  and  thirty  days  respec- 
tively. A  similar  beneficial  effect  was  produced  in  a 
case  of  tubercle  of  the  testis  in  a  boy,  aet.  14,  who  had 
also  scrofulous  ulcers  on  the  scrotum  ;  here  the  eosin 
solution  only  was  injected.  In  lupus  the  specific 
tissues  disappeared  under  the  influence  of  the  eosin 
and  light  treatment.  Condylomata  on  the  female 
genitals  also  disappeared  in  ten  days,  and  likewise  a 
primary  lesion  of  the  tongue.  Here  the  regionaJy 
secondary  swellings  also  disappeared.  A  case  of 
primary   genital   lesion    with    inguinal    scleradenitis 


Feb.   tj.  igo4- 


CONTINENTAL  HEALTH  RESORTS,     tat  medical  p*ess.     177 


also  promptly  disappeared,  but  sixteen  weeks  later  there 
was  a  sparse  roseola  on  the  abdomen. 


Hustrta. 


[from  our  own  correspondent.] 

Vli^SA.  frebrOMT  141b,  1004. 

The  Theory  of  Hearing. 
It  the  Gesellschafl  der  Aerzte,  Exner  and  Potiak 
-tive  paper  between  them  on  the  theory 
mg.  The  sum  and  substance  of  their  arguments 
faithful  adhesion  to  Helm  hoi  z's  original  idea,  or 
resonating  theory,  r>.,  when  a  tuning-fork  is  set 
sn  motion  the  outside  sound  comprehends  one-half  of 
the  sound,  but,  if  a  resonator  be  conducted  from 
between  the  prongs,  a  double  or  complete  wave  of  the 
tuning-fork  will  be  obtained* 

^  The  necessary  irritation  lo  produce  hearing  at  all 
was  modified  by  physiological  and  anatomical  con- 
tiOO  differing  in  some  measure  from  the  other 
senses,  such  as  taste  and  smell,  which  were  more 
chemical  in  action,  and  depending  upon  the  moisture 
of  the  mucous  membrane  involved  in  the  physiological 
transformation. 

The  sensation   of   feeling    was    purely   mechanical, 
while  sight  depended  on  a  photochemic  action. 

In  the  ear  we  have  two  senses  so  closely  related  that 

"mes  difficult  to  separate  the  one  from  the  other, 

fcUtfe  and  auric,  which  are  probably  both  media* 

meal  in  origin,  depending  on  the  wave  transmission  of 

tng    molecules    of    air,    whose    movements    are 

delicately    conveyed    by    intermediate    organs    to    the 

of    Corti,    which   has   a   basal   membrane,    and, 

having   different    lengths,    is    suited    to    receive    wave 

rounds  varying  from  33  per  second  to  4.000  in   the 

same  time.     They  seriously  assure  us  that  this  theory 

has  been  assailed  of  late  with  an  intermediate  theory 

of  intermission. 

Besunnino  the  Throat. 
he  meeting  of  the  Innere  Medizin  Association, 
Sorgo  showed  a  case  in  which  he  had  treated  a  tuber- 
culous  growth    in    the    throat    with    reflect ed    sun's 
■vith  perfect  success.     The  neoplasm  was  about 
>e  of  a  large  pea,     The  treatment  was  intermittent, 
tent   vomiting,    that   seriously  delayed 
;ui>  methodical  application  of  the  treatment, 

Schrotter  remarked  that  this  idea  of  Sorgo's  was  not 
a  new  one,   and   had   been   in   practice  at   the  Third 
Imperial  clinic  for  a  long  time   past  ;    but,  owing  to 
some  delay  in  the  preparation  of  particular  apparatus, 
toe  treatment  had  been  somewhat  suspended,  although 
rhe  results  so   far   obtained    had    been   favourable  in 
many  cases  ;  but  it  must  be  admitted  that  this  therapy 
Hi  is  not  all  that  could  be  desired.     In  many 
cases  the  tubercle  will  disappear  entirely,  but  in  others 
I  persist  in  spite  of  the  most  heroic  treatment, 
more  especially    in    such    cases    where    the    neoplasm 
to   shrink   and    almost    disappear.     Such   cases 
cannot  be  assumed  to  be  cured  either  locally  or  gener- 
ally although  the  growth  has  been  very  much  reduced, 
*hi!e  the  source  and   general   nucleus  lies  still  active 
and  undisturbed.     It  must  be  admitted  that  this  is  a 
temporary  expedient  in  many  cases,  and  not  a  cure. 
Elevated  Climates, 
Sucke  gave  a  theoretical  explanation  of  elevated 
on    disease,   and    attributed    the  successful 
treatment  of  tubercle,  &c,  to  the  high  radio-activity 
of  the  sun  *s  ra  ys .    After  Ion  g  and  la  bo  rio  us  o  bs  erva  t  ions 
ids  that  the  emanations  are  five  or  six  times  as 
great  at  5,900  ft,  above  sea  level  as  it  is  on  the  sea- 
shone.    The  potentiality  is  equal  to  the  difference  of 
-n  between  the  positive  air  and   negative  earth. 


Thus  the  human  tissues  are  acted  on  after  Becqueters 
theory  in  proportion  to   the  surroundings. 

Variation  ok  Temperature  in  Insects. 

Bachmetjew,  Professor  of  Physics  at  Sofia,  has 
recently  added  to  our  knowledge  the  astonishingly 
vvnk  variation  of  temperature  that  prevails  in  the 
insect  order  of  life.  In  the  Tropics,  where  the  air  Is 
dry  and  the  heat  intense,  the  hydrocatitharis 
beetle,  according  to  Girard,  exists  in  welts  of  an  enor- 
mous temperature,  Cantoni  has  fed  the  caterpillar  of 
the  Borabyx  mori  at  a  temperature  of  47 °  C,  or 
iia^6  R,  without  the  slightest  injury  to  the  insect. 
On  the  other  hand,  different  insects  and  caterpillars, 
are  found  in  glaciers  without  having  suffered  in  any 
way.  Again,  the  eggs  of  the  Bombyx  rabri  have  been 
treated  to  temperatures  varying  from  39 °  C.  to  59  < 
or  from  ;oc  to  122*  F.,  without  being  disturbed  in  their 
activity,  which  must  be  accepted  as  an  interesting 
biological  experiment  to  know  that  this  insect  can  be 
cultivated  at  different  temperatures  than  the  geogra- 
phical positions  at  present  assigned  to  them.  In  dis- 
cussing the  accommodation  of  these  insects,  Bach- 
metjew  attributes  the  power  of  resistance  to  the  con- 
dition of  the  air  and  moisture  of  the  insect.  At  ordinary 
temperature  the  insect  remains  undisturbed  j  but  a 
rise  to  37*  C,  or  98"  F.,  will  increase  the  moisture  and 
body  heat  in  proportion  to  an  unbearable  extent  ;  but 
to  overcome  this  the  insect  throws  o£F  a  large  quantity 
of  its  moisture,  thus  reducing  the  body  temperature 
to  something  like  15°  below  the  temperature  that 
would  be  attained  if  it  had  not  gone  through 
that  transformation.  These  changes  are  accomplished 
through  the  skin  and  body,  and  the  usual  pulmonary 
apparatus  of  the  insect. 

The  vital  maximum  temperature,  therefore,  ranges 
between  45*  and  54"  C,  or  113'  and  rac*"  F.  The  vital 
minimum  ii  placed  at  8*  to  io°  C„  whick  is  the  lowest 
temperature  the  fluids  of  the  insects  are  able  to 
resist  before  the  critical  or  freezing  point,  when  death 
takes  place. 


Continental  tJealtb  HesortB. 


[from  our  special  correspondent,] 


CHATEL-GUYON, 

The  Thermal  Station  of  Chatel-Guyon  is  situated  in 
the  department  of  Puy-de-Dome  (part  of  the  old  pro- 
vince of  Auvergne),  France,  It  is  accessible  from 
Paris  by  the  Paris-L,yon*Mediterranee  Railway,  vi£ 
St.  Germain -des- Fosses  and  Clermont-Ferrand,  The 
nearest  railroad  station  is  Riom," seven  hours*  rail  from 
Paris  and  half  an  hour  carriage  drive  from  Chatel- 
Guyon.  There  are  several  excellent  trains  from  Paris 
each  day.  and  a  good  omnibus  service  from  Riom, 

At  Chatel-Guyon  are  two  bath  establishments,  both 
belonging  to  the  same  company  and  under  one  manage- 
ment. The  two  establishments  include  excellent  hydro- 
pathic arrangements  of  high  merit  and  of  wide  variety. 
The  new  one  ranks  among  the  best  of  modern  European 
hydropathics.  It  is  especially  notable  for  its  ex- 
cellent and  special  appliances  for  vaginal  injections, 
"  washings-out  M  of  the  stomach,  and  for  general 
intestinal  lavages.  The  electro- therapeutic  department 
has  also  peculiar  adaptations  for  electric  baths,  as 
also  its  mecano-therapic  annexe  for  the  active  gym* 
nastic  treatment  of  the  abdominal  muscles, 

Chatel-Guyon  lies  on  a  slope  of  the  Dome  mountains 
at  1,200  feet  altitude;  its  mineral  waters  descend 
underground  from  high  levels,  finding  their  way  to  the 
surface  (partially  through  natural  fissures  in  the  rocks 


178    The  Medical  Press. 


OPERATING   THEATRES. 


Feb.  17,  1904. 


and  partly  by  borings)  at  temperatures  varying  from 
750  to  10 1  °  Fahrenheit. 

There  are  here  twenty-seven  mineral  spirngs,  with 
a  combined  flow  exceeding  three  million  litres  every 
twenty-four   hours.     This    enormous   quantity  makes 
■Chatel-Guyon  one  of  the  most  important  Spas  of  the 
world,  as  the  mineral  waters  are  not  only  great  in 
•quantity,  but  also  of  high  excellence  in  quality. 

The     most     celebrated     spring,     Source     Gubler, 
shows,  by  analysis  of  Dr.  Magnier  : — 

Gaz  acide  carbonique  libre     . .  . .      1  *  1 1 20 

Chlprure  de  magnesium         ..  1*5630 

Chlorure  de  soude       ..  ..  ..      1*6330 

Bicarbonate  de  chaux  ..  2*1796 

Bicarbonate  de  fer      . .  . .  . .     0*0685 

Bicarbonate  de  li thine  ..     0*0194 

Bicarbonate  de  potasse  ..  0*2583 

Bicarbonate  de  soude  . .  . .     0*9550 

Sulfate  de  chaux         . .  . .  0*4990 

Silice  ..  ..  , .  ..     0*1108 

Arsenic  . .  . .  . .  . .     Traces 

Acide  phosphorique    . .  . .  . .     Traces 

Acide  borique . .  . .  . .  Traces 

Alumine  . .  . .  Traces 

Total  ..  ..     8*3986 

The  Chatel-Guyon  waters  are  used  both  internally 
and  for  bathing.  The  baths  are  given  with  running 
water,  coming  directly  from  the  springs,  and  so  having 
all  advantages  of  natural  temperatures  and  combina- 
tions. They  stimulate  the  skin  functions  and  promote 
-circulation.  The  first  sensation  in  the  baths  is  one 
of  coolness,  but  in  a  few  minutes  the  body  is  covered 
with  gas-bubbles,  and  heat  is  produced.  On  emerging 
from  the  bath  the  body  is  red,  the  blood  rushes  to  the 
skin,  and  there  follows  a  decongestion  of  the  internal 
organs.  This  beneficial  effect  aids  and  increases  the 
<iecongesting  action  which  had  been  produced  internally 
by  drinking  the  waters. 

Owing  to  the  constant  running  of  the  water  while  in 
the  bath  its  theraputic  action  is  maintained  during  the 
whole  period  of  immersion,  and,  because  of  the  different 
temperatures  of  the  springs,  baths  can  be  given  varying 
from  750  to  95 °  F.  without  any  artificial  heat. 

The  good  effects  from  drinking  and  bathing  can  be 
further  extended  at  the  physician's  pleasure  by  adding 
local  applications  and  internal  irrigations. 

The  chief  indications  for  a  course  of  treatment  at 
Chatel-fcuyon  are  obesity,  constipation,  dyspepsia, 
enteritis,  appendicitis,  congestion  of  the  liver  and 
•spleen,  diseases  of  the  kidneys,  ovaries,   uterus,  &c. 

Chatel-Guyon  has  during  the  summer  season  a  very 
competent  medical  staff,  including  English-speaking 
physicians.  It  has  also  good  hotels,  pensions,  villas, 
and  furnished  apartments.  Prominent  amongst  the 
hotels  are  the  Splendide  and  Nouvel  (succursales  of  the 
well-known  Hotel  Mirabeau,  of  Paris),  which  occupy 
a  beautiful  situation  in  the  park  of  the  thermal  estab- 
lishment, and  have  all  modern  comforts.  The 
large  park  also  includes  the  baths,  buvettes,  music 
kiosques,  casino,  covered  promenade,  and  gymnasiums. 

Around  the  isolated  hill  on  which  Chatel-Guyon 
stands  are  many  interesting  excursions  near  and  far. 
The  old  town  of  Riom,  and  various  ancient  chateaux, 
are  within  thirty  minutes'  drive,  and  also  comparatively 
near  are  the  city  of  Clermont-Ferrand  and  the  adjoining 
fashionable  town  of  Royat.  The  whole  Auvergne 
•district  is  one  of  the  most  attractive  in  all  France, 
attractive  alike  to  archaeologist,  antiquarian,  curiosity- 
seekers,  and  lovers  of  the  picturesque.  Those  fond  of 
delicacies  would  likewise  be  gratified  by  visits  to  the 
popular  preserved-fruit  factory  of  Vieillard,  in  Rue 
Pascal  at  Clermont-Ferrand,  and  to  the  unique 
chocolaterie  of  Rouzaud-Bouchet,  at  Royat. 


Operating  TTbeatrea. 

NORTH-WEST  LONDON  HOSPITAL. 

Operations  for  Fistula  in  Ano. — Mr.  Mayo 
Collier  operated  on  two  cases  of  fistula  in  ano,  one 
of  which,  he  pointed  out,  was  of  exceptional  interest. 
The  patient  was  a  man,  aet.  55,  who  had  suffered  some 
years  before  from  some  affection  of  the  rectum,  the 
nature  of  which  apparently  could  not  be  clearly  made 
out.  He  had  suffered  from  pain  and  difficulty  in 
defalcation  for  some  weeks.  This  was  followed  by  an 
abscess  outside  the  rectum,  which  burst  in  the  ischio- 
rectal fossa  ;  subsequently  to  this,  his  condition  mended 
for  a  time,  but  this  was  again  followed  by  a  recrudes- 
cence of  pain  and  discomfort,  succeeded  by  a  second 
abscess,  which  burst  in  the  opposite  ischio-rectal  fossa. 
No  history  of  syphilis  could  be  elicited,  nor  could  history 
of  bladder  or  prostatic  affection  be  made  out.  The 
family  history  was  good,  and,  apparently,  there  had 
been  no  tubercle  in  any  members  «f  his  family.  The 
lungs  and  heart  were  seemingly  sound,  and  there  was 
no  albumin  in  the  water.  On  examination,  the  whole 
perinaeum  was  found  to  be  riddled  with  sinuses  and 
marked  with  scars  and  unhealthy-looking  tissue  as  far 
as  the  tuberosities  of  the  ischia.  The  prostate  could 
be  felt  apparently  normal,  and  there  was  nothing 
abnormal  within  the  rectum  excepting  evidence  of  a 
hard  fibrous  stricture  at  the  upper  raarg  n  of  the  in- 
ternal sphincter.  It  was  curious,  Mr.  Collier  thought, 
to  note,  in  association  with  this  stricture,  that  at  no 
time  had  there  been  difficulty  of  defalcation,  nor  had 
the  word  stricture,  so  far  as  the  patient  remembered, 
ever  been  mentioned  to  him.  Aga;n,  Mr.  Collier 
pointed  out,  none  of  the  external  sinuses  led  into  the 
bowel  above  the  stricture,  nor,  as  far  as  could  be  made 
out,  was  there  evidence  of  these  sinuses  having  at  any 
time  communicated  with  the  rectum,  the  coats  of  the 
bowel  above  the  stricture  feeling  quite  normal  to  the 
touch.  On  probing  the  sinuses,  it  was  found  that  they 
extended  up  into  the  pelvis  as  far  as  the  division  of 
the  pelvic  fascia  at  the  white  line ;  the  levator  ani 
muscle  was  perforated  and  partly  destroyed,  and  the 
lower  half  of  the  rectum  was  apparently  completely 
denuded.  Other  sinuses  led  outwards,  burrowing 
beneath  the  skin  and  denuding  the  deep  fascia  for 
several  inches.  The  whole  lower  pelvic  cavity  was 
seemingly  riddled  with  abscess  burrows.  Mr.  Collier 
said  that  no  hope  of  cure  could  be  entertained  unless 
the  stricture  of  the  rectum  could  be  completely  divided 
and  the  parts  set  at  rest.  Mr.  Collier,  therefore, 
having  passed  his  finger  into  the  rectum  above  the 
stricture,  divided  all  the  tissues  backwards  to  the 
coccyx,  thus  laying  the  internal  and  external  sphincters 
completely  open.  The  other  sinuses  were  carefully 
investigated  and  curetted,  and  the  undermined  skin 
laid  open.  Strips  of  gauze  soaked  in  tincture  of  iodine 
were  packed  into  the  recesses,  and  the  wound  in  the 
rectum  plugged  with  strips  of  iodoform  gauze.  Mr. 
Collier  said  that  this  was  a  most  interesting  case,  and 
although  there  was  apparently  a  complete  absence  of 
history  of  syphilis,  yet  the  stricture  associated  with  the 
course  of  the  disease  could  only  be  explained  by  a 
specific  infiltration  of  the  outer  wall  of  the  rectum 
leading  to  gumma  and  the  usual  breaking  down  of  the 
new  tissue. 

The  second  case  was  that  of  a  man,  aet.  45,  which 
illustrated,  Mr.  Collier  pointed  out,  the  relationship  of 
tuberculous  disease  of  the  lung  to  fistula  in  ano.  This 
association,  he  said,  had  been  recognised  and  well 
understood  for  many  years,  and,  indeed,  in  the  early 
days  of  surgery  the  student  was  taught  that  the  fistula 
in  ano  acted  in  the  same  way  as  a  safety  valve  to  the 


Feb    [7,   1904. 


LEADING    ARTICLES, 


The  Medical  Puss*     170 


tubercle,  and  prevented  its  rapid  extension-  In  this  ! 
case,  Mr.  Collier  remarked,  there  was  marked  thickening 
i.)i  the  tissues  immediately  adjacent  to  the  rectum  in  ; 
the  isc hio- rectal  fossa.  The  external  sinus  was  hum:! 
to  communicate  with  the  cavity  of  the  rectum,  and 
there  was  some  burrowing  forwards  and  backwards, 
Tbe  parts  were  laid  open,  the  sinus  well  scraped  and 
picked  with  gauze  soaked  in  iodoform  emulsion,  Mr. 
Collier  anticipated  in  this  case  a  satisfactory  recovery, 
The  two  cases,  he  thought,  were  interesting  as  illus- 
trating the  causation  oi  fistula  *«  ana  from  two  distinct 
of  view. 

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"  SALUS  POPULI  SUPREMA  LEX  " 


WEDNESDAY,  FEBRUARY  17,  1904. 


THE  TREATMENT  OF  CANCER, 

The  victories  of  modem  medical  science  are 
being  won  with  a  swiftness  and  a  completeness  that 
are  simply  amazing.  The  introduction  of  aseptic 
RUgery  alone  has  probably  achieved  more  for  the 
advance  of  the  art  of  healing  and  the  benefit  of 
humanity  than  the  united  labours  of  all  previous 
workers  in  the  same  field.  There  nevertheless 
remains  a  wide  territory  yet  to  be  conquered. 
Tike  the  case  of  cancer,  using  that  term  in  a 
broad  sense  to  include  malignant  growths  gener- 
ally. The  origin  of  that  terrible  and  apparently 
increasing  scourge  of  mankind  remains  a  profound 
mystery,  just  as  its  treatment  is  for  the  most  part 
hopeless  and  discouraging.  For  all  that,  there 
arc  many  signs  of  the  times  that  this  most  elusive 
loe  is  being  gradually  out* manoeuvred.  In  con- 
sidering the  position  with  regard  to  cancerous 
maladies  it  is  reassuring  to  recall  the  course  of 
events  with  regard  to  a  disease  that  hardly  a  genera- 
tion tfO  was  no  less  mysterious,  and  but  little  less 
and  hopeless  when  once  established — 
namely,  tuberculosis.  To-day  phthisis  is  read 
like  an  open  book,  and  its  prevention,  treatment, 
cure  are  carried  out  with  the  precision  and 
success  that  are  begotten  of  knowledge  and 
experience.  There  is  no  particular  reason,  so  far 
in  be  seen,  why  scientific  medicine  should  not 
one  day  unravel  the  secrets  of  malignant  growths 
as  she  has  done  in  the  case  of  tuberculosis.  But 
meanwhile,  as  we  have  said,  our  knowledge,  full 


and  adequate,  is  yet  to  come.  Bacteriology,, 
which  furnishes  the  key  to  tuberculosis,  has 
hitherto  been  appealed  to  in  vain  as  regards 
malignant  neoplasms,  Many  persons  have  fondly 
hoped  they  have  found  a  specific  "cancer"" 
micro-organism,  but  no  such  discovery  has  stood 
the  test  of  experience,  One  of  the  most  recent 
claims  of  the  kind  was  that  of  Dr,  Otto  Schmidt,  of 
Cologne,  who  devised  a  method  of  immunising 
treatment  by  serum  obtained  from  a  *'  pure  cul- 
ture "  of  a  specific  organism  alleged  to  have  been 
isolated.  Dr.  Schmidt,  it  is  to  be  1  cared,  has  per- 
suaded himself  into  an  untenable  position.  Dr. 
John  Shaw,  the  well-known  London  physician,  has 
personally  investigated  the  matter  and  has  pub- 
lished his  observations  and  conclusions  in  a  fair  and 
judicial  pamphlet,  A  more  crushing  exposure  of 
pseudo- scientific  fallacy  parading  in  the  garb  of 
responsible  medical  wisdom  could  hardly  be 
imagined.  Dr.  Josse  Johnson,  in  communicating 
the  pith  of  Dr.  Schmidt's  conclusions  to  the  Abcr- 
nethian  Society  (a)  observed  that  "  Dr,  Schmidt 
isolated  one  single  parasitic  cell,  and  by  artificial 
cultivation  under  varying  conditions  of  light,  air,, 
moisture,  and  warmth  produced  all  the  other 
forms  from  it/'  The  lavish  variety  of  the  descen- 
dants of  that  u  single  "  organism  may  be  gathered 
from  DrT  Shaw's  account.  He  was  shown  a  pure 
culture  of  an  alleged  parasite  from  melanotic 
sarcoma  under  the  microscope.  His  astonished 
eye  was  presented  with  a  field  of  granules  varying 
in  size  from  that  of  a  red  blood  corpuscle  to  that  of 
a  gonococcus.  Another  "pure  culture  '*  from 
an  epithelioma  of  the  breast  showed  similar 
variations  in  size  of  granules.  It  appears  that  Dr. 
Schmidt  has  abandoned  injections  of  serum  in 
favour  of  increasing  doses  of  sterilised  cultures. 
Dr.  Shaw  examined  various  patients  said  to  have 
been  benefited  by  the  treatment.  In  one  case  a 
woman  was  going  home  with  the  cancerous  pro- 
cess if  perfectly  cured,"  but  he  found  that  the 
tumour  on  her  forehead  was  about  one-third  larger 
than  when  seen  a  few  weeks  previously.  An 
English  medical  man  under  treatment  was  said  to 
have  improved  markedly,  but  Dr  Shaw  found 
serious  extension  of  the  growth.  This  case  we 
have  ourselves  examined  and  can  certify  that 
there  is  no  appearance  of  arrest  of  the  malady.  In 
short  no  medical  man  should  countenance  a  visit 
on  the  part  of  a  patient  to  Dr.  Schmidt  unless  he 
has  first  carefully  read  Dn  Shaw's  pamphlet. 
Of  other  new  forms  of  treatment,  notably  the 
focus  tube,  the  high  frequency  current  and  last, 
and  most  wonderful  agent  of  all,  radium,  we 
cannot  as  yet  speak  more  than  hopefully.  It  is 
clear,  however,  that  in  certain  cases  we  are 
able  to  modify  profoundly  the  progress  of 
carcinomata  and  sarcomata.  The  curative 
influence  of  the  X-ray  tube  upon  second- 
ary enlargement  of  glands  and  recurrent  nodules  is 
definite,  as  well  as  upon  ulcerating  surfaces. 
The  high  frequency  current  appears  to  have  cured 
some  accessible  sarcomata  and  it  certainly  removes 


<4>  L*net't  November  I  <th.  1003. 


180     The  Medical  Press. 


LEADING   ARTICLES. 


Fbb.   17.    1904 


the  pain  of  cancer  and  arrests  other  symptoms  in  a 
remarkable  way.  The  most  promising  agent, 
however,  is  radium,  which  may  now  be  regarded 
as  having  curative  powers  over  rodent  ulcer,  and 
over  epitheliomata  if  not  of  too  old  standing.  It 
is  safe  to  predict  that  radium  will  be  the  object  of 
universal  investigation  in  the  immediate  future. 
Hitherto  the  surgeon  has  failed  in  his  attempts  to 
arrest  the  progress  of  cancer  when  it  has  once 
gained  a  footing  in  the  human  body.  Here  and 
there  he  may  appear  to  gain  an  isolated  success, 
but  in  the  vast  majority  of  cases  he  is  powerless. 
It  is  to  the  discovery  of  a  trustworthy  therapeutic 
remedy  that  the  hopes  of  scientific  medicine  must 
naturally  turn.  Has  that  much-desired  specific 
agency  been  placed  in  our  hands  by  the  discovery 
of  radium  ? 


THE  TEACHING  OF  HYGIENE. 
Recent  researches  into  the  problems  of  disease 
have  gone  far  to  secure  evidence  of  the  scientific 
truth   that    "  prevention   is   better   than   cure."  | 
Already  the  life  work  of  many  medical  men  is  being 
definitely  directed  to  prophylaxis,  and  the  admir- 
able work  accomplished  by  our  medical  officers  of 
health  has  amply  demonstrated  the  value  of  a 
scientifically    directed    service   of   public   health. 
The  slow-moving  mind  of  the  general  public  has 
realised  .something  of  the  advantages  arising  from 
improved   sanitation    and    the    enforcement    of 
measures  for  the  protection  of  the  physical  welfare 
of  the  Commonwealth.     The  "healer,"  it  may  be 
hoped,  will  always  be  treated  with  respect  and 
accorded  sympathetic  support,  but  it  is  well  that 
the  "  teacher  M  of  sanitation  should  be  accorded  a 
status  meet  for  the  important  responsibilities  and 
duties  which  devolve  upon  him,  and  we  believe 
the  medical  man  of  the  future  will  render  service 
chiefly  as  an  adviser  in  all  matters  pertaining  to 
the  preservation  of  health  and  the  prevention  of 
disease, „ rather  than  by  a  mere     practice  of  the 
apothecary's  art.      We  are  glad  to    find,   there- 
fore, that  medical   practitioners  throughout  the 
country  are  supporting  the  very  influential  petition 
which  is  to  be  presented  to  the  central  educational 
authorities  of  the  Kingdom,  urging  upon  them  the 
necessity  of   providing   compulsory   teaching   of 
hygiene  in  all   public  elementary  and  secondary 
schools.     We  understand  that  already  more  than 
fourteen  thousand  signatures  have  been  appended 
to  this  remarkable  and  most  representative  appeal 
of  the  registered  medical  men  of  Great  Britain. 
It  is  likely  that  such  a  document  will  do  much, 
not  only  to  influence  our  educational  authorities, 
but  also  to  draw  public  attention  to  the  functions 
of  the  physician.     For  too  long  the  practitioner 
has  been  willing  to  follow  rather  than  insisted  on 
his  right  to  lead.  In  all  that  pertains  to  the  health 
of  the  people  the  medical  man  should  play  the  part 
of  the  pioneer.     In  the  document  to  which  we  have 
referred  special  reference  is  made  to  the  necessity  of 
imparting  trustworthy  information  to  the  scholars 
of  our  public  schools  concerning  the  dangers  arising 
from  the  abuse  of  alcohol.     The  widespead  preva- 
lence of   alcoholism   among  our  people   and   the 


growing  addiction  of  women  to  a  dangerous  indul- 
gence which  is  threatening  the  race  with  serious 
deterioration  make  such  a  step  most  desirable. 
Apathy,  ignorance  and,  we  venture  to  add,  a 
fanaticism  born  of  misconception  and  partial 
knowledge,  have  done  much  to  make  us  "  a  drunken 
nation."  If  intemperance  is  to  be  arrested  it  must 
be  by  a  scientifically  controlled  effort  to  secure 
sound  education  in  the  principles  and  practice  of 
hygiene,  of  which,  of  course,  temperance  should 
form  an  important  part.  It  is  to  be  hoped  that 
medical  men  throughout  the  country  will  not  rest 
satisfied  with  a  mere  approval  of  such  action  as  is 
proposed,  but  will  afford  active  support,  and  we 
hope  the  day  is  not  far  distant  when  in  connection 
with  every  school  throughout  the  country  there 
shall  be  a  thoroughly  qualified  medical  man  or 
medical  woman  who  shall  be  responsible  for  the 
well-being  of  the  scholars  and  shall  act  as  adviser 
in  all  that  pertains  to  the  hygienic  condition  of  the 
school. 


THE    CENTRAL    MIDWIVES    BOARD     AND 
IRISH    MATERNITY    HOSPITALS. 
We  print  in  another  column  a  letter  from  th* 
Master  of  the  Rotunda  Hospital  to  the  Secretary 
of   the   Central   Midwives    Board    regarding    the 
position  which  Irish  trained  nurses  occupy  under 
the  new  Act,  and  the  Board's  reply  thereto.     The 
resolution  adopted  by  the  Board  will,  we  fear, 
prove  incomprehensible  to  the  ordinary  individual. 
It  reads  as  follows  : — "  That,  having  considered 
the  letter  addressed  to  them  by  the  Master  of  the 
Rotunda   Hospital,   the    Board   regret   that   the 
suggested  alterations  were  not  brought  to    their 
knowledge  before  the  Rules  were  sent  to  the  Privy 
Council,  as  having  been  now  approved  by  that 
I  Body,  it  is  impossible  for  the  Board  to  alter  them." 
j  We  presume  the  Board  meant  this  resolution  to 
convey  some  meaning,  but  we  confess  that  -we  are 
unable  to  even  guess  what  it  is.     The  Board  say 
that  the  Master  of  the  Rotunda  Hospital  should 
have  brought  the  conditions  under  which  nurses 
are  trained  at  the  Rotunda  Hospital  to  their  notice 
before  the  draft  copy  of  rules  recommended  by 
the  Board  was  submitted   to  the  Privy   Council. 
We  venture  to  ask  the  Board  at  what  exact  stage  of 
their  proceedings  could  the  Master  of  the  Rotunda 
j  Hospital  have  taken  this  step.     Did  the  Board 
!  invite  suggestions  or  seek  information  from  the 
I  heads  of  lying-in  hospitals  before  drawing  up  their 
rules  ?     The  account  which  has  gone  out  to  the 
public,  be  it  a  correct  one  or  not,  we  do  not  know, 
j  is  very  different.     It  is  that  the  Board  after  its 
I  appointment    had    many    stormy    meetings    in 
!  earner d.     That  these  meetings  resulted  in  the  draw- 
|  ing  up  of  a  majority  and  of  a  minority  report. 
That  the  majority  report  was  one  which  was  not 
consonant  with  the  assumed  object  with  which  the 
Act  was  passed  and  that  it,  in  fact,  proposed  rules 
which  would  not  have  conduced  to  the  improve- 
ment of  the  present  type  of  midwife.     That  the 
Privy  Council  refused  to   sanction  the  majority 
report  and  sent  the  draft  rules  back  to  the  Board 
!  in  a  form  which  adopted  many  of  the  points  on 


Fe* 


NOTES  ON  CURRENT  TOPICS, 


DtCAL    I'SKSS.       1^1 


which  the  minority  report  insisted.  That  all 
these  paiccedings  were  regarded  as  confidential, 
and  that  not  until  the  Rules  had  been  approved 
by  the  Privy  Council  were  they  allowed  to  see  the 
light  [  t  this  was  so,  the  question  naturally 

arises,  When  should   the  Master  of   the   Rotunda 


illness.  In  the  (ace  of  the  detailed  microscopical 
report  and  the  emphatic  statements  of  other 
medical  journals,  both  in  this  and  other  countries, 
it  required  some  courage  to  adopt  that  attitude. 
It  is  difficult  to  understand  how  a  responsible 
medical  editor  could  countenance  the  publication 


il  and  the  heads  of  other  Irish  maternity    of  positive  assertions  of  the  innocency  of   a  par- 
Is  have  brought  to  the  notice  of  the  Board    ticular  malady  upon  the  strength  of  bulletins  and 


the "  suggested  alterations  "  in  the  rules.  Perhaps 
the  Bo  ard  wi  11  sugg  est  an  ans  w  er .  T  he  re  were  two 
i -m  which  the  authorities  of  the  Rotunda 
Hospital  were  able  to  make  representations  on 
behalf  of  their  training  school.  One  was  during 
the  passage  of  the  Act  through  Parliament,  the 
other  was  when  the  Rules  were  made  public. 
Represen  tatio  ns  w  ere  mad  c  o  n  bo  th  o  ccas  ions.  On 
the  first  occasion ,  these  authorities  were  informed 
that  nothing  in  the  Act  would  prove  prejudicial 
to  the  Rotunda  nursing  school,  and  that  the  pro- 
moters of  the  Act  recognised  that  that  institution 
was  deserving  of  support.  On  the  second  occa- 
sion—the present  one— they  are  informed  that  the 
Board  is  sorry,  but  that  they  cannot  admit  Rotunda 
trained  nurses  to  their  examination,  We  have 
read  Mr,  Heywood  Johnstone's  letters  to  the  Royal 
!  Physicians  of  Ireland,  at  the  time  of  the 

-luction  of  the  several  Midwives  Kills,  letters 
iq  which  he  gave  a  definite  guarantee  that  the  Bill, 
tf  passed,  would  in  no  way  interfere  with  the 
Chartered  Irish  Maternity  Hospitals,  as  he   was 

LI  aware  of  the  good  work  they  had  done/* 

Heywood  Johnstone  is  a  member  of  the 
.1  Midlives  Board,  and  that  body  has  unani- 
mously adopted  the  resolution  given  above.  We 
presume  that  Mr.  Heywood  Johnstone  did  not 
attend  the  meeting  at  which  the  resolution  was 
adopted,  but  he  must  have  known  that  Dr, 
Tweedy* s  letter  was  to  come  before  the  Board, 
and  to  our  mind  he  should  have  been  in  attendance 
to  support  his  pledge,  The  resolution,  however, 
conveys  one  item  of  information  that  may  prove 
of  value,  It  conveys  the  fact  that  the  Board 
that  their  ignorance  of  the  course  of  train- 
ing for  midwives  considered  advisable  by  the  great 

nuty  hospitals  led  to  the  drawing  up  of 
which  excluded  the  nurses  trained  in  the 
largest  of  these  hospitals.  If  the  regrets  of  the 
Board  are  not  a  mere  fa^on  dc  patter,  we  presume 
that  ihcy  will  be  willing  to  support  the  application 
which  we  understand  the  Irish  hospitals  are  about 
to  make  to  the  Privy  Council.  If  they  refuse  to 
support  such  an  application,  their  action  will,  we 

be  added  to  the  list  ol  broken  pledges  with 
which,  rightly  or  wrongly,  many  Irishmen  asso- 
ciate English  rule  in  Ireland. 

notes  on  Current  topics. 

The  Health  of  the  Emperor  of  Germany. 

The  accounts  of  the  health  of  the  Emperor  of 
Germany  are,  to  say  the  least  of  it,  not  reassuring; 
ration  on  the  throat  was  announced 
same  time  ago,  alene  of  the  medical  journals  in  this 
country  The  Medical  Press  asd  Circular  raised 
a  note  of  warning  as  to  premature  conclusions 
il  the  real  nature  and  gravity  of  the  Kaiser's 


reports  published  under  strict  official  censorship. 
A  report  given  at  the  present  moment  by  an 
unimpeachable  medical  authority  would  be  of  far 
greater  value  than  that  given  at  the  time  of  the 
operation,  It  is  to  be  hoped  that  such  an  authori- 
tative statement  will  be  shortly  forthcoming  and 
that  it  will  reassure  the  sympathising  world  that 
exists  outside  Germany; 


Epilepsy  and  Genius. 
Thk  belief  that  insanity  and  genius  are  so  closely- 
interdependent  as  to  be  regarded  by  some  as  all 
but  synonymous  is  one  which  was  largely  shared 
by  the  older  psychologists.  Genius — the  ne  plus 
ultra  of  intellectual  activity — is,  in  reality,  the 
highest  expression  of  nervousness,  using  the  word 
not  as  it  is  usually  interpreted,  but  to  indicate  the 
most  highly  exalted  condition  of  nervous  organisa- 
tion of  which  the  human  mind  has  shown  itseU  to 
be  capable.  It  is  its  very  perfection,  in  fact, 
which  tends  irrevocably  towards  its  ultimate 
deterioration,  The  seeds  of  decay  arc  inherent 
in  the  most  luxurious  bloom  of  intellect.  "  Le 
genie/'  according  to  Lamartine,  u  porte  en  lui 
une  principe  de  destruction,  de  mort,  de  folic, 
comme  le  fruit  porte  le  ver/k  The  truth  of  the 
Aristotelian  maxim,  "  Nullum  magnum  ingenium 
sine  mixtura  dementiae,"  is  abundantly  verified 
by  everyday  observation,  for  it  is  the  exact  ex- 
pression of  a  modern  psychological  doctrine.  Of 
all  mental  disorders  accompanying  genius,  epilepsy 
is  the  one  the  occurrence  of  which  perhaps  sur- 
prises us  most  i  n  this  connection.  It  can  be  readily 
understood  that  acute  mania,  for  instance,  might 
result  from  mental  strain,  leaving  the  patient  but 
little  damaged  after  recovery,  but,  knowing  the 
mental  obtuseness  and  deterioration  so  often  seen 
in  those  of  epileptic  tendency  or  heritage,  it  is 
more  difficult  to  realise  that  any  good  mental  work 
can  be  achieved  by  such.  Yet  there  are  many 
well -known  instances  of  epileptics  who  were  men 
of  real  power  and  genius.  Julius  Caesar,  Mahomet, 
and  Napoleon  are  each  supposed  to  have  been 
subject  to  epileptic  fits,  A  far  greater  number,  of 
course,  of  statesmen,  poets,  musicians,  and 
scientists  arc  included  in  the  ik  glorious  group  of 
madmen  "  who  have  enriched  our  knowledge,  and 
left  behind  them  the  indelible  imprints  of  their 
noble  intellects.  In  common  with  some  epileptics, 
they  were  all  men  of  highly -strung  nervous  systems 
possessing  refinements  of  thought  and  reasoning 
unknown  to  minds  of  more  sober  but  less  active 
mental  organisation.  As  in  some  over-ripe 
fruit  the  more  subtle  and  delicate  aromatic  flavours 
appear,  so  in  the  mind  which  is  over- developed  in 
certain  directions  are  peculiarities  and  eccentrici- 
ties,   often    the  precursors  or    associates    of    true 


182    The  Medical  Press. 


NOTES  ON  CURRENT  TOPICS. 


Feb.  17 ,  1904. 


epilepsy,  prone  to  manifest  themselves.  Epilepsy 
in  early  life  is  generally  regarded  as  fatal  to  the 
subsequent  mental  development  of  the  individual, 
but  all  who  are  epileptics  in  childhood  and  who 
outgrow  the  disease  do  not  deteriorate;  on  the 
contrary,  many  show  distinct  evidences  of  intel- 
lectual superiority,  "  perilous  "  though  this  may 
sometimes  be.  The  recognition  of  these  facts  has 
led  to  a  great  change  in  the  manner  in  which  this 
form  of  mental  disorder  is  regarded  and  also  in  the 
various  modes  of  treatment  adopted  for  its  relief  or 
cure.  The  value  of  psychical  influences,  of  an 
adequate  amount  of  rest  and  nourishment,  of 
exercise,  and  of  genial  surroundings  are  becoming 
more  generally  appreciated  in  this  as  in  other 
diseases  of  the  mind.  As  an  evidence  of  mental 
degeneration  it  must  still  remain,  but  in  considera- 
tion of  its  relationship  to  some  of  the  highest  grades 
of  mental  activity  it  will  not  bear  the  social  stigma 
to  such  an  extent  as  other  forms  of  alienation. 


Howard  Marsh  into  the  chair.  If  it  really  be  the 
case — which  seems  open  to  grave  doubt — that  no 
Oxford  graduate  of  sufficient  eminence  will  come 
forward  at  the  moment,  Oxford  might  imitate  the 
example  of  her  sister  University,  and  bide  her 
time.  There  are  many  erudite  and  cultured 
physicians  who  would  welcome  the  learned  leisure 
of  the  Isis  as  a  relief  from  the  turmoil  and  buzz  of 
practice. 


The  Regius  Professorship  at  Oxford. 
A  good  deal  of  feeling  has  been  aroused  by  the 
recommendation  made  to  the  Prime  Minister  to 
fill  the  Regius  Prof  essorship  of  Medicine  at  Oxford, 
vacant  through  the  resignation  of  Sir  John 
Burden  Sanderson,  by  the  appointment  of  the  pre- 
sent Reader  in  Pathology.  An  important  meeting 
of  Oxford  medical  graduates  took  place  under 
the  presidency  of  Sir  William  Church  and  protested 
strongly  on  public  grounds  against  thus  handing 
the  Professorship  over  to  a  specialist  in  one  branch 
of  medicine.  There  has  been  no  attempt  at  intro- 
ducing personalities  into  the  contest,  and  it  is 
known  that  Dr.jRitchie,  the  Reader  in  Pathology, 
has  made  himself  a  persond  grata  to  all  his  colleagues 
since  he  came  south.  The  plea  put  forward  on 
behalf  of  his  appointment  is  one  of  economy,  that 
the  funds  of  the  University  would  be  relieved  of  a 
strain  if  the  Readership  could  be  merged  into  the 
Professorship,  and,  moreover,  it  has  been  urged 
that  no  Oxford  medical  graduate  of  the  position 
and  parts  necessary  to  make  an  ornamental  and 
useful  Professor  would  be  forthcoming  to  fill  the 
chair.  The  Regius  Professorships  at  Oxford  and 
Cambridge  are  ancient  and  dignified  offices, 
and  the  holders  of  them  are  something  more  than 
mere  provincial  physicians.  They  emphatically 
embody,  or  should  embody,  all  that  is  modern  in 
progress  of  the  day  with  all  that  is  sound  in  the 
learning  of  the  ancients,  and  their  position  is  one 
that  commands  the  ear  of  the  whole  medical  world. 
There  has  never  been  any  difficulty  in  getting  a 
Regius  Professor  of  high  learning  and  wide  culture 
at  Cambridge,  but  a  few  years  ago,  when  Sir 
George  Humphry  died,  the  University  could  not 
get  a  suitable  candidate  at  the  time  to  fill  his  chair. 
The  Professorship  of  Surgery,  however,  is  not  a 
royal  one,  and  is  of  quite  modern  origin,  being 
created,  in  fact,  for  Sir  George  Humphry,  when  he 
resigned  the  Professorship  of  Anatomy  in  1888. 
In  that  case  the  University  appointed  a  com- 
petent Reader  to  give  the  lectures,  and  waited 
The  wisdom  of  this  course  has  recently  been 
demonstrated   by   the   happy   induction   of   Mr. 


State  Medicine  in  Russia. 
Our  hygienic  reformers  are  wont  to  complain 
of  the  difficulties  that  surround  them,  and  of  the 
inertia   of    the    legislative    machine   when    they 
strive  to  put  it  in  motion.     Local  authorities  are 
obstinate    and    short-sighted,    and    members    of 
Parliament    are     complacently    indifferent.       In 
Russia,  however,  indifference  is  not  displayed  by 
the  Government,   and  obstructive  measures  are 
not  in  favour.     The  political  advisers  of  the  Czar 
keep  a  very  vigilant  eye  on  most  things  that  are 
going  on,  and  if  they  do  not  approve  of  the  trend 
they   are  taking,  they   have  sharp  and  incisive 
methods    of    dealing    with    objectors.     In    their 
scheme  the  passive  resister    has    no   place.     At 
the   recent    National   Congress  of    Medical   Men 
resolutions  were  submitted    on    various    subjects 
urging   reform    and    progress,    especially   in   the 
education    of  the  peasants.       These   resolutions 
pointed  out  that  it  was  hopeless  to  expect  intelli- 
gent co-operation  in  hygienic  reforms  from  a  pro- 
letariat little  better  than  the  lower  animals  in  their 
knowledge  and    intelligence.     An  official  intima- 
tion was  conveyed  to  Dr.  Rostovtseff  that  the 
resolutions  were  not  pleasing  to   his  Majesty's 
advisers,   and  that  they  had  better  be  dropped. 
The  Congress  was  loth  to  have  its  views  set  at 
naught,  and  demanded  that  the  resolutions  should 
be  read  and  put.      This  the  President  declined 
to  do — and  for  his  sake  it  is  perhaps  as  well  that 
he  did  not — and  he  proceeded  to  declare  the  sittings 
ended.     His  action  created  considerable  indigna- 
tion,  and  the  murmers  of    the    members    were 
drowned  by  the  music  of  a  military  band.    "  A 
tumult  then  arose  and  loud  protests  were  made. 
As  if  by  magic  policemen  appeared  in  the  midst 
of  the  angry  doctors,  and  they  were  dispersed  by 
the  gentle  methods  that  the  Russian  gendarmerie 
acquire  by  long  practice.     Numerous  arrests  were 
made."     After   this,   one   feels   that   though  we 
have  our  obstructions  to  remove  over  here,  our 
brethren  in  the  Czar's  country  have  their  own 
special  difficulties — to  which  ours  are  mere  child's 
play.     The  part  of  sanitary  reformer  is  not  likely 
to  become  really  popular  amongst  Russian  medical 
men  while  it  is  mounted  on  a  stage  controlled  by  a 
brutal  police  and  backed  by  a  desolate  prospect  of 
Siberia. 


Boasting  Extraordinary. 
It  has  often  been  maintained  by  The  Medical 
Press  and  Circular  that  every  medical  man, 
who  is  at  all  qualified  for  it  and  can  spare  the 
necessary  time,  should  enter  in  some  way  or  other 
into  the  public  life  of  his  district.     Much  of  the 


NOTES  ON  CURRENT  TOPICS. 


The  Medical  I'hess.      183 


JMfjlect    and    misunderstanding    from    which    the 

le  onerous  nature  of  its 
which  denu  rubers  the   chance  of 

■aii  interests  and  the  interests  of 
health    bom  positions  of  authority. 
Even  when  considerable  sacrifice  of  personal  ease 
recreation  is  entailed,  it  is  well   worth  while 
turtht*  medical  practitioner  to  sit  on  public  bodies, 
I  lor  his  own  benefit  a  >r  that  of    the 

profession  and  the  community.     In  the  report  of 
a  mayoral  banquet  recently  held,   we   regret    to 
note  that  the  mayor,  himself  a  medical  man,  seems 
to  have  employed  the  occasion  offered  him  by  his 
h    tit    denounce    Koch's    "treatment"    for 
rcufosiftj  and  to  boast  what  he  would  do  if  Mr, 
Rockefeller  would  provide  him  with  a  bacteriologi- 
boratory.     The  mayor  appears  not  to  have 
ular  skill  in  laboratory  research  himself, 
.rasp  of  the  principles  of   Koch's   M  treat - 
seems    to    be    more    forcible    than    dis- 
ng.     The  tubercle  bacillus  seeks,  accord- 
mayor,     to     kill    his    offspring    by 
ding,  while  he  (the  mayor]    would    kill 
by    inoculating    stronger   ones    that    v 
I tly  overpower  them .     The  report  of  the  sj 
not  indicate  the  result  on  the  patient  himself  ; 
cannot   resist  the  puny   tubercle  bacillus,  it 
difficult  to  understand  how  he  could  survive 
infinitely  more   powerful  +p  bacilli   that   the 
would     provide,     Perhaps,     however,     a 
it   would   not    be   needed,   asr   if   the   mayor 
seated  with  a  laboratory,  "  he  would 
speedily   convince   the  world  of  the  truth  of   his 
We  are  all  anxious  that  res* 
tine  problems  may  be  pushed  by  every 
proper  means,  but  this  sort  of  Thrasonical  magnilo- 
quence is  more  likely  to  hinder  than  to  help  the 
ausc  we  have  at  heart.     The  moral  of  this  Dart- 
outh  oration  is  that  medical  men  should   not  air 
ly  personal  and  unproved  theories  in  public ; 
there   is    plenty    of    solid    and    established    fact 
dter-dmner  purposes. 


making  history  without  being  hampered  by  pedantic 
precedents  or  effete  regulations.  She  has  built 
up  a  first-rate  fleet  and  a  first -rate  army,  and  every 
detail  of  their  organisation  and  equipment  has  been 
worked  out  with  a  thoroughness  and  an  expedition 
that  are  wholly  admirable.  Perhaps  the  greatest 
testimonial  to  their  efficiency  is  that  their  medical 
services  fall  not  a  whit  below  the  general  level  of 
excellence.  The  pathetic  incident  of  an  admiral 
signalling  a  request  for  lint  after  an  action,  as 
happened  in  the  Spanish- American  warh  is  not 
likely  to  be  repeated,  from  the  Japanese  side  at  all 
events.  The  pattern  on  which  the  medical  sen  ice 
is  organised  is  that  which  many  of  our  reformers 
have  contended  for  for  years-  Each  unit  of  each 
arm  of  the  service  has  its  own  medical  staff — and  a 
very  complete  one,  too — which  forms  on  integral 
part  of  equipment,  A  most  important  point  is 
that  the  medical  department  has  its  own  transport t 
and  is  therefore  not  dependent  on  the  goodwill  of 
the  commissariat  corps.  As  wastage  occurs  in  the 
ranks  and  men  are  moved  to  hospital,  a  propor- 
tionate part  of  the  medical  staff  goes  with  them, 
so  that  the  ratio  between  the  officers  serving  in  the 
field  and  the  officers  serving  in  hospital  varies 
according  to  the  demands  for  each.  The  dis- 
cretionary powers  left  in  the  hands  of  the  executive 
in  the  field  are  very  large,  and  references  to  head- 
quarters are  reduced  to  a  minimum.  If  a  medical 
military  attach*?  were  to  accompany  the  Japanese 
army,  there  is  little  doubt  but  that  he  could  sup- 
ply oui  War  Office  mandarins  with  some  informa- 
tion that  would  be  better  for  the  rank  and  file 
of  the  Army  than  for  their  own  dignity. 


The  Japanese  Medical  Sendees. 
Whilst  all  eyes  are  turned  to  the  East  watching 
ur  sturdy  little  ally  engaged  in  a  hfc  and  death 
gJe   with    a    mighty    European    power,    the 
icaj  man   will   feel  a  peculiar  interest  in  the 
iqements  made  for  the  care  and   treatment 
tints  of  the  contest.     As  a  straw  shows 
way  the  current  is  flowing  so  does  efficiency 
ttt  the  secondary  or  auxiliary  sen  ices  demonstrate  I 
preparedness    in     the    primary    ones.     The     first 
object  oi  an  army  or  navy  is  to  becomean  efficient 
which  endt  of  course,  must  be 
•  d   all   purely   humanitarian  considera- 
tions.    Hut    no    sound,    well- administered    army  | 

n  afford  to  neglect  its  medical  service. 
Tht  disregard  shown  fci  generations  to  the  medical 
cstab&shinje  -  DWn  Army  is  now  seen  to  be 

tmly  a  part  ol  the  general  laissez  alter  policy 

ned    the   whole  oi    the   War  Office  system. 

it  is  hoped,  is  now  in  course  of  being  righted. 

With  Japan  it  is  different,   "Happy  is  the  nation 

thit  has  no  history/'  and  Japan  can  claim  to  be 


Universal  Training  and  National  Physique. 
It  is  stated  that  "  the  most  important  topic 
which  can  exercise  the  mind  and  the  intelligence 
of  anyone  dealing  with  racial  phenomena  "  is  the 
question  of  our  alleged  physical  deterioration  as  a 
Elation.  The  Royal  Commission  appointed  to  deal 
with  this  matter  is  now  busily  engaged  in  receiving 
evidence  on  one  side  or  the  other  from  those  who 
are  in  a  position  to  give  authoritative  opinions 
upon  the  subject.  Whether  or  not  the  adoption  of  a 
system  of  universal  service  —a  modified  form  of  con- 
scription, so  to  speak — would  be  the  best  means  for 
improving  our  national  physique  and  rendering  the 
citizens  of  our  Empire  thoroughly  fit  to  defend  their 
hearths  and  homes  is  a  question  which  may  well 
occupy  the  minds  of  statesmen  and  sanitai 
alike,  in  the  current  number  of  the  National 
Service  Journal ,  the  official  organ  of  the  National 
Service  League,  Lieut. -Colonel  W.  Hill  Ctimo/M.D., 
points  out  that,  as  a  preparation  for  such  service, 
special  attention  is  required  at  the  three  critical 
periods  of  infancy,  childhood,  and  adolescence. 
Stress  is  laid,  and  rightly  so,  upon  maternal  re- 
•ibility  as  being  capable  of  influencing  materi^ 
al  1  y  t he  na t i o nal  phy s i q  u e  f o r  goo d  o r  c vi  1 .  Among 
the  classes  from  which  recruits  are  drawn  it  is, 
unfortunately,  only  too  true  that  the  women  are 
11  singularly  ignorant  of  the  duties  of  maternity. M 
In  more  senses  than  one,  the  physical  life  of  man  is 
fashioned    in    the    cradle.     The    returns    of    the 


184    The  Medical  Press.  NOTES  ON  CURRENT  TOPICS. 


Feb.  17.  *9<>4- 


Inspector-General  of  Recruiting,  of  which  mentio11 '  sequela  of  injury.  Similar  lesions  of  the  internal 
has  already  been  made  in  our  columns,  show  plainly  '  organs  resulting  from  traumatism  are  of  compara- 
that  there  is  a  considerable  increase  in  the  percent-  tively  rare  occurrence,  and  in  this  connection  it 
age  rejected  for  various  ailments.  The  introduction  may  be  observed  that  of  all  the  predisposing  and 
of  some  system  of  universal  service,  whether  purely  exciting  causes  of  pulmonary  phthisis  injury  to 
military  or  partaking  more  of  the  nature  of  a  com-    the  chest  is  one  about  which  less  has  been  written 


pulsory  course  of  physical  training  at  school  or 
college,  would  go  far  towards  counteracting  the 
unhealthy  influences  now  at  work  upon  our 
national  physique. 

i 
The  Ocular  Basis  of  Migraine. 

Much  has  been  written  lately  with  regard  to  the 
part  played  by  eye-strain  in  the  production  of  many 
physical    evils,    chiefly   of   the    nervous    system, 
especially  in  those  who  follow  literary  or  other 
occupations  necessitating  the  habitual  accommo- 
dation of  the  eyes.     Dr.  George  M.  Gould  (a),  of 
Philadelphia,  the  chief  exponent  of  this  modern 
theory,  believes  that  migraine  may  be  similarly 
caused,  and  that  the  use  of  the  eyes  at  near  range 
is  at  the  root  of  this  distressing  affection  in  the 
great  majority  of  cases.     The  disease  is  one  which  t 
renders  the  life  of  the  sufferer  therefrom  well  nigh 
intolerable  while  it  lasts,  and  its  victims  live  in  , 
perpetual  dread  of  the  next  attack.     It  is  hardly  j 
to  be  wondered  that  such  individuals  will  fly  at , 
anything    which    they    think    will    relieve    their 
symptoms,  but,  strangely  enough,  the  condition    phthisis 


of  their  eyes  is  the  last  thing  to  which  attention  is 
drawn.  The  interval  between  the  attacks  is  only 
too  often  spent  in  a  round  of  social  excitement, 
in  travel,  or  in  closer  application  to  their  work. 
It  is  noteworthy,  too,  that  the  affection  is  more 
common  in  those  of  finely  strung  nervous  organisa- 
tions and  those  who  are  capable  of  getting  through 
an  immense  amount  of  mental  work.  As  the  French 
say,  "  La  migraine  est  le  mal  des  beaux  esprits." 
The  cases  are,  therefore,  seen  more  frequently  in 
private  than  in  hospital  practice.  Dr.  Gould 
states  that  the  condition  may  be  produced  ex- 
perimentally by  wearing  misappropriate  glasses, 
and  he  is  convinced  that  some  error  of  refraction 
will  generally  be  found  in  these  patients  if  it  be 
looked  for.  On  account  of  the  association  of 
vomiting  and  gastric  disturbances,  it  is  very  gener- 
ally believed  that  the  source  of  the  trouble  lies  in 
the  liver  or  stomach,  but  in  how  many  cases  has  it 
not  been  observed  that  the  treatment  of  these 


than  many  others  of  minor  importance.  It  might 
be  supposed  that  unless  the  injury  to  the  thoracic 
wall  also  involved  the  lung,  as  in  the  case  of  a  bad 
fractured  rib  or  a  perforating  wound,  it  could  have 
but  little  influence  in  lowering  the  vitality  of  that 
organ,  and  so  rendering  it  a  more  easy  prey  to 
tuberculous  infection.  The  case  described  by  Dr. 
Nogues  (a)  has  an  important  bearing  on  this 
point.  A  criminal  was  sentenced  to  one  hundred 
and  fifty  lashes.  At  the  conclusion  of  the  punish- 
ment he  was  taken  away  to  the  prison  infirmary 
in  a  state  of  unconsciousness.  Within  the  next 
few  days  cough,  dyspnoea  and  haemoptysis  appeared 
until  a  condition  of  phthisis  was  well  advanced. 
It  was  stated  that  the  anterior  aspects  of  the  lungs 
were  scarcely  affected  at  all.  This  may  appear  a 
somewhat  exaggerated  instance  of  the  influence 
of  traumatism  upon  the  development  of  the 
disease.  As  a  result  of  a  fractured  rib  from  the 
kick  of  a  horse  a  man  recently  recovered  substan- 
tial damages  in  the  Edmonton  County  Court,  not 
so  much  for  the  injury  itself  as  for  the  fact  that 
had   ensued,   which,    according    to    the 


medical  evidence,  was  directly  set  up  by  the  acci- 
dent. The  so-called  "  accidental  phthisis "  is, 
therefore,  far  from  being  a  myth. 


Music  and  Digestion. 

The  gratification  of  one  or  more  of  the  special 
senses  in  some  form  or  other  has  long  been  recog- 
nised as  one  of  the  most  agreeable,  and  at  the  same 
time  the  most  valuable,  accompaniment  of    the 
table.     It  is  not  only  by  stimulation  of  the  palatal 
I  nerves  that  the  appetite  for  food  is  quickened, 
i  the  influence  arising  from  the  auditory  and  visual 
(  organs  upon  the  digestive  processes  themselves, 
when  of  a  pleasing  character,  are  distinctly  bene- 
ficial.    The  presence  or  absence  of  cheerful  sur- 
roundings, entertaining  conversation,  or  distant 
melodious  strains  materially  affect  the  enjoyment 
of  a  meal,  such  is  the  power  of  the  mind  over  the 


vital  functions  of  the  body.  The  effect  of  music  in 
^iJlJj^Il*  vw^*vv,v*  v**c*w  w*s,  uvauu^m  u»  /"7°j  I  this  direction  was  well  known  to  the  ancients,  and 
disorders  after  the  most  approved  fashion  has  failed    .  ,  A  x  .    .  ,     ^"*'»OMU 


to  prevent  the  recurrence  of  the  malady  ?  The 
ocular  theory  of  migraine  is  one  which  deserves  the 
weightiest  consideration  of  every  practitioner 
under  whose  care  the  patient  happens  to  be. 


Traumatism  and  Phthisis. 
The  ready  ingress  of  the  ubiquitous  tubercle 
bacillus  into  any  part  of  the  body  whose  tissues 
have  been  damaged  by  injury  and  their  resisting 
power  to  infection  consequently  lowered  is  one  of 
the  commonest  pathological  events.  It  is,  per- 
haps, in  surgical  work,  especially  in  bone  and  joint 
affections,  that  tuberculosis  is  frequently  seen  as  a 


(a)  Jour*.  Aner.  Med,  Auoc.,  January  2Srd,  1904. 


in  modern  times  a  restaurant  is  incomplete  without 
its  orchestra.  Nor  is  it  the  aesthetic  and  social 
qualities  alone  which  render  melody  and  harmony 
such  useful  adjuncts  to  the  pleasures  of  the  table, 
for  it  would  seem  as  if  music  were  capable  of 
directly  influencing  the  gastric  functions.  Scien- 
tific proof  of  such  influence  would  be  difficult, 
indeed,  to  provide,  especially  as  these  effects  arc 
far  from  constant,  and  vary  in  proportion  to  the 
individual's  susceptibility  and  musical  sense. 
Thus,  the  statement  recently  made  in  court  by  a 
lady  to  the  effect  that  a  certain  street-organ  pro- 
duced indigestion  is  freed  from  the  domain  of  fancy 
when    considered    from    the    standpoint   of    the 

(a)  Uncet,  vol.  i.,  1888,  page  1,044. 


Feb,   rr-   1904- 


NOTES  ON  CURRENT  TOPICS.        The  Medical  Fekss.    185 


musician  and  the  neurologist.  The  music  may 
have  been  insufferably  bad,  a  concession  which  will 
be  readily  made,  and,  at  the  same  time,  the  reflex 
nervous  arc  may  have  been  abnormally  excitable* 
The  grinding  of  the  "  instrument  of  torture," 
in  common  with  other  unpleasant  external  stimuli, 
may  be  quite  sufficient  to  exert  an  unfavourable 
inhibitory  influence  upon  the  digestive  processes, 
even  in  those  who  are  not  of  a  musical  disposition, 


The  U.S.A.  Antitoxin  M  Trust  " 
For    some    time    past    sensational    paragraphs 
have  gone  the  round  of  the  British   Press  with 
regard  to  the   inhumanity  oi  a  M  corner  '*  in  anti- 
whereby  the  cost  of  that  absolutely  essential 
drug  had  been  unduly  forced  up  by  a  few  mono- 
polists who  controlled  the    supply*     We   are  glad 
to  learn  on  no  less  an  authority  than  that  ol  Messrs. 
Parke ,  Davis  and  Co.,  one  of  the  three  producers 
01  antitoxin  in  the  United  States, that  the  report 
is  based  on  a  misconception  of  the  facts  of  the 
«ee.     The  exclusion  of   a  weak   and  ineffective 
and  the  sale  of  a  standard  product  in 
packages,    has     necessitated    a    somewhat 
ice  for  the  latter.     So   far  from  losing,  1 
however;  the  purchaser  gains  in   value  received. 
1  For    instance,"    says    the    American    Druggist,  , 
"  the  1, coo  unit  package  now  costs  $2,  as  against 
and   the    2,000   unit   package    now    costs  1 
as  against  the  former  price  oi    $4.*'      The 
lacturers    explain    their    change    to    larger 
standard  packages  on  the  ground  that  the  ten- 
dency is  to   use   larger  doses  of   the   remedy,   it 
.  ^far  to  use  large  doses  rather  than  to  run 
the  risk  of  a  small  dose  being  insufficient  to  bring 
about  immunity.     That  the  whole  affair  is  a  mere 
rm  in  a  teacup"  is  shown  by  the  fact  that  at 
tlie  present  moment  the  original  small  packages  of 
500  and  ]»ooo  units  can  still  be  purchased   at  the 
old  prices.     We  are   glad  to   learn  on  such  good 
authority  that  an   adequate  explanation  for  the 
1  nsc  *  in  the  price  of  American  antitoxin  may  be 
found  in  the  fallacy  above  exposed.       Finally,  it 
may  be  noted    that  no  change  in  prices  has  taken 
-n  the  English  market. 


have  been  a  miscarriage  of  justice  if  he  had  to 
suffer  on  their  account.  We  are  glad  to  see  that 
the  College  authorities  did  not  retire  from  the 
case,  although  they  had  the  opportunity  of  so 
doing,  and  we  trust  that  they  will,  in  financial 
matters,  come  to  the  aid  of  their  Professor  and 
of  their  assistant  Haire. 

A  Viceregal  Slight  to  the  Medical  Profession. 
The  Lord -Lieutenant  of  Ireland — the  Earl  of 
Dudley — has  intimated  to  the  Royal  Colleges  of 
Physicians  and  Surgeons  of  Ireland  that  he  has 
withdrawn  from  their  future  Presidents  the  right 
of  private  entree  to  the  Levees  and  Drawing-rooms 
at  Dublin  Castle.  We  presume  that  Lord  Dudley 
has  well  considered  the  necessity  for  an  action 
which  has  been  regarded  by  the  medical  profession 
as  an  undeserved  slight,  and  that  the  withdrawal 
of  a  long-existing  right  was  dictated  by  necessity. 
The  Presidents  of  the  Royal  Colleges  are  the 
ex-officio  heads  of  the  medical  profession  in  Ireland, 
and  we  cannot  agree  that  their  right  to  the  pri- 
vilege of  private  entree  is  a  whit  inferior  to  that 
of  the  heads  of  Government  offices — for  whom 
the  privilege  is  to  be  in  future  reserved*  Lord 
Dudley  to  be  consistent  must  also  deprive  the 
Provost  of  Trinity  College,  the  President  of  the 
Queen's  Colleges,  and  similar  officials  of  the  right, 
and  we  fear  that  such  a  radical  action  will  not 
meet  with  general  approval.  Lord  Dudley's 
action  is  all  the  more  strange  when  his  personal 
indebtedness  to  the  Irish  medical  profession  is 
remembered — an  indebtedness  which  he  himself 
acknowledged,  and  which  he  expressed  himself  as 
desirous  of  discharging, 


The  Galway  X-Ray  Case* 

In  another  column  will  be  found  a  full  and 
special  report  of  this  important  case,  which  has 

>ied  the  Dublin  Law  Courts  for  many  days. 
We  may  at  once  remark  that  we  are  in  complete 
accord  with  the  finding  of  the  jury.     There  was 

judi  that  the  sore  was  caused  by  the  rays, 
but  both  Dr.  Colohan  and  Mr,  Haire  did  their  best 

be  patient.  In  all  new  applications  of  science 
accidents  are  bound  to  occur,  and  if  a  medical 
man  is  to  be  exposed  to  an  action  for  malpraxis 
and  damages  on  every  occasion  that  such  an 
accident  occurs  it  will  put  a  stop  to  all  advance, 
and  eventually  result  in  depriving  patients  of 
much  that  science  has  to  offer*  Dr.  Colohan's 
ere  inspired  by  the  best  motives,  they 
were  performed  with  due  care,  and  with  the  full 
amount  of  knowledge  that  can  be  expected  from 
a  non-spec iah st  in  a  special  subject,  and  it  would 


Radium  in  Malignant  Disease  of  the  Tnroat- 
Of  all  the  radio-active  substances  hitherto  intro- 
duced into  the  field  of  therapeutics  none  is  pregnant 
with  greater  hopefulness  than  radium.  That 
substance  has  been  applied,  both  in  the  Old  World 
and  in  the  New,  with  considerable  success  to 
malignant  growths  in  accessible  placesJ  such  as  the 
cheeks,  tongue,  and  surfaces  of  the  body.  Else- 
where in  the  present  number  of  The  Medical 
Press  and  Circular  we  print  a  remarkable  article 
by  Dr.  Walsh  describing  the  application  of 
radium  to  such  sensitive  structures  as  the  soft 
palate,  tonsil,  fauces,  and  posterior  pharynx.  The 
object  of  the  writer  is  simply  to  call  the  attention 
of  the  medical  profession  to  the  fact  that  it  is 
henceforth  possible  to  treat  cancerous  processes  of 
the  upper  throat  and  fauces  by  the  direct  contact- 
application  of  radium.  From  their  peculiar 
anatomical  relations  it  is  obviously  difficult,  and 
in  many  cases  impossible  to  bring  the  X-ray  tube 
to  bear  upon  those  parts.  Operation,  again,  if 
carried  out  in  that  region,  has  to  be  so  extensive, 
and  is  so  uncertain  in  its  results,  that  it  is  very 
rarely  resorted  to.  It  would  be  hard  to  over- 
estimate the  importance  of  a  new  procedure  that 
brings  a  reasonable  method  of  alleviation,  and 
possibly  of  cure  within  the  reach  of  sufferers  from  a 
terrible  and  hitherto  hopeless  malady. 


186    The  Medical  Press.  SPECIAL  CORRESPONDENCE. 


Feb.  17.   1904. 


PERSONAL. 


Dr.  Henry  Corby,  of  Cork,  has  been  elected  High 
Sheriff  of  that  city  for  the  ensuing  year. 

A  sixty  milligramme  tube  of  radium  has  been  pre- 
sented to  Queen's  College  by  the  Lord  Mayor  of  Belfast, 
Sir  Otto  Jaffe. 


1  Mr.  W.  P.  Johnstone,  M.B.Edin.,  Witwatersrand, 
South  Africa,  has  been  presented  with  several  valuable 
mementos  by  the  officers  of  the  1st  Battalion  Gordon 
Highlanders   in   recognition   of   his   services   when   in 

j  charge  of  the  temporary  hospital  at  Mariasburgh  during 

I  the  recent  war. 


Dr.  S.  H.  R.  Montgomery  has  been  appointed 
Inspector-General  of  the  Insane,  Western  Australia, 
under  the  New  Lunacy  Act. 

The  Milroy  Lectures  for  1904  will  be  given  shortly 
by  Dr.  W.  Williams  on  the  important  subject  "Deaths 
in  Children,  a  Preventible  Mortality." 

The  Gilison  Scholarship  in  Pathology  of  the  London 
Society  of  Apothecaries  has  been  awarded  to  Mr. 
Leonard  Stanley  Dudgeon,  M.R.C.P.Lond. 

The  Senatus  of  Edinburgh  University  has  resolved 
to  confer  the  honorary  degree  of  LL.D.  in  April  next 
upon  Professor  Alexander Macalister,  F.R.S., Cambridge. 

A  paper  on  "  Tropical  Diseases  "  will  be  read  on 
March  8th  by  Sir  Patrick  Manson  at  the  West  India 
Committee  Rooms,  under  the  presidency  of  the  Duke 
of  Marlborough. 


At  a  meeting  held  on  February  9th,  of  the  Governors 
of  Steevens'  Hospital,  Dublin,  Di.  Winter  was  elected 
Assistant-Physician  ;  Dr.  Stephenson,  Assistant  Sur- 
geon ;    and  Dr.  Charles  Benson,  Anaesthetist. 


It  has  been  decided  to  invite  the  Duke  of  Devonshire, 
who  is  the  President  of  Owens  College,  Manchester,  to 
become  President  of  the  Victoria  University,  in  which 
it  is  proposed  to  merge  Owens  College. 


The  Goulstonian  Lectures  of  the  Royal  College  of 
Physicians  for  the  year  will  be  delivered  by  Dr.  R. 
Hutchison,  on  March  8th,  10th,  and  15th.  on  "Some 
Disorders  of  the  Blood  and  Blood-forming  Organs  in 
Early  Life."  The  Lumleian  Lecture  of  the  same 
college  will  be  given  by  Dr.  F.  Taylor  later  in  March 
on  "  Some  Disorders  of  the  Spleen." 


Special  correspondence. 


[from   our   own   correspondent.] 


We  regret  to  hear  that  Sir  Samuel  Wilks  is  lying  at 
his  residence  at  Hampstead  suffering  from  appendicitis. 
An  operation  was  successfully  performed  on  Thursday 
last,  and  favourable  progress  is  reported. 

The  patients  of  Dr.  John  Smith,  formerly  Vice- 
President  of  the  Border  Counties  Branch  of  the  British 
Medical  Association,  have  presented  him  with  a  life- 
sized  portrait  on  his  retirement  from  practice. 

The  important  post  of  Superintendent  of  Statistics 
under  the  Registrar-General  of  Scotland,  left  vacant 
by  the  death  of  the  late  Dr.  Blair  Cunyngham,  has  been 
filled  by  the  appointment  of  Dr.  James  Crauford 
Dunlop. 


The  Senatus  of  the  University  of  Edinburgh  has 
awarded  the  Cameron  Prize  in  Practical  Therapeutics 
to  Professor  Niel  Finsen.  M.D.,  of  Copenhagen,  in 
recognition  of  his  work  with  regard  to  light  thera- 
peutics. 


Mr.  Frederick  Purser,  F.T.C.D.,  has  presented 
the  sum  of  £2,000  to  the  equipment  fund  of  Queen's 
College,  Belfast,  to  found  a  studentship  in  mathematics 
in  memory  of  his  brother,  the  late  Professor  John 
Purser,  D.Sc,  who  was  for  many  years  a  member  of 
the  staff  of  the  college. 


Sir  Douglas  Powell  will  deliver  the  lecture  to  the 
Congress  of  the  Sanitary  Institute  to  be  held  in  Glasgow 
in  July  next,  and  Sir  Charles  Cameron  has  accepted  the 
presidency  of  the  Conference  of  Medical  Officers  of 
Health,  to  be  held  in  connection  with  the  congress. 


BELFAST. 
The  Health  of  the  City. — At  the  last  monthly 
meeting  of  the  Corporation,  the  quarterly  report  of  the 
city  analyst  was  presented  by  the  Public  Health  Com- 
mittee. This  report  contained  some  serious  state- 
ments about  the  milk  supply  of  Belfast.  "  From  a 
careful  study  of  the  results  of  my  analyses  I  cannot 
arrive  at  any  other  conclusion  than  that  the  milk  being 
supplied  to  Belfast  has  diminished  in  quality  during 
the  past  two  years.  It  would  be  difficult  to  say  how 
far  this  may  be  due  to  the  milk  regulations,  or  to  the 
smallness  of  the  fines  frequently  imposed,  even  in  some 
serious  cases  of  adulteration.  .  .  .  Watering  to  such  a 
large  extent  or  so  frequently  as  formerly  does  not  now 
take  place,  but  I  am  afraid  that  the  use  of  skimmed 
or  partially  skimmed  milk  as  an  adulterant  is  on  the 
increase."  Councillor  M'Innes,  in  a  vigorous  speech, 
called  attention  to  the  gravity  of  these  remarks,  con- 
sidered in  conjunction  with  the  high  death-rate  of 
infants  and  young  children.  The  report  of  the  Medical 
j  Superintendent  Officer  of  Health  stated  that  in  the  five 
■  weeks  ending  January  23rd,  233  cases  of  zymotic 
diseases  had  been  notified,  viz.,  86  cases  of  scarlatina, 
1  58  erysipelas,  27  typhoid,  23  simple  continued.  17 
diphtheria,  14  small-pox,  6  puerperal  fever,  and  2 
membranous  croup.  During  the  same  period  the  total 
deaths  numbered  869,  and  the  births  1 ,034.  The  deaths 
from  zymotic  diseases  numbered  88,  those  from  phthisis 
and  diseases  of  the  respiratory  organs  107  and  310 
respectively.  The  annual  death-rate  from  all  causes 
was  25*3,  or  1*2  more  than  the  corresponding  period 
last  year. 

Belfast  Union  and  Boarding-Out  of  Children.— 
At  the  present  time  the  Belfast  Guardians  have  placed 
no  less  than  1 5  5  children  out  at  nurse,  and  at  a  recent 
meeting  of  the  Board  a  most  interesting  report  on  them 
was  received  from  Mrs.  Dickie,  the  Local  Government 
Board  Inspector,  which  is  worthy  of  note  by  all  medical . 
men  concerned  with  Poor-law  work.  She  states  that 
the  boarding-out  system  possesses  one  great  advantage 
over  all  other  systems,  and  that  nowhere  has  this  been 
more  impressed  on  her  than  in  Belfast,  and  that  is, 
that  the  children  acquire  a  home,  where  they  make 
friends,  are  nursed  in  sickness,  and  often  live  on  in 
after  they  go  to  work.  "  Of  the  boys  who  go  into  the 
Army  and  Navy,  the  majority  write  '  home '  frequently, 
sending  money  from  time  to  time,  and  they  come 
'  home  '  on  furlough  as  if  they  were  members  of  the 
family.  Other  systems  may  turn  out  children  better 
disciplined  and  better  trained,  and,  where  the  super- 
vision is  inadequate,  even  better  treated  and  better  fed  ; 
but  no  other  system  provides  those  somewhat  inde- 
finable adjuncts  which  go  to  make  a  '  home.'  This,  in 
the  boarding-out  system  is.  I  think,  too  often  over- 
looked, and  yet  it  is  one  of  the  most  humanising  in- 
fluences which  can  be  brought  to  bear  on  the  waifs  and 
strays  of  our  population  with  which  the  Poor-law  has. 
to  deal." 


Feb,  ir-  JQ04- 


CORRESPONDENCE. 


The  Medical  Press.     187 


THE  CENTRAL  MIDWIVKS  BOARD  AND  IRISH 
MATERNITY   HOSPITALS, 
Sir— Will    you    kindly    insert    the    following   corre- 
which  has  taken   place  in  reference  to  the 

t  midwifer)   nurses  to  be  held  under  the 

the  Central  Mid  wives  Board  1 — 
I  am,  Sir.  yours  truly 
E.  Hastings  Tweedy,  F.R.C.RL 
Rotunda  I  Dublin.  Februarys  8th. 


Rotunda  Hospital,  Dublin, 

January  25th,    1904. 
DfiAJ)  Slit, — 1  shall  feel  much  obliged  by  your  bring- 
llowing  matter  before  your  Board,  as  it  is 

of  much  importance    that  a   definite   pro- 
poftoeement  &b*wJd  be  obtained  as  to  the  position  our 

tfifery  nurses,    trained   m    the   Rotunda   Hospital, 
writ  occupv  in  respect  to  the  State  Examination  to  be 
held  under  the  di ret  rJon  of  the  Central  Midlives  Board* 
training  oi  our  uiidwivcs  is  strict  and  full,  in- 
ing  everything  that  ia  requisite  for  making  a  good 
ttufte,     Th  for  a  period  of  six  months  in  the 

hospital      they  watch  the  progress  of  over  200  confine- 
ments.  »»t    these  they  personally  conduct  at  least  two  ; 
to  make  not  less  than  ten  vaginal  examina- 
Ihey  palpate  many  scores  oi  abdomens  ;    they 
3  the  lying-in  woman  from  the  time  of  her  admis- 
jtal  to  her  discharge  on  the  eighth  day  : 
takes  entire  charge  of  three  lying-in  women 
daily,  with  their  respective  children  during  the  puer- 
m  .  thev  take  records  of  temperatures  and  pil 
the  supervision  ol  the  Master  of  the  hospital  and 
the  assistant  masters  ;    they  receive  constant  instruc- 
tion in  the  art  of  midwifery,  are  systematica II v  trained 
in  asepsis    and  antiseptics  ;    they  pass  catheters,  give 
lb,  arc  taught  to  distinguish  Between  normal  and 
■ihrionual  labours,  and  finally  do  not  receive  our  certi- 
ficate until  a  stringent  examination  has  been  passed. 
The  Rules  that  at  present  seem   to   preclude   them 
from  qualifying  are  as   follows  ;  — 

\   woman  must   have   "attended  and 
Oi  not  fewer  than  twenty  labours, 
making  abdominal  and  vaginal     examinations  during 
iiit-  course  of   labour,  and   personally  delivering 
at/' 

rm  [V. — A  woman  has  **  to  my  satisfaction  nursed 
tty  lying-in  women  during  the  ten  days  following 

;7." 

It  would  be  impossible  for  our  resident  nurses   lo 
fellow  I  he  course  of  the  puerperium  for  tea 
Irishwomen  will  not  remain  in  hospital  for  more  than 
days.     In  this  connection  it  may  be  mentioned 
that  the   Scottish    Universities  and   Conjoint   Boards 
indent  to  produce  evidence  that  he  has  per- 
sonally co ml uc ted  twelve  cases  of  labour,  or  that  he 
has  taken  out  a  three  months'  course  in  a  recognised 
tut  ion,  in  which  case  the  personal  conduct! 

is  sufficient.     Durham  University  requires  s 
have  p«.-?  twenty  cas 

labour,  or  to  have  attended  the  indoor  practice  of  a 
tn  hospital  for  three  months.     Dublin  University, 
London  University,  and   the   Royal   University  of  Ire- 
land compel  a  student  to  take  a  six  months'  course  in  a 
kOSpital,  but  they  do  not  specify  any  necessary 
Bomber  of  personal  conductions,  and  they  refuse  alto- 
r   bo   recognise   instruction   received,   or   labours 
than  in  a  lying-in  hospital. 
I  uiriv  summarise  by  saying  that  the  licensing  bodies 
;  inversitiea  regard  a  six  months'  course  Of  instruc- 
tion lying-in  hospital  as  the  ideal  train- 
11  practical  midwifery  for  a  student  ;    that  some  of 
:>t  a  three  months'  course,  with  the  addition 
number  of  personal  conductions  ; 
that  only  those  whit  do  not  require  any  proof  of 
a  recognised  institution  require  even  a 
t    to   personally  conduct  as   many  as 

e  seen  that  a  course  of  six  mouths'  in-  ' 
rn  department  of  a  h  ing-in  hospital 
!  as  the  ideal  training  f<<r  the  medical  student. 
«ing  much  preferable  to  a  longer  course  of 


instruction  from  a  nou-hospitat  practitioner,  and  that 
the  reasons  which  render  this  course  much  better  in  the 
case  of  the  medical  student  are  still  more  cogent  in  the 
case  of  the  midwife,  who  admittedly  is  best  trained 
when  trained  in  a  hospital. 

Taking  all  these  tacts  into  consideration,  and  having 
regard  to  the  undoubted  spirit  of  the  Bill  which  was 
framed  in  the  interests  of  the  lying- in  patient,  I  trust 
that  your  Board  will  be  able  to' accept  out  curriculum 
as  an  equivalent,  or  to  make  such  exception  or  modifi- 

q  in  the  present  rule-  fc  will  'liable  our  run- 
qualify  for  the  Slate  Examination  m  Midwifery. 
I   remain,   yiurs    faithfully, 

I      Hastings  Tweedy, 

Kotunda  Hospital. 
To  the  Secretary.  Central  Mid  wives  Board. 


Central  Mjdwnes  Board, 

6  Suffolk  Street.  Pall  Mall, 
London,   S.W\>    Feb.    ist,    1^4 
Dear  Sir, — Referring  to  your  loner  ot  January  25th, 
I  have  to  inform  you  that  the  subject  raised  therein 
was   taken  into  consideration   by   the   Board  at   their 
meeting  on  the  28th  ult,     I  am  directed  to  point  out 
that  the  Rules  were  approved  by  the  Privy  Coum 
August  12th,  1903.  for  a  period  of  three  years,  and  to 
forward  you  a  copy  of  the  resolution,  which,  having 
regard   to  that  fact,  the  Board  passed  unanimously. 
I  remain,  yours   faittMollv, 

G.  \V\  Dincan,  Secretary, 
The  Master  of  the  Rotunda  Huspital.  Dublin, 


moved    and    carried    at 
Mid  wives    Board,    held 


the 
mi 


Copy  of  a  resolution 
meeting  of  the  Central 
January  38th.,   1904:  — 

"  That,  having  considered  the  letter  addressed  to 
thorn    by    the    Master  Rotunda    Hospital,    the 

Board  regret  that  the  suggested  alterations  were  not 
brought  to  their  notice  before  the  Rules  were  sent  to 
the  Privy  Council,  as  having  been  now  approved  by 
that  body  tt  ia  impossible  for  the  Board  to  alter  them." 

[The  above  correspondence  is  of  first  importance  not 
only  from  the  point  of  view  of  the  Irish  maternity  hos- 
pitals, but  also  of  the  whole  administration  of  the"  Mid- 
wives  Act.  That  measure  was  conceived  and  passed  in  the 
interest -of  the  child-bearing  population  of  the  United 
Kingdom,  If  its  administration  is  to  be  inaugurated 
by  the  exclusion  of  the  mid  wives  who  admittedly  have 
a  training  second  to  none  in  the  Kingdom,  things  had 
better  have  been  left  alone.  What  have  Mr.  Heywood 
Johnstone  and  other  active  supporters  of  the  Act  to 
say  as  regards  this  retrograde  and  short  -sighted  policy? 
The  subject  is  dealt  with  in  a  leading  article  ol  our 
present  issue,  It  cannot  be  allowed  to  rest  m  its  present 
unsatisfactory  position,  which  U  simply  an  outrage 
upon  common  si'use  and  justice,  and  the  spirit  of  what 
is.  upon  the  whole,  a  salutary  Act,  at  any  rate  in  its 
inception.— ED  J 

CorresponOence* 

\  Wo  do  not  hold  ourselves  responsible*  tor  the  opinio nt  of  our 
oonetpomtae  to.  1 

LIFE  ASSURANCE  FEES  FOR  MEDICAL 
EXAMINATIONS. 
Tft  the  Editor  of  The  Medical  Press  and  Circuit*. 
Sir, — In  your  issue  of  January  ^th  you  call  atlen* 
tion  to  the  fact  that  certain  insurance  companies  are 
now  "  sweating  "  the  medicals  in  the  matter  of  fees. 
This,  too.  when  the  united  funds  and  the  annual  income 
Of  the  life  assurance  business  are  going  up  by  leaps  and 
bounds.  Well,  1  am  glad  to  see  this  coming  about. 
If  any  class  of  men  think  they  will  get  their  proper 
dues  in  this  life  without  organisation  and  combination, 
then  such  "  men  " — if  we  can  call  them  men — must 
stand  their  being  taken  at  only  their  own  value.  The 
*■'  nigger M  is  not  thought  much  of.  and  evidently 
medicals  are  at  a  discount.  Why  ?  All  over  England 
80  per  cent,  of  the  medicals  are  quite  willing — to 
judge  by  their  actions — to  give  medical  and  surgical 
treatment    and    medicine     for     one    penny    a    week. 


188     The  Medical  Pkess. 


LITERATURE. 


Please  do  not  think  I  am  making  a  joke  !  Also,  over 
5,000  are  now  gladly  taking  a  half -penny  per  week  from 
life  assurance  offices,  who  supply  medical  aid  and  death 
policy.  I  think  this  is  quite  too  excessive  payment 
for  such  doctor  "  men." 

But  there  is  a  much  graver  side  to  this  question — 
the  question  of  honesty.  Honesty  in  examinations 
and  honesty  in  reports.  Now  in  common  it  is  quite 
understood  that  if  an  employe  is  paid  a  smaller  salary 
than  he  deserves,  he  is  supposed  to  make  up  the  dif- 
ference by  swindling  his  employer.  In  this  country 
swindling  is  not  a  crime — unless  one  is  found  out. 
Now  that  insurance  against  sickness  is  widening  out 
there  is  a  wider  field  for  agreement  between  the  patient 
and  the  doctor  as  to  stating  that  the  disease  is  an 
"  insured  disease,"  while  it  is  not.  In  such  a  case  the 
medical  will  "  get  even  "  with  the  company.  Again, 
in  cases  where  a  medical  sees  that  a  patient  has  died 
from  a  disease  for  which  the  company  will  refuse  to 
pay,  here  again  the  medical  can  "  get  even  "  with  the 
company  by  substituting  another  named  disease. 
Again,  take  the  case  where  a  medical  is  asked  to  "  put 
a  patient  in  order,"  so  that  he  can  run  the  best  chance 
of  "  doing "  the  company's  medical  !  Again,  take 
the  case  where  the  patient  asks  the  medical  to  put  him 
up  to  what  he  should  take  to  make  him  look  and  feel 
seedy,  with  a  view  to  getting  good  terms  for  an  annuity, 
and  soon. 

Now,  I  have  no  sympathy  with  any  company  which 
cuts  down  the  examination  fee — because  the  company 
"  can  get  a  medical  who  will  do  it  for  less."  Such 
deserve  scant  respect.  While  the  companies,  and  the 
public,  too,  become  wealthier,  they  think  it  right  to 
cut  down  medical  fees.  Amongst  the  working-men 
thev  laugh  at  the  "  club  doctor's  physic."  The  time 
wilf  come  when  doctors  who  examine  for  companies 
will  be  similarly  laughed  at,  and  where  mutual 
contempt  and  distrust  will  set  in. 

The  public  have  this  matter  in  its  own  control.  I-ct 
the  public  try  to  act  with  honesty,  and  the  profession 
will  not  fail  to  serve  them  faithfully. 

I  am.  Sir,  yours  truly, 

Robert  R.  Rentoul. 

[We  have  inserted  the  foregoing  letter,  but  think  it 
well  to  record  our  conviction  that  in  our  own  country 
the  honesty  of  the  medical  insurance  examination  is 
not  a  matter  of  lees.  At  the  same  time  we  agree  that 
to  lessen  fees  is  not  the  way  to  strengthen  the  stan- 
dards of  honesty.  Highly  skilled  and  responsible 
services  demand  an  adequate  reward.  A  general 
lowering  of  medical  fees  on  the  part  of  the  insurance 
companies  would  probably  end,  sooner  or  later,  in 
disaster. — Ed.] 


Feb.  17.  1904. 


ALOPECIA   AND    DENTAL   CARIES. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — The  letter  of  your  correspondent  "  M.R.C.S., 
L.D.S.,"  comes  upon  one  like  a  hot  blast  of  a  simoon. 
It  passes  away,  however,  and  one  is  not  "  a  penny  the 
worse."  In  my  letter  of  the  3rd  inst.,  I  remarked: 
"The statement  that  the  solid  constituents  of  the  teeth, 
once  deposited,  undergo  no  further  change  "  seemed  to 
me  pure  assumption.  "M.R.C.S."  accepts  this  as  an  asser- 
tion from  me  that  they  undergo  such  a  change.  Heaven 
forbid  !  He  then  proceeds  to  pulverise  and  annihilate 
me  for  what  I  never  said.  Let  me  hasten  to  say  that 
I  have  the  greatest  respect  for  the  brilliant  researches 
of  the  late  Sir  John  Turner.  I  have  not  found  time  to 
refer  to  his  work,  but  I  dare  swear  he  never  made  any 
dogmatic  statement  that  the  solid  constituents  of 
teeth,  once  deposited,  never  change.  Why  does  not 
**  M.R.C.S."  support  his  case  by  a  concise  quotation  from 
Turner?  His  generalisations  seem  to  hinge  chiefly 
upon  the  reverence  one  should  have  for  Turner.  It 
is  this  blind,  unquestioning  acceptance  of  authority 
that  constantly  proves  the  greatest  hindrance  to  scien- 
tific progress. 

"  M.R.C.S."  is  evidently  a  master  of  his  subject,  but 
why  be  angry  ?  It  so  happens  I  have  a  nodding 
acquaintance  with  the  work  of  Miller  in  the  microbic 
invasion  of  the  teeth.     I  do  not  see  that  my  argument 


as  to  some  teeth  being  obviously  less  resistent  than 
others  is  upset  by  anything  in  your  correspondent's 
didactic  criticisms.  Some  teeth  break  off  short  in 
youth  and  middle  age,  while  others  last  for  a  hundred 
years — some  decay  early,  others  do  not  decay  at  all, 
and  last  for  a  long  lifetime  whole  and  sound.  Why 
should  "M.R.C.S."  wax  indignant  because  I  assume 
there  is  some  difference  of  structure  in  teeth  as  in  other 
tissues,  that  makes  them  more  or  less  resistent  to 
microbial  and  other  adverse  invasions,  and  accounts 
for  the  differences  in  question  ? — 

I   am,   Sir,   yours   truly, 

Medicus  Senex. 


Xtterature* 


HERBERT  ON  CATARACT  EXTRACTION.(a) 

This  small  practical  handbook  has  passed  already 

into  its  second  edition,  and  Major  Herbert  has  taken 

the  opportunity  to  set  right  a  number  of  small  errors 

and  has  brought  his  statistics  up  to  March,  1003. 

We  have  already  during  the  past  year  reviewed  this 
book  at  length,  and  we  have  nothing  further  to  add, 
save  to  insist  that  it  is  an  eminently  suitable  work  for 
all  ophthalmic  surgeons  to  possess,  and  we  have  great 
pleasure  in  recommending  it.  The  change  from  a 
stiff  cloth  to  a  limp  leather  cover  has  greatly  increased 
the  handiness  of  the  book,  and  we  have  little  doubt 
this  second  edition  will  confirm  the  opinions  formed  by 
leading  ophthalmic  surgeons  ot  the  book  when  it  first 
appeared  a  short  while  since. 


THE  AFTER-TREATMENT  OF  OPERATIONS.(fc) 
This  is  a  difficult  subject  to  put  in  a  handy  and  useful 
form,  for  the  after-treatment  of  operation  cases  adopted 
by  different  surgeons  varies  very  considerably.  But, 
as  the  author  states  in  his  preface,  "  no  good  purpose 
would  be  served  by  a  recital  of  all  the  different  me- 
thods "  ;  he  has,  therefore,  given  in  each  case  that  line  of 
treatment  which  seems  to  be  most  practical.  We 
must  congratulate  Mr.  Mummery  on  the  excellent 
way  he  has  performed  his  task,  for  the  book  is  wonder 
fully  complete.  The  chapters  we  would  like  par- 
ticularly to  praise  are  those  dealing  with  abdominal 
operations — viz.,  Chapters  XII.  and  XIII.,  and 
Chapter  IV.  on  "Shock  and  Collapse";  the  latter, 
based  as  it  is  on  the  more  recent  physiology  of  the 
subject,  tends  to  put  the  treatment  of  this  complication 
on  a  more  scientific  footing. 

This  book,  which  replaces  a  long-felt  want,  is  one 
we  can  strongly  recommend,  not  only  to  the  prac- 
titioners and  house  surgeons  for  whom  it  is  intended, 
but  to  everyone  concerned  in  the  successful  after-treat- 
ment  of  operations. 


FLEMENTS     OF     SURGICAL     DIAGNOSIS,  {c) 

We  welcome  the  third  edition  of  this  useful  little 
book.  The  whole  text  have  been  revised,  much  has 
been  rewritten,  and  many  additions  have  been  made. 

A  section  on  the  diagnosis  of  the  intra-cranial 
complications  of  middle  ear  disease  has  been  added 
to  the  chapter  on  diseases  of  the  head.  This  is  an 
important  addition,  and  the  author  deals  with  it  in  a 
very  clear  manner. 

Two  new  chapters  have  been  introduced,  one  on  the 
diagnosis  of  abdominal  tumours,  the  other  on  certain 
acute  abdominal  diseases  for  which  surgical  aid  is  now 


(a)  "  The  Practical  Details  of  Cataract  Extraction."  By  H.  Her- 
bert, F.R.C.8.Bng.,  Major  I.M.J8. t  Professor  of  Ophthalmic  Medicine 
and  Surgery,  Grant  Medic*!  College  ;  in  charge  of  the  Sir  Oowasjee 
Jehangir  Ophthalmic  Hospital,  Bombay  ;  Fellow  and  Late  Syndic  of 
the  Bombay  University.  Second  edition,  London  :  Bailliere,  Tindall 
and  Cox.  1903.  Pp.  x  and  114.  Illustrations  and  plates.  Crown 
8vo,  price  4s.  net. 

(6)  "The  After-Treatment  of  Operations.*'  By  P.  Locknart  Mum- 
mery, F.B.C.S.l£ng.,  B.A.,  M.B.  B  C.Cantab.,  Demonstrator  of  Opera- 
tive Surgerv,  St.  George's  Hospital ;  late  senior  House  Surgeon,  St. 
George '8  Hospital.  London  :  Bailliere,  Tindall  and  Cox.  1903.  Pp. 
viii,  and  221.    Illustrations  29.    Crown8vo.price5s.net: 

(<■)  "Elements  of  8urgical  Diagnosis."  By  A.  rearce  Gould, 
M.S.Lond..  F.R.C.SEng.  Third  Edition,  revised  and  enlarged. 
London,  Paris,  New  York,  and  Melbourne:  Cassell  and  Co.,  Ltd. 
1903. 


Ft*  17,  1904- 


OBITUAKX 


The  Medic al  Press.     189 


sought.  These  two  chapters  go  far  towards  making  the 
book  thoroughly  up  10  date,  and  we  consider  them  of 
etcat  value*  We  can  strongly  recommend  this  book 
M  all  students,  and  it  will  well  repay  most  practitioners 
to  read  it, 

YEAR-BOOK  OF  PHARMACY,  {a) 

This  excellent  yearbook  contains  a  good  account  of 
the  investigations  cm  the  subject  of  radium,  together 
with  a  summary  of   the  history  of  the  element,   by 
W*     RanolL     Everything     connected     with     this 
marvellous  substance  which  has  already  given  pause 
to  many  of  our  fundamental  theories  on  chemistry,  is 
«1  reply  interesting,  and  the  concise  statement  of  Mr. 
.R  a  noli  makes   the    present  volume    one  of  the    most 
vat  tiah)  e  o  f  a  v  cry  valu  able  5  e  ries .    H  a  rd  1  y  less  in  t  eres  t  - 
in^are  the  experiments  of  H,  Moissau  on  the  behaviour 
forms  of  carbon  at  high  temperatures, 
^tablished  views  are  further  shaken  by  J-  Dcwar's 
instration     that     fluorine     retains     its     chemical 
v  low  temperatures — 252°  C.     Coming 
to  materia  medica  we  find  that  ipecacuanha  still  gives 
alien     to     analytical     chemists    without     much 
:  their  labour.     Mr.  Mueller's  suggestive  and 
useful  paper  on   the   solubilities  ot  alkaloids  is  given 
with  sufficient  tumess  to  allow  of  his  experiments  being 
,,<d    and    understood.     The    continuous   struggle 
neat  inn  and  analysis  is  well-known  in 
tl  oils-  notably  in  the  adulteration 
ppcrmint    oil   with    triacetin,   which   apparently 
fargel-;  ■  ester  value    of    the    oil.      It   is 

interesting  to  note  that  there  is  a  growing  tendency 
curious  animal  products,  and  as  we  read  Ke  bier's 
!\ui©oast*s  papers  on  bear's  grease,  rattlesnake  oil, 
kunk  oil,  we  seem  as  if  reading  a  page  of  Bullens 
Qttincy/1  or  M  Culpeper,"  or  Mr.  Brooks*  M  Batn  na 
.Uiiibuan   Hausa,"  in  wliich  he  describes  the  making 
Hausa  arrow  poison,  thus  : — "  Seek  the  head  of 
the  Striped  snake,  the  head  of  the  black  snake,  and  the 
fruit  of  wild  hme,  pepper,  and  tobacco.     These  are  all 
I  together;  pounded,  and  put  into  a  day  bowl, 
-ared   on   a   spear.'*     We   are   glad    to 
that  the  editors  consider  that  many  of  the  new 
remedies    foisted   on    the    notice   of   therapeutists   as 
synthetic  preparations  are  unworthy  of  notice.     Some 
alae  from  the  new  Pharmacopoeia  of  St.  Thomas's 
rum  formulae  employed  in  British  naval 
tals,  are  included  ;   which  cannot  but  be  helpful 
to  the  practitioner.     We  have  given  more  space  than 
to  this  year-book,  for  we  think  that  our  medical 
brethren  cannot  know  how  much  information  it  con- 
tains or  1  hey  would  more  generally  subscribe  for  it. 

HANDBOOK  TO  THE  PARIS 
MEDICAL  SCHOOL,  (h) 
TJUB  is  an  extremely  useful  little  guide  to  the  Paris 
husp.ii  der  each  is  given  a  list  of  physicians  and 

surgeon*  with  their  hours  of  attendance.     The  readiest 
means  of  reaching  the  various  hospitals  mentioned  is 
out,  so  that  foreigner*  may  have  no  dim- 
in    finding    their   way    about.     A    table   of    the 
Budfe  .is  supplied  with  their  dates  of  meeting 

and  correct  addresses,     The  best  part  of  the  guide  is 
that  entitled  "  Daily  Diary,"  in  which  we  have  noted 
under  each  day  of  the  week  the  names  of  the 
various  lecturers,  their  hours,  subjects,  and  place  of 
ng.     The    foreigner   may   be   surprised    to    find 
Sunday  included  h  but  in  Paris  this  is  no  day  of  rest 
tor  those  holding  hospital  appointments  in  the  same 
itnse  as  it  is  hert,      \   list  is  also  given  of  the  Pans 
members  of  the  Continental  Anglo-American  Medical 
We    have  no  doubt   Dr    Warden's  pocket- 
will  hnd  a  home  in  many  a  medical  vagabond's 

Etoak  ol  Phftrmw-'Y,  WOTprWaff  Atwtmrt*  or  Ptpere 
Bating  to  Pinrmicr,  Materia  Ai«dicnn  and  Chemistry.  c*u- 
Wtafe«S  trt  British  *ad  foreign  i>HimaLii  hrotn  Julj  lit,  J&/2,  to 
J mw,    lftJ3 "        lij    J,    O.    Braithwalte.        London :    J,    tiud    A. 

An  friglub  Hand  boo  k  to  tha  Parii  Medical  School.         By 

4  A.  Wtrikn.  M,  V  Fhjsloiui  to  toe  Hortlonl  BritisUi 

t*l,  Puin    Frice  $**  o*t.      London:   J    and  A*  Churchill, 


pocket.  We  trust  he  will  keep  the  work  well  up  to 
dale,  and  would  suggest  that  a  smart  map  of  Paris 
indicating  the  situation  of  the  various  hospitals  and 
medical  and  scientific  institutions  should  be  added 
in  the  next  edition. 


DR.  GEORGE  PATRICK  O  CONNOR. 
Thl  an,uU  ntal  death  of  Dr.  George  Patnck  O'Connor 
at  the  early  ftgfi  of  thirty-one  will  be  the  cause  of  much 
regret  to  his  many  friends  in  Ireland.  At  the  beginning 
of  the  year  he  met  with  a  carriage  accident,  being  th  1 
over  a  precipice  one  hundred  feel  in  depth,  and  sus- 
tained injuries  which  proved  fatal  a  few  weeks  later. 
Deceased  was  the  son  of  Dr,  M.  O'Connor,  of  Chatteris, 
Cambridgeshire,  and  was  Medical  Officer  of  Health 
for  Harding  in  Alfred  County,  South  Africa.  His 
death  took  place  at  Fine-town  Bridge,  Natal. 

DAVID  THOMSON  FLAYFAIR,  M,D. 

By  the  death  of  David    Thomson    Playfair,    M  !/),, 

Bromley  has  lost  one  of  its  busiest  and   most  popular 

if  practitioners.      His  death  took  place  somewhat 

nly  at  Bournemouth  at  the  comparatively  early 

age  of  forty -eight.     He  was  a  son  of  the  Rev.  David 

Pla v f ai r ,  of  A ber co rn ,  N . B .     He  s t ud  1  ed  at  Ed i nbu rgh , 

where  he  qualified  as  L,R,C,S,  and  P.  in  1877,  M.B., 

CM.  or  Edinburgh  University  in  the  same  year,  and 

M.D.  in  1 888-     For  many  years  he  acted  as  honorary 

medical    officer    to    the    Bromley    Cottage    Hospital. 

Deceased    was  well-known    as   B  skilful    musician   am] 

photographer.     Death  was  due  to  appendicitis* 

MR,  WARBURTON,  M.R^C.S.  L.S  A 
We  regret  to  announce  the  death  of  Mr  Warburton, 
of  T re herbert,  a  well-known  medical  practitioner. 
Deceased,  who  was  sixty  years  of  age,  had  carried  on 
practice  in  the  neighbourhood  for  the  last  thirty  years, 
during  the  whole  of  which  period  he  acted  as  surgeon 
to  the  Ynsfew  and  Blaenavon  Colleries. 


DAVID  PORTEOUS,  M.D.GLASG. 
We  regret  to  announce  the  death  of  Mr.  David 
Port eo us,  who  was  medical  officer  to  Sir  John  Ross's 
expedition  in  1850  to  the  Arctic  regions  in 
search  of  Sir  John  Franklin,  at  Mtddleton  SL 
George,  Darlington,  recently,  at  an  advanced  age. 
In  early  manhood  he  was  an  assistant -surgeon  in  the 
Navy,  and  had  medals  for  service  in  the  Arctic  region, 
in  the  Baltic  and  Crimean  campaigns,  and  in  the  Indaa 
Mutiny.  He  graduated  as  M.D.  of  Glasgow  in  1S4S 
and  for  thirty  years  practised  at  Middleton. 

DUNCAN  CAMPBELL  LONGDEN.  M,B„ 
M,R.C.S,ENG..  D,P.H.ED,,  F.R.C.S.ED. 
It  is  with  much  regret  we  announce  the  death  of 
Mr.  D,  C.  Longden,  at  his  brother's  house  in  London, 
at  the  early  age  of  37.  His  education  began  in  1884  at 
Edinburgh  University,  where  two  years  later  he  took 
a  gold  medal  in  anatomy,  and  later  became  Senior 
Demonstrator  of  Anatomy.  Some  time  after  qualifica- 
tion be  became  lecturer  on  anatomy  at  the  School  of 
Medicine  for  Women,  but  some  years  later  was  com- 
pelled to  go  abroad  on  the  return  of  chest  symptoms. 
For  five  or  six  years  he  acted  as  surgeon  to  a  steamship 
line,  and  then  became  Medical  Officer  to  the  Boer 
Refugee  Camp.  Soon  after  his  return  home  his  fatal 
iilucss  was  ushered  in  by  an  attack  of  haemoptysis,  and 
the  end  speedily  came  to  a  career  of  more  than  usually 
brilliant  promise. 

E.  C  GARLAND,  MR.C.S,,  D.P.H..  OF  YEOVIL. 
The  death  took  place  recently  at  Yeovil,  of  Dr, 
Garland,  Medical  Officer  of  Health  of  that  town. 
Deceased,  who  was  70  years  of  age,  was  educated  at 
Sherborne  School,  and  qualified  as  M.KX.S.  in  1*55. 
He  also  held  the  diplomas  of  L.S.A.,  L.R-CS,.  and 
L.R,CREd*.  and  D,F,H.  He  was  consulting  surgeon 
to    the  Yeovil  Hospital,  and   for  many  years  Deputy 


1 90    The  Medical  Press. 


MEDICAL  NEWS. 


Feb.  17,  1904. 


Coroner  for  the  late  Dr.  Wybrants,  of  Shepton  Mallet. 
His  loss  will  be  felt  by  a  wide  circle  of  friends  and  by 
his  two  children. 


Hew  3m>entions  &  flDe&tcal  appliances. 

THE  HYPODERMIC  "  TABLOID  M  BRAND  ~~ 
POCKET  CASE  (No.  21.). 
The  attention  of  medical  men  generally  may  be 
drawn  to  the  Hypodermic  "  Tabloid  "  Brand  Pocket 
Case  (No.  21),  which  is  now  issued  in  gun-metal.  All 
in  want  of  an  aseptic  hypodermic  outfit  may  avail 
themselves  of  this  useful  and  extremely  compact  case. 
The  outside  measurements  are  si  ins.  by   3I  ins.   by 

Jin.,  and  the  case  may 
therefore  be  carried  in 
the  waistcoat  pocket. 
The  fittings  comprise  a 
special  detachable  nickel- 
plated  aseptic  frame  and 
revolving  rack  for  nine 
tubes  of  '*  Tabloid  "  hypo- 
dermic products,  capsule 
of  ether,  glass  stoppered 
and  capped  phial,  the 
B.  W.  and  Co.  AU-Glass 
I  Aseptic  Hypodermic 
Syringe,  with  one  explor- 
ing and  two  regular  needles.  This  rnultum  in  parvo 
is  one  of  the  neatest  and  most  ingenious  cases  ever 
contrived  to  lighten  the  anxiety  ot  the  busy  practi- 
tioner. Armed  with  this,  he  may  with  confidence 
encounter  many  an  emergency  when  thrown  upon 
his  own  resources  far  from  the  aid  of  chemists  or 
consultants.  For  every-day  routine  work  it  is  simply 
perfect  and  unsurpassable    in  its  up-to-dateness. 


AeMcal  Views. 


Lectures  on  Medical  Jurisprudence. 

Oft  February  4th,  Dr.  F.  J.  Waldo,  coroner  for  the 
Citv  of  London,  delivered  the  fourth  of  a  series  of  six 
lectures  before  the  Council  of  Legal  Education  at  the 
Old  Hall,  Lincoln's  Inn.  Sir  Alfred  Marten,  K.C.,  vice- 
chairman  of  the  council,  presiding.  Dr.  Waldo  said 
that  the  two  standpoints,  that  of  law  and  that  of  medi- 
cine, with  regard  to  insanity  were  of  a  different  nature, 
although  both  agreed  in  the  absence  of  any  satisfactory 
definition  of  the  term  "  insanity."  He  then  de- 
scribed at  some  length  the  various  types  of  "  medical  in- 
sanity "  from  the  modern  point  of  view — namely, 
mania,  melancholia,  delusional  insanity,  general  paralysis 
dementia,  and  idiocy.  One  practical  fact  insisted  upon 
was  the  necessity  of  a  medical  examination  of  persons 
of  previously  blameless  life  who  suddenly  committed 
some  offence  that  brought  them  into  the  custody  of  the 
police,  as  it  not  infrequently  happened  that  the 
prisoners  were  not  responsible  for  their  actions.  The 
second  halt  of  the  lecture  was  devoted  to  the  legal 
attitude  with  regard  to  insanity,  chiefly  in  its  particular 
application  to  the  criminal  responsibility  of  the  insane. 
Lord  Hale  in  1675  ruled  that  **  if  a  traitor  become 
non  compos  mentis  before  conviction  he  shall  not  be 
arraigned  ;  if  after  conviction  he  shall  not  be  executed." 
In  1843  the  House  of  Lords  repudiated  the  old  test 
of  sanity  as  an  abstract  knowledge  of  right  and  wrong 
and  substituted  a  knowledge  of  right  and  wrong  as 
regards  the  particular  crime  of  which  a  person  was 
accused. 

Royal  College  of  Surgeons  in  Ireland. 

The  annual  charter  dinner  of  the  Royal  College  of 
Surgeons  in  Ireland  took  place  in  the  College,  Stephen's 
Green,  on  Saturday  night.  The  Museum,  in  which  the 
dinner  was  served,  was  tastefully  decorated.  At  either 
end  of  the  room  were  large  representations  of  the  Royal 
Arms  and  motto,  and  numerous  flags  were  neatly 
arranged  in  various  positions. 


Sir  Lambert  H.  Ormsby,  President  of  the  College, 
occupied  the  chair,  having  on  his  right  his  Excellency 
the  Lord  Lieutenant,  the  Right  Hon.  the  Earl  of  West- 
meath,  Right  Hon.  Mr.  Justice  Ross,  Sir  Philip  Smyly, 
Sir  Cnristopher  Nixon,  Sir  Charles  Cameron,  C.B., 
Sir  Charles  Ball,  and  Sir  Augustine  Baker.  To  the 
left  of  the  President  were  Lord  Ashbourne,  Lord  Chan- 
cellor of  Ireland  ;  Lord  Plunket,  K.C.V.O.  ;  the  Right 
Hon.  Sir  Anthony  P.  MacDonnell,  K.C.S.I..  K.C.V.O. ; 
the  Hon.  A.  Browne,  Sir  Arthur  Macan,  President 
Royal  College  of  Physicians ;  Sir  James  Murphy, 
Bart.,  and  Major-General  Vetch,  Commanding  13th  In- 
fantry Brigade,  Dublin.  The  vice-chairs  were  occupied 
by  Mr.  G.  F.  Blake,  J. P.,  Registrar,  and  Mr.  J.  Barton, 
F.R.C.S.,  Secretary  to  the  Council. 

After  dinner,  and  the  toast  of  "  The  King  "  had 
been  proposed,  the  President  proposed  the  toast  of 
"  His  Excellency  the  Lord  Lieutenant,  and  prosperity 
to  Ireland."  His  Excellency,  in  returning  thanks, 
said  that  it  had  been  suggested  that  in  some  of  his 
speeches  he  had  used  vague  and  ambiguous  language. 
He  had  always  attempted  to  be  frank  and  straight- 
forward in  the  opinions  he  had  expressed.  Wnile 
not  claiming  that  tne  utterances  of  the  Lord  Lieu- 
tenant should  be  absolved  from  legitimate  criticism, 
he  protested  against  their  being  invested  with  mean- 
ings that  were  never  intended.  He  specially  objected 
when  this  was  done  by  people  sitting  in  London  whose 
opinions  were  cramped  by  the  recollection  of  past  dis- 
comfitures. As  to  the  Land  Act,  there  were  un- 
doubtedly some  defects  in  its  provisions  which  it  would 
be  their  duty  to  rectify  on  the  earliest  possible  occasion. 
However,  having  regard  to  the  present  state  of  the 
money  market,  it  was  by  no  means  an  unmixed  evil  that 
the  Land  Act  should  be  working  steadily  but  surely. 
He  echoed  the  opinion  expressed  by  the  President  of 
the  College  that  land  purchase  would  not  have  the 
effect  of  driving  the  resident  gentry  from  Ireland. 

Sir  Thomas  Myles  proposed,  "  The  Navy,  the  Army, 
and  Auxiliary  Forces."  Sir  Charles  Camersn  pro- 
posed "  The  Royal  College  of  Physicians,"  the  Vice- 
president  of  the  College,  Mr.  Chance,  "  The  Guests," 
and  the  Lord  Chancellor,  "  The  Royal  College  of 
Surgeons." 

The  Royal  University  of  Ireland. 

List  of  Examiners  in  Medical  Subjects  for    1904. 
In  the  Faculty  of  Medicine. 
Anatomy.— Ambrose     Birmingham,     M.D.,     Joseph 
P.  Pye,  D.Sc,  M.D.,  Johnson  Symington,  M.D. 

Physiology. — John  J.  Charles,  M.A.,  M.D.,  Denis  J. 
Coffey,  M.A.,  M.B.,  B.Ch.,  B.A.O.,  ♦T.  H.  Milroy,  M.D. 

Medicine. — ♦James  A.  Lindsay,  M.A.,  M.D.,  John 
I.  Lynham,  M.D.,  M.Ch.,  M.A.O.,  ♦Joseph  F.  O'Carroll. 
M.D. 

Surgery.— John  S.  M'Ardle,  F.R.C.S.I..  Charles  Y. 
Pearson,  M.D.,  M.Ch. 

Ophthalmic  Surgery. — ♦Arthur  W.  Sandford,  M.D., 
M.Ch.,  *Louis  Werner,  M.B. 

Midwifery.— *John  W.  Byers,  M.A.,  M.D.,  M.A.O., 
♦Alfred  J.  Smith.  M.B.,  M.Ch.,  M.A.O. 

Medical  Jurisprudence  and  Sanitary  Science.— 
♦Patrick  T.  O'Sullivan,  M.D.,  Antony  Roche,M.R.C.P.I, 

Materia  Medica. — ♦Martin  Dempsey,  M.D.,  *Sir 
William  Whitla,  M.A.,  M.D. 

Pathology. — ♦Edmond  J.  M'Weeney,  M.A.,  M.D., 
♦James  Lorrain  Smith,  M.D. 

Sanitary  Science. — ^Sir  Charles  A.  Cameron,  C.B., 
M.D. 

Extern    Examiners. 

Surgery.— ♦Charles   Stonham,   F.R.C.S.E. 

Midwifery.— ♦Henry  Jellett,  M.D. 

Pathology. — ♦Alexander   C.    O'Sullivan,    M.D. 

Ophthalmology.— ♦William  G.   Sym,  M.D. 

Examiners     marked     thus    (♦)      were    reappointed 
for  the  year  1904.     The    names  of   Fellows    of    the 
I  University    are    not    marked.      Mr.    Jack     and  Mr. 
I  McElderry  are  appointed  for  1904. 


Fan,  if,  1904) 


MEDICAL  NEWS. 


The   Me picai.  Press,     ICjl 


Volunteer  Army  Medical  corps. 

lawn    recently    distributed    the    prizes 

;r  Lotidon  Volunteer  C/niipauies  o>  the  Royal  Army 

Ileal  Corps.     Colonel  J.   E.  Squirts,  explaining  the 

jK.^iiioa,    said    he    was    oblig  j*ort    a    further 

nuiion  »»(  the  strength  of  tin-  corps.     At   the  end 

ajj  the  total  wa  u  year  later  44",  and  last 

vear  }9j.      1'he  letters  of  resignation  were  nearly  all 

to  the  effect  ilia  1  the  writers  were  unable  to  comply 

vita  the  turn  Volunteer  regulation*.    With  regard  to 

recni  were   only   %r  fast  vear,   against   uj  in 

=  th    regard    to  numbers   hail    the  corps 

as  high  as  ever,  and 

■n  some  respet  I  The  prices  I  n  dis- 

1  ted.  Colonel  Squire  asked  Lady  Howe  to  unveil  an 

I-ufc  tablet  tin  one  o!  the  walls  id  the  hall  recording  the 
of   86    members   of    the    corps   woo    served 
hi  the  South  African  War      l^jdy  Howe,  having 
the  memorial,  said  she  could  testify  to  the 
tetJencr  ol  the  men  ol  this  corps  from   tin-  reports  *he 
recen  hem    and    their    comrades    when     they 

ial  Ycomany  Hospital  anil    Bearer 
<  ompany  in  South    Vfrica, 

Balneological  Congress  at  Aachen  (Air  la  Chapelle) 

The  twenty-tilth  Balneological  Congress  wrijl  l><   held 

11  Vac hen  tri »ni,  March  jrtl  t«>  7th,  11  inter  the  presidency 

ufHan  Liebreich*  ol  Berlin.     The  opening  ceremony  n 

sauced  to  take  place  at  the  Kurhaue  a1  tf  p.m,  on 

Thursday,  March  3rd.     The  Congress  will  open  al  ten 

the  following  morning  with  speeches  from  Herr  von 

egierungs  President  "  ;   Herr  Velimami. 

Oberburgermeister "  ;     I>r.    Braider,    rector   of    the 

1  *r.      Beissei,        Sanitatsrath        and 

others*     Communications   are   announced    frona    Hen 

\achen,  on  "The  CJimatH  Conditions  of  the 

Ittune  Herr  Burwinkel,  of  Maubefm,  on 

le  Rheumatism  in  the  Joints        fh-rr  Rothschild, 

•  ■i  ll  The  Climv  tent  ol  Heai  1  I  m  1- 

Lints  w  ,     Herr   KugJer,   of  Marienhad.   on       Hahieu- 

1  Climatic  Health   Resorts  "       and  others. 

the  entertainments  there  will  be  ■<  special  per- 

Ni  i  oi  Haydn's    '  Creation  "  in  the  large  con 

0*1    the    Kurbaus,     Further  pmftioularfl   will    be 

applied  by  Herr  Sanitatsrath  Dr.   Bcissel,   18    Klcin- 

kilnstrassc.    Aachen. 

The  Royal  Commission  on  Shell  fish, 
onkeren'ce    of    oyster    merchants    and    others 
interested  in   the  shell-fish  Industry  was  held  at  the 
Eastern    Hotel.    Liverpool    Street,    London,    on 
ly,  February  5th.      Mr    I  >r  J.  Morgan,  MI'.,  pre- 
sided, and   the   business   was  to   consider   the  recent 
report  of  the  Royal  Commission  on  Sewage  Disposal 
bearing  upon  toe" protection  of  shell  dish  layings. 
Darmstadt  Poisoning, 
The  eleventh  death  from   the  eating  of  poisonous 
beuti    at     Darmstadt    has     occurred.        The    latest 
victim  was  an  elderly  lady,  who  was  one  of  the  first  to 
exhibit  the  symptoms  of  poisoning,  but  she  had  so  far 
recovered  that   the  doctor  on  Tuesday  considered   her 
f  danger. 

PASS  LISTS. 

army  Medical  Service. 
The,  following  is  the  official  list  of  Candidates  who 
*ere  successful  at  the  recent  examination  in   Loudon 
mmissions  in  the  Royal  Army  Medical  Corps,  and 
tght  candidates  entered  : — 

*«U.  Name*. 

kngg,  G.  F     fiff.B  I  .S  Eng^  L.R.C.P,Lond. 
Thomson.  D.  5.  B.,  B.A,.  MB,,  B.Ch.,  B.A.O.  Dub. 
^2  Arthur,  A.  S.,  M.B.,  B.S.Durh. 
I-airbatrn,  J.,  M.B.,   B.Ch.Edin 

R    *       W.RJ   S.Eng.,  L.R.C.RLond. 
Bousneld,   L,B,A„M3f.  B.CCaatab.,  M.R.C.S. 

E.,   L.R,C-P.Lond. 
Douglass,    J,    H.,    B.A.,    M.D.,    B.Ch.,    B.A.O., 
D.RH.Dub. 
?J7  Le  Bas,  D*.  M.R.CS.Eng.,  L.RX.RLond. 
Lewis,  R,  R.>  M.R.C.S.Eng.,  L.R.P.Lond. 
--  Turner,  C,  H„  M,R,CS+EnK  ,  L.R.CP.Lond. 
Soke,    F.    H  ,    MB.,    B.S.Lond.,  M.R.C.S,Eng., 
L,R.C  PUuuL 
530  Cathcart,  G,  E,,  M.ILCS.Eng..  L.R.CP.Lond. 


519  Whitehead,    B.    C,    M.B.Lond.,    M.R.C.S.Eng,, 

L.R.CP.Lond. 
5  1$  Lucas,  T.  C„  B,CXantab.,  M.RX.S.Eng.,  L.R.CP. 

Lond 
5N  TumbuU,  J,    \,,  LK.i    r.  and  >.Edm .,  11 

I  -lasg* 
509  Wiley,  VY\,   (t.A,,  MJ1.   I  \.<>.Dub. 

Hole,  R,  B,,  M,B.N  B.Ch.Edi 
506  Otway,  A+  L.,  B.A  ,  M.B.4  B.Ch.Dub. 
503   Vaiighau,  \V.  )■,  H..  U.R.C.S*Eng..  L.R.C.PLond, 
'■rant,      M.      F,,      B.A,CantaljP(      M.R.C.S,Eng.t 

L.R.CP.Lond. 
SOO   Harding,  H .,  M ,B  ,   M J  h.I.diu. 
40;    Johnstone,  l>.  IV,  LJiXP.  and  S  lldin,  I.F.P.S 
tv  Glasg« 

4«i>  Moore,   E*  H,  M..  ll.R.C.S.Eng.,  L.R.C.PXond, 
480  Garlanrt,  I      |.,  >fji,,  H.Ch.,  H  \,n     R 
478  Ahem.  U  Drt  UR.CP  and  S.EOki. 

47J   Conn.  II.    U.   U  ,  L.H  i.V    and   S.Edin. 

40K   Haves.  (..  S,  (  SLR  (   s  \nK  .  1  ,K,< .'.RLond. 

!^*wlet    S,    C,  M,K.*'  S  I -n-;,    L.R.C.P.Lond.. 
L.D.S.Eog. 

Mcadeu.    \.    A  KnK      !.!(.(    P.Lonti. 


461 

4>"  Cahill,  R,  J  +  F  M.B..  B.Ch.,  aXO.,  rtUJ 
Royal  College  or  Physicians,  Edinburgh.  Royal  College  of 
burgeons.  Edic burgh,  and  Faculty  or  Physicians  and 
Surgeons  of  Glasgow, 
*  The  tpiarlcrJy  examination*  uf  the  above  Board,  held 
m  Edinburgh,  were  concluded  on  the  39th  u|tL>  Vvith 
the  following  results  ; — 

Ititui  Examiftativn,  u\  66  oandklatss  entered  the 
following  38  passed  the  examination,  and  were  ad- 
mitted L.R.C.P.F.,  L.R.C.S.E.,  and  LF,P.  and  S+G.  :^ 
Edith  Serjeant,  Hunts ;  Walter  Alphonso  Dorion, 
Canada  ;  James  Sydney  Cooper,  London  ;  Alexander 
Hugh  Blaxell  Pearcc.  Edinburgh  ;  Harry  Lome  Pavey, 
Canada  j  Robert  Brodie  Anderson,  Canada ;  Rupert 
Altai  Clayton  Rigby,  Ceylon  j  John  Daly  Nicolas*  Cal- 
cutta ;  John  James  Andrews,  Montreal  *  Ida  Mar* 
garni  GniUaunie,  London;  Leo  Ferdinando  Bianchj, 
England  ;  Williatn  James  Purves.  Hartlepool ;  Henry 
Murray  Agnew.  Lurgan  ;  William  Rotherham.  Lanes/; 
Joseph  Stark,  Lanark  ;  William  Black  Hendry,  Edin- 
burgh ;  James  MaoGregor,  Montreal  ;  Henry  Maurice 
Madden,  Cork;  Samuel  James  Mathewson,  Tyrone; 
tan  Campbell,  Perthshire  ;  Henry  Ronald  Leonard, 
Malta ;  Patrick  Shaw,  Melbourne  ;  Jesudawson 
Joseph  Anthony-Pi  Hay,  Sr  India  :  Sheik  Nizam  ud  din, 
Punjab  ;  Edward  Rolston  Langrill,  Toronto  ;  Ram 
Sarup  X'arma,  India  ;  Andrew  Malachy  Walsh, 
co.  Waterford  j  John  Herbert  \'earsley,  Welshpool ; 
John  Mounctte  Hney»  Londonderry ;  Denham  Cecil 
Woods,  India  ;  Thomas  Sargent  Pearse,  New  Zealand  ; 
Enl alia  Sisley  Uichards,  Battle  Creek,  Mich,;  Charles 
Henry  Arthur  Alder  ton,  India  ;  Wdliam  T^ang  Hodge, 
Plymouth  ;  John  Wat  son,  co.  Armagh  ;  Hon  I  and 
Samuel  Rasaiah,  Ceylon  ;  Kershaw  Dinshah  Kham- 
batta,  India  \  and  Sidney  Percival  Joseph,  Ceylon ; 
and  11  passed  in  medicine  and  therapeutics  j  '1  in 
surgery  and  surgical  anatomy  ;  4  in  midwifery  ;  and  3 
in  medical  jurisprudence. 

Trinity  College,  Dublin 
Thl.  following  candidates  passed  the  Emal  Examina- 
tions in  surgery  at  the  Hilary  term,  1904  : — Thomas 
C  A,  Sweet  man,  Robert  Bailev,  Charles  E.  Moore, 
Winstow  S,  S.  Berry,  Washington  P.  Tate,  John  C. 
Hall,  Herbert  Stone,'  William  M,  Wade, 

Conjoint  Examinations  in  Ireland, 
hi)  following  have  passed  the  examination  for  the 
i  onjoint  Diploma  in  Public  Health: — Joseph  P,  Dee, 
M+B.,  &c>,  It  Julvan  fieorge,  M.B.,  Ac.  Christopher  A. 
Johns,  M.B.,  &c,  J.  M.  S.  Levis,  L.R.CRAS.L 
(Honours),  Thos.  J.  Nicholl,  LJLC.P.AS.L,  E.  M+  J. 
O'Farrell,  F.K.C.S.L,  1  hos,  Khind,  M.RX.S.,  LR.CP. 
Alex.  W.  Sampev.  L.R  (  .P.^S.L.  Lieut.  K.AJ.f. 
(Honours).   Ed,  J.  Tynan,   RR.C.S.L 

The  General  Medical  Practitioners'  Association  has 
circulated  some  adverse  comments  on  the  new  London 
University  scheme  for  centralising  the  teaching  of 
medical  science  subjects,  If  maintains  that  these 
subjects  can  best  be  taught,  as  now,  in  class-rooms  of 
moderate  size  rather  than  in  vast  and  crowded  labora- 
tories in  South  Kensington 


194    The  Medical  Press.       NOTICES  TO  CORRESPONDENTS. 


Notice*  to 
(Samflpantetttg,  Shxrrt  %ttitxB9  &t 

Jtj9*  Oobjubwohebhtb  requiring  a  reply  in  this  column  are  particu- 
larly requested  to  make  use  of  a  distinctive  signature  or  initial,  and 
avoid  the  practice  of  signing  themselves  "  Reader,"  "Subscriber,'* 
'•Old  Subscriber,"  Ac.  Much  confusion  will  be  spared  by  attention 
to  this  rale. 

Original  Articles  or  Lrttrrs  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

NEW  TBEATMENT  OF  RENAL  AND  CARDIAC  DROPSY, 

Our  Freach  correspondent  has  sent  us  the  abstract  of  an  important 

Saper  by  Professor  Renaut  on  a  new  treatment  of  renal  and  cardiac 
ropsy  with  reports  of  cases  in  which  it  had  proved  very  efficacious. 
Report  in  our  next  issue. 

A  Pbovihcial  Practitioner  —If  you  will  furnish  us  with  data  on 
which  to  form  an  opinion,  we  shall  be  pleased  to  go  iuto  the  matter 
and  state  our  views. 

A  correspondent  writes :— **  What  fee  should  1  charge  a  patient- 
living  in  a  £28  per  annum  rental— for  the  operation  of  injecting 
diphtheritic  serum.— (a)  When  on  my  ordinary  round  ?  (b>  When 
as  a  special  visit,  two  miles  off  and  a  cab  fare  of  2s.  6d  ,  at  8.90  p.m  ?  " 

f  Perhaps  some  of  our  readers  will  furnish  the  desired  information. 

A8artmsjLt>  8ur*eok.— The  craze  for  erecting  large  and  costly 
sanatoria  tar  oonsamption  must  speedily  come  to  end.  The  essence 
•f  successful  treatment  of  tuberculosis  is  isolation  and  simplicity. 

U.  A.  8.  (Enfield).— The  case  would  be  most  suitable  for  treatment 
in  the  house  of  a  medical  man.  There  is  an  association  in  Bourne- 
mouth for  the  registration  of  medical  men  who  can  take  such  resident 
patients.    The  Hon.  Sec.  is  Dr.  Crallan. 

Burootke.— Madeira  is  generally  considered  unfitted  for  gouty 
persons.  That  is  so,  speaking  generally,  but  if  the  patient  be 
abstemious,  as  a  rule  a  glass  of  sound  Madeira  now  and  then  will  do 
no  harm.    Crtde  Exptrto. 

De.  Pbabrb  (Plymouth).— We  hope  to  have  space  for  your  paper  on 
*  Immunity  "  in  an  early  number. 

Jfodinge  of.  the  goaetie*,  $ettur«,  &c 

Wednesday,  February  17th 

Royal  Microscopical  8ociett  (20,  Hanover  Square,  W.).— 8  p  m 
Mr.  C.  L.  Curties:  Exhibition  of  Specimens  of  Marine  Objects 
mounted  by  Mr.  H.  J.  Waddington.  Papers  —Mr.  E.  M.  Nelson  •  (I) 
On  the  Vertical  Illuminator;  (2)  The  Influence  of  the  Antipoint  on 
the  Microscopic  Image  shown  Graphically. -Mr.  K.  Lucas :  A  Micro- 
scope with  Geometric  Slides. 

Royal  Meteorological  Society  (Institute  of  Civil  Engineers.  Great 
George  Street,  Westminster,  8, W.).— 7.30  p.m.  Papers  -kr.  E 
Mawley :  Report  on  the  Phrenological  Observations  for  1908.  —Mr  W* 
H.  Dines ;  Observations  by  means  of  Kites  at  Crinan  in  the  summer 
of  1903. 

Medical  Geaduates'  College  ato  Polyclinic  (22,  Chenies  Street. 
W,0Jt>    P'm'     Mr/    K  0wen:    Clinique.     Surgical.)    5.16  p.m. 
Mr.  8.  Stephenson  :  Some  of  the  Newer  Remedies  in  Eye  Disease. 
Thueedat,  Frbbuaet  18th. 

Medical  Gbadcatm' Collbok  akd  Polyclinic  (22,  Chenies  8treet, 
W*°J"^4  £"•**>•  Hutchinson:  Clinique  (Surgical.)  6.15  p.m 
Mr.  E.  Clarke  :  Errors  of  Refraction,  their  Diagnosis  and  Treatment. 
~J*0JJ}2  Z***0**  Hosmtal  for  Consumftioh  and  Diseases  or  the 

?K(7lTSi?>y.:8qU*/e^W)— 5P'm-  Dr  TN-  Kelynack:  Prin 
ciplea  and  Practice  of  the  Sanatorium  Treatment  of  Consumption 
(Post  Graduate  Course.)  ^ 

w^'/SPS?  ? ^^V^^P  op  T"»  SKIN  Bicester  Square. 
(C&Ueldl^ure?-   *'   ^^    ^^   Diw^    "8k-- 

Friday,  February  I9th. 
fJ^^^^^^^or^DOSllhC^ndo^  Street,  Cavendish 
Square.  W.).— 8.30.  p.m.    Paper  :— Dr.  M.  Coplans  :  The  Etiology  of 

*™™°™v£*<*™»*  and  PoLTCLimc  (22.  Chenies  Street, 
w.c.j.— 4  p.m.    Mr.  p.  Grant :  Clinique.    (Ear.) 
Monday,  Fbbbuary  22nd. 
Oiwmtowwical  Society  of  Great  Beitain  (20,  Hanover  Square, 

W,)C!SFer8iLMrCorneUuiJobbiMand  Mr  J-  Thornton  barter 
on  Further  Notes  on  some  Prehistoric  Skulls.-Dr.  H.  Bellamy 
Gardner  will  give  a  Casual  Communication  on  Variations  in  the  At- 
AnMtheXcaVe88Ure'  "^  th*ir  rnfluence  uP°n  the  Inhalation  of 
Tuesday,  Febeuaet  23rd. 
Thbeafbutical  Society  in  the  Apothecaries'  Hall  at  4  p.m.  (1)  Dr. 
JjBurnet  oe  lohthoform  and   IcWrgan  :  An  Account  of  their 


Feb.  17;  1904. 


Birmingham  and  Midland  Eye  Hospital, -House  Surgeon.  Salary  £75 
per  annum.  Applications  to  the  Chairman  of  the  Medical 
Board  on  or  before  Monday  February  29th.  Any  further  infor- 
motion  may  be  obtained  on  application  to  the  Secretary.  By 
order,  J.  Cranmer  CtalL  Secretary,  Secretary's  Office,  Church 
Street JMrmingham,  February  13th,  1904. 

Bradford  ChDdretfs  Hosoital.-House  Surgeon,  Salary  £100,  with 
board,  residence ,  and  washing.  Applications  to  C.  V.  Wood- 
cock, Secretary,  Bradford. 

Cheltenham  General  Hospital— Junior  House  Surgeon,  Salary  £70 
rTT*Carr?  gta?  h°*Xd' lodgin9'  ***  w**Wm7-    Applications  to 


City  of  Sheffield.— Second  Assistant  Medical  Officer,  Salary  £160  per 
annum,  with  board,  lodging,  and  atteodance.     Applications  to 
,v  1  iHo8a>er'  Town  Clerkf  Town  Clerk's  Office.  Town  Hall,  Sheffield. 
Civil    Service     Commission.— Forthcoming    Examination.     Junior 
Assistant  in  the  Department  of  the  War  Office  Chemint,  Wool- 
wich.    Applications  to  the  Secretary,  Civil  Servioe  Commission, 
Burlington  Gardens,  London,  W.    (See  Advt.). 
Clayton  Hospital  and  Wakefield  General  Dispensary.— Junior  House 
Surgeon,  Salary  £80  per  annum,  with  board,  lodgings,  and  wash- 
ing. Applications  to  the  Hon.  Secretary,  Clayton  Hospital,  Wake- 
County  Council  of  Middlesex.-Medical  Officer  of  Health,  Salary  £700 
per  annum.    Applications  to  Richd.  Nicholson,  Guildhall,  Wett- 
minster,  aw.    (See  Advt.). 
Gesto  Hospital,  Skye.— Resident  Medical  Officer,   8alary  £*»  per 
annum,  with  furnished  house,  coals,  light,  and  taxes.    Applies, 
tions  to  the  Secretary,  J.  8impson,  North  of  Scotland  Bank, 
Limited,  Portree,  Skye. 
Joint   Counties  Asylum,   Carmarthen.— Junior   AssiaUnt   Medical 
Officer,   Salary  £150  per  annum,  with  board,  furnished  apart- 
ments,  and   washing.     Applications   to   Dr.  GoodsJl,  Medical 
Superintendent,  The  Asylum,  Carmarthen. 
Lancashire  County  Asylum,  Winwick,  Warrington.— Assistant  Medic* 
Officer,  Salary  £160  per  annum,   with   furnished   apartments, 
board,  attendance,  and  washing.    Applications  to  the  Medical 
Superintendent. 
Lincoln  General  Dispensary.— Resident  Male  Medical  Officer,  Salary 
£150  per  annum,  with  furnished  apartments.  Are,  and  gas  pro- 
vided.   Applications  to  William  Dean,  Secretary,  Board  Boom, 
Lincoln. 
Roscommon  Union.— Medical  Officer  of  the  Ballyleague  Dispenssrr 
District,  Salary  £100  per  annum.  Applications  to  T.  J.  O^Keeffe. 
(See  Advt.). 
Royal    Albert    Edward    Infirmary  and  Dispensary,  Wigan.— Junior 
House  Surgeon,  Salary  £80  per  annum,  with  board,  apartments, 
and  washing.    Applications  to  W.  M.  Taberner,  General  Superin- 
tendent ana  Secretary. 
Royal  Surrey  County  Hospital,  Guildford.— Resident  House  Surgeon, 
Salary  £100  per  annum,  with  board,  residence,   and  laundry. 
Applications  to  the  Hon,  Secretary. 
West   Riding   Asylum,   Wadsley,   near    Sheffield.— Fifth  Assistant- 
Medical  Officer,  8alary  £140  per  annum,  with  board,  Ac,    Appli- 
cations to  the  Medical  Superintendent. 
West  Riding    Asylum,  Wadsley,  near  Sheffield.— Fouth  Assistant 
Medical  Officer.  Salary  £150  per  annum,  with  board,  Ac    Appli- 
cations to  the  Medical  Superintendent. 


JlppointmeniB. 


Awdet,  Walter  Rorbet,  M.B.,Durh.,  M.R.O.8.,  Honorary  Surgeon  te 
the  Berkeley  Hospital. 

Battkk,  R.  Wixtrbbotham,  M.D..  F.R.C.P.Lond.,  M.R.C.8.,  Honorary 
Consulting  Physician  to  the  Berkeley  Hospital, 

Bowks,  T.  A.,  M.  D  Cantab.,  Certifying  Surgeon  under  the  Factorv  Act 
for  the  Heme  Bay  District  of  the  county  of  Kent. 

Flbmiho.  R.  J..  M.D.,  House  Surgeon  to  the  Richmond,  Whit- 
worth,  and  Hardwicke  Hospitals. 

Grant,  L.,  L.D.,  M.S.  Edin.,  Certifying  Surgeon  under  the  Factory 
Act  for  the  Ballaohulish  District  of  the  county  of  Arvyil. 

Hedlrt,  A.  S.,  M.B..  B.fl.Durh.,  Certifying  8urgeon  under  the  Fac- 
tory Act  for  the  Rothbury  District  of  the  county  of  Northumber- 
land. 

Lancaster,  Ernest  Lb  Crokibb,  B.A.,  M.B.,  B.CKOxon.,  M.R.OS. 
Eng.,  Physician  to  the  Swansea  General  and  Eye  Hospital. 

Lex,  Dr.  R.  H..  elected  House  Physician  to  the  Richmond,  With  worth 
and  Hardwicke  Hospitals. 

Milward,  F.  Victor,  MB.,  B.C.Cantab.  F.R.C8.Eng,  Medical 
Referee  under  the  Workmen's  Compensation  Act  for  Birmingham, 

"IT  Bromsgrove.  Redditch,  and  Solihull. 

Nuthall.  A.  W.t  F.R.C.8.Eng.,  Surgeon  to  out-patients  to  the  Bir- 
mingham and  Midland  Free  Hospital  for  Sick  Children. 

Salomon,  Hekrt.  M.D.Boston,  L  R.C.P.,  L  R.C.8  Edin.,  L.FJ\8. 
Glasg  ,  Medical  Officer  to  the  Leicester  Dispensary. 

Wilson,  J.  Clark,  M.D..  CM. Edin.,    D.P  H.Camb.,  Pathologist  to 

H.r-  Friedenheim  Hospital,  Upper  Avenue  Road.  N.W. 


girths. 


Bartholbmkw.— On  February  9th,  at  Cranbrook,  Lansdowne  Road. 

Aldershot,  the  wife  of  Captain  E.  Urquhart  Bartholomew,  Royal 

Army  Medical  Corps  (Militia),  of  a  son. 
Camrron.— On  February  10th,  at  9,  Elms  Road,  Clapharo  Common, 

London,  S  W.,  the  wife  of  Albert  Comeroo,  M.BM  CM.,  of  a  son. 
Colman.—  On  Februarv  11th,  at  5,  Home  Terrace,  Broughty  Ferry, 

N.B.,  the  wife  of  Horace  C.  Col  rat  11,  M.D.,  of  a  son. 
Solly.— On  February  7th,  at  Strathlea.  Harrogate,  the  wife  of  Ernest 

Solly,  M.B.,  F.R.C.S  ,  of  a  daughter. 


4ftatriage0. 


Bridoe— Davis.— On  February  11th,  at  St.  Matthew's  Church,  Baling. 
John  Crosthwaite  Bridge,  M.R  C.S.,  L.R.C.P.,  son  of  the  late 
Rev.  J.  H.  Bridge,  vicar  of  Mucking.  Essex,  to  Bessie  Coleridge 
Davis,  eldest  daughter  of  the  late  Gateword  Coleridge  Daro, 
barrister-at-law,  Inner  Temple. 

Camerok— MACKnrNOK .— On  February  11th.  at  the  Parish  Church, 
Welwyn,  Herts,  by  the  Rev,  P.  M.  Wathen,  rector,  Captain 
Kenneth  M.  Cameron,  B.A.M.C,  to  Norah  Charlotte,  second 
daughter  of  the  late  Walter  Carr  Mackinnon,  87th  Regiment  sod 
3rd  Buffs. 


Bcaths. 


Bridge -On  Fedruary  10th,  at  49,  Lissenden  Mansions,  London,  N.W., 
Emily  Sarah,  widow  of  the  late  Alexander  Bridge,  M.D., 
M.R.C.P.,  of,  Argyll  Place,  W.,  aged  82. 


flic    ^tcdiral   %§tm    and    tf -irnilar. 


"SALUS    POFULI    STJPEEMA    LEX-" 


VOL.CXXVIU.  WEDNESDAY,     FEBRUARY     24,    1904.        No.    8. 


Original  Communications. 


PROGNOSIS     IN     HEART 
DISEASE,  [» 

By  JAMES  BARR,  M.D*,  F.R.C.R, 

Pmideat,  Liverpool  Medical  Institution  j  Senior  Phy*ici*ti,  Liver- 
pool  ftoytl  Infirmary ;  *nd  Lc-.turer  on  Clinic*!  Medicine,  Lirer- 
poo]  Vnivtr 

(Concluded  from  page  169.) 

Mitral  Stenosis. — This  is  a  lesion  which  usually 
commences  very  early  in  life  as  the  result  of  rheu- 
matic endocarditis,  or  of  chorea,  and  progresses 
very  slowly,  It  is  much  more  common  in  females 
than  in  males,  as  they  are  more  emotional,  have 
active  thyroidsl  and  consequently  are  more 
liable  to  palpitation  with  straining  and  forcible 
impact  of  the  mitral  cusps.  This  leads  to  sub- 
endothelial  pro  HI  era  tio  11  of  the  connective  tissue, 
with  subsequent  scarring,  contraction,  and  narrow- 
ing of  the  orifice.  If  the  lesion  starts  in  early 
childhood,  it  is  likely  to  end  fatally  within  ten  or 

n  years  ;  but  if  it  begin  after  puberty,  when 
the  body  is  fairly  developed,  the  patient  may  live 
to  forty  or  fifty  years  of  age,  enjoy  fairly  good 
health,  and  bear  a  large  family,  though  this  is  the 
lesion  of  all  others  most  seriously  affected  by 
gestation.  If  there  be  a  loud  auricular  systolic 
murmur,  a  regular  pulse,  about  80,  of  fairly 
good    volume    and    moderate    tension,    and    no 

nee  of  failure  of  the  right  side  of  the  heart, 
the  prognosis  is  good.  On  the  other  hand,  if  the 
orifice  is  much  contracted,  the  auricle  dilated, 
perhaps  no  murmur  at  the  mitral  orifice,  the  pulse 
small,  irregular  in  force  and  rhythm,  infrequent, 
and  only  relatively  high  tension,  a  diastolic  murmur 
at  the  pulmonic  orifice,  dilated  right  side  of  the 
heart  w*th  incompetency  of  the  tricuspid  valve, 
and  a  large  pulsating  liver,  the  prognosis  is  very 
fjrave.  They  are  usually  patched  up  for  a  time 
by  rest,  digitalin,  strychnine,  and  nitro- glycerine, 
but  under  any  stress  or  strain  they  break  down  and, 
after  a  few  years'  invalid  life,  succumb*  Many 
patients  in  the  early  stage  of  this  affection,  if  they 
happen  to  come  under  the  care  of  an  energetic 
therapeutist,  scarcely  get  a  fair  chance  ;  they  are 
practically  poisoned  with  digitalis,  which  raises  the 
already  far  too  high  blood  pressure,  contracts  an 
already  too  small  ventricle,  and  further  strains  the 
mitral  cusps  and  hastens  the  progress  of  the  mis- 
chief,    At  this  stage  the  patients  require  moderate 

ise,  a  dry  diet,  and,  if  any  medicine  be  neces- 
tt  must  be  something  like  nitro -glycerine. 


<«J    Vn   Addrett  delivered  At    the   Bouthport    Medical   Society, 
Jumirj  27Ui,  130k 


which  lessens  the  arterial  blood  pressure,  allows  a 
greater  accumulation  of  blood  in  the  systemic 
circuit,  and  lessens  that  in  the  pulmonic  system. 
Patients  suffering  from  advanced  mitral  stenosis 
are  specially  liable  to  embolism  in  the  left  middle 
cerebral  artery  from  soft  clots  formed  in  the 
auricle.  On  the  other  hand,  those  suffering  from 
infective  endocarditis  are  more  liable  to  infarcts 
in  the  spleen  and  kidneys.  I  look  upon  mitral 
stenosis  as  a  lesion  very  amenable  to  treatment  if 
intelligently  dealt  with  during  aU  its  stages,  but 
still,  withal,  a  very  serious  affection,  second  only  to 
1  aortic  incompetency,  not  only  from  its  effc 
shortening  life,  but  also  from  its  crippling  effects 
on  the  whole  organism*  Owing  to  the  high 
arterial  blood  pressure,  there  is  no  anasarca  until 
a  late  stage,  when  cardiac  failure  occurs. 

Ascites  frequently  precedes  the  oedema  of  the 
lower  extremities,  and  when  there  is  also  tricuspid 
stenosis,  pleural  effusion  is  not  at  all  uncommon. 
Occasionally  there  is  mitral  stenosis  following 
granular  kidneys,  but  in  such  cases  the  contraction 
of  the  orifice  is  never  very  great,  and  the  prognosis 
depends  more  on  the  renal  affection  than  on  the 
cardiac. 

Mitral  Stenosis  accompanied  by  Mitral  Incom- 
petence.— The  puckering  of  the  mitral  cusps  and 
thickened  edges  often  causes  a  buttonhole  opening 
in  the  centre  of  a  diaphragm,  or  at  the  end  of  a 
funnel-shaped  orifice.  This  not  only  causes  mitral 
obstruction  but,  being  permanently  open,  allows 
of  more  or  less  free  regurgitation.  In  advanced 
cases,  the  orifice  may  be  very  narrow,  in  some  in- 
stances not  larger  than  would  admit  a  lead  pencil, 
and  consequently  the  ventricular  systolic  murmur 
may  be  very  loud  and  musical,  this  being  an 
exception  to  the  dictum  that  the  louder  the  murmur 
the  less  serious  the  lesion*  In  many  of  these  cases 
the  auricle  is  so  much  dilated  that  it  fails  to  pro- 
duce an  auricular  systolic  murmur,  hence  many 
competent  observers,  who  depend  too  much  on 
murmurs  in  their  diagnosis,  fail  to  recognise  the 
obstructive  lesion,  and  treat  such  cases  as  those  of 
pure  mitral  incompetency.  Probably  from  these 
failures  in  diagnosis  has  arisen  the  impression  in 
many  minds  that  mitral  incompetency  is  a  more 
.serious disease  than  mitral  stenosis.  In  my  opinion 
the  regurgitation  really  adds  nothing  to  the  gravity 
of  the  case,  and  I  hold  that  the  man  who  cannot 
diagnose  any  cardiac  lesion  independently  of  the 
existence  or  non-existence  of  a  murmur  has  only 
half  learnt  his  work*  In  fact,  he  should  have 
practically  made  his  diagnosis  before  he  puts  his 
ear  to  the  stethoscope.  The  prognosis  in  these 
cases  largely  depends  on  the  extent  of  the  lesion, 
which  can  be  readily  inferred  from  the  secondary 


196    The  Medical  Press.  ORIGINAL  COMMUNICATIONS. 


Feb.  24,  1904. 


conditions,  such  as  the  character  of  the  pulse,  the 
congestion  and  subsequent  brown  induration  of 
the  lungs,  the  competency  of  the  pulmonic  valves, 
the  sta^e  of  the  right  side  of  the  heart,  including 
the  tricuspid  valve,  and  the  condition  of  the  liver. 
I  have  seen  some  of  these  advanced  cases  last  a 
few  years  as  chronic  invalids.  The  duration  of 
these  cases  depends  on  the  primary  condition  of 
stenosis,  and  is  not  practically  affected  by  the 
incompetency.  That  the  regurgitation  is  usually 
not  great  is  shown  by  the  arterial  tension  remain- 
ing relatively  high,  and  there  being  no  anasarca 
until  there  is  cardiac  failure. 

Mitral  Incompetency. — A  pure  mitral  incom- 
petency arising  in  early  life  from  rheumatic  endo- 
carditis is,  in  my  opinion,  the  most  harmless 
valvular  lesion.  Moreover,  it  is  the  disease  which 
is  most  benefited  by  digitalis,  and  therefore  one  to 
which  the  amateur  physician  can  do  least  harm. 
A  fellow-student  of  mine  had  mitral  regurgitation 
of  some  standing,  and  has  since  been  engaged  in 
active  practice  for  over  thirty  years.  However, 
like  any  other  lesion,  there  are  different  degrees  of 
severity,  and  if  you  get  marked  hypertrophy  with 
dilatation  of  the  left  ventricle,  the  chances  of  a 
long  life  are  not  great.  This  is  more  especially  the 
case  if  the  pulse  be  very  irregular  in  force  and 
rhythm,  and  there  be  a  marked  delay  in  its  trans- 
mission ;  if  there  be  frequent  attacks  of  oedema 
of  the  lower  extremities  not  very  amenable  to 
treatment;  and  if  there  be  much  dyspnoea  and 
other  pulmonary  symptoms  with  secondary  in- 
volvement of  the  right  side  of  the  heart. 

Mitral  incompetency  arising  in  late  adult  life 
from  degenerative  changes  in  the  aorta  and 
coronary  arteries,  with  dilatation  of  the  left 
ventricle  and  enlargement  of  the  mitral  orifice,  is 
a  very  serious  lesion,  and,  although  in  the  com- 
paratively early  stage  is  amenable  to  treatment, 
soon  leads  to  cardiac  failure  and  death.  It  is  very 
difficult  to  put  a  time  limit  on  this  condition,  but 
if  life  is  to  be  prolonged,  the  patient  must  live  at  a 
low  level,  and  avoid  all  stress  and  strain,  whether 
physical  or  moral.  The  mitral  regurgitation 
which  frequently  occurs  in  advanced  chronic 
Bright's  disease  is  merely  an  indication  that  the 
heart  is  giving  way  sooner  than  the  vessels,  and 
shows  that  the  case  is  drawing  to  a  close. 

Aortic  Obstruction. — This  is  generally  looked 
upon  as  the  least  serious  valvular  defect — in  fact, 
a  very  simple  and  usually  harmless  cardiac  lesion — 
but  it  all  depends  on  what  is  meant  by  aortic 
obstruction.  If  you  look  upon  every  case  of  an 
aortic  systolic  murmur  due  to  slight  thickening  and 
roughening  of  the  aortic  cusps  arising  from  an 
attack  of  rheumatic  endocarditis  as  one  of  ob- 
struction, then  the  prognosis  may  be  considered 
extremely  good.  In  such  cases  little  or  no  hyper- 
trophy is  required,  and  the  less  the  hypertrophy 
the  more  favourable  the  prognosis.  If  there  be 
much  obstruction  from  narrowing  of  the  orifice, 
with  perhaps  two  of  the  cusps  fused  together,  the 
pulse  long,  slow,  and  infrequent,  and  the  ven- 
tricle considerably  hypertrophied,  the  prognosis 
becomes  correspondingly  more  serious.  But  such 
cases  may  last  for  many  years,  even  with  an  ex- 
ceedingly small  orifice,  if  the  coronary  arteries 
have  escaped.  The  ventricle  hypertrophies  suffi- 
ciently to  meet  the  obstruction,  and  remains 
healthy,  provided  the  patient  eschew  alcohol,  tea, 
coffee,  and  tobacco,  and  is  not  dosed  with  arsenic. 

In  cases  of  aortic  systolic  murmurs  arising  in 
advanced  adult  life  and  associated  with  atheroma 


or  calcareous  degeneration  of  the  aorta,  aortic 
cusps,  and  coronary  arteries,  the  outlook  is  very 
bad.     The  clear  ringing  or  clanging  short,  second 
sound  indicative  of  k  dilated  and  inelastic  aorta  is 
very  ominous.     If  there  be  any  suspicion  of  small 
aneurysms  about  the  size  of  pigeons'  eggs  in  the 
sinuses  of  Valsalva,  you  may  be  on  the  look-out 
for  sudden   death   from   rupture  into   the  peri- 
cardial sac.     The  best  that  could  happen  in  such 
a  case  would  be  aortic  incompetency,  but  failing 
that,  the  blood  pressure  should  be  kept  low.    In 
cases  of  aneurysm  of  the  thoracic  aorta  you  not  in- 
frequently  find   that   the    aortic   cusps   become 
secondarily  incompetent ;  but  in  cases  of  primary 
aortic    incompetency    due    to     rheumatic    endo- 
carditis you  never  get  aneurysm.      Hence  I  look 
upon  the  incompetence  in  such  cases  as  a  conser- 
vative lesion.  In  a  case  of  aneurysm  of  the  thoracic 
aorta  I  have  seen  all  the  pressure  symptoms  dis- 
appear  and   life   much   prolonged    by    such  an 
occurrence.     The  greatest  obstruction  occurs  in 
cases  of  granular  kidneys,  where,  to  use  an  Irishism, 
there  is  no  aortic  obstruction  at  all.     Some  time 
ago  Dr.  J.  D.  Wright  and  I  had  under  our  care  a 
very  clever  and  well-to-do  engineer,  but  a  rather 
cantankerous    and    obstinate    patient.     He   was 
suffering  from  gouty  kidneys,  an  aortic  systolic 
murmur,    an    hypertrophied   and   powerful   left 
ventricle  with  a  mean  blood  pressure  of  over 
250  millimetres  of  mercury.     He  had  also  peri- 
pheral neuritis  with  complete  absence  of  the  knee- 
jerks.     I  wished  to  make  him  a  teetotaller  and  a 
vegetarian,  but  he  strongly  resented  my  treatment, 
and  said  that  to  hear  Dr.  Wright  and  myself 
talking,  one  would  think  that  he  never  went  to  bed 
sober,  but  he  could  assure  us  that  there  was  not  a 
plainer-living  man  in  Liverpool.     I  told  him  that 
was  where  the  difference  of  opinion  came  in,  and 
that  I  thought  it  would  have  been  much  better 
for  him  if  he  had  gone  occasionally  to  bed  drunk, 
even  with  his  boots  on,  rather  than  have  continu- 
ally lived  at  what  I  considered  a  high  level.    I 
plainly  told  him  that  if  he  did  not  lower  the  head 
of  the  liquid — to  use  an  engineering  term — the 
boiler  would  soon  burst.     However,  he  was  not  a 
man  who  was  afraid  to  die,  and  while  alive  he  was 
not  going  to  be  deprived  of  the  pleasure  of  worrying 
his  medical  attendants.     Under  my  treatment  he 
declared  he  was    "  getting    weaker  and  weaker 
every  day,"  although  I  could  point  to  the  return 
and  gradual  improvement  in  the  knee-jerks,  and 
increased  muscular  power.     Eventually  he  thought 
he  would  like  other  and  perhaps  more  agreeable 
advice,  and  I  gave  him  a  letter  to  an  eminent 
London  physician  who  had  done  some  good  work 
on  the  diseases  of  the  circulation.     He  evidently 
expressed  his  opinion  very  freely  about  me  and  my 
treatment,  because  I  was  very  much  amused  to 
find  in  the  letter  which  I  received  from  my  London 
friend  that  he  took  credit  to  himself  for  having 
patched  up  a  quarrel  between  me  and  the  patient. 
He  did  not  know  that  when  I  give  the  best  advice 
I   can,   I   am   not  very  particular  whether  the 
patient  is  pleased  or  not.     If  he  does  not  take  my 
advice  that  is  his  look-out,  and  he  had  better  go  to 
someone  else.     In  impressing  the  patient  with  the 
great   benefit  which  he  had    derived   from  my 
treatment,  my  friend  told  him,  inter  alia,  that  I 
had  found  albumin,    now  he  could  assure  him 
there  was  not  a  trace.     This  was  no  doubt  a  fact, 
but  in  granular  kidneys  the  presence  or  absence  of 
albumin  is  of  very  little  diagnostic    and  of  no- 
prognostic  value.     It  is  not  what  is  excreted,  but 


Feb.   24.   1904. 


ORIGINAL  COMMUNICATIONS.  The  Medical  Pkess,    197,^ 


the  waste  products  which  are  retained  that  work 
the  mischief.  My  friend  relaxed  my  regime  very 
considerably,  of  which  the  patient  did  not  fail  to 
apprise  us  when  he  returned.  He  soon  afterwards 
^)t  a  slight  apoplectic  seizure.  Our  advice  was 
sought  and  followed.  He  recovered  suffr- 
■.iently  to  gp  a  trip  up  the  Mediterranean,  a  voyage 

h  was  undertaken  by  his  own  hrm  deter- 
mination ,  He  said  the  sea  always  did  him  good, 
,md  if  he  were  going  to  die  he  might  as  well  die 
there  as  anywhere  else.  He  returned  much  im- 
proved, went  to  Llandudno,  had  another  apoplectic 
seizure.,  and  died. 

Avtttt   Incompetency* — This  is    a  lesion   about 
which  there  have  been  very  varied  expressions  of 

ion.  My  own  belief  is  that  it  is  the  most 
serious  of  all  cardiac  valvular  lesions.  On  the 
other  hand,  Rosenstein,  in  Ziemssen's  "  Cyclo- 
paedia," says  .^-*'  The  prognosis  as  regards  the 
length  of  life  and  activity  of  the  patient  is  more 
favourable  in  aortic  insufficiency  than  in  any  other 
valvular  disease.  He  may  enjoy  years  of  un- 
disturbedly good  health,  as  long  as  the  increased 
force  of  the  left  ventricle  suffices  to  prevent  any 
stagnation  of  the  circulation.'*  I  published  a  case 
where   the   disease   lasted   more  than   thirty- five 

.  during  the  whole  of  which  time  the  man 
led  an  exceedingly  active  life,  and  for  at  least 
twenty  years,  as  a  School  Board  visitor,  he  walked 
fifteen  to   twenty  miles  or  more  daily.     In  this 

the  regurgitation  was  slight,  the  compen- 
sation good  without  much  hypertrophy,  and  he 
veiy  temperate  life.  The  prognosis  largely 
depends  on  the  extent  of  the  lesion.  If  the  re- 
gurgitation is  free  and  the  dilated  hypertrophy 
nerative  changes  and  cardiac  failure  set 
m  early .  For  this  reason  the  lesion  occurring  in 
the  very  young  is  certain  to  be  progressive,  and 
the  life  of  the  individual  comparatively  short. 
11  it  arise  from  an  attack  of  rheumatic  endocar- 

about  the  age  of  zo  to  25,  when  the  heart  has 

n«d  its  normal  development,  the  prognosis  is 
usually  good.  In  such  cases  the  lesion  is  not  pro- 
gressive, and  if  compensation  do  not  require  much 
hypertrophy,  the  patient  may,  with  ordinary  care, 
have  a  long  life.  The  coronary  arteries  escape 
and  the  aorta  retains  its  elasticity.  These  cases 
are  easily  separated  from  those  arising  from  de- 
generative changes  in  the  aorta  by  the  slight  but 
appreciable  delay  which  takes  place  in  the  trans- 

bft  of  the  pulse  wave;  hence  I  look  upon  this 
delay  as  a  favourable  omen.  Healthy  exercise  is 
essential  for  the  maintenance  of  healthy  tissues, 
and  every  patient  should  avoid  alcohol,  tobacco, 

<md  coffee.  When  incompetency  results 
from  degenerative  changes  in  the  aorta  the  re- 
gurgitation is  often  very  slight,  and  if  the  patient 
<:an  be  induced  to  lead  a  healthy  life  and  avoid  all 
gout-producing  agents  he  may  run  the  allotted 
span  of  life  ;  but  in  many  of  these  cases,  before 
^gurgitation  has  taken  place  and  before  advice  is 
sought,  the  coronary  arteries  may  be  involved  in 
the  degenerative  processes,  and  cardiac  failure  soon 
takes  place      When  compensation  fails,   the  left 

icle  gets  more  dilated  and  the  mitral  valve 

ota  incompetent*  and  you  get  much  dyspnoea 
and  cedema  of  the  lower  extremities,  the  end  is  not 
laroff.  This  is  the  disease  of  all  others  where  you 
get  sudden  death,  and  this  is  especially  apt  to 
occur  where  there  are  frequent  intermissions  in 
the  pulse.  There  may  have  been  no  previous 
evidence  of  any  failure  of  the  left  ventricle,  but 
arteries  are  involved  and  the  right 


side  of  the  heart  is  often  fatty;  under  any  strain 
requiring  increased  oxidation  it  suddenly  fails  and 
the  left  side  follows  suit, 

A  or  tic  Incompetency,  Mitral  Stenosis  t  and  Mitral 
Regurgitation* — This  combination  of  lesions  usually 
arises  from  rheumatic  endocarditis.  The  mitral 
stenosis  does  not  attain  to  any  great  degre* 
severity ;  the  prognosis  chiefly  depends  on  the 
aortic  lesion,  and  is  practically  always  grave* 

Angina  pectoris  is  generally  associated  with 
aortic  lesions.  There  are  many  cases  of  pseudo- 
angina,  but  in  a  true  case,  especially  where  the 
aorta  is  atheromatous,  dilated,  and  walls  thin,  as 
indicated  by  a  short,  clear,  ringing  second  so  and, 
the  patient  is  on  the  brink  of  a  precipice. 

Aortic  and  Mitral  Lesions  in  the  very  Aged.— tn 
people  from  70  to  So  years  of  age  or  over,  it  is 
remarkable  what  loud,  rasping,  aortic  systolic  and 
diastolic,  and  mitral  systolic  murmurs  are  often 
heard  without  causing  much,  if  any,  cardiac  dist- 
urbances. These  murmurs  are  due  to  calcareous 
deposits  in  the  valves,  but  the  muscular  structure 
is  healthy,  hence  the  freedom  from  symptoms, 
except  those  of  senility, 

Pulmonic  Obstruction. — This  lesion,  we  may 
say,  is  always  congenital  and  usually  associated 
with  imperfect  septum.  It  is  only  an  exceptional 
case  that  reaches  adult  life. 

Pulmonic  Incompetence.— -This  lesion  arises  from 
high  intra-pulmonary  pressure  due  to  mitral 
stenosis.  It  is  very  amenable  to  treatment;  the 
prognosis  is  that  of  the  mitral  lesion. 

Tricuspid  Incompetence. — This  is  nearly  always 
a  secondary  lesion,  due  to  cardiac  failure  from 
some  primary  disease  of  the  left  side  and  often 
marks  the  terminal  stage,  However,  it  is  not 
always  so,  and  if  the  muscular  structure  be  fairly 
healthy  it  is  very  amenable  to  treatment.  Some 
eight  months  ago  I  was  asked  to  sec  an  old  gentle* 
man,  the  father  of  an  eminent  surgeon,  who  was 
supposed  to  be  dying  from  heart  disease,  I  found 
extensive  arterial  degeneration,  aortic  and  mitral 
incompetency,  congestion,  and  cedema  of  both 
lungs,  very  free  tricuspid  incompetency  with  a 
tender,  pulsating,  huge  liver,  which  extended  much 
below  the  level  of  the  umbilicus.  He  recovered, 
and  is  now  fairly  well,  but  the  murmurs  are  there, 
and  the  liver,  though  much  reduced  in  size,  still 
gives  a  very  forcible  pulsation,  WThcn  the  in- 
competency is  due  to  acute  strain  from  over- 
exertion or  mountain  climbing,  the  prognosis  is,  as 
a  rule,  good,  if  the  patient  gets  over  the  immediate 
effects,  both  as  to  life  and  the  complete  recovery 
of  the  ventricle. 

Tricuspid  Stenosis. — This  is  frequently  con- 
genital, though  it  may  be  acquired  from  endo- 
carditis in  early  life,  and,  I  may  say,  is  always 
associated  with  mitral  stenosis.  It  is  always  less 
in  extent  than  the  mitral  lesion,  and  I  do  not  think 
adds  much  to  the  gravity  of  the  latter  affection. 
However,  certain  complications  more  readily  occur, 
such  as  pleural  effusion,  ascites,  pulmonary 
infarcts,  and  the  venous  sinuses  in  the  heart  are 
dilated,  At  present  I  know  a  child  a  few  months 
old  who  has  got  well-marked  tricuspid  and  mitral 
systolic  murmurs  ;  the  child  is  perfectly  well,  and 
the  murmurs  were  discovered  accidentally.  I 
daresay  that  the  case  will  eventually  end  in 
mitral  and  tricuspid  stenosis.  As  the  child  gets 
older  the  lesions  may  stunt  her  growth  and 
development  without  giving  rise  to  any  cardiac 
symptoms. 

Cardiac     hypertrophy      and      dilatation,      from 


198    The  Medical  Press.  ORIGINAL  COMMUNICATIONS. 


Feb.  24,  1904. 


whatever  cause  arising,  is,  sure  to  be  followed  by 
degeneration,  and  the  greater  the  hypertrophy  the 
•earlier  does  failure  take  place. 

Chronic  Myocarditis  and  Fatty  Degeneration  of 
Jhe  Heart. — The  diagnosis  of  these  conditions  is 
usually  very  difficult,  unless  the  affection  be  far 
advanced,  and  then  the  prognosis  is  correspond- 
ingly serious.  I  differ  from  many  writers  in 
thinking  that  the  right  side  of  the  heart  is  more 
frequently  affected  in  an  extreme  degree  than  the 
left,  and  it  is  very  fortunate  for  the  patients  when 
such  is  the  case.  At  post-mortems  I  have  often 
seen  the  right  ventricle  so  fatty  or  fibroid  that  it 
must  have  been  of  very  little  use  for  years,  and 
yet  the  patient  had  enjoyed  fair  health.  I  am 
inclined  to  think  that,  given  a  vigorous  left 
ventricle  and  an  active  respiratory  pump  one 
might  get  on  with  only  a  simple  reservoir  on  the 
right  side.  I*know  an  old  lady,  now  nearly  eighty 
years  of  age,  active  and  vigorous,  who  has  had 
evidence  of  chronic  myocarditis  affecting  chiefly 
the  right  side  of  the  heart,  such  as  arterio-sclerosis, 
irregular  action  of  the  heart,  short,  dull,  right  first 
sound,  frequent  doubling  of  first  sound,  and 
irregular  pulse,  for  more  than  twenty  years.  Her 
mental  energy  often  makes  her  undertake  more 
work  than  she  is  capable  of  performing,  and  then 
she  gets  knocked  over,  has  a  bilious  attack,  &c, 
but  with  rest  quickly  recovers. 


A  STRANGE  RESULT 

OF 

IODOFORM    DRESSING,   {a) 

By  H.  MACNAUGHTON-JONES,  M.D.,  &c. 

The  local  toxic  effects  of  iodoform  occasionally 
result  in  cutaneous  conditions  which  are  more  or 
less  serious,  according  to  the  extent  of  their  in- 
vasion of  the  skin  and  their  spread  to  other  parts. 
The  more  common,  which  I  have  frequently  seen, 
are  general  redness  and  swelling  of  the  skin  of  the 
abdomen  and  down  the  thighs,  sometimes  extend- 
ing from  the  trunk  to  the  upper  extremities,  the 
eruption  being  very  similar  to  that  of  scarlet 
fever.  In  several  cases  it  was  associated  with  a 
fine  vesicular  eruption,  principally  affecting  the 
region  of  the  wound.  Other  observers  have  had 
cases  in  which  the  vesiculation  has  extended  into 
the  deeper  layers  of  the  skin,  resulting  in  consider- 
able oedema,  and,  in  some  instances,  in  a  sanguino- 
lent  effusion  resembling  superficial  gangrene,  (b) 

A  patient,  aet.  30,  on  whom  I  recently  operated 
for  retroversion  of  the  uterus  by  ventro-suspension, 
at  the  same  time  resecting  an  ovary,  was  pro- 
gressing favourably  until  the  third  day  after  the 
operation.  She  then  complained  of  irritation, 
and  some  smarting  in  the  neighbourhood  of  the 
wound,  which  had  been  stitched  with  celloidin- 
zwirn,  a  pad  of  moist  sterilised  10  per  cent,  iodo- 
form gauze  being  placed  over  it,  and  covered  with 
coeletin.  On  raising  the  dressing,  the  nurse 
found  some  slight  swelling  and  redness  along  the 
area  of  the  incision.  On  the  following  day, 
when  1  examined  the  wound,  the  redness  had 
extended  to  a  considerable  area,  and  the  entire 
surface  of  the  skin  for  a  few  inches  at  either  side 
was  vesicated.     Attributing  the  condition  to  the 

(a)  Read  at  a  meeting-  of  the  British  Gynecological  Society, 
February  11th,  1904. 

(6)  "  Reference  Book  of  Practical  Therapeutics."  By  E.  P.  Foster. 
Page  839,  Vol.  I„  IS 97.     " Taylors  Jurisprudence,"  p.  427,  Vol.  I. 


iodoform,  I  had  this  removed,  and  the  wound  . 
lightly  sponged  over  with  some  weak  formalin  i 
solution,  dried,  and  dusted  with  dermatol  (the 
subgailate  of  bismuth),  covered  with  plain  ' 
sterilised  gauze  and  protected  with  coeletin. 
The  distress  continued,  and  on  removing  the  ' 
dressing  the  next  day  I  found  several  large 
vesicles,  like  those  raised  from  an  ordinary  blister. 
One  or  two  had  burst,  and  the  others  were  opened, 
and  a  quantity  of  serous  fluid  evacuated.  There 
now  appeared  on  the  arms  and  hands  some 
eczematous  vesicles,  and  also  a  papillary  eruption 
here  and  there,  which  was  attended  by  great 
irritation.  Much  the  same  condition  followed  on 
the  legs.  The  palms  of  the  hands  became  red, 
and  finally  desquamated.  Some  three  days  later 
fresh  vesicles  appeared  in  the  neighbourhood  of 
the  wound.  There  were  no  constitutional 
symptoms,  and  the  range  shows  that  there  was 
but  slight  elevation  of  temperature  on  a  few 
occasions,  while  the  pulse  remained  normal. 
The  skin  healed  by  first  intention,  the  suture  being 
removed  on  the  eleventh  day. 

Inquiring  into  the  history  of  the  case,  it  appeared 
that  many  years  previously  the  patient  had  had 
an  ulcer  on  the  leg.  This  had  been  dressed  with 
iodoform,  when  much  the  same  effects  had  followed, 
the  leg  becoming  cedematous,  and  a  slough,  ex- 
tending some  distance  up,  leaving  an  extensive 
cicatrix.  The  effects  of  the  dressing  were  not 
discovered  until  after  the  toxic  consequences  had 
resulted.  From  her  childhood  she  had  suffered 
from  an  eczematous  tendency,  and  there  were 
symmetrical  palmar  patches  of  dry  eczematous 
desquamation  of  long  standing  on  the  hands. 

She  left  the  Home  perfectly  well  at  the  end  of 
the  fourth  week,  with  only  some  remains  of  the 
eczematous  condition  in  parts. 

I  have  not  seen  the  record  of  any  case  exactly 
similar  to  this,  which  is  peculiar  in  the  large 
blebs,  somewhat  like  those  of  pemphigus,  that 
appeared  in  the  neighbourhood  of  the  incision. 
One  cannot  help  pondering  on  the  consequences 
which  would  have  followed  in  such  a  case  had 
vaginal  hysterectomy  been  performed,  and  the 
vagina  tamponed  with  iodoform.  I  had  the 
wound  photographed  when  the  vesiculation  was 
at  its  height,  but  unfortunately,  owing  to  the 
defective  light,  the  photograph  was  not  successful. 
One  thing  is  clear — it  is  worth  while  inquiring,  in 
any  abdominal  or  pelvic  operation  in  which 
iodoform  is  likely  to  be  used,  whether  the  patient 
has  been  subject  to  any  cutaneous  affection,  and 
if  so,  to  substitute  another  dressing  for  that  of 
iodoform. 


NOTE  ON  ONE  OF  THE  CAUSES  OF 

BLADDER    IRRITATION    IN 
GIRLS,  (a) 

By  W.  DUNNETT  SPANTON,  F.R.C.S.,  &c, 
Surgeon  to  the  North  Staffordshire  Infirmary. 

Every  surgeon  must  have  sometimes  met  with 
obscure  cases  of  bladder  irritation  or  cystitis  in 
little  girls,  in  which  it  has  been  difficult  to  assign 
a  cause.  Some  instances  have  occurred  in  my 
practice  which  will  tend  to  throw  light  on  this 
subject,  and  are,  therefore,  I  think,  worth  record- 
ing  

(a)  Read  at  a  meeting  of  the   British   Oynaoologieal  Society, 
February  11th,  1904. 


Fkb.    a*   "^^ 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Pi  ess.    IQQ 


When  a  child  is  brought  to  the  surgeon  com- 
plaining  oi  pain  in  the  vesical  region,  frequent 
micturition  and  urethral  irritation,  the  urine 
cloudy,  perhaps  containing  a  small  quantity  of 
blood  and  mucus,  or  muco~pus,  without  any 
constitutional  disturbance,  one  generally  would 
^scribe  it  to  one  of  the  following  conditions  : — 

Diabetes,  azoturia,  calculus  or  other  foreign 
body  in  the  bladder,  or  urethra,  or  kidney,  or 
possibly  tubercle  or  malignant  growth*  The  two 
last  are  rare  and  improbable. 

Of  course,  the  first  thing  to  be  done  is  to  examine 
the  condition  of  the  urethra,  and  alter  examining 
the  urine,  to  explore  the  bladder.  The  urethra 
may  show  signs  of  urethritis,  but  insufficient  to 
account  for  all  the  symptoms  ;  the  examination 
ct  the  urine  may  indicate  an  excessive  amount  of 
uric  acid,  sugar,  mucus,  pus,  blood,  and  possibly 
sach  irritating  substances  as  oxalate  of  lime  or 
triple  phosphates. 

If  either  oxaluria  or  azoturia  exist,  simple 
remedies  will  soon  suffice  to  remove  the  irritation, 
but  the  presence  of  any  inflammatory  products 
will  render  this  less  likely.  Then  it  will  probably 
be  fond  that  the  orifice  of  the  urethra  is  sore  and 
tender,  and  there  may  be  discovered  a  tiny 
caruncle — and  these  will  have  to  be  eliminated 
tram  consideration.  We  then  explore  the  bladder 
and  find  nothing  ;  when  the  puzzle  as  to  the  cause 
ins  unsolved. 

It  is  in  such  a  case  as  this  I  found  the  wisdom 
of  going  more  minutely  into  the  question.  And 
I  will  give  a  short  account  of  three  little  patients 
in  whom  the  same  condition  was  found  to  exist, 
which  will  serve  as  an  illustration  :■ — 

The  first  was  a  bright,  healthy  little  girl  about 
three  years  of  age,  who  cried  in  micturition, 
which  became  very  frequent,  only  small  quantities 
of  urine  being  passed  each  time.  I  found  the 
urethral  orifice  tender  and  sore,  and  thinking 
this  might  be  the  sole  cause  of  the  trouble,  pre- 
scribed some  soothing  application  and  gentle 
aperient  simply.  The  urine  was  examined  and 
I  free  from  sugar  and  abnormal  elements, 
but  contained  a  little  mucus,  and  a  few  blood 
cj>qni&cles.  The  symptoms  continued  the  same, 
so  1  passed  a  sound  into  the  bladder  under  chloro- 
form, suspecting  there  might  be  a  calculus  or 
same  other  foreign  body.  This  revealed  nothing  ; 
but  the  urine  which  was  next  passed  being  exa- 
mined, we  found  in  it  a  shreddy-looking  mass, 
with  mucous  cells,  a  few  blood  corpuscles,  and 
mixed  phosphates  and  urate  of  soda.  Under  the 
microscope  the  fluffy  mass  was  shown  to  consist 
of  an  aggregation  of  woollen  fibres  entangled  in 
mucus,  and  there  were  other  woollen  fibres  also 
tound  free.  Beyond  a  few  blood  corpuscles, 
crystals  of  mixed  phosphates  and  amorphous 
urate  of  soda,  nothing  unusual  was  seen. 

The  next  point  was  to  discover  how  this  irri- 
tating material  had  found  its  way  into  the  bladder* 
I  examined  the  child's  under- garments,  which  con- 
sisted of  thick  woollen  combinations,  rather  rough 
at  the  edges.  The  woollen  fibres  of  these  garments 
were  carefully  examined.  I  then  came  to  the 
conclusion  that,  as  the  woollen  fibres  found  in 
urine  exactly  corresponded  to  those  in  the 
new  set  of  "  combinations  "  the  child  had  been 
wearing,  that  the  woollen  material  had  chafed  the 
urethra,  some  of  the  fibres  had  wormed  themselves 
along  it  into  the  bladder,  and  so  set  up  the 
imtation.  When  we  remember  the  peculiar 
barbed  edges  of  woollen  fibres,  it  is  quite  easy  to 


understand  how  they  would  travel  up  the  urethra 
in  the  same  way  as  an  ear  oJ  grass  or  barley  does  ; 
and  this  also  explains  why  the  smooth  fibres  of 
flax  or  linen  fail  to  do  so.  The  garment  was 
changed  for  a  cashmere  one,  diluents  were  given 
freely  to  wash  out  the  bladder,  and  in  a  few  days 
every  symptom  had  disappeared,  and  there  has 
never  been  any  since  that  time.  I  imagine  that 
the  sounding  dislodged  some  of  the  woollen  fibres, 
and  as  no  more  entered  the  bladder,  this  led  to 
cure, 

The  next  case  was  an  older  sister  of  the  first, 
a-t,  about  six,  The  symptoms  in  this  child  began 
in  precisely  the  same  manner.  The  urine  on 
examination  was  found  to  contain  woollen  fib  res  > 
as  in  her  sister's  case,  along  with  some  mucus, 
and  was  of  high  specific  gravity.  The  mother 
described  it  as  containing  M  a  long  filmy  substance/' 
which  proved  to  be  wool  fibres  held  together  by 
bladder  mucus.  I  did  not,  in  the  fight  of  the 
former  case,  think  it  necessary  to  pass  any  instru- 
ment ;  but  merely  changed  the  under-clothing, 
gave  Contrexeville  water  freely,  and  very  soon 
every  symptom  disappeared — never  to  return, 

Some  time  afterwards,  in  iqoi,  another  instance 
presenting  similar  features  came  under  my  notice. 
A  merry  little  girl,  set.  about  five,  was  observed 
to  show  signs  of  irritation  about  the  bladder, 
with  frequent  micturition  and  complaints  of 
pain.  There  was  no  incontinence  nor  retention, 
I  found  her  apparently  in  perfect  general  health* 
The  symptoms  were  precisely  similar  to  the 
former  ones,  but  the  urine  was  found  over- 
loaded with  uric  acid  and  urates,  as  well  as  con- 
taining the  minute  woollen  threads.  The  note  of 
urine  examination  was  as  follows  : — Sp.  gr«  1030, 
no  albumin  nor  sugar,  uric  acid  and  oxalate  of 
lime  crystals,  mucus  and  aggregations  of  fine 
woollen  fibres. 

The  first  thing  to  be  done  was  to  lessen  the 
amount  of  nitrogenous  food,  to  exchange  the 
woollen  garments  next  the  skin  for  silk,  and  then 
give  Contrexeville  water  freely.  The  child 
speedily  got  well,  as  in  the  former  cases,  and  has 
had  no  trouble  since, 

It  is  often  such  little  matters  as  these  which, 
being  overlooked,  lead  to  the  discredit  of  the 
surgeon,  and  it  behoves  the  younger  practitioner 
especially  to  bear  in  mind  that  such  trivial  causes 
may  readily  simulate  more  grave  ones.  They 
may  then  lead  to  a  persistence  of  symptoms 
which,  if  unrelieved,  may  lay  the  foundation  for 
gravel,  for  intractable  cystitis,  or  possibly  form, 
in  a  tuberculous  subject,  a  focus  for  tubercle  to 
attack — or,  in  other  instances,  a  nucleus  for 
stone.  In  fact,  if  we  adopt  Reginald  Harrison's 
theory  oi  the  formation  of  calculi,  it  seems  highly 
probable  that  threads  entangled  in  the  mucus  of 
the  bladder  would  readily  lend  themselves  to 
such  an  evil  purpose. 

I  daresay  the  same  observations  have  been 
made  by  other  surgeons,  but  no  mention  of  them 
has  ever  come  under  my  notice,  and  1  have 
looked  for  them  in  the  text-books  in  vain. 


Trinity  College,  Dublin. 
The  following  passed  the  Final  in  Medicine  at  the 
Hilary  Term.  1004  :— Herbert  St.  M,  Carter,  Arthur 
VV\  Goldsmith.  Wright  Mitchell  Owen  J.  Parry- 
Edwards.  Henrv  M.  Crawford.  John  C.  Hail  Wilfrid 
Thunder,  William  J.  M'lver,  and  David  C.  Pearson. 
M.B.— Robert  Moore. 


200    The  Medical  Press.  ORIGINAL  COMMUNICATIONS. 


RUPTURE  OF  A  TUBAL 
PREGNANCY 

ON  THE  NINETEENTH  DAY   AFTER   CON- 
CEPTION, AND  TEN   DAYS   AFTER  THE 
UTERUS  HAD  BEEN  CURETTED,  (a) 
By  WILLIAM  DUNCAN,  M.D.,  F.R.C.S., 

Obstetric  Phymcian  to  the  Middlesex  Hospital. 

Mrs.  H!,aet.  27,  was  married  in  1900.     She  con- 
sulted   me    in    October,    190 1,    for   menorrhagia. 
The  periods,  which  commenced  at  the  age  of  12, 
were  quite  regular  (lasting  four  days)  until  the 
early  part  of  190 1  (some  months  after  marriage), 
when  they  began  to  increase  in  amount,  with  pain, 
the  passage  of  clots,  and  a  muco -purulent  inter- 
menstrual discharge.     The  patient  was  a  healthy- 
looking   but  pale  young  lady  of  very  active  tem- 
perament. On  examination,  the  uterus  felt  a  little 
enlarged,  was  somewhat  tender  on  palpation,  was 
freely  mobile  and  in  normal  position.     Nothing 
abnormal  could  be  felt  in  either  the  lateral  or 
posterior  fornices.     Per  speculum,  the  os  uteri  was 
eroded   and   some   purulent   discharge   was   seen 
exuding    from    it.     I    diagnosed    fungous    endo- 
metritis, and  recommended  that  the  uterus  should 
be  curetted.     The  patient  went   into  a  nursing 
home  arid,  under  anaesthesia,  I  dilated  the  cervix 
uteri  up  to  No.  14  Hegar,  and  scraped  away  a  very 
hypertrophied    endometrium.     The  uterus,    after 
having  been  swabbed  out  with  liquor,  iodi,  was 
packed  with  iodoform  gauze  for  forty-eight  hours. 
At  the  end  of  that  time  the  gauze  was  removed, 
and  a  vaginal  douche  of  1   in  4,000  solution  of 
perchloride  of  mercury  was  ordered  to  be  given 
night  and  morning  whilst  the  patient  remained  in 
the  home.  (This  is  my  usual  method  of  treatment 
after  curetting  the  uterus.)    The  patient  made  a 
perfectly  uneventful  recovery,  and  returned  home 
well  at  the  end  of  three  weeks.     I  saw  nothing 
more  of  her  until  the  beginning  of  last  November 
(1903),  when  she  again  consulted  me  for  a  re- 
currence of  the  menorrhagia.     She  then  informed 
me  that  she  had  had  a  miscarriage  at  the  third 
month,  at  Christmas,   1902,  and   that  since   that 
time  the  periods  have  been  excessive    and  with 
clots.     Since  the  miscarriage  she  has  never  missed  a 
period.     On  examination,  I  found  a  similar  con- 
dition of  things  to  that  present  when  she  con- 
sulted me  in  1901,  except,  perhaps,  that  the  uterus 
was  somewhat  more  bulky  than  on  the  former 
occasion,   but   nothing   whatever   abnormal   was 
found  in  either  fornix.     As  the  next  period  was 
due  in  a  few  days  it  was  decided  that  the  curettage 
(which  I  again  advised)  should  be  deferred  until  a 
couple  of  days  after  the  period  had  ceased.     Ac- 
cordingly, when  this  occurred,  on  November  14th, 
after  a  week's  loss,  I  went  down  to  the  patient's 
home  on  November  16th,  and,  with  the  assistance 
of  Dr.  Gordon  Hogg,  of  Ealing  (under  whose  care 
the  patient  had  placed  herself,  and  to  whose  skill 
and    unremitting   attention    the    favourable    ter- 
mination of  this  most  interesting  case  is  largely 
due),  I  again  curetted  the  uterus,  removing,  as  on 
the  former  occasion,  a  very  hypertrophied  endo- 
metrium, but  one  which  did  not  in  the  least  raise 
in  my  mind  the  suspicion  of  its  being  a  decidual 
lining.     The   patient  progressed  uninterruptedly 
well,  having  neither  pain  nor  rise  of  temperature, 
until  November  25th,  when  rupture  took  place. 
At  9  p.m.  that  evening,  Dr.  Gordon  Hogg  rang 

(a)  Re»d  at  a  meeting  of  the  British  Gynecological  Society    on 
February  11th,  1904. 


Feb.  24.  1904. 


me  up  on  the  telephone  and  asked  me  to  go  down 
and  see  the  patient  as  she  was  bad.     He  told  me 
that  he  paid  his  usual  visit  about  2  p.m.  that  after- 
noon, when   the  patient  was,  apparently,  quite 
well,  laughing  and  joking,  and  saying  she  would 
get  up  next  day.     On  returning  home  from  his 
round  of  professional  visits  at  7  p.m.,  he  found  a 
letter  from  the  nurse  asking  him  to  send  something 
to  relieve   the  patient,  who  was  complaining  #f 
pain    at     the    chest     and    indigestion.     Almost 
directly  after  reading  the  letter  he  received  an 
urgent  message  asking  him  to  go  at  once  and  see 
our  patient.     This  he  did,  and  on  arrival  he  found 
her  collapsed,  pulseless,  semi-conscious,  and  tossing 
about  in  bed,  with  gasping  respiration.     He  at 
once  injected  strychnine  hypodermically,  and  put 
hot  bottles  to  the  extremities  in  order  to  remedy 
the   collapsed   condition.     As   the  patient's  con- 
dition continued  serious  he,  as  I  have  mentioned, 
summoned  me.    On  my  arrival,  soon  after  10  p.m., 
I  found  the  patient  practically  moribund,  pulseless, 
blanched  lips  and  gums  very  pale,  and  extremities 
cold.     On  palpating  the  abdomen,  I  found  dulness 
in  both  flanks  and  over  the  hypogastrium.     I  also 
thought  there  was  diminished  resonance  over  the 
liver.     It  was  evident   that   there   was   internal 
rupture  of  something,  with  haemorrhage,  also  that 
abdominal    section,    unless    associated    with,  or 
preceded  by,  transfusion,  would  be  certainly  fatal. 
Not  having  the  necessary  apparatus  and  instru- 
ments with   me,   I   at   once    telephoned    to  my 
colleague,   Mr.   Pearce   Gould,   and,   fortunately, 
found  him  at  home,  and  got  him  to  come  out  at 
once.     Whilst  waiting  his  arrival  we  prepared  in 
readiness    the    operating    table,    also    plenty  of 
sterilised  water.     Mr.   Gould   arrived  soon  after 
midnight. '  The  patient  was  at  once  placed  on 
the  table  and  skilfully  put  under  the  influence  of 
ether   by    Dr.    Robert    Pitcairn   Cockburn.    Mr. 
Gould  first  started  the  infusion  of  saline  fluid  into 
the  left  submammary  cellular  tissue,  and  handed 
the  care  of  this  over  to  Dr  Gordon  Hogg,  whilst 
he  opened  the  left  cephalic  vein  and  performed 
intravenous    transfusion    (also    of    saline  fluid). 
Immediately    this    transfusion    was    thoroughly 
started,  I  rapidly  opened  the  abdomen,  which  was 
found  full  of  liquid  blood  with  some  clots.    The 
right  uterine  appendage  was  brought  into  view  and 
proved  to  be  normal,  but  when  the  left  was  drawn 
out  there  was  seen  to  be  a  small,  round  perforation 
of  the  somewhat  thickened  tube  near  its  uterine 
end  (specimen  shown).     The  broad  ligament  was 
quickly  transfixed  and  tied  with  silk  in  the  usual 
way,  and  tube  and  ovary  removed.     Most  of  the 
blood  was  sponged  out  of  the  abdominal  cavity, 
which  latter  was  also  flushed  with  a  lot  of  sterilised 
water,  some  of  which  was  left  inside.     The  abdo- 
minal wall  was  sewn  up  in  three  layers.     Whilst 
this  operation  was  proceeding,  nearly  two  quarts  of 
saline  fluid  had  been  injected  (submammary  and 
intravenous).     After  the  operation,  which  lasted 
from  twenty  to  thirty  minutes,  the  patient  was 
returned  to  bed,  still  in  an  extremely  dangerous 
condition,  although  the  pulse  was  faintly  percep- 
tible  at   the   wrist.     Hot   bottles   were  applied, 
strychnine  injected  hypodermically,  and  an  enema 
of  brandy  and  beef-tea  administered  per  rectum. 
When  Mr.  Gould  and  I  left  we  could  only  give  the 
relatives  slight  hope.     Everything,  of  course,  de- 
pended on  whether  the  patient  could  be  kept  alive 
for  the  next  few  hours.     We  left  her  in  Dr.  Gordon 
Hogg's  care,  and  the  ultimate  successful  issue  is 
greatly  due  to  his  unremitting  attention. 


Fb&.  24.  1904- 


ORIGINAL   COMMUNICATIONS,        The  Medical  Fa^ 


201 


1 


At  aboii I  9  a.m.  Dr.  Hogg  telephoned  the  wel- 
come news  that  the  patient  was  alive  and  con- 
scious, that  her  pulse  was  better,  her  temperature 
normal,  and  she  was  able  to  take  nourishment. 
The  subsequent  history  can  be  related  in  a  few 
words.  The  patient  made  an  uneventful  recovery, 
and  is  now  ;  January  30th,  1904 '  quite  well  and 
getting  about  as  usual. 

Remarks. 
This  very  interesting  case  presents  several  points 
for  consideration  : — 

1,  The  Duration  of  Pregnancy  before  Rupture  took 
place. — This  can  be  accurately  stated  to  be  the 
nineteenth  day,  as  after  her  recovery  I  went  to 
see  the  patient  in  order  to  make  sure  oi  the  date. 
She  informed  me  that  coitus  took  place  on  the 
Friday  before  her  period  commenced,  namely, 
November  6th,  and  not  for  some  time  previous  to 
then.  Before  questioning  the  patient  I  expected 
to  hear  that  coitus  had  occurred  on  either  of  the 
two  days  which  intervened  between  the  cessation 
el  the  period  and  the  curettage.  This  would  have 
pven  eleven  or  twelve  days  before  rupture. 
However r  the  patient  was  very  positive  that  no 
nut  us  had  taken  place  on  either  of  those  dates. 
As  far  as  I  can  ascertain,  there  is  only  one  other 
case  recorded  in  which  rupture  of  a  tubal  gestation 
took  place  as  early  as  the  nineteenth  day.  That  is 
ported  by  Mr,  RumJey  Dawson  in  the  Ob- 
stetrical M  Transactions  "  for  the  year  1 898.  (Vol.  40,  \ 

j ,)     In  that  case  the  rupture,  which  was  near 
the  uterine  end  of  the  tube,  is  said  to  have  occurred  , 
on  the  fifteenth  day      T he  patie nt  w as  a  m u  1  tipara , 
and  had  not  missed  a  period.    Internal  ha?mor-  , 
rhage  was  diagnosed,  but  no  operation  was  per-  ! 

■d,  and  the  ruptured  tubal  gestation  was  only  I 
discovered  post-mortem. 

A$  regards  Diagnosis.— When  I  first  saw  the  I 
tient  there  can  be  no  question  but  that  she  was  f 
rig  from  fungous  endometritis,  and  although  : 
l  tubal  gestation  was  present  when  J  curetted  the 
uterus,  seeing  that  it  was  only  nine  days  oldf  and  ' 
that  the  history  was  totally  against  pregnancy,  I  ' 
think  it  will  be  considered  excusable  my  having 
tailed  to  detect  the  slight  enlargement  of  the  left 
Fallopian  tube,  which  must  have  been   present  j 
when   I  examined  the  patient  under  anaesthesia 
before  proceeding  to  curette  the  uterus.     The  more  ' 
I  see  of  cases  of  extra-uterine  pregnancy,  both  in 
hospital  and  private  practice,  the  less  value  do  I 
know  can  be  placed  on  the  history  of  a  patient 
having  missed  one  or  two  periods.      In  many  of 
these  cases  no  such  history  can  be  obtained  by 
most  careful  questioning. 
3,  When    the    Rupture    took    place.— When  Dr.  ( 
Gordon  Hogg  rang  mc  upon  the  telephone  I  confess 
1  did  not  attach  as  much  importance  as  I  ought  to  \ 
have  done  to  his  statement  that  the    patient,    a  ! 
after  he  had  seen  her  perfectly  well,  was  ' 
collapsed    and    pulseless.     I    could    not    imagine 
anything  having  gone  wrong  with  the  pelvic  organs  | 
to*  days  after  curetting  the  uterus.     However,  on 
ray  arrival  at  the  house  and  seeing  the  patient 
blanched  'she  was  naturally  pale),  pulseless,  and 
fading  dulncss  in  the  flanks  and  over  the  abdomen, 
it  was  at  once  obvious  that  rupture  of  something  j 
bad  taken  place  with  extensive  haemorrhage,  which  ' 
wetild  ere  long  prove  fatal  unless  operated  upon. 
It  seemed  to  me  that  the  diagnosis  lay  between  1 

pture  of  a  tubal  gestation,  and  (b)  perforation 

astric  ulcer  with  profuse  bleeding.    I  leaned  to 
the  gastric  ulcer  view,  as  not  only  was  the  history  j 
»mpletely  against  tubal  pregnancy,  but  also  I ' 


could  not  imagine  myself  failing  to  detect  an  en- 
larged tube  j  the  fact  also  that  on  the  afternoon  of 
the  accident  the  patient  complained  of  indigestion 
and  pain  at  the  epigastrium  helped  to  obscure  the 
diagnosis, 

4.  Whatever  the  cause  of  the  condition  was  it 
was  perfectly  certain  that  the  abdomen  must  "be 
opened,  as  no  one  suffering  from  rupture  of  any 
internal  organ  with  severe  haemorrhage  should  be 
allowed  to  die  without  an  exploratory  operation 
having  been  performed.  In  this  case  the  patient 
was  too  bad  to  subject  her  to  a  severe  operation 
without  first  (or,  at  any  rate,  simultaneously) 
transfusing  her,  and  as  I  had  not  taken  my  trans- 
fusion apparatus  with  me,  it  was  indeed  fortunate 
to  be  within  telephonic  reach  of  skilled  help  and 
all  the  necessary  instruments.  This  case  teaches 
the  lesson  to  always  cany-  one's  transfusion  appa- 
ratus. 

Lastly.— With  regard  to  the  parts  removed,  it 
will  be  seen  from  the  specimen  that  the  thickening 
of  the  Fallopian  tube  was  comparatively  slight, 
limited  to  the  uterine  half  of  the  tube,  and  that 
the  rupture  took  place  near  the  uterus. 

My  friend,  Dr.  Victor  Bonney  (Obstetric  Regis- 
trar and  Tutor  at  the  Middlesex  Hospital),  has 
made  some  excellent  microscopical  sections  across 
the  gestation  sac,  and  a  beautiful  drawing  of  one 
of  these  is  given.  The  section  and  the  drawing 
made  from  it,  which  you  see  thrown  on  the  screen 
with  the  epidiascope,  very  clearly  show  the 
gestation  sac  to  be  altogether  away  from  the 
lumen  of  the  Fallopian  tube,  and  proves  that  what 
ns  when  a  tubal  gestation  occurs  is  this  :— 
"The  minute  embryo  burrows  through  the  epi- 
thehal  lining  of  the  tube  into  the  muscular  coat, 
where  it  develops,  whilst  the  opening  into  the  tube 
itself  closes  up  again/* 

Pathological  Report  by  Dr.  Victor  Bonney, 
The  specimen  consisted  of  a  Fallopian  tube  and 
Attached  ovary,  The  tube  appeared  normal  to  the 
naked  eye,  except  at  the  junction  of  the  isthmic  and 
ampullary  portions.  Here  was  situated  a  small, 
hollow  enlargement  communicating  with  the  outside 
by  means  of  a  clearly  punched  hole  through  which  a 
small  pencil  might  he  passed.  The  cavitv  was  prin- 
cipally in  the  tube  wall,  its  outer  wail  being  formed 
o!  thinly  stretched  tubal  peritoneum,  whilst  its  inner 
boundary  was  evidently  in  close  connection  with  the 
tubal  lumen,  though  whether  it  communicated  with  it 
was  impossible  to  determine  without  cutting  trans- 
versely across  the  lube  at  this  point.  On  a  transverse 
section  being  made  across  the  tube  on  the  uterine  side 
of  the  punched -out  aperture  it  was  seen  that  the  cavity 
was  situated  in  the  wall  of  the  tube,  and  did  not 
communicate  with  the  tubal  lumen  at  any  point.  Its 
outer  wall  was  very  thin,  consisting  practicalh  of 
peritoneum  only,  hut  that  towards  the  hi  men  ot  the 
tube  was  thicker,  and  contained  muscle  elements. 
The  course  of  the  lumen  of  the  tube  was  marked  in  the 
inner  wall  of  the  cavity  as  a  curved  elevated  ridge, 
much  in  the  same  way  as  the  course  of  the  acqueductus 
Fallopii  is  indicated  on  the  inner  and  posterior  walls 
of  the  tympanic  cavity  when  the  middle  ear  is  opened 
up    for   dissection.     The    cavity    contained    clot    and 

ions  of  chorionic  villi. 
Microscopically,  the  following  appearances  were 
found: — A  considerable  section  of  the  tuU-  ami  its 
contained  gestation  sac  was  removed,  and  the  con- 
tinuity of  the  specimen  restored  by  sutures.  This 
section  was  then  prepared  and  cut  m  serial  sections 
to  the  number  ot  about  150.  The  appearances  of  in- 
dividual sections  were  practically  the  same.  The 
tubal  lumen  appeared  intact,  and  was  separated  from 
the  gestation  sac  by  a  well-marked  muscular  layer 
(capsularis)    of    considerable     thickness.     The    phc^ 


202    The  Medical  Press. 


SPECIAL   ARTICLES. 


Feb.  24,  1904. 


appeared  perfect,  as  was  also  the  case  with  the  columnar 
epithelium  covering  them.  The  tube  was  empty.  The 
gestation  sac  is  situated  in  the  outer  part  of  the  tube 
wall.  It  contained  well-marked  chorionic  villi,  with 
a  distinct  epithelium  consisting  of  the  two  layers 
known  as  Langhans  and  syncytial  respectively.  In 
many  parts,  however,  a  much  greater  thickness  of 
the  syncytial  layer  was  observable,  and  in  those  parts 
of  the  section  where  the  villus  was  applied  to  the  wall 
of  the  gestation  sac  these  proliferating  syncytial 
masses  could  be  seen  infiltrating  the  sac  wall.  The 
sac  wall  contained  many  spaces  containing  blood,  part 
of  which  appeared  to  be  surrounded  by  cells  of  em- 
bryonic origin.  Many  large  cells  resembling  decidual 
cells  were  seen  in  the  sac  wall,  but  these  were  continuous 
with  masses  of  syncytium,  and  in  all  probability  they 
were  of  embryonic  and  not  of  maternal  origin.  There 
was,  therefore,  an  absence  of  any  structures  which 
could  be  described  as  "  decidual,"  and  it  is  probable 
that  such  cells  are  strictly  the  derivative  of  the  stroma 
cells  of  the  endometrium,  and  therefore  do  not  occur 
when  the  ovum  is  situated  in  the  midst  of  muscular 
tissue  as,  in  the  absence  of  a  subepithelial  stroma,  it 
appears  to  be  in  tubal  gestation.  To  the  absence  of 
decidual  cells  is  probably  to  be  ascribed  the  rapidity 
with  which  a  tubal  gestation  erodes  the  walls  of  the 
gestation  sac  and  brings  about  early  rupture.  The 
specimen  is  of  great  interest,  bearing  out,  as  it  does, 
the  views  put  forward  by  all  the  modern  German  au- 
thorities, and  lately  epitomised  in  England  by  Dr. 
Russell  Andrews,  that  in  all  cases  the  implantation  of 
the  tubal  gestation  is  primarily  in  the  muscular  wall 
of  the  tube,  and  not,  as  was  formerly  supposed,  in 
the  surface  of  the  tubal  epithelium,  and  therefore  within 
the  tubal  lumen. 


Clinical  Kecotfts* 


NOTE    ON    A   CYST     SIMULATING     FEMORAL 
HERNIA,  (a) 
By  HERBERT  SNOW,  M.D.Lond.,  Ac, 
Senior  8urgeon,  Cancer  Hospital. 

Mrs.  L.  S.,  aet.  69,  widow,  a  rather  flabby,  elderly 
woman,  consulted  me  on  December  10th  last.  She  had 
worn  a  femoral  truss  on  the  left  side  for  seven  years, 
and  now  had  on  the  right  groin  a  globular  elastic 
swelling  of  between  three  and  four  years'  duration.  It 
was  of  the  size  of  a  pigeon's  egg,  could  not  be  reduced 
or  diminished  in  bulk  by  pressure,  and  gave  some  im- 
pulse on  coughing.  She  had  never  worn  any  truss  for 
this.  On  removal  of  the  left  truss,  a  similar  swelling 
became  apparent,  also  with  a  certain  degree  of  impulse 
on  coughing.  On  pressure  this  diminished  considerably 
in  apparent  size,  though  it  did  not  wholly  disappear. 
She  considered  that  the  truss  had  given  her  great  relief. 

An  operation  was  advised.  Upon  incision  it  became 
apparent  that  the  right  tumour  was  a  cyst  containing 
about  an  ounce  of  clear,  straw-coloured  fluid,  and  with 
a  narrow  pedicle  issuing  from  the  femoral  canal  below 
Poupart's  ligament  in  the  usual  site  of  femoral  hernia. 
It  contained  nothing  but  this  liquid.  The  wall  re- 
sembled thickened  peritoneum.  It  was  slit  up,  and 
the  interior  carefully  inspected.  No  aperture  in  the 
pedicle  could  be  detected,  and  attempts  to  pass  a 
probe  failed.  The  cyst  was  excised  and  the  pedicle 
ligatured.     The  woman  made  an  uneventful  recovery. 

The  left  tumour  was  not  interfered  with,  as  no  per- 
mission had  been  obtained  to  attack  it.  and  the  woman 
was  quite  satisfied  with  her  truss.  There  can  be  no 
doubt  that  the  condition  was  exactly  identical.  The 
impulse  on  coughing  was  found  to  disappear  when  the 
cyst  was  lifted  up  from  its  pedicle. 

The  right  femoral  cyst  excised  was  evidently  a  peri- 
toneal diverticulum,  exactly  similar  in  appearance  and 
in  average  size  to  the  common  canal  of  Nuck  cyst 
above  Poupart's  ligament.  Mr.  Cecil  Leaf,  who  kindly 
assisted  me  at  the  little  operation,  suggested  that  a 
hernial  sac  had  become  nipped  (and  the  lumen  of  the 

(a)  Read  at  a  meeting  of  the  British  Gynecological  Society, 
February  11th,  1904. 


pedicle  thus  obliterated)  by  the  edge  of  Gimbernat's 
ligament,  the  usual  site  of  strangulation  in  hernia. 
The  explanation  is  to  some  extent  plausible,  but  we 
have  no  evidence  that  any  intestine  or  omentum 
had  ever  been  extruded,  and  the  cysts  were  bilateral. 
I  am  inclined,  therefore,  to  consider  that  the  condition 
was  of  congenital  orign. 

I  was  not,  before  operating,  satisfied  that  the  im- 
pulse on  coughing  was  sufficiently  marked  to  be  charac- 
teristic of  hernia.  But  there  certainly  was  a  suffi- 
ciently marked  impulse  to  deceive  a  hasty  observer. 

To  find  an  exactly  parallel  condition  to  that  pre- 
sented by  the  canal  of  Nuck  cyst,  with  which  we  are  all 
familiar,  at  the  external  abdominal  ring — not  above 
but  below  Poupart's  ligament,  and  with  its  pedicle 
issuing  from  the  femoral  canal — seems  to  me  a  very 
unusual  state  of  things.  I  shall  be  glad  to  learn  if  any 
Fellow  has  encountered  a  similar  case. 


FATAL  CASE   OF   PERTUSSIS   IN   AN   INFANT 

OF  TWELVE  DAYS  OLD. 
Under  the  care  of  J.  C.  McWalter,  M.A..  D.P.H., 
M.D.Brux. 

Pertussis  is  still  the  opprobrium  of  the  physician, 
and  after  eighty  years  of  study  and  treatment  of  it 
the  deaths  per  thousand  from  all  causes  have  gone  up 
from  twenty-nine  to  thirty-six  in  London. 

I  think  that  the  following  case  ought  to  be  recorded, 
not  because  of  any  special  treatment,  for  the  child 
promptly  succumbed,  but  because  of  the  fact  that  the 
infant  had  never  been  outside  the  door  of  the  house  in 
which  it  was  born,  and  because  the  disease  had  de- 
veloped to  the  second  stage,  and  proved  fatal  on  the 
twelfth  day  from  its  birth. 

On  the  ninth  day  the  mother  had  noticed  the  infant 
feverish  and  restless,  and  with  a  slight  catching  cough. 
She  called  me  in  on  the  following  evening,  and  I  found 
mild  catarrhal  symptoms,  with  a  temperature  of 
99*5°  F.  There  appeared  to  me  to  be  no  reason  for 
alarm,  but  the  infant  happened  to  give  a  cough  which 
betrayed  its  malady.  The  mother  could  not  readily 
be  brought  to  believe  in  the  possibility  of  its  having 
whooping-cough,  as  she  positively  asserted  that  the 
infant  had  never  been  outside  the  house  since  its  birth, 
and  was  not  even  christened,  neither  was  there  any 
whooping-cough  in  the  house,  which  was  in  a  respectable 
middle-class  neighbourhood. 

The  child  was  worse  next  day,  and  Dr.  Vivian,  who 
was  called  in,  agreed  with  the  diagnosis.  The  violence 
of  the  cough  seemed  to  rupture  a  blood-vessel  in  the 
brain,  and  such  violent  and  uncontrollable  convulsions 
set  in  that  the  infant  died  in  a  few  hours. 


Special  Articles. 

BRITISH    SANATORIA    FOR    CONSUMPTION.- 
XXXIV. 

[by  our  special  medical  commissioner.] 


HAILEY  SANATORIUM. 

Hailby  Sanatorium  is  situated  on  the  picturesque 
slopes  of  the  Chiltern  Hills,  on  the  borders  of  Oxfordshire, 
and  with  wide  sweeping  views  along  and  across  the 
Thames  Valley.  It  is  far  removed  from  the  habitations 
of  mankind,  but  offers  peculiar  attractions  for  the  lover 
of  country  life,  and  furnishes  many  advantages  for  the 
hygienic  treatment  of  tuberculosis.  In  our  former 
articles  we  have  had  occasion  to  indicate  the  great 
variations  which  exist  in  the  structural  conditions  and 
manner  of  management  of  British  sanatoria.  To  a 
very  large  extent  the  English  treatment  of  consumption 
by  institutional  methods  is  yet  in  the  experimental  stage, 
and  we  are  still  in  process  of  evolution. 

Hailey  Sanatorium  is  an  interesting  example  of  what 
may  be  accomplished  by  the  chalet  or  so-called  hut 
sytem. 

Hailey  offers  three  special  features — isolated  sleeping 
chalets,  considerable  natural  shelter  and  variation  in 
level. 

The  administrative  portion  consists  of  an  old  country 


Feb.  24.  1904- 


SPECIAL    ARTICLES, 


The  Medical  Pa  ess.     203 


house  which  has  manifestly  been  enlarged  since  first 
built.  The  dining-room  is  situated  in  the  more  modern 
portion.  A  kitchen  annexe  has  been  added.  A  few 
rooms  are  available  for  patients. 

The  front  of  the  house  faces  east,  and  along  this  aspect 
is  a  large  well -lit  verandah  which  is  a  popular  resort. 

The  sleeping  chalets  are  of  very  simple  construction* 
Each  13  a  plain  room  raised  on  stanchions  well  above 
the  ground,  with  eight  windows  which  open  in  four 
directions,  so  that  much  adjustment  is  possible  accord- 
ing 10  direction  of  wind  or  sunshine.  Every  ehilet 
ha*  a  verandah  or  covered  balcony.  They  are  built  of 
with  air  space  between  the  outer  and  inner 
▼alK  A  ventilator  is  fixed  in  each  gable.  The  inner 
are  varnished,  and  the  outside  painted.  The 
iurmture  is  necessarily  limited  and  exceedingly  simple. 
A  stove  affords  warmth  when  required.  Lamps  are  used 
for  lighting.  An  electric  light  installation  would  prove 
of  great  service.  Each  chalet  is  in  communication  with 
the  administrative  block  by  an  electric  bell.  Acetylene 
gas  is  used  to  light  the  dining-room  and  the  large 
verandah  in  front  of  the  house,  and  we  were  informed 
m  thoroughly  satisfactory.  We  understand  the 
cost  of  a  chalet  is  about  £45, 

ft  is  manifest  that  the  chalet  system,  theoretically 
considered,  has  many  advantages,  but  in  actual  practice 
even  its  keenest  supporters  are  compelled  to  admit 
that  it  has  serious  drawbacks. 

The  ground  at  Hailey  will  allow  of  considerable 
addition  being  made  to  the  little  colony  oi  chalets. 

The  estate  cum  prises  nearly  seventy  acres.  A  well- 
wooded  portion  is  immediately  adjacent  to  the  house, 
and  some  distance  away  is  an  extensive  upland,  The 
fobsotl  is  of  gravel  and  thus  is  usually  dry.  Water 
is  obtained  from  a  deep  well 

On  one  side  of  a  large  walled 'in  kitchen  garden  there 
b  a  long  shelter  having  a  south  aspect  anil  serving  as  an 
admirable  liegehalle. 

There  are  several  good  verandahs  in  the  grounds,  one 
forming  an  excellent   "  sun-trap/" 

In  addition  to  pleasant  lawns,  gardens,  and  orchards, 
there  is  a  small  farm  with  dairy  and  good  accommoda- 
tion for  poultry 

The  old-fashioned  ivy-clad  elm  trees,  ornamental 
pities,  rose  trees  and  shrubberies  not  only  add  much 
To  the  picturesqueness  of  the  grounds,  but  afford  con- 
siderable shelter.  The  house  is  about  350  feet  above 
seadevel.  but  the  elevation  of  the  grounds  varies  from 
250  to  600  feet.  There  are  various  paths  about  the 
estate,  and  the  surrounding  country  offers  ample  oppor- 
tunities for  graduated  hill-climbing  and  carefully 
regulated  walking  exercise. 

The  sanitary  arrangements  are  not  elaborate,  but 
appear  to  be  effectual :  earth  closets  are  employed. 

An  adjacent  cottage  at  the  time  of  our  visit  was  also 
being  used  for  patients, 

There  is  accommodation  at  present  for  about  four- 
teen persons. 

We  had  an  Opportunity  of  inspecting  the  sanatorium 

ilurinu  a  severe  southerly  gale.      Dr.  Charles  Gaskell 

iM>n  was  acting  as  resident  medical  officer.       The 

nors,  we  learn,  are  Dr.  Charles  Rein  hard  t  and 

Dr   Frank   Fowler,   and    the   former  acts   as   visiting 

physician, 

StourheJd   Park    Sanatorium    at    Pokesdown,    near 
Bournemouth,  which  we  described  in  a  former  number 
tMEDtc4L  Press  and  Circular,  January  20th.  1904). 
1  !ucted  by  the  same  proprietors. 

The  sanatorium  appears  to  be  conducted  on  sound 
hygienic   lines*     The  food   is  good    and    well    served. 
There  is  a  matron,  nursing  staff,  and  moderately  large 
ervants. 

The  rules  are  reasonable  and  were  apparently,  at  the 
1  our  visit,  well  and  wisely  enforced.  The  following 
are  selections  from  the  "  Rules  for  Patients  "  :  — 

"Patients  ftmless  the  doctor  advises  otherwise)  rise 
at  a  a.m.,  an!  retire  at  9  p.m.  ;  all  lights  to  be  out  by 
IC  p.m+ 

a  hours  are  from  12.30  to  3.30  and  from  6  to 
7  pm.  All  patients  should  rest  in  silence.  An  hour's 
f«t  after  each  meal  is  usually  advisable. 


' '  Patients  must  not  congregate  in  each  other's 
ch&lets,  nor  in  the  public  rooms,  nor  visit  patients  who 
are  confined  to  bed,  without  permission/' 

The  terms  are  lour  to  five  guineas  weekly,  according 
to  accommodation,  but  some  patients  can  be  taken  at 
three  guineas.  "The  fees  are  inclusive  of  everything 
except  personal  laundry  and  alcohoL  but  patients  whose 
condition  renders  it  necessary  to  have  meals  served 
in  their  rooms  are  charged  one  guinea  a  week  extra  ; 
and  if  a  special  nurse  is  needed,  her  fees  and  board 
must  be  paid  ior  by  the  patient." 

The  postal  address  is  Hailey  Sanatorium,  Ipsden, 
Wallingford.  Telegrams  should  be  addressed 
"  Sanatorium,  Ipsden,"  Goring  and  Wallingford 
Stations  on  the  Great  Western  system  are  each  about 
four  and  a  half  miles  distant. 

The    Ipsden    Subscription    Sanatorium. 

Adjacent  to  Hailey  there  has  recently  been  opened 
by  the  same  proprietors  a  small  sanatorium  on  the 
chalet  system  for  patients  of  limited  means.  The  chalets 
are  of  the  type  above  described.  A  small  bungalow 
serves  as  administrative  block,  It  was  intended  to 
develop  an  industrial  colony  for  consumptives,  but  it  is 
found  that  the  cases  received  are  generally  more  or  less 
un suited  for  work  or  so  untrained  as  to  be  useless  for  poul- 
try farming,  pheasant  rearing,  bee-keeping,  or  such 
duties  as  it  was  hoped  might  have  given  opportunity 
for  the  learning  of  the  conduct  of  some  form  of  useful 
out -door  employment.  It  was  originally  intended  that 
only  incipient  cases  should  be  admitted.  A  medical 
certificate  is  necessary,  and  patients  are  obliged  to  con- 
form to  special  rules.  Among  those  the  following 
may  be  quoted  : — 

Patients  (unless  the  doctor  advises  otherwise) 
rise  at  8  a.m.,  and  retire  at  9  p.m.  All  lights  to  be  out 
by  9.  jo. 

"No  alcoholic  drink  must  be  taken  unless  specially 
ordered  by  the  doctor. 

"  Smoking  is  forbidden  in  the  bungalow  or  chalets, 

"  Patients  are  expected  to  assist  in  the  performance 
of  household  duties,  the  making  of  their  beds,  the 
cleaning  of  the  bungalows  and  chalets,  or  work  on  the 
farm  or  gardens  attached  to  Hailey  Sanatorium,  at  the 
direction  of  the  doctor," 

The  charges  range  from  33s,  to  two  guineas  per  week, 
the  lower  fee  being  accepted  for  patients  s$nt  by  muni- 
cipalities and  charitable  societies. 

The  work  at  the  Hailey  and  Ipsden  Sanatoria 
furnishes  instructive  object-lessons,  and  the  important 
experiments  here  proceeding  are  deserving  of  sym- 
pathetic criticism  and  careful  observation. 

ROYAL  COLLEGE  OF  SURGEONS  OF  ENGLAND 
AND    THE    MIDWIVES    BOARD. 

At  an  ordinary  Council,  held  on  February  nth,  the 
following  important  report  on  the  Central  Midwives 
Board  was  received  and  entered  on  the  minutes  ; — 

Mr.  President  and  Gentleman, — I  have  the  honour 
to  present  to  you  a  short  statement  of  the  work  of  the 
Central  Midwives  Board  during  the  past  year.  Twenty- 
two  meetings  have  been  held,  and  also  many  other 
meetings  of  Committees  which  were  duly  appointed 
by  the  Board.  The  first  meeting  of  the  Board  was 
held  on  December  nth.  1902,  and  the  last  meeting 
took  place  on  January  28th.  1904, 

The  preliminary  business  consisted  in  framing  rules 
in  accordance  with  Section  III  of  the  Midwives  Act 
of  1902.  and  this  important  work  occupied  many 
meetings  and  caused  considerable  discussion,  As  soon 
as  the  report  of  the  majority  of  the  Board  was  com- 
pleted it  was  forwarded  to  the  Privy  Council,  together 
with  another  report  prepared  by  a  minority  of  the 
Board. 

The  present  rules  sanctioned  by  the  Privy  Council 
are  the  outcome  of  these  two  reports,  and  they  are 
arranged  in  the  following  sections  :  (1)  Rules  regulating 
the  proceedings  of  the  Central  Midwives  Board,  (2) 
The  conditions  of  admission  to  the  roll  of  midwives 
and  the  issue  of  certificates.  (3}  The  course  of  train- 
ing and  the  conduct  of  examinations.  (4)  The  admis- 
sion  to   the    roll  of  women  already  in    practice    as 


204    Thk  Medical  Prbss. 


BRITISH  HEALTH  RESORTS. 


Fbb.  24,  1904. 


mid  wives  at  the  passing  of  the  Act .  ( 5 )  The  supervision 
and  restriction  within  due  limits  of  the  practice  of 
mid  wives.  (6)  The  conditions  under  which  mid  wives 
may  be-  suspended  from  practice. 
*  The  attention  of  the  Board  was  next  directed  to  the 
preparation  of  other  important  details  :  ( 1 )  Suggestions 
to  county  and  county  borough  councils  in  reference  to 
the  duties  assigned  to  them  under  the  Midwives  Act. 
(2)  Special  rules  of  procedure  for  the  removal  of  a  name 
from  the  roll  and  the  cancelling  of  a  certificate.  (3) 
Other  rules  of  procedure  respecting  the  restoration  to 
the  roll  of  a  name  previously  removed. 

The  first  roll  of  midwives  was  opened  in  November, 
1003,  and  it  records  the  names  of  the  midwives  who 
have  been  accepted  by  the  Board  under  Section  II  of 
the  Midwives  Act.  The  following  table  indicates  the 
number  of  midwives  certified  up  to  date  : — 
Women        holding" 

London  Obstetrical  Society     468 

„  Rotunda    27 

Coombe     1 


certificates  from 
I  n  sti  tu  tions 
specified-  in  Sec- 
tion II  of  the 
Midwives  Act. 


Women        holding 
certificates    from 
bodies  not  speci-„ 
fied  in  Section  II  * 
but  approved  by 
the  Board. 


26 


Queen  Charlotte's   Hospital 
St.    Mary's   Hospital.    Man- 
chester        22 

Glasgow  Maternity  Hospital  19 
Liverpool  Lying-in  Hospital  3 
City    of    London     Lying-in 

Hospital    1 

Edinburgh  Royal  Maternity  1 
Salvation  Army  Maternity  2 
Manchester    Southern    and 

Maternity  Hospital — 

^British  Lying-in  Hospital  . .     — 
Women  certified  as^ 
having    been    in 

bond-fide  practice  I 1.079 

at  least  one  year  | 
before   July    1st, 
1962.  J 

Total  certified 1,649 


The  regulations  respecting  the  course  of  training 
and  the  conduct  of  examinations  have  not  yet  been 
completed.  The  following  training  institutions  have 
been  already  accepted  by  the  Board  under  Section  C 
of  the  Rules  : — 

Queen  Charlotte's  Lying-in  Hospital ;  Liverpool 
Ladies'  Charity  and  Lying-in  Hospital ;  Manchester 
Southern  and  Maternity  Hospital ;  British  Lying-in 
Hospital ;  Newcastle-on-Tyne  Lying-in  Hospital ; 
General  Lying-in  Hospital,  Lambeth ;  Glasgow 
Maternity  Hospital ;  Dundee  Maternity  Hospital ; 
•District  Nursing  Association,  Cheltenham  ;  Maternity 
Charity  and  District  Nurses'  Home,  Plaistow  ;  National 
Maternity  Hospital,  Dublin ;  Edinburgh  Royal 
Maternity  Hospital ;  City  of  London  Lying-in  Hospital. 

An  unforeseen  difficulty  has  recently  arisen  between 
the  Irish  training  institutions  and  the  Central  Mid- 
wives  Board  respecting  the  certificates  which  must  be 
produced  before  a  candidate  can  be  admitted  to  the 
Board  examination.  The  rules  under  Section  C 
make  it  compulsory  that  every  woman  shall  have 
personally  conducted  twenty  labours,  and  also  nursed 
twenty  lying-in  women  during  ten  days  following 
labour. 

On  behalf  of  the  hospitals,  such  as  the  Rotunda  and 
the  Coombe,  in  Dublin,  it  is  stated  that  the  medical 
staff  of  these  institutions  are  unable  to  arrange  that 
every  midwife  pupil  should  personally  attend  twenty 
cases  of  labour,  as  this  would  necessitate  doubling  the 
size  of  the  hospitals  and  increasing  the  number  of 
patients.  It  is  also  equally  impossible  to  enable  every 
midwife  pupil  to  nurse  twenty  patients  for  ten  days 
following  labour,  as  nearly  all  the  women  leave  the  hos- 
pital on  the  eighth  day  and  refuse  to  remain  longer,  even 
when  the  medical  officers  are  anxious  to  detain  them. 

Now  these  regulations  are  scarcely  fair  to  the  Irish 
midwifery  institutions,  and  a  solution  of  the  difficulty 


could  easily  be  secured  (1)  by  a  modification  of  the 
regulations  of  Admission  to  the  examination ;  or  (2) 
by  accepting  the  six  months'  training  in  the  wards  of 
the  hospitals,  and  the  long  course  of  instruction 
conducted  by  the  staff,  as  equivalent  to  the  three 
months'  midwifery  tutelage  required  by  the  Central 
Midwives  Board. 

At  a  recent  meeting  of  the  Board  two  important  and 
conciliatory  communications  were  read  from  the  Irish 
hospitals,  but  the  majority  of  the  Board  declined  to 
consider  any  alteration  of  the  existing  rules ;  and, 
therefore,  it  is  probable  the  matter  will  be  referred  for 
the  decision  of  the  Privy  Council. 

The  appointment  throughout  the  country  of  local 
bodies  for  carrying  out  the  Midwives  Act  is  a  very 
hopeful  and  practical  method,  but  up  to  the  present 
time  very  little  has  been  reported  to  the  Central  Mid- 
wives  Board  to  indicate  the  progress  of  the  work.  The 
Supervision  of  midwives  is  everywhere  in  the  hands  of 
local  supervising  authorities  ;  but  it  is  quite  certain 
that  effectual  supervision  and  the  successful  operation 
of  this  Act  must  in  a  great  measure  depend  upon  the 
co-operation  and  assistance  of  the  medical  men  prac- 
tising within  the  area. 

I  am,  Mr.  President  and  Gentlemen, 
Yours  very  faithfully, 

John  Wajid  Cousins. 

JSritfsb  fteaitb  "Resorts. 


CORNWALL  AS  A  WINTER  HEALTH  RESORT. 

To  many  a  British  health  wanderer  in  the  sunny 
regions  of  Southern  France  or  the  dry  desert  districts 
of  Egypt.,  the  homeland  of  Cornwall  is  a  veritable  terror 
incognita.  It  is  undoubtedly  the  case  that  but  few 
physicians  have  any  accurate  knowledge  as  to  the 
advantages  offered  by  Britain's  south-western  penin- 
sula. Invalids  and  convalescents  are  often  sent  abroad 
when  tastes  and  temperaments  would  have  been  better 
met  by  a  sojourn  at  one  of  the  stations  on  the  Cornish 
Riviera.  Ignorance  and  prejudice  account  for  much 
of  this  neglect,  but  it  must  be  remembered  that  until 
comparatively  recent  times  the  land  of  "  Tre,  Pol,  and 
Pen  "  was  to  a  very  great  extent  inaccessible.  Now, 
however,  through  the  enterprise  of  the  Great  Western 
Railway,  the  Cornish  littoral  is  being  brought  near  to- 
England's  capital  and  other  busy  centres.  In  an  attrac- 
tive pamphlet  just  published  by  that  company,  entitled 
"The  Cornish  Riviera  and  its  Claims  as  a  Winter  Health 
and  Pleasure  Resort."  the  peculiar  attractions  of  the 
West  are  faithfully  portrayed,  and  by  means  of  meteoro- 
logical reports,  carefully  expressed  opinions  of  ex- 
perienced physicians,  and  descriptions  of  the  various 
resorts  available  medical  men  may  secure  directions 
and  suggestions  which  should  avail  much  in  selecting 
a  suitable  winter  station  where  out-door  life  may  be 
obtained  without  the  risk  and  discomforts  of  foreign 
residence. 

Cornwall  has  long  exercised  a  fascination  over 
the  artist  and  romancer,  and  the  land,  rich  in 
legendary  lore  and  crowded  with  traditions  and  super- 
stitions of  peculiar  attractiveness,  is  still  capable  of 
exciting  psychological  conditions  of  an  alleviating 
influence   to   the  wearied   body  and   harassed   mind. 

Cornwall  is  not  only  a  convenient  district  for  the 
enfeebled  in  body,  but  a  desirable  haven  for  the  over- 
worked, brain-fagged  citizen  and  wearied  student. 

Our  Western  Riviera  has  long  had  its  admirers,  and 
medical  men  will  not  forget  the  high  praise  bestowed 
by  such  careful  observers  as  Paris,  T.  Q.  Couch,  Sir 
Edward  Sieveking,  Sir  Joseph  Fayrer,  and  others. 
Among  lay  writers,  such  as  Carew,  Michael  Drayton, 
Baring  Gould,  Norway,  and  many  another,  Cornwall 
has  been  a  word  around  which  an  enthusiasm  has 
clustered  and  found  outlet  in  much  charming  literature. 

The  winter  climate  of  Cornwall  is  peculiarly  suited 
to  the  needs  of  many  invalids,  convalescents,  and 
sufferers  from  various  maladies,  and  for  the  feeble  and 
aged  it  can  offer  altogether  exceptional  advantages. 

The  winter  climate  of  the  Cornish  Riviera  would 
appear  to  rival  that  of  many  of  the  most  popular 


FSB.    34     TQ04. 


TRANSACTIONS  OF  SOCIETIES        J«k  Medicai-  Press.    205 


FALMOUTH. 


foreign  health  resorts  in  the  matter  of  mildness.  In 
equability  it  undoubtedly  surpasses  not  a  few  of  the 
most  popular  Continental  stations, 

A  considerable  amount  of  sunshine  is  enjoyed,  pro- 
tection from  winds  can  be  obtained,  and  usually  sudden 
and  violent  alternations  of  temperature  are  avoided. 

We  cannot  attempt  to  deal  with  the  various  places 
available  for  the  health -seeker  and  pleasure -desiring 
visitor.  We  hope  in  a  subsequent  series  of  articles  on 
British  Health  Stations  to  deal  with  the  more  important 
features  of  the  individual  resorts,  At  the  present  time 
Falmouth,  the  Lizard  district,  St.  Ives,  Penzance,  and 
[he  neighbourhood  of  Mount's  Bay,  Newquay,  and 
Fowey  are,  perhaps,  the  best-known  centres,  but  with 
a.  little  local  enterprise  there  is  no  reason  why  many 
tresh  localities  should  not  be  opened  up.  The  Scillv 
Ulands,  the  great  flower-garden  for  Tendon  in  the 
early  days  of  the  spring,  might  readily  be  developed 
into  a  British  sanatorium. 

a  the  influx  of  visitors,  suitable  hygienic  hotels 
will  come-  The  Great  Western  Railway  already  own 
the  attractive  Tregenna  Castle  Hotel,  overlooking 
St  Ives. 

It  may  be  safely  prophesied  that  in  the  near  future 
Cornwall  will  be  considered  one  of  the  most  valuable 
recruiting  grounds  for  the  overworked,  and  probably 
the  best  of  our  winter  districts  for  the  infirm  and  ailing. 

Medical  men  will  do  well  to  make  themselves  fully 
acquainted  with  the  many  merits  of  this  new  and  easily 
accessible  winter  health  and  pleasure  district  of  the 
Cgrarab  Riviera, 


^raiisactlone  of  Societies, 


BRITISH  GYNECOLOGICAL  SOCIETY. 
Meeting   Held   Thursday,   February    htm,    1904. 


Professor  John  WVTaylor,  M.D.,  F.R.CS,,  President, 
in  the  Chair, 


Dr,  William  Duncan  read  notes  of  a  case  of 
early    rupture    of    a    tubal  gestation, 
nineteen  days  after  conception  and  tea  after  the  uterus 


had  been  curetted,  which  will  be  found  under  the  head 
of  "  Original  Communications,"  page  200. 

Dr.  Macnaughtoh-Jones  made  a  supplementary 
report  on  a  tubal  cyst  shown  by  him  at  the  December 
meeting,  in  which  there  had  been  some  question  as  to 
the  nature  of  the  hematocele  and  the  relation  of  the 
blood  sac  to  the  tube.  The  patient  had  gone  a  fort- 
night past  her  period  when  he  first  saw  her.  and  there 
was  no  suspicion  of  ectopic  gestation  ;  he  operated  a 
few  days  later  and  she  got  perfectly  well.  The  speci- 
men had  since  been  carefully  examined ;  there  was  no 
doubt  as  to  the  tubal  gestation,  as,  though  there  were 
no  products  of  gestation  in  the  blood  clot,  chorionic 
villi  were  found  in  the  section  of  the  tube.  The  blood 
sac.  with  which  alone  at  the  operation  he  thought  he 
was  dealing,  was  completely  surrounded  by  the  layers 
of  the  broad  ligament,  but  it  now  appeared  that  it  was 
an  ovarian  sac  that  constituted  the  hematocele,  the 
constituent  parts  of  the  ovary  being  completely  de- 
stroyed. There  was  a  communication  between  the 
ovarian  sac  and  that  of  the  ectopic  gestation. 

The  President  said  that  Dr.  Duncan  *s  paper  and  the 
beautiful  demonstration  he  had  given  them  of  a 
tubal  pregnancy,  not  in  the  lumen  of  the  tube,  but 
invading  the  muscular  wall,  were  of  extreme  interest, 
In  his  own  book  he  had  described  a  case  in  which 
rupture  followedalmost  immediately  after  dilatation  and 
the  use  of  the  curette.  It  was  most  important  in  the 
clinical  diagnosis  to  exclude  extra-uterine  pregnancy, 
before  venturing  upon  that  proceeding  the  effect  of 
which,  in  some  cases,  had  been  to  precipitate  disaster. 

Dr.  Herbert  Snow  congratulated  Dr,  Duncan  on 
the  very  successful  issue  of  his  case.  Personally,  he 
thought'  that  curetting  was  not  a  procedure  to  be  lightly 
undertaken,  as  there  was  always  a  risk  of  serious  haemor- 
rhage, and  that,  by  swabbing  out  the  cavity  of  the  uterus 
with  a  strong  preparation  of  iodine,  as  good  results 
could  be  obtained  as  by  the  most  thorough  use  of  the 
curette. 

Mr.  W.  D.  Spanton  said  that  the  issue  of  such  cases 
as  the  one  narrated  seemed  to  him  to  depend  very 
greatly  on  the  length  o*  the  operation,  Every  minute 
was  of  importance.     He  therefore  demurred  to  the  use 


206    the  Medical  Press.        TRANSACTIONS  OF  SOCIETIES. 


Feb.  24,  1904* 


of  three  layers  of  sutures,  as  one  layer  was,  he  thought, 
sufficient,  and  should  occupy  a  minute  at  the  most. 

Mr.  Christopher  Martin  asked  for  further  ex- 
planation of  the  separation  of  the  gestation  sac  from  the 
lumen  of  the  tube  by  a  distinct  muscular  layer  ;  might 
there  not  have  been  a  rupture  of  the  muscle  and  of  the 
lumen  of  the  tube  elsewhere,  and  not  shown  in  the 
section  ? 

Dr.  H.  C.  Pope  asked  for  the  particulars  of  any  dis- 
charge which  had  occurred  before  the  operation  for 
curetting. 

Dr.  Duncan,  in  reply,  said  that  he  entirely  agreed 
with  the  President  that  there  was  danger  in  curetting 
if  there  was  any  likelihood  of  extra-uterine  gestation. 
He  did  not  consider  that  there  was  much  risk  in  dilating 
and  curetting  the  uterus  and  swabbing  it  out,  or,  as 
preferred  by  himself,  pouring  in  tincture  of  iodine  so  as 
to  wash  out  the  entire  cavity.  Very  little  extra  time 
was  taken  up  by  suturing  in  three  layers ;  the  entire 
proceeding  need  only  take  a  couple  of  minutes  or  so. 
The  section  shown  was  not  cut  through  the  rupture,  but 
the  number  of  sections  made  proved  that  the  gestation 
sac  did  not  open  into  the  lumen.  When  an  ovum 
attached  itself  to  the  mucosa  of  the  tube  wall,  it  pene- 
trated the  mucous  and  muscular  layers  and  its  port  of 
entry  closed  up  behind  it. 

Dr.  Macnaughton-Jonbs  showed  an  aseptic  cap  to 
cover  the  nose  and  mouth  during  operations  which 
he  had  devised ;  it  was  very  light  and  was  supported  on 
a  spectacle  frame  and  was,  he  thought,  more  suitable 
than  other  instruments  of  the  kind.  He  then  read  some 
notes  on 

a  strange  result  of  iodoform  gauze  dressing, 
which  will  be  found  on  page  198. 

Dr.  Herbert  Snow  read  notes  on 

A    CYST    SIMULATING    FEMORAL    HERNIA, 

which  are  to  be  found  on  page  302 ,  under  the  head- 
ing of  "  Clinical  Records." 

Mr.  W.  D.  Spanton  read  a  short  paper  on 

WOOLLEN  FIBRES  AS  A  CAUSE  OF  IRRITATION  OF  THE 
BLADDER  IN  GIRLS, 

which  is  given  on  page  198. 

The  President,  after  thanking  Dr.  Snow  and  Mr. 
Spanton  for  their  interesting  communications,  proceeded 
to  read  his  Inaugural  Address  on 

THE  DIMINISHING  BIRTH-RATE  :     ITS  TENDENCY,  CAUSES, 
AND   POSSIBLE   REMEDIES, 

which  we  hope  to  publish  in  our  next  issue. 

A  vote  of  thanks  to  the  President  for  his  masterful 
address  was  proposed  by  Dr.  Heywood  Smith, 
seconded  by  Dr.  Macnaughton  -  Jones,  and  carried 
with  acclamation. 


ROYAL  ACADEMY  OF  MEDICINE  IN  IRELAND. 
Section  of  State  Medicine. 


Meeting  held  February  12th,  1904. 

Sir  John  Moore,  the  President  of  the  Section,  de- 
livered an  Inaugural  Address  on  the  subject  of 

SOME  PUBLIC  HEALTH  PROBLEMS  IN  IRELAND. 

He  instanced  the  dying  out  of  opposition  to  the 
principle  of  compulsory  notification  of  infectious 
disease  as  a  substantial  advance  in  preventive  medicine. 
A  second  great  advance  has  been  the  official  recognition 
of  diplomas  in  State  Medicine  or  Public  Health.  As  to 
the  prevention  of  tuberculosis,  he  considered  that  some 
such  scheme  as  the  following  should  be  carried  out  with 
the  view  of  checking  the  awful  ravages  of  consumption  in 
Ireland — namely,  I.  The  rise  and  spread  of  tuber- 
culosis in  the  cottage  homes  of  the  peasantry  and  in  town 
dwellings  must  be  grappled  with  by — (1)  Notification, 
which  should  be  compulsory ;  (2)  verification  of  the 
diagnosis  by  means  of  bacteriological  examination  of 
the  sputum,  &c.  ;  (3)  removal  of  the  patients  to 
"  hospital,"  using  the  term  in  its  fullest  sense  ;  (4) 
periodic  inspection  of  the  homes  of  the  tuberculous  ; 
(5)  periodic  disinfection  of  those  homes.  II.  The 
provision  of  "  hospital  accommodation  "  for  (1)  Early 
cases,  with  a  view  to  cure  ;  (2)  advanced  cases,  to  pro- 
vide comfort  for  the  dying,  and  to  secure  safety  for  the 
living.     [The  expression  '*  hospital  accommodation  " 


should  include  "  isolation  hospitals/'  "  sanatoria/' 
"  consumption  wards/'  and  hospices  for  the  dying.] 
III.  The  vigorous  and  absolute  segregation  of  tuber- 
culous cases  in  workhouses,  asylums,  and  other  public 
institutions.  IV.  Education  of  the  public  in  all 
matters  relating  to  the  prevention  and  management 
of  pulmonary  tuberculosis.  V.  Improvement  of  the 
housing  of  the  working  classes  and  of  the  very  poor, 
especially  in  towns.  Closely  connected  with  the  pre- 
vention of  tuberculosis  is  the  question  of  the  housing 
of  the  working  classes  and  of  the  very  poor — a  very 
burning  question  in  Dublin  of  late  years.  Much 
has  already  been  done  in  this  city  to  mitigate  the  evil 
of  overcrowding.  "  Old  Dublin  "  is,  in  fact,  disappear- 
ing, and  with  it  typhus  fever  has  well  nigh  ceased  to 
exist.  The  President  severely  criticised  the  Poor-law 
system  of  Ireland,  stigmatising  the  internal  economy 
of  the  workhouses  as  a  grave  scandal  and  a  national 
disgrace.  He  specified  the  lines  upon  which  reform 
should  go.  In  conclusion,  he  dwelt  upon  the  very  un- 
satisfactory state  of  what  may  be  called  "  the  Home 
Medical  Service,"  the  Poor-law  Medical  Service— 
particularly  in  relation  to  the  sanitary  organisation  of 
the  country.  In  Dublin,  as  throughout  Ireland,  the 
dispensary  medical  officers  remain  the  medical  officers 
of  health  for  their  respective  districts,  and  he  con- 
tended that  this  hard- worked,  badly-requited  body 
of  public  servants,  whose  efforts  for  the  health  and 
welfare  of  the  community  are  often  misunderstood, 
and  seldom,  if  ever,  appreciated,  should  be  properly  re- 
compensed for  their  services  under  the  Public  Health 
Acts.  If  this  is  done,  and  if  the  suggestions  for  the 
betterment  of  the  health  of  the  people  made  by  the  local 
medical  officers  are  carried  out  intelligently  and  in  a 
generous  spirit,  the  dawn  of  a  brighter  day  for  the  Irish 
race  will  at  last  be  near  at  hand. 
Dr.  R.  B.  McVittie  read  a  paper  on 

THE  ATTITUDE  OF  THE  PROFESSION  TOWARDS  MODERN 
EDUCATION,  FROM  A  PHYSICAL  AND  MENTAL  STAND- 
POINT, 

in  which  he  pointed  out  that  the  great  progress  made 
in  Denmark,  Sweden  and  Germany  of  late  years  was 
mainly  due  to  the  control  exercised  by  the  medical 
profession  over  primary  education  ;  that  as  man  is  a 
living  and  growing  being,  only  those  who  had  made 
a  life  study  of  physiology  and  biology  were  fit  to  be 
intrusted  with  this  development,  while,  unfortunately, 
in  these  countries  the  only  qualification  which  ap- 
peared necessary  for  what  was  called  an  educationalist 
was  a  knowledge  of  some  antiquated  classic,  which, 
being  purely  abstract,  tended  more  to  arrest  than  to 
encourage  orderly  growth  ;  that  as  the  nerve  fibres 
from  the  surface  to  the  pyramidal  cell  are  myelinated 
first,  all  true  education  must  be  first  concrete,  and  that 
the  abstract  should  be  discouraged  as  much  as  possible 
till  the  period  of  adolescence  is  fully  completed,  as  too 
early  a  development  of  the  psychic  processes  diverted 
the  nerve  energy  from  the  control  of  tissue  formation, 
which  is  its  natural  function  during  the  period  of 
growth. 

Lt.-Col.  McNeece  expressed  his  gratification  at 
hearing  the  paper,  and  considered  that  if  the  principles 
implied  in  it  could  be  practically  carried  out,  it  would 
be  to  our  great  advantage  as  a  nation.  He  gave  a 
personal  instance  of  the  distaste  and  nausea  which 
the  present  system  of  education  raised  in  the  minds  of 
school  children,  and  the  essentially  different  view  of 
things  which  was  taken  on  going  to  a  foreign  country. 

Sir  John  Moore  reminded  Dr.  McVittie  that  the 
Irish  universities  were  moving  towards  improving 
education  in  the  direction  suggested  by  him  ;  the  Royal 
University  had  established  a  diploma  in  Education,  and 
examined'  candidates  for  the  qualification  ;  Trinity 
College  was  moving  on  the  same  lines,  and  lately,  a 
course  of  lectures  was  delivered  there  on  the  subject 
of  Education.  He  instanced  the  kindergarten  as  an 
example  of  the  attention  which  was  now  given  to  the 
teaching  of  the  concrete  as  distinguished  from  the  ab- 
stract. He  also  related  instances  in  which  he  had 
personally  seen  the  miserable  conditions  in  which  many 
of  the  children  in  Dublin  were  taught. 

Dr.  McVittie,  in  reply,  said  he  was  greatly  obliged 


Fm-  14-  '904- 


TRANSACTIQNS  OF  SOCIETIES.        The  med.cal  Pbess.    207 


for" the  favour  with  which  his  paper  had  beenjreceived. 
He  said  that  he  dirl  not  sijm  a  recent  circular  from 
London  asking  for  the  signatures  of  members  of  the  pro- 
fession with  a  view  to  having  instruction  in  hygiene 
and  temperance  introduced  into  schools,  as  such  in- 
struction only  meant  more  classes  and  more  exhaustion 
of  the  nerve  centres,  which  would  bring  a  desire  for 
stimulation.  He  said  that  in  the  schools  in  Sweden 
and  Denmark  the  children  were  only  allowed  to  stay  in 
00c  class  for  about  forty-five  minutes;  they  then  stood 
up  and  did  exercises  tending  to  correct  the  cramping 
from  sitting  down,  after  which  they  went  out  to  the 
playground  lor  some  minutes.  He  also  emphasised 
the  necessity  for  children  being  medically  examined 
two  or  three  times  a  year. 


WEST    LONDON     MEDICO-CHIRURGICAL 

SOCIETY. 
Meeting  held  February  sth 
Dft,  Seymour  Taylor,   President,  in  the  Chair. 
Dr.  Samuel  West  read  a  paper  on 

SOME    POINTS      IN      FUNCTIONAL      ALBUMINURIA. 

a  full  abstract  of  which  was  published  in   our  issue  of 
February   loth. 

In  the  discussion  that  followed  the  President 
considered  all  such  cases,  provided  that  catheter 
specimens  of  the  urine  contained  albumin,  to  be 
pathological,  but  urged  the  necessity  for  careful  micro- 
tfopical  examination  to  supplement  this  evidence. 
The  presence  of  tube  casts,  free  blood,  or  an  excess  of 
desquamated  renal  epithelium  rendered  the  diagnosis 
of  renal  disease  imperative.  One  important  point  that 
required  further  observation  was  the  length  of  time 
that  might  elapse  in  cases  of  renal  disease  after  the 
appearance  of  albumin  in  the  urine  before  signs  of 
cardio-  vascular  disease  manifested  themselves,  If 
signs  of  increased  tension  in  the  renal  pulse,  accentua- 
tion of  the  aortic  second  sound,  and  displacement 
downwards  and  outwards  of  the  heart's  apex  beat 
were  present,  although  the  albuminuria  might  be 
fugitive,  all  such  cases  must  be  regarded  as  coming 
Uidcr  the  category  of  Bright's  disease. 

Dr,  C.  A*  Sutherland  believed  the  postural  or 
orthostatic  variety  to  be  a  definite  form  of  functional 
albuminuria.  In  these  cases  albumin  appeared  in  the 
urine  soon  after  the  patient  assumed  the  erect  position 
in  the  morning,  and  decreased  in  amount  as  the  day 
went  on.  The  patients  were  most  frequently  young 
adolescents  who  exhibited  accompanying  symptoms 
which  were  very  definite,  chiefly  of  the  nature  of  general 
vaso-motor  disturbance,  and  which  might  be  best 
summed  up  under  the  term  neurasthenia.  There  were 
nane  of  the  signs  or  symptoms  of  nephritic  disease  in 
these  cases.  The  card io- vascular  system  showed  evi- 
dence of  feeble  circulation.  The  hands  and  feet  were 
cold  and  dusky,  the  pulse  was  of  low  tension  and  small 
volume,  the  cardiac  action  weak,  irregular,  and  rapid, 
the  first  sound  was  poor  and  a  general  condition  of 
cardiac  atony  was  present.  The  prognosis  of  this  form 
oi  functional  albuminuria  was  frequently  based  on  the 
view  that  it  was  an  early  symptom  of  nephritis,  but  no 
uncomplicated  case  had  ever  been  shown  to  develop 
into  organic  renal  disease,  All  the  classical  symptoms 
of  adult  neurasthenia  were  reproduced  in  these  cases, 
and  he  had  found  from  experience  that  treatment  of 
this  underlying  condition  was  productive  of  the  best 
results. 

Dr.  E,  A.  Saunders  agreed  with  the  President  as 
to  the  necessity  for  microscopical  examination  of  the 
urine  in  every  case.  The  presence  of  a  few  hyaline 
casts  he  did  not  consider  of  greater  clinical  significance 
than  the  occurrence  of  albumin  itself,  but  if  many  casts 
were  present,  especially  if  these  were  of  the  granular 
variety,  they  might  be  taken  as  evidence  of  chronic 
kidney  disease*  In  estimating  the  prognosis  in  cases  of 
albuminuria  in  the  apparently  healthy  he  attached 
Kieat  importance  to  the  age  of  the  patient  and  the 
amount  of  the  albumin.  After  thirty  years  of  age  the 
gravity  of  the  condition  increased  with  every  year  of 
liie,  and,  speaking  generally,  the  larger  the  amount  of 
the  albumin  the  more  serious  the  prognosis  became. 


LARYNGOLOGICAL      SOCIETY  r  OF      LONDON, 
Meeting   held    Friday,   February   5TK    1904, 

Mr,  J.  Charters  Symonds,  Vice-President,  in  the 
Chair, 


DlL  &  S,  Yonge  showed  Professor  Meyer's  apparatus 
for  demonstrating  the  laryngeal  image  and  intra* 
laryngeal  manipulations.  The  apparatus  was  ex- 
amined by  most  of  the  members  of  the  Society,  and 
proved  to  be  extremely  suitable  for  the  purposes  men- 
tioned. He  also  showed  microscopical  sections  of  bone 
and  soft  tissues  from  a  case  of  early  polypus,  The 
sections  showed  that  the  subjacent  "  bone  was  per- 
fectly healthy,  and  that  there  were  no  signs  of  either 
caries  or  necrosis. 

Mr.  A,  H.  Burt  showed  a  case  of  a  man,  aet,  49, 
with  questionable  mild  gland' 

Dr.  H.  L.  Lack  showed  ft)  a  case  of  malignant 
disease  of  the  tonsils  is  which  he  had  operated  with 
good  results  ;  [2}  a  microscopical  section  of  endo- 
thelioma of  the  maxillary  antrum  ;  {3)  a  microscopical 
section  and  patient  showing  endothelioma  of  the  larynx  ; 
and  (4)  n  specimen  of  large  osteoma  of  the  ethmoid* 
with  nasal  polypi, 

Dr,  F,  Potter  showed  a  case  of  recurring  papilloma 
of  the  larynx. 

Mr.  A.  Thorne  showed  (1)  a  case  of  immobile  left 
vocal  cord  in  a  man,  aet.  35  ;  (2 J  a  man,  aet.  35,  with 
severe  paroxysmal  pain  starting  from  the  larynx  ; 
and  (J)  a  tumour  of  the  right  side  of  the  larynx  in  a 
woman,  art.  45,  This  latter  case  gave  rise  to  a  fair 
amount  of  discussion,  the  general  "opinion  of  the  Society 
being  that  the  tumour  was  of  tuberculous  origin, 

Mr.  H,  W.  Carson  showed  a  case  of  laryngeal  ulcera* 
tion  in  a  phthisical  patient  for  diagnosis. 

Mr,  R.  Lake  showed  a  case  of  subglottic  thickening, 

Dr,  J.  Donelan  showed  a  youth  with  fracture  I 
septum,  and  a  depressed  nose  improved  by  operation 
and  paraffin  injection. 

Dr.  D uno as  Grant  showed  (1)  a  case  of  fixation  of 
the  vocal  cord  with  extreme  pain  in  swallowing  in  a 
female  patient*  set  45.  The  question  was  whether 
it  was  tuberculous  perichondritis  ;  (2)  a  case  of  chronic 
cedema  of  the  larynx  (shown  previously)  in  a  middle- 
aged  woman — probably  tertiary  syphilitic  infiltration 
—greatly  improved  under  mercurial  inunction  ;  (3)  a 
case  of  ulceration  of  the  pharynx  after  cervical  fistula 
and  oedema  of  the  right  half  of  the  larynx  in  a  middle- 
aged  woman.  The  question  of  specific  perichondritis 
oi  the  arytenoids  was  raised. 

Dr,  W.  Hill  showed  a  skiagram  from  a  male,  act.  48, 
showing  a  ptn  which  had  been  in  the  larynx  for  four 
and  a  half  years,  and  which  had  been  removed  sub- 
sequently by  lateral  laryngotomy. 

ULSTER  MEDICAL  SOCIETY. 
Meeting  held  in  the  Medical  Institute,  Belfast, 
on    February    iSth, 

Professor  Lindsay  in  the  Chair. 

Dr.  John  M'Caw  read  a  short  paper  on 

PSEUDO-HYPERTROPHIC  PARALYSIS, 

and  showed  a  case  for  which  we  hope  to  have  space  in 
out  next  issue. 

The  paper  was  discussed  by  Dr.  Beat ty,  Dr.  McQuit- 
ty,  Dr,  McKisack,  and  Professor  Lindsay, 

Dr,  W.  D*  DoNNAN.  Holy  wood,  showed  a  specimen 
of  intestinal  sand.  The  patient  was  a  middle-aged 
man  of  alcoholic  habits.  He  complained  of  pains  in 
the  region  of  the  liver,  and  Dr,  Donnan,  thinking  of 
gall-stones,  told  his  wife  to  watch  the  motions  for  a 
few  days,  with  the  result  that  this  sand  was  found 
shortly  after  each  attack  of  pain. 

Dr,   W.  D.  Donnan   also   read  notes  of  a   m 
teres  ting  case  of 

ACUTE  LYMPHATIC  LELXAMIA. 

The  patient  was  a  schoolboy,  act,  t2,  apparently  ty- 
pically healthy,  one  ot  a  large  and  healthy  family. 
Last  Easter  he  came  home  from  school  in  England 
with  a  slight  rash  on  his  chest,  and,  feeling  a  Utile 


208    The  Medical  Press. 


FRANCE. 


Feb.  24,  1904. 


languid,  Dr.  Donnan  was  called  to  see  him  on  April  28th 
and  found  him  very  anaemic,  the  tongue  coated,  the 
heart  normal,  the  spleen  just  felt,  and  abundant 
petechial  spots  on  the  chest,  but  no  lymphatic  enlarge- 
ments. On  May  4th  there  were  fresh  spots,  and  the 
morning  temperature  was  ioo°.  On  May  12th  he 
got  Dr.  Houston  to  take  a  blood  count,  and  he  found 
the  red  corpuscles  to  be  1,600,000,  and  the  white 
40,000 ;  of  the  latter  99  per  cent,  were  lymphocytes. 
On  May  14th  the  spleen  was  distinctly  larger.  He  was 
then  seen  by  Sir  Wm.  Wnitla  in  consultation.  On 
May  15th  both  pulse  and  temperature  rose,  and  severe 
epistaxis  began,  the  spleen  rapidly  returning  to  its 
former  size.  There  was  intense  pain  in  the  left  ear. 
On  May  16th  the  temperature  was  1010  in  the  morning 
and  1030  in  the  evening,  and  the  pulse  160.  On  the 
evening  of  the  19th  he  became  delirious  and  died  next 
day.  The  interesting  points  to  note  are  that  the 
symptoms  only  became  really  acute  six  days  before 
death,  and  that  nothing  indicated  the  serious  nature 
of  the  illness  till  the  blood  count  was  made.  The 
epistaxis  was  easily  controlled  by  plugging,  and  death 
seemed  to  be  due  to  an  acute  septicaemia. 

Dr.  Houston  said  that  he  had  notes  of  about  sixty 
cases  of  pernicious  anaemia  which  he  had  examined, 
and  only  four  of  them  were  of  this  rare  form,  lymphatic 
leucaemia.  Of  these  four,  two  had  no  glandular  en- 
largements ;  all  four  were  under  twenty  years  of  age  ; 
all  died  within  three  months,  and  two  within  six  weeks 
of  the  onset. 

Professor  Lorrain  Smith,  Dr.  M*Caw,  and  Dr. 
Trimble  also  made  remarks  on  the  case. 

Dr.  J.  Gorman  (Bangor)  gave  an  account  of  in- 
tra- tracheal  injections  in  the  treatment  of  abscess 
ot  the  lung,  phthisis,  asthma,  and  whooping-cough. 
He  had  used  various  drugs  and  media,  but  favoured 
menthol  in  olive  oil.  He  read  notes  of  a  number  of 
cases,  one  of  which,  a  bad  case  of  abscess  of  the  lung, 
excited  special  interest.  Dr.  A.  B.  Mitchell,  who  had 
seen  this  case,  admitted  that  he  had  considered  it 
hopeless,  and  when  Dr.  Gorman  had  suggested  the 
intra-tracheal  injections,  he  had  said  that,  at  any  rate, 
they  could  do  no  harm. 

Dr.  Cecil  Shaw  (to  whose  paper  on  the  same  sub- 
ject read  before  the  Ulster  Medical  Society  several  years 
ago  Dr.  Gorman  had  referred)  said  that  he  had  round 
menthol  one  of  the  most  useful  drugs  in  affections  of 
the  upper  respiratory  tract. 

Professor  Lindsay  thought  that  while  such  treat- 
ment might  be  useful  in  some  affections,  such  as 
abscess  ot  the  lung,  it  could  not  be  of  any  real  benefit 
in  phthisis. 


tfrance. 


[from  our  own  correspondent.] 


Paris,  February  21st,  1904* 
Treatment  of  Ingrowing  Nail. 
Dr.  Martel,  a  rising  surgeon  of  one  of  the  provincial 
hospitals,  protests  strongly  against  the  classical  method 
(avulsion)  of  treating  that  frequent  but  painful  affec- 
tion known  as  ingrowing  nail.  The  operation  as  prac- 
tised, he  admitted,  was  not  grave,  necessitating  the 
most  local  anaesthesia  produced  by  refrigeration  or 
cocaine,  the  latter  being  preferable,  although  frequently 
general  anaesthesia  might  be  preferred  to  either,  as 
giving  less  trouble  to  the  operator.  It  mattered  little, 
however,  which  of  the  methods  was  employed,  the 
chances  of  a  rapid  healing  were  very  doubtful.  In  any 
case,  the  patient  is  obliged  to  keep  his  bed  three  weeks 
at  least,  and  frequently  one  or  two  more  weeks  have  to 
pass  before  he  can  walk  with  ease,  and  sometimes  the 
new  nail  grows  badly,  and  the  toe  assumes  a  deformed 
and  unsightly  aspect.  In  his  opinion,  the  painful 
ulceration  of  the  ingrowing  nail  is  only  an  ordinary  sore, 
caused  by  the  irritating  and  continued  presence  of  a 
foreign  body  under  the^edge  of  the  nail,  and  by  the 


difficulty  of  keeping  that  region  in  an  antiseptic  con- 
dition— two  defective  conditions  which  alone  hinder 
the  healing  of  the  parts,  Naturally,  the  suppression 
of  the  foreign  body  or  the  cause  of  the  irritation  would  be 
obtained  by  the  simple  ablation  of  the  nail  if  the  avul- 
sion were  not  so  terribly  painful,  but  that  radical  treat- 
ment is  not  even  necessary.  1  It  suffices  to  suppress  the 
pressure  of  the  foreign  body  into  the  ulceration,  and 
this  is  easily  done  by  paring  as  thinly  as  possible 
the  back  of  the  nail  with  a  piece  of  ordinary  glass* 
Thus  treated  the  nail  can  support  pressure  without 
affecting  the  edges ;  the  foreign  body  remains,  but 
its  painful  effect  is  suppressed  ;  from  this  moment  the 
treatment  of  the  sore  alone  requires  the  attention  of 
the  surgeon.  « 

For  several  years  M.  Martel  has  treated  such  cases  as 
follows  : — After  paring  the  nail  as  already  described, 
he  makes  the  patient  take  a  footbath,  and  then  washes 
out  the  groove  with  a  solution  ot  corrosive  sublimate 
( 1  in  1 ,000)  very  gently,  so  as  to  avoid  making  the  parts 
bleed  ;  the  nail  is  cut  straight,  and  without  sacrificing 
the  angle,  which  will  be  found  useful  later  on  in  lifting 
the  nail  above  the  ulceration.  A  very  small  quantity 
of  [iodoform  is  then  placed  in  the  wound  with  a  few 
threads  of  iodoform  gauze  packed  at  the  bottom  of  the 
groove,  and  all  covered  by  a  little  zinc  ointment. 
Beneath  the  angle  of  the  nail  a  little  plug  ot  prepared 
agaric  is  inserted  so  as  to  separate  the  fungous  edge 
from  the  nail.  The  fungosites  are  treated  by  the  applica- 
tion of  nitrate  of  lead.  The  operation  is  completed  by  a 
small  compress  of  cotton-wool  moistened  with  some 
antiseptic  solution  (boric  acid),  and  finally  a  bandage. 
Immediately  after  the  first  dressing  the  patient  finds 
himself  much  relieved,  and  can  put  on  his  shoe.  On 
the  second  day  the  dressing  is  removed,  and  the  sore 
found  to  be  much  less  inflamed,  while  suppuration  has 
ceased.  The  third  dressing  is  made  four  or  five  days 
later.  Generally  only  four  or  five  dressings  are  needed. 
Compared  with  the  classical  treatment,  this  bloodless 
method  affords  a  double  advantage  :  economy  of  suffer- 
ing and  of  time. 

Treatment  of  Epilepsy. 
Professor  Toulouse,  of  the  Villejuif  Hospital,  has 
been  making  experiments  on  the  effect  of  salt  (chloride 
of  sodium)  on  the  bromide  treatment  of  epilepsy,  and 
has  come  to  the  conclusion  that  by  diminishing  to 
almost  suppression  the  daily  amount  of  salt  absorbed 
in  the  food  of  an  individual,  the  bromides  acted  with 
greater  intensity  and  at  less  doses.  He  submitted 
a  certain  number  of  patients  having  almost  daily 
seizures  to  the  treatment  of  hypochloridation,  and 
found  that  they  were  brought  much  more  quickly 
under  the  influence  of  the  bromide  treatment;  the 
attacks  became  less  frequent  and  less  intense,  while 
those  allowed  the  ordinary  diet  improved  much  more 
slowly  and  required  increasing  doses  of  the  bromide. 
The  amount  of  salt  absorbed  normally  per  diem  is 
about  halt  an  ounce.  By  reducing  this  quantity  to  one 
drachm,  and  finally  to  20  grains  a  day,  the  physiolo- 
gical point  of  hypochloridation  is  attained,  and  this 
point  may  be  maintained  for  months  without  great 
harm  to  the  patient.  While  going  through  this  period 
the  patient  need  not  take  more  than  15  grains  of  bro- 
mide of  potassium  three^times  a  day.  Thecells,  it  would 
seem,  deprived  of  chloride  of  sodium,  showed  more 
avidity  for  the  bromides,  which  acted  thus  with  ex- 
traordinary intensity.  If  symptoms  of  bromism  ap- 
peared (pupils  indolent  to  light,  tongue  loaded,  general 
depression,  face  drawn,  lower  lip  hanging),  the  bromide 
is  suspended,  a  purgative  enema  given,  and  the  patient 
put  on  milk,  to  which  salt  is  added — ateaspoonfultoa 
quart.  Three  or  four  days  afterwards  the  treatment 
may  be  continued. 


Feb.  24,   1904. 


OPERATING    THEATRES, 


The  Medical  Press.     209 


HuBtria- 


[FROSI    OUR    OWN   CORRES  PON  DENT,] 


Viiikna.  February  20th,  1B04. 

Paroxysmal  Tachycardia- 

At  the  Gesellschaft  Schlesinger  demonstrated  from 
drawings  and  photos,  the  anatomical  and  pathological 
uons  of  a  pa  lien  t,  set.  57,  who  died  of  paroxysmal 
tachycardia,  and  who  had  suffered  for  the  last  ten  years 
with  severe  typical  attacks*  1 1  may  be  well  to  note  that 
there  was  insufficiency  of  both  the  aorta  and  mitral 
1,  The  attacks  usually  lasted  about  a  minute,  but 
were  frequently  repeated  for  an  hour,  and  even 'days 
at  a  time.  Though  not  severe,  they  were  easily  induced 
by  cough,  pressure,  or  other  movement  in  the  fauces* 
The  pulsations  were  accelerated  suddenly  from  60 
or  80  pulsations  in  a  minute  to  too  or  250  in  a  minute, 
which  might  as  suddenly  be  reduced,  by  compression  on 
the  right  vagus  near  the  end  of  the  attack,  to  its  normal 
•\<->n.  The  patient  felt  by  this  sudden  fall  that  he 
had  had  a  shock  which  he  expressed  as  having  passed 
through  the  entire  body.  On  account  of  these  attacks 
lasting  unduly  long,  the  patient  was  brought  to  hospital* 
where  he  died  alter  one  of  the  attacks. 

The  post-mortem  reveal ed  the  right  vagus  firmly 
bound  up  in  the  thorax  with  fibrous  and  lymphatic 
tissue.  Over  the  compressed  portion  of  the  nerve 
the  neurine  structure  wTas  atrophied  and  the  true 
nerve  cell  gone,  being  displaced  in  some  measure  by 
interstitial  tissue*  There  were  port  ions  of  the  nerve  both 
below  and  above  the  compressed  site  whose  section 
revealed  a  perfectly  normal  condition. 

Winterniu,  in  criticising  the  case,  recollected  one 
Rinular  having  the  paroxysmal  tachycardia, of  which  he 
still  retained  sphygmographic  tracings,  but  at  the  time 
Lad  do  opportunity  of  a  post-mortem  examination* 
He  was  persuaded  then,  and  is  now  more  convinced, 
that  the  case  was  one  of  severe  pressure  of  the  vagus  . 
The  pulse  usually  commenced  to  rise  suddenly  to  great 
frequency,  and  just  as  suddenly  fell  to  normal. 
Should    Infants'    Food    be   Steril^ed  ? 

This  is  a  question  that  many  practitioners  have 
had  difficulty  in  replying  to  rationally,  as  the  irrational 
■pinion  is  the  one  usually  forced  upon  us  as  to  the  ortho- 
dox food  of  a  baby.  This  tyrannical  opinion  has  had 
the  charm  broken  by  no  less  a  personage  than  B  eh  ring 
himself,  who  avows  that  the  food  of  infants  is  more 
rous  and  less  digestible  when  sterilised  than  when 
the  milk  is  supplied  in  a  pure  natural  form.  Tins  to 
somewhat  refreshing  to  know,  and  must  relieve  the 
minds  of  many  a  sceptic  who  never  had  any  faith  in 
boiled  whisky,  milk,  or  beer  !  Common  sense  should 
lead  us  to  the  conclusion  that  boiling  is  destroying  the 
ferment  necessary  for  the  digestion  of  the  proteid. 

Sterilisation  as  a  germicide  is  not  always  desirable, 
as  a  fluid  perfectly  inert  when  taken  into  the  mouth 
meets  and  takes  up  those  germs  from  the  air  which 
may  not  be'  the  most  [healthy  for  the  child.  The 
milk,  having  no  healthy  resisting  bacilli,  is  dominated 
by  the  worst  germs  that  the  child  could  be  expose!  t> 
This  opinion  of  B  eh  ring's  has  been  rapidly  and  very 
widely  circulated  by  the  layVaPer;j.  which  seem  rather 
jubilant  over  the  affair,  while  some  of  the  medical 
papers  breathe  heavily-  The  conversions  are  certainly 
n°t  11  it  the  present  moment,  as  Escherich, 

Paltauf,  and  Frankel  are  still  resolute  in  holding  to  the 
demised  idea,  yet  it  is  remarkable  that  the  first  shell 
tomes  from  the^midst  of  the  Continental  savants. 

Experimental  Physiology  at  High  Elevations. 
At  the  last  Physiological  Congress  held  in  Turin  in 

1901  it  was  decided  that  a  series  of  experiments  should 


be  carried  out  on  the  summits  of  some  of  the 
Alpine  peaks.  ForTthis  purpose  Professor  Mosso 
selected  Mont  Rosa  for  the  site  of  his  laboratory,  but 
to  secure  success  if  was  necessary  to  have  the  patronage 
of  a  lady  of  high  degree,  which  was  easily  obtained  in 
the  person  of  the  Queen  Mother  Margherita,  who  al- 
ready possessed  a  hut  on  the  mountain  of  seven  rooms, 
double  walled  and  surrounded  with  a  fine  terrace.  The 
building  has  been  greatly  enlarged  and  fully  equipped 
for  the  purpose  of  accurate  observation.  The  hut  is 
5.500  metres  above  sea  level,  or  t/4040  feet.  The 
enthusiastic  pioneer  has  along  with  him  three  of  the 
profession  of  his  own  country  as  well  as  Professor 
Alt  water,  from  Middletown,  America,  who  is  over 
sixty  years  of  age  and  90  kilos  or  [4  stone  in  weight. 

One  devotes  his  whole  time  to  respiration,  &c.  ; 
another  to  the  muscles  and  fluids  :  while  others  are 
engaged  on  the  circulation. 

Foa  finds  when  experimenting  with  dogs  and  guinea- 
pigs,  that  the  rarefied  air  does  not  alter  the  condition 
of  the  blood  as  was  generally  supposed  ;  the  distribu- 
tion of  the  blood  to  surface  and  interior  is  the  most 
important.  Mosso  finds  that  the  blood  of  dogs  takes 
up  only  half  the  amount  of  oxygen  at  this  elevation,  as 
ir  contains  only  one-half  of  that  at  sea  level  in  the 
same  volume,  He  finds  less  COa  in  the  blood  of  the 
dog  in  proportion  to  the  height.  From  venesections 
performed  it  b  found  that  the  alkalinity  of  the  blood 
varies  between  36  and  44  per  cent.  This  alkalinity 
is  due  more  to  barometric  pressure  than  to  the  pre- 
sence of  oxygen,  hydrogen,  or  other  gases. 
Moser's  Polyvalent  Serum. 

Bokay,  who  has  been  experimenting  with  Moser's 
polyvalent  serum  for  the  scarlatinal  streptococcus, 
records  rapid  and  good  results.  Shortly  after  the 
injection  the  whole  condition  improves,  the  cerebral 
conditions  disappear,  the  exanthemata  fade,  and  the 
temperature  falls  11  per  cent.  The  necrotic  state  of 
the  throat  ceases  and  a  healthy  appearance  returns. 
No  bad  effects  have  been  observed,  except  a  serum 
rash  m  58  per  cent,  of  the  eases. 

Ube  ©peratins  XCbeattes* 

ST.  BARTHOLOMEW'S  HOSPITAL. 
Appendjcectomy  during  Pregnancy.  —  Mr, 
McAdam  Ecclis  operated  upon  a  woman,  a»t.  39.. 
who  had  been  admitted  suffering  from  pain  in  the  right 
iliac  fossa.  She  gave  a  history  of  having  been  seized 
with  violent  pain  in  the  lower  part  of  the  abdomen, 
and  chiefly  on  the  right  side,  in  September,  1903, 
associated  with  vomiting  and  a  raised  temperature. 
She  was  kept  in  bed  for  three  weeks.  Up  till  then  she 
had  been  menstruating  regularly.  Her  last  period 
was  in  the  middle  of  October,  1903,  since  which  time 
there  had  been  no  loss.  Soon  after  Christmas,  1903, 
she  was  again  attacked  by  similar  pain,  which  had 
continued,  but  gradually  became  less  until  admission. 
On  examination,  there  was  no  evidence  of  any  ovarian 
mischief,  and  nothing  could  be  palpated  in  the  region 
of  the  appendix.  The  uterus  was  enlarged,  as  in  the 
fourth  month  of  pregnancy,  Mr.  Ecctes  decided  to 
explore.  He  opened  the  abdomen  by  an  incision 
about  two  and  a  half  inches  long,  made  through  the 
anterior  layer  of  the  sheath  of  the  right  rectus  muscle, 
some  two  fingers*  breadth  interna!  to  the  semilunar 
line ;  he  then  displaced  the  rectus  inwards,  and 
divided  the  posterior  layer  of  its  sheath  behind  the 
position  of  the  displaced  muscle,  and  after  it  the  extra- 
peritoneal tissue  and  the  peritoneum  ;  there  imme- 
diately presented  the  omentum  containing  a  serous 
cyst  the  size^of  a  cob-nut.     This  Mr.  Eccles  took   to. 


2Z0    The  Medical  Peess. 


OPERATING   THEATRES. 


Feb.  24,  1904. 


indicate  that  there  had  been  inflammation  in  its  neigh- 
bourhood, producing  some  obstruction  to  the  lym- 
phatics of  the  omentum  and  the  formation  of  the  cyst. 
On  drawing  this  aside  the  appendix  came  spon- 
taneously into  view,  rather  sharply  kinked  upon  itself, 
and  some  four  inches  long.  Its  blind  extremity  was 
dilated  to  about  four  times  its  proper  size,  and  was 
lying  in  juxtaposition  with  the  side  wall  of  the  pregnant 
uterus.  The  tube  was  removed  in  the  usual  way, 
and  the  small  stump  buried  beneath  a  covering  of 
serous  membrane  to  prevent.it  becoming  adherent 
to  the  enlarging  uterus.  The  cyst  in  the  omentum 
was  removed,  and  the  parts  returned  within  the  ab- 
domen. The  aperture  in  the  serous  membrane  and 
the  posterior  layer  of  the  rectus  sheath  were  closed 
by  a  series  of  interrupted  sutures  of  fine  silk,  then  the 
rectus  muscle  was  replaced  in  position,  and  the  anterior 
layer  of  its  sheath  similarly  stitched  ;  the  skin  and 
subcutaneous  tissues  were  finally  brought  together 
by  a  series  of  silkworm-gut  sutures,  and  the  wound 
dressed  with  gauze  and  collodion. 

The  patient,  who  had  double  mitral  disease  as  well 
as  the  abdominal  trouble,  took  chloroform  fairly  well. 
She  stood  the  operation  excellently  and  exhibited  no 
untoward  signs  whatever,  having  no  indications  of  any 
threatening  of  miscarriage.  Mr.  Eccles  stated  that 
although  the  diagnosis  could  not  be  said  to  be  cer- 
tainly that  of  appendix  inflammation,  yet  it  was  so 
suggestive  that  he  deemed  it  advisable  to  explore,  in 
spite  of  the  fact  that  the  woman  was  pregnant,  and 
had  a  cardiac  lesion.  In  fact,  he  was  convinced  that 
the  condition  of  the  pregnancy  was  a  strong  argument 
in  favour  of  exploration,  for  there  was  a  great  pro- 
bability that,  seeing  the  patient  had  had  two  definite 
attacks  of  some  inflammatory  mischief,  she  was  likely 
to  be  again  subjected  to  it.  Suppurative  appendicitis 
in  the  course  of  pregnancy,  he  thought,  was  of  the 
gravest  import,  particularly  when  the  appendix  hung 
over  the  brim  of  the  pelvis,  for  then  the  side  of  the 
enlarged  uterus  might  be  a  portion  of  the  abscess  wall, 
and  abortion  or  miscarriage  was  extremely  liable  to 
occur,  leading  to  a  rapid  diminution  in  the  size  of  the 
uterus,  and  thus  a  tearing  away  of  one  part  of  the 
limiting  wall  of  the  abscess  and  the  flooding  of  the 
peritoneum  with  pus.  The  operation  in  the  quiescent 
period  was,  he  pointed  out,  almost  without  risk,  and 
placed  the  patient  in  a  safe  condition.  Mr.  Eccles  be- 
lieved that  the  incision  which  he  had  employed  was 
the  best,  namely,  that  through  the  rectus  sheath,  with 
displacement  of  the  muscle.  True,  it  had  the  objection 
of  rendering  the  operation  a  little  more  difficult  from 
its  internal  position,  but  it  had  the  great  advantage 
in  being  practically  safe  from  the  after  occurrence 
of  a  ventral  hernia.  This  in  such  a  case  as  the  present 
one  was  a  great  desideratum. 

A  week  after  the  operation  the  wound  was  com- 
pletely healed,  and  the  patient  entirely  free  of  pain. 
GREAT   NORTHERN   HOSPITAL. 

Two  Cases  of  Gastric  Ulcer. — First  Case. — Mr. 
Peyton  Beale  operated  on  a  woman,  aet.  about  40, 
who  had  been  under  medical  treatment  at  the  hospital 
for  three  months  for  symptoms  which  led  to  a  diagnosis 
of  gastric  ulcer.  She  had  improved  markedly  for  a 
fortnight,  but  directly  any  attempt  was  made  to  give 
her  solid  food  she  at  once  relapsed  with  intense  localised 
epigastric  pain,  vomiting  and  repeated  haemorrhage. 
As  these  symptoms  had  recurred  two  or  three  times, 
and  as  further  medical  treatment  appeared  to  be  of 
no  avail,  and  the  patient  was  evidently  losing  ground, 
she  was  transferred  to  a  surgical  ward.  The  following 
operation  was  performed  : — A  skin  incision  about 
three  inches  long  was  made  parallel   to,  and  about 


half  an  inch  below,  the  left  costal  margin,  the  incision 
beginning  about  the  median  line  of  the  abdomen. 
The  edges  were  retracted  and  the  muscular  and  peri- 
toneal layers  incised  in  the  same  direction,  but  about 
half  an  inch  below  the  skin  incision.  The  anterior 
wall  of  the  stomach  being  thus  exposed,  a  hard  lump, 
about  the  size  of  a  florin,  could  be  felt  in  it ;  this  appeared 
to  involve  the  mucous  membrane  and  about  one-half 
of  the  muscular  wall,  and  was  only  felt  when  the 
stomach  was  pinched  up  between  the  finger  and  thumb. 
The  anterior  wall  of  the  stomach,  including  the  lump, 
was  pulled  out  of  the  wound  and  a  two  inch  incision 
made  through  the  stomach  wall  about  half  an  inch 
above  the  margin  of  the  lump.  It  was  then  seen  that 
there  was  a  ragged  ulcer  about  half  an  inch  in  diameter, 
with  very  hard  and  thickened  edges.  This  was 
excised,  together  with  the  whole  thickness  of  the 
stomach  wall,  with  scissors,  the  incision  commencing 
on  the  mucous  aspect  of  the  stomach.  The  aperture 
resulting  from  the  excision  of  the  ulcer  was  stitched 
up  from  within  with  interrupted  sutures  placed  about 
one-eighth  of  an  inch  apart,  then  the  original  wound 
in  the  stomach  wall  was  stitched  up  from  the  outside 
with  continuous  and  interrupted  silk  sutures.  During 
the  performance  of  the  operation  the  house  surgeon 
kept  a  sufficient  portion  of  the  stomach  outside  the 
abdominal  wound  as  to  prevent  any  of  its  contents 
entering  the  peritoneal  cavity.  The  abdominal 
wound  was  then  closed  in  the  usual  manner,  a  small 
gauze  drain  being  left  in  for  the  first  twenty-four 
hours. 

Second  Case. — A  young  woman,  aet.  20,  was  admitted 

with  symptoms  of  ruptured  gastric  ulcer.  There  was 

a  typical  history  of  an  ulcer  extending  over  two  years. 

Thirteen  hours  previous  to  admission  she  was  suddenly 

seized   with   very   intense   pain   and   collapse,    which 

clearly  coincided  with  the  rupture  of  the  ulcer.     An 

abdominal  incisidn  similar  to  that  in  the  previous  case 

was  made,  and  the  peritoneal  cavity  found  full  of  the 

contents  of   the  stomach,   the  ruptured  ulcer  being 

discovered  without  much  difficulty  on  the  posterior 

wall  at  the  pyloric  end   of   the   viscus.     A  two  inch 

incision  was  made  through  the  anterior  wall  of  the . 

stomach,  and  the  organ,  together  with  as  much  of  the 

peritoneal  cavity  as  possible,  was  quickly  washed  out 

with  large  quantities  of  hot  sterile  water.     The  ulcer 

in  this  case  was  only  about  half  an  inch  in  diameter, 

the  perforation   being  about  a  quarter  of  an  inch. 

As  in  the  previous  case,  the  whole  ulcer  was  excised 

with  scissors  from  within,  through  the  incision  in  the 

anterior  wall,  and  its  edges  were  rapidly  sutured  as 

before,  the  anterior  stomach  incision  being  afterwards 

stitched  up.      In  this  case  a  couple  of  large  gauze 

drains  were  left  in  the  abdominal  wound  to  remain 

for  two  days,  and  the  peritoneal  cavity  was  left  as  full 

as  possible  of  hot  sterile  water.     Mr.  Beale  said  that 

in  all  cases  of  gastric  ulcer  on  which  he  had  operated 

within     the    last   two   years,   including  chronic  and 

ruptured,    he   had   adopted   this   method   of   opening 

the  stomach  at  some  little  distance  from  the  ulcer, 

and  then  excising  the  latter    including  the  thickness 

of   the   whole   stomach   wall,    the   edges   being   then 

stitched  together.     The  advantages,  he  pointed  out. 

of  this  method  were  that  it  could  be  done  very  quickly, 

that    the   stitches   passed    through    healthy   stomach 

wall,  and  that  it  involved  comparatively  very  little 

pulling  about  of  the  organ.     He  said  it  was  true  that 

operating  in  this  way  involved  the  stitching    up  of 

two  incisions  in  the  stomach  wall,  but  even  this  could 

be  performed  rapidly.     It  was  necessary,  he  said,  to 

feed  the  patient  per  tectum  for  three  days,  and    he 

had  found  that  on  the  fourth  day  there  was  no  danger 


FfeB.  14*   "904* 


LEADING   ARTICLES, 


The  Medical  Press.     211 


ill  feeding  the  patient  by  the  mouth  with  fluid  food. 
01  'course,  it  was  unlikely  that  the  sutured  wounds 
m  the  stomach  were  absolutely  watertight  when  they 
were  stitched  up,  but  they  appeared  to  become  so 
in  about  tweuty*four  hours.  He  considered  it  more 
important  to  carry  out  an  operation  of  this  kind 
quickly  than  to  attempt  to  obtain  an  absolutely 
watertight  junction. 

In  one  of  these  cases,  at  least,  il  was  certain  that 
gastric  juice  was  escaping  into  the  peritoneal  cavity 
when  the  wound  was  dressed  twelve  hours  after  opera- 
tion, but  its  presence  appeared  to  have  no  ill  effects. 
Both  patients  did  well. 


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■ 

STREET  NOISES. 

TiiERE  are  some  influences  in  modern  life  to 
b  it  is  extremely  difficult  to  assign  a  definite 
place  in  the  etiology  of  disease,  and  yet  there  can 
be  no  doubt  that  they  exercise  a  highly  deleterious 
effect  both  upon  individuals  and  upon  the  public 
health.  Noise  is  one  of  these  influences.  Every- 
one will  agree  that  quiet  is  essential  to  the  main- 
tenance of  that  placidity  of  the  nervous  system 
which  enables  it  to  do  its  work  to  the  greatest  ad- 
vantage.     Many  of  the  jars  of  modern  life  are  harm- 

»ful   although    none    the    less    inevitable.     Irrita- 
bility of  disposition,   spasmodic  activity   of    the 
nerve    centres,    continual    tension — all    of    these 
conduce  to  early  fatigue  and  rapid  wearing  ou  t  of 
the  tissues,     A  train  of  evils  follow  in  their  wake. 
Sleeplessness  is  perhaps  the  worst.     The  working 
value  of  the  citizen  to  the  State,  to  say  nothing  of 
his  own  peace  of  mind* is  greatly  lowered.     Caesar 
wished  for  his  counsellors  calm ,  placid  individuals. 
"Let  me  have  men  about  me  that  are  fat ; 
Sleek -headed  men,  and  such  as  sleep  o'  nights. " 
And  Caesar  was  right.  The  man  that  has  his  nervous 
system  constantly  on  the  stretch,  "  keyed-up,"  as 
the  Americans  call  it,  is  the  man  who  will  break 
Q  when  the  big  strain  comes.     Noise  is  perhaps 
<>nc  of  the  most  potent  factors  in  producing    that 
im  lability  which  denies  men  the  power  of  doing 
Hieir  best  work  when  young,  and   tends   to   the 
abrogation  of   the  power  of  working  at  all   soon 


after  middle  age,     How  far  it  may  handicap  even 
a  genius  is  shown  by  the  effect  it  had  on  such  a 
concentrated  worker  as  Carlyle.  The  exasperation 
caused  to  the  sage  by  the  Chelsea  cocks  is  notorious,, 
and  the  ebullitions  of  wrath  that  followed   their 
incessant    crowing    have   often   been    the   subject 
Oj  mirth   among   men  of   coarser  temper  than  the 
author  of  H  Sartor  Resartus,*'  But  that  they  really 
prevented  his  turning  out  his  masterpieces  till  he 
had  constructed  the  sound-proof  chamber  in   his 
house  is  an  actual  fact  that  no  one  doubts.     So, 
too,  with  sleep.     It  is  hardly  worth  stating  so 
obvious  a  truism  as  that  noise  prevents  sleep,  and 
that  without  sound  sleep  no  one  is  capable  of  sus* 
taincd  effort.     Now  noise  is  bad  enough  in  itself, 
but  its  influence  is  far  wider  than  the  mere  reflex 
it    produces.     A  continuous   noise   may   cease   to 
ruffle  the  dispositions  of  those  within  its  range  ; 
use  makes  one  unconscious  of  it.     The  engineer  of  a 
ship  no  more  notices  the  noise  of  his  engines   than 
he  does  the  ticking  of  his  watch  ;  but  he  will  wake 
in  an  instant  if  his  engines  stop.     It  is,  then,  not 
noise  itself  that  is  harmful,  but  unexpected  noise. 
Perhaps  what  is  even  more  distracting  is  the  antici- 
pation of  noise,  the  uncertainty  as  to  whether  it 
will  come  or  not.  The  strain  of  expecting  the  noise 
which  is  postponed  is  more  trying  than  the  actual 
sound  when  it  does  come,  and  the  tension  that  is 
not  relieved  amounts   to  positive  pain  at   times. 
The   town  dweller  gets  accustomed   to  a  certain 
normal  roar  or  hum  in  the  atmosphere  and  takes 
but  little  notice  of  it  ;  the  cabs,  the  omnibuses,  the 
carts  go  by  in  a  continual  stream,  and  he  is  not 
disturbed.      There    is    a    merciful    compensatory 
mechanism  somewhere    in   the    cerebrum.        But 
the  cries  of  the  street -hawker,  the  music  of  the 
barrel-organ,  and  the  vociferations  of  the  newsboy 
are    different.     These    sounds    come    irregularly 
and     sporadically,     and    frequently ;     none    are 
necessary  and  all  are  of  the  most  irritating    type, 
The  street  hawkers*  wares  are  visible  to  the  eye 
without  stentorian  appeals  to  the  ear  being  required 
to  attract  the  customer  ;    the  clatter  of  the  street 
organ  is  painful  to  all  who  have  music  in  themselves 
and  delights  only  the  quidnunc  urchin  of  the  gutter; 
the  contents  bill  of  the  newspaper  is  generally  got 
up  to  make  a  sufficient  impression  on  the  senses 
without  the  hullabaloos  of  gamins  who  sell    them 
being  needed  to  confirm  it.     The  wear  and  tear  of 
town  life  already  tax  the  resources  of  the  nervous 
system  to  the  uttermost,  and  it  is  high  time  that  it 
should  be  relieved  of  a  burden  already  almost  too 
heavy  to  be  borne.     We  sympathise  sincerely  with 
the  desire  of  the  County  Council  to  put  an  end  once 
and  for  all  to  all  unnecessary  cries  and  clatter  by  a 
by-law  for  the  whole  area  of  the  Metropolis,  and 
we  think  it  a  pity  that  the  Home  Secretary  should 
have  decided  that  it  was  better  to  Leave  the  framing 
to  these  laws  to  the  borough  councils  individually. 
As,  however,   the  duty  has  been  left   to  them  we 
trust  they  will  take  the  matter  in  hand  without 
delay.     The  more  stringent   the  by-law  and   the 
heavier  the  penalty  (within  reason)  the  better  we 
shall  be  pleased.     Kensington  has  already  taken 
the  matter  in  hand,  and  Paddington  is  proposing 


212    The  Medical  Press. 


LEADING   ARTICLES. 


to  follow  suit.  Is  it  too  much  to  hope  the  other 
borough  councils  will  not  lag  behind,  but  make  a 
determined  effort  to  suppress  an  unnecessary  evil 
that  makes  life  unbearable  for  many  and  may  even 
shorten  it  for  not  a  few  ? 


Feb.  24,  1904. 


TYPHOID  FEVER  AND  MALARIA. 
Every  practitioner  knows  that  there  are  few 
diseases  so  difficult  of  diagnosis  as  typhoid  fever. 
Insidious  in  its  onset,  and  rarely  answering  in  any 
one  case  in  more  than  a  few  of  its  features  to  the 
classical  descriptions,  there  are  at  least  half  a 
dozen  other  conditions  which  one  must  bear  in 
mind  when  giving  an  opinion  early  in  the  disease. 
Until  its  duration  and  some  special  characters  dis- 
tinguish it,  it  is  very  liable  to  be  mistaken  for 
influenza,  and,  on  the  other  hand,  diseases 
differing  so  enormously  in  pathology  from  it  and 
from  each  other  as  general  miliary  tuberculosis  and 
tuberculous  meningitis  have  not  seldom  been  mis- 
taken for  it.  In  this  country  luckily  we  have  not, 
as  a  rule,  to  consider  malaria  as  one  of  the  diseases 
needing  a  differential  diagnosis  from  typhoid  fever. 
In  the  United  States,  however,  there  seems  to  be 
a  very  great  difficulty  in  distinguishing  them. 
Indeed,  so  notorious  is  this  that  at  the  last  meeting 
of  the  American  Medical  Association  a  warm 
debate  took  place  on  the  question  whether  in  many 
parts  of  the  continent  what  is  described  as 
*  *  malaria/ '  or  simply  "fever,"  is  not  in  truth 
typhoid.  It  appears  that  taking  the  States  as  a 
whole,  the  Census  returns  furnished  by  the  pro- 
fession give  malaria  credit  for  half  as  many  deaths 
as  typhoid.  On  the  other  hand,  a  special  Govern- 
ment Commission  which  inquired  into  the  health 
of  the  army  was  unable 'to  find  any  evidence  that 
fatal  malarial  infection  had  occurred  among 
soldiers  in  any  part  of  the  States.  Again,  the 
mortality-rate  with  which  the  profession  at  large 
charges  malaria  is  entirely  out  of  proportion  to  the 
rate  as  determined  by  hospital  physicians.  Ac- 
cording to  Dr.  Fulton,  of  Baltimore,  a  critical 
observer,  not  one  person  a  year  dies  of  malaria  in 
Maryland,  although  it  is  undoubtedly  a  consider- 
able cause  of  disability  in  some  parts  of  that  State. 
In  the  same  strain,  Dr.  Krauss,  of  Memphis,  fixes 
the  malarial  mortality-rate  in  his  own  practice  as 
low  as  0*4  per  cent.  It  is  also  noted  that  in  Mary- 
land, where  examinations  of  the  blood  for  the 
malarial  parasite  are  regularly  made  by  the  health 
authorities,  only  in  5  per  Cent,  of  the  specimens 
submitted  I  has  the  diagnosis  been  confirmed. 
Under  the  circumstances  there  is  much  in  favour  of 
Osier's  dictum  that  every  continued  fever  not 
yielding  in  six  or  seven  days  to  quinine  should  be 
regarded  as  typhoid,  until  it  is  definitely  decided 
to  be  something  else. 


THE  PLEA  OF  INSANITY. 
The  old  question  as  to  who  is  the  better  judge 
of  insanity — the  lawyer  or  the  medical  man- 
was  again  to  the  fore  in  a  case  heard  at  the  Oxford 
Assizes  on  the  fourth  of  this  month.  The  facts 
were  very  simple,  and,  indeed,  were  not  seriously 
in    dispute.      The   prisoner,     Mr.    Bond,    was    a 


gentleman   who,    after   much  hardship  in  early 
life,  succeeded  in  educating  himself  and  graduating 
with  /clat  at  the  University  of  Dublin.    He  took 
Holy  Orders,  held  several  responsible  masterships 
in  schools,   and   finally  was  appointed  chaplain 
to  a  county  lunatic  asylum.    This  post  he  held 
for  twenty-seven  years,  at  the  end  of  which  time 
he  retired  of  his  own  accord  on  accepting  a  living. 
Soon  after  this  mental  symptoms  developed,  and 
one  day  he  was  charged  with  committing  an  act 
of  indecency  with  a  little  girl,    a  charge  that  the 
magistrates    dismissed.     He    thereupon    resigned 
his  living,  and  went  with  his  wife  to  live  near 
Oxford.     Since  then  other  acts  of  the  kind  men- 
tioned were  charged  against  him,  and  eventually 
he  found  himself  committed  for  trial  at  the  Assizes. 
Now  we  admit  that  to  the  ordinary  healthy  mart 
no  crime  is  more  revolting  than  that  with  which 
Mr.  Bond  was  charged,  and  none  raises  so  much 
indignation  in  one's  breast.     That,  however,  is 
not  the  point  at  issue.    The  question  is — Does  a 
man  who  has  lived  an  upright,  straightforward 
life,    who    has    held    honourable    positions   with 
credit  to  himself,  who  has  won  respect  as  a  minister 
of  religion  for  more  than  a  quarter  of  a  century, 
does  such  a  man,  we  ask,  in  the  evening  of  his 
days,  fall  into  practices   that  would  disgrace  a 
guttersnipe,   without  serious   cause  ?     If  a  man 
were    the   depraved    degenerate    that    such   acts 
would  proclaim  him,  he  could  not  have  passed 
through  a  long  life  without  giving  evidence  of 
the  fact.     In  this  case  such  evidence  was  lacking. 
The  defending  counsel  called   two  alienists  of  the 
highest  standing,  who  both  swore  that  the  prisoner 
was  suffering  from  senile  degenerative  changes,  for 
which  there  was  abundant  physical  confirmation 
apart   from   the  subjective   symptoms  of  which 
the  prisoner  complained.    There  had  been  pro- 
gressive numbness  of  the  limbs  for  the  previous 
eighteen  months,  attacks  of  giddiness,  confusion 
of  ideas,  and  loss  of  memory  ;  besides  these  the 
arteries    showed    degenerative    changes    in   their 
walls.     Will    power    was    defective    and    uncon- 
trollable, perverse  sexual  ideas  came  upon  him 
from  time  to  time.    In  fact,  a  clearer  case  of  senile 
decay,  physical  and  mental,  could  not  be  con- 
ceived.    The  judge,   Mr.    Justice   Ridley,  in  his 
summing  up,  said  that,  with  all  respect  for  the 
medical  witnesses,  the  question  for  the  jury  was— 
Did  the  prisoner  know  that  the  act  was  wrong 
at  the  time  it  was  committed,   or  not  ?      In  the 
latter  case  he  had  established  his  defence  ;  in  the 
former  he  had  not.     Now,  as  it  had  been  already 
admitted    by    the    medical    witnesses    that    the 
prisoner  knew  he  was  doing  wrong  and  yet  could 
not  help  it,  this  was  tantamount  to  telling  the 
jury  what  verdict  they  should  give.     They  under- 
stood it  evidently  in  that  sense,  and  found  the 
prisoner  guilty.     He  was  sentenced  to  six  months' 
imprisonment    with    hard    labour.    There    can, 
therefore,  be  no  question  as  to  what  the  judge 
himself   thought   of   the   case.     Here   is   a  clear 
issue.     Mr.  Justice  Ridley  doubtless  felt  himself 
bound  by  the  Macnaughten  rules,  which  laid  down 
that  the  responsibility  of  the  insane  rested  on  the 


Feb.   24.    1904* 


NOTES    ON    CURRENT    TOPICS,  The  Medical  Press.     213 


appreciation  of  the  Tightness  or  wrongness  of  the 
particular  act  committed,  and  in  this  case  the 
;ver  knew  that  he  was  doing  wrong  at  the 
time.  The  medical  witnesses  were  emphatic 
that  he  acted  under  an  uncontrollable  impulse, 
and  that  this  want  of  control  was  part  of,  and 
resulted  from,  his  pathological  condition.  Surely 
here  was  a  case,  if  ever  there  was  one,  for  the  judge 
to  exercise  his  discretion.  But  Mr.  Justice 
RidJey  entirely  repudiated  the  idea  that  mere 
decay  of  faculties  was  evidence  of  insanity p  or 
that  a  person  suffering  from  senile  decay  was  not 
responsible  for  his  actions.  On  this  view  he 
signed  what  must  practically  be  the  death- 
warrant  of  the  unfortunate  prisoner.  Two  con- 
clusions follow  obviously  from  these  facts.  First, 
that  Mr.  Justice  Ridley  has  the  most  crude  notions 
of  mental  pathology.  He  thinks  that  because  he 
has  known  a  certain  number  of  people  who  have 
shown  eccentricities  in  their  old  age,  and  yet  have 
remained  responsible  agents,  that  he  understands 
the   whole   of    that    morbid     condition   which   we 


call  senile  dementia.  Secondly,  that  the  rules 
laid  down  by  the  Lords  after  the  Macnaughten 
case,  although  certainly  an  improvement  on  those 
that  existed  before  h  are  far  from  meeting  every 
case  of  insanity,  The  lawyer  prides  himself  on 
knowing  all  that  it  is  necessary  to  know  of  insanity 
because  be  has  a  good  knowledge  of  things  in 
general  ;  the  alienist  doctor  in  his  view  is  a  crank 
who  is  perhaps  a  little  tainted  by  contact  with  his 
patients  ;  in  fine,  Mr.  Justice  Ridley  summed  the 
situation  up  concisely  when  the  told  the  jury  **  to 
exercise  their  common  sense  as  men  of  the  world ." 
This  form  of  legal  arrogance  cannot  be  too  stren- 
uously resisted — for  the  sake  of  the  victims  who 
suffer  from  its  presumption.  A  lawyer,  have  he 
never  so  much  common  sense  as  a  man  of  the 
world,  would  not  feel  it  within  his  province  to 
decide  if  a  patient  were  suffering  from  typhoid 
fever  or  acute  tuberculosis  ;  he  would  be  glad  to 
avail  himself  of  the  services  of  the  man  who  had 
spent  a  lifetime  in  the  study  of  the  conditions, 
and  to  take  his  decision,  For  the  same  reason  he 
should  understand  that  the  only  person  in  the 
least  capable  of  deciding  whether  or  not  a  patient 
was  suffering  from  senile  dementia >  or  any  other 
form  of  insanity,  is  the  man  who  has  made  himself 
master  of  the  manifestations  of  the  brain  in  health 
and  disease.  An  educated  man  does  not  lose 
"his  common  sense  as  a  man  of  the  woild'4 
because  he  happens  to  have  studied  the  pathology 
of  the  human  body,  and  it  would  be  well  if  the 
lawyers  were  gifted  with  a  sufficient  sense  of 
humour  to  see  how  egregiously  they  err  when 
they  pronounce  opinions  on  subjects  which  they 
cannot  in  the  least  understand. 


Botes  on  Current  Hoptcs, 

The  Royal  Army  Medical  College. 

Standing  far  apart  from  the  ordinary  run  of  open- 

ing  addresses,  and  of  interest  alike  in  its  occasion 

and  its  matter,  was  Sir  William  Taylors  welcome 

to  the  young  Army  medical  officers  just  arrived 


at  the  Royal  Army  Medical  College.  There  has 
been  far  too  much  running-down  of  the  Army 
Medical  Service  in  the  past,  and  civilians  have 
sometimes  shown  a  tendency  to  contemn 
their  brethren  in  the  Service,  as  men  of  a  lower 
professional  standing  than  themselves.  Such 
an  attitude  must  have  a  strong  and  bad  effect  on 
the  self-respect  of  medical  officers,  while  at  the 
same  time  it  tends  to  deter  the  better  class  of 
young  graduates  from  entering  the  Service.  The 
Director-General  is  quite  right  in  believing  that 
he  can  do  nothing  of  so  much  value  to  his  Corps 
as  make  the  young  surgeons  recognise  that  they 
should  be  proud  to  belong  to  it,  and  his  address 
is  eminently  well  calculated  to  that  end.  The 
progress  of  science  owes  far  more  to  officers  in 
the  Government  service  than  is  usually  admitted. 
In  two  great  departments  the  pioneers  during 
the  last  half  century  were  Army  medical  men — 
in  hygiene  and  tropical  diseases.  "  The  Army 
Medical  School  may  well  be  proud  of  the  world- 
wide fame  which  its  first  Professor  of  Military 
Hygiene  earned  for  himself.  Among  the  many 
reputations  as  hygienists  which  have  since  been 
earned  there  is  no  name  so  illustrious  as  that 
of  Professor  Parkes.1*  And  among  Parkes'  pupils 
there  have  been  many  who  have  well  maintained 
tbe  honours  of  the  Service  in  the  field  of  hygiene. 
In  early  days  DcChaumont,  and  later  Colonel  Lane 
Notter,  Colonel  Firth,  Colonel  Davics,  and  Major 
Horrocks,  are  men  of  more  than  insular  reputa- 
tion. In  the  field  of  pathology  almost  our 
whole  knowledge  of  trypanosomiasis  is  due  to 
the  Services,  from  Lewis*  disco  very  of  the  flagel- 
late in  the  blood  of  rats,  to  Colonel  Brace's  recent 
researches  on  sleeping  sickness  in  Uganda.  It  is 
superfluous  to  say  anythingof  Major  Ronald  Ross. 
Of  living  pathologists  there  are  no ne  of  greater  em- 
inence in  England  than  Professor  Wright  and  Ins 
successor  Major  Leishman.  Sir  William  Taylor  has 
done  excellently  in  directing  the  attention  of 
his  recruits  to  such  men  as  he  has  mentioned,  for 
in  their  footsteps  any  man  of  science  may  be 
proud  to  walk. 


More  About  Radium 
Almost  every  week  fresh  reports  come  to  hand 
of  the  therapeutical  applications  of  M.  Curie's 
wonderful  discovery.  In  our  last  number  a 
rfsunif  of  some  of  the  results  so  far  obtained  was 
published  by  Dr.  WTalsh  in  his  account  of  the 
remarkable  case  of  malignant  disease  of  the 
throat,  which  he  is  now  treating  by  the  application 
of  radium.  Experimental  observations  of  the 
effect  of  the  emanations  in  various  morbid  con- 
ditions other  than  malignant  disease  are  being 
Carried  out  in  several  widely  distant  centres. 
A  most  suggestive  and  interesting  paper  was  read 
by  Dr.  Darier,  on  February  17th,  before  the 
Academic  de  Medecine,  at  Paris,  on  the  use  of  radium 
of  low  radio-active  potentiality.  The  high  radio- 
activity of  the  pure  element  is  needed  for  the 
destructive  metamorphosis  of  new  growths,  but 
radio-activity  of  far  lower  potentiality  can  be  used 
in     other    conditions,     apparently    with    benefit. 


214    The  Medical  Press. 


NOTES  ON  CURRENT  TOPICS. 


Feb.  24,  1904. 


The  lower  grade  activities  have  two  advantages  ;  1  to  grasp.  In  an  English  court  of  law  a  medical 
first,  they  can  be  used  over  far  longer  periods  of  j  man  is  bound  to  reveal  secrets  confided  to  him. 
time — Dr.  Darier  has  used  them  for  as  long  as  ,  In  France  he  is  forbidden  to  do  even  this.  A 
six  hours  at  a  stretch — and,  secondly,  the  pre-  I  doctor  there  was  fined  lately  because,  in  defending 
parations  of  radium  from  which  the  rays  are  an  action  for  negligence  brought  against  himself, 
obtained  cost  only  a  fraction  of  the  element  :  he  detailed  the  nature  of  the  case  and  his  treat- 
itself.  One  of  the  cases  treated  suffered  from  j  ment.  But  in  this  country  outside  a  court  of 
facial  paralysis  of  what  seemed  to  be  rheumatic  ,  law  a  doctor  is  bound  by  the  Hippocratic  tradition, 
origin,  and  he  was  cured  by  a  single  application,    and  whether  the  patient  be  "  duke's  son,  cook's 


Two  cases  of  convulsive  seizures  of  a  hystero- 
epileptic  character  lost  their  symptoms  after 
three  days'  exposure  to  radium  emanations 
directed  on  to  the  temples,  and  another  patient 
of  the  neurasthenic  type  was  restored  to  health 
in  a  similar  period.  Remembering  the  extra- 
ordinary degree  to  which  treatment  by  suggestion 
was  carried  in  some  of  the  French  cliniques  a 
few  years  ago,  one  hesitates  to  take,  unconfirmed, 
these  reports  as  establishing  more  than  a  presump- 
tion. But  in  cases  where  all  methods  fail  in 
dealing  with  anomalous  functional  nervous  sym- 
ptoms— and  one  is  at  one's  wit's  end  to  devise 
new  ones — the  mental  and  moral  effect  of  radium 
emanations  may  procure  a  result  that  could  not 
be  compassed  by  other  means.  If  only  tem- 
porary amelioration  can  be  promised  by  the  use  of 
radium  and  radio-active  substances,  they  may 
still  be  of  service  to  prevent  these  cases  drifting — 
where  they  generally  do  drift — into  the  hands  of  the 
quacks. 

Professional  Secrecy. 
The  usual  misunderstandings  and  the  usual 
crop  of  comments  have  been  excited  by  the 
strictly  justifiable  attitude  taken  up  by  Dr. 
Parsons,  of  the  Fulham  Infirmary,  in  a  recent  case 
of  suspected  crime.  The  police  had  reason  to 
believe  that  a  servant-girl,  who  had  been  in  the 
Infirmary,  had  concealed  the  birth  of  a  child, 
whose  body  was  found  in  a  dust-destructor. 
They  made  inquiries  of  Dr.  Parsons,  who  pointed 
out  to  them  that  it  was  no  part  of  his  duties  to 
give  them  information  with  regard  to  the  patients 
under  his  care.  An  inquest  was  held  on  the 
child's  body,  and  Dr.  Parsons  being  called,  he 
proceeded  to  give  his  evidence  on  oath.  The 
servant  girl  was  subsequently  charged  at  the  West 
London  Police  Court  with  concealment  of  birth, 
but  in  the  result  was  dismissed.  The  authorities 
complained  to  the  magistrates  of  their  inability 
to  extract  information     from  Dr.  Parsons,  when 


son,  or  son  of  a  belted  earl,"  his  duty  is  the  same. 
It  takes  considerable  moral  courage,  especially 
in  those  holding  public  appointments,  to  act  up 
to  the  level  of  their  convictions  in  this  matter, 
and  Dr.  Parsons  is  to  be  congratulated  in  main- 
taining his  position  before  the  authorities  in 
question  with  so  much  firmness  and  dignity. 


Osborne  College. 
The  King,  like  all  good  F.R.C.P.'s,  does  not 
"  want  the  natural  touch."  There  is  no  monarch 
of  ancient  or  modern  times,  not  even  excepting 
the  late  Queen,  who  has  shown  so  admirably  what 
true  philanthropy  is.  Matthew  Arnold  called 
religion,  "  morality  tinged  with  emotion  "  ;  we 
might  define  philanthropy  as  "  pity  tinged  with 
discrimination."  The  King  does  nothing  rashly- 
even  his  good  works — and  nothing  half-heartedly. 
His  gift  of  Osborne  House  to  the  nation  for  the 
double  purpose  of  a  naval  college  and  a  con- 
valescent home  for  sick  officers  could  not  have  been 
more  happily  conceived.  Instead  of  keeping  the 
beautiful  house  as  a  kind  of  mausoleum,  as  would 
have  been  quite  comprehensible  under  the  cir- 
cumstances, he  has  perpetuated  his  mother's 
memory  far  more  nobly  by  making  it  a  place 
where  national  need  and  national  pity  find  joint 
expression.  The  part  of  the  house  that  is  to  be 
used  as  a  convalescent  home  is  nearly  ready  for 
occupation,  and  the  Office  of  Works  have  done 
their  work  well  and  efficiently,  without  much 
alteration  to  the  existing  structure.  Provision 
has  been  made  for  thirty-eight  single  and  five 
married  officers'  quarters,  the  former  being  pro- 
vided with  an  elegant  bed-sitting  room,  the  latter 
with  two  communicating  chambers,  with  the 
necessary  wardrobe  accommodation.  Sisters'  and 
nurses'  quarters  are  also  being  prepared,  and,  of 
course,  rooms  for  the  servants  and  attendants. 
The  beautiful  grounds  and  terraces  overlooking 
the  Solent  are  to  be  reserved  for  the  patients' 
use,  whilst  the  chapel  has  been  turned  into  a 
called  on  by  the  police,  and  the  magistrate  ex-  reading  and  recreation  room.  Nor  has  His 
pressed  surprise  that  the  doctor  should  not  have  |  Majesty's  regard  for  his  officers  led  him  to  forget 
done  what  he  could  to  "  assist  the  course  of  I  one  who  has  served  him  in  another  capacity, 
justice."    This  incident  has  given  rise  to  similar    Miss  Haines,  the  lady  who  nursed  him  so  devotedly 


expressions  of  surprise  in  our  lay  contem- 
poraries. The  burden  of  professional  secrecy 
laid  on  medical  men  will  probably  never  be  under- 
stood by  the  public.  They  are  exceedingly 
indignant  when  a  doctor  reveals  anything  to  then- 
hurt,  and  quite  ready  to  sue  him  for  damages. 
But  in  the  case  of  a  poor  unfortunate  servant  girl, 
who  has  "  got  into  trouble,"  how  the  same  ethical 
principle  can  apply  when  the  girl  is  not  likely  to 
be  able  to  take  the  offensive  they  seem  unable 


in  his  last  illness,  is  to  be  the  matron  of  the  home, 
a  reward  for  her  skill  and  fidelity  that  does  credit 
alike  to  herself  and  her  Royal  master. 


Inquiry  into  London  Tuberculosis. 
The  Council  of  the  Royal  Institute  of  Public 
Health  have  been  moved  to  consider  whether 
the  time  has  not  arrived  when  a  full  inquiry  into 
the  prevalence  and  causes  of  tuberculosis  in  London 
should  not  be  made.    The  eventual  object  of  such 


Feb.  14.  1904. 


NOTES  ON  CURRENT  TOPICS. 


Thx  Medical  Pskss.     215 


mquiry  would  be  to  ascertain  what  would  be  the 
best  plan  for  systematic  effort  to  work  on  in 
carrying  out  repressive  and  preventive  measures. 
With  this  idea  they  have  had  written  a  letter  to  the 
President  of  the  Local  Government  Board  asking 
if  the  Board  propose  to  take  any  steps  with  a 
view  to  advising  on  the  subject.  From  the  letter 
it  appears  that  the  Metropolitan  Asylums  Board 
already  been  asked  to  undertake  such  an 
inquiry,  and  the  Council  of  the  Royal  Institute 
still  hope  that  the  Board  may  consent  to  do  so 
if  pressure  be  exerted  by  the  Local  Government 
Board.  Failing  this,  however,  the  Royal  Institute 
proposes  to  set  about  the  task  itself.  It  would  be 
m  excellent  and  public -spirited  action  on  the  . 
part  of  the  Institute  to  undertake  a  work  of  such  . 
magnitude  and  importance,  and  it  is  to  be  hoped  \ 
that  if  it  does  so,  it  will  secure  the  services  of  men  1 
of  distinction  and  authority  to  sit  on  the  com- 
mittee. It  will  be  no  light  matter  to  investigate 
and  take  evidence  upon  every  point  that  should 
be  dealt  with  in  so  enormous  a  field  as  that  of 
London  tuberculosis,  and  it  is  to  be  feared  that 
the  thanks  which  an  unauthorised  committee 
will  get  will  not  be  at  all  commensurate  with  the 
amount  of  work  its  members  will  have  to  put 
in  It  is  a  matter  for  wonder  that  the  Council  of 
tte  Institute  do  not  see  the  absurdity  of  suggesting 
that  a  technical  and  complicated  inquiry  of  this 
load  should  be  undertaken  by  the  Metropolitan 
Asylums  Board,  The  Board  consists  of  repre- 
sentatives of  the  Guardians,  with  a  leavening  of 
nominees  of  the  Local  Government  Board,  and 
counts  only  two  or  three  medical  men  among  its 
members.  Such  a  function  would  be  quite  foreign 
to  them,  and  a  body  less  well  qualified,  both  by  its 
experience  and  its  personnel,  to  pursue  such  an 
inquiry  it  would  be  difficult  to  conceive. 

Resuscitation  from  Asphyxia, 
Apart  from  the  efficacy  of  mechanical  move- 
ments imitative  of  natural  respiration,  the  most 
important  question  in  the  treatment  of  asphyxia, 
especially  from  the  lay  standpoint,  is  that  of  the 
administration  of  stimulants.  In  cases  of  immer- 
sion, artificial  respiration  is  more  effective  than 
any  stimulant  because  it  acts  directly  in  removing 
foreign  material  from  the  air  cells  and  also  in 
relieving  the  engorged  right  side  of  the  heart. 
When  the  respiratory  movements  have  once  again 
become  automatically  established,  stimulants  may 
then  be  given  if  necessary.  In  asphyxia  from 
other  causes,  such  as  the  inhalation  of  carbonic 
acid  gas  or  other  noxious  fumes,  it  is  not  so  much  a 
matter  of  removing  foreign  matter  from  the  lungs 
as  of  supplying  the  needed  oxygen  to  the  blood . 
For  individuals  who  have  been  "  overcome  "  by 
tfie  efiects  of  smoke  from  a  fire,  it  is  obviously 
essential  to  provide  fresh  air  at  once,  and  that  in  a 
concentrated  form.  We  are  informed  that  in 
Berlin  every  fire-station  has  been  furnished  with  an 
oxygen  apparatus  for  this  purpose,  and  it  has  been 
suggested  that  the  London  Fire  Brigade  should 
fcUffw    suit.      The    ubiquitous     brandy- flask     is 


usually  forthcoming  upon  such  emergencies  in  this 
country,  and  very  often  no  attempt  is  made  to 
provide  a  sufficiency  of  fresh  air  for  the  patient. 
It  is  a  little  difficult  to  compare  the  actions  of 
oxygen  gas  and  brandy  under  these  circumstances, 
for  the  additional  injurious  efiects  of  excessive 
heat  have  also  to  be  taken  into  consideration. 
There  can  be  no  doubt,  however,  that  oxygen  is  a 
powerful  stimulant  to  the  heart  as  well  as  to  the 
respiratory  centre,  and,  moreover,  its  action  is  sus- 
tained and  unaccompanied  by  any  depressing 
after  effects.  Its  expense  would  be  the  chief 
drawback  to  its  general  use,  and  it  would  also  be 
necessary  to  have  it  supplied  in  small  portable 
cylinders  which  could  be  easily  conveyed  by 
hand.  Should  these  difficulties  be  surmounted, 
oxygen  would  doubtless  prove  a  valuable  addition 
to  the  equipment  of  ambulance  and  fire-stations. 


The 


Viceregal     Slight   to     the      Medical 

Profession. 
The  slight  which  has  been  put  upon  the  medical 
profession  in  Ireland  by,  as  it  is  generally  con- 
sidered, certain  officials  at  Dublin  Castle  has  been 
universally  condemned  in  Dublin,  not  alone  by 
the  medical  profession  but  by  the  general  public. 
The  opinion  is  freely  expressed*  and  we  fancy  it  is 
correct,  that  the  slight  is  none  of  His  Excellency's 
doing,  but  that  it  is  the  result  of  a  notion  that  has 
grown  in  the  minds  of  the  Castle  officials  that  the 
Court  of  Dublin  Castle  can  be  approximated  in  all 
particulars  to  the  Court  of  St,  James.  We  learn 
Lhat  a  meeting  was  held  at  the  Royal  College  of 
Surgeons  during  the  past  week  to  consider  the 
reply  received  from  His  Excellency's  private 
secretary,  and  that  it  was  resolved  by  that  body 
to  take  common  action  with  the  Royal  College  of 
Physicians  in  the  matter-  We  doubt  that  a  change 
in  His  Excellency's  plans  can  be  eflected  by  such 
action,  or  that  the  Colleges  will  gain  anything  by 
pressing  their  claim  beyond  a  certain  point. 
Already  the  matter  has  been  taken  up  by  the  Press, 
and  the  actions  of  the  Castle  officials  condemned. 
If  the  right  of  private  entree  is  net  restored  to  the 
colleges,  they  will,  we  consider,  best  consult  and 
maintain  their  dignity  if  their  future  Presidents 
refrain  from  attending  the  Lord  Lieutenant's 
levees  until  such  time  as  their  position  as  the 
titular  heads  of  the  medical  profession  in  Ireland 
is  again  recognised  by  Dublin  Castle. 

Family  Predisposition  to  Disease* 

The  belief  that  certain  diseases  occur  in  those 
who  are  related  by  family  ties,  even  apart  from  the 
influence  of  heredity,  has  long  been  held,  both  by 
the  general  public  and  also  by  the  medical  pro- 
fession. There  can  be  little  doubt  about  the  trans- 
mission of  a  tendency  to  phthisis  or  acute  rheu- 
matism from  one  generation  to  another,  and  it  is 
usually  considered  to  be  a  question  of  an  inherited 
peculiarity  of  soil  whereby  the  individual  is  more 
liable  to  a  specific  infection  from  without  than 
others  in  whom  this  special  predisposition  is 
wanting.  Lithiasis,  with  its  associated  condition  of 
arteriosclerosis,  is  well  known  to  run  in  families. 


2l6    The  Medical  Press. 


NOTES  ON  CURRENT  TOPICS. 


Feb.  24,  1904. 


What  the  exact  factors  may  be  which  determine 
the  appearances  of  disease  in  those  of  one  flesh 
and  blood,  it  is  difficult  to  ascertain  with  precision. 
Any  information,  therefore,  which  tends  to  throw 
new  light  upon  morbid  processes  is  to  be  welcomed. 
The  occurrence  of  uterine  fibro-myomata  in  five 
members  of  one  family,  in  all  of  whom  hysterectomy 
was  successfully  performed,  related  by  Dr.  J. 
Macpherson  Lawrie,  (a)  of  Weymouth,  is  of  great 
interest  in  connection  with  this  subject.  Another 
curious  pathological  feature  is  that  all  five  sisters 
were  also  affected  with  cataract .  Several  instances 
have  been  recorded,  from  time  to  time,  where 
fibroid  disease  of  the  uterus  has  been  met  with  in 
more  than  one  member  of  the  same  family,  and 
in  some  of  these  the  affection  has  been  traced  back 
for  one  or  two  generations.  The  suggestion  that 
the  degenerative  changes  affecting  two  important 
tissues  of  the  body,  the  uterine  and  the  lenticular, 
may  be  due  to  one  common  factor  indicating  some 
inherited  weakness  of  the  organs  concerned  sounds 
tempting  enough,  but  our  knowledge  of  the  condi- 
tions affecting  the  development  of  the  germ-cell  is 
so  small  that  it  would  probably  be  more  scientific 
to  regard  these  associations  as  merely  accidental. 


Irish  Maternity  Hospitals  and  the  Central 
Midwives  Board. 
We  publish  a  letter  from  Dr.  Ward  Cousins  in 
another  column  regarding  the  attitude  of  the 
Central  Midwives  Board  towards  the  great  Irish 
maternity  hospitals,  as  well  as  his  Report  to  the 
English  College  of  Surgeons.  It  will  be  remem- 
bered that  we  published  in  our  last  issue  a  copy 
of  the  correspondence  which  has  passed  between 
the  Master  of  the  Rotunda  Hospital  and  the  Board. 
In  a  covering  letter  from  the  Secretary  of  the 
Board  to  the  Master  of  the  Rotunda,  the  state- 
ment was  made  that  the  resolution  "  regretting  " 
that  the  Board  were  unable  to  recognise  Rotunda 
trained  nurses  had  been  unanimously  adopted  by 
the  Board.  This,  it  appears,  is  an  incorrect  state- 
ment, inasmuch  as  Dr.  Cousins  was  present  at  the 
meeting  and  did  not  support  the  resolution.  It 
also  appears  that  Dr.  Japp  Sinclair  was  absent 
from  the  meeting,  and  as  he  is  capable  of  forming 
an  opinion  of  the  merits  of  the  different  methods 
of  training  nurses,  we  think  we  may  assume  that 
if  he  had  been  present  he  would  not  have  sup- 
ported the  resolution.  It  will  doubtless  interest 
the  heads  of  the  Irish  maternity  hospitals  to  learn 
that  Dr.  Cousins  considers  the  treatment  to  which 
they  have  been  subjected  of  sufficient  importance 
to  present  a  statement  of  it  to  the  Royal  College 
of  Surgeons  of  England.  The  Irish  maternity  hos- 
pitals have  every  reason  to  be  grateful  to  Dr. 
Cousins  for  his  support. 


Death     of     two      German     Pioneers     in 
Tuberculosis. 

Within  the  last  few  days  two  figures  prominent 
in  the  treatment  of  tuberculosis  have  disappeared 
from  the  world.    Clur  was  the  exponent  of  the 


climatic  treatment,  and  preached  mid-ocean 
island  climates  ;  while  Detweiler  was  among  the 
first  of  our  modern  pioneers  for  the  open-air  treat- 
ment on  high  situations.  As  a  young  man  he  went 
as  assistant  to  Brehmer,  who  had  a  sanatorium,  a 
rare  thing  in  those  days,  in  Gerbersdorf ,  where  he 
wrote  much  on  the  Brehmer  treatment  and  elevated 
situations.  Later  in  life  Detweiler  went  to 
Falkinstein,  in  the  Taunus  Mountains,  where  we 
find  his  opinions  are  more  in  favour  of 
exposure  rather  than  elevation.  On  this  sub- 
ject a  severe  battle  was  fought  between  him  and 
Brehmer,  and  minor  skirmishes  often  took  place 
till  Brejimer  died.  Toxins  and  antitoxins  were 
equally  discussed,  while  tuberculins,  tuberculo- 
zidins,  the  serum  of  Maragliano,  Marmoreck,  &c, 
have  all  been  tested  in  turn.  There  is  one  of  the 
phthiseo-therapies  of  Detweiler  that  is  remem- 
bered against  him  as  a  blemish  in  the  treatment  of 
tuberculosis,  viz.,  the  liberal  use  of  alcohol.  His 
advice  was  alcohol  at  every  meal,  and  never  go 
out  without  it. 


(a)  Brit.  M$d.  Journ.,  February  2Srd,  1904. 


The  Birth  of  Giants. 

A  writer  in  one  of  our  Continental  contempor- 
aries has  made  an  interesting  collation  of  the 
records  of  the  births  of  giant  children  in  the 
Koniglichen  Charite  at  Berlin.  The  term  "giant," 
it  may  be  necessary  to  explain,  is  applied  to  infants 
who  weigh  over  4,000  grammes.  In  this  sense  it 
appears  that  the  average  of  giant  births  to  the 
total  number  of  births,  for  a  period  of  ten  years, 
was  about  3*  per  cent.  In  most  cases 
the  mothers  were  women  of  over  thirty  years  of 
age,  multipara,  with  large  pelves.  As  might  be 
expected,  the  time  of  expulsion  of  giant  children 
averages  much  longer  than  that  in  normal  birth. 
In  most  cases  there  was  no  actual  difficulty,  and 
when  artificial  delivery  was  necessary,  it  was 
usually  merely  on  account  of  the  size  of  the  child. 
In  fact,  although  the  term  "  contracted  pelvis  " 
cannot  correctly  be  applied,  yet,  in  view  of  the 
increased  size  of  foetus,  this  term  best  expresses  the 
kind  of  difficulty  met  with.  Abnormal  presenta- 
tions were  rare,  and  prolapse  of  the  cord  less  fre- 
quent than  usual.  Lacerations  of  the  soft  parts 
were,  as  might  be  expected,  common.  Curiously 
enough,  the  mortality-rate  among  the  mothers 
was  lower  than  normal,  but  on  the  other  hand  the 
rate  among  the  children  was  four  times  as  high 
among  giants  as  among  others.  A  surprising 
result  appears  when  the  relative  number  of  boys 
and  girls  are  noted,  for  there  are  nearly  three  times 
as  many  male  giants  as  female.  At  the  same  time 
the  average  weight  among  the  females  was  as  great 
as  that  among  males 


The  Carnegie  Trust  and  Scotch  Students* 
The  lines  of  students  in  Scotch  medical  schools 
and  universities  seem  to  have  fallen  in  pleasant 
places  so  far  as  fees  are  concerned.  We  learn  that 
under  the  Carnegie  Trust  the  total  number  of 
beneficiaries  since  the  institution  of  the  Trust  un- 
til December  31st,  1903,  was  4,5 17.  There  has  been 
paid  by  the  Trust  for  summer  session,  1903,  the  sum 
°*  ^x3»5°9   I2S-  on  behalf  of  1,755  students,  repre- 


Fsk  34,  1904. 


NOTES  ON  CURRENT  TOPICS.  T*k*tinatAL  Press     217 


seating  the  fees  of  5,392  class  attendances  ;  and 
for  winter  session  1903-4  the  sum  of  £30,5 10  15s. 
on  behalf  of  3,027  students,  representing  the  fees 
of  8,076  class  attendances — in  all,  for  the  year  to 
December  31st,  1003,  the  sum  of  £44,080  7s. 
Of  this  golden  shower  we  presume  the  medical 
students  partake.  It  is  to  be  hoped,  however, 
they  do  not  figure  in  the  latter  part  of  the 
following  announcement :— +*  During  the  year  1903 
six  students  have  voluntarily  refunded  the  fees 
paid  for  them  by  the  Trust  to  the  amount  of  £yi  2s. 
There  is  also  a  decrease  in  the  number  of  cases 
where  return  of  fees  has  been  demanded  from 
beneficiaries  who  have  failed  to  obtain  requisite 
certificates  of  attendance  and  work.'1  The  com- 
mittee have  entered  into  an  agreement  with  the 
Royal  College  of  Physicians  of  Edinburgh  by 
which  the  Trust  has  purchased  the  property  and 
laboratory  of  the  college  in  Forrest  Road,  Kdin- 
burghr  for  £xO,O0O.  During  the  past  year  the 
claims  of  extra-mural  schools  have  received  at  ten- 
lion.  After  inquiry  and  conference  two  cases 
have  been  dealt  with — that  of  the  medical  school 
of  the  Royal  Colleges  of  Edinburgh,  and  that  of 
Medical  College  for  Women,  Edinburgh;  and 
under  certain  conditions  limited  grants  have  been 
offered  for  permanent  equipment  and  provisional 
assistance. 


A  New  Use  for  the  X-Rays. 
The  phenomena  of  radio-activity    are   so   sur- 
prising in  their  effects  upon  organic  and  inorganic 
substances  that  fresh  spheres  of  usefulness  seem  to 

>vered  for  them  almost  daily.  The  power  J  small-pox  comes  into  his  parish  is  in  much  the 
of  the  X-rays  to  influence  cell  growth  is  taken  I  position  of  Mrs.  Eddy,  who  went  to  the  dentist 
advantage  of  in  the  treatment  of  malignant  disease,   and  had  a  tooth  extracted  instead  of  applying  her 


current  to  the  glpttjs,  will  generally  effect  a  speedy 
cure  in  ca^es  of  hysterical  aphonia,  but  where  other 
methods  have  (ailed  the  psychic  influence  of  tho 
X-rays  might  well  be  boi:u-  in  mind, 

Small-pox  in  the  Provinces, 

As  anticipated,  the  London  epidemic  of  small- 
pox reappeared  in  a  mild  form  in  1903,  and  still 
lingers  on  in  1004.  Th,e  field  open  for  its  invasion 
has  been  narrowed  down  to  an  extremely  small 
margin  by  the  number  of  ,L  unprotected  IJ  persons 
who  were  attacked  by  the  disease  in  the  earlier 
days  of  the  outbreak,  and  also  by  the  wholesale 
protection  of  previously  "  unprotected  **  citizens 
by  vaccination  and  re -vaccination.  It  was  almost 
inevitable  in  these  times  of  rapid  and  universal 
commerce  and  transit  that  the  huge  mass  of  small- 
pox infection  centred  in  the  Metropolis  should  give 
rise  to  scattered  epidemics  throughout  the 
Kingdom,  That,  indeed,  has  happened.  In  some 
instances  the  disease  has  been  conveyed  by  tramps. 
Glasgow,  Liverpool,  Derby,  Sheffield,  Cardiff, 
and  many  other  towns  in  England,  Scotland,  Ire- 
land, and  Wales,  have  been  invaded  more  or  less 
disastrously  with  small -pox  during  the  past  two 
years.  Nottingham  and  Derby  appear  to  be  on 
the  eve  of  a  serious  epidemic.  It  is  to  be  hoped 
that  the  moral  of  these  events  will  not  be  lost  upon 
those  of  our! weaker  brethren  who  have  not  made 
up  their  minds  as  to  the  efficacy  of  vaccination. 
In  London  the  advent  of  the  small-pox  brought 
shoals  of  unbelievers  and  scoffers  to  their  senses. 
An    anti-vaccinator     who   gets   vaccinated    when 


while  their  physical  properly  of  penetrating  objects 
hitherto  deemed  impenetrable  renders  them  in- 
dispensable to  surgical  work.  Now  we  are 
informed  that  they  are  accredited  with  certain 
psychic  effects,  for  M.  A.  B6clcre  has  reported  a  case 
ot  hysterical  mutism  cured  through  their  agency, 
The  patient   was  a  young  married  woman,  aged 

ho  received  a  severe  mental  shock  through 
witnessing  a  conflagration,  She  suddenly  lost 
consciousness,  and  on  recovering  herself  found  she 
had  completely  lost  the  power  of  speech,  She 
was  consequently  admitted  into  Mw  H6pital 
Saint -An  toine.  The  pharyngeal  and  corneal 
reflexes  were  abolished,  and  there  were  irregularly 
scattered  areas  of  anaesthesia  and  hyperesthesia 
about  the  body*  There  was  no  paralysis,  Methy- 
lene blue  was  prescribed,  together  with  active  sug- 
gestion, but  this  treatment  proved  of  no  avail,  for 

lays  afterwards  she  was  still  aphasic.  She 
was  then  taken  to  a  room  where  other  patients 
were  about  to  undergo  radioscopic  examination. 
The  apparatus  and  the  dark  surroundings  caused 
her  some  alarm,  but  when  the  current  was  switched 
an  she  recovered  her  speech  from  that  moment. 

influence  of  suggestion  was,  no  doubt,  not 
unimportant  in  the  production  of  the  beneficial 
result,  but  the  rays  were  the  medium  through 
which  it  acted.  Any  sudden  or  unexpected 
shock,  such  as    the  application  of   the   galvanic 


creed  that  pain  has  no  existence  in  fact,  and  that 
faith  and  prayer  are  all-sufficing  substitutes  for  the 
art  of  the  medical  man  and  the  dental  surgeon. 


Anaesthesia  with  Sterile  Water- 
Hydropathic  enthusiasts,  and  for  that  matter,, 
all  practitioners  who  believe  in  the  occasional 
therapeutic  properties  of  water,  will  be  interested  to 
learn  that  the  use  of  water  as  a  local  anaesthetic 
agent  is  being  revived.  The  idea  is  by  no  means 
new,  having  been  formulated  by  Burney  Yeo  and 
Griffith  in  t86S.  Dr.  Samuel  G.  Gant,  of  New- 
York,  has  recently  called  attention  to  this  little- 
known  property  of  water  when  injected  under  the 
skin.  The  theory  of  its  action  is  that  the  tissues 
are  so  distended  that  the  sensory  nerve-endings 
in  the  epidermis  are  compressed  in  such  a  manner 
as  to  temporarily  paralyse  their  function*  In  the 
case  of  a  superficial  abscess,  in  which  the  same 
thing  might  be  supposed  to  occur (  this  compression 
is  gradual  owing  to  the  slow  accumulation  of 
inflammatory  products  and  subsequent  suppura- 
tion, resulting  in  acutely  painful  sensations.  But 
when  a  fluid  is  injected  from  without ,  the  disten- 
sion is  sudden  and  unexpected t  so  that  !the  con- 
trary effect,  anaesthesia,  is  produced,  Dr,  Gant 
has  employed  the  method  more  particularly  in 
surgical  affections  of  the  rectum  and  anus,  such  as. 
fissures,  haemorrhoids,  and  polypi.     It  is  claimed 


2l8    The  Medical  Press. 


SPECIAL  CORRESPONDENCE. 


Feb.  34*  *9Q4« 


that  the  use  of  a  general  anaesthetic  may  be  dis- 
pensed with,  that  the  anaesthesia  is  quickly  obtained 
and  that  systemic  complications  are  avoided.  The 
after  pain  is  said  to  be  less  than  when  cocaine  or 
eucaine  has  been  used,  and  the  risk  of  a  possible 
toxic  action  of  these  substances  is,  of  course,  re- 
moved. The  more  the  tissues  are  distended,  the 
greater  the  anaesthesia.  Simplicity  of  apparatus 
is  certainly  one  point  in  its  favour,  all  that  is 
needed  being  a  syringe  full  of  sterilised  water,  but 
in  nervous  and  sensitive  patients  it  is  questionable 
whether  even  the  puncture  of  a  needle  in  the 
delicate  hemorrhoidal  area  would  be  tolerated. 
Where  it  is  known  that  a  morbid  susceptibility  to 
cocaine  is  present  and  a  general  anaesthetic  in- 
advisable, this  method  might  then  be  worthy  of  a 

trial.  

Longevity  in  Ireland. 
By  no  means  the  least  interesting  part  of  the 
4t  Quarterly  Return  of  Marriages,  Births,  and 
Deaths,"  issued  by  the  Registrar-General  for 
Ireland,  is  the  section  devoted  to  remarks  made  by 
the  local  registrars  on  matters  concerning  the  public 
health  of  their  districts.  On  looking  over  the 
return  for  the  last  quarter  of  1903  recently  issued, 
one  cannot  but  be  struck  with  the  great 
number  of  cases  recorded  of  deaths  occurring  at 
advanced  ages.  In  the  Cavan  district  a  death  has 
been  registered  at  the  age  of  120  years,  and 
at  Ballycroy,  in  co.  Mayo,  one  at  the  age  of  113, 
which  age  the  registrar  believes  to  be  accurate.  In 
addition  to  these,  no  less  than  thirteen  other 
centenarians  are  reported  to  have  died  during  the 
past  quarter.  Curiously,  of  those  who  just  failed 
to  reach  the  even  hundred,  the  number  is  some- 
what less,  as  only  nine  deaths  are  drawn  attention 
to  as  occurring  between  90  and  100.  When  we 
come  to  octogenarians  the  numbers  rapidly  increase, 
as  notes  are  made  of  about  thirty  deaths  between 
80  and  90,  and  there  are  probably  many  more  of 
which  the  registrars  do  not  think  it  worth  while  to 
make  special  mention.  A  comparison  of  the 
mortality  among  old  people  with  that  among  the 
total  population  also  gives  some  interesting  facts. 
For  example,  out  of  thirty  deaths  in  the  Grean 
district,  co.  Limerick,  thirteen  occurred  at  ages 
exceeding  73  years.  In  the  Ederney  district  of 
Fermanagh,  the  total  number  of  deaths  was 
thirteen,  of  which  nine  were  at  ages  varying  from 
70  to  97.  Out  of  twenty  deaths  in  the  Kilsea 
district  of  Londonderry,  eight  were  at  ages  over 
75 .  These  instances  are  all  taken  from  rural  areas , 
where  life  may  reasonably  be  expected  to  be  long; 
but  looking  at  the  whole  of  Ireland,  town  and 
country,  it  would  appear  that  about  half  the  total 
number  of  deaths  occur  after  the  age  of  60.  It 
would  add  interest  to  future  issues  of  the  already 
very  interesting  quarterly  returns  if  a  column  were 
added  including  all  deaths  registered  at  ages  above 
So  years. 

PERSONAL. 


Mr.  A.  W.  Mayo  Robson  has  been  chosen  Bradshaw 
Lecturer  by  the  Royal  College  of  Surgeons  of  England 
for  the  ensuing  collegiate  year. 


It  is  reported  that  the  well-known  American 
surgeon,  Dr.  William  Senn,  will  act  as  Surgeon-General 
of  the  Japanese  Army. 

Dr.  Robert  J.  Rowlettb  has  been  appointed 
Lecturer  in  Pathology  to  the  Queen's  College,  Galway, 
for  the  year  1904. 

We  understand  that  Sir  Christopher  Nixon.  ex- 
President  of  the  Royal  College  of  Physicians  of  Ireland, 
may  become  a  candidate  for  Parliamentary  honours 
in  the  St.  Stephen's  Green  Division  of  Dublin. 


A  lecture  on  "  Trypanosoma  and  Sleeping  Sickness 
at  Uganda  "  was  delivered  in  the  zoology  theatre  of 
the  Liverpool  University  on  February  12  th  by  Colonel 
David  Bruce,  F.R.S.,  R.A.M.C.,  under  the  auspices  of 
the  Liverpool  Biological  Society. 

The  gold  medal  established  by  the  friends  and  pupils 
of  Mr.  Net  ties  hip,  to  commemorate  his  work  in  oph- 
thalmic surgery,  was  recently  handed  over  to  the 
custody  of  the  Ophthaimological  Society  of  the  United 
Kingdom  by  Sir  Thomas  Barlow,  representing  the 
subscribers  to  the  fund. 


The  annual  dinner  of  the  medical  officers  of  the 
auxiliary  forces  will  take  place  at  the  Imperial  Res- 
taurant, Regent  Street,  London,  on  Friday,  April 
15  th,  at  7.30  p.m.,  under  the  presidency  of  Lieu  tenant- 
General  Lord  Grenfeil,  G.C.B.,  G.C.M.G.  Tickets  may 
be  had  from  Lieutenant  Montgomery-Smith,  36 
Abbey  Road,  N.W. 


The  members  of  the  Ulster  Medical  Society  have 
arranged  to  have  a  marble  bust  of  Sir  William  Whitla 
done  for  the  entrance  hall  of  the  Medical  Institute, 
the  building  which  he  presented  to  the  Society  a 
a  little  over  a  year  ago.  The  execution  of  the  work 
has  been  entrusted  to  Miss  Kathleen  Shaw  (daughter 
of  the  late  Dr.  Shaw),  who  has  lately  completed  an 
excellent  bust  of  the  Irish  Primate,  and  is  now  engaged 
on  one  of  His  Eminence  Cardinal  Logue. 

Dr.  Jameson  of  "  the  Raid  "  notoriety,  has  been 
entrusted  with  the  formation  of  the  new  Cabinet  of 
the  Cape  Ministry.  It  may  be  added  that  Dr.  Jameson 
was  compelled  to  relinquish  medical  practice  in  London 
nearly  a  quarter  of  a  century  ago  on  account  of  bis 
health ;  he  settled  in  Kimberley,  became  medical 
adviser  to  the  late  Mr.  Cecil  Rhodes,  took  part  in  the 
Matabele  war,  and  became  administrator  of  Rhodesia 
in  1 89 1.     He  now  becomes  Premier  of  Cape  Colony. 

Special  correspondence* 

[from  our  own  correspondents.] 
EDINBURGH. 


The  Late  Dr.  Robert  Milne  Murray.— The 
announcement  of  the  death  of  Dr.  Milne  Murray  will 
come  as  a  great  blow  to  the  many  who  were  privileged 
with  his  personal  acquaintance,  and  will  be  deplored 
by  the  wider  circle  of  workers  in  all  departments  of 
scientific  medicine,  particularly  in  the  field  of  obstetrics 
and  gynaecology,  where  he  made  for  himself  a  world- 
wide reputation.  About  fifteen  months  ago,  while 
engaged  in  professional  work,  he  contracted  pneu- 
monia, and  since  then  had  been  more  or  less  completely 
laid  aside ;  while  for  a  considerable  time  hope  of  his 
recovery  was  entertained,  the  disease  latterly  progressed, 
and  he  died  on  February  14th.  Dr.  Milne  Murray 
was  born  in  Kincardineshire  in  1855.  The  son  of  a 
gifted  father,  a  schoolmaster,  he  passed  from  his 
tuition  to  St.  Andrews,  where  he  took  an  Arts  degree 


Fa*.  24,  1904* 


CORRESPONDENCE. 


The  Medical  Press.     2I<J 


3 


at  the  age  of  30,  whence  he  came  to  Edinburgh  to 
study  medicine   and   graduated  in    1875.     Thereafter 
he  became  associated  with  Sir  Halliday  Croom  as  his 
assistant,  and  this  determined  for  him    the    selection 
i->]  ubstetrics  and   gynecology  as  his  life  work.     He 
very  rapidly  acquired  eminence  in   his   specialty,  and 
tilled  in  turn  the  position  of  President  of  the  Edinburgh 
Obstetrical  Society  and  vice-president  of  the  British 
Gynaeco logical  Society,  white  at  the  time  of  his    death 
he  was  One  of  the  physicians  to  the  Maternity  Hospital 
and   assistant    gynecologist    at    the   Royal    Infirmary. 
About  ten  years  ago,  he,  along  with  four  or  five  col- 
leagues,  took  an  active  part  in  establishing  the  New 
School,  which  is  one  of  the  most  important   teaching 
centres  in  the  School  of  Medicine  of  the  Royal  Colleges, 
and  in  the  lecture  rooms  of  which  he  conducted  one  of 
the  most  popular  and  successful  classes  in  midwifery 
m  Edinburgh,     He  urns  eminently  clear  and  practical 
as  a   teacher,    while    his   numerous    contributions    to 
medical  literature  were  concise,  original,  and   authori- 
tative.    Milne     Murray's    great    strength     as    an    ob- 
^tncian   and   gynaecologist   lav  in   the   fact   that   his 
interests  were  by  no  means  bounded  by  the  limits  of 
lus  own  specialty,  but  that  he   brought  to  bear  on  its 
problems    a    mind    versed    in    other    departments    of 
He  was  esteemed  an  expert  in  other  depart- 
ments besides  his  own  specialty,   and   particularly  in 
electrical  science,  which  was  for  him   something   more 
than  a  hobby.     His  collection  of  electrical  apparatus, 
gathered    together  at  great    cost,  is  unique,  and   his 
private  laboratory  was  much  visited  by  distinguished 
electricians.     His  services  as  an  expert  in  this  branch 
Of  science  were  greatly  111  request,  and  he  it  was  who 
was  consulted   by   the   managers  of   the   Intirmary  in 
connection    with    their    electrical    installation,    which 
lirtbef  directed  by  him  as  official  electrician  to 
the  institution  until  the  date  of  his  appointment  as 
gynecologist.     In  addition   to  these  scientific    attain- 
had  considerable    artistic    talents,    and    was 
iician    of   no    mean     order.      Of    Ins     personal 
tics  this  is  hardly  the  place  to  speak.     Through 
lits  death  many  have  lost  a  dear  friend,  and  more  a 
wise   and    genial    counsellor.     He    is    survived     by    a 
uidow  but  no  family. 
Carnegiij  TrustI— Third  Annual  Report, — The 
.uinual  report  of  the  Executive  Committee  was 
on  February  20th.     Of  the  grant  of  £40,000 
ted  to  the  universities  for  permanent  equipment 
and  teaching  endowment,  over  £30,000  has  been  dkime  I 
ind  paid  over.     This  sum  includes  the  grants  of  £1,000 
to  each  of  the     libraries,  and    £2,400  for  provisional 
assistance,   which   have   been   claimed   in   full,   £7,725 
claimed  for  buildings,  and  £6aoo   for  endowment   of 
teaching.     The  fun  Is  of  the  trustees  have  been  partially 
omental  in  founding  a  chair  of  history 
•tvjeen.  a  chair  of  geology  in  Glasgow,  lecture- 
in  French  and  botany  in  St.  Andrews,  and  grants 
l    of  modern   languages    in    Edinburgh    and  of 
German  in  SL  Andrews  have  also  been  male.      Under 
the  scheme  for  the  endowment  of  post-graduate  research 
.iwariJs    have    been    made,    as    published    last    July  ; 
implications   were  received,    and    live   fellowships 
and   fifteen   scholarships    created,    while    grants    were 
made    to    fifty    applicants.     As    to    grants    in    aid    of 
research,  the  general  principle  adopted  was  that  these 
should  not  include  payments  for  personal  expenses  or 
assistance  in  work.     In  pursuance  of  their  policy  of 
retaining    the   administration    ul    the   endowment   of 
research,    in    their   own    hands    the    Committee  have 
purchased    the    laboratory    of    the    Royal    College    of 
understanding    that    the    annual 
r^butions  of  that    College   and    of  the  College  of 
be  continued,  and  that  the  Trust   have  two 
representatives  on   the   Board  of  Management.     This 
iru&sement  is  to  remain  m   force  for  five  years,    at 
the  end  of  which  tim^  should  either  party  desire  to 
terminate  it,  the  College  may  repurchase  the  laboratory, 
Tht  amount  paid  h»r  class  fees  during  the  year  1903 

L was  £44,000,  and  while  the  Committee  do  not  anticipate 
that  daring  the  current  year  the  claims  will  exceed 
the  available  income,  they  have  prudently  made  the 
requirements  as  to  preliminary  education  somewhat 


more  stringent,  and  have  barred  payment  of  fees  for 
non -obligatory  classes  unless  in  special  cases* 

GLASGOW, 

Southern  Medical  Society,  Glasgow. — At  the 
beginning  of  the  session  Sir  J.  HaUiday  Croom,  Edin- 
burgh was  unanimously  elected  honorary  President 
of  the  Society.  Probably  over  a  hundred  members, 
of  the  profession,  including  many  o£  the  consultants, 
met  in  the  Faculty  Hall,  242  St.  Vincent  Street,  on 
the  evening  of  Thursday.  18th  inst.P  to  hear  Sir  Halliday 
deliver  his  address  on  *'  Some  Moot  Points  in  Cancer/' 
Mr-  Thomas  Richmond,  President,  occupied  the  chair. 
As  was  to  be  expected,  the  address  was  as  eloquent  as 
it  was  exhaustive  and  instructive.  Wc  expect  to 
give  a  fairly  full  report  of  this  contribution  to  the 
literature  of  cancer,  which  is  exciting  considerable 
attention  at  the  present  Lime,  On  the  motion  of 
Professor  McCall  Anderson,  seconded  by  Professor 
Murdoch  Cameron,  a  very  hearty  vote  ul  thanks  was 
awarded  Sir  J.  Halliday  Croom  for  his  extrei- 
interesting  address. 

The  Sanitary  Institute  or  Great  Britain. — 
The  meetings  of  the  above  are  to  be  held  this  year  in 
Glasgow  during  the  month  of  July.  Preliminary 
meetings  have  been  held,  and  various  influential 
committees  formed.  The  Corporation  of  Glasgow 
has  very  generously  agreed  to  meet  the  entire  expense, 
and  it  is  expected  there  will  be  a  considerable  amount 
ot  private  entertaining*  It  is  certainly  unfortunate 
that  the  date  fixed — -the  end  of  July — corresponds 
with  the  annual  meeting'of  the  British  Medical  Asso- 
ciation at  Oxford,  which  will  certainly  attract  large 
numbers.  Many  medical  men  are  on  the  committees 
Conned  for  the  Sanitary  Congress*  It  was  explained 
that  the  matter  had  been  very  carefully  considered, 
but  the  date  could  not  be  altered.  All  that  remains 
to  be  said  is  that  it  is  rather  unfortunate. 

Small-pox  is  Glasgow. —  This  disease  is  still 
prevailing  in  the  city  to  an  extent  that  is  causing  the 
authorities  considerable  uneasiness.  There  are  at 
present  in  Belvidere  Hospital  172  cases,  A  circular 
was  recently  issued  by  the  Medical  Officer  of  Health, 
Dr,  Chalmers,  to  the  members  of  the  profession, 
inviting  ihem  to  vaccinate  all  who  may  apply,  the 
Corporation  defraying  the  expense  to  the  extent  of 
giving  a  lee  of  is*  6d,,  the  operator  to  find  his  own 
lymph  1  Few  medical  men  have  taken  advantage  of 
this  parsimonious  offer,  and  rightly  so.  The  n 
is  that  small -pox  is  allowed  to  go  on  spreading 
from  day  to  day.  A  large  economic  question  is  in- 
volved which  the  Corporation  will  in  all  probability 
have  to  face  when  public  opinion  is  aroused,  and  that 
at  an  early  date. 


CottcsponOencct 

THE  CENTRAL  MID  WIVES  BOARD* 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Dear  Sir, —  You  say  in  your  article  to-day  on  *'  The 
Central  Mid  wives  Board  and  the  Irish  Maternity  Hos- 
pitals." that  the  Board  resolution  was  unanimously 
adopted,  and  I  write  to  inform  you  that  this  is  in- 
correct. Seven  members  of  the  Board  were  present 
at  the  meeting,  I  did  not  support  the  resolution*  and 
Miss  Oldham  and  Dr.  Sinclair  were  absent. 
I  am.  Sir,  yours  truly, 

Ward  Cousins* 
Southsea,  February  17th,  1934. 

[We  are  much  obliged  to  Dr.  Ward  Cousins  for  his 
correction,  especially  as  it  discloses  a  very  improper 
and  misleading  mistake  on  the  part  of  the  Secretary 
of  the  Central  Midwives  Board,  who,  in  writing  to  the 
Master  of  the  Rotunda  Hospital,  used  the  following 
words: — "  I  am  directed  to  point  out  that  the  Rules 
were  approved  by  the  Privy  Council  on  August  12th, 
1903,  and  to  forward  you  a  copy  of  the  resolution, 
which,  having  regard  to  that  fact,  the  Board  passed 
unanimously"  The  italics  are  ours. — Ed.  Medical 
Press  and  Circular,] 


220    The  Medical  Press. 


LITERATURE. 


Feb.  24.  1904. 


Xlterature, 


CONSUMPTION,  (a) 
This  work,  as  Professor  Koch  indicates  in  his  brief 
introduction,  is  intended  as  a  popular  exposition  of 
the  tuberculosis  question.  It  is  primarily  addressed 
to  English  readers.  The  author  claims  that  his  book 
"deals  with  tuberculosis  as  a  great  social  problem 
which  is  at  present  exercising  the  minds  of  medical 
men,  legislators,  local  and  public  health  authorities, 
and  intelligent  citizens  in  every  civilised  country  in 
the  world."  Dr.  Hiilier  has  no  hesitation  about  his 
text :  "  Tuberculosis  may  be  cured,  can  be  avoided, 
and  ought  to  be  prevented,"  and  he  insists  on  the 
infectious  character  of  phthisis  to  an  extent  which  we 
venture  to  think  is  likely,  at  least  in  certain  quarters, 
to  develop  a  dangerous  and  very  undesirable  phthisio- 
phobia.  The  work  opens  with  what  purposes  to  be  a 
description  of  the  history  and  nature  of  tuberculosis, 
but  it  is  peculiarly  incomplete.  We  are  told  that 
Botticelli's  Venus  died  of  consumption  at  an  early 
age,  and  more  than  a  page  and  a  half  are  devoted  to 
the  writings  of  antiquity,  while  extensive  reference  is 
made  to  the  views  of  physicians  in  the  Middle  Ages, 
but  we  have  searched  the  index  in  vain  for  any  note 
of  such  pioneers  as  Parrish,  Bodington,  MacCormac, 
and  B.  W.  Richardson  ;  even  the  names  of  Brehmer, 
Detweiler  and  Walthers  are  conspicuous  by  their  ab- 
sence. Dr.  Hiilier  teaches  that  there  is  much  danger 
from  cough-sprayed  sputum.  We  are  inclined  to 
believe  that  he  lays  far  too  much  stress  on  this  mode 
of  infection.  It  is  amusing,  as  well  as  pathetic,  to 
find  Frankel's  respirator  figured  and  carefully  de- 
scribed. Dr.  Hillier's  method,  if  allowed  free  course, 
would,  we  fear,  go  far  to  make  every  consumptive  a 
social  outcast. 

The  relation  of  bovine  to  human  tuberculosis  is 
discussed  fairly  fully,  and,  as  might  be  expected, 
Koch's  views  have  great  prominence. 

There  is  a  useful  section  on  personal  precautions 
which,  so  far  as  it  goes,  is  good.  The  chapter  on  public 
action  raises  many  points  still  under  discussion,  but 
there  is  a  lack  of  statesmanlike  grasp  of  the  subject. 
Dr.  Hiilier  is  an  ardent  advocate  of  compulsory  notifi- 
cation. The  section  dealing  with  sanatoria  is  far  too 
scrappy  to  be  of  much  service.  The  author  describes 
the  institution  with  which  he  is  connected,  but  he 
might  well  have  drawn  attention  to  some  of  the  excellent 
features  to  be  found  in  the  many  other  sanatoria 
which  are  now  to  be  found  in  almost  all  parts  of  the 
country.  In  discussing  the  financial  aspects  of  the 
question,  reference  is  made  to  German  methods,  but 
few  suggestions  are  presented  regarding  measures 
likely  to  find  favour  with  English  people. 

The  work  is  disappointing.  It  is  full  of  evidences 
of  haste  and  hurry.  Its  incompleteness,  and,  as  it 
appears  to  us,  its  unscientific  dogmatism,  will  much 
militate  against  its  usefulness.  The  author  lacks  the 
judicial  spirit,  and  his  clinical  work  is  not  sufficiently 
based  on  a  perception  of  the  limitations  of  our  patho- 
logical knowledge. 

Undoubtedly,  the  most  useful  portion  of  the  book 
is  to  be  found  in  the  appendix,  which  contains  matter 
reprinted  from  the  publications  of  the  National  Asso- 
ciation for  the  Prevention  of  Consumption  ;  a  de- 
scription by  Dr.  W.  B.  Ransom  of  the  Nottingham- 
shire sanatorium ;  particulars  of  sleeping  accom- 
modation as  provided  at  the  interesting  Kelhng 
Sanatorium  in  Norfolk  ;  a  note  on  homes  for  advanced 
consumptives  ;  and  an  essay  on  State  insurance  for 
workmen  in  Germany. 

ZOOLOGICAL   STUDIES   IN   MALAY,    (b) 
This  work  describes  the  result  of  an  expedition  under. 

(a)  "The  Prevention  of  Consumption."  By  Alfred  Hiilier,  1LD., 
CM.,  B.A.,  Secretary  to  the  National  Association  for  the  Prevention 
of  Consumption,  Visiting  Physician  to  the  London  Open-air  Sana- 
torium Ac.  Revised  by  Professor  B.  Koch.  Pp.  226.  With  illus- 
trations.   Loudon:  Longmans,  Green  and  Co..  190 »     rrice5s.net 

(b)  ••  Fasciculi  Malayenses:  Zoological  Result  of  an  Expedition 
to  Perak,  the  Siamese  Malay  States.  1901-1002."    By  Kelson  Annan- 


taken  by  Messrs.  N.  Annandale  and  H.  C.  Robinson 
to  study  the  zoology  of  the  Malayan  mainland,  and 
will  doubtless  prove  of  value  in  the  hands  of  all  in- 
terested in  the  fauna  of  that  region.  The  report  on 
the  amphibia  and  reptilia  is  especially  interesting, 
six  new  forms  being  described.  The  collection  of 
mammals,  of  which  sixty-four  were  obtained,  including 
eight  new  species,  is  a  notable  contribution  to  our 
knowledge  of  the  zoology  of  this  district.  The  notes 
on  the  mammalia  also  contain  several  interesting 
facts  relating  to  the  habits  and  distribution  of  certain 
new  species.  The  other  descriptions  of  the  Heterocera. 
Cicendelidae,  and  Odonata,  also  deserve  the  attention 
of  the  student  of  these  groups.  Notwithstanding 
that  the  writers  were  unable,  for  various  reasons,  to 
pay  particular  attention  to  the  collection  of  molluscs, 
five  new  species  were  obtained.  The  Rhynchota  were 
remarkable  by  the  absence  of  many  common  forms,  and 
by  the  presence  of  a  large  number  of  obscure  and  little- 
known,  or  new  species,  and  even  some  new  genera. 
The  reports  contain  papers  on  marine  fishes,  a  list  of 
fresh  water  fishes,  and  other  studies  which  will  be  of 
value  to  investigators  in  this  department  of  biology. 
Messrs.  Annandale  and  Robinson  publish  in  the  form  of 
a  supplement  an  itinerary  of  their  travels,  giving 
a  general  account  of  their  wanderings  in  the  little-known 
Malay  States  under  Siamese  rule.  The  account  is 
mainly  of  a  personal  nature,  with  a  brief  description 
of  the  various  districts  and  villages  in  which  they 
sojourned,  and  a  note  on  the  work  done  in  each  place. 
It  forms  a  convenient  epitome  of  the  investigations 
of  these  most  industrious  explorers.  The  report  is 
admirably  illustrated,  and  all  concerned  in  the  ap- 
pearance of  these  excellent  studies  may  well  be  con- 
gratulated. 

®bttuars* 

MR.  DAVID  KENNARD,  M.R.C.S.,  L.S.A. 
As  the  result  of  an  accident  in  the  hunting  field,  a 
well-known  county  practitioner,  Mr.  David  Kennard, 
met  with  his  death.  He  was  a  student  at  Westminster 
Hospital,  and  took  the  M.R.C.S.,  Eng.,  in  i860.  For 
many  years  he  has  been  a  prominent  social  and  pro- 
fessional figure  in  Berkshire  society.  His  chief  ap- 
pointment was  the  medical  omcership  of  the  Lambourn 
District  Hungerford  Union. 

DEPUTY-SURGEON-GENERAL  JAMES  LEITCH. 
We  regret  to  note  the  death  01  Deputy -Surgeon- 
General  James  Leitch.  of  the  Army  Medical  Depart- 
ment, a  native  of  Crieff,  and  son  of  the  late  Dr.  James 
Leitch,  R.N.,  on  the  12th  instant,  at  his  residence, 
Clare mont  Street,  Edinburgh.  He  had  attained  the 
age  of  79  years.  On  passing  through  the  various  grades 
of  his  profession  in  the  army  Dr.  Leitch  accompanied 
the  78th  Highlanders  to  India,  and  was  on  active 
service  there  during  the  Mutiny  in  1857. 

GEORGE  NIVEN,   M.A..   M.B.   Cantab. 

On  February  7  th,  Dr.  George  Niven  succumbed 
to  pneumonia.  Dr.  Niven  was  born  at  Peterhead, 
and  had  a  distinguished  career  as  a  student  at  Aberdeen, 
where  he  took  his  M.A.  degree  in  1877,  and  at  Cam- 
bridge, where  he  took  the  B.A.  in  1882,  and  M.B. 
in  1886,  obtaining  also  in  the  latter  year  the  diploma 
of  M.R.C.S.  On  the  completion  of  his  university 
studies,  he  entered  upon  professional  practice  at 
Didsbury,  Manchester.  He  leaves  a  widow  and  three 
young  children  by  his  early  death  at  the  age  of  45. 
MR.  EDMUND  SAMUEL  WARBURTON, 
M.R.C.S.Eng..  L.S.A. 

The  medical  practitioners  of  the  Rhondda  valley, 
have  lost  a  valued  colleague  and  the  colliers  a  trusted 
friend  and  a  skilled  surgeon  through  the  death  on 
February  6th  of  Mr.  E.  S.  Warburton.  of  Treherbert 
He  was  born  nearly  sixty  years  ago  in  Cheshire  and 
came  of  a  family  of  medical  men.     After  making  several 


dale  and  Herbert  C.  Robinson 

Part  II ,  price  20s.  net. 

pool  by  Longmans,  Green  and  Oo. 


Zoology,  Part  I.,  price  15*.  net. 
Published  for  the  University  Fret*  of  Lirer- 


1903. 


MEDICAL  NEWS. 


The  Medical  Press, 


vo rages  as  i  ship's  surgeon   he  settled  in  Treherbert 

the  Rhondda   valley  was    beginning  to 

be  developed,  and  wm  appointed  surgeon  to  several 

Urge  collieries.    He  was  a  very  able  diagnostician  and 

a  most  capable  operator.     Although  educated  in  an 

school,  he  was  always  abreast  of  the  times,  and 

ready  to  give  his  patients  the  advantages  of  the  newest 

remedies  ;  for  example,  when  diphtheria  was  epidemic 

m  the  districL  a  few  years   ago+  he  was  one  of  the  first 

10  recognise  the  value  of  the  antitoxin  treatment. 

PECTOR-GEKERAL     OF     HOSPITALS     AND 

FLEETS    WILLIAM    MACLEOD,    C.B„     H.N. 

We  regret  to  announce  the  death  of  Inspector- Genera  I 

spitals  and  Fleets  William  MacLeod,  C.B.,  K.N.. 

.it  his  residence.  West  Kensington,  at  the  age  of  84- 

Educated  at  Edinburgh  L'niversitv,  where  he  took  the 

degree  of  M.D.  in  1841,  he  entered   the  Navy  as    an 

assistant-surgeon  in  1842,  and  served  on    the    China 

;i  in  that  rank  from   1S45-47.     He  was  surgeon 

i«  "Driver"  in  the  Baltic  during  the  Crimean 

War,  and  ot   the       Madagascar*'   in    1859  at  Rio  de 

Janeiro  during  a  severe  epidemic  of  yellow  fever,  and 

is  journal  and  report  of  that   year  received  Sir 

n    Blaue's   Medal.     Promoted    to    the    rank    oi 

Deputy 'Inspector-General  in   1R66,  he  was  in  charge 

-  Royal  Naval  Hospital  at  Yarmouth  from  that 

year  until  April,   l$J$,  when  he  was  promo  led  to  the 

rank  of  I nspector -General.      He   continued   in   charge 

annonth  until   t88o,  when  he  retired   from   the 

I  ti  Ni  ivcmber,  1880.  his  services  were  recognised 

by  the  award  of  the  Companionship  of  the  Bath,  and 

eight  years  later  he  received  a  Greenwich   Hospital 

Pension 


fl>c&tcal   Hews, 


Re  British  Medical  Association's  Proposed  Scheme  for 

Medical  Defence  Depart  men  t. 

At  i  meeting  of  the  Council  of  the  Medical  Defence 

held   at   the  registered    offices    February    t8th, 

mg  resolution  was  unanimously   passed  : — 

i'  this  Council  resolves  to  do  nil  in  its  power  to' 

maintain   tee  integrity  of  the  Medical  Defence  Union 

present  existing." 

The  BsJlacaulish  Quarry  Dispute, 

At  a  special  meeting  of  the  Ballachuhsh  Workmen's 

■tcicty   held   last   week   it   was   unanimously 

igTeed  that  the  expenses  of  the  legal  actions  incurred 

\£  Medical  Club  and  Dr.  Grant  during  the  recent 

1011M  be  paid  by  the  Society.  This  is  a  most 

Lcton     ending    to    this    prolonged    controversy, 

which  ha^fin  no  small  degree,  vindicated  the    honour 

Afid  standing  of  the  medical  profesn 

The  London  School  of  Tropical  Medicine.  -  Craggs' 
♦Research  Priie. 
izr.  of  £$a  will  be  awarded  to  a  past  or  present 
is   school  who  during   the   current   year 
(October  n  makes  the  most  valuable  con- 

tribution  to    Tropical   medicine.     Contributions   must 
ritten  in  Knghsh.  and  essays  must  be  sent  in  on 
October  to  the  medical   tutor  at 

ontfon  School  of  Tropical  Medicine,  Royal  Albert 
Dock,  E,,  who  will  gladly  afford  further  information. 
The  Bristol  Eye  Hospital! 
LTinual  meeting  of  the  subscribers  to  the  Bristol 
Hospital  was  recently  held,  under  the  presidency 
rd  Mayor.     The  annual  report  stated  that 
«] tiring  1905  the  in-patients  numbered  486,  being  21 
ta  excess  of  those   for   190a,      The  out-patients  were 
being  an   increase  of  915   compared   with   the 
previous  year.     The  financial  statement   showed    thai 
ihc   subscriptions    received    amounted    to   £660,   and 
thai  a  deficit  of  ^593  remained. 

The  Hurses  Registration  Bill 

Registration    Bill,    promoted    by    the 

the  State  Registration  of  Nurses,  was  intro- 

m,  anil   read  a  first   lime  in 

to*  ^  on  Monday  last.     It  is  backed 

I'vJHr    HaMant\   Sir  Thomas  Wrightson,    Sir    James 


Joicey*  Sir  John  Tnke,  Mr,  H.  C.   Smith,    Mr.    Munro 
I  Ferguson,  Mr.  Tennant,  Mr,  Black,  Mr.  Colston,  Mr. 
Eve,  and  Dr.  Thompson,  and  the  second  reading  was 
put  down  formally  for  Monday  next. 

Tub  Medical  Officer  of  the  Female  Prison,  limerick. 

On  Monday  last  Mr.  Joyce  asked  the  Chief  Secretary 
in  the  House  of  Commons  if  he  would  explain  why  the 
services  of  Dr.  John  Holmes,  medical  officer  to  the 
Female  Prison,  Limerick,  had  been  dispensed  with  ; 
what  number  of  years  Dr.  Holmes  had  been  in  charge 
of  the  prison,  and  what  pension  or  compensation  111 
lieu  of  pension,  If  any,  had  been  offered  to  him.  Mr. 
Wyndham  replied  that  Dr.  Holmes  had  held  the  position 
of  temporary  medical  officer  of  the  Limerick  Pi  1  son 
for  13  years.  His  services  had  been  dispensed  with 
upon  the  amalgamation  of  the  medical  omcerships  of 
the  male  and  female  prisons.  He  was  not  entitled  to 
any  pension  or  compensation. 

The  Associated  Hospitals  Association. 

The  Associated  Hospitals  Association,  which  repre- 
sents the  lay  and  medical  staffs  of  all  the  London 
Hospitals  with  medical  schools  attached,  have  decided 
to  oppoee  the  Nurses  Bill.  Sir  F.  Dixon-Hartland  has 
placed  on  the  Paper  a  motion  for  the  rejection  of  the 
BilL 

Free  Dispensary  for  Aliens, 

Sttt  SAMUBX  Montagu  and  other  wealthy  members 
of    the    Jewish    faith  are   taking  steps   to  establish  a 
free  dispensarv  for  East  End    aliens,  so     that     they 
shall  not  be  chargeable  to  the  rates  for  medicine,  Sec. 
Bhuula  Medic  si  Bfen  Dispense 

At  a  meeting  of  the  Central  Division  of  the  Metro* 
politau  Counties  Branch  of  the  British  Medical  Asso- 
ciation, held  at  Chandos  Street,  W.+  a  motion  that  a 
clause  be  added  to  a  draft  Medical  Acts  Amendment 
Bill  proposing  that  doctors  should  not,  under  pain  of 
a  heavy  penalty,  supply  drugs  or  medicaments  to 
anyone,  was  lost  by  an  overwhelming  majority.  Ex- 
ceptioftfl  were  mentioned,  and  these  covered  medical 
officers  on  ships  and  in  the  army,  emergency  medicines 
and  certain  sparsely-populated  areas  which  could  not 
support  both  a  doctor  and  a  chemist.  A  few  expressed 
approval  of  the  principle  of  the  motion,  but  not  the 
means  proposed,  and  only  two  voted  for  the  resolution 
Ambidexterity. 

"  The  Ambidextral  Culture  Society  for  the  Pro- 
motion of  Symmetrical,  Physical,  and  Mental  Develop- 
ment "  has  arranged  a  course  oi  lectures,  to  be  given 
in  the  rooms  of  the  Medical  Society  of  London  at 
5  p.m.  during  the  next  four  months.  The  subjects 
will  vary  from  ambidexterity  iu  fly -fishing  to  the  same 
accomplishment  in  the  infants*  school.  Furt  uff 
particulars  can  be  obtained  from  the  honorary  h 
tary,  St.  Duns  tan's  House,  Fetter  Lane,  London,  B.C. 
The  Treatment  of  the  Blind  In  Ireland. 

In  the  Commons  Mr.  Nannetti  asked  the  Chief 
Secretary  to  the  Lord  Lieutenant  of  Ireland  wlvj  her 
it  was  the  intention  of  the  Government  to  deal  With 
the  condition  of  the  blind  in  Ireland  during  the  present 
session,  in  accordance  with  the  finding  of  the  U 
Commission  of  i&lig,  which  recommended  special 
treatment  for  them.  Mr+  Wyndham  answered  that 
he  could  not  give  a  pledge  to  "deal  during  the  present 
session  with  the  condition  of  the  blind  in  Ireland  in 
accordance  with  the  recommendations  of  the  Royal 
Commission  of  1889. 

PASS  LISTS. 


Society  of  Apothecaries  of  London,  February,  1904. 
The  following  candidates  passed  En  ; — Surgery,  R. 
H\  Cooper  (Section  L),  and  W.  G,  Kinton  (Section  IL)* 
nt\  J.  Bromlev  (Sections  L  and  IT),  R.  H, 
Cooper  (Section  L),  W«  G.  Kinton  (Section  11.),  N.  O. 
Roberts  (Section  IL).  and  $♦  Zweiback  (Section  n)., 
Forensic  Mcdtanc.  M.  B.  Taylor  Midwifery,  G.  W 
Rogers,  and  A.  C.  Stof]  .  The  Diploma  of  the  Society 
was  granted  to  the  following  candidate,  entitling  him 
to  practise  medicine,  surgery,  and  midwifery  :— W\,G- 
Kinton* 


222    Th«  Mbdical  Pbess.      NOTICES  TO  CORRESPONDENTS. 


Feb.  24,  1904. 


Jtoticts  to 
forreepmtiimts,  Short  %ttttxs,  &c 

fJ^P*  Oobehpondbitc  requiring  a  reply  In  thif  column  are  particu- 
larly requested  to  make  nee  of  a  dUHmctiv  tignatwrt  oriwttioJ,  and 
avoid  the  practice  of  signing  themselves  "  Header,"  "  Subscriber," 
♦•Old  Subscriber,"  60.  Much  oonfueion  will  be  epared  by  attention 
to  this  rule. 

Original  Articles  or  Letters  intended  for  publication  should  be 
written  on  one  aide  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

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

Reprints.— Reprints  of  articles  appearing  in  this  Journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

RusTicTJ*  (Bucks).-  The  best  thing  is  to  confirm  the  diagnosis  of 
impacted  fracture  by  a  Rontgen-ray  photograph  of  the  hip.  You 
will  have  to  get  an  operator  with  apparatus  from  town.  In  our 
opinion  it  is  fairer  to  the  profession  to  get  a  medical  man.  It  will 
be  wiser  to  warn  your  patient  that  shortening  may  occur  from 
absorption  some  time  after  apparent  recovery. 

Dr.  IH.  W.  A.  Zeiss.— One-twelfth  inch  oil  immersion  lens  will 
serve  your  purpose. 

Rontoen  Bat  (Eastbourne).— Write  to  Mr.  Harry  Cox,  Cursitor 
'  Street,  London,  E.G.,  for  a  treatment  tube. 

Bastohan.— (1)  We  know  no  book  on  the  subject.  (2)  The  harvest 
'  mouse  is  distinguished  from  all  other  British  mammals  by  the  fact 
that  it  has  a  prehensile  tail. 

Scrutator  (Croidon).— The  League  of  Mercy,  as  you  say,  is  doubt- 
less founded  on  principles  that  are  in  the  main  praiseworthy.  We 
note,  however,  that  the  tradesmen  and  the  administration  are  all 
paid  with  one  exception,  namely,  the  medical  attendant.  Why 
should  not  the  skilled  service  of  the  medical  man  be  recognised  like 
all  other  indispensable  services?  Some  day  the  hollowness  of 
gratuitous  medical  work  will  be  recognised  everywhere,  yet  no 
gratuitous  post  goes  long  a-begging. 

Qujrrens.—  It  seems  to  be  more  than  probable  that  the  injection 
of  paraffin  by  an  unqualified  person  as  a  plastic  operation  to  remedy 
a  defectively  shaped  nose,  if  followed  by  disastrous  consequences, 
would  lay  the  operator  open  to  an  action  for  vety  heavy  damages. 
The  Medical  Act  is  so  defective  that  anyone  posse* aed  of  moderate 
-cunning  and  caution  can  practise  medicine  or  surgery  for  a  livelihood 
without  the  slightest  dread  of  consequences. 


clfoetittgs  of  the  gtorietie*,  %tttmtBf  &c. 

WEDNESDAY,  FRBRDART   24th. 

'"    Huhterian  Socixtt  (London  Institution,  Pinsbury  Circus,  E.C.).— 
8.30  p.m.    Clinical  Evening.    Exhibition  of  Oases. 

Medical  Graduates'  College  and  Polyclinic  (22,  Chenies  Street, 
W.O.).— 4  p.m.  Mr.  H.  L.  Barnard :  Clinique.  (Surgical.)  5.15  p  m. 
Mr.  8.  Stephenson  :  Some  of  the  Newer  Remedies  in  Eye  Disease. 

Thursday,  February  25th. 

Harvbian  Pociett  of  London  (St.  Mary's  Hospital}.— Clinical 
Meeting.    Patients  will  be  in  attendance  at  8.15  p.m. 

Childhood  8ocinr  (Library  of  the  Sanitary  Institute,  72,  Margaret 
8treet,  W.).— 8  p.m.  Lecture.— Mr.  H.  Hall :  On  Some  Elementary 
Aims  in  Education. 

Medical  Graduates'  College  and  Polyclinic  (22,  Chenies  Street, 
W.O.) -4  p.m.  Mr.  Hutchinson:  Clinique  (Surgical.)  6.15  p.m. 
Mr.  E.  Clarke  :  Errors  of  Refraction,  their  Diagnosis  and  Treatment. 

Mount  Vernon  Hospital  for  Consumption  and  Diseases  op  the 
Chest  (7,  Pltxroy  8quare,  W.).— 5  p.m.  Dr.  T.  D.  Lister :  The  Treat- 
ment of  Advanced  Phthisis  at  Home.    (Poet-Graduate  Course.) 

St.  John's  Hospital  for  Diseases  of  the  Skin  (Leicester  Square, 
W.O.).™ 6.15  p.m.     Dr.  M.  Dockrell :   Acne.   (Chesterfield  Lecture.) 

Friday,  February  26th. 

Clinical  Society  of  London  (20,  Hanover  Square,  W.).— 8  p.m. 
Exhibition  of  Clinical  Cases  followed  by  discussion.  Patients  will  be 
in  attendance  from  8  p.m.  to  9  p.m. 

Medical  Graduates'  College  and  Polyclinic  (22,  Chenies  Street, 
W.C.).— 4  p.m.    Clinique. 


Aberdeen  City  District  Lunacy   Board.— Assistant  Medical  Officer, 

8alary  £110  per  annum,  with   board.     Applications  to  0.  B. 

Williams,  Clerk.  20,  Union  Terrace,  Aberdeen. 
Birmingham  and  Midland  Eye  Hospital— House  Surgeon,  8alary  £75 

per  annum,  with  board  and  attendance.      Applications  to  the 

Secretary. 
Bradford  Children's    Hospital.— House  Surgeon,  Salary  £100  per 

annum,  with  board,  residence,  and  washing.      Applications  to 

C.  V.  Woodcock,  Secretary. 


Cheltenham  General  Hospital— Junior  House  Surgeon,  Salary  £70 
per  annum,  with  board,  lodging,  and  washing.    Applications  to 


H.  T.  Carrington,  Hon.  Sec.  and  1 

Clayton  Hospital  and 'Wakefield  General  Dispensary.— Junior  Howe 
Surgeon,  salary  £80  per  annum,  with  board,  lodging,  and  wash- 
ing. Applications  to  the  Hon.  Secretary,  Clayton  Hospital,  Wake- 
field. f 

Denbighshire  Infirmary,  DenMgh.-Houee  Surgeon,  Salary  £100.  with 
board,  residence  and  washing.  Applications  to  J.  Parry  Jones, 
Secretary. 

East  London  Hospital  for  Children  and  Dispensary  for  Women, 
Shadwell,  E.— Medical  Offloer  Salary  £100  per  annum.  Applica- 
to  Thomas  Hayes,  Secretary. 

Gesto  Hospital,  Isle  of  8kye.— Resident  Medical  Offloer,  Salary  £300  per 
annum,  with  furnished  house,  coals,  light,  and  taxes.  Applica- 
tions to  the  Secretary,  J.  Simpson,  North  of  Scotland  Bank, 
Limited,  Portree,  8kye. 

Guest  Hospital,  Dudky.  -Senior  Resident  Medical  Offloer,  Salary 
£100  per  annum,  with  board,  residence,  attendance  and  washing. 
Applications  to  the  Secretary. 

Joint  Counties  Asylum,  Carmarthen.— Junior  Assistant  Medical 
Officer,  Salary  £150  per  annum,  with  board,  furnished  apart- 
ments, and  washing.  Applications  to  Dr.  Goodall,  Medical 
Superintendent,  the  Asylum  Carmarthen. 

Salford  Royal  Hospital.— Junior  House  Surgeon,  8alary  £70  per 
annum,  with  board  and  residence.  Applications  to  George 
Buddie,  Secretary  and  Superintendent. 

St.  Mary's  Hospital,  Paddington,  W.— Resident  Casualty  Home 
Surgeon,  Salary  £100  per  annum,  with  board  and  lodging. 
Applications  to  Thomas  Ryan,  Secretary. 

West  Bromwich  District  Hospital. -House  Su'geon,  8alary  £100  per 
annum,  with  board,  residence  and  washing.  Applications  to 
Thos.  Foley  Rache,  Esq.,  Churchill  House,  West  Bromwich. 

West  Riding  of  Yorkshire.— Bacteriologist  and  Assistant  to  County 
Medical  Officer.  8alary  £250  per  annum.  Applications  to  Treror 
Edwards,  Clerk  to  the  Committee. 

West  Riding  Asylum.  Wadsley,  near  Sheffield.— Fifth  Assistant 
Medical  Officer,  8alary  £140  per  annum,  with  board,  Ac.  Appli- 
cations to  the  Medical  Superintendent. 

West  Riding  Asylum,  Wadsley,  near  Sheffield.— Fourth  Assistant 
Medical  Officer,  Salary  £150  per  annum,  with  board,  Ac  Appli- 
cations to  the  Medical  Superintendent. 


Jlppointmems. 

Andrews.    Marion,   M.B.,  Surgeon  to  the  Women's  DsTMutroest, 

Ulster  Hospital  for  Children  and  Women,  Belfast,  vice  Dr.  John 

Tennant,  resigned. 
Bennion,  J.  M.,  M. B.Cantab.,  Junior  House  Surgeon  to   the  Rad- 

cliffe  Infirmary,  Osford. 
Curl,  Sydnet  W..  M.A..  M  B.Cantab..  MR.CP.Lond.,  Pathologist 

and  Bacteriologist  to  the  North-Eastern  Hospital  for  Children. 

Hackney  Road. 
Ewart,  D.,  M.a,  B.S.Edin.,  F.R.C.8.E.,  Certifying  Surgeon  under 

the  Factory  Act  for  the  Chichester  District  of  the  county  of 

Sussex* 
Foster.  C.   W..  M.R.C.8.,  L.R.O.P.Lond.,  House  Surgeon  to  the 

Badcliffe  Infirmary,  Oxford 
Gardner,  A.,  M.B.,  C.MEdin..  Medical  Officer  of   Health  for  the 

Kirbymoorside  District  of  Ryedale,  Yorkshire. 
Gibson.  A.  G.,  M.B.,  B.Ch.Oxon.,  House  Physician  to  the  BadcUfte 

Infirmary,  Oxford. 
IVENS,  Frances,  M.S.Lond.,  Surgical  Assistant  to  the  New  Hospital 

for  Women. 
Manning,   Richard   Beattie.   LR.CP.Lond.,  M.R.C.S..   Honorary 

Medical  Officer  to  the  Wells  (Somerset)  District  Cottage  Hospital 
Marsh,  C.  J.,  L  R.C.P  Edin.,  M.R.C.8.,  Certifying  Surgeon  under 

the    Factory  Act   for  the   Yeovil   District  of  the  county  of 

Somerset. 
Marshall,  J.  Cole.  M.B..  F.R.C.S.Eng.,  Clinical  Assistant  to  the 

Chelsea  Hospital  for  Women. 
Svbll,  Sidney  H.,  M.D.,  RS.Lood.,  Assistant  Anaesthetist  to  the 

Royal  Ear  Hospital,  Sdho. 


girths. 


StRRiDOE.— On  February  19th,  at  Knutsford,  Cheshire,  the  wife  of 
E.  N.  Surridge,  RA.,  M.B.,  B.O.,  of  a  daughter. 


4&rmages. 

Warner— Adcocx.— On  February  15th,  in  London,  Charles  I.  Warner, 
of  Somersham.  Huntingdonshire,  to  Clara,  second  daughter  of 
the  late  Dr.  and  Mrs.  Adcock,  of  Hunstanton,  Norfolk. 


§t$Att*. 


Brown.- On    February    17th,    at    Dovedale,    Wimblehurst    Road,. 

Horsham,  Augustus  Brown.  M.D.,  in  his  76th  year. 
DREScnrsLD.— On   February  20th,    Selma.  dearly-beloved   wife  of 

Julius  Dresohfeld,  M.O..  of  43,  Leyland  Road.  Southport. 
Hind.— On   February     16th,.  at    Blythehohne,    Harrogate,    Annie 

Charlotte,  wife  of  Henry  Hind,  F.R.C.8. 
MacLeod.— On   February    17  th,   at   18,   Mornington    Avenue.  W.,. 

Inspector  General  of  Hospitals  and    F*eets  William  MacLeod, 

M.D.,  C.B.,  B.X.  (Retired),  aged  84. 
Price.— On  February  14th,  at  Cheltenham.  Jane  Staopoole,  younger 

daughter  of  the  late  William  F.  Price.  M.D.,  of  Monmouth. 
Tulloch.— On    February   19th.    at    Brighton,   Isabelle    JfayoardV 
winger  daughter  of  the  late  James  Tulloch,  M.D.,  Pembridge 
''lace,  Bayawater. 


Pli 


Ut 


km  m&   fcular. 


"SALUS   POPULI    SUFREMA    LEX-' 


Vol.  CXXVIII. 


WEDNESDAY,     MARCH   2,    1904. 


No.    9. 


©it  gin  a  I  Communications. 

THE 

IMINISHING     BIRTH-RATE  ; 

CAUSE.    ITS  TENDENCY,  AND   POSSIBLE 
REMKPY.   (a) 

By  JOHN  W.  TAYLOR,  M.D.,  F.RX.S. 

I'Meistfr  of  Gynecology  in  th*-  University  of   Birmingham  ;  Fresi* 
dent  of  the  British  Gynecological  So> 

Part  I. 

Gentxemen, — The  Presidency  of  the  British  Gynae- 
-  al  Society  is  an  honour  which  I  hilly  appreciate, 
ind  which  I  would  Simply  and  heartily  acknowledge. 
This  Society,  from  its  beginning,  has  been  truly  British 
•n  its  scope  and  interests.  It  has  freely  and  graciously 
recognised  the  work  and  claims  of  the  Provinces  as 
well  as  those  of  the  Metropolis  ;  and  in  representing 
to  Boms  extent,  however  unworthily,  the  work  and 
Uaims  of  Birmingham  and  the  Midlands,  I  do  joyfully 
eiate  the  place  held  by  us  in  the  heart  of  the 
Society,  and  in  the  very  centre  of  its  labours, 

As  I  enter  upon  my  duties  this  evening,  I  do  so 
with  a  sense  of  great  responsibility;  and  this  is  un- 
doubtedly increased  by  the  recognition  of  the  difficulty 
yet  immense  importance  of  the  subject  which  I 
have  chosen  for  my  Inaugural  Address.  This — "The 
Diminishing  Birth-rate,  and  what  is  involved  in  it  " — 
I  purpose  now  to  deal  with,  trusting  I  may  count  on 
that  considers  ttuii,  sympathy  and  interest  which  so 
serious  an  undertaking  may  reasonably  demand* 
t 

In  one  of  the  chapters  of  Mr.  Ruskin's  well-known 
book  on  Biblical  Economy,  "  Unto  This  Last/*  he 
deals  with  an  inquiry  into  what  he  calls  the  "  veins  of 
wealth."  He  exposes  the  fallacy  that  the  wealth  of 
be  lies  solely  or  essentially  in  material  possessions — 
thawing  that  apparent  or  nominal  wealth  which  fails 
in  its  authority  over  men,  fails  in  essence  and  ceased 
to  be  wealth  at  all  — t hat  the  true  veins  of  wealth  are, 
as  he  fays,  "  purple— not  in  rock  but  in  flesh/'  and  the 

final  outcome  and  consummation  ol  all  wealth  is 
in  the  producing  as  many  as  possible  full-breathed, 
bright -eyed,  and  happy -hear  ted  human  creatures." 

In  his  final  chapter,  "  Ad  Valorem/*  Mr.  R  us  kin 
1  ;— "There  is  no  wealth  but  life.  That  country 
u  the  richest  which  nourishes  the  latest  number  of 
noble  and  happy  human  beings  " — "  the  nobleness 
being  not  only  consistent  with  the  number,  but  essential 
to  it.  The  maximum  of  life  can  only  be  reached  by 
the  maximum  of  virtue." 

The  principles  or  truths  contained  in  these  passages — 

iges  which   bear   the  strictest   examination   and 

criticism— may  be,  and  aret  very  generally   accepted, 

theoretically.     But  the  history  of  the   nation   during 

iast  twenty-five  years  shows  that  the  prin 
which  govern  its  reaf  life  are  altogether  different  and 
directly  contradictory. 

To-day,  we  are  brought  face  to  face  with  unauswer- 


<■)  Inaugural  Addren  read  at  the  meeting  of  the  British  M\  d*co- 
*>l**l  Society,  r 


.Thursday,  February  Utb,  1904. 


able  statistics  proving  that  our  birth-rate  is  steadily 
■nnnnishing.  This  has  already  attracted  the  seriou* 
consideration  of  statisticians  and  of  some  of  our  states- 
men, but  the  inquiry  into  its  causes  has  been  confused 
and  incomplete.  Here,  I  hope,  we  can  at  least  discuss 
these  plainly  and  fearlessly,  for  some  of  the  problems 
connected  with  causation  are  essentially  gynaecological, 
and  can,  perhaps,  only  be  rightly  gauged  by  those 
who  have  special  medical  and  gynaecological  ex- 
perience. 

The  subject  is  a  great  one— so  great,  indeed,  that  if 
the  nation  could  only  see  it  in  its  true  proportion,  it 
would,  I  think,  be  found  to  dwarf  all  other  questions  of 
the  day, 

I  cannot  hope  in  the  time  at  my  disposal  to  enter 
fully  into  all  its  phases.  I  do  hope*  however,  to  take 
the  most  salient  and  striking  features  of  the  statistical 
data  at  our  command,  to  inquire  what  is  meant  and 
involved  by  these,  and  to  consider  how  far  the  pro- 
fession and  the  public  may  do  anything  to  check  the 
apparently  relentless  progress  of  an  evil  destiny. 

The  best  tables  for  our  primary  consideration  are 
some  of  those  which  have  been  compiled  by  Mr,  Holt 
Schooling,  the  statistician*  In  Table  I  we  see  the 
average  yearly  number  of  births  to  each  thousand 
persons  hying  in  the  United  Kingdom  during  five 
successive  periods  of  five  years  each. 

Table  /\— The  average  yearly  number  of  births  per 
1,000   persons   living   in   Great    Britain   and  Ireland, 
during  the  5 -yearly 
Periods, 

1874-1878 Hk3 

1870-1883 *>  , .  ..  ..  .,     32*6 

1884-1888,.  ,,  ,      31*2 

1880-1893 29'8 

1894-1898 , .     29*1 

(Note  the  steady  decrease,  34,  32,  31,  nearly  30, 
29,  and  in  1901  it  had  come  down  to  28*) 

Now  let  us  compare  this  with  exactly  similar  statistics 
of  other  countries  :  — 

Tabic  II. — The  average  yearly  number  of  births  per 
1,000  persons  living  during  the  5-yearly 

Great  Britain 
MMt 
Period i.  Austria.,  Germany.     Italy.       Ireland.      France* 

1874-1878    .,   39'4--   401  ..   37'Q  -   34*3  ■  ■   *5"8 
1879-1883    .,   38*4  ..,    37*5  ♦♦    36*8  ..   32-6  ,.   248 
1884-1888    . .   38'f  ♦-   36*9.,   382.,    3t"2..   33*9 
1889-1893    .,    37"i  ■-    3«'3  -    36'9*.    29*8.  ♦   22*5 
1K94-1898    ...    37-3  .-    36*1  ..    349  .♦    29-1  ♦.    22-3 
If  we  compare  the  top  line  with  the  bottom  we  see 
that  in  each  case  there  has  been  a  fall,  so  that  a  dimin- 
ishing birth-rate  is  not  a  feature  of  our  own  Kingdom 
only,  but  is  to  some  extent  European  in  its  scope  or 
effect,  and  the  lowest  birth-rate  is  that  of  France, 

Of  the  other  great  powers  and  nations — the  United 
States,  Russia,  China,  and  Japan — -no  certain  statistics 
are  available,  but  we  have  very  good  reason  to  belie  vt? 
that  the  birth-rate  is  seriously  falling  in  the  States, 
but  notably  rising  in  Russia  and  Japan.  According 
to  Russian  statistics  from  1892-1894,  the  birth-rate 
per  i,ooo  was  477,  and  from  1894-1897  the  birth-rate 


224    The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


March  2.  1904. 


per  1,000  was  49*5,  so  that  there  has  been  not  only 
no  loss  or  diminution  in  the  birth-rate  here,  but  the 
figures  are  also  far  above  those  already  tabulated.  So 
far,  the  data  we  have  considered  show  us  that  the 
birth-rate  throughbut  the  whole  of  the  West  is  di- 
minishing, while  that  of  the  East  is  rather  expanding. 

We  now  want  to  consider  the  relative  birth-loss  of 
the  various  Western  nations  as  compared  with  one 
another,  and  this  brings  us  to  the  most  important  and 
startling  of  Mr.  Schooling's  tables. 

He  takes  the  birth-rate  statistics  for  1874- 1878  in 
each  European  nation  as  the  standard  for  that  nation, 
and  places  against  this  the  statistics  for  1894- 1898, 
computing  from  this  the  loss  of  birth-force  in  the 
twenty  years.     The  following  is  the  result : — 

The 


The  yearly 

The  yearly 
birth-foroe 

percentage 

birth-foroe 

of  yearly 

during 
1874.1878 

daring 

toes  during 

1804-1896 

1804-1806 

taken  at 

was  only 

wat 

Norway 

IOO 

.      96      .. 

4 

Denmark 

IOO 

.     95      .. 

5- 

Austria 

.  .      IOO 

.     95     .. 

5 

Italy 

IOO 

.     94     .. 

6 

Hungary 

IOO      . 

.     91      .. 

9 

Germany 

IOO 

.     00     .. 

10 

Switzerland 

IOO 

.     00     .. 

10 

Belgium 
Holland    .. 

IOO 

.     89     .. 

11 

IOO 

.     89     .. 

11 

Sweden 

IOO 

.     88      .. 

12 

France 

IOO 

.     86     .. 

14 

United  Kingdom 

IOO 

.     85      .. 

15 

England  and  Wales 

.  .       IOO 

.     83      .. 

17 

In  other  words,  while  Norway,  Denmark  and  Austria 
very  nearly  keep  up  their  birth-force  of  twenty  years 
ago,  the  other  nations  in  their  order  show  an  increasing 
loss,  and  England  and  Wales  stand  at  the  very  bottom 
of  the  list.  None  of  the  other  nations  have  sustained 
so  great  a  loss  as  we  have  in  this  definite  period  of 
time. 

During  the  same  period  of  time  the  marriage-rate 
in  the  United  Kingdom  has  not  altered  much,  but, 
during  the  last  ten  years  or  so,  has  been  slowly  rising. 
The  figures  in  the  returns  of  the  Registrar-General  are 
as  follows  (Table  44,  1900) : — 

Persons  married 
to  100  living. 

1876-1880 14*2 

1881-1885 141 

1886-1890 138 

1891-1895 14*3 

1 896- 1 9OO 15*2 

So  that  we  may  take  the  birth-loss  in  the  United 
Kingdom  as  due  to  causes  operating  in  the  married 
life  of  its  inhabitants.     It  is  not  simply  due  to  celibacy. 

The  fertility  of  marriages  appears  to  have  so  much 
diminished  that  the  decrease  in  London  alone  is  said 
to  "  equal  26,000  births  yearly,  or  about  500  weekly." 
(Mr.  T.  A.  Welton  at  a  meeting  of  the  Royal  Statistical 
Society,  June  17th,  1902.) 

But  some  may  say,  England  and  Wales  are  only  a 
small  part  of  the  Empire,  and  the  statistics  of  Great 
Britain,  where  there  is  but  little  room  for  expansion 
and  increase,  form  no  criterion  of  the  birth-rate  in  our 
Colonies.  Unfortunately,  what  statistics  are  available 
on  this  point,  and  notably  those  of  Australia,  offer 
no  encouragement  to  the  hope  that  the  Colonies  are 
much  better  than  ourselves. 

In  Australia  the  birth-rate  has  fallen  with  an  even 
still  greater  rapidity  than  in  England.  In  1 861  -1865 
the  rate  was  41*9  per  1,000,  but  had  diminished  in 
1871-1875  to  37*3 ;  in  1881-1885  to  35*2 ;  and  in 
1891-1895  to  31*5  ;  while  in  1896-1899  the  rate  was 
only  27*35,  or  actually  below  the  rate  of  increase  at 
home.  If  we  work  out  these  figures  in  harmony  with 
Table  III  we  find  Australia  a  long  way  below  all  the 
European  nations,  with  a  birth-force  down  to  70*3, 
and  a  percentage  of  yearly  loss  amounting  to  nearly 
30! 

Regarding  this,  Mr.  H.  W.  Wilson  writes :— "  The 
decline  in  Australia  is  great  in  every  position  of  life, 

"•ong  the  poorest  and  the  richest  alike,  and  it  is  the 


more    extraordinary    because    the    greatest    want   of 
Australia  is  a  teeming  population." 

But  any  statistical  inquiry,  to  be  of  value,  must  be 
considered  in  all  its  bearings.  It  has  been  said,  and 
with  considerable  reason,  that  there  is  nothing  so- 
unreliable  as  statistics,  and  this  may  be  the  case  when 
these  are  imperfectly  considered.  In  the  present 
instance,  if  we  are  desirous  of  estimating  the  true  wealth 
or  value  of  the  population  we  possess,  there  may  be  a 
fallacy  in  mere  numbers.  It  may  well  be  that 
twenty  children  better  clothed,  better  fed,  better 
educated,  better  trained,  may  develop  into  men 
higher  socially  and  morally,  stronger  and  better  able 
to  hold  their  own  than  100  children  less  advantage- 
ously brought  up.  Can  we  hope  that  the  type  of 
man  is  improving  ? — that  the  generation  of  English- 
men to-day,  though  falling  short  in  birth-force,  is  yet 
greater  than  the  generation  preceding  it  ? 

Again,  unfortunately,  we  must  sorrowfully  admit 
that  we  have  no  sufficient  ground  for  believing  this. 
The  criminal  statistics,  though  showing  a  general  and 
steady  reduction  in  the  whole  criminal  population  of 
the  United  Kingdom,  during  the  last  twenty  years  (a 
fact  which  is  very  encouraging),  do  not  show  a  corres- 
ponding diminution  in  juvenile  criminality,  and  it  is 
necessarily  the  youth  of  our  country  to  which  any 
estimate  of  the  last  twenty-five  years  would  more 
particularly  apply. 

According  to  August  Brahms,  in  his  work  on  "  The 
Criminal "  (p.  272),  "  Juvenile  criminalism  is  on  the 
increase.  Forty  per  cent,  of  the  convictions  in  England 
every  year  are  against  young  persons  under  twenty- 
one  years  of  age."  And  on  page  281  he  appends  a 
table  which  shows  a  higher  percentage  of  criminals- 
under  twenty  years  of  age  in  England  than  in  any  of 
the  other  European  countries  there  tabulated. 

The  Lunacy  statistics  of  England  and  Wales  show  a 
steady  proportionate  increase  of  lunatics  and  idiots, 
especially  during  the  last  few  years. 

In  1869  there  were  23*93  lunatics,  idiots  and  persons- 
of  unsound  mind  to                  10,000  of  population. 
1879  ••  ••     27*54        

!i889   . .                 29*65 
1894   ..          ..     30-58        
1899   ..                 32-96        
1903   ••          ••     34H        

(From  the  57th  Report  of  the  Commissioners  in 
Lunacy,  1903.     Parliamentary  Blue  Book.) 

Or,  in  other  words,  the  increase  of  lunatics  and  idiots 
in  England  and  Wales  has.  during  the  last  fifteen  to 
twenty  years,  been  very  nearly  double  the  old  rate. 

The  natural  deduction  from  these  figures  that 
insanity  and  idiocy  are  increasing  seems  also  to  be 
proved  by  the  recent  statistics  of  the  new  admissions 
to  asylums  and  licensed  houses.  The  ratio  of  first 
admissions  to  10,000  of  population  has  been  as 
follows : — 
In  1899. .  . .  . .  4*94 

„    1900. .  . .  . .  . .  . .  5*02 

„    1901 5*28 

,,    1902 576 

(Ibid.,  p.  95.) 

It  is  very  difficult  to  obtain  trustworthy  statistics  re- 
garding  alcoholism,  but  those  given  in  the  "  Temperance 
Problem,"  by  Messrs.  Rowntree  and  Sherwell,  are 
probably  the  best.  According  to  these  the  consump- 
tion of  wine  per  head  of  the  population  has  varied 
but  little  during  the  twelve  years  from  1885  to  1897, 
but,  during  the  same  time,  the  consumption  of  beer  has 
gone  up  from  27* 5  gallons  to  31*3  gallons,  and  of  spirits 
from  *9j  gallons  to  1*02  gallons.  And  the  "  national 
drink  bill  "  (p.  437),  which  was  estimated  at  £$  7s.  iod. 
per  head  in  1885,  came  to  £$  16s.  io|d.  in  1898.  In 
London  (Metropolitan  Police  Area)  there  were,  from 
1885  to  1889,  4*33  arrests  for  drunkenness  to  1,000  of 
the  population.     In  1897  the  proportion  had  risen  to 

7*35  (p-499).  ,  jt_. 

So,  m  juvenile  criminalism,  in  mental  disease  and  brain 
weakness,  and  even  in  alcoholism,,  the  restricted 
population  of  the  present  day  compares  unfavourably 
with  that  of  a  former  generation. 

If  we  try  to  go  on  and  trace  this  comparison  further. 


March  2,  1904. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Peess.     225 


and  compare  the  general  culture  of  the  more  intellectual 
classes  of  the  two  generations  over  a  limited  field — for 
no  general  statistics  are  available— still  the  investi- 
1  (though  necessarily  imperfect  and  tentative) 
**ems  to  point  to  an  unfavourable  conclusion. 

In  ray  own  city  of  Birmingham,  a  critical  survey  of 
Ui  chief  semi-public  literary  and  artistic  institutions 
.  r.n  recently  made  by  Mir.   Howard  S,   Pearson, 
aad  he  publishes  a  tabulated  statement  showing  the 
irt  given  to  these  twenty  years  ago,  ten  years  ago, 
r/  Literary  Magazine,  Nov.,  1903.  J 
His  figures  show  as  a  net  result  that  in  the  course  of 
twenty  vcars  there  has  been  a  loss  of  366  subscriber-, 
lit  one  in  fourteen,     **  This  would  be  discourag- 
ing, but  it  is  by  no  means  all-     The  population  of  the 
and  district  has  vastly  increased,  while  this  care 
UeUectual    and   artistic    culture   has    materially 
diminished.     In    brief,    the  population   has  increased 
bv  more  than  one- fourth,  while  the  interest  in  the 
institutions  named  has  decreased  by  one-fourteenth/1 
later   onT    Mr.  Pearson  writes  : — "  These  institutions 
are  not  some  among   many  ;   they  have  actually   no 
rivals  at  all,     Neither  111  the  city  nor  in  the  neighbour- 
hood is  there  anything  which,  even  pretends  to  touch 
(km  special  work,     They  stand,  each  in  its  own  way, 
ii>r  the  general  and  intellectual  culture  of  the  educated 
s.     The  very  aim  and  intent  of  all  our  strenuous 
efforts  in  the  cause  of  education  is  to  increase  the  pro* 
portion  of  the  educated  classes  and  to  lead  to  a  life- 
interest  in  culture.     And  as  the  population  rises. 
citation  becomes  more  far-reaching,  as  art  is  more 
more  talked  about,  even  so  must  grow  the  dis- 
:*  mi  nt  "i  all  who  might  have  hoped  to  gather 
from  the  changed  conditions  a  large  sympathy  in  their 


It  must  be  confessed  that  the  more  deeply  and 
thoroughly  one  goes  into  this  matter  the  more  serious 
rme,  Prof.  Karl  Pearson  {Huxley  Memorial 
Lecture,  1903,  and  British  Medical  Journal,  October 
:4th.  1903),  who  has  approached  it  from  an  altogether 
different  standpoint — from  a  careful  study  of  the 
tnheritance  by  children  of  the  mental  and  moral,  as 
a  the  physical  characters  of  their  progenitors—  ' 


a\v-\    hie -history  of  these  relatively  sterile   marriages. 
Some,  and  notably  M,  Arsene  D  union  t,  in  his  work  on 
the  age  of  marriage,  profess  to  consider  the  elevation  of 
the  age  when  marriage  is  entered  into  as   mainly   re* 
sponsible  for  the  deficit  in  the  birth-rate.  It  does  un- 
doubtedly account  for  some  of  the  loss.     Obviously, 
if  marriage  be  deferred  until  thirty-five  or  forty  years 
of  age,  there  must  he  less  expectation  of  progeny  than 
in  a  marriage  contracted  some  ten  years  earlier,     It  is, 
however,  idle  to  suppose  that  this  touches  more  than 
the  fringe  of  the  nation's  loss.     The  main  cause,  and 
we  who    are  in  gynaecological  practice  must  know  it, 
is    the    deliberate    prevention    of    conception.     This, 
which    was   first  encouraged  and    taught   in   England 
some  thirty-five  years  ago,  has  gradually  spread  like   a 
blight  over  the  middle-class    population    uf  the  land. 
and  the  true  wealth  of  the  nation,  the  "  full-breathed , 
bright-eyed,  and  happy-hearted  children  "  of  Ruskin, 
have  more  or  less  gone  down  before  it.     It  is  this  which 
has  so  altered  the  family  life  of  our  country  that  the 
most  superficial  observer  of  middle  or  advancing  age 
must    be   struck   by    the   difference.     Instead   of   the 
families  of  six  or  twelve  to  eighteen  children,  we  see 
more  often  the  so-called  family  of  three  or  two  or  one, 
and   that  which  used  to  lie — and  still  should  be — the 
highest  and  noblest  function  of  the  married   woman, 
the  rearing  of  sons  and  daughters  to  the  family,  tlu 
nation  and  the  Empire,  is  very  largely  handed  over  to 
the   lower  classes  of  our  own  papulation  and    to   the 
Hebrew  and  the  alien. 

For  a  long  time  it  appears  to  have  been  assumed  that 
whatever  might  be  the  loss  to  the  nation  and  the  race 
by  such  a  practice,  the  individual  must  gain.  The 
avoidant*  of  the  troubles  of  pregnancy,  the  dangers 
incidental  to  parturition,  the  confinement  of  the 
tymg-inT  the  worries  of  lactation,  the  expense  of  another 
child,  and  the  extra  work  wThich  this  entails — all  of  this 
avoided  seems  at  first  to  be  an  undoubted  gain  to  the 
struggling  husband  and  over-anxious  wife*  and  it 
would  ill-become  me,  with  the  knowledge  I  possess,  if  1 
failed  to  appreciate  the  difficulties  of  the  position  or 
to  imder-estimate  the  power  of  that  current  advice 
which  seems  ou!y  to  be  dictated  by  common  prudence. 
But  the  question  arises  whether  this  immunity  from 
comes  to  much  the  lusions.     He  notes  that  I  p3jn  atuj    trouble   may   not   be   too  dearly  purchased. 

there  appears  to  be  a  want  of  intelligence  in  the  British  |  even    by    the   persons   themselves  who   are   primarily 
merchant,  workman  and  professional  man  of    to-day ,  I  concerned. 


es  but  little  hope  in  the  usually  proposed  rem 
uf  foreign  methods  of  instruction  and  the  spread  of 
ucal  education,     "  The  reason  for  the  deficiency. M 


It  would  be  strange  indeed  if  so  unnatural  a  practice 
^-one  so  destructive  to  the  best  life  of  the  nation- 
should  bring  no  danger  or  disease  in  its  wake,  and  I 


fetes,  **  is  that   the  mentally   better  stock  in   the  ,  am  convinced,  after  many  years  of  observation,  that 
m  is  not  reproducing  itself  at  the  same  rate  as  of  ,  both  sudden  danger  and  chronic  disease  may  be  pro- 
^d— the  less  able  and  the  less  energetic  are  the  more    dueed  by  the  methods  of  prevention  very  generally 
fertile.     Education  cannot  bring    up  hereditary  weak-  I  employed. 

ness  to  the  level  of  hereditary  strength,  and  the  only  ]n  one  or  two  instances  I  have  known  acute  peri- 
remedy  is  to  alter  the  relative  fertility  of  the  good  and  tonitis  to  immediately  follow  the  use  of  an  injection 
had  stocks  of  the  community.  The  psychical  characters  after  sexual  intercourse.  The  cervical  canal  appears 
urbicharc  the  backbone  of  a  State  in  the  modern  struggle  (  ^0  ^  often  unusually  patent  at  this  time,  and  thi- 
ol nations  are  not  so  much  manufactured  by  home  and     danger  is  neither  an  unimportant  nor  isolated  one. 

it  and  college;    they   are   bred   in   the  bone,    and         in  another  instance    I    was  consulted   for  an  acute 

Hie  last  forty  years  "the  intellectual  classes  of  the    purulent    vaginitis    directly    following    the    use    of    a 

nation    enervated  by  wealth  or  by  love  of  pleasure,  1  mechanical  shield,  and  as  both  parties  were  free  from 

[lowing  an  erroneous  standard  of  life,  have  ceased     anv  disease  previously,  there  could  be  no  doubt  that 

to  Rive  m  due  proportion  the  men  wanted  to  carry  on     ^  infection  or  cause  of  irritation  arose  from  this. 

the  ever-growing  work  of  the  Empire,"  These  are  casual    instances    of    sudden  danger  or 

All  this  tends  to  show  that  the  marriages  of  to-day  are    acute  illness   that   have  come  under  my  own   notice, 

rdy  relatively  infertile,  but,  also,  either  {t  J :— that     hut  none  the  less  real  and   far  more  common  is  that 

hildren  born  of  such  marriages  are  weak,  neurotic,  ,  cnromc    impairment    of    the    nervous    system    which 

specially  liable  to  alcoholism,  criminality  and  insanity,     frequently  follows  the  long-continued  use  of  any  pre- 

autl  90  hi  Unfit  for  the  battle  of  life,  or,  (2)  that  mar-    ventive  measures,   whether  open  to   hostile  criticism 

nages  of   the   middle   and   better  classes  are   now   so    or  not  as  immediately  dangerous. 

ile  that  quite  an  undue  and  dangerous  proportion        'fhis  chronic  impairment  of  nervous  energy  of  which 

ising   generation  is  recruited    from   the   lower,     j  am  uow  speaking,  often  referred  to  under  the  name 

the  in  ire  Ignorant,  the  more  vicious  and  semi-criminal  i  o1  neurasthenia,  and  BtiU  more  recently  under  that  of 

1  **  brain-fag,"  has  manv  causes,  and  may  be  produced 


In     any     case     the     conclusion     is     one     of      the 

atooi  and  almost  paralysing  in  the  serious- 

m       It  is  indeed  a  u  handwriting  on  the 

latms  the  fullest  ami  wisest  interprela- 

■A  throughout  the  Kingdom, 

II. 


We  now  pass  on  to  the  consideration  of  the  cause    mental  depression  and  abject  misery    often    felt 

D 


whenever  there  has  been  too  great  a  tax  or  drain  upon 
the  nervous  system,  and  too  short  a  time  for  real 
recuperation  ;  but  it  is  especially  marked  in  many  of 
these  cases  of  sexual  onanism. 

The  inability  to  fix  attention,  the  unreasonable  fears, 
the  loss  of  memory,  the  loss  of  emotional  control,  the 

by 


226    The  Medical  Press.  ORIGINAL  COMMUNICATIONS. 


March  2.  1904. 


the  sufferer — himself  or  herself — and  shown  more  or 
less  in  countenance,  word  and  act,  these  are  symptoms 
well  known  to  all  of  us,  and  symptoms  that  may  be 
studied  exceptionally  well  perhaps  in  the  school-boy 
addicted  to  the  habit  or  vice  of  self-abuse.  With  the 
reform  of  this  habit  in  the  boy,  all  of  these  symptoms 
quickly  disappear.  It  is  difficult,  therefore,  to  escape 
from  the  conclusion  that  the  storing-up  of  semen  in  the 
male  is  of  value  in  the  economy.  It  is  undoubtedly 
a  source  of  strength  both  in  man  and  in  the  lower 
animals,  and  it  appears  as  if  the  seminal  fluid  must 
therefore  have  some  function  beyond  and  in  addition 
to  its  power  in  the  reproduction  of  species.  Its  loss 
is  often  followed  immediately  by  loss  of  strength  and 
staying  power,  and  this  loss  of  strength  or  vitality  after 
the  process  of  reproduction  is  noticeable  throughout 
all  the  animal  creation,  man  being  no  exception  to  the 
general  rule. 

Further,  the  artificial  injection  of  "  testicular  juice  " 
in  senility,  though  a  means  of  treatment  by  no  means 
free  from  objection,  and  one  of  which  I  have  no  personal 
knowledge,  is  stated  by  many  competent  observers 
(from  Brown-Sequard  to  Boy  Teissier  in  the  **  Twentieth 
Century  Practice  of  Medicine")  to  be  attended 
by  very  marked  results,  and  this,  I  believe,  quite  irrespec- 
tive of  the  sex  of  the  patient  submitted  to  the  treat- 
ment, (a) 

Do  we  understand  the  whole  of  the  physiology  of  the 
act  which  often  ends  in  conception  ?  Is  it  limited, 
as  most  have  too  readily  assumed,  to  the  carrying  of 
spermatozoa  for  the  fecundation  of  the  ovum,  or  is  some 
portion  of  the  fluid  retained  by  the  uterus  and  absorbed  ? 

Modern  investigation  shows  that  traces  of  the 
seminal  fluid  may  be  found  quite  high  in  the  female 
genital  tract,  beyond  the  confines  of  the  uterus,  and 
the  ever  varying  mucous  surface  of  the  body  of  the 
uterus  can,  as  we  know,  under  certain  conditions 
easily  absorb  septic  poisons  and  mercurial  salts. 

Beyond  this,  it  is  by  no  means  certain  that  the 
endometrium  and  so-called  uterine  glands  are  inactive. 
Except  during  menstruation  there  is  no  visible  dis- 
charge from  the  body  of  the  normal  uterus,  and  if  the 
theory  of  Arthur  Johnstone  be  accepted,  that  the 
cavity  of  the  corporeal  endometrium  is  essentially  an 
open  lymph-gland,  the  channel  of  absorption  may  be 
immediate  and  direct. 

It  is  quite  possible,  then,  that  in  one  or  both  of 
these  suggested  ways  some  tonic  constituent  of  the 
seminal  fluid  may  be  taken  up  by  the  uterus,  and  thus 
affect  the  general  organism  ;  and  there  is  nothing  un- 
reasonable in  the  suggestion  that  such  absorption  may 
allay  the  exhaustion  which,  without  it,  is  liable  to 
follow  the  act  of  connection. 

It  is  very  noticeable  that  exactly  the  same  train  of 
neurasthenic  symptoms  are  nearly  always  to  be 
observed  in  the  worst  cases  of  cervicitis,  where  the 
cervical  canal  is  effectively  plugged  by  thick  mucus, 
and  the  patient,  though  married,  is  temporarily  but 
necessarily  sterile.  In  both  cases  the  resulting  im- 
perfect acts  of  sexual  congress  appear  to  be  directly 
harmful. 

But  apart  from  this,  is  the  prevention  of  pregnancy 
the-  gain  to  the  woman  that  so  many  imagine  ?  It 
may  well  be  questioned  whether  in  the  study  of  preg- 
nancy sufficient  attention  has  been  paid  to  the  period 
of  ovarian  rest  which  appears  to  accompany  the  growth 
of  the  pregnancy.  The  raising  of  the  ovaries  out  of  the 
pelvis  into  the  abdomen,  the  diversion  of  the  main 
blood  stream  for  nine  months  directly  to  the  uterus,  and 
the  absence  of  menstruation,  through  pregnancy  and 
lactation,  argue  a  time  of  rest  and  comparative  in- 
activity for  the  ovaries  which  cannot  but  have  an 
important  value  in  the  life  of  the  woman  who  is  married, 
and  at  the  same  time  physiologically  ready  for  con- 
ception and  for  pregnancy. 

During  this  time  of  uterine  activity,  but  of  ovarian 


(a)  Dr.  Boy  Teissier  writes  :-  "  I  have  employed  injections  of 
testicular  juice  in  certain  rasrs  of  irregular  and  »omeiimea  very 
adTanced  senility,  and  the  T*ry  faTourable  resul'  e  thereby  obtained 
are  of  such  a  nu' are  as  to  make  me  re* a  d  this  substance  as  an  agent 
of  real  po  *er  the  employment  of  which  la  larely  contra-indicated. 


rest,  there  is  ample  opportunity  for  the  nervous  supply 
of  the  ovary  to  recover  from  any  undue  stimulus,  and 
it  is  perhaps  worthy  of  notice  that  this  period  is  usually 
attended  by  improvement  in  general  nutrition  and 
increase  of  fat.  This  comparative  suspension  of 
ovarian  activity  also  coincides  with  the  time  when  the 
uterus  is  filled  and  unable  to  retain  the  secretion  of 
the  male. 

When  this  period  is  fully  over  it  is  only  reasonable 
to  suppose  that  the  ovaries  have  gained  by  this  alterna- 
tion in  the  sexual  apparatus,  and  that  the  maturation 
of  the  follicle  may  proceed  more  healthily,  and  even 
the  ovum  itself  may  be  more  perfectly  formed,  than 
in  the  case  of  a  woman  in  whom  this  natural  cycle  has 
been  artifically  prevented.  In  this  case  the  ovaries 
suffer  and  the  woman  suffers  with  them — far  more, 
as  a  rule,  than  »he  would  by  repeated  child-bearing. 
Widely  as  the  practice  of  prevention  has  spread  you 
will  still  have  to  go  to  the  mothers  of  large  families  if 
you  want  to  point  to  the  finest  and  healthiest  examples 
of  advanced  British  matronhood.  The  natural 
deduction  from  this  reasoning  is,  that  the  artificial 
production  of  modern  times — the  relatively  sterile 
marriage — is  an  evil  thing  even  to  the  individuals 
primarily  concerned,  injurious,  not  only  to  the  race, 
but  to  those  who  accept  it. 

Much  that  I  have  said  regarding  the  married  life  of 
the  mothers  of  our  race  has  a  very  similar  bearing  on 
that  of  the  fathers  also.  The  incomplete  act  of  sexual 
congress  is  but  slightly  removed  from  that  of  self- 
abuse,  and  is  open  to  much  the  same  criticism  and 
strictures.  The  lower  passions  are  usually  stronger 
in  man  than  in  woman,  and  demand  a  firmer  control. 
This  is  encouraged  by  the  natural  progress  of  the 
healthy  married  life.  The  recurring  periods  of  ab- 
stinence and  restraint  induced  by  each  pregnancy,  at 
the  confinement  and  lying-in,  not  only  tend  to  raise  the 
man  himself,  but  the  power  obtained  by  this  we  may 
expect  (as  Prof.  Pearson  has  demonstrated  regarding 
other  moral  faculties)  to  be  mathematically  trans- 
mitted to  his  children. 

The  increased  work  and  self-sacrifice  also  necessi- 
tated by  the  growth  of  the  family,  the  simpler  and 
plainer  standard  of  life  corresponding  to  this,  all  have 
their  ennobling  effect  on  parents  and  children.  But 
when  the  opposite  of  this  obtains  then,  indeed,  there 
follows  not  only  a  moral  deterioration  of  the  individual 
but  a  step  has  been  taken  reversing  the  great  order  of 
progress  from  the  brute.  For  then  the  higher  powers 
of  the  race,  knowledge  and  the  intellectual  application 
of  it  shown  in  "  prevision  "  and  "  precaution  "  have 
become  systematically  subservient  to  the  lower  and 
the  animal.  And  when  this  is  the  case  decadence  has 
begun. 

There  is  no  method  of  prevention,  whether  by  with- 
drawal or  by  the  use  of  injections,  or  shields,  or 
medicated  suppositories,  that  can  be  regarded  as 
innocuous. 

The  health,  and  especially  the  mental  and  moral 
stamina,  of  those  who  use*  these  "  checks  "  is  slowly 
undermined.  The  very  life  of  the  nation,  as  we  have 
seen,  is  seriously  imperilled,  and  there  is  increasing 
reason  to  believe  that  such  isolated  children  as  are 
"  arranged  for  "  and  produced  under  these  conditions 
may  themselves  suffer  and  be  degraded  by  their 
antecedents. 

To  the  evils  of  disease,  race-limitation,  or  destruction 
and  hereditarv  weakness  which  appear  to  inevitably 
follow  the  arti'icaUy  sterile  marriage,  we  have  to  add 
the  accompanying  evil  of  a  debased  and  stunted 
education  for  the  children. 

In  the  most  plastic  period  of  the  child's  life,  in  its 
earliest  years,  the  more  or  less  solitary  child  brought 
up  in  a  land  of  solitary  children  is  necessarily  isolated 
and  self-centred.  Reared  in  greater  comfort  or  com- 
parative luxury,  with  no  brothers  or  sisters  of  similar 
age  to  rub  off  its  angles  and  selfishness,  it  is  ill-pre- 
pared for  every  step  of  the  succeeding  battle  of  life, 
and  it  is  very  generally  the  child  of  the  larger  family 
and  poorer  parents,  and  very  often  the  child  of  a  lower 
class,  who  pushes  his  way  in  front  of  him  and  elbows 


March  3,  1904. 


ORIGINAL  COMMUNICATIONS.  The  Med.cal  PBESS.    227 


bun  to  the  wail.  I  have  no  time  to  dwell  on  this, 
-*  Inch  opens  out  an  important  field  for  further  obser- 
vation and  Study,  but  you,  gentlemen,  who  have 
necessarily  been  students  of  human  nature  all  your 
will  know  how  much  there  is  to  bear  out  every 
word  that  I  have  said, 

{To  be  concluded  in.  out  next.) 

PUBLIC     HEALTH    PROBLEMS 
IN    IRELAND,  (a) 


By  Sir  JOHN  W.  MOORE,  M.D.,  D.P.H.Univ.  Dub, 

F.R.C.P.L, 
Freodeatof  the  Section  of  8t.it .■  Medicine  in  the  Hojal  Academy  of 
Medicine  id  Ireland* 

On  February  5  th,  1885,  I  addressed  this  Section — 
■i,  as  it  was  then,  Subsection — of  the  Academy  on 
"  Sanitary  Organisation  in  Ireland  in  its  Medical 
Aspect."  Two  years  later,  on  February  3rd,  1887.  the 
sooject  of  my  Inaugural  Address  was  "The  Present 
and  the  Future  ol  Stale  Medicine," 

In  the  seventeen  years  which  have  passed  away  since 

the  latter  date,  State  Medicine  has  made  unexampled 

progress  in  all  its  departments;  sanitary  organisation 

in  Ireland,  on  the  contrary,  has  advanced  "  with  halting 

steps  and  slow.'*      Yet  substantial  advance  has  taken 

place  in  many  directions  even  in  this  country. 

Sotification. — In  1887   1  had  to  deplore  an  uncom- 

a   to   the  principle  of  compulsory 

notification  of  infectious  diseases  on  the  part  of  the  vast 

majority  of  the  medical  profession*     On  August  30th, 

an  "Act  to  Provide  for  the  Notification  of  In- 

>us  Disease  to  Local  Authorities  "  (52  &  53  Vict,, 

chapter  ?2)  received  the  Royal  Assent.     All  opposition 

1  I  the  principle  of  notification  has  long  since  happilv 

►ut,  and  the  Act  has  now  been  adopted  practically 

throughout  the  length  and  breadth  of  the  laud,   with 

untold  benefit  to  the  public  health. 

The  provisions  of  the  "  Infectious  Disease  (Notifi- 
cation) Act,  iB8o."  are  too  well  known  to  need  any  ex* 
plana tion  at  my  hands.     I  may,  however,  refer  to  a 
useful  application  of  the  Act,  whereby  comparatively 
J  infections  which  simulate  more- serious  maladies, 
like  chicken-pox  in  Its  relation  to  small- pox,  or  rubella 
m  its  relation  to  measles  or  scarlatina,  are  temporarily 
added  to  the  schedule  of  notifiable  diseases  when   the 
more  deadly  infections  threaten  to  be,  or  are,  epidemic, 
On  August  4th,  1890,  an  "  Act  to  Prevent  the  Spread 
of  Infectious  Disease  "  {53  and  54  Vict.,  chapter  34), 
iy   called    the    "  Infectious    Disease    (Prevention) 
At,  189c*,"  was  put  upon  the  Statute  Book,  with  the 
object  of  enabling  sanitary  authorities  to  give  practical 
effect  to  preventive  measures  based  on  information 
tied  through  notification. 
These  two  measures— the  Magna  Chart  a  of  Public 
Health— have  been  cordially  received  by  the    medical 
profession,    who   with   a   noble   self-denial   have   once 
mm  admitted  the  truth  of  the    adage— Solus  poputi 
• 
Qwdificattnns    tn    Ptthlic    Health.— A    second    great 
advance  has  been  the  official  recognition  of  diplomas 
to  State  Mi  Public  Health.     The  initial  step 

-en  taken  m  1 8$6\  when  the  Medical  Act  (49  and  50 
Vict,  chapter  48),  by  its  twenty  first  section,  provided 
It  the  registration  by  the  General  Medical  Council  of 
diplomas   in  Sanitary    Science,      Since    January    1st, 
the  medical  officer   of   health  of  a  county,  dis- 
trict or  combination  of  districts  with  a  papulation  of 
irds.  must,  in  addition  to  his  qualdica- 
•  n  medicine,  surgery  and  midwifery,  be  registered 
AS  The  holder  ot  a  diploma  in  Sanitary  Science,  Public 
Health,  or  State  Medicine  under  Section  2 1  of  the  Medical 
ft  is  gratifying  also   to  note  how  many 
1    the    naval,    military,    and    Indian    Medical 
ts  are   taking   this   higher  qualification.      In  mv 
address  to  this  Section  in  1887,  I  recalled  the  fact  that 
University  of  Dublin  belongs  the  credit  of  having 
been  the  very  first  institution  in  the  United  Kingdom 

\n\  K\m  nurl  ol  an  AdMrcwinftiigiimrMiir  the  fusion  of  1  DOS  1 W4, 
Wwnrf  More  the  ffeettoti  of  SUte  Medicine  in  ih«  Royal  Academy 
ttJMCiftt  ia  Ireland,  Fridaj.  FVbruarj  12th,  1001. 


to  establish  a  diploma  in  State  Medicine,  or  (as  it  is 
now  called)  **  Public  Health/'  The  first  examination 
for  the  diploma  took  place  in  June,  1871—  nearly  thirty- 
three  years  ago,  when  it  was  granted  to  Dr.  Arthur 
Wynne  Foot,  Dr.  Gerald  Francis  Yeo,  Dr.  John  Tod* 
hunter,  and  myself. 

Tuberculosis  and  its  Prevention,— A  notable  con- 
tribution to  the  literature  of  this  all-important  qucs* 
tion  has  been  recently  published.  I  refer  to  an  article 
in  Tuberculosis  for  January,  1904,  on  u  The  present 
Position  of  the  Tuberculosis  Problem  in  Ireland/' 
by  Dr.  Alfred  E.  Boyd,  Honorary  Secretary  of  the 
Dublin  Branch  of  the  National  Association  for  the  Pre- 
vention of  Consumption  and  other  Forms  of  Tuber* 
culosis.  Dr.  Boyd  shows  by  figures  taken  from  the 
Annual  Report  of  the  Registrar-General  for  Ireland 
far  iqai,  that  the  deaths  from  tuberculosis  in  Ireland 
m  that  year  were  11.837,  against  12,331;  to  1901,  and 
an  average  of  12,716  in  the  ten  years  1 891-1900-, 
Phthisis,  or  pulmonary  consumption,  was  responsible 
for  9,400  deaths  in  1902,  The  highest  county  death- 
rates  for  tuberculosis  in  general  for  the  same  year  are- 
Dublin  County  Borough,  47  per  1,000  of  the  popula- 
tion annually  ;  Belfast  County  Borough,  4-0  ;  Dublin 
County,  VS  :  Cork  County  and  Cork  Borough,  30  ; 
The  lowest  rates  are— Cavan,  \'$  ;  Roscommon,  r6 ; 
Mayo,  Fermanagh,  Longford,  and  Donegal,  each  17, 

For  the  whole  country  Ike  deatfee  in  1902  represent 
an  annual  death-rate  of  27  per  1,000  of  the  popula- 
tion—the lowest  rate  recorded  in  Ireland  since  1890, 
Commenting  on  these  figures,  Dr.  Boyd  observes  ♦ 
"  The  upward  tendency,  which  during  recent  years  has 
caused  grave  anxiety,  has  thus  been  checked,  and  there 
is  ground  for  hope  that  ere  long  there  will  be  a  sub- 
stantia) decrease  in  the  prevalence  of  tuberculous 
disease  in  Ireland," 

Having  described  what  has  already  been  done  in 
Dublin  to  cope  with  the  evil,  Dr.  Boyd  set  forth  the 
chief  measures  still  required,  in  order  to  control 
tuberculosis.  These  will  be  found  in  the  article  above 
quoted. 

The  Housing  0/  the  Poor.— Closely  connected  with 
the  prevention  of  tuberculosis  is  the  question  of  the 
housing  of  the  working  classes  and  of  the  very  poor— a 
burning  question  in  Dublin  of  late  years.  It  will  be 
within  the  recollection  of  the  Fellows  that  in  1900  the 
Local  Government  Board  for  Ireland  appointed  a 
Committee  to  inquire  into  the  public  health  oi  the  City 
of  Dublin.  In  their  report,  dated  Mav  14th,  tooo, 
the  members  of  that  committee  speak  of  "  large 
tenement  houses,  each  room  occupied  by  a  separate 
family  ;  the  house  itself  in  a  state  of  dilapidation  ; 
water  supply  inconvenient  of  access;  dirty  common 
staircases  ;  inadequate  water-closet  accommodation 
in  a  foul  state  ,  back-yards  ill  paved  and  littered  with 
refuse  and  excrement,  are  conditions  of  life  in  Dublin 
which  are  frequently  encountered  in  connection  with  the 
dwellings  of  the  poorer  classes."  The  committee 
point  out  that  these  conditions  tend  to  produce  a  state 
of  lowered  vitality  favourable  to  the  contraction  of 
disease,  and  to  a  fatal  result  of  disease  when  contracted. 
They  also  directly  encourage  the  spread  of  infective 
maladies,  including  phthisis  and  other  forms  of  tuber- 
calosis,  which  are  excessively  prevalent  in  a  fatal  form 
in  Dublin.  Strict  cleanliness  in  the  home  is  of  the  first 
importance  in  checking  the  spread  of  consumption, 
and  cleanliness  11  wis  no  place  in  most  of  the  houses 
occupied  by  the  Dublin  poor.  And  in  this  connection 
it  has  to  be  borne  in  mind  that  the  proportional  amount 
of  poverty  in  Dublin  is  very  large,  so  that  the  un- 
favourable conditions  associated  with  the  houses  of  the 
poor  are  widely  spread  throughout  the  city. 

The  committee  go  on  to  state  that  "  the  question  of 
the  housing  of  the  poor  of  Dublin  is  one  of  magnitude. 
The  provision  of  an  adequate  number  of  healthy  dwell- 
ings by  way  of  relief  for  the  present  Overcrowding  of 
population  under  unhealthy  conditions  must,  of  neces- 
sity, be  on  a  considerable' scale,  and  would  probably 
involve  several  schemes.  Sites  for  the  provision  of 
dwellings  for  the  poor  could  best  be  obtained  outside 
the  citv.  in  localities  within  easy  reach  of  the  principal 


228    The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


March  2.  1904. 


Irasiness  quarters  of  Dubln.  In  these  schemes  it 
should  be  borne  in  mind  that  healthy  dwellings  are 
especially  needed  in  Dublin  for  the  very  poor.  Houses, 
therefore,  intended  with  this  object  should  be  of  the 
plainest  kind,  in  order  that  such  schemes  may  not 
entail  heavy  loss  upon  the  ratepayers. 

As  to  the  last  point,  we  must  remember  that  any- 
thing  which    will    reduce    the    liability    to    epidemic 
disease  will  be  a  direct  saving  to  the  ratepayers.     It 
was  calculated   that  the  small-pox  outbreak  of  1878 
cost  the  city  of  Dublin  not  less  than  £20,000  sterling. 
In  the  paper  from  which  I  have  already  quoted  Dr. 
Boyd  points  out  that  much  has  been  done,  and  is  being 
done,  in  Dublin  to  mitigate  the  evil  of  overcrowding. 
The  Dublin  Artisans'  Dwellings  Company,  the  Iveagh 
Trust,  and  the  Corporation  of  Dublin  "  have   erected 
modern  buildings  on  sites  which  were  formerly  covered 
by  houses  in  which  sanitation  was  too  often  primitive, 
aad  in  which  healthy  existence  was  almost  impossible  ; 
while  the  Association  for  the  Housing  of  the  Very  Poor, 
the  Social  Service  Tenements  Company,  and  the  Alexan- 
dra Guild  have,  in  a  smaller  way.  attacked  the  problem 
by  buying  buildings  which  were  capable  of  renovation, 
rendering  them  sanitary,  and  letting  them  to  the  poor 
at  rents  which  cover  expenses,   and   in  some  cases 
allow  of  a  small  rate  of  interest  being  paid  on  the  capital 
invested."    The  Social  Service  Tenements  Company 
Is  worked   by   students  and   others   connected   with 
Trinity    College,    Dublin.     The    Alexandra    Guild    is 
connected  with  the  Alexandra  College,  Dublin,  an  in- 
stitution  for   the   higher  education  of  women.     The 
Urban    District    Councils    of  Rathmines,   Pembroke, 
Kingstown  and  Blackrock  are  also  engaged  in  extensive 
building  operations  for  the  better  housing  of  the  work- 
ing classes  and  the  poor.     In  the  very  heart  of  the 
city    the   space    between    the   ancient    cathedrals    of 
Christ  Church  and  St.  Patrick  has,  within  the  past  few 
years,  been  changed  by  a  magician's  wand.     A  charm- 
ing park    and  wide,    well-paved   streets,   with    airy, 
well-built  houses,  have  taken  the  place  of  squalid  lanes 
and  alleys,  reeking  with  filth  and  hot-beds  of  disease — 
typical  *'  fever-nests,"  such  as  were  so  graphically  de- 
scribed    by     the     late     ever-to-be-lamented     philan- 
thropist and  sanitarian,  Dr.  Thomas  W.   Grimshaw, 
C.B.,  Registrar-General  for  Ireland.     In  many  other 
districts  also,  both  north  and  south  of  the  River  Liffey, 
wholesome  homes  for  the  industrious  working  classes 
have  sprung  up   under   the  auspices  of   the   Dublin 
Artisans'  Dwellings  Company.     "  Old  Dublin  "  is.  in 
fact,  xapidly  disappearing  and  with  it  typhus  fever 
has  already  well-nigh  disappeared. 
*  Workhouse  Reform. — I  wonder  whether  at  the  present 
time  a  single  champion  of  the  existing  Poor-law  sys- 
tem of  Ireland  could  anywhere  be  found  ?     In  the  first 
place  universal  suffrage  and   the  Local  Government 
(Ireland)    Act  of   1900   have  flooded   the  boards  of 
guardians  all  over  the  country  with  "  representatives  " 
of  the  sovereign  Plebs.     In  many  instances  these  men 
are,  from  the  accident  of  their  birth,  social  position, 
calling  and  education,  incapable,  however  well-mean- 
ing they  may  be,  of  discharging  their  duties  to  the  poor 
and  infirm  in  an  enlightened  philanthropic  spirit,  un- 
trammelled by  political  and  sectarian  considerations. 
A  single  instance  by  way  of  illustration  must  suffice  : — 
The  medical  officer  of  Granard  Workhouse — himself  a 
Roman  Catholic  —complained   that  his  patients  were 
not  being  properly  nursed.     The  nurses  were  nuns, 
the  rules  of  whose   sisterhood  forbade  them  carrying 
out  certain  details  of  sick  nursing.      What  was   the 
result  ?     The  Sisters  resign.     The  Bishop  of  the  diocese 
espouses  their  quarrel.     An  unseemly  wrangle  between 
the  Local  Government  Board  and  the  guardians  ensues, 
and  drags  on  for  months.    The   Bishop  insists  on  an 
apology  to  the  nuns  by  the  medical  officer,  who   did 
nothing  more  than  his  duty.     And  so  the  interests  of 
the  sick  poor  are  wantonly  sacrificed. 

But  matters  are  even  worse  when  we  come  to  con- 
sider the  internal  economy  of  the  workhouses  of  our 
land.  As  it  exists,  it  is  a  grave  scandal  and  a  national 
disgrace. 

"  The   workhouse   system,"    says   Miss    Emily    Bu- 
nan  (herself  a  Poor-law  guardian),  in  a  paper  read 


by  her  before  the  Philanthropic  Reform  Association  on 
September  22nd,  1903,  "  is  unjust  and  distasteful  to 
the  sick  and  helpless  classes,  and  is  only  too  attractive 
to  the  undeserving  who  thrive  upon  its  corruptions. 
In  no  other  country  in  Europe,  outside  the  United 
Kingdom,  is  such  a  system  to  be  found." 

Reform  should  proceed  on  such  lines  as  the  follow- 
ing:— 

1.  All  children  should  be  boarded  out,  and  properly 
educated. 

2.  The  respectable  aged  poor  should  also  be  boarded 
out.  In  Denmark  there  are  asylums  apart  from  the 
workhouses  for  the  reception  of  old  men  and  old 
women  who,  through  no  fault  of  character,  but  by 
reason  of  advancing  years  and  failing  powers,  have 
been  reduced  to  penury.  In  these  asylums  they  find 
a  comfortable  home  and  retain  their  self-respect. 

3.  No  lunatics  or  epileptics  should  be  admitted  to 
the  workhouse.  This  is  the  law  in  England  and  Scot- 
land. 

4.  The  union  hospital  or  infirmary  should  be  entirely 
separate  from  the  workhouse  ;  nor  should  the  hospital 
patients  be  drafted  into  the  workhouse  when  con- 
valescent. 

5.  It  is  desirable  that  women  inspectors  should  be 
appointed  under  the  Local  Government  Board.  The 
principle  of  such  an  appointment  has  already  been 
admitted  in  regard  to  boarded-out  children.  To 
the  Irish  Workhouse  Association,  headed  by  its  noble 
President,  Lord  Monteagle,  is^due  the  credit  of  initiating 
this  great  reform. 

6.  The  employment  of  fully-trained  nurses  should 
be  compulsory  on  all  boards  of  guardians. 

These  are  some  of  the  lines  along  which  Poor-law 
reform  should  move. 

The  Poor-law  Medical  Service. — At  last — after  long 
years  of  unaccountable  apathy — the  medical  profession 
appears  to  be  awaking  to  a  sense  of  the  grave  and  most 
unsatisfactory  state  of  what  may  be  called  "  the  home 
medical  service."  The  lot  of  the  average  dispensary 
medical  officer  in  Ireland  is,  of  a  truth,  not  an  enviable 
one.  Overworked  and  underpaid,  at  the  beck  and  call 
of  masters,  whose  views  as  to  his  duties  and  their 
rights  are  not  always  controlled  by  that  "  sweet 
reasonableness "  which  is  begotten  of  a  liberal 
education  and  a  ripe  experience  of  the  world ;  ham- 
pered in  his  ministrations  to  the  sick  by  official  book- 
keeping ;  with  no  prospect  of  promotion  after  years 
of  toil  and  drudgery  ;  face  to  face  with  the  conviction 
that  he  must  die  in  harness,  or  run  the  risk  of  retire- 
ment without  pension  or  "  superannuation  " — what  a 
calling  for  a  member  of  a  "  learned  profession  M  ! 

It  is,  however,  in  the  aspect  of  the  question  which 
bears  on  the  sanitary  organisation  of  the  country  that 
the  interest  of  the  State  Medicine  Section  of  the  Royal 
Academy  mainly  centres.  The  members  of  the 
Section  will  remember  that  every  dispensary  medical 
is  ipso  facto  medical  officer  of  health  for  his  dispensary 
district.  He  is  obliged  to  perform  many  and  onerous 
duties,  which  are  specified  in  detail  in  an  order  to 
sanitary  authorities  issued  by  the  Local  Government 
Board  under  the  Public  Health  Act  of  1878.  Ad- 
ditional duties  have  been  imposed  upon  him  by  sub- 
sequent Acts  of  Parliament,  such  as  the  Labourers' 
Dwellings  Act  (1890  and  1893)  >  the  Infectious  Disease 
Notification  Act  (1889) ;  the  Infectious  Disease  (Pre- 
vention) Act,  1890 ;  the  Public  Health  Amendment 
Acts  of  1884  and  1885  ;  the  Housing  of  the  Working 
Classes  Act  of  1890 ;  and  the  Local  Government 
(Ireland)  Act  of  1898. 

For  these  multifarious  and  highly  responsible  duties 
a  shamefully  inadequate  remuneration  has  been  fixed 
at  the  instigation  and  with  the  approval  of  the  Local 
Government  Board  for  Ireland.  The  sanitary  authori- 
ties are  no  doubt  to  blame  for  having  so  grievously 
misjudged  the  value  of  skilled  services  rendered  to 
preventive  medicine  by  the  local  medical  officers  oi 
health ;  but  the  chief  fault  lies  at  the  door  of  the 
central  controlling  authority — the  Local  Government 
Board,  which  should  have  refused  to  sanction  mere 
nominal  salaries  to  medical  officers  of  health  whose 
duties  were  bound  to  be  anything  but  nominal  unless  the 


Makch  a.  1904. 


ORIGINAL  COMMUNICATIONS. 


Tub  Medical  Pa  ess.     220, 


ill  ministration  of   the  public  health  code  in   Ireland 
was  to  be  a  sham 
As  has  been  already  stated,    in   the  year  1900  the 

(J  Government  Board  for  Ireland  appointed  a 
committee  to  inquire  into  the  public  health  of  the  city 
of  Dublin,  I  had  the  honour  to  serve  on  that  com- 
mittee, and  I  need  not  say  with  what  deep  regret  I  felt 
hound,  alter  hearing  an  immense  mass  ot  evidence, 
to  subscribe  to  the  following  rinding  of  the  commit- 
*« : — "  The  evidence  laid  before  us  leads  to  the  belief 
that  the  provision  of  Section  u  of  the  Public  Health 
{Ireland  \  Act,  1878,  whereby  each  dispensary  medical 
Miged  to  act  as  medical  officer  of  health  ibr 
his  dispensary  district,  has  worked  unsatisfactorily 
m  Dublin,  and  should  be  altered/" 

Let  mt*  not  be  misunderstood.  The  committee 
Jnund  no  fault  with  the  way  in  which  the  duties  of 
maiieal  officer  of  health  had  been  discharged  by  the 
si*  teen  dispensary  medical  officers  of  the  city  of  Dublin 
districts.  Quite  the  contrary.  Their  conduct  has 
been  on  all  occasions  most  praiseworthy t  self-denying 
jnd  devoted.  But  their  executive  power  existed  only 
m  name  ;  they  could  do  little  more  than  report  ;  they 
*ere  little  better  than  "  sanitary  sub-officers  *'— to 
quote  the  ridiculous  nomenclature  of  the  eleventh 
section  of  the  Public  Health  Act  of  1878  ;  the  many 
daims  upon  their  time  as  district  physicians  curtailed 
their  usefulness  as  health  officer*, 

Effect,  however,  has  not  been  given  to  the  recommen 
■  lation  of  the  co  mmittee  that  the  public  health  duties  of 

^pensary  medical  officers  "should  be  discharged  by 
an  assistant  medical  officer  of  health*  who  should  re~ 
cm-e  an  adequate  salary,  and  who  should  give  his 
whole  time  to  the  duties  of  his  office."  In  Dublin. 
IS  throughout  Ireland,  the  dispensary  medical  officers 

in  the  medical  officers  of  health  for  their  respective 
list  nets,  and  what  I  now  contend  for  is  that  this  hard- 

ed,  badly-requited  body  of  pubhc servants, whose 
efforts  for  the  health  and  welfare  of  the  community 
are  often  misunderstood,  seldom,  if  ever,  appreciated, 
should  he  properly  recompensed  for  their  services  under 
the  Public  Health  Acts.  If  this  is  done,  and  if  the 
suggestions  for  the  betterment  of  the  health  of  the 
people,  made  by  the  local  medical  officers,  are  carried 
oat  intelligently  and   in  a  generous  spirit,   the  dawn 

brighter  day  for  the  Irish  race  will  at  last  be  at 
band, 


bNEW    TREATMENT    OF 
RENAL    AND   CARDIAC 
DROPSY,    (a) 
By  Professor  RENAUT;  M.IX, 
qf  Ljone. 
Wk    have    already  referred  briefly*  to  the    new 
departure  in  the  treatment  of  renal  and  cardiac 
dropsy  recommended  by  Prof.  Renaut,  of  Lyons, 
consisting    in    the    administration    of    macerated 
pork  kidneys,   on    which    he    read     a     paper    at 
(he  meeting  of  the  Academic  de  Medccine,  Paris. 
The    great    importance   of    the    subject    and    the 
remarkable  results  obtained   merit   more   than   a 
passing  notice ,  consequently  we  think  it  right  to 
reproduce  the  paper  as  fully  as  possible. 

Alter  some  preliminary  observations  on  the 
method  of  administration,  Prof+  Renaut  gave  the 
wing  cases  with  results  : — 
Cast  /.— Outstanding  nephritis,  bronchitis, 
albuminuria,  and  cedema  of  the  extremities  in 
1902,  attack  of  renal  insufficiency  with  oedema 
and  uremia  in  January,  1903.  Restitution  of  the 
normal  diuresis  and  disappearance  of  the  :d- 
butnmuria  from  May,  1903,  and  continued  up  to 
the  present  time. 

1*1  Uwtrect  of  *  FfcfmrMfcl  before  the  Ac&ieuie  de  Mfotedne, 
P*rta.    fit  ported  b/  our  French  Correspondent. 


E ,  at.  56,  living  in  the  conn  try,  heavy  eater, 

but  not  alcoholic.  Frequent  attacks  of  bronchitis 
since  1901.  Slight  cedema  of  the  legs,  cedema  of 
the  base  of  both  lungs,  oppression,  urine  strongly 
albuminous.  Lac  to  vegetal  regime  followed  by 
improvement.  In  consequence  of  particular 
strain  in  moving  his  home  to  Lyons,  oedema 
returned,  buL  disappeared  after  application  of 
leeches  to  the  lumbar  region.  In  December, 
1902,  the  pal  tent  worried  about  his  business, 
and  suddenly  the  amount  of  urine  fell  to  one 
pint  in  the  twenty -four  hours,  while  symptoms 
of  u nemic  dyspncea  set  in.  Five  leeches  were 
again  put  to  IV til's  triangle,  and  the  following 
day  the  quantity  of  urine  had  more  than  doubled, 
but  there  was  still  a  certain  amount  oi  albumin. 
At  the  end  of  a  few  days  the  oliguria  returned. 
Digitalis  in  decreasing  quantities  again  opened 
the  kidneys  and  dissipated  the  uraemia.  But 
from  that  lime  the  attacks  returned  every  ten 
days. 

The  patient  showed,  however,  great  power  of 
endurance,  but  in  spite  of  constant  changes  in 
the  treatment  he  never  could  urinate  for  two 
consecutive  days  the  amount  of  liquid  he  consumed. 
The  urine  was  always  albuminous.  It  was  under 
these  conditions  of  a  struggle  for  life  indefinitely 
renewed  that  I  commenced  (March  15  th,  1903) 
the  administration  of  two  pork  kidneys  macerated 
for  four  hours  in  a  pint  of  salt  water.  In  two 
days  the  kidneys  were  freed j  and  the  patient  passed 
three  quarts  of  urine,  or  one  quart  more  than  he 
drank.  Digitalis,  theobromin,  or  the  appli- 
cation of  leeches  would  not  have  acted  better 
At  the  same  time  the  albumin  was  quickly  reduced t 
and  in  ten  days  after  the  treatment  only  traces 
were  found,  and  on  April  23rd  it  had  disappeared, 
to  return  from  time  to  time  in  only  inappreciable 
quantities.  On  May  8th,  it  had  disappeared 
for  good,  and  examined  October  31st  last,  the 
urine  of  twenty -four  hours  was  absolutely  free 
from  it.  The  patient,  maintained  on  the  milk 
and  the  maceration,  passes  about  as  much  urine 
as  he  imbibes  liquid.  Every  trouble  has  also 
disappeared  No  more  oedema  nor  bronchitis. 
As  to  drugs,  he  only  takes  a  little  strophanthus  to 
sustain  the  muscular  energy.  He  takes  the 
macerated  kidney  for  periods  of  ten  days, 
followed  each  time  by  a  period  of  rest  of  five  days. 

Case  //.—Generalised  arte rio- sclerosis  -  slight 
aortitis,  interstitial  nephritis,  attacks  of  uremic 
dyspnoea  with  pulmonary  cedema. 

F >,  art.  52,     Suddenly  seized  with  an  attack 

of  oppression  in  returning  from  shooting,  followed 
by  persistent  headache.  Having  a  syphilitic 
history,  the  specific  treatment  was  tried,  but 
without  effect  The  attacks  of  dyspnoea  were  of 
uraemic  character,  accompanied  by  pulmonary 
cedema  and  sanguineous  sputa ;  cedema  oi  the 
legs.  The  patient  had  manifestly  arrived  at  the 
toxic  period  of  Bright's  disease.  Put  to  bed  and 
ordered  milk  diet,  the  man  was  given  alternately 
strophanthus  and  digitalis,  while  leeches  were 
applied  over  the  kidneys  followed  by  injection 
of  a  pint  of  artificial  serum.  No  great  change 
took  place  until  the  patient  was  given  the 
maceration,  and  almost  immediately  the  flow  of 
urine  became  abundant  and  the  albumin  ended 
by  disappearing  altogether.  At  present  the  man 
enjoys  good  health,  walks  about  without  feeling 
fatigued  or  oppressed* 

Case    ///,— The    following    case    furnishes    an 


,230     The  Medical  Psess. 


ORIGINAL  COMMUNICATIONS. 


March  2,  1904. 


example  of  the  effect  of  maceration  of  the  kidney 
,on  a  patient  with  albuminuria  of  cardiac  origin. 
A  man,  set.  59,  suffering  from  myocarditis,  from 
grippe  and  mental  strain,  albuminuria  and  renal 
•insufficiency.  Digitalis,  strophanthus,  and  theo- 
•bromin  having  given  but  temporary  relief,  macer- 
ated kidney  was  tried.  Almost  immediately  the 
patient  experienced  an  improvement ;  the  urine 
rose  to  the  normal  quantity,  cyanosis  and  dyspnoea 
disappeared,  the  appetite  returned,  and  the 
tongue  cleared,  and  finally  the  albumin  was 
reduced  to  an  infinitesimal  quantity. 
.  Case  IV. — Alcoholism,  interstitial  nephritis,  big 
liver  with  ascites,  albuminuria  and  oedema  of  the 
extremities,  hypertrophy  of  the  heart  and  oedema 
of  the  lungs. 

Butcher,  aet.  53,  drank  daily  about  five  quarts 
of  wine,  albuminuria  for  the  last  three  years, 
several  attacks  of  uraemia. 

Classical  treatment  (milk,  digitalis,  theobromin, 
blood-letting,  purgatives,  &c.)  without  effect. 
The  ascites  increased  and  suffocation  became 
fmore  and  more  imminent.     The  condition  of  the 

<  patient  was  very  critical.  The  treatment  by 
maceration  was  substituted,  and  the  urine,  which 
amounted  to  only  a  glass  a  day,  returned  to  the  nor- 
mal, the  visceral  congestion  and  ascites  disappeared, 
the  liver  became  less  voluminous,  while  the  albu- 
min  persisted,  but  oniy  in  small  quantities. 

<  I  could  multiply  such  cases,  for  I  have  notes  of 
•very  many,  but  they  would  not  teach  us  anything 
more  on  the  subject,  but  by  the  above  I  think 
•that  I  have  sufficiently  established  the  efficacy 
of  the  treatment.  Macerated  kidney  adminis- 
.tered  to  patients  suffering  from  renal  insuffi- 
ciency constitutes  one  of  the  most  active  remedies 
.proposed  up  to  the  present.  Better  than  any 
other,  it  opens  the  kidneys  annulled  by  uraemic 
/•oedema ;  it  acts  rapidly  and  surely,  even  where 
leeches  have  not  been  applied  to  the  lumbar 
region,  and  its  diuretic  effects  are  intense  when 
prolonged   sufficiently ;    it   restores    the    urinary 

•emission  to  its  normal  quantity,  and  maintains 
it  there.  The  method  has  also  the  advantage  of 
surely  diminishing  the  albumin  and  causes  it  to 
disappear  for  long  periods.  It  consequently 
gives  a  chance,  by  prolonged  functional  rest, 
.for  the  restoring  of  the  renal  epithelium  of  glan- 
dular order  in  cases  where  it  is  histologically 
possible.  I  have  never  witnessed  the  slightest 
accident  through  its  administration,  the  only 
inconvenience  observed  was,  in  some  cases,  a 
slight  pruritus,  urticaria  or  sweating. 

The  modus  operandi  is  as  follows  : — Take  one, 
more  frequently  two,  absolutely  fresh  pork  kidneys, 
-chop  them  up  fine,  and  then  wash  them  thoroughly 
in  water  so  as  to  remove  any  stagnant  urine  they 
might  contain.  The  chopped  meat  is  then  pounded 
up  in  a  mortar  with  about  twelve  ounces  of  salt 
'water  (half  a  teaspoonful  of  salt),  and  the  whole 
left  to  macerate  for  four  hours  ,  and  then  decanted. 
The  patient  will  take  it  in  three  or  four  doses  in 
the  day.  In  order  to  make  it  more  palatable, 
or  rather  less  repugnant  to  the  patient,  I 
generally  have  added  to  it  a  little  warm  soup 
(soup  julienne). 

.  The  administration  of  the  macerated  kidney 
should  not  exceed  ten  consecutive  days,  after 
which  a  rest  of  five  days  should  be  ordered,  and 
the  treatment  recommenced.  It  is  needless  to 
add  that  fresh  kidneys  should  be  procured  every 
iiay- 


PSEUDO-HYPERTROPHIC 
PARALYSIS  : 

ITS  HISTORY,  ETIOLOGY,  SYMPTOMS,  AND 

TREATMENT,  WITH  AN  ILLUSTRATIVE 

CASE,  (a) 

By     JOHN     McCAW,     M.D.R.U.I., 
Senior  Physician,  Belfast  Hospital  for  Sick  Children. 

History. — The  recognition  of  this  affection  is  of 
comparatively  modern  date,  the  first  cases  being 
described  by  Sir  Charles  Bell  in  1830,  and  by 
Partridge  in  1847.  Meryon  followed  in  1852,  with 
a  very  accurate  account  of  the  disease  which  he 
discovered  in  four  boys  of  one  family.  From  this 
time  onwards  numerous  observers  have  published 
details  of  cases,  among  whom  may  be  mentioned 
Little  1853,  Duchenne  1855,  Eulenberg  and  Cohn- 
heim  1865,  Charcot  1871,  Leyden  1876,  and 
Go  wers  1879. 

Etiology. — Little  is  known  of  the  causes  of  this 
disease.  It  is  essentially  a  disease  of  childhood, 
and  boys  are  at  least  four,  and  perhaps  seven,  times 
as  frequently  affected  as  girls.  Heredity  plays  an 
important  part  in  most  cases,  and  it  is  not  unusual 
for  several  members  of  the  same  family  to  be 
attacked  ;  on  the  other  hand,  the  disease  may 
single  out  one  boy  in  a  numerous  family.  The 
affection  is  transmitted  by  women  who  are 
not  themselves  the  subjects  of  it.  Consanguinity 
and  intemperance  in  the  parents  do  not  seem  to 
have  any  influence  in  its  production.  In  one-third 
of  the  cases  the  first  symptoms  are  noticed  when 
the  child  is  making  attempts  to  walk  ;  in  another 
third  the  child  appears  healthy  and  vigorous  in  all 
respects  until  it  has  reached  its  fourth,  fifth,  or 
sixth  year,  when  some  want  of  power  is  observed  ; 
in  three-quarters  of  the  cases  the  disease  is  detected 
before  the  tenth  year,  and  very  rarely  no  sym- 
ptoms are  seen  till  puberty. 

Symptoms. — Some  want  of  power  is  the  sym- 
ptom which  first  attracts  attention,  and  it  is 
common  for  the  parents  to  notice  that  the  child 
becomes  easily  tired  when  walking.  This  is  soon 
followed  by  another  early  symptom,  that  is,  he  falls 
frequently  and  shows  considerable  difficulty  in 
getting  on  his  feet  again,  or,  as  Sir  William  Gowers 
has  tersely  put  it,  "  he  walks  clumsily,  falls  with 
ease,  and  rises  with  difficulty."  On  the  other 
hand,  the  difficulty  experienced  by  the  child  in 
getting  upstairs  is  that  which  first  attracts  atten- 
tion. In  a  typical  example  of  the  disease  it  is 
usual  to  find  certain  muscles  hypertrophied,  hard, 
and  firm,  while  others  are  atrophied.  The  muscles 
most  commonly  hypertrophied  are  the  calf  muscles, 
which  may  attain  a  remarkable  size,  the  glutei, 
the  infraspinati,  the  deltoid,  and  the  triceps. 
Those  most  commonly  atrophied  are  the  costal 
and  sternal  portions  of  the  pectoralis  major,  the 
latissimus  dorsi,  the  biceps,  the  serratus  magnus, 
the  flexor  muscles  of  the  thigh  and  the  dextensors 
of  the  leg.  The  atrophy  of  the  lower  portions  of  the 
pectoralis  major  and  the  latissimus  dorsi  causes 
the  posterior  axillary  fold  to  disappear  to  a  con- 
siderable extent,  a  condition  that  is  well  seen  when 
the  arms  are  extended  in  front.  The  face  muscles 
are  rarely  affected.  The  position  assumed  by  the 
patient  when  standing  and  when  sitting  is  very 
characteristic.  When  standing  the  trunk  is  held 
erect  and  there  is  marked  lordosis,  the  upper  part  of 

(a)  Paper  read  and  Case  shDwn  before  the  Ulster  Medical  Society, 
February  18th,  1904. 


March  2>    1904. 


SPECIAL  ARTICLES. 


The  Medical  Press.     231 


the  trunk  being  carried  so  far  back  that  a  vertical 
line  from  the  scapula  fails  an  inch  or  more  behind 
the  sacrum.  When  sitting  the  lordosis  is  replaced 
by  an  opposite  curve,  in  which  the  back  becomes 
inn  vex,  both  curves  being  due  to  weakness  of  the 
extensor  muscles  of  the  hip.  The  gait  is  also  very 
characteristic  ;  it  is  waddling  in  character  and 
Lin  certain,  so  that  small  obstacles  arc  overcome  with 
difficulty  and  the  child  falls  readily,  The  greatest 
difficulty  is  experienced  in  rising  from  the  floor, 
If  the  child  is  placed  on  his  back  on  a  rug  the  first 
movement  made  towards  rising  is  to  roll  over  on  the 
face  ;  he  then  gets  on  his  hands  and  knees  ; 
next  he  manages  to  get  his  feet  on  the  ground,  and 
finally  by  placing  first  one  hand  on  the  thigh  just 
above  the  knee,  and  then  with  the  other  hand 
similarly  placed,  he  pushes  the  trunk  up  by 
gradually  moving  the  hands  higher  and  higher  up 
ihe  thighs,  or,  as  Cowers  says,  ,J  he  climbs  up  him- 
The  feet  tend  to  assume  a  position  of 
equiuus  owing  to  the  contraction  of  the  calf 
muscles,  and  at  the  same  time  the  foot  is  inverted. 
The  electrical  excitability  of  the  muscles  is  greatly 
rushed  both  to  the  iaradic  and  the  galvanic 
current ;  and  there  is  never  any  reaction  of  degen- 
eration. The  superficial  reflexes  are,  as  a  ruleT 
preserved  ;  the  knee-jerks  are  lost  early,  or  greatly 
<h  according  to  the  condition  of  the 
quadriceps  extensur.  Sensation  is  never  affected  in 
w  ay  -  T  he  bl  adder  and  rectum  general  1  y  re  m  ai  n 
unaffected  to  the  last.  The  progress  'of  the 
disease  is  slow  ;  when,  however,  the  power  of 
standing  is  lostJ  weakness  tends  to  increase  more 
rapidly p  though  life  after  this  may  be  preserved  for 
several  years.  Death  is  generally  brought  about 
by  some  acute  disease,  and  frequently  by  a  pul- 
monary affection  such  as  broncho-pneumonia  or 
phthisis,  The  mental  condition  of  the  subjects 
ol  this  disease  has  been  variously  stated,  Gowers 
says  the  mental  development  is  generally  beyond 
that  of  other  children  of  the  same  age,  and  that 
mental  defect  is  a  pure  complication  ,  Ashby  thinks 
that  some  degree  of  mental  deficiency  is  a  not  un- 
common  association. 

Pathology. — No  lesion  can  be  found  cither  in  the 
spinal  cord,  the  anterior  or  posterior  roots,  the 
peripheral  nerves,  or  in  either  the  finer  motor  or 
sensory  fibres  passing  to  the  muscles.  The  muscles 
alone  show  any  pathological  change,  although  Babes 
has  shown  that  changes  exist  in  the  motor  end 
plates.  The  muscles  to  the  naked  eye  appear  pate, 
and  resemble  a  mass  of  fat,  or  they  have  a  brown, 
firm,  and  hard  appearance,  On  section  of  a  muscle 
it  is  seen  that  there  is  a  great  increase  of  the  con- 
nective tissue,  not  only  between  muscular  bundles, 
but  also  between  the  individual  muscular  fibres, 
so  that  the  fibres  themselves  become  surrounded 
by  a  ring  of  connective  tissue.  Some  fibres  are 
atrophied,  while  others  may  bchypertrophied,  and 
in  between  the  fibres  fat  becomes  deposited,  No 
matter  to  what  degree  the  fibres  become  atrophied 
-till  retain  their  transverse  striation.  A  few 
of  the  fibres  may  show  fatty  degeneration  and  some 
may  be  vacuolated.  A  very  striking  feature  in 
some  of  the  muscles  is  the  number  of  muscle- 
spindles  that  can  be  seen  in  cross  section  of  a 
muscle  in  a  given  area. 

Treatmr. nt .—Drugs  are  powerless  to  effect  any 
amelioration  of  this  disease  or  even  to  stay  its  pro- 
press.  The  most  important  items  in  the  care  of 
such  cases  are  to  keep  the  little  patient  warm, 
and  to  shield  him  from  the  risks  of  catching  cold 


or  developing  any  lung  trouble.  Something  may 
be  done  in  the  way  of  massage  and  faradisi ng  the 
affected  muscles,  and  he  should  be  encouraged  to 
walk  as  much  as  he  is  able,  and  as  long  as  it  is 
possible,  Gymnastic  exercises  are  indicated 
and  should  be  used  persevcringly.  The  general 
health  and  strength  should  be  maintained  at  the 
highest  standard,  and  to  this  end  the  most  nourish- 
ing food  and  cod-liver  oil  are  desirable.  Such 
general  tonics  as  iron,  arsenic,  phosphorus,  and 
strychnine  may  be  given, 

Illustrative  CilS*.— The  patient  shown  to-day  is 
W.  H — — ,  who  was  admitted  to  the  Queen  Street 
Hospital  for  Sick  Children  under  my  care  on 
February  3rd,   1904, 

History. — He  ts  o£  years  of  age,  and  is  the  fifth 
child  of  a  family  of  eight,  which  consists  of  five 
boys  and  three  girls.  All  the  other  children  are 
strong  and  healthy,  and  in  particular  his  four 
brothers  have  never  shown  any  sign  or  symptom 
ol  being  affected  in  a  similar  way.  The  parents 
say  that  he  was  late  in  attempting  to  walk  vvhni 
compared  with  the  other  children,  and  that  he  vraa 
easily  knocked  down  and  had  considerable  difficulty 
in  getting  up  again,  He  was  sent  to  school  when 
four  years  old,  and  at  this  period  was  able  to  walk 
fairly  well,  but  his  power  of  walking  became 
steadily  worse,  so  that  for  the  past  three  years  he 
has  been  unable  to  walk  the  distance.  His  speech 
is,  and  always  has  been,  defective,  and  he  was  slow 
to  learn  and  very  irritable  in  temper.  He  is 
mentally  deficient  and  at  times  impulsi%'e  and 
violent.  The  calf  muscles  are  enormous,  measur- 
ing n£  in.  in  circumference;  the  glutei  and 
infraspinati  are  very  prominent,  while  the 
pectoralis  major  and  latissimus  dorsi  are  greatly 
atrophied,  The  forearm  muscles  are  hyper- 
trophied  and  the  upper  arm  ones  atrophied. 
His  parents  axe  strong  and  healthy,  and  no 
history  of  any  similar  affection  could  be  obtained 
as  having  occurred  in  either  of  their  families. 
The  patient  is,  therefore,  an  example  of  pseudo- 
hypertrophic paralysis  associated  with  mental 
deficiency,  and  the  history  of  the  case  leaves  little 
room  to  doubt  that  it  is  congenital, 

With  the  kind  cooperation  of  Mr.  Robert 
Campbell  and  Dr,  Beatty,  a  small  portion  of  the 
left  calf  muscle  has  been  excised  and  mounted, 
from  which  it  will  be  seen  that  the  fibrous  tissue  is 
increased  and  the  muscle  bundles  atrophied. 

Special  articles. 

BRITISH    SANATORIA    FOR    CONSUMPTION,— 
XXXV. 


[by  our  special   medical  commissioner,] 

THE  LONDON  OPEN-AIR  SANATORIUM, 
Pinewood,  the  London  Open-air  Sanatorium,  m 
situated  at  Nine  Mile  Ridep  Wokingham,  It  owes  its 
existence  to  the  generosity  of  Messrs,  Wernher,  Beit. 
and  Co.(  who  contributed  £40,000  towards  its  estab- 
lishment. It  was  intended  to  meet  the  needs  of  con- 
sumptive belonging  to  the  less  wealthy  middle-class, 
and   be  self-supporting. 

I  I  if  sanatorium  is  delightfully  situated  at  an  eleva- 
tion of  352  feet  amidst  pine  woods,  on  the  confines  of 
Old  Windsor  Forest.  The  adjacent  country  is  studded 
with  pines  or  consists  of  heather-land.  The  estat*  b 
eighty-two  acres  in  extent,  and  the  sanatorium  stands 
in  a  clearing  well  open  to  the  south.  The  soil  is  sandy. 
The  surrounding  pine  woods  afford  much  shelter  and 
offer  opportunities  for  varied  walks,  and  are  peculiarly 
suited  to    serve    as    pleasant  resting-places,     Several 


232    The  Medical  Press.     CONTINENTAL  HEALTH  RESORTS. 


March  2,  1901. 


well-designed  roomy  shelters  have  been  erected 
near  the  main  building.  Although  new  houses  are 
quickly  arising  in  the  neighbourhood,  the  sanatorium 
is  secluded,  and,  having  fairly  extensive  grounds,  is  not 
likely  to  suffer  serious  detriment,  at  least  for  some 
years  to  come. 

The  most  serious  drawback,  perhaps,  is  the  somewhat 
isolated  position,  which  renders  access  difficult.  The 
sanatorium  is  about  two  miles  from  Wellington 
College  Station  on  the  Sou th-Eas tern  Railway,  three  and 
a  halt  miles  from  Bracknell  on  the  London  and  South- 
western Railway,  and  eleven  miles  from  Reading. 
The  quickest  approach  is  by  taking  the  Great  Western 
express  to  Reading,  and  thence  by  a  stopping  train 
on  the  South-Eastern  Railway  to  Wellington  College, 
where  a  carriage  is  always  to  be  obtained  at  the 
adjacent  hotel. 

The  sanatorium  has  been  built  in  accordance  with 
modern  conceptions,  but  is  wanting  in  several  im- 
portant respects,  such,  for  instance,  as  end  or  outside 
staircases,  and  there  is  very  conspicuous  lack  of 
privacy  in  the  resident  medical  officers'  quarters. 
Many  improvements,  however,  have  been  made  since 
the  opening  of  the  institution  upwards  of  three  years 
ago,  and  no  doubt  as  funds  are  forthcoming  other  ex- 
tensions and  modifications  will  be  undertaken. 

The  building  consists  of  a  central  administrative 
block  with  separate  bedroom  blocks  on  either  side. 
The  medical  officers'  rooms  are  small  and  not  suffi- 
ciently separated  from  the  patients'  quarters,  and  the 
main  corridor  runs  through  the  central  block. 

The  patients'  blocks  consist  of  ground  and  first 
floors.  Each  patient  has  a  separate  room.  The  rooms 
face  approximately  south.  There  are  no  balconies  and 
no  verandahs  to  these  parts  of  the  building,  but  at 
either  end  there  are  excellently  designed  open-air 
galleries,  which  allow  of  free  exposure,  and  yet  provide 
for  shelter  from  winds.  These  galleries  or  open 
balconies  are  so  constructed  as  to  allow  of  the  north 
aspect  being  available  during  hot  summer  weather. 

Each  bedroom,  although  small,  is  comfortable, 
simply  furnished,  well  lighted,  but  the  windows  might 
with  advantage  have  been  brought  nearer  the  floor. 
Each  bed  is  of  good  construction,  and  a  cane  couch  is 
also  available  and  would  seem  to  serve  as  an  encourage- 
ment for  the  patient  to  rest  in  his  or  her  own  room 
during  the  day,  a  procedure  which  many  would  not  ap- 
prove. Each  room  is  supplied  with  a  fire-grate,  but 
radiators  have  been  added.  The  sanitary  offices  are 
well  placed,  and  the  appliances  thoroughly  efficient. 

The  dining-room,  which  stands  north  of  the  adminis- 
trative block,  is  a  particularly  well  designed,  excellently 
lit  and  airy  structure.  A  nurses'  dining-room  is 
adjacent,  and  the  kitchen  near  by  is  well  fitted  with 
all  modern  appliances.  There  is  a  good  laundry,  and 
the  boiler-room,  electric  plant,  stables,  and  other  out- 
buildings are  conveniently  placed  and  well  equipped. 
The  accommodation  for  nurses  is  inadequate,  and 
better  arrangements  generally  should  be  made  for  the 
resident  staff.  The  sanatorium  is  lighted  throughout 
by  electric  light.  Sewage  is  dealt  with  in  a  septic 
tank.  The  water  supply  is  good,  and  arrangements 
have  been  made  to  provide  against  the  danger  of 
fire.  There  is  accommodation  for  sixty-four  cases, 
an  equal  number  of  each  sex.  Many  of  the  cases 
are  "  bed  "  patients. 

The  resident  medical  officers  are  Drs.  C.  C.  Chidell  and 
Roland  Stevenson.  Dr.  Hector  Mackenzie  and  Dr. 
Alfred  Hellier  are  the  visiting  physicians. 

Treatment  is  conducted  in  strict  accordance  with 
modern  hygienic  conceptions.  We  lunched  with  the 
patients  and  found  the  character  of  the  food  and 
manner  of  serving  thoroughly  good.  The  general  daily 
routine  is  well  defined.  The  "  directions "  are  as 
follows : — 

"  7.30  to  8.30  a.m. :  Rub  down  or  bath  as  ordered. 
Bath  should  be  nearly  cold.  Don't  get  out  of  breath 
by  rubbing  with  towel.  Please  do  not  leave  your  room 
till  you  have  seen  the  doctor.  8.30  a.m. :  Breakfast. 
9.30  a.m. :  Morning  walk  begins  (distance  and  pace 
regulated  for  each  patient).     If  you  are  up  to  breakfast 


you  must  be  out  by  9.30.  11.55  to  I2-55  :  Rest  on 
couch  in  bedroom.  Go  to  your  room  at  1 1.45  to  take 
your  temperature  so  as  to  ensure  a  full  hour's  rest. 
(Reading  or  writing  allowed,  but  not  hard  study  or 
business  correspondence.)  1  p.m.  :  Dinner.  2  to 
3  p.m.  :  Rest  sitting  or  lying,  out  of  doors  or  in  a 
shelter.  A  short  siesta  is  advisable,  but  talking  and 
sedentary  games  are  allowed.  An  exception  to  this 
rule  is  made  on  Sunday.  4  p.m. :  Afternoon  tea. 
4.30  p.m.  :  Afternoon  walk  (distance  one-half  or  one- 
third  of  morning  walk).  If  the  weather  is  not  too  hot 
this  walk  may  be  taken  between  3  and  4.  5.55  to 
6.55  p.m.  :  Rest  on  couch ;  go  to  your  room  at  5.45. 
7  p.m. :  Supper,  after  which  a  short  stroll  may  be 
taken,  or  the  time  spent  in  dining  hall,  library,  or, 
better  still,  in  a  shelter.     9.30  p.m.  at  latest  :  Bed  time. 

"  A  bath  (not  too  hot)  may  be  taken  once  a  week. 
10.30  at  latest :   All  lights  out. 

"Temperature  is  taken  four  times  daily:  (1)  On 
awaking,  before  rising  (stop  in  bed  if  temperature  is 
above  98*6°  F.,  or  37*0°  C).  (2  and  3)  Immediately 
after  morning  and  afternoon  walks.  (4)  After  getting 
into  bed  at  night." 

The  following  are  among  the  "  instructions  "  given 
to  patients  when  leaving  for  home : — 

"  Disposal  of  Sputum. — If  there  is  a  water-closet,  the 
simplest  way  is  to  empty  the  sputum  direct  from  the 
pocket-flask  into  the  pan.  In  the  absence  of  a  water- 
closet,  the  sputum  should  be  poured  into  a  "  poke  " 
{i.e.,  a  conical  bag)  made  of  three  or  four  layers  of 
newspaper  and  containing  sawdust.  The  sputum  must 
be  well  mixed  with  a  little  stick,  which  should  then  be 
burnt  with  the  poke  and  its  contents.  Every  mug 
used  for  spitting  should  be  lined  with  butter-paper,  and 
it  is  well  to  have  a  little  carbolic  acid  solution  (one  part 
pure  carbolic  acid  to  nineteen  parts  of  water)  at  the 
bottom  of  the  paper.  The  butter-paper  and  its  con- 
tents may  be  thrown  into  the  water-closet  pan  or 
burnt  with  sawdust  as  above.  If  there  are  neither 
drains  nor  fires  (only  gas  cooking  stoves)  the  sputum 
should  be  buried. 

"Cleansing  of  Flasks  and  Mugs. — After  emptying  the 
flask,  pour  into  it  a  teaspoonful  of  the  above  carbolic 
acid  solution.  At  least  once  a  week  the  flask  should 
be  disinfected  by  immersion  with  open  ends  in  the 
same  solution  over  night ;  in  the  morning  the  carbolic 
acid  is  thrown  into  the  pan  of  the  water-closet,  and  the 
flask  is  rinsed  through  with  hot  water,  to  which  common 
washing  soda  (about  two  teaspoonfuls  to  a  pint  of 
water)  may  be  added.  Mugs  should  be  cleansed  daily 
after  use  with  carbolic  acid  solution,  followed  by  rinsing 
with  hot  water  or  hot  soda  solution. 

"Disinfection  of  Handkerchiefs. — Cheap  Japanese 
paper  or  calico  handkerchiefs  may  be  burnt  after  use. 
This  method  is  the  best,  and  is  essential  when  the 
handkerchief  has  been  especially  exposed  to  infection 
by  coughing  or  still  more  by  spitting  into  it.  If  better 
handkerchiefs  are  used  they  should  be  boiled  for  half 
an  hour  in  a  special  saucepan,  or  any  of  the  following 
disinfectants  may  be  used  to  soak  the  handkerchiefs  for 
twelve  hours  before  washing  in  the  ordinary  way:— 
Carbolic  acid,  1  in  20 ;  chloros,  1  in  200 ;  formalin, 
1  in  20. 

"It  is  desirable  that  the  above  precautions  should  be 
taken  as  long  as  there  is  any  expectoration." 

It  was  hoped  that  the  fees  at  Pinewood  would  be 
kept  low  in  order  to  meet  the  needs  of  the  cases  for 
which  it  was  originally  intended,  but  already  the 
sanatorium  is  in  active  competition  with  other  insti- 
tutions for  comparatively  well-to-do  patients,  and  the 
fees  are  £$  3s.  a  week.  The  sanatorium  is,  however, 
an  excellent  one,  pleasantly  situated,  skilfully  con- 
trolled, and  as  far  as  we  can  ascertain  accomplishing 
much  good  work. 

Continental  Dealtb  "Resorts. 


[from  our  special  correspondent.] 

BEX-LES-BAINS     (Switzerland). 
Bex-les-Bains   is   situated    in    the    Rhone   Valley 


March  2,  1904. 


TRANSACTIONS  OF  SOCIETIES, 


The  Medical  Pi  ess.     233 


jabout  twelve  miles  from  Lake  Leman),  at  an  altitude 
oi  1,430  feet,  on  the  line  of  the  J  ura-SimpIon  railroad 
running  from  Geneva  and  Lausanne  to  Zermatt  and 
Briqne.  From  Martignv,  twelve  miles  above  Bex 
his  line,  picturesque  carriage  roads  ascend  to 
nounix  and  to  the  p"eat  St.  Bernard.  At  Loeehe- 
Souste  station,  thirty  miles  from  Martigny,  are  carriage 
n.nnections  with  Loeche-les- Bains,  at  the  foot  of  the 
celebrated  Gerarai  Pass  on  to  the  Bernese  Oberland. 
Twelve  miles  further  up  the  Rhone  valley,  at  Vii 
the  junction  with  the  Vicge-Zermait  railway.  Five 
miles  above  Viuge  from  the  terminus  station  at  BliqiM 
ences  run  to  the  wot  Id  -  fa  m  on  s  G  la  cier  d  u  K  fa  <  >  n  c . 
and  thence  by  the  Grimsel  Pass  to  the  Interlaken 
Valley,  or  by  the  Furka — finest  of  Swiss  passes — 
10  the  St.  Got  hard  railways,  connecting  with  the 
Lucerne  Lakes,  the  Kighi,  Zurich,  Engadine,  Tyrol, 
and  Italian  lata 

Bex*les-Bains    is    thus    admirably    located     m    the 

leading  tourist  routes  It  is,  likewise,  an  excellent 
centre  for  short   excursions.     The  ancient    towns   of 

-Imricc  and  Siont  and  the  well-known  glacier, 
cascade  and  gorge  of  Trient,  are  within  easy  distances  ; 

r'--  also  Atgle-les-Bains,  Corbeyrier,  Leys  in,  Dia- 
Merels  and  the  Ormonts  ;  and  the  Castle  of  Chilli-n. 
Muntreux,  Cattle,  and  the  Roc  hers  -de  -Na  ye.  Across 
die  river  are  the  Val  d' lilies  and  Champcry  with  their 
line  forests ,  rich  and  varied  flora  ;  and  bifurcated 
feminine  attire  of  antique  desceni  and  design,  yet 
j  fa  Bloomer  t 

m  Bex  station,  a  tramway,  passing  through  the 
town  and  near  the  salt  mines,  ascends  to  the  attractive 
summer-homes  of  Gryon,  Arveyres,  Ches  teres,  and 
YiUars-sur  Ollon. 

I  tit  town  of  Bex,  built  on  a  plateau  m  a  vale  of 
tfeadoil  Alps,  is  well  sheltered  OQ  the  north  by 
{he  Monte  t  hill  and  woods,  and  easterly  by  a  chain 
ng  the  Morcles,  Muveran  and  Diablerets  ranges. 
Southerly  and  westerly  are  the  superb  heights  of  the 
Dents  de  Morcles  and  du  Midi,  and  the  sur- 
mounting ranges,  of  hills  and  peaks  stretching  away 
in  the  distance  from  Valais  into  Haute-Savoie.  Half 
a  mile  from  the  town  and  nearly  200  feet  above  it.  is 
an  undulating  large  park,  with  umbrageous  avenues, 
pleasant  shady  paths,  small  lakes,  grottoes,  and  tennis- 
lawns,  in  which  stand  the  Saline  Thermal  establish- 
ments  and  the  Grand  Hotel  des  Salines,  with  their 
annexes*     Here,    in    clos  To  fine  forests   and 

mountains,  the  air  is  very  pure  and  salubrious,  the 
diraate  mild  and  sedative,  and  there  is  a  remark 
freedom  from  winds,  saving  occasional^  the  fothn. 
the  warm  south  wind  of  Alpine  valleys.  Although 
Itered.  even  in  hot  summer  days  only  the  midday 
ml  try.  refreshing  mountain  freezes  rendering 
the  evenings  and  mornings  COOl  and  agreeable.  The 
atmospheric  calm  is  delicious  and  beneficial  to  the 
delicate  gnat!  at  Bex.  as  they  can  remain  long  in  the 
Open  air. 

i){*  sunny    and    sheltered    position    the 

ing  "  season  "  here  commences  earlier  and  ton- 
later  (April  1st  to  October  31st)  than  is  usual 
Omental    spas.     For     Brili  ncatis  and 

Colonials  the  preferable  mouths  are  in  spring  and  autumn 
particularly   spring,    when    the    glades     and    terraces 
he    wooded    slopes    are    most    attractive    for    the 
tnt    greens    and    exquisite    colourings    of    their 
Upine    flora.      From    the    Jura-Simplon    railroad 
u  an  electric  tramway  runs   through   the  town 
to  the  Salines  Hotel  and  Baths,  and  thence  on  to  the  , 
Itevieux.     The   mines,   au  BouiUel.   lie 
in  hour's  walk  further,  amidst  rocks  and  erratic 
-     The  galleries,  some  at  600  feet  depth  and  one 
a  mile  in  length,  are  cut  into  the  subterranean  | 
m\  beds  from  which  the  salt  is  washed  out,  the  brine 
I  wing  conveyed  by  pipes  to  the  works  for  condensation 
ns,    A  cemented  covered  brick  canal  connects  the 
■  wuh  the  Baths  at  the  Grand  Hotel  des  Salines,  j 
■  !l  the  other  hotels  at  Bex,  the  brine  is  carried  in  ! 
I  barrels. 


By  the  analyses  of  Professor  Brunner,  of  Lausann* , 
the  Bex  brine  contains  : — 


;  7  4  *4 1  3  gra  m  mes 
22876 

0*104 


Chlorides  de  sodium 

calcium     . . 
magnesium 
potassium 
lit  Ilium     1 . 
Bromine  et  iodine  magne- 
sium        .,  .  *  . ,         0*101 
These  analyses  show  that  the  saline  waters  of  Bex- 
ies-Baitis   rank  very  high    among    the    strongest    salt 
waters  of  Europe*     And   for  the  efficient  applications 
of   the  Bex  waters  the  bath  establishment    possesses 
the     most     approved     and  latest     hydro -therapeutic 
1  apparatus. 

The  Grand  Hotel  des  Salines  here  has  also  the  most 
modern  arrangements  for  the  comfort  of  its  visitors, 
added  to  the  very  great  advantage  of  having  on  each 
floor  direct  communication  with  the  baths. 

In  his  article  "  The  Salt  Baths  of  Bex  "  (see  Medical 
<  Press  and  Circular,  1002),  Dr.  Eugene  de  la  Harpe. 
the    resident    physician    at    Bex    Salines   during     the 
season,  says,  *'  Bex  can  be  advised  in  all  cases  where 
I  salt     medication     is     useful  ;     lymphatism,    scrofula. 
j  rickets    (the  combination  of  baths  and  climate  being 
('  especially  good),  chronic  diseases  of  the  female  genera 
I  tive  organs,  exudates,  and  remains  of   acute  processes 
in  the  pelvis  ;  also  such  remnants  in  the  abdomen  after 
peri  typhlitis,  appendicitis,  peritonitis,  or  in  the  chest 
after    pleurisy,    chronic    rheumatism,    rheumatoid    ar- 
thritis, &c,     Anaemic  and  neurasthenic    patients    come 
to  Bex  for  the  hydrotherapy  treatment/' 

At  the  Bex  Salines  is  likewise  a  cold  sulphur  spring 
used  for  drinking,  inhalation,  gargling.  Ac.  The  fango. 
Nauheim,  and  rasin  cure  treatments  are  also 
administered  here.  The  resident  phvsician  speaks 
English. 


^Transactions  of  Societies, 


CLINICAL   SOCIETY   OF   LOSDUV 
I  1  r>  kal  Evening   held   Friday.    February    aGrfc, 
1004. 

Dr,  Frederick  Taylor,  President,  in  the  Chair, 


ftgft,  F.  j.  Steward  exhibited  a  case  of  movable 
knee -joint  three  and  a  half  years  after  operation  for 
extensive  tuberculous  disease  /in  a  girl,  Bet  $.  Primai -\ 
healing  was  obtained,  and  the  limb  was  in  a  piaster  oi 
Paris  splint  for  two  years. 

Dr.  H.  Batty  Shaw  showed  a  mother  and  infant 
daughter  affected  with  a  congenital  deformity  of 
hands  and  feeL  The  mother  was  asl.  20,  When  the 
hands  were  at  rest  the  digits  were  held  somewhat 
flexed,  the  index  Angers  being  curved  laterally,  and 
appearing  to  be  separated  more  than  usual  from  the 
remaining  digits.  The  inter-osseous  spaces  were  wasted. 
Movements  of  flexion  and  extension  were  satisfac- 
torily performed,  but  abduction  and  adduction  of  the 
digits  were  greatly  reduced.  There  was  also  complete 
paralysis  of  the  iron  talis  muscle.  The  child,  xt.  2 
months,  presented  a  similar  deformity  of  the  hands  and 
feet.  Radiograms  of  the  mother's  hand  showed  that 
beyond  the  slender  character  of  the  fourth  metacarpal 
bones  and  the  prominence  at  the  base  of  the  third,  the 
bones  were  normal. 

Dr.  Bertram  Abrahams  showed  a  sporadic  case  of 
Friedreich's  disease  m  a  boy,  xt,  |j(  the  third  of  eight 
children,  of  whom  the  others  were  perfectly  healthy. 
The  illness  began  five  years  ago,  and  the  ataxy  had 
rapidly  increased  during  the  past  three  years.  There 
was  slight  lateral  nystagmus.  The  pupils  were  widely 
dilated,  but  reacted  briskly  to  light  and  accommoda- 
tion. Romberg's  sign  was  well  marked.  The  speech 
was  nasal,  slow,  slurred,  and  monotonous.  There 
was  considerable  ataxy  of  the  hands.  Roth  knee- 
jerks  were  lost,  and  the  plantar  reflexes  were  of  the 
extensor  type.   Pes  cavus  was  present  on  both  sides. 


234    The  Medical  Psess. 


TRANSACTIONS  OF  SOCIETIES. 


March  2,  1904. 


and  there  was  distinct  dorso-lumbar  scoliosis.  Treat- 
ment by  Fraenkel's  method  was    proposed. 

Dr.  J.  Porter  Parkinson  exhibited  an  unusual  case 
of  morbus  cordis  in  a  girl,  aet.  9,  who,  since  the  age  of 
seven,  had  had  repeated  attacks  of  acute  rheumatism. 
The  cardiac  impulse  was  best  marked  in  the  fourth 
interspace  just  inside  the  nipple,  and  on  admission  to 
hospital  she  had  epigastric  pulsation  and  extension  of 
the  cardiac  dulness  to  the  right  of  the  sternum.  At 
the  apex  were  double  mitral  murmurs,  and  at  the  base 
were  systolic  and  diastolic  murmurs,  heard  best  at  the 
second  left  interspace.  There  was  no  abnormal 
arterial  pulsation,  and  the  pulse  was  70,  small,  regular, 
and  compressible. 

Dr.  H.  Batty  Shaw  thought  that  the  proof  that  the 
case  was  one  of  aortic  regurgitation  was  very  incom- 
plete. He  could  not  help  feeling  that  the  condition 
was  due  to  high  tension  in  the  pulmonary  artery,  which 
gave  rise  to  the  murmur,  which  had  been  described  by 
Dr.  Graham  Steele. 

Dr.  Alexander  Morison  considered  that  the  ab- 
sence of  a  thrill  negatived  the  diagnosis  of  pulmonary 
-endocarditis,  and  he  was  inclined  to  agree  with  Dr. 
Shaw  that  the  condition  was  more  functional  in 
character. 

Dr.  W.  Hale- White  said  that  the  presence  of  the 
systolic  murmur  rather  indicated  the  existence  of  some 
endocarditis  of  the  pulmonary  valves. 

The  President  observed  that  the  murmur  in  ques- 
tion was  heard  very  distinctly  high  up  on  the  left  side 
of  the  sternum.  He  would  hesitate  to  pass  an  opinion 
without  further  examination. 

Dr.  Parkinson,  in  replying,  commented  upon  the 
great  rarity  of  pulmonary  endocarditis,  and  considered 
that  the  condition  was  probably  due  to  dilatation  of  the 
orifice  from  incompetence  of  a  normal  valve. 

Dr.  W.  G.  Stone  showed  a  lad,  act.  8,  with  enlarge- 
ment of  the  bones  of  the  cranium,  jaw,  and  thorax. 
The  evidence  was  very  strong  that  the  lesions  were 
syphilitic. 

Mr.  Charles  R.  Keyser  exhibited  a  male  infant, 
aet.  15  months,  the  subject  of  achondroplasia  with 
spinal  curvature.  The  head  was  large,  and  the  fonta- 
nelles  widely  open.  The  nasal  bridge  was  depressed. 
There  was  marked  disproportion  between  the  length 
of  the  body  and  that  of  the  limbs,  the  bones  of  which 
were  only  slightly  curved.  The  fingers  showed  the 
typical  appearance  of  the  disease,  the  index  and  middle 
fingers  curving  to  the  radial  and  the  ring  and  little 
fingers  to  the  ulnar  side.  There  was  no  lordosis, 
nor  was  bony  tenderness  marked.  There  was  a  pro- 
minent anteroposterior  curve  in  the  dorso-lumbar 
region.  The  lower  ribs  were  everted  and  the  abdomen 
was  prominent.  The  father  was  only  4  ft.  8  in.  in 
height. 

The  President  inquired  if  anything  unusual  was 
noticed  about  the  child  at  birth. 

Mr.  Keyser  replied  that  the  shortness  of  the  limbs 
had  been  observed.  He  considered  that  there  were 
several  features  in  the  case,  especially  the  spinal 
curvature,  which  resembled  those  met  with  in  ordinary 
rickets. 

Mr.  Edred  M.  Corner  showed  a  case  of  pyo- 
pneumothorax due  to  phthisis,  in  a  man,  aet.  32,  for 
the  cure  of  which  operations  on  the  principle  of  Est- 
lander's  (thoracoplasty)  were  performed.  Healing 
had  taken  place  with  the  formation  of  an  aerial  fistula. 

Mr.  W.  G.  Spencer  referred  to  a  case  under  his  own 
care  in  which  a  bronchial  fistula  had  resulted  which  had 
remained  stationary  for  three  years. 

Dr.  William  Hunter  and  Mr.  Stephen  Paget 
showed  a  lad,  aet.  17,  the  subject  of  progressive  myo- 
sitis ossificans.  The  disease  began  at  the  age  of 
four,  and  since  then  had  steadily  advanced.  Ten 
years  ago  he  was  seen  by  Sir  James  Paget,  and  reported 
by  Mr.  Stephen  Paget  at  the  time.  There  was  a 
definite  family  history  of  rheumatic  fever.  The 
muscles  now  chiefly  affected  were  the  pectoral,  the 
latissimus  dorsi,  and  the  teres  muscles,  all  of  which 
were  firm,  rigid,  and  contracted,  so  that  both  arms 
were  tied  to  the  chest  at  the  shoulder-blade.  There 
was  a  deposit  of  bony  growth  around  the  left  angle  of 


the  scapula.  A  considerable  degree  of  scoliosis  of 
the  spine  was  present,  with  great  wasting  of  the  muscles 
of  the  back.  Radiograms  exhibited  well-marked 
shadows  at  the  attachment  of  the  pectoralis  major 
to  the  humerus. 

Dr.  C.  Gould  May  showed  a  female  child,  aet.  6, 
with  multiple  exostoses  on  the  bones  of  the  limbs. 
There  was  no  history  of  rheumatism,  nor  was  there  any 
pain. 

Mr.  William  H.  Battle  asked  if  there  was  a  family 
history  of  a  similar  condition,  and  if  any  effect  had  been 
produced  upon  the  growth  of  the  bones. 

Dr.  May  replied. 

Mr.  Donald  Armour  showed  a  man,  aet.  20,  who 
had  a  cyst  arising  in  connection  with  the  organ  of 
Giraldes,  the  origin  of  which  was  unknown. 

Mr.  T.  Horrocks  Openshaw  exhibited  a  female 
patient,  aet.  31,  in  whom  he  treated  a  contracture  of 
the  right  hip  and  knee  by  elastic  traction.  The 
condition  had  lasted  for  fifteen  years  as  a  result  of 
infantile  paralysis.  In  July,  1903,  she  was  placed  in 
a  Hessing's  apparatus  with  elastic  traction.  Con- 
siderable improvement  had  resulted,  and  confidence 
in  walking  was  increasing. 

Mr.  William  H.  Battle  showed  a  woman,  aet.  55, 
the  subject  of  a  large  femoral  hernia  on  the  right  side. 
The  hernia  had  been  present  for  seventeen  years  ;  it 
was  as  wide  as  the  patient's  thigh,  and  extended  down- 
wards as  far  as  the  upper  margin  of  the  patella.  It 
contained  intestine,  and  the  skin  over  it  was  some 
what  eczema tous  in  parts.  He  proposed  to  operate 
upon  it  when  the  general  condition  had  improved. 

ROYAL  ACADEMY  OF  MEDICINE  IN  IRELAND. 

Pathological  Section. 

Meeting  held  Friday,    February    iqth,  1004. 

H.  C.  Earl,  M.D.,  President,  in  the  Chair. 


POINTS    IN    THE    PATHOLOGY    OF    SENILE    HYPERTROPHY 
OF    THE    PROSTATE. 

Mr.  Tobin  remarked  that  whereas  when  he  read  a 
paper  on  this  subject  some  ten  years  ago  all  the  speci- 
mens were  derived  from  the  post-mortem  room,  now 
the  operating  theatres  provide  the  material  for  dis- 
cussion. This  material  usually  came  in  two  shapes: 
one,  a  smooth-faced,  easily  enucleated  adenoma,  often 
of  large  size  ;  the  other,  commonly  a  smaller  mass  with 
a  rough  surface  and  looking  like  muscular  tissue  to 
the  naked  eye,  and  containing  in  its  centre  the  pros- 
tatic urethra,  torn  portions  of  which,  or  of  the  mem- 
branous urethra,  hung  out  at  one  end.  Specimens 
presenting  such  points  of  identification  had  been  looked 
upon  as  showing  an  hypertrophied  prostate  removed  in 
its  entirety.  Anyhow,  such,  he  said,  was  his  opinion 
till  reading  what  he  called  an  epoch-marking  paper  on 
this  subject  by  Mr.  Wallace  in  the  British  Medical 
Journal,  January  30th,  1904.  He  then  showed  some 
recently  removed  specimens,  which  he  maintained 
both  microscopically  and  macroscopically  fully  bore 
out  Mr.  Wallace's  contention.  Among  them  was 
one  which  he  described  as  follows  : — "  When  my  finger, 
shelling  out  this  large  adenoid,  had  reached  its  pos- 
terior surface  and  was  still  between  the  layers  of  the 
surgical  capsule,  I  opened  into  a  sac  in  which  these 
calculi  were  lying  free.  They  are,  as  you  see,  a 
hundred  or  so  in  number,  varying  in  size  from  a 
grain  of  snipe-shot  to  a  swan-shot,  smooth  and  round 
except  one,  which  is  the  size  and  shape  of  a  bean. 
The  received  opinion  is  that  calculi  such  as  these  de- 
velop primarily  in  the  glandular  crypts  of  the  prostate, 
and  that  their  presence  in  one  pocket  is  due  to  an 
amalgamation  of  crypts.  If  this  is  so  the  opening 
up  of  these  crypts  while  my  finger  was  traversing  the 
capsule  points  very  clearly  to  the  composition  of  that 
envelope." 

Dr.  Dargan  stated  that  the  sections  shown  were  made 

from   the  very  outermost   laminated   layers  of  what 

seemed  to  be  merely  a  fibrous  envelope  to  the  growth 

They  showed  here  and  there  atrophic  glandular  spaces, 

I  lined  in  many  cases  by  cubical  cells,  but  greatly  com- 

'  pressed,    and    evidently    undergoing  involution.    The 


\H»CH    2,     1904- 


TRANSACTIONS  OF  SOCIETIES,        The  Med.cal  Piess.    235 


presumption  is,  that  these  are  derived  from  greatly 
compressed  prostatic  tissue. 

The  Secretaiv  stated  that  he  was  quite  certain 
to*  1  a  few,  at  least,  of  the  cases  of  senile  enlargements 
of  the  prostate  were  true  hypertrophies. 

Hie  PmestDEXT  said  that  he  agreed  thai  senile  en- 
largement of  the  prostate  was  of  a  glandular  nature. 
He  had  not  always  been  able  to  find  glandular  or 
:lar  tissue  in  the  fragment  of  tissue  adhering 
to  the  prostates  removed  by  operation.  In  a  num- 
ber of  examinations  he  hat!  only  once  found  a  small 
myoma-  He  mentioned  a  ease  of  prostatic  obstruc- 
tion due  to  a  cyst  in  the  left  loin 

Mr.  TqbiSs  m  replying  to  the  remarks  of  the  Pre- 
sident stating  that  most  of  the  cases  that  he  had 
tvammed  were  either  true  hypertrophies  of  the 
noma t a  in  the  prostate,  but  not  con- 
verting    it     into     a    capsule,     asked  :     What,    then, 


however,  the  general  appearance  of  a  cystic  adenoma, 
the  epithelium  lining  of  the  cysts  being  mostly  com- 
posed of  goblet  cells.  Sections  of  the  skin  cysts  had 
not  yet  been  made,  but  Dr.  Neville  was  convinced  that 
the  tumour  realty  consisted  of  a  very  unusual  and  very 
solid  form  of  dermoid  cyst  adenoma, 

TERATOMA. 

The  President  showed  a  teratoid   tumour  of  the 

ovary.     It  was  taken  from  a  young  woman,  who  died 

with    abdominal    symptoms    some    months    after    lt» 

removal.     Sections  taken  from  different  parts  of  the 

tumour  showed     small     cavities   lined   by   epidermic 

and    having    hairs   and    sebaceous    glands     in     their 

walls.     Uther  cavities  were  found  to  be  lined  with  a 

columnar  epithelium,   and   glands   resembling   Lieber- 

kiihn's    crypts    opened    into    them,     Bone,    cartilage, 

masses  of  pigmented  cells,  adipose  tissue,  and  tissue 

I  resembling   that  of  the  central  nervnus  svstem   were 

Uje   capsule     that     certainly    exists    in    all  cases    also  found,  as  welJ  as  groups  of  ganglionic  nerve  cells, 

rule  hypertrophy  ?     He  had  never  faded  to  shell  calcified  fibro-myoma 


lie    offending    mass   in  such    cases,  but  he  had 
faded    to     shell    out     a    tuberculous 
operating  theatre  or  a  normal  prostate 
in  the  dissecting  monk 

ENDOTHELIOMA. 

Mr-  £»  G  howed  a  case  of  endothelioma  of 

the  peritoneum  occurring  in  a  man,  act,  2 ft.  with  ex- 
tensive secondary  growth!  in  lung,  hver,  and  bronchial 
Januh, 

Mr  Bennllt  asked  whether  the  primary  growth 
had  been  found,  as  all  the  growths  shown  seemed  to  be 
secondary . 

Mr.  Genu  replied  that  the  most  careful  search  for  a 
primary  lesion  had  failed,  and,  acting  on  the  presump- 
tion thai  the  growth  had  originated  from  the  peritoneum 
it  had  been  labelled  an  endothelioma. 

IM  PL  A  STATION  (OVARIAN}  TUMOUR*. 

Mr*  L.  G.  Gi'NN  showed  a  femoral  hernia,  in  which  a 

ct    secondary    ovarian    growth    had     occurred. 

The  ovarian  tumour  had  been  removed  nineteen  years 

The  hernia  had  enlarged  for  a  few  months 

before. 

B    exhibited    a    transplantation   cystic 

tumour  from   the  scar  of  an  old   (five  years)  ovario- 

Jftmy,     The  tumour  shown  was  about  the  size  of   an 

ordinary   fist,   and  consisted   of  a  congeries  of  small 

approximating   twenty  in  number,    varying  in 

•l :un  that  of  a  pea  to  that    of    a    large  walnut. 

Microscopic    examination    showed    a    marked    resem- 

bknee   between    the  peculiar  epithelium   lining  each 

cyst,  and  that  constantly  found  in  Graafian    follicles. 

!  membrana  granulosa,  specimens  of  u 

■hown.     It  was,  of  course,  impossible  to  rely  very 

lily  upon  such  a  resemblance  in  the  absence    of 

any  other  explanation. 

The  Secretary  found  some  difficulty,  owing  to  the 
amount  of  calcification,  as  shown  by  the  sections  under 
scope,    in  believing   that    the    transplanted 
^rarian  papilloma  had  recently  been  actively  growing, 
*Bd  *  *"u  Mr.  Gusin's  opinion  on  that  point. 

Mr  Gunsc  replied  that,  in  his  opinion,  most  of  the 
ttUrgemimt  was  due  to  the  growth  within  the  omentum, 
inri  nr>t  (rotn  any  fresh  omentum  coming  down  into  the 

DOUBLE-SIDED  DERMOID  CYSTs, 

exhibited    tumours   which    were     re- 

>atient.  aet.  25,  in  the  Rotunda  Hospital, 

t   Master,   Dr.   E.  Tweedy,  and  remarkable   for 

Jices    of    the    two    tumours.     One, 

r   onz,   was  an   ordinary  dermoid,    in    size 

that  of  a  foetal  head,  and  consisting  mainly  of  two 

a   considerable    portion    of    the    inner   surface 

>ch  was  lined  by  skm,  covered  with  white  hairs. 

But  the  larger  tumour,  rounded,  smooth,  and  measuring 

eight  inches,  was  essentially  a  solid 

ir<  presenting  on  section  a  very  peculiarly  varie- 

urfaee,  with  occasional  small  cysts,  few  of  which, 

were  larger  than  a  walnut.     Some  of  these 

small  cysts  were  partially  fined  by  skin  and  hair, 

>Udity  and  malignant  appearance  of  the  growth 

had  a  iggested   that  it  might  prove   to  be  a 

teratoma  on  microscopical  examination.     This  showed, 


Dr, 


CALCIFIED    FIBRO- MYOMA. 

Neville  also  exhibited  a  completely  calcified 
fibro-myoraa  of  the  uterus,  removed,  with  other  non- 
calcified  hbro-myomata.  by  l>r.  L.  Kidd.  of  Kimi*.- 
killeiL  Tumours  so  completely  calcified  were  cer- 
tainly rare  in  connection  with  hospital  practice,  though 
not  uncommonly  found  in  connection  with  ana- 
tomical  schools. 

Mr.  Bennett  related  a  case  which  he  saw  several 
years  ago.  in  which  a  calcified  myoma  ulcerated  intr* 
the  bladder,  and  was  diagnosed  as  stone.  In  the  at- 
tempt to  remove  it  the  patient  died,  The  true  nature 
of  the  mass  was  only  discovered  years  afterwards. 


THR  HARVEIAN  SOCIETY  OF  LONDON. 
Meeting  held  February  t  ith,  1904, 

Mr.  E.  W.  Rough  ton  read  a  paper  on  a  case  of 

INTESTINAL     OBSTRUCTION      WITH      GANGRENE     OF     THE 
C^CUM. 

The  case  was  one  of  obstruction  needing  immediate 
treatment;  an  umbilical  hernia  existed,  but  was  soft, 
painless,  and  gave  an  impulse  ;  it  was.  therefore,  not 
the  source  of  the  symptoms*  A  median  incision  was 
and  an  enormously  distended  caecum  was  seen, 
!  taring  manipulation  the 'caecum  burst  and  flooded  the 
operation  area  with  fa&ces.  but  the  peritoneum  was  pro- 
tected by  gauze  packing,  Paul's  tube  tied  in.  Later 
Mr,  Leg£  removed  a  cancerous  growth  from  the  sig- 
moid.    The  patient  made  a  good  recovery. 

Mr,  Legg  described  the  method  of  removal  of  tin- 
growth  in  the  sigmoid  flexure,  which  included  font 
inches  of  the  gut  and  a  wedge  of  the  mesentery.  End- 
to-end  suture  employed,  the  first  layer  through  all  the 
coats,  and  the  second  through  sera -muscular  coats, 
parietal  wound  closed.  The  colotomy  wound  was 
plugged  with  a  sponge,  and  the  skin  sutured  closely 
over  it  during  the  operation.     Patient  did  welL 

Mr,  Paton  discussed  two  cases  of  partial  hernia  lie 
had  recently  treated,  in  one  of  which,  although  a  smalt 
portion  of  the  gut  was  tightly  constricted  and  was 
sloughing  through,  symptoms  were  purely  local;  in 
another  case  the  condition  of  the  hernia  aid  not  in- 
dicate the  existence  of  local  symptoms,  which  rather 
Membied  perforated  gastric  ulcer,  thus  showing  how 
sloughing  of  the  gut  often  gives  rise  to  anomalous 
symptom, 

CORK     MEDICAL     AND     SURGICAL     SOCFETY. 
Meeting  held  Wenesday,  February  24*11,    1904. 

j.  Cotter,  M.D.,  F.R«CSJ..  President,  iu  the  Chair. 

Dr.  H.  R-  Townsend  read  notes  of  five  cases  of 
appendicitis  operated  on.  in  the  acute  stage.  In  four 
cases  recovery  followed,  while  in  one  case,  owing  to  the 
mildness  of  the  symptoms,  surgical  aid  was  not  re- 
quisitioned at  an  early  stage,  and  when  the  operation 
was  performed  the  appendix  and  surrounding  portions 
of  intestine  were  found  in  a  gangrenous  condition, 
and  the  patient  died  five  days  later.  Iu  his  opinion, 
as  soon  as  a  diagnosis  of  appendicitis  was  made,  an 


236    The  Medical  Press. 


GERMANY. 


March  2,   1904. 


operation  should  be  at  once  advised,  as  there  were 
no  trustworthy  means  of  foretelling  from  day  to  day 
what  course  the  case  would  take. 

Dr.  T.  Gelston  Atkins  read  notes  of  a  series  of 
cases  of  cholecystotomy,  choledochotomy  and  chole- 
cystectomy, and  maintained  that  with  the  improved 
methods  now  adopted,  gall-stones  should  be  always 
treated  by  surgical  means. 

Dr.  P.  J.  O'Brien  read  notes  of  a  case  of  puerperal 
eclampsia  complicated  by  acute  sepsis,  and  of  a 
similar  case  of  eclampsia  complicated  by  acute  mania. 
The  patient  in  the  first  case  recovered  after  a  very 
severe  illness.  In  the  second  case  the  patient  had  to  be 
removed  to  the  asylum,  but  was  at  present,  after  two 
months,  practically  well,  and  was  about  to  be  dis- 
charged. 

Dr.  D.  Morrissy  read  notes  of  three  cases  of  tetanus 
treated  by  anti-tetanic  serum.  In  two  of  the  cases 
the  patients  recovered.  In  the  third  case  the  patient, 
a  woman,  aet.  50,  recovered  completely  from  the 
tetanus  in  a  week,  but  sixteen  days  after  admission  to 
hospital  was  attacked  by  broncho-pneumonia,  which 
proved  fatal  nine  days  later. 


France. 


[from  our  own  correspondent.] 


Paus,  February  28th,  1904. 
Treatment  of  Chronic  Rheumatism. 
According  to  Dr.  Huchard,  the  medical  treatment 
of  chronic  rheumatism  consists  essentially  in  iodide  of 
potassium  and  arsenic.  If  the  patient  seems  weak, 
arsenic  will  be  given  for  three  weeks  in  the  form  of 
Fowler's  solution  (5  drops  twice  daily),  or  of  solution 
of  arseniate  of  soda  :  arseniate  of  soda,  1  grain ;  water, 
10  ounces  (a  tablespoonful  before  lunch  and  dinner). 

If,  on  the  contrary,  the  patient  is  vigorous,  preference 
will  be  given  to  iodide  of  potassium  (6  grains  daily), 
and  continued  three  weeks  or  a  month. 

However,  if  the  rheumatism  be  of  arthritic  character, 
iodide  will  be  of  little  use  ;  it  should  be  replaced 
by  tincture  of  iodine,  5  drops  three  times  a  day  in  a 
glass  of  water,  gradually  increased  by  1  drop  daily  to 
10  or  15  drops  each  time,  and  continued  a  month, 
after  which  it  should  be  suspended  for  ten  days,  and 
then  recommenced.  The  treatment  might  be  continued 
for  months  if  the  patient's  stomach  can  support  it. 
If  an  excess  of  uric  acid  be  secreted,  piperazine 
might  be  given  : — 

Piperazine,   1  drachm. 
Water,  10  oz. 
A  tablespoonful  twice  a  day  for  five  days,  and  suspended 
five  d  ays,  and  so  on  for  six  weeks. 

Colchicum  was  recommended  by  different  authors, 
but  in  the  hands  of  Dr.  Huchard  it  gives  no  good 
result  except  when  the  rheumatism  is  of  a  gouty  nature. 
Salicylate  of  soda  might  be  tried  in  acute  attacks  of 
chronic  rheumatism,  but  it  acts  less  effectively  than 
in  the  inflammatory  form.  In  any  case  it  is  superior 
to  antipyrin,  aspirin,  salophene,  &c. 

As  regards  external  remedies,  igni-puncture  and  blisters 
are    employed    successfully    in    chronic    rheumatism, 
and  tincture  of  iodine  is  of  current  application.     An 
ointment  which  is  frequently  found 4  very  serviceable 
is  that  composed  of  salicylic  acid  : — 
Salicylic  acid, 
Ess.  of  turpentine, 
Lanoline,  aa  10  drachms. 
In  cases  of  painful  chronic  rheumatism.  M.  Dieulafoy 
recommends    a    very    simple    application :    poultices 
of  bread  crumb  moistened  with  spirits  of  camphor  and 
coated  with  the  following  mixture  : — 
Camphor,  2  drachms. 
Extract  of  opium,  1  drachm. 
Alcohol,  q.s. 


The  preparation  of  the  poultices  is  a  little  intricate. 
Four  pounds  of  bread  crumb  are  steeped  in  water  for 
about  five  minutes  ;  it  is  then  pressed  in  linen  and 
placed  in  a  sand  bath  for  three  hours.  At  this  point 
tKe  bread  forms  a  dry  paste,  and  is  softened  gradually 
by  the  addition  of  spirits  of  camphor.  The  paste  i* 
then  kneaded  and  spread  upon  a  piece  of  linen,  while 
the  above  mixture  is  spread  over  the  whole  surface. 
Thus  prepared,  the  poultice  is  placed  on  the  articula- 
tion and  covered  with  a  sheet  of  gutta-percha,  and  held 
in  place  by  a  flannel  bandage  ;  the  application  remains 
in  place  from  eight  to  ten  days. 

Of  the  other  methods  generally  recommended  for 
chronic  rheumatism,  M.  Huchard  mentions  massage, 
electricity,  warm  baths,  hot  air  baths,  turpentine 
vapour  baths.  Massage  renders  great  service  in  the 
treatment  of  rheumatism  deformans  by  suppressing 
pain  and  avoiding  ankylosis.  The  ointment  employed 
in  the  massage  would  be  as  follows  : — 

Tincture  of  nux  vomica,  1  drachm. 
Spirit  of  lavender,  1  drachm. 
Vaseline,  6  drachms. 
Lanoline,  6  drachms. 
The  warm  baths  are  given  every  two  days  for  ten 
or  twenty  minutes,  and  the  temperature  of  the  water 
is  gradually  raised  while  the  patient  is  in  the  bath  to 
the    highest    degree    possible.     Different    substances 
might   be   added    to   the   bath,   but   more   especially 
essence  of  turpentine  (black  soap  emulsion,  essence  ot 
turpentine,    of  each  4    ounces).     The  hot  sand  bath 
gives   much  relief.     The  sand,  heated   in   an  oven,  is 
poured  into  a  tub  and  allowed  to  cool  to  1  io°,  the  limb, 
bandaged,  is  plunged  into  the  tub  for  twenty  to  twenty- 
five     minutes.     Bergeret     recommended     enveloping 
the  joint  in  carded   wool   and   placing  on  it   three  or 
four  pounds  of  hot  sand.     He  alleged  that  this  treat- 
ment applied  to  hydarthrosis  of  the  knee  caused  the 
effusion  to  disappear  in  a  very  few  days. 

Turpentine  vapour  baths  are  frequently  employed. 
M.  A.  Robin  uses  them  freely  at  the  Hopital  de  la 
Pitie.  The  baths  are  administered  every  two  days, 
and  last  from  ten  minutes  to  a  quarter  of  an  hour; 
the  vapour  jet  is  received  in  a  sort  of  tent  in  which 
the  body  of  the  patient  is  imprisoned  up  to  the  neck. 

The  hydropathic  establishments  for  the  treatment  of 
chronic  rheumatism  are  very  numerous  in  France,  but 
they  should  not  be  recommended  indiscriminately. 
La  Bourbonne  (Haute-Marne)  suits  inveterate  and 
exhausted  rheumatic  patients ;  Luxeuil  (Haute- 
Saone)  neuropaths  ;  Neris  (Allier)  neuro-arthritics , 
Aix  (Savoie)  torpid  rheumatism,  peri-arthritis ;  the 
mud  baths  (sulphur)  of  Saint-Amand  (Nord)  succeed 
very  well  in  all  forms  of  chronic  rheumatism. 

In  conclusion,  M.  Huchard  says  that  chronic  rheu- 
matism is  much  more  amenable  to  treatment  than  the 
arthritic  form.  This  latter  is  not  as  yet  very  well 
understood  as  to  its  real  cause,  its  nature  being  very 
complex,  but  the  treatment  already  indicated — large 
doses,  internally,  of  tincture  of  iodine,  massage,  and 
the  hot  sand  bath — gave  the  least  unfavourable 
results. 


(Bermang* 

[from  our  own  correspondent.] 

BntUK,  February  28th,  1904. 
At  the  Free  Society  of  Surgeons,  Hr.  Karewski  gave 
an  address  on 

Hernia  of  the  Bladder. 
As  to  the  origin  of  the  condition,  either  a   prevesical 
fatty  tumour  dragged  the  bladder  forward  or  grew  in 
the  bladder  wall  and   weakened  it.     The  important 


M*ftLW     2,      lQ04t 


STRIA. 


The  MeoicjU.  Press.     237 


I 


is  in  connection  with  it  were  thosize  of  the  bladder, 
peritoneal  adhesion*  h  the  size  of  the  rupture  and  of  the 
tng.     He    had    seen    five    cases.     Two    of    them 
lie  verified  cystoscopically  :  one  was  recognised 
js  such  a!  the  operation,  one  only  by  a  fistula  remain- 
tor  Operation.      On  a  ligature   being  applied,  a 
a  of  the  bladder  wall  was  included  in  it.  and  the 
tiitula  resulted.     Four  were  extraperitoneal  au«l 

peritoneal.      All  were  characterised    by    a    large 

■irvelopment   of    pra  vesica  I    fat.     He   had    also    made 

twenty- three     observations     on     seven     bodies.      The 

result  of  his  investigations  was  to  determine  that  with 

ler  a  connection  existed  between  the  hernial 

inning  and  the  bladder  wall,  the  more  intimate,   the 

torger  the  •  I ;  with  i  ncrease  in  growl  h ,  there  - 

the  danger  increased  of  including  the  bladder   wall 

HI  the  ligature.     There  wis  no  diverticulum,  however. 

ft  the  Madder  wall  wns  injured  on  such  an  occasion, 

QUI  a  proof  that  an  actual  hernia  existed,     A 

further  result  of  his  investigation  was  to  show*   that 

was  an  intimate  connection  lie t ween  pr a- vesical 

preperitoneal  fat  and  the  bladder  wall. 

Hr.  Israel  spoke  on 

ifictal  Substitutes  for  the  Creters. 
fa  oi  the  importance  that  congenital  hindrances 
CO  the  flow  m  hydronephroses.     The  disease  first 
Dfl  manifest  in  the  course  of  years  either  through 
increase  of  tension  and  accompanying  cohc,  or  through 
ion  of  the  contents.     Thus  a  boy,  ad.  ijt  suffered 
from  left-sided  renal  colic,   in  whom  a 
I  &K  could  be  felt  during  the  attack,  which  be- 
came tffialier   however,  when  the  attack  subsided.     As 
racks  became  more   frequent  an  operation  was: 
Joed  in  December,    1902,      a  son  of  blind    sac- 
g  of  the  pelvis  of  the  kidney  was  found     Ijelow 
*vhcrt  the  ureter  was  given  off,     The  ureter  was  per- 
permeable.     The  kidney  was  deeply  placed,  and 
lis  fixation  at  a  holier  level  was  nut  practicable.     The 
ton  of  ihe  kidney   was  plainly  congenital.     Ex- 
tually   he    first   of   all   sutured    the   ureter  with 
rwer  part  of  the  dilated  pelvis  of   the  kidney,  but 
hours    later    the    colic    returned    and    a 
•  be  inserted.      For  ten  days  the  urine  re- 
u  i,  then  it  became  cloudy,  and  a  metastatic 
suddenly  developed   in  a  hydronephrosis  of 
gbi  side   that   had   up  to   then   been   latent.     A 
IttmottT  was  -n.u  palpable,  and  anuria  set  in,   the  left 
1  eeasmg  to  secrete.     The  sac  of  the  right 
id  now  to  be  emptied  and  a  drain  inserted.     The 
'  urme  then  came  on  again,  but  there  were 
BO  means  of  conducting  the  urine  into  the  bladder. 
I  he  speaker  at  last  determined  t.j  make  a  suprapubic 
I  nsiula  and  to  join  the  kidney  and  the  bladder 
by  means  of  a  lube  running  externally,  and  provided 
Map  in  order  to  prevent  any  back  flow,    The 
apparatus  had  now   t>een  working  Vor  eight    months 
ni  acted  well. 
He  had  operated  four  times  tor  hydronephrosis  of 
'Higemtal  origin.     He  the  .  d  a 

SING  the  Posterior  Surface  of 
the  Liver, 
Vn  Officer,  a  L  41,  had  suffered  for  five  months  from 
ptiO  in  the  right  lorn,   which  was  worse  on  coughing, 
■  2.   or    pressure   on    the   lumbar   region.     More 
'«'  had  b  r.     In  spite  ot  an  enor 

ly   increased    appetite    there   was   extreme   weak- 
rine  normal,  the  right  kidney  could  be  felt  ; 
not  enlarged.     The  symptoms  pointed 
roe  mischief  in  the  right  subphrenic  space. 
1  1  was  thought  of  +  but  against  any 
"lipase  of  this  was  the  fact   that  there  was  no  dis- 
location.    Only     the     liver     remained. 
nt  spoke  of  syphilis  in  earlier  life, 


and  the  most  probable  assumption  now  was  of  a  break- 
ing down  gumma  in  the  liver.  It  was  decided  tn 
explore.  He  made  a  transverse  incision  on  the  lower 
border  of  the  twelfth  rib  and  exposed  the  kidney. 
This  was  healthy,  so  he  resected  the  twelfth  rib  sub- 
periostcally,  divided  the  fatty  capsule  of  the  kidnev 
and  pulled  it  on  one  side.  The  suprarenal  capsule  was 
healthy,  and  there  was  no  pus  in  the  subphrenic  space, 
A  prominence  was  felt  through  the  peritoneum  at  the 
fovea  renahs  hepati*.  m  being  cut  into,    proved 

to  be  a  gumma.  This  was  extirpated.  Both  fever 
and  pain  ceased  at  once  and  the  patient  recovered. 
This  method  of  freeing  the  posterior  surface  of  the  liver 
could  be  made  use  of  if  the  ligaments  of  the  kidnev 
allowed  sufficient  movement. 


Susrrfa. 

[from  our  own  correspondent.] 

Vikxxa,  February  30th»  1«H, 
Pityriasis  Follicular]*  Chronica, 
mann  presented  a  young  man.  <rt.  28.  with 
pityriasis  follkularis  chronica.  Over  the  whole  body, 
but  more  particularly  the  trunk,  there  were  brown 
coloured  elevations  about  the  size  oi  peas,  with  a 
covering  of  thick  scurf  which,  when  rubbed  off,  left 
a  red.  granular,  efflorescent  base.  The  lymphatic, 
inguinal,  and  crural  glands  were  all  swollen,  although 
the  mucous  membrane  was  in  a  normally  heal  tin- 
condition.  This  condition  of  the  mucous  membranes, 
witli  the  ha^morrhagic  appearance  under  the  dry 
covering,  were  strong  evidence  against  syphilis,  of  which 
nothing  could  be  gleaned  from  the  history  of  the  case. 

Than  psoriasis  vulgaris  was  excluded  by  the  absence 
of  the  shiny  covering  and  the  presence  of  the  hemor- 
rhagic condition  just  described,  He  had  had  the  case 
under  his  observation  for  the  last  ten  years. 

Histologically  the  disease  is  an  inflammatory  process 
of  the  cutis,  which  has  gone  on  to  a  true  para-keratose 
state.  The  affection  recovered  under  the  use  of  ung. 
Wilkinsonii. 

tf  euro-Fibroma. 

Ehrmann  showed  two  cases  of  neuro- fibroma  of  the 
skin.  The  tubercles  or  tumours  removed  ranged  from 
g«  of  a  pea  to  that  of  a  bean,  of  soft  consistence, 
jutting  forward  with  muscular  movement  as  if  from 
a  pedicle.  They  contained  pigment,  and  were  asso- 
ciated with  skeletal  anomalies  and  slight  psychical 
defects, 

Riehl  remarked   that   these  cases  were  not  simple 
growths  from   the  nerve  sheaths,  but  must  be  eon- 
I  hereditary  vegetations  in  a  wider  sense. 
Ata  \ 

Koth  brought  forward  a  case  of  tabetic  ataxia, 
which  he  had  successfully  treated  with  faradic  electric 
baths,  followed  by  Fraenkel's  ataxia  gymnastics,  the 
principle  of  which  is  to  teach  movements  of  the  muscles 
through  the  sense  of  sight. 

Barlow's  Disease, 

At  the  Gesellschaft  for  Children.  Weiss  showed  a  female 
child,  a  t+  4\  months,  with  the  so-called  Barlow's  disease. 

luld  wasat  the  breast,  and  weighed  5.040  gran 
or    127  lbs.     For   three   weeks   it    had   suffered    from 
dyspeptic  stools  andeczcnia  intertrigo;  the  lower  h ml ,. 
were  well  developed.     Without  any  apparent  c;i 
swelling  about  the  size  of  an  orange  appeared  on  the 
right  side  of  the  face  on  the  upper  maxillary  bone, 
with  a  broad  base.     It   was   movable    with   difficulty 
and    generally    hard    in    consistence,    although 
fluctuation  could  be  felt  on  the  apex  of  the  swelling. 
The  skin  was  glazed  but  could  not  be  lifted  up.     In 
parts    the  surlace  had  spots  as  if  congested  ;    and  the 


238    The  Medical  Peess. 


OPERATING   THEATRES. 


March  2.  1904. 


whole  swelling  seemed  to  have  no  pain.  An  explora- 
tion syringe  was  driven  into  the  fluctuating  part,  but 
nothing  but  a  small  quantity  of  fluid  sterile  blood  was 
obtained.  A  little  later  a  quantity  of  blood  exuded 
from  the  lower  eyelid,  which  was  repeated  in  two  days, 
the  blood  being  of  a  dark  colour.  This  bleeding  after- 
wards became  more  frequent  from  mouth,  eyes,  and 
nose.  Cranio-tabes  was  not  a  prominent  feature  of 
the  case.  The  soft  tissue  of  the  cheek  conveyed  the 
opinion  that  it  was  a  traumatic  swelling  having  its  origin 
in  the  subperiosteal  structure.  From  the  age  of  the  child 
and  the  subsequent  haemorrhage  from  skin  and  mucous 
membrane  he  was  led  to  the  conclusion  of  Barlow's 
disease.  The  most  successful  therapeutics  for  this 
was  change  of  diet  for  the  mother  and  antiscorbutic 
adjuncts  for  the  child. 

Kassowitz  agreed  with  the  diagnosis,  but  felt  some 
misgivings  about  the  etiology,  which  was  often  attri- 
buted to  the  malnutrition  of  the  child,  particularly  in 
those  cases  where  children  were  fed  with  sterilised 
milk.  He  confessed  that  the  disease  was  very  seldom 
met  with  in  Vienna,  although  this  could  not  be  averred 
of  all  Austria.  He  did  not  quite  agree  with  the  opinion 
that  the  change  of  food  was  a  success,  as  he  often 
thought  better  air  and  anti-rhachitic  treatment  was 
more  effectual  than  change  of  food  alone.  His  reason 
for  thinking  that  the  disease  had  a  rhachitic  basis  was 
the  contrast  of  its  rareness  to  the  frequency  of  rhachitis. 

Neurath  asked  if  the  probing  needle  struck  against 
bone.  This,  he  thought,  would  prove  its  subperios- 
teal origin.  He  thought  the  mobility  of  the  tumour, 
and  the  site  of  the  swelling,  was  againstBarlow's  theory 
of  the  disease. 

Knoepfelmacher  said  he  had  a  child  about  ten 
months  under  observation,  in  which  a  similar  haemor- 
rhage occurred  in  the  cheek.  The  histological  exami- 
nation proved  no  connection  with  the  periosteum. 
After  one  cheek  healed  the  same  haemorrhage  occurred 
in  the  other  cheek.  It  was  confined  entirely  to  the 
soft  tissue. 

Weiss  replied  that  he  had  no  other  opportunities  to 
prove  that  the  swelling  was  subperiosteal,  although  the 
Rontgen  rays  and  exploration  tended  to  that  opinion. 
Number  of  Practitioners. 

The  number  of  medical  men  practising  in  Austria 
has  increased  from  1 1 ,339  to  1 1 ,689,  or  about  3  per  cent. 
The  greatest  increase  is  in  Lower  Austria,  which  has 
risen  from  3.325  to  3,454.  Then  comes  Bohemia, 
Galacia,  Ac.  Of  the  capital  towns,  Vienna  comes  first 
with  an  increase  from  2,576  to  2,721,  while  Prague  ha3 
538  to  558. 

Zbe  ®perattn<)  Ztbeatres* 

GUY'S  HOSPITAL. 
Operation  for  the  Mechanical  Obstruction  of 
the  Large  Bowel  resulting  from  Chronic  Con- 
stipation.— Mr.  Arbuthnot  Lane  operated  on  a  man, 
set.  38,  who  had  for  many  years  suffered  from  severe 
constipation,  his  bowels  not  being  opened  at  times 
for  a  week,  in  spite  of  constant  drugging.  The  chief 
reason  which  made  him  think  of  surgical  treatment 
was  the  constant  abdominal  pain  with  which  this 
condition  was  associated  ;  this  pain  and  discomfort 
made  his  life  a  burden  to  him.  and  rendered  him  quite 
unable  to  do  any  regular  work.  As  this  was  clearly 
one  of  those  cases  of  mechanical  obstruction  of  the 
large  bowel,  consequent  on  constipation,  which  Mr. 
Lane  has  described  in  the  Lancet  of  January,  1903 
and  1904,  he  proceeded  to  make  a  vertical  incision  just 
a  little  to  the  left  of  the  middle  line  of  the  abdomen. 
The  intestines  were  seen  to  present  that  condition  of 


inactivity    and   plasticity    which    is    constantly   seen 
under  these  circumstances.     The  ileum  entered     the 
left  side  of  the  true  pelvis,  where  it  opened  at  once  into 
the  caecum,  which      was  enormously  elongated  and 
considerably   distended,   occupying   the   bulk   of   the 
true  pelvis.     Emerging  from  the  pelvis  it  ran  upward* 
and  to  the  right  on  to  the  iliac  fossa  and    loin,  where 
it  was  tightly  bound  down,  and  its  lumen  very  con- 
siderably obstructed  by  the  presence  of  stout  bands 
and    adhesions.     He    divided    these    bands    and    ad- 
hesions very  freely,  liberating  this  part  of  the  bowel 
from  their  constricting  influence.     Then  he  examined 
carefully   the   mechanical    condition    of    the    altered 
caecum,  and,  from  the  knowledge  he  had   gained  pre- 
viously of  surgical  interference  in  these  cases,  he  knew 
that  the     mere  division  would  only  give  temporary 
relief,   since   the  adhesions  would  re-form   almost  at 
once  when  the  freed  bowel  fell  back  into    its    original 
position.     He,    therefore,   decided   to   disconnect   the 
large  bowel.  This  he  did  by  bringing  out  the  sigmoid, 
to  effect  which  it  became  necessary  to  divide  abundant 
adhesions  which  had  shortened  up  the  meso-sigmoid 
externally  and  had  pinned  down  the  sigmoid  into  the 
iliac  fossa.  He  effected  a  lateral  anastomosis  between 
the  end  of  the  ileum  and  the  sigmoid,  after  which  he 
divided  the  ileum  between  its  terminations    and    the 
newly-formed  anastomosis.       It  was  of  interest,  he 
said,   to   point   out   that   the   appendix  had   become 
obliterated  in  the  whole  of  its  length  ;  it  was  stretched 
over  the  caecum,  to  which  it  was  adherent.     It  was 
not  interfered   with.     Mr.  Lane   said    that   these  me- 
chanical conditions  of  obstruction  of  the  large  bowel, 
causing  symptoms  of  septic  absorption  of  a  more  or 
less     disabling  or  disagreeable   character,   and   very 
often  associated  with  pain  of  a  griping  character,  and 
with  much  soreness  of  the  abdomen,  were  very  common, 
and  often  with  evidence  of  damage  to  the  appendix. 
The  only  doubt  generated  in  his  mind  in  dealing  with 
these  cases,  he  remarked,  was  whether  the  freeing  of 
the  large  bowel  from  the  adhesions  and  bands  was 
likely  to  be  followed  by  permanent   relief   from   the 
several  symptoms,   or  whether  it   was   not  wiser  at 
once  to  disconnect  the  greater  part  of  the  large  boweL 
and   especially   that   portion   of   it   which   forms  the 
cesspool  of  the  gastro-intestinal  tract,  so  effectually 
disposing  of  any  recurrence  of  the  patient's  symptoms. 
He  pointed  out  that  in  the  earliest  operations  which 
he  had  performed     he  had  been  satisfied  to  make  a 
very  large  anastomosis  between  the  ileum  and  sigmoid 
or  rectum,  removing  portions  of  the  circumference  of 
each  so  as  to  obviate  the  passage  of  faeces  into  the 
caecum.     He,  however,  found  that  when  the  caecum 
and  sigmoid  were  permitted  to  become  loaded  up  the 
result     was   that      material       passed     out     of     the 
combined     ileum  and  sigmoid  into  the  ileum  beyond 
the     anastomosis,  and  so  into  the  caecum,  producing 
for  the  time  being  the  old  painful  symptoms.    This 
he    obviated    by    again    opening    the    abdomen   and 
dividing  the  ileum  beyond  the  anastomosis,  so  render- 
ing any  recurrence  of  the  painful  symptoms  impossible. 
He  believed  that  the  individual  suffered  no  appreciable 
loss  from  the  fact  that  the  large  bowel  down  to  the 
level  of  the  aperture  in  the  sigmoid  was  totally  dis- 
connected.    On  the  other  hand,  besides  a  very  marked 
improvement   in    the  colour   and   complexion  of  the 
patient,  the  weight,  energy,  activity  and  intelligence 
of    the    individual,    all    improved    steadily    after  the 
operation.     He  was  convinced    that  the  time  was  not 
far  distant  when  this  operation  would  be  performed 
very    frequently    indeed,    since    a    very    considerable 
proportion  of  women  and  a  much  smaller  proportion 
of  men  have  not  the  energy  to  work  the  large  bowei 


March  2.   1904. 


LEADING   ARTICLES. 


The  Medical  Peess*     239 


efficiently,  And,  once  its  functions  become  altered  by 
mechanical  interference  with  its  lumen  in  the  manner 
odicated,  the  absorption  of  products  from  the  large 
towel  assist  in  thoroughly  poisoning  the  system  and 
reducing  still  further  the  capacity  of  the  several  organs 
and  tissues  of  the  body  to  carry  out  their  normal 
functions.  In  addition  to  this  it  was  hardly  necessary, 
he  said,  to  point  out  what  he  has  often  called  attention 
to  before,  that  the  interference  with  the  mechanics 
of  the  appendix,  which  results  from  loading  of  the 
larfiffc  bowel,  and  the  consequent  formation  of  adhesions, 
mas  a  matter  of  serious  importance,  constantly  en- 
ring  the  life  of  the  individual.  Of  course,  he 
added,  the  more  rational  way  would  be  to  make 
women  lead  natural  and  healthy  lives,  keeping  them 
m  ihe  open  air,  supplying  them  with  suitable  foods, 
Ac,  so  rendering  them  capable  of  performing  satis- 
\\y  their  physiology  and  of  producing  vigorous 
and  healthy  offspring,  and  so  being  efficient  members 
01"  a  welt-organised  society  ;  but,  as  it  is,  women  are 
practically  a  hopeless  failure  in  a  large  proportion  oi 
cases;  civilisation  has  ground  them  down  into  the 
poor,  ill-developed  creatures  they  often  are,  totally 
unlit  to  perioral  satisfactorily  that  function  for  which 
purpose  Ihey  exist,  and  to  carry  on  the  physiology  of 
ihe  rest  of  their  body  in  anything  approaching  a 
aormal  manner*  This  degeneration,  he  thought,  must 
of  necessity  increase,  since  the  intelligence  of  the  nation 
h  that  the  only  remedy  it  can  find  19  to  make 
in  excessive  demand  upon  the  capital  energy  of  women, 
lyjth  as  regards  their  brains  by  what  is  called  education, 
and  upon  their  muscular  system  by  what  are  called 
games.  They  are  obviously  both  disastrous  in  the 
IDA.  The  educationalists,  or  rather  those  on 
whom  the  care  oi  the^t-  imlortunate  young  creatures 
devolves*  seem  to  forget  that  the  girl  is  too  often 
mortgaged  up  to  the  hilt  by  the  demands  of  her  sexual 
apparatus,  and  having  met  that  demand,  more  or 
k»  unsatisfactorily,  she  has  no  energy  left  to  expend 
beyond  bearing  a  fairly  normal  mechanical  relation- 
ship to  her  surroundings. 


RlOIJSTfUD    rOl    TaAN^Irt^lQK    ABUGaO, 

Ebe  Aedtcai  press  an&  Circular. 

PublnlVeJ  every    Wednesday  morninif,   Price   5d,      Post   free,    6jd* 
ADVERTISEMENTS. 
OS*    liYiKimoK    -Whole    Page,    fiS    (fa      Od.  ;      Halt    Page, 

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Dtaiideniblfl  Reduction*  from  the  fun^oinir  ncule  tire  mule  when 

«ii  order  it  given  for  a  teriat  of  insertions.     Tdrms  on  appiica* 

Lion.  10  the  'pnUbher* 
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M,  per  line  beyond, 

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ttbe  AeMcal  press   anD  Circular. 

" SAtUS  POPULI  SUPREMA  LEX  M 


WEDNESDAY,  MARCH  2,  1504. 


THE  PLAGUE  OF  ADVERTISEMENT. 

It  is  not  so  long  since  Sir  Cnchton  Browne  spoke 

I    dinner   on    the   evils   and    dangers 

uiuag  from  the  licence  permitted  to  advertisers  in 

the  daily  press.     And,  if  we  remember  aright,  it 


was  his  idea  that  the  insertion  of  advertisements 
of  a  certain  type  should  be  controlled  by  a   Press 
Censor,    inasmuch    as    they   constituted   a   direct 
danger  to  the  public  weal.     This  danger  is  real, 
not  only  from  its  moral  but  also  from  its  physical 
aspect.     The  crass  ignorance  shown  in  many  of 
these  announcements  is  matched  only  by  the  im- 
pudence with  which  they  herald  to  the  public  the 
specific  potency  of  certain  wares,  which  are  asserted 
to  cure  every  disease  or  affection  of  every  organ  of 
the  body.     It  is  a  matter  of  congratulation  that 
some  journals  have  refused  to  open  their  coin, 
to  a  notorious  form  of  advertisement,  which   is 
merely  a  thinly-veiled  inducement,  to   those  who 
may  be  desirous  of  using  them,  to  resort  to  dan- 
gerous agents  to  effect  illegal  objects.      How  many 
women  suffering  from  affections  of  the  genitalia 
<<\v    their  diseased  pelvic  states  to   the  frequent 
use  of  such  *'  remedies  "  it  would  be  difficult  to 
estimate.     There  is  also  a  class  of  advertisement, 
■  imphlet   or  circular,  or    through   the  press, 
which  assumes  a  technical  and  intimate  acquaint- 
ance with  the  affections  of  some  special  organ,  all 
of  which  are  supposed  to  be  cured  by  the  exhibi- 
tion   of    that    particular   medicine ,    appliance,   or 
mode  of  treatment  which  is  being  proclaimed  to 
the  public  as  an  infallible  remedy.     It  is  an  easy 
matter  to  find  someone  who  will  express  in  the 
suggested    terms    the    required   euiogium   on    the 
efficacy  of  the  vaunted  "  cure."     In  fact,  there  is 
an  art  and  science  in   the  manipulation  of  such 
advertisements  which  secures  a  fair  livelihood  for 
those  whose  services  are  at  the  disposal  of  some 
enterprising   charlatan,     A   cynic    might    say,   in 
the  words  of  Dean  Swift,  "  If  you  like  your  secu- 
rity, down  with  the  dust  !  '*  and  if  people  will  rush 
blindfold   for  every   miraculous  nostrum  or  mys- 
terious appliance  they  hear  of,  they  must  take  the 
consequences.     But  there  is  a  serious  side  to  this 
trafficking  with  human  life  and  health.     Sooner  or 
later,  in  a  certain  proportion  of  cases,  the  deluded 
victims  find  that  the  maladies  which  they  had  for 
a  time  persuaded  themselves  were  being  mitigated 
or  cured    had  only  strengthened  their  hold,  and 
they    are   at   last   forced    to  seek    skilled   advice. 
They  then  awake  £0  the  fact  that  money  has  been 
wasted  and  time  of  priceless  value  lost,  and  that 
organic    conditions    are    now   present    which    are 
beyond  amelioration  or  cure.     It  is  not,  however, 
in  the  exhibition  of  drugs  only  that  we  find  the 
most  flagrant  examples  of  this  dangerous  risk  lo 
the     health     of     sensitive     organs.     Uneducated 
people,  who  are  utterly  ignorant  of  the  delicate 
and   transitional  phases  which  mark  the  border- 
land between  that  which  is  physiological  and  that 
which   is   pathological,   as,    for   example,    in    the 
tunics    of    the    eye,    more    especially    the    retina, 
where   they   are   associated   with   disturbances   oi 
vision,  undertake,  with  a  mere  knowledge  of  re- 
fractive aberrations,  to  treat  visual  disturbances. 
And  perhaps  no  organ  is  more  open  than  the  ear  to 
the  assaults  of  the  harpies  who  speculate  in  distress 
and  suffering,  drawing  their  handsome  profits  out 
of  some   "  boomed  "  system  of  treatment,  while 
no  organ  requires  a  nicer  balance  of  judgment  in 


240      The  Medical  Press. 


LEADING   ARTICLES. 


March  2,  1904. 


the  management  of  its  maladies,  or  a  finer  adjust- 
ment of  means  to  ends  than  this.  All  the  advances 
made  in  recent  years  in  otology  have  tended  to 
the  more  exact  differentiation  of  the  causes  of 
deafness,  and  the  experience  and  knowledge  re- 
quired for  an  accurate  differential  diagnosis  are 
considerable.  Both  prognosis  and  treatment  de- 
pend upon  this.  Yet  various  mechanical  appli- 
ances for  the  treatment  of  affections  of  the  ears  are 
being  ordered  indiscriminately,  after  so-called 
"  consultations."  Pamphlets,  interspersed  with 
quotations  from  recognised  authors,  are  plentifully 
issued,  and  popular  descriptions  of  such  physio- 
logical or  anatomical  facts  as  can  serve  the  purpose 
are  added  to  give  point  to  the  asserted  potency  of 
the  electrical  or  other  appliance  from  the  sale  of 
which  some  speculative  company  reaps  its  profits. 
And  so  in  other  matters,  even  more  serious  than 
the  functional  integrity  of  an  organ  of  sense. 
44  Institutions,"  with  "  professors,"  are  springing 
up  everywhere  for  "  electrical,"  "  high  tension," 
"  Finsen  light,"  "  X-ray,"  and  "  massage  "  treat- 
ment. The  initial  stages  of  grave  nervous  dis- 
order, spinal  arthropathies,  ataxies,  obscure  cere- 
bral changes  in  nerve  tissues  or  vessels,  secondary 
complications,  in  which  other  organs  are  involved 
than  those  in  which  the  nervous  disturbance  is 
showing  itself,  are  liable  to  be  regarded  as  the 
results  of  il  rheumatism,"  "  gout,"  "  general 
debility,"  "  muscular  weakness,"  and  so  forth. 
The  skin  affords  a  rich  harvest  to  some  of  the 
"  beauty  doctors,"  whose  audacity  in  prescribing 
for  and  treating  various  cutaneous  affections  per- 
haps almost  surpasses  every  other  class  of  the 
charlatan  brood.  We  have  said  sufficient  to  draw 
attention  to  this  multiform  omnivorous  canker, 
which  demands  closer  attention  in  the  proper 
quarters  than  it  has  hitherto  received.  Further- 
more, the  open  effrontery  with  which  names  of 
certain  medical  men  of  repute  are  used  to  boom 
and  puff  these  wares  is  a  disgrace  to  the  profession, 
and  must  be  a  cause  of  embarrassment  and  great 
annoyance  to  those  whose  names  are  thus  so  ruth- 
lessly sent  broadcast  to  the  public. 


PROGNOSIS  IN  HEART  DISEASE. 
The  Address  by  Dr.  Barr,  of  Liverpool,  on 
"  Prognosis  in  Heart  Disease,"  which  we  published 
in  our  last  two  numbers,  will,  we  feel  sure,  have 
been  read  with  the  greatest  interest.  The  problem 
that  the  Address  deals  with  is  one  that  faces  the 
practitioner  at  every  turn,  and  its  interest  is  only 
equalled  by  its  complexity.  There  must  always 
be  certain  elements  wanting  in  the  basis  of  all 
human  prognostications,  and  one  is  often  tempted 
to  think  that  because  predictions  are  so  often 
falsified  in  the  event,  that  it  is  impossible  ever  to 
forecast  with  any  degree  of  accuracy.  This, 
however,  is  not  so,  if  primary  factors  that  go  to 
make  up  a  sound  prognosis  are  in  one's  possession; 
and  in  medicine,  if  the  diagnosis  is  well  made,  and 
the  concurrent  circumstances  are  carefully  taken 
into  account,  our  knowledge  of  the  natural  course 
of  diseases  will  enable  us  often  to  form  a  pretty 
shrewd  estimate  as  to  the  line  likely  to  be  pursued 


by  a  particular  case.  But  without  accurate 
diagnosis  all  prophecy  as  to  the  future  is  mere 
guess-work.  For  this  reason  Dr.  Barr  rightly  laid 
emphasis  on  the  importance  of  examining  the 
heart  as  opposed  to  merely  auscultating  it,  and 
weighty  and  sententious  are  his  words,  "  I  hold 
that  the  man  who  cannot  diagnose  any  cardiac 
lesion  independently  of  the  existence  or  non- 
existence of  a  murmur  has  only  half  learnt  his 
work."  It  is  said  of  that  great  clinician,  Sir 
William  Jenner,  that  the  deafness  which  in  later 
life  prevented  him  using  his  stethoscope  to  prac- 
tical advantage  never  hampered  his  wonderful 
acumen  in  the  diagnosis  of  cardiac  affections.  la 
speaking  of  co-existent  mitral  stenosis  and  regurgi- 
tation, Dr.  Barr  points  out  that  in  many  such 
instances  the  auricle  is  so  much  dilated  that  the 
auricular  systolic  murmur  is  not  produced,  and 
the  ventricular  systolic  murmur  alone  is  heard. 
Thus  the  one-sided  auscultator  regards  the  case  as 
one  of  mitral  regurgitation  alone,  and  is  thus 
inclined  either  to  take  too  favourable  a  view  of  the 
patient's  future,  or  to  attribute  a  graver  signifi- 
cance to  pure  mitral  stenosis  than  is  justified  by 
the  facts.  Proper  regard  to  all  the  contributory 
circumstances,  then,  is  due  from  the  discriminating 
physician,  and  we  venture  to  think  that  a  food 
deal  of  the  discredit  that  has  been  thrown  on 
medical  selection  for  life  assurance  has  been  in- 
curred by  hasty  diagnoses  founded  on  the  hearing 
of  a  murmur.  The  life  offices  often  complain  that 
the  examiner  turns  away  a  great  many  lives  which 
are  quite  assurable,  and  no  doubt  there  are  many 
cases  of  organic  heart  disease  whose  risk  is  assess- 
able that  are  often  declined  altogether.  In 
fact,  in  no  small  proportion  of  sufferers  from  un- 
complicated mitral  regurgitation,  in  whom  there 
are  no  secondary  effects,  a  very  moderate  extra 
sum  alone  is  called  for  on  a  limited  term  policy. 
Thus  Dr.  Barr  recalls  the  case  of  a  fellow-student 
of  his  who  was  afflicted  with  mitral  regurgitation 
early  in  life,  and  yet  has  borne  it  with  equanimity 
during  thirty  years  of  active  practice.  Few 
medical  men  cannot  produce  parallel  cases  from 
their  own  experience.  Mitral  stenosis  is  a  far 
more  serious  affection,  and  yet  a  patient  who 
develops  it  after  puberty  may  have  forty  or 
fifty  years  of  fairly  good  health  before  him.  It 
is  not,  indeed,  the  physical  signs  of  the  lesion 
itself  that  give  the  clue  to  the  after-history  of  the 
patient,  but  the  collateral  symptoms  and  the 
previous  record.  Aortic  stenosis,  the  result  of 
slight  thickening  or  roughening  of  the  cusps  by 
rheumatic  endocarditis,  has  of  all  forms  of  heart 
disease  the  most  hopeful  outlook  ;  but  aortic 
stenosis  due  to  atheroma  of  the  valves,  associated 
with  calcareous  changes  in  the  aorta,  gives  warning 
of  a  rapidly  fatal  issue.  Most  physicians  will 
agree  with  Dr.  Barr  that  aortic  incompetence  is 
the  most  serious  of  the  valvular  lesions  of  the  heart, 
and  it  is  surprising  to  read  that  the  writer,  Rosen- 
stein,  in  Ziemssen's  "  Cyclopaedia,"  should  have 
expressed  such  an  opinion  as  that  "  the  prognssis 
as  regards  the  length  of  life  and  activity  of  the 
patient  is  more  favourable  in  aortic  insufticiency 


MAJICg   2,    19Q4* 


NOTES  ON  CURRENT  TOPICS.        The  Medical  Fmsss.     241 


than  in  any  other  valvular  disease."  No  doubt 
individual  cases  of  unexpected  longevity  in  sub- 
jects of  aortic  regurgitation  are  noted  from  lime 
to  time,  as  in  Dr,  Barr's  patient,  who  led  an  active 
life  for  thirty -five  years  ;  but  in  this  country,  at 
least,  they  are  relatively  few  and  far  between. 
On  the  other  hand,  we  read  with  surprise  the 
optimistic  view  taken  by  Dr.  Barr  with  regard  to 
the  outlook  in  chronic  myocarditis  and  fatty 
degeneration.  Dr.  Barr  is  probably  correct  in 
thinking  that  the  right  ventricle  is  more  often 
affected  by  these  lesions  than  is  usually  supposed, 
bat  it  surely  is  unusual  for  a  degeneration  affecting 
50  vital  a  structure  as  the  right  cardiac  wall  to  run 
so  chronic  a  course  that  the  patient  is  able  to  enjoy 
tairty  good  health  for  many  years.  We  ourselves 
iave  always  felt  that  fatty  degeneration  of  the 
heart  was  the  first  nail  in  the  coffin,  and  that  it 
would  not  be  long  before  the  rest  were  needed. 
Patchy  degenerations  are  not  always  of  great 
moment,  especially  such  as  occur  as  the  result  of 
acute  myocarditis,  but  the  senile  progressive  fatty 
changes  must  be  considered  of  very  grave  omen. 
The  key 3  wc  take  it,  of  Dr.  Barr's  thoughtful  and 
instructive  address  is  to  be  found  in  the  words, 

*  Cardiac  hypertrophy  and  dilatation,  from  what- 
ever cause  arising,  are  sure  to  be  followed  by 
degeneration,  and  the  greater  the  hypertrophy  the 
earlier  does  failure  take  place.'*  The  true  esti- 
mate of  the  effect  of  a  valvular  obstruction  or  leak 
is  to  be  found,  first,  in  the  effects  produced  on 
the  cardiac  structures  themselves,  and,  secondly, 
on  those  of  the  other  tissues  and  organs.  Dilata* 
tif .ri  of  the  heart  rapidly  disorganises  the  circu- 
latory apparatus,  unless  it  be  succeeded  either  by 
recovery  or  by  hypertrophy  ■  and  hypertrophy 
itself  is  evidence  of  chronic  embarrassment.  The 
greater  the  embarrassment,  the  greater  the  hyper* 

•  rophy,  and  hypertrophy  is  a  process  that  can  only 
act  within  strictly  definite  limits.  The  breakdown 
cumes  when  those  limits  are  over-stepped. 


"ttotes  on  Current  Uoplce* 

*  Dr.  Jim." 

The  result  of  the  recent  Cape  elections  has  led 
lo  another  kaleidoscopic  change  in  I  he  career  of 
this  extraordinary  man.  Dr.  Jameson  now  finds 
himself  Prime  Minister  of  Cape  Colony  and  the 
chief  adviser  of  His  Majesty's  representative  in 
that  turbulent  State,  Dr.  Jameson's  career  alone 
would  give  the  lie  to  the  statement  often  made 
the  days  of  romance  are  over,  for  surely  no 

enson  or  Henty  out  of  his  fertile  imagination 

Ld  have  evolved  a  creation  more  daringly  at 

variance    with     the    probabilities     of    e  very-day 

espcrieuce.     Captain  Kettle's  vagaries  are  not  a 

whit  more  startling  than  the  new  PrimejM  mister's 

—a  promising  medical  student,  an  ad- 
mirable resident  officer,  a  successful  operating 
surgeon,  the  conqueror  of  a  savage  country,  a 
capable  Colonial  administrator,  a  Commander  of 

Math,  the  leader  of  a  troop  of  raiders,  a  felon 
condemned  to  death,  a  prisoner  in  the  dock  before 

<  wn  countrymen,  a  convict  for  years,  near  the 
point  of  death  after  a  surgical  operation,  shut  up 


during  a  prolonged  siege,  comforting  the  last  days 
of  his  great  friend,  an  active  Parliamentarian,  a 
Prime  Minister,  Can  such  a  record  as  this  be 
matched  from  the  annals  of  oui  profession  since 
the  days  of  Dover,  the  old  pirate  who  reformed  his 
ways,  practised  as  a  physician,  and  invented  pulv. 
ipecac,  co.  ?  The  name  of  Jameson  has  stunk  in 
the  nostrils  of  a  large  section  of  his  fellow-country- 
men since  his  daring,  unauthorised  enterprise,  but 
it  says  volumes  for  the  respect  inspired  by  his 
personality  that  he  should  have  come  out  of  penal 
servitude  to  be  the  leader  of  a  great  and  patriotic- 
party  in  the  very  Colony  which  felt  the  effects  of  the 
raid  most  severely.  All  people  who  have  come  in 
contact  with  him  are  agreed  on  one  point— that 
he  is  possessed  of  a  peculiarly  lovable  disposition. 
He  has  no  personal  enemies,  even  though  he  has 
many  bitter  political  opponents.  No  one  will  deny 
the  honesty  of  his  convictions  and  intensity  of  his 
devotion  to  what  he  believes  to  be  his  duly,  though 
it  is  universally  admitted  that  the  Raid,  planned 
and  executed  as  it  was,  was  a  hideous  blunder. 
In  spite  of  his  fantastical  career,  Dr,  Jameson  is  no 
adventurer,  but  a  strong-minded  man  of  great 
determination,  and  some  people  still  feel  regret 
that  he  should  have  abandoned  surgery,  of  which 
he  was  one  of  the  foremost  exponents  in  South 
Africa,  for  the  political  arena.  There  is  one  other 
medical  Prime  Minister  of  the  present  day,  M, 
Combes,  but  of  him  it  cannot  be  said  that  he  was- 
instrumental  in  saving  the  life  of  his  keenest  oppo- 
nent. It  is  an  open  secret,  however,  that  Dr. 
Jameson  was  able  to  render  such  service  lo  Presi- 
dent Kruger. 


The  Eating*  of  Rate  and  Mice 

The  peculiar  habits  of  the  N  Heathen  Chinee  " 
are  at  the  present  moment  very  much  to  the  front 
in  journalism.  The  point  which  appears  to  appeal 
most  strongly  to  the  ephemeral  scribe  as  salient 
to  his  pungent  pen  is  the  matter  of  food.  Accord- 
ing to  him,  the  average  Chinaman  feasts  on  rotten 
eggs,  decayed  shark,  and  birds*  nests,  after  which 
he  retires  to  sleep  heavily  after  a  few  pipes  of 
opium,  the  while  he  dreams  of  further  delights  in 
the  shape  of  droves  of  rats  and  mice.  As  a  matter 
of  fact  delicate  cates  of  that  kind  would  be  1  u 
beyond  the  command  of  the  Chinese  coolie,  who 
is  one  of  the  poorest  men  on  the  face  of  the  globe. 
But  why  should  the  Western  journalist,  full  of  the 
superior  pride  of  his  new-born  civilisation,  con- 
demn John  Chinaman  because  he  eats  rats  ?  Has- 
not  perchance  the  Eastern  wisdom,  hoary  and 
ripened  with  a  millennium  of  years,  hit  upon  a 
perfectly  savoury  and  sound  source  of  sustenance 
in'  the  common  rat  ?  In  other  words,  why  do  the 
inhabitants  of  the  New  World  not  eat  rats  ? 
During  the  siege  of  Paris  the  citizens  paid  high 
prices  for  rats  as  well  as  for  dogs,  cats,  and  any 
other  town  mammal.  Perchance  it  was  a  similar 
stimulus  of  chronic  hunger  that  first  led  the  Chinese 
to  take  to  rats  and  mice  as  staple  articles  of  diet. 
Apart  from  prejudice  there  is  no  particular  reason 
why  we  should  not  feed  on  our  domestic  rodents. 
Their     flesh     is     delicate     and     savoury.      The 


242    The  Medical  Press. 


NOTES  OH  CURRENT  TOPICS. 


March  z,  tqa*. 


-possible  objection  that  rats  have  recently  been 
shown  to  be  powerful  agents  in  the  distribution  of 
the  germs  of  plague  and  of  other  disease  need  not 
•disturb  the  philosophic  gourmand,  for  precisely  the 
same  observation  applies  to  the  flesh  of  all  edible 
warm-blooded  animals,  and  possibly  or  probably 
to  some  of  the  cold-blooded  creatures  as  well. 
Thorough  cooking,  however,  would  sterilise  the 
flesh  of  the  rat  as  it  undoubtedly  does  that  of  other 
animal  food.  Is  it  not  possible  that  the  patient 
intellectual  prescience  of  the  most  ancient  civilisa- 
tion of  the  world  has  long  ago  solved  these  little 
problems  as  regards  the  eating  of  the  rat,  while 
we  in  the  West  are  clinging  to  prejudices  that  it 
would  be  impossible  to  support  with  any  degree  of 
scientific  candour  ? 


Popular  Views  of  Cancer. 

The  position  of  the  medical  profession  with 
regard  to  cancer  is  very  much  to  the  front  in 
•everyday  journalism.  Every  fresh  scientific  move 
is  instantly  unearthed  from  the  medical  journals 
and  noised  abroad  through  the  length  and  breadth 
of  the  land,  in  many  cases  much  to  the  discomfiture 
of  the  investigator,  whose  one  aim  is  to  avoid  that 
kind  of  notoriety.  There  seems  to  be  little  chance, 
however,  of  arresting  the  modern  curiosity  of  the 
man  in  the  street  with  regard  to  the  curability  of 
his  bodily  ailments,  especially  of  those  that  have 
hitherto  been  of  a  peculiarly  deadly  nature.  It 
is  quite  understandable  that  the  causation  and  the 
possible  cure  of  cancer  should  exercise  the  greatest 
fascination  over  his  mind,  distracted  as  it  has  been 
in  times  past  by  many  a  grim  tragedy,  to  which  he 
himself  may  one  day  be  similarly  a  victim.  But 
the  restlessness  of  the  public  imagination  is  not 
•confined  to  the  scientific  aspects  of  the  question. 
The  correspondence  columns  of  many  newspapers 
are  simply  flooded  with  "  cures  "  and  theories  of 
causation  of  cancer.  An  amusing  instance  of  the 
kind  appeared  last  week  in  a  leading  London 
journal,  where  a  lay  correspondent  mentioned  the 
case  of  a  man  who  suffered  from  cancer  of  the  lower 
intestine  and  fasted  for  four  weeks.  "  It  was  the 
cancer  that  died."  This  sapient  gentleman  then 
sums  up  his  views  as  follows  : — "  When  the  natural 
processes  of  life  can  go  on,  and  except  when  a 
patient  has  been  exhausted  by  operations,  a  cure 
may  be  effected  by  a  spare  diet  of  meal,  fresh  and 
ripe  fruits,  salads  (uncooked),  with  an  abundance 
of  pure  air  night  and  day,  a  perfectly  clean  skin, 
and  total  abstinence  from  animal  food.  This 
remedy  is  of  course,  beneath  the  notice  of  the 
Cancer  Research  Society.  They  have  given  up 
radium,  their  latest  and  most  absurd  proposal, 
and  are  still  looking  through  their  microscopes, 
vivisecting  animals,  and  spending  the  brewers' 
money."  The  writer  does  not  date  his  letter,  as 
might  have  been  anticipated,  from  a  lunatic 
asylum.  It  is  to  be  feared  he  represents  a  large 
number  of  well-meaning  but  intellectually  untrained 
persons  who  form  the  prey  of  the  quack  cancer 
^urer.  Meanwhile,  it  is  reassuring  to  note  that 
there  is  every  prospect  of  radium  securing  a  recog- 
nised position  in  the  treatment  of  cancerous 
growths. 


A  German  Quaok  in  Court. 
As  regards  quacks  and  quack  medicines  it  is 
tolerably  safe  to  conclude  that  they  manage  these 
things  better  in  Germany.  The  law  demands,  for 
instance,  that  the  composition  of  every  patent 
medicine  should  be  fully  stated  on  the  label  of  the 
containing  bottle,  jar,  or  other  package.  In  that 
way  the  reflective  Teuton  has  at  least  the  oppor- 
tunity of  learning  what  drugs  he  is  taking  into  his 
internal  economy.  Quack  practitioners  are  dealt 
with  by  summary  police  methods.  A  laughable 
case  is  still  occupying  the  Berlin  courts,  where  a 
notorious  quack  doctor  of  Tilsit,  Richard  Schroeter 
by  name,  has  been  placed  upon  his  trial.  The 
quality  of  his  methods  may  be  gauged  from  the 
statement  that  he  practised  heaUng  mainly  by 
prayer.  One  case  was  adduced  in  which  a  young 
girl  was  made  to  pray  that  a  certain  coachman 
who  had  swallowed  a  thaler  (about  three  shillings 
should  eject  it  in  small  change  so  as  to  avoid 
choking.  Schroeter  was  called  upon  to  demon- 
strate his  powers  of  diagnosis  on  patients  brought 
into  open  court.  Put  to  this  test  he  missed  well- 
marked  lung  diseases.  When  told  the  patient  also 
had  an  ulcer  on  one  leg  he  replied  that  he  had  seen 
unmistakable  symptoms  of  ulcer  imprinted  on 
the  eye  of  the  patient.  In  answer  to  a  question 
from  the  judge  he  promptly  referred  the  ulcer  to 
the  wrong  leg.  All  this  sounds  like  a  scene  from 
comic  opera.  The  British  public,  however,  before 
they  laugh  might  do  well  to  practise  a  little  heart- 
searching  as  to  the  Eddys  and  the  Dowies  and 
the  Viavis,  and  the  quack  curers  of  cancer,  deaf- 
ness, nerve  disorders,  and  every  other  malady 
that  flesh  is  heir  to,  all  and  every  one  of  whom 
flourish  on  the  credulity  of  their  victims.  Under 
the  protection  of  a  three-halfpenny  stamp  the 
Government  sanctions  the  sale  of  poisonous  drugs 
that  the  chemist  would  not  be  empowered  to  sell 
separately.  The  average  Briton,  however,  swallows 
them  all  without  knowledge  and  without  reflection. 
Why  should  not  Government  forgo  the  patent 
medicine  tax,  which  brings  in  a  comparatively 
trifling  sum  ?  Or,  failing  that,  why  should  they 
not  take  a  leaf  out  of  the  German  book,  and  insist 
on  the  publication  of  the  ingredients  of  even' 
patent  medicine  ? 


The  Training  of  Soldiers'  Sight. 

The  Army  Medical  Service  is  waking  up,  or, 
perhaps,  it  would  be  more  generous  to  say  that  the 
authorities  are  beginning  to  realise  the  vital  im- 
portance of  that  branch  of  the  Service,  and  the 
necessity  of  encouraging  its  scientific  develop- 
ment. Upon  the  statement  of  the  Times  we 
learn  that  steps  are  being  taken  to  introduce  more 
generally  into  the  Army  a  system  of  training  for 
increasing  the  visual  powers  of  soldiers  and  further 
developing  their  powers  of  observation  in  the  field, 
which  has  already  been  tried  under  Field  Marshal 
Sir  Evelyn  Wood,  V.C.,  in  the  2nd  Army  Corps. 
The  purposes  of  the  training  now  proposed  are 
stated  to  be — To  improve  the  soldiers'  vision  and 
develop  his  quickness  of  perception  so  that  he  may, 
under  ordinary  conditions,  find  his  way  about  and 
locate    an    enemy    without    his   presence  being 


March  2,  1904* 


NOTES    ON    CURRENT    TOPICS,       The  Medical  Fuess.    2#3 


disclosed.  To  trainthe  soldier  so  that  he  may  acquire 
an  eye  for  country  which  will  enable  him  to  report 


appreciable  factor— freshness.     The    invigorative 
and  tonic  effect  of  the    air   of  one  place  and  the 


accurately  what  he  has  observed,  and  instinctively  depressing,  enervating  influence  of  another  may 
to  select  the  position  which  wilt  afford  the  best  1  be  obvious  to  everyone,  and  yet  chemically  and 
cow  and  best  field  of  fire  and  the  most  suitable  ]  physically  the  two  airs  may  be  indistinguishable, 
lines  of  advance  and  ret reat .  To  enable  hi m ,  wh e n 
fried  upon  from  an  unknown  quarter,  to  judge  the 


Probably  one  of  the  reasons  why    plenum  and 

vacuum  systems  both  fail  to  convey  this  quality 

most  likely   position   which    an   enemy   may    br-    oi    sreshness  in   the  air   they  supply  is   that   the 


occupying,  and  to  teach  him  how  to  counteract 
the  ordinary  ruses  and  stratagems  employed  by  an 
enterprising  enemy  in  war.  The  improvement  of 
the  soldier's  sight  and  powers  oi  observation,  it  is 
suggested,  can  only  be  effected  upon  a  system 
to  that  of  the  training  he  receives  at  school 
at  the  gymnasium.  The  instruction  should  be 
individual  and  progressive,  proceeding  gradually 
tram  the  training  of  the  group  or  section  by  its 
leader  to  the  higher  training  oi  the  squadron, 
battery,  or  company  by  its  commander. 

Ventilation  for  Public  Buildings. 

The  inquiry  into  the  best  method  of  ventilating 
the  House  of  Commons  made  by  tlie  Select  Com- 
mittee appointed  last  year  brought  to  lightsome 

hi  cresting  facts  and  views.  The  House  of  Com- 
mons system  of  ventilation,  which  was  designed 
by  the  late  Dr,  Reid,  has  often  been  held  up  in  the 
past  as  a  model  of  what  such  a  system  should  be, 
and  theoretically  it  was  as  perfect  as  it  was 
mechanically  ingenious.  Yet  the  members  were 
continually  complaining  oi  alternate  draughts  and 
stuffiness.  More  significant  than  either  of  these 
was  the  general  experience  that  even  when   the 

m  was  working  without  a  hitch  a  feeling  of 
languor  and  oppression  was  felt  by  members  sitting 
in  the  House.  The  Select  Committee  had  before 
them  a  large  number  of  architects,  professors,  and 
other  experts,  and  their  evidence  is  very  instructive 
as  applying  to  ihe  value  of  mechanical  systems  of 
ventilation.     The   rules  laid  down   in   text-books 

vgiene  with  regard  to  ventilation  are  very- 
precise,  and  seem  to  leave  no  doubt  as  to  how  they 
should  be  ad j  u s  t ed  t  o  c  ire  u ms  t  an  ces .  The  s  t  andard 
usually,  taken  is  that  set  by  the  proportion  of 
carbonic  acid  gas  in  the  air  of  the  room,  and  this  we 


velocity  and  composition  of  the  air  is  uniform,  and 
the  stimulus  that  currents  of  varying  in  tensities 
produce  is  lacking.  The  place  of  the  open  window 
has  not  yet  been  taken  by  any  mechanical  arrange- 
ment for  supplying  air,  and  it  does  not  seem  likely 
that  it  will  in  the  near  future.  One  can  hardly 
imagine  Duncan  saying  of  the  air  of  any  of  our 
mechanically-ventilated  buildings  that  it  "  nimbly 
and  sweetlv  recommended  itself  unto  his  senses/* 


Plucky  Rescue  by  Medical  Men. 
The  saving  of  life  is,  of  course,  one  of  the  essential 
and  central  motives  for  which  the  medical  pro- 
fession has  been  called  into  existence.  Indeed, 
it  has  become  so  much  a  part  of  the  professional 
career  that  the  average  medical  practitioner  accepts 
as  a  matter  of  course  the  fact  that  he  has  saved  a 
patient  from  imminent  death  by  the  exercise  oi 
his  skill  and  experience.  At  times  it  is  given  t<> 
medical  men  to  save  life  in  the  ordinary  civilian 
way,  that  is,  by  physical  daring  and  presence  ol 
mind.  In  that  way  two  members  of  the  medical 
profession,  we  are  pleased  to  place  on  record, 
recently  distinguished  themselves  in  Carnarvon 
Harbour.  Drs,  1\  W,  Clay  and  R,  T.  Ellis  were 
walking  together  late  at  night  when  they  heard 
a  shout,  and  proceeding  in  that  direction  they  met 
with  an  adventure  which  is  thus  described  in  the 
Carnarvon  Herald  of  February  19th.  "As  they 
approached  the  Beach  Yard,  someone  in  the  dis- 
tance shouted  for  help,  and  both  ran  down  to  the 
end  of  the  Mackenzie  Pier.  There  they  saw  a 
boat  with  a  rope  attaching  it  to  the  railings.  The 
night  was  very  dark,  and  the  tide  low,  so  that  it 
was  impossible  to  see  anything.  They  pulled  the 
rope,  and  clutching  to  it  they  found  a  man,  who 
was  gradually  slipping  into  the  water.  One  of  the 
have  always  been  told  should  not  exceed  o+6  per  doctors  leaned  forward— the  otherone  taking  hold  of 
I  .ooo  by  volume.     Therefore ,  as  fresh  air  contains   him,  so  that  he  could  keep  his  balance— and  grasped 


*4  cubic  feet  of  carbonic  acid  gas  per  1,000,  and  as 

man  gives  off  o+6  cubic  feet  per  hour,  the  quantity 

ah  air  needed  per  man  per  hour  is  3,000  cubic 

leet.    But  this  calculation  only  touches  the  fringe 


the  man.  Slowly  they  dragged  him  from  his 
dangerous  position.  By  this  time  the  man  was 
unconscious,  and  the  two  doctors,  with  considerable 
difficulty,  carried  him  up  the  pier,  and  applied 


of  the  question.     There  are  two  other  factors  that   artificial  respiration  until  he  regained  consciousness. 

are  at  least  equaUy  important.   One  oi  these  is  the  |  They  next  called  for  help,  but,  none  forthcoming, 

quantity  of  organic  matter  in  the  air,  and  the  they  carried  him  into  the  Sailors'  Home,  where  he 
r  the  number  and  quality  of  the  micro-organ-   received  every  attention.'*     It  will  be  seen  from 

tim  r  vanes  in  its  qualities  enormously  ;   the  foregoing  narrative  that  both  gentlemen  in- 

curred great  personal  risk,  which,  in  our  opinion, 
deserves  recognition  not  only  from  the  Humane 
Society,  but  from  the  hands  of  Royalty  itself. 

British  Medical  Association  and  Medical 
Defence. 

Since  the  British  Medical  Association  under- 
went a  radical  change  in  its  constitution  a  year 
or  two  ago,  it  has  shown  marked  signs  of  vitality 


and  the  air  of  Manchester  during  a  fog,  one  of  which 

deposited  rive  tons  of  solid  matter  in  three  days 

years  ago,  is  hardly  likely  to  have  the  same 

rativc   effect   on   the   breather  as  an    equal 

mi.-intily  of  air  inhaled  from  the  top  of  Mont  Blanc. 

But  let  the  mechanically  driven  air  be  as  pure  as 

be,  tt   iree  from  bacteria  and  as  tree  from 

organic  matter   as   filtration   can    make   it,  there 

always  remains  &  want  of  that  indefinable  but  well 


344    The  Medical  Press.       NOTES    ON    CURRENT    TOPICS. 


in  various  directions  which  had  been  untried 
previously.  There  is  a  tendency  to  stretch  the 
extent  of  its  activity  beyond  purely  scientific 
work,  and  to  make  the  Association  representative 
of  the  entire  profession  wherever  unity  of  action 
is  possible.  From  time  to  time  we  have  com- 
mented on  various  proposals  put  forward  in  or 
by  the  Association,  and  though  we  have  not 
approved  of  all  of  them,  yet  we  think  that  the 
increased  initiative  shown  by  the  branches,  and 
the  increased  interest  in  professional  matters 
shown  by  the  Council  are  healthy  signs  of  the 
intellectual  activity  of  the  profession  as  a  whole. 
The  latest  scheme  sent  down  to  the  Divisions  for 
discussion  is  in  reference  to  the  Association 
undertaking,  in  addition  to  its  work  in  other 
directions,  the  duties  and  responsibilities  of  medical 
defence.  The  suggestion  is  that  the  Medical 
Defence  Union,  the  London  and  Counties  Medical 
Protection  Society,  and  other  like  bodies  should 
be  invited  to  merge  themselves  in  the  British 
Medical  Association  so  as  to  form  one  organisation 
for  medical  defence.  In  its  finances  the  new 
department  would  be  entirely  independent  of 
the  Association,  and  members  who  wish  to  share 
the  benefits  of  medical  defence  would  pay  a 
special  subscription  for  the  privilege.  An  obvious 
advantage  of  such  a  scheme  is,  that  one  thoroughly 
representative  body  would  take  the  place  of  several 
minor  organisations,  and  the  unpleasant  spectacle 
would  be  abolished  of  two  defence  societies 
taking  up  cudgels  on  opposite  sides  of  the  same 
case.  We  think,  too,  that  the  British  Medical 
Association  is  the  only  existing  body  strong 
enough  to  assume  such  a  position.  The  matter 
is  one  of  great  importance,  and  we  are  sure  will 
receive  the  deliberation  it  deserves  at  the  hands 
of  the  Divisions. 


The  Lungs  of  London. 
It  is  difficult  to  conceive  what  the  vast  Metro- 
polis would  be  like  were  the  numerous  open  spaces, 
large  and  small,  with  which  it  is  happily  dotted, 
to  be  swept  away  and  their  places  occupied  by 
grim  structures  of  bricks  and  mortar.  To  the 
hygienic  enthusiast  the  idea  is  repulsive,  in  the 
harmony  which  should  exist  in  the  aesthetic  re- 
lationships of  art  and  Nature  it  strikes  a  discordant 
note,  while  to  the  many  thousands  of  weary  and 
jaded  toilers  of  the  great  city  it  would  mean,  if 
carried  into  effect,  a  deprivation  of  much  that  is 
beautiful  and  a  distinct  danger  to  health.  Yet 
such  is  the  greed  for  gain  exhibited  by  certain 
speculative  builders  and  landowners  that  some 
of  our  most  picturesque  square  gardens,  several  of 
which  possess  historic  associations,  would  be 
sacrificed  in  this  fashion  to-morrow  if  only  the 
necessary  legal  building  rights  could  be  obtained. 
One  such  garden  in  Kensington,  three  acres  in 
extent,  has  been  sold  for  this  purpose,  and  so  it  is 
that  here  a  little  and  there  a  little  these  precious 
air-spaces,  which  have  been  termed  appropriately 
"  London's  lungs,"  become  consolidated  by  an 
exudation  of  building  materials.  The  value  of 
♦hese  areas  as  estates  is  enormous,  and  it  is  this 


March  2.  1904. 


fact  which  lures  on  those  by  whom  the  health  of 
city-dwellers  is  seldom  mentioned,  except  with  a 
contemptuous  snap  of  the  finger,  to  acquire  for 
themselves  the  right  of  increasing  still  further  the 
already  over-congested  state  of  the  Metropolis. 
The  London  County  Council  has,  in  many  in- 
stances, done  good  work  in  rescuing  some  of  our 
open  spaces  from  immolation  upon  the  building- 
altar,  but  it  obviously  cannot  buy  up  all  the 
squares  in  every  part  of  London.  Apart  from 
mere  sentimental  considerations,  the  subject  is  one 
which  is  to  be  earnestly  commended  to  the  notice 
of  legislators,  and  it  is  to  be  hoped  that  the  present 
Bill  which  is  before  the  House  of  Lords  may 
receive  sufficient  support  to  strengthen  the  hands 
of  the  Council  in  securing  protection  for  citizens 
in  this  matter. 


A  Small-pox  Hospital  Action. 
The  not  unnatural  objection  of  the  inhabitants 
of  a  locality  to  have  a  small-pox  hospital  planted 
in  their  midst  fortunately  does  not  often  end  in 
legal  complications.  Last  week,  however,  the 
Nottingham  Corporation  appeared  in  the  Chancery 
Division  of  the  High  Court  of  Justice  to  oppose  an 
application  for  an  injunction  to  restrain  them  from 
erecting  a  small-pox  hospital  in  Bulwell  Forest. 
The  usual  contention  as  to  the  conveyance  of 
infection  by  aerial  infection  from  such  a  hospital 
to  the  surrounding  neighbourhood  was  emphatically 
advanced.  Mr.  Justice  Farwell  gave  judgment 
with  costs  in  favour  of  the  Corporation.  Having 
regard  to  the  necessities  of  the  case,  as  when 
persons  attacked  with  the  disease  lived  in  one  or 
two  tenement  rooms,  he  held  that  if  the  fact  of 
public  nuisance  were  established  it  would  be  no 
answer  to  private  owners  of  houses  who  objected 
to  say  that  the  hospital  would  have  to  be  placed 
elsewhere.  When  the  question  was  whether  the 
nuisance  in  fact  existed  or  not,  all  the  circumstances 
should  be  taken  into  consideration.  In  the  present 
case  he  found  that  the  result  of  the  evidence  was 
that  the  site  of  the  present  hospital  was  carefully 
chosen,  and  it  had  not  constituted  any  danger 
to  public  health  or  to  the  plaintiffs'  property. 
His  lordship  held  it  was  no  part  of  the  functions  of 
the  Court  to  decide  in  what  way  the  disease  would 
be  picked  up.  The  importance  of  this  judgment  is 
crucial  to  the  future  of  infectious  hospitals.  From 
a  common-sense  point  of  view  such  institutions 
must  exist  somewhere.  The  Nottingham  case 
will  apparently  be  carried  to  the  Lords  for 
further  and  final  settlement. 


The  Science  Schools  at  Cambridge. 

It  is  certainly  interesting  to  note  how  the  Uni- 
versity of  Cambridge  has  changed  during  the  past 
thirty  or  forty  years  in  the  attention  it  has  given  to 
the  development  of  Science  in  its  system  of  educa- 
tion. Classics  and  mathematics  were  alone  recog- 
nised as  deserving  any  help  or  encouragement, 
less  than  fifty  years  ago.  [Science  was  a  some- 
thing that  both  these  regarded  with  suspicion  or 
contempt.  Gradually  ^things  changed.  The 
influence  of  such  men  as  Gabriel  Stokes,  Lord 


March  2t   1904. 


PERSONAL. 


The  Medical  Peeks,     245 


Kelvin,  Sedgwick,  Henslow*  Humphry,  and  their 
successors  made  itself  felt,  and  now  the  Natural 
Science  Tripos  has  grown,  and  grown  from  half  a 
doj&n  entries  or  so  to  be  the  most  important 
tripos  in  the  University.  The  Medical  School 
ntty  years  ago  had  three  or  four  students,  indeed, 
in  one  year  there  was  only  one,  to  attend  the  lec- 
tures on  materia  me  die  a  or  comparative  anatomy. 
It  was  really  to  the  attractions  which  physical 
science  had  for  such  men  as  Stokes  and  Thompson 
I  jird  Kelvin)  that  the  changes  at  Cambridge  are 
v  to  be  traced*  There  is  no  doubt  that 
the  Medical  School  has  followed,  as  the 
outcome  of  good  tuition  in  the  sciences  of 
chemistry,  botany,  and  physics  has  always  been 
.  aised  in  the  preparation  of  medical  students, 
and  the  advantages  of  good  preliminary  education, 
which  could  not  be  obtained  at  school,  or  at  hospi- 
tal, were  appreciated  by  those  who  wished  their 
50ns  to  be  trained  on  the  highest  lines  for  the  work 
of  the  profession  they  were  going  to  devote  them- 
selves to,  In  the  teaching  of  every  department 
of  science  it  is  necessary  to  organise  a  system 
different  from  that  suitable  for  the  study  of 
mathematics  or  classics.  In  the  branches  of 
science  it  is  bv  experiment,  by  demonstration, 
and  by  something  far  more  than  can  be  learnt 
books  that  knowledge  is  to  be  acquired  ; 
and  we  hope  that  every  support  will  now  be- 
to  the  promotion  of  science  teaching  at 
University  of  Cambridge,  and  that  the  work 
□  carried  on  there  may  be  fully  consistent 
with  the  character  of  the  important  buildings 
I  by  HM.  the  King  this  week, 


thin-walled  capillaries  in  this  region*  In  other 
varieties  of  generalised  cutaneous  eruptions, 
especially  when  characterised  by  vascular  dis- 
turbances or  inflammatory  changes J  the  lower 
extremities  are  found  principally  affected,  and 
upon  them  the  malady  lingers  the  longest.  The 
vertical  position,  no  doubt,  interferes  somewhat 
with  the  equilibrium  of  the  circulation,  but,  con- 
sidering the  confusion  which  already  exists  be- 
tween the  various  forms  of  purpura,  it  would  be 
inadvisable  to  employ  a  term  which  simply  signi- 
fies one  of  the  modes  of  its  production  as  an 
appellation  which  would  appear  to  indicate  a 
special  variety  of  the  disease  . 


Postural  Haemorrhages* 
tr  For  the  privilege  of  assuming  the  erect  position, 
man  has  had  to  pay  the  penal  ty  of  a  special  liability 
irions  circulatory  and  other  disturbances 
arising  as  a  direct  consequence  therefrom.  The 
term  M  orthostatic/*  as  applied  to  different  morbid 
processes,  serves  to  emphasise  the  influence  of 
posture  in  the  production  or  aggravation  of  disease, 
It  has  lately  been  shown  that  albuminuria  of  the 
cvdical  or  physiological  type  is  affected  con- 
siderably by  changes  in  position.  The  common - 
sense  mode  of  treatment  in  almost  all  forms  of 
external  haemorrhage  is  the  immediate  assumption 
oi  the  horizontal  position,  whereby  the  heart's 
force  is  lessened.  At  a  recent  meeting  of  the 
Societe  Medicate  des  Hopitaux,  MM,  Achard  and 
Grenet  reported  the  case  of  a  tuberculous  patient 
in  whom  symmetrical  purpura  appeared  upon  the 
lower  extremities,  which  disappeared  after  some 
hours*  rest  in  bed,  but  reappeared  on  getting  up. 
To  this  internal  hemorrhagic  eruption  they  have 
given  the  name  of  orthostatic  purpura.  As  was 
pointed  out  by  M.  Apert,  this  feature  is  not  un- 
trequently  seen  in  many  forms  of  purpuric  rashes. 
The  distance  of  the  blood-vessels  in  the  legs  from 
the  heart,  and  the  fact  that  the  blood  in  them  has 
10  return  to  opposition  to  the  effect  of  gravity, 
combine  to  render  the  valves  in  the  veins  incom- 
petent, to  produce  or  aggravate  a  condition  of 
even  to  cause  slight  ruptures  of  the 


The  Private  Entree  to  the  Viceregal  Court. 
As  we  go  to  press  we  learn  that  his  Excellency 
Marl  Dudley  has  been  pleased  to  direct  that  the 
right  of  private  entree  to  his  Excellency's  Levees 
and  Drawing-rooms,  which  was  recently  with- 
drawn from  the  Presidents  of  the  Royal  Colleges 
of  Physicians  and  Surgeons  should  be  restored  to 
them.  We  have  referred  hi  recent  issues  to  the 
withdrawal  of  the  private  entree,  and  although  we 
have  felt  compelled  to  express  in  positive  terms 
our  opinion  on  the  action  of  those  officials  who 
were  responsible  for  the  withdrawal,  we  have  all 
along  taken  up  the  view  that  whoever  was  respon- 
sible for  an  ungracious  act,  it  was  not  the  Lord 
Lieutenant.  This  opinion  is  strengthened  by  the 
gracious  manner  in  which  his  Excellency  has 
restored  the  right,  and  we  tender  to  him,  on  behalf 
of  the  medical  profession  in  Ireland, our  thanks  for 
the  action  he  has  taken,  As  a  lay  contemporary 
very  well  expresses  it,  it  can  matter  nothing  to 
anyone  inside  Dublin  Castle  whether  the  Presidents 
of  the  Royal  Colleges  enter  the  Castle  by  one  door 
or  by  another,  and  this  very  fact  intensified  the 
sense  of  slight  caused  by  the  removal  of  a  privilege, 
intrinsically  valueless,  but  from  the  mere  fact  that 
it  was  a  privilege,  highly  prized.  The  same  con- 
temporary expressed  the  hope  that  his  Excellency 
would  administer  a  severe  <(  wigging  "  to  those 
who  were  responsible  for  the  unnecessary  friction 
to  which  the  withdrawal  of  the  entree  gave  rise, 
and  would  restore  the  latter  to  the  medical  pro- 
fession. We  know  that  his  Excellency  has  dis- 
charged the  latter  task,  and  perhaps  we  may  be 
forgiven  if  we  express  the  hope  that  he  has  also 
discharged  the  former, 

PERSONAL. 


Mr.  Ed  red  M.  Corner,  B.S.Cantab.,  F.RX.S.E.,  has, 
we  are  pleased  to  learn,  been  appointed  assistant 
surgeon  to  St.  Thomas's  Hospital. 

The  Lord  Chancellor  has  placed  the  name  of  Dr. 
George  Fletcher,  of  Highgate,  on  the  Commission  of 
the  Peace  for  the  County  of  Middlesex. 

We  understand  that  Sir  Lauder  Bnmton  contem- 
plates an  early  retirement  from  his  post  of  senior 
physician  at  St.  Bartholomew's  Hospital. 

Ix  is  with  extreme  regret  we  learn  that  Sir  Samuel 
Willis'    general  condition    is    causing    great    anxiety, 


246    Thb  Medical  Press. 


OBITUARY. 


March  2,  1904. 


and  has  strength  has  not  rallied  in  a  satisfactory  manner 
since  his  recent  operation. 

Robert  Bell,  Esq.,  LL.D.,  M.D.,  D.Sc.  F.R.S., 
Acting-Director  of  the  Department  of  Geological 
Survey,  Canada,  has  been  appointed  a  Companion  of 
the  Imperial  Service  Order. 

At  the  annual  general  meeting  of  the  Royal  Medical 
and  Chirurgical  Society,  to  be  held  on  Tuesday  next, 
the  Council  will  propose  the  election  of  Sir  Richard 
Douglas  Powell  as  President. 

Dr.  William  Murrell  presided  last  week  at  the 
Guthrie  Lecture,  which  was  given  by  Captain  Hutton 
on  the  highly  practical  subject  of  the  methods  of 
restraint  of  refractory  patients. 

Sir  Sandford  Fleming  has  presented  Queen's 
University,  Kingston,  with  a  one-tenth  interest  in 
a  coal  mine  near  the  Rockies.  The  proceeds  will 
probably  be  used  for  the  development  of  the  medical 
school. 


His  Majesty  the  King  has  been  graciously  pleased 
to  promise  a  donation  of  100  guineas  in  response  to  the 
appeal  of  the  Senate  for  funds  to  build  and  endow  an 
Institute  of  Medical  Sciences  under  the  control  of  the 
University. 


The  following  have  been  appointed  the  examiners 
for  the  new  diploma  in  tropical  medicine  and  hygiene 
at  the  Universitv  of  Cambridge  :— Dr.  G.  H.  F.  Nuttall, 
Sir  Patrick  Manson.  K.C.M.G.,  F.R.S.,  and  Major 
Ronald  Ross,  C.B.,  F.R.S. 


Dr.  Edward  Malins,  the  well-known  Birmingham 
obstetric  physician,  was  recently  presented  by  his 
friends  and  admirers  with  a  handsome  series  of  testi- 
monials, in  recognition  of  twenty-five  years'  honorary 
service  at  the  Birmingham  General  Hospital. 

The  annual  dinner  of  the  medical  officers  of  the 
auxiliary  forces  will  take  place  at  the  Imperial  Res- 
taurant, London,  on  Friday,  April  15th,  at  7.30  p.m., 
under  the  presidency  of  Lieu  tenant-General  Lord 
Grenfell.  G.C.B.,  G.C.M.6.,  Commanding  the  Fourth 
Army  Corps.  Tickets,  10s.  6d.  each,  may  be  had  from 
Lieutenant  Montgomery-Smith,  36  Abbey  Road, 
N.W. 


The  King  visited  Osborne  House  on  February  20th 
to  inspect  the  alterations  which  have  been  made  to 
convert  it  into  a  convalescent  home  for  officers  of  the 
Navy  and  Army.  His  Majesty  expressed  his  satis- 
faction with  the  changes  made,  and  also  spoke  some 
words  of  encouragement  to  Miss  Haines,  the  matron, 
who  acted  as  his  nurse  during  the  historical  illness  that 
caused  the  postponement  of  the  Coronation. 


Special  correspondence. 


[from    our    own    correspondent.] 


BELFAST. 

Belfast  Samaritan  Hospital. — The  annual  meet- 
ing of  this  Institution  was  held  in  the  hospital  last 
week.  The  medical  report  was  presented  by  Dr. 
John  Campbell,  F.R.C.S.,  who  stated  that  the  number 
of  patients  treated  in  the  extern  department  of  the 
hospital  during  the  past  year  was  636,  and  the  visits 
paid  were  1,439.  In  the  wards  172  patients  were 
treated,  and  of  these  113  required  surgical  operations. 
In  supplementing  the  report.  Dr.  Campbell  spoke  of 
the  work  done  in  the  two  isolated  cancer  wards  which 
had  been  added  to  the  hospital  by  the  munificence  of 
the  late  Mr.  Forster  Green,  and  said  that  they  had 
proved  most  useful. 

Belfast  Maternity  Hospital. — The  1 10th  annual 
meeting  of  this  vigorous  old  institution  was  held  in 


the  Y.M.C.A.  last  week.  The  work  of  the  hospital 
has  outgrown  the  present  premises,  which  it  has 
occupied  for  78  years,  and  it  is  hoped  that  in  a  few 
months  a  new  building  will  be  ready  for  occupation. 
Last  year  326  patients  were  admitted  to  the  hospital, 
and  only  one  death  occurred.  The  extern  nurse 
attended  304  poor  women  in  their  own  homes.  During 
the  year  Dr.  John  Campbell  resigned  his  post  of 
honorary  attending  physician,  and  Dr.  R.  J.  Johnstone 
was  elected  to  fill  the  vacancy. 

The  Question  of  Fees. — At  a  meeting  of  the 
Ballymena  Board  of  Guardians  last  week,  the  question 
of  medical  fees  was  again  under  discussion.  The 
former  resolution  of  the  Board  not  to  pay  temporary 
substitutes  of  medical  officers  more  than  £2  per  week 
was  rescinded,  and  it  was  agreed  that  Dr.  Davison 
should  be  paid  £g  9s.  for  three  weeks'  duty. 

Death  of  Sir  James  Musgrave. — Much  regret  is 
felt  in  Belfast  at  the  sudden  death  last  week  of  Sir 
James  Musgrave,  Bart.,  who  has  been  not  only  a 
prominent  figure  in  municipal  aflairs  for  many  years, 
but  has  shown  special  interest  in  the  furtherance  of 
scientific  education.  A  few  years  ago  he  gave  a  sum 
of  £5,000  to  the  Queen's  College  to  endow  a  Chair  of 
Pathology. 

Correspondence. 

rWe  do  not  hold  ourselves  responsible  for  the  opinion  of  the  corres- 
pondents.] 


ALOPECIA  AND  DENTAL  CARIES. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir,— My  trenchant  critic,  "  M.R.C.S.,"  not  having 
condescended  to  furnish  the  quotations  establishing 
the  dogmatic  assertion  that  "  enamel  and  dentine 
are  incapable  of  physiological  and  pathological  ac- 
tivity," I  have  referred  to  several  standard  works  on 
the  subject.  Sewell  ("  Dental  Surgery,"  fourth  edition, 
p.  53)  says :  "  By  very  careful  decalcification  of  mar- 
supial enamel,  however,  a  considerable  substratum 
of  organic  material  is  left  after  the  complete  removal 
of  the  lime  salts,  and  this  substratum  is  seen  to  corres- 
pond perfectly  in  structure  and  general  appearance 
with  the  original  cytoplasm  of  the  ameloblasts."  Could 
Tomes,  "  M.R.C.S.,"  or  any  other  man  of  scientific 
training  venture  to  assert  that  the  organic  matter  in 
question  had  no  possible  active  physiological  or 
pathological  relationship  to  the  hard  dental  tissues  ? 
Organic  matter  exists  in  dentine  and  enamel,  and  I  am 
aware  of  no  exact  demonstration  that  its  nutritive 
and  absorptive,  aye,  and  reparative  functions,  are  not 
exercised.  How  about  absorption  of  hard  dental 
tissue  in  the  roots  of  the  milk  teeth  ?  There  is  an  in- 
stance, anyway,  of  where  the  deposit  of  dentine  har 
not  been  permanent  and  final. 

It  is  an  acknowledged  fact  that  union  of  a  fractured 
tooth  may  take  place.  An  instance  has  come  under 
my  own  notice  in  the  course  of  ordinary  practice. 
Smale  and  Colyer  ("  Diseases  of  Teeth,"  1001,  p.  i&SY 
say  such  union  may  take  place.  Can  "  M.R.C.S. " 
reconcile  his  dogmatic  position  with  the  repair  of  so 
serious  an  injury  as  the  fracture  of  a  tooth  ? 

Unfortunately  I  have  not  the  works  of  Sir  John 
Tomes  at  hand  for  reference,  but  I  feel  confident  that 
so  scientific  a  man  made  no  such  dogmatic  statement 
as  that  attributed  to  him  by  "  M.R.C.S."  By  the 
way,  the  printer  made  me  say  "  Sir  John  Turner  "  in 
my  last  letter  instead  of  "  Sir  John  Tomes." 

It  is  to  be  regretted  that  a  correspondent  who  stri  ke 
so  hard  should  fall  out  at  the  first  round  after  inviting 
a  contest. 

I  am.  Sir,  yours  truly, 

Medicus  Sewex. 

London,  February  29th,  1904. 

Qbituar?* 

SIR  EDWARD  SIEVEKING.  M.D.Edin.. 
F.R.C.P.Lond.,  K.B. 
We  regret  to  announce  the  death  of  Sir  Edward 


\Uvch  t,   TQ04- 


MEDICAL  NEWS. 


The  Medical  Press,     247 


Sieveking,  Physician  Extraordinary  to  the  King,  ou  the 

24th  inst.  Edward  Henry  Sieve  king  was  born  in  London 

1  rr  iSiti,  and  *»S  a  son  of  a  merchant  of  the  same  name, 

himself  a  descendant  of  a  family  well  known  inHam- 

The  son  was  educated    at  University    College 

mrgh,  graduated  as  M.D.  of  the  Edinburgh 

t  mvenaty  in  1841.  and  settled  m  London  to  practise, 

laca  Fellow  of  the  Royal  College  of  Physicians 

in  185J,     tie  joined  the  Mails  of  St.  Mary's  Hospital 

,f  the  Lock  Hospital,   to  b  >th  of  which  he  was 

Jting  physician  at  the  time  of  his  death.   He  was 

also  for  a   lime   physician   to   the   National   Hospital 

be   Paralysed   and    Epileptic,    and    Physician   in 

-rv  to  Her  late  Majesty  Queen  Victoria,  as  well 

Majesty  King  Edward  VI L  when  Prince  of 

. 'painted    Physician   Extraordinary 

Iiu  II15  Majesty  in  1901,  Dr.  Sieveking  was  lor  some 
editor  of  the  Medico-Ckirwgical  Rtvtiw,  and 
wrote  much  upon  diseases  ,1  tin-  nervous  system,  of 
iad  large  experience  at  the  National  Hospital, 
He  invented  the  aestbesiorfieter,  for  determining  tto 
tactile  sensitiveness  of  the  skin  in  different  regions  of 
the  body,  Among  his  works  may  be  mentioned 
**  Crooman  Lectures  on  Epilepsy  Delivered  before  the 
Royal  College  of  Ptu  and  editions  of  "  Rom- 

berg on  Nervous  Diseases  "  and  of  M  Rokitansky's 
Logical  Anatomy/'  both  prepared  for  the  Syden- 
ham Society,  Dr.  Sieveking  received  the  honour  of 
knighthood  in  18S6.  and  he  was  a  Knight  of  Grace  of 
the  Order  of  St,  John  of  Jerusalem*  He  married 
in  [849,  Jane,  daughter  of  the  late  Mr*  John  Ray,  J,P., 
and  one  of  his  sons  is  also  practising  as  a  phy 
in  London. 

The  funeral  took  place  on  Saturday  at  Abney  Park 
Cemetery,  and  a  special  service  was>  previous  to 
the  interment,  conducted  at  St.  Thomas's  Church, 
Fartman  Square,   by   the   Rev.    Ralph    P.    Thompson. 

»lir.  Dyce  Duckworth,  Dr.  Verrier,  Mr,  Douglas  Powell, 
Mr  William  Church,  Dr\  Charlton  Bastian.  and  Dr. 
Robert  Farquharson,  M.P.,  were  among  those  who 
attended,  and  the  British  Medical  Association,  the 
ye  of  Physicians,  the  University  of  Edinburgh, 
and  other  bodies  were  represented,  Mr,  and  Mrs, 
Herbert  Forbes  Sieveking  and  Miss  Sieveking  were 
principal  mourners.  The  King  has  sent  a  letter 
expressing  bis  sympathy, 

^  THOMAS    DAWSON,    SEN.,    M.  R.C.S. 

Wi  regret  to  record  the  death  of  Mr.  Thomas  Dawson. 
«bo  for  many  years  practised  in  Rodney  Street, 
rpooL  He  was  in  his  eighty-sixth  year,  and  died 
\  Alder  ley  Road,  Hoy  lake,  where  he  had  been 
hvmg  in  retirement  for  several  years,  Apart  from 
his  professional  activities,  Dr,  Dawson  at  one  time 
figured  with  some  prominence  in  the  life  of  the  city. 
In  ti!66  he  entered  the  City  Council  as  a  Conservative 
t  ntative  for  Rodney  Ward,  in  succession  to  Mr. 
C  J.  English,  ami  two  years  after  was  defeated  at 
the  poll  by  Mr.  David  Campbell.  In  iS?o  he  at- 
tempted, unsuccessfully,  to  regain  the  seatr  his  op* 
;it  being  the  late  Mr,  P.  H,  Rathbonc,  For  about 
Dawson  was  a  member  of  the  Liverpool 
Lyceum,  and  m  1S73  was  elected  president  of  the 
lotion,  He  obtained  the  diploma  M.R,C.S,Ertg, 
ni  1 ;-  J 

flDeMcal   "Hews. 

The  Finances  of  the  Meath  Hospital. 

In   the   House  of   Commons   last    week    Mr,   Clancy 

J    the   Chief   Secretary   whether   he   would   state 

what  was  the  contribution  out  of  the  county  cess  or 

the  Poor-rate,  by  the  governors  and   subscribers,  and 

any  other  source  towards  the  maintenance  of  the 

County  Dublin  Infirmary  in  the  years  1897  and  1898, 

and  what  was  the  proportion  of  the  contribution  out 

v  county  cess  or  Poor-rate  towards  the  building 

Oi  that    in-  Mr,    Wyndham,    in    reply,    gave 

.^ures  as  the  sources  of  income  of  the 

i  and  County  Dublin  Infirmary  for  the 

ended    March    31st,    1897,    1898.    and    1901  :  — 


Con  n  ty  presen  t  ment  ( 1 896-97 ) ,  £  1 , 000  ;  ( 1 S97  -98 ) 
£1,000  ;  ( 1900-01 },  £1,000.  Contributions  from  gover- 
nors and  subscribers,  i  1.487,  £,  1,995,  £1*622,  All  other 
sources,  £3,249,  £2,831,  £2,992,  Totals:  £5,736, 
£5,826*  £5,614.  Mr,  Wyndham  further  stated  that 
in  the  report  of  the  Dublin  Hospitals  Commission , 
which  was  presented  to  Parliament  in  1887.  the  hos- 
pital, as  it  was  then  reported  upon,  was  built  at  a  cost 
of  / 12,876,  partly  contributed  by  private  subscrip- 
tions and  partly  by  grants  from  the  grand  jury.  The 
latter  grants,  lie  understood,  amounted  to  £4,788. 
No  grants  have  since  been  made  from  county  sources 
for  building  purposes,  A  further  sum  of  £17,593  has 
been  expended  on  new  buildings  since  the  date  of  the 
report,  all  of  which  was  privately  provided. 

Central  Midwive*  Board  and  Pupil  m  id  wives. 
At  a  meeting  of  the  Central  Mid  wives  Board  on 
February  25th,  Dr,  F.  H.  Champneys  in  the  chair, 
the  following  business  was  transacted  : — A  letter  was 
read  from  the  President  of  the  Royal  Academy  of 
Medicine  in  Ireland  setting  out  the  difficulties  that 
would  be  experienced  by  the  Irish  Chartered  Maternity 
Hospitals  iu  enabling  their  pupil  mid  wives  to  comply 
with  the  ruJes  of  the  Board  as  to  personal  delivery  of 
twenty  cases  and  a  ten  days'  puerperium,  A  copy 
of  the  following  resolution  ol  the  Section  of  Obsn 
adopted  by  the  General  Council,  was  enclosed  :  Ht  That 
in  the  opinion  of  the  Obstetrical  Section  of  the  Royal 
Academy  of  Medicine  in  Ireland,  any  women  holding 
the  nursing  certificate  of  the  Irish  Chartered  Maternity 
Hospitals  should  be  deemed  to  have  complied  with  the 
rules  of  the  Central  Mid  wives  Board  regulating  t  he- 
course  of  training  of  pupil  mid  wives,  and  should  be 
eligible  to  present  herself  for  the  examination  of  the 
Central  Mid  wives  Board.1'  After  consideration  of  the 
foregoing,  it  was  resolved  :  u  That  having  considered 
the  letter  addressed  to  them  by  the  President  of  and  the 
Secretary  of  the  Royal  Academy  of  Medicine  in  Ireland, 
the  Board  regret  that  the  suggested  alterations  were 
not  brought  to  their  notice  before  the  rules  were  sent 
to  the  Privy  Council,  as,  having  been  approved  by 
that  body,  it  is  impossible  for  the  Board  to  alter  them.'" 
The  question  of  framing  a  scheme  of  examinations  to 
be  instituted  by  the  Board  was  referred  to  the  Stand- 
ing Committee  for  consideration  and  report,  and  other 
routine  business  was  transacted. 

The  Poisoning  at  Portsmouth  Asylum. 

The  inquiry  into  the  circumstances  attending  the 
deaths  of  four  female  inmates  of  the  Borough  Asylum, 
Milton,  Portsmouth,  to  whom  sleeping  draughts  were 
administered  on  February  3rd,  was  concluded  last 
week.  The  evidence  of  the  borough  analyst  and  the 
public  analyst  for  Hampshire  as  to  the  analysis  of  t be 
one  draught  which  was  not  given  but  was  similar  to 
those  administered  showed  that  if  contained  192  gram> 
of  chloral  hydrate  to  the  fluid  ounce.  Dr.  Ly  Sander 
May  bury  staled  that  in  his  opinion  Inn  four  unonten 
died  from  an  overdose  of  chloral  hydrate,  and  that  the 
drug  was  more  effective  im  account  of  the  diseased 
stale  of  the  internal  organs,  as  all  the  patients  were 
suffering  from  inflammation  of  the  lungs.  The  jury 
found  that  death  resulted  from  chloral  hydrate  poison- 
ing severally  administered  in  the  four  sleeping  draughts, 
the  result  of  misadventure,  and  they  were  of  opinion 
that  all  dispensing  should  iu  future  be  performed  by 
fully -qualified  persons  only  ;  and  they  also  regretted 
that  the  person  or  persons  who  last  lilled  the  dispensing 
bottles  had  not  had  the  courage  to  admit  the  act. 
Sanitac. 

At  the  annual  general  meeting  of  this  Company,  held 
on  Wednesday  last.  Mr,  £  T,  Knigzett,  KI.C,  F.C.S,, 
the  Chairman,  called  particular  attention  to  the  ,H  Pine- 
Oxygen  "  treatment  of  consumption  and  lung  and  throat 
affections  which  had  been  elaborated  by  the  Company, 
and  he  anticipated  a  growing  demand  by  the  medical 

firofession  for  San  it  as  Oil  and  Sanitas  Fumigators  and 
nhaters,  which  appliances  are  associated  with  that 
treatment.  It  was  pointed  out  that  this  treatment  of 
consumption  is  inexpensive,  and  is  within  the  reach  of 
the  very  poor,  while  it  does  not  necessitate  residence 
abroad  and  obviates  the  rigours  of  the  so-called  open- 
air  cure. 


248    The  Medical  Pkebs.       NOTICES  TO  CORRESPONDENTS. 


March  a,  1904. 


Jtotias  to 
Qotxtsptmbtnts,  Short  %ttttxs,  &c 

Mr  Correspondents  requiring  a  reply  in  this  oolumn  are  particu- 
larly requested  to  make  use  of  a  distinctive  signature  or  initial,  and 
avoid  the  practice  of  signing  themselves  "Reader,"  "Subscriber," 
"Old  Subscriber,"  6c  if uch  confusion  will  be  spared  by  attention 
to  this  rule. 

Original  Articles  or  Lamms  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

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

Reprints.— Reprints  of  articles  appearing  in  this  Journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

RUPTURE  OP  TUBAL  PREGNANCY  ON  THE  NINETEENTH 
DAY.— A  CORRECTION. 

To  the  Editor  of  Tub  Medical  Press  and  Circular. 

Sir,— In  the  account  vou  publish  of  the  above  case,  notes  of  which 
I  read  before  the  British  Gynaecological  Society,  the  name  of  Dr. 
Gordon  Hogg  is  inadvertently  substituted  for  that  of  Dr.  A.  J.  Hogg, 
of  Ealing. 

I  am,  8lr,  faithfully  yours, 

William  Duncan. 

Reoivivub  (Hampstead).— We  doubt  if  you  will  find  a  single 
supporter  of  any  standing  among  the  medical  profession  in  your 
condemnation  of  the  antitoxin  treatment  of  diphtheria.  The 
experiments  you  mention  were  carefully  conducted,  but  their  con- 
clusion has  long  since  been  generally  abandoned. 
THE  DISCUSSION  OP  MEDICAL  QUESTIONS  WITH  LAYMEN. 

Medical  men  will  do  well  to  avoid  discussion  of  physiological  pro- 
blems, such  as  those  relating  to  the  use  of  alcohol  and  tobacco* 
vivisection  and  the  like,  with  persons  who  lack  proper  scientific 
training.  Dr.  Oliver  Wendell  Holmes  thus  condenses  his  own  views 
on  this  subject  :— 

••You  know  that  if  you  had  a  bent  tube,  one  arm  of  which  was  the 
size  of  a  pipe-stem  and  the  other  big  enough  to  hold  the  ocean,  water 
would  stand  at  the  same  height  in  one  as  in  the  other.  Controversy 
equalises  fools  and  wise  men  in  the  same  way    and  the  fools  know  it, 

B.  W.  H.  (Winchester).  The  poison  administered  to  your  cat  was 
undoubtedly  prussic  acid.  It  is  a  curious  fact  that  an  animal 
poisoned  with  that  drug  will  sometimes  run  a  considerable  distance, 
as,  for  instance,  up  and  down  several  flights  of  stairs,  before  dropping 
down  dead. 

8.  H.  H.  Stephenson.— We  beg  to  acknowledge  with  thanks  the 
exchange  number  of  the  Ophthalmoscope. 

Bristoli ah.— There  is  an  excellent  volume  dealing  with  the  subject 
in  the  Medical  Monograph  Series  (Bailliere). 


4Rjeeting0  of  the  ^oriettee,  %zdv(Xt*f  &t. 

Wednesday,  March  2nd. 

Obstetrical  Society  of  London  (20,  Hanover  Square,  W.).— 8  p.m. 
Specimens:  Mr.  A.  Doran:  Pregnant  Fibroid  Uteri  removed  by 
Operation!  Dr.  Addinsell  and  Mr.  Walker  (introduced  by  Dr.  Addin- 
sell) :  Demonstration  of  Microscopical  and  Lantern  Slides  showing 
Mitotic  Changes  in  Cancer  Cells.  Papers:— Mr.  H.  Grippe  and  Dr. 
H.  Williamson :  Two  Cases  involving  the  Question  of  the  Site  of 
Impregnation. — M  rs.  Boyd :  Two  Cases  of  Abdominal  Hysterectomy 
for  Fibroids  complicated' by  Pregnancy,  with  Specimens. 

Medical  Graduates'  College  and  Polyclinic  (22,  Chenies  Street, 
W.C.).— 4  p.m.     Mr.  A.  H.  Tubby :  Clinique.     (Surgical.)    5.16  p.m. 
Dr.  F.  J.  Smith :  Cough  and  its  Significance. 
Thursday,  March  3rd. 

Roktobn  Societt  («0,  Hanover  Square,  W.}.— 8.80  p.m.  Presidential 
Address:— Some  Laboratory  Notes  of  the  ast  Six  Mouths. 

Childhood  Society  (Library  of  the  Sanitary  Institute:  72,  Margaret 
Street.  W.).— 8  p.m.  Lectuie.— Prof.  W.  A.  Potts :  The  Protection 
of  Feeble-minded  Children  during  and  after  School  Age. 

British  Balneological  and  Climatological  Societt  (20,  Hanover 
8quare,  W.).— 5.30  p.m.  Discussion  on  Obesity  (opened  by  Dr.  L. 
Williams). 

Medical  Graduates*  College  and  Polyclinic  (22,  Chenies  Street, 
W.C.)— 4  p.m.  Mr.  Hutchinson:  Clinique.  (Surgical.)  5.15  p.m. 
Dr.  F.  J.  Smith  :  Cough  and  its  Significance. 

Mount  Vernon  Hospital  roR  Consumption  and  Diseases  of  the 
Chest  (7,  Fitxroy  Square,  W.).— 5  p.m.  Dr.  F.Price:  Mitral  Stenosis 
(illustrated  by  cases).    (Post-Graduate  Course.) 

8t.  John's  Hospital  for  Diseases  op  the  Skin  (Leicester  Square, 
W.C.).-- 6.15  p.m.    Dr.  M.  Dockrell :    Sycosis.    (Chesterfield  Lecture.) 

Friday,  March  4th. 

Society  or  Anesthetists  (20,  Hanover  Square,  W.).— 8.30  p.m. 
Paper  :_Dr.  D.  Buxton.  Communications  by  the  President  (Mr.  0.  C. 
Brjdne)  and  Dr.  Flux.    Annual  General  Meetiug. 

Larynoolooical  Socibty  of  London  (20,  Hanover  Square,  W.).— 
5  p.m.  Cases,  Specimens,  die.,  will  be  shown  by  Dr.  McBride, 
Dr.  F.  Potter,  Dr.  Bmurthwalte,  and  others. 


Medical  Graduates'  College  and  Polyclwio  (tt,  Chenies.  Street 
W.0.).,-4  p.m.    Mr.  R.  Clarke:  Clinique.    (Eye.) 

Bacanrie*. 

Aberdeen  City  District  Lunacy  Board.-Assistant  Medical  Officer. 
8alary  £110  per   annum,  with  board.      Applications   to  O.  B 

t^Wi^ft?erk^^nionTerraoc.  Aberdeen 

Brentwood  U^.-Medtoal  Superintendent  of  Infirmary  and  Medical 
Officer  of  Workhouse  and  Schools.  Salary  £300  per  annum,  with 
furnished  residence  in  the  Infirmary,  rations,  washing,  4c. 
Applications  to  William  Stephens,  Ulerk  to  the  Guardians 
Union  Offices,  Isleworth,  W.  «™»»na, 

County  Lunatic  Asylum,  Lancaster. —Assistant  Medical  Officer. 
Salary  £150  per  annum,  with  board,  lodging,  wasWngTE 
Applications  to  the  Medical  Superintendent.  w»"°"1*'  ■*• 

Eu\sua»  »U°fPl!£  ftLJ rhUdre»  «">  Dtopwamiy  for  Women. 
Snadwell,  R-Medical  Officer.  Salary  £100  per  annum.  ApS 
cations  to  Thomas  Hayes,  Secretary. 

Joint  Counties  Asylum.  Carmarthen.— Junior  Assistant  Medical 
Officer.  Salary  £150  per  annum,  with  board,  furnished  apart- 
ments, and  washing.  Applications  to  Dr.  GoodaU,  Medical 
Superintendent,  the  Asylum.  Carmarthen 

London  Fever. Hospital,  Islington,  N -Assistant  to  the  Resident 
Medcal  Officer  Salary  £120  a  year,  with  board  and  lodging. 
Applications  to  the  Secretary.  ~*b-«. 

Manchester  Children's  Hospital— Junior  Resident  Medical  Officer. 
Salary  £80  a  year,  with  board  and  lodging.  Applications  to  the 
Secretary,  Gartside  8treet.  Manchester. 

£150 
W.L. 

Nurses'  Co-operation,  8,  New  Cavendish  Street,  London.— Ladv 
Superintendent.  Salary  £140  per  annum,  with  board  and 
residence.    Application  to  Committee  of  Management. 

Roscommon  Union.— Medical  Officer.  Salary  £120  per  annum 
together  with  Vaccination  Fees  about  £8,  also  to  act  as  Sanitary 
S^061,  **,!  8lU*r.y  of  £m-  Application  to  J.  J.  Keeffe.  Clerk  of 
Union.    (See  Advt.) 

Westminster  Hospital.- Medical  Officer. 
Applications  to  Sidney  M.  Quenneli 


Manchester  Royal  Infirmary.— Resident  Medical  Officer.    Salary 
per  annum,  with  board  and  residence.     Applications  to  1 


Salary  £120  per  annum. 


&ppoitttmtniB. 

BuLLMORB,  Charles  Cecil.  L  R.C.P.,  L.R.C.S.Edhi.,  L.F.P.S  Glaag., 
SHK  u??  *£} he  Falmouth  Workhouse  and  to  the  Falmouth 
District  by  the  Falmouth  Board  of  Guardians.  —■■»»« 

C008aWBLi'  F™D:h  m:rc^  L.R.C.P.Lond.,  Medical  Officer  of  the 
Stanton  District  in  the  Hinckley  Union.  «*~r«  we 

Grossman.  Ewwaed,  M.D.Durh.,  L.R.O.P.Lood.,  M.R.C.8..  L.8.A. 
Medical  Officer  of  Health  for  the  Barton  Regis  Rural  District 
Uounoil. 

Aot  for  the  Hastings  District  of  the  county  of  Sussex. 
S^  ?K2l  t  AT'  ?  B  •  B-8-*>urh.,  F.R.C  «»  Bdin  .  M.R.C.8. 
^g.f  L.RO.P.Lond.,  Surgeon  in  Ordinary  to  the  Royal  Hants 
County  Hospital,  Winchester. 
Harttoan.  T.  J.  P..  F.R  C-*.En*.,  Assistant  Surgeon  to  the  Hospital 
for  Diseases  of  the  Skin,  Blackfriars  ™p"ai 

^AS^^  £R'C'^-.  >8.A.,   Medical  Officer  of 

Health  by  the  Aston  Manor  Corporation. 
Rainbird,  P.  H.  L.R.C.  P.Bdin.,  L.R.C.i.Edin..  L.F.P.8.O..  Certifying 

Surgeon  under  the  Factory  Act  for  the  Saxilby  District  of  the 

county  of  Lincoln. 
SMrra    M.  Hambun,  M.B.C.S     LR.C.P.,  Deputy  Medical  Officer, 

a H.M.  Prison,  Manchester,  H.M.  Prison.  Wandsworth. 

Bn*£Si  ^"W  8mm.  M.O.,  C.M.Glasg.,  D.P.H.Oamb.  the  Deputy 

Medical  Superintendent  to  the  Glamorganshire  County  Asylum, 

Bridgend,  buperintendent. 

WAV22L  P'  Pi:  M:?VB-8^lM«-  Certifying  Furgeon  under  the 
Factory  Act  for  the  Bye  District  of  the  county  of  «ussex. 

Weaver  J.  J.,  M.R.C.S.,  L.8.A.,  Medicsl  Officer  of  Health  of 
South  port. 


girths. 


Backhouse .— On  February  24th,  at  the  Terrace,  St.  Ives,  Cornwall. 

the  wife  of  Charles  F.  Backhouse,  M.R.O.S.,  L.R.C.P.,  of  a  son. 
Steel.— On  February  23rd,  at  the  Duke  of  York's  Royal  Military 

School,  Chelsea,  the  wife  of  Capt   R.  B.  Steel,  Royal  Army 

Medical  Corps,  of  a  daughter. 
Warrington.— On  February  17th.  at  69,  Rodney  Street,  Liverpool,  the 

wife  of  W.  B.  Warrington,  M.D..  M.R.O.P.,  of  a  son. 
Wellbt.— On  February  25th,  at  Fletham,  Lias,  the  wife  of  8.  Wellby, 

M.D.,  of  a  daughter. 


4ftarrtege0. 

Richardson -Woodland.— On  February  24th.  at  Rye  Lane  Baptist 
Chapel,  Henry  Edward  Richardson.  LR.C.P.,  M.H.C.S..  of 
London,  son  of  Charles  Winterton  Richardson,  late  Presidency 
Magistrate,  Bombay,  to  Lilly,  daughter  of  Thomas  William  Wood- 
land, Forest  of  Dean,  Gloucestershire. 


Scattis. 


Christie.— On  February  25th,  at  Brompton  8quare,  London,  8.  W., 
Robert  J.  Holder,  eldest  son  of  the  late  tfobert  Christie,  M.R.U&, 
aged  75. 

Dixon.— On  February  22nd,  at  50.  Granada  Road,  Southsea,  Janus 
Deighton  Dixon,  M.B.,  Newoastle-on-Tyne,  aged  50. 


%k  fflt&wft  ttot**  mA   (ttimlm. 


f<SALUS    POPULI    StfPREMA    LEX" 


Vol.  CXXVIIL 


WEDNESDAY,     MARCH  9,    1904.  No.    10, 


©rfotnat  Communications. 


must  have  a  clear  idea  of  what  are  the  functions  of  the 

noge.  and  bow  the  physiology  of  this  organ  is  related  to 

ON'  WJB  physiology  of  the  surrounding  organs,  and  to  the 

I4TFNTT      OR       INTPUMITTPMT    economy  in  general,     The  nose  has  important  relations 

un  1  i^l^  1       ur,      llM   L  cisjvil  1  1  Cl\]  I     Wlta  respiration,  with  digestion,  with  audition    tfttb 

NASAL     OBSTRUCTION  speaking  and  singing,  with  taste  and  smell,  with  sight 

and  with  the  various  emotional  states. 

The  nose  may  also  be  looked  upon  as  a  respiratory 
organ  in  itself,  as  it  is  certain  that  a  considerable  inter- 
change of  gases  takes  place  in  its  recesses  and  cavities. 
There  is  also  some  reason  to  believe  that  the  nose  is 
the  safety  valve  of  the  brain. 

In  order  to  fully  appreciate  the  effect  of  the  h> 


I  COLLIER,  M.B.,  M.S.Lond\.  F.R.C.S.Eng., 
snwai)  to  trie  North  w«t  Lowtaa  Hospital  vnd  RvPntL 
dent  of  the  British  LsktyngQlogiwd  Association. 

President    and     Gentlemen, — The    object 
communication  to -day  is  to  ask  yon     to  con- 
h     me    a    condition    of    things   within     the 


it  op  to  the  present,  has  scarcely  been  enter-  I  tne  functlo,l!>  °*  tne  nose,  and  the  harm  that  miv  in 
tttttd  by  rhiiioKjfiists,  antl  certainly  not  with  the  ■  pi,lset|uence  accrue  to  the  individual,  we  most  first  be 
^prehension  that  this  condition  was  one  of  any  moment    m  JS  jf08***611  to  appreciate  their  value. 

sirieration.  Tnis  can  onlY  De  clone  by  a  careful  survey  and  atcu- 

I  *ant  bo  point  out  to  you  that  there  is  a  condition  of   rat^  ^^''^^  o(  tQese  functions  as  far  as  we  are  able. 
ithm    the   nose   that   is   extremely  common  ;        In  orde^  l?  obtain  this,  we  will  discuss  striatim  the 
iition.  although  extremely  common,  hat   nose  in  re'at,on  lo  the  various  functions  I  have  emi- 
+t..\\ t  1  general  recognition.  mfldted, 

nditionof  things  is  potent  for  harm,  and  Ana"  Arst  "*  al1  w,Ul  respiration,  and  so  through  re- 
spiration with  the  circulation  and  oxidation  of  the  blood. 
As  baldly  stated  in  the  physiology  books  the  nose 


of  many  of  the  affections  found  within  the 
nose,  and  post-nasal  space. 

tent  or  intermittent  nasal  obstruction 
descriptive  of  the  condition  I  wish  to 
with  you  this  afternoon. 

to  you,  that  apart  from  the  various  form* 
rti  nasal  obstruction  due  to  growths,  outgrowths, 
detections,  or  what  not  with  which  we  are  all  fam U 
I  here  is  a  turm  of  nasal  obstruct  km  that  is  more  common 
mj  m>re  harmful  than  all  these  put  together.  This 
firm  of  n&sal  obstruction  is  latent,  that  is  to 
*  miy  come  on  in  a  nose  that  is  physiologically 
tent,  and  in  which  there  is  nothing  abnormal 

obstruction  may  alternate  with  a  con- 
si  things  in  which  the  fractions  of  the  nose  are 
perfectly  performed,  and  yet  for  twelve  hours  out  of  the 
if  ihe  nose  may  be  absolutely  occluded,  and 
urn  1  in  a  condition  of  extreme  misery  and  dis- 
comfort 


warms,  moistens,  and  filters  the  air,  hut  how  this  is 
accomplished  the  learned  writers  of  text-books  have 
not  attempted  to  explain.  At  tirst  it  is  a  little  difficult 
to  see  how  a  stream  of  air  some  thirty  or  forty  cubi  c 
inches  in  volume  can  become  warmed,  moistened,  and 
filtered  whilst  passing  through  the  nose  in  the  space  of 
two  seconds, 

Whenp  however,  we  examine  the  upper  respiratory 
tract  as  a  whole,  we  sec  that  it  is  not  a  channel  or  tube 
of  one  uniform  calibre,  but  that  it  presents  several 
remarkable  constrictions  that  alternate  with  equally 
remarkable  expansions. 

We  then  begin  to  see  that  these  constrictions  prevent 
the  very  thing  from  taking  place  that  we  are  told  does 
take  place— u/?,,  that  the  air  from  the  exterior  passes 
slkk  through  the  nose  from  front  to  back,  and  on  into 
the  lungs  in  a  solid,  more  or  less  cylindrical  stream, 
and  does  not  mix  with  its  surroundings.     This  is  mani- 


nttrmittent  form  of  nasal    obstruction  often    festlv  incorrect.     If  we  look  at  the  upper  respiratory 
ution,    and    the    surgeon    is    led    astray    tract,  and  view  it  as  a  whole,  we  shall  be  surprised  at  the 
use  at  the  time  of  his  examination  the  nasal  cham-    variations  that  it  presents. 

beti  are  nerft^rtlv  frpp  am\  nr*t#»nt    anil  tUt*  f>i«r.»iA>.  **t  „  , ±.       ,  , 

Commencing  with  the  external  nares,  we  find  that 
the  vestibule  becomes  narrower  as  it  passes  inwards  ; 
and  joins  the  nasal  chamber  opposite  the  nasal  process 
of  the  superior  maxillary  bone, 

The  vestibule  or  inlet  to  the  respiratory  function  is 
cone-shaped,  and  at  its  junction  with  the  nasal  chamber 
becomes  so  contracted  as  to  constitute  perhaps  the 
narrowest  point  in  the  whole  respiratory  tract  It  is 
curious  to  note  that  whereas  the  external  nares  are 
capable  of  expansion  and  contraction,  the  canal  of 
the  upper  respiratory  tract  at  its  junction  with  the 
nasal  chamber  is  rigid  and  unalterable,  being  surrounded 
by  bony  and  cartilaginous  borders,  A  limit  is  thus  put 
to  nasal  respiration  by  the  size  of  the  anterior  opening 
of  the  nasal  chamber. 


en  are  perfectly  tree  and  patent,  and  the  functions  of 
are  perfectly  performed. 

Lire    that   no  one   present   would  resent    the 

n  t!iat  more  or  less  complete  obstruction  of 

!  chambers  might  be  harmful  to  the  individual 

aod  might  lead   to  ear,   throat,  or  nose  troubles*     If 

>-oii  admit  that  constant  nasal  obstruction  is  in  many 

ir,  throat,  and  nose  troubles,  I  am 

r  imagination  when   I   ask  you    to 

ruiltent    nasal    obstruction   is     also 

foi  hirm  in  the  same  direction.     Or, mother 

us  loss  of  the  functions  of  the  nose 

trouble  in  the  nose,   throat,  and  ear,  I  am 

n  t  that  intermittent  loss  of  Ihe  functions 

similar  effect. 
-  t he  s u bj  ec t -ma t ter  of  my  rema rks  to  y o u 

ftc  to  properly  understand  this  question,  we 


After  passing  this  narrow  spot  in  the  respiratory 
tract  we  find  that  the  canal  expands  in  a  remarkable 


250     The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


March  9,  1904. 


manner  into  the  nasal  chamber,  which,  with  its  recesses, 
constitutes  a  cavity  of  considerable  dimensions. 

These  recesses  must  not  be  dismissed  from  our  calcu- 
lations when  studying  the  act  of  respiration. 

It  is  sore  and  certain  as  anything  can  be  that  these 
recesses  act  not  only  as  resonance  chambers  to  the  voice, 
but  as  warming  and  mixing  chambers  ;  so  that  the  air 
as  it  is  admitted  from  the  exterior  in  a  raw  and  unpre- 
pared state  is  mixed  with  the  contents  of  the  nose  and 
its  recesses,  and  so  made  ready  to  pass  on  into  the 
pharynx  and  upper  tubes. 

An  observation  I  had  the  advantage  of  making  on  a 
healthy  frontal  sinus  will  go  a  long  way  in  substantiating 
this  fact. 

I  opened  a  frontal  sinus  for  exploratory  purposes, 
and  being  very  careful  I  removed  the  button  of  bone 
without  injury  to  the  lining  of  the  sinus. 

At  each  inspiration  the  lining  membrane  was  depressed 
and  at  each  expiration  bulged  into  the  wound,  proving 
incontestably  that  part  of  the  contents  of  the  nasal  sinus 
is  withdrawn  during  inspiration,  to  be  replaced  during 
expiration.  The  air  then  entering  by  the  cone- 
shaped  vestibule  must  do  so  with  an  increasing  rate  of 
speed  till  it  has  passed  the  narrows  of  the  anterior 
opening.  It  must  here  lose  much  of  its  velocity,  and 
becoming  slowed  down  will  distribute  itself  in  all 
directions,  as  regulated  by  the  sides  of  the  delivery 
tube  of  the  vestibule. 

It  is  thus  seen  that  as  a  stream  of  air  it  must  be  sub- 
ject to  and  conform  to  the  shape  of  the  tract  through 
which  it  passes,  and  that  the  rate  of  motion  of  the  air 
will  be  an  average  between  the  rates  of  motion  in  the 
narrowest  and  widest  parts  of  the  respiratory  tract. 

Passing  onwards  we  come'to  a  second  marked  narrow- 
ing, that  of  the  posterior  nares.  This  is  crescent-shaped 
and  varies  with  the  size  of  the  posterior  end  of  the 
inferior  turbinal  body.  The  cross  section  of  this 
opening  can  only  be  a  very  small  fraction  of  the  cross 
section  of  the  nasal  chamber.  Consequently  the  air  in 
its  passage  backwards  must  be  greatly  delayed  by 
having  to  pass  this  constriction,  thus  allowing  time 
for  the  necessary  warming,  moistening,  and  filtering 
of  the  inflow. 

Following  on  this  constriction  is  a  remarkable  dilata- 
tion, that  of  the  pharynx  extending  from  the  base  of 
the  skull  to  the  upper  opening  of  the  larynx. 

The  nasal  contents,  having  passed  the  posterior 
opening  of  the  nares,  lingers  in  the  pharynx  and  passes 
slowly  on,  but  with  increasing  speed,  to  the  larynx. 
The  act  of  warming,  moistening  and  filtering  is 
continued  in  the  pharynx. 

So  far  we  have  traced  the  inflowing  air  to  the  larynx, 
and  can  surmise  that  the  anterior  and  posterior  con- 
strictions of  the  nasal  chamber  serve  a  very  good 
purpose  in  delaying  and  slowing  down  the  air  in  its 
passage  through  the  nose. 

The  narrow  anterior  opening  or  inlet  insures  that  the 
inflowing  air  shall  be  distributed  and  mixed  with  the 
nasal  contents.  The  posterior  constriction  prevents 
the  too  rapid  emptying  of  the  nasal  chambers  by 
the    powerful  aspiration  of  the  lungs. 

It  is  curious  to  note  the  alteration  in  the  positions  of 
the  contents  of  the  respiratory  tract  from  the  com- 
mencement of  inspiration. 

At  the  commencement  of  inspiration  the  air  in  the 
bronchial  tubes  will  pass  in  and  fill  the  bronchioles 
and  vesicles.  The  air  in  the  larynx  and  trachea  will 
follow  on  into  the  bronchial  tubes,  and  the  air  in  the 
pharynx  will  pass  on  and  take  the  place  of  the  air 
in  the  trachea  and  large  tubes,  whilst  the  air  in  the 
nasal  chambers  will  flow  into  the  pharynx,  larynx, 
and  trachea. 

We  thus  see  that  the  air  passes  in,  and  mixes  with, 
and  dilutes  the  impure  reserve  and  residual  air,  but 
cannot  displace  it. 

During  expiration  the  impure  expirate  extrudes  the 
contents  of  the  pharynx  and  nose,  and  fills  the  upper 
respiratory  tract.  This,  no  doubt,  undergoes  considerable 
purification  in  the  chambers  and  recesses  ot  the  nose  in 
the  interval  before  the  next  inspiration. 

I  would  here  remind  you  whilst  on  the  subject  of 
respiration  that  this  is  the  supreme  function  of  the 


economy.  The  circulation  and  oxidation  of  the  blood, 
not  only  in  the  systemic  but  portal  system,  is 
dependent  on  respiration.  It  is  not  unreasonable  to 
suggest  to  you  that  any  interference  with  the  functions 
of  respiration,  and  so  with  the  proper  oxidation  and 
circulation  of  the  blood  for  a  considerable  period  in 
twenty-four  hours,  must  be  harmful  and  baneful  to  the 
individual. 

The  functions  of  the  nose  are  closely  related  to  the 
functions  of  digestion,  both  directly  and  indirectly. 

Directly  by  the  interference  with  mastication  that 
follows  an  obstructed  nose. 

A  person  with  his  nose  occluded  cannot  shut  his 
mouth  sufficiently  long  to  properly  masticate  his  food, 
and  consequently  bolts  the  same  before  it  is  half 
divided,  to  the  detriment  of  his  stomach. 

Again  the  congestion  of  the  pharynx  and  post-nasal 
space  incidental  to,  and  associated  with,  nasal  obstruc- 
tion upsets  the  stomach  in  more  ways  than  one. 
Directly  by  the  amount  of  unhealthy  mucus  that 
passes  into  the  stomach,  and  indirectly  by  the  constant 
irritation  of  the  pneumogastric  centre  by  the  branches 
of  the  pharyngeal  plexus. 

The  insanitary  state  ot  the  mouth  that  follows  mouth 
breathing,  and  the  amount  of  contaminated  and  dusty 
mucus  that  must  pass  into  the  stomach  (or  what  has 
been  properly  termed  oral  sepsis)  is  a  considerable  dis- 
advantage to  digestion. 

Seeing  that  the  whole  of  the  circulation  of  the  liver 
and  abdominal  organs  is  carried  on  by  the  respiratory 
act,  any  interference  with  this  must  be  of  serious 
detriment  to  the  absorptive  functions  of  the  alimentary 
canal,  and  so  a  fertile  source  of  slow  digestion  and  other 
forms  of  dyspepsia. 

Digestion  and  respiration  are  so  intimately  associated 
that  I  seldom  meet  with  a  patient  suffering  from  nasal 
obstruction  in  a  marked  and  chronic  form  who  escapes 
from  symptoms  of  indigestion,  sluggish  liver,  or  other 
abdominal  troubles.  Now  what  relation  have  the 
functions  of  the  nose  to  the  eye  ?  The  nose  is  the 
drain  of  the  conjunctival  sac.  Nasal  obstruction 
will  cause  epiphora,  and  conjunctivitis  and  other 
troubles.  The  two  functions  are  intimately  and  sym- 
pathetically associated.  The  same  nerve  and  the 
same   artery    supply  both. 

Any  irritation  in  the  nose  is  responded  to  by  flushing 
of  the  conjunctiva  and  watering  of  the  eye.  The  nose 
is  the  guardian  of  the  eye. 

A  strong  light  detrimental  to  the  retina  will  cause 
sneezing,  and  so  prevent  further  damage  by  altering  the 
position  of  the  head  and  casting  the  eyes  to  the  ground, 
or  closing  them  altogether. 

Congestion  in  the  nose  will  be  followed  by  fulness 
of  the  retinal  veins  and  congestion  of  the  conjunctiva. 
The  nutrition  of  the  nose  and  eye  are  intimately 
associated.  The  ophthalmic  and  spheno-palatine 
ganglia  are  anatomically  and  physiologically  closely 
related.  Passing  on  to  the  relations  of  the  nose  to 
the  ear,  it  is  not  surprising  to  find  that  these  are 
peculiarly  sensitive. 

The  middle  ear  or  tu  bo-tympanum  is  developed  from 
the  nose  by  two  finger-like  prolongations.  It  is  simply 
a  prolongation  of  the  nose  cavity.  The  cavity  of 
the  nose  and  ear  are  practically  one.  Any  increase  or 
decrease  of  tension  within  the  nose  is  immediately 
felt,  and  communicated  to  the  contents  of  the  ear. 

It  is  not  difficult  to  realise  that  whatever  affects  the 
main  cavity  of  the  nose  will  affect  its  various  recesses 
and  prolongations.  The  unity  of  the  nose  and  middle 
ear  must  be  taken  into  consideration  and  fully  realised 
as  the  first  and  essential  step  in  the  proper  under- 
standing and  treatment  of  many  of  the  affections  of  this 
cul-de-sac. 

There  is  little  doubt  that  in  normal  nasal  respiration 
both  inspiration  and  expiration  are  felt  in  the  tympanic 
cavity,  and  that  a  slight  movement  of  the  membrana 
tympani  takes  place  inwards  with  inspiration,  and  out- 
wards with  expiration,  the  same  as  has  been  recorded  in 
the  frontal  sinus. 

In  corroboration  of  this  may  be  mentioned  the  fact 
'  that,  when  one  is  listening  very  carefully  for  a  sound. 

the  mouth  is  opened,  and  respiration  is  suspended  or 


March  9,   1904. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press.    251 


on  ihi 
and  m 


earned  011  very  gently  by  way  of  the  mouth  in  order  to 
(I   suggest)   the  oscillations   incidental    to  re- 
-piratim) 
I  lie  relation  between  the  functions  of  the  nose  and 

£*  are  peculiarly  apparent. 

Besides  preserving  the  covering  of  this  organ  in  a 

healthy  condition,  the  nasal  chamber  is  the  delivery 

of  the  voice,  as  well  as  its  resonator.     The  func- 

of  smell  and  taste  are  almost  entirely  dependent 

ie  patency  and  proper    functioning  of  the   nose, 

and  must  be  entirely  annulled  if  the  nose  be  ocdu 

lad,  lastly,  there  are  some  grounds  for  supposing  that 

the  safety-valve  of  the  brain,  by  acting  as  a 

drain  to   the   arachnoid   cavity.     We    know    that    the 

arachnoid  sheat  h  is  continued  through  each  opening  in 

nbnform  plate  and  surrounds  the  olfactory  nerves 

almost  to  their  terminations.    The  confusion  of  intellect, 

the  forgetfu loess,   the  difficulty  of  concentrating   the 

Itts,  the  headache,  the  morning  drowsiness,  and 

i.ther  mental  symptoms  that  are  associated  with  nasal 

■■totruction  may  well  be  due  to  increase  of  arachnoid 

tal,  and  congestion  following  on  nasal  obstruction 

and  the  consequent  arrest  of  the  functions  of  the  nose. 

There  may  be  some  reason,  also,  for  believing  that  some, 

at  least,  of  the  large  quantity  of  moisture  that  is  taken 

jp  by  the  inspired  air  comes  "from  the  arachnoid  fluid. 

Again,  the  pathological  conditions  known  as  hydro- 

where   pints  of  fluid   are  discharged    from  the 

nasal  cavities,      associated     with     polypi  and     other 

ual   states  can  more  easily   be  explained  by  the 

assumption  ol   an  outflow  from  the  arachnoid  exten- 

tnto  the  nose  modified,  possibly,  by  filtration.    In 

to  remind  you  of  the  relation  of  the  functions  of 

the  nose  to  the  emotion*,  I  would  ask  you  to  imagine 

any    great    actor    with    an    obstructed     nose  and   an 

mouth,     The  emotional  display  of  the  face  would 

uite  impossible,  and    the  actor's  efforts    mined. 

The  relation  of  the  nose  to  the  sexual  functions  is  well 

marked  in  some  of  the  carnivora  but  may,   I  think, 

be  altogether  discarded  when  dealing  with  the  genus 

How,  gentlemen,  you  will  agree  with  me  that   the 

a  not  an  unimportant  or  idle  organ,  and  is  well 

wnnhy  of  your  best  care  and  consideration. 

1  will  now  return  to  our  main  subject,  and  explain  to 

ore  fully  what  is  meant  by  latent  or  intermittent 

obstruction,  the  mechanism  of  its  production,  its 

and  lastly,  if  we  have  time,  I  shall  say  a  few 

as  to  treat n 

I  can  more  easily  explain  to  you  the  exact   condition 
to  be  known  as  latent  or  intermittent    nasal  obstruc- 
tion by  citing  you  one  or  more  out  of  the  large  number 
sei  I  t\aw  records  of.     In  [895  I  was  consulted  by 
a  medical  man  who  gave  the  following  account  of  him- 
He   was   sixty-three   years   of   age,    for   the   last 
fourteen  or  fifteen  years  he  had  been  troubled  with  his 
nose  becoming  occluded  at  night,  and  at  other  times, 
rieral    health,   he  said,  was  indifferent,    he  was 
fatigued,  and  suffered  from  flatulent  dyspepsia. 
headache   and    deafness.     His   sleep    was    constantly 
i-ed  at  night,  and  he  awoke  in  the  morning  uu« 
I  and  tired.     He  said  for  years  he  had  suffered 
iJY'iu  catarrh  in  the  nose  and  head,  but  late!',    u 

much  worse  that  he  felt  sure  he  would 

his  mind  if  something  was  not  done  for  him. 

gentleman  was  a  tall,  pale  .liverish-looking  person. 

die  l<x»k  of  suffering  stamped  on  his  "face.     I 

that  he  had  treated  himself  with  washes, 

"nut,  and    inhalations,  but  with  little  effect,  and  that  he 

under  the  care  of  a  distinguished  physician 

I  him  his  heart,  lungs,  ami  abdominai'oruM[i> 

d,     I  found  in  his  present  condition  nothing 

that  one  could  lay  one's  hands  on  and  label  as  disease. 

throat  was  pale  ami  anaemic,  the  interior  of  the 

and  the  mucous  membrane  was,  if  any- 

rnic.     There  was  ample  room  for  nasal  re- 

and  nothing  abnormal  or  irregular  was  ap- 

te  sign  which  I  venture  to  suggest   was 

the  whole  situation.     On  ei Lbcr  side  of  the 

lere  was    the  tell-tale  hollow  or  groove,  the 

i  of  the  lower  turbinal  bod  v.     Beyond   this 


there  was  nothing  to  indicate  that  the  nose  had  been 
anything ^but  free  night  or  day, 

Well,  gentlemen,  with  this  physical  condition  of 
complete  freedom  of  nasal  respiration  and  the  absence  of 
anything  abnormal  with  the  nose,  this  patient  was  on 
the  very  verge  of  melancholia  from  the  misery  and 
discomfort  of  complete  nasal  occlusion  10  soon  as  his 
head  was  placed  upon  the  pillow.  The  functions  of  the 
vere  here  intermittently  performed  :  for  sixteen 
hours  the  nose  was  free,  for  eight  hour*  it  was  closed. 
Yet  this  nocturnal  occlusion  was  quite  sufficient  to 
tnd  put  out  of  gear  all  the  correlated  functions 
of  the  nose,  and  to  bring  the  economy  almost  to  a  stand 
still.  An  almost  exactly  similar  case  was  that  of  S 
barrister  sent  to  me  from  Dublin  by  a  member  of  this 
Association*  These  are  extreme  but  typical  cases,  and 
happily,  I  am  glad  to  say,  are  few  and  far  between. 
The  commoner  forms  of  intermittent  nasal  obstruction 
present  symptoms  of  less  seventy.  In  many  cases  there 
is  only  the  slight  hoarseness  and  morning  cough,  and 
difficulty  in  clearing  the  throat  on  rising  in  the  morning. 
There  may  only  be  a  tendency  to  flatulent  dyspepsia 
or  distension  after  meals. 

■  ^The  hearing  may  not  be  quite  so  good  as  it  was,  and 
the  patient  may  tell  you  he  thinks  he  is  getting  deafer, 
until  he  finds  out  he  is  suffering  from  a  marked  degree 
of  ^deafness.  This  is  constantly  the  only  symptom 
of  intermittent  nasal  obstruction.  I  believe  that  in 
intermittent  or  latent  nasal  obstruction  we  have  a 
valid  and  sufficient  explanation  for  the  existence  of  that 
large  class  of  slow,  insidious,  painful  forms  of  ear  trouble 
known  as  chronic  progressive  deafness*  Given  an 
occlusion  of  the  nose  for  eight  out  of  the  twenty-four 
hours,  and  you  have  all  the  factors  ready  and  able  to 
produce  occlusion  of  the  Eustachian  tubes,  congestion  of 
the  tympanic  cavity,  and  depression  of  the  drumhead, 
and  the  subsequent  physical  changes  known  as  sctco> 
sis.  This  explanation  is  worthy  of  your  consideration, 
and  the  more  I  live  and  learn  the  more  assured  I  am 
of  its  soundness,  I  have  on  more  occasions  than  one 
insisted  that  there  is  an  intimate  relation  between 
intermittent  nasal  obstruction  and  the  affections  of  the 
other  recesses  and  extensions  of  the  noser  and  the  same 
anatomical  and  physiological  facts  that  govern  the 
recess  of  the  middle  ear  apply  equally  with  all  the  other 
extensions  of  the  nose. 

The  tympanic  cavity  and  the  antrum  or  trontal  sinu 
are  on  all  fours  with  each  other.  They  have  a  common 
origin.  Their  lining  membrane  is  similar  and  continuous. 
They  are  subject  to  the  same  variations  in  air  tension 
and  supply,  and  they  are  subject  to  the  same  affections. 
I  have  recently  ^exhibited  to  you  a  case  of  frontal  sinus 
trouble  where  the  suppuration  was  kept  up  for  three 
years  by  occlusion  of  the  nostril  on  the  same  side  from 
collapse'  of  the  wing  of  the  nose,  and  enlargement  of  the 
turbinal  body. 

On  reducing  the  turbinal  body  and  supporting  the 
win  g,  the  su  p  p  ura  t  ion  promp  1 1  y  d  is  a  ppeared.  LT  n  co  mph  - 
cated  chronic  suppuration  of  the  accesssory  cavities 
of  the  nose  is  induced  and  maintained  by  intermittent 
obstructions  of  the  nose.  This  applies  equally  to  the 
aural  accessory  cavity.  The  obstinate  discharges  from 
these  cavities  that  continue  sometimes  after  operations 
are  to  be  explained  when  intermittent  nasal  obstruction 
is  present*  We  have  heard  a  good  deal  lately  about 
the  etiology  and  treatment  of  polypi.  My  experience 
is  that  when  these  growths  are  properly  removed,  ami 
the  nose  properly  ventilated,  and  nocturnal  nasal 
obstruction  prevented,  they  do  not  return.  I  have  one 
case  that  illustrates  my  meaning  perfectly. 

I  operated  on  a  gentleman  whom  I  exhibited  in  this 
room  as  a  typical  martyr  to  asthma  relieved  b\  cle&rfrlD 
his  nose  from  polypi.  Well,  these  growths  recurred 
ami  required  removal  off  and  on  for  eleven  years.  In 
the  earlier  periods  i>l  my  treatment  I  took  no  account  of 
the  fact  that  he  was  completely  obstructed  at  night 
time  and  yet  was  free  during  the  day.  The  asthma 
was  better  when  the  nose  was  cleared,  but  returned 
with  the  obstruction*  Some  four  or  five  years  ago  I 
operated  on  both  lower  turbinal  bodies.     I  have  never 


252    The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


March  9,  1904. 


had'occasion  to  treat  him  medically  since,  and  his  nose 
remains  perfectly  free  from  polypi  to  this  day. 

I  believe  that  intermittent  nasal  obstruction  plays  an 
important  part  in  the  production  and  recurrence  of 
polypi.  Much  more  could  I  say  on  this  important 
subject,  but  the  time  at  my  disposal  will  not  suffice  for  a 
mare  extended  view.  We  pass  now  on  to  the  subject  of 
diagnosis.  How  do  we  know  when  intermittent  nasal 
obstruction  is  present  or  not  ?  If  there  is  nothing  ab- 
normal to  be  seen  in  the  nose,  and  if  the  functions  of 
nasal  respiration  are  perfectly  and  adequately  per- 
formed, by  what  signs  shall  we  be  able  to  recognise  this 
form  of  obstruction  ?  In  latent  or  intermittent  nasal 
obstruction,  the  obstruction,  as  a  rule,  occurs  at  night- 
time when  the  head  is  on  the  pillow,  and  the  body  is 
more  or  less  in  a  horizontal  position.  When  up  and 
about,  as  in  sitting,  walking,  or  standing,  there  is  seldom 
obstruction  except  on  passing  from  a  cold  to  a  warm 
atmosphere,  and  sometimes  when  drinking  hot  liquids 
or  taking  spiced  or  pungent  meals,  with  alcoholic 
drinks.  In  the  vertical  position  of  the  trunk,  gravity' 
retains  the  venous  blood  in  the  great  vessels  of  the  neck, 
chest,  and  abdomen.  On  assuming  the  horizontal 
position,  the  blood  flows  into  the  veins  and  sinuses  of 
the  head  and  neck,  in  response  to  the  same  force. 
When  sleeping,  the  arteries  become  smaller  in  calibre, 
and  the  veins  larger,  so  that  the  veins  of  the  head  and 
neck  contain  relatively  more  blood.  The  cavernous 
tissue  and  mucous  membrane  of  the  nose  become, 
when  lax  and  atonic,  distended  mechanically  by  the 
increased  intravascular  pressure  caused  by  the  mere 
inflowing  of  blood  to  these  parts.  The  distended  tur- 
binal  bodies  approach  the  septum  on  either  side,  and 
press  upon  it  so  vigorously  as  to  form  a  groove  or  exact 
cast  of  themselves,  and  completely  to  obliterate  the 
lumen  of  the  nasal  chambers.  The  erectile  tissue  on 
the  floor  and  lower  part  of  the  septum  helps  to  com- 
plete this.  The  groove,  then,  is  to  besought  for  and  is 
undoubtedly  evidence  of  the  condition  I  am  attempting 
to  describe  to  you.  It  is  indeed  more  than  evidence, 
it  is  pathognomonic  of  intermittent  nasal  obstruction, 
and  is  the  only  objective  sign  that  will  present  itself  to 
you.  With  subjective  symptoms  of  laryngeal,  throat, 
nose,  or  ear  trouble,  and  the  objective  sign  I  have 
described  to  you,  you  have  all  the  evidence  you  require 
to  make  the  diagnosis  of  intermittent  nasal  obstruction. 

I  place  no  credence  on  the  answers  of  patients  to  the 
question  as  to  the  method  of  breathing  at  night.  Some, 
very  often  the  worst  cases,  will  indignantly  repudiate 
the  suggestion  that  they  breathe  through  the  mouth  at 
night,  yet  will  in  the  same  breath  tell  you  that  they 
awake  with  the  tongue  dry,  and  are  always  anxious  for 
a  cup  of  tea  in  the  morning.  The  subject  of  treat- 
ment will  involve  much  time  and  consideration,  and 
as  I  feel  I  have  already  occupied  a  large  measure 
of  your  time,  and  like  yourselves  am  anxious  and 
looking  forward  to  the  Presidential  Address,  I  will 
postpone  it  to  a  more  opportune  moment.  If  in  the 
remarks  I  have  made  I  have  given  you  any  suggestions 
worthy  of  your  acceptance,  or  set  you  thinking  on  this 
important  subject,  I  shall  be  more  than  amply  repaid 
for  the  anxiety  and  labour  attendant  on  this  com- 
munication. 


THE 

DIMINISHING     BIRTH-RATE  : 

ITS  CAUSE,   ITS  TENDENCY,  AND  POSSIBLE 
REMEDY,  (a) 

By  JOHN  W.  TAYLOR,  M.D.,  F.R.C.S., 
Professor  of  Gynaecology  in  the  University  of  Birmingham ;  Presi- 
dent of  the  British  Gynecological  Society. 

(Concluded  from  page  227.) 
Part  II. 

III. 
What  will  be  the  outcome  for  England  in  the  future 
if  nothing  be  done  to  check  this  and  allied  abuses  of 

(a)  Inaugural  Address  read  at  the  meeting  of  the  British  Gynaeco- 
logical 8ociety.  Thursday,  February  llth,  1904. 


so-called  modern  civilisation  ?  If  I  shall  not  weary  you 
with  statistics  I  would  ask  you  to  turn  your  attention 
for  a  short  time  to  our  sister  nation,  France,  where 
(as  in  a  magic  mirror)  one  can  apparently  see  the  future 
of  those  countries  in  which  the  birth-rate  tends  to 
fall  until  the  population  becomes  stationary,  or  even 
less  than  stationary,  as  it  is  in  France  to-day.   (a) 

In  a  remarkable  paper  written  by  M.  Alfred  Fouillee. 
of  the  School  of  Moral  Sciences,  in  the  Rtvue  de$ 
deux  Mondes  of  January  15  th,  1897,  we  find  the 
following  account  of  the  criminal  statistics  of  France: 
"  Since  1881 — that  is.  from  1881  to  1896 — the  number 
of  prisoners  before  the  Correctional  tribunals  has  risen 
from  210,000  to  240,000.  Since  1889— or  in  7  years- 
manslaughter  has  risen  from  156  to  189,  murder  from 
195  to  218,  and  sexual  crime  from  539  to  651. 

"  In  addition  to  the  general  increase  in  criminality 
of  all  kinds,  a  sort  of  specialisation  of  crime,  especially 
for  acts  of  violence,  is  to  be  noticed.  These  belong 
more  and  more  to  a  certain  class,  that  of  the  old 
offenders.  The  number  of  these,  which  was  30  per 
cent,  in  1850,  is  now  65  per  cent.  In  short,  during 
the  last  fifty  years  criminality  has  trebled  itself  in 
France,  although  the  population  has  hardly  increased 
at  all. 

"  The  saddest  side  of  the  criminal  statistics  is  that 
regarding  children  and  young  people.  From  1876-1880, 
while  the  misdemeanours  of  common  law  had  trebled 
among  the  adults,  the  criminality  of  youths  (from 
sixteen  to  twenty-four)  had  quadrupled,  that  of  young 
girls  had  nearly  trebled,  and  the  number  of  children 
prosecuted  had  doubled.  In  the  period  1880  to  1893 
criminality  has  increased  still  more  rapidly.  To-day 
child-criminality  is  nearly  double  that  of  adults,  not- 
withstanding that  minors  from  seven  to  sixteen  years 
only  represent  seven  millions,  while  adults  amount 
to  more  than  twenty  millions.  In  Paris  more  than 
half  of  the  individuals  arrested  are  under  twenty-one, 
and  nearly  all  have  committed  the  more  serious  offences." 
According  to  M.  Adolphe  Guillot,  the  acts  of  the  young 
prisoners  are  marked  by  an  exaggerated  ferocity,  a 
special  refinement  of  lust,  and  a  bragging  of  vice  that 
are  never  met  with  to  the  same  degree  at  a  more 
advanced  age. 

"Child  prostitution  is  growing,  and  in  ten  years  the 
number  of  children  charged  with  prostitution  was 
estimated  at  40,000.  In  1830  the  number  of  suicides 
was  5  in  100,000  ;  in  1892  there  were  24  to  the  same 
number.  By  1887  the  suicides  of  children  under 
sixteen  years  (formerly  extremely  rare)  amounted  to 
the  number  of  55.  In  1896  we  had  375  suicides  of 
young  people  between  the  ages  of  sixteen  and  twenty- 
one,  and  the  suicides  of  children  under  sixteen  were 
87." 

These  are  facts  written  by  a  Frenchman  for  French 
readers  in  the  best  known"  French  magazine  of  the 
day.  (6) 

If  we  like  to  extend  our  inquiry  we  find  that  these 
figures  are  taken  from  the  national  statistics,  and  are 
in  harmony  with  other  observations.  "  Since  1880— 
that  is,  during  the  last  twenty  years — the  consumption 
of  alcoholic  drink  in  France  has  trebled,  and  France 
has  passed  from  the  seventh  place  in  order  of  con- 
sumption of  alcohol  to  the  first."     (Mr.  Yoxall,  M.P.) 

The  figures  in  Mulhall's  "  Dictionary  of  Statistics," 
though  varying  to  some  extent,  are  in  rough  accordance 
with  these.  According  to  this  authority,  we  find  that 
insanity  is  steadily  increasing  in  France,  and  that  the 
ratio  of  suicides  has  risen  from  112  per  million  in  1880 
to  205  (or  nearly  double)  in  1885. 

I  do  not  want  to  press  these  figures  beyond  their 
bare  legitimate  application.  In  particular,  with 
regard  to  alcoholism,  this  depends  on  many  factors. 


(o)  "In  France  during  the  past  year,  according  to  the  returniof 
the  Bureau  of  Vital  Statistics,  there  were  25,998  more  deaths  thai 
births,  and  20,000  fewer  births  than  during  the  previous  year.  Tte 
record  shows  only  827.297  births  for  a  population  of  39  000,000. 
though  there  was  a  slight  increase  ill  the  number  of  marriages,  and 
a  slight  decrease  in  number  of  divorces."  (Montreal  Medial 
Journal,  December,  1903. 

(b)  A  very  similar  or  parallel  article  on  the  increase  of  crime  in  the 
United  states  (where  "prevention  *'  is  exceedingly  common)  is  written 
by  Dr.  Buckley  in  the  Century  Magazine  for  November.  1908. 


March  9-   iQCM- 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press.     253 


and  is  very  much  governed  by  the  legislation  of  the 
country  regarding  its  sale.  In  England,  for  instance, 
there  was  a  marked  diminution  in  national  expenditure 
1. he  Early  Closing  Act  of  1872,  and  in  France 
there  has  been  a  great  increase  since  1880.  when,  as  I 
understand,  the  facilities  for  obtaining  it  were  much 
increased. 

But  this  does  not  alter  the  fact  that  after  half  a 
century  of  trial  with  an  increasingly  limited  population 
France  shows  more  and  more  a  lowered  and  still 
tailing  moral  average,  a  lessening  virtue  and  strength, 
and  an  increasing  national  neurasthenia,  which  seems 
ve  and  to  need  the  help  of  constant  stimulation 
in  order  to  face  the  ordinary  routine  of  life. 

Here  we  see  a  great  nation,  a  people  and  a  land 
which,  next  to  my  own.  I  think  I  understand,  appre- 
ciate aod  love  better  perhaps  than  any  other,  and  to 
1  I  wish  nothing  but  good  ;  but  a  nation  so  bound 
by  the  letters  she  has  forced  for  herself  that  nothing 
he  lite  she  has  deliberately  cast  aside  could 
apparently  save  her  from  her  slow  decay. 

And  is  not  this  refusal  of  life  by  the  French  at  the 
mot  of  the  deep  anti-Semite  feeling  which  otherwise 
TOiitd  be  so  contrary  to  the  frank  spirit  of  the  French  ? 
The  Hebrew  race,  to  their  lasting  honour,  with  very 
Eceptknxa,  have  not  only  kept  themselves  free 
fraa  the  vice  of  which  I  have  been  speaking,  but,  by 
reason  of  their  laws  and  customs,  are  the  most  syste- 
matically temperate  in  their  sexual  relations  of  any 
nation  or  people  I  know. 

Consequently,  among  them,  the  natural  breeding    of 
the  better  stock  has  never  been  interfered  with,  and  in 
a  country  like  France,  the  Hebrew  seems  to  rise  not 
<miy  individually,  but  racially,  among  the  people  with 
whom  he  has  his  dwelling,  until  what  appears  to  be 
an  unfair  proportion  of  responsibility  and  power  and 
wealth  rests  in  the  hands  of  an  alien  race.     When  this 
overed*  and  the  cause  of  it  but  dimly  recognised, 
cannot  but  be  bitter  feelings  of    jealousy  and 
hatred  in  the  great  mass  of  the  nation  among 
the  Hebrew  dwells,  and  it    is    not    surprising 
that  the  power  of  combination  and  of  number  is  some- 
times unjustly  used  to  overcome  {if  possible)  the  dis- 
advantage* 

So  far,  I  have  been  dealing  only  with  what  is  open 
to  observation  and  experience.  But  may  we  not  reason- 
ably go  a  step  further  ?  What  must  be  the  future  of 
BOCA  ■  society  if  degeneration  goes  on  and  the  power 
democracy  remains  as  at  present  or  increases  ? 
tig  as  the  race  progresses  the  people  can  be  trusted 
with  the  powers  of  Government,  but  when  decadence 
has  been  going  on  for  years,  or  even  ages,  what  can  be 
the  final  outcome  of  such  democracy  but  anarchy  and 
G mlusion  r 

IV 

In  dealing,  or  attempting  to  deal,  with  the  treatment 

•if  this  grave  national    evil  it  is  necessary  to  take  a 

hroad  and  yet  sympathetic  view  of  the  problem. 

It  b  sentiaily  to  the  higher  gyu«e- 

in  which  no  false  sympathy  or  lower  obstetric 

platform  must   be  permitted  to  interfere  with  what  is 

reallj  the  individual  and  the  race.     And  yet 

we  recognise    that    the    whole  force  of  modern 

honour  paid  to  riches,  its  luxury,  its 

its  impatience,   its  society,    its    manner    of 

vy       neurasthenia'*    seems  all  more  or  less 

Opposed    to   the     cultivation   of   that    true   family    life 

rs  its  best  safeguard  against  decay,  one  needs 

indeed  to  temper  judgment  with  a  quick  appreciation 

olall  the  difficulties  encountered  by  every  modern  wife 

ano  mother,  and  to  recognise  the  almost  insurmountable 

-r  the  Church,  the  State,  and  the  Profession 

!y  overcome. 

I  ihink,  the  help  of  all  is  needed.     The  Roman 

"ic  Church  teaches  that    prevention  is  a  sin,  and 

lis  is  altogether  beyond  my  province.  1  would 

1    that   no   lower  standard   of   sexual    morality 

allowed  by  those  who  belong   to  another 

union,  and  that  every  effort  should  be    made  by 

the  rciigi'  ins  and  the  moralist  t«-  inculcate  a  higher  ideal, 

and  a  plainer  and  simpler  standard  of  life.    _j 


In  the  State  it  might  be  possible  to  encourage  this 
higher  ideal  by  regard ing  the  well  brought-up  family 
as  one  of  the  attendant  qualifications  for  high  distinc- 
tion and  honour,  and,  in  addition,  by  some  wide 
scheme  of  old-age  insurance  or  pension,  by  better 
facilities  for  the  higher  education  of  children ,  and 
by  some  special  remission  of  taxation  to  lighten 
the  burdens  of  those  who  are  bringing  up  large  families 
to  be  a  credit  to  themselves,  and  a  lasting  benefit  to 
the  nation. 

A-gaio.  where  further  education  is  demanded,  and 
legitimately  demanded,  by  any  profession  or  calling 
as  necessary  to  full  qualification,  1  would  have  the 
Slate  rather  jealously  guard  the  earliest  possible  date 
at  which  productive  work  may  begin.  Part  of  the 
difficulties  of  our  modern  life  seems  to  be  caused  by  the 
ever -receding  age  at  which  such  work  is  possible.  In 
my  own  student-days  many  of  us  qualified  at  twenty- 
one,  were  earning  our  own  living  at  twenty-two.  au>1  vi 
managed  to  keep  up  study  and  hospital  attendance 
until  taking  the  higher  degrees  at  twen ty-fi ve  or  twenty- 
six.  This  may  have  been  mistaken,  but  I  am  convinced 
it  is  a  far  greater  mistake  to  keep  a  young  man,  with  a 
mans  vigour  and  ambition,  from  any  real  independent 
work  through  most  of  the  years  from  twenty  to  thirty. 

In  the  Medical  Profession  itself  the  evils  of  prevention, 
both  immediate  and  remote,  should  be  studied  more 
closely,  and  explained  to  such  patients  as  need  direction 
and  advice.  No  advice  should  be  given  in  favour  of 
it  without  special  consideration  of  the  subject  in  all 
its  bearings  and  due  consultation. 

My  own  opinion  is  that  while  occasional  abstinence 
rried  life  is  perfectly  allowable  and  may  have,  as 
I  have  suggested,  a  high  moral  hereditary  value,  no 
artificial  prevention  is  advisable  save  that  which  is 
produced  by  operation,  when  deformity  or  grave 
disease  imperatively  demands  it. 

Certainly  in  the  present  day  when  septic  diseases,  as 
we  know,  can  be  reduced  to  a  minimum  and  should  be 
almost  entirely  avoided,  when  surgery  can  so  effec- 
tually and  safely  deal  with  nearly  everykind  of  difficult 
or  dangerous  labour,  it  is  not  the  time  for  the  fairly 
healthy  parents  of  one  child  to  shelter  themselves 
behind  the  terrors  and  troubles  of  a  first  confinement, 
and  demand  some  easy  but  evil  way  of  further  im- 
munity. 

But  as  civilisation  increases,  there  can  be  little  doubt 
that  the  susceptibility  to  pain  increases  also,  and  it 
may  be  that  the  mothers  of  to-day  need  a  greater  con* 
sideration  and  help,  during  the  progress  of  pregnancy 
and  lactation,  than  the  mothers  of  former  years.  Very 
much  more  may  be  done  during  these"  periods  by 
suitable  advice,  management,  and  diet  than  many 
imagine.  In  some  cases,  as  I  showed  last  year,  re- 
peatedly disastrous  pregnancies  may  be  changed  into 
ones  of  healthy  tvpe  and  character  solely  by  what 
amounts  to  a  special  and  more  liberal  dietary  before 
and  during  pregnancy;  (a)  and  much  of  the  partial 
collapse  and  ill-health  that  is  apt  to  follow  parturition 
and  accompany  lactation  may  be  modified  or  alto- 
gether avoided  by  due  provision  and  direction  for  the 
hygienic  requirements  of  mother  and  child,  parti- 
1  cularly  as  regards  rest  and  food. 

In  these  ways,  and  especially  by  personal  influence 
I  and  example.  *the  medical  practitioner  may  do  more 
I  perhaps  than  anyone  else  to  reform  the  judgment  aud 
,  correct  the  practice  of  this  and  coming  generations. 

But  when  all  this  is  said  and  done,  there  still  seems  to 
i  be  needed  some  general  awukening  of  the  national  con- 
science if  any  thorough  and  lasting  change  is   to  be 
hoped  for.     Let  us  be  careful  that  the  awakening  i<  in 
the  right  direction. 

One  word  of  caution  may  be  needed-  Whatever  mav 
be  the  merits  or  demerits  of  celibacy  as  compared  with 
marriage,  statistics  show,  as  I  have  already  stated, 
that  it  has  but  very  little  practical  bearing  on  the  sub- 
ject before  us*  "  "Vhe  birth-loss  in  the  United  Kingdom 
must  be  due  to  causes  operating  in  the   married    life 

(fl)  British  MttHcat  Jtntrnmt,  April  Xltli.  1W& 


254    The  Medical  Press.         ORIGINAL  COMMUNICATIONS. 


March  9^1904. 


of  fits  inhabitants."  True  celibacy,  maintained,  as 
it  often  is,  for  the  sake  of  the  better  service  of  mankind, 
is  worthy  of  the  highest  honour  and  may  well  be  subject 
to  a  higher  law  than  that  of  physiological  increase. 
Many  noted  examples  of  this  will  occur  to  all  as  I 
speak,  in  every  profession  and  of  both  sexes.  These 
are  vicarious  fathers  and  mothers  whose  children  far 
out-number  the  limits  of  a  physiological  family,  and 
the  lives  they  protect  or  encourage  or  save  make  for 
that  "  maximum  of  life  "  which  is  associated  with  the 
11  maximum  of  virtue." 

There  is  no  reason  to  fear  any  high  ideal  of 
chastity  or  continence,  and  especially  none  when  it  is 
associated  with  the  care  of  those  forces  which  go  for 
the  defence  of  the  nation  and  that  child-life  which  is 
its  future  hope. 

On  the  other  hand,  there  is  every  reason  to  fear  that 
debased  ideal  of  married  life  which  is  secretly  and 
insidiously  working  for  the  ruin  of  the  nation's  power 
and  for  the  destruction  of  its  hope. 

Artificial  prevention  is  an  eviL  and  disgrace — the 
immorality  of  it,  the  degradation  of  succeeding  genera- 
tions by  it,  their  domination  or  subjection  by  strangers 
who  are  stronger  because  they  have  not  given 
way  to  it,  the  curses  that  must  assuredly  follow  the 
parents  of  decadence  who  started  it — all  of  this  needs 
to  be  brought  home  to  the  minds  of  those  who  have 
thoughtlessly  or  ignorantly  accepted  it.  For  it  is 
undoubtedly  to  this  that  we  have  to  at t tribute  not  only 
the  diminishing  birth-rate,  but  the  diminishing  value 
of  our  population. 

No  truer  words  were  ever  said  than  those  by  Ruskin : 
"  The  maximum  of  life  can  only  be  reached  by  the 
maximum  of  virtue."  Do  they  not  carry  with  them 
another  truth  which  has  now  become  almost  a  demon- 
strable fact,  that  the  prevention  of  life  is  always 
accompanied  by  moral,  deterioration  ? 

And  this  evil  harvest,  for  ourselves  and  for  our 
children,  is  of  our  own  sowing.  Some,  looking  back 
on  past  history  and  bygone  civilisations,  have  imagined 
that  the  rise  and  fall  of  empire  follows  some  unalterable 
law,  and  that  nations,  like  individuals,  must  necessarily 
suffer  from  senility  and  decay. 

But  it  is  not  so.  National  decay  or  degeneration 
is  by  no  means  the  inevitable  consequences  of  age. 
Our  modern  ally,  Japan,  is  an  evidence  of  this.  After 
a  long  and  chequered  history,  quite  as  long  or  longer 
than  our  own,  she  has  emerged  in  all  the  activity  and 
strength  of  a  second  youth. 

And  it  is  interesting  to  not©  that  this  new-found 
power  is  directly  associated  in  the  mind  of  the  Japanese 
with  the  knowledge  of  their  own  racial  strength  and 
power  of  increase  ;  indeed,  it  is  thi3  which  gives  them — 
youth. 

This  is  well  shown  by  some  recent  remarks  of  one  of 
their  more  prominent  men.  He  writes  : — "  Japan  is  in 
no  danger  of  race-suicide.  .  .  The  mothers  are  not 
shirking  maternity  as  in  other  lands,  and  the  result  is 
that  we  can  spare  half  a  million  of  men  a  year  for  an 
indefinite  number  of  years  and  not  miss  them. 

"  Barring  Formosa  and  the  Pescadores,  we  have 
less  than  150.000  square  miles  of  territory,  of  which 
eleven- twelfths  is  unproductive  of  food.  Nevertheless, 
we  have  close  to  50,000,000  folk  to  feed.  Do  you 
wonder  that  we  are  land-hungry — that  we  want  elbow- 
room  ?  "  (Reported  by  Stephen  England  in  the 
Daily  Mail  of  December  23rd,  1903.) 

In  a  somewhat  different  way  the  Hebrew  race,  to 
whom  I  have  already  referred,  may  also  be  cited  as  an 
example  of  an  ancient  people,  old  in  every  sense,  and 
still  not  dying  out.  Conquest  and  dispersion  have 
left  their  ineffaceable  impress  on  the  race,  but  they 
are  with  us  to-day,  not  infrequently  showing  evident 
traces  of  centuries  upon  centuries  of  nervous  training 
and  development,  of  nervous  wear  and  tear ;  possessing, 
too,  a  history  of  great  achievement  in  music,  art,  and 
literature,  corresponding  to  that  development,  and 
yet  showing,  so  far  as  I  am  able  to  ascertain,  no  sign 
of  real  decay  or  loss  of  reproductive  energy. 

We  have  the  same  power  with  far  better  oppor- 
tunities and  a  much  brighter  outlook.  At  no  period 
in   our  history,   perhaps,   was   there   less  reason   for 


racial  suicide,  and,  apart  from  this,  for  pessimism. 
All  of  us,  both  men  and  women,  need  a  truer  and  braver 
conception  of  life.  Life  is  entrusted  to  us — life  and  the 
power  of  life — and  we  should  be  ready  to  work,  to 
suffer  and  to  adventure  greatly  and  cheerfully,  for  the 
honourable  and  wise  employment  of  the  entrusted 
capital. 

"  Then  welcome  each  rebuff 
That  turns  Earth's  smoothness  rough. 
Each  sting  that  bids,  nor  sit,  nor  stand,  but  go. 
Be  our  joys  three  parts  pain  ! 
Strive  and  hold  cheap  the  strain  ; 
Learn,    nor   account    the    pang ;    dare,    never 
grudge  the  throe." 

I  must  confess  when  I  hear  of  thoughtful  men  among 
the  Boers  in  South  Africa,  military  authorities  in 
St.  Petersburg,  and  Japanese  in  far  Japan,  noticing 
and. counting  on  their  own  racial  increase,  and  com* 
paring  this,  kindly  or  unkindly,  with  our  own  com- 
parative stagnation,  I  would  like,  if  I  could,  to  sting 
my  fellow-countrymen  into  some  proportionate  sense 
of  shame  and  duty. 

My  voice  is  weak,  but  in  the  responsible  position  in 
which  you  have  so  generously  placed  me,  as  the  tem- 
porary head  of  a  great  British  Society,  which  may  well 
claim  to  be  the  greatest  British  authority  on  such 
questions,  I  am  surely  not  overstepping  my  province 
if  I  ask  for  the  grave  interest  of  every  Fellow  in  this 
important  subject ;  if  I  ask,  not  so  much  for  any 
following  of  my  leadership  as  for  the  fullest  independent 
investigation  into  all  the  facts,  figures  and  arguments 
I  have  brought  before  you.  For  with  us  lies  a  great 
responsibility,  and  ours  will  be  to  a  very  large  extent 
the  blame  if,  in  after  years,  the  lamp  of  the  Anglo- 
Saxon  is  found  to  be  burning  dimly. 


SOME  OF  THE 

LIMITATIONS     OF    MEDICINE 

IN 

ABDOMINAL   DISEASES,  (a) 

By    G.    P.    CHAPPEL,    M.D.,    B.C.Cantab., 
Physician  to  Out-PatienU  tottenham  Hospital. 

Those  morbid  abdominal  conditions,  both  acute  and 
chronic,  which  are  amenable  to  surgical  treatment  have, 
since  the  introduction  of  antiseptics,  become  so  nu- 
merous that  I  only  propose  to  touch  upon  those  which 
are  more  commonly  met  with  in  everyday  practice. 

Stomach.—  The  remarkable  advances  in  surgery 
which  have  been  made  during  the  last  few  years  in  the 
treatment  of  perforated  gastric  ulcer  have  robbed  this 
fatal  complication  of  much  of  its  terrors.  Every  hour 
that  laparotomy  is  postponed  very  seriously  diminishes 
the  chance  of  recovery.  Patients  who  are  the  subjects 
of  simple  gastric  ulcer  are  always  liable  to  get  relapses 
when  surrounded  by  bad  hygienic  conditions.  When 
repeated  small  haemorrhages  or  a  second  large  one 
occur,  and  the  ulcer  will  not  heal  in  spite  of  medical 
treatment,  I  think  it  is  our  duty  to  call  in  the  surgeon. 
Another  class  of  cases  are  those  of  chronic  gastric 
catarrh  in  which  the  digestive  powers  are  much  im- 
paired, and  the  recurrence  of  pain  and  flatulence  causes 
much  suffering.  The  process  of  lavage  is  very  helpful 
in  getting  rid  of  the  stringy  mucus,  and  it  is  one  which 
patients  can  soon  learn  to  perform  for  themselves,  but 
where  this  fails  to  give  relief  the  question  of  performing 
a  gastroenterostomy  should  be  seriously  entertained. 
In  malignant  disease  of  the  stomach,  medical  treatment 
is  useless,  except  as  a  palliative. 

Liver.r-Wt  may  say  broadly  that  the  treatment  ot 
hepatic  disorders  belongs  to  the  physician,  with  the 
exception  of  liver  abscess  and  hydatids,  both  of  which 
have  to  be  distinguished  from  perihepatitis  and  hyper- 
trophic cirrhosis.  In  the  two  latter  the  enlargement 
of  the  organ  is  uniform,  whereas  abscess  and  hydatids 
usually  affect  one  or  other  lobe.     The  case  becomes 


(a)  Abstract  of  a  Paper  read  before  the  V^lb^U^fm  Oinietl 
Society,  at  the  Tottenham  Hospital,  Thursdsy,  March  3rd  1  W. 


March  q.  1904. 


■-  complicated,  however,  when  these  conditions  are 

Tlie  most  common  cause  of  jaundice  is  a  catarrhal 
Ltion  spreading  up  the  commun  duct  and  causing 
ti  by  swelling  of  it>  mucous  membrane.       If 
ry  severe,  it  is  probably  due  to  the  passage 
1  if  a  gatt-stone.     Medical  treatment  must  be  anodyne. 
have  been  recti  in  mended  in  the  shape  of  large 
doses  of  olive  oil.     A   large   proportion   of   autopsies 
ihOft  ihat  gall-stones  are  frequently  present  in  t he  gall- 
bladder without  causing  any  trouble.     Surgical  inter- 
act is  indicated  under  the  folio  wing  conditions — 
1 1 1  When  there  are  repeated  attacks  of  biliary  colic 
which  tend  to  exhaust  the  patient  ;  (a)  when   there  is 
evidence     of     inflammation      of      the      gall-bladder ; 
in    cases     of    dropsy    of    the    gall-bladder;    and 
nictivc  jaundice  due  to  the  impaction  of  a 
l^JcliIus  in  the  common  duct* 

-. — I  pass  te   general  peritonitis  as 

\icmg   entirely    surgical,    and    also    acute    peritonitis 

-jf   an    acute    miliary    tuben 
In  chronic  tuberculous  peritonitis  there  are  usually  many 
jdhesioiii,  and  ascites  may  be present,      I  lie  treatment 
lid  be  medicinal  at  first,  consisting  of  attention  to 
^a nt  t    hygiene,    together   with    cod-liver   oil    and 
•  nunction    to    the    abdomen.     A    large    per- 
centage of  cases  are  either  cured  or  greatly  improved 
!te  performance  of  laparotomy,  which  should  be 
undertaken  if  no  progri  e   "ii   iiu-dica)   lines. 

The  p&thology  of    the    cure  is  not  fully  understood* 
tion  is,  of  course,  useless  in  cases  associated 
with  extensive  tuberculous  lesions  of  the  lungs  or  other 
era.     Carcinoma    of    the    peritoneum    oflers     very 
liope  for  surgical  interference 
fnkshnss.  —  In  typhoid  fever  one  oi  the  most  serious 
rforation,   whether  viewed  from  a 
point   of  view.     It  is  most  apt  to 
:   in  protracted  cases,  though  it  may  happen  as 
he  eighth  day.      I  welt  remember  a  case  m  the 
Lcwul  ul,  which  perforated  some  three  weeks 

after  the  temperature  was  normal,  when   the  patient 
.g  up  and  taking  solid  food.     The  chief  danger 
to  Hie  Tig  peritonitis.     It  is  our  duty 

lQ  gs  ent  the  chance  of  life  afforded  by  opera- 

hough  the  mortality  is  very  great.     Perforation 
tri><rii  us  disease  is  not  a  common  occurrence. 

unediate  laparotomy  affords  the  beat  prospect  of 
:        rit  disease  of  the  intestine  should  Come 
under  the  surgeon's  notice  as  soon  as  possible,  as  by 
ihts  means  the  chance  of  a  radical  cure  is  rendered  more 

4ppmdiciHs, — This  disease  has,  of  late  years,  become 

and  more  a  surgical  one,  and  to  my  mind  rightly 

lays  "f   "  waiting   tor  an   abscess   to   form  *' 

have  passed.     Any  treatment  is  generally 

hopeless  in.  those  terrible  fulminating    cases    in    which 

1   of  a  gangrenous  appendix  occurs  without 

wanting.      In   an   ordinary   cast   absolute   rest    in 

!    be   enforced .   and    an    ice-bag  placed   over  the 

ppendix.     Opium  should  not  be  given, 

or  unlv  in  small  quantities,  as  it  m  vmptoms. 

itivea  do  more  harm  than  goo. 1.     One  enema  may 

en,  but  not  repeated,      If  after  forty-eight  hours 

nt  is  manil  ind  the  temperature 

ther  with  vomiting. 

item*  tperatton  should' be  seriously  entertained. 

iptoms  are  subsiding,  operation   should  be 

tor  at  any  rate  a  week       Many  persons  who 

had  one  attack  ol  appendicitis  by  careful  aiten- 

fil  and  to  the  slate  of  their  teeth  may  avoid  a 

*Kand,  but  they  are  ne\-  Yiter  the  second  at 

I    think    in   all    cases    the    appendix    should    be 


ORIGINAL   COMMUNICATIONS,  The  Medical  fez*.    255 


A    CASE    OF 

ECTOPIC   GESTATION   NEAR 
TERM  WITH  INFECTED  OVUM 

— LAPAROTOMY— RECOVE  R  V 
CTadcr  the  care  of  Dr.  E,  GOINARD, 

Obitetno  Surgeon  to  thi*  Civil  Hospital.  Altera. 


[Specially  Reported  for  "The  Medical  Press 
and  Circular  "  by  Dr.  Gitjh.] 


I  recently  had  under  my  care  a  voting  woman, 
set.  25,  who,  on  April  20th,  was  brought  to  the 
hospital  with  symptoms  pointing  to  an  acute 
abdominal  lesion.  I  elicited  that  her  last  men- 
strual period  was  at  the  end  of  January,  and  beyond 
the  usual  symptoms  of  pregnancy  she  "had  observed 
nothing  abnormal  until  that  afternoon  when, 
during  the  act  of  micturition,  she  felt  a  sharp  pain 
in  the  hypogastrium.  lollowed  by  a  feeling  of  faint- 
ness  which,  however,  soon  passed  off. 

When  I  saw  her,  she  was  pale,  the  features 
drawn,  and  the  lips  blanched.  The  abdomen  was 
distended,  painful  all  over,  and  the  rigidity  of  the 
muscles  rendered  it  impossible  to  obtain  any  direct 
information  by  the  aid  of  palpation.  Pulse  150, 
Temperature  normal.  No  vaginal  discharge. 
On  vaginal  examination  the  os  was  felt  to  be  small 
and  round. 

Ice-bags  were  applied  to  the  abdomen,  the 
bowels  emptied  by  an  enema  and  opium  given  to 
relieve  the  pain.  She  gradually  improved,  and 
two  days  later  I  was  enabled  to  make  out  a  globular 
swelling  in  the  lower  part  of  the  belly,  reaching 
three  fingers'  breadth  above  the  pubes.  This  was 
taken  to  be  the  gravid  uterus.  Vaginally  some 
tumefaction  was  felt  in  Douglas'  pouch,  ifke  that 
associated  with  an  inflamed  tube.  The  improve- 
ment continued  and,  in  opposition  to  my  advice, 
the  patient  left  the  hospital  on  April  30th,  eight 
days  after  admission. 

A  week  later  she  returned  to  the  hospital  com- 
plaining of  further  abdominal  symptoms,  but  she 
did  not  come  under  my  notice,  and  in  view  of  the 
obscurity  of  the  symptoms  the  surgeon  on  duty 
performed  an  exploratory  laparotomy.  He  made 
a  short  incision  in  the  middle  line  and  came  down 
upon  a  globular  tumour  which  looked  like  the 
1  uterus,  so  he  closed  the  wound,  and  in  du6 
course  the  wound  healed  and  the  patient  was 
discharged . 

She  was  not  seen  again  until  September,  when 
she  told  us  that  pregnancy  had  followed  its  course 
with  more  or  less  discomfort.  She  was  somewhat 
emaciated  and  the  lower  limbs  were  extremely 
eedematous.  The  urine  contained  six  grammes 
of  albumin  per  litre,  The  belly  was  smaller  than 
one  would  expect  in  view  of  the  period  of  gestation, 
but  the  fcetal  movements  were  distinctly  felt  and' 
the  fcetal  heart-beat  was  audible.  1 1  was  remarked 
that  the  uterus  lacked  the  limited  mobility  usual 
in  the  gravid  organ.  She  complained  of  ab- 
dominal pain,  recurring  in  spasms  and  accom- 
panied by  a  slight  discharge  of  blood.     Labour, 


J^JT^^SSfe^L^  !  however,  d,d  not  proceed,  and  the  pains  uluma.ely 


Poplar  and  one  each  from  Rethnal  Green,  Stepney, 

it—  have   been   admitted    to    the   Metro- 

ifclitan  Small-pox   hospitals.     There  are  now  44 

patients  under  treatment  in  London.     This  state 

lairs  naturally  gives  rise  to  a  good  deal  of 

dety. 


ceased.  From  this  time  the  foetal  heart  beat  ceased 
to  be  audible,  and  the  mother's  plight  underwent 
b  in  -irked  change  for  the  worse.  She  became 
more  and  more  emaciated,  the  albuminuria  per- 
sisted, and  finally  her  temperature  rose.  On 
i  vaginal  examination  the  cervix  was  not  obliterated, 


256     The  Medical  Press. 


CLINICAL  RECORDS. 


March  q.  1004. 


and  a  fulness  could  be  felt  in  the  posterior  cul- 
de-sac. 

On  October  8th,  as  a  blood  count  revealed  an 
increase  in  the  proportion  of  polynuclear corpuscles, 
I  determined  to  operate.  Having  obtained 
anaesthesia  by  rachis-cocainisation  I  punctured  the 
posterior  cul-de-sac  with  a  fine  needle  and  with- 
drew pus.  I  then  made  a  small  incision,  but  without 
obtaining  the  evacuation  of  much  fluid,  and  on 
introducing  my  finger  I  felt  the  foetal  bones,  so  that 
I  had  evidently  opened  up  the  gestation  sac. 
Thereupon,  I  passed  my  finger  through  the  cervix, 
which,  though  not  obliterated,  was  easily  perme- 
able, and  found  to  my  surprise  that  the  uterine 
cavity  was  empty;  in  fact,  it  was  evident  that  we 
had  to  do  with  an  ectopic  gestation  sac. 

The  patient's  condition  was  most  alarming. 
Her  pulse  was  thready  and  rapid,  and  her  collapse 
was  such  that  it  hardly  seemed  possible  that  she 
could  withstand  another  operation.  However, 
as  it  was  her  only  chance,  I  at  once  made  an  inci- 
sion twenty-five  centimetres  long  in  the  middle 
line,  through  which  I  withdrew  the  macerated 
foetus.  The  placenta  was  removed  without  occa- 
sioning any  bleeding.  I  left  the  wound  open, 
having  packed  the  cavity  with  gauze.  At  this 
stage  we  injected  artificial  serum  in  considerable 
quantity. 

The  subsequent  history  can  be  related  in  a  few 
words.  The  temperature  at  once  fell  to  normal, 
and  the  sac  rapidly  closed.  The  only  complica- 
tion was  the  formation  of  a  small  urinary  fistula 
which  soon  healed  spontaneously,  and  the  patient 
left  the  hospital  in  good  health  six  weeks  after  the 
operation.  A  small  sinus  still  remained,  but  was 
rapidly  cicatrising. 

The  interest  of  the  case  lies  in  the  difficulty 
with  which  the  diagnosis  was  arrived  at.  Of 
course,  laparotomy  is  of  ten  performed  in  the  treat- 
ment of  ectopic  gestation,  but  in  this  instance  the 
central  position  and  general  appearance  of  the  cyst, 
even  when  exposed  by  an  exploratory  laparotomy, 
led  to  its  being  taken  for  the  uterus.  Yet  it  must 
"be  admitted  that  there  were  certain  signs  which, 
looking  at  the  case  in  the  light  of  our  subsequent 
experience,  might  have  suggested  the  possibility 
of  the  case  being  one  of  extra-uterine  gestation, 
such,  for  instance,  as  the  post-cervical  tumefaction. 
As  already  explained,  the  spherical  outline  and 
median  position  of  the  cyst  led  us  to  ignore  this 
indication,  so  certain  did  we  feel  that  the  tumour 
felt  above  the  pubes  was  the  gravid  uterus.  Had 
we  employed  the  uterine  sound  much  assistance 
would  have  been  obtained,  but  I  need  not  insist 
upon  the  reluctance  with  which  one  has  recourse 
thereto  in  such  cases. 

Then,  too,  when  the  patient  re-entered  the 
hospital  for  the  purpose  of  delivery,  certain  signs 
ought,  perhaps,  to  have  put  us  on  our  guard — viz., 
the  immobility  of  the  tumour  and  the  resistance 
of  the  abdominal  walls,  but  these  conditions  might 
conceivably  be  due  to  various  causes  other  than 
extra-uterine  pregnancy.  I  do  think,  however, 
that  by  means  of  careful  bimanual  exploration  it 
would  have  been  possible  to  discover  the  ovoid 
body  on  the  right  of  the  tumour  which  turned  out 
to  be  the  empty  uterus.  I  repeat  that  what  misled 
us  was  the  steady  development  of  the  cyst, 
exactly  in  the  position  normally  occupied  by  the 
uterus.  The  case  illustrates  once  again  the  many 
difficulties  which  the  diagnosis  of  extra-uterine 
pregnancy  may  present  with  the  result  that  when 
present  it  is  often  mistaken  for  some  other  affec- 


tion and  is  not  unfrequently  diagnosed  when  non- 
existent. On  the  whole  I  can  only  congratulate 
myself  on  the  happy  issue  of  my  intervention, 
though  my  satisfaction  is  attenuated  by  the  reflec- 
tion that,  had  we  operated  earlier,  we  might  have 
saved  not  only  the  life  of  the  mother  but  also  that 
of  the  infant. 


Clinical  IRecor&s. 

PSORIASIS    IN   CHILDREN. 

By  G.  Norman  Meachen.  M.D.,  B.S.,  M.R.C.P.. 
Physician  for  Skin  Diseases,  Tottenham  Hospital. 

The  influence  of  age  in  determining  the  course, 
clinical  appearances,  and  other  manifestations  of 
disease  is  by  no  means  the  least  important  or  in- 
teresting among  its  etiological  factors.  With  regard 
to  cutaneous  disorders,  there  are  very  few  that  are  not 
met  with  in  infancy  and  childhood,  but.  like  other 
maladies,  certain  features  may  be  intensified  or  sup- 
pressed in  varying  degrees,  so  that  an  altogether 
different  picture  may  be  presented  in  the  child  from  that 
which  is  commonly  seen  in  the  adult.  Psoriasis  is  a 
disease  which  is  distinctly  rare  in  infancy,  but  when 
it  does  occur  it  forms  no  exception  to  the  general 
principle  of  age-modification. 

A  male  infant,  at.  2J,  was  brought  to  my  out-patient 
department  with  the  history  that  the  child's  body  had 
been  covered  with  spots  for  two  months.  The  mother 
stated  that  she  had  had  "  acute  rheumatism,"  for 
which  she  was  attended  by  a  doctor,  and  that  she  had 
also  suffered,  as  well  as  her  sister,  from  an  exactly 
similar  skin  eruption  some  years  ago.     On  examination. 


Casi   of  Pm-kjams   in        ■    •;    i-     i-T.    2 \. 

the  whole  of  tlit-  trunk  was  covered  with  discrete , 
nummular  patches,  typical  of  psoriasis,  the  scaJe> 
being  somewhat  profuse  and  easily  detached.  The  photo- 
graph  shows  how  Loosely  they  were  attached*  There 
were  a  few  sjjflts  upon  The  face  and  some  scaly  patches 
upon  the  scalp.  The  eruption  was  best  marked  & 
the  dorsal  region  ami  front  oi  the  chest,  the  buttock* 
and  grmns  being  less  affected,  while  the  lower  extie- 
ties  were  perfectly  clear.  I'pon  the  arms  the  rash  W 
complicated  by  a  moist  eezemalous  condition,  pn* 
bftbly  secondary  in  origin.  The  child's  general hea ft li 
was  good,   with   the  exception   that   the   bowels  were 


March  9    1904. 


SPECIAL  ARTICLES, 


The  Medical  Press,      257 


tftstipated.     There   did   not   appear   to   have 
retkm  in  the  dieting.      1  should  mention 
that  the  ca>e  was  kindly  sent  to  me  from  the  medical 
in-patient  department  by  Di\  G.  P.  Chappeh 
J  prescribed   the  pharmacopoeia!  ung,  picis.  liq.   for 
ation  to  the  spots  on  the  body  ;  the  nag,  hydrarg. 
jmVLon*  for  the  places  on  the  scalp  and  on  the  face  ; 
1  mixture  of  soda  and  rhubarb  internally,  together  with 
a  lotion   of   "  cyllin  "    (formerly    known    as   creolin), 
\  mek  after  this  treatment   the  eruption  had  nearly 
disappeared   from    the    trunk,    all    the   scales    having 
vanished.     The   ammoniated    mercury    ointment    was 
.Muted  with  the  ung,  zinci  cum  plumb*  acet*  for  ap- 
•n  to  the  forearms. 
All  ottservers  are  agreed  as  to  the  rarity  of  psoriasis 
More  the  fifth  year  of  life.     In  a  series  of  334  cases 
ilisease  collected  by  Pietro  Benassi  (Ctorn.  itaL  d. 
Mai,   Vc*.  e  detlt  Pelte,  vol.  xliv,    1003),   of   Bologna, 
fourteen  were  met  with  before  the  age  of  ten.    The 
lafWt  case  on  record  is  that  of  M«  Rille  {Jaurn.  des 
cutan*  et  syph>.  vol.   xi,    1899)4   where  the  afiee- 
ccurred  in  an  infant,  five  days  old,     A  few  cases 
have  been  reported  in  children  from  three  to  eighteen 
months     old.       Rille    has     drawn     attention    to     the 
hat  psoriasis  may  occur  after   vaccination,  but. 
1  he  readiness    with   which   parents  among    the 
hospital  out -patient  class  ascribe   cutaneous  eruption 
16  the  effects  of  vaccination,  too   much   stress  cannot 
r.l  upon  this  as  an  exciting  factor  in  the  production 
oJ   the    malady.     The    connection    between    psoriasis 
■  «ne  or  other  of  the  acute  exanthemata  is  some- 
more  obvious.     The  influence  of  heredity  would 
•ftcn  appear  considerable,  and  Besuier  and  Doyen  have 
;  that  in  the  majority  of  cases  of  infantile  psoriasis 
ily  history  of  the  disease  is  usually  obtainable. 
present  case,  it  will  be  noticed  that  the  child's 
mother  and  aunt  had  both  suffered  from  it.  and  in 
tl   other      instances    ^hich    I    have   come   across 
lasts  in  rather  older  children — »>♦.  from 
—  I  have  not  failed  to  obtain  some  evidence 
^enee  of  the   malady  in  other  members  of 
rnily 
The  chief  characteristics  of  infantile  psoriasis  may 
to    be    the   smaller    sise   of    the   individual 
heir    tendency    to   a    punctate,    guttate,    or 
r     I'.riTL     the    liability    to    complication    by 
moist   eruptions,    the   easily   detached   con- 
he  scales,  and  the  less  extensive  area  oi    Ji- 
of    the    lesions,     In    my    case,    the   gradual 
of    the  eruption    from    the   lumbar   region 
:y    noticeable,     and    it    was    also 
that  the  disease   affected   the  flexor  surfaces 
nk  and  upper  limbs   quite  as  much  as   thi- 
latter  feature   is  not  infrequently  ob- 
adults,     A   readier   response   to   treatment 
be  noticed  in  psoriasis  in  childhood,  but  this  is 
ren  in  many  other  kimls  of  skin  diseases,  and  is 
lue    to    the    greater   cutaneous    reaction    to 
medication  which  is  met  with  in  the  earlier 
tte. 


Spectal  Articles, 

BRITISH    SANATORIA    FOR    CONSUMPTION,— 
XXXVI 


[BY   OUR    SPECIAL    HEDJCAL    COMMISSIONER.] 

SHERWOOD  FOREST  SANATORIUM. 

>ur  previous  articles  we  have  on  several  occasions 
to  draw  attention  to  the  advantages  of  a  judicious 
:  ition  of  public  bodies  111  establishing  and  main- 
taining institutions  for  the  consumptive  poor,  and  we 
have  already  described  such  interesting  experim. 

•riaas  those  of  Ketling,  at  Holt  for  the  tuberculous 

writers    of    Norfork,  the    Westmorland     Sanatorium. 

It  ts  only  by  adequate  combination  of 

'  or   philanthropic  supporters   that    sanatoria   for 

the  poor  consumptive  of   our   various    counties    can 

be  efficiently  conducted, 

riant  work  for  the  phthisical  of  Nottingham 


and  district  is  being  carried  out  at  the  Sherwood  Forest 
Sanatorium  by  the  Nottingham  and  Nottinghamshire 
Association  for  the  Invention  id  Consumption.  The 
objects  of  this  body  are  defined  as  : — 

"  {a}  To  establish  in  the  County  of  Nottingham  a 
sanatorium  for  the  treatment  of  consumption  in  persons 
of  limited  means  ;  (&}  to  spread  a  knowledge  of  the 
laws  oi  health,  and  to  encourage  voluntary  measures 
tending  to  reduce  the  causes  of  tuberculosis  ;  (c)  to 
co-operate  in  educational  and  voluntary  measures  with 
the  National  Association  for  the  Prevention  of  Con- 
sumption, and  with  its  local  branches,"  The  Associa- 
tion has  influential  supporters  and  a  committee  which 
is  responsible  for  the  conduct  of  the  sanatorium.  We 
were  privileged  to  visit  the  institution  in  company  with 
the  House  Committee  and  one  of  the  hon+  secretaries* 
Dr.  Wr  B.  Ransom,  who  is  also  one  of  the  hon.  con- 
sulting physicians. 

The  sanatorium  is  situated  on  high  ground  in  pic* 
turesque  country  at  Ratcher's  Hill,  in  Sherwood 
Forest,  The  estate  consists  of  fifty  acres  of  pine  wood 
and  heather-covered  moorland,  and  was  presented  by 
the  Duke  of  Portland,  The  site  is  excellent,  the  soil 
is  sandy,  and  pines  afford  considerable  protection  and 
admirable  opportunities  for  enjoyable  outdoor  hfe, 
The  elevation  is  470  feet  above  sea-level,  and  towards 
the  south  there  is  a  wide  expanse  of  open  country. 
Mansfield,  the  nearest  town,  is  about  three  miles  dis- 
tant and  is  in  telephonic  communication  with  the 
sanatorium. 

The  building  has  been  erected  bv  the  Portable 
Buildings  Company,  of  Fleetwood,  It  is  constructed  of 
wood,  with  double  walls  placed  on  a  brick  foundation. 
The  double  walls,  with  a  layer  of  felt  and  air-space 
between,  are  said  to  secure  warmth  m  winter  and  cool- 
ness in  summer.  Long  and  wide  glass-covered  veran- 
dahs have  been  constructed  on  both  sides  of  the  wards, 
thus  allowing  of  a  ready  and  convenient  arrangement 
of  the  patients  so  that  according  to  the  state  oi  the 
wind  shelter  may  be  obtained  and  life  m  the  open  be 
fully  maintained.  The  wards  are  light,  clean,  and  so 
constructed  as  not  to  harbour  dirt. 

There  are  several  shelters  near  the  main  building,  and 
there  is  at  present  accommodation  for  twenty^aix 
patients,  thirteen  of  each  sex, 

There  is  a  good  electric  light  installation,  the  dynamo 
being  worked  by  an  oil  engine.  The  building  is  heated 
by  low  pressure  hot  water,  in  pipes  and  radiator 
The  drainage  is  on  the  water  system,  and  the  sewage  is 
dealt  with  in  a  septic  tank,  A  good  supply  of  water  is 
obtained  from  the  Mansfield  Water  Works.  The  con* 
struct  ion  and  equipment  of  the  sanatorium  has  cost 
over  £5,000.  The  initial  cost  per  bed  is  placed  at  £220, 
It  is  estimated  that  at  but  slight  additional  expense 
provision  can  be  made  for  an  addition  of  twelve  patients* 

Treatment  is  conducted  on  strict  hygienic  lines*  A 
lady  medical  acts  as  resident  medical  officer.  There  is 
a  matron,  sister,  and  probationer  and  staff  of  servants. 
On  all  hands  there  is  evidence  of  efficient  oversight, 
judicious  economy,  and  common-sense  management. 
We  were  glad  to  find  that  much  local  interest  and 
support  were  forthcoming  ;  there  are  visiting,  house, 
and  after-care  committees,  all  of  which  appear  to  be 
accomplishing  much  good  work. 

Two  practitioners  resident  in  Mansfield  act  as  hon, 
visiting  medical  officers  in  case  of  need  ;  and  there  are 
four  hon,  consulting  physicians.  According  to  the 
last  medical  report  available,  during  the  first  eleven 
months  of  the  existence  of  the  sanatorium  (which  was 
opened  for  patients  February  3rd,  1902),  61  patients 
were  admitted,  41  were  discharged,  and  of  these  only 
11  were  m  an  early  stage,  while  21  were  classified  as 
serious,  and  9  as  advanced.  Recently  encouraging 
results  have  been  obtained,  but  hitherto  it  has  not  been 
found  possible  to  find  desirable  forms  of  out -door  work 
suited  to  the  physical  condition  of  the  patients, 

The  manner  of  management  presents  man)'  features 
of  interest.  According  to  the  rules,  only  those  persons 
are  eligible  for  admission  who  "  (a)  satisfy  the  Ouri- 
mittee  that  they  are  unable  to  pay  for  treatment  in  a 


258    The  Medical  Press.     CONTINENTAL  HEALTH  RESORTS. 


March  9,  1904. 


private  institution,  or  to  obtain  proper  treatment  at 
home ;  (b)  are  certified  by  one  of  the  consulting 
physicians  to  be  in  such  a  stage  of  the  disease  as  to 
afford  reasonable  expectation  of  permanent  improve- 
ment or  cure."  Patients  must  live  in  the  county  of 
Nottinghamshire,  or  within  ten  miles  of  its  borders  ; 
but  preference  is  given  to  inhabitants  of  the  county. 
We  understand  a  number  are  now  on  the  "  waiting 
Ust."  Much  care  is  taken  in  the  selection  of  cases,  many 
being  first  kept  under  observation  by  the  examining 
physician  in  the  Nottingham  General  Hospital. 
Patients  are  admitted  to  the  sanatorium  "  (a)  on  the 
nomination  of  persons  or  groups  of  persons  called 
nominators,  who  pay  the  cost  of  maintenance  of  a  bed 
and  have  the  right  of  nominating  to  that  bed,  subject 
to  the  by-laws  drawn  up  by  the  Committee  ;  (b)  on 
the  recommendation  of  members  of  the  Association  ; 
(c)  the  Committee  shall  have  power  to  enter  into  any 
agreement  with  any  local  authority  for  the  reception 
of  sick  inhabitants  of  the  district  of  such  authority 
(subject  to  these  rules  and  to  any  by-laws  made  by 
the  Committee)  on  payment  of  such  annual  or  other 
sum  as  may  be  agreed  upon."  Persons  or  groups  of 
persons  subscribing  £7$  annually  have  the  right  of 
nomination  to  a  Free  Bed  for  one  year.  A  subscription 
of  £40  annually  gives  a  nomination  for  six  months,  and 
£20  for  three  months.  Persons  or  groups  of  persons 
may  also  become  Nominators  to  a  bed  for  which  the 
patient  pays  ten  shillings  a  week  on  the  following 
terms  : — "  50  guineas  for  one  year  ;  26  guineas  for  six 
months  ;  and  1 3  guineas  for  three  months.  If,  how- 
ever, all  the  beds  are  not  allotted  to  nominators  and 
the  income  of  the  Association  permits,  persons  may  be 
admitted  on  the  recommendation  of  a  member  to  a 
free  bed,  to  a  partly  free  bed,  or  to  a  paying  bed,  where 
the  patient  pays  the  whole  cost  of  his  maintenance 
(31s.  a  wesk)." 

The  Notts  Consumption  Sanatorium  is  worthy 
of  careful  study  by  all  county  authorities,  public 
bodies,  and  combinations  of  benevolent  persons 
anxious  to  alleviate  the  lot  of  the  phthisical  sufferer 
and  lessen  the  prevalence  of  human  tuberculosis.  It 
affords  an  excellent  example  of  good  work  accom- 
plished in  the  face  of  considerable  difficulties  and  at 
almost  a  minimum  of  expenditure. 

Continental  Dealtb  IResorts, 

RIVIERA    NOTES— CANNES. 


[from  our  special  correspondent.] 


Years  ago  our  British  people  came  to  the  Cote 
d'  Azur  for  rest  and  for  health.  Now,  the  Riviera  seems 
chiefly  sought  for  pleasure.  Each  year  the  "  season  " 
here  grows  shorter ;  visitors  come  later  and  go  away 
earlier.  Even  the  most  comfortable  trains  begin  in 
what,  not  long  ago,  would  have  been  considered  the 
middle  of  the  season,  and  are  taken  off  before  what  are 
really  the  most  agreeable  months  on  the  Riviera. 

For  those  busy  bread-winners  and  active  politicians 
who  cannot  spare  a  longer  play-time,  this  brief  breathing 
spell  is  better  than  none  ;  but  for  those  who  have 
leisure,  and^especially  for  those  who  are  invalid,  delicate, 
or  need  rest  and  a  climatic  change,  the  old  custom 
of  coming  in  October  or  November,  and  remaining 
along  the  Mediterranean  Coast  until  May,  was  de- 
cidedly the  better  and  safer  course.  To  derive  benefit 
from  a  climatic  change,  it  is  well  to  get  acclimatised 
before  winter  commences ;  better  still,  not  to  whirl 
away  from  a  southern  climate  abruptly,  before  May 
has  ameliorated  our  insular  weather. 

Years  ago  likewise,  medical  writers  dwelt  much  on  the 
climatic  differences,  and  these  are,  of  a  truth,  morenotice- 
able  between  not  only  the  different  resorts  on  the  Riviera, 
but  also  of  the  really  diverse  "  zones  "  at  each  of  the 
principal  Riviera  resorts.  Comparisons  and  statistics 
abounded  in  medical  articles  and  books  formerly. 
Now,  so  many  thousands  of  our  people  come  abroad 
that  everyone  is  supposed  to  know  all  that  is  necessary 
about  Continental  places. 


This  idea  of  the  superiority  of  present  day  know- 
ledge is  a  fallacy,  as  is  nowhere  more  apparent  than  on 
the  Riviera.  All  along  the  coast  one  meets  families 
in  hotels  and  villas  located  precisely  where  one  or  more 
of  the  members  ought  not  to  be  even  for  a  limited  visit. 
It  would  have  been  better  for  their  health  had  they  stayed 
away.  If  one  asks  why  they  selected  that  particular 
place,  the  reply  is,  "Somebody  said  to  them  'go  to  the 
Riviera,'  or  others  recommended  such  and  such  hotels." 
It  is  old  adage,  "  One  man's  meat  is  another  man's 
poison."  So  on  the  Riviera,  some  towns  suit  certain 
constitutions  and  benefit  some  individual  or  transient 
states  of  health  which  would  not  suit,  and  might  even 
be  detrimental  to,  other  peculiarities  and  constitutions. 
In  the  same  towns  even  different  localities  vary  notice- 
ably. Continental  physicians  seem  to  be,  at  present, 
studying  these  phases  of  the  question  more  actively 
than  our  own  medical  writers.  The  "  Index  Medical," 
recently  published  by  the  Syndicat  General  des  Medecins 
des  Stations  Balneaires  et  Sanitaires  de  France,  gives 
an  admirable  rhurrJ  of  the  climatic  and  other  advan- 
tages of  Cannes,  and  of  the  indications  for  its  different 
residential  zones,  relative  to  particular  cases,  needs, 
and  constitutions. 

Medically  considered,  Cannes  includes  the  large 
territory,  formerly  the  great  valley  of  the  Liagne  river, 
embraced  between  Cap  Roux  of  the  Esterel  range  on 
the  west,  and  on  the  east  by  the  spurs  of  the  Alpes 
Maritimes,  terminating  at  the  Croisette.  This  territory 
of  triangular  shape,  the  town  of  Cannes  lying  at  its 
southern  base,  and  the  town  of  Grasse  at  its  northern 
point,  is  well  shielded  by  heights,  especially  from  north 
and  west  winds— i.e.,  from  mistrals  by  mountains,  and 
by  wooded  hills  from  undesirable  easterly  winds  coming 
across  the  Gulf  of  Genoa  and  from  the  snow  peaks  01 
Northern  Italy.  It  lies  open  to  southern  winds  and 
sea-breezes.  It  is  broken  up  in  the  interior  of  the  plain 
and  in  Cannes  itselt  by  a  variety  of  small  hills,  the 
chains  of  which  run  chiefly  north  and  south,  affording 
many  sites  more  or  less  elevated.  These  sites  are  much 
varied,  some  on  summits,  some  in  glades,  others  on 
hill-sides  amid  woods  and  flowers.  Sheltered  or  in 
open  spaces,  shaded  by  trees,  or  in  full  sunlight ;  near 
the  sea  or  inland  ;  in  spacious  vivifying  atmosphere, 
i  or  in  calm  and  sedative  seclusion  ;  in  all  kinds  of 
1  positions  are  residences,  elegant  or  modest,  suitable  for 
I  a  variety  of  purses  and  of  preferences.  In  this  lies 
the  great  charm  of  Cannes,  as  compared  with  less 
I  varied  and  less  favoured  seashore  resorts.  Owing  to 
'  the  convenient  elevations  on  which  in  large  gardens  are 
many  picturesquely  situated  villas  and  hotels,  as  the 
Hotel  Continental  on  a  rock  yet  only  five  minutes  from 
the  central  sea-side  square,  visitors  can  very  agreeably 
remain  at  Cannes  throughout  April  and  May  ;  and 
at  the  neighbouring  town  of  Grasse  (1,100  feet  altitude) 
even  until  midsummer.  The  numerous  easy  excursions 
around  Cannes  and  Grasse,  among  hills,  woods,  and 
vales  rich  in  flora,  mediaeval  villages,  prehistoric 
vestiges,  and  grand  scenery,  make  the  montns  of  April, 
May,  and  early  June  the  most  pleasant  here  of  the  year. 
Those  who  do  not  wish  to  travel  long  distances,  yet 
desire  to  derive  all  the  benefits  of  summer  at  an  Alpine 
altitude,  would  find  at  the  Grand  Hotel  Climateriqueof 
Thorens  (three  hours'  drive  from  Grasse  railway  station), 
a  very  desirable  summer-home,  over  4,000  feet  above 
ocean-level,  amidst  vast  forests  and  great  hills,  and  in 
every  respect  most  comfortable.  Tne  high  valley  of 
Thorens  consists  of  about  12,000  acres  of  park-like 
ground,  broken  up  by  woods  and  rock  terraces,  the 
views  extending  from  snow-covered  Alps  to  the 
Mediterranean  ;  and  its  mountain  atmosphere,  tem- 
pered by  pine  forests,  is  delicious  and  fortifying. 

^Transactions  of  ©octettes. 


HARVEIAN  SOCIETY  OF  LONDON. 
Clinical  Meeting  at  St.  Mary's  Hospital, 
February  25TH,   1904. 
Dr.  D.  B.  Lees  showed  a  case  of 

APHASIA       WITH     ANOMALOUS    SYMPTOMS, 

also  a  case  illustrating  the  use  of  large  doses  of  sodium 


March  9.  1904- 


salicylate.  This  patient  had  taken  at  irregular  periods 
a*  much  as  400  grains  of  sodium  salicylate  in  com- 
bination with  potass,  bicarbonate  per  diem »  and  if  the 
drug  was  disco  n  ti  n  ued  sy  mp  toms  i  mmedi  a  tel  y  recurred- 
This  case  exhibited  well  the  great  tolerance  patients 
had  or  soon  acquired  tor  sodium  salicylate. 

Dr*  Phillips  remarked  that  he  never  used  such  heroic 
doses  of  sodium  salicylate,  but  in  these  cases  prelerred 
aspirin. 

Dr,  Wm.  Hill  inquired  the  cause  of  absence  oi 
tinnitus  when  administering  these  large  doses  of  sodium 
salicylate.  Was  it  due  to  the  combination  with  potass, 
lucaibonate  7 

The  President  inquired  of  the  cause  t>i  aphasia  in 
the  first  case — Cft,  what  was  its  pathology  in  this 
l£e  J  In  t lie  second  case,  was  she  to  continue 
liCg  Lit*.-  k*r  ever  ? 

Dr  Lees  said  salicylate  in  large  doses  was  really 
ifortny,  and  we  wTere  discouraged  when  ear  sym- 
ptoms appeared,  and  immediately  discontinued  the 
drug.  Tie  pathology  of  tinnitus  was  probably  that  of 
pirtial  cerebral  thrombosis 

Dr.  Sidney  Phillips  showed  a  case  of 

Q5TEO-ARTHR[TIS    OF    THE   SPINE, 

m  which  there  waft  thickening,  pain,   tenderness,  par- 

iial  fixation  by  spasm  and   rigidity  over  the  upper  lour 

uuraal  spines.     The  head  was  slightly  flexed  to  the  left 

and  rol  n  angle  to  the  vertebra?.      The  deltoid, 

and  triceps  on  the  one  side  were  wasted,  and 

[heft  was  deformity  oi  the  fmgeft,  with  glossy  skin  and 

same  hand,  suggesting  pressure  on  the 

es  in  the  inter-vertebral  l)r.    Phillips 

thought  these  cases  much  more  common  than  is  usually 

ignmed 

Mr.  LocRhART  Mummery  considered  the  case  to  be 
*)fie  of  those  called  Bp  md\  lilis  deformans. 

Mr,  Silcock  considered  it  the  type  of  disease  found  10 
workers  in  the  open  air,  and  was  very  ancient,  being 
bond  in  Roman  bones. 
Dr.  Phillips  did  not   consider  it   to  be  one  of  th? 
lary  type  referred  to.  but  it  seemed  to  him  to  be  a 
case  of  pure  osteoarthritis  of  the  spinal  articulations* 
Dr*  Cale^  a  case  ol 

S    DISEASE    WITH    SPLENOMEGALY. 

Dr,  1LEY    asked    Dr.  Caley  if  the  splenic 

notch  was  in  a  normal  condition,  that  is,  was  the  growth 
symmetrical  ?  He  had  seen  a  case  with  twisting  of  the 
pedicle  m  which  the  organ  enlarged,  then  subsided,  but 
Ir ft  some  permanent  enlargement.  This  case  might  be 
dl  the  same  nature. 

Dr.  Caley  thought  the  axis  normal,  and  notch  pro- 
portionately normal,   but  was  l<»<>   lender  to  examine 
osl  twisting  of  the  pedicle  was  the  fact 
that  symptoms  came  on  when  the  patient  was  at  rest. 
The" President  commented  on  the  case. 
Mr.  A,  Q,  Silcock  showed  a  woman,  set.  30,  who  bad 
been  the  subject  of  a  dermoid  cyst  of  right  side  of  chest. 
She  was  admitted   to  St.  Mar  r  Dr.   Lees,   in 

presumably  suffering  from  empyema, 
■  pened  and  found  to  contain  a  large  quantity 
ebaceous    material    mixed    with    pus. 
linatii  n  proved  the  (?)  empyema  to  be  a 
mpptn  rmoid  cyst.      Portions  of  the  cyst  wall 

removed  at  intervals,  the  patient  being  too  weak 
ged  operations.      As  a  result,  the  cavity 
became  smaller  and  the  suppuration  diminished.  Finally 
the  Whole  of   the  remaining   cyst   wall    was   dissected 
dock  remarked    upon    the   infrequency 
affection,  and  upon  the  iact  thai  many  oi  the 
ad  been  mistaken  lor  empyema.     The 
ibout  the  sii  I  or  larger.     He  had 

been  unable  to  find  a  case  in  which  a  cyst  of  this 
te  Lad  been  extirpated,  and  pointed  out  the  difficulties 
pecially  in  separating  it  from  the  peri- 
Lin. 
Dt   Lees   considered    the   case    practically   unique. 
admitted  he  thought  it  to  be  a  pleuritis;  there 
Ught  pain  in  the  side,  with  cough;  the  heart  was 
L  far  into  the  left  axilla,  a  point  against  pleurisy, 
bnl  which  may  be  present  in  hydatid  of  the  lung  or 
liver.    The  case  was  difficult  to  examine. 


TRANSACTIONS  OF  SOCIETIES.        The  Medical  Press.     259 


Mr.  Clayton  Greene  showed  a  case  of  hernia 
cerebri  following  a  compound  depressed  tract ure  of  the 
skull.  The  patient,  a  girl,  set.  10,  leU  out  of  a  window 
into  an  area  on  October  26th,  and  was  admitted  under 
Mr.  Silcock.  In  spite  of  local  treatment  the  brain  pro- 
trusion increased,  a  leaden  plate  was  applied  without 
benefit,  absolute  alcohol  was  beneficial,  but  did  not 
check  the  hernia  cerebri,  carbolic  acid  was  useless, 
About  a  month  after  admission  a  mass  of  hernia  cerebri 
the  size  of  an  orange  was  excised  :  Jree  haemorrhage 
resulted,  which  adrenalin  failed  to  check. 

The  hernia  gradually  re- formed  and  surpasses 
original  size.  Everything  failing  to  remedy  this  condi- 
tion, it  was  again  removed,  this  time  by  means  ot  an 
electric  snare.  It  was  followed  by  little  bleeding  and 
no  shock.  Extensive  rcdema  of  eyelids,  face  and  neck 
appeared,  but  gradually  subsided,  Three  points  of 
interest  were  remarked  upon.  ( i  J  The  hernia  consisted 
largely  ot  brain  matter,  not  granulation  tissue.  (2) 
All  treatment  short  of  removing  the  protrusion  was 
ineffectual.  (3)  In  spite  of  abscision  of  a  large  portion 
oi  the  frontal  lobe,  there  was  no  loss  of  intelligence, or 
moral  perversion,  as  far  as  could  be  judged.  The  facial 
paralysis  was  rapidly  improving, 

Mr.  Silcock  considered  the  condition  due  to  exten- 
sion of  the  suppuration  into  the  cranial  cavity,  and 
regretted  he  did  not  open  up  and  remove  bone  more 
freely  in  the  first    instance. 

Mr.  P.  L.  Daniel  showed  a  case  of  a  young  woman, 
l,  who,  immediately  after  delivery  of  a  second 
child  nineteen  months  ago,  was  seized  with  small  -pox. 
Seven  weeks  later,  when  she  returned  from  hospital,  she 
noticed  a  sin  ill  turn -or  on  the  right  side  6i  thorax.  Mr. 
Daniel  considered  the  case  to  be  cutaneous  actino- 
mycosis associated  wnh  visceral  involvement,  a  con- 
dition which  in  recent  yearS  was  shown  to  be  not 
uncommon,  and  was  considered  to  be  syphilitic  b€< 
it  cleared  up  under  potassium  iodide. 

Mr.  J  affray  referred  to  two  cases  of  a  somewhat 
similar  nature,  which  he  had  first  treated  as  gum  ma  la, 
which  did  not  break  down,  but  cleared  up  under 
potassium  iodide. 

Dr.  Graham  Little  showed  an  interesting  case  of 
lupus  associated  with  lichen  scrophulosorum.  An 
injection  of  tuberculin  (No.  1)  resulted  in  a  typical 
reaction,  in  which  the  lichen  scronhulosorum  partici- 
pated, becoming  vividly  red.  The  reaction  of  the 
lichen  scrophnlosorain,  and  its  association  with  a 
definite  tubcrculrnis  lesion,  was  interesting.  He 
exhibited  drawings  of  the  condition. 

Dr.  Nicholson  (for  Dr.  Cheadle)  showed  a  case  of 
11  primary  malignant  disease  oi  the  liver,  with  micro- 
scope specimens. 


LIVERPOOL  MEDICAL  INSTITUTION. 
Meeting  held  Thursday,  February  i8th,  1904- 


James  Barr,  M.D.,  F.R.CRf  President,  in  the  Chair, 

PERFORATING    ULCER    OF    THE   STOMA* 

Dr.  Buchanan  and  Mr.  W.  Thelwall  Thomas  re- 
lated a  case  in  which  an  operation  had  been  successfully 
performed  for  perforated  gastric  ulcer.  The  patient 
was  an  anaemic  girl  who  was  suddenly  seised  with  acute 
abdominal  pain,  for  which  she  was  admitted  into 
hospital.  The  diagnosis  was  at  first  doubtful,  the  con- 
tinued elevation  of  temperature  and  a  marked  leucocy- 
tosis  suggested  the  possibility  of  typhoid  fever.  The 
subsequent  progress  of  the  case,  however,  revealed  a 
localised  peritonitis,  which  was  thought  to  be  most 
probably  due  to  a  perforated  gastric  ulcer.  On  the 
twelfth  day  ol  the  illness  Mrt  Thelwall  Thomas  ope- 
rated. The  stomach  and  the  liver  were  adherent  to  the 
unal  wall,  and  on  separating  these  adhesions  a 
localised  abscess  was  opened  and  a  distinct  hole  seen  in 
the  stomach.  An  unsuccessful  attempt  was  made  to 
close  the  perforation  with  stitches,  and  finally  trie 
abdominal  wound  was  left  open  and  packed  with  gauze. 
Convalescence  was  prolonged,  but  the  patient  ulti- 
mately made  a  satisfactory  recovery. 


260    The  Medical  Press.         TRANSACTIONS  OF  SOCIETIES. 


March  9,  1904. 


PERFORATING    ULCER   OF    THE    DUODENUM. 

.Mr.  Damer  Harrisson  related  a  case  in  which  he 
had  successfully  operated  upon  a  man,  set.  45,  for 
perforating  ulcer  of  the  duodenum.  There  had  been 
no  previous  gastric  symptoms.  The  patient  was 
suddenly  seized  with  acute  abdominal  pain,  which  he 
referred  more  especially  to  the  right  iliac  fossa.  An 
operation  was  performed  eleven  and  a  half  hours  after 
the  onset.  A  perforated  ulcer  of  the  duodenum,  close 
to  the  pylorus,  was  found  and  closed  with  sutures. 

Mr.  Littler  Jones  referred  to  a  case  in  which  per- 
foration of  a  gastric  ulcer  had  occurred  at  midnight. 
The  patient  finding  that  the  pain  was  relieved  by  the 
knee-elbow  position,  remained  in  that  posture  all  night. 
At  the  operation  next  day,  there  was  found  an  anterior 
perforation  of  the  stomach,  with  little  if  any  extra- 
vasation, but  fair  adhesions. 

Dr.  E.  T.  Davies,  Mr.  Newbolt,  Mr.  George  Hamilton, 
Dr.  Carter,  and  Dr.  Macalister  took  part  in  the  dis- 
cussion on  these  cases. 

THE   TREATMENT   OF    MALARIAL   FEVER. 

Dr.  Carter  read  a  note  on  the  treatment  of  some 
cases  of  malarial  fever.  Four  cases  had  come  under 
his  care  during  1903  ;  they  all,  more  or  less,  resembled 
each  other.  They  were  cases  of  obstinate  continuance 
of  fever,  in  spite  of  all  the  ordinary  remedies ;  there 
was  complete  breakdown  of  the  general  health,  and 
loss  of  weight.  In  every  instance,  a  complete  and 
apparently  permanent  relief  of  all  symptoms  had 
followed  upon  the  administration  of  Warburg's  tincture. 
In  one  case  the  patient  had  suffered  from  frequent 
attacks  of  malarial  fever  during  the  last  three  years, 
and  during  the  last  attack,  in  spite  of  the  administra- 
tion of  large  doses  of  quinine,  the  temperature  rose  to 
1060  F.,  but  after  a  few  doses  of  Warburg's  tincture 
the  temperature  fell  to  normal,  the  general  health 
markedly  improved,  and  apparently  permanent  relief 
has  followed. 

Dr.  Briggs  read  a  paper  on  the 

TREATMENT  OF  SEVERE  CASES  OF  PLACENTA  PREVIA. 

By  severe  cases  were  understood  one  considerable,  or 
two  or  more  recurrences  of,  haemorrhage,  regardless  of 
the  degree  of  placenta  praevia.  The  paper  was  mainly 
based  upon  the  more  modern  means  of  treatment, 
which  promises  to  improve  the  results  obtainable  in 
the  management  of  these  cases.  Dr.  Briggs  first 
alluded  to  the  bag  devised  by  Champetier  de  Ribes, 
which,  together  with  its  forceps,  presents  an  incon- 
venient and  cumbrous  appearance,  hence,  possibly,  the 
comparative  rarity  of  the  use  of  the  bag  in  the  treat- 
ment of  severe  cases  of  placenta  praevia.  Its  use  could 
be  rendered  easy  by  preliminary  dilatation  of  the  cervix, 
by  the  finger  or  by  Bossi's  method  in  the  rare  instances 
in  which  the  latter  is  required.  The  twenty- two  cases 
tabulated,  and  the  conclusions  formulated  in  the  paper 
by  Dr.  Blacker,  in  the  Obstetrical  Society's  "  Trans- 
actions *r  for  1897,  were  freely  used  by  Dr.  Briggs. 
Blacker  quotes  the  words  of  Champetier  de  Ribes  : — 
"  I  should  be  disposed  in  a  case  of  placenta  praevia, 
with  no  pains,  to  rupture  the  membranes  when  I  was 
able  to  reach  them,  and  to  place  the  bag  within,  the 
amniotic  cavity.  I  am  convinced  that  the  bag  would 
form  an  excellent  tampon,  fulfilling  all  the  conditions 
necessary  in  these  grave  cases  to  ensure  the  best  result 
to  the  mother  and  to  the  child."  Dr.  Briggs  cited 
two  severe  cases  of  placenta  praevia,  as  illustrating  the 
value  of  the  treatment  he  advocated — ( 1 )  in  the  twenty- 
eighth  week  of  gestation,  when  the  cervix  was  closed, 
the  bleeding  was  free  and  labour  pains  absent ;  and 
(2)  a  full-term  labour  with  copious  haemorrhage.  In 
both  the  bag  was  used,  and  in  the  former  preliminary 
dilatation  was  effected  by  Bossi's  instrument,  which 
enabled  the  medical  attendants  to  complete  what  had 
been  a  presumptive  diagnosis,  and  to  introduce  the 
bag  of  Champetier  de  Ribes,  which  served  its  purpose 
by  controlling  the  bleeding,  inciting  and  completing 
labour  in  eight  hours.  In  the  second  case,  labour  had 
commenced  and  was  completed  with  a  living  child  in 
the  first  vertex  position,  in  two  and  a  half  hours  after 
the  bag  had  been  introduced.  Dr.  Briggs  then  referred 
to  De  Paoli's  nineteen  cases  of  placenta  praevia  treated 
/  Bossi's  method,  completed  in  five  to  twenty-five 


minutes,  without  laceration  of  the  cervix,  and  with  a 
death-rate  of  one  mother  and  three  children.  Dr. 
Briggs  expressed  his  opinion  that  rapid  delivery  in 
cases  of  placenta  praevia  was  becoming  a  more  common 
practice.  He  cited  his  own  experience  in  six  cases  in 
which  for  grave  internal  conditions  he  had  used  Bossi's 
method.  As  to  the  use  of  the  bag,  its  great  value  con- 
sisted in  its  easy  introduction,  its  standing  boiling,  and 
its  perfect  control  of  the  bleeding,  forming,  as  Dr. 
Herman  had  stated,  a  better*  haemostatic  wedge  than 
the  half -breech  of  the  child,  after  turning.  From  his 
own  experience  of  thirty  cases  treated  by  version,  he 
concluded  that  forcible  delivery  was  rarely  necessary, 
for  in  all  these  cases  the  bleeding  had  been  controlled, 
and  without  exception,  traction  on  the  child  was  not 
required  to  check  bleeding.  It  was  probable  that  in 
many  cases  haemorrhage  from  laceration  of  the  cervix 
during  podalic  version  was  a  source  of  bleeding,  due  to 
the  treatment  adopted.  The  interests  of  the  child  were 
improved  by  the  use  of  the  bag  of  Champetier,  and 
whenever  the  bag  was  available  it  ought  to  be  used  in 
the  treatment  of  placenta  praevia. 

Dr.  John  Gemmell  said  that  most  cases  of  placenta 
praevia  were  of  the  marginal  type,  and  in  these  the 
use  of  the  bag  was  not  necessary.  Further,  the  intro- 
duction of  the  bag  necessitated  the  presence  of  a 
second  medical  attendant  to  administer  an  anaesthetic, 
which  would  render  its  being  generally  employed  im- 
practicable. 

Dr.  Llewellyn  Morgan  relied  upon  tight  packing 
as  a  routine  treatment  in  cases  of  severe  haemorrhage. 

Drs.  Heatherley,  E.  T.  Davies,  Mackay,  Blair  Bell, 
and  Littlejalso  took  part  in  the  discussion,  and  Dr. 
Briggs  replied. 


THE  SOCIETY  FOR  THE  STUDY  OF  DISEASE 
IN  CHILDREN. 

A  meeting  of  this  Society  was  held  on  February 
19TH,  1904,  at  11  Chandos  Street,  Cavendish  Square, 
W.,  Mr.  R.  Clement  Lucas  in  the  chair. 

A  case  of  cerebral  diplegia  with  changes  in  the  fundus 
oculi  was  shown  by  Dr.  Robert  Hutchinson.  The 
child  was  aet.  17  months.  It  was  full  time,  the  labour 
was  easy,  and  there  was  no  history  of  syphilis.  All  its 
limbs  were  flexed  on  the  trunk,  the  muscles  were 
spastic  and  the  deep  reflexes  were  exaggerated.  It  -was 
imbecile.  The  optic  discs  were  atrophic,  there  was 
extensive  choroido-retinitis  and  diffuse  opacities  in  the 
lenses.  The  condition  was  thought  to  be  due  to 
arrested  development  of  the  cortex  cerebri,  probably 
syphilitic. 

A  case  of  progressive  cerebral  degeneration  of  the 
family  type  was  also  shown  by  Dr.  Hutchinson.  A 
boy,  act.  4,  was  healthy  until  aet.  10  months,  when  fits 
occurred  on  and  off  for  some  weeks.  Two  months  ago 
he  began  to  stagger  when  walking,  and  he  next  developed 
some  spasticity  of  the  legs  with  mental  apathy.  The 
optic  discs  were  becoming  atrophic.  There  was  another 
child  in  the  family  who  became  affected  in  the  same  way 
and  at  the  same  age.     There  was  no  history  of  syphilis. 

Mr.  Sydney  Stephenson  thought  the  case  belonged 
to  a  group  which  had  been  more  or  less  worked  out 
lately,  one  in  which  systemic  symptoms  were  those  of 
cerebral  degeneration,  which  were  correlated  with 
fundus  changes,  the  optic  discs  being  pale,  but  not 
necessarily  atrophic.  Smallness  of  the  retinal  vessels 
was  also  noticed,  and  fine  pigmentary  changes  in  the 
central  region  of  the  fundus.  He  had  seen  one  case  the 
offspring  of  a  consanguineous  marriage. 

Mr.  Jackson  Clarke  thought  the  cases  illustrated 
the  importance  of  consultation  with  a  physician  before 
surgical  treatment  was  undertaken  in  young  children 
with  general  spasticity. 

A  case  of  symmetrical  bilateral  branchial  fistula? 
with  symmetrical  bilateral  helical  fistulas  and  mis- 
shapen aural  pinnae  was  shown  by  Mr.  J.  Howell 
Evans.  In  the  cases  recorded  by  Sir  James  Paget  there 
was  a  very  definite  hereditary  influence.  There  were 
other  congenital  deformities  in  members  of  the  family 
in  Mr.  Evans'  case. 

Mr.  Mummery  did  not  agree  with  Mr.  Evans  that  the 


March  g, 


TRANSACTIONS   OF  SOCIETIES.  The  Medical  Press.     36* 


lisful*  m  the  Case  were  m  the  position  of  the  ioimh 

branchial  cleit  ;  lie  thought  it  was  the  third. 

Mr.  C  i  lwext  Lucas  said  the  cases  showed  the  ex- 

rv  tendency    th  He   had    seen 

istaken  Urt  glands  in  the  neck  owing  to 

In   reply,  said   it  was  the  third   cleft  as 
usiiA.Ur  reckoned,  but  he  was  inclined  to  view  it  differ  - 

V  portion  of  a  coin  catcher  which  had  been  removed 

trotomy  was  shown  by  Mr.  Donald  Armour. 
\  case  of  vertical  monocular  nystagmus  was  ihcmii 

OLD  LAWSON, 

An  early  case  of  Friedreich's  disease  was  shown  by 
Mr.  Jackson  Clarkel 

\  specimen  of  secondary  iflgio  oarcoroa  of  the  lung 
was  shown  by  Dr.  W.  A.  Wills  and  Mr*  Douglas 
Mr,  Drew  removed  the  bit  testicle  for  sarcoma 
m  April,  1903,  and  there  was  no  recurrence,  local  or 
general,  until  December,  1903,  It  was  thought  to  be  a 
case  of  empyema  when  admitted,  and  a  rib  was  rrsected 
to  sanguine  were  they  that  there  was  pus,  hut  at  the- 
resection  a  new  growth  was  disco  %rered.  At  the  post- 
ern it  was  thought  to  be  a  primary  sarcoma  oi 
(he  June,  hut  subsequent  inquiries  negatived  that  idea, 
and  the  case  illustrated  how  a  fallacy  might  arise  even 
a  very  careful  post-mortem  examination.  Mr. 
Ltoqgla*  Drew  reminded  the  Society  that  in  the  previous 
isiber  he  had  exhibited  the  child  as  one  of  cure  alter 
removal  of  sarcoma  of  the  testicle.  On  the  last  occasion 
ht  had  seen  the  child,  Dr.  Parkinson  had  found  no 
evidence  of  disease  in  the  lungs.  The  primary  growth 
vftfl  ad  enu- myxosarcoma.  The  lung  tumour  resembled 
the  primary  growth  in  part,  but  the  rest  of  it  was  of  the 
nature  of  angio-sarcoma  or  endothelioma. 

Dr.  Parkinson  thought  that  the  growth  started  at  the 
root  of  the  lung,  that  it  came  to  the  surface  compara* 
lively  late  and  that  was  why  there  were  not  any  physical 
signs* 

J>r.  WlLLS,  in  reply,  thought  the  growth  had  been 
extremely  rapid  at  the  last. 

A  case  of  anaesthesia  and  recurrent  ulceration  of  the 
gluteal  regions  from  spina  bifida  was  shown  by  Dr. 
Parkes  Weber, 

HkftJSCOpic  sections  of  the  kidney  from  a  case  of 
d  cedema  tn  an  infant  were  shown  by  Dr.  George 
ntejl  The  infant  was  breast- Jed.  It  was 
lirupsical  like  a  case  of  nephritis,  and  there  was  albu- 
minuria, but  no  tube  casts.  Post-mortem,  there  were 
lammatory  renal  changes,  but  the  kidneys  could 
not  be  looked  upon  as  absolutely  normal  in  that  they 
showed  exudation  between  the  glomeruli  and  their 
Jes  and  in  the  convoluted  tubules,  but  there  was 
■:<  rnpiete  absence  of  catarrhal  or  interstitial  changes. 
He  considered  the  condition  toxa;mic,  but  the  nature 
"i  the  toxin  was  not  obvious  or,  indeed,  the  cause  fur 

Dr.  Parkes  Weber  thought  the  case  was  an  example 
oi  what  could  be  called  toxemic  oedema  and  toxaemic 
albuminuria.  Absence  of  nephritis  in  such  cases  might 
He  due  to  personal  peculiarity.  Microscopic  sections 
heart  and  kidney  from  a  case  of  acute  oedema  of 
the  lungs  and  sudden  death  were  shown  by  Dr.  George 
Carpenter.  The  child  came  under  ubservatiou  clini- 
cally as  a  case  of  heart  failure,  and  it  was  diagnosed 
during  hie  as  one  of  uncomplicated  myocarditis,  The 
Drift!  was  loaded  with  albumin,  there  were  no  patellar 
reflexes  and  the  soft  palate  was  thought  not  to  move 
Ireelv,  There  was  no  history  of  diphtheria,  but  taking 
the  clinical  findings  into  consideration  the  condition 
was  thought  to  he  diphtheritic.  Dr.  Carpenter  drew 
Attention  to  his  observations  on  uncomplicated 
myocarditis  in  children  during  the  previous  session  and 

ded  in  the  Reports ol  the  Society,  and  published 
111  the   l.i*  poj,   and   said    that    the   case   well 

illustrated  the  clinical  conditions  met  with  in  those 
tast*  which  were  diphtheritic  and  rheumatic.  The 
child  died  lOddeniy  the  following  day.  The  heart 
ihowcd  well-marked  degenerative  changes, 
finding  in  one  of  his  published  cases, 
there  were  no  interstitial  changes  in  the  present  instance, 

the  Condition  was  not  inflammatory.     He  thought 


observations  should  more  frequently  be  directed  to 
the  microscopical  examination  of  the  cardiac  muscle  in  all 
■s  than  happened  at  present.  Clinically  in  his 
experience  cases  of  weak  cardiac  action  and  probably 
of  toxa?mic  origin  were  not  uncommon,  and  he  thought 
that  such  cases  as  he  had  called  attention  to  would  be 
more  frequently  discovered  it  looked  for. 

Dr.  Hutchinson  said  he  agreed  with  Dr.  Carpenter' s 
view  that  the  condition  of  the  heart  was  due  to  the 
diphtheritic  p  uson. 

Dr.  C.  Q.  Hawthorne  was  disposed  to  agree  with  Dr. 
Carpenter.  Cases  of  sudden  syncope  after  diphtheria 
were,  of  coins.  urll  known*  Dr.  Carpenter's  case,  in  all 
probability,  a  Horded  a  demonstration  ot  the  manner  in 
which  these  disasters  were  produced, 

Pr  C  W,  Chapman*  narrated  a  case  of  post  -diphtheritic 
rapid  cardiac  dilatation  with  syncope* 

Dr,  Parkes  Weber  thoughtthat  Dr.  Carpenter  had 
hit  upon  the  only  possible  explanation. 

Mr,  Clement  Lucas  thought  the  case  showed  that 
the  condition  might  easily  be  overlooked.  He  called 
1  attention  to  an  epidemic  of  slight  sore  throats  in  a 
surgical  ward  where  the  diphtheria  bacillus  was  found 
in  swabs  taken  irom  these  throats,  but  the  patients  had 
no  serious  symptoms. 

Dr.  Carpenter,  in  reply,  said  a  girl  a?t,6.  under  his 
care  for  cardiac  failure,  with  a  systolic  apex  bruit,  a 
dilated  heart,  and  a  pulsating  liver  and  albuminuria 
completely  recovered  in  due  course  and  before  she 
developed  paralysis  of  the  soft  palate  nearly  a  month 
after  she  was  first  seen,  which  thus  clearly  demon- 
strated the  nature  of  the  toxaemia,  though  at  the  time 
ihexause  of  the  heart  failure  was  not  obvious. 

A  paper  on  the  treatment  of  hernia  in  young  children 
was  read  by  Mr.  Lockhart  Mummery. 

Mr  Clement  Lucas  alluded  to  the  special  difficulty 
in  young  children,  that  of  isolating  the  vas  deferens 
from  the  sac.  There  was  a  real  danger  of  destruction  in 
inexperienced  hands. 

Mr.  Mummery,  in  reply,  said  it  was  precisely  that 
difficulty  referred  to  by  Mr.  Lucas  to  which  he  alluded. 

The  organs  from  a  case  of  hemi-hypertrophy  were 
shown  by  Dr.  Robert  Hutchinson.  Hewasahealihv. 
well -developed  child  with  three  small  capillary  nsvi 
in  the  skin.  The  left  arm  and  leg  were  hyperlrophied, 
and  to  some  extent  the  trunk  also.  The  asymmetry  of 
t  hi  Li  mbs  was  apparently  due  to  an  increase  of  the  subcu- 
taneons  tissues  of  the  left  side,  resembling  a  diffuse 
lipoma.  He  subsequently  developed  an  empyema 
and  died.  The  increased  thickness  of  the  left  limbs 
was  entirely  owing  to  an  increased  deposit  of  subcu- 
taneous fat.  The  bones  were  normal.  Most  of  the 
paired  organs  were  decidedly  larger  on  the  left  side  than 
on  the  right.  The  left  lobe  o(  the  thymus  was  larger, 
but  the  two  lobes  of  the  thyroid  were  symmetrical. 
The  liver  contained  some  multiple  angiomata,  He 
thought  the  condition  must  date  back  to  embryonic  life 
and  be  in  consequence  of  unequal  segmentation  in  the 
ovum. 

\n  Hawthorne  alluded  to  a  case  of  Dr.  MacGregor's. 
of  Glasgow,  where  the  hypertrophy  was  limited  to  the 
lower  limb.  Post-mortem ,  there  was  a  tumour  of  the 
optic  thalamus.  In  view  of  the  relation  between  the 
enlargement  of  the  pituitary  body  and  the  condition  of 
acromegaly.  Dr.  MaeGregor's  case  seemed  of  much 
importance. 

Dr.  Parkes  Weber  said  the  case  furnished  an  ex- 
cellent example  of  the  association  of  congenital  general 
overgrowth  of  a  portion  of  the  body  with  angiomata 
in  the  skin  representing  vascular  overgrowth. 

J>r.  Hutchinson*  in  reply*  showed  a  giant  finger 
which  had  been  amputated  and  also  an  enlarged  supra- 
renal capsule  on  the  same  side  from  the  same  patient. 


NORTH-EAST      LONDON     CLINICAL     SOCIETY, 
Meeting    held    Thursday.    March    ^rd,    1904. 

Dr.   j.   W.   Hunt,   President,   in   the  Chair. 
Dr.  G.  P.  Chappel  read  a  paper  on  some  of  the 

UMlTATtONS  OF  MEDLCTNE  TN  ABDOMINAL  DISEASE, 

an  abstract  of  which  will  be  found  on  page  254. 

Drr  Frederick  H.  Daly  remarked  upon  the  great 


262    Tfeft  Medical  Press. 


AUSTRIA. 


March  9.  19°4- 


advances  which  antiseptic  surgery  had  made,  whereby 
it  was  possible  to  operate  successfully  upon  cases  of  gall- 
stones, and  he  referred  to  a  paper  which  he  had  read  upon 
the  subject  twenty-five  years  ago  before  the  Clinical 
Society  of  London,  when  such  an  operation  as  cholecys- 
totomy  was  deprecated  by  nearly  all  present. 

Dr.  £.  Hooper  May  expressed  the  opinion  that  cases 
were  invariably  sent  into  hospitals  too  late,  and 
pleaded  for  the  earlier  assistance  of  the  surgeon.  He 
considered  that  those  cases  of  perforated  gastric  ulcer 
in  which  there  was  a  history  of  profuse  haemorrhage 
often  did  better  than  those  in  which  this  symptom  was 
only  slightly  marked. 

Dr.  R.  Murray  Leslie  agreed  that  much  haemate- 
mesis  was  seldom  a  feature  of  the  cases  which  went  on  to 
perforation.  The  reason  why  the  hemorrhagic  cases 
recovered  sooner  was  probably  because  the  physician 
was  thus  placed  earlier  upon  his  guard,  and  a  rigid  diet 
was  at  once  enforced. 

Dr.  Thomas  Rushbrooke  said  that  there  were  many 
cases  of  appendicitis  in  which  •  it  took  longer  than 
twelve  hours  to  decide  the  diagnosis.  He  thought  that 
if  the  consulting  surgeon  realised  the  great  difficulties 
which  beset  the  general  practitioner  in  respect  to  the 
question  of  operative  interference  he  would  sympathise 
more  with  him. 

Mr.  Walter  Edmunds  referred  to  the  difficulty  of 
diagnosis  caused  by  the  presence  of  a  pancreatic  cyst, 
and  said  that  surgical  aid  had  been  of  value  in  certain 
cases  of  spasmodic  contraction  of  the  pylorus  in  children. 

Mr.  Herbert  W.  Carson  considered  that  abdominal 
troubles  might  be  divided  into  two  groups,  those  which 
were  primarily  surgical,  and  those  which  secondarily 
became  so.  In  the  first  class  he  wbuld  include  all 
acute  perforative  lesions  and  all  cases  of  appendicitis. 
To  the  second  class  he  referred  all  cases  of  chronic 
gastric  disorders  accompanied  by  perigastric  adhesions. 
He  drew  attention  to  the  prospect  held  out  of  the  cure 
or  alleviation  of  cirrhosis  oi  the  liver  by  surgical 
measures,  and  to  the  importance  of  more  frequent 
examination  of  the  blood  for  leucocytosis  as  an  index 
of  suppurative  changes. 

The  President  thought  that  the  moral  effect  upon 
the  patient's  mind  of  a  proposal  to  operate  must  be 
taken  into  consideration,  and  that,  while  an  exploratory 
incision  was  of  the  greatest  value  in  all  doubtful  cases, 
it  was  as  well  that  the  public  should  be  disabused  of  the 
idea  that  a  surgeon,  when  called  in,  would  of  necessity 
operate  in  all  cases. 
Dr.  Chappel  replied. 

Bustrta, 


[from  our  own  correspondent.] 


Virnka.  March  6th,  1904. 
Intestinal  Experiment. 

Kreidl  showed  a  dog  to  the  members  of  the  Gesell- 
schaft  der  Aerzte,  on  which  he  had  operated  fourteen 
days  previously  by  stripping  off  the  muscular  covering 
of  the  small  intestine  over  a  metre  of  its  length.  The 
day  after  the  operation  the  dog  was  quite  fresh  and 
took  its  food  as  the  other  dogs.  The  stools  were  regular 
and  natural  without  any  abnormal  appearances.  He 
concluded  that  muscularis  mucosa  was  quite  sufficient, 
as  it  had  proved  in  this  case,  to  carry  on  the  continuity 
of  the  bowels  without  the  support  of  the  muscular 
covering  of  the  canal. 

Vesicular  Diverticulum. 

Kolles  exhibited  a  young  man,  «t.  17,  with  a  diver- 
ticulum in  the  bladder  which  could  be  felt  and  seen  as  a 
firm  tumour  in  the  right  lower  part  of  the  abdomen. 
Tts  size  varied  from  that  of  an  apple  to  a  man's  fist. 
The  cystoscope  revealed  two  funnel-shaped  openings 
in  the  wall  of  the  bladder  from  which  urine  could  be 
pressed.  The  Rontgen  rays  confirmed  the  pouch, 
which  could  be  emptied  and  blown  up  as  a  tumour. 
The  bladder,  when  full,  would  contain  two  litres,  while 


the  residue  or  sac  would  give  out  850  cubic  centimetres 
when  pressed  empty. 

Perforation  of  the  Process  Vermifoxjus. 
Moszkowicz  brought  forward  a  girl,  set.  8,  who  in 
her  fifth  year  had  a  perforation  of  the  vermiform  process, 
followed  by  two  abscesses,  one  in  the  right  and  one 
in  the  left  iliac  fossae,  which  were  opened  as  soon 
as  they  were  discovered.  Five  weeks  later  an  operation 
had  to  be  performed  for  a  stenosis  of  the  bowel,  owing 
to  soma  backing  of  the  ileo-omentum,  when  an  artificial 
anus  was  made  in  the  upper  part  oi  the  ileum.  After 
this  time  she  rapidly  gained  in  weight,  rising  from 
sixteen  to  twenty-one  kilos  in  a  very  short  space  of  time. 
A  fistula  formed  later  within  the  rectum  that  admitted 
of  the  closure  of  the  artificial  anus. 

The  saving  of  this  child  he  attributed  to  the  early 
opening  of  the  two  abscesses,  which  were  not  in  com- 
munication. 

Purulent  Perityphlitis. 
This  is  a  subject  that  had  been  opened  for  discussion 
by  Moszkowicz  at  a  former  meeting. 

Schnitzler  said  that  he  had  operated  oh  seventy-two 
cases  for  pus  in  connection  with  the  appendix,  with  the 
death-rate  of  14  per  cent. 

This  form  of  abscess  should  be  operated  on  as  soon  as 
it  has  been  diagnosed  that  matter  is  present ;  when  it 
occurs  in  the  pouch  of  Douglas,  the  rectal  operation 
is  the  best.  When  meteorism  is  present  the  danger  of 
infection  in  the  peritoneum  is  very  great.  He  thinks 
it  very  bad  practice  to  go  searching  through  the  abdo- 
men for  hypothetical  abscesses  after  opening  the 
primary  one.  He  is,  however,  a  strong  advocate  of 
early  opening.  Whatever  has  to  be  done  in  the  way  of 
operating  should  be  done  within  the  first,  twenty-four 
or  forty-eight  hours,  whenever  diagnosed. 

Spieler  preferred  the  radical  operation  at  once.  If 
the  appendicitis  be  the  real  cause  why  not  remove  the 
appendix  in  the  first  place,  and  more  particularly  in 
children  where  the  diffuse  form  is  more  common,  and 
which  form  two-thirds  of  the  whole  number?  He 
thought  there  was  no  more  danger  in  the  radical  opera- 
tion than  in  the  expectant  one  of  opening  an  abscess.  It 
is  noteworthy  that  the  peritoneum  loses  its  power  of 
absorption  after  inflammations,  such  as  that  of  the 
vermiform  process,  and  becomes  very  inactive,  pro 
bably  owing  to  the  changes  in  the  endothelium,  which 
may  have  the  power  of  destroying  the  function  of  the 
membrane. 

Toges  related  the  history  of  a  few  cases  that  had  come 
under  his  own  observation,  where  certain  inflammatory 
processes  of  the  female  genitals  had  produced  puru- 
lent perityphlitis.  These  often  result  in  purulent  in- 
flammation of  the  adnexa,  with  subsequent  bands  of 
adhesion. 

Lotheissen  said  that  he  invariably  incised  the  peri- 
typhiitic  abscesses  where  it  was  at  all  possible,  over  the 
appendix  in  the  caecal  region.  He  is  also  in  favour  of 
early  action,  even  though  there  be  no  fever  but  a 
quick  pulse  and  fluid  in  the  right  flank.  The  prognosis 
is  always  better  in  the  single jabscess  than  in  the  multi- 
locular.  The  prognosis  of  a  general  peritonitis  accom- 
panying the  abscess  will  depend  upon  the  nature  of  the 
exudation,  the  cause  of  the  abscess  and  the  resisting 
power  of  the  patient,  such  as  age  and  temperament. 

He  related  the  history  of  twelve  cases  of  purulent  peri- 
tonitis he  had  operated  on  when  collapse  had  set  in  and 
the  patients  were  almost  pulseless.  Yet  only  three  were 
saved  out  of  the  twelve.  If  he  were  to  offer  any  advice 
on  the  subject,  he  would  say,  operate  within  the  first 
four  days  of  the  illness,  by  performing  laparotomy 
and  draining  thoroughly. 

Ullmann  thought  that  the  purulent  ichorous  perito- 
nitis  is   usually   the  consequence  of  the  bursting  of 


IUbch  p.  1904, 


OPERATING   THEATRES. 


The  Medical  Press.     263 


the  abscess  and  not  the  opposite  as  Moszkowici  had 
,amrmed.  He  condemned  the  further  search  for  other 
abscesses  alter  opening  the  primary,  and  thought  it  im- 
possibie  to  diagnose  multiple  abscesses.  It  was  better 
tu  watt  with  confidence  and  hope  after  incising  the 
primary  abscess. 

Owing  to  the  absence  of  a  precise  clinical  diagnosis 
the  whole  question  was  a  difficult  one  to  offer  an  opinion 
<j«.  As  to  operating  early  with  success  he  entertained 
grave  doubts  on  this  point  and  was  glad  to  see  that 
;^red  this  opinion.  He  had  operated  early  in 
many  cases,  perhaps  too  early,  where  the  disease  had 
the  appearance  of  a  simple  abscess,  but  to  hb  disap- 
pointment they  had  turned  out  to  be  the  most  severe 
cases  he  had  had.  There  was  danger  also  in  being  too 
early. 

Hochenegg   announced   himself  as   an   advocate  of 

early  operation  and  admonished  all  his  colleagues  to 

operate  as  soon  as  they  hat  I  made  a  correct  diagn 

It  is  difficult  to  forecast   from  any  diagnosis  we  can 

make  what  will  be  a  light  case  or  a  severe  case.    He  had 

recently  opera  ted  on  twelve  cases  111  the  early  stage,  and 

not  one  ot  them  died.     In  the  same  time  he  had  operated 

nine    cases,    with    diffuse   peritonitis,   and 

twenty-seven  oi  them  died  !    There  was  no  doubt  that  a 

ess  would  be  a  favourable  case  and  would 

r  ia  a  -Iwrt  time,  while  a  multilocular  form  would 

ted. 

method  of  opening  an  abscess  in  the  pouch 

para -sacral  operation.     What   he 

uti-ler--  1  Douglas  abscess  was  one  quite  closed 

up  in  that  sac  of  the  peritoneum  having  no  connection 

*uh  th»:  appendix,     The  radical  operation  is  not  alwav  s 

;«le  as  described,  as  not  infrequently  we  meet  with 

psnled  abscesses  around  the  appendix, 

pus  that  may  or  may  not  be  removed,  but  a^ 

s  rule  the  interval  operation  is  the  more  successful. 

ZTbe  ©Derating  TEbeattes. 
.north  ay  est  london  hospital. 

Lots  Disease  of  Elbow-Joint,' — Ekasjon 

or  the  Er  sow- Joint.— Mr  Mayo  Colueu  operated  on 

a  boy  wilt,  disease  of  the  left  elbow-joint. 

was  admitted  under  his  care  for  opera- 

05  to  this  he  had  been  treated  for  pro- 

th  immobility  secured  by  splints,  and 

getter*]  attention  to  health.    Some   improvement    had 

taken  place  so  long  as  the  elbow  was  kept  fixed,  but 

1  U  Kmctiuiii]  activity  was  allowed  the  trouble 

with  increased  vigour.     The  present  condition 

tor  operation,  and  a  useful   [dial 

matter  of  considerable  doubt,     The  disease  had 

1  1  the  whole  lining  membrane  of  the  joint  and 

tod   intended    in    various    direction;.     There    was    a 

. tending  from  the  outer  condyle  half- 

iown  the  radius,  and  a  similar  boggy  coudii ion 

tea  over  the  lower  third  t*\   the  humerus, 

was  distinct  grating  in   ttu-  radio -humeral  and 

ral  joints.     The  question  was,  What  form  of 

Lion  would  be  most  advisable  ?    Excision  was  out 

st ion,  as  by  this  procedure  it  would  be  im- 

le  to  get  beyond  the  disease.    The  treatment  lay 

rn  amputation  and  eraston,  and  seeing  that  the 

other  respects  apparently  free  from  disease. 

decided  to  do  an  erasion  of  the  joint  and 

and  curette  all  the  abscess  cavities  and  tracts, 

JA-1,  ii  possible,  secure  a  fair  joint.     At  all  events,  the 

re  operation  of  amputation  could  always  be 

ir  the  present  procedure  failed  to  remove 

►llier   made   an    incision   over    the 

the  radius  and  opened   a    large  cavity 

tuberculous   granulations  and   d/btis<   ex- 


posing the  upper  third  of  the  radius  in  a  bare  and 

canoqs  condition.  The  elbow-joint  was  further 
opened  by  a  transverse  incision  over  the  back  of  the 
joint,  opening  a  second  large  collection  of  tuberculous 
granulations  and  d/bris.  The  olecranon  was  next 
sawn  through  transversely,  and  the  cavity  of  the  joint 
being  now  freely  exposed,  the  operator  set  to  work 
with  scissors,  curette,  and  forceps  to  remove  the  n 
of  the  tuberculous  synovial  membrane  and  diseased 
structures.  This  procedure  occupied  a  considerable 
time.  The  upper  third  of  the  radius  was  re- 
moved, and  the  whole  cavity  deluged  with  hot  car- 
bolic lotion.  The  bleeding  being  arrested,  the  tracts 
and  hollows  were  packed  with  strips  of  gauze 
soaked  in  iodoform  emulsion.  A  drain  was  left  in 
opposite  each  condyle,  and  the  limb  supported  on 
a  rectangular  splint,  Mr  Collier  said  this^elbow  was 
an  excellent  example  of  the  harm  that  may  result  111 
Lrusting  too  long  to  rest  and  splints,  In  the  very 
earlifltt  stages  this  was  good  treatment,  but  so  soon 
as  definite  thickening  and  granulate m  had  occurred 
nothing  but  erasion  or  excision  could  be  of  the  smallest 
use.  In  this  case,  the  disease  had  got  beyond  the 
jodni  and  invaded  the  tissue  of  the  forearm,  and  it  was 
perhaps  too  much  to  expect  that  the  procedure  now 
adopted  would  result  in  a  useful  limb.  However.  Mr. 
Collier  thought  it  right  lo  j^ive  the  hoy  the  chance. 
FRENCH  HOSPITAL  AND  DISPENSARY. 
KisEcnos  of  Ribs.— Mr.  Clayton  Greene  ope- 
niti.it  <m  a  patient,  aet.  21.  who  had  been  admitted  four 
months  ago  for  a  large  swelling  (fluid}  over  the  rib* 
and  sternum  of  the  shape  of  an  inverted  pear,  pulsating 
with  the  heart-beats,  and  which  had  gradually  been 
increasing  in  size  for  the  past  three  months.  There 
was  a  history  of  a  blow  received  about  four  months 
before  the  man's  admission,  and  alsn  a  history  o|  in- 
fluenza. On  examination,  the  swelling  was  found  to 
be  fluctuant,  not  reducible,  and  was  evidently  an 
abscess.  On  inserting  an  exploring  needle,  purulent 
material  was  withdrawn.  The  swelling  was  incised 
and  about  a  pint  and  a  half  of  pus  was  let  out,  On 
J  further  examination  it  was  found  that  the  second  rib 
an  I  the  posterior  part  of  the  sternum  wer*.  ppAOOB, 
and  fclw  taUfi  was  flattened  on  to  the  posterior  chest 
wall.  The  second  rib  was  removed  and  a  large  em- 
pyema tube  WAS  insert!  I.  About  three  months  after- 
wards the  patient  was  sent  to  the  Brighton  Con- 
valescent Home  with  a  small  discharging  sinus.  A 
month  afterwards  he  was  readmitted  to  the  hospital 
with  a  small  fluctuating  mass  over  his  sternum.  This 
was  incised  and  scraped,  and  was  found  to  communicate 
with  the  old  sinus,  and  oil  iurther  exploration  the  &T44 
nb  was  also  found  to  be  carkmi.  This  rib  was  then 
removed  after  very  careful  separation  of  the  struc- 
tures in  the  immediate  vicinity  :  the  old  sinus  was 
well  scraped  out  ;  new  bone  was  found  to  have  been 
formed  where  the  second  rib  had  been  removed  ;  the 
lung,  loo,  had  expanded.  The  incision  for  the  excision 
Of  tit*  Brat  rib  was  completely  sc-wn  npr  and  a  large 
drainage-tube  then  inserted  up  to  the  nrst  rib  cartilage, 
together  with  gauze  plugging,  which  was  to  be  re- 
moved in  twenty-four  hours.  The  wound  healed  by 
hr^i  intention  and  the  patient  is  doing  urwy  well  indeed. 
KeiiiiOks  by  Mr.  Greene  on  this  case  will  be  published 
next  week  in  "  Operating  Theatres." 


The  following  telegram  from  the  officer  ad* 
ministering  the  Government  of  Mauritius  was 
received  at  the  Colonial  Office  on  the  4th  inst.  : — 
"  For  the  week  ending  March  3rd,  six  cases  of 
plague,  five  fatal." 


264    The  Medical  Press. 


LEADING   ARTICLES. 


March  9,  1904. 


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"  SALUS  POPULI  SUPRRMA  LEX  " 


WEDNESDAY,  MARCH  9,  1904. 


THE  DIMINISHING  BIRTH-RATE. 
The  birth-rate  of  a  nation  affords  a  sure  index 
of  its  vitality,  and  denotes  with  unerring  finger  the 
period  of  its  growth,  its  maturity,  and  its  decay. 
It  is  governed  by  laws  that  are  not  yet  understood 
in  their  entirety,  but  which  it  is  of  the  utmost  im- 
portance should  be  reduced  to  a  scientific  basis. 
It  is  with  pleasure,  therefore,  that  we  publish  at 
length  an  exhaustive  discussion  on  the  subject  b^ 
Dr.  Taylor,  of  Birmingham,  in  his  recent  Inaugural 
Address  to  the  British  Gynaecological  Society. 
Dr.  Taylor  bases  his  essay  on  the  theory  of  Ruslrin, 
that  there  is  no  wealth  but  life,  and  on  the  fact 
that  the  birth-rate  of  the  United  Kingdom  is 
steadily  diminishing.  The  latter  proposition  is 
borne  out  by  the  gradual  decrease  of  the  birth-rate 
per  1,000  from  34*3  in  the  five  years  1874-78  to 
28  in  the  years  1897- 1901.  A  diminishing  birth- 
rate is  not  a  feature  of  our  own  country  only,  but 
has  occurred  also  in  Austria,  Germany,  Italy,  and 
France.  In  the  absence  of  exact  information, 
there  is  good  reason  to  think  a  similar  fall  has  taken 
place  in  the  United  States,  while  it  is  notably 
rising  in  Russia  and  Japan.  In  the  United  King- 
dom the  marriage-rate  has  not  altered  much,  so 
that  the  lessened  birth-rate  must  be  due  not  to 
celibacy,  but  to  causes  operating  in  the  married 
life  of  its  inhabitants.  The  fertility  of  marriages, 
in  point  of  fact,  has  decreased  to  such  an  extent 
that  it  has  been  estimated  by  a  statistical  authority 
to  mean  26,000  less  births  per  annum  in  London 
alone.  A  mere  decrease  in  quantity  might  possibly 
not  be  an  unmixed  evil  were  that  attended  by  a 
bettering  in  quality.  We  are  compelled,  however, 
to  the  conclusion  that  race  deterioration  is  taking 
place.  The  juvenile  population  of  to-day  com- 
pares unfavourably  with  a  former  generation  in 
criminality,  in  mental  diseases,  and  brain  weakness, 
and  even  in  alcoholism.  Dr.  Taylor's  conclusion 
:s  that  not  only  are  modern  marriages  relatively 
infertile,  but  that  the  offspring  are  weak  and 
neurotic,    being    specially    prone    to    alcoholism, 


criminality,  and  insanity.  He  further  points  out 
that  the  marriages  of  the  upper  and  middle  classes 
are  now  so  sterile  that  an  undue  and  dangerous 
proportion  of  the  rising  generation  is  recruited 
from  the  more  ignorant,  the  more  vicious,  and  the 
more  criminal  substratum  of  society.  At  the 
same  time  it  should  be  remembered  that  there  is 
no  finer  foundation  for  the  stamina  of  a  nation 
than  the  presence  of  a  large  and  prosperous 
labouring  element.  Coming  to  the  cause  of  the 
relative  sterility  of  modern  marriages,  Dr.  Taylor 
courageously  goes  to  the  root  of  the  matter.  He 
says  that  the  elevation  of  the  age  of  marriage  is  a 
small  factor,  but  the  main  cause  is  the  deliberate 
use  of  preventives  against  conception.  Instead 
of  the  families  of  five,  twelve,  or  eighteen  children 
familiar  to  our  grandparents,  we  commonly  find 
three,  two,  or  one.  Dr.  Taylor  traced  various  un- 
favourable results  to  the  use  of  preventives.  He 
pointed  out  that  the  storing  of  seminal  fluid  is  a 
source  of  strength  in  man  and  the  lower  animals. 
That  the  testicular  secretion  has  a  profound  in- 
fluence upon  the  bodily  economy  has  been  abun- 
dantly proved  by  the  researches  of  Brown-Sequard 
and  Boy  Tessier.  As  regards  the  female,  it  has 
clearly  some  function  beyond  fertilisation.  As  an 
illustration  of  that  proposition  might  be  taken  the 
neurasthenia  that  often  accompanies  sterility  due 
to  plugged  cervical  canal.  Then,  again,  preg- 
nancy plays  an  important  part  in  giving  ovarian 
rest  during  its  continuance.  When  the  natural 
cycle  is  prevented  the  woman  probably  suffers  far 
more  than  she  would  do  from  child-bearing.  It  is 
a  noteworthy  fact  that  the  mothers  of  large 
families  still  furnish  the  finest  and  healthiest 
specimens  of  British  matronhood.  Prevention, 
moreover,  robs  the  male  of  the  moral  control  ac- 
quired by  the  recurring  periods  of  abstention  and 
restraint  due  to  pregnancy  and  parturition,  a 
quality  that  is  presumably  more  or  less  trans- 
missible to  his  offspring.  As  regards  the  child,  it 
is  usually  the  child  of  the  larger  family  and  the 
poorer  parents,  often  from  the  lower  ranks  of 
society,  who  pushes  his  way  to  the  front  and 
elbows  out  the  child  whose  coming  has  been  care- 
fully "  arranged  for."  The  influence  of  prevention 
of  families  upon  a  nation  is  undoubtedly  great. 
During  the  past  fifty  years  in  France,  although 
the  population  has  hardly  increased  at  all,  yet  its 
criminality  has  been  trebled.  In  1830  the  suicides 
amounted  to  5  per  100,000  of  population  as  against 
24  per  100,000  in  1887,  55  of  the  latter  being  under 
fifteen  years  of  age  ;  whereas  in  1896  there  were 
no  less  than  375  between  fifteen  and  twenty-one 
years  of  age.  Then,  again,  is  the  highly  significant 
fact  that  since  1880  France  has  passed  from  the 
seventh  to  the  first  place  among  the  nations  as  a 
consumer  of  alcohol.  After  fifty  years  of  limited 
birth-rate,  France  appears  to  be  afflicted  with  a 
hopeless  national  neurasthenia  which  demands 
constant  stimulation  in  order  to  face  the  ordinary 
routine  of  life.  In  considering  the  possible  reme- 
dies one  must  recognise  the  fact  that  the  forces  of 
modern  civilisation  appear  antagonistic  to  family 
life.     Religion  should  inculcate  a  higher  ideal  and 


March  q. 


LEADING   ARTICLES. 


The  Medical  Pmess.     265 


a  ampler  standard  of  life.  The  State  might  afford 
special  relief  of  taxation  to  the  parents  of  large 
Umrlies,  and  by  better  protection  lower  the  ever 
receding  ape  at  which  remunerative  work  is 
possible  in  the  learned  professions.  Medical  men 
would  do  well  to  make  a  closer  study  of  the  evils 
due  to  limitation  of  families  and  educate  the 
laity  on  the  point*  Dr.  Taylor  personally  con- 
demned all  artificial  prevention  except  in  cases  of 
deformity  or  of  grave  disease.     Almost  all  labours 

-die  in  the  hands  of  modern  surgeons.  To 
artificial  prevention  must  be  attributed  not  merely 
the  diminishing  birth-rate ,  but  also  the  diminish- 

■-.  alue  of  our  population.  The  maximum  of 
life  can  be  attained  only  by  the  maximum  of 
virtue  ;  the  prevention  of  life  is  always  accom- 
panied by  moral  deterioration.  This  eloquent 
address  on  a  weighty  subject  is  worthy  of  earnest 
Study  bv  every  member  oi  the  medical  profession. 

COMPOUNDING  BY  MEDICAL  MEN, 
This  question,  recently  discussed  at  the  meeting 
0!  the  Metropolitan  Counties  Branch  of  the 
British  Medical  Association,  where  so  decisive 
an  expression  of  adverse  opinion  was  given, 
touches  several  matters  of  grave  interest  to  the 
profession,  Dr.  Heron  must  have  foreseen  that 
his  proposal  to  alter  the  Medical  Act  by  the  in- 

n  ol  prohibitive  clauses  could  never  for  a 
moment  obtain  any  support.  To  endeavour  to 
hamper  medical  practitioners  in  the  exercise  of 
their  undoubted  right  to  compound  their  own 
prescriptions  was  an  idea  so  obviously  unpractic- 
able  and  unjustifiable,  that  we  can  only  attribute 

t  hope  on  his  part  that  its  very  extravagance 
would  lead  to  the  discussion  of  other  issues  which 
arc  inseparably  associated  with  the  one  he  desired 
to  raise.  It  is  profitless  to  discuss  either  the 
necessity  or  expediency  of  the  compounding  of 
medicines  by  practitioners.  Apart  altogether 
from  the  question  of  professional  interests  there  is 
that  ol  the  public  need,  which  in  numberless 
instances  cannot  be  met  in  any  other  way  than  by 
the  practitioner  dispensing,  for  the  doctor's 
medicine  as  well  as  his  services,  in  many  localities, 
go  together.  Also,  even  in  places  where 
there  is  an  over-abundant  supply  of  chemists, 
there  are  populations  which  cannot  afford  to  pay 
both  doctor  and  chemist,  to  whom  the  phytic 
that  goes  with  the  advice  is  indispensable  if  they 
arc  to  seek  medical  aid  at  all.  A  large  number  of 
those  who  crowd  our  out-patient  departments  in 
the  hospitals  come,  as  it  is,  from  this  class,  Nor 
does  the  evil,  though  widely  known  to  exist, 
decrease,  As  yet  no  means  has  been  found  to 
k  the  shameful  abuse  of  hospitals,  and „ the 
impositions  practised  on  them  by  persons  who  can 
well  afford  to  pay  for  advice  and  medicine  which 
practitioners  in  their  immediate  vicinity  are 
willing  to  give  for  most  moderate  fees.     Not  only 

but  it  is  no  uncommon  event,  having  run 
up  bills  with  their  doctor  for  services  rendered  by 
night  as  well  as  by  day,  and  for  the  required 
medicines,  to  seek  evasion  of  their  debt  by  going 
to    the    out-patient    department  of    the  nearest 


hospital,  and,  since  depreciation  of  the  doctor's 
services  is  a  necessary  part  of  their  dishonest 
duplicity,  to  return  and  spread  reports  that  u  the 
doctors  at  the  hospital  "  said  that  the  previous 
treatment  had  been  altogether  wrong.  Or  they 
have  a  chemist  close  at  hand  who  is  ready  to 
give  "  over  the  counter  "  advice,  and  to  prescribe 
tor  all  ailments  at  the  cost  of  some  registered  pill 
or  bottle  of  patent  medicine.  Thus,  the  unfor- 
tunate practitioner  is  hard  pressed  between  the 
abused  hospital  department  on  the  one  hand, 
and  the  prescribing  chemist  on  the  other.  Little 
wonder  is  it  that  "  fees,"  if  we  can  regard  the  sums 
paid  in  the  light  of  these,  are  so  miserably  small. 
It  must  be  so  in  the  face  of  such  competition. 
There  is,  of  course,  the  danger  that  in  the  further 
reduction  of  fees  comes  the  temptation  to  the 
practitioner  to  give  the  cheapest  medicines  and 
thus  in  some  measure  find  himself  recouped  for 
his  time  and  advice.  And  this  is  a  danger  that 
cannot  be  ignored.  In  medicine,  as  in  other 
matters,  necessity  is  a  strong  incentive,  and  even 
a  doctor  has  "  to  eat  to  live."  If  he  can  only 
get  a  shilling  for  his  advice  and  medicine,  or 
cighteenpence  for  his  visit  and  medicine,  he  must 
be  a  man  with  a  strong  sense  of  professional 
honour  and  duty  to  give  50  per  cent,  of  the 
amount  back  in  the  shape  of  physic.  The  point 
is,  can  anything  be  done  to  lessen  these  eviis  ? 
Can  hospital  authorities  be  induced  to  make  more 
stringent  regulations  regarding  the  notes  for  the 
out-patient  departments  of  the  legion  of  hos- 
pitals, general  and  special,  that  are  everywhere 
springing  up  ?  Can  the  evil  of  "  over  the 
counter  "  prescribing  by  chemists  be  curtailed  ? 
We  fear  that  but  little  can  be  done  to  mitigate 
the  latter  evil.  The  Pharmaceutical  Society  may 
impose  certain  conditions  with  the  view  of  re- 
stricting counter  prescribing,  in  the  granting  of 
its  diploma,  but  this  cannot  avail  much  as  long 
as  the  practice  can  be  pursued  with  impunity, 
iind  that  no  penal  results  follow.  For  the  rest, 
so  far  as  compounding  is  concerned,  the  profession 
itself  is  gradually  drawing  a  clear  distinction 
between  two  classes  of  practitioners.  There  is 
11  surgery  practice/'  with  its  dispensing  depart- 
ment and  surgery  hours,  filling  a  great  want  for 
the  lower  middle  classes,  and  there  is  the  general 
practitioner  who  h&a  nothing  to  say  to  compound- 
ing, and  who  is  rapidly  treading  on  the  heels  ot 
the  consultant.  For  things  are  altering  quickly, 
and  the  high  class  general  practitioner  is  doing  his 
own  work,  and  only  calls  in  the  aid  of  a  consultant 
on  rare  occasions  of  emergency  or  doubt.  Am- 
bition will  lead  any  capable  man  to  desire  to  join 
the  ranks  of  the  latter.  As  time  goes  on  these 
ranks  will  be  largely  increased,  and  surgery 
practice  with  its  dispensing  will  be  more  and  more 
confined  to  poorer  districts,  and  those  in  which  the 
services  of  a  pharmaceutical  chemist  cannot  be 
had.  It  was  unfortunate  that  at  any  time  the 
skilled  services  of  the  medical  adviser  should  not 
have  been  kept  entirely  apart  from  the  medicines 
which  he  prescribed,  and  that  they  should  have 
come  to  be  linked  with  the  latter  in  the  medical 


266    The  Medical  Press.  NOTES  ON  CURRENT  TOPICS. 


charges.  One  thing  is  clear— that  as  long  as 
young  men  without  private  means  adopt  medicine 
as  their  profession,  and  are  compelled  to  accept 
the  low  fees  at  present  paid  for  their  services, 
they  will  be  forced  to  compound  their  own  pre- 
scriptions at  least  during  the  earlier  years  of 
their  professional  career. 


Dotes  on  Current  Tropics* 

"P.J.F." 

One  of  the  least  admirable  features  of  the  pro- 
prietary drug  trade  is  that  each  sample  of  the  pre- 
paration has  to  bear  a  penny-halfpenny  Govern- 
ment stamp.  The  amount  gained  from  this  tax 
is  inconsiderable  in  proportion  to  the  total  revenue, 
but  nevertheless  doubtless  forms  one  of  the  many 
obstacles  to  the  aboUtion  of  the  trade  in  secret 
medicinal  preparations.  Moreover,  it  gives  many 
of  the  purchasers  an  idea  that  the  Government 
guarantee  the  preparation  as  possessing,  if  not  all 
that  the  advertisers  claim  for  it,  at  least  no  noxious 
properties.  Of  course,  it  does  nothing  of  the  kind. 
The  boot,  indeed,  is  on  the  other  leg.  By  recent 
legal  decisions  it  appears  that  so  long  as  the  in- 
gredients of  a  medicine,  pill,  or  powder  are  printed 
on  the  outside  of  the  bottle  or  box,  or  published 
in  a  well-known  book  of  reference,  the  Govern- 
ment cannot  claim  stamp-duty  ;  whereas  if  the 
vendor  does  not  choose  to  let  people  into  the 
wonderful  mystery,  he  must  pay  his  penny-half- 
penny. When  the  article  is  priced  at  a  shilling  or 
two,  he  generally  prefers  to  keep  the  secret 
locked  in  his  own  bosom  ;  but  if  he  only  expects  a 
few  pence  for  his  preparation,  his  profits  are 
seriously  curtailed  if  be  has  to  pay  the  Inland 
Revenue  authorities  a  penny-halfpenny  out  of 
them.  To  relieve  the  dispensing  chemist  of  this 
disadvantage,  the  Pharmaceutical  Journal  has  just 
brought  out  a  book  of  10,000  recipes.  By  putting 
on  the  label  of  any  bottle  or  box  dispensed  the 
cabalistic  symbols  "  P.J.F.  "  ("  Pharmaceutical 
Journal  Formulary  "),  followed  by  the  reference 
number,  the  chemist  will  evade  the  obligation  to 
pay  stamp  duty.  The  Formulary  will  be  "A 
well-known  book  of  reference  "  in  the  eye  of  the 
law,  as  the  dispenser  will  find  it  save  him  a  great 
deal  of  trouble.  Thus  one  little  drawback  to  the 
prescribing  chemist's  business  will  be  removed, 
and  he  will  be  free  to  go  on  and  prosper.  One 
doubts  if  the  Pharmaceutical  Journal  will  gain  in 
respect  from  the  medical  profession  by  its  action 
in  bringing  out  a  book  of  this  kind  ;  but  no  doubt 
it  has  met  the  convenience  of  many  members  of 
its  clieniHe  by  so  doing. 


A  Poor-law  Infirmary  and  Puerperal  Fever. 
The  Bristol  Board  of  Guardians  have  been  faced 
with  a  serious  state  of  affairs  by  the  occurrence  of 
two  cases  of  puerperal  fever  in  their  lying-in  wards. 
Their  Medical  Officer  has  not  minced  matters,  for 
in  reporting  the  cases  above  alluded  to  he  said  there 
would  always  be  a  risk  of  lying-in  women  becoming 
infected  in  that  way  when  nurses  who  were  doing 
ward  work — dressing  septic  cases  or  working  in  a 
ward  where  such  cases  were— were   allowed   to 


March  9,  1904. 

attend  midwifery  cases.  Clearly  no  nurse  should 
be  allowed  to  tempt  providence  in  that  way 
Indeed,  we  have  no  hesitation  in  saying  that  any 
Board  of  Guardians  who  permitted  such  a  practice 
after  due  warning  should  be  indictable  for  damages 
and  death  from  resulting  puerperal  infection. 
There  is  no  disease  more  disastrous  and  more  diffi- 
cult to  eradicate  than  puerperal  fever,  yet  at  the 
same  time  it  is  absolutely  preventive  bv  rigorous 
preventive  measures.  We  note  that  the  occurrence 
has  raised  the  whole  question  of  the  Poor-law 
Infirmary  at  Bristol.  One  of  the  guardians  stated 
that  there  were  eighty-nine  patients  in  eighty  beds, 
and  two  of  them  testified  to  having  seen  two 
patients  in  one  bed.  We  are  happy  to  believe  that 
so  far  as  England  and  Scotland  are  concerned, 
such  a  state  of  affairs  is  practically  obsolete.  It 
is  to  be  hoped  that  all  Poor-law  Infirmaries  will 
take  the  hint  from  what  has  happened  at  Bristol 
and  appoint  independent  lying-in  nurses.  Why 
have  the  Local  Government  Board  inspectors  per- 
mitted this  overcrowding  and  improper  nursing  > 

Surgical  Diagnosis  of  Abdominal 
Conditions. 
It  has  happened  to  most  surgeons  of  experience 
at  one  time  or  another  to  open  the  abdomen  in 
search  for  one  disorder,  and  to  find  something 
quite  different.  Many,  indeed,  have  operated  for 
an  inflamed  or  suppurating  appendix,  and  have 
found  the  appendix  quite  healthy.  Again,  as 
everyone  knows,  there  is  no  more  difficult  point  in 
surgical  diagnosis  than  the  recognition  of  perfora- 
tion. Only  a  few  days  ago  we  heard  of  a  surgeon 
of  great  experience  and  undoubted  diagnostic 
acumen  who,  in  presence  of  all  the  symptoms  of 
acute  appendicitis,  found  a  healthy  appendix, 
but  a  perforated  ulcer  of  the  stomach.  With  such 
facts  before  the  mind  it  is  perhaps  hardly  to  be 
wondered  at  that  in  hospital  practice,  at  any  rate, 
exploratory  operation  in  doubtful  cases  is  becoming 
more  and  more  common.  In  private  practice  this 
procedure  is  not  usually  so  feasible,  since  before 
submitting  to  a  serious  operation  a  patient  likes, 
if  possible,  to  get  a  decided  opinion  as  to  the  nature 
of  his  disease.  Nevertheless,  we  think  there  is 
too  great  a  readiness  on  the  part  of  many  surgeons 
to  suggest  exploratory  section,  when  some  more 
care  might  suffice  to  guide  the  opinion  without 
resort  to  operation.  As  Mr.  Tubby  remarks,  in  a 
recent  paper,  (a)  "  The  method  of  settling  the 
diagnosis  by  making  an  exploratory  incision  is  .  .  . 
strongly  to  be  deprecated,  because  it  savours 
merely  of  the  art  of  surgery,  and  not  of  the  science. 
He  is  a  poor  surgeon  who  finds  himself  compelled 
to  cut  the  Gordian  knot  of  his  difficulties  by  acting 
on  the  formula,  '  Let  us  open  the  abdomen  and 
look  inside.'  "  Mr.  Tubby  goes  on  to  relate  some 
interesting  cases  of  abdominal  injury  or  disease 
in  which  the  diagnosis  was  very  difficult,  and  he 
gives  some  hints  as  to  the  symptoms  which  he 
himself  has  found  most  useful  in  diagnosing  sup- 
purative inflammations.  Special  emphasis  is 
laid  on  an  altered  relation  between  pulse-rate  and 


(a)  Brit.  Med.  Journ.,  February  18th,  1904. 


KAKH   9      1r^'4 


NOTES    ON    CURRENT    TOPICS,     The  Medical  Press.     267 


temperature,  rigidity,  absence  of  peristalsis,  per- 
^t*nt  tenderness,  and  excessive  teueacytosK 
An  he  same  lime,  and  we  think  rightly,  it  is  pointed 
oat  that  the  marked  prominence  of  one  of  these 

floras  should  nearly  always  outweigh  the 
absence  of  others,  Special  attention  to  these 
points  through  the  whole  course  of  an  abdominal 

■e  will  do  much  to  obviate  the  necessity  of 
manv  exploratory  operations.  At  the  same  time 
it  must  be  remembered  that  often  even  the  best 
surgeon  may  be    left   in   doubt,   and  exploration 

lie  not  only  justifiable,  but  compulsory. 

Ultra-Microscopic  Germs. 
Is  lighting  on  ultra- microscopic  disease  germs  as 
a  subject  lor  his  afternoon  lecture  at   the  Royal 
Dublin  Society  recently.  Dr.  McWeeney  chose  a 

HOI  only  of  great  interest  to  the  lay  public 

sequent  I  rnblies,  but  of  deep  scienti- 

fic importance.  After  the  discovery  of  the  bacterial 

-  of  many  diseases  it  was  at  first  thought 
that  all  infectious  diseases  would  finally  be  brought 
into  line  by  the  discovery  of  a  specific  organism 
tor  each.  Repeated  failure,  however,  in  the  case  of 
many  diseases,  and  these  neither  unimportant  nor 

ntmon,  turned  the  minds  of  bacteriologists  to 
The  possibility  of  the  specific  organism  being  too 
small  to  be  seen,  even  with  the  most  powerful 
microscope.  The  wave-length  in  the  case  of  white 
li^ht  is  about  ri^7t  of  an  inch  in  length,  and 
particles  less  than  halt  a  wave-length  in  size  can 
only  be  seen  as  little  blurred  spots.  The  bacteria 
with  which  we  are  most  familiar  vary  in  size  from 
about  a  micron  in  diameler  to  seven  or  eight  micra 
m  length,  but  it  is  easy  enough  to  conceive  that 
organisms  much  smaller  may   exist,    the   limit   of 

vat  ion  being  about  quarter  ol  a  micron,  that 
15  to  say.  half  a  wave-length  of  white  light.  Germs 
less  than  this  are  by  their  size  quite  beyond 
our  ken,  yet  it  is  possible  that  their  presence  may 
be  made  out  by  their  effects,  and  such  has  been  the 

qq  \mtmus  diseases.     In  the  case  of  pie  urn 

neumonia  of  catile    the   late  Professsor   Nocard 

Wnd  out   how   to  grow  the  microbe  in  nutritive 

fluids.    They  became  opalescent  from  suspended 

particles  too  minute  to  be  seen  distinctly  with  the 

powerful  microscope,     Other  diseases  due  to    when 

11H1  a-visible   microbes  are   the  so-called   foot-and-  '  possessors   liable   to   make   mistakes   in   common 

mouth  disease  of  cattle,  the  South  African  rinder-     signal  lights."     At  the  same  time  the  Committee 

among  human  maladies  yellow  fever  and  '  agree  with  Dr.   Edridge-dreen   that  certain  cases 

tikeiihood  hydrophobia.     An  important  point     cannot  be  detected  by   Holmgren's  test,   however 
in  regard   to   these  germs  is   that   they  can  pass 


and  the  treatment  somewhat  tentative,  it  is  well  to 
call  attention  to  them.  The  attack  is  very  sudden, 
and  is  accompanied  by  a  feeling  of  suffocation, 
severe  palpi  tat  ion,  excessive  dyspnoea,  and  collapse  ♦ 
The  patient  is  usually  cya nosed,  and  cannot  lie 
down  in  bed.  Cough  vi.ty  BOOH  begins,  and  there  b 
copious,  pink,  frothy  expectoration,  amounting  in 
some  cases  to  as  much  as  a  pint  tn  half  an  hour* 
A  temporary  albuminuria  occurs.  Though  the 
clinical  appearance  is  very  distinctive,  the  patho- 
logy is  quite  vague,  beyond  that  the  lungs  are  very 
dropsical,  In  some  cases  there  has  been  distinct 
mitral  valve  disease  and  in  others  a  tatty  heart,  but 
in  many  it  was  impossible  to  find  evidence  during 
life  of  any  definite  lesion*  There  is  considerable 
difference  of  opinion  as  to  the  proper  treatment. 
Dr.  Steven,  of  Glasgow,  who  published  a  lecture  on 
the  subject  a  year  or  two  ago,  (a)  believing  that  the 
collapse  was  the  most  pressing  condition,  strongly 
advised  stimulant  treatment,  and  condemned 
the  use  of  sedatives  as  tending  to  prevent  free 
expectoration.  On  the  other  hand,  Dr.  Lissaman 
(6)  found  inhalations  of  chloroform  of  great  use  in 
shortening  the  duration  of  attacks,  and  Dr,  Hewlett, 
in  several  cases  recently  reported,  (c)  got  equally 
good  results  from  hypodermic  injections  of 
morphia. 


Th©  Value  of  Holmgren *e  Colour  Test. 

The  testing  of  detects  of  colour- vision  is  a 
question  of  interest,  not  only  to  the  ophthalmic 
surgeon,  but  also  to  every  medical  man  in 
general  practice.  The  serious  consequences  that 
may  arise  from  the  mis-reading  of  coloured  signals 
are  too  obvious  to  need  discussion.  Under  these 
circumstances  it  is  somewhat  disquieting  to  learn 
that  the  most  classical  and  easily  applied  test  tV.r 
colour-defect  is  inadequate.  That  fact  was 
originally  pointed  out  by  Dr,  Edridge-Green , 
and  subsequently  found  the  subject  of  investi- 
gation by  a  special  committee  appointed  for  the 
purpose  by  the  Ophthalmological  Society  of  the 
United  Kingdom.  Their  report  has  been  lately 
issued.  It  states  that,  used  in  the  proper  way, 
Holmgren's  test  is  sufficient  to  detect  a  large 
proportion  of  cases  of  colour-blindness,  especially 
the  delect  is  of  such  a  kind  as  to  render  its 


through  filters  which   are   sufficient   to  block   all 
vn  bacteria 


Acute  Suffocative  Pulmonary  (Edema, 

Ik  comparatively  few  of  the  text-books  is  there 
tent  ion  paid  to  the  acute  form  of  pulmonary 
tfdema,  Osier,  Fagge,  and  Fowler  just  mention  that 
such  a  condition  occurs,  while  Nothnagel,  All  butt, 
and  G  ibson  pass  it  over  unnoticed,  T  he  mos  t  com- 
pile clinical  description  is  that  given  many  years 
ago  by  Dieulafoy*  There  have,  however,  be  en  several 
described  by  individual  observers  during  the 
past  lew  years,  and  as  the  condition  is  very  serious 


skilfully  applied.  A  supplementary  report  is 
promised.  Meanwhile  it  will  be  well  for 
medical  men  who  are  testing  candidates  for  any 
of  the  military,  naval,  mercantile  marine,  or  other 
service  where  normal  colour-vision  is  an  essential, 
to  bear  in  mind  the  fallacy  that  lurks  in  the  method 
of  Holmgren, 


Mediaeval  Hospitals. 
An  interesting  account  oi  hospitals  in  the  Middle 
Ages   is   contributed   to   a.  recent  number  of  the 

(ftj  Laruxl,  January  Hth.  l«0i* 
(b)  /btf.,Februu»>-  B  h.  IMS, 

(e)  Inferential  Mtdieal  Journal  if  /Ituff'flfrutVf ,  December  *Ulh, 
1002. 


268    The  Medical  Press.         NOTES    ON    CURRENT    TOPICS. 


March  9,  1904. 


Dublin  Review  by  Miss  Elizabeth  Spearman.  The 
organisation  of  charitable  relief  to  the  poor  and 
sick  is  almost  entirely  of  Christian  origin.  In 
Greece  and  Rome  there  was  little,  if  any,  provision 
for  the  needy  and  though  in  the  East  hospitality 
and  charity  to  the  poor  are  proverbial  virtues,  yet 
they  were  practised  individually  and  without 
system.  The  establishment  of  hospitals  in  Europe 
being  entirely  due  to  Christian  influence,  it  was 
but  natural  that  they  remained  for  the  most  part 
under  ecclesiastical  management,  and  were  often 
merely  appendages  to  the  great  monasteries.  In 
the  Middle  Ages  medical  science  was  not  far  ad- 
vanced, and  beyond  the  ministrations  of  the 
monks,  who,  indeed,  were  frequently  the  most 
learned  leeches  of  the  da},  there  was  before  the 
sixteenth  century  no  regular  medical  service  in 
the  hospitals.  Their  mission  was  rather  to  pro- 
vide rest,  food,  and  spiritual  comfort,  than  to  cure 
the  body.  The  nursing,  if  ignorant,  was  careful, 
and  night  nurses  were  provided.  In  addition  to 
the  general  hospitals,  which  were  more  numerous 
than  one  would  think,  there  were  many  leper 
houses.  Asylums  for  the  insane  were  few,  and 
treatment  was  barbarous.  Miss  Spearman  believes 
that  the  disappearance  of  leprosy  from  Europe  is 
due  to  the  practice  of  segregation  of  lepers.  In 
some  places,  however,  this  segregation  was  lax  in 
the  extreme,  while  in  others  it  was  sufficiently 
strict. 


Nelson's  Arm. 
A  Blue-Book  which  has  just  been  issued  will 
have  more  than  ordinary  interest  for  medical  men, 
as  it  contains  extracts  from  the  naval  medical 
officers'  journals  from  1793  to  1856,  and  therefore 
recounts  in  brief  the  medical  history  of  those  great 
sea-fights  with  Napoleon  which  constitute  the  most 
glowing  records  in  our  naval  annals.  Turning  the 
leaves  of  this  book  one  encounters  much  that 
brings  before  the  mind  the  horrors  ot  surgery  in 
pre-anaesthetic  days,  and  much  that  is  merely 
grotesque  in  the  way  of  obsolete  remedies.  But 
the  extract  that  will  rivet  more  attention  than  any 
other  is  a  description  from  the  log  of  the  surgeon  of 
the  "  Theseus  "  of  the  operation  and  after-treatment 
of  our  greatest  admiral  when  wounded  before 
Santa  Cruz.  Nelson,  it  will  be  remembered,  was 
in  the  act  of  stepping  out  of  a  boat,  which  con- 
tained part  of  the  landing  party  that  was  to  storm 
the  town,  when  he  was  shot.  The  musket-ball 
struck  his  right  arm  a  little  above  the  elbow, 
cutting  the  brachial  artery  and  producing  a  com- 
pound fracture  of  the  humerus.  Lieutenant 
Nisbet  rendered  timely  first  aid  to  his  step-father 
by  binding  the  limb  firmly  with  his  handkerchief 
above  the  wound,  probably  saving  his  life  thereby. 
The  invariable  treatment  of  a  compound  fracture 
— amputation — was  resorted  to  on  Nelson  reaching 
the  ship,  and  he  was  given  "  R  Opii  gr.  ij.  ft.  Pil. 
statim."  It  is  curious  to  contrast  the  after- 
history  of  the  patient  as  given  respectively  by 
the  surgeon  and  by  Southey.  According  to  the 
former,  everything  went  as  well  as  possible,  and 
in  a  week's  time  he  tells  us  : — "  Continued  getting 


well  very  fast,  stump  looked  well,  no  bad  symptom, 
sore  reduced  to  the  size  of  a  shilling."  Southey 
says  that  Nelson's  sufferings  were  long  and  painful, 
and  that  it  was  not  till  the  final  ligature  came  away 
at  the  end  of  November  that  he  got  rid  of  the  pain 
and  the  wound  began  to  heal. 


Radium  at  Bath. 
The  good  citizens  of  Bath  appear  to  be  some- 
what unduly  elated  at  the  discovery  of  radium  in 
their  renowned  hot  springs.  A  few  days  ago  their 
Mayor  offered  his  warm  congratulations  to  the 
Town  Council  on  the  discovery  of  this  most  up-to- 
date  constituent  in  connection  with  what  has 
always  constituted,  so  to  speak,  the  backbone  of 
Bath.  Can  the  Romans  with  splendid  intuition 
have  recognised  the  effects  of  dormant  radium  in 
their  beloved  hot  baths  ?  Or  was  not  the  dis- 
covery first  made  by  a  sagacious  hog,  who  re- 
vealed the  virtues  to  a  Saxon  King  by  wallowing 
in  the  warm  mud  around  which  the  city  of  Bath 
grew  and  multiplied  and  has  ever  since  flourished  ? 
Is  the  claim  of  priority  of  discovery  of  the  radium 
in  Bath  springs  to  be  conferred  upon  hog,  or  Saxon 
King,  or  Roman,  or  the  modern  analytical  chemist  ? 
Whatever  answer  may  be  given  by  posterity  to 
that  important  question,  we  fancy  the  Mayor  has 
somewhat  over-estimated  the  value  of  the  radium 
in  the  famous  mineral  waters  of  his  ancient  city. 
The  baths  will  be  no  better  and  no  worse  than  they 
have  been  during  many  bygone  centuries.  The 
quantity  of  this  revolutionary  element  is  so  minute 
that  it  would  not  repay  extraction,  which  is  the  only 
way  in  which  the  Bath  Corporation  would  be  likely 
to  make  money  out  of  their  radium  mine.  It  is 
possible,  however,  that  some  visitors  may  be 
attracted  to  the  city  with  the  object  of  bathing  in 
water  charged  with  so  precious  and  fashionable  a 
medicinal  agent.     So  mote  it  be  ! 


Hospital  Amalgamation  in  Dublin. 

An  interesting  event  took  place  the  other  day  in 
Dublin  in  the  completion  of  the  scheme  for  the 
union  of  the  two  ophthalmic  hospitals.  For 
many  years  St.  Mark's  and  the  National  Eye 
and  Ear  Hospital  have,  pending  the  construction 
of  the  new  building,  been  working  as  separate 
branches  of  one  institution.  A  few  months  ago 
however,  the  necessary  part  of  the  building  was 
completed,  and  the  patients  are  now  all  lodged  in 
what  is  known  as  the  Royal  Victoria  Eye  and 
Ear  Hospital  in  Adelaide  Road.  The  out- 
patient department  and  another  wing  are  still 
to  be  built,  but  we  understand  that  the  Board  do 
not  intend  to  proceed  until  funds  are  torthcoming, 
although  the  institution  is  at  present  free  from 
debt.  As  Mr.  Swanzy  pointed  out  in  his  speech 
at  the  annual  meeting  on  the  25th  ult.,  the  amal- 
gamation of  these  two  special  hospitals  is  only  part 
of  a  much  more  general  scheme  proposed  twenty 
years  ago.  During  Lord  Spencer's  viceroyalty 
there  was  much  talk  of  amalgamating  Dublin 
hospitals,  and  he  appointed  a  Commission  to 
inquire  into  the  matter  and  make  recommenda- 
tions.    In  the  Report  the  amalgamation  of  some 


NOTES  ON  CURRENT  TOPICS.        The  Mkpical  Fskss.     269 


ol  the  general  hospitals  on  either  side  of  the  city  I  had  used  adrenalin  in  a  case  of  double  glaucoma, 
was  recommended,  but    the  solitary   fruit   of   the     in  which  relief  of  pain  and  some  con Lract ion  of  the 


Commission  is  the  Royal  Victoria  Hospital.     We 

cannot  help  thinking  that  Dublin  would  gain  if 
some  ol  the  smaller  general  hospitals  would 
seriously  think  of  copying  the  special  hospitals 
in  this  direction. 


The  Purity  of  Sweets 
The  universal  sweetmeat  has  long  and  often  been 
s  subject  ol  suspicion  to  vigilant  custodians  of  the 
health,  and  over  and  over  again  analyses 
been   made  to  see  if  the  variegated  dainties 
ire  sucked  by  the  children  of  the  poor  are  not 
doing  more  harm  than  merely  stimulating    early 
dental  caries.     It  is  comforting  to  think  that  cheap 
sweets  are  generally  found  to  be  above  reproach, 
dlt  which  is  due  to  the  cheapness  of  sugar 
It  simply  does  not  pay  to  adulterate  as  it  is 
find  any  substance  wherewith  to  sophis- 
ticate   sweet  men  is    that    is    cheaper    than    sugar 
To  this  reason  more,  one  would  be  inclined 
to  think,  than  to  the  unflinching  moral  rectitude 
the  lower  order  of  confection -mongers  is  due  the 
ness  of  the  pear-drop,  aniseed  balls,  and 
eyes  that   tickle  the  palates  of   the  street 
urchins.     Vegetable  essences  to  flavour  the  sweets 
arc  also  very  cheap,  and  aniline  dyes  are  very  little 
Whether  a  rise   in    the  price  of  sugar  by 
uxatbn  and  the  abolition  ol  bounties  will  lead  to 
sequent  adulteration  is  a  point  to  be  watched, 
but  in  the  meantime  it  may  be  said  fairly  safely 
ihat  weeMacGreegor's  "  taiblct  "  is,  it  taken  in  a 
moderation    to   which   he   appears    to   have   been 
«p   quite    as  wholesome  as  any  other  part  of 


Adrenalin  in  Acute  Glaucoma. 

The   pathology   of   acute    glaucoma   has    been 

isly  described  as  being  due  to  a  retention  of 

ocular  fluids  or  to  their  hyper-secretion. 

While  modem  ophthalmological  opinion  is  inclined 
is  the  acceptance  of  the  former  theory, 
uin  be  little  doubt  that  vascular  congestion 

plays  no  small  part  in  the  production  of  the  glau- 
ous  state.     The  performance  of  iridectomy 

and  the  use  of  myotics  have,  up  to  the  present  time, 

constituted  the  main  forms  of  treatment.   The  anti- 

I  glaucomatous  effect  of  a  myotic  depends,  of  course, 
entirety  upon  Its  power  of  bringing  about  contrac- 
tion of  the  pupil,  and  if  this  cannot  be  done  the 
drug  is  valueless.     M.  Grandclement  (a)  showed  at 
a  recent    meeting    of    the    Societe    des    Sciences 
»  Medicates,  of  LyonSj  a  patient,  aged  thirty-seven, 
nm  he  had  cured  an  attack  of  acute  glaucoma 
hy  the   instillation   of   adrenalin.     The   strength 
employed  was    1    in   5,000,  and    the  solution  was 
od  into  the  affected  eye  every  half -hour  for 
'iircc  consecutive  days.     It  has  been  found  experi- 
mentally   that    suprarenal     extract     arrests    the 
mat  ion  of  the  aqueous  humour  in  the  eyes  of 
md,    therefore,   diminishes    tntra-ocular 
on.     In    the   discussion    which    followed    the 
hihition  of  the  case,  M,  Auratid  stated  that  he 

1  JLfOM  Vtdwle,  February    I4ftt,  1904, 


pupil  were  obtained,  but  he  performed  iridectomy 
aiterwards.  Until  it  can  be  proved  that  this  bene- 
ficial effect  of  adrenalin  is  more  than  temporary, 
it  is  doubtful  whether  this  powerful  vaso-con- 
strictor  will  find  favour  with  ophthalmic  surgeons. 
It  it  be  established  that  operation  affords  the  best 
chances  of  success  in  acute  glaucoma,  there  can 
be  no  object  in  wasting  time  by  employing  less 
radical  measures.  We  have  by  no  means  ex- 
hausted the  therapeutical  possibilities  of  supra- 
renal extract,  and  its  use  in  this  department  of 
surgery  may,  after  further  experiment,  be  found 
of  service. 


Nurses  of  Yore. 
The  nursing  profession  is  advancing  every  day, 
and  if  the  Bill  for  the  registration  of  its  members 
passes  into  law  (which  seems  very  unlikely  this 
n;i  it  will  acquire  a  status  that  will  not  be 
grudged  to  it  by  those  who  know  the  value  oi  B 
trustworthy  and  skilled  nurse.  It  is  amusing  to 
read  in  the  records  of  one  of  our  big  hospitals  that 
the  salary  of  a  sister  in  the  year  1552  was  only  40s. , 
whilst  a  "  herb- woman  *'  was  in  receipt  of  double 
that  sum.  The  sisters  of  the  present  day  are  not 
overpaid,  but  most  of  them  would  not  find  devo- 
tion to  their  work  sufficient  to  carry  them  through 
the  year  with  only  two  pounds  to  spend  on  dress 
and  amusements.  The  restrictions  placed  on  the 
sisters'  movements  were  considerably  greater  than 
they  are  now.  The  *  late  pass  " — or,  indeed — 
any  pass— did  not  exist,  as  there  is  a  record  of  three 
sisters  being  threatened  with  discharge  for  going 
about  the  townf  and  this  severe  penalty  was  to  be 
inflicted  M  yf  they  doe  the  like  hereafter."  The 
amorous  house-surgeon,  or  his  homologues,  would 
seem  to  have  been  more  or  less  en  Evidence  even  in 
1552,  for  the  sisters  were  bidden  to  beware  the 
machinations  of  the  males  about  the  hospital 
precincts,  The  rule  enjoined  that  no  one*'  should 
talk  susspitiously  nor  contract  matrimony  with 
each  other  within  the  house/'  One  sister  who 
ventured  to  "  carry  on  "  in  spite  of  this  rule  was 
so  far  successful  in  her  object  as  to  be  "  axte  in 
church  if  by  her  swain.  On  being  handed  over  by 
the  authorities  to  the  matron's  r<  discressyon  "  she 
seems  to  have  found  but  little  fa%^our  with  that 
adamantine  female,  for  she  was  politely  requested 
not  to  "  reniayne/'  The  work  of  the  modern 
nurse  may  present  a  marked  contrast  to  that  of  her 
prototype  of  three  and  a  halt  centuries  ago,  but 
her  predilections  and  weaknesses  seem  to  have 
undergone  but  little  alteration,  and  it  would  seem 
that  the  rules  relating  to  her  discipline  have  not 
substantially  changed  in  principle. 


Phalangeal  Enlargement  in  Rickets. 

Although  aSecting  more  or  less  the  whole 
system,  the  stress  of  rickets  appears  to  fall  most 
heavily  upon  the  osseous  structures.  The  charac- 
teristic epiphyseal  thickenings,  many  of  which 
bear  distinctive  names,  are  early  brought  before 
the  notice  of  the  student  of  medicine,  who  soon 


270    Thz.  Medical  Press. 


NOTES  ON  CURRENT  TOPICS. 


March  <y.   1904 


learns  to  recognise  the  "  rickety  rosary  "  and  other 
bony  abnormalities  met  with  in  the  course  of  the 
disease.  Dr.  Jacob  Sobel,  (a)  of  New  York,  has 
called  attention  to  the  fact  that  enlargement  of  the 
bones  of  the  phalanges  is  not  unfrequently  seen  in 
true  infantile  rickets,  and,  indeed,  is  often  over- 
looked. The  condition  is  one  of  true  bony  hyper- 
trophy, though  the  clinical  appearances  sometimes 
resemble  very  strongly  those  seen  in  strumous  or 
syphilitic  dactylitis.  There  is,  however,  an 
absence  of  the  dusky  hue  which  generally  accom- 
panies tuberculous  lesions  of  the  phalanges,  and 
other  signs  of  rickets  may  be  found  elsewhere. 
The  diagnosis  from  syphilitic  dactylitis  may  be 
more  difficult,  especially  as  enlargement  of  the 
spleen  occurs  in  both  affections.  With  morbus 
cordis  of  congenital  origin  associated  with  clubbing 
of  the  fingers  it  is  hardly  likely  that  there  would  be 
confusion.  Dr.  Sobel  quotes  the  experience  of 
Dr.  Rudolph  Neurath,  who  has  found  that  perio- 
steal thickening  may  be  easily  demonstrated  in 
these  cases  by  means  of  the  X-rays,  the  interior  of 
the  bone  being  practically  unaffected.  The  term 
44  rhachitic  dactylitis*'  is  suggested  for  the  condition 
which  principally  affects  the  phalanges  of  the 
upper  extremities. 


The  Complications  of  Measles. 

The  acute  exanthemata,  as  a  class,  are  not  so 
much  to  be  dreaded  for  their  own  sake  as  on 
account  of  the  many  and  varied  complications  by 
which  they  are  so  often  accompanied,  or  the 
sequelae  which  sometimes  follow  in  their  wake. 
The  secondary  lesions,  from  their  gravity  and 
importance,  are  naturally  feared  more  than  the 
disease  itself,  and  it  is  for  their  prevention  that 
the  skilful  practitioner  earnestly  strives.  The 
readiness  with  which  the  general  public  are  apt  to 
make  light  of  the  milder  varieties  of  the  acute 
specific  fevers,  calling  them — as  they  do—"  only 
children's  complaints,"  and,  perhaps,  treating 
them  themselves  by  the  aid  of  some  popular  hand- 
book of  household  medicine,  contributes  in  no 
small  degree  to  the  really  high  comparative  mor- 
tality associated  with  these  diseases.  It  is  noto- 
rious, for  instance,  that  the  epidemic  form  of 
measles  is  by  no  means  the  simple  affection  it  is 
supposed  to  be,  for  statistical  returns  show  the 
death-rate  to  be  considerable,  especially  in  poor 
districts  and  among  ill-fed  or  wasted  infants. 
Complications  cf  a  pulmonary  nature  are  chiefly 
responsible  for  the  fatal  issue  in  measles,  capillary 
bronchitis  and  broncho-pneumonia  being  specially 
prone  to  occur.  Acute  nephritis  is  not  often  seen 
as  a  complication  in  this  disease,  and  many  text- 
books of  medicine  do  not  mention  it.  A  case  of 
this  nature,  reported  in  the  Guy's  Hospital  Gazette, 
is  worthy  of  notice  in  this  connection  as  showing 
that  nephritis  may  be  absolutely  unsuspected 
during  life  and  yet  may  be  the  actual  cause  of 
death.  An  infant  of  ten  months  was  admitted 
with  a  typical  morbilliform  eruption  and  signs  of 
bronchitis.     A  week  later  diarrhoea  supervened, 

(a)  Medical  Nevt,  Feb.  13th,  1904. 


which  increased  in  severity  in  spite  of  treatment 
until  the  child's  death  thirteen  days  later.  At  the 
autopsy  the  kidneys  were  found  to  weigh  ninety 
grammes  and  to  present  all  the  appearances  of 
acute  nephritis.  No  dropsy  was  present  during 
life.  Cases  such  as  these  only  serve  to  illustrate 
the  clinical  importance  of  giving  a  guarded  pro- 
gnosis as  long  as  any  unfavourable  symptoms  in 
the  course  of  measles  are  manifest. 

Latent  Disease  in  Childhood. 

As  "  sickly  plants  betray  a  niggard  earth,"  so 
surely  does  the  weakly  condition  of  the  child 
reveal  the  quality  or  constitution  of  the  soil  from 
which  it  has  sprung  and  the  heritage  which  com- 
prises its  physical  capital.  It  is  true  that  many 
puny  infants  ultimately  develop  into  a  state  which 
may  pass  for  comparative  or  even  excellent  health 
as  the  result  of  incessant  watchfulness  and  per- 
severing care  ;  but  when  they  are  put  to  the  sharp 
test  of  a  severe  illness  their  lack  of  staying  power 
is  only  too  conspicuous.  The  modern  life  of 
board-school  children,  as  portrayed  in  the  daily 
press,  shows  unmistakably  that  a  large  proportion 
of  these  little  ones  are  absolutely  unfitted  for  the 
stress  and  strain  of  an  ordinary  school  education, 
while  numerous  instances  have  come  to  light  where 
the  increased  demands  placed  upon  their  feeble 
reserve  power  in  the  shape  of  some  kind  of  work 
undertaken  in  "  out-of -school  hours  "  have  been 
responsible  for  an  utter  physical  breakdown.  To 
a  great  extent,  this  incapacity  for  work  is  due  to 
improper  feeding,  which  is,  in  its  turn,  the  direct 
result  of  parental  ignorance.  There  is  littie  wonder 
then,  that  under  such  circumstances  any  latent 
tendency  to  disease  which  may  be  constitutionally 
present  in  these  children  ceases  to  be  a  mere  pre- 
disposition, but  develops  into  some  actual 
morbid  state.  Tuberculosis,  in  one  of  its  many 
varieties,  is  the  malady  which  is  most  often  de- 
veloped in  this  way.  As  Dr.  Robert  Jones  re- 
I  marked  in  his  lecture  before  the  Society  of 
'  Arts,  last  week,  the  amount  of  physical  deficiency 
and  latent  disease  found  among  a  considerable 
number  of  the  poorer  class  of  school  children  was 
enough  to  "  sadden  a  medical  expert."  The  truth 
of  these  words  can  only  be  fully  appreciated  by 
those  who  have  themselves  personally  conducted 
the  medical  examination  of  these  little  ones.  How 
to  prevent  potential  or  latent  disease  from  becom- 
ing an  actuality  is  one  of  the  problems  which 
should  engage  our  utmost  attention. 


An  Advance  in  Entero-Anastomosis. 

From  time  to  time  surgeons  in  various  parts  of 
the  world  have  devoted  a  good  deal  of  ingenuity 
to  the  anastomosing  of  stomach  and  gut.  Of 
special  devices,  perhaps  none  is  more  widely 
known  than  Murphy's  button.  In  the  next  issue 
of  The  Medical  Press  and  Circular  will  appear 
an  account  of  a  novel  method  of  anastomosing 
stomach  and  bowel  without  opening  into  the  lumen 
of  either  viscus,  sent  by  our  Austrian  correspondent. 
The  special  operation  appears  to  have  been  per- 
formed only  on  dogs  and  monkeys,  and  has  not 


March  v.  1904 


SRSONAL, 


The  Medical  F&ess,     271 


►een  tried  on  the  human  subject.  Sato,  who 
has  devised  this  most  ingenious  procedure,  re- 
moves  the  muscular  and  submucous  coats  of  the 
stomach  and  intestine  over  the  parts  it  is  desired 
to  unite.  Nitrate  of  silver  is  then  applied  to  the 
mucous  membrane  of  both  bowel  and  stomach, 
which  are  then  brought  together  and  fastened  in 
position  by  a  few  §e  to- muscular  sutures.  A  free 
<:r»mmuni  cation  follows  after  two  days  in  the 
monkey,  and  three  in  the  dog,  Should  the 
feasibility  and  safety  of  this  method  become 
established,  it  will  obviously  do  much  to  simplify 
and  to  render  safer  anastomosing  operations  of 
the  kind  mentioned.  The  principle,  moreover, 
is  capable  of  extension.  Whether  ultimately 
adopted  or  not,  the  proposal  is  typical  of  the 
restless  ingenuity  and  daring  of  modern  surgery. 


Latent  or  Intermittent  Nasal  Obstruction. 

The  physiology  of  the  upper  air  passages  is 
times  apt  to  escape  due  recognition  by  those 
make  a  special  study  of  the  nose  and  throat. 
That  its  careful  consideration  is  capable  of  fur- 
nishing fresh  and  valuable  data  is  shown  by  the 
able  and  original  article  jiublished  elsewhere  in 
our  columns  by  Mr.  Mayo  Collier,  He  points  out 
that  the  naso- pharyngeal  tract  is  not  a  simple 
but  a  canal  that  widens  out  here  and  then 
into  reservoirs,  which  provide  mixing  chambers 
lor  the  inspired  fresh  air.  Otherwise  it  would  be  im- 
passible for  the  nasal  passages  to  "  warm,  moisten 
and  purify  air  "  that  passes  through  the  nose  in 
an  average  space  of  two  seconds,  Mr.  Collier 
died  attention  to  an  often  unsuspected 
condition,  where  the  patient  breathes  through  the 
nose  in  the  daytime,  but  during  the  night  becomes 
1  "  mouth-breather."  The  consequences  are  of 
the  usual  kind,  but  the  observer  is,  maybe,  thrown 
**n  his  guard  by  a  confident  denial  of  mouth 
breathing  on  the  part  of  his  patient.  The  author 
states  that  the  groove  on  the  septum  is  in  moat 
cases  the  only  objective  sign  of  this  state  of  affairs, 
but  it  is  fortunately  constant  and  pathognomonic. 


to  constant  applications  for  admission,  lo  restrict 
each  patient's  stay  to  a  period  of  about  three 
months.  Messrs.  Guinness  and  Sons,  however, 
maintain  one  ward  for  the  use  of  their  employees, 
and  are  able,  as  a  rule,  lo  permit  a  longer 
For  this  reason  the  report  of  their  medical  officer. 
Dr.  Lumsden.  is  of  particular  interest,  and  it 
would  be  hard  to  find  more  satisfactory  evidence 
of  the  efficacy  of  the  treatment  at  Newcastle.  He 
relates  that  every  patient  he  sent  to  the  Hospital 
improved  greatly,  and  most  oi  them  are,  he 
believes,  cured.  Without  the  treatment  they 
received  they  were  all,  in  his  opinion,  doomed  to 
speedy  death.  When  our  Commissioner  visited 
the  hospital  last  autumn,  he  recommended  a 
the  establishment  of  a  dispensary  in  Dublin, 
where  old  patients  could  be  kept  under  ob 
scrvation,  candidates  for  admission  examined, 
and  instruction  given  to  unsuitable  patients.  We 
are  glad  to  see  that  the  Board  intend  shortly  to 
carry  out  this  suggestion,  but  at  present  they 
have  their  hands  full  in  building  a  new  wing  for 
females. 


PERSONAL. 


The  medical  profession  will  learn  with  pleasure  that 
Sir  Samuel  Wilks  is  now  well  on  the  road  to  recovery 
from  his  recent  operation. 


Dh.  de  Havm  LARD  Hall  presided  at  the  animal 
dinner  of  the  Medical  Society  of  London,  held  yester- 
day evening  at  the  Hotel  Metropole.  London. 

The  n?wly- appointed  Demonstrator  of  Hygiene  and 
Public  Health  at  University  College,  London,  is  Mr. 
G.  E,  Richmond,  M.D-,  *B,S.,  B-A,,  BScLoOd., 
D.RH.Camb. 


The  Irish  National  Hospital  for 
Consumption. 

The    Annual     Report    of    the  Royal  National 
ital  for  Consumption   for  Ireland  presented 
list  week    give*    fresh    evidence   of    the    valuable 
work  which    is    being   done    by    that    institution. 
During    the    year    1003,    265    patients   were   dis- 
ced after   treatment,  of  whom   204  were  im- 
proved.    Many  presented,  a  I  the  time  of  discharge, 
110  sign  of  disease,  and  were,  to  all  appearance  feu  n.jd . 
Eighty-five  per  cent,  of  the entircnumberof  patients 
treated  showed  an  increase  in  weight,  the  highest 
individual     gain    being     *st«     fibs.     Dr.    Steede, 
resident    physician,    is,    however,    properly 
cautious    about    drawing   conclusions    irom    very 
1  cast's,  and  he  adds  to  his  report  extracts 
letters   received    from   former  patients  who 
were  in  the  early  days  of  the  hospital  six 

ven  years  ago.  Many  oi  these  old  patients 
m  excellent  health,  and  have  been  at  their 
tar  employment  since  leaving  Newcastle, 
Oi  Hie  hospital  it  is  necessary,  owing 


Deputy  -  Inspector  -General  oi  ]  Hospitals  and 
Fleets  Herbert  Mack  ay  Ellis  has  been  promoted  to 
UtC  rank  Of  Inspector-General  of  Hospitals  and  Fleets 
in  His  Majesty's  Fleet, 

Dr.  T.  G,  Brodie,  Professor  of  ^Physiology  at  the 
Royal  Veterinary  College  and  Superintendent  of  the 
Brown  Institute,  is  one  of  the  new  Fellows  Of  the  Royal 
Society. 

rAMONG  others  of  the  fifteen    new    Fellmvs   ore  Or, 
<j.  II,  F.  Nuttall,  University  Lecturer  in  Bacteriology 
and  Preventive  Medicine  at  Cambridge  ;   and  Pr<>i 
A.  E*  Shipley,  the  well- known  Cambridge  lecturer  upon 
invertebrate  morphology, 

A  fellovvmhh'  oi  the  value  of  £100  a  year  fur  three 
years  has  been  founded  111  the  University  i.d  Lnerpool 
U\  Mr  ,\\  . ,  I  hehvall  Thomas,  assistant  SQTgeOti  to  the. 
Royal  Liverpool  Infirmary, 


THI    Kin-     rilihuugh    unable   to   attend    the   State 
service    at     St.    Paul's     on     Sunday    last,    teem 
Eroao   los  recent   indisposition  sufficiently   to   preside 

it  .i  Privy  Council  on  Monday,  thu  7th  inst. 

Thomas  R,  Fraser,  M,D.*  F.R.S..  Professor  of 
Materia  Medica  and  Clinical  Medicine  in  the  Univtr-iu 
of  Edinburgh,  has  had  the  well-deserved  honour  con^ 
ferred  on  him  of  appointment  as  an  Honorary  Physioon 
to  His  Majesty  the  King  in  Scotland. 

(A)  Tan  tf  Kim  al  Frk**  ash  Cihltlah,  3vpu»mli*r  30th,  lPia 


272    The  Medical  Press. 


CORRESPONDENCE. 


March  9,  1904. 


The  two  remaining  Hunterian  lectures  on  the 
•"  Pathology  and  Surgery  of  the  Pancreas,"  will  be 
delivered  before  the  Royal  College  of  Surgeons  by 
Professor  Mayo  Robson  on  March  9th,  and  nth, 
at  5  p.m.  each  day. 

Professor  Boyce,  Dean  of  the  Liverpool  School  of 
Tropical  Medicine,  on  his  return  from  Egypt,  where  he 
has  been  investigating  malaria,  was  entertained  last 
week  at  a  complimentary  luncheon  by  Sir  Alfred  Jones, 
K.C.M.G.,  and  a  distinguished  company. 

Sir  William  Turner,  K.C.B.,  was  the  guest  of 
the  Royal  Medical  Society  on  the  3rd  instant,  in  the 
Hall  of  the  Society  at  Edinburgh.  The  President  of 
the  evening  was  Dr.  Fitzwilliams,  and  there  was  a 
large  and  distinguished  attendance  of  medical  men. 

The  Council  of  Owens  College  recently  invited  Dr. 
Mott  and  Mr.  Brudenell  Carter  to  deliver  two  lectures 
to  the  medical  men  of  Manchester  and  the  neighbouring 
districts.  The  first  of  these  lectures  was  delivered  on 
February  19th  by  Dr.  Mott.  on  "  The  Cerebro-Spinal 
Fluid  and  its  Relation  to  Diseases  of  the  Nervous 
System." 

Special  correspondence* 

[from  our  own  correspondent.] 

SCOTLAND. 

Royal  Edinburgh  Asylum  for  the  Insane. — Dr. 
•Clouston's  annual  report  of  the  asylum,  which  is  always 
well  worth  reading,  was  adopted  at  the  meeting  of  the 
Asylum  Corporation  on  February  29th.  The  first 
paragraph  of  the  report  deals  mainly  with  statistics, 
and  the  main  feature  of  the  admissions  for  the  year 
was  the  number  of  cases  of  aged  and  broken-down 
people,  of  general  paralytics,  and  of  alcoholics.  The 
prevalence  of  tuberculosis,  four  times  as  common  in 
asylums  as  among  the  general  population,  was  now 
attracting  an  enormous  amount  of  attention.  At  the 
Edinburgh  Asylum,  16  per  cent,  of  the  deaths  were 
associated  with  tuberculosis,  while  in  13*5  per  cent, 
it  was  the  sole  cause.  On  going  over  the  statistics  he 
was  astounded  to  find  that  in  Craig  House  there  had 
■only  been  three  deaths  in  nine  years,  that  these  were 
imported  cases,  and  that  no  case  of  tuberculosis  had 
•ever  arisen  there.  While  this  was  a  striking  testimony 
to  the  thoroughness  of  the  measures  taken  to  prevent 
infection  spreading  in  Craig  House,  it.  of  course,  meant 
that  the  amount  of  tuberculosis  in  the  West  House  was 
correspondingly  higher — 22- 5  per  1,000  inmates,  and 
14*5  per  cent,  of  the  total  deaths,  as  against  the  English 
numbers  of  182  and  169.  As  might  be  expected, 
during  the  last  nine  years,  since  they  became  distinctly 
overcrowded,  tuberculosis  had  distinctly  increased. 
The  general  death-rate  of  the  whole  institution  was 
13  per  cent,  on  the  average  numbers  resident,  and 
8*8  per  cent  on  the  totals  under  treatment. 

Lunacy-Rate  for  Thirty  Years. — In  1873  one 
insane  person  was  chargeable  on  the  rates  for  every  413 
of  the  population  of  Edinburgh  and  Leith  ;  in  1883, 
the  number  was  the  same ;  in  1893,  there  was  one  to 
379;  in  1903,  one  to  315.  These  figures  probably 
corresponded  pretty  closely  with  the  general  Scottish 
rate.  The  increase  of  insane  persons  did  not  mean 
any  great  increase  in  insanity,  but  was  due  to  the  fact 
that  people  were  less  afraid  of  asylums,  to  the  enlarge- 
ment of  the  area  of  what  constituted  certifiable  mental 
defect,  and  to  the  prolongation  of  life  of  patients  in 
asylums.  The  proportion  of  one  rate-paid  patient  to 
every  315  of  the  population  did  not,  however,  represent 
our  whole  mental  defect.  When  every  person  affected 
with  any  form  of  mental  disease  or  weakness  was  in- 
cluded, there  was  a  proportion  of  one  to  230  of  the 
population  of  Edinburgh,  and  of  one  to  220  for  Scotland 
generally.     The  extremes  were  one  to   118  in  Argyll 


and  one  to  334  in  Dumbarton.  Argyll,  however,  sent 
out  a  large  proportion  of  sane,  energetic  young  adults  to 
work  in  Glasgow  and  Dumbarton,  while  insane  and 
weak-minded  ones  were  left  at  home  on  the  rates. 
Dumbarton  produced  yearly  more  acute  insanity  than 
Argyll,  but  this  was  a  kind  of  insanity  which  either 
killed  its  victims  soon,  or  allowed  them  to  recover 
rapidly.  In  any  case,  it  did  not  run  up  the  number  of 
permanent  weak-minded.  The  low  infant  death-rate 
of  Argyll  meant  the  survival  of  imbeciles  ;  the  high 
rate  of  Dumbarton  killed  off  the  imbeciles  with  the  rest. 
The  care  of  child  life  ought  to  have  a  better  reward  than 
the  burden  of  supporting  so  many  imbeciles  out  of  the 
rates.  The  cost  of  lunacy  was  high,  chiefly  on  account 
of  this  class,  in  Orkney  and  Shetland,  where  the  death* 
rate  under  ten  years  was  only  11  per  1,000 — a  record, 
compared  with  the  37*5  per  1,000  mortality  of  Lanark. 
During  the  thirty  years  the  recovery-rate  had  decreased 
and  the  death-rate  increased.  This  was  due  largely 
to  increased  admissions  of  senile  insanity  and  of  general 
paralysis.  Adolescent  insanity  had  also  become  more 
prevalent.  Alcoholic  insanity  was  steadily  going  up ; 
this  year  no  fewer  than  42*3  per  cent,  of  men  and 
18  per  cent,  of  women  admitted  had  excess  in  alcohol 
assigned  as  a  cause  of  insanity.  The  percentage  had 
steadily  risen  in  the  thirty  years,  until  now  it  had 
doubled  itself.  One  of  the  after-effects  of  the  nervous 
lowering  which  the  influenza  epidemic  of  1890  un- 
doubtedly caused  might  have  been  the  craving  for  the 
stimulus  of  alcohol.  Undoubtedly  since  that  time  far 
more  cases  of  depressive  insanity  had  been  admitted. 
Possibly,  too,  more  money  was  earned  by  those  who  had 
not  self-restraint  to  use  it  rightly.  It  was  satisfactory 
to  learn  that  some  forms  of  insanity — epileptic,  and 
those  connected  with  child-bearing — had  become  re- 
latively less  frequent.  It  was  much  to  be  desired  that 
the  public  should  take  a  rational  view  of  mental  disease, 
and  look  on  it  as  a  disease  of  the  brain — like  a  disease 
of  any  other  organ.  In  about  a  third  of  the  cases  it 
was  due  to  arrest  of  development  or  disturbance  of 
growth  during  adolescence  ;  in  about  a  sixth  to  pre- 
mature senility.  In  the  remainder  it  was  thought  to 
be  due  to  toxaemia,  to  which  heredity  predisposed. 
Such  terms  "  idiot  "  or  "  madman  "  should  cease  to 
be  used  as  terms  of  reproach.  The  world  would  gain 
if  only  a  rational  view  of  mental  disease  were  universally 
taken  and  the  facts  about  it  manfully  faced. 

Royal  Medical  Society's  Annual  Dinner. — This 
function  was  held  in  the  society's  hail  on  March  3rd. 
Dr.  Fitzwilliams,  who  presided,  having  on  his  right  the 
guest  of  the  evening,  Principal  Sir  William  Turner. 
The  dinner  was  largely  attended  by  the  principal 
medical  men  in  Edinburgh,  and  universal  regret  was 
felt  that,  on  account  of  illness,  Dr.  Shaw,  the  Senior 
President,  was  unable  to  be  present. 

Chalmers  Hospital,  Edinburgh. — After  holding 
the  appointment  of  surgeon  to  this  hospital  for  nearly 
forty  years,  Sir  Patrick  Heron  Watson  will  retire  on 
October  1st  next.  He  will  maintain  his  connection 
with  the  hospital  in  the  capacity  of  consulting  surgeon, 
and  a  bed  in  each  ward  will  be  named  the  Heron 
Watson  Bed  in  recognition  of  the  eminent  services  he 
has  rendered  during  that  long  period. 


CorresponDence- 

rWe  do  not  hold  ourselves  responsible  for  the  opinion  of  the  corres- 
pondents.] 

THE  LEGAL  AND  MEDICAL  PROFESSIONS. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — The  spirit  of  friendly  relationship  that  for- 
merly existed  between  the  professions  of  law  and 
medicine,  and  the  courtesy  that  was  its  natural  ex- 
pression, seem  to  have  departed  altogether  in  our 
times,  or  to  be  recalled  only  by  the  occasion  of  social 
functions  outside  the  sphere  of  professional  work. 
Anyone  who  has  had  experience  of  the  system  that 
presently  obtains  in  the  Courts  cannot  fail  to  have 
been  struck  by  the  unwarranted  impertinence — fre- 
quently amounting  to  positive  insult — to  which  medical 
witnesses   are   constantly  subjected,   as   if   it   were  a 


LITERATURE. 


The  Medical  Press.     273 


recognised    fact  chat  even"  medical  witnRS  must  not 

,],    but"  prepared    to    sacrifice    his 

professional  honour     anil     degrade  his   office   in    the 

oJ  whatever  party  has  employed  him. 

t   an   infrequent   occurrence   to   find   judges 

priding    themselves     upon     the    knowledge    of    petty 

,d  technicalities    and   parading   it   in   a   scries  of 

question*    that     should  arouse     indignant 

:  it  did  not  afford  compensation  in  the  silent 

meat  of  the  doctor  who  happens  to  he  pilloried 

'  OX. 

tures  regarding  excessive  fees  and  the  unrc: 

>f    medical    men   are  occasionally 

I  trresisliblv  force  one  to  the  cond 

id"    has   been   a   diligent   student   of   the 

ductory  remarks  to  the  advertisements  of  patent 

mes      Tlie  Bar,  of  course,  takes  its  cue  from  the 

i  I    the   method    of   cross-examination   of   a 

.  bears  frequently  a  close  resemblance 

lo  |ta  ssions  Court  style,  where  the  evidence 

^ivihtful  character  is  being  sifted. 

cross-examination  of  medical  witn 

irected  to    minimise  the  injuries  alleged  to  have 

taken  place,  and  the  mosL  vigorous  investigation  of 

iacts  did   001    prfcclnde  the   observance  of   that   old- 

that    was   honourable   alike   to   both 

however,     the     medical     man     is 

to  every  indignity,  his  motives  are  impugned , 

and  his   testimony   regarded   as,   at  least,  not  above 

<  i-  in. 

That  this  is  the  actual  state  of  things  can  scarcely 

unsaid    the  reason  for  it  may  be  debatable,     It 

-  <ll\   seem  that  the  present  duly  of  medical 

!   resolutely  any 

insulting  observations  or  insinuations  addressed  to  them 

]a  a  ,  .  whether  they  emanate  from  the 

judge  or  counsel. 

]  am.  Sir,  \  ours  truly, 

E.  Magenmis,  M.D..  D,RH. 
tttrconrl  Street,  Dublin, 

\I.      PROFESSION      IK      IRELAND 
D    THE    PRIVATE    ENTREE. 

l  Press  and  Circ 

—I    beg    to  forward  you*  for   publication,   the 

viug    letter    from    the    Private   Secretary    of   his 

the  Lord   Lieutenant,  which   was  read   at 

loinhly  meeting  of  the  President  and  Fellows  of 

the  Royal  College  of  Physicians  of  Ireland  held   this 

■urs. 

James  Craig,  Ml' 

Fellow  and  Registrar. 
Roy3l  College  of  Physicians  of  Ireland, 
n,  March  4tb>  t9°4- 

"  The  Castk\   Dublin, 
M  36th  Feb,,    I9O4. 
"Beat  Sir, — With  reference  to  the  question  •■!  the 
Private   Entree   at   Dublin  Castle,   I   am   directed    to 
request  you  to  inform  vour  Council  that,  after  careful 
tion  i»l  all  the  circumstances  of  the  case,  the 
I,<lTf! .1  it    has    decided    not    to  carry   out    the 

cban.  ;  emplated,  but  to  adhere   Uj  the  rules 

iiiuler  which  up  to  the  present  it  has  been  regul 

lency  trusts  that  this  decision  will  be  in  all 
tory  to  vour  Council,  and  to  the  pro- 
ents.— I  am,  faithfully  yours. 

"  (Signed),  Plunket* 

al  College  of  Physicians  of  Ireland,  " 

$bttuan>. 

DEXIS    NYHAN,  L.B.C.S..    L.R.C.P.EDlx.f    BRYN- 

M  \WR. 

We  regret   i>>  announce   the  death  of  Dr.    Dennis 

Xvhan.  medical  officer  of  health  for  Brynniawr.  on  the 

1st  Hist .  from  pneumonia,  with  which  he  was  seized  only 

previously.  A  large  and  represen  La  Uveal  ten- 

w Inch  met    at    the  London  ami  North-Western 

1  i  'where  the  mourning  party  entrained 


for  New  Milford,  en  route  for  Cork,  testified  to  the 
esteem  in  which  deceased  was  held.  The  cortege  in- 
cluded members  of  public  bodies,  friendly  societies, 
and  a  large  number  of  his  professional  brethren  from 
different  parts  of  the  Principality,  The  coffin  was 
covered  with  wreaths.  Deceased  came  U»  Brynmawr 
nearly  eight  years  ago  as  assistant  to  the  Jat- 
Alexander  Lowe,  M.B.,  whose  practice  he  acquired. 
1  Don  arrival  at  Cork  the  remains  were  removed  lo 
Kilnagross,  near  Clonakiltv,  his  native  place,  where 
I  the  interment  took  place  on  Friday  last. 

ALEXANDER  DAVIDSON.  M.D.ED1N..F.R.CPXOKD. 
M.A., 
The  death  is  announced  of  Dr,  Alexander  David 
Of    _■    Gambler  Terrace,  Liverpool,  at  the  age  of  66 
years.     The  deceased,  who  had  been  ill  for  some  time, 
|  expired  on  March  3rd,    and  was  buried  in  Smithdown 
Road  Cemetery,  after  private  cremation.     Dr.  David- 
son,   who   had    a    practice    in    Liverpool,    obtained   his 
degrees  from  Edinburgh  and  London,  and  held  honorary 
as  physician,  and,  later,  as  consulting  physician, 
at  the  Northern  Hospital   and   the  Royal   Infirmary. 
In   former  times  he  was  one  of  several  lecturers  on 
clinical  medicine  at  the  University  College,  now  the 
Liverpool  University,     He  was  professor  of  pathology 
in   the  Liverpool  School  of  Medicine,  and  on  rci 
was  made  Emeritus  Professor  of  Pathology  of  Univer- 
sity College, 

J.  D,  DIXON,  MJLDltr.,  M.K 
We  regret  to  announce  the  death  of  Dr,  J,  D,  Dixon, 
a  well- known  and  highly  esteemed  member  of  the 
medical  profession  of  Gateshead,  son  of  the  late  Dr. 
Dixon,  of  that  town.  He  was  educated  at  Durham 
University,  where  he  graduated  M.13.  up  tS?8,  having 

I  previous! y     taken     the    M  RCS.Kng,    in     1875,      The 
deceased       was     at      one     time     house     surgeon      <>f 

1  Newcastle  Infirmary,  and  subsequently  joined  the  itafll 
of  the  Dispensary,  He  afterward,  entered  into  private 
practice,  and  in  the  course  of  time,  owing  to  somewhat 
Ith,  took  up  his  abode  at  Harrogate.  Lately 
he  went  to  live  at  Southsea,  where  he  died  on  Monday 
of  last  week,  and  was  interred  there  on  Thursday. 
Dr.  Dixon  about  ten  years  ago  married  Miss  Kate  U. 
Clarke,  daughter  of  Mr,  Clarke,  of  the  firm  of  Clarke, 
Chapman  and  Co,  He  was  only  fifty  years  of  age, 
and  leaves  a  widow  and  three  children,  lb-  b 
prominent  position  in  Freemasonry,  and  took  high 
rs   in    the  Province. 

Xlteratuce. 

EEALE'S  AIDS  TO  PHYSIOLOGY.*  («| 
The  volume  under  review  forms  one  of  tht  latest 
additions     to     the     "  Students'     Aids     Series/'      I  nr 
some  time  past  been  a  felt  want  in  regard  to 

a  handv  summary  of  the  facts  regarding  physio! 
Phis  want  has  at  last  been  supplied,  and  students  are 
under  a  deep  debt  of  gratitude  to  the  author  of  these 
\ids"  for  the  trouble  he  has  taken  in  condensing 
so  large  a  subject  as  physiology  within  the  compass 
pages,  It  might  be  considered  hardly  possible 
or  even  advisable  to  epitomise  so  important  a  Sttl 
as  this,  but  at  the  present  time  students  absolutely 
must  have  such  handy  guides  as  these  to  help  them  in 
finding  their  way  about  in  the  maze  of  subjects  through 
which  they  are  forced  to  journey.  Turning  to  the 
book  Itself,  we  find  that  each  one  of  (he  twenty  chap* 
lers  of  which  it  is  made  up  is  characterised  by  con- 
ciseness of  diction  and  deriniteness  of  statement.  The 
illustrations,  for  a  small  book  of  this  kind,  are  nu- 
merous and  exceptionally  clear  and  helpful.  The 
book  certainly  presents  as  good  a  summary  of  modern 
physiology  as  one  would  wish  for  or  expect.  Students 
in  "particular  will  derive  much  benefit  from  a  careful 
study  of  its  pages  just  before  examination,  while  prac- 


(«)  *'  Aid*  to  FhfSbltatT,"  Br  Peyton  T,  B,  Be,de,  F.R.CS.  Bfefj  , 
E*iutthter  in  Phvnolojrv  to  the  Society  of  Apothec*rie*,  Lecturer  in 
Phyiiology  and  HUfoloir>  ,Ktt)£'n  Coljejr*  Ac.  Pp,  vi ,  £S&  Pries  3i  IHL 
London  :  BuMiere,  Tinrtoli  and  Cox.     1903. 


274     The  Medical  Press. 


MEDICAL    NEWS. 


titioners  who  do  not  consider  themselves  too  old  to 
learn  will  find  within  its  pages  much  that  differs  from 
the  physiology  as  taught  in  earlier  days,  and  which 
is  instructive  and  absolutely  essential  if  they  desire 
to  keep  pace  with  modern  research  and  its  teachings. 
We  have  little  doubt  that  yet  another  edition  of  this 
masterpiece  of  conciseness  will  not  be  long  in  being 
called  lor,  and  if  such  be  the  case  we  may  suggest 
that  the  author  extend  the  usefulness  of  the  book  by 
adding  to  the  short  chapter  on  development,  as  this 
has  recently  become  a  very  important  subject  at 
certain  examinations.  Otherwise  we  have  no  further 
suggestions  as  to  improvement  of  a  work  which  has 
only  to  be  seen  to  be  appreciated. 


March  9,  1904. 

the  commoner  diseases  of  children,  and  will,  we  are 
sure,  be  a  great  source  of  help  to  workers  at  this  branch 
of  medical  practice. 

AeMcal   ttews. 


DOCTORS  AND  THEIR  WORK,  (a) 
This   charming   collection   of   essays   dealing  with 
matters   medical,   although  apparently   addressed    to 
the  intelligent  layman,  should  also  be  studied  by  the 
family  practitioner,   the  fashionable  consultant,  and 
that    enigma    of   possibilities,    the    medical   student. 
Mr.  Carter  writes  out  of  the  fulness  of  a  wide  and  varied 
experience.     Every  chapter  gives  evidence  of  keenness 
in  observation,  patient  thought,  painstaking  research, 
and  intense  sympathy  with  all  that  is  of  human  interest 
in  medical  science  and  politics.     The  primary  object 
of  the  author  appears  to  bring  about  a  better  under- 
standing of  medical  objects  and   methods,    and   he 
certainly  has  spared  no  pains   in    his  endeavours  to 
show  how  patients  may  best  co-operate  with   their 
physicians   for   the  attainment   of  ends  which   both 
classes  are  bound  to  regard  as  of  the  first  importance, 
the   relief  of  suffering  and   the  prolongation  of  life. 
Mr.  Carter  writes  in  a  peculiarly  attractive  style,  and 
with   a  winning   turn   of  phraseology  and   a   pretty 
touch  of  humour,   features  all  too  rare  in  much  of 
medical  writing  of  the  present  day.     We  do  not  pretend 
to  agree  with  Mr.  Carter  in  all  his  precepts,  and  it  is 
certain  he  will  not  escape  scathless  from  his  colleagues 
north  of  the  Border  respecting  some  of  his  strictures  on 
the  influence  of  Scotch  education.     But  in  spite  of 
his  admiration  for  London  as  the  natural  centre  of  all 
that  is  most  meritorious  in  medicine,  and  a  tendency 
to  profuseness  sometimes  verging  on  wear isomen ess, 
his  book  is  a  peculiarly  opportune  one,  and  merits 
careful    consideration.     Among     so     much     that    is 
excellent,  it  is  almost  impossible  to  differentiate,  but 
particular  attention  may  be  directed  to  the  sections 
dealing  with  the  wishes  of  the  patient,  the  hindrances 
to    medicine,    specialism    and    medical    "  etiquette." 
The  chapter  on  medical  women  is  short  but  judicious, 
and  to  the  point.     We  commend   the  book  to  prac- 
titioner and   patient.      An    endeavour    to    profit    by 
Dr.  Carter's  advice  should  do  much    to    smooth    the 
path  for  all. 

DISEASE  IN  CHILDREN,  (b) 
This,  the  third  volume  of  the  Reports  of  the  Society 
for  the  Study  of  Disease  in  Children,  fully  maintains 
the  standard  of  its  predecessors.  The  most  important 
event  in  the  work  of  the  year  with  which  the  volume 
deals  was  a  discussion  on  tuberculous  peritonitis, 
at  which  a  number  of  valuable  papers,  published 
in  extenso  here,  were  communicated.  Among  a 
number  of  shorter  articles  and  records  of  interesting 
cases  we  have  papers  by  Carpenter  on  myocarditis, 
syphilitic  nephritis,  and  splenomegaly,  by  Ashby  and 
Stephenson  on  acute  amaurosis  following  infantile 
convulsions,  by  Sutherland  on  syphilitic  nephritis,  and 
by  Tubby  on  the  urban  hospital  treatment  of  surgical 
tuberculosis.  We  have  not  space  to  mention  even  a 
fraction  of  the  other  communications,  suffice  it  to  say 
that  with  each  year  of  its  appearance  the  series  of 
reports  becomes  a  more  and  more  valuable  treasure- 
house  of  facts  concerning  both  the  more  obscure  and 

(a)  "  Doctors  and  their  Work,  or  Medicine,  Quackery,  and  Dis- 
ease." By  Robert  Brud«nell  Carter.  F.R.C.&,  Consulting  Ophthal- 
mic Surgeon  to  St.  George's  Hospital,  and  to  the  National  Hospital 
for  the  Paralysed  and  Epileptic.  Pp.  316.  London .  Smith.  Elder 
and  Co.    1908. 

(b)  ••  Report  of  the  Bociety  for  the  Study  of  Disease  in  Children.' 
Vol.  III.    London.    1908. 


The  usual  monthly  meeting  of  the  Executive  Com- 
,  mittee  of  the  Medical  Sickness,   Annuity,   and  Life 
Assurance  Society  was  held  at  429  Strand,  W.C.   on 
the  26th  ult.      There  were  present  the  Chairman.  Dr 
De  Havilland  HaU.  Dr.  Frederick  S.  Palmer.  Dr.  J  W* 
Hunt.  Mr.  F.  S.  Edwards,  Dr.  W.  Knowsley  Sibley' 
1  Dr.  M.  Greenwood,  Mr.  E.  Bartlett,  Dr.  H.  P.  Symonds 
Dr.  J.  F.  Allan,  and  Dr.  J.  B.  BaU.     The  business  of 
the  society  is  in  a  satisfactory  condition.     The  in- 
clement weather  in  the  early  part  of  the  year  always 
produces  a  large  number  of  claims  on  the  Sickness 
Fund,  but  so  far  those  received  in  1904  have  not  ex- 
ceeded the  expectation  either  in  number  or  amount. 
A  large  proportion  of  these  claims  have  arisen  through 
influenza,  a  malady  to  which  members  of  the  medical 
profession  seem  specially  liable,  but  considering  that 
many  of  the  members  have  arrived  at  an  age  when 
attacks  of  this  kind  have  to  be  carefully  attended  to, 
the  total  amount  disbursed  by  the  society  is  not  ex- 
cessive.    Prospectuses  and  all  particulars  on  applica- 
tion to  Mr.  F.  Addiscott,  secretary,  Medical  Sickness 
and   Accident   Society,    33    Chancery  Lane,   London. 

Marmorek's  Serum  in  Tuberculosli. 

Two  patients  at  the  Notre  Dame  Hospital.  Mon- 
treal, one  suffering  from  tuberculosis  of  the  lungs,  the 
other  from  tuberculosis  of  the  knee-joint,  have  recently 
been  treated  by  injections  of  Marmorek's  serum.  The 
injections  were  made  under  the  supervision  of  Dr. 
L.  J.  Lemieux,  of  Montreal,  who  has  lately  returned 
from  Paris,  where  he  states  that  he  saw  twenty-five 
cases  in  which  consumption  was  cured  by  means  of  this 
method.  He  brought  back  with  him  serum  sufficient 
for  the  treatment  of  fifteen  patients.  This  is  said  to 
be  the  first  time  the  serum  has  been  employed  in 
Canada. 

Irish  Medical  Schools'  and  Graduates'  Association. 
We  are  asked  to  announce  that  the  annual  Festival 
Dinner  of  the  above  Association  will  take  place  in 
London    at    the    Trocadero    Restaurant,    Piccadilly 
Circus,   on  St.   Patrick's  Day,  March   17th  next,  at 
7.15   p.m.       Tickets    may  be  obtained   by  members 
from  Mr.  E.  Canny  Ryall,  30  Harley  Street,  W. 
Fradential  Assmranee. 
The    fifty-fifth    annual    report    of    the    Prudential 
Assurance  Company  is  now  before  us,  the  figures  being 
truly  amazing.     As  the  largest  office  in  the  world,  its 
assets  amount  to  the  astounding  sum  of  nearly  fifty- 
two  millions  sterling,  the  number  of  policies  in  force 
at  the  end  of  last  year  was  712,097,  the  premiums  re- 
ceived during  the  year  £9,661,410,  and  the  claims  paid 
during  the  same  period  £3,624,510.     Happy  the  mem- 
bers and  policy-holders  of  an  insurance  company  which 
can  show  a  total  surplus  for  the  year  of  £2,194.981. 
Fost-araduate  Glasses  in  Dublin  University. 
We  are  glad  to  learn  that  the  authorities  in  the 
School  of  Physic  in  Trinity  College  have,  with  the 
sanction  of  the  Board,  taken  the  important  step  of 
instituting  post-graduate  courses  in  all  the  subjects 
that  are  required  for  the  examinations  of  the  Indian 
and  Home  Army  Medical  Service  and  the  Navy  Medical 
Service.     It  has  been  a  distinct  drawback  in  the  past 
that  nowhere  in  DubUn  were  there  established  any- 
thing in  the  nature  of  post-graduate  courses,  and  such 
an  omission  necessarily  resulted  in  many  men  being 
driven  to  London  or  elsewhere  when  preparing  for  the 
different   Services.      Once   the   establishment  of  the 
new  classes  is  known,  we  are  sure  that  they  will  be 
largely  attended,  and  in  this  connection  we  must  draw 
special  attention  to  the  fact  that  no  limitation  is  placed 
on  those  desirous  of  attending  the  classes,  which  are 
open  to  every  qualified  medical  man.     Further  par- 
ticulars will  be  found  in  our  advertisement  columns, 


19°4- 


PASS  LISTS. 


The  Medical  Pbess.     275 


ntlemen  whom  the  Board^of  Trinity 
have  appointed  To  lecture. 

Dentists  for  Soldiers. 

:i\   informed  that  at  the  beginning  of 

April  eight  dentj  I    sur^nms  will  be  appointed  to  attend 

the  troops   in    the    United    Kingdom.     They   will    be 

requir  lb*     whole  of  their  time  to  Army 

work,  and    will    be    paid   £365   a  year,  exclusive    of 

travelling    expenses.     As   at    present    arranged,    they 

will  led    at    Aldershot,    Devon  port,    Lurk. 

Portsmouth,     Dublin,     Colchester,     and 

Woolwich,      Thev  will,  however,  be  required   t<> 

it  tendance  as  ordered  by  the  officers  in  command  of 

ts  stations.    Applications  for  these  appoint* 

meats  should  be  made  to  the  Secretary  of    the  Army 

Council,    63     Victoria   Street,    S.W.,    not    later    than 

Malaria  In  Egypt, 
i  luncheon  given  last  week  by  Sir  Alfred  Jones, 
dent  of  the  Liverpool  Chamber  of  Commerce,   to 
Dr.  Boyce,   Holt  Professor  of  Pathology  in  Liverpool 
on  his  return   from   Egypt,  where  he  has 
nqnire   into   the  result   of   the    Anti-malarial 
which  was  sent  to  Ismailia  by  the  Li%rer- 
5<    ■•  >i    of    Tropical    Medicine,    about    eighteen 
months  ago.     professor  Boyee  stated  that  as  a  result 
>A  the  campaign  against  the  malaria- bearing  mosquito, 
which  ituted  at  Ismalia  bj  Major  Ronald  Ross, 

the  average  number  of  cases  of  malaria  had  fallen  from 
something  like  2,000  per  annum  to  200.  There  had 
been  no  net  ing  Europeans  during  the  past  year, 

nlv  four  amongst    the  natives,   as  against   thirty 
deaths  in  the  previous  yean     The  enormous  improve- 
ment which  had  been  effected  in  the  health  of  Ismailia 
rce  of  great  gratification  to  the  Suez  Canal 
Company*  and  especially   to  Prince  D'Arenberg,  the 
of  the  company,  who  had  interested  himself 
most   deeply    m    the    Anti- malarial    Campaign.     The 
iduevemetlta  in  Ismailia  ought  to  encourage  them  to 
truest  in  the  work  of  fighting  malaria  in 
Africa.     They  could  now  go  to  the  Government 
with  this  Report   from  Ismailia  and  ask  that  similar 
iken  in  those  British  Colonies  wliL-re  malaria 
was  prevalent. 

Society  of  Medical  Phonographers, 
annual  shorthand  examination  by  this  Society 
*iU  he  held  m  May,  1904.     Two  prizes  will  be  offered, 
r.mU  oJ  the  value  of  j\t  one  for  first  year  students  and 
t  students    of    more   than  one  year's  standing. 
The  Competition  will    be    open,  without   entrance   fee, 
to    any    registered    medical    student    in    the    United 
Kingdom  who  has  nut  taken  a  first  prize  at  one  of    tin- 
previous     examinations.     Intending     can- 
didates should  send  in  their  names  as  early  as  possible, 
and  in  any  case  before  April  15th,  to  Dr.  P.  G.  Griffith, 
Villa  Mo  liter,    Green    Lanes,    Hornsey,    N>.   who    will 
sappjy  a  detailed  prospectus  of  the  examination. 
A  Oath  He  Lecture  on  Refractory  Patients. 
At  a  meeting  of  the  Guthrie  Society,   held  at  the 
i   liisicr   Hospital,    under   the   presidency  of     Dr, 
Murrel!.  on    Thurdsay,  February  25th,  Captain  Alfred 
KsttOl     the    well-known    fencer    and    author   of    the 
ttd  and  the  Centuries,"  gave  a  demonstration  of 
the  methods  of   dealing  with  violent  and   refractory 
patients.     The     chairman     pointed     out     that     many 
tally  those  engaged  in  lunacy  prac- 
nbject    to   attack  by  dangerous   and    irre- 
sponsible patients,  whum  it  wTas  desirable  to  disarm 
ng  on  them  bodily  injury.     The  subject 
Wat  -natically    taught'  in    the   schools,    and 

in  the  iput  oi  the  moment,  to  act  on 
hi*  own  initiative.  There  were  certain  recognised 
metri<  re  in  such  cases,  some  of  which 

utrre  of  Japanese  origin,  and  there  was  no  one  in  this 
country  who  had  a  larger  experience  of  them  than 
Captain  Hnttoir.  Yiikio  Tarn's  locks,  various  knock-out 
ible  removal  of  resisting  people,  and 
'  liver  were  demonstrated  on  members  of  the 

tceedingh  concluded   with    a  vote 
the  lecturer,     it  is  probable  that   this 


new  departure  in  the  held  of  physical  instruction  will 
be  followed  bv  other  medical  sclio. 
Institute of  Medical  Sciences  Appeal -University  of  London. 
The  following  additional  promises  of  support  have 
been  received  ; — Alfred  Beit,  Esq,.  /$,ooo ■;  H,  T. 
Butlin,  Esq.,  F,R.C  S..  £t,ooo  ;  Messrs,  Rothschild 
and  Sons,  £500  ;  J,  K.  Fowler,  Esq.  M.A.,  \LD,,  £250  ; 
Sir  WillianiS.  Church,  Bart,  K.i.H.  President  Royal 
College  of  Physicians,  £105  ;  John  Tweedy,  Esq.,  Pre-, 
sident  Royal  College  of  Surgeons,  ^100  ;  Sir  Henry 
Roscoe,  F'.R.S,,  £100;  Sir  E.  Cooper  Perry,  M,D,, 
£100  ;     E,  Lauriston  Shu  M,P*.  ^105  ;    M.  J, 

Cliinnery,  Esq..  £ioo;  George  Raphael,  Esq,,  £100  ; 
Charles  Maw,  Esq,,  ^10^;  A,  Pea  rce  Gould,  Esq,. 
F.R.C.S.,  /too;  F,  Goodhart,  Esq.,  M.D.,  £100; 
Sir  K.  Douglas  Powell,  Bart,,  M>D„  £50;  P,  Frank, 
Esq,,  M.D,,  £?o:  C  R.  Lockwood.  Esq,,  RR,CS„ 
£50  ;  Sir  Charles  Metcalfe.  KC-M.G.,  £15,  A  large 
sum  is  needed  to  cam-  out  the  scheme,  Donation*, 
which  may  he  extended  over  a  period  of  three  1 
should  be  sent  to  the  hon.  treasurers,  J.  K.  Fowler, 
M.A.,  ILD.,  Member  of  the  Senate,  and  H,  T,  Butlin, 
F.RC.S..  Dean  of  the  Faculty  of  Medicine,  at  $5, 
Clarges  Street.  W. 

PABS  LISTS, 


Royal  College  of  Surgeons  In  England. 

The  following  candidate-  having  pawed  the  neces- 
sary examinations,  have  been  admitted  members  of 
the   College  :  — 

Messrs.  P.  E.  H,  Adams,  B,A.Oxon.  R,  Appieton, 
L.S.A.Lond..  E.  L.  Ash.-- L.  D,  Bailey,  H,  H,  Bash- 
ford,  H.  E.  Batten,  A-  V*.  Benson,  \\\  B.  Billinghurst 
B.A.Oxon,  H,  J.  D.  Birkett,  BA.Camb.,  A.  J.  Blaxiaml, 
I.,  H.  H.  Boye,  H.  R>  Burpitt,  Christopher  A,  Campbell, 
B,A.,  M.B.Toronto.  Colin  A,  Campbell,  M.D.Toronto, 
L. S, A. London,  N.  C.  Carver,  J,  H.  Chauney,  A.  A.  F. 
Clarke,  G,  R,  H,  Chell,  J.  W.  Cleveland,  G,  M.  Clowes, 
P.  P.  Cole,  L.D,S.Eng„  J,  B.  Copland,  C,  M.  L.  Cowper. 
T.  W.  W,  Crawford,  M.D.West.  Univ.,  Canada,  M.  J, 
Cromie,  S,  T.  Crump.  A.  Davidson,  M.D.McGitl. 
G.  B,  Davis,  M.AXamK,  J.  J.  Davis,  M,D.  West.  Umv, 
Ontario,  A.  C.  Dixon,  T.  L.  Drapes,  B.A.Camb,,  G.  D, 
Drury.  A,  G,  V,  Elder,  J,  W,  Elliott,  L.S.A.Lond,. 
H.  H.  El  worthy,  H.  H,  Emmerson,  Moses  Feldmau, 
J.  A.  Ferriere,  J,  Ferguson,  H.  Finzel,  A.  F.  Forster. 
R.  R,  Garrett.  M,  B,  German,  R.  K.  G,  Graves,  C.  |.  H, 
Gunning,  M.  F.  Grant,  B,A<Camb,,  C,  F,  Hadheld, 
M.AXamb..  H.  A.  Hai*.  R.  H  Hardwil -k.  G.  H.  Harper- 
Smith,  B.A.Camb.,  D.  R.  Harris,  W.  L,  Hawkins, 
V.  tlethermgton,  H,  B.  Hill.  W.  A.  L,  Holland.  W,  H, 
Howard,  L,  W,  Huelin,  F,  R  Hughes,  P,  R,  Humphry, 
R.  M.  Ini  Thurn,  F.  W.  Jones,  B.Sc.Lond,,  J,  Jones, 
W.  A.  D,  King.  \\\  E.  Lee,  B.A.Camb.,  P.  A,  Lloyd- 
Jones,  B.A.Camb,,  J,  S.  Le  Fevre,  M.  G.  Uiuisson, 
J.  G.  Macdonald,  J,  W.  Manchester,  M.D.,  C.M.McGilt, 
H,  F,  Marris,  B.A.Camb,,  J.  A.  Milne,  C.  W.  P.  Moffat t. 
M.A,Lond.,  B.AXamb.,  L  N,  Morgan.  R,  Mbyte,  J, 
Muirhead,  M.B.Durh.,  i\  M  Murrav,  M.A,Camb.f  J.  H. 
Napper.  T.  M,  Ncatby.  M.A.Camb.(  M.  A.Lond.,  C.  H.  W, 
Page,  M,A.Camb.k  j.  5.  Pearson,  M.AXamb,,  J,  E. 
Pellow,  B.C.Caml>T,  W.  O.  Pou.  B,A,,  M.D,MichiRaii, 
T,  C.  Power,  E,  C,  Racker,  J,  j,  Ramforth,  W.  H. 
Rayner,  B.AXamb..  J.  F.  Rev.  L.D.S.Eng,.  B.  B, 
Riviere,  H.  E,  Roaf,  M.B.Toronto,  R,  H.  Robbm^ 
E.  Roberts,  L.M.S.Ceylon,  J.  A.  Roberts,  M.B.Toronto. 
E.  S.  Routle%^f  L.  W.'Shadwell.  A,  Shelley,  B.A.Oxon, 
S,  Smulian,  S.  J.  Stewarrl,  B.C.Camb..  L.  V.  Thurston. 
E.  F,  Travers,  G.  A,  Ticehurst,  R,  H,  Tribe.  A.  H 
TomeTJ  E.  R.  Von  Ofenheim,  M.D.Leipsig,  J,  C. 
Wadmore.  K.  L.  Ward,  G.  H,  Warren,  F.  E.  Wayle. 
V.  N,  Whjtamora.  R,  K,  Wrhite,  W,  N,  Whitney. 
M.D,Penn„  ».  M  Wilson,  F,  H,  Wood,  F.  R.  E.  Wright, 
S .   L,  0.  Young. 

Royal  College  of  Surgeons  In  Ireland. 

Den*tal  Examination, — The  following  candidates, 
having  passed  the  secondary  examination,  have  been 
admitted  Licentiates  in  Dental  SurRervof  the  College  : — 
Mr.  C.  de  Fouhert  and  Mr.  H.  D  Griffith.  The  follow- 
ing candidate  passed  the  primary  part  of  the  examina- 
tion : — Mr.  W.  Matthews. 


276    The  Medical  Pjusm.       NOTICES  TO  CORRESPONDENTS. 


March  9,  1904. 


Jtotice*  to 
(flJorosponbntfcB,  $hort  %ttUxet  &t. 

WBH  Correspondents  requiring  a  reply  in  this  oohimn  are  particu- 
larly requested  to  make  use  of  a  Minctiv*  $ignatwr*  or  initial,  and 
avoid  the  practice  of  signing*  themselves  "Reader,"  ••  Subscriber," 
••Old  Subscriber ,"  4c  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

Original  Articles  or  Lbttkes  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

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

Reprints.— Reprints  of  articles  appearing  in  this  journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

M.  R.  O.  S.— The  commonest  cause  of  post-partum  hemorrhage  is 
uterine  atony.  That  condition,  however,  should  not  occur  in 
ordinary  cases  treated  by  expresson  of  the  placenta  and  the  subcu- 
taneous injection  of  ergotin.  The  next  common  cause  is  laceration 
of  the  cervix.  If  the  tear  extends  into  the  uterine  tissue  proper  and 
involve  deep  vessels,  it  may  prove  a  formidable  matter.  In  all  cases 
the  placenta  should  be  promptly  delivered.  8ome  authorities 
recommend  bimanual  pressure,  so  conducted  as  to  force  the  con- 
tracted uterus  low  down  in  the  pelvis. 

Dr.  W.  M.— The  notice  was  in  type  ready  for  our  last  issue,  but 
owing  to  pressure  upon  our  space  was  held  over.  We  hope  to  insert 
it  at  an  early  date. 

Irish  Branch  Brit.  Dental  Assoc.— Your  letter  was  sent  to  the 
wrong  office,  and  consequently  was  too  late  to  appear  in  the  present 
iiwue.    It  will  appear  next  week. 

Our  Paris  Correspondent.— The  receipt  of  the  Clinical  Lecture, 
by  Professor  Debove,  on  "Cancer  of  the  Bile- Ducts  "  is  hereby 
acknowledged  with  thanks. 

Dr.  C.  Robertson  (Birmingham).— Your  observation  is  interesting. 
As  a  matter  of  fact  many  of  the  laity  think  that  cold  is  a  part  of  the 
"open-air"  treatment,  whereas,  in  point  of  fact,  it  is  notbing  of  the 
kind.  Clearly,  warm  clothing  is  especially  required  for  all  depressed 
conditions  of  general  health  and  circulation. 

W.  B.  Com pton.— Common  ink  is  an  old  remedy  for  ring  worm. 
We  cannot  speak  from  experience,  but  should  imagine  its  efficacy 
would  not  extend  beyond  the  megalo-sporon  variety,  which  is  readily 
scotched.  It  is  extremely  unlikely  that  ink  would  be  of  the  least 
use  in  the  common  microsporon  form. 

Dr.  Vincent  (Algiers).— We  have  marked  your  paper  on  "Cancer 
bf  the  Rectum  and  Sigmoid  Flexure  "  for  early  insertion. 
-    Mr.  Wilson  will  find  the  subject  exhaustively  dealt  with  in  our 
issue  for  February  17th. 


^JUeiittge  of  the  gtorietkd,  %tctvLvtBf  &c. 

Wednesday,  March  9th. 

Hunterian  Society  (London  nstitution,  Finsbury  Circus,  E.C.).— 
8.30  p.m     Pathological  Evening.     Exhibition  of  Specimens. 
.    Dermatolooical  Society  or  London  (11  Chandos  8treet  Cavendish 
Square,  W.).— 5.16  pan.    Demonstration  of  Cases  of  Interest. 

South-West  London  Medical  Society  (BoUngbroke  Hospital, 
Wandsworth  Common).— 8.45  p.m.  Dr.  R.  Maguire :  The  Treatment 
of  Aneurysm  by  Gelatin  Injections. 

Royal  College  ok  Surgeons  or  England.— 5  p.m.  Prof.  ▲.  W.  M. 
Robson  :  The  Surgery  of  the  Pancreas.    (Hunterian  Lecture.) 

Medical  Graduates'  College  and  Polyclinic  (22  Chenies  Street, 
W.C.).— 4  p.m.  Mr.  M.  Collier:  Clinique.  (Surgical.)  5.15  p.m. 
Mr.  G.  Ogilvie :  What  is  Syphilitic  ? 

Thursday,  March  10th. 

Harveiaw  Society  or  London  (Stafford  Rooms,  Titchborne  Street. 
Edgw*re  Road,  W.).— 8.30  p.m.  Papers: -Mr.  L  Evans:  The 
Treatment  of  Congenital  Clubfoot  during  early  Infancy,  with  a  Series 
of  Consecutive  Cases.— Dr.  S  V.  Pearson  :  The  Diagnosis  of  Pulmonary 
Tuberculosis  in  Infants  and  Young  Children. 

Ophtualmolooical  Society  of  the  United  Kingdom  (11  Chandos 
Street,  Cavendish  Square,  W.).— 9  p.m.  Clinical  Evening.  Cases 
will  be  shown  by  Mr.  J.  B.  Lunn,  Mr.  H.  Grimsdale,  Mr,  A.  H. 
Bennett,  Mr.  H.  L.  Eason,  and  Mr.  C.  Worth.  Patients  will  be  in 
attendance  at  8  p.m. 

British  Gynaecological  Society  (20  Hanover  Square,  W.).— 8  p.m. 
Specimens  will  be  shown  by  Dr.  G.  Atkins,  Dr.  W.  Duncan,  Dr.  I, 
Parsons,  and  Mr.  F.  Jordan.  Paper :— Dr.  D.  Buxton :  The  Vernon 
Harcourt  Chloroform  Inhaler,  and  Exact  Percentage  Vapours  of 
Chloroform  in  Snrgical  Antes  thesis. 

Royal  College  or  Physicians  ok  London  (Pall  Mall  East).  — 
5  p.m.  Dr.  R.  Hutchinson  :  Some  Disorders  of  the  Blood  and  Blood- 
forming  Organs  in  Early  Life.    (Gonlstonian  Lecture.) 

Medical  Graduates'  College  and  Polyclinic  (22  Chenies  Street, 
W.C.)  -4  p.m.  Mr.  Hutchinson:  Clinique.  (8urgical.)  6.15  p.m. 
Dr.  P.  Stewart :  Cranial  nerve  Paralyses. 

Mount  Vernon  Hospital  for  Consumption  and  Diseases  or  the 
Chest  (7  Fltxroy  Square,  W.).— 2.30  p.m.  Mr.  R.  Lake :  Demonstra- 
tions on  Laryngeal  Tubercular  Cases.    (L)  (Post-Graduate  Course.) 


St.  John's  Hospital  for  Diseases  or  tub  Skin  (Leicester  8ouare. 
W.O.X-0.15  p.m.  Dr.  M.  Dockrell :  Herpetic  Diseases.  (Chesterfield 
Lecture.) 

Friday,  March  11th. 

The  Incorporated  Society  'of  Medical  Officers  of  Health  (9 
Adelphi  Terrace,  Strand,  W.C.).— 7.30  p.m.  Paper:  Dr.  C.  K. 
Millard:  The  Leicester  Method  of  dealing  with  8maU-pox.  To  be 
followed  by  discussion. 

Clinical  Society  of  London  (20  Hanover  Square,  W.).— s.80  did. 
Papers -Dr.  P.  Weber  and  Dr.  J.  H.  Watson :  A  Case  of  Polycr- 
thromia  with  Enlarged  8pleen,  possibly  a  Disease  of  the  Bone- 
Marrow.— Dr.  Pasteur  and  Mr.  T.  H.  Kellock:  Foreign  Bodyim. 
pacted  in  Bronchus :  Removal  by  Operation. 

Royal  College  of  Surgeons  of  England.— 6  p.m.  Prof.  A.  W.  M. 
Robson  :  The  Surgery  of  the  Pancreas.    (Hunterian  Lecture.) 

Medical  Graduates'  College  and  Polyclinic  (22  Chenies  Street, 
W.C.).— 4  p.m.    Dr.  StClair  Thomson :  Clinique.    (Throat.) 

*B*ainzxtB. 

Ayr  District  Asylum. -Assistant  Medical  Officer.    Salary  £1»  per 

annum,    with   board,   furnished   apartments,    attendance,  sod 

washing.     Applications  to  the  Medical  Superintendent. 
Birkenhead  Borough  Hospital. -Senior  House  8urgeon  (Reddest'. 

8alarv  £100  per  annum  and  fees.     Applications  to  the  Honorsrv 

Secretary. 
Birmingham  General  Dispensary.— Resident  Surgeon.     8alary  £15» 

per  annum,  with  furnished  rooms,  fire,  lights,  and  attendance. 

Applications  to  Ernest  W.  Forrest.  Secretary. 
Birmingham  and  Midland  Eye  Hospital.— House  Surgeon.     Salary 

£75  per  annum,  with  board  and  attendance.     Applications  to  the 

Secretary,  Secretary's  Office,  Church  Street,  Birmingham. 
Brentford  Union.— Medical  Superintendent  of  Infirmary  and  Medical 

Officer  of  Workhouse  and  Schools.    8alary  £300  per  annum,  with 

furnished   residence   in   the   Infirmary,   rations,    washing,  Ac. 

Applications  to  William  Stephens,  Union  Offices.  Isleworth,  W. 
Cumberland  Infirmary.  Carlisle.— Resident  Medical  Officer.     8alarr 

£30  per  annum,  with  board,  lodging,  and  washing.    Application* 

to  J.  G.  Howitt.  Secretary.  "^ 

Devonshire  Hospital,  Buxton,  Derbyshire.— Matron.     Salary  £80per 

annum,  with  board,  lodging,  and  laundry.     Applications  to  the 

Secretary. 
Horton    Infirmary,    Banbury.— House    Surgeon.     Salary   £80  per 

annum,  with  board  and  residence  in  the  Infirmary.     Applications 

to  the  Honorary  Secretary,  21  Marlborough  Road,  Banbury. 
Kent  and  Canterbury  Hospital.— House  8urgeon.    Salary  £90  a  year, 

with  board  and  lodging.    Applications  to  the  Secretary. 
London    Fever  Hospital,  Islington,  N.—  Assistant  to  the    Resident 

Medical  Officer.    Salary  £120  a  year,  with  board  and  lodging. 

Applications  to  the  Secretary. 
Manchester  Royal  Infirmary.— Resident  Medical  Officer.    Salary  £150 

per  annum,  with  board  and  residence.     Applications  to  W.  I. 

Baunder. 
Mercers  Hospital.  Dublin.— House  Surgeon.    Applications  to  John 

Robinson,  Registrar.    (See  Advt.) 
Wolverhampton    and     Staffordshire    General     Hospital  .—Assistant 

House  Surgeon.      Salary  £75  per  annum,  with  board,  lodging, 

and  washing.    Applications  to  Edmund  Forster,  House  Governor 

and  Secretary. 


appointments. 

Asiidown,  Wallace.  F.B  C.H.En*.,  Assistant  Surgeon  to  the  Metro- 
politan Hospital,  Kingsland  Road,  N.E. 

Bennett,  H.  «.,  M  R.C.8.,  L.R.C.P.Lond.,  House  Surgeon  to  the  Oat- 
Patient  Department  at  St.  Thomas's  Hospital. 

Clikt,  M.  L  ,  M.R.C.S.Eng.,  L.1A.,  Divisional  Surgeon  to  the  City 
Road  8tation.  G  Division  Metropolitan  Police. 

Harnett.  W.  L.,  M.B.,  B.C.Cantab.,  Resident  House  8urgeon  to 
St.  Thomas's  Hospital. 

Ketmer,  Thas.  R.,  F.R.C.4Eng,  Surgical  Registrar  to  the  Cancer 
Hospital. 

Pounden,  J.  C,  M.D.Dub ,  Certifying  Surgeon  under  the  Factory 
Act  for  the  Alfreton  District  of  the  county  of  Derby. 

Richmond,  G.  E.,  M  D.  B.8..  B.8c  Lood.,  D.P.H.Camb.  Demonstrator 
of  Hygiene  and  Public  Health  at  University  College,  London. 

Sears,  C.  N.  M.B.,  B.S.Lond.,  Junior  Obstetric  House  Physician  to 
St.  Thomas's  Hospital. 

Wig  ram.  L.  E.,  M.B..  B.C.Cantab.,  Resident  House  Surgeon  to 
St.  Thomas's  Hospital 


girths. 


Hubert.— On  March  5th,  at  Bromsgrove.  Billiogshurst,  Sussex,  the 
wife  of  W.  A.  Hubert,  M.R,C.S.Eng.,  L  R.C.P.Lond.,  of  a  son. 

NowLAN.-On  March  1st,  at  Balbriggan,  the  wife  of  F.  B.  Nowiao. 
M.B.  B.C.H.,  B.A.O.,  of  a  son. 


garths. 


Cheyne.— On  March  6th,  at  Edgefield,  West  Norwood,  London,  Mary 

Amelia  Cheyne,  wife  of  the  late  Robert  Romley  Cheyne,  F.R.C.&, 

London,  in  the  86th  year  of  her  age. 
Kent.— On  March  4th,  at  Carlton  House,  Rragwood,  Hants,  Herbert 

Arthur  Kent,  M.R.C.S.Eng.,  LR O.P.Lond.,  fourth  son  of  the 

Bev.  Geo.  Davies  Kent,  B.D.,  aged  44  year*. 
Leah— On    March    3rd,  William  Leah,  B.A.Ozon,  M.D.T.C.D.,  of 

Teignmouth,  Devon,  aged  57. 
Smith.  -On  March  5th  at  Bridger.  Montana,  U.S. A.,  Henry  Murray, 

only  son  of  Dr.  Stanley  Smith,  of  Wimpole  8treet,  London, 

aged  23. 
Button.— On  March  1st,  at  6  Camden  Crescent,  Dover,  William  Button, 

Esq.,  M.D.,  aged  77  years 
Waylen.— On  February  20th.  at  20  Beaumont  Street,  W.,  Louisa, 

widow  of  Alfred  Robert  Waylen,  M.D..  F.R.C.S. 


Zk   )\\tt\'Ui\\   |frtM   mA   (tirrulur. 


"SALUS    POPULI    SUPREMA    LEX1 


Vol.  CXXVIIL 


WEDNESDAY,     MARCH   i6f    1904,  No,    11, 


Original  Communication s, 

A  FEW  POINTS  CONCERNING 

INGUINAL   TRUSSES    AND 
THEIR     MANUFACTURE,    (a) 

HvVV.  McADAM  ECCLES,  M,S,Lond,,  F.R.C.S.Eug., 

Uai-uct  Siinff on  to.  and  Joint  Lecturer  on  Anatomy  at,  St.  Bex* 
Xho\am4w*a  Hospital;  iiiimiiier  In  Anfttomy  to  the  Society  of 
•  pf'hecartes:  lata  Assistant  burgeon  to  tm  Citf  of  Loudon 
Tru>  ftoeietj  and  to  th«  West  Loudon  Hospital, 

Mr.  President  and  Gentlemen, — I  scarcely  like 
►re  this  Society  with  such  a  subject  for 
hut  ours  is  a  liberal  society,  and  our  energetic 
ry  assures  me  that  such  »i  subject  is  not  only 
le<  but  that  it  is  one  that  will  not  be  without 
its  interest   to  the  members  of   this  vigorous  young 
1.  v . 
I   have   chosen    the   matter  oE    the   manufacture  of 
icfly  because   I  am  deeply  interested  in   it. 
ntly  because  I  feel  very  strongly  that  everyone 
uttu  prescribes   the  wearing  of  a   truss  ought  to  be 
ntly  acquainted  with  the  principles  and  essen- 
tial details  of  its  manufacture  in  order  that  he  may  know 
a  good  truss  from  a  bad  one.     And  this  I  say,  for  in 
*pite  of  the  fact   that   we  treat  hernia  so  largely  by 
operation  in  the  present  day,  there  still  remains  a  con- 
her  of  persons  who  are  obliged  from  one 
and  another  to  fall  back  upon  an  externa!  support, 
b  ls  to  them  that  the  proper  construction  and  adjust- 
nt  a  truss  constitute*  all  the  difference  between 
ad  distress,  security  and  danger* 
It  is  not  my  intention  to  embark  upon  a  descrip 
even  of  many,  of  the  varieties  oi  ins trun 
1  have   from    time   to    time    been    invented,    my 
ited  Length  of  paper  and  your  patience  would  not 
Suffice  it,  therefore,  to  say  that  the  application 
very  remote  origin,  but  it  is  interesting 
t   Hippocrates  and  in 

nothing   so  on  aware, 

Probably    one    of    the 
taut  indications  of  external  support  is  to  be 
representing  one  of  the  minor 
tnylholo^  11  the 

auch  more   mere   mortal 

premise  my  remarks  by  stating  that  I  con- 
lorms  "f  hernial  protrusions    the 
rms  to  a  type  ha 
perture,  placed  upon  a  spring  which 
link,   and   accessory   straps   tor  better 
m  but  a  simple  affair  for  any 
intent-maker  to  fashion,  yet,  believe  me, 
into  which  the  mechanician  may  stumble 
uclion  are  many  an  1  serious. 

pe  a*i  ordinary  inguinal 

[   a   well  made  and  a  bad!y-f  Lshioncd 

pie      I    would    lav    down   the    following   as    the 

Ic  ordinary  inguinal  trus>  :  — 

undition  of  soft   iron.     This 

i*PtrKr  o.lnt  a  meeting  of  the  Thempeutieal  Sadet 


should  be  somewhat  oval  in  shape*  with  two  studs  on 
its  anterior  surface,  and  two  sharp  points  on  its  pos- 
terior  aspect.  The  size  of  an  inguinal  pad  for  an  adult 
is  about  tour  inches  long,  two  inches  broad,  and  one 
and  a  half  inches  thick  when  its  facing  of  cork  is  in 
position,  and  held  there  by  the  points.  The  lower 
border  ot  the  pad.  which  is  curved,  should  project 
only  halt  an  inch  below  the  inferior  edge  of  the  spring. 
It  is  of  great  importance  that  it  should  not  descend 
further  than  this,  for  ii  it  does  there  will  be  a  tendency 
for  the  pad  to  become  displaced  upwards  by  the  move- 
ments of  the  thigh.  The  pad  should  as  a  rule  be  solid, 
and  fixed  immovably  to  the  spring  by  rivets. 

2.  The  spring.  The  tunc  Lion  of  the  spring  is  to 
induce  pressure,  such  pressure  to  act  as  a  counter- 
pressure  to  the  normal  or  abnormal  intra-abdominal 
pressure.  The  external  pressure  as  projected  by  the 
spring  is  capable  of  interpretation  in  two  ways,  first, 
the  resilient,  and  secondly,  the  resistent.  the  former 
being  much  more  pliable  than  the  latter. 

The  resilient  pressure  should  only  come  into  play  in 
preventing  the  descent  of  viscera  in  a  bubonocele  both 
while  the  patient  is  quiet  and  when  he  has  to  exert 
some  increased  amount  ot  abdominal  strain.  The  re- 
M^U-nt  is  needed  when  resilient  pressure  is  not  sufficient 
to  retain  the  viscera  in  the  periods  of  quietude  or 
where  the  patient  is  liable  to  excessive  strain  by  reason 
ol  his  occupation,  &c.  It  is  therefore  not  correct  to 
use  the  resilient  form  of  pressure  where  the  resistent 
is  needed,  and  it  is  still  more  improper  to  apply  the 
resistent  variety  where  only  the  resilient  is  required, 

In  order  that  a  spring;  may  act  efficiently,  and  at  the 
same  time  may  be  com  tort  able,  there  are  several 
essential  points  in  its  manufacture,  which  are  uu 
|  fortunately  frequently  not  understood  bv  truss  makers, 
or  at  least  overlooked  !  v  them.  En  0  single  truss  there 
have  to  be  considered  the  iol  lowing—  the  length,  the 
breadth,  the  curve,  the  temper,  and  the  free  em  I  of  the 
spring. 

I  am  confident  that  the  spring  in  a  single  truss  should 
be  more  than  a  semicircle— that  is  to  say,  it  should 
round  the  pelvis  and  reach  to  just  behind  the  anterior 
superior  iliac  spine  ot  the  sound  side,  Prom  IttfS  point 
the  coverings  of  the  spring  are  prolonged  as  a  cross- 
strap,  which  is  Listened  to  the  upper  stud  on  the  1 

the  pail.    The  breadth  ot  the  spring  is  likewise   *t  im- 
portance,    if  too  broad,  it  will  be  too  powerful,  U 
narrow,  it  will  tend  to  cut  into  the  tissues  of  the  u- 

Asa  rule  half  an  Inch  or  a  trifle  more  i-.  tfa  adthi 

The  curve  of  the  spring  Ls  where  not  infrequently 
failure  is  to  be  noticed,  It  should  be  such  that  the 
pad  is  on  a  plane  only  slightly  posterior  to  that  ot  the 
anterior  portion  oi  the  spring,  Ii,  as  is  the  case  in 
some  badly-fashioned  trusses,  the  curve  is  so  great  as  to 
make  the  pad  almost  touch  the  hinder  pan  of  tin 
spring,  the  pressure  that  will  bj  exerted  by  it  will  be  so 
that  the  patient  will  not  be  able  to  endure  it. 
Further,  the  temper  ot  the  steel  from  which  \\\>> 
is  cut  should  be  brought  to  such  a  nicety  that  it  will 
allow  a  very  considerable  opening  out  ot  the  curve 
without  the  least  liability  of  the  metal  snapping. 

In  order  that  the  spring  may  rest  flat  upon  the  body, 
the  lower  edge  of  it  must  be  the  arc  of  a  larger  circle 


278    Thb  Medical  Press.         ORIGINAL  COMMUNICATIONS. 


March  16,  i9°4- 


than  the  upper  edge,  owing  to  the  increasing  circum- 
ference of  the  pelvis  against  which  the  spring  is  applied. 
It  this  were  not  so,  it  would  naturally  follow  that  the 
truss  would  only  rest  upon  its  lower  edge,  and  would 
consequently  be  exceedingly  uncomfortable.  It  is 
astonishing  how  seldom  this  practical  point  is  carried 
out  in  the  manufacture  of  trusses,  and  yet  it  is  one  of 
the  most  important,  if  a  comfortable  instrument  is  to  be 
provided. 

And,  lastly,  the  termination  of  the  spring  should  in 
the  process  of  manufacture  be  hammered  out  so  that  it 
becomes  thin  and  flat,  and  therefore  much  more 
flexible  than  the  rest  of  its  length,  and  thus  likely  to 
cling  steadily  around  the  hip  opposite  to  the  side  on 
which  the  hernial  protrusion  exists.  This  little,  but 
important,  point  is  one  of  the  many  ways  in  which  a 
poorly-fashioned  and  cheap  truss  can  be  readily  dis- 
tinguished from  a  well-made  one.  The  spring  has  to  be 
covered  with  soft  material,  partly  to  protect  it,  and 
partly  to  render  its  application  to  the  patient's  body  a 
source  of  the  least  discomfort.  There  is  always  a  great 
tendency  for  the  metal  of  the  spring  to  rust  owing  to 
the  action  of  the  moisture  from  the  body,  and  it  is 
desirable  to  cover  it  with  some  material  which  will  pre- 
vent this  as  far  as  possible.  Nothing  has  up  to  the 
present  been  found  which  is  entirely  satisfactory. 
Neither  has  any  form  of  plating  been  of  complete 
service. 

Immediately  next  the  steel  comes  a  layer  of 
what  is  known  in  the  trade  as  "  glaze,"  a  material 
which  does  in  some  measure  prevent  the  moisture 
of  the  body  from  reaching  the  metal.  Outside 
this,  there  should  be  two  layers  of  "  blanketing." 
which  act  in  making  the  spring  comfortable  to  the 
wearer,  and  upon  the  thickness  of  it  within  reasonable 
limits  depends  its  value.  Many  badly-made  trusses 
are  wanting  in  a  sufficiently  thick  layer  of  this  material, 
in  fact,  may  have  none  of  it  whatsoever.  External 
to  these  coverings  is  placed  one  of  "  flesh,"  not  ordinary 
chamois  leather,  and  posteriorly  for  support  and  pro- 
tection is  a  layer  of  calf  leather. 

For  bathing  purposes  the  spring  should  be  covered 
with  gum-elastic,  or  pure  indiarubber,  and  the  former 
is  a  useful  covering  for  use  in  hot  climates,  or  where  the 
wearer's  occupation  induces  much  perspiration. 

3.  The  under-strap.  Every  inguinal  truss  should  be 
provided  with  an  under-strap,  and  the  wearer  should 
look  upon  it  as  an  essential  part  of  his  instrument. 

It  is  of  practical  utility  in  preventing  the  spring  from 
riding  up  over  the  hip  bone,  in  securing  the  position  of 
the  pad  from  change,  and  in  giving  this  latter  a  slight 
tilt  at  its  lower  edge  so  that  it  will  face  a  little  upwards. 
The  proper  adjustment  of  the  under-strap  is  all  im- 
portant, for  if  it  be  incorrectly  applied  it  is  worse 
than  useless.  It  should  be  fixed  just  behind  the 
shoulder  of  the  truss — i.e.,  to  that  part  of  the  spring 
which  is  directly  behind  the  anterior  superior  spine 
of  the  ilium  on  the  same  side  as  the  hernia.  It  must 
be  so  fastened  that  it  will  not  of  itself  have  any  tendency 
to  shift  its  position.  This  can  be  accomplished  by  a 
very  simple  manoeuvre  of  placing  the  strap  on  the  inner 
side  of  the  spring  and  threading  the  end  through  the 
loop  held  on  the  outer  side  near  the  shoulder  of  the 
truss. 

The  under-strap  is  then  carried  downwards  and  back- 
wards along  the  gluteal  fold,  across  the  perinaeum,  and 
upwards  to  fasten  in  front  to  the  lower  stud  on  the 
front  of  the  pad.  It  is  not  to  be  applied  tightly,  but 
is  to  be  well  drawn  upon,  whilst  it  is  being  fixed  in 
position.  Often  the  under  strap  is  placed  by  the 
patient  or  instrument-maker  at  or  near  the  middle  line 
behind,  where  it  cannot  by  any  possible  chance  fulfil 
its  functions,  but  only  serves  to  irritate  and  worry  the 
wearer.  Many  patients  on  this  account  discard  the 
under-strap,  considering  it  of  no  value,  which  is  true, 
but  are  delighted  to  find  the  added  comfort  it  gives 
if  correctly  adjusted. 

I  would,  therefore,  sum  up  a  good  ordinary  inguinal 
truss  as  one  in  which  there  is  a  solid  pad  of  the  proper 
shape  and  size,  fixed  immovably  upon  a  steel  spring 
encircling  three-quarters  of  the  circumference  of  the 


pelvis,  and  held  in  position  by  properly  adjusted  under- 
and  cross-straps. 

The  spring  is  to  have  its  lower  border  the  arc  of  a 
larger  circle  than  the  upper  edge,  and  its  curve  such  that 
the  pressure  which  it  exerts  is  moderate  in  every  case, 
resilient  in  most,  and  somewhat  resistent  in  others, 
while  its  termination  is  so  hammered  out  that  it  is 
beautifully  flexible. 

If  a  patient  is  provided  with  a  truss  of  this 
character,  and  his  medical  attendant  should  see  to  it 
that  he  is,  he  will  come  to  look  upon  his  instrument  as 
little  more  than  part  of  his  ordinary  clothing,  and 
as  giving  him  less  inconvenience  even  than  his 
boots  !  On  the  other  hand  an  incorrectly  fashioned 
appliance  may  entail  daily  and  hourly  misery, 
which  is  sure  to  be  unwittingly  placed  to  the  credit 
of  the  practitioner's  prescription  rather  than  to  the 
ignorance  of  the  instrument-maker. 

If  I  have  not  already  wearied  you  with  what  I  fear 
may  seem  somewhat  trifling  matters,  though  in  truth 
to  me  they  are  of  essential  importance,  I  would  venture 
to  call  your  attention  to  two  more  elaborate  and  highly 
useful  forms  of  an  inguinal  truss. 

The  first  is  the  rat-tail  truss.  Its  use  is  specially 
seen  in  scrotal  herniae  in  elderly  men.  As  a  rule 
these  patients  are  wholly  unsuitable  for  any  radical 
operative  procedures,  and  their  protrusions  often 
fail  to  be  controlled  by  an  ordinary  inguinal  truss, 
even  with  a  resistent  pressure.  Here,  again,  there  may 
be  all  the  difference  between  comfort  and  efficiency, 
and  misery  and  danger,  solely  on  account  of  the  proper 
construction  and  adjustment,  or  the  improper  conforma- 
tion and  application  of  a  rat-tail  truss. 

In  a  well-made  instrument  of  this  pattern  the  pad  is 
somewhat  fuller  than  in  the  ordinary  inguinal  truss, 
and  there  is  the  addition  of  a  tapering  piece  of  soft 
material  springing  from  the  lower  part  of  the  pad, 
and  prolonged  into  a  strap  which  takes  the  place  of  the 
usual  under-strap,  and  it  is  fastened  to  an  immovable 
hook  or  buckle  just  behind  the  shoulder  of  the  truss. 
It  is  very  important  that  the  iron  of  the  pad  should  not 
pass  down  into  the  tail,  for  if  it  does  so  the  soft  parts, 
and  particularly  the  spermatic  cord,  must  necessarily 
be  compressed  between  the  metal  and  the  bone,  since 
the  tail  occupies  a  position  over  the  superficial  ring  and 
the  crest  and  the  body  of  the  os  pubis.  This  prolonga- 
tion of  the  pad  metal  into  the  tail  of  the  truss  is  fre- 
quently seen  in  badly-constructed  instruments  and  is 
much  to  be  deprecated,  as  is  also  the  use  of  a  movable 
buckle,  to  which  the  termination  of  the  tail  is  attached. 
Seeing  that  in  the  upright  position  the  rings  and  the 
canal,  particularly  in  a  stout  patient  whose  abdomen 
tends  to  sag  downwards  and  forwards,  assume  a  rather 
more  horizontal  plane,  it  is  well  that  the  face  of  the 

Ead  should  look  upwards  so  that  pressure  may  be 
rought  to  bear  directly  over  the  hernial  aperture, 
while  at  the  same  time  the  spring  rests  comfortably 
against  the  abdominal  wall  outside  the  sits  of  the  hernia. 
This  can  be  brought  about  by  slightly  cranking  the 
steel  of  the  spring  just  external  to  the  place  where  the 
pad  is  rivet  ted  to  it.  If,  on  the  other  hand,  the  pad  is 
flat,  the  iron  of  the  pad  prolonged  down  into  the  tail, 
the  pad  maintained  on  the  same  plane  as  the  rest  of  the 
spring  immediately  external  to  it,  and  the  termination 
of  the  tail  fastened  to  a  movable  buckle,  not  one  of  the 
essential  features  of  a  proper  rat-tail  truss  will  be 
obtained.  Yet  by  tar  the  larger  proportion  of  such 
trusses  are  made  by  instrument-makers  in  this  im- 
proper fashion,  and  it  is  only  necessary  to  scan  the 
illustrations  of  their  catalogues  to  see  the  truth  of  this 
statement.  r* 

The  last  variety  of  truss  that  I  submit  to  you  is 
one  which  is  of  the  greatest  service  in  the  treatment  of 
irreducible  scrotal  herniae.  One  is  often  consulted  as 
to  the  best  manner  of  dealing  with  irreducible  scrotal 
herniae  in  elderly  and  stout  persons.  Operative  measures 
are  out  of  the  question  in  almost  all.  The  applica- 
tion of  an  ordinary  bag  truss  is  merely  to  court  danger, 
and  cannot  have  the  least  effect  in  bringing  about  any 
reduction  ot  the  contents  of  the  hernial  sac. 

It  is  under  these  conditions  that  I  believe  that  the 
practitioner  is  often  at  a  loss  to  know  how  best  to  treat 


M-tgcH  to,  1904, 

his  cases.     Here  it  is  that  the  ingenious  truss  known 

e  hinged~cup  inguinal  truss  comes  in  so  usefully. 

It  Lsiis  been  urged  that  pressure  applied  to  an  irreducible 

bemta  is  very  liable  to  produce  irritation  ot  the  contents 

jiui  of  the  sac  wall,  and  thus  lead   to  complications 

other  than  those  of  mere  non-reduction.     Such  unto- 

.  r,  do  not  in  reality  occur  if  the 

are  is  o\  The  right  amount  and  is  employed  In  the 

t    maimer.     On   the  other   hand,    such     proper 

pressure  mav  be  most  beneficial  in  tending  to  the  reduc- 

tents  oi  the  -sac.     To  do  its  work   this 

>  continuous  and  must  be  in  a  direction 

It   likely  to  bring  about  the  return  ot   the 

-oned    viscera  into  the  abdominal  cavity.     The 

s  consists  oi  the  on  Unary  circular  steel 

modified,   however,  as   to   meet  the  special 

I   the  condition  under  review.     To  the 

tront  is  attached  a  flattened  pad,  with  what  is  known 

torked-tongue  addition,  and  to  the  lower  edge  ot 

the  part  is  tautened  through  the  medium     I  ;i  lunge  an 

triangular  cup  of  metal,  covered  in  the  completed 

leather.     From  the  inferior  angle  of  this 

liere  pass  two  leather  straps,  which  act  as  perineal 

Is,  and  go  to  be  fastened   to  movable  buckles  on 

!  nig.     The  action  of  the  truss  is  to 

ige  upward  and  backward  pressure  upon  the  irre- 

con tents  lying  in  the  scrotal  part  ot  the  sac  by 

ill  of  the  under-straps  acting  upon  the  hinge,  which 

i  in.  vement  in  an  upward  and  backward 

direction. 

results  in  the  way  ot  reduction  obtained  by    this 

instrument  areola  most  satisf actor y  character,  and  it  is 

ible  that  the  utility  of  the  truss  should  be  more 

widely  recognised, 

In  conclusion,  I  trust,  gentlemen,  that  yon  will  not 

thought   me  presumptuous  in  reminding  you  of 

t  truss  manufacture,  apparently  ot 

but  little  importance  in  themselves,  but  in  their  sum 

it  deal  to  those  who  have  the  mis- 

lortune  to  need  external  assistance, 


ORIGINAL   COMMUNICATIONS.         Ths  Medical  Piess.    279 


DR.  OTTO  SCHMIDTS 
SPECIFIC  TREATMENT 

OF 

CANCER  : 

RITTQUE  BA.SED  ON   PERSONA!. 
OBSERVATION. 
By  JOHN  SHAW,  M.D.Lond„  M.R.C.RLond., 
flutirun  tor  Diteues  o(  W<inn>n  it  the  Nor th» West  l^ndon  Hoa- 
piUJ ;  late  V  joe-  Preside  ot  ot  the  Britiah  Ujiiwcti  logical  Sodefcy, 

li  was  with  intense  interest  that  I  heard  of  the 
address  given  by  Dr,  Josse.  Johnson  at  the  Abernethian 
Society,  and  determined  to  take  the  opportunity  of  a 
holiday  in  Switzerland  to  examine  Dr.  Otto  Schmidt's 
cases  /both  on  my  way  out  and  on  my  return,  so  as  Lo 
be  able  to  judge  or  what  a  month's  tteatmeut  had  done 
lor  the  patients. 

The  dates  of  my  two  visits  were  December  t6th. 

and    January    nth,    1904,  so    that    the   actual 

rvml   was    twenty- rive   days.     I   should,    perhaps, 

in  that  it  was  during  tins  interval  that  I  took  the 

opportunity  of  reading  Dr,  Johnson's  address,  in  order 

belter  ftp  appreciate  the  matters  which  I  desired  "to 

tg&te. 

On  the  occasion  of  my  first  visit.  I  saw  three  patients 

at  the  Augustiner  cWtcr,  and  in  the  afternoon  three 

at   the  doctor's  own   home,   of  whom 

two  were    fellow-countrymen — one    being    a    Te tired 

medical  m 

On  my  second  visit  I  went  straight  to  the  Augustiner 
tbsttr,  in   order    that    L  might    communicate    with 

Br,  Schmidt  and,  if  necessary,  a^k  to  see  Mrs.  H , 

to  his  absence,  as  I  had  been  informed  that  this  lady, 
one  of  the  cases  reported  by  Dr.  Johnson,  was  that  day 
to  leave  for  home,  completely  cured  of  the  cancerous 
process.  Dr.  Schmidt  was,  however,  as  I  learnt  by 
telephone,  already  on  his  way  to  the  Closter,  He 
w&i.  therefore,    not   expecting  mc,    but   nevertheless 


kindly  showed  me  three  patients  and,  further,  unasked, 
invited  me  to  visit  his  laboratory  in  the  evening. 

The  English  patients  who  visited  his  house  in  the 
afternoon  were,  however,  so  eagerly  desirous  that  I 
Bhottld  accompany  them  that  the  necessary  permission 
was  applied  for  by  telephone,  and  thus  I  had  the 
further  opportunity  of  renewing  acquaintance  with  a 
patient  whom  I  had  seen  on  the  occasion  of  my  first 
visit. 

In  the  evening  1  had  the  pleasure  of  seeing  Dr. 
Schmidt's  new  laboratory,  a  visit  which  gave  me  a 
mod  deal  to  think  about,  hut  as  I  have  dealt  elsewhere 
with  some  of  my  difficulties,  it  may  be  preferable  to 
confine  myself  in  this  paper  to  the  clinical  cases,  short 
particulars  of  which  fellow* 

Case  [.  —  I  will  l«far ID  the  first  place  to  the  Mrs,  H . 

reported  by  D*.  Juhnson.  (ti)  At  my  first  visit,  tills 
lady  presented  the  appearance  fairly  described  by 
Dr.  Johnson,  excepting  that  t  was  unable  to  detect 
any  diminution  of  the  frontal  swelling  as  compared 
with  a  photograph  taken  a  fortnight  before  her  ad- 
mission under  Dr,  Otto  Schmidt's  care.  Moreover, 
there  was  a  central  excavation  in  the  frontal  growth 
going  down  nearly  to  (if  not  actually  reaching)  the 
bone,  which  excavation  was  being  treated  by  dressings 
with  the  very  strong  solution  (Merck  and  Co.'s)  of 
hydrogen  peroxide. 

It  will  be  important  to  quote  certain  passages  from 
Dr,  Johnson's  report,  merely  mentioning  that  I  took 
no  measurements  for  the  purpose  of  comparison  : — 

**  On  July  1  st,  the  last  operation  wound  was  not  yet 
dosed  ;  there  was  no  local  recurrence  and  no  glandular 
infections  were  to  be  found.  On  the  upper  right  fore- 
head there  was  a  smooth,  hard,  evenly  rounded  swell- 
ing, three  and  a  half  inches  long  sagit  tally,  two  and  a 
haH  inches  broad,  and  rising  to  a  height  of  five  centi- 
metres (that  is  to  say,  two  inches)  above  the  surround- 
ing scalp,  measured"  vertically-  The  consistence  was 
everywhere  equally  hard  Uke  a  fibroid.  The  colour  over 
the  skin  was  natural.  Further  behind  and  to  the  left 
there  was  another  knot  of  the  size  of  a  broad  bean.  .  ,  , 
When  1  saw  the  forehead  tumour  for  the  first  time,  it 
was  about  one-third  bigger  than  when  I  saw  it  for  the 
last  time  on  Friday,  October  30th.  It  had  steadily 
decreased  the  whole'  time,  and  the  patient  herself  was 
perfectly  well  except  for  the  pain  in  the  arm.  She 
was  cheerful  and  putting  on  flesh,  and  was  going  on  as 
well  as  any  patient  could  wish  to." 

It  was  my  interest  in  this  patient  that  took  me  to 
the  Augustiner  Closteron  January  Jith.  having  under- 
stood that  she  was  that  day  to  be  discharged  perfectly 
cured  of  the  cancerous  process. 

Dr,  Schmidt  assured  the  patient  and  myself  that 
sections  of  the  growth  evidenced  the  cessation  of  the 
carcinomatous  condition,  although  he  admitted  that 
she  still  had  some  febrile  reaction  after  injections. 
The  forehead  tumour  showed,  in  my  judgment,  con- 
siderable increase  in  superficies,  although  it  may  have 
slightly  diminished  in  height  owing  to  the  extensive 
degeneration  and  undermining  which  was  taking  place. 
It  was  breaking  down  in  at  least  two  other  spots.  It 
was  marked  bv  enlarged  and  somewhat  tortuous  veins, 
a  sign  of  malignant  mfn-ilw  but  which  I  was  assured 
was  an  evidence  of  its  quieting  down.  The  second 
swelling  was,  in  my  estimation,  at  least  double  thr 
and  there  was  an  enlarged  gland  of  considerable  size 
behind  the  right  ear.  My  oiler  to  take  a  photograph 
of  the  patient  was  declined.  This  patient  had  been 
seven  months  or  so  under  treatment ;  had  had  about 
cine  hundred  and  fifty  injections  :  was  acknowledged  to 
have  lost  Mesh  (although  her  weight,  it  was  said,  had 
not  been  taken  during  the  whole  course  of  the  seven 
months),  the  loss  of  ilesh  being  ascribed  to  the  feverish 
reaction  from  the  injections. 

TH*     patient    Ms    g<HSg    home     with     the    cancerous 

;  arrested  t     Hearing  that  her  home  was  bej 

Berlin,  I  asked  if  Professor  von  Bergmann  had  given 

any  opinion  as  to  the  arrest  of  the  cancerous  process, 

and  was  assured  by  the  old  formula  with  which  I  shall 


(U)  LanctK  NQTftffilwr  iitb.  l»03.    P.  1  IK*. 

D 


280    The  Medical  Press.         ORIGINAL  COMMUNICATIONS. 


March  \6,  1904. 


always    associate    Dr.    Schmidt  :     "Es    hat    keinen 
Zweck." 

On  the  other  side,  it  must  be  remembered  that  it  is 
alleged  that  von  Bergmann  had  given  a  prognosis  of 
but  two  months  if  he  operated,  and  that  the  patient  was 
seven  months  later  not  only  living,  but  was  showing 
remarkably  little  facial  evidence  of  all  that  she  had 
gone  through — a  circumstance  which  is  not  unknown 
in  patients  who  have  not  undergone  any  serum  treat- 
ment, but  who  are  rapidly  nearing  the  term  of  their 
sufferings. 

Case  2  was  that  of  a  poor  lady  who  had  come  from 
Russia  in  the  hope  of  finding  relief,  buoyed  up,  it  may 
be,  by  Dr.  Johnson's  words :  "  Dr.  Schmidt's  ex- 
perience, when  treating  absolutely  inoperable  cases — 
and  he  has  had  no  others — is  so  favourable  that  he 
would  not  hesitate  to  use  it  in  all  these  seemingly 
hopeless  cases."  She  was  frightfully  ill  when  I  saw 
her,  and  shortly  after  died.  Dr.  Johnson  has  since 
assured  the  writer  that  the  patient  was  under  Dr. 
Schmidt's  treatment  before  his  paper  was  published, 
so  that  the  patient  mast  have  succumbed  after  she 
had  been  under  treatment  for  a  very  considerable 
time. 

Case  3  was  that  of  a  lady  who  had  had  her  breast 
amputated  by  Dr.  Schmidt.  As  I  saw  her  on  the 
occasion  of  my  first  visit,  she  had  a  largish  open  wound, 
where  an  incision  had  been  made  to  relieve  the  tension 
on  the  cicatrix,  and  pus  was  issuing  from  a  drainage- 
tube  in  the  axilla.  At  my  second  visit,  this  lady  came 
for  treatment,  but  Dr.  Schmidt  explained  that  there 
was  no  reason  why  I  need  see  her  ("  Es  hat  keinen 
Zweck  "),  the  rise  of  temperature  reaction  indicating 
that  there  must  be  still  some  infected  gland  which  he 
had  failed  to  remove. 

Whilst  this  patient's  wound  was  being  dressed,  we 
waited  outside  in  the  corridor,  and  Dr.  Schmidt  ex- 
plained that  he  had  first  injected  culture  and  got  a 
violent  reaction,  during  the  continuance  of  which  he 
had  operated,  whereupon  the  temperature  had  fallen 
as  markedly  as  if  an  abscess  had  been  opened. 

Case  4  was  seen  on  my  second  visit  to  the  Closter, 
and  is  reported  by  Dr.  Johnson  on  page  1,377  of  the 
Lancet,  November  14th,  1903.  The  appearance  of 
this  patient  came  as  a  shock  to  me.  She  was  thin  and 
very  pale,  though  there  was  a  flush  on  her  cheeks,  and 
she  was  quite  cheerful.  Dr.  Schmidt  repeatedly  drew 
my  attention  to  the  fact  that  she  could  put  up  her 
left  hand  to  the  back  of  her  neck  or  head,  which  she 
had  been  unable  to  do  before  the  treatment,  and  with 
this  accomplishment  the  patient  seemed  very  gratified. 
With  regard  to  the  left  breast,  I  really  am  perfectly 
puzzled.  It  may  still  be  cancerous  or  it  may  have 
passed  into  the  cirrhotic  and  innocuous  condition 
described.  Immediately  below  the  breast,  however, 
there  is  what  I  certainly  believe  to  be  cancerous  involve- 
ments of  the  skin.  Moreover,  the  left  elbow  and  parts 
immediately  above  were  very  markedly  oedematous. 

But  there  is  one  very  remarkable  circumstance  about 
this  case.  There  had  developed  in  the  right  breast  a 
cancerous  tumour,  which  has  been  removed  by  operation, 
although  the  inoperable  cancer  of  the  left  breast  is 
claimed  as  a  success  without  operation. 

Case  5  was  a  gentleman  suffering  from  a  large  swelling 
below  the  right  ramus  of  the  lower  jaw.  The  swelling 
was  said  to  be  of  the  nature  of  an  embryonic  remnant, 
and  to  have  wonderfully  improved  under  treatment, 
Dr.  Schmidt's  statement  being  borne  out  by  the 
patient.  A  month  later,  as  I  saw  him  for  the  second 
time,  the  swelling  had  very  greatly  increased,  and  the 
patient  was  so  hoarse  that  I  had  the  greatest  difficulty 
in  understanding  him.  I  learnt  from  Dr.  Schmidt,  and 
the  patient  nodded  his  assent,  that  he,  the  patient, 
had  been  hoarse  on  a  former  occasion,  and  that  the 
swelling  had  been  even  greater  than  that  which  I  was 
at  the  time  witnessing.  In  answer  to  my  inquiry  as  to 
whether  there  was  any  paralysis  of  the  vocal  cords,  I 
was  informed  that  Dr.  Schmidt  had  not  himself  exa- 
mined the  case,  but  that  Dr.  Johnson  had  done  so, 
and  had  reported  that  the  right  cord  was  pushed  over 


by  the  growth,  and  was  very  congested,  but  that  there 
was  no  paralysis. 

Case  o  can  be  dismissed  in  a  few  words.  It  is  one  of 
cancer  beneath  the  tongue  with  involvement  of  the 
glands  on  both  sides.  In  comparing  the  condition  as 
seen  at  the  two  visits,  I  should  say  that  the  swelling 
is  about  doubled  in  bulk,  and  is  said  to  have  become 
somewhat  painful,  that  there  is  increasing  disability  to 
project  the  tongue  between  the  teeth,  and  that  owing  to 
this  cause  a  slight  lisp  has  become  noticeable  to  the 
patient  and  to  myself,  although  so  little  marked  as  not 
to  have  attracted  the  attention  of  relatives. 

Case  7  is  that  of  an  English  gentleman,  aet.  55,  and. 
excepting  for  gout  and  other  tendencies  to  chronic 
inflammatory  processes,  was  quite  well  until  September, 
1902,  since  which  time  he  has  suffered  from  enlarged 
glands  in  the  neck,  with  recurrent  attacks  of  sore 
throat,  but  has  not  lost  weight.  In  consequence  of 
the  absence  of  the  inflammatory  reaction  which  is  said 
to  be  diagnostic  of  cancer,  the  patient  and  his  English 
medical  attendant  felt  justified  in  doubting  the 
accuracy  of  the  previous  diagnosis,  to  which,  however 
Dr.  Schmidt  clung,  claiming  that  the  absence  of  the 
diagnostic  reaction  was  due  to  the  fact  that  he  had 
purposely  avoided  the  reaction  by  giving  very  minute 
doses.  In  comparing,  however,  the  figures  entered  by 
Dr.  Schmidt's  assistant  in  the  patient's  temperature 
record  with  those  quoted  by  Dr.  Johnson  as  the  routine 
practice,  I  find  that  they  are  absolutely  identical,  and, 

indeed,  exceed  those  given  to  the  Mrs.  H ,  to  whom 

both  Dr.  Johnson  and  I  refer,  I  may  say  that  this 
patient  came  back  to  London,  in  order  to  see  an  eminent 
cancer  specialist,  and  returned  to  his  home  enjoying 
a  peace  of  mind  to  which  for  many  weeks  previously  he 
had  been  a  stranger. 

Unfortunately,  the  history  of  this  patient  does  not 
end  thus.  I  am  informed  that  malignant  mischief  of 
undoubted  character  has  developed.  What  am  I  to 
conclude  ? 

That  he  had  had  cancer,  and  that  Schmidt's  treat- 
ment had  checked  or  temporarily  cured  it  ?  I  cannot 
accept  this  position,  for  the  following,  among  other 
reasons  : — (1)  The  patient's  throat  trouble  dated  from 
September,  1902,  since  which  time  he  has  never  lost 
the  enlarged  glands.  Can  any  member  of  the  pro- 
fession point  to  a  single  case  of  undoubted  cancer  of 
the  tongue  which  lasted  fourteen  months  without 
treatment,  the  patient  in  the  meanwhile  having  main- 
tained his  weight  ?  (2)  The  patient  was  seen  on  the 
morning  of  November  17th,  1903,  by  a  very  well-known 
man  who  himself  is  strongly  interested  in  cancer,  and 
there  was  no  suspicion  then  of  the  condition  being 
cancerous  ;  indeed,  this  medical  man  has  expressed 
himself  as  unable  to  accept  the  position,  seeing  that 
he  recorded  the  pulse  as  but  64.  He  prescribed  tinct. 
benz.  co..  and  with  this  the  patient  thoroughly  steamed 
his  throat  before  getting  into  bed.  A  few  minutes 
after  lying  down,  he  (the  patient)  was  taken  with  a 
severe  choking  sensation,  immediately  sat  up  and 
vomited  a  quantity  of  "  blood,  and  phlegm,  and 
stuff."  after  which  he  felt  great  relief  and  slept  all 
night.  Is  this  the  history  of  cancer  ?  (3)  Ten  days 
after  this  (November  27th,  1903),  the  patient  having 
in  the  meanwhile  gone  to  Cologne,  he  received  from 
Dr.  Schmidt  his  first  injection,  V100  milligramme 
of  culture,  and  on  the  following  day  V10  milli- 
gramme. The  next  day  was  Sunday,  and  the  patient 
felt  his  throat  well,  a  fact  which  was,  the  patient 
alleges,  confirmed  by  Dr.  Schmidt  on  the  following 
Thursday,  there  having  been  no  laryngoscope  available 
before  that  date  for  the  examination  ;  in  the  meanwhile, 
therefore,  he  had  had  three  more  injections,  the  last 
being  2  J  milligrammes.  My  first  visit  to  Cologne  was  on 
December  16th,  1903,  and  I  took  down  from  the  patient 
the  following  note  : — "  December  3rd.  Throat  was 
examined  and  found  to  be  quite  well ;  [absolutely 
completely  healed  over]."  The  inverted  brackets  are 
the  alleged  words  of  Dr.  Otto  Schmidt,  who  later 
assured  me  that  he  himself  had  never  seen  an  ulcer  in 
the  patient's  throat.  (4)  There  is  the  very  important 
consideration  that  side    by  side  with  this  doubtful 


March  i6t  1904, 


ORIGINAL  COMMUNICATIONS, 


Thk  Medical  Peess,     2S1 


case  was  a  case  of  undoubted  malign  ant  mischief 
(Case  6  above),  which,  to  the  best  of  my  belief — 
a  belief  which  is  shared  by  one  whose  interest  is  to 
believe  quite  otherwise — there  has  been  absolutely 
improvement  whatever;  it  is  the  case  referred  to 
m  the  leading  article  in  The  Medical  Press  and 
Circular  for  February  17 1  a,  1904, 

The  serious  question  is  this*  had  this  patient  malig- 
nant disease  before  he  was  treated  by  Dr+  Schmidt  ? 
I  have  given  the  chief  reasons  which  would  guide  mc 
to  an  opinion.  It  is  to  be  noted  that  immediately 
before  leaving  Cologne  he  had  had  three  injections  of 
what  was  alleged  to  be  a  very  virulent  culture,  in  doses 
of  10,  2op  and  30  milligrammes  respectively  ;  that  is  to 
say,  I4OOO4  ajooo,  and  3,000  times  as  large  a  dose 
respectively  as  that  with  which  the  treatment 
otmrnenced.  Now,  supposing  that  this  patient  at  the 
present  time  has  malignant  disease  {which  I  will  hope 
n-pfDven),  the  serious  question  is,  has  it  been  pru- 
'  hy  the  injections  of  these  alleged  cultures  ?  To 
me  the  position  is  such  a  serious  one  that  I  shall  con- 
umie  in  urge  an  immediate  discussion  before  a  suitable 
medical  society,  an  effort  in  which,  up  to  the  present, 
I  have  not  succeeded. 


THE    TREATMENT    OF 
CHRONIC  MIDDLE-EAR  DEAF- 
NESS   BY   OZONE. 

By  GEORGE  STOKER,  M.RX.RI., 
OwuuJtuii;  *nil  Hon.  I'h^ttfri&n.  London  Hospital  for  Diauutti  of  thi? 
Thnnl,  Nnw,  and  Ear :  Hn«+  Meriicul  Ufneerto  the  Oxygen  Batpita], 

rat  form  of   deafness  to  which  the  present  paper 
is  that  popularly  known  as  throat  deafness,  and 
to  the  medical  profession  as  "  chronic  dry  catarrh  of 
the  middle  ear," 
It  is  generally  believed  to  be  due  to  Stenosis  of  the 
LCbian  tube.     This  latter  condition  may  be  brought 
about  by  some  interference  with  nasal  respiration,  the 
result  of  congenital   malformation,  or  chronic  nasal 
catarr1!. 
The  symptoms  are  progressive  deafness,  with  tinnitus 
nous  kinds  and  varying  intensity.     It  is  also  to 
I  that  in  a  large  number  of  cases  the  hearing  is 
iratively  more  defective  in  reference  to  sounds 
at  hand  than  to  those  at  a  distance.     The  con- 
dition is  analogous  to  what  is   known  as  presbyopia 
of  sight,  and  I   venture  to  describe  it  as 
prcsbyaudia.        The  best  illustration  I  know  is  that  of 
at,  who,  white  conversing  in  a  room  with  irieuds, 
i  a  difti cully  in  hearing  those  near  him,  but  was 
able  to  delect  the  approach  ot  a  carriage  10  the  house 
before  the  others  heard  it.     This  condition  is  possibly 
suit  of  some  loss  of  i>ower  of  accommodation  in 
luscles,    due    to    the    thickening   of   the    mucous 
membrane  covering  them. 
The  tympanic    membrane   is   retracted   and   usually 
le.     There  are  no  signs  or  symptoms  of  the  audi- 
Og  involved-     Of  all  forms  of  deafness 
Lhffl  is  the   most  common  and    the   most  intractable, 
ud  il  is  no  exaggeration  to  describe  it  as  theopprobrium 
frf  otology. 
It  would  seem  that  stenosis  of  the  Eustachian  tube 
affect  the  mucous  membrane  lining  the  middle 

la)  By  preventing  the  free  ingress  and  exit  of  air, 
[b]  By  causing  an  unhealthy  condition  of  the  seere- 
Uiat  exude  from  the  lining  of  the  cavity  and  pre- 
venting their  exit, 

c  conditions  lead  to  a  thickening  of  the  mucous 
membrane  of  the  tympanum  and  consequent  deafness. 
The  nasal  stenosis  may  be  1  utd  the  Eusta- 

chian tube  become  more  open,  but  the  deafness  still 
increases  ;  this  points  to  a  remaining  unhealthy  con- 
I  of  the  middle  ear. 
The  elect  of  oxygen,  and  more  particularlv  of  its 
inotropic  form,  ozone,  in  restoring  a  healthy  condition 
to  diseased  nasal  mucous  membrane,  and  in  purifying 


the  secretions,  suggested  a  trial  of  the  latter  in  chronic 
progressive  deafness, 

The  ozone  is  generated  by  means  of  an  electric 
current  acting  on  a  Ruhmkorff  coil,  to  which  the 
ozonising  tube  is  attached.  The  ozone  is  passed  in  a 
gentle  current  through  a  Eustachian  catheter  into  the 
middle  ear  for  about  tour  minutes  at  a  time,  the  opera- 
tion being  repeated  several  times  a  week,  daily,  it 
possible. 

The  following  are  notes  of  cases  treated,  the  con- 
ditions first  described  being  those  existing  before  the 
ozone  was  appbed,  They  were  nearly  all  cases  of 
•'  chronic  dry  catarrh  *'  of  the  middle  ear,  accompanied 
by  the  usual  symptoms, 

Some  of  them  had  been  previously  treated  by  various 
methods,  for  considerable  periods. 

Case  1.— Patient  had  been  getting  deaf  for  ten  years. 
There  was  "  hissing  "  tinnitus,  especially  111  the  left  ear. 
Before  treatment.— Watch  hearing:  R.  ear  =  1)  m 
L.  ear  =  contact.  After  two  months'  treatment.— 
Watch  hearing :  R.  ear  —  4  in.  -  L.  ear  —  3  in. 
After  five  months'  interval  without  treatment. —Watch 
hearing  :    R.  ear  =  5  in.  ;    L.  ear  =  3  in. 

Case  2. — Deaf  for  many  years.  Before  treatment. — 
Watch  hearing  ;  R,  ear  =  5  in.  j  L.  ear  =  3  in. 
After  six  weeks*  treatment.— Watch  hearing  :  R.  ear  — 
12  in.  ;    L.  ear  aa  6  in- 

Case  3.— Getting  deaf  for  twelve  years.  Before 
treatment.— Watch  hearing  ;  R.  ear  —  J  in. ;  L,  ear  = 
I  in.  After  six  weeks'  treatment, — Watch  hearing  : 
R.  ear  --  S  in.  ;    L.  ear  —  3  in. 

Case  4.  —Getting  deaf  in  right  ear  for  three  years. 
Before  treatment. — Watch  hearing  ;  R.  car  =  3  in.  ; 
L.  ear  b=  20  in,  Alter  six  weeks*  treatment. — Watch 
hearing  ;    R.  ear  =5  9  in.  ;    L.  ear  —  24  in. 

Case  5. — This  patient  had  chronic  suppurative  otitis 
media  Of  t fie  right  ear,  and  chronic  dry  catarrh  of  the 
left  ear,  of  old  standing.  Before  treatment. — -Watch 
hearing  :  R.  ear  a  minus  ;  L.  ear  =  6  in,  After  six 
weeks'  treatment. — Watch  hearing  :  R.  ear  =  3  in,  « 
L.  <:ir  =  24  in. 

Case  6,— This  patient  was  deaf  for  fifteen  years  with 
buzzing  tinnitus.  Before  treatment.— Watch  hearing  : 
R.  ear  =  \  in.  ;  L,  ear  =  minus.  After  six  weeks* 
treatment.— Watch  hearing  :  R,  ear  iShi.  ;  L.  ear 
—   I  m. 

Case  7, — This  patient  was  deal  in  the  left  ear  for  nine 
years.  Before  treatment— Watch  hearing  ■  L.  ear  = 
}  in.  After  six  weeks*  treatment.— Watch  hearing: 
L,  ear  =»  4  in. 

Cast  S.—  This  was  a  case  of  deafness  of  nine  years* 
standing  with  M  tidal  tinnitus."  Before  treatment.— 
Watch  hearing  :  R,  ear  =  contact ;  L.  ear  —  }  in. 
Tuning-fork  hearing  :  R.  ear  —  3  in. ;  L.  ear  —  5  m. 
After  six  weeks'  treatment.— Watch  hearing  :  R.  ear  = 
4  in,  ;  L,  ear  =  if  in.  Tuning-fork  hearing  ; R, ear  — 
2  ft. ;   L,  ear  —  a  ft* 

Case  9, — This  patient  had  been  deaf  for  twelve  years. 
Before  treatment. — Watch  hearing  :  Rt  ear  =  4  in,  \ 
L.  ear  —  £  m.  After  six  weeks*  treatment.— Watch 
hearing  :    R.  ear  =  to  in.  ;    L,  ear  =   10  in. 

Case  10.— Patient  was  deaf  in  right  ear  for  ten  vears 
with  singing  tinnitus,  Before  treatment,— Watch 
hearing  :  R,  ear  =■  J  in.  After  six  weeks'  treatment,— 
Watch  hearing  :    R.  ear  =  6  in. 

Case    11. — In   this  case   patient  was  deaf  for  five 

years     with     hissing     tinnitus.     Before     treatment. 

Watch  hearing:  R.  ear  =  i\  in.  ;  L.  ear  —  hard 
contact.  Tuning  fork  hearing:  R.  ear  =  6  in.  ; 
L.  ear  —  4  in.  After  two  months'  treatment  —  Watch 
hearing  ;  R.  ear  —  3  in.  t  L.  ear  =  2  in.  Tuning-fork 
hearing:  R.  ear  —  2 $  ft.  ;    L,  ear  =  2  ft. 

Com  12.— Patient  had  been  deaf  for  twelve  years  with 
buzzing  tinnitus.  Before  treatment, — Watch  hearing  : 
R.  ear  =  1  in.  ;  L.  ear  =  i|  in.  Tuning-fork  hearing: 
R,  ear  ~  2  in,  ,-  L.  ear  =  j  in.  After  six  weeks* 
treatment,— Watch  hearing  :  R  ear  =7  m,  ;  L,  ear  = 
9  in.  Tuning-fork  hearing  :  R,  ear  =  2ft. ;  L.  ear  = 
2  ft. 

In  all  the  above  cases  it  will  be  seen  that  the  bearing 


282     The  Medical  Press. 


ORIGINAL  COMMUNICATIONS- 


March  1 6,  1904. 


has  improved.  In  some,  the  progress  made  has  been 
remarkable.  The  improvement,  as  shown  by  the 
watch,  represents  comparatively  a  very  much  greater 
degree  of  progress  when  the  voice  is  in  question.  A 
patient  with  only  one  inch  of  watch  hearing  may  be 
considered  rather  deaf,  whereas  with  four  inches  of 
-watch  hearing  the  deafness  is  not  by  any  means  evi- 
dent. 

In  cases  of  such  a  degree  of  deafness,  of  such  long 
duration,  the  time  during  which  the  treatment  was 
continued  was  far  too  short  to  produce  the  best  results, 
and  it  is  reasonable  to  suppose  that  if  the  treatment  had 
been  carried  out  daily,  and  for  a  longer  period,  the 
results  would  have  been  better  still.  Another  favour- 
able result  achieved  by  this  treatment  is  the  dis- 
appearance of  the  distressing  tinnitus  that  existed 
in  nearly  every  case.  In  conclusion  I  would  point  out 
that,  after  all,  there  are  two  objects  in  treating  such 
cases  as  are  alluded  to  in  this  paper — first,  to  improve 
the  hearing,  and  secondly,  to  prevent  the  deafness  from 
becoming  worse,  and  there  is  conclusive  evidence  that 
both  these  objects  may  be  brought  about  by  the  use 
of  ozone. 


CHRONIC 
INTESTINAL  OBSTRUCTION 

CAUSED    BY 

ANNULAR  STRICTURE  (MALIGN)   OF   THE 
LARGE    INTESTINE,  (a) 

By  DAVID  WALLACE,  M.B.Ed.,  F.R.C.S.Ed., 
Assistant  Surgeon,  Edinburgh  Royal  Infirmary. 

The  paper  was  based  on  ten  cases  of  stricture 
of  the  large  intestine  (exclusive  of  the  caecum  and 
rectum)  operated  on  during  the  past  year.  In 
eight  the  cause  of  the  stricture  was  ascertained  to 
be  malignant,  while  in  two  there  had  been  every 
likelihood  of  a  similar  cause,  though  from  the 
necessity  of  rapidly  completing  the  operation  it 
had  not  been  definitely  determined.  By  annular 
stricture  was  meant  a  cylindrical-celled  epithe- 
lioma, resulting  in  a  very  hard  ring-like  formation 
transverse  to  the  long  axis  of  the  bowel,  and 
giving  rise  to  an  hour-glass  constriction.  The 
bulk  of  the  tumour-growth  is  inside  the  bowel, 
the  margins  standing  out  abruptly  from  the 
mucous  membrane,  and  greatly  narrowing  the 
lumen  of  the  gut,  so  that  in  many  cases  the 
aperture  will  only  admit  of  the  passage  of  a  crow- 
quill.  Above  the  stricture  the  bowel  is  hyper- 
trophied  and  dilated.  Although  for  such  a  con- 
dition to  have  arisen  considerable  time  must  have 
elapsed  since  the  tumour  began,  yet  in  most  cases 
there  is  little  discomfort  other  than  constipation, 
requiring  the  use  of  purgatives.  The  higher  the 
tumour  the  less  likely  are  symptoms  to  become 
manifest,  as  the  fluid  contents  of  the  bowel  easily 
pass  through  a  smaller  orifice  than  the  more  solid 
faeces  in  the  sigmoid  and  lower  part  of  the  colon. 
Owing  to  the  insidious  onset,  chronic  obstruction 
is  often  the  first  reason  for  the  patient  seeking 
medical  advice — often  too  late  for  curative  treat- 
ment. In  six  of  his  ten  patients  this  had  been  the 
case,  and  as  all  were  drawn  from  the  better  classes, 
it  was  reasonable  to  suppose  that  the  delay  in 
getting  medical  advice  was  not  due  to  carelessness 
or  disregard  of  symptoms,  as  might  have  been 
the  case  in  hospital  patients.  The  most  common 
symptoms  for  which  advice  is  sought  prior  to  the 
onset  of  obstruction  was  constipation,  and  ab- 
dominal distension,  and  pain  ;  occasionally  there 
was  loss  of  weight,  and  sometimes  a  tumour  had 
been  noticed.     The  latter,  however,  was  rare,  and 

(a)  Abstract  of  Paper  read  before  the  Edinburgh  Medico-Chirur- 
fricai  Scctetj,  Maich  2nd,  1904. 


even  to  the  clinician  a  tumour  could  usually  only 
be  felt  after  the  disease  had  extended  beyond  the 
wall  of  the  bowel.  In  four  out  of  his  ten  patients 
a  tumour  was  to  be  felt  before  operation.  In 
early  stages  the  significance  of  constipation  and 
abdominal  pain  was  not  readily  recognisable,  and 
we  had  to  delay  diagnosis  until  later  indications 
arose,  viz.,  continuance  of  abdominal  discomfort 
and  constipation,  distension  and  borborygmi, 
paroxysmal  pain  and  visible  peristalsis,  loss  of 
weight,  a  palpable  tumour,  and  acute  or  chronic 
obstruction.  The  absence  of  these,  however,  did 
not  exclude  the  possibility  of  stricture.  Con- 
stipation was  present  in  all  his  cases,  alternating 
with  diarrhoea  in  two,  loss  of  weight  in  seven,  dis- 
tension and  borborygmi  in  four,  tumour  in  four, 
visible  peristalsis  in  only  two.  Three  other 
symptoms  were  usually  mentioned  :  (1)  Ballooning 
of  the  rectum,  present  in  one  case  of  stricture  of 
the  hepatic  flexure  ;  (2)  change  in  the  form  of  the 
stools,  on  which  no  reliance  could  be  placed  ;  and 
(3)  passage  of  mucus  and  blood,  which  was  also 
unimportant.  In  six  patients  obstruction  was  the 
symptom  for  which  advice  was  sought  ;  in  none 
was  there  a  palpable  tumour,  and  in  four  an 
annular  stricture  without  adhesions  was  present. 
In  two  other  cases  a  tumour  was  detected  at  the 
first  examination,  and  in  two  more  at  subsequent 
examination  only  ;  of  the  last,  the  symptoms 
were,  in  one  instance,  diarrhoea  alternating  with 
constipation  and  loss  of  weight  ;  in  the  other,  pain, 
constipation,  and  loss  of  weight.  Six  patients  were 
females  and  four  males,  and  the  ages  from  47  to 
82  years.  Five  of  the  tumours  were  at  the  splenic 
flexure,  three  at  the  hepatic  flexure,  and  two  at 
the  upper  part  of  the  sigmoid  flexure.  The 
anatomical  relations  of  the  two  first -mentioned 
parts  of  the  bowel  explained  the  infrequency 
of  palpable  tumour.  As  to  the  diagnosis,  Mr. 
Wallace  pointed  out  that,  given  a  case  of  chronic 
obstruction  in  a  person  of  middle  life,  there  being 
neither  palpable  tumour  nor  evidence  of  rectal 
neoplasm,  annular  stricture  was  most  probable. 
Though  each  case  had  to  be  considered  on  its  own 
merits,  it  was  most  important  that  such  cases 
should  not  be  treated  medically  for  too  long  a 
time,  and  that  the  practitioner  should  recognise 
that  the  history  of  chronic  constipation  with 
abdominal  pain  was  prima  facie  ground  for  sus- 
pecting annular  stricture.  The  prospect  of  success- 
ful surgical  treatment  would  be  immensely  en- 
hanced if  the  patient  could  only  be  operated  on 
at  this  stage,  before  invasion  of  adjacent  tissues, 
or  definite  obstruction  symptoms,  had  taken  place. 
When  a  patient  was  seen  in  whom  obstructive 
symptoms  existed,  it  was  usually  justifiable  to 
wait,  provided  these  were  not  urgent,  and  first 
to  try  medical  measures,  watching  the  pulse,  the 
degree  of  abdominal  distension,  and  the  general 
condition.  If  relief  was  obtained,  the  day  was 
long  past  for  being  thankful  and  believing  all  was 
at  an  end  ;  a  second  and  more  serious  attack  was 
inevitable — the  justification  for  delay  in  the  first 
instance  was  the  desirability  of  operating  during  a 
quiescent  period,  the  prospect  of  successful 
radical  treatment  being  so  much  greater  when 
the  conditions  were  the  most  favourable  possible, 
the  chief  desideratum  being  the  emptiness  of  the 
intestines.  It  ought  always  to  be  explained  to 
the  patient  that  it  may  not  be  possible  to  remove 
the  tumour,  and  that  it  may  be  necessary  to  make 
an  artificial  anus.  Three  operations  are  possible  : 
(1)  Excision  and  end-to-end  anastomosis,  (2)  short 


March  16,   1904- 


circuiting,  (3}  colostomy*  The  incision,  unless 
ihere  was  a  definite  contra -indie  a!  ion,  ought  to 
be  made  through  the  right  rectus  just  missing  the 
umbilicus,  from  which  all  sites  of  cancer  could  be 
explored,  and  if  the  growth  was  on  the  left, 
allowed  of  the  transverse  colon  being  opened,  while 
if  it  was  on  the  right  an  ileo-colostomy  could  be 
done.  This  incision  should  be  made  large  enough 
at  first  ;  ventral  hernia  was  not  likely  to  result, 
and  it  was  a  favourable  position  for  an  artificial 
anus.  If  the  tumour  was  removable ,  a  second 
incision  would  probably  be  required.  Colectomy, 
ugh  the  best  operation,  could  seldom  be  per- 
formed primarily  in  obstruction  cases.  Usually 
all  that  could  be  done  was  to  make  an  artificial 
anus,  leaving  the  tumour  outside  the  abdominal 
wall,  and  dealing  with  it  later.  For  successful 
excision  absence  of  tension  on  the  stitches  was  of 
the  first  importance.  The  most  favourable  method 
of  short  circuiting  was  ileum  to  transverse  colon. 
Here,  again,  absence  of  tension  was  essential,  and 
emptying  the  bowel  a  great  aid  to  a  good  result. 
Alter  short  circuiting,  the  tumour  often  diminished 
b  sbe.  Colostomy,  the  least  desirable,  was  often 
the  only  admissible  operation  ;  he  had  adopted  it 
in  live  cases,  oi  which  one  died  on  the  fifth  day. 
The  position  of  the  artificial  anus  depended  on 
the  site  of  the  tumour,  but  should  be  as  far  from 
the  caecum  as  possible,  as  the  comfort  of  the 
patient  depended  greatly  on  the  fcsces  being  solid, 
the  gut  should  be  opened  at  the  lowest  part  to 
avoid  the  risk  of  retention  of  foetid  faecal  matter  in 
the  bowel — a  fertile  source  of  toxaemia  and  heart 
failure.  His  results  were  : — Two  colectomies,  one 
patient  living  after  thirteen  months,  one  death  on 
fourth  day  from  peritonitis  ;  three  ileo- 
colostomies  with  one  death  on  the  fifth  day  from 
giving  way  of  stitches  ;  four  colotomies  with  one 
death- 


TRANSACTIONS  OF  SOCIETIES.        Tm  Medico  Press,     283 


Gransacttoiia  of  Societies, 


CLINICAL  SOC1HTY  OF  LONDON. 

Meeting  held  Friday.  March  ijth,  1904. 

Dr.  Frederick  Taylor,  President,  in  the  Chair 

K   Fakkes  Weber  and  J,  H.  Watson  com- 
nmnic.it ed  a  ca 

Oil  YCYTH  r\TI\    WITH    ENLARGED   SPLEEN, 

The  patient  w&s  a  cabinet -maker,  at,    $H,  who  had 

previously  heeti  very  ruddy  in  the  (ice,  but  for  tk 

six  years  a  variable  amount  of  cyanosis  in   the  face 

and    extremities    had    been    noticeable.      In    1003    he 

fractured   Some   ribs,   and  afterwards  commenced    to 

1W'1  at  persecution.     The  peculiar  symptom- 

upUx  >'j  chronic  cyanosis  with  splenomegaly  and 

ilycylhacmia  was  ■  rman    Hospital 

in  the  latter  pari  of  the  same  year.  At  Colney  Hatch 

tayhim.  iq  which  he  was  removed,  he  remained  bodily 

and  mentally  loeble.  and  during  an  attack  ol  greatly 

denly   on    February  4th, 

The  chief   clinical   features   oi    the  case  were 

the  chronic   cyanosis,   not    to    be    accounted   for   by 

,  the  enlarged  spleen,    and  the  poly- 

1  -iiiia.     The    blood    contained    about    double    the 

Lai  amount  oi  red  celK  and  the  hemoglobin  value 

was  about    170  per  cent,   ol    the   normal.     Extreme 

distension  of  the  retinal  vessels  was  observed.      The 

ne  was  high -colon  rod-     Asthenia  was  well  marked. 

tanortem    examination    showed    an   extreme 

ndition   of   vascular   plethora.     The  yellow  marrow 

ut  the  shafts  of  the  long  hone--  was  transformed    into 

t*±    This   ipodal  combination  ot  symptoms  had  been 

described  by  several  observers,  notably  by  Osier. 

Dalton  inquired  if  any  of  the  other 
ductless  glands  in  the  body  were  similarly  enlarged. 


Dr.  Herbert  French  remarked  that  if  the  disease 
were  due  to  an  excessive  activity  oi  the  bone-marrow 
he  would  have  thought  that  the  .  I\  id  at  ion  of  the  tissues 
would  have  been  rendered  thereby  easier,  whereas, 
on  the  contrary,  cyanosis  was  one  of  the  most  pro- 
minent features.  This  seemed  to  suggest  that  the 
fault  lay  in  the  tissues  themselves,  He  thought 
that  experiments  upon  the  comparative  tensions  of  the 
carbonic  acid  and  oxygen  in  the  expired  air  in  such  1 
case  would  be  valuable. 

Dr<  Leonard  S«  Dudgeon  asked  if  the  blood  from 
the  small  vessels  had  been  examined  as  well  as  that 
from  the  tissues.  He  referred  to  the  condition  ol  thr 
bone-marrow  in  a  case  of  congenital  heart-disease, 
accompanied  by  cyanosis,  which  he  had  examined  at 
the  East  London  Hospital  for  Children,  which  was  ■  »x  a 
red  colour, 

Dr,  W.  Pasteur  asked  if  any  thrombosis 
sent  in  Dr  Weber's  case,  as  he  had  met  with  this  con* 
tlition  hi  two  cases  ot  extreme  plethora. 

Dr.  G.  Russell  referred  to  a  similar  case  which  he 
had  seen  where  the  spleen  was  considerably  enlarged 
before  any  cyanosis  appeared.  He  was  also  struck 
with  the  extreme  degree  of  asthenia  present. 

The  President  inquired  whether  the  arteries  in 
the  retina  were  enlarged  as  well  as  the  veins. 

Dr.  Weber ,  in  replying,  said  that  the  spleen  in  these 
cases  might  also  be  regarded  as  a  manometer  of  the 
capillary  circulation.  It  was  possible  that  the  bone- 
injury  had  influenced  the  polycythemia  by  exciting 
the  bone-marrow  to  increased  activity  and  by  diminish- 
ing the  destruction  of  erythrocytes. 

Mr,  Jonathan  Hutchinson,  jun,,  read  notes  of  a 
case  in  which  he  had  performed  intracranial  resection 
of  the  second  division  of  the  fif th  nerve  for  epileptiform 
neuralgia.  The  patient  had  remained  free  from  pain 
at  the  end  of  a  year*  The  method  adopted  was  that  of 
trephining  the  temporal  fossa,  after  which  the  trunk  of 
the  superior  maxillary  division  was  exposed,  and 
about  half  an  inch  resected,  (The  paper  will  be  pub- 
lished in  full  at  in  early  date*) 

Mr.  Stanley  Boyd  mentioned  the  case  ol  a  woman, 
act-  6gt  m  whom  he  had  performed  a  somewhat  similar 
operation  for  intractable  neuralgia*  In  this  case 
some  recurreace  of  the  pain  took  place  alter  the  end  of 
a  year,  though  to  a  much  slighter  extent. 

Dr.  W.  Pasteur  and  Mr.  T.  H,  Kellock  communi- 
cated a  case  of 

FOREIGN    BODY    IMPACTED    IN    BRONCHUS  J    REMOVAL   BY 
OPERATION. 

The  patient  was  a  boy,  a;t-  5,  who  swallowed  a  glass 
stopper.  Four  days  later  phy>ic;d  signs  at  the  apex 
of  the  left  taog  were  discovered  by  a  doctor,  and  be 
was  sent  in  to  the  Middlesex  Hospital.  On  deep 
pesgrimtfoa  a  strtdulous,  wheezing  sound  could  be  heard. 
The  temperature  was  102- 8°,  Examination  of  the 
chost  revealed  signs  of  obstruction  in  the  left  bronchus. 
An  X-ray  examination  showed  an  indefinite  shadow 
in  the  region  of  the  left  bronchus.  Tracheotomy  was 
at  once  performed,  and  a  foreign  body  could  be  felt 
with  a  probe  passed  down  the  trachea.  Attempts 
to  dislodge  it  with  this  instrument  or  with  the  forceps 
proved  unsuccessful,  but  the  stopper  was  finally 
recovered  by  the  aid  ot  a  rather  stir!  loop  of  wire. 
The  wound  in  the  trachea  was  closed  ,  after  clean iue, 
away  some  pus  which  hail  come  up  with  the  foreign 
body*  Foot  days  later  Tin-  wound  had  practically 
healed <  and  shortly  afterwards  the  physical  sijms  in 
the  chest  became  normal 

1  he  Pkbsident  referred  to  a  case  in  which  pul- 
monary symptoms  were  present  resembling  those  of 
tuberculosis ,  insomuch  that  the  pitied!  was  sent  on  a 
sea- voyage-  One  day,  however,  he  expectorated  a 
little  blood  and  a  piece  of  a  broken  tooth,  after  which  the 
chest  trouble,  which  had  persisted  foe  same  month*, 
d  isappeared. 

Dr.   George    Eastks   remarked    upon    the   value  ol 
inversion  in  these  cases,  especially  when  the  foreign 
body  was  almost  on  the  point  of  coming  up,  but  was 
I  back  again  bv  inspiration. 
Mr,  G.  H.  MAKiNssaid  that  glass  objects  someti 


284     The  Medical  Press.        TRANSACTIONS  OF  SOCIETIES. 


March   16,   1904. 


threw  definite  shadows  on  the  screen.  He  recalled  a 
case  of  great  dyspnoea  due  to  a  suspected  foreign  body 
in  which  the  cause  of  death  was  found  to  be  owing  to 
obstruction  from  a  caseating  bronchial  gland. 

Mr.  J.  Hutchinson,  jun.,  remarked  that  the  glass 
stopper,  though  to  all  appearances  clean,  was  pro- 
bably virulently  septic,  hence  the  formation  of  pus 
in  the  prasent  case.  He  agreed  that  the  flexible 
silver-wire  loop  often  succeeded  in  extracting  foreign 
bodies  when  all  other  means  had  failed. 

Dr.  Pasteur  and  Mr.  Kellock  replied. 


BRITISH  LARYNGOLOGICAL,    RHINOLOGICAL, 

AND  OTOLOGICAL  ASSOCIATION. 

Meeting  held  Friday,  March   iith,   1904,  at  the 

Rooms  of  the  Medical  Society  of  London. 


Mr.    John    Bark,    F.R.C.S.Edin.,   President,   in   the 
Chair. 


The  President  delivered  his  Presidential  Address, 

which  we  hope  to  insert  at  length  in  an  early  number. 

Dr.   Kelson  showed  a  case  of  "  Paralysis  of  the 

Right  Vocal  Cord,"  in  a  man,  aet.  50,  who  had  suffered 

from  difficulty  in  swallowing  for  one  year. 

Dr.  Harold  Barwell  showed  a  case  of  "  Bilateral 
Abductor  Paralysis." 

Dr.  Peter  Abercrombie  read  notes  of  a  case  of 
"  Caseous  Rhinitis." 

Dr.  Wyatt  Wingrave  read  a  report  on  the  patho- 
logy of  the  above  case,  and  remarked  that  the  con- 
ditions were  perfectly  consistent  with  fatty  changes 
occurring  in  old  pus.  Had  it  originated  in  epithelial 
cells  there  would  doubtless  have  been  evidence  of 
squames  and  cholesterin. 

Dr.  Fred.  Spicer  showed  a  laryngeal  case  for 
diagnosis  in  which  there  had  been  a  gradual  loss  of 
voice,  but  neither  a  tuberculous  nor  a  syphilitic  history. 
A  tumour  was  visible  in  the  larynx.  There  was  im- 
provement under  iodide  of  potassium. 

Dr.  R.  H.  Woods  advised  that  tubercle  bacilli  be 
carefully  examined  for,  as  in  a  similar  case  they  had 
been  found. 

Mr.  Mayo  Collier  suggested  that  the  case  was  one 
of  syphilis,  but  said  he  would  first  examine  the  sputum 
for  tubercle  bacilli. 

Dr.  Dundas  Grant  showed  a  case  of  "  Acute 
Laryngitis  "  following  influenza. 

Mr.  Mayo  Collier  showed  a  case  of  "  Chronic 
Osteo-myelitis,"  with  old  ulceration  of  the  palate,  and 
asked  tor  the  opinion  of  the  Fellows  on  it. 

Mr.  Chichele  Nourse  said  that  there  was  some 
haziness  of  the  corneae,  and  that  he  thought  it  was  a 
case  of  congenital  syphilis. 

Mr.  Kelson  considered  that  the  eyes  gave  evidence 
of  inherited  syphilis,  the  corneae  being  nebulous. 
Probably  the  eyes  were  affected  at  an  early  age. 

Dr.  D.  Vinrace  said  that  the  teeth  also  bore  evidence 
of  congenital  syphilis. 

Dr.  Woods  showed  a  skiagram  of  a  maxillary 
antrum,  containing  a  piece  of  indiarubber  drainage- 
tube  which  had  been  retained  after  an  operation  eight 
years  before. 

Dr.  Woods  showed  an  artificial  denture  removed 
from  the  gullet  of  a  lady  patient,  where  it  had  remained 
tor  four  months.  There  was  now  a  fistula  between  the 
oesophagus  and  the  trachea  at  the  level  of  the  cricoid 
cartilage.  (Esophagotomy  was  performed  for  the  re- 
moval of  the  denture,  but  the  fistula  still  remained. 

Dr.  Dundas  Grant  suggested  that  a  large  tracheal 
incision  would  be  a  good  method  of  reaching  the  fistula. 
A  case  had  been  reported  where  success  was  attained 
by  means  of  a  tracheotomy  tube  with  a  jacket  of  india- 
rubber,  this  being  maintained  in  position  for  one  year. 

The  President  said  the  case  was  a  very  interesting 
one,  and  that  he  had  never  seen  a  case  like  it. 

Dr.  Wyatt  Wingrave  showed  microscopic  speci- 
mens illustrating  recent  histological  investigations 
respecting  malignant  growths.  Two  forms  of  cancer 
parasites  were  exhibited — parasites   free   and   encap- 


suled — which  had  been  found  in  innocent  as  well  as  in 
malignant  tumours. 

Dr.  G.  George  Reid  exhibited  an  automatic  sound- 
ing-box for  measuring  the  auditory  appreciation  in 
deafness  and  other  forms  of  ear  disease. 

a  new  invention. 

A  small  audiometer  tor  testing  the  auditory  appre- 
ciation in  deafness  and  ear  disease.  Up  to  the  present 
the  method  of  testing  by  striking  a  tuning-fork 
has  been  inefficient,  and  for  reference  or  further 
testing  useless.  The  important  points  in  this 
instrument  are  : — (1)  The  force  starting  the  fork  is  con- 
stant both  for  one  and  for  every  fork,  therefore  there 
is  never  variation  in  volume  in  the  same  fork.  (2)  The 
individual  fork  is  constant  for  one  and  the  same 
patient,  and  for  every  other  patient  at  any  time  ;  there- 
fore, the  record  is  a  valuable  reference  in  a  patient's 
history  or  for  comparison,  and  as  noting  the  value  of 
any  medical  or  surgical  treatment  or  appliance.  (3) 
The  fork  is  heard  by  the  patient  and  operator  at  the 
same  time,  and  it  is  heard  under  the  same  condition. 
After  some  experiments,  it  has  been  found  advisable 
to  keep  the  box  at  this  size  for  either  one,  two,  three, 
or  four  forks,  considering  the  question  of  vibration. 
For  whilst,  on  the  one  hand,  you  do  not  wish  to  unduly 
lengthen  the  period  of  vibration,  on  the  other  hand 
you  do  not  want  to  diminish  it  too  much.  The  forks 
can  be  chosen  by  the  surgeon,  the  C  fork  being  the 
usual  one  suppUed.  The  terminals  are  of  glass,  which 
can  be  removed  after  each  patient  and  dropped  into 
an  antiseptic  solution,  and  replaced  by  fresh  ones.  I 
may  add  that  the  instrument  is  a  valuable  assistant 
to  the  operator,  should  he  be  suffering  from  temporary 
deafness  due  to  catarrh,  as  the  volume  of  the  fork 
never  alters,  and  the  normal  period  of  appreciation 
being  known,  his  subjective  condition  does  not  prevent 
the  correct  determination  of  the  patient's  time  of 
audition.  There  is  no  objection  to  variation  in  the 
length  of  the  tubes. 

Dr.  D.  Vinrace  asked  if  it  would  assist  in  calculating 
the  percentage  of  hearing  power. 

Dr.  Hemmington  Pegler  wished  to  know  how  the 
over-tones  were  to  be  got  rid  of,  and  if  a  range  of  forks 
could  be  used,  and  remarked  that  the  name  "  audio- 
meter "  was  in  danger  of  being  confounded  with 
"  acometer." 

Dr.  Haslam  asked  how  air  and  bone  conduction 
were  to  be  distinguished. 

Dr.  Dundas  Grant  thought  this  instrument  would 
prove  useful  in  recording  the  progress  of  an  ear  case. 
Dr.  Woods  asked  if  it  could  test  bone  conduction. 
Dr.    Harold    Barwell    thought    that    the   spring 
would  gradually  get  weakened. 

Dr.  R.  H.  Woods  likened  the  spring  to  that  of  a 
watch,  which  did  not  weaken. 

Dr.  Fred.  Spicer  considered  it  full  of  fallacies — 
transmitting  a  mixture  of  bone  and  air  conduction. 

Dr.  St.  George  Reid,  in  reply,  said  that  there  was 
no  bone  conduction  whatever  in  using  this  audio- 
meter. The  spring  had  not  been  found  to  appreciably 
lessen  in  strength.  Over-tones  were  not  of  any  im- 
portance, as  they  were  constant,  being  always  started 
with  the  same  force  and  in  the  same  manner. 

Dr.  Dundas  Grant,  in  opening  the  adjourned  dis- 
cussion on  Mr.  Mayo  Collier's  paper  on  "  Latent  or 
Intermittent  Nasal  Obstruction,"  said  that  he  could  not 
agree  that  the  subject  had  not  been  noticed  before  by 
rhinologists,  as  it  was  discussed  at  the  meeting  of  the 
British  Medical  Association  in  1888.  The  effect  of 
nasal  obstruction  on  the  ear  was  still  a  disputed  point. 
The  part  that  negative  pressure  played  was  still  in  doubt. 
Dr.  Scanes  Spicer's  investigations  were  mentioned. 
Typical  sclerosis  of  the  ear  must  be  placed  in  a  separate 
chapter  as  nasal  obstruction  had  no  effect  in  this  con- 
dition. The  hollow  groove  on  the  nasal  septum  was 
not,  in  Dr.  Dundas  Grant's  opinion,  always  produced 
by  the  engorged  inferior  turbinal.  The  groove  was 
often    more    apparent    than    real,    a    well-developed 


MariH   it 


TRANSACTIONS  OF  SOCIETIES.         The  Medical  Press.     285 


Jacohsons  cartilage  accounting  for  this  in  some  cases. 
The  treatment  he  raised  on,  in  many  cases,  was  galvano* 
cautery  puncture.  High  frequency  currents  might  be 
useful  for  infra-nasal  vascular  dilatation. 

Dr.  R.  ft,  Woods  said  that  he  doubted  the  effect  oi 
nasal  obstruction  on   ear  pressure,  as    the  Eustachian 
mm  a  closed  tube  except  during  swallowing. 
The  discussion  b  to  be  continued  at  the  next  meeting. 
The  Annual  Dinner  was  held  at  the  Imperial  Res- 
taurant tin-  nine  evening. 


EDINBURGH  MEDIOOCHIKURGICAL  SOCIETY. 

Meetist.  hi  in  Wfonesday,  March  2&d,  1904. 

professor  J  oh  s  C  h  1 t  n  e  .  C .  B.  ,  Pres  id  en  t ,   in  t  he  C  ha  i  r. 

Mr.  H-  J.  Stiles  showed  (1)  patient  after  operation 
sy    following    suppurative    leptomeningitis, 
the  result  of  middle  ear  disease.     Two  years  previi  >  u  - 1  v 
she  patient  had  been  successfully  trephined  iormenin- 
■md  fur  the  la>t  nine  months  had  suffered  from 
psy.     Adhesions  at   the  old   trephine  wound   were 
ted.   the  skull  was  again  opened,    the  dura  re- 
moved, and  a  piece  of  gnld  leaf  inserted  over  the  brain  ; 
the  scalp  was  then  replaced.     There  was  s<  une  Bttppurar 
probably  from  organisms  which  had  remained 
latent    in  the  old  acai  tissue,  and  the  gold  leal  ssb- 
stqueutlv  came  away,  hut  there  had    been  complete 
•m'frorn    his    since    the    operation.     (2)    Infant 
ligature   ol    both   common   carotid   arteries   ff>r 
aic  hydrocephalus,  an  operation  which  wasii 
I  those  already  in  use    were    unsuccessful.     The 
only  enlarged  a  quarter  of  an.  inch  in  cir- 
cumference  since    the    operation.     (3)    Two    patients, 
aftei   thoracoplasty  for  empyema.      In    the   first    the 
fourth  to  ninth  ribs  had  been  resected  on    account  of 
an  empyema  of  three  months"  standing,  which  had  burst 
through    the    intercostal    muscles    and    become    sub- 
cutaneous.     The  interesting  point   was   the  deformity 
of  the  spine,   which   showed    convexity    towards    the 
diseased  side,  but  no  rota  linn  of  the  vertebral  bodies. 
The  other  patient  was  shown  to  contrast  with  this,  the 
deformity  being  of  the  usual  type,  with  the  concavity 
diseased    side, 
fa   W      l      kirvuiE   showed    a    man.    a*,    4*<    with 
intra  thoracic    pressure    symptoms:  hnskiness   of    the 
ind  paralysis  of  the  left  vocal  cord  in  the  cadaveric 
n.    inequality    of    the    radial    pulses,    incn 
1  ol  the  left  palpebral  aperture  and  dilatation  of  the 
pujul.    The    heart    was    slightly    hypertrophied.    the 
arteries  thickened,  and  there  was  a  history  of  syphilis, 
|KJiiUnij^  therefore,  to  aneurysm. 

br.  Chalmers  Watsos  showed  a  woman  suffering 
from  exophthalmic  goitre  of  ten  years'  duration,  and 
[i,  xt.  10.  born  just  after  the  symptoms  began, 
ug  general  weakness  and  loss  of  appetite,  en- 
tablement of  the  circulation  with  coldness  of  the 
cainetmties,  tachycardia  and  von  Graefe's  sign --all 
probably  referable  to  alterations  in  thyroid  and  para- 
thyrin! secretion. 

Mr  1-   M  Curd  showed  a  patient  after  jejunostomy 
be  cancer  of  the  stomach.     Owing  to  the  extent  of 
the  disease,  gastroenterostomy  had  had  to  be  aban- 
doned.    By    making    the  opening  into     the    jejunum 
method,    he    had    obtained    a    tistula, 
Sgfc  which  patient  could  l>e  feel,  but  through  which 
1  contents  escaped, 
Dr,  Bvrom  Bkamwell  showed  a  case  of  pancreatic 
infantilism,  a  new  disease,   ilk  (he  benefits  of 

treatment  by  pancreatic  extract.     Two  years  ago  the 
it   was    nineteen,    and    looked    like    a    boy     of 
**  or  i 2,    There  was  no  arrest  1  rf  mental  development  — 

'  th.     The   different 

parts  of  the   body  were  well   proportioned,   arid   there 

*a*  tinism,    congenital  syphilis, 

ticket?  1- ,  to  which  was  often  due. 

ujsc  seemed  to  be  chronic  diarrhoea  of    nine 

duration.    The  genitalia  were  quite  undeveloped  ; 

it.    3j    in.       The     diarrhoea     was 

be  due  to  defective  pancreatic  secretion  by 

(f/t|ir  prt'sencc  of  undigested  fat  in  the  stools,  and  its 


disappearance  when  pancreatic  extract  was  given  J 
(2)  small  amount  of  phosphoric  acid  in  the  urine  on 
nu Ik  diet,  with  increase  when  pancreatic  extract 
given;  (3)  the  use  of  Sahh's  test  capsules  of  glucoid 
containing  iodoform,  which  showed  that  iodine  was 
only  eliminated  in  the  saliva  when  the  patient  took 
pancreatic  extract.  The  patient  had  now  been  under 
treatment  with  pancreatic  extract  for  two  years,  and 
had  grown  five  inches,  he  looked  much  more  like  ln> 
age,  and  the  genital  organs  had  developed,  there  beinii 
a  growl h  oi  pubic  hair,  increase  in  the  pern*  and 
testicles,  &c. 

Dr.  John  Thomson  showed  two  cases  of  infantilism 
Similar  In  Dr.  Bramwell's  case.  The  elder  was  twenty- 
four,  and  was  about  the  size  of  a  boy  of  10*  He  was 
perfectly  intelligent,  had  none  oi  the  signs  of  cretinism  , 
the  genitals  were  undeveloped,  the  colour  a  peculiar 
yellowish  pallor,  the  voice  high  pitched,  and  there  had 
been  digestive  disturbance  and  abdominal  distension 
for  many  years.  The  pattest  had  had  from  four  to 
seven  motions  daily,  for  which  many  remedies  had 
l)een  fruitlessly  tried.  He  had  grown  one  and  a  half 
inches   between    t?   and  n,    two   inches    from 

o  io\,  and  since  then  had  remained  stationary 
rams  showed  an  ossification  of  the  epiphyses 
corresponding  with  that  of  a  child  of  six  or  eight  years. 
The  second  case  was  art.  til,  and  resembled  a  child  of 
eight  or  nine.  He  was  quite  intelligent,  and  appeared 
to  be  of  the  same  type  as  the  preceding.  In  him  the 
diarrhoea  was  periodic,  there  being  six  or  seven  attacks 
yearly.  He  had  just  come  under  observation.  In 
neither  case  had  pancreatic  treatment  yet  received  a 
trial 

Mr.  Stiles  showed  (i)  hernial  sac  of  a  child  con- 
taining the  vermiform  appendix  adherent  to  the 
le  ;  (2)  portions  of  intestine  resected  for  obstruc- 
tion ;  (5)  congenital  displacement  of  the  kidney-., 
associated  with  extroversion  of  the  bladder  and  sacral 
teratoma  ;  (4)  gangrenous  Meckel's  diverticulum  . 
(5)  two  renal  sarcomata. 

Mr     Miles   showed    (1)   portions   of   resected    I 
intestine  from  cases  of  hernia  and  traumatic  rupture  . 

(2)  three  prostates  removed  by  perineal  prostatectomy  . 

(3)  portion  of  rectal  mucosa  excised  for  prolapse. 

Dr.  Gibsok  showed  skiagrams  from  a  case  of  in- 
fantilism. 

Mr.  Cotter  ill  showed  specimens  from  recent  opera- 
tions for  appendicitis, 

Mr,  Thomson  showed  stomach  from  a  man,  a  1.    i;, 
enormously  dilated  in  consequence  of  pyloric  sti  1 
from  ulcer. 

Dr.  Alexander  Brltce  gave  a  demonstration  of 
electrical  currents  ol  high  frequency,  their  mo.  I 
production,  and  therapeutic  applications.  After  ex- 
plaining what  high  frequency  currents  actually  wen- 
and  demoiistratiai  the  condensers  from  which  they 
were  obtained,  and  the  static  machines  and  coils  used 
to  excite  these  condensers  as  well  as  the  various 
electrodes,  couches,  Ac,  used  in  their  practical  appli- 
cation. Dr.  Bruce  adverted  to  the  unfortunate  if  not  un- 
natural scepticism  with  which  these  and  allied  methods 
of  treatment  were  apt  to  be  regarded.  He  was  con- 
vinced that  in  certain  directions  ihey  had  definite 
value*  though,  of  course,  much  was  claimed  for  them 
by  their  more  enthusiastic  advocates  which  they  could 
never  fulfil.  He  proposed  to  speak  only  of  their  benefits 
from  his  own  experience,  He  had  found  them 
of  great  service  in  the  relief  of  pain  ;  in  neuralgias, 
neuritis,  locomotor  ataxy,  rheumatoid  arthritis,  acute 
muscular  rheumatism,  hbrositis,  lumbago,  and  neur- 
asthenic pains  generally.  The  general  condition  was 
also  improved  in  these  conditions  by  their  use.  lit 
hysterical  pain  they  did  not  seem  of  service,  but  rather 
aggravated  the  suffering,  Neither  were  they  useful 
m  nvulsive  disorder!  or  diseases  accompanied  hy 
tremor,  They  also  did  good  in  neurasthenia,  and 
shortened  the  trksonue  course  of  the  Weir-Mitchell 
method  of  treatment.  He  thought  that  he  had  also 
got  improvement  m  sume  of  trie  forms  of  primary 
muscular  atrophy.  They  usually  produced  a  feeling 
of  him  ftrc,  and  improved  the  she]..     He  had  seen 


286     The  Medical  Press. 


SPECIAL    ARTICLES. 


March   16.   1004. 


effects  in  dilatation  of  the  stomach  due  to  atony,  and 
in  haemorrhoids.  It  was  extremely  doubtful  whether 
they  could  do  any  good  in  gout,  diabetes,  tubercle, 
arterio-sclerosis,  or  cancer. 

Dr.  Bramwell  felt  that  the  Society  was  to  be  con- 
gratulated in  that  one  whose  judgment  they  could  so 
thoroughly  trust  as  Dr.  Brace's  had  taken  up  the 
subject.  It  would  be  a  great  step  if  they  really  bene- 
fited muscular  dystrophies. 

Dr.  Gardiner  spoke  of  failure  in  the  treatment  of 
tuberculosis  with  high  frequency  currents,  and 

Dr.  Webster  compared  their  action  on  the  skin  to 
that  of  the  Nauheim  baths. 

Mr.  David  Wallace  read  a  paper  on  chronic 
intestinal  obstruction  caused  by  annular  stricture 
(malign)  of  the  large  intestine,  an  abstract  of  which 
will  be  found  on  page  282. 

The  subject  was  discussed  by  Mr.  F.  M.  Caird,  Mr. 
Stiles,  Dr.  Affleck,  and  Mr.  Thomson. 


ROYAL  ACADEMY  OF  MEDICINE  IN  IRELAND. 

Medical  Section. 

Meeting  held  Friday,  March  4TH,  1904. 


THERAPEUTICAL    SOCIETY. 

Meeting  held  at  the  Apothecaries'  Hall,  London, 

Tuesday,  February  23RD,  1904. 


Dr.   Rose  Bradford,   Vice-President,   in  the  Chair. 


Sir  J.  W.  Moore  in  the  Chair. 

MILK  :      HUMAN    AND    BOVINE. 

Dr.  Walter  Smith  made  a  communication  upon 
milk,  and  demonstrated  some  chemical  tests  which 
have  been  recently  proposed.  One  of  the  most  curious 
facts  in  regard  to  the  composition  of  milk  is  the 
presence  in  it,  in  measurable  amount,  of  citric  acid, 
which  may  be  considered  a  specific  product  of  the 
mammary  gland.  It  has  been  shown  that  cow's  milk 
includes  from  1  to  3  times  as  much  citric  acid  as 
woman's  milk,  and  the  amount  may  be  reckoned  as 
equivalent  to  about  0*25  per  cent,  of  calcium 
citrate.  To  distinguish  between  human  and  bovine 
milk  a  simple  test  has  been  advanced  by  Unikoff,  of 
St.  Petersburg.  It  consists  simply  in  treating  the 
milk  with  half  its  volume  of  ordinary  liq.  ammonia, 
and  keeping  the  mixture  at  a  temperature  of  6o°C. 
for  about  twenty  minutes.  Human  milk  assumes  a 
violet  red  colour,  the  shade  being  deeper  according  to 
the  puerperal  age  of  the  milk.  Cow's  milk  turns 
faintly  yellow.  This  test  is  valid  and  satisfactory. 
Mr.  Saul  has  proposed  a  test  to  distinguish  raw  milk 
from  scalded  or  boiled  milk.  To  10  c.c.  of  milk  add 
1  per  cent,  of  a  recently  prepared  aqueous  solution  of 
ortol  (used  in  photography),  and  then  one  or  two 
drops  of  H202.  A  vivid  deep  red  colour  is  produced. 
Boiled  milk  is  unaffected.  To  detect  formaldehyde 
added  to  milk  as  a  preservative,  a  simple  test  has  been 
proposed  by  Manget  and  Marion.  Sprinkle  a  few 
crystals  of  amidol  (another  photographic  developer) 
on  the  milk,  slightly  diluted.  Fresh  milk  quickly 
assumes  a  pink  or  salmon  colour.  Milk,  which  con- 
tains a  very  small  trace  of  formaldehyde,  slowly  assumes 
a  canary  yellow  colour. 

Dr.  Langford  Symes  laid  stress  upon  the  practical 
importance  of  Dr.  Smith's  paper,  and  strongly  endorsed 
the  opinion  as  to  the  futility  of  giving  lime  to  children 
as  a  medicinal  measure.  The  only  use  of  lime  added 
to  cow's  milk  was  to  modify  the  physical  properties  of 
the  curd  in  the  stomach.  Too  little  was  absorbed  from 
the  digestive  tract  to  render  lime  of  use  in  treating 
rickets.  He  believed  that  it  was  not  fully  understood 
to  what  extent  sterilisation  altered  the  properties  of 
milk,  and  expressed  the  opinion  that  a  diet  of  sterilised 
milk  was  capable  of  producing  rickets  and  scurvy  in 
children.  It  was  open  to  question  whether  human 
milk  was  secreted  absolutely  sterile  or  not. 

Dr.  Travers  Smith  asked  if  the'citric  acid  in  milk  was 
affected  by  boiling,  for  if  such  were  the  case  an  explana- 
tion was  afforded  of  the  powers  of  sterilised  milk  to 
produce  scurvy. 

Dr.  Coleman  and  Dr.  Cranny  also  spoke. 

Dr.  Walter  Smith,  in  replying,  thanked  the  mem- 
bers for  the  interest  his  paper  had  elicited.  He  stated 
that  calcium  citrate  being  less  soluble  in  hot  than  cold 
milk,  some  was  removed  in  the  scum  of  boiled  milk. 


Dr.  J.  Burnet,  of  Edinburgh,  read  a  paper  on 
ichthotorm  and  ichthargan,  of  which  the  following  is 
an  abstract : — 

After  briefly  referring  to  f enrich thol  and  certain  oi 
the  other  compounds  ot  ichthyol,  Dr.  Burnet  went  on 
to  speak  more  particulaily  ot  ichthoform  and  ichthargan. 
He  referred  more  especially  to  his  use  of  the  former  as 
an  intestinal  astringent  and  antiseptic.  He  found 
that  in  tuberculous  lesions  of  the  intestinal  tract 
ichthotorm  gave  great  satisfaction.  Where  diarrhoea 
was  a  prominent  symptom  he  had  frequently  ad- 
ministered this  ichthyol  compound  in  doses  ot  irom 
ten  to  fifteen  grains  thrice  daily,  with  marked  effect. 
He  suggested  its  use  as  an  enema  with  mucilage  ot 
starch.  Ichthotorm  had  also  given  him  very  good 
results  in  cases  of  varicose  ulcer,  and  also  in  a  variety 
ot  skin  affections,  including  eczema.  He  mentioned 
ichthotorm  gauze  as  a  substitute  for  iodoform  gauze 
for  packing  cavities.  With  regard  to  ichthargan  he 
had  found  it  very  beneficial  in  quite  a  number  of  cases 
ot  urethritis,  and  in  gynaecological  affections  he  had 
used  it  with  marked  success.  In  skin  diseases  ich- 
thargan had  been  employed  pietty  extensively  with 
uniformly  good  effect.  In  atrophic  rhinitis  Dr.  Burnet 
found  an  ointment  containing  1  per  cent,  of  ichthargan 
extremely  useful.  He  referred  to  its  use  in  diseases 
ot  the  eye,  and  mentioned  that  it  might  be  given  in- 
ternally. He  concluded  by  stating  that  the  various 
preparations  have  a  wide  sphere  of  therapeutic  appli- 
cation. 

(In  a  future  issue  we  hope  to  give  this  paper  at 
length.) 

A  cordial  vote  of  thanks  was  given  to  Dr.  Burnet  tor 
his  paper. 

Mr.  W.  McAdam  Eccles  read  a  communication 
"  Respecting  Trusses  and  their  Uses,"  which  will  be 
found  on  page  277  ot  the  present  issue. 

A  vote  of  thanks  was  given  to  Mr.  Eccles  tor  his 
paper. 

Special  articled* 

BRITISH    SANATORIA    FOR    CON  SUMPTION. - 
XXXVII. 
[by  our  special  medical  commissioner.1 
MOORCOTE  SANATORIUM,  EVERSLEY,  HANTS. 

For  many  cases  of  phthisis  .seclusion  from  all  the 
stress  and  strain  indissolubly  connected  with  residence 
in  or  near  town  or  city  is  an  absolute  necessity,  and 
when  combined  with  picturesque  surroundings,  protec- 
tion from  unfavourable  climatic  conditions  and  asso- 
ciated with  strict  medical  supervision,  the  best  is 
provided  for  the  establishment  and  maintenance  of 
processes  making  for  arrest  and  restoration.  Such 
therapeutic  requirements  are  amply  provided  at 
Moorcote.  This  sanatorium  was  established  in  1899. 
and  is  situated  close  to  the  northern  border  of  Hamp- 
shire in  a  district,  the  natural  features  of  which  have 
marked  it  out  as  chief  favourite  for  public  institu 
tions  of  national  importance  and  constituted  it  a  suit- 
able sanatorium  country  for  the  metropolis.  The 
landscape  is  varied  and  rich  in  natural  beauty,  pine 
trees  abound,  and  everywhere  there  is  evidence  of  un- 
spoilt rural  simplicity.  The  subsoil  is  of  gravel  and 
speedily  dries,  even  after  heavy  rain.  The  roads  are 
excellent  for  cycling.  Beautiful  walks  abound.  And 
it  must  not  be  forgotten  that  Eversley  is  rich  in  associa- 
tions, for  in  the  quiet,  quaint,  and  isolated  rectory 
Charles  Kingsley  spent  thirty  years  of  his  busy  life; 
and  here  he  lies  in  the  sombre  little  churchyard  close 
to  the  country  he  long  loved  so  well. 

The  main  building  of  the  sanatorium  consists  of  a 
two-storeyed  building  of  good  construction  with  a  large 
hall,  airy  corridors,  and  convenient  rooms  each  with 
casement  windows.      Here  nine  patients  can  be  accom- 


Jrtsb  fl>oor«3La\v  &  ftunaqp 

Jntelltgence. 

BEING  THE  SUPPLEMENT  OF  THE   "MEDICAL   PBK8S  AND  CIKUULAH" 


MARCH  Ut  1901. 


Notice  to  Correspondents  in  Ireland, 


sc risers  to,  and  correspondents  of,  The 
Medical  Press  and  Circular  who  live  in  Ireland 
aterequested  to  address  their  letters,  subscriptions, 
&c.t  in  all  eases  to  the  Irish  office  of  the  Journal, 
16  Lincoln  Place,  Dublin.  If  Irish  matter  is  for- 
warded to  the  English  office  delay  results,  as  it  has 
in  such  cases  to  be  re-forwarded  to  the  office 
responsible  for  dealing  with  it. 


CONTENTS. 



PAGE 

Mm.  O'M  m  ■  ey'sBiu. 

I 

1  in  Cork  S  vnatorkm 

I 

'    ORK  S.\\\TOR1UM 

2 

■n    In  ion    .. 

■  ■    s 

v    1  \m\ 

1 

rowv  UKIOK 

; 

1  i  t  L  UfOftE  I  ilflOK   .  . 

•■     J 

EClLEVSfl    In jon 

■♦     J 

,i>ux  Union 

»-      4 

*iu  wvv  Ukiom 

.  .      4 

1  HE  Nhuhi   |>i  i  r  in   CniuS 

-  ■      4 

OfllTl  \«Y  — 

Dk.  St,  <  rSOKGE  Ami 

.  ■      4 

M.  1  Hvnes  .. 

,  .      4 

\<  11 11  1.     I-i    |  M-. 

4 

I  -alwav  Hospital 

-        4 

MR.  O'MALLEY'S  HILL. 

\lii    D'Malley's   Hill   for   the   superannuation 

aioo  medical  officers  at  sixty-five  years  ol  age 

ilk-r,  if  from  accident  or  disease  they  become 

unable  to  lion   out   the  duties  ol  their  offii 

printed.      Thus  Lfcc  initial  step  has  been  made  in 

this  very  necessary  reform  in  tin  Poor-law  Service, 

lad  to  sec  thai   thi    Bill  is  non-con- 

itn lions      mi  ooursc    loroe  crank  may  come  for- 

■ -.lul  and  defeat  the  cfforl   to  bettor  the  existing 

ant]     postpone    «>n    act    <>t 

i«*tb  irs.     En  its  present  stage  tlie  Hill  is 

and   w<    believe   it    i^ 

lions  that  u  be  ni.uli-  as  perk-cl  as 

possible  wit  ho  til  introducing  contentious  ma  tun 

hence,  although  we  ^w\  ourselves  in  accord  with 

itie  principle  of  service  on  which  the  pension   is 

'   we  think  that  there  should  bra  good  service 


clause ,  enjoining  the  addition  of  a  given  number 
of  years  to  those  on  which  the  pension  is  calcu- 
lated in  all  cases  in  which  no  complaint,  other  than 
a  trivial  one,  has  been  made  against  the  officer 
during  his  term  of  office.  If  a  public  servant  has 
completed  forty  years  service,  performing  his 
duties  so  well  that  no  serious  charge  was  brought 
against  him,  we  think  that  instead  of  paying  him  a 
pension  of  forty-sixtieths,  he  should  be  paid  the 
fifty-sixtieths  of  his  salary,  Such  a  provision 
would  be  a  reward  to  efficient  officers  with- 
out in  any  way  violating  the  principle  of 
the  BilL  We  would  also  like  to  see  introduced 
into  the  Bill  the  pensioning  of  the  wives  of  officers 
who  me i  their  death  in  the  discharge  of  their  duty. 
Dr.  William  Smith's  death  in  the  performance  of 
duly  does  not  stand  alone*  Is  not  the  widow  of 
such  a  man  entitled  to  a  two- thirds  salary  pension  ? 
It  is  the  duty  oi  the  State  and  the  people  to  honour 
and  reward  those  that  its  best  sons  have  given  to 
their  care.  We  know  that  every  additional  line 
adds  to  the  difficulty  of  carrying  a  Bill  through 
Parliament  ;  but  justice  and  honour  demand  that 
the  widows  and  orphans  of  men  whose  noble 
deedi  and  sell-sacrifice  called  forth  the  admiration 
of  the  nation  should  be  remembered.  We  honour 
ourselves  by  fulfilling  such  a  duty, 


Till:  CORK  SANATORIUM. 
In  tOniay's  issue  we  report,  as  iully  as  our 
columns  admit  ot,  the  inquiry  held  on  the  ist  inst. 
in  the  board-room  <»i  the  Cork  Workhouse,  into 
the  petition  presented  by  the  Cork  Rural  District 
Council  i<>r  a  provisional  order  i«>  provide  a  sana- 
torium for  mnsuntpliscs  Cor  the  City  and  County  of 
Cork.  And  also  ;l  report  t><  the  proceedings  on 
the  same  dale  of  tin  Midleton  Board  of  Guardian^ 
in  reference  to  the  same  sanatorium,  when  a 
deputation  from  the  Cork  Branch  ut  the  National 
Association  lor  the  Prevention  of  Consumption 
waited  "ii  them-  The  circumstances  that  called 
hir  the  inquiry  and  trough!  about  the  deputation 
.in-  *>l  such  importance,  and  so  far-reaching  in 
their  effects,  thai  wo  think  they  deserve  mure  than 
ordinary  notice,  On  December  nth,  1903,  a 
deputation  1mm  the  Society  lor  the  Prevention  of 
Consumption  waited  on  the  Cork  Rural  District 
Council  and  solicited  them  to  Like  advantage  ol 
the  powers  they  possessed  under  the  Local  Gomtii- 


ThtM< 


OkmlPr-g 


ta 
and  Or  ctum. 


IRISH  POOR-LAW  &  LUNACY  INTELLIGENCE.  March  16,  iqo4. 


mcnt  Act" (Ireland),  of  1902,  which  legalised  con- 
tributary~payments  to  iitnrmaries  and  so  forth  ; 
the  initial  step  of  which  was  the  formation  into  a 
united  district  of  the  Urban  and  Rural  Districts  of 
the  County  and  also  of  the  Corporation  of  the  City, 
forTthe  purpose  of  providing  a  sanatorium  for 
consumptives.      On  the  17th,  the  Rural  District 
Council  passed  a  resolution  asking  the  I.L.G.B.  to 
sanction  the  amalgamation  so  far  as  was  necessary 
for  the  contemplated  action.    This  was  but  the 
beginning  of  the  arduous  task  that  had  been  under- 
taken by  the  Cork  branch  of  the  National  Asso- 
ciation on  the  initiative  of  Dr.  P.  J.  Cremen.     But 
they  were  so  successful  in  their  first  move,  and  so 
enthusiastic  in  the  cause,  that  they  have  carried 
through  their  scheme,  and  Cork  will  be  the  richer 
for  their  efforts  by  the  first  sanatorium  sanctioned 
under  the  Act  in  the  three  kingdoms.    This  success 
is  the  outcome  of  a  well-organised  body  of  enthu- 
siasts in  sanitary  science  who,  living  in  a  city  de- 
cimated by  phthisis,  had  daily  before  their  eyes 
the  necessity  for  such  an  institution  as  a  sana- 
torium.    By  lectures  and  letters   to   the  public 
papers  they  educated  the  people  to  the  recognition 
of  the  fact  that  the  disease  which  was  so  rife  in 
their  midst  was  a  curable  one,  and  that  the  cure 
was  fresh  air  and  proper  food,  and  that  to  ensure 
these  an  hospital  of  a  special  construction,  and  in 
a  healthy  locality,  was  a  necessity.     To  accom- 
plish their  self-imposed  task  the  medical  members 
of  the  Cork  branch,  assisted  by  their  rural  brethren, 
travelled  backwards   and   forwards   through   the 
length  and  breadth  of  the  county,  reasoning  and 
persuading  urban  and  rural  councils  until  they 
induced  the  whole  twenty  boards  to  become  con- 
tributing members  to  id.  in  the  £t  on  the  valua- 
tion, which  is  more  than  sufficient  for  a  building 
twice  the  size  of  that  about  to  be  erected,  as  the 
county  valuation  is  £1,094,346,  and  that  of  the 
city  £172,085,  making  a  total  of  £1,265,431.    The 
discussion  at  the  Midleton  Board  of  Guardians  is 
interesting  as  showing  the  interest  that  is  being 
taken  in  the  treatment  of  the  disease  and  as  a  proof 
of    the    care  with  which   the  Cork  branch  had 
prepared  their  statistics  and  facts  before  engaging 
in  the  work.     What  the  Cork  physicians  have  done 
in  this  matter  should  be  an  incentive  to  members 
of   the  medical   profession   in  other  counties   to 
emulate  their  successes.    The  difficulties  in  Cork 
were  many  and  great.     Twenty  boards  had  to  be 
convinced  that  a  sanatorium  was  not  only  urgently 
wanted  but  that  its  erection  and  support  would  in 
the  end  result  in  a  saving.     The  immense  size  of 
the  county  made  a  sacrifice  of  time  and  comfort 
unavoidable,  and  yet  the  zeal  and  energy  of  the 
Cork  men  were  equal  to  the  task,  and  they  have 
scored  the  honour  of  being  the  first  to*  secure  to 
the  people  the  great  blessing  of  a  sanatorium  for 
the  poor,  as  a  right  from  the  ratepayers.     We 
sincerely  hope  that  their  example  will  not  be  lost 
on   the  other  county  branches  of  the   National 
Association. 


COUNTY  CORK  SANATORIUM. 
On  Tuesday,  the  1st  inst.,  an  I.L.G.  Board 
inspector  held  an  inquiry  in  the  Board  room  ol  the 
Cork  Workhouse,  the  result  of  a  petition  by  the  Cork 
Rural  District  Council,  for  a  Provisional  Order  to 
provide  a  sanatorium  for  consumptives  lor  the  County 
and  City  oi  Cork.    The  matters  which  led  up  to  the 


signing  of  the  petition  were  that  a  deputation  from 
the  Society  for  the  Prevention  of  Consumption  ap- 
peared before  the  Cork  Rural  District  Council,  who 
on  December  17th,  1903,  passed  a  resolution,  asking 
that  they  be  formed  into  a  united  district  with  the 
several  urban  and  rural  districts  in  the  county,  and 
also  with  the  Corporation  of  the  City,  for  the  purpose 
of  providing  for  the  inhabitants  of  the  united  districts 
under  the  powers  ot  the  Public  Health  Act,  an  hospital 
or  sanatorium   lor   curable   cases   ot      consumption ; 
and  that,  subject  to  the  consent  ot  the  other  councils 
being  obtained,   the  L.G.  Board  should  make  a  Pro- 
visional Order  on  the  subject.     Subject  to  the  pro- 
vision that  the  cost  on  the  united  area  should  not 
exceed  one  penny  in  the  pound  a  year.     The  valuation 
ot  the  County  and  City  oi  Cork  is  calculated,  on  a 
penny  in  the  £,  to  yield  £5.331   is.   id. — a  sum  fully 
equal   to   the   support   ot   the   proposed   sanatorium. 
Professor  Corby  said  the  Corporation  oi  the  City  oi 
Cork  was  heartily  in  support  ot  the  scheme,  both  from 
a  financial  and  hygienic  point  of  view.     Financially, 
it  would  benefit  by  restoring  the  worker  to  his  employ- 
ment, and    the    two   years'    burden   ot   a   workhouse 
infirmary   patient   would   be   avoided,   as   would   the 
propagation  of  the  disease  by  the  infection  ot  other 
workers.     He  warmly     recommended  segregation  ot. 
all  consumptives,  and  the  loundation  oi  sanatoria  for 
advanced  cases  as  the  true  and  best  prophylactic  for 
the  disease.     It  was  also  necessary  tor  them  to  clear 
away  the  wretched  hovels  in  which  some  ot  their  poor 
lived.    In  recently  visiting  some  oi  their  back  streets 
he  found  seven  people  with  but  336  cubic  feet  space  in 
all.  Eleven  persons  were  found  living  in  one  room.  That, 
was  a  most  scandalous  state  ot  aftairs.       Everything 
in  such  surroundings  was  favourable  to  the  propagation 
oi  phthisis.      Dr.  Ashley  Cummins  said  that  in  1903 
the  number  ot  deaths  was  135  irom  consumption  alone. 
The  Cork   District   Hospital,   to  which  he  belonged, 
was  absolutely  unsuitable  tor  the  treatment  ot  con- 
sumption.    Not    the    least    oi    the   advantages    oi   a 
sanatorium  would  be  its    educative    effect    on    the 
patients.     Nothing  could  be  worse  than  the  tenement 
houses,  every  room  oi  which  became,  from  expectora- 
tion on  the  walls  and  floors,  a  nidus  ot  the  disease. 
Dr.  Donovan.  Superintendent  Medical  Officer  oi  Health, 
said  the  estimated  population  ot  Cork  City  in   1901 
was  76,162.     The  death-rate  ior  1903  was  1938;  the 
death-rate  irom  phthisis  was  3*  66.     During  the  year 
the  mean  temperature  was  5 3- 61  ;  the  mean  reading  oi 
the  barometer  was  29*92  ;  and  the  rainfall  52*77  inches. 
The    prevailing  winds  were  south,  and  west.     "  The 
City   oi   Cork  possesses   the   unenviable  notoriety  ot 
having   a  higher  death-rate  irom   consumption   than 
any  other  town  in  Great  Britain  and  Ireland."     Dr. 
Donovan     recommended    as    prophylactic     measures 
the   following  :— ( 1 )   Voluntary   or   compulsory   noti- 
fication  oi   phthisis ;    (2)   isolation   and   disiniection ; 
(3)   a  sanatorium   tor   incipient   cases,   and   isolation 
hospitals  ior  advanced  cases  ;  (4)  instruction  in   ele- 
mentary hygiene  in  pubUc  and  private  schools,   and 
specially  on  the  value  ot  air,  light,  and  cleanliness 
(5)  the  providing  ot  houses  ior  the  very  poor ;  (6)  the 
systematic  examination  oi  the    milk  supplied  to  the 
people.       Dr.     O'Meara,     Skibbereen,     thought     the 
disease   iniectious.     Dr.     Cremen     said    he     thought 
promiscuous  spitting  should  be  prohibited.    In  the  year 
1902,  there  were  985  deaths  from  phthisis  in  the  City 
and  County  oi  Cork,  whilst  in  the  rest  oi  Munster, 
comprising    Clare,    Limerick,    Tipperary,    Kerry   and 
Wateriord  there  was  only  1,309.   Mr.  C.  F.  McMullen, 
C.E.,  said  an  hospital  oi  iorty  beds  would  cost  £150  a 
bed  on  an  average.     If  they  atterwards  wanted  further 
accommodation  the  chalet  system    could  be  adopted. 
A  tax  ot  a  penny  in  the  £  would  support  eighty  beds. 
Mr.  Barter  had*  generously  offered  a  site  of  twenty 
acres  at  Myshall,  Coachtord,  which,  he  thought,  should 
be  accepted,  as  the  position  and  grounds  were  most 
suitable  ior  a  sanatorium.     The  proceedingsthen  closed 
with  a  vote  oi  thanks  to  the  inspector.         ~__     .  . 


,.  t«   i«>4.  IRISH  POOR  LAW  &  LUNACY  INTELLIGENCE. 


Th*  MALllcB.n>r»u  ft&d  CLrcn!*|, 


3ri0b  tuitions. 


MIDLETOK  UNION P 
Ar  the  nice  ling  of  the  Midleton  Board  ol  Guardians, 
held  «»n  Tuesday,  the  ibth  ult..  a  deputation  ol 
medical  nun  was  received  by  the  Guardians,  1  he 
deputation  attended  to  submit  ilv  chums  ol  the  Cork 
branch  oi  the  National   lasociation  lot  the  Treatment 

otisumption  Mr.  Rohan,  a  guardian,  opposed 
the  levy  ol  o  penny  in  the  /'.  on  the  valuation  ot  the 
Union  u  tor  Hlarney  air,"  lie  contended  that  the 
.  ms  consented  to  give,  £375  a  year,  which 
with  costs  *■»!  collection  amounted  to  /400  a  year,  w,is 
urh  tt  practically  meant  handing  over  £1 0,000 
to  the  Cork  Association  And  he  believed  the  money 
would  hi.-  more  advantageously  spent  in  building 
lor  the  poor.  Dr.  Cremin,  in 
addressing  ihe  Board,  said  the  representatives  >il  the 
Cotts  City  hospitals  and  their  medical  friends  in  Midle 
mn  were  on?  with  them  on  this  o;iu-.iion  He  ih ui 
proceeded]  to  show  ihe  nece^ity  tlj.it  existed  i«»r  the 
proposed  sanatorium  Provision  had  u-mi  mult-  Jor 
every  chua  oi  disease  except  consumption,  which  wan 
decimating  their  poor.  Tney  had  appealed  success- 
fully h»r  aid  on  behuli  of  the  institution  to  all  the  urban 

rural  districts,  and  the  actions  ol  these  bodies  was 
a  credit  tu  themselves  and  to  It  eland.  He  reminded 
the  Board  that  they  would  get  due  and  proper  reprfe- 

tiou   i»n    the   governing    body    oi    the    proposed 
iriunt.     He  showed  by  statistics  that  consump- 
tion 111  its  early  stages  was  curable,     and     instanced 
how  !  manj   did  to  check  the  ravages  ot    the 

disease,  and   he  stated   that   even  from   an  economic 
ol    view    the    expenditure    was    justified.     Dr. 

ton  Atkins  supported  the  view  put  lor  ward  by 
l>r.  <  renin i.  He  said  the  rapidly  increasing  death- 
rate  Jroin  consumption  told  that  the  sanatorium  was 
urgently  needed.  The  tate  had  risen  trom  40  per  10.000 

¥96  to  130  per  10,000  in  1901.  He  agreed  with  Mr. 
Rohan  that  the  sanatorium  ol  itself  was  not  enough, 
houses  tor  the  poor  were  very  necessary,  hut  the 
Istuciation  thought  it  wisest  to  commence  with  the 
sanatorium,  In  Germany  they  had  seventy  sanatoria, 
md  in  England  and  Scotland,  since  the  introduction  ot 
sanatoria,  the  death-rate  was  considerably  less.  He 
abo  mentioned  that  there  were  z$g  deaths  trom  con- 
sumption in  the  County  am!  City  oi  Cork  during  the 
ten  vears  1893-1901,  and  he  quoted  statistics  to  show 
□SB  represented  a  sum  equivalent  to  £145,000. 
which  shows  the  desperate  loss  this  disease  is  trom  an 
ink  point  ol  view.  Mr.  Riordan,  in  a  short  ami 
excellent  speech,  appealed  to  Mr.  Rohan  to  withdraw 
his  motion  and  allow  the  grant  to  be  passed  unani- 
mously, which  Mt  Rohan  did,  ami  the  deputation. 
bltftllg  thanked  the  Board,  withdrew 

On  Friday,   the   4th  instant,  an   IX. G.   Board   in- 

<r   lie  Id   an   inquiry   in    the   board    room   of    the 

workhouse,  into  the  circumstances  under  which  Mary 

nan  met  her  death.  Dr.  O'Connel,  dispensary 
tint  tor  of  the  Castlemartyr  district,  requisitioned  by 
certificate  I  he  relieving  o  nicer  tor  the  infirmary  am- 
ice to  remove  two  women,  Mary  Harry  and 
Mary  Cab  hi  nan,  the  latter  of  whom  died  two  hours 
her  admission  to  the  house.  From  the  evidence, 
it  appears  that  Dr.  O'Connel  tilled  and  left  his  medical 
certificates  for  the  removal  of  the  patients  and  the 
requisition  for  I  he  ambulance  at  Castlemartyr  dis- 
pensary Station,  and  that  verbal  messages  only  were 
given  to  Fit*  Maboney,  ihe  relievi ng officer  at  Midle ton. 
by  the  friend*  of  tin  patients.  The  relieving  officer 
declined  to  act  011  their  message,  or  to  lake  any  steps 
tu  the  matter  until  he  had  the  medical  certificate,  on 
the  ground  that  M  the  medical  officer  in  charge  of 
patients  was  bound  to  send  the  certificates  to  him, 
either  by  post  or  by  the  patient's  friends."  The  friends 
seeing  that  they  could  not  get  the  ambulance,  had  the 


two  patients  conveyed  to  Midleton  by  irain  and  a 
common  springtess  country  farm  cart.  The  deacon 
is  awaited  with  much  interest.  We  think  that  n. tu- 
rn onsense  might  have  suggested  lo  the  relieving  oflicrt 
that  a  telegram  to  1  ir.  Q'Conjtel  telling  him  of  I|m 
fact  would  have  secured  the  ambulance,  and  have 
made  unnecessary  the  sworn  inquiry  and  its  expense, 
and  l he  ill- feeling  that  it  so  often  engenders. 


CAY.VN   UNION 
\i   the  meeting  of  the  Cavaa  Hoard  ot  Guardians, 

held  on  Tuesday,  the  1st  hist.,  a  letter  was  read  trom 
the  LI  .('..  Board  relative  to  the  charges  made  against 
Mis.  Dun,  mid  wile  ot  the  Ballinaph  dispensary  district, 
and  the  Board  have  decided  with  reference  to  ihe 
Guardians4  views  OH  the  matter,  that  they  will  not  press 
toff  Mrs.  Ihitt's  resignation.  They,  however,  think 
that  the  Guardians  should  severely  censure  her,  and 
minim  her  that  the  tacts  have  been  noted  against  her 
in  the  records  of  the  department.  The  attention  of 
the  medical  oraoer  should  alsn  be  formally  drawn  to 
Article  16,  par,  xviii.,  ot  the  dispensary  rides  under  which 
he  is  required  to  report  to  the  Hoard  ol  Guardians,  or 
ti>  the  !.!..( r  Hoard,  auv  neglect  or  failure  ml  the  part 
oi  the  midwite  to  discharge  punctually  and  property 
the  duties  appertaining  to  her  office, 

IRVINESTOWN  UNION. 
Ai  the  meeting  of  the  lrvinestown  Hoard  of  Guar- 
dians, held  on  Wednesday,  the  2nd  inst.,  in, 
Warnock,  ot  Trillick.  was  appointed  medical  smb- 
stitute  h>r  lrvinestown  Workhouse  and  dispensary 
district,  during  tin  illness  ot  Dr.  Graham,  at  a  salary 
ol  /o  6ft,  a  week.  An  amendment,  fixing  the  remunera- 
tion at  £4  4s.  a  week,  found  no  supporters,  We 
think  that  such  an  object  lesson  ought  to  lell  the 
II. G.  Hoard  that  the  Guardians  in 'every  part  ot 
Ireland  have  come  to  hilly  recognise  that  the  onion 
medical  officers  throughout  the  country  are  worthy 
oi  a  rate  ot  payment  much  higher  than  the  central 
authorities  are  willing  to  sanction. 

Tl  LLAMORK  UNION. 
At  the  weekly  meeting  ot  the  Tullamorc  Board  ot 
Guardians,  held  on  Tuesday,  the  tst  mat.,  a  letter 
was  read  from  Dr,  W.  J.  McCarthy  stating  thai  Ij- 
would  go  to  reside  at  the  Blueball  residence  "  within  a 
few  weidts,"  that  is  provided  the  necessary  repairs 
were  executed  in  the  meantime.  The  Guardian 
dined  to  consider  the  notice  ot  motion  as  Dr.  McCarthy 
w;i,  not  reMdin^  in  the  Blueball  residence  and  had  not 
signed  the  agreement.  They  sard  they  could  not 
leave  the  poor  ol  the  district  any  longer  without  a 
resident  doctor,  and  ordered  the  clerk  to  intorm  Dr. 
McCarthy,  that  ii  he  were  not  residing  in  Blueball,  mid 
I » Lid  not  the  agreement  signetl  before  their  next  meeting 
they  would  lake  steps  to  elect  his  successor. 

KILRUSH  UNION. 
At  the  meeting  of  the  Kilrush  Board  of  Guardians 
held  on  Saturday  the  27  th  nit.,  a  letter  was  read  from 
the  I.L,G.B.  drawing  attention  to  the  condition  ol  the 
workhouse  and  the  workhouse  infirmary.  The  repirt 
lo  the  I.L.G.B,,  from  their  inspector,  draws  attention 
to  the  want  of  accommodation  for  phthisical  patients 
in  the  infirmary,  There  consumptives  are  inmates  of  a 
general  ward,  and  it  is  recommended  that  two  apt?  ial 
wards,  one  for  males  and  one  for  females,  for  the  disease 
be  constructed,  the  male  and  female  probationary 
yards  are  described  as  being  "in  a  disgraceful  state 
ot  filth  and  neglect,  the  privies  being  entirely  broken 


XRISH  POOR-LAW  MEDICAL  SERVICE.— Medical 
Officers,  before  applying  for  appointments  in  above 
service,  should  communicate  with  the  Hon.  Secretary 
of  the  Irish  Medical  Association',  Royal  College  of 
Surgeons,  Dublin. 


^4  TuuJtf^S&r***.  tRISH  frOORLAW  &  LUNACY  INTELLIGENCE,  march  16,  1904. 


down,  and  the  roofing  of  the  same  gone.  .  .  .  Wet 
comes  through  the  ceiling  of  the  hospital,  and  also  into 
a  room  used  as  a  sewing-room,  which  lies  between  the 
top  wards  of  the  male  and  female  sides.  The  roofing  in 
the  sheds  belonging  to  Ballyena  Hospital  is  also  de- 
fective in  several  places,  the  damp  coming  into  all  the 
wards,  but  especially  into  the  ward  used  as  a  sleeping 
apartment  by  the  wardsmaids."  After  some  dis- 
cussion the  guardians  decided  to  carry  out  the  sugges- 
tions made,  and  an  order  was  made  to  refer  the  ques- 
tion of  hospital  repairs  to  the  engineer  for  a  report;  and 
an  advertisement  was  ordered  to  be  inserted  in  the 
papers  calling  for  an  estimate  from  contractors  for  the 
necessary  repairs. 

STROKKSTOWN  UNION. 
At  the  meeting  of  the  Strokestown  Board  of  Guar- 
dians, held  on  Friday,  the  nth  instant,  a  letter  was 
read  from  the  I.L.G.  Board  enclosing  a  copy  of  their 
inspector's  report  on  the  condition  of  the  house.  Tho 
report  draws  attention  to  the  absence  of  suitable 
accommodation  for  consumptives  ;  the  necessity  for 
whitewashing  the  hospital  wards  ;  the  imperfect  con- 
dition of  the  lavatory  ;  the  necessity  for  three  new- 
baths  for  adults  and  one  for  children  ;  the  faulty 
arrangements  for  drying  the  linen  ;  the  fact  that  the 
bed-linen,  at  the  time  of  the  visit,  was  dirty  ;  the 
deficient  water  supply  ;  the  necessity  for  a  new  kitchen 
range  ;  the  neglect  in  not  providing  nursing  during  the 
night  to  the  infirm  female  department  ;  and  the 
quality  of  the  brandy  supplied.  It  costs  but  3s.  id.  a 
quart. 


Mrs.    Power   then   went   behind    the   backs   of  her 
colleagues  to  the  Local  Government  Board,  but  the 
;  latter,  having  the  full  reports  of    the  case,  paid   no 
■  attention   to  her.     I   may  add,  sir,   that  so  long   as 
three-fourths  of  a  Board  of  sixty-two  members  endorse 
1  my  actions  in  connection  with  the  Union  Hospital,  I 
fail  to  see  the  necessity  of  requesting  the  Local  Govern- 
ment Board  to  intervene. 

I  am.  Sir,  yours  truly, 

Caleb    J.    Powell,    F.R.C.S.I. 
30,  Harcourt  Street,  Dublin,  February  29th,  1904. 


GALWAY  UNION. 
At  the  meeting  of  the  Galway  Board  of  Guardians 
held  on  Wednesday,  the  9th  instant,  a  letter  was  read 
from  the  I.L.G.  Board,  ordering  that  a  new  election 
l>c  held  for  the  appointment  of  medical  officer  for  the 
No.  1  Galway  dispensary  district,  as  at  the  last  election 
neither  candidate  got  a  majority  of  votes. 


Corrcsponfccncc- 


THE  NORTH  DUBLIN  UNION. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir. — My  attention  has  been  drawn  to  a  letter  in 
your  issue  of  February  17th,  from  Mrs.  Power,  P.L.G. 

In  that  communication  reference  has  been  made  to 
the  case  of  a  girl  who,  some  twelve  months  ago.  had 
been  under  treatment  in  the  North  Dublin  Union 
Hospital,  suffering  from  purulent  ophthalmia.  She 
was  under  the  care  of  Dr.  Montgomery,  and  was,  by 
his  advice,  discharged  cured.  She  left  the  hospital 
perfectly  well.  Although  I  never  had  the  girl  under 
my  care*,  your  correspondent  stated  in  the  board  Room, 
at  a  meeting  of  the  Guardians,  that  the  girl  lost  the 
sight  of  one  of  her  eyes  through  not  being  properly 
treated  by  me.  I  was  not  present  at  the  meeting,  but 
I  wrote  to  the  clerk  on  the  next  Board  day,  and  pointed 
out  that  I  never  had  this  girl  as  a  patient,  and  that 
she  was  perfectly  well  of  the  disease  fiom  which  she 
had  been  suffering,  and  I  enclosed  a  report  to  that 
effect  from  Dr.  Montgomery.  Even  then  Mrs.  Power 
was  not  satisfied.  She  made  further  statements,  but 
the  Board  of  Guardians  marked  their  disapproval,  by 
passing  the  following  resolution  : — 

"  That  the  Board  have  every  confidence  in  the 
way  Dr.  Powell  treats  the  patients  under  his  care,  and 
the  members  deem  it  inadvisable  to  interfere  with  him 
in  his  discretion  as  to  the  discharge  of  patients  from 
hospital  or  otherwise." 


©biiuar^. 


DR.  ST.  GEORGE  ASH. 
We  regret  to  announce  the  death  of  Dr.  St.  George 
Ash,  medical  officer  of  the  No.  2  South  City  dispensary 
district,  and  physician  to  Cork  Street  Fever  Hospital. 
Dr.  Ash  obtained  the  licences  of  the  College  of  Physi- 
cians and  Surgeons  in  1882,  and  soon  after  he  was 
appointed  to  the  No.  2  South  City  dispensary,  to  the 
duties  of  which  he  devoted  himself  with  unremitting 
energy.  A  quiet,  unobtrusive,  painstaking  man.  who 
made  the  poor  ot  his  district  his  care,  and  daily,  in  the 
wretched  slums  ot  the  Castle  Street  neighbourhood,  h*» 
was  lound  fighting  lever  in  its  natural  home  ot  dirt 
and  poverty.  His  name  is  held  in  respect  and  affection 
among  the  poor  in  whose  midst  he  laboured. 

DR.  M.  J.  HYNES. 
We  regret  to  announce  the  death  of  Dr.  M.  J.  Hynes, 
at  his  residence,  Ray  View,  Leenane,  on  Saturday,  the 
13th  ult.  Dr.  Hynes  obtained  the  licence  of  the 
R.C.S.I.  and  of  the  R.C.P.I.  in  1899.  Soon  afterwards 
he  was  appointed  medical  officer  to  the  Clonbur  No.  2 
and  the  Bundunagh  dispensary  districts.  He  quickly 
became  very  popular,  as  was  evidenced  by  the  immense 
numbers  that  followed  his  funeral  tor  a  distance  of 
thirty  miles.  His  death  is  ascribed  to  an  attack  ot 
pneumonia,  contracted  at  the  funeral  of  his  uncle, 
Dr.  Lydon. 

ACHILL  ISLAND. 
An  outbreak  of  small-pox  has  occurred  on  Achill 
Island  in  two  of  the  largest  and  most  congested  villages 
on  the  seaboard — Keel  and  Dovagh.  The  outbreak 
is  ascribed  to  a  case  of  the  disease  which  came  from 
Glasgow.  The  sanitary  conditions  under  which  the 
islanders  live  are  of  the  lowest  type,  and  in  such  sur- 
roundings, amidst  a  population  a  large  percentage 
of  which  is  unvaccinated,  the  epidemic  cannot  easily 
be  controlled.  Measures  for  preventing  the 
spread  of  the  disease  are  being  taken.  An  isolation 
hospital  has  been  opened  by  the  District  Council, 
under  the  superintendence  of  Dr.  Croly,  the  dis- 
pensary medical  officer  of  the  island,  and  the  services  of 
trained  nurses  have  been  obtained. 


COUNTY  GALWAY  HOSPITAL. 
At  the  usual  monthly  meeting  of  the  Board  of 
Management  of  the  County  Galway  Hospital,  held  on 
Saturday,  the  5th  instant,  Mr.  Higgins  proposed  the 
following  resolution  : — "  That  we,  the  Board  of  Manage- 
ment of  the  County  Galway  Hospital,  request  the 
Local  Government  Board  to  hold  a  sworn  inquiry 
into  the  circumstances  of  the  refusal  of  admittance  of 
a  man  named  John  Holland  into  the  County  Hospital, 
who  since  died,  and  for  which  refusal  of  admission 
this  Board  does  not  hold  itself  responsible."  Mr. 
Murphy  seconded  the  resolution,  wluch  was  carried 
unanimously. 


BOILEAU     &    BOYD,    Limited. 
St.  Bride's  Laboratory,  DUBLIN. 
Standardized   Pharmaceutical  Preparations. 
Pjirkst  Drugs  and  Chemicals. 


BOILEAU     &     BOYD,     Limited. 
St.  Bride's  Laboratory,  DUBLIN. 
All  requirements  of  Medical  Practitioners. 
Ask  for  Quarterly  Price  List. 


March  16,  1904. 


FRANCE, 


The  Medical  Press.      287 


men!  a  led.  In  an  adjacent  house  there  is  £<■ 
modal  ion  for  six  more-  The  chief  building  is  delight  - 
fully  -if it.it--- 1  in  ,1  himIi  clearing  amidst  pines  and  com- 
pletely protected  on  all  skies.  It  is,  however,  well 
exposed  tosunhght,  anil  in  the  grounds  belonging  to  the 
estate  there  area  number  of  shelters, 

Special  mention  should  be  made  of  a  useful  form  Q*  con- 

vertible  chalet  shelter  (made  by  Messrs. Browne  and  Lilly, 

:  Greyfriars  Works,  Reading)    in  use  at  Moorcote  and 

which  we  had  an  Opportunity  of  inspecting.    It  may  be 

iv shelter  and  closed  as  a  night  chalet,  The 


^iiHII-"-IIP 


re  particularly  ingenious,  and  can  be  opened 

nml  closed  in  a  simdar  manner  to  all  other  casements,  and 

tf£  provided   with  awnings  so  that  when  the  windows 

during  dressing  or  undressing, they  can  be 

used   a.s   blinds  or  curtains.     When   used    as  a   night 

chalet,    with    windows   open    and    weather    blinds    in 

ion,  no  rani  can  enter,  full  protection  is  ensured, 

yd  ample  ventilation  would  seem  lo  be  afforded. 

By  a  simple  contrivance  with  the   use  of  curtains  the 

open  shelter  can  be  rendered  quite  suitable  for  sleeping 

in  the  open  during  the  sum  men     We  commend   this 

i<>rm  0»l  convertible  chalet  shelter  to  those  who  desire 

r.'p  up  open-air  life  in  their  own  grounds*     The 

price  complete,  with  curtains, 

The  iogeaioua  medical  director  has  a!s:>  just  introduced 
very  cheap  and,  as  far  as  we  have  been  able  to  judge, 
tuent   and   efficient   form  of  bed-rest,  which  pro- 
mises to  be  of  great  service  for  sanatoria  and  hospitals* 
The  grounds  ol  bfoorcotc  are  extensive,  well  laid  out, 
and,  even  in  early  March  and  on  a  bitterly  cold  day, 
when  we  visitednhc  sanatorium, afforded  almost  complete 
r  from  winds,  being  thickly  planted  with  pines, 
hrs,  and    innumerable  evergreen   shrubs.     The  water 
is  said  lo  be  good.     Sewage  is  dealt  with  in  a 
simple  but  efficient  manner.     Treatment  is  conducted 
in  accordance  with  strict  hygienic  requirements. 
Dr.  Haydn  Brown  is  the  medical  superintendent,  and 
listed   by   his  wife,   who   has  had   thorough 
training  is  nursing.     There  is  a  capable  lady  Superin- 
ent.  and  good  stafl,     <  mlj  ived. 

Institution  is  peculiarly  fitted  for  Bttcta  patients  who 
require  isolation  from  mi  rrying  friends  and  a 

mfortable  existence  free  from  worry  of  all 
kinoa.     The  terms  are  £3  js,  to  £%  4s.  weekly,  according 
to  rooms,     Alcoholic  beverages  (if  required)  and  per- 
as.     Moorcote    1-    only    forty 
from  1  ondon,  but  it  it  about  si*  miles  from  Woking 
5.W.R.,  the  most  convenient    station  for 
>m  Waterloo.     The  patients  from  the  west  and 
north  should  come  t«»  Reading  on  the  G-W.R.,  which 
i*  about  nine  miles  distant.  A  carriage  meets  patients 
by  appointment, —— 

In  the  Metropolis,  three  further  cases  of  small- 
pox— from  Dcthnal  Green,  Mile  End,  and  Blooms- 
bury  respectively — were  yesterday  admitted  to 
the  Rotherhithe  shelters.  At  noon  the  consider- 
able number  o(  forty-eight  patients  remained 
under  treatment  at  the  Joyce  Green  Hospital, 
lord,  and  other  hospitals. 


France. 


[from  our  own  correspondent*] 


Fajok,  Mart h  13th,  1BC4 

Treatment  of  Angina  Pectoris. 

Prof,  Huchard,  the  acknowledged  authority  on 
cardiac  disease,  epeaMng  on  the  treatment  of  angina 
pectoris,  says  that  it  is  necessary  at  the  outset  to  dis- 
tinguish between  Uu  false  and  the  true  angina.  The 
tofmftf  gets  W*U  by  SBppreiatog  the  cause  that  pro- 
voked it  neurasthenia,  gastric  troubles, 
over-indulgence  in  tobacco  ;  but  in  true  angina  pec- 
[1  is  of  little  use  tu  treat  the  causal  affection — gout* 
diabetes,  syphilis,  malaria — far  the  result  is  always  *& 
To  successfully  treat  the  malady,  it  is  nut  the  patho- 
lo-ical  cause  that  should  receive  attention,  but  the 
anatomical  cause— Jiseu$>e  of  the  coronary  artery*  I  Fence 
a  double  medicati-ui  is  necessary,  one  addressed  to  the 
mil.minatiuu  of  the  arteries,  the  other  to  the  pOBfttbft 
and  ever  threatening  risk  of  syncope.  The  first  indi- 
cation is  met  Avith  iodide  oi  sodium,  or,  rather,  iodide 
of  potassium,  which  is  more  active  if  well  borne  {iodide 
of  potassium,  one  drachm  ;  water,  ten  ounces;  a 
tables  poo  nfu  I  three  turns  a  day).  Against  the  danger 
of  syncope,  the  result  id  myoeardiac  ischacmia, 
vaso -dilators  should  be  prescribed.  But  before  com- 
mencing 1  lie  medical  treatment  attention  should  be 
paid  to  the  diet,  which  should  be  lac  to- vegetarian  and 
without  salt  as  much  as  possible.  As  to  remedies  he 
prescribes  along  with  the  iodides  thcobromiu.  as  being 
one  of  the  best  diuretics  it  eliminates  the  chloride 
of  sodium,  the  toxins,  and  the  vaso -constrictive 
substances  from  the  organism.  Ten  grains  are  given 
twice  a  clay  for  fifteen  days.  The  other  fifteen  clays 
of  the  month  he  divides  between  two  vaso-dilator 
agents — trim  trine  and  tetranitrol.  The  trinitrine  is 
given  in  solution,  in  tablets,  *ir  in  hypodermic  solution*. 
Sol.  of  trinitrine  (1  per  cent,).  60  minims. 
Water,  10  ounces. 

TWO   to   four  table*  p.naistul   a  da  v. 

Sometimes  this  drug  is  not  well  borne  ;  it  provokes 
violent  headaches.  In  such  cases  the  dose  should  be 
diminished,  but  not  too  tpiickly,  so  as  aot  to  give  a 
dose  too  weak  to  be  of  any  bench t,  The  same  pre- 
cautions should  lie  observed  £0  regard  to  tetranitrol, 
which  is  in  one  way  superior  to  trinitxi&e  by  the  fact 
thai  the  effect  lasts  longer  {one  tu  two  hours).  Being 
insoluble  in  water,  tetranitrol  is  employed  in  the  form 
of  tabloids  (i,  2.  _;,  to  milligrammes},  An  average  dose 
( 5  milligrammes)  lo  commence  with  should  be  given  twice 
or  three  times  a  day*  and  diminished  if  headaches  are 
produced,  As  a  substitute  for  the  above  two  agents, 
M.  Huchard  livnaiently  prescribes  nitrites  of  soda 
associated  with  diurel 

Nitrite  of  soda,  grs.   15. 
Nitrate  of  potash,  g|j. 
rb,  of  potash,  5iv. 
Water,  5VI- 

A   tablespoon  nil  each  morning. 

It  frequently  happens  that  patients  get  tired  ami 
impatient  of  the  same  treatment,  consequently  it  is 
well  to  vary  it.  The  extract  of  cactus  graiiditiora,  in  one- 
grain  pills  three  times  a  day,  is  an  excellent  cardiac 
lonic. 

When  the  heart  shows  signs  of  weakness,  M.  Huchard 
gives  small  doses  of  digitalin  (to  drops  of  the  solution 
of  crystallised  digitalin.  1 — i,ooo)  once  a  day  for  five 
days.  Sulphate  of  spartein  is  also  a  cardiac  tonic, 
but  not  always  trustworthy. 

When  the  patient  is  seized  with  an  attack  of  angina 
pectoris,  nitrite  of  amyl  is  the  life-saving  agent. 

As  to  the  general  treatment,   the  patient  is  warned 


288    The  Medical  Press.       THE    OPERATING    THEATRES. 


March  16,  1904. 


against  violent  exercise,  constipation,  long  -walks 
against  the  wind  or  after  meals.  He  should  be  en- 
joined to  take  a  rest  of  one  hour  after  each  meal. 


Austria. 


[from  our  own  correspondent.] 

Vienna,  March  12th,  1904. 
Acquired  Malformation. 

At  the  Gesellschatt  der  Aerzte,  Heim  related  the 
history  of  a  mother,  aet.  40,  whom  he  exhibited  to  the 
meeting.  Twenty-one  years  ago  she  was  wounded 
with  a  needle  in  the  right  middle  finger.  A  severe 
panaritium,  or  phlegmonous  inflammation,  set  in 
after  this,  and  lasted  tor  two  years,  which  finally 
necessitated  the  amputation  of  the  finger  with  the 
third  metacarpal  bone.  The  parts  after  this  would  not 
unite,  and  thus  left  the  hand  in  two  parts  or  cloven,  as 
at  present  seen.  The  strange  part  ol  the  history  now 
commences.  Since  marriage  she  has  had  six  children, 
(our  of  whom  have  cloven  hands.  These  have  both 
hands  split  in  the  same  manner  as  the  mother,  having 
in  some  cases  a  rudimentary  third  metacarpal  bone. 

Along  with  these  cases   he   gave    the  history  of  a 
similar  condition  existing  in  three  generations. 
Crural    Hernia. 

Heim  next  related  the  case  of  repeated  incarcerated 
hernia,  which  was  finally  supported  by  fixing  it  in  the 
ileo-caecal  region,  but  was  followed  by  a  stenosis  in 
the  lower  part  of  the  ileum.  Subsequently  incar- 
ceration of  the  hernia  was  repeated,  but  owing  to 
the  loss  of  the  power  in  the  bowel  by  the  stenosis,  an 
operation  was  undertaken,  under  which  the  patient 
died. 

Anastomosis  of  Stomach  and  Bowel/' 

Sato  related  his  experiments  on  animals,  in  which  he 
produced  anastomosis  or  communication  with  the 
stomach  and  bowel  without  opening  into  the  lumina 
ol  either,  and  without  any  danger  of  the  contents  of  the 
bowel  and  stomach  entering  the  abdominal  cavity. 
These  operations  were  performed  on  dogs  and  monkeys 
by  opening  the  abdomen  and  removing  the  muscle 
and  submucosa  opposite  the  parts  to  be  united  ;  when 
ready  for  union  nitrate  of  silver  was  then  applied  to 
the  mucous  membrane,  the  bowel  and  stomach  united 
and  held  together  by  a  tew  sero-muscular  sutures. 

After  three  days,  in  the  case  oi  the  dogs,  and  two 
in  that  of  the  monkeys,  the  communication  appeared 
to  be  perfectly  free  and  sufficient. 

Iselsberg  remarked  that  the  operation  was  ol  con- 
siderable interest  as  it  greatly  simplified  the  operation 
of  gastio-enterostomy  where  a  communication  between 
the  stomach  and  bowel  was  necessary. 
Tuberculous  Kidney. 

Kapsamer  demonstrated  a  normal-sized  kidney 
with  a  small  tuberculous  cavity  in  the  upper  parts  of 
the  organ.  The  diagnosis  could  only  be  made  after 
a  few  injections  ot  guinea-pigs  with  urine  taken  from 
the  ureter,  by  means  ot  a  catheter.  The  infected 
animals  developed  tuberculous  peritonitis  six  weeks 
after  the  insertion  ot  the  fluid.  All  examinations  oi 
the  urine  itself  baffled  diagnosis,  and  operation  was 
delayed  until  the  tuberculous  condition  was  proved 
by  animal  injection.  Alter  the  nephrectomy  the 
patient  felt  comparatively  well,  and  was  able  to  return 
to  duty  in  a  short  time.  He  related  the  history  oi  a 
similar  case  where  it  had  extended  into  the  ureter,  and 
after  removing  the  organ  and  canal  the  patient  also 
recovered.  He  was  a  military  officer,  and  became  as 
strong  and  active  as  ever  he  had  been.  Catheterising 
the  ureters  to  locate  the  disease  is  the  only  method  of 
arriving  at  a  correct  diagnosis.     It  should  not  be  for- 


gotten that  both  ureters  should  be  examined 
separately  in  order  to  determine  the  function  ot  the 
supposed  healthy  kidneys. 

Sarcoid  Cutaneous  Swellings. 

Riehl  exhibited  thiee  cases  ot  skin  disease  to  the 
members,  which  were  of  considerable  interest.  The 
first  was  one  ot  lymphoderma  perniciosa  Kaposi,  the 
second  one  of  universal  psoriasis,  the  third  was  a  female, 
aet.  35,  with  numerous  confluent  swellings  inthecorium. 
The  tumours  ranged  from  the  size  of  a  pea  to  that  of 
a  pigeon's  egg,  passing  from  white  to  a  puiple  colour, 
with  a  glazed  surface,  moderately  hard  in  consistence, 
and  situated  symmetrically  around  the  ear,  mamma', 
and  over  the  inguinal  and  lower  extremities.  In  the 
blood  were  found  60,000  leucocytes  to  the  centimetre, 
with  60  per  cent,  ot  eosinophile  cells. 

Pal  tan  f  remarked  that  this  60  per  cent,  ot  eosino- 
phile cells  were  those  not  so  named  by  Ehrlich,  but 
included  a  large  number  ot  fine  granular  cells,  which 
might  otherwise  be  termed  neutrophile  cells,  and  in 
animals  were  represented  as  eosinophile  granulation. 


TLbc  Operating  Gbeatres. 

WEST  LONDON  HOSPITAL. 
Gastrotomy  for  Removal  of  a  Murphy's  Button. 
— Mr.  Swinford  Edwards  operated  on  a  young 
woman,  aet.  25,  on  whom  he  had  performed  an  anterior 
gastroenterostomy  four  months  previously,  which 
operation  had  been  undertaken  for  the  relief  of  dys- 
peptic symptoms  accompanied  by  occasional  haema- 
temesis.  The  junction  between  the  stomach  and  the 
jejunum  had  been  effected  by  means  of  a  Murphy's 
button,  and  the  patient  left  the  hospital  after  a  normal 
convalescence  with  complete  relief  to  her  symptoms. 
Her  gastric  symptoms,  however,  had  to  some  slight 
extent  returned  during  the  month  preceding  the  present 
operation,  and  as  there  was  no  evidence  that  the  button 
had  passed,  she  was  submitted  to  the  X-rays  and  the 
button  was  seen  in  the  neighbourhood  of  the  stomach. 
It  was  then  thought  advisable  to  open  the  stomach 
again  in  order  to  remove  the  button.  As  the  previous 
incision  had  been  through  the  linea  alba,  Mr.  Edwards 
now  made  a  longitudinal  incision  four  inches  long  over 
the  left  rectus.  This  muscle,  having  been  exposed, 
was  drawn  to  the  left.  The  posterior  layer  of  the  rectus 
sheath  was  then  divided  and  the  abdomen  opened. 
On  digital  examination  the  button  was  found  not  to  be 
loose  in  the  stomach,  but  to  be  tightly  fixed  in  the 
junction  between  the  stomach  and  the  jejunum.  The 
parts  having  been  brought  outside  the  abdomen  and 
well  packed  round  with  gauze,  an  incision  was  made 
into  the  anterior  wall  of  the  stomach,  and  the  finger 
inserted.  The  portion  of  the  Murphy's  button  pre- 
senting towards  the  stomach  was  entirely  covered  by 
mucous  membrane  and  tightly  fixed  in  situ.  This 
mucous  membrane  was  then  incised  on  to  the  button 
to  the  extent  of  about  an  inch,  and  the  operator  tried 
to  deliver  the  button  through  this  opening,  but.  failing 
to  do  so,  he  disengaged  the  male  from  the  female  por- 
tion of  the  button  by  unscrewing.  The  part  of  the 
button  presenting  towards  the  small  intestine  was 
then  easily  removed,  and  soon  afterwards  the  other 
portion  of  the  button,  which  was  more  tightly  held,  was 
successfully  extracted.  A  few  bleeding  points  re- 
quired ligation,  and  the  incision  into  the  stomach  was 
closed  by  the  insertion  of  a  few  Halsted's  sutures.  It 
might  here  be  mentioned  that  the  communication 
between  the  stomach  and  the  intestine  was  found,  after 
the  removal  of  the  button,  to  be  quite  free  and  of  a 
size  capable  of  admitting  two  fingers.  The  abdominal 
wound  was  closed  in  the  usual  way.     Mr.   Edwards 


March  16,  1904. 


LEADING   ARTICLES. 


The  Medical  Tress,     g8g 


remarked  that  it  was  the  second  case  Li  which  he  had 
had  to  perform  a  secondary  gastrotomy  for  the  re- 
moval of  a  Ifttfpby'a  hut  ton.  He  thought  that  this 
occasional  retention  of  the  button  was  a  serious  draw- 
back to  its  use.  and  he  now  utilised  the  direct  suture 
without  the  employment  of  either  button  or  bobbin 
for  gas tro-enteros torn y.  In  cases  where  the  button 
had  .fallen  back  into  the  stomach  and  been  retained 
there,  it  was  curious,  he  said,  how  few  symptoms  it 
gave  nse  to,  even  after  a  long  period  ;  but  he  could  not 
believe  that  even  m  casea  which  presented  no  sym- 
ptoms thai  the  surgeon  was  just  died  In  no  further 
interference,  but  he  considered  that  after  three  months, 
be  fort*,  a  secondary  operation  should  be 
.ken, 


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23s,  fid,  credit  rate. 


FRENCH  HOSPITAL  AND  DISPENSARY, 

Operation  for  Resection  of  Hibs— With  reference 

to  this  operation,  reported  in   Inst  week's  "  Operating 

Mr.  Cuyton  Greene  said  thai  the  following 

tl  appeared  to  be  of  interest  In  connection  with  the 

(1)  The  diagnosis.  This  had  to  be  made  from  empy- 
ema and  cario us  ribs  producing  peripleuritis.  At  first  he 
was  i ad  1  tied  to  regard  the  case  as  one  of  empyema 
(tocttlar).  as  at  the  hrst  operation  no  sign  of  lung  could 
be  detected.  This,  however,  was  shown  to  be  wrong 
at  the  second  operation,   the  case  being  one  of  very 

.-.vcpehpleurat  abscess.  {2J  The  cause.  Hewas 
inclined  to  look  upon  this  as  influenzal  from  the 
character  of  the  pus  and  the  subsequent  course  of  the 
(j)  Treatment.  Mr.  Greene  pointed  out  that  at 
the  tirst  operation  there  was  an  enormous  cavity  found, 
the  finger  readily  passed  np  into  the  neck  behind  the 
Email  vessels.  The  first  and  second  ribs  were  bare 
and  carious,  as  was  also  the  back  of  the  sternum.    The 

irdium  lay  below  the  aorta  on  the  inner  side — 

f:T  formidable  state  of  affairs.  As  the  man  was 
very  ill  with  a  pulse  of  140,  Mr.  Greene  contented 
lumself  with  removing  the  second  rib  and  draining. 
seemed  to  do  fairly  well  as  a  temporary  measure, 
•nd  eventually  the  whole  cavity  closed  up.  He  said 
ta  was  not  surprised,  however,  to  find  the  patient  back 
again  with  more   trouble,  but    this  appeared   at   the 

1  operation  to  he  due  to  the  persistence  <d  the 
carious  first  rib,  as  an  abscess  over  the  sternum  ran 
tight  op  to  it*  There  was  nothing  f<>r  it  but  to  attempt 
its  removal,  and  this  was  done  without  great  difficulty. 
Tht  scjlenu?  anticus  and  medius  were  both  seen  and 
cut,  bnl  the  subclavian  vessels  were  not  in  evidence,  or, 
lather,  not  m  troublesome  evidence,  The  left  half  of  the 
^rrmim  was  similarly  dealt  with,  the  ster  no -thyroid 
king  cot,  but  the  clavicular  Joint  was  left  alone.  The 
patient  made  a  good  recovery,  but  still  has  an  irregular 
Ma. 


TEbe  /IDe&teal  press   an&  Circular. 

"  SALUS  POPULI  SUPREMA  LEX  " 


WEDNESDAY,  MARCH  16.  1904. 


l he  fifth  annual  report  of  the  Liverpool  School  id 

Topical  Medicine  states  that  testimony   is  constantly 

arriving  from  West  Africa  and  Other   unhealthy  regions 

pics  to  the  effect  that  where  the  recommenda- 

Ikh&  of  the  bc hi  >ol  hi  Folk  rwe<  I  r  he  heal t h  cond  i- 

much  improved.        Since  the  fnuiida- 

IkiB  oi   the   school    tweh  it  ions     have    been 

Uched  to  the  Tropics    i'-r  the  study  of  malaria. 

^r,  trypanosomiasis,  and  sanitation.     During 

been  admitted  into  the 

al  ward  attached  to  the  scln  k>L      \  new  laboratory 

been    built    and    equipped    with    the    n 

natus.     The  attendance   of    students     has    been 

formerly,  they  have  generally 

Weamedical  officers  holding appo in tm  ponsj- 

ri  p  irt  appends  a  list  of  subscribers  to  the 

red   [ones  Chair  of  Tropical  Medicine  (now  occu* 

by  Maj.-.r  Ronald  Ross,  F.R.S.)  and  to  the  general 

h  of  the  school. 


SIGHT-TESTING  BY  OPTICIANS. 
Thi;  encroachment  of  unqualified  persons  upon 
the  field  oi  legitimate  medical  practice  is  reaching 
a  pitch  that  must  sooner  or  later  force  the  medical 
profession  into  collective  action  for  the  purposes  of 
self  defence.  There  never  was  a  time  in  which 
this  "  poaching  " — to  use  a  homely  but  expressive 
term — %vas  more  daring,  subtle  and  universal. 
Apart  from  the  mere  vulgar  claptrap  of  the  ignorant 
quack  practitioner  and  patent  medicine  vendor, 
there  is  the  more  insidious  net  spread  by  the  pseudo- 
scientific  poacher.  The  latter  reads  up  medical 
treatises  and  sets  up  in  medical  practice— nothing 
more  nor  less — in  the  broad  light  of  day  as  a 
specialist  in  skin,  hair,  nerves,  eyes,  ears,  dermo- 
featural  defects,  bone-setting,  orthopaedics,  cancer, 
and  what-not  generally.  There  is  no  one  to  say 
him  nay.  The  Medical  Acts  are  defective.  They 
provide  for  the  competency  and  proper  conduct  of 
the  legally  qualified  practitioner,  but  they  protect 
neither  him  nor  the  outside  public  from  the  un- 
speakable evils  of  unqualified  medical  practice. 
The  General  Medical  Council  is  too  busy  in  regula- 
ting the  doings  of  legitimate  practitioners  to  have 
any  time  to  waste  upon  quacks,  even  supposing 
Us  constitution  permitted  it  to  suppress  unqualified 
practitioners.  The  lawyers  made  no  such  fatal 
mistake  as  to  call  into  existence  a  central  governing 
body  without  powers  to  resist  and  prosecute  illegal 
practitioners.  If  the  General  Medical  Council 
were  really  representative  of  the  medical  profession 
generally,  which  it  is  not,  the  reform  of  such  an 
anomaly  would  occupy  its  utmost  energies  with 
a  view  to  influence  early  legislation.  Take  the 
case  of  the  Spectacle  Makers'  Company  and  the 
testing  of  vision.  The  name  of  that  ancient  City 
Guild  sufficiently  indicates  its  function.  It  was 
originally  formed  as  a  corporate  body  to  prcT 
tect  craftsmen  who  made  and  sold  spectacles. 
That  clearly  defined  function,  however,  is  not 
enough  for  the  modern  optician,  who  wishes  to 
pose  as  an  expert  in  sight-testing  as  well  as  iu  the 
making  and  selling  of  spectacles.     For  some  time 


290    The  Medical  Press. 


LEADING  ARTICLES. 


March  16,   1904. 


past  the  diploma  certifying  to  efficiency  in 
practical  optics,  and  accompanied  with  the 
usual  Brummagem  farrago  of  appended  letters, 
has  been  granted  by  the  Company.  The 
Court  of  the  Company  has  recently  decided  that 
the  diploma  is  in  future  to  include  a  certification  as 
to  competency  in  sight  testing.  The  former 
diploma  was  signed  by  an  examiner,  who  was 
both  a  member  of  the  medical  profession  and  of 
the  Ophthalmological  Society.  Since  the  inclusion 
of  the  sight- testing  clause  Dr.  Lindsay  Johnson, 
the  gentleman  in  question,  has  resigned  the 
examinership.  It  is  to  be  hoped  that  under  present 
conditions  he  will  take  the  further  step  of  throwing 
up  all  connection  with  the  Spectacle  Makers' Com- 
pany, as  Dr.  Lloyd  Owen  and  other  medical  men 
have  done.  From  the  point  of  view  of  the  medical 
profession  the  testing  of  vision  by  opticians  is  an 
unwarrantable  invasion  of  their  particular  field. 
From  the  point  of  view  of  the  safety  of  the  public 
the  sight-testing  optician  constitutes  a  serious 
and  deplorable  source  of  potential  disaster.  It  is 
impossible  for  the  optician  to  recognise  the  many 
disturbances  of  disease  due  to  early  or  advanced 
maladies  apart  from  mere  errors  of  refraction. 
We  are  glad  to  see  that  this  view  of  the  situation 
has  been  clearly  recognised  by  a  leading  member 
of  the  optician's  craft,  Mr.  W.  A.  Dixey,  of 
New  Bond  Street,  London.  In  a  recent  pamphlet 
he  has  published  weighty  arguments  against  the 
sight  testing  diploma  of  the  Spectacle  Makers' 
Company.  The  reasonableness  of  his  remarks 
may  be  gathered  from  the  following  quotation : 
"  Sight-testing  requires  the  furniture  of  the  con- 
sulting room,  with  special  provision  for  ophthal- 
moscopy, and  so  on — the  counter  and  showcases  of 
a  shop  are  in  the  way.  It  also  requires  the 
etiquette  of  the  consulting  room.  The  sight  tester 
should  have  the  authority  of  a  professional  man. 
He  has  to  inquire  (and  this  I  regard  as  very 
material)  as  to  the  age,  the  health,  and  the  habits 
of  the  patient ;  some  of  these  questions  are  quite 
impossible  except  in  the  privacy  of  the  consulting 
room.  He  has  to  give  advice  as  to  the  use  and 
treatment  of  the  eyes.  Occasionally  he  advises 
that  spectacles  are  of  no  use.  Often,  after  spec- 
tacles are  given,  results  have  to  be  noted,  and  sub- 
sequent visits  must  be  paid.  This  all  points  to 
professional  convention,  and  especially  to  re- 
muneration in  the  shape  of  a  fee.  A  professional 
man  may  properly  charge  a  fee  for  each  visit  ; 
a  tradesman  can  only  properly  charge  for  his  goods. 
The  consultation  must  either  be  given  gratis,  or 
shirked."  There  is  much  more  apposite  wisdom 
in  this  pamphlet,  which  should  be  in  the  possession 
of  every  medical  reformer.  The  immediate 
practical  conclusion  is  that  every  ophthalmic 
surgeon  and  every  medical  practitioner  should 
take  care  to  send  his  patients  who  may  want 
spectacles  to  Mr.  Dixey  or  some  brother  tradesman 
of  his  way  of  thinking,  that  is,  one  who  is  content 
to  confine  himself  to  the  shop.  In  that  way  the 
medical  profession  may  to  a  great  extent  check- 
mate the  sight-testing  optician,  who  is  fortified  by 
a  childish  diploma  in   fondly   imagining   himself 


to  have  attained  the  skill  and  knowledge  of  a 
qualified  medical  man. 


DAKHYL  versus  LABOUCHERE. 
The  anomalous  condition  of  the  medical  pro- 
fession with  regard  to  irregular  medical  practice  is 
a  standing  injury  to  the  legal  medical  practitioner, 
and  a  menace  to  the  safety  of  the  public.  The 
General  Medical  Council,  mainly  representative  of 
class  interests,  has  no  power  to  prosecute  irregular 
practitioners.  On  the  other  hand,  that  august 
body  has  both  the  will  and  the  power  to  harass  to 
the  utmost  degree  any  offences  against  the  written 
or  unwritten  decrees  of  the  medical  profession.  The 
history  of  how  the  penal  machinery  was  set  in  action 
against  a  practitioner  who  added  an  American 
degree  to  his  English  diploma,  is  written  in  indelible 
letters  of  accusation  against  the  Council.  The 
only  way  of  attacking  unqualified  medical  practice 
is  by  the  clumsy  and  indirect  exercise  of  certain 
powers  conferred  by  statute  upon  the  corporation 
of  the  Apothecaries.  That  particular  machinery, 
however,  is  cumbersome,  feeble,  and  easily  evaded. 
In  point  of  fact,  there  is  no  system  of  any  kind 
whereby  illegal  medical  practice  may  be  readily  and 
consistently  suppressed.  The  thankless  work  of 
exposure  and  detection  of  the  wiles  of  the  un- 
scrupulous charlatan  should  belong  in  the  natural  I 
order  of  things  to  the  General  Medical  Council, 
just  as  in  an  analogous  case  it  falls  to  the  lot  of  the 
Council  of  the  Incorporated  Law  Society  to  pro- 
tect its  members  as  well  as  the  outside  public  from 
unqualified  legal  practice.  So  far  as  the  medical 
police  system  is  concerned  it  may  be  said  to  exist 
mainly  in  the  columns  of  Truth,  the  editor  of  which 
enterprising  journal  does  work  that  should  be 
provided  for  by  law  and  carried  out  by  the  General 
Medical  Council.  The  uncomfortable  fact  remains, 
however,  that  the  only  real  effort  to  protect  the 
public,  and  incidentally  the  medical  profession, 
against  the  evils  of  irregular  medical  practice  is 
provided  by  the  energies  of  a  lay  newspaper 
proprietor.  For  some  time  past  the  puissant 
gentleman  in  question,  Mr.  Labouchere,  has  been 
castigating  as  a  hollow  and  heartless  fraud  the 
notorious  Drouet  Institute  for  the  treatment  of 
deafness.  It  appears  that  in  the  service  of  that 
institute  was  a  certain  Dr.  Dakhyl,  an  M.D.  of 
Paris,  who  left  that  position  and  set  up  indepen- 
dent practice  as  an  aurist  in  another  part  of  London. 
Truth  described  him  as  "  a  quack  of  the  rankest 
species."  The  Parisan  specialist  then  brought  an 
action  for  libel,  for  which  he  was  awarded  £1,000 
damages.  Had  the  editor  contented  himself  with 
a  statement  of  Dr.  Dakhyl' s  former  connection 
with  the  Drouet  Institute,  and  with  an  exposure 
of  the  absolute  worthlessness  of  the  system  of 
diagnosis  and  advice  by  letter,  on  which  Dr. 
Dakhyl  appears  to  have  largely  depended,  there 
would  have  been  no  ground  for  action.  As  it  is, 
the  case  raises  important  grounds  for  opening  the 
whole  question  of  the  relation  of  our  General 
Medical  Council  to  irregular  practice.  Many 
medical  men  have  been  summarily  deprived  of 
their  English  qualifications  for  accepting  positions 


Uarcis  j6+  1904- 


LEADING   ARTICLES. 


The  Medicai.  Press,     291 


in  commercial  enterprises  of  the  Drouet  type. 
Why  should  not  the  Council  have  power  to  prose- 
cute an  M.D.  of  Paris?  Surely  the  Paris  University 
cannot  recognise  any  graduate  who  allies  himself 
to  notorious  quackery,  and  to  the  hardly  less 
reprehensible  practice  of  giving  advice  by  letter. 
The  Council  would  do  well  to  invite  the  instant 
co-operation  of  the  Paris  University  with  a  view  of 
combined  and  reciprocal  action  with  regard  to 
unworthy  graduates  and  diplomat es  in  either 
country.  At  present  there  is  considerable  diffi- 
culty in  ascertaining  whether  any  given  claimant 
tu  the  title  of  M.D.  ot  Paris  is  really  the  holder  of 
that  honourable  distinction,  We  repeat  that  were 
the  General  Medical  Council  armed  with  reasonable 
powers,  and  animated  with  a  desire  to  protect  the 
interests  of  the  medical  profession  and  of  the 
public,  there  would  be  no  further  need  for  Mr. 
Labouchere  to  belabour  quacks,  charlatans, 
pretenders,  and  unworthy  though  legally  qualified 
members  oj  the  profession.  It  is  only  when  the 
Council  is  made  really  representative  of  the  main 
issues  of  the  profession  rather  than  of  a  number  of 
scattered  rival  corporations  that  we  may  hope 
r.y  real  progress  towards  the  effective  control 
of  the  irregular  competition  that  fastens  a  heavy 
and  increasing:  burden  upon  the  shoulders  ol  the 
harassed  general  practitioner. 

THE    PRACTICE    OF    MEDICINE     AND 
DENTISTRY  BY  COMPANIES. 

We  reproduce  in  another  column  a  letter  from 
the  Irish  Branch  ot  the  British  Dental  Association, 
dealing  with  a  matter  which  we  have  no  hesitation 
in  terming  the  most  important  practical  question 
lo  be  faced  at  the  present  moment  by  the 
medical  and  denial  professions.  We  believe 
that  there  are  many  men  in  both  these 
professions  who  are  ignorant  of  the  method  of 
evasion  of  the  Medical  and  Dental  Acts  which  has 
heen  rendered  possible  by  the  **  failure  of  the 
Legislature  in  its  policy  and  object,  owing  to  the 
m appropriateness  and  inadequacy  of  the  language 
it  employed."  At  the  present  moment,  it  is 
possible  lor  one  man,  with  six  dummies  behind  him, 
lorm  a  company— limited  or  unlimited — for 
the  purpose  of  practising  medicine  and  surgery, 
or  dentistry,  even  though  not  one  of  the  seven 
possess  a  registrable  qualification  ;  to  term  them- 
selves physicians  and  surgeons  or  dentists,  as  the 
case  may  be  ;  and  to  escape  all  penalties  therefrom. 
The  company  comes  into  being  under,  for  instance, 
the  name  of  '■  Sir  William  Jenner,  Physician  and 
Surgeon/'  It  does  not  "  make  or  use  "  any  name 
save  that  under  which  it  was  born,  and  there  is 
nothing  lo  prevent  it  from  beins  born  with  any 
name  it  pleases.  Consequently,  the  individual 
who  heads  the  company  can  place  such  a  title  as 
ibove  on  his  door,  and  can  prescribe  and  treat 
patients  %s~ith  due  security,  provided  that  he  has 
hfchiud  Mm  his  six  dummies.  In  this  way,  the 
entire  object  of  the  Medical  and  Dental  Acts  is 
void,  and  for  practical  purposes  the  Acts 
night  fts  well  be  non-existent.  The  decision  of 
111  King's  Bench,  in  the  case  to  which  the  Dental 


Association  draws  attention  was,  to  say  the  least 
of  it,  remarkable.  The  Dental  Act  of  1878  states 
that  u  any  person  who,  *  .  .  not  being  registered 
under  this  Act,  takes  or  uses  any  name  or  title  .  .  . 
shall  be  liable  on  summary  conviction  to  a  fine 
not  exceeding  twenty  pounds/*  The  Act  of  Inter- 
pretation of  1889  slates  that  the  word  "  person," 
appearing  in  any  Act,  includes  a  body  of  persons, 
corporate  or  not  corporate,  unless  the  context 
otherwise  requires.  It  would  appear  to  anyone 
save  a  lawyer,  that,  when  the  admittedly  desired 
object  of  an  Act  is  overcome  by  interpreting  the 
word  "  person  M  in  any  other  sense  than  that 
ascribed  to  it  by  the  Act  of  the  Interpretation, 
the  context  cannot  prevent  ihe  word  from  such 
an  interpretation.  In  order  that  the  penal 
clause  of  the  Dental  Act  may  be  carried  into  effect, 
that  is,  in  order  that  the  Act  may  fulfil  the  object 
for  which  it  was  passed,  the  context  requires  that 
the  word  "  person  "  should  include  corporate 
bodies,  and  yet  the  King's  Bench  decided  that  in 
this  particular  clause  the  context  showed  that  such 
a  meaning  could  not  be  attached  to  the  word. 
The  position  of  the  medical  profession  in  resisting 
this  fraudulent  evasion  of  the  Medical  Acts  Is  even 
stronger  than  that  of  the  dental  profession,  and 
appears  to  us  to  be  so  clear  that  we  cannot  see  bow 
any  Court  could  give  a  similar  decision  to  lhat 
given  in  the  case  of  the  Dental  Acts.  The  pre- 
amble to  the  Medical  Act  of  1858  states  as  the 
object  of  the  Act  that  "it  is  expedient  lhat 
persons  requiring  medical  aid  should  be  enabled 
to  distinguish  qualified  from  unqualified  prac- 
titioners." Clause  XL.  of  that  Act  is  a  penal  clause 
similar  to  that  of  the  Dental  Act.  The  Medical  Act 
of  1886,  in  its  definitions,  states  that  in  this  Act 
(which  is  to  be  construed  as  one  with  the  Medical 
Acts;,  unless  the  context  otherwise  requires,  "  the 
word  person  includes  a  body  of  persons  corporate 
or  not  corporate."  Here,  then,  the  whole  pre- 
amble of  the  Act  is  rendered  null  and  void  unless 
the  word  "  persons  "  is  given  the  meaning  attri- 
buted to  it  in  the  definitions  of  the  Act.  Can  any 
Court  say  in  such  a  case  that  the  context  requires 
the  word  to  be  read  otherwise  ?  Tfre  Irish  Dental 
Association  has  vigorously  set  itself  to  defend  its 
privileges,  but  so  far  it  has  not  been  successful. 
It  may,  however,  be  that  if  it  had  proceeded  in  a 
different  manner,  which,  instead  of  bringing 
finality  with  the  judgment  of  the  Kings  Bench, 
had  enabled  them  to  proceed  to  the  House  of 
Lords,  the  result  might  have  been  different.  It 
is  true  that,  in  a  somewhat  similar  case  brought 
by  the  Pharmaceutical  Society  against  a  company 
practising  as  pharmaceutical  chemists,  the  Lords 
dismissed  the  Society's  appeal*  They,  however, 
did  so  for  the  definite  reason  that,  in  order  to  ensure 
the  working  of  Ihe  Pharmacy  Act,  it  was  not 
necessary  to  prevent  companies  from  selling 
poisons,  as,  unless  the  individual  who  actually 
handed  the  poison  across  the  counter  was  regis- 
tered, he  could  be  successfully  prosecuted.  Fur* 
ther,  they  intimated  that,  if  10  ensure  the  working 
of  the  Act  it  was  necessary  to  interpret  the  word 
"  person  **   as    including  companies,    they   would 


292     The  Medical  Press.       NOTES    ON    CURRENT    TOPICS. 


March  16,   1904. 


probably  have  been  prepared  to  so  interpret  it. 
In  the  case  of  the  Dental  Act,  such  an  interpre- 
tation is  essential  to  the  working  of  the  Act,  and, 
sooner  or  later,  unless  the  Government  take  steps 
to  pass  a  Bill  dealing  with  the  matter,  the  Dental 
Association  will  have  to  institute  a  case  in  such  a 
manner  that  it  can  be  taken  to  the  House  of 
Lords.  The  question  arises — What  are  the  heads 
of  the  medical  profession  going  to  do  ?  Are  they 
going  to  sit  by  with  their  hands  folded  and  watch 
the  earnings  of  their  less  fortunate  brethren  being 
diverted  by  a  prescient  public  to  the  swindler,  or 
are  they  going  to  take  action  in  support  of  the 
Dental  Association  ?  The  confrhe  of  the  Irish 
Dental  Association  is  the  Irish  Medical  Associa- 
tion, and  as  the  finances  of  the  latter  body  are  in 
a  healthy  state,  it  cannot  make  better  use  of  its 
resources  than  to  institute  a  test  case  similar  to 
that  of  the  Dental  Association.  Even  if  the 
action  is  not  successful,  the  Association  will  be 
able  to  elicit  expressions  of  opinion  from  the  Irish 
judicature  which  cannot  but  be  helpful  in  forcing 
the  Government  to  do  something  to  remedy  the 
evil.  The  Irish  Medical  Association  has  not  far  to 
go  to  look  for  a  test  case,  inasmuch  as  there  is  an 
eminently  suitable  one  within  a  few  hundred 
yards  of  the  Association's  headquarters.  A  com- 
pany terming  itself  the  American  Electro-Medical 
Institute  has  established  itself  in  Kildare  Street, 
and,  in  an  advertisement  in  the  Evening  Herald  of 
the  2nd  inst.,  evidently  encouraged  by  the  judg- 
ment in  the  case  of  O'Duffy  v.  Jaffe,  it  makes  use 
of  the  following  expressions  : — "  When  the  physi- 
cians at  the  American  Electro-Medical  Institute," 
&c. ;  and,  again — "  There  is  no  necessity  for 
Dublin  people  spending  their  money  on  humbugs 
.  .  .  when  they  can  have  scientific  treatment  at 
the  hands  of  reliable  physicians."  If  the  clauses 
of  the  Medical  Acts  bear  the  interpretation  which 
the  words  used  convey  to  the  ordinary  English- 
speaking  person,  these  people  can  be  successfully 
prosecuted  before  the  magistrates.  If  another 
interpretation  can  be  put  on  the  Acts  by  the  legal 
mind,  then  at  least  the  ventilation  of  the  case  will 
do  good,  and. the  need  for  action  on  the  part  of 
the  Government  will  be  made  more  plain. 


Vlotes  on  Current  Copies* 

The  Central  Midwives  Board  and  the  Royal 
Academy  of  Medicine  in  Ireland. 
The  Central  Midwives  Board  once  again  com- 
mitted themselves  to  a  policy  of  retrogression 
when,  at  their  last  meeting,  they  returned  to  the 
Royal  Academy  of  Medicine  in  Ireland  an  identical 
answer  to  that  which  they  had  returned  to  the 
Master  of  the  Rotunda  Hospital.  This  was,  we 
think,  a  short-sighted  policy,  especially  in  view 
of  the  fact  that  the  Board  propose  to  give  the 
Irish  hospitals  the  opportunity  they  require  in 
order  to  get  their  claims  recognised.  The  Central 
Midwives  Board  has  discovered  that  the  authors 
of  the  Act  have  put  English  midwives  in  the 
position  that  if  they  do  certain  things  that  are 
beyond  their  powers  they  will  be  punished, 
while,  at  the  same  time,  there  is  no  mechanism 


by  which  to  bring  medical  men  to  do  these  things 
for  them.  In  other  words,  there  is  no  provision 
for  the  payment  of  medical  men  who  may  be  re- 
quested by  a  midwife  to  come  to  her  assistance. 
This,  as  the  Board  recognises,  will  compel  them  to 
go  to  Parliament  for  an  amendment  to  the  Act 
"  to  provide  for  the  payment  of  legally  qualified 
medical  practitioners  when  called  in  by  midwives 
to  assist  them."  Do  the  Board  in  the  innocence 
of  their  hearts  think  that  such  an  amending  Act 
will  be  carried,  unless  it  includes  a  clause  making 
the  examinations  of  the  incorporated  Irish  hos- 
pitals equivalent  to  the  examination  of  the  Central 
Midwives  Board  ?  It  is  not  often  that  Irish 
members  unite,  but  we  think  they  will  unite  for 
this,  and  that  no  Bill  will  become  law  which  does 
not  do  the  fullest  justice  to  Irish  hospitals.  We 
understand  that  it  has  been  suggested  by  some 
members  of  the  Board '"that  the  Irish  hospitals 
must  raise  their  standard  of  training  in  order  to 
comply  with  the  requirements  of  the  Board.  We 
thought,  however,  that  it  had  been  made  suffi- 
ciently obvious  that,  if  the  Irish  hospitals  chose  to 
lower  their  standard  of  training,  they  could  easily 
comply  with  the  requirements  of  the  Board  ;  and 
that  it  is  only  their  objection  to  adopt  such  a 
course  and  to  depart  from  their  present  standard 
that  makes  them  desire,  in  the  interests  of  mid- 
wives,  that  the  Board  should  revise  their  rules. 

A  Butlers  Analogy— to  a  Physician. 

The  Admirable  Crichton,  the  butler  who  could 
turn  his  hand  to  anything  and  to  whom  one  was 
recently  introduced  by  a  play  of  Mr.  Barrie's, 
seems  to  have  found  his  exemplar  in  the  flesh  at 
Albion  Street,  Hyde  Park.  The  leisure  ol  the 
servants'  hall  there  appears  to  have  been  beguiled 
by  adventurous  sallies  on  the  part  of  the  butler 
into  the  domain  of  therapeutics.  Perhaps  be- 
cause doctors  may  have  partaken  of  the  wine  under 
his  charge,  Mr.  Miller  did  not  see  why  he  should 
not  try  his  hand  at  the  healing  art.  If  William 
Wright  was  his  first  patient,  he  may  be  some- 
what discouraged  by  his  maiden  efforts,  for  the 
means  he  employed — "  praying  and  putting 
Christianity  into  practice  " — met  with  such  poor 
success  in  the  treatment  of  double  pneumonia 
and  chronic  Blight's  disease  that  an  inquest  had 
to  be  held  on  the  body  of  the  patient.  His  dia- 
gnosis, too,  did  not  quite  accord  with  the  patho- 
logical phenomena  revealed  by  a  post-mortem, 
for  he  "  thought  that  Mr.  Wright  suffered  from 
paralysis."  This  is  difficult  to  reconcile  with  his 
statement  to  the  deputy-coroner  that  he  did  not 
believe  in  disease,  but  is  partly  relieved  from  a 
charge  of  inconsistency  by  his  qualifying  remark, 
' '  I  cannot  shut  my  eyes  an  d  say  there  is  no  disease."" 
One  would  have  thought  if  he  had  opened  them 
the  fact  would  have  been  unpleasantly  apparent- 
One  admission  must  be  accepted  with  gratitude — 
"  In  cases  of  broken  bones,  we  advise  our  followers 
to  have  the  aid  of  a  surgeon  " — for  it  makes  the 
third  class  of  disease  handed  back  to  us  by  the 
Christian  scientists.  First,  it  was  the  infectious 
fevers  ;  next  (by  implication)  dental  diseases,  and 


Maech  i  6,   1904* 


NOTES    ON    CURRENT    TOPICS,      The 


I'EBSg        Z93 


now  wc  have  fractures*  In  a  lew  years  we  shall 
My  have  the  rest — till  some  new  folly  arises 
l  activate  the  imaginations  of  weak  intellects. 
It  is  pitiable  to  think  that  pernicious  nonsense 
of  this  sort  can  be  taken  for  gospel  by  people 
wise  capable  oi  performing  their  daily  duties, 
but  it  will  probably  continue  to  have  its  predi- 
cants and  mendicants  so  long  as  juries  return  the 
\tnlict  they  did  in  the  case  under  notice— that 
the  death  resulted  from  natural  causes,  and  that 
the  blame  rested  on  no  one  but  the  patient  himself- 


Rowton  Houses* 
One  ot  the  prime  difficulties  that  presents  itself 
•<►  the  reformer  ol  the  conditions  of  town-life  is 
ih?  problem  of  cheap  housing,  ior  without  a 
clean,  airv,  well -lighted  house,  the  worker  has 
no  chance  of  bringing  up  a  vigorous  family  > 
not  to  mention  the  maintenance  of  his  own  and 
it'e's  health.  The  question  has  been  tackled 
irom  many  sides,  and  the  ultimate  crux  has  always 
been  that  ot  cost.  Land  can  be  obtained,  build- 
ings erected,  and  transport  facilities  obtained  — 
il  they  can  be  paid  for.  Many  of  the  excellent 
plans  ot  the  County  Council  have  failed  trj  achieve 
their  object,  for  the  expense  ot  acquiring  land. 
Clearing  insanitary  area*,  and  erecting  good  houses 
has  compelled  them  to  place  the  rents  at  a  figure 
that  is  beyond  the  means  of  the  class  formerly 
tenanting  the  area.  It  is  a  curious  comment  on 
the  efficiency  of  well-intentioned  municipal  govern- 
ment that,  while  the  richest  and  most  important 
body  in  the  world  has  been  wrestling  with  the 
(Miculty  for  yfears,  a  single  high-minded  gentle- 
uld  have  been  able,  on  his  own  initiative, 
to  provide  excellent  lodging-houses,  in  which 
v  reasonable  amenity  is  provided,  not  only 
at  a  rate  within  the  reach  of  the  poorest  worker 
but  at  one  that  provides  a  dividend  nearly  double 
what  the  County  Council,  with  their  enormous 
credit,  pay  for  borrowed  money.  The  tenth 
report  of  the  Rowton  Houses,  limited,  which  has 
just  been  issued,  shows  that  the  institutions  are 
gaining  in  popularity*  among  the  class  they  cater 
for  every  year,  and  the  directors,  after  paying  the 
preference  shareholders,  are  able  to  declare  a 
dividend  of  5  percent,  and  carry  forward  fyl%* 
They  anticipate,  moreover,  judging  from  the  ex- 
perience ot  the  L^t  few  years,  that  the  prosperity 
will  not  onlv  continue,  but  increase  still  more. 
Knterprises  like  I,ord  RowtonTs  show  that  good, 


in  our  correspondence  columns  last  week,  is  a 
topic  of  frequently-recurring  interest  and  indigna- 
tion. The  object  of  the  lawyer  lie*  t.ir  more  in 
the  direction  of  playing  to  the  gallery — in  this 
case  the  jury — than  in  arriving  at  an  impartial 
decision  on  the  facts  of  the  case,  To  throw  doubt, 
and  even  ridicule  and  scorn,  on  the  medical  evi- 
dence is  py  game  to  blind  the  jury  to  the 
weight  it  brings  to  bear  against  his  client,  The 
Bench  itself  is  not  always  free  from  t he  8  u<]  1  i  cjj  m  0 1 
making  light  of  medical  views  that  tell  against  its 
own  conceptions.  To  what  lengths  this  rcpre* 
hensible  procedure  can  be  carried  is  aptly  illus- 
trated by  a  (true)  story  told  in  a  book  just  pub- 
lished on  M  The  Art  ol  Cross-examination,"  In  a 
trial  for  murder  a  medical  witness  was  called  to 
prove  that  the  prisoner  was  a  homicidal  maniac, 
and  that  he  acted  under  an  uncontrollable  influence 
in  committing  the  crime.  The  judg.-  wished  to  get 
round  this  evidence,  and  after  some  circumlocution, 
asked  the  doc  lor  if  he  thought  that  theaceused  would 
have  acted  as  he  did  if  a  policeman  had  been  pre- 
sent, To  this  the  medical  witness  replied  in  the 
negative.  Thereupon  the  judge  remarked,  *'  Your 
definition  of  an  irresistible  impulse  must,  then, 
be  an  impulse  irresistible  at  all  times  except  when 
a  policeman  is  present.*'  This  story  is  told  as  an 
illustration  of  the  way  to  i(  floor  t#  a  doctor,  but 
one  is  glad  to  say  that  the  judge  who  condescended 
to  such  puerilities  in  dealing  with  human  life 
was  an  American,  Doubtless  the  court  laughed  ; 
the  doctor  was  "  scored  off?'  and  the  man  hanged. 
The  fallacy  involved  in  the  judge's  repartee  is 
obvious  to  anyone  with  a  brain  in  his  head  ;  the 
policeman  might  have  acted  as  a  restraining  in- 
fluence had  he  been  present.  But  he  wTas  not. 
The  cunning  and  secrecy  of  the  homicidal  lunatic 
are  notorious,  and  in  this  case  probably  found  no 
exception  to  the  rule*  While  the  barrister  is 
encouraged  to  use  every  weapon  lor  his  attack, 
and  the  judge  is  prepared  to  pander  to  the  renown 
gained  by  paragraphs  in  halfpenny  evening  papers, 
the  course  of  **  justice  '*  may  run  smooth,  but  we 
must  revise  our  definition  of  justice. 


Medicine  Militant* 

Pugnacity  may  be  reprehensible,  but  militancy 

is  the  surest  guard  of  a  people's  rights-     There 

may  be  occasional  pugnacious    medical  men,  but 

of  properly  ^drilled  and  organised  militancy  there 


is  a  sad  tack.     It  is  pitiable  tn  see  our  prut' 
effiacnt  and  cheap  housing  is  to  be  provided  for  j  degraded   and  trampled  upon  again  and  again, 


the  poorest,  if  the  venture  is  properly  worked, 

the  loss  of  a  philanthropist  so  true  and  so 

practical  is  one  that  cannot  cease  to  cause  poignant 

Bt  to  all  who  have  the  health  of  the  poor  and 

of   the   nation   at   heart.     Lord    Rowton 's   name 

might  have  endured  longer  if  he  had  written  his 

master's  biography,  but  he  would  not  have 

deserved  a  tithe  of  the  gratitude  that  is  his  due 

from  the  present  generation. 


Law  and  Medicine- 
Tue  treatment  of  medical  witnesses  by  counsel, 
ven  by  judges,  to  which  attention  was  called 


whilst  they  i(  take  it  lying  down/'  as  Mr,  Cham- 
berlain would  say.  One  knows  the  reason  does 
ii'ft  lie  in  want  of  spirit,  but  from  the  nature  of 
their  work,  exacting  an  amount  of  personal, 
constant  attention  that  renders  combination, 
and  the  absence  of  elected  representatives  from 
their  own  neighbourhoods,  inimical  to  success  in 
practice.  The  latter  diflicultv  can  never  be  over- 
come till  we  have  in  our  ranks  a  sufficiently 
large  number  of  men  who  are  wealthy  enough  to 
be  independent  of  practice,  and  public-spirited 
enough  to  devote  their  leisure  to  the  cause  of  their 
cenfrhes.     Medicine    is    not    a    profession     that 


294    The  Medical  Press. 


NOTES  ON  CURRENT  TOPICS. 


March  16,  1904. 


attracts  such  men  ;  the  social  prestige  it  confers 
is  not  great,  and  the  pursuit  of  scientific  problems 
is  far  more  fascinating  than  the  hurly-burly  of 
contending  politicians  Fortunately,  though 
poorly  represented  in  point  of  numbers  in  the 
House  of  Commons,  the  personnel of  our  members 
at  St.  Stephen's  is  gradually  increasing  in  size 
and  force  and,  one  notes  with  great  satisfaction, 
in  homogeneity.  On  the  8th  inst.,  the  medical 
M.P.'s  met  and  resolved  to  form  a  committee 
to  watch  all  legislation  affecting  public  health. 
This  is  an  excellent  first  step  with  regard  to  making 
the  voice  of  the  profession  heard  authoritatively 
in  the  House.  All  the  leading  professions  have 
an  organisation  of  their  parliamentary  represen- 
tatives who  consider  questions  affecting  their 
interests,  and  resolve  on  united  action.  Now 
we  have  ours.  It  is  only  to  be  trusted  that  they 
will  speak  with  no  uncertain  voice*  and  that  they 
will  show  themselves  as  good  a  fighting  body 
as  the  soldiers  in  Parliament  have  done  in  the  past. 
The  Irish  have  illustrated  how  a  well-disciplined, 
vigorous  minority  may  make  things  uncomfortable 
all  round,  and  though  one  would  not  wish  to  see 
all  their  tactics  reproduced  by  the  medical  M.P.'s, 
their  example  may  furnish  a  stimulus  to  the  deter- 
mined action  that  is  so  sadly  needed. 


The  School  of  Physic  in  Ireland. 
The  School  of  Physic  in  Ireland,  or,  as  it  is 
more  generally  called,  the  Trinity  College  Medical 
School,  has  during  the  last  year  or  two  shown 
many  signs  of  renewed  vitality  and  of  fresh  energy. 
We  drew  attention  in  our  last  issue  to  the  estab- 
lishment in  connection  with  the  school  of  certain 
classes  of  preparation  for  the  Government  services, 
and,  judging  from  the  successes  of  Irish  students 
in  the  past,  we  believe  the  scheme  will  supply  a 
distinct  want.  We  now  learn  that  it  is  arranged 
that  post-graduate  courses  in  various  subjects 
shall  be  given  each  summer  in  connection  with  the 
school,  and  that  this  year  series  of  lectures  on 
diseases  of  the  eye,  ear,  and  throat  have  been 
arranged.  The  University  has  also  taken  the  very 
progressive  step  of  establishing  a  Degree  and 
Diploma  in  Dentistry,  the  Degree  to  be  confined 
to  persons  who  hold  a  degree  in  Arts.  The 
details  of  the  scheme  have  not  yet  been  made 
public.  We  understand  that  a  good  many  women 
are  expected  to  begin  medical  work,  and  that  in  pre- 
paration for  them,  the  Board  of  Trinity  College  are 
making  suitable  accommodation  by  building  a 
separate  dissecting-room  and  reading-room.  In 
view  of  the  fact  that  the  school  is  much  ham- 
pered by  lack  of  necessary  funds,  it  is  very  satis- 
factory that  it  is  able  to  show  such  progress  on 
the  scientific  side. 


as  hydronephrosis,  due  to  kinking  of  the  ureter, 
might  result  from  abnormalities  of  the  renal  posi- 
tion, or  that  dyspeptic  symptoms  should  arise 
from   intermittent   pressure   upon   the   stomach, 
but  the  occurrence  of  gall-stones  or  mucous  colitis 
in  association  with  undue  renal  mobility  is  a  little 
more  difficult  to  explain.     The  close  connection 
of  the  kidney  with  the  sympathetic  nervous  sys- 
tem may,  to  some  extent,  be  sufficient  to  account 
for  many  of  the  strange  symptoms  of  reflex  origin 
which  are  manifested  by  patients  who  suffer  in 
this  way.     The  falling  of  the  viscera  owing  to  a 
genera]  slackness  of  their  peritoneal  attachments, 
and  comprehended  under  the  name  of  "  Glenard's 
disease,"    or    enteroptosis    and    gastroptosis,    in 
which  the  renal  organs   also   share,   not   unfre- 
quently  gives  rise  to  symptoms  in  which  nervous 
phenomena  predominate.     Even  appendicitis  has 
been  thought  to  be  due  to  the  visceral  derange- 
ment set  up  by  floating  kidney.     Dr.  Wharton 
Sinkler,  of  Philadelphia,  (a)  considers    that   dis- 
orders   of    the    nervous    system    are    commonly 
associated  with  nephroptosis,  and  that  foremost 
among  these  must  be  placed  neurasthenia.    The 
mere  presence  of  a  movable  abdominal  tumour 
of  any  kind  is  apt  to  cause  in  some  patients  con- 
siderable mental  anxiety,  which  passes  on  into 
actual  melancholia.     More  often,  however,,  hys- 
terical symptoms  are  present,  among  which  are 
nervous    dyspepsia,    irritability  of    temper,    dis- 
turbances of  sensation,  and  neuralgias  in  various 
parts    of    the    body.     After    nephropexy    these 
symptoms  generally  pass  away,  not,  of  course, 
immediately,  any  more  than  they  do   after  an 
ovariotomy,  but  the  procedure  of  anchoring  up  the 
kidney  to  the  abdominal  parietes  certainly  seems 
to  have  a  pronounced  effect  in  a  beneficial  direc- 
tion upon  the  nervous  system. 


Neuroses  Associated  with  Movable  Kidney. 

There  are  few  morbid  conditions  of  the  ab- 
dominal viscera  associated  with  such  varied  dis- 
orders as  that  known  as  movable  kidney.  The 
majority  of  these  are  local,  or,  at  any  rate,  con- 
fined to  disturbances  affecting  other  organs  in 
the  immediate  neighbourhood  of  the  kidney.  It 
is  quite  easy  to  understand  that  such  a  condition 


The  Unfortunate  Barber. 
There  are  signs  of  reaction  in  the  hairdressing 
business  against  the  present  almost  universal,  and 
exceedingly  tiresome,  practice  of  employers  pushing 
the  sale  of  hair-lotions  and  dressings  by  unsolicited 
comments  and  advice  to  their  customers.  There 
are  few  people — men  or  women — who  have  not 
during  their  visits  to  the  barber's  been  obliged  to 
listen  to  dissertations  of  the  crudest  description  on 
the  pathological  affections  of  the  scalp  and  hair. 
The  hair  is  a  hollow  tube  up  whose  centre  runs 
blood  to  nourish  it — the  blood  gets  parched  up 
and  the  hair  falls  off  if  the  outside  is  not  protected 
by  grease.  The  scalp  gets  scurfy  and  itching  if 
washed  with  water  or  not  washed  with  water,  as 
the  case  may  be,  and  such-like  twaddle.  Curiously 
enough  the  customer's  own  scalp  always  examples 
some  of  these  morbid  propensities,  and  an  infallible 
cure  is  always  to  hand  in  the  shape  of  a  bottle  of 
proprietary  lotion  of  exorbitant  price.  The  game 
must  pay  or  it  would  have  died  of  atrophy  long 
ago,  and  that  it  certainly  has  not  done.  Indeed, 
it  seems  to  be  in  a  vastly  flourishing  condition. 
Some  barbers  do  not  stop  at  the  usual  point.  If 
the   customer    shows  signs  of  being  impressed, 

(a)  Joum.  Amir.  Med.  A$soc.,  Feb.  13th,  1904. 


March  io\   1904* 


NOTES  ON  CURRENT  TOPICS.        The  Medical  Piess.     205 


especially  if  a  condition  of  u  funk  "  be  established. 
the  proprietor  is  summoned,  and  his  valuable 
experiences  brought  to  bear  on  the  knotty  prob- 
lem. This  generally  leads  to  a  course  of  treatment, 
and  the  victim  is  mulcted  to  the  furthest  point 
compatible  with  prudence,  Some  hairdressers 
like  to  be  known  as  ■*  scalp-specialists/1  and  they 
find  a  ready  prey  among  the  credulous  members  of 
their  female  clientUe,  It  is  all  very  foolish  and 
very  deplorable.  One  feels  little  enough  sym- 
pathy with  the  dupes  who  suffer  themselves  to  be 
imposed  upon  in  so  blatant  a  fashion ,  and  still  less 
with  the  impudent  rascals  who  practise  the  im- 
posture. It  happens  occasionally  that  a  man  or 
woman,  through  some  accidental  contamination, 
gets  the  hair  infected  with  pediculi  or  even  ring- 
worm without  finding  out  the  fact.  In  such  cases 
he  is  not  unnaturally  taken  aback  when  the  fact  is 
conveyed  to  him  by  the  man  who  cuts  his  hair. 
To  trade  on  these  occasional  occurrences  in  the  way 
that  is  sometimes  done  is  a  monstrous  imposition. 
Some  barbers  in  the  Strand  who  made  a  systematic 
practice  of  so  doing  were  brought  to  book  a  few 
years  ago,  and  sentenced  to  prison  for  obtaining 
money  under  false  pretences.  They  have  certain 
near  imitators  in  many  shops  at  the  present  day, 
and  customers  who  are  informed  as  to  scalp 
diseases  they  are  suffering  from  unawares  are 
strongly  advised  to  have  the  barber's  diagnosis 
confirmed  by  their  medical  man  before  submitting 
to  any  treatment,  and  then  not  to  go  to  the  barber 
for  it.  In  the  better-class  shops  it  seems  that  a 
stand  is  being  made  against  attempts  by  the 
employes  to  cajole  or  frighten  customers  into  buy- 
ing things  they  do  not  want  and  which  will  do 
them  no  good.  It  is  to  be  hoped  that  the  smaller 
shops  will  follow*  suit,  for  the  present  state  of  things 
B  little  less  than  a  scandal. 


Accidental  Mercurial  Poisoning- 
The  edges  of  the  most  powerful  weapons  which 
the  physician  can  wield  in  his  warfare  with  disease 
are  sometimes  blunted   in   action  owing,  perhaps, 
to  an   entirely    unforeseen    contingency,    such   as 
ah  inexplicable  idiosyncrasy  on   the  part  of  the 
patient.     This  is  doubly  unfortunate  when  a  given 
drug,  and  that  alone,  is  the  one  above  all  others 
to  meet  a  particular  need  or  to  relieve  a  certain 
►torn.     Mercury  is  one  of  these  potent  reme- 
dies the  reaction  to  which  it  is  impossible  to  fore- 
nnd,  therefore,  is  one  which   frequently  pro- 
!■   mi  testations,     M.  P.   Brouardel(a) 
hes    the    accidental    forms   of    hydrargyrism 
"ilft  those  following  an  obvious  error  in  dosage, 
and  those  resulting  from  absorption  of  legitimate 
ses   or    applications.     Setting    aside    the    first 
p  of  cases,  which  are  rare,  it  must  have  hap- 
pened to  every  house  surgeon  to  have  administered 
grains  of  calomel  on  admission  to  a  patient 
ring  from  concussion  of  the  brain  with  good 
,  and,  in  a  similar  case,  to    have  seen   severe 
vmptunis    of    mercurial    poisoning  ensue    after, 
perhaps,     %     smaller     dose.     Tins     susceptibility 
rcury  is  a  clinical  fact  which  is  often  over- 


!*>t'jime  J>tt6f,  *t  de  He  J.  fcgafa,  .Junu4rjt  tffcl-l. 


looked,  especially  in  the  ordinary  routine  treat- 
ment of  syphilis.  The  sudden  appearance  of  a 
severe  stomatitis  in  the  latter  affection  is  a  warn- 
ing which  cannot  be  neglected.  A  troublesome 
form  of  local  irritation  by  the  drug  is  sometimes 
seen  in  the  vicinity  of  wounds  which  have  been 
dressed  with  cyanide  gauze,  or  after  the  applica- 
tion of  a  mercurial  ointment,  in  the  shape  of  a 
pustular  eruption  which  may  prove  very  intrac- 
table. In  the  field  of  obstetrics,  the  perehloride 
of  mercury  is  a  valuable  and  trust  wo  rthv  disin- 
fectant, but  it  is  well  known  that  it  is  more  dan- 
gerous to  employ  it  as  a  douche  after  deli v err 
than  before,  as  the  sundry  minute  and  unavoidable 
lacerations  provide  greater  facilities  for  absorp- 
tion. 


A  New  Audiometer. 

One  of  the  chief  obstacles  in  the  way  of  reducing 
otology  to  the  level  of  an  exact  science  has  hitherto- 
lain  in  the  difficulty  of  obtaining  exact  standards 
of  observation  and  experiment.  At  the  recent 
meeting  of  the  British  Laryngological  and  Oto- 
logical  Society  a  new  instrument  was  shown 
which  bids  fair  to  put  matters  on  a  more  satisfac- 
tory footing  so  far  as  this  particular  branch  of 
specialism  is  concerned.  It  consists  of  a  new 
audiometer,  devised  by  Dr.  St,  George  Reid,  for 
measuring  the  auditory  appreciation  in  deafness 
and  other  forms  or  ear  disease,  Readers  who  are 
interested  in  the  subject  will  find  full  details  in 
our  report  of  the  Society's  last  meeting  in  another 
part  of  the  present  issue  of  The  Medical  Press 
and  Circular.  This  instrument  promises  to 
advance  the  study  of  otology  in  no  small  degree 
by  establishing  conditions  of  greater  accuracy  and 
more  nearly  approaching  a  general  standard 


The  Humanitarian  League  s  Work 
Tuk  Humanitarian  League  lias  just  published 
its  annual  report,  which  shows  a  remarkable  record 
of  good  work.  In  the  criminal  law  and  prisons 
department  the  question  of  corporal  punishment 
has  been  prominent,  and  effective  protests  have 
been  made  against  a  number  of  illegal  and  **  extra- 
judicial "  sentences,  while  the  flogging  of  young 
men  which  still  goes  on  in  the  Royal  Navy  has  been 
closely  watched.  That  the  League's  protests 
against  this  practice  are  not  without  avail  is  shown 
by  the  fact  that,  while  the  juvenile  element  in  the 
Navy  has  increased,  the  number  of  floggings 
inflicted  with  the  birch  has  decreased.  Other 
departments  of  the  League  have  been  actively 
engaged  in  combating  spurious  sports,  hare- hunt- 
ing at  Eton  College,  the  cruelties  of  the  Irish  cattle 
trade,  the  private  slaughter-house  system,  the 
iur  and  feather  fashion,  and  so  on.  Satisfaction 
is  expressed  at  the  reforms  lately  adopted  at  the 
Zoological  Gardens,  especially  in  the  discontinuance 
of  feeding  the  larger  serpents  on  living  prey.  The 
work  of  the  Humanitarian  League  has  so  gfl 
increased  during  the  past  lew  year's  that  it  has 
become  more  and  more  necessary  to  confine  1 

Unes  of  its  four  special  departments.  The 
work  of  this  society  must  command  the  respect 
of    all    right-thinking     members    of    society.     Its 


296    Thb  Medical  Press.  NOTES  ON  CURRENT  TOPICS. 


March  16,  1904 


methods  arc  based  on  principles  that  appeal  to 
reason  and  judgment  as  well  as  to  sentiment, 
and  compare  most  favourably  with  the  one-sided 
and,  as  we  believe,  misguided  fanaticism  of  the 
an  ti -vivisection  movement,  which  assails  a 
humane  and  honourable  profession  in  the  interests 
of  certain  lower  animals. 


Town  Ambulance  Services, 

It  goes  without  saying  that  a  good  ambulance 

■service  is  just  as  necessary  to  the  complete  equip- 
ment of  the  modern  town  as  a  well-organised 

police,    fire,    or    scavenging    brigade.     Yet    how 

often  such  a  service  is  conspicuous  by  its  absencei 

London,  the  largest  and  richest  city  of  the  world, 

to  this   moment    lacks  an  adequate  organisation 

of  the  kind.      The  average  citizen  of  the  United 

Kingdom,  injured  in  the  streets,  has  often  to  be 

conveyed  to  hospital  in  a  cab,  on  a  cart,  or  in 

some  emergency  Utter  which  adds  a  thousandfold 

to  his  discomfort  and  his  danger.     So  great  has 

the  scandal  become  in  the  metropolis  that  an 

energetic  movement  is  on  foot  to  furnish  London 

with   a   complete   up-to-date   service   worthy   of 

a  wealthy  and  humane  civilisation.     In  this  re- 
spect it  is  interesting  to  note  that  London  lags 

far   behind   many   provincial   towns.     We   learn 

from  the  Manchester  Courier,  for  instance,  that 

•"  not  only  is  there  a  shortage  in  the  provision  of 

ambulances,  but  there  is  not  a  single  horse  am- 
bulance in  the  whole  of  the  metropolis.  In  New 
York  the  horse  ambulance  system  originated  in 
1870,  and  proved  so  valuable  that  many  other 
American  cities  quickly  adopted  the  same  me- 
thods. In  Vienna  the  service  was  established 
in  1 88 1,  and  in  Paris  in  1888,  while  in  Liverpool 
the  horse  ambulance  for  street  accidents  was! with  swelling  volume  upon  the  correspondence 
first  tried  in  1884,  and  ever  since  has  proved  to  be  !  columns  of  the  daily  press.  One  of  the  more  re- 
invaluable.  Horse  ambulances  summoned  by  tele- 1  markable  of  these  effusions  was  from  a  gentleman 
phone  have  long  been  looked  on  as  an  in- ,  who  declared  that  he  had  suffered  from  a  cancer 
dispensable  feature  of  hospital  work  in  Birken-  J  oi  the  bowels  which  he  had  cured  by  a  pure  food 
head,  Manchester,  Newcastle,  Huddersfield,  Bol- 1  diet-  He  had,  so  he  said,  "starved"  the  cancer 
ton,  Burnley,  Hull,  Sheffield,  Leeds,  Wolver- ,  and  got  well.  This  communication  is  of  the 
hampton,  and  Ipswich."  Bearing  in  mind  the  loss  j  greatest  philosophic  interest,  as  it  reveals  the 
of  time  occasioned  in  Ixmdon  by  the  use  of  the  attitude  of  a  great  mass  of  mankind  towards  what 
hand  ambulance,  it  is  not  surprising  that  from 
8,000  to  10,000  street  casualties  have  to  be  re- 
moved each  year  in  cabs  or  in  other  unsuitable 
conveyances.  Verily  !  London  is  a  city  of  strange 
contradictions. 


food.  At  the  same  time,  although  we  did  not 
advocate  the  eating  of  rats  here  at  home  as  a 
feasible  or  hopeful  project,  we  nevertheless  venture 
to  say  that  a  valuable  supply  of  food  is  lost  by 
neglecting  the  common  water-rat  or  vole,  which 
is  a  clean-feeding,  wholesome  and  succulent  crea- 
ture enough.  Our  readers  may  have  noticed  that 
the  average  journalist  is  usually  very  strong  and 
decisive  in  the  matter  of  food-stuffs.  Once  a 
London  newspaper,  in  its  leading  columns,  ad- 
vocated the  flogging  of  persons  who  consumed 
horseflesh.  It  is  not  improbable  in  that  case  that 
the  writer  would  have  suffered  from  a  self-in- 
flicted penalty,  for  a  vast  quantity  of  horseflesh 
is  consumed  in  the  metropolis  in  one  form  or 
another.  The  strong,  outspoken  language  of  the 
average  journalist  on  the  matter  of  food  arises, 
we  take  it,  from  the  safety  of  the  subject.  He 
may  use  honey,  vitriol,  vinegar,  rose-water, 
thunder,  fire,  or  anything  else  in  his  handling  of 
that  universal  topic  without  offence  to  editor  or  to 
readers.  The  rat  as'an  article  of  diet,  for  instance, 
has  no  friends  in  the  Western  world  outside  a 
besieged  city.  The  Chinese  journalist  doubtless 
would  have  to  sing  to  a  different  tune.  Mean- 
while, we  assure  the  Daily  News  we  leave  the 
eating  of  the  common  sewer  rat  to  be  decided  by 
the  tastes  of  the  individual  citizen.  We  content 
ourselves  with  the  scientific  aspects  of  the  rat 
as  an  article  of  food.  Fleet  Street  will  doubtless 
be  equal  to  the  sentimental  side  of  the  question. 

Cancer  and  the  Vox  Populi. 

The  popular  mind  continues  to  be  sorely  exer- 
cised by  the  mystery  of  cancer,  at  least,  so  it  may 
be  inferred  from  the  flood  of  letters  that  surge 


Hats  and  Rat-Eating*. 

Referring  to  a  paragraph  that  appeared  re- 
cently in  the  columns  of  The  Medical  Press  and 
Circular  with  regard  to  the  eating  of  rats,  the 
Daily  News  says  "  we  warmly  advocated  that  prac- 
tice." As  a  matter  of  fact  we  did  nothing  of  the 
kind.  We  merely  pointed  out  that  there  was  no 
scientific  reason  why  rats  should  not  be  eaten  after 
having  been  sterilised  of  evil  germs  by  the  process 
of  cooking.  Further,  that  there  was  little  point  in 
the  journalistic  anathema  so  constantly  hurled 
against  the  Chinese  because  they  were  unpre- 
judiced in  that  particular  direction,  and  availed 
themselves   of    rats    as    a    much-prized    form   of 


medical  men  are  wont  to  regard  as  the  mysteries  of 
disease.  The  correspondent  apparently  had  no 
doubt  as  to  his  diagnosis  of  cancer  of  the  bowels. 
The  plain  medical  man  would  tell  you  that  cancer 
of  the  bowel  is  invariably  fatal  except  in  rare 
instances,  where  the  patient  may  sometimes  be 
saved  by  a  desperate  and  radical  operation  re- 
moving the  whole  of  the  diseased  intestine.  But 
the  gentleman  who  "  starved  "  the  cancer  ma\ 
reasonably  be  asked  to  explain  why  starvation 
should  cure  cancer  cells,  which  are  usually  credited 
with  a  fierce  aggressive  power  of  parasitic  feeding, 
while  the  healthy  tissues  of  his  body  escaped  their 
attack.  The  picture  is  a  sad  one.  It  reflects  on  the 
reasoning  sanity  of  the  writer,  who  starved  his 
imaginary  cancer,  no  less  than  of  the  editor  who 
admitted  such  pernicious  nonsense  to  his  corres- 
pondence columns.  It  is  such  men  in  the  street 
who  form  an  easy  prey  to  cancer  curers,  who  are 
perhaps  the  most  venomous  of  all  the  brood  of 


March   ]&.    ro^, 


CORRESPONDENCE. 


blood-sucking  harpies  that  prey  on  the  credulity 
of  the  public,  The  quack  who  professes  to  cure 
cancer  too  often  persuades  his  victim  to  put  off  a 
icaJ  operation  in  the  early  stage  where  it 
might  prove  effectual,  and  leaves  him  in  the  long 
nm  to  die  a  miserable  and  painful  death  im- 
poverished in  pocket  and  a  prey  to  illimi  table 
and  unspeakable  woes, 


PERSONAL. 


The  recovery  of  His  Majesty  the  King  from  his 
recent  sharp  catarrhal  attack  may  now  be  regarded  as 
complete  and  satisfactory. 

Dfc*  J.  D*  Small,  of  the  Lagos  Medical  Department, 
has  left  England  lo  resume  duty  after  leave  of  absence. 

Da.  E.  G.  Fen-ton,  Senior  Medical  Officer  of  Southern 
Nigeria,  lias  arrived  in  England  on  leave. 

Dr.  Thomas  H  oust  on  has  been  appointed  joint 
Lecturer  on  Medical  Jurisprudence  in  Queen's  College. 
Belfast. 


The  new  operating  theatre  at  the  Royal  Infirmary. 
Liverpool,  vis  formally  inaugurated  on  the  oth  inst. 
by  the  president  oi  the  Infirmary  Committee,  Mr,  E.  R. 
teth.  ■ 

Dr.  Tat  ham  Thompson  who  recently  resigned  his 
position  of  Ophthalmic  Surgeon  to  the  Cardiff  Infirmary 
Ins  been  reappointed  Ophthalmic  Surgeon  to  the  in- 
patients ot  that  institution. 


Da*  Alfred  Hill,  for  so  many  years  medical  officer 
r.l  health  al  Birmingham,  last  week  left  Acock's  Green, 
where  he  baa  so  long  resided,  and  has  taken  up  his 
abode  in  the  Isle  of  Wight* 

■ad   that  a  Fellowship  of  £100  yearly 

years,    for  the  purposes  of  Dermatological 

Rraarch,    has   been   founded   at    the  University    of 
•  jol,  by  Dr.  St  op  ford  Taylor. 


Wvxdham   has   consented    to   preside 
ftt  the  Jinner;  at  the  Hotel  Cecil,  in  connection 

•sitil  nary  of  the  Koyal  I^ndou  Ophthalmic 

1  ily  Road,  on  Friday,  April  22nd. 

tr    K\ jncke.  medical  officer  of  the  City  of  Ham- 

a  paper  on  the  Epidemiology  of  Enteric 

in   that  City  before  the  Epidemio- 

of    London,    at    ii,    Chandos    Street. 

March  tSth,  at  8*30  p.m. 

neas    the    Duchess    of    Albany    i> 

ticularly  charitable  enterprise 

r,  a  horticultural  bazaar  to  be  held  at 

ihe.nl,    111    aid    ol    the    Royal 

iren     ami     Women,    'on 

11  l   lhur>..l  ay,  April  6th  and  7th. 

in  Washington  ted, 

t,   the  offer  of 

Dr.  At  to  tit  out  a  nursing  staff  for 

\rmy.      The    same   lady 

0fprj;  nursing  corps  during  the  Spanish- 

1  '  served  both  in  <  uba  and  in 

■   ■■  - — - 

Tit  Kin .  en    pi  a  vera! 

tier  of  the 

Land,     <  olonel 

ral)     William     IH11  pbell 

Hun.  Associate,   and  Dr,  O 

m  iate,  and  Dr.  William  Allan 

[.,  ,  ome  Knights   ot  G 

mbers  of  the  House  of 

it li    the    medical    profession,    it 

to  arrange   for  con- 


The  Medical  Piess.     297 

certed  action  in  the  House  on  matters  affecting  public 
health.  Dr.  Farquharson  presided, and  there  were 
present  Sir  Michael  Foster.  Sir  \,  Batty  Tuke,  Di 
H  a  t chinson ,  and  Dr,  R u t he rfoord  Harris.  Sir  Mi c hae I 
Foster  has  agreed  to  act  as  Hon,  Secretary  to  the  Com- 
mittee. 


Correspon&ence. 

TWe  do  not  hoM  onrttlve*  rwpotiaiUe  far  the  opinion  ot  the  eoiret- 
ponctontj*  J 


THE  PRACTICE  OF  MEDICINE  AND  DENTISTRY 

BY  COMPANIES, 
To  ike  Editor  of  Thi;  Medical  Press  and  Circular, 
Dear  Sir,— A  careful  study  of  the  judgment  given 
in  the  Court  of  Kind's  Bench,  Ireland,  111  a  test  case 
of  "  O'Duffy  v.  Jfcfie/'  will  convince  anv  thoughtful 
man  that  there  are  principles  and  rules  therein  bid 
down,  the  importance  of  which  it  would  be  indeed 
hard  to  exaggerate.  Not  atone  are  existing  laws  shown 
to  be  totally  inadequate  for  the  protection  of  the  public 
from  the  danger  and  frautl  oi  unqualified  practice 
(whether  dental  or  medical),  but  the  road  is  clearly 
demonstrated  by  which,  if  it  be  not  blocked  by  the 
legislature,  trickery  and  deception  may  even  farther 
legally  invade  the  realm  of  public  interests  111  pro- 
fessional life. 

Briefly  stated,  the  case  was  as  follows  ! — The  Irish 
Branch  of  the  British  Dental  Association  determined 
ta  I -ring  to  an  issue  the  question,  which  had  long  been 
let  go  by  default ,  whether  the  restrictions  and  penalties 
imposed  by  the  Dentist's  Act  of  1878  upon  M  persons  " 
using  the  title  of  "  Dentist  "  {i.e.,  without  being 
registered)-  did  or  did  not  apply  equally  to  a  com  pan  v 
or  corporation  as  to  individuals,  and  to  obtain  instead. 
"  counsels'  opinio©/'  which  hnd  up  to  then  been  con- 
sidered conclusive  a  definite  and  binding  1 
noun~ement.  They  accordingly,  as  a  test  case,  pro- 
secuted, for  taking  and  using  the  title  "  Surgeon 
Dentists/*  and  thus  infringing  the  Dentists  Act, 
"  jaffe.  Surgeon  Dentists,  Ltd,"  a  company  which 
consisted  of  two  drapers,  four  married  wmnen,  and  a 
denial  mechanic  none  of  whom  possessed  any  dental 
qualification    whatever.     The  C&ae  d   by  the 

local  bench  at  Limerick,  in  May  'ast,  and  being  dis- 
tin  .  i,  was  carried  by  the  plain  till  to  the  King's 
Bench.  Wo  send  you  herewith  an  ofhciil  copy  ol  the 
arguments  advanced  1  v  counsel  on  both  side,  and  the 
Judgment  delivered  pv  the  Court  after  some  three 
weeks  deliberation,  upholding  the  magistrate's  decision* 
We  would  invite  c\  refill  consideration  of  this  Judg- 
ment, under  three  headings.  First ,  the  Court  turwii- 
mouaiy  held  tint  tlie  word  "  person  "  in  the  Dentists 
Act  did  not  include  a  company  or  corpora t ion  ;  and  1 
company   or   corporation    can    tin -r  ume   with 

impunity  a  misleading  title,  announcing  a  |<i 
qualification,  the  assumption  oi  which  by  an  individual 
would  subject  liim  to  a  penalty  of  /jo.     The  grounds 
of  the  appear  also  to  apply  jnsl  as  much  to 

the  Medical  Act,  and  the  veterinary  surgeons  are  ateo 
affected  by  it.     The  public ,   eve*  gullible,  can  thus  be 
legally  imposed  upon  by  a  company  with  a  high  sound- 
an  individual  (without six"  dumrn 
1  him)  would  assume  only  at  his  peril.     Further, 
not  only  can  a   company   formed    *id   hoc   play    » 
pranks   with    the   public,    but   any   existing   com, 
whose  memorandum  does  not  preclude  '^ng, 

may  boldly  assume  anv  medical  of  dental  titu 
instance,  tire  Army  and  Navy  Stores  would   not 
within  the  penal  provisions  oi  these  A-  tB  by  assuming 
the  description  of  physicians,  surgeons,  or  dentists. 

The  second  point  in  the  case,   |q  which  m- 
invite  attention,  a  this  : — Counsel  for  "  J  a  fie 
Dentists,  Ltd./'  ingeniously  put  forward  a  further  line 
of  defence.     The  point  raised  was  this  : — *'  The  Defen- 
dants   have   added    nothing    to    their  name  ;    *'  1 
Surgeon   Dentists,   Ltd."     is   their  name."     How    this 
argument   impressed    the   Court   was   shown    by    the 
Lord  Chief   Justice  asking   the   following  question    — 
"  If  a  man  be  born  with  the  nmne  '  Dentist/  can  !i 


298    The  Medical  Press. 


LITERATURE. 


March  16,  1904. 


prosecuted  under  this  Act  for  using  his  name — e.g., 
1  John  Dentist '  ?  "  The  significance  of  the  defence 
was,  therefore,  not  lost  sight  of,  and  in  the  formal 
judgment  of  the  Court,  the  point  was  decided  as 
follows  : — 

Lord  O'Brien,  L.C.  J.,  said :  " '  Person/  I  think,  means 
a  person  who,  having  one  name,  takes  another  name 
or  description,  that  is,  a  natural  person  who  has  his 
own  name  and  adds  to  it  another  name  or  description. 
It  would  seem  to  me  not  to  include  a  company  which 
comes  into  being  with  a  name,  and  adds  nothing  to 
it." 

Gibson,  J.  :  "  The  question  before  us  is,  whether  a 
company,  part  of  whose  registered  name  is  '  Surgeon 
Dentists/  by  using  that  name  committed  an  offence 
under  Section  3  of  this  Act.  The  Act  was  never 
designed  to  apply  to  a  corporation  at  all,  or  to  prevent 
a  limited  company  from  using  its  own  proper  name, 
in  which  it  was  registered." 

Madden,  J.,  agreed  in  the  judgment  of  the  Court, 
without  specially  referring  to  this  point. 

The  case  being  on  the  criminal  side  of  the  Court, 
no  appeal  could  be  taken  from  the  decision.  This, 
then,  being  the  law,  it  appears  that  any  fraud  or 
deception  on  the  public  by  a  company,  involving  the 
assumption  of  a  false  or  misleading  title  or  name,  as 
of  doctor  or  dentist,  can  be,  and  is,  legalised  by  the 
irresponsible  action  of  the  Board  of  Trade  in  registering 
as  a  company,  without  question,  any  such  name,  title 
or  description  which  is  presented  to  it.  For,  be  it 
understood,  the  Board  of  Trade  has  no  power  to 
question  or  refuse  any  title  brought  to  it  for  registration 
as  a  company,  saving  only  when  such  title  has  been 
already  appropriated  by  some  other  company,  and 
this  registered  title,  though  knowingly  and  wilfully 
intended  to  deceive  by  those  who  form  the  company, 
becomes  forthwith  the  "  proper  name,"  under  which 
the  company  "  came  into  being,"  its  right  to  the  use 
of  which  is  as  clear  and  indisputable  as  the  right  of 
Lord  O'Brien's  suppositious  "  John  Dentist  "  to  the 
use  of  his  own  patronymic.  The  hall  porter  from  the 
hospital  may  then,  should  he  desire  it,  rest  secure  in  the 
name  of  "  Sir  Peter  Smith,  Doctor  and  Surgeon," 
and  the  bottle  washer  in  the  pharmacy  may  undis- 
turbed prey  upon  the  public  as  "  Sir  Ebenezer  Dodd, 
M.D.Lond."  An  individual,  of  course,  would  be 
liable  to  penalties  and  imprisonment,  but  on  con- 
stituting himself  a  "  company "  by  virtue  of  six 
"  dummy  "  names  behind  him,  under  the  a^gis  of  the 
Board  of  Trade,  the  company,  or  the  individuals  who 
compose  it,  are  beyond  the  reach  of  all  penalties.  In 
fact,  any  common  swindler  may  gull  the  credulous  under 
a  name,  with  the  addition  of  doctor,  physician,  surgeon, 
dentist,  veterinary  surgeon,  or  any  other  "  proper 
name  "  which  may  suit  his  nefarious  purposes,  and 
under  which  he  may  elect  to  "  come  into  being." 
To  the  lay  mind,  there  is  some  difficulty  in  seeing 
where  the  hne  is  to  be  drawn,  or  what  limit  exists  to 
the  assumption  of  titles  by  a  "  one  man  company." 
All  one  has  got  to  do  is  to*  form  himself  into  a  "  one 
man  company."  He  need  not  be  a  "  limited  company  "  ; 
the  responsibilities  of  unlimited  liability  are  nothing 
to  a  swindler,  who  need  not  be  a  shareholder  in  the 
fraudulent  company.  It  is  the  same  to  the  law 
whether  he  calls  himself  under  the  guise  of  a  company, 
"  Medical  Doctor,"  or  "  Medical  Doctor,  Ltd.," 
"  Surgeon  Dentist,"  or  *'  Surgeon  Dentist,  Ltd.,"  but 
the  omission  of  the  qualification  "  Limited  "  would 
deprive  even  the  most  intelligent  members  of  the 
public  of  the  only  means  of  detecting  the  fraudulent 
company  concealed  behind  the  mask  of  a  professional 
title. 

The  third  important  point  in  the  judgment  is  the 
outspoken  opinion  of  the  Court  on  the  position  as  it 
stands,  and  the  judicial  suggestion  of  a  remedy. 
•"  Before  as  well  as  since  the  Dentists  Act,"  said 
Lord  O'Brien,  "  the  Legislatuie  has  not  infrequently 
failed  in  its  policy  and  object,  owing  to  the  innppro- 
priateness  and  inadequacy  of  the  language  it  employed. 
The  ingenious  have  often  invented,  and  I  daresay  will 
often  invent,  devices  to  get  out  of  Acts  of  Parliament.     . 


.  .  .  We  cannot  import  the  words  which  are  neces- 
sary to  hit  the  device  and  reach  the  mischief." 

Judge  Madden  says,  "  If  the  general  intention  of  the 
Legislature  in  regard  to  the  protection  of  the  public 
has  been  frustrated,  and  I  believe  it  has,  this  is  a 
necessary  consequence  of  the  language  that  has  been 
employed."  Further  on,  he  speaks  of  "  the  mischief 
against  which  the  present  prosecution  is  directed," 
and  finally  crystallises  the  suggestion  of  himself  and 
his  colleagues  in  these  words  : — "  The  Legislature,  if 
it  thinks  fit,  can  pass  a  Statute  specially  directed 
against  the  mischief  which  has  recently  come  into 
existence." 

The  importance  of  enlisting  the  aid  of  your  valuable 
journal  in  rousing  public  opinion  among  professional 
men,  and  also  among  your  colleagues  of  the  medical 
press,  and  drawing  attention  to  the  incalculable  effect 
of  this  judgment  of  the  Irish  Court  of  the  King's 
Bench,  must  be  our  apology  for  making  such  a  large 
demand  upon  your  space  ;  and  we  feel  convinced  that 
when  the  facts  come  to  be  widely  known  to  the  pro- 
fession and  the  public,  such  pressure  will  be  brought 
to  bear  upon  Parliament  as  will  ensure  the  effectual 
ending  of  this  anomalous  condition.  We  are  advised 
that  a  short  Act  of  Parliament  providing  that  the 
penal  clauses  of  the  Medical,  Dental  and  Veterinary 
Surgeons  Acts,  under  which  unqualified  persons  are 
prevented  from  taking  or  using  the  titles  of  Doctor, 
Surgeon  Dentist,  Veterinary  Surgeon,  &c.  shall  apply 
to  companies,  would  have  the  effect  of  putting  an 
end  to  an  audacious  and  rapidly  increasing  fraud,  not 
only  on  professional  men,  but  on  the  public. 

Herbert  Williams,  President. 

A.  W.  W.  Baker,  M.D..  F.R.C.S.I., 

Past  President,  Irish  Branch,  B.D.A. 
Geo.  M.  P.  Murray,  F.R.C.S.L, 

Past  President,  Irish  Branch,  B.D.A. 
Kevin  E.  O'Duffy,  Honorary  Secretary. 


Xlterature- 


DORLAND'S  MEDICAL  DICTIONARY,  (a) 
We  are  very  glad  to  see  a  new  edition  of  this  much 
appreciated  work.  The  second  edition  is  published 
for  so  short  a  time  that  the  third  does  not  call  for  much 
comment,  save  to  note  that  it  is  fully  revised  and 
enlarged.  Perhaps  we  might  suggest  that  it  contains 
a  few  words  which  are  not  as  yet  included  in  the 
English  language.  There  are  only  two  limits  to  the 
additions  that  may  be  made  to  a  dictionary,  the  one  is 
the  exigencies  of  facts,  the  other  the  limitations  of 
imagination.  We  venture  to  suggest  that  future 
additions  should  be  governed  by  fact,  that  is,  they 
should  consist  of  words  whose  existence  is  sanctioned 
by  modern  usage ;  as  once  "  make-ups  "  which  appeal  to 
the  imagination,  or  which  may  appear  to  the  lexico- 
grapher to  be  useful,  are  introduced,  there  is  no  limit 
to  the  extent  to  which  the  dictionary  will  extend. 
There  is  no  such  word  as  "  fluidram."  It  may  seem 
a  very  obvious  contraction,  but  it  is  not  sanctioned 
by  modern  use,  and  a  dictionary  must  follow,  not  pre- 
cede the  language.  The  abolition  of  the  hyphen  in  such 
words  as  fibro-cartilage,  fibro-carcinoma,  fibro-sarcoma, 
&c,  is  unwarranted,  and  is  the  first  step  towards  the 
production  of  word-sentences  akin  to  the  German. 
We  would  like  to  point  out  to  the  compiler  that  anyone 
can  invent  words  or  modify  pre-existing  words  to  suit 
his  own  fancy,  and  some  of  his  inventions  may  have 
much  to  recommend  them.  Still,  the  broad  fact  re- 
mains that  once  the  licence  to  invent  is  given  to  every 
man,  the  language  ceases  to  be  a  language,  and  becomes 
something  more  particular  than  a  dialect. 

(a)  "The  Illustrated  Medical  Dictionary  of  the  Terms  used  in 
Medicine,  Surgery,  Dentistry,  Pharmacy,  Chemistry,  and  the 
Kindred  Branches,  with  their  Pronunciation.  Derivation,  and 
DeBnition."  By  W.  A.  Newman  Dorland,  A.M.,  M.D  ,  Assistant 
Obstetrician  to  the  University  of  Pennsylvania  Hospital,  Ac.  Third 
Edition,  revised  and  enlarged.  Pp.  798.  Philadelphia,  New  York.: 
SauLders  and  Co.    1903.  ' 


tfutdf  iG#  1904- 


LITERATURE. 


The  Medical  Press.     299 


TOLDT  ON  ANATOMY.   (V;) 

\Ht  second  volume  of  this  very  excellent  atlas  of 

my  has  appeared .  and  is  1 11  e  v  cry  way  wort  by  of  its 

■■  essor.      It  deals  with  the  subject  of  arthroiogy, 

>ntaroi  11  r  drawings,  and  a  full  index.     We  have 

no  thing  but  praise  for  the  way  in  which  the  work  is 

1  out,  and  for  the  care  the  translator  has  taken. 

is   followed    the  system  which  he   adopted   with 

results  in  the  former  volume  of  appending  the 

h  term  in  every  case  in  which  they  differ  from 

.rfman.     As  an  introduction  to  the  study  <>[  the 

■hial  joints,  excellent  drawings  are  given  of  the 

r  joint  met  with  in  man.     Altogether 

Atlas  **  promises  to  be  a  distinct  addition  to  British 

caj  literature. 


MAGEXNIS  ON  EYE  SYMPTOMS,  (h) 

l\\  ol  the  making  of  books  there  is  no  end. 
Ti m>  book  is,  according  to  the  preface,  intended  chiefly 
A  the  Poor-law  medical  officers  in  their  pr 
labours  ;    but  we  may  candidly  doubt  if  it  will 
We  are  of  opinion  that  to  condense,  so  as  to  be 
.    use  to  a  busy    general    practitioner,    the    eye 
Mmpttfftts  of  general  diseases  into  eighty-four  small 
pages  printed  in  large  type  is  an  almost  impossible 
To  say,  for  instance*  "  In  the  eyes  we  look  for 
same  of  the  early  diagnostic  signs  of  measles.     In  this 
e  the  conjunctiva  becomes  inflamed  and  reddened, 
'Ipebral  portion  especially  ;  the  whites  of  the  eyes 
led  ;    there  is  photophobia  and  lacrymation  " 
1 .  not  to  make  a  statement  which  will  be  of  aid 
to  any   Poor-law    medical   officer.     To   multiply   in- 
stances would  be  useless,  for  we  regret  that  we  cannot 
recommend  the  book. 


TRANSACTIONS  OF  THE  ROYAL  ACADEMY  OF 
MEDICINE    IN    IRELAND,   (c) 

The  last  volume  of  the  u  Transactions  of  the  Aca- 
demy of  Medicine  *'  contains,  like  most  of  its  prede- 
cessors, many  papers  of  interest,  and  some  of  real 
importance.  Inasmuch,  however,  as  all  of  them  have 
appeared  either  in  abstract  or  in  exienso  in  our  columns 
during  the  past  twelve  months,  it  is  not  necessary  now 
to  enter  into  any  detailed  criticism.  Comparing 
hiic  section  with  another,  the  medical  section  seems  to 
contain  m>st  valuable  work.  The  case  of  erythema 
marginatum  reported  by  Dr.  Finny,  with  an  ex- 
alien t  photograph  by  Dr.  July*  is  one  of  a  very  rare 
■  i-nhtii  n,  for  he  has  been  only  able  to  discover  three 
rafted  cases  which  show  any  similarity  to  it. 
We  think,  however,  that  the  two  cases  of  paroxysmal 
tachycardia  reported  by  Dr.  Travers  Smith  and 
Dr.  O'Carroll  are  the  most  interesting  in  the  volume, 
hi  Dr.  Smith's  case,  the  condition  was  definitely  asso- 
ciated with  epilepsy,  major  and  minor,  and  the  ex- 
hibition of  potassium  bromide  gave  excellent  results. 
h>  hr.  0" Carroll's  case,  though  there  was  no  evidence 

;k'psy,  the  same  drug  was  used  with  equally  satis- 
iacinrv    result.     It   ia,    of  course,    no   explanation   of 

ysmal  tachycardia  to  state  that  it  is  "  cardiac 

the    pathology    of    epilepsy   itself   is 

unknown;  yet  if  the  two  conditions  are  in  reality  allied , 

vp  are   m>rc   likely  to  get  at  a  true  understanding 

rn  by  considering  them  together.    In  the  patho- 

il  section.  Dr.  McWeeney  gives  a  very  lucid  ex- 
planation of  the  Conradi-Drigalsbi  method  of  isolating 
Mw  typhoid  bacitlus  ;  this  method  is,  we  believe,  the 
DOVt  convenient  yet  introduced,  and  has  hardly  re- 

I    the    attention   it    deserves.      In     the   surgical 

to)  '"  An  Atlas  of  Human  Anatomy  for  Stuiknts  and  Physicians," 

By  Carl  Toldt,  M  D  g  Professor  of  Anatomy  Ui  the  Uaivanftf  of 

Vstnni,      Aaabted  by  PrQfes*jr  A.  D>  Rotto,  M.D.      Translated  from 

nan  Edition  bv  11.  Eden  Paul,  M.D.,  M.R.C.9.    Second 

Lrtfcrolory  iFif*-  37^439,  and  Index).     Pages  1B3-IS7, 

:  Kcbnian  and  Co. 

.fttoma  H    an    Aid    in     ftiacnosis. "     By    Rlwarcl 

urus,  1LD.,  D.  P  H_  laf*  Clinical  Assistant  at the Roya]  London 

Ophthalmic  UotpiUL     Bristol :  John  W.feht  and  Co,   liajrt    Pp  lay. 

of  the,  Royal  Academy  of  M  dieim!  in   Ireland." 

I      BdJt*d  bv  John  II.  Story,  M  B.,  F.R.C.S.,  General  tfecre* 

Uq     Ulth  XrulcfM    Vols.  L  to  XX.     Compiled  by  K.  J,  McWeeney, 

W  [>.    bnitiin     Brown  and  Nolan.    1DQ& 


section  Mr.  T.  E.  Gordon  details  the  history  of  a  case 
in  which  he  excised  the  Gas&efi&n  ganglion  for obstinate 
trigeminal  neuralgia.  It  is  obviously  an  operational 
mat  difficulty  ami  Borne  ri*%  but  in  his  case  was  per- 
formed without  any  ill  results,  and  with  entire  relief 
id  the  neuralgia.  The  reports  of  the  Rotunda 
Hospital,  both  gynweo  logical  nad  obstetric,  are 
given  in  full,  and  furnish  interesting  reading.  It  is  a 
pity  that  more  care  is  not  taken  in  the  product; 
the  volume*  The  descriptions  added  to  the  names 
in  the  list  of  Fellows  and  members  are  very  unequal, 
some  gentlemen  being  credited  with  appointments  lunfj 
since  given  up,  and  others  not  credited  with  any. 
Apparently  the  proofs  of  the  body  of  the  book  have 
not  been  read  at  all,  but  we  do  not  know  whether  the 
editor  or  the  individual  authors  are  responsible.  The 
Index  of  the  first  twenty  volumes  compiled  by  Dr. 
McWeeney  should  ma  he  this  number  oi  gTcat  use  for 
purposes  of  reference.  It  is  not,  however,  as  com- 
plete as  could  be  desired. 


THESAURUS  OF  MEDICAL  WORDS  AND 

PHRASES.  (a\ 

This  is  a  work  of  quite  a  novel  kind,  and  promises 
to  supply  a  want  often  experienced  by  authors  and 
others  who  find  themselves  unable  to  End  the  exact 
terms  in  which  to  clothe  an  idea  present  to  the  mind. 
It  aims,  in  fact,  at  performing  for  medical  literature 
the  same  services  that  Roget's  well-known  "  Thesaurus 
of  English  Words  and  Phrases  "  has  done  for  literature 
in  general.  Instead  of  giving  the  meaning  of  technical 
terms,  it  provides  lists  of  the  technical  equivalents  of 
ordinary  words  ;  in  other  words*  it  is  a  dictionary  of 
medical  synonyms  starting  from  the  toot  word  of  the 
idea. 

For  instance,  if  we  require  to  describe  in  technical 
language  a  certain  affection  of  the  knee-joint,  the  pre- 
cise word  having  slipped  our  memory,  we  turn  to 
"  joint/*  under  which  we  find  all  the  anatomical  designa- 
tions oi  the  various  kinds  of  joints,  their  malformation 
and  their  diseases*  Suppose  we  require  to  know  the 
name  of  a  particular  instrument  used  in  ophthalmic 
practice,  we  turn  to  "  instrument/'  and,  under  separate 
headings,  we  find  lists  of  the  principal  instruments  and 
appliances  employed  in  the  various  departments  of 
medicine  and  surgery. 

This  "  Thesaurus  "  will  be  useful  to  writers  in  search 
of  the  word  to  lit  a  certain  definite  idea,  and  also  to  the 
physician  who  has  but  a  vague  idea  in  his  mind  of  the 
words  he  needs*  but  who  will  find  therein  suggestions 
that  may  haply  help  him  out  ot  his  difficulty.  The 
reader  must  first  think  whether  or  not  the  desired  term 
has  a  common  equivalent  (pyonephrosis,  abscess  of 
kidney) ;  if  so,  this  will  enable  him  to  reverse  the  pro- 
cess and  obtain  access  to  the  whole  list  of  kidoey 
affections.  If  not  he  must  ask  himself  whether  the 
term  is  associated  with  some  anatomical  part,  in 
which  event  it  will  be  discovered  under  the  name  of 
that  part,  or  under  the  name  of  the  secretion  or  ex- 
cretion, or  that  of  the  function  with  which  it  is  asso- 
ciated. 

It  will  be  seen  that  the  "Thesaurus"  in  no  wise 
takes  the  place  of  a  medical  dictionary  ;  indeed,  it 
is,  so  to  speak,  the  opposite  of  a  dictionary,  hence  its 
special  value,  especially  as  no  work  of  the  kind  has  here* 
tofore  been  attempted. 


TEXT-BOOK  OF  MIDWIFERY  FOR  NURSES,  {b) 
This  excellent  text-book  has  now  reached  its  second 
edition,  and  we  strongly  recommend  it  to  nurses  and 
pupil  midwives.  We  quite  agree  with  the  author  when 
he  says  the  more  a  nurse  knows  about  the  difficulties 

i  1 — — ^^ _ 

(a]  "Taciturn*  of  Medical  Words  and  Phrases.'  By  Wyfrwl  M. 
Barton,  M.O.,  A^-in  int  Profauor  of  Therapeutici  atid  Materia 
Medio  an rt  Lecturer  ia  Pharmacy,  Georgetown  University,  and 
Walter  A  W*JK  M  IE.  Adjunct  Prole»or  of  Laryngology,  Washing- 
ton J\i9|.0nduate  School,  Ac,  Philadelphia  ■  W.  H.  Maunder*  and 
Co.     1KKE 

O)  "  Pra^ttoal  Text  Back  of  Midwifery  for  Nurses."  By  Robert 
.lurdinc.  M.  ft.  ft!..  MRUS,,  fto*  Prof  elisor  of  Midwifery  in  SU 
Mungo'd  College,  illasgo"'.     >       hi  Edition.    Price  0*. 


300    The  Medical  Press.      NEW  BOOKS  AND  NEW  EDITIONS. 


March  16,  1904. 


of  midwifery  work  the  less  likely  is  she  to  allow  her 
cases  to  drag  until  they  are  beyond  hope,  before  she 
sends  ior  skilled  assistance.  Therctore  nurses  must 
be  taught  in  a  thorough  and  practical  fashion.  In  the 
text-book  before  us  we  have  one  that  reaches  this 
ideal.  The  most  important  addition  is  a  complete 
chapter  treating  of  the  accidents  which  may  happen  to 
a  child  during  delivery,  common  abnormalities  met 
with,  and  also  the  common  diseases  of  the  new-born 
infant.  Considering  the  great  importance  of  palpation, 
we  think  the  chapter  devoted  to  this  subject  is  alto- 
gether too  scamped,  and  a  few  illustrations  would  have 
been  most  useful  for  beginners.  The  only  chapter 
that  is  well  illustrated  is  the  one  devoted  to  contracted 
pelvis.  What  is  the  advantage  of  devoting  so  much 
valuable  space  to  rare  pelvic  deformities  in  a  nurses' 
text-book  ?  We  must  say  a  word  of  special  praise 
to  the  chapter  on  infant  feeding ;  it  is  well  done,  the 
information  full  and  well  given — it  is  the  best  in  the 
book.  There  is  excellent  advice  on  page  122 — when 
a  Nurse  should  send  for  the  Doctor — it  should  be  read 
to  be  appreciated.  The  publishers,  William  F.  Clay, 
Edinburgh,  have  done  their  work  well. 

THE  EDINBURGH  MEDICAL  JOURNAL,  (a) 
The  present  volume  of  the  Edinburgh  Medical 
Journal  well  upholds  the  high  place  it  has  occupied 
among  medical  monthlies  since  its  first  number. 
It  is  difficult  in  the  short  space  at  our  disposal  to  give 
any  true  idea  of  the  wealth  of  information  the  volume, 
of  570  odd  pages,  contains.  We  will,  however,  just 
draw  attention  to  the  contents  of  a  number  on  which 
we  accidentally  opened ;  in  it,  following  editorial  matter, 
we  find  a  paper  on  transverse  sectional  anatomy  of  the 
thorax,  eclampsia  treated  by  saline  infusions,  neuralgia 
paraesthetica,  some  peculiarities  of  the  X-ray  image, 
latent  empyema  in  infants,  glimpses  of  the  Medical 
Congress,  a  modification  of  Talma's  operation  for 
ascites,  reviews,  and  a  summary  of  recent  advances 
in  medicine  under  the  heads  of  medicine,  surgery, 
obstetrics,  gynaecology,  therapeutics,  pathology,  bac- 
teriology, dermatology,  and  diseases  x>i  children. 
The  journal  is  profusely  illustrated,  the  type  is  plain 
and  large,  the  binding  is  strong,  and  the  whole  get- 
up  of  the  volume  is  worthy  of  the  valuable  scientific 
and  practical  papers  it  contains. 

ELEMENTARY  DISPENSARY  PRACTICE,  (b) 
Mr.  Joseph  Ince,  as  a  writer  onpharmacy,  has  been 
known  to  two  generations  of  pharmaceutical  chemists, 
and  now,  as  a  septuagenarian,  he  once  more  comes  for- 
ward with  this  little  work  which  he  modestly  calls 
elementary.  The  book  contains,  however,  the  cream 
of  the  experience  of  an  accomplished  pharmacien, 
and  cannot  fail  to  be  helpful  to  compounders  of  pre- 
scriptions and  druggists.  The  author's  intimate  know- 
ledge of  the  difficulties  that  beset  the  pharmaceutical 
chemist  in  selecting  a  suitable  excipient  for  pill-masses 
and  menstrua  for  mixtures,  and  the  list  of  agents  re- 
commended in  each  case  bears  conviction  that  the  author 
is  familiar,  as  are  few  men,  with  his  subject,  and  a  trust- 
worthy guide  in  all  such  difficulties. 


The  present  volume  is  of  unusual  interest^but  we  have 
not  space  to  give  even  the  titles  of  the  forty-two  original 
papers  and  cases  that  form  the  number.  Typhoid 
fever  is  the  subject  of  three  papers  ;  asthma,  withTa 
short  summary  of  over  400  cases,  of  another ;  hernia, 
gastrotomy,  congenital  dislocation  of  the  hip,  inva- 
gination, and  an  unusually  great  dilatation  of  the 
heart.  In  such  there  is  enough  mental  pabulum  to 
satisfy  Teufelsdorch  himself,  and  a  variety  that  should 
excite  an  interest.  In  our  experience  therejis  no 
more  helpful  book  in  the  physician's  library  than  the 
^Transactions  of  the  Clinical  Society." 


TRANSACTIONS  OF  THE  CLINICAL  SOCIETY 
OF  LONDON,  (c) 
Practitioners  who  wish  to  keep  up  with  the  progress 
of  medicine  as  a  science  and  an  art  would  do  wefi  to  sub- 
scribe to  the  "Transactions  of  the  Clinical  Society." 
We  know  no  volume  which  more  truly  reflects  medical 
progress  in  every  branch  of  pure  medicine.  As  the 
name  of  the  Society  implies,  the  papers  deal  with 
clinical  cases,  and  for  the  practical  physician  such  word- 
pictures  of  disease  are  more  valuable  than  any  others. 

(a)  The  Edinburgh  Medical  Journal,  Vol.  XIV.  Edited  by  G.  A. 
Gibson,  M.D.,  F.R.C.P.Ed„  and  Alexis  Thomson,  M.D.,  F.R.0J3JCd. 
Newheries.    Published  by  Young  J.  Pentland.    1908. 

(?) .-  ?lemeB,SlirE  I>kpen«U7  Practice  for  Student*  of  Pharmacy 
and  Medicine."  By  Josepn  Ince,  P.C.8.,  F.L.8.,  F.B.M.8.,  Ph. 
Chemist,  Ass.  King's  College.  London.  Published  at  the  office  of  the 
Chemitt  and  DruagUt.    London.    190.*. 

(0  "  Transactions  of  the  Clinical  Society  of  London."  Vol. 
XXXVI.    London:  Loogmaas,  Green  and  Go.    190*. 


NEW   BOOKS  AND  NEW  EDITIONS. 
The  following  have  been  received  since  the  publication 
of  our  last  list : — 
Baillierx,  Tindall  &  Cox  (London). 
A  Practical  Guide  to  the  Administration  of  the  "  Nauheim"  Treat- 
ment of  Chronic  Diseases  of  the  Heart  in  England.     By  Leslie 
Thorne  Thome,  M.D..  B.Sc.Durham,  Ac.    Illustrated.        Pp.  53. 
Price  2s.  6d.  net. 
The  Bacteriology  of  Every-day  Practice.     By  J.  Odery  Symes, 
M.D.,  being  No.  2  of  the  Medical  Monograph  Series.    Second 
Edition.    Illustrated.    Pp.  106.    Price  2s.  6d.  net. 
John  Baxk,  Eoks  k  DAMELSfcON,  Ltd.  (London). 
Diseases  of  the  Appendix  Vermiformis  and  their  Treatment    By 
F.  G.  Lloyd,  M.R.C.8.,  L.R.C.P.    Pp.87.    Price2s.net. 
J.  &  A.  Churchill  (London). 
Subjective  Sensations  of  8ight  and  Sound,  Abiotrophy  and  other 
Lectures  on  Diseases  of  the  Nervous  System.    By  Sir  Win.  R. 
Gowers,  M.D.,  F.R.8.    Illustrated.       Pp.260.    Price  6s.  net 
Insanity  in  Every-Day  Practice.    By  E.  G.  Younger,  M.D.Brux,, 
M.R.C.P.,  being  No,  8  of  the  Medical  Monograph  Series.   Pp.  109. 
Price2s.6d.net. 
Lectures  chiefly  Clinical  and  Practical  on  Diseases  of  the  Lungs  and 
the  Heat  t.     By  James  Alexander  Lindsay,  M.D.,  F.B.C.P.    Pp. 
447.    Prioeds.net. 
Diseases  of  the  *4  Gall-Bladder "  and  Bile-Ducts,   including  Gall- 
stones.    By  A.  W.   Mayo  Bobson,  F.R.O.S.,  assisted  by  J.   F. 
Dobson.  M.S.,  F.B.C.S.    Third  Edition.    Illustrated.    Pp.  485. 
Price  15s.  net. 
Couish  Bros.  (Birmingham). 
Contributions  to  Practical  Medicine.     By  Sir  James  Sawyer,  M.D. 

Fourth  Edition.    Pp.  227.    Price  8s.  net. 
Insomnia:   Its  Causes  and  Cure.      By  Sir  James  Sawyer,  M.D. 
Pp.  66.    Price  Is.  3d.  net. 
Gale  &  Polden,  Ltd.  (London). 
Compounding  and  Dispensing  made  Easy.     By  H.  Harold  fcott, 
M.RLond.,  M.R.C.8.,  Ac.,   Lieut.  R.A.M.C.      Pp.  816.    Price 
7s.  6d.net. 
Chablis  Gbiffis  &  Co.,  Ltd.  (London). 
Physiology   and    Pathology  of   the   Urine  with  Methods  for  its 
Examination.     By  J.  Dixon  Mann,  M.D.,  F.B.C.P.    Illustrated. 
Pp.  272.     Price  8s.  6s.  net 
H.  K.  Lewis  (London). 
The  General  Pathology  of  Inflammation,  Infection  and  Fever,  being 
the  Gordon  Lictures  for  1902.     By  E.  W.  Ainley  Walker,  M.A., 
D.M.Oxod.    Pp.  260.    Price  4s.  6d.  net. 
J.  B.  LiPPiNOOTT  Company  (London). 
Diseases  of  the  Nervous  System.    By  H.  Oppenheim,  M.D.    Trans- 
lated and  Edited  by  Edward  E.  Mayer,  A.M.,  M.D.    Second 
American  Edition  revised  and  enlarged.     Illustrated.     Pp.  953. 
Price  21s.  net. 
Blood-Pressure  in  Surgery :  An  Experimental  and  Clinical  Research. 

By  Geoige  W.  Crile,  A.M.,  M.D.    Pp.  422.    Price  18s.  net. 
The  Cartwright  Prise  Essay  for  1908. 
Macmillak  &  Co.,  Ltd.  (Locdon). 
The  Eve:   Its  Refraction  atd  Diseases.    By  Edward  E.  Gibbons, 
M.D.    Pp.  472.    Price  21s.  net. 
Young  J.  Pektland  (London). 
Mannual  of  Operative  Surgery.     By  H.  J.  Waring,  M.S.,  M.B.,  Ac 
Second  Edition.    Illustrated.    Pp.  659. 
Bbbmah,  Limited  (London). 
An  Atlas  of  Human  Anatomy  for  Students  and  Physicians.    By 
Carl  Toldt,  M.D.,  assisted  by  Professor  Rosa,  M.D.    Tianslated 
from  the  German  by  M.  Eden  Paul,  M.D.Brux.  Third  Section,  D. 
Myology.    Price  8s.  6d.  net. 
Smitu  Elder  &  Co.  (London). 
St.  Bartholomew's  Hospital  Reports.    Edited  by  A.  E.  Garrod, 
M.D.,  and  W.  McAdam  Eccles,  M.S.,  F.R.C.8.    Vol.39.    Price  6s. 
The  Smithsonian  Inotitutioh  (Washington,  U.S.A.). 
Philadelphia  Hospital  Reports.    Vol.  5. 1902.     Edited  by  Herman 
B.  Allyn,MD.    Pp.178. 
John  Wright  &  Co.  (Bristol). 
The  Infectivity  of  Enteric  Fever.     By  Alexander  Coliie,  M.D.    Pp. 

47.    Price  Is.  6d. 

Dispersing  made  Easy.    By  Wm.  G.  Sutherland,  M.B.    Pp.  102. 

Price  3s.  6d.  net.  m   . 

A  Guide  to  Urine  Testing ;   for  Nurses  and  others.     By  Mark 

Bobinson,  L.R.C.P.,  L.R.C.S.     Second  Edition.     Pp.56.     Price 

Is.  net. 

Memoranda  on  Infectious  Diseases  for  the  use  of  School  Teachers. 

By  James  W.  Allan,  M.B.    Pp.  28.    Price  6d. 
Ailments  of  Women  and  Girls.    By  Florence  Stack  pool  e.     Pp.  238. 
Prioe2s.net.  _„_ 

Golden  Rules  of  Dental  Surgery.    By  C.  W.  Glaseington,  M.B  OS., 

L.D.8  Ed.,  "Golden  Rules  "  Series,  No.  18.    Pp.  W.    Price  Is. 

The  Medical  Annual :  A  Year  Book  of  Treatment  and  Practitioner  s 

Index,  1904.    Pp.  852.    Price  7s.  6d.  net,  and  Stereoscope  2s. 


March  16    190*. 


MKDICAL  NEWS. 


The  MEDICAL  Pbess.     301 


Xa  bora  tors  "Motes. 


UfGJER'S    PETROLEUM     EMULSION.     (Wiih 
HypopHosPHtTEs,  Lime,  and  Soda.) 

l.emieal  Co.,  Ltd..  Snow  Hill,  London, 
r>e  by  the  Angier  Chemical  Co.,  Boston,  United 
.  who  have  torwarded  us  samples  of  their  well- 
town  staple  preparation, 
FiUfBuTf. — "  Each     ounce     contains  jj  |    per    cent. 
-  pun  lied  petroleum,  and  9  grains  of  the  combined 
I  soda/' 
have  examined    a   sample   of    this   well-known 
"  Petroleum  Emulsion,''  and  have  found   its    compo- 
sition to  agree  very  closely  with  the  official  formula, 
which  appears  tin  the  label.     The  whole  of  the  mineral 
r  presen  t»  I  h  e  h  y  po  phosphi  tes  o  f  sod  1  u  m 

dcium.     We  have  kept  the  sample  under  observa- 
ir  a  considerable  period ,  in  order  to  see  whether 
the  emulsion,  which  is  ol  a  very  perfect  nature,  retains 
iracter,  and  we  have  found  that  even  when  pre- 
111  a  warm  place  it  remains  homogeneous* 
Angier's  emulsion  is  well  spoken  of  by  many  medical 
men  who  have  used  it  in  practice.     That  fact  alone 
entitles    it    to    the    careful    attention   of    the    medical 
profession,   which   ia   approached    by   the   makers  of 
the  preparation  in  a  perfectly  open  and  above-board 
manner.     The    emulsion    has    the    advantage    of    an 
tive  appearance,  and  is  not  altogether  unpleasant 
to  the  palate. 


[OX'S  PURE  RICH  CREAM.— (Sterilised.) 
Fussetl  and  Co*,  4.  Monument  Street,  London,  E.C 
This  cream  1*  tt&fc  ;  repared  in  Norway  by  a 

new  process,  by  which  the  flavour  is  not  impaired,  and 
without  the  addition  of  any  chemicals,  We  have  exam- 
ined two  samples  of  this  cream  and  have  specially 
tested  for  preservatives,  which  are  so  commonly  found 
in  the  Beam  ropplied  by  dairymen,  and  in  that  sold  in 
We  are  able  to  state  that  tliis  cream  is  entirely 
irec  from  chemical  additions,  and  is  preserved  by  stt-ri  I 
1  alone;  this  is  a  very  important  point  in  its  favour, 
uuj  renders  it  suitable  lor  children  and  for  people  in 
debcate  health, 

analysis  we  have  found  it  to  contain  upwards  of 
40  per  cent,  of  butter  fat,  which  is  a  very  satisfactory 
lage;  the  mineral  matter  was  5  percent.,  which  is 
.mount  found  in  genuine  samples  of  cream.  In 
order  to  make  a  thorough  test  of  its  sterility j  we  placed 
two  samples  in  an  incubator,  maintained  at  blood  heat, 
nd  on  examining  these  after  a  lapse  ol  three  v, 

proved  to  be  perfectly  sweet  and  fresh,     We  have 
t   pleasure   m   recommending    this   article    to   our 
lets  as   being  of  standard  quality,  and  absolutely 
preservatives. 


area  none  were  affected  with  plague.  As  regards  the 
Mauritius  a  telegram  from  the  Acting  Governor  received 
at  the  Colonial  Office  on  March  4th  stales  that  for  the 
week  ending  March  %x4  theft  lague 

and  five  deal  lis  from  the  disease* 

I  The  Central  MidviYes  Board  ana  tne  Irish  Hospitals. 

As  we  have  already  recorded  at  the  last  meeting  of 
the  Central  Mid  win  the  following  resolution 

was  drawn  np  and  adopted  in  answer  to  the  resolution 
forwarded  by  the  secretary  of  the  Royal  Academy 
of  Medicine  in  Ireland  \—Ai  That,  bavin?  considered 
the   letter  addressed    to    them   by    the    |  and 

Secretary  of  the  Royal  Academy  of  Medicine  in  Ireland, 
the  Board  regret  that  the  suggested  alteration*  were 
not  brought  to  their  notice  before  the  rules  were  sent 
to  the  Privy  Council,  as,  having  been  approved  by 
that  body,  it  is  impossible  for  the  Board  to  alter  them,'1 
It  has  now  transpired  that  the  following  amendment 
was  moved  by  Dr.  Sinclair  and  seconded  by  Dr.  Ward 
Cousins,  but  was  lost  on  a  division  : — '*  That  ha%ing 
considered  the  letter  received  from  the  President  of 
the  Royal  Academy  of  Medicine  in  Ireland,  the  Board 
regrets  that  the  circumstances  of  the  midwifery  training 
schools  were  not  considered  before  the  regulations 
were  sent  to  the  Privy  Council ;  the  Board,  however, 
sympathises  with  the  Irish  institutions  in  their  diffi- 
culties, and  will  give  every  assistance  in  obtaining 
revision  of  the  rules  by  the  Privy  Council/*  The 
Irish  hospitals  have  been  waiting  for  a  declaration 
from  the  Board  as  to  whether  they  would  or  would 
not  unite  with  the  hospitals  in  appealing  to  the  Privy 
Council.  Now  they  have  got  their  answer,  if  our 
information  is  correct,  and  they  will  doubtless  know 
the  course  to  adopt  in  future. 


fl&e&fcal   Hews. 


Death  under  Chloroform. 

V    s\n    occurrence   was    reported    from    Wrexham 

last  week*     It  seems  that  Daniel  Roberts,  coachman 

lr.  Frederick  W.  Soames,  ex-Mayor  of  Wrexham, 

bed   suffered    from    appendicitis,    and     the    medical 

1  in  attendance  decided  that  an  operation  was 

Mr.     Roberts    was    consequently    placed 

influence  of  chloroform,  but,  unfortunately, 

becarr  «ly  affected,  and,  despite  strenuous 

forts  to  revive  animation,  all  attempts  proved  futile, 

fld  death  ensued. 

The  Plague. 

0 nicer  of  health  of  Cape  Colony  reports 

that  lor  the  week  ending   February   tjth,  no  case  of 

"ague    in    human    beings    occurred    throughout    the 

PI  ague -infected  rodents  were  found  at  Port 

tabeth.  East  London,  and  Queens  town,  but  of  175 

ais  examined  in  the  Cape  Town  and  Harbour  Board 


Accelerate  a  Bet  vice  Between  England  and  America. 
In  view  of  the  fact  that  Plymouth  has  now  become 
the  first  port  of  call  on  the  homeward  journey  for  all 
the  Atlantic  mail  steamers  of  the  American  Line  pro- 
ceeding to  Southampton,  the  London  and  South 
Western  Railway  Company  have,  at  Stonehouse  Pool, 
erected  a  new  ocean  quay  station  which  is  connected 
with  their  main  line  at  Devonport.  and  from  April  <>ih 
onward  passengers  landing  at  Plymouth  will  be  con- 
veyed by  that  company  to  their  destination.  On 
landing  at  the  Ocean  Quay,  they  will  submit  their  bags*-  e 
t^  the  inspection  of  the  Customs  officers,  and  then 
enter  the  express  train  ready  to  convey  them  direct  to 
Waterloo  Station.  The  journev  to  London  without  a 
stop,  covering  the  distance  of  230  miles,  will  be  com- 
pleted in  about  four  hours  and  a -ha  if.  For  this  service 
the  London  and  South  WesteTn  Comoany  have  just 
built  a  very  handsome  and  richly -appointed  corridor 
tram,  containing  restaurant  cars,  and  other  accom- 
modation. Such  arrangements  will  be  pfeatly  appre- 
ciated by  the  medic? I  profession  on  both  sides  of  the 
Atlantic"  inter- visits  being  greatly  on  the  increase  of 
recent  years* 

Royal  College  of  Surgeons  or  England. 
Three  lectures  on  "  Acute  Infective  Gangrenous 
Processes  (Necroses)  in  the  Alimentary  Tract/'  will  be 
delivered  in  the  theatre  of  the  College  by  Ed  red  M. 
Corner,  F.R.C.S,  (Erasmus  Wilson  Lecturer).  The 
first  of  the  fourse  will  be  delivered  on  Monday,  March 
21st,  at  g  o'clock  p.m.*  the  second  and  third  on  Wed- 
nesday (23rd}  and  Friday  (25th)  at  the  same  hour* 
Vlnu-vsmii  is  free  to  Fellows  and  Members  nko  to  non- 
members  of  the  College  on  presentation  of  their  address 
cards. 


New  York  City  is  scourged  by  a  pneumonia  death- 
list  of  6.000  since  December  last.  The  Board  of 
Health  has  announced  that  it  will  fight  the  disease 
like  the  plague  and  treat  it  as  infectious,  and  physicians 
may  be  required  to  report  cases  in  order  that  they  may 
be  isolated,  lite  importance  of  this  outbreak  from 
an  epidemiological  point  of  view  is  obvious. 


302    The  Medical  Press.        NOTICES  TO  CORRESPONDENTS. 


March   16,   1904. 


Notices  to 
€orrc6ponbtnt0t  ^hurt  fetters,  &£. 

tjS*  Correspondents  requiring  a  reply  in  this  column  are  particul- 
arly requested  to  make  use  of  a  distinctit*  tignatwrt  or  initial,  and 
avoid  the  practice  of  signing  themselves  "Reader,"  '•Subscriber," 
"Old  Subscriber,"  Ac.  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

Original  Articles  or  Letters  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion,  but  as  evidence  of  identity. 

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

Publisher.  LABGE  MEDICAL  FEES. 

A  good  deal  has  been  written  from  time  to  time  on  the  exception- 
ally large  fees  that  have  l»een  paid  to  medical  men  in  various 
countries.  In  America,  for  instance,  Mr.  Jay  Gould,  who  died  in 
1893  is  said  to  have  paid  his  doctor  a  regular  salary  of  £8,000  a  year, 
whether  sick  or  well.  For  two  months  attendance  on  his  daughter, 
he  paid  between  £17,000  and  £18,000.  Mr.  Whitney,  another 
millionaire,  paid  £5,000  for  a  week's  attendance.  For  a  consultation 
in  the  Riviera,  the  late  Sir  Morell  Mackeuade  got  1,000  guineas ;  and 
for  bis  attendance  on  the  Emperor  Frederick  be  received  in  all 
£13  000.  Professor  Zakharin.  of  Moscow,  is  credited  with  haviux 
received  for  two  days  at  the  deathbed  of  the  late  Czar,  *  3,000;  and 
for  a  visit  to  a  Russian  millionaire  £1,400,  with  £&00  foi  his  assistant. 
One  of  the  largest  fees  on  record  is  that  received  by  Dr.  Dimsda  e,  an 
ancestor  of  the  ex-Lord  Mayor  of  London,  for  inoculating  Catherine 
the  Second,  Empress  of  Bussia,  against  small-pox  in  1764.  1  he  fee 
itself  was  £10,0U0,  with  £2,000  for  travelling  expenses,  and  in  addition 
a  life  pension  of  £500. 

Dr.  Hblfibld  (Malta).— Foreign  medical  qualifications  entitle  to 
practise  in  the  United  Kingdom  from  those  countries  only  which  afford 
reciprocal  advantages  to  British  diplomates.  We  believe  the  United 
States  of  America  does  not  afford  suvh  opportunities.  At  any  rate 
tnere  are  only  certain  American  qualifications  recogni**d  as  affording 
a  sufficient  guarantee  of  competency.  If  our  correspondent  writes  to 
the  Secretary,  General  Medical  Council,  Oxford  Street,  London,  he 
will  be  able  to  ascertain  full  particulars.  Or  if  he  furnishes  us  with 
the  required  details  we  shall  be  pleased   to  make  the  necessary 

n<M  ATc.  S.  (Crosshaven).— Davidson,  140,  Great  Portland  Street, 
London,  W.,  will  make  the  arrangements  you  require.  It  is  usual 
and  more  dignified  to  make  an  iuclusive  charge.  A  fee  of  fifteen 
shillings  should  be  within  the  means  of  all  patients,  a-  d  would  leave 
you  a  fair  profit.  We  think  it  would  be  well  to  consult  your  brother 
practitioners  and  the  tradesmen  referred  to  before  you  take  the 
step  you  propose.  The  latter  might  be  led  to  see  the  error  of  their 
ways  and  as  we  said  in  our  leader,  it  is  better,  if  possible,  to  keep  the 
two  functions  distinct.  The  delay  in  answering  your  letter  i»  due  to 
its  having  to  be  forwarded  to  our  London  Office. 

H  T  wood  (London)  —The  serum  treatment  of  cancer  introduced 
by  Dr  Otto  Schmidt,  has  been  tried  and  found  wanting  Careful 
experiments  carried  out  in  England  by  well-known  surgeons  have 
proved  the  serum  to  be  inert  as  regards  maligoant  neoplasms.  The 
serum  came  direct  from  Dr.  Schmidt's  laboratories,  and  was  of  the 
••  killed  culture  "  kind. 

INCOME  TAX  REPAYMENTS. 
The  Income  Tax  Acts  provide  that  no  repayment  can  be  made, 
aave  in  certain  quite  exceptional  cases,  unless  the  claim  is  made 
within  three  years.  April  5th  next  is,  therefore,  the  last  possib.e 
day  on  which  a  claim  for  the  year  ended  April  5th,  1901,  can  be 
lodged. 

A  first  rate  parody  is  that  of  The  Country  Doctor,  which 
appeared  originally  in  the  "Bart's"  Hospital  Magazine.     The  first 

verse  runs  as  follows :—  

As  I  was  a-goin'  'ome  to  bed,  through  a  muddy  country  lane, 

I  seen  a  man  in  a  oilskin  cape,  a-trudgin'  through  the  rain, 

'E  'adn't  a  match,  an'  's  pipe  was  out,  as  I  ses  to  'im,  •*  Oo  are 

you  ?  " 
An'  e  ses,  "  I'm  a  doctor,  the  country  doctor,  surgeon  an*  mid- 
wife too ! " 
Now  *e  never  gets  paid  for  'art  'e  does,  an'  'e  does  the  work  of  two, 
An'  'e  isn't  one  of  the  gentlefolks,  an'  'e  ain't  like  me  nor  you, 
'E's  a  sort  of  a  bloomin'  chameleotype,  surgeon  an'  midwife  too. 


^clings  of  the  gocutiea,  JLtttmte,  -fo, 

WEDNESDAY,  MARCH   16th. 

Royal  College  of  Surgeons  of  England.  -  5  p.m.  Mr.  J.  H. 
Parsons :  The  Neurology  of  Vision.    (Arris  and  Gale  Lecture.) 

Medical  Graduates'  College  and  Polyclinic  (22  chenies  Street, 
W.C.).— 4  p.m.  Mr.  C.  Byall:  Clinique.  ^Surgical.)  5.15  p.m. 
Mr.  J.  Pol*nd :  Deformities  after  Fractu  es. 

Thursday,  March  17th. 

Royal  College  of  Physicians  of  London  (Pall  Mall  East).— 
5  p.m  Dr.  F.  Taylor:  Some  Disorders  of  the  Spleen  ^Lumleian 
Lecture )  ,_  ^     .      «.      ,. 

Medical  Graduates*  College  and  Polyclinic  (22  Chenies  Street, 
W.C.)  -4  p.m.  Mr.  Hutchinson:  Clinique.  (Surgical.)  5.15  p.m. 
Mr.  A.  Lane :  Abdominal  Surgery. 

Mount  Vernon  Hospital  for  Consumption  and  Diseases  of  the 


Chest  (7  Fitaroy  Square,  W.).—  2.30  p.m.  Mr.  R,  Lake :  Demonstra- 
tions on  Laryngeal  Tubercular  Cases.    (II.)  (Post-Graduate  Course.) 

8t.  John's  Hospital  for  Diseases  of  the  Skin  (Leicester  .square, 
W.C.).™ 6.15  p.m.  Dr.  M.  Dockrell :  Alopecia.  (Chesterfield  Lecture.) 
Friday,  Mahcii  18th. 

Epidemiological  Societt  of  London  (11  Chandos  Street,  Cavendish 
Square,  W.).-8  30  p.m.    Meeting. 

Socuty  for  the  Study  of  DisEASi  in  Children  (11  Chandos  Street, 

W.). fi.so  p.m.      Clinical   Cases.    Papers:— Mr.   8.   Stephenson. 

Congenital  Word  Blindness  in  Children. -Dr.  P.  Parkinson  and  Mr. 
L».  Drew  :  Notes  on  a  Case  of  Nephrolithotomy. 

Royal  College  of  Surgeons  of  England.— 5  p.m.  Mr.  J.  H. 
Parsuns  :  The  Neurology  of  Vision.    (Arris  and  Gale  Lecture.) 

Medical  Graduates'  College  and  Policlinic  {tt  Chenies  Street, 
W.C\).-4  p.m.    Mr.  W.  Dodd :  Clinique.    (Eye.) 

Ayr  District  Asylum.— Assistant  Medical  Officer.  Salary  £120  per 
annum,  with  board,  furnished  apartments,  attendance,  and 
washing.      Applications  to  the  Medical  Superintendent. 

Birmingham  General  Dispensary.  -  Resident  Surgeon.  Salary  £150 
per  annum,  with  furnished  rooms,  fire,  lights,  and  attendance. 
Applications  to  Ernest  W.  Forrest,  Secretary. 

Birmingham  General  Hospital.  -Resident  Surgical  Officer.  Salary 
£100  per  annum,  with  residence,  board,  and  washing.  Applica- 
tions to  the  House  Governor. 

Birmingham  and  Midland  Ear  and  Throat  Hospital,  Edmund 
Stieet.— House  Surgeon.  Salary  £70  per  annum.  Applications 
to  S.  G.  Grew,  Secretary. 

Bristol  Royal  Hospital  for  Sick  Children  and  Women.— House 
Surgeon.  Salary  £120  per  annum,  with  rooms  and  attendance. 
Applications  to  the  Secretary. 

Kent  and  Canterbury  Hospital.— House  Surgeon.  Salary  £90  a  year, 
with  board  and  lodging-.    Applications  to  the  Secretary. 

London  Fever  Hospital,  Islington,  N  —Assistant  to  the  Resident 
Medical  Officer.  Salary  £120  a  year,  with  board  and  lodging. 
Applications  to  the  Secretary. 

London  Lock  Hospital.— House  Surgeon  to  the  Male  Hospital. 
Soho.  Salary  £80  per  annum,  with  board,  lodging,  and  washing. 
Applications  to  the  Secretary. 

Parish  of  Torosay.— Medical  Officer.  Salary  £100  per  annum.  Appli- 
cations to  John  Livingstone,  Inspector  of  Poor,  Auchnacraig, 
Isle  of  Mull. 

Royal  Dental  Hospital  of  London  and  London  School  of  Dental 
Surgery,  Leicester  Square,  W.C— Two  Senior  Demonstrators, to 
attend  each  three  mornings  a  week,  from  9  to  U  Stipend  £60 
first  year,  £66  second  y  ar,  £70  third  year.  One  8enior  Demon- 
strator, to  attend  five  afternoons  a  week,  from  1  to  5.  otipend 
£i00  first  year,  £110  second  year,  £12o  third  year.  Two  Junior 
Demonstrators,  to  attend  each  six  mornings  a  week,  from  9  to  1 
8tipend.  £100  first  year,  £110  second  year,  £120  third  year. 
Applications  to  Morton  ttmale.  Dean. 

Sussex  County  Hospital.— House  Physician.  Salary  £80  per  annum, 
with  board  and  residence  in  the  hospital,  with  washing.  Applica- 
tions to  the  Secretary. 

West  Riding  County  Council— Scalebor  Park  Asylum,  Burley-in* 
Wharfedale,  Private  Patients.— Assistant  Medical  Offionr,  Salary 
£160  per  annum,  with  furnished  rooms,  board,  Ac.  Applications 
to  the  Medical  Superintendent. 


tj^oitttmems. 

Bower,  E.  Dtkrs,  F.R  O.Edin.,  Medical  Referee  under  the  Work- 
men's Compensation  Act  for  the  Newnham  District  of  County 
Court  Circuit  No.  68. 

Dawson,  George  W„  F.R.C.8  I.,  Assistant  Surgeon  to  St.  John's 
Hospital  for  Diseases  of  the  Skin,  Leicester  Square, 

Lanoley.  J.  E  ,  M  R.C.S.,  L  R.C.P.Lond.,  Clinical  Assistant  to  the 
Chelaea  Hospital  for  Women. 

Latham,  O.  H ,  M.&.C.S*.,  L.R.C.P.Lond.,  House  Physician  to  the 
Out-Patient  Department  at   t.  Thomas's  Hospital 

Newton,  W.  T.,  M.R  CS.Eng.,  L.8.A.,  Divisional  Surgeon  to  the  City 
Road  station,  G  Division  Metropolitan  Police. 

Pbnnt,  John,  D.Sc.,  Puolic  Health,  M.B.Edin.,  FH8.E.,  Medical 
Officer  to  the  Union  Workhouse  No.  2  District,  and  Public 
Vaccinator  for  No.  2  District,  Cockermouth. 


#irth8. 


Beath.— On  March  9th,  at  0  Dunsford  Place.  Bath,  the  wife  of  David 

Leslie  Beath,  M.R.C.S.,  L.R.C.P.,  a  son.     (Australian  papers 

please  copy.) 
Condon.— Ou  March  6th,  1904,  at  the  Mall,  BaHyshannon.  the  wife  of 

Fred  W.  Condon,  F.R.C.S  I.  of  a  son. 
Fleming.— On  March  9th,  1904.  at  3,  Arkwright  Road,  Hampstead,  to 

Dr.  and  Mrs.  A.  J  Fleming,  a  daughter. 
Woods.  —On  March  6th  at  89,  Metriou  Square,  the  wife  of  Robert  H. 

Woods,  M.B.  of  a  daughter. 


4ftarriages.  _ 

Wardale— Robinson.— On  March  9th,  1904,  at  Christ  ChurchTOates- 
head.  John  Robs  >n  Wardale,  MB.,  B  S.,  youngest  sou  of  John 
Dobso  •  Wardale,  Esq..  J.P  ,  M.lust.0  E.,  of  Gateshead,  to  Anne 
Georgina  Robinson,  eldest  daughter  of  J.  W.  Robiuson,  Esq  ,  of 
Gateshead  and  Hay  don  B.  idge. 


9  eat  hs. 


Allden.— On  February  28th,  at  No.  82,  West  Allington,  Bridport, 
Sidney  James  Alldeu,  M.D.,  B.S.,  Mayor  of  Bridport. 


flit 


toss   and   (Eutular. 


"SALUS    POPULI    SUPREMA    LEX." 


Vol.  CXXVIII. 


WEDNESDAY,    MARCH  33,    1904.  No.   12. 


Original  Communications, 


CHLOROFORM  IN  SURGICAL 
ANESTHESIA: 

THE  VERNON   HARCOURT  INHALER  AND 

EXACT  PERCENTAGE  VAPOURS,    (a) 

By  DUDLEY  W.  BUXTON.  M*D,*  B.S..  M*R*C*P., 

Auniliettot  nod  Lectnfvr  011  Aninthetia  Id  Uturartity  College 
Hoapitm]. 

The  apparatus  which  1  have  been  asked  to  explain 
En  you  this  evening  owes  its  origin  to  the  ingenuity  of 
Mi*  A*  Vernon  Har court,  F.R.S.,  sometime  Reader  in 
Caenustry  at  Christ  Church,  Oxfcmi*  The  British 
Medical  Association  in  1901  appointed  a  Committee,  of 
which  I  was  a  member,  to  carry  out  certain  investiga- 
tions with  regard  to  chloroform,  and  Mr,  Vernon 
Harcourt  was  co-opted  a  member  of  that  Committee. 
In  the  course  of  our  investigations,  it  became  apparent 
that  we  must  obtain  some  method  of  exactitude  by 
which  wc  could  insure  a  definite  amount  ol  chloroform 
being  delivered,  in  other  words,  a  definite  dosage  by 
a  known  percentage  of  chloroform  vapour  in  air. 
Now,  in  J  899  Mr,  Vernon  Harcourt  published,  in  the 
"Transactions  of  the  Chemical  Society,  "a  description  of 
a  method  whereby  a  current  of  air  could  be  mixed  with 
any  desired  proportion  of  chloroform  vapour  This 
method  was.  however,  only  applicable  to  small  animals, 
and  was  supplemented  in  June,  1902,  by  a  communi- 
cation by  Mr.  Harcourt  to  the  Royal  Society,  In  the 
paper  m  question  reference  is  made  to  two  methods, 
both  of  which  were  demonstrated  before  the  Com- 
mittee of  the  British  Medical  Association,  and  the 
second  was  adopted  by  them,  after  various  experiments 
and  trials,  as  being  applicable  tn  human  beings  {b). 
The  apparatus  shown  to-night  is  the  outcome  oi  these 
experiments,  and  is  a  remarkably  ingenious  applica* 
Hon  of  chemicophysics  to  the  "service  of  suffering 
humanity, 

[k  the  Committee  of  the  British  Medical  Asso- 
ciation were  studying  the  various  methods  and  appa* 
Tatijs  for  giving  chloroform,  I  was  requested  to  report 
won  various  inhalers,  and  among  them  upon  Mr. 
Vernon  Harcourt '5  Chloroform  Regulator,  Let  me, 
before  going  into  detail,  explain  that  the  principle  of 
11m  apparatus  is  that  air  passes  over  the  surface  of 
chloroform  by  the  aspiration  of  the  patient's  respiiatinu, 
and  that  by  its  construction  the  apparatus  delivers  a 
maximum  strength  of  2  per  cent.  1  was  first  uncertain 
whether  this  2  per  cent,  strength  would  satisfy  the 
requirements  of  surgery,  although  possibly  adequate 
Iff  physiological  work.     Probably   those  of  you  who 

not  used,  or  seen  the  apparatus  used,  will  be  in- 
clined to  take  this  view*  I  mention  my  own  mental 
attitude    at     the    commencement     of     my    research* 

M  fte*d  &t  a  meeting  of  the  British  GjtuKwlflginl  Boaietv,  Much 
m\  1904, 

Ity  Hr*  Harcourt  forma  lata)  »  Report  on  them*  metbodv,  which  the 
t*»mltt*r  duly  pmentodto  the  UrRish  Medical  Ajaoeiation*  Sw 
iMfii.,  July  18,  Ifttijcxlii, 


However,  experience  lias  convinced  me  tliat,  like 
theories  based  on  a  priori  reasoning,  this  one  is 
entirely  wrong* 

The  great  bugbear  of  this  chloroform  question  has 
always  been  a  priori  reasoning,  coupled  with  a  con- 
fiding faith  that  chloroform  as  an  anaesthetic  obeyed 
no  laws  like  other  drugs.  Like  the  blessed  word 
"Mesopotamia,*'  the  much -abused  word  "idiosyncrasy." 
has  Consoled  many  an  aching  heart  and  ministered  to 
the  amour  propre  of  not  a  few  chloroformists* 

But,  if  you  wiU  bear  with  me,  I  hope  to  convince  you 
that  there  is  overwhelming  evidence  tn  favour  of  the 
statement  that  chloroform  is  not  only  a  most  law- 
abiding  body,  but  is  impeccable  in  the  matter  of  idio- 
syncrasy, while  no  evidence  exists  in  support  of  the 
contrary  view  save  various  ipse  dixits,  which  are  in- 
admissible as  against  definite  experimental  and  clinical 
observations. 

Snow,  who  in  1858  was  the  voice  of  one  crying  in 
the  wilderness  of  inexact  experimentation,  conducted 
researches  on  chloroform,  which  succeeding  workers 
have  elaborated  and  confirmed,  but  have  not  disproved. 
His  conclusions  were  that  12  minims  of  chloroform  in  the 
body  produces  the  2nd  degree  of  narcosis  ;  1 8  minims 
the  3rd  degree,  24  minims  the  4th  degree,  and  36 
minims  the  5th  degree.  Thus  18  minims  is  2  per  cent,, 
36  minims  equals  4  per  cent*  (Fluids  of  body,  30  lbs. 
equals  1 5  litres,  or  300  litres  of  vapour  in  1 5,000,  The 
figures  are  given  by  Waller*  Brit  Med*  Journ.,  April 
23rd,  1898.  p*  1,059,) 

Paul  Bert,  although  working  on  somewhat  different 
lines,  and  without  any  knowledge  of  Snow's  views, 
arrived  at  the  same  figures.  1**-,  2  per  cent*  vapour  will 
produce  anaesthesia.  It  is  true  that  Snow  speaks  of  a 
safe  5  per  cent,  vapour,  but  his  methods  oi  giving 
chloroform  were  so  inexact  that  the  actual  vapour 
inhaled  was  never  anything  like  the  dangerous  $  per 
cent,  spoken  of. 

When  Clover  adopted  a  dosage  method  of  giving 
chloroform*  he  fixed  his  maximum  at  4*5  Per  °ent** 
which  was  too  dangerous  for  operations  lasting  any 
time,  and  even  in  his  skilled  hands  actually  proved 
fatal.  His,  like  other  methods  based  upon  the  prin- 
ciple of  mixing  large  quantities  oi  air  and  chloroform 
vapour,  was  fallacious*  In  the  first  place,  the  gases  do 
not  remain  equally  intermingled,  and  the  heavy 
chloroform  vapour  sinks,  so  that  the  first  portion  in- 
haled possesses  a  lower  tension  than  the  last. 

An  apparatus  I  have  seen  used  in  France,   invented 

by  Dr*  Dubois,  and  which  was  described  in  the  press 

tly  by  Dr*  Waller,  who  showed  it  in  London  and 

at  Hereford,  gives  a  2  per  cent*  vapour,  and  produces 

anaesthesia. 

Thus  we  see  that  experiment  shows  2  per  cent*  of 
chloroform  vapour  is  safe,  and  clinical  experience  reveals 
that  it  is  effectual  certainly  in  some  a 

Further*  we  may  dismiss  most  of  the  methods 
suggested,  such  as  are  inapplicable  for  general  use  on 
account  either  of  their  inaccuracy  or*  in  the  case  ot 
Dubois'  machine,  as  being  too  cumbersome  and  costly. 

The  next  question  is— What  are  the  requiremen ! 
the  surgeons  of  to-day,  and  how  far  can  these  require* 
ments  be  met  by  low-tensioned  chloroform  vapours  ? 


304    The  Medical  Peess.         ORIGINAL  COMMUNICATIONS. 


March  23,  19041 


All  admit  it  is  a  very  different  matter  to  undertake  the 
conduct  of  the  anaesthetic  for  the  more  serious  opera- 
tions in  vogue  at  the  present  time  than  it  was  in  the 
case  of  such  surgical  proceedings  as  were  performed  a 
generation  or  so  back.  The  anaesthetist  is  expected  not 
only  to  make  and  keep  his  patient  unconscious,  but  he  is 
asked  to  insure  muscular  relaxation,  and  the  abeyance 
of  as  many  of  the  reflexes  as  is  consistent  with  his 
patient's  ultimate  recovery.  Indeed,  in  many  in- 
stances, the  inability  of  the  chloroformist  to  accom- 
plish this  must  result  in  the  failure  of  the  operation  and 
jeopardise  the  patient's  chances  of  after-recovery. 

You  ask,  then— £an  2  per  cent,  of  chloroform  vapour 
effect  this  ?  and  I  am  bound  to  say  that,  with  Mr. 
Harcourt's  inhaler  I  must  answer,  It  will  do  so.  But 
before  I  tell  you  in  a  few  words  what  I  have  done  with 
it,  I  am  anxious  to  point  out  what  will  explain  the 
apparent  discrepancy  between  myself  and  others  with 
regard  to  "  light  "  and  "  deep  "  narcosis. 

In  the  teaching  and  in  many  of  the  books  of  trust- 
worthy men,  you  will  find  that  they  emphatically 
caution  against  "  light  anaesthesia,"  and  point  out  the 
many  reflex  dangers  liable  to  accrue  if  their  directions 
are  unheeded.  I  am  convinced,  however,  that  a 
common,  if  not  general,  misapprehension  exists  with 
regard  to  so-called  -light  anaesthesia."  It  is  this. 
The  patients  who  reveal  these  reflex  troubles  are  not 
anaesthetised  at  all.  There  are  two  conditions  ;  one 
is  incomplete  or  irregular  narcosis  or  anaesthesia,  and 
the  other  is  light  anasthesia,  and  these  are  absolutely 
different  things.  In  practically  all  cases  the  patient 
must  pass  definitely  into  the  third  degree  of  narcosis 
before  the  anaesthesia  is  complete.  Then,  and  not 
until  then,  if  in  the  view  of  the  anaesthetist  a  light 
phase  of  anaesthesia  is  best  for  the  patient,  and  is 
sufficient  for  the  requirements  of  the  surgeon,  the 
anaesthetist  can,  by  lessening  the  dosage  of  the  anaes- 
thetic, diminish  the  depth  of  the  narcosis  without 
running  any  risk  of  reflex  dangers.  He  will,  of  course, 
have  to  expect  the  phenomena  characteristic  of  the 
particular  phase  of  narcosis,  but  of  none  other.  The 
incomplete  anaesthesia  is  the  type  one  commonly  hears 
of,  and  sometimes  sees,  in  the  hospitals  among  learners. 
The  patient  is  hurried  often  with  a  too  strong  vapour 
of  chloroform  into  a  drugged  state,  the  mixture  of 
chloroform  in  the  blood  stream  is  irregular,  some 
tissues  are  over-dosed,  others  are  under-dosed.  The 
operation  is  commenced  and  the  patient  moves  or 
vomits  ;  then  the.  anaesthetic  is  pushed,  and  disaster 
may,  and  commonly  does,  occur. 

Will  you  forgive  me  if  I  pursue  this  matter  a  little 
further  and  compare  the  physiology  of  "  incomplete" 
with  "light"  narcosis  ? 

We  have  to  deal  with  the  vasomotor  system,  the 
lungs,  their  nerve  mechanism,  the  pulmonary  circu- 
lation, the  heart,  and  the  vagus  control.  To  insure 
safety,  all  these  must  work  in  harmony.  What  may 
occur,  however,  and  I  am  afraid  often  does  occur,  is 
that  in  this  irregular  anaesthetisation  first  one  strength, 
then  another,  the  machinery  is  put  out  of  gear. 

The  work  of  McWilliam  has  recently  been  extended 
by  Bliss  Sowton  and  Professor  Sherrington,  and  we  now 
know  by  their  research  on  the  isolated  mammalian 
heart  that  not  only  does  the  heart  undergo  acute 
dilatation  when  chloroform  perfuses  the  coronary 
vessels,  but  that  even  1  in  100,000  produces  a  weaken- 
ing of  both  the  auricular  and  ventricular  beats  by 
30  per  cent,  and  49  per  cent.  When  more  concen- 
trated solutions  were  perfused  the  effects  were  even 
more  marked,  and  were  ultimately  destructive  to  the 
structure  of  the  muscle.  But  equally  important  re- 
searches in  this  connection  are  those  of  Rudolph  and 
Embley,  who  have  independently  worked  out  the 
part  played  by  the  vagus  control  in  chloroform  nar- 
cosis. The  first  point  is  that  the  vagal  centre  becomes 
unduly  irritable  under  chloroform,  and  the  more  so 
when  the  vapour  is  strong.  In  early  narcosis  Embley, 
working  with  over  2  per  cent,  vapour,  repeatedly 
obtained  complete  and  fatal  vagal  inhibition  of  the 
heart. 

With  lower  dilutions  the  inhibitory  action  was  not 


fatal.  The  point  I  desire  to  emphasise  is,  that  the 
dilatation  of  the  heart  and  the  vagal  inhibition  are  not 
fatal  when  a  lower  tension  of  chloroform  is  uniformly 
acting  upon  the  tissues  of  the  body,  but  are  unavoid- 
ably fatal  when  the  uniform  tension  is  high  or  an 
irregularly  distributed  amount  of  chloroform  finds  its 
way  to  vital  points.  Then,  as  regards  vasomotor 
action.  All  observers  agree  that  under  chloroform  the 
blood  pressure  falls.  This  fall  is  proportional  to  the 
actual  tension  of  the  chloroform,  fr"d  always  makes  for 
danger  both  by  depriving  the  nerve  centres  and  heart 
of  their  necessary  blood  supply,  and  by  draining  the 
blood  generally  from  the  arteries  into  the  veins,  more 
particularly  into  the  large  abdominal  veins,  felicitously 
called  by  Leonard  Hill  "  the  abdominal  pool."  One 
sees  in  abdominal  sections,  especially  under  chloroform, 
that  as  soon  as  the  abdominal  walls  are  opened  there 
is  some  shock,  which  steadily  increases,  and  is  most 
marked  in  deep  narcosis.  This  is  easily  explained. 
The  vessels  are  no  longer  protected  by  the  parietes, 
and  the  thin-walled  vessels  dilate  and  receive  more 
blood.  The  reverse  is  seen  when  the  abdomen  is 
closed.  The  shock  lessens,  the  patient  gradually 
rallies,    because    the   hemodynamics  of  the  abdomen 


Mr.  Vernon  Harcourt's  inhaler— the  index  point  is  1  per  cent. 

have  again  resumed  their  normal  condition.  ~~  Now, 
with  a  low  percentage  of  chloroform,  these  dangers 
are  lessened  or  even  annulled.  To  put  it  in  another 
way,  if  dangers  arise  when  the  chloroform  in  the  body 
is  uniformly  distributed  and  is  of  low  tension,  remedial 
measures  result  in  the  safety  of  the  patient:  if  the 
tension  is  high,  the  patient  dies.  It  would  be  worth 
much  discomfort  to  the  operator  to  ensure  this  main- 
tenance of  safety,  but  I  think  that  my  cases  will  show  no 
discomfort  to  the  surgeon  need  arise  when  a  low  tension 
of  chloroform  is  employed. 

With  high-tensioned  vapours,  my  past  experience 
goes  to  show  that  it  is  extremely  difficult  to  ensure  a 
uniform  distribution  of  chlorotorm,  and  it  often  hap- 
pens that  a  patient,  seemingly  narcotised,  is,  in  fact, 
incompletely  anaesthetised,  and,  even  if  he  safely 
emerges  from  the  stage  of  induction,  is  in  greater  peril 
ot  reflex,  shock,  respiratory  failure  and  death.  It 
must  never  be  forgotten  that  unlike  other  anaesthetics 
chloroform  is  a  protoplasm  poison,  and  that  at  a  cer- 
tain strength  it  not  only  paralyses  nerve  and  muscle, 
but  absolutely  kills  them.  This  destructive  power 
actually  increases  with  the  strength  of  chloroform  which 
is  carried  through  the  tissues  by  the  blood  stream. 

Now  if  we  admit  that  a  2  per  cent,  vapour  of  inhaled 
chloroform,  even  taken  for  a  prolonged  period,  is  not  de- 
structive to  nerve  and  other  tissues,  that  it  does  not  ren- 
der the  dilated  heart  unable  to  contract  sufficiently  to 


March  33,  1904.' 


ORIGINAL  COMMUNICATIONS.        the  Mewcal  Pmm.    305 


maintain  the  circulation,  that  it  does  not  involve  risk  of 
fatal  vagal  inhibition,  that  it  docs  not  cause  a  dangerous 
fall  of  blood  pressure,  we  have  at  least  got  to  know  what 
haven  of  safety  we  should  seek.  For  the  present  we 
are,  I  submit,  warranted  in  believing  that  possibly  as 
our  methods  improve  and  our  knowledge  increases  we 
may  recognise  that  z  per  cent,  is  too  high  a  concentration. 

1  will  aot  attempt  here  to  suggest  what  2  per  cent,  inhaled 
chloroform  represents  in  the  residual  air  of  the  lungs 

the  blood  or  tissues  .  The  data  at  present  is 
wnating,  I  propose  rather  to  explain  how,  by  means 
■  <i  Mr.  Harcourt 's  simple  apparatus,  we  can  obtain 
ibis  2  per  cent.,  and  Jessen  it  as  the  necessities  of  the 
case  require.  The  apparatus  consists  of  a  two- 
necked  bottle,  which  is  filled  with  chloroform 
to  near  the  top  of  the  conical  part,  and  two  coloured 
glass  beads  are  dropped  into  the  liquid  to  indicate 
when  the  temperature  is  within  the  range  13**15°  £ 
If  the  temperature  of  the  chloroform  is  below  1 3°,  both 
the  coloured  beads  will  float ;  if  it  is  above  1 5°  both 
will  sink  ;  in  the  former  case  the  proportion  of  chloro- 
form inhaled  will  be  less  than  the  pointer  of  the  stop- 
cock indicates ;  in  the  latter  case  it  will  be  greater. 
During  inhalation  the  chloroform  is  cooled  by  evapora- 
tion ;  its  temperature  may  be  kept  between  130  and 
if  by  nofw  and  then  holding  the  bottle  in  the  hand 
till  the  red  bead  has  floated  up  and  the  blue  bead  is 
beginning  to  rise. 

The  stopcock  is  so  made  that  when  the  pointer  is  at 
the  end  of  the  arc  nearest  the  bottle  of  chloroform  the 
inaximum    quantity   is   being    administered— namely, 

2  per  cent.  When  the  pointer  is  at  the  opposite  end 
only  air  will  be  inhaled  ;  and  when  it  is  midway  dilu- 
tion of  the  2  per  cent,  mixture  with  an  equal  volume  of 
air  will  make  the  proportion  1  per  cent.  The  shorter 
lines  on  either  side  indicate  intermediate  quantities, 
namely,  q-S,  06,  0/4,  0/2,  and  towards  the  chloroform 
bottle,  12  i'4  1-6,  r8. 

The  valves  on  the  two  branches  prevent  the  entrance 
into  the  apparatus  of  expired  air,  and  also  serve  to 
show  whether  the  stopcock  is  working  rightly.  Only 
one  valve  opens  when  the  pointer  is  at  either  end  ol  the 
scale,  both  equally  when  the  pointer  is  midway,  ;itu1 
for  all  other  positions  one  valve  opens  more  and  the 
other  less,  in  the  degree  indicated  by  the  position  of 
the  pointer  on  the  scale.  The  movement  of  thtiM 
valves  shows  also  how  full  and  regular  the  breathing  is, 

It  is  generally  found  that  beginning  with  the  pointer 
at  0*2,  and  moving  it  on  towards  the  chloroform  bottle 
at  the  rate  of  one  division  about  every  half-minute  up 
to  r6or  i'8,  produces  narcosis  as  quickly  as  is  desirable. 

For  the  maintenance  of  narcosis  it  is  believed  that  1 
per  cent,  or  even  less  will  be  found  sufficient*  The 
stopcock  can  be  moved  by  a  touch  of  the  finger  so  as  at 
once  to  increase  or  diminish  the  dose. 

The  face-piece,  which  is  provided  with  an  expiratory 
valve,  and  can  be  fixed  in  any  position,  is  either 
attached  directly  to  the  inhaler,  which  in  this  case  is 
held  in  the  hand,  and  should  be  kept  as  nearly  vertical 
and  as  steady  as  possible,  or  can  be  connected  by 
about  20  in,  of  half-inch  rabbet  tubing,  the  inhaler  in 
ase  being  supported  on  a  stand  or  hung  on  to  the 
back  ot  the  bed. 

The  mask  is  made  of  solid  toughened  rubber,  fitted 

a  rubber   air-cushion.     It    can   be    washed,    or 

boiled,  and  as  it  becomes  plastic  in  hot  water  the 

shape  can  easily  be  modified,  if  required!  so  as  better 

to  fit  the  patient's  face. 

Now  any  apparatus  must  differ  in  the  hands  of 
various  men,  for,  happily,  none  can  even  invent  "  a 
peony-iu-the-slot  chloroform  machine."  There  must 
be  the  con t rolling  mind  behind  the  mechanism  ;  in  the 
first  place  the  hand  must  acquire  the  dexterity  necessary 
to  get  the  full  use  of  the  contrivance,  and*  secondly* 
as  the  user  has  the  power  of  altering  the  strength  of 
vapour  his  knowledge  must  guide  him  in  selecting  the 
requisite  strength  of  vapour  for  each  patient. 

It  would  be  tedious  to  read  lists  of  cases  to  you,  so  I 
will  only  mention  a  few,  and  in  passing  say  I  have 
now  used  this  inhaler  for  some  hundreds  of  cases, 
including  the  graver  abdominal  operations  involved  in 


partial  resection  of  the  stomach,  pylorectomies  * 
enterectomies,  gas  tro -enterostomies,  hysterectomies* 
colectomies,  append ico to mies  ;  with  cholecystectomies, 
and  other  very  complex  operations  involving  the  Liver 
and  intestines.  I  must  add  to  mv  list  removal  of  cerebral 
growths*  Hartley- Krause's  resection  of  the  Gas- 
serian  ganglion,  the  dissection  of  the  nerves  in  the 
suboccipital  triangl  e  for  torticollis,  and  a  number 
of  other  operations  more  severe  to  perform  in  some 
cases  than  their  mere  names  might  indicate.  In  most 
of  these*  although  employing  a  2  per  cent*  for  induction, 
I  have  worked  with  a  1  per  cent.,  or,  in  some  cases,  a 
*S  per  cent,  vapour.  Now  I  think  these  operations  re* 
quire  two  things  from  the  anaesthetic  a  they  call  for 
a  complete  and  absolute  narcosis,  and  a  freedom  from 
reflex  movements.  These  cases  tax  the  skill  of  the 
surgeon,  and  induce  him  to  look  for  and  demand  from 
his  chloroformist  that  such  desiderata  are  given  him*  and 
when  I  say  that  in  only  one  case  have  I  supplemented 
the  Harcourt  inhaler*  and  then  only  for  a  minute  at 
a  critical  moment  in  a  gall-bladder  case,  when  there 
was  some  rigidity,  I  think  I  may  say  that  I  have  some 
reason  to  believe  that  the  narcosis  offered  was  satis- 
factory from  the  point  of  view  of  the  surgeon.  In 
none  of  these  cases  have  I  been  caused  any  alarm  by 
conditions  arising  from  the  anaesthetic. 

*  But  there  are  other  cases  in  which  the  operation  is 
not  so  much  to  be  dreaded  as  the  actual  condition  of 
the  patient.  Into  this  category  come  bad  empyemas 
and  liver  abscesses,  communicating  with  a  bronchus, 
extensive  goitres  with  tachycardia,  and  fat*  feeble 
people  with  an  addiction  to  alcohol. 

I  have  used  the  inhaler  now  for  several  goitres  and 
several  empyemas,  and  with  these  have  found  the 
greatest  comfort  from  being  able  to  diminish  my  per- 
centage of  chloroform.  You  may  say  that  a  skilled 
man  with  a  Skinner's  mask  and  a  drop  bottle  can  do 
this.  Possibly,  but  how  many  can  ?  And  if  you  try 
even  your  skilled  men  and  test  them  by  accurate 
methods  I  venture  to  say  that  their  percentages  will 
be  wildly  wide  of  the  wished-for  amount. 

I  wish,  if  I  may,  to  mention  a  few  cases. 
*~  A  lady  of  extreme  obesity*  over  60*  puffy,  had 
cancer  of  the  body  of  the  uterus,  and  as  abdominal 
section  through  many  inches  of  fat  was  thought  im- 
possible, it  was  decided  to  perform  a  vaginal  hysterec* 
tomy.  Her  condition  was  so  unsuitable  for  any  anaes- 
thetic that  I  had  to  warn  the  friends  that  her  life  was 
in  danger.  As  a  matter  of  fact,  she  not  only  gave  me 
no  trouble,  she  was  not  sick,  had  no  headache,  and 
told  me  subsequently  she  had  no  idea  that  she  had 
taken  an  anaesthetic. 

A  lady  of  over  40,  a  chronic  asthmatic,  with  grave 
aortic  lesions,  kidney  trouble,  and  bronchial  catarrh, 
was  another  case  so  bad  that  I  was  seriously  anxious 
about  her.  The  result  of  the  chloroformisation  was 
absolutely  perfect.  There  was  no  trouble  during  the 
narcosis  or  afterwards. 

But  an  even  worse  case  was  that  of  a  gentleman 
whom  I  was  asked  to  see  to  determine  whether  he  could 
take  an  anaesthetic.  1  am  allowed  to  mention  this 
case  by  the  courtesy  of  one  of  the  Fellows  of  this 
Society.  This  patient,  aet.  60,  about  five  feet  high,  and 
nig  over  seventeen  stone,  had  rolls  of  fat  all  over 
him.  He  suffered  from  bronchitis  and  emphysema, 
with  a  feeble  fatty  heart  with  dilated  aortic  and  mitral 
orifices,  and  albuminuria.  I  expressed  the  opinion 
that  unless  the  operation  were  imperative  with  a  view 
to  saving  life  he  ought  to  be  spared  what  I  regarded 
as  a  grave  risk,  especially  as  previously  he  had  taken 
an  anaesthetic  with,  I  was  told*  extreme  difficulty,  and 
was  placed  in  some  danger.  However,  as  the  opera- 
tion had  to  be  done,  I  used  the  Harcourt  inhaler,  and 
had  no  difficulty  in  maintaining  anaesthesia*  after 
obtaining  fuli  narcosis,  by  a  1  per  cent*  vapour* 

♦  Another  class  of  cases  is  that  of  intestinal  obstruction 
with  vomiting.  With  some  grave  cases  of  this  sort  I 
have  used  the  inhaler  successfully  because  I  was  able 
to  limit  my  doses  so  accurately.  In  the  same  way 
patients  with  a  cerebellar  tumour,  since  there  is  com- 
monly pressure  in  the  region  of  the  medullary  centres. 


306     The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


March  23,  1904. 


are  among  the  most  dangerous  with  which  chlo re- 
formists have  to  deal.  When  we  employ  a  low  per- 
centage vapour  these  dangers  are  lessened,  and  with 
Mr.  Harcourt's  inhaler  I  have  satisfactorily  dealt  with 
several  of  these  cases. 

The  dangers  met  with  in  using  this  inhaler  have  been 
in  no  case  serious.  I  have  never  had  to  employ  arti- 
ficial respiration  or  tongue  traction  or,  indeed,  any 
heroic  treatment  whatever.  As  to  after-effects, 
vomiting  has  often  been  absent,  and  I  believe  generally 
less  severe  than  when  other  methods  are  adopted. 
In  many  instances,  delayed  vomiting  follows  chloro- 
form in  cases  where  morphine  has  been  given,  and  it  is,  I 
believe,  often  the  combination  of  these  two  drugs 
which  occasions  the  troublesome  vomiting. 

In  conclusion,  I  would  say  that  the  gist  of  this  com- 
munication is  to  be  found  in  the  statement  that  a 
vapour  of  chloroform  not  exceeding  2  per  cent,  is  quite 
adequate  for  surgical  anaesthesia,  and  its  use  avoids 
most  of  the  grave  dangers  of  this  anaesthetic ;  that 
such  a  percentage  can  be  obtained  by  the  proper  use  of 
Mr.  Harcourt's  inhaler,  and  this,  with  experience,  will 
be  found  sufficient  for  all  requirements.  like  all 
apparatus,  its  technique  must  be  mastered,  and  it 
must  be  used  with  intelligence  and  a  knowledge  of 
the  powers  and  limitations  of  chloroform  in  order  that 
the  most  satisfactory  results  may  be  obtained* 

BRONCHOSTENOSIS,  (a) 

By  A.  FRAENKEL,  M.D., 
Professor  of  Medicine,  University  of  Berlin, 

Bronchostenosis  was  divisible,  he  said,  into  four 
groups  :  (1)  By  wandering  disease  ;  (2)  by  compression 
from  without ;  (3)  by  foreign  bodies  ;  (4)  by  spasm  of 
the  bronchial  muscles.  The  two  first  groups  only  would 
be  discussed. 

Stenosis  might  affect  any  part  of  the  bronchi.  Bron- 
chitis and  bronchi  ectasia  belonged  to  the  first  group. 
Strictly  speaking,  only  those  cases  in  which  the  stenosis 
was  the  prominent  symptom  should  be  called  bron- 
chostenosis. To  it  also  belonged  a  disease  which  he  was 
the  first  to  diagnose  during  life — viz.,  bronchiolitis 
acuta  fibrosa  obliterans,  and  which  might  lead  to  death 
in  a  fortnight.  The  case  he  first  reported  was  briefly 
as  follows : — A  man,  who  was  a  brazier,  aet.  35,  had,  a 
few  hours  before  being  admitted  into  hospital, 
bent  too  low  over  the  acid  trough,  and  had  inhaled 
the  caustic  vapour  in  large  quantities.  Immediately 
an  attack  of  choking  came  on  which  passed  off  after  a 
time.  Repeated  bad  attacks  of  dyspnoea,  however, 
compelled  him  to  seek  relief.  On  admission,  there 
were  excessive  dyspnoea,  cyanosis  and  increased 
volume  of  the  lungs.  There  was  no  distinct  dulness, 
but  everywhere  small  vesicular  sounds  were  to  be 
heard  ;  no  fever.  The  speaker  took  it  to  be  a  case  of 
acute  congestion.  Gradually  the  lung  symptoms  sub- 
sided and  he  was  inclined  to  a  favourable  prognosis. 
A  week  later  the  symptoms  returned  with  increasing 
violence,  for  which  he  could  find  no  explanation.  On 
that  day  he  happened  to  take  up  a  volume  of  the 
Archiv.  /.  hlinische  Medizin  containing  an  article 
by  Lange,  in  which  were  related  two  cases  where  a 
certain  anatomical  condition  of  lung  was  described. 
The  lung  was  described  as^thicklyjstudded  with  small 
white  nodules,  as  in  acute  miliary  tuberculosis,  and 
it  was  seen  that  the  bronchioles  were  blocked  up  with 
connective  tissue.  Through  this  the  conception  of  the 
case  was  clear.  In  the  first  period  of  the  disease 
necrosis  of  the  epithelium  of  the  bronchioles  had  taken 
place,  and  cauterisation  of  the  deeper  structures ; 
these  caused  acute  swelling  and  dyspnoea.  The  con- 
dition improved  temporarily  as  the  acute  inflammatory 
symptoms  passed  away,  but  got  worse  as  the  granu- 
lation tissue  from  the  cauterised  surface  of  the  bron- 
chioles led  to  closure  of  the  passages.  The  patient 
died  on  the  twenty-first  day  of  his  illness,  and  the 
diagnosis  was  confirmed  at  the  autopsy.  There  was 
obliterating  fibrous  bronchiolitis  with   the  signs  de- 

(«)  Abstract  of  a  Paper  read  before  the  Verein  far  innere  Median, 
Berlin. 


scribed  by  Lange.  This  affection  had  been  hitherto 
overlooked.  Within  the  last  two  years  he  had  seen 
three  similar  cases,  the  last  only  ending  in  recovery. 

The  first  case  was  that  of  a  young  man  who  was 
admitted  into  hospital  during  the  writer's  absence 
from  Berlin.  There  were  cyanosis,  marked  dyspnoea, 
and  extensive  vesicular  breathing,  and  the  patient 
died  rapidly.  Acute  miliary  tuberculosis  had  beta 
diagnosed.  The  autopsy  revealed  the  condition 
described  in  the  previous  case.  The  man  had  worked  at 
making  composition  walls,  in  which  wire  netting  was. 
covered  with  a  mixture  of  plaster  of  Paris,  calves'  hair, 
glue,  and  mortar.  A  large  quantity  of  dust  was  caused, 
which  was  inhaled  by  the  workmen.  Perhaps  mischief 
was  set  up  by  inhalation  of  bacteria  on  the  hair. 

The  second  case  had  similar  symptoms,  and  showed 
identical  signs  after  death.  The  history  showed  that 
the  man  had  opened  a  drug  business  a  fortnight  before,, 
and  had  probably  inhaled  some  sharp  vapours. 

The  third  case  occurred  three  months  ago.  A 
young  man  was  admitted  with  frightful  dyspnoea 
and  cyanosis.  Some  chloride  of  lime  had  been  shaken 
up  from  which  a  good  deal  of  dust  had  been  given  off. 
After  inhalation  of  oxygen  the  patient  had  been  dis- 
charged a  fortnight  after  inhaling  the  dust. 

In  all  the  cases  in  which  a  post-mortem  examination 
was  made  there  had  been  necrosis  of  the  smaller 
bronchi  and  a  development  of  connective  tissue  in 
the  bronchioles. 

He  now  ^urned  to  stenosis  of  the  larger  bronchi, 
caused  by  pathological  processes  in  the  bronchial 
glands.  These  had,  as  was  known,  the  beneficial 
function  of  keeping  back  corpuscular  elements,  such 
as  bacteria  and  dust.  When  much  dust,  however, 
was  collected,  they  eroded  and  died  off.  There  was 
danger  of  serious  disease  starting  from  them,  such  as 
suppurations,  the  giving  off  of  sequestra,  &c.  Pss- 
might  burst  through  into  the  oesophagus,  the  large  blood- 
vessels in  the  mediastinum.  .Constriction  of  the  bronchi 
might  be  caused  by  periadenitis,  or  adhesive  pericarditis 
might  be  set  up. 

He  mentioned  two  cases,  one  that  of  a  stone-mason, 
who  was  admitted  with  stridor  and  cyanosis ;  there 
was  dulness  over  the  left  lobe  and  feeble  respiration. 
The  diagnosis  lay  between  aneurysm  of  the  aorta  and 
chalicotic  thickening  of  the  lung.  The  patient  died, 
and  the  autopsy  showed  chalicosis  with  adhesive 
pericarditis,  the  wall  of  the  pulmonary  artery  being 
eroded,  and  narrowing  of  the  bronchus.  The  second 
was  that  of  a  woman,  aet.  78,  who  was  admitted  with 
symptoms  of  tumour  in  the  lung.  She  died  as- 
phyxiated. The  autopsy  showed  there  was  no  tumour* 
but  periadenitic  processes  with  consecutive  broncho- 
stenosis. 

The  diagnosis  in  such  cases  could  only  be  deter- 
mined by  stridor,  contraction  of  the  chest  wall,  weak- 
ened respiration  and  dulness.  In  slowly-developing 
cases,  however,  both  stridor  and  dyspnoea  might  be 
absent. 

A  third  group  of  affections  causing  bronchostenosis 
were  thoracic  tumours,  especially  malignant  ones. 
They  proceeded  in  60  per  cent,  of  the  cases  from  the 
bronchi.  The  sarcomata,  on  the  other  hand,  generally 
started  from  the  lymph  glands,  spread  along  the 
bronchi,  grew  into  the  lungs,  and  might  compress  them. 
If  the  tumour  were  large  there  was  intense  dulness. 
Sometimes  the  tumour  was  small,  and  the  dulness 
would  then  be  due  to  secondary  processes.  The 
following  was  a  case  : — A  colleague  was  taken  suddenly 
ill  with  dyspnoea  and  fever,  and  expectorated  foul- 
smelling  sputa.  Dulness  over  the  whole  posterior  wall- 
It  was  believed  to  be  influenza  with  secondary  putrid 
empyema  emptying  into  the  lung.  The  patient  died 
with  typhoid  symptoms,  and  the  autopsy  showed  that 
it  was  not  a  case  of  influenza,  but  that  there  had  been 
a  tense  infiltration  with  melting  down.  There  was  a 
carcinoma  the  size  of  a  hazel-nut  in  the  right  lower  lobe- 
that  had  blocked  up  the  bronchus.  There  was  no 
stridor,  as  the  lumen  was  completely  blocked. 

He  drew  attention  to  two  symptoms  in  such  cases : 
(1)  A  change  of  all  symptoms  where  a  tympanitic 


Marcr  JZJ*    1904> 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Psjess.    3°7 


tanged  with  d  illness  caused  liy  i  contracting 
ihing  oi  the  mediastinum  towards 
The  afi  j  action  of  the  lung* 

vtmentif  syphilis  was  the  cause,  relief  would 

...n  by  sounding  ;    but  this  was  nut   easily  done. 

By   !  (,re    in    a    position    to    know 

her  we  could  do  anything  or  not.     We  should  be 

was  no  aneurysm  before  attempting 

lo  u$e  the  sound.     The  best   results  were  obtain i 

ise  of  foreign  bodies,  the  situation  oi  uhich  we 


yielded  highly  sa  lis  fat to  ry  results,  j^ogrm*.  of  meat 
and  a  corresponding  quantity  of  sanatogen  were  cm- 
1  in  the  experiment  ,  and  nearly  Mjnilat  qostu 
tities  of  unahsorbed  nitrogen  were  eliminated  — i  \Q2 
grms.  and  147=5  grffll,  ol  nitrogen  daily.  So  that  ."in 
the  case  of  a  healthy  man.  there  is  little  difference  as 
regards  facility  for  absorption.     Without   referring  to 

its,    I   ran  state   from  up.    own   cli] 
experience    that    /    A.irr     uaed    tamatogen    fa    a    U*w§§ 
number   ■•/  cases   [nutritional  disorders   of   neural 


were  ablets  .It-  J.-ct  by  bronchoscopy.     Here  extraction    neurasthenic   origin),  and   haw   s* 

should  not  be  delayed,  but  should  be  carried  out  « I  Thft  proportion  of  glyoertti-plioanliofic  arid  present  ha* 


is  made,   so  that  secondary 
lischiei  \  led, 


thk 
ABSORPTION  OF  SANATOGEN 

IN 

ENTERIC    FEVER; 

By  Da.  C    A.   BWAUJ. 

Proteflftor  of  ktedteEirtln  the  Tniiertity  of  Berlin. 


also  induced   me    fco   pr-  scribe   tins   food;   which,  as  a 
cleavage  product    ot    lecilhin,     should,     accxir.hn. 
French  investijj  !y    \.    Robin,   exercise  a 

pronounced  tonic  action,  (n)  The-  patimts  look  it  in 
their  soup.  milk.  cocoa,  and  other  usual  ways.  mm\  it 
always  seemed  to  promote  the  general  nutrition  m  such 
a  way  t  hat  l  here  was  a  resulti  n  g  increase  of  bod  y  -  \\  < 

It  has  recently  been  repeatedly  suggested  that 
typhoid  patients  should  receive,  during  the  course  of  the 
fever,  a  dirt  rich  tn  albuminous  ^utfotanees,  and  thai 
by  such  means  the  resistance  of  the  organism  would  be 


fTRANSLATEn   B\    m   H    BeRUN   CORRESPONDENT.! 

bet  oi  artificial  food -stuffs  which  are  being    increased,  the  severity  of  the  disease  lessened,  and  the 
continuously  produced  m  the  present  day  have  come  i  period  of  convalescence  shortened.    Gornieki  Barrs,  and 


[iresent    a    special    and    extensive    form   of    00m< 

irtlingly,    it    may   be    regarded 

a*  a  public  duty   to  examine  some  special  one,   and 

demonstrate  in  cxa  its  relative   facility  for 

absorption   and    Hs    value    to    the    human    organism . 

There  exists  such  an  +r  embarrassment  o!  riches  "  in 

tins  domain  that  a  hi>t  i  likely  to  depend 

.  ident  than  on  any  special  superiority  in  the  article* 

he  other  hand,  1  wish  to  emphasise  the  view  that 

important  whether  a  certain  preparation 

soluble   carbohydrate  or  peptone   than 

ther,  than  is  its  taste  and  property  of  "  agreeing 

"  the  digestive  organs.     And  as  these  qualm 

ire  so  very  prone  to  alter  or  deteriorate, 
trd  to  the  remedy  itself  and  the  patient, 
isually  desirable  to  have  a  variety  of  such  pre- 
parations in  readiness.     Here*  as  elsewhere,    the  rule 
■  deUctaL     In  the  exeat  majority  of  cases  Its 
which  we  administer  artificial  foods,  the  natural  diges- 
:  unction  is  at  fault,  but  has  not  completely  abdi- 
:  the  exercise  of  its  powers  ;  and  there  still  remains 
ion  of  the  alimentary  canal  which  has  not  suffered, 
and  is  even  able  to  take  on  a  vicarious  action,     Accord- 
it  is   by   no   means   necessary   that,   m  making 
choice  of  artificial  aliment,  the  latter  shall  have  been 
nipletely  as  possible  digested  extra  corpus  ;   it  is 
sufficient    that   it   be   $0   modified   as   to    facilitate   its 
digestion  within  the  body  in  the  direction  in  which  it 
would  otherwise  be  prone  to  disagree  with  the  patient, 
while,  the  organism  is  still  allowed  some  scope  for  the 

Inch  it  can  yet.  to 
ftme  extent,  draw  upon  in  time  of  need.  Only  in  the 
cases  in  which  its  powers  have  completely  failed,  and 
there  i>   no    possibility   of   the   exercise   of   vicaj 

.id  the  food-stuffs  be  admi tu- 
rn the  form   ot    prepared    dextrin,    glucose,    or 
peptone. 
The  artificial    food   industry  has  recently    been   in 
measure  conducted  in  accordance  with  this  view  ; 
series  of  preparations  have  been  placed  on  the 
market     whose    values   depend    not   so    much   on    the 
i    of   pre-di^eslcd   products   actually   present 
their  solubility   in    the  digestive   fluids,    their 
easy  modification  thereby,  and — last,  not 
convenience  of  form,  and  consequently 
fluent  price. 
To  this  class  belongs   s  ana  to  gen.    a    glycerin-phos- 


Purilz  (b)  have  even  ad  ministered  food  prepared  from 
hard-boiled  eggs,  cutlets,  white  and  brown  bread 
minced  and  pulverised,  and  have  reported  favourable 
results.  Such  advice  does  not  commend  itself  to  mv 
clinical  conscience.  Where  one  has  hundieds  of  typhoid 
intestines  under  his  care,  and  recollects  that  in  appa- 
rently mild  cases  extensive  and  deep  ulceration  often 
he  will  not  lightly  undertake  the  administration 
of  such  crude  diet — .which,  under  any  circumstances,  is 
not  an  indifferent  one  for  the  mucous  membra  Hi 
deal  with,  I  regard  it  as  a  specially  fortunate  circuit 
stance  that  those  observers  have  had  no  untoward 
results  ;  I  would  not  venture  to  administer  such  crude 
diet  to  a  typhoid  patient  till  a  fever- tree  period  of  six 
to  eight  days  had  elapsed.  It  appears  decidedly 
rational  to  maintain  the  nutrition  of  a  typhoid  patient 
at  a  hi^h  standard  from  the  beginning  ;  and  the  time- 
honoured  milk  diet,  enriched  w+ith  the  alloy  of  an  easily- 
digested  fluid  or  pulpy  preparation  of  albumm,  may 
be  employed  for  this  purpose.  One  can  in  this  way, 
by  the  employment  of  sugar  and  thin  cream,  and 
small  quantities  of  alcohol,  easily  attain  a  calorie  value 
of  front  2,500  to  3,oot>  calories;  that  is.  a  proportion  of 
35  to  40  calories  per  kilo,  of  body-weight,  and  15  l 
grms.  of  albumin  per  kilo.  For  this  purpose  I  employ 
sanatogen  as  an  albuminous  preparation.  The  object 
was  to  determine  whether  it  is  freely  absorbed,  and 
whether  it  has  some  influence  on  the  course  of  typhoid. 
The  following  case  was  found  instructive  ;  — 

A  male  patient.  a?t.  34,  was  admitted  to  hospital 
(December  .list,  1902}  complaining  of  debility,  diar* 
rli  ia.  #c+  The  sensortum  was  not  affected.  The 
distinctive  features  ol  pronounced  enteric  fever 
were  all  present — rose-rash,  splenic  tumefaction,  pea- 
soup  diarrhrea,  and  Widal  reaction*  There  was  no 
real  Hon  .  the  urine  contained  traces  of  albumin, 
but  no  sugar.  Pulse  120,  and  dicrotic  ;  tempera- 
ture varied  between  3 8'  =; c"  and  40*  C  ;  yielded  Lo  baths 
on  fifth  and  sixth  days,  and  fell  (spontaneously)  below 
50°  on  the  eighth  da>\  with  the  usual  (slight}  oscilla- 
tions following  ;  but  from  the  nineteenth  day  after 
admission  there  was  but  little  rise  over  37*  observed. 
There  were  no  serious  compb 

Till  the  fifth  day  his  daily  diet  consisted  of  i\  litre 
of  milk,  a  little  moistened  biscuit,  and  1  to  ij  glass  of 
red  wine,  as  his  genera]  strength  demanded  no  special 
restorative.     On   this  day,    the  gastric  contents  were 


V hone -acid    sodium -casein   compound  :   which    is    not    ___ -,£«_-!  .  j,.iWJ  u  n  i  -  „i       ,«      ,       ,    r 

t   .,  ^  •  iiined     tree  H  LI  was  absent,  and  pepsin-digestion 

astly  soluble,  but  p< assesses  the  advantage  over  minimal 


rmlk-casein  preparations  of  a  better  taste  and  i 
rt                        ,        j.   y      £      ,  4        . ■     .          ,           1  a      I  daily  a  quantity  ot  milk,  cream,  sugar,  and  sanatogen 
flavour,     On  the  relative  facility  of  absorption  of  tha    mM/K .?;_  .  ^J  >    J? 

preparation  and  that  ol  pure  flesh  (beef-sleakj  Vis  and 

Treiipel  \a\  have  conducted  an  investigation   which 


V'u  unci  Tretipel*  "  L'ctwr  die  VerdA«iHehk«ft  eirilger  KiwciM- 


From  that  date  there  was  administered 

y  of  milk,  cream,  sugar,  and  sanatogen 

representing  a    total   of  about   2*74"   calonei,    in   the 

I")  LoMrf,  "  La  Mcdicntion  Phosphor^ e,'*   V&ri*,   11*04.     BulluVm 

ri  mk 

in)   Purity     "■  B+Mi  hli-'he    K^TiwhrnL^     I  -i-U-t^phtt*.1* 

\  irehow '=>  Arr*i*t  Bd,  ISl,  8.  327. 


308    The  Medical  Press. 


CLINICAL  RECORDS. 


March  23,  1904. 


following  proportions  : — Milk,  1,500  c.cm.  =  1,040  cal.  ; 
saline,  500  c.cm. =1,1 50  cal.  ;  milk  sugar,  100  c.cm.= 
410  cal.  ;  red  wine,  100  c.cm.  =  72  cal.  ;  sanatogen, 
20  grms.  =  78  cal. 

This  diet  was  continued  to  the  end  of  the  fever,  and 
till  convalescence  had  been  well  established  (two 
months  after  admission).  He  had  increased  in  weight 
from  45  on  January  20th,  to  46  kilo,  on  January  30th  ; 
4Q  on  February  5th  ;  49I  on  February  12th  ;  52  on 
February  19th  ;  58  on  February  26th  ;  and  59  on 
March  5th.  During  the  first  week  (January  7th  to 
14th),  a  complete  record  of  the  metabolism  was  made 
by  Dr.  Glaessner,  assistant  physician  in  the  hospital. 
During  this  period  the  temperature  ranged  between 
380  and  390  C,  and  fell  but  on  two  mornings  to  370  C. 

The  daily  ingesta  represented  1 1  '46  grms.  of  nitrogen, 
192*2  grms.  of  carbohydrates,  and  78*916  grms.  of  fat. 

The  daily  excreta  for  same  period  : — ia/351  gnns.  of 
nitrogen,  of  which  18*802  appeared  in  the  urine,  and 
the  rest  (0*54  grms.)  in  the  faeces.  The  latter  also 
contained  4*811  grms.  of  fat. 

A  control  experiment  was  made  with  a  working  man, 
apt.  20,  who  was  taken  into  the  hospital  for  a  vague 
indisposition.  He  had  no  fever  nor  visceral  lesion. 
On  the  nasal  mucous  membrane  (left  side)  were  some 
small  erosions,  which  produced  a  somewhat  foetid  dis- 
charge of  blood-stained  mucus.  He  also  complained 
of  uneasiness  in  his  stomach,  but  nothing  was  dis- 
covered to  account  for  it.  He  was  placed  on  a  diet 
similar  to  that  given  to  the  fever  patient,  also  for  a 
period  of  seven  days  (January  15th  to  21st).  He 
weighed  55  kilos,  on  January  12th,  57*5  on  January 
25th,  and  58  on  January  30th.  The  ingesta  per  diem 
represented  11*46  grms.  of  nitrogen,  192*2  of  carbo- 
hydrates, and  78*96  of  fat.  The  daily  excreta  corre- 
sponded to  11*487  grms.  of  nitrogen,  of  which  10*614 
appeared  in  the  urine  and  0687  in  the  faeces  ;  there 
was  also  6*608  grms.  of  fat. 

In  this  connection  we  find  a  glaring  contrast  between 
the  data  regarding  calorie  values  given  in  Dettweiler's 
tables  (in  which  the  milk-sugar  is  reckoned  as  cane- 
sugar)  and  the  actual  contents  of  the  aliment  in 
nitrogen,  carbohydrate,  and  fat,  and  the  results  of 
Glaessner's  analysis  and  the  corresponding  calorific 
value.  Glaessner  determined  the  nitrogen  and  fat  of 
milk  directly,  and  calculated  the  carbohydrates  on  the 
hypothesis  of  4*5  per  cent,  ol  sugar  and  42  of  cream. 
II  we  calculate  the  nitrogen  from  the  albumin  and 
the  maximum  value  of  the  fat  at  9*5  calories  (instead 
oi  9*3),  we  arrive  at  a  total  of  only  1,834-1,840  calories, 
instead  of  the  2,740  which  have  been  reckoned  in  the 
usual  way  in  dealing  with  a  pure  milk  diet.  And  even 
with  a  poor  specimen  of  milk  there  would  be  2,300 
ca  lories.  We  have  thus  to  reckon  with  both  milk  and 
cream  of  poorer  quality.  Nevertheless  we  have  for 
the  original  weight  of  the  individuals  dealt  with  (45  and 
55  kilos,  respectively),  40  and  33*4  calories  per  kilo, 
respectively  ;  and  for  the  mean  of  the  attained  body- 
weight,  34*3  and  33*9  calories  per  kilo.  :  accordingly,  a 
co-extensive  importation  of  calories.  The  conclusion 
of  our  experiment  is  without  result  as  regards  the 
difference  between  the  actual  and  the  calculated 
amount  of  nutriment,  but  it  shows  how  little  reliance 
can  be  placed  on  the  calculated  metabolism  in  cases 
in  which  the  nutrient  material  has  not  been  previously 
subjected  to  an  ad  hoc  process  of  analysis. 

From  the  above  results  we  may  conclude  :  ( 1 )  That 
the  absorption  of  sanatogen  was  very  prompt  in  each 
case.  The  unabsorbed  nitrogen  found  in  the  faeces 
of  the  typhoid  patient  hardly  represented  a  less  favour- 
able proportion  than  in  the  research  of  Vis  and  Treupel. 
In  the  second  case  the  result  was  not  so  good  ;  it  rose 
to  double;  and  it  should  be  remembered  that  such 
occurrences  in  a  prolonged  research  may  introduce 
some  unforeseen  and  unavoidable  complications. 
Nevertheless,  it  remains  clear  to  us  that  the  absorption 
of  freely  soluble  nitrogenous  substances  may  go  on 
freely  and  promptly  in  the  course  of  typhoid,  and  to  a 
degree  not  differing  widely  from  that  of  health.  (2)  The 
fact  that  the  patient  used  as  standard  displayed 
approximate    nitrogen -equilibrium,     although    about 


9  kilos,  heavier  than  the  typhoid  patient  at  the  start ' 
shows  that  the  chosen  diet  was  sufficient — and  more 
especially  as  both  increased  in  weight  during  its  use. 
The  fact  of  more  copious  diminution  of  nitrogen  in  the 
fever  case  is  simply  due  to  the  fact  of  increased  nitrogen 
waste  produced  by  the  fever  process.  Engel  (a)  had 
found  for  a  period  of  eight  days  in  enteric  fever 
a  daily  excess  of  10 '8  grms.  of  nitrogen  excreted  over 
that  ingested.  Svenson  (6)  found  on  the  fifth  and 
sixth  days  of  pneumonia  17  to  20  grms.  of  excess. 
Indeed,  the  net  result  of  the  observation  of  ourselves 
and  others  is  to  confirm  the  general  rule  that  increased 
ingestion  of  nitrogen  in  fever  is  followed  by  increased 
waste,  if  there  be  not  at  the  same  time  a  free  adminis- 
tration of  fat  and  carbohydrates  to  diminish  the 
nitrogen  exchanges.  (3)  As  regards  fat,  about  6*2  per 
cent,  in  typhoid,  and  8*3  per  cent,  in  other  patients, 
remain  unabsorbed.  Rubner  (c)  makes  the  loss 
4*  5  per  cent,  for  milk-fat,  and  4*  1  per  cent,  for  butter. 
Sachse  {d)  found  a  loss  of  ii*i  per  cent,  of  fat  in  a 
woman  with  occluded  cystic  duct,  who  was  fed  on 
milk,  white  bread  and  butter  ;  and  in  another  with 
hydrops  vesica  fellem,  similarly  nourished,  5  per  cent,  of 
the  fat  was  unabsorbed.  V.  Noorden  emphasises  the 
individual  oscillations  in  the  use  of  fat ;  and  holds  that 
a  waste  of  1 1  per  cent,  is  not  proof  of  impaired  diges- 
tion, according  to  which  the  numbers  obtained  by  me 
are  within  normal  limits.  At  all  events,  there  is  more 
effective  use  of  fat  by  typhoid  patients  than  by  others 
with  healthy  stomachs  and  intestines. 

This  holds  good  but  for  the  period  of  fever,  in  which 
our  research  on  metabolism  was  carried  out.  But  the 
metabolism  which  accompanies  the  increase  of  weight 
during  convalescence  must  be  differently  regarded. 
Luethje  (e)  and  Svenson  have  shown  that  the  organism 
at  the  onset  of  convalescence  enters  on  an  intensive 
struggle  for  the  attachment  of  nitrogen.  The  fever- 
patient  and  the  convalescent  retain  per  kilo,  of  body- 
weight  in  their  nutrition  a  proportion  of  58  to  60 
calories — even  running  up  to  90  !  But  our  research 
shows  that  even  with  a  small  quantity  a  higher 
record  can  be  reached.  It  also  shows  that  absorption 
of  fat  is  unaffected  in  fever.  And  the  proportion  of 
93*6  per  cent,  found  by  Svenson  in  convalescence,  and 
of  93*8  per  cent,  in  our  patient,  is  within  normal  limits. 

Our  conclusion,  accordingly,  is,  that  sanatogen,  both 
in  conditions  of  chronic  debility  and  in  acute  febrile 
diseases — more  especially  in  typhoid,  adds  greatly  to  the 
value  of  the  diet,  on  account  of  its  facility  of  absorption 
and  absence  of  irritating  qualities. 

Clinical  IRecorDs* 


LARGE  UTERINE  MYOMA  IN  THE  LEFT  BROAD 
LIGAMENT,      COMPLETELY      FILLING     THE 
PELVIC      CAVITY.  —  HYSTERECTOMY.  —  RE- 
COVERY.  (/) 
By  William  Duncan,  M.D.,  M.R.C.P.Lond., 
Obstetrical  Physician  10  the  Middlesex  Hospital :  Senior  Pnysician  to 
the  Chelsea  Hospital  for  Women. 
The  patient,  set.  53,  was  seen  by  me  in  consultation 
with  Dr.  Tom  Godfrey,  of  Finchley.     Married  in  1875, 
she  had  had   seven  children,   the  youngest,    aet«    13, 
and    five  miscarriages,   the  last  two  years  ago.    The 
catamenia  were  regular  up  to  1902,  when  they  began 
to  be  erratic,  and  sometimes  a  flooding  took  place; 
the  patient  also  complained  of  much  backache  and 
frequent    micturition.     On    examination,    a    central 
firm  tumour  could  be  felt  extending  upwards  midway 
between  pubes  and   umbilicus,   and,    per  vagtnmm,  a 


(a)  Engel,  "  Mitteilungen  aus  der  medinnischen  Klinik  xu  Wners- 
burir,  1886/'  Bd.  2, 8. 116.  ,  ....„, 

(6)  Svenson.  -Stoffweth  ulversuche  an  Rekonveleasenten."  ZnU./. 
klin.  Med.,  Bd.  48,  8. 110. 

(c)  Rubner,  "  Handbuchder  Ernaehrongs-therapie  herausgtgeben. 
Von  v.  Leydon.    Bd.  1,  8. 11«.  ... 

d)  W.  Sachse,"  Ueber  die  Resorption  der  Nehring  bei  Virschluss der 
Gahenblasen  gangen."  Lnang-Dissert.  Berlin,  1894. 

(«)  H  Luethje, "  Beitraege  sur  Kenntoisdes  Eiweissstoff-wechsels, 
Z*it$.  J  klin.  M»d.%  Bd.  44, 8.  66.  .  . 

(  / )  Read    at  the  mseting  of  the    British  Gynecological  Society 
March  loth,  1904. 


March  23,  1904. 


CLINICAL  RECORDS. 


fHE  Medical  Press,     309 


mmour  was  felt,  filling  the  pelvic  cavity  and  displacing 

the  cervix  downwards  and  to  the  right-     This  tumour 

was  evidently  part  of  the  one  felt  in  the  abdomen, 

and  movement  of  it  moved  the  cervix.  The  sound  was 

not  passed* 

Hysterectomy  was  recommended,  and  was  performed 

ptcmber  *J4thh    1903.     When  the  abdomen  was 

opened*  the  tumour  was  found  to  be  attached  to  the 

posterior  wall  ot  the  uterus,  and  to  be  growing  between 

tho  (olds  of  the  left   broad   ligament.     The  ligament 

sncisstl    and    the    tumour,    with   some    difficulty, 

led  out  of  the  pelvic  cavity  ;  the  ovarian  and  uterine 

\es  were  secured  in  the  usual  way  j  the  left  ovary 

«imly  was  removed. 

The  cervix  was  divided  in  the  usual  way,  and  a  hu  ge 

cavity  could    then    lie   seen   extending  between    the 

rs  of  the  broad  ligament  down  to  the  floor  of  the 

After  all  the  oozing  vessels  had  been  secured,  the 

malls  of  this  cavity  were  whipped  together,  from  below 

upwards,   by   a   continuous   suture  of     fine    silk,    the 

peritonea]    nm  were  united  over  the  stump  of  the 

K,  and   the  abdominal  wound   was  closed   with 

three  layers  of  suture,  fine  silk  for  the  peritoneum, 

-.n terra p ted  silkworm-gut  sutures  for  the  sheath  of  the 

muscles,   and   strong   continuous   sdk   suture   for 

■kin. 

The  patient  made  an  absolutely  uneventful  recovery, 

A    rise   ad    temperature,    sickness   or    trouble   of 

r:ind,  and  now,  five  months  after  the  operation, 

perfectly  well,  and  can  take  long  walks  without 

btigtte, 

The  interest  of  this  case  lies  in  the  manner  of  closing 

^irge  cavity  left  between  the  layers  of  the  broad 

nt  after  the  tumour  had  been  removed,  a  method 

h  is  infinitely  better,  and  safer,  than  packing  with 

il  .»rm  gauze,  as  recommended  by  some  operators. 


J,  FIBROCYSTIC  TUMOUR  OF  THE  UTERUS,    {a) 
By  J»  Inglis  Parsons,  M.D.,  M^R.CP.Lond., 

Physician  to  the  Ohetoa  HoepiUl  for  Women  t 
patient,  a  single  woman,  a?t.  40,  complained 
ot  difficulty  in  passing  water  for  the  last   three  years, 
latterly,  of  complete  retention,  necessitating  the 
t  the  catheter.      For  the  last  eighteen  months 
has  noticed   a   swelling   in    her   abdomen ,   accom- 
panied by  pain.     Her  mens  l  mat  ion  has  been  regular, 
twenty-eight  days,  lasting  for  five  days  and  very 
tree  and  painful  for  the  first  three  days. 

Dr.    Cameron .    the    house    surgeon,    described    the 

.abdomen  as  much  distended  by  a  large  tumour  with 

■re  or   less   uniform   surface,    movable   and   not 

tender,  of  a  doughy  consistence,  and  with  a  contour 

like  a  bullock's    heart,    such   as    Professor   Murdoch 

Cameron    has  described  to  be  characteristic  of  fibro* 

astic  tumours.     The  cervix  was  obliterated  and  almost 

hole  of  the  lower  pelvis  was  filled  by  the  tumour. 

The  sound,   passed   with  some  difficulty,   showed   the 

tie  cavity  to  be  seven  inches  long. 

<  >n  opening  the  abdomen,  on  January  12th,  1904,  I 

found  the  pouch  of  Douglas  entirely  obliterated,  the 

pentoneum.  which  usually  forms  it.  with  part  of  the 

rectum  and  sigmoid  flexure,  lying  on  the   back  of    the 

tumour.     After  tying  off  the' broad  ligament  at  each 

and    removing   the  appendages,  as  both  ovaries 

were  diseased,  I  cut  through  the  peritoneum  on   the 

pewter  ,ind  stripped    it  and   the  bowel  down 

away  from  the  tumour,  until  I  came  to  a  point  where 

it  was  firmly  adherent, 

.inents  were  then  tied,  and  the  anterior 

of  the  peritoneum  cut  across  from  side  to  side 

and  stripped  down,  taking  the  bladder  with  it.     The 

ei   the    tumour   were    then    carefully   examined, 

js  the  ureters  seemed  to  be  bclow\  both  uterine 

ineries  were  tied.     The  tumour  was  then    cut  across 

low  down  and  removed,  a  piece  of  the  ad  her  en  t  capsule 

hetug  left  on  the  bowel.     Finally,  the  remains  of  the 

cervix  containing  a  portion  of  the  tumour  were  com- 

t*j  foul  ai  Lhf   Arttinj  u?    iln-  .Bthkh    <_lv  ni*.oolo^ieiU  Bocwly, 
3t«uh  luth»  1904 . 


pletely  removed,  thus  opening  the  vagina.  One  or 
two  small  vessels  had  to  be  tied.  The  vagina  was  then 
closed  by  a  mattress  suture,  the  anterior  and  posterior 
Haps  of  peritoneum  were  united  by  a  continuous  Mlk 
suture,  though  on  the  right  side  there  was  not  en 
of  the  pos tenor  flap  to  meet  the  anterior,  on  account  oJ 
the  adhesions.  The  abdominal  wall  was  united  in 
three  layers.  The  patient  made  an  uninterrupted 
recovery  without  a  single  bad  symptom. 

I  have  brought  this  case  forward  because  fibrocystic 
tumours  are  rare  in  women  of  forty,  and  on  account 
of  the  amount  of  the  growth  in  the  lower  part  of  the 
pelvis  the  removal  of  the  tumour  presented  unusual 
difficulty,  and,  also,  because  Dr.  Cameron,  the  house 
Burgeon,  made  a  correct  diagnosis  based  on  his  father's 
observation  of  the  bullock's  heart  shape  of  fibro- 
cystic tumours. 

It    LARGE      FIBROMA     OF    THE     BROAD 
LIGAMENT. 

The  patient,  a  single  woman,  a?t.  35,  for  two  years 
had  suffered  from  pelvic  pain,  especially  at  her  men- 
strual periods,  which  were  regular,  and  lasted  three 
days  with  a  scanty  discharge. 

On  examination,  a  large  tumour  was  found  filling 
the  pelvis  and  extending  above  the  pobes.  It  was 
hard,  nodular  and  movable,  and  gave  a  sense  of 
fluctuation.  The  uterus,  displaced  upwards  and  U> 
the  right,  was  normal  in  sire,  the  sound  passing  2k 5 
inches.  Abdominal  section,  on  February  23rd.  1004, 
showed  that  the  tumour  was  a  large  nbromyorna  of  the 
right  broad  ligament.  After  tying  the  left  ovarian 
and  uterine  arteries  in  the  usual  way,  and  tying  the 
right  broad  ligament,  the  peritoneum  was  cut  across 
before  and  behind  the  tumour,  and  the  flaps  stripped 
downwards  ;  the  cervix  was  then  divided  from  the 
left  side  until  the  right  uterine  artery  was  exposed, 
and  when  this  vessel  had  been  caught  and  tied  1 13 
Dr.  Bonney,  who  was  assisting  me,  the  tumour  «r&S 
rolled  up  out  of  its  bed.  In  doing  this  the  bladder, 
which  was  closely  adherent  to  the  tumour,  was  un- 
avoidably opened,  and  a  large  raw  space  was  left  in  the 
bed  of  the  tumour,  from  which  there  was  a  great  deal 
of  oozing.  After  several  small  vessels  had  been  secured 
antl  the  oozing  checked  by  hot  sponges,  this  space  was 
brought  together  with  fine  silk  and  the  bladder  sewn 
up.  The  peritoneum  was  then  united ,  and  the  wTound 
closed.  A  soft  rubber  catheter  was  kept  in  the  bladder, 
Three  hours  after  the  operation  the  patient  collapsed 
from  shock,  but  Mr.  Rose,  the  house  surgeon,  promptly 
transfused  a  pint  and  a  half  of  saline  fluid,  and  injected 
Vm  grain  of  strychnine.  The  bladder  was  drained  for 
ten  lays,  and  beyond  passing  some  blood  in  her  urine, 
she  has  had  no  bad  symptoms.  She  can  now  retain 
her  water  for  some  hours,  and  in  a  few  days  will  be 
able  to  get  up. 

III.   SUBMUCOUS  MYOMA, 

The  patient,  a?t.  31,  married  for  eighteen  months, 
but  childless,  was  sent  to  me  by  Dr.  Lauchlan  on 
account  of  profuse  nienorrhagta  of  four  or  five  years* 
duration.  She  was  very  anaemic  from  loss  of  blood, 
and  on  examination,  1  found  a  large,  hard,  irregular, 
nodular  swelling  involving  and  forming  part  of  the 
uterus,  and  reaching  to  the  umbilicus ;  the  sound 
passed  4*  5  inches. 

On  February  23rd,  1904.  1  performed  a  supra* 
vaginal  hysterectomy,  removing  the  left  ovary,  winch 
was  diseased,  but  leaving  the  other.  The*  patient 
made  a  good  recovery,  and  was  able  to  sit  up  on 
March  10th. 


The  question  of  who  shall  remove  the  carcases  of 
dead  animals  in  the  River  Thames  is  a  subject  of  con- 
troversy. It  appears  the  Conservancy  declines  to  deal 
with  these  floating  carcases,  although  empowered  to 
abate  or  remove  *H  all  hindrances  and  abuses  what* 
ever"  in  the  river  or  on  its  banks.  The  medical 
officer  recommends  that  the  City  Solicitor  should  be 
asked  for  his  opinion  as  to  who  is  responsible. 


310    The  Medical  Press.        TRANSACTIONS  OF  SOCIETIES. 


^Transactions  of  Societies- 


BRITISH  GYNAECOLOGICAL  SOCIETY. 
Meeting  held  Thursday,  March  ioth,  1904. 


Professor   John   W.   Taylor,   M.D.,    F.R.C.S., 
President,   in   the   Chair. 


Specimens  and  Cases. 
By  request  of  the  author,   Dr.   H.   Macnaughton- 
Jones  read  the  following  notes  accompanying  tne  two 
specimens  : — 

notes  of  a  case  of  successful  hystero-salpingo- 
o6phorectomy  for  pelvic  suppuration,  by 
T.  Gelston  Atkins,  M.D.,  M.Ch. 

Mrs.  L a  woman,  aet.  about  35,  consulted  me  in 

October,  1903,  stating  ttiat  early  in  January  she  had 
been  confined  of  a  large  male  child  after  a  slow  labour. 
All  seemed  to  go  on  well  for  the  first  five  days,  when 
she  had  a  shivering  attack  with  acute  pain  in  her  left 
side.  For  some  days  the  pain  was  very  severe,  till 
she  felt  something  give  way,  a  gush  of  discharge  took 
place  and  she  felt  greatly  relieved.  She  remained  in 
bed  for  six  weeks,  during  which  time  the  discharge 
diminished  considerably,  but  never  ceased,  and  when  I 
saw  her  early  in  October,  and  made  a  vaginal  exa- 
mination, a  torrent  of  pus,  fully  one  pint,  was  passed, 
and  could  be  seen  coming  out  of  the  os  uteri.  On 
each  side  of  the  uterus  there  was  a  swelling,  and 
pressure  on  either  of  these  caused  the  pus  to  flow 
more  abundantly.  It  was  therefore  clear  that  there 
were  sacs  communicating  with  the  uterus.  A  Sims' 
probe  could  be  easily  made  to  enter  the  sac  on  the 
left  side,  but  not  the  one  on  the  right.  I  therefore 
concluded  that  these  sacs  were  either  pus  tubes  or 
broad  ligament  or  ovarian  abscesses  opening  directly 
into  the  uterus,  and  advised  an  exploration  and  the 
adoption  of  the  proper  course  when  the  exact  condition 
was  made  out.  On  opening  the  abdomen,  I  found 
that  the  omentum  was  adherent  all  round,  and 
presented  the  appearance  of  a  cover  to  the  pelvic 
roof.  When  this  had  been  tied  off,  the  swellings 
were  seen  to  be  the  ovaries  embedded  in  a  dense 
mass  of  adhesions  to  the  bladder,  bowel,  uterus 
and  pelvic  walls,  and  it  was  evident  that 
nothing  short  of  clearing  out  the  pelvis  would  be 
of  any  use.  This  proved  to  be  a  very  difficult  pro- 
ceeding, as  the  tubes  and  ovaries  had,  literally,  to  be 
dug  out  of  the  dense  mass  of  adhesions.  The  first  step 
consisted  in  tying  the  ovarian  arteries  ;  the  bladder 
was  then  detached  from  the  uterus,  and  the  separation 
of  all  the  adhesions  was  completed  by  working  upwards 
from  below ;  total  hysterectomy  was  preferred  to 
supravaginal,  as  the  cervix  seemed  to  be  infected, 
though  examination  proved  that  the  pus  from  the 
abscesses  was  sterile.  The  patient  made  an  uneventful 
recovery,  and  left  the  hospital  quite  well  in  four  weeks. 
Referring  to  the  specimen,  the  opening  of  the 
abscesses,  into  which  a  bristle  is  passed,  can  be  seen 
in  the  uterine  canal.  The  case  is  the  first  of  the  kind 
that  I  have  seen,  and  I  believe,  from  the  literature  I 
can  lay  hands  on,  that  the  condition  is  a  very  rare  one. 
It  is  an  interesting  question  how  both  ovaries  became 
infected.  From  the  severity  of  the  puerperal  attack 
the  infection  must  have  been  streptococcic,  and  it 
must  have  passed  through  the  uterus  and  tubes  and 
lodged  in  the  ovaries,  but  there  is  no  sign  that  either 
uterus  or  tubes  were  involved.  If  the  mode  of  in- 
fection had  been  through  the  lymphatics,  through  the 
uterine  wall  and  parametrium,  one  would  have  ex- 
pected an  endometritis  or  metritis,  and  then  a  para- 
metritis. From  the  extent  and  density  of  the  adhesions 
there  had  evidently  been  a  considerable  amount  of 
pelvic  peritonitis. 

notes  on  a  case  of  hystero-sai.pingo-oophorectomy 
for  double  ovarian  papilloma  and  carcinoma 
of  the  cervix  uteri,  by  t.  gelston  atkins, 
M.D.,  M.Ch. 

Mrs.  C ,  aet.  53,  was  admitted  under  my  care  in  the 

South  Infirmary,  on  December  6th,  1903  ;  she  had  been 


March  23,  1904* 


kindly  sent  by  Dr.  Orpin,  of  Youghal,  with  a  diagnosis 
of  uterine  cancer.  He  had  only  seen  her  a  few  days  be* 
fore,  but  feeling  sure  of  his  diagnosis,  sent  her  to  hospital. 
On  admission,  she  was  greatly  attenuated  and  pallid, 
and  complained  of  shortness  of  breath  and  general 
abdominal  discomfort.  Her  pulse  was  150,  and  the 
vessel  was  not  well  filled.  She  stated  that  she  had 
had  a  coloured  discharge  for  three  or  four  weeks,  but 
otherwise,  except  for  the  gradual  abdominal  enlarge- 
ment, she  had  no  symptoms.  There  was  ascites,  and 
two  large  growths  could  be  felt,  one  in  each  iliac  region, 
which  were  freely  movable  in  the  ascitic  fluid. 
The  cervix  was  hardish.  with  a  patulous  os  which 
bled  easily.  A  scraping  of  the  cervical  canal  gave 
unmistakable  evidence  of  malignant  disease.  There  did 
not  seem  to  be  any  adhesions.  A  few  days'  observation 
showed  that  she  had  decided  tachycardia.  The  urine  was 
normal.  I  decided  to  explore,  and  on  opening  the  abdo- 
men, a  large  quantity  of  ascitic  fluid  came  away,  and  the 
swellings  in  the  ilia  floated  up  into  the  abdominal 
incision,  and  proved  to  be  malignant  papillomata. 
I  therefore  determined  to  remove  them  and  the 
uterus,  which  I  did  by  the  ordinary  operation  of  hystero- 
salpingo-oophorectomy,  as  in  the  preceding  case, 
without  meeting  any  difficulties.  She  bore  the 
operation  well,  but  her  pulse  remained  up  between 
150  and  160,  and  her  temperature  was  from 
990  to  99*6°  F.  For  the  first  seven  days  she  seemed  to 
be  making  an  uneventful  recovery,  and  on  reference  to 
the  hospital  notes,  I  find  that  on  the  fifth  day  she 
had  boiled  fish,  light  food  which  she  digested  well,  the 
bowels  moving  regularly.  On  the  evening  of  the 
seventh  day  her  breathing  quite  suddenly  became 
very  irregular,  short  and  jerking,  and  the  pulse  rose 
to  165.  On  the  eighth  day,  when  the  stitches  were 
removed,  the  abdominal  wound  was  quite  healed  and 
aseptic,  but  the  rapid  breathing  and  pulse  never  went 
down,  and  she  died  on  the  night  of  the  ninth  day  after 
the  operation.  The  cause  of  death  was  in  no  way 
connected  with  septic  processes,  but  simply  due  to 
the  tachycardia.  The  specimen  is  a  beautiful  example 
of  double  papilloma  of  the  ovaries,  and  of  cancer  of  the 
cervix.  It  is  an  interesting  point  whether  the 
cervical  cancer  was  due  to  infection  from  the  ovaries. 

Dr.  Macnaughton-Jones  remarked  that,  seeing 
how  frequently  papilloma  of  the  ovary  partook  of  the 
nature  of  ad eno -carcinoma  or  carcinoma,  or  was 
associated  with  such  disease,  he  was  not  surprised  at 
the  cervix  being  cancerous  in  this  instance.  As  re- 
garded the  source  of  infection  in  the  other  case,  as 
often  happened  in  suppuration  of  the  adnexa  mani- 
festing itself  during  childbed,  it  was  difficult  to  account 
for  it  exactly  ;  no  doubt  in  this  instance  the  ovary 
had  been  infected  before  pregnancy. 

The  President  said  that  Dr.  Atkins  was  to  be 
warmly  congratulated  upon  his  successful  operation. 
It  was  a  very  bold  undertaking  to  remove  the  uterus 
and  ovaries  in  such  a  state  of  suppuration. 

Dr.  William  Duncan  thought  the  question  whether 
the  papilloma  was  the  source  of  the  cancer  of  the 
cervix  was  a  very  pertinent  one.  He  had  never  seen 
the  two  conditions  associated. 

Dr.  Inglis  Parsons  said  that  the  combination  must 
be  a  very  rare  one,  as  he  had  never  met  with  it. 

Dr.  William  Duncan  exhibited  the  following 
specimens  : — (1)  Fibroid  uterus  removed  by  vaginal 
hysterectomy  after  enucleation  had  failed.  (2)  Fibroid 
of  the  vaginal  wall.  (3)  Uterine  myoma  growing 
between  the  layers  of  the  broad  ligament,  and  com- 
pletely filling  the  pelvic  cavity ;  hysterectomy : 
recovery,  reading  notes,  which  will  be  found  on  page 
308. 

Mr.  Bowreman  J essett  dissented  from  Dr.  Duncan's 
opinion  about  closing  such  a  cavity  as  the  one  de- 
scribed. His  own  practice  was  to  put  some  gauze 
into  the  cavity,  bring  the  gauze  through  a  drainage- 
tube  into  the  vagina,  and  withdraw  them  both  on  the 
second  or  third  day. 

Dr.  J.  J.  Macan,  in  relation  to  the  absence  of  any 
capsule  and   the  general  condition  of  fibrosis  of  the 


23.   IQ°4- 


uterus,  described  by  Dr.  Duncan,  drew  attention  to  a 
recent  discussion  in  the  French  Surgical  Society,  on  a 
paper  by  Richelot  on  malignant  degeneration  of  the 
-.lamp  after  supravaginal  hysterectomy,  in  which  he 
insisted  that  uterine  sclerosis,  of  which  fibromata  were 
merely  incidental  modi  ri  cat  ions  t  was  an  initial  stage 
preceding  cancerous  degeneration.  An  epitome  of  the 
I »aper  and  discussion,  prolonged  over  six  meetings  of 
the  Society,  vvould  be  found  in  the  February  number  of 
the  BnUsk  Gynecological  Journal,  Summary,  p.  186. 

The  President  remarked,  in  regard  to  enucleation. 

that  when  there  was  a  good    capsule    and    no    sepsis 

there  was  no  reason  that   course  should  not  be  adopted 

could  be  carried  out  without  difficulty,  but  in  a 

Mich  as  the  one  described,    especially  where  there 

it  was  infinitely  better  to  remove  the  uterus 

altogether,   as   Dr,    Duncan   had  done,  with  marked 

success.     As    to    myoma  ta    of    the    vaginal  wall    lie 

(the  President)  had  met  with  five  or  six,  most  of  them 

in  the  anterior  wait     The  largest  was  close   to   the 

I  ;  another  was  near  the  urethra,  and  in  enucleating 

jt  there  would  have  been  a  great  risk  of  damaging  the 

urethra.     Cavities  such  as  those  left  by  the  removal  of  a 

1  amour  of  the  broad  ligament    he  had  himself  been  in 

the  habit  of  draining  with  iodoform  gauze  without  any 

ttfbt, 

Dr.  Duncan,  in  reply,  said  in  regard  to  the  possibility 

of  enucleating  the  tumour  from  the  broad  ligament. 

the  uterus  was  a  fibroid  one,  and  the  patient  was  over 

fifty  years  of  age,  there  was  no  extra  risk  in  removing 

the  uterus,  and  the  patient  was  left  in  a  much  better 

tondi lion  than  if  it  had  been  allowed  to  remain,     He 

l   Ins  own  method  of  treating  the  cavity,  from 

h,  in  his  own  experience,  and  in  that  of  oi 

he  had  never  known  of  any  ill  result,  always  provided 

was  taken  to  arrest  all  oozing  before  whipping 

the  sides  of  the  cavity  together,  and  considered  it  a 

far  safer  proceeding   than  draining  into   the  vagina, 

and  thereby  risking  septic  infection. 

Dr.  Incus  Parsons  showed  specimens  of  (r)  fibro- 
lumour  of  the  uterus  ;  (>}  large  nbro~myo ma  of 
the  hroad  ligament,  and  (3)  submucous  myoma,  read« 
tng  antes,  which  will  be  found  on  page  309 

naughton-Jones  remarked  that  there  had 
much  divergence  of  opinion   as  to   the  patho- 
genesis of  fibrocystic  tumours.     The  cyst  may  be  due 


TRANSACTIONS  OF  SOCIETIES.        The  Medical  Press.     311 


as  it  is  a  well-ascertained  fact  that  gelatinous  material 
in  large  masses  is  formed  by  certain  saccharomyeetes 
in  symbiosis  with  certain  hactena. 

Dr.  Bedford  Fenwick  read  the  following  notes  on 
■  specimen  he  exhibited  : — 

A       FIBROID       UTERUS       REMOVED      FOR       MENORRHAGIA, 

The   patient  was  a   governess,    single,  ;et,  33,     Her 
catamenia  had  been  established  at  14.  and  had   been 
regular,  lasting  four  or  rive  days,  with  normal  loss  and 
without  pain,  until  two  years 'ago,  when  they  began 
to  be  more  protracted  with  more  discharge.     For  the 
last  nine  mouths  the  periods  have  lasted  from  eight  to 
ten  days,   the  discharge  has     gradually  become  more 
■\  and  large  and  small  clots  have  been  passed 
with  great  straining  pain  ;  for  the  last  month  the  loss 
has  been  almost  continuous.     She  has.  fur  some  months, 
been    suffering    from    increasing    giddiness,    muscular 
weakness,  dimness  of  sight,  palpitation,  dyspnoea,  and 
faintness  on  exertion.     When  she  was  sent  to  nn 
February    10 th,  1004.  her  skin  and  mucous  membrane 
were   waxy   and    yellowish;   her  pulse   wai    1 20;   her 
first  heart  sound  was  almost  mandible  at  the  apex, 
which    was    most  perceptible  in  the  nipple  line.     The 
cervix  was  small  with  a  pinhole  os  ;   the  uterus  was 
slightly  enlarged,  soft  and  mobile  ;  the  ovaries    and 
tubes  felt  normal.     She  was  at  once  admit  ted  into  the 
Hospital  for  Women,  So  ho  Square,  and  after  a  week's 
absolute  rest,  I  dilated   the  cervix  and  found  several 
fibroid   growths  in   the  canal   too  deeply  situated   to 
be  enucleated  with  safety,     On  March  8thr  I  therefore 
performed  hysterectomy',  leaving  the  ovaries,  as  they 
were  perfectly   healthy.     This  afternoon,  only   forty- 
eight  hours    after  the  operation,  her  pulse  is  only  75, 
and  there  is  a  faint  tinge  of  colour  in  her  lips  and  eyelids! 
The   case   is  interesting  because   the  uterus  measures 
only  three  niches  in  length  by  two  and  a  quarter  in 
thickness,  but  it  is  simply  studded  with  small  fibroid 
nodules,  and  the  canal  is  full  of  submucous  growths.     I 
may  call  special  attention  to  the  facts  that  there  are  no 
growths  at  the  cornua  of  the  uterus,    and    that    tbe 
ovaries    and     tubes    were    perfectly    healthy,    which 
supports  the  theory  I  have  advanced  that  the  disease 
Oi     the     appendages    so    frequently    found     associated 
with  uterine  fibroids  is   due  to  the  presence  of  such 
growths     at   the   fundus,   causing   hypertrophy   oi    the 
ovarian   arteries   and    consequent    hyperemia   of    the 


to  (t)  the  deliquescence  of  a  portion  of  a  fibroma  ;    ovaries  a"d  tubes,  a  condition  which  is  certainly  an 


ordinary  antecedent  to  chronic  disease  and  degeneration 
of  structure. 
Dr.  Duncan  said  that  the  appearance  of  the  speei- 


the  dilatation  of  the  lymphatics  and  the  formation 

■luses  at   the  extremities  of   the  several  vessels 

The  first  of   these  views  Vvas  accepted   by   Virchow, 

Klebs  attributed   them     to     hvdropsia    and    csdema.     raen  suggested  *o  him   that   there  might  be  malignant 

disease,  and  he  thought  that  a  proper  pathological 
report  would  be  of  much  value,  as  the  case  was  w  til 
interesting. 

Mr.    Bow  re  man    Jessett   concurred,    and    on    the 
invitation  of  the  President 

Dr.    Fenwick    undertook    to    have    a   pathological 
report  prepared,  and  bring  it  before  the  Society  on 


The  view  of  lymphatic  dilatation  was  advocated  by 
Billroth  and  Kiberle.  the  lymphangceomatous  nature 
<>l  the  tumour  lending  force  to  the  sup  posit  inn,  as 
alio  the  rich  peripheral  supply  of  lymphatics.  Dr. 
Mary  Dixon  Jones,  who  has  recently  discussed  the 
Mibject,   does  not  accept  this  explanation,     and     she 

[5  the  new  cystic  formations  as  a  consequence  of 
medullary  changes  in  the  tissues,  and  new  formations  ^Pme  future  occasion.  In  reply  to  Dr,  Haywood 
eventuating  jrom  this  medullary  condition.  The  cyst  I  Smith,  he  ^d  that  on  passing  the  sound  he  could  feel 
El  a  development  from  the  medullary  material.  She  il  quite  distinctly  pass  over  the  nodule  j  there  was  no 
(alces  the  view  that  a  fibroid  tumour  is  a  diseased  I  question  as  to  the  presence  of  intra-uterine  growth, 
omdihon  arising  out  of  an  inflammatory  corpuscular  I  ^r*  Dudley  Buxton  then  read  his  paper  on  "  Chora- 
change  in  the  tissues  of  the  uterus.  Fibroid  tumours  i  *om  in  Surgical  Ans&sthesia:  the  Vernon  Harcourt 
donot cause  degeneration,  but  the  degeneration  arises  Chloroform  Inhaler  and  Exact  Percentage  Vapours,** 
from  the  secondary  processes  ot  disease  developed  in    which  will  be  found  on  page  303. 

theiumnur  or  in  the  uterus.     And.  further,  she  believes        T^e  President  said  that  before  declaring  the  dis* 
that  intection  ot  the  adnexa  is  carried  Irom  the  tumour 
to  the  ovaries  and  tube.     She  supports  her  contention 
bra  number  of  microscopical  researches  into  the  nature 

•    fibrocystic  degeneration,   in   which  she   found 

inatory  changes  in  the  tissues,  with  the  presence 
mules  and   inflammatory   corpuscles,   sometimes 
osseous      degeneration,     another     time     pus, 


cussion  upon  the  extremely  interesting  paper,  for 
which  they  were  indebted  to  Dr,  Dudley  Buxton, 
open,  he  desired  to  welcome,  in  the  name  of  the  Society, 
the  several  distinguished  visitors  present,  especially 
Mr.  A,  Vernon  Harcourt,  F.R,5. 

Mr.  Mavo  Robs  on  said  that  when  he  first  came  to 


degeneration,     another     time     pus,      asso-  j  London  it  was  seldom  that  he  would  have  any  other 
CUted  with  sinuous  cystic  canals  or  irregular  cavities.  J  anaesthetic  administered  but  ether,  but  having  such  a 
n  some  the  changes  partook  of  the  endotheliomatous    very  competent  anaesthetist  as  Dr.  Buxton,  he  "felt  that 


nature,  and  blood  cysts  were  present 

Inclis  Parson*  thought  that  the  gelatinous 
nutter  in  fibrocystic  tumours  resembled  that  found  in 
malignant  ovarian  cysts,  and  that  it  would  probably 
bt  found  some  day  that  it  was  due  to  micro-organisms, 


very  competent  3 
he  might  place  implicit  reliance  upon  his  judgment, 
and  Dr.  Buxton  had  given  chloroform  for  him  with  the 
Vernon  Harcourt  inhaler  in  a  large  number  of  serious 
cases,  in  some  of  which  practically  the  whole  of  the 
danger   depended    on    the   anaesthesia.     In   no   single 


312    The  Medical  Press. 


TRANSACTIONS  OF  SOCIETIES. 


March  23.  1904. 


instance  had  there  been  the  slightest  difficulty,  and  he 
could  bear  out  every  word  Dr.  Buxton  had  said  with 
regard  to  the  use  of  the  apparatus,  which,  so  far  as  he 
could  see,  would,  by  giving  the  operator  complete 
control  of  the  dose  administered,  completely  revolu- 
tionise the  administration  of  chloroform. 

Dr.  Inglis  Parsons  remarked  that  in  the  adminis- 
tration of  chloroform  there  were  many  points  that  were 
surprising.  A  well-known  Fellow  of  the  Society,  in 
the  habit  of  giving  the  anaesthetic  for  their  Honorary 
President,  employed  an  enormous  inhaler,  containing 
a  sponge,  upon  which  he  used  to  pour  one  or  two  drachms 
of  chloroform,  and,  then  putting  it  over  the  patient's 
face,  entirely  exclude  the  air  for  a  time.  When  asked 
to  adopt  this  method  himselt,  he  (Dr.  Parsons)  had 
decidedly  refused,  though  the  Fellow  referred  to  had 
never  had  an  accident  from  it.  On  one  occasion, 
when  he  was  a  dresser,  the  house  surgeon  was  using 
Junker's  apparatus  upon  a  patient  whose  tongue  was 
to  be  removed  for  epithelioma ;  unfortunately  the 
tube  which  should  have  been  in  connection  with  the 
air  space  was  inserted  in  the  fluid,  and  a  considerable 
amount  of  chloroform  was  pumped  down  the  man's 
throat.  He  (Dr.  Parsons)  took  the  opportunity  of 
observing  whether  the  respiration  or  the  heart's 
action  was  first  arrested,  and  by  keeping  his  finger  on 
the  temple  found  that  the  pulse  continued  after  the 
respiration  had  immediately  stopped.  That  was 
perhaps  a  unique  case,  but  there  was  no  doubt  that  in 
it  the  respiratory  centre  was  first  affected. 

Dr.  Macnaughton-Jones  said  that  he  had  had  the 
advantage  of  having  chloroform  administered  for  nim 
by  Dr.  Buxton  with  the  Vernon  Harcourt  inhaler  on 
several  occasions,  mostly  for  abdominal  sections,  and 
once  for  a  deep  operation  on  the  posterior  triangle  of 
the  neck,  and  in  his  experience  the  apparatus  was 
altogether  satisfactory.  The  time  taken  to  induce  the 
requisite  amount  of  narcosis  had  not  been  greater 
than  with  the  Junker  inhaler,  and  in  no  case  had  the 
full  2  per  cent,  vapour  been  required  to  maintain 
unconsciousness;  moreover,  the  post-operative  con- 
dition of  the  patients  had  been,  on  the  whole,  more 
satisfactory  than  with  any  other  chloroform  inhaler 
with  which  he  was  acquainted.  The  success  of  an 
operation  depended  greatly  on  the  judgment  and  self- 
reliance  of  the  administrator,  and  tney  were,  therefore, 
much  indebted  to  Dr.  Buxton  for  his  paper,  and  to  the 
other  anaesthetists  for  their  presence  at  its  discussion. 

Dr.  Aarons  said  that  so  far  as  he  could  judge,  the 
Vernon  Harcourt  inhaler  answered  its  purpose  per- 
fectly, but  whatever  form  of  apparatus  was  employed 
the  successful  administration  of  an  anaesthetic  was  a 
question  of  brains. 

Dr.  Bakewell  said  that  the  present  form  of  the 
instrument  was  an  improvement  on  an  older  one,  with 
which  he  had  had  some  difficulty  on  account  of  the 
buckling  of  the  valves.  He  had,  however,  used  the 
improved  instrument  with  great  success  in  a  great 
number  of  cases,  and  was  sure  that  the  after-effects  of 
the  chloroform  were  less  when  this  inhaler  was  em- 
ployed. It  was  splendid  for  children,  and  he  had  used 
it  many  times  at  Great  Ormond  Street,  but  as  children 
disliked  anything  in  the  torm  of  a  mask  over  their 
faces  he  found  it  better  to  begin  with  a  few  drops  of 
chloroform  on  lint.  It  was  a  great  advantage  that, 
with  a  little  manoeuvring,  the  apparatus  could  be 
satisfactorily  adjusted  for  laminectomies,  in  spite  of 
the  difficult  position  in  which  the  patient  had  to  be 
placed.  The  importance  of  knowing  the  exact  amount 
of  chloroform  being  administered  at  every  time  during 
the  anaesthesia  certainly  made  the  use  of  this  inhaler 
desirable. 

Mr.  A.  Vernon  Harcourt  (a  visitor)  explained  that 
originally  the  valves  were  of  celluloid,  which  gave  a 
beautiful  flat  and  very  elastic  surface,  but,  unfor- 
tunately, the  vapour  of  chloroform  acted  upon  it,  and 
caused  a  deformation  which  no  doubt  was  the  cause  of 
the  failure  mentioned  by  Dr.  Bakewell.  He  after- 
wards had  the  valves  made  of  metal,  so  light  as  to  be 
quite  easily  moved  ;  it  was  also  an  advantage  that  the 
action  of  the  metal  valves  was  more  easily  inspected 
than  that    of   the  more   transparent  ^celluloid.  u  He 


thought  that  for  childbirth  or  prolonged  operations  it 
might  perhaps  be  well  to  have  some  sort  of  a  stand  to 
hold  the  instrument  upright  so  that  there  would  be 
no  splashing  of  the  contents ;  a  tube  twenty  inches  or 
so  could  be  used  to  connect  it  with  the  mouth-  and 
nose-piece,  and  the  administrator  would  be  spared 
fatigue  in  prolonged  cases.  On  this  point  he  would  be 
glad  to  have  Dr.  Buxton's  opinion.  He  had  been 
gratified  by  hearing  those  gentlemen  who  had  spoken 
of  their  successes  in  using  the  apparatus. 

Dr.  Dudley  Buxton,  in  reply,  said  that  in  regard 
to  the  case  of  poisoning  with  the  Junker  apparatus, 
it  was  quite  possible  that  the  overwhelming  amount  of 
chloroform  swallowed  had  produced  various  unknown 
conditions  which  had  led  to  the  respiration  ceasing 
before  the  circulation.  He  was  in  the  habit  of  taking 
from  six  to  ten  minutes  to  induce  chloroform  anaes- 
thesia, and  he  might  say  that  if  an  anaesthetist  knew 
how  to  give  chloroform  by  Junker's  inhaler  he  could  al- 
ways get  a  patient  under  it.  He  mentioned  a  case  in 
which  an  attempt  was  made  to  give  ether  by  pouring  it 
on  to  a  towel,  which  was  held  over  the  patient's  face; 
the  patient  naturally  got  excited,  and  the  administrator 
said,  "  This  gentleman  will  not  take  ether,  I  will  give 
him  chloroform."  He  insisted  on  the  importance  ot 
surgeon  and  anaesthetist  being  in  perfect  accord  with 
each  other,  and  that  the  Vernon  Harcourt  inhaler 
was  calculated  to  promote  this  feeling.  He  thought 
the  stand  and  tubing  suggested  by  Mr.  Vernon  Har- 
court might  be  advantageously  adopted  in  some  cases, 
but,  as  a  matter  of  fact,  the  fatigue  of  holding  the 
instrument  when  one  was  accustomed  to  it  was  not 
great,  even  in  a  long  operation. 

HARVEIAN  SOCIETY. 
Meeting  held  March  10TH/1904. 


Dr.  S.  Verb  Pearson  read  a  paper  on  the  "  Diagnosis, 
of  Pulmonary  Tuberculosis"  in  infants  and  young 
children.  The  diagnosis  of  intra- thoracic  tuberculosis 
was  considered  under  four  heads: — (1)  Broncho- 
tracheal  gland  affection:  the  differentiation  and 
classical  symptoms  were  described.  First,*  a  per- 
sistent cough  following  whooping-cough  was  dealt  with ; 
the  disease  was  shown  by  the  exclusion  of  the  two- 
common  causes  of  such  persistent  cough,  namely,  ade- 
noids and  habit  combined  with  a  tendency  to  repeated 
catarrhal  attacks,  which,  if  appropriately  treated, 
soon  disappear  unless  tuberculous  glands  were 
present  within  the  chest.  (2)  Miliary  tubercu- 
losis of  the  lungs.  The  diagnosis  of  this  form 
depended  upon  a  study  of  the  general  features,  the 
history  and  course  of  the  case,  not  upon  any  special 
local  signs.  An  insidious  and  progressive  wasting 
without  adequate  cause  should  arouse  suspicion.  The 
state  of  the  skin,  especially  the  presence  in  it  of  small 
haemorrhages,  or  of  subcutaneous  tubercles,  the  con- 
dition of  the  hair,  irregular  pyrexia,  quiet  demeanour,, 
enlarged  spleen,  and  the  variety  of  anaemia  present, 
were  important.  The  wasting  had  to  be  distinguished 
from  simple  marasmus  and  that  due  to  septic  infection, 
&c.  (3)  Tuberculous  broncho-pneumonia.  Certain 
peculiarities  of  this  type  were  described,  and  its 
differentiation  from  the  simple  form  with  its  com- 
plications, and  from  localised  empyema,  purulent 
pericarditis,  and  lung  abscess,  were  reviewed.  (4> 
Rarer  types  of  pulmonary  tuberculosis  ;  the  varieties, 
the  times  of  occurrence,  and  the  nature  ol  these  types 
were  dealt  with  briefly. 

Mr.  Laming  Evans  read  a"1  paper  on  the  "  Treatment 
of  Congenital  Club-foot  in  Early  Infancy,"  and  showed 
a  number  of  cases.  He  advocated  manipulation 
immediately  after  birth,  and  early  recourse  to  teno- 
tomy of  the  tibials  (anterior  and  posterior),  and  the 
flex.  long,  digit,  for  the  cure  of  the  varus,  followed  then 
by  tenotomy  of  the  tendo  Achillis,  to  overcome  the 
equinus ;  with  prolonged  after-treatment  in  some 
apparatus  and  constant  observation  by  the  surgeon. 

Mr.  Noble  Smith  congratulated  Mr.  Evans  upon  his 
firm  support  of  the  principle  ot  maintaining  the  fixation 
of  the  heel  until  the  inversion  of  the  foot  had  been. 
entirely  overcome.     Until  the  great  toe  was  brought 


March  23,  1904. 


TRANSACTIONS  OF  SOCIETIES.        The  Medical  Press.     313 


nlO  hi  beyond  a  straight  line  with  the  inner  border 
the  patella,  the  inversion  could  not  be  considered 
&Cted.     He    supported    early    treatment,    ami    re- 
d    to   the   difficulty    oi    treating   neglected    cases. 
He  strongly  deprecated  extensive  operation  and  every- 
thing which  leaded  to  destroy  the  natural  movement 
foot.   Lately,  he  had  practised  Lorenz's  method, 
which  differed  from  the  former  forced  manipulation  by 
the  persistency  of  the  surgeon's  effort*  at  the  time  of 
titan.     He   showed   some   casts  and   photographs 
tratmg  excellent  results  obtained  by  the  improved 
of  treatment, 
Mr.  J.   Jackson  Clarke  agreed  with  Mr.   Evans' 
method    of    treatment,    which    he    thought    was    now 
followed  at  all   the  orthopaedic  hospitals  in  Lout  Jon. 
There  were  a   few  exceptional  cases  in  which  other 
methods  were  required   in  order  to  obtain  a   perfect 
result.     That  of  manipulation  and  fixation  in  plaster 
of  Pans,  as  practised  by  Lorenz,  was,  in  Mrr  Clarke's 
experience,  the  most  valuable.      It  should  not  be  done 
until  Che  1  luM  is  able  to  walk.     Preparatory  deanftuig 
•I  the  skin  should  always  be  undertaken  and  sterility 
itmed  at  m  case  ot  rupture  of  the  skin  occurring  during 
the  manipulation,     Such  wounds  under  these  circum- 
stances give  no  trouble  and  heal  well  under  dry  dressing, 

ROYAL  ACADEMY  OF  MEDICINE  IN  IRELAND. 
Section  of  Obstetrics. 


Mkliiso  helo  FRfDAY.  March   uth,    1904, 


essor  A.  J.    Smith,    President,    m    the    Chair, 

Sir  Arthur  V  M.v  \n  showed  a  most  interesting 
series  of  eight  plaster  casts  of  toetal  heads,  by  Professor 
'  lUternUz,  of  Tubingen,  illustrating  the  changes 
in  the  child's  head  due  to  the  several  presentations; 
also  an  enlarged  (six  diameters)  cast  of  lcetal  1 
He  also  demonstrated  an  obstetric  phantom  (Dr. 
im"s),    and    a  pap  I  head,   by   Dr. 

Hugo  Gloeckner.     A  u  lav  figure  "  of  a  foetus  designer! 
by  Drr   Ludwig   Knapp  and   several  plaster  casts  of 
Died  pelves  were  also  shown. 
Dr.  A*  Dempsey  (Belfast}  read  a  brief  report  of  his 
operative  work  in  the  gynaecological  wards  ot  the  Mater 
Hospital,   Belfast,  1  luring  the  year   1903.     There  were 
aerations,  25  being  intraperitoneal  with  only  one 
death.     In    cases    01    metritis    and    endometritis,    he 
regarded  curettage  alone  as  not  sufficient  to  cure  all 
caws.     He  referred  to  the  hot,  dry  air  treatment,  and 
apparatus  introduced  by  Reitter,  ot  Vienna,  tor  ovarian 
and    vague  pelvic  painT  ami    for   the    absorption    of 
cellular  exudates   in    the    pelvis,     He   had  found  verv 
factory  results  from  its    use  in    both  classes     of 
cases.     Temperatures   of     [20      to     i$0     C,   can     be 
obtained  by  it.     This     treatment     is     not   applicable 
when    any  active   inflammation   is    present.      Among 
the   laparotomies   were     1 1    ovariotomies.     o     retro- 
peritoneal   hysterectomies,   2    extrauterine    tdet&tioD 
I  betore  rupture,  one  case  of  gastric 
utestinal  adhesions,  one  append icectoiny.  and  one 
intraperitoneal  abso  I  through  the  abdominal 

■ ounrl . 

Sir  Arthur  Macan,    Hr    W    T.  Smyly,  E>r.  Tweedy, 
and   the  President   having  discussed   the  report,    Dr. 
replied* 
Drs.  Jellett  and  Earl  read  a  paper  on  g"  Sarcoma 
of  the  Vagina/'  and  showed  a  specimen . 
The  meeting  then  adjourned < 


WEST     LONDON     MEDICO-CHIRURGICAL 
SOCIETY, 

Meeting  held  Friday,  March  4TH,  1904. 


The  President,  Dh.   Seymour  Taylor,   in   the  Chair. 


Mr,  Garry  Simpson  read  a  paper  on  Adenoid 
Growth* :  When  and  How  to  Operate.  He  recom- 
mended breathing  exercises  for  patients  with  tem- 
porary engorgement  of  existing  lymphoid  tissue  due 
mainly  to  an  attack  of  acute  rhinitis  ;  such  cases, 
however,   should    be   watched.     Frequently   recurring 


attacks  of  deafness  were  strong  indications  for  opera- 
tive interference,  and  a  chronic  otitis  media  would 
clear  up  much  more  rapidly  if  listing  adenoids  were 
removed,  Deaf  patients  with  retracted  drum-mem- 
branes were  benefited  by  operation,  provided  the 
mischief  had  not  existed  for  too  long  a  period.  He 
insisted  on  an  examination  of  the  nose  in  every  case, 
because  if  an  obstruction  was  overlooked  theopera* 
tion  would  fad  to  restore  nasal  respiration.  He  also 
recommended  an  operation  if  the  child  were  suffering 
in  health  mentally  and  physically,  and  if  it  were  an 
habitual  mouth  '  breather'  He  had  never  found 
patients  suffering  from  enuresis  benefited  by  the 
operation-  He  preferred  to  operate  with  the  patient 
lying  on  his  right  side  near  the  edge  of  the  table,  with 
the  legs  slightly  drawn  up.  The  head,  which  rested  00 
a  low  pillow,  was  thus  made  depend ent,  and  no  blood 
or  growth  could  enter  the  larynx,  The  great  advan- 
tage of  this  posture  was.  that  the  patient  was  in  l  sn It- 
position  from  tie  first.  He  pcef erred  chloroform  tai 
children  under  ten  ye^s  of  age.  and  gas  and  ether  for 
older  patients* 

Dr.  FukNiss  Potter  expressed  complete  agreement 
with  all  that  had  been  said  with  regard  to  the  m 
tiuns  for  operation.  He  regarded  the  carrying  out  of 
breathing  exercises  as  impracticable  in  private  pete* 
tice,  and  considered  that  much  less  upset  and  worry,  as 
well  as  a  more  certain  result ,  were  likely  to  accrue  from 
radical  operation  for  removal  of  the  adenoids.  He  dis- 
approved strongly  of  "  gas  only  "  as  an  anaesthetic 
in  these  operations.  The  anaesthesia  was  so  short — 
thirty  or  forty  seconds  at  the  most— that,  should  toy 
slight  delay  occur,  such  as  readjustment  of  the  gag.  or 
rigidity  ol  the  soft  palate  interfering  with  ready  intro- 
duction of  the  curette,  the  operation  became  a  hurried 
scramble  and  was  in  all  probability  incompletely  per- 
formed. Thoroughness  of  removal  was  more  import- 
ant than  rapidity  of  operation,  and  thoroughness  1 
not  be  assured  in  the  short  time  allowed  by  4+  gas  only  ♦"* 
Nitrous  oxide  gas  followed  by  ether  he  considered  a 
much  more  satisfactory  combination,  and,  if  properly 
administered,  there  need  be  no  anxiety  on  accoum  .1 
the  ana-sthetic.  In  chloroform  anaesthesia  one  en- 
countered a  much  larger  proportion  of  cases  which 
gave  rise  to  this  anxiety.  The  early  abolition  of  the 
cough  reflex  which  occurred  under  somnoform  rendered 
this  drug  an  unsuitable  anaesthetic  in  adenoid  opera- 
tions. On  the  whole  the  forceps  was  a  more  certain 
and  trustworthy  instrument,  although  its  use  entailed  a 
greater  expenditure  of  time.  He  was  accustomed  to 
operate  with  the  patient  in  the  supine  position,  a 
substantial  pillow  or  sand -bag  being  placed  under  the 
nape  ot  the  neck,  so  arranged  that  the  vault  was  the 
lowest  part  of  the  pharynx.  By  this  means  the  like- 
lihood of  any  blood  finding  its  way  into  the  larynx  was 
reduced  to  a  minimum.  He  did  not  use  the  forehead 
mirror,  but  relied  on  the  sense  of  touch  ior  the  removal 
both  of  adenoid  vegetations  and  of  enlarged  tonsils. 

Dr.  j.  B.  Ball  considered  that  the  question  when  to 
operate  was  the  more  important  of  the  two  dealt  with 
in   the   paper,     The  pharyngeal    tonsil   was   normally 
well  developed  in  young  children,  and  the  line  between 
the  normal  and  the  hvpertrophud  tonsil  was  not  e; 
defined,  although  it  was  easy  to  define  where  dta 
as  betrayed  by  certain  symptoms,  began.     It  was 
tain  that  a  moderate  enlargement  of  this  tonsil  often 
existed  without   producing   any   symptoms  whatever. 
In    these   cases    there   was   no   reason   for   operating. 
There  were,  again,  borderland  eases  in  winch  the  sym- 
ptotns  were  slight  and  trivial  in  which  operation  was 
not  justifiable.     1 1  was  bo  these  cases  that  the  breathing 
exercises     mentioned     by    Mr*     Garry    Simpson  were 
specially  useful.     The  four  main  indications  for  opera- 
tion he  considered  to  be  {1}  habitual  mouth -breathing 
in  a  child,   which  showed   nu  sign   of  improving  and 
which  had  existed  for  a  considerable  time  ;    (2)  chronic 
deafness,  repeat ed  attacks  of  deafness  or  earache.  «n 
chronic  otorrncea;    (3)  repeated  attacks  of  bronchitis 
or  the  presence  of  asthmatic  symptoms  ;    (4)  repeated 
colds  in  the  head  of  a  severe  or  prolonged  character,  ot 
paroxysmal  sneezing  and  hay  fever  symptoms* 

The' President  referred  lo'thc  risks  of  the  op-ration, 


314    The  Medical  Press.         TRANSACTIONS  OF  SOCIETIES. 


March  23.  iooj. 


and  asked  for  further  information  as  to  the  mortality 
due  either  to  the  anaesthetic,  the  operation,  or  its  after- 
effects. It  would  be  a  great  advantage  if  in  advising 
operation  they  were  able  to  assure  parents  that  the 
dangers,  as  shown  by  authoritative  statistics,  were  com- 
paratively trivial. 

Mr.  A.  B.  Kingsford  advocated  the  use  of  nitrous 
oxide  gas  as  an  anaesthetic  for  adenoid  operations. 
It  had  been  administered  at  the  Central  London  Throat 
Hospital  17,000  times  without  a  single  fatality,  and 
chloroform  had  been  for  some  three  or  four  years  en- 
tirely discarded  in  its  favour.  From  four  years  of  age 
and  upwards  this  was  the  common  anaesthetic  ;  younger 
children  were  generally  given  a  "  whiff  of  ether."  The 
rigidities  caused  by  gas,  especially  that  of  the  soft 
palate,  and  the  difficulty  of  anaesthetising  young 
children  fully  without  asphyxiating  them  were  the 
chief  drawbacks  to  the  use  of  nitrous  oxide.  In  these 
cases  somnoform  had  distinct  advantages.  Anaesthesia 
was  rapidly  induced  and  lasted  for  from  one  to  two 
minutes,  while  rigidities  and  asphyxia  were  absent. 
It  was  more  apt,  however,  to  be  followed  by  sickness. 

Dr.  G.  E.  Shuttleworth  believed  that  breathing 
exercises  were  of  value  in  counteracting  the  habit  of 
mouth-breathing  which  frequently  persisted  after 
adenoid  operations,  as  well  as  remedial  in  the  milder 
cases  which  were  not  submitted  to  operation.  Such 
was  his  experience  in  the  case  of  feeble-minded  children, 
with  whom  he  was  specially  conversant,  and  for  whom 
he  prescribed  these  exercises  in  the  upright  position  as 
part  of  their  daily  school  drill. 

Mr.  Stephen  Paget  read  a  short  paper  on  the  Uses 
of  Paraffin]  in  Plastic  Surgery.  He  had  used  this 
method  in  more  than  sixty  cases  of  sunken  nose,  and 
ten  cases  of  prolapse  ol  the  bowel  or  vagina.  He  was 
sure  that  the  result  was  permanent ;  but  the  treatment 
of  severe  cases  of  prolapse  was  a  difficult  problem,  and 
two  of  the  ten  cases  had  relapsed.  In  the  treatment 
of  sunken  noses,  he  emphasised  the  necessity  of  not 
attempting  to  do  too  much.  It  all  depended  on  the 
state  of  the  skin.  If  this  were  fairly  free,  soft,  healthy, 
not  scarred,  nor  adherent,  the  surgeon  could  be  fairly 
sure  of  doing  a  great  deal  of  good  ;  and  the  risk  was, 
that  he  might  do  harm  by  trying  to  do  too  much  good, 
tn  cases  of  prolapse,  a  great  deal  of  good  could  be  done  ; 
but  each  case  had  to  be  taken  on  its  own  merits.  He 
described  the  conditions  that  are  favourable,  and  those 
that  are  unfavourable,  especially  the  condition  of  the 
skin  in  nose  cases,  and  the  condition  of  the  sphincters 
in  cases  of  prolapse  of  the  bowel.  In  the  nose  cases, 
the  presence  of  ozaena,  or  of  perforation  of  the  septum, 
did  not  hinder  a  successful  result,  provided  only  that 
the  skin  were  healthy,  free,  and  fairly  abundant. 
Rigidity,  tension,  scarring,  and  adhesion  of  the  skin 
were  the  conditions  that  hindered  success,  or  might 
even  make  it  impossible  to  treat  the  case  with  any 
reasonable  hope  of  doing  any  real  good.  But,  in 
favourable  cases,  the  result  was  excellent ;  and,  even 
in  cases  that  were  less  favourable,  a  fairly  good  result 
might  be  obtained. 

Dr.  J.  B.  Ball  had  operated  in  fourteen  cases  of  de- 
pressed bridge  of  the  nose  by  this  method  with  satis- 
factory result.  His  first  case  had  been  done  for  almost 
two  years  and  the  result  was  still  perfect.  In  most 
of  his  cases  the  condition  had  been  that  of  simple 
depressed  bridge  without  scarring  or  adhesions,  and  in 
tour  only  had  an  anaesthetic  been  given.  He  agreed 
with  Mr.  Paget  as  to  the  necessity  for  not  injecting 
too  much  paraffin.  It  was  better  to  be  under  than 
over  the  mark. 


LARYNGOLOGICAL  SOCIETY  OF  LONDON. 
Meeting  held  Friday.   March  4TH,  1904. 


The  President,   Dr.   P.  McBride,  in   the  Chair. 


Dr.  McBride  showed  a  knife  for  slitting  up  the 
tonsil  of  the  lacunae,  and  a  pair  ot  punched  forceps  for 
removing  the  stumps  of  polypi. 

Dr.  Furniss  Potter  showed  a  case  of  Immobile 
Right  Vocal  Cord  in  a  youth,  set.  19.  The  case  was 
probably  of  a  tuberculous  nature,  though  there  were 


no  definite  signs  of  disease  in  the  chest  or  sputum.  He 
also  showed  a  case  of  Infiltration  of  the  Larynx, 
involving  both  crico-arytaenoid  joints  and  an  indurated 
ulcer  on  the  tongue.  The  patient  was  a  man,  aet.  60, 
and  examination,  revealed  a  hard,  ulcerated  swelling 
on  the  tongue  far  back,  and  fixation  of  the  right  vocal 
cord,  and  the  left  vocal  cord  was  markedly  hampered  in 
abduction.  The  glottic  aperture  was  much  diminished, 
and  the  patient  had  had  to  have  tracheotomy  per- 
formed for  severe  dyspnoea.  There  w«rc  no  glands  to 
be  lelt  in  the  neck.  The  diagnosis  rested  between 
syphilitic  and  malignant  disease.  A  piece  ot  the 
growth  from  the  tongue  had  been  examined  micro- 
scopically, but  the  sample  removed  was  too  super- 
ficial for  a  correct  diagnosis  to  be  made. 

The  case  was  discussed  by. the  President,  Dr.  D. 
Grant,  Mr.  P.  de  Santi;  and  Dr.  Potter  replied. 

Dr.  Smarthwaite  showed  a  specimen  of  Tubercu- 
losis of  the  Larynx,  and  Trachea,  of  rapid  course,  in  a 
man,  aet.  67. 

Dr.  H.  Tii.ley  showed  three  cases  in  which  radical 
operations  for  empyemata  of  the  accessory  sinuses  had 
been  carried  out.  All  three  cases  had  been  severe  in 
their  symptoms,  and  the  final  result  of  operation  in 
each  case  was  cure. 

The  cases  were  discussed  by  the  President,  Dr.  D. 
Vinrace,  Dr.  Fitzgerald  Powell,  and  Dr.  StClair 
Thomson. 

Dr.  D.  Grant  showed  a  case  of  Ulcer  of  the 
Tonsil,  probably  the  primary  lesion,  in  a  young 
woman  with  well-marked  cutaneous  syphilides ;  also 
a  case  of  extreme  laryngeal  oedema  in  a  man,  probably 
secondary  to  tertiary  specific  lesion,  and  treated  by 
mercurial  inunction  and  local  incision(n early  recovered). 

Mr.  Attwood  Thorne  showed  a  man,  aet.  32,  with 
adhesion  ot  the  soft  palate  to  the  posterior  pharyngeal 
wall.  The  interest  of  the  case  was  that  when  first 
seen  there  was  a  mere  pinhole  aperture,  but  that  in- 
stead of  the  opening  closing,  it  had  without  operative 
interference  got  larger  month  after  month,  apparently 
by  contractions  of  the  adhesions  towards  their  fixed 
points  in  the  periphery. 

Mr.  R.  Lake  showed  a  case  of  Chorditis  Tuberosa, 
and  a  woman  with  tuberculous  ulcer  on  the  left  vocal 
cord. 

Dr.  H.  W.  Kelson  showed  a  girl  suffering  from  a 
nasal  sinus  situated  about  an  inch  from  the  tip  in  the 
mid-line. 

Dr.  F.  Powell  showed  a  male,  aet.  34,  with  a  swelling  ot 
the  right  ventricular  band,  and  a  small  papillomatous- 
like  growth  on  the  anterior  margin  of  the  right  cord ; 
also  a  patient,  aet.  28,  who  had  suffered  from  what  he 
considered  to  be  necrosis  of  the  premaxillary  bone ; 
this  diagnosis  was  contested  by  Dr.  W.  Hill,  who  con- 
sidered that  the  sequestrum  was  not  the  premaxilla 
itself,  but  the  Stensonian   portion  of  the  premaxilla. 

Dr.  H.  J.  Davis  showed  a  patient  with  an  enormous 
swelling  between  the  arytaenoids  and  an  cedematous 
mass  of  raised  mucous  membrane,  resembling  a  large 
mucous  polypus,  and  extending  below  the  cords.  The 
question  was  whether  the  case  was  one  of  acute  oedema 
resulting  from  syphilis  alone,  or  one  ot  mixed  tuber- 
culous and  syphilitic  infection. 

The  case  was  discussed  by  the  President,  Dr.  Grant, 
and  Mr.  Lake. 


NORTH     OF     ENGLAND     OBSTETRICAL     AND 

GYNAECOLOGICAL    SOCIETY. 
Meeting  held  at  Sheffield,  February  iqth,  1904. 


Dr.  W.  J.  Sinclair,  President,  in  the  Chair. 


Dr.  Arnold  Lea  (Manchester)  related  a  case  of 

FIBRO-MYOMA       UTERI,       ASSOCIATED       WITH       ORGANIC 
HEART     DISEASE, 

treated  by  abdominal  hysterectomy.  The  patient 
was  a  sterile  married  woman,  aet.  44,  with  a  history  of 
two  years'  menorrhagia.  The  heart  was  hypertrophied 
and  dilated,  and  a  thrill  and  a  systolic  murmur  over 
the  apex  beat  were  present.  Some  slight  albuminuria 
disappeared  under  treatment,  and  supra- vaginal 
pan-hysterectomy   was   performed    and    followed    by 


SPECIAL    ARTICLES. 


The  Medical  Pbess.     315 


complete  recovery.  Dr.  Lea  thought  that  as  signs  of 
loss  Dsation  only  appeared  after  the  tumour 

l«ad  begun  to  grow  rapidly,  the  cardiac  mischief  being 
I  tie  heart  muscle  was  probably  healthy. 
imported    by    the    great    improvement    after 
a  the  tumour,     Dr,  Lea  also  read  notes  of  a 
ted    Myoma  of   the   Tutus  with   severe 
mm     treated    by  abdominal    hysterectomy.     The 
jiaticnt  was  married,  sterile.  a?l.  44!     When  first  seen 
lome  elevation  rature,  pulse  rate  of 

no  to  IjOv  sickness,  diarrhoea,  and  an  offensive  dis- 
charge from  the  uterus.     For  ten  years  there  hart  been 

for  a  fortnight 

to  allow  of  improvement  in  the  toxemic  symptoms 
taking  place.  Then  total  abdominal  hysterectomy 
wa*  carried  out  in  the  usual  way,  and  uneventful 
recovery  took  place.  The  tumour  measured  two 
and  a  half  inches  in  diameter,  and  projected  intn  the 
cavity  of  the  uterus  :  its  surface  wTas  necrosed.  The 
n  ppendages  we  re  healthy .  Mi  cros  topically,  the  a  ppear- 
ances  suggested  sarcoma,  but  Dr.  Lea  remarked  that 
it  was  extremely  difficult  to  distinguish  between  an 
inflamed  myoma  and  a  sarcoma. 

Dr,  R,  Fa v ell   (Sheffield)   showed   a   Fibro -myoma 
Fieri    undergoing     Necrotic     Changes*     It    had    been 
removed  by  pan-hysterectomy  from  a  barren  married 
.  who  gave  a  'history  of    tnenorrhagia 
■r\  years  previously.     During  the  six  months  pre- 
ceding operation  there  had   been  an  offensive  puruWl 
discharge,   and   also  elevation  of  temperature,  varying 
from  too"  to  ro2r\ 
Dr.     Pefcival    Barber    showed   a  Cystic    Fibro- 
sa    of    the     Uterus,      removed      by     abdominal 
rectomy,  from  a  patient,  set.  3d.     In  1899,  when 
l*>th  ovaries  were  removed,  the  uttrus  was  attached 
the  teft   pedicle  to   the  abdominal  wall;  a  small 
itcal   fibroid  was  noticed  growing  from  the 
Mind  us.     Severe     menorrhagia    and     increase    in    size 
ol    the    tumour    during    the    stsbeet)uen1    four   years 
>itated  its  removal.     At  the  second  operation,  do 
■  if  adhesion  could  \hi  found  between    the    uterus 
and  the  abdominal  wall. 

In    the    ensuing    discussion    Drs.    Lloyd    Roberts* 
Dnnaitlp  Gemmell,  and  the  President  took  part,  and 
replies  were  marie  by  Drs.  Lea  and  Favell. 
Dr.  Gemmell  (Liverpool)  read  notes  of  a  case  of 

AVtEtf  ORRHG5A  ASSOCIATED  WITH  SEElOUs  EVE  SYMPTOMS. 

The  patient  was  a  schoolgirl,  at.  16,  in  whose  right  eye 
severe  hemorrhage  occurred,  leading  to  total  blindness 
iitd  absence  of  fundal  reflex  ;  some  haemorrhage  also 
red  into  the  left  eye,  leading  to  slight  interference 
vision*  He  commented  upon  the  frequent  occurrence 
of  amenorrhea  m  young  ladies  going  of!  to  boarding 
!s,  more  particularly  when  going  to  the  Continent, 
htit  had  never  known  such  serious  effects  to  be  produced. 
En  this  case  there  was    an    absence  of  all  the  usual 
causes  of  amenorrhea,  no  abnormal  condition  of  the 
blood,   and    no    renal    disorder.     The    only    possible 
re   change    from   home   to   boarding  school 
utrd  mental  work  and  want    of  exercise.     Gynae- 
cological   literature    does    not    refer    to    eye    changes 
iated     with    menstruation    or    menstrual    irre- 
ties,    whereas  every  work  on  ophthalmic  surgery 
points  out  the  intimate  reflex  relationship  between  the 
de    reproductive   system,    menstruation    and    the 
eye.  The   prognosis   from  the  ophthalmic  point  of  view 
was  grave,  aud  much  depended  upon  the  re-estabhsh- 
Rieat  of   the  menstrual   function  ;  otherwise     bsemof- 
u.  re  apt  to  recur  at  the  periods.     These  ha-mor- 
r liases  may  be  a  form  of  vicarious  menstruation,  or 
result    from    reflex    uterine    irritation    and    vasomotor 
changes  associated  with  the  absorption  of  toxins  from 
the  uterus. 

The  case  was   discussed  by  Drs.   Martin*   Donald. 
Arnold  Lea,  Arthur  Wallace/ and  the  President,  and 
1  .'BUM ell  replied* 
Dr.  Pbucival  E.  Barber  {Sheffield)  related  a  case  of 

ENCVSTEO  PERIMETRITIS. 

patient  was  a  married  woman,  at.  34,  the  last  of 
e  nine  children  had  been  horn  nine  months 
kftsJy.      There  had   been  no  abortions,  and   the 


labours  and  puerperia  had  been  normal.  Shortly 
before  admission  there  had  been  slight  menorrhagia,  the 
patient  caught  cold  and  suffered  from  abdominal  pain. 
tins  gpt  well  under  treatment,  and  the  patient  got 
about  for  twelve  days,  when  the  onset  of  paroxysmal 
pain  around  the  anus*  bearing  down,  and  difficulty 
on  micturition  led  to  her  admission  to  hospital  On 
examination,  some  swelling  was  detected  in  the  right 
iliac  region,  and  bulging  of  the  posterior  walls  was 
made  out.  Pressure  symptoms  rapidly  increased,  and 
being  uncertain  of  the  nature  of  the  swelling.  Dr. 
Barber  performed  laparotomy.  The  pelvis  was  found 
occupied  by  a  tense  rounded,  elastic  tumour  so  shut 
off  by  adhesions  as  to  be  practically  extraperitoneal. 
The  abdomen  was  therefore  closed  and  the  cystic 
Collection  opened  per  vaginam,  a  large  quanta 
clear  serous  fluid  and  a  lump  of  coagulated  lymph 
escaping.  No  pathological  changes  111  uterus  or  appen- 
dages could  be  discovered. 

The  case   was   discussed    by    Drs*    Lloyd    Roberts, 
Donald,  Arnold  Lea.  and  the  President* 


Special  articles, 

BRITISH    SANATORIA    FOR    CONSUMPTION.— 
XXXVIIL 

[by  our  special  medical  commissioner. J 


THli  LIVERPOOL  SANATORIUM,   KINGS  WOOD. 

The  Liverpool  Sanatorium  for  Consumption  is  de- 
lightfully situated  on  the  borders  of  Delamere  Forest. 
It  is  about  500  ft.  above  sea -level,  and  has  exhaustive 
views  of  the  Mersey,  the  Welsh  hills,  and  the  un- 
dulating uplands  of  Cheshire.  Frodsham  is  some 
three  aud  a  half  mites  distant,  and  sfibfdfl  the  mnst 
convenient  means  of  railway  approach.  The  sana- 
torium is  conducted  by  the  committee  of  the  Liverpool 
Hospital  for  Consumption  and  Diseases  of  the  Cheat* 
The  new  establishment  has  been  made  possible  by  the 
munificence  of  Lady  Willox  and  Mr<  W,  P.  Hartley, 
the  chairman  of  the  hospital  The  foundation -stone 
of  the  new  building  was  laid  in  October,  1900  h  and  the 
sanatorium  was  opened  to  patients  in  September,  1901- 
It  has  cost  about  £1 5,000.  There  is  now  accommoda- 
tion for  some  forty  patients.  There  is  evidence  on  all 
hands  of  sound  judgment,  discriminating  care,  wise 
economy,  clear  perception  of  the  special  needs  of  the 
and  not  only  has  common  sense  been  manifest  in 
the  planning,  but  the  present  management  is  marked 
by  dear  signs  of  efficiency. 

The  main  building  has  been  well  designed  ;  it  is  of 
simple  bnt  good  construction,  and  particularly  well 
fitted  for  the  class  of  patient  received.  The  rooms  are 
particularly  airy,  with  large  windows  and  charming 
outlook.  On  the  first  floor  the  rooms  open  on  to 
balconies.  The  dining-room  is  a  separate  structure, 
and  the  kitchens  are  conveniently  adjacent.  In  addi- 
tion to  the  mam  building  there  are  five  bungalows, 
which  accommodate  twenty-two  patients— eighteen 
men  and  four  women  There  is  also  a  well-constructed 
satiitarv  block.  The  water  supply  is  good.  Sewage  is 
dealt  with  in  a  septic  tank.  Hlectric  lighting  is 
vided. 

I>r.  Herapath  Wood  is  the  resident  medical  super- 
intendent. There  is  a  matron  and  good  nursing  statl. 
Since  the  opening  of  the  sanatorium  and  up  to  Decem- 
ber 31st,  1903,  238  patients  have  been  treated.  A 
careful  analysis  of  these  shows  that  1 1 3  are  still  in  good 
health,  37  are  capable  of  doing  light  work,  36  are  more 
or  less  invalided.  30  have  died,  and  22  have  been  lost 
sight  of, 

Patients  are  admitted  on  the  nomination  of  donors 
and  subscribers.  Subscribers  of  twenty  guineas  per 
annum  arc  supplied  with  thirteen  monthly  "  recom- 
mendation "  forms,  each  entitling  the  patient  Co  all 
the  benefits  of  the  sanatorium  for  a  payment  of  1  2s.  6d. 
per  week.  Patients  at  ordinary  fees  must  come  from 
within  twenty  miles  of  Liverpool,  A  limited  number 
of  cases  may  be  received  at  £3  gs.  per  week. 

In  order  to  allow  subscribers  and  donors  to  assist 


316    The  Medical  Press. 


AUSTRIA. 


March  23,  1904. 


deserving  cases,  "  for  two  guineas  subscribed  one 
5  recommendation  '  form  is  placed  at  the  disposal  of 
the  subscriber.  This  form  enables  the  patient  to  whom 
it  is  given  to  enjoy  all  the  benefits  of  the  institution 
for  a  payment  of  12s.  6d.  per  week  for  four  weeks." 
We  have  thoroughly  examined  the  Liverpool  Sana- 
torium, and  studied  its  rules  and  manner  and  method  of 
management,  and  have  no  hesitation  in  placing  it  in 
the  forefront  of  public  institutions,  wisely,  economically 
and  scientifically  conducted  in  the  interests  of  the  con- 
sumptive poor. 

tfrance- 

[prom  our  own  correspondent.] 

Parw,  March  Wth,  1904. 
Adenoma  and  Cancer  of  the  Breast. 

In  discussing  the  subject  of  tumours  of  the  mammary 
gland.  Professor  Fillany  said  that  it  was  very  important 
that  the  practitioner  should  be  able  to  distinguish 
between  adenoma  and  cancer.  In  the  "first  place, 
adenoma  should  not  be  classed  among  the  benign 
tumours,  and  the  distinction  between  benign  and 
malign  tumours  of  the  gland  should  be  abandoned.  What 
was  necessary  to  be  done  was  to  establish  a  difference 
between  encysted  tumours  and  those  non-encysted. 
The  adenoma  of  the  breast  was  an  encysted  tumour  ; 
it  was  separated  from  the  gland  by  a  cyst,  which  was 
recognised  by  palpation  ;  the  tumour  would  be  found 
to  move  freely  on  the  subjacent  parts.  Such  was  not 
the  condition  of  cancer,  which  formed  an  intimate  part 
of  the  gland,  developed  at  its  expense  and  could  not  be 
separated  from  it. 

The  development  of  adenoma  was  very  gradual, 
unless  it  were  a  case  of  sarcoma  from  the  outset  ;  in 
such  a  case  the  evolution  was  more  rapid.  But  almost 
always  the  tumour  began  by  a  simple  adenoma,  not 
infiltrated  with  sarcomatous  tissue.  The  tumour, 
mobile  and  spherical,  could  remain  stationary  for  years. 
But  one  day  sarcomatous  degeneration  appeared, 
and  then  the  benefits  of  an  operation  were  diminished. 
For  that  reason,  the  practitioner  should  always  advise 
the  ablation  of  those  tumours  at  an  early  period. 

In  cancer,  the  evolution  was  regular,  progressive, 
more  or  less  rapid,  but  continuous.  The  external 
aspect  revealed  other  distinctive  signs.  The  base  of 
the  tumour  lay  flattened  out  on  the  thorax,  while 
sarcoma  stood  out  in  relief,  was  a  pediculated  spherical 
tumour  larger  at  the  periphery  than  at  the  base. 

In  cancer,  the  skin  adhered  by  fibrous]tracts  directly 
to  the  tumour,  producing  folds  in  the  skin.  The 
adherence  of  sarcoma  when  it  existed  was  quite  different : 
it  was  adherent  by  distension  as  that  observed  in  an 
abscess.  Further,  the  skin  over  a  sarcoma  was  red, 
shining,  and  covered  by  a  network  of  large  veins. 

The  nipple  was  retracted  in  cancer  and  simply 
effaced  by  extreme  distension  of  the  skin  in  sarcoma. 
Ulceration  in  cancer  was  produced  by  destruction  of 
the  skin  ;  in  sarcoma  it  was  exaggerated  distension.  The 
edges  of  the  sarcoma  were  soft  and  scooped  out,  while 
in  cancer  they  were  hard  and  regular.  Palpation  re- 
vealed in  cancer  a  hardened  mass,  in  sarcoma  a 
fluctuating  tumour  of  variable  consistence. 

The  lymphatic  system  was  not  invaded  in  sarcoma 
on  account  of  the  protecting  envelope  ;  in  cancer,  the 
glands  were  rapidly  infected.  Sarcoma  never  affected 
the  general  health,  while  cancer  produced  cachexia 
very  rapidly.  Cancer  returned  frequently  after  opera- 
tion ;  relapses  in  sarcoma  were  much  more  rare  and  less 
grave. 

Vertigo. 

According  to  Professor  Robin,  vertigo  proceeded  in 
the  immense  majority  of  the  cases  (90  per  cent.)  from 


gastric  troubles.  In  persons  suffering  from  heart 
disease,  vertigo  was  frequently  complained  of  and 
attributed  to  some  obstacle  in  the  encephalic  circula- 
tion, but  that  was  not  so.  Digestion  was  bad,  tongue 
furred,  abdomen  tympanitic,  cramps,  somnolence.  By 
treating  the  stomach  the  vertigo  disappeared. 

The  vertigo  of  gastric  origin  occurred  under  two 
principal  conditions  :  when  the  patient  changed  posi- 
tion, either  passing  from  the  horizontal  to  the  upright, 
or  vice  versd. 

The  prognosis  was  benign  if  there  were  no  reason  to 
suspect  arterio-sclerosis.  The  three  great  causes  which 
produce  gastric  vertigo  were  coffee,  tobacco,  and  con- 
stipation. 

The  treatment  should,  after  suppressing  the  coffee 
or  the  tobacco  as  the  case  might  be,  consist  in  bitters 
before  meals,  quassia  amara,  nux  vomica,  strychnine* 
&c,  and  an  absorbing  powder  after  meals  : — 
Bicarbonate  of  soda,  fysa. 
Calcined  magnesia,  3iss. 
Carbonate  of  lime,  5j« 
Lactose,  3j- 
Divide  into  twelve  powders — three  daily. 
If  the  vertigo  does  not  disappear,  the  following  change- 
might  be  made  : — 

Calcined  magnesia,  gr.  vi. 
Carbonate  of  lime,  gr.  iv. 
Bicarb,  of  soda,  gr.  iv. 
Powder  of  nux  vomica,  gr.  £. 
Powder  of  belladonna,  gr.  \. 
For  one  powder ;  three  daily  after  meals. 
The   following   mixture   was   recommended   by  M- 
Robin  : — 

Bromide  of  potassium,  oiss. 
Cherry  laurel  water,  3ij. 
Syrup  of  ether,  5*s. 
Syrup  of  valerian,  $ss. 
Water,  3v. 
A  tablespoonful  at  the  moment  of  the  attack. 

Bustria. 


[from  our  own  correspondent.] 

Vikc«a,  March  19th,  1004. 
Lupus  Exulcerans. 

Freund  showed  a  patient  to  the  Gesellschaft  der 
Aerzte  with  lupus  exulcerans  of  the  nose,  the  elbow, 
and  back  of  the  hands,  which  were  nearly  cured 
after  sixty  applications  of  the  Rontgen  rays.  The 
treatment  has  extended  over  two  years. 

He  showed  another  with  spina  ventosa  of  the  right 
thumb  which  was  receiving  a  similar  treatment  with 
good  results. 

Neuro-Fibroma. 

Hanke  brought  forward  a  young  girl  with  a  large 
soft  tumour  on  the  left  temporal  region  of  the  head 
which  extended  to  both  eyelids;  through  the  soft 
swelling  hard  bands  could  be  felt.  The  members  agreed 
with  the  diagnosis  of  Hanke. 

Fuchs  related  several  cases  that  had  come  under  his 
own  observation  of  a  similar  nature,  but  situated  on 
other  parts  of  the  body. 

Carcinoma. 

Wagner  gave  his  results  to  the  meeting  ot  experi- 
ments conducted  with  carcinoma,  which  Adamkicmci 
had  started  some  time  ago,  by  affirming  that  if  a  piece 
of  cancerous  tissue  be  placed  in  the  brain  of  a  healthy 
dog  that  animal  will  die  of  typical  carcinoma.  Wagner 
performed  this  operation  under  different  conditions 
and  in  a  variety  of  ways,  but  cannot  arrive  at  the  same 
conclusion.  It  the  cancerous  tissue  be  inserted  in  the 
brain  substance  sterile  it  will  remain  there  indefinitely 
without  any  apparent  reaction.     No  bacterial  infection. 


\UftCH    2h     iQi'M. 


OPERATING    THEATRES. 


Tim  Medical  Press.      317 


ean  be    traced   by    ihe  implantation   of  this   foreign 
morbid  insertion. 

Traumatic  (Edema  of  Hands. 
Kienbock    showed    a   case  of  so-called     traumatic 
hard  swelling  on  the  back  of  the  hands*     The  R>  • 
shadow   showed    that    this    inexplicable   disease    was 
probably  due   to  injury  of  the  trophic  nerve,  as  the 
tiones  of  the  hand  were  greatly  reduced. 
Purulent  Perityphlitis. 
Eiselsberg  continued  the  discussion  on  the  subject  o! 
purulent   perityphlitis,   which  Moszkowi  cz  introduced 
bO  the  meeting  some  time  ago,  and  which  has  given 
rise  to  a  good  deal  of  excitement  in  the  profession  as 
leading  opinions  are  so  diverse,  and  many  of  them  are 
-ed  to  one  another-     Eiselsberg  could  not  see  how 
anyone  can  indicate  diffuse   peritonitis   and    multiple 
ss  as  cause  and  effect,  as  he  was  persuaded  that 
the  abscesses  were  the  cause  of  the  peritonitis  and  not 
tn  the  reverse  order,  as  Mosskowicz  would   have  us 
heheve.     In  confirmation  of  this  fact  he  could  fthdw 
.1  patient  m  thewards  at  the  present  time  who  hadhad 
diffuse  peritonitis  seven  days  after  the  abscess  formed. 
He   condemns    the   sacral    method    of    opening    the 
abscess,  as  it  is  very  difficult   to  reach  the  appendix 
from   this  quarter,  besides  the  disadvantage  of  an  un- 
necessarily prolonged  recovery.     The  principal  points 
to  guide  the  surgeon  in  perityphlitis  were  the  etiology 
and  the  results  of  the  bacterial  examination, 

Teleky  said  that  according  to  his  own  experience 
and  many  other  clinicians  he  found  that  So  per  cent. 
OJ  the  cases  of  peri typh litis  recovered  without  any 
operation  whatever,  and  without  any  subsequent  bad 
effect.  On  this  account  he  thought  it  madness  to 
stand  with  a  knife  in  hand  ready  to  fly  at  any  case  that 
may  present  itself  10  the  practitioner.  He  Would 
therefore  recommend  a  more  conservative  treatment 
than  that  prescribed  by  many  of  those  who  had  already 
spoken  on  the  subject.  There  is  one  thing  he  would 
earnestly  recommend — that  the  operation  should  be 
conducted  by  a  surgeon  well  accustomed  to  the  work. 
Gersuny  said  that  the  statistics  quoted  by  Teleky 
very  favourable  and  included  a  large  number  of 
colica  appendicular js.  Admitting  this  happy  result  of 
our  statistics,  what  was  to  become  of  the  other  20  per 
Lfnt.  }  These,  he  contendel,  were  the  cases  for  which 
this  protracted  discussion  was  opened,  and  of  which 
he  thought  every  surgeon  should  have  the  most 
comprehensive  knowledge. 

Moszkowi  cz  concluded  the  discussion  by  briefly  reply- 
ing to  some  of  the  questions  that  had  been  put  to  him, 
He  thought  it  unnecessary  to  reply  individually  as 
many  oi  the  speakers  had  answered  each  other.  He 
was  still  of  an  opinion  that  the  operation  should  he 
performed  at  any  stage  and  the  appendix  removed,  or 
any  abscess  that  may  be  formed  when  the  diagnosis  is 
ijsively  arrived  at. 


Ube  ©perattng  Hbeatres, 

ST.  PETER'S  HOSPITAL, 
Internal     Urethrotomy     for     Stricture.— Mr. 
Thomson  Walker  operated  on  a  man,  itt.  52,  who  had 
been   admitted    for  diihculty   and    frequency   of   mic- 
hirition  and  recurrent  attacks  of  retention.     He  had 
't'd   twenty   years  before   from   gonorrhoea.     The 
present  symptoms  had  lasted  a  year,  and  had  gradually 
mereased*     On  admission,  not  even  the  finest  instru-  | 
raeut  could  be  passed  through  the  stricture,  which  was 
in  the  bulbous  urethra.     On  the  following  morning 
however,  a  Maisonneuve  guide  was  passed  and  lied  in. 
I'nder  an  anaesthetic,  a  Maisonneuve  urethrotome  was 
KfftHfid   on    to    the    guide,    and    passed    through    the 
m\     The  fine  knife  of  the  instrument  was  the 


tn  trod  need  and  the  Stricture  cut.     After  withdrawing 
he  instrument  the  meatus  was  enlarged  with  a  probe- 
pointed  bistoury,  and  large  steel  bougies  were  then 
passed  up'to  16-18  English,  in  order  to  make  certain 
that   all   the  strictures   had   been  divided,     A   coude 
catheter  was  then  passed,  and  the  bladder  washed  out 
with  weak  silver  nitrate  solution,  followed  by  boracic  ; 
the  catheter  was  then  tied  in,  and  the  patient  sent 
back    to    bed.     Mr.    Walker  said    that   only   a   small 
proportion  of  strictures  require  a  cutting  operation  ; 
the  great  majority  are  treated  quite  satisfactorily  by 
intermittent  dilatation,  that  is  to  say,  the  introduction 
of  graduated  gum  elastic  or  steel  bougies  of  increasing 
1  sizes  at  increasing  intervals.     A  minority  of  stric 
he  said,  require  a  cutting  operation,  and  these  include 
the  following  :— Certain  strictures,  after  persisting  for 
many  years,  become  so  hard  and  cartilaginous  that  it 
is  impossible   to  make  any  progress  by  intermittent 
dilatation  ;   other  strictures  of  more  recent  formation 
return  almost  at  once  to  their  former  calibre  alter  the 
passage  of  bougies.     These  are  termed  resilient  stric- 
tures,   In  a  certain  number  ^of  these  latter,  attacks  of 
retention  follow  almost  every  instrumentation.     A  few 
strictures,  when  they  come  under  examination,  are  so 
narrow  that  only  a  filiform  bougie  can  be  passed  after 
much  difficulty.     In  all  such  cases  it  is  better  to  submit 
the   patient    to   a   slight  operation,    such   as   internal 
urethrotomy,  than    to    fatigue    him    by   the   repeated 
passage  of  a  filiform  bougie  wit  In  nit  being  able  to  make 
any  progress    towards    the   introduction   of   a   larger 
instrument.     To  this,  however,  there  is,  he  pointed  out, 
an  exception.      It  will  be  sometimes  found  that  after 
the  passage  of  a  filiform  bougie  through  a  very  tight 
stricture,  a  much  larger  instrument  ta  passed  without 
difficulty  on  the  next  occasion  ;    in  such  a  case  part 
of  the  narrowing  at  least  is  due  to  congestion.     In 
regard  to  strictures  complicated  by  urinary  fistula*,  he 
preferred  to  perform  internal  urethrotomy,  and  at  the 
same  time  to  scrape  out.  or,    if  possible,  excise  com- 
pletely, the  fistulous  tract.     The  operation  of  internal 
urethrotomy  is,   he   considered,  an  easy  one  in   the 
majority  of  cases ,  but  in  a  few  may  become  extreme!  v 
difficult.     The  most  frequent  difficulty  was  found  to 
be   in   the   passage  of  instruments  after  cutting   the 
stricture.     This  is  due    to  incomplete  cutting  of  the 
stricture,  or  strictures,  and  if  the  difficulty  is  met  with 
the.  metal   guide  of   the   Maisonneuve's   urethrotome 
should  be  again  introduced  and  the  knife  passed  again. 
The  danger  of  hemorrhage  after  internal   urethrotomy 
is,  he  believes,  greatly  exaggerated.     He  had  heard  of 
one  or  two  cases,  but  had  not  met  with  this  a  mi  plica- 
tion  himself.     Should  such  occur  a  large  guniL 
catheter  should  be  tied  in  and  pressure  applied  to  the 
perineum,  taking  the  point  d'appui  from  the  patient's 
shoulders,     Should  this  fail  to  arrest  the  hemorrhage 
a  staff  should  be  passed  and  perineal  section  performs  | 
the  pressure  of  the  large  perineal  tube   is  sufficient  to 
arrest  the  bleeding.     It  was,  he  said,  his  custom  to  tie 
ill   f->r  twenty-four  hours  a  large    gum -elastic  catheter 
after  the  operation  as  a  routine  measure,  as  he  believes 
there  is  less  danger  of  a  rigor  when  the  patient  passes 
his    urine.     After   urethrotomy,    whether   external    or 
internal,  it  is  a  mistake   to  suppose,  he  pointed  out, 
that  all  cases  of  stricture  are  cured,     A  large  instru* 
mr nt  should  be  passed  fourteen  days  after  the  internal 
urethrotomy  and  once  or  twice  at  intervals  after  this  ; 
it  is  found,  however,  that  in  a  few  cases  the  stricture 
again   contracts  and   intermittent   dilatation   is   again 
resorted    to.     A    like    condition    may    follow   external 
urethrotomy.     In    comparing    internal    and    external 
urethrotomy  ihe  saidlthat  the  former  was  a  much  Iqm 
severe  operation,  the  patient  remaining  in  bed  after  it 


318     The  Medical  Press. 


LEADING   ARTICLES. 


March  23,  1904. 


for  a  week  or  ten  days  at  the  outside  ;  in  external 
urethrotomy,  on  the  other  hand,  the  patient  is  confined 
to  bed  for  a  much  longer  period,  and  has  the  additional 
discomfort  of  a  perineal  drain.  As  regards  thorough- 
ness in  the  division  of  the  stricture,  an  internal  urethro- 
tomy is,  he  considered ,  more  thorough  than  an  external- 
Tn  the  latter  the  narrowest  stricture,  that  is  to  say,  the 
-one  nearest  the  bladder,  is  thoroughly  cut,  but  others 
of  wider  calibre  and  situated  nearer  the  external 
meatus  are  left  untouched,  and,  further,  in  internal 
urethrotomy  the  wound  is  confined  to  the  stricture 
itself  and  does  not  affect  the  perineal  structures  out- 
side the  urethra,  and  lead  to  that  distortion  of  the 
urethra  which  is  sometimes  found  many  years  after 
the  external  urethrotomy.  There  are,  however,  a  few 
strictures  in  which  he  believed  that  an  external  urethro- 
tomy was  necessary,  such  as  cases  in  which  not  even 
a  filiform  bougie  could  be  passed  through  the  stricture 
after  repeated  attempts.  Here  a  Wheelhouse  opera- 
tion is  necessary,  and,  again,  certain  cases  of  long- 
standing stricture  in  old  men  with  a  dirty  bladder. 


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"  SALUS  POPULI  SUPREMA  LEX." 


WEDNESDAY,  MARCH  23,  1904. 


THE  CHINESE  LABOUR  IMPORTATION. 

The  proposed  importation  of  Chinese  coolies  to 
work  in  the  gold  mines  of  the  Transvaal  has  roused 
a  good  deal  of  feeling  in  this  country.  Of  the 
political  advisability  of  the  step  we  have  no  opinion 
to  offer,  but  whatever  view  is  taken  of  the  neces- 
sity for  such  importation,  it  is  hardly  possible  to 
regard  it  as  other  than  an  unfortunate  necessity: 
However,  for  good  or  for  ill,  the  Labour  Ordinance 
of  the  Transvaal  Legislature  has  received  the 
approval  of  the  Home  Government,  and  it  is  the 
duty  of  both  sides,  those  who  agree  with  its 
ratification  and  those  who  disagree  with  it,  to 
urge  that  such  regulations  shall  be  passed  that  the 
working  of  the  system  may  be  free  from  objection. 
This  must  be  secured  for  both  parties  concerned, 
the  South  African  Colonies  and  the  Chinese 
labourers,  and  though  their  interests  are  appar- 
ently divergent  at  several  points  they  are  really 
identical.  In  no  particular  is  this  more  true  than 
in  the  necessity  for  ensuring  that  every  precau- 
tion shall  be  taken  that  the  Chinese  shall  be  free 
from  disease  when  they  embark,  shall  be  kept  free 


from  disease  on  the  journey,  and  shall  be  preserved 
— often  against  their  will — free  from  disease  during 
their  sojourn  in  the  Colony.  The  Chinese  are  a 
notoriously  uncleanly  race  according  to  our  occi- 
dental ideas,  and  dirt-bred  diseases  flourish  in  their 
midst.  Plague  seems  to  have  originated  among 
them  ;  typhus  is  endemic  in  North  China,  and 
typhoid  fever  and  cholera  prevail  more  or  less 
over  the  whole  country.  Other  diseases  of  one 
kind  and  another  are  rife.  The  peril,  then,  of 
importing  indiscriminately  many  thousands  of 
Chinese  into  a  British  Colony  is  no  light  one. 
The  fact  that  the  influx  of  this  human  stream  is 
redolent  of  danger  is  one  to  be  faced,  and  dealt 
with  intelligently  and  firmly  by  anticipatory  safe- 
guards. Besides  this,  it  is  the  duty  of  all  con- 
cerned in  the  importation  to  see  that  even- 
reasonable  care  shall  be  taken  of  the  labourers 
during  the  time  they  are  under  our  jurisdiction. 
The  word  "  slave  "  has  often  been  mentioned  in 
connection  with  this  traffic,  and  it  is  due  to  those 
who  entertain  strong  feelings  on  the  subject,  no 
less  than  to  the  humanitarian  instincts  of  our  race, 
that  no  reproach  such  as  is  implied  by  that  word 
should  be  capable  of  being  levelled  at  men  acting 
under  a  British  Government.  For  this  reason,  too, 
it  is  necessary  that  adequate  skilled  supervision 
should  be  exercised  over  the  labourers,  so  that  no 
niggardly  economy,  and  no  specious  plea  of 
necessity,  should  at  any  time  be  allowed  to  deprive 
the  coolies  of  a  proper  supply  of  air,  food,  water, 
and  sanitary  conveniences.  They  have  a  right — 
the  common  right  of  all  human  beings — to  these, 
and  it  would  be  disastrous  cheese-paring  to  allow 
any  obstacle  to  prevent  their  proper  provision. 
Now,  how  are  these  dangers  to  be  met,  or  rather, 
averted  ?  We  say  unhesitatingly  by  the  employ- 
ment of  experienced  medical  men  all  along  the 
line.  A  point  to  which  we  attach  the  greatest 
importance  is  the  early  detection  and  elimination  of 
people  suffering  from  infectious  and  contagious 
diseases.  It  is  useless  to  wait  till  the  transports 
with  their  human  freights  are  at  sea  before  ascer- 
taining who  these  are,  and  equally  futile  to  expect 
to  weed  them  out  by  a  single  medical  examination. 
We  hold  that  the  only  safe  plan  is  to  provide 
quarantine  camps  at  the  ports  of  embarkation, 
where  the  labourers  and  their  families  can  be 
detained  under  rigid  medical  inspection  and  super- 
vision. Whilst  in  these  camps  they  should  be 
vaccinated  and  watched  carefully  for  three  weeks 
or  a  month  to  see  which  of  them  are  incubating 
transmissible  diseases.  If  they  are  hurried  from 
their  pestilential  homes  straight  on  to  the  transports 
it  is  a  moral  certainty  that  these  ships  will  become 
hot-beds  of  disease.  Then  for  the  voyage.  It 
goes  without  saying  that  a  medical  man  with 
competent  assistants  should  be  in  charge  of  the 
ship's  company,  with  power  to  see  that  proper 
food,  and  attendance  during  sickness,  are  provided, 
and  that  sanitary  regulations  are  rigorously 
enforced.  Anyone  who  has  had  experience  of  the 
pilgrim  traffic  in  the  East  will  recognise  that 
capable  and  resourceful  medical  men,  backed  up 
by  vigilant  and  conscientious  officials  on  shore, 


March  z*.  1904- 


LEADING   ARTICLES. 


The  Medical  Press.     319 


form  the  only  safeguard  against  abuse  under  such 
l  instances.     On     arrival      at     the     point    of 
rk.ition,    apparently    Durban,    the   labourers 
are  to  be  taken  up  country  and  made  to  live  in 
ixjunds,  or  special  communities,     Here,  too, 
for  humanitarian  and  sanitary  reasons  it  is  ncccs- 
that  a  good  staff  of  competent  medical  men 
should  be  employed,  not  onlv  for  ordinary  attend- 
ance cm  the  sick,  but  also  to  sec  that  every  known 
iiition    is    taken    to    prevent    disease.     The 
mment  ought  hardly  to  need  to  be  reminded 
of  what  took  place  in  the   concentration  camps 
during  the  late  war.     The  same  perils  await  the 
formation  of  the  Chinese  compounds  unless  and 
until  shrewd  foresight,  and  vigorous  administration, 
remove   the   causes   that  inevitably   produce   the 
^me  lamentable  results,     We  understand  that  the 
Colonial  Secretary  and  his  advisers   are   framing 
regulations   with   regard    to    the   working   of    the 
Labour  Ordinance,  and  we  commend  these  sug- 
►ns  to  him  as  the  minimum  compatible  with 
>\     Governments  in  their  corporate  capacity 
are  notoriously  chary  of  receiving  medical  advice, 
and    as  notoriously  land  themselves  in  difficulties 
and   dangers    as    the    result    of    ttoedl    obstinacy. 
We  trust  that  the  good  name  of  this  country,  the 
well-being  of  its   prongs,  and  the  health  ot  its 
Colonists  will  not  be  allowed  to  suffer  from  neglect 
of    the    elementary    precautions    that    we    have 
indicated. 


THE     FUTURE    OF    PHOTO-THERAPY. 

The  value  oi  light  as  a  prophylactic  against 
disease  has  been  recognised  from  time  imme- 
morial. The  belie i  in  its  efficacy  has  in  no  way 
diminished  in  the  course  of  ages,  but  rather,  owing 
to  recetvtscientinc discoveries, it  has  gained  strength 
irom  being  confirmed  in  the  laboratory  and 
by  the  bedside.  It  is  not  a  little  remarkable 
to  observe  the  great  extent  to  which  the  physical 
iorccs  of  Nature  render  therapeutical  assistance  to 
man,  as  if  to  sympathise  with  him  in  his  sufferings. 
The  exact  manner  in  which  these  latent  powers  of 
light,  air,  and  electricity  exert  their  beneficial 
effects  upon  diseased  tissues,  and  the  best  means  of 
evoking  and  concentrating  them,  we  arc  only  just 
Liiing  to  comprehend.  The  power  of  the 
aclinic  light- rays  and  the  marvellous  phenomena 
of  radio-.ii  tivitY  have  already  been  utilised  in  the 
treatment  of  widely  different  morbid  conditions. 
The  bactericidal  action  of  sunlight  is  acknowledged 
by  all,  and  it  has  become  quite  a  proverb  that  the 
sunny  side  of  a  street  is  the  one  in  which  infectious 
disease  is  less  likely  to  be  found.  Photo- therapy. 
So-called,  is  merely  the  adaptation  of  the  actinic 
rmya  which  arc  comprised  in  the  ultra-violet  zone 
ctrum  to  the  exclusion  of  others,  and  their 
projection  in  a  concentrated  form  upon  various 
parts  of  the  body  in  which  it  is  desired  to  produce 
special  effect.  It  is  not  even  essential  to 
employ  the  actual  light  of  the  sun  for  this  purpose, 
as  the  electric  light  from  an  arc  lamp  will  provide 
a  sufficiency  of  penetrating  ravs.  The  disco%*eries 
OJ  Finsen  have  opened  up  a  new  land  of  promise  in 
this  department  of  therapeutics,  but  even  though 


it  is  not  absolutely  flowing  with  the  milk  and 
honey  of  success  it  has  Taised  the  expectations 
sufficiently  high  of  those  explorers  who  have  ven- 
tured only  a  short  distance  within  this  i  new 
territory  to  justify  their  following  up  the  yet  un- 
trodden path.  Great  may  be  the  difficulties 
encountered,  but  the  long  desired  goal  may  not  be, 
after  all,  so  very  far  oft.  Much  is  written  nowa- 
days about  the  effect  ot  light  upon  the  internal 
parts  of  the  body,  including  its  tissues  and  the 
circulating  fluids  in  which  they  arc  bathed,  We 
hear  of  such  phrases  as  "imprisoned  sunlight,'" 
or  "internal  fluorescence/1  but  after  the  almost 
instantaneous  reflex  sneer  which  these  expressions 
mayt  perhaps,  have  momentarily  evoked  has  died 
away j  the  thought  is  apt  to  force  itself  upon  the 
mind  of  even  the  most  sceptical  among  us  that 
may  be  some  deep  significance  conveyed  in 
these  words.  Reference  has  been  made  before  in 
our  columns  to  the  observations  of  Dr,  W,  J, 
Morton,  who  has  employed  the  X-rays  with  signal 
benefit,  combined  with  the  internal  administration 
of  a  substance  capable  of  becoming  fluorescent 
within  the  body.  More  recently,  Dr.  Albert  E. 
Sterne,  oi  Chicago,  has  found  radiant-light  bat  lis, 
in  which  free  ozone  is  also  given,  of  great  service 
in  the  treatment  of  Junctional  and  some  forms  ot 
organic  nerve-disorders.  The  light  was  derived 
from  powerful  arc  lamps,  and  in  the  case  of  small 
animals  the  luminosity  of  their  internal  tissues  was 
placed  beyond  doubt  when  exposed  to  such  a 
plethora  of  radiance.  It  is  claimed  also  that 
several  t,isi>  oi  incipient  phthisis  and  one  case  of 
inveterate  psoriasis  were  cured  in  this  way.  The 
rationale  of  the  method  would  appear  to  lie  in  the 
germicidal  and  oxidising  jxjwers  of  the  acting 
rays,  especially  when  combined  with  nascent 
oxygen,  It  is  not  improbable  that  the  emana- 
tions from  radium  may  act  in  a  similar  manner, 
and  that  the  waters  of  some  of  our  spas  produce 
theirlbeneficialJfefTects  by  virtue  of  their  radio* 
activity*  A  wide  field  for  scientific  research  is 
thus  opened  up,  but  we  must  tread  cautiously, 
It  is  here  that  the  charlatan,  with  noisome  per- 
sistence, intrudes  with  his  light  and  other  "  cures  " 
upon  the  province  of  the  physician  said  radio- 
therapeutist.  Regardless  of  medical  diagnosis, 
all  is  fish  that  comes  to  his  netJ  and  if  the  unfortu- 
nate victim  should  happen  to  be  suffering  from  an 
incurable  disease  he  is  hopelessly  ensnared  and 
hired  on  by  false  hopes  of  ultimate  recovery. 
I  here  arc  some  in  mis  of  organic  disease  of  the 
nervous  system  which  are  greatly  benefited  by  a 
judicious  exposure  to  radiant  light  or  heat,  but  the 
selection  of  such  cases  can  only  be  made  by  a 
medical  practitioner,  who  alone  is  competent  to 
judge  of  the  suitability  of  this  form  oi  treatment, 
A  great  future  may  be  in  store  for  photo- therapy, 
but  in  this,  as  in  all  other  branches  of  science,  true 
progress  is  made  by  patient  and  often  silent  work 
which,  in  the  end,  will  be  surely  recognised, 

VENEREAL  DISEASE  IN  THE  ARMY. 
At  the  present  time,  when  there  is  so  much 


320    The  Medical  Press.       NOTES    ON    CURRENT    TOPICS. 


March  23,  1904. 


public  interest  being  taken  in  the  state  of  the 
British  Army  and  in  the  inquiry  into  the  causes 
which  tend  to  lessen  its  efficiency,  very  earnest 
attention  must  be  paid  to  all  matters  affecting  the 
individual  health  and  physique  of  the  men.  The 
Medical  Department  of  the  Army  never  was  as 
energetic  or  as  much  alive  as  at  the  present  time, 
but  unfortunately,  in  some  directions  its  efforts 
are  unavailing,  and  its  advice  falls  on  deaf  ears. 
The  discussion  of  the  effect  of  venereal  disease  on 
the  personnel  of  the  British  Army  is  far  from 
savoury,  and  this  is  probably  the  explanation  of, 
though  by  no  means  an  excuse  for,  the  widespread 
ignorance  of  the  subject  on  the  part  not  only  of 
the  laity,  but  of  the  rank  of  the  profession.  It  is, 
by  its  nature,  unfitted  for  public  debate,  but  we 
hope  that  by  keeping  the  facts  prominently  before 
the  medical  men  of  the  country,  their  advice  may 
indirectly  tell  on  public  opinion.  In  1883,  tnc 
operation  of  the  Contagious  Diseases  Act  was 
suspended  in  these  countries,  and  in  1888  in  India, 
so  that  there  has  been  a  long  enough  period  from 
which  to  form  a  just  opinion  as  to  the  value  of  the 
present  system.  The  figures  given  by  the  annual 
reports  on  the  health  of  the  Army,  compiled  by  the 
medical  officers,  are  sufficiently  instructive,  not  to 
say  surprising.  They  have  been  collected  by  Mr. 
A.  C.  Profeit  in  a  pamphlet  (a)  on  the  subject, 
lately  published  by  Messrs.  Churchill,  from  whose 
pages  we  shall  quote.  In  the  year  1806,  out  of  a 
total  strength  of  just  over  200,000  men,  there  were 
no  less  than  60,000  admissions  for  venereal  disease 
to  military  hospitals,  the  average  daily  number  of 
patients  suffering  from  it  being  nearly  6,000.  In 
other  words,  six  battalions  of  soldiers  are  con- 
tinually inactive  owing  to  a  preventable  disease. 
In  order  to  get  a  comparison  of  the  incidence  of 
disease  in  different  garrison  towns  during  the 
operation  of  the  Act,  one  cannot  do  better  than 
contrast  London  with  Chatham  and  Sheerness. 
Chatham  and  Sheerness  were  under  the  Act,  while 
London  was  not.  In  the  year  1875,  there  were  in 
London,  out  of  a  garrison  of  about  4,000,  some 
7  50  admissions  for  venereal  disease ;  but  of 
Chatham  and  Sheerness,  with  an  equal  garrison, 
there  were  seventy  admissions.  In  Aldershot, 
during  the  five  years  previous  to  1883,  the  average 
admission  rate  was  79  per  1,000;  in  1884,  it 
was  188.  Colchester  showed  a  similar  immediate 
increase  from  45  Per  l>°°°  to  J45  ;  and  Ports- 
mouth from  47  to  138.  Figures  of  like  import  are 
returned  by  every  other  town  to  which  the  Act 
had  applied.  But  it  is  India  which  furnishes  even 
more  convincing  returns.  The  Act  was  first  intro- 
duced in  the  year  1866,  and  in  Lucknow  the 
admission  rate  fell  from  252  per  1,000  in  1865  to 
62  in  1867.  In  Sitapur,  it  fell  from  481  to  54.  In 
1885,  owing  to  pressure  from  outside,  the  Govern- 
ment of  India,  as  an  experiment,  suspended  the 
operation  of  the  Act  at  fifteen  stations.  The 
admission  rates  were  during  the  following  year 
doubled  or  trebled.  At  the  present  time  more 
than  half  the  Army  in  India  passes  through  the 

(a)  "Army  Inefficiency :  Its  Greatest  Cause."     By  A.  C.  Profeit 
31.  B.  London.    1903. 


venereal  wards  in  the  year,  and  in  several  stations 
more  than  nine  out  of  every  ten  men  do  so.  For 
instance,  in  1897,  m  Shahjahanpur,  Chakrata, 
Ahmedabad,  and  Saugor,  the  admission  rates  per 
1,000  were  978,  951,  905,  and  912  respectively. 
During  the  ten  years  1875-84,  the  highest  rate  in 
any  of  these  towns  was  289.  It  is  certainly 
appalling  that  in  two  large  stations  only  one  man 
out  of  every  ten,  in  one  station  only  one  man  out 
of  every  twenty,  and  in  another  one  out  of  every 
forty,  escapes  venereal  disease  each  year.  The 
hospital  at  Netley  receives  practically  all  soldiers 
invalided  home  from  abroad,  so  that  the  number 
of  admissions  of  venereal  disease  to  that  institu- 
tion is  some  measure  of  the  severity  of  the  disease 
in  the  Army  abroad.  Of  course,  it  is  understood 
that  none  but  very  severe  forms  reach  Netley,  ail 
minor  conditions  being  treated  locally.  During 
the  years  preceding  1888,  in  which  year  the  Con- 
tagious Diseases  Act  was  suspended  in  India,  the 
number  of  admissions  per  annum  never  exceeded 
100.  From  1888  to  1897  *t  steadily  increased  to 
804,  while,  of  course,  in  recent  years  during  the 
war  in  South  Africa  it  declined  slightly.  Equally 
striking  with  the  figures  we  have  quoted  is  the 
comparison  between  admission  rates  in  the  various 
Continental  armies.  The  lowest  figure  is  the 
German,  at  27  per  1 ,000  ;  the  highest  the  Italian, 
at  7 1 .  The  English  rate,  however,  is  205 .  We 
have  said  enough,  we  think,  to  point  out  the 
serious  inefficiency  of  our  Army  owing  to  this 
scourge.  The  danger  comes  home  to  us  still  more 
when  we  remember  that  most  of  the  soldiers 
affected  are  young  men  who  will  soon  return  to 
civil  life  to  spread  infection  far  and  wide,  and  to 
pass  it  on  to  generations  to  come.  The  recon- 
struction of  the  War  Office  and  the  improvement 
of  the  Army  Medical  Service  are  of  little  avail  to 
the  country  until  such  problems  as  this  are  faced 
and  solved. 


notes  on  Current  Tropics. 

Small-pox  at  the  London  Hospital. 

The  discovery  of  several  cases  of  small-pox  at 
the  London  Hospital  on  the  19th  instant  naturally 
gave  rise  to  a  good  deal  of  excitement.  On  that 
date  the  disease  was  found  in  three  in-patients 
lying  in  three  separate  wards  as  well  as  in  two  out- 
patients. Energetic  steps  were  at  once  taken  to 
curtail  the  mischief  as  far  as  possible.  The  patients 
were  sent  off  forthwith  to  the  hospital  ships  of  the 
Metropolitan  Asylums  Board,  and  the  infected 
wards  at  once  isolated  from  the  rest  of  the  wards 
under  the  special  charge  of  a  house  physician  told 
off  for  that  particular  duty.  Visitors  were  for- 
bidden to  patients  in  those  wards  and  the  nurses 
also  isolated.  As  the  malady  has  attacked 
patients  in  three  different  wards,  it  seems  likely 
that  the  infection  has  been  communicated  by  some 
person  suffering  from  small-pox  in  an  unrecognised 
form,  or  who  has  otherwise  conveyed  the  poison. 
The  invasion  of  so  large  an  institution  as  the  London 
Hospital  by  small-pox  must  be  regarded  as  a  serious 
matter.    The  East  End,  moreover,  from  which  its 


1904- 


NOTES    ON    CURRENT    TOPICS.      The  Medical  Pun.    321 


patients  are  mainly  drawn,  contains  a  larger  pro- 
portion of  inhabitants  unprotected  by  vaccination 
than  other  parts  ot  the  metropolis.  In  any  case 
the  outbreak  serves  as  a  sharp  reminder  that  small- 
pox: still  lingers  in  London.  It  is  sincerely  to  be 
hoped  in  the  interests  of  the  community  at  large, 
not  only  in  the  metropolis,  but  also  in  the  pro- 
v  inccs,  that  the  authorities  of  the  great  institution 
thus  invaded  will  be  successful  in  their  endeavours 
10  eradicate  the  disease. 


The  RA,M.C.  and  Enteric  Fever. 
The  air  is  full  of  rumours  and  schemes  of  Army 
rclorra,  lootan  d  branch  t  not  excluding  the  Ro  yal 
Army  Medical  Corps.  One  of  the  great  reproaches 
against  that  department  of  the  Service  is  that  if 
appears  unable  to  keep  camps  and  barracks  tree 
irom  enteric  fever.  The  mortality  from  that 
malady  in  South  Africa  was  no  less  terrible  than 
'  n table,   and  so  far  there  is  nothing  to  show 

were  the  British  forces  to  be  embarked  in 
another  great  war  to-morrow  they  would  be  any 
better  protected  against  enteric  fever  by  the  Army 
medical  officers  than  they  were  in  the  recent  Boer 
war.     More  than  that,  there  is  abundant  evidence 

the  Army  Medical  Department  is  unable  to 
cope  with  the  disease  at  home  when  the  problem 

seated  to  them  on  a  small  scale,  and  where 

I  hey  have  ample  resources  and  leisure  to  think 
out  their   preventive   measures.     It  is   notorious 

sn  various  Irish    and  English  camps  enteric 
is  endemic.     Such  a  state  of  affairs  would 
:cwed  in  the  light  of  a  personal  disgrace  were 
the  sanitary  charge  of  any  implicated  camp  con- 
fided to  a  smart  civilian  medical  officer  of  health. 

II  the  Army  medical  officers  cannot  exclude  enteric 
lever  from  permanent  home  camps  and  barracks 
under  their  charge  they  had  better  confess  their 
incompetence  and  study  practical  hygiene  under 
some  leading  civilian  expert.  The  latest  flagrant 
instance  of  their  failure  is  shown  by  the  invasion 
of  the  new  camp  on  Salisbury  Plain  by  enteric 
fever,  for  which  no  cause  has  yet  been  traced. 

uld  be  interesting  to  learn  who  is  responsible 
tor  the  sanitation  of  that  camp. 


'The  Cinematograph  in  Medical  Work, 

The  French  use  of  the  cinematograph  to  illus- 
trate and  demonstrate  surgical  operations  is  not 
likely  to  appeal  to  the  profession  generally  in  other 
parts  of  the  world.  For  teaching  purposes  the 
student  would  probably  learn  far  more  from  a 
truftt  to  the  operating  theatre  than  from  a  set  of 
pictures,  however  lifelike  and  accurate.  I  The 
difference,  indeed,  between  the  two  processes 
represents  the  old  story  of  the  man  who  has  learned 
his  surgery  from  practice  and  the  high  standard 
sr.uluate  whose  stock  in  trade  consists  of  an 
immeasurable  but  abstract  dowry  picked  up 
itom  books  and  plates.  It  is  conceivable  that  the 
cinematograph  might  prove  of  considerable  value 
in  the  lecture  room  in  demonstrating  various  gaits, 
muscular  palsies,  and  so  on.  At  the  same  time, 
we  feci    it  would  be  unsafe  to  prophesy,  fur  by  a 


turn  at  the  wheel  the  wizard  of  modern  science 

may  disclose  undreamt  of  marvels  at  any  moment,  i  scheme  appears  to  be  based  on  the  effort  to  push 


At  one  time  it  was  hoped  that  a  combination  of 
Rontgcn  ray  pliotography  with  the  cinematograph 
would  reveal  many  facts  both  physiological  and 
pathological  with  regard  to  bones  and  joints.  The 
great  difficulty  has  been  the  impossibility  of  getting 
flash  pictures  with  the  Rontgen  rays  through 
deeply  seated  structures,  as  the  hip~joint.  When 
such  flash  photographs  are  possible  there  may  yet 
be  a  great  place  for  the  radio-cinematograph, 
if  the  phrase  may  be  coined,  in  the  investigation 
and  demonstration  of  various  phases  of  com- 
parative biology. 

medical  men  who  have  gained  njgn  distinction  ; 
one  does  not  readily  find  a  name  to  stand  quite 
beside   that  of  Huxley.     In  politics  we  have  at 
present! no   less   than   three   medical    premiers — 
those  of  France,  Switzerland,  and  Cape  Colony. 
The  ranks  of  the   Indian   medical   service  in  its 
earlier  days  gave  to  political  work  many  of  the 
most  noted  makers  of  English  India,  and  it  was  to 
render  such  change  of  occupation  more  easy  that 
Sir  James  Out  ram  penned  the  minute  for  Council 
from  which  we  have  quoted.     In  a  recent  article  (a) 
Licut.-Colonel     Crawford,     I.M.S.,     has    brought 
together  the  names  of  many  of  these  members  of 
his  Service  who  have  occupied  a  high  place  in  the 
political  or  military  affairs  of  India.     Passing  over 
Holwcll,  whose  career  is  well  known,  one  of  the 
earliest  of  these  worthies  is  Murray t  who  rose  to  the 
rank  of  Adjutant- General,  and  in  1803,  while  on 
his  voyage  home,  was  killed ,  sword  in  hand,  in  a 
fight  Jwith  a    French  privateer  off    Ferro.     The 
notable  scholar,  John  Leyden,  included  among  the 
many  parts  he  played  in  his  short  career  that  of  as- 
sistant-surgeon   in  the  Madras  Army,    Among  his 
other  rotes  are  those  of  minister  in  the  Established 
Kirk  of  Scotland,  literary  assistant  to  Sir  Walter 
Scott,  professor  of   Hindustani,   judge,  poet,  and 
master  of  the  Calcutta  Mint.     Others  mentioned 
by  Colonel    Crawford    are  Sir  John  Macneill,  who 
— *-c_i„*.A.   Watxinatenriarv   to   Persia,   the 
American  Quackery  "in  Exoeleis.*' 
A   correspondent   has   sent    us   some   letters 
received  from  a  certain  Dr.  Thomas,  dated  from 
Huntingdon,  Indiana.     The  letters  were  sent  him 
by  the  American,  who  claims  to  be  a  "  specialist 
in  appendicitis ,'*  and  writes  '*  M.D."  after  his  name. 
This  extraordinary  practitioner  encloses  a   "  dia- 
gnosis blank  "  containing  twenty  questions,  upon 
the  answers  to  which  he  forms  his  opinion  as  to  the 
malady     concerned     and     its     treatment.       The 
dangerous  and  scandalous  nature  of  this  mamru- 
vre    may    be  gathered    from    Dr.   Thomas'   own 
words  when  he  says  :    M  Here  is  my  proposition— 
If  you  have  not  got  appendicitis  I  will  write  and 
frankly  tell  you  so.     I  shall  also  give  you  a  com- 
plete diagnosis  of  your  case,  telling  you  just  how 
you  are  afflicted  and  I  will  send  you  one  $4  treat- 
ment selected  to    suit    your  condition  which  you 
will  take  according  to  the  directions  and  instruc- 
tions.    If  you  are  improved  and  desire  to  continue 
you  may  remit  $4,  and,  if  desired,  for  $3  I  shall 
send  you  another  treatment  for  which  you  may 
remit    after    taking,     if     benefited."     The    whole 


March  23.  1904. 


NOTES  ON  CURRENT  TOPICS. 


The  Medical  Press.     322 


called 


quack  cure  for  appendicitis,  which  is 
"  appendicine."  Our  correspondent  remarks 
mildly  that  "surely  American  quackery  is  getting 
past  all  bounds."  If  our  American  cousins  can 
allow  legally  qualified  men  to  act  in  this  way  and 
yet  retain  their  qualifications  then  there  must  be 
''something  rotten  in  the  state  of  Denmark." 
American  common  sense  should  be  able  to  remove 
a  reproach  of  that  kind  from  their  midst. 

Raising  the  Wind. 
The  devices  to  which  our  public  hospitals  and 


times  the  eccentric  conduct  of  the  devotees  can 
only  be  characterised  as  madness.     The  dancing- 
mania  of  the  Middle  Ages,  in  which  whole  villages 
1  of  people  took  to  jumping  like  frogs  under  the 
I  influence  of  religious  excitement,  is  only  a  little 
more  remarkable  than  the  conduct  of  the  Russian 
I  settlers  in  Canada  last  year,  who  rushed  in  such 
,  mad  droves  to  meet  the  return  of  the  Messiah. 
The  exhibition  of  religious  fanaticism  that  is  now 
going  on  in  Beal  Island,  Maine,  must,   however, 
I  be  hard  to  parallel.     The  fisherfolk  living  there 
have  been  roused  to  the  utmost  pitch  of  excitement 
Qj  by  three  preachers  belonging  to  a  sect  known  by 
^  the  presumptuous  title  of  "  The  Holy  Ghost  and 
jn  Us."     At  their  services  hell-fire  is  preached  in 
tj  lurid  terms,  and  the  people  stirred  up  to  sacrifice 
everything  they  possess.     So  completely  are  the 
people  under  the  sway  of  these  fanatics  that  they 
sell  their  houses  and  goods,  slaughter  dogs  and 
cats,  and  one  man  was  narrowly  prevented  from 
offering  up  his  own  child.     The  authorities  have 


ignorance  of  the  subject  on  the  part  not  only  of 
the  laity,  but  of  the  rank  of  the  profession.  It  is, 
by  its  nature,  unfitted  for  public  debate,  but  we 
hope  that  by  keeping  the  facts  prominently  before 
the  medical  men  of  the  country,  their  advice  may 
indirectly  tell  on  public  opinion.  In  1883,  the 
operation  of  the  Contagious  Diseases  Act  was 
suspended  in  these  countries,  and  in  1888  in  India, 

so  that  there  has  been  a  long  enough  period  from    ..  {ortunatel     st       ^  in  and  sto       d  ^   further 
wmchtoformajustopimonastothevalueofthc[8<  ^.^^   y^™   and  m{f±  ./^.^  mdu^w 
present  system.    The  figures  given  by  the  annual  j  w 
reports  on  the  health  of  the  Army,  compiled  by  the  :  si 
—  *     if     '--^ — ^ —  — A  x-    a 

C 

G 


medical  officers,  are  sufl&ciently  instructive,  not  to 
say  surprising.    They  have  been  collected  by  Mr.  j 
A.  C.  Profeit  in  a  pamphlet  (a)  on  the  subject,  | 
lately  published  by  Messrs.  Churchill,  from  whose  j 
pages  we  shall  quote.     In  the  year  1896,  out  of  a  | 


religious  services,  and  quiet  is  being  gradually 
restored.  "  Religious  mania" — as  it  is  popularly 
termed — in  the  individual  is  pitiable  in  the  ex- 
treme, but  mania  of  a  religious  type  in  a  whole 
community  is  little  less  than  terrifying. 


The  Inventor  of  the  Laryngoscope. 

The  seventeenth  of  this  month  saw  the  hundredth 
total  strength  of  just  over  200,000  men,  there  were    sc|  birthday  of  that  remarkable  man,  Signor  Manuel 


no  less  than  60,000  admissions  for  venereal  disease 
to  military  hospitals,  the  average  daily  number  of 
patients  suffering  from  it  being  nearly  6,000.  In 
other  words,  six  battalions  of  soldiers  are  con- 
tinually inactive  owing  to  a  preventable  disease. 
In  order  to  get  a  comparison  of  the  incidence  of 
disease  in  different  garrison  towns  during  the 
operation  of  the  Act,  one  cannot  do  better  than 
contrast  London  with  Chatham  and  Sheerness. 

one  of  their  ladies  as  "  lies,"  and  now,  when  their 
secretary  publicly  utters  a  cruel  and  unfounded 
libel,  without  taking  any  trouble  to  obtain  con- 
firmation of  its  truth  or  falsehood,  the  anti-vivi- 
sectionists  rally  round  him  and  present  him  with  a 
xound-robin,  indemnity  and  endowment ! 

"  Religious  '  Mania. 
The  psychology  of  a  community  or  crowd  is 
at  times  curiously  different  from  that  of  individuals ; 
at  others  it  is  exceedingly  like.  The  influence 
that  is  exerted  on  people  by  seeing  their  neighbours 
do  anything  out  of  the  ordinary  drives  them  either 
to  wish  to  do  the  same,  or  to  be  afraid  of  being 
compelled  to  do  it.  Sometimes  the  minds  of 
people  appear  to  be  infected  en  masse,  and  we  have 
a  whole  nation  suffering  from  war-fever,  panic,  or 
demoralisation.  No  mental  state,  however,  is 
more  curious  than  that  in  which  bodies  of  people 
are  filled  with  religious  excitement.  On  a  small 
scale  it  may  be  seen  at  almost  any  Salvation  Army 
meeting  ;  on  a  larger,  at  "  revival  "  gatherings  at 
mission-halls  and  chapels,  or  it  may  be  some 
"  ritualist  "  orthodox  church  gathering.  Some- 
times whole  communities  are  affected,  and  at  such 


Garcia,    the   Spanish   teacher   of   singing.     It  is 

w;  interesting  to  recall  the  fact  that  it  is  to  him  that 

.1  we  owe  the  invention  of  the  laryngoscope  as  we 

Cl  now   have  it.     Fifty  years   ago,   after  long  and 

*i  ingenious   experiments,  Signor   Garcia   presented 

S^  our  own   Royal   Society  with   a  paper   entitled 

??  "  Physiological    Observations    on     the     Human 

or  Voice."     His  paper  was  based  on  observations 

conducted  on  himself  with  a  laryngoscope  of  his 

own   design.     Although   his   work   was   received 

coldly — and  even  incredulously  in  England — Dr. 


Turck,  of  Vienna,  was  impressed  by  the  value  of 
his  instrument,  and  a  couple  of  years  later  he  tried 
to  use  it  for  clinical  purposes  in  the  wards  of  the 
General  Hospital.     His  attempt  was  attended  with 

j  poor  success,  owing  to  the  many  initial  difficulties 
attending  the  new  practice — difficulties  that  were 
brushed  away  by  the  genius  of  Czermak,  who  laid 
the  foundation  of  our  modern  knowledge  of  laryn- 
goscopy. It  seems  curious  that  a  lay  mind  should 
thus  have  introduced  the  laryngoscope  with  all  its 
potentialities,  when  medical  men  had  been  endea- 
vouring since  the  time  of  Levrit  (in  1743)  to  devise 
an  instrument  with  which  to  investigate  the  larynx 
in  the  living  subject.  As  in  all  inventions,  Garcia 
had  his  predecessors,  but  of  these  he  apparently 
had  not  heard.  As  long  before  as  1829  Guy 
Babington  had  exhibited  an  instrument  much  like 
our  modern  laryngoscope  to  the  Hunterian  Society, 
but  for  some  reason  his  invention,  like  those  of 

.  Bozzini,  Senn,  Bennuti,  and  others,  did  not  hit  the 
fancy  of  his  time.  One  may,  then,  without  stretch- 
ing the  truth  unduly,  acclaim  Signor  Garcia  as  the 
father  of  modern  laryngoscopy,  and  at  the  same 


March  23,  1904. 


NOTES    ON    CURRENT    TOPICS.       The  Medical  Press.      323 


time  express  the  hope  that  the  heavy  weight  of  his 
years  wilJ  not  deny  him  a  further  extension  of  his 
Jong  and  honourable  career. 


£100,000  to  Medical  Education  in  London. 

The  endowment  of  London  University  medical 

education  proceeds  apace.     If  the  present  influx 

is  maintained  at  anything  like  the  present  pitch 

the  students   of   succeeding   generations   will   in- 
deed find  their  lot  fallen  in  pleasant  places.     The 
1  giit  is  one  of  £100,000  by  Sir  Donald  Currie 

to  University  College  on   its  incorporation  with 

the  University  of  London.     A  large  new  building 

will  be  erected  on  vacant  land  belonging  to  the 
present  Gower  Street  site.  At  the  present  mo- 
ment it  would  be  premature  to  speculate  on  the 
way  in  which  Sir  Donald's  magnificent  giit 
JD  be  applied.  Clearly,  however,  it  will  lighten  Franks  *^7teTiSm"I^ll 
the  load  of  the  governors  of  the  hospital,  who 
have  obtained  only  £270,000  in  response  to  their 
lately  issued  appeal  for  a  million  sterling.  The 
endowment  of  medical  education,  not  only  in 
London,  but  throughout  the  kingdom  generally, 
is  one  of  the  most  urgent  educational  needs  of 
the  present  day. 


Diabetic  Flours, 
As  our  readers  know,  there  arc  on  the  market 
many  "  diabetic  flours  "  which  claim  to  be  free 
from  Starch,  and  suitable  for  use  as  food  in  cases  of 
diabetes.  Some  manufacturers  have  succeeded  fair- 
ly well,  and  gluten  flours  suitable  for  bread-making 
have  been  produced,  but  most  of  the  articles  put 
forward  are  expensive,  misleading,  and  conse- 
cuentlv  injurious   substitutes   for  ordinary  flour, 

and  quite  a  number  of  deaths  have  been  traced  tar 
poisons  thus  administered,  In  our  opinion  th^ 
Patent  Medicine  Stamp  Act  should  be  at  oner 
repealed.  It  should  be  impossible  for  anyone  t<t 
sell  poisons  except  under  the  Poisons  [Regulatioi1 
Act.  No  proprietary  medicine  or  medio  naT 
application,  moreover,  should  be  allowed  to  beF 
sold  without  a  full  formula  of  the  composition  01  * 
the  accompanying  label. 

The  Plague  at  Johannesburg-  r 

For  the  last  few  years  Johannesburg  has  been- 
a  city  afflicted  with  many  woes.  News  of  4 
downing  disaster  came  on  Monday  last  in  thi 
announcement  of  an  outbreak  of  plague  amonf 
the  coolies  in  the  native  location.  Seven  patients' 
were  reported  to  be  in  a  critical  condition,  and 
l>r,  Marais,  a  medical  man  in  attendance  upon* 
the  location,  is  said  to  have  died  from  bubonic 
plague.  Later  reports  state  that  there  have  beer 
thirty-eight  cases  since  Thursday,  while  thirty 
of  the  afflicted  have  died  since  Friday.-  Thl 
native  location  has  been  placed  in  quarantine" 
and  many  suspects  are  receiving  the  attention  or 
the  authorities,  The  invasion  of  Johannesburg 
by  this  malady  will  have  a  special  interest  to  thosf 
readers  of  The  Medical  Press  and  Circular 
who  remember  that  on  the  first  invasion  of  th*1 
Cape  by  plague  during  the  recent  war  we  ex- 
a  firm  conviction  that  sooner  or  latei 


administrator.  An  interesting  list  might  be 
made  of  the  many  medical  men  who  have  become 
distinguished  in  non-medical  fields— literature, 
politics,  art,  science — and  it  would  be  a  study  of 
considerable  psychological  interest  to  attempt  to 
estimate  how  far  and  in  what  way  their  medical 
training  has  been  to  them  a  help  or  a  hindrance,- 
In  literature  such  names  as  Smollett,  Goldsmith, 
Lever,  Southey,  at  once  occur,  and  in  the  case  ot 
the  last  two  any  reader  can  see  many  traces  of 
medical  knowledge.  As  regards  pure  science  it  is 
curious  how  comparatively  few  are  the  names  of 
medical  men  who  have  gained  high  distinction 
one  does  not  readily  rind  a  name  to  stand  quite 
beside  that  of  Huxley,  In  politics  we  have  at 
present! no  less  than  three  medical  premiers — 
those  of  France s  Switzerland,  and  Cape  Colony. 

service  in  its 
earlier  days  gave  to  political  work  many  of  the 
most  noted  makers  of  English  India,  and  it  was  to 
render  such  change  of  occupation  more  easy  that 
Sir  James  Outram  penned  the  minute  for  Council 
from  which  we  have  quoted.  In  a  recent  article  (a) 
Lieut  .-Colonel  Crawford,  I, M.S..  has  brought 
together  the  names  of  many  of  these  members  of 
his  Service  who  have  occupied  a  high  place  in  the 
political  or  military  aflairs  of  India,  Passing  over 
Hoi  well,  whose  career  is  well  known ,  one  of  the 
earliest  of  these  worthies  is  Murray,  who  rose  to  the 
rank  of  Adjutant-General,  and  in  1803,  while  on 
his  voyage  home,  was  killed,  sword  in  hand,  in  a 
fight  fwith  a  French  privateer  off  Feno.  The 
notable  scholar,  John  Ley  den,  included  among  the 
many  parts  he  played  in  his  short  career  that  of  as- 
sistant-surgeon in  the  Madras  Army.  Among  his 
other  r&ies  are  those  of  minister  in  the  Established 
Kirk  of  Scotland,  literary  assistant  to  Sir  Walter 
Scott,  professor  of  Hindustani,  judge,  poet,  and 
master  of  the  Calcutta  Mint.  Others  mentioned 
by  Colonel  Crawford  are  Sir  John  Macneill,  who 
became  Minister  Plenipotentiary  to  Persia,  the 
Login  Brothers,  one  of  whom  was  Postmaster- 
General  of  the  Punjab,  Charles  Hathaway,  still 
alive,  one  time  Secretary  to  Lord  Lawrence,  and 
in  recent  days  Sir  George  Robertson  of  Chitral 
fame. 


Foreign  Dispensing:. 
Our  contemporary,  the  Paris  edition  of  the 
New  York  Herald,  has  done  well  in  pointing  out  to 
the  English  community  in  Paris,  and  to  the  Conti- 
nent generally,  the  danger  of  bringing  English  pre- 
scri  ptions  to  foreign  chemists ,  In  most  French  cities 
where  English  people  congregate  one  sees  the 
inviting  words  "  English  spoken  py  on  the  window- 
panes  of  many  drug-stores.  It  is  natural  enough 
that  a  visitor  should  present  an  English  prescrip- 
tion to  be  dispensed  in  such  an  establishment, 
quite  ignorant  of  the  fact  that  the  English  and 
French  official  preparations  are  different.  We  are 
not  doing  the  average  pharmacien  any  injustice 
when  we  say  that  he  rarely  knows  that  the  prepara- 
tions ordered  are  different  from  those  he  has  in 


324    The  Medical  Press. 


NOTES  ON  CURRENT  TOPICS. 


March  23.  1904. 


stock,  and  if  he  does  know  this,  that  he  is  not  likely 
to  act  on  the  knowledge.    He  is  usually  content 
with  reducing  the  English  measures  to  the  metric 
system,   and  then  dispensing  from  the   French 
-official    preparations.    Indeed,    in    some    cases 
quoted  no  reduction  was  made,   and  one  well- 
founded  story  is  told  of  a  gentleman  being  served 
with  a  two-gramme  instead  of  a  two-grain  pill  of 
calomel.    It  is  also  probably  overlooked  by  the 
-dispenser  that  in  England  liquid  preparations  are 
•dispensed  by  fluid  meaure,  in  France  by  weight. 
It  is  hardly  to  be  expected  that  French  drug- 
stores, even  those  where  English  is  spoken,  can 
afford  to  stock  a  complete  set  of  pharmacopoeial 
preparations,  so  that  error  in  dispensing  is  nearly 
'  unavoidable.  Und er  the  circumstances  our  country- 
men abroad  ought,  as  far  as  possible,  to  confine 
their  custom  to   reputable  English  pharmacies, 
and  in  cities  such  as  Paris  there  is  no  difficulty  in 
-doing  so. 


iThe  Medical  Bxaminership  of  the  Spectacle 
Makers. 

It  is  rumoured  on  apparently  good  authority 
that  the  City  Company  of  the  Spectacle  Makers 
-contemplates  the  appointment  of  a  registered 
medical  examiner  for  their  diploma.  If  that  be 
indeed  the  case  it  may  be  well  to  utter  a  note  of 
warning  to  members  of  the  medical  profession  who 
might  be  inveigled  into  applying  for  such  a 
position.  The  facts  of  the  case  are  that  the  Com- 
pany have  for  some  time  past  granted  a  diploma 
certifying  to  a  competency  in  optical  knowledge. 
That  diploma  was  signed  by  three  examiners,  one 
•a  professor  of  physics,  another  an  ophthalmic 
surgeon,  and  a  third  a  practical  optician.  The 
Company  has  now  resolved  to  add  sight  testing  to 
the  subjects  of  examination  for  the  diploma.  It 
.follows  that  the  optician  thus  fortified  by  a  diploma 
and  a  formidable  array  of  letters  after  his  name 
will  enter  into  competition  with  the  ophthalmic 
surgeon.  The  optician,  however,  cannot  use 
mydriatics,  and  many  errors  of  refraction  require 
an  artificial  enlargement  of  the  pupil  by  means  of 
drugs.  The  optician  who  does  not  use  mydriatics 
is  incompetent  and  the  optician  who  uses  them 
becomes  a  quack,  because  he  is  using  drugs  he 
knows  nothing  about,  and  is  unable  to  diagnose 
the  diseased  conditions  that  may  be  thereby 
disclosed.  The  former  medical  examiner,  we 
are  glad  to  say,  has  resigned  his  position.  Any 
member  of  the  medical  profession  who  proposed  to 
accept  the  examinership  in  question  would  do  so 
at  the  risk  of  professional  ostracism,  to  say  nothing 
of  more  serious  complications,  in  which  it  is  con- 
ceivable that  the  General  Medical  Council  might 
be  not  remotely  concerned. 


Restaurants  for  Dyspeptics. 
It  is  stated  that  one  of  the  forthcoming  novelties 
at  the  St.  Louis  Exhibition  will  consist  of  a  restau- 
rant for  dyspeptic  individuals  for  whom  the  attrac- 
tions of  the  ordinary  dining-saloon  would  prove 
futile.  On  the  face  of  it,  such  an  innovation  might 
appear  to  be  simply  pandering  to  the  gastronomic 
weakness    of    humanity,  or    even    to    encourage 


directly  the  perpetuation  of  that  kind  of  malady 
by  providing  an  easy  remedy  for  the  dyspepsia 
which  must  inevitably  ensue  from  hasty  feeding 
and  other  dietary  indiscretions.     For  the  "quick- 
lunch  "  system,  which  at  one  time  threatened  to 
invade  the  sanctity  of  the  average  city  man's 
half-hour,  such  an  institution  as  that  proposed 
would  almost  of  necessity  follow  as  an  antidote,  to 
be  resorted  to  once  or  twice  a  week.    But,  on  the 
whole,  the  Londoner  has  too  much  respect,  if  not 
for  his  digestion,  for  established  custom,  and  he 
views  with  disfavour  any  procedure  which  tends 
to  shorten  his  mid-day  intercourse  over  his  chop  or 
steak.     Now   that   the   efficiency    of    restaurant 
kitchens   in   the   metropolis   will   be   practically 
guaranteed  by  the  compulsory  possession  of  a 
sanitary  certificate,  there  will  be  less  excuse  than 
ever  for  people  to  deceive  their  constitutions  with 
a  superfluity  of  carbohydrate  diet.     The  spread  of 
hygienic  knowledge  with  regard  to  the  quality  and 
quantity  of  food  required  in  health  when  working 
hard  cannot  fail  to   react  favourably  upon  the 
digestion   of   the   masses.    For   the  unfortunate 
minority  who  are  always  suffering  more  or  less 
from  some  chronic  gastric  disorder,  and  yet  who 
do  not  think  it  worth  their  while  to  take  medical 
advice,  a  special  restaurant  all  to  themselves  where 
each  could  indulge  his  or  her  own  fad  to  the  full 
might  be  a  great  boon,  but  if  these  same  individuals 
would  only  put  themselves  under  the  right  dietetic 
conditions   and   appropriate   medical    treatment^ 
there  are  few  restaurants  of  the  ordinary  kind  where 
that  which  was  needful  for  the  exigencies  of  the 
case  could  not  be  obtained. 

now    nave    it.      nny     ycctis    ago,    Aitci     long    an  1 

ingenious   experiments,  Signor   Garcia   presented    ' 
our  own  Royal   Society  with   a  paper   entitled 
11  Physiological    Observations    on     the     Human 
Voice."     His  paper  was  based  on   observations 
conducted  on  himself  with  a  laryngoscope  of  his 
own   design.     Although   his  work   was    received 
coldly— and  even  incredulously  in  England— Dr. 
Turck,  of  Vienna,  was  impressed  by  the  value  of 
his  instrument,  and  a  couple  of  years  later  he  tried 
to  use  it  for  clinical  purposes  in  the  wards  of  the 
General  Hospital .     His  attempt  was  attended  with 
poor  success,  owing  to  the  many  initial  difficulties 
attending  the  new  practice— difficulties  that  were 
brushed  away  by  the  genius  of  Czermak,  who  laid 
the  foundation  of  our  modern  knowledge  of  laryn- 
goscopy.    It  seems  curious  that  a  lay  mind  should 
thus  have  introduced  the  laryngoscope  with  all  its 
potentialities,  when  medical  men  had  been  endea- 
vouring since  the  time  of  Levrit  (in  1743)  to  devise 
an  instrument  with  which  to  investigate  the  larynx 
in  the  living  subject.     As  in  aU  inventions,  Garcia 
had  his  predecessors,  but  of  these  he  apparently 
not    heard.     As   long    before  as  1829 


had 


as  1829  Guy 
Babington  had  exhibited  an  instrument  much  like 
our  modern  laryngoscope  to  the  Hunterian  Society, 
but  for  some  reason  his  invention,  like  those  of 
Bozzini  Senn,  Bennuti,  and  others,  did  not  hit  the 
fancy  of  his  time.  One  may,  then,  without  stretch- 
ing the  truth  unduly,  acclaim  Signor  Garcia  as  the 
father  of  modern  laryngoscopy,  and  at  the  same 


f March  23,  1904. 


OBITl: 


RENT    TOPICS. 


The  Medical  Press.    325 


Professors  Symington,  Lindsay,  and  Fitzgerald,  and 
Doctors  Mitchell  and  Lowry.  Most  of  the  speakers 
gave  expression  to  the  very  bitter  disappointment 
which  all  those  in  any  way  interested  in  the  College 
feel  just  now  at  the  refusal  of  the  Government  to  give 
any  help  to  the  College.  The  claims  of  the  College  have 
been  urged  on  many  successive  Governments,  but  never 
more  strongly  than  on  this  last  occasion,  and  as  these 
claims  were  backed  up  by  all  the  Ulster  members  and 
by  every  learned  society  and  influential  body  in  the 
North,  it  was  confidently  expected  that  at  last  a  favour- 
able answer  would  be  given.  All  hopes  were,  however, 
Roomed   to   disappointment,  and  on  last  Wednesday 

Patent  or  Proprietary  Poisons. 
It  is  curious  with  what  courage  and  confidence 
ttie  average  British  citizen  will  swallow  anything 
that  comes  to  him  in  the  shape  of  a  patent  medicine. 
When  presented  to  him  in  that  sacred  guise  he  is 
prepared  to  dose  not  only  himself,  but  his  wife  and 
his  family  and  his  mother-in-law,  and  all  other 
relatives    and  friends  with   any  drug,   however 
impotent  or  however  poisonous,  that  it  may  please 
the  proprietor  of  the  nostrum  to  have  included  in 
his  "  remedy."  So,  too,  with  a  vast  array  of  lotions, 
hair-restorers,  germ-destroyers  and  other  external 
applications.    Recently  the  purchaser  of  a  hair- 
restorer  wrote  to  the  Morning  Leader  a  frenzied 
letter.     He  admitted   therein   that  the  restorer 
had  certainly  changed  the  colour  of  his  hair,  but  it 
made  him  feel  as  if  he  had  taken  poison.    He  got 
41  acute  rheumatism  "  all  over  his  body,  and  felt 
for  several  hours  "as  if  he  should  have  a  fit." 
What  actually  happened  in  this  case  it  is  of  course 
impossible    to     say    exactly.    The     "  restorer " 
may  have  contained  corrosive  sublimate  or  some 
other  deadly  poison.    There  is  nothing  to  hinder 
anyone  from  selling  what  he  likes  as  a  hair-restorer, 
and  quite  a  number  of  deaths  have  been  traced  to 
poisons  thus  administered.     In  our  opinion  the 
Patent  Medicine  Stamp  Act  should  be  at  once 
repealed.     It  should  be  impossible  for  anyone  to 
sell  poisons  except  under  the  Poisons  [Regulation 
Act.     No    proprietary    medicine    or    medicinal 
application,  moreover,  should  be  allowed  to  be 
sold  without  a  full  formula  of  the  composition  on 
the  accompanying  label. 

The  Plague  at  Johannesburg:. 
For  the  last  few  years  Johannesburg  has  been 
a  city   afflicted  with  many  woes.    News  of   a 
crowning  disaster  came  on  Monday  last  in  the 
announcement  of  an  outbreak  of  plague  among 
the  coolies  in  the  native  location.   Seven  patients 
were  reported  to  be  in  a  critical  condition,  and 
Dr.  Marais,  a  medical  man  in  attendance  upon 
the  location,  is  said  to  have  died  from  bubonic 
plague.    Later  reports  state  that  there  have  been 
thirty-eight  cases  since    Thursday,  while   thirty 
of  the   afflicted   have   died   since    Friday.-    The 
native  location  has  been  placed  in  quarantine, 
and  many  suspects  are  receiving  the  attention  of 
the  authorities.     The  invasion  of   Johannesburg 
hy  this  malady  will  have  a  special  interest  to  those 
readers  of  The  Medical  Press    and  Circular 
who  remember  that  on  the  first  invasion  of  the 
Cape  by  plague  during  the  recent  war  we  ex- 
pressed a  firm  conviction  that  sooner  or  later 


the  disease  would  spread  up  country  and  involve 
the  whole  of  colonised  but  grossly  insanitary  South 
Africa.  That  precise  event,  although  long  de- 
layed, has  now  come  about.  The  outbreak  of 
plague  has  a  marked  political  significance  in  view 
of  the  coming  importation  of  Chinese  labour,  and 
the  establishment  of  coolie  compounds  with  their 
unspeakable  filthiness.  On  public  health  grounds 
we  unhesitatingly  condemn  the  importation  of 
Asiatic  natives  and  their  segregation  under  a  poor 
and  bad  environment.  To  bring  them  to  a  country 
already  infected  with  plague  is  indeed  to  fly  in 
the  face  of  providence  and  to  invite  the  filling 
up  of  the  measure  of  war  and  famine  with  the 
further  evil  of  a  most  dreaded  pestilence. 


The  Mimetic  Cough* 
The  man  in  the  street,  as  a  rule,  fails  to  recog- 
nise how  deeply  his  acts  are  influenced  by  sheer, 
simple,  unconscious  mimicry.  His  very  face,  as 
he  walks  along  the  busy  pavement,  often  reflects 
in  kaleidoscopic  fashion  the  various  moods,  sad, 
sorrowful,  reflective,  or  what  not,  framed  on  the 
faces  of  the  passers  by.  Inside  a  church,  one 
single  cough  is  perhaps  sufficient  to  make  him 
cough  intermittently  during  the  rest  of  the  service, 
while  all  the  other  men  from  the  street  bark  separ- 
ately or  in  chorus,  as  it  were,  like  the  baying 
of  a  pack  of  hounds.  A  good  preacher  can  often 
keep  the  coughing  in  hand,  while  a  drone  or  a  bore 
cannot  withdraw  the  attention  of  the  congregation 
from  their  fielding  throats  to  the  realms  of  a  higher 
abstract  life.  In  a  court  of  law  mimetic  coughing 
seems  to  be  regulated  by  much  the  same  set  of  con- 
ditions. The  other  day  Mr.  Justice  Darling,  his 
patience  exhausted  by  continuous  and  horrid 
coughing,  laid  down  the  law  that  there  must  be 
silence  in  his  court.  Those  who  could  not  stifle 
their  cough  must  leave  the  court,  and  he  would 
recommend  them  to  some  consumption  hospitals 
We  can  imagine  those  paroxysms  that  would  at 
once  attack  prisoners  and  jurymen  and  witnesses 
whose  unwilling  presence  had  been  compelled  by 
the  stern  command  of  the  law,- 


Small-pox  in  London. 
A  fresh  interest  is  given  to  the  small-pox 
statistics  of  the  Metropolis  by  the  outbreak  of 
the  malady  at  the  London  Hospital.  At  the 
Metropolitan  Asylums  Board  meeting  on  Saturday 
it  was  reported  that  forty-nine  cases  of  small-pox 
had  been  admitted  during  the  fortnight,  as  com- 
pared with  nine  in  the  preceding  fortnight,  and 
five  in  the  corresponding  period  of  last  year* 
During  the  fortnight  three  small-pox  patients  had 
died,  eleven  had  been  discharged,  and  sixty-six 
remained  under  treatment,  being  thirty-five  in 
excess  of  the  previous  fortnight.  The  total 
number  of  small-pox  cases  "  notified "  to  the 
board  during  the  fortnight  was  fifty,  whereas  in 
the  preceding  fortnight  only  nine  cases  were 
notified. 


The  appointment  is  gazetted  of  Fleet-Surgeon 
L.  H.  Kellett,  M.D.,  M.A.,  tothepost  of  Deputy-In- 
spector-General  of  Fleets,  on  promotion. 


326    The  Medical  Press. 


SPECIAL  C0R]**ENT  TOPICS. 


March  23,  1904. 


PERSONAL. 


directly  the  perpetuation  of  that  kind  of  malady 

by  providing  an  easy  remedy  for  the  dyspepsia 

Dr.  Garrett  Anderson  has  retired  from  the  Com-  wnich  must  inevitably  ensue  from  hasty  feeding 


mittee  of  Management  of  the  New  Hospital  for  Women, 
Euston  Road 


and  other  dietary  indiscretions.  For  the  "quick- 
(lunch  "  system,  which  at  one  time  threatened  to 
m  Dr.  Marmorbk  wiU  lecture  upon  the  nature  and  in^f? e  tne  Sanctity  of  the  average  city  man's 
use  of  his  anti-tuberculous,  serum  at  8.30  to-morrow  half -hour,  such  an  institution  as  that  proposed 
evening  (the   24th  instant)  at  St.  George's  Hospital.       would  almost  of  necessity  follow  as  an  antidote,  to 

Signor  Manuel  GAR^Tthe   famous   teacher  of  SJ^St*0  T*  °rJ"*?  *  ™£'    But»  on  >th* 
singing  and  inventor  of  the  laryngoscope,  last  week  wnoie>  tne  l^ondoner  has  too  much  respect,  if  not 


entered  upon  his  hundredth  year. 

Dr.  J.  W.  Simpson,  Medical  Registrar  to  the  Royal 
Hospital  for  Sick  Children,  Edinburgh,  has  been 
appointed  an  Extra  Physician  to  the  institution. 

Dr.  Thomas  Houston  has  been  appointed  to  the 
Joint  Lectureship  of  Medical  Jurisprudence  (with 
Professor  Lorrain-Smith)  in  the  Queen's  College,  Belfast. 

We  regret  to  say  that  Dr.  Renaud,  the  venerable 
and  well-known  physician  of  the  Manchester  Infirmary, 
is  lying  seriously  ill  at  his  residence  at  Alderley  Edge. 

The  University  of  Aberdeen  has  resolved  to  confer 
the  honorary  degree  of  LL.D.  upon  Dr.  C  J.  CuUing- 
worth,  Obstetric  Physician  of  St.  Thomas's  Hospital, 
London. 


r  The  University  of  Glasgow  will  confer  a  similar 
distinction — the  honorary  LL.D. — upon  Professor 
Stirling,  of  Owens  College,  University  of  Manchester, 
and  upon  Sir  William  Taylor,  K.C.B.,  M.D..  Director- 
General  of  the  Army  Medical  Service. 

An  interesting  address  on  the  Place  of  Medicine  in 
a  Modern  University  was  recently  delivered  by  Dr. 
Denis  J.  Coffey,  at  the  University  College,  Stephen's 
Green,  Dublin. 


Surgeon-General  Sibthorpe,  C.B.,  presided  over 
perhaps  the  most  successful  annual  festival  dinner  ever 
held  of  the  Irish  London  Medical  Graduates'  Associa- 
tion on  St.  Patrick's  Day. 

Professor  Byers,  Queen's  College,  Belfast,  was  on 
Friday  last  presented  with  his  portrait,  to  be  hung  in 
the  hall  of  the  College.  The  presentation  was  made 
by  the  Right  Hon.  Thomas  Sinclair  in  the  name  of  a 
large  number  of  friends. 

The  annual  general  meeting  of  the  London  Medical 
Graduates'  College  and  Polyclinic  will  be  held  at 
Chenies  Street,  on  March  28th,  3.30  p.m.,  under  the 
presidency  of  Dr.  C.  Theodore  Williams. 

Mr.  Ernest  R.  Evans,  M.R.C.S.Eng..  has  been 
presented  with  a  handsome  testimonial  on  his  retire- 
ment after  nearly  twenty  years'  service  as  Honorary 
Medical  Officer  of  the  Hertford  General  Infirmary. 

Mr.  Harold  J.  Stiles  has  been  appointed  Acting- 
Surgeon  to  the  Chalmers  Hospital,  Edinburgh,  in 
succession  to  Sir  Patrick  Heron  Watson,  who  has 
retired  from  his  long  connection  with  that  institution. 


Sir  Michael  Foster,  M.P.  for  University  College, 
London,  and  Secretary  of  the  Royal  Society,  reached 
the  age  of  sixty-eight  last  week.  He  was  born  at 
Huntingdon,  and  was  educated  at  the  Grammar 
School  of  that  town  and  at  University  College. 

The  resignation  has  been  announced  of  Sir  Lauder 
Brunton  from  the  post  of  Physician  to  St.  Bartholo- 
mew's Hospital,  which  he  has  held  for  nine  years. 
For  more  than  twenty  years  previously  he  acted  as 
Assistant  Physician,  and  as  casualty  physician  for 
our  years  before  that  again.  Sir  Thomas,  who  is  now 
sixty  years  of  age,  has  been  appointed  Consulting 
Physician  and  Governor  of  St.  Bartholomew's  Hospital. 


ftWuhtf  ^\yptfommea"m  the"  Blue  Book  touiaum^  h*, 
report  of  the  Physical  Degeneration  Commission,  have 
attracted  considerable  attention, both  in  Parliament  and 
in  the  press,  the  generally  inferior  physique  of  the  Edin- 
burgh children  as  compared  with  those  of  Aberdeen 
being  somewhat  startling  at  first  sight.  It  is  therefore 
gratifying  to  learn  that  Dr.  Mackenzie  and  the  staff  of 
assistants  who  were  employed  in  the  former  obser- 
vations have  resumed  their  inquiry,  and  are  at  present 
engaged  in  the  task  of  examining  a  considerably  larger 
number  of  children  than  on  the  first  occasion.  We 
understand  that  part  of  the  previous  statistics  dealt 
with  the  same  school  which  is  being  worked  at  on  this 
occasion  ;  if  the  schedules  formerly  used  still  exist  it 
would  lend  added  interest  to  the  final  result  to  com- 
pare the  individuals  who  happen  to  have  been  examined 
twice  ;  by  this  means  some  judgment  might  be  arrived 
at  as  to  the  effect  of  nearly  two  years  of  physical  drill 
on  a  class  of  children  drawn  from  among  the  poorest 
members  of  the  community.  The  medical  examination 
is  associated  with  an  inquiry  into  the  housing,  neces- 
sitating a  system  of  house  to  house  visitation — no  light 
task — in  which  the  members  of  the  Edinburgh  Social 
Union  are  co-operating.  The  expense  of  the  work  is 
being  defrayed  by  a  few  private  donors,  more  fir- 
sighted  than  the  Government  of  these  islands.  The 
total  cost  of  the  previous  investigation  was.  we  under- 
stand, less  than  a  hundred  pounds.  How  much  could 
be  done  for,  let  us  say,  the  cost  of  a  third-class  cruiser ! 

Scottish  Association  for  the  Medical  Educa- 
tion op  Women. — The  fourteenth  annual  report, 
adopted  at  a  meeting  on  March  18th,  shows  that  the 
high  quality  of  work  which  has  always  been  a  feature 
of  the  Medical  College  for  Women  (has  been  well  main- 
tained, and  that  the  number  of  students  has  increased 
from  118  to  126.  As  the  result  of  an  application  to  the 
Trust,  the  Carnegie  Trustees  have  promised  for  four 
years  to  pay  the  college  matriculation  fees  of  all 
students.  It  should  be  explained  that  this  is  a  burden 
which  male  students  escape — the  women,  in  addition  to 
the  university  matriculation  fee,  having  to  pay  a 
similar  fee  to  their  own  college. 

Old  Edinburgh  Infirmary. — This  historic  building, 
round  which  so  much  of  the  glamour  and  tradition  of 
the  palmy  days  of  the  Edinburgh  Medical  School  hang, 
in  which  Spence,  Syme,  and  Lister  operated*  and 
Bennet  and  Laycock  taught  a  former  generation,  is 
now,  seeing  that  it  is  no  longer  to  be  used  as  a  fever 
hospital,  about  to  be  disposed  of  by  the  Corporation. 
It  is  understood  that  the  University  have  indicated 
their  willingness  to  acquire  the  buildings  for  labora- 
tories. 

Small-pox. — The  disease  still  continues  unduly  pre- 
valent, fresh  cases  cropping  up  at  frequent  intervals  in 
Edinburgh,  Glasgow,  Leith,  Dumfries,  Upper  Renfrew, 
while  the  disease  has  also  appeared  at  Dunfermline, 
Bo'ness,  and  Stirling.  In  Go  van,  where  it  was  formerly 
bad,  it  is  satisfactory  to  hear  that  it  is  now  almost 
stamped  out. 


BELFAST. 
Dinner  of  Past  and  Present  Queensmen.— The 
annual  dinner  of  past  and  present  students  of  Queen's 
College,  Belfast,  was  held  in  the  Old  Castle  Restaurant, 
Belfast,  on  the  evening  of  St.  Patrick's  Day,  and  was  a 
highly  successful  function.  The  President  of  Queen's 
College  occupied  the  chair,  and  about  eighty  graduates 
and  students  were  present.  Among  the  speakers  were 
the  President,  Mr.  O'Shaughnessy,  K.C.,  Serjeant  Dodd , 


W March  j*.   iqo4. 


OBITUARY. 


The  Medical  Peess.      337 


professors  Symington.  Lindsay,  and  Fitzgerald,  and 
Doctors  Mitchell  and  Lowry."  Most  of  the  speakers 
gave  expression  to  the  very  bitter  disappointment 
which  all  those  in  any  way  interested  in  the  College 
ted  just  now  at  the  refusal  of  the  Government  to  give 
any  help  to  the  College.  The  claims  of  the  College  have 
been  urged  on  many  successive  Governments,  but  p 
more  strongly  than  on  this  last  occasion,  and  as  these 
claims  were  backed  lip  by  all  the  Ulster  members  and 
by  every  learned  society  and  influential  body  in  the 
k  it  was  confidently  expected  that  at  last  a  favour- 
able answer  would  be  given.  All  hopes  were,  however, 
doomed  lo  disappointment,  and  on  last  Wednesday 
Mr.  Wynd ham  announ ced  his  re  f  usal  >  1 1  only  re  ma  i  mi , 
as  several  of  the  speakers  said,  for  the  college  to  depend 
on  its  own  friends,  and,  happily,  there  are  signs  that 
these  will  not  fail.  Two  new  assistants  hi  ps  are  at 
pen  to  applicants — the  Riddel  Demonstrator- 
shin  in  Pathology,  at  £150  per  annum,  and  the  Purser 
Assistantship  in  Mathematics,  worth  £ioo  per  annum, 
intended  to  make  appointments  to  both  the** 
before  the  next  winter  session,  and,  moreover,  the 
President  hinted  thai  something  more  of  a  similar 
nature  might  he  forthcoming  soon. 

Presentation  to  Professor  Byers.  — As  an- 
nounced in  this  column  some  months  ago,  Pnjfi 
Bvers'  friends  decided  to  comnemorate  his  happy 
emergence  from  a  very  annoying  and  frivolous  action 
promise,  by  presenting  his  portrait  to 
the  gueen's  College  and  a  replica  to  his  wife.  The 
presentation  was  made  at  the  College  on  Friday  after- 
noon,  when  the  portrait  was  unveiled  by  the  Right, 
Hon,  nomas  Sinclair,  the  President  of  the  College 
presiding.  Subsequently  Professor  and  Mrs.  Byers 
Lined  a  number  of  their  friends  to  tea.  The 
speeches,  which  were  about  twelve  or  fourteen  in 
number,  dealt  with  the  success  of  Professor  Byers  in 
Us  college  career,  and  subsequently  in  his  practice, 
most  of  the  speakers  testifying  to  the  esteem  and 
regard  m  which  his  patients,  among  whom  they  them- 
selves were  n urn bered ,  held  him.  The  po r trai t ,  which 
is  a  life-size  three-quarter  length  is  by  Mrs.  Normand, 
and  is  an  admirable  likeness.  Dr,  Byers  is  painted  in 
ha  professional  robes,  wearing  two  hoods,  the  red  of  a 
doctor  of  medicine  and  the  purple  of  a  master  of  ohstel- 
nes.  The  picture  presented  to  Mrs.  Bvers  is  a  smaller 
«f»py  of  the  same, 


CotteBpoit&ence« 

[Wert©  not  hold  cmiwK«  naponiibl*  lor  the  opinion  of  the  oorh- 


ALOl'KUA     AND    DENTAL    CARIES. 

To  ike  Editor  of  The  Medic  a  L  Press  and  Circular. 
Sir*— As  a  matter  ot  fact,  I  have  been  in  Italy  since 
my  last  letter  on  the  above  subject  appeared,  and  it 
is  only  to-4ay,  16th,  that  I  have  seen  your  issue  of 
3ml,  with  "  Medic  us  Senex's  "  communication.  It', 
a*  he  says,  "  I  fell  out  at  the  first  round  after  inviting 
a  contest/'    it    was  not   for  the  reason   he  sue.^ 

e  quite  frank,   I  do  not  recognise  in   "  Medicus 

man    worthy    of    my   steel.     He    must 

h>i    plainly  saying   that    he  is  evidently 

luainted  with  the  fundamental  facts  of 

rsiology  and  pathology.      I  cannot   take  up 

imparting   information   which   he   can 

flick-in  study  of  current  text  books,      A  little 

>ng  is   a  dangerous   thing,  and   nothing  is  more 

dangerous  than  to  quote  a  in  mute    fragment   of    fact 

ml  of  a  large  subject,  the  greater  part  of  which  has 

Qflt    been     grasped     or    even     examined.     "  Medicus 

tg   Sewill,  states    quite  correctly   that  a 

-l>stratum  of  organic    material   is  dis- 

in  marsupial  enamel  but  he  ignores  the  fact 

marsupial    enamel   differs   very   materially    from 

tk  human  Tissue.     If  ■'  Medicus  Sencx  "  will  carefully 

n  the  histology  and  physiology  of 

human  enamel  and  dentine  in  the  work  he  cites,  and 

1   the  pathology  of  caries  and 

ugy.   I   think    he    will  gain  a  clear  conception 

at  issue.'    If  he  will  then  express  his 


views  in  your  columns,  it  will,  I  think,  prove  interesting, 
and  on  ray  return  I  can  again,  if  it  seems  necessary  and 
you  will  allow  me,  take  part  in  further  discussion  oi 
the  subject. 

I  am,  Sir,  yours  truly, 

MR.C.S.,  L.D.S. 
Hotel  Paoli,  Florence, 

March  16th,  1904. 
P.S. — "  Medicus    Senex M    has    fallen    into    errors 
regarding  the  absorption  of  roots  of  milk  teeth,  &c„  &c, 
&c,  all  of  which  he  can  clear  up  by  a  study  of  Se will's 
manual. 


Obituarv. 


OF 


JOHN  STOTHERT  BARTRUM,  F.R,C,S.Eng., 
BATH. 

The  death  is  announced  of  Mr.  j,  S.  Bart  rum, 
one  of  the  most  prominent  citizens  of  Bath, 
in  which  city  he  was  bom.  He  studied  at  King's 
College.  London,  and  became  Member  ot  the  English 
College  of  Surgeons  in  tS 38,  and  a  Fellow  of  the  same 
College  in  1  $47.  In  Bath  he  held  the  honorary  appoint  - 
ment  of  medical  officer  to  the  Eastern  Dispensary* 
and  as  Surgeon  to  the  Mineral  Water  Hospital.  lrfr„ 
Bart  rum  retired  from  active  practice  in  1882.  He 
was  an  active  Conservative  and  Churchman,  a  Justice 
of  the  Peace,  an  Alderman,  and  twice  Mayor  of  his 
native  citv. 


GEORGE  ARCHER,  L.S.A. 
We  regret  to  announce  the  death  of  Mr.  George 
Archer,  of  Felt  well,  Brandon  .Norfolk,  at  the  ripe  age 
of  83.  His  professional  education  was  received  at 
Guy's  Hospital,  whence  he  took  the  diploma  of  L.S.A. 
He  was  well  known  throughout  the  county  as  a  keen 
sportsman,  an  amateur  farmer,  and  an  interested  and 
active  worker  in  Poor- law  and  general  county  adminis- 
tration. He  kept  in  touch  with  active  and 
practice  almost  to  the  end  of  his  d.v 


busy 


OF 


ROBERT  S.  K1NNIER,  L.F.PS.Glas 
SALTCOATS. 
Mr.  R,  S.  Kinnier  the  oldest  medical  man  in 
Saltcoats,  died  on  the  16th  instant.  He  was  widely- 
known  and  respected,  A  native  of  Saltcoats,  he  had 
a  most  extensive  practice  there,  and  was  popular 
with  ail  classes.  He  was  returned  at  the  top  of  the 
poll  at  the  first  burgh  election,  and  was  afterwards 
elected  Bailie,  serving  for  a  term.  In  the  Northern 
District  of  the  County  Council  he  represented  Saltcoats 
lor  some  years.  As  a  Justice  of  the  Peace  he  took  a 
good  share  in  the  duties  at  the  local  Courts,  Dr. 
Kinnier  was  educated  at  Glasgow  University,  where 
he  took  the  L.F. P. S.Glasgow,  in  1858. 


JOHN  WILSON,  M.RCS.  Eng.,  L.S.A..  OF  WHITBY. 
The  death  is  announced  ot  Mr.  Juhn  Wilson,  the 
oldest  medical  practitioner  m  Whitby*  at  hia  residence, 
011  the  15th  inst.,  after  a  very  brief  illness,  from 
pneumonia.  The  deceased  gentleman  was  practically 
a  vegetarian,  and  had  practised  in  Whitby  almost 
ever  since  he  attained  his  degree.  He  was  educated 
at  King's  Coliege,  London,  and  in  1858  took  the 
qualification  of  ERX.S. England  and  L.S.A.  He 
was  highly  respected  and  esteemed  by  all  sections  of 
the  community,  He  was  60  years  of  age,  and  leaves 
a  grown-up  family.  Deceased  was  medical  officer  of 
the  Post  Office  staff. 


THOMAS  HUNTER  HUGHES,  M.RX.S.,  L.S.A-Eng. 
We  regret   to  announce   the   death,    on    the    i;th 
instant,  at  a  ripe  age,  of  Dr.  Thomas  Hunter  Hughes, 
of  Penmaen,   Pwllheli.   Coroner  of  South  Carnarvon- 
shire   for    twenty-four    years.     The    Corouerslnj. 
in  the  family  for  over  a  century,  the  decea- 
father  and    grandfather—both   medical  men— having 
preceded    him   in    the    appointment.     Deceased,    who 
was  aged  sixty-seven,  qualified  as  far  hack  as   185H, 
passing  from  St.   Bartholomew's.     He  had  filled   the 
office  of  President  to  the  North  Wales  branch  oJ 


328    The  Medical  Press. 


LITERATURE. 


March  23,  1904. 


British  Medical  Association,  and  was  one  of  the  best 
known  figures  socially  in  the  county  of  Carnarvonshire. 


JOHN  ANDERSON,  M.D.ST.  ANDREWS. 
Dr.  John  Anderson  died  recently  at  his*  residence 
Hamilton  'Villa,  Ulverston.  He  was  a  native  of 
Hamilton,  Lanarkshire,  and  went  to  Ulverston  forty 
years  ago,  as  assistant  to  the  late  Dr.  Amos  Beardsley, 
of  Grange-over-Sands,  and  afterwards  began  kto 
practise  for  himself.  He  was  within  a  few  days  of 
attaining  his  seventy-second  year,  and  was  universally 
and  widely  esteemed.  He  had  eight  sons,  and  of 
six  living  five  are  medical  men.  He  studied  at  Glasgow 
University  and  Vienna,  and  took  the  M.D.  of  St. 
Andrews  m  1855. 


LIEUT.-COLONEL  E.    FERRAND,   M.D..   F.R.C.S. 

The  death  is  announced  at  Peshawur,  at  the  age  of 
fifty-three,  of  Lieut. -Colonel  E.  Ferrand,  M.D.,F.R.C.S., 
of  the  Indian  Medical  Service,  attached  to  the  66th 
Punjabis.  Born  on  March  17th,  185 1,  he  qualified  as 
a  physician  and  surgeon  in  1875,  m  which  year  he 
joined  the  Indian  Medical  Service.  He  served  with 
the  Burmese  Expedition  of  1886-89,  in  the  campaign 
on  the  North-West  Frontier  of  India  in  1897-98,  and 
in  the  Tirah  Expedition.  During  the  campaign  on 
the  North-West  Frontier  he  was  engaged  in  the  opera- 
tions on  the  Samana  and  in  the  Kurram  Valley,  in 
August  and  September,  1897,  and  i&  the  relief  of 
Gulistan.  For  the  Burmese  Expedition  he  had  the 
medal  with  clasp,  for  that  on  the  North- West  Frontier 
a  second  medal  with  two  clasps,  and  forthe  Tirah 
Campaign  a  clasp. 

View  Dsfltentc  appliances. 

AN  IDEAL  DOOR-MAT. 
The  street-door  mat  is  a  most  necessary  article  of 
domestic  equipment,  but  for  all  that  there  is  little 
doubt  that  in  its  ordinary  form  it  constitutes  a  standing 
menace  to  health.  The  microbes  of  street  mud 
accumulate  in  the  meshes  of  the  matting,  to  be  stirred 
up  later  in  clouds  of  dust  by  the  feet  of  those  who  walk 
0ver  the  threshold.  Then,  again,  there  is  the  nuisance 
created  by  the  vigorous 
housemaid  who  shakes  the 
mat  in  the  face  of  passers- 
by  in  the  street.  Thanks  to 
science  and  the  inventive- 
ness of  man,  there  is  a  way 
out  of  the  difficulty.  The 
fibre  mat  can  now  be  re- 
placed by  a  metal  mat, 
made  of  non-corrosive  flat 
steel  bands  i-i6th  of  an 
inch  thick  by  jths  of  an 
inch  deep,  hinged  together 
with  galvanised  steel  rods. 
The  best  we  have  yet 
seen  is  that  patented  by 
T.  C.  MacPherson,  and 
sold  by  the  Roll-up  Steel 
Matting  Co.,  Cromwell 
House,  Surrey  Street, 
.  Strand,  London.  Durability 
*  and  cheapness  are  some  of 
its  strongest  points.  It  is 
the  most  practical,  hygienic  and  cleanly  article  of  its 
kind.  It  is  reversible,  and  loses  the  dirt  as  quickly  as 
it  gathers  it.  A  prime  advantage  is  the  convenience 
with  which  it  can  be  handled  ;  one  has  simply  to  roll 
and  pick  it  up.  When  doing  duty  it  remains  in  a  flat 
position  without  a  tendency  to  curl.  It  is  weather- 
proof, rust-proof  and  keeps  its  shape  and  wears  as  only 
true  non-corrosive  steel  can  wear,  and  can  be  made  to 
any  size.  We  cordially  recommend  it  to  every  house- 
holder who  wishes  to  prevent  as  far  as  possible  the 
invasion  of  his  house  by  the  manifold  bacteria  of  street 
mud. 


Xtteratnre* 

MAY'S  DISEASES  OF  THE  EYE.  (a) 
The  success  of  this  small  manual  has  been  pheno- 
menal, seeing  that  it  has  reached  its  third  edition  in 
less  than  three  years.  Nevertheless,  that  success 
has  been  deserved,  inasmuch  as  the  author's  compila- 
tion represents  almost  the  best  of  the  smaller  text- 
books on  the  subject  now  extant.  This  new  edition 
is  an  improvement  on  the  last,  partly  because  ot  the 
careful  revision  to  which  it  has  been  subjected,  partly 
by  reason  of  the  new  plates  and  additional  illustrations 
for  the  more  ample  elucidation  of  the  text.  The 
coloured  drawings  of  the  fundus  are  for  the  most  part 
excellent,  and  will  be  found  very  helpful  to  the  student. 
For  examinational  purposes  the  latter  will  find  that 
this  manual  is  an  excellent  one,  being  readable,  concise, 
and  up  to  date,  and  it  will  remain  as  a  trustworthy, 
practical  work  for  reference  inA after  years.  We  can 
cordially  recommend  it. 

JELLETTS  GYNAECOLOGY.  (*) 
After  the  lapse  of  three  years  a  second  edition  of 
this  handy  guide  has  made  its  appearance.  It  is  now 
published  in  slightly  altered  form,  necessitated  by 
the  addition  of  several  new  illustrations  as  well  as  of 
textual  matter.  The  opening  chapter  deals  very 
thoroughly  with  the  diagnosis  of  gynaecological  con- 
ditions; the  various  instruments  employed  in  the 
routine  examination  of  patients  being  clearly  explained 
and  illustrated.  The  section  on  menstruation  and 
its  disorders  is  disappointingly  short,  in  view  of  the 
fact  that  these  form  a  large  percentage  of  the  conditions 
for  which  medical  men  are  consulted.  The  chapter 
on  diseases  of  the  vulva  is  excellent,  and  we  observe 
with  satisfaction  that  the  author  recommends  the 
use  of  glycerine  and  ichthyol  in  cases  of  pruritus 
vulvae.  Turning  to  Chapter  VII,  which  deals  with 
displacements  of  the  uterus,  we  are  pleased  to  note 
that  Jellett,  in  speaking  of  retroflexion,  remarks 
that  "  too  much  prominence  has  been  given  to  the  use 
of  this  instrument  (i.e.  the  sound)  both  as  a  means  of 
diagnosing  and  as  a  means  of  correcting  displacements 
of  the  uterus."  He  maintains,  and  we  think  he  is 
justified  in  doing  so,  that  the  sound  should  only  be 
used  when  the  bimanual  method  fails. 

The  chapter  on  inflammatory  diseases  of  the  uterus 
contains  a  very  precise  description  of  these  conditions. 
Among  uterine  tumours  fibro-anxiomata  are  naturally 
given  the  first  place,  and  the  author  gives  a  very  fuW 
account  of  their  etiology,  diagnosis  and  treatment 
Uterine  cancer  has  not  been  given  the  prominence  we 
think  it  deserves.  In  Chapter  XI  ovarian  tumours  are 
very  well  described  and  illustrated.  Chapters  XIII, 
XIV,  and  XV  are  headed  respectively  Traumatic 
Diseases  of  the  Genital  Organs.  Genital  Atresias,  and 
Internal  Haemorrhage  o*  Genital  Origin.  We  mention 
these  because  they  are,  in  many  respects,  original,  and 
because  they  contain  statements  and  facts  collected 
together  which  can  onlv  be  found  elsewhere  after  much 
difficult  searching  out.  With  Chapter  XV  the  first 
part  of  the  work  ends  ;  and  the  second  part,  which  is 
devoted  entirely  to  the  consideration  of  operative 
procedures,  begins.  A  brief  account  of  the  prepara- 
tions necessary  for  a  gynaecological  operation  is  xiven 
as  an  introduction.  Then  follow  a  series  of  chapters 
which  cover  very  completely  the  whole  ground  of 
operative  gynaecology.  The  general  practitioner,  or 
even  the  specialist,  will  find  here  the  fullest 
account  of  perinaeorrhaphy  that  is  to  be  had  outside 
the  pages  of  the  larger  tieatises  on  this  subject.  Tait's, 
Martin's,  Hegar's.  and  Kelly's  methods  are  all  fully 


(a)  "  Manual  of  the  Diseases  of  the  Eye,  tor  Students  and  General 
Practitioners."  By  Charles  H.  May.  M  V.  Third  Edition.  Revised, 
with  276  Original  Illustrations,  including  16  Plates,  with  36  Coloured 
Figures.    London  :  Bailliere,  Tisdall  and  Cox,  1903. 

(6)  ••  A  Short  Practice  of  Gynaecology."  By  Henry  Jf  llett.  B.A., 
M.D.,  BCh.,  Bi.O.  Dub.  Univ.,  F.RO.PI.,  L.M..  Ex-Assistant 
Master  Rotunda  Hospital.  Ac.  f  econd  Edition,  Revised  and  Enlarged. 
Pp.  xiv,  406,  with  223  Illustrations.  10s.  Cd.  London:  J.  and  A. 
Churchill,  1903. 


March  35,  1904; 


MEDICAL  NEWS, 


described  and  illustrated  so  that  we  should  have  no 
difficulty  in  following  the  text. 

la  spite  ol  the  minor  flaws  to  which  we  have  inci* 
dentally  referred,  and  which,  we  trust,  will  be  put 
ngfat  m  the  next  edition,  we  have  nothing  but  praise 
lortfajs  really  "  short  practice."  The  author  imparts 
his  information  in  a  clear  and  categorical  fashion 
sot  Jeavin*?  the  reader  in  the  dark  as  to  how  to  act  in 
any  given  condition,  We  need  hardly  point  out  that  the 
book  reflects  the  teaching  ot  the  Dublin  school, 
and  this  fact  alone  should  make  it  popular, 

flDe&icat  Hew*. 

The  Director-General  of  the  Army  Medical  Service 
has  given  instructions  for  the  forwarding  to  hiin  from 
time  to  time  of  the  names  of  serving  Army  officers  for 
whom  admittance  to  the  Convalescent  Home  for 
Officers  at  Osborne  is  desired.  The  Home  will  be 
opened  for  the  reception  of  such  officers  on  the  6th  prox, 

international  Coweta  of  Ophthalmology  in  Lucerne. 

As  previously  aunounced  in  these  columns,  the  tenth 
International  Congress  will  be  held  from  September 
13th  to  the  16th,  and  on  the  17th  an  excursion  will 
bring  the  session  to  a  close.  It  should  be  impressed 
on  contributors  of  papers  that  only  those  will  have 
the  right  to  be  discussed,  which  have  been  printed 
and  sent  beforehand  to  all  the  members  of  the  Con- 
gress, Manuscripts  must  be  sent  before  Mav  1st 
(latest  date)  to  Prof.  Dr,  Melhnger,  Bale,  Switzerland. 
Attached  to  the  proceedings  there  will  be  an  exhibition 
ot  objects  of  interest  to  oculists,  either  practical  or 
historical  (instruments,  books,  illustrations,  appliances 
etc.)  In  order  to  make  this  as  complete  as  possible 
attributions  will  be  gladly  received,  before  lulv  1st 
addressed  to  Prof.  Dr.  Siegrfct,  Berne,  Members 
wishing  to  secure  accommodation  at  Lucerne  are 
advised  to  apply  before  September  nrt  to  Dr  F 
blocker.  Lucerne  who  will  engage  for  them  a  room  at 
one  of  the  best  hotels  (early  breakfast  included)  at 
S  Irenes  a  day.  Further  Information  can  be  obtained 
m  London  of  Mr,  W  H  Jessop,  ?3t  Harley  Street,  ; 
m  rhibhn,of  Mr  H  R,  Swaney,  23,  Mexrion  Souare 
Ltfens  *  Mackay,    zo,  Drumsheugh 

w  f?1!^8  f^fff  as»nut  a  Medical  Practitioner. 

At  Uieboath-Wcst  London  Police  Court    Dr   Hueh 

Sunley    Revell.    of    Wandsworth,    was    charged    with 

rung  money  under  false  pretences  by  issuing  false 

icates   of   vaccination.     According    to    the   state- 

meat  of  the  prosecution,  the  alleged  frauds  had  been 

gomg  on  for  a  considerable  time,  and  lanre  sums  of 

re  involved .     The  case  has  been  several  times 

^E!?1'  aDd-  n  Stii!  un£*T  magisterial  investigation 

London  ana  Countiea  Medical  Protectloa  Bodetr 

rs     London     and     Counties     Medical     Protection 

ty,  Ltd..  have  elected   the   following  officers  for 

the    coming    official    year:  -  President,     Jonathan 

Hutchinson,    LL,D.    F.R.C.S.,    F,R,S,     Trustees    for 

K^Vn      nfk    ^i??'    HetT*    Broadbeat,    Bart,, 
S°«    M.D..    F.R.S.;    John    Tweedy,     F.R.CS 
President  of  the  Royal  College  of  Surgeons,  England! 

MrfTL^  Cha,[mT  °f  CoimCi!'  ^  A'  Heron, 
MJ)..  F.R.C.P.,  S;  Harley  Street,  W,  In  addition  to 
a  number  of  vice-presidents,  the  following  were 
elected  on  the  Councif  —A.  G.  Aukl,  M.D,  M  R  C  P  • 
K  Hum,  V,D„  M,D, ;  E.  C.  Beaaley  p.RCS    Robert 

Henry,  M.D.  ;  CM.  Fegea,  M.R.C.S.  ;  R   Denism, 

M.R,CS     LDS     R.CS,;   Major  Greenwood,   lLBl 

Whait    M.B     CB1     Secretaries,  Hugh  Woods,  M.D.. 

B,A  (General),  A,  G,  R.  Foulerton,  RR.CS.  (Financial) 

31  Craven  Street.  Strand,  W.C,  irinanciaij. 

The  Irian  Medical  Graduates*  Dinner 

ntE  annual   Festival   Dinner  of   the   Irish   Medical 

s  and  Graduates'   Association  was  held  on  St 

Pack's   Day,   March   17th,   at    the  TrocadeW  Rc£ 

m.     The    chair  was  under  S  ab  e  a nd 

presidency  ol  Surgeon  -General  SibtborpS    CB 

Itin  was  a  large  and  brilliant  assemblage,  including 


The  Medical  Press.  329 


many  ladies,  to  the  number  of  two  hnnHi^  ™j 

trfti  *  expec^ed  ,a  -  j^SSW's 

fend,  the  various  Services  were  largely  represents 
There  was  a  good  deal  of  after  dinnf  r  U,^0^ 
of  the  speeches  be.ng  excellent,  but  most  of  fh^ 
would  have  been  improved  by  a  time  hm™  The  even™ 
of  the  evemng  was  the  presentation  of  the  a™, 
Memorial  Medal  to  Lieut. -Colonel  Preyer  in  r££ 
n.lion  of  his  distinguished  services  to  surreal  sc?e^" 
The  condition  of  the  presentation  and  the  Serial 
merits  of  the  recipient  were  most  eloquently  seMbr. h 

uur  Defenders  was  proposed  bv  Mr  uC^J"f 
^eS  *•»  -viewecfat^ngVh  &  h^ory^hi 
recent   South  African  war.  and  specially  deprecated 

^UerieT^Our1  r  ^  K*"**VdeCert 
Anderson  gave  the  Ume-hono^'uS^.  S„£^ 

Society  of  Art* 

Sti FSS%"t  sir  WilUa* ^&'^ 

l^ti'  uu  haJ  ,l  was  universally  admitted  that 
public  health  was  better  at  the  end  of  the  nin^eenth 
century  than  at  its  beginning,  and  if  tb" bX  were 
proved  to  be  nnfounded  then  the  alleged  ProCTessTnd 
prospenty  of  the  V.ctorian  era  most  L  aPm5th  Dr 
Harry  CampbeU  said  that  the  subnormal  phystoue 
of  urban  popnations  was  due  principally  to  theusTof 

Dr    wml^Ch.,rKq.Te?   "*"   0^  »o   mastication 

Dr.  William  Hall  held   that  the  evils  complained  of 

arose    through    mothers    not    suckling    the,?   infants 

Sir  Ralph   hn„x.  of  the  War  Office,  speakmg  of  the 

arguments   drawn    fmm    the   recruit  ngP  r«urns    slid 

that   there   had   always  been  a   larg/  proton   of 

rejectIOna,and   that  a  recruit  after  Ms  ^rejection 

often  renewed   h»  application  elsewhere,  so  that   h " 

rejection  appeared  more  than  once  in  the  return" 

Proposed  Census  In  ims 

At  a  recent  meeting  of  the  Royal  Statistical  Society 

he  Conned  announced  its  intention  of  reprefenhng  to 

he  Board  of  Trade  the  desirability  of  taLg  Tcefsus 

in  the  year  1906  mstead  of  in  1911      A  mot.on  on  the 

Common^     Pr°baWy  **  5Ub™Ucd  to  "hc  Ho»' 
Medical  Offlews  at  Hereford. 
The  medical  officers  of  health  belonging  to  the  West 

™n,g1anlan.d  So?*  W«l«  branch  of  the  Incor- 
porated Society  of  Medical  Officers  of  Health 
assembled   at   Hereford   last  week.     During   ,h"   day 

S  t^rt"  t0rthe  b"sineSS  -"""W.  v.s.tsBw 're  £fi 
to  the  vanoos  Corporation  undertakings.  The  1  .usiness 
meeting  wh.ch  was  held  in  the  Counril  ChambtT  "^s 

CStn*?  °,V|fr1bJ',D,i-Tubb  Thoraaa-  medial  offi^ol 
health  to  the  Wilts  County  Council.  Dr.  H  C  Moore 
read  a  paper  on  the  improvements  effected  in  Hereford 
?aL  ^^  fdSp,jOB  °(  lhe  ^P^vement  Act  ,„ 
i™«f     1^     Sm  Parker'  c,tv  anrvevor.  dewsibed  the 

t,,?^  P".  .  WOrks  Carried  out  i"  »He  city  during  the 
past  twenty-two  years.  J  s 

Dn]  verslty  of  Cambridge. 
The  degree  of  Doctor  of  Science,  hvnorh  causi,  is 
to  be  conferred  on  Dr.  Wilhelm  Ostwald.  Professor  of 
Chem,Stry  rathe  University  of  Leipsic.  At  a  con- 
gregation on  March  10th,  the  following  medical  degrees 
were  conferred  :— M.B.  and  B  C  R  M  nlvT 
Pembroke  M.B.  0>Uy,  H.  tcktyd.  £i  "  .S  In' 
DonneU.  Cams  :  B.C.  0^v>  T.  H.J  E.    Walls  iilyL^r, 

Uniymlty  of  Otfwd-  Board  or  Faeultv  of  Medicine. 

..;  J' J'  PAY^E  aad  Dr  G"  L  Schoratein.  whose 
term  oi  office  on  the  Board  of  Faculty  had  terminated. 
DOT  been  again  co-opted  members  of  the  Board 


330    The  Medical  Peess.       NOTICES  TO  CORRESPONDENTS. 


March  25,  1904. 


JjtotixtB  to 
$mtt*voxibtxd*f  ^hxrrt  %tttztB9  <&& 


*rly  requested  to  make  use  of  a  distincHv  iignatwrt  or  initial,  and 
avoid  the  practice  of  signing  themselves   "  Reader,"    "Subscriber,*   1 
"Old  Subscriber,"  *c    Much  confusion  will  be  spared  by  attention 
to  this  rule. 

W.  P.  Wrlls.— There  is  no  reason  why  an  amicable  understanding  , 
should  not  be  arrived  at,  provided  that  the  patient  has  stated  the  ' 
correct  facts  of  the  case. 

Ubiqub.— The  highest  bodily  temperature  on  record  in  a  patient  . 
who  recovered  is  said  to  have  been  114*87  F. 

Dr.  T.  B.  Sblls.— Chinosol,  as  an  antiseptic,  has  come  much  into  | 
vogue  during  recent  years.     In  genera)  surgery,  a  1  2000  solution  | 
may  be  used,  while  in  ophthalmic  surgery,  for  which  it  is  the  best 
antiseptic,  a  1*4000  solution  is  the  proper  strength  to  employ. 

J.  R.  (Birmingham).— Thank  you  for  the  letter,  which,  however,  , 
seems  rather  more  suitable  for  the  pages  of  a  musing  journal.  The 
matter,  however,  as  you  point  out,  has  a  distinct  professional  bearing, 
and  if  your  letter  is  recast,  we  shall  be  pleased  to  insert  it.  Prom  | 
personal  experience  we  can  l>ear  testimony  10  the  excel-  , 
lent  and  unassuming  work  done  by  many  of  the  District  Nursing  | 
Societies.    In  the  case  you  mention  there  ought  to  be  no  great  dim. 


tions  tott?  Scree8id€n°e  *"  ** hoep{U1' *****  ^^^  Applies 
Chorlton-upon-Medlock  Dispensary,  Manches ter.— Resident  House 

Burgeon.    Salary  £100  per  annum,  with  furnished  rooms  sad 

attendance.      Applications  to  the  Hon.  Secretary. 
OOBSBFOXDBxn  requiring  a  reply  in  this  column  are  parttcu-  j  B°Xu  South  Hants  and  Southampton  Hospital.— Bouse  Physician. 

*r»*7    f100   per   annum,  with    rooms,  board,  and  washmi. 

Applications  to  T.  A.  Fisher-Hall,  Secretary.  «-« ■%> 

MMchei-ter  Northern  Huspital  for  Women  and  Children.  Park  Place, 

Cheetham  Hill  Road  —House  Surgeon.    Salary  £80  per  annum 

with  apartments  and  board.  Applications  to  Mr.  Hubert  Teaine, 

Secretary, 88  Barton  ArcedeTManchester. 
Bridgnorth    and    South    Shropshire    Infirmary.- House    Burgeon. 

Salary  £100  with  board  amf  lodgings  in  Infirmary.    Applications 

to  the  Hon.  Secretary,  Infirmary. 
Western   General   Dispensary,  Marylebone  Bead.- Second  House 

Surgeon.      8alary  £80  per  annum,  with  board,  residence,  and 

laundry.     Applications  immediately  to  the  Hon.  Secretary,  at 

the  Dispensary. 
Oravesend  Hospital. -House    Surgeon     Palary  £100  per  annum, 

with  board  and  residence.    Applications  to  F.  H.  Stevens,  Hon. 
_  Pecfetary,  146,  Milton  Road,  Oravesend. 
Devonshire  Hospital,  Buxton,  Derbyshire.— House  Surgeon.     Salary 

£100  per  annum,  with  furnished  apartments,  board  and  lodgings. 

Applications  to  the  Secretary. 
Bradford  Royal  Infirmary.— House  Surgeon.  Salary  £100  per  annum. 

with  board  and  residence.  Application  to  William  Haw,  Secretary. 
Somerset  and  Bath  Asylum,  Ootford,  Taunton. -Assistant  Medical 

Ofitoer.  8alary  £l«o   per  annum,  with  furnished  apartments. 

board, fuel,  lighting  and  washing.    Applications  to  the  Medical 

Superintendent. 


culty  in  raising  the  funds  necessary  for  carrying  on  so  deserving  a 
charity.    One  could  hardly  imagine  a  more  necessary  and  Christian 


mission  than  to  nurse  the  poor  of  a  great  modern  manufacturing 
town. 

DEATH  OF  THE  "  MARINE  BRIDE." 

Doubtless  some  of  our  readers  will  remember  a  street  character 
well  known  to -visitors  in  Berlin,  who  stood  about  the  Untei  den 
Linden  carrying  a  heavy  bundle.  Thirty  years  sgo  she  received  the 
news  that  her  fiance,  a  marine  surgeon,  had  been  drowoed  at  sea. 
The  tragiq  message  unbalanced  her  mind :  hence  the  title  of 
"  Marine  Bride  "  given  her.  For  these  longtyears  the  poor  demented 
creature  has  been  waiting  in  the  street  forhis  return,  her  hallucina- 
tion being  that  he  would  return  through  the  Brandenburg  Gate,  The 
rags  she  invariably  carried  in  her  bundle  she  believed  were  a  dry  suit 
of  clothes  for  her  lover. 

"  A  Practitioner  of  the  present  day  "  must  send  his  name  and 
address,  not  necessarily  for  publication,  if  he  desires  his  communi- 
cation to  be  published. 

Mr.  J.  F.  Jajissbn.— All  the  members  of  the  medical  staff  of  the 
German  Hospital  in  London  hold  British  degrees  or  diplomas,  so 
that  the  point  raised  in  your  letter  loses  its  significance. 

Jfteeting0  of  the  gtorittu*,  %tttmt*9  •&£• 

Wbdsrbday,  March  23rd. 

Huxtbrian  PociBTT  {London  Institution,  Finsbury  Circus,  E.C.— 
8  p.m.  Council  Meeting.  8.30  p. m.  Dr.  P.  France  (Nauheim) : 
Description  of  the  Nauheim  Treatment.    Followed  by  a  discussion. 

Royal  Collmb  op  Surgeons  of  Etoland.— 5  p.m.  Mr.  E.  M. 
Corner  :  Acute  Infective  Gangrenous  Processes  (Necroses)  in  the 
Alimentary  Tract.    (Erasmus  Wilson  Lecture.) 

Mrdical  Graduates'  Collbob  and  Polyclinic  (22  Chenies  Street, 
W.C.)— Mpjn.  Mr.  E.  W.  Rougnto* :  Chnique.  (8urgicaL)  5.16  pjn.  Dr. 
L.  Guthrie :  On  Neurotic  Children. 

Thursday,  March  24th. 

Childhood  Society  (Library  of  the  Sanitary  Institute,  72  Margaret 
Street,  W.).— 8  p.m.  Lecture  :— Dr.  H.  R.  Jones:  Child  Punish- 
ments. 

Royal  Collbob  or  Physicians  op  London  (Pall  Mall  East).— 
6  p.m.  Dr.  F.  Taylor:  Some  Disorders  of  the  Spleen  (Lumleian 
Lecture.) 

Mrdical  Graduatrs'  Collbob  amd  Polyclduc  (22  Chenies  Street, 
W.C.).— 4  p.m.  Mr.  Hutchinson :  Clinique.  (8urgical.)  6.15  p.m. 
Dr.  J.  M.  H.  Macleod:  Some  General  Principles  of  Treatment  in 
Dermatology. 

St.  John's  Hospital  for  Disrabbs  or  tub  Skin  (Leicester  J  Square, 
W.C.).— 6.15  p.m.  Dr.  M.  Dockrell :  Epithelioma.  (Chesterfield  Lee- 
ture.) 

Friday,  March  25th. 

Clinical  Society  or  London  (20  Hanover  Square,  W.).— 830 p.m. 
Papers  :— Dr.  E  W.  Goodall :  Two  cases  of  Intestinal  Obstruc- 
tion immediately  following  an  attack  of  Typhoid  Fever.— 
Mr.  W.  G.fSpencer:  A  Case  of  Severe  and  Fatal  Hematuria  of  Unknown 
Origin.— Mr.  C.  S.  Wallace  and  Mr.  H.  J.  Maniage  :  A  Case  of 
Attempted  Division  of  the  Eighth  Nerve  within  the  8kull  for  the 
Relief  of  Tinnitus. 

Royal  Colleoe  or  Surofons  op  England.— 5  p.m.  Mr.  E.  M. 
Corner:  Acute  Infective  Gangrenous  Processes  (Necroses)  fn  the 
Alimentary  Tract.    (Eramus  WHson  Lecture.) 

Mrdical  Graduatrs'  Collbob  and  Policlinic  (22  Chenies  Street, 
W.C.).— 4  p.m.    Mr.  M.  Gunn  :  Clinique.    (Eye.) 
Monday,  March  28th. 

Odontolooical  Socirtt  op  Grrat  Britain  (20  Hanover  Square,  W.) 
— 8  p.m.  Mr.  J.  Howard  Mummery  will  show  Zeiss'  Stereoscopic 
Photographs  of  Colonies  of  Bacteria.  &c.— Mr.  Dowcla*  M.  Caush  will 
read  a  Paper  :  Some  Notes  on  the  Enamel. 

Tuesday,  March,  29th. 

Thrrapkutical  Socikty  (Apothecaries*  Hall)— 4  p.m.  Mr.  W. 
Chat  tawny,  F.I.C.,  short  description  of  Photography  in  Natural 
Colour,  illustrated  by  Lantern  Slides. 


Birkenhead  Borough  Hospital.— Senior  House  Surgeon  (resident). 

Salary  £100  per  annum  and  fees.  Applications  to  the  Honorary 

Secretary, 
Sussex  County  Hospital— House  Physician.     Salary  £80  per  annum, 


JLjxpomtmeniB. 

FLBMMiNe.  Pbrct,  BA.Lond..  FJLG.ft.Eng.,  Professor  of  Ophthalmic 

Medicine  and  Surgery  in  University  College,  London,  and  Surgeon 

to  the  Ophthalmic  Department  of  University  College  Hospital. 
Farrlll,  Lo jis,  M.B.,  Assistant  House  Surgeon  to  the  Jervts  Street 

Hospital,  Dublin. 
Gardnrr,  Harry,  M.B  OS,,  UR.CP.Lond.,  Junior  Home  SurgeoR 

to  the  Croydon  General  Hospital. 
Goodman,  T.  Hrrbbrt,  M.R.C.H.Eng.,  L.8.A..  Medical  Officer  and 

Public  Vaccinator  for  the  Haverhill  District  of  the  Risbridge 

Union. 
Grunbaum,  Otto,  M.B.,  B.C. Cantab..  D.3o.Lond.,  Assistant  Physiciaa 

to  the  Belgrave  Hospital  for  Children. 
Hawes,  Ivon,  bJ.B,.  B.&Durh.,  Junior  House  Surgeon  to  the  Royal 

Infirmary,  Bristol 
Johns,  H.  D„  MJKDurh.,  Certifying  8urgeon  under  the  Factory  Act 

for  the  Hornsea  District  of  the  county  of  York. 
Kmo,  D.  Bartt,  M.D.,  M.R.C.P  JSdin.,  Honorary  Physician  to  Queen 

Alexandra's  Home  for  Officers'  Widow*  and  Daughters. 
Lawbon,  F.  H.,  M.B.C.S.,  L.R.C.P.LondM  Certifying  Surgeon  under 

the  Factory  Act  for  the  8teyning  District  of  the  county  of 

Sussex 
Milnbr.  Cyril  William.  M  B.C.8.,  L.R.C.P.Lond.,  Honorary  Con- 
sulting Surgeon  to  the  Nottingham  General  Dispensary. 
Pbarsk.  E.  M..  MR.C8.Emr,  L.R.C.P  Loud,,  Honorary  Ansesthetist 

to  the  Boy-si  Infirmary.  Bristol. 
Phillips,  p.  0..  M.R.0  8.,  LJt.C.P.Lond.,  Honorary  Surgeon  to  the 

Grantham  Hospital.  Lincolnshire. 
Ryan.  J.  J.,  M.B.,  Senior  House  Surgeon  to  the  Jervis  Street  Hos- 
pital, Dublin. 
Scon,  W.  H.,  M.B.0.8  Rng.,  LR.CP.Lomt,  Casualty  Ottoer,  Royal 

Infirmary,  BristoL 
Smith,  W.  C,  M.R.C  8.,  UR.CP.Lond.,  Senior  House  8urgson  to  the 

Croydon  General  Hospital. 
Stumblbs,  Hbnrt  Marttk,  M.B.,  Ch  REdin.,  PoBce  Burgeon  to  the 

Amble  District,  Northumberland  County  Constabulary. 
Wrbr.  W.  T.,  M  R.C.aEng.,  L.R.O.P.Lond.,  Resident   Obstetric 

Officer  to  the  Royal  Infirmary,  BristoL 

girths. 

Brrryman.— On  March  17th,  at  Windsor,  the  wife  of  Captain  H.  A. 

Berryman,  Royal  Army  Medical  Corps,  of  a  son. 
Dowdrn.— On  December  24,  1008,  atGopeng,  Perak,  Federated  Malay 

States,  the  wife  of  Richard  Dowden.  M.D.,  of  a  daughter. 
Darker.— On  March  80th.  at  5,  Croft  Villas,  Forest  Hill,  London, 

8.E.,  to  George  FitzJames  Darker,  M.R.C  8  .L.R.C.P.,  barrister- 

at-law  D.M.O.,  Southern  Nigeria,  and  Mrs.  Darker,  a  daughter. 
Elwut.— On  March  17th,  at  186  Blackf  riars  Road.  London,  S.E.,  the 

wife  of  G.  R.  Elwin.  M.D.,  of  a  son  (Kingslev  Graves). 
Grboory.— OnlMarch  17th,  at  Englefield  House,  Highgate,  London.X., 

the  wife  of  H.  L.  Gregory,  M.B.,  B.C.,  of  a  son. 


iatflts. 


Caley.— On  March  19th,  at  Leavesden,  Weybridge,  Deputy  Surgeon 

General  Henry  Caley.  O.M.G.,  I.M.8.,  retired.    Honorary  Sur- 
I  geon  to  the  Kiog,  in  his  70th  year. 

CoBBRTT.— On  Match    18,  at  Ashton,  Bournemouth,  Laura  Lous* 

CobbHt,  widow  of  the  late  R.  N.  Cobbett,  Surgeon,  and  youngest 

daughter  of  the  late  Captain  W.  Slark.  J.  P.,  of  Heme  Bay,  Kent. 
FbrraKd.— On  March  9th,  at  Peshawur,  India.  Lt.-Oolooel  Edward 

Ferrand,  M.D.,  FJt.CS.,  Indian  Medical  Service,  60th  Puojabe, 

aged  53. 
Hunter  Huqiies.— On  March  17th,  at  Penmaen,  Pwllheli,  Thomas 

Hunter   Hughes,   M.R.C.&   .E.),  Ac,   &c.,  *  Coroner  for  the 

county  of  Carnarvon,  aged  67  years. 
Smith.— On   March  5th    at  Bridger,   Montana,  United  States,  of 

Bneumonia,  Henry  Murray  Stanley,  only  son  of  E.  Stanley  Smith, 
LD.,  of  68,  Wimpole  Street,  London. 
Smyth. -On  March  19th,  at  Castle  Acre,  Adelaide  Road,Brockley,  Lon- 
don, 8.  E,  Charles  Stanley  Abbott  Smyth,  aged  14  years,  son  of 
F.  bvdney  Smyth,  F.R.C.S. 


$lw  gm«»l  gfrt**  m&  €mnht 


»BkLUS   POPULI    SOTEEMA    LEX-J 


Vol,  CXXVIII. 


WEDNESDAY,     MARCH   30,     1904, 


No.    13- 


Ociouial  Communications. 


ON  A 

NEW    RETENTION   SPLINT 

FOR  l 

CONGENITAL  TALIPES 


forgotten,  and  the  efforts  of  the  surgeon  seem 
to  be  principally  directed  to  rectify  the  varus  de- 
formity from  the  ankle-joint.  The  retention  splints 
in  use  seem  to  be  constructed  on  the  same  principle, 
To  my  mind  this  accounts  very  often  for  the  pro- 
longed treatment  necessary,  tor  relapses  that 
often  occur,  and  for  the  unsatisfactory  results 
that  we  sometimes  see.  In  the  hope  of  remedy- 
ng  this  state  of   things   1    have  introduced   this 


EQUINO-VARUS: 

\M  I  H   SOME  NOTES  ON    THE  TREATMENT    retention  splint,  which  I  have  used  lor  a  consider- 
nc  ^ljtt   nt:iY-iu\iiTV    rvi  1  *ble  time,  and  which  has  given  me  a  great  deaj 

61  THE  DLKJRMIIV  (*)  '  J  satlsfaction      The  advan5tages  which  I  believe 

By  DENIS  KENNEDY,  F,R,C.S.,  this   splint   to   possess   are  ;    First,   e  version   and 

9orY^>«iotheChiWi^iihtH^pfiAl,T*mf.ieatfrHtl>iibifa.  abduction   of   the   foot   are   produced   principally 

My  principal  object  in  bringing  the  subject  of  from  the  medio- tarsal  joint  ;  secondly,  while  this 
congenital  talmes  equmo-varus  under  discussion  aversion  is  being  produced  on  the  anterior  part 
is  to  introduce"  to  you  a  new  retention  splint,  as  ?]  the  foot  the  os  calcts  and  astragalus  are  pressed 
well  as  to  offer  some  practical  suggestions  in  the  inwards,  and  thus  the  tarsal  bones  are  kept  as 
treatment  ol  the  deformity,  and  to"  criticise  some  nearly  as  possible  in  a  normal  ps si tion  ;  thirdly, 
ot  the  methods  at  present  in  use.  In  order  to  do  a  powerful  leverage  is  obtained  which  materially 
this  satisfactorily,  it  is  necessary  to  understand  aids  in  correcting  the  delormity  ;  fourthly,  on 
thoroughly  what  the  deformity  really  consists  in  ;  account  of  the  ratchet  arrangement,  rectification 
in  other  words,  the  pathological  anatomy.  With  e»  the  deformity  can  be  increased  if  necessary 
the  eqninus  part  of  the  deformity  I  need  not  trouble  from  day  to  day,  and  thus  the  ill  effects  of  pres- 
vottl     You  are  all  aware  that'll  consists  in  the   sure  are  completely  avoided      As  well,  the  splint 


posterior  part  of  the  os  calcis  being  drawn  up- 
wards by  the  tendo  Achillis,  its  anterior  part 
being  depressed,  while  the  astragalus  is  tilted 
forward  between  the  malleoli ,  so  that  its  superior 
articular   facet  is  placed  more   posteriorly   than 


is  simple,  easily  applied,  and,  what  is  equally  as 
important,  very  cheap.  The  points  to  be  at* 
tended  to  in  making  the  splint  are,  first,  the 
os  calcis  must  be  well  gripped  by  the  heel  part  ; 
secondly,   the  ratchet  arrangement  must  be  im- 


normal.     The  varus  part  of  the  deformity  is  not,   mediately  behind  the  medio- tarsal  joint;   thirdly, 


however,  so  simple.  Instead  oi  this  deformity 
existing  at  the  ankle-joint,  it  exists  principally 
at  the  medio- tarsal  joint.  Whatever  the  cause, 
the  cupoid  and  scaphoid,  with  the  foot  in  front 
ot  them,  are  partially  dislocated  inwards  from 
the  os  calcis  and  astragalus,  and  kept  in  this  ab- 
normal position  by  shortened  tendons,  ligaments 
and  fasciae.  As  well  as  this,  the  os  calcis  and 
astragalus  have  a  direction  from  behind,  for- 
wards and  outwards,  which  increases  the  medio  - 
tarsal  displacement,  and  renders  the  deformity 
more    difficult    to    rectify.      In    consequence    of  ( 


the  heel  part  must  not  be  too  high  on  the  outside 
to  allow  for  eversion  of  the  anterior  part  of  the 
foot.  The  splint  must  fit  accurately.  The  ap- 
pliance can  be  used  as  a  retention  splint  after 
operation,  either  immediately  or  after  removal 
of  plaster  of  Paris.  It  can  also  be  used  in  the 
treatment  of  cases  before  operation,  or  where  no 
operation  seems  necessary*  In  these  cases  it 
may  take  the  place  oi  plaster  of  Paris,  and  this  I 
consider  to  be  of  great  service,  because  the 
application  of  plaster  of  Paris  to  the  club-foot  of  a 
young   infant   for   any   length   of   time     has   two 


this  displacement  of   the'   bones    the    facets    for  \  great    disadvantages.     While    it    is    applied     no 
articulation  with  each  other  and  with  the  malleoli  .massage    nor    manipulation   of    the    foot   can   be 


are  placed  in  abnormal  positions,  and  it  is  well 
to  remember  that  a  cure  is  not  complete  until  the 
bones  are  in  their  normal  position  without  any 
tendency  to  displacement,  their  facets  developed 
in  the  proper  situations,  and  the  muscles  and 
ligaments  have  accommodated  themselves  to  the 
new  condition  of  things. 

In  treating  the  deformity  the  presence  of  the 
medio -tarsal    dislocation  seems  to   be  frequently 


(*&  P*pcr  read  at  the  Surgical  Section  of  the  Roy*l  Academy  of 
UedtoD*  Id  Ireland,  Jihujatj  *0th,  1W4* 


carried  out,  and  not  alone  will  development 
of  the  muscles  not  take  place,  but  actual  wasting 
occurs.  The  splint  is  not  intended  for  a  walking 
appliance.  It  has  been  made  for  me  by  Messrs, 
Smith  and  Sheppard,  who  have  spared  neither 
time  nor  trouble  in  carrying  out  my  idea  in  every 
detail, 

With  regard  to  the  operations  carried  out  for 
the  cure  of  congenital  club-foot,  there  seems  to 
be  practically  no  limit  to  the  number,  and  when 
one  begins   to   work   at   orthopaedic   surgery   the 


332     The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


March  30,  1904. 


difficulty  is  to  choose  between  them.  I  know 
that  was  my  trouble  some  live  years  ago.  I  be- 
lieve that,  in  dealing  with  children,  at  all  events, 
many  of  these  operations  are  quite  unnecessary, 
and  some  are  positively  productive  of  great  mis- 
chief. Consequently,  you  will  pardon  me  if 
1  briefly  detail  to  you  the  steps  that  I  usually 
carry  out  for  the  cure  of  this  deformity,  and  which 
in  my  hands  have  been  productive  of  very  good 
results.  When  I  consider  it  necessary  to  operate, 
I  first  do  tenotomy  of  the  tendo  Achillis,  and  if 
necessary  the  anterior  and  posterior  tibial  ten- 
dons. Then,  if  I  cannot  bring  the  foot  easily 
into  position,  I  insert  a  tenotome  between  the 
internal  malleolus  and  the  tubercle  of  the  sca- 
phoid, and  cut  subcutaneously  the  plantar  fascia 
and  some  of  the  short  muscles  of  the  great  toe. 
In  the  large  majority  of  cases  I  can  then  bring  the 
foot  readily  into  normal  position,  and  over  correct 
the  deformity  if  necessary.  I  then  apply  plaster 
of  Paris  to  the  foot  in  the  corrected  position  and 
leave  it  for  three  or  four  weeks,  and  then  use  the 


fascia,  or  of  the  short  muscles  on  the  inside  of  the 
foot,  there  is  much  less  danger  of  cicatricial  con- 
traction following  when  the  skin  is  left  unbroken. 
But  I  may  add  that  I  have  no  hesitation  what- 
ever in  cutting  a  tendon  openly  if  there  is  any 
difficulty  or  danger  in  doing  it  subcutaneously.  " 
I  am  perfectly  aware  that  many  good  authori- 
ties hold  that  section  of  the  tendo  Achillis  should 
not  be  done  until  the  varus  deformity  has  been 
rectified  for  some  weeks,  to  allow,  as  they  say,  for 
the  "  unfolding  of  the  foot  to  take  place."  Now, 
unless  where  pes  cavus  exists  to  a  marked  degree, 
1  see  nothing  to  warrant  this  procedure  either 
clinically  or  anatomically.  On  the  contrary,  I 
consider  this  tendon  should  be  cut  first,  and  for 
the  following  reasons  : — In  some  cases  section 
of  this  tendon  at  once  enables  us  to  rectify  the 
varus  as  well  as  the  equinus  deformity,  and  a  lot 
of  unnecessary  cutting  is  thus  avoided.  Secondly, 
it  is  impossible  in  almost  all  cases  to  rectify  the  varus 
deformity  fully  until  the  tendo  Achillis  is  cut, 
because  in  those  cases  the  tendo  Achillis  is  inserted 


Showing  usual  manner  of  hold ing^club- foot  for  appli 

cation  of  plaster  of  Paris,  and  for  manipulation.     One 

hand    being    above    the    ankle. 

retention  splint,  and  have  massage  and  passive 
motion  of  the  foot  carried  out  a  couple  of  times 
daily.  When  the  child  is  fit  to  walk  I  get  him 
fitted  with  a  walking  appliance.  I  believe  there 
is  no  case  in  a  child  up  to  ten  or  twelve  years  that 
cannot  be  made  perfectly  well  in  this  fashion, 
provided  after-treatment  is  carried  out  by  the 
parents  for  a  requisite  time. 

Although,  since  the  advent  of  asepsis  there  is 
not  the  same  necessity  for  subcutaneous  surgery 
in  operating  for  talipes  as  formerly,  still  it  has 
the  following  advantages  over  the  open  method : 
First,  when  plaster  is  applied  after  the  operation, 
it  can  be  done  with  much  greater  ease  and  satis- 
faction, and  there  is  less  danger  of  sepsis  ;  secondly, 
the  necessity  for  changing  the  dressing  does  not 
exist,  and  consequently  the  bones  will  be  left 
undisturbed  in  their  new  position  ;  thirdly,  it  is 
said  by  some  that  where  open  tenotomies  are  done 
there  is  danger  of  the  tendon  ends  becoming 
engaged  in  the  cutaneous  cicatrix  ;  and  lastly, 
where  there  is  extensive  cutting  of  the  plantar 


Showing  proper  manner  of  holding  club-foot  for  appli- 
cation of  plaster  of  Paris,  and  for  manipulation.     One 
hand  gripping  the  os  calcis. 

into  the  inner  aspect  of  the  tuberosity  of  the  os 
calcis,  and  this  tilts  the  anterior  extremity  of  the 
os  calcis  outwards,  and  so  long  as  the  tendon  re- 
mains uncut  the  os  calcis  cannot  be  brought  into 
position.  Lastly,  it  saves  time.  What  is,  how- 
ever, all  important  to  produce  the  necessary  un- 
folding of  the  inside  of  the  foot  in  those  cases  is 
that  the  plaster  of  Paris  be  applied  properly  after 
operation.  To  do  this  an  assistant  grasps  the 
anterior  part  of  the  foot  with  one  hand,  flexes 
it  to  a  right  angle,  abducts  and  everts  it,  while 
with  the  other  he  grips  the  heel-bone  and  presses 
it  inwards.  In  this  way,  and  in  this  way  only, 
can  the  medio-tarsal  displacement  be  reducea, 
at  the  same  time  that  the  structures  uncut  on  the 
inside  of  the  foot  are  stretched  to  their  utmost. 
The  foot  should  be  held  in  this  position  while  the 
plaster  is  being  applied  and  while  it  is  setting. 
This  retention  splint  of  mine  keeps  the  foot  in 
the  same  position  afterwards. 


March  30,  1904. 


ORIGINAL  COMMUNICATIONS.        The  Mbd,cal  P.ess.    333 


The  necessity  for  operating  on  the  tarsal  bones, 
and  the  operations  to  be  earned  out,  are  points 
that  have  given  rise  to  a  good  deal  of  discussion 
in  text-books,  and  to  a  good  deal  of  anxiety  in 
operators.  After  a  fairly  good  experience,  t  am 
fairly  convinced  of  the"  following  facts :  First, 
that  all  cases  in  children  under  twelve  years  of 
age  can  be  cured  perfectly  without  any  operation 
whatever  on  the  tarsal  bones ;  seconaly,  that 
many  older  cases  can  be  cured  without  it  j  thirdly , 
that  tarsectomy  is  dangerous,  and  usually  does 
more  harm  than  good  to  the  foot  as  regards 
utility  -  fourthly,  that  the  only  operations  on 
these  hones  that  give  good  results  are  Bradford's, 
namely— osteotomy  of  the  neck  of  the  astragalus 
Ami  removal  of  a  wedge-shaped  piece  of  the  os 
calcis  on  its  outer  and  anterior  part. 

When  we  remember  that  the  tarsal  bones  in 
children  are  nearly  altogether  cartilaginous,  and 
that  consequently,  with  a  little  perseverance, 
they  can  be  moulded  into  any  shape  we  wish,  it 
is  at  once  apparent  that  removal  of  any  of  these 


bones  is  quite  unnecessary.  And  when  we  see 
the  after-results  of  the  o peration,  the  shortened, 
ned  feet,  without  a  trace  of  elasticity  or 
movement  at  the  tarsal  joints,  or  sometimes  even 
■u  the  ankle-joint,  I  consider  the  procedure 
little  short  of  criminal  Nevertheless,  I  fre- 
quently see  the  astragalus  removed,  or  a  wedge- 
shaped  piece  of  the  tarsal  bones  taken  from  the 
outside  of  the  foot  for  an  ordinary  case  of  varus 
in  a  child.  The  great  arguments  put  forward  in 
its  favour  are  that  it  saves  time  in  the  cure,  and 
that  relapses  -will  not  occur.  The  answer  to 
these  is,  where  the  bones  are  removed  no  cure  is,  or 
can  be,  effected,  and  the  same  arguments  could  be 
put  forward  in  favour  of  amputating  straight  off. 
The  two  great  points  to  be  remembered  in  treat* 
mg  this  deformity  are,  that  we  must  make  the  foot 
as  useful  as  possible,  and  give  it  a  good  appearance, 
the  latter  being  secondary  to  the  utility. 

The  best  workers  of  the  present  day  at  ortho- 
pedic surgery  condemn  tarsectomy.  Mr.  Keetley 
quotes  the  case  of  a  man  with  double  congenital 
tahpes  equi no- varus:. one    foot  had  been  subject 


to  tarsectomy  and  the  other  left  untreated.  The 
patient  found  the  untreated  foot  more  useful  than 
the  other.  Tubby  says  that  '•  tarsectomv  should' 
only  be  done  when  orthopaedic  treatment  has  been 
tried  and  failed,  when  progression  is  impossible, 
owing  to  severe  pain,  and  the  pressure  of  inflamed 
corns,  and  bursa,  and  ulcerated  skin." 

Sometimes  I  am  asked  what  is  the  proper  age  to- 
operate  on  infants  with  club-feet/  While  we 
cannot  make  any  hard  and  fast  rule  as  to  the  age, 
because  a  great  deal  depends  on  the  progress  that 
can  be  made  by  manipulation  and  retention  ap- 
pliances, still,  if  operation  has  to  be  done  I  think 
the  earlier  it  is  carried  out  the  better,  because 
cure  can  be  effected  with  greater  ease,  the  time 
taken  will  be  shorter,  and  the  more  perfect  will 
be  the  result. 

If  the  milder  treatment  is  not  satisfactorv, 
tenotomy  need  not  be  delayed  after  the  infant  is 
three  months  old. 

In  treating  talipes  we  must  remember  that  half 
cures  are  no  cures,  and  that  no  matter  what  opera- 
tion we  do,  or  how  fully  we  rectify  the  deformity, 
the  tendency  to  relapse  remains  for  a  considerable 
time.  Consequently,  the  after-treatment  is  all 
essential.  It  consists  in  massage  and  passive 
motion  of  the  foot  daily,  and  in  providing  the 
patient  with  a  good  retention  splint,  and,  later,  a 
walking  appliance,  I  find  this  occasionally  the 
most  difficult  part  of  the  treatment.  As  a  rule, 
the  majority  of  the  parents  when  told  what  to  do, 
shown  how  to  do  it,  and  impressed  with  the  neces- 
sity of  having  it  carried  out,  are  very  willing  to 
co-operate.  The  great  difficulty  is  with  the  instru- 
ment -makers.  The  appliances  for  walking  are 
expensive,  complicated,  get  out  of  order  frequently, 
and  the  child  out-grows  them,  Besides,  a  good 
many  of  them  are  not  entirely  satisfactory  in 
keeping  the  foot  in  good  position.  The  best  in" the 
market  is  undoubtedly  Bradford's. 

Some  of  you  may  possibly  think  that  a  discus- 
sion  on  the  treatment  of  congenital  club-foot  is 
unnecessary,  and  anyone  who  takes  the  recorded 
results  as  gospel  will  agree  with  you.  But,  while 
fully  convinced  that  every  ease  of  congenital 
talipes  in  a  child  can  be  cured  perfectly,  neverthe- 
less we  frequently  meet  cases  who  go  trom  one 
surgeon  to  another,  from  one  hospital  to  another, 
and  even  from  one  country  to  another,  and  are  still 
uncured.  At  the  present  time  1  have  under  my 
care  a  boy,  ael,  9,  who  was  twice  operated  on  in  a 
London  orthopedic  hospital.  Quite  recently  I  had 
another  boy,  act*  io,  who  was  operated  on  several 
times  in  Johannesburg.  I  occasionally  even  get 
cases  which  have  been  previously  operated  on  in 
Dublin.  And  as  an  excuse  for  my  communicatibn 
to  you  to-night,  I  cannot  do  better  than  quote 
for  you  the  remarks  of  Bradford,  of  Boston,  on  the 
treatment  of  club-foot :  "  The  literature  of  the 
treatment  of  club-foot  is,  as  a  rule,  that  of  unvary- 
ing success  ;  it  is  often  brilliant,  and  yet  in  practice 
there  is  no  lack  of  half-cured  or  relapsed  cases — 
sufficient  evidence  that  the  methods  of  cure 
are  not  universally  understood/* 


Or.  Herbert  Williams,  medical  officer  of  health 
for  the  Port  of  London,  is  continuing  the  crusade 
ftgaittft  rats*  In  his  monthly  report  he  mentions  that 
within  the  period  covered  5,599  rats  had  been  destroyed, 
making  a.  loial  of  273,819  since  the  work  had  been 
commenced, 

D 


334    The  Medical  Paws.        ORIGINAL  COMMUNICATIONS. 


March  30,  1904* 


THE  DIAGNOSIS  OF 

CHRONIC  VALVULAR  DISEASE 
OF  THE  HEART,  (a) 

By  WALTER  CARR,  M.D.,  F.R.C.P., 

Phygfcian  to  the  Royal  Free  HotpiUO. 

The  first  point,  said  the  lecturer,  in  any  case  of 
heart  disease  was  to  decide  whether  the  lesion  was 
valvular  or  myocardial  in  nature.  Dealing  with 
the  former  only,  disease  of  the  pulmonary  valve 
might  be  safely  set  down  as  congenital  in  origin, 
and  in  the  tricuspid  valve  as  commonly  secondary 
to  a  lesion  of  the  left  heart,  so  that  present  con- 
sideration might  be  limited  to  a  morbid  condition 
of  the  aortic  or  mitral  valves. 

The  first  thing  was  to  discover  the  valve  af- 
fected and  the  nature  of  the  lesion  (obstruction 
or  incompetence)  ;  these  points  are  settled  by  the 
murmur  heard,  in  what  area  it  is  most  audible, 
along  what  lines  it  is  conducted,  and  its  relation 
to  the  heart  sounds.  These  observations  will  lead 
to  a  safe  conclusion  as  to  the  nature  of  the  lesion. 
'  In  some  cases  diagnosis  is  helped  by  the  presence 
of  a  thrill ;  a  presystolic  thrill  at  the  apex  may  be 
relied  upon  as  indicating  mitral  obstruction.  The 
pulse  often  is  of  great  assistance,  sometimes  from, 
its  character  alone  it  is  possible  to  diagnose  the 
lesion  ;  for  example,  in  the  case  of  aortic  regur- 
gitation, when  the  typical  water-hammer  pulse  is 
present  along  with  visible  pulsation  in  the 
vessels ;  here  are  two  lesions  which  may  be  dia- 
gnosed apart  from  the  murmur.  The  next  point 
to  consider :  Is  the  murmur  produced  by  any  con- 
dition except  disease  of  the  valve  in  question  ? 
In  the  case  of  a  diastolic  murmur  heard  over  the 
aortic  area  the  diagnosis  can  only  be  aortic  re- 
gurgitation, and  similarly  with  a  presystolic  mur- 
mur at  the  apex,  it  is  nearly  always  mitral  ob- 
struction, though  in  this  case  it  is  not  quite  so 
absolute,  as  a  similar  murmur  is  occasionally  heard 
in  aortic  regurgitation.  This  bruit  is  produced 
by  a  backward  flow  of  blood  impinging  on  the 
mitral  valves,  and  is  called  Flint's  murmur. 

A  systolic  murmur,  heard  best  in  the  aortic  area, 
is  commonly  due  to  other  causes  than  aortic 
stenosis  ;  it  is  mostly  due  to  a  mere  roughen- 
ing of  the  valves,  not  sufficient  to  cause  obstruc- 
tion, bat  it  may  also  be  haemic  or  aneurysmal. 
It  is  important  to  realise  that  this  systolic  mur- 
mur does  not  as  a  rule  mean  aortic  obstruction, 
and  to  diagnose  this  lesion  there  must  be  some 
evidence  of  hypertrophy  of  the  left  ventricle,  and 
also  some  change  in  the  pulse.  A  systolic  aortic 
thrill  (if  not  due  to  an  aneurysm)  is  probably 
diagnostic  of  obstruction,  but  it  is  not  always 
present. 

A  systolic  murmur,  heard  over  the  apex  and  con- 
ducted out  into  the  axilla,  may  be  present  when 
there  is  no  valvular  disease  ;  it  is  then  due  either 
to  dilatation  of  the  left  ventricle  or  to  imperfect 
contraction,  and  merely  indicates  there  is  re- 
gurgitation through  the  mitral  orifice.  It  is, 
therefore,  evident  that  a  murmur  may  be  heard 
when  no  valvular  lesion  is  present.  The  converse 
|s  also  true,  for  in  some  cases  of  advanced  mitral 
disease,  obstructive  or  regurgitant,  there  is  no 
murmur,  because  the  heart  is  too  feeble  to  drive 
the  blood  through  the  orifices  with  sufficient  force 
to  produce  one.  It  is  rare  to  have  aortic  disease 
without  a  murmur. 

Secondly,  having  discovered  what  the  lesion 


(«)  Abstract  of  Lecture  delivered  at  the  Boyal  Free  Hoepfttal, 
Mmwry  lltb,  WO*. 


is,  and  where  it  is,  the  cause  must  be  ascertained. 
Is  it  rheumatic  ?  Is  it  degenerative  ?  This 
distinction  is  important,  as  the  prognosis  largely 
turns  on  it.  In  rheumatic  endocarditis  the  disease 
is  stationary  if  the  patient  is  beyond  the  age  of 
puberty,  but  a  degenerative  lesion  is  by  its  very 
nature  progressive,  and  the  prognosis,  therefore, 
should  be  guarded.  In  later  life  degenerative 
changes  may  supervene  on  old  rheumatic  endo- 
carditis, and  syphilitic  lesions  may  be  classed 
among  degenerative  ones,  except  that  they  are 
more  amenable  to  treatment  in  the  early  stages 

Under  thirty  years  of  age  an  acquired  heart 
lesion  is  almost  certainly  rheumatic  in  origin,  and 
this  may  be  the  case  in  the  absence  of  any  history 
of  rheumatic  fever,  which,  on  account  of  its  in- 
sidious character,  is  frequently  overlooked.  A 
history  of  chorea  or  of  rheumatism  in  the  family 
will  sometimes  settle  the  cause.  After  thirty 
years  of  age  the  cause  is  not  so  obvious,  but  after 
fifty  or  sixty  years  of  age  the  lesion  is  probably 
degenerative,  if  no  history  of  rheumatic  fever  is 
obtained. 

The  third  point  to  consider  is  the  severity  of 
the  lesion  ;  this  is  independent  of  the  loudness  of 
the  murmur,  and  there  is  practically  no  relation 
between  the  two.  A  gradual  disappearance  of  a 
murmur  is  always  of  grave  significance,  as  it 
denotes  increasing  feebleness  of  the  heart.  The 
severity  of  the  lesion  is  estimated  mainly  by  the 
enlargement  of  the  heart,  for  the  graver  the  lesion 
the  greater  is  the  degree  of  cardiac  enlargement. 
In  cases  of  aortic  regurgitation  the  pulse  is  an 
important  guide  to  the  severity  of  the  lesion  ; 
in  double  aortic  disease  the  pulse  will  have  the 
characters  of  the  predominant  lesion  (usually 
regurgitant).  In  cases  of  aortic  and  mitral  lesions 
combined,  the  severity  of  the  lesion  is  gauged  by 
the  degree  of  enlargement  of  the  ventricles,  for 
disease  of  the  mitral  valve  throws  extra  strain  on 
the  right  ventricle,  which  is  consequently  en- 
larged, and  dulness  is  obtained  to  the  right  of  the 
sternum,  with  more  or  less  epigastric  pulsation. 
In  the  same  way  disease  of  the  aortic  valves 
manifests  itself  by  enlargement  of  the  left  ventricle, 
with  displacement  of  the  apex-beat  downwards 
and  outwards.  In  rheumatic  endocarditis  it  is 
impossible  to  be  sure  of  the  severity  of  the 
lesion  till  at  least  six  months  have  elapsed  since 
the  attack  of  acute  rheumatism,  for  it  takes  this 
time  for  the  attack  of  valvular  inflammation  to 
become  developed,  and  for  the  consequent  com- 
pensatory changes  to  occur  in  the  ventricle,  and 
therefore  for  the  first  few  months  it  is  not  ad- 
visable to  give  a  definite  prognosis. 

The  fourth  question  to  settle  is,  whether  the 
cardiac  lesion  is  compensated  or  not ;  this  is  im- 
portant because  the  treatment  varies  accordingly. 
If  the  compensation  is  good  no  treatment  is  re- 
quired beyond  the  avoidance  of  over-exertion  and 
anything  that  may  cause  the  compensation  to 
break  down.  A  severe  lesion  may  be  present, 
and  compensation  be  quite  good,  and,  on  the  other 
hand,  compensation  may  fail  with  very  slight 
lesions ;  it  is  then  generally  brought  about  by 
deterioration  of  the  general  health,  vis.,  anaemia, 
mental  worry,  senile  changes,  Ac. 

The  symptoms  of  failing  compensation  are 
different  in  mitral  and  aortic  disease  ;  in  the  latter 
pain,  palpitation  and  dyspnoea  are  usually  the 
chief  features ;  the  pain  may  assume  a  true 
anginal  character.  Failing  compensation  in 
mitral  disease  is  denoted  mainly  by  lung  sym~ 


March  30,  1904. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Piess.    335 


ptoms,  such  as  dyspnoea,  cough  and  haemoptysis, 
the  latter  being  especiallymarked  in  mitral  stenosis, 
by  irregularity  of  the  pulse,  and  later  on  by 
cedema  of  the  legs,  enlargement  of  the  liver, 
increasing  weakness  of  cardiac  impulse,  In  chil- 
dren the  symptoms  are  different ;  the  pulse  in 
them  seldom  becomes  irregular,  dropsy  is  un- 
common, and,  in  fact,  the  symptoms  of  back 
pressure  through  the  tricuspid  orifice  are  mostly 
absent  ;  there  "is  generally  marked  pallor,  wasting 
and  failure  of  general  nutrition,  death  taking 
place  from  syncope.  While  compensation  is 
maintained  there  is  a  well -marked  accentuation 
of  the  pulmonary  second  sound,  which  gradually 
disappears  as  compensation   fail-.. 


A  FURTHER  EXPERIENCE  OF  THE 

OPERATION    FOR   EXCISION 

OF   THE 

GASSERIAN    GANGLION, 


By  T.  E.  GORDON,  F  R.C.S., 

Surgeon  to  the  AdeUufe  Hotpft*].  DubUti* 

Last  year,  at  one  of  the  surgical  meetings  of  the 
Academy,  1  gave  an  account  of  a  case  of  trigeminal 
neuralgia,  for  which  I  performed  the  operation  of 
on  of  the  Gasscrian  ganglion.  The  removal 
was  not  complete,  for  I  left  the  ophthalmic 
division  and  the  inner  parts  of  the  ganglion,  as 
well  as  the  sensory  root,  Up  to  the  present  there 
has,  in  this  case,  been  no  return  of  the  neuralgia. 

Some  surgeons  consider  this  partial  excision 
sufficient,  and  therefore  to  be  preferred  to  the 
complete  operation,  which  is  more  difficult  and 
•dangerous.  It  is,  however,  obvious  that  recurrence 
of  the  neuralgia  is  possible  where  any  part  of 
the  ganglion  with  the  sensory  root  remains  intact, 
Moreover,  U  one  aims  at  such  partial  excision  one 
runs  a  chance  of  leaving  behind  the  entire  ganglion, 
or,  at  all  events,  much  more  of  it  than  that  be- 
longing to  the  nphthalmic  division.  In  the 
present  case  I  made  a  determined  effort  to  remove 
the  ganglion  in  its  entirety,  with  what  measure  of 
success  I  will  narrate  when  I  have  given  the 
clinical  history 

The  patient  is  a  man,  art,  31,  He  was  in  good 
health  until  his  present  illness  began.  In  June, 
.  he  had  his  first  attacks  of  facial  neuralgia. 
The  pain  had  then  a  darting  character,  M  not  like 
ordinary  toothache/'  and  was  referred  to  his  chin 
and  to  the  front  of  the  left  ear.  It  began  one  day 
whilst  he  was  taking  his  breakfast,  continued  for 
about  three  weeks,  and  was  relieved  by  the  ex- 
traction of  two  teeth.  He  remained  free  from 
pain  until  Christmas  of  the  same  year.  It  is  worth 
noting  that  the  pain  continued  for  two  weeks  after 
the  extraction  of  the  teeth,  and  during  this  time 
occurred  as  sudden  single  darts,  which  caused  his 
head  to  jerk  to  the  opposite  side. 

The  pain  returned  on  Christmas  Day,  1902,  but 
was  not  very  severe  till  May,  1003  ;  thus,  he  could 
sleep  and  was  able  to  continue  his  work, 

In  May  it  became  more  severe.  In  June  he 
had  several  decayed  stumps  removed  from  the 
left  upper  jaw.  This  operation  only  gave  relief 
lor  a  couple  of  days.  He  saw  Dr.  James  Little 
tn  October.  The  pain  had  continued  since  May, 
and  would  often  occur  every  hour,  and  even  every 
ha* f  hour «  Eati ng ,  speaki ng ,  and  an  yt  hi  n  g  causing 
movement  in  his  face  might  induce  an  attack. 
He  would  sometimes  rush  away  from   his  work 


when  the  pain  suddenly  seized  him.  His  face 
would  become  flushed  during  the  paroxysms,  but 
there  was  no  overflow  of  tears,  nor  did  the  face 
sweat  or  become  swollen. 

He  was  admitted  to  the  Adelaide  Hospital  in 
November,  1903,  and  remained  there  till  December 
20th.  During  his  stay  in  hospital  he  was  given 
gr.  £  morphia  occasionally,  and  this  was  effective. 
He  was  also  given  the  usual  drugs  for  the  cure  of 
neuralgia,  but  these  only  gave  temporary  relief. 

He  went  home  for  Christmas,  but  returned  on 
January  1st.  The  pain  was  constant  whilst 
at  home,  and  had  become  more  severe  than  at 
any  time  before. 

The  following  is  the  note  taken  at  the  time  of 
his  re -admission  to  hospital  :— "  Since  admission  on 
January  ist,  has  had  bad  pain  each  night,  begin- 
ning at  about  7.30.  The  pain  is  *  much  worse  ' 
than  when  here  before.  The  act  of  swallowing 
appears  to  cause  most  pain.  The  pain  is  referred 
to  two  places  in  particular*  (1)  Just  in  front  of  the 
ear  above  the  root  of  the  zygoma,  and  (2)  the 
chin  about  the  mental  foramen,  and  a  short  dis- 
tance along  the  lower  jaw.  The  pain  in  front  of 
the  ear  has  a  boring  character.  At  times  he  gets 
a  flash  of  pain  along  the  gum  of  the  upper  jaw? 
He  had  running  from  both  eyes  for  a  couple  ot 
days  before  coming  here.  The  only  tender  point 
is  "about  the  lower  lip,  and  this  is  inconstant  j 
There  is  no  anaesthesia  anywhere/' 

Such  is  the  history  of  "the  case.  There  are  two 
points  to  which  I  draw  special  attention.  The 
first  is  the  age  of  the  patient ;  he  is  much  younger 
than  the  large  majority  of  cases  of  trigeminal 
neuralgia  ;  the  second  concerns  the  distribution 
of  the  pain  ;  as  is  usual,  the  third  division  of  the 
nerve  is  that  principally  involved,  but  there  was 
also,  at  times,  pain  in  the  area  of  the  secona 
division.  I  do  not  think  there  was,  at  any  time, 
pain  in  the  branches  of  the  ophthalmic  nerve. 

Seeing  that  this  patient  was,  so  far  from  im- 
proving under  drug  treatment,  gradually  becoming 
worse,  Dr.  Little  placed  him  under  my  care,  and 
I  operated  on  January  7th. 

As  in  the  last  case,  so  now,  I  performed  the 
Hartley -Krause  operation,  Last  year  I  gave  full 
details  of  this  method,  so  that  I  may  now  only 
point  out  the  general  features.  I  turned  down  a 
temporal  flap,  and  opened  the  skull  with  a  f-in, 
trephine  in  the  upper  and  back  part  of  the  exposed 
area  of  bone.  This  opening  I  then  enlarged  to 
the  requisite  extent  with  suitable  forceps.  Next 
I  retracted  the  dura  as  far  as  the  openings  in  the 
skull  for  the  passage  of  the  two  lower  nerve 
divisions  and  the  middle  meningeal  artery.  All 
this  was  accomplished  easily  and  quickly,  but  the 
remainder  of  the  operation  proved  difficult. 
This  difficulty  arose  from  haemorrhage.  This  can 
usually  be  controlled  by  plugging  the  foramina, 
and  tends  to  stop  of  itself  as  a  result  of  the  lowered 
blood- pressure,  which  is  caused  by  the  shocks  of 
the  operation,  but  in  the  present  case  the  bleeding 
was  not  thus  controllable.  I  think  this  was  in 
great  part  due  to  the  age  and  vigour  of  the  patient. 
However,  I  succeeded  eventually  in  thoroughly 
opening  up  Meckel's  space,  and  exposing  the  nerves 
and  ganglion.  I  also  succeeded  in  evulsing  much 
of  the  sensory  root,  after  dividing  at  their  fora- 
mina the  second  and  third  divisions  of  the  nerve. 

I  thought  I  had  removed  the  whole  of  the 
sensory  root,  but  in  this  I  was  mistaken,  for  the 
patient  retains  sensation  over  the  entire  ophthal- 
mic area. 


336    The  Medical  Press.  ORIGINAL  COMMUNICATIONS. 


March  30,  1904 


The  patient's  recovery  is  so  far  complete,  and 
seeing  that  pain  was  probably  at  no  time  felt  in 
the  area  of  the  first  division  one  may  hope  that 
the  neuralgia  has  been  permanently  cured.  For 
some  days  after  the  operation  there  was  a  partial 
loss  of  memory  for  words,  and  also  a  diplopia, 
which  Mr.  Swanzy,  who  kindly  examined  him  for 
me,  found  to  depend  on  a  loss  of  power  in  the 
inferior  rectus. 

Now,  although  this  case  is  so  far  successful 
and  may  be  permanently  so,  it  can  scarcely  be 
claimed  as  a  complete  success  from  the  operator's 
standpoint.  I  intended  to  remove  the  ganglion 
completely,  and  I  left  behind  the  ophthalmic  part 
of  it,  with  its  central  and  peripheral  connections. 

I  have  now  something  to  suggest,  which  I  think 
T  have  learnt  from  this  operation,  and  from  an 
operation  on  the  cadaver  which  I  have  done  since. 
Let  me  again  insist  on  the  importance  of  com- 
plete excision  of  the  ganglion.  The  cause  of  the 
neuralgia  is  a  neuritis — a  neuritis  ascending  from 
the  periphery — and  when  the  pain  extends  to 
the  area  of  other  divisions  of  the  nerve  such  ex- 
tension is  due  to  a  spread  of  the  chronic  inflam- 
mation to  this  other  division  by  way  of  the  Gas- 
serian  ganglion.  Now,  if  these  statements  are 
true,  and  I  have  the  very  best  authority  for  them, 
then  it  follows  that  if  any  part  of  the  ganglion 
remain,  inflammatory  change  may  continue  and 
spread  to  the  remaining  ophthalmic  division.  As 
further  argument  against  partial  removal  let  me 
again  say  that  if  the  operator  aims  at  removing 
only  the  outer  part  of  the  ganglion,  he  may  fail 
to  remove  any  of  it.  This  is  not  imaginary ; 
it  has,  as  I  think  I  said  last  year,  actually  happened 
in  operations  performed  by  good  surgeons.  But, 
without  supposing  so  extreme  a  case,  if  any  of  the 
cells  remain  which  belong  to  the  lower  divisions  of 
the  nerve,  from  them  fibres  may  grow  outwards, 
and  with  a  restoration  of  function  there  may  be, 
indeed  probably  will  be,  a  return  of  the  neuralgia. 
I  have  so  far  spoken  of  the  relation  of  the  ganglion 
to  the  nerve  divisions  ;  its  relation  to  the  great 
sensory  root  is  different. 

If  the  entire  sensory  root  has  been  successfully 
torn  from  its  attachment  to  the  pons,  nothing  is 
more  improbable  than  that  the  ganglionic  cell 
should  ever  again  establish  a  central  connection. 
It  seems  then  to  me  that  the  chief  aim  which  the 
surgeon  should  have  before  him  in  performing  this 
operation  is  the  isolation  and  complete  evulsion 
of  the  sensory  root.  You  will  remember  that  in 
tie  operation,  as  usually  performed,  the  space  of 
Meckel  is  opened  by  splitting  the  dura  between 
the  foramen  rotundum  and  foramen  ovale,  and 
the  dissection  of  the  ganglion  is  carried  out  mainly 
from  before  backwards.  Thus,  it  happens  that 
the  operator  reaches  the  sensory  root  as  a  final 
step  in  the  operation,  and  when  his  mind  is  much 
fatigued  if,  jas  in.  this  case  of  mine,  the  dissection 
-has  been  difficult  owing  to  haemorrhage.  Miy 
suggestion  is  that  Meckel's  space  should  be  opened 
from  the  foramen  ovale  in  a  backward  instead. of  a 
forward  direction.  .  The  middle  meningeal  artery 
must,  of  course,  be  divided,  but  this  is  a  matter  of 
no  importance.  Having  opened  the  space  in 
which  thelgang;lion  lies  in  this  way,  I  propose,  in 
my  next*  operation,  to  at  once  proceed  to  the 
identification  and.  separation  of  the  sensory  roots. 
If  then  the  .evulsion  is  well  done,  I  think  one  might 
leaye  both  the  ganglion  and  the  nerve  divisions 
untouched. 

Having  put  forward  this  suggestion,  the  mam 


purpose  of  my^paper  is  accomplished.  The  sug- 
gestion is  briefly  this  : — A  complete  evulsion  of 
the  sensory  root  will  produce  the  same  effect  as 
removal  of  the  ganglion,  and  the  effect  will  be 
permanent.  This  being  so  the  operator  should, 
from  the  first,  aim  at  the  isolation  and  evulsion 
of  this  sensory  root,  and  it  might  simplify  the 
operation  to  open  the  space  of  Meckel  behind  the 
foramen  ovale  and  third  division  of  the  fifth  nerve, 
instead  of  in  front  of  it. 

foreign  CUntcal  Xectures* 

THE    SCOPE    AND    VALUE  OF 

SURGICAL  INTERVENTION 

IN  CANCER. 

By  F.  LEJARS.  M.D., 

ProfaMor  at  the  Ifcoulty  of  Medicine  of  P*rto. 

[Specially   translated  for  Thb   Medical   Press   and 

Circular.] 

According  to  Professor  Kosinski,  of  Varsovia. 
once  cancer  has  gained  a  footing  in  the  human  organism 
no  treatment,  surgical  or  other,  can  arrest  its  progress.(a) 
In  this  view  I  cannot  acquiesce.  It  is  true  that  the 
therapeutical  measures  upon  which  we  rely  in  the 
treatment  of  the  general  run  of  maladies  are  not  in- 
tended so  much  to  fight  the  disease  as  to  fortify  the 
organism  with  the  object  of  enabling  it  to  hold  its  own 
in  the  struggle,  and  in  this  we  are  greatly  aided  by 
the  vis  medicatrix  natura,  whereas  in  cancer  the  or- 
ganism is  absolutely  unable  to  resist  the  disease,  and 
a  spontaneous  cure  is  quite  unknown.  It  follows  that 
we  can  only  hope  to  attack  it  successfully  by  surgical 
means.  I  am  aware  that  the  professor's  views  are 
shared  by  a  number  of  experienced  observers,  but  it 
is  worth  while  studying  the  question  from  the  point 
of  view  of  the  results.  We  do  not  despair  of  the  dis- 
covery, sooner  or  later,  of  a  therapeutical  means  ot 
combating  this  disease  other  than  by  ablation,  but  for 
the  time  being  no  procedure  other  than  surgical  can 
be  taken  into  account.  The  problem  may  be  sub- 
divided into  three— w..  (1)  In  what  proportion  of  cases 
is  ablation  foUowed  by  permanent  cure  ?  (2)  What  are 
the  "  operative  conditions  "  under  which  such  results 
may  be  hoped  for.  and,  failing  which,  our  intervention 
must  be  futile  ?  and  (3)  What  are  the  principles  that 
must  guide  us  in  palliative  but  beneficial  intervention 
in  inoperable  cases  ? 

There  was  a  time,  not  so  far  removed,  when  the 
removal  of  malignant  growths  was  in  itself  so  risky 
that  operative  success  often  masked  therapeutica 
failure.  Now  that  operative  success  is  much  easier 
of  achievement,  we  are  left  at  liberty  to  consider  the 
ultimate  results  of  an  operation,  and  behind  the .  opera- 
tion which  has  proved  successful  we  have  acquired itne 
habit  of  distinguishing  the  patient  who  has  not  been 

cured.  .  »u 

There  is  no  lack  of  statistics  of  the  results  in  the 
ordinarv  forms  of  cancer— of  the  breast,  skin.  Up.  tongue, 
stomach,  rectum,  and  uterus.  If  we  add  them  up  we 
Ket  large  numbers  yielding  percentages  which  really 
teach  us  very  little.  The  most  trustworthy  idea l  may, 
perhaps,  be  obtained  from  the  results  of  a  particular 
operator  whose  experience  comprises  a  very  large  num- 
ber of  cases  extending  back  over  a  considerable  penoa . 
but  even  then  we  must  only,  attacfe  comparative  im- 
portance'to  the  figures.  '  ' 
F  Cancer  of  the  breast  is  reputed  to  be  the^form  m 
which  permanent  cure  is  Obtained  with  least  difficult), 
and  the  result*  have  appeared  to  improve  as  the  tccn- 
niaue  was  perfected.  Let  us  take,  however  two 
recent  series^f  results,  those  of  Mr.  Bryant  and  Pro- 
fessor Le  Pentu.  Ql  fifty-three  patients  operated  upon 
by  the  laUer,  down  to  July,  1901.  thirty-six  ««d*jtt- 
twenty^f  ,  them  Whin  three  years  of  the  operation 

~"  (a)    Arch.  International*  de  Chirurgie,  1903.  p.  231. 


March  jo,  1904, 


ORIGINAL  COMMUNICATIONS. 


Thx  Medtcal  Press,     337 


and  sixteen  after  three  years.  In  five,  death  was  due  to 
some  intercurrent  disease,  in  thirty-mir  to  recurrence 
or  metastasis,  and  seventeen  are  still  alive — seven 
of  them  operated  upon  less  than  three  years  ago,  ten  up- 
wards of  three  years,  with  an  average  survival  period 
for  the  latter  of  94  years.  Mr.  Bryant's  observations 
bear  on  forty-six  cases  ;  seventeen  of  his  patients  re- 
mained free  from  recurrence  till  death,  occurring  from 
five  to  sixteen  years  after  the  operation,  in  nine  between 
three  and  seven  years,  seven  between  ten  and  thirty 
years,  while  in  ten  the  disease  made  its  appearance  in 
I  her  breast  in  periods  varying  from  two  to  twenty- 
bur  years  after,  A  point  that  calls  for  particular 
attention  jn  these  figures  is  the  comparatively  large 
number  of  instances  of  delayed  recurrence,  an  element 
of  disquietude  to  which  we  shall  have  occasion  to  refer 
later,  since  it  cannot  but  modify  the  meaning  we 
attach  to  the  term  cure.  Nevertheless,  the  long 
periods  of  immunity  testify  in  favour  of  the  utility 
©f  surgical  intervention  in  these  cases. 

Cancer  of  the  extremities,  primary  skin  cancer, 
cancer  the  outcome  of  chronic  ulceration,  &c,  justify 
&  very  favourable  distant  prognosis.  In  205  opera- 
tion! on  patients  belonging  to  this  class,  Dr.  von  Brunn 
gives  y«  per  cent,  of  permanent  cures  over  four  years 
ol  aj^e.  In  cancer  of  the  Up  the  prognosis  is  also  favour- 
able, for  Dr.  Loos,  having  analysed  the  returns  of  the 
Tubingen  Hospital  between  the  years  1843  and  1S85, 
51  per  cent,  of  cures,  and  between  1885  and  1898 
tiie  proportion  of  successes  rises  to  66  per  cent.  These 
figures,  however,  bear  on  a  special  variety  of  cancer 
which,  in  the  event  of  recurrence,  admits  of  repeated 
1  ion,  and  this  remark  applies  up  to  a  certain  point 
to  cancer  of  the  skin  and  breast. 

The  results  are  very  different  when  we  turn  to  cancer 
of  the  cavities  of  the  body.  In  respect  of  cancer  of  the 
le,  von  Mickulicz  operated  in  thirty-two  cases 
let  ween  L&$1  and  1901.  He  had  three  operative 
deaths,  four  incomplete  operations  followed  by  death 
within  a  few  months,  twenty* five  successful  operations, 
in  nineteen  nf  which  the  subsequent  history  was 
ascertained-  Of  these  nineteen,  fourteen  died  at 
ig  intervals  before  the  end  of  the  second  year* 
while  in  five  no  recurrence  had  taken  place  more  than 
two  and  a  half  years  after  the  operation  (including 
several  female  patients).  Between  1888  and  1900, 
Professor  Czerny  operated  in  thirty- one  cases,  with 
four  operative  deaths,  eight  in  which  the  subsequent 
is  unknown,  and  nineteen  who  were  kept  under 
observation.  Of  the  latter  twelve  succumbed  to  re- 
currence, and  seven  were  still  free  three  and  a  half, 
four  and  a  half,  five  and  a  half,  and  eleven  years  after. 
The  average  gain  of  life  in  the  recurring  cases  was  a  little 
1  ve  months.  Here,  again,  one  is  struck  by  the  fact 
ol  recurrence  after  a  long  period  of  apparent  cure. 

Now,  for  cancer  of  the  stomach.  Of  144  cases 
operated  upon  at  the  Hamburg- Eppindorf  Hospital 
iince  1889,  and  analysed  by  Ringel,  resection  was  per- 
formed in  sixty -four  and  gastroenterostomy  in 
eighty -one*  Of  the  sixty-four  gastrectomies,  thirty- 
tiffht  died  from  the  effects  of  the  operation,  and  of  the 
twenty-six  who  survived  five  could  not  be  traced,  two 
were  lost  sight  of  after  the  first  year,  eleven  died 
ul  recurrence  or  metastasis,  with  an  average  survival 
period  of  thirteen  months,  eight  are  still  living,  having 
been  operated  upon  four  months,  eight  months,  fifteen 
months,  seventeen  months,  two  and  a  half  years,  375 
years.  It  is  recorded  that  the  patient 
operated  upon  three  years  and  eight  months  ago  now 
has  a  recurrence.  In  Professor  Kronlcin's  clinic 
fifty  gastrectomies  (188 1-1902)  gave  fourteen  operative 
deaths,  lwenty*four  subsequent  deaths,  twenty-two  of 
which  were  due  to  recurrence  with  an  average  survival 
ptnod  of  seventeen  and  a  half  months  ;  twelve  still 
Bring,  two,  possibly  three,  with  actual  recurrence, 
seven  in  whom  the  operation  was  performed  from  five 
months  to  two  years  since,  and  two  in  which  the  patient 
has  remained  free,  one  for  eight  and  the  other  for  four 
rears  We  may  compare  with  these  the  results  of 
seventy-four  gas tro- enterostomies — vi**,  eighteen  opera* 
tivt  deaths,  three  still  living,  two  lost  sight  of,  fif  ty*one 
subsequent  deaths,  with  an  average  survival  of    six 


I  months  and  a  half.     Dr,  Schonhauser  concludes   that 
I  resection  of  the  stomach  for  cancer  prolongs  life  by  one 
year,  and   g  astro  -enterostomy,  on  an   average,     by  a 
hundred  days. 

In  cancer*  of  the  large  intestine  and  rectum,  Hoche- 
n egg  performed  the  radical  operation  11194  out  of  283 
cases,  with  87*6  "successful  operations"'  and  r6'2 
cures,  in  which  there  was  no  recurrence  in  three  year;, 
and  upwards.  These  comprise  1 74  cases  of  cancer  of 
the  rectum,  of  whom  thirty-five  remained  free  from 
recurrence  for  upwards  of  three  years,  though  five  of 
them  ultimately  succumbed  to  the  disease,  The  pro- 
portion of  permanent  cures,  therefore,  is  t7'2. 

Cancer  of  the  kidney  is  notoriously  of  grave  pro- 
gnosis. Of  324  cases  collected  by  Albarran  and  lmbert 
of  renal  cancer  in  adults,  254  survived  operation.  Of  t  S4 
whose  subsequent  history  was  ascertained,  in  eighty-five 
there  was  fatal  recurrence  (of  which  sixty-four  occurred 
during  the  first  year),  nine  died  from  other  causes 
(seven  before  two  years),  and  ninety  have  remained 
in  good  health,  having  been  seen,  nineteen  six  months 
after,  sixteen  between  six  and  twelve  months,  twenty- 
two  between  one  and  two  years,  ten  between  two 
and  three  years,  and  twenty- three  between  four  and 
sixteen  years. 

Probably  no  variety  of  cancer  has  been  the  subject 
of  so  much  observation,  research  and  statistical  treat- 
ment as  that  of  the  uterus.  The  compilations  of 
statistics  almost  invariably  wind  up  with  a  precise 
summary  of  the  operative  mortality,  less  than  before, 
and  of  permanent  cures,  which  are  more  numerous. 
The  former  may  be  conceded,  but  with  regard  to  the 
latter,  some  authors  manifest  an  optimism  which  daily 
experience  renders  it  impossible  to  endorse.  Placing  on 
one  side  the  statistics  brought  before  the  Roman  Con- 
gress in  1002,  I  will  deal  only  with  the  summarised 
figures  of  Professor  Zweifel,  of  Leipsig,  which  comprise 
ad  1  he  cases  of  uterine  cancer  for  nearly  fifteen  years 
that  came  under  his  care  in  private  and  hospital  prac- 
tice. They  number  974.  and  of  these  only  260  were 
held  to  justify  operative  intervention  (2fr(\4  per  cent,). 
There  were  twenty-two  deaths  from  operative  shock 
{8*46 per  cent,).  For  statistical  purposes  cognisance  is 
taken  only  of  patients  operated  upon  since  January  1st. 
1897,  the  term  "  cure  "  being  restricted  to  patients  free 
from  recurrence  for  at  least  five  years,  Under  this  head 
we  have  610  cases,  of  which  153  were  operated  upon 
(2508  per  cent.)'  Deducting  the  patients  who  suc- 
cumbed to  shock  or  who  were  lost  sight  of,  there  re- 
main ij2  cases  with  eighty -five  subsequent  deaths 
from  recurrence,  and  forty-seven  survivals  free  from 
recurrence,  verified  by  inspection  five  years  after 
operation.  This  gives  a  proportion  of  j^6  per  cent, 
permanent  cures,  but  if  we  calculate  the  proportion  of 
the  total  number  of  cases  obseved,  operated  or  not, 
the  percentage  of  cures  falls  to  7*7,  which  represents 
the  curability  of  the  disease. 

This  is  the  only  proper  way  to  make  these  calcula- 
tions if  we  wish  to  obtain  a  true  representation  of  the 
curability  of  uterine  cancer,  If  this  method  be  applied 
to  the  statistics  of  other  kinds  of  cancer — breast, 
stomach,  rectum,  Sec. — the  proportion  ol  permanent 
cures  will  undergo  a  very  material  depreciation,  By 
making  use  of  results  bearing  only  on  the  operable 
cases,  we  are  apt  to  convey  a  very  false  and  misleading 
idea  of  the  mortality  due  to  the  disease, 

It  is  a  step  in  the  right  direction  to  have  substi- 
tuted a  period  of  five  for  that  of  three  years  as  evidence 
of  the  permanence  of  the  cure.  And  recurrence  after 
three  years,  and  even  after  five  years,  is  by  no  means 
rare  ;  this,  indeed,  is  one  of  the  most  troublesome  and 
disturbing  factors  in  such  estimates.  Lafahardt  has 
collected  112  cases  of  recurrence  or  metastasis  after 
three  years  as  follows  : — 

Tardy  Tardy 

recurrences,     metastases. 
....      44  (0 


Breast 
Rectum 
Tongue 
Lips      , . 
Other  organs 


14 
S 

26 
II 


Most  of  these  repetitions  of  the  morbid  process  take 


338    The  Medical  Press.        ORIGINAL  COMMUNICATIONS. 


March  30,  1964* 


place  between  the  sixth  and  fourth  year  after  operation  ; 
then  they  become  rare,  regaining  a  certain  frequency 
after  twenty  years.  It  is  claimed,  of  coarse,  that  the 
latter  are  the  new  tumours,  yet  the  fact  remains  that 
the  fresh  growth  takes  place  in  most  instances  in  the 
cicatrix.  Moreover,  the  very  cancers  which  display 
most  markedly  the  tendency  to  tardy  recurrence  are 
precisely  those  which  are  known  to  be  of  moderate 
malignancy  and  of  slow  evolution — vi*.,  scirrhous 
growths.  We  are  almost  constrained  to  admit  with 
Labhardt  'that  "  once  cancerous,  always  cancerous, 
although  the  danger  of  recurrence  diminishes  in  all 
probability  with  the  lapse  of  years."  We  may,  how- 
ever, affirm  that  cancer  is  capable  of  cure  by  ablation 
under  certain  conditions,  not  all  of  which  are  known  to 
us,  but  only  in  a  small  proportion.  Apart  from  these 
there  is  unquestionable  evidence  of  a  more  or  less 
considerable  gain  of  life,  which  must  not  be  passed  over 
as  of  no  importance.  It  is  better  to  look  at  the  ques- 
tion from  this  modest  standpoint  rather  than  to  incur 
the  discouragement  into  which  some  surgeons  have 
fallen,  or  the  unjustifiable  optimism  of  others.  We  have 
only  to  reflect  upon  the  enormous  number  of  those  who 
yearly  succumb  to  cancer  in  one  form  or  another,  and 
to  bear  in  mind  the  infinitesimal  proportion  of  opera- 
tive survivals  and  permanent  cures,  to  be  constrained  to 
admit  that  there  is,  properly  speaking,  no  true  thera- 
peusis  of  cancer,  and  that,  be  the  benefit  small  or  great, 
the  benefit,  such  as  it  is,  is  obtainable  only  by  surgical 
means. 

What  is  the  use  of  removing  a  cancerous  growth, 
however  skilfully,  if  the  operation  is  to  be  followed 
in  a  comparatively  short  time  by  fatal  recurrence  ? 
We  have  done  with  brilliant  operations  which  have  no 
morrow.  We  can  only  justify  ablation  of  a  cancerous 
growth  if  the  tumour  presents  itself  in  certain  con- 
ditions, and  if  the  operation  be  carried  out  in  a  certain 
manner,  above  all,  it  must  be  possible  to  remove  the 
tumour  en  bloc. 

Be  it  admitted,  then,  that  we  know  nothing  of  the 
pathogeny  of  cancer,  of  its  determining  factor.  Let 
us  beware  of  using  terms  and  expressions  implying 
assumptions  outside  and  beyond  our  actual  knowledge, 
for  they  are  worse  than  useless.  Whatever  be  the 
factor,  the  primum  tnovens,  the  disease  commences 
and  was  the  cause  of  an  inoculable  disease.  In  practice 
it  is  useful  to  consider  it  as  such,  and  even  to  consider 
it  as  a  very  virulent  and  most  tenacious  disease  against 
which  the  cells  are  unarmed.  When  we  scrape  away 
a  tuberculous  growth  the  removal  in  most  instances  is 
by  no  means  complete,  but,  having  taken  away  the 
major  part.  Nature  does  the  rest.  Nothing  of  the  kind 
is  to  be  anticipated  in  cancer.  An  incomplete  opera- 
tion in  cancer  is  not  only  useless,  but  is  supremely 
injurious,  in  that  it  helps  to  disseminate  the  disease 
and  to  hasten  its  generalisation.  And  the  term  incom- 
plete applies  not  only  to  the  tumour  itself  and  its  out- 
lying parts,  but  to  the  isolated  foci  of  malignancy 
embedded  in  the  neighbouring  lymphatic  glands  and 
vessels. 

Consequently,  early  intervention  affords  the  best 
guarantee  of  successful  intervention,  and  it  is  in  this 
direction  that  we  must  labour  if  we  wish  to  increase 
the  proportion  of  survivals,  and  not  in  an  illusorv 
extension  of  the  indications  for  ablation.  No  one  will 
deny  that  in  regard  to  affections  of  an  innocent  or  inflam- 
matory type  we  are  justified  in  carrying  surgical  in- 
tervention to  its  extreme  limits,  but  radical  operations 
have  no  significance,  for  they  often  have  absolutely 
the  opposite  effect  to  that  aimed  at.  What  is  the  use 
of  tediously  separating  adhesions  over  a  tumour  and 
removing  this  and  that  chain  of  glands  when  we  know 
all  the  time  that  our  operation  must  of  necessity  be, 
and  remain,  incomplete  ?  We  only  pave  the  way  to  a 
fresh  outburst  of  active  neo-formation.  In  cancer  of 
the  breast,  if  the  skin  is  involved,  be  it  over  ever  so 
small  a  surface,  the  prognosis  is  singularly  aggravated. 
Not  that  there  is  any  difficulty  in  removing  the  infected 
skin,  but,  once  affected,  the  skin  spreads  the  infection 
through  its  vessels  over  an  undeterminable  area. 
Visceral  neoplasms  show  this  even  more  plainly.    Why 


is  it  that  epithelioma  of  the  body  or  cavity  of  the  uterus.- 
and  limited  thereto,  gives  a  proportion  of  permanent 
cures  far  in  excess  of  cancer  of  the  cervix  ?  Why  is 
it  that  even  large  tumours  of  the  kidney,  if  freely  mov- 
able, well  encapsuled  and  not  involving  the  ureter, 
are  often  recovered  from  for  periods  long  enough  to 
justify  the  assumption  of  actual  cure,  while  much 
smaller,  but  adherent,  tumours  "  exteriorised  "  by  a 
small  portion  of  their  surface  give  lamentable  results  ? 
It  would  be  interesting  to  draw  up  a  table  of  the  pro* 
portion  of  cases  of  visceral  cancer  followed  by  cure,  in 
which  the  tumour  had  contracted  adhesions;  AN 
barran  and  Imbert  have  done  this  in  respect  of  the 
kidney,  and  they  tell  us  that  "in  no  instance  of  long 
survival  qud  cure  was  the  tumour  clinically  adherent, 
and  in  two  instances  only  were  adhesions  formed  after 
removal.  And  "  in  none  of  the  twenty-six  cases  of  per* 
manent  cure  is  any  mention  made  of  the  removal  of 
glands."  Decidedly  it  is  only  by  doing  our  best  to 
operate  on  "  young  "  cancers  that  we  can  hope  to  effect 
any  material  increase  in  the  proportion  of  survivals — 
certainly  not  by  more  and  more  extensive  removal 
of  glands.  In  this  direction  is  progress  possible, 
and  in  this  direction  only. 

Another  principle  which  commands  universal  assent 
is  that  ablation  should  be  wide  of  the  growth.  We  do 
not  dissect  out  or  seek  to  isolate  a  cancer,  as  we  should 
any  other  kind*  of  tumour  formation  ;  we  cut  wide  of 
the  mark  through  healthy  tissues.  All  sectioning,  all 
piecemeal  removal,  is  out  of  the  question  in  cancer,  and 
is  incompatible  with  the  principles  of  cancer  surgery. 
We  must  treat  them  as  potentially  infective,  highly 
septic  masses,  and  we  cannot  push  these  precautions 
too  far  in  order  to  avoid  a  contamination  which  is 
none  the  less  real  because  we  are  ignorant  of  its  precise 
modus  operandi. 

It  is  wrong,  perhaps,  to  speak  of  operative  inoculation, 
because  such  an  expression  begs  the  question  of  patho- 
genesis, but,  apart  from  growths  in  the  immediate 
neighbourhood  due  to  portions  of  infected  tissue  left 
behind,  we  must  allow  the  existence  of  foci  of  implanta- 
tion due  to  minute  dJbris  conveyed  hither  and  thither 
by  the  surgeon's  fingers  or  instruments.  Hahn  long 
since  called  attention  to  these  instances  of  operative 
implantation,  and  my  late  house  surgeon,  M.  Levesque, 
dealt  with  this  question  as  a  whole  in  his  thesis,  in 
which  he  brought  together  a  number  of  instances  which 
militate  in  favour  of  this  view  :  cancer  round  the  punc- 
ture performed  for  ascites,  cancer  of  the  abdominal 
cicatrix  after  laparotomy  for  the  removal  of  a  pelvic 
cancer,  cancer  in  the  vulvo-vaginal  scar  after  removal 
of  epithelioma  of  the  roof  the  vagina  or  of  the  cervix. 
Moreover,  have  we  not  often  seen  after  removal  of  the 
breast  for  cancer,  nodules  of  cancer  develop  in  the 
suture  punctures  ?  It  may  plausibly  be  urged  that 
such  recurrences  may  be  due  to  infection  conveyed  by 
the  lymphatics  and  vessels,  but  we  cannot  altogether 
ignore  the  possibility  of  these  formations  being  really 
of  the  nature  of  operative  inoculations.  We  must  bear 
in  mind,  too,  that  the  tumour  itself  is  not  the  only 
source  of  danger,  for  we  must  be  on  our  guard  against 
effusions  of  infected  lymph  and  the  dJbris  of  broken- 
down  glands.  The  moral  to  be  deduced  from  these 
considerations  is  that  in  cancer,  above  all,  we  cannot  be 
too  stringent  in  applying  the  principles  of  antisepsis, 
and  the  technical  details  of  all  operations  tor  cancer 
must  be  devised  with  these  considerations  fully  be- 
fore us. 

Now  that  we  understand  the  limitation  of  the  cura- 
tive powers  of  which  we  dispose  by  surgical  intervention 
we  may  perhaps  be  more  willing  to  consider  what  is 
to  be  clone  with  the  so-called  inoperable  cases, 
which  constitute  some  75  per  cent,  of  the  total 
number  of  cases.  Here,  too,  surgical  intervention, 
though  only  palliative,  is  capable,  in  certain  cases,  of 
procuring  a  notable  prolongation  of  life,  far  more  than 
would  result  from  more  radical  measures.  When  we 
see  what  a  number  of  those  who,  after  successful  ex- 
tirpation, die  during  the  first  year,  and  especially 
when  we  reflect  how  they  die,  the  conclusion  is  forced 
upon  us  that  by  exceeding  the  rather  narrow  limits 


March  30,   1904, 


TRANSACTIONS  OF  SOCIETIES.        The  Medical  Press,    339 


assigned  above,  we  have  not  fulfilled  our  duty  to  our 
patient  in  ihe  light  of  our  present  knowledge. 

In  point  of  fact  there  is  much  that  can  be  done  for 
tbfi  moperaptes.  the  incurables,  for  those  whose  destiny 
j*ems  to  be  limited  in  two  words— morphine  and 
I  do  not  admit  that  the  surgeon's  whole  duty 
is  limited  to  morphine  and  expectancy  in  cases  where 
the  seat  or  the  extent  of  the  growth  renders  remova 
impossible.  I  need  but  mention  such  operations  as 
eDtero-anastomosis,  gastroenterostomy,  Ac,  to  prove 
this.  These  operations,  it  is  true,  are  only  applicable 
to  certain  well-defined  forms  of  cancer,  but  even  in 
uterine  cancer  something  can  be  done.  We  can 
cauterise  and  apply  the  curette,  taking  care  to  confine 
1  he  cautery  to  the  neoplasm  in  order  not  to  set  up 
fresh  foci  round  about,  Czerny  has  employed  the 
following  procedure  in  ninety-five  cases  of  inoperable 
serine  cancer  with  marked  benefit*  He  begins 
raring  out  the  tissue  with  the  curette,  -'■  la  mise 
aw  Mt*H  checking  the  bleeding  with  the  actual  cautery, 
plugging  the  cavity.  The  bleeding  having  been 
urestedp  which  usually  takes  a  few  days,  he  plugs  the 
uterine  cavity  with  gauze  steeped  in  a  solution  of 
chloride  of  tine  (20  to  50  per  cent.).  The  vagina  is 
dehydrated  by  the  aid  of  alcohol,  freely  vaselined,  and 
plugged  with  gauze  impregnated  with  a  5  per  cent, 
solution  of  carbonate  of  soda.  In  twenty-four  hours 
the  chloride  of  zinc  tampon  is  withdrawn,  and  the  vagina 
irrigated  with  the  soda  solution.  According  to  this 
author  the  pain  disappears  in  two  or  three  hours,  and 
the  ■■  neoplastic  H  scab  comes  away  in  from  six  to 
twenty  days.  Secondary  hemorrhage  is  of  very  rare 
occurrence.  We  mayf  if  we  prefer*  make  use  of  the 
actual,  or  the  gal  vano- cautery,  but  their  action  must 
be  deep  and  prolonged.  So  promising  have  been  the 
results  of  this  treatment  that  one  is  tempted  to  accept 
the  view  of  the  optimists  who  declare  that  persistent 
cauterisation  may  really  determine  retrogression  of 
rhe  neoplastic  growth.  Without  going  that  far,  we 
have  no  hesitation  in  affirming  that  this  procedure 
does  much  to  assuage  the  sufferings  of  the  victims,  and 
m  every  point  of  view,  preferable  to  the  combined 
"  morphia  and  expectancy  attitude,  which  is  at 
present  the  lot  of  most  of  them. 

Moreover,  this  method,  within  certain  limits,  gives 
better  results  than  ligature  of  the  arteries.  It  is.  in- 
deed, open  to  question  whether  the  anaemia  thus  in- 
duced is  not  likely  to  prove  as  injurious  to  the  normal 
cells  in  their  resistance  as  to  the  infected  cells  in  their 
disordered  growth.  Nevertheless,  experience  seems 
to  show  that  Ligature  of  both  hnguals,  or  both  hypo- 
gastrics,  is  productive-  of  some  measure  of  rehef, 
notably,  in  a  checking  of  hemorrhage,  relieving 
pain  and  improving  the  patients  general  condition. 

In  conclusion,  we  may  mention  the  attempts  to  delay 
the  evolution  of  the  disease  by  removal  of  both  ovaries. 
As  Mr,  Butlin  has  pointed  out.  this  procedure  does  not 
repose  on  the  shadow  <>f  a  proof,  and  he  not  unreason- 
expressed  astonishment  at  the  enthusiasm  with 
which  Beatson's  proposal  was  received  at  the  Chelten- 
ham meeting  of  the  British  Medical  Association. 
Moreover,  Mr*  Morrison  has  instanced  a  case  in  which 
he  operated  for  mammary  cancer  in  a  patient  who 
twenty  -five  years  before  had  had  both  ovaries 
removed,  and  another  in  which  the  patient  died  from 
unter  of  the  breast  five  years  after  double  ovariotomy. 

matters  stand,  no  one  is  in  a  position  to  formulate 
any  definite,  trustworthy  conclusions.  At  any  moment 
4  gleam  of  light  on  one  or  other  of  the  many  obscure 
problems  involved  may  throw  down  the  superstructures 
which  we  have  raised  on  hypotheses,  and  it  may 
be  that  the  technique  and  the  general  plan  of  our  opera- 
tionti  will  appear  to  our  successors  as  strange  and  un- 
reasonable as  certain  practices  of  pre- antiseptic  days 
appear  to  us.  We  can  ooly  reason  with  what  we  know, 
Uut  it  is  essential  that  we  should  not  labour  under 
any  delusion  as  to  the  scope  of  the  means  at  our  dis- 
posal, that  we  should  look  the  reality  straight  in  the 
lace  without  flinching  and  without  despairing  in  our 
struggle  with  this  elusive  problem  of  cancer  formation. 


XTran&actiouB  of  Societies. 


CLINICAL  SOCIETY  OF  LONDON. 
Meeting  held  Friday,  March  25x11.  1904. 


Dr.  Frederick  Taylor,  President,  in  the  Chair, 


Dr.  E.  W.  Good  all  communicated  a  paper  upon 
two  cases  of 

INTESTINAL   OBSTRUCTION  IMMEDtATIt  V   |ol  LOWING  Alt 
ATTACK    OF   TYPHOID    FEVER. 

The  first  case  was  that  of  a  boy,  *t  14,  who  was 

admitted  to  the  Eastern  Hospital  at  the  end  of  an 
attack  of  typhoid  fever,  during  the  latter  part  of  which 
there  had 'been  some  abdominal  pain.  A  relapse 
followed,  and  at  the  end  of  this  the  patient  suffered 
for  three  days  from  vomiting,  hiccough,  and  pain  in 
the  abdomen.  About  three  weeks  later  a  second 
relapse  took  place,  which  was  again  followed  by  an 
attack  of  pain,  hiccough  and  vomiting.  During  this 
attack  the  patient  died.  At  the  autopsy  the  small 
intestine  was  found  to  be  partially  obstructed  about 
2  J  ft.  above  the  valve  by  a  fibrous  band  stretching  from 
the  mesentery  to  another  part  of  the  gut.  Appar- 
ently  this  band  had  arisen  out  of  a  patch  of  local  peri- 
tonitis opposite  a  deep  ulcer.  There  were  many 
healing  ulcers  in  the  small  intestines. 

The  second  case  was  that  of  a  young  man,  set.  22 1+ 
who  was  operated  upon  for  perforation  on  the  twentieth 
day  of  an  attack  of  typhoid  fever.  At  that  time  there 
was  no  generalised  peritonitis  nor  any  peritoneal  bands. 
The  patient  did  well  for  about  a  fortnight,  wkn  he 
began  to  suffer  from  vomiting.  A  week  later  there 
were  other  symptoms  of  partial  obstruction,  and  the 
patient  died  suddenly  from  a  second  perforation.  A I 
the  autopsy  a  number  of  small  bands  were  found, 
kinking  and  compressing  various  parts  of  the  small 
intestine.  The  second  perforation  was  situated  about 
6  ft.  above  the  valve,  in  an  ulcer  just  above  the  highest 
band. 

Dr,  Seymour  Taylor  inquired  if  there  had  been 
anything  in  the  diet  in  the  first  case  to  account  for  the 
relapse,  as  he  believed  that  such  an  event  could  fre- 
quently be  traced  to  a  change  of  food.  The  occurrence 
of  intestinal  obstruction  as  a  sequela  of  enteric  fever 
was  of  such  rarity  that  no  mention  of  it  was  made  in 
classical  treatises  upon  the  subject. 

Dr.  G  cod  all  did  not  consider  that  a  relapse  in 
typhoid  fever  was  necessarily  associated  with  a  change 
in  the  diet.  The  clinical  history  and  post-mortem 
appearances  of  these  cases  suggested  that  the  bands 
were  formed  out  of  local  patches  of  peritonitis  opposite 
intestinal  ulcers.  It  was  possible  that  other  cases  of 
obstruction  by  bands  might  sometimes  have  been  pro- 
duced from  previous  attacks  of  typhoid  fever  many 
years  ago. 

Mr,  Walter  G,  Spencer  read  notes  of  a  case  of 

SEVERE    AND    FATAL    HEMATURIA   OF    UNKNOWN    ORIGIN 

in  a  man,  aet.  44.  who  had  first  noticed  blood  in  his 
urine  about  a  fortnight  before  his  death.  His  previous 
health  was  good*  The  chief  symptom  had  been  an 
increasing  hematuria,  unaccompanied  by  pain  or 
frequency  of  micturition.  On  admission  to  the  West* 
minster  Hospital  he  was  very  anaemic,  practically 
pulseless,  and dyspneeic.  The  bladder  was  distended, 
but  not  tense  nor  tender.  The  temperature  was  just 
below  normal.  He  was  infused  with  salt  solution, 
given  repeated  enemata  of  water,  and  stimulated  with1 
alcohol  and  strychnine.  He  passed  urine  containing  a 
large  proportion  of  blood,  the  temperature  became 
subnormal,  and  he  died  within  twelve  hours  of  admis- 
sion. The  post-mortem  examination  failed  to  throw 
any  light  on  the  cause  or  source  of  the  haemorrhage. 
The  urinary  tract  appeared  normal,  and  no  gross 
lesions  were  observed.  The  blood-vessels  were  not 
diseased.  Microscopic  sections  of  the  kidney,  bladder* 
wall,  and  of  the  aorta  did  not  show  anything  abnormal, 
except  that  the  latter  vessel  appeared  thinner  than  was 
usual  at  this  a  ge .  A  second  case  of  recurren  t  haema  t  u  ria 
was  also  narrated,  in  a  man,  aet.  42 1  in  whom  the  con* 
dition  was  arrested  for  a  time  by  supra-pubic  cysto* 


34°    The  Medical  Pmg.        TRANSACTIONS  OF  SOCIETIES. 


tomy  and  drainage  of  the  bladder.  Cases  of  hema- 
turia unaccompanied  |by  lesions  had  been  referred  to 
by  Osier,  who  mentions  Gull's  term  •'  renal  epis taxis." 
Klemperer,  in  discussing  the  subject,  uses  the  term 
"  angio-neurosis."  <Some  of  the  cases  might  be  com- 
pared to  those  of  post-operative  haematemesis,  where 
no  gastric  lesions  were  found. 

Dr.  W.  P.  Herri ngh am  remarked  that  he  had  seen 
varicose  veins  in  the  ureter  in  some  cases  of  fatal 
hematuria.  He  thought  that  much  stress  could  not 
be  laid  upon  the  size  of  the  aortic  coats,  as  these  were 
subject  to  great  variation.  The  age  of  the  patients 
rather  suggested  a  vascular  origin  of  the  condition. 

Dr.  A.  E.  Russell  referred  to  a  case  of  fatal  haema- 
temesis in  which  a  minute  ulcer  was  found  post- 
mortem at  the  junction  of  several  large  vessels. 

Dr.  Wilfred  Harris  asked  if  the  coagulation-time 
of  the  blood  had  been  tested,  and  also  if  calcium 
chloride  had  been  administered. 

Mr.  C.  H.  Fagge  inquired  if  any  hemoglobinuria  were 
present  in  the  cases. 

Mr.  George  Eastes  asked  if  the  clots  which  the 
patient  had  passed  had  been  floated  out  in  water  in 
order  to  ascertain  their  shape  with  a  view  to  deter- 
mining their  origin. 

Mr.  Spencer  replied. 

Mr.  Cuthbert  S.  Wallace  and  Mr.  H.  J.  Marriage 
described  a  case  in  which  an  attempt  had  been  made 
to-  divide  the  eighth  nerve  within  the  skull  for  the 
relief  of  tinnitus.  The  patient  was  a  girl,  aet.  23,  who 
contracted  left  otitis  media  in  1898.  Several  opera- 
tions followed,  and  four  years  afterwards  she  began  to 
sutler  from  tinnitus  and  vertigo,  which  symptoms 
increased  in  intensity  to  such  a  degree  that  her  life 
was  rendered  well-nigh  intolerable.  It  was  therefore 
decided  to  attempt  to  divide  the  eighth  nerve.  Nume- 
rous experiments  were  made  on  the  cadaver,  with  the 
result  that  an  elaboration  of  the  operation  for  the  ex- 
ploration of  the  posterior  surface  of  the  petrous  bone 
was  finally  adopted  and  practised  on  September  3rd, 
1903.  The  procedure  was  rendered  very  difficult  on 
account  of  the  constant  discharge  of  cerebrospinal 
fluid  and  haemorrhage,  but  the  auditory  nerve  was  ex- 
posed and  Anally  divided  with  a  blunt  hook.  Noises 
were  present  on  the  following  day.  There  was  no 
facial  paralysis.  The  wound  never  showed  any  re- 
action, and  continued  to  discharge.  The  patient 
gradually  sank  and  died  on  the  twenty-first  day.  At 
the  autopsy  it  was  found  that  a  fine  strand  of  the 
auditory  nerve  had  escaped  division.  There  was  no 
meningitis,  and  the  internal  ear  presented  a  normal 
appearance. 

Dr.  E.  Farquhar  Buzzard,  who  had  made  a  micro- 
scopical examination  of  the  nerve  by  the  anatomical 
method,  said  that  the  vestibular  and  two- thirds  of  the 
cochlear  nerves  were  degenerated  as  a  result  of  the 
section.  He  believed  that  very  little  was  known  with 
regard  to  the  morbid  anatomy  of  tinnitus,  which  was 
not  a  common  symptom  in  gross  organic  disease  of  the 
brain,  except  where  there  were  lesions  affecting  the 
nerve-roots  at  the  base.  What  evidence  there  was,  was 
distinctly  against  the  view  that  it  was  of  central  origin. 

Mr.  C.  H.  Fagge  referred  to  two  cases  in  which  he 
had  exposed  the  eighth  nerve,  and  he  had  not  found 
it  a  matter  of  great  difficulty.  He  considered  that 
tinnitus  was  more  common  after  operations  for  chronic 
mastoid  disease  than  was  usually  supposed,  and  that 
it  was  probably  peripheral  in  origin. 
'  Dr.  Parkes  Weber  pointed  out  that  peripheral 
disease  of  the  nerve  had  been  met  with  in  cases  of 
Meniere's  disease,  in  which  tinnitus  was  a  prominent 
symptom,  and  referred  to  the  observation  of  Alt,  oi 
Vienna,  who  had  found  a  leukaemic  infiltration  of  the 
serve  in  one  case. — Mr.  Wallace  replied. 

LIVERPOOL  MEDICAL  INSTITUTION. 

Meeting  held  March  17TH,  1904. 
Dr.  Jambs  Barr,  President,  in  the  Chair. 

VOTE   OF   CONDOLENCE. 

.  The  following  resolution  was  proposed  by  the  Pre- 
sident, seconded  by  Mr.  Chancey  Puzby,  and  carried 
nanimouslv : — "  Tne     members     of     the    Liverpool 


March  30,  1904. 


Medical  Institution  desire  to  place  on  record  their 
sincere  regret  at  the  great  loss  which  the  Institution 
and  the  medical  profession  have  suffered  by  the  death 
of  Alexander  Davidson,  M.D.,  F.R.C.P.  Dr.  David- 
son was  a  trustee  of  this  institution,  and  for  many  years 
took  an  active  part  in  all  matters  appertaining  to  the 
welfare  of  the  medical  profession,  in  which  he  held  a 
distinguished  position.  He  was  a  man  of  sound  and 
mature  judgment,  in  whom  his  professional  brethren 
had  the  utmost  confidence,  and  he  exercised  a  great 
influence  for  the  public  weal.  He  was  the  soul  of 
honour  and  a  model  of  integrity,  a  man  who  always 
strove  fearlessly  to  do  his  duty  in  a  most  unselfish 
manner  and  without  any  aim  of  personal  aggrandise- 
ment. The  members  also  wish  to  tender  Mrs.  Davidson 
and  her  son  their  sincere  sympathy  in  the  irreparable 
loss  which  they  have  sustained." 

TUBERCULOUS     ULCERATION     TREATED     WITH      RADIUM 
RAYS. 

Dr.  Colin  Campbell  related  two  cases  of  tuberculous 
ulceration  of  the  mouth  and  of  the  pharynx  which  he 
had  tieated  with  radium  rays.  The  first  case  was  that 
of  a  young  man  suffering  from  advanced  phthisis,  who 
also  had  extensive  ulceration  of  the  pharynx  and  a 
painful  ulcer  just  inside  the  mouth.  The  frequent 
application  of  radium  rays,  which  were  directed  to  the 
ulcerating  areas  by  means  of  a  lead  tube,  resulted  in 
healing  of  the  ulcers,  but  the  patient  ultimately  died 
of  phthisis.  The  second  case  was  that  of  a  lady 
suffering  from  disease  of  the  frontal  sinus  and  nostril, 
who  also  had  a  tuberculous  ulcer  between  the  pillars 
of  the  fauces.  Radium  rays  applied  for  twenty 
minutes  twice  daily  had  been  followed  by  sound 
healing  of  the  ulcer. 

THE  VALUE  OF  X-RAYS  IN  THE  TREATMENT  OF  MALIGNANT 
DISEASE. 

Dr.  Thurston  Holland  read  a  note  on  this  subject, 
his  remarks  being  based  on  a  case  of  recurrence  oi 
mammary  carcinoma,  involving  the  skin  of  the  whole 
of  the  left  breast.  Under  prolonged  X-ray  treatment 
a  large  spreading  ulcer  healed  entirely,  and  numerous 
outlying  cancerous  nodules  disappeared.  Enlarged 
glands  have  since  appeared  in  the  axilla  and  neck,  but 
have  not  appreciably  increased  in  size  for  some  weeks. 
Dr.  Holland  said  the  results  obtained  must  largely 
depend  upon  the  efficient  application  of  the  rays.  It 
was  difficult  to  say  which  class  of  case  will  derive  most 
benefit  from  the  treatment,  but  he  had  obtained  the 
best  results  in  cases  of  cutaneous  cancer ;  deeply-seated 
growths  had  not  responded  to  the  treatment.  He 
suggested,  as  a  preventive  measure,  that  all  cases  after 
operation  for  malignant  disease  should  be  treated  with 
X-rays. 

INFANT    MORTALITY    AND    THE    SUPPLY    OF    HUMANISED 
STERILISED    MILK. 

Dr.  E.  W.  Hope  read  a  paper  on  the  above  subject 
He  described  the  investigation  into  the  causes  of  infant 
mortality,  which  had  been  undertaken  by  himself  and 
other  members  of  the  Medical  Institution  for  many 
years,  and  which  established  the  fact  that  among 
artificially-fed  children  below  three  months  of  age,  the 
mortality  in  the  summer  and  autumn  months  from 
digestive  disorders  was  fifteen  times  as  great  as  it  was 
among  breast-fed  infants,  vis.,  approximately  300  per 
1,000  instead  of  20  per  1,000.  Dr.  Hope  detailed  the 
close  and  rigorous  attention  given  to  the  milk  supply, 
not  only  that  from  cows  within  the  city,  but,  under  a 
special  Act  of  Parliament,  to  milk  brought  into  the 
city  from  country  cowsheds,  and  he  described  the 
methods  of  sterilising  and  preparing  the  milk,  the  food 
being  distributed  in  baskets  of  nine  bottles,  containing 
a  sufficient  supply  for  twentv-four  hours,  no  bottle 
being  used  twice.  He  strongly  emphasised  that  the 
milk  is  intended  solely  for  the  use  of  those  infants  whose 
mothers  are  unable  to  suckle  them,  or  who  can  only 
partially  suckle  them.  This  fact  is  stamped  upon 
every  card  of  instructions,  and  is  brought  into  promin- 
ence on  every  opportunity.  There  must  be  no  mis- 
understanding on  this  point.  The  problem  of  finding 
a  complete  substitute  for  the  milk  of  a  healthy  mother 
has  not  been  solved,  and  probably  never  will  be  solved. 


M\rch  jo,  tg&^i 


TRANSACTIONS  OF  SOCIETIES.        The  Medical  Press.    341 


m  tin 
10  p 


Afl  the  infant  grows  there  may  no  doubt  be  some  varia- 
tion in  the  quality  of  the  mother's  milk,  which  specially 
adapts  it  to  the  infants  need— nice  ties  in  Nature  which 
cannot  be  approached  artificially*     It  must  be  remem- 
bered that  milkt  as  Nature  intended  it  to  be  given,  is 
exposed  to  the  air  ;    it  passes  directly  from  the 
gtaad  to  the  stomach  ;    its  composition,  temperature, 
mature  adapt  it  to  the  needs  of  the  infant  ;    it 
fan  neither  abstractions,  adulterations,  preservatives, 
n<ir   uncleanliness  ;     it    us,    moreover,    bacteriologically 
clean  and  pure.     Nothing  the  municipality  can  do  can 
rqual  this,     Dr,  Hope  expressed  the  thanks  due  to  the 
staff  of  the  Children's  Infirmary  and  to  the  medical 
■-ion  generally  for  the  care  taken  in  assisting  in 
M  of  the  work,     The  results  have  been 
that  6,195  infants  have  been  fed  upon  this  milk  up  to 
December  Jtat,   1903.     A  study  of  the  case  books  in 
which  the  particulars  of  each  case  are  entered,   and 
rogreaa  of  the  child,  as  far  as  it  can  be  ascertained, 
record  -  that  over  50  per  cent,  were  ill  when 

the  milk  was  first  issued  to  them.  The  careful  records 
relating  to  4,453  of  the  total,  which  had  been  easier  to 
keep  under  observation  than  the  remainder  who  had 
been  supplied  through  dairies*  showed  a  mortality- 
rate  of  78  per  t,ooo.  The  causes  of  death  showed  no 
peculiarity.'  being  certified  to  be  due  to  bronchitis, 
pneumonia,  whooping-cough,  convulsions,  &C,  Com- 
,  this  rate  with  the  ordinary  infantile  mortality 
city,  11  is  extremely  favourable,  more  especially 
when  the  large  number  of  children  who  were  already 
sick  fe  taken  into  account.  The  value  of  the  sub- 
stitution of  pure,  clean,  and  suitable  food  for  the  con- 
tents of  the  Jon  1 -smelling  feeding-bottles  and  the  pro- 
mJscuoiu  food  given  to  infants  is  beyond  the  slightest 
doubt,  and  the  educational  value  of  the  method  will  be 
considerable*  The  large  number  of  infants  has  ren- 
.ilmost  impossible  as  close  a  medical  observation 
ai  that,  for  example,  referred  to  by  Professor  Budin. 
a  I  the  C  Unique  Tarnier.  There,  the  infant?,  all  of 
whom  had  been  born  in  the  Institution*  were  under 
co  est  ant  medical  supervision*  In  712  cases  quoted 
hy  Professor  Budin,  extending  over  a  period  of  two 
the  mortality-rate  was  reduced  to  36  5,  These, 
of  course,  were  selected  infants,  and  large  numbers  of 
mem  were  only  very  partially  Jed  on  sterilised,  huma- 
nbed  milk  ,  whereas  in  the  case  of  those  fed  from  the 
Liverpool  depots  there  was  no  selection,  and  a  large 
proportion  were  ill  to  commence  with. 

Dr,  Peter  Davidson  remarked  that  milk  from 
ujuniry  dairies  was  apt  to  be  stale  before  delivery,  and 
suggested  that,  if  possible,  the  milk  should  be  obtained 
from  town  dairies,  He  also  said  the  strength  of  the 
milk  should  be  modified  to  suit  infants  of  different  ages, 
for  rickets  and  scurvy  were  likely  to  follow  the  pro- 
longed use  of  humanised  milk. 

I;r  Ml^en  referred  to  the  educational  value  of  the 
system,  and  spoke  of  the  excellent  work  done  in  this 
respect  by  the  lady  sanitary  inspectors. 

Dr.  M  \c  a  lister  suggested  that  measures  might  be 
employed  whereby  milk  prescriptions  could  be  made 
up  at  the  depots  on  forms  supplied  to  the  hospitals  and 
to  medical  men  working  in  the  districts. 

Dr.  Hubert  Armstrong  took  exception  to  the  term 
"humanised,"  for  he  considered  it  au  incentive  to 
mothers  to  utilise  what  was  after  all  only  modified 
cow's  rnilk,  in  place  of  suckling  their  infants. 

Drs.  F.  W.  Inman,  A,  C.  Rendle,  Littler  Jones,  A.  G. 
Gal]  an,  and  F.  H»  Barendt  also  made  remarks. 

Dr.  Hope,  in  replying  to  the  various  criticisms  and 
observations  which  had  been  made,  said  that  the  Com- 
mittee quite  realised  the  necessity  for  obtaining  the 
milk  frc?h  to  start  with,  and  he  doubted  whether  that 
problem  would  be  solved  until  cows  were  specially  kept 
by  the  Committee  for  the  purpose,  and  he  hoped  that 
would  be  done.  It  was  not  claimed  that  the  system 
wbs  perfect,  or  even  as  perfect  as  it  might  be,  and 
nothing  the  Corporation  could  do  would  ever  relieve 
the  mother  from  the  obligations  incidental  to  mater- 
nity ,  but  the  gratifying  feature  was  that  the  care  and 
pains  taken  had  been  of  so  much  benefit  to  the  com- 
1  v\  and  would  certainly  encourage  the  Committee 
t&  persevere, 


ROYAL  ACADEMY  OF  MEDICINE  IN  IRELAND* 
Section  of  Pathology. 


Meeting  held  Friday,  March  i8th,   1904. 


Mr.  E.  H,  Taylor  and  Dr.  O'Sullivan  exhibited 
a  tumour  from  the  lee,  of  a'man*  a=t.  42,  which  had 
originated  a  year  previously  in  a  mole.  The  tumour, 
1  was  attached  by  a  pedicle*  was  pigmented,  and 
had  grown  very  rapidly.  The  glands  in  the  inguinal 
region  and  in  "the  iliac  fossa  were  large  and  hard. 
Dr,  O" Sullivan  demonstrated  microscopic  preparations 
from  various  portions  of  the  tumour.  It  showed  near 
the  periphery  spaces  lined  by  a  single  layer  of  high 
cubical  cells  separated  from  blood-vessels  by  hyaline 
connective  tissue.  In  a  deeper  portion  the  cells, 
several  layers  deep*  had  encroached  on  this  connective 
tissue  and  formed  a  sort  of  outside  sheath  to  the  vessels. 
The  main  part  of  the  growth  consisted  oJ  solid  columns 
of  cells  separated  from  one  another  by  a  fine  fibrous 
stroma.  These  cells  showed  very  numerous  mitoses. 
The  pigment  was  confined  to  the  stroma. 

Dr.  O'Sullivan  considered  the  tumour  to  be  an 
endothelioma  growing  from  the  lymph  spaces  in  the 
subcutaneous  tissue. 

The  President  discussed  the  paper. 

Mr.  L,  G,  Gunn  showed  two  tumours  from  kidneys 
of  different  subjects.  One  he  called  a  sarcoma*  showed 
large  round -cells  invading  the  kidney  substance.  He 
discussed  the  possibility  of  the  tumours  being  a  carci- 
noma of  the  suprarenal  capsule,  The  second  tumour 
showed  a  firm  cystic  structure  with  a  papillary  growth 
extending  into  and  dilating  the  ureter. 

The  President  and  Dr.  O' Sullivan  spoke. 

OTOLOGICAL  SOCIETY  OF  THE  UNITED 
KINGDOM. 
Meeting  held  March  ?th,  1904. 


The  President,  Dr.  Thomas  Barr,  in  the  Chair, 


Resumed  discussion  on  Dr.  Milligan's  paper*  "  The 
Etiology  and  Treatment  of  Labyrinthine  Suppuration.** 

Mr.  Gbbatle  thought  vertigo  was  not  to  be  reUed 
on  as  an  indication  for  operation*  nor  did  erosion  of 
the  inner  walls  of  the  antrum  and  tympanum  always 
imply  nstuiar  communication  between  those  cavities 
and  the  labyrinth.  Cases  often  recovered  from  these 
conditions  after  the  complete  post-aural  operation,  and 
without  exploration  of  the  labyrinth,  and  without  the 
total  loss  of  hearing  caused  by  such  exploration.  On 
these  and  other  grounds  he  recommended  operating  by 
stages.  He  thought  the  posterior  limb  of  the  external 
semicircular  canal  a  better  way  of  approaching  the  laby- 
rinth than  either  the  anterior  limb  or  the  fenestras*  on 
account  of  the  proximity  of  the  latter  to  the  facial 
nerve  and  bulb  of  the  jugular  vein. 

Mr.  Whitehead  gave  au  analysis  of  691  cases  of 
acute  and  chronic  mastoid  disease  dealt  with  by  him- 
self and  colleagues  at  the  General  Infirmary,  Leeds. 
Of  these,  2 7  had  suppuration  of  the  labyrinth,  of  which 
14  had  facial  palsy*  5  vertigo,  1 1  no  special  symptoms  ; 
tl  cases  died,  6  from  cerebellar  abscess,  3  from  menin- 
gitis, and  2  from  marasmus,  Mr.  Whitehead  remarked 
on  the  danger  of  tearing  the  dura  mater  in  attempting 
to  remove  large  sequestra  before  they  were  thoroughly 
loosened. 

Prof.  Urban  Pritchard  supported  the  views  ex* 
pressed  by  Mr.  Cheatle*  and  suggested  the  use  of  a  t  per 
cent,  solution  of  nitric  acid— as  practised  by  himself 
tor  many  years — for  the  decalcification  of  sequestra. 

Dr.  Dundas  Grant  also  discussed  the  difficulty  of 
exploring  supposed  fistuJae  in  the  labyrinthine  walls 
without  producing  the  very  disease  whose  existence 
was  feared,  The  diagnosis  of  latent  labyrinthitis  was 
extremely  difficult. 

Mr.  Faggk  thought  the  posterior  limb  of  the  external 
semicircular  canal  was  the  best  route  for  exploration 
of  the  labyrinth. 

Mr.  Lake  referred  to  the  frequent  causation  of  deaf- 
mutism  by  necrosis  ot  the  labyrinth,  especially  in 
scarlet  fever, 


342    The  Medical  Press. 


SPECIAL   ARTICLES. 


March  30,  1904. 


The  President  spoke  of  the  intimate  relations  of 
the  cerebellar  fossa  and  the  labyrinth,  and  the  conse- 
quent frequency  of  intracranial  lesions  in  labyrinthine 
suppurations.  He  also  referred  to  the  fallacies  of 
Weber's  test  for  nerve  deafness,  instancing  a  case  in 
which  the  sound  of  the  tuning-fork  was  referred  ex- 
clusively to  the  affected  ear,  although  it  was  proved 
by  the  autopsy  that  the  labyrinth  had  been  destroyed. 

Dr.  Milligan  replied. 

Dr.  Dundas  Grant  reported  a  case  of  thrombo- 
phlebitis of  the  sigmoid  sinus  in  which  recovery  took 
place  alter  removal  of  the  suppurating  clot  from  the 
sinus  and  without  ligation  of  the  internal  jugular  vein. 

Mr.  Lake  showed  four  patients,  with  drawings  of 
the  membrana  tympani.  One  case  had  herpetic 
vesicles  on  the  lip,  concha,  and  membrane.  The 
other  three  had  aural  pain  and  papules  on  the  mem- 
brane, which  were  "  nearly  allied  to,  if  not  actually, 
herpes." 

Dr.  Potter  showed  a  patient  with  signs  of  hereditary 
syphilis,  in  whom  appreciable  improvement  of  hearing 
had  occurred,  apparently  as  the  result  of  treatment  by 
pilocarpine  injections  (subcutaneous).      '"'.., 

Mr.  Cheatle,  Prof.  Pritchard,  antf  Dr.  Horne 
thought  pilocarpine  was  of  less  value  than  repeated 
blistering  behind  the  ear. 

Dr.  McBride  considered  pilocarpine  to  be  by  far  the 
best  remedy  yet  introduced  for  labyrinthine  deafness. 

Mr.  Lake  was  of  the  same  opinion. 

Dr.  Dundas  Grant  thought  it  was  of  value  in  cases 
where  there  was  increased  vascularity  of  the  labyrinth 
and  tympanum,  but  strongly  contra-indicated  in 
anaemia  of  the  labyrinth. 

Mr.  Hugh  E.  Jones  exhibited  a  specimen  of  abnor- 
mally small  antrum,  and  another  in  which  the  antrum 
was  replaced  by  diploe. 

Dr.  Pegler  exhibited  a  sclerosed  temporal  bone  in 
which  no  antrum  could  be  found. 

These  specimens  were  shown  in  response  to  Dr. 
Tilley's  suggestion  at  the  last  meeting  that  the  antrum 
might  be  absent  in  rare  cases.  Dr.  Tilley  now  ex- 
hibited a  bone  with  a  very  small  antrum. 

Mr.  Cheatle  exhibited  temporal  bones  showing  some 
fallacies  of  Macewen's  triangle  as  a  guide  to  the  antrum. 

Dr.  John  Horne  :  Preparations  illustrating  the 
surgical  and  morbid  anatomy  of  labyrinthine  suppura- 
tion. 

It  was  announced  that  the  next  summer  provincial 
meeting  of  the  Society  would  be  held  at  Glasgow. 

Special  articles. 

ALGIERS  AS  A  WINTER  RESORT. 


[from  our  special  correspondent.] 


Since  penning  my  first  letter  (a)  I  have  had  an 
opportunity  of  ascertaining  for  myself  what  the 
climate  is  like,  and  if  this  communication  has  been 
delayed  it  is  largely  due  to  the  fact  that  I  was  awaiting 
a  time  when  I  could  conscientiously  speak  in  praise  of 
it.  That  occasion,  however,  did  not  present  itself  un- 
til about  a  few  weeks  since,  and  so  I  held  my  hand. 
The  early  part  of  November  was  warm  and  bright, 
and  Mustapha  Superieur  seemed  a  paradise  after 
autumnal  London.  Towards  the  end  of  the  month, 
however,  it  began  to  rain,  not  the  gentle  rain  from 
Heaven  that  falls  upon  the  place  beneath,  but  water- 
spouts ;  two  or  three  inches  of  rain  fell  in  the  twenty- 
four  hours,  and  this  continued  off  and  on  for  quite  six 
weeks.  At  times,  in  fact  on  most  days,  we  had  two 
or  three  hours  sunshine,  and  then  down  came  the  rain 
again.  Even  when  it  rained  it  was  bright,  but  the 
rare  visitors  were  loud  in  their  lamentations  over  what 
they  regarded  as  a  breach  of  contract.  At  first  they 
were  pacified  with  the  assurance  that  it  would  not 
last  more  than  a  week  or  two;  then  the  hotel  pro- 
prietors fell  back  on  the  assertion  that  such  weather 
was  phenomenal,  unheard  of,  un-Algerian,  quite  an 
infamously  record  year.     By-and-by,  even  the  natives 


(•)  Vid*  Tn  Mboical  Pans  ajtd  Oibculab,  December  Sard,  WOS. 


failed  to  excuse,  still  less  to  justify,  the  climatic 
vicissitudes.  Discontented  visitors  scraped  the  mud 
off  their  boots  on  the  hotel  steps  and  betook  them- 
selves to  Biskra,  Tunis,  and  Hammam  R'Irha,  hoping 
for  better  things ;  but  the  weather  was  that  of  the 
whole  Mediterranean  basin,  and  was  not  to  be  evaded. 
Anything  more  dreary  than  to  be  cooped  up  in  a 
palatial  hotel  with  a  fiftieth  part  of  the  usual  comple- 
ment of  visitors,  at  such  a  place  as  Biskra,  with  dripping 
shivering  Arabs  and  washed-out  palm  trees  for  spec- 
tacle, it  would  be  difficult  to  imagine.  And  it  was 
cold,  i.e.,  the  maximum  temperature  did  not  rise 
above  65 °,  while  the  minimum  fell  to  450  or  there- 
abouts. When  the  thermometer  marks  less  than 
6o°  F.  here,  people  shiver,  complain  of  the  cold,  and 
don  winter  clothing. 

About  the  middle  of  January  matters  began  to 
mend,  and  with  the  advent  of  February  the  sun  re- 
sumed its  sway,  the  roads  dried  up,  wayside  vegetation 
began  to  thrive,  and  oranges  became  a  drug  in  the 
market.  Now  one  lives  with  the  windows  wide  open, 
and  heavy  garments  are  oppressive — nay,  the  straw 
hat  is  beginning  to  come  into  fashion.  The  barometer 
traces  a  monotonous  straight  line,  and  we  are  in  for  a 
prolonged  spell  of  fine  weather.  This  is  the  Algerian 
climate  as  it  is  described  and  as  visitors  expect  it,  and 
when  one  gets  it  life  is  shorn  of  its  gloom. 

I  have  collected  the  meteorological  reports  through- 
out the  winter,  and  certain  facts  stand  out  prominently. 
Apart  from  the  prevalence  of  heavy  rains,  which  have 
been  as  phenomenally  in  excess  here  as  they  were  last 
year  in  Europe  generally,  the  winter  is  surprisingly 
mild.  Never  the  slightest  trace  of  snow,  except  on  the 
distant  Atlas  mountains ;  never,  indeed,  did  the 
thermometer  get  within  ten  degrees  of  freezing  point 
at  night,  while  during  the  daytime  it  was  almost  always 
comfortably  warm.  The  humidity  of  the  air  renders 
it  desirable  to  have  fires,  which,  however,  are  not  a 
necessity  for  persons  of  active  habits,  in  the  daytime, 
although  for  invalids  they  are,  of  course,  indispensable. 
There  is  also  a  noteworthy  absence  of  marked  oscilla- 
tions of  temperature,  the  greatest  variations  not  ex- 
ceeding ten  degrees  in  the  twenty-four  hours.  During 
the  month  of  January,  for  instance,  the  average  maxi- 
mum was  590,  and  the  minimum  49*8°,  being  19*3° 
above  the  maximum  for  Paris,  and  6*6°  above  that  of 
Nice.  No  leaden  skies ;  even  at  the  worst  of  our 
pluvious  misery  on  only  three  occasions  was  the  day 
really  dark  and  dreary  ;  indeed,  for  persons  strong  and 
energetic  enough  to  go  out  clad  for  the  fray  the  rain 
offers  little  impediment  to  exercise  in  the  open  air. 

The  rain  does  not  always  fall  in  December,  some- 
times that  month  is  delightful ;  but  the  rain  has  to 
fall  at  one  time  or  another,  so  if  it  be  not  in  December 
it  must  be  later.  Considering  that  they  get  practically 
no  rain  for  eight  months,  we  must  not  grudge  the  in- 
habitants their  few  weeks  steady  pour,  though  it 
would  admittedly  be  an  advantage  if  one  could  know 
exactly  when  it  was  coming. 

But  how  for  the  invalid  ?  Well,  it  is  much  to  have 
a  climate  with  limited  thermometric  oscillations,  where 
the  air  is  pure,  and  never,  even  in  the  depth  of  winter, 
decidedly  cold  ;  where  it  is  very  exceptional  not  to 
see  the  sun  for  at  least  two  or  three  hours  during  the 
day ;  one,  too,  in  which,  when  the  sun  does  come  out, 
we  are  transported  in  a  few  minutes  into  scenes  so 
bright,  so  cheerful,  of  such  tremulous  beauty  as  to  be 
almost  fairylike.  At  the  worst  the  rainy  season  is 
measured  by  weeks,  and.  outside  that,  life  here  is 
perfection,  or  will  be  so  soon  as  they  have  discovered 
a  means  of  preventing  the  dust  which  has  developed 
into  a  nuisance  since  the  advent  of  automobilism. 

Such  as  it  is,  the  climate  seems  well  suited  for 
persons  with  "  weak  lungs,"  especially  those  who  are 
strong  enough  to  enjoy  life  in  the  open  air;  for  the 
subjects  of  chronic  bronchitis  who.  in  England,  would 
be  compelled  to  remain  indoors  for  months  together, 
and  also  for  cardiac  patients  whether  suffering  from 
the  effects  of  valvular  disease  or  from  cardiac  neurosis. 
It  is  doubtful  whether,  the  more  advanced  lung  cases 
derive  any  benefit  beyond  that  to  be  obtained  from 


If  ARCH    JO,    1904. 


GERMANY, 


Tax  Medical  Press.      343 


the  vivifying  influence  of  direct  sunlight  and  cheerful 
■*urrGundrag3,  The  climate  is  said  to  be  stimulating* 
but  what  most  people  notice  is  that  one  requires  more 
rhan  north  of  the  Mediterranean,  This  tendency 
to  sleep  is  in  a  sense  recuperative,  and  persons  of  irri- 
table nervous  constitution  derive  benefit  from  this 
quasi-enforced  repose. 

Then,  too,  those  the  subjects  of  chronic  renal  disease, 
w&O  require  warmth  and  equality  of  temperature,  do 
very  well  in  Algiers.  High  up  the  slopes  in  Hnstapha 
■  ieur  and  in  the  neighbourhood  of  El  Biar.  the 
very  bracing,  and  visitors  who  prefer  the  warmth 
of  the  less  elevated  parts  to  live  in  can  drive  or  walk 
there,  when  climatic  conditions  are  favourable,  re- 
turning at  least  an  hour  before  sunset. 

In  my  next  letter  I  shall  deal  with  the  local  circum- 
.stances  as  they  affect  those  who  come  to  spend  the 
whole  winter  here  as  distinguished  from  those  who 
only  propose  to  spend  a  few  weeks. 


Jfrance. 


poia 
coca 
cavi 
casi 
with 


[FROM    OUfc   OWN    CORRESPONDENT.] 

Paris,  March  !6tfi,  1901, 
Treatment  or  Cold  Abscess, 
Prof.  Lannelongue,  an  authority  on  tuberculous 
■  iLieases.  says  that  cold  abscesses  are  in  reality  tuber- 
culomes  of  which  the  centre  is  softened,  liquefied,  and 
the  walls  constituted  by  an  active  membrane  contain- 
ing tuberculous  nodules  of  increasing  proliferation, 
These  cold  accesses  are  aseptic,  the  bacilli  of  Koch 
are  alone  the  cause  No  matter  what  their  origin — 
sealed  in  the  ganglions,  articulations,  or  the  bones — 
cold  abscesses  give  rise  to  more  or  less  pronounced 
general  phenomena.  Locally,  fistula  are  formed 
rapidly.  Profuse  suppuration  follows  amyloid  de- 
generation of  the  viscera >  frequently  ending  in  fatal 
complications, 

The  treatment  of  such  abscesses  should  be  at  first 
addressed  to  the  general  condition  of  the  patient  \ 
cod -liver  oil,  strengthening  food,  sea  air.  Locally  , 
the  best  treatment  is  tapping  followed  by  a  modifying 
injection.  Large  incisions  should  be  proscribed  ; 
they  do  not  suppress  the  walls  of  the  abscess  and 
frequently  expose  to  secondary  infection.  Modifying 
injections,  on  the  contrary,  have  for  aim  the  destruction 
of  the  bacilli  of  Koch,  and  above  all  to  determine  in 
the  walls  of  the  cavity  a  fibrous  reaction  necessary  to 
every  tuberculous  lesion.  These  injections  are  anti- 
septic and  sci  fro  gene.  Different  liquids  have  been 
employed  ;  tincture  of  iodine,  chloride  of  zinc,  chloride 
■t  Mlver,  camphorated  naphthol,  and  iodoform  in 
ether,     The  most  used  are  the  last  two. 

The  tapping  is  practised  with  an  ordinary  trocar, 
fhe  largest  of  Potain's  aspirators,  The  parts  should 
be  carefully  washed  with  soap  and  water,  and  finally 
with  alcohol,  white  particular  attention  must  be 
paid  to  the  hands  of  the  operator,  to  render  them 
absolutely  aseptic.  According  to  Kinisson,  this 
operation  requires  as  much  preliminary  precaution  as 
laparotomy.  The  point  at  which  the  trocar  is  to  be 
inserted  is  of  considerable  importance  ,  it  should  be 
select ed  a  little  beyond  the  limits  of  the  abscess,  so 
that  before  penetrating  into  the  cavity  the  instrument 
should  pass  through  a  section  of  healthy  tissue.  This 
point  should  be  situated  at  the  highest  part  oi  the 
abscess,  and  not  in  the  lowest  as  in  ordinary  inflam- 
matory suppurations.  These  precautions  are  necessary* 
to  avoid  secondary  fistulae.  After  anaesthetising  the 
point  chosen  with  chloride  of  methyl  or  a  solution  of 
cocaine  (woo),  the  trocar  is  inserted  slowly  until  the 
G&vity  is  reached,  when  it  is  withdrawn,  leaving  the 
cannula  *m  ttt*.  The  liquid  flows  out  generally 
without    difficulty  ;    however,   it    sometimes    happens 


that  none  appears — in  such  case  the  tube  has  got 
blocked  up  by  fungosities.  These  can  be  easily 
removed  by  passing  down  a  blunt  stile  tte, 

The  amount  of  liquid  to  be  injected  varies  with  its 
nature.  If  camphorated  naphthol  be  used,  it  must  be 
remembered  that  it  is  not  an  inoffensive  substance, 
and  that  it  provokes  sometimes  very  serious  if  not 
mortal  iccideilta  ;  the  dose  should  not  exceed  half  a 
drachnt.  If  iodoform  Is  ether  be  employed,  one 
drachm  may  lie  injected,  but  unless  care  be  taken,  it 
determines  violent  pains  and  sphacelus  of  the  skin  by 
exaggerated  distension  of  the  cavity, 

To  obviate  these  accidents,  the  cannula  should  be 
left  a  few  minutes  in  Tttu  ;  the  ether  vapours  escape 
and  the  powdered  iodoform  alone  remains  in  the  cavity- 
A  small  piece  of  sterilised  gauze  held  in  position  with 
collodion  terminates  the  operation. 

Psoriasis  of  the  Scalp. 
The  following  will  be  found  useful  in  the  treatment 
of  this,  at  times,  intractable  disease  :  — 

Pyrogallic  acid  w  gr.  x\  , 

Salicylic  acid  ..  ..  . .     gr.  xv, 

Resorcin  ■  , .     gr,  xy. 

Chrysophanic  acid gr.  vj , 

Ichthvol  Sf;xv* 

Oil  of  Cade 5jiv. 

Lanoline  ,.  .♦         ■«  , .     5  iv. 


©ermang* 


[FROM     OUR     OWN     CORRESPONDENT] 


*J 


ttcMiltf.  March  BStti,  1WM. 

At  the  Hufetand  Society  Hr,  A,  Fraenkel  gave  some 
demonstrations  of 

C  A  SES  OFTUB  ERCU  LOS  IS , 

In  a^previous  address  he  had  divided  pulmonary 
tuberculosis  into  three  groups,  (i)  The  circumscribed. 
This  was  the  best-known  form,  and  it  showed  itself 
after  haemoptysis.  Shortly  after  a  catarrh  of  the 
apex  could  be  determined.  There  was  generally  fever, 
that  passed  ofi  after  a  time,  but  a  demonstrable 
catarrh  of  the  apex  remained.  (2)  and  (3)  The  diffuse 
and  the  disseminated  forms.  The  hist  was  represented 
by  tuberculous  pneumonia.  The  most  characteristic 
clinical  feature  was  that  m  a  patient  who  had  pre- 
viously had  manifest  symptoms  of  a  variously  ex* 
tended  tuberculosis,  a  lobar  dulness  developed,  as 
la  pneumonia,  with  rusty  sputum,  but  resolution  did 
not  take  place,  and  when  it  did,  in  the  great  majority 
of  cases,  it  took  place  en  Moc-  In  the  disseminated 
furm  there  were  various  disseminated  patches,  with 
portions  of  lung  containing  air  lying  IB  between.  In 
tliis  three  subsidiary  forms  were  to  be  distinguished— 
the  hirmoptoic,  in  which  numberless  patches  were 
met  with  of  a  reddish-brown  colour,  and,  later,  casea- 
tions, the  peribronchitis  with  numberless  patches,  which 
closed  up  the  smaller  bronchi;  and  the  ulcerating 
form,  which,  in  a  narrower  sense,  had  been  called 
galloping  consumption.  This  was  characterised  by 
rapid  melting  away  of  the  lung  tissues,  dependant  on 
mixed  infection.  We  observed  this  form  principally 
when,  in  a  case  of  tuberculosis,  a  sudden  extension  of 
the  disease  took  place  under  the  influence  of  an  acute 
infective  disease,  or  when  diabetes  was  present  or  in 
childbed.  During  the  past  few  months  the  question, 
How  did  human  tuberculosis  arise  ?  had  moved  the 
medical  world,  v,  Behring  was  of  opinion  that  it  spread 
to  the  lungs  from  the  intestines  along  the  lymphatics. 
The  notion  was  not  new.  It  had  been  generally 
assumed  |rhat  the  virus  first  entered  the  bronchial 
glands  through  the  airfpassages,  and  from  there  in- 
fected  the  lungs,  either  by   the  blood  or  the  lymph 


344    The  Medical  Press. 


AUSTRIA. 


tract.  v<  Behringhad  shown  that  up  to  the  present 
there  was  not  a  single  proof  that  tuberculosis  of  the 
adult  was  an  inhalation  tuberculosis  ;  we  saw  the 
patient  first,  however,  after  he  had  passed  through 
a  latent  stage.  A  greater  part  of  mankind  had  small 
tuberculous  patches  in  the  lungs  without  being  can- 
didates for  tuberculosis.  An  acute  tuberculosis  could, 
therefore,  come  through  a  haemorrhage.  By  this  the 
bacilli  slipped  into  the  alveoli.  The  circumscribed 
tuberculosis  proceeded  from  the  bronchi  (Virchow). 
It  might  be  lighted  up  by  childbed.  It  might  be 
observed  that  the  immediate  factor  must  be  sought  in 
the  preceding  struggle  during  the  labour.  The 
speaker  showed  a  preparation  from  a  woman,  aet.  30, 
who  was  healthy  at  the  time  of  her  confinement.  She 
came  into  hospital  with  copious  foetid  expectoration 
and  quintities  of -bacilli  that  lay  together  in  thick 
heaps.  No  constant  dulnesses  could  be  made  out, 
so  that  it  was  clear  that  there  were  no  cavities  that 
were  at  times  emptied  of  their  contents.  This  assump- 
tion was  found  at  the  necropsy  to  be  correct.  The 
patient  shown,  a  young  man,  presented  the  rare  com- 
bination of  a  pulmonary  arteriosclerosis  with  tuber- 
culosis, to  which  Tranbri  had  drawn  attention. 

At  the  Medical  Society  Hr.  Oppenheim  showed  a 
case  of 

Congenital  Myatony. 
The  patient,  a  child*  aet.  19  months,  was  of  healthy 
parentage,  and  had  come  into  the  world  in  a  normal 
manner.  Soon  after  its  birth,  it  was  remarked  that 
it  could  not  move  its  extremities.  It  was  not  until 
t  was  nine  months  old  that  it  began  to  move  its 
arms  a  little,  and  it  only  began  to  move  its  legs  & 
few  weeks  ago.  Its  development  otherwise  was  normal. 
The  volume  of  the  muscles  was  not  reduced,  the  bones 
were,  however,  diminished,  and  the  tendon  reflexes 
were  absent.  The  leg  muscles  did  not  react  to  any 
stimulus,  either  mechanical  or  electrical.  Sensi- 
bility was  normal. 

The  speaker  had  observed  Ave  cases  of  the  like 
affection,  which,  however,  differ  in  the  extent  of  the 
disease  ;  in  no  case  was  the  region  of  the  central  nerves 
implicated.  It  was  typical  that  the  muscles  were  not 
atrophied.  It  was  distinguished  from  poliomyelitis 
by  being  congenital ;  the  kiad  of  paralysis  was  also 
different.  There  might  be  an  incomplete  develop- 
ment of  the  muscular  system,  or  possibly  an  atrophy 
of  the  anterior  horn  of  the  spinal  cord. 

Austria, 


[from  our  own  correspondent.] 

VmnrA,  Mwch  ttth,  1004. 
Facial  Paralysis  and  Otitis. 

At  the  Gesellschaft  der  Aerzte,  Alexander  de- 
monstrated the  case  of  a  patient  who  had  suffered 
from  facial  paralysis  for  five  years  after  a  running  from 
the  left  ear.  The  diagnosis  was  an  embolic  condition 
of  the  trunk  of  the  vessel  supplying  the  hypoglossals. 
For  this  an  operation  was  undertaken  and  the  embolus 
removed,  which  had  the  effect  of  relieving  in  a  great 
measure  the  paralysis  of  the  tongue  and  associated 
atrophy,  but  the  facial  paralysis  still  persisted  and  is 
none  the  better  for  the  operation. 

Gastric  Volvulus. 

Pendl  next  showed  a  case  of  volvulus  of  the  stomach 
to  the  members  of  the  institution,  which  he  said  was 
the  second  on  record.  The  patient  was  a  male,  aet.  62, 
who  experienced  a  severe  pain  one  night  in  the  left 
side  of  the  body  when  turning  over  in  bed,  associated 
with  vomiting  and  retching.  After  his  arrival  at . 
hospital  a  large  swelling  about  the  size  of  a  man's  fist 


March  30,  1904* 


and  tympanitis  were  easily  discovered  on  the  left  side 
of  the  abdomen.  The  patient  seemed  to  be  collapsed, 
having  no  eructations  or  flatus.  It  was  immediately 
resolved  to  perform  laparotomy,  and  after  opening  the 
abdomen  the  stomach  was  found  blown  up  with  gas 
which  could  not  escape  owing  to  the  organ  having 
been  turned  on  its  axis  between  the  cardia  and  pylorus, 
thus  preventing  escape  either  upwards  or  downwards. 
After  puncture,  the  organ  was  reversed  and  placed  in 
its  normal  position. 

The  cause  of  this  accident  Pendl  attributed  to  a 
slight  form  of  gastroptosy  associated  with  a  long, 
transverse  mesocolon,  which  would  be  hastened  by  the 
sudden  movement  of  the  body,  causing  the  organ  to 
revolve,  throwing  it  under  the  diaphragm,  where  it 
seems  to  have  become  fixed. 

Hernia  Epigastrica  Libera. 

Weinlechner  exhibited  a  patient  on  whom  he  had 
performed  the  radical  operation  for  hernia  epigastrica 
libera,  with  the  best  results.     He  had  operated  on  the 
same  subject  for  varicocele  seventeen  years  ago. 
Rontgen  Ray  Table. 

Some  difficulty  has  been  experienced  by  surgeons  in 
operating  under  the  Rdntgen  rays  owing  to  the  position 
of  the  light  and  limitation  of  space,  particularly  in 
those  foreign  bodies  that  move  about  among  the 
tissues  when  they  begin  to  follow  them  with  the  knife. 
Grunfeld  showed  a  table  so  arranged  for  operation  that 
any  part  of  the  body  can  be  illuminated  by  the  rays 
for  the  surgeon  to  cut  down  on  at  once. 

Gersuny  thought  the  best  method  for  operating  on 
these  bodies  by  any  light  was  first  to  take  a  hypo- 
dermic syringe  of  methylene  blue,  and  with  the  assist- 
ance of  the  Rdntgen  rays  drive  the  needle  into  the 
foreign  body,  where  a  little  of  the  fluid  may  be  left, 
and  when  gradually  withdrawing  the  needle  allow  a 
small  portion  to  escape  along  the  line  of  the  needle 
insertion.  This  line  will  guide  the  operator  with  day- 
light to  cut  down  exactly  on  the  foreign  body  and 
have  it  remove^  at  once. 
Tuberculosis   in  the  Diaphysis  of  Long  Bones. 

In  the  so-called  primary  form  of  tubercle  in  the 
diaphysis  three  groups  may  be  easily  separated — (1) 
The  progressive  cheesy  infiltration ;  (2)  the  cheesy 
infiltration  with  the  formation  of  sequestra ;  and  (3) 
the  granulating  centre. 

These  three  forms  are  not  always  rays  of  separation 
as  one  is  apt  to  run  into  the  other  without  any  dis- 
tinguishing barrier.  The  first  must  be  distinguished 
from  periosteal  hyperostosis  and  extreme  eccentric 
atrophy  of  the  affected  diaphysis,  where  the  osteophytal 
covering  rapidly  dies,  leaving  the  bone  with  a  normal 
appearance  without  any  sequestra.  In  this  case  the 
new  formation  of  bone  is  destroyed  internally,  thus 
increasing  the  bony  cavity. 

The  second  passes  on  to  a  cheesy  infiltration  of  the 
marrow  tissue  of  the  bone,  although  a  sort  of  mixed 
progression  is  often  observed  where  an  outer  and  inner 
hyperostosis  exists  with  necrosis  and  final  separation 
of  sequestra.  These  morbid  changes  are  sometimes  so 
far  advanced  that  no  evidence  of  pus  or  fistula  is  pre- 
sent to  establish  the  true  state  of  affairs.  The  seques- 
tra in  this  stage  differ  from  those  of  purulent  osteo- 
myelitis, in  so  much  as  they  are  not  only  sclerotic  in 
character,  but  that  they  contain  tubercle  in  addition. 

The  third  form  has  a  similar  cheesy  infiltration 
without  the  tendency  to  solution,  although  no  power 
to  form  large  sequestra.  Here,  also,  we  have  internal 
and  external  hyperostosis,  which,  in  common  with  the 
second  group,  differs  from  purulent  osteo-myelitis  by 
the  areal  extent  and  intensity  of  the  disease. 

The  cause  usually  contributing  to  this  diaphyseal 


March  30,  1904, 


OPERATING   THEATRES. 


The  Medical  Press. 


345 


Jub  is  the  rapid  increase  10  the  length  of  bone,  winch 
shuuld  always  be  marked  as  a  phenomenon  of  the 
UN  which  occurs  mostly  in  child  re  fi,  or  when  the 
bones  are  extending.  Any  destruction  in  the  soft 
times  does  not  provoke  the  disease  until  it  becomes 
protracted  and  capsuled,  when  transmission  to  a  joint 
may  become  possible. 

ihis  disease  has  the  ad  vantage  over  many  others  that 
it  can  be  early  diagnosed  by  means  of  the  Rontgen  rays. 

Treatment  should  be  operative  when  the  centre  is 
solitary ,  but  when  it  becomes  multiple  judgment  is 
required  to  secure  success.  In  many  cases  of  multiple 
centres  it  often  arises  for  consideration  whether  an 
important  joint  should  not  be  operated  on,  although 
it  may  be  impossible  to  attack  all  the  other  centres 
ihat  have  presented  themselves.  The  method  pursued 
by  Mosetig  of  using  iodoform  plugging  is  recommended. 

Phtbisiogenesls  and  Anti-Tubercle. 
Behring  has  contributed  a  very  interesting  and  im- 
portant article  on  the  genesis  and  suppression  of  tuber- 
culosis, Disposition  is  necessary  for  infantile  infec- 
tion, which  is  probably  imported  by  air,  as  anti- 
tuberculin  is  found  in  milk  as  a  soluble  colloid  incor- 
porated in  the  protoplasmic  element,  which  is  derived 
from  the  endothelium  of  the  secreting  gland.  This 
an ti- tuberculin  is  destroyed  by  boiling  milk  and  con- 
served by  one  in  1 0,000  of  formalin.  This  dictum 
revolutionise®  the  whole  of  our  elaborate  sterilising 
and  disinfecting  of  milk. 


Ubc  Operating  Gbeatres. 

GUTS  HOSPITAL. 
Operation  for  Obstructive  Jaundice  in  the 
Last  Stage,— Mr.  R,  Clement  Lucas  operated,  as  a 
last  chance,  on  a  patient  whose  complexion  was  deep 
olive  green  from  obstructive  jaundice,  and  who  had 
been  condemned  with  good  reason  as  dying  from 
cancer  of  the  head  of  pancreas  and  secondary  deposits. 
Her  symptoms  commenced  four  months  before,  after 
exposure  to  cold  when  driving  in  an  open  wagonette. 
In  the  evening  she  felt  cold  round  the  waist  and  unwell. 
She  then  began  to  sufler  from  severe  indigestion, 
vomiting  all  her  food,  and  was  reduced  to  taking 
msed  milk  and  beef-tea,  A  week  or  two  alter  her 
drive  she  became  deeply  jaundiced  and  about  the  same 
time  a  swelling  was  noticed  in  the  abdomen  near  the 
umbilicus,  which  gradually  increased  in  sire.  She  has 
had  no  great  pain,  but  since  the  swelling  appear* 
experiences  a  sense  of  weight  in  the  abdomen  when 
fitting  erect.  The  swelling,  which  is  movable,  is  some- 
what tender  when  handled,  and  for  four  month 
has  had  to  take  medicine  every  night  to  keep  her 
bowels  open.  She  has  lost  a  great  deal  of  flesh,  and 
her  vomit  is  dark  green.  She  has  never  passed  blood 
in  her  motions ,  and  has  never  had  any  attack  of  colic. 
She  had  had  the  best  advice  in  the  country  town  where 
she  resided,  and  as  it  was  decided  there  that  no  opera, 
turn  would  be  likely  to  give  relief,  her  husband  re- 
quested that  she  might  be  placed  under  Mr.  Lucas' 
D  (iuy's  Hospital.  She  was  intensely  jaundiced 
and  very  feeble  on  admission,  and  there  were  ani 
oi  dark  brown  spots  under  the  skin  of  the  abdomen. 
The  swelling  opposite  the  umbilicus  was  very  hard  and 
about  the  size  of  a  Urge  orange,  but  movable  on  the 
deeper  part*.  It  had  been  thought  to  be  a  secondary 
Git  in  the  omentum,  Mr.  Lucas  determined  to 
>rc  m  the  region  of  the  gall-bladder,  and  made  an 
incision  four  inches  in  length  over  the  right  linea  semi- 
lunaris, which  was  cut  through  and  the  peritoneum 
opened*     A    littla    omentum    protruded,    which    was 


pushed  back  and  the  liver  exposecl  Ft  was  extremely 
nodular  and  irregular  on  the  surface,  with  yellowish 
masses  showing  through  the  liver-coloured  tissues,  and 
at  one  place  there  seemed  to  be  a  distinct  scar  ;  but 
whether  this  appearance  was  due  to  secondary  deposits, 
cirrhosis,  or  syphilis  could  not  be  determined,  Mr. 
Lucas  pointed  out,  through  the  limited  area  exposed. 
The  whole  liver  was  intensely  hard  and  irregular,  and 
below  it  a  large  cyst  was  reached  lying  over  the  kidney, 
apparently  the  much-d  is  tended  gall-bladder.  This  was 
tapped,  and  at  first  a  thin,  lightly-coloured  brown  fluid 
escaped,  which  gradually  became  darker  and  more 
viscid,  till  fifteen  ounces  were  collected.  Towards 
the  end  a  distinctly  slimy  discoloured  mucus  escaped* 
The  whole  cyst  was  then  drawn  into  the  wound,  and 
it  was  found  that  the  tumour  opposite  the  umbilicus 
had  then  disappeared*  This  swelling  had  evidently 
been  caused  by  a  pouched  end  of  the  gall-bladder, 
which,  on  the  left  side,  was  thickened,  opaque,  yellow 
in  appearance,  and  hard  ;  but  whether  due  to  growth 
Ln  the  wall  or  to  inflammatory  thickening  as  the  result 
of  ulceration  within  Mrr  Lucas  could  not  say  ;  but  he 
said  he  could  distinctly  feel  several  large  gatUs tones 
within  the  bladder.  He  would  have  liked  to  have  gone 
on  and  excised  the  gall-bladder  and  cleared  out  its  con- 
tents, but  owing  to  their  viscidity  the  tapping 
had  taken  some  time,  and,  the  patient's  con* 
ditum  becoming  critical,  the  anaesthetist  thought  she 
would  bear  no  more  on  that  day*  The  peritoneum 
was  therefore  sewn  all  round  to  a  portion  of  the  gall- 
bladder, which  was  left  exposed  for  further  operation, 
and  antiseptic  packing  was  applied  over  it.  The 
patient  was  somewhat  relieved  as  the  result  of  the 
emptying  of  the  fluid  contents  of  her  gall-bladder,  and 
two  days  later,  on  March  17th,  Mr.  Lucas  proposed  to 
operate  again  ;  but  the  patient,  who  had  suffered  a 
gpod  deal  of  discomfort  as  the  result  of  the  ether 
administered  on  the  previous  occasion,  absolutely  re* 
fused  to  take  an  anaesthetic  a  second  time.  She,  after 
some  persuasion,  consented  to  have  the  gall-bladder 
opened  under  eucaine.  The  gall-bladder  was  again 
tapped  preliminary  to  incising  it,  and  ten  ounces  of 
bile -stained  fluid  were  drawn  off.  It  was  then  opened 
with  scissors  and  the  edges  sewn  to  the  margin  of  the 
skin.  Gall-stones  immediately  made  their  appearance 
in  the  opening,  and  by  means  of  various  forceps  two 
hundred  and  seventy-eight  stones  were  removed.  Two 
of  these  were  of  large  sixe,  in  the  form  of  cubes,  measur- 
ing half  to  three-quarters  of  an  inch  in  diameter  ;  seven 
were  of  medium  size,  about  a  quarter  of  an  inch  in 
diameter,  and  the  rest  small  facetted  stones.  The 
opening  in  the  gall-bladder  was  plugged  with  gauze,  as 
it  was  doubted  whether  all  had  been  extracted,  Mr. 
Lucas  remarked  that  the  occurrence  of  so  distended  a 
gall-bladder  and  the  presence  of  so  many  stones  does 
not  exclude  the  possibility  of  the  diagnosis  of  cancer 
being  correct,  as  such  conditions  are  frequently  asso- 
ciated with  cancer,  The  patient's  condition,  he  said, 
had  improved  since  the  first  operation,  and  her  jaun* 
dice,  though  still  intense,  is  somewhat  less  marked,  so 
that  the  exploration  at  this  late  stage  has  been  justified. 
If  her  condition  would  admit  of  it  and  her  consent 
could  be  gained  to  submit  a  second  time  to  an  anaes- 
thetic, Mr,  Lucas  said  he  would  open  the  abdomen  in 
the  median  line  with  a  view  of  exploring  and.  if  possible, 
of  clearing  the  common  bile-duct. 

When  dressed  on  the  following  day  the  home 
surgeon  extracted  two  more  half-inch  cubic  stones 
that  were  presenting,  and  twenty -five  smaller  ones. 
Five  days  afterwards  the  dresser  secured  two  other 
small  stones,  making  the  total  extracted  up  to  three 
hundred  and  seven.  ^ 


346    The  Medical  Press. 


LEADING  ARTICLES. 


March  30,  1904* 


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SALUS  POPULI  SUPREMA  LEX 


WEDNESDAY,  MARCH  30,  1904. 


RADIUM  AND  CANCER. 
During  the  past  week  an  announcement,  with 
every  semblance  of  an  official  origin,  has  been 
made  to  the  effect  that  the  use  of  radium  in  the 
treatment  of  cancer  has  been  abandoned  at  the 
Brompton  Cancer  Hospital.  That  news,  whether 
true  or  fallacious,  having  been  published  in  some  of 
the  leading  London  newspapers,  has  since  gone  the 
round  of  the  provincial  press.  At  a  moment  when 
the  popular  mind  has  become  fascinated  with  the 
question  of  cancer  and  its  possible  cure,  a  bald 
and  abrupt  announcement  of  that  sort  is  liable 
to  do  a  great  deal  of  harm.  We  have  no  hesita- 
tion in  saying  that  a  communication  of  the  kind 
Should  be  made  only  through  the  medium  of  a 
scientific  medical  journal.  At  present  it  is  im- 
possible to  know  in  what  way  the  journalist  has 
pbtained  the  information  that  has  led  him  to 
proclaim  the  failure  of  the  radium  treatment  of 
cancer.  Perhaps  his  busy  pen  has  been  set 
going  on  the  strength  of  some  partially  under- 
stood statement  made  by  someone  or  other 
attached  to  the  Cancer  Hospital.  In  the  present 
stage  of  investigation  he  would  indeed  be  a  bold 
man  who  would  deliberately  say  that  radium  is 
of  no  use  in  cancer,  and,  moreover,  is  not  likely 
to  be  of  any  future  value  in  the  treatment  of 
that  baffling  and  mysterious  malady.  Rodent 
ulcer  is  a  disease  of  carcinomatous  type,  and  there 
is  no  surgical  fact  more  clearly  and  definitely 
proved  than  the  cure  of  many  cases  of  rodent  ulcer 
by  the  application  of  radium.  This  reflection 
will  at  once  occur  to  the  cautious  investigator  of 
the  phenomena  of  cancer,  and  the  cautious  man 
alone — it  may  be  added— is  likely  to  advance 
our  scientific  knowledge  in  a  highly  technical 
investigation  of  the  kind  involved.  We  decline 
to  believe,  therefore,  that  a  responsible  body  of 
surgeons,  having  a  special  knowledge  and  ex- 
perience of  cancer,  could  have  [given  utterance^to 
any  such  sweeping  rejection  of  radium,  past, 
present  or  future,  as  the  lay  journalists  would 
have  us  believe.     The  undesirability  of  the  public 


newspaper  dabbling  in  such  subjects  could  hardly 
be  more  pointedly  illustrated  than  in  the  instance 
under  discussion.  From  the  facts  of  the  case 
it  is  impossible  to  examine  the  evidence  on  which 
the  conclusion  has  been  founaeo,  for  the  simple 
reason  that  no  such  evidence  has  been  furnished. 
A  formal  article  in  a  medical  journal,  on  the  other 
hand,  would  have  dealt  with  the  matter  syste- 
matically, and  enabled  the  trained  medical  man 
either  to  detect  fallacies  of  fact  or  of  reasoning, 
or  to  confirm  the  matter  from  terms  to  conclusion. 
What  may  be  the  future  place  of  radium  in  thera- 
peutics it  is  at  present  impossible  to  say  with  any 
approach  to  reasonable  accuracy.  There  can  be 
little  doubt  that  with  this  mysterious  metal  a  new 
and  potent  remedy  has  been  put  in  the  hands  of 
medical  science.  It  may  be  that  radium  is 
merely  a  precursor  of  greater  marvels,  just  as  at 
the  present  moment  it  stands  at  the  head  of  a 
series  of  raaio-active  therapeutic  agencies  that 
started  from  the  dermatitis  due  to  the  Rdntgen- 
ray  tube  some  years  ago.  The  readers  of  a 
medical  journal  need  hardly  be  reminded  that 
a  great  deal  remains  to  be  learnt  with  regard  to 
the  clinical  uses  of  radium.  At  the  same  time 
facts  are  being  rapidly  accumulated  by  the  labours 
of  enthusiastic  workers  in  all  parts  of  the  civilised 
globe.  Time  alone  will  show  whether  the  failure 
will  be  outbalanced  by  success  or  vice  versd.  It 
is  doubtful  whether  we  have  yet  ascertained  the 
elementary  facts  as  regards  the  action  of  radium 
upon  both  sound  and  unsound  tissues,  both  of  which 
are  a  necessary  preliminary  to  an  adequate  scientific 
knowledge  of  the  subject.  At  the  same  time  it  is 
fortunately  possible  to  arrive  at  definite  thera- 
peutic conclusions  on  grounds  that  are  purely 
empirical,  although  on  a  similar  basis  it  would  be 
rash  to  advance  theories  of  negation  with  any- 
thing like  the  same  amount  of  confidence. 

WANING  BIRTH-RATES. 
It  is  customary  to  refer  to  French  birth-rates 
whenever  it  is  desired  to  give  an  object-lesson  in 
how  not  to  do  certain  things,  but  in  point  of 
fact  the  waning  fertility  of  the  French  nation  is 
only  one  example  of  an  inhibitory  influence  which 
is  common  to  all  races  under  certain  social  con- 
ditions. Precisely  the  same  phenomenon,  in  an 
even  more  aggravated  form,  is  witnessed  in  respect 
of  the  white  population  of  the  United  States— 
that  is  to  say,  of  individuals  who  really  form  part 
thereof  in  the  sense  of  having  been  born  under  the 
flag.  Even  more  remarkable,  from  many  points 
of  view,  is  the  fact  that  the  same  waning  fertility 
is  the  subject  of  anxious  comment  in  Australia, 
where  fertile  marriages  are  becoming  rarer,  and 
the  birth-rate  of  fertile  marriages  much  reduced. 
As  in  the  United  States,  the  fertility  of  Australian 
born  women  is  markedly  less  than  that  of  women 
emigrants.  Looking  at  these  facts  in  the  aggregate 
it  is  obvious  that  the  diminution  of  the  various 
birth-rates  is  not  due  to  any  physical  deterioration 
on  the  part  of  the  populations,  but  rather  to 
certain  social  conditions,  foremost  among  which 
is   a   comparatively   high   standard   of   physical 


March  jo.  1904. 


LEADING   ARTICLES. 


The  Medical  Pexss.     347 


probably  a  mere  bogey,  since  Nature  seems  to 
have  provided  an  automatic  check  on  over- 
population which  we  can  see  in  operation  on  every 
hand.  The  lesson  to  be  learned  is  that  a  reduction 
of  fertility  is  not  per  se  a  sign  of  actual  physical 
degeneracy,  nor  even  of  national  decrepitude,  but 
it  is  an  indication  that  a  period  has  been  reached 
in  the  history  of  a  race  which  corresponds  to 
obesity  in  the  individual,  and  this,  as  we  know,  is 


SCARLET 


well  -being.  Physiologists  teach  us  that  the 
fertility  of  the  individual  increases  in  proportion 
to  the  abundance  of  nourishment,  and  sociologists 
have  familiarised  us  with  the  theory  of  "  limits  of 
subsistence,"  Doubtless  these  arguments  arc 
physiologically  true,  but  here,  however,  we  have  to 
deal  with  another  set  of  influences,  social  and 
ethicaL  In  support  of  the  view  that  the  change 
is  due  to  social  and  not  to  physiological  influences 

may  be  instanced  the  observation  that  where  the  !  a  sign  of  slowed  nutrition, 
marriage  birth-rate  is  lowest,  the  illegitimate 
birth-rate  is  highest.  One  explanation  of  the 
stationary  birth-rate  in  France  is  suggested  in  the  | 
artificial  difficulties  placed  in  the  way  of  marriage 
by  the  ineligibility  of  undowered  women  and 
exaggerated  administrative  hindrances  to  lawful 
union.  These  considerations  do  not,  however, 
apply  either  to  the  United  States  or  to  Australia, 
since  in  both  these  countries  the  pre-marital 
normalities  are  simple  and  pecuniary  considerations 
are  of  quite  secondary  importance.  The  whole 
explanation,  indeed,  must  be  sought  in  the  social 
rather  than  in  the  physiological  domain.  Given 
a  high  standard  of  living,  the  units  of  which  the 
population  is  composed  are  indisposed  to  assume 
responsibilities  entailing  a  redistribution  of  the 
means  to  that  comfort,  and  deliberately  curtail 
their  reproductive  ability,  The  Statct  which  is 
primarily  interested  in  securing  a  progressively 
increasing  population,  does  nothing  to  bring  that 
about.  From  the  tax  and  ratepaying  point  of 
view  the  parents  of  large  families  are  treated  on 
exactly  the  same  footing  as  the  unmarried  and 
infertile,  the  service  they  have  rendered  to  the 
State  being  ignored.  A  small  concession  to  the 
perception  of  this  crying  injustice  has  been 
made  in  France,  where  the  parents  of  six  children 
and  upwards  are  exempted  from  certain  payments 
to  the  State,  but  nothing  of  the  kind  has  been 
attempted  elsewhere.  Yet  a  man  who,  by  the 
sweat  of  his  brow,  rears  six  or  more  children  to 
maturity,  and  provides  them  with  an  education 
suited  to  their  social  position,  has  in  reality  done 
far  more  for  the  State  than  his  fellows  who  have 
been  enabled  to  lead  a  life  of  potential  self -indul- 
gence by  limiting  their  expenses  to  themselves. 
When  a  once  prolific  nation  becomes  wealthy* 
the  one  idea  is  to  restrict  its  enjoyment  of  that 
wealth  to  the  minimum  number  of   citizens,  and 

the  production  of  citizens  in  embryo  is  curtailed. 
This  may  be  in  virtue  of  a  natural  law  whereby 
the  weak  producing  powers  of    nations  are  kept 

within    comparatively    narrow    limits,    and    if    so 

it  is  useless  to  repine.     Education  is  certainly  no 

remedy  for  such  a  state  of  things  -t  on  the  contrary, 

the  most  highly-educated  classes  of  the  community 

are  the  least    fertile,  education,  indeed,  being  one 

item  in  the  high  standard  of  comfort  which  we 

have  referred  to  as  the  real  cause  of  this  voluntary 

infertility.     The  tendency  is  the  same  everywhere, 

everywhere   the   marriage  age   tends   to   increase, 

and    the    proportion    of    children    per    marriage 

diminishes,  it  is  everywhere  only  a  question  of 

degree— and  of  time.  The  Nemesis  of  over- 
population,   the   spectre    evoked   by    Mai  thus,    is 


ISOLATfON 


FEVER      AND 
HOSPITALS. 

Considering  the  great  importance  of  scarlet 
fever  from  the  point  of  view  of  public  health, 
it  is  hardly  to  be  wondered  at  that  the  proper 
public  policy  in  regard  to  it  is  a  matter  of  prime 
interest.  For  many  years  it  has  been  the  custom 
to  isolate,  or  segregate,  those  who  are  suffering 
from  any  infectious  disease,  and  by  preventing 
communication  with  others,  to  attempt  to  "  stamp 
out ' '  the  disease.  In  the  case  of  many  diseases — 
leprosy,  small-pox,  typhus  fever — there  is  little 
doubt  that  this  plan,  in  conjunction,  of  course, 
with  other  methods,  has  been  successful.  With 
the  modern  interest  in  public  health,  isolation 
as  a  public  policy  has  practically  become  uni- 
versal. Fever  hospitals  have  been  put  up  bv 
the  local  health  authorities  all  over  the  country, 
the  main  purpose  being  not  to  cure  the  individual 
sufferer,  but  to  prevent  the  spread  of  infection. 
The  diseases  which,  for  the  most  part,  have  filled 
these  hospitals  are  scarlatina,  typhoid,  diphtheria, 
and  measles,  As  regards  typhoid  and  diphtheria, 
it  is  obvious  that  the  spread  of  infection  is  not 
the  only  advantage  aimed  at  ;  it  is  but  rarely 
that  in  a  working  man's  family  the  requisite 
nursing  and  medical  attention  can  be  given  to  a 
serious  case  of  either  of  these  diseases.  With 
them,  then,  the  benefits  of  hospital  treatment  are 
so  great  that,  apart  altogether  from  considera- 
tions of  public  safety,  they  will  J  continue  to 
be  treated  in  hospitals  rather  than  in  private 
houses.  As  regards  scarlatina,  however,  no 
such  argument  holds.  There  is  but  little  diffi- 
culty in  treating  a  case  of  scarlatina  in  any  house 
where  a  sick  person  can  have  a  room  to  himself, 
and,  consequently,  if  it  can  be  shown  that  there 
is  no  danger  to  public  health  in  so  treating  scarla- 
tina patients,  there  will  be  little  excuse  for  further 
expense  in  the  maintenance  of  public  institutions 
for  them*  The  economic  importance  of  this  con* 
tention,  if  proved ,  is  very  great,  for  at  the  lowest 
computation  the  expenditure  on  the  isolation  of 
scarlet  fever  is  at  least  equal  to  the  expenditure 
on  isolation  of  all  other  diseases  taken  together. 
There  neea  hardly  be  any  question  that  the 
isolation  policy  in  regard  to  scarlet  fever  has 
not  been  attended  with  the  success  attached 
to  it  with  other  diseases.  Though  it  is  difficult 
to  obtain  suitable  statistics  for  argument,  there 
is  little  reason  to  believe  that  the  disease  is  diminish- 
ing in  numbers  ;  and,  in  the  opinion  of  those 
who  have  most  experience,  it  is  certainly  not  dim- 
inishing in  virulence.     Indeed,  some  good  observers 


348    Thb  Mkdical  Press.      NOTES   ON    CURRENT    TOPICS. 


March  30,  1904. 


believe  that  serious  complications,  such  as  otitis 
and  rhinitis,  are  more  commonly  met  with  in 
hospital  than  in  private  practice.  Many  figures, 
fallacious  or  pertinent,  have  recently  been  put 
forward  to  show  that  the  towns  where  scarlet 
fever  has  not  been  isolated  are  in  no  worse  case  as 
regards  incidence  of  the  disease  than  those  where 
isolation  has  been  most  rigorous,  and  some  well- 
known  sanitarians,  such  as  Dr.  Millard,  of 
Leicester,  and  Dr.  Fraser,  of  Portsmouth, 
have  put  forward  the  view  that  hospital  treatment 
of  scarlet  fever  has  proved  a  failure.  It  is  main- 
tained by  them  that  infection  is  spread  quite  as 
much  if  the  cases  are  treated  in  hospital  as 
out  of  it,  while  the  type  of  the  disease  is  usually 
worst  in  hospital.  In  such  circumstances  they 
think  it  unjustifiable  to  continue  spending  large 
sums  of  public  money  in  keeping  up  a  useless  sys- 
tem. We  hardly  think  their  case  is  proved.  If 
hospital  treatment  is  unsuccessful  it  is  a  failure 
in  practice,  and  not  an  error  in  theory.  And 
being  so,  it  can  be  amended.  In  some  cases 
the  construction  of  the  building  is  bad,  in  many 
there  is  a  culpable  overcrowding;  and  the  whole 
question  of  disinfection  of  clothes  is  still  in  an  un- 
settled condition.  In  many  institutions  it  has 
been  found  that  the  exit  of  a  patient  with  nasal 
or  aural  discharge  is  followed  immediately  by  a 
crop  of  "  return  cases,"  yet  it  is  often  the  custom 
to  permit  patients  to  leave  as  soon  as  peeling  is 
finished,  quite  regardless  of  the  presence  of  an 
infectious  discharge.  But  there  still  exists  much 
difference  of  opinion  among  medical  officers  of 
health  on  the  whole  subject ;  many  of  them  have 
given  it  most  careful  consideration,  and  still  hold 
firmly  to  the  principle  of  isolation.  We  believe 
with  Dr.  Millard,  however,  that  a  searching 
inquiry  into  the  whole  system  is  advisable,  but 
such  inquiry  must  be  undertaken  with  perfectly 
open  mind,  and  without  predisposition  in  favour 
of  one  conclusion  rather  than  another. 


notes  on  Current  Ztopics. 

Medicine  in  the  Seventeenth  Century. 

The  present  can  be  understood  only  by  a  careful 
study  of  the  past ;  and  those  who  would  see  the 
pathway  into  the  future  must  not  disregard  the 
footmarks  in  the  road  which  has  been  trodden. 
There  is  much  of  arrogance  and  pride  in  the  spirit 
of  to-day  which  a  proper  consideration  of  history 
would  go  far  to  reduce  to  proper  dimensions  of 
humility,  and  with  a  due  infusion  of  reference, 
knowledge  might  grow  and  ignorance  and  quackery 
be  confounded.  The  self-opinionated  and  mentally 
inflated  in  medical  circles  would  do  wisely  te 
turn  to  the  attractive  study  of  physic  in  thle 
seventeenth  century;  as  portrayed  by  the  latie 
Sir  Walter  Besant  in  the  recently,  .published 
41  London  in  the  Time  of  the  Stuarts."  Thje 
Cockney  of  these  bygone  days  had  as  many 
nostrums  and  infallible  medicines  as  his  successor 
of  the  present  day.  .When  the  Queen  was  &\  ip 
1663,  they  shaved  her  head  and  applied  pigeons 
to  her  feet.    A  dentist  had  his:  regular  round,  and, 


carrying  his  dentist's  "  key  "  and  decorated  with 
drawn  dental  structures,  bawled  his  calling  in  the 
streets.  Salt  or  chloride  of  gold  was  taken  by 
noble  ladies.  Pearls  were  supposed  to  have 
mystic  virtues.  Coral  was  a  fashionable  remedy. 
Complexion-washes  for  ladies  and  fops,  love- 
philtres  for  the  melancholy,  and  anodynes  for 
the  aged  were  commonly  dispensed  in  every 
apothecary's  establishment.  "  Tumours  "  then, 
as  now,  were  pathological  puzzles,  but  supposed 
to  be  curable  by  stroking  with  the  hand  of  a 
dead  man.  Everyone  in  those  days  believed  in 
astrology.  "  Texts  of  Scripture,  mystic  letters, 
cabalistic  rings,  and  other  devices  were  commonly 
worn  even  by  the  most  intelligent."  Advance 
has  undoubtedly  been  made  since  the  days  of 
the  Stuarts,  and  yet  it  is  well  for  the  modern 
physician  to  remember  that  still  to  the  majority  of 
people  there  is  much  of  mystery  surrounding 
medical  procedure,  and  no  little  amount  of  super- 
stition prevailing,  even  in  so-called  cultivated 
society.  It  is  only  necessary  to  scratch  the  surface 
of  the  diseased  divine,  or  uncover  the  cuticle  of 
the  ailing  lawyer,  and  beneath  will  be  found  the 
lingering  liking  for  the  quack  and  the  doubting 
faith  which  is  oftentimes  only  too  willing  to  adopt 
the  practice  of  the  occult  and  uncanny.  The 
twentieth  century  is  not  far  distant  from  the 
seventeenth  in  matters  medical. 


The  Sanatorium  Report. 

It  is  to  be  regretted,  although  perhaps  not  alto- 
gether surprising  to  find,  that  the  optimistic 
predictions  of  the  advocates  of  sanatorium  treat- 
ment for  tuberculosis  should  be  beginning  to  be 
followed  by  disappointment  to  many,  now  that 
the  system  is  in  full  swing.  To  hear  much  of  the 
talk  that  was  freely  vented  three  or  four  years 
ago,  one  would  have  thought  that  a  millennium 
was  about  to  dawn  for  the  poor  consumptive, 
and  yet  no  discovery  had  been  made  that  would 
have  warranted  any  statement  of  the  kind. 
The  most  that  can  be  said  was,  that  after  many 
years  of  stifling  the  patient  in  a  confined  atmos- 
phere, the  profession  as  a  body  awoke  to  the  fact 
that  it  was  far  better  for  him  to  enjoy  the  natural 
conditions  provided  for  mankind  by  Nature  than 
to  impose  artificial  ones  on  him.  Fresh  air, 
sunlight,  and  plenty  of  food  have  always  been 
good  for  man,  and  he  will  always  be  better  with 
them  than  without  them— even  if  he  is  a  con- 
sumptive. From  the  application  of  that  f act- 
already  well  recognised  by  many  physicians— 
by  the  profession  generally  to  the  holding  out  of 
hopes  of  cure  to  all  ana  sundry  was  a  far  cry,  and 
an  unjustifiable  one.  Consumptives  got  well  and 
dieo  long  beiore  sanatoria  were  thought  of,  and 
they  will  continue  to  do  so  iong  after  sanatoria 
have  found  their  way  into  the  limbo  of  obsolete 
appliances— a  formidable  list— for  the  cure  of 
consumption.  Our  sanitarians  seem  to  be  what 
Ixird  Rosebery  calls  "  whole-hoggers  "  ;  in  order 
£0  induce  people  to  take  up  a  reform  the  most 
lurid  attractions  must 'T>e  '  held  out.  The  Leeds 
Association  for.  the  'Prevention  and  Cure  of  Con- 


March  30,  1904. 


NOTES    ON    CURRENT    TOPICS,      The  Mxdicax  piUL    349 


sumption  have  lately  ^issued  ]their  annual  1  report 
since  the  opening  of  their  sanatorium  at  Gateforth. 
In  this  they  admit  that  though  in  incipient  cases 
hope  may  be  held  out.  in  advanced  cases  temporary 
nnprovement  only  can  be  looked  for,  and  in  active 
lebrile  cases  sanatorium  treatment  does  no  good, 
In  their  experience,  loo,  relapses  frequently  occur, 
<md  leave  the  patient  much  as  he  was  before, 
and  these  relapses  are  particularly  frequent  in  the 
class  for  which  they  cater.  They  fall  back  on  the 
old  argument  of  *'  educating "  the  patient  as 
evidence  of  the  good  they  may  unconsciously  be 
doing,  but  they  admit  that  the  diminishing 
tuberculosis  mortality  in  Leeds  may  not  be  at  tri- 
ple directly  to  the  sanatorium.  In  order  that 
advanced  cases  among  the  poor  may  not  be  left 
at  home  to  infect  others,  they  have  taken  a  house 
where  they  can  be  placed.  Finally,  they  appeal 
for  further  subscriptions.  The  Leeds  Association, 
although  disappointed,  seem  to  feel  themselves 
entitled  to  say,  with  Lord  Campbell,  militmn  non 
sine  gloria,  but  they  certainly  are  not  dazzled  with 
the  brilliancy  of  their  achievements  up  to  the 
present. 


A  Medical  Provost  of  Trinity  College, 
Dublin. 

The  vacancy   which   has  existed   for    the   past 
two  months  in  the  Provost  ship  of  Trinity  College, 
Dnblin,   has    been    filled    by    the    nomination    of 
Dr.  Anthony  Traill,  Senior  Fellow  of  the  College. 
We  ihink  this  is  the  first  time  that  this  important 
educational  post  has  been  filled  by  a  medical  man, 
it  any  rate,  during    the  past  century   there  has 
been  no  such  incumbent  ;  nor  since  the  death  of 
the  famous   Holy    Hutchinson    has   there  be^n  a 
lav  provost.      The  association  of  the  office  with 
science  has,  however,  been  very  close,  for  we  find 
that  out  of  the  eight  provosts  who    held    office 
during  the  nineteenth  century,  no  less  than  four 
had,  like  Dr.  Traill   himself,   occupied   the  Chair 
i Jural   Philosophy.     Dr.  Traill  obtained    his 
Fellowship    in     1865,    and    immediately    devoted 
himself  to  the  study  of  medicine,  taking  his  doc- 
torate   in    1870.     He  never  practised,  and    some 
years  later  he  studied  engineering,  while  he  had 
previously   gone    through    the    Law   School.     His 
contributions   to    the   literature   of  science   have 
been    many,  and   he  is  eminently  a  man  of 
affairs    rather     than     a    scholar.     His     business 
"  ity  is  great,  and  his  reputation  as  a  financier 
&  high.     In  public  affairs  in  Ireland  he  has  taken 
a  prominent  part  as  an  Ulster  landlord  ;  and  so 
strenuously  aid   he  oppose   the  scheme  put   for- 
ward last  year  by  Mr,  Wyndham  for  the  settlement 
"I  the  University  question,  that  his  appointment 
as  Provost   is   taken   to  signify   the  entire  with- 
drawal of  that  scheme  by  the  Government.    Since 
the  death  of  the  late  Dr.  Houghton,  Dr.  Traill  has 
been  chairman  of  the  Medical  School  Committee, 
and  he  has  been  energetic  in  helping  progress  in 
that  department  of  the  University.     It  is  hoped 
that  with   the  increased  influence  he  obtains  as 
Pmvost  that  he  will  be  able  to  further  still  more 
I  he  interests  of  science. 


Death  in  Suicidal  Hanging. 

It  is  not  so  long  since  it  was  taught  that  the 
cause  of  death  in  all  cases  of  hanging  was  asphyxia, 
due  to  constriction  of  the  larynx  or  trachea. 
Several  well-observed  cases  have,  however,  shown 
during  recent  years  that  this  doctrine  requires 
considerable  modification.  We  do  not  make 
reference  here,  of  course,  to  the  cause  of  death  in 
judicial  hanging,  which  under  the  u  drop  " 
system,  now  for  many  years  in  use,  is  fracture  of 
the  vertebral  column,  but  simply  to  the  causes 
operating  in  suicidal  hanging,  in  one  case  rc^ 
cently  reported  on  the  Continent  the  absence  of 
the  effect  of  any  laryngeal  obstruction  was  made 
quite  clear,  as  the  victim  was  at  the  moment  of 
suicide  wearing  a  tracheotomy  tube,  and  death 
was  apparently  due  to  constriction  of  the  great 
vessels  of  the  neck.  In  three  instances  recently 
occurring  in  India  (a)  death  did  not  take  place 
till  after  intervals  varying  from  twenty-four 
hours  to  nine  days.  In  two  of  these  cases, 
pulmonary  and  cerebral  congestion  were  noticed, 
but  there  were  no  distinct  lesions  found  sufficient 
to  cause  death.  One  can  only  suppose  that 
although  obstruction  to  breathing  was  not  im- 
mediately fatal,  yet  depressing  effects  of  a  serious 
nature  were  produced  on  the  nervous  and  mus- 
cular systems  by  the  circulation  of  venous  blood. 
In  the  third  case  the  immediate  cause  of  death 
was  cerebral  meningitis,  which  was  probably 
originated  by  the  venous  stasis  at  the  time  ot 
hanging,  nine  days  earlier.  In  all  the  cases 
unconsciousness  seems  to  have  taken  place  at  the 
moment  of  suspension,  and  respiration  ceased 
before  the  heart -beat. 


The  Effects  of  Typhoid  Fever  upon  the 
Heart. 

Among  the  numerous  complications  of  the  acute 
specific  fevers  the  cardiac  are,  perhaps,  the  most 
to  be  feared.  The  poison  of  certain  of  the  exan- 
themata, notably  of  rheumatic  and  scarlet  fever, 
seems  to  fasten  upon  the  heart  in  a  large  pro- 
portion of  cases  with  a  fatal  persistence  inspiteof 
prolonged  rest  in  bed  and  medicinal  treatment. 
If  actual  structural  changes  are  not  produced, 
there  is  always  a  risk  of  a  sudden  heart  failure, 
this  being  particularly  liable  to  occur,  sometimes 
without  any  previous  warning,  in  diphtheria. 
Quite  early  in  the  course  of  an  attack  of  enteric 
fever  the  physician  will  be  on  the  look-out  for 
signs  of  cardiac  failure,  as  evidenced  by  a  greatly 
enfeebled  or  almost  inaudible  first  sound,  a  prompt 
exhibition  of  cardiac  stimulants  being  then  in- 
dicated, especially  if  the  pulse  be  at  the  same  time 
markedly  dicrotic.  The  rarity  of  endocarditis 
in  such  cases  is  generally  recognised,  neither  is  it 
usually  considered  common  to  meet  with  cardiac 
lesions  later,  or  after  convalescence  has  been  well 
established.  In  order  to  ascertain  if  such  effects 
upon  the  heart  frequently  occur  as  a  sequela  to 
enteric,  Dr.  W,  S.  Thayer,  (b)  of  the  Johns  Hop- 
kins University,  has  examined  183  patients  who 
had    been   previously    admitted    to    the    hospital 

(a)  India*  Me4  Gm&,  ifecembrr,  1908, 
(fr)  Ahw\  Mm,  Xcdt  3&.>  SWh,  100*, 


35°    The  Medical  Press. 


NOTES  ON  CURRENT  TOPICS. 


March  30,  1904. 


suffering  from  typhoid  fever  during  the  last  thir- 
teen years.  The  results  of  his  examinations  go  to 
show  that  the  disease  leaves  its  mark  upon  the 
heart  with  greater  frequency  than  is  generally 
supposed.  Thus,  the  average  blood  pressure  was 
higher  than  that  observed  in  normal  individuals 
of  the  same  age  under  the  same  conditions,  and 
that  the  radial  arteries  were  palpable  with  greater 
ease.  A  considerable  number  also  presented  some 
evidence  of  cardiac  hypertrophy.  In  eight  cases, 
where  on  the  patient's  discharge  from  the  hospital 
the  heart  was  judged  to  be  normal,  the  after- 
examination  revealed  mitral  regurgitation  and 
cardiac  hypertrophy.  Those  cases  in  which  a 
systolic  murmur  was  heard  during  the  attack, 
showed  afterwards  an  increase  of  general  blood- 
pressure  and  of  the  size  of  the  heart.  Typhoid 
fever  would  therefore  appear  to  play  by  no  means 
an  unimportant  part  in  the  development  of 
cardiac  lesions,  endocarditic  or  otherwise. 


A  Surgical  Competition. 

Men  have  vied  with  each  other  in  every  form 
of  contest — from  duelling  with  pistols  to  seeing 
who  could  eat  the  most  biscuits  in  an  hour — 
since  the  world  began,  but  although  every  medical 
man  is  striving  to  show  his  worth  by  doing  his 
best  for  his  patients,  it  surely  is  an  unprecedented 
occurrence  for  two  surgeons  to  engage  in  an  open 
competition  to    decide  whose  method  and  skill 
is  the  superior.    This,  however,  is  what  is  an- 
nounced to  take  place  at  Jefferson  Medical  College 
on   June   6th,    the   contending   gladiators   being 
Dr.  Adolf  Lorenz  and  Dr.  Albert  Hoffa.  Many  of 
our  readers  will  remember  the  name  of  the  former, 
who  attracted  some  little  attention  a  few  months 
ago  by  giving  demonstrations  of  his  "  bloodless 
surgery,"  and  who  was  reported  to  have  received 
some   very    large   fees  for  his   wonderful   cures. 
Dr.  Hoffa,  who  does  not  appear  to  be  advocating 
any  particular  method,  is   to  demonstrate   that 
he  can  do  better  than  Dr.  Lorenz,  and  he  is  pro- 
posing to  start  on  some  of  the  patients  whom 
Dr.   Lorenz   failed    to   rehabilitate   by   bloodless 
surgery.     Of  course,  the  American  reporter  is  all 
agog  for  the  "copy"  which  he  expects  the  contest 
will  furnish,   and  which  one  may  be  sure  he  will 
supply  whether  the  contest  furnishes  it  or  not. 
At  present  one  has  to  rest  content  with  the  as- 
surance that  the  Titanic  combat  will  take  place 
before   the  eyes  of   the  world's  representatives, 
for  he  is  already  announcing  the  names  of  pro- 
minent orthopaedic  surgeons  who  are  to  foregather 
for  the  purpose.     A  little  healthy  rivalry  is  all 
very  well  in  every  profession,  but  it  will  be  a  bad 
day  for  the  respect  in  which  medical  mea  are 
held  when  we  have  open  competitions  as  to  who 
can  amputate  a  leg  with  the  greatest  celerity, 
or  handicaps,  at  weight  for  age,  for  the  extraction 
of  cataracts.     In   this   country  one   may  safely 
postpone    the    possibility    of    such    occurrences 
beyond  our  own  lifetime  and  that  of  our  children's 
children,  whilst  as  for  America,  the  country  of 
"  etwas  neues,"  its  inhabitants  can  be  trusted  to 
look  after  themselves. 


Motorpatbia  Cerebralis. 

This  affection  is  not  to  be  found  in  the  official 
nomenclature  of  diseases  issued  by  the  College 
of  Physicians,  and  yet  there  are  a  good  many 
patients  who  have  suffered  from  it  during  the 
last  few  years.  Every  innovation  that  appears 
in  our  midst  brings  its  own  drawbacks  with  it, 
and  since  motoring  came  into  fashion  a  number 
of  its  devotees  have  found  out  that  even  the 
joy  of  spinning  through  the  air  at  twenty  or 
thirty  miles  an  hour  has  to  be  paid  for  in  some  shape 
or  form.  The  yachtsman  suffers  from  mal-de-mer, 
the  mountaineer  from  mal-de-montagne,  and 
automobilists  from  motorpathia  cerebralis.  The 
vibration  of  the  car,  especially  at  high  rates  of 
speed,  produces  in  some  the  same  temporary 
disorganisation  of  function  in  the  semicircular 
canals,  and  their  nervous  supplies,  that  the  motion 
of  the  ship  does  in  the  sea-sick  passenger,  and 
nausea,  giddiness,  and  headache  are  the  result 
of  a  fast  journey  over  a  rough  road.  Fortunately, 
the  art  of  the  car-builder  is  able  to  reduce  this 
disadvantage  to  a  great  extent  by  providing  large 
and  powerful  springs,  but  some  people,  especially 
ladies,  suffer  considerably  from  the  jolting  and 
swinging  of  the  car.  The  frequent  use  of  the 
car  in  every-day  practice  in  a  district  in  which  the 
roads  are  bad  seems  to  tend  to  upset  the  normal 
equilibrium  of  the  nervous  system,  and  unsteadi- 
ness of  gait  and  shakiness  of  the  hand  result.  In 
fact,  one  sees  similar  effects  produced  on  some 
CDnstitutions  to  those  manifested  by  men  whose 
occupation  leads  them  to  pass  much  of  their  time 
in  trains,  a  general  unrestfulness  that  must  lead 
to  serious  nervous  trouble  in  time.  Horse-exeicisc 
does  not  tend  to  set  up  these  disturbances,  and  the 
motion  conveyed  to  the  rider  is  well  known  to 
act  beneficially  on  the  torpid  viscera.  "  The 
best  place  for  the  inside  of  a  man  is  the  outside 
of  a  horse,"  Lord  Palmerston  used  to  say,  and  it 
is  certainly  a  better  place  than  the  inside  of  a 
rapidly-driven  motor-car. 

Professor  Marmorek'e  Serum. 

In  his  paper  read  at  St.  George's  Hospital  on 
the  23rd  inst.,  Professor  Mannorek  described  his 
serum,  and  detailed  the  results  which,  if  supported 
by  further  investigations,  must  largely  affect 
the  future  curative  treatment  of  tuberculous 
disease.  He  dealt  with  those  cases  in  which  the 
natural  individual  resistance  towards  tuberculosis 
was  either  imperfect  or  absent.  He  was  convinced 
that  tubercle  was  not  the  primary  cause  of  the 
pathogenic  symptoms  of  tuberculosis,  but  that 
it  was  merely  a  reactive  which  caused  the  bacilli 
to  secrete  another  and  hitherto  unknown  toxin, 
the  toxin,  in  short,  by  which  the  bacilli  attacked 
and  undermined  the  organism.  The  therapeutic 
use  of  this  reactive  serum  was  an  attempt  to  pro- 
duce an  active  immunisation,  but  it  commonly  failed 
to  be  of  use  because  the  reaction  was  so  great 
that  there  was  no  time  for  the  formation  of  anti- 
toxins. It  was  therefore  passive  immunisation 
which  must  be  sought,  and  his  aim  had  been  the 
production  of  a  serum  in  which  ready-made  anti- 


M * hCH  30,   1004. 


NOTES    ON    CURRENT    TOPICS. 


The  Medical  Piess,     j 5 x 


toxins   already  existed.     Having  discovered    this 
serum  and  aso  ih^f  even  in  large  doses  it 

did  no  harm  to  healthy  animals,  and  that  it  cured 
diseased  ones,  he  had  put  himself  into  a  position 
:n  in-  it  on  the  human  subject.  In  practice  it 
found  that  a  few  patients  could  not  support 
the  serum.  As  a  general  proposition,  however, 
Professor  Marmorek  claimed  that  in  the  great 
majority  of  persons  the  serum  not  only  produced 
ao  unpleasant  effects,  but  proved  a  distinctly 
curative  agent,  the  prompt  effect  and  efficacy  of 
which  varied  directly  with  the  acuteness  of  the 
disease  and  the  earliness  of  the  attack. 


An  Anti-vivieectionist  Town  Council 
If  there  be  one  scientific  dogma  clearly  estab- 
lished beyond  reach  of  dispute  it  is  that  hydro- 
phobia can  be  banished  from  a  country  by  the 
strict  supervision  of  stray  dogs  and  the  universal 
muzzling  for  a  certain  period  of  those  that  are 
provided  with  homes.  By  some  strange  freak 
in  the  legislative  mind,  Parliament  has  de ter- 
minal that  owners  of  cattle  and  other  domestic 
animals  worried  by  dogs  shall  receive  compensa- 
tion, whereas  the  human  individual  injured  by 
a  dog  shall  not  be  entitled  to  receive  damages 
unless  the  injured  party  can  prove  the  dog  has 
iously  biiten  someone  else.  However,  the 
ue  against  stray  dogs  has  resulted  in  prac- 
tically removing  a  great  danger  from  our  midst. 
During  the  past  few  years  it  has  succeeded  in 
destroying  an  enormous  aggregate  of  dogs  in 
the  United  Kingdom.  In  Manchester  alone  over 
4,000  stray  dogs  were  captured  last  year.  Of 
that  number  3,000  were  killed,  and  1,000  pro- 
vided with  new  masters.  All  purchasers  of  these 
dogs  were  required  to  sign  a  declaration  stating 
(Or  what  purpose  the  dog  was  required,  and  that 
mid  not  be  used  for  physiological,  patho- 
logical and  toxicological  experiments.  We  arc 
thus  furnished  with  the  strange  spectacle  of  a 
town  that,  on  the  one  hand,  is  pushing  on  schemes 
of  University  education  with  might  and  main, 
while  on  the  other  it  is  doing  its  best  to  check 
the  progress  of  precise  scientific  research  upon 
Subject*  that  cannot  fail  to  yield  rich  results  to 
the  bodily  comfort,  safety  and  preservation  of  its 
■  ns.      It  is  the  old  conflict  between  sentiment 

and  reason,  

The  '  Medical  Register  "  for  1904, 
The  annual  appearance  of  our  old  friend,  the 
Medical  Register,  reminds  us  at  times  somewhat 
nharpty  of  the  rapid  lapse  of  the  years  of  our 
professional  lifetime.  The  first  volume  appeared t 
we  believe,  in  1859,  the  year  after  the  founda- 
tion of  the  General  Medical  Council  by  the 
Medical  Act  of  1^58.  That  measure  con- 
tained the  fatal  defect  of  not  rendering  regis- 
tratiun  of  legally  qualified  medical  men  com- 
pulsory. It  is  likely  that  few  practitioners 
e  the  amount  of  legislation  that  has  taken 
plate  in  medical  matters  since  1858.  For  all 
that,  the  necessity  for  drastic  reforms  in  the 
Medical  Act  was  probably  never  more  generally 
recognised   than    at,  the   present    moment  in   the 


interests  of  the  public,  not  less  than  of  the  medical 
profession,  Those  who  wish  to  be  enlightened 
on  many  facts  affecting  the  inner  life  and  history 
of  the  medical  profession  will  find  a  mine  of  useful 
and  accurate  information  in  I  he  pages  of  the 
Register.  To  take  one  point,  let  the  reader  care- 
fully peruse  the  long  list  of  registrable  degrees 
and  diplomas  in  the  United  Kingdom,  and  he 
will  grasp  the  groundwork  of  the  pros  and  cons  of 
the  famous  one-portal  system  advocated  by 
many  strenuous  reformers  in  face  of  a  multitude 
of  conflicting  interests.  The  total  number  of 
persons  on  the  Register  for  1904  in  England  (in- 
cluding Wales\  Scotland,  and  Ireland  was  37,878. 
The  moderate  price  of  the  Register  brings  it  within 
the  reach  of  every  purse. 


The  London  and  Counties  Medical 
Protection  Society. 

The  annual  general  meeting  of  this  most  ex- 
cellent Institution  took  place  on  the  nth  inst., 
under  the  presidency  of  Mr.  Jonathan  Hutchinson. 
The  total  membership  at  the  end  of  the  year 
under  report  (1903)  was  2,682,  with  the  addition  of 
470  new  members,  and  the  loss  of  fifteen  by  death 
and  eighty- two  by  resignation,  The  afTairs  of 
the  Society  are  in  a  flourishing  condition,  as  will 
be  seen  from  the  statement  that  although  the 
expenditure  of  the  Society  during  the  year  left 
the  comparatively  small  balance  of  ^I3i  is,  6d. 
over  income,  yet,  on  the  other  hand,  there  was  a 
substantial  reserve  fund  of  £2,2^2  19s,  Sd,  At 
the  present  moment  the  medical  world  is  full  of 
rumours  of  associated  and  amalgamated  defence 
movements.  Notwithstanding  the  desirability  of 
the  collective  strength,  wisdom  and  economy 
that  would  be  derived  from  amalgamation,  each 
body  concerned  appears  to  be  agreed  una  voce 
that  it  is  at  present  out  of  the  question,  In  the 
words  of  Dr<  Heron,  the  chairman  of  the  Council, 
amalgamation  with  the  Medical  Defence  Union 
is  just  as  impossible  now  as  it  was  three  years  ago, 
when  a  determined  effort  was  made  in  that  direction 
The  fact  is  none  the  less  to  be  regretted.  Mean- 
while, amalgamation  or  no  amalgamation,  it  is 
the  bounden  duty  of  every  medical  man  to  join 
one  of  the  defence  societies. 


A  New    Dietary    Disease 

Some  of  our  American  contemporaries  report 
the  occurrence  in  large  districts  of  the  Western 
States  of  an  epidemic  hitherto  unobserved,  but 
with  a  very  definite  group  of  clinical  symptoms. 
As  will  be  seen,  the  etiology  and  therapeutics  of 
the  disease  are  simple  enough,  but  the  pathology 
presents  a  wide  field  lor  investigation,  "  The 
first  deviation  from  the  normal  is  a  dilatation  of 
the  pupil,  and  a  peculiar  and  marked  effacement 
of  all  expression  from  the  countenance  of  the 
victim.*'  This  is  followed  by  M  an  erection  and 
cropping  out  of  the  ears,  and,  in  the  male  patient, 
by  a  twitching  of  the  moustache  hairs ,  while  the 
female  seems  to  be  possessed  of  an  increased 
mobility  of  the  muscles  of  the  lips,  which,  in  the 
more  advanced  stages,  leads  to  a  perpetual  labia] 


352    The  Medical  Press. 


quivering.  Finally,  a  characteristic  movement 
appears,  and  the  patient  seems  unable  to  avoid 
making  sudden  bounds  into  the  air,  which  is  par- 
ticularly marked  when  the  sufferer  is  making  un- 
usual haste.11  We  do  not  know  what  feature  in 
this  group  of  sufficiently  surprising  clinical  phe- 
nomena directed  the  attention  of  the  observers 
towards  the  food-supply  of  the  district.  It  seems, 
however,  that  the  high  price  this  year  of  beef, 
mutton,  and  "  hog-meat "  has  rendered  them 
somewhat  inaccessible  to  the  common  people, 
and  as  far  as  flesh  was  concerned,  the  sole  diet 
was  perforce  jack-rabbit.  The  symptoms  sub- 
side rapidly  on  the  substitution  of  other  foods.  Our 
imaginative  contemporary,  from  whom  we  have 
quoted,  suggests  that  the  course  of  this  curious 
"  leporism  "  is  possibly  that  the  jack-rabbit  Hves4o 
a  great  extent  on  a  diet  of  belladonna  leaves,  and 
that  those  who  use  his  meat  as  food  are  affected  by 
a  chronic  atropinism.  This  seems  to  us,  however, 
an  unnecessarily  far-fetched  explanation.  We 
think  the  phenomena  rather  explicable  on  the 
same  principles  as  the  curious  case  in  surgery  of  a 
patient  who,  at  the  hands  of  a  skilful  surgeon, 
received  a  sheep's  stomach  instead  of  his  own  ;  he 
would  eat  nothing  but  grass.  We  cannot  help 
rejoicing  that  it  is  the  flesh  of  such  an  amiable 
and  harmless  animal  as  the  jack-rabbit  that  has 
this  peculiar  power  of  conveying  its  own  proper- 
ties to  the  consumer.  If  it  had  been  beef,  for 
instance,  or,  still  worse,  bacon,  how  unpleasant 
social  life  might  have  been  rendered  in  the  Missis- 
sippi Valley! 


PERSONAL.  March  30.  i??4- 

the  wounds  treated  were  of  most  menacing 
character.  The  report  gives  also  an  interesting 
table  of  the  animals  by  which  the  bites  had  been 
inflicted.  As  one  would  expect,  dogs  are  by  far 
the  most  numerous  in  the  list,  but  we  find  other 
domestic  animals  implicated — cats,  horses,  cows, 
mules,  pigs,  sheep.  Among  wild  animals  are 
skunks,  wolves,  burros  and  coyotes.  Curiously 
enough,  no  less  than  twenty-two  patients  were 
bitten  by  human  beings,  themselves  victims  of 
hydrophobia. 


Anti-rabio  Treatment  in    Chicago. 

It  is  curious  that  it  is  in  the  case  of  a  disease 
whose  germs  are  still  unknown  that  measures  of 
artificial  immunisation  have  been  most  effective. 
The  most  notable  instances  are  small-pox  and 
hydrophobia.  In  the  case  of  the  latter  disease, 
before  Pasteur  introduced  his  method  of  treatment, 
inoculation  with  the  virus  was  almost  invariably 
fatal.  Nowadays,  unless  the  patient  neglects 
himself  for  some  time,  death  is  practically  always 
averted.  From  the  report  of  the  Pasteur  In- 
stitute at  Chicago  recently  issued,  it  appears 
that  in  the  thirteen  years  since  it  was  established; 
2,026  patients  have  received  anti-rabic  treatment. 
Nearly  half  of  these  had  been  bitten  by  animals 
proved  either  by  laboratory  experiments  or  other 
conclusive  tests  to  have  been  rabid.  Out  of  the 
total  number  but  seven  deaths  occurred,  giving  a 
mortality  of  034  per  cent.  Truly  figures  such  as 
these  show  that  this  most  dreaded  of  all  diseases 
has  been  robbed  of  its  terrors.  It  is  well  known 
that  bites  received  on  exposed  parts  are  much 
more  likely  to  cause  dangerous  results  than  those 
occurring  on  parts  covered  with  clothes,  since  in 
the  latter  case  but  little  of  the  saliva  of  the 
animal  reaches  the  wound.  Turning,  then,  to  the 
Chicago  returns  as  to  the  sites  of  the  lesions,  we 
find  that  279  had  occurred  on  the  head  and  face, 
and  1 ,008  on  the  hands  and  wrists.  The  remainder 
occurred  on  parts  probably  protected  by  clothes. 
It  will  be  seen,  then,  that  about  three-fifths  of 


The  Early    Diagnosis   of   Oirrhoeifl  of  the 
Liver. 

Many  grave  and  incurable  conditions  are 
characterised  by  their  gradual  and  insidious  onset. 
Except  in  a  few  well-defined  instances,  such  as  the 
acute  specific  fevers,  it  is  impossible  to  state  exactly 
the  time  when  a  given  disease  first  made  its  appear- 
ance. It  is  certainly  not  comforting  to  be  informed 
that  a  malady  has  been  "  in  the  system  "  for  some 
time,  weeks  or  months,  before  the  first  manifesta- 
tions of  anything  wrong.  Nevertheless,  the 
phrase  is  commonly  used  because  it  is  conceived 
to  be  an  impossibility  that  wide-spread  pathological 
changes  could  occur  in  an  organ  or  tissue  without  an 
appreciable  space  of  time  being  consumed  in  their 
production.  Hepatic  cirrhosis  is  one  of  these 
conditions.  When  fully  established,  the  clinical 
picture  is  most  definite,  the  attacks  of  haemate- 
mesis  or  melaena,  the  presence  of  dilated  venules  in 
various  parts  of  the  body,  the  jaundiced  com- 
plexion, and  the  enlarged  liver  with,  perhaps, 
associated  ascites,  leaving  no  doubt  as  to  the 
actual  state  of  the  organ.  And  yet,  all  these  morbid 
features  have  not  appeared  suddenly,  they  have 
taken  considerable  time  to  develop,  and,  in  common 
with  many  other  disorders  of  the  viscera,  it  is  felt 
that  if  only  the  condition  could  be  recognised  in 
its  early  stages  the  patient  would  stand  a  much 
better  chance  of  recovery.  The  association  of 
cirrhosis  of  the  liver  with  over-indulgence  in 
alcoholic  liquor  is  well  known,  and  this  fact,  of 
itself,  is  doubtless  responsible  for  the  masking 
of  the  earliest  symptoms  of  hepatic  disease.  Dr. 
Charles  G.  Stockton,  (a)  of  Buffalo,  New  York, 
has  endeavoured  to  ascertain  the  first  signs  of 
cirrhosis  of  the  liver,  and  he  points  out  that  it  is 
the  non-alcoholic  cases  which  should  be  the  most 
instructive.  It  is  suggested  that  many  cases  of 
"  biliousness,"  accompanied  by  pain  in  the  right 
hypochondrium  and  gastro-intestinal  disturbances 
may  constitute  the  early  stage  of  this  affection. 
The  idea  of  hepatic  incompetence  due  to  auto- 
intoxication from  the  alimentary  canal  is  put 
forward  as  a  possible  explanation  of  the  manner 
in  which  the  disease  begins. 


PERSONAL. 


The  new  Provost  of  Trinity  College,  Dublin,  holds 
the  degrees  of  M.D.,  M.Ch.,  although  he  has  never  been 
engaged  in  the  active  practice  of^the  medical  profession. 

(a)  iUrtv.  Penn.  Med,  Bull.  February  1904. 


March  jo,  1904. 


SPECIAL  CORRESPONDENCE. 


The  Medical  Press.     353 


<*At  a  meeting  of  the  Royal  College  of  Physicians  of 
London  held  <m  Monday  last,  being  the  dav  after  Palm 
Suttda)  ^;r  U  ilham  Sefby  Church,  Bart  ,  k.CR.  M.D.. 
re-elected  President  by  a  substantial  majority. 
Vote*  were  recorded  in  favour  of  Sir  William  Broadbent, 
ltd  Douglas*  Powell,  and  Dr.  Pye-Smith. 
There  was  an  unusually  large  at  tendance  ol  Fellows, 
,iud   the  election  excited  much  interest* 

Her  Majesty  the  Queen  has  presented  /100  to  the 
fund  for  the  removal  of  King's  College  Hospital  to 
yuith  London. 

Mr.  H.  T.  Hillis  has  succeeded  Mr.  H  H  Brodribb 
countant  of  the  Medical  Department  of  Western 
Vustralia.  

Among  medical  marriages  announced  for  April  we 
note  that  of  Dr.  T.  M.  Kelvnack  and  Miss  Violet 
McLaren,  MJ,  Ch.B. 

The  retirement  is  announced  ->f  Dr,  F,  F.  MacLeod, 
who  for  twenty-three  years  baa  been  connected  with  the 
Lai  Department  of  Grenada,  West  Indies. 


Dk,  George  Oliver  will  deliver  the  Gliver-Sharpey 
Lectures  on  April  12th  and  14th,  at  5  p.m.,  at  the  Royal 
College  of  Physicians  of  London,  on  "  Recent  Studies 
in  the  Tissue  Lymph  Circulation/1 

understand  that  the  War  Office  has  officially 
appointed     Lieutenant -Co  lone  I     W.     C     Ma  ep  hereon, 
i     R.A.M.C.,  to  report  upon  the  medical  arrange- 
ments of  the  Japanese  in  the  present  war. 

The  Fellowship  l Honors  Cause)  of  the  Koyal 
:.».•  of  Surgeons  of  Edinburgh  has  been  conferred 
i  J .  <  unningham,  DA  L,  I,L«D..  Professor  of 
any  tn  die  University  of  Edinburgh. 

The  director!  oi  the  Edinburgh  Royal  Infirmary 
have  elected  Dr.  F-  W.  X  Haullain  to  the  post  of 
Assistant  Gynaecologist,  vacant  through  the  death  >>f 
Dr.  Milne  Murray.  There  were  numerous  applicants 
for  the  oust  

Surgeon  -General  J.  A.  fiery,  the  Principal  Medical 

Officer  of  the  md  Army  Corps,  is  investigating    the 

outbreak  of  enteric  fever  at  Bulford  Camp,  on  Salisbury 

Plain,   assisted   by    Lieutenant -Colonel   A,   M,    Daves, 

I1C.  

Pr  Percivai.  WxtGRt  has  resigned  the  Chair  -►[ 
Botany  in  the  University  of  Dublin,  and  the  Board 
Eateikd  shortly  to  appoint  a  successor.  Dr.  Wright, 
however,  has  consented  to  continue  to  act  as  Keeper 
iMhe  Herbarium. 


Volunteer  medical  officers  may  be  reminded  that 
the  annual  dinner  of  their  Association  takes  pla^ 
Friday,  April  i;th,at  the  Imperial  Restaurant, Regent 
Street;   Ij>ndon,   under  the  Presidency  of    Lieutenant 
General  Lord  Grenfell,  G.C.B...  G.C.M.G. 

It  is  announced  that  Mr,  Gilbert  Barling,  Professor 
irgery  in  the  University  of  Birmingham,  intends 
to  offer  himself  as  a  candidate  at  the  next  election 
of  the  Council  of  the  Royal  College  of  Surgeons  til 
England,  Mr,  Barling  became  a  Member  of  the 
College  in   i8;m    and  a  Fellow  in  1881. 


Dr    R.    V*   Moffat,   who  for  some  time  past   has 

;.ied   the  position  of  Principal  Medical  Officer  of 

the  EftSl    Africa   and    I'ganda   Protectorates,   has  re- 

$i«ied  the  appointment  so  far  as  it  relates  to  the  East 

Africa  Protectorate,  and  will  retain  that  of  Principal 

oi  the  Uganda  Protectorate. 


The  medal  and  set  oi  books  forming  the  Bathgate 

rial    Prize,  presented    to  the   Royal  College  of 

burgeons  of  Edinburgh   by  Colonel  William  Lorimer 

'ate.    in    memory    of    his   late    father,    William 

MUhune    Bathgate,    F.R.t  .S.Ed,,  has  been    awarded 

I  lelen    Neklrum    McMillan,    lor    the   highest 

niarks  obtained  in  competitive  examination  in  materia 

medica  and  therapeutics. 


Special  Correspondence. 

[FROM  OI  R  OWN  CORRESPONDENTS.] 
TLAND, 

Inebriate  Retreats, -In  his  fii*i  Report  on 
Inebriate  Retreats,  In.  J,  C.  Dunlop,  Inspector  for 
Scotland  under  the  Inebriates  Acts,  draws  attention 
in  a  covering  letter  to  the  desirability  of  abolishing 
the  present  tax  on  retreats,  to  the  great  need  of 
retreats  for  the  poorer  class,  and  to  the  want  of  suffi- 
cient inebriate  reformatory  accommodation  infSootland. 
The  Legislature.  I»y  giving  power  to  local  authorities 
to  contribute  to  retreats,  evidently  anticipated  that 
these  would  be  of  two  classes,  one  for  patients  with 
means,  the  other  lor  the  poor  ;  but  so  far  none  of  the 
i  class  have  been  instituted  either  by  chanty 
or  by  Town  or  County  Councils,  Only  two  retreats 
have  been  licensed,  anil  as  these  are  under  the  same 
management  they  may  for  practical  pnrpoftee  be  con 
ftdered  as  one  institution— both  being  for  male  ine- 
briates of  the  better  cla^s.  The  licence  for  one  of 
these  has  now  lapsed  and  the  inmates  transferred  to 
the  second  —  l.athallan  House,  Fifeshire — which  has 
ample  and  good  accommodation  for  twenty- two 
inmates,     From    iqoi    to    iqoj  private  cases 

ami  twenty- two  under  the  Act  of  1H70  have  been 
treated*  ail  having  been  genuine  cases  of  habitual 
inebriety,  a>  defined  by  the  Act,  The  intoxicant  was 
not  always  alcohol.  u%  being  cases  of  morphinism,  and 
lour  ot   cocaine   habit.     A   marked   feature   in   nearly 

II  caei  1  was  i\u  neurotic  diathesis,  of  which,  ind 
inebriety  is  a  itrong  presumptive  evidence.  Toe 
amount  of  actual  lunacy  was,  however,  small.  I  In 
association  «d  the  neurotic  temperament  with  habitual 
inebriety  is  of  practical  importance  in  treatii 
wen  inebriety  a  vice  pure  and  simple  it  wOttl 
readily  amenable— much  more  so  than  is  the  case. 
The  treatment  adopted  in  the  retreats  wan  abstinence 
tram  the  drug,  a  healthy  outdoor  life,  and  symptomatic 
treatment  by  drugs — the  last  especial! v  in  cocaimsm 
and  morphinism,  The  abstention  tram  intoxicants 
Bred  by  prohibiting  patients  carrying  money,  and 
bj  avoiding  place*  where  they  can  be  pl&l  ured.  Whi)e 
supervision  is  very  strict  at  the  beginning  of  treatment 
it  is  relaxed  before  discharge,  so  as  to  accustom  the 
patient  to  liberty.  The  results  of  treatment  are 
shown  by  the  following  figures  :— Alcoholic  cases  ad- 
mitted todale,  &a;  <ii  these  17  are  still  under  treatment. 
13  have  had  no  recurrence  within  a  year  of  discharge. 
11  are  doing  well,  and  have  not  relapsed,  but  have  not 
been  away  from  retreat  for  complete  year  ;  19  have 
relapsed,  2!  have  not  been  heard  of,  and  1  is  absent 
on  leave,  of  23  alcoholic  cases  treated  for  less  than 
six  months,  8  did  well,  and  15  relapsed  ;  while  of  20 
cases  treated  for  from  six  months  to  one  year,  to  did 
well,  and  4  relapsed*  ,H  Cured  "  inebriates  are  not, 
of  course,  brought  into  the  condition  of  a  normal, 
temperate  individual,  because,  though  the  habit  miiv 
be  checked,  the  neurotic  diathesis  remains  ;  they 
cannot,  therefore,  be  trusted  to  use  stimulants  in 
moderation,  It  has  been  estimated  that  there  are 
about  2, 000  inebriates  in  Scotland  urgently  requiring 
treatment  ;  theiv  is  im  licensed  retreat  for  anyone 
who  cannot  pav  £1 50  per  annum ,  and  none  at  all  for 
iemale  inebriates.  There  are  a  considerable  number 
of  unlicensed  homes,  some  good,  some  conducted  by 
charlatans,  and  it  is  a  pity  that  well-conducted  in- 
stitutions should -not  apply  for  a  licence,  which  would 
improve  their  position  by  {1}  conferring  power  of 
detention,  (2}  making  the  approved  rules  statutory. 
(3)  guaranteeing  the  bona  fides  of  the  institution,  and 
{4)  making  the  institution  one  to  which  local  authorities 
may  subscribe  from  the  rates.  It  aleo  safeguards  the 
patient's  liberty,  and  gives  him  a  means  of  appeal, 
The  only  disadvantage  is  the  tax  of  5s.  per  inmate 
per  annum,  which  might  be  a  consideration  in  the 
case  of  institutions  dependent  on  voluntary  sub- 
scriptions, and  might  well  be  abolished* 
BELFAST, 

Koyal   Victoria   Hospital. — The  annual   meeting 


354    The  Medical  Press.     BRITISH  SANATORIA   FOR  CONSUMPTION.    March  30,  1904 


of  this  hospital  was  held  on  the  22nd  inst.,  and  was  of 
interest  as  being  the  first  meeting  since  the  opening 
of  the  new  hospital.  Though  only  open  since  last 
July,  the  reports  showed  a  marked  increase  in  the 
work  done,  but  there  are  still  ninety-six  beds  unused 
on  account  of  lack  of  funds.  An  increase  of  ^4,000 
in  the  income  will  be  necessary  to  maintain  these. 
The  Plenum  system  oi  ventilation,  to  suit  which  the 
hospital  was  designed,  was  announced  to  be  a  great 
success,  the  hospital  being  an  object-lesson  to  all 
interested  in  such  institutions. '  ■* 

Ulster  Hospital  for  Women  and  Children, 
Belfast. — The  annual  meeting  of  this  hospital  was 
held  on  the  25th  inst.,  Sir  Wm.  Whitla,  M.D.,  presiding. 
The  reports  showed  that  while  the  year  began  with  a 
debt  of  nearly  £2,000,  it  closed  with  a  credit  balance  of 
over  £500,  thanks  to  the  very  successful  bazaar  opened 
by  his  Excellency  the  Lord  Lieutenant,  last  November. 

Gift  of  Radium. — Part  of  the  sixty  milligrammes 
ot  radium  presented  to  the  Queen's  College  by  the  Lord 
Mayor  of  Belfast,  Sir  Otto  Jane,  has  just  been  received. 
It  is  to  be  placed  at  the  disposal  of  the  hospitals  for 
therapeutic  purposes  when  so  desired. 

Correspondence* 

r  We  do  not  hold  ourselves  responsible  for  the  opinion  of  the  corres- 
pondents] 

ALOPECIA  AND  DENTAL  CARIES. 
To  the  Editor  of  The  Medical  Press  and  Circuiar. 
*%Sir, — It  is  comforting  to  learn  that  the  silence  of 
"  M.R.C.S."  was  simply  due  to  holiday -making  in 
the  sunny  Mediterranean.  At  the  same  time,  a  gentle- 
man who  strikes  with  so  much  energy  might  surely 
arrange  to  have  his  letters  forwarded.  He  has  placed 
himself  in  the  situation  of  a  duellist,  who  has  to  deliver 
or  receive  a  shot  once  a  week  by  the  terms  of  his 
duel,  but  who  suddenly  fails  to  put  in  an  appearance 
for  several  weeks.    ^  ^  *     « 

Of  course  I  may  not  be — as  "  M.R.C.S."  deems — 
a  "  foeman  worthy  of  his  steel."  He,  certainly,  so 
far  has  not  thought  fit  to  meet  me  with  the  precise 
weapons  of  reason,  but  has  contented  himself  by 
general  statements  and  assertions,"  for* which  he  has 
advanced  no  proof,  and  in  answer  to  points  raised  by 
me,  accuses  me  of  gross  ignorance.  That  is  hardly  the 
way  either  to  lighten  my  darkness  or  to  settle  the  point 
at  issue.  Your  readers'  may  well  ask  to  be  reminded 
what  th&t  issue  is.  My  original  remark  was,  I  doubted 
if  so  scientific  a  man  as  Tomes  ever  stated  that  the 
hard  dental  tissues,  once  'deposited,  underwent  no 
further  change.  "  M.R.C.S."  has  never  given  his 
quotation  in  proof  of  Tomes  having! taken  up  that 
dogmatic  position,  but  has  since  abused  me  roundly 
and  raised  various  side  issues. i 

As  it  was  impossble  to  get  any  justification  of  his 
statement  from  "  M.R.C.S."  I  ventured,  not  as  a 
dental  expert,  but  as  a  medical  man  of  average  educa- 
tion, to  suggest  certain  points  in  which  it  seemed  to 
me  possible  that  change  might  occur  in  the  hard 
dental  tissues. 

Generally,  I  "pointed  out  that : — (1)  In  the  more  or 
less  analogous  instance  of  bone  it  was  not  established 
that  the  earthy  tissues  did  not  undergo  changes  (e.g., 
absorption,  hypertrophy,  repair,  etc.). 

(2)  That  both  enamel  and  dentine — not  to  mention 
crusta  petrosa — contain  a  certain  amount  of  living 
organic  material  (What  is  its  relation  to  the  earthy 
constituents  ?) 

Particularly,  I  pointed  out  of  hard  dental  tissues 
that  :—  ■«■» 

(a)  Some  teeth  are  more  prone  to  decay  and  atrophy 
than  others.  (This  variation  may  be  acquired,  and 
then  surely  points  to  inters  titial  changes.) 

(6)  That  absorption  takes  place  in  fangs  of  milk 
teeth.  (I  am  aware — pace  "  M.R.C.S."— of  the  histo- 
logical changes  that  occur  during  that  process.) 

(c)  That  repair  can  take  place  in  a  fractured  tooth. 
(This  fact  alone  I  take  to  be  conclusive  disproof  of 
the  statements  that  changes  cannot  take  place  in  hard 
dental  tissues  when  once  deposited.  The  repair  of 
dental  fracture  I  supported  by  a    quotation  from  a 


leading  dental  authority,  and  from  an  observation  of 
my  own.) 

Now  here,  sir,  are  surely  considerations  enough  to 
make  one  question  the  sweeping  assertion  of  "M.R.C.S." 
that  no  further  changes  take  place  in  the  hard  dental 
tissues  when  once  deposited.  Having  committed 
himself  to  a  universal  negative  proposition  of  that 
kind,  the  onus  of  proof  when  challenged  lies  upon 
"  M.R.C.S.,"  and  not  upon  me.  If,  as  I  take  it,  a 
fractured  tooth  is  capable  of  self -repair,  I  have  refuted 
him  by  producing  a  particular  positive  instance  which 
is  directly  contradictory  to  his  statement. 

It  is  impossible,  however,  for  me  to  teach  "  M.R.C.S." 
logic,  nor  can  I  argue  with  him  except  with  logical 
weapons.  As  he  has  expressed  himself  so  freely  with 
regard  to  my  assumed  ignorance,  I  may  perhaps  be 
excused  remarking  that  he  seems  to  be  so  stuffed  with 
dogmatic  learning  that  he  cannot  spare  the  time  for 
logical  analysis  of  his  statements.  Knowledge  comes, 
but  wisdom — scientific  wisdom — lingers.  In  other 
words,  he  cannot  see  the  wood  for  the  leaves.  Why 
so  erudite  an  opponent  should  meet  criticism  by  abuse 
worthy  of  an  oyster-wench  surpasses  the  wit  of 

Yours  truly, 

March  26th,  19x34  Medicus  Senex. 


A  DISCLAIMER. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — I  have  just  received  by  post  a  circular,  entitled 
14  Fruitless  Experiment,"  edited  by  Stephen  Smith. 
M.R.C.S.,  and  published  by  the  London  Anti- Vivi- 
section Society.  In  it  I  find  reproduced  an  article  of 
mine  on  the  treatment  of  phthisis,  published  some 
three  years  ago.  Will  you  kindly  allow  me  to  state 
that  I  know  nothing  of  Mr.  Smith,  that  I  have  had  no 
communication  with  any  anti-vivisection  society,  and 
that  the  use  of  my  name  and  work  in  this  connection 
is  entirely  unauthorised  and  is  extremely  distasteful  to 
me. 

I  am,  Sir,  yours  truly, 

William  Murrell. 

17,  Welbeck  Street,  W.,  March  26th,  1904. 

BRITISH    SANATORIA   FOR   CONSUMPTION. 


By  the  courtesy  of  Dr.  Haydn  Brown  we  are  enabled 
to  supply  illustrations  of  the  novel  convertible  chalet- 
shelter  inspected  by  our  special  commissioner  at 
Moorcote  Sanatorium,  and  referred  to  by  him  in  the 
Medical  Press  and  Circular  of  March  16th.  It 
is  an  entirely  new  departure  from  the  ordinary  chalet, 
as  the  name  implies,  and  is  a  structure  which  is  par- 
ticularly suitable  for  those  wishing  to  continue  open- 
air  treatment  in  their  own  private  grounds,  when  long 
continuance  at  a  sanatorium  is  not  convenient  or 
possible,  while  being  also  a  most  practicable,  seivice- 
able  and  cheap  form  of  building  suitable  for  erection 
in  colony  numbers,  to  meet  the  desire  of  advocates  of 
the  separate  hut  system.  It  is  a  sleeping  chalet  by 
night  and  a  shelter  by  day,  being  readily  and  almost 
entirely  automatically  convertible.  Some  of  the 
advantages  will  be  seen  from  the  following  illustrations. 


Convertible     Chalet-Shelter.     Open    duringl  daytime 

for  use  as  Shelter. 
Its  manufacturers  (Messrs.  Brown  and  Lilly,  of  Read- 
ing) claim  for  it.  having  been  instructed  by  Dr.  Hadyn 
Brown,  who  designed  it,  the  fullest  efficiency  and 
scientific  arrangement  according  to  modern  methods 
of  treatment.     Abundance  of  window  air  ^provided. 


MEDICAL  NEWS. 


March  30.  1904- 

ghta   or   discomfort.      The  windows  are 

s  to  afford  complete  protection  in  case  0\ 

ram  or  wind.     The  same  window  can  be  adapted   to 


The  Metrical  Pkess.  355 


time  a  director  of  the  local  Gas  Company,  and  inter 
ested  in  many  public  and  philanthropic  undertakings. 
His  son,  Dr.  Henry  Colgate,  is  engaged  in  practice  in 
Eastbourne.  Mr.  Colgate's  funeral  was  the  occasion 
of  a  large  private  and  official  gathering  Among  other 
tributes  a  beautiful  wreath  was  sent  by  members  of  the 
Eastbourne    Medical  with  the  inscription — 

"'  In  affectionate  remembrance;  of  our  first  President/' 


■rtible  Chalet -Shelter.  Closed  as  for  sleeping, 
window*  open,  weather  blinds  in  position.  No  raia 
,:\  enter  open  windows, 
existing  chalets  or  sanatoria.  They  open  and  close 
just  as  ordinary  casements  do,  and  the  awnings  on 
top  of  them  are  made  detachable  so  that  when  the 
windows  are  closed  for  dressing  or  undressing  they 
can  i>e  used  as  inner  blinds.  On  warm  spring  or 
summer  nights  the  chalet -she  Iter  may  remain  entirely 


HERBERT  ARTHUR  KENT,  M.R.C.S.Eng..  L.R.C.P, 
With  much  regret  we  note  the  death  of  Mr.  H.  A, 
KentT  of  RingwOOd,  Hants,  in  the  early  part  of  the 
EtfdMnt  month.  The  son  of  the  late  Rector  of  Stratford 
Tony,  Salisbury  ;  he  was  educated  at  Chelten1 
College,  and  St.  George's  Hospital,  whence  he  qualified 
in  1884.  His  death  was  due  to  malignant  disease  of  the 
tongue.  Although  Mr.  Kent  was  of  a  somewhat 
retiring  disposition,  and  kept  aloof  from  local  politics, 
his  loss  will  none  the  less  be  widely  felt  in  the  district 
in  which  he  lived  and  worked. 


Convertible    Chalet  -  Shelter,     Open,    with    curtains 

drawn  for  sleeping  on  hot  nights, 
open  while  curtains  are  provided  to  cover  the  entrance. 
The  price  of   the  complete  chalet,  with  curtain 
we  are  informed,  £27  10s.  complete.     This  form  of  hut 
may    also     be     recommended    for    colonial    use    as    a 
temporary  living  hut  for  trav. :U 


©bttuan?. 


H,  CAYLEY, 


DEPUTY-SURGEON-GENERAL 
F.K.CS.Eng. 

We  regret  to  announce  the  death  at  his  residence. 
Leavesrien.  Weybridge,  of  Beputy-Surgeon-General 
Henry  Cay  lev.  retired,  honorary  surgeon  to  the  Km£, 
m  his  seventieth  vear.  The  fourth  son  of  the  late 
Edward  Caylcy,  ot  Stamford,  Lincolnshire,  he  received 
his  professional  training  at  King's  College  Medical 
School,  and  became  a  member  of  the  Royal  College  01 
Surgeons  in  tfl$5,  receiving  the  fellowship  in  1886, 
In  the  Indian  Medical  Service  he  rendered  useful 
service  during  the  Indian  Mutiny,  and  ultimately  rose 
to  th*  position  erf  deputy-surgeon-general.  Though 
he  retired  in  1887  he  aeain  placed  his  knowledge  and 
skill  at  the  disposal  of  his  country  when  the  late  war 
broke  out,  and  served  with  the  Scoitish  National 
Hospital  in  South  Africa,  He  received  a  Companion- 
ship of  the  Order  of  St.  Michael  and  St.  George  in  190a 
and  in  the  following  year  was  appointed  honorary  sur- 
geon lo  his  Majesty- 

ROBERT  COLGATE,     F.R.CS.Eng. 
Another  aged  member  has  been  lost  to  the  medical 
raion  in  the  person  of  Robert  Colgate,  F.R.C.S.. 
who  died  last  week  at  East  bourne,  at  the  age  of  eighty- 
1.     Deceased  took  the  diploma  of  membership  of 
th\r  I  Hege  of  Surgeons  in  1842,  and  the  Fellow- 

ship of  the  same  body  a*  1860.     He  was  3  well-known 
and  prominent  citizen  of  Eastbourne, and  was  at  one  [spent 


flDebical    Hews. 

Central  Midwives  Board. 

At  a  meeting  of  the  Central  Midwives  Board,  held 
on  March  24th,  Dr.  l\  H,  Champneys  in  the  chair, 
the  following  business  was  transacted  : — 

The  Certificate  of  the  National  Maternity  Hospital, 
DubHfi,  was  approved  ;  and  the  following  institutions 
were  approved  for  the  training  of  midwives  under 
Section  C.  of  the  Rules,  subject  to  an  undertaking  to 
comply  with  the  requirements  of  Section  E.  :  Bir- 
mingham Workhouse  Infirmary,  Bristol  Royal  Infir- 
mary, Brownlow  Hill  Workhouse  Hospital  (Liverpool), 
Essex  County  Cottage  Nursing  Society,  Gloucester 
District  Nursing  Society,  Hull  Lying-in  Charity,  and 
Ipswich  Nurses'  Home. 

The  following  registered  medical  practitioners  were 
approved  as  teachers  under  Section  Cl  (3)  of  the  Rules  ; 
A.  B.  Batley,  M.R.CS..  A,  B.  Calder,  M,R,CS.,  John 
Gutch,  M,D,,  E.  S.  Hoare.  M.R.CS.,  Wilfrid  Kingdon, 
M.B.,  E.  J,  Maclean,  M.D..  Thomas  Pimley.  ALB*, 
Penrose  L.  \\\  Williams.  MR  <  \S. 

After  consideration  of  applications  for  certificates, 
the  names  of  849  women  were  passed  under  Section  2 
of  the  Act,  and  ordered  h»r  entry  on  the  Roll.  The 
following  table  shows  the  separate  numbers  of  the 
various  qualiti  cat  ions  at  present  entered  on  the  Roll  : 
Royal  College  of  Physicians  of  Ireland,  I  ;  Obstetrical 
Society  of  London.  953  ;  Rotunda  Hospital,  43  ; 
Coombe  Hospital,  12  ;  Queen  Chariot tVa  Hospital,  52  ; 
Liverpool  Lying-in  Hospital,  15  ;  British  Lying-in 
Hospital,  2  ;  Glasgow  Maternity  Hospital,  32  ;  St, 
Mary's  Hospital,  Manchester,  53  ;  City  of  London 
Lying-in  Hospital,  6 ;  Royal  Maternity  Hospital, 
Edinburgh,  5  ;  Salvation  Army  Maternity  Hospital.  3  . 
Women  Ed  folia  pdc  practice,  July,  1901,  2t2^$r     Total 

enrolled    j 

The  Plague  at  Johannesburg. 

On  March  26th,  eight  fresh  cases  of  suspected  plague 
were  notified.  Four  of  the  sufferers  are  whites. 
There  has  been  one  native  death  frurn  plague  ;  and  nn 
March  27th,  six  cases  of  suspected  plague  were  re- 
ported, including  one  white.  The  total  number  of 
cases  up  to  date  is  96,  of  which  13  have  been  whites. 
Seven  whites  and  £4  coloured  men  have  died  of  the 
disease. 

The  Dublin  University  Biological  Association. 

The  members  of  this  society  made  a  commendable 

move   last   week  in   instituting  an  annual   dinner  in 

connection  with  the  end  of   the  session.     Some  seventy 

members  and  guests  sat  down  in  the  Dolphin  Hotel. 

under  the  Presidency  of  Mr,  Charles  Maunsell.     The 

lation  is,  we  are  glad  to  know,  in  a  most  vigorous 

condition,  its  membership  having  quadrupled  in  the 

last  ten  vears.     Among  those  who  spoke  to  the  various 

toasts  were  Sir  Arthur  Macan,  President  of  the  Royal 

)ge  of  Physicians;  Dr,  James  Little,    Dr,    Walter 

Smith,    Professor   Francis   Dixon.   Mr,   G.    M.    Miller, 

|and    the    President,     A    very    pleasant    evening    was 


356    Ths  medical  Pre«s?        NOTICES  TO  CORRESPONDENTS. 


March  30,  1904. 


Jtotict*  to 
G0rre*p(mbtnt0,  $toort  %titztBf  ice 

W^  OoKBiSPOKDiim  requiring  a  reply  In  this  column  are  particu- 
Wly  requeeted  to  make  uae  of  a  dUtinctiw  aignature  or  initial,  and 
avoid  the  practice  of  signing  themaelvea  "Reader,"  " Subscriber/' 
"Old  Subscriber,"  *c.  Much  contusion  will  be  spared  by  attention 
to  this  rule. 

Obmucal  Articles  or  Lbttrrr  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

Contributors  are  kindly  requested  to  send  their  communications, 
if  resident  In  England  or  the  Colonies,  to  the  Editor  at  the  London 
offloe ;  if  resident  in  Ireland,  to  theDublin  office,  in  order  to  save  time 
in  re-forwarding  from  office  to  office.  When  sending  subscriptions 
the  same  rule  applies  as  to  offloe;  these  should  be  addressed  to  the 

Publisher. 

KtraiMTS.— Reprints  of  artioles  appearing  in  this  journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

J  G,  M.  (Lowestoft) .-The  question  of  the  liability ^of  persons  who 
let  lodgings  has  been  often  raised.  In  the  event  of  the  place  so  let 
bVinginfected  with  vermin,  it  appears  that  the  hirer  may  cry  off  his 
toSin  80  far  as  infectious  disease  is  concerned,  liability  would 
urobably  rest  with  the  owner  only  if  it  could  be  shown  that  reason- 
able  wecautione  had  not  been  taken  to  exclude  Infected  persons  or  to 
aecuie  thorough  disinfection  after  the  stay  in  the  house  of  any  person 
buffering  from  a,,  Infectious  malady. .It -would  be  best  tola y toe f  acts 
befo.e  a  solicitor.  Litigation,  it  need  hardly  be  remarked,  is  no  less 
tedious  and  uncertain  in  cases  of  this  kind  than  in  others  of  everyday 
occurrence. 

THE  SLAUGHTER  OK  SONG-BIRDS. 

A  coriespondent  who  has  Just  returned  frcm  a  tour  in  the  Pf™**. 
writes  us:->  Although  the  scenery  is  delightful  aid  £«  travel  healUi. 
riving,  I  am  not  sorry  to  come  back  to  a  la.d  where  birds  can  be  both 
•een  ird  heard.  They  seem  to  kill  anything  that  flies  in  France  ex- 
rent  magpies.  I  never  saw  nor  heard  a  thrush  or  la.k,  pheasant  or 
iJrtridge;  nor  heard  a  singing  bird  of  anykind  du  ing  my  jourr  eys 


forest  districts,  have  deplored  the  fact,  and  wondered  why 

W.  A.  Mirbrn.— Although  the  subject  of  hypnotism  has  long  since 
been  removed  from  the  field  oi  quackery  and  deception,  it  is  neverthe- 
less desirable  to  exercise  the  greatest  caution  in  its  use  for  therapeu- 
tic purposes.  The  inexactitude  and  obscurity  of  the  science  still 
renders  it  an  attractive  hunting-ground  for  the  unscrupulous  char- 
latan. Much  theory  passes  for  fact  in  the  calculations  of  not  a  few 
investigators  of  the  subconsciousness  of  the  human  mind. 

Cottaoi  Surgeoh.— Yon  are  fortunate  in  having  such  a  case  under 
your  care.  Sarcoma  of  the  fibula  is  essentially  a  rare  condition,  and 
may  be  met  with  only  once  or  twice  duri  g  the  professional  lifetime 
of  a  busy  operative  surgeon.  The  radiograms  are  excellent.  We 
should  be  pleased  to  publish  the  cases  you  refer  to. 

Couxtry  8cbobok  (Bucks).— Write  and  lay  the  facts  before  Dr. 
Bat*  man  .Secretary,  Medical  Defence  Union,  4  Trafalgar  Square, 
London,  W  C.  Even  if  you  are  not  a  member  of  that  body  you  are 
sure  of  a  prompt  and  courteous  reply. 

Dm.  F.  H.  F.  (Australia).— The  closing  of  abdominal  incision  by 
suturing  in  layers  is  now  almost  universally  employed.  The  method, 
however,  can  hardly  be  considered  established,  as  time  will  be  required 
to  show  the  ultimate  results  of  years  of  muscular  traction  upon  the 
resulting  scar.  Dr.  Arthur  Wallace,  Liverpool,  has  well  remarked 
that  hitherto  too  much  attention  has  been  devoted  to  the  closure  of 
abdominal  wounds,  and  too  little  to  the  method  of  making  them. 
There  appears  to  be  a  distinct  future  for  the  extra-median  (or  muscu- 
lar) line  of  abdominal  incision. 

^Btethtgs  of  the  ^otictiee,  JLttimt*,  &t. 

Wbdbebdat,  March  80th. 
Medical  Graduates'  College  and  Polyclinic  (22  Chenies  8treet, 
W.C.)— 4  p.m.  Mr.  J.  Pmith:  Olinique.     (8urgical.)  5.16  p.m.  Dr.  L. 
Sambon :  Ticks  and  Tick  Fevers. 

Teursdat,  April  7th. 
Boxtobn  Society  (20  Hanover  Square,  W.).— 8.80  p.m.   Ordinary 
General  Meeting.    Exhibition  Evening:  a  large  and  varied  Exhi- 
bition of  Novel  Apparatus  is  promised.    Tea  and  Coffee  will  be  pro- 
vided.   Smoking  will  be  permitted. 

Friday,  April  8th. 
Wmt    London   Mrdico-Chircroical    Society.— 8  p.m.     Clinical 
Evening :— Cases  will  be  shown  by  Dr.  8eymour  Taylor,  Dr.  Ball,  Dr. 
Saunders,  Mr.  Lunn,  Mr.  Pa  ton,  Mr.  Pardee  and  others. 

UacancitB. 

Royal  South  Hants  and  Southampton  Hospital.— House  Physician. 

Salary  £100  per  annum,  with  rooms,  board,  and  washing  found. 

Applications  immediately  to  T.  A.  Fisher-Hall,  Secjetary. 
Chorlton  Union  Workhouse  Infirmary,  Withiogton,  near  Manchester. 

—Hospital  Matron  a>  d  Superintendent  of  Nurses,    balarv  £100 

E>r  annum,  with  board  and  furnished  apartments  in  the  Nurses 
ome.    Applications  to  David  8.  Bloom  field,  Clerk  to  the  Guar- 
dian*, Vnion  Offices,  All  Saints,  Mat  cluster 
Liveri>ool  Stanley  Hospital.— Senior  House  Surgeofc.  '  Salary  £100 


per  annum,  with  board,  residence,  and  washing.    Applications  to 
the  Chairman  of  the  Medical  Board. 

Biistol  Dispensary.— Assistant  Dispenser.  Salary  £80  per  annum. 
Applications  to  H.  Merrett  Stock. 

Liverpool  Eye  and  Ear  Infirmary  —House  Surgeon.  Salary  £80,  with 
residence,  maintenance,  and  laundry.  Applications  to  Hon 
Secretary,  The  Infirmary,  Myrtle  Street  Liverpool. 

Chorlton-upon-Medlock  Dispensary,  Manchester.— Resident  Howe 
Surgeon.  8alary  £120  per  annum,  with  furnished  rooms  and 
attendance.      Applications  immediately  to  the  Hon.  Secretary. 

Bedford  County  Hospital— House  8urgeon.  Salary  llOO^per  annum 
with  apartments,  board,  and  laundress.  Application  to  W.  F. 
Morlev.  Secretary. 

Chester  County  Asylum.— Third  Assistant  Medical  Officer.  Salary 
£100  per  annum,  with  board,  lodging,  and  washing.  Application 
to  Dr.  Lawre>  ce,  County  Asylum,  Chester. 

London  County  Asylum,  Claybury,  Woodford  Bridge,  Essex.— Junior 
Assistant  Medical  Officer.  Salary  £150  per  annum,  with  board, 
furnished  apartments,  and  washing.  Applications  to  R.  W.  Part- 
ridge, Clerk  of  the  Asylums  Committee,  Asylums  Committee 
Office.  6  Waterloo  Place,  S  W. 

Lincoln  General  Dispensary.— Resident  Medical  Officer.  Salary  £i:# 
per  annum, with  furnished  apartments,  fire,  and  gas  Applications 
to  William  Dean,  secretary.  Board  Room.  Lincoln. 

St  Mary's  Hospital  for  Sick  Children,  Plaiatow,  £.— Assistant  Resi- 
dent Medical  Officer.  Salary  £80  per  annum,  with  board,  resi- 
dence, and  laundry.    Applications  to  Percy  J.  Glen  ton.  Secretary. 

Devonshire  Hospital,  Buxton,  Derbyshire.— House  Surreon.  Salary 
£100  per  annum,  with  furnished  apartments,  board  and  laundry. 
Applications  to  William  Stevenson,  Secretary. 

Bridgnorth  and  South  Shropshire  Infirmary.— House  Surgeon. 
Salary  £100  with  board  and  lodgings  in  the  Infirmary.  Applica- 
tions to  the  Hon.  Secretary,  Infirmary. 

Somerset  and  Bath  Asylum,  Cotford,  Taunton.— Assistant  Medical 
Officer.  Salary  A 100  per  annum,  with  furnished  apartments, 
board,  fuel,  lighting  aud  washing.  Applications  to  the  Medical 
Superintendent. 

Roscommon  Union.— Medical  Officer.  In  addition  to  Salary,  Vaccina- 
tion Fees  about  £8 ;  also  to  act  as  Medical  Officer  of  Health  at  a 
salary  of  £15  per  annum.  Immediate  application  to  T.  J. 
OKeeffe.  Clerk  of  Union.    (See  Advt.) 

Ballinas'oe  District  Lunatic  Asylum.— Resident  Medical  Fuperinten- 
dent  f  alary  £60 »  per  annum,  with  allowances  valued  at  £190 
per  annum.  Applications  to  John  Mills,  Acting  Resident  Medical 
Superintendent      See  Advt ) 

Torquay  -Medical  House  fo-  sale  with  Turkish,  Russian,  Medical  and 
Electric  Baths.    (See  Advt.) 


JlppoitttmtmB. 

Barwkll,  Harold,  M.B.  Lond.,  F.R  C.S.  Eng.,  Honorary  Surgeon  for 

Diseases  of  the  Throat  and  Ear  to  the  Cripples'  Home  for  OirU, 

Northumberland  House,  Marylebone. 
Brjbcoi,  William  Thomas,  A  B ,  M.D.,  M.Ch.Dub,,  Medical  Offioer 

for  the  Pewsham  District  by  the  Chippenham  Boerd  of  Guardians 
Bullmore,  CffAJtLtt  Cecil,  L.R.C.P.  A  8.  Ed  in.,  faJF  P.&  Gka?„ 

Medical  Offioer  to  the  Falmouth  Lodge  of  Oddfellows.    Certifying 

8urgeon  under  the  Factory  Act  for  the  Falmouth  District  of  the 

County  of  Devon. 
Chary,  M.  R ,  L.B.C.8.I.,  L.K  Q.C.P.I.,  Certifying  Surgeoo  under 

the  Factory  Act  for  the  Hospital  District  of   the  County  of 

Limerick. 
Dimes,  Hbvry,  M.R.C.S.,  L.R.C.P.Lond*  Clin ical  Assistant  to  the 

Chelsea  Hospital  for  Women. 
Goodmax,  T.  H.,  M.RO.8.,  L8A.,  Certifying  Surgeon  under  the 

Factory  Act  for  the  Haverhill  District  of  the  county  of  Suffolk. 
SiiTPMAX,  O.  A.  C.  M.A..  M.B ,  B.C.  Cantab,,  M.R.C-8  ,  L.RC.P., 

Sunreon  to  the  Grantham  Hospital,  Lincolnshire. 
Stoma*,  G.  W.,  L.R.C  P.,  M.R.CS.,an  Honorary  Consulting  Medical 

Officer  to  the  Grantham  Hospital. 


girths. 


Deaxssly.— On  March  29th,  at  7  Waterloo  Road,  Wolverhampton,  the 
wife  of  Edward  Deanes'y,  M  D..  F.R.C.8.,  of  a  son. 

Fairrib  -On  March  24th.  at  Oswald  House.  Cleveland  Road,  South 
Woodford,  London,  N  E  ,  the  wife  of  Capt.  8.  H.  Fairrie,  M.B., 
R.A.M  C.,  of  a  son. 

Lahore.— On  March  22nd,  at  Hathersage,  Derbyshire,  the  wife  of  H. 
W.  G.  Lander.  M.B.,  of  a  son. 

Roberts. —On  March  23rd,  at  IS  8outh  Eaton  Place,  S.W..  the  wife 
of  Edward  A.  Roberts,  M.D.,  of  a  daughter. 

Rubbt— Qn  March 26th, at 869  Coldharbour  Lane,  Brixton,  Kathar- 
ine (nee  Wright),  wife  of  E.  L.  M.  Busby,  MB.  Lond.,  of  a 
son. 

Stauktoh.—  On  March  20th.  at  22  North  Frederick  Street,  Dublin, 
the  wife  of  M.  C.  Staunton,  M.D.,  of  a  son. 


4ttarragt«. 

Burksidl- Radford.— On  Match  24th,  at  New  College  Chapel, Upper 
Avenue  Road,  London.  N.W.,  Ernest  John  Crawshaw,  M.RC.8. 
Erg.,  L.R.C.P.  Lond.,  Tregunter,  Burnham  Somerset,  third  too 
of  8.  C.  Burnside,  Ilkley.  to  Cicely  Kate,  third  daughter  of  George 
Radford,  M.A.,  38  St.  John's  Wood  Par*.  N.W. 

Maurice— Oreykk.— On  March  23rd,  at  Durban,  Natal,  Charles  James 
Kindersley  Maui  ice,  Government  Works.  Pretoria,  son  of  D  .  J. 
Blake  Maurice,  Marlboro'.  Wilts,  to  8ylvia,  daughter  of  the  late 
Walter  Pennington  Crcyke,  Esq..  and  Mrs.  Creyke,  of  S  feamore 
Place,  Mayfair. 

Roper— Watts.— On  March  23rd,  at  the  Parish  Church,  Kahopston. 
|  George,  eldest  son  of  the  late  Alfred  George  Roper,  F.R.G8 ,  to 
j         Alma,  second  daughter  of  the  late  Alfred  Watts. 


%fo  gllediral   ^tm   mi   Circular. 


"SALtJS    POFULI    SUPREMA    LEX" 


Vol.  CXXVIIL 


WEDNESDAY,    APRIL  6,    1904, 


No.   14. 


Original  Communications. 
APPENDICITIS,  (a) 

By  RITHERFORD  MORISON,  MtCS;, 

&xitean  to  the  Royal  Infiraiinr.   NewcMtle-on/Tjijc,  Consalling 
Surgeon  to  the  D#&t*l  Ho#pit*l* 

After  thanking  the  members  for  their  kind  invi- 
n  to  give  an  address,  he  said:  The  subject  I 
sen  is  thai  of  appendicitis,  a  disease  of 
the  greatest  interest  because  of  its  frequent  occur- 
rence, its  grave  risks,  and  the  consequent  respon- 
o'.hihties  its  treatment  involves.  Little  remains  to  be 
said  of  the  technique  of  operations  for  appendicitis ; 
il  will  be  difficult  to  make  any  advance  on  our  present 
methods,  and  to  this  aspect  of  the  subject  I  do  not 
intend  to  devote  any  of  the  limited  time  at  my  dis- 
posal to-night. 

The  point  I  especially  want  to  impress  upon  every- 
tm  beare  ii  the  importance  of  early  diagnosis.  The 
fate  of  ihe  patient  more  often  depends  upon  the  judg- 
ment ot  the  practitioner  first  in  attendance  than  upon 
kill  or  care  of  anyone  else,  and  it  is  to  him  that 
Wt  must  look  for  any  marked  improvement  in  the 
results  of  cases  of  appendicitis, 

Before  dealing  with  the  more  practical  questions  of 
didwtosts,  prognosis,  and  treatment,  it  is  necessary 
that  1  itumld  shortly  consider 

Pathology, 
Inflammation  of  the  appendix  possesses  no  special 
\ jecuti ar 1 1  y  in  its  cau s e ,  progress  or   te  rmina  I  i  on ,  and 

I  be  thought  of  on  the  same  lines  as  any  other 

instance  of  acute  or  chronic  inflammation.  The  four 
poothk  results  of  acute  inflammation  are  all  repre- 
sented hi  appendicitis. 

1.  The  disease  may  undergo  resolution*  Evidence 
of  this  is  difficult  to  procure,  but  it  can  scarcely  be 
^pen  10  reasonable  doubt  than  an  appendix  which  has 
U'en  inflamed  may  recover  so  entirely  that  no  trace  ot 

Chief  remains. 

2,  Fibroid  thickening  may  result,  I  have  a  specimen 
removed  from  a  young  male  adult  who  had  had  many 
at  Lacks,  The  whole  organ  was  thickened  and  rigid. 
J iisl    after    removal    it    felt    hard    and    resilient,     On 

mi,  it  showed  great  thickening  of  all  the  wails, 
without  any  stricture,  ulceration,  or  enterolith,  A 
specimen  from  a  young  female  who  had  had  many 
attacks  showed  the  whole  appendix  converted  into  a 
k  fibrous  cord  without  a  lumen.  Another,  removed 
irom  a  bov  who  had  had  several  abscesses,  winch  had 
hurst  into  the  bowel,  and  one  of  which  had  been  opened 
hy  a  surgeon,  showed  the  ea*cal  end  much  thickened 

rii pi etely  obliterated,  the  distal  end  thickened,  but  ' 
still  retaining  its  lumen.  In  similar  cases  the  distal  end 
lias  been  found  ddated  and  forming  a  cyst  or  an  em-  j 
pvema.  A  large  numLrer  of  specimens  show  one  on 
wore  n  bro  u  s  s  t  r  k t  u  re*  a  i  d « fife  r en  t  pa  r t  s  of  t  he  a  ppe  nd  ix  J 
j.  Local  destruction  may  result  in  ulceration  and 
perforation-     In  many   instances  where  such   lesions 

'  ""  "  ^ 

<«)  Aji  Addrew  delivered   before   (lie  lUlifm   Meilio&l   Society,  , 

Octofc*  lib*  1903,  I 


were  found,  one  or  more  enteroliths  were  discovered  on 
opening  the  appendix,  fa  many  the  caecal  end  oi  the 
appendix  appears  to  be  normal,  or  only  a  little  con- 
gested,  while  the  distal  end  is  red  and  swollen.  On 
section,  the  mucous  membrane  is  seen  to  be  swollen, 
and  about  the  centre  or  nearer  the  tip.  an  enterolith 
may  be  impacted.  The  site  of  the  enterolith  is  ulcer- 
ated, or  it  may  frequently  happen  that  an  enterolith  has 
escaped  into  an  abscess  through  a  perforation.  The 
explanation  which  I  offer  oi  the  course  ot  events  and 
the  perforation  is,  that  given  the  inflammation,  per- 
foration  reanlti  from  pressure  necrosis  at  the  site  of 
the  enterolith.  The  swollen  mucous  membrane  of  the 
appendix  occupies  the  lumen,  except  where  the  entero- 
lith prevents  it  from  doing  so.  and  at  this  spot  the 
vascular  supply  II  arrested  by  its  presence.  The  same 
sequence  of  events  occurs  as  m  the  formation  of  a 
bed-sore.  A  second  type  of  perforation  shows  the 
formation  of  a  follicular  abscess  fas  in  the  tonsil)  and 
its  discharge  into  the  peritoneal  cavity,  A  third  form 
of  perforation  is  due  to  tension  from  inflammation  and 
pent-up  secretion.  If  intra -appendicular  tension  is 
serious,  but  not  sufficiently  suddenly  increased  fcO 
cause  total  gangrene,  spots  of  gangrene  may  appear 
on  the  wall  of  the  appendix,  usually  at  parts  most 
defective  in  blood  supplv,  and  through  these  perforation 
ultimately  occurs,  A  large  number  of  my  specimens, 
I  believe,  illustrate  this  variety.  The  same  explana- 
tion holds  good  for  perforations  in  other  hollow  viscera. 
I  have  observed  it  more  than  once  in  the  caecum  of 
cases  of  obstruction  in  the  large  intestine,  and  in  the 
<  lis  tended  gall-bladder  of  obstructed  cvstic  duct,  and 
once  in  the  urinary  bladder  of  a  young  man  who  had 
retention  of  urine  from  acute  prostatic  abscess  and 
alcoholism.  Perforation  and  gangrene  are  explained 
in  all  recent  text-books  by  assuming  vicious  virulence 
of  the  attacking  organisms,  but  there  is  not  much 
evidence  of  the  truth  of  this*  The  mechanical  view 
offered  here  receives  strong  support  from  examination 
of  specimens  of  perforated  appendix,  and  still  stronger 
from  an  examination  of  the  larger  hollow  viscera, 
where  the  effects  ol  tension  can  be  more  easily  studied, 
and  to  which  the  same  principles  are  applicable. 
Stricture,  the  comaqnemoa  of  a  previous  attack,  would 
thus  be  expected  to  predispose  to  perforation  in  a 
subsequent  attack,  and  there  is  in  my  collection 
abundant  evidence  of  the  fact  that  many  appendixes 
perforated  towards  the  distal  end  are  strictured  nearer 
the  caecum.  In  one  example  of  strictured  appendix 
in  my  possession  there  are  three  perforations,  I  have 
also  observed  multiple  perforations  in  an  over-distended 
tense  caecum.  In  another  specimen  an  enterolith  and 
a  stricture  co-exist.  The  stricture  is  at  about  the 
middle  of  the  appendix  ■  the  enterolith  is  impacted 
near  the  end  of  it.  Per  foration  liad  occurred  imme- 
diately distal  to  the  stricture.  At  the  tip  of  the 
appendix  there  is  a  patch  of  gangrene.  The  portion  of 
the  wall  against  which  the  enterolith  rested  is  ulcerated, 
and  so  soft  that  it  looks  as  if  it  would  soon  have 
ruptured-  The  sequence  of  events  here  was  probably  : 
hrst.  stricture  witti  distension  by  secretion  distal  to 
)t  j  next,  infection  of  the  mucous  membrane  by  bacteria 
growing  vigorously  in  the  retained  secretion  ;  and, 
finally,    threatened   gangrene   of    the   whole   append  i 


358    The  Medical  Press.         ORIGINAL  COMMUNICATIONS. 


April  6,   1904. 


distal  to  the  stricture,  averted  and  made  partial  by 
the  occurrence  of  perforation  and  relief  of  tension. 

Enteroliths  found  in  the  appendix  vary  in  size  and 
somewhat  in  shape,  though  for  the  majority  of  them 
the  61d  comparison  with  a  date-stone  in 'colour,  shape 
and  size  is  very  near  the  mark.    They  look  as  if  com- 

S>sed  of  hardened  faeces,  but  Mr.  Lockwood  ("  Surgical 
iseases  of  the  Appendix")  is  convinced  that  they 
consist  of  a  conglomerated  mass  of  bacteria,  and  are, 
consequently,  of  considerable  pathological  importance. 
That  they  may  remain  in  its  lumen  without  causing 
disease  or  changes  in  the  appendix  observable  by  the 
naked  eye  is  certain,  for  it  requires  no  extended 
acquaintance  with  the  post-mortem  room  to  prove  it ; 
but  that  they  nevertheless  possess  some  pathological 
importance  is  made  still  more  certain  by  operations 
performed  on  cases  of  appendicitis.  It  is  difficult  to 
fix  the  exact  rSle  played  by  enteroliths  in  appendicitis, 
but  on  general  surgical  principles  it  may  be  said  that, 
like  stone  in  the  gall-bladder  or  kidney  or  urinary 
bladder,  they  are  not  likely  to  cause  serious  symptoms 
until  inflammation  supervenes.  Once  inflammation 
is  started,  the  enterolith  often  determines  the  site  of 
perforation.  The  enterolith  may  also,  by  blocking  the 
lumen  of  the  appendix,  produce  the  same  consequences 
as  a  stricture.  In  one  of  my  specimens  the  perforation 
was  at  the  tip  of  the  appendix,  the  concretion  being 
impacted  close  to  the  caecum. 

Most  of  the  appendixes  removed  during  an  acute 
attack  are  firm,  reddened  and  much  enlarged,  with 
their  walls  presenting  oedema  and  more  or  less 
ulceration  of  the  mucous  membrane.  At  a  later  stage 
they  present  small  patches  of  gangrene  with  or  without 
perforation,  according  to  the  length  of  time  that  has 
elapsed  since  the  attack  commenced,  or  the  virulence  of 
the  attacking  organisms. 

In  abscess  cases  where  there  have  been  many  attacks, 
I  have  found  fibroid  thickening  of  the  appendix,  with 
obliteration  at  parts,  and  the  unobliterated  portion 
inflamed  and  perforated.  In  a  few  abscess  cases  the 
appendix  is  very  much  destroyed,  and  only  fragments 
of  it  are  found  at  the  operation.  Part  of  this  de- 
struction is  doubtless  the  result  of  maceration  in  pus, 
and  not  wholly  a  consequence  of  the  primary  lesion. 

4.  Gangrene  of  the  appendix  is  the  final  result  ot 
inflammation.  It  is  difficult  in  some  instances  to  say 
whether  a  given  example  should  be  included  in  the 
last  group  or  this,  and  doubtless  the  time  of  operation, 
and  the  strength  of  the  peritoneal  coat  of  the  appendix, 
are  circumstances  that  respectively  have  some  in- 
fluence in  deciding  whether  the  gangrene  shall  be 
partial  or  total.  When  the  gangrene  is  total,  the  cases 
form  a  very  distinct  group,  and  are  clinically  of  a 
severe  type.  The  appearance  of  the  appendix  is  very 
characteristic.  It  looks  like  a  tense,  yellow  sausage, 
and  on  section  contains  from  a  few  drops  to  as  many 
drachms  of  foetid,  dark  fluid,  together  with  its  gan- 
grenous loosened  inner  coats.  The  vessels  of  the 
meso-appendix  exhibit  thrombosis,  but  this  is  probably 
never  the  primary  cause  of  the  lesion,  as  has  been 
suggested  by  eminent  authorities,  for  thrombosis  of 
these  vessels  would  not  cause  gangrene  of  the  caecal 
end  of  the  appendix,  which  receives  a  blood  supply 
from  the  caecum  itself.  The  result,  I  believe,  depends 
chiefly  upon  the  strength  of  the  peritoneal  coat  of 
the  appendix.  With  its  caecal  end  blocked  by  inflamed 
and  swollen  mucous  membrane,  the  cavity  of  the 
appendix  is  converted  into  a  closed  sac,  and  the  in- 
creasing tension  of  its  contents,  unless  relieved  by  a 
discharge  into  the  caecum— this  sometimes  occurs 
when  the  distended  appendix  is  laid  hold  of  during 
operation — or  by  perforation  through  a  weak  spot, 
ends  in  total  gangrene.  Specimens  of  mine  show 
such  appendixes,  like  a  glove  finger,  and  consisting  only 
of  a  thin  peritoneal  coat.  I  have  seen  total  gangrene 
of  the  caecum  and  ascending  colon  follow  enormous 
distension  due  to  malignant  stricture  of  the  splenic 
flexure  of  the  colon,  and  the  patient  was  so  little 
disturbed  by  the  pathological  processes  occurring  in 
his  abdomen  that  a  few  hours  before  operation  he 
underwent   treatment   by   vigorous   massage,   in   the 


endeavour  to  empty  his  bowel.  The  ordinary  result 
of  such  extreme  distension  of  the  caecum  is  a  patchy 
gangrene,  and  the  bowel  perforates  before  total  gan- 
grene can  occur.  If  a>  mechanical  explanation,  which 
can  be  readily  understood,  suffices  to  explain  these 
processes,  why  resort  to  a  theory  impossible  to  verify 
or  confute,  based  upon  the  virulence  of  bacteria  ? 
Everyone  will  admit  that  bacterial  infection  starts 
the  inflammation,  and  that  the  more  active  the  bacteria 
are  the  more  acute  the  resulting  inflammation  will  be ; 
but  the  importance  of  the  mechanical  factor  has  been 
too  much  forgotten  in  studying  results. 

Interesting  as  is  the  whole  study  of  the  diseased 
appendix,  one  of  the  most  important  details  in  it  is 
the  form  of  peritonitis  always  associated  with  it  when 
the  case  is  of  sufficient  importance  to  require  a  surgical 
operation.  The  peritoneal  reaction  and  resulting 
plastic  peritonitis  may  be  terminated  by  the  formation 
of  adhesions  and  the  production  of  a  strong  barrier 
against  further  peritoneal  infection.  Or  it  may  be 
that  with  a  more  virulent  infection  and  less  resistance 
the  peritoneum  has  been  unable  to  deal  in  a  wholly 
satisfactory  way  with  the  invading  organisms,  and  an 
abscess  has  resulted. 

Finally,  a  diffuse  septic  infection  generally  results 
from  the  sudden  escape  through  a  perforation  of  a 
large  quantity  or  virulent  quality  of  poisonous  material 
from  the  interior  of  the  appendix.  There  are,  therefore, 
for  practical  purposes,  three  forms  of  peritonitis 
resulting  from  infective  appendicitis,  and  each  form 
associates  itself  in  the  mam  with  a  special  type  of 
appendix  and  a  particular  clinical  history. 

1 .  A  localised  and  dry  peritonitis,  usually  associated 
with  fibroid  changes  and  stricture  in  the  appendix, 
with  a  history  of  recurring  attacks. 

2.  A  localised  collection  of  pus  or  inflammatory 
products  shut  in  by  adhesions,  a  perforated  appendix, 
and  an  enterolith,  with  a  history  of  sudden  severe 
onset  followed  by  a  tender  iliac  tumour. 

3.  Septic  infection  of  the  peritoneal  cavity,  with  a 
gangrenous  appendix,  a  large  perforation,  and  a  history 
of  sudden,  overwhelming  pain,  and  illness  following  a 
day  or  two  of  bearable  aching  in  the  right  iliac  fossa. 

These  three  types  of  appendicitis  may  be  used  as  a 
means  of  classification,  but  a  study  of  individual 
cases  does  not  always  lead  to  any  such  easy  classifi- 
cation on  hard  and  fast  lines.  Both  abscesses  and 
diffuse  peritonitis,  according  to  trustworthy  observers — 
and  I  have  myself  seen  such  cases — may  result  from 
infection  through  the  walls  of  the  appendix.  Also  a 
totally  gangrenous  appendix  surrounded  by  a  localised 
collection  of  pus  is  not  infrequently  found  in  the  sub- 
caecal  fossa.  And  a  perforation,  an  enterolith,  and  a 
localised  collection  of  pus  may  be  found  associated 
with  a  diffuse  peritonitis  ;  indeed,  no  classification  can 
be  made  which  can  cover  every  case,  and  _  which  is 
free  from  all  serious  objections. 
Diagnosis. 

A  careful  study  of  the  history  of  the  case,  and  of  the 
symptoms  and  signs  present,  will  establish  a  correct 
diagnosis  in  the  great  majority  of  instances.  In  a 
small  minority  it  is  impossible  to  form  any  reasonable 
opinion.  In  more,  a  definite  diagnosis  is  difficult. 
The  symptoms  and  signs  in  all  cases  may  be  alike  in  the 
commencement. 

Pain. — This  at  first  cannot  be  localised,  and  does 
not  confine  itself  to  definite  anatomical  landmarks. 
It  is  referred  indefinitely  to  the  whole  abdomen,  most 
frequently,  so  far  as  my  observations  go,  when  it  can 
be  defined,  to  the  epigastrium,  occasionally  to  the 
neighbourhood  of  the  umbilicus.  More  than  once,  to 
my  knowledge,  the  epigastric  pain  of  early  appen- 
dicitis has  led  to  a  suspicion  of  ruptured  gastric 
ulcer  ;  hence,  it  is  of  some  importance  to  recognise  this. 
By  the  second  or  third  day,  if  not  earlier,  the  pain  has 
become  localised  on  the  right  side.  In  the  great  ma- 
jority of  healthy  young  adults  attacked  by  a  sudden, 
severe  abdominal  pain,  appendicitis  has  been  found  to 
be  the  cause,  an  important  fact  to  remember  in  making 
a  diagnosis.  Many  authorities  teach  that  pain  does 
not  result  from  disease  limited  to  the  appendix,  that 


April  (y.   1904. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press,     35g 


appendicitis  itself  is  painless,  and  that  pain  only  comes 
with  the  consequent  peritonitis.  This  is  true  of  the 
ABC  severe  type  of  pain,  but  early  Operation  proves 
that  the  pain  of  an  inflamed  and  distended  appendix 
IS  severe  enough  to  prevent  sleep. 

TrKdrmfss. — McBurney   has    descried     a   point    in 

right    iliac    fossa    I  wo    inches    irom    the    anterior 

superior  iliac  spine,  on  a  line  drawn  from  it  to  the 

umbilicus,   pressure  over  which    with    the    finger- tip 

marks    the    ca?cal    attachment    of    the    appendix,  and 

dicits  tendentesv  m  every  case  of  appendicitis.     Though 

not  able  to  make  so  definite  a  statement  as  to  the  point 

pf  its  anatomical  meaning,   I  regard  this  as  the  ttJOBl 

important  sign  Off  appendicitis,      ft  occurs  early  in  the 

illness  and  lasts  longer  than  any  other  evidence  of  the 

attack,  often  being  the  only  guide  to  a  knowledge  of 

Peel  recovery  has  not  yet  occurred, 

rati'tn  -»/  the  Appendix. — During'  the  first  hours 

»i  an  attack  it  is  possible  by  careful  effort  to  feel  the 

swollen   tender  appendix.   &nd   if   this  can  be  done   DO 

J    d  eq&al  value. 

t7oV  —  Early  in  the  most  acute  cases,  the  ab- 
ual  muscles  of  the  right  side,  either  wholly  or  in 
part— and  it  is  surprising  how  partial  the  hardening 
may  be — become  hard  and  resisting,  and  though 
rigidity  is  not  always  present,  especially  in  the  later 
stages,  it  must  be  rare  to  have  rigidity  absent  during 
the  whole  course  of  the  illness.  1  have  found  localised  , 
rigidity  over  a  swollen  tender  appendix  five  hours 
after  the  commencement  of  an  attack,  and  though  the 
•id ix  removed  then  by  operation  was  acutely 
mrUmed,  there  was  no  evidence  that  the  rigidity  was 
the  result  of  peritonitis,  as  has  always  been  assumed, 
\  localised  rigidity  can  closely  simulate  a  tumour,  and 
the  deepest  surgical  anaesthesia  may  not  suffice  to 
dissipate  t  Attending  the  rigidity  there  is,  of  course, 
more  or  less  interference  with  the  respiratory  move- 
ments  of  the  abdominal  wall.  Extending  rigidity  is 
"i  prognostic  value,  for  an  extension  of  the  rigid  area 
the  spreading  of  an  underlying  peritonitis, 
Vontffing. — This  is  a  frequent  occurrence  at  the 
i  of  the  illness,  and.  if  repeated,  points  to  a  severe 
attack,  In  robust  men,  with  abundant  will  power, 
it  may  be  long  deferred  and  even  absent  in  serious 
cases,  The  vomited  matter  consists  mostly  of  what 
has  l>een  swallowed  by  the  patient,  whose  craving  for 
fluids  in  this,  as  in  all  conditions  involving  peritoneal 
traumatism,  is  irresistible,  Bile-staining  of  the 
vomited  matter,  or  an  intestinal  character  of  it,  may 
occur  in  serious  attacks.  The  vomiting  is  usi 
readily  arrested  by  abstinence  from  food  and  drink, 
11)  the  administration  of  opium.  Early  coffee-ground 
vomiting  is  rare,  but  it  occurs  rarely  in  acute  cases  as 
the  result  of  "  abdominal  shock."  Regurgitation  of 
curlee-ground  liquid  occurs  later,  and  is  in  this,  as  in 
other  conditions  resulting  in  peritonitis,  a  most  ini- 
lavnurable  sign* 

«  of  the  Bowels, — Either  constipation  or 
diarrhcea  may  be  present  at  first,  though  constipation  , 
with  inability  to  pass  flatus  is  the  rule.  Borborygini 
are  often  heard  m  the  early  stages,  and  I  have  seen 
intestinal  obstruction  of  purely  mechanical  origin  still 
more  closely  simulated  by  the  occurrence  of  visible 
intestinal   peristalsis. 

Rigors, — These   are   uncommon    even   when    pus   is 

it.      Early   in   the  illness   they   denote  a   serious 

attack,    and    are    often    associated    with    gangrenous 

iuUx,     Later    on,    if    repeated,    they    are    strong 

evidence  in  favour  of  supposing  pus  to  be  present. 

'  ptsrofl  of  the  Abdomen, — This  is  the  most  serious 
tigs;  for  it  indicates  intestinal  paresis  due,  to  peri- 
tonitis-  Increasing  distension  of  the  abdomen 
measured  round  the  umbilicus  is  of  grave  significance, 
fbf  it  means  increasing  peritonitis.  During  the  first 
hours  of  attack  the  abdomen  is  likely  to  be  retracted, 
distension  seldom  being  marked  before  the  third  day. 
The  worst  cases  have  an  abdomen  which  is  tense  and 
considerably  distended.  During  convalescence  some 
'intension  may  occur  from  constipation. 

The  Presence  of  a   Tumour*— A  definite   tumour  in 
the  right  iliac  fossa,  with  a  preceding  history  of  sudden 


abdominal  pain  followed  by  an  acute  illness,  is  the 
trustworthy   indication   of   an   attack   of   appendicitis 

\  diagnosis  based  on  these  grounds  is  one  of  the  Biotl 
certain  of  abdominal  diagnoses.     During  the  first 

firm  resistance,  depending  upon  rigidity  ot  ihr 
underlying  muscles  and  possibly  on  the  presence  of 
a  mass  of  inflamed  (Edematous  omentum  and  some 
pent-up  appendix  contents,  may  simulate  very  closdv 
the  iliac  turn* hi r  ;  hut  careful  examination — ami  this, 
i>  aided  by  the  use  of  chloroform — will  show  that 
there  is  no  definite  tumour,  but  more  of  what  may  be 
described  as  marked  resistance.  Over  the  reaistent 
area  the  percussion  note  1^  likely  to  be  impaired.  After 
the  third  day  a  definite  iliac  tumour  may  Safety  tie 
regarded  as  a  collection  of  pus.  for  the  exceptions  to 
this  rule  are  so  few  as  to  be  of  tittle  practical  importance. 
It  is  curious  to  note  how  Jon^  it  takes  for  the  profession 
to  realise  the  importance  of  such  a  tact  as  this,  tot  1 
first  pointed  it  out  in  the  paper  previously  referred  to 
{Edin.  Med,  /etttW.J  in  180$  and  again  in  the  Lancet 
of  February  23rd.  1001,  and  still  the  most  recent 
writers  on  abscesses  in  connect  ion  with  the  appendix- 
attach  little  or  no  value  to  it,  and  surest  entire 
dependence  on  a  leucocyte  count.  The  prognostic 
value  of  this  iliac  tumour  is  of  the  greatest  significance  ; 
and  to  surgeons  a  careful  study  of  it  may  make  the 
difference  between  a  successful  and  an  unsuccessful 
operation.  An  abscess  hanging  over  the  brim  of  the 
pelvis,  for  example,  is  attended  by  much  more  danger 
than  one  situated  behind  or  on  the  outer  side  of  the 
caecum.  By  the  relations  of  the  abscess,  also,  the 
operating  surgeon  is  guided  to  a  knowledge  of  the 
position  of  the  appendix,  and  the  operation  under- 
taken with  a  definite  knowledge  of  its  whereabouts 
is  more  likely  to  be  followed  by  success  than  one  re- 
quiring  an  indefinite  and  therefore  pro  Ion  Red  search. 

Whilst  on  the  subject  of  tumour  as  an  aid  to  diagnosis. 
it  may  be  well  to  say  that  a  tender  resistance  or  nodule, 
left  after  apparent  recovery,  indicates  the  existence  in 
the  appendix  of  changes  of  a  permanent  character, 
the  probability  of  another  attack,  and  the  propriety  of 
excising  the  appendix  without  further  delay* 

Puke  and  Temperature.— Unless  a  complete  record 
is  presented,  these  may  be  unreliable  guides  to  diat 
and  prognosis.  A  steadily  rising  pulse  points  with 
certainty  to  an  increasing  abdominal  lesion,  and  m 
pulse  of  100  usually  denotes  a  serious  attack  of  appen- 
dicitis. The  temperature  in  the  early  stages  is  rarely 
other  than  elevated,  and  it  may  rise  to  iojg  or  104° 
without  meaning  extreme  danger,  if  the  pulse  continues 
to  be  under  100,  Along  with  a  quick  pulse,  elevation  of 
temperature  points  still  more  certainly  to  a  seriousv 
attack  than  quickening  of  the  pulse  alone.  Excep- 
tionally it  is  possible  to  see,  as  I  have  seen,  a  patient 
with  a  pulse  of  Ho.  of  good  volume,  and  with  a  normal 
temperature,  who  has  nevertheless  only  a  few  hours  to 
live,  the  abdomen  containing  so  much  pus  that  the 
ordinary  signs  of  free  fluid  in  the  belly  are  present. 

Frequtvt  Micturition  or  Retention  of  Urine  may  be 
met  with  as  symptoms  of  appendicitis  ;  and  retention 
has,  more  than  once  to  my  knowledge,  led  to  mistaken 
diagnosis,  Both  symptoms  are  the  result  of  extension 
of  peritonitis  to  the  vesical  peritoneum,  and  ma. 
found  in  any  disease  resulting  in  pelvic  peritonitis. 

Rectal  Tenesmus  is  occasionally  an  urgent  and 
typical  symptom.  It  is  due  to  a  pelvic  abscess  press  - 
ing  upon  the  anterior  wall  of  the  rectum,  and  causing 
u'dema  and  bulging  of  the  wall.  Associated  with  it 
is  a  spurious  mucous  diarrhcea  and  frequently  sphincter 
paresis. 

iut  a* I  Expression,  though  mentioned  last,  is  by  no 
means  the  least  faithful  recorder  of  the  patient's  Con- 
dition for  those  who  are  able  to  judge  from  it.  The 
seriousness  or  otherwise  of  the  illness  can  often  be 
gauged  by  a  glance  ■  the  hollow-eyed,  pinched,  grey 
face  of  general  septic  peritonitis  conveys  a  message, 
the  meaning  of  which  cannot  be  mistaken.  The 
ordinary  straightforward  case  with  sudden,  painful 
onset,  vomiting,  tenderness,  rigidity,  a  rise  in  tem- 
perature, and  an  iliac  swelling  on  the  right  side,  is 
not  likely  to  be  mistaken  for  anything  else  than  acute 


36o    Tag  Mwucal  Pi**.        ORIGINAL  COMMUNICATIONS. 


April  6.  1004. 


appendicitis.  It  is  in  the  early  stages  and  in  atypical 
Cases  that  diagnosis  is  difficult  and  sometimes  im- 
possible. The  most  frequent  cause  of  acute  peritonitis 
being  appendicitis,  unless  there  are  definite  indications 
otherwise,  this  is  the  diagnosis  most  frequently  made. 
Every  kind  of  acute  abdominal  lesion  has  frequently 
been  mistaken  for  appendicitis,  and  the  same  error 
will  be  committed  over  again.  The  mistakes  that 
have  most  impressed  me  have  occurred  when  some  of 
the  chief  physical  signs  were  misleading,  and  I  will 
point  out  the  nature  of  these  mistakes. 
The  Diagnosis  of  the  First  Type  of  Appendicitis, 
in  which  there  are  at  intervals  sudden,  sharp  attacks 
of  abdominal  pain  which  quickly  pass  off  and  leave 
no  trace,  is  very  difficult.  A  tender  nodule  in  the 
right  iliac  fossa  or  in  the  pelvis  is  the  most  definite 
guide  ;  but  even  that  may  fail. 

Diseases  with  which  it  may  be  Confounded. 
t.  Gallstones. — Gall-stone  attacks  which  pass  off 
and  leave  no  physical  signs  are  readily  mistaken  for 
attacks  of  appendicitis  ;  and  conversely,  if  the  appendix 
has  remained  under  the  liver,  as  in  a  case  of  un- 
descended caecum  I  operated  upon,  the  attacks  of 
appendicitis  may  so  closely  simulate  gall-stones  as  to 
make  correct  diagnosis  impossible. 

2.  Calculus  in  the  Kidney,  unless  it  cause  changes 
in  the  urine,  gives  rise  to  attacks  which  are  difficult 
to  distinguish  from  this.  A  young  woman,  upon  whom 
I  operated  for  appendicitis,  removing  an  apparently 
healthy  appendix  which  had  some  flimsy  adhesions 
attaching  it  to  the  parietal  peritoneum,  returned  five 
years  later.  She  stated  that  she  had  continued  to 
suffer  from  attacks  similar  to  those  which  the  operation 
had  been  intended  to  cure.  Her  right  kidney  was 
enlarged,  her  urine  contained  pus,  and  exploration  of 
the  kidney  showed  it  to  be  converted  into  a  pus  sac 
containing  calculi.     Nephrectomy  cured  her. 

3.  Temporary  Attacks  of  Hydronephrosis  from  other 
causes  besides  calcylus  also  occasion  similar  symptoms 
and,  except  during  the  attack,  no  enlargement  of  the 
kidney  may  be  discoverable — there  is  merely  some 
increase  in  its  mobility. 

4.  A  Stone  impacted  in  the  Pelvic  Portion  of  the 
Ureter  on  one  occasion  misled  me.  The  painful 
attacks,  due  to  temporary  hydronephrosis,  occasioned 
symptoms  such  as  would  arise  from  appendicitis. 
Tenderness  in  the  right  iliac  fossa  was  present,  and  a 
rounded  tender  nodule  was  felt  from  the  rectum  and 
from  the  vagina  below  the  pelvic  brim.  Exploration 
showed  the  appendix  to  be  normal,  and  the  tender 
nodule  to  be  a  stone  impacted  in  the  ureter  and  fixed 
in  position  by  exudation  due  to  peri-ureteritis. 

In  the  Second  Type  of  Appendicitis, 
that  form  associated  with  localised  peritonitis  and  an 
abscess,  the  diagnosis  may  be  confounded  with  : — 

1.  Gall-stones. — A  distended  and  inflamed  gall- 
bladder may  be  found  in  the  right  iliac  fossa,  surrounded 
by  inflamed  peritoneum.  A  long,  narrow,  and  much- 
distended  gall-bladder  may  reach  there  with  the  liver 
in  its  normal  position,  but  the  ordinary  position  is 
that  the  liver  is  dislocated  downwards — a  more  common 
condition  than  is  generally  believed — and  has  carried 
the  gall-bladder  with  it.  In  such  cases  a  recognition 
of  the  position  and  condition  of  the  liver  may  save 
from  error. 

2.  Leaking  Ectopic  Gestation,  with  a  swelling  in 
the  right  iliac  fossa,  can  give  rise  to  error.  The  sex 
of  the  patient  and  the  history  of  a  missed  menstrual 
period  may  suggest  caution. 

3.  Calculous  and  Pyonephrotic  Kidney  has  fre- 
quently been  a  cause  of  error,  especially  if  the  history 
alone  has  been  relied  upon  as  a  guide  to  diagnosis. 
A  mistake  is  not  likely  to  arise  when  the  physical 
signs  are  carefully  studied,  though  a  movable  kidney, 
containing  calculi,  and  suppurating,  may  extend  so  far 
down  into  the  right  iliac  fossa  as  to  simulate  the  iliac 
tumour  of  abscess  in  connection  with  the  vermiform 
appendix. 

4*  Ovarian  Cyst  with  Twisted  Pedicle. — If  an  ovarian 
cyst  the  size  of  an  orange  has  a  twisted  pedicle,  and 
is  located  in  the  right  iliac  fossa,  the  swelling  there 


and  the  surrounding  peritonitis  simulate  very  closely 
an  acute  appendicitis.  In  young  unmarried  women, 
and  I  believe  it  occurs  most  frequently  in  them,  the 
diagnosis  may  be  difficult.  The  following  symptoms 
have,  however,  more  than  once  sufficed  to  guide  me 
to  a  correct  view  of  the  patient's  condition,  viz.,  a 
trifling  uterine  haemorrhage  at  the  commencement  of 
the  attack,  a  temporary  entire  abatement  of  the 
symptoms,  a  more  definitely  round  tumour  than  is 
found  in  appendicitis  discovered  by  bimanual  examina- 
tion, and  during  the  intervals  of  ease,  a  normal  tem- 
perature. 

5.  Pelvic  Peritonitis,  having  in  women  another 
origin  than  in  appendicitis,  may  be  mistaken  for  that 
due  to  disease  of  the  appendix.  A  history  of  gonorrhoea 
or  sepsis,  followed  by  uterine  disturbances  and  the 
presence  of  definite  tubal  swellings,  if  an  abscess  is  not 
sufficiently  large  to  obliterate  such  landmarks,  may 
aid  the  making  of  a  correct  diagnosis.  In  many  in- 
stances, however,  the  cause  of  a  pelvic  abscess  is  not 
even  cleared  up  after  operation  or  post-mortem  exa- 
mination, for  both  the  appendix  and  the  tubes  are 
involved,  and  which  has  been  primarily  to  blame  it 
may  be  impossible  to  guess. 

6.  A  Definite  Tumour  in  the  right  iliac  fossa  may 
be  found  with  symptoms  suggestive  of  appendicitis, 
and  this  tumour  may  be  due  to  tubercle  or  cancer  of  the 
caecum.  If  an  abscess  has  formed,  as  I  have  seen, 
in  connection  with  either,  a  diagnosis  may  be  impossible. 
In  tuberculous  cases,  however,  the  onset  is  not  usually 
abrupt  or  definite  ;  the  course  is  chronic,  diarrhoea  is 
a  frequent  symptom,  the  appearance  of  the  patient — 
there  is  marked  pallor — and  the  history  of  profuse 
night-sweats  are  suggestive,  the  patient  can  usually 
get  about  without  difficulty,  and  the  tumour  is  firmer 
and  bears  handling  better  than  that  due  to  appendicitis. 
As  an  exception  to  this  chronic  course,  I  have  operated 
upon  a  case,  that  of  a  young  man  who  was  admitted 
very  ill,  with  high  temperature  and  all  the  signs  of 
general  peritonitis,  and  whose  illness  had  commenced 
five  days  before  with  sudden,  severe,  abdominal  pain. 
and  have  found  general  tuberculous  peritonitis  when 
a  diagnosis  had  been  made  that  his  condition  was  due 
to  acute  appendicitis. 

In  malignant  cases  the  first  symptoms  have  usually 
been  bowel  disturbances,  constipation  alternating  with 
diarrhoea,  rumbling  pain  and  forcible  intestinal  con- 
tractions, both  increased  by  purgatives,  and  all  result- 
ing from  contraction  of  the  ileo-caecal  valve.  Blood 
may  be  present  in  the  evacuations,  and  the  course  is 
usually  chronic.  The  age  of  the  patient  may  suggest 
caution,  but  it  has  to  be  remembered  that  an  appendix 
abscess  in  old  people  may  produce  none  of  the  urgent 
illness  it  does  in  the  young.  If  a  hard,  nodular,  well- 
defined  tumour  is  found  along  with  the  symptoms 
mentioned,  a  diagnosis  of  cancer  involving  the  ileo-cxcal 
valve  may  be  easy. 

(To  be  concluded  in  our  next.) 

A    NON-TOXIC    PREPARATION 
OF    IODINE. 

By  WYATT  WINGRAVE,  M.D.Dur., 

PhytfoUn  to  the  Central  Londoa  Thro**  aad  Bar  Hospital. 

Being  specially  interested  in  the  supplemental 
treatment  of  enlarged  glands  and  adenoids  with 
iodine,  about  seven  years  ago  I  made  several 
experiments  with  preparations  of  that  drug,  with 
the  object  of  finding  one  which  could  be  given 
internally  in  large  doses  for  considerable  periods 
without  causing  any  symptom  of  iodism,  while 
exercising  its  specific  effects  on  lymphatic  en- 
largements. 

The  late  Mr.  Martindale  and  the  manager  oi 
Messrs.  Morson  and  Sons  were  good  enough  to 
try  several  formulae  for  me  in  their  laboratories, 
and  finally  succeeded  in  producing  an  easily 
made  compound  in  which  iodine  was  loosely  com- 
bined with  an  organic  substance,  and  rendering 


April  6,  1904- 


ORIGINAL   COMMUNICATIONS,  The  Medical  Press.     361 


it  fit  for  ready  absorption  without  causing  any 
irritation  of  the  digestive  canal,  and  affording  a 
high  physiological  activity  without  any  evidence 
olerance. 
This  preparation  I  have  prescribed  ever  since, 
both  in  hospital  and  private  practice,  and  having 
watched  lite  effects  have  come  to  the  conclusion 
that  it  has  fully  confirmed  my  first  estimate  of 
its  value. 

The  formula  which  I  am  now  using  has  been 
perfected  for  me  by  Mr.  W,  H.  Martindale,  is 
easily  prepared  and  very  palatable.  The  iodine 
is  in  loose  chemical  combination  with  tannic  acid t 
since  none  can  be  demonstrated  as  free,  yet  it  is 
sufficiently  tree  to  be  readily  given  up  to  the 
tissues  after  absorption,  and  consequently  there 
k  no  fear  of  any  local  intestinal  or  gastric  irritation, 
so  often  associated  with  the  administration  of  free 
iodine.  Such  combination  is  of  a  nature  similar 
to  that  of  oxyhemoglobin. 

Formula — Syr.   lodo-Tannic. 
Iodine,  2 J  grammes; 
Tannic  acid,  4  grammes  ; 

>hol  (oo  per  cent.),  38  cc,  ; 
Syrup,  95  to  75  cc. 
Dissolve  the  iodine  in  the  alcohol,  add  the  tannic 
C.  of  the  syrup  ;    heat  lo  just  below 
boiling-point  until  the  solution  affords  no  evidence 
iodine   with    the   starch  reaction  (about 
twenty  minutes:.     Cool  and  add  the  remainder  of 
the  syrup,  with  flavouring.     Each  drachm  con- 
2  grains  of  iodine.     It  may  be  given  in  doses 
of  J  to  2  drachms  in  water  or  win«  be tore  meals, 
according  to  age. 

I  have  found  that  children  tolerate  it  well,  and 
it  has  proved  specially  useful  in  cases  of  chronic 
lymphadenitis,  associated  with,  or  independent 
-denoids  and  enlarged  faucial  tonsils,  particu- 
larly when  the  cervical  glands  persist  after  ton- 
sillotomy. It  is  further  indicated  in  those  chil- 
dren who  possess  but  slightly  enlarged  faucial 
and  pharyngeal  tonsils,  and  in  whom  opera- 
tion is  contra- indicated  or  objected  to. 

In  atrophic  rhinitis  it  has  afforded  very  gratify- 
ing results,  especially  when  combined  with  arsenic  ; 
also  in  simple  bronchocclc  supplemented  with  the 
use  of  pigment    of    iodine-oleatc   (1  in  9  of  oleic 

Such  an  organic  combination  of  iodine  is  by 
no  means  new,  as  it  was  introduced  many  years 
ago  in  the  form  of  a  wine  /'  vin  NourryT')t  but  BO  Ua 
as  I  know,  no  definite  or  simple  formula  suitable 
for  prescribing  purposes  has  been  available. 
It  is  for  this  reason,  and  for  the  very  satisfactory 
results  which  it  has  afforded  in  a  prolonged  trial, 
that  I  venture  to  recommend  it. 


THEORIES    OF    COLOUR 
VISION. 

By  F.  W.  EDR1DGE-GREEN,  M.D  ,  F.R.C.S, 

In   this   paper   I   will   review  a  certain  number 

of  the  well-known  facts  of  colour  vision  to  prove 

that    a    theory    which    presupposes    definite    sub- 

stances  of   fibres   in    the   retina  corresponding  to 

certain  colour  sensations  cannot  be  true,  and  that 

,ust,  therefore,  seek  for  another  explanation 

of  the  phenomena  of  colour. 

The  limitation  of  the  number  of  colour  sensa- 

was    thought    to   be    necessary,   because   it 

wemed  impossible  that  a  single  fibre  of  the  optic 

ocrve    could    convey    impulses    corresponding    to 


all  waves  of  light,  but  exactly  the  same  was  said 
with  regard  to  the  transmission  of  sound  by  ft 
single  wire,  and  the  telephone  shows  how  this  can 
be  accomplished  through  electricity.  The  theory 
was  also  said  to  agree  with  what  has  been  called 
the  law  of  the  specific  energy  of  nerves.  This 
so-called  law  was  based  on  the  following  experi- 
ment ;— It  was  found  that  when  a  divided  optic 
nerve  was  stimulated  by  heat,  electricity,  or  any 
mechanical  or  chemical  stimulus,  a  sensation  of 
light  was  caused,  and  the  inference  was  drawn 
that  the  nerve  fibres  could  only  convey  one  kind 
of  nervous  impulse,  the  difference  in  result  bern£ 
due  to  the  central  connections  of  the  nerve.  Not 
only  has  the  actual  experiment  itself  been  dis- 
puted— that  is  to  say,  observers  have  stimulated 
the  cut  section  of  the  optic  nerve  without  pro- 
ducing any  sensation  whatever,  but  we  might  just 
as  well  say  that  a  telephone  wire  was  incapable 
nveying  by  electricity  all  waves  of  sound 
because,  having  cut  off  the  transmitter,  all  stimuli 
applied  to  the  proximal  end  were  only  able  to 
give  rise  to,  if  anything,  a  similar  noise  at  the 
distal  receiver.  It  seems  to  me  tar  simpler  to 
assume  that  each  optic  nerve  fibre  is  able  to 
convey  impulses  corresponding  to  all  kinds  of 
light,  these  impulses  differing  in  quality  just  as 
the  waves  of  light  differ  in  wave  length.  Then, 
in  the  impulse  itself  we  have  the  physiological 
basis  of  light,  and  in  the  quality  of  the  impulse  the 
physiological  basis  of  colour. 

I  have  assumed  that  the  quality  of  the  impulse 
is  perceived  by  a  special  perceptive  centre  in  the 
brain  within  the  power  of  perceiving  differences 
possessed  by  that  centre  or  portions  of  that  centre. 

I.  The  Facts  of  Coiour+Blindness, — The  facts 
of  colour-blindness  are  absolutely  incompatible 
with  the  view  that  there  are  definite  fuudami 
colour  sensation  substances  in  the  retina.  Cases 
of  colour-blindness  may  be  divided  into  two 
classes  which  are  quite  separate  and  distinct  (nun 
each  other^  though  both  may  be  present  in  t be 
same  person.  In  the  first  class  there  is  light  as 
well  as  colour  loss.  In  the  second  class  the  per- 
ception of  light  is  the  same  as,  or  better  than,  the 
normal-sighted,  but  there  is  a  defect  in  the  per- 
ception of  colour.  In  the  first  class  certain  rays 
are  either  not  perceived  at  all  or  very  imperfectly, 
Both  these  classes  arc  represented  by  analogous 
conditions  in  the  perception  of  sounds.  The 
first  class  of  the  colour-blind  is  represented  by 
those  who  are  unable  to  hear  very  high  or  very 
low  notes,  The  second  class  of  the  colour- blind 
are  represented  by  those  who  possess  what  is  com- 
monly called  a  defective  musical  ear.  Colour-blind 
individuals  belonging  to  this  class  can  be  arranged 
in  a  series.  At  one  end  of  this  series  are  the  nor- 
mal-sighted, and  at  the  other  the  totally  colour- 
blind. The  colours  appear  at  the  points  of  greatest 
difference,  and  I  have  classified  the  colour- blind 
in  accordance  with  the  number  of  colours  which 
they  see  in  the  spectrum.  If  the  normal-sighted 
be  designated  hexachromic,  those  who  see  five 
colours  may  be  called  pentachromic,  those  who 
see  four  tctrachromic,  those  who  see  three  tri- 
ehromic,  those  who  see  two  dichromic,  and  the 
totally  colour-blind  monochromic.  There  are 
many  degrees  included  in  the  dichromic  class, 
there  may  or  may  not  be  a  neutral  band,  and  this 
is  widest  in  those  cases  approaching  nearly  to 
total  colour-blindness.  I  have  recorded  a  case  of 
a  patient  who  was  colour-blind  with  one  eye. 
It  is  an  interesting  fact  that  the  colour-blind  eye 


362    The  Medical  Prbss.         ORIGINAL  COMMUNICATIONS. 


April  6,  1904. 


was  much  the  better  of  the  two,  and  he  could  re- 
cognise fine  lines  in  the  spectrum  with  this  eye 
which  were  not  visible  to  the  other.  He  saw  the 
two  ends  of  the  spectrum  (a)  tinged  with  colour  and 
the  remainder  grey.  It  will  be  noticed  that  his 
colour  sensations  were  limited  to  the  extreme 
red  and  the  extreme  violet,  namely,  those  colours 
which  present  the  greatest  physical  contrast  to 
each  other.  Neither  the  red  nor  the  violet  ap- 
peared of  the  nature  of  a  primary  colour,  but  gave 
the  impression  that  they  were  largely  diluted  with 
grey.  A  theory  of  colour  vision  must  account  for 
a  case  of  this  kind,  and  also  for  the  other  varieties 
and  degrees  of  colour-blindness.  The  trichromic 
are  a  very  important  class,  and  any  theory  must 
account  for  the  fact  that  they  see  yellow  as  red- 
green,  and  blue  as  violet-green.  As  we  should 
theoretically  expect,  when  there  is  a  shortening 
of  the  spectrum  the  centres  of  the  colours  are 
moved  towards  the  unshortened  side.  It  is 
obvious  that  the  facts  of  colour-blindness  cannot 
be  explained  by  the  absence  of  one  or  more  sets 
of  fibres  or  substances.  This  was  my  primary 
objection  to  the  Young-Helmholz  theory,  and 
Helmholz  conceded  this  point  in  the  second  edition 
of  his  book. 

2.  The  Evolution  of  the  Colour  Sense. — All  the 
facts  which  can  be  obtained  from  the  examina- 
tion of  museums  or  literature  point  to  the  view 
that  the  sense  of  light  was  developed  first  and 
then  the  sense  of  colour,  those  rays  which  differ 
most  physically  being  the  first  to  be  differen- 
tiated. In  the  course  of  evolution  all  the  varie- 
ties of  psycho-physical  colour-blindness  have  been 
passed  through.  .  ^ 

3.  The  Class  of  the  Heptachromic. — Any  theory 
of  colour  vision  must  explain  why  it  is  that  those 
who  possess  a  very  acute  colour  perception  see 
seven  colours  in  the  spectrum,  as  for  example, 
Newton.  In  accordance  with  the  theory  which 
I  have  given,  this  seventh  colour  appears  at  the 
seventh  point  of  difference. 

4.  Contrast. — (1)  Simultaneous.  These  are 
easily  explained  on  the  view  that  colour  being  a 
point  of  difference,  this  becomes  more  marked 
on  comparison,  the  perceptive  centre  being  in  the 
most  favourable  position  for  the  detection  of  any 
difference.  If  we  contrast  a  yellow  with  a  greenish- 
yellow  the  yellow  inclines  to  orange  and  the 
greenish-yellow  to  yellow-green.  This  could  not 
be  explained  by  assuming  that  the  colours  differ 
by  the  addition  of  the  complementary  to  each. 
(2)  Successive.  There  is  one  fact  which  is  more 
quoted  than  any  other  as  evidence  of  definite 
substances  in  the  retina  representing  funda- 
mental sensations,  that  is,  that  after  looking  at 
blue-green  the  red  of  the  spectrum  appears  a 
more  saturated  red  than  when  seen  under  or- 
dinary circumstances.  But  the  same  occurs 
with  all  physiological  sensations.  For  instance, 
warm  water  feels  warmer  if  we  have  had  our 
hands  previously  in  cold  water,  and  if  one  hand 
be  put  in  cold  water  and  the  other  in  hot,  and 
then  both  be  plunged  into  lukewarm  water, 
the  water  feels  hot  to  the  one  hand  and  cold  to 
the  other.  A  sweet  substance  tastes  much  sweeter 
if  we  have  previously  tasted  a  sour  liquid.  A 
high  note  is  positively  disagreeable  in  its  shrill- 
ness if  the  previous  part  of  the  tune  has  been 
played  in  the  bass.  These  facts  are  only  evidence 
of  the  fatigue  which  takes  place  in  all  parts  of 


(a)  "Colour-blindness  and  Colour-perception."      International 
Scientific  Series. 


the  nervous  system,  and  which  gives  rise  to  a  false 
standard  of  comparison.  That  this  is  the  explana- 
tion is  proved  by  Burch's  experiments  on  artificial 
colour-blindness.  He  says :  "  The  temporary 
abolition  of  any  one  colour  sensation  is  without 
effect  on  the  intensity  of  the  remaining  colour 
sensations,  neither  increasing  nor  diminishing 
them  unless  they  also  have  been  to  some  extent 
implicated  in  the  light  used  for  producing  colour- 
blindness." (a) 

5.  After-Images. — A  positive  rose-coloured  after- 
image can  be  obtained  after  white  light  or  any 
spectral  colour.  The  ordinary  explanation  of 
this,  namely,  that  the  hypothetical  red  and  violet 
fibres  are  called  into  action  soner  than  those  for 
green,  cannot  be  true,  because  it  is  exceedingly 
difficult  to  obtain  this  after-image  after  spectral 
red,  and  very  easy  to  see  it  after  green.  It  would 
be  against  at he  whole  principle  of  the  theory  that 
the  red  fibres  should  be  excited  most  efficiently  by 
green.  But  if  we  assume  that  the  visual  sub- 
stance is  the  visual  purple,  then  we  have  an  easy 
explanation  of  the  facts. 

6.  Pathological  Facts. — Many  cases  have  been 
reported  in  which  the  perception  of  colour  has 
been  abolished,  whilst  the  perception  of  form  and 
light  has  not  been  altered.  All  objects  have  ap- 
peared of  different  shades  of  grey  as  in  a  photo- 
graph. In  each  case  disease  of  the  brain  has 
been  found.  A  similar  condition  can  be  produced 
by  hypnotism. 

7.  Colour  Fields. — Abney  (6)  has  examined  this 
subject  very  carefully,  and  comes  to  the  same 
conclusion  as  I  had  from  the  consideration  of 
other  facts.  He  says  :  "  These  results  as  they 
stand  do  not  seem  to  confirm  either  one  of  the 
two  main  theories  of  colour  vision.  The  existence 
of  a  colour  field  at  all  is  difficult  to  explain  on 
the  Young  theory,  the  fact  that  a  colour  field 
for  red  can  be  obtained  with  bright  illumination, 
although  the  disappearance  of  this  colour  and 
light  takes  place  almost  together  at  the  centre  of 
the  retina  is  not  easily  accounted  for  on  Hering's 
theory.  It  appears  as  if  light  were  the  funda- 
mental sensation  caused  by  the  main  vibration 
generally,  whilst  colour  is,  as  it  were,  an  overtone 
to  which  the  receiving  nerves  are  less  susceptible 
than  to  light  the  further  away  they  are  situated 
from  the  centre,  and  may  be  due  to  the  form  of 
the   vibration." 

8.  Luminosity  Curves. — The  fact  that  certain 
variations  occur  with  colour-blind  persons  will 
not  account  for  the  colour-blindness,  as  the  same 
variations  may  be  found  with  the  normal-sighted, 
and  there  are  many  colour-blind  persons  who  have 
exactly  the  same  perception  of  shade  as  the  normal- 
sighted.  It  is  easy  to  suppose  that  a  colour  may 
be  more  absorbed  by  "the  media  of  the  eye  in 
the  case  of  one  person  than  another,  but  that  the 
resultant  impulse  had  the  same  character  in  both 
though  the  luminosity  curves  differed  in  each  case. 

A  CASE  OF 

CANCER  OF  THE   RECTUM 

AND 

SIGMOID    FLEXURE  : 

REMOVAL    AND     RECOVERY. 

By  Dr.  VINCENT, 

Suzfton  to  the  Olril  Hospital.  MutUphsSuperieur,  Professor  of 

Surgery  at  the  School  of  Medicine,  Algiers,  eYe. 

*  Cancer  of  the  rectum  is  an  affection  which  calls 

(a)  ••Phil.  Trans.,"  1899.    P.  ft. 

(b)  "Phil.  Trans.,"  1897.  A.  p.  195. 


ArRiL  6,  1904- 


ORIGINAL  COMMUNICATIONS. 


TttK  Medical  Puss.    363 


ior  active  surgical  intervention.  The  urgency  of 
the  symptoms— pain,  hemorrhage,  and  more  or 
less  marked  intestinal  obstruction— to  which  it 
gives  rise  and  the  constitutional  impairment 
which  this  disease  determines  as  the  result  of  the 
presence  of  the  malignant  growth,  constrain  the 
surgeon  to  speedy  intervention,  even  though  the 
best  result  to  be  hoped  for  may  be  merely  relief 
of  the  patient's  sufferings. 

The  palliative  operation  promptly  determines  a 
rapid  improvement  in  the  patient's  general  condi- 
tion, to  such  an  extent,  indeed,  that  for  a  time  he 
may  persuade  himself  that  he  is  actually  cured.  If, 
on  the  other  hand,  we  select  the  radical  operation, 
■comprising  the  removal  of  the  neoplasm  in  tojot 
we  may  be  successful  in  obtaining  a  notable  pro- 
longation of  life  and,  in  certain  cases,  permanent 
■cure  of  the  disease.  The  rectum  appears  to  share 
with  the  breast  the  privilege  of  yielding  more 
satisfactory  and  consoling  results  than  we  are 
entitled  to  expect  from  operations  performed  for 
the  relief  of  visceral  cancer,  provided  always  that 
the  operation  be  undertaken  at  a  sufficiently  early 
period,  and  that  the  growth  be  freely  excised. 

Early  intervention  is  a  sine  qud  nan  of  success. 
Many  practitioners  do  not  seem  to  appreciate  the 
extreme  importance  of  this  factp  for  how  many 
patients  come  under  our  notice  who  have  gone  on 
month  after  month  with  cancer  of  the  rectum  btill 
undiagnosed,  simply  because  the  practitioner  has 
contented  himself  by  assuming  that  the  hemor- 
rhage, Ac,  were  due  to  piles  without  taking  the 
trouble  to  introduce  his  finger  into  the  anus  'J 
How  many  others,  in  whom  the  diagnosis  has  possi* 
bly  been  made,  but  who  pin  their  hopes  to  medical , 
and  therefore  necessarily  ineffectual,  treatment  ? 
If  those  upon  whom  devolves  the  responsibility 
of  treating  these  cases  were  fully  con- 
vinced of  the  efficacy  of  early  surgical  inter- 
vention, we  should  be  enabled  to  record  a  vastly 
larger  number  of  successful  cases  than  we  are  at 
present  in  a  position  to  do. 

The  desirability  of  generalising  a  knowledge  of 
the  possibility  of  a  cure  by  the  removal  of  rectal 
cancer  must  be  my  excuse  for  placing  on  record  the 
case  of  a  patient  on  whom  I  recently  practised 
extensive  ablation  of  the  rectum  for  cancer, 
extending  so  high  up  that  many  surgeons  would 
have  considered  it  inoperable.  The  growth 
occupied  the  upper  part  of  the  rectum  and  involved 
the  sigmoid  flexure,  Owing  to  its  seat  so  high  up 
the  only  way  in  which  it  could  be  got  at  for  the 
purpose  of  a  radical  operation  was  by  an  abdominal 
operation,  in  association  with  the  perineal  or  sacral 
method,  a  procedure  recommended  in  France  by 
Gaudier  and  Quenu.  This  operation  so  far  has 
not  been  very  irequently  resorted  to,  and  the 
resulfe  in  every  instance  deserve  to  be  placed  on 
record,  for  they  peremptorily  establish  the  benefit 
that  can  be  conferred  thereby  on  even  moribund 
patients  who,  after  the  operation,  are  often  re* 
stored  to  a  state  of  health  which  leaves  little  to  be 
desired. 

I  need  not  dwell  upon  the  details  of  the  opera- 
tive procedure,  for  they  are  strictly  in  conformity 
with  those  set  forth  by  Gaudier  and  Quenu,  the 
only  difference  being  due  to  my  personal  views  as 
to  the  possibility  of  pulling  down  the  rectum,  after 
having  isolated  it,  sufficiently  to  allow  of  its  re- 
section, and  the  suture  of  the  divided  end  to  the 
anus,  the  sphincter  action  whereof  I  was  desirous 
of  retaining.  In  this  particular  case  the  extension 
of  the  growth  upwards  rendered  this  resection  of  the 


rectum  impracticable,  and  I  was  therefore  obliged 
to  alter  my  plan  of  action  on  the  spot  and  to 
attack  the  disease  through  the  abdomen.  Never- 
theless this  case  taught  me  the  possibility  of  isolat* 
ing  the  lower  part  of  the  rectum  through  the  dilated 
anus.  Quenu  gets  at  it  through  the  sacral  region, 
a  step  which  greatly  complicates  the  operation, 
which  is  already  quite  serious  enough  of  itself. 
Gaudier  prefers  to  attack  it  through  the  perineum 
by  Lisfranc's  method,  but  this  case  has  convinced 
me  that  we  may  leave  the  floor  of  the  pelvis  intact  by 
simply  dilating  the  anus.  The  task,  I  must  admit, 
is  rather  more  arduous,  but  it  is  practicable.  It 
follows  that,  in  addition  to  the  ab  do  mi  no -perineal 
method  of  Gaudier,  and  the  abdo  mi  no -sacral 
method  of  Quenu,  we  also  have  at  our  disposal  an 
abdomino-anal  method. 

The  patient  in  question  was  a  government 
employe,  aet.  60 ,  admitted  to  the  Dupuytren  Ward 
of  the  Civil  Hospital  of  M  us  tap  ha  on  April  22nd, 
1903.  His  personal  history  presented  no  points  of 
particular  interest  beyond  the  fact  that,  at  the  age 
oi  a  i .  he  contracted  syphilis  in  Mexico.  He  under- 
went a  course  of  mercurial  treatment  and  has  since 
been  quite  free  from  any  symptoms  attributable 
thereto. 

About  two  years  ago  the  patient  noticed  blood 
in  his  motions,  but  attached  no  importance  to  the 
fact,  which  he  ascribed  to  the  presence  of  piles, 
from  which  he  had  previously  suffered  Soon, 
however,  the  bleeding  recurred  daily,  and  his 
medical  adviser,  adopting  the  patient's  own  view, 
treated  him  for  piles.  He  persevered  with  the 
treatment  for  some  ten  months,  not  only  without 
benefit,  but  he  steadily  got  worse  in  spite  of  it. 
His  appetite  failed  and  the  bleeding  had  become 
a  serious  matter. 

At  this  stage  he  consulted  another  practitioner 
who,  in  presence  of  the  bleeding,  and  the  glairy, 
foetid  stools,  examined  him,  diagnosed  stricture 
of  the  rectum,  and  recommended  the  following 
treatment — vfs.t  quinine,  by  the  mouth,  and 
quinine  injections  per  nee  turn.  After  eight  months 
of  this  tonic  treatment  the  patient's  general 
health  appears  to  have  improved  somewhat, 
but  defaecation  had  become  even  more  difficult, 
the  bowels  being  relieved  only  at  intervals  of  several 
days  and  then  only  after  the  use  of  strong  purga- 
tives or  by  the  aid  of  enemata.  J 

In  March,  1903,  he  came  to  see  me,  and  lat  once 
concluded  in  favour  of  immediate  operation  for  the 
removal  of  cancer  of  the  rectum,  and  relief  of  the 
obstruction  occasioned  thereby. 

On  admission,  the  patient's  general  condition  was 
decidedly  bad.  His  complexion  was  straw- 
coloured,  he  was  greatly  emaciated,  indicative  of 
the  onset  of  malignant  cachexia,  his  strength  and 
appetite  were  markedly  diminished,  and  he  was 
obviously  suffering  in  a  marked  degree  from  intoxi* 
cation  due  to  f^cal  retention.  He  only  had  a 
motion  every  eight  days  or  so,  in  spite  of  active 
purgatives,  and  then  he  has  acute  diarrhoea.  The 
motions  were  neither  grooved  nor  flattened; 
They  were  always  glairy  and  blood  -stained,  and 
defaecation  was  always  accompanied  by  pain. 

On  rectal  examination,  at  a  spot  some  nine  cen- 
timetres from  the  anal  margin,  I  made  out  a  tumour 
which  impinged  upon  the  lumen  of  the  gut  in  the 
form  of  a  thick. annular  constriction,  leaving  an 
aperture  about  the  sire  of  a  silver  fourpenny  piece. 
The  tumour  was  movable,  it  could  be  pushed  up 
with  the  finger  and  was  apparently  free  from  any 
adhesion  to    the   pelvic  floor.     Though  carefully 


364    The  Medical  Press.    THE  OUT-PATIENT  DEPARTMENTS. 


April  6,  1904. 


made,  the  examination  was  followed  by  bleeding. 
The  surface  of  the  stricture  was  fungous  and 
rugous,  irregularly  hard  and  very  friable.  Frag- 
ments of  tissue  came  away  on  the  examining  finger. 
The  limits  of  the  growth  above  could  not  be  made 
out  by  abdominal  palpation,  but  the  inguinal 
glands  were  noticed  to  be  enlarged. 

I  proposed  to  remove  the  growth  in  its  entirety, 
but  before  doing  so,  in  order  to  obtain  antisepsis, 
as  far  as  possible,  of  the  field  of  operation,  I  created 
an  artificial  anus  through  the  descending  colon 
(methodofMaydl-Reclos;,unoerrachi-cocainisation. 
I  took  advantage  of  this  laparotomy  to  explore 
the  tumour,  which  reacheo  up  to  the  level  of  the 
first  sacral  vertebra  just  below  the  bifurcation  of 
the  left  iliac  artery.  The  growth  was  limited 
to  the  gut,  it  was  movable  from  above  downwards, 
and  laterally  with  the  colon.  Apparently  it  had 
not  involved  the  meso-rectum,  and  the  pelvic 
glands  were  not  obviously  enlarged.  I  performed 
colostomy  high  up  in  the  descending  colon,  in  order 
to  give  freer  play  for  pulling  down  the  rectum  in 
the  event  of  rectal  extirpation  being  deemed 
practicable. 

The  motions  passed  through  this  artificial  rectum 
for  a  month  to  the  great  benefit  of  the  patient, 
who  gained  greatly  in  health  and  strength.  Mean- 
while, the  lower  segment  was  methodically  cleansed 
by  injections  of  permanganate  solution  and  oxygen 
water,  and  I  then  proceeded  to  remove  the  growth, 
forty  days  after  the  preliminary  operation. 

The  operation  was  done  in  several  stages.  First, 
dilatation  of  the  anus  with  section  of  the  rectum 
above  the  sphincter,  dissection  of  the  rectum  and 
plugging  of  the  passage  with  iodoform  gauze  right 
up  to  the  sigmoid  flexure.  I  managed  to  dissect 
out  the  lower  part  of  the  growth,  but  I  could  not 
reach  its  upper  part.  It  proved  to  be  slightly 
adherent  to  the  pelvic  floor.  In  view  of  the 
impossibility  of  pulling  down  the  segment  of  in- 
testine  just  above  the  cancer  I  decided  forthwith 
to  attack  it  vid  the  abdomen.  The  next  step  was 
an  incision  below  the  umbilicus  and  section  of  the 
pelvic  colon  on  a  level  with  the  left  psoas-iliacus 
muscle,  between  two  ligatures,  and  the  intestinal 
ends,  after  cauterisation  with  the  thermo-cautery, 
were  wrapped  in  gauze.  The  remaining  intestinal 
segment,  between  the  divided  colon  and  the  anus, 
consisted  of  two  parts,  one,  the  upper  part  near 
the  artificial  anus  and  the  lower  part  far  removed 
from  it.  The  meso  of  the  proximal  part  was 
ligatured  and  divided.  By  means  of  a  catheter 
introduced  through  the  anus  the  freed  colon  was 
doubled  on  itself  by  Quenu's  method  and  removed. 

Then  the  meso  of  the  distal  portion  was  ligatured 
in  part.  A  clamp  was  applied  vid  the  dilated  anus 
to  the  postero-inferior  part  of  the  rectum,  along 
the  curve,  and  the  growth  as  a  whole  was  removed 
by  the  aid  of  scissors  in  dividing  the  pelvic  floor, 
especiallv  in  the  prostatic  region.  The  length  of 
gut  removed  was  45  cc.  The  abdominal  wound 
was  closed  and  the  lower  part  of  the  pelvis 
plugged  with  gauze  vid  the  anus. 

In  a  few  days  the  patient,  who  was  much 
exhausted  after  the  operation,  began  to  regain 
strength,  thanks  to  injections  of  artificial  serum. 
A  small  abscess  formed  in  the  abdominal  wound, 
but  the  patient  was  able  to  sit  up  in  bed  within  a 
month,  and  was  able  to  take  ordinary  food. 

During  the  vacation,  Dr.  Goinard  removed  the 
enlarged  glands.  In  February,  1904,  the  patient, 
eight  months  after  the  operation,  prefers  to  make 


use  of  his  artificial  anus,  especially  as  he  can  com- 
pare it  with  the  gluteal  anus,  also  incontinent,  but 
less  easy  to  attend  to,  of  another  patient  operated 
on  by  Kraske's  method. 

The  patient  has  resumed  his  post  as  government 
officer  and  appears  to  be  in  perfect  health.  He  has 
gained  upwards  of  21  lbs.  in  weight.  He  was 
shown  at  the  last  meeting,  of  the  Medical  Society 
of  Algiers,  together  with  the  portion  of  ablated 
bowel. 


ZTbe  ®nt*pattent  departments. 

ST.    MARK'S    HOSPITAL. 

Surgical    Cases    under    the    care    of 

P.  Lockhart  Mummery,  B.Ch,,  F.R.C.S., 
Assiatant  Burgeon  to  the  HoepiUl. 

Case  I.  Pruritus  Ani. — A  healthy-looking  man, 
aet.  34.  He  stated  that  five  months  ago  he  began  to 
suffer  from  itching  round  the  anus.  This  itching: 
caused  him  constant  discomfort,  and  frequently  pre- 
vented him  from  sleeping  at  night.  He  had  tried 
numerous  ointments  and  other  forms  of  medication,, 
but  without  obtaining  any  relief. 

Seven  weeks  ago  he  began  to  notice  pain  after  the 
bowels  acted  ;  this  pain  was  never  very  severe,  and 
his  chief  complaint  was  the  itching,  which  had  been 
getting  much  worse  during  the  last  few  weeks. 

On  examining  the  anus,  it  was  found  that  the  skin 
for  about  an  inch  around  the  anal  margin  was  thickened, 
and  had  the  "  dead  white  "  appearance  so  often  seen 
in  these  cases.  On  examining  the  rectum  a  small 
ulcer  could  be  felt  on  the  posterior  wall,  and  with  a 
speculum  this  ulcer  was  seen  to  be  situated  just  inside 
the  anal  margin.  It  was  about  half  an  inch  in  length, 
and  the  muscular  fibres  of  the  sphincter  were  laid  bare 
in  its  base.  Under  eucaine  anaesthesia,  the  base  of 
the  ulcer  was  divided,  and  the  incision  carried  out 
through  the  fibres  of  the  external  sphincter,  freely- 
dividing  them.  When  seen  a  week  later,  the  incision 
was  almost  healed,  and  the  pruritus  much  relieved. 

Mr.  Mummery  pointed  out  that  this  case  illus- 
trates very  well  the  importance  of  carefully  examin- 
ing the  rectum  in  all  cases  of  pruritus  ani,  as  although 
a  local  cause  is  by  no  means  always  present, 
this  is  not  infrequently  the  case,  and  till  it  is  found 
and  treated  no  amount  of  general  treatment  will 
avail  to  cure  the  pruritus.  It  is  also  interesting  to 
notice  that  the  ulcer  did  not  give  rise  to  very  charac- 
teristic symptoms  of  that  affection.  It  was,  no  doubt, 
the  continuous  slight  discharge  and  irritation  caused 
by  the  ulcer  that  started  the  pruritus. 

The  next  case  affords  an  interesting  comparison 
with  this  one,  as  although  the  condition  was  almost 
identical,  the  symptoms  were  very  different. 

Case  II.  Anal  Fissure. — The  patient  was  a  married 
woman,  aet.  36.  Her  history  was  that  she  had  suffered 
for  three  months  from  "  very  bad  pain  "  after  the 
bowels  acted.  She  said  that  the  pain  came  on  about 
ten  minutes  after  the  bowels  acted,  and  lasted  for 
about  three  hours.  The  pain  was  so  severe  at  times 
that  she  had  to  lie  down  after  she  had  relieved  the 
bowels.  She  said  that  occasionally  she  had  noticed 
a  little  blood  after  the  bowels  acted.  She  also  stated 
that  she  had  been  very  much  constipated. 

On  examination,  a  small  ulcer  or  fissure  could  be 
felt  just  within  the  anal  margin,  on  the  posterior  wall 
of  the  rectum.  It  was  acutely  sensitive,  and  exami- 
nation was  difficult  and  painful.  Under  eucaine 
anaesthesia,  however,  a  speculum  was  passed,  and  the 
ulcer  cauterised  with  the  galvano-cautery.  She  was 
then  told  to  introduce  an  iodoform  suppository  daily. 
For  the  first  two  days  after  this  small  operation,  the 
parts  were  slightly  painful,  though  not  sufficient  to 
confine  her  to  bed.  The  bowels  have  acted  since 
without  causing  her  any  pain,  and  the  ulcer  was  quite 
healed  in  about  a  fortnight. 

Patients,  and  especially  women,  often  get.  very 
anxious  and  distressed  about  themselves  when  suffering. 


T004* 


TRANSACTIONS   OF  SOCIETIES.         THE  Medical  Press.     365 


Inmi   this  painful  complaint,  and   this,  added  to   the 

>- fleets  of   the   constipation   which  is   almost   in* 
variably  present,  and  which  is  caused  by  their  putting 
ofi  any  action  of  the  bowels  for  as  long  as  possible, 
ig  to  the  extreme  pain  which  it  causes,  often  results 
,n  th-  _■  into  a  very  bad  stateof  health;  and, 

m  fact,  the  illness  of  the  patient  may.  and  often  does, 
-r  rm  oat  of  all  proportion  to  the  cause.  In  some  cases 
of  fissure,  as  in  this  one,  the  application  of  the  cautery 
and  suitable  medication  is  all  that  is  needed  to  effect 
a  cure  of  the  condition.       In  more  chronic  cases,  and 

DM  where  there  is  much  hypertrophy  or  irritability 
of  the  sphincter,  dilatation  or  division  of  the  external 
sphincter  is  usually  necessary  before  the  fissure  can 
Ik  got  to  heal. 

IS  III,  Venous  Hemorrhoids. — The  patient 
a  dressmaker's  assistant*  a?t.  3$.  She  was  a  tall 
woman,  and  in  the  course  of  her  work  was  obliged  to 
do  a  great  deal  of  standing  during  the  greater  part  of 
day.  She  complained  of  pain  across  the  lower 
part  o{  the  back  and  down  the  sacrum.  The  pain 
came  on  towards  the  end  of  the  day  and  was  worst 
uing<  She  first  noticed  this  about  two 
months  ago.  There  was  often  a  protrusion  from  the 
anus  after  the  bowels  had  acted,  but  she  had  never 
noticed  any  blood. 

On  examination  fc  the  whole  of  the  lower  part  of  the 
rectum  was  seen  to  be  rather  congested  and  swollen, 
and  bluish  in  colour.  There  were  no  individual  piles, 
but  the  whole  of  the  mucous  membrane  just  inside  the 
anus  was  in  a  haemorrhoidal  Condition,  and  on  separat- 
ing the  sphincter,  a  large  and  bluish  mass  of  pile -like 
tissue  could  be  seen.  The  mucous  membrane  was 
much  thinned,  and  looked  as  if  it  would  give  way* 
this  patient  was  given  an  astringent  ointment,  she 
was  told  to  carefully  regulate  her  bo  web,  and  to  use  a 
cold  water  douche  daily* 

This  1*  one  of  those  cases  of  piles  which  is  comparable 

<nx  of  the  legs.     The  veins  of  the  rectum  are  111 

B  similar  condition,  in  these  cases,  to  the  veins  of  the 

leg  in  a  bad  case  of  vari\. 

They  occur  in  the  same  typeof  patient*  and  from  the 

lisposing  causes*  namely,  prolonged  standing 

and  constipation,     In  some  cases  there  is  a  primary 

nital  cause  in  the  shape  of  absence  or  inefficiency 

C  valves.  It  not  infrequently  happens  that  one 
rinds  piles  of  this  nature  and  varix  of  the  leg  associated 
111  the  -ame  patient, 

The  indications  for  treatment  in  cases  of  this  nature 
arc  towards  general*  rather  than  local,  treatment. 
The  boweh  should  be  carefully  regulated,  and,  if 
got  to  act  just  previous  to  retiring  to  bed. 
ilic  purges  must  be  avoided.  Careful  regulation 
of  the  habits  and  dietary  are  also  important,  and  cold 
douches  or  si  tz -baths  are  most  useful  in  relieving  the 
congestion  and  improving  the  tone  of  the  parts. 
Operation  is  not  indicated  unless  there  is  much  bleeding, 

rdess  the  condition  fails  to  react  to  treatment. 

I  alter  operation  in  these  cases  there  is  sometimes 
a  tendency  to  recurrence  unless  care  is  exercised. 

■  IV  Cart- interna  of  Rectum. — The  next  case 
was  a  woman,  a?t.  63.  She  complained  of  piles  and 
bleeding  when  the  bowels  acted.  On  examining  her, 
the  anus  was  found  to  be  patulous*  and  there  was  a 
large  mass  of  partially  prolapsed  piles  protruding. 
On  examining  the  rectum  a  large  carcinomatous 
growth  was  discovered  on  the  anterior  wall  of  the 
rectum,  and  just  above  the  internal  sphincter.  On 
examining  the  vagina,  it  was  found  that  the  growth 
■  lid   not   involve   the   uterus  or  cervix,   and   that   the 

us  membrane  of  the 'posterior  fornix  was  free  from 
the  tumour.  It  was  possible  to  pass  the  finger  well 
above  the  growth  in  the  rectum,  and  the  tumour  itself 
was  not  fixed.  In  fact,  the  case  was  a  fairly  favourable 
one  for  excision,  and  this  was  advised. 

This  case  illustrates  the  great  importance  of  always 

carefully  examining   the  rectum  in  all    affections  of 

the    rectum    or    anus*    especial Iv    in    elderly    people. 

Without    an   examination   of    the    rectum,    this    case 

ht  easily  have  been  mistaken  for  one  of  ordinary 

ial  hemorrhoids*  and  treated  with  ointment,  Ac* 


in  which  case  the  true  nature  of  the  case  would  prob- 
ably not  have  been  discovered  until  it  was  too  late 
to  have  done  anything  but  colotomv . 


^Transactions  of  Societies, 


NORTH     OF     ENGLAND     OBSTETRICAL     AND 

\ ECOLOGICAL  SOCIETY. 
Meeting  held  at  Liverpool,  Friday,  March  j;th, 
1904- 


Dr.  W,  J,  Sinclair,  President,  in  the  Chair. 

I*r  Lloyd  Roberts  (Manchester)  related  a  case  of 
epithelioma  of  the  clitoris.  The  disease  began  in  the 
glans,  and  not,  as  is  usual,  in  the  prepuce,  which  in  this 
instance  could  be  freely  separated  from  the  glans. 
Stress  was  laid  on  the  early  and  persistent  occurrence 
of  intolerable  itching  and  smarting  in  these  cases,  and 
on  the  late  appearance  of  pain.  Dr.  Roberts  had  only 
seen  three  cases  of  the  disease,  and  the  age  of  the  patients 
was  always  over  50- 

Dr.  Briggs  remarked  on  the  rarity  of  the  condition 
as  compared  with  the  frequency  of  cancer  of  the  penis. 

The  President  said  that  despite  its  infrequency,  the 
condition  was  usually  seen  in  an  early  stage,  hut  its 
treatment  was  unsatisfactory,  as  speedy  recurrence 
usually  took  place. 

THE     TREATMENT     OF     RUPTURED     ECTOPIC     GESTATION. 

Dr,  Nathan  Raw  read  notes  of  three  cases  of  rup- 
tured tubal  pregnancy  which  had  come  under  his  care 
in  the  hospital  recently.  In  two  of  the  cases  the  onset 
was  sudden  and  alarming,  the  patient  becoming  rapidly 
collapsed  and  semi-conscious,  with  all  the  symptoms  of 
serious  internal  hemorrhage.  In  the  third  case  the 
onset  was  mild  in  its  symptoms,  and  the  haemorrhage 
was  limited  and  not  progressive,  but  in  the  course  of 
ten  days  bleeding  recurred  with  most  alarming 
symptoms  of  collapse.  In  all  three  cases  the  ab- 
domen was  opened  and  found  to  be  full  of  fluid  and 
clotted  blood.  The  ruptured  tubes  were  ligatured 
and  removed*  recovery  following  in  two  cases  ;  the 
t hir d  died  t  wo  da y s  a f  t ef  t r o m  sh o c k .  D  r .  Raw  s  t  rongly 
advocated  early  operation  in  all  cases  where  the 
haemorrhage  was  serious  and  progressive ,  although  in 
a  few  cases  it  was  desirable  to  wait  a  few  hours  until 
the  patient  had  rallied  from  the  state  of  collapse. 

Dr.  Briggs  {Liverpool)  could  not  realise  the  meaning 
of  the  expression  Hi  an  abdomen  full  of  blood/'  He  had 
never  seen  it,  and  felt  that  hurried  operations  were  a 
mistake*  He  had  never  operated  upon  a  patient  who 
was  in  a  state  of  collapse,  although  it  was  easy  to  be 
persuaded  that  the  patient  was  dying, 

Dr,  Blair  Bell  (Liverpool)  thought  that  collapse 
should  be  treated  by  transfusion,  which  was  a  some- 
what neglected  method  of  treatment.  Probably  the 
transfusion  of  four  or  five  pints,  together  with  some 
adrenalin,  would  allow  of  an  operation  being  performed 
in  an  hour's  time. 

Dr.  Lloyd  Roberts  (Manchester)  held  that  opera- 
tion should  be  carried  out  as  soon  as  possible  after 
rupture  had  occurred.  When  there  were  signs  of  severe 
loss  ol  blood  it  was  impossible  to  tell  whether  the 
bleeding  was  persisting  or  not,  therefore  it  was  safer  to 
open  the  abdomen. 

Dr.  Favell  (Sheffield)  suggested  that  implantation 
of  the  ovum  in  the  isthmus  of  the  tube  might  account 
for  the  severe  bleeding  in  Dr.  Raw's  case. 

Dr,  Donald  ( Manchester )  said  that  his  experience 
of  ruptured  tubal  pregnancy  amounted  to  four  cases, 
and  he  considered  that  many  cases  of  so-called  rupture 
were  instances  of  tubal  abortion  or  tubal  mole  forma- 
tion. If  the  tube  had  undoubtedly  ruptured,  operation 
should  be  performed  at  once.  It  was  possible  that  the 
bleeding  might  cease  if  the  patient  became  profoundly 
collapsed,  but  as  soon  as  she  rallied  the  haemorrhage 
would  recommence. 

Dr,  Arnold  Lea  (Manchester)  had  had  four  cases  in 
which  the  tube  was  actually  bleeding  when  the  abdomen 
was  opened*     As  a  preliminary  measure  in  such  cases 


366     The  Medical  Press. 


TRANSACTIONS  OF  SOCIETIES. 


April  6,  1904. 


he  had  found  benefit  from  placing  a  heavy  sandbag  oyer 
the  abdomen  to  diminish  the  amount  of  blood  passing 
along  the  abdominal  aorta  until  preparations  for 
operation  were  completed.  He  thought  it  ought  to  be 
possible  to  make  an  exact  diagnosis  as  to  the  continu- 
ance or  arrest  of  bleeding. 

Dr.  Walter  (Manchester)  took  Dr.  Donald's  views. 
A  bleeding  vessel  in  the  tube  ought  to  be  treated  on 
ordinary  surgical  principles.  The  difficulty  was  to 
know  whether  the  haemorrhage  was  progressing.  A 
history  of  previous  collapses  was  in  favour  of  a  waiting 
policy,  but  even  under  such  circumstances  the  re- 
sponsibility was  very  great. 

Dr.  Gemmell  (Liverpool)  thought  that  the  sym- 
ptoms in  tubal  abortion  were  due  rather  to  peritoneal 
irritation  than  to  loss  of  blood,  and  considered  that 
these  two  conditions  could  be  differentiated. 

Dr.  J.  M.  C.  Given  (Liverpool)  appealed,  from  the 
general  practitioner's  point  of  view,  for  some  guidance 
on  this  somewhat  bewildering  matter. 

The  President  remarked  that  in  these  cases  the 
difficulties  were  not  apparent  to  him.  He  had  repeatedly 
seen  the  abdomen  full  of  blood,  and  sometimes  actually 
distended  by  it. 

Dr.  Grimsdale  (Liverpool)  having*  spoken.  Dr. 
Raw  replied. 

ULSTER  MEDICAL  SOCIETY. 

Meeting  held  in   the  Physiological  Laboratory, 

Queen's  College,  Belfast,  March  24TH. 


The  President,  Dr.  John  Campbell,  F.R.C.S.,  in  the 
Chair. 


Professor  T.  H.  Milroy  gave  a  microscopic 
demonstration  of 

ascending  degenerations  in  the  spinal  cord, 
after  section  of  the  posterior  sacral  roots.  He  showed 
that  while  in  the  lower  parts  of  the  cord  the  posterior, 
columns  were  full  of  degenerated  fibres,  in  the  higher 
parts  they  were  only  found  in  the  postero-internal  zone, 
owing  to  healthy  fibres  entering  and  filling  up  the  space. 
The  degenerated  fibres  mostly  ended  in  the  funiculus 
gracilis. 

Professor  T.  H.  Milroy  also  showed  a  method  of 
demonstrating  the 

ACTION    OF    DRUGS    UPON    THE    BLOOD    PRESSURE, 

and  upon  the  volume  of  organs.  The  novelty  of  this 
method  consisted  in  the  use  of  moulds  made  to  fit  the 
organs  instead  of  the  usual  brass  oncometers,  the 
moulds  being  very  rapidly  constructed  from  dental 
wax. 

Professor  Milroy  gave  a  demonstration  of  the  action 
of  light  of  different  wave  lengths  upon  the  retina.  In 
experimenting  with  the  ova  of  trout,  he  had  found  that 
the  pigment  cells  began  to  respond  to  light  long  before 
the  rod  and  cone  layer  is  developed. 

Dr.  J.  A.  Milroy  read  a  paper  on  "  Some  Products 
of  the  Action  of  Reducing  Agents  on  Blood  Pigment, 
considered  in  their  relation  to  the  pigments  of  urine 
and  bile." 

UROLOGY. 

Dr.  J.  A.  Milroy  gave  a  demonstration  of  the 
methods  for  the  recognition  of  (a)  reducing  substances 
other  than  glucose  which  may  be  present  in  the  urine ; 
(b)  indican  and  other  aromatic  substances  in  the  urine. 
Carbohydrates,  such  as  pentoses,  are  found  in  urine  in 
pancreatic  diabetes,  and  the  chief  distinctive  test  is  as 
follows : — 1  o  a  small  quantity  of  urine  add  an  equal 
quantity  of  concentrated  hydrochloric  acid  and  a  few 
granules  of  phloro-glucine,  and  heat  to  boiling  point ; 
if  pentoses  are  present  we  get  a  cherry  red  colour.  The 
pigment  precipitate  may  easily  be  extracted  with 
amyl  alcohol  and  examined  in  the  spectroscope.  To 
recognise  indican,  the  following  method  was  recom- 
mended : — To  a  small  quantity  of  urine  add  an  equal 
quantity  of  hydrochloric  acid,  and  then  an  equal  volume 
of  chloroform ;  shake  well  and  add  calcium  hydrochloride 
drop  by  drop  very  slowly.  If  indican  is  present  an 
indigo  blue  colour  is  produced.  If  the  indican  is  very 
abundant  the  oxygen  of  the  air  may  suffice  to  oxydise 
it  without  the  calcium  hydrochloride,  and  the  blue 


colour  may  be^got'merely  by  heating  and  shaking  well 
after  adding  the  chloroform.  To  recognise  carbolic 
acid  a  considerable  quantity  of  urine  must  be  taken, 
not  less  than  half  a  litre,  and  strong  sulphuric  acid  added 
to  it  till  it  contains  5  per  cent,  of  acid.  This  is  dis- 
tilled, and  the  distillate  will  give  the  tribromphenol 
test  for  carbolic  acid  if  it  is  present.  These  tests- 
are  rapid  and  easy,  and  the  recognition  of  these  bodies 
is  of  considerable  practical  value,  as  showing  increased 
intestinal  decomposition. 

Professor  Symington  and  Dr.  Carnwath  showed  (a)- 
an  excellent  example  of  flat-foot,  got  in  the  anatomical 
rooms.  It  illustrated  a  change  found  in  severe  cases ; 
the  os  calcis  rotates  so  much  on  its  long  axis  that  the- 
fibula  articulates  with  it  and  forms  a  large  false  joint. 
(b)  A  case  of  marked  disease  of  both  elbow-joints,  the 
other  joints  being  normal.  This  would  probably  be 
called  chronic  rheumatic  arthritis,  and  the  bilateral' 
symmetry  was  interesting,  (c)  A  case  of  hydrocephalus- 
and  spina  bifida,  in  which  a  dissection  had  been  made 
to  show  the  parts  involved,  (d)  A  set  of  photographs- 
to  show  the  topographical  anatomy  of  the  cerebellum. 

Professor  Lorrain  Smith  read  a  paper  on 

THE     INFECTIVITY     OF     TYPHOID     FEVER, 

in  which  he  criticised  the  recently  expressed  views  of 
Koch  on  the  subject,  and  applied  to  them  as  a  test  the 
distribution  of  the  disease  in  Belfast  during  the  years 
for  which  figures  are  available.  In  the  year  1900  there 
were  1,777  cases  notified,  occurring  in  763  streets,  the 
average  in  the  streets  infected  being  2*3  cases  per  street,, 
and  the  cases  where  only  one  occurred  in  the  street 
numbering  50  per  cent.  In  190 1  there  were  2,530  cases 
in  857  streets,  being  2*9  per  street,  and  40  per  cent,  being 
single  cases.  In  1902  there  were  1,044  cases  in  581 
streets,  being  i*8  per  street,  and  60  per  cent,  being 
single  cases.  About  50  per  cent,  of  these  cases  are  sent 
to  hospital,  but  on  Koch's  hypothesis  there  are  nine 
times  as  many  cases  with  such  mild  symptoms  that 
they  are  never  treated  and  yet  act  as  centres  of  infec- 
tion, so  that  only  about  5  per  cent,  of  the  persons- 
infected  (according  to  Koch)  are  isolated.  If  Koch's- 
theory  of  direct  infection  were  correct,  one  would  expect 
to  find  the  cases  occurring  much  more  in  centres  and 
groups  than  they  do,  according  to  these  figures. 

Dr.  Calwell  expressed  the  opinion  that  two  or  more 
cases  in  one  house  are  much  commoner  than  would 
appear  from  these  figures.  He  did  not,  however, 
believe  in  this  theory  of  direct  infection.  He  had  several 
times  seen  groups  of  cases  which  seemed  to  be  due  to 
direct  infection,  but  each  time  it  was  ultimately  found 
that  there  was  a  source  of  infection  outside. 

Professor  Lorrain  Smith  and  Dr.  A.  L.  Graham. 
gave  a  demonstration  of  the  toxic  effects  of  oxygen  at 
high  pressure  on  nerve  cellSv 

Dr.  John  M'Caw  and  Mr.  Robert  Campbell 
showed  a  specimen  of  congenital  stricture  of  the 
pylorus. 

Dr.  Dempsey  made  some  remarks  on  the  case,, 
which  he  had  seen. 

Dr.  John  M'Caw  showed  (a)  the  brain  from  a  case  of 
tuberculous  meningitis  ;  (b)  the  intestine  of  a  child  who* 
died  from  intussusception. 

Dr.  Thomas  Houston  gave  an  account  of  a  case  ot 

SEVERE  AN  AIM  I  A,  DUE  TO  SEPSIS, 

that  closely  simulated  pernicious  anaemia,  and  showed/ 
preparations  from  the  case.  He  said  that  secondary 
anaemia  could  generally  be  distinguished  from  pernicious 
anaemia  by  the  blood,  but  in  this  case,  in  which  the- 
patient  had  been  in  failing  health  for  nine  months,  the 
blood  closely  simulated  that  of  pernicious  anaemia,  the- 
only  point  of  difference  being  a  marked  leucocytosis- 
The  diagnosis  was  a  matter  of  doubt,  and  the  case  was 
only  explained  by  the  autopsy,  when  a  large,  sloughing 
fibroid  was  found  to  have  ulcerated  into  the  intestine. 
He  could  offer  no  explanation  of  the  fact  that  the  blood 
differed  so  much  from  that  of  an  ordinary  case  of  severe 
secondary  anaemia. 

At  the  conclusion  of  the  scientific  business.  Sir 
^/illiam  Whitla  moved  that  a  letter  of  condolence  be 
sent  to  the  relatives  of  the  late  Dr.  Stuart,  of  Bailymena* 
This  was  seconded  by  Professor  Byers  and  passed. 

Captain  M'Clelland,  M.B.,  Bangor;    and  Dr.  Wm. 


Apart  6,   1904 


SPECIAL  ARTICLES. 


Tm  MEprCAL  Fbess.      367 


Bumside,    Belfast,    were    elected    members    of      the 


Special  articles. 

BRITISH    SANATORIA    FOR    CONSUMPTION.— 
XXXIX. 


[by  our  special  medical  commissioner.] 


THE     MANCHESTER     HOSPITAL     FOR 
CONSUMPTION, 

The  Manchester  Hospital  for  Consumption  has  its 
in  patient  department  at  Bowi.!»n,  in  Cheshire.  Out- 
fits are  seen  in  the  city  at  Hardman  Strc .■; 
Deansgate,  A  large  sanatorium  is  in  course  oi  erection 
on  the  borders  of  Delamere  Forest,  some  three  and  a  half 
miles  from  Frodsham,  the  entire  cost  of  which  is  being 
met  by  the  munificence  of  the  Chairman,  Mr.  W.  J, 
Crossley.  We  have  recently  visited  this  sanatorium, 
and  hope  to  describe  it  in  a  subsequent  communication- 

The  hospital  at  Bowdon  is  as  far  as  possible  con- 
ducted in  accordance  with  modern  hygienic  methods ; 
the  grounds  are,  however,  limited,  and  are  surrounded 
by  residences,  and  Bowdon,  once  a  country  hillside,  is 
rapidly  becoming  a  little  commercial  and  manufacturing 
centre.  We  should  imagine  that  when  the  new  sana- 
torium is  completed  on  the  high  lands  of  Cheshire,  the 
committee  would  close  the  establishment  at  Bowdon ;, 
of,  at  all  events,  use  it  for  a  somewhat  different  class  of 
case.  The  establishment  consists  of  the  old  building, 
which  was  originally  apparently  a  private  residence, 
and  which  is  now  used  principally  as  an  administrative 
block,  although  it  also  contains  day  rooms  and  the 
common  dining-room. 

The  wards  are  large,  airy,  well-lit,  and,  considering 
the  limited  space  at  command,  well  placed-  The  wards 
i.»men  accommodate  26  patients,  and  are  56  ft, 
by  24  ft.  by  14  ft..  allowing  1.270  cubic  feet  per 
bed  :  and  42  ft.  by  24  ft.  by  14  ft-,  allowing  1,283  cubic 
teet  per  bed.  The  wards  for  men  accommodate  twenty- 
lour  patients,  and  are  50  ft,  by  24  it,  by  17  ft,  each, 
allowing  1,700  cubic  feet  per  bed,  ami  there  are  good 
bath-rooms  and  lavatory  accommodation.  There  is 
also  a  throat  room  and  dispensary. 

In  front  of  the  male  wards  are  lieKeuallen  where 
ripen -air  treatment  is  carried  out.  The  limited  extent 
of  the  grounds  does  not  allow  of  much  opportunity  for 
the  carrying  out  of  systematic  walking  exercise. 

A  medical  officer  resides  at  the  hospital,  and  there  is 
an  honorary  visiting  staff. 

We  have* studied  the  diet  chart  and  find  it  plain,  but 
good  and  abundant.  The  day's  routine  is  somewhat 
too  much  in  keeping  with  ancient  hospital  traditions. 
We  consider  it  undesirable  to  make  female  phthisical 
patients  rise  at  7.15,  when  breakfast  is  not  served  till 
We  also  believe  it  to  be  desirable  to  discontinue 
as  far  as  possible  the  regular  administration  of  medi- 
cines at  certain  hours,  as  thereby  patients  are  in  danger 
uJ  depending  more  on  drugs  than  on  the  disciplining  of 
their  lives  in  accordance  with  strict  hygienic  procedure. 

The  Manchester  Hospital  for  Consumption,  with 
limited  means  and  in  the  face  of  considerable  difficulties, 
is  accomplishing  excellent  work,  and  deserves  a  greatly 
increased  support  from  the  community  it  serves  so 
well.  The  hospital  issues  annually  a  full  report  which 
contains  much  information  concerning  the  medical 
Upsets  of  the  work. 


DUTY  OF  MEDICAL     MEN  AS  WITNESSES. 

The  opinion  of  witnesses  possessing  peculiar  skill  is 
admissible  in  courts  of  justice  whenever  the  subject- 
matter  of  inquiry  is  such  that  inexperienced  persons 
are  unlikely  to  prove  capable  of  forming  a  correct 
judgment  upon  it  without  such  assistance  j  in  other 
words,  when  it  so  far  partakes  of  the  nature  of  a  science 
as  to  require  a  course  ot  previous  habit  or  study  in  order 
to  attain  to  a  knowledge  of  it.  Thus,  the 
opinions  of  medical  men  are  constantly  admitted  as 
to  the  cause  o(  death  or  of  disease,  or  the  consequences 
of  wounds,  and  as  to  the  sane  or  insane  state  of  a 


person *&  mind,  as  collected  from  a  number  of  circum- 
stances, and  as  to  other  subjects  of  professional  skill. 
Nothing  more  is  requisite  to  entitle  anyone  to  give 
evidence  as  a  medical  witness  than  that  he  has  been 
educated  in  his  profession,  nor  is  it  necessary  that  he 
should  be  engaged  in  the  practice  of  his  profession. 
The  tribunal  must  determine  the  weight  due  to  such 
testimony  in  eacb  particular  instance,  and  it  is  a 
question  of  fact  to  be  decided  by  the  court  at  the  trial 
whether  a  witness  offered  as  an  expert  has  the  necessary 
qualifications. 

Medical  men,  when  called  as  skilled  witnesses,  may 
only  say  what,  in  their  judgment,  would  be  the  result 
of  certain  facts  submitted  to  their  consideration,  and 
may  not  give  an  opinion  as  to  the  general  merits  of 
the  case,  or  on  things  with  which  a  jurv  may  be  sup* 
posed  to  be  equally  well  acquainted.  Thus  the  opinion 
of  a  medical  witness  was  not  admitted  where  the  ques- 
tion was  whether  a  physician,  in  refusing  to  consult 
with  the  plain  tiff ,  had  honourably  and  faithfully  dis- 
charged his  duty  to  the  medical  profession,  nor  was 
such  opinion  admitted  as  to  whether  the  act  tor  which  a 
prisoner  was  being  tried  was,  taking  into  consideration 
the  other  testimony  given,  an  act  of  insanity,  but  the 
witness  -was  allowed  to  be  asked  whether  such  and  such 
appearances  proved  by  other  witnesses  were,  in  his 
judgment,  symptoms  of  insanity- 

Where  an  accused  person  is  supposed  to  be  insane, 
a  medical  man  conversant  with  the  disease  of  insanity, 
who  never  saw  the  prisoner  previously  to  the  trial, 
but  who  was  present  during  the  whole  trial  and  the 
examination  of  all  the  witnesses,  may  be  asked  his 
opinion  as  to  the  state  of  the  prisoner's  mind  at  lie 
time  of  the  commission  ot  the  alleged  crime,  or  his 
opinion  whether  the  prisoner  was  conscious*  at  the 
time  of  doing  the  act,  I  hat  he  was  acting  contrary  to 
law,  or  whether  he  was  labouring  under  any  and  what 
delusions  at  the  time,  when  tre  facts  are  admitted. 
or  not  disputed,  and  the  question  bet  ernes  one  of 
science  only.  On  an  indictment  for  manslaughter  by 
the  negligence  and  ignorance  of  a  medical  practitioner, 
medical  witnesses  may  be  called  to  give  their  opinion 
as  to  the  skill  of  the  accused.  On  a  plea  of  insanity 
at  the  time  of  making  a  contract  the  opinion  of  the 
medical  men  who  gave  certificates  on  which  the 
defendant  was  confined  as  insane,  at  or  about  the  time, 
is  only  evidence  for  the  jury,  who  must  judge  of  the 
grounds  on  which  it  was  formed.  In  an  action  against 
an  accoucheur  for  injury  sustained  by  his  want  of  skill, 
an  eminent  member  of  the  medical  proJession  win.  had 
been  in  court  and  heard  all  the  evidence  was  asked 
whether  he  was  of  opinion  that  there  had  been  any 
want  of  due  care  or  skill  on  the  part  of  the  defendant  ; 
the  question  in  that  form  was  objected  to,  and  the 
witness  was  then  asked,  with  the  sanction  of  the  court, 
whether  he  had  heard  anything  which  was  improper 
in  the  defendant's  treatment  of  the  patient,  in  a  medical 
point  of  view, 

A  physician  may  strengthen  his  recollection  by  re- 
ferring to  books  which  he  considers  to  be  works  of 
authority,  or  may  be  asked,  after  such  a  reference, 
whether  his  judgment  was  or  was  not  thereby  con- 
firmed^— and  this  though  medical  books  are  n<*t  directly 
admissible  in  evidence.  It  does  not,  however,  appear 
that  this  latter  course  has  ever  been  directly  sanctioned, 
though  a  medical  witness  has  been  asked  whether,  in 
the  course  of  his  reading,  he  has  not  found  a  certain 
mode  of  treatment  pruscrioed  ;  and  has  also  been  per- 
mitted, in  explanation  of  the  grounds  of  his  opinion, 
to  state  that  his  judgment  was  in  part  founded  on  the 
writings  of  his  professional  brethren.  A  counsel,  in 
his  address  to  the  jury,  has  no  right  to  quote  the 
opinions  of  medical  men  as  given  in  their  works. 

A  Medical  Man  has  no  Privilege, — Com  muni  cation  a 
made  to  legal  advisers  arc  privileged.  Medical  men 
and  clergymen,  on  the  other  hand,  are  bound  to  dis- 
close any  information  which,  by  acting  in  their  pro* 
fessional  character,  they  have  confidentially  acquired. 
The  propriety  of  extending  privilege  to  communica- 
tions to  clergymen  admitting  criminal  conduct  has 
been  strongly  urged,   on   the  ground    that  evil-doera 


368    The  Medical  Press. 


GERMANY. 


April  6,  1904. 


should  be  enabled  with  safety  to  disburden  their  guilty 
consciences,  and  by  spiritual'  instruction  and  discipline 
to  seek  pardon  and  relief .  The  Roman  Catholic  Church 
adopts  this  principle  in  its  fullest  extent,  not  only  by 
•excepting  such  confessions  from  the  general  rules  of 
evidence,  but  by  punishing  the  priest  who  reveals 
them,  and  even  allows  a  priest,  who  has  heard  a  con- 
fession as  such,  when  appearing  as  a  witness  in  his 
private  character,  to  swear  that  he  knows  nothing 
of  the  subject.  In  Scotland,  the  confession  of  a 
prisoner  in  custody,  while  preparing  for  his  trial,  in 
order  to  obtain  spiritual  advice  and  comfort,  is  privi- 
leged ;  but  communications  made  confidentially  to 
clergymen  in  the  ordinary  course  of  their  duty  are  not. 
By  the  common  law  of  England,  no  distinction  is  re- 
cognised between  clergymen  and  laymen,  and  all  con- 
fessions and  other  matters  not  confided  to  legal  ad- 
visers must  be  disclosed  when  required  for  the  pur- 
poses of  justice. 

Representations  made  by  a  sick  person  of  the  nature 
and  effects  of  the  malady  under  which  he  is  labouring 
are  receivable  as  original  evidence,  whether  they  be 
made  to  the  medical  attendant  or  to  any  other  person, 
though  the  former  are,  naturally,  entitled  to  greater 
weight  than  the  latter  ;  but  statements  in  writing  by 
patients  to  a  medical  man,  describing  the  symptoms 
of  the  illness  upon  which  the  medical  man  has  advised 
the  patient,  are  not  admissible  in  evidence. 

A  confidential  report  to  an  insurance  company  by 
its  medical  officer  as  to  the  state  of  health  of  a  party 
whose  life  is  proposed  to  be  insured  is  not  of  such  a  con- 
fidential character  as  to  entitle  it  to  the  privilege  of 
protection,  nor  is  the  report  made  by  the  medical 
officer  of  a  railway  company  as  to  the  injuries  sustained 
by  a  passenger  in  an  accident  on  their  line,  unless  such 
report  has  been  obtained  by  the  company  with  a  view 
to  impending  litigation. 

Before  any  contession  can  be  received  in  evidence  in  a 
criminal  case,  it  must  be  shown  that  to  have  been  volun- 
tarily made,  for  "a  confession  forced  from  the  mind 
by  the  flattery  ol  hopes,  or  by  the  torture  of  fear,  comes 
in  so  questionable  a  shape  when  it  is  to  be  considered 
as  the  evidence  of  guilt,  that  no  credit  ought  to  be 
given  to  it ;  and  therefore  it  is  rejected."  Although 
no  definite  rule  can  be  framed  which  shall  be  an  un- 
erring guide  in  any  supposable  case,  there  are  some 
points,  both  in  regard  to  the  person  by  whom  the 
promise  or  threat  is  made,  and  also  in  regard  to  the 
nature  of  the  inducement  itself,  on  which  the  judges 
have  pretty  generally  agreed.  It  is  very  clear  that  if 
the  promise  or  threat  be  made  by  anyone  having  au- 
thority over  the  prisoner  in  connection  with  the  prose- 
cution the  confession  will  be  rejected  as  not  being 
voluntary.  In  "  R.  v.  Downing"  (1840)  a  woman 
was  indicted  for  child-murder,  and  a  confession  made 
by  her  to  an  elderly  woman,  who  was  her  neighbour  and 
nurse,  and  who  told  her  it  was  better  to  confess,  was 
held  by  Lord  Abinger  to  be  inadmissible,  and  his 
lordship  refused  to  admit  evidence  of  a  confession 
subsequently  made  to  a  surgeon. 

Dying  Declarations. — Medical  men  are  frequently 
called  upon  to  give  evidence  with  regard  to  dying  de- 
clarations. Such  a  declaration,  it  must  be  remembered, 
is  not  admissible  in  evidence  unless  the  deceased  was 
conscious  of  approaching  death,  and  made  it  under  a 
sense  of  impending  death.  Any  hope  of  recovery, 
however  slight,  renders  such  a  declaration  inad- 
missible, and  the  question  turns  rather  on  the  state 
of  mind  at  the  time  of  making  the  declaration  than 
.upon  the  interval  between  it  and  the  death.  Thus, 
where,  in  a  trial  for  murder  by  administering  poison,  a 
surgeon  who  was  called  as  a  witness  said,  "  I  had  told 
the  deceased  she  would  not  recover,  and  she  was  per- 
fectly aware  of  the  danger.  I  told  her  I  understood 
she  had  taken  something;  she  said  that  she  had,  and 
that  damned  man  had  poisoned  her.  I  asked  her 
what  man,  and  she  said  C  (the  prisoner).  She  said 
•she  hoped  I  would  do  what  I  could  for  her,  for  the  sake 
of  her  family.  I  told  her  there  was  no  chance  of  her 
recovery  "  ;  "it  was  held  that  thi6  showed  such  a  degree 
of  hope  in  the  mind  of  the  deceased  as  rendered  the 


declaration  inadmissible,  and  the  whole  of  the  evidence  ' 
was  rejected. 

Jury  of  Matrons. — A  medical  man  may  be  called 
upon  to  assist  a  jury  of  matrons  erapannelled  to  try 
whether  a  prisoner  is  quick  with  child  ;  but  if  they 
require  the  evidence  of  a  surgeon  before  they  give 
their  verdict  they  must  return  into  court,  and  the 
surgeon  must,  after  he  has  examined  the  prisoner,  be 
sworn  and  examined  as  a  witness  in  open  court. 

Evidence  of  Deeased  Medical  Men. — An  entry  made 
by  a  medical  man,  in  the  course  of  his  profession,  is 
admissible  in  evidence  after  his  decease,  especially 
if  such  evidence  be  against  his  own  interests.  Thus, 
an  entry  made  by  a  deceased  man-midwife,  that  he 
had  delivered  a  woman  of  a  child  on  a  particular  day, 
and  referring  to  his  ledgers,  in  which  the  charge  for  his 
attendance  was  marked  paid,  was  admitted  as  evidence 
on  the  trial  of  an  issue  as  to  the  age  of  the  child. 

Scotch  Law. — By  the  Scotch  law  a  medical  man  may 
read  to  the  jury  as  part  of  his  evidence  a  report  of  any 
medical  facts  or  appearances  made  by  him  at  the  time, 
confirming  it,  at  its  close,  by  a  declaration  on  his  oath 
that  it  is  a  true  report.  As  a  matter  of  practice,  a 
medical  man  will  find  it  extremely  convenient  in 
any  case  in  regard  to  which  he  may  be  likely  to  be 
called  upon  to  give  evidence  in  the  future  to  draw  up  a 
report  or  memorandum  of  facts  and  appearances  at 
the  time  while  they  are  fresh  in  his  recollection,  for 
such  facts  and  appearances  are  generally  so  minute  and 
detailed  that  they  cannot  with  safety  be  entrusted  to 
the  memory,  and  although  the  witness  may  not  be 
allowed  to  read  such  a  report  as  part  of  his  evidence, 
according  to  English  law,  yet  he  will  always  be  at 
liberty  to  refer  to  it,  even  in  the  witness-box,  for  the 
purpose  of  refreshing  and  assisting  his  memory. 

Germany. 

[from    our   own   correspondent.] 


Bwux,  April  2nd.  1904. 
At  the  Society    f.  innere    Medizin,    Hr.    H.    Ury 
related  a  case  of 

Carcinoma  of  the  Pancreas, 
with  excessive  loss  of  fat  and  albumin  in  the  faeces. 
He  showed  the  intestinal  evacuation  of  a  woman, 
aet.  47,  and  not  jaundiced,  who,  since  the  end  of 
December  last  had  parted  with  fluid  fat  in  large 
quantities,  and  which  came  away  distinct  from  the 
other  faecal  matter.  It  quickly  got  solid  on  cooling* 
Besides  this,  although  but  little  albumin  was  given  in 
the  food,  numerous  well-preserved  long  muscular 
fibres  were  present,  with  an  abnormal  amount  of 
albumin.  The  faeces  showed  a  normal  amount  of 
urobiline ;  the  consistence  was  firm,  thick,  and 
pultaceous.  The  stomach  was  never  depressed, 
showed  normal  conditions  as  regarded  motility  and 
secretion,  the  liver  was  not  enlarged.  There  was 
nothing  special  about  the  urine.  After  1  grm.  of 
saloi  there  was  no  salicylic  reaction  in  the  urine  until 
after  four  hours  ;  and  after  3  grms.  iodopin  there  was 
no  iodine  in  the  urine  eight  hours  after.  From  the 
laboratory  experiments  it  was  shown  that  of  102*30 
grms.  of  fat,  72  per  cent,  passed  away  in  the  faeces, 
and  ol  the  nitrogen  given  40  per  cent,  was  lost  in  this 
way.  The  faecal  fat  consisted  mostly  of  butter  ;  82  per 
cent,  of  the  fat  was  not  split  up,  and  only  18  per  cent, 
split  up.  When  1  grm.  of  pancreon  was  given  five 
times  daily  with  the  same  diet  as  before,  the  loss  ot 
fat  was  58  per  cent.,  and  the  nitrogen  loss  27  per  cent. 
That  the  pancreon  acted  favourably  was  probable  from 
the  fact  that  when  the  fat  ration  was  reduced  to 
60  grms.  (one-third  in  the  form  of  emulsion),  no  visible 
fat  was  passed  during  fourteen  days.  On  the  basis  of 
animal  experiment  and  only  the  slightest  clinical  ex 
perience,  the  speaker  suggested  a  diagnosis  of  a  more 
or  less  perfect  shutting  off  of  the  pancreatic  secretion 


&TKTL   6,    1904- 


AUSTRIA, 


The  Medical  Press.   J&* 


the  intestines,  probably  due  to  carcinoma  of  the 
pancreas      He  was  the  more  inclined  to  this  op 

the  (act  that  two  year*  ago,  in  conjunction  with 
[»r    I  he  had  treated  an  exactly  anak 

vd urn     m  which  there  was  carcinoma 
l^ra  turn?,  shown  J 
\t  the  Medical  Society,  Professor  Waldever  discussed 
the 

Origin  of  Hernia. 
During  the  course  of  years,  he  said,  he  had  collected 
i  large  amount  of  materia!,  and  from  it  he  had  arrived 
at  the  conviction  that  when  a  hernia  formed  there  had 
*  been  a  congenital  disposition  to  it,  This  dis- 
lioaition  consisted  in  a  dilatation  of  all  the  exit  passages 
i a  people  who  hail  hernias,  even  if  they  remained 
empty.  He  would  not  say  that  the  hernia;  were  con- 
genital, but  the  disposition  to  them  was  so. 

If  in   inguinal  hernia   Ikjwel  and   testicle  lay  in  the 

same  sac.  the  hernia  must  have  been  congenital.     It 

the  tunica   vaginalis  propria  closed  close  above   the 

testicle  and  the  processus  vaginalis  remained  open,  so 

ihat  rupture  could  take  place,  and  the  covering  was 

at  tidied  to  the  tunica  vaginalis  propria  of  the  testicle, 

1   was  ool  i  congenital  hernia,  but  thetendency 

to  hernia  was  congenital. 

The  anterior  abdominal  wall  showed  three  depres- 

neal  side  which  were  bounded   by 

tftc  projections  of  three  (olds.     The  fold  in  the  middle 

wis  Jormed  by  the  obliterated  urachus  ;  between 

\kk  ;md  the  plica  vesica  lis  lateralis  lay  the  fovea  stipra- 

vesicahs  j    to  tne  aide  of  this,  and  separated   from   it 

'  last-named  fold,  lay  the  fovea  inguinatis  media  ; 

this  extended  laterally  to  the  plica  epigastrica  formed 

K  the  epigastric  artery  ;    then  followed  the  fovea  in- 

teralis.     Rupture  might  take  place  through 

all  three  depressions,  most  rarely   through   the    I 

Hjpra-vi SBTCali*.     All    three    kinds    took    place    at  the 

externa}  or  subcutaneous  inguinal   ring. 

Cooper's    fascia,    which    covered    the   inguinal    ring, 
was  the  external  muscle  fascia  of  the  external  oblique 
muscle  ;    it  mixed  with  the  aponeurosis  of  the  muscle, 
I  his  Cm, riers  fascia  formed  the  external  layer  of  the 
hernial  sac,  and  it  might  be  very  thick.     The  reason 
why   the   region   above    Pou  part's    ligament   was  so 
often  the  ]*nn*  of  exit  for  hernia  was  that  the  abdo- 
minal wall  was  thinnest  here,     The  transverse  muscle 
ceased    a  little  above   the  symphysis.     The   external 
<ie  had  a  division  here  forming  the  pillars  of  the 
ual  opening,  and  the  internal  oblique  muscle  was 
thin  at  this  spot. 
rr]ing   to    Braune.    a   bundle  passed    from    the 
•1  the  transverse  muscle  to  the  inguinal  ligament, 
to    the   sheath   ol    the   rectus  ;     both    these 
huudles  surrounded    the  fascia  inguinahs  media.     As 
regarded  obturator  hernia*,  they  passed  through  a  canal 
7  to  i  ■  L.tm.  m  length.     The   bone    here  was  not  so 
thick,  but   the  hernia  passed  it  obliquely.     The  obttt- 
ratic  foramen  was  filled  by  lumps  of  very  soft  fat,  which 
*U  always  present  even  in  thin  people.     The  hernia 
low    three    courses,  according    as   it  pushed 
the  fat,  the  obturator  muscle,  ur  the  pectineus  muscle 
e  it , 

I  D  regard  to  ischiadic  hernia  there  were  three  kinds— 

supra- piriformis,     iiifra-pynformis,     and 

toheroso-spiiiosa. 

He  uould  call  the  peritoneal  fascia  the  subperitoneal 

In  internal  hernia*  the  intestine  pushed  through 

aprevj  LisLy  formed  fossa  without  appearing  under  the 

Diaphragmatic*  ihemjse  'also  'passed  out  through  a 
rntal  split  or  divergence  of  fibres. 


Hustrta, 


[from  our  own  correspondent.] 


VibtMp  AprttSnd.UKk, 
Failures  of  Radiograph  v. 

At  the  Gesellschaft  Riehl  brought  forward  a 
female  patient  who  had  been  treated  with  the  Rontgen 
rays  for  chronic  eczema  two  years  ago.  One  year  after 
the  patient  was  supposed  to  be  cured  and  the  disease 
had  disappeared,  a  cicatricial  shrinking  commenced  in 
the  skin,  so  that  the  neck  and  upper  part  of  the  chest 
were  drawn  together,  as  after  a  severe  burn.  The 
large  veins  stand  out  prominently  in  the  atrop 
skin,  which  now  extends  down  the  right  arm4  render- 
ing it  useless  for  active  work.  He  thought  this  was  a 
good  example  of  some  of  the  results  of  radiography, 
which  should  not  be  lost  sight  ot  in  this  form  id  therapy. 
He  did  not  wish  to  discourage  thifl  form  of  treatment, 
but  he  would  like  to  see  the  failures  as  well  as  the 
su  cc  esses  re  co  rded , 

Scruff  agreed  with  Riehl  m  his  desire  for  more  in* 
formation  on  this  form  of  treatment,  and  related  a 
number  of  failures  that  had  occurred  in  his  own 
practice.  He  was  afraid  that  we  mete  now  thoorfttfl 
too  many  successes  without  failures,  and  bringing  the 
whole  treatment  into  disrepute. 

Osteitis  HEREDOLUEttcA* 

Lorenr  showed  a  girl,  art,  n.  who  had  had  osteitis 
Of  a  syphilitic  origin  that  caused  great  thickening  of 
the  tibia  as  well  as  extension  in  its  length*  ultimately 
producing  pes  vulgus. 

Reducing    Power    of    Milk, 

Hecht.  who  has  recently  been  carrying  on  experi- 
ments on  the  oxidising  qualities  of  milk,  surprised  the 
Geselischatt  with  the  announcement  that  milk 
has  also  a  reducing  property.  To  prove  this  fact  he 
placed  methylene  blue  with  a  little  paraffin  in  the  milk 
and  excluded  air  from  it.  In  a  short  time  the  reducing 
ferment  abstracted  the  colouring  of  the  methylene 
blue  from  the  milk,  thus  proving  the  presence  of  a 
reducing  agent.  Milk  with  a  great  amount  of  coins* 
trum  reduced  the  colour  much  more  quickly  than 
ordinary  milk,  while  poor  milk  had  little  power  over 
the  colour.  When  heat  was  applied  to  6o°  or  £oc, 
the  power  of  reducing  was  lost* 

Schlesinger  thought  that  Hecht  had  not  proved 
clearly  by  his  chemical  method  that  milk  had  really  a 
reducing  power,  as  the  sugar  present  in  the  milk  would 
undergo  the  changes  he  had  shown  without  the  presence 
of  a  ferment. 

Hecht  replied   by  saying   that  he  had  proved   this 

conclusively,  as  the  heating  checked  the  ferment  in  its 

reducing    power,   whereas  if    Schlesinger's    argument 

were   accepted,    the   reduction   woukl   not  commence 

but  it  actually  ceases  when  it  reaches  6o°. 

Asthma   and   the   Stetograph. 

Ho  f  bauer  showed  a  number  ol  curves  on  paper, 
which  he  considered  were  sufficient  to  prove  the  etiology 
ol  asthmatic  attacks,  and  thought  the  instrument 
was  capable  of  diagnosing  typical  cases  ot  asthma, 
which,  ftjtatg  with  the  clinical  symptoms,  could  eliminate 
il  at  once  from  such  co-rekited  diseases  as  1 
down,  bronchitis,  &e. 

Pauh  considered  Hofbauers  method  of  relying  on 
the  stetograph  lor  a  diagnosis  of  the  different  etiologies 
for  asthmatic  attacks  was  rather  vague.  As  the  steto- 
graph only  measured  the  excursion  of  the  ribs 
not  the  movement  ol  the  diaphragm,  it  could  not 
possibly  register  correctly  the  volume  of  air  inspired 
or  expired. 

Grossman  agreed  with  Pauh  that  the  instrument  was 


37°    Ths  Medical  Press. 


THE    OPERATING    THEATRES. 


April  6,  1904. 


inaccurate,  which  his  own  experience  had  proved. 
He  found  that  the  respiratory  curve  varied  according 
to  the  stage  of  the  disease  or  the  dyspnoea  present. 
It  is  found  experimentally  by  respiration  that  tracheal 
stenosis  first  produces  slow  and  deep  breathing,  while 
later  it  becomes  shallow  and  frequent. 

Hofbauer,  in  his  reply,  said  that  the  Rdntgen  rays 
proved  that  the  diaphragmatic  curve  was  exactly  in 
proportion  to  the  costal  curve.  With  this  data  we 
must  accept  the  fact  that  the  curve  of  the  diaphragm 
can  be  exactly  calculated  from  the  costal  curve.  He 
also  noted  that  Grossman  confounded  dyspnoea  with 
asthma,  which  he  thought  ought  to  be  distinguished. 
He  did  not  claim  the  results  of  the  stetograph  to  be 
absolute,  but  along  with  the  clinical  symptoms  the 
diagnosis  could  be  more  accurately  obtained,  just  as 
an  examination  of  the  urine  or  blood  assists  the  clinician 
in  other  diseases. 

Grossman  said  that  he  could  not  distinguish  between 
dyspnoea  and  asthma,  as  the  two  run  gradually  into 
each  other  without  any  line  of  limitation. 

Thiosinnamin  and  Pyloric  Stenosis. 

Hartz  records  a  successful  result  from  the  use  of 
thiosinnamin  in  pyloric  stenosis,  which  had  produced 
ectasia  ventriculi.  Before  performing  gastroenteros- 
tomy he  injected  a  15  per  cent,  alcoholic  solution  of 
thiosinnamin.  After  fourteen  injections  the  disease 
receded,  enabling  the  patient  to  take  food  without 
much  discomfort.  He  is  now  able  to  take  a  mixed 
diet  and  expresses  himself  as  quite  well. 


Dungan?- 


[from  our  own  correspondent.] 


Budapest,  April  2nd,  1904. 

At  the  recent  meeting  of  the  Budapest  Royal 
Society  of  Physicians,  Dr.  Magyar  read  a  paper  on 
"  The  Treatment  of  Hiccough  with  Corrosive  Sub- 
limate." During  last  summer  he  attended  three 
obstinate  cases  of  hiccough.  He  applied  every  hitherto 
known  method,  and  yet  failed  to  effect  the  least  result. 
Just  then  he  experienced  excellent  results  by  washing 
the  throat  with  sublimate  in  diphtheritic  cases  ;  there- 
fore he  tried  this  treatment  in  the  hiccough  cases. 
The  result  was  quite  surprising,  for  out  of  fourteen 
cases,  thirteen  entirely  recovered  in  about  eight  to 
sixteen  days. 

The  method  of  treatment  is  as  follows : — A  cotton 
tampon  well  soaked  in  1  per  cent,  corrosive  solution, 
or  a  brush,  is  carried  into  the  mouth ;  at  the  root  of 
the  tongue  it  is  squeezed  out,  so  that  the  liquid  well 
damps  the  epiglottis  and  the  neighbouring  mucous 
membranes  ;  then,  pulling  out  the  tampon,  we  touch 
the  tonsils,  the  uvula,  and  the  soft  palate  with  it.  In 
severe  cases  this  should  be  done  daily,  while  in  less 
serious  cases  washing  every  second  day  will  do. 
Sublimate  poisoning  need  not  be  feared. 

Dr.  Neinet  read  a  paper  on  "  The  Reduction  of  Fever 
by  the  External  Application  of  Guaiacol."  He  said 
that  Da  Costa  had  advocated  this  method  in  the  year 
1894.  Since  that  time  it  had  been  overlooked.  Neinet 
revived  this  method  in  his  hospital  clinic,  and  he  had 
no  reason  to  repent  it.  He  smeared  the  belly  of 
typhoid  patients  with  twenty  to  twenty-five  drops  of 
guaiacol,  and  afterwards  covered  it  with  some  im- 
permeable cloth.  In  all  cases  the  temperature  was 
greatly  reduced,  nominally  the  more,  the  higher  the 
fever  and  the  dose  of  the  medicine  had  been.  The 
temperature  was  reduced  slowly  but  steadily  ;  in  some 
cases  slight  shivering  and  perspiration  ensued.  Both 
the  pulse-beat  and  respiration  were  unchanged.    Some- 


times the  quantity  of  the  urine  was  increased,  but 
albumin  has  never  been  found  therein.  The  nervous 
and  cerebral  symptoms  have  decidedly  improved,  as 
also  the  wandering  and  drowsiness.  Though  the  smell 
of  the  medicine  is  disagreeable,  it  can  be  concealed  by 
mint  oil.  The  smearing  with  guaiacol  is  insofar 
better  than  the  cold  bath ;  it  is  not  inconvenient  for 
the  patient,  and  is  not  contra-indicated  in  case  of 
intestinal  haemorrhage. 

Dr.  Olah,  speaking  about  rheumatism,  pointed  to 
its  dim  pathogenesis.  The  reason  of  this  lies  in  the 
fact  that  rheumatic  cases  are  seldom  the  subject  ot 
post-mortem  examinations,  and,  besides,  the  disease 
having  a  short  course,  a  complete  study  of  its  essen- 
tialities cannot  be  made.  He  sums  up  his  experiences, 
founded  on  the  clinical  observations  of  200  cases,  as 
follows : — 

1.  Rheumatism  often  is  initiated  by  general  sym- 
ptoms, as  malaise,  a  feeling  of  cold  and  chill,  want  of 
appetite,  &c.  These  general  symptoms  might  stand 
alone  through  a  considerable  time  before  muscular 
pains  have  set  in.     These  usually  occur  suddenly. 

2.  Rheumatism  is  accompanied  by  fever.  In  one- 
third  of  the  cases  the  temperature  is  high. 

3.  The  chief  symptom  of  the  disease,  that  is  to  say, 
the  muscular  pain,  is  evoked  by  a  mechanical  factor. 
However,  this  etiological  connection  is  only  apparent. 

4.  The  real  cause  of  the  rheumatism  is  infection. 
This  is  shown  by  the  general  symptoms,  which  precede 
the  pains,  by  the  passing  character  of  the  symptoms, 
the  fever,  and  the  occurrence  of  complications,  vii.t 
the  localisation  of  the  virus  in  other  organs. 

5.  In  the  course  of  rheumatism,  endocarditis 
is  not  at  all  such  a  rare  complication  as  might  be  be- 
lieved. Olah  quotes  three  cases,  in  which  endocar- 
ditis has  occurred  during  the  course,  while  at  the 
beginning  of  the  disease  no  trace  of  any  heart  failure 
could  be  discovered. 

6.  The  infectious  character  of  the  disease  is  shown  by 
the  fact  that  sometimes  rheumatic  cases  crop  up  like 
an  epidemic.  Cold  promotes  the  occurrence  of  rheu- 
matism. 

7.  The  supposed  poison  is  at  any  rate  akin  to  the 
virus  of  the  arthritic  process,  and  it  can  be  assumed 
that  it  is  a  weaker  form  of  it,  because  rheumatism  can 
turn  to  arthritis  and  vice  versd. 


TLbc  ©peratinfl  Ttbeatres* 


ST.  THOMAS'S  HOSPITAL. 
Case  of  Complicated  Ovarian  Multilocular- 
Tumour. — Mr.  Battle  operated  on  a  married  woman, 
act.  28,  who  had  been  married  tour  years,  but  there  were 
no  children  living.  The  first  two  were  stillborn,  the 
third  only  lived  nine  days.  Nearly  a  year  ago  she 
had  been  confined  of  her  last  child.  Since  that  time 
she  had  not  been  well,  having  suffered  from  pain  in 
the  abdomen  and  feverish  attacks,  which  had  com 
pelled  her  to  keep  her  bed.  Six  months  ago  she  was 
taken  into  a  cottage  hospital,  and  her  medical  man 
explored  to  find  out  the  nature  of  a  swelling  which  had 
appeared  in  the  right  iliac  fossa.  He  found  a  very 
fixed,  hard  swelling,  and  did  not  attempt  to  remove  it. 
Since  that  time  there  has  been  little  change.  The 
tumour  has  remained  about  the  same  as  far  as  she 
knows,  and  she  has  had  feverish  attacks  as  before ;  in 
fact,  she  has  been  no  better  for  the  exploration.  Her 
general  condition  is  fair,  and,  but  for  the  presence  of 
this  swelling  and  a  general  aching,  she  would  feel  fairly 
well.  On  examination  of  the  abdomen  there  was  an 
evident  swelling  the  size  of  two  fists  in  the  right  iliac 


Arm  6,   1904. 


LEADING   ARTICLES. 


The  Medic  ax  Press,     37 1 


fOtta  and  extending  into  the  pelvis.  Over  the  most 
prominent  part  of  this,  which  corresponded  to  the  right 
I'mea  semilunaris,  there  was  a  cicatrix  about  three 
snches  long,  which  appeared  to  be  attached  by  its 
deeper  parts  to  the  underlying  tumour*  The  tumour 
fluctuated,  but  was  harder  towards  the  anterior  superior 
spine  than  towards  the  pelvis.  Examination  per 
vaginam  showed  nothing  abnormal ;  no  thickening 
could  be  felt  on  the  right  side,  but  the  uterus  was  a 
little  more  nxed  than  usual.  The  temperature  was 
normal.  At  the  operation  a  median  incision  was  made 
in  the  middle  line  below  the  umbilicus,  and  the  peri- 
toneal cavity  opened.  The  intestines  were  packed  into 
the  upper  part  o(  the  abdomen,  and  a  gauze  sponge 
placed  in  Douglas'  pouch.  A  large  cystic  expansion 
of  the  tumour,  which  covered  the  uterus  and  occupied 
most  of  the  pelvis,  was  then  tapped  and  emptied,  and 
nther  cysts  were  emptied  through  the  opening  which 
liad  been  made  into  the  first*  The  contents  of  these 
cysts  varied  somewhat*  but  were  evidently  ordinary 
an  fluid.  This  diminished  very  much  the  size  of 
the  tumour,  the  part  remaining  being  composed  mostly 
i.t  solid  material,  which  was  firmly  adherent  to  the 
iltac  fossa  and  the  excum,  It  was  separated  from  its 
uterine  attachments  and  then  from  its  attachment  to 
the  caecum.  This  last  was  very  firm  and  it  was  evident 
that  the  interior  of  the  ca?eum  communicated  with  the 
anterior  of  a  cyst*  A  large  opening  was  present  in  the 
raput  ca?eit  some  parts  of  which  were  considerably 
thickened ►  It  was  covered  with  gauze  and  placed  on 
une  side  until  the  cyst  and  tumour  had  been  completely 
removed.  Although  the  attachments  were  very  firm 
Did  at  some  stages  scissors  had  to  be  used,  the  growth 
was  removed  without  much  hemorrhage.  The  omentum 
and  small  intestine  were  adherent  at  one  or  two  points, 
and  the  separation  was  attended  with  bleeding,  which 
required  the  application  of  ligatures  to  arrest  it.  The 
caecum  was  then  sutured,  a  continuous  stitch  tieing 
hrst  of  all  inserted  drawing  the  two  edges  together,  this 
stitch  passing  through  all  the  coats.  A  continuous 
Lembert's  suture  was  then  put  in  which  closed  the 
.Tig  satisfactorily,  excepting  at  one  or  two  points, 
where  interrupted  sutures  were  also  placed*  The  area 
of  operation  was  then  cleansed  with  sterilised  saline, 
the  sponges  removed,  the  abdomen  again  cleansed,  a 
i^lass  drainage-tube  placed  in  Douglas"  pouch,  and 
strips  oi  gauze  over  the  site  previously  occupied  by 
the  tumour,  these  being  brought  out  of  the  wound  by 
the  side  ul  the  tube.  Mr.  Battle  said  that  the  diagnosis 
rested  between  ovarian  tumour  and  pyo-salpinx,  and 
he  had  thought  from  the  history  and  the  nxed  character 
tit  the  lump  that  it  was  pyo-salpinx  ;  but  the  operation 
revealed  a  very  unusual  condition  of  things,  and  it  was 
probable  that  the  patient  had  had  a  small  multilocular 
ovarian  cyst  which  had  received  damage  during  her 
confinement  j  this  cyst  had  suppurated,  become 
adherent  to  the  caecum,  and  discharged  into  it  j  it 
uas  probable,  also,  that  her  symptoms  had  been 
temporarily  relieved,  and  then  things  had  become 
Troublesome  again  as  other  cysts  developed 
dragging  on  the  original  tumour  and  parts  to 
wtuch  it  was  attached,  The  amount  of  discharge 
from  the  cyst  which  opened  into  the  bowel  was  not 
great,  and  the  cyst  itself  was  small,  utberwise  there 
would  have  been  the  passage  of  flatus  into  the  cyst  and 
Us  presence  would  have  been  detected  on  examination 
of  the  abdomen. 

The  plugs  were  removed  on  the  second  day,  the 
Irainage-lube  being  kept  in  hume  time  longer,  and 
although  the  patient  suffered  at  first  from  shock  and 
from  sickness  from  the  anaesthetic,  she  has  made  a 
good  recovery* 


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SALUS   POPULI   SUPREMA   LEX-" 


WEDNESDAY,  APRIL  6,  1904, 


THE  /'  TABLOID  "  APPEAL  CASE. 

In  the  issue  of  The  Medical  Press  and  Circular: 
for  December  23rd,  1903,  we  commented  upon  an 
action  tried  shortly  before  that  date.  The  plain- 
tiffs were  Messrs.  Burroughs  Wellcome  and  Co., 
who  sought  to  restrain  Messrs,  Thomson  and 
Capper,  homoeopathic  chemists,  of  Liverpool  and 
elsewhere,  from  passing  off  goods  not  made  by 
plaintiffs  when  the  word  M  tabloid  Jf  was  used  in 
prescriptions  or  orders.  In  other  words  Burro ughs 
Wellcome  claimed  exclusive  and  proprietary 
right  to  manufacture  drugs  in  "  tabloid  n  form. 
They  coined  or  invented  the  word  "  tabloid  ,T  in  1884 
to  describe  the  well-known  rounded  and  flattened 
discs  into  which  their  drugs  were  compressed. 
Their  useful  little  invention  has  proved  enormously 
successful,  but  none  the  less  its  development  has 
demanded  a  vast  deal  of  energy,  skill,  organising; 
capacity,  and  capital.  To  have  deprived  them  of 
the  benefits  attached  to  the  trade  in  M  tabloids  '*" 
would  clearly  have  been  contrary  to  the  funda- 
mental laws  of  justice.  Yet,  as  a  matter  of  fact,  that 
was  being  done  by  all  persons  who  substituted  the 
preparations  of  other  firms  than  Burroughs  Well- 
come and  Co.  when  "  tabloids  "were  ordered.  The 
defendants  retaliated  by  a  motion  to  expunge  the- 
trade  marks  in  question  from  the  Register,  The 
case  was  tried  by  Mr.  Justice  Byrne  last  December 
in  the  Chancery  Court.  After  a  seven  days'  trial 
the  learned  judge  decided  (j)  that  Thomson  and 
Capper  had  been  guilty  of  passing  off  or  substituting 
other  goods  in  place  of  the  **  tabloids  ,+  made  by 
plaintiffs,  and  (a)  that  the  trade  mark  M  tabloid  " 
was  a  descriptive  fancy  word  not  in  common  use 
at  the  time  it  was  placed  on  the  Register,  that  there- 
fore the  mark  was  a  good  one,  and  Messrs.  Thomson 
and  Capper's  motion  to  expunge  it  must  be  dis- 
missed. In  connection  with  the  morality  of  the 
kind  of  transaction  involved  Mr.  Justice  Byrne 
gave  the  significant  opinion  that  the  plaintiffs 
j  were  entitled   to   an  injunction  independently  of 


372    Thb  Medical  Press. 


LEADING   ARTICLES. 


April  6,  1904. 


registered  trade  marks.  That  is  to  say,  the  learned 
judge  condemned  absolutely  the  practice  of  "sub- 
stitution "  applied  to  drugs  by  chemists  who,  asked 
for  one  thing,  sold  another  to  their  customers. 
The  plain  Anglo-Saxon  word  for  a  business  pro- 
ceeding of  that  kind  is  to  be  found  readily  enough 
outside  a  court  of  law.  That  part  of  the  original 
•case  was  so  clearly  established  in  the  December 
trial  that  Thomson  and  Capper,  in  their  appeal, 
wisely  abandoned  any  attempt  to  justify  the 
practice  of  substitution.  They  confined  their 
appeal  against  the  decision  of  Mr.  Justice  Byrne 
to  the  portion  of  the  judgment  which  dealt  with 
their  motion  to  rectify  the  Register.  The  second 
or  appeal  case  was  heard  on  March  29th  by  the 
judges  of  the  Supreme  Court,  who  all  agreed  in 
•dismissing  the  appeal.  The  result  of  this  trial 
is  a  vindication  of  the  common  sense  of  English 
law,  which  thus  enforces  the  method  of  common 
honesty  in  ordinary  business  transactions.  The 
appellants  asked  the  judges,  in  effect,  to  say  that 
the  word  "  tabloid  "  was  not  a  good  trade  mark, 
although  Burroughs  Wellcome  and  Co.  had  origi- 
nated the  word  and  had  applied  it  continuously 
and  without  challenge  for  twenty  years.  In 
fighting  for  their  trade  mark,  it  is,  of  course, 
obvious  that  Burroughs  Wellcome  and  Co.  were 
primarily  fighting  for  their  own  hand.  At  the 
same  time  a  little  consideration  will  show  that  they 
have  also  done  a  great  and  real  service  alike  to  the 
public  and  to  the  medical  profession  in  drawing 
attention  to  the  pernicious  practice  of  substitution 
by  pharmaceutical  chemists.  That  point  was 
•dealt  with  somewhat  fully  in  our  comments  upon 
the  original  trial  in  December  last.  We  then 
remarked  "  that  there  were  many  local  pharmaceu- 
tical associations  throughout  the  country,  and  it 
was  to  be  hoped  that  so  important  an  action  would 
bring  the  matter  home  to  them  in  such  a  way  as 
practically  to  scotch  the  baneful  practice  of  substi- 
tution.' '  We  venture  to  think  that  the  conse- 
quences to  dispensing  chemists  will  be  serious 
enough  in  all  consicience  if  medical  men  find  they 
cannot  depend  upon  chemists  for  the  faithful 
dispensing  of  prescriptions.  It  is  because  we 
believe  that  the  great  majority  of  chemists  loyally 
serve  both  the  public  and  the  profession  that  we 
hope  the  local  trade  associations  and  the  phar- 
maceutical societies  of  the  United  Kingdom  will 
once  and  for  all  dispose  of  what  is  clearly  a  menace 
to  the  status  of  the  craft.  With  certain  dispensers, 
public  and  private,  we  have  reason  to  believe  that 
the  fraud  of  substitution  is  cultivated  as  a  fine 
art.  From  this  point  of  view,  as  well  as  on  per- 
sonal grounds,  we  heartily  congratulate  Messrs. 
Burroughs  Wellcome  and  Co.  on  the  happy 
termination  of  the  two  recent  trials,  the  ultimate 
results  of  which  are  likely  to  be  appreciated  for 
years  to  come  by  the  medical  profession. 


THE  HOSPITAL  QUESTION. 
During  the  past  thirty  or  forty  years  the  rela- 
tions which  once  existed  between  the  public  and 
hospitals  have  greatly  changed.     Th$  latter  were 
-originally   intended   for   the   poor   only,    that   is, 


for  those  who  could  not  possibly  afford  to  pay 
anything  for  medical  care  and  treatment.  Hos- 
pitals stood  in  somewhat  the  same  relation  to  us 
as  the  charity  schools*;  as  the  State  did  not  pro- 
vide fully  for  the  education  of  the  poor,  those 
schools  were  supported  by  charity.  Things 
have  changed,  and  hospitals  are  now  made  use 
of  by  a  class  that  some  years  ago  would  not  have 
been  allowed  to  enter  them,  or  would  have  re- 
frained from  doing  so,  as  the  claim  of  poverty 
could  not  be  made  for  admission  to  their  benefits. 
The  question  now  arises  whether  the  public 
intend  to  extend  the  principle  that  has  been 
growing  up  for  many  years,  and  whether  a  very 
different  class  of  people  are  going  to  organise  the 
hospital  system  for  their  own  benefit  and  con- 
venience. It  looks  very  much  as  if  this  were  the 
case.  When  the  Charity  Organisation  Society 
started,  the  most  important  work  it  had  in  hand 
was  to  investigate  the  abuse  of  hospitals,  that  is  to 
say,  the  extent  to  which  persons  by  n«  means 
qualified  by  poverty  for  admission  were  resorting 
to  them  unfairly.  For  some  reason  or  other  no- 
thing came  of  the  attempts  of  the  Conjoint  Com- 
mittee of  the  British  Medical  Association  and  the 
Charity  Organisation  Society  to  correct  this  abuse  ; 
and  as  now  the  metropolitan  asylums  and  in- 
firmaries, supported  out  of  the  rates,  provide  in  a 
way  that  was  never  done  before  for  the  poor,  it 
would  be  well  for  the  hospital  question  to  be 
widely  raised.  This  constant  appeal  to  the  chari- 
table for  funds  by  way  of  bazaars,  fancy-dress 
balls,  performances  of  various  kinds,  and  other 
undignified  methods  of  raising  money  are  not 
consistent  with  such  a  matter  as  the  support  of 
our  hospitals.  Doubtless  the  sentiment  of  charity 
may  be  cultivated  to  a  certain  extent,  but  it 
should  not  be  asked  to  do  more  than  it  has  done 
in  the  matter  of  our  schools.  Charity  may  cover 
a  multitude  of  sins,  but  we  are  rather  inclined  not 
to  let  too  much  be  covered  by  it.  There  is  no 
doubt  that  the  hospital  system,  like  that  of 
the  schools,  is  one  that  should  interest  classes 
removed  entirely  from  that  of  the  very  poor.  It 
is  difficult,  if  not  impossible,  to  provide  in  most 
homes,  in  serious  cases,  for  the  medical  and  sur- 
gical attention  that  can  be  received  with  great 
facility  in  hospitals.  Some  provision  for  the 
admission  of  patients  of  the  better  class  into  hos- 
pitals has  been  made  for  some  years  by  such 
homes  as  that  at  St.  Thomas's,  and  by  private 
wards  at  other  hospitals.  What  Lord  Rowton 
has  done  for  the  working-class  who  are  above  the 
workhouse  is  evidence  of  the  changes  coming 
into  our  social  system.  To  look  at  the  hospital 
question  in  a  fair,  sensible  and  practical  way 
is  growing  every  day  more  and  more  neces- 
|  sary,  and  the  medical  profession  will  do  well  to 
j  assist  in  bringing  about  the  reform  that  is  evi- 
dently demanded  in  the  present  hospital  system. 
King  Edward's  Hospital  Fund  is  really  intended 
for  the  absolutely  poor  and  not  for  those  who 
can  afford  to  pay,  and  those  who  dispense  this 
Fund  should  pay  particular  attention  to  this 
point,  otherwise  there  is  a  danger  of  the  Fund 
being  misapplied.  _ 


Amu  <>>   1904* 


NOTES    ON    CI 


JT    TOPICS.       The  Medical  Phess,     373 


PHYSICAL  TRAINING  IN  SCHOOLS. 
With  the  advent  of  the  new  educational   au- 
thorities, on  the  principle  of  the  new  broom,  a 
good  deal  of    remodelling  is  being  carried  out  in 
the   courses    of    instruction    in    our    elementary 
schools.     So    far   as   this   indicates   interest   and 
enthusiasm   in   educational   matters,   it  is   all   to 
the  good  ;     so   far   as   it    give*   the   irresponsible 
iaddist  a  chance  of  initiating  his  pet  experiments, 
it  is  fraught  with  some  little  danger.     Education 
in  the  past  has  been  regarded  far  too  much  in  the 
hght  of  a  process  for  conveying  a  cut-and-dried 
quantity  of    "knowledge"   into   the   cranium  of 
the  pupil   and  far  too  little  as  a  means  for  turning 
healthy,    well-conducted,    capable    units    to 
take  their  place  in  the  ranks  of  the  nation.     There 
are  certain   welcome   signs   that   a   broader   and 
more   catholic  view  is  supplanting   the  old,  and 
these  lead  one  to   hope  that  individual   training 
may  come  to  be  the  chief  end  of  our  educational 
■  institutions,  and  that  standards  and  examinations 
may  recede  gracefully  into  the  background.     It 
[|  a  thousand  pities  that  at  this  moment,  when 
the  question  of  national  efficiency  is  more  urj 
than  ever,  that   political   and  religious  partisans 
should  be   engaged   in   bandying   recriminations, 
aod  that  education— the  fitting-out  of  the  child— 
should  be  used  as  a  mere  pawn  in  political  chess, 
have    consistently    urged    that    measures    to 
safeguard  the  health  of  pupils  in  schools  should 
be  instituted,  that  the  children  unfitted  for  work 
in  class  should  be  eliminated,  and  that  systematic 
inspection  by   a  medical   expert  should  be   con- 
sidered eomplemental  to  instruction  by  teachers. 
Wfl   have   noted,   too,    with   great   pleasure,  that 
several  of  the  most  important  OJ  tin-  educational 
bodies    have    recognised    the    necessity   of    these 
precautions,  and  have  appointed  medical  officers 
rry  them  into  effect.     We  feel  that  the  time 
has  come,  when  so  much  futile  discussion  is  taking 
place,   to    speak  definitely  about  the  subject  of 
ical  training.     We  need  not  dwell  on  the  dis- 
concerting   facts   that    have   lately   been   brought 
to  light  by  the  recruiting  returns,  and  the  late 
inquiry    into    the    health    of    school-children    in 
Scotland.     Without  being  unduly  pessimistic  we 
may    say,  without  fear  oi  contradiction,  that  the 
physique  of  the  nation  is  in  a  condition  that  no  one 
carl  contemplate  without  apprehension,     Vaiious 
remedies   have   been   proposed,   but    the   one    we 
have  to  speak  of  at  the  moment  is  that  of  physical 
ding    in    elementary    schools.     It    might    be 
Thought  a  platitude  to  assert  that  physical  train- 
ing was  no  less  important  than  mental  training, 
were   it  not  that  the  latter  engages    the    whole 
of  the  working  hoursin  many  schools  m  this  country. 
If,  however,  the  object  of  our  system  is  to  turn  out 
men  and  women  capable  of  earning  a  living  and 
undergoing   fatigue,  surely  a  sound   constitution 
a  well -developed   muscular   system    are     at 
least  of  as  much  moment  as  capability  to  read 
penny  "dreadfuls/1  reckon    up   wages,  and  write 
answers  to   competitions  in  comic  papers.     But 
when   the   necessity— the   pressing   necessity— for 
physical  training    s  appreciated  it  is  just  as  im- 


portant to  grasp  the  principles  on  which  it  should 
be  founded.     It  is  not  merely  a  development  of 
the  muscles  that  is  to  be  aimed  at,  far  less  th> 
velopment  of  one  set  of  muscles.     Most  of  the  sug- 
gested systems  aim  at  the  production  ol  hyper- 
trophy in  the  musculature  oi  the  upper  or  lower 
limbs.     Now  a  healthy  child  should  have  all  his 
muscles   developed   in   proportion,   and   this   de- 
velopment should  not  be  at  the  expense  of,  but 
rather  carried  out  pari  passu  with,  the  building 
up    oi    his    viscera.     The    tax   should    be    levied 
equably  and   gradually,  so  that  every  organ  and 
muscle   in   the   body   should   share  in   the   extra 
strain  proportionately  ;  that  the  biceps  should  not 
be  brought  into  play  more  often  than  the  adductor 
magnus,  nor  the  heart  be  called  upon  more  than 
the   lungs.      Movements,    having   the    health    of 
the   child  in  view,  should  be  conducted  in  the 
open  air,  and  not  in  Stuffy  class-rooms  *>r  halls, 
and  the  psychical  influence  of  properly -contrived 
exercise    never   should    be   left    out    oi    account, 
The  dull,  monotonous  e%'olutions  of   the  parade- 
ground  never   furnish    the    pleasurable    stimulus 
of   the  cricket  or  football  field,  and  the  disposition 
may  be  moulded,   and  moral    virtues  inculcated, 
along  with  the  development  of  the  form  and  con- 
stitution.    Games,  however,  have  the  disadvan- 
tage that  only  a  certain  number  can  play  i 
time,  and  Swedish  exercises  are  not    exhilarating, 
Gymnastic    apparatus  is    costly,  and  gymnastics 
have  to  be  practised  under  rover  J  there  is  little 
opportunity      for     competition.       Military       en- 
thusiasts wish  to  seize  the  occasion  for  subjecting 
boys   to   military   drill,    so   that   their   exen 
may  have  a  direct  utilitarian  bent,  but  we  think 
that  military  exercises  are  not  the  best     Let  them 
remember  that  we  wish  to  turn  out  men,  and  as 
General   Chanzy   used  to  say,   *'  raites  nous   des 
hommes,    nous    en    ferions    des    soldats/'     What 
system,    then,  is  the  best  adapted  to  all  the  ends 
one  must  aim  at  ?    It  is  a  far  cry,  %ve  admit,  but 
if  fas  est  ah  ho  sic  doccri,  it  must  be  even  more 
permissible  to  learn  from  our  allies.     The  sy 
which  seems  to  fulfil  all  the  requirements  we  have 
enumerated  better  than   any  other  is  the  il  Jiu- 
jitsu  "   (muscle-breaking  or  training    of  the  Ja- 
panese.    The    training    and    discipline    of    these 
exercises  are  reduced  to   a  science,  and  they  can 
be  practised  out  of  doors  without  any  apparatus. 
The  physical  and  mental   results  of  this  culture 
show    themselves   in    the   form    and  qualities   of 
the  Japanese  of  to-day,  who  are   notoriously  one 
of  the  best -developed,  best -mannered,  and  hardiest 
races   of    the   world.     They    have   freely   availed 
themselves  of  all  that  is  good  in  our  civilisation  ; 
we  might  do  worse  than  return  the  compliment 
by  fashioning  our  physical  culture  on  theirs. 

Botes  on  Current  topics. 

Fresh  Air  and  Diseases  of  the  Chest* 

It  must  have  occurred  to  many  that  the  sik 

ful  treatment  of  phthisis  by  a  life  in  the  open  air 

is  not  due  to  such  a  life  being  a  specific  against 

the  tubercle   bacillus,   but    owes   its  efficacy  to  a 


374    The  Medical  Press. 


NOTES  ON  CURRENT  TOPICS. 


April  6.  1904. 


general  hygienic  result.  As  a  natural  conse- 
quence it  would  follow  that  similar,  if  not  equal, 
good  effects  should  attend  open-air  treatment  of 
other  diseases  of  the  lungs.  Various  Continental  phy- 
sicians have  from  time  to  time  suggested  that 
patients  su  ffering  from  pertussis  should  be  given,  at 
any  rate,  a  trial  of  open-air  life,  and  they  ha ve  report- 
ed this  procedure  certainly  diminishes  the  tendency 
to  tuberculous  infection  during  convalescence. 
In  these  countries,  however,  up  to  the  present  there 
lias  been  a  strong  prejudice  regarding  the  danger 
•of  a  "  chill "  in  whooping-cough,  as  there  was  twenty 
years  ago  in  the  case  of  phthisis.  Recent  obser- 
vations seem  to  suggest  that  the  belief  in  the  case 
of  one  disease  is  no  better  founded  than  in  the 
case  of  the  other.  In  the  City  Hospital  at  Edin- 
burgh, under  orthodox  treatment,  two  out  of 
every  three  children  who  developed  broncho- 
pneumonia as  a  complication  of  whooping-cough 
died.  For  the  past  two  or  three  years  Dr.  Claude 
Ker,  the  medical  superintendent,  has  employed 
open-air  treatment  in  all  cases  of  whooping- 
cough,  whether  broncho-pneumonia  was  present 
or  not.  As  a  result  it  was  found  that  broncho- 
pneumonia as  a  complication  occurring  in  hospital 
has  entirely  disappeared  ;  while  of  children  who 
suffer  from  it  at  admission,  instead  of,  as  formerly, 
two  out  of  every  three  dying,  now  two  out  of  three 
recover.  The  effect  on  the  whooping-cough  itself 
was  slight,  but  some  favourable  differences  were 
observed.  The  children  had  better  appetites, 
their  strength  was  greater,  and  they  were  much 
less  irritable.  Their  temperature  came  down  sooner, 
and  cyanosis  was  less  f requen  tly  no  t  iced .  We  have 
no  hesitation  in  saying  that  wherever  possible,  and 
it  is  nearly  always  so,  open  -  air  treatment 
of  whooping-cough  should  be  practised. 


Colloidal  Silver  in  Erysipelas. 

During  the  past  few  years  there  have  been 
several  encouraging  reports,  principally  from  the 
Continent,  on  the  use  of  intravenous  injections 
of  colloidal  silver  in  various  infective  processes. 
Two  requisites  are  necessary  to  commend  a  drug 
for  intravenous  administration — efficacy  for  its 
purpose,  and  harmlessness  in  other  directions. 
As  regards  the  latter,  everyone  who  has  examined 
the  subject  is  agreed  that  no  ill  results  occur  from 
the  use  of  colloidal  silver.  As  to  its  efficacy,  it 
has  been  used  with  success  in  pyaemia,  septi- 
caemia, surgical  sepsis,  anthrax,  pneumonia, 
gonorrhoea,  and  erysipelas.  Dr.  Warren  Coleman, 
of  New  York,  has  recently  (a)  reported  his  ex- 
perience of  its  use  in  the  last-mentioned  disease, 
and  though  his  cases  are  not  sufficiently  numerous 
to  justify  absolute  conclusions,  they  are,  as  far 
as  they  go,  entirely  favourable.  The  preparation 
used  was  a  1  per  cent  aqueous  solution  of  colloidal 
silver,  and  the  dose  varied  from  5  to  10  cc.  The 
injections  were  made  with  an  ordinary  antitoxin 
syringe.  Care  should  be  taken  to  prevent  any 
of  the  solution  escaping  into  the  tissues,  as  it 
•causes  considerable  pain  and  sensation  of  burning. 


When  used  properly  the  injection  is  followed  by 
no  unpleasant  symptoms.  In  most  of  Dr.  Cole- 
man's cases  one  injection  was  sufficient  to  bring 
down  the  temperature,  and  to  cause  disappearance 
of  the  inflammation.  It  is  to  be  hoped  that  further 
trial  will  bear  out  the  good  results  arrived  at  up 
to  the  present. 

Protargol  in   Gonorrhoea, 

Among   laymen    it   is   often    the   custom    to 
underrate  the  importance  of  an  attack  of    gonor- 
rhoea, and  to  regard  the  period  spent   while  suffer- 
ing from  it  as  merely  a  time  of  enforced   absence 
from    alcohol    and    sexual    intercourse,    together 
with  the  undergoing  of  a  regular  routine  of  medical 
treatment.    To    anyone,    however,    who    knows 
the  severity  of  the  complications  and  sequelae  of 
gonorrhoea,  as  well  as  its  wide  distribution  in  all 
classes  of  society,  the  case  is  far  otherwise,  and 
anything  which  promises  to  cut  short  the  disease 
in  its  early  stages    appears    as    a  boon.     There 
have   been   various   specifics   put    forward   from 
time  to  time  with  the  view  of  aborting  gonorrhoea 
when  the  case  was  seen  sufficiently  early,  but  none 
of    them    has    received    entire    confidence.    The 
reason  lies  probably  quite  as  much  in  careless- 
ness of  application  as  in  any  failure  of  the  agent 
employed,  since   the   method   used   in   all  is  the 
destruction  of  the  infecting  gonococcus  before  it 
has  become  intracellular.     In  several  cases  recently 
reported,     principally     from      America,     where 
gonorrhoea  appears  to  be  even  commoner  than 
here,  protargol  has  been  used  with  great  success. 
The  method  employed  by  Dr.  Bierhoff,  of  New 
York,  (a)  is  the  complete  flushing  of  the  urethra 
by  a  J   to  J  per  cent,  protargol  solution.    Dr. 
Bierhoff  employs   the  drug  only  in  early  cases 
where  the  discharge  has  just  begun,  and  where, 
on   microscopic    examination,   but    few    intracel- 
lular organisms  are  seen.     He  first  anaesthetises 
the  urethra  with  mixed  solutions  of  cocaine  and 
protargol,    and     then     thoroughly    washes    the 
anterior  part  of  the  urethra  with  protargol.    The 
entire    urethra    is  next   irrigated  with  protargol 
solution  in  large  quantities,  the  patient  emptying 
his    bladder    and    the    injection    being   repeated 
several  times  in  succession.    This  is  done  by  the 
medical  man  once  a  day,  while  the  patient  washes 
his  urethra  and  bladder  with  the  same  solution 
four   or    five    times    in    addition.      At    the  end 
of  four  or  five  days  the  discharge  has  usually 
ceased,  no  organisms  can  be  discovered,  and  the 
disease  is  cured. 


Hyperpyrexia. 

The  treatment  of  hyperpyrexia  has  considerably 
^proved  in  late  years,  although  the  hopelessness 
of  extreme  types  must  still  be  acknowledged. 
One  of  the  best  recorded  observations  on  the 
treatment  of  a  number  of  cases  of  this  condition 
is  that  of  Lewis  and  Packard,  based  on  ninety- 
two  cases  treated  in  the  Philadelphia  Hospital, 
in  July,  190 1.    They  were  all  cases  of  insolation 


(a)  Medical  Recori,  Norember  21st,  1908. 


(«)  Medial  Newt,  March  12th,  1904. 


April  'j.  1904. 


NOTES    ON    CURRENT    TOPICS. 


or  M  sunstroke;"  and  considering  the  serious  nature 
©f  the  malady,  the  total  mortality  of  14*4  per 
cent,  must  be  regarded  as  distinctly  favourable. 
In  mild  cases— that  is  10  say,  where  the  tempera- 
ture does  not  exceed  1020  F, — simple  measures 
such  as  an  occasional  cold  bath,  an  ice -cap,  and 
the  administration  of  mild  diffusible  stimulants 
were  found  sufficient.  Where  the  temperature 
ranges  between  102°  F.  and  io6Q  F-  cold  baths 
and  rubbing  down  with  large  pieces  of  ice,  with 
iree  circulation  of  cool  air;  were  most  effective. 
Intravenous  injection  of  normal  saline  solution 
proved  a  rapid  and  valuable  remedial  measure, 
The  general  statement  is  made  by  Lewis  and 
Packard  that  all  the  cases  recovered  in  which 
the  temperature  registered  was  under  106*  F., 
while  all  over  111*  F+  died,  and  the  fatal  cases 
ranged  between  ioo:  F.  and  ma  F.  Albumin 
was  noted  in  the  urine  in  most  of  the  cases. 


"Br/1  Deighton's  Great  Walk^ 

This  extraordinary  teat  of  endurance,  which 
terminated  last  week,  is  one  that  naturally  excites 
more  than  ordinary  interest  in  those  who  know 
something,  but  not  everything,  of  the  human  body 
audits  capabilities,  The  so-called  "  Dr.*'  Deighton 
is  not  a  medical  man,  but  was  formerly,  we  under- 
stand, a  trainer.  His  walk  started  on  February 
39th  at  Land's  End,  and  finished  on  March  28th 
at  John  o'  Groat's  House— ar  total  distance,  as 
be  travelled,  of  950  miles.  It  lasted  twenty-four 
4ays;  four  hours,  and  twenty  minutes,  deducting 
Sundays,  on  which  days  he  rested,  His  average 
rate  of  movement  night  and  day  was  just  under 
two  miles  an  hour,  and  this  over  some  bad  roads, 
drifts,  and  heavy  ground.  That  he  was  not 
unduly  fatigued  is  evidenced  by  the  fact  that  he 
covered  the  last  mile  in  nine  and  a  half  minutes, 
even  carrying  his  trainer  on  his  back  for  the  last 
fitly  yards.  When  it  is  considered  that  this 
journey  was  made  by  a  man  over  three  score 
years  of  age,  it  must  surely  be  termed  unique. 
A  man  of  the  constitution,  stamina,  and  pluck  of 
Deighton  may  well  deserve  a  niche  in  any  national 
Valhalla,  and  it  would  be  well  to  commemorate 
a  hero  of  so  healthy  and  useful  a  pastime  as 
walking,  when  professional  footballers,  jockeys, 
and  variety  actresses  fill  the  public  eye  and  fire 
eothusiasm  in  the  way  ^they  do Jatjthe  present 
day  Apart  from  the  elasticity  and  "  condition  *' 
of  the  muscular  system,  the  heart  and  arteries  of 
the  athlete  of  sixty-one  years  must  be  in  a  wonder- 
ful condition  of  juvenility  to  be  able  to  accom- 
modate themselves  to  so  prolonged  and  severe  a 
strain,  and  one  may  well  hope  that  the  veteran 
will  feel  no  constitutional  ill-effects,  beyond  some 
stiffness  of  the  muscles,  after  his  exertion.  It  is 
well  recognised  that  ^the  most  severe  trials  to 
which  the  vital  organs  can  be  putjare  the  short, 
sharp  bursts  of  energy  called  forth  by  a  sprinting 
match  or  a  boat  race,  but  extended  efforts  demand 
a  much  larger  reserve  of  tissue  and  visceral 
activity,  and  it  is  all  the  more  gratifying  to  find 
that  such  immense  stores  can  be  drawn  upon 
even  up  to  the  age  which  Deighton  has  reached. 


The  Medical  Press.     J?5 


We  must  protest  strongly t  however,  against  his 
assumption  of  a  title  to  which  he  has  no  claim. 
The  fact  of  his  using  it  without  let  or  hindrance 
in  itself  constitutes  a  sardonic  commentary  on 
the  efficiency  with  which  the  Register  is  protected 
by  the  law  and  the  General  Medical  Council* 


Plague* 

The  outbreak  of  plague  at  Johannesburg 
reminds  one  that  this  scourge  is  ready  to  pounce 
on  the  unwary  community  at  any  moment.  The 
scare  that  occurred  in  this  country  a  few  years 
ago  subsided  quickly  when  it  was  found  that  the 
measures  taken  to  arrest  the  disease  at  its  source^ 
namely,  the  seaports — were  effectual.  But  the 
success  that  attended  those  efforts  must  not  allow 
one  to  shut  one's  eyes  to  the  fact  that  plague  is 
still  in  the  air,  and  that  this  is  no  time  for  relaxing 
vigilance.  The  Indian  mail  ship  "Persia/'  which 
arrived  in  London  last  week  from  Bombay, 
narrowly  escaped  a  visitation  of  plague,  as  one  of 
the  mail -sorters,  who  was  dropped  at  Aden, 
developed  the  disease  soon  after  landing.  For- 
tunately, no  further  cases  resulted,  but  the  port 
officers  treated  her  as  an  infected  ship,  and  carried 
out  the  Local  Government  Board  regulations  to 
obviate  any  chance  of  the  disease  being  conveyed 
on  shore.  So  long  as  plague  continues  to  simmer 
at  Bombay,  no  country  trading  thither  will  be 
free  from  risk,  and  it  will  be  lucky  if  the  port 
authorities  manage  to  catch  all  sufferers— actual 
or  potential— in  their  net,  Plague  is  one  oi  the 
last  things  desired  in  this  country. 

Medical  Practice  in  the  Orange  River  Colony. 

It  is  not  a  little  tantalising  for  our  medical 
reformers  at  home,  who  are  striving  and  agitating 
year  after  year  to  obtain  recognition  for  some  of 
the  most  elementary  rights  of  the  profession,  to 
see  practically  the  whole  of  their  programme 
become  law  at  one  stroke  of  the  pen — in  one  of  our 
dependencies.  Such,  however,  is  what  his  just 
taken  place  in  the  Orange  River  Colony.  An 
ordinance  has  recently  been  promulgated  that 
embraces  almost  every  provision  needed  to  place 
medical  practice  on  a  satisfactory  basis.  One 
need  hardly  say  that  the  kernel /of  the  whole 
matter  is  contained  in  the  clause  that  imposes  a 
penalty  of  a  hundred  pounds  (or,  in  default, 
six  months'  imprisonment)  on  those  using  titles 
calculated  to  make  people  infer  that  they  are 
qualified  and  registered,  or  on  those  who  practise 
for  gain,  or  by  any  means  whatever  profess  to  prac- 
tise or  advertise  that  they  give  advice*  It  is  to  be 
hoped  that  the  phraseology  covers  the  undoubted 
intention  of  the  Legislature,  and  that  the 
quacks,  vampires,  and  harpies  who  prey  on  the 
credulity  of  their  fellows  will  find  that  there  is 
no  loop-hole  in  the  ordinance  through  which 
they  may  creep  to  ply  their  nefarious  trade. 
It  is  an  easier  matte^for  a* small  and  compact 
legislative  body,  with  the  experience  of  the  Mother 
Country  to  guide  them,  to  make  sound  and  com- 
prehensive laws  than  for  a  trad  it  ion -ridden  country 
like  ours    to      rise   superior   to   the   prejudice  of 


376    Th*  M*dical  Press.      NOTES    ON    GURRENT    TOPICS. 


April  6,  1^04. 


centuries.  One  must  not,  however,  be  led  to 
think  that  it  is  only  in  thorough  government  by 
oligarchy  that  such  beneficent  enactments  can 
be  reached,  for  New  Zealand,  by  far  the  most 
truly  democratic  country  in  the  world,  has  ,a 
similar  law  in  force.  The  inward  reason  of  the 
success  of  the  profession  in  "these  countries  lies 
in  the  energy  displayed  by  their  medical  men. 
When  our  own  members  by  personal  influence  on 
their  patients  bring  them  to  realise  the  gigantic 
extent  to  which  the  evils  of  unqualified  and  un- 
skilful practice  prevail,  a  disposition  will  be  created 
in  the  country  that  will  make  the  passage  of  a 
Bill  restraining  charlatans  from  plying  their 
trade  a  matter  of  little  difficulty  to  our  medical 
politicians.  Till  that  happy  day  arrives,  one 
must  be  content  to  look  with  envious  eyes  on 
the  beatific  conditions  that  prevail  in  the  daughter- 
states  of  the  Empire. 


The   Significance  of  Melanuria. 

Among  the  physical  appearances  of  the  urine 
which  are  met  with  in  certain  normal  and  diseased 
conditions,  few,  perhaps,  are  more  striking  than  its 
variations  in  colour.  Upon  this  objective  phe- 
nomenon the  ancients  laid  great  stress,  both  as 
regards  the  diagnosis  and  the  prognosis  of  a  given 
malady.  Since  the  depth  of  tint  depends 
largely  upon  the  degree  of  concentration  of  the 
urine,  it  follows  that  when,  from  some  cause,  the 
amount  of  fluid  in  the  excretion  is  diminished, 
a  high  colour  is  produced.  But  mere  depth  bf 
tint  must  not  be  confounded  with  actual  blacken- 
ing due  to  the  presence  of  a  pigment  in  solution. 
The  various  derivatives  of  haemoglobin  may  give 
rise,  when  dissolved  in  the  urine,  to  a  coloration 
closely  approaching  black.  True  melanuria,  as 
Dr.  A.  E.  Garrod  (a)  has  pointed  out,  may,  indeed, 
occur  in  the  urine  of  individuals  who  are  apparently 
in  perfect  health,  that  is,  the  urine  is  absolutely 
black  at  the  moment  of  passing.  Several  authentic 
cases  of  this  nature  are  on  record,  and  such  a 
condition  would  doubtless  cause,  not  unnaturally, 
considerable  alarm  both  to  the  patient  and  the 
physician.  The  cases  are  divided  into  two  groups 
— those  in  which  the  urine  is  black  when  passed, 
and  those  which  become  so  on  standing  for  a  short 
time.  In  the  first  class  are  comprised  the  idio- 
pathic cases,  so-called,  those  in  which  the  colour 
is  due  to  the  passage  of  modified  pigment,  to  the 
excretion  of  melanin,  as  in  melanotic  sarcoma, 
and  those  in  which  the  pigmentation  is  caused  by 
some  toxic  condition.  To  the  second  division 
belong  other  toxic  cases,  such  as  indicanuria  and 
alkaptonuria.  Hale-White  has  found  that  in 
certain  cases  of  phthisis  the  urine  becomes  almost 
black  on  standing.  Some  articles  of  diet  will  also 
produce  the  same  effect,  and  the  darkening  of  the 
urine  due  to  contained  products  of  oxidation  of 
phenol  is  not  an  uncommon  occurrence,  especially 
in  children  after  the  application  of  a  carbolic 
compress.  Urinary  melanosis  is  a  clinical  phe- 
nomenon full  of  interest  both  to  the  physician  and 
the  pathologist. 


(a)  Practitioner,  March,  1904. 


Observations  on  School-Children. 

While  we  are  sitting  considering  whether  it 
would  be  worth  while  to  make  a  series  of  ob- 
servations on  the  physique  of  school-children, 
the  French  are  going  ahead.  The  Council  of  the 
Royal  College  of  Surgeons  requested  the  Physical 
Deterioration  Committee  of  the  Privy  Council, 
now  sitting,  to  take  into  consideration  a  scheme 
suggested  by  Professor  Cunningham  for  making 
an  ant hro pome trical  survey  of  the  children  of  the 
country.  Thus  only  could  any  concrete  standard 
be  established  by  which  to  gauge  the  progress  of 
future  generations  in  physical  development.  The 
Physical  Deterioration  Committee  have  had  the 
matter  under  consideration,  and  it  may  be  of 
interest  to  them  to  study  the  measure  just  intro- 
duced by  the  Minister  of  Public  Instruction  in 
!  France.  This  law  requires,  inter  alia,  that  every 
pupil  in  a  public  school  shall  be  medically  ex- 
amined every  three  months,  and  that  his  height , 
weight,  chest  measurement,  and  general  con- 
dition be  entered  on  his  report.  The  law  supplies 
many  other  useful  provisions  with  regard  to  the 
hygienic  arrangements  at  schools.  For  instance, 
no  dry  sweeping  is  allowed,  carpets  are  forbidden, 
and  curtains  and  furniture  must  be  frequently 
cleaned.  The  bedrooms  and  kitchens  of  boarding 
schools  are  put  under  rigorous  conditions  of 
cleanliness,  and  no  consumptive  is  to  be  allowed 
at  school.  Now  that  the  religious  orders  have 
given  up  their  establishments,  it  will  be  possible 
by  the  required  registration  to  obtain  a  firm  grip 
of  the  schools  by  systematic  inspection,  and  the 
zeal  of  the  Government  for  the  public  health 
will  be  able  to  permeate  into  every  corner  of  its 
educational  system.  If  the  French  can  manage 
to  examine  their  children  four  times  a  year,  we 
surely  ought  to  be  able  to  do  so  once  in  a  lifetime. 

The  Fhysioloary  of  Hunger. 

There  are  few  physical  sensations  which  have 
not,  from    time    to    time,  been  subjected  to  the 
m  inutest  investigation  and  analysed  with  an  almost 
morbid  thoroughness,  yet  that  of  hunger  does  not 
appear  to  have  been  so  frequently  scrutinised.  The 
reason  for  this  would  seem  to  consist  largely  in 
the  difficulty  experienced  by  all  in  concentrating 
the  mind  upon  any  topic  when  the  body  is  ex- 
hausted  through  want  of   nourishment.    To  be 
of  any  real  value,  the  observations  should  be  con- 
ducted   by    the    physiologist    himself    upor    his 
own    sensations,    and    auto-starvation    is   not  a 
method    which   commends   itself   readily   to   the 
scientific  or  any  other  mind.     Dr.  Emil  Gibson  Ka) 
believes  that  the  three  essential  factors  concerned 
in  the  physiology  of  hunger  are — an  empty  stomach, 
an  intact  nervous  mechanism,  and   the  cerebral 
consciousness  of  the  gastric  condition.     The  latter 
factor  is,  in  all  probability,  the  most  important- 
Modern  experimental  researches  upon  the  secre- 
tion of   the  gastric    juice    in  dogs  have  amply 
shown  that  this  fluid  is  poured  out  in  abundance 
at   the  mere  sight  of  food,  or,  in  other  words, 
the  actual  presence  of  food  in  the  stomach  is.  not 
essential   for   its   secretion.     The    author  quotes 

(a)  Medical  Record,  New  York,  March  5th,  1904. 


Artit  6,  1904. 


NOTES  ON  CURRENT  TOPICS. 


TiTE  MfcDICAL  Puss*      377 


fcrQfl)  the  "  posthumous  notations  "  of  Antonio 
VUerbi,  a  Corsican  lawyer,  who  starved  himself 
to  death  in  order  to  avoid  the  capital  punishment 
to  which  he  was  sentenced.  The  record  of  the 
st-nsations  experienced  by  this  temarkable  in- 
dividual shows  that  alter  the  third  day  of  the  fast 
ilic  feeling  of  hunger  practically  disappeared, 
though  the  two  days  before  were  full  of  suffering. 
Sensations  of  thirst  manifested  themselves  at 
irregular  intervals,  but  none  of  hunger  were  felt 
until  his  death,  the  intellect  remaining  clear  up 
to  the  last.  The  influence  oi  the  mind  m  paying 
attention  to  or  disregarding  the  impulses  sent 
up  to  the  brain  from  the  stomach  determines,  to 
a  large  extent,  the  presence  and  extent  of  the 
sensation  of  hunger ,  which  fact  may  be  of  some 
practical  value  in  the  case  of  those  who  arc  com- 
pelled to  go  for  long  periods  without  food* 


Beri-Beri  in  Monkeys. 

The  pathology  of  beriberi  still  rests  in  ob- 
scurity. Dr.  Hamilton  Wright  has  recently 
recorded  the  results  oi  careful  observations  of 
bervberi  in  monkeys,  which  go  to  show  that 
the  disease  is  an  acute  infectious  one.  The 
.ism  appears  to  exist  in  close  sunless  foci. 
Food  either  qualitatively  or  quantitatively  is  a 
factor  of  no  great  importance.  The  organism 
however,  probably  ingested  with  food  acci- 
dentally contaminated  by  it.  It  appears  to 
multiply  in  the  stomach  and  upper  part  of  the 
intestine,  causing  a  local  congestion  or  inflamma- 
tion, and  elaborates  a  toxin  which,  being  absorbed, 
acts  with  varying  force  bilaterally  and  syste- 
matically on  certain  vital  and  ordinary  neurons, 
to  give  rise  to  the  collection  of  symptoms  known 
as  beri-berit  The  incubation  period  seems  to  be 
abort.  Rice  is  considered  to  have  no  relation  to 
the  analogy  of  the  disease.  But  the  actual 
organism  is  still  uncaught,  and  much  regarding 
the  pathology  of  beri-beri  must  necessarily  re- 
main as  little  better  than  ingenious  conjecture. 


The  Care  ot  the  "Register," 
When  the  General  Medical  Council  is  accused 
ol  lethargy  in  defending  the  medical  profession 
against  unqualified  practice,  the  answer  of  that 
august  body  is  an  indignant  non  posst4mus.  They 
have  no  statutory  powers  beyond  the  control 
of  medical  education  and  the  maintenance  of 
the  purity  of  the  Register  by  striking  off  the  names 
"I  Lin  worthy  qualified  men,  and  by  prosecuting 
those  who  falsely  assume  medical  titles.  That 
being  the  case,  how  is  it  that  the  General  Medkal 
Council  have  permitted  a  medical  man  to  house, 
and  presumably  to  work  with,  the  notorious 
Drouet  Institute  for  the  treatment  of  deafness  ? 
The  methods  of  that  organisation  have  been 
exposed  again  and  again  by  truth,  the  editor  of 
which  does  not  hesitate  to  call  the  whole  business 
a  heartless  and  wicked  fraud,  These  attacks 
have  never  been  answered  in  a  court  of  law  by  the 
Drouet  Institute,  a  fact  that  needs  no  comment. 
\  recent  police-court  case  shows  that  a  registered 
medkal  practitioner  had  the  same  address  as  the 
Drouet     Institute,     A     police     Deputy- Inspector, 


who  had  evidently  read  his  Truth,  asked  that  if 
ball  were  granted  it  should  be  substantial,  because 
of  prisoner's  connection  with  that  Institute,  It 
is  interesting  to  inquire  what  machinery  is  resorted 
to  by  the  General  Medical  Council  for  maintaining 
the  purity  of  the  Register.  How  can  a  man  retain 
his  qualification  and  be  for  years  connected  with 
a  semi-commercial,  semi -medical  concern  like 
the  Drouet  Institute  ?  We  trust  one  of  the 
direct  representatives  will  thresh  this  matter 
out  next  session. 


The  First  Liverpool  Graduates. 
The  newly-constituted  University  of  Liverpool 
has  got  to  work  in  earnest,  and  its  first  degree - 
conferring  ceremony  has  just  been  held,  A 
happy  omen  was  the  fact  that  the  first  candidates 
admitted  to  the  dignity  of  its  degrees  were  four 
medical  students,  who  will  hence fnr ward  be  dis- 
tinguished as  its  senior  graduates.  These  four 
young  men  will  have  a  noble  task  to  their  hand — 
that  of  creating  and  shaping  the  traditions  of 
their  Alma  Mater.  The  l£.fi.Liv.  has  yet  to 
establish  its  title  to  respect,  and  it  wilt  soon  be 
judged  by  the  subsequent  careers  of  its  first 
holders,  and  on  them  the  future  reputation  of  the 
University  rests.  But  if  the  University  have  no 
traditions  yet — to  hamper  or  spur  them  on,  as 
the  case  may  be — the  Liverpudlians  have  at  least 
a  noble  record  of  intelligent  and  sympathetic 
philanthropy  to  show.  Their  School  of  Tropical 
Medicine  has  already  a  world-wide  reputation, 
and  indeed  there  are  few  places  already  where  the 
effect  ol  its  work  has  not  reached,  In  Professor 
Ronald  Ross  the  school  possesses  a  man  who  has 
a  justly-earned  reputation  wherever  medicine  is 
practised  or  the  Anopheles  exists.  The  other 
great  departments  of  medical  education  arc  well 
equipped  and  appointed,  and  now  that  Liverpool 
is  freed  from  her  association  with  Manchester, 
one  may  depend  on  the  local  patriotism  of  that 
great  port — a  patriotism  second  to  that  of  nr> 
other  city  of  the  Empire — to  keep  them  abreast  of 
modern  conditions.  The  provincial  medical 
schools  are  hitting  the  London  ones  hard,  but  it 
cannot  but  be  an  advantage  to  allow  a  desire 
for  higher  culture  free  play  in  the  great  business 
towns— even  though  the  emoluments  of  the 
London  teacher  are  not  what  they  used  to  be. 
It  would  indeed  be  paradoxical  if  with  her 
wealth  of  clinical  material  Liverpool  did  not  rise 
to  take  her  stand  alongside  the  old  medical  schools 
of  Scotland.  Her  future  lies  in  her  own  hands 
and  that  of  her  graduates. 


Industrial  Flumbism. 

It  will  be  remembered  that  a  few  years  ago 
the  public  were  roused  to  take  notice  of  the 
shockingly  high  death-rate  Irom  lead -poisoning  in 
the  pottery  manufactories  in  Staffordshire,  The 
result  of  this  wholesome  agitation  was  that  Lord 
Ridley,  the  then  Home  Secretary,  issued  a  series 
of  very  admirable  and  stringent  rules  which  were 
to  be  observed  by  all  employers  of  labour  in  the 
pottery  trade.  These  rules  caused  a  good  deal 
of  resentment  on  the  part  of  the   manufacturers, 


37^    The  Medical  Press. 


PERSONAL. 


but  the  Home  Secretary  was  firm  ;  the  rulesjwere 
enforced  and  a  special  inspector  appointed  to 
mark  their  effect.  The  official  return  for  1903  has 
just  been  issued,  and  its  perusal  indicates  the 
immense  advantage  that  has  accrued  to  the 
workers  through  their  operation.  Whereas  in 
1899  there  were  249  cases  of  plumbism  with  16 
deaths,  in  1903  there  were  only  97  cases  with  3 
deaths,  among  over  six  thousand  operatives. 
This  is  a  fact  that  will  be  deeply  appreciated  by 
those  who  originally  interested  themselves  in  the 
movement,  and  one  that  reflects  great  <tf*edit  on 
the  Home  Office  staff.  It  is  to  be  hoped  that 
now  that  the  value  of  the  special  rules  has  been 
so  fully  established,  they  will  be  made  to  bear 
more  strictly  on  the  smaller  employers,  many  of 
whom  are  not  so  closely  under  the  thumb  of  the 
inspectors  as  those  in  a  larger  way  of  business. 
This  vindication  of  the  justice  of  the  promoters' 
contention  may  well  serve  to  put  courage  into 
them  to  agitate  that  fresh  precautions  shall  be 
enforced  in  other  lead-employing  industries,  some 
of  which  still  show  up  badly  in  their  sickness  and 
mortality  returns.  House-painters  and  plumbers 
were  responsible  for  201  cases  of  lead-poisoning 
in  the  year,  and  this  number  shows  a  tendency 
to  increase.  In  several  other  industries  lead- 
poisoning  is  rife,  and  it  is  high  time  they  were 
taken  in  hand  seriously.  The  use  of  fritted  lead 
should  be  made  compulsory,  and  proper  pre- 
cautions enforced  with  regard  to  the  cleanliness  of 
the  hands  and  mouth.  The  workers  themselves 
are  often  most  difficult  to  d?al  with,  as  they 
pooh-pooh  the  rules  made  for  their  benefit ;  but 
now  that  they  hear  how  beneficial  these  have  been 
to  their  fellow-employes,  their  good  sense  may 
be  trusted  to  come  to  the  rescue.  When  their 
co-operation  is  secured — intelligently  and  en- 
thusiastically— lead-poisoning  will  become  a  rata 
avis. 


The  Great  Wyrley  Cattle-Maiming:  Case. 

Some  six  months  have  passed  since  The  Medical 
Press  and  Circular  petition  was  presented  to  the 
Home  Secretary  on  behalf  of  the  prisoner  Edalji, 
undergoing  penal  servitude  for  the  maiming  of 
cattle.  The  ground  of  the  appeal,  as  readers  will 
remember,  was  that  if  Edalji,  an  educated  pro- 
fessional man,  committed  the  senseless  and  motive- 
less outrages  for  which  he  was  convicted,  then  he 
must  have  been  to  all  intents  and  purposes  insane 
and  fitted  for  a  lunatic  asylum  rather  than  a 
prison.  Our  petition  was  that  the  state  of  mind 
of  Edalji  be  inquired  into  by  a  skilled  medical 
commission.  Edalji  is  still  in  gaol,  and  we  have 
no  means  of  knowing  whether  any  such  formal 
inquiry  de  lunatico  as  that  we  asked  for  has  been 
made.  If  the  point  has  not  been  investigated  from 
the  point  of  view  of  mental  irresponsibility,  we 
venture  to  assert  that  the  Home  Secretary  is 
running  the  risk  of  acquiescing  in  a  grave  mis- 
carriage of  British  justice.  Our  petition  was  signed 
by  such  eminent  authorities  and  well-known  men 
as  Professor  Clouston,  Dr.  Savage,  Dr.  Bevan 
Lewis,  Dr.  F.  J.  Waldo,  Dr.  Younger,  Dr.  Ward 


April  6,  1-904. 

Cousins,  and  many  others  too  numerous  to  mention 
Last  week  another  cattle  outrage  was  reported 
from  the  neighbourhood  of  Great  Wyrley,.  one  of 
many  that  have  occurred  since  the  imprisonment 
of  Edalji.  A  series  of  more  dramatic  comments 
upon  that  unfortunate  man's  sentence  it  would  be 
hard   to  conceive. 


The  Administration  ©t  Oxygen. 

Of  all  the  therapeutic  measures  employed  in 
the    treatment    of    respiratory    and    circulatory 
disorders,  oxygen  gas  is  one  of  the  most  valuable. 
The  embarrassment  which  all  living  animal  cells 
feel    when    deprived  of    this    substance    speedily 
disappears   when   it   is   once    more    supplied    in 
abundance,  always  provided,  of  course,  that  the 
integrity  of  the  red  blood  corpuscles  with  regard 
to    their    oxygen -carrying    propensities    remain* 
unimpaired.     And    yet,    while    fully    recognising 
the   physiological    value   of    this   life-giving  gash 
how  reluctantly,  in  many  cases,  is  it  carried  into 
the  sick  room  or  hospital  ward.     The  mere  sight 
of  the  black  cylinder  by  the  bedside  is  said  by  some 
practitioners  to  be  an  ill -omen — a  death  warrant, 
as  it  were — serving  only  to  remind'  them  of  their 
inability  to  stay  the  progress  of  disease  and  to» 
fill  them  with  secret  despair.     To  the  lay  mind 
very  much  the  same  idea  is  conveyed,  the  use  of 
oxygen  being  regarded  as  a  dernier  rtssort:       Why 
should  this  be  so  ?     Because  in  nine  cases  out  of 
ten  this  remedy  is  left  until  it  is  far  too  late. 
Powerful  as  oxygen  is,  it  cannot  work  miracles, 
and  it  is  unfair  both  to  physician  and  patient  to 
employ  it  when  the  tissues  of  the  body  are  not  in 
a  position  to  receive  any  benefit  therefrom.    Dr. 
Solis  Cohen,  of  Philadelphia,  pleads  for  a  much 
freer  and  earlier  use  of  this  vitalising. gas,  especially 
in  lobar  pneumonia,  or,  indeed,  in  any  condition 
where    pulmonary   embarrassment    is    a   marked 
feature.     Two    to    three    hours,'    continuous   ad- 
ministration is    recommended,  long    before  any- 
thing like  cyanosis  has  appeared,  the  effects  being 
carefully  watched  meanwhile.     The.  use  ef  a  wash- 
bottle  not   more   than  half  filled  with  water  is 
necessary,  and  a  hard  rubber  terminal  at  the  end 
of    the   customary   glass    tube    may   be    inserted 
between    the    teeth.     The    beneficial    action   of 
oxygen  will  be  much  greater  when  given  freely 
over  long  periods  than  when  it  is  only  spasmodically 
administered. 


PERSONAL. 


H.R.H.  the  Prince  of  Wales  has  been  presented 
with  the  certificate  of  honorary  membership  of  the 
British  Medical  Association. 


The  annual  Harveian  Oration  of  the  London  Royal' 
College  of  Physicians  will  be  delivered  in  June  by 
Dr.  Caton,  of  Liverpool. 

The  first  Horace  Dobell  lecture  of  the  same  College 
will  be  delivered  in  November  by  Pr.  Edward  E. 
Klein,  F.R.S. 


In  the  same  month  it  is  announced  that  the  Fit* 
patrick  lectures  of  the  College  will  be  given  by  Dr.  J.- 
Frank Payne,  and  the  Bradshaw  lecture  by  Dr.  F.  F. 
Caiger. 


Afrtl  6,  1904. 


CORRESPONDENCE. 


The  Medical  Press.     379 


The  interesting  and  important   Milroy  lectureship 

x>i  of  I  he  London   Royal  College  of  Physicians 

iL  conferred  upon  Dr,  Thomas  Morisou  Legge, 

tfajesty'a  Inspector  of  Factories ,  who  has  chosen 

U  subject  +  *  Industrial  Anthrax.** 


The   Prince  of  Wales  has   sent  a  donation  of   £50 
ID    1  fit?    Dorset    County    Hospital. 


Sir  William    Broadbent   has    retired    from    the 
Presidency  of  the  London  Medical  Graduates'  College 
"  Polyclinic . 


Dr.  H.  R.  Fuller,  physician  to  the  late  Duke  of 
abridge,  has  been  appointed  by  the  King  a  Member 
f  the  Fourth  Class  of  the  Royal  Victorian  Order. 

At  the  first  commemoration    day  oi  the  University 
I  Glasgow  an  oration  will  be  delivered  by  Sir  \\ 
1   Psay,    K.C.B.,    LL.D.r   upon   whom   the  honorary 
degree  of  LL,D«  will  be  conferred  after  the  graduation 
nriony, 


On  March  23rd  a  valuable  presentation  of  Georgian 

silver  was  made  by  the  Lord  Mayor  of  Liverpool  to 

rhomai  Clarke,  J. P.,  on  his  retirement  from  the 

City  Council,   of  which    he   had    been    a   member    tor 

ran  years. 


Mr,  Henry  S,   Wellcome,   the  surviving  original 

partner    of    Messrs.    Burroughs    Wellcome    and    Co.r 

has  vindicated  on  appeal  his  sole  right  of   the  firm  10 

Bit  use  of  the  word   "  tabloid/'  after  prolonged  and 

itigation, 


>r   Seelev.    King's  College,   London,   will 
ct     ten    geological    excursions    to    examine    the 
1  channel  of  the  Thames  and  some  of  its  tributaries, 
n  April  jjrd,  at  Purrleet,  where  the  Thames 
■ver  the  chalk. 


assaults  on  cattle  at  Great  Wyrley.  The  petition  was 
extensively    signed    by   medical    men,  irhonj 

among  the  most  distinguished  members  of  the 
profession.  It  pointed  oat  that  there  was  every  reason 
to  suspect  a  grave  miscarriage  of  justice  f-.r  in  the 
first  place,  it  was  hardly  credible  that  a  man  of  educa- 
tion and  learning  should  have  executed  a  number  q| 
purposeless  assaults  on  cattle;  and,  secondly,  that 
had  he  really  done  so.  he  was  certainly  far  more  of  a 
lunatic  than  a  criminal.  Now.  sir  comes  the  stgni* 
iicant  news  that  the  outrages  have  re-commenced. 
Oil   tlit-  night   of  March  *4th,  two  ,|  a  Iamb, 

belonging  to  Mr,  Badger,  of  Great  Wvrlev,  w  r<  placed 
in  a  pen  011  his  hum  ft  *  perfectly  sound  ami  healthy 
condition.  On  the  morning  of  the  25th  all  three  were 
found  lying  side  by  side  with  their  heads  almost 
severed  f n ■  runks.     From  certain  iniormatinn, 

I  may  say  there  was  no  reason  to  attribute  any  ll 
feeling  on  the  part  of  any  particular  person  ti 
Badger,  and  the  same  brutal  blood-hiMiuh •>  - '.  harac- 
terised  this  outrage  that  had  characterised  the  others. 
The  case,  then,  for  inquiring  into  Edalji's  conviction 
is  stronger  than  ever,  tor  it  is  certain  that  he  cannot 
have  had  any  hand  in  this  affair,  and  the  circum- 
stances all  point  to  the  same  person  being  the  criminal 
in  each  instance. 

1  trust,  sir,  that  you  will  maintain  the  outspoken 
and  fearless  attitude  as  regards  this  unhappy  com  iction 
which  you  showed  in  drawing  np  the  Petition,  I 
maintain  that  the  Home  Office,  as  a  simple  duty  to  the 
public,  should  declare  the  grounds  upon  which  Edalji 
QJ  in  a  convict  prison, 

I  am,  Sir,  yours  truly. 

V  General  Practitioner. 
Birmingham.  April   im.   1904, 


Da  C.    W,   F.   Young,    formerly  assistant   medical 

lor  the  County  of  London ♦  was  last  week  ap- 

"1     by    the   Middlesex   County   Council   medical 

»tfrcer  ot  health  for  the  county,  at'a  salary  of  £700  a 

v?ar  and   expenses. 


The  Glasgow  University  Court  has  appointed  as 
lecturer  on  physical  chemistry  Professor  Soddy, 
Jxon.,  well  known  for  his  researches  in  radio- 
utivity.  which  he  has  conducted  with  Professor 
Rutherford,  of  Montreal,  and  Sir  William  Ramsay, 
K.C.B. 


The  next  meeting  of  the  Incorporated  Society  of 
IfadkaJ  Officers  of  Health  is  to  be  held  at  8  p.m.  on 
Fnday,  April  8th,  when  a  paper  will  be  read  by  Dr. 
j  Howard -Jones,  medical  officer  of  health  of  Newport 
(Man.  |,  on  the  Control  of  Measles  Epidemics,  to  be 
■d  by  a  discussion. 

annual  dinner  of  the  West  London  Medico- 
r^i,.al  Society  will  be  held  at  the  Trocadero 
Restaurant.  Piccadilly,  London,  W.,  on  Wednesday 
evening,  Bfay  4th,  at  7,30.  Communications  should  be 
j'Wressed  to  Dr.  Charles  But  tar,  10,  Kensington 
hardens  Square,  W . 


Corcc0pon&encc. 

rW*iJa  not  bold  tnirwtvei  mpaDfliMr  for  the  opinion  of  the  uorrn- 


INK    GREAT    WYRLEY    CATTLE    OUTRAGES. 

Editor  <v  The  Medical  Press  and  Circular. 

Sir,— In  November  last   year   there   was  issued  in 

connection  with  The  Medical  Press  and  Circular 


UNIVERSITIES   AND   THE   PROFESSION. 
T*  th  f  The  Medical  Press  and  Circular. 

Sir,— It  is  well  that  parents  whose  sons  are  looking 
forward  to  the  medical  profession  should  understand 
clearly  the  value  of  universities  as  a  part  in  preparation 
for  it.  Some  parents  may  consider  that  they  are  wise 
in  investing  capital,  at  some  cost  to  themselves,  in 
sending  a  son  to  a  university,  an  a  good  degree  will 
probably  be  of  value  to  him  in  his  future  career, 
parents 'may  take  the  view  that  after  leaving  scS, 
boy  requires  some  training  before  he  begins  the  actual 
life  of  acquiring  practical  professional  knowledge. 
The  question  reduces  itself  to  a  careful  consideration 
of  when  they  may  expect  a  son  to  be  in  a  position  to 
support  himself.  Assuming  that  they  can  put  aside 
1  certain  amount  of  capital  to  be  expended  in  nn 
education  to  the  best  advantage,  the  question  of  amount 
and  how  to  expend  it  ought  lo  be  thoroughly  under- 
stood, otherwise  the  son  may  be  left  in  a  very  doubtful 
and  unhappy  position. 

When  a  hoy  shows  great  talents,  the  universities, 
particularly  Oxford  and  Cambridge,  offer  great  tempta- 
tions. When  we  axe  dealing  with  1k>\-*  ol  average 
ability  is  is  very  important  that  capital  should  not  be 
uselessly  expended  on  the  education  that  is  afforded  by 
those  universities.  It  is  well  to  recognise  clearly  the 
kind  of  work  that  is  carried  on  in  the  practlceof  medicine, 
and  how  the  work  differs  in  its  character  and  the 
training  it  requires  according  to  this  difference, 
There  is  no  doubt  but  that  our  universities  are  realising 
the  kind  of  training  that  is  necessary  (of  those  who 
are  preparing  for  such  a  profession  as  that  ct  an 
engineer,  chemist  or  a  doctor.  The  training  <d  the 
mind  by  the  study  of  classics  or  mathematics  may  be 
of  some  peculiar  value,  but  now  it  is  being  acknow- 
ledged that  a  more  practical  view  must  be  taken  of 
university  education,  and  that  along  with  the  training 
oi  the  mind  it  is  well  that  some  attention  should  be 
paid  to  the  practical  use  of  the  knowledge  that  is 
being  acquired  by  university  students. 

When  a  student  begins  hospital  life  there  1^  oo  doubt 
that  he  should  come  with  a  good  sound  basis  of  scientific 


■  petition    to    the    Home    Secretary,    asking    him    to 
gttatti  an  inquiry  into  the  case  of  Mr.  Edalji.  the  j  iSk^^Vpartrcu'tokiSd,  todTit  &.*3STh* 

■  minsham    solicitor     who   was    convicted    and    sen-     is  expected  to  obtain  in  a  university.     There  h 
WWW  on  a  charge  of  performing  a  sera  of  brutal  I  danger  lest  the  system  of  university  education  should 


380    The  Medical  Press. 


LITERATURE. 


April  6,  1904. 


rather  provoke  in  a  student's  mind  a  contempt  for 
the  technical  practical  knowledge  which  is  absolutely 
necessary  for  those  who  -  re  going  into  general  practice. 
There  is  a  singular  feeling  of  antagonism  between  the 
scientist  and  the  practical  workman. 

The  combination  of  the  scientist  and  the  workman, 
as  in  such  a  man  as  Lord  Kelvin,  is  rare  and  of  the 
highest  value.  The  man  of  science  must  go  through 
the  workshops  if  he  wants  to  be  at  least  equal  to  the 
ordinary  workman.  When  he  has  done  this  he  rises 
infinitely  above  him  by  reason  of  his  having  what  the 
other  cannot  approach  him  in,  a  knowledge  of  the 
science  of  the  work  on  which  they  are  engaged. 

The  question  of  how  to  prepare  our  younger  men 
for  the  profession  of  medicine  is  a  very  important  one, 


the  hard  tissue.  In  some  extremely  rare  cases  a  root 
of  a  tooth  fractured  within  the  alveolus  has  become 
more  or  less  united  ;  but  this  has  been  brought  about 
not  by  deposition  of  new  dentine  but  by  calcification 
of  the  pulp  between  the  broken  ends  and  by  ossification 
extending  from  the  investing  periosteum.  Such  cases 
are  the  rarest  of  curiosities  in  dental  museums. 
I  am,  Sir,  yours  truly, 

M.R.C.S.,  L.D.S. 
March  31st,  1904. 


Xfteratnre* 


MANUAL  OF  OPERATIVE  SURGERY,  (a) 
"The  Manual  of  Operative  Surgery,"  by  Sir  Fre- 


and  this  line  of  education  requires  as  much  considera-  .  , 

tion,  indeed  a  great  deal  more,  than  the  very  general ;  derick  Treves,  has  been  eagerly  looked  for  by  many 
question  of  how  to  educate  the  great  class  of  workmen  j  surgeons.  It  is  twelve  years  since  the  first  edition  was 
that   is   now  engaging   the   attention  of  our  leading    published,  and  during  this  period  tremendous  advance 


statesmen  and  philanthropists. 

I  am,  Sir,  yours  truly, 


R.  L. 


ALOPECIA  AND  DENTAL  CARIES. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — The  last  sentence  of  "  Medicus  Senex's " 
letter  in  The  Medical  Press  and  Circular  of  March 
30th  ought  to  put  him  out  of  court  so  far  as  I  am  con- 
cerned. To  charge  me  with  "  abuse  worthy  of  an 
oyster  wench  "  is  a  gross  travesty  of  the  truth  ;  and 
if  "  Medicus  Senex's  "  argument  and  style  did  not 
afford  countervailing  amusement  and  entirely  blunt 
the  sting  of  his  invective,  I  might  feel  almost  as  much 
annoyance  as  he  seems  to  labour  under.  I  have  told 
him,  and  I  repeat,  that  he  is  ignorant  of  the  facts  of 
dental  physiology,  without  a  knowledge  of  which  it  is 
impossible  to  understand  the  pathology  of  the  teeth. 
I  have  told  him  that  one  of  these  fundamental  facts  is 
that  enamel  and  dentine  once  fully  calcified  are 
physiologically,  and  therefore  pathologically,  un- 
alterable, and  that  whatever  changes  take  place  in 
them  subsequently  are  due  to  external  agents.  These 
fundamental  facts  were  virtually  demonstrated  more 
than  forty  years  ago  by  the  late  Sir  J.  Tomes,  who,  in 
summing  up  his  account  of  caries  in  the  first  edition 
of  his  work,  declared  that  "  the  hypothesis  of  vital 
action  in  any  way  modifying  the  disease  must  be 
abandoned  in  toto  ;  dental  caries  cannot  be  said,  strictly 
speaking,  to  have  any  pathology."  The  advance  of 
science  has,  since  Sir  J.  Tomes'  time,  put  the  facts  of 
dental  histogenesis  and  histology  beyond  the  range  of 
controversy.  "  Medicus  Senex  asks  me  to  tell  him 
the  story.  I  reply  that  he  can  find  it  all  clearly  told 
in  the  text-book  from  which  he  has  cited  one  or  two 
isolated  statements,  but  which  he  has  evidently  not 
studied  and  mastered  ;  and  that,  if  I  could  expect  you 
to  give  space  to  it,  I  cannot  trouble  myself  to  write  for 
his  benefit  a  lengthy  rteumJ  of  elementary  dental 
physiology.  Having  once  mastered  this  elementary 
Knowledge,  "  Medicus  Senex "  will  recognise  the 
absurdity  of  suggesting  the  possibility  of  the  pheno- 
mena of  "  absorption,  hypertrophy,  repair,  &c,  in 
enamel  and  dentine,"  and  he  will  perceive  that  it  is 
almost  more  absurd  to  speak  of  "  atrophy  of  teeth." 
The  teeth  before  calcification  begins  are  represented  in 
soft  tissue.  In  a  very  large  proportion  of  instances  in 
human  teeth  the  process  of  calcification  is  imperfectly 
performed.  Enamel  and  dentine  are  of  ten  deficient  in 
hardness  throughout,  or  present  patches  of  badly 
formed  tissue  at  parts.  These  patches  are  often  only 
discoverable  by  the  microscope.  Sometimes  the 
exteriors  of  the  crowns  show  gross  visible  defects  as 
in  "  honeycombed  "  and  "  spinous  "  teetn  and  in 
syphilitic  teeth.  The  quality  of  the  tissues  varies 
infinitely  in  different  individuals  ;  and  this,  with  the 
ever-varying  conditions  of  the  secretions  of  the  mouth, 
explains  much  that  seems  to  puzzle  "  Medicus  Senex  " 
with  regard  to  the  apparent  varying  susceptibility  of 
different  teeta  to  decay.  The  absorption  of  the  roots 
of  milk  teeth  is  brought  about  by  the  action  of  their 
external  vascular  covering ;    not*  through  activity  in 


has  been  made  in  almost  every  branch  oi  surgery. 
We  naturally  expect  great  changes  in  the  second 
edition,  and  our  expectations  are  still  further  increased 
by  the  statements  made  in  the  preface.  It  would 
appear  that  Sir  Frederick  Treves  has  had  little  to  do 
with  the  revision,  and  the  new  opinions,  &c,  are  those 
of  Mr.  Hutchinson.  Whilst  gladly  recognising  Mr. 
Hutchinson's  eminent  abilities,  yet  we  are  disappointed 
that  the  present  volume  does  not  represent  the  matured 
and  dispassionate  opinions  ot  the  great  surgeon,  who 
has  retired  from  active  work  and  of  whom  it  would 
have  served  as  a  memento.  The  book  commences  with 
a  section  upon  such  matters  as  modern  theatres,  pre- 
paration of  the  patient,  advice  to  the  operator  about 
himself,  preparation  of  instruments,  &c,  which,  on 
the  whole,  is  a  most  excellent  section,  and  well  up  to  date 
except  for  a  few  blemishes  such  as  opposition  to  the 
use  of  gloves,  the  statement  that  catgut  is  the  best 
suture  material,  the  very  imperfect  method  of  sterili- 
sation recommended  tor  catgut,  the  recommendation 
to  use  marine  sponges,  and  the  faulty  directions  for 
sterilisation  of  gauze  sponges.  In  the  chapter  dealing 
with  instruments,  we  heartily  endorse — "  The  art  of 
operative  surgery  would  benefit  greatly  if .  the  director 
were  to  be  entirely  banished  from  the  list  of  surgical 
instruments."  The  sections  treating  of  amputations 
and  excisions,  &c,  are  clear,  concise,  and  the  anato- 
mical descriptions  most  useful  ^  but  surely  the  illus- 
trations should  be  blotted  out,  in  many  cases,  for  the 
credit  of  British  surgery.  Instruments  should  not  be 
depicted  with  wooden  handles,  operators  should  not 
appear  wearing  coats  and  cuffs,  operation  areas  should 
not  be  left  unshaved. 

Turning  to  the  second  volume,  we  are  pleased  with 
some  things,  such  as  the  chapters  dealing  with  intes- 
tinal obstruction  and  intestinal  anastomosis ;  but,  as 
a  whole,  the  volume  is  decidedly  poor.  The  chapters 
dealing  with  the  female  pelvis  and  perineum  should 
either  be  lett  out  or  else  lengthened  and  brought  up 
to  date.  The  statistics  of  gastro-enterostomy  are 
needlessly  gloomy,  and  certainly  there  must  be  some- 
thing wrong  in  the  technique  of  an  operator  who  says 
that  following  the  radical  cure  of  hernia  recurrence 
takes  p|ace  in  20  per  cent,  to  30  per  cent,  of  the  inguinal 
variety  and  in  30  per  cent,  to  40  per  cent,  of  the  femoral. 

The  fast  chapter  in  this  volume  deals  with  amputa- 
tion of  the  breast  for  malignant  disease.  We  will  refer 
the  would-be  reader  of  this  chapter  to  Fig.  473,  and  to 
the  following  paragraph  : — "It  appears  to  be  totally 
unnecessary  in  ordinary  cases  of  malignant  disease  to 
remove  the  whole  of  the  skin  covering  the  breast, 
whether  sound  or  unsound,  as  some  advise." 

We  think  that  these  two  references  should  suffice  to 
satisfy  the  most  sceptical  that  this  chapter  is  not  up  to 
date,  and  should  only  be  read  tor  the  purpose  of 
criticism,  and  as  an  example  ot  how  slowly  scientific 
truths  become  disseminated,  notwithstanding  the  easy 
access  to  literature  which  we  now  enjoy. 

la)  "  A  Manual  of  Operative  8urgery."  By  Sir  Frederick  Tnres, 
Bart.,  K.C.V.O.,  C.B.,  LL.D.,  F.B.C.8.  New  Edition,  revised  bv  tbe 
Author  and  Jonathaa  Hutobiaaon.  ]*■»..  K.B.C.8.  Id  two 
Volume*.  London :  Caasell  and  Co*  1966.  Otmy  Svo.  Pp.  1*2- 
Price  42s. 


lrta  '\  1904* 


OBITUARY. 


The  Medical  Press,     381 


literary  Botes  anO  (Bossip* 

Health  seekers  about  to  depart  for  Centra]  Italy 
would  do  well  to  put  Mr.  Egertou  R.  Williams*  new 
ivorl  "n  "  HiH  Towns  of  Italy  "  among  their  impedi* 
mtHfa. 

Vacation  Days  in  Greece/'  by  Mr.  Ruius  B.  Rich- 
infrea  (London  1  Smith,  Elder  and  Co.),  is  a  work 
which  may  well  be  treated  as  a  companion  by  those 
ieeiring  rot  or  health  in  this  classic  land- 

V 

The    first    number    at    a    new    periodical,    entitled 

f  fated  Revtew  of  Pttysiotogu  Therapeutics,  has  just 

appeared   in   America,   under   the   able  editorship  of 

Dr+  S.  D.  Morrell  ;    the  publisher  is  E+  R.  Pel  ton,  of 

Htm  York. 

*  * 

Mr,  F.  Berkeley  Smith,  in    'The  City  of  the  Magyars" 

idem  :    T.  Fisher  Unwin),  has  interesting  references 

10  the  hospitals  of  Bnda  and   of   Pest,  and   describes 

of  what  may  be  mildly  termed  the  non-hygienic 

procedures  of  the  Hungarians 

We  understand  that  Mr.  R,  Mackenzie  Moore. 
Actuary  to  the  United  Kingdom  Temperance  and 
General  Provident  Institution,  is  publishing  his  im- 
portant monograph  on  "  The  Comparative  Mortality 
among  Assured  lives  of  Abstainers  and  (Non-abstainers 
tkoholtc  Beverages  "  in  the  M edkal  Temperance 
Review. 

Dr.  Reginald  J.  Gladstone  has  a  moat  scientific  and 
-ting  paper  in  the  new  Archives  of  the  Middi 
Hospital  <.n  "  Some  Cephalometric  Data  hearing  noon 
Ihe  Relation  of  the  Size  and  Shape  of  the  Head  to  Men- 
tal Ability,"  which  should  be  studied  by  phrenologists 

—  and  others. 

*  * 

# 

its.  Kegau  Paul*  Trench,  Truhner  and  Co.  have 
just  issued  the  first  number  of  Omt  Hospitals  and 
Ckaritits,  the  object  of  which  is  to  present  the  par- 
ticulars of  hospital  life  and  work  in  such  a  form  as  shall 
strengthen     charity     and     increa»  ithy.     The 

ranee  of  the  magazine  is  attractive  and  it  is  coll- 
ide that  the  new-comer  may  find  a  place  in  the 
fait  multiplying  journalism  of  oar  modern  chariiiesp 
hut  we  doubt  that  there  is  a  need  for  it. 

*  * 

This     smart    pocket    book    ("A     Pocket    Book     of 
Clinical    Methods,"     by     Chas.    H.    Melland,     M.L> .. 
MK,C,p.,   Physician   to  the    kneoate   Hospital,  Mau- 
ri   is  intended  as  a  convenient  uuide  lo  clinical 
examination.     It     describes     trustworthy 
methods    for    the    investigation    of    sputum,    gastric 
contents,   faeces,   urine,   blood,   pas  and   other  fluids, 
bonld    prove  of   service   to   the  student.     A   few 
illustrations  might  have  been  given  with  advantage. 

*  * 

Mr.  Angus  Hamilton,  in  his  opportune  work,  "  Korea  " 
(London  William  Hememann),  makes  reference  to  the 
common  diseases  of  the  country,  Malaria  is  common  ; 
small-pox  nearlv  always  present  ;  leprosy  prevails  ; 
tuberculous  affections  are  very  rife  ;  cataract  is  frequently 
met  with  ;  and  venereal  disease  is  said  to  be  as  general 
as  it  used  to  be  in  England.  Sanitation  is  practically 
unknown,  so  that  "fifth  "  diseases  are  rampant.  In 
no  country  in  the  world,  we  believe,  arc  parasitic 
WORD  diseases  more  prevalent  and  universal. 

Mr.  Douglas  Stolen,  another  opportune  writer  on 
the  Far  Eastr  m  his  attractive  "  Queer  Things  Abou: 
J  apan  * '  ( I  jond  on  :  A 11 1  h  on  y  1  re  hem  e  and  Co . ) , 
deals  with  many  points  concerning  personal  hygiene 
and  public  sanitation  in  that  progressive  country. 

* 

The      Orient     Press     announces    the      appearance 

The     Duties    of    the    Heart,"     translated     from 

the  Arabic    of   Rabbi   Bachye,   with   an  introduction 

bv   Edwin   Collins;     "  The   Sayings    of     Confucius," 

The*     Odes     of     Confucius/"     and     "  The     Sayings 


of  the  Brothers  of  Sincerity."  The  teachings 
and  doctrines  of  this  interesting  sect,  which  flourished 
in  Persia  and  Arabia  in  the  ninth  and  tenth  centuries, 
will  be  edited  by  Dr.  Paul  Bronnle.  Readers  will  be 
interested  to  leant  that  Dr.  S.  A.  Kapadia,  secretary 
of  the  Norlhbrook  Society,  has  1!  d  superin- 

tendence of  the  works  upon  Indian  religions  and  litera* 
ture.  which  the  Orient  Press  intends  to  publish. 


©bituarg. 


JOSEPH  PEEKK  RICHARiJS.  M.R.C.S  .  LS.A. 
By  the  death  of  Mr.  Richards,  on  March  12nd,  I  lie 
psychological  branch  of  the  medical  profession  loses 
a  well-known  and  popular  figure  as  well  as  a  pleasant 
and  interesting  personality.  Mr.  Richards  was  n  m 
at  Plymouth  sixty-three  years  ago,  but  was  brought  up 
in  London,  where  his  father  was  for  many  years  a 
well-known  practitioner  in  Newcastle  Street  Strand. 
He  pursued  his  medical  studies  at  King's  College 
Hospital,  and  became  1I.R.C&.  and  L .S.A".  in  i$6j. 
After  a  short  period  spent  as  house  surgeon  at  the 
Stockport    Infirmary    Mr.    Richards    *  .in  led 

assistant  medical  officer  to  the  Devon  County  Lunatic 
Asylum,  Thence,  111  1867.  he  went  in  a  similar 
capacity  to  the  Middlesex  County  Asylum  at  Han  well, 
and  was  after  a  few  years  promoted  to  the  post  of 
medical  superintendent  of  the  female  depart; 
there,  w+hich  appointment  he  held  for  some  twenty 
years,  retiring  with  a  substantial  and  well-earned 
pension  a  few  years  ago.  Mr.  Richard*"  Life-work  at 
Hanwell  was  characterised  by  extreme  thoroughness 
and  he  was  a  model  of  painstaking  industry.  His 
kindness  of  heart  was  extreme  ;  and  though  he  never 
posed  as  a  showy  medical  superintendent,  his  one 
object  in  life  was  to  ensure  the  happiness,  comfort, 
and  improvement,  where  possible,  of  the  irresponsible 
beings  under  his  care.  Mr+  Richards  was  a  constant 
attendant  at  the  meetings  of  the  Medical  Society  of 
London,  and  had  served  on  the  Council.  He  was  also 
a  member  of  the  Medico- Psychological  Association 
and  of  the  Neurological  Society,  At  the  time  of  his 
death  he  was  one  of  the  Directors  of  the  Society  for  the 
Relief  of  Widows  and  Orphans  of  Medical  Men,  in 
which  charity  he  took  great  interest,  Mr,  Richards' 
married  life  was  an  ideally  happy  one.  and  he  leaves 
a  widow  and  three  children  to  mourn  hia  I 


HON.  THOMAS  ROBERT  Mc.TN\ 
The  career,  of  the  Hon.  Thomas  Robert  Mclnnes, 
whose  death,  at  the  age  of  63,  was  briefly  reported  in 
the  Tutus  of  Thursday,  March  17th,  began  in  the 
extreme  east  of  the  Dominion,  had  "ts  middle  period 
1  in  the  centre,  and  found  its  culmination  and  collapse 
in  the  extreme  west.  An  Inverness  man  by  descent, 
he  was  born  and  went  to  school  in  Nova  Scotia,  but, 
after  going  to  Harvard  College  and  Chicago  i<>t  medical 
training,  he  settled  as  a  doctor  at  Dresden,  Ontario, 
in  1869,  Five  years  later,  having  served  as  town 
reeve  and  county  coroner,  he  migrated  to  British 
Columbia,  built  up  a  large  practice  at  New  Westminster, 
and  became  medical  superintendent  of  the  provincial 
insane  asylum  and  physician  to  the  Royal  Columbia 
Hospital.  He  was  mayor  of  New  Westminster  from 
1876  to  1878,  and  in  the  latter  year  the  town  sent 
him  to  the  Federal  House  of  Commons.  For  several 
years  he  was  reckoned  an  Independent,  and  in  1881 
he  was  raised  to  the  Senate  under  the  Conservative 
r/gime  ;  but  before  very  long  he  was  recognised  as  a 
member  of  the  Liberal  party,  and  he  was  une  of  the 
first  public  advocates  ot  unrestricted  policy  with  the 
Cm  ted  States.  In  November,  1897.  Sir  Wilfrid 
Laurier's  Ministry  appointed  him  Lieutenant-Governor 
of  British  Columbia.  In  February,  1900,  the  pro- 
vincial  Government  was  defeated  in  the  Legislature  by 
a  majority  of  oner  on  the  second  reading  of  a  Redis- 
tribution "  Bill.  The  position  of  the  Lieutenant- 
Governor  became  an  impossible  one,  yet  he  refused 
to  resign  at  the  request  of  the  Federal  Government, 
which  was  therefore  compelled  to  deprive  him  of  his 


3S2        The  Medical  Press.    LABORATORY  NOTES,  &c. 


April  6,  1904. 


office.  He  was  succeeded  by  Sir  Henri  Joly  de  Lot- 
biniere,  the  most  eminent  French  Protestant  in  the 
Dominion. 


UELT.-COLONEL  EDWARD  FERRAND. 
Lieutenant-Colonel  Edward  Ferrand,  of  the 
Indian  Medical  Service,  who  died  at  Peshawar  on 
March  9th,  at  the  age  of  53,  was  educated  at  Edinburgh 
and  Durham,  and  entered  the  Madras  Army  as  assis- 
tant surgeon  in  September,  1875.  He  served  with  the 
Burmese  expedition  in  1886,  and  remained  on  duty 
there  until  the  pacification  of  Upper  Burmah  was 
completed  in  1889.  He  also  served  in  the  operations 
on  the  Samana  and  in  the  Kurram  Valley  during 
August  and  September,  1897,  at  the  relief  of  Gu  lis  tan, 
and  with  the  Tirah  expedition  in  1897-98.  He  was 
promoted  to  his  lieutenant  •  colonelcy  in  1895,  and 
was  on  regimental  duty  with  the  66th  Punjabis  at  the 
time  of  his  death. 


COUNCILLOR  R.  W.  HAINES,  M.R.C.S.Eng. 

The  Birmingham  City  Council  and  the  Liberal 
Unionist  party  at  Balsall  Heath  have  sustained  a 
regrettable  loss  in  the  death,  at  the  age  of  61.  of  Dr. 
R.  W.  Haines.  He  was  seized  about  mid-day  on  the 
25th  ult.  with  an  attack  of  angina  pectoris  at  home, 
and  in  about  three  hours  he  succumbed.  Dr.  Haines 
was  among  the  oldest  medical  practitioners  in  Bir- 
mingham. He  was  born  at  Bromsgrove,  and  educated 
at  the  Grammar  School  of  that  town,  afterwards  being 
trained  for  his  profession  at  King's  College,  London, 
where  he  qualified  as  M.R.C.S.Eng.  and  L.S.A.  He 
went  to  Birmingham  over  thirty-six  years  ago,  and 
started  in  practice  at  Balsall  Heath,  where  he  built 
up  a  wide  connection,  and  was  held  in  much  esteem. 
He  took  a  keen  interest  in  public  affairs  and  in  the 
City  Council  was  associated  with  the  Free  Libraries 
Committee  and  the  Lunatic  Asylums  Committee, 
and  had  passed  the  chair  ot  the  former  body.  The 
deceased  gentleman  was  an  active  Freemason.  He 
was  a  past  master  of  the  Arter  Lodge,  and  had  held 
prominent  offices  in  the  Grand  Lodge  of  his  Province. 

JOHN  PRYTHERCH.  M.D.St.And. 
After  a  week's  illness  from  pleurisy,  despite  the 
assiduous  attention  of  two  consultants  and  his  own 
medical  attendant,  Dr.  Prytherch,  of  Menai  Bridge, 
died  on  the  25th  ult.,  in  the  prime  of  life.  The 
deceased  gentleman  is  described  as  in  his  youth 
one  of  the  strongest  men  in  an  island  noted  for  physi- 
cally tine  men,  and  he  long  ago  established  a  reputation 
as  a  hard-working  and  skilful  practitioner.  He 
studied  medicine  at  the  Charing  Cross  School,  and 
took  the  L.S.A.  and  M.R.C.S.Eng.,  in  1857,  and  the 
M.D.St.  And.,  in  1862.  His  deatft  will  be  deeply  and 
generally  regretted. 

MR.    JAMES    HAY    DUNLOP,    L.S.A. 
Mr.  Dvnlop,  Douglas,  died  on  the  21st  ult.  at  Lead- 
hills,  after  two  months'  severe  illness.     The  deceased, 
who  had  been  in  practice  at  Douglas  for  a  number  of  i 
years,  was  well  known  throughout  the  whole  upper 
ward  of  Lanarkshire,  where  he  had  practised  for  the  last 
twenty  years.     Twelve  months  ago  he  underwent  an 
operation  for  a  serious  malady,  and  it  was  a  recurrence 
of  this  disease  that  caused  his  death  at  a  comparatively  | 
early  age.     He  took  the  licentiateship  of  the  London 
Apothecaries  in  1881. 

DR.  JAMES  STUART,  OF  BALLYMENA. 
We  regret  to  announce  the  death  of  Dr.  James 
Stuart,  of  Ballymena,  00.  Antrim,  on  the  23rd  ult. 
Dr.  Stuart  was  a  native  of  Ulster,  and  studied  in 
Queen's  College,  Belfast,  taking  his  M.D.  in  the  Queen's  ' 
University  in  1877.  He  settled  in  practice  in  Bally- 
mena, and  soon  attained  marked  success,  having  a 
large J practice  not  only  in  the  town  of  Ballymena,  but 
in  the  prosperous  country  round  about.  He  was  a 
man  of  a  most  bright  and  cheery  disposition,  and  a 
great  personal  favourite  with  all  classes,  making  friends 
wherever    he    went.     His    professional    ability    and 


sound  common  sense  gained  him  the  respect  of  hi 
professional  brethren,  by  whom  he  was  often  called  in 
in  consultation,  and  by  whom  he  was  a  few  years  ago 
elected  President  of  the  North  of  Ireland  Branch  of 
the  British  Medical  Association.  At  the  latter  end 
of  last  year  he  became  seriously  ill  and  went  to  a 
private  hospital  in  Belfast  for  some  time,  then  to 
Rostrevor  Sanatorium,  and  then  to  the  South  of 
France.  It  soon  became  clear,  however,  that  he  was 
failing,  and  he  started  for  home,  but  died  in  London, 
the  cause  of  death  being  disseminated  tubercle. 

Xaborators  notes  &  flew  appliances. 

WRIGHT'S  LIQUOR  CARBONIS  DETERGENS. 
This  well-known  preparation  consists  essentially  of 
a  specially  devised  solution  of  the  medically  active 
principles  of  coal-tar.  It  differs  from  the  Liq.  Picis 
Car  bonis  of  the  1 898  B.P, ,  which  is  so  poor  an  imitation 
as  to  be  quite  dissimilar.  These  two  preparations  are 
very  readily  distinguished  on  examination  in  the 
laboratory,  as  Wright's  is  considerably  richer  in  tar 
constituents.  The  Pharmacopoeia  preparation  is  very 
apt  to  throw  down  a  copious  deposit,  particularly  in 
cold  weather,  and,  presumably,  its  efficacy  is  propor- 
tionately diminished.  Even  when  freshly  prepared  it 
does  not  contain  much  more  than  half  the  tar-con- 
stituents of  Wright's  preparation. 

Mr.  C.  G.  Moor,  in  his  well-known  work  on  "  Stan- 
dards for  Food  and  Drugs,"  records  finding  2  or  3  per 
cent,  of  solids  (tar-constituents)  in  the  British  Phar- 
macopoeia preparation,  and  goes  on  to  say :  "  This 
official  preparation  is  probably  the  outcome  of  the 
Liquor  Carbonis  Detergens  (Wright)  which  is  prepared 
by  special  apparatus,  and  has  a  total  solids  of  about 
five  grammes  per  100  c.c." 

We  have  examined   a  recent   sample   of  Wright's 
manufacture,  and  find  the  solids  to  be  5*5  per  cent., 
which  corresponds  with  the  figure  quoted  above,  and 
doubtless  the  volatile  oils  will  also  be  present  in  greater 
quantity  in  the  original  preparation.     We  are  glad  to 
have  the  opportunity  of  placing   the  results  of  our 
analysis  before  our  readers,  though  they  may  not  be 
new  to  many,  and  we  would  urge  all  to  carefully  specify 
the  original  preparation  when  prescribing. 
THE  B.  W.  AND  CO.  ALL-GLASS  ASEPTIC  SERUM 
SYRINGE. 
Every  up-to-date  medical  practitioner  must  have 
often  asked  the  question,  "  What  is  the  best  syringe  for 
serum  treatment  ?  "     The  absolutely  essential  import- 
ance of  avoiding  septic  contamination  is  obvious,  and 
a  simply  constructed  syringe  which  can  be  readily 
sterilised  is  the  best  means  to  that  end.    The  B.  W. 
and   Co.   All-Glass   Aseptic   Serum   Syringe  is   made 
of  glass,   and  consists  of  three  simple  parts,  barrel, 
piston,  and  nozzle,  which  are  instantly  detachable  and 
easily  sterilised.  The  adop- 
tion of  a  solid  piston  which 
fits  the  barrel  with  abso- 
lute precision  renders  un- 
necessary the  use  of  leather 
or  other    packing.      The 
needle  is  attached  to  the 
nozzle  by  a  flexible  rubber 
joint,  which  guards  against 
injury  from  sudden  move- 
ment on  the  part  of  the  patient.    The  B.  W.  and  Co. 
All-Glass  Aseptic  Serum  Syringe  is  manufactured  in  five 
sizes  of  2  c.c,  3  c.c,  5  c.c,  10  ex.,  and  20  c.c.  capacity 
respectively.     Each  syringe  is  issued  in  a  metal  case, 
and  is  accompanied  by  two  steel  needles.     If  platino- 
iridium  needles  are  desired,  they  can  be  fitted  to  order. 
For  convenience,  safety,  neatness  and    efficiency  we 
can    confidently  recommend   this  most    workmanlike 
syringe  to    every  medical   man  in  need  of  such  an 
appliance.  

The  annual  dinner  of  the  Pharmaceutical  Society  of 
Great  Britain  will  take  place  on  Tuesday,  May  17th, 
at  the  Whitehall  Rooms  of  the  Hotel  Metropole, 
London,  S.W.,  at  7  o'clock  p.m.  precisely. 


PASS  LISTS. 


The  Medical  Press.     3§3 


flDeMcal    ttewa. 

1U  Maintenance  or  the  Queen's  College.  Cork, 

-sizes  m  Cork,  the  Grand  Jury  passed 

esolntion,  and  submitted  it  to  the  Lord 

i^tice  -— *'  That   we.   the  Grand  Jurors  of  the 

>rk.  assembled  at  the  Spring  Assizer  of  1904, 

,    strongly    of    opinion    that    the    intellectual    and 

material  interests  of  the  city  demand  that  Cork  shall 

inns  to  be  a  university  centre;   thai    the   more 

lined  the  intelligence  of  a  community  is  the 

tetter  fitted  that  commuiun    is  t<>  participate  in  the 

administration  of  justice  ;  that  as  there  is  at  present 

Mich  keen  competition  in  trade  and  commerce,  it  m 

ty  that  the  citizens  of  Cork  should 

have  ample  facilities  for  obtaining  the  highest  intel- 

lettuaf  training,  in  order  that  they  may  be  in  a  pus  11  ion 

rccessfaliy  compete  with  the  various  commercial 

nations  of  the  world."     We  are  glad  to  learn  that  the 

citizens  of  I  art  so  thoroughly  appreciate  the  need  for 

the  Queen's  College,  but  we  would  remind    them  that 

if  they  wish  to  bring  the  latter  into  a  really  prominent 

position,  thev  must  be  prepared  to  support  it  financially 

and  otherwise,  in   the  same  whole-hearted  manner  m 

which  the  citizens  of  Belfast  support  their  College. 

Care  of  the  Feeble-Minded, 

A   conference    of    the    after-care    committee-    of 

Birmingham,  Leicester,  and  Nottingham  was  recently 

held  at  Birmingham  to  discuss  questions  and  difficulties 

with  regard    to  the  treatment   of   the  feeble-minded. 

The  Lord  Mayor  presided  at  the  opening  ol  the  pro- 

ceediuj-^      Mi^s    Dendy,   secretary   of    the    Lancashire 

and  Cheshire  Society  "for  the  Permanent  Care  of  the 

Feeble- Minded,    in     a    paper    upon    *'  Special    Classes 

and    Boarding    Schools    for    the    Mentally  Defective/* 

nded  that  the  Act  of  irtou  should  be  made  com- 

ptilsory  instead  of  permissive.     Every  school  authority 

Id  be  compelled  to  provide  suitable  accommodation 

elective  and    epileptic   children.     At  the  age  of 

[4  or  sooner  every  child  of  this  type  should  be  trans- 

ferred  to  the  residential  school,  there  to  remain  to  the 

end  of  its  days — a  child  still,  but  a  harmless,  happy 

child,  instead  of  a  dangerous  and  degraded  one,     All 

the  book  learning  in  the  world  to  such  a  child  would  be 

of  no  use  ;  but /on  the  other  hand,  manual  training 

would  be  most  helpful,  and  it  should  always  he  of  a 

practical     Wild,       A     discussion     followed.  *     At     the 

afternoon  sitting  Mr,  VV\   H.   Dickinson,  chairman  of 

the  National   Association   for  Promoting  the  Welfare 

*d  the  Feeble-Minded,  read  a  paper  on  the  responsibility 

of  the   Slate  towards   the   feeble- mi  nded,     The  most 

suitable  authority   to  deal  with   the  matter  was   the 

county  council,  smce  it  had  already  the  control    over 

hi  nan  1.1    and  over  education.     The  necessary   homes 

not  be  maintained  on  the  methods  of  Poor  Law 

jil ministration  ;  they  must  be  industrial  Coionif 

discussion  followed,      Mrs,  Hume  C.  Pinsent,  chairman 

<d   the   Birmingham  Special  Schools  Subcommittee, 

read  a  paper  on  the  need  for  further  accommodation 

u-pauper  imbeciles. 

Tilt  Devonshire  Hospital. 
The  report  of  the  committee  of  management  of  the 
Devonshire  Hospital  and  Buxton  Bath  Charity  for  the 
year    1903    states    that    *!,gio    in-patients   have    been 
admitted  during  the  year,  being  247  less  than  in  the 
■■Lis   year.     The  number  of  on t-patients  admitted 
was  209, '  The  average  number  ot  patients   daily    in 
the  hospital  was  102*5,     The  average  cost  per  week 
of  each  inpatient  has  been   15s,  Qjd.     In  connection 
with   this  charity  there  is  a  Samaritan   fund  for  the 
purpose  ot   helping  needy  patients  to  return  to  their 
Nonet,     The    hospital,    which    commenced    n*    bene- 
ficent work  in  the  year  1850.  has,  since  its  inception, 
cured  or  relieved  nearly  76,000  patients  and  the  con- 
t  ly   widening   sphere   of   its   usefulness   entails   a 
,   expenditure. 

Royal  College  or  Physicians  of  London, 

I" me  Cuuned  of  the  Royal  College  of  Physicians  have 

appointed   Dr.  T,   H.  Green,   Dr.   E,  Seaton,  and    l>rr 

VVethercd  adjudicators  of  the  "  Weber- Pa rkes  "  prize 

medals  for  too6+  and  have  selected  as  the  subject 

e  essay  for  that  occasion,  +4  The  degree  ot  infectivity 


of  pulmonary  tuberculosis,  and  the  administrative 
measures  desirable  for  the  control  and  treatment  of 
the  disease/*  The  prize,  of  the  value  of  150  guinea 
and  a  silver  medal,  is  awarded  triennially  to  the  writer 
of  the  best  essay  upon  some  subject  connected  with 
the  etiology*  prevention,  pathology,  or  treatment  of 
tuberculosis,  especially  with  reference  to  pulmonary 
consumption  IS  man,  and  is  open  bO  members  of  the 
medical  profession  in  all  countries. 

Royal  College  of  Surgeons  In  Ireland. 

The  following  candidates  having  passed  the  necessary 
examination  have  been  admitted  Fellows  of  the  College  : 
— Mr.  J,  FL  Barrs,  L.S.A.  Lond.  fBurton-on-Trent); 
and  Mr.  W-  F.  Law,  M.B.,  B.Ch,  Dub,  (British  Guiana). 
At  a  meeting  of  the  President,  Vice  president,  and 
Council,  held  on  March  24th,  the  following  motion  was 
passed  unanimously:  —  "That  the  President ,  Vice- 
president,  and  Council  express  their  gratification  at  the 
appointment,  for  the  first  time,  of  a  medical  man  to 
the  office  of  Provost  of  Trinity  College,  and  con- 
gratulate Dr.  Anthony  Traill  on  his  appointment  to 
that  distinguished  position/' 

Plague  tn  South  AMea. 

The  medical  officer  of  health  of  the  Cape  Colon  v 
states  that  for  the  week  ending  March  5th  there  were 
eight  cases  of  plague  discovered  at  Port  Elisabeth,  all 
in  coloured  persons.  There  were  four  males  and  four 
females  and  seven  of  them  are  dead.  All  the  patients 
contracted  the  disease  in  tenements  in  Rudolph  Street. 
No  other  cases  of  plague  in  human  beings  were  dis- 
covered throughout  the  Colony,  but  plagu effected 
rodents  were  found  at  Port  Elizabeth  and  East  London. 
Of  315  rats  examined  in  the  Cape  Town  and  HarN.ur 
Board  area  none  was  affected  by  plague.  As  regards 
the  Mauritius  a  telegram  from  the  Acting  Go\ 
received  at  the  Colonial  Office  on  March  25th  states 
that  for  the  week  ending  March  24th  there  were  no 
cases  of  plague,  As  regards  Johannesburg  four  fresh 
cases  were  reported  on  March  29th, 


PASS  LISTS- 


Victoria  University  Of  Manchester. 

At  examinations  held  in  the  Faculty  of  Medicine 
in  March  the  following  candidates  were  successful  :  — 

Final  Examination* — Part  L — Francisco  da  Cunha 
and  H,  S.  Dixon,  Owens  ;  John  Dixon,  R,  G,  Dixon, 
and  Harold  Fearnley,  Yorkshire  ;  R.  L,  Ferguson 
Owens  ;  Alfred  Gough  and  H.  S.  Harhng,  Yorkshire  ; 
Robert  Haslam,  Owens  ;  \V\  B.  Hill,  J.  J.  Hummel,  and 
A.  J.  Landman.  Yorkshire  ;  G.  C.  Mort,  Owens  ;  t 
Smith.  Yorkshire:  Harold  Spurway.  and  Douglas  Ward- 
leworth,  Owens  ;  and  Frederick  Whalley  and  F.  W.  B. 
Young.  Yorkshire* 

Part  II. — P,  W.  Ashmore,  Yorkshire  ;  John  Bat 
tersby  and  J.  W.  Hartley,  Owens  ;  F.  W.  Hayes  and 
S.  L.  HeaUL  Yorkshire  ;  W.  G.  Kinton.  W.  Y /Martin, 
Stuart  Murray,  and  S.  H,  Ryan,  Owens  j  and  Bertram 
Suggitt,  Yorkshire, 

Conjoint  Examinations  in  Irelamt. 

Candidates Jiave  passed  the  Preliminary  Examina- 
tion as  undernoterj  :  —Messrs.  P,  N.  Allmaa,  J,  J, 
Blake,  F.  Cassidy.  D.  F,  Curran,  H.  R  Heney,  A. 
Humph  revs.  W.  S.  Johnston,  A-  R.  Mallet,  J.  Moynihan, 
J.  T,  O'Boyle,  M.  C  Q'Hara.  F.  E.  Preston,  B.  Ri 
S  Robinson,  Israel  Scher,  G.  E.  Snevd,  R.  H.  F. 
Taaffe.  M.  M.  Tobin,  B.  Wallace,  J,  F.  Williamson, 
and  R.  A,  Wright, 

Royal  Collage  of  Burgeons  of  Edinburgh. 

At  a  meeting  of  the  Council,  held  on  March  24th,  the 
Fellowship  of  the  College  was  conferred,  after  the  usual 
examinations,  on  John  Evans  Hadden  Ben  net,  M.B., 
CM.,  County  Cork  ;  Arthur  William  Stark  Christie, 
M-B,f  Ch.B.,  Edinburgh  ;  Owen  Gilmore,  L.R.C.S.E., 
Edinburgh  ;  Harold  Edgar  Atheling  Jackson,  bLR.CS. 
Eng..  L.R.C.P.  J-ond..  Victoria.  Australia  ;  Alfred 
Dudley  Eskell  Kennard.  M.RX.S.Eng.,  L.R.C.P. 
Lond*,  Hampton  Wick,  Middlesex  ;  William  Llovd, 
L.R.C.S.E.,  London,  W,  :  Maitland  Bodley  Scott, 
af.R.CS.Eng.,  L.R,C.P.I,ond„  Bournemouth;  Harry 
Moss  Traquair,  M.D,,  CM.,  Edinburgh. 


384    Thb  Medical  Press.       NOTICES  TO  CORRESPONDENTS. 


Aprh.  6,  1904. 


Jtoikes  to 
(JIorrcspoTtbcnls,  $hort  %tiba»f  -to. 

9St~  OoRMMPOMmDrrs  requiring  a  reply  in  this  oolumn  are  particu- 
larly requested  to  make  use  of  a  distinctive  ngnahm  or  initial,  and 
avoid  the  praotios  of  signing  themselves  "Reader,"  "Subscriber/" 
"Old  Subscriber,"  ato.  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

Original  Articles  or  Lsttrrs  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

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

Reprihts.— Reprints  of  articles  appearing  in  this  journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

R.  W.C.— We  are  not  aware  of  any  restrictions  of  the  kind. 

Dr.  8.  P.  B.— Gastroenterostomy  would  appear  to  be  indicated  in 
the  case :  as,  however,  the  position  of  the  patient  precludes  a  con- 
sultation, our  correspondent  will  probably  agree  that  the  best  course 
to  pursue  will  be  to  send  her  to  a  hospital. 

Nasalis.— Gangrene  of  the  covering  skin  has  been  caused  in  many 
cases  in  which  too  much  paraffin  was  injected . 

Dr.  McDonald.— Statistical  evidence  shows  that  tuberculosis  in 
Germany  is  deci  easing.  In  the  five  years  ending  in  1881  the  mortality 
from  the  disease  in  the  German  towns  of  16.000  or  more  inhabitants, 
was  867-7,  and  in  the  five  years  ending  in  1901  it  was  2187. 

Mr.  Francis  C  Bakrr.— The  leper  population!  of  the  world  has,  we 
believe,  not  been  computed ;  but  there  are  said  to  be  half  a  million 
lepers  in  India  alone. 

R.  MacKrnzir.— Glioma  of  the  retina  is  now  often  regarded  as  a 
kind  of  sarcomatous  or  endotheliomatous  growth. 

Jtoetings  of  the  gorietiw,  %zttvxt*t  &c 

Wednesday,  April  0th. 
Obstetrical  Soctrtt  op  London  (20  Hanover  Square,  W.).— 8  p.m. 
Specimens  will  be  shown  by  Dr.  W.  W.  H.  Tate,  Dr  Horrocks,  Mr. 
Bland -8utton,  and  Dr.  Handfield- Jones.  Short  Communication  :— Lieu- 
tenant-Colonel 8turmer,  I  M.S. :  41  Cases  of  Puerperal  Eclampsia 
Treated  by  Thyroid  Extract.  Paper  —Dr.  R.  H.  Bell :  Torsion  of  the 
Pedicle  in  Hydrosalpinx  and  other  Morbid  Conditions  of  the  Fallopian 
Tube. 

Thirbdat,  April  7th. 

Bontorn   Society  (20  Hanover  Square,  W.).— 8.80p.m.  Exhibition 
Evening.    Exhibition  of  Novel  Apparatus  by  Different  Makers. 
Friday,  April  8th. 

Tin  Incorporated  Society  of  Medical  Officers  of  Health  (9 
Adelphi  Te*race.  Strand,  W.C.)  —8  p.m.  Council  Meeting.  Paper : 
—Dr.  J.  Howard-Jones:  The  Control  of  Measles  Epidemics. 

Writ  London  Medico-Chirurgical  Socirtt.— 8  p.m.  Clinical 
Evening:— Cases  will  be  shown  by  Dr.  8  Taylor,  Dr.  Ball,  Dr. 
8annders,  Mr.  Lunn,  Mr.  Pa  ton,  Mr.  Pardoe  and  others. 

Larykgological  Society  op  London  (20  Hanover  Square,  W  )— 
6  p.m.  Cases,  Specimens,  Ac.,  will  be  shown  by  Dr.  StClair  Thomson, 
Mr.  P.  de  8anti,  Dr.  L.  Lack,  Mr.  H.  Tod,  Dr.  H.  Tilley.and  others. 


Barattcu*. 


Chester  County  Asylum.— Third  Assistant  Medical  Officer.  Salary 
.  £100  per  annum,  with  board,  lodging,  and  washing.  Applications 
to  Dr.  Lawrerce,  County  Asylum,  Chester. 

Great  Yarmouth  Hospital.— House  Surgeon.  Salary  £90  per  annum, 
with  board,  lodging,  and  washing.  Applications  to  Richa-d  F.  E. 
Ferrier,  Honorary  Secretary,  83  Hall  Plain,  Great  Yarmouth. 

Liverpool  Stanley  Hospital.— Senior  House  Surgeon.  Salary  £100 
per  annum,  with  board,  residence,  and  washing.  Applications  to 
the  Chairman  of  the  Medical  Board. 

Manchester  Royal  Ioflrmary.— Resident  Medical  Officer  at  the  Con- 
valescent Hospital,  Cheadle.  Salary  £160  per  annum,  with  board 
and  residence.  Applications  to  W.  L.  fc'aunder,  General  Super- 
intendent and  Secretary. 

Newport  and  Monmouthshire  Hospital— Junior  Resident  Medical 
Officer.  Palary  £70  per  annum,  with  board,  residence,  and  warn- 
ing.   Applications  to  the  Secretary. 

Preston  Royal  Infirmary.— Assistant  House  8urgeon.  Salary  £00  per 
annum,  with  board,  washing,  &c.  Applications  to  Walter  Davies, 
Secretary. 

Richmond,  Whltworth,  and  Hardwicke  Hospitals.— Anesthetist. 
Particulars  of  Wm.  Thomson,  C.B.,  54  sit.  Stephen's  Green, 
Du  lin.    (SeeAdvt.) 

Victoria,  Australia.— Inspector-General  of  the  Ineane.  Salary  not  to 
exceed  £1,000.  Applications  to  the  A  Kent-General  for  Victoria, 
142  Queen  Victoria  Stieet,  London,  E.C.   (See  Adv*) 

West  Kent  General  Hospital,  Maidstone.— House  8urgeon.  .Salary 
£120  per  annum,  with  board  and  residence.  Applications  to  the 
Secretary  before  April  22nd.    


Colclouoii,  W.  Frank,  M.D.,  B.CCantab.,  Medical  Officer  to  Out- 
patients, Yeatman  Hospital,  Sherborne. 
Cook,  A.  H..M.B.Lond..  M.R.0.8.,L.RC.P.Lond.,  Honorary  Medical 

Officer  to  the  Infants'  Hospital.  Hempstead,  N.W. 
KRLYHACK.T.N.M.D.Viat;,  M\R.C.P.Lond.,  Honorary .  Physician  to 

the  Infants*  Hospital.  Hatnpstead,  N.W. 
Laidlaw.  J.  H.,  M.D.,  Clinical  Assistant  to  the  Chelsea  Hospital  for 

Women. 
Lomohurst,  Frbderic,  W..  L.B.C.P.Lond.,  M.R.C.8.,  Anaesthetist  to 

the  Gordon  Hospital.  Vauxhall  Bridge  Road,  8.  W. 
Moritx,  8.  M.R.C.FXond.,  Lecturer  on  Diseases  of  the  Throat 'and 

Nose  st  the  Victoria  University  of  Manchester. 
Paos,Hnrbrrt  Mark  ant,  M.D.Brux.,  M.R.C.S.,  LAA„  D.P.H,Cai> 

tab.,  Medical  Offioer  of  Health  of  Yeovil  ^ 

girth*. 

Bk*E*-z£*  Ma£h  XH-K**  I7.  Redclifle  Gardens.  South  Kensington-. 

the  wife  of  Charles   N.  Barton,  ;L.R.C.P.Lond.,   M.R.O&Eng., 

LAA  Load.,  of  a  daughter. 
Corr.TOn  March  27th,  at  30,  Hyde  Park  Gate,  London,  S.W.,  the 

wife  of  Dr.  Stanton  Coit,  of  a  daughter. 
HARRisoN.-On  March  27th,  at  104,  Marine  Parade,  Worthing,  the 

wife  of  H.  Leeds  Harrison,  R  A.,  M.B.Oabtab.,  of  a  daughter. 
jAJiRs.-On  Marsh  31st.  at  00,  Gloucester  Jetraoe,  Hyde T»ark,  the 

wife  of  Dr.  Arthur  James,  of  a  daughter. 
LocKJIR~°n  March  ^^  the  ****    of  Cuthbert  Lockver,    M.Di, 

as.,  M.R.C.P.,  F.R.C.&,  of   117a,  Harley  Street,  London,  of  a 

son. 


Brvan— Frw.— On  March  26th.  at  Emmanuel  Congregational  Church, 
Cambridge,  Henry  Vaughan  Bevan,  M.A.,  Fellow  of  Trinity  Col- 
lege, Cambridge,  fourth  son  of  Dr.  LI.  D.  Bevan,  of  Melbourne, 
Victoria,  to  Hilda  Cornelia,  third  daughter  of  H.  G.  Few,  Esq. 
J  P.,  of  Berry  croft,  Cambridge. 

3  eat  Its. 

Brrryman.— On  March  20th,  at  Windsor,  the  infant  son  of  Cantab 

H.  A.  Berryman,  Royal  Army  Medical  Corps.  ^f«w 

Crowther.— On  March  29th,  at  St.  Leonar  ds-on-Sea,  Selina  Pritikx, 

ioungest  daughter  of  the   late   William    Lodewyk  Crowtber 
[  R.C.8  Bng.,  of  Hobart,  Tasmania. 

Evrm.— On  March  29th,  at  17  York  Crescent  Road.  Clifton,  Clara, 
widow  of  the  late  Augustus  William  Eves,  M.R.C.S 

Marcbt.— On  April  2nd,  at  37  Queen's  Mansions,  Victoria  Street, 
Westminster,  of  pneumonia,  Constance  Louisa  Marcet.  widow  of 
the  late  William  Marcet,  M.D..  F.R.8.  * 

Pottrr.— On  April  2nd,  at  Ellesboro',  Bedford,  Henry  Potter.  M.D 
late  of  61,  Pall  Malt 

Riqdkn— Riodrn.— Oo  March  21st,  at  SO  St  George's  Place,  Canter- 
bury, George  Rigden,  M.R.C.8.,  in  his  89th  year,  and  on  March 
28th,  Imogen  Rigden,  in  her  82nd  year. 

OPERATIONS.—  METROPOLITAN 
HOSPITALS. 

WEDNESDAY.— 8t.  Bartholomew's  (1.80  p.m.X  Universitv  College 
(2  p.m.),  Royal  Free  (2  p.m.),  Middlesex  (1.80  p.m.)!  Charimr 
Cross  (3  p.m.),  St.  Thomas's  (2  p.m.),  London  (2  p.m.),  Kin?» 
College  (2  p.m.),  St.  George's  (Ophthalmic,  1  p.m.),  St.  Mary's 
(2  pro.).  National  Orthopaedic  (10  a.m.),  St.  Peter's  (2  p.m.), 
Samaritan  (9.30  a.m.  and  2.30  p.m.),  Gt.  Orraond  Street  (9.» 
a.m.),Gt.  Northern  Central  (2  30  p.m.),  Westminster  (2  p.m.), 
Metropolitan  (2.30  p.uu),  London  Throat  (9.30  a.m.),  Cancer 
(2  p.m.),  Throat,  Golden  Square  (9.30  a.nu),  Guy's  (1.30  p.m.). 


J^ppomtmtnt*. 


Barton,  Charles  M.,  L.B.C.P.Lond.,  M.R  C.S.,  Anaesthetist  to  the 
Gordon  Hospital,  Vauxhall  Bi  idge  hosd,  g  W . 


THURSDAY.— St.  Bartholomew's  (1.30  p.m.),  St.  Thomas's  (8.30 
University  College  (2  p.m),  Charing  Cross  (3  p.m.),  St. 


p.m.), 


George's  (1  p.m.X  London  (2  p.m.).  King's  College  (2 p.m.),  Middle- 
sex (1.30  p.m.),  St.  Mary's  (2.30  p.m.),  Soho  8quare  (2  p.m.), 
North-West  London  (2  p.m.),  Chelsea  (2  p.m.).  Great  Northern 
Central  (GyntecoIogScal,  2.30  p.m.),  Metropolitan  (2 JO  p.m.), 
London  Throat  (9.30  am.),  St.  Mark's  (2  p.m.)r  Samaritan  (9.30 
a.m.  and  2.30 .p.».),  Throat,  Golden  Square  (9.30  a.  m.),  Gov's 
(1.30  p.m.). 

FRIDAY.— London  (2  p.m.),  8t  Bartholomew's  (1.30  p.m.),  St 
Thomas's  (3.80  p.m.),  Guy's  (1.30  p.m.),  Middlesex  (1.80  p.m.), 
Charing  Cross  (8  p.m.),  8t.  George^  (1  p.m.),  King  s  College  (2 
p.m.),  St.  Mary's  (2  p.m.),  Ophthalmic  (10  a.m.),  Cancer  (2  pjn.) 
Chelsea  (2  p.m.),  Great  Northern  Central  (2.30  p.m.).  West 
London  (2.80  p.m.),  London  Throat  (9.80  a.m.),  Samaritan  ($>*> 
a.m.  and  2.30  p.m.),  Throat,  Golden  Square  (9.30  a.m.),  Citv 
Orthopa3dic  (2.30  p.m.),  Soho  Square  (2  p.m.). 

SATURDAY.— Royal  Free  (9  a.m.),  London  (2  p.m.),  Middlesex  (UO 
p.m.),  St  Thomas's  (2  p.m.),  University  College  (9.15  a-m.), 
Charing  Cross  (2  p.m.),  8t.  George's  (1  p.m.),  at.  Mary's  (10  p.m.) 
Throat,  Golden  8quare  (9  30  a.m.1,  Guy  s  (1.80p  m.). 

MONDAY.- London  (2  p.m.),  St.  Bartholomews  (1.30  p.m.),  St 
Thomas's  (8.80  p.m.),  St.  George's  (2  p.m.),  St  Man's  (iSO 
p.m.),  Middlesex  (1.80  p.m.).  Westminster  (2  p.m.),  Chelsea  (2 
p.m.),  Samaritan  (Gynaecological,  by  Physicians,  2  pjn.),  Soho 
Square  (2  p.m.),  Royal  Orthopedic  (2  p.m.).  City  Orthopaedic  (4 
p.m.),  Great  Northern  Central  (2  30  p.m.),  West  London  (i*> 
p.m.),  London  Throat  (9.30  am.),  Royal  Free  (2  p.m.),  Guy's  (UO 
p.m.). 

TUESDAY.— London  (2  p.m.),  St.  Bartholomew's  (1.80  p.m.),  St 
Thomas's  (3.30  p.m.),  Guy's  (1.30  p.m.),  Middlesex  (1.30  p.m.), 
Westminster  (2  p.m.),  West  London  (2.80  p.m.),  University 
College  (2  p.m.),  St.  George's  (1  p.m.),  St.  Mary's  (1  p.m.),  St 
Markr*(x.80  p.m.),  Cancer  (2  p.m.).  Metropolitan  (2.90  pjn.), 
London  Throat  (9.30  a.m.),  Royal  Ear  (3  p.m.),  8amaritan  (9.9) 
a.in.  and  2.80  p.m.),  Throat,  Golden  Square  i9.3p  a.m.),  Bono 
8quart  (2  p.m.) 


JThc    #lrdirat 


\m  mft   €iun\M. 


"BALUS    FOPULI    STJPREMA    LEX-1 


Vol.  CXXVIIL 


WEDNESDAY,    APRIL   i  j,    1904. 


No.    I5« 


©cigiaal  Communications, 

TWO  CASES  OF  STONE  IN  THE 
FEMALE  BLADDER. 

By  G.  P.  NEWBOLT,  M.B.Dur.,  F.RA 

Siuwton  to  tbf  Koy&l  Southern  Ho^iital,  Uiwi  -pool. 

My  object  in  recording  these  cases  of  stone  in  the 
female  bladder  is  to  make  a  few  remarks  concerning 
ia  different  methods  of  removing  a  calculus 
[HOT  that  organ, 

Case  I> — Miss  E.,  aH.  21,  for  some  months  had 
shown  signs  of  a  stone  in  I  he  bladder,  and  I  was 
I  by  her  medical  man  to  make  an  examina- 
tion with  a  view  to  future  operation.  On  intro- 
dnemg  a  lithotrite,  the  patient  being  under  an 
inline  tic,  I  at  once  gripped  the  stone,  and,  to 
cut  the  story  short,  crushed  it  right  away  and 
removed  the  fragments  with  an  e  vacua  tor.  The 
whole  proceeding  took  about  half  an  hour  ;  the 
final  washings  ol  the  bladder  were  just  tinged  with 
blood j  and  the  patient  was  up  and  about  in  threu 
or  lour  days,  has  had  no  further  trouble,  and  has 
since  married*  The  stone  was  a  small  oxalate 
weighing  three  drachms,  and  it  could  have  been 
equally  well  removed  by  dilating  the  urethra. 

Case  II. — Ellen  D.,  aet.  40,  was  sent  to  me  from 
the  Isle  of  Man   in    1901,  suffering   Irom   a  large 
fibroid    tumour   of    the    uterus.     On    May    28th, 
ifjoi,  I   removed   the  tumour,   together  with   the 
uterus  and  appendages,   the  whole  mass  weighing 
fourteen    pounds.     Whilst     separating     the 
bladder,   which  was   very   thin -walled   and   much 
<  Mated,  from  the  anterior  surface  OJ    the  tumour, 
n   was    unavoidably    torn    in    three    places.     The 
fears  were  sutured  with  silk,  but  one  of  the  sutures 
included    the   mucous  membrane   of   the  bladder, 
tar  at  this  particular   spot  there    was    practically 
nothing     else    to     bring     together.       Peritoneum 
sewn  over   the   raw   surfaces  Irom  adjoining 
and  the  bladder  was  kept  drained  tor  ten 
days.     She  relumed  to  her  home  in  the  Isle  of  Man 
tptember    10th,   1901,  perfectly  well,  except 
nmc    irritability    of    the    bladder.     Patient 
nally  dev eloped  symptoms  of  stone  and  re- 
lumed to  the  Royal  Southern  in  November,  190,2, 
tor  its  removal.     I  was  convinced  that  the  stone 
had  formed  around  the  silk  ligature  in  the  bladder 
wall,  and   that   from   the  condition  of  the  urine 
pat  p roba  b I  y  p ho s ph a  t  ic ,  but   I  de  t e rm inecl  t o 
uprapubic  cystotomy   in  order  that    I  might 
ondition  of  the  bladder  wall  in 
the  region  of  the  old  tears,     On  November  iSth, 
.   the   stone   was   removed   with    the  greatest 
by  the  suprapubic  method,  the  patient  being 
rendelenberg  position,  the  vagina  packed 


]  with  gauze,  and  the  bladder  distended  with  the 
lotion  injected  through  a  Higginson's  syringe, 
tlit*  nozzle  of  which  was  left  in  siitt  and  fixed  with 
tapes.  The  stone,  which  weighed  an  ounce,  split 
into  two  halves,  ami  wis  covered  with  putrid 
muco-pus.  The  mucous  membrane  of  the  bladder 
was  rough  and  intensely  injected,  bur  (here  was 
nm  of  the  old  injuries,  and  it  w.is  normal  in 
size  The  stone  was  phosphatic,  with  a  silk 
nucleus  at  one  side.  The  phosphates  apparently 
deposited  on  the  ligature  as  it  toy  in  the 
bladder  wall,  and  after  a  time  the  weight  of  the 
deposit  pulled  out  the  ligature  ;  the  body  thus 
formed  then  became  entirely  coated  with  phos- 
phatic  material,  leaving  the  nucleus  of  silk  at  one 
side.  In  spite  of  the  cystitis  which  was  present,  I 
I  closed  the  bladder  with  a  double  layer  of  catgut 
sutures,  avoiding  the  mucous  membrane,  and 
1  !os<NJ  ilu*  skin  around  the  wound,  leaving  a  gauze 
'drain  at  its  lower  end,  A  eatheur  was  tied  in  for 
five  days,  and  it  was  washed  out  after  this.  The 
gauze  drain  was  removed  on  the  third  day,  the 
stitches  on  the  sixth,  and  there  was  no  leakage* 
After  removal  of  the  stone,  the  urine,  which  had 
contained  3  oz,  to  *)  i  of  muco-pus,  rapidly  cleared 
up  on  washing  out  with  boracic  lotion,  aided  by 
I  the  administration  of  a  mixture  containing 
nro tropin,  ammonium   benzoatc,  and   boric  acid. 

The  essential  points  in  this  operation  are; 
!  making  a  free  incision  into  the  bladder  wall, 
avoiding  injury  to  it  with  forceps,  and  using  the 
Trendelenbcrg  position,  I  find  thai  with  a  pair 
of  Morris"  kidney  retractors  and  the  electric  lamp 
one  gets  a  most  perfect  view  of  the  interior  of  the 
bladder,  far  better  than  by  Harry  Fen  wick's 
caisson  method,  and  the  floor  can  be-  kept  quite 
dry  enough  if  carefully  sponged. 

Now  with  regard  to  the  different  methods  of 
removing  a  stone  from  the  female  bladder  : — 

In  the  first  place,  as  most  surgeons  are  aware, 
it  is  an  uncommon  complaint,  probably  Ix 
small  stones  easily  pass  through  the  lemale  urethra. 

Individual  experience  of  stone  m  the  female 
is  so  small  as  to  be  almost  valueless. 

I,  however,  venture     to    record     the     loljowing 
p  points  ; — 

1  All  small  and  medium-sized  stones  can  and 
should  be  removed  by  dilating  the  urethra  by 
lithotrity,  or  by  a  combination  of  both — lithotrily 
being  avoided  if  there  is  severe  cystitis. 

To  support  this  statement,  1  will  quote  from  a 
paper  by  Mr.  Bryant  {Med.-Chi.  Jaunt.,  vol.  xlvii, 

on  urethral  dilatation  as  a  means  of  remov 
tag  stone  from  the  bladder.     He  says — 

>     That    the   female   urethra   may  be   dila 
I  to  a  considerable  extent  with  facility  and  without 
I  danger. 


386    The  Medical  Press.         ORIGINAL  COMMUNICATIONS. 


April  13.  1904. 


(b)  That  slow  and  tedious  dilatation  of  the 
urethra  with  sponge  tents  or  other  means  appears 
to  be  injurious. 

(c)  That  rapid  urethral  dilatation  under  chloro- 
form is  the  safest  and  more  expeditious  method  of 
removing  all  average-sized  calculi  and  foreign  bodies 
from  the  female  bladder.  Calculi  one  inch  in 
•diameter  in  children,  and  even  two  inches  in 
adults,  have  been  extracted  by  this  practice. 

He  quotes  thirteen  cases  of  slow  dilatation, 
with  four  of  incontinence  following,  and  fifteen 
cases  of  rapid  dilatation,  with  no  incontinence 
afterwards.  He  recommends  Weiss  dilators, 
covered  with  rubber  tubing. 

2.  All  very  large  stones  should  be  removed 
suprapubically. 

Against  suprapubic  cystotomy  I  have  nothing 
to  urge.  Fear  of  wounding  the  peritoneum  is  ex- 
aggerated ;  and  even  if  this  accident  occurs,  no 
evil  will  acrue  in  a  modern  aseptically  conducted 
•operation. 

By  keeping  in  the  middle  line,  and  not  digging 
about  with  the  finger,  all  fear  of  urinary  infiltra- 
tion will  be  avoided,  especially  if  suitable  drainage 
be  provided. 

Fistula  as  a  result  is  most  unlikely  to  occur 
in  the  female,  as  the  causes  which  sometimes  pro- 
duce it  in  the  male — i.e.,  enlarged  prostate  or 
stricture,  are  not  present. 

3.  Vaginal  lithotomy  may  be  done — 

(a)  Where  an  attempt  to  crush  has  failed,  and 
it  is  advisable  to  empty  the  bladder  and  com- 
plete the  operation  as  speedily  as  possible. 

(b)  Where  the  stone  occupies  a  pouch  which  pro- 
jects into,  or  is  easily  accessible  from,  the^vagina. 

(c)  Where  the  complication  of  pregnancy  exists. 

(d)  Where  there  is  already  a  vesico-vaginal  fistula. 

The  only  point  in  favour  of  the  vaginal  opera- 
tion is  its  simplicity.  The  strong  point  against  it  is, 
that  vesico-vaginal  fistula  has  frequently  followed 
the  proceeding,  and  that  this  may  need  one  or 
more  plastic  operations  for  its  cure,  with  a  chance 
of  ultimate  failure. 

It  is  not  a  suitable  operation  for  young  children, 
on  account  of  the  smallness  of  the  parts  and  the 
damage  inflicted  upon  them. 

My  evidence  with  regard  to  the  occurrence  of 
vesico-vaginal  fistula  after  vaginal  lithotomy 
is  the  following  : — 

Erichsen  (1895  edition)  says  : — "  Lithotomy, 
as  a  general  rule,  should  be  reserved  for  large 
calculi,  for  those  which  have  a  foreign  body  as  a 
nucleus,  or  where  there  is  severe  cystitis.  The 
suprapubic  operation  is  to  be  preferred,  especially 
if,  as  is  usually  the  case,  the  stone  is  large  or 
cystitis  is  present.  The  vaginal  operation  is  very 
easy,  but  is  open  to  the  objection  of  possibly 
leaving  a  permanent  urinary  fistula,  a  danger, 
however,  which  is  probably  not  great  if  the  lips 
of  the  incision  have  not  been  bruised  by  the  for- 
ceps or  by  the  extraction  of  the  stone. 

"It  may  be  the  only  alternative;  I  extracted 
by  this  method  a  stone  8  in.  by  6  in.  in  circum- 
ference from  the  bladder  of  a  woman,  aet.  23, 
in  whom  the  stone  offered  so  serious  an  obstacle 
to  the  descent  of  the  foetal  head  during  parturi- 
tion that  craniotomy  had  been  rendered  necessary. 
The  anterior  vaginal  wall  had  been  a  good  deal 
bruised,  and  I  feared  that  sloughing  of  it  might 
take  place,  hence  I  extracted  the  stone  by  the 
vaginal   method."     The   result   is   not   stated. 

Jacobson  (1902  edition)  says  : — "  Vaginal  litho- 
tomy, though  the  simplest  and  the  easiest  of  all 


the  methods  of  cutting  for  stone,  will  be  but  rarely 

called  for,  as  in  all  moderate  stones  in  women 

litholapaxy  is  usually  available,  while  in  the  case 

of  larger  ones,  and  with  all  calculi  in  female  children 

the  suprapubic  method  is  indicated,  save  for  tiny 

stones,  which  can  be  removed   after  dilatation. 

The   only  drawback  of   a   vaginal   lithotomy  is 

■  the  risk  of  a  fistula,  but  this  need  only  be  taken 

I  into  account  where  phosphatic  urine  is  present, 

or  where  the  edges  of  the  wound  have  been  bruised 

1  during  the  extraction  of  the  stone.     In  either  case 

j  the  calculus  will  probably  be  a  large  one  or  mul- 

1  tiple,  a  condition  better  dealt  with  otherwise." 

He  then  quotes  a  case  of  vaginal  lithotomy  in  a 

patient  six  and  a  half  months  pregnant,  done  for 

its  simplicity,  small  amount  of  anaesthetic  needed, 

and   the  facilities  it  gave  for  washing  out   the 

bladder  at  the  time  of  operation.     Result  good— 

safely  confined. 

Mr.  Walsham  (St.  Bart.'s  Reports,  1875)  tabulates 
sixty-two  cases  of  stone  occurring  in  female  chil- 
dren ;  eight  were  cut  by  the  vaginal  method,  by 
such  well-known  surgeons  as  Sir  T.  Smith,  Sir  W. 
Ferguson,  and  Mr.  Howard  Marsh ;  three  cases 
of  vesico-vaginal  fistula  occurred ;  the  ages 
varied  from  three  years  to  twelve  years.  Sutures 
were  used  by  Sir  T.  Smith  in  one  of  these  cases, 
and  the  fistula  was  closed  at  a  later  operation. 
It  does  not  state  how  the  other  two  were  treated 
primarily,  or  what  the  after-result  was. 

Richard  Barwell,  Senior  Surgeon,  Charing 
Cross  Hospital,  in  a  paper  on  suprapubic  litho- 
tomy, read  before  the  Medico-Chirurgical  Society 
on  March  30th,  1886,  says  : — "  My  thoughts  were 
more  especially  led  in  this  direction  by  a  rapid 
sequence  in  my  clinic  of  cases  of  vesico-vaginal 
fistula.  I  had  under  my  care  in  seven  months 
(the  latter  part  of  1883  and  beginning  of  1884) 
three  cases  of  this  affection,  all  originating  in 
the  extraction  of  calculi  during  infancy  and  youth 
by  different  surgeons.  Such  fistulae  are  very- 
recalcitrant  to  treatment  by  operation,  for  they 
lie  in  the  midst  of  hard,  thick  cicatricial  tissue. 
The  bladder  is  much  diminished  in  capacity. 
In  two  of  the  cases  the  fistulae  were  very  high, 
and  in  the  thickened  state  of  parts  the  uterus 
could  not  be  drawn  down.  I  do  not  know  how 
or  why  these  cases  should  have  all  come  under  my 
notice  in  such  rapid  succession,  but  they  made  a 
great  impression  on  my  mind,  and  I  determined 
that  when  any  female  child  came  under  my  care 
with  a  stone  too  large  and  hard  to  be  extracted 
per  urethram,  either  whole  or  in  fragments,  it 
should  be  taken  out  above  the  pubis. 

"  Note. — After-history  of  these  patients  : — 
"  One  of  these  women,  aet.  19, 1  succeeded  after 
two  operations  in  curing.  Another,  aet.  24,  had 
been  thrice  subjected  to  operation  before  I  saw 
her.  I  gave  a  guarded  prognosis  concerning  the 
result  of  any  fresh  attempt,  and  have  not  seen 
her  since.  One  is  incurable,  the  fistula  lying  close 
to  the  os  uteri,  which,  in  the  almost  cartilaginous 
hardness  of  parts,  cannot  be  brought  down.  She 
is  approaching  the  menopause  ;  and  when  that 
occurs  I  shall  occlude  the  vagina." 

Mr.  Barwell  concludes  : — "  For  female  children, 
probably  for  females  of  all  ages  whenever  litho- 
tomy is  necessary,  the  high  operation  is  preferable 
to  all  other  methods  ;  it  is  quite  as  safe,  and  cannot 
I  lead  to  any  form  of  urinary  fistula." 
1      Hermann  Tilman,  Professor  of  Surgery  in  the 
j  University    of    Leipsic,     says  : — "  The    incisions 
'  through  the  vestibule  and  through  the  vagina  are 


April   ij.   1904. 


ORIGINAL  COMMUNICATIONS.         The  Ubmqml  Pub*.    3S7 


no  longer  in  vogue*  The  later  operation  is  justi- 
fiable only  in  case  of  a  co-existing  vesico- vaginal 
fistula  or  a  vagina!  cystocele." 

To  sum  up  :  Mr.  Harwell  strongly  condemns 
the  vaginal  operation.  The  occurrence  of  three 
Astute  m  eight  cases  operated  upon  by  this  method 
!r  WalshanVs  table  also  condemns  it.  Pro- 
fessor Tilman  is  directly  against  it,  and  Erichsen 
and  jacobson  are  in  favour  of  the  suprapubic 
method  when  a  cutting  operation  is  necessary, 
pretty  strong  evidence  against  vaginal  lithotomy 
being  done  unless  under  the  exceptional  conditions 
already  mentioned,  or  where  a  surgeon  can  obtain 
neither  dilators  nor  lithot  rites. 


Paris  Clinical  Xccturcs 


CANCER  OF  THE  BILE-DUCTS. 

By  Professor  DEBOVE, 

Ooyen  of  the  Ficalt*  dt  MMeoinc  :  Physician  to  the  HopiUl 
fteftujoti,  P*m. 

[REPORTED  BY  OUR   PARIS  CORRESPONDENT.] 

I  want  to  speak  to  you  to-day  on  an  aflection 
which  is  not  very  common — cancer  of  the  bile - 
ducts,  that  is  to  say,  cancer  developed  in  the  bile- 
due  ts,  but  with  little  tendency  to  become  genera- 
lised, as  from  an  early  date  in  its  formation  it 
obstructs  completely  the  ducts  and  rapidly  en- 
dangers the  existence  of  the  patient. 

If  the  cancer  is  seated  in  the  ductus  choledochus, 
the  same  symptoms  are  found  as  in  cases  of  cancer 
of  the  head  of  the  pancreas,  that  is  to  say,  in- 
tense chronic  icterus,  distension  of  the  biliary 
le,  tumefaction  of  the  liver,  and  frequently 
tumefaction  of  the  spleen.  The  icterus  is  easy  to 
explain  by  the  obliteration  of  the  canal.  Dis- 
tension of  the  gall-bladder  is  the  rule,  and  con- 
stitutes a  good  diagnostic  sign,  especially  as  it  is 
not  generally  observed  where  the  canal  is  ob- 
structed by  a  calculus.  The  difference  is  ac- 
counted for  by  the  fact  that  the  calculi  come 
generally  from  the  vesicle,  and  are  accompanied 
hronic  catarrh  of  this  receptacle.  This  in- 
flammation gives  rise  to  a  thickening  and  a  re- 
traction of  the  wall,  which  produce  a  diminution 
tie  cavity,  and  consequently  oppose  its 
i  sion . 

The  tumefaction  of  the  liver  observed  is  due 
to  the  distension  of  the  bile -ducts,  congestion  and 
perhaps  also  to  cirrhosis.  In  cancer  of  the  vesicle 
ami  ol  the  duct,  the  malady  remains  latent  until  the 
ductus  choledochus  is  invaded,  and  then  the  signs 
already  mentioned  are  observed,  and  to  which  is 
added  the  tumour  of  the  gall-bladder.  If  the 
cancer  is  situated  on  the  hepatic  canal,  icterus 
*s  naturally  present,  but  the  biliary  vesicle  is  not 
distended.  Moreover,  m  such  cases,  and  for 
reasons  unknown  to  ust  the  liver  and  the  spleen 
are  but  little  hypertrophied. 

The  preceding  explanations  were  necessary 
for  clearly  understanding  the  evolution  of  the 
affection  under  consideration — a  case  of  cancer 
situated  in  the  region  of  the  biliary  canal  near  its 
bifurcation. 

The  patient,  B.,  a?t,  75,  entered  our  ward  on  Oc- 
tober 23rd  ;  he  remained  with  us  but  a  short  time, 
n  he  died  November  21st,  His  father  and 
mother  died  at  an  advanced  age  ;  he  had  four 
brothers  and  sisters  still  living  ;  there  was  no 
cancerous  history  in  the  family.  He  himself 
vs  enjoyed  good  health,  never  was  a  day  in 
bed  for  illness,  had  never  had  syphilis,  and  never 


drank,  A  month  before  he  entered  the  hospital 
the  patient  remarked  that  he  was  getting  yellow, 
and  his  skin  itched  very  much.  In  cancer  of  the 
bili&ry  tract  the  dJbut  is  latent,  and  the  icterus  is 
generally  the  first  sign  to  attract  attention. 

The  patient  continued  nevertheless  to  work, 
but  he  soon  found  that  his  strength  declined, 
and  that  he  got  thin,  feeling  constantly  tired. 
He  had  to  keep  lying  down  a  greater  part  of  the 
day. 

When  he  entered  the  hospital  our  attention 
was  immediately  attracted  by  the  jaundice. 
The  skin  and  the  mucous  membranes  were 
intensely  yellow,  and  I  remember  remarking 
that  I  rarely  saw  a  patient  so  yellow  ;  the  urine 
was  almost  black  with  biliary  pigment.  The 
saliva  and  the  expectoration  contained  also 
a  quantity  of  pigment,  while  the  f^ces  were  white. 
The  examination  of  the  liver  was  easy  on  account 
of  the  emaciation  of  the  patient  ;  it  was  not  in- 
creased in  volume,  and  the  gall-bladder  was  not 
distended.  There  was  no  ascites  nor  any  signs 
of  collateral  circulation. 

The  heart  presented  nothing  of  moment,  but 
the  pulsation  was  slow— fifty  to  the  minute. 
Signs  of  disseminated  bronchitis,  with  congestion 
at  the  base,  were  found  in  the  lungs.  The  as- 
thenia of  the  patient  was  so  considerable  that  he 
remained  in  a  somnolent  condition  all  day,  dis- 
turbed only  by  the  pruritus. 

YVhen  we  had  terminated  our  examination, 
we  arrived  at  the  conclusion  that  it  was  a  case  of 
cancer  pressing  on  the  biliary  ducts.  It  was 
evidently  a  case  of  icterus  by  retention,  the  dis- 
coloration of  the  faecal  matter,  joined  to  the  in- 
tensity of  the  jaundice,  being  sufficient  to  prove  it, 
The  cause  of  this  obstruction  was  not  a  calculus, 
for  the  patient  never  had  hepatic  colic,  and  in  any 
case  the  rapid  alteration  of  the  general  health  did 
not  plead  in  favour  of  that  diagnosis  ;  the  hy- 
pothesis of  cancer  of  the  stomach  or  of  the  in- 
testines was  eliminated,  because  in  the  history 
of  the  patient  there  was  no  morbid  sign  in  that 
direction, 

The  patient  remained  four  weeks  in  the  wards 
before  he  died  ;  during  the  first  ihrce  his  con- 
dition was  about  the  same,  but  eight  days  before 
he  succumbed  he  presented  a  series  of  symptoms 
which  arc  generally  attributed  to  the  gravest 
form  of  icterus ;  hemorrhage  from  the  gums, 
epistaxis,  and  purpura  spots  over  the  body  and  the 
limbs  ;  decrease  in  the  quantity  of  urine  (about 
four  ounces  in  the  twenty-four  hours),  intermittent 
delirium,  and  coma  j  low  temperature  (950  F.), 
and  pulse  50. 

The  autopsy  showed  a  cancerous  lesion  en* 
tirely  limited  to  the  hilum  of  the  liver.  The  pan* 
ere  as  and  the  duel  us  choledochus  were  normal, 
Tha  biliary  vesicle  was  shrivelled  and  thickened,  and 
contained  only  mucus  ;  examined  histologically 
it  was  found  to  be  absolutely  free  from  morbid 
disease.  The  cystic  canal  was  patent,  but  the 
hepatic  canal  was,  on  the  other  hand,  impermeable 
and  transformed  into  a  neoplastic  tissue.  The 
cancerous  tumour  was  not  larger  than  a  small 
orange  ;  no  trace  of  cancer  could  be  found  in  any 
other  part, 

I  took  this  subject  because  it  is  interesting,  as 
regards  the  prognosis,  to  differentiate  such  cases, 
which  develop  very  rapidly  and  terminate  in  a 
short  time  in  death,  from  other  cases  of  chronic 
icterus,  of  which  the  prognosis  is  much  less 
grave.     If  we  had  diagnosed  an  obstruction  bv  a 


388    The  Medical  P«ss.        ORIGINAL  COMMUNICATIONS. 


April  13.  1904* 


calculus  or  by  a  cancer  of  the  head  of  the  pancreas, 
we  might  have  attempted  an  operation,  which 
would  have  been  useless,  and  probably  the  patient 
would  have  succumbed  on  the  table.  On  the 
other  hand,  in  the  case  of  obstruction  by  a  calculus 
of  the  biliary  tract,  too  great  attention  could  not 
be  paid  to  forming  a  precise  line  of  conduct, 
as  surgical  interference  at  the  proper  time  has 
saved  many  patients. 


THE 

RELATION    OF    INEBRIETY 

TO 

MENTAL    DISEASE. 

By    ROBERT    JONES,    M.D.Lond.,    M.R.C.P., 
F.R.C.S., 

Medical  Superintendent  of  the  London  County  Asylum,  Clay  bury. 

The  author  referred  primarily  to  the  chemical 
composition  of  the  alcohols,  and  pointed  out  that 
ordinary  alcohol  was  one  of  a  long  chain  of  organic 
bodies  of  which  the  members  at  one  ex- 
treme end,  the  pentavalent  alcohols,  were  de- 
finitely poisonous,  aromatic  substances,  whose 
poisonous  properties  were  made  use  of  for  out- 
ward application  owing  to  their  destructive  effects 
upon  the  lower  forms  of  animal  life,  whilst  the 
lower  monovalent  groups  constituted  the  alcohol 
which,  in  its  abuse,  caused  much  physical  and 
mental  deterioration,  and  was  also  responsible 
for  much  human  misery.  He  referred  to  the 
effect  of  definite  quantities  of  alcohol  upon  the 
growth  of  vegetable  and  animal  protoplasm,  and 
drew  attention  to  the  physiological  effect  upon  the 
structure  and  functions  of  the  various  organs  in 
man.  He  then  referred  to  the  mental  effects  of 
alcohol  in  various  doses,  and  quoted  his  ex- 
perience in  regard  to  the  effect  of  a  severe  illness 
as  precipitating  a  mental  breakdown  in  persons 
who  were  described  only  as  long-continued 
moderate  drinkers.  The  tendency  to  the  develop- 
ment of  illusions  of  a  visual  character,  and  to 
delusions  of  a  persecutory  nature,  were  charac- 
teristic of  the  effects  of  alcohol,  as  was  also  the 
tendency  to  sudden  impulsive  movements.  He 
stated  that  it  was  almost  without  exception  when 
delusions  were  present  as  the  result  of  alcohol 
they  were  of  a  malignantly  fearful  and  perse- 
cutory character,  also  that  when  alcoholic  de- 
lusions were  exalted  and  grandiose  in  character, 
these  were  egotistical  and  selfish  in  comparison 
with  the  benevolent  altruism  of  general  paralysis. 
He  stated  that  although  the  improvement  under 
treatment  which  occurred  in  cases  of  alcoholic 
insanity  was  often  noticed,  this  improvement  rarely 
ended  in  complete  recovery,  as  such  cases  were 
always  unstable,  and  when  discharged  from  the 
asylum  often  relapsed.  He  described  the  con- 
dition paramnesia  as  a  symptom  of  drink  in- 
sanity, and  referred  to  it  as  a  failure  of  memory 
for  recent  events,  an  impairment  through  the 
deleterious  effects  of  alcohol  upon  the  special 
quality  of  nerve  cells  which  he  termed  the  "  sticki- 
ness," or  the  adhesiveness,  or  the  plasticity  to 
retain  impressions  characteristic  of  nerve  matter. 
There  was  in  consequence  a  loss  of  the  power  of 
association.  The  person  became  confused  and 
lost.  He  had  no  memory  for  recent  events,  and 
he  tended  to  bring  the  long  past  events  of  his  life 
into   the   present.     He  became  busy  with  plans, 

(a)  Abstract  of  Paper  read  before  the  Society  for  the  Study  of 
Inebriety  on  Tuesday,  April  12th,  1904, 


he  made  imaginary  journeys,  and  had  just  seen  old 
companions,  all  of  which  statements  have  do 
basis  of  reality.  It  was  this  deficiency  which 
caused  the  apparent  lying  so  often  met  with  in  drink 
cases,  the  apparent  self-contradiction  being  a  dis- 
ease, although  the  moral  sense,  being  the  last 
developed  and  highest  attainment  of  man,  was 
greatly  affected  in  all  cases  of  alcoholic  indulgence. 
When  the  moral  sense  became  perverted  in  this 
manner,  no  appeal  to  reason  was  of  any  avail,  and 
ordinary  motives  were  useless  to  save  the  victim 
from  the  domination  of  the  drink  craving. 

The  speaker  then  defined  inebriety,  and  divided 
the  class  of  inebriates  into  two  divisions,  the 
periodic  drinker,  and  the  more  or  less  constant 
drinker.  The  victims  of  these  two  classes  were 
of  different  ages,  those  in  the  periodic  class  being 
mostly  young  men  who,  in  the  intervals  of  their 
paroxysms,  were  apparently  rational  and  fulfilled 
their  obligations  both  to  society  and  to  their 
friends.  He  stated  the  distinction  between  the 
inebriate  and  the  insane  person  suffering  from 
alcoholic  insanity  was  the  result  of  the  persona] 
equation.  It  was  the  immunity  of  the  individual 
in  whom  the  locus  resistentia  minoris  suffered. 
The  bodily  organs  underwent  a  fibroid  degenera- 
tion in  the  inebriate,  and  the  brain  was  the  last 
to  hold  out,  but  there  undoubtedly  was  in  all  ine- 
briates a  considerable  mental  deterioration,  as  was 
evidenced  by  the  fact  that  over  20  per  cent,  of  all 
the  inebriates  under  treatment  in  retreats  and  re- 
formatories were  transferred  during  one  year— 
1902,  the  last  for  which  there  were  published 
statistics  from  these  places — into  asylums  for  the 
insane.  He  then  gave  statistics  dealing  with  the 
effects  of  alcohol.  He  stated  that  out  of  the  1 16,000 
cases  of  insanity  at  the  present  time  detained 
in  asylums  there  were  probably  no  less  than  1 1 ,000 
males  and  6,000  females  whose  insanity  was 
directly  or  indirectly  caused  through  drink. 
He  quoted  the  statistics  of  the  London  County 
Asylums  for  the  ten  years  1893- 1902  inclusive, 
and  stated  that  during  this  period  35,916  persons 
(16,356  males,  19,560  females)  had  been  ad- 
mitted into  these  institutions,  of  whom  a  pro- 
portion of  21  per  cent,  among  the  men  and  1 1  per 
cent,  among  the  women  were  ascertained  to  owe 
their  insanity  to  drink  alone,  a  proportion  which 
accounted  for  the  insanity  from  this  cause  of 
5,727  (3,497  males  and  2,320  females)  persons. 
At  Clay  bury  Asylum,  at  which  he  was  medical 
officer,  there  had  been  admitted  during  1 893-1903 
inclusive,  9,544  persons  (4,250  males,  5,393 
females),  of  whom  1,664  (965  males  and 
699  females)  owed  their  insanity  to  drink,  a  pro- 
portion of  227  per  cent,  males,  and  13*1  per  cent, 
females.  He  stated  that  there  were  over  400 
persons  at  the  present  time  in  retreats  and  re- 
formatories whose  detention  was  caused  through 
inebriety,  and  that  this  only  represented  a  small 
proportion  of  the  inebriates  in  the  country,  whose 
presence  among  the  young  was  most  injurious, 
both  directly  through  their  own  neglect  and  cruelty 
of  those  for  whom  they  were  responsible,  and  in- 
directly by  their  evil  influence  and  example,  fordrink 
brought  many  evils  in  its  wake,  of  which  vice,, 
crime  and  disease  were  often  the  direct  conse- 
quence. He  pointed  out  that  hitherto  the  chief 
reason  given  for  the  detention  of  inebriates  was 
for  cruelty  to  children  and  neglect  of  the  home. 
He  referred  to  the  influence  and  to  the  extent  oi 
legislation  in  regard  to  drink,  and  he  also  re- 
ferred to  the  loss    to  the  community  from   drink. 


Apjul  13,   1904. 


through  the  interference  with  the  working  power 
ie  skilled    craftsman   and    the    artisan,    and 
pointed  out  how  devitalising  alcohol  was  to  the 
individual  and  to  the  race.     He  quoted  statistics 
to  show  the  susceptibility   which   alcoholic  cases 
showed  to  the  bacillus  tuberculosis.     The  heredity 
ol  acquired  characters  was  then  discussed  t  and 
examples  of  the  influence  of  the  environment  in 
the  vegetable  kingdom  were  given  and  how  these 
became  acquired.     The  relationship  between  ine- 
briety as  such  and  alcoholic  insanity  wis  evidenced 
by   the    result    of    treatment    in  the    two  forms. 
In  each  of  these  alcohol  reduced  the  self-restraint , 
iXkd  the  highest  power  man  possessed,  vit.t    his 
inhibition  or  the  power  he  had  of  saying  "  No," 
His  experience  ol  the  treatment  of  dfink  cases  in 
asylums  had  been  a  disappointing  one  as  to  the 
actual  recovery  which  took  place,  as,  when  patients 
discharged  irom  this  cause ,  they  almost  in- 
variably relapsed  if  they  tasted  alcohol  at  all.  and 
there  were  only  a  few  who  could   afterwards  go 
through  life  without  it.     This  led  him  to  analyse 
the  motives  which  men  and  women  had  in  drink- 
ing, and   he  felt  strongly  that  it  began  from  a 
deficient  physic  logical  knowledge  of  the  effects  of 
alcohol,  and  that  this  education  should  be  especi- 
ally impressed  ii|x>n  the  women ,  who,  m  his  opinion 
were  greatly  responsible,  owing  to  a  lack  of  know- 
ledge of  cooking  and  selecting  good  and  proper 
for  men  drinking  to  excess,     The  feeling  con- 
veyed by  alcohol  was  a  stimulation,  and  it  was 
ken    by   those  among  the  poor  tor  the  feel- 
or  nutrition  and  repletion  alter  a  good  meal  and 
11    this    were    provided     there     would      be  '  lesa 
pecourse  to  alcohol   as    a  .stimulant,  which    was 
tpativc  rather  than  conservative  of  energy. 
He    ventured   to   suggest    BOWt    topics   for   dis- 
cussion :  — 

Why  do  people  drink  ?     What  are  the  best 
means  to  control  the  abuse  of  alcohol  ?     What  is 
the  effect  of  repressive  or  restrictive  legislation  ? 
2.  Is    there    a    hereditary    traasmission  of  the 

ol  drink  to  descendants  ? 
;    Are    there   any  definite  and   separate  effects 
of  the  different  varieties  of  alcohol  ? 

4    Is    there    any    physical    exnlanatbn    nf    the 
'uq  "  for  alcohol  ? 

Is    the   total   amount   of   alcohol    consumed 

people  a  measure  of  the  temperance  of  these 

pie  * 

6.  What    is   the   nature  of    the   fatU    changes 

in    alcohol?     Docs    alcohol    exercise 

a  "  protective  oxidation  "over  Lhc  tissues  ? 

APPENDICITIS,  (a) 

By  RCTHEKFORD  MORtSON.  F.R  C  S 
BiSJtoa  to  lhc  Royal  1nflriii»r>a   N»  wraHtle-on-Tynt*    Cons U tin* 
Burgeon  to  the  D#nt*J  ItosplE*].  K 

(Lvmtufftfi  from  out  Ust  Number*) 
In  THM  Third  Tttfb, 
sdden  rupture  of  an  appendix,  not  surrounded 
Rives  rise   tu   the  simc  symptoms 
my  other  visceral  perforation*  but  it  is  most 
used  with 
1,    Ruptured  Duodena!  Vice*  m  Gastric  Ulcer  at  the 
ne^hWhuod  of  the  pylorus.      Escaping  tluid  contents 
r  pouch,  then  trickle  down  by  the  outer 
wfe  of  the  ascending   colon,  and   on  into  the  right 
iliac  fossa  and  |wlvis.     Their  track  is   marked    by   the 
■nitt«.   and   rigidity,    tenderness,  pain   in 
'lie  riKh*  iliac  fossa  and  a  rise  of   temperature  weest 
the  diagnosis  uf  appendicitis 


ORIGINAL  COMMUNICATIONS. 


The  Medical  P*ess.    389 


I  HmKyJEiSS!  dtUTetted  *****  ib*  lf",if"*  *•*"!  Soeis*, 


3.  Acute  Intcsttuut  Obstruction.— There  b  alwavs 
one  sign  for  which  we  search  with  great  care  as  a 
mark  of  intestinal  obstruction,  and  that  is  viable 
palpable  or  audible  intestinal  peristalsis,  If  we  can 
see  or  fee!  or  hear  unusual  movement  of  the  intestine 
we  know  that  there  ia  some  obstruction,  and  sssumc 
that  the  case  is  not  one  of  appendicitis.  But  apart 
from  the  purely  mechanical  effects  of  an  adherent 
appendix  acting  as  a  band,  or  of  adhesions  due  to  old 
peritonitis,  acute  peritonitis  rising  from  this  cause 
may  produce  obstruction  tram  interference  with  n->rm,i! 
peristalsis,  distension,  and  kinkinK  of  the  involved 
intestine,  and  so  give  rise  to  error. 

Intestinal  obstruction,  if  due  to  bands  compn 
the  ileum,  or  to  stricture  of  it.  or  to  intussusception 
may  give  rise  to  symptoms  closely  simulating  those  of 
appendicitis.  Detection  of  the  fact  that  the  pains  are 
due  to  violent  peristaltic  movements  of  the  intestine, 
that  the  temperature  is  normal,  and  that  the  passage 
of  flatus  is  entirely  arrested,  will  make  a  differential 
diagnosis  possible.  The  tumour  of  intussusception 
may  mislead  a  careless  observer,  but  it  is  usually  above 
the  position  of  the  appendix,  hardens  and  softens 
intermittently,  and,  in  the  case  of  intussusct sptiOtt  ,t 
hnger  introduced  into  the  rectum  returns  blood- 
stained, 

Prognosis. 
It  ls  the  difficulty  of  prognosis  that  causes  such 
wide  difference  of  opinion  as  to  the  proper  treat  men  I 
in  each  individual  case.  At  the  commencement  of 
any  given  attack,  it  Ls  impossible  to  foretell  the  result 
This  is  admitted  by  all  authorities,  and  it  is  of  little 
value  to  kn-ov  that  only  10  or  15  per  cent,  of  case* 
die  if  left  alone,  or  that  the  mortality  from  operation, 
if  done  early  enough,  should  not  be  more  than  2  per 
cent.  What  is  the  prognosis  of  the  particular  ease 
in  question  is  the  important  requirement,  and  this 
QQOCenui  both  the  immediate  and  the  remote  result. 

In    a   simple   case   the   immediate   prognosis   fa   ad- 
mittedly   jfood.     With    careful    tnuttmnt    the    patient 
will  be  well  in  a  few  days.     Careful  treatment  ensures 
entire  rest  in  bed,  and  the  avoidance  of  active  purga- 
tives.    In    such    a   case    the    patient    will    never    look 
m Tiuiisly   ill-      The  pain  will  not  be  sufficiently  severe 
to  cause  Outcries  or  to  prevent  all  sleep.     There  will 
be  tenderness  over  the  appendix  and  localised  rigidity 
in  the  right  iliac  fossa,  but  neither  sufficiently  marked 
to     prevent    examination.      Vomiting    will    ant    be    a 
troublesome  symptom,  the  pulse  will  not  be  over  lOD, 
and   the  temperature  will  reach  little  more.     On  the 
third  day  all  the  symptoms  and  signs  will  have  begun 
to  abate,  and  the  patient's  convalescence  will  seem  to 
iiretl.      Ina  few  more  days  the  attack  ought   (0 
have  passed  off  entirely.     If  this  is  the  first  attack, 
and  perfect  recovery  follows,   I  believe  it   may  lie  the 
this    belief   is    based    upon    the    knowledge   ol 
cases  that  have  passed  live  years  without  a  recurrence, 
and    though   I   h*\  e  reported    one  (Win.   M#L  JoWU.) 
in  which  thirty-six  years  elapsed  between  the  first  and 
second  attack*  for  practical  purposes  such   exceptional 
instances  must  be  ignored.     After  a  second  attack  iht 
prognosis  is  considerably   less  hopeful     Either  some 
organic  change  has  been  produced  in   the  appendix, 
or  the  patient  has  a  predisposition  to  the  disease,  and 
the  probability  is  that  further  trouble  will  ensue.      \ 
sensitive  nodule  in  the  right  iliac  fossa,  or  dyspeptic 
symptoms  with  irregular  bowel  action,  and  a  certain 
amount  of  anaemia  and  malaise,  or  marked  tenderness 
over  M'Burney 's  pomt.  or  a  variety  of  uneasy  sensations 
in   the  neighbourhood  of   the  appendix,   are  noted  in 
my  cases  as  signs  that  perfect  recovery  has  not  followed 
the  attack,  and  as  heralds  of  the  approach  of  another. 
As  a  rule,   it   may   be  said   that   the  serums    Forms  oi 
appendicitis  do  not  follow  a  number  pj  mild  attacks, 
but  this  rule  has  so  many  exceptions  that  it  cannot 
be  confidently  offered  as  a  practical  guide.     In  one 
patient  of  mine  eighteen  mild  attacks  during  the  pre- 
ceding five  years  were  followed  by  a  nineteenth  with 
gangrene  of  the  appendix,  and  general  peritonitis  and 
death.      This   would   not   have  occurred    if    the   usual 


390    The  Medical  Press.         ORIQINAL  COMMUNICATIONS. 


April  13,  1904. 


result  of  recurrent  attacks — dense  adhesions  round  a 
thickened  vascular  appendix — had  been  present. 

The  prognosis  in  the  second  class  of  cases — those  in 
which  a  septic,  localised  peritonitis  from  perforation  of 
the  appendix  is  likely  to  follow,  must  be  grave.  The 
illness  commences  acutely,  and  the  pain,  as  a  rule,  is 
severe  enough  to  prevent  sleep  for  the  first  three  or 
four  nights.  Tenderness  is  a  marked  feature  from  the 
first,  and  rigidity  of  the  muscles  in  the  right  iliac  fossa 

.    is  sufficient  to  prevent  any/ satisfactory  examination. 

.  At  the  end  of  the  second  or  third  day,  especially  with 
the  help  of  chloroform,  a  more  or  less  distinct  swelling 
is  usually  to  be  discerned  in  the  right  iliac  fossa  ;  the 
temperature  and  pulse  continue  to  be  elevated.  At 
a  later  stage  a  definite  tender  tumour  indicates  the 
presence  of  pus  ;  with  this  there  may  be  no  elevation  of 
temperature,  but  there  is  usually  some  night-sweat.  If 
the  appendix  is  hanging  over,  the  pelvic  brim,  the 
abscess  will,  be  found  on  bi-manual  examination  as 
a  pelvic  tumour,  and  the  prognosis  is  that  for  the  worst 
form  of   abscess  in  connection  with  the  appendix. 

In  the  most  acute  cases  it  may  be  difficult  to  say 
whether  the  infective  fluid  surrounding  the  appendix 
is  shut  in  by  adhesions  or  free  in  the  general  peritoneal 
cavity  ;  and  even  after  an  operation  no  certainty  may  be 
felt.  The  best  evidence  is  to  be  obtained  by  observing 
the  tension  of  the  fluid.  If  it  is  pent  up,  a  free  gush 
escapes  from  the  opening  in  the  abdomen,  and  the 
prognosis  is  hopeful ;  whereas,  if  it  is  distributed 
among  the  intestinal  coils,  it  wells  out  slowly,  and 
the  prognosis  is  bad. 

The  prognosis  varies,  too,  with  the  position  of  the 
appendix  and  its  surrounding  abscess  ;  and  this  may 
be  determined,  as  I  have  elsewhere  (Lancet,  February 
23rd,  1901)  pointed  out,  by  the  relations  of  the  tumour. 

•  Inflammation  of  an  appendix  outside  of  or  behind 
the  caecum  and  ascending  colon  is  attended  by  less 
risk  of  general  peritionitis  than  is  the  case  if  the 
position  of  the  appendix  is  internal,  pointing  into  the 
small  intestinal  area  or  into  the  pelvis. 

Many  of  these  abscess  cases  will  get  well  if  left  alone. 

-  by  rupture  of  the  abscess  into  adjoining  viscera,  or  by 
'    its   external   rupture.     The   latter   is    an   uncommon 

termination  now,  when  operative  treatment  has  been 
universally  accepted  as  the  right  course,  but  occasionally 
a  patient  is  seen  with  a  faecal  fistula  in  the  groin 
or  abdominal  wall,  due  to  this  cause.  On  the  other 
hand,  my  operative  work  proves  that  many  abscesses 

•  burst  into  adjoining  viscera,  and  the  patient  may  be 
"  cured  "  in  this  way.  I  do  not  doubt  that  this  occurs 
with  a  much  greater  frequency  than  has  been  supposed, 
and  that  the  risks,  serious  though  they  are,  of  an 
appendix  abscess    have   been  much  exaggerated.     A 

-  ■  localised  collection  of  pus  on  the  outside  of  or  behind 

the  caecum  and  ascending  colon  will  almost  certainly 
■  find  its  way  into,  and  discharge  through,  the  bowel ; 
but  before  this  happens  much  and  dangerous  local 
damage  may  be  done  to  the  surrounding  tissues.  An 
abscess  on  the  inner  side  is  more  likely  to  discharge 

•  into  the  ileum  near  its  termination,  and  next  to  the 
caecum  and  colon  I  have  found  this  to  be  the  most 
common  site  for  a  spontaneous  opening.  These  cases 
are  not  commonly  recognised  because  pus,  unless  in 
very  large  quantity,  is  so  changed  in  appearance^  in 
its  passage  through  the  colon,  as  to  have  lost  all  its 
ordinary  character.  The  bladder  and  rectum  and 
vagina,  though  seldom  chosen,  are  other  not  extra- 
ordinary routes  through  which  discharge  of  pus  may 
occur,  and  I  have  seen  examples  of  each. 

I  have  notes  of  several  post-mortem  examinations 

•  at  which  it  was  found  that  the  right  pleura  was  full 
of  pus  from  an  appendix  abscess  which  had  escaped 
through  a  sloughy  nole  in  the  diaphragm,  and  there 
are  cases  recorded  in  which  in  such  instances  pus  has 
been  discharged » through  the  chest  wall,  or  into  the 
bronchus,  and  coughed  up. 

The  greatest  risk  of  an  abscess  left  alone  is,  that  it 
will  probably  spread  and  cause  a  gradually  extending 
infection  of  the  peritoneum  or  of  the  surrounding 
cellular  tissue,  and '  death  from  septic  poisoning  or 
exhaustion.  A  less  common  event  is  the  sudden 
rupture  of  such  an  abscess  into  the  general  peritoneal 


cavity,  and  this  may  easily  occur  at  a  time  when  the 
patient  has  the  appearance  of  nearly  completed 
recovery.  The  symptoms  and  signs  may  then  be 
those  of  a  sudden  perforation,  viz.,  agonising  pain, 
collapse,  quick  and  feeble  pulse,  and  cold  extremities. 
After  the  abscess  has  burst  spontaneously  in  a  favour- 
able situation,  or  has  been  opened  to  the  immediate 
relief  of  the  patient,  the  more  remote  prognosis  has  to 
be  considered.  The  dense  adhesions  involving  the 
intestinal  loops  surrounding  the  abscess  will  in  a  small 
(?  $)  percentage  of  cases  cause  intestinal  obstruction. 
The  obstruction  in  my  own  cases  has  been  acute. 
and  has  occurred  when  convalescene  seemed  to  be 
assured— during  the  second  or  third  week  in  eight  out 
of  ten  examples.  It  was  due  in  all  cases  to  extensive 
adhesions  and  kinking,  and  did  not  recur  after  separa- 
tion of  the  adherent  intestines.  Intestinal  obstruction 
after  a  late  date  appears  to  be  rare,  for  I  have  only  seen 
two  instances,  the  latest  of  which  came  on  six  years 
after  spontaneous  external  rupture  of  an  abscess  in 
connection  with  the  vermiform  appendix.  The  pro- 
bable explanation  of  this  is,  that  adhesions  disappear 
soon  after  the  attack  is  recovered  from. 

The  second  important  question  remains  to  be  dis- 
cussed in  connection  with  the  subsequent  prognosis  of 
abscess  cases,  in  which  the  appendix  has  not  been 
excised.  In  a  certain  proportion  the  appendix  b 
destroyed,  and  on  several  occasions  I  have  found  the 
entire  sloughing  organ  in  the  abscess  cavity.  For 
these  cases  the  prognosis  is  obviously  good.  There 
can  be  no  return  of  appendicitis.  This,  however,  is 
true  only  of  the  minority.  In  a  great  majority  of  in- 
stances— at  least  90  per  cent. — the  appendix  is  not 
destroyed,  and  soon  recovers  after  its  contents  have 
been  discharged  by  sloughing  or  perforation.  Any 
statement  to  the  contrary  is  based  upon  untrust- 
worthy evidence,  for  my  operations  offer  abundant 
proof  that  there  is  at  least  enough  of  the  appendix  left 
to  cause  another  attack  of  appendicitis.  Whether  it 
will  do  so  or  not  is  another  question,  and  one  still  much 
discussed.  I  have  elsewhere  {Lancet,  February  23rd. 
1  ox)  1 )  published  a  series  of  cases  of  recurrence  of  appen- 
dicitis after  the  evacuation  of  an  abscess,  and  have 
since  then  obtained  notes  of  several  more.  In  one 
instance  recurrence  did  not  follow  the  first  attack  of 
abscess  for  thirty-six  years.  This  patient  died  of 
septicaemia,  the  result  of  a  perforated  appendix,  which 
was  removed  post-mortem,  and  of  a  large  abscess  in  the 
loin.  Though  for  practical  purposes  such  an  exceptional 
instance  must  be  ignored,  I  have  more  than  once  had 
experience  of  a  second  abscess  following  immunity  of 
five  years'  duration,  from  which  it  is  obvious  that  the 
history  of  a  large  number  of  cases  must  be  kept  over  a 
long  series  of  years  before  the  question  of  percentage 
of  recurrence  can  be  settled  with  anything  approaching 
accuracy.  Meanwhile,  from  careful  observation  of 
many  cases,  I  believe  that  the  appendix,  if  not  re- 
moved, is  in  a  large  percentage  of  instances  destined  to 
cause  further  grave  trouble. 

In  the  most  serious  cases  a  perforation  exists  in  the 
appendix,  and  general  peritonitis  is  present.  In 
some  cases,  closely  approaching  them  in  severity,  the 
appendix  has  not  yet  perforated,  there  are  no  ad- 
hesions, and  a  quantity  of  milky  fluid  is  found  in  the 
abdomen.  These  cases  get  well  after  operation.  CM 
the  former  set  of  cases  the  great  majority  die,  but  some 
are  saved  by  operation,  and  some,  I  have  also  learned, 
may  get  well  without  an  operation.  Before  distension 
of  the  intestines  has  occurred  to  such  an  extent  as  to 
cause  marked  increase  in  the  abdominal  tension, 
operation,  I  believe,  offers  the  best  chance  of  recovery. 
When  the  abdomen  has  become  distended  and  tense, 
operation,  in  my  experience,  has  always  been  followed 
by  a  fatal  result.  A  patient  with  rigid,  tense,  distended 
abdomen  never,  so  far  as  I  know,  recovers.  If  the 
tension  and  rigidity  are  not  marked  features,  there  is 
always  some  room  for  hope.  A  gradually  increasing 
girth  round  the  umbilicus  is  consequently  of  bad  pro- 
gnostic import. 

Almost  equally  of  bad  import  is  a  gradual  increase 
in  the  pulse  rate.  A  quickened  pulse  means  an  ex- 
tension  of   the   peritonitis.     Escape   of   coffee-ground 


t3>    '9°4- 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press.     391 


fluid  from  the  stomach,  cold  hands,  ami  the 

aowu  face  of  septic   pcritionitis   all  foretell  the 

rriini»  end.     On    a    single  occasion    a    woman    with 

ntonitis,   oil   wham    I   had   unrated,   lay   for 

alter   operation   semi-conscious,    with   cold 

and   imperceptible    pulse,    and   distended    ab- 

ilnmtm,  constantly  .spitting  out  coffee- ground  <>r  green 

ihrid,  which" irritated   the  skin  of  her  chin  and 

uch  an  extent  as  to  excoriate  it  ;  yet  she 

red.     The  onlv  noteworthy  point   in  her  case 

speared  to  me  to  be  that  her  abdomen,  though  dis- 

icuoY'.  •■■   tense, 

tral     peritonitis     of      more      than     twenty-four 

hours*     duration   is   not    likely     to    lie    benefited    by 

■inn,  for    the   favourable*  chanci     has    been  lost  ; 

3,    an   operation    not    seldom    hastens  the  end, 

may   be    the  cause  <if  death.     This  statement,  I 

\s  justified  because  it  has  not  been  without  surprise 

oerved  recovery  in  such  cases  without 

itiou.     Of    this    1    have   had    clinical,     operative 

post- mortem  proof,  but  time  will  only  allow   <.l  :l 

umniAry  of  the  following  illustrative  cases,  which 

n'curred  during  the  last  two  years. 

ND1CITIS  WITH  GENERAL  SEPTIC  PERITONITIS. 

St  pi  it     PeriionUti 

tftihi      "/     Lit 

ha  rat:.  .    \tj>   dl  ;   fades 

,enexal  distension  of  the  abdomen  and 

of   tree   fluid   in   it  ,    pulse    140,     Left   alone   for 

deven  days  :   rtSoMioti  $0  abscess  in  ri^ht  ilia*-  ! 

operation  ;  appendix  removed  :  abscess  drained.      Ten 

ration  large  residual  collection  opened 

ctum  and  drained  ;  recovery. 

t     2$.     Duration   /..  Octolier  15th, 

very   ill ;  general   distension  ;  d  illness   in    flanks, 

rilone  ;    gradually   improved   and  left   hospital   in 

dayswitM  no  physical  lisease,     Rt-admtiUd 

:irch    ^4th,    1003,    five    months   later,    with    another 

Attack  Of  five  days*   duration  ;   abscess  in   ri*ht   iUm 

pendix  removed  ;  drainage  ,  recm  \  1 

M..    ;rt.    18.     Admitted    October     8th.     1902; 

:ive    days;    very    ill;    belly  distended;    free 

in  abdomen.     Left   alone  ;   left  hospital  in  seven 

with  no  physical  sigttS    of    disease.     Re-admitted 

Utter  with  acute  attack  ;  operation  ;  appendix 

removed  ;  rccoi 

F*p  ait*  to,«  Admitted  October  jrd.  190*  ; 
duration  four  days  /  extremely  ill  ;  general  distension 
dulness  in  ftank.i>.  October  16th,  1902,  thirteen 
Ktter.  resolution  to  abscess  ;  appendix  removed  . 
drained  ;  recovery. 

5.  F„  ^t.  9,     Admitted  with  illness  of  two   days' 
duration*     Died     in     two     days     without     operation. 
opsy  showed  diffuse    septic  peritonitis  and  gall- 
ons   perforate*  I     appendix.      There     was     double 
obular  pneumonia. 
Five  cases  ;  four  recoveries. 

The  clinical  proof  is  sure  to  be  disputed,   but   all   I 

can  say  is.   that  experience  has   taught   me  that   the 

diagnosis  of  general  septic  peritonitis  is  unlikely  to  be 

wrong      It  is  easy  to  miss  a  general  peritonitis,  but 

dt  to  mistake  it.     The  following  illustrates  this, 

other  points  raised  : — 

.  ic  Abscess  from  Appendicitis, — Drainage 
per  Rectum, — Genekal  Septic  Peritonitis, — 
Death* 

Male,  act  I  mi t  ted  Sunday*  August  3rd,  1902* 

■   previous  day  I  saw  him  and  diagnosed  general 
■nit  is  from  appendicitis. 

—He  woke  up  quite  well  on   the  previous 
ngt  and  went  to  work.     Whilst  at  work 
commenced.     It  was  diltuse  all  over  the  whole 
^Im lumen.     He  worked  all  day. 

H&y.— He   had    pain   all   day  ;    stayed    in    bed  ; 

was  not  sick. 

Wtdnisday* — The  pain  was  worse  ;  still  diffuse,  but 

in  lower  abdomen  ;  he  vomited, 

day    morning,     *    a.m. — Awakened    from    sleep  ; 

."  pain  in  neighbourhood  of  right  iliac  fossa,  and 

bled  up  for  six  ho,ir>      v limited  ;  then  pain  abated. 


He  had  frequency  and  difficulty  of  micturition  on 
Friday  and  Saturday.  Some  pain  on  defalcation  all 
the  week.  Sweating  at  nights.  Then  was  a  history 
0/  several  previous  attacks. 

ih<  adntissi  u.— He  was  in  good  general  condition, 

>L- — There  was  a   tumour   in   the  hypogastric  01 

like   a  distended   bladder.     There  were  signs  of   Ere* 

fluid    in     the    belly.     The    hypogastric    swelling    was 

resonant  and  not  altered  by  the  passage  of  the  catheter, 

Per  rectum* — Then  pus  of  fluid  in  the  re 

vesical  pouch,  which  was  bulging  down  the  anterior 
rectal  wall, 

Operation,  4ugUSt  5//.,  woj,— Abscess  opened  per 
rectum.  Four  hours  later  the  boy  became  collapsed, 
vomited  l>t.  and  died  late  on  night  of  opera* 

tiou. 

ypsy, — General  septic  peritonitis.  Pus  all  over 
and  in  pockets  among  the  coils  of  small  intestinei 
The  remains  of  a  lar-  were  found  in  the  pelvis. 

There  WM  a  large  collection  of  pus  in  the  hepatic 
pouch  and  extending  up  over  the  liver.  The  appendix 
was  hanging  down  mto  the  pelvis,  its  end  was  gan- 
grenous, and  it  contained  an  enterolith.  Pus  collections 
inal  coils  were  large  and  appeared  to 
he  11  Mdual- 

-On  Monday — day  before  death— the  patient 
seemed  so  well  that  the  previous  diagnosis  of  general 
septic  peritonitis  was  gravely  doubted. 

On  Tuesday,  the  boy  appeared  to  be  ivi  excellent 
Condition,  and  at  the  operation  it  was  remarked  how 
safe  and  easy  a  proceeding  the  opening  of  a  pelvic 
abscess  per  rectum  was.  His  death  was  UHMXpecUd, 
and  the  post-mortem  revelation  a  surprise. 

Of  ten  cases  admitted  to  hospital  during  the  last 
two  years  with  general  septic  peritonitis,  and  operated 
upon,  eight  died  and  two  recovered, 

It  was  noted  of  more  than  one  that  operation  wa- 
undertaken  in  the  belief  that  peritonitis  was  not  yet 
dill  use. 

The  prognosis  depends  upon  the  duration  of  the 
peritoneal  infection — the  longer  the  patient  lives,  the 
n-ulent  it  is  likely  to  be,  and  the  better  the  chance 
of  recovery;  and  upon  the  tension  oi  the  abdominal 
muscles— the  less  this  is,  the  more  hopeful  being  the 
outlook*  Certain  rare  cases  of  sudden  perforation  of 
the  appendix  are  followed  by  such  serious  septic  in- 
toxication that  death  occurs  in  a  few  hours  before  the 
peritoneum  or  the  patient  have  time  to  show  any  sign 
of  reaction* 

A  Note  on  the  Functions  of  the  Omentum* 
I  or  years  I  have  taught  that  the  omentum  has  very 
important  functions,  and  to  impress  this  upon  students 
I  have  Called  it  the  abdominal  M  policeman."  A  well- 
developed  omentum  will  wrap  itself  round  an  inflamed 
Fallopian  tube  in  the  depths  of  the  pelvis  ;  it  will  be 
found  surrounding  an  inflamed  gall-bladder  or  diseased 
appendix  ;  Indeed,  there  can  be  no  doubt  that  it 
travels  about  in  the  abdomen  with  considerable 
rapidity,  and  is  attracted  by  some  sort  of  information 
to  neighbourhoods  in  which  mischief  is  brewnng.  I 
have  more  than  once  found  a  totally  gangrenous, 
perforated  appendix  wrapped  up  in  omentum,  with 
peritonitis  localised  in  the  portion  of  omentum  in- 
volved, and  it  is  impossible  to  doubt  that  the  life  oE 
the  patient  was  saved  by  his  omentum.  It  is  a  recog- 
nised fact  that  the  prognosis  of  appendicitis  in  children 
is  worse  than  in  adults.  Elsewhere  than  m  the  ab- 
domen their  resistance  to  septic  infection  is  much 
greater  than  it  is  in  adults.  The  only  suggestion  I 
can  offer  as  an  explanation  of  this  anomaly  is,  that  in 
children  the  omentum  is  undeveloped.  The  purulent 
fluid  in  many  cases  of  appendicitis  will  be  found  to 
follow  a  definite  course,  and  to  assume  a  horse-shoe 
shape.  On  the  right  side  it  tracks  up  the  outer  side 
of  the  ascending  colon  into  the  liver  pouch  above  and 
into  the  pelvis  below*  On  the  left  side  it  ascends  from 
the  pelvis  along  the  outer  side  of  the  descending  colon, 
and  not  till  it  reaches  the  spleen  and  escap 
does  the  infection  attack  the  small  intestine  area, 
covered  and  protected  by  the  omentum. 


392    The  Medical  Pjiess.         ORIGINAL  COMMUNICATIONS. 


April  r3r  rgtxj 


My  colleague,  Mr.  W.  G.  Richardson,  tells  me  that  one 
of  the  most  acute  cases  of  peritoneal  infection  which 
has  come  under  his  observation  occurred  in  an  adult 
patient  whose  omentum  was  wholly  rudimentary,  (a) 
Treatment. 

The  ordinary  object  of  this  is  to  prevent  serious 
extension  of  the  septic  infection  of  the  peritoneum 
which  accompanies  appendicitis ;  for  cases  in  which 
peritonitis  is  sUght  or  absent  may  be  disregarded  here. 
The  only  reasonable  treatment  of  such  an  inflammation 
arising  from  a  local  septic  infection  is  to  remove  its 
cause;  consequently,  the  treatment  for  appendicitis 
is  surgical,  and  this  should  be  the  point  of  view  from 
which  every  case  is  considered  from  the  first.  By 
bearing  this  in  mind,  the  practitioner  may  save  his 
patient  from  grave  danger,  and  himself  from  a  most 
responsible  position,  sometimes  aggravated  by  the 
prospect  of  serious  discredit.  Let  me  emphasise,  as 
strongly  as  I  can,  my  belief  in  the  advantage  of  early 
operation  in  all  but  the  most  trivial  cases.  I  have 
previously  mentioned  that  some  of  the  most  dangerous 
conditions  may  recover  when  left  alone,  and  that  some 
very  serious  cases  may  (under  the  circumstances  stated, 
vide  supra)  have  a  better  chance  without  than  with 
operation,  and  I  intend  to  speak  presently  of  a  medical 
plan  of  treating  cases  of  appendicitis,  but  it  must  be 
clearly  understood  that  in  the  passages  referred  to  I 
am  dealing  with  exceptions  to  the  general  rule,  which 
is,  as  I  have  stated  above,  that  in  all  but  trivial  cases, 
it  is  best  to  operate,  and  to  operate  early. 

My  experience,  as  an  operator,  has  invariably  been 
that  the  amount  of  pathological  change  which  has 
already  occurred  has  been  in  excess  of  what,  from  the 
condition  of  the  patient,  had  been  anticipated,  and 
that  the  medical  man  in  charge  has  been  surprised  to 
find  that  his  patient  was  the  possessor  of  such  a  diseased 
appendix.  . 

Patients  or  their  friends  often  wish  to  know  it 
nothing  but  an  operation  will  suffice  for  the  "  cure1." 
There  can  be  but  one  answer  to  the  question.  A 
majority  will  recover  from  the  present  attack  without 
operation.  A  minority  wjll  as  certainly  die.  Of  the 
recovered  majority,  a  majority  will  get  weU  m  the 
course  of  a  week  or  two,  while  a  minority  of  them  will 
pass  through  an  anxious  and  tedious  illness  to  con- 
valescence. Of  all  who  recover  without  operation,  a 
large  majority  will  suffer  from  recurrent  attacks  of 
appendicitis.  In  the  case  of  the  patient  who  under- 
goes operation  and  recovers,  such  attacks,  on  the 
contrary,  can  recur  no  more. 

When  I  add  that  I  have  never  seen  even  an  acute 
case  die  if  the  appendix  was  removed  before  there  was 
extensive  peritonitis,  who  dares  to  blame  me  for 
teaching  that  operation  cannot  be  done  too  early,  if 
the  diagnosis  is  assured  ?  The  responsibility  of  urging 
early  operation  is  a  light  one,  that  of  delay,  heavier  than 
I  care  to  accept. 

Pain  in  nearly  all  cases  is  the  occasion  of  the  summons 
of  the  practitioner,  and  to  relieve  this  is  doubtless  his 
duty.  It  should  not,  however,  be  his  first  duty.  That 
consists  in  making  an  honest  attempt  at  a  diagnosis 
of  its  cause,  and  in  answering  the  question  whether 
the  patient  is  dangerously  ill  or  not.  In  some  instances 
the  pain  is  so  agonising,  and  the  general  condition  qf 
the  patient  such,  that  only  a  very  serious  lesion  could 
explain  the  symptoms.  A  few  days  of  aching,  followed 
by  a  serious  attack  of  pain,  means  perforation.  In  this 
case,  the  pain  should  be  relieved  by  a  hypodermic 
injection  of  morphia,  and  preparations  made  for  imme- 
diate operation.  In  less  serious  cases  a  similar  attempt 
to  arrive  at  a  definite  diagnosis,  clinical  and  pathological, 
should  be  made  before  administering  morphia,  for  the 
effect  of  the  latter  is  -little  short  of  miraculous  in 
relieving  every  symptom,  and  after  the  patient  has 
been  brought  under  its  influence  it  may  be  difficult 


Mr.  O.  Gr»y  Tomer,  8urgioel  Regiitwr,  Royal  !»*"■«»»£. 
oU«*i«.nn.T™  in  an  "  Esaay  on  Appendicitis,"  which  wm  written 
h^STMO?fSSe  555am  uSTe«ity^Ue«e  of  Medicine, 
NewcMtle-on-Tync,  and  which  secoNd  the  ••  Stephen  Scots "  prize, 
wST  intone  I  know,  the  first  to  describe  thie  distribution  of  th- 
nns.'  More  teoently,  Mr.  Harold  L.  Barnard,  in  three  lectures  of 
Sreat  ▼atae,  "  On  Appendicitii"  (in  the  Oinicaljoumml  for  Sep- 
tember,  190S),  deecribed  the  same  ooorse  followed  by  pui. 


to  judge  of  his  condition.  If  the  first  dose  (one-fourth 
of  a  grain  hypodermically  for  an  adult)  fails  to  relieve 
the  pain,  or  if  the  symptoms  become  progressively 
worse — increasing  rapidity  of  pulse,  thirst,  vomiting, 
temperature,  tenderness  and  rigidity — operation  should 
at  once  be  resorted  to.  The  position  that  has  to  be 
faced  is  this :  The  case  is  a  serious  one,  the  outlook 
is  uncertain,  and  operation  may  have  to  be  performed 
later  under  unsatisfactory  conditions. 

Every    case     requires    careful,     hourly     watching, 
for    even    those   which   appear   to    be  most   favour- 
able  may   quickly    develop    threatening    symptoms. 
In    cases   not  requiring    immediate    operation,    rest 
in    its    widest    acceptation   is   the    treatment.     The 
patient  must  lie  in  bed  and  make  no    effort,    rest- 
ing    as     much    as    possible    in    one    position.     The 
acts  of    micturition  and   defalcation    are    to  be  pro- 
vided for  without  getting  up,  and  with  as  little  dis- 
turbance as  possible.     All  solid  food  is  to  be  avoided, 
and  only  minute  quantities  of  liquid  are  to  be  taken. 
Equal    parts    of    milk    and    barley    water,    or    hot 
milk  and  soda  water  are  the  best.     After  each  drink 
the  mouth  should  be  cleansed  with  boracicacid  lotion, 
and  three  times  a  day  it  should  be  wiped  out  by  the 
nurse  with  borax  and  glycerine.     A  large,  hot,  linseed 
meal  poultice  should  be  laid  over  the  abdomen  and 
worn  for  an  hour,  and  this  replaced  by  hot  cotton-wool 
and  a  many-tailed  bandage.     Every  eight  hours    thU 
poultice  may  be  repeated.     At  the  commencement  of 
an  attack,   purgatives  and   enemata  are  dangerous, 
and  even  if  they  do  no  harm,  are  of  little  service.    It 
is  easy  where  perforation  is  threatening  to  precipitate 
this  even  by  the  administration  of  a  strong  purgative. 
At  the  end  of  twelve  or  eighteen  hours,  the  effect  of 
the  morphia  will  have  passed  off,  and    the  pain  may 
have  returned.     If  it  is  not  severe,  and  if  all  the  con- 
ditions are  favourable,  a  further  dose  of  opium  may 
be  given.     Such  a  prescription  as  pulv.  ipecac,   co.. 
gr.  v. ;  hydrarg.  c.  creta,  gr.  i. ;  repeated   every   tour 
hours,  is  a  suitable  one,  but  this  should  not  be  con- 
tinued for  more  than  fifty  hours.     If  doubt  be  felt  as 
to  the  satisfactory  progress  of  the  case,  opium  should 
be  withheld  for  the  purpose  of  careful  watching.    On 
the  other  hand,  it  is  possible  that  the  patient  may  be 
obviously  better,  the  pain  may  have  ceased,  and  the 
pulse  and  temperature  may  have  become  more  normal. 
Even  if  this  is  the  case,  it  is  necessary  that  up  to  the 
end  of  the  fourth  day  most  rigid  care  and  abstinence 
from  any  but  a  fluid  diet,  and  entire  rest,    should  be 
insisted   upon.       It   is   seldom   that   the   bowels  are 
moved  during  this   time,   and   a  certain  amount  of 
abdominal  distension  and  increased  peristaltic  move- 
ments of  the  intestines  may  be  observed  towards  the 
end  of  it.       If  the  abdomen'is  soft  and  free  from  special 
tenderness,  the  indication  is  to  get  the  bowels  moved. 
In  the  first  place,  a  soap  and  water  enema,  gently  used. 
may  be  tried,  and  if  this  is  effectual  nothing  further  is 
required.     If  not,  five  grains  of  calomel  followed  in  six 
hours  by  small  and  repeated  doses  of  white  mixture, 
should  be  given  until  the  bowels  have  acted  properly. 

In  dealing  with  the  subject  of  operation,  I  shall 
revert  to  the  classification  previously  mentioned.  As 
I  have  related,  it  is  possible  that  the  inflammation  may 
undergo  resolution,  and  complete  recovery  follow  the 
attack.  This  is  probable  if  no  tenderness  and  no 
discomfort  and  no  nodule  persist,  and  in  these  cases  I 
do  not  advise  operation.  A  second  attack  generally 
means  that  the  appendix  is  diseased,  and  a  tender 
nodule  with  local  discomfort  on  occasions  makes  this 
certain.  Associated  with  this  form  there  are  usually 
peritoneal  adhesions.  The  operation  of  choice  in 
such  cases  is  an  interval  one,  when  the  appendix  can  be 
removed  through  a  small  incision,  and  with  a  minimum 
of  danger  to  life  or  infection  of  the  wound.  When  some 
doubt  is  felt  as  to  the  diagnosis,  or  on  the  propriety  of 
operation,  I  give  the  patient  directions  to  return  to 
hospital  on  the  first  warning  of  an  attack  ;  then  the 
diagnosis  may  be  readily  confirmed  or  refuted,  ana 
operation  undertaken,  if  not  under  the  most  favourable 
circumstances,  at  any  rate  under  conditions  which  are 
very  fairly  favourable. 

In  abscess  cases,  unless  very  exceptionally,  I  remove 


A?RIL   13,    1904- 


TRANSACTIONS  OF  SOCIETIES.        The  Medical  Press,    393 


tie  appendix  at  the  same  time  as  the  abscess  is  drained. 
ts  so  obvious  an  advantage,  if  the  risk  is  not  iu- 
L  that  it  requires  BO  further  argument  to  support 

Recently,   two   patients,   on  whom  X   operated  for 
accesses, "  have  died,   one    trom    diffuse    infection  of 
the  abdominal   wall,    the  second    with  symptoms  of 
prolonged    shock,    and    probably    from    acute   sepsis, 
neither  was  there  any  evidence  of  peritoneal  in- 
Uion  bevond  the  localised  area  exposed  by  operation. 
I  tojthesc  I  had  operated  upon  1  to  consecutive 
of   abscess   in   connection   with   the   vermiform 
without  a  death. 
el  me  again  repeat  that  the  object  of  treatment  is 
he  prevention  of  peritonitis,  and  that  this  can  only  be 
bttmed  with  certainty,  m  most  cases,  by  immediate 
rmoval  of  the  appendix,  and  in  all  by  early  operation, 
I  is'onJy  by  making  such  a  rule  that  the  present  large 
ath-roll    attributable    to  septic  peritonitis    can  be 
scelled,  or  that  patients  can  be  saved  from  the  pro- 
id    and    serious    illness   consequent    on   abscess, 
the  high  death-rate,  and  the  large  percentage  of 
ses  in   which  abscess  occurs,   still   occasion  serious 
reflections  upon  the  promptitude  and  courage  and  skill 
t  our  profession. 
The  tables  (an  abstract  of  which  is  appended),  pre- 
for  me  by  Mr*  G,  Grey  Turner  and  Mr*  Heslop, 
ply   particulars   of  every   case   on   which    I   have 
ited  during  the  period  of  two  years  included  by 
It  is  difficult   to  classify  some  of  the  cases, 
tally  to  differentiate  between  the  less  acute  and 
interval  cases,  for  several  of  these,  sent  for  operation 
because  of  frequent  relapses,  were  found  to  have  active 
wi*chiet  in  progress  in  the  appendix,     AH  cases  judged 
lo  have  active  and  possibly  progressive  infection  of  the 
appendix  at  the  time  of  operation  have  been  included 
r  acute  cases. 
\  similar  difficulty  arises  in  separating  some  acute 
feotfi  abscess  cases-     Every  case  in  which  a  localised 
collection  of  pus  was  found  round  the  appendix  has 
ken  put  under  the  heading  of  abscess. 

Copy  of  a  letter  sent  to  patients  who  have  been 
vperated  upon  :— ~ 

Royal  Infirmary,  Newcastlc-ou-Tyne, 
Folio  No. 

Sir  or  Madam. 
foq  were  a  patient  in  this  hospital  in 
I  were  operated  on  for  appendicitis. 
■ft  M orison  is  anxious  to  know  what  the  result  of 
operation  has  been,  and  would  be  glad  if  you  will 
er  the  following  questions  and  return  this  letter 
in  the  envelope  enclosed,     Should  you  feel  unable  to 
*rply  to  the  questions  yourself,  please  hand  the  letter 
la  your  doctor  and  ask  him  to  be  kind  enough  to  do  so. 
Yours  faithfully. 

For    Rutherford    Morisov, 
Have  you  had  any  of  your  former  attacks  ? 
Have  you  had  any  abdominal  pain  at  all  \ 
Describe  any  pain  you  may  have  had  ? 
Is  your  general  health  better  than  before  - 
Are  you  able  to  follow  your  employment  ? 
Does  the  scar  give  you  any  truuble  ? 
State  any  other  facts  you  may  think  important  ? 
Many  of  them  have  been   examined   by  myself  or 
ants*    others    have    not,       Under    one    heading 
•Remarks)  the  present  condition  is  the   result   of  an 
examination  or  an  answer  to  these  questions. 
Abstract    of    Tables. 
Cases  operated  upon  during  two  years  from  July, 
to  July.  IOX>3,  in  the  Royal  Infirmary,  Newcastle- 
.  Tyne,  and  in  a  private  hospital,  from  tables  pre- 
pared  by  Mr.  G,  Grey  Turner,  Surgical  Hesgistrar  : — 

ctat  Septic  Peritonitis  ™  15, — 10  cases  operated  on, 
j  not  operated  on.  Of  the  cases  immediately  operated 
BpOBi  ^  recovered,  $  died.  (In  these  the  diagnosis  was 
riiied  by  post-mortem  examination, 
[  5  cases  not  operated  upon,  but  left  for  localisation 
I  later  operation,  4  recovered,  i  died. 

r  C<ws=  16, — All  recovered  (1  died  a  month  after 
ation  from  intestinal  obstruction),     The  earliest 
se  was  ol  six  hours'  duration. 


Abscess  Cmes*=  57, — All  recovered.  In  two  of  these 
cases  the  appendix  was  totally  gangrenous,  and  was 
removed  as  a  slough. 

In  two  the  abscess  was  drained  by  the  rectum  or 
vagina,  and  the  appendix  was  not  looked  for. 

In  two  the  appendix  was  not  excised  on  account  of 
bad  local  and  general  conditions* 

ItLft  of  the  57  cases  the  appendix  was  excised. 

mptkaUd  Cases  ^10.— In  this  class  are  included 
excisions  of  portions  of  the  intestine  for  tubercle,  anil 
cases  complicated  by  diseases  of  the  ovaries,  tubes, 
and  uterus,  necessitating  ovariotomy,  salpingectomy, 
and  hysterectomy,  All  of  these  cases  recovered, 
though  two  still  have  faecal  fistula'. 

Interval  Cases  —  40.— All  recovered.  In  all  the 
appendix  was  excised. 

Hernia  of  the  scar,  though  carefully  looked  for. 
was  only  found,  and  reported,   in  one  1 

transactions  of  Societies. 


1. 
4* 


THE  SOCIETY  FOR  THE  STUDY  OF   DiSl 
IN     CHILDREN, 
Meeting    held    Friday,    March    i8th\    1904. 

Dr,  Percy  Lewis   in  th?  Chair. 

Mr.  Harold  Burrows  showed  a  case  of  enlarged 
liver  and  spleen  in  a  girl,  a?t.  1 3.  Six  months  previous  ly 
laparotomy  had  been  performed,  for  supposed  hydatid 
disease  of  the  liver,  but  the  liver  was  found  to  be 
uniformly  enlarged  and  smooth.  There  was  no  h is tory 
of  syphilis,  but  as  there  were  the  remains  of  old  retino- 
ciioroiditis  m  lx>th  eyes,  a  diagnosis  of  syphilis  had 
been  made, 

Dr.  Gvtf*r[e  agreed  that  the  case  was  probably 
syphilitic,  and  asked  if  there  was  an  excess  of  red 
blood  cells,  which  had  been  found  in  some  cases  of 
hepa  to-sple  no  mega  ly . 

Dr.  Porter  Parkinson  recalled  a  ease  ptthrfsbrrl 
by  Sir  Thomas  Barlow,  in  which  hepa  to -splenomegaly 
had  persisted  from  infancy  lo  adult  He,  accompanied 
by  recurrent  attacks  of  abdominal  nam  and  jaundice. 

Dr,  C.  W,  Chapman  showed  a  girl.  act.  a,  who  had 
suffered  from  mitral  disease,  with  recurrent  attacks  of 
dilatation  of  the  heart.  These  had  at  first  yielded  to 
the  ordinary  remedies,  but  later  the  dilatation  and 
failure  of  compensation  were  not  relieved  until  the 
administration  of  adrenalin  solution  in  5 -drop  doses 
every  four  hours.  This  was  followed  by  steady  im- 
provement. 

In  reply  to  questions  by  Dr,  Fortescue  Brickdale, 
Dr.  Chapman  said  that  the  symptoms,  amongst  which 
was  orthopnea,  had  been  unrelieved  by  ordinary 
measures,  and  until  the  use  of  the  adrenalin  solution, 

Mr.  Keogh  Murphy  showed  a  case  of  hematoma 
of  the  parietal  bone  in  an  infant  of  eight  weeks.  At 
the  age  of  six  weeks  the  swelling  was  still  soft  and 
fluctuating,  but  a  fortnight  later  it  was  rather  larger, 
and  hard  and  bony  throughout. 

Dr.  Carpenter  said  that  in  a  similar  case  the 
X-rays  had  shown  that  the  swelling  was  not  realty 
composed  of  bony  tissue,  and  asked  whether  Mr, 
Murphy  had  made  this  test, 

Mr,  Howell  Evans  thought  that  the  tumour  was 
bony,  and  that  the  development  of  such  a  condition 
was  a  strong  argument  in  favour  of  early  surgical 
interference  in  alt  cepha!-tuematomata> 

Dr.  Burgess  said  that  in  an  experience  of  twenu 
years  he  had  seen  many  cephalhematoma  ta,  and  had 
never  seen  any  had  results  from  leaving  them  alone. 

Mr.  Murphy  also  showed  a  case  of  double  pes  cavus 
in  a  boy,  a»t.  4.  Two  years  previously  his  walking 
had  become  awkward,  and  had  steadily  become  worse. 
There  was  no  history  of  acute  illness  as  an  exciting 
cause.  The  left  lower  extremity  showed  a  condition 
of  equina -varus,  with  contraction  of  the  plantar 
end  tendo  Achillis.  The  foot  coukl  only  be 
put  into  a  good  position  with  difficulty.  The  right 
lower  extremity  showed  a  condition  of  talipes  calcaneus 
and  valgus,  with  great  laxity  of  ligaments.     The  tendo 


394    The  Medical  Press^        TRANSACTIONS  OF  SOCIETIES. 


April  13,  1904* 


Achiilis  and  the  tendon  of  the  tibialis  posticus  could 
not  be  felt,  and  there  was  great  wasting  of  the  gastro- 
cnemius muscle. 

Mr.  Douglas  Drew  thought  that  the  condition  was 
due  to  anterior  poliomyelitis,  and  suggested  that  a 
good  result  might  be  brought  about  by  transplanting 
the  peroneus  longus  of  the  right  leg  on  to  the  tendo 
Achiilis. 

Dr.  Guthrie  thought  that  careful  electrical  reactions 
should  be  taken  so  as  to  settle  the  question  as  to 
whether  the  disease  was  anterior  poliomyelitis,  or  a 
congenital  want  of  development,  or  some  obscure  form 
of  myopathy. 

Dr.  Leonard  Guthrie  showed  a  boy,  act.  11,  who 
for  two  years  had  been  subject  to  peculiar  attacks,  in 
which  he  would  suddenly  run  to  his  mother,  exclaiming 
"  Horrid  smell."  He  would  appear  much  agitated 
and  distressed  for  a  few  moments,  sometimes  spitting 
and  grimacing,  and  going  through  the  action  of  trying 
to  pull  something  out  of  his  mouth.  He  would  then 
behave  "  as  if  he  were  silly,"  running  to  persons  in  the 
room,  and  trying  to  embrace  them.  After  five  or  ten 
minutes  of  this  behaviour  he  would  become  quiet,  turn 
pale,  shiver  as  if  cold,  seem  exhausted,  and  lie  down  to 
sleep.  Dr.  Guthrie  regarded  the  case  as  one  of  automa- 
tism, with  olfactory  and  gustatory  aurae,  a  condition 
allied  to  epilepsy  or  megrim.  Under  treatment  with  bro- 
mide of  potassium  in  8-grain  doses  thrice  daily,  the 
attacks  diminished  rapidly  in  frequency  and  severity. 

The  Chairman  (Dr.  Percy  Lewis)  commented  on  the 
large  pupils  and  a  tendency  to  exophthalmos  in  the 
patient. 

Dr.  £.  A.  Jones  said  that  visual  aura;  were  of  two 
kinds — (1)  of  persons,  which  were  usually  unpleasant ; 
and  (2)  of  landscapes,  which  were  usually  pleasant. 

Dr.  Edmund  Cautley  showed  a  case  of  multiple 
congenital  deformities  in  a  girl,  aet.  5.  She  was  one 
of  twelve  children,  all  the  others  being  healthy  and 
well  formed.  She  was  very  small  and  intellectually 
deficient.  Walking  or  standing  had  not  yet  been 
accomplished,  although  there  was  no  indication  of 
muscular  or  nervous  lesion.  The  eyes  were  marked 
by  notching  of  the  upper  lids,  dermoid  cysts  on  the 
conjunctiva?,  coloboma  of  the  iris  and  choroid,  and 
choroidal  atrophy.  There,  were  accessory  auricles, 
and  macrostoma  on  the  right  side. 

Mr.  Lockhart  Mummery  said  a  most  interesting 
point  was  the  association  of  auricular  appendages 
with  the  fissure  of  the  mouth,  because  those  cases 
seemed  to  carry  out  the  theory  that  the  auricular 
appendages  were  developed  around  the  outer  end  of  a 
partly  persistent  inter-maxillary  cleft,  the  anterior 
part  of  which  was  represented  by  the  fissure  of  the 
mouth. 

Mr.  Howell  Evans  pointed  out  that  the  notch  in 
the  upper  eyelids  occurred  at  a  point  where  there  was 
a  division  between  the  nerve  supply  of  the  outer  two- 
thirds  and  the  inner  third,  a  situation  often  occupied  by 
birth-marks,  moles,  &c. 

Dr.  G.  A.  Sutherland  showed  a  boy.  aet.  8,  suffering 
from  chronic  interstitial  nephritis.  There  was 
marked  cardiac  hypertrophy  and  thickening  of  the 
radial  arteries.  The  urine  was  of  low  specific  gravity, 
and  contained  occasionally  a  trace  ot  albumin  amd 
granular  casts.  There  were  no  retinal  changes.  Dr. 
Sutherland  commented  on  the  syphilitic  origin  of  these 
cases,  although  no  history  of  that  disease  was  present 
in  this  instance.  The  prognosis  was  worse  than 
in  adult  life,  for  the  disease  ran  a  more  rapid  course  in 
children. 

Mr.  Thomson  Walker  thought  that  syphilis  was  a 
frequent  cause  of  such  cases,  and  asked  whether  there 
was  any  possible  septic  focus  in  the  present  case,  which 
might  have  started  interstitial  nephritis. 

Dr.  E.  P.  Baumann  showed  a  specimen  of  early 
Parrot's  nodes  from  a  child,  aet.  2.  The  nodes  were  in 
an  early  stage,  being  small,  sharply  limited,  and  still 
vascular.  It  was  uncommon  to  find  them  developing 
at  such  a  late  age.  The  patient  had  well-marked 
signs  of  syphilis. 

Dr.  George  Carpenter  said  that  he  regarded 
Parrot's  nodes  as  definite   evidence  of  syphilis,  and 


that  the  spleen  would  usually  be  found  to  be  enlarged  in 
such  cases. 

Dr.  Baumann  also  showed  an  embryonic  cyst  of  the 
mesentery,  from  an  infant  eight  months  old.  The 
patient  developed  symptoms  of  acute  intestinal 
obstruction  ;  intussusception  was  diagnosed,  and  on 
operation  a  cyst  was  found  between  the  layers  of  the 
mesentery,  tanking  the  lower  end  of  the  jejunum. 
The  cyst  was  the  size  of  a  pigeon's  egg,  and  contained 
a  quantity  of  viscid  fluid,  in  which  chotesterin  crystals 
were  present.  Such  cysts  were  formerly  known  as 
chylous  cysts  of  the  mesentery,  but  were  now  regarded 
as  embryonic  in  character. 

The  following  papers  were  read  : — 

(1)  "Congenital  Word-Blindness  in  Children,"  by 
Mr.  Sidney  Stephenson;  and  (2)  "  Notes  on  a  Case  ot 
Nephro-lithotomy,"  by  Dr.  Porter  Parkinson  and 
Mr.  Douglas  Drew. 


NORTH-EAST     LONDON     CLINICAL     SOCIETY. 
Meeting  held  Thursday,  April  7TH,  1904. 


Dr.  J.  W.  Hunt,  President,  in  the  Chair. 

The  President  showed  a  boy,  act.  1 2,  who  presented  3 
swelling  in  the  upper  part  of  the  chest  and  neck,  ac- 
companied by  cyanosis  and  venous  enlargement. 
The  symptoms  had  appeared  about  two  years  ago. 
There  was  no  leucocytosis,  nor  did  skiagraphic  ex- 
amination reveal  anything  abnormal.  The  clinical 
aspect  resembled  that  of  congenital  heart  disease, 
but  there  were  no  cardiac  murmurs.  He  was  in- 
clined to  the  view  that  there  was  a  mass  of  tuberculous 
glands  in  the  mediastinum  pressing  upon  the  veins  of 
the  neck.     There  was  no  glandular  enlargement. 

Dr.  F.  J.  Tresilian  (Enfield)  showed  (1)  a  case  of 
commencing  syphilis  affecting  the  epiglottis  in  a  man. 
aet.  53  ;  (2)  a  young  man  with  a  double  empyema  of 
the  maxillary  antrum  ;  and  (3)  a  case  of  chronic 
glossitis  with  superficial  ulceration  of  the  tongue  in  a 
woman,  set.  59.  The  condition  had  proved  very  in- 
sistent to  treatment. 

Dr.  R.  Murray  Leslie  exhibited  (1)  a  girl,  aet.  ;. 
with  syphilitic  cirrhosis  of  the  liver  and  a  greatly  en- 
larged spleen.  There  were  no  abnormal  blood  changes, 
neither  was  there  any  history  of  syphilis  ;  (2)  a  case 
of  tetanus  in  a  boy,  at.  9,  who  had  recovered  after 
the  intra-thecal  and  subcutaneous  injection  of  anti- 
tetanic  serum.  The  source  of  infection  appeared  to 
be  broken  chilblains.  Though  the  boy  had  prac- 
tically recovered,  yet  there  still  persisted  some  rigidity 
of  the  abdominal  and  cervical  muscles  ;  (3)  a  woman. 
act.  54,  with  jaundice  of  obstructive  origin. 

Mr.  Herbert  Carson  considered  that  the  patholo- 
gical condition  in  the  latter  case  was  probably  one  of 
chronic  pancreatitis  in  the  head  of  the  organ,  set  up 
originally  by  the  impaction  of  a  calculus. 

Dr.  R.  J.  Marjoribanks  showed  a  specimen  of  a 
stone  forming  a  complete  cast  of  the  gall-bladder 
which  he  had  obtained  from  a  woman,  a?t.  80,  wru> 
had  died  from  a  fatty  heart.  The  wall  of  the  gall- 
bladder was  extremely  attenuated. 

Dr.  Arthur  E.  Giles  exhibited  a  specimen  of  a 
uterine  fibroid  which  was  undergoing  myxomatou* 
degeneration,  which  he  had  recently  removed  from  a 
married  woman,  aet.  45,  who  had  been  sent  into  the 
hospital  with  a  profuse  haemorrhage. 

ULSTER     MEDICAL     SOCIETY. 
Meeting     in    the    Medical    Institute,     Belfast, 
Thursday  Evening,  April  7TH,  1904. 


The  President,  Dr.  John  Campbell,  F.R.C.S..  in  the 
Chair. 


Dr.  Thomas,  Houston  showed  a  case  of  Friedreich":* 
ataxia  in  a  boy,  a?t.  10.  The  patient  was  the  sixth 
member  of  a  family  of  thirteen  children,  all  the  others 
being  in  good  health.  It  was  interesting  to  note  that 
his  mother  attributed  his  ailment  to  the  fact  that  she 
had  sustained  a  severe  fright  in  an  accident  about 
two  months  before  his  birth. 


\pait  ij,  1004 


GERMANY. 


The  Medical  Piess,     395 


Dr.  William  Calwlll  read  a  paper  entitled  "  Some 

Observations  on  Two  Hundred  Cases  of  Gastric  I  leer/' 

He  d»d  Mot  deal  with  matters  on  which  all  were  agreed, 

at  w-rth  points  of  uncertainty  and  theories  on  which 

•  red.     In  looking  over  the  notes  of  more  than 

ninach  cases,  he  found  they  included  son 

trie  ulcer,  eleven  of  acule  catarrh,   twenty -nine 

a  chronic  catarrh,   twenty -eight  neurotic  cases,  ami 

-even    malignant.     The    first    thing   one    noticed 

in  this  list  was  the  total  disappea ranee  of  **  dyspepsia  " 

indigestion  "  ;  he  agreed  with  the  view  that  these 

should    be   used    to   indicate  certain   groups   of 

ymptoms,  and  not  to  designate  separate  entities  as 

•.t ion  of  the  stomach  w;is  ;l1mi  aliment  as  | 
*  substantive  disease;  he  believed  independent  dilata-  • 
tiOQ  very  rare,  if,  indeed,  it  ever  existed  at  all. 

regard*  the  etiology  of  gastric  ulcer,  Dr.  Calwell 
thought  there  were  two' varieties  of  the  disease — the 
fevetoproental    and     the    post-developmental.      The 
former  occurred  in  young  females,  ami  he  had  notes  of 
u:  cases  between  the  ages  oi  13  and  15,     The  (alter 
variety  occurred  also  in  males,  but   few,  it  any,  cases 
were  seen  before  28,     The  frequency  id  the  affection 
in  young  women  at  different  ages  was  shown  by  curves 
one  diagram,  ami   this  diagram  was  compared   with 
It     By  ram     Bram  well's    diagram    for    chlorosis,    the 
two  curves   being  seen    bo   hi    very   much  alike.      I  *r. 
ell  said  that  probably   in  85  per  cent,  of  cases  oi 
ric  ulcer   there    was  "anemia,    and   few  cases  of 
chlorosis  were  found  without  stomach  symptoms.     The 
afte  incidence  was  also  compared  with  that  of  another 
Inpmeutal  disease,  acn«j  vulgaris,    while   tne  age 
met   of  the    post -developmental  ulcer  compares 
iatof  acne  rosacea. 
The   symptoms    of    gastric    ulcer    were    considered 
under  the  heads  of  (a)  essential,   and   {it)  incidental. 
Hardly  any  disease  presents  more  complications  than 
■  lues  tins,     The  essential  symptoms  Dr.  Calwell  took 
10  be  a   fair   appetite   and    clean    tongue,    pain    aftfit 
and  marked  local  tenderness.      Catarrhal    syin- 
were  incidental,  but  local  tenderness  was  present 
in  95   per  cent,   of  cases.     The   most   difficult    Cases 
nose  ol  nk'T  with  neurotic  symptoms.    Chronic 
cases  were  generally  relieved  by  rest  tubed,  the    sym- 
ptoms returning  when  the  patient  resumed  the  upright 
km,   and    this  In    took    to   he  due   to   the  sagging 
itomach  in   the  latter  position.     In  considering 
uu   question  of  diagnosis,   l>r.  Calwell  dwelt  on  the 
difficulties     with     neurotic     patients,     and     described 
fhere   was   the   over-worked 
sad  over-anxious  man,  always  busy  and  always  ha  a 
hurry,    »n    whom    gastric    symptoms    were   completely 
py  rc*t  and  a  good  holiday.     Then  then 
neurotic    female,   in    whom   symptoms   came   .md 
withunt  anv  relation  to  rest,  which  always  isn* 
,\  gastric  nicer.     The  third  type  was  the  usual 
neurotic   but  with  some  dilatation,  tne  explanation  of 
which  was  not  1 


The  Channels  of  Tuberculous  Infection  ts 
childhood, 
t'or   the  purpose  of  experiment  he  liad  made  use  of 
guinea  pi^s,  rabbits  and  calves,  and  had  injected  into 
them   111    the  region  of  the  loins  or  back   tuberculous 
material,    mostly    taken    from    the    human    subject, 
After    some    time    hod      elapsed      ihere    was     alv 
caseation     at     the     point  of    injection,     as      also    of 
the  regionary  lymph  glands,     There  was  also  caseation 
in  all  OSM  of  the  glands  in  front  of  the  sacral  promon- 
tory, at  the  pomt  oi  division   of    the   aorta  and  of  the 
I  retro -peri  to  nea  I    and   subdiaphragmatic    glands.     The 
liver    and  spleen  were  also  generally  diseased,  anil  LelS 
frequently    the    lungR,    and    still    less   so    the    kidney*. 
This    showed    that    tubercle    first    spread    along    1 1n- 
ly in  ph  tracts.     In  a  certain  number  of  the  ofioet,  the 
bronchial    e,  lands    were    also    affected,    but     wi1 

in    the    lungs    themselves.     In    one    case    the 
submaxillary  glands  even   were  affected.     Daily    ex- 
perience   at    the    Berlin    Central    Abbatoir    confirmed 
these  observations,      I  he  experiences  of  both  physicians 
and  pathologists  had  shown  that  tuberculosis  did  not 
show  itself  in   the  infant  before   the   third    mouth  of 
life,    and    that   from    this  date   it    gradually   increased 
111    frequency.     The    speaker    explained    this    by    the 
statement  that  the  hrst  dentition  began  at  this  period, 
that   the  mucous  membrane  of   the  mouth  irfi  in  an 
irritable  condition,  and   that    it  frequently  sustained 
>Iight    damage.     This    was    why    small    children    lay 
more  quietly    and  were  less  exposed  to  infection  than 
after   they  had   passed   the   third  month  of   life,       ihir 
domestic  animals  were  either  born  with  teeth,  or  thev 
got   them    a  lew  days  after   birth.      The   pig    was   an 
exception  to  this,  and  it  was  the  only  one  of  the  domestic 
animals  that  became  tuberculous  during  the  first  year 
existence.      It    must  also  be  borne  in  mind  that 
the  pig  was   the  only  animal  fed  on   offal,  the  others 
Uiiijj  led  with  care.     Virchow  and  SchulU  found  that 
in  young  pigs  the  disease  began  in  the  submaxillary 
glands. 

The  cuurse  of  infection  was  this  : — In  a  portion  of 
the  C*S«9  the  disease  of  the  cervical  glands,  and  perhaps 
of  the  bronchial  also,  healed  up  ;  in  another  portion  the 
disease  burst  through  into  the  bugs;  b  other-  lh- 
disease  remains  latent. 

It  was  remarkable  that  the  so-called  ulcerosa 
phthisis  scarcely  ever  occurred  in  children 

If  the  patches  that  were  healed  in  the  apices  <d  the1 
lungs  in  adults  were  examined,  it  would  be  seen  that 
they  were  mostly  bronchial  patches.  As  regarded 
Lh*  question  of  inhalation,  it  might  be  looked  upon  ;i> 


Regarding    hemorrhage,    he    had    found    it    present     certai„  that  lubercle  bacilli  could  penetrate  as  far  as 


in  ;;  per  cent,  of  his  cases,  and  in  K  per  cent,  it  was  the 
torn.     In  some  cases,  especially  in  alcoholic 
-is.  he  had  seen  intense  acute  pain  following  an 
i  in  diet, 
hr     Calwell    concluded    by    some    observation 
ilttodena)  ulcer,  of  which  he  had  noted  fourteen  1 

ii   with  a  query,  and  by  some  remarks  on   the 
al   treatment    of    gastric    cases,    advocating    an 
rjcplora  fralion  it,  after  two  years  of  medical  1 

>  nt.  the  cast-  was  still  unrein 
paper  was  discussed   by  Sir  Win.   Wnitla.   Pro 
irs     Lindsay     and     Bycrs,     and     Urs      Dempsej 
McKisack  ami  McQuitty. 


ii    not 


into    the   alveoli,   into    the   email 


<3erman\\ 

[FftOM      OUR      OWN      CORKENFONDKVJ    J 


BmiMtt,  April  Oth.  IDU4. 

\i    the  Medical    Society  Hr,  Westenhofer  brought 
forward  the  subject  of 


dust   could , 
bronchi. 

The  tonsils  and  glands  of  the  fauces  might  occasion 
ally  be  ports  of  entry  for  tuberculous  infection.  Care- 
iul  investigation,  limvever,  had  but  very  rarely  revealed 
tuberculous  disease  Of  this  form.  U  disease  from  this 
si  hi  roc  were  more  frequent  t  we  must  often  find  these 
organs  with  their  lymphatic  structure,  diseased,  for 
tuberculosis  was  typically  a  disease  of  the  lymph 
glands, 

The  practical  teaching  of  these  investigations 
to  show  how  very  important  the  careful  cteanstn 
the  gums  and   the  mouths  of  young  children  wai 
peeiully  i"   families  in  which  a  member  suffered   town 
tuberculosis  ;  how  much  care  must  be  taken  to  prevent 
any  object  being  put  into  the  child's  mouth  that  bad 
dkectly    or    indirectly    come    into    contact    with    the 
sputum  of  a  tuberculous  individual 

Tuberculous  infection  with  cow's  milk,  on  the  C 


3g6    The  Medical  Press. 


AUSTRIA. 


April  13,  1904. 


hand,  did  not  come  into  consideration.  The  flesh  tage  of  the  high  penetrating  power  of  the  yellow-red 
of  tuberculous  cattle  was  generally  harmless,  as  tubercle  rays  of  the  illuminant.  To  prove  this  he  inserts  a 
bacilli  had  not  yet  been  found  in  it.  sensitive  body  deep  in  the  tissues  and  then  applies 

-  Speaking  of  v.  Behring's  views,  he  remarked  that  j  the  light  which  acts  on  this  sensitised  substance,  at 
they  presupposed  an  increased  permeability  of  the  I  the  same  time  eliminating  the  green  and  orange  rays 
walls  of  the  intestines.  It  had  been  shown,  however,  from  the  pencil  of  light.  The  therapeutic  effects  of 
that  the  mucous  membrane  of  the  intestines  of  the  this  method  have  given  very  favourable  results.  He 
infant  did  not  differ  from  that  of  the  adult,  and  that  of  recorded  the  history  of  twenty-five  cases  of  deeply 
its  stomach  only  in  the  two  first  days  of  life,  during    placed  tuberculosis,    which   speedily   recovered  under 


which  it,  as  a  rule,  did  not  get  any  milki  It  was  true, 
as  Ofth  had  shown,  that  tubercle  bacilli  could  pass 
direct  through  the  walls  of  the  intestines  of  adnlts. 
v.  Behring's  trial  animals  were  all  tuberculous ;  in 
children,  however,  he  assumed  that  the  disease 
remained  latent,  and  yet  tuberculosis  in  children  ran 
a  very  rapid  course.  He  agreed  with  v.  Behring  in 
this,  that  the  contest  against  tuberculosis  should 
begin  with  the  children,  but  by  other  means  than 
his. 

Hr.  Orth  said  that  from  the  first  he  had  kept  careful 
statistics  in  regard  to  his  cases  of  tuberculosis,  and 
had  ascertained  the  extraordinary  rarity  of  primary 
intestinal  tuberculosis.  Heller  had  arrived  at  different 
results  in  Kiel ;  these  must  depend  on  the  difference 
of  material. 

He  conceded  that  tubercle  bacilli  caused  no  changes 
at  their  point  of  entrance,  but  under  all  circumstances 
the  regionary  lymph  glands  must  become  diseased. 
It  was  possible  that  infection  took  place  from  the 
mouth,  but  it  had  not  been  proved. 

Acute  miliary  tuberculosis  lent  itself  to  the  study 
of  the  spread  of  the  infection  as  these  fresh  patches 
were  met  with.  It  was  there  seen  that  a  caseated 
bronchus  lay  in  the  centre  of  each  diseased  patch,  from 
which  the  disease  spread  concentrically.  Acute  miliary 
tuberculosis  was  unquestionably  a  hematogenous 
disease  ;  yet,  in  spite  of  this,  each  tubercle  appeared  to 
begin  at  a  bronchus.  This  showed  the  great  difficulty 
there  was  in  deciding  whether  the  infection  was  through 
the  blood  or  by  inhalation,  and  it  showed  the  great 
caution  that  was  necessary  in  attributing  a  meaning 
to  the  condition  met  with. 

Infantile  infection  had  not  been  proved,  as,  according 
to  v.  Behring,  it  gave  rise  to  no  anatomical  changes. 

Hr.  H.  Neumann  said  it  was  not  correct  to  bring 
dentition  into  the  question,  as  medicine  had  at  last 
succeeded  in  reducing  its  importance  to  its  proper 
dimensions.  It  was  questionable  whether  invasion 
took  place  through  the  tonsils. 

Hr.  M.  Wolff  doubted  whether  germs  went  through 
the  walls  of  the  intestines.  Infection  by  inhalation 
was  the  more  frequent. 

Hr.  Summerfeld  claimed  that  the  greater  prevalence 
of  the  disease  among  those  whose  callings  entailed 
injury  to  the  lungs  showed  that  the  disease  was  acro- 
genous. 

Hr.  A.  Meyer  laid  stress  on  the  fact  that  in  England, 
where  milk  was  consumed  raw,  although  it  had  been 
proved  to  contain  bacilli,  tuberculosis  was  more  rare 
than  on  the  Continent.  That  was  against  the  blood 
theory'.  In  Sardinia  there  was  no  cattle  tuberculosis, 
but  human  tuberculosis  did  exist. 


Hustrla. 


[from  our  own  correspondent.] 

VinrvA,  April  9th,  1004. 

Light  and  Bacteria. 

It  has  been  generally  accepted  that  the  ultra-violet 

rays  have  little  or  no  effect  upon  bacteria  lying  deep 

in  the  tissues  of  the  body.     To  obviate  this  defect, 

Dreyer  has  adopted  another  method,  by  taking  advan- 


its  influence.  The  sensitising  agent  used  is  a 
1  per  cent,  or  1  in  a  1,000  solution  of  erythrosine  in 
another  solution  of  0*85  per  cent,  of  sodium  chloride. 
This  mixture  is  inserted  deep  into  the  tissues  by 
means  of  a  subcutaneous  syringe.  After  this  an 
interval  of  from  two  to  five  hours  is  allowed  to  elapse 
before  applying  the  Finsen  lamp  for  fifteen  to  twenty 
minutes. 

Resisting  Tuberculosis.  * 

Flugge.  in  his  latest  article  on  treating  and  resisting 
tuberculosis,  affirms  that  the  tuberculous  bacilli  do  not 
primarily  proceed  from  the  lung  where  they  arc 
supposed  to  be  generated  after  inhalation,  but  may 
also  take  their  origin  in  the  lymphatics,  and  subse- 
quently be  conducted  to  the  lung  where  they  complete 
their  ravages.  In  the  treatment,  however,  he  still 
advocates  all  the  hygienic  measures  in  vogue  at  the 
present  time  to  eliminate  tubercle  from  inhalation. 
The  danger  of  infection  through  infected  milk  from 
cows  is  very  remote  if  at  all  possible,  as  many  of  the 
poorer  families  who  are  thus  affected  have  always  been 
in  the  habit  of  using  their  milk  cooked  in  some  form. 
He  considers  that  the  two  principal  inlets  of  the 
tubercle  bacilli  are  inhalation  and  contact,  and  that 
the  formalin  milk  of  Behring  is  useless  as  the  bacterial 
infecting  power  of  this  nutrient  fluid  is  nil;  besides 
formalin  is  not  at  all  conducive  to  the  health  of  the 
infant. 

Forensic  Blood  Test. 
Marx  and  Ehrnbooth  record  a  method  of  detecting 
human   blood   which   at  'first   sight   appears  simple, 
although  its  ultimate  value  will  depend  very  much  on 
the  manipulation  of  the  operator.     It  is  well  known 
that  the  human  corpuscles  when  placed  in  foreign 
serum  become  agglutinated,  while  in  homologous  serum 
they  remain  unaffected.     Supposing  the  case  of  dry 
blood  on  any  substance  to  be  proved,  it  is  necessary 
first  to  immerse  the  suspected  blood  in  a  o' 6  per  cent, 
solution  of  common  salt  and  then  place  a  drop  of  the 
Uquid  on  an  object-glass.     To  this  another  drop  of  the 
foreign  serum  may  be  added  and  the  result  observed. 
Phthisis  in  Apex  of  Lung. 
The    results    of    Hoffman's    observations    in    the 
operation  of  excising  the  first  rib  for    the   cure    of 
phthisis  are  not  so  favourable  as  those  of  some  other 
experimenters.     He  assures  us   that   neither  the  rib 
or  manubrium   when  individually  excised    give    any 
beneficial  results   in   the  cure  of  phthisis.     If  both, 
however,  be  performed,  the  improvement  is  decidedly 
better,  as  the  lung  is  fully  inflated  and  the  blood  circu- 
lation increased,  which  are  both  in  favour  of  ultimate 
cure  of  the  morbid  condition  of  the  lung.     One  of  these 
operations  alone  is,  in  his  opinion,  of  no  value. 
Hemolysin  in  Normal  Blood  Serum. 
Sachs  is  of  opinion  that  the  haemolysin  in  normal 
blood  serum,  which  Gruber  has  recently  designated 
alexine,  operates  in  the  same  manner  as  that  given  in 
the  **  ambozeptdr  "  theory,  where  the  combination  is 
by  complement.     The  proof  of  this    theory  is  deduced 
from  the  method  of  cultivating  an  inactive  serum,  such 
as  the  fcetal,  which  only  contains  the  complement,  or  by 
the  separation  of  the  "ambozeptor  "  and  com^ement 
in  combining  with  the  blood  corpuscle  at  370 


which 


April  jjt  1304, 


lysis  checks.  There  arc  many  "  arubozeptor  '* 
which  cannot  I*-  separated  without  diffi- 
culty at  ?ero  or  3;0  C.  The  union  thus  takes  place 
when  the  *  amboieptdr  *•  and  complement  are  brought 
together,  but  their  separatum  becomes  impracticable,  in 
which  it  differs  from  the  agglutinin  which  is  o-.MiIy 
absorbed  at  zero*  while  the  M  amboceptor  "  lies  dor- 
mant at  that  tempera 1 11 1  • 


THE    OPERATING    THEATRES.        The  Medical  E-MU 


397 


Ebe  ©perattne  Gbeatres. 

MIDDLESEX  HOSPITAL, 

SlKAVit  LATED        IffGUlNXL        HERNIA.— Mr.        JoHN 

Mithr.iy  operated  on  a  manf  a?l,  *i,  who  had   bees 

admitted  suffering  from  a  strangulated  inguinal  hernia 
OH   the   right  side*     The  patient  was  a  healthy,  well- 
oped  man,  who  stated  that  he  had  been  ruptured 

tor  one  year.     He  had  had  a  severe  attack  of  pain  in 

the    abdomen    three    months    previous    to    admission, 
which     had    subsided    without    any    treatment.     The  I 
i  only  occasionally  came  down,  and  he  had  never  j 
worn  a  truss.     The  day  before  operation*  the  man  was 
MuMrnly  sti*6d  with  pain  in  the  a  ltd  a  men  and  vomited 
immediately  after  taking  food  :    the  henna  had  come 
down  and  he  was  unable  to  reduce  it     On  admission, 
the  patient  complained  of  very  severe  pain  in   the 
R    "f   the   umbilicus,   and   also   in    the   right   iliac 
1.      There  was  a  swelling  in  the  right  side  of  his 
tiim,  extending  up  into  the  inguinal  region,     He 
was  still  vomiting,     His  Ik?  we  Is  had  been  opened  the 
■■lay  the  hernia  came  down,  Imt  not  since.     On  examin- 
ing the  swelling,  it  was  found  to  consist  of  two  distinct 
parti  ;     the  right  side  of  the  scrotum  was  very  much 

nUr^ed.  the  swelling  being  soft  and  fluctuating  though 
not  translucent  ;  in  the  inguinal  region  was  another 
ill -defined  swetling,  which  appeared  to  be  deep  to  the 

i  ^neurosis  of  the  external  oblique,  and  did  not  project 
through  the  external  ring.  This  swelling  was  tense  to 
the  feel  and  extremely  tender*  Operation  was  per- 
formed an  hour  after  admission*  An  incision  three 
inches  long  was  made  over  the  inguinal  canal  ending 
just  below  the  externa!  ring  ;  the  sac  was  exposed  and 
Opened,  when  a  quantity  of  bloodstained  fold  escaped. 
On  investigation  the  fluid  was  found  to  escape  from 
the  tunica  vaginalis*  and  passing  the  finger  in  an 
upward  direction  towards  the  neck  of  the  sac  and 
through  the  external  ring,  a  coil  of  intestine  was  felt 
King  in  the  inguinal  canal.  The  aponeurosis  of  the 
em]  oblique  was  divided*  and  the  intestine  ex- 
posed  ,  it  was  lying  in  a  pouch  projecting  from  the 
lunicutar  process  ;  the  coil  of  intestine  was  about  four 
laches  in  length  and  dark  in  colour,  The  constriction, 
which  was  situated  at  the  internal  ring,  was  divided, 
■ad  the  intestine  returned  into  the  alxlomeu.  The 
>ai<  was  separated  from  the  cord,  ligatured  at  the 
interna]  ring,  and  the  portion  of  the  sac  occupying  the 
inguinal  canal  was  removed.  The  cut  aponeurosis  of 
the  external  oblique  was  united  by  continuous  suture, 

"I  the  wound  closed  completely  without  drainage. 
Sir.  Murray  said  that  the  points  qj  nil  crest  in  this  Case 
*ere  first  of  all  the  diagnosis  of  the  exact  condition 
present,  and.  secondly,  the  nature  of  the  sac.  With 
the  first,  the  presence  of  two  distinct  swellings 
o1  a  dissimilar  nature,  the  lower  scrotal  swelling  being 
•Oil,  painless,  and  fluctuating,  and  I  he  upper  one  tense, 
RMOfuJ,  and  extremely  tender,  led  to  the  conclusion 
that  the  lover  was  simply  a  collection  of  fluid,  whilst 
rta  crpper  was  undoubtedly  a  strangulated  piece  of 
'"ttMine  on  the  whole,  the  most  likely  explanation 
teemed  to  be  that  there  existed  the  condition  known  as 
lion  tn  masu,  that  the  forcible  attempt  on  the 
part  0*  the  patient  to  reduce  the  hernia  had  brought 


about  this  condition,  or  else  that  the  reduction  had 
(>ccurred  into  an  hour-glass  sac.  the  intestine  being 
reduced  into  the  upper  whilst  the  lower  part  became 
distended  with  llnuT  At  theoperation  it  was  obvious 
that  owing  to  the  narrowness  of  the  sac  at  the  external 
ring  the  intestine  had  never  passed  beyond  this  point, 
but  had  entered  a  diverticulum  from  the  funicular 
process  ;  it  therefore  was  one  of  the  varieties  of  inter- 
stitial hernia.  With  regard  to  the  nature  of  the  sac  it 
was  of  the  kind  known  as  a  congenital  Bat  He  pointed 
out  that  this  term  was  used  to  express  that  particular 
variety  where  the  sac  Wal  formed  by  the  tunica 
vaginalis.  The  majority  of  hernias,  be  remarked,  wen 
congenital  in  origin,  inasmuch  as  a  hernial  sac  existed 
irotn  birth,  though  it  is  only  in  a  small  percentage  of 
cases  that  the  sac  is  of  a  congenital  variety.  Th* 
of  the  hernia  not  appearing  in  this  patient  until  he. 
fit  jo  was  no  thin-  unusual,  but  Mr.  Murray 
thought  it  would  be  interesting  to  know  whether  the 
man  had  suffered  from  li>  rma  when  a  child. 

The  wound  healed  by  first  intention,  and  three  week?, 
after  operation  the  patient  was  convalescent,  and,  owing 
to  radical  cure  having  been  performed  at  the  time  of 
operation,  a  truss  is  unnecessary. 

Strangulated      Femoral      Hernia.— The     same 
surgeon  operated  on  a  woman,  atL  ;a.  for  a  strangu- 
lated   femoral    hernia    on    the    right    side,     She    had 
suffered  from  hernia  for  five  years,  during  which  time 
she  had  had  a  good  deal  of  pain  at  intervals.     The  last 
two  days  she  had  suffered  a  considerable  amount  of 
pain  and  also  from  constant  vomiting,  and  the  bowels 
had    not    acted    for    three    days.     On    admission,    the 
patient  was  a  feeble  old  woman,  obviously  in  great 
pain,  vomiting  frequently,  the  vomit  being  distinctly 
feculent    in   character,   and    there   was  absolute   con- 
stipation.    There  was  a  swelling  in    the  right   groin 
which    was     tender,     painful    and     irreducible.     The 
stomach  was  washed  out  immediately  before  operation, 
A  transverse  incision  was  made  over  the  swelling,  and 
thfi   *ac  opened;    some  clear  blood-stained  fluid   es- 
caped :    the  sac  was  found  to  contain  a  knuckle  of 
small  intestine  which  was  dark  red  in  colour  and  not 
very  tightly  constricted.     The  constriction  was  divided 
and  the  intestine  returned  into  the  abdomen.     The  sac 
was  rapidly  separated    from    the    surrounding  parts, 
ligatured  at  the  neck,  and  removed.     The  skin  wound 
was  closed  by  continuous  suture.     The  whole  operation 
only  lasted  about   fifteen   minutes.     Mr,   Murray   re- 
marked  that   there   were  several  interesting  points  in 
this  case.      He  would  first  of  all  like  to  emphasise  the 
imjM>rtance  of  washing  out   the  stomach  in  all  cases 
where  the  vomit  was  of  a  f^cal  character       If  this  is 
not   done   there   was  a  great  danger  of   the   patient 
vomiting    when    under    the    anaesthetic,    the    vomited 
matter  getting  into  the  trachea,  and  death  occurring 
on  the  table  from  suffocation  :    moreover,  the  absorp- 
tk>n  of  fa'caJ  matter  by  the  stomach  has  an  injurious 
effect  and  may  even  prove  fatal,     Another  point,  he 
said,  was  the  necessity  of  diminishing  shock  as  mvich 
Mbie,  first  of  all  by  the  careful  administration  of 
the  anaesthetic,  as  little  anaesthetic  as  possible  being 
given.     He  much  preferred  in  these  cases  to  run  the 
nsk  of  the  patient  moving  during  the  operation  than 
that   she   should   be   too   deeply   under.       Again,    the 
operating   table  should    be   thoroughly   well  warmed  ; 
for  this  purpose  there  is  nothing  better  than  a  water- 
bed       where    this   b   not   available   hot  water  bottles 
should    be    used.     The   patient   should,   of   course,    be 
well  wrapped   up,  and  all  undue  exposure  should  be 
avoided.     With  the  same  object  the  operation  should 
be  performed  aa quiet  ,due>     In  this  particular 

cane  the  age  of  the  patient,  her  general  debilttv.  end 


39**     Tint  Medical  Press. 


LEADING   ARTICLES. 


April   13.  1904. 


the  acuteness  of  her  symptoms  rendered  her  condition 
before  the  operation  extremely  critical.  The  acuteness 
and  severity  of  the  symptoms  appeared,  he  thought, 
to  be  out  of  proportion  to  the  tightness  of  the  strangu-^ 
lation,  the  second  day  after  strangulation  being  early 
for  the  vomit  to  have  become  distinctly  faeculent.  He 
could  only  account  for  this  by  supposing  that  the 
intestine  involved  was  high  up.  No  attempt,  he  said, 
was  made  to  close  the  crural  canal  first  of  all,  because 
such  operations,  especially  in  elderly  people,  the  sub- 
jects of  long-standing  hernia,  are  not  very  satisfactory  ; 
secondly,  because  it  was  more  important  to  complete 
the  operation  as  quickly  as  possible. 

Beyond  very  slight  bronchial  catarrh,  the  patient 
made  an  uninterrupted  recovery,  and  three  weeks  after 
the  operation  she  is  convalescent. 


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[  SALt/S  POPULI  SUPREMA  LEX." 


WEDNESDAY.  APRIL  13,  1904. 

THE  STATE  REGISTRATION  OF  NURSES. 
It  has  been  found  of  advantage  to  every  pro- 
fession whose  members  undertake  obligations  of 
a  fiduciary  nature  that  an  official  register  should 
be  kept  under  the  auspices  of  its  chosen  heads. 
The  advantage  has  not  been  one-sided  ;  the  public 
has  benefited  in  at  least  an  equal  degree  by  being 
thus  enabled  to  distinguish  between  competent 
and  incompetent  persons.  The  essentials  of  such 
a  register  are  that  a  certain  standard  of  know- 
ledge shall  have  been  attained  before  admission, 
and  that  grave  misconduct  shall  disqualify  from 
continuance  on  its  pages.  A  register  of  this  kind, 
moreover,  gives  to  the  body  which  keeps  it  a  con- 
trolling hand  over  the  members,  and  by  the 
judicious  exercise  of  this  power  a  level  of  ethical 
morality  is  set  and  maintained  throughout  the 
profession.  Now  it  is  only  when  a  profession  has 
attained  a  certain  stage  in  its  evolution — the 
stage  when  it  has  become  distinctively  marked  off 
from  all  other  callings — that  it  becomes  possible 
for  registration  and  its  ensuing  benefits  to  be  con- 
ferred. The  nursing  profession  has  certainly 
reached   this  stage,  and  nurses  are  undoubtedly 


entitled  to  claim  for  themselves  State  recognition 
and  self-government.     Since  the  early  sixties  the 
nurse  has  passed  from   the  homogeneity  of  the 
unskilled    worker    to    the    heterogeneity    of   the 
trained  expert,  and  she  is  now  able  to  assert  of 
herself  that  she  possesses  a  distinct  amount  of 
technical   knowledge   that   no  one   who  has  not 
passed  through  a  similar  course  and  had  similar 
experience  can  possibly  possess.     After  having  at 
much    trouble   and    (to    her)    no    little     expense 
attained    a   distinctive    position,    it    is    naturally 
annoying  to  her  to  see  half-trained,  or  wholly  un- 
trained,   persons   masquerading    as    nurses    and 
demanding    the    same    remuneration    for    their 
services  as  she  expects  herself.     For  the  medical 
man,  too,  it  is  most  embarrassing.     He  is  brought 
into  contact  with  a  nurse,  and  gives  her  certain 
directions,   expecting   that    they   will   be  "carried 
out    in    the   usual   way  ;     he   discovers    that    the 
"  nurse  "  has  no  more  idea  how  to  act  than  the 
man  in  the  moon.     For  the  public  it  is  highly  un- 
satisfactory,   not    to    say    positively    unsafe.     A 
nurse  is  obtained  from  an  institution  ;    her  em- 
ployers imagine  that  she  will  understand  and  con- 
scientiously carry  out   the   medical  orders,   and 
they  place  themselves  in  her  hands  unreservedly- 
Perhaps  they  discover  too  late  that  she  cannot 
give  a  hypodermic  injection,  pass  a  female  catheter,, 
or  carry  out  an  ordinary  dressing  without  making 
a  mess  of  it.     This  difficulty  of  distinguishing  a 
trained  nurse  from  an  untrained  one  is  no  unsub- 
stantial bogey  ;    it     is  encountered  every  day  in 
general   practice.     Nursing   homes   find    the   un- 
trained nurse  cheaper  than  the  real  article,  and 
hundreds  of  incompetent  persons  are  walking  about 
to-day   in   nursing  uniform   to   the  detriment  of 
everybody  except  the  proprietress  of  the  institu- 
tion  they  hail  from.     Now,   this  being  so,   it  is 
amazing  that  a  number  of  hospital  authorities  and 
men  of  high  position  in  the  medical  profession  can 
have  signed  a  manifesto  deprecating  the  registra- 
tion of  nurses  on   the   flimsy  grounds   they  put 
forward.     Their  great  objection  lies  in   the  fact 
that  character  and  disposition   are  of   high  im- 
portance in  a  nurse,  and  that  a  register  cannot 
take    cognisance  of    these ;    therefore,  unsuitable 
persons    would   be  admitted  to  the  register  and 
the    suitable  ones    lowered    by    association  with 
the  unsuitable.     No  one  values  personal  character 
and  womanly  qualities  in  a  nurse  more  than  we  do 
ourselves,  but  surely  it  lies  with  those  who  have 
the  supervision  of  the  nurses  for  their  three  years' 
training  to  weed  out  those  who  are  unsuitable  for 
the  work,  and  to  make  it  impossible  for  them  to 
obtain  the  certificate  which  would  be  a  passport 
to    the    register.     A    probationer    is    bound    in 
apprenticeship  to  the  hospital  she  serves  for  three 
years,  and  if  improper  and  unsuitable  persons  are 
allowed    to   finish   their  course   and  obtain  their 
certificates,  it  argues  gross  dereliction  of  duty  on 
the  part  of  the  matron  of  the  hospital  concerned. 
One  knows,  alas  !    that  black  sheep  will  be  found 
in  every  fold,  but  we  cannot  see  that  the  present 
(or  any  conceivable)  system  can  or  could  wholly 
eliminate  all   the  bad  ones.     To  use   this  as  aa 


April  13,  1904. 


LEADING   ARTICLES. 


The  Medical  Press.     399 


argument  against  registration  is  about  as  logical 
as  Mark  Twain's  attempt  to  prove  that  it  was  a 
million  times  more  dangerous  to  go  to  bed  than 
to  travel  in  a  train,  because  a  million  times  more 
people  died  in  the  former  than  in  the  latter.  The 
signatories  of  the  manifesto  object  also  to  the  one 
portal  system  of  admission  to  the  register — a 
point  that  our  own  profession  has  over  and  over 
again  striven  to  get  established.  The  third  and 
chief  reason  stated  in  the  manifesto  for  their 
opposition  is  that  great  difficulty,  personal  odium, 
and  perhaps  expense  in  defending  an  action  for 
libel  would  fall  to  the  lot  of  the  person  who  tried 
to  get  a  nurse's  name  removed  from  the  register  for 
misconduct.  The  answer  to  this  is  supplied  by 
the  recent  history  of  our  profession.  The  penal 
cases  that  have  been  brought  before  the  General 
Medical  Council  have  all  been  satisfactorily  adju- 
dicated upon,  and  no  libel  action  has  followed  in 
any  case.  If  proper  inquiries  are  made  beforehand, 
and  trustworthy  evidence  obtained,  the  position 
of  the  prosecutor  can  be  thoroughly  established, 
and  only  express  malice  could  lay  him  open  to 
retaliation.  The  nurse's  character  is,  like  the 
character  of  any  professional  person,  her  highest 
possession,  and  she  may  be  trusted  to  keep  it  at 
the  highest  level — if  suitable  people  are  turned 
out  by  the  nursing  schools.  The  pressure  must 
come  from  below,  but  before  refusing  nurses  the 
privilege  of  registration  far  more  cogent  argu- 
ments must  be  adduced  than  are  to  be  found 
advanced  by  the  signatories  of  this  ill-timed 
manifesto. 


SHELL-FISH  AND  SEWAGE  POLLUTION. 
Several  recent  outbreaks  of  typhoid  fever, 
due  to  the  ingestion  of  contaminated  molluscs, 
have  forcibly  drawn  public  attention  to  the* 
dangers  which  await  the  careless  use  of  such  food. 
Probably  moved  by  some  such  events  which  had 
come  under  their  own  notice,  the  Local  Govern- 
ment Board  of  Ireland  have  undertaken  an  in- 
vestigation of  ,the  first  importance  into  the  con- 
dition and  situation  of  the  various  beds  and 
layings  of  shell-fish  on  the  Irish  coast.  One  of 
the  Board's  inspectors,  Dr.  T.  J.  Browne,  has 
made  a  topographical  examination  of  the  harbours, 
estuaries  and  inlets,  where  oysters  are  laid  or  grown, 
and  where  mussels,  cockles,  or  periwinkles  are 
picked  for  food.  He  has  in  particular  observed 
whether  the  various  beds  are  subject  to  con- 
tamination, and  has  expressed  his  opinion  as  to 
whether  such  contamination  is  likely  to  be  of 
practical  importance.  While  Dr.  Browne  was 
making  his  local  inspection  he  despatched  speci- 
mens of  shell-fish,  water,  and  mud  from  every 
laying  to  Dr.  McWeeney,  the  Board's  bac- 
teriologist, for  bacterioscopic  examination.  The 
latter,  who  was  kept  in  ignorance  of  his  colleague's 
opinions  as  to  the  likelihood  of  contamination,  re- 
ports his  results  as  to  the  presence  of  B.  coli  in 
the  samples  submitted.  Though  there  is,  as 
might  be  expected,  a  certain  amount  of  incon- 
sistence between  the  conclusions  of  Drs.  Browne 
and  McWeeney,  yet  in  the  main  there  is  a  very 


general  agreement.  In  every  case,  where  on 
local  examination  Dr.  Browne  found  evidence  of 
sewage  pollution,  his  results  have  been  supported 
by  Dr.  McWeeney.  Likewise,  where  he  thought 
sewage  pollution  impossible,  the  bacterioscopic 
experiments  are  negative.  In  the  cases  where 
there  is  a  difference  of  opinion,  the  beds  in 
,  question  lay  in  estuaries  where  contamination 
appeared  possible,  but  was  thought  improbable  ; 
cultures,  however,  gave  evidence  of  the  presence 
of  intestinal  bacteria.  The  Report  is  quite  right 
in  expressing  a  judgment  that  the  mere  fact  of 
finding  a  few  B.  coli  in  certain  situations  is  not 
sufficient  to  justify  an  opinion  that  the  waters 
are  polluted  to  a  degree  serious  to  public  health. 
Until  much  more  is  known  of  the  life-history  of 
B.  coli,  its  persistence  in  sea-water,  and  its  dis-' 
tribution  in  Nature,  its  presence  is,  at  best,  only 
suggestive  of  the  presence  of  faecal  matter. 
It  is,  of  course,  clear  that  the  report  now  before 
us  does  not  claim  to  be  more  than  a  sketch  of  the 
existing  conditions  on  the  Irish  coast.  Both 
investigators  emphasise  the  fact  that  much  more 
minute  local  and  scientific  examinations  must 
be  made  before  anything  like  an  accurate  know- 
ledge of  the  shell-fish  beds  is  possible.  Enough, 
however,  has  been  done  to  point  out  some  neces- 
sary reforms.  In  the  main,  the  fisheries  are  in  an 
excellent  sanitary  condition,  free  from  all  taint 
of  pollution.  Two  notable  exceptions  occur — 
the  beds  in  Dublin  Bay  and  those  in  Carlingford 
Lough.  All  the  beds  in  these  localities  are 
obviously  subject  to  gross  pollution.  The  oyster- 
beds  and  'cockle  strands  at  Clontarf  and  Blackrock 
are  practically  washed  by  sewage.  Already  cases 
of  enteric  fever  have  been  traced  to  the  eating  of 
shell-fish  from  Clontarf  and  Carlingford.  As 
the  law  stands  at  present  there  are  no  adequate 
means  of  protecting  the  public  against  the  sale  of 
polluted  shell-fish.  Not  only  for  the  safety  of  the 
consumer,  but  in  the  interests  of  those  concerned  in 
the  shell-fish  industry — a  considerable  one  in 
Ireland — no  time  should  be  lost  in  obtaining 
special  legislation  on  the  subject.  The  dis- 
location of  the  industry  by  the  shifting  of  the  beds 
from  insanitary  to  sanitary  surroundings  will  be 
slight.  The  coast  is  well  supplied  with  sheltered 
inlets  of  the  purest  sea-water,  exactly  suitable 
for  the  cultivation  of  oysters.  The  additional 
confidence  among  consumers  of  Irish  oysters 
when  affairs  have  been  set  in  order  will  more 
than  repay  the  growers  for  any  temporary  in- 
convenience and  loss. 


THE  GREAT  WYRLEY  CATTLE-MAIMING 
CASE. 
The  golden  rule  of  police  administration  in  the 
United  Kingdom  appears  to  be  the  necessity  of 
securing  convictions.  There  seems  little  doubt 
that  the  application  of  this  principle  leads  to  a 
vast  amount  of  injustice  and  tyranny.  In  the 
police-courts  a  constable  rarely  fails  to  secure  the 
conviction  of  any  prisoner  whom  he  has  charged,, 
and  his  efficiency  is  gauged  by  his  superiors  on 
the  proportion  of  success  achieved  in  that  direc- 


A00    The  Medical  Press. 


NOTES  ON  CURRENT  TOPICS. 


April  13,  1904. 


tion.  Judged  by  the  mere  criterion  of  probabili- 
ties, there  must  be  a  considerable  percentage  of 
cases  in  which  a  police  charge  should  fall  to  the 
ground  on  the  score  of  defective  or  contradictory 
evidence — the  lack  of  corroboration,  presence  or  ab- 
sence of  motives  on  either  side,  and  a  number  of 
other  points  too  numerous  to  mention.  The  desire 
to  secure  conviction  appears  to  have  pervaded  the 
•magistracy,  for  we  find  the  Bench,  both  paid  and 
unpaid,  as  a  rule,  ready  to  accept  the  uncorro- 
"borated  testimony  of  a  police  constable.  We 
question  whether  such  a  proceeding  is  constitu- 
tional ;  certainly  it  is  not  in  accordance  with  the 
Anglo-Saxon  spirit  of  justice  that  is  an  essential 
characteristic  of  the  race.  The  unsupported  word 
of  a  police  officer,  again,  is  often  taken  against 
that  of  an  accused  person.  Without  going  further 
into  the  subject,  we  venture  to  assert  that  reform 
is  needed  in  many  branches  of  the  criminal  law. 
At  the  same  time  it  must  be  conceded  that  of  late 
years  various  useful  reforms  have  been  introduced, 
and  that  the  police  system  of  the  Kingdom  is, 
on  the  whole,  admirable.  The  absolute  necessity 
of  reform  of  some  kind  is,  in  our  opinion,  proved 
by  the  facts  of  what  is  known  as  the  Great  Wyrley 
cattle-maiming  case.  A  number  of  horses  and 
cattle  were  barbarously  mutilated  from  time  to 
time  in  the  neighbourhood  of  Great  Wyrley.  A 
young  solicitor,  named  Edalji,  of  that  village, 
was  ultimately  accused  of  the  crime,  and  on  the 
strength  of  certain  circumstantial  evidence  was 
convicted  of  the  offence  and  sent  to  penal  servi- 
tude. The  absence  of  a  court  of  criminal  appeal 
has  made  it  impossible  to  test  the  reasonableness, 
or  otherwise,  of  that  verdict  in  a  higher  tribunal. 
Several  petitions  for  release  were  presented  to 
the  Home  Secretary  on  the  ground  of  the  doubtful 
nature  of  the  evidence  given  at  the  trial,  and,  later, 
on  account  of  the  fact  that  further  outrages  of  a 
similar  nature  were  going  on  while  Edalji  was 
safe  in  prison.  We  pointed  out  at  the  time  tnat 
the  maiming  was  probably  the  work  of  an  im- 
becile, and  that  it  was  extremely  unlikely  that 
two  or  more  persons  were  acting  together  in  this 
<ruel  and  foolish  manner.  We  accordingly  drew 
up  a  petition  to  Mr.  Akers  Douglas,  praying  for  an 
inquiry  into  the  state  of  mind  of  the  prisoner 
Edalji,  pointing  out  that  if  an  educated  young 
solicitor  committed  so  wanton  and  purposeless  an 
outrage  he  must  be  presumably  insane,  and  fitted 
for  a  lunatic  asylum  rather  than  for  a  convict 
prison.  That  petition  was  signed  by  some  of  the 
leading  alienists  of  the  United  Kingdom.  Whether 
it  has  been  acted  upon  we  have  no  means  of 
learning,  but  Edalji  is  still  in  prison.  Now  comes 
an  extraordinary  comment  on  his  sentence  in  the 
shape  of  conviction  of  another  person  for  maiming 
cattle  at  Great  Wyrley.  At  the  Staffordshire 
Quarter  Sessions  last  week  a  jury  found  a  miner 
guilty  of  having  maliciously  killed  two  sheep  and  a 
lamb.  The  accused  was  convicted  on  purely 
circumstantial  evidence.  If  he  really  committed 
the  offence  of  which  he  was  charged,  we  question 
if  this  second  man  was  sane,  just  as  we  questioned 
Edalji's  sanity.     That   two  imbeciles,  both  pur- 


poseless cattle-maimers,  dwelt  in  a  small  village 
we  can  hardly  believe.  The  police,  by  finding  a 
second  guilty  man,  have  immensely  strengthened 
the  case  in  Edalji's  favour.  At  the  same  time  they 
have  shown  how,  in  case  Edalji's  innocence  is  estab- 
lished, how  little  circumstantial  evidence  is  worth 
in  the  case  of  the  second  prisoner.  The  problem 
presented  to  the  Home  Secretary  has  been  seriously 
complicated  by  the  second  conviction.  For  the 
credit  of  British  justice  it  is  to  be  hoped  that  the 
case  will  be  reopened  or  revised  from  the  point  of 
view  of  mental  irresponsibility.  Meanwhile,  the 
case  suggests  forcibly  the  need  of  a  court  of 
criminal  appeal  and  the  want  of  an  independent 
scientific  board  of  medical  experts  to  investigate 
the  condition  of  mind  of  men  accused  of  such 
dastardly    and    meaningless   offences. 

notes  on  Current  tropica. 

Fatigue. 
Some  of  the  phenomena  of  everyday  life  from 
their  very  familiarity  are  apt  to  attract  but  little 
attention,  and  just  as  everyone  knows  what  it  is 
to  be  tired,  so  it  is  that  few  think  of  inquiring  into 
the  physiology  of  this  complicated  state.  Pro- 
fessor Mosso  has  just  published  a  study  of  the 
whole  subject  of  fatigue,  and,  interesting  as  the 
conclusions  founded  on  his  series  of  experiments 
are,  he  admits  that  they  must  only  be  regarded 
as  tentative  in  view  of  the  complexity  of  the 
problem.  His  method  consisted  in  making  obser- 
vations on  small  muscles  by  means  of  the  "  ergo- 
graph,"  an  instrument  which  transmits  to  smoked 
paper  the  movements  conveyed  to  it  by  the 
middle  finger  when  moved  in  response  to  stimuli, 
either  voluntary  or  electric.  By  noting  the 
tracings  thus  produced  when  the  body  and  brain 
were  in  various  conditions  of  fatigue,  Professor 
Mosso  was  able  to  deduce  certain  general  prin- 
ciples. Perhaps  the  most  interesting  of  these  is 
that  muscular  strength  is  very  closely  allied  to  the 
condition  of  activity  of  the  brain,  so  that  when  the 
brain  is  exhausted  by  mental  effort,  the  muscular 
power  of  the  body  (which  may  have  remained 
quiescent  during  the  excitation  of  the  brain)  is  at 
a  very  low  ebb.  In  this  connection  both  exhaus- 
tion of  the  brain  from  sustained  effort  and  from 
great  excitement  seems  to  act  equally  deleteriously 
on  the  muscular  strength.  The  excitable  dis- 
position of  the  South  European  leads  him  to  make 
more  sudden  and  exacting  calls  on  his  nervo- 
muscular  resources  than  is  the  case  with  the  phleg- 
matic Northerner,  and  fatigue  sets  in  earlier  in 
consequence.  On  the  other  hand,  the  muscles 
when  fresh  react  more  quickly  to  brain-messages 
than  do  those  of  the  Teuton  ;  hence  the  greater 
skill  of  the  Italians  in  exercises  such  as  fencing. 
The  complicating  factors  of  this  very  abstruse 
subject  are  personal  idiosyncrasy  and  habituation 
to  stimulants  and  narcotics.  One  cardinal  lesson 
that  may  be  learned  is  that  although  the  average 
of  life  may  be  prolonged  by  care  and  attention  to 
the  general  health  of  the  body,  the  brain  is  only 
!  capable  of  being  subjected  to  extra  strain  within 


April  13,  1904. 


NOTES   ON    CURRENT   TOPICS.     Tm  M«pical  Press.     401 


very  severe  limits,  so  that  it  is  always  advisable 
to  reckon  first  and  foremost  the  effect  of  any  effort 
on  the  brain  before  considering  what  may  be  its 
result  on  the  musculature. 


An  Ancient  Corset. 
Every  hygienist,   and   most   sensible   people, 
have  anathematised  the  corset  with  every  exple- 
tive in  the  dictionary,  and  there  is  no  doubt  that 
of  all  the  follies  of  woman's  dress  the  tight  corset 
is  not  only  the  most  ridiculous  but  also  the  most 
harmful.     It  would,  indeed,  seem  difficult  to   find 
anything  new  to  say  about  it,  except  that  the 
various  crusades  seem  to  have  had  a  certain  in- 
fluence on  society,  and  that  a  good  many  women 
are  now  more  or  less  alive  to  the  fact  that  the  lines 
of  the  natural  figure  have  an  ease  and  elegance 
that  can  never  be  shown  by  bunched -out  shoulders, 
tapering  waists,  and  beetling  hips.     It  has  often 
been  assumed  that  the  corset  is  a  modern  inven- 
tion, and  the  ancient  statuary  is  referred  to  to 
show  what  was  the  shape  of  lovely  woman  before 
she  took  to  encasing  herself  in  steel  and  whale- 
bone.   That  the  corset  is  nearly  as  old  as  history 
seems,  however,  to  be  the  fact.     The  researches 
that  are  now  being  made  into  the  ruins  of  the 
forest  cities  of  South  America  throw  a  new  light 
on  the  antiquity  of  waist-compressing  garments. 
A  bas-relief  that  was  lately  unearthed  shows  a 
female  figure,  which  is  depicted  as  being  compressed 
between  the  lower  ribs  and  the  hips  by  an  elaborate 
appliance.     It  appears  to  have  been  arranged,  as 
is  its  latter-day  anti-type,  in  transverse  and  cir- 
cular foldings,  so   that   the  greatest  amount  of 
uniform  pressure  can  be  brought  to  bear  on  the 
unfortunate  abdomen  of  the  wearer,  and  from  the 
appearance  of  the  bas-relief  the  grip  it  exerted 
would  seem  in  no  wise  less  tenacious  than  that  of 
the  modern  production  of  the  French  corsetihe. 
Thus  the  corset's  last  claims  to  respect — those  of 
originality  and  up-to-datism — go  by  the  board, 
and  if  it  bring  any  shame  to  those  who  gird  them- 
selves with  these  vicious  garments  to  know  that 
the  South  American  degenerates  of  many  centuries 
ago  deformed  themselves  in  a  similarly  grotesque 
fashion,  one  would  be  glad  for  them  to  know  the 
fact. 


Pocket-Therapy* 

We  are  now  threatened  with  a  new  method  of 
treatment — or,  rather,  an  old  method  revived,  for 
in  quackery,  as  in  everything  else,  there  is  no  new 
thing  under  the  sun.  By  pocket-therapy  one 
does  not  refer  to  tabloids  and  handy  hypodermic 
medications,  but  to  the  far  more  valuable  method 
of  carrying  a  charm  about  in  the  pocket — and 
being  cured  without  further  trouble.  Old  ladies 
have  been  know  to  carry  about  potatoes  in  their 
reticules  to  ward  off  rheumatism,  and  amulets  are 
as  old  as  the  hills.  Anti-rheumatic  rings  sell  by 
the  hundred.  One  is  not  altogether  astonished, 
therefore,  to  learn  that  an  ore,  described  (probably 
not  without  justification)  as  "  peculiar,"  has  been 
discovered  in  the  mines  near  Montana,  which  has 
only  to  be  carried  in  the  pocket  to  chase  away 
rheumatism,    stomach     ailments,     nervous     and 


kindred  troubles.  This  news  is  considered  so- 
portentous  that  cables  have  been  sent  to  this 
country — and  duly  published  in  the  popular  Press 
— announcing  the  discovery.  One  hears  with 
regret  that  some  of  this  peculiar  substance  has 
been  sent  to  Paris  for  analysis  ;  a  revelation  of  its 
composition  might,  like  a  candle  in  a  spiritualistic 
seance,  break  the  charm.  In  the  meantime,  the 
ore  is  called  radiumite,  and  if  it  turns  out  to  be 
related  to  that  really  valuable  metal  radium  one 
would  advise  people  not  to  carry  it  about  in  their 
pockets  unless  they  wish  to  experience  very  un- 
pleasant consequences.  An  ore  from  Montana 
is  rather  a  new  line  for  an  enterprising  charlatan 
to  exploit,  and  if  properly  advertised  may  find  a 
ready  sale  among  that  large  class  of  people  who  are 
always  hungering  to  be  imposed  upon. 

Occupation  and  Residence. 

One  of  the  greatest  arguments  in  favour  of 
residence  in  the  outskirts  or  suburbs  of  a  large 
city  is  that  the  journey  therefrom  to  the  place  of 
occupation  and  the  return  at  night  afford  a  wel- 
come break  in  what  would  otherwise  be  an  almost 
unbearable    monotony.     Change   of   scene    is   as 
necessary  to  physical  and  mental  well-being  as 
proper  food  and  sufficient  sleep.    To  some  natures 
the  *'  modern  malady  of  sameness  "  is  far  more 
irksome  than  to  others,  and  it  is  those  individuals 
who  are  more  sensitive  in  this  respect  that  are 
more  benefited  by  a  short  journey  to  and  from  their 
place  of  business.     Frequent  short  holidays  be- 
come,  indeed,   a  necessity   to   those   who   reside 
immediately  among  their  scenes  of  toil  and   to 
whom  the  small  privilege  of  a  daily  walk  or  ride  is 
denied.     Theoretically,    the    further    away    from 
business  the  worker  can  reside,  within  reason,  the 
better,  which  fact  has  recently  been  taken  advan- 
tage of  by  the  directors  of  a  well-known  railway 
company  in  announcing  their  special  facilities  for 
rapid  transit.     For  the  large  class  of  shop  assis- 
tants whose  long  day  is  chiefly  spent  in  standing 
behind  the  counter,  retailing  invariable  courtesy 
together  with  their  goods,  the  journey  home  is  most 
welcome,  and  the  change  of  scene,  food,  and  air 
which  is  thereby  ensured  goes  a  long  way  towards 
the  maintenance  of  health.    .The  idea  of  "  living 
in,"  as  a  system,  is  one  which  is  naturally  repulsive 
j  to  the    freedom-loving  Britisher,  and    should  it 
become  the  rule  it  would  seriously  menace  the 
health  of  a  large  number  of  people,  apart  from 
any  question  of  independence.    At  a  conference 
of  the  National  Union  of  Shop  Assistants  and 
Warehousemen,  held  at  Glasgow  on  April  4th, "a 
resolution  was  passed  condemning  such  a  system 
most  emphatically,  as  being  detrimental   to   the 
physical,   mental,   and   social   well-being   of   the 
workers.     With    these    sentiments    we    cordially 
agree. 


A  Study lof  Paralysis  Afifitans. 

The  etiology  and  morbid  anatomy  of  the  affec- 
tion originally  described  by  Parkinson  in  18 17,  and 
bearing  his  name  to  this  day,  have  not  yet 
been  satisfactorily  worked  out,  in  spite  of  the 
developments   of    modern    neurological    research. 


402     The  Medical  Press. 


NOTES  ON  CURRENT  TOPICS. 


April  13,  1904. 


Minor  degenerative  changes  have  been  found  post- 
mortem, in  the  smaller  blood-vessels  of  the  central 
nervous  system,  and  also,  to  a  less  extent,  in  the 
nerve  elements  themselves  ;  but  none  of  these  can 
be  said  to  be  in  any  way  characteristic  of  the 
disease,  for  they  are  also  found  in  other  degenera- 
tive affections  as  a  result  of  senile  change.  Dr.  T. 
Stuart  Hart  (a)  has  analysed  219  cases  of  paralysis 
a  git  an  s  in  patients  from  the  neurological  clinic  of 
Professor  M.  Allen  Starr,  of  New  York.  The 
influence  of  sex  is  seen  by  the  fact  that  139  of 
these  were  men  and  80  women.  It  was  found 
that  occupation  had  little  or  no  bearing  upon  the 
etiology  of  the  disease,  neither  was  heredity  a 
marked  factor.  Emotion  or  mental  shock  could 
be  frequently  traced  as  an  antecedent,  while  some 
cases  appeared  to  be  the  direct  outcome  of  injury. 
This  latter  fact  has  also  been  pointed  out  by 
Charcot  and  Gowers  ;  thus,  a  contusion  of  the 
thigh  has  been  followed  by  tremor  in  the  limb  of 
the  same  side,  and  a  dislocation  of  the  jaw  by 
tremor  in  it.  Prolonged  exposure  to  fatigue  was  a 
predisposing  cause  in  several  instances,  while  in 
others  it  would  appear  that  toxins  were  respon- 
sible for  the  onset  of  the  malady.  The  earliest 
symptom  of  all  was  tremor,  and  many  patients 
were  quite  definite  in  describing  its  occurrence  in 
particular  digits.  It  was  seven  times  more  fre- 
quent in  the  upper  than  in  the  lower  extremity. 
Rigidity  was  well  marked  in  142  cases.  With 
regard  to  the  tendency  to  fall,  so  commonly 
observed  in  paralysis  agitans,  propulsion  was  most 
often  seen.  The  state  of  the  deep  reflexes  varied 
greatly.  Paraesthesia  and  voice  changes  were 
noticed  in  many  of  the  cases.  The  systematic 
use  of  massage  appeared  to  be  the  most  efficacious 
mode  of  treatment,  while  hydrobromatc  of 
hyoscin  was  the  only  drug  of  any  value.  The  use 
of  stimulants,  tea,  and  coffee  was  forbidden. 


The  Psychology  of  School  Punishment. 

The  exact  form  which  punishment  shall  take, 
and  the  manner  of  its  application  in  a  given  case, 
are  subjects  of  perennial  interest  to  all  those  who 
have  charge  of  the  young.  Whether  the  inflictor 
be  a  parent  or  a  teacher,  or  the  victim  a  first 
offender  or  a  hardened  scamp,  the  moral  effect 
which  it  is  intended  to  produce  is  the  first  thing 
aimed  at.  The  sentiment  of  anticipation  is  gener- 
ally stronger  than  that  of  realisation,  especially  in 
children  in  whom  the  deterrent  influence  of  punish- 
ment is  greatly  increased  the  longer  the  interval 
between  its  infliction  and  the  committal  of  the 
fault.  "  That  penalty's  the  best  to  bear  which 
follows  soonest  on  the  sin,"  and  it  is  one  of  the 
greatest  mistakes  to  punish  a  child  immediately 
after  it  has  done  wrong.  A  reasonable  amount  of 
time  should  elapse  during  which  the  impression  of 
the  gravity  of  the  oftence  will  be  deepening  and 
the  after-correction  will  become  a  more  powerfully 
restraining  factor.  To  be  thoroughly  effective, 
punishment  must  be  methodical  and  sensible,  as 
Dr.    Hugh    Jones   wisely   remarked    at    a   recent 

(a)  Jwrn.  of  Nero,  and  Mtnt.  D.*.,  March,  1904. 


meeting  of  the  Childhood  Society.  The  enforced 
going  without  some  little  luxury  or  the  curtailment 
of  some  pleasure  will  have  far  greater  value  than 
the  senseless  imposition  of  some  mechanical  or 
mental  task  which  can  do  no  possible  good.  With 
regard  to  the  vexed  question  of  corporal  punish- 
ment, it  is,  of  course,  necessary  that  some  re- 
striction should  be  placed  upon  its  use  by  irre- 
sponsible individuals,  and  also  that  one  or  more 
witnesses  should  be  present  at  the  time  of  its 
infliction.  Painful  sensory  stimuli  are  sometimes 
very  potent  for  good,  and  in  certain  types  of 
character  such  chastisement  is  the  only  thing  that 
is  of  any  use  ;  but  the  possibility  of  setting  up  a 
reflex  excitability  of  the  lower  centres  of  the  spinal 
cord  as  the  result  of  a  flogging  should  be  borne  in 
mind.  The  cruelty  and  senselessness  of  boxing 
the  ears  or  caning  the  hands  need  only  be  mentioned 
to  be  unreservedly  condemned. 


The  State's  Immoral  Profit. 

Mr.  John  Troutbeck,  the  coroner  for  Wands- 
worth, has  done  good  service  to  the  community 
for  many  years  past  in  calling  attention  to  the 
evils  of  patent  foods  and  patent  medicines.  The 
harm  done  by  dangerous  proprietary  physic  is 
more  direct  and  self-evident  than  the  slower  process 
of  starvation  that  is  effected  by  the  use  of  patent 
foods  in  infancy.  In  summing  up  at  a  recent 
inquest,  Mr.  Troutbeck  remarked  that  in  the 
present  state  of  the  law  the  sale  of  patent  foods  for 
children  was  allowed,  and  there  was  not  the  slightest 
doubt  that  this  was  the  cause  of  many  deaths  and 
of  much  disease.  The  same  criticism  applied  to 
patent  medicines,  but  in  their  case  it  was  worse, 
because  not  only  were  the  proprietors  making  huge 
profits  out  of  the  medicine,  but  the  State  made  a 
large  profit  upon  this  immoral  sale  of  patent  medi- 
cines. The  latter  phrase  sums  up  the  position  in  a 
masterly  way,  and  should  prove  valuable  to  future 
writers  on  the  subject.  It  is  to  be  regretted  that 
a  gentleman  capable  of  such  clear  and  sensible 
views  should  maintain  the  immoral  boycott  he 
has  instituted  against  the  medical  profession  by  the 
employment  of  Dr.  Freyberger  to  the  practical  ex- 
clusion of  all  other  medical  men  from  the  coroner's 
court  of  his  district.  The  imputation  against  the 
competency  of  those  general  practitioners  is  so 
grave  that  it  conceivably  warrants  the  intervention 
of  the  General  Medical  Council,  and  certainly  of 
the  Defence  Societies. 


The  Sense  of  Vision  in  Medical  Practice. 
Of  all  the  special  senses,  that  of  vision  is  the 
most  indispensable  to  the  medical  man  Who,  with 
"  fate  and  physic  in  his  eye,"  comprehends  at  one 
glance  the  condition  of  his  patient,  whereby  his 
verdict  may  be  materially  influenced.  The  im- 
portance of  educating  the  visual  faculty  up  to  the 
highest  pitch  of  perfection  is  early  impressed  upon 
the  medical  student,  who  has  first  to  learn  what 
there  is  to  see  in  a  given  disease,  and,  secondly  to 
interpret  the  appearances  aright.  In  this  lies  the 
whole  art  of  diagnosis,  the  knowledge  of  which  can 
only  be  gained  by  constant  practice  and  experience 


April  13,  1904. 


tfOxES  ON  CURRENT  TOPICS. 


The  Medical  Press.     403 


The  sense  of  touch  follows  closely  upon  vision  in 
its  importance  and  degree  of  specialisation,  the 
iactus  eruditus  appertaining  more  especially  to  the 
surgeon.  A  blind  physician  would  be  as  much  an 
anomaly  as  a  deaf  musician,  and  yet,  there  are 
occasions  when  a  judicious  neglect  of  visual 
impressions  is  called  for  in  dealing  with  certain 
morbid  conditions.  A  healthy-looking  counten- 
ance does  not  always  indicate  the  absence  of 
•disease,  and  many  an  early  sign  of  visceral  or 
nervous  disorder  has  been  overlooked  on  no  other 
grounds  than  that  the  aspect  of  the  patient  has 
belied  his  statements  with  regard  to  the  perform- 
ance of  his  bodily  functions.  In  many  cases  it  is  a 
wise  policy  to  "  have  eyes  and  yet  see  not,"  and 
particularly  in  medicine,  for  nothing  is  easier  than 
to  be  led  astray  by  repeated  assertions  calling  at- 
tention to  some  minor  or  imaginary  manifestations 
of  disease  which  can  have  no  possible  bearing  upon 
the  case  in  point.  There  are  other  circumstances 
in  which  the  practitioner  deliberately,  though 
perhaps  unconsciously,  excludes  all  ocular  im- 
pressions, as  in  auscultation  of  the  chest.  It  is 
well  known  that  a  doubtful  cardiac  murmur  can  be 
much  better  heard  and  its  significance  appreciated 
when  tbe  eyes  are  closed,  the  voluntary  attention 
being  thereby  concentrated  upon  sense-impressions 
received  through  one  channel  only.  The  tactile 
sense  may  be  similarly  increased,  as  if  by  way  of 
compensation,  in  those  whose  eyesight  is  defective 
or  lost.  This  fact  has  been  taken  advantage  of  by 
individuals  engaged  in  massage. 


Temperance  Reform  in   Ireland. 

Everyone  who  knows  anything  of  social   life 
among  the  peasant  class  of  Ireland  knows  that 
much  of  the  drunkenness,  which  in  some  parts 
of  the  country  is  still  such  a  blot  on  their  morality, 
is  due,  not  to   any  love  of  intoxicating  liquor, 
but  to  a  feeling  of  hospitality  and  good  fellowship. 
Irishmen     are     not    only    sober,     but    actually 
abstinent  for  six  days  of  the  week,  but  on  market 
and  fair  days  it  is  the  custom  when  neighbours 
meet  to  show  their  good  feeling  by  drinking  to- 
gether in  public  bars.     This  social   custom  has 
the  force  of  long  tradition  behind  it,  and  the  Irish 
peasant    is    proverbially    conservative    of    social 
tradition.     The  effects  of    this   weekly   or    fort- 
nightly    debauch     are      not      only     disastrous 
morally   and   economically,    but     physically    are 
very    deleterious.      Whisky  is  the  drink  usually 
demanded,  and  the  whisky  supplied    is    of  the 
vilest,  rankest    description.      For    the    past    few 
years   a  movement,   called    the    "  Anti-Treating 
League,"  initiated  by  Rev.   Father  Rossiter,  of 
Enniscorthy,  has  endeavoured  to  check  the  cus- 
tom we  refer  to  by  pledging  its  members  against 
treating  in  public  bars.     In  his  recent  book,  Sir 
Horace  Plunkett  has  borne  witness  to  the  good 
work  the  League  is  performing,  and  has,  as  a  mark 
of   his    approval,   sent    a    generous   subscription 
to  its  funds.     We  need  hardly  say  the  movement 
has  our  heartiest  approval,  and  we  are  sure  our 
readers  in  the  country  parts  of  Ireland  can  support 
from  their  own  experience  Sir  Horace  Plunkett's 
good  opinion: 


Pisoalitis  and  the  Medical  World. 

The  question  of  the  general  prosperity  of  the 
United  Kingdom  is  one  with  which  the  medical 
profession  is  closely  concerned.  National  pros- 
perity means  a  higher  standard  of  health,  with 
increased  power  of  paying  for  professional  services, 
to  say  nothing  of  a  greater  inclination  to  employ 
those  services.  Financial  depression,  on  the  other 
hand,  lowers  the  popular  vitality  and  lessens  the 
inclination  to  call  in  medical  men,  besides  curtailing 
the  means  available  for  their  remuneration.  From 
this  point  of  view  the  medical  profession  may  find 
it  desirable  to  pay  some  amount  of  consideration 
to  the  "  pros  and  cons  "  of  the  great  fiscalitis 
controversy.  Speaking  generally,  medical  men 
are  by  their  training  specially  fitted  to  master  the 
I  root  principles  of  natural  laws  upon  which  the 
science  of  political  economy  is  based.  It  need 
I  hardly  be  pointed  out  to  medical  readers  that  a 
'  firm  grasp  of  principles  is  the  best  way  of  avoiding 
and  of  detecting  fallacies.  In  many  cases  what 
is  described  as  "  a  trenchant  exposition  of  facts  " 
simply  serves  as  the  cloak  to  a  profound  ignorance 
of  elementary  laws.  As  a  general,  common-sense 
rule  of  life,  it  is  better  for  medical  practitioners 
to  avoid  partisanship  in  politics  and  religion,  but 
it  does  not  follow  that  they  should  not  form  their 
own  private  and  carefully  considered  conclusions 
upon  both  those  important  subjects. 

Refinements  in  Diagnosis. 

By  his  capability  to  form  an  accurate  diagnosis 
to  a  great  extent  a  medical  man  is  judged,  es- 
pecially by  his  colleagues.  In  proportion  to  his 
powers  in  this  direction  will  be  his  success  in 
treatment,  up  to  a  certain  point.  When  he  is 
brought  face  to  face  with  disease  in  its  obscurer 
forms,  an  element  of  conjecture  enters  into  the 
case  and  the  balance  of  probabilities  has  then  to 
be  deduced  after  carefully  weighing  every  clinical 
sign.  Allowing  a  margin  for  error,  there  still 
remain  a  number  of  morbid  conditions  in  which  a 
certain  amount  of  exactitude  is  not  only  possible 
but  absolutely  necessary  as  a  working  basis  for 
future  treatment.  The  localisation  of  disease  in 
the  several  parts  of  the  nervous  system  is  apt  to  be 
considered  by  many  as  falling  within  the  province 
of  the  neurologist  rather  than  of  the  physician, 
but  the  practitioner  speedily  discovers  that  a 
sound  knowledge  of  morbid  pathology  is  of  the 
greatest  assistance  to  him  in  his  everyday  practice. 
It  is  only  given  to  a  gifted  few  to  make  what  are 
called  "  lightning  diagnoses,"  which,  when  correct, 
are  startling  in  their  brilliancy,  but  should  they 
fall  wide  of  the  mark,  as  the  autopsy  may  un- 
relentingly reveal,  they  recoil  with  contumely 
and  ridicule  upon  the  head  of  their  author.  Too 
great  minuteness  in  diagnosis,  on  the  other  hand, 
amounting  in  some  cases  to  a  paradox,  is  to  be 
deprecated.  This  habit  is  popular  with  a  certain 
section  of  the  public,  but,  since  there  is  no  absolute 
certainty  in  medicine,  extreme  precision  and  hair- 
splitting refinements  in  diagnosis  are  apt  to 
savour  somewhat  of  the  charlatan.  The  definition 
of  drunknenness,  for  instance,  especially  in  ex- 
tenuating   circumstances,    may    be    so    worded 


404     The  Medical  Press.       NOTES    ON    CURRENT    TOPICS. 


April  13,  1904. 


by  carefully  steering  between  the  strict  physio- 
logical truth  and  popular  belief,  that  an  accused 
individual  may  be  completely  shorn  of  his  guilt, 
as  recent  evidence  before  a  metropolitan  police- 
court  has  disclosed.  It  Is  quite  possible  to  be 
pathologically  accurate  without  entering  into 
details  which  may  be  liable  to  misconception. 

Diet  in  Typhoid  Fever. 
In  hardly  any  department  of  therapeutics  has 
there  been  a  greater  change  in  the  last  ten  years 
than  in  regard  to  the  diet  permitted  in  typhoid 
fever.  It  is  only  a  short  time  since  it  was  uni- 
versally believed  that  starvation  rations  were 
the  proper  allowance,  and  many  a  poor  patient 
suffered  unnecessary  hunger  in  consequence. 
That  the  belief  has  not  wholly  died  out  was  brought 
to  light,  curiously  enough,  by  one  of  the  medical 
witnesses  before  the  recent  War  Commission. 
This  gentleman,  an  officer  holding  high  rank, 
while  admitting  that  during  the  early  part  of  the 
war  typhoid  patients  had  to  go  without  food, 
stoutly  maintained  that  starvation  was  the  proper 
treatment.  Apart,  however,  from  the  opinions 
of  those  who  have  drifted  into  the  backwaters  of 
medical  progress,  there  has  been  a  gradual  and 
steady  change  of  opinion  on  this  point,  and 
nowadays  there  is  no  truth  held  more  strongly  by 
clinical  teachers  than  that  typhoid  fever  must  be 
fed.  At  first  this  was  only  held  to  apply  \o 
liquid  foods,  and  the  old  menu  of  milk  and  beef- tea 
was  enlarged  to  contain  soups,  coffee,  cocoa,  egg- 
flip,  lemonade,  jellies.  Later,  however,  the  scep- 
tical mind  asked  why  solid  food  was  debarred, 
and  suggested  that  a  solid  food,  if  soluble,  will 
certainly  be  liquid  before  it  reached  the  ileum. 
A  new  and  large  field  of  permissible  foods  was 
thus  open  to  choice.  In  fact,  if  one  remembers 
the  old  maxim  of  avoiding  "  strings  and 
stones  and  skins  and  bones,"  one  need  hardly 
fear  injuring  the  typhx>id  ulcers,  while  the  satis- 
faction to  the  patient  of  having  "  something 
to  bite  "   is  not  likely  to  be  overrated. 

The  New  Military  Hospitals. 
The  defence  of  the  Army  Medical  Service  during 
the  recent  war  in  South  Africa  in  certain  quarters 
attained  a  fervour  beside  which  the  most  violent 
political  partisanship  might  have  seemed  cold  and 
colourless.  For  all  that,  the  hand  of  reform  has 
been  at  work  in  the  medical  as  well  as  in  other 
branches  of  the  Army.  Many  of  the  proposals, 
it  is  true,  have  fallen  to  the  ground,  still-born,  and 
the  ounce  of  fact  has  been  too  often  swamped  by 
the  ton  of  theory.  The  new  Army  Advisory  Council, 
in  spite  of  warning  and  remonstrance,  contains  no 
medical  officer.  To  an  army  on  active  service  the 
medical  organisation  is  well-nigh  as  important 
as  that  of  the  commissariat.  The  lessening  of  the 
preventable  mortality,  it  must  be  remembered, 
of  troops  on  actual  service  must  be  secured  not 
only  by  the  care  of  the  sick  and  wounded,  but  by 
the  prevention  of  enteric  fever  and  other  communi- 
cable diseases  by  the  provision  of  pure  air,  water, 
and  environment.  So  far  as  hospitals  are  con- 
cerned the  present  cast-iron  system  is  to  be  aban- 


doned, and  three  first  grade  hospitals  on  certain 
lines  are  to  be  established  at  Aldershot,  Devonport, 
and  Salisbury  Plain  ;  second  grade  hospitals  will 
be  placed  at  Warley,  Pembroke  Dock,  Preston, 
and  other  places,  while  numerous  third  grade 
hospitals  will  be  created  where  less  than  six 
hundred  troops  are  located.  The  new  Army 
Council  must  be  credited  with  this  attempted 
reform  of  Army  hospitals. 

State  Registration  of  Nurses. 
Our  readers  will  doubtless  remember  that 
strenuous  endeavours  are  being  made  by  a  section 
of  the  nursing  profession  to  obtain,  by  Act  of 
Parliament,  a  State  Register  of  Nurses. 
Until  recently  we  had  heard  little  but  what 
was  in  favour  of  the  proposal,  and  we  had  under- 
stood that  nurses,  at  any  rate,  were  unanimous 
in  the  general  demand,  whatever  difference  might 
exist  as  to  details.  We  find,  however,  that  a  mani- 
festo against  the  proposal  has  been  issued,  with 
the  signatures  of  a  large  number  of  matrons,  chair- 
men of  hospitals,  and  distinguished  medical  men. 
The  principal  object  of  the  scheme  seems  to  be 
the  benefit  which  would  result  to  the  public  from 
the  possibility  of  distinguishing  by  means  of  a 
certificate  of  registration  the  competent  nurse 
from  the  ignorant  usurper  of  the  title.  On  the 
one  hand,  the  signatories  to  the  manifesto  point 
out  that  State  registration  would  depend  on  State 
examination,  and  that  examination  is  a  quite 
insufficient  test  of  the  competency  of  a  nurse. 
It  can  at  best  only  estimate  her  technical  skill, 
but  must  leave  out  of  all  account  her  personal 
qualities  of  tact,  temper,  discretion,  patience, 
and  so  on,  which  are  of  far  greater  importance. 
There  is,  on  the  other  hand,  much  to  be  said  in 
favour  of  registration,  as  there  is  no  doubt  that  at 
present  the  public  and  the  medical  profession  are 
victimised  by  untrained  women  passing  themselves 
oft  as  "  trained  nurses."  A  meeting  is  to  be  held 
in  Dublin  on  Friday  next  in  the  College  of  Physi- 
cians, Kildare  Street,  in  favour  of  the  movement, 
further  particulars  of  which  will  be  found  in 
another  column.  We  may  add  that  the  success 
of  the  General  Medical  Council  in  the  government 
of  the  medical  profession  has  not  been  so  marked 
as  to  recommend  a  similar  system  to  the  nursing 
profession.  Still  less  do  the  recent  antics. of  the 
Central  Midwives  Board  encourage  towards  the 
formation  of  other  such  bodies. 

The  New  Patent  Medicine  Regulations. 

The  new  regulations  under  the  Medicine  Stamp 
Act  came  into  operation  at  the  beginning  of  the 
present  month.  Mixtures  or  pills  are  exempt 
from  duty  if  the  ingredients  be  stated  oh  the  label, 
or  if  made  up  from  any  well-known  formula  in  the 
British  Pharmacopoeia.  All  such  remedies  pur- 
porting to  cure  particular  diseases  will  have  to  bear 
a  1  Jd.  stamp.  In  this  wa,y  it  has  been  pointed  out 
that  whereas  a  box  of  "  antibilious  "  pills  would 
need  a  stamp,  although  the  pills  themselves  might 
be  worth  a  fraction  of  a  penny,  it  seems  an 
undignified  proceeding  for  a  Government  enjoying. 


April  13.  1904. 


NOTES    ON    CURRENT    TOPICS.       The  Medical  Press.    405 


vast  revenues  to  descend  to  such  paltry  means  of 
raising  money.  The  damage  done  to  the  public, 
both  in  pocket  and  in  health,  by  the  sale  of  patent 
medicines  is  simply  incalculable.  No  drug  is  too 
dangerous  to  enter  into  the  composition  of  a  secret 
nostrum.  For  the  most  part  the  claims  of  such 
preparations  to  cure  this  or  that  disease  are  fraudu- 
lently and  extravagantly  grotesque.  In  return 
for  sanctioning  all  this  fraud  and  suffering,  the 
Government  lays  upon  the  community  the  stamp 
tax,  for  clearly  the  ultimate  payment  falls  on  the 
consumer.  The  amount  raised  by  this  "  immoral  " 
tax  is  comparatively  trifling  and  is  unworthy  of 
any  civilised  and  intelligent  Government. 

Exeat  Malaria. 

The  discovery  of  the  cause  and  of  the  agency  of 
distribution  of  malaria  forms  one  of  the  most 
striking  romances  of  modern  medical  science.  To 
our  forefathers  the  mere  notion  of  a  mosquito 
possessing  a  salivary  gland  would  have  seemed 
a  flight  of  wild  grotesque  imagination.  To  have 
pictured  in  that  gland  a  living  parasite  capable  of 
causing  malaria  in  man  would  have  served  as  a 
climax  to  the  drollery.  To-day,  however,  as 
everyone  knows,  the  war  against  malaria  has 
resolved  itself  largely  into  a  war  against  mosquitoes. 
At  the  Paris  Academie  des  Sciences  Prince  d'Aren- 
berg  recently  described  the  methods  of  extermina- 
tion employed  by  the  Suez  Canal  Company. 
By  the  use  of  petroleum  in  places  where  refuse 
and  stagnant  water  is  found,  by  unceasing  watchful- 
ness, and  by  the  use  of  quinine  on  a  large  scale  the 
number  of  malaria  cases  has  been  reduced  from 
two  thousand  a  year,  at  which  it  stood  during  the 
five  years  before  1902,  to  two  hundred  in  1903. 
On  the  West  Coast  of  Africa,  where  the  habits  of 
the  native  black  are  primitive,  it  is  almost  im- 
possible to  make  headway  against  the  malady. 
In  the  case  of  Madagascar,  in  spite  of  preventive 
measures,  the  mortality  from  malaria  among  the 
French  soldiers  reaches  the  high  figure  of  30  per 
1,000.  On  the  whole,  the  results  of  the  anti- 
malaria  campaign  are  most  encouraging,  and  it 
may  reasonably  be  hoped  that  they  presage  the 
day  when  the  tropical  will  be  not  less  healthy 
than  the  temperate  zones  of  the  earth. 

Abortion  and  Death  Certificates. 

The  need  of  caution  on  the  part  of  medical  men 
who  are  asked  to  grant  death  certificates  after  a 
short  attendance  is  one  of  the  self-evident  and 
conspicuous  facts  of  professional  life.  At  the 
same  time  it  is  clear  from  the  evidence  of  criminal 
and  of  coroners'  courts  that  the  death  certificate 
is  often  signed  by  the  practitioner  upon  loose  and 
defective  knowledge.  An  instance  of  the 
kind  is  furnished  in  the  case  of  Bertha  Bandach, 
who  has  just  been  sentenced  to  seven  years' 
penal  servitude  for  manslaughter  as  the  result 
of  procuring  an  abortion.  The  medical  man 
who  attended  the  deceased  woman  when  dying 
was  thrown  off  his  guard  by  various  statements 
made  to  him,  and  signed  a  death  certificate  on 
the  strength  of  which  burial  would  have  followed. 


Bandach,  however,  had  been  tried  and  acquitted 
of  a  similar  charge  in  1903,  and  in  1895  convicted 
and  sentenced  to  five  years'  penal  servitude. 
Deceased  had  been  the  object  of  a  previous  inquiry 
of  the  kind,  and  her  medical  attendant  on  that 
occasion,  hearing  of  Iter  death,  communicated  with 
the  coroner.  Obviously,  in  all  cases  connected 
with  premature  deliveries  it  behoves  medical  men 
to  be  perpetually  on  their  guard  as  to  the  possi- 
bility of  criminal  practices.  It  argues  little  for  the 
value  of  police  supervision  that  a  woman  of  so 
notorious  a  character  as  that  of  Bandach  should 
have  been  allowed  to  advertise  on  a  brass  plate 
her  business  as  a  midwife  and  to  cause  the  death 
of  another  victim  under  circumstances  that  were 
brought  to  light  only  by  the  accidental  intelligence 
and  public  spirit  of  a  private  medical  man. 

The  Plague  at  Johannesburg. 

The  future  prospects  of  plague-stricken  Johan- 
nesburg, from  a  sanitary  point  of  view,  are  simply 
appalling.  The  invasion  of  the  Oriental  pestilence 
can  be  treated  with  calm  confidence  by  that 
country  alone  which  possesses  the  highest  modern 
standard  of  public  sanitation.  Speaking  of  South 
Africa  generally,  its  sanitation  is  probably  about 
one  of  the  most  primitive  and  defective  of  any 
country  under  the  British  flag.  When  plague 
creeps  into  such  quarters  it  comes  to  stay. 
Under  such  circumstances  the  importation  of  a 
number  of  Chinese  coolies,  who  will  be  segregated 
practically  as  prisoners  in  large  camps,  will  be 
fraught  with  untold  danger.  It  is  hardly  possible 
to  imagine  the  result  of  an  outbreak  of  plague 
in  a  densely  populated  coolie  compound.  The 
most  recent  official  reports  give  about  150  sus- 
pected cases  of  plague,  with  some  seventy  deaths, 
one  in  ten  being  that  of  a  white.  Deaths  are 
now  being  reported  from  neighbouring  towns, 
and  altogether  the  outlook  is  of  a  most  unpromising 
character.  To  oust  the  plague  from  a  country 
requires  a  strong  and  well-equipped  sanitary  or- 
ganisation, armed  with  unlimited  powers  and 
resources.  It  is  not  enough  simply  to  kill  off  a 
number  of  rats,  but  the  strictest  isolation  is 
necessary,  together  with  a  drastic  setting  in  order 
of  the  sanitary  house,  especially  as  regards  drain- 
age and  water  supply. 


Where  Shall  I  Send  my  Patient? 

"  Heaven  helps  those  who  help  themselves  " 
is  a  motto  that  the  medical  profession  would  do 
well  to  lay  to  heart.  In  every  case  where  they 
have  lived  up  to  its  tenour  their  efforts  have  been 
rewarded  with  conspicuous  success.  It  has  been 
the  golden  rule  with  medical  defence,  the  future 
whereof  what  man  can  tell?  It  was  so  with  the 
British  Medical  Association,  which  began  as  a 
small  provincial  gathering  and  is  now  attaining 
Gargantuan  proportions.  It  was  so  with  the 
Medical  Sickness  and  Accident  Society,  which 
owed  its  origin  long  ago  to  the  forethought  and 
prudence    of     a    few     medical    practitioner-;     in 


406    The  Medical  Press. 


SPECIAL  CORRESPONDENCE. 


April  13,  1904. 


Birmingham.  So,  too,  with  Epsom  College  and 
various  other  benevolent  undertakings.  Recently 
a  number  of  medical  men  embarked  on  a  modest 
venture  of  another  kind.  It  occurred  to  them 
that  a  good  organisation  might  be  arranged  for  the 
mutual  convenience  of  medical  men  wishing  either 
to  find  a  home  for,  or  to  receive,  resident  patients. 
The  Society  was  started  a  few  years  ago  in  Bourne- 
mouth. It  already  commands  a  goodly  list  of 
members,  and  contemplates  removal  of  its  head- 
quarters to  London.  A  most  useful  little  book 
is  published  by  the  Society,  giving  particulars 
of  health  resorts  and  institutions  for  patients, 
public  and  private,  in  the  United  Kingdom,  to- 
gether with  a  list  of  medical  men  willing  to  receive 
patients  into  their  houses.  The  title  of  the  book 
is  "  Where  Shall  I  Send  my  Patient  ?  "  It  is 
published  by  E.  J.  Frampton,  of  Bournemouth. 
The  subscription  of  the  Association  is  ridiculously 
small,  five  shillings  per  annum,  as  matters  are  so 
arranged  that  the  Society  is  almost  self-supporting. 
Every  medical  man  who  is  open  to  take  a  resident 
patient  should  write  to  the  honorary  secretary, 
Dr.  Crallan,  Bournemouth. 


PERSONAL. 


By  the  will  of  the  late  Miss  Elizabeth  Wade,  of 
Sheffield,  a  legacy  of  £2,000  was  bequeathed  to  the 
infirmary  of  that  town. 


Lady  Rayleigh  will  open  the  new  building  of  the 
Brentwood  Convalescent  Home  for  Children  to- 
morrow, Thursday,  the  14th  inst. 


Sir  Samuel  Wilks,  we  are  glad  to  learn,  is  making 
steady  progress  towards  convalescence,  and  full  re- 
covery from  the  operation  may  soon  be  expected. 


The  thirty-third  Congress  of  German  Surgeons  was 
inaugurated  yesterday  in  Berlin  under  the  Presidency 
of  Dr.   Braun,   a  well-known  Gottingen   surgeon. 

The  correspondent  of  a  London  newspaper  states 
that  the  discoverer  of  radium  is  the  grandson  of  a 
homoeopathic  practitioner  who  settled  in  London  in 

183-. 


Lord  Kelvin  was  unanimously  chosen  Chancellor 
of  the  University  of  Glasgow  at  the  recent  meeting  of 
the  General  Council  of  that  University,  held  on  the 
<5th  inst. 

Dr.  William  Mair  has  been  appointed  to  the  new 
Riddel  Demonstratorship  in  Pathology  and  Bacterio- 
logy, founded  by  the  Misses  Riddel,  in  the  Queen's 
College,  Belfast. 

Professor  Seeley,  of  King's  College,  London.^on 
April  23rd,  at  Purfleet,  will  conduct  the  first  of  ten 
geological  excursions,  embracing  the  main  channel  of 
the  Thames  and  some  of  its  tributaries. 


H.R.H.  the  late  Duke  of  Cambridge  was  a  patron 
of  the  Royal  London  Ophthalmic  Hospital  (formerly 
Moornelds),  and  the  festival  dinner  of  that  institution 
has  been  postponed  to  Tuesday,  May  icth,  on  account 
ot  his  death. 


Dr.  A.  Hodgkinson,  of  Manchester,  has  been  pre- 
sented with  a  testimonial  upon  the  occasion  of  his 
retirement  from  the  post  of  Senior  Physician  of  the 
Manchester  Hospital  for  Consumptives,  of  which  he 
wa«  co-founder  in  1875. 


Mr.  F.  W.  Lowndes,  of  40  Knight  Street,  Liverpool, 
will  send  an  official  statement  of  the  increased  fees  and 
allowances  recently  sanctioned  by  the  Home  Secretary 
to  any  medical  practitioner  on  receipt  of  a  letter  en- 
closing two  penny  stamps. 


Lord  Lister  entered  his  seventy- eighth  year  on 
the  5th  of  the  present  month.  As  the  founder  of 
aseptic  surgery  he  has  probably  been  the  means  of 
saving  more  lives  already  than  any  man  .who  has  ever 
existed  on  the  face  of  the  earth. 


The  Bishop  of  Worcester  has  resigned  his  position 
as  President  of  the  local  Society  for  the  Prevention  of 
Cruelty  to  'Animals.  The  Worcester  Medical  Society 
has  sent  him  a  formal  congratulation  on  his  distinction 
between  scientific  experimentation  and  cruelty. 

Major  M.  P.  C.  Holt,  D.S.O.,  R.A.M.C,  has  been 
awarded  the  Sir  William  Taylor  prize  of  2$  gs.  for  the 
present  year,  in  recognition  of  distinguished  attain- 
ments in  surgery  shown  by  the  return  of  operations 
performed  in  Ireland.  This  prize  is  awarded  annually 
fcy  Sir  William  Taylor  to  the  executive  officer  of  the 
Royal  Army  Medical  Corps  on  the  active  list,  or  on 
full  pay  below  the  substantive  rank  of  colonel,  who 
shall  be  deemed  most  deserving  on  account  of  pro- 
fessional or  scientific  work. 


Special  correspondence. 


SCOTLAND. 


[from  our  own  correspondents.] 


Ayr  District.  Asylum. — The  annual  report — this 
time  covering  a  period  of  twenty-one  months  to 
December  31st,  1903 — has  just  been  issued,  and, 
under  an  unpretentious  exterior,  contains  so  many 
valuable  facts,  and  gives  evidence  of  so  much  care  in 
the  compilation  of  its  elaborate  statistical  tables, 
that  Dr.  Easterbrook,  the  newly  -appointed  super- 
intendent, who  is  responsible  for  its  production,  may 
well  be  congratulated  on  its  appearance.  The  asylum 
accommodates  about  500  pauper  lunatics,  and  the 
recovery -rate,  based  on  the  direct  admissions,  was 
45  per  cent.  ;  the  death-rate  11 '8  per  cent.  Ayrshire 
is  happy  in  being  near  "  the  foot  of  the  class  "— 
twenty-eighth  among  the  thirty-three  counties  of 
Scotland,  arranged  in  order  of  the  prevalence  of  mental 
unsoundness,  with  about  2*6  pauper  lunatics  per  1,000 
of  the  population.  The  causal  and  associated  factors 
of  the  insanity  in  the  patients  admitted  are  discussed 
and  carefully  classified  by  Dr.  Easterbrook,  who. 
speaking  of  alcoholism,  says  that  it  was  present  as  an 
hereditary  factor  in  7,  and  as  a  personal  factor  in 
27  per  cent.,  and  excluding  cases  in  which  alcoholism 
was  a  contributory  factor  only,  there  were  fifty-five 
cases  of  alcoholic  insanity  among  the  212  admissions— 
a  percentage  (25*9)  not  exceeded  in  any  other  county 
asylum  in  Scotland.  Dr.  Easterbrook  thinks  that  the 
habitual  inebriate  who  becomes  insane  through  his 
folly  is  ipso  facto  guilty  of  an  offence  against  the 
public  weal,  and  certainly  if  he  repeat  the  offence  and 
be  committed  a  second  time  to  an  asylum  should,  on 
his  recovery,  be  dealt  with  under  the  Inebriates  Acts. 
Whether  we  regard  inebriety  (and  vagrancy,  vice, 
and  crime)  as  a  deliberate  act  of  a  responsible  person 
who  eschews  right  and  pursues  wrong,  or  whether  we 
regard  it  as  a  manifestation  of  degeneracy  in  a  person 
of  impaired  moral  responsibility,  the  mere  recurrence 
of  the  "  offence  "  in  such  a  form  as  to  bring  it  again 
under  the  notice  of  the  authorities  emphasises  its 
habitual  nature,  and  the  failure  of  the  previous  mode 
of  remedying  it.  Habitual  inebriates  should,  like 
fever  cases,  be  isolated  for  the  good  of  the  community, 
and  sent  to  colonies  where  they  can  propagate  neither 
their  crime  nor  their  influence.  Nearly  naif  of  the 
cases  admitted  were  cases  of  insanity  connected  with 
the  physiological  crises  of  life,  many  of  which  might 
be   prevented    by   attention    to    the   rules   of  health. 


April  13,   iqo.i. 


CORRESPONDENCE. 


The  Medical  Press.     407 


Whatever  be  the  truth  about  the  increase  of  physical 
degeneracy,  of  insanity,  of  inebriety,  and  of  pauperism 
the  first  remedial  essential  is  good  health.  Much  good 
may  be  done  by  popular  health  lectures,  and  by  the 
creation  among'  the  people  of  a  "  health  conscience," 
and  it  is  the  duty  of  the  State  to  see  that  its  scheme 
of  compulsory  education  includes  the  development  of 
physique,  medical  inspection  and  teaching  hygiene, 
the  latter  emphasising  the  importance  of  suitable 
feeding  in  infancy,  of  abundant  open-air  exercise 
during  childhood,  and  the  effects  of  the  abuse  of 
alcohol  and  tobacco.  As  to  the  habitual  degenerates  at 
present  existing  segregation  seems  the  only  plan.  The 
report  is  full  of  details  of  administration,  and  is  well 
worth  perusal. 

Spring  Graduation  Days  at  Aberdeen  and 
Edinburgh. — The  spring  graduation  took  place  at 
Aberdeen  on  April  6th,  when  a  number  of  degrees  in 
arts,  science,  divinity  and  medicine  were  conferred 
in  the  Mitchell  Hall.  The  regulations  announced  for 
the  preservation  of  order  did  not  apparently  commend 
themselves  to  all  the  students,  a  considerable  number 
of  whom  absented  themselves  by  way  of  protest.  A 
graduation  address  was  delivered  by  the  principal. 
Among  the  recipients  of  honorary  degrees  was  Dr. 
C.  J.  Cullingworth,  London,  on  whom  an  LL.D.  was 
conferred.  The  Edinburgh  Spring  Graduation  cere- 
mony took  place  in  the  M'Ewan  Hall  on  April  9th, 
when  a  number  of  honorary  degrees  were  conferred, 
amongst  them  being  that  of  LL.D.  given  to  Professor 
MacAlister.  Cambridge — whose  birthday,  by  the  way, 
happened  to  fall  on  April  9th.  The  Secretary  for 
Scotland  also  received  the  same  degree.  After  the 
ordinary  degrees  had  been  conferred,  the  graduates 
were  addressed  by  Professor  Hume  Brown  on  the 
relation  of  the  individual  to  present  day  social  require- 
ments, it  being  pointed  out  that  while  it  was  futile  to 
denounce  the  mechanical  tendencies  of  the  age,  it  did 
not  follow  that  an  individual  must  become  a  mere 
pedicle  of  the  great  machine  of  society,  but  could 
always  realise  in  his  own  life,  while  giving  the 
mechanical  mastery  of  some  one  energy  which  society 
demanded,  the  harmonious  development  of  his  nature 
as  a  whole. 


BELFAST. 

Belfast  Ophthalmic  Hospital. — The  annual  meet- 
ing of  this  institution  was  held  on  the  8th  inst.  The 
medical  report,  read  by  Dr.  Cecil  Shaw,  showed  that 
2,184  patients  were  seen  in  the  extern  department  last 
year,  upwards  of  7,000  visits  being  paid  by  them. 
The  intern  patients  numbered  171.  An  appeal  was 
made  by  the  medical  staff  for  funds  to  complete  the 
famishing  of  their  new  extern  department  and  operat- 
ing theatre. 

Small-pox  in  Belfast. — There  is  great  difficulty  in 
explaining  the  continued  presence  of  this  disease  in 
the  city,  in  the  small  numbers  of  cases  which  still 
occur.  For  some  months  now  new  cases  have  continued 
to  crop  up  at  the  rate  of  one  every  week  or  ten  days, 
though  every  effort  is  made  to  stamp  out  the  infection 
by  isolating  suspects,  disinfecting,  &c.  The  public 
health  authorities  attribute  it  to  repeated  new  infection 
from  Glasgow,  with  which  city  there  is  very  free  com- 
munication. 

Mrs.  Pirrie  and  the  Royal  Victoria  Hospital. — 
At  a  meeting  of  the  Belfast  Corporation,  held  last 
week,  it  was  unanimously  decided  to  confer  the  freedom 
of  the  city  on  Mrs.  Pirrie  "  in  recognition  of  her  signal 
services  to  the  community  in  inaugurating  and  raising 
by  her  untiring  zeal  and  personal  influence  a  fund 
sufficient  for  the  erection,  equipment,  and  endow- 
ment of  the  Royal  Victoria  Hospital,  which  was  in- 
stituted to  commemorate  the  Diamond  Jubilee  of  her 
late  Majesty  Queen  Victoria,  and  to  confer  lasting 
benefits  upon  tne  citizens  of  the  city  of  Belfast." 

Mr.  Dan  P.  S.  Hill,  M.B.,  died  last  week  at  his 
residence,   Larne    Harbour,    co.   Antrim,   in   his   41st 


invalid,  travelling  in  the  winter,  and  spending  the 
summer  months  at  Lame,  where  his  tall  spare  figure 
and  genial  face  were  very  familiar  on  the  golf  links. 
His  ready  wit  and  kind  heart  made  him  a  favourite 
with  all,  and  his  early  death  will  be  sincerely  regretted 
by  a  large  circle  of  acquaintances  and  friends. 

Correspondence. 

Donde  lit  lDOt  h°W  0Mreelve8  responsible  'or  the  opinion  of  the  oorres- 


RELIGIOUS     MANIA. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — In  your  issue  of  March  23rd  you  draw  attention 
by  some  well-founded  remarks  to  the  serious  religious 
fanaticism  which  has  been  going  on  in  Beal  Island, 
Maine,  and  the  terrible  consequences  thereby  ensuing, 
and,  as  I  believe  there  is  a  dangerous  tendency  in 
the  present  time  to  render  religious  teaching  as 
theatrical,  emotional,  and  as  fascinating  as  possible,  in 
order  to  counteract  the  calmer  and  more  judicial 
mind  of  those  whose  logical  faculties  are  better  de- 
veloped, it  behoves  our  experts  in  lunacy  to  be  on  the 
alert,  and  especially  those  connected  with  our  public 
asylums,  lest  any  violent  intrusion  on  the  part  of  well- 
disposed  people  should  gain  the  upper  hand. 

I  think  it.  must  be  fairly  obvious  to  any  thoughtful 
and  observant  mind,  if  it  only  opens  its  eyes  wide 
enough  to  the  great  scheme  of  evolution.  When  brought 
face  to  face  with  the  development  of  the  human  mind 
and  intellect,  it  cannot  fail  to  see  that  the  mind  in  its 
infinite  degrees  of  gradation  from  the  intelligence  of  a 
lower  animal  to  the  logical  capacity  of  man,  I  say  it 
is  clear  that  the  mind  has  held  from  all  time  in  history 
(and  this  independent  of  the  doctrine  of  evolution) 
superstitions  and  beliefs  which  have  been  in  a  moral 
sense  to  all  intents  and  purposes  indistinguishable  from 
insane  delusions,  and  I  have  read  it  recorded  that  at  no 
remote  date  some  of  our  English  judges  believed  in 
what  is  known  as  witchcraft ;  but  there  is  no  need  to 
enlarge  upon  this  evidence  after  the  numerous  in- 
stances you  have  illustrated. 

In  an  article  which  you  published  some  years  ago, 
you  pointed  out  the  impossibility  for  any  scientific 
mind  to  escape  the  conviction  that  some  supreme 
intelligence  overrules  the  universe,  and  it  is,  I  appre- 
hend, further  quite  conceivable,  and  hence  logical,  for 
those  who  give  credence  to  miracles  to  insist  that  some 
person  has  been  sent  on  earth  to  communicate  to  our 
materialistic  faculties  things  supernatural,  or,  in  other 
words,  there  is  nothing  insane  in  believing  in  a  reve- 
lation ;  but  when  we  go  beyond  this,  and  a  sect 
styling  themselves  "  The  Holy  Ghost  and  us  "  starts, 
and  so  agitates  the  public  mind  as  to  lead  to  the  viola- 
tion of  criminal  law  and  social  order,  it  is  high  time 
that  experts  in  lunacy  should  bring  their  influence  into 
play,  as  it  must  be  evident  to  them  that  language 
being  merely  the  outward  expression  of  our  ideas, 
the  term  "  Holy  Ghost  and  us "  can  represent  no 
coherent  and  definite  train  of  thought. 

It  so  happens  that  in  the  development  of  the  human 
mind  and  in  its  ultimate  formation  we  have  a  force 
resistant  and  antagonistic  to  reason,  and  this  we  call 
prejudice ;  and  it  happens  further  that  any  ideas 
which  are  inculcated  in  the  infantile  mind,  whether  true 
or  false,  produce  such  a  tenacious  hold  on  any  in- 
dividual mind  that  only  in  those  whose  logical  faculty 
dominates  their  emotional  is  it  very  possible  to  eradi- 
cate the  false  teachings  of  childhood,  and  it  may  be 
noted  as  a  matter  of  common  occurrence  that  in 
marriages,  when  the  creeds  of  the  contracting  parties 
differ,  it  is  often  a  matter  of  mutual  agreement  as  to 
what  religious  belief  the  issue  of  such  marriage  should 
be  trained  to,  on  the  assumption  that  the  child  will 
ultimately  adhere  to  the  religion  of  that  parent  to 
whom  the  concession  has  been  granted,  and  hence  we 
see  on  a  larger  scale  how  slow  the  process  of  oblitera- 
tion of  the  superstitious  heresies  and  imaginations  of 


year.     Dr.  Hill  studied  at  Queen's  College,    Belfast, 

and  took  his  degree  in  the  Royal  University  of  Ireland 

in   1890.     Never  very  robust,   he  developed   phthisis  I  our  forefathers*  must  necessarily  be,  and  I  submit,  Sir, 

soon  after  graduating,  and  for  some  years  was  a  semi-  I  that  it  is  no  exaggeration  to  say  that  the  bloodshed 


408     The  Medical  Press. 


CORRESPONDENCE. 


April  13.  1904. 


and  persecution  of  the  mediaeval  times,  instead  of 
bringing,  as  superficial  observers  suppose,  evidence  of 
the  truth  of  any  given  belief,  were  in  reality  evidence 
of  the  unhinged,  perturbed,  and  morbid  condition  of 
the  public  mind  of  the  period,  but  even  in  the  present 
day  we  witness  amongst  different  schools  of  thought, 
and  in  the  same  denomination — say,  for  instance, 
amongst  high  and  low  Churchmen — so  much  acrimony 
and  intensity  ot  feeling  as  must  necessarily  stifle  any 
judicial  discussion. 

I  trust,  in  conclusion,  I  have  said  nothing  distasteful 
to  any  of  your  readers,  but  as  guardians  of  the  public 
health  and  in  our  responsible  duties  as  medical  men. 
we  are  sometimes  called  upon  to  discriminate  between 
a  morbid  and  a  healthy  state  of  a  religious  mind,  and, 
indeed,  upon  one  occasion,  I  had  myself  to  fill  in  a 
certificate  for  an  insane  person  who  held  exaggerated 
and  intensified  ideas  on  what  I  believe  Calvinists  call 
the  doctrine  of  predestination,  and  which  so  worked 
upon  the  feeble  mind  of  the  patient  that  her  removal 
to  an  asylum,  where  she  ultimately  died,  became 
absolutely  necessary,  and  it  follows  from  all  these 
considerations  how  necessary  it  is  for  the  medical 
profession  to  discourage  and  tone  down  any  violent 
efforts  to  excite  a  dangerous  and  intoxicated  religious 
enthusiasm  in  order  to  counteract  the  apathy  which 
religious  teachers  appear  to  think  exists  nowadays. 
I  am.  Sir.  yours  truly, 

Clemekt  H.  Sers. 

Brighton,  March  30th,  1904. 

"ARMY    INEFFICIENCY"    AND    ITS 

PREVENTION. 

To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — I  have  read  with  great  interest  the  article  on 
this  question  in  The  Medical  Press  and  Circular 
of  March  23rd,  and  also  Mr.  Profeit's  pamphlet  therein 
alluded  to.  Mr.  Profeit  puts  his  points  in  a  very 
striking  way,  and  some  of  his  suggestions  are  excellent. 
But  his  pamphlet  cannot  be  taken  as  an  exhaustive 
analysis  of  the  question.  He  does  not  seem  to  have 
followed  up  the  recent  statistics  of  the  Home  Army 
Medical  Reports.  It  is  quite  true  that  there  was  an 
increase  of  disease  after  the  suspension  of  the  C.  D. 
Act  in  1883 — an  increase  which  continued  just  three 
years,  that  is  to  say,  there  was  a  rise  of  14  per  1,000 
in  1883,  of  11  per  1,000  in  1884,  and  of  4  per  1,000  in 
1885.  Nevertheless,  in  1886  the  Act  was  not  revived, 
but  finally  repealed.  Many  doctors,  civilian  as  well 
as  military,  believed  at  the  "time  that  the  result  would 
be  a  permanent  increase  of  disease.  But  it  turned 
out  quite  otherwise.  That  year  there  was  a  decrease 
of  8  per  1,000,  the  next  year  15  per  1,000,  the  next 
28  per  1,000,  the  next  year  12  per  1,000,  the  next  no 
change,  the  next  a  fall  of  15  per  1,000,  the  next  an 
increase  of  4 — the  only  increase  in  a  period  of  fifteen 
years.  Next  year  (1893)  the  diminution  begins  again 
at  6  per  1,000,  then  successively  13,  8,  16,  18,  7,  11, 
and  29  per  1,000.  The  year  1901  shows  an  increase 
of  12.  I  have  not  the  later  figures.  But  it  is  plain 
from  these  that  other  causes  than  the  C.  D.  Act  are 
capable  of  producing  a  striking  and  continuous  re- 
duction of  disease  in  the  Army — a  reduction  of  nearly 
two-thirds  in  fifteen  years. 

In  India,  again,  the  question  is  by  no  means  as 
simple  as  it  looks  in  Mr.  Profeit's  pamphlet.  Taking 
figures  and  facts  from  the  Indian  Medical  Blue-Books 
("  Reports  on  Sanitary  Measures  in  India  "),  and  the 
Report  of  Lord  Onslow's  Commission  in  1897,  we  find 
that  from  1861  to  1867  the  rate  of  disease  (which  had 
risen  very  high  in  the  years  immediately  following  the 
Mutiny)  had  sunk  steadily,  year  by  year,  from  352  to 
160  per  1,000.  The  majority  of  the  Lock  hospitals 
under  the  new  system  were  not  opened  till  1867.  From 
that  year  an  irregular  increase  set  in,  and  by  1884 
(the  year  before  the  experimental  closure  of  the  fifteen 
hospitals)  the  figures  had  reached  293  per  1,000.  The 
short  service  system,  with  its  large  relays  of  young 
•unmarried  men,  is  said  to  be  responsible  for  much  of 
this  increase  from  1873  onwards.  The  great  famine 
of  1877,  which  drove  large  numbers  of  native  women 


into  prostitution,  undoubtedly  had  its  share.  Both 
these  instances  show,  however,  that  under  conditions 
tending  to  foster  immorality  the  Act  failed  to  afford 
protection.  During  the  whole  of  this  period,  the 
varying  reports  from  different  stations  give  constant 
evidence  of  the  discrepancy  between  effort  and  result. 
In  1874-5,  we  find  28  stations  in  Bengal  showing  an 
increase  of  disease,  as  against  17  showing  a  decrease. 
Next  year  the  Punjab  has  only  three  out  of  16  which 
do  not  show  an  increase.  At  Secunderabad  that  year 
disease  increased  in  spite  of  the  most  zealous  working 
of  the  system.  At  Bellary,  with  no  increase  of  zeal, 
there  is  marked  improvement.  An  improvement  at 
Darjeeling  is  attributed  to.  strict  surveillance  of  the 
men.  At  Bangalore,  a  little  later,  it  is  complained 
that  the  registered  women  are  few  and  the  unregistered 
many  ;  yet  disease  diminishes  both  among  men  and 
women.  Instances  like  these  might  be  multiplied 
indefinitely,  along  with  others,  such  as  Mr.  Profeit 
quotes.  It  is  impossible,  on  a  careful  survey  of  the 
whole  series,  to  find  any  constant  relation  between  the 
measures  taken  and  the  variations  of  disease.  In  1878 
the  official  comment  is,  "  The  results  are  less  favour- 
able than  those  of  any  year  since  1862."  In  1884, 
"  In  every  government  the  disease  has  advanced,  in 
the  face  of  every  means  of  prevention  which  has  been 
adopted."  It  was  this  profound  dissatisfaction  that 
led  to  the  "  experimental "  closing  of  the  fifteen 
hospitals  in  1885.  A  sudden  increase  of  disease  was 
the  result.  What  else  could  any  sane  person  expect, 
when  every  means  of  obtaining  treatment  was  suddenly 
closed  against  the  sufferer  ? 

A  similar  thing  took  place  in  Italy,  when  Signor 
Crispi  abolished  the  compulsory  system  and  there 
were  no  voluntary  hospitals  ready  to  receive  patients. 
The  present  Inspector-General  of  Public  Health,  Dr. 
Santoliguido,  has  inaugurated  a  system  of  voluntary 
gratuitous  treatment  throughout  the  country,  which 
seems  likely  gradually  to  replace  the  compulsory 
system,  and  with  better  results. 

Your  readers  are  doubtless  aware  that,  since  the 
two  great  International  Conferences  at  Brussels  in 
1899  a^d  *902,  tne  system  has  become  more  and  more 
discredited  on  the  Continent,  where  even  a  champion 
of  regulation  like  Professor  Fournier  avers  that  it  has 
been  of  little  use,  and  is  likely  to  be  of  still  less  in  the 
future  ;  while  an  important  Medical  Committee  in 
New  York,  appointed  to  consider  the  question  in  the 
light  of  all  tne  evidence,  refused  to  recommend  the 
adoption  of  similar  methods  in  the  United  States,  on 
the  ground  that  they  were  certain  to  prove  a  failure, 
and  added,  "  The  system  has  so  many  countervailing 
disadvantages  that  the  movement  for  its  modification 
or  abolition  in  many  European  countries  will  probably 
result  successfully." 

Mr.  Profeit  very  justly  calls  attention  to  the  extra- 
ordinary neglect  of  other  remedial  measures,  such  as 
the  improvement  of  barracks  in  stations  like  Hong 
Kong,  the  placing  infected  bazaars,  &c,  out  of  bounds, 
the  proper  care  of  patients  on  board  ship,  better 
amusements,  and  the  cultivation  of  a  higher  moral 
standard — which  last,  however,  though  technically 
supposed  to  rest  with  the  chaplains,  probably  depends 
far  more  on  the  influence  of  a  man's  own  comrades  and 
officers. 

I  am,  Sir,  yours  truly, 

D.  Leppington 

(Member  of  the  International  Prophylactic  Society). 

Irish  Nurses  AjeocUUod. 

A  meeting  will  be  held,  by  the  kind  permission  of 
the  Fellows,  in  the  Royal  College  of  Physicians, 
Kildaire  Street,  Dublin,  on  Friday  next,  April  15th, 
at  4.30  p.m.  Mrs.  Bedford  Fenwick,  one  of  the  chief 
promoters  of  the  Bill  for  the  State  Registration  of 
Trained  Nurses  which  is  now  before  Parliament,  will 
address  the  meeting  on  this  important  subject.  Dr. 
James  Little  has  kindly  consented  to  preside.  All  who 
are  interested  in  the  subject  are  invited  to  attend 
this  meeting. 


April  13,  1904.* 


OBITUARY. 


Thk  Medical  Press.     40Q 


literature. 


NATURAL  MINERAL  WATERS,  (a) 
The  value  of  natural  mineral  waters  for  dietetic  and 
therapeutic  purposes  is  gradually  gaining  recognition 
even  among  the  most  conservative  of  British  prac- 
titioners. Resort  to  watering-places  is  not  only  fashion- 
able but  oftentimes  beneficial.  The  well-to-do  not 
infrequently  select  for  themselves,  under  the  guidance 
of  attractive  advertisements,  rather  than  as  the  result 
of  consultation  with  their  medical  advisers.  And  it 
must  be  admitted  that  many  physicians  take  but  little 
pains  to  obtain  trustworthy  information  concerning 
the  various  natural  springs  and  health  stations  either 
in  this  country  or  on  the  Continent.  For  all  serious 
students  of  balneology  and  hydrotherapeutics,  the 
admirable  epitome  issued  by  Messrs.  Ingram  and  Royle 
will  be  of  the  greatest  service.  In  the  present  edition 
up-to-date  information,  arranged  in  compact  form  and 
concisely  presented,  suitable  for  ready  reference,  is 
available  concerning  most  of  the  important  natural 
mineral  waters  now  in  use.  Particulars  are  given  re- 
garding the  geographical  position  of  the  spring,  the 
composition  of  the  waters,  the  nature  of  its  action, 
usage,  and  much  else  likely  to  be  valuable  to  the  busy 
physician.  The  work  is  one  which  should  have  a  place 
among  the  "  working  books  "  of  every  practitioner. 
We  understand  that  the  publishers,  Messrs.  Ingram 
and  Royle,  Upper  Thames  Street,  London,  will  be 
pleased  to  forward  a  copy  of  the  brochure  gratuitously 
to  any  member  of  the  medical  profession. 

J  EX-BLAKE  ON  THE  CARE  OF  INFANTS,  (b) 
Much  has  been  written  on  this  subject,  and  no  doubt 
much  has  still  to  be  written.  Meantime,  we  welcome 
this  contribution  to  the  ever-increasing  literature 
#  devoted  to  infants  and  their  management.  The 
authoress  takes  for  her  motto  "  Prevention  is  better 
than  cure."  She  writes  for  the  information  of  mothers 
and  nurses,  and  hence  much  that  she  has  to  say  is 
elementary  and  commonplace.  At  the  same  time,  it  is 
a  pleasure  to  find  that  every  statement  made  and  every 
direction  given  is  simple  as  well  as  accurate.  Her 
remarks  on  the  use  of  medicines  in  the  nursery  should 
be  laid  to  heart  by  every  mother  in  the  land  ;  for,  if 
thev  were,  infantile  mortality  would  become  greatly 
reduced.  This  is  just  such  a  book  as  medical  men  may 
confidently  recommend  to  their  patients,  as  it  contains 
nothing  which  is  outside  simple  home  treatment.  In 
this  respect  it  differs  from  most  of  its  newer  competitors, 
and  accordingly  we  have  great  pleasure  in  calling  the 
attention  of  our  readers  to  it,  believing  that  it  will  fill 
a  very  useful  place  in  every  family  library. 

CARPENTER  ON  DISEASES  OF  CHILDREN,  (c) 
This  forms  one  of  the  *'  Golden  Rule  "  series.  The 
first  edition  contained  10 1  pages,  and  the  space  allotted 
was  altogether  inadequate  for  the  subject.  The  new 
issue,  however,  contains  nearly  twice  that  number,  the 
author  having  found  it  necessary,  in  order  to  render 
the  book  really  useful,  to  add  to  certain  of  the  sections, 
as  well  as  to  make  an  appendix  of  twenty-seven  pages 
on  skin  affections.  The  whole  field  of  diseases  of 
infancy  and  childhood  is  now  traversed,  and  although 
it  would  be  absurd  to  class  it  with  the  text-books  or 
treatises  on  the  subject,  it  nevertheless  contains  an 
immense  amount  of  information  in  a  very  small  com- 
pass presented  with  sufficient  fulness  to  be  intelligible 
and  helpful.  It  is  not  a  book  to  lay  aside  for  future 
reference,  but  one  to  be  consulted  day  by  day  as 
necessity  arises,  because  of  the  many  practical  hints 
given  in  crisp  and  concise  language  within  its   covers. 


(a) "  Natural  Mineral  Waters  :  their  Properties  and  Uses." 
Eleventh  Edition.  Revised  and  Enlarged.  London  :  Ingram  and 
Boyle,  Limited.    W04. 

(ft)  H  Tne  Care  of  Infanta  :  a  Manual  for  Mothers  and  Nones." 
By  Sophia  J  -x-Blake,  M.D.  Second  Xdltton.  Is.  net.  Edinburgh : 
Geo.  i.  Morton.    1903. 

to  "Qo.dea  Roles  for  Diseases  of  Infants  and  Children."  By 
Geonre  Carpenter,  M.O.Lond..  M.B.C.P.,  Assistant  Physician  as 
ths  North-Eaatern  Hospital  for  Children,  Ac.  &c.,  "  Golden  Bole." 
Series,  Ho.  XL  Second  Edition,  enlarged,  is.  Bristol :  John 
Wright  sad  Co. 


Dr.  Carpenter's  handy  guide  certainly  strikes  us^as 
being  one  of  the  best  in  this  vest-pocket  series.  2^\ 

©bituarp. 

THE  LATE  SIR  PHILIP  CRAMPTON  SMYLY,  M.D. 

It  is  with  feelings  of  profound  regret  we  have  to 
record  the  death  of  one  of  the  most  distinguished 
members  of  the  profession  in  Dublin  in  the  person  of 
Sir  Philip  C.  Smyly.  Though  a  martyr  to  gout  from 
his  childhood,  he  remained  in  excellent  health  until  a 
couple  of  years  ago,  when  degenerative  changes  began 
to  manifest  themselves.  He  had  only  recently  re- 
turned from  Nantwich  so  much  improved  that  his 
friends  began  to  hope  he  might  be  spared  for  years  to 
come,  but  the  end  came  suddenly.  He  was  taken  ill 
at  dinner  on  Thursday  evening  last.  His  friend  and 
medical  attendant,  Sir  Francis  Cruise,  and  hi*  brother, 
Dr.  W.  J.  Smyly,  were  sent  for,  but  arrived  only  to 
find  that  the  long-dreaded  accident  had  happened, 
and  a  cerebral  haemorrhage  had  taken  place.  He 
never  recovered  consciousness,  and  passed  away  at 
2  a.m.  on  Friday. 

The  most  heartfelt  sorrow  has  been  evoked  by  the 
sad  event  by  which  a  great  man  has  been  removed — 
a  sorrow  which  will  not  be  confined  to  his  native  city, 
but  be  felt  in  England  and  on  the  Continent,  where 
the  deceased  was  well  known  and  highly  esteemed 
by  the  profession. 

Philip  Crampton  Smyly  was  born  on  June  17th, 
1858,  at  8  Ely  Place,  Dublin.  His  father  was  the 
late  Josiah  Smyly — a  distinguished  surgeon — and  his 
mother  was  a  daughter  of  the  late  Matthew  Franks, 
of  Merrion  Square  and  Jerpoint  Hill,  Thomas  town, 
County  Kilkenny.  Educated  privately,  he  was  appren- 
ticed to  his  grand-uncle,  Sir  Philip  Crampton,  Bart., 
on  whose  decease  he  was  apprenticed  to  the  late 
William  Henry  Porter,  Professor  of  Surgery  and 
Surgeon  to  the  Meath  Hospital.  He  studied  at 
Trinity  College  and  at  the  Royal  College  of  Surgeons. 
His  undergraduate  career  was  a  brilliant  one.  He 
carried  off  the  first  prize  in  chemistry,  was  awarded 
the  gold  medal  of  the  Pathological  Society,  and  obtained 
his  degree  by  taking  a  moderatorship  and  silver  medal 
in  experimental  science  in  1859. 

At  the  Meath  Hospital  he  was  awarded  the  Senior 
Medical  prize  and  the  Stokes  Stethoscopic  prize,  but 
his  father,  who  was  a  surgeon  to  that  institution,  did 
not  permit  him  to  compete  for  any  of  the  surgical 
prizes. 

He  obtained  his  M.B.  and  the  licence  of  the  Royal 
College  of  Physicians,  Ireland,  in  i860,  and  then  went 
to  Berlin,  where  he  underwent  a  course  of  study  in 
operative  surgery  under  Langenbeck,  and  also  attended 
the  cliniques  of  v.  Graefe  and  other  distinguished  Con- 
tinental teachers.  He  obtained  the  licence  of  the 
Royal  College  of  Surgeons  in  1861,  after  which  he 
returned  to  Germany  and  spent  several  months  in 
study  in  Vienna.  In  July  of  this  same  year  (1861) 
he  was  appointed  Surgeon  to  the  Meath  Hospital,  in 
succession  to  his  old  teacher  and  master,  Professor 
William  Henry  Porter.  In  1863  he  took  the  M.D. 
degree,  and  aiso  obtained  the  Fellowship  of  the  Royal 
College  of  Surgeons.  In  1878,  at  the  unprecedentedly 
early  age  of  40  years,  he  was  elected  to  the  distinguished 
position  of  President  of  the  Royal  College  of  Surgeons 
in  Ireland.  In  1889  he  was  elected  President  of  the 
Laryngological  Association  of  Great  Britain.  In 
1893  he  was  elected  to  represent  the  Royal  College  of 
Surgeons  in  Ireland  in  the  General  Medical  Council,  a 
position  to  which  he  was  re-elected  yearly  until  1900, 
when  he  resigned.  In  1900  he  was  elected  President 
of  the  Irish  Medical  Association.  In  1902  he  was 
elected  President  of  the  Irish  Schools  and  Medical 
Graduates'  Association  in  London.  From  1869  to 
1895  he  was  Surgeon-in-Ordinary  to  successive  Lords- 
Lieutenant  of  Ireland.  In  1892  he  received  the  honour 
of  Knighthood.  In  1895  he  was  appointed  Surgeon- 
in-Ordinary  in  Ireland  to  Her  late  Majesty  Queen 
Victoria.  In  1900  he  was  appointed  Surgeon-in- 
Ordinary  in  Ireland  to  His  Majesty  the  King,  a  position 


410    The  Medical  Piess. 


MEDICAL  NEWS. 


April   13,  1904. 


which  he  held  till  his  death.  In  addition  to  being 
Surgeon  to  the  Meath  Hospital  from  1861 — for  43 
years — the  deceased  was  Consulting  Surgeon  to  the 
Hospital  for  Diseases  of  the  Throat  and  Ear  ;  Consulting 
Surgeon  to  the  National  Children's  Hospital,  Harcourt 
Street ;  and  Consulting  Surgeon  to  the  Rotunda 
Hospital. 

In  1864  the  deceased  married  the  Hon.  Nina  Plunket, 
the  fifth  daughter  of  the  Right  Hon.  John  third  Baron 
Plunket,  a  sister  of  the  late  Archbishop  of  Dublin, 
and  of  the  present  Lord  Rathmore.  By  her  he  had 
three  sons  and  five  daughters.  One  of  his  sons,  the 
Hon.  P.  Crampton  Smyly,  has  held  the  office  of  Chief 
Justice  of  Sierra  Leone  since  1901,  having  previously 
occupied  the  positions  of  Queen's  Advocate  (1895) 
and  Attorney-General  (1 896-1 901)  in  that  Colony. 
Another  son  is  a  Fellow  of  Trinity  College,  Dublin, 
while,  we  understand,  the  youngest  son  intends  follow- 
ing his  father's  profession. 

As  an  operating  surgeon  he  was  not  what  one  would 
term  brilliant,  but  he  was,  what  is  often  far  better,  a 
neat,  careful  operator,  ever  mindful  of  the  welfare  of 
his  patient.  For  many  years  the  deceased  enjoyed  one 
of  the  largest  and  most  lucrative  practices  in  the  city, 
but  failing  sight  during  the  past  three  or  four  years 
compelled  him  to  refuse  to  undertake  major  operations. 
His  conversational  powers  and  his  happy  gift  as  a 
raconteur,  combined  with  the  thorough  kindliness  of 
his  nature,  and  his  method  of  doing  kind  things  in 
the  kindest  manner,  endeared  him  to  all  with  whom 
he  came  in  contact. 

A  man  absolutely  free  from  jealousy  and  from  any 
kind  of  ignoble  thought,  he  was  held  in  the  highest 
esteem  and  respect  by  his  professional  brethren,  to 
whom  he  was  a  perfect  example  of  integrity  and 
uprightness. 

Passionately  fond  of  music,  and  himself  a  performer 
on  the  violin  and  'cello  of  no  mean  order,  he  thus 
acquired  relaxation  in  the  evening  after  an  arduous 
day's  work.  In  the  Masonic  Order  Sir  Philip  Smyly 
was  greatly  esteemed  and  occupied  a  very  high  position, 
having  received  the  33rd  degree. 

In  his  domestic  relations  he  was  particularly  happy. 
No  man  ever  kept  the  Fifth  Commandment  more 
faithfully  than  he.  His  whole  life  was  an  evidence  of 
his  religious  convictions,  and  truly  indeed  might  his 
epitaph  be:  "I  have  fought  a  good  fight,  I  have 
finished  my  course,  I  have  kept  the  faith." 


He  was  for  some  years  consulting  physician  of  the 
Haydock  and  the  Clifton  Hall  Lunatic  Asylums,  and  in 
1864  was  appointed  consulting  physician  to  Coton  Hill 
Asylum.  In  the  course  of  a  long  and  distinguished 
career  Dr.  Renaud  was  naturally  the  recipient  of  many 
public  and  private  recognitions,  both  inside  and  out- 
side the  professional  side  of  his  life.  Among  his  best- 
known  antiquarian  works  are  his  "  Contributions  to- 
wards a  History  of  the  Ancient  Parish  of  Priestbury," 
an  interesting  short  history  of  the  "  Home  of  Recovery," 
in  Ay  town  Street,  Manchester.  His  career  was  essenti- 
ally that  of  the  gifted,  hard-working,  humane,  and 
cultured  provincial  physician,  a  type  ot  man  ot  whom 
both  the  medical  profession  and  the  community  may 
well  be  proud. 

*   *  

NATHANIEL    ALCOCK,    L.R.C.S.,    L.R.C.P.I., 
R.A.M.C. 

Lieut.-Colonel  Nathaniel  Alcock,  of  the  Royal 
Army  Medical  Corps,  retired,  who  died  at  Bellevue, 
Bally  brack,  county  Dublin,  on  the  4th  inst.servedasa 
surgeon  in  the  Kaffir  War  of  1878.  He  was  a  licen- 
tiate of  the  Royal  College  of  Physicians  and  of  the 
Royal  College  of  Surgeons  of  Ireland,  and  joined  the 
Army  as  an  assistant  surgeon  in  i860,  became  a  surgeon 
in  1873  and  surgeon-major  in  1875,  and  retired  in  1889 
with  the  rank  of  lieutenant-colonel.  He  was  sixty-four 
years  of  age. 


MR.  JOSEPH  MAY,  F.R.C.S. 
A  notable  figure  passed  away  at  Devonport  on 
Sunday  last  at  the  patriarchal  age  of  96,  in  the  person 
oi  Mr.  Joseph  May*  who  had  been  in  practice  in  that 
town  for  over  seventy  years,  during  which  period  he 
was  elected  Mayor  on  four  occasions.  Like  most  of  the 
surgeons  in  the  early  part  of  the  last  century,  he  saw 
much  of  war.  In  183 1,  he  arrived  in  Paris  immediately 
after  the  three  days'  hard  fighting  when  Charles  X. 
was  compelled  to  flee  the  country,  and  helped  to 
attend  the  wounded  who  filled  the  hospitals.  He 
afterwards  joined  the  Polish  Army,  was  appointed 
Surgeon-Major  of  Mjardowa  Hospital,  and  was  present 
at  the  siege  and  fall  of  Warsaw.  A  year  later  he 
settled  down  to  private  practice,  and  at  his  death  was 
supposed  to  be  the  oldest  inhabitant  of  Devonport. 

FRANK    RENAUD,    M.D.Edin.,   M.R.C.S.Eng. 

It  is  with  regret  we  announce  the  death,  at  the  ripe 
age  of  85,  of  the  well-known  Manchester  physician,  Dr. 
Renaud.  He  came  of  ancient  Huguenot  stock,  and 
was  an  authority  and  writer  upon  antiquarian  subjects. 
His  medical  education  was  conducted  in  London  and 
Edinburgh,  and  in  1844  he  took  the  degree  of  M.D.  of 
Edinburgh  University,  with  the  membership  of  the 
London  College  of  Surgeons.  In  1 848  he  was  appointed 
honorary  physician  to  the  Manchester  Royal  Infirmary, 
an  active  connection  which  he  relinquished  only  m 
1892  to  become  honorary  consulting  physician  of  that 
institution.  He  was  also  at  one  time  lecturer  on 
Medical  Jurisprudence  at  the  Manchester  Medical 
School,  and  later  of  Morbid  Anatomy  and  Pathology. 


CAPT.  H.  F.  HAYMES,  R.A.M.C. 
A  Reuter  message  from  Cairo  states  that  Captain 
Haymes,  of  the  Royal  Army  Medical  Corps,  who  was 
recently  wounded  in  an  encounter  with  a  party  of 
Niam-Niams,  died  in  the  Bahr-el-Ghazal  province  on 
March  1 5  th.  Captain  Henry  Evered  Haymes,  M.R.C.S. 
L.A.C.P.,  became  a  lieutenant  in  the  R.A.M.C.  in  1899, 
and  was  promoted  captain  in  1902. 

ROBERT  MAJOR  BROWN,  M.A.,  M.B.Camb.,  J.P. 
Mr.  Robert  Major  Brown,  M.A.,  M.B.Camb..  of 
The  Wilderness,  Spondon,  Derby,  who  had  a  distin- 
guished career  at  St.  Bartholomew's  Hospital  and  at 
Cambridge,  died  last  week,  at  the  Cotswold  Sanatorium, 
at  the  age  of  forty-four.  He  was  admitted  a  member 
of  the  Royal  College  of  Surgeons,  England,  in  1885, 
and  took  the  M.A.  and  M.B.  degrees  at  Cambridge 
in  1888.  While  at  St.  Bartholomew's  he  was  assistant 
demonstrator  of  biology.  Mr.  Brown  was  in  the  com- 
mission of  the  peace  for  Derbyshire. 


flteMcal   Dews. 


Supposed  Accidental  P<  Isonlng  of  an  Edinburgh 
Demonstrator  of  Zoology. 

Mr.  Edward  Pattison  Witten,  B.Sc..  Demon- 
strator of  Zoology  at  the  School  of  Medicine.  Edin- 
burgh, died  under  singular  circumstances  on  Saturday 
at  his  home  in  Sunderland,  where  he  had  been  spending 
a  holiday.  A  week  ago  he  was  seized  with  illness, 
suffering,  apparently  from  an  acute  abdominal  trouble. 
No  natural  cause  of  death  could  be  ascertained,  and  it 
is  thought  the  deceased  succumbed  to  irritant  poisoning. 
It  is  assumed  that  Mr.  Witten  may  have  accidentally 
swallowed  some  poisonous  substance.  Mr.  Witten, 
though  only  twenty-four  years  of  age.  had  had  a 
brilliant  career.  He  was  the  son  of  the  late  Captain 
Witten,  of  Seaham  Harbour.  He  won  a  number  of 
scholarships,  and  received  his  later  education  at 
Rutherford  College,  Newcastle,  and  at  Durham  College 
of  Science,  Newcastle.  At  the  latter  institution  he 
gained  the  Alder  Scholarship  and  took  honours  in 
Zoology.  He  obtained  his  appointment  at  Edinburgh 
about  six  months  ago. 

Central  MidvivM  Board. 

A  meeting  of  the  Central  Midwives  Board  was  held 
at  the  Board  Room,  Suffolk  Street,  S.W.,  on  March  24th, 
Dr.  F.  H.  Champneys  in  the  chair.  On  consideration 
of  applications  for  approval  of  certificate  as  a  qualifi- 
cation the  certificate  of  the  National  Maternity  Hos- 
pital, Dublin,  was  approved.   .The  following  institu- 


April  13,1904. 


PASS  LISTS. 


tions  were  approved  for  the  training  of  midwives,  sub- 
ject to  an  undertaking  to  comply  with  the  require- 
ments of  section  E  of  the  rules  : — Birmingham  Work- 
house Infirmary,  Bristol  Royal  Infirmary,  Brownlow 
Hill  Workhouse  Hospital,  Liverpool,  Essex  County 
Cottage  Nursing  Society,  Gloucester  District  Nursing 
Society,  Hull  Lying-in  Charity,  Ipswich  Nurses' 
Home.  Certain  registered  medical  practitioners  were 
approved  as  teachers  and  midwives  for  the  purpose 
of  signing  certificates  of  attendance.  After  considera- 
tion of  applications  the  names  of  849  women  were  ordered 
for  entry  on  the  Roll.  The  following  table  shows 
the  separate  numbers  of  the  various  qualifications  at 
present  entered  on  the  Roll : — Royal  College  of  Physi- 
cians of  Ireland.  1  ;  Obstetrical  Society  of  London. 
953  ;  Rotunda  Hospital,  43  ;  Coombe  Hospital,  12  ; 
Queen  Charlotte's  Hospital,  52  ;  Liverpool  Lying-in 
Hospital,  15  ;  British  Lying-in  Hospital,  2  ;  Glasgow 
Maternity  Hospital,  32  ;  St.  Mary's  Hospital,  Man- 
chester, 53  ;  City  of  London  Lying-in  Hospital,  6 ; 
Royal  Maternity  Hospital,  Edinburgh,  5  ;  Salvation 
Army  Maternity  Hospital,  3  ;  women  in  bona-fide 
practice,  July,  1901,  2,238  ;  total  enrolled,  3,415. 
Boyal  Institute  of  Public  Health. 

Good  progress  is  being  made  with  the  arrangements 
for  the  Annual  Congress  of  the  Royal  Institute  of  Public 
Health,  to  be  held  at  Folkestone  next  July.  There 
will  be  sections  for  preventive  medicine.  Municipal  and 
Parliamentary  subjects,  comparative  pathology,  bac- 
teriology, and  chemistry,  engineering  and  building 
construction,  child  study,  and  school  health  (of  which 
Sir  George  Kekewich  is  President),  and  a  ladies'  section 
(with  the  Countess  of  Radnor  as  President).  The 
Committee  have  also  decided,  in  view  of  Shorncliffe 
Camp  and  Dover  Garrison  being  so  near  at  hand,  to 
have  a  Military  section  for  the  discussion  of  such  sub- 
jects as  early  military  training  and  tropical  medicine. 
The  programme  of  festivities  will  be  an  attractive  one. 
In  addition  to  other  fixtures,  Lord  Radnor  (the  Presi- 
dent) will  give  a  reception  and  an  evening  entertain- 
ment, and  Sir  Edward  Sassoon,  M.P.,  a  garden  party. 
The  trips  to  other  towns  will  include  visits  to  Canter- 
bury and  Boulogne,  the  Mayors  of  both  cities  having 
promised  assistance. 

Greth&m  Lectures. 

Dr.  E.  Symes  Thompson,  Gresham  Professor  of 
Medicine,  will  deliver  a  course  of  four  lectures  on 
"Heredity  and  Evolution,"  in  Gresham  College, 
Basinghall  Street,  London,  E.G.,  on  April  19th,  20th, 
21st,  and  22nd,  at  6  o'clock  each  evening.  The  course 
is  entirely  free,  and  it  may  be  mentioned  en  passant,  that 
the  present  is  the  learned  professor's  one  hundred  and 
ninth  course  at  the  College. 

Royal  College  of  Surgeons  In  Ireland. 
Prize  List,  Winter  Session,  1003-1004. 

Descriptive  Anatomy. — Junior:  D.  P.  Clement,  1st 
prize  (£2)  and  medal ;  G.  S.  Levis,  2nd  prize  (^1)  and 
certificate.  Senior :  D.  Adams,  1st  prize  (£2)  and 
medal ;  P.  G.  M.  Elvery,  2nd  prize  (^1)  and  certificate. 

Practical  Anatomy. — First  Year  :  G.  S.  Levis,  1st 
prize  {£2)  and  medal;  D.  P.  Clement,  2nd  prize  (^1) 
and  certificate.  Second  Year  :  P.  G.  M.  Elvery,  1st 
prize  (£2)  and  medal ;  T.  A.  Buchanan,  2nd  prize  (^1) 
and  certificate. 

Practice  of  Medicine. — R.  Bury,  1st  prize  (£2)  and 
medal;   P.  D.  Sullivan,  2nd  prize  (£1)  and  certificate. 

Surgery. — J.  S.  Dunne,  1st  prize  (£2)  and  medal ;  R. 
Bury  and  F.  Ly burn,  equal,  2nd  prize  (^1)  and  certifi- 
cate. 

Midwifery. — J.  S.  Dunne,  1st  prize  (£2)  and  medal ; 
R.  A.  Brown,  2nd  prize  (^1)  and  certificate. 

Physiology. — D.  Adams,  1st  prize  (£2)  and  medal ; 
T.  Sheefiy,  2nd  prize  (/i )  and  certificate. 

Chemistry. — D.  P.  Clement,  1st  prize  (£2)  and 
medal ;  A.  E.  S.  Martin,  2nd  prize  (£1)  and  certificate. 

Pathology. — L.  Lucas,  1st  prize  (£2)  and  medal ; 
P.  D.  Sullivan,  2nd  prize  (£1)  and  certificate. 

Physics. — A.  E.  S.  Martin,  1st  prize  (£2)  and  medal ; 
W.  0.  Rjgway,  2nd  prize  (/i)  and  certificate. 

The  lectures  and  practical  courses  of  the  Summer 
Session  will  commence  on  Monday,  April  1  ith. 


The  Medical  Press.      41 1 
PASS  LISTS. 


Universities  of  Aberdeen. 

Ths  following  degrees  were  conferred  at  the  Gradua- 
tion ceremony  on  April  6th  : — 

Degree  of  Doctor  of  Medicine  (M.D.). — Thomas 
Barrett  Heggs,  M.B.,  Ch.B.,  Charles  Hunter,  M.A.. 
M.B.,  Ch.B..  Robert  Donald  Keith,  M.A..  M.B.,  Ch.B. 
(Honours),  Ronald  Cadeil  Macdonald,  M.B.,  CM.  (under 
old  regulations),  Alexander  Reid,  M.B.,  CM.  (under 
old  regulations). 

Degrees  of  Bachelor  of  Medicine  (M.B.)  and  Bachelor 
of  Surgery  (Ch.B.) : — James  Clark  (First  Class  Honours). 
Passed  the  Final  Exam,  with  much  distinction. 
Francis  Hernaman- Johnson  and  Archer  lrvine-Fortes- 
cue  (Second-Class  Honours).  Passed  the  Final  Exam, 
with  "Distinction."  Ordinary  Degrees  : — George  Adam, 
M.A.,  Francis  Anderson,  William  Beedie,  Alex.  Dyce 
Davidson,  M.A.,  Francis  William  Davidson,  Alexander 
Duguid,  M.A.,  James  Farquhar,  M.A.,  Alexander 
Flett,  James  Alex.  Gibb,  James  Smith  Gray,  M.A., 
John  Dunlop  Henderson,  John  Hunter,  Alex.  Hutchi- 
son, M.A.,  Herbert  Mather  Jamieson,  Neil  Kennedy, 
M.A.,  Wm.  Wilfrid  James  Lawson,  Donald  McKay, 
M.A.,  Malcolm  MacLeod,  Charles  Grant  Macmahon, 
Wm.  Martin  McPherson,  Alexander  McRobbie, 
Archibald  Douglas  Pringle,  James  Robertson,  Alex. 
Nicholas  Ross,  Bertie  Ronald  Gordon  Russell,  Herbert 
William  Black  Ruxton,  Wm.  Alex.  Smith,  Wm.  Wood. 
Passed  Final  Exam,  with  "  distinction." 

Diploma  in  Public  Health  : — Edward  James  Bruce, 
M.B.,  Ch.B.  Aberd..  John  Macdonald,  M.B..  C.M.,Edin., 
George  Mitchell,  M.B..  Ch.B.,  Aberd.,  William  Robinson 
Pirie,  M.B.,  Ch.B.,  Aberd.,  Cornelius  Agnew  Suvoong, 
M.A..  M.B.,  Ch.B.,  Aberd..  Alexander  Wal\  M.B., 
Ch.B.,  Aberd. 

UnlYereity  of  Glasgow. 

At  the  recent  professional  examinations  for  the 
Degrees  of  M.B.,  Ch.B.,  the  following  candidates  passed 
with  distinction  in  the  subjects  indicated  : — 

First  Examination. — In  Zoology  and  Physics. — 
William  Aikman  Muir.  In  Zoology  and  Chemistry — 
Thomas  Edmonstone  Gray,  Peter  Russell  M'Naught, 
Archibald  Campbell  Munro.  In  Physics  and  Che- 
mistry— Alexander  Thomas  Arthur  Gourlay.  In  Bo- 
tany— Margaret  Gardner  Forrest,  Peter  Cunningham 
M' Arthur,  M.A.  In  Zoology — John  Lindsay  Boyd, 
Benjamin  Hutchinson,  Robert  M'Kenzie  Morison, 
M.A.,  Albert  Rutherford  Paterson,  Ralph  Mont- 
gomery Fullarton  Picken.  In  Physics — Walter  Daw- 
son, James  Kirkwood  Dunlop,  Mabel  Folev,  Josiah 
Stranaghan  Harbinson,  Archibald  Hogg,  Alexander 
Campbell  MacDougall,  Francis  William  Mackichan, 
James  M'Millan  M'Millan,  Edward  Quigley.  Thomas 
David,  Coulthard  Ross,  Jessie  Cappie  Russell,  Allan 
Semple,  James  Brown  Sim,  Hugh  Cochrane  Storrie, 
Charles  Percival  Williamson,  Hugh  Mundle  Wilson. 
In   Chemistry — John   Cruickshank,    Berkeley   Gale. 

Second  Examination. — In  Anatomy,  Physiology, 
and  Materia  Medica  and  Therapeutics. — David  Lau- 
rence Alexander  Tate.  In  Anatomy  and  Physiology — 
Peter  Mitchell,  M.A.,  Alfred  Cecil  Sharp.  In  Ana- 
tomy— Rober  M'Cowan  Hill.  In  Physiology' — Charles 
James  Colquhoun  Macquarie,  William  James  Ruther- 
ford. 

Society  of  Ipotheearlei  of  London 
Preliminary  Examination,  Part  II. 

The  following  candidates  passed  in  : — 

Anatomy. — I.  R.  Fearn,  J.  W.  Featherstone,  T.  S. 
Harrison,  R.  J.  W.  McKane.,  A.  W.  C  Miller,  F.  B. 
O'Dowd.  H.  V.  White,  F.  H.  P.  Wills,  R.  P.  Wylde. 

Physiology.— A.  C.  Dickson,  I,  R.  Fearn,  J.  C 
Fletcher,  J.  W.  Featherstone,  W.  J.  G.  Gay  ton,  T.  S. 
Harrison,  A:  W.  C  Miller,  F.  B.  O'Dowd,'  H.  V.  White, 
F.  H.  P.  Wills.  

TrntBE  further  cases  of  small-pox — from  Poplar, 
Bethnal  Green,  and  Islington  respectively — have  • 
been  admitted  to  the  Rotherhithe  shelters.  At 
noon  126  patients  remained  under  treatment  at 
the  Joyce  Green,  Dartford,  and  other  London 
fever  hospitals. 


412    The  Medical  Press.       NOTICES  TO  CORRESPONDENTS. 


April  13.  1904. 


^lotites  to 
Correspondents,  $hori  fetters,  &c 

WGF  Oorrrrpoh  drkti  requiring  *  reply  in  this  column  are  particu- 
larly requested  to  make  use  of  a  distinctive  gignaturt  or  initial,  and 
avoid  the  practice  of  signing  themselves  "Reader,"  "Subscriber," 
4 'Old  Subscriber,"  6c.  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

Ormucal  Articles  or  Lrttrrs  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

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

Reprints— Reprints  of  articles  appearing  in  this  journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

Bestlrbr.—  A  high  bracing  climate  might  be  tried 

Oe.  O.  C-  There  need  be  no  hesitation  with  legard  to  the  photo- 
graph of  the  case  illuH  ated  in  youi  article.  The  process-block  maker 
can  readily  blot  out  the  face  so  as  to  prevent  identification  of  patient. 

R.  F.  WilliamsoK.— We  take  it  that  the  discovery  of  radium  in  the 
mineral  waters  of  your  native  town  is  not  likely  to  affect  either  the 
popularity  or  the  efficacy  of  the  springs  to  any  material  extent.  All 
the  same,  as  you  say.  it  affords  a  good  advertisemeut. 

DisrftNS4RT  M  D  (Birmingham).  -If  the  patient  has  a  lead  opacity  of. 
the  cornea  due  to  the  use  of  a  lead  lotion  prescribed  by  a  chemist  on  his 
own  authority,  it  seems  ro^re  than  probable  that  an  action  for  damages 
could  be  made  good  against  the  chemist.  The  use  of  lead  as  an  eye 
lotiou  has  been,  we  Deli  eve.  abandoned  for  some  time  by  scientific 
ophthalmologists.  It  is  quite  easy  to  obtain  therapeutic  effects  equal 
to  those  of  lead  by  the  use  of  other  ageute. 

MEDICAL  BOOKS  BOUND  IN  HUMUS'  SKIN. 

According  to  the  Critic,  the  late  Dr.  P.  Stockton-Hough,  of  Tren- 
ton, who  left  a  valuable  medical  library  in  several  languages,  had  a 
fancy  for  bindings  made  of  human  s  *  in.  He  owned  at  least  six  books 
thus  bound.  Oue  of  them,  "Catalogue  des  sciences  Medicate* 
Bibbotheque  Nationale  a  Pa* is*'  (1857-78),  is  a  large,  very  thick 
quarto  half  bound  in  skin  from  the  back  of  a  man.  On  the  fly -leaf 
of  a  second  book,  "t?owper  on  Impregnation "( 1789),  the  owner 
wrote  :  "  Bound  in  leather  tanned  from  the  skin  of  the  thigh  of  Maria 
L.,  affected  with  encysted  trichinae,  who  died  of  consumption  in  the 
Philadelphia  Hospital.'  Maria  L.  also  furnished  the  binding  for 
three  other  books :  "  Das  Buoh  der  Liebe,  oder  das  Geschlechtsleben 
inseimen  ganxem  Umfaoge  " ;  Barles's  •  Parties  de  la  Generation," 
and  ••  Recuel  des  Secrets  de  Louyse  Bourgeois.*'  the  famous  French 
midwife. 

Rikowood.— The  slow  course  of  some  forms  of  scirrhus  carcinoma 
is  remarkable.  la  one  recorded  case  a  scirrhus  of  the  breast  gave 
rise  to  a  secondary  growth  five  years  later  on  the  collar  bone,  and  five 
years  later  again  in  another  part  of  the  body.  A  far  earlier  general- 
isation, however  is,  of  course,  the  rule. 

8C0TU8.— Parrot's  nodes  are  usually  regarded  as  evidence  of  syphilis 
especially  when  found  together  with  an  enlarged  spleen.  A  good 
account  of  the  subject  will  be  found  in  Dr.  George  Carpenter's  Mono- 
graph on  Syphilis  in  Cbildren  (Bailliere). 

Hastiwo«  Practttiokrr.— We  should  consider  it  unwise  for  you  to 
wait  until  the  defence  organisation  of  the  British  Medical  Association 
becomes  an  established  fact  So  far  as  can  be  judged  at  present  that 
event  may  be  expected  about  the  Ides  of  March.  It  would  be  far 
better  for  you  to  strengthen  the  hands  of  one  of  the  exist  log  defeoce 
unions  bv  becoming  a  member  forthwith.  Professional  dangers  much 
resemble  the  disease  that  stalketh  by  day,  and  no  man  can  tell  when 
and  where  he  may  be  attacked.  A  ten  shining  annual  subscription 
paid  to  a  substantial  society,  like  the  Medical  Defence  Association, 
is  one  of  the  best  possible  of  a  1  insurance  premiums. 

J.  R.  P.  (Parkstone).    Your  suggestions  are  exce  lent.    The  text- 
books are  far  too  given  to  quote  a  list  of  remedies  without  comment, 
and  to  give  prominence  to  remedies  that  are  novel .  ephemeral  and  in 
nine  cases  out  of  ten,  wo  thless.    For  all,  it  would  be  a  pity  to  use  the  ! 
useful  tenth  remedy  for  the  sake  of  the  unworthy  nine.    Thei e  can 
be  little  doubt  that  an  immense  amount  of  va'uable  information  ' 
acquired  in  the  routine  of  general  practice  is  lost  in  thin  sir,     Nor  is  i 
it  clear  how  such  information  oou  a  be  collated  and  sifted. 

Mrs.  Wyse  Power  —Your  letter  was  not  received  in  time  to  ' 
appear  in  the  last  supplement  of  the  Medical  Press  akd  Circular 
and  consequently  could  not  appear  before  the  issue  of  the  next  num- 
ber. We  venture  to  suggest  that,  if  the  same  tone  is  used  In  speaking; 
of  and  to  medi-al  officers  of  the  North  Dublin  Union  as  has  been  used 
in  speaking  of  the  Editor  of  the  Medical  Press  ard  Circular,  it  is 
not  difficult  to  dete  mine  the  cause  of  the  late  friction. 


W.C.).— 4  p  m.    Mr.  J.  Berry :   Clinique.      (Surgical.)     5.15  p.m. 
Dr  H.  Tiiley :  Nasal  Discharges-their  Diagnosis  and  Treatment 
Thursday,  April  14th. 
British  Balneological  and  Climato  logical  Society  (20  Hanover 
Square  W.).    8  80  p.m.    Discussion  on  Obesity  (reopened  by  Dr.  W 
Bain,  Harrogate). 

Rotal  College  ok  Physicians  or  Loiroov  (Pall  Mall  East).— 5  p.m. 
Dr.  G.  Oliver  :  Recent  Studies  on  the  Tissue  Lymph  Circulation 
J  (Oliver-Sharpey  Lecture.) 

I      Medical  Graduates'  Collrgc  and  Polyclinic  (22  Cbenies  8treet, 
W.CMpm.     Mr.  Hutchinson.  Clinique.    (Surgical.)    5.16  p.m. 
1  Dr.  W.  e.  A.  Griffith  :  Gonorrhoea  in  Women. 

I  Friday,  At*RiL  15th. 

Epidemiological  Rocibty  or  London  (11  Chandos Street-,  Cavendish 

Square,  W  ).- 8  p.m.    Council  Meeting.    8.30  p.m.  Meeting. 
Society  for  yiie   Study  or  Disrase  iv  Children  (11  Chandoi 
<  8treet,  Cavendish  Square,  W  ).— 5.30  p.m.     Cases  will  be  shown  b> 
;  Dr.  H.  Ashby,  Dr.  Hawthorne,  Dr.  J.   Taylor,  Dr.  Morison,  Dr.  A. 

Nmith,  i>r.  F.  Buzzard,  Mr.  8.  Stephenson,  and  Mr.  Pernet.     Paper* 

by  Mr.  L.  Bid  well.  D<\  O.  Carpenter,  and  Mr.  R.  Dun. 
!  Z  Mbdical  Graduate'  College  ard  Polyclinic  (22  Cbenies  Street, 

W.C.). -4  p.m.    Dr.  K.  Waggett :  Clinique.     (Ear.) 

Bury  Infirmary.— Senior  House  Surgeoo.     Salary   a: 1 10,  with  board. 

residence,  and  attendance.     Application  to  the  Hon.  Secretary, 

Dispensary  'Knowsley  Street,  Bury.  Lancashire. 
Great  Yarmouth  Hospital.— House  burgeon.    Salary  £90  per  annum. 

with  board,  lodging,  and  washing.     Applications  to  Richard  F.  E. 

Ferrier,  Honorary  Secretary,  88  Hall  Plain,  Great  Yarmouth. 

Royal  Sei-Bathing  Hospital,  Margate.     Resident  8urgeon.      Salary 

|         £80  per  annum,  with  board  and  Resideooe.     App  ications  to  the 

becietary,  R.S.B.H.  Offices,  18  Charing  Cross,  London.  S.  W. 
Royal  City  of  Dublin  Hospital.— Roentgen  Rayist.     Applications  to 

Mr.G.  Jamesoi  Johuston,  F  R.C.S  f  Hon.  Sec.  Medical  Board, 

(See  advu). 
Tiverton,   Devonshire  -Infirmary'  and  Dispensary.— House  Surgeon 

and  Dlspe  ser.  Salary  £80  per  annum  and  all  found.  Applications' 

to  ArthurfFisher,  Hon.  Secretary. 
Torquay.  -Medical  House  for  sale  with  Turkish,  Russian,  Medical, 

and  Electric  Baths.    (See  Advt.) 
The  Middlesex  Hospital,  W  -First,  Second,  and  Third  Assistants  to 

the  Director  of  the  Cancer  Research  Laboratories  at  the  Middle 

sex  Hospital.    Salary  of  the  First  Assistant  £200  a  year.  Second 

£150,  Third  £100.    Applications  to  F.  Clare  Melhado,  Secretary 

Superintendent. 
Warwick  County  Asylum,  Hatton,  near  Warwick.— Assistant  Medical 

Officer.    Salary  £180  per  annum,  with  apartments,  board,  Ac 

Applications  to  the  Medical  Sunt. 
West  Kent  General   Hospital,  Maidstone. -House  Surgeon.    Salary 

£120  f per  annum,  »with  board  and   residence.     Applications  to 

W.  C.  Lewis,  Secretary. 


^ppointmeniB. 


j  Griffith,  W.  S.,  M.B.,  C.M.Edin.,  Certifying  Surgeon  under  the  Far- 

,         tory  Act   for   the  Mildford   Haven    District  of  the   county  of 

■         Pembroke 

[Janes.    Walter  T,  M.B  ,  Ch.B.Edin,  Second    Assistant   Medical 
Officer  to  the  Joint  Counties  Asylum,  Ct»tmarthen. 
Jrfkarks,    J.,   L.B.O.P.,    L.R.C8.Edin.,    L.F.P.S.Glas.,    Certifying 

1         Surgeon  under  the  Factory  Act  for  the  Kegworth  District  of  the 

;         county  of  Leicester. 

I  Jones,  Herbert,  L.R.C.S  Irel.,  D.P.H.,  Honorary  Bacteriologist  to 

.         the  Herefordshire  General  Hospital,  Hereford. 

!  Stumbles.  H.  M.,  M.B.,  B.S  Edin.,  Certifying  Surgeon  under  the 
Factory  Act  for  the  Amble  District  of  the  county  of  Northumber- 
land. , 

I  Thomas,  Jour  Lewis.  MR.C.S.,  L.8.A.,  Medical  Officer  of  Health  of 
the  Brynmawr  Urban  District. 

1  Young,  C.  W.  F.  M.D.Lond.,  F.R  C&  ,  County  Medical  Officer  to  the 
Middlesex  County  Council 


ductings  of  the  Societies,  $ectares,  &c. 

Wbdhrsday  April  isth 

Hcxteria*  8ociett  (London  Institution,  Finsbury  Circus,  E.C.).— 
$.30  p  m.    Clinical  Evening. 

Dbrmatolooioal  80CIRTY  op  LoffDftK  (11  Chandos  Street,  Cavendish 
Square.  W.).— 6 15  p.m.    Demonstration  of  Cases  of  Interest. 

Socth- West  London  Medical  Society  (Bolingbroke  Hospital, 
Wandsworth  Common).— 8.45  p.m.    Clinical  Evening. 

Mkdical  Graduate*'  CoLLRoa  ard  PoLYCLWic  (22  Chenies  Street, 


girths. 

Butler.— On  April  8  h.  at  Westfleld,  Flaxton,  York,  the  wife  of 

William  Barber  Butler,  M.R.C.8.,  of  a  son. 
Roger-Smith.— On  April  ttth,  at  1  College  Terrace,  Hampstead,  the 

wife  of  Hugh  Roger-Smith,  M.D.,  of  a  daughter. 

(4ttarriage*. 

Hollist- HoDOftov.— On  April  7th,  at  8t.Margaret's  Church,  Lee,  Kent 
Gerald  Wetherell  Capron  Hollist,  M  R.CJB.,  second  ton  of  Lieut.- 
Col.  Hollist,  J.P.,  D.L.,  of  Lodworth,  Petworth,  Sussex,  to  Kuby. 
twin   daughter  of  Nevill  L.  Hodgson,  Esq.,  of  Woolwich  and 

MACKRWiR~Asirrox.-On  February  23rd.,  at  Koochpw.  the  Bev. 
Marcus  Mackeusie,  B.A..M.B..O.M.,  to  Agnes  Elisabeth  Maud, 
fourth  daughter  of  the  late  Rev  John  Aston,  of  Cheltenham. 

Zellweger- Vincrrt -Jacksor.-Oti  April  6th,  at  Ht  Paul's  Kingston 

Hill.l  Richard  Zellweger,  of  Marseilles,  to  Winifred,  daughter  of 

the  late  Chas.  Jas.  Symonds,  M.R.C.8.  L.R  OP.,  of  Southampton, 

and  widow  of  the  late  T.  Vlncent-Jackaon,  J.P.,  F.R.C.8.,  of 

\        Wolverhampton. 

geatit*. 

PirrocR.-On  April  8th,  at  Victoria  Villa, .Vernon  PUce. ,<**«*"'£ 
Francis  William  PHtoc*,  M.D.,  eldest  eon  of  the  late  Wiffiam 
Pittock,  surgeon,  of  Eltham,  Kent,  aged  88. 


lb*  fWcdinil  %tm  and   We 


"SALUS   POPULI   SUPREMA    LEX." 


Vol.  CXXVIII. 


WEDNESDAY,    APRIL  20,    1904. 


No.    16. 


©rtoinal  Communications. 
PRIMARY  SARCOMA 

OF  THE 

VAGINA    IN    THE    ADULT, 

WITH    THE    NOTES    OF    A    CASE. 

By  HENRY  JELLETT,  M.D.,  F.R.C.P.I.. 

Gynecologist  to  Steevens'  Hospital,  Dublin  ; 

AND 

H.  C.  EARL,  M.D..  F.R.C.P.I., 
Pathologist  to  the  Richmond  Hospitals,  Dublin. 

Sarcoma  of  the  vagina  is  so  rare  a  condition  that  I 
feel  that  I  need  make  no  apologies  for  publishing  the 
present  specimen,  and  for  taking  advantage  of  the 
opportunity  to  make  a  few  remarks  on  sarcoma  of 
the  vagina  in  general.  So  far  as  I  can  ascertain,  this 
is  the  first  specimen  of  the  kind  that  has  been  recorded 
in  Ireland. 

Case. — A  woman,  M.  T.,  aet.  55,  came  to  me  in  August 
last  at  Sir  Patrick  Dun's  Gynaecological  Dispensary, 
where  I  was  at  the  time  doing  duty  for  Sir  Arthur 
Macan.  She  gave  the  following  history  : — Age  55, 
nine  children.  Last  pregnancy  eleven  years  ago. 
Menstruation  ceased  five  years  ago.  Two  years  pre- 
vious to  the  present  date,  she  noticed  the  occurrence  of 
a  fairly  profuse  white  discharge,  which  persisted  for 
about  six  months,  and  then  became  purulent.  It  has 
continued  up  to  the  present,  and  at  times  contains  traces 
of  blood.  The  patient  considers  that  she  has  been 
getting  progressively  weaker  during  the  last  twelve 
months.  At  times  she  is  seized  by  attacks  of  dizziness, 
followed  by  extreme  drowsiness,  both  of  which  again 
pass  off  completely.  Her  appetite  is  bad,  and  she  is 
getting  thinner.  Pain  is  absent,  but  she  complains  of 
weakness  of  the  back.  She  informs  me  that  she  has 
not  lived  with  her  husband  for  the  last  twelve  months, 
and  for  the  two  years  previous  to  that  only  very 
occasionally.  The  bowels  are  fairly  regular.  The 
urine  is  passed  in  normal  quantities,  but  for  the  last 
four  or  five  months  has  been  escaping  involuntarily  at 
times,  due  probably  to  weakness  of  the  sphincter.  In 
appearance,  the  patient  is  a  tall,  thin  woman,  very 
sallow,  and  looking  rather  more  than  her  age. 

On  separating  the  labia,  the  mucous  membrane  at 
the  vulvo- vaginal  junction  is  seen  to  be  completely 
changed  in  character,  and  to  present  instead  of  its  nor- 
mal characteristics  the  appearance  shown  in  the  plate. 
There  is  an  oval  area  of  what  is  at  first  sight  apparently 
congested  and  hypertrophied  mucous  membrane.  This 
area  is  defined  below  from  the  skin  covering  the  labia 
minora  and  surrounding  parts  by  two  sharply  cut  and 
sinuous  edges,  which  start  in  front  just  behind  the 
clitoris  and  run  backwards,  one  at  each  side,  along  the 
inner  surface  of  the  labia  minora  to  meet  at  the  anterior 
edge  of  the  perineum.  The  surface  of  the  included 
area  lies  below  the  level  of  the  surrounding  parts,  but 
as  it  is  covered  over  with  irregular  bosses  or  tubercles, 
this  is  only  noticeable  in  certain  places,  notably  on  the 
posterior  vaginal  wall.     These  bosses  furnish  the  most 


characteristic  part  of  the  growth.  Some  are  rounded 
tumuli,  while  others  are  blunt-topped  ridges.  They 
are  not  unlike  the  sub-amniotic  bosses  which  are  found 
in  cases  of  decidual  endometritis,  but  are  widely 
different  in  causation. 

Anteriorly,  a  curious  flap  is  present  beneath  the 
orifice  of  the  urethra  ;  its  position  and  form  are  clearly 
shown  in  the  drawing.  When  the  patient  first  pre- 
sented herself  at  the  dispensary  it  was  very  marked, 
but  while  she  was  under  treatment  it  became  smaller. 
At  the  time  of  operation  it  was  only  half  its  former 
size,  and  has  become  still  further  shrunken  in  the 
specimen.  It  was  probably  due  to  a  chronic  in- 
flammatory process  which  subsided  under  treatment. 
On  separating  the  vaginal  walls  with  the  finger  the 
extent  of  their  involvement  can  be  seen.  Anteriorly, 
the  growth  is  limited  in  an  upward  direction  by  the 
flap  already  alluded  to.  Laterally,  it  extends  upwards 
on  the  right  side  about  an  inch  and  a  half,  and  on  the 
left  side  about  an  inch.  Posteriorly,  its  outline  is 
curious,  and  appears  to  take  almost  the  exact  course 
of  a  recent  perineal  laceration.  The  limiting  edge 
starts  at  the  left  side  of  the  junction  of  the  posterior 
and  lateral  vaginal  walls  about  half  an  inch  above  the 
vulvo-vaginal  junction,  runs  straight  upwards  to  a 
point  nearly  two  inches  above  the  perineum,  and  then 
comes  straight  down  again  so  as  to  form  a  very  sharp- 
angled  inverted  V.  This  brings  it  to  a  point  on  the 
median  raphe  of  the  posterior  wall  nearly  an  inch  above 
the  perineum,  from  which  it  again  runs  upwards  to  form 
a  second,  though  much  shallower,  inverted  V  on  the 
right  side  of  the  median  line.  From  here  it  runs  across 
the  right  lateral  wall,  as  has  been  described,  about  an  , 
inch  and  a  half  above  the  vaginal  orifice.  The  pos- 
terior edge  is  not  only  sharply  cut  but  undermined, 
and  I  think  that  there  can  be  but  little  doubt  that  its 
course  has  been  determined  by  the  presence  of  an  old 
perineal  laceration.  The  surface  of  the  growth  is 
covered  by  a  purulent  discharge.  The  entire  area  is 
firmer  in  consistence  than  the  surrounding  parts,  into 
which  it  imperceptibly  passes.  The  growth  does  not 
i  penetrate  deeply,  but  is  apparently  confined  to  the 
I  vaginal  wall  and  the  adjacent  tissue. 
I  The  vaginal  walls  above  the  growth  are  markedly  in- 
flamed, and  here  and  there  are  small  prominences 
!  resembling  those  found  in  granular  vaginitis  and  pro- 
|  bably  similar  to  them  in  origin.  The  mucous  mem- 
I  brane  of  the  vaginal  portion  of  the  cervix  is  also  deeply 
I  congested.  It  may  also  be  noted  that  the  passage 
1  of  the  speculum  caused  slight  haemorrhage  from  the 
narrowed  vaginal  orifice,  but  did  not  give  rise  to  any 
pain.     Indeed,  the  parts  were  curiously  insensitive. 

As  the  diagnosis  of  the  case  was,  to  say  the  least, 
]  obscure,  I  endeavoured  for  the  next  fortnight  to  bring 
.  the  vagina  to  a  more  aseptic  condition  by  the  use  of 
■  vaginal  douches,   insufflations  of  iodoform,   and   the 
tamponnading   of    the    vagina    with  plugs  soaked  in 
ichthyol  and  glycerine.     This  reduced  the  amount  of 
purulent  discharge  and  eventually  caused  a  shrinkage 
of  the  small  anterior  flap  to  which  I  have  alluded,  but, 
as  might  be  expected,  produced  no  effect  on  the  re- 
mainder of  the  growth.     Accordingly,  I  removed  one 
of  the  small  bosses  at  the  junction  of  the  posterior  and 


414    The  Medical  Pees*.         ORIGINAL  COMMUNICATIONS. 


April  20,  1904. 


lateral  wall  for  examination.  The  removal  caused  no 
pain,  but  a  little  persistent  haemorrhage,  which  was 
stopped  by  the  application  of  adrenalin.  Dr.  Moorhead, 
who  was  then  assistant  physician  to  the  hospital,  very 
kindly  cut  several  sections  of  the  removed  portion  for  me, 
and  haying  examined  it,  expressed  the  opinion  that 
it  was  either  sarcomatous  in  nature  or  a  mass  of  chronic 
inflammatory  tissue.  The  sections  were  then  submitted 
to  two  pathologists  in  the  persons  of  Dr.  Earl  and 
Professor  O'Sullivan.  Both  gentlemen  declined  to 
commit  themselves  absolutely  without  examining 
another  piece  of  growth  ;  both  considered  that  the 
growth  presented  many  points  of  resemblance  to 
a  sarcoma  ;  but,  while  one  considered  that  it 
probably  was  sarcomatous,  the  other  considered 
that  it  probably  was  not  sarcomatous,  but  a  chronic 
inflammatory  process. 

By  this  time,  the  patient  had  been  under  treatment 
regularly  twice  a  week  for  a  period  of  three  or  four 
weeks,  without  any  benefit  save  a  diminution  in  the 
amount  of  purulent  discharge,  and  a  corresponding 
alleviation  of  her  symptoms.  On  the  other  hand,  it 
appeared  to  me  that  when  the  growth  was  grasped 
between  the  fingers  and  thumb,  its  base  had  become 
slightly  more  infiltrated.  Accordingly,  I  decided  to 
remove  it. 

Operation. — The  removal  of  the  growth  necessitated 
the  removal  at  the  same  time  of  at  least  the  lower  third 
of  the  vagina,  and  I  was  at  first  rather  doubtful  as  to 
whether  the  accompanying  haemorrhage  might  not 
render  the  operation  difficult.  However,  this  was  not 
so,  and  the  actual  operation  was  comparatively  easy. 
I  commenced  by  injecting  into  the  base  of  the  tumour, 
at  some  half-dozen  different  points,  a  few  minims  of  a 
1  in  5,000  solution  ot  adrenalin,  and  to  this  was  pro- 
bably due  the  fact  that  the  operation  was  comparatively 
bloodless.  The  incisions  were  commenced  in  front,  at 
the  base  of  the  clitoris  anterior  to  the  urethral  orifice, 
and  deliminated  the  anterior  quarter  of  the  growth. 
The  urethra  was  then  dissected  out,  and  its  terminal 
portion  removed.  The  incisions  were  then  carried 
backwards  so  as  to  completely  surround  the  vagina, 
and  partly  with  the  scissors  and  partly  by  separation 
with  the  fingers,  the  lower  third  of  the  vagina  was 
completely  isolated  from  the  surrounding  parts.  As 
soon  as  this  separation  had  extended  well  above  the 
growth,  the  vaginal  wall  was  divided  circularly,  and 
the  lower  portion  removed  as  a  complete  ring. 

Anteriorly,  the  cut  end  of  the  urethra  was  then 
sutured  to  the  cut  edges  of  the  inner  surfaces  of  the 
labia  minora,  and  posteriorly  and  laterally,  the  divided 
vaginal  wall  was  easily  drawn  down  and  sutured  to  the 
perineum  and  lateral  cut  edges  of  the  skin.  There 
was  no  difficulty  in  drawing  down  the  wall  save  at  one 
point  on  the  right  side,  where  the  growth  had  extended 
outwards  and  upwards  more  deeply  than  elsewhere, 
and  here,  in  consequence,  there  was  some  tension  on 
the  sutures.  The  haemorrhage  during  the  operation 
was  very  slight,  and  only  a  few  small  vessels  had  to  be 
ligated.  Finally,  the  vagina  was  plugged  with  iodo- 
form gauze  and  a  firm  pad  applied  externally  with  a 
T-bandage. 

Convalescence  was  uneventful,  and  I  removed  the 
sutures  on  the  eighth  day.  Union  was  satisfactory 
all  round  save  at  the  point  on  the  right  side  where 
there  had  been  tension  on  the  sutures.  Here,  the  latter 
had  cut  through  and  the  vaginal  wall  had  retracted 
upwards,  leaving  an  ugly  gaping  cavity.  This,  however, 
rapidly  granulated  up,  and  the  patient  left  the  hospital 
on  October  3rd,  three  weeks  after  the  operation. 

After -History. — The  patient  came  back  to  see  me  on 
November  9th.  She  stated  that  her  general  health 
was  extremely  good,  that  her  appetite  had  returned, 
and  that  she  was  a  pound  and  a  half  heavier  than  when 
she  had  left  the  hospital,  a  result  that,  at  any  rate, 
shows  that  she  had  lost  no  weight.  The  cicatrix 
caused  no  discomfort,  but  the  occasional  urinary  in- 
continence of  which  she  had  complained  prior 
to  the  operation  was  still  present.  It  could,  however, 
be  prevented  by  emptying  the  bladder  at  intervals  of 
a  couple  of  hours,  and  did  not  trouble  her  at  all  at  night. 


On  examination,  the  junction  of  vaginal  mucous 
membrane  and  skin  was  complete  all  round,  save  at 
the  urethral  orifice,  and  at  the  point  where  the  sutures 
had  cut  out  and  where  there  had  been  the  greatest 
difficulty  in  getting  completely  outside  the  growth. 
The  urethral  orifice  was  situated  in  the  middle  of  a 
small  triangular  area,  which  appeared  to  be  formed 
of  granulation  tissue,  over  which  the  skin  had  not 
spread,  while  on  the  right  side  there  was  a  small  linear 
patch  of  what  also  appeared  to  be  granulation  tissue, 
from  which  sprang  two  delicate  leaf-like  flaps,  the  size 
of  a  small  shamrock  leaf.  On  the  probability  of  these 
being  granulations.  I  burnt  them  off  with  nitric  acid. 

I  saw  the  patient  for  the  last  time  on  January  21st  of 
this  year  ;  the  wound  was  completely  healed,  and  all 
trace  of  granulation  tissue  had  disappeared. 

Report  by  Dr.  Earl  on  the  removed  growth  : — 
"  The  tumour  is  an  example  of  infiltrating  sarcoma, 
the  rarer  of  the  two  varieties  met  with  in  the  vagina. 
The  new  growth  forms  a  layer  on  the  surface  which 
reaches  to  the  vaginal  epithelium  and  invades  it. 
There  is  some  ulceration,  very  superficial,  and  the 
ulcerated  surface  is  covered  in  part  by  a  fibrinous 
membrane.  The  new  growth  extends  between  the 
bundles  of  the  dense  fibrous  tissue  which  forms  the 
mucous  membrane  of  the  vagina  as  far  as  the  muscular 
coat,  which  it  sUghtly  invades.  In  some  of  the  sec- 
tions a  tubular  gland,  lined  by  columnar  epithelium, 
occurs.  It  lies  in  the  deep  part  of  the  mucous  mem- 
brane and  partly  in  the  muscular  coat,  and  it  is  invaded 
by  the  growth.  The  cells  which  form  the  new  growth 
are  small,  and  most  of  them  are  round,  but  some  few 
are  oval  or  short  spindle  cells.  They  have  a  nucleus 
which  stains  darkly  in  haematoxylin  and  a  very  distinct 
layer  of  protoplasm.  There  are  numerous  thin-walled 
vessels  in  the  growth." 

I  do  not  propose  to  enter  into  a  detailed  account  of 
sarcoma  of  the  vagina.  Two  very  admirable  articles  on 
this  rare  condition  are  to  be  found  already  in  British 
medical  literature.  In  the  Reports  of  St.  Bartholo- 
mew's Hospital,  of  1 89 1,  there  is  an  article  by  Dr. 
W.  J.  Gow.  in  which  are  the  notes  of  what  appears  to 
be  the  only  British  case  then  recorded  of  sarcoma 
vaginae  in  the  adult,  and  a  very  complete  account  of 
all  the  other  cases  he  was  able  at  the  time  to  collect. 
In  the  Journal  of  Obstetrics  and  Gynecology  of  the 
British  Empire  for  April,  1902,  there  is  an  article  by 
Dr.  Roger  Williams,  in  which  he  refers  to  several 
previously  reported  cases,  and  among  these  appear 
another  British  case  recorded  by  Morris.  Williams' 
article  is,  however,  unfortunately  and  unnecessarily 
complicated  by  the  inclusion  of  cases  due  apparently 
to  the  engrafting  of  tumours  of  chorionic  origin  on 
the  vaginal  wall.  There  is  also  available  an  interesting 
paper  by  Otto  Seitz,  published  in  von  Volkmann's 
Sammlung  klinischer  Vortrage,  No.  280,  on  primary 
vaginal  sarcoma,  in  which  Seitz  deals  with  the  cases 
recorded  up  to  1900,  and  adds  a  case  of  his  own.  It 
may  be  of  interest  if  I  endeavour  to  bring  Seitz's  list 
up  to  date.  ; 

So  far  as  I  can  ascertain.  39  cases  of  primary  vaginal 
sarcoma  in  the  adult  have  been  recorded,  and  in 
the  table  I  have  given  shortly  the  general  particulars 
of  each  case. 

We  thus  see  that  among  the  39  cases  of  vaginal 
sarcoma  there  is  a  much  larger  proportion  of  the  spindle- 
celled  than  of  the  other  varieties,  but  at  least  six  of 
these  are  in  all  probability  derived  from  the  endo- 
thelium of  the  blood-vessels  or  lymphatics,  and  so 
consequently  should  rather  be  termed  endothelioma 
than  sarcoma.  Four  cases  are  described  as  angio- 
sarcoma, but  of  these  at  least  one  would,  I  think,  in 
virtue  of  its  history,  be  more  correctly  termed  a 
deciduoma  malignum  or  chorio-epithelioma.  It  was 
described  by  Steinthal  and  occurred  in  a  multipara, 
act.  32,  four  months  after  she  had  been  delivered  of  a 
hydatidiform  mole.  On  the  lower  part  of  the  anterior 
vaginal  wall  there  was  a  swelling  the  size  of  a  walnut 
with  an  ulcerated  patch  on  its  surface ;  and,  on  the 


April  20,   1904. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Prxss.    415 


PARTICULARS    OF    RECORDED    CASES— 39  CASES. 


CMC 

Age 

Situation  of  Growth 

Histological  Structure 

Besult 

Becorded  by 

1 

!  58 

All    round   lower   part    of 
vagina 

Round-celled 

Death  result  of  operation 

Spiegelberg 

2 

i  — 

1 

Lower        part        anterior 
vaginal  wall 

Spindle-celled 

No  recurrence  after  4  years 

Idem 

3 

,5 

,  Lower        part        anterior 
vaginal  wail 

do. 

Rapid  recurrence 

Kaschewarowa  - 
Rudnewa 

4 

- 

Posterior      vaginal      wall, 
upper  part 

do. 

Not  mentioned 

Idem 

-; 

38 

Lower        part        anterior 
vaginal  wall 

do. 

Death  after  operation 

Meadows 

6 

*" 

Lower    part    anterior    and 
posterior  vaginal  wall 

Angio  -sar  00  ma  (pro  - 
bable  deciduoma 
malignum) 

Rapid  recurrence 

SteinthaT 

/ 

19 

Lower        part        posterior 
vaginal  wall 

Spindle-celled 

do. 

Simmons 

8 

23 

Lower        part         anterior 

vaginal  wall 
Lower      part       left      and 

Angio-sarcoma 

Rapid  growth  and  death 

Kalustou- 

9 

3° 

Round -celled 

Recurrence 

Fraenker 

posterior  vaginal  wall 

10 

25 

Ix>wer  part  posterior  wall 

do. 

do. 

Bajardi 

11 

39 

Lower  part  anterior  wall 

do. 

No  recurrence  after  10  mths. 

Menzel 

12 

38 

Lower  part  anterior  wall 

Spindle-celled 

Recurrence 

Herzfelcf 

13 

55 

Lower  part  posterior  wall 

Round -celled 

do. 

Langton 

14 

15 — 20 

Anterior  wall 

Spindle-celled 

do. 

Wirtz 

82 

Posterior  wall 

do. 

do. 

Senn 

16 

31 — 40 

Anterior  wall 

do. 

No  recurrence  after  1 1  years 

Rubeska. 

17 



Spindle-celled 

Recurrence 

Amann 

(Endothelioma) 

18 

50 

Right  lateral  wall 

Spindle-celled 
(Endothelioma) 

do. 

Jung 

19 

51 — 60 

Anterior  wall 

Round -celled 

do. 

Munr 

20 

52 

Right  lateral  wall 

— 

do. 

Jung 

21 

41 — 50 

Posterior  wall 

Giant-celled 

Recurrence 

v.  Rosthorrr 

22 

Anterior  wall 

Melanotic,  spindle- 

do. 

Parana 

celled 

23 
24 

25 

21 — 30 

: 

Myxo-sarcoma 

No  recurrence 

Gatti 



do. 

— 

Ferrari 

15 — 20 

Anterior  wall 

Round  and  spindle- 

Recurrence 

Ahfeld 

celled 

26 

41 

Posterior  wall 

Spindle-celled 
(Endothelioma) 

Result  unknown 

Seitz- 

27 

20 

Right  lateral  wall 

Spindle  and  round - 

celled 
Melanotic  sarcoma 

No  recurrence  after  2J  years 

Morris- 

28 

49 

Anterior  wall 

Recurrence 

Horn 

29 
30 

31 

Telangiectatic 

do. 

Alglave 



Posterior  wall 

Spindle-celled 

do. 

Mores  tin 

24 

Anterior  and  lateral  walls 

Angio-sarcoma 

Death  from  haemorrhage 

Schwartz 

32 

60 

Posterior  wall 

Round  and  spindle- 
celled 
Spindle-celled 

Died 

Savage 

33 

44 

Anterior  wall 

Recurrence 

Macnaugh  ton- 

* 

Jones 

34 
35 
36 

56 
14 

55 

Left  side 

Endothelioma 

do. 

Klien's 

do. 

do. 

Gebhard 

Posterior  wall 

do. 

do. 

Franke 

17 
38 
39 

Posterior  wall 

Round-celled 

do. 

Gervis 

16 

Anterior  wall 

do. 

No  recurrence  after  6  years 

Handfield-Jones- 

55 

All  round  vagina 

do. 

No  recurrence  after  5  mths. 

-     Jellett 

posterior  wall,  opposite  the  tumour  on  the  anterior 
wall,  was  a  swelling  the  size  of  a  hen's  egg.  The  uterus 
was  only  slightly  enlarged.  The  growth  spread  rapidly 
and  filled  the  vagina.  The  patient  died  soon  after, 
but  there  was  no  post-mortem.  Even  assuming  that 
in  this  case  the  uterus  was  unaffected,  there  is  no 
difficulty,  in  view  of  what  is  now  known  of  the  pathology 
of  deciduoma  malignum,  in  regarding  the  tumour  in 
this  case  as  the  result  of  the  vaginal  implantation  of 
actively  proliferating  fcetal  ectoblast.  I  notice  that 
Roger  Williams  also  considers  such  a  view  of  Stein- 
thal's  case  probable.  I  have,  however,  allowed  the 
case  to  remain  in  the  list  of  sarcomata  as  it  was  pre- 
viously placed  there  by  Gow  and  Seitz. 

Vaginal  sarcoma  appears  to  arise  with  slightly 
greater  frequency  from  the  anterior  than  from  the 
posterior  wall,  but,  so  far  as  I  can  find,  there  is  only  one 
case  described  in  which  there  is  the  same  distribution 
of  the  growth  all  round  the  vagina  that  there  is  in  my 


specimen.  This  case  was  one  of  two  recorded  by 
Spiegelberg  in  a  patient,  oet.  58.  The  menopause  had 
occurred  at  40,  and  a  year  prior  to  the  time  at  which 
she  came  under  treatment  she  noticed  a  gradually 
increasing  bleeding  from  the  vagina.  The  patient  was 
pale  but  well  nourished.  Close  to  the  vaginal  orifice, 
and  involving  the  lower  portion  of  the  vagina,  was  an 
irregular  firm  infiltration  of  the  vaginal  mucous  mem- 
brane, elevated  above  the  level  of  the  healthy  tissue , 
with  hard  everted  edges  and  a  granulating  surface, 
which  bled  on  being  touched.  In  the  middle  of  the 
posterior  wall  was  an  isolated  nodule  the  size  of  a  pea. 
The  uterus  was  atrophied  and  intact,  and  there  was  no- 
involvement  of  the  pelvic,  organs.  The  inguinal 
glands  were  not  swollen  and  the  abdominal  and  thoracic 
viscera  appeared  to  be  healthy.  The  growth  was  re- 
moved, but  the  patient  died  a  week  later  of  septic 
infection.  Microscopical  examination  showed  that  the 
growth  was  a  round -celled  sarcoma. 

D 


416    The  Medical  Press.         ORIGINAL  COMMUNICATIONS. 


April  20.  1904. 


The  age  of  the  patients  varied  from  14,  in  the  case 
of  endothelioma  recorded  by  Gebhardt,  to  82  in  Senn's 
case  of  spindle-celled  sarcoma.  Seven  cases  occurred 
prior  to  21,  22  cases  between  21  and  60,  and  one  case 
after  60.  The  disease  occurred  with  equal  frequency 
during  the  three  decades  between  20  and  50.  Between 
50  (and  60  the  largest  number  of  cases  occurred.  I 
have  not  been  able  to  ascertain  the  relative  frequency 
of  the  two  main  types  of  vaginal  sarcoma — tie  in- 
filtrating type  and  the  circumscribed  type.  There  is 
no  doubt,  however,  that  the  infiltrating  type  is  very 
much  the  rarer  of  the  two.  Indeed,  in  addition  to 
Spiegelberg's  first  case,  the  description  of  which  I  have 
quoted,  and  to  my  own  case,  I  cannot  find  a  distinct 
statement  that  any  of  the  others  were  of  this  type. 
It  is,  however,  probable  that  some  of  those  described 
as  angiosarcoma  may  have  answered  to  this  descrip- 
tion. 

The  prognosis  of  vaginal  sarcoma  is,  judging  from 
the  history  of  the  cases  I  have  collected,  dis- 
tinctly bad.  Seitz  states  that  only  three  cases  have 
been  recorded  in  which  the  disease  was  removed  and 
did  not  recur.  These  are  Spiegelberg's  second  case,  in 
which  there  was  no  recurrence  after  four  years ;  Gatti's 
case,  in  which  there  was  no  recurrence  after  several 
years;  and  Rubeska's  case,  in  which  there  was  no  re- 
currence after  eleven  years.  To  this  number  may,  I 
think,  also  be  added  Morris'  case,  in  which  there  was 
no  recurrence  after  two  and  a  half  years ;  and  Hand- 
field- Jones'  case,  in  which  there  was  no  recurrence  after 
six  years.  Menzel's  case,  in  which  there  was  no  re- 
currence after  ten  months,  cannot  be  added  to  the  list 
of  successful  cases  as  the  period  for  which  it  was 
watched  is  not  sufficiently  long.  For  the  same  reason, 
my  own  case  cannot  as  yet  be  included,  as  only  five 
months  have  elapsed  since  the  operation.  I  hope  on 
a  future  occasion,  as  soon  as  a  definite  conclusion  can 
be  formed  as  to  the  result  of  this  case,  to  complete 
these  notes. 

In  conclusion,  I  must  express  my  indebtedness  to 
Dr.  H.  C.  Earl  for  his  report  on  the  specimen  and  for 
his  kindness  in  looking  into  the  bibliography  of  the 
subject.  I  am  also  indebted  to  Mr.  Roger  Williams 
and  to  Dr.  Macnaughton-Jones  for  additional  refer- 
ences, to  Dr.  Arthur  Ball  for  some  very  excellent 
photographs  from  which  the  plate  was  drawn,  and  to 
Dr.  Wigham  for  a  micro-photograph  of  a  section  of 
the  tumour. 


SOME  POINTS  IN  THE 

HYGIENIC   TREATMENT 

OF 

PULMONARY    TUBERCULOSIS,  (a) 

By  T.  N.  KELYNACK,  M.D.,  M.R.C.P., 

Physician  to  the  Mount  Vernon  Hospital  for  Consumption  and  Diseases 
of  the  Chest. 

The  open-air,  hygienic,  or  sanatorium  treatment  of 
consumption  undoubtedly  offers,  as  is  now,  indeed, 
generally  admitted,  the  most  effectual  method  hitherto 
discovered  for  securing  its  arrest. 

Sanatoria  are  rapidly  springing  into  being  in  all 
parts  of  the  country.  (6) 

Some  are  elaborate,  substantial,  even  palatial 
structures  ;  while  others  are  of  Spartan  simplicity  and 
almost  as  ephemeral  as  the  nomad's  tent. 

I  have  recently  visited  many  of  the  most  important 
of  the  modern  sanatoria  in  this  country,  and  the  sub- 
stance of  this  short  paper  is  the  outcome  of  a  careful 
■study  of  the  conditions  under  which  the  so-called 
hygienic  treatment  of  pulmonary  tuberculosis  is  now 
being  conducted 

Both  the  medical  profession  and  the  general  public 
have  at  last  recognised  the  value  of  what  has  been 

(a)  Substance  of  a  Paper  read  before  the  Therapeutical  Society  at 
the  Apothecaries'  Hall  of  London,  Tuesday,  January  19th,  1904. 

(6)  For  a  convenient  list  of  Sanatoria  in  the  British  Isles  see  Medical 
Annual,  1904.  I  have  furnished  reports  on  a  considerable  number  of 
these  establishments  to  Ths  Medical  Press  and  Circular,  July 
Sth,  1903,  et  seq.  For  useful  details  see  "  Sanatoria  for  Consumptives/' 
by  Rufenacht  Walters,  M.D.  Second  Edition.  London:  1901.  Aho 
"  The  British  Sanatoria  Annual."  London:  190a. 


well  designated  ' '  the  natural  method  "  of  managing  con- 
sumptives. There  is,  indeed,  some  danger  in  certain 
quarters  of  the  open-air  system  being  considered  a 
"  specific  "  for  consumption. 

There  is  much  need  that  the  whole  subject  should 
not  only  be  considered  in  a  spirit  of  practical  sympathy, 
but  fully  investigated  in  a  scientific  manner  and  under 
the  directing  light  of  clinical  experience  and  well- 
conducted  experiment.  The  sanatoria  now  existing 
for  consumptives  are  truly  of  "all  sorts  and  con- 
ditions." Structurally,  they  vary  greatly,  and  in 
regard  to  the  manner  and  method  of  the  application 
of  hygienic  principles  there  are  wide  differences.  In 
order  that  progress  may  be  maintained  it  is  verv 
desirable  that  the  spirit  of  empiricism  and  the  stulti- 
fying influence  of  mere  routine  should  not  be  allowed 
to  hamper.  But  at  the  present  time  there  is  much 
need  that  there  should  be  some  means  whereby  those 
responsible  for  the  conduct  of  these  institutions  should 
be  able  to  discuss  methods,  compare  results,  and 
intelligently  engage  in  collective  scentific  research. 

To  understand  adequately  the  situation  it  is  neces- 
sary that  there  should  be  a  thoughtful  study  of  the 
past,  a  critical  survey  of  the  present,  and  a  mind  at 
least  willing  to  attempt  some  forecast  of  the  future. 

Sanatorium  treatment  is  still  to  a  great  extent  in 
the  experimental  stage.  Our  procedures  are  in  great 
measure  based  upon  a  comparatively  short  experience, 
and  the  so-called  "  principles  "  of  hygienic  treatment 
can  scarcely  be  said  to  be  the  outcome  of  clearly  re- 
cognised and  well-established  scientific  data. 

A  rational  conduct  of  the  hygienic  treatment  of 
consumption  should  be  based  upon  a  thorough  under- 
standing of  the  pathology  of  the  condition  and  an 
extensive  knowledge  of  its  widely  varied  symptoma- 
tology. This,  it  must  be  regretfully  admitted,  is  not 
always  the  case,  and,  indeed,  to-day  we  stand  in  much 
perplexity,  for  distinguished  pathologists  are  presenting 
for  our  consideration  widely  divergent  views  which 
cannot  but  greatly  influence  our  acceptance  or  rejec- 
tion of  various  prophylactic  or  so-called  "  curative  " 
procedures,  (a) 

The  Evolution  of  Hygienic  Treatment  of 
Consumption. 

It  is,  however,  well  to  remember  that  success  in  the 
treatment  of  a  disease  may  sometimes  precede  the 
discovery  of  its  causal  factors  or  a  full  perception  of  its 
pathology.  Such  has  undoubtedly  been  the  case  with 
consumption. 

While  it  is  right  that  we  should  accord  homage  to 
such  German  pioneers  as  Brehmer  of  Gorbersdorf, 
Dettweiler  of  Falkenstein,  Walther  of  Nordrach,  and 
their  disciples,  in  the  development  of  our  modern  con- 
ception of  the  institutional  treatment  of  consumption, 
it  is  but  just  that  we  should  also  accord  due  honour  to 
those  of  our  own  kin  who  were  among  the  first  clearly 
to  indicate  the  path  along  which  advance  might  be 
made. 

Parrish  (b)  wrote,  as  far  back  as  1830  : — 

"  Vigorous  exercises,  and  a  free  exposure  to  air,  are 
by  far  the  most  efficient  remedies  in  pulmonary  con- 
sumption. It  is  not,  however,  that  kind  of  exercise 
usually  prescribed  for  invalids — an  occasional  walk  or 
ride  in  pleasant  weather,  with  strict  confinement  in 
the  intervals — from  which  much  good  is  to  be  expected. 


(a)  Consult  such  special  periodical  literature  as  Zeu\  /.  Tubercuku 
and  HeilstaeUenwesen ,-  Tuberculosis,  the  monthly  publication  of  the 
Central  International  Bureau  for  the  Prevention  of  Consumption. 
Leipsig;  Tuberculosis,  the  organ  of  the  National  Association  for  the 
Prevention  of  Consumption,  London;  Revue  de  Tubercukset  the 
Journal  of  Tuberculosis,  London.  See  also  Transactions  of  the 
British  Congress  on  Tuberculosis,  London,  xooa;  Transection 
of  the  Huntenan  Society,  London,  1903 ;  Deuts.  mad.  Woch.,  Sep- 
tember 24th,  1903.  Reference  may  aho  be  made  to  such  recent 
and  readily  accessible  works  as — "  The  Principles  of  'Open-Air'  Treat* 
ment  of  Phthisis  and  Sanatorium  Construction."  By  Arthur  Ransom. 
M.D.,  F.R.C.P.,  F.R.S.  London :  2903.  "  The  Prevention  of  Con- 
sumption." By  Alfred  Hillier,  M.D.,  C.M.,  BJL  Revised  by  Pro- 
fessor R.  Koch.  London  :  1903.  "  The  Diagnosis  and  Modern  Treatment 
of  Pulmonary  Consumption."  By  Arthur  i-nth*™  MJL,  MJ).  Loodoo : 
1903.  "Tuberculosis/'  By  Norman  Bridge,  A.IL,  M.D,  Philad-. 
New  York  and  London:  1903.  "The  Sanatorium  Treatment  of 
Consumption."     By  T.  N.  Kelynack,  MIX,  M.R.C.P.    London:  X9°4- 

(*)  North  Amer.  Med.  and  Surg.  Journ.,  1830.  Quoted  by  the  late 
Sir  Benjamin  W.  Richardson  in  his  "  Hygienic  Treatment  ofPotawnarf 
Consumption."     London:  1837. 


Apr:l  20,  1904. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press.    417 


Daily  and  long-continued  riding  on  horseback  or  in  a 
.carriage  is,  perhaps,  the  best  mode  of  exercise ;  but 
where  this  cannot  oe  commanded,  unremitting  exertion 
of  almost  any  kind  in  the  open  air,  amounting  even  to 
labour,  will  be  found  highly  beneficial.  Nor  should 
the  weather  be  scrupulously  studied.  Though  I  would 
not  advise  a  consumptive  patient  to  expose  himself 
recklessly  to  the  several  inclemencies  of  the  weather,  I 
would,  nevertheless,  warn  him  against  allowing  the 
dread  of  taking  cold  to  confine  him  on  every  occasion 
when  the  temperature  may  be  low,  or  the  skies  over- 
cast. 

"  I  may  be  told  that  the  patient  is  often  too  feeble 
to  be  able  to  bear  exertion,  but  except  in  the  last 
stage,  where  every  remedy  must  prove  unavailing,  I 
believe  there  are  few  who  cannot  use  exercise  out  of 
doors  ;  and  it  sometimes  happens  that  those  who  are 
exceedingly  debilitated  find,  upon  making  the  trial, 
that  their  strength  is  increased  by  the  effort,  and  that 
the  more  they  exert  themselves  the  better  able  they 
are  to  support  the  exertion." 

As  every  physician  now  knows,  the  first  medical  man 
to  establish  an  open-air  sanatorium  was  the  village 
doctor,  George  Bodington.  Ignorant  though  he  was  of 
^he  cause  and  nature  of  pulmonary  tuberculosis,  he 
nevertheless  seized  the  essentials  of  the  hygienic  life, 
and  applied  them  with  conspicuous  success,  as  a  study 
of  his  clinical  reports  abundantly  proves. 

Permit  me  to  make  a  few  quotations  from  Bodington's 
now  classic  monograph,  (a)  These  I  think,  should  afford 
sufficient  evidence  that  this  comparatively  obscure 
practitioner  anticipated  in  great  measure  the  modern 
application  of  hygienic  measures  in  the  treatment  of 
phthisis. 

"  To  live  in  and  breathe  freely  the  open  air,  without 
being  deterred  by  the  wind  or  weather,  is  one  important 
and  essential  remedy  in  arresting  its  progress.  The 
cold  is  never  too  severe  for  the  consumptive  patient  in 
this  climate  ;  the  cooler  the  air  which  passes  into  the 
lungs  the  greater  will  be  the  benefit  the  patient  will 
derive.  The  common  hospital  in  a  large  town  is  the 
most  unfit  place  imaginable  for  consumptive  patients, 
and  the  treatment  generally  employed  there  very  in- 
efficient, arising  from  the  inadequacy  of  the  means  at 
command.  1  think  in  the  neighbourhood  of  every  large 
town,  sufficiently  distant  to  be  clear  of  its  contamina- 
tion from  smoke,  &c.  and  in  well-chosen  spots,  medical 
men  should  be  established  with  all  the  means  about 
them  for  the  treatment  of  the  disease  in  question,  to 
whom  those  who  live  in  the  towns  should  confide  their 
patients  of  this  kind,  at  the  same  time  rendering  them 
the  benefit  of  their  advice  as  far  as  needful,  rather  than 
that  they  should  be  dismissed  to  the  care  of  nurses 
and  lodging-house  keepers  in  distant  situations  ;  and 
again  I  repeat,  I  do  think  that  for  the  poorer  classes, 
on  account  of  the  magnitude  of  the  evil  as  regards 
them,  hospitals  especially  for  their  use  and  treatment 
ought  to  be  established  in  fit  situations." 

Reference  should  also  be  made  to  the  quaint  writings 
of  Henry  MacCormac,  of  Belfast,  who  was  an  enthusiast 
in  open-air  methods.  (6) 

But  among  the  pioneers,  undoubtedly  the  most 
masterly  presentation  of  the  case  for  open-air  methods 
•came  from  the  late  Sir  Benjamin  Ward  Richardson.  I 
have  been  surprised  to  find  how  few  of  those  engaged 
in  sanatorium  work  are  acquainted  with  his  remarkable 
monograph,  which  was  published  as  long  ago  as  1857.  (c) 

In  justice  to  this  scientific  seer,  I  should  like  to  be 
allowed  to  make  a  few  quotations  from  his  almost  for- 
gotten work : — 

"  In  a  cosy  room  the  consumptive  is  bound  never  to 
live,  nor  in  any  room,  indeed,  for  great  lengths  of  time. 
So  long  as  he  is  able  to  be  out  of  doors,  he  is  in  his  best 
and  safest  home.  Stoves  of  all  kinds,  heated  pipes, 
and,  in  a  word,  all  modes  of  supplying  artificial  warmth, 

(4)  "  The  Treatment  and  Core  of  Pulmonary  Consumption,"  1840. 
See  Reprint  in  "  Selected  Essays  and  Monographs,  chiefly  from  English 
Sources."     London:  New  Sydenham  Society.    1001. 

{b) "  Consumption,  as  Engendered  by  Re-breathed  Air."  By  Henry 
MacCormac,  MJXLond.    First  Edition.  1835  ;  Second  Edition,  1865. 

(c)  "The  Hygienic  Treatment  of  Pulmonary  Consumption."  By 
Benjamin  W.  Richardson,  M.D.  London :  John  Churchill,  1837.  See 
abo  Tin  Medical  Press  and  Circular,  June  10th,  1903. 


except  that  by  the  radiation  from  an  open  fire,  are, 
according  to  the  facts  which  I  have  been  able  to  collect, 
injurious.  If  special  hospitals  for  consumptives  are 
to  be  had,  they  should  be  as  little  colonies,  situated 
far  away  from  the  thickly-populated  abodes  of  men, 
and  so  arranged  that  each  patient  should  have  a  dis- 
tinct dwelling-place  for  himself.  They  should  be  pro- 
vided with  pleasure-grounds  of  great  extent,  in  which 
the  patients  who  could  walk  about  should  pass  every 
possible  hour  in  the  day  ;  and  with  glass-covered  walks 
overhead,  where  the  open  air  could  be  freely  breathed, 
even  if  rain  were  falling." 

Richardson's  prophetic  essay  should  be  studied  by 
modern  sanitarians  and  all  those  in  any  way  respon- 
sible for  the  conduct  of  institutions  for  the  consump- 
tive.    A  reprint  might  well  be  issued  with  advantage. 
The  Modern  British  Sanatorium. 

What  I  may  call  the  British  type  of  sanatorium  is  still 
in  process  of  development,  (a)  While  we  may  admire 
the  thoroughness  and  do  well  to  strive  after  the  scien- 
tific precision  with  which  some  German  sanatoria  are 
conducted,  I  venture  to  think  that  it  is  altogether  false 
policy  and  wrong  practice  to  adopt  a  merely  imitative 
attitude.  It  is  well  to  remember  that  a  considerable 
number  of  those  engaged  in  sanatorium  work  in  this 
country  have  themselves  been  sufferers  from  pulmonary 
tuberculosis,'  and  not  a  few  have  been  brought  under  the 
masterful  influence  of  Walther,  and  hence,  perhaps,  we 
may  find  some  excuse  for  the  fact  that  various  estab- 
lishments in  this  country  bear  the  presumably  attrac- 
tive designation  of  Nordrach.  My  point  is  this  :  Those 
responsible  for  sanatorium  treatment  in  Britain,  and 
especially  when  carried  on  in  establishments  primarily 
designed  for  the  benefit  of  the  poor,  should  recognise 
the  influence  of  racial  characters,  national  customs, 
local  conditions  of  life  and  work,  and  insular  prejudices, 
dispositions,  tastes,  and  sentiments. 
The  Hygienic  "  After-Care  "  of  Consumptives. 

I  wish  particularly  to  refer  to  a  matter  which  I  con- 
sider to  be  of  pressing  importance.  Much  of  our  sana- 
torium treatment  is  being  rendered  ineffectual  by  the 
neglect  of  what  I  may  term  a  hygienic  "  after-care." 

In  only  too  many  cases,  particularly  where  the 
patient  is  a  "  breadwinner,"  the  period  of  residence  in 
a  sanatorium  is  almost  necessarily  short.  Frequently 
before  arrest  is  satisfactorily  secured  the  patient  is 
compelled  by  financial  or  other  considerations  to  return 
to  home  and  work,  and  place  himself  or  herself  under 
almost  identically  the  same  conditions  as  those  which 
caused  or  favoured  the  breakdown. 

The  various  ways  in  which  philanthropic  energy, 
municipal  enterprise,  and  action  by  the  State  may  deal 
with  this  difficulty  cannot  be  discussed  here ;  but  I 
would  suggest  that  at  least  some  attempt  should  be 
made  to  secure  some  approach  to  a  hygienic  after-care 
of  those  who  have  been  enabled  to  arrive  at  a  relative 
cure  by  sanatorium  treatment,  and  I  should  like  to 
draw  attention  to  the  method  which  is  being  employed 
at  the  Kelling  Open-air  Sanatorium,  the  admirable 
institution  which  Dr.  Burton-Fanning,  of  Norwich, 
and  his  cousin,  Mr.  W.  J.  Fanning,  as  resident  medical 
officer,  have  developed  for  the  consumptive  poor  of 
East  Anglia.  During  a  recent  visit  to  this  sanatorium 
I  found  the  following  circular  was  being  sent  to  the 
friends  of  such  patients  as  are  found  to  react  satis- 
factorily to  treatment.  It  is  of  such  suggestive  value 
that  I  make  no  apology  for  quoting  it  in  full : — 

"  It  is  important  to  remember  that  the  open-air 
treatment  of  the  patient  should  not  cease  on  leaving 
the  sanatorium.  Whether  the  disease  is  arrested  or 
the  condition  merely  improved  it  is  essential  that  he 
should  always  continue  the  principles  of  the  treatment. 
All  the  living  rooms  should  be  abundantly  supplied 
with  fresh  air,  and  windows  should  be  kept  open  day 
and  night.  If  the  patient  is  to  maintain  his  health  he 
must  be  well  fed  and  lead  a  healthy  life.    This  may 


(a)  See  Dr.  H.  T.  BubtrodVs  Mitaoy  Lectures  :  "  On  the  Causes, 
Prevalence,  and  Control  of  Pulmonary  Tuberculosis."  Lmncet,  July 
nth,  35th ;  August  xst,  8th,  15U1,  1903.  Consult  Prize  Essays 
in  Lancet,  January  3rd,  1903  ;  also  "  The  Prize  Essay  on  the  Erection 
of  a  Sanatorium  for  the  Treatment  of  Tuberculosis  in  England."  By 
Arthur  Latham,  M.A.,  M.D.,  and  William  West.    London :  1903. 


418    The  Medical  Piess.  ORIGINAL  COMMUNICATIONS. 


April  20,  1904. 


entail  the  necessity  of  changing  his  former  occupation. 
As  all  this  may  be  difficult  to  arrange,  it  is  very  neces- 
sary for  the  friends  and  for  those  interested  to  begin  to 
consider  the  question  at  once,  and  to  begin  to  find 
suitable  employment  as  soon  as  possible  after  the 
patient's  admission.  The  moral  effect  on  the  patient 
of  knowing  that  he  has  some  work  to  look  forward  to 
is  very  good,  and,  on  the  other  hand,  it  is  most  unde- 
sirable that  the  patient,  on  leaving  the  sanatorium, 
should  be  met  with  the  anxiety  of  obtaining  work  and 
off  providing  for  himself  and  his  dependents.  Any 
employment  which  does  not  demand  arduous  labour 
or  strain,  and  which  allows  of  a  good  deal  of  fresh  air,  is 
suitable  ;  exposure  to  bad  weather  is  not  necessarily 
harmful,  but  work  in  unventilated  rooms  or  shops  is 
most  prejudicial.  Light  farm  work  or  light  gardening 
work,  such  clerical  work  as  can  be  performed  in  good 
air,  agency  work,  driving,  caretaking — in  fact,  any 
light  work  in  good  air  or  out  of  doors  is  suitable  ;  but 
before  deciding  it  will  be  well  to  ask  advice  at  the  sana- 
torium, as  the  exact  condition  of  the  patient  must  be 
allowed  to  determine  the  precise  nature  of  the  work  for  i 
which  he  is  best  fitted.  This  advice  will  most  willingly 
be  given,  but  the  onus  of  finding  suitable  employment 
must  rest  with  the  patient's  friends." 
The  Science  and  Art  of  Sanatorium  Treatment. 

Numerous  works  have  been  written  concerning  the 
details  of  the  hygienic  treatment  of  consumption,  and 
various  attempts  have  been  made  to  indicate  the 
"  principles  "  on  which  the  practice  of  sanatorium 
management  depends  ;  but  while  rapid  progress  has 
been  made  in  what  may  be  termed  the  art  of  institutional 
control,  the  coming  of  a  directing  knowledge  regarding 
the  science  of  the  subject  still  lingers,  (a) 

In  the  few  moments  left  at  my  disposal,  it  is  quite 
impossible  for  me  to  indicate  anything  of  the  scope  or 
conclusions  of  recent  investigations  into  the  various 
factors  constituting  what  we  understand  as  "  sana- 
torium treatment."  I  particularly  desire,  however,  to 
draw  attention  to  the  fact  that,  at  the  present  time, 
wide  differences  in  clinical  methods  and  very  consider- 
able divergence  in  therapeutic  practice  exists  among 
those  responsible  for  the  conduct  of  institutional  treat- 
ment. 

In  regard  to  the  so-called  open-air  treatment  of  con- 
sumption, I  venture  to  think  that  the  time  has  now 
arrived  when  serious  efforts  should  be  made  to  secure 
some  degree  of  scientific  uniformity  in  clinical  procedure, 
a  measure  of  combination  in  scientific  investigation, 
and  suitable  means  for  a  trustworthy  comparison  of 
results.  In  such  a  special  form  of  medical  work  it  is 
most  desirable  that  every  tendency  to  a  faddish  or 
quackish  narrowing  of  outlook  should  be  avoided  and 
a  strict  scientific  spirit  firmly  maintained. 


LARYNGEAL   CREPITUS 

AS  A  SIGN  OF 

PULMONARY    TUBERCULOSIS. 

By  Dr.  REMOUCHAMPS, 

Physician  to  the  Ghent  Hospital. 

r  As  a  general  rule  the  diagnosis  of  pulmonary 
tuberculosis  is  not  a  matter  of  much  difficulty, 
auscultation  of  the  chest  and  the  bacteriological 
examination  of  the  sputum  sufficing  to  establish 
the  nature  of  the  affection.  Now  and  again, 
however,  we  meet  with  cases  in  which  neither  of 
these  methods  of  examination  enables  us  to  arrive 
at  a  definite  conclusion,  especially  at  the  onset  of 
the  malady.  The  morbid  changes  in  the  pulmonary 
structures  may,  at  that  period,  be  so  limited  in 
extent  as  not  to  give  rise  to  the  least  pathological 
sound  perceptible  by  the  ordinary  methods  of 
auscultation,  or  the  lesions  may  be  so  deeply  seated 


(a)  °  The  Sanatorium  Treatment  of  Consumption."  The  HospiUl, 
January,  1904;  "The  Hygienic  Treatment  of  Consumption,"  The 
Medical  Press  and  Circular,  January  12th,  1904. 


in  the  parencyhma  of  the  lungs  that  the  character- 
istic sounds  do  not  reach  the  ear. 

Bacteriological  examination,  on  the  other  hand,, 
may,  even  if  repeatedly  made,  give  negative 
results,  even  in  cases  in  which  the  tuberculous 
nature  of  the  infection  is  conclusively  proved  by 
the  subsequent  course  of  the  disease  or,  it  may  be, 
at  the  post-mortem  examination.  Moreover,  it 
must  be  borne  in  mind  that  the  tuberculin  test  is 
only  applicable  to  apyretic  cases,  and  that  the 
reaction  is  often  the  reverse  of  characteristic. 

Under  these  circumstances,  it  may  not  be  devoid 
of  interest  if  I  make  known  a  method  of  clinical 
exploration  which  appears  to  me  to  possess  con- 
siderable diagnostic  importance — one  too,  whichhas 
never  been  referred  to  except  by  Dr.  Cybulski,  of 
Gorbersdorf ,  (a)  who  had  recourse  to  this  procedure 
in  the  diagnosis  of  pulmonary  cavities,  the  ausculta- 
tory  signs  whereof  were  not  accessible  to  stetho- 
scopic  examination,  they  being  marked  by  other 
sounds  nearer  the  surface.  The  procedure  is 
simplicity  itself.  The  patient,  preferably  in  the 
erect  position,  stands  face  to  face  with  the  physi- 
cian. He  is  directed  to  open  his  mouth  and  then, 
placing  his  right  hand  on  the  patient's  left  shoulder, 
and  resting  his  left  thumb  on  the  patient's  chin,  the 
physician  brings  his  left  ear  close  to  the  patient's 
mouth,  keeping  it  at  a  distance  of  two  or  three 
inches.  He  will  then  perceive,  in  cases  of  pul- 
monary tuberculosis,  a  fine  crepitation  which  I 
have  termed  "  laryngeal "  merely  because  its 
maximum  intensity  appears  to  be  in  the  larynx, 
the  latter  having  for  effect  to  amplify  sounds  having 
their  origin  in  lesions  of  the  pulmonary  parenchyma 
The  sound  is  very  similar  to  that  of  a  fine  pen  slowly 
scratching  on  paper.  It  is  audible  both  in  inspira- 
tion and  expiration,  but  more  particularly  the 
latter. 

The  laryngeal  crepitation  is  present  and  audible 
throughout  the  whole  course  of  the  malady,  increas- 
ing, diminishing,  or  disappearing  according  as  the 
lesions  themselves  become  more  marked,  improve, 
or  are  recovered  from.  In  some  instances  it  is 
loud  enough  to  be  audible  without  the  patient's 
opening  his  mouth,  and  I  have  met  with  cases  in 
which  it  could  be  heard  at  a  distance  of  from  one  to 
three  feet  from  the  patient.  When  patients  who 
exhibit  this  phenomenon  in  such  a  marked  degree 
begin  to  talk,  no  other  sound  interfering  with  its 
transmission,  the  practised  ear  is  enabled  to  dis- 
tinguish  between  the  words  a  fine  crepitation 
which  seems  to  come  from  the  back  of  the  throat, 
and  is  the  outward  and  audible  manifestation  of 
pulmonary  tuberculous  lesions,  the  existence 
whereof  may  be  confirmed  by  the  usual  methods 
of  exploration. 

During  the  last  year  or  two  I  have  been  enabled 
to  ascertain  the  existence  of  this  crepitation  in 
upwards  of  a  hundred  phthisical  patients,  and  the 
evidence  of  my  own  senses  has  been  confirmed  by 
various  colleagues  and  students  in  my  clinic. 
By  its  aid  I  have  been  enabled  to  diagnose  incipient 
phthisis  in  subjects  who,  at  first  sight,  presented  no 
obvious  indication  of  the  affection,  and  this  before 
any  information  afforded  by  the  patient  had 
placed  me  in  possession  of  the  reason  for  their 
seeking  medical  advice. 

Pulmonary  tuberculosis  is,  it  is  true,  not  the 
only  malady  in  which  ausculation  vid  the  mouth, 
without    the   aid    of    any    instrument,    renders 


(a)  '*  Bin  Betragr  zur  TJiaffnoae  dcr  Lusgtn-KaverneD."     £«"<*» 
ud.  Wo*.,  November  4th,  1902. 


April  20.  1904. 


valuable  service.  Speaking  generally,  it  may  be 
stated  that  all  sounds  arising  in  the  lungs  are  pro- 
pagated to  the  buccal  aperture,  although  there  are 
sundry  exceptions,  as,  for  instance,  in  ordinary 
pneumonia,  pulmonary  oedema,  and  congestion, 
&c.  The  transmission  vid  the  mouth  of  morbid 
sounds  is  particularly  well  marked  when  cavities 
exist,  the  gurgling  and  crackling  being  heard  with 
really  remarkable  clearness.  In  bronchitis  the 
sibilant  rhonchi  and  subcrepitant  rdles  are  well 
marked,  but  none  of  these  sounds  could  possibly 
be  mistaken  for  the  crepitation  of  tuberculosis. 

It  can  only  be  in  altogether  exceptional  cases 
that  it  becomes  necessary  to  establish  the  differ- 
ential diagnosis.  In  the  early  period  of  bronchitis 
limited  to  the  apex,  for  instance,  the  sound 
of  mucous  and  bullous  rdles  gives  rise  for  two  or 
three  days  to  a  sort  of  crepitation  which  somewhat 
resembles  the  crepitation  in  question,  from  which, 
however,  it  can  always  be  distinguished  by  the 
presence  of  rhonchous  and  sibilant  rdles.  The 
same  may  be  said  of  attacks  of  bronchial  asthma 
in  which,  be  it  observed,  the  sounds  disappear  with 
the  subsidence  of  the  attack. 

I  may  add,  in  conclusion,  that  extensive  and  care- 
ful clinical  observation  has  convinced  me  that  per- 
sistent laryngeal  crepitation  is  pathognomonic  of 
pulmonary  tuberculosis  from  its  very  onset,  also 
that,  when  for  a  time  the  diagnosis  remains  doubt- 
ful, the  persistent  absence  of  this  sign  justifies  our 
discarding  the  diagnosis  of  phthisis.  Conversely 
if,  on  examining  the  chest  of  a  phthisical  patient, 
we  fail  to  detect  any  abnormal  sounds  and  if  on 
bacteriological  examination  of  the  sputum  no 
tubercle  bacilli  are  present,  even  then  that  patient 
cannot  be  pronounced  cured  so  long  as  we  detect 
the  least  trace  of  laryngeal  crepitation. 


ORIGINAL  COMMUNICATIONS.        The  Medical  Peess.    4IQ 


NOTES    ON  THERAPEUTICS. 

By  DAVID  WALSH,  M.D.Edin., 
Senior  Phjaiefen,  Western  Skin  Hospital,  London,  Ac 

The  desirability  of  keeping  in  touch  with  what 
is  good  in  modern  materia  medica  and  thera- 
peutics is  no  less  obvious  than  the'  difficulty  of 
keeping  abreast  of  the  stream  of  the  new  matter 
that  sweeps  down  continuously  upon  the  medical 
world.  A  few  of  the  new  drugs  and  a  few  of  the 
new  methods  will  survive  the  test  of  time,  and  it 
is  on  that  account  impossible  to  ignore  the  claims 
of  all  new  comers.  What  is  wanted  is  a  kind  of 
standing  committee  to  advise  and  report  au- 
thoritatively to  the  medical  profession  upon  all 
fresh  claims.  As  things  stand  at  present  the  in- 
dividual practitioner  has  to  conduct  his  own 
investigation  and  to  form  his  own  conclusions  as 
to  the  value  of  this  or  that  drug,  preparation  or 
method.  Sooner  or  later  a  sound  general  con- 
clusion is  formed  in  each  instance,  and  forms  thence- 
forth part  of  the  common  stock  of  knowledge.  The 
waste  of  time  and  energy  on  the  part  of  the  in- 
dividual, however,  pending  that  consummation 
can  hardly  be  estimated.  Any  plan  that  would 
gather  together,  and  thereby  save  from  destruc- 
tion, the  everyday  experience  of  the  general  prac- 
titioner of  the  United  Kingdom  would  be  of  in- 
estimable value  to  the  progress  of  medical  science. 
It  would,  so  to  speak,  place  the  stamp  of  the  work- 
shop upon  the  production  of  the  laboratory  and 
the  study  table. 

The  idea  is  hardly  novel.  It  has  for  a  genera- 
tion or  more  formed  a  kind  of  stock  subject  for 
presidential  addresses  and  for  professional  journa- 


lism. Some  years  ago  it  was  formally  re- 
cognised by  the  British  Medical  Association, 
and  a  Special  Therapeutic  Committee  was  ap- 
pointed with  a  flourish  of  trumpets.  To  Sir 
Lauder  Brunton  was  allotted  the  leading  part, 
and  at  the  time  much  was  hoped  from  the  de- 
parture. That  took  place  some  years  ago,  but 
nothing  more  has  been  heard  about  the  committee, 
which  appears  to  have  been  unable  to  survive  the 
plaudits  that  hailed  its  birth.  Yet  the  scheme 
was  admirable.  Perhaps  its  failure  was  due  to  the 
well-nigh  limitless  field  of  investigation  that  lay 
before  the  committee,  the  members  of  which  were 
all  busy  men,  whom  it  would  be  difficult  to  bring 
together  for  the  purposes  of  a  collective  investiga- 
tion. 

The  aim  of  the  series  of  notes  which  commence 
with  the  present  brief  article  is  modest — namely, 
to  give  short  and  suggestive  notes  oi  new  reme- 
dies that  may  serve  as  some  sort  of  guide  to  medical 
men.  At  the  same  time  it  is  not  intended  to  for- 
get old  and  trusty  friends,  whose  virtues  may  be 
brought  to  mind  by  an  occasional  reference,  to  say 
nothing  of  fresh  qualities  that  may  be  discovered 
in  them.  Although  it  would  be  too  ambitious  to 
attempt  to  stop  the  gap  in  medical  literature 
which  has  been  alluded  to,  it  may  nevertheless  be 
hoped  to  bring  together  in  readable  form  a  quan- 
tity of  concentrated  and  readily  assimilable  in- 
formation. 

Osmic  acid  is  one  of  a  host  of  remedies  vaunted 
in  the  treatment  of  neuralgia.  Its  efficacy  in 
some  otherwise  intractable  cases  appears  to  be 
proved  on  good  authority.  Certainly,  in  the 
round  of  remedies  which  the  medical  attendant 
is  bound  to  try  in  severe  cases,  the  injection  of  osmic 
acid  should  have  a  place.  Mr.  G.  A.  Wright,  M.B., 
F.R.C.S.,  (a)  has  published  an  interesting  note  on 
thirteen  cases  of  neuralgia  thus  treated,  with  partial 
or  entire  relief  of  pain  lasting  over  a  period  varying 
from  six  weeks  to  three  and  a  half  years.  The 
author  agrees  with  Sir  William  Bennett  in  the  view 
that  the  irregular  results  obtained  heretofore 
are  attributable  to  the  fact  that  the  injections  have 
been  made  at  random,  and  may  or  may  not  have 
penetrated  the  nerve  trunks  implicated.  In  all 
his  cases  he  exposed  the  nerve  and  injected  a 
ij  or  2  per  cent,  watery  solution  of  the  acid 
into  the  trunk  or  into  branches.  If  by  this  simple 
little  operation  the  more  serious  procedure  of 
excision  of  the  spheno-palatine  or  of  the  Gasserian 
ganglion  can  be  avoided,  an  advance  will  have 
been  made  in  the  treatment  of  that  most  serious 
malady — trifacial  neuralgia  of  severe  type. 

The  serious  consequences  of  the  various  drug 
habits  upon  their  victims  make  the  uncontrolled 
sale  of  such  drugs  or  of  preparations  containing 
them  nothing  less  than  a  public  scandal.  It  would 
be  well  were  the  attention  of  the  British  Govern- 
ment called  to  a  resolution  recently  passed  by  the 
Druggists'  Association  of  Syracuse,  New  York. 
Their  legislative  committee  drafted  a  tentative  Bill 
which  provided,  in  substance,  that  no  retail  drug- 
gist or  pharmacist  might  sell  cocaine  or  its  salts 
except  on  the  written  prescription  of  a  practising 
physician  or  dentist  ;  that  all  preparations  con- 
taining cocaine  should  be  labelled  poison  ;  that  no 
prescription  be  repeated  and  no  copy  of  same  given 
to  the  customer  ;  it  also  prohibited  its  use  in  pro- 
prietary articles,  the  penalty  being  $25  for  every 

(a)    Mid.  Chron.,  February,  1904,  page  291. 


420    Tm  Mbdical  Pebss.        TRANSACTIONS  OF  SOCIETIES. 


April  to,  1904. 


bottle  found  containing  cocaine  and  not  properly 
labelled.  The  foregoing  suggestions  would  pro- 
bably secure  the  universal  approval  of  the  medical 
profession  in  our  own  country,  where  a  good  deal 
of  reform  is  needed  as  regards  the  sale  of  dangerous 
drugs  in  proprietary  medicines. 

A  capital  inhaler  has  been  introduced  for  ethyl 
chloride  by  our  old  friends  Duncan  and  Flock- 
hart,  of  Edinburgh  and  chloroform  fame.  It  is 
a  thoroughly  workmanlike  apparatus,  without 
being  too  costly.  This  anaesthetic  is  coming 
greatly  into  vogue.  Its  popularity  and  success, 
however,  depend  not  a  little  on  the  way  it  is 
administered,  and  that,  again,  on  the  efficiency  of 
the  apparatus.      Crede  experto. 

Gbe  ©inpatient  Departments. 

ST.   PETER'S   HOSPITAL. 

A  Case  of  Malignant  Adrenal  Growth  presenting  Some 

Points  of  Interest. 

By  John  Pardob,  M.B.,  F.R.C.S., 

JuMtetant  Surgeon  to  th«  Maath  Hospital. 

H.  B.,  aet.  53,  was  sent  to  me  in  December,  1903, 
by  Dr.  Pinel  Gallie,  of  Camberwell,  with  the  following 
history : — 

He  was  in  his  usual  good  health  until  July,  1903 
(about  five  months  before  he  came  under  my  care), 
when  he  was  seized  with  sudden  acute  pain  in  the 
right  lumbar  region,  of  a  sharp,  tearing  nature  but 
remaining  fixed  in  the  renal  area.  The  pain  caused  a 
good  deal  of  collapse  with  sweating  and  retching,  and 
lasted  for  four  or  five  hours.  Two  similar  attacks 
occurred  in  August,  the  patient  remaining  free  from 
symptoms  in  the  intervals.  On  September  4th,  the 
patient  was  surprised  to  find  his  urine  loaded  with 
dark  blood,  although  no  attack  of  pain  had  occurred 
to  herald  this  symptom.  Hematuria  had  gone  on 
intermittently  ever  since  this  first  attack,  the  longest 
interval  being  of  a  fortnight's  duration  towards  the 
end  of  November.  The  haemorrhage  had  varied  in 
character,  sometimes  being  slight,  at  other  times  being 
profuse,  and  on  these  occasions  being  accompanied 
with  considerable  pain  radiating  into  the  groin  and 
testis.  On  these  occasions  a  large  number  of  clots 
was  passed,  their  passage  down  the  ureter  undoubtedly 
cauttng  the  pain.  These  clots  were  noticed  to  be  of 
two  kinds,  long,  thin,  worm-like  clots,  and  others  of  an 
irregular  shape,  but  no  triangular  or  conical  clots  were 
seen.  On  one  or  two  occasions  the  bleeding  was  so 
severe,  and  the  clots  so  large  and  numerous,  that 
retention  occurred,  requiring  relief  by  catheter.  Fre- 
quency of  micturition  was  normal  at  first,  increasing 
a  little  latterly,  and  necessitating  the  patient  rising 
once  or  twice  at  night.  These  symptoms  were  present 
on  the  patient's  admission  to  St.  Peter's  Hospital  on 
December  14th.  On  examination,  neither  kidney  could 
be  felt,  and  nothing  abnormal  could  be  detected  in 
the  abdomen.  The  prostate  was  slightly  enlarged, 
particularly  on  the  right  side,  but  there  was  no 
diminution  in  the  stream  of  urine,  which  was  excellent, 
except  during  the  passage  of  clots. 

The  urine  on  admission  was  smoky,  specific  gravity 
1018,  acid  in  reaction.  By  the  microscope  blood  and 
a  few  pus  cells  were  seen.  No  casts,  no  crystals,  and 
no  pieces  of  growth  were  observed. 

I  examined  the  bladder  with  the  cystoscopy  and 
found  it  normal  with  the  exception  of  the  right  ureteric 
meatus,  which  was  somewhat  larger.  Perfectly  clear 
urine  was  being  ejected  from  the  left  ureter,  but  on 
pressure  being  made  over  the  right  renal  area  deeply 
blood -stained  urine  was  discharged  from  the  right 
ureteric  orifice.  Whilst  I  was  watching,  this  suddenly 
ceased,  and  though  from  the  left  ureter  normal  urine 
continued  to  be  ejected,  not  a  drop  more  came  from 
the  right  side. 

A  diagnosis  of  renal  growth  was  made,  and  I  cut 
down  upon  the  right  kidney  by  the  usual  oblique  lumbar 


incision.  The  lower  pole  of  the  kidney  felt  quite 
normal,  but  on  palpating  the  pelvis  a  mass  was  felt 
which  gave  the  impression  of  a  stone. 

On  freeing  the  upper  part  of  the  kidney  it  was  found 
to  be  invaded  by  a  growth,  bossy  and  irregular  in 
character.  The  organ  was  therefore  delivered  into 
the  wound,  and  as  the  pedicle  was  very  short,  two 
pedicle  clamps  were  placed  upon  it,  and  the  kidney 
removed. 

On  cutting  through  the  pelvis  the  mass  which  had 
simulated  a  stone  was  found  to  be  a  portion  of  growth, 
which  had  become  detached  within  the  pelvis,  and 
had  blocked  its  outlet,  lying  loose  in  the  pelvic  cavity. 

The  clamps  were  left  on  the  pedicle,  and  removed 
thirty-six  hours  later,  no  anaesthetic  being  required. 
The  patient  made  a  good  recovery,  though  a  little 
anxiety  was  caused  by  some  bronchitis  during  the 
first  few  days  after  operation.  He  went  to  the  sea-side, 
and  on  his  return  a  few  weeks  later  the  loin  was  found 
to  be  perfectly  sound,  no  sign  of  recurrence  anywhere, 
and  the  patient  in  excellent  condition.  He  has  re- 
turned to  his  work  as  a  railway  van-man.  The  growth 
proved  to  be  an  endothelioma  growing  from  a  cortical 
adrenal  nest.  It  had  invaded  the  whole  of  the  upper- 
pole  of  the  kidney,  and  had  perforated  the  lining  of 
the  pelvis,  projecting  into  one  of  the  upper  calyces, 
thus  accounting  for  the  severe  haemorrhage.. 

This  case  was  operated  upon  in  a  sufficiently  early 
stage  to  render  the  prognosis  very  hopeful.  Their 
growth  had  not  passed  beyond  the  limit  of  the  kidney 
tissue,  the  pelvis  and  ureter  were  not  invaded,  and 
no  enlarged  glands  could  be  felt. 

There  is  a  very  strong  tendency,  in  malignant  new 
growth  of  the  kidney,  to  the  occurrence  of  secondary 
growths  in  other  situations,  and  early  removal  is, 
therefore,  of  supreme  importance.  Nephrectomy  is 
also  a  simple  matter  when  the  growth  is  confined  to 
the  kidney  and  has  not  invaded  the  surrounding 
tissues  and  organs. 

Very  free  bleeding,  bright  red  in  colour,  such  as 
occurred  in  this  case,  is  often  considered  to  be  strong 
presumptive  evidence  that  its  site  is  in  the  bladder, 
especially  when  there  are  no  localising  symptoms,  such 
as  pain  in  the  lumbar  region,  to  draw  attention  to  the 
kidneys.  Conversely,  pain  in  the  renal  area  with  the 
accompaniment  of  "  smoky "  urine  is  considered 
indicative  of  kidney  trouble.  If  entire  reliance  is 
placed  upon  these  symptoms  the  surgeon  will  not 
seldom  be  led  into  error.  I  have  recently  recorded 
cases  {Lancet,  March  28th,  1903)  where  on  the  one 
hand  free  haemorrhage  with  increased  frequency  and' 
pain  on  micturition  and  suprapubic  pain  was  due  to 
a  renal  growth,  and  in  the  other  moderate  bleeding 
with  renal  pain  was  due  to  a  bladder  growth  springing 
from  the  neighbourhood  of  the  ureteric  meatus  and 
causing  reflex  pain  in  the  corresponding  kidney.  The 
use  of  the  cystoscope  affords  positive  evidence  of  the- 
source  of  the  bleeding. 

I  am  indebted  for  the  excellent  notes  of  this  case 
to  our  senior  house  surgeon,  Mr.  R.  J.  Swan. 


^Transactions  of  Societies. 


ROYAL  ACADEMY  OF  MEDICINE  IX  IRELAND. 

Medical    Section. 

The  President,  Sir  A.  V.  Macan,  in  the  Chair. 

FURTHER  NOTES  ON  GLYCOSURIA  AND   INSANITY. 

Dr.  W.  R.  Dawson  gave  an  account  of  a  second 
series  of  cases,  twelve  in  number,  of  insanity  in  which 
glycosuria  had  been  observed.  In  seven  of  these 
sugar  was  found  on  one  occasion  only ;  in  two  more  it 
was  present  in  the  urine  for  about  a  month  on  one 
occasion,  but  was  cured  by  dieting  ;  and  in  two  others 
glycosuria  occurred  transitorily  on  more  than  one 
occasion.  The  last  case  was  one  of  minor  epilepsy 
with  short  periods  of  alternating  insanity,  who  after 
a  number  of  years  developed  a  glycosuria  which  has 
persisted  in  varying  intensity  for  nearly  two  years,  but 
does  not  seem  to  be  afiectmg  the  bodily  health.  It 
has  yielded   latterly   to   Poehl's  cerebrin,   which  also* 


April  20,  1904. 


TRANSACTIONS  OF  SOCIETIES.        The  Medical  Press.    421 


seemed  to  benefit  the  epilepsy,  and  on  the  whole  the 
number  of  seizures  have  been  very  considerably 
reduced  since  the  sugar  appeared.  Of  the  twelve 
cases,  eight  were  melancholic  or  subject  to  depressing 
delusions ;  two  were  doubtfully  happy,  and  two  were 
demented,  and,  therefore,  supported  previous  obser- 
vations. In  two  cases  some  mental  depression  seemed 
to  be  associated  with  the  glycosuria,  but  on  the  whole 
this  symptom,  if  transitory,  had  no  particular  signi- 
iicance. 

Dr.  T.  P.  Kirkpatrick  inquired  the  pathogenesis  of 
true  diabetic  insanity.     Was  it  due  to  toxaemia  ? 

Dr.  Dawson,  in  reply,  said  that  none  of  these  were 
cases  of  true  diabetic  insanity.  He  had  only  seen 
one  such  case,  which  he  had  described,  and  the  disease 
was  very  rare.  In  a  paper  published  about  two  years 
ago  he  had  urged  that  the  mental  symptoms  were  due 
to  absorption  of  the  haemic  oxygen  by  the  sugar  in 
the  blood.  The  last  patient  did  not  show  markedly 
the  other  symptoms  of  diabetes. 

Dr.  T.  G.  Moorhead  reported  a  case  of 

GASTRO-TBTANY 

which  terminated  fatally  a  week  after  the  onset  of 
the  symptoms.  Post-mortem,  the  stomach  was  found 
dilated,  and  there  was  a  commencing  carcinomatous 
growth  at  the  pylorus.  The  kidneys  were  intensely 
congested,  and  also  showed  slight  chronic  changes. 
Nothing  abnormal  was  found  in  the  motor  cells  of  the 
spinal  cord.  Several  experiments  were  carried  out 
with  the  vomit,  but  all  proved  negative  as  far  as  effects 
upon  animals  were  concerned.  This,  he  pointed  out, 
was  in  accordance  with  the  majority  of  other  obser- 
vations, and  seemed  to  point  to  the  fact  that  either 
the  disease  was  not  of  a  toxic  nature,  or  else  that  the 
toxin  was  not  contained  within  the  vomit. 

Dr.  Craig  mentioned  a  case  of  gastro-tetany  which 
he  had  seen  in  the  Meath  Hospital.  The  patient 
suffered  from  dilated  stomach,  and  the  characteristic 
symptoms  of  tetany  appeared  soon  after  lavage  had 
been  practised.  A  fatal  result  ensued  early.  Dr. 
Craig  briefly  mentioned  a  case  of  true  tetany,  which  he 
had  also  observed. 

Dr.  H,  C.  Drury  suggested  that  the  condition  of 
the  kidneys  in  this  case  might  have  had  its  share  in 
the  causation  of  the  symptoms.  He  was  interested 
in  the  tact  that  a  large  proportion  of  the  recorded 
cases  of  gastro-tetany  had  renal  trouble  of  some 
description.  He  advocated  the  operation  of  gastro- 
enterostomy as  likely  to  obviate  the  condition  in 
cases  of  pyloric  obstruction  and  gastrectasis. 

Dr.  J.  B.  Coleman  had  seen  a  man  in  the  Whitworth 
Hospital  who  had  been  brought  in  with  tetany,  when 
a  greatly  dilated  stomach  was  discovered.  The 
patient  refused  to  remain  in  hospital. 

Dr.  G.  Peacocks  questioned  the  importance  of 
leucocytosis  as  a  sign  of  an  early  fatal  issue,  or  as 
necessarily  a  sign  of  severe  toxaemia. 

Dr.  Moorhead  replied. 

LARYNGOLOGICAL      SOCIETY      OF      LONDON. 
Meeting  held  Friday,  April  8th,  1904. 


The  President,  Dr.  P.  McBride,  in  the  Chair. 


The  following  cases  and  specimens  were  shown  : — 

Dr.  StClair  Thomson  :  A  case  of  Membranous 
Ulceration  of  Fauces,  of  six  weeks'  duration,  in  a 
female,  aet.  36.  The  glands  were  enlarged,  but  there 
was  no  fever,  Klebs-Loeffler  bacilli,  Vincent's  spirilla, 
or  fusiform  bacilli.  Those  members  who  discussed  the 
case  inclined  to  a  diagnosis  of  syphilis. 

Mr.  P.  de  Santi  showed  a  case  of  chronic  hoarseness 
in  a  woman,  aet.  43.  There  was  general  thickening  of 
the  inter-arytaenoid  space  and  of  the  larynx,  and  there 
was  a  small  nodule  at  the  right  processus  vocalis  with 
a  corresponding  depression  on  the  other  side  (pachy- 
dermia laryngis).  The  case  was  brought  forward  for 
the  question  of  treatment,  and  was  subsequently  dis- 
cussed by  Messrs.  Tilley,  Lack,  Thomson,  Dundas 
Grant,  and  the  President. 

Dr.  H.  L.  Lack  showed  a  man  with  bilateral  abductor 


paralysis,  the  result  of  trauma.  The  question  was, 
could  any  operation  be  done  to  relieve  the  laryngeal 
obstruction  ?  The  general  opinion  of  the  meeting  was 
that  nothing  could  be  done. 

Mr.  H.  Tod  showed  a  case  of  tuberculous  laryngitis 
in  a  girl,  aet.  13,  with  definite  tuberculous  disease  of 
both  lungs.  He  also  showed  three  cases  where  the 
"  fenster-resection "  operation  for  deviation  of  the 
septum  had  been  performed.  The  results  were  satis- 
factory, but  those  members  who  spoke  in  connection 
with  the  cases  were  of  opinion  that  this  operation  was 
no  new  one,  but  had  been  performed  frequently  in 
England  for  the  last  fifteen  years. 

Dr.  H.  Tilley  showed  a  case  that  had  been  pre- 
viously exhibited  twelve  months  ago  to  illustrate  the 
permanence  of  the  successful  operation  for  extensive 
adhesions  of  the  soft  palate  to  the  posterior  pharyngeal 

wall. 

Dr.  H.  W.  Kelson  showed  two  cases  of  Disease  of 
the  Fauces  simulating  Syphilis. 

Dr.  J.  B.  Ball  showed  a  very  interesting  case  oi 
Melanotic  Sarcoma  of  the  soft  palate  in  a  man,  aet.  53, 
who  noticed  some  black  patches  on  the  palate  about  two 
years  ago.  Some  seven  or  eight  months  ago  a  growth 
commenced  on  the  soft  palate  which  had  grown  con- 
siderably during  the  last  few  weeks,  and  the  patient 
had  lost  a  stone  in  weight  during  the  last  year.  There 
was  some  slight  glandular  enlargement  under  the  chin 
in  the  middle  line. 

Mr  P.  de  Santi  advised  thorough  extirpation  of  the 
growth  itself  and  surrounding  parts,  but  thought  the 
prognosis  very  bad  in  any  case.  . 

Mr  E  B.  Waggett  showed  a  pair  of  shears  for  doing: 
the  operation  of  thyrotomy,  and  an  aseptic  forehead 
mirror-handle  for  use  during  operations  on  the  throat 
and  nose. 

SHEFFIELD   MEDICO-CHIRURGICAL   SOCIETY, 
Meeting  held  March  31ST,  1904. 

The  President,  Mr.  G.  H.  West  Jones,  in  the  Chair, 

Mr  Edward  Skinner  showed  a  large  sarcomatous 
tumour  weighing  14  lbs.,  removed  post-mortem  from 
the  abdomen  of  a  man,  aet.  28.  The  tumour  was  first 
felt  in  the  right  flank  five  months  previously.  The 
patient  was  also  the  subject  of  marked  molluscum 
fibrosum  of  many  years'  duration. 

Dr.  Arthur  Hall  showed  {a)  Two  Cases  of  Lupus 
Erythematosus,  one  in  a  middle-aged  married  woman, 
associated  with  tuberculous  glands  in  the  neck  and  an 
attack  of  pleurisy  with  effusion.  Uncertain  physical 
signs  in  the  ches\  of  phthisis.  In  this  case  salicm, 
kt  x  t.ds..  had  been  of  distinct  service  m  clearing  up 
the  eruption.  While  under  large  doses  of  urea ^pre- 
viously the  glands  had  become  much  less.  The  other 
case  was  much  more  extensive,  in  a  child,  a*.  12,  a 
rheumatic  subject  with  recent  acute  rheumatism, 
during  which  the  rash  became  much  worse. 

lb)  Lupus  Vulgaris  in  Association  with  Pulmonary 
Tuberculosis.  The  course  of  events  has  been  tuber- 
culous lymphatic  glands  of  right  neck  in  childhood, 
secondary  infection  of  the  skin  when  these  burst, 
extension  to  apex  of  right  lung. 

{c)  Cases  of  Psoriasis  in  two  sisters.  Marked 
improvement  under  thyroid  extract  alone. 

(d)  >  Herpetiform  Dermatitis  or  Pemphigus.  In 
favour  of  the  former  is  the  multiformity  of  the  eruption  ; 
against  is  the  entire  absence  of  pain. 

le)  Hysteria  in  Male.  Complete  loss  of  speech  with 
right  hemi-ansesthesia  and  slight  right  paresis.  Patient, 
single,  middle-aged,  began  with  a  fit  in  the  street  On. 
admission,  he  was  unable  to  utter  a  sound  of  any  kind, 
but  was  conscious  and  able  to  write  out  a  full  account 
of  himself.  On  being  asked  to  say  "  Oh  !  "  he  was 
able  to  place  his  mouth  and  lips  in  the  proper  position, 
but  could  not  make  any  sound.  In  a  few  days  the 
speech  gradually  returned  and  the  hemi-anaesthesia 
disappeared. 

Mr.  Sinclair  White  showed  the  following  cases  and 
specimens:    (1)  Four  men  whose  prostates  had  been. 


422     The  Medical  Piess. 


GERMANY. 


April  20,  1904. 


removed  suprapubically  in  1002.  Their  ages  ranged 
irom  61  to  72  years.  All  were  in  excellent  health,  and 
had  completely  recovered  power  to  empty  the  bladder. 
42)  A  scries  of  specimens  of  enlarged  prostate  recently 
tremoved,  including  one  showing  a  very  marked  so- 
-called middle  lobe.  (3)  Two  specimens  of  cancer  of 
*he  mid-rectum  recently  removed  by  the  trans-sacral 
•route.  In  both  cases  the  rectum  was  slit  up  along  its 
•posterior  surface  as  high  as  the  growth,  and  divided 
•transversely  from  within  outwards,  at  least  one  inch 
below  the  cancer.  The  diseased  segment  was  then  dis- 
sected from  the  surrounding  tissues  until  well  clear  of 
the  upper  limit  of  the  growth,  when  the  bowel  was  again 
•divided  transversely.  The  rectal  walls  were  then 
pulled  down  and  stretched  to  the  anal  margin.  He  had 
performed  Kraske's  operation  for  cancer  of  the  rectum 
•eighteen  times  with  four  deaths.  (4)  Three  myomatous 
^and  one  cancerous  uteri  removed  abdominally.  All 
made  good  recoveries.  The  entire  uterus  was  removed 
in  each  case.  Unless  the  patient  was  stout  he  preferred 
the  abdominal  to  the  vaginal  route  for  removing 
♦cancerous  uteri.  (5)  A  large  sarcomatous  growth  of 
the  lower  end  of  the  humerus  removed  by  disarticu- 
lation at  the  shoulder- joint.  The  axillary  glands  were 
also  removed,  as  they  had  become  much  enlarged. 
The  patient,  a  young  female,  made  a  rapid  recovery. 
X6)  A  partial  resection  of  the  stomach  for  a  chronic  ulcer 
of  many  years'  duration,  situated  on  the  upper  border 
two  inches  to  the  left  of  the  pylorus.  The  stomach 
walls  were  much  thickened  and  indurated  about  the 
ulcer,  and  as  the  patient  had  for  some  months  been 
losing  flesh  rapidly,  it  was  feared  it  might  have  become 
•cancerous.  A  Murphy's  button  was  employed  to  unite 
the  duodenum  to  the  posterior  wall  of  the  stomach. 
One-half  of  the  button  was  introduced  into  the  stomach, 
which  was  then  completely  closed  by  a  double  row  of 
•continuous  sutures.  A  small  opening  was  then  made 
in  the  posterior  wall  of  the  stomach,  through  which 
*he  shank  of  the  button  was  protruded.  The  patient 
made  an  excellent  recovery. 

Mr.  P.  E.  Barber  read  notes  of  a  case  of  Belladonna 
Poisoning  due  to  application  of  a  belladonna  plaster 
to  the  mamma. 


f  ranee- 

[from  our  own  correspondent.] 

Paris,  April  16th,  1904. 
Treatment  of  Cirrhosis  of  the  Liver. 

Dr.  Cregny  made  an  interesting  communication  at 
the  Societe  de  Therapeutique  on  the  treatment  of 
cirrhosis.  A  hard  drinker,  aet.  58,  was  for  months  ill 
with  cirrhosis  accompanied  by  the  usual  train  of  sym- 
ptoms, ascites,  emaciation,  &c.  The  classical  treat- 
ment (tapping,  iodides,  cholagogues)  was  tried  with 
but  little  success.  The  condition  of  the  patient  became 
precarious,  voluminous  haemorrhoids  causing  great  loss 
of  blood,  producing  profound  anaemia.  Ulcerations  of 
the  sacrum  indicated  that  the  end  was  not  far  off.  It 
was  at  this  period  that  M.  Cregny  decided  to  try  hepatic 
opotherapy.  The  patient  was  ordered  each  day  milk 
diet,  an  egg,  and  a  small  quantity  of  pig's  liver  (raw), 
.and  fifteen  grains  of  hepatic  extract  every  morning  in 
a  cup  of  milk.  Improvement  took  place  almost  imme- 
diately. The  oedema  of  the  legs  and  scrotum  dis- 
appeared, while  the  acites  did  not  return  after  the  last 
tapping  ;  the  appetite  became  better,  and  the  strength 
gradually  returned.  At  the  end  of  four  months,  the 
patient  was  able  to  resume  his  work. 

M.  Hirtz  said  that  he  had  similar  success  in  a  man 
aet.  54,  a  heavy  drinker.  The  ascites  was  so  abundant 
.as  to  render  breathing  very  difficult ;  the  abdomen 
was  covered  with  a  network  ot  veins,  while  the  legs 
were  considerably  swollen.  Milk  diet,  calomel  one 
.grain  daily,  diuretics,  and  repeated  tappings  did  not 
produce  much  improvement.     The  speaker  finally  had 


recourse  to  the  use  of  raw  pig's  liver,  of  which  the 
patient  ate  five  ounces  daily.  The  condition  im- 
proved perceptibly  from  this  moment ;  the  oedema 
and  ascites  diminished  rapidly,  abundant  diuresis  set  in, 
and  the  present  condition  of  the  patient  is  excellent. 

Diagnosis  of  Uterine  Fibroma  and  Pregnancy. 

The  diagnosis  between  uterine  fibroma,  salpingitis, 
and  pregnancy,  says  Professor  Tillaux,  is  not  always 
easy.  Pregnancy  might  pass  unperceived  or  be  taken 
for  a  tumour,  and  the  best  accoucheurs  have  made 
mistakes. 

Three  women  came  to  the  hospital  presenting  good 
examples  of  the  difficulties  that  can  be  encountered, 
The  first  patient  was  thought  to  have  a  fibroma 
whereas  she  was  pregnant ;  the  second  was  also 
thought  to  have  a  fibroma,  it  was  in  reality  a  case  of  sal- 
pingo-ovaritis,  and  the  third  patient  likewise.  The 
three  women  entered  the  hospital  for  abundant  metror- 
rhagia. The  first  patient,  aet.  28,  had  already  had  five 
pregnancies,  of  which  two  miscarried.  She  did  not 
think' herself  pregnant,  was  regular,  but  for  the  pre- 
vious fifteen  days  lost  a  good  deal.  The  uterus  was 
increased  in  volume  and  could  be  felt  as  a  hard  mass 
above  the  pubis.  Fibroma  of  the  anterior  wall  of  the 
uterus  was  the  conclusion  arrived  at,  and  an  operation 
was  spoken  of  as  a  near  possibility.  A  few  days  after- 
wards the  woman  was  examined  again,  but  this  time 
the  tumour  had  changed  its  consistency ;  instead  of  being 
hard  it  was  soft  and  enlarged,  removing  all  doubt  ol 
the  true  nature  of  the  case,  which  was  that  of  a  gravid 
uterus.  The  rest  in  bed  stopped  the  haemorrhage, 
and  the  patient  went  on  to  her  term  without  much 
difficulty. 

The  second  case  was  that  of  a  woman,  aet.  24.  Here, 
also,  a  fibroma  was  thought  to  be  the  cause  of  her 
trouble,  but  examination  through  the  vagina  corrected 
the  mistake.  The  tumour  occupied  the  right  cul  de  sac 
of  the  vagina,  and  was  of  the  size  of  an  infant's  head, 
and  was  fixed.  In  cases  of  fioroma  the  tumour,  at 
least  at  the  beginning,  is  very  mobile.  It  was  a  case 
of  salpingo-ovaritis. 

The  third  patient  was  aet.  25.  In  the  right  cul  de  sac 
a  tumour  was  found  large  enough  to  displace  the 
uterus.  The  following  day  the  idea  of  a  fibroma  was 
abandoned,  as  a  groove  of  separation  between  the 
tumour  and  the  uterus  was  discovered.  This  groove 
had  been  remarked  before,  but  no  attention  had  been 
paid  it.  However,  it  soon  became  evident  that  the 
case  was  one  of  salpingo-ovaritis,  as  no  groove  exists 
in  fibroma. 

The  three  signs  above  mentioned  should  not  be  for- 
gotten by  practitioners  when  such  cases  present  them- 
selves, in  order  to  arrive  at  an  exact  diagnosis. 

In  the  first  case  the  existence  of  a  fibroma  was  re- 
jected on  account  of  the  changes  in  the  consistency  of 
the  uterus,  never  observed  in  fibroma  ;  the  patient  was 
pregnant.  In  the  second  case  (salpingo-ovaritis)  the 
immobiUty  of  the  tumour  and  its  independence  of  the 
uterus  proved  that  a  fibroma  was  not  the  cause.  As 
regards  the  third  patient,  the  tumour  was  separated 
from  the  uterus  by  a  groove  ;  such  groove  is  not  met 
with  in  fibroma. 


oermanj?. 

[from    our    own    correspondent.] 

Bum*.  April  16th,  1904. 
At  the  Society  for  Innere  Medizin,  Hr.  v.  Leyden 
related  a  case  of 
Rupture  of  an  Aneurysm  of  the  Aorta  into  the 

Vena  Cava  Superior. 
On  February  29th  a  labourer,  aet.  57,  was  admitted  into 


April  20,  1904 


AUSTRIA. 


The  Medical  Press.    423 


the  F  rst  Medical  Klinik  with  very  marked  symptoms.  He 
sat  upright  in  bed,  the  upper  part  of  the  body — face, 
thorax  and  upper  extremities — were  very  oedematous, 
more  so  than  generally  seen  in  dropsy.  On  examin- 
ing the  lower  half  of  the  body,  it  was  found  to  be  free 
from  swelling.  The  speaker  thought  from  this  that 
there  was  probably  closure  or  compression  of  the 
veins  of  the  upper  part  of  the  body,  or  of  the  vena 
cava,  or  of  the  right  ventricle,  possibly  by  a  tumour 
in  the  mediastinum.  Rontgen  illumination  showed 
an  aneurysm  of  the  aorta,  and  the  hand  laid  on  the 
manubrium  sterni  felt  a  strongly  heaving  pulsation. 
The  venous  stasis  was  extreme,  the  commencing  cyanosis 
increased,  but  the  dilatation  of  the  vein  was  covered 
by  the  oedema.  The  radial  pulse  could  be  felt  after 
removing  the  oedema  by  pressure.  Percussion  gave 
scarcely  any  result ;  the  lung  resonance  was  on  the 
whole  normal ;  dulness  over  the  sternum  not  much 
marked ;  the  left  cardiac  dulness  only  slightly 
extended  ;  the  heart  impulse  strongly  heaving.  Auscul- 
tation revealed  sounds  in  the  neighbourhood  of  the 
aorta  ;  two  sounds  following  one  another  not  of  an 
endocardial  nature,  more  of  a  rushing  character, 
comparatively  circumscribed,  and  not  to  be  heard  either 
in  the  carotids  or  at  the  base  of  the  heart.  The 
sounds  bear  the  character  of  venous  ones.  The  pulse 
could  be  plainly  felt  in  the  femoral  arteries.  He 
thought  that  the  aorta  was  compressed  by  the 
aneurysm.  The  patient  stated  that  the  symptoms 
had  appeared  suddenly  a  short  time  before.  On 
February  13th  he  had  felt  as  if  he  had  received  a 
blow  in  the  region  of  the  heart,  and  had  felt  giddy 
from  it.  The  day  after,  the  eyes  were  swollen  and  then 
the  swelling  had  spread  over  the  whole  upper  part  of 
the  body.  Then  shortness  of  breath  came  on,  giddi- 
ness, pressure  on  the  l\ead,  and  bleeding  from  the 
nose.     The  urine  was  scanty. 

The  sudden  onset  of  the  symptoms  led  to  a  belief 
that  the  case  was  one  of  dissecting  aneurysm.  The 
day  after  the  patient's  admission  he  felt  somewhat 
better,  and  the  oedema  had  given  way  a  little  to 
diuretics,  but  there  was  no  real  improvement.  At 
night  the  difficulty  of  breathing  became  worse,  so 
that  the  patient  had  to  get  out  of  bed.  These  steno- 
cardiac  attacks  were  repeated  every  night,  but  were 
not  of  long  duration.  He  died  on  March  15th.  The 
course  of  the  illness  reminded  Hr.  v.  Leyden  of  that 
of  a  highly  honoured  colleague  ;  similar  attacks  with 
moderately  free  intervals,  except  that  the  attacks 
were  not  so  severe  as  those  of  his  colleague,  and 
lastly  there  was  the  same  sudden  passing  away. 

At  the  autopsy  an  aneurysm  the  size  of  an  egg  was 
found  lying  on  the  right  auricle  and  superior  vena 
cava  and  compressing  it.  The  cervical  veins  were 
filled  with  thrombi  ;  the  innominata  was  free. 

Hr.  Westenhoeffer  reported  on  the  anatomical 
condition,  and  showed  the  preparation.  It  was  a 
typical  sacciform  aneurysm  with  a  sharply  denned 
neck  with  multiple  cavities.  At  one  spot  the  wall 
of  the  aneurysm  was  thinned,  so  that  rupture  into 
the  pericardium  was  imminent.  The  sac  completely 
covered  the  right  auricle.  Perforation  into  the  vena 
cava  had  taken  place  through  a  small  sharp-edged 
opening,  a  proof  that  it  must  have  been  in  existence 
several  weeks.  The  patient  had  formerly  suffered 
from  trichinosis,  as  was  shown  by  numerous  calcifica- 
tions and  also  by  some  livingjencapsuled  trichinie.  The 
walls  of  the  sac  showed  sclerotic  changes. 

Hr.  A.  Fraenkel  brought  to  mind  three  similar  cases 
observed  by  himself,  in  two  of  which  he  had  arrived 
sat  a  correct  diagnosis.   The  sudden  onset  of  the  venous 


stasis  and  the  other  symptoms  when  once  seen  could 
not  point  to  anything  else.  The  onset  of  the  catas- 
trophe was  generally  associated  with  some  bodily 
exertion.  In  his  first  case  the  symptoms  came  on 
whilst  the  patient  was  mounting  steps,  and  oedematous 
swelling  soon  followed.  In  the  second  case  he  had  at 
once  diagnosed  perforation  of  an  aneurysm  into  the 
superior  vena  cava.  In  this  case  the  patient  died  in 
six  or  eight  days.  The  diagnosis  was  based  on  three 
symptoms  : — ( 1 )  The  sudden  oedematous  swelling  in 
the  upper  half  of  the  body  in  patients  with  cardiac 
symptoms,  but  without  previous  swelling ;  (2)  the 
onset  of  "  rushing  "  cardiac  sounds  ;  (3)  venous  pulse 
in  the  upper  extremities,  which,  however,  often  re- 
mained unnoticed,  as  in  his  own  three  cases.  The 
perforation  opening  was  characteristic  :  it  was  as  sharp 
as  if  cut  out  with  a  punch. 

Hr.  Westenhoeffer  showed  a  preparation  of  an 
aneurysma  dessicans  three  fingers'  breadth  above  the 
aortic  valves. 

Hr.  Guttmann  also  showed  (1)  a  preparation  of  an 
aortic  aneurysm  just  above  the  aortic  valves.  There 
was  sclerotic  degeneration  of  the  walls  of  the  aneurysm. 
A  sharp-edged  opening  led  to  a  hollow  space  that  was 
divided  into  two  parts  by  a  septum.  Possibly  two 
aneurysms  had  developed  that  had  later  on  united 
into  one.  The  opening  into  the  left  carotid  was  very 
narrow.  (2)  Preparation  in  connection  with  Ostreich's 
address  on  obstructing  thrombosis  of  the  abdomina 
aorta.  The  abdominal  aorta  just  above  its  division 
was  blocked  by  thrombi,  without  changes  in  the  lower 
extremities,  however. 


Austria. 


[from    our    own    correspondent.] 

Vmnu,  April  16th,  1904. 
Hepatic    Cirrhosis    and    Ascites. 

At  the  Gesellschaft  Pal  presented  a  waiter, 
aet.  48,  who  four  years  ago  was  operated  on  by  Talma 
without  any  apparent  success.  After  the  operation 
the  ascites  returned  as  before.  After  six  tappings,  a 
form  of  polyserositis  set  in,  1  such  as  perihepatitis, 
pleuritis,  &c,  then  the  ascites  ceased,  and  has  not 
been  observed  for  the  last  eighteen  months.  The 
presumption  is  that  the  intestinal  peritoneum  has 
become  united  with  the  costal  layer,  and  thus  ob- 
literated the  sac. 

Hemophilia. 

Schlesinger  gave  the  members  a  history  of  two  cases 
of  internal  haemorrhage — one  from  the  bowels,  another 
with  morbus  maculosus  "  Werlhofii."  After  ex- 
hausting the  pharmacopoeia,  he  resorted  to  a  supra- 
renal extract  with  perfect  success.  He  gave  it  by  the 
mouth  in  the  form  of  an  extract  containing  1  per  cent, 
of  the  gland  substance.  Ten  to  twenty  drops  of  this 
solution  were  given  every  hour  till  the  bleeding  ceased. 
Stricture  of  the  Rectum. 

Wagner  showed  a  patient  who  had  stricture  of  the 
rectum,  which  he  had  cured  by  operation.  The 
cicatrix  was  probably  due  in  the  first  place  |  to 
gonorrhoea.  The  treatment  he  adopted  was  to  make 
an  opening  into  the  sigmoid  flexure,  and  with  a  conical 
tube  pass  a  cone  down  through  the  anus,'_ where  it  was 
allowed  to  remain  for  some  time.  „  After  this  a  wider 
cone  was  applied  daily,  until  the  lumen  was  fairly 
dilated. 

Congenital   Growth   of  the  Conjunctiva. 

Konigstein  exhibited  a  child,  aet.  i£,  with  a  con- 
genital overgrowth  of  the  conjunctiva  of  both  the 
upper  and  lower  lids.  The  solid  red  growth  extended 
from  the  inner  angles  of  the  eyes  to  the  middle  of  the 


424    The  Medical  Press. 


OPERATING   THEATRES. 


April  20.  1904. 


lids.  The  bulbus  was  perfectly  normal.  The  etiology 
of  the  growth  is  very  obscure,  but  he  conjectured  that 
it  was  in  consequence  of  an  eczema,  with  loss  of 
substance  in  the  fibrous  tissues  of  the  lids,  or  possibly 
an  early  diphtheria  of  the  conjunctiva. 

Multiple  Fatty  Necrosis. 
Wiesel   showed   several    microscopical   preparations 
which  he  had  taken  from  the  liver  of  an  individual 
who  had  suffered  from  fatty  necrosis  in  consequence 
of   pancreatitis   haemorrhagica,  from  which  he  died. 

Many  of  these  centres  of  fatty  degenerations  were 
found  where  large   fatty  globules  filled  the  cells  of  the 
hepatic  tissue  as  well  as  those  of  the  capillary  walls. 
Besides  the  fat,  free  iron  pigment  cells  were  found. 
Rontgen  Injuries. 
Holzknecht     brought     forward     several     cases    of 
injuries  sustained  by  the  Rdntgen  rays,  which  only 
adds  to  the  sad  havoc  that  atrophica  cutis  produces 
after  the  treatment.     These  cases,  like  those  recorded 
at  a  former  meeting,  had  all  suffered  from  persistent 
eczema.     He  thought  the  statistics  of  injury,  or,  more 
properly  stated,  the  percentage  of  failures,  were  greater 
than  those  recorded  at  the  present,  which  varied  from 
4*8  per  cent,  to  o  per  cent.     He  did  not  think  the  use 
of  the  chromo-radiometers  had  proved  to  be  so  success- 
ful as  was  supposed,  and  that  the  exact  measurement 
of  the  intensity  of  the  ray  is  only  a  vague  relative 
term.     Riehl  remarked  that  the  statistics  of  1903  were 
not  sufficiently  accurate,  nor  have  the  observations 
been  so  carefully  recorded  as  to  give  us  such  assurance 
of  correctly  forming  an  opinion  of  the  injury  done  by 
the  rays.     It  is  generally  admitted   that  burning  is 
accidentally    effected  through  peculiar  idiosyncrasies. 
It  is  to  be  hoped,  however,  that  these  warnings  will 
have  a  better  result  in  future  among  dermatologists. 
He  thinks  that  eczema  is  not  a    suitable  disease  to  b* 
treated  with  the  rays. 

Ehrmann  quite  agreed  with  Riehl  that  the  painful 
lessons  so  recently  revealed  should  teach  us  to  be 
more  guarded  with  different  individuals  when  apply- 
ing the  rays  to  the  skin,  as  the  healthy  cuticle  could 
suffer  more  exposure  than  the  morbid  condition,  on 
which  the  rays  acted  more  rapidly  and  with  greater 
intensity. 

Schiff  believed  that  different  individuals  had  dif- 
ferent powers  of  reaction  under  these  rays,  and  that 
it  behoves  us  to  exercise  great  judgment  in  application 
where  such  treatment  was  indicated,  and  that  both 
factors  should  be  duly  considered. 

Kienbock  said  he  could  not  deny  all  that  had  been 
advanced  on  the  idiosyncrasies  of  different  individuals 
where  atrophy  of  the  skin  has  occurred,  but  it  must  not 
be  forgotten  that  the  question  often  arises  whether 
it  is  better  to  suffer  from  the  consequences  of  the  rays 
than  the  disease  itself.  There  are  certain  diseases, 
however,  such  as  favus,  sycosis,  &c,  where  the  results 
have  been  excellent,  and  no  bad  effects  when  carefully 
applied. 

TLbc  ®perattn<3  Cbeatres. 


ST.  BARTHOLOMEWS  HOSPITAL. 
Operation  for  Excision  of  a  Carcinoma  of  the 
Tonsil. — Mr.  McAdam  Eccles  operated  upon  a  man, 
aet.  67,  with  a  view  to  the  extirpation  of  a  carcinoma 
of  the  left  tonsil.  The  patient  was  placed  under 
chloroform  by  inhalation  through  the  nose  and  mouth. 
Then  a  laryngotomy  was  performed  by  a  transverse 
incision  one  inch  in  length.  During  the  rest  of  the 
operation  the  anaesthetic  was  administered  through 
the  laryngotomy  tube.  The  pharynx  having  been 
>htly  plugged  with  a  sponge,    Mr.  Eccles  slit  back 


the  left  cheek  on  a  line  with  the  mouth,  and  notched  the 
anterior  part  of  the  masseter  and  the  internal  pterygoid. 
This  manoeuvre  gave  a  very  free  exposure  of  the  opera- 
tion area.    By  means  of  a  scalpel  the  soft  palate  was- 
divided  well  to  the  right  side  of  the  uvula,  and  detached 
from  its  junction  with  the  hard  palate.     The  incision 
was  then  carried  in  front  of  the  anterior  pillar  of  the 
fauces  down  to  the  base  of  the  tongue,    then  across 
the  posterior  part  of  this  organ,  back  to  the  side  wall 
of  the  pharynx,  and  up  behind  the  posterior  pillar  of 
the  fauces.     In  this  way  the  whole  of  the  growth  was 
isolated.     By    deepening    the   incision   and    working 
with  the  finger  and  scissors  curved  on  the  flat,  a  good 
extent    of    tissue    beneath  the  growth  was  separated 
from   the   underlying  parts.     There  was   pretty   free 
haemorrhage    during    these    manipulations,    but    the 
greater  portion  of  it  was  easily  checked  by  sponge 
pressure.     After  all  the  bleeding  had  been  arrested, 
the  cheek  was  sewn  up   with   silkworm-gut    sutures 
externally,  and  catgut  stitches  internally.     The  sponge 
from    the    pharynx   was   removed,    and    the    patient 
breathing  well,  without  any  cough,  it   was   thought 
feasible  to  remove  the  laryngotomy  tube,  and  to  sew 
up  this  wound  before  the  patient  left  the  table.  Both 
wounds  were  dressed  with  gauze  and  collodion. 

Mr.  Eccles  said  that  the  prognosis  in  cases  ©f  malig- 
nant disease  of  the  tonsil  was  very  grave,  possibly 
worse  in  cases  of  sarcoma  than  in  those  of  carcinoma. 
There  were  two  chief  methods  of  dealing  with  those 
examples  of  the  growth  which  had  not  progressed  too 
far  for  operative  measures.  The  first  was  to  remove 
the  growth  without  making  any  opening  in  the  neck, 
and  the  second  was  to  get  at  the  growth  by  a  lateral 
cervical  incision.  In  early  cases,  Mr.  Eccles  was 
sure  that  it  was  better  to  excise  through  the  mouth, 
after  splitting  the  check,  than  Jo  perform  the  operation 
from  the  outside. 

By  the  operation  through  the  mouth  all  likelihood 
of  septic  infection  of  the  important  cellular  planes  of 
the  neck  was  avoided,  the  patient  was  saved  from 
the  discomfort  of  a  drainage-tube,  and  healing  was 
much  more  rapid.  He  was  certain  of  the  value  of  a 
preliminary  laryngotomy.  It  enabled  the  anaesthetist 
(in  this  case  Mr.  H.  E.  G.  Boyle)  to  administer  the 
chloroform  with  perfect  precision,  it  completely  avoided 
the  passage  of  blood  into  the  air-passages,  it  prevented 
the  breathing  efforts  of  an  imperfectly  anaesthetised 
sufferer  from  throwing  escaping  blood  up  into  the 
face  of  the  operator  at  critical  moments  when  the  value 
of  a  clear  line  of  sight  was  most  essential,  and  last, 
but  by  no  means  least,  it  prevented  a  half -conscious 
patient  from  disturbing  the  persons  actually  engaged  in 
the  operation,  and  also  from  harrowing  the  feelings 
of  the  onlookers,  by  his  struggles  and  semi-articulate 
cries.  Mr.  Eccles  was  of  opinion  that  the  only  point 
against  the  employment  of  a  preliminary  laryngotomy 
or  tracheotomy  was  the  objection  to  the  tube  after  the 
operation  was  finished,  and  during  the  first  few  dap 
of  convalescence,  but  it  was  easy  to  overcome  this 
by  removing  the  tube,  after  the  arrest  of  all  haemor- 
rhage.whilst  the  patient  is  still  under  the  anaesthetic,  ami 
by  sewing  up  the  wound  in  the  air-way  then  and  there. 
Mr.  Eccles  stated  that  this  was  his  usual  custom, 
and  that  he  had  never  seen  any  harm  arise  from  it, 
but  that  patients  had  invariably  done  well,  and, 
therefore,  very  much  better  than  in  some  instances 
in  which  he  had  seen  a  tube  left  in  for  some  days 
after  the  operation.  He  believed  in  the  value  of 
actually  stitching  the  wound  in  the  middle  line  of 
the  neck,  and  discountenanced  the  mere  leaving  of 
the  wound  open  after  the  removal  of  the  tube. 


April  20.  1904. 


LEADING   ARTICLES. 


The  Medical  Press.     425 


The  patient  recovered  well  from  the  operation, 
and  was  able  to  swallow  fairly  comfortably  on  the 
second  day.  Both  wounds  healed  by  primary  union, 
and  there  was  not  the  least  discomfort  with  breathing. 
Tlie  patient  left  his  bed  seven  days  after  the  operation. 

Xo  attempt  was  made  to  remove  the  glands  in 
the  neck  at  the  above  operation,  as  Mr.  Eccles  believes 
that  it  is  well  to  perform  this  extirpation  as  a  second 
operation  after  the  patient  had  practically  recovered 
from  the  first.  In  this  case  there  were  no  enlarged 
glands  to  be  felt  in  the  neck,  but  Mr.  Eccles  a  fortnight 
after  the  first  operation  proceeded  to  remove  all  the 
glands  in  the  submaxillary  and  upper  cervical  region, 
so  as  to  limit  the  risk  of  growth  appearing  there.  It 
is  satisfactory  to  note  that  this  operation  was  entirely 
successful,,  and  that  the  patient  left  the  hospital 
within  a  month  of  the  first  operation,  his  only  dis- 
comfort being  some  alteration  in  his  voice,  and  some 
slight  difficulty  in  easy  deglutition.  Both  these 
defects  would  be  greatly  minimised  by  time  and  habit. 


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SALUS  POPULI  SUPREM A  LEX 


WEDNESDAY,  APRIL  20,  1904. 


TRAMPS  AND  SMALL-POX. 

The  prevalence  of  small-pox  in  London  and  the 
provinces  during  the  last  few  years  has  awakened 
general  interest  in  the  preventive  measures 
available  to  control  and  eradicate  that  most  loath- 
some and  deadly  disease.  It  is  probable  that,  owing 
to  the  object-lesson  furnished  by  recent  epi- 
demics the  margin  of  population  unprotected  by 
vaccination  and  re-vaccination  was  never  at  a 
lower  ebb.  The  machinery  of  notification 
isolation  of  the  sick  and  of  "  contacts/'  and  dis- 
infection was  never  more  universal  or  more 
efficient  throughout  the  country.  There  is  one 
glaring  defect,  however,  in  the  national  preventive 
system  which  renders  it  impossible  to  prevent  the 
spread  of  small-pox  infection  into  every  quarter 
of  the  United  Kingdom,  namely,  the  agency  of 
infected  tramps.  This  vagrant  class  of  society 
lives   under   conditions   admirably   calculated   to 


foster  and  to  multiply  the  infection.  Its  members 
herd  together  in  crowded  lodging-houses  and 
casual  workhouse  wards  nightly  on  their  incessant 
journeyings  to  and  fro  over  the  whole  face  of  the 
country.  Time  after  time  they  have  been  shown 
to  have  brought  small-pox  into  local  communities, 
great  and  small,  which  have  been  thereby  sub- 
jected to  epidemics  of  that  disease,  with  the  con- 
sequent toll  of  suffering  and  death,  to  say  nothing 
of  the  monetary  burden  cast  upon  the  shoulders 
of  ratepayers.  This  particular  question  has  been 
carefully  investigated  by  Dr.  H.  E.  Armstrong,  the 
able  and  energetic  Medical  Officer  of  Health  for 
Newcastle-on-Tyne.  Ten  years  ago  he  published 
a  startling  report  which  showed  that  the  disease 
had  been  introduced  by  tramps  into  58  per 
cent,  of  the  sixty-three  large  towns  from  which 
returns  were  received.  Further,  he  pointed  out 
that  the  same  class  of  person  had  sooner  or  later 
carried  the  infection  into  72  per  cent,  of  the  urban 
centres,  on  an  average  about  five  times  to  each. 
Stimulated  by  these  disclosures,  the  London 
County  Council  convened  a  meeting  of  sanitary 
authorities  from  various  parts  of  the  Kingdom  r 
and  a  number  of  admirable  resolutions  were 
adopted  and  subsequently  presented  to  the  Local 
Government  Board.  No  official  action,  however, 
has  so  far  arisen  out  of  that  timely  and  wise 
counsel.  Ten  years  later  the  tramps  of  the 
United  Kingdom  are  still  wandering  about  at  their 
own  sweet  will  from  village  to  town  and  from 
town  to  village  in  all  parts  of  the  United  Kingdom. 
The  liberty  of  these  vagabond  subjects — for  nine 
out  of  ten  tramps  are  worthless  rogues — is  pre- 
served at  the  cost  of  respectable  citizens,  who 
have  to  maintain  the  Poor-law  infirmaries  and 
small-pox  hospitals  and  to  bear  the  brunt  of  the 
sickness  and  death  directly  due  to  the  small-pox 
planted  in  their  midst  by  these  pestiferous  visitors- 
A  law-abiding  resident  citizen  is  subject  to  a 
Draconian  system  as  regards  the  communication  of 
small-pox  infection.  It  is  only  the  irresponsible 
vagrant  that  escapes  a  similar  wholesale  control  > 
simply  because  he  is  here  to-day  and  there  to- 
morrow, and  in  that  way  evades  the  surveillance 
of  the  local  sanitary  authorities.  Reports  from 
all  parts  of  the  country  remind  us  that  the  evil 
is  still  with  us.  Dr.  Armstrong  has  brought  the 
matter  to  a  climax  by  a  second  report  dealing 
with  the  epidemic  of  1902-03,  and  based  on  a 
hundred  and  twenty-five  replies  received  from  a 
circular  addressed  to  the  medical  officers  of  health^ 
of  205  invaded  places  with  a  population  of 
20,000  and  upwards.  The  general  conclusion 
may  be  best  given  in  his  own  words,  as  follows  : — 
"  Of  the  districts  making  returns  1 1 1  had  been 
visited  by  small -pox  during  the  recent  outbreak, 
and  to  fifty-seven,  or  51  per  cent.,  of  these  the 
infection  was  brought  in  the  first  instance  by  the 
disease-spreading  tramp.  Moreover,  small-pox 
was  introduced  at  least  305  times  by  vagrants 
into  fifty-eight  places  where  it  had  already  made 
its  appearance.  Twenty-three  times  it  was 
carried  into  Sheffield  in  this  manner,  twenty-four 


426     The  Medical  Press. 


LEADING   ARTICLES. 


April  20.   1004. 


times  into  Manchester,  thirty-one  times  into  Wake- 
field, and  thirty-four  into  Liverpool."  In  the  face 
of  these  facts  it  is  evident  that  a  great  part  of  the 
national  expenditure  upon  the  prevention  of 
small-pox  is  neutralised  by  the  lack  of  supervision 
over  the  vagrant  class.  The  matter  must  be 
handled  firmly  sooner  or  later  in  the  interests  of 
"the  community.  Short  of  rendering  the  life  of 
the  professional  tramp  illegal  it  would  be 
feasible  to  impose  fresh  conditions  of  medical  in- 
spection upon  common  lodging-houses  and  va- 
grant wards.  The  cost  of  such  a  step  would  be, 
no  doubt,  considerable,  but  at  the  same  time  it 
would  be  far  less  than  the  loss  entailed  by  the 
alternative  small-pox  outbreaks.  Then,  again, 
surely  it  would  be  possible,  even  in  a  free  country, 
to  make  vaccination  and  re-vaccination  com- 
pulsory upon  all  tramps.  It  might  be  made  a 
condition  necessary  to  a  night's  residence  in  a 
•casual  ward  or  in  a  common  lodging-house  that 
vaccination  and  re-vaccination  be  compulsory. 
In  that  way  the  unprotected  margin  of  vagrancy 
would  be  reduced  to  a  minimum,  and  the  danger  of 
small-pox  conveyance  be  proportionately  lessened. 
With  the  approach  of  the  milder  weather  of  spring 
the  active  wanderings  of  the  tramp  commence,  and 
the  risk  of  the  spread  of  his  personal  infections  will 
be  multiplied  accordingly.  The  problem  of  how 
to  deal  with  the  tramp  is  admittedly  far  from 
•easy.  At  the  same  time  we  think  the  time  has 
come  when  the  country  at  large  has  a  right  to 
demand  protection  from  the  Legislature  against  a 
danger  of  a  peculiarly  insidious,  universal  and  yet 
preventable  nature. 


HOSPITAL    DECENTRALISATION  AND 

TRANSPORT. 
The  enormous  growth  of  London  during  recent 
years  has  not  only  dislocated  many  arrangements 
that  worked  well  enough  in  the  past,  but  has  created 
fresh  difficulties  and  brought  into  existence  new 
requirements.  The  happy-go-lucky  system,  or 
rather  want  of  system,  that  characterised  the 
erection  of  the  old  hospitals  has  been  tested  and 
found  wanting,  but  a  love  of  continuity  and  a 
reverence  for  tradition  have  handicapped  many 
proposals  to  institute  a  newer,  more  logical,  and 
more  efficient  hospital  service.  The  taison  d'ttre 
of  hospitals  is  primarily  to  supply  sick  people 
with  medical  attendance  and  nursing  during  ill- 
ness, and  secondarily,  to  provide  means  whereby 
persons  can  be  trained  as  doctors  and  nurses.  Now 
great  and  important  as  is  this  second  function,  it 
must  and  should  be  made  subservient  to  the  first, 
for  that  was  the  prime  object  for  which  the  charit- 
able benefactors  gave  their  money.  Moreover,  it 
may  be  said  without  fear  that  medical  teachers, 
medical  students,  and  nurses  will  find  means  to 
accommodate  their  habits  to  the  demands  which 
any  shifting  of  their  centre  of  activity  may  make 
on  their  convenience.  Any  opposition  that  may 
come,  then,  from  such  quarters  cannot  be  considered 
single-eyed,  and  we  think  well  enough  of  our  hospital 
.staffs  to  believe  that  they  are  prepared  to  carry  out 
.their  hospital  work  in  a  public-spirited  manner,  if 


they  are  convinced  that  the  transference  of  hospital 
sites  to  other  quarters  is  in  the  interest  of  the  people 
and   of    the   institution.     We  lately   viewed    the 
spectacle  of  the  obstinate  retention  of  that  grand 
old  institution  St.  Bartholomew's  on  its  extrava- 
gantly expensive  site  by  its  governing  body,  who 
appeared  to  regard  its  removal  to  a  cheaper,  more 
salubrious,    and    more    accessible    neighbourhood 
with  as  much  horror  as  his  followers  displayed  over 
the  fate  of  their  patron  saint.  But,  dispassionately 
regarded,  it  is  nothing  less  than  an  anomaly  that 
the  chief  hospitals  should  be  huddled  together  in 
the  inner  ring  of  London,  when  the  vast  suburbs 
not  only  need   their  ministrations  at  their  own 
doors,  but  can  provide  them  with  cheaper  sites, 
more  healthy  surroundings,  and  purer  air.     We 
have  often  dealt   with    these  questions,  but  the 
view  we  wish  to  present  at  the  moment  seems  to  us 
to  remove  the  principal  practical  objection  to  any 
scheme  for  planting  the  larger  hospitals  at  some 
distance  from  the  main  thoroughfares  of  a  great 
city.     We   mean    the   question   of   transport    for 
sick,   and  especially   for  accident,  cases.     Owing 
to  the  praiseworthy  activity  of  the  Metropolitan 
Street  Ambulance  Association,  almost  every  one  of 
the    County     Councillors     returned    at    the    last 
election  is  pledged  to  support  a  plan  for  instituting 
an  efficient  ambulance  service  for  London.     Now, 
then,   is   the  opportunity  for  placing  the  whole 
question  of  sick  transport  on  a  satisfactory  basis. 
The  ambulance  service  of  the  Metropolitan  Asylums 
Board  provides  for  the  removal  of  cases  of  infectious 
diseases,  and  the  Board  is  unwilling  to  add  to  its 
responsibilities  in  the  matter.     The  field,  therefore, 
is  clear  for  a  fresh  authority  to  take  the  matter  up, 
unhampered  and  with  a  clear  conscience.     Let  us 
state  what  is  urgently  needed.     First,  a  rapid  and 
efficient  method  for  dealing  with  street  accidents. 
Secondly,  a  good  and  expeditious  means  of  trans- 
porting   injured    people    to    hospital.      Thirdly, 
machinery  for  quickly  disposing  of  minor  accidents 
and  slight  wounds  without  interference  with  the 
normal  work  of  a  busy  hospital.     And,  finally,  a 
means  whereby  poor  persons  dangerously  ill  may 
be  transported  from  their  own  homes  to  hospital. 
Were  the  streets  and  houses  of  London  properly 
served  in  this  respect,    the  need  for  aggregating 
great  hospitals  in  the  centre  of  the  city  would  lose 
its  last  claim  to  consideration  on  the  part  ofjhose 
responsible  for  their  direction.     These  indications 
would  seem  to  us  to  be  met  most  completely  by 
providing   dressing-stations    for  the  treatment  of 
slight  injuries  and  sudden  illness  at  each  police- 
station,  under  the  charge  of  a  young  medical  man 
of   the   house  surgeon   type.     Attached    to    each 
such  station   should  be  a  well-equipped  motor- 
ambulance  always  in  readiness,  which  could  be 
summoned  by  policemen  on   their  beats  in  the 
neighbourhood  by   telephone  or  other  call.    On 
receiving  a  summons  the  surgeon  should  go  at  once 
with  a  driver  to   the  scene  of  the  accident,  the 
ambulance  being  given  the  precedence  of  other 
traffic   now   accorded    to   fire   engines.     By  this 
means   a   qualified   man   with   all   the   necessary 


April  20,  1904. 


NOTES    ON    CURRENT    TOPICS.     Thb  Medical  Press.     427 


apparatus  would  be  on  the  scene  of  any  accident  in 
a  few  minutes,  prepared  to  deal  with  the  case,  and, 
if  necessary,  send  it  off  to  hospital  by  a  rapid  and 
easy  method  of  transport.  Finally,  by  a  system 
of  such  ambulances — more  than  one  would  be 
required  at  each  station — severe  cases  of  illness, 
strangulated  hernias,  ruptured  gastric  ulcers,  bad 
pneumonias  and  so  on,  could  be  taken  to  hospital 
from  their  own  homes  in  half  or  three-quarters  of 
an  hour  at  the  most.  It  would  probably,  also,  be 
found  advantageous  that  a  nurse  should 
accompany  each  ambulance  to  minister  to  and 
control  the  patient  on  the  way,  for  the  medical  man 
having  dealt  with  the  case  would  return  at  once  to 
the  dressing-station  on  foot  or  in  a  cab.  In  order 
that  such  a  system  should  come  into  being,  there 
would  have  to  be  harmonious  co-ordination  between 
the  County  Council,  the  hospital  authorities,  and 
the  Home  Office,  but  we  think  that  the  diplomacy 
of  the  County  Council  ought  to  be  equal  to  the 
occasion.  That  some  such  scheme  as  we  have 
outlined  is  a  desideratum  few  will  doubt,  for  the 
present  haphazard  method  of  dealing  with  street 
accidents  is  a  grave  reproach  to  the  first  City  of 
the  Empire  and  of  the  world. 

"Rotes  on  Current  topics. 

The  Medical  Side  of  the  Great  Fort  Arthur 
Fight. 
The  medical  aspects  of  modern  naval  warfare 
are  of  great  interest  to  the  public  as  well  as  to  the 
medical  profession.  It  is  with  great  pleasure, 
therefore,  that  we  are  able  to  publish  authoritative 
details  straight  from  official  sources  of  the  naval 
fight  at  Port  Arthur  on  February  9th  last. 
Six  of  the  Japanese  ships  reported  losses  in 
action  to  the  extent,  all  told,  of  four  killed  and 
sixty  wounded.  The  Mikasa,  the  flag-ship  of  the 
commander  of  the  Japanese  squadron,  had  seven 
wounded.  The  chief  injuries  were  34  lacerated 
wounds,  including  compound  fractures,  13  pene-. 
trating,8  perforated,  3  burns.  Eleven  fragments 
of  shell,  some  as  large  as  the  palm  of  the  hand,  were 
found  buried  in  the  tissues.  All  surgery  is  strictly 
aseptic,  and  most  of  the  wounds  have  progressed 
favourably.  Moderate  reactionary  fever  of  a  few 
degrees  appeared  in  the  severer  cases,  but  the 
temperature  fell  to  normal  in  the  course  of  a  few 
days.  The  whole  of  the  medical  organisation, 
which  is  of  the  most  modern  and  scientific  type,  is 
under  the  direction  of  Deputy- Inspector  General 
Tuzuki,  Surgeon-in-Chief  of  the  combined  squad- 
ron of  the  Imperal  Japanese  Navy. 

What  is  Brandy? 
Last  week  a  London  Magistrate  raised  the 
pertinent  question  "  What  is  brandy  ?  "  The  case 
that  suggested  the  need  of  a  definition  was  a  pro- 
secution by  the  Islington  Town  Council  of  three 
persons  for  selling  as  brandy  an  article  not  exclu- 
sively derived  from  the  grape,  and,  therefore,  in 
legal  jargon, "not  of  the  nature,  quality, and  sub- 
stance demanded  by  the  purchaser."  It  is  to  be 
hoped  that  this  enlightened  action  of  the  Islington 


authorities  will  settle  once  and  for  all  whether  the 
purchaser  of  an  article  labelled  "  brandy "  is 
entitled  to  a  spirit  obtained  from  the  grape,  or 
derived  from  potatoes  and  other  ignoble  sources 
remote  from  the  sunny  vineyards  where  cognac 
is  begotten.  This  very  question  was  discussed  by 
The  Medical  Press  and  Circular  on  April  22nd, 
1903.  We  began  by  quoting  Murray's  definition 
of  brandy  as  "  properly  an  ardent  spirit  distilled 
from  wine  or  grapes  ;  but  the  name  is  also  applied 
to  spirits  of  similar  flavour  and  appearance,  ob- 
tained from  other  materials."  It  is  around  the 
latter  half  of  that  definition  that  the  battle  of  the 
Islington  prosecution  will  be  waged.  The  subject  is 
one  of  much  importance  alike  to  the  public,  the 
publican,  the  real  cognac  distillers,  the  producers 
of  the  potato  and  other,  so  to  speak,  artifical 
brandies,  and  the  medical  profession.  In  our 
article  above  mentioned  we  remarked  that  "  from 
a  medical  point  of  view  this  inaction  of  the  local 
authorities  is  a  very  serious  matter,  as  brandy  is, 
when  pure,  one  of  the  most  trustworthy  and  gener- 
ally useful  of  our  therapeutic  remedies. "  The  differ- 
ence between  good  old  cognac  and  publican 
brandy  is  not  unlike  that  which  exists  between 
two  forms  of  carbon,  the  diamond  and  charcoal. 
The  decline  in  the  popularity  of  brandy  of  recent 
years  has  been  probably  due  mainly  to  the  substi- 
tution of  raw  corn  and  potato  spirit  for  the 
genuine  product.  The  wise  physician  knows  the 
bedside  value  of  fine  old  cognac  from  houses  of 
classic  fame  like  those  of  Hennessy,  Martell,  Gautier 
and  other  prominent  houses. 


Tramps  and  Small-Pox. 
Sooner  or  later  legislation  will  have  to  settle  the 
question  of  vagrancy,  if  only  in  relation  to  its 
malign  influence  in  the  spread  of  communicable 
diseases.  That  particular  danger  has  been  shown 
ever  and  over  again  to  exist  in  the  case  of  small- 
pox, a  disease  which,  as  a  rule,  can  be  readily  tracked 
to  its  original  lair.  An  important  contribution  to 
the  literature  of  the  subject  has  recently  been  made 
by  Dr.  Armstrong,  the  well-known  Medical 
Officer  of  Health  for  Newcastle-on-Tyne.  His 
communication  take3  the  form  of  a  report  based  on 
inquiries  addressed  to  local  authorities  throughout 
the  Kingdom.  The  answers  show  that  out  of  a 
hundred  and  eleven  districts  invaded  by  small-pox 
the  disease  was  introduced  in  more  than  50  per 
cent,  by  the  agency  of  tramps.  The  cost  of  dealing 
with  these  outbreaks  must  inflict,  both  directly  and 
indirectly,  an  enormous  loss  upon  the  community. 
The  question  arises,  apart  from  any  communal 
defensive  right  in  the  control  of  communicable 
disease,  whether  any  one  class  of  persons  should  be 
permitted  to  continue  such  a  drain  upon  the  public 
purse.  They  are,  it  is  true,  products  of  our  social 
system,  and  worthless  citizens  though  they  be,  the 
State  has  recognised  their  right  to  Poor-law  main- 
tenance. In  return  for  that  kind  of  relief,  however, 
it  is  surely  reasonable  to  insist  upon  conditions 
that  will  prevent  injury  to  society  at  large.  The 
private  citizen  becomes  liable  if  he  spreads  disease 


428    The  Medical  Press.  NOTES  ON  CURRENT  TOPICS. 


April  2a  1904. 


wantonly  and  is  placed  under  careful  surveillance 
if  by  contact  he  has  become  liable  to  convey 
infection.  Why  should  the  tramp,  who  is  often 
worthless  and  incorrigible,  be  allowed  to  carry 
devastating  disease  far  and  wide  at  the  expense  of 
the  ratepayer  ? 

A  Pro-Mortu8eotionist. 
An  anti-vivisectionist  may  object  to  experiments 
on  the  bodies  of  live  animals  without  entertaining 
a  similar  prejudice  with  regard  to  experiments  on 
himself — at  least,* so  it  appears.  One  has  been 
accustomed  to  think  that  operations  of  an 
experimental  nature  should  not  be  practised  on 
human  beings,  but  an  anti-vivisectionist  may  hold 
a  contrary  opinion.  One  has  grown  used  to  many 
inconsistencies  from  the  emotional  sisterhood  and 
brotherhood  of  Victoria  Street,  but  one  was  not 
prepared  for  this.  Miss  Francis  Power  Cobbe,  who 
died  the  other  day,  was  an  anti-vivisectionist  of  the 
anti-vivisectionists,  and  no  one  in  her  day  was  a 
louder  or  more  persistent  champion  of  the  "  rights " 
of  various  sections  who  were  supposed  to  be  down- 
trodden or  kept  under.  The  "  flayed  "  dog  and 
the  "  baked  "  cat  were  paraded  for  public  delecta- 
tion, and  the  grossness  and  brutality  of  the  medical 
profession  were  continually  held  up  to  public 
obloquy.  One  rubs  one's  eyes  to  see  if  one  is 
awake,  therefore,  when  one  reads  that  in  the  will 
of  that  philanthropical — or  more  correctly 
philthereutical — lady  she  desired  that  on  her  body 
should  be  performed  the  operation  of  "completely 
and  thoroughly  severing  the  arteries  of  the  neck 
and  wind-pipe,  nearly  severing  the  head  altogether, 
so  as  to  render  any  revival  in  the  grave  absolutely 
impossible."  Note  that  this  operation  could  be  of 
no  advantage  to  anybody  unless  she  were  still 
alive.  In  that  case  the  operator  would  be  what 
the  common  law  would  call  a  murderer.  Giving 
Miss  Cobbe  every  credit  for  the  courage  that  would 
be  required  to  lie  still  when  this  ghastly  proceeding 
was  in  preparation,  one  still  fails  to  see  how  it  is 
reconcilable  with  a  prejudice  against  operations  on 
*  living  beings.  It  is  reported  that  this  solemn  farce 
was  actually  carried  out,  the  penalty  being  that  if 
it  were  omitted  all  the  bequests  in  her  will  were  to 
be  void.  The  fear  of  being  buried  alive  that  dic- 
tated this  injunction  was,  of  course,  a  mere  bogey, 
so  that  the  proceeding  really  resolved  itself  into 
sectio  cadaveris,  but  the  intention  on  the  part  of  the 
testatrix  to  destroy  life  "if  necessary"  remains. 
Truly  the  ways  of  the  anti-vivisectionists  are  past 
finding  out. 


Defective  Hospital  Administration. 

The  Bolingbroke  Hospital  at  Wandsworth  is 
an  institution  founded  on  admirable  principles. 
That  there  is  room,  however,  for  improvement 
in  its  medical  organisation  is  the  strongly  ex- 
pressed view  of  the  district  coroner  and  of  his 
jury.  It  was  shown  in  evidence  at  a  recent  in- 
quest that  a  child  was  taken  to  the  hospital  suffer- 
ing from  severe  burns,  and  was  seen  once  by  the 
"  house  surgeon."  There  was  not  room  in  the 
hospital  for  the  reception  of  the  child,  and  the 


whole  of  the  subsequent  medical  attention  was 
said  to  have  been  conducted  by  a  nurse,  who 
dressed  the  burns  on  seven  different  occasions. 
The  child  died  from  pneumonia,  a  complication 
that  is  not  surprising  under  the  circumstances.  It 
would  hardly  be  possible  to  imagine  a  more  hazar- 
dous happening  for  a  badly-burnt  child  than 
to  be  carried  to  and  fro,  in  all  weathers,  between 
a  poor  home  and  an  out-patient  hospital  depart- 
ment. Surely  if  the  Bolingbroke  Hospital  au- 
thorities could  not  admit  the  child,  they,  recog- 
nising the  dangerous  nature  of  the  injury,  should 
have  made  it  their  business  to  procure  the  patient's 
admission  to  some  public  or  Poor-law  infirmary. 
It  would  be  interesting  to  learn  how  many  of  the 
hospital  beds  were  occupied  at  the  moment  by 
chronic  or  well-to-do  patients,  who,  there  is  reason 
to  suspect,  encumber  many  of  our  charitable  in- 
stitutions. The  chairman  of  the  Bolingbroke 
Hospital  states  that  the  child  was  seen  by  the 
medical  officer  in  charge  of  the  out-patient  de- 
partment on  three  separate  occasions.  It  is  a 
pity  his  statement  was  not  made  at  the  inquiry, 
and  ii  should  be  made  clear  whether  his  de- 
scription applies  to  the  house  surgeon  or  to  a 
member  of  the  honorary  medical  staff. 

Conteseions. 

The  recent  translation  into   English    of  "  The 
Confessions  of  a  Physician,"  by  V.  Veresaeff  (V. 
Smidovich),  gives  our  profession  the  opportunity 
of  reading  a  book  that  created  a  tremendous  stir 
in  Russia  when  it  was  first  issued.     Dr.  "  Vere- 
saeff "  might  be  said  to  have  "  given  the  show 
away  "  as  far  as  the  practice  of  medicine  in  Russia 
was  concerned,  and  naturally  the  Russian  doctors 
did   not   like  it.     Moreover,   a  large   number  of 
students  were  induced  to  give  up  reading  medicine 
and  take  to  other  studies    when  it  was  brought 
home  to  them  what  their  lot  would  be  when  they 
had  attained  their  desideratum — a  medical  degree. 
The  confessions  divide  themselves  into  two  parts, 
one  a  disclosure  of  what  the  lot  of  the    Russian 
doctor  dependent  on  his  profession  for  a  livelihood 
consisted  in,  and  the  second  a  rather   jaundiced 
view  of  the  potentialities  of  medicine  to  achieve- 
any  good  at  all.     As  to  the  first  part,  it  may  be 
said  at  once  that  the  practice  of  medicine  among 
the  poorer  classes  of  Russia  seems  considerably 
worse  than  the  practice  of  medicine  under  Irish 
dispensary  conditions,  which  are  bad  enough  in  all 
conscience.     As    to    the   second,    there    is   much 
that  is  unfortunately  true  in  great  measure.    Dr. 
"  Veresaeff,"    after    discussing    the    powers    and 
applicability   of   medicine   in  various   conditions, 
asks  whether,  as  the  knowledge  of  its  operations  is 
so  empirical,  medicine  can  really  be  learned  at  all. 
"  What,"  he  says,  "  I  could  not  reconcile  myself  to, 
and  what  shook  my  satisfaction  in  my  life's  work, 
was  the  utter  fictitiousness  of  these  powers  in  the 
face  of  modern  reality."     Few  of  us  have  not  felt 
the  same  at  one  time  or  another,  but,  if  one  looks 
at  the  alternative — surely,  it  is  far  better  that  the 
practice  of  medicine  should  be  in  the  hands  of  honest 
men  who  work,  as  far  as  maybe,  on  logical  lines# 


April  20,  1904* 


NOTES  ON  CURRENT  TOPICS. 


Trs  Medical  Piess.    429 


than  exploited  by  vicious  and  unscrupulous 
adventurers  whose  only  object  is  to  fill  their  own 
pockets.  If  Dr.  "  Veresaeff "  looked  back  a 
hundred  years  would  he  hesitate  to  say  that  the 
sufferer  is  in  an  infinitely  better  position  with  regard 
to  relief  and  cure  than  he  was  before  anaesthetics, 
antiseptics,  and  Rontgen  rays  were  thought  of  ? 
Study,  patience,  and  zeal  will  yet  bring  to  light 
many  other  arcana  of  still  greater  benefit. 

Human  and  Bovine  Tuberculosis. 

The  most  important  pronouncement  yet  made 
bearing  on  Koch's  views  of  the  difference  between 
human  and  bovine  tuberculosis  has  just  appeared 
in  a  volume  published  by  the  German  Imperial 
Health  Office.     It  contains  an  account  of  the  ex- 
periments conducted  jointly  by  Professor  Kossel, 
Dr.  Weber,  and  Dr.  Heuss,  at  the  suggestion  and 
according  to  the  plan  of  a  committee  of  men  of 
science  who  were  unconvinced  of  the  truth  of  Koch's 
views.     Over  fifty  attemtps  were  made  to  produce 
tuberculosis  in  calves  by  inoculation  with  tubercle 
bacilli   obtained   from   human   sources.     The,  in- 
vestigators  report  that  in  the  immense  majority 
of  instances  they  found  that  the  bacilli  of  human 
tuberculosis  and  of  perlsucht   were    quite    distin- 
guishable,   not    only    culturally    but    also    mor- 
phologically.    So    far,  their   conclusions  entirely 
support  Koch's  views.     Some  curious   and  sug- 
gestive results,  however,  tend  in  the  other  direc- 
tion:    In  some  cases  typical  perlsucht  was  pro- 
duced in  calves  by  inoculation  with  bacilli  from 
cases  of  miliary  tubercle  occurring  in  children. 
This,  of  course,  suggests  the  possibility  of  a  con- 
verse transmission,  i.e.,    from    mammary  tuber- 
culosis in  cows  to  miliary  tuberculosis  in  children, 
and  would  prove  the  advisability  of  maintaining 
all  precautions  against  infected  or  suspected  milk. 
AFthe  same  time  a  problem  of  far-reaching  im- 
portance   suggests    itself :    does  the  bacillus  of 
miliary  tuberculosis  differ  in  kind  from  the  bacillus 
of  the  commoner  local  infections  ?     Is   miliary 
tuberculosis   not   merely   a   disease   of   different 
distribution,  but  a  different  disease  ?    There  are 
no  facts  at  present  from  which  to  argue  with  any 
-  show  of  probability,  but  nevertheless  the  idea  is 
not  to  be  carelessly  scouted;    Professor  Kossel 
and  his  colleagues,  while  admitting  that  in  the 

main  their  results  are  in  support  of  Koch's  theory, 
very  properly  point  out  that  they  are  still  far 
from  conclusive. 


the  most  hopeful  case  for  the  application  of 
radium.  As  the  applications  reported,  however, 
were  made  only  for  five  or  ten  minutes  between 
November  18th  and  20th,  it  is  hardly  surprising 
that  no  good  results  are  recorded.  Applications 
of  at  least  fifteen  minutes,  extending  over  several 
weeks,  or  months,  and  regulated  according  to 
eflects,  would  constitute  a  fairer  trial  of  the  radium. 
The  general  conclusion  arrived  at  by  Mr.  Plimmer 
is  the  following  : — "  It  appeals  as  if  the  emanations 
from  radium  can  only  act  upon  young  and  rapidly- 
growing  cells,  and  that  older  cells,  especially  if 
surrounded  by  fibrous  tissue,  are  less  and  less 
easily  affected,  and  if  there  be  an  excess  of  fibrous 
tissue  the  cells  are  not  at  all  affected."  This 
seems  to  confirm  the  generally  accepted  view  that 
radio-active  agencies  cannot  so  far  be  applied 
effectively  to  any  but  surface  epitheliomata, 
and  possibly  some  accessible  sarcomata,  together 
with  early  recurrent  nodules. 


Cancer  and  Radium  Bromide. 
Mr.  Plimmer,  of  the  Lister  Institute,  has  pub- 
lished an  important  communication  on  the  treat- 
ment of  cancer  with  radium  bromide.  He 
experimented  on  seventeen  cases,  in  which  the 
diagnosis  of  the  disease  was  established  micro- 
scopically, (a)  With  one  exception,  the  cases 
treated  were  schirrus,  primary  or  secondary, 
secondary  nodules,  and  one  fungating  mass, 
secondary  to  an  epithelioma  of  the  jaw.  The  ex- 
ception was  a  sloughing  epithelioma  of  the  lip, 


"Bennett's  Stave  o'  Thumb"  Fracture. 

It  is  more  than  twenty  years  since  Mr.  Bennett, 
of  Dublin,  first  drew  attention  to  the  fact  that 
fracture  of  the  base  of  the  metacarpal  bone  of  the 
thumb  is  a  common  injury.     He  maintained,  in- 
deed, that  it  is  the  most  common  fracture  of  the 
metacarpus,  but  that  it  is  often  overlooked.     In 
support  of  his  thesis  he  detailed  instances  of  four- 
teen cases,  met  with  either  in  the  museum  or  in 
clinical    practice.     Curiously    enough    but    little 
reference  has  been  made  in  the  text-books  either 
to  the  fracture  or  to  his  description.     In  fact,  in  a 
somewhat  exhaustive  survey  of  surgical  literature, 
Messrs.  Miles  and  Struthers,  of   Edinburgh,  have 
found  only  two  recorded  cases  outside  Mr.  Ben- 
nett's   own    writings.     Many   of   the   text-books 
mention  the  injury  as  a  rare  one,  and  some  of  them, 
without  any  argument,  state  that  it  is  one  of  the 
rarest,  even  of  metacarpal  fractures.     The  injury, 
however,  is  not  so  rare  as  is  supposed,  and  we  belie  %  e 
most  surgeons  in   charge   of  out-patient  depart- 
ments have  seen  more  than  one  case.     Messrs: 
Miles  and  Struthers,  in  a  recent  article,  (a)  hav .» 
reported  their  own  conclusions  from  no  less  than 
fifteen  clinical  cases  seen  by  them  during  the  last 
three  years.     On  every  point  they  are  in  harmony 
with  the  original  describer,  not  only  as  to  the 
relative  and  absolute  frequency  of  the  injury,  but 
also  in  regard  to  causation  and  treatment  they 
can  make  no  advance.     They  explain  the  lack  of 
notice  which  the  fracture  has  received  as  being 
due,  on  the  one  hand,  to  the  carelessness  of  the 
text-books,  and  on  the  other  to  the  fact  that  the 
patient  usually  regards  the  accident  as  a  trivial  one. 


(a)  Lanes  t,  April  x6th,  1904,  p.  104. 


I 


The  Bisks  of  Radiographers. 

Every  week  brings  to  our  knowledge  new  fields 
of  radio-activity  and  new  uses — diagnostic  and 
therapeutic — of  Rontgen  and  other  rays.  But  "  he 
that  increaseth  knowledge  increaseth  sorrow  "  is 
a  true  saying,  and  we  are  not  surprised  to  find 
an  article  in  an  American  contemporary  entitled 
(a)  Edinburgh  Medical  Journal,  April,  1904. 


430     The  Medical  Press.       NOTES    ON    CURRENT    TOPICS. 


April  20,  1904. 


"  Dangers  of  the  X-ray  Operator."  At  first  we 
imagined  that  the  intention  of  the  author  was 
to  warn  the  public  against  the  unscrupulous  wielder 
of  the  eight-inch  tube,  but  on  perusing  the  article 
we  found  that  the  author,  being  an  operator  him- 
self, was  in  reality  recounting  his  own  sufferings, 
both  in  retrospective  and  prophetic  mood.  And 
one  gathers  that  in  his  opinion  the  uses  of  X-rays 
are  not  at  all  as  numerous  as  their  dangers.  There 
seems  to  be  no  conceivable  disease  or  lesion,  from 
baldness  to  blindness,  and  from  cancer  to  "  spas- 
modic muscular  oedema  (whatever  that  may  be), 
which  is  not  liable  to  be  produced  by  the  rays  in 
their, irresponsible  omnipotence.  We  read  of  the 
occurrence  of  "  pain  and  suffering,  hyperesthesia 
and  paraesthesia,  which  no  language,  sacred  or  pro- 
fane, is  adequate  to  describe."  It  is  doubtless 
an  instance  of  adaptation  in  Nature  that  "  cica- 
trices form,  drawing  the  angles  of  the  mouth 
downwards,  giving  the  operator  a  sad  expression 
of  countenance."  One  operator,  we  are  told,  lost 
his  nose,  another  his  arm,  and  another  his  hair. 
Other  gentlemen  have  escaped  with  mottled 
features,  black  and  white  or  scaly  skin  diseases, 
profuse  haemorrhages,  and  abscess  at  the  roots 
of  the  teeth,  all  as  a  result  of  exposure  to  the  rays. 
While  in  some,  as  we  have  said,  baldness  is  pro- 
duced, in  others  there  is,  most  unfairly,  "  an 
erratic  or  redundant  growth  of  hair."  It  is 
stated  also  that  insanity  with  hallucinations  is 
an  occasional  sequel,  and,  indeed,  the  paper  before 
us  is  suggestive.  We  miss  from  his  list  one  risk 
which  severely  threatened  operators  in  Ireland 
recently — that  of  being  mulcted  in  damages  for 
permitting  any  injury  to  take  place. 


servers,  the  neurasthenic  or  neurotic  temperament 
being  generally  well  marked  in  these  patients. 
The  beneficial  results  of  operation  may,  perhaps, 
be  explained  by  the  necessary  manipulations  of  the 
bowel  interfering  with  the  formation  of  the  mem- 
brane. Of  the  exact  manner  in  which  the  mental 
factor  is  responsible  for  the  morbid  process  we  are 
still  ignorant.  One  thing  remains,  however, 
namely,  that  it  is  not  always  sufficient  to  restore 
the  mucous  membrane  of  the  colon  to  its  normal 
condition  by  lavage,  douches,  or  even  by  opera- 
tive measures.  The  nervous  system  must  be 
treated  at  the  same  time. 


The  Neuropathio   Factor    in   Membranous 
Colitis. 

That  variety  of  colitis  which  is  characterised 
bv  the  passage  of  membranous  casts  of  the  mucous 
coat  of  the  large  intestine  is  of  great  clinical  in- 
terest, partly,  no  doubt,  on  account  of  the  fact 
that  its  origin  is  often  veiled  in  obscurity.  The 
irritation  to  the  mucous  membrane  resulting  from 
injury  or  septic  conditions  may  give  rise  to  the 
formation  of  casts,  but  these  are  seldom,  if  ever, 
recognised  during  life.  The  special  form  of  the 
disease  which  has  been  called  dyspeptic  mem- 
branous colitis  by  Hale- White,  is  a  most  trouble- 
some infection,  of  more  or  less  chronicity,  and  is 
frequently  accompanied  by  wasting  and  depression. 
It  is  much  commoner  in  women  than  in  men,  and 
is  rarely  seen  in  children.  In  several  cases  of 
membranous  colitis  under  the  care  of  Mr.  C.  H. 
Golding-Bird,  of  Guy's  Hospital,  the  plan  was 
adopted  of  giving  complete  physiological  rest  to  the 
colon  by  performing  colotomy,  and  in  1895  a  case 
was  exhibited  before  the  Clinical  Society  in  which 
this  had  been  done  with  success.  At  a  discussion 
upon  this  subject  recently  held  at  the  Societe 
Medicale  des  Hdpitaux,  MM.  Linossier  and  Barth 
concurred  in  the  view  that  the  so-called  membranous 
colitis  is  a  symptom  rather  than  a  distinct  morbid 
entity.  The  frequency  with  which  nervous  troubles 
are  associated  with  this  affection  has  struck  all  ob- 


Red  Light  and  Small-pox. 

The  beneficial    effect  of  the  red  light  treatment 
of  small -pox  may  now  be  accepted  as  one  of  the 
interesting  facts  of  medical  science.     Not  only  is 
the    rash    less  severe,   but    its   after  scarring   is 
'  lessened  or  even  altogether  avoided.     This  result 
!  appears  to  be  due  to  the  exclusion  of  certain  rays 
!  of    light    that   have   an   irritant  effect   upon   the 
]  eruption.     The  red  light  treatment  is  simple  and 
I  readily   applied,   and    it   is   somewhat   surprising 
I  that  it  has  not  come  into  general  use.     It  might 
1  be  carefully  tested,  and  its  result   compared  with 
I  a  number  of  other  cases  treated  under  ordinary 
!  light    conditions    in    many    small-pox    hospitals . 
Dr.  Herbert  Peck,  the  Medical  Officer  of  Health 
for  Chesterfield,  has  applied  it  to  patients  suffer- 
ing   from     the    malady    in    question    under    his 
charge  at  the  borough  hospital.     He  has  reported 
favourably  on  the  therapeutic  effects  of  the  light 
treatment,  both  on  the  progress  and   the  after- 
effects of  the  malady.     "  I  am  inclined,"  he  adds, 
"  to  attribute  the  low  mortality  to  the  agency  of 
the  red  rays  ;  but  the  experiment  must  be   tried 
on  a  much  larger  scale  before  success  can  be  claimed 
for  it."     The  example  of  Dr.  Peck  in  this  direc- 
tion might  well  be  followed  by  those  in  charge  of 
small-pox  hospitals  in  various  parts  of  the  King- 
dom.    Unhappily,  the  prevalence   of   the   disease 
is  likely  to  furnish  a  wide  field  for  that  special 
experimentation. 


A  Medical  Amazon. 

It  was  generally  expected  when  women  wefb 
admitted  to  the  ranks  of  the  medical  profession 
that  they  would  confine  their  activity  to  treating 
their  own  sex,  with  occasional  excursions  into  the 
domain  of  pediatrics.     Those  who  were  guileless 
enough  to  suppose    so  did  not  know  what  an 
"  emancipated  "  woman  would  be,  nor  to  what 
lengths   her  emancipation  would   go.     Women's 
hospitals  are  now  entirely  staffed  by  women  doctors 
in    some    instances ;     some  children's    hospitals 
cater  for  women   house  surgeons   and    assistant 
surgeons  ;  while  several  infirmary  and  asylum  posts 
are  regularly  held  by  women.  Women  missionaries, 
some  with  medical  qualifications  and  some  with 
a  year  or  two's  **  medical  training,"  go  abroad, 
and    one    hears    of    ovariotomies    and    cataract 
extractions  of  daily  occurrence  in  their  practice. 
But  hitherto  the  field  of  military  surgery  has  not 
been  sought  by  them  in  great  numbers,  or,  at  least, 


Apkxl  2o,  1904. 


NOTES    ON    CURRENT    TOPICS.       The  Medical  Press.    43* 


not  with  the  sanction  of  the  responsible  authorities. 
But  that  the  medical  Amazon  was  in  posse  if  not 
in  esse  has  been  shown  by  the  recent  departure  of  a 
Dr.  Anita  Newcomb  MacGee,  in  command  of  a 
contingent  of  the  Red  Cross  Satiety,  for  the  front, 
or  perhaps  the  base,  of  the  Russo-Japanese  opera- 
tions. This  enterprising  lady  is  said  to  be  a 
commissioned  officer  in  the  American  Army,  so 
she  should  perhaps  be  designated  Surgeon-Lieu- 
tenant MacGee.  At  any  rate,  she  went  through  th2 
Spanish-American  war  with  credit  to  herself  and 
advantage  to  her  patients.  One  cannot,  however, 
allow  her  the  title  of  the  first  military  lady  doctor 
the  world  has  had,  a  distinction  which  the  American 
paragrapher,  with  his  usual  grandiloquence,  has 
claimed  for  her.  It  has  been  persistently  stated 
that  a  once-distinguished  Surgeon-General  in  our 
own  Army  was  a  woman  who  had  managed  to  con- 
ceal her  sex  from  girlhood,  and  certainly  during  the 
Ashantee  campaign  of  1900  a  woman  doctor  was 
employed  at  the  base  hospitals  on  the  Gold  Coast — 
the  shortage  of  men  doctors  caused  by  the  drain  of 
the  South  African  campaign  being  so  great  that 
sufficient  numbers  were  not  forthcoming.  The 
departure  from  tradition  that  Dr.  Anita  MacGee 
has  just  taken  may  be  unusual,  but  it  is  not  un- 
precedented. 

Delusions  at  an  Inquest. 

Were  the  delusions  of  every  asylum  patient 
to  be  treated  seriously,  a  special  coroner  would  be 
needed  for  every  lunatic  establishment  of  any  size. 
It  seems  hardly  credible,  indeed,  that  the  asser- 
tions of  admitted  delusional  insanity  should  be 
able  to  set  in  motion  the  machinery  of  a  coroner's 
court.  Such  was  the  case,  however,  last  week 
at  Hoxton  Asylum,  where  a  formal  inquiry  was 
conducted  on  the  body  of  a  late  inmate,  aged  sixty- 
two.  The  inquiry  was  held  in  consequence  of  an 
application  made  by  the  widow  of  deceased  for  a 
post-mortem  examination,  because  her  husband 
told  her  that  drugs  and  starvation  would  soon 
cause  his  death.  The  jury  found  that  death  was 
due  to  natural  causes,  and  that  there  was  no  truth 
whatever  in  the  allegations.  The  incident  has  its 
humorous  side,  and  the  idea  of  taking  official  action 
on  the  strength  of  a  lunatic's  ravings  is  worthy  of 
the  grotesque  imagining  of  comic  opera.  The  fact 
that  an  inquest  could  be  obtained  under  such  cir- 
cumstances throws  into  comforting  relief  the 
safeguards  that  nowadays  surround  the  Poor-law 
lunatic  under  the  enlightened  guardianship  of  the 
London  County  Council.  It  is  to  be  feared  that 
he  is  not  always  so  well  ofi  in  the  insane  wards  of 
workhouse  infirmaries  both  in  the  metropolis 
and  in  various  parts  of  the  United  Kingdom, 
a  point  the  Local  Government  Board  might  well 
take  in  hand. 


reported  in  Nottingham,  Derby,  ^  Leicester, 
Grimsby,  Stockport,  and  many  other  places. 
At  Derby  no  less  than  twenty-two  cases  were  re- 
ported within  a  few  days  at  the  beginning  of  last 
week,  and  at  the  end  of  the  week  some  forty 
patients  were  in  hospital.  Two  weeks  ago  Sheffield 
was  pronounced  free  from  the  disease,  but  fresh 
cases  have  appeared,  apparently  introduced  from 
Coventry.  Bristol  has  become  exposed  to  infec- 
tion by  a  tramp  who  slept  in  that  city  one  night, 
and  was  discovered  to  have  small-pox  a  few  days 
afterwards  in  a  neighbouring  village.  In  London 
there  is  a  considerable  amount  of  the  disease,  but 
not  more  than  may  be  expected  in  the  way  of  re- 
crudescence after  a  great  epidemic.  The  un- 
protected population  of  the  metropolis,  however, 
has  been  to  a  great  extent  diminished  either  by 
attacks  of  small-pox  or  by  the  panic-stricken 
resort  to  vaccination  or  re- vaccination.  The 
prevalence  of  small-pox  in  London,  never- 
theless, as  often  pointed  out,  is  a  menace  to  the 
safety  of  the  rest  of  the  Kingdom.  At  the  present 
moment  the  whole  of  England  and  Wales,  of 
Scotland  and  of  Ireland,  may  be  said  to  contain 
the  potential  and  actual  germs  of  widespread 
epidemics  of  small-pox.  Fortunately  next  month 
will  witness  the  cessation  of  the  seasonal  curve 
of  greatest  incidence  of  the  disease,  which  in  this 
particular  instance  attains  its  maximum  between 
January  and  May. 


Small-pox 

From  various  parts  of  the  Kingdom  alarming 
reports  continue  to  come  in  as  to  the  prevalence 
of  small-pox  and  the  occurrence  of  further  out- 
breaks.      Fresh    cases    are    being    almost    daily 


Coroners  and  the  Medical  Profession* 

To  the  list  of  coroners  who  have  taken  up  a 
position  in  opposition  to  the  medical  profession 
must  be  added  the  name  of  Mr.  Christopher 
Friery,  Coroner  for  the  North  County  Dublin.  At 
a  recent  inquest  held  on  a  patient,  who  was  brought 
in  dead  into  the  Royal  City  of  Dublin  Hospital, 
this  gentleman  held  forth  in  no  measured  terms 
on  the  "  practice  which  had  sprung  up  amongst 
the  members  of  the  medical  profession  of  refusing 
to  give  an  opinion  in  cases  such  as  this  as  to  the 
cause  of  death  unless  they  held  a  post-mortem 
examination."  "  It  is  monstrous/'  he  continued, 
"  to  think  that  a  post-mortem  examination  should 
be  held  in  such  a  clear  case  as  this,  and  I  am  deter- 
mined, so  far  as  I  can  as  coroner,  to  put  an  end  to 
the  practice  in  my  district."  We  are  informed 
that  the  facts  of  the  case  were  that  the  patient  had 
formerly  attended  the  hospital  during  the  life  of 
the  late  Sir  George  Duffy,  but  had  not  been  there 
for  some  time.  Finally,  he  was  brought  in  dead, 
and  the  resident  surgeon  very  properly  refused  to 
give  a  certificate  on  a  matter  on  which  it  was  ob- 
viously impossible  for  him  to  formadefinite  opinion. 
We  understand  that  the  coroner  is  a  member  of  the 
solicitors'  profession,  and  it  may  be  that  his  early 
training  or  his  subsequent  work  in  his  profession 
may  not  have  taught  him  that  it  is  the  desire  of 
all  those  who  are  in  any  way  interested  in  the  pro- 
longation of  human  life  that,  so  far  as  possible, 
attempts  should  be  made  to  ascertain  the  causes  of 
death  with  at  least  approximate  accuracy,  as  very 
much  depends  on  the  correctness  or  otherwise  of 


432    The  Medical  Press. 


SPECIAL  CORRESPONDENCE. 


April  20,  1904. 


the  vital  statistics  of  a  country.  This  fact  may 
not  have  been  within  Mr.  Friery's  ken,  and  he  may 
not  have  recognised  that  he  was  setting  himself 
against  the  concensus  of  scientific  opinion.  But 
Mr.  Friery,  as  a  lawyer,  must  know,  or  should  know, 
that  the  introduction  of  a  practice  that  medical 
men  should  give  certificates  based  on  supposition 
in  the  case  of  sudden  death  would  be  fraught  with 
the  most  dangerous  consequences  to  the  safety  of 
the  community.  We  wonder  if  Mr.  Friery  happens 
to  have  read  the  comments  of  a  certain  learned 
English  judge  on  a  medical  man  who  gave  a  cer- 
tificate of  death  in  a  recent  case  of  poisoning  by 
antimony.  If  he  has  not  done  so,  we  commend 
them  to  his  attention,  not  because  they  were  prac- 
tical comments,  as  they  insisted  on  an  impossibility 
but  because,  if  they  meant  anything,  they  meant 
that  certificates  of  death  should  be  refused  when- 
ever the  smallest  doubt  existed  in  the  mind  of  the 
medical  man.  Mr.  Friery  considered  that  in  the 
present  case  the  resident  surgeon  should  give  a 
death  certificate  to  the  effect  that  a  man  had  died 
of  heart  disease  because  another  member  of  the 
medical  profession  had  treated  the  man  for  that 
complaint.  We  wonder  what  Mr.  Friery's  com- 
ments would  be  on  a  member  of  his  own  profession 
who  ventured  to  support  his  statements  on  behalf 
of  a  client  by  similar  ,;  evidence."  We  strongly 
advise  medical  men  to  allow  the  Coroner  for 
North  Dublin  to  take  on  himself  the  responsibility 
which  he  is  so  desirous  of  assuming,  and  in  no 
case  of  sudden  death  to  give  certificates  based 
on  mere  assumption. 


PERSONAL. 


Her  Majesty  the  Queen  has  graciously  accepted 
the  office  of  President  of  the  London  Hospital,  in 
place  of  the  late  Duke  of  Cambridge,  who  held  the 
position  for  the  long  period  of  half  a  century. 


Mr.  John  Atkinson,  the  famous  bone-setter, 
on  the  16th  instant  at  his  London  residence. 


died 


Major  J.  Will,  R.A.M.C.,  has  been  appointed 
Principal  Medical  Officer  of  the  East  Africa  and 
Uganda  Protectorates. 


Mr.  J.  E.  Panton,  M.D.Durh..  M.R.C.S.Eng.,  has 
been  placed  upon  the  Commission  of  Justices  of  the 
Peace  for  Bolton. 

Dr.  F.  Drew  Harris,  Medical  Officer  of  Health 
for  St.  Helens,  has  tendered  his  resignation  to  the 
Council.  He  will  relinquish  his  duties  at  the  end  of 
July. 


We  regret  to  learn  that  Dr.  Dalton,  Mayor  of  Cam- 
bridge,is  suffering  from  an  acute  attack  of  influenza.com- 
plicated  with  pneumonia.  His  case  is  considered 
serious,  but  not  hopeless. 

Sir  T.  N.  Fitzgerald,  who  received  the  K.C.B. 
for  his  services  in  the  field  hospitals  during  the  South 
African  War,  has  been  ordered  a  voyage  from  Melbourne 
to  Colombo  on  account  of  ill-health. 


Lieut.-Colonel  Hughes,  of  the  Royal  Army 
Medical  Corps,  Principal  Medical  Officer  at  Dublin, 
has  been  appointed  Administrative  Medical  Officer  at 
Bombay,  vice  Colonel  Corbett,  deceased. 


Shortly  after  the  outbreak  of  hostilities  between 


Russia  and  Japan,  Deputy-Inspector-General  S. 
Suzuki  was  appointed  surgeon -in-chief  of  the  combined 
squadron  of  the  Imperial  Japanese  Navy. 

Dr.  P.  H.  Bryce,  Secretary  to  the  Provincial 
Board  of  Health  for  the  Province  of  Ontario,  Canada, 
has  been  appointed  Medical  Inspector  for  the  Depart- 
ments of  the  Interior  and  of  Indian  Affairs. 


Sir  Frederick  Banbury,  in  the  House  of  Commons 
last  week,  moved  a  curious  motion  to  the  effect  that 
"  in  the  opinion  of  this  House  no  operations  for  the 
purposes  of  vivisection  should  be  performed  on 
dogs." 


The  Lords  Commissioners  of  the  Admiralty  have 
awarded  the  Greenwich  Hospital  Pension  of  £50  a 
year,  vacant  by  the  death  of  Deputy-Inspector- 
General  L.  H.  G.  Hayne,  to  Deputy-Inspector-General 
W.  D.  Longfield. 

Dr.  C.  T.  Cullingworth,  obstetric  physician  to 
St.  Thomas's  Hospital,  will  deliver  the  Ingleby  Lectures 
of  the  University  of  Birmingham  on  May  10th  and 
17th,  on  "A  Plea  for  Exploration  in  Suspected  Malig- 
nant Disease  of  the  Ovary." 

Mr.  J.  B.  Story,  the  General  Secretary  of  the  Royal 
Academy  of  Medicine  in  Ireland,  has  intimated  his 
intention  not  to  seek  re-election  in  October  next.  We 
are  informed  that  Dr.  James  Craig  and  Dr.  Travers 
Smith  are  candidates  for  the  office. 


Dr.  Henry  Horace  Dixon  has  been  appointed  to 
the  Professorship  of  Botany  in  Dublin  University, 
rendered  vacant  by  the  resignation  of  Professor  E. 
Percival  Wright.  Dr.  Dixon  is  well  known  for  his 
original  work  in  botanical  subjects. 

The  following  surgeons  of  His  Majesty's  Fleet  have 
been  promoted  to  be  staff-surgeons,  viz.  : — T.  S. 
Jeans,  M.B.,  J.  H.  Pead,  M.B.,  M.A.,  H.  S.  Burniston, 
M.B.,  H.  P.  Jones.  A.  O.  Bobardt,  M.D.,  S.  T.  Reid, 
C.  H.  J.  Robinson,  and  H.  Huskinson,  M.B. 


In  answer  to  the  request  of  the  Ameer  of  Afghanistan 
to  send  him  a  medical  man  to  treat  him  for  an  injury 
to  his  hand  in  a  recent  shooting  accident,  Lord  Curzon 
replied  : — "  I  am  sending  my  own  doctor,  Major  R. 
Bird,  who  is  leaving  Simla  to-morrow  for  Kabul." 

The  Central  Conservative  Council  of  the  East 
Grinstead  Division  of  Sussex  on  Saturday  selected 
Mr.  E.  M.  Crookshank,  Professor  of  Bacteriology  at 
King's  College,  London,  as  the  candidate  to  contest 
the  division  at  the  next  election  in  the  place  of  the 
present  member,  the  Hon.  G.  Goschen. 


The  sessional  prizes  for  the  surgeons  under  special 
instruction  at  the  Royal  Naval  Hospital,  Haslar,  were 
presented  on  the  7th  instant  by  Inspector-General 
Sir  John  D.  Macdonald.  K.C.B.,  M.D.,  F.B.S.,  Director- 
General  of  the  Medical  Department  of  the  Navy.  The 
Blue  Ribbon  of  Haslar,  in  the  shape  of  the  gold  medal, 
was  won  by  Surgeon  W.  P.  Yetts,  late  of  St.  Bartho- 
lomew's Hospital,  London. 

Special  correspon&ence. 

[from  our  own  correspondents.] 


SCOTLAND. 
and  Shell-Fish. — In    his 


Enteric  Fever  and  Shell-Fish. — In  his  annual 
report,  Dr.  Barras,  medical  officer  of  health,  Govan, 
Glasgow,  states  that  in  the  month  of  July,  i9°3»  a 
family  went  to  a  watering-place  for  their  holidays. 
While  there,  they  all  on  one  occasion  partook  of  raw 
cockles,  and  brought  home  with  them  to  Govan  a 
supply  which  they  gave  to  some  of  their  friends.  The 
family,  four  in  number,  were  all  removed  to  the  hos- 
pital suffering  from  enteric  fever,  which  proved  fatal 


April  20.   1904. 


CORRESPONDENCE. 


Thb  Medical  Press.    433 


to  the  father  and  a  son.  In  other  cases  where  the 
cockles  were  boiled  before  being  eaten  no  disease 
followed,  while  in  several  cases  where,  again,  they  were 
used  raw,  symptoms  of  enteric  developed.  Dr. 
Buchanan,  bacteriologist  for  the  City  of  Glasgow,  who 
examined  some  of  the  shell-fish,  found  them  contami- 
nated. Other  cases  similar  to  those  described  occurred 
in  Glasgow,  and  where  contaminated  shell-fish  had 
been  consumed. 

Royal  Infirmary  Reconstruction  Scheme. — At 
a  meeting  of  the  Institute  of  Architects,  held  recently, 
the  successful  designs  for  the  above  were  again  sub- 
jected to  adverse  criticism  by  the  President,  who 
expressed  the  hope  that  the  scheme  might  yet  be  much 
modified.  The  height  of  it  seemed  to  be  a  serious 
objection,  and  reference  was  made  to  the  remarkable 
modern  hospital  in  Belfast,  which  is  only  one  storey  high, 
and  the  one  contemplated  in  Birmingham,  which  is  to 
be  two  storeys  in  height.  In  view  of  that,  and  for 
other  reasons,  "  he  could  not  help  seeing  the  ill-advised  - 
ness  in  spending  a  large  sum  of  money  after  the  manner 
of  a  bygone  generation."  We  understand  that  the 
Institute  of  Architects  will  consider  this  matter  again 
later  on. 

Small-pox  in  Glasgow. — Notwithstanding  that  this 
disease  prevails  to  a  considerable  extent,  there  being 
128  cases  in  Belvedere  Hospital  at  present,  nothing  is 
heard  of  re-vaccination  on  the  part  of  the  medical  men 
m  the  city.  Many,  of  course,  ignored  the  invitation 
issued  by  the  authorities  to  re-vaccinate  on  account  of 
the  paltry  fee  offered.  The  disease  has  now  existed 
for  such  a  long  time  that  surely  more  drastic  measures 
should  be  adopted  for  stamping  it  out  than  have 
obtained  for  some  time  back.  Is  the  Corporation 
afraid  to  face  the  expenditure  of  a  few  thousand 
pounds  in  having  re-vaccination  thoroughly  done 
throughout  the  city,  and  by  medical  men,  not  sanitary 
inspectors  and  others  ? 

BELFAST. 
Newtownards  District  Nursing  Society. — The 
Marchioness  of  Londonderry  presided  at  the  annual 
meeting  of  this  society,  which  was  held  on  Friday  last. 
The  report  showed  that  during  the  year  the  nurse  had 
attended  120  patients  and  had  paid  4,283  visits.  In 
speaking  of  the  work  done,  Lady  Londonderry  laid 
stress  on  the  fact  that  the  nurse  is  not  meant  in  any 
way  to  take  the  place  of  the  doctor,  but  is  only  to  act 
under  his  orders.  She  suggested  a  plan  for  the  better 
support  of  the  society,  by  which  the  working  classes 
would  pay  small  weekly  sums,  and  where  the  workers 
in  a  factory  of  any  sort  subscribed  more  than  £$  10s. 
per  year  they  should  have  a  representative  on  the 
committee  of  management.  Already  she  had  had 
favourable  replies  from  several  factories  to  which  she 
had  suggested  her  scheme.  It  is  to  be  regretted  that 
among  those  who  took  part  in  the  meeting  no  medical 
men  appeared.  It  is  sincerely  to  be  hoped  that  they 
have  not  taken  up  an  attitude  of  hostility  to  a  society 
which  can  be  of  so  much  use  to  them  as  this  can  be. 
Anti-Vivisectionists  in  Belfast. — Vigorous  efforts 
are  being  made  to  get  some  support  for  a  local  branch 
of  the  London  Anti -vivisection  Society,  but,  appa- 
rently, with  a  very  moderate  amount  of  success.  Last 
week  the  secretary  of  the  parent  society  appeared  on 
the  scene  with  Dr.  Stephen  Townsend,  who  gave  an 
address  to  a  number  of  ladies  and  a  few  clergymen,  who 
were  afterwards  entertained  to  tea.  As  regards  the 
part  clergymen  take  in  these  functions,  it  is  certain 
that  the  medical  profession  is  somewhat  to  blame,  for 
many  of  them  do  it  through  pure  ignorance,  having 
heard  one  side  of  the  question  only,  and  if  their  medical 
man  will  only  take  the  trouble  to  put  the  truth  before 
them,  many  are  quite  open  to  conviction.  Your 
correspondent,  for  instance,  lately  asked  one  who  had 
given  his  name  to  the  committee  of  this  branch  why  he 
had  done  so.  He  said  that  one  of  the  lady  members 
of  his  congregation  had  asked  him  to  join,  and  he  had 
done  so,  but  knew  nothing  about  it.  On  being  asked 
if  he  would  allow  antitoxin  to  be  used  for  his  children 
if  they  had  diphtheria,  he  said  that  he  certainly  would, 
and  was  quite  surprised  to  hear  that  if  this  society  had 


its  way  antitoxin  could  never  have  been  discovered, 
nor  could  fresh  supplies  be  prepared.  His  name  does 
not  appear  as  attending  the  meeting,  and  is  never 
likely  to  do  so. 


Correspon&ence- 


TWe  do  not  hold  ourselves  responsible  for  the  opinion  of  the  corres- 
pondents] 


PALM  AM  QUI  MERUIT  FERAT.— A  PROTEST. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — How  often  will  it  be  necessary  to  protest 
against  the  statement — repeated  in  the  current  number 
of  The  Med  cal  Press  and  Circular — that  Lord 
Lister  is  the  founder  of  aseptic  surgery  ? 

It  is,  not  even  correct  to  say  that  the  aseptic  system 
is  the  outcome  of  the  antiseptic.  That  the  former  followed 
the  latter  is  true,  but  it  was  as  a  protest  against  it, 
and  a  distinct  advance  upon  it. 

The  men  who  advocated  the  aseptic  system  under 
the  name  of  cleanliness  only  met  with  abuse — as 
witnesseth  my  double  rejection  by  a  London  society 
because  of  my  views  on  this  subject — and  even  now 
do  not  get  the  credit  which  is  their  due.  This,  too, 
in  the  face  of  the  fact  that  in  his  address  at  Berlin 
Lord  Lister  renounced  his  system. 

The  late  Mr.  Lawson  Tait's  record  of  136  consecutive 
ovariotomies  without  a  death,  and  my  own  of  ninety — 
in  a  public  hospital — still  stand  unrivalled.  These 
operations  were  done  under  a  system  of  simple  cleanli- 
ness. 

I  only  ask  for  fair  play,  which  is  supposed  to  be  a 
characteristic  of  the  British  mind.  Is  it  too  much  to 
expect  that  this  will  be  forthcoming  ? 

I  am,  Sir,  yours  truly, 

Geo.  Granv  lle  Bantock. 

14  Upper  Hamilton  Terrace,  N.W. 


ALOPECIA  AND  DENTAL  CARIES. 
To  the  Editor  of  The  Medical  Press  and  Circular* 

Sir, — Your  correspondent,  "  M.R.C.S.,  L.D.S.," 
appears  to  forget  he  is  writing  in  the  columns  of  a  medi- 
cal journal.  His  statements  are,  therefore,  made  to 
medical  men,  who  have  an  incurable  habit  of  weighing 
and  analysing  propositions  before  accepting  them.  On 
reading  his  assertion  that  Tomes  said  the  hard  dental 
tissues  once  deposited  never  underwent  subsequent 
change,  I  rubbed  rny  eyes  and  reflected  that  dental 
surgery  and  physiology  must  be  fast  attaining  the 
position  of  an  exact  science.  I  then  sought  to  get 
information  from  "  M.R.C.S."  as  to  the  grounds  on 
which  so  dogmatic  an  assertion  had  been  made. 

"M.R.C.S."  has  not  adopted  the  obvious  course  of 
giving  me  the  exact  citation  from  Tomes,  so  that  I 
might  verify  the  quotation. 

He  has  bespattered  me  with  sarcasm  invective ► 
The  personal  element  in  our  argument  was  intro- 
duced by  him.  He  has  J  accused  ine  repeatedly 
of  gross  ignorance  of  the  subject.  That  is  neither 
here  nor  there,  as  the  subject  under  discussion  is  a 
general  affirmative  statement  'attributed  to  Tomes, 
and  from  that  point  I  refuse  to  be  drawn. 

Let  "  M.R.C.S."  dismiss,  if  possible,  the  bogey  of  my 
ignorance  from  his  mind,  and  let  us  turn  for  a  moment 
to  his  own  intellectual  methods.  Hesays  (p.  380)  that — 
"  '  Medicus  Senex  '  will  recognise  the  absurdity  of  sug- 
gesting the  possibility  of  the  phenomena  of  absorption, 
hypertrophy,  repair,  &c,  in  enamel  and  dentine." 
He  then  goes  on  to  explain  that  "  the  absorption  of  the 
roots  of  milk  teeth  is  brought  about  by  the  action  of 
their  external  vascular  covering,  not  through  activity 
in  the  hard  tissue."  That  is  to  say,  absorption  in 
one  sentence  is  an  absurdity;  in  the  next  its  method  ot 
causation  is  indicated.  A  thing  cannot  both  be  and 
not  be.     That  is  a  primary  law  of  thought. 

I  never  suggested  that  the  hard  dental  tissues  took 
an  active  part  in  any  possible  changes.  Heaven 
forbid  !  I  have  asserted  nothing,  only  sought  to  get 
at  the  attitude  of    'M.R.C.S."  with  regard  to  what,  if 


434    The  Medical  Press. 


OBITUARY. 


April  to,  1904. 


true,  must  be  a  most  interesting  and  suggestive  point 
in  physiological  investigation.  So  far,  however, 
"M.R.C.S."  has  not  held  up  the  necessary  light.  As  a 
medical  reader  of  The  Medical  Press  and  Circular 
of  average  education,  I  surely  have  a  right  to  ask  what 
are  his  authorities  and  his  chain  of  logical  argument  in 
support  of  what  seems  to  be  the  dogmatic  proposi- 
tion we  are  often  obliged  to  accept  in  place  of  state- 
ment capable  of  exact  proof  on  the  basis  of 
ascertained  phenomena.  In  other  words,  the  physi- 
ology and  pathology  of  the  teeth  has  not  yet  obtained 
the  unassailable  position  of  an  exact  science. 
I  am,  Sir,  yours  truly, 

Medicus  Se  nex. 
April  20th,  1904. 


PHYSICAL  EDUCATION. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — I  think  it  would  be  well  when  we  are  consider- 
ing such  questions  as  that  of  physical  deterioration 
and  how  to  relorm  it,  to  look  back  some  forty  or  fifty 
years,  and  see  how  things  were  managed  in  those  days 
at  one  of  our  Universities.  It  is  very  doubtful  whether 
we  shall  do  any  good  by  bringing  education  to  bear 
upon  the  exercises  and  athletics  of  English  boys  and 
girls.  It  may  suit  German  boys  to  be  drilled  and 
disciplined,  but  English  boys  hate  everything  of  the 
kind.  Those  who  can  look  back  to  the  training  days 
at  Cambridge  about  forty  years  ago,  when  Charles 
Kingsley,  and  Leslie  Stephen  and  many  other  well- 
known  men  might  have  been  seen  on  the  banks  in 
keenest  excitement  watching  the  boats  as  they  came 
down  for  the  May  races,  will  acknowledge  that  the 
discipline  was  strict  and  the  language  select  that  entered 
into  it ;  but  it  was  all  in  the  hands  of  the  "  men  " 
themselves,  and  no  dons'  influence,  except  subscription 
to  the  College  Boat  Club,  was  allowed.  No  ;  English 
boys  do  not  want  drilling.  It  is  better  to  leave  them 
alone  to  discipline  themselves.  A  good  eight,  or  a 
good  eleven,  and  a  good  football  team  is  not  badly 
disciplined.  What  has  spoilt  our  sports  of  late  has 
been  the  betting,  and  the  public  exhibitions,  and  the 
far  too  great  contentious  sentiments  that  have  come 
into  the  exercises  of  our  public  schools  and  Universities. 
We  shall  have  to  look  to  something  else  than  education 
if  we  wish  to  reform  the  deterioration  of  to-day. 
I  am,  Sir,  yours  truly, 

R.  L. 


©bttuars- 

EBENEZER  DONALDSON.  B.A.Dub.,  L.R.C.S.I., 
L.R.C.P.I. 
We  regret  to  announce  the  death  of  Dr.  Donaldson, 
at  the  age  of  49,  in  Londonderry  on  April  7  th.  He  was  a 
native  of  Cork,  and  educated  in  the  Dublin  School  of 
Medicine.  He  afterwards  became  Dispensary  Medical 
Officer  of  Burt,  near  Derry.  He  founded  the  London- 
derry Eye  and  Ear  Hospital,  of  which,  with  Dr.  Hunter, 
he  was  joint  surgeon.  Among  other  offices  he  filled 
that  of  President  of  the  North-West  Branch  of  the 
British  Medical  Association,  and  was  for  many  years 
its  secretary  and  representative  on  the  General  Council. 
An  able,  gifted  and  versatile  man,  his  loss  will  be 
mourned  by  a  large  circle  of  friends  in  all  classes  of 
society. 


B.  C.  GOWING.  M.R.C.S.Eng.,  OF  STOCKSBRIDGE. 
The  death  of  Mr.  B.  Gowing  took  place  on  Sunday 
evening,  at  his  residence  at  Stocksbridge,  in  which 
district,  and  in  partnership  with  Dr.  Ross,  of  Penistone, 
he  had  practised  for  a  considerable  number  of  years. 
He  was  also  the  medical  officer  to  the  Wort  ley  Board 
of  Guardians  for  the  parish  of  Stocksbridge,  in  addition 
to  other  offices  which  he  held  locally.  Deceased  studied 
at  Guy's  Hospital,  and  took  the  diploma  of  M.R.C.S. 
Eng.  so  long  ago  as  1865.  and  that  of  L.S.A.  in  1866. 
Although  in  failing  health  for  some  time,  the  deceased 
gentleman   had   attended    to   his   professional   duties 


up  to  three  weeks  ago.     He  leaves  a  widow,  a  son,  also 
in  the  medical  profession,  and  several  daughters. 

FRANCIS    JOSEPH    LANDER,    M.R.CS.Eng., 
L.R.C.P. 

A  fatal  accident  occurred  at  Stamford  on  the  14th 
instant.  Mr.  Lander,  who  lived  on  Barn  Hill,  went 
for  a  cycle  ride  in  the  country,  accompanied  by  his 
wife.  In  riding  down  a  hill,  it  is  supposed  the  brake 
failed  to  act,  and  he  was  carried  at  a  great  pace  into 
the  main  thoroughfare,  which  passes  at  right  angles. 
Just  at  that  moment  a  brewer's  float  was  passing,  and 
into  this  Mr.  Lander  was  hurled  with  great  force. 
Medical  aid  was  immediately  summoned,  and  Mr. 
Lander  was  taken  home,  but  he  died  during  the  night. 
Deceased  studied  at  the  London  Hospital  and  took 
the  M.R.C.S.Eng.  in  1891.  Mr.  Lander,  who  was  in 
the  prime  of  life,  had  only  been  in  practice  in  Stamford 
a  few  months,  having  purchased  the  practice  of  Dr. 
Mackenzie.  He  was  formerly  in  practice  in  Notting- 
ham. 


SAMUEL  SMILES,  M.D. 
We  regret  to  announce  the  death  of  Samuel  Smiles, 
the  author  of  "  Self-Help "  and  other  well-known 
books,  at  the  ripe  age  of  92.  Born  at  Haddington. 
N.B.,in  1812,  he  entered  the  medical  profession,  and 
for  six  years  was  engaged  in  practice  as  a  surgeon  in 
his  native  county.  He  then  became  editor  of  the 
Leeds  Times,  and  secretary  of  the  Leeds  and  Thirsk 
Railway.  He  came  prominently  before  the  public  as 
an  anti-Corn  Law  lecturer,  and  m  1854  w^  appointed 
secretary  to  the  South-Eastern  Railway,  a  post  which 
he  retained  until  1866.  His  magnum  opus,  "Self- 
Help,"  has  attained  a  circulation  of  some  250,000 
copies.  Among  his  other  works  may  be  mentioned 
"  Duty,"  "  Thrift,"  "  History  of  the  Huguenots/' 
biographies  of  John  Murray,  Nasmyth,  George  Moore. 
George  and  Robert  Stevenson,  and  a  "  History  of 
Ireland."  His  life  has  been  emphatically  that  of  a 
busy,  industrious,  and  talented  man,  guided  by  high 
practical  ideals  of  usefulness  and  honour. 

SURGEON  F.  C.  STEARN,  R.N. 
We  regret  to  record  the  death  of  Surgeon  F.  C. 
Stearn,  who  had  been  one  of  the  surgeons  doing  duty 
at  Portsmouth  Dockyard  surgery  since  November,  1902, 
who  died  at  his  residence  in  the  dockyard.  Dr.  Stearn 
was  appointed  to  the  Walsall  Hospital  in  October. 
1 892,  and  resigned  in  October,  1 894-  After  his  partner- 
nership  with  Dr.  Scott  Wilson,  he  was  appointed 
surgeon  in  the  Navy.  He  was  taken  suddenly  ill 
on  the  previous  Thursday  evening  with  peritonitis, 
and,  although  two  or  three  medical  men  were  in  constant 
attendance  ever  since,  Surgeon  Stearn  passed  away 
as  stated.  The  deceased  officer  leaves  a  widow  and 
one  child.  He  was  a  most  popular  officer,  and  will 
be  greatly  missed.  He  was  medically  educated  at 
Guy's  Hospital,  and  took  the  qualification  of  M.R.C.S. 
Eng.  and  L.R.C.P.  in  1892. 

TIMOTHEUS  JOHN  HARAN.  L.R.CS.I. 
The  death  is  announced  of  Inspector-General 
Timotheus  John  Haran,  a  distinguished  naval  surgeon, 
at  Kensington,  on  the  10th  instant,  at  the  age  of 
74.  When  assistant-surgeon  with  the  Harlequin,  in 
18U.  he  was  employed  in  charge  of  the  boats  in  the 
attack  on  Lagos,  when  he  was  mentioned  in  des- 
patches, and  subsequently  was  engaged  in  the  sup- 
pression of  the  slave  trade  "on  the  West  Coast  of  Africa. 
During  the  war  with  Russia  he  was  assistant-surgeon 
of  the  Viper  in  the  Black  Sea.  being  repeatedly  in 
action,  and  taking  part  in  the  battle  at  Eupatona. 
in  the  capture  of  Kertch,  in  the  expedition  in  the  Sea 
of  Azoff,  in  the  night  attacks  on  the  sea  defences  of 
Sebastopol,  and  in  the  capture  of  Kinburn.  for  which 
he  received  the  medal  with  clasps  for  Aroff  and  Sebas 
topol  and  the  Turkish  medal.  In  1862,  while  surgeon 
of  the  Brisk,  Mr.  Haran  accompanied  Commodore 
Wilmot  on  a  mission    to  the    King   of  Dahomey,  at 


April  20,  1904. 


LITERATURE. 


The  Medical  Pkess.  435 


that  time  considered  a  perilous  enterprise.  He 
received  the  honour  of  being  appointed  Hon.  Surgeon 
to  His  Majesty  the  King. 

COLONEL  R.  de  la  COUR  CORBETT,  M.D.R.U.I. 
We  regret  to  announce  the  death  at  Lucknow,  in 
his  60th  year,  of  Colonel  Robert  de  la  Cour  Corbett, 
principal  medical  officer  of  the  Oude  and  Rohilkund 
districts.  He  was  a  son  of  Dr.  Richard  Corbett,  of 
Innishannon,  county  Cork,  and  was  educated  at 
Queen's  College,  Cork,  and  at  Trinity  College,  Dublin. 
He  joined  the  medical  service  of  the  Army  in  1867, 
and,  becoming  a  surgeon-major  in  1879,  served  with 
the  Burmese  Expedition  in  1886-87  in  charge  of  No. 
5  Field  Hospital.  He  was  senior  medical  officer  with 
the  Bhamo  Expeditionary  Force  and  acting  principal 
medical  officer  with  the  Burma  Field  Force.  He 
obtained  mention  in  despatches  and  was  rewarded 
with  the  Burma  medal  with  clasp  and  the  Companion- 
ship of  the  Distinguished  Service  Order.  He  became 
a  colonel  in  June,  1898,  and  in  September  of  that  year 
was  appointed  an  administrative  medical  officer  in 
Bengal.  Colonel  Corbett  took  the  M.D.R.U.I.  in 
1867,  and  was  elected  a  Fellow  of  the  Royal  College 
of  Surgeons   of  Ireland  in  1880. 

EDMUND  EYRE  LLOYD,  LATE  I.M.S. 
Mr.  Edmund  Eyre  Lloyd,  a  rethed  deputy  surgeon- 
general  of  the  Indiap  Medical  Service,  died  on  Friday 
at  Markham  House,  Wokingham,  Berks,  in  his  75th 
vear.  He  was  a  son  of  the  late  Mr.  Edmund  Lloyd, 
of  Barham,  Kent,  and  entered  the  Madras  Medical 
Service  in  January,  1855.  He  was  for  some  time 
Zillah  surgeon  and  superintendent  of  the  gaol  at 
Tanjore,  and  was  placed  on  the  retired  list  as  a  deputy- 
snrgeon-general  in  1885. 

JOHN  MARTIN.  M.D..  OF  CLEVEDON. 
The  sudden  death  of  Dr.  John  Martin,  M.D.,  of 
Albert  Road,  Clevedon,  has  caused  widespread  regret 
in  the  district.  The  deceased  gentleman  was  well 
known  and  highly  respected  in  the  town,  where  he 
had  resided  for  a  number  of  years.  The  cause  of 
death  was  heart  failure.  Dr.  Martin  was  connected 
with  the  Cottage  Hosptal  in  an  honorary  capacity, 
and  was  also  a  Freemason,  besides  which  he  always 
showed  he  had  the  true  welfare  of  the  town  at  heart. 
He  leaves  a  widow  and  a  grown-up  son  and  daughter. 
His  medical  education  was  acquired  at  Birmingham 
and  Glasgow.  He  took  the  M.D.St.  And.  in  1898, 
the  F.R.C.S.Ed.  in  1876,  and  the  L.R.C.P.  in  1872. 

Xtterature. 


ANDERS'  PRACTICE  OF  MEDICINE,  (a) 
The  fact  that  this  American  manual  has  in  six  years  run 
to  as  many  editions  is,  in  itself,  a  sufficient  evidence  of 
its  usefulness  and  popularity.  From  the  absence  of 
controversial  matter,  and  on  account  of  the  precise 
directions  which  are  given  for  treatment,  we  consider 
that,  on  the  whole,  it  is  a  very  complete  text-book, 
well  adapted  to  the  needs  of  the  student  or  practitioner. 
The  chapter  upon  typhoid  fever  is  one  of  the  best  in 
the  book.  The  diagnostic  value  of  the  Widal  reaction 
is  discussed  at  length,  and  there  is  .1  good  account  of 
the  different  clinical  types  of  the  disease.  Five  pages 
are  devoted  to  a  description  of  hydrotherapy  as 
applied  to  enteric  fever,  under  which  treatment  the 
average  mortality  is  stated  to  be  73  percent.  Photo- 
graphs are  dven  of  a  form  of  portage  bath-tub  which, 
as  it  only  weighs  twenty-five  pounds,  should  not  be 
difficult  to  manipulate  at  the  bedside.  Due  mention 
is  nnde  of  that  group  of  affections  comprised  under 
the  term  "  paratyphoid  "  fever.  It  is  a  little  curious 
to  see  a  description  of  mountain  sickness  following 
immediately   after    that   of    typhoid    fever,    the   only 

(a)  "  A  Text-Book  of  the  Practice  of  Medicine."  By  James  M. 
Anders.  M.D  ,  Pb  D..  LL  D„  Professor  of  Medicine  at  the  Medico- 
Chirurrical  College.  Philadelphia,  Revised  Edition.  Pp  1.271. 
With  illustrations.    W.  B.  Saunders  and  Co.    1903.    Price  24s.  net. 


excuse  for  which  procedure  would  appear  to  be  that 
the  "  mountain  fever  "  of  older  writers  was  nothing 
less  than  a  modified  form  of  enteric. 

The  section  on  tuberculosis  is  very  full,  and  the  views 
of  Koch  and  others  are  set  forth  concisely.  Consider- 
able stress  is  rightlv  lnid  upon  the  prophylaxis  of  con- 
sumption. One  of  the  most  useful  features  of  the 
book  are  the  tables  of  differential  diagnosis,  which 
should  afford  ?,reat  assistance  to  the  busy  practitioner, 
or  to  refresh  the  memory  of  the  student  prior  to  an 
examination. 

Great  pains  have  evidently  been  taken  to  bring  the 
book  up  to  date,  and  in  many  places  references  are 
given  to  British  and  Continental  authorities.  In 
spite  of  this,  however,  there  are  a  few  conspicuous 
omissions.  Thus  we  look  in  vain  for  a  description  of 
late  rickets,  achondroplasia,  or  Banti's  disease,  and 
the  name  of  sleeping  sickness  is  not  given  as  an  alter- 
native title  to  the  article  on  trypanosomiasis,  though 
the  symptoms  of  that  affection  are  well  described. 
We  do  not  like  the  term  "  opiumism  "  as  applied  to 
chronic  poisoning  with  opium. 

THE  DENTAL  ANNUAL,  1904.  (a) 
We  have  nothing  but  praise  to  bestow  upon  the 
first  issue  of  this  book,  and  as  the  new  edition  contains 
much  additional  information  and  displays  various 
improvements,  we  can  but  endorse  our  verdict,  and 
repeat  that  the  Annual  must  prove  an  indispensable 
requisite  for  the  great  majority  of  dental  surgeons. 
This  edition  contains  a  dental  directory  of  all  registered 
practitioners  arranged  topographically  under  the 
towns  of  the  United  Kingdom  alphabetically  classified. 
No  other  such  list  being  published,  this  feature  alone 
makes  the  Annual  worth  its  price  to  the  busy  practi- 
tioner. The  information  brought  together  upon  edu- 
cation, organisation,  legal  decisions,  and  the  proceedings 
of  the  General  Medical  Council  is  given  in  wider  scope 
than  in  the  first  edition,  whilst  the  summaries  of  recent 
research  and  work  are  both  extended  and  improved, 
more  especially  by  restricting  the  number  of  cross 
references.  This  department  of  the  Annual  alone 
makes  it  worth  its  price  to  all  those  in  any  way  actively 
concerned  in  dental  science  and  dental  literature. 

CHARLES  WHITE,  F.R.S.  (6) 
This  octavo  volume  of  fifty-six  pages  not  only  offers 
to  the  reader  an  interesting  and  instructive  biogra- 
phical sketch ;  it  presents  a  truly  inspiring  object- 
lesson  to  every  medical  practitioner  who  truly  loves  his 
proiession,  and  is  desirous  of  making  his  own  career 
worthy  of  his  noble  calling.  Charles  White,  the 
subject  of  the  sketch  which  now  lies  before  us,  was  not 
only  a  truly  "  great  provincial  surgeon  and  obstet- 
rician "  in  the  ordinarily  accepted  (and  too  frequently 
abused)  sense  of  such  epithets ;  he  was  a  man  oi  the 
widest  culture  and  most  advanced  philosophical  views 
and  attainments  in  all  the  important  domains  of  science. 
His  contributions  to  the  literature  and  science  of  his 
own  profession  were  numerous ;  and  it  may  safely  be 
affirmed  that  there  is  not  one  of  them  which  will  not 
be  fouud  to  contain  matter  of  original  discovery,  or 
new  and  profound  views  of  previously  recognised  facts. 
Charley  White  was  a  through-and-tnrough  Manchester 
man  ;  he  was  born  in  that  city  in  1728,  and  died  near 
it  in  181 3,  in  the  eighty-fifth  year  of  his  age. 

In  the  clinical  and  lecture-room  teaching  of  the  pre- 
sent day,  the  name  of  Charles  White  is  frequently 
mentioned  as  one  of  the  earliest  and  most  skilful  of  the 
pioneers  in  the  excision  of  joints  ;  and  as  the  devisor 
ot  reduction  of  unmanageable  dislocations  of  the  shoul- 
der-joint, by  the  method  of  "  vertical  upward  exten- 

(a)  "  The  Dental  Annual  and  Directory,  1904 :  a  Tear-Book  of 
Den  ai  burgery.  The  Practioner'n  Guide  to  the  Current  Literature 
a»»d  ResouroM  of  Dentistry."  Loudon ;  Ballliere,  Tindall  and  Cox, 
1904.    Price  7i.6d. 

(b)  "Charles  White.  F.R.8  ,  a  Great  Provincial  Surjreon  and 
Obstetrician  of  the  Eighteenth  Century.  An  Address  Delivered 
before  the  Medical  Society  of  Manchester,  Octobe  7th.  1903."  By 
Charles  .  Cullingwo*  th,  M.D  ,  F  B  C.P.,  Ac,  Ac.  With  Notes  and 
Illustrations.     London:  Henry  J. Glaisher.     19<>4. 


436     The  Medical  Press. 


MEDICAL  NEWS. 


April  20.  1904. 


sion."  But  nearly  all  his  communications  will  be 
found  on  examination  to  contain  correspondingly 
original  and  important  views  and  methods,  although 
many  of  the  latter  have  necessarily  been  superseded 
in  the  progress  of  time. 

There  is  one  of  his  works  which  is  seldom  referred  to 
by  physicians  and  surgeons  of  the  present  generation; 
but  which  will,  we  trust,  be  permanently  remembered 
\n  the  history  of  scientific  progress,  as  a  landmark  of 
a  period  down  to  which,  at  least,  medical  men  were 
nearly  always  the  pioneers  in  every  department  of 
natural  and  physical  science.  The  paper  we  refer  to 
was  published  (in  quarto  form)  in  1799.  It  bears  the 
title,  "  An  account  of  the  regular  gradation  in  man  and 
in  different  animals  and  vegetables,  and  from  the 
former  to  the  latter."  The  curious  reader  who  cares 
to  take  the  trouble  to  examine  this  volume  will  pro- 
bably be  much  more  surprised  than  edified  to  find  that 
its  pages  contain  many  of  the  most  "  profoundly 
original  "  views  with  which  the  author  of  the  "immortal 
41  Origin  of  Species  "  electrified  the  scientific — and 
theological — world,  exactly  sixty  years  afterwards  ! 


MACMILLAN'S  GUIDE  TO  SWITZERLAND,  (a) 
This  new  Guide  to  Switzerland,  though  it  may  never 
take  the  place  of  the  well-known  "  Baedeker  "  in  the 
affections  of  many  travellers,  cannot  but  commend 
itself  by  the  excellence  of  its  maps,  its  up-to-dateness, 
and  thorough  information  as  to  routes,  hotels,  and 
others  details,  and  by  the  very  convenient  general 
arrangement  of  the  book  as  a  whole.  The  first  part  of 
the  Guide  contains  articles  which  should  be  of  interest 
and  use,  especially  to  those  visiting  Switzerland  for 
the  first  time.  A  history  of  the  country  is  given  with 
details  as  to  its  government  and  interests,  and  this  is 
followed  by  various  articles  containing  valuable  hints 
to  travellers  on  such  important  points  as  outfit, 
luggage,  languages,  health  precautions,  climbing,  &c. 
No  pains  have  been  spared  in  the  planning  out  of  the 
various  routes,  and  the  descriptions  of  the  natural 
landmarks,  mountains,  glaciers,  towns,  villages,  and 
places  of  interest  are  very  complete.  The  Hotel  List 
is  well  arranged  in  alphabetical  order,  and  by  slight 
differences  of  type  the  tourist  can  see  at  a  glance  what 
hotels  or  pensions  are  most  suited  to  his  individual 
taste.  The  maps  are  excellent.  We  have  no  hesitation 
in  recommending  this  Guide,  and  wish  it  the  success  it 
deserves.  Medical  men  will  find  it  of  much  service 
in  affording  assistance  in  the  selection  ot  health 
stations  for  their  patients  and  holiday  resorts  for  them- 
selves. 


ALPINE  FLORA,  {b) 
Among  the  thousands  of  tourists  who  yearly  visit 
the  High  Alps  there  must  be  few  who  are  not  awakened 
into  enthusiastic  admiration  of  the  wonderfully 
brilliant  floral  carpets  which  cover  their  slopes  and 
upland  pastures.  The  amateur  botanist  will  therefore 
gladly  welcome  this  translation  of  Dr.  Hoffman's 
valuable  handbook  on  "  Alpine  Flora,"  as  it  will  afford 
him  a  means  ot  easily  identifying  and  classifying  the 
most  important  plants  he  may  meet  on  his  mountain 
rainMes.  The  arrangement  ot  the  book  is  admirable, 
bu  its  chief  attraction  lies  in  the  forty  coloured  plates, 
softie  of  which  are  reproductions  of  the  original  water- 
colour  drawings  by  Herman  Friese,  while  the  remainder 
of  the  figures  were  painted  from  nature.  The  Natural 
Orders  are  grouped  on  De  Candolle's  system  and  only 
the  Most  important  characteristics  of  the  various  plants 
are  described  in  the  text.  The  book  is  of  convenient 
size  and  ought  to  be  a  valued  companion  to  many 
botanists  during  the  next  Alpine  season.  Many 
medical  men  will  gain  much  delight  from  a  perusal  of 
this  artistic  volume. 


(a)  "  Mftcmilfen's  Guide  to  Switierland/'    Lor  don  :  Macmfllan  and 
Company.    1908. 

» £6{»IlA!pineT PI?ra"  rBy  7h'   Juliui  Hoffman.     Trwwlated  by 
E.g.  Barton.    London :  Longmans  Green  and  Company.    J0O3. 


jflDeMcal   flews* 


The  Rtglgtratlon  of  Nnrsea. 

An  important  meeting  was  held  in  Dublin  on  Friday 
last,  in  support  of  the  proposal  to  introduce  a  Bill  in 
Parliament    providing    for    the    State   registration  of 
nurses.     The  meeting  took  place  in  the  Royal  College 
of  Physicians,  Dr.  Little  in  the   chair,  and  was  very 
largely  attended.     Mrs.  Bedford  Fenwick  delivered  an 
address  on  the  subject,  in  which  she  pointed  out  the 
great  necessity  for  the  establishment  of  some  mechanism 
by  which  the  trained  nurse  could  be  plainly  distin- 
guished from   the  untrained.     The  Bill  which  it  was 
proposed  to  introduce  provided  for  the  establishment 
of  a  central  executive  body  of  thirty-one  to  control 
the  registration  of  nurses  in  the  three  countries,  the 
duties  of  which  body  had  not  been  too  closely  defined, 
as  what  was  desired  was  that  a  Bill  should  be  brought 
forward  which  could   be   discussed   in   committee  by 
those  qualified  to  do  so.     What  they  wanted  was  that 
the  first  principles  of  training  should  be  laid  down  bv 
scientific   men.     They   could   not   get    the   very  best 
material  unless  they  provided  a  standard  of  education 
suitable  to  the  times.     In  some  of  the  London  hospital 
no  change  had  been  made  in  the  curriculum  for  fullv 
forty   years.     They  wanted   better   clinical    teaching. 
At  present  it  was  a  perfect  gamble  as  to  who  was 
selected  for  the  teaching  of   probationers.      This  va* 
to  a  great  extent  also  true  of  the  selection  of  matron?. 
What  they  wanted  was  that  a  high  standard  of  pro- 
fessional responsibility  should  be  maintained,  and  that 
the  nurses  should  be  protected  from  the  competition 
of  the  unworthy  and  the  untrained.     Sir  John  Moore, 
in  proposing  the  following  resolutions,   very  sensibly 
pointed  out  that  it  was  unwise  of  the  nurses  to  describe 
their  calling  as  a  "  profession."  and  that  it  would  be 
much   more    correct    to    term   it   a    "  calling."     This 
may  appear  to  be  a  splitting  of  words,  but  we  also 
consider  that  the  use  of  such  a  term  would  make  it 
perfectly  clear  that  there  was  no  attempt,  as  in  the 
case  of  the  Midwives     Bill,   to  introduce  an  inferior 
type  of  medical  practitioner.     The  resolutions  proposed 
were  as  follows  : — (1)  That  it  is  essential  the  nurse- 
throughout  the  United  Kingdom  should  be  efficiently 
educated  for  the  performance  of  the  responsible  dutie> 
entrusted  to  them.     (2)  That  a  minimum  standard  ot 
education    and    common    rules   of   discipline   can  be 
secured  only  by  an  Act  of  Parliament.     (3)  That,  as 
a   preliminary    to   such   legislation,    it   is   desirable  a 
Select  Committee  of  the  House  of  Commons  should  be 
appointed  at  an  early  date  to  inquire    into  the  twhole 
nursing  question.     Dr.  O'Carroll  seconded  the  motion 
and   it  was   adopted   with  a    few   dissentients.    ^On 
the  motion  of  Sir  Charles  Ball,  seconded  by  Dr.  Hayes, 
a  vote  of  thanks  was  passed  to  Mrs.  Fenwick,  and  the 
proceedings  terminated. 

The  Mtdloal  Tournament. 

By  permission  of  the  Northwood  Golf  Club,  the 
annual  medical  tournament  will  be  held  on  the  North- 
wood  links,  on  Thursday,  June  9th.  An  18-holes 
handicap  competition  against  bogey  will  be  decided 
in  the  morning,  the  players  being  divided  into  two 
classes — handicaps  of  12  and  under,  and  handicap* 
exceeding  12.  In  the  afternoon  there  will  be  a  four- 
some competition. 

Flogging  In  the  Navy. 

The  following  letter  has  been  sent  to  the  Right 
Hon.  the  Earl  of  Selborne,  First  Lord  of  the  Ad- 
miralty : — 

"  My  Lord, — The  Committee  of  the  Humanitarian 
League  desire  to  bring  the  following  matter  to  your 
notice.  There  is,  as  you  are  aware,  a  widespread  but 
erroneous  impression  that  corporal  punishment  has 
been  abolished  in  the  Royal  Navy,  whereas,  in  fact, 
the  birch  and  the  cane — the  latter  very  frequently 
and  for  a  number  of  minor  offences — are  still  inflicted 
on  boys  and  young  men  up  to  the  age  of  18.  With  a 
view  to  enlightening  the  public  on  this  subject,  the 
Humanitarian  League  proposes  to  placard  the  walls 
of  London,  and  the  chief  sea-port  towns  with  a  pictorial 
representation  of  a  naval  caning  or  birching ;  and  as 


April  20,1904 


PASS  LISTS. 


The  Medical  Press. 


437 


we  are  anxious  that  the  picture  shall  be  in  every  way 
accurate,  and  not  liable  to  any  charge  of  exaggeration, 
we  venture  to  ask  whether  the  Admiralty  will  allow 
photographs  to  be  taken  of  the  punishment  as  inflicted. 

As  such  great  interest  is  felt  in  the  Navy,  and  as 
it  is  generally  held  to  be  desirable  that  the  public 
should  be  made  familiar  with  the  features  of  so  popular 
a  Service,  we  trust  that  you  will  see  your  way  to  grant- 
ing this  request. 

I  remain,  my  Lord,  your  obedient  servant. 

Hon.  Secretary, 
Humanitarian  League. 
Presentation  to  a  Medical  Practitioner. 

Mr.  Sidney  C.  Lawrence.  M.R.C.S.Eng..  L.R.C.P. 
Lond.,  D.P.H.,  lecturer  and  examiner  of  the  St.  John 
Ambulance  Association  and  honorary  surgeon  to  the 
Earls  Barton  division  of  that  Association,  has  been 
presented  with  a  pair  of  opera  glasses  as  some  acknow- 
ledgment of  the  valuable  assistance  which  he  has  given 
to  the  cause  of  first  aid  and  nursing  at  Earls  Barton 
during  the  past  seven  years. 

Toe  Society  for  Relief  of  Widows  and  Orphans  of  Medical 
Men. 

At  a  quarterly  Court  of  the  directors  of  this  Society, 
held  on  Wednesday  last,  the  president,  Mr.  Christopher 
Heath,  F.R.C.S.,  in  the  chair,  one  new  member  was 
elected,  and  the  deaths  of  six  members  reported. 
Two  widows  had  become  ineligible  for  further  grants. 
Fresh  applications  tor  grants  were  read  from  four 
widows,  and  assistance  was  given  to  three,  the  fourth 
not  being  eligible  under  the  bye-laws.  Fifty-four 
widows,  fourteen  children,  and  four  orphans  on  the 
Copeland  Fund  applied  for  a  renewal  of  their  grants, 
and  £1.319  was  voted  for  distribution  at  the  next 
Court.  A  legacy  of  £1,000  from  the  late  Mrs.  Du 
Pasquier  was  announced.  The  tollowing  gentlemen 
were  nominated  for  election  at  the  annual  general 
meeting  to  fill  the  vacancies  in  the  Court  of  Directors  : — 
Mr.  Snell.  Mr.  Bell,  Dr.  Godson.  Mr.  May,  Dr.  James, 
Mr.  Green  and  Dr.  West.  The  expenses  of  the  quarter 
were  £57  3S-  6d.  It  was  decided  to  hold  the  annual 
General  Meeting  on  Wednesday,  May  18th. 
Royal  College  of  Surgeons  in  Ireland. 

The  election  of  examiners  will  be  held  on  Tuesday, 
May  3rd.  1904.  as  follows  : — Two  examiners  in  Anatomy, 
four  examiners  in  Surgery,  two  examiners  in  Physiology 
and  Histology,  one  examiner  in  Pathology  and  Bac- 
teriology, one  examiner  in  Pathology,  one  examiner 
in  Midwifery  and  Gynaecology,  one  examiner  in  Biology, 
two  examiners  in  Ophthalmology,  one  examiner  in 
Sanitary  Law  and  Vital  Statistics,  one  examiner  in 
Engineering  and  Architecture,  two  examiners  in 
Chemistry  and  Physics,  two  examiners  in  Dental 
Surgery  and  Pathology,  two  examiners  in  Mechanical 
Dentistry,  one  examiner  (not  being  a  Fellow  or 
Licentiate  of  the  College)  in  Languages,  one  examiner 
(not  being  a  Fellow  or  Licentiate  of  the  College)  in 
Mathematics,  Physics,  Dictation,  and  English  Essay. 
Candidates  are  requested  to  lodge  their  applications 
in  writing  with  the  Registrar,  at  the  College,  on  or 
before  Tuesday,  April  26th,  at  10  a.m. 


PASS  LISTS. 


Biyal  Oolleie  of  fPhyiicians  of  Edinburgh,  Royal  College 
of  Surgeons  of  Edinburgh,  and  Faculty  of  Physicians 
and  Surgeons  of  Glasgow. 

The  quarterly  examinations  of  the  above  Board, 
held  in  Edinburgh,  were  concluded  on  nth  inst., 
with  the  following  results  : — 

First  Examination — Five  Years*  Course. — Of  twenty- 
five  candidates  entered  the  following  thirteen  passed 
the  Examination  :  —  Zerk  Daniel  Lotter-Luther, 
Andrew  Johnstone  (with  distinction),  Cecil  Berry, 
Charles  Kingsley  Carroll,  Thomas  Mohan  (with  dis- 
tinction), Maria  Shepherd  Allen,  Daniel  Johannes 
joubert,  Michael  Joseph  Hayes,  Cornelius  Alexander 
O'Driscoll,  Edward  John  Lumsden,  Graham  Smith, 
Easton  Spence  Shiach,  and  Jacobus  du  Toit  Malan. 

Second  Examination — Four  Years*  Course. — One 
candidate  passed  in  the  division  of  Materia  Medica. 


Second  Examination — Five  Years*  Course.  —  Of 
twenty-four  candidates  entered,  the  following  sixteen 
passed  the  Examination  :— Archibald  McKendrick 
(with  distinction),  Edward  Albert  Williams  (with 
distinction),  Harold  Hubert  Babington,  James  Haig 
Johnston  (with  distinction),  Ronald  Wingrave  Duncan, 
Wilfrid  Metcalfe  Chambers,  Arthur  Patrick  O'Connell, 
Joseph  Benjamin.  Norman  Raphael-Tom.  Howard 
Douglas  Stewart,  Krishnaji  Waman  Dani;  John 
Theodore  Anderson,  Douglas  Llewellyn  George  Radford, 
Herbert  Moncrieff  Sturrock,  Herbert  Charles  Orrin, 
Thomas  Wrenn  Faulkner,  and  Lakshmi  Narayan  Ghosh, 
and  two  passed  in  Physiology. 

Third  Examination — Five  Years'  Course.  —  Of 
nineteen  candidates  entered,  the  following  nine  passed 
the  examination  : — William  Wallace  Dunlop  (with 
distinction),  James  Wilson  (with  distinction),  Henry 
Traill  Simpson  (with  distinction),  George  Augustus 
Stewart  Hamilton,  David  James  Melville  Legge, 
Henry  Albert  Pascoe  (with  distinction),  Thomas 
McLaren  Gallowav  (with  distinction),  William  Fleming, 
and  John  Edmund  Cox,  and  one  passed  in  Pathology, 
and  one  in  Materia  Medica. 

Final  Examination. — Of  fifty-one  candidates  entered 
the  following  twentv  passed  the  Examination,  and 
were  admitted  L.R.C.P.E.,  L.R.C.S.E.,  and  L.F.P. 
and  S.G.  :— Alford  Rogers.  Andrew  Sergeant  McNeil, 
John  Alexander  Tolmie,  Marian  Theresa  Pool,  John 
Clegg  Pickup,  William  Douglas  Yuille,  Harry  Andrew 
Foy,  Phirozshaw  Cooverji  Bharucha,  Edmund 
O'Shaughnessy,  Abdul  Hakim  Khan,  Gunamal 
Santdas  Thadani.  John  Cretin,  Dora  Mann,  Edwin 
Nelson  Jan,  Chauncey  Eugene  Coke,  Herbert  James 
George,  William  Thomas  Clarke,  George  William 
Armstrong,  Arthur  Charles  Lodge  I<a  Frenais,  and 
David  John  Lewis,  and  three  passed  in  Medicine  and 
Therapeutics  ;  two  in  Surgery  and  Surgical  Anatomy  ; 
nine  in  Midwifery,  and  three  in  Medical  Jurisprudence. 

The  London  School  of  Tropical  Medicine. 

Of  the  students  of  the  above  school  who  presented 
themselves  for  the  examination  at  the  end  of  the 
January- April  Session,  1904.  the  following  have 
passed  : — Dr.  Norah  Lenwood,  Dr.  A.  L.  Hoops 
(Colonial  Service),  Dr.  W.  M.  Eaton,  Dr.  J.  B.  Cleland, 
Dr.  Olive  McDougall,  Dr.  K.  McGahey  (Colonial 
Service),  passed  with  distinction  ;  Dr.  J.  Eldon,  Dr. 
J.  E.  M.  Brown  (Colonial  Service),  Dr.  M.  E.  Leicester, 
Dr.  A.  E.  E.  Twynam  (Colonial  Service),  Dr.  R.  L. 
Roe  (Colonial  Service),  Dr.  H.  G.  McKinney  (Colonial 
Service),  Dr.  G.  E.  Whyte  (Colonial  Service),  Dr.  C. 
T.  Costello  (Colonial  Service),  Dr.  C.  W.  Somerville. 

Naval  Medical  Service. 

Combined   Result   of  the   Examination   in    London    on 

Entry  and  of  the  one  at  Haslar  Hospital. 

Name  of  Officer.         Total  Name  of  Officer.  Total 
Marks.                                    Marks. 

W.  P.  Yetts 4,678  E.  R.Townsend    ..  3,301 

T.  D.  Liddle 4. 1 5 1  J-  c-  Bringan     3.278 

N.  S.  Meiklejohn  ..    4.028  W.  G.  M.  Anderson  3,225 

R.  H.  St.  B.  E.  G.  L.  Buckeridge  . .  3,161 

Hughes 3,824  A.  D.  C.  Cummins  3. 115 

F.  M.  V.  Smith 3.68 1  T.  W.  Jeffrey     ....  3,073 

C.  J.  Boucher    3,641  P.  E>.  Ramsay 3,068 

A.  H.  S.  Richardson   3.516  E.  P.  G.  Causton    ..  3,046 

H.  Woods 3.494  G.  D.  Walsh 2,939 

G.  H.  S.  Milln    ....    3.479  J-  E.  Johnston  ....  2,925 

D.  H.Vickery   ....    3.455  F.  Cock 2,830 

E.  B.  Kenny 3,450  A.  R.  Davidson     . .  2,803 

A.  R.  Schofield ....    3.353  B-  R-  Bickford  ....  2.779 

J.Shipsey      3.320  C.M.Woods      2,609 

F.  J.  Go  wans 3.306  L.  C.  E.  Murphy    ..  2,516 

Surgeon  W.  P.  Yetts,  late  of  St.  Bartholomew's 
Hospital,  London,  the  gold  medal.  Surgeon  T.  D. 
Liddle,  M.B.,  late  of  Queen's  College,  Belfast,  the 
microscope.  Surgeon  N.  S.  Meiklejohn,  late  of  St. 
George's  Hospital,  London,  the  silver  medal  and 
books. 


438    The  Medical  Pib».       NOTICES  TO  CORRESPONDENTS. 


April  20,  1904. 


JUrtices  to 
Comsponbente,  Short  fetters,  &c 

f^T  Correspondents  requiring  a  reply  in  toil  oolumn  are  particu- 
larly requested  to  make  use  of  a  distinctive  tignalwrt  or  initial,  and 
avoid  the  practice  of  signing  themtelvee  "Reader."  " Subecriber," 
"Old  Subecriber,"  fee  Muoh  confusion  will  be  spared  by  attention 
to  this  rule. 

Orwinal  Articles  or  Letters  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

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

Reprints.— Reprints  of  articles  appearing  in  this  journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

Medicus  (Salop).— We  are  not  aware  that  in  this  country  any  pro- 
posal  has  been  seriously  made  to  exclude  tuberculous  pupils  from 
schools.  That  step  has  been  recommended  by  Dr.  O.  W.  Webster, 
President  of  the  Illinois  State  Board  of  Health,  or,  at  any  rate,  the 
segregation  of  such  children.  On  many  grounds  the  suggestion  is 
worthy  of  most  carefm  attention  at  the  hands  of  those  responsible  for 
educational  hygiene. 

Q.  H.  E.  (Bolton).— The  question  of  the  advisability  of  removing 
both  Fallopian  tubes  in  a  case  of  ectopic  pregnancy  is  still  debatable. 
On  the  whole,  however,  the  balance  of  opinion  appears  to  be  in  favour 
of  removal  of  both  tubes.  Cases  are  on  record  where  tubal  pregnancy 
has  occurred  in  an  apparently  healthy  Fallopian  tube  after  removal 
of  an  ectopic  gestation  from  tne  other  side. 

▲  Relative.— We  will  make  inquiries,  and  if  the  required  informa- 
tion can  be  obtained,  it  will  be  given  in  our  next  issue. 
SIR    JAME9  PAGET'S  WIT. 

While  the  late  Sir  James  Paget  was  staying  at  the  country  house  of 
a  colleague  of  great  fame,  the  conversation  turned  on  the  number  of 
letters  which  each  received.  When  the  post  arrived  onlv  one  or  two 
letters  came  for  Sir  James  Paget, while  his  friend  received  an  imposing 
bundle.  The  friend  good-naturedly  called  attention  to  his  mall,  but 
Sir  James  Paget,  with  a  twinkle  in  his  eye,  observed,  "  Yes,  but  1  see 
yours  are  all  in  black  envelopes."— Medical  Book  New. 

Resident  Patient  (Bournemouth).— The  advertisement  is  open  to 
grave  suspicion,  and  has,  we  understand,  been  discontinued  by  the 
Journal  in  questiou.  On  ordinary  grounds  of  prudence  it  is  obviously 
unwise  to  lodge  a  "registration  "  fee  of  one  or  two  guineas  without 
having  proof  of  the  absolute  bona- fide*  of  the  advertiser. 
A  LUCRATIVE  APPOINTMENT. 

Tub  post  of  Inspector-General  of  the  Insane  for  Victoria,  Au  straHa, 
is  advertised  in  our  columns,  and  carries  with  it  a  salary  of  £1,600 
per  annum,  with  the  advantages  of  an  official  position.  We  are  glad 
to  call  the  attention  of  such  of  our  readers  as  may  think  it  desirable 
to  apply  for  an  appointment  of  this  nature.  The  Agent-Genera  for 
Victoria,  142  Queen  victoria  Street,  London,  E.G..  is  prepared  to  receive 
applications  from  legally  qualified  medical  practitioners,  accompanied 
by  say,  Ave  recent  testimonials.  He  will  also  be  glad  to  furnish 
particulars. 

cgfcetings  of  the  £ooetiee,  lectures,  &c. 

Wednesday,  April  20th. 

Royal  Microscopical  Society  (80  Hanover  8quare,  W.).— 8  p.m. 
Exhibition  of  Pond  Life. 

Medical  Graduates'  College  and  Polyclinic  (22  Chenies  Street, 
W.C.).-  4  p.ni.  Mr.  H.  L.  Barnard :  Clinique.  (^urRical.)  6.15  p  m. 
Dr.  D.  Grant :  Some  Common  Errors  in  the  Diagnosis  and  Treatment 
of  Diseases  of  the  Nose. 

North-East  London  Post-graduate   College  (Tottenham  Hos- 

fital,  X.).— 4.30p.m.  Mr.  B.  P.  Brooks:  External   Diseases  of  the 
lye. 

Thursday,  April  21st. 
Medical  Graduates'  College  and  Polyclinic  (22  Chenies  6treet, 
W.C).— 4  p  m.     Mr.  Hutchinson  :  Clinique.    (Surgical.)    5.15  p.m. 
Mr.  J.  Clarke  :  Circumcision. 

Friday,  April  22nd. 
Clinical  Society  op  London  (20  Hanover  Square,  W.). — 8  p.m. 
Exhibition  of  Clinical  Cases  followed  by  Discussion.    Patients  will  be 
in  attendance  from  8  p.m.  to  9  p  m. 

Medical  Graduate'  College  and  Polyclinic  (22  Chenies  Street, 
W.C.).— 4  p.m.    Mr.  X.  MacLehose  :  Clinique.     (Eye.) 


Cannes. 


Bradford  Royal   I nfir man.— Dispensary  Surgeon.    Salary  £100  per 

annum,  with  board  and  residence.    Applications  to  William  Maw, 

Secretary. 
Bridgnorth     and    South    Shropshire     Infirmary —House    Surgeon. 

Salary  £100  per  annum,  with  board  and  lodgings  iu  the  Infirmary. 

Applications  to  the  Hon.  Secretary,  Infirmary,  Bridgnorth. 
County  Borough  of  St.  Helens.— Medical  Officer  of  Health.    Salary 


£460  per  annum.  Applications  to  the  Chairman  of  the  Official 
Staff  Committee,  Town  Hall,  St.  Helens. 

Inspector-General  of  the  Insane  for  Victoria,  Austraiia.— Inspector- 
General  of  the  Insane.  Salary  not  to  exceed  41,500  per  annum. 
Applications  to  the  Agent-General  for  Victoria,  142  Queen 
Victoria  Street  E.C. 

Leeds  Hospital  for  Women  and  Children.— Resident  House  8urgeon. 
Salary  £80  per  annum,  with  board.  Applications  to  the 
Secretary  of  the  Faculty. 

Nottingham  General  Hospital.— Assistant  House  Sraveon.— Salary 
£100  per  annum,  with  board,  lodgimr,  and  washing  in  the 
Hospital.  Applications  to  the  Secretary. 

Robbeo  island  Lunatic  snd  Leper  Asylum.— Senior  Medical  Officer. 
8alary  £600  per  annum.  Free  quarters  and  four  ration*. 
Applications  to  the  Agent  General  for  the  Cape  of  Good  Hope, 
100  Victoria  Street,  London,  8.W. 

Robben  Island  Lunatic  and  Leper  Asylum.— 8econd  Assistant 
Medical  Officer.  Salary  £260  per  annum.  Free  quarters  and  two 
rations.- Applications  to  the  Agent-General  for  the  Cape  of  Good 
Hope,  100  Victoria  Street,  London,  S.W. 

Royal  Alexandra  Hospital  for  Sick  Children,  Dyke  Road,  Brighton. 
—House  8urgeon.  8alary  £80  per  annum,  with  board,  lodging, 
and  washing.     Applications  to  A.  F.  Graves,  Secretary. 

Royal  Halifax  Infirmary.— Third  House  Surgeon.  Salary  £80  per 
annum,  with  residence,  board  and  washing.  Applications  to 
Oates  Webster,  Secretary. 

Royal  «e*-Bathing  Hospital,  Margate.— Resident  Surgeon.  Salary 
£80  per  annum,  with  board  and  reside oce.  Applications  to  the 
Secietary,  R.S.B.H.  Offices,  IS  Charing  Cross,  London,  8.W. 

Seamen's  Hospital  Society  ("Dreadnought1'),  Greenwich,  «.B.— House 
Physician.  Salary  £05  per  annum,  with  board,  residence,  and 
washing.  Applications  to  P.  Michelli,    ecretary. 

Seamen's  Hospital  Society  ('*  Dreadnought "),  Greenwich,  RE.— Junior 
Resident  Medical  Officer.  Salary  £40  per  annum,  with  board, 
residence,  and  washing.    Applications  to  P.  Michelli.  Secretary. 

Sussex  County  Hospital,  Brighton.  Stephen  Ralli  Memorial- 
Pathologist.  Salary  £300  a  year.  Applications  to  the  Secretary 
of  the  Hospital. 

The  Middlesex  Hospital.  W  -  First,  Second,  and  Third  Assistant*  to 
the  Director  of  the  Cancer  Research  Laboratories  at  the  Middle- 
sex Hospital.  Salary  of  the  First  Assistant  £200  a  year.  Second 
£150,  Third  £100.  Applications  to  F.  Clare  Melhado,  Secretary- 
Superintendent 

Tiverton,  Devonshire,  Infirmary  and  Dispensary. — House  8urgeon 
and  Dispe  ser.  Salary  £80  per  annum  and  all  found.  Application* 
to  Arthur  Fisher,  Hon.  Secretary 

Westminster  General  Dispensary.— Resident  Medical  Officer.  Salary 
£120  per  annum,  with  rooms,  gas,  coal,  and  attendance.  Appli- 
cations to  the  Secretary,  9  Getrard  Street,  bono,  W. 


JlppointnuniB. 


Carsbero,  A.  E-,  M.B.,  B.C.Cantab.,  Certifying  Surgeon  under  the 
Factory  Act  for  the  Burton  District  of  the  county  of  Somerset. 

Fruman.  W.T.,  M.D.Durh.,  F.R  CB  ,  L.B.C.P.Lond.,  Senior  Physician 
to  the  Royal  Berkshire  Hospital. 

Hiohet,  John,  M.D  ,C.M  Glas.,  D.P  H.,  Medical  Officer  to  the  Pott- 
offices  of  Troon,  Dundonald,  and  8ymington, 

Hill,  P.  E ,  M  R.C.8.,  L.8.A.,  Medical  Officer  of  Health  for  the 
Crickhowell  Combined  Districts 

Michbll,  John  Charles,  M.R.CS  Eng.,  L.S.A.Lond.,  Medical  Officer 
of  Health  to  the  Lynton  (Devon)  Uiban  District  t  ouncil. 

Oliver,  F.  Hewitt,  L.BC.P.Lond.,  L.S.A.,  Suigeon- Accoucheur  to 
the  City  of  London  Lying-in  Hospital. 

PRITCHARD,  W.  L..  M.B.,  C.H.Edin„  Certifying  Surgeon  under  the 
Factory  Act  for  the  Brynmawr  District  of  the  county  of  Biecon. 


#irth0. 


Pace.— On  April  16th,  at  Tavistock,  Lea  Bridge  Road,  Leyton,  the 
wife  of  Harold  Everitt  Pace,  M.RLond.,  of  a  son. 


Axoe— Lbacroft.— On  April  12th,  at  St.  James's  Church,  Derby, 
Archibald  Drakeford  Cradock  Amos,  M. A.,  youngest  son  of  the 
late  Rev.  James  Amos,  of  St.  Ibbs,  Hitchin,  and  Paston  Home, 
Cambridge,  to  Florence  Ada  (Lily),  daughter  of  Dr.  and  Mn 
Leacroft,  o*  Hartington  8treet,  Derby. 

ANDEStsoN— Brown.- On  April  14th.  at  All  Saint's  Boyn  Hill,  Maiden- 
head, Kenneth  Anderson,  M.B.Lond ,  of  Banwell,  Somerset, 
youngest  son  of  the  late  ir  William  Anderson,  K.C.B.,  F.R.S.,  t*> 
Dorothy  Mary  Sneade,  eldest  daughter  of  the  late  Rev.  J.  H. 
Brown,  Rector  of  Bedstone.  Shropshire,  and  Mrs.  J.  H.  Brown, 
Heartsease.  Boyn  Bill,  Maidenhead. 

Andrews-  Matthews.-  On  April  16th  at  8t.  Paul's  Church,  Hamp- 
stead,  Major  Louis  James  Andrews,  Indian  Army  second  son  of 
the  late  Su  geon  Major  Charles  Gould  Andrews,  Bei  gal  Arniy, 
to  E.  Margaret  eldest  daughter  of  John  B.  Matthews,  ol  the 
Limes,  New  Southgate. 


Bcaths. 


Donnelly— On  April    12th,  at  his  residence,  90  Stephen's  Green. 

Dublin,  Michael  A.  Donnelly,  F.R.C.8.I.  R  I  P. 
Fa-jlkner.— On  April  12th,  at  Wcstcliffeon-Sea,  Herbert  Faulkner, 

M.R.CS. Eng.,  L.R.C. P.,  late  of  Clifton,  aged  47  years. 
Hioiimore.— On    Thursday,   April   14th,   at  Hardibrow.  Alumburrt 

Road.  Bournemouth,  Nathaniel  Jarvis  Highraore,  M.D.,  late  or 

Bradford-on-Avon,  aged  62. 
Thomson.— On  April  2nd,  at  Oxford,  Frances  M.  B.  Thomson,  oi 

Richmond,  youngest  daughter  of  the  late  Anthony  Todd  Thomson, 

M,D.,  F.R.C.P.,  F  L.S.,  of  London. 


%U  $Ucdirat  ^xm   m&   (Tirrular. 


M  8 ALUS  POPULI  SUPBEMA  LEX-1 


Vol.  CXXVIIL 


WEDNESDAY,    APRIL  27,    1904. 


No.   17. 


(Prtfltnal  Communications* 

ON    THE 

APPLICATION  OF  PESSARIES 
AND  THEIR  DANGERS    (a) 

By  H.  MACNAUGHTON-JONES,   M.D., 
F.R.C.S.I.&E. 

It  might  appear  that  nothing  further  remains  to  be 
said  on  the  subject  of  pessaries.  Their  use  and  abuse 
have  been  so  frequently  discussed,  and  so  much  has 
been  written  with  regard  to  them,  that  it  might  be 
concluded  that  the  question  had  been  exhausted.  I 
hope  to-night  to  prove  that  this  is  not  so,  and  that  the 
time  has  arrived  when  more  definite  ideas  should 
prevail  as  to  the  objects  to  be  attained  by,  and  the 
dangers  which  may  follow,  this  method  of  treatment. 
Such  accuracy  of  idea  comes  to  be  more  necessary, 
when  we  reflect  on  the  fact  that  in  general  practice 


"  that  in  all  forms  of  displacement,  where  its  employ- 
ment is  dearly  indicated,  a  pessary  generally  gives 
material  relief.  I  know  few  steps  in  gynaecological 
therapeutics  attended  with  such  obvious  and  imme- 
diate benefit  and  comfort  to  a  patient  as  the  restora- 
tion of  a  retroverted  uterus  to  its  normal  position,  and 
its  support  and  retention  by  a  well-fitting  pessary." 
Or,  again,  "  that  by  replacement  of  the  uterus,  the 
use  of  a  pessary,  and  the  adoption  of  the  postural  plan 
and  periodical  reposition  in  the  knee-elbow  position, 
in  cases  of  retroversion,  the  uterus  and  its  supports 
can  be  restored  to  a  healthy  state,  so  that  in  time  the 
necessity  is  obviated  for  any  mechanical  appliance." 

Again,  "  Let  me,  then,  again  express  my  opinion 
that  a  very  large  proportion  of  cases  of  retroversion 
can  be  treated  and  cured  by  the  aid  of  a  pessary,  that 
a  smaller  number,  assuming  that  the  patient  may  have 
time  and  opportunity  to  avail  of  the  treatment,  can  be 


Such  accuracy  of 'idea  comes  to  be  more  necessary,  """J. not  ?nly  °  the  ^placement,  but  of  its  com- 
when  we  reflect  on  the  fact  that  in  general  practi^ P^'10?8'  '"  h*.^me  ^  .  .  ...  ,„. 
treatment  by  pessary  is  probably  more  resorted  to  |  KAs,.al?°  hat:J1  ?vet^  ™obtlle  *nd  reducil>le  nte™s 
than  is  any  oth«  therapeutical  step  in  the  conduct  of  sh°.u'd  *•  ^^  m  )he  first  ™«mm*  **  a  8"PP°rt; 
a  gyruecological  case.    %  is  true  that  the  more  bar-  T^t^t^^J^  ^^  ±^1  ^^°Tt 


barons  contrivances  of  the  past  have  disappeared 
though,  indeed,  some  still  figure  in  the  catalogues  of 
instrument-makers.  Also,  with  the  advance  of  sur- 
gical measures  for  the  relief  of  uterine  displacements, 
and  the  better  understanding  of  their  causation,  as 
well  as  the  various  anatomical  points  of  departure 


to  the  tendency  there  is  on  the  part  of  the  uterus  to 
revert  to  the  backward  position.  Associated  adnexal 
conditions  are  frequently  amenable  to  treatment  in 
such  cases,  and  it  should  follow  the  reposition  of  the 
uterus." 

To    prove    that   some   of    the   most   distinguished 


from  the  normal  relations  of  the  pelvic  viscera  in-  P10"eers  ,n SY^^ogy  recognised  not  only  the  futility, 
volved  in  their  stages,  pessaries  are  not  now  so  indis- !  bu*  als°  ***  dan8f.r'  o£  *he  nnsuse  °*  P*******  * 
criminately  used,  Sor  does  every  other  woman  who  5J®fifnt  l°  menUon  *he  *amej  2*  ^anon  Sims, 
happens  to  have  a  backache  move  about  with  an  in- '  Matthews  Duncan,  and  Gaillard  Thomas.  Marion 
ternS  prop.  Time  was,  and  not  so  long  since,  when !  Sims  recognised  in  their  use  a  necessary  evil.  -We 
for  eveVy  pain  in  the  back,  every  sense  of  weight  or !  f  h°uld'  ^e  says,  always  do  without  them  if  possible, 
bearing  down,  every  vesical  trouble  attributable  to  I  but »{  l\**  ^possible,  then  it  is  the  part  of  wisdom  to 
the  uterus,  any  descent  of  the  latter,  a  commencing  re^r\.to  such  apphances  as  will  best  answer  the 
rectocele  or  vesicocele,  a  pessary  was  at  once  adjusted  !  in<*ications  of  the  mdividual  case.  The  man  who 

as  at  least  affording  a  teniporary  means  of  relief.  It ' ,s  not  a  mechanic  should  not  trust  himself  to  use  a 
was  not  considered  how  far  such  a  temporising  with   P6??!1?*  ,     .    .     „  w  . ..  _  „ ,    t 

the  commencement  of  affections  which,  should  they  u  Think  twice  says  Matthews  Duncan,  -before 
increase  in  magnitude  or  extent,  must  entail  in  their  I  beg^ning  the  often  baneful  practice  of  using  any 
ulterior  consequences  far  greater  suffering  on  the  ^strument  teachmg  a  woman  to  depnd  on  what,  if 
woman,  and  involve  her  in  operative  procedures  of  not  positively  useful,  is  positively  injurious,  though 
much  greater  severity  than  those  which  might  have  P<*haPs  n°*  much.  Many  a  woman  has  suffered  from 
rectified  her  trouble  had  they  been  adopted  in  its  early  and  manv  a  woman  has  died  of,  a  pessary  ;  but  most 
stages,  would  go.  Prolapseof  the vaginl before involv-  P**?™*'  ** }  fin<*  tnen\aIf  nearly  ^nocuous  for  evil 
ing  either  rectSm,  bladder,  or  uterus?  relaxation  of  the  or  *or  &°?d'  '  /-  :  ,When  ev.ery<*ay  experience 
vaginal  outlet  or  defect  in  the  perineum,  before  they  ■  ******  tnat  «very  kmd  of  P^/Y, «  cases  of  antever- 
bring  about  descent  and  retn£iisplacement  of  the ,  Sl°n  or  retroflexion frequently  fails ?  to  give  relief,  and 
uterus;  hyperplasia  and  subinvolutio i  of  the  uterus,  •  °{ten  only  creates  distress  we  shall  hesitate  before  we 
before  procidentia  and  ultimate  retroversion  and  pro-  P^**  m  ,the  va8ma  f°r  this  variety  of  utenne  dis- 
lapse ;  interstitial  myomata  leading  to  displacement  i  P*cement  a  Pf88*^  of  any  kind, 
and  hemorrhage,  are  some  examples  of  the  effects  of  I  Writing  as  far  back  as  1876,  Gaillard  Thomas,  re 
such  procrastination  and  expectant  treatment.  ler1n^  *°  Ahe  gcncnil  USC  °f  Pessanes'  ****  j.  **  ^eAf  ] 

To  clear  the  ground  of  misapprehension,  let  me  dis-  ****  at  the  ?*****  moment  whether  I  believed  that 
tinctly  say  that  no  one  appreciates  the  utility  and  ,  ln  ^e  »Wf «*te  they  accomplished  more  good  or  evil. 
■'       J  '      •         *       »anes  more  than  I  do,  and   l  should  ^  ^J0^   *>  ?Ye  a  d°nbtful  reply."     He 


therapeutical  value  of  pessaries 

if  I  do  not  adhere  to  everything  I  have  elsewhere  said 

and  written  with  regard   to   their  use,  I  still  believe 


(a)  Read  at   a  meeting  of   the  British   Gynecological   Society, 
April  I4tb,  1904. 


goes  on  to  attribute  the  injurious  consequences  not  so 
much  to  the  instruments  themselves  as  to  their  mode 
of  application. 

"  I  myself  believe,"  says'Schultze,  "  that  anyone  who 
is  able  to  replace  a  retroflected  uterus  in  itsjnormal 


44°    The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


April  27,  1904. 


position  by  the  bimanual  method  can  manage  to  make  |  "  As  its  name  indicates,  this  pessary  acts  on  theprin- 
out  of  a  rubber-covered  xing  of  wire  a  figure-of-eight  or  ciple  of  a  lever  ;  but  the  mechanism  of  its  action  is 
sledge-shaped   pessary  of    a  suitable  shape,   and   can  |  twofold.     By  stretching  the  vagina  upward  and  back- 


1.  2. 

1.  Schullze's   figure-of-eight  pessary   in   position. 

2.  Schultze's  sledge-shaped  pessary  in  position. 


!  3.  4. 

]  3.  Position  of   curved  celluloid  cushion  (Smith-Hodge), 
keeping  uterus  in  fairly  normal  position.     (Author.) 


afterwards    introduce    it    properly.     Anyone    who    is   *  Ulerui Restored  to  the  normal  position-the  S  pessary 
unable  to  replace  the  uterus  in  its  normal  position       °'  author  «PP1"*- 
wants  no  pessary  to  retain  it  there,  but  may  go  on 


sticking  some  indiarubber  ring,  or  one  of  Hodge's 
pessaries,  under  the  somewhat  elevated  but  still  retro- 
ftected  uterus. 

A 


ward,  it  draws  the  cervix  in  the  same  direction.  The 
womb  then  turns  on  its  central  point  of  ligamentous 
attachment  as  on  a  fixed  pivot,  and  the  fundus  is  con- 
sequently tilted  forwards.  The  womb  itself  thus 
becomes  a  lever,  of  which  its  point  of  attachment  to 
I  the  bladder  is  the  fulcrum.  The  power  is  applied  to 
I  the  cervix,  and  the  fundus  becomes  the  weight  or 
resistance.  This  action  remedies  retroversions,  but 
J  not  retroflexions,  unless  complicated  with  retroversion,  as 
'  they  usually  are.  The  anterior  vaginal  wall,  with  the 
!  visceral  pressure  above  it,  now  becomes  the  power 
applied  to  the  lower  limb,  or  '  long  arm,'  of  the  fever  ; 
the  posterior  vaginal  wall  is  the  fulcrum,  or  support ; 
and  the  upper  limb,  or  short  arm,  lying  behind  the 
I  cervix,  directly  pushes  the  weight  or  fundus  uteri. 
This  action  tends  to  remedy  both  retroflexion  and 
retroversion.  For  instance,  during  the  act  of  inspira- 
tion the  descending  diaphragm  crowds  down  the 
abdominal  viscera  upon  the  bladder,  to  which  are 
attached  the  cervix  uteri  and  the  anterior  wall  of  the 
vagina.  These  organs,  therefore,  descend.  As  a 
result,  the  lower  or  fore  end  of  the  lever  is  necessarily 
pushed  down  by  the  descending  anterior  wall  of  the 
vagina,  on  which  it  rests,  while  its  upper  or  hind  end 
proportionately  rises  up  and  tilts  forward  the  retro- 
verted  or  the  retroflexed  fundus.  In  expiration,  the 
reverse  takes  place.  The  pressure  is,  therefore,  not  a 
steady,  but  a  gentle  rocking  one,  which  is  the  most 
"  There  is  still  a  very  widespread  misconception  that  efficient  of  all.  This,  also,  is  one  least  liable  to  inflict 
a  uterus  can  be  brought  out  of  an  anomalous  position  |  injury  on  the  soft  parts,  because  the  points  of  pressure 
into  the  normal  one  by  the  pessary.  No  pessary  in  are  varying  ones.  But  to  attain  these  ends  the  pessary 
existence  can  do  this.  The  normal  position  must  first  must  be  mobile,  and  never  so  long  as  to  put  the  vagina  on 
be  Trestored  bimanually  ;  a  pessary  may  afterwards  the  stretch  ;  otherwise  it  loses  its  distinctive  character  of 
maintain  it."  Referring  to  the  introduction  ot  a  a  lever,  and  degenerates  into  an  ordinary  ring  pessary. 
Hodge  or  ring,  he  says  that  for  those  who  can  content  it  should  further  impinge  on  the  soft  parts  only,  and  take 
themselves  with  giving  a  little  relief,  these  will  always  no  bearings  on  the  solid  structure  of  the  pelvis.  .  .  ." 
remain  in  use,  though  all  they  can  possibly  do  is  to  |  a  certain  degree  of  stretching  is,  however,  inevitable 
diminish  the  painful  mobility  of  the  uterus.     •"  The   in  the  drawing  back  of  the  vaginal  portion. 


B  C 

Two  of  Schultze's  sledge  shapes.   A  and  ,8.  Moulded  from 
rim;.     C.  Side  view. 


troubles  and  inflammatory  complications  arising  from 
an  unreposed  retroflected  uterus  are,   however,  very 


Schultze  is  naturally  somewhat  prejudiced  in  favour 
of  his  figure-of-eight  and  his  sledge-shaped  pessaries. 


often  made  decidedly  worse  by  the  introduction  ot  a   We  may,   therefore,  in  some  degree  qualify  what 
pessary  underneath  it."  ——    u~*  :*  ;-  *M  **"■'  —.«;-  *«•— 

The  questions  I  should  like  discussed  are  these  : — 


he 


says,  but  it  is  in  the  main  true. 

"  Both  by  Hodge  himself."  he  remarks, 


' and  bv 


(1)  What  is  the  action,  and  what  the  purpose,  of  a    Braun,  who  first  introduced  it  to  us,  the  instrument 

was  extolled  distinctly  upon  the  ground  that  it  ren- 
dered reposition  by  the  sound,  the  method  at  the  time 
practised,  unnecessary.  .  .  .  The  question  remains 
whether,  after  reposition,  this  pessary  can  keep  the 
uterus  in  its  normal  position,  an  effect  attributed  to  it 


properly  designed  and  adjusted  pessary  ?  (2)  What 
are  the  pathological  conditions  which  make  the  use  of 
a  pessary  dangerous?  (3)  What  are  the  best  forms  ot 
pessary  for  use  under  the  different  circumstances  in 
which  their  application  is  indicated  ? 

I  cannot  improve  on  the  description  given  by  Goodell  J  by  many  gynaecologists, 
oi  the  principle  of  the  ordinary  Smith-Hodge  or  lever  *•  As  a  matter  of  fact,  if  the  uterus  has  been  pre- 
pessary,  whatever  the  material  be  of  which  it  is  made,  viously  replaced,  Hodge's  pessary  does  in  some  cases 
And  this  description  refers,  of  course,  also  to  the  same  \  keep  it  in  its  normal  position,  and  does  so  because,  by 
class  of  pessary  which  has  a  cushion  posteriorly.  To  a  ,  extending  the  posterior  vaginal  vault  backwards  and 
certain  extent  it  also  applies  to  Fowler's  cradle  pessary, '  upwards,  it  compels  the  vaginal  portion  to  keep  in  its 
and  to  Schultze's  figure-of-eight  support.  '  proper  position,  well  at  the  back  of  the  pelvis. 


AFRTL   27.    IQO*. 


ORIGINAL  COMMUNICATIONS.         The  Medical  Press.    44* 


"  But  the  posterior  vaginal  vault,  if  tender ,'as'it  very 
often  is  directly  after  the  elevation  of  a  retroflexion, 
cannot  be  put  sufficiently  upon  the  stretch  to  fix  back 


5. 


ing,  walking,  and  sitting  in  different  pdsitions,  and  the 
absence  of  any  sense  of  distension  or  pressure.  In 
order  to  fulfil  its  action  in  retro-displacement  and 
support  the  uterine  fundus,  while  it  retains  it  in 
position,  its  posterior  curve  should  be  such  as  to 
occupy  the  posterior  fornix  so  as  to  prevent  a 
doubling  over  of  the  uterus  on  the  pessary  during 
such  acts  as  those  of  defalcation,  any  strain  of  the 
abdominal  muscles  in  lifting  weights  or  during  fits  of 
coughing  and  the  unavoidable  pressure  resulting  from 
over-distension  of  the  bladder.  A  pessary  also  should 
be  as  light  as  possible  consistent  with  its  strength  and 
hardness.  The  material  should  resist  the  corroding 
or  solvent  action  of  the  vaginal  secretions,  and  one 
which  can  be  easily  kept  clean.  T  e  rings  I  show 
are  of  two  kinds:  the  first  are  my  own  celluloid 
and  wire  rings,  made  for  me  many  years  since  by 
Arnold.  They  can  be  moulded  into,  any  form  desir- 
able. The  others  are  Schultze's  celluloid  rings. 
These  are  tue  most  perfect  that  can  be  con- 
ceived. They  are  so  light  tnat  the  weight  of  the  ring 
j  is  hardly  felt.  On  the  other  hand/when  mou'ded  by 
means  of  boiling  water  they  become  very  hard,  and 
though  elastic  never  alter  tneir  shape. 

When  the  position  of  the  uterus  is  such  that  a  pessary 
can  be  taken  out  and  replaced  by  the  woman  herself  it 
is  well  that  it  should  then  be  of  such  a  kind  as  will  enable 


5.  (A)  Complete  retroversion.     Pouch  of  Douglas  occupied 

by  fundus,  with  pediculated  polypus   in  the  cavity. 

Rectum    encroached    on    and    the    bladder    drawn 

upwards  and  backwards. 

(B)  Same  uterus  with  fungoid  or  carcinomatous  mass  in 

fundus.  '  her  to  do  this  easily.     Such  conditions  involving   the 

the  portio  vaginalis.  If  the  upper  and  back  part  of  i  application  of  an  ordinary  lever  pessary  cannot  be 
the  vagina  be  roomy  and  relaxed,  a  condition  in  which  fulfilled  unless  it  be  moulded  at  the  time  according  to 
it  very  commonly  is  in  retroflexion,  we  may  stretch  the  '  the  anatomical  peculiarities  of  the  vagina  and  uterus, 
vaginal  vault  as  far  backwards  as  ever  we  like  without  Nor  can  this  frequently  be  decided  on  its  first  adap- 
thereby  compelling  the  vaginal  portion  to  remain  in  ,  tation.  It  has  to  be  worn  for  a  certain  time  before  its 
the  back  of  the  pelvis  ;  it  slips  forward  in  the  loop  of  j  efficacy  and  comfort  can  be  finally  determined.  The 
pessary,  and  though  the  latter  is  in  a  proper  position,  application  of  a  pessary  without  such  determination  as 
the  uterus  falls  back  over  it  into  retroversion,  just  as  if  I  to  its  suitability  from  these  points  of  view  is  obviously 
it  were  not  there  at  all.  wrong.     What  we  want  specially  to  avoid  is  that  over- 

.  "  It  is  only  when  the  vagina  is  fairly  rigid  as  well  as  *  distension  of  the  vaginal  walls  which  leads  to  an  atonic 
long,  and  where  there  is  no  tenderness  in  the  posterior  i  condition  of  the  muscular  structure    and  subsequent 

relaxation  of  the  vesical  and  utero-rectal  supports. 
Even  supposing  that  a  uterus  be  kept  in  position  tem- 
porarily by  such  over-stretching,  when  the  pessary  is 
removed  the  tendency  is  to  recurrence  of  the  deviation, 
and  the  last  state  of  the  woman  is  often  worse  than  the 
first,  relaxation  of  the  vagina  assisting  in  the  down- 
ward and  backward  movement  of  the  uterus. 

If  we  look  at  a  Fowler's  pessary,  we  see  that  its 
posterior  projection  rests  against  the  junction  of  the 
infra-vaginal  with  the  supra-vaginal  cervix,  tilting  the 


6.  Large  retro  flexed  uterus,  obliterating  the  pouch  of  Douglas 
and  pressing  on  the  rectum,  drawing  the  fundus  of 
the  bladder  backwards. 
vaginal  vault — a  combination  of  circumstances  not 
often  found  with  retroversion — that  Hodge's  pessary 
actually  replaces  the  uterus,  forces  the  vaginal  portion 
'Qto  a  posterior  position,  and  thereby  transfers  the 
intra-abdominal  pressure  on  to  the  posterior  surface 
of  the  uterus." 

There  are  certain  points  which  must  be  remembered 
in  regard  to  all  pessaries :  First,  the  consequent 
stretching  of  the  vaginal  walls  and  the  distension  of 
the  canal,  especially  at  its  uterine  end.  Secondly,  the 
necessity  for  perfect  mobility  of  the  pessary.  Thirdly, 
the  need  for  adaptation  in  size  and  shape  of  the  pessary 
to  the  dimensions  of  the  canal,  and  to  the  length  of  the 
portio  vaginalis.  The  support  should  not  interfere 
with  the  normal  acts  of  defalcation,  nor  impinge  on  the 
neck  of  the  bladder  or  urethra  so  as  to  cause  either 
distress  to  the  bladder  or  impediment  to  micturition. 
The  main  points  to  be  considered  are — the  capacity  of 
the  vaginal  fornix,  the  length  of  the  canal,  and  the  size 
of  the  portio  vaginalis :  after  the  application  of  the 
pessary,  th2  comfort  with  which  it  is  worn  while  stand. 


/• 
7.  Fowler* s  cradle  pessary  in  position. 

latter,  with  the  fundus,  forwards,  while  the  smooth  and 
convex  surface  of  the  bowl  fills  the  posterior  fornix. 
The  narrow  end  of  the  cradle  lies  in  front  ol  the  cervix 
against  the  vaginal  wall,  and  should  not  press  on  the 
urethra.  The  pessary  itself  should  be  made  in  one 
piece,  so  that  there  can  be  no  chance  of  any  want  of 
continuitv  which  would  permit  the  entrance  of  vaginal 
secretions*  into   the  hollow  space  between  its  walls. 

Such  pessaries  as  those  I  have  mentioned,  if  properly 
adjusted  to  the  individual  case  of  retro-deviation, 
assuming  that  any  form  of  pessary  will  maintain  the 
uterus  in  anything  approaching  its  normal  axis,  exert 

D 


442     The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


April  27,  1904. 


their  action  by  tilting  forward  and  at  the  same  time 
supporting  the  fundus,  the"cervix  being  thrown  back- 
wards. No  bad  effects  follow.  A  ring  of  any  kind  is 
quite  different.  It  is  not  a  lever  in  the  sense  of  the 
Smith-Hodge,  and  does  not  support  the  uterus  in  the 
samo  manner.  A  movable  ring  lying  obliquely  in  a 
rigid  unrelaxed  vagina  is  useful,  but  in  the  majority  of 
cases  of  retroflexion  in  a  relaxed  vagina  it  is  absolutely 
useless.  It  plays  as  active  a  part  in  retaining  the 
uterus  in  position  as  the  ring  on  the  woman's  finger. 

With  regard  to  stem  pessaries,  I  can  only  repeat  what 
I  have  several  times  said  and  written.  For  years  I 
have  not  inserted  one  into  the  uterus  save  after  an 


8.  (A)  Glycerine  ring  in  position  in  the  vagina.  Uterus 
has  been  replaced,  but  not  quite  in  the  normal 
position, 

(B)  Effect  on  same  uterus  by  over-distended  bladder. 

operation  for  stenosis  with  anteflexion,  and  then  only 
rarely.  In  few  cases  is  the  use  of  a  stem  required,  and 
the  risks  incurred  during  the  time  it  is  worn,  the  con- 
stant supervision  required  from  the  medical  attendant, 
and  the  onpreventable  carelessness  of  patients  render 
its  employment  particularly  hazardous  in  busy  general 
practice.  I  am  always  uneasy  while  a  stem  is  in  the 
uterus,  and  in  applying  it  give  the  patient  strict  in- 
junctions regarding  rest  and  medical  supervision. 
(1)  I  nevex  place  one  in  the  uterus  immediately 
before  a  menstrual  period,  and,  when  one  is  worn, 
I  remove  it  on  the  approach  of  a  period.  (2)  I 
always  teach  the  patient  how  to  remove  the  instru- 
ment by  means  of  a  string  attached  to  its  lower  end, 
and  direct  her  to  do  so  on  the  least  indication  of  un- 
easiness, pain,  chill,  or  a  feeling  of  general  malaise. 
No  stem  should  be  placed  in  the  uterus  if  there  be 
signs  of  recent  perimetritis,  or  during  an  inflammatory 
state  of  the  endometrium.     I  use  a  smooth,  straight, 


9.  Celluloid  stem  of  10,  Method  of  moulding  the 

author.  •  *?■     ,  figure-of-eight  ring. 

or  slightly  curved  stem,  such  as  my  celluloid  bulbous 
one.  The  stem  should  not  reach  the  fundus  of  the 
uterus. 

1  have  removed  stems  which  had  been  worn  in  the 


uterus  for  months,  and,  apart  from  my  pity  for  the 
patient,  my  regret  was  that  the  person  who  had  placed 
the  stem  in  position  was  not  present  to  learn  a  lesson 
from  the  effects  of  its  sojourn  there. 

Schultze,  speaking  of  intra-uterine  stems,  in  con- 
nection with  flexions,  regards  one  as  a  suitable  addition 
provided  there  be  no  active  inflammation  present, 
preferring  the  independent  stem  to  the  combination  of 
pessary  and  stem,  and  only  using  it  where  the 
flexions  are  such  that  they  cannot  be  permanently 
adjusted. 

• '  They  are,"  he  says,"  the  only  cases  in  which,  with  our 
present  knowledge  of  the  normal  and  abnormal  posi- 
tions of  the  uterus,  there  can  be  any  indication  for 
their  application. 

"  The  more  cases  of  retroflexion  I  have  to  treat,  the 
fewer  are  those  in  which  I  meet  with  this  exceptional 
indication  for  the  use  of  intra-uterine  pessaries.  Years 
have  repeatedly  passed  without  my  coming  across  it, 
because  in  all  cases  of  the  sort  coming  under  my  obser- 
vation, in  which  the  circumstances  were  not  such  that  I 
had  for  the  time  to  abstain  from  reposition,  either  the 
peritoneal  adhesions  which  caused  the  anomalous 
position  of  the  uterus  were  discovered  and  removed, 
or  the  action  of  the  parametric  cicatrices  could  be 
compensated  with  vaginal  pessaries  of  appropriate 
shape." 

The  views  Professor  Schultze  held  some  years  since 
are  practically  those  he  advocated  in  1898,  which,  he 
says  in  a  letter  to  me,  "hold  as  good  now  as  when 
they  were  written." 

In  regard  to  anteversion  and  anteflexion,  though  we 
still  have  to  include  degrees  of  the  former  condition 
in  our  text-books,  we  all  now  know  that  it  is  not  correct 
to  speak  of  anantevertedwomb  as  a  displacement*  II 
the  womb  leans  forward  at  an  angle  of  forty-five  degrees 
and  upwards,  it  is  then  out  of  the  normal  plane  and  has 
an  abnormal  relation  to  the  pelvic  axis,  and  may  then 
require    support.     Anteflexion    is    a    different    state 


11.  Ante  flexed  uterus  with  elongated  cervix  pressing  on 
bladder,  altering  the  position  of  the  pouch  of  Douglas, 
and  drawing  on  the  rectum.  Ovary  prolapsed 
anteriorly. 

Most  frequently  it  is  not  merely  the  abnormality  we 
have  to.  deal  with,  but  we  have  also  present  stenosis  of 
the  uterine  canal,  possibly  enlargement  from  hyper- 
plasia, or  tumour  in  the  anterior  wall  of  the  fundus. 

"  I  have  learned  to  unlearn,"  says  Goodell,  "  that 
anteflexion  and  anteversion  in  themselves,  that  is  to 
say,  as  displacements  merely,  and  without  narrowing  of 
the  uterine  canal,  are  necessarily  pathological  condi- 
tions of  the  womb  "  ;  and  he  goes  on  to  urge  the  mis- 
take of  attributing  to  this  natural  position  of  the  womb 
such  an  affection  as  irritability  of  the  bladder,  naturally 
dwelling  on  this  frequently  occurring  symptom,  which 
is  often  attributed  to  pressure  of  the  uterus  when  it  is 
in  reality  due  to  an  impaired  nervous  system  with  lack 
of  brain  control.  •"  Upon  making  a  vaginal  examina- 
tion, the  fundus  of  the  womb  is  found  resting  on  ihe 
bladder,  where  it  naturally  should  rest,  and  the  con- 
clusion is  jumped  at  that  the  whole  trouble  is  due  to 
the  existing  natural  anteflexion  or  anteversion  as  the 
case  may  be.     The  surgeon  racks  his  brains  to  adap* 


April  27.   1904. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press.     443 


or  devise  some  pessary  capable  of  overcoming  the 
supposed  difficulty,  heedless  of  the  dilemma  that  the 
upward  or  shoring  pressure  of  the  pessary  on  the 
bladder  must  be  greater  than  the  counter  or  down- 
ward pressure  ot  the  womb  to  which  he  attributes  the 
vesical  irritability." 

For  my  own  part,  I  have  not,  in  anteflexion,  for 
years  used  any  pessary  save  either  one  which  I  have 
moulded  myself  irom  a  ring,  such  as  I  show  here,  or 
a  Galabin,  which  it  practically  resembles. 

Ventro-suspension  of  the  uterus,  or  the  enucleation 
of  a  myoma,  will  rapidly  and  completely  cure  symptoms 
of  bladder  trouble,  even  in  cases  where  a  urinal  has 
to  be  worn. 

I  may  now  briefly  summarise  the'pathological  con- 
ditions which  contra-indicate  the  use  of  any  pessary, 
and  where  its  presence  constitutes_a*distinct  danger. 


12.  Myomatous  uterus — nucleus  in  anterior  wall  pressing 
on  bladder — fediculated  tumour  in  the  pouch  of 
Douglas. 
(1)  Displacements  which  are  associated  with  inflam- 
matory states  of  the  endometrium,  until  such  endo- 
metritis be  cured.  (2)  Those  which  are  complicated 
by  adhesions,  rendering  restoration  of  the  uterus  to 
its  normal  position  impracticable.  (3)  Those  asso- 
ciated with  adnexal  tumours  and  inflammatory  con- 
ditions of  the  ovaries  and  tubes.  (4)  Those  com- 
plicated by  other  than  adnexal  tumours  in  thejpouch 


a  pessary  and  palliative  treatment  of  the  displacement, 
the  prolonged  use  of  a  pessary  is  necessitated,  inasmuch 
as  without  the  latter  the  displacement  recurs,  and  when, 
even  with  the  pessary  in  situ,  the  uterus  cannot  be  kept 


13.  (A)  Pouch  of  Douglas  occupied  by  a  large  pyo-salpinx 
adherent  to  the  uterus  or  incorporated  with  it  and 
altering  its  position — mistaken  for  retroflexion. 
This  may  be  a  myoma,  an  ectopic  sac,  an  ovarian 
cyst,  or  a  tumour  of  the  mesosalpinx  or  Fallopian 
tube. 
(B)  Idea  of  the  nature  of  tumour  conveyed  on  exami- 
nation by  vagina  and  rectum,  confusing  it  with 
myoma. 

of  Douglas,  such  as  an  enlarged,  sensitive,  and  pro- 
lapsed ovary,  cysts  of  the  ovary  or  meso-salpinx,  pus 
cysts  of  tube  or  ovary,  ectopic  sacs,  pediculated 
myomata,  solid  tumours  of  the  ovary  or  Fallopian 
tube.    (5)  All  case3  in  which,  after  reasonable  trial  of 


14.  (A)  Large  uterus  encroaching  on  the  bladder,  which  is 
elongated  as  the  result  of  pressure  and  over-disten- 
sion. Loaded  rectum  pressing  on  adnexa  in±the 
pouch  of  Douglas. 

(B)  Galabin* s  pessary  supporting  the  uterus.        |fl    g 

(C)  Galabin* s  pessary  supporting  uterus  with  myoma  in 

anterior  wall. 

in  the  normal  position.  It  is  altogether  unsurgical  to 
consign  a  woman  to  the  lifelong  burden  of  an  irksome 
appliance  in  tho  vagina.  |pj 

In  my  own  experience  I  have  seen,  not  once  but 
several  times,  pessaries  worn  when  one  or  morejof 
those  pathological  conditions  I  have  enumerated  have 
been  present.  It  is  not  necessary  to  dwell  on  the  risks 
and  dangers  thereby  entailed.  Nor  is  it  any  matter 
for  surprise  that  such  conditions  have  not  been  detected 


15- 
15.  (A)  Myoma  in  posterior    wall  of   retro  flexed  uterus. 

Ovary   and  tube  in  the  pouch  of  Douglas. 
(B)    Myomatous    anieflexed    uterus,    which    has    become 

retroverted.      *;    ,  ,*-i 

when  complicating  a  retroflexion,  for  they  are~out  of 
reach,  and,  save  under  an  anaesthetic  and  by  the  bi- 
manual method,  it  is  impossible  to  detect  their  pre- 
sence. And  even  with  this  advantage  the  most  ex- 
perienced gynaecologists  are  liable  to  err  in  diagnosis. 
It  may  be  thought  more  inexcusable  to  confound  the 
occurrence  of  any  of  these  with  a  retroflexion,  but  here, 
again,  so  intimately  associated  are  certain  growths — 
cystic  tumours,  pus  sacs,  and  solid  tumours — with  the 
uterus,  so  hard  and  resistcnt  do  they  become,  and  so 
difficult  is  it  to  dissociate  and  define  what  is  uterine 
from  that  which  is  extra-uterine,  that  it  is  a  matter  of 
common  knowledge  that  operators  of  the  highest  skill 
and  the  widest  experience  have  not  detected  the  error 
of  diagnosis  until  the  abdomen  has  been  opened. 
How  much  less,  then,  is  the  surgeon  in  general  practice 
to  be  blamed  if  he  fail  occasionally  to  differentiate  a 
mass  in  the  pouch  of  Douglas!  I  have  elsewhere  re- 
corded some  such  "  pitfalls  "  in  my  own  practice,  and 


444    The  Medical  Press.  ORIGINAL  COMMUNICATIONS. 


April  27,  1904. 


have  been  present  when  even  the  most  wary  have 
slipped.  Accidents,  we  know,  happen  to  the  most 
cautious  and  knowing  of  rodents.  Only  lately  I  saw 
a  case  in  which  a  pessary  had  been  worn  lor  some  time, 
an  opinion  afterwards  being  given  that  there  was 
nothing  seriously  wrong.  Finally,  a  distinguished  sur- 
geon pronounced  the  case  to  be  one  of  myoma,  another 
experienced  gynaecologist  viewed  it  as  a  case  of  in- 
operable carcinoma.  I  came  on  the  scene,  and  con- 
curred in  the  view  of  myoma.  It  turned  out  to  be  one 
of  old  pyo-salpinx. 

Quite  recently  I  operated  upon  a  case  the  full  par- 
ticulars of  which  I  intend  soon  to  report,  with  a  peculiar 
history.  The  facts  would  fit  in  with  the  presence  of 
an  ectopic  gestation  sac,  a  molar  pregnancy,  or  a  long- 
standing pyo-salpinx,  forming  a  hard  adnexal  tumour 
in  Douglas'  poucn.  The  latter  was  the  view  I  took  in 
the  first  instance.  Under  anaesthesia,  before  operation, 
by  bimanual  examination,  different  views  were  ex- 
pressed as  to  the  nature  of  the  tumour.  Before  pro- 
ceeding to  open  the  abdomen,  I  proved  with  the  sound 
that  the  uterus  was  in  its  proper  position,  and  that  the 
mass  was  not  part  of  the  uterus,  though  closely 
incorporated  with  it. 

On  exposure  of  the  pelvis,  an  old  infiltration  was 
found  extending  from  side  to  side,  raising  the  broad 
ligaments  and  extending  as  far  as  the  second  lumbar 
vertebra  ;  the  mass  behind  the  uterus,  which  was 
firmly  incorporated  with  it,  proved  to  be  a  large  in- 
filtration, communicating  with  a  pyo-salpinx,  and 
tunnelled  through  by  a  portion  of  the  bowel. 

VVhen  we  ourselves  trip  and  stumble  into  one  of 
these  pitfulls,  we  usually  feel  what  an  American  calls 
**  pretty  bad."  Is  it  a  brotherly  feeling  that  makes  us 
so  sympathetic  to  a  fellow-traveller  on  the  same  road 
that  we  cannot  restrain  the  desire  to  talk  of  his  mis- 
fortune ?  Or,  is  it  the  philanthropic  motive  to  make 
him  serve  as  an  object-lesson  which  may  prevent  others 
from  following  in  his  rash  footsteps  ? 

An  ovum  of  half  truth,  when  impregnated  by  the 
dual  germs,  insatiable  love  of  gossip  and  cancrous 
jealousy,  develops  not  infrequently  into  a  twin 
monster  of  insinuation  and  falsehood,  which  even  its 
original  generative  force  would  not  "recognise  as  its  own 
conception.  Let,  then,  the  Gods  of  gynaecology  be 
lenient  in  their  judgment  on  the  errors  of  the  less  in- 
fallible mortals  who,  treading  the  rougher  highways 
and  byways  of  general  practice,  occasionally  make 
such  mistakes  as  those  I  have  referred  to — mistakes  to 
which  even  the  immortals  themselves  have  been  proved 
to  be  liable. 

All  I  have  here  said  with  reference  to  my  second 
question  tends  to  show  that  a  pessary  is  not  the  harm- 
less appliance  it  is  generally  thought  to  be,  and  that 
before  it  be  applied  it  is  our  duty,  by  bimanual  exami- 
nation and,  should  doubt  exist,  under  anaesthesia,  to 
exclude  those  often  obscure  pathological  conditions 
which  altogether  contfa-indicate  its  use. 

I  need  not  refer  to  the  dangers  of  allowing  a  pessary 
to  remain  too  long  in  the  vagina  without  being  cleansed 
or  changed.  I  once  showed  at  this  Society  a  ring 
pessary  which  had  been  worn  for  nine  years ;  it  was 
covered  with  a  calcareous  coating,  and  had  worn  a  deep 
groove  in  the  walls  of  the  canal;  It  is  not  so  very  long 
since  that  I  removed  a  pessary  which  had  been  worn 
without  change  for  five  years.  Such  occurrences 
should  not  be  possible  were  the  dangers  emphasised 
to  the  patient  when  leaving  the  immediate  care  of  the 
surgeon  who  inserts  the  pessary. 

As  to  the  best  forms  of  pessary  for  application  under 
the  different  circumstances  in  which  they  are  indicated, 
I  believe  that  for  retroversion  or  retroflexion  the  well- 
curved  S  pessary,  which  the  practitioner  himself 
moulds  for  the  vagina  in  which  it  is  to  rest,  and  adapts 
for  the  uterus  that  it  has  to  keep  in  position,  is  tne 
safest  and  best.  After  the  uterus  has  been  first  re- 
placed, and  where  we  suspect  that  the  uterus  will  not 
remain  as  we  have  replaced  it,  a  Fowler's  pessary, 
carefully  selected  as  to  its  size,  is  an  admirable  one. 
So,  also,  are  the  celluloid  cushion  and  Schultze's  figure- 
of-eight. 

Wheu  we  require  a  pessary  tor  anteflexion  or  extreme 


forward  displacement  of  the  uterus  Galabin's  pessary, 
which  can  easily  b«»  kept  clean  and  be  worn  without 
change  for  some  months,  I  consider  the  best.  Here, 
again,  the  most  important  points  are  its  width  and 
length,  as  if  these  be  not  attended  to  the  pessary  is 
certain  to  cause  distress.  Also,  care  must  be  taken  in 
its  removal,  for  if  roughness  be  used  in  abstracting  it, 
considerable  pain  will  be  caused,  and  the  outlet  may 
be  bruised  and  injured.  The  pessary  has  to  be  got  by 
the  finger  with  the  long  axis  of  its  arched  portion 
corresponding  to  the  long  axis  of  the  outlet,  and  the 
perineum  has  to  be  well  drawn  back  so  as  to  permit  of 
the  escape  of  the  broad  portion  of  the  pessary. 

Where  the  uterus  is  anteflexed,  and  there  is  a 
myoma  in  its  anterior  wall,  or  where  there  is  relaxation 
of  the  vagina,  with  tendency  to  cystocele  and  prolapse, 
with  attendant  retroversion,  it  is  as  good  a  support  as 
we  can  use.  It  does  not  prevent  conception.  If  a 
Galabin  be  not  at  hand,  a  pessary  much  on  the  prin- 
ciple of  Schultze's  sledge-shaped  one  can  be  fashioned 
from  a  celluloid  ring  and  adapted  in  size  and  shape  to 
the  anatomical  conditions  of  the  individual  case.  It 
acts  much  in  the  same  way  as  Galabin's,  and  is  useful 
under  similar  conditions. 

With  regard  to  prolapse,  in  its  earlier  stages,  when 
retroflexion  is  the  first  consequence  of  relaxation  of 
the  utero-sacral  folds,  and  where  reposition  of  the 
uterus  is  called  for  as  a  palliative  measure,  a  pessary  is 
of  use,  and  a  celluloid  cushion  support  or  one 
moulded  for  the  case  from  a  ring  is  indicated; 
a  glycerine  ring  of  suitable  size  often  affords 
considerable  relief.  But  when  both  the  uterus  and 
vagina  begin  to  descend,  when  the  uterus  is  retroflected, 
while  the  vaginal  outlet  is  relaxed,  and  there  is  prolapse 
of  some  portion  of  the  vaginal  wail,  operative  measures 
are  called  for  and  a  pessary  ol  any  kind  is  injurious,  and 
becomes  more  so  in  proportion  as  the  vagina  is  stretched 
by  it.  By  early  operative  measures,  those  more  serious 
ones  which  have  to  be  considered  in  the  later  stages  ot 
procidentia  will,  in  all  probability,  never  have  to  be 
undertaken.  Hardly  any  of  those  cases  in  which  opera- 
tions on  the  utero-sacral  ligaments,  extirpation  of  the 
vagina,  in  whole  or  part,  or  removal  of  tne  procident 
mass  are  indicated  would  ever  occur  were  suitable 
operative  steps  taken  instead  of  the  attempt  being 
made  to  palliate  the  woman's  troubles  by  resort  to  an 
appliance  which  is  not  intended  to  cure,  and,  as  a  rule, 
aggravates  the  mischief.  For  those  who  will  not  con- 
sent to  operation,  the  best  support  will  be  that  which 
is  moulded  by  the  surgeon  himself  to  suit  the  degree  of 
the  prolapse,  and  in  some  extreme  cases  under  the 
same  circumstance,  Godson's  wire  modification  of 
Zwancke's  pessary,  if  care  be  taken  witn  regard  to 
cleanliness.  I  have  known  afford  the  greatest  relief. 
I  trust  that  I  have  shown  that  a  pessary,  waether  we 
view  it  from  the  point  of  view  of  the  positive  mischief 
it  may  do  or  the  negative  consequences  tnat  follow  its 
use  by  delaying  suitable  and  efficient  treatment,  is  not 
the  harmless  agent  it  is  often  thought  to  be. 

flotes  on  Hberapeuttcs  ant)  Materia 
flDe&ica. 

By  DAVID  WALSH,  M.D.Edin., 
Senior  Pfy  s.cian,  Wei  tern  Skin  Hospital,  London,  W. 

MULTIPLE     MEDICATION— URANIUM. 

The  obstinacy  of  a  malady  in  resisting  treatment 
may  be  fairly  well  gauged  by  the  number  of  drugs 
recommended  for  use  in  that  particular  condition. 
Take,  for  instance,  rheumatoid  arthritis  as  an 
illustration  of  that  general  statement.  The 
stock  internal  remedies  for  that  complaint  are 
arsenic,  iron,  cod-liver  oil,  guaiacum,  the  iodides 
and  the  salicylates,  and  general  tonics.  In  spite 
of  that  list,  however,  every  practitioner  knows 
that  drugs  are  useless  in  the  cure  of  arthritis 
deformans,  to  use  the  more  scientific  name, 
when   once   established.     The   condition  appears 


April  27,  1904. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press.    445 


to  be,  in  its  chronic  form,  a  slow  progressive  in- 
fection attacking  the  articular  and  peii-articular 
structures.  Rheumatism,  gout,  influenza  and 
gonorrhoea  are  common  preceding  conditions, 
and  there  is  good  reason  for  the  view  that  a  phthisi- 
cal family  history  is  extremely  common  in  patients 
afflicted  with  arthritis  deformans.  It  is  in  this 
complex  etiology  that  we  shall  most  likely  find 
the  key  to  the  remedies  that  have  been  vaunted 
by  various  authorities.  Where  the  brunt  of  the 
mischief  has  fallen  on  the  structures  around  the 
joint  good  results  may  possibly  result  from  iodide 
of  potassium.  The  salicylates,  again,  may  be  of 
use  in  the  acute  febrile  forms  of  rheumatoid 
arthritis,  or  in  those  cases  of  chronic  articular 
rheumatism  which  are  difficult  to  distinguish  from 
arthritis  deformans,  and  which  ultimately  merge 
into  that  condition. 

The  hot  air  treatment  of  arthritis  deformans, 
however,  has  in  many  cases  placed  in  the  hands  of 
medical  men  a  cure  for  the  disease  in  its  earlier 
stages,  and  the  means  either  of  arresting  its  pro- 
gress or  of  lessening  its  bad  effects  in  the  later  stages: 
Massage  and  surgical  measures  may  also  lessen 
the  mischief. 

The  displacement  of  drugs  by  physico- thera- 
peutic measures  is  going  on  apace  in  the  treatment 
of  many  diseases.  As  yet  it  is  impossible  to 
forecast  the  future  therapeutic  applications  of 
radium.  One  point  is,  that  many  of  our  trusted 
remedies  are  more  or  less  radio-active.  Supposing 
the  tissues  of  a  patient  to  be  charged  with  one  or 
other  of  these  particular  drugs,  then  it  would  be 
easy  to  expose  him  to  conditions  in  which  general 
radio-active  saturation  would  be  set  up. 

Recently  Dr.  Morton,  of  New  York,  has  raised 
an  interesting  point  in  an  article  entitled  "  The 
Artificial  Fluorescence  of  Living  Tissue  in  Rela- 
tion to  Disease."  (a)  He  charges  the  body  with  a 
fluorescible  solution  such  as  that  of  quinine,  and 
then  exposes  a  given  part  to  radium  or  the  X-ray 
tube.  In  this  way  he  sets  up  local  fluorescence, 
and  claims  that  the  therapeutic  action  of  the 
radium  or  of  the  focus-tube  is  thereby  increased. 
The  idea  is  suggestive.  For  instance,  the  value 
of  a  seaside  visit  in  the  treatment  of  many  ob- 
stinate maladies  is  a  fact  well  known  to  the  physi- 
cian. More  good  is  often  done  in  a  week  near  the 
sea  than  by  month  after  month  of  physic  and 
nursing  at  home.  Possibly  the  change  to  radio- 
active surroundings  of  sun  or  sea  or  shore  have 
fluoresced  the  drugs  that  have  lain  inert  in  the 
patient's  tissues  and  roused  them  into  fresh  and 
energetic  action.  Morton,  in  some  cases,  exposes 
the  whole  of  the  body  to  the  action  of  the  X-rays, 
whereby  he  seeks  to  flood  the  tissues  with  fluo- 
rescence from  the  drug  that  has  been  previously 
administered.  It  seems  not  unreasonable  to  assume 
that  chemical  or  physico-chemical  effects  would 
be  in  that  way  "  brought  into  very  intimate 
internal  relations  with  vital  processes." 

Radio-activity  in  some  form  or  other  may  pos- 
sibly be  found  one  day  to  account  for  the  action  of 
certain  drugs,  which  will  have  to  be  investigated 
from  an  entirely  fresh  point  of  view.  Let  us  turn 
for  a  moment  to  uranium,  the  metal  first  obtained 
from  pitch-blende  in  1789  by  Klaproth.  A  capital 
account  of  the  properties  and  therapeutics  of 
uranium  is  given  by  Dr.  C.  D.  F.  Phillips  in  the 
third  edition  of  his  invaluable  book  on  "  Materia 
Medica  and   Therapeutics."     Uranium  was  first 

(a)  Aew  York  Med.  J^urn.,  February  13th,  1904. 


brought  into  general  notice  by  Dr.  Samuel  West 
{Brit.  Med.  Journ.,  ii.,  1895)  as  a  remedy  for  dia- 
betes. Mr.Symonds  failed  to  detect  it  in  the  urine 
of  some  of  Dr.  West's  patients  taking  the  drug,  an 
observation  that  was  confirmed  by  Dr.  Bond. 
On  the  other  hand,  Lecomte,  in  1851,  had  stated 
that  small  doses  caused  glycosuria  in  dogs. 
Chittenden  produced  a  similar  result,  and  the 
appearance  of  sugar  was  preceded  by  nephritis. 
He  found  evidence  of  tolerance,  namely,  that  given 
doses,  which  caused  at  first  albuminuria,  ceased  to 
do  so  at  a  later  period.  Dr.  West  found  that 
full  doses  caused  dyspepsia.  Dr.  Phillips  him- 
self gave  uranium  nitrate  a  fair  trial  in  twenty-five 
cases  of  diabetes  mellitus.  For  two  months  he 
kept  his  patients  under  the  influence  of  the  drug. 
The  first  week  he  gave  half  a  grain  thrice  daily ;  the 
second  week  three  grains,  and  afterwards  five 
grains.  The  diabetic  symptoms  were  not  re- 
lieved, and  in  no  case  was  albuminuria  or  dyspepsia 
produced.  In  some  cases  there  was  slight  loose- 
ness of  the  bowels,  but  no  diarrhoea. 

A  writer  in  the    Therapeutic  Gazette  (October, 

1  1888,  p.  698)  states  that  uranium  is  liable  to  pro- 

!  duce  inflammation  of  the  intestines  and  kidneys, 

I  sugar   in    the   urine,   with   nervous     symptoms, 

such  as  cardiac  paralysis  and  failure  of  locomotor 

power.    May  it  not  be  possible  that  these  effects 

are  due  to  the  irritation  of  the  intestinal  mucous 

membrane  by  the  slow  passage  of  a  radio-active 

substance  through  the  bowel  ? 

Sir  G.  Duncan  Gibb,  many  years  ago,  recom- 
mended uranium  nitrate  as  a  spray  in  sore  throat. 
Possibly  the  instinct  of  these  observers  may  have 
led  them  to  the  verge  of  the  discovery  of  an  im- 
portant remedy.  At  any  rate,  the  action  of  ura- 
nium, and  possibly  of  many  other  forgotten  or 
half-forgotten  remedies,  deserves  careful  scientific 
investigation  in  the  light  of  recent  physical  or 
chemico-physical  advances. 


A   CASE    OF   MYOMA 

OF   THE 

RIGHT     BROAD    LIGAMENT 

SUCCESSFULLY  ENUCLEATED  BY 
ABDOMINAL  SECTION,  (a) 
By  FREDERICK  EDGE,  M.D.,  F.R.C.S.,  Ac, 

Surgeon  to  the  Wolverhampton  and  to  the  Birmingham  and  Midlands 
Hospital  for  Women. 

The  patient  is  a  multipara,  set.  43,  well  nourished 
and  generally  healthy,  except  that  she  is 
anaemic  and  careworn ;   last  child,  get.  12. 

She  has  suffered  from  painful  and  profuse 
menstruation,  which  has  become  worse  and 
worse.  There  was  pressure  on  the  bladder  rfnd 
consequent  frequent  micturition  with  tenesmus. 
On  examination  there  was  found,  per  vaginam, 
a  round,  cystic  swelling  of  the  anterior  vaginal 
wall  about  the  size  of  a  walnut.  This  was  dia- 
gnosed as  a  retention  cyst.  The  uterus  was  found 
to  be  enlarged  irregularly,  chiefly  to  the  right, 
and  a  sound  passed  four  and  a  half  inches,  which 
was  about  half  the  distance  it  would  have  entered 
had  the  uterus  been  continued  to  full  extent  of 
the  tumour.  Therefore  it  was  considered  that 
the  myomatous  mass  was  chiefly  subperitoneal, 
but  it  was  not  diagnosed  as  intra-ligamentary, 
As  the  tumour  was  growing,  the  bleeding  increasing, 
and  the  pressure  symptoms  causing  great  suffer- 
ing, especially  from  the  bladder,  I  advised  operation. 

(a)  Read  at  a  meeting  of  the  British  Gynaecological  Society,  Apri 
14th,  1904. 


446    The  Medical  Press. 


CLINICAL  RECORDS. 


April  27,  1904. 


On  opening  the  abdomen,  the  parietal  peri- 
toneum was  found  to  have  been  carried  up  the  | 
front  wall,  and  this  for  a  moment  obscured  matters. 
However,  by  noticing  the  size  of  the  uterine  fundus 
it  was  evident  at  once  that  the  myoma  was  intra- 
ligamentary.  I  shelled  it  out,  but  found  that  it 
had  a  very  intimate  union  with  the  right  anterior 
lower  uterine  wall,  where  its  vessels  entered. 
There  was  severe  bleeding  when  I  divided  this, 
but  only  one  or  two  arteries  spouted,  and  were  tied. 
The  venous  bleeding  was  controlled  by  sutures 
drawing  together  the  uterine  tissue.  The  cavity 
in  the  broad  ligament  shrank  a  good  deal,  and  its 
peritoneal  coat  was  sutured  to  the  parietal  peri- 
toneum at  the  lower  angle  of  the  wound.  The 
rest  of  the  operation  was  finished  as  usual.  The 
retention  cyst  in  the  vagina  was  emptied.  The 
patient  recovered  uninterruptedly  and  without 
any  reaction. 

I  have  removed  several  broad  ligament  myo- 
mata,  where  no  connection  with  the  uterus  was 
present,  but  it  is  a  question  whether  the  majority 
of  broad  ligament  myomata  are  not  originally 
pedunculated  uterine  growths. 
Calculus  of  the  Bladder  formed' on  Silk  Sutures 
used  in   Performing  Hysterectomy. 

This  calculus  was  removed  by  vaginal  lithotomy 
three  years  after  panhysterectomy  of  a  myo- 
matous uterus. 

It  was  encysted  and  not  easy  to  sound.  Dilata- 
tion of  the  urethra  and  traction  with  forceps  failed 
to  remove  it.  I  therefore  incised  the  base  of  the 
bladder,  per  vaginam,  and  removed  it  with  the 
finger.  The  vaginal  incision  was  not  sutured, 
but  the  bladder  was  drained.  The  wound  healed 
within  the  week,  and  there  was  no  leakage.  I 
have  treated  several  cases  in  this  way,  and  con- 
sider that  where  there  has  been  considerable 
alteration  of  the  parts  by  contraction  of  cicatrices, 
it  is  best  not  to  suture,  especially  if  the  bladder  is 
septic  or  in  a  doubtful  condition. 
A  Displaced  Spleen  Simulating  a  Broad  Liga- 
ment Cyst  Successfully  Removed  by    Abdominal 

Section. 

The  patient,  a  school  teacher,  aet.  24  and  un- 
married, in  August  suffered  from  peritonitis  and 
was  sent  to  Birmingham  by  Dr.  Wilson,  of  Barns- 
ley.  To  me  she  complained  of  paroxysmal  pain 
in  the  abdomen.  She  had  had  amenorrhea  for 
three  months,  and  before  that  time  scanty  men- 
struation ;  she  was  costive,  but  had  no  swelling 
of  the  feet,  and  her  general  organs  were  normal. 
A  rounded  tumour  was  to  be  felt  on  the  right  side 
of  her  small  uterus ;  the  hymen  was  intact. 
Per  rectum  the  tumour  was  diagnosed  as  a  cyst 
of  the  broad  ligament. 

After  abdominal  section  and  the  separation  of 
adhesions  I  enucleated  a  reniform  tumour  from 
between  the  broad  ligament  and  omentum;  as,  owing 
to  twisting  of  the  pedicle  the  mass  was  black  with 
extravasated  blood,  and  it  seemed  doubtful  of 
vitality  if  left,  it  was  therefore  removed.  There 
was,  however,  some  question  as  to  how  to  treat 
the  pedicle,  as  from  its  shape  the  tumour 
appeared  to  be  a  kidney.  On  cutting  into  the 
mass  it  proved  to  be  a  spleen,  and  the  pedicle  was 
therefore  ligatured  and  dropped. 

The  blood,  examined  after  the  operation, 
showed  some  deficiency  in  the  red  cells  (4,000,000), 
a  slight  increase  in  the  leucocytes  and  a  good 
many  polynuclear  cells.  A  week  later  the  blood 
was  normal.  The  patient  did  perfectly  well, 
and  has  returned  to  her  work. 


Clinical  Hecoitos. 


Case  of   Dermoid   Cyst  of  both    Ovaries.    Treble  Twist 
of  Pedicle  with  Strangulation  of  the  Left,  (a) 

By  FREDERIC  BOWREMAN  JESSETT.    F.R.C.S.. 
Surgeon  to  the  Can<«r  Hospital 

I  am  indebted  to  Dr.  Balgarnie,  who  kindly  called  roe 
in  to  see  the  patient  with  him.  for  the  note  of  this  case 
until  the  date  of  our  consultation. 

B.  B.,  aet.  21,  had  always  enjoyed  good  health. 
Catamenia  regular  and  without  pain.  One  child  born 
May,  1903. 

In  November,  1903,  she  had  a  sudden  attack  of  pain 
referred  to  the  left  hip,  causing  faintness  and  sickness : 
she  was  in  bed  for  four  days,  but  saw  no  doctor.  About 
noon  on  Februrary  24th.  1904,  just  at  the  termination 
of  an  uneventful  period,  she  again  had  severe  pain 
referred  to  the  left  hip,  accompanied  by  faintness  and 
sickness.  Dr.  Balgarnie  was  called  in  to  see  her  in  the 
evening  of  the  25  th.  She  was  then  in  bed  and  com- 
plained of  "  sciatica."  She  had  a  rapid  pulse,  120. 
Temperature  normal. .  On  examination  of  the  abdomen 
a  tumour  was  noticed  in  the  lower  abdomen,  slightly 
tender.  Morphia  was  given  by  the  mouth,  but  was 
rejected  at  once.  Fomentation  and  a  second  dose  of 
morphia  gave  relief.  On  February  26th,  her  condition 
was  much  the  same — pain,  very  severe,  was  relieved 
by  hypodermic  injection  of  morphia.  On  the  27th. 
unknown  to  Dr.  Balgarnie,  she  was  led  into  another 
room  ;  by  the  evening  her  symptoms  were  much 
more  severe,  with  a  rising  pulse,  temperature  ioi*. 
increased  sickness,  tenderness  much  more  marked  over 
tumour,  which  until  now  had  been  more  or  less  denned. 
Its  outline  was  obscured  by  obvious  peritonitis; 
subsequently  the  symptoms  gradually  abated.  On 
February  29th  I  saw  the  patient  with  Dr.  Balgarnie. 
She  had  a  rather  anxious  expression,  and  some  tender- 
ness over  the  lower  abdomen.  The  abdominal  muscle^ 
were  tense  and  it  was  with  difficulty  that  anything  like 
a  defined  tumour  could  be  felt.  Per  vaginam  there  was 
distinct  fulness  in  the  left  fornix,  tender  on  pressure, 
and  somewhat  tense.  Bimanually  this  fulness  was 
distinctly  connected  with  that  of  the  lower  part  of 
abdomen.  On  the  right  side,  the  right  ovary  was 
prolapsed,  distinctly  cystic  and  about  the  size  of  a 
Tangerine  orange.  The  uterus  was  somewhat  fixed 
and  tender.  The  diagnosis  was  rather  obscure,  but 
I  arrived  at  the  conclusion  that  we  had  to  deal  with  a 
ruptured  tubal  gestation  or  an  ovarian  tumour  and 
twisted  pedicle. 

I  advised  early  operation ;  as,  however,  the  symptoms 
had  abated  and  the  patient  was  in  every  way  better 
than  she  had  been,  and  it  was  necessary  to  remove  her 
to  the  Cottage  Hospital,  because  no  convenience 
existed  at  her  own  home,  we  decided  to  wait  and  con- 
tinue the  treatment  she  had  been  having. 

On  March  7  th,  she  was  removed  to  the  Cottage 
Hospital,  and  on  the  12th  I  operated,  with  the  assistance 
of  Dr.  Balgarnie,  Dr.  Adams  administering  the  anes- 
thetic. 

On  opening  the  abdomen  in  the  middle  line  by  an 
incision  about  three  inches  in  length,  between  the 
pubes  and  umbilicus,  I  found  the  omentum  adherent 
to  the  parietes  by  recent  adhesions ;  on  carefully 
separating  these  the  omentum  was  found  to  be  adherent 
to  the  tumour.  This  was  carefully  detached.  On 
endeavouring  to  pass  my  hand  around  the  tumour  I 
found  it  wedged  into  the  pelvis  and  very  adherent  to  the 
parietal  walls  in  front  and  the  intestines  above  and  be- 
hind. These  adhesions  were  separated  by  sweeping 
the  hand  carefully  round  the  tumour,  which  extended 
quite  down  into  the  pouch  of  Douglas.  I  next  extended 
my  parietal  incision  upwards  as  high  as  the  umbilicus, 
and  by  passing  my  hand  into  the  pouch  of  Douglas, 
lifted  the  tumour  bodily  out,  not,  however,  without  the 
rupture  of  a  small  cyst  on  its  posterior  surface.  The 
pedicle  was  then  seen  to  have  three  distinct  twists  and 
was  quite  black,  and  very  shortly  would  have  become 

(a)  Read  at  ft  meeting  of  the  British  Gynaecological  Societ/, 
April  14th,  1904. 


April  27.  1004. 


TRANSACTIONS  OF  SOCIETIES.        The  Medical  Press.     447 


gangrenous.     I  transfixed  the  pedicle  and  tied  it  in  the 
usual  manner. 

I  next  examined  the  uterus,  which  was  normal,  and 
drew  up  the  right  ovary,  which  was,  as  I  had  dis- 
covered, cvstic  and  enlarged.  I  removed  this.  The 
patient,  with  the  exception  of  a  stitch  abscess,  made 
an  uneventful  recovery. 

On  cutting  into  the  larger  tumour  it  was  found  to  be 
a  dermoid,  and  on  bisecting  the  smaller  right  cystic 
ovary  a  distinct  dermoid  cyst  is  seen  in  the  centre. 

I  have  ventured  to  bring  the  case  forward  as  ovarian 
-dermoids  are  sufficiently  rare  to  make  them  of  interest. 
Thus  Olshausen  has  collected  a  series  of  2,275  ovario- 
tomies performed  by  various  operators,  and  among 
them  there  are  only  eighty  cases  of  dermoid  cysts  (35 
per  cent.),  and  to  find  both  ovaries  so  affected  is  still 
more  rare.  The  case  is  also  remarkable  on  account  of 
the  treble  twist  of  pedicle.  In  my  experience  the 
pedicles  of  dermoid  or  solid  tumours  are  much  more 
liable  to  become  twisted  than  those  of  ordinary  cysts 
of  the  ovary.  The  diagnosis  was  also  somewhat  un- 
certain, as  although  the  sudden  pain  experienced  pointed 
to  ovarian  tumour  with  a  twisted  pedicle,  yet  the  fact 
that  per  vaginam  a  distinct  fulness  was  felt  in  the  left 
fornix  rather  suggested  the  possibility  of  a  tubal  preg- 
nancy. 

Case  of  Large  Fibroid  Springing  from  the  Anterior 
Surface  of  the  Cervix  Uteri,  Pushing  up  the  Bladder 
and  Peritoneum  to  within  an  inch  of  the  Umbilicus. 
Mrs.  D.,  set.  48.  married,  no  family,  was  sent  to  me 
by  Dr.  Case,  of  Fareham,  suffering  from  an  abdominal 
tumour.  About  five  years  ago  she  first  noticed  pain 
in  the  lower  abdomen,  for  which  she  consulted  Dr. 
Case ;  at  that  time  there  was  no  tumour.  A  year  later 
she  suffered  from  menorrhagia,  with  pain  in  the  back 
and  right  side,  which  continued  with  greater  or  less 
severity  until  about  a  year  ago,  when,  notwithstanding 
treatment,  it  increased  considerably,  and  the  tumour, 
which  had  been  noticed  for  some  time,  began  to  en- 
large. When  she  consulted  me  on  March  3rd,  I  found 
a  tumour  situated  in  the  lower  abdomen,  extending  as 
high  as  the  umbilicus  and  very  slightly  mobile.  Bi- 
manually,  it  extended  to  within  two  inches  of  the  outlet 
of  the  vagina,  and  the  os  uteri  could  not  be  clearly 
defined,  but  was  pushed  backwards  by  the  growth. 
The  whole  tumour  seemed  to  be  somewhat  fixed. 
The  patient  suffered  from  rather  frequent  desire  to 
micturate,  menorrhagia,  and  pain.  She  was  blanched, 
and  moved  about  with  decided  discomfort.  I  advised 
operation,  and  on  March  13th,  with  the  assistance  of 
Mr.  Hugh  Case,  I  operated,  Dr.  Hanson  giving  the 
anesthetic,  Dr.  George  Case  being  present. 

On  making  the  usual  incision  in  the  middle  line 
between  the  pubes  and  umbilicus  and  dividing  the 
parietes,  I  failed  to  find  the  peritoneum,  but  came 
down  upon  what  was  apparently  the  bladder,  and  had 
to  extend  my  incision  upwards  to  the  umbilicus  before 
1  could  get  into  the  peritoneal  cavity.  On  passing  my 
hand  downwards  into  Douglas'  pouch  behind  the 
tumour,  and  endeavouring  to  lift  it  out,  I  found  it  was 
firmly  bound  down.  I  then  separated  the  bladder  from 
the  tumour  and  introduced  Doyen's  myoma  screw,  and 
by  firm  traction  upon  the  tumour  and  digging  around 
it  with  my  disengaged  hand,  I  succeeded  with  difficulty 
in  drawing  it  out  of  the  pelvis.  Having  ligatured  the 
arteries  on  that  side,  I  enucleated  the  tumour  from 
the  fibres  of  the  uterus. 

The  body  of  the  uterus  was  then  seen  to  be  in  the 
abdominal  cavity  covered  by  its  peritoneum.  As  there 
was  very  considerable  oozing  from  the  surface  of  the 
uterus  from  where  I  had  peeled  the  tumour  I  thought 
it  advisable  to  remove  it.  There  was  a  considerable 
cavity  left  from  where  the  tumour  had  been  extracted  ; 
this  I  laced  over  by  several  strands  01  catgut  in  the 
manner  described  by  Dr.  W.  Duncan  at  our  last 
meeting.  By  this  means  the  cavity  was  closed  and 
much  of  the  oozing  stayed.  I,  however,  introduced  a 
gauze  drainage  into  the  lower  angle  of  tne  wound,  and 
having  carefully  closed  the  divided  peritoneum  in  the 
abdominal  cavity  I  closed  the  parietal  wound  by  means 
of  three  layers  of  ten-day  gut  sutures.  The  patient 
made  a  good,  although  rather  slow,  convalescence. 


Remarks. — This  tumour  evidently  sprang  from  the 
anterior  suriace  of  the  cervix  uteri  and  extended 
laterally  to  the  right,  splitting  up  the  right  broad 
ligament.  It  thu3  extended  forward  and  upwards, 
carrying  the  bladder  and  the  peritoneum  upwards. 
The  notable  points  about  the  operation  were,  first, 
the  bladder,  being  directly  under  the  parietal  wound, 
was  in  great  danger  of  being  cut  into,  and,  secondly, 
the  difficulty  of  extracting  the  tumour  was  very  great, 
and  had  I  not  had  the  myoma  screw  would  have  been 
very  much  more  so. 


Transactions  of  Societies* 


CLINICAL    SOCIETY    OF    LONDON. 
Clinical    Evening,  held  Friday,  April  22nd,  1904. 


Dr.  Frederick  Taylor,  President,  in  the  Chair. 


Mr.  F.  J.  Steward  showed  a  case  of  movable 
knee-joint,  three  and  a  half  years  after  operation 
for  extensive  tuberculous  disease.  The  limb  had 
remained  in  a  plaster  of  Paris  splint  for  two  years. 
No  attempts  had  been  made  to  produce  movement. 

Mr.  T.  Crisp  English  referred  to  a  case  of  tuber- 
culous disease  of  the  ankle  in  which  post-operative 
spontaneous  movement  had  supervened,  and  also  to 
a  case  of  acute  general  septic  arthritis  of  the  knee- 
joint,  following  gonorrhoea,  in  which  similar  results 
had  been  obtained  after  freely  opening  the  joint. 

Dr.  F.  Parkes  Weber  exh.bited  a  case  of 
polycythemia  with  enlarged  spleen  and  chronic 

er  ythrombl  algi  a. 
The  patient  was  a  married  woman,  set.  36,  a  Jewess, 
who  had  had  previous  good  health,  but  after  her  last 
confinement,  seven  years  ago,  she  suffered  from 
"inflammation  of  the  womb"  with  swelling  of  the 
whole  of  the  left  lower  extremity,  when  lasted  a 
month.  Burning  sensations  in  both  feet  appeared 
about  three  years  ago,  and  when  first  seen,  in  1903, 
the  feet  were  turgid  with  blood,  hot  and  painful.  All 
these  signs  were  much  more  prominent  in  the  left 
foot.  At  the  present  time  the  erythromelalgia  was 
practically  limited  to  the  left  foot,  the  skin  over  which 
presented  several  discrete  purplish  patches.  The 
spleen  was  enlarged,  but  there  was  no  cyanosis.  An 
examination  of  the  blood  showed  that  the  haemoglobin 
was  about  125  per  cent,  of  the  normal ;  red  cells, 
9,000,000  per  c.mm.  ;  white  cells,  8,100.  Poly- 
morphonuclear leucocytes  were  7375  VeT  <*&*'  The 
heart  and  lungs  were  normal.  The  pulse  was  88, 
regular,  and  of  rather  increased  tension. 

Dr.  James  Galloway  said  that  Dr.  Weber's  case 
appeared  to  revive  the  original  conception  of  ery- 
thromelalgia as  described  by  Weir-Mitchell,  for  arterio- 
sclerotic changes  were  certainly  not  prominently 
marked.  Many  of  the  cases  recently  described  showed 
that  the  condition  could  be  well  simulated  as  a  result 
of  such  vascular  degeneration,  and  he  referred  to  a 
case  under  his  own  care  in  Charing  Cross  Hospital 
from  an  examination  of  which  he  had  come  to  the 
conclusion  that  cases  of  redness,  pain  in  one  extremity, 
leading  to  necrosis,  in  an  adult  over  middle  age  were 
more  likely  to  be  due  to  ischaemia  of  arteriosclerotic 
origin,  rather  than  to  true  erythromelalgia.  He 
thought,  moreover,  that  a  revised  classification  of  the 
cases  was  called  for,  based  upon  the  blood-changes 
rather  than  upon  the  actual  condition  of  the  vascular 
walls. 

Dr.  Weber,  in  replying,  said  that  the  case  could  not 
very  well  have  been  mistaken  for  anything  else  when 
it  was  seen  in  the  acute  stage.  Radiograms  of  the 
affected  side  revealed  a  lighter  shadow  than  that  seen 
in  the  opposite  limb,  but  he  feared  that  this  would  not 
prove  of  much  diagnostic  value. 

Mr.  T.  H.  Opbnshaw  showed  (1)  a  case  of  firm 
ankylosis  and  contracture  of  the  left  knee  treated  by 
elastic  steel  bar  traction  in  a  patient,  aet  15,  who  had 
been  able  to  walk  about  during  the  application  of 
the  apparatus.  (2)  A  case  of  osteo-arthritis  of  the 
knee-joint  following  a  fracture  of  the  femur,  improved 


448     The  Medical  Prkss.        TRANSACTIONS  OF  SOCIETIES. 


Aprtl  27,  100J. 


after  removal  of  pressure  by  means  of  a  splint,  which 
had  transferred  the  weight  of  the  body  from  the 
pelvis  to  the  ground,  thus  giving  the  affected  joint 
rest. 

Mr.  Lawrie  H.  McGavin  called  attention  to  the 
resemblance  of  the  joint  in  the  second  case 
to  the  condition  met  with  in  Charcot's 
d  sease.  He  thought  that  a  fracture  of  the  femur 
would  hardly  account  for  such  disorganisation  as  was 
present. 

Dr.  W.  P.  Herringham  concurred  in  this  view. 

Dr.  Wilfred  Harris  exhibited  a  girl,  aet.  20,  the 
subject  of  acromegaly.  The  disease  was  in  an  early 
stage,  the  symptoms  having  only  appeared  about  two 
years  ago.  She  had  suffered  from  slight  epileptiform 
attacks  and  headache.  Prognathism  was  well  marked, 
and  the  hands  were  enlarged.  There  were  no  urinary 
nor  ocular  changes. 

Dr.  Parkes  Weber  inquired  if  the  patient  were 
above  the  average  height. 

Dr.  Harris  replied  that  she  was  5ft.  5m.  in  height, 
and  appeared  to  be  still  growing. 

Dr.  Lee  Dickinson  showed  a  woman,  aet.  27,  with 
congenital  heart  disease.  She  was  not  cyanosed, 
but  there  was  a  long  rumbling  murmur  and  thrill 
audible  in  the  second  left  interspace  close  to  the 
sternum,  occupying  the  whole  cardiac  cycle.  The 
pulmonary  second  sound  was  indistinguishable.  A 
provisional  diagnosis  of  patent  ductus  arteriosus  was 
made. 

Dr.  William  Pasteur  asked  if  the  murmur  were 
heard  at  the  back. 

Dr.  Herringham  referred  to  the  great  difficulty 
which  was  almost  always  experienced  in  arriving  at  such 
a  diagnosis,  and  suggested  that  the  lesion  was  chiefly 
confined  to  the  pulmonary  artery. 

Dr.  Wilfred  Harris  said  that  the  murmur  bore  a 
strong  resemblance  to  that  heard  where  an  aneurysm 
of  the  aorta  had  ruptured  into  the  pulmonary  artery. 

The  President  remarked  that  several  cases  had 
been  recorded  in  which  the  diagnosis  of  patent  ductus 
arteriosus  made  during  life  had  been  subsequently 
confirmed  at  the  autopsy,  and  he  referred  to  one 
published  by  the  late  Dr.  Hilton  Fagge  in  the  Guy's 
Hospital  Reports  in  which  a  long-way  murmur  was 
heard  in  that  situation.  He  would  incline  to  the  view 
that  the  present  case  was  an  instance  of  that  abnor- 
mality. 

Dr.  Dickinson  replied. 

Mr.  R.  P.  Rowlands  showed  a  case  of 'congenital 
malformation  and  deformity  in  a  woman,  aet.  30. 
The  principal  defects  were  absence  of  the  ear  and 
.seventh  and  eighth  cranial  nerves.  There  was  com- 
plete facial  paralysis  and  nerve  deafness  on  the  left 
side.  Portions  only  of  the  external  ear  were  present. 
There  was  also  an  absence  of  the  radius  and  upper 
part  of  the  humerus  on  the  same  side,  with  abnormal 
smallness  of  the  shoulder,  scapula  and  clavicle.  Two 
metacarpal  bones  were  absent,  while  there  were  only 
four  carpal  bones.     The  elbow  was  flail-shaped. 

Mr.  McGavin  inquired  as  to  the  condition  of  the 
Eustachian  tube  upon  the  affected  side. 

Mr.  Rowlands  replied  that  this  canal  was  present, 
but  that  tne  catheter  passed  a  shorter  distance  than 
normal,  the  tympanum  being  absent.  The  non- 
development  of  the  two  cranial  nerves,  including  the 
pars  in  termed ialis,  explained  the  loss  of  taste,  which 
also  existed  over  the  left  half  of  the  tongue. 

Mr.  Rowlands  also  showed  a  case  of  premature 
puberty  in  a  child,  aet.  2,  in  whom  the  external  genitals 
were  similar  to  those  of  a  boy  of  fifteen.  In  the  few 
recorded  cases  of  this  condition  it  had  been  generally 
found  that  senile  changes  commenced  at  a  much 
earlier  age  than  usual. 

Mr.  Charters  J.  Symonds  exhibited  a  man,  aet.  45, 
with  gangrene  of  the  tips  of  the  fingers  of  both 
hands.  The  condition  had  begun  two  years  ago. 
He  was  a  horse-keepei,  but  had  not  been  exposed  to 
cold  more  than  this  occupation  would  suggest.  There 
was  no  arterial  or  nervous  disease,  nor  any  diabetes. 
The  patient  was  under  the  care  of  Mr.  Golding-Bird 
at  Guy's  Hospital. 


Dr.  Pasteur  thought  that  the  possibility  of  Ray- 
naud's disease  could  not  be  excluded,  especially  as 
some  of  the  cases  went  on  to  the  more  profound 
changes  without  the  earlier  ones  being  specially 
manifest. 

Mr.  Symonds  also  showed  a  man,  aet.  42,  in  whom  a 
spontaneous  fracture  of  the  neck  of  the  femur  had 
occurred  while  he  was  kneeling  to  open  a  cupboard. 

Mr.  Anthony  A.  Bowlby  said  that  the  fact  that 
one  of  the  earliest  signs  of  tabes  dorsalis  might  be 
spontaneous  fracture  was  hardly  sufficiently  appre- 
ciated. He  referred  to  two  cases  in  which  this  accident 
preceded  all  other  signs  of  the  disease. 

Mr.  Symonds  replied  that  there  were  as  yet  no 
definite  signs  of  locomotor  ataxy  in  his  case  with  the 
exception  of  a  suspicion  of  some  insufficiency  of  the 
ocular  muscles. 


BRITISH  GYNECOLOGICAL  SOCIETY. 
Meeting  held  Thursday,  April  14TH,  1904. 


Professor  John  W.  Taylor,  President,  in  the  Chair- 


Specimens    and    Cases. 

Mr.  J.  Furneaux  Jordan  read  notes  ofi(i)  a'case 
of  Hydrometra,  and  (2)  one  of  Double  Hydro-salpinx, 
exhibiting  the  specimens  from  the  latter.  4/rhe  notes 
of  these  we  shall  publish  in  our  next  issue. 

The  President  said  that  hydro-salpinx  might  some- 
times be  accounted  for  by  the  swelling  and  occlusion 
of  the  ends  of  the  Fallopian  tubes,  owing  to  the  in- 
fluence of  an  inflammation  which,  while  it  gave  rise 
to  a  watery  exudation,  was  independent  of  micro- 
organisms, but  these  two  cases  seemed  to  bear  out  an 
idea  that  had  been  advanced,  but  the  truth  of  which 
he  had  been  inclined  to  doubt,  that  hydrometra  was 
rather  a  late  stage  of  hydro-salpinx.  The  President 
then  alluded  to  the  presence  of  several  distinguished 
visitors,  including  the  President  of  the  Obstetrical 
Society,  Dr.  Prochownic,  of  Hamburg,  and  Dr. 
Fellner,  of  Franzenbad,  and  welcomed  them  in  the 
name  of  the  Society. 

Dr.  Frederick  Edge  exhibited  ( 1 )  a  Myoma  of  the 
Broad  Ligament,  (2)  a  Vesical  Calculus  formed  on  a 
hysterectomy  ligature,  and  (3)  a  Spleen  taken  to  be 
a  Broad  Ligament  Cyst  and  removed  from  the  right 
side  of  the  pelvis,  and  read  notes,  which  will  be  found 
on  page  445. 

Dr.  Heywood  Smith  remarked  that  it  was  but  rarely 
that  the  spleen  became  a  pelvic  tumour.  Some  years 
ago  a  case  sent  to  him  as  an  ovarian  growth  turned 
out  on  examination  to  be  splenic.  Mr.  G.  Sutton 
operated  and  found  it  behind  the  uterus  on  the  left 
side. 

Dr.  Bedford  Fenwick,  referring  to  the  first  speci- 
men shown  by  Dr.  Edge,  said  that  myomata  of  the 
broad  ligament  were  always  muscular  or  fibroid 
growths,  and  different  in  structure  from  the  tissue  of 
the  broad  ligament ;  in  such  cases — and  he  had  operated 
on  several  within  the  last  few  months — he  bad  in- 
variably been  able  to  trace  some  connection  with  the 
uterus.  In  one  case,  quite  recently,  a  calcareous 
fibroma,  attached  to  the  omentum,  had  a  fine  pedicle 
projecting  downwards,  which  had  evidently  at  some 
time  been  connected  with  the  uterus  and  afterwards 
become  detached.  It  was,  of  course,  not  unusual  to 
find  calcareous  degeneration  in  a  fibroid  with  a  very 
slender  pedicle.  He  thought  the  spleen  shown  most 
interesting ;  the  entire  removal  of  the  spleen  was 
sufficiently  rare  to  make  the  blood  condition  of  the 
patient,  when  some  months  had  elapsed,  an  important 
point,  and  he  hoped  that  Dr.  Edge  would  report  upon 
it. 

Dr.  Macnaughton-Jones  maintained  that  myomata 
of  the  broad  ligament  were  sometimes  quite  inde- 
pendent of  the  uterus.  In  regard  to  what  the  President 
had  said  about  hydro-salpinx  being  a  sequence  of 
pyo-salpinx,  Dr.  Charles  Hanley  had  recently  published 
a  very  able  paper  which  showed  that  hydro-salpinx 
might  be  quite  independent  of  any  pyogenic  invasion 
whatever. 

Dr.  Edge,  in  reply,  said  that  he  should  not  think 


ArRiL  27,   1904 


TRANSACTIONS  OF  SOCIETIES.        The  Medical  Press.     449 


of  removing  a  displaced  spleen  if  there  was  no  torsion, 
bat  would  replace  and  fix  in  with  a  few  sutures.  Many 
cases  had  been  successfully  treated  in  that  way.  In 
myomata  of  the  broad  ligament,  in  the  majority  of 
cases,  there  was,  in  his  experience,  a  certain  connection 
with  the  uterus  which  led  him  to  think  that  they  had 
their  origin  in  that  organ.  They  sometimes  became 
detached,  but  it  was  a  mistake  to  suppose  that  there 
was  no  tissue  in  the  broad  ligament  itself  of  the  kind 
from  which  a  fibroma  might  arise.  Every  opportunity 
would  be  taken  to  ascertain  the  condition  of  the  blood 
in  the  patient,  who  had  gone  back  to  Warwickshire 
without  her  spleen. 

Mr.  Bowreman  Jessett  read  notes  of  a  case  of 
Bilateral  Dermoid  Cysts,  with  torsion  of  one  pedicle,  and 
of  a  large  Cervical  Fibroid  elevating  the  bladder  nearly 
to  the  umbilicus,  which  will  be  found  under  "  Clinical 
Recards,"  on  page  446. 

In  reply  to  a  question  from  Dr.  Edge,  Mr.  Jessett 
said  that  the  bladder  had  not  been  injured  in  any 
way. 

Dr.  T.  Arthur  Helme  read  a  paper  on 

SUGGESTION     OF     A     NEW    METHOD     OF    TREATMENT     IN 
PUERPERAL  ECLAMPSIA. 

After  brief  reference  to  the  fact  that,  whilst  our 
knowledge  of  the  etiology  and  pathology  of  eclampsia, 
of  pregnancy  and  the  puerperium  is  so  unsatisfactory 
as  to  afford  no  rational  basis  for  treatment,  it  was 
generally  agreed  that  the  phenomena  are  largely 
dependent  upon  the  presence  of  toxic  material  in  the 
maternal  blood,  the  nature  of  the  toxin  and  its  manner 
of  producing  the  convulsions  being  still  sub  judice. 
Dr.  Helme  alluded  to  the  three  chief  indications  in 
the  method  of  treatment,  upon  each  of  which  there 
exists  a  bewildering  diversity  of  opinion.  The  chief 
object  of  the  paper  was  to  advance  a  suggestion  that 
the  convulsions  are  dependent  upon  an  increased 
cerebro-spinal  tension — an  intracranial  pressure.  Dr. 
Helme  alluded  to  the  fact  that  in  order  to  control  the 
convulsions,  when  once  they  had  set  in,  we  must  at 
present  chiefly  depend  upon  the  use  of  drugs.  He 
suggested,  as  a  safer  method,  the  withdrawal  of  a 
quantity  of  cerebro-spinal  fluid  by  means  of  lumbar 
puncture,  in  order  to  reduce  the  cerebro-spinal  tension  ; 
and  reported  a  case  in  which  the  treatment  had  been 
successfully  employed. 

The  President  described  the  paper  as  a  very 
valuable  communication  on  a  most  important  subject. 

Dr.  Macnaughton-Jones  said  that  it  would  be 
premature  to  express  any  opinion  on  a  mode  of  treat- 
ment the  action  of  which  had  been  ascertained  in  one 
case  only.  If  further  experience  substantiated  Dr. 
Hclme's  view,  puncture  of  the  spinal  canal  would  be 
recognised  as  a  most  valuable  method  of  dealing  with 
one  of  the  most  terrible  contingencies  which  medical 
men  had  to  face.  Personally,  he  thought  that  in 
pilocarpine  they  had  a  means  of  relieving  eclampsia, 
the  value  of  which  was  not  sufficiently  recognised, 
and  he  instanced  two  cases  of  its  successful  use.  The 
first  was  one  occurring  at  midterm;  the  patient 
was  brought  to  him  one  day  complaining  of  loss  of 
sight,  and  as  there  was  incipient  choking  of  the  disc 
and  the  urine  was  loaded  with  albumin,  he  advised 
the  induction  of  labour.  This  course  was  adopted, 
and,  labour  coming  on  at  night  in  his  absence,  delivery 
was  effected  by  Dr.  Bland  Sutton,  but  eclamptic 
convulsions  ensued  and  continued  the  whole  of  that 
night  and  part  of  the  next  day,  when  he  administered 
a  hypodermic  injection  of  pilocarpine,  which  induced 
profuse  diaphoresis ;  the  convulsions  immediately 
ceased,  and  the  woman  made  a  perfect  recovery. 
The  second  caie  was  a  woman  who,  during  pregnancy, 
had  suffered  from  much  gastric  disturbance  and 
hyperemesis,  and,  after  delivery,  from  post-partum 
haemorrhage.  A  quantity  of  clots  were  removed  from 
her  distended  uterus,  and  she  seemed  to  be  doing 
perfectly  well,  but  after  a  time  was  attacked  with 
rapidly  succeeding  convulsions  ;  on  the  injection  of 
10  minims  of  a  2  per  cent,  solution  of  pilocarpine  the  | 
convulsions  ceased  for  some  hours,  and  an  injection 


of  5  minims  more  was  followed  by  total  cessation  of 
the     fits,  and  perfect  recovery. 

Mr.  J.  Furneaux  Jordan  asked  what  the  total 
amount  of  the  cerebro-spinal  fluid  was  supposed  to- 
be.  It  was  an  important  point  what  quantity  of  the 
fluid  should  be  withdrawn,  and  he  hardly  thought 
that  the  removal  of  merely  a  drachm  and  a  half  would 
relieve  the  intracranial  pressure  as  much  as  vene- 
section to,  say,  1 5  ounces. 

Dr.  Bedford  Fenwick  agreed  that,  as  Dr.  Helme 
had  clearly  explained,  the  real  cause  of  the  fits  in 
puerperal  eclampsia  was  intracranial  pressure,  and 
that  the  treatment  should  be  directed  to  the  vascular 
system.  He  (Dr.  Fenwick)  thought  that  it  was  an 
error  to  suppose  that  it  was  entirely  the  nervous 
system  which  was  at  fault,  and  that  more  attention  to 
the  condition  of  the  heart  and  to  the  vascular  con- 
dition of  the  brain  and  nervous  system  generally  would 
lead  to  a  clearer  perception  of  the  proper  lines  of  treat- 
ment of  the  eclamptic  condition,  and  to  an  increase  in 
the  recoveries  from  that  condition.  Some  years  ago, 
on  the  supposition  that  the  convulsions  were  due  to 
intracranial  pressure,  he  treated  a  succession  of  cases 
by  bleeding  to  from  15  to  25  ounces,  without  drugs 
or  injections  of  any  kind,  and  they  all  recovered. 
Even  without  bleeding  to  such  an  extent,  he  thought 
that  better  results  than  hitherto  might  be  obtained  by 
tapping  the  pelvic  circulation  by  means  of  sulphate  of 
soda,  and  reducing  the  heart  pressure  by  the  use  of 
nitrate  of  amyl. 

Dr.  R.  H.  Hodgson  remarked  that  the  convulsions 
of  epilepsy,  in  which  it  was  not  asserted  that  there  was 
any  increase  of  the  cerebro-spinal  fluid,  were  very 
like  those  of  puerperal  eclampsia.  From  personal 
experience  he  could  confirm  all  that  Dr.  Macnaughton- 
Jones  had  said  as  to  the  beneficial  effects  of  pilo- 
carpine. 

Dr.  Edge  asked  what  position  the  patient  was  put 
into  for  the  spinal  puncture. 

Dr.  Helme,  in  reply,  said  that  his  paper  was  in  no- 
way intended  as  a  criticism  of  the  action  of  any  drugs 
individually,  but  simply  to  record  the  effects  of  a 
method  independent  of  drugs.  Pilocarpine  was  a 
remedy  of  great  value,  but  one  that  required  careful 
watching,  because  of  its  depressing  influence  upon  the 
heart,  and  though  in  some  cases  of  eclampsia  there  was 
a  robust,  bounding  pulse,  in  others  the  pulse  was  weak, 
and  in  the  latter  he  would  prefer  not  to  give  pilo- 
carpine. He  was  not  aware  that  the  amount  of  cere- 
bro-spinal fluid  in  the  human  body  had  been  ascertained,, 
but  just  as  the  removal  of  a  few  drops  from  an  india- 
rubber  ball  full  of  water  would  materially  diminish 
the  tension  of  its  wall  so  he  had  no  doubt  that  the 
abstraction  of  a  drachm  and  a  half  of  fluid  from  the 
cerebro-spinal  canal  would  profoundly  influence  the 
tension  in  the  cerebro-spinal  system.  There  was  an 
element  of  danger  in  withdrawing  too  much  ;  one  case 
he  knew  of  in  which  an  intense  headache,  associated 
with  chronic  Bright's  disease  and  lead  poisoning,  had 
been  relieved  after  puncture  and  allowing  the  drainage 
to  go  on  till  it  stopped,  so  that  perhaps  the  whole  of 
the  fluid  might,  in  some  cases,  be  removed  without  a 
fatal  result ;  in  other  instances,  the  abstraction  of 
six  drachms  had  been  followed  by  coma,  not  neces- 
sarily fatal.  For  the  operation,  which  was  quite 
easily  performed,  the  patient  was  placed  under 
chloroform,  on  her  left  side,  so  bent  as  to  arch  her  back  ; 
the  needle  was  inserted  at  a  point  about  half  an  inch 
to  the  right  of  the  line  of  the  spinal  processes  at  the 
level  of  an  imaginary  line  joining  the  posterior  iliac 
spines,  and  with  a  simple  upward  movement  was 
passed    between  the  laminae  of  the  two  vertebrae. 

Dr.  Macnaughton-Jones  then  read  a  paper  "  On 
the  Application  of  Pessaries  and  their  Dangers,"  which 
will  be  found  on  page  430  of  this  number,  illustrated 
by  a  series  of  sections  of  the  female  pelvis  projected 
by  the  epidiascope. 

On  the  motion  of  Dr.  Heywood  Smith,  it  was  agreed 
to  postpone  the  discussion  of  the  paper  to  a  future 
meeting  of  the  Society. 


45°    The  Medical  Press. 


TRANSACTIONS  OF  SOCIETIES. 


April  27.  190*. 


ROYAL  ACADEMY  OF  MEDICINE  IN  IRELAND. 
Obstetric  Section. 


Meeting  held  April  15TH,  1904. 


The  President,  Dr.  Alfred  Smith,  in  the  Chair. 


Dr.  Glenn  showed  specimens  of  Dermoid  Tumour 
•of  the  Ovary.  Sarcoma  of  the  Ovary,  Carcinoma  of  the 
Ovary,  and  Epithelioma  of  Clitoris  and  Labia  Minora. 

Dr.  E.  H.  Tweedy  showed  a  specimen  of  Sarcoma 
of  the  Uterus. 

Dr.  Gordon  Fitzgerald  showed  a  very  interesting 
Tubo-ovarian  Cyst. 

The  President  read  a  paper  on 
tuberculosis  of  the  vaginal  portion  of  the  cervix, 
and  gave  notes  of  a  case.  He  said  the  patient.  a?t.  25, 
was  admitted  to  St.  Vincent  Hospital  in  January  last. 
The  history  of  the  case  was  that  of  an  incomplete 
abortion,  with  foul-smelling  discharge.  The  tempera- 
ture on  admission  was  100*4°  F.,  which  was  put  down 
to  septic  absorption.  On  inspection  a  fungous  ulcerating 
mass  projected  more  or  less  uniformly  around  the  os. 
It  broke  down  easily  on  pressure  with  the  finger, 
-causing  a  well-marked  haemorrhage.  Cancer  was  pro- 
visionally diagnosed,  but  the  examination  under  the 
microscope  of  a  piece  cut  out  of  the  cervix  showed  it 
to  be  tuberculous.  Section  demonstrating  the  tuber- 
culous system  was  shown  under  the  microscope.  Both 
lungs  were  affected  with  tuberculosis,  and  large  quan- 
tities of  tuberculous  bacilli  were  found  in  the  sputum. 
Hence  palliative  treatment.  The  chief  points  of 
interest  discovered  were  (1)  the  rarity  of  the  affection ; 
(2)  consideration  as  to  the  source  of  the  infection; 
<3)  some  points  in  differential  diagnosis. 

Dr.  Wm.  Dargan  said  the  tuberculous  process  as 
«hown    under    the    microscope    had    extended    pretty 
deeply  into  the  muscular  tissue,  separating,  where  it 
had  not  destroyed,  the  muscular  fibres,  and  sparing 
here  and  there  the  blood-vessels.     At  the  advancing  | 
part  typical  tuberculous  systems  with  their  giant-cells  , 
and  epithelioid   cells  can   be  made  out  between   the 
muscular  bundles,  and  suggest  having  been  formed  in  ! 
the  lymph  spaces,  as  many  of   them   are  completely  j 
surrounded  by  normal  muscular  bundles.     Tuberculous  I 
bacilli  could  not  be  demonstrated  in  the  section. 

Drs.  Glenn,  Tweedy,  and  Neville  also  discussed  the  j 
paper.  j 

Dr.  E.  H.  Tweedy  read  a  paper  on 
some  recent  methods  of  opening  and  closing  the 

ABDOMEN. 

The  President,  Drs.  Glenn  and  FitzGibbon  spoke, 
and  Dr.  Tweedy  replied. 
The  meeting  then  adjourned. 


LIVERPOOL    MEDICAL     INSTITUTION. 
Meeting   hel6    April    14TH,    1904. 


Dr.  James  Barr,  the  President,  in  the  Chair. 


CARCINOMA    OF   THE    OISOPHAGUS  :    GASTROSTOMY. 

Mr.  Philip  Nelson  related  a  case  of  carcinoma  of 
the  oesophagus,  which  occurred  in  a  woman,  act.  50. 
Difficulty  in  swallowing  had  only  existed  for  three 
months,  but  had  rapidly  increased.  Her  voice  was 
hoarse,  and  there  had  been  several  attacks  of  laryn- 
geal spasm.  Upon  examination,  there  was  found  to 
be  complete  paralysis  of  the  left  vocal  cord,  and  ab- 
ductor paralysis  of  the  right  cord.  An  oesophageal 
bougie  became  arrested  at  a  point  opposite  the  cricoid 
•cartilage.  Gastrostomy  was  performed  by  Mr.  Paul 
in  June  of  last  year.  The  patient  obtained  marked 
relief  from  the  operation,  and  all  went  well  until 
January  of  this  year,  when  she  died.  Subsequent 
examination  showed  that  the  growth  had  opened  into 
the  trachea,  and  the  right  lung  was  the  seat  of  a  large 
abscess. 

EXCISION  OF  GASSERIAN  GANGLION. 

Mr.  Damer  Harrisson  related  two  cases  in  which 
he  had  removed  the  Gasserian  ganglion  for  paroxysmal 
neuralgia.      The  first  case  was  that  of  a  man,  set.  45, 


who  for  years  had  suffered  from  severe  neuralgia, 
corresponding  to  the  distribution  of  the  inferior  dental 
and  infra-orbital  nerves.  The  inferior  dental  nerve 
was  exposed  in  the  bony  canal,  and  a  portion  of  it 
excised ;  the  infra-orbital  nerve  was  exposed  and 
stretched.  The  operation  was  followed  by  complete 
relief  of  the  symptoms.  Some  months  later,  however, 
there  was  a  return  of  the  neuralgia,  and  Mr.  Harrisson. 
after  reflecting  the  zygoma,  exposed  and  tore  through 
the  middle  and  inferior  divisions  of  the  fifth  nerve. 
Pain  was  relieved  for  ten  months,  but  it  returned  again. 
Finally  the  Gasserian  ganglion  was  excised  by  Rose's 
method.  This  operation  was  performed  seven  and  a 
half  years  ago,  and  since  then  there  has  been  no  return 
of  the  neuralgia.  In  the  second  case  the  neuralgia 
was  confined  to  the  distribution  of  the  inferior  dental 
nerve,  which  Mr.  Harrisson  exposed  near  the  base  of 
the  skull,  and  tore  through.  Marked  temporary  relief 
followed  ;  but  some  months  later,  owing  to  a  return 
of  the  neuralgia,  the  Gasserian  ganglion  was  excised 
by  the  same  method  as  in  the  previous  case.  This 
operation  was  performed  in  1896,  and  the  patient  has 
been  entirely  free  from  pain  ever  since. 

THE  TECHNIQUE  OF  ASEPTIC  SURGERY. 

Mr.  Paul,  in  opening  a  discussion  on  this  subject, 
said  that  the  recent  changes  in  the  treatment  of 
wounds  did  not  constitute  a  revolution  like  the  intro- 
duction of  Listerism,  but  they  were  unquestionably 
very  important,  and  he  thought  there  were  many 
advantages  in  discussing  the  details  of  their  practice. 
He  first  dealt  with  the  preparation  of  the  skin  of  the 
patient,  and  said  there  was  a  strong  tendency  among 
surgeons  to  leave  this  important  matter  too  much  to 
the  discretion  of  the  nurses.  The  hands  of  the  surgeon 
were  next  considered.  For  his  own  part  he  employed 
the  permanganate  method,  and  was  well  satisfied  with 
it.  Except  in  septic  cases  he  did  not  wear  rubber 
gloves,  but  his  assistants  did.  For  ligatures  and 
buried  sutures,  he  much  preferred  catgut,  prepared 
according  to  a  method  he  described,  to  silk ;  and  for 
skin  sutures  he  used  silk- worm- gut.  He  did  not  hesitate 
to  employ  drainage  in  the  form  of  a  glass  tube  or  gauze, 
if  there  was  any  reason  to  expect  an  accumulation  of 
serum  in  the  wound.  For  dressings  he  preferred 
plain  sterilised  gauze  and  absorbent  wool.  In  con- 
clusion, he  said  that,  while  the  introduction  of  Listerism 
had  been  the  means  of  saving  many  lives,  the  intro- 
duction of  the  aseptic  method  had  been  the  means  of 
saving  much  time  in  the  more  perfect  healing  of 
wounds. 

Sir  William  Banks  said  he  had  followed  the  whole 
course  of  antiseptic  surgery  from  1865,  when  he  had 
learnt  its  tenets  from  Professor  Lister,  until  to-day, 
and  had  practised  it  in  every  phase  of  its  development. 
More  and  more  it  was  resolving  itself  into  simple  but 
thorough  surgical  cleanliness.  He  deprecated  the 
lavish  expenditure  upon  modern  operating  theatres, 
and  said  he  found  his  operations  done  in  private  just 
as  successful  as  those  done  in  the  most  elaborately 
built  hospital  theatres.  He  boiled  everything  that 
came  in  contact  with  the  wound,  and  for  this  reason 
preferred  silk  to  catgut  as  a  ligature.  As  to  skin 
cleansing,  if  the  skin  was  well  shaven  a  good  scrubbing 
with  any  mild  antiseptic  was  all  that  was  necessary. 
He  had  a  strong  opinion  that  aseptic  surgery  would 
soon  resolve  itself  into  boiling  everything  that  could 
be  boiled,  and  shaving  everything  that  could  be 
shaved. 

Mr.  Thelwall  Thomas  thought  the  term  aseptic, 
when  used  as  opposed  to  antiseptic,  unfortunate; 
there  was  no  such  thing  as  aseptic  surgery  in  the  strict 
sense  of  the  term,  for  every  surgeon  used  chemical 
antiseptics  for  the  skin.  He  was  convinced  that  the 
deeper  parts  of  the  skin  were  never  rendered  sterile, 
and  was  an  ardent  advocate  for  the  wearing  of  rubber 
gloves  by  the  surgeon  and  his  assistants.  He  con- 
sidered the  question  of  aerial  infection  a  negligible 
quantity  in  private  practice,  but  in  hospital  theatres, 
where  septic  and  clean  cases  were  operated  upon,  a 
matter    for   serious    consideration,    and    he  strongly 


April  27,  1904 


GERMANY. 


The  Medical  Press.     451 


approved  of  the  principle  of  special  theatres  and  wards 
for  septic  cases. 

Mr.  Newbolt  compared  the  results  of  126  con- 
secutive cases  of  hernia  operated  upon  without  and 
with  rubber  gloves,  the  conditions  otherwise  being 
the  same.  In  the  first  series  one  case  in  five  suppurated , 
in  the  second  series  suppuration  occurred  in  one  case 
in  seven. 

Mr.  George  Hamilton  said  he  had  performed  125 
major  operations  since  May  last,  and  in  only  five  of 
those  had  suppuration  occurred. 

Mr.  Larkin,  Mr.  Darner  Harrisson.  Dr.  Alexander, 
Dr.  Briggs,  Dr.  Grimsdale,  Mr.  Rushton  Parker,  Dr. 
John  Gemmell,  and  Dr.  E.  T.  Da  vies  also  took  part  in 
the  discussion. 


/ranee. 

[from  our  own  correspondent.] 

Paris,  April  24th,  1904. 
Treatment  of  Cerebral  Arterio-Sclerosis. 

What  is  arterio-sclerosis  ?  asks  Professor  Huchard. 
It  is  an  endarteritis  characterised  by  Hypertrophy  of 
the  conjunctive  tissue  of  the  internal  tunic  of  the 
arterial  vessels.  When  it  is  localised  in  the  small 
arteries,  it  generally  affects  an  obliterating  character 
and  tends  towards  the  obstruction  of  the  diseased 
arteries.  In  vessels  of  average  and  large  calibre  it 
assumes  the  fibro -calcareous  form  which  is  the  charac- 
teristic of  atheroma,  and  by  means  of  its  effect  on 
the  elasticity  of  the  arterial  walls  invaded  by  the 
calcareous  deposit  it  disposes  the  arteries  to  permanent 
distension  (aneurysm)  and  to  rupture. 

The  etiology  of  arterio-sclerosis  is  dominated  by 
three  factors — family  predisposition,  abuse  of  animal 
food,  alcoholism.  Other  causes  of  lesser  importance 
might  be  mentioned — mental  strain,  worry,  syphilis, 
abuse  of  tobacco,  late  hours  and  chronic  intoxications 
in  general.  Arterio-sclerosis  is  generally  observed 
in  persons  over  fifty  years  of  age,  but  it  would  be  a 
mistake  to  consider  it  t!:e  apanage  of  mature  or  old 
age.  It  can,  although  very  exceptionally,  be  found  at 
any  age  and  even  in  children.  The  affection  has  a 
marked  tendency  to  become  generalised,  but  at  the 
beginning  it  is  localised  in  certain  arterial  districts. 
In  any  case  it  would  be  an  unpardonable  error  to 
conclude  from  its  absence  in  the  superficial  arteries 
(radial)  that  the  deep  vessels  were  sound.  The 
rigidity  of  the  radial  arteries  spoke  more  in  favour  of 
atheroma  of  the  large  vessels  than  of  sclerosis  of  the 
small  arteries  ramifying  on  the  viscerae.  One  of  the 
most  frequent  localities  of  arterio-sclerosis  is  repre- 
sented by  certain  arterial  systems  of  the  brain.  This 
cerebral  sclerosis,  relatively  frequent  in  individuals 
close  on  fifty,  passes  easily  unperceived  in  its  in- 
ception, as  it  develops  very  insidiously.  It  declares 
itself  by  vertigo  and  diminished  resistance  to  mental 
fatigue,  weakening  of  the  memory,  unusual  irritabiUty, 
cephalalgia,  curious  sensations  which  the  patients 
localise  in  the  occiput,  vaso-motor  troubles,  local 
asphyxia  of  the  extremities  (fingers) — in  a  word, 
those  manifestations  which  in  the  present  day  are 
frequently  put  down  to  the  account  of  neurasthenia. 
However,  in  treating  as  a  neurasthenic  a  patient  who 
presents  symptoms  of  cerebral  sclerosis,  the  prac- 
titioner would  hasten  the  development  of  the  gravest 
accidents,  attesting  that,  in  certain  portions  of  the 
brain,  the  small  arteries  attacked  in  the  structure  of 
their  walls  have  become  incapable  of  filling  their  r6let 
or  have  become  fragile  and  liable  to  break.  The 
initial  manifestations  would  become  aggravated,  the 
morbid  irritability  would  degenerate  into  attacks  o 


mania,  the  temporary  weakness  of  the  memory  into 
mental  confusion,  vertigo  into  absences. 

On  these  '*  cerebral  congestions,"  as  they  are  called 
in  popular  language — an  improper  term,  as  in  reality 
it  is  a  case  of  attacks  of  ischaemia — would  follow  sooner 
or  later  regular  seizures  of  apoplexy,  symptoms  of 
haemorrhage  or  softening  of  the  brain.  All  this  train 
of  possible  accidents  may  be  obviated  by  judicious 
treatment  of  the  cause — arterio-sclerosis — when  not 
too  advanced,  by  a  drug  which  has  almost  the  value  of 
a  specific. 

To   Dr.    Huchard   is   due   the   merit   of   presenting 
iodide  of  potassium  as  the  only  efficacious  treatment 
of  the  malady.     He  gives  it  at  the  daily  dose  of  from 
15  to  50  grains.     In    order  to  favour  its  tolerance  he 
associates  with  it  small  doses  of  extract  of  opium  : — 
Iodide  of  potassium    . .  . .  . .    oiiss. 

Ext.  of  opium  . .  . .  . .     grs.  ii. 

Water gx. 

Two  tablespoonfuls  a  day  at  meals  in  a  little  milk 
or  beer. 

He  begins  by  small  doses  and  gradually  increases 
them.  The  treatment  is  continued  for  a  year  or 
eighteen  months  with  monthly  interruptions  of  eight 
days  at  first,  and  somewhat  longer  later  on. 

Dr.  Erlenmeyer  has  recently  published  the  results 
of  his  treatment  to  advocate  the  simultaneous  em- 
ployment of  iodide  of  potassium  and  iodide  of  sodium. 

He  begins  with  small  doses  : — 

Iodide  of  potassium   . .  . .  . .     grs.  xv. 

Iodide  of  sodium        . .         . .         . .     grs.  xv. 

Water $ix. 

Three  large  tablespoonfuls  daily  in  Vichy  water. 
Each  time  the  prescription  is  renewed,  he  raises  the 
doseby  15  grains,  so  that  when  the  patient  has  renewed 
it  ten  times,  he  absorbs  3*  of  iodides  daily.  At  the 
end  of  that  bottle  he  has  been  taking  iodides  thirty- 
seven  days,  and  absorbed  during  that  period  two 
ounces  of  each  kind. 

The  same  author  insists  on  the  necessity  of  estab- 
lishing an  alimentary  regime  for  such  patients.  Pro- 
hibition of  all  fluids  and  acidulated  drinks,  as  little 
meat  as  possible,  light  repasts,  proscription  of  alcoholic 
drinks,  &c. 


German?. 

[from    our    own    correspondent.] 

Bbrmn,  April  23rd,  1904. 

At  the  thirty-third  annual  meeting  of  the  German 
Society  for  Surgery,  Hr.  R.  Kdrte  related  a  case  of 
Suture   of  Vessel  for  Popliteal  Arterio-venous 

»  Aneurysm,  i 
A  boy,  aet.  13,  received  an  injury  in  the  right  popliteal 
space,  which  was  sutured  by  a  surgeon  and  which  healed 
up.  On  account  of  swelling  in  the  region  developing 
later,  he  was  admitted  into  the  Urban  Hospital 
on  January  16th,  where  the  speaker  found  an  arterio- 
venous aneurysm.  As  there  was  severe  eczema  of  the 
part,  he  first  tried  to  reduce  the  swelling  by  pressure, 
but  without  success.  After  the  eczema  had  to  a  great 
extent  subsided,  the  operation  was  performed.  It  was 
found  that  the  popUteal  artery  and  the  popliteal  vein 
were  grown  together  for  a  distance  of  six  millimetres . 
After  separation  the  opening  in  each  was  sutured. 
Recovery  was  uninterrupted  except  for  a  slight  suppura- 
tion in  the  skin  on  account  of  the  eczema  that  was  not 
completely  healed.  The  continuity  of  the  vessels  had  • 
been  restored  and  the  pulse  in  the  anterior  and  pos- 
terior tib  als  could  be  plainly  felt. 

Hr.  Franz  followed  with  a  paper  on 
Clinical    and     Experimental    Contributions    in 

Regard    to    Arterio-venous    Aneurysm. 
He   related   a  case   with   raised    temperature,    when 


452    The  Medical  Press. 


AUSTRIA. 


April  27,  1904. 


as  a  rule  the  temperature  was  lowered.  A  successful 
operation  was  performed.  He  also  related  the  results 
of  his  experiments  on  animals  in  forming  an  artificial 
union  betweenXarteries  and  veins,  and  also  in  the 
formation  of  a  sac  between  an  open  artery  and  an  open 
vein.  In  suture  of  vessels  the  whole  wall  may  be  1 
punctured  fwithout  doing  any  harm  as  a  thrombus  1 
only  took  place  from  infection.  The  conditions  imme- 
diately after  an  experimental  operation  were  the  fol- 


Bustrla. 


[FROM  our  own  correspondent.] 


Vikkma.  April  23rd,  1904, 
Formalin  in  Milk. 
At  the  meeting  for  Padiatria  and  Internal  Medicine 
Moro  raised  the  all-important  question  of  milk  as  a 
foodstuff,  its  danger  of    transmitting  tuberculosis  and 


lowing— the  blood  riured  at  once  out"  ofthe'a^tery  into  '  *s  Preservation  by  the  addition  of  formalin.     Moro 


the  peripheral  end  of  the  vein,  which  became  greatly 
distended,  when  the  central  end  collapsed  with 
peculiar  longitudinal  folds.  After  the  lapse  of  fifteen 
minutes  the  central  end  was  also  filled  and  the  arterial 
blood  could  be  followed  as  high  as  the  vena  cava. 
By  forming  an  intermediary  sac  the  filling  of  the  vein 
was  delayed. 

As  regarded  the  typical  anacroty  or  widening  of  the 
apex  of  the  curve  seen  by  some  observers  and  denied  by 
others,  it  was  typical  in  his  experimental  cases.  Care- 
ful observation,  however,  showed  that  immediately 
after  the  injury  there  was  a  typical  arterial  curve  in  the 


thought  that  Behring  had  added  another  unit  to  our 
knowledge  in  the  immunising  of  milk  by  the  addition 
of  formalin.  Milk  has  been  charged  with  a  number 
of  evils,  particularly  in  the  cultivation  and  transmission 
of  bacteria  or  their  poisons,  which  has  stimulated  many 
active  minds  to  devise  some  method  for  the  removal 
of  this  grave  danger.  With  this  knowledge  Behring 
set  himself  the  difficult  task  of  attempting  something 
to  ameliorate,  if  not  remove,  the  poisonous  property. 
He  commenced  regularly  planned  experiments  on 
animals  to  prove  the  efficacy  of  every  method  he  could 
think  of.     Among  these,  formalin  appears  to  have  met 


veins,  but  that  in  the  course  of  two  or  three  turns  this  1  with. the  most  favour-     ™&  substance  can  be  added 


was  changed  into  an  anacrotic  curve. 

The  thrill  and  rushing  sound  in  an  arterio-venous 
aneurysm  had  been  held  to  be  due  to  vibration  of  the 
walls  of  the  vessels.  Other  observers  considered  them 
to  be  simple  fluid  sounds.  The  speaker  had  now 
discovered  the  following  law  for  them.  When  the 
central  part  of  the  vein  was  ligatured  the  continual 
rushing  in  the  vein  disappeared ;  if,  on  the  other  hand, 
the  peripheral  end  was  ligatured  the  sounds  became 
strong,  a  proof  that  they  were  caused  by  the  inrush 
of  the  arterial  blood  into  the  veins.  If  both  ends 
were  ligatured  only  arterial  sounds  were  heard.  With 
ligature  of  the  veins,  thrombosis  of  the  arteries  always 
took  place.  As  regarded  temperature  after  some  time 
it  was  raised  in  the  neighbourhood  of  the  injury,  but  it 
was  about  normal  in  the  peripheries. 
The  Pathogenesis  of  Lupus  and  its  Significance 
in  Regard  to  Treatment. 

This  subject  is  discussed  by  Dr.  L.  Philippson  in  the 
Arch.  /.  Dermat.,  September,  Bd.  67,  H.i.  Henames 
two  groups  of  lupus  which  must  be  kept  quite  distinct 
from  every  other,  not  only  on  scientific  but  also  on 
clinical  grounds.  One,  which  he  calls  primary,  is  a  local 
disease,  caused  by  infection  from  without  and  occurring 
in_an  individual  previously  healthy ;  when  the  second, 
which  he  calls  secondary  lupus,  occurs  in  an  individual 
already  tuberculous,  the  skin  affection  is  the  result 
of  infection  from  the  tuberculous  disease  already  in 
existence.  The  skin  affection  in  this  case  is  only  a  new 
symptom  of  the  old  disease.  The  first  form  leads,  only 
slowly  and  only  under  certain  conditions  in  which  the 
resistance  in  the  skin  is  lowered,  to  disease  which  really 
deserves  the  name  of  "  eating  spots."  In  most  cases  of 
secondary  lupus  commencing  in  childhood,  on  the  other 
hand,  the  general  weakness  of  constitution  and  possible 
fresh  infection  from  the  original  disease  lead  to  rapid 
advance.  Generally  the  infection  proceeds  from  some 
disease  in  the  neighbourhood  of  the  skin,  the  bones, 
joints,  sheaths  of  tendons,  lymph  glands,  the  nasal 
mucous  membrane  ;  it  more  rarely  is  of  embolic  origin 
from  distant  organs  such  as  the  mesenteric  and  bron- 
chial glands.  The  curability  of  this  form  of  lupus 
depends  essentially  on  that  of  the  primary  disease,  and 
the  treatment  must  in  the  first  instance  be  directed  to 
this.  As  the  complete  cure  of  this  can  often  not  be 
effected  the  prognosis  in  a  bad  case  of  secondary  lupus 
is  grave,  in  spite  of  the  newer  methods  of  treatment  such 
as  the  Finsen  light  and  the^Rontgen  rays. 


to  milk  without  affecting  its  taste  or  smell,  yet  arresting 
all  vegetable  growth  in  the  fluid  for  an  incredible 
length  of  time.  Formalin  may  be  added  to  milk 
in  the  proportion  of  1  in  500,  without  taste  or  smell, 
but  for  bactericidal  purposes  1  in  4,000  is  sufficient, 
and  this  is  not  possible  to  be  detected  in  the  milk  by 
taste  or  smell.  Examples  were  shown  to  the  members 
where  the  milk  had  been  kept  for  two  months  without 
any  sign  of  change  or  decomposition,  although  some  of 
the  samples  had  been  kept  in  the  laboratory  for  six 
days  at  summer  heat.  Two  in  a  1,000  is  a  good  pro- 
portion in  which  to  adminster  this  diet,  which  has  neither 
taste  nor  smell,  according  to  Behring' s  judgment. 
This  is  sufficient  to  destroy  any  tuberculous  germs  that 
may  chance  to  be  in  the  milk,  thus  proving  it  to  be  a 
protective  for  infants  or  invalids,  who  use  milk  largely 
as  a  diet. 

The  result  of  this  practice  is  left  for  the  future,  which 
may  be  discovered  to  be  injurious  to  the  organism, 
even  in  small  doses,  when  constantly  supplied  to  deli- 
cate children.  Already  cases  are  put  forward  where 
renal  complications  have  arisen  from  its  use,  but  such 
conclusions  should  be  received  with. caution.  Behring 
himself  acknowledges  this  danger  as  he  thinks  formalin 
should  not  be  used  in  milk  for  very  young  infants. 
Some  others  of  his  colleagues  have  discovered  in  this 
form  of  treatment  an  eclectic  bactericidal  property,  as 
the  addition  of  formalin  to  milk  does  not  reduce  or 
destroy  the  Bacillus  coli  communis,  but  rather,  on  the 
other  hand,  increases  its  growth  in  new  milk.  As 
practitioners  we  must  be  careful  in  the  adoption  of  such 
theoretical  methods,  notwithstanding  the  authoritative 
pronouncement  of  Behring. 

Hypothetically,  this  appears  to  be  a  safe  way  of  using 
raw  milk,  but  how  are  we  to  reconcile  this  method  with 
the  experiments  of  Schottelius,  who  found  that  all 
these  dreaded  bacteria  in  milk  would  not  live  in  the 
bowel  of  an  infant,  and  far  less  propagate  under  such 
circumstances  ?  Fundamentally,  our  knowledge  in 
feeding  infants  with  cows'  milk  is  somewhat  in  error. 
We  have  too  many  theories  irreconcilable  in  them- 
selves to  be  of  any  use  practically  as  a  substitute  for 
mothers'  milk,  and  as  long  as  this  exists  we  had  better 
keep  close  to  Nature's  example  in  using  the  milk 
without  any  adjunct  that  may  ultimately  prove  to  be 

I  injurious,  as  boiling  Vnilk  has  proved  to  be. 

]  Hematoma  Septi  Narium  Abscendens. 

Konigstein  exhibited  a  child,  _aet/*4.  on  whom  he  had 
operated  for  haemitoma  protrudingfrom  both  nostrils. 


April  27.  iqoi 


OPERATING   THEATRES. 


The  Medical  Press      453 


A  few  weeks  ago  the  child  fell  and  injured  the  nose, 
after  which  two  large  tumours,  about  the  size  of  a  cherry, 
appeared,  entirely  blocking  up  the  lumina  of  the  nose. 
Both  of  the  tumours  were  fluctuating  and  free  from 
the  sides  of  the  nose,  except  at  one  part  in  the  septum. 

Incising  the  tumours  and  examining  the  septal 
cartilage  no  opening  or  communication  could  be  found 
existing  between  the  two  nasal  cavities.  Conservative 
methods  were  tried  without  success.  Finally,  the 
nose  was  split  and  small  flaps  of  mucous  membrane 
removed  at  the  seat  of  growth  with  perfect  success. 

In  connection  with  this  case  he  reported  another, 
uhere  a  child,  aet.  2j,  was  reported  by  Friediander, 
with  a  similar  history,  except  the  previous  accident. 
He  operated  on  the  nasal  tumours  and  histologically 
found  a  great  hypertrophy  of  the  mucous  membrane, 
blood-vessels  and  lymphatics.  There  was  also  much 
thickening  of  the  deeper  fibrous  tissue  involving  an 
irregular  area  of  the  cartilaginous  septum. 

Roth  said  that  these  injuries  often  produced  hema- 
toma in  the  walls  of  the  nasal  cavities  of  varying  sizes 
which  passed  unobserved  for  many  years,  leaving  no 
history  of  their  primary  origin.  He  was  convinced  that 
these  accidents  were  moie  common  than  the  profession 
had  as  yet  recognised. 

Konigstein  was  surprised  at  the  bilateral  neo- 
plasm, which  is  easily  explained  when  the  histology 
of  the  part  is  examined.  Throughout  the  whole  quad- 
rangular cartilage  there  is  a  system  of  fine  canaliculi, 
rapidly  carrying  the  blood  from  one  side  to  the  other. 
We  can  thus  understand  that  if  an  abscess  or  an 
accumulation  of  blood  occur  in  one  side  and  become 
infected  it  will  rapidly  affect  the  other  side,  and  thus 
produce  a  pair  of  fluctuating  tumours  in  the  nose, 
instead  of  one  as  might  be  expected.  If  pus  happens  to 
form  instead  of  blood,  the  same  result  would  occur. 
He  quite  agreed  with  the  treatment  as  the  radical 
operation  was  the  only  successful  method  to  adopt. 


TTbe  ©perattna  Ttbeatres. 


NORTH-WEST    LONDON    HOSPITAL. 

Aspiration  of  Pericardium  for  Sudden  Increase 
op  Heart  Dulness. — Mr.  Mayo  Collier  operated 
on  a  case  of  heart  disease  presenting  symptoms  of 
unusual  interest  and  difficulty.  The  patient,  aet.  24, 
was  admitted  into  the  North-West  London  Hospital 
on  March  6th  last.  He  had  never  been  strong,  and 
the  last  three  or  four  years  had  suffered  from  indigestion, 
with  pain  after  meals.  Nine  months  ago  he  had  com- 
plained of  weakness  in  the  legs.  There  was  no  history 
of  rheumatism,  chronic  cough,  or  any  other  serious 
affection.  On  the  day  of  admission,  the  temperature 
was  1020,  respiration  was  30/pulse  72;  tongue  funed, 
but  skin  moist.  The  apex  of  the  heart  was  outside 
the  middle  line.  There  was  a  systolic  murmur  at  the 
apex,  and  an  occasional  thrill ;  varying  murmurs  could 
be  heard  all  over  the  cardiac  area.  These  were  looked 
upon  as  exocardial.  There  was  no  definite  murmur 
over  the  aortic  orifice,  although  the  pulse  was  dis- 
tinctly aortic  in  character.  The  area  of  cardiac 
dulness  was  increased  outwards,  but  not  increased 
upwards  or  to  the  right.  Pulsation  could  be  seen  in  the 
arteries  of  the  face  and  extremities.  There  was  a 
thrill  over  the  great  vessels  at  the  root  of  the  neck. 
Moist  sounds  were  apparent  on  both  sides  ot  the  chest. 
There  wa<»  crepitation  at  the  left  apex  with  dulness 
and  tubular  breathing.     There  was  apparently  nothing 


abnormal  in  the  abdomen;  there  was  no  albumin  in 
the  urine.  There  was  no  optic  neuritis  or  other  nerve 
lesions.  The  patient  was  inclined  to  be  delirious  at 
times.  Up  to  the  22nd,  the  patient  did  not  improve. 
There  was  now  a  distinct  aortic  diastoUc  murmur. 
The  apparent  pleuritic  sounds  had  become  less  marked, 
and  the  cardiac  dulness  was  less.  The  moist  sounds 
of  the  lungs  had  not  increased.  The  patient  was  now 
very  weak  and  unable  to  sit  up  for  examination. 
The  heart  sounds  were  distant  and  the  pulse  very 
weak,  although  the  area  of  cardiac  dulness  had  not 
ncreased.  The  case  was  seen  by  five  or  six  members 
of  the  staff.  On  the  24th,  Mr.  Collier  was  asked  to 
see  the  case  with  the  physician  in  charge  with  a  view 
to  operative  interference.  The  area  ot  dulness  was 
now  considerably  enlarged,  extending  some  ten  inches 
from  right  to  left,  and  some  nine  inches  from  above 
downwards.  The  patient  was  rapidly  becoming  worse, 
the  smallest  exertion  producing  heart  failure.  The 
diagnosis  lay  between  acute  dilatation  of  the  heart 
and  purulent  effusion  into  the  pericardium.  Mr 
Collier  said  the  condition  of  the  patient  precluded 
any  set  operation  on  the  pericardium  such  as  should 
be  undertaken  were  the  patient  in  a  less  critical  con 
dition.  The  safer  procedure  would  have  been,  i 
possible,  to  cut  down  on  to  the  pericardium,  and 
removing  a  portion  of  rib,  if  necessary.  To  aspirate  the 
pericardium  in  a  doubtful  diagnosis,  the  risk  of  punc- 
turing the  heart  must  necessarily  be  run.  la  this 
case  the  extremely  sudden  increase  of  heart  dulness, 
with  the  rapidly  failing  powers,  pointed  to  fluid  in 
the  pericardium — pus  or  serum.  The  patient  was 
evidently  moribund.  Mr.  Collier  thought  it  was  right 
tolrun  the  risk  of  aspirating  the  area  of  dulness  with  a 
hope  of  relieving  the  urgent  heart  symptoms.  Ether 
being  administered  after  a  strychnine  injection,  Mr. 
Collier  passed  a  fairly  large  size  needle  and  trochar  into 
the  lowest  point  of  dulness.  On  entering  the  peri- 
cardium, the  needle  oscillated,  being  apparently  in 
contact  with  the  heart.  On  being  sUghtly  withdrawn, 
aspiration  produced  about  two  ounces  of  fairly  red 
blood.  A  second  aspiration  produced  the  same  effect. 
No  pus  or  serum  was  mixed  with  or  accompanied  the 
blood.  The  patient  ceased  to  breathe,  and  the  heart 
failed  immediately  after  the  second  aspiration  and 
before  the  trochar  was  withdrawn.  At  the  post- 
mortem there  was  ulcerative  endocarditis  on  all 
the  valves  in  an  early  stage.  There  was  moderate 
dilatation  of  the  heart  ;  there  was  an  oblique  punctured 
wound  at  the  right  ventricle.  valve-Uke  in  character, 
the  internal  and  external  openings  being  some  distance 
from  each  other  ;  there  was  very  little  blood  in  the 
heart ;  the  pericardium  was  healthy,  and  contained 
twenty-four  ounces  of  serum  and  clot ;  there  was 
recent  tuberculosis  of  the  left  apex.  Mr.  Collier  said 
this  case  was  full  of  interest,  both  from  a  medical  and 
surgical  point  of  view.  The  only  surgical  procedure 
that  could  be  adopted  was  adopted  in  this  case.  The 
extremely  sudden  dilatation  of  the  heart  cavities 
rendered  the  diagnosis  uncertain.  The  puncture  of 
the  ventricle  in  the  condition  of  extreme  distension 
and  thinning  of  the  right  ventricle  was  followed  by  a 
rapid  and  extensive  outpouring  into  the  pericardium. 
The  condition  of  the  heart  post-mortem  showed  few 
signs  of  the  condition  previous  to  death,  and  from 
the  position  and  direction  of  the  needle  puncture, 
it  was  difficult  to  see  how  any  quantity  of  blood  could 
have  escaped  into  the  pericardium.  The  malignant 
endocarditis  and  tuberculous  disease  of  the  lung  were 
the  immediate  causes  of  this  man's  deplorable  con- 
dition. 


454    The  Medical  Press. 


LEADING  ARTICLES. 


April  27,  1904. 


Rkoutbbbd  for  Tbaxbmhbioh  Abroad. 

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Ttbe  fl&e&lcal  press  and  Circular, 


SALUS  POPULI  SUPREMA  LEX. 


WEDNESDAY.  APRIL  27,  1904. 


THE  DEVELOPMENT  OF  BRITISH  SPAS 
AND  WATERING-PLACES. 
It  is  to  be  hoped  that  the  wave  of  sentiment 
in  favour  of  all  things  national  which  has  recently 
swept  over  the  country  will  gather  unto  itself 
consistency  as  well  as  strength.  As  regards  our 
spas  and  health  resorts,  both  inland  and  by  the 
sea,  the  United  Kingdom  enjoys  a  selection  almost 
incomparable  for  variety,  beauty  and  salu- 
brity. Yet  the  average  Briton  and,  it  is  to  be 
feared,  also  his  medical  attendant  are  prone  to 
patronise  and  to  recommend  any  foreign  resort  in 
preference  to  those  that  lie  near  at  hand  within 
their  own  sea-girt  shores.  The  reason  is  not  far 
to  seek.  As  a  general  rule  the  English  health  re- 
sort is  not  properly  developed,  and  offers  few 
attractions  to  visitors  in  the  way  of  promenades, 
shelters,  music  and  organised  amusements,  to  say 
nothing  of  adequate  hotel  and  boarding  accom- 
modation. Contrast  that  state  of  things  with  the 
perfect  and  public-spirited  municipal,  machinery 
of  the  average  Continental  spa,  and  the  diversion 
of  patronage  to  the  Continent  is  readily  explained. 
It  is  not  that  France,  or  Germany,  or  Switzerland 
possess  medicinal  springs  of  greater  value  or  air 
of  purer  or  more  health-giving  quality  ;  it  is  be- 
cause the  visitor  in  hotels  or  apartments  can  amuse 
himself  with  bands,  clubs,  winter  gardens,  golf, 
sleighs,  and  finds  everything  carefully  and  pru- 
dently arranged  to  anticipate  his  wants,  hobbies, 
caprices  and  eccentricities.  It  is  true  that  of 
recent  years  some  of  the  more  progressive  of  the 
British  health  resorts  have  risen  to  the  occasion, 
and  have  added  to  the  natural  attractions  of  their 
towns  the  requisite  house-room,  together  with 
the  hardly  less  necessary  equipment  of  recreation 
and  social  intercourse.  Among  such  places  may 
be  mentioned  Buxton,  Scarborough,  Harro- 
gate, Folkestone,  St.  Leonards,  Bournemouth, 
Yarmouth,  Eastbourne,  Blackpool,  Woodhall 
Spa,  and  many  others.  A  great  deal  has  been 
done    to    develop    the    attractions    of    the    Isle 


of  Wight,  but  much  remainsjto  be  done  with  jegard 
tothe  Isle  of  Man,  the  Shetlands,  Orkneys,  the  is- 
lands of  the  Forth  and  the  Scilly  Islands.  Nor  can 
the  beautiful  English  lakes  be  said  to  have  ever  been 
properly  developed,  as  they  would  have  been  in  the 
hands ,  say,  of  a  Swiss  Canton .  Still  less  have  the  in- 
describable beauties  of  the  Irish  lakes  ever  been 
rendered  accessible  and  attractive  to  the  British 
people  in  search  of  health,  or  of  rest  and  change. 
To  some  extent  the  railway  companies  have  been 
to  blame,  by  reason  of  the  costliness  and  incon- 
venience of  their  service.  Of  late  years,  however, 
the  great  railway  corporations  have  shown  a  most 
laudable  desire  to  develop  the  health  resorts  on  their 
routes  in  every  way  in  their  power.  In  this  way  the 
Great  Eastern,  the  London  and  North  Western, 
the  Great  Western,  the  London  and  South 
Western,  the  London,  Brighton,  and  South  Coast 
South  Eastern  and  Chatham,  and  the  North 
British,  to  mention  only  a  few,  have  rendered  a 
vast  public  service  by  making  known  the  manifold 
attractions  of  marine  and  inland  watering-places, 
by  cheapening  and  extending  the  service  of  trains, 
and,  in  some  instances,  by  supplying  hotel  accom- 
modation. The  Highlands  have  been  greatly  deve- 
loped in  this  way,and  by  the  combination  of  rail  with 
steamboat  and  coaching  accommodation ;  but  much 
still  remains  to  be  done  in  those  directions.  The  mat- 
ter is  one  in  which  the  medical  profession  is  consider- 
ably interested,  for  it  may  be  assumed  that  most 
medical  men  would  prefer  having  their  patients 
at  home  in  charge  of  British  practitioners  than 
abroad,  under  the  care  of  foreigners,  however 
skilful  and  conscientious.  A  similar  feeling  of 
additional  comfort  and  security  would  probably 
be  felt  by  the  patients  themselves,  especially  by 
those  not  conversant  with  one  or  more  foreign 
languages.  So  far  as  the  medical  profession  is 
concerned,  a  few  spasmodic  attempts  have  been 
made  at  a  collective  investigation  of  the  merits 
of  British  health  resorts  from  both  the  scientific 
and  the  social  standpoints.  A  great  deal  more  is 
required,  however,  to  bring  the  information  to  the 
high  general  standard  desirable  in  such  a  matter. 

THE  MILK  SUPPLY  OF  TOWNS. 
No  word  can  be  considered  supererogatory 
whilst  the  present  unsatisfactory  system  of  milk 
supply  in  towns  continues.  The  conditions  under 
which  milk  is  obtained,  transported,  stored,  and 
distributed  in  most  large  towns  leave  a  large  margin 
for  contamination,  adulteration,  and  deteriora- 
tion. In  the  case  of  a  food  of  such  vital  import- 
ance~these  gratuitous  risks  should  be  impossible, 
and  could  be  made  so  were  a  proper  degree  of 
interest  taken  in  the  matter  by  the  public.  At 
present  they  seem  to  content  themselves  with  the 
reflection  that  "  the  pedigree  of  honey  does  not 
concern  the  bee/'  and  continue  to  drink  dirty  and 
adulterated  milk  and  give  it  to  their  children  with 
the  greatest  complacency.  Yet  if  there  is  one 
subject  on  which  the  whole  medical  profession  can 
speak  with  a  united  voice,  and  with  no  reserve,  it 
is  on  the  value  of  milk  as  an  article  of  diet,  not 
only  for  the  healthy  but  also  for  the  sick  and  the 


April  27.  1904. 


LEADING  ARTICLES. 


The  Medical  Press.     455 


young ;  and  inasmuch  as  it  constitutes  the  staple, 
if  not  the  sole,  food  of  the  two  latter  classes,  it 
is  of  the  first  importance  that  a  pure  and  whole- 
some supply  should  be  always  at  hand.  Nowadays 
when  the  breast  feeding  of  infants  has  gone  out 
of  fashion — with  all  its  advantages — the  necessity 
has  become  all  the  greater,  and  yet  it  may  be 
said  that  every  day  makes  it  more  difficult  to  get 
fresh  milk  of  a  dependable  character.  With  the 
increase  of  urban  populations — 70  per  cent,  of  the 
inhabitants  of  this  country  are  now  town  dwellers 
—milk  has  to  be  obtained  from  greater  and 
greater  distances,  and  in  the  case  of  the  Metropolis 
even  Scotland,  Cornwall,  and  the  Continent  have 
been  drawn  upon  to  supply  "  fresh  "  milk.  True, 
there  are  a  certain  number  of  urban  and  suburban 
dairies  which  keep  their  own  cows  and  produce 
milk  under  something  'approaching  healthy 
conditions,  but  in  the  London  area  these  supply 
only  about  one-fifteenth  of  the  demand,  and  the 
rural  districts  from  which  the  remaining  fourteen- 
nfteenths  come  lie  outside  the  jurisdiction  of  the 
councils,  county  and  borough,  that  control  the 
districts  where  the  milk  is  consumed.  What  is 
required  is  a  complete,  systematic  inspection  of 
the  milk  from  its  source  to  its  destination.  Hy- 
gjenists  are  always,  and  quite  properly,  drawing 
attention  to  the  enormous  drain  on  the  efficiency 
of  the"  nation  made  by  the  annual  loss  of  infant 
lives,  due  principally  to  diarrhoea  and  diseases 
of  nutrition.  To  counteract  this,  several  enter- 
prising^ municipalities  have  inaugurated  depots 
where  sterilised  milk  is  sold  at  a  low  figure,  but 
without  going  into  a  discussion  of  the  desirability 
of  municipal  trading,  we  may  say  that  such  a 
course  is  at  best  only  a  pis-oiler.  Fresh,  clean  milk 
from  healthy  cows  does  not  need  to  be  sterilised — 
that  is,  assuming  the  conditions  of  distribution  to 
be  sanitary — and  there  is  no  reason  why  it  should 
not  be  available  if  proper  precautions  are  enforced. 
Moreover,  the  sterilisation  of  milk  has  been  shown 
to  deprive  it  of  some  principle  that  acts  as  an 
anti-scorbutic,  and  even  pasteurised  milk  has 
lately  been  shown  to  be  capable  of  producing 
scurvy  in  infants  fed  on  it  alone.  So  that  apart 
from  the  undesirability  and  expense  of  subjecting 
milk  to  artificial  processes,  it  cannot  be  held  to 
be  wholly  innocuous  after  it  has  been  treated. 
The  whole  question  'needs  to  be  dealt  with  in  a 
firmjmd  enlightened  manner.  We' are  not  among 
those  who  make  unduly  fight  of  "the" danger  of 
tuberculosis  being  conveyed  by  milk,  nor  among 
the  alarmists  who  see  danger  in  every  can  of  un- 
sterilised  milk  ;  but  we  think  that  no  cow  giving 
a  tuberculin  reaction  should  be  used  for  dairy 
purposes,  and  certainly  none  with  tuberculous 
deposit  in  the  udder.  The  systematic  inspection 
of  the  cows  themselves  by  competent  veterinary 
surgeons  is  of  the  greatest  moment.  No  less  so  is 
the  condition  of  their  byres  and  milking  sheds. 
Some  farms  are  filthy  to  the  last  degree.  Then 
the  pails  and  cans  should  be  cleansed  with  boiling 
water  and  steam  before  and  after  use,  and  not 
merely  rinsed  out  in_an  adjacent  stagnant  pond. 


The  next  great  need  is  for  a  sound  system  of  trans- 
port for  the  milk  from  the  farm  to  the  dairy. 
This  seems  impossible  of  accomplishment  without 
co-operation  between  those  unenterprising  in- 
dividuals, the  farmers,  and  the  railway  companies. 
If  proper  vans  could  collect  tne  milk  irom  various 
farms  for  stated  trains,  it  would  be  possible  to- 
force  the  railway  companies  to  supply  special 
carriages  which  could  be  cooled  and  ventilated  in 
warm  weather.  No  preservatives  are  necessary 
to  keep  milk  if  measures  are  adopted  by  which 
it  can  be  kept  at  a  temperature  below  that  at 
which  bacterial  activity  takes  place,  and  though  it 
is  difficult  to  say  exactly  that  small  quantities 
of  such  antiseptics  as  boric  acid  and  borax  are 
injurious,  they  are  certainly  not  desirable,  if  only 
because  they  permit  stale  milk  to  be  passed  off  as 
fresh.  In  a  well-regulated  milk  trade,  where  long 
distances  have  to  be  traversed,  locked  cans  should 
be  used,  so  that  adulteration  cannot  take  place. 
The  crude  method  of  adding  water  to  milk  is  less 
usual  than  it  was,  but  the  addition  of  separated 
milk  and  the  removal  of  part  of  the  cream  have 
taken  its  place,  and  under  the  present  legal  stan- 
dard it  is  often  difficult  to  assert  in  the  case  ot 
poor  milk  that  it  has  actually  been  tampered  with 
in  these  ways.  A  good  supply  of  pure  fresh  milk  is 
to  be  obtained  if  it  is  demanded  authoritatively  and 
unanimously,  but  as  Turgot  said  in  another  con- 
nection, "It  is  not  error  which  opposes  the  pro- 
gress of  truth  ;  it  is  indolence,  obstinacy,  and  the 
spirit  of  routine.' ' 


THE  REGISTRATION  OF  BOGUS  MEDICAL 
COMPANIES. 
A  decision  of  great  importance  to  both  the 
medical  and  the  dental  professions  was  given  in 
the  Court  of  the  King's  Bench  in  Ireland  on  . 
Wednesday  last,  in  the  case  of  the  King  (Rowell)  r. 
the  Registrar  of  Joint  Stock  Companies.  The 
case  before  the  Court  was  in  the  form  of  an  appli- 
cation on  behalf  of  a  man  named  Rowell  to  make 
absolute  a  conditional  order  for  mandamus  direct- 
ing the  Registrar  of  Joint  Stock  Companies  to 
register  the  company  entitled  "  S.  G.  Rowell, 
Dentists,  Limited."  The  applicant  was  a  dentist 
in  Clonmel,  and  his  business  had  been  formed 
into  a  joint  stock  company.  Application  had 
been  made  to  the  Registrar,  but  he  had  put  off 
the  registration  of  the  company,  owing,  ap- 
parently, to  some  recent  legal  decisions,  although 
it  was  stated  that  by  the  17th  section  of  the  Com- 
panies Act,  1862,  he  was  obliged  to  register  when 
the  documents  were  in  order.  The  application 
was  opposed  on  behalf  of  the  Irish  Branch 
of  j  the  British  Dental  Association  on  the 
ground  that  under  the  Dental  Act  of  1878 
no  person,  unless  fully  qualified,  "was  en- 
titled to  use  the  name  dentist,  that  a  certain, 
training  was  required  by,  and  certain  formalities 
were  obligatory  on,  all  persons  who  become  dentists, 
and  that  what  the  applicant  could  not  do  as  an 
individual  he  could  not  do  on  forming  his  business 
into    a   company.     The    Lord    Chief    Baron,    in 


456    The  Medical  Press.      NOTES    ON    CURRENT    TOPICS. 


April  27,  1904.. 


delivering  judgment,  held  that  the  first  sentence 
in  the  3rd  section  of  the  Act  of  1878  amounted  to 
a  statutory  definition  of  the  word  "  dentist," 
and  meant  that  for  the  future  a  dentist  should 
mean  a  registered  dentist.  In  the  present  case 
the  company  was  not,  and  could  not  be,  registered  | 
under  the  Act  of  1878,  and  such  a  registration 
would  imply  that  there  was  a  business  of  dentist 
carried  on  by  registered  persons,  and  as  the  aid 
of  that  Court  could  not  be  granted  for  the  purpose 
of  effecting  a  false  representation,  the  application 
must  be  refused  with  costs.  This  decision  is  of  the 
utmost  importance,  as  it  not  only  rules  the  par- 
ticular case  that  was  before  the  Court,  but  will 
iorm  a  precedent  which  will  govern  all  similar 
•cases,  and  so  will  permit  the  Registrar  of  Joint 
Stock  Companies  to  refuse  to  register  bogus 
companies.  Further,  even  if  the  Registrar 
should  accede  to  the  request  for  registration, 
the  decision  puts  it  in  the  power  of  any 
interested  party  to  obtain  an  injunction 
to  prevent  him  from  so  doing.  The  Irish 
Branch  of  the  British  Dental  Association 
is  to  be  heartily  congratulated  on  its  success. 
We  do  not  know  what  effect,  if  any,  the  decision  * 
will  have  on  the  status  of  those  bogus  companies 
that  have  been  already  registered  as  "  dentists," 
and  "  physicians,"  and  "  surgedns,"  but  if  there 
is  any  means  of  rescinding  their  registration  we 
trust  that  the  British  Dental  Association  will 
not  be  content  until  they  have  obtained  such  a 
result.  It  is  strange  that  these  efforts  to  maintain 
the  dignity  of  the  medical  and  dental  professions 
should  be  wholly  left  to  the  Dental  Association. 
The  medical  profession  is  a  far  stronger  body  of 
men,  and  ought  to  be  better  organised ;  still  we 
are  not  aware  that  any  effort  has  been  made  by  it 
to  cope  with  similar  bogus  companies  who  are  re- 
gistered as  "  physicians  "  and  "  surgeons."  In 
a  recent  issue  we  called  attention  to  the  fact  that 
a  company  terming  itself  the  American  Electro- 
Vibration  Institute  had  an  office  in  Kildare  Street, 
Dublin,  and  that  it  termed  its  members  or  its 
servants,  whichever  they  may  be,  "  physicians." 
If  these  men  are  physicians,  why  does  not  the 
General  Medical  Council  take  action  to  compel  them 
to  dissociate  themselves  from  an  advertising 
company  ?  If  they  are  not  physicians,  why  does 
not  the  Irish  Medical  Association,  or  some  kindred 
body,  take  action  to  protect  the  privileges  of  the 
medical   profession  ? 


Vlotes  on  Current  Tropics, 

The  Streets  at  Night. 
It  is  not  easy  for  the  sound  sleeper  to  sym- 
pathise with  those  to  whom  every  passing  hour  is 
an  agony  and  each  sound  a  veritable  torture.  Some 
there  are  who  actually  cannot  bear  silence  at 
night-time,  and  who  welcome  extraneous  noises  as 
serving  to  remind  them  that  they  are  in  a  habitable 
world.  The  increased  excitability  of  the  wakeful 
mind  during  the  hours  of  darkness  is  in  itself  pro- 
luctive  of  much  suffering  and  vexation  of  spirit. 


"  Night  hath  no  wings  to  him  that  cannot  sleep," 
and  only  those  who  are  so  unfortunate  as  to  be 
deprived,  almost  nightly,  of  Nature's  restorer  can 
adequately  describe  the  mental  agony  and  sub- 
sequent depression  which  they  endure.  There  is 
little  time  of  absolute  quiet  in  a  large  city  during 
the  night,  for  hardly  have  the  wheels  of  hansom 
cabs,  with  their  pleasure-seeking  occupants,  ceased 
to  reverberate  than  the  slow,  measured  tramp  of 
the  sturdy  cart-horse,  drawing  his  load  of  hay  or 
garden-produce  on  the  way  to  market,  echoes  down 
the  street.  A  new  nocturnal  terror  has  lately 
appeared  to  threaten  the  peace  of  slumberers  in 
certain  of  our  suburbs,  namely,  the  ponderous 
traction-engine,  with  its  noisy  puffing  and  earth- 
shaking  motion.  We  cordially  sympathise  with 
the  ex-Mayor  of  Hackney  (Dr.  F.  Montague 
Miller)  in  his  efforts  to  influence  the  London 
County  Council  to  forbid  the  passage  of  these 
heavy  vehicles  along  the  suburban  streets  at  night. 
In  the  north-eastern  districts  of  the  metropolis  the 
nuisance  appears  to  have  much  increased  of  late, 
and  the  health  of  many  persons  is  really  seriously 
interfered  with  owing  to  their  rest  being  disturbed 
in  that  way.  The  second  schedule  of  the  new  code 
of  by-laws  drafted  by  the  Public  Control  Com- 
mittee of  the  County  Council  includes  many 
thoroughfares  in  which,  on  account  of  inconveni- 
ence to  inhabitants,  traction  engines  are  only  to 
be  allowed  between  the  hours  of  7  a.m.  and  10  p.m. 
The  number  of  streets  in  this  schedule,  however, 
needs  to  be  greatly  increased. 

Experimental  Typhoid. 

The  recent  report  by  Dr.  Albert  Grunbaum  of 
his  researches,  begun  whilst  he  was  holding  the 
Ernest  Hart  Memorial  Scholarship,  is  of  the 
greatest  interest.  Dr.  Grunbaum's  object  was  to 
attempt  to  test  the  specificity  of  Eberth's  bacillus, 
in  the  production  of  typhoid  fever,  by  seeing 
whether  it  could  be  made  to  fulfil  Koch's  postulate 
that  a  pure  cultivation  of  an  organism  introduced 
into  the  blood  and  tissues  of  an  animal  should 
reproduce  the  phenomena,  clinical  and  anatomical, 
of  the  disease.  This  condition  has  never  been 
satisfactorily  fulfilled  by  the  bacillus  in  question, 
except  in  the  case  of  Remlinger's  experiments  on 
rabbits  fed  on  cabbages  infected  with  typhoid 
cultures,  and  some  of  those  of  Chantemesse.  Dr. 
Grunbaum  managed  to  secure  four  chimpanzees 
for  his  experiments — a  happy  circumstance,  con- 
sidering how  expensive  and  oUfncult  to  procure  are 
anthropoid  apes.  The  first  one  was  given  one  centi- 
metre of  broth  culture  of  bacillus  typhosus  in 
milk,  and  though  WidaTs  reaction  was  not  given 
very  markedly  by  the  blood,  after  death  the 
Peyer's  patches  were  enlarged  and  swollen,  as  were 
also  the  mesenteric  glands  and  the  spleen.  The 
organism  was  also  recovered  from  broth  cultures 
of  the  spleen.  The  second  animal  was  given  a 
similar  dose,  and  for  the  following  ten  days  the 
agglutinative  reaction  was  given  by  the  blood  in 
increasingly  high  dilutions,  the  highest  being 
one  in  eighty,  obtained  in  half  an  hour.  At  the 
post-mortem  similar  appearances  to  those  noted 


April  27,  1904. 


NOTES    ON    CURRENT    TOPICS.       The  Medical  Piess.    457 


in  the  first  case  were  seen,  some  of  the  agminated 
follicles  showing  distinct  ulceration.  The  last 
two  chimpanzees  died  of  other  causes,  but  one  of 
them  gave  a  well-marked  Widal's  reaction  for  ten 
days  following  infection  in  a  dilution  of  1  in  30. 
The  temperature  charts  were  not  characteristic 
of  typhoid  fever,  but  the  chimpanzee  seems  to  be 
an  animal  whose  normal  temperature  is.  very  erra- 
tic. Much  patience  and  skill  must  have  been 
needed  to  obtain  this  result,  and  Dr.  Grunbaum 
is  to  be  congratulated  on  his  valuable  contribu- 
tion to  the  difficult  subject  he  had  in  hand.  One 
hopes  that  he  may  find  the  opportunity  of  con- 
tinuing his  work  as  he  wishes  to,  especially  in  the 
direction  of  elucidating  some  of  the  mysteries  of 
41  paratyphoid  "  fever. 


Popular  Impressionability. 

The  death  of  Sir  Henry  Thompson  serves  to 
remind  one  of  the  story  he  used  to  tell  of  how 
his  front-door  was  besieged  for  several  months 
after  he  had  operated  on  the  King  of  the  Belgians 
for  stone  in  the  bladder  by  people  who  fancied  they 
were  suffering  from  a  similar  complaint.  A  few 
of  them  actually  had  calculi,  but  the  large  ma- 
jority were  victims  of  their  own  impressionability. 
Their  imagination  had  been  fired  by  reading  the 
newspaper  accounts  of  the  illness,  and  a  turn  for 
morbid  introspection  completed  the  delusion. 
The  last  illness  of  the  Emperor  Frederick  brought 
Sir  Morell  Mackenzie  many  sufferers  from  similar 
psychical  affections  of  the  throat,  and  most  prac- 
titioners have  seen  a  good  many  patients  with 
pseudo-appendicitis  during  the  last  year  or  two. 
Few  of  us,  indeed,  have  been  free  from  imaginative 
maladies  of  a  more  or  less  serious  and  fleeting 
nature.  It  is  a  curious  phase,  this,  of  the  psy- 
chology of  highly  civilised  man,  and  it  is  difficult 
to  decide  if  it  be  a  mere  extension  of  the  mimick- 
ing tendencies  of  his  arboreal  ancestors  or  a 
new  development  in  the  education  of  self-con- 
sciousness. The  fact,  however,  is  undoubted.  One 
sensationalsuicide — suchasthat  of  Whitaker  Wright 
—is  almost  invariably  followed  by  others  among 
obscure  people,  and  the  epidemicity  of  self-destruc- 
tion is  almost  as  well  marked  as  are  the  curves  of 
typhoid  and  scarlet  fever.  Two  interesting  little 
episodes  reported  last  week  from  Paris,  taken 
together,  tend  to  show  that  these  curious  happen- 
ings take  origin  eventually  in  the  imitative  faculty 
that  lies  dormant  in  each  of  us.  The  first  of  these 
was  the  discovery  by  a  waterman  of  some  boys 
dragging  a  big  box  by  a  string  through  the  river. 
Asked  what  they  were  doing,  the  boys  replied, 
"  Playing  at  submarines,"  and  on  further  inquiry 
the  submarine  was  found  to  contain  its  human 
freight  in  the  shape  of  a  young  companion,  who 
was  nearly  drowned.  Here,  surely,  was  a  case  of 
direct  realistic  imitation.  The  other  was  like 
unto  it.  A  man  dressed  in  semi-nautical  costume 
was  stopped  by  the  police  just  in  time  to  prevent 
him  flinging  himself  under  an  electric  tram  under 
the  idea  that  he  was  a  torpedo.  Of  course  he 
was  insane,  and  his  brain  had  been  inflamed  by 
accounts  of  the   Japanese  war.     The   desire   to 


re-create  is  nearly,  if  not  quite,  as  strong  as  the 
desire  to  create.  Fortunately,  it  generally  de- 
velops along  more  orthodox  lines. 


Treatment  by  Proxy. 

It  is  an  unwritten  rule  in  the  medical  profession 
never  to  prescribe  for  a  patient  without  first  seeing 
him,  though  it  is  one  from  which  departure  has 
occasionally  to  be  made  under  exceptional  circum- 
stances. But  in  this  country,  at  all  events,  it  has 
yet  to  be  learnt  that  treatment  can  be  ad- 
ministered to  one  patient  with  a  view  to  relieving 
another.  Perhaps  of  all  therapeutical  measures 
the  administration  of  a  purgative  could  least  be 
expected  to  do  good  by  proxy.  This  view,  how- 
ever, does  not  seem  to  obtain  among  the  Kaffirs. 
In  a  most  interesting  book  just  published  on  the 
manners  and  customs  of  the  Kaffirs,  a  story  is 
related  by  the  author,  Mr.  Dudley  Kidd,  of  a  man 
who  came  to  him  relating  various  symptoms  that 
pointed  to  lethargy  of  the  colon.  He  met  the 
indication  by  prescribing  jalap  and  Epsom  salts, 
which  the  man  took,  explaining  that  though  he 
himself  was  enjoying  the  most  perfect  regularity 
in  his  daily  habits,  such  was  not  the  case  with  his 
wife,  but  that  now  that  he  had  swallowed  the 
medicine  doubtless  his  consort  would  be  relieved 
of  her  symptoms.  The  Kaffir  idea  of  medicine  is 
that  it  acts  as  an  antidote  to  magic,  and  as  dis- 
tance does  not  affect  the  potency  of  magic  neither 
does  it  affect  that  of  medicine.  One  has  often  been 
touched  by  the  belief  of  poor  patients  in  the 
efficacy  of  a  bottle  of  medicine,  but  their  faith 
must  certainly  yield  to  the  Kafiir's  in  this  instance. 

Official  Hair  splitting. 

One  of  our  contemporaries  of  the  drug  trade 
interests  its  readers  from  time  to  time  by  pub- 
lishing examples  of  the  ingenuity  shown  by  officials 
of  the  Board  of  Inland  Revenue  in  deciding  what 
labels  render  a  medicine  liable  to  duty.  It  will  be 
remembered  that  a  description  attached  to  a  pack- 
age recommending  it  as  a  cure  for  any  disease 
or  ailment  renders  it  subject  to  a  tax,  unless  the 
composition  be  clearly  stated.  In  the  application 
of  this  rule  there  is  room  for  considerable  casuistry, 
and  we  do  not  know  which  to  admire  more,  the 
attempts  at  evasion  on  the  part  of  druggists,  or 
the  lynx-eyed  discrimination  shown  by  the  Govern- 
ment clerks.  As  instances  of  the  latter,  we  may 
quote  the  decision  that  of  the  two  following  de- 
scriptions : — "  Digestive  tablets,  composed  of  rhu- 
barb, ginger,  cardamoms,  and  other  stomachic 
and  antiacid  ingredients/ '  "  Digestive  tablets, 
composed  of  rhubarb,  ginger,  cardamoms,  and 
other  valuable  ingredients,"  the  former  is  liable 
to  duty,  and  the  latter  not.  Apparently  the  word 
"  antiacid  "  is  responsible,  for  we  find  in  other  in- 
stances that  that  same  word  constitutes  the 
principal,  if  not  the  only,  difference  between  a 
dutiable  and  a  non-dutiable  description.  Again, 
we  find  that  "  Throat  lozenges,  astringent  and 
heading,' '  must  pay,  but  "Balsamic  throat  pellets  " 
escape.  "  Soothing  syrup  "  passes  unchallenged, 
but  when  the  direction  is  added,  "  to  be  taken 


458  The  Medical  Press.  NOTES    ON    CURRENT    TOPICS. 


April  27,  1904. 


until  free  from  pain/'  the  claims  of  Government 
must  be  satisfied.  We  confess  that  these  fine 
distinctions  of  tweedle-dum  and  tweedle-dee  are 
quite  beyond  us,  and  we  can  only  regret  that  public 
servants  are  not  employed  in  some  useful  occu- 
pation. 


Premature  Burial. 
The  will  of  the  late  Miss  Frances  Power  Cobbe, 
on  which  we  commented  last  week,  draws  atten- 
tion to  the  periodically  recurring  bogey  of  pre- 
mature burial.  As  has  often  been  pointed  out, 
the  fear  of  being  buried  alive  is  one  of  the  most 
baseless  of  all  fears,  yet  from  time  to  time  it  gains 
an  extraordinary  hold  on  the  public  mind.  There 
is  a  Bill  at  present  before  the  Massachusetts 
Legislature  providing  an  alarming  list  of  fines 
and  punishments  for  those  who  shall  neglect  any 
of  the  prescribed  precautions  against  premature 
burial.  It  is  forbidden  to  put  "  corpses  "  into 
coffins  which  exclude  light,  air,  or  movement  until 
certain  tests  of  death  shall  have  been  satisfied. 
The  tests  are  sufficiently  stringent,  since,  although 
no  less  than  ten  other  criteria  are  given,  no  body 
is  to  be  accounted  dead  until  decomposition  shall 
have  set  in.  Among  the  subsidiary  tests  are  ab- 
sence of  heart-sounds  and  breath-sounds  to  stetho- 
scopic  examination,  equalisation  of  temperature 
with  that  of  the  surrounding  air,  coagulation  of 
the  blood  in  the  veins,  and  presence  of  rigor  mortis. 
"  Provided,  further,  that  if j[there~is~aTny~"absence 
of  the  signs  of  death  except  decomposition,  all 
known  means  of  resuscitation  shall  be  tried  while 
such  signs  are  absent.*1  Miss  Cobbe's  method 
of  making  sure  is  much  simpler  than  this 
elaborate  nonsense. 


Olive  Oil  as  a  Therapeutic  Agent. 

There  are  few  agents  in  materia  medica  to 
which  less  space  is  usually  given  in  the  text-books 
than  olive  oil,  a  few  lines  being  considered  suffi- 
cient to  mention  that  it  has  nutritive  qualities  of 
importance,  and  that  it  may  be  substituted  for 
cod-liver  oil.  During  the  last  few  years,  however, 
observers  in  Germany  and  America  have  drawn 
attention  to  the  high  value  of  this  drug  in  very 
varying  conditions  of  disorder  in  the  stomach 
and  intestines.  In  chronic  dysentery  excellent 
results  have  followed  the  continued  use  of  olive 
oil  given  in  large  quantities.  Starting  with  a 
dose  of  one  ounce  three  times  a  day,  this  is  gradu- 
ally increased  to  four  ounces.  Very  little  objec- 
tion is  made  to  the  taste  of  the  oil,  and,  after  a 
short  time,  patients  develop  a  liking  for  it.  The 
beneficial  results  obtained  are  ascribed  by  some 
observers  to  a  supposed  stimulation  of 
the  secretion  of  bile.  In  the  very  dif- 
ferent condition  of  gastric  ulcer,  Cohnheim  has 
longjrelied  on  olive  oil  as  an  adjunct  in  treatment. 
He  believes  that  it  relieves  pain,  lubricates  sur- 
faces of  ulcers  or  fissures,  reduces  hyperacidity, 
and  acts  as  an  easily  digested  food.  In  employ- 
ing olive  oil,  one  should  take  precautions  to  make 
sure  that  the  oil  is  pure,  as  in  commerce  it  is 


commonly  adulterated  to  a  large  extent  with 
cotton-seed  oil,  a  body  whose  therapeutic  and 
nutritive  qualities  have  not  been  fully  examined. 


Piano-Tuner's  Lunacy. 
An  amusing  illustration  of  hasty  generalisation 
from  a  single  instance  has  recently  gone  the  round 
of  the  Press.  A  piano-tuner,  apparently  filled  with 
forebodings  of  coming  insanity,  drew  up  a  short 
narrative  of  his  mental  position,  which  he  attributed 
to  the  terrible  monotony  of  the  pursuit  by  means  of 
which  he  gained  his  livelihood.  Without  further 
ado  the  new  malady  of  "  piano -tuner's  insanity  " 
secured  a  firm  foothold  in  the  great  mountain  of 
popular  beliefs,  where  it  will  probably  linger  for 
the  next  two  or  three  centuries.  As  a  matter  of 
fact,  piano-tuners  are  not  in  the  least  liable,  as  a 
class,  to  become  insane.  Piano-tuning  is  a  healthy 
occupation,  a  fact  that  in  itself  would  render  any 
undue  stress  upon  the  nervous  system  unlikely. 
The  trades  that  have  a  low  comparative  mortality 
according  to  occupation  are  those,  broadly  speak- 
ing, that  suffer  least  from  insanity.  Take  fisher- 
men, with  a  mortality-rate  of  60  per  cent,  com- 
pared  with  a  standard  mortality  figure  of  1,000*; 
agriculturists'stand  at  ( 1,000,  and  both  are  a^toler- 
ably  sane  class,  the  proportion  of  deaths  from  nervous 
disease  being  5 1  in  the  fishermen  and  102  in  the 
agriculturists.  At  the  other  extreme  we  may 
instance  lead-workers,  with  a  mortality  of  1,983* 
nervous  diseases  being  161  ;  costermongers, 
1,652  and  139  ;  and  file-makers,  18 10  and  212 
respectively.  Piano-tuning  is  not  a  highly  intel- 
lectual occupation,  nor  does  the  possession  of  the 
faculty  to  acquire  that  art  necessarily  imply  well- 
developed  brain  faculties  generally.  It  may  be 
relieved,  however,  of  the  stigma  of  causing 
insanity. 


Joseph  Black,  M.D. 

At  the  first  annual  Commemoration  Day  of  the 
University  of  Glasgow,  Sir  William  Ramsay, 
K.C.B.,  Professor  of  Chemistry  in  University 
College,  London,  delivered  a  most  interesting 
address  upon  Joseph  Black,  M.D.,  the  famous 
chemist  of  the  18th  century.  He  was  the  son  of 
a  native  of  Belfast  of  Scotch  extraction,  whose 
father  was  a  wine  merchant  at  Bordeaux,  where 
Joseph  Black  was^born  in  1728.  He  was  educated 
at  the  University  of  Glasgow  and  early  attracted 
the  attention  of  Cullen,  at  that  time  lecturer  in 
chemistry.  Black  graduated  M.D.  in  Edinburgh, 
in  1754  ;  two  years  later  he  succeeeded  Cullen  in 
the  chair  of  anatomy  and  the  lectureship  in 
chemistry  at  Glasgow.  Shortly  afterwards,  how- 
ever, he  exchanged  the^chair  of  anatomy  for  that  of 
medicine  and  engaged  in  medical  practice.  In 
1766,  Cullen  became  professor  of  medicine  at 
Edinburgh,  and  Black  succeeded  him  in  the  chair 
of  chemistry.  He  became  a  founders'  teacher  and 
worked  hard  all  his  life.  Black's  greatest  work 
was  his  research  on  fixed  air  ;  he  showed  that  a  gas 
could  be  retained  by  a  solid,  and  afterwards  be 
made  to  escape  by  acid  or  by  heat ;  he  was  then 
led  to   the  discovery    of    latent  heat,  and  his 


April  *7.  1904. 


NOTES  ON  CURRENT  TOPICS. 


researches  upon  this  subject,  though  carried  on  at  a 
time  when  precision  in  experiment  was  very  difficult, 
gave  a  value  for  the  latent  heat  of  water  which  was 
within  one  seven-hundredth  of  that  subsequently 
established.  Black's  proof  that  the  change  of  a 
complex  compound  to  simpler  compounds,  and  the 
building  up  of  a  complex  compound  from  simpler 
ones  could  be  followed  successfully  by  the  use  of 
the  balance,  has  had  for  its  consequence  the  whole 
development  of  chemistry.  He  died  in  his  seventy- 
first  year  in  the  year  1799,  and  wa3  one  of  the  master 
minds  of  that  have  graced  the  medical  profession. 

A  Hat  Exterminator. 
Some  parts  of  the  United  Kingdom  have  recently 
been  invaded  with  swarms  of  rats,  much  to  the 
damage  and  consternation  of  the  inhabitants. 
Their  misfortune  is  one  of  no  little  seriousness,  for 
it  is  an  extremely  difficult  matter  to  get  rid  of 
a  plague  of  that  kind .  Some  comfort  may,  perhaps, 
be  afforded  them  by  learning  that  the  goddess  of 
omnipotent  science  has  come  to  the  aid  of  their  fellow- 
sufferers  in  France,  that  is  to  say,  if  we  may  accept 
the  authority  of  a  contemporary  upon  that  point. 
The  cost  to  France,  according  to  that  journal,  of  the 
plague  of  rats,  voles,  and  field  mice  has  been 
estimated  at  /8 ,000 ,000  per  annum,  and  the  official 
Journal  of  our  Board  of  Agriculture  for  April 
reports  that  drastic  measures  have  been  taken  to 
eradicate  the  pest.  The  French  Government, 
after  experimenting  with  the  aid  of  the  Pasteur 
Institute,  have  adopted  a  poison  discovered  by  Dr. 
Danysz,  which,  it  is  claimed,  is  fatal  to  rats  and 
voles,  but  not  injurious  to  mankind  or  domestic 
animals.  It  costs  about  is.  6d.  per  acre,  exclusive 
of  labour.  The  news  seems  almost  too  good  to  be 
true,  but  if  the  exterminator  prove  anything  like 
equal  to  its  description,  the  labours  of  port  sanitary 
officers  will,  in  future,  be  materially  lightened. 


The  Medical  Press.    459 


Notonecta,  a  Destroyer  of  Malaria. 
One  comforting  fact  about  modern  science  is 
that  the  discovery  of  a  first  cause  of  disease  is 
sure,  sooner  or  later,  to  be  followed  by  the  intro- 
duction of  a  remedy.  Thus,  the  days  of  the  deadly 
malaria  were  numbered  from  the  hour  that  its 
parasite  was  identified  in  the  salivary  gland  of 
a  mosquito.  Prevention  thenceforth  resolved 
itself  into  the  problem  of  how  to  exterminate 
certain  species  of  mosquitoes,  found  to  be  the  cul- 
prits in  this  microscopic  drama.  The  most  rational 
plan  was  clearly  to  attack  the  insects  in  their 
larval  stage  by  destroying  them  in  their  breeding 
pools  with  paraffin,  or,  better  still,  by  draining  away 
the  stagnant  water  from  ponds  and  ditches.  Then 
it  was  noted  that  certain  small  fishes  feed  whole- 
sale on  mosquito  larvae,  and  straightway  another  na- 
tural history  weapon  was  put  into  the  hands  of  the 
sanitarian.  But  the  resources  of  modern  scientific 
civilisation  are  by  no  means  exhausted  in  the  war 
against  malaria.  We  have  been  favoured  with  a 
note  of  information,  sent  by  Dr.  Albert  Hahl  to  Dr. 
Belgrave,  the  Government  Medical  Officer  of 
Sparto  Bay,  Western  Australia.  Dr.  Hahl,  Im- 
perial^ Governor   cf  Hubertshoehe,    New_Guinea, 


states  that  Dr.  Dempwolff,  the  leader  of  the 
malaria  expedition  to  that  place,  discovered  a 
water  insect  belonging  to  the  species  Notonecta, 
which  feeds  on  the  mosquito  larvae  (anopheles 
and  culex).  These  insects  are  the  born  enemies 
of  the  mosquito  grub,  and  if  it  be  found  possible 
to  breed  them  freely  in  mosquito-haunted  pools 
or  puddles  a  great  advance  will  have  been  made 
towards  the  extermination  of  that  midget  scourge 
of  mankind,  the  malaria-bearing  mosquito. 


The  Portsmouth  Asylum. 

The  recommendation  of  the  Lunacy  Com- 
missioners that  two  of  the  medical  staff  should 
be  called  upon  to  resign  certainly  calls  for  some 
public  attention  and  explanation.  It  will  be 
within  the  recollection  of  readers  that  not  long 
ago,  in  consequence  of  some  unfortunate  error, 
four  female  patients  were  poisoned  by  chloral 
given  by  way  of  sleeping  draught.  The  coroner's 
jury,  after  due  investigation,  absolved  the  medical 
staff  from  blame.  In  spite  of  that  finding,  how- 
ever, the  Commissioners  in  Lunacy  recommended 
that  Dr.  Henderson,  Acting  Superintendent  of 
the  Asylum  at  the  time  of  the  fatality,  and  Miss 
Watson — a  lady  doctor  who  acted  as  assistant 
medical  officer — should  be  called  upon  to  resign. 
The  Portsmouth  Corporation  have  very  properly 
entered  the  lists'on  behalf  of  their  officials.  Either 
the  officials  in  question  were  responsible  or  not 
responsible  for  the  events  that  led  to  the  deaths 
of  the  unfortunate  inmates.  The  coroner's  jury, 
with  a  full  knowledge  of  the  facts  of  the  case, 
said  the  medical  [staff  were  [not  to  blame.  The 
Lunacy  Commissioners,  who  have  presumably 
made  themselves  acquainted  with  all  available 
evidence,  apparently  think  the  opposite,  or  they 
would  hardly  ask  Dr.  Henderson  and  Miss  Watson 
to  resign.  If  the  Commissioners  make  scapegoats 
of  two  innocent  persons  they  are  incurring  a  heavy 
responsibility  in  stamping  two  professional  careers, 
with  an  indelible  mark  of  incompetency.  In  the 
interests  of  common  sense  and  justice  the  Com- 
missioners of  Lunacy,  on  the  whole  a  fair-minded, 
honourable  and  competent  body,  should  be 
compelled  by  the  force  of  public  opinion  to  qualify 
or  abandon  their  position  on  this  matter. 


The  Use  of  the  Birch.  H 
However  much  individual  views  may  differ 
as  to  the  desirability  of  the  birch-rod  as  an  occa 
sional  means  of  admonishing  rebellious  boys, 
there  can  be  no  room  for  difference  of  opinion  as 
to  the  brutal  use  of  that  or  (any  other  form  of 
punishment.  In  the  days  of  our  grandfathers 
the  '^swish-block  "  became  a  degrading  and  in- 
human monument  of  perverted  discipline. ,  Nowa- 
days the  swing  of  the  pendulum  has  probably 
carried  us  too  far  in  the  other  direction,  for  there 
is  little  doubt  that  a  sparing  use  of  the  rod  is  the 
best  of  moral  tonics  for  the  erring  schoolboy. 
The  use  of  the  cane,  or  of  the  birch,  however,, 
must  be  reserved  for  special  offences,  and  should 
never  be  permitted  at  all  in  the  case  of  delicate 
and  highly  sensitive  lads.     It  is  not  safe,  speaking 


460    The  Medical  Press. 


PERSONAL. 


April  27.  1904. 


broadly,  to  allow  an  angry  schoolmaster  or 
superintendent  to  administer  corporal  punish- 
ment with  his  own  hands.  No  such  disciplinary 
step  should  be  permitted  without  the  express 
and  particular  sanction  of  the  controlling  au- 
thorities behind  the  nominal  head  of  a  school  or 
other  institution.  Finally,  the  actual  punish- 
ment should  be  applied  by  an  assistant  under 
close  personal  supervision.  Had  precautions  of 
this  kind  been  taken  by  the  Wolverhampton 
Guardians  they  would  have  been  saved  from  an 
unpleasant  experience  at  one  of  their  cottage 
homes.  An  unruly  runaway  boy  was  birched  by 
the  superintendent.  According  to  the  evidende 
of  an  inspector  of  the  Society  for  the  Prevention 
of  Cruelty  to  Children  "  the  boy  was  covered  with 


would  yet  mean  the  ordering  of  strychnine  in 
heroic  doses.  The  need  of  a  medical  editor  on 
the  staff  of  every  lay  journal  was  never  more 
apparent.  Supposing  some  enterprising  reader 
of  the  paragraph  in  question — some  prescribing 
man  in  the  street — were  to  make  up  a  similar 
prescription  and  try  its  effects  upon  himself  or 
his  friends  ! 


The  Royal  Waterloo  Hospital,  London. 

The  authorities  of  the  Royal  Waterloo  Hospital 
for  Women  and  Children  have  thrown  an  exemplary 
amount  of  energy  into  the  rebuilding  of  that 
institution.  On  April  20th,  the  first  section  of  the 
new  building  was  opened  by  special  invitation  to 
the  Press.     The  out-patient  department  is  now 


WAoio  o«^  ,K«ein«fl  *~~      *u  x  *i_  1  ready  for  use,  and  will  in  a  short  time  be  open  for 

weals  and  abrasions  from  the  nape  of  the  neck  .,     J       ..     '  .. .     .       «,,     .  .        r  ,  ., 

*~  +u~  u  ~i      t  iL    1  „         %_    •      ,      ,  A,  the  reception  of  patients.     The  importance  of  the 

to  the  back  of  the  knees  and  on  the  back  of  the  .  x V.  ,        .f  .  .  \\         AU    .  _, 


right  arm."  The  superintendent  was  censured, 
and  the  discontinuance  of  the  birch  rod  and  leather 
strap  as  instruments  of  punishment  was  resolved 
upon.  The  official  leather  strap  savours  of 
Chinese  rather  than  of  Western  methods. 


A  Fleet  Street  Critic  on  Strychnine. 

The  perils  of  amateur  prescribing,  though 
patent  enough  to  the  physician,  will  probably 
never  in  the  history  of  mankind  be  recognised  by 
the  man  in  the  street.  In  other  words,  that 
ubiquitous  gentleman  will  continue  to  assert  his 
right  to  be  a  fool  or  an  (unqualified)  physician 
at  forty,  or,  so  far  as  that  goes,  at  any  age  what- 
ever from  the  cradle  upwards.  The  Daily  Tele- 
graph recently  furnished  an  amusing  instance  of  the 
flounderingsof  Fleet  Street  journalism  when  plunged 
suddenly  into  the  fathomless  sea  of  modern 
medical  science.  The  Paris  correspondent  of  that 
journal  commented  on  the  "  vague  manner  "  in 
which  strychnine  pills  had  been  prescribed  by  a 
medical  man  for  his  patients  as  follows:  "  Arseniate 
of  soda,  ten  grams  ;  sulphate  of  strychnia,  fifteen 
grams ;  sulphate  of  soda,  five  grams.  For  one 
pill,  number  twenty."  The  physician  meant 
that  twenty  pills  were  to  be  made  of  the  total 
fifteen  grams,  so  says  Fleet  Street,  which  is  care- 
ful and  responsible  in  most  of  its  statements.  The 
chemist's  boy,  it  continues,  "  understood  the 
prescription  to  be  for  twenty  pills,  each  containing 
the  above  quantities,  and  made  them  up  accord- 
ingly." Here  let  us  pause  to  remark  that  half  a 
grain  of  strychnine  or  one  of  its  salts  is  a  poison- 
ous quantity,  and  likely  to  prove  fatal.  A  gram 
contains  roughly  about  fifteen  grains,  or  thirty  fatal 
doses.  Fifteen  grams  contain  450  fatal  doses, 
which  Fleet  Street  says  was  intended  by  the  medical 
man  to  go  into  twenty  pills,  but  was  actually  put 
by  the  stupid  chemist's  assistant  into  each  single 
pill.  Now  comes  the  marvel.  The  patient  "  took 
the  pills  " — how  many  is  not  stated — and  was 
very  ill.  He  sued  his  medical  attendant  and  the 
chemist  for  /i,ooo,  but  was  awarded  only  /20. 
Further  authentic  details  of  this  extraordinary 
toxicological  mystery  should  certainly  be  pub- 
lished. Supposing  the  original  error  to  have  been 
the  substituting  of  "  grams  "  for  "  grains,"  that 


completed  hospital  may  be  gauged  from  the  fact 
that  it  will  contain  provision  for  no  less  than 
twenty-two  beds,  together  with  a  separate  nurses 
home.  The  ground-floor  contains  the  administra- 
tive offices,  with  accommodation  for  secretary, 
committee,  matron,  resident  medical  staff,  waiting- 
rooms,  hall  and  entrance  porch,  situate  at  the  corner 
of  Waterloo  Road  and  Stamford  Street.  The  first, 
second,  and  third  floors  are  devoted  to  the  ward?. 
The  wards  are  excellently  arranged.  Each  has  an 
open  balcony  facing  Waterloo  Road,  with  separate 
sister's  room  and  ward  scullery.  The  bath-rooms 
and  sanitary  offices  are  separated  by  a  ventilated 
corridor  on  each  floor.  A  day  room  is  provided 
on  the  first  floor,  an  isolation  ward  on  the  second 
floor,  and  an  operating  theatre  on  the  third  floor. 
The  fourth  floor  is  devoted  to  the  kitchen  offices 
and  bedrooms  of  the  staff.  Hydraulic  patients' 
and  service  lifts  run  from  top  to  bottom  of  the 
building.  Hydrants  will  be  attached  to  each 
landing  and  an  iron  escape  staircase  be  fitted  outside 
with  exits  from  every  floor.  The  heating  will  be 
by  hot  water,  and  electric  light  will  be  provided 
throughout.  The  energetic  secretary,  Captain 
Houston,  may  be  "congratulated  on  the  outcome 
of  his  untiring  energy  in  the  shape  of  a  fine  modem 
hospital.  Apart  from  the  somewhat  curious 
omission  of  an  electrical  and  X-ray  department, 
the  arrangements  are  most  complete.  The 
contractors  are  Messrs.  Holliday  and  Greenwood, 
Limited,  and  the  architects  are  Messrs.  Waring  and 
Nicholson,  of  38  Parliament  Street,  London,  SAW 


PERSONAL. 
Their  Majesties  the  King  and  Queen  have  arranged 
to  dine  at  the   Royal  Hospital,  Dublin,   to-day 
27th  instant. 


the 


Mb.  J.  S.  Wallbridge,  Government  Medical  Officer, 
British  Guiana,  has  retired  from  the  public  service. 

Dr.  Robert  Farquharson,  M.P.,  LL.D.,  wi'1 
preside  at  the  dinner  of  the  Sanitary  Institute,  to  be 
held  on  May  2nd  at  the  Hotel  Metropole,  London. 

The  Jacksonian  prize  of  the  English  Royal  College 
of  Surgeons  on  the  various  forms  of  conjunctivitis 
has  been  awarded  to  Mr.  Stephen  Mayou,  F.R.C.S. 

4The  Triennial  Prize  of  the  same  College  has  been 


April  27,  1904. 


SPECIAL  CORRESPONDENCE. 


The  Medical  Press.     461 


awarded  to  Mr.  T.  R.  H.  Bucknall,  F.R.C.S.,  for  his 
dissertation  on  the  Pathological  Conditions  arising 
from  Imperfect  Closure  ot  the  Visceral  Clefts. 

Mr.  W.  H.  A.  Jacobson  has  been  elected  a  member 
of  the  Court  of  Examiners  of  the  Royal  College  of 
Surgeons,  England,  in  the  place  of  Mr.  Henry  Morris, 
who  has  resigned  that  position. 

The  Council  of  the  same  College  elected  to  the 
Fellowship  Mr.  Edward  Ward,  Professor  of  Surgery  in 
the  Yorkshire  College,  Leeds,  as  a  member  of  twenty 
years'  standing. 

Dr.  T.  C.  Orford,  House  Surgeon  of  the  Colony 
and  Yaws  Hospitals,  Grenada,  has  been  promoted  to 
the  office  of  District  Medical  Officer  of  the  Colony. 


Dr.  E.  F.  Hatton,  Medical  Officer  of  Grenada,  has 
been  made  an  official  member  of  the  Legislative 
Council  in  place  of  Dr.  P.  F.  M'Leod.  who  has  retired. 

Major  H.  C.  Thurston,  Royal  Army  Medical 
Corps,  from  Bermuda,  is  to  be  appointed  Deputy- 
Assistant  Director-General  of  the  Army  Medical 
Service.' 

The  Secretary  of  State  for  the  Home  Department  has 
appointed  Dr.  William  H.  O'Meara  to  be  a  Medical 
Referee  under  the  Workmen's  Compensation  Acts,  1897 
and  1900,  to  act  for  00.  Carlow. 


Mr.  James  McR.  Cowie,  M.D.Aber.,  D.P.H., 
formerly  assistant  of  Dr.  J.  Niven,  Medical  Officer  of 
Health  for  Manchester,  has  been  appointed  Medical 
Officer  of  Health  and  Public  Analyst  for  Burton- 
on-Trent. 


An  important  discussion  on  Food  and  Meat  In- 
spection, to  be  held  at  the  Sanitary  Institute  Sessional 
Meeting  at  the  Parkes  Museum,  London,  W.,  will  be 
opened  by  Colonel  J.  Lane  Notter,  R.A.M.C.,  and 
Mr.  W.  Hunting,  F.R.C.V.S. 

The  foundation-stone  of  the  new  building  of  the 
Birmingham  and  Midland  Hospital  for  Women  was 
laid  by  Mr.  Arthur  Chamberlain  on  the  20th  instant. 
The  Institution  in  question,  which  began  on  a  humble 
scale  in  1871,  and  is  now  to  be  rebuilt  at  a  cost  of 
^40,000. 

In  delivering  the  Commemoration  Day  address 
at  Glasgow  University  on  April  18th,  Principal 
Story  expressed  his  regret  that  our  Government  did 
not  furnish  the  ^20,000  needed  to  complete  the  Exten- 
sion Fund  ;  in  Germany  the  money  would  have  been 
speedily  forthcoming. 

We  are  informed  that  Dr.  J.  G.  Crony n  intends  to 
offer  himself  as  a  candidate  for  the  post  of  General 
Secretary  to  the  Royal  Academy  of  Medicine  in  Ireland, 
which  will  be  vacant  shortly  in  consequence  of  the 
resignation  of  the  present  secretary.  There  are  thus 
three  candidates  in  the  field. 


Sir  William  Ramsay,  K.C.B.,  delivered  an  in- 
teresting lecture  on  Joseph  Black,  M.D.,  formerly  a 
Lecturer  upon  Anatomy  in  Glasgow  University,  and  who 
was  appointed  Professor  of  Chemistry  in  1766,  in 
which  position  he  made  his  famous  researches  upon 
fixed  air,  latent  heat,  and  laid  the  foundation  of 
modern  analytical  and  synthetical  chemistry. 


Special  correspondence. 


SCOTLAND. 


[from  our  own  correspondent.] 

Poor-law  Medical  Relief  and  Management  of 
Poor-houses. — A    report  was  issued  on  April    17th 


by  the  Departmental  Committee  appointed  by  the 
Local  Government  Board  to  inquire  into  the  methods 
and  conditions  under  which  Poor-law  medical  relief 
is  administered  in  Scotland.  Even  a  brief  summary 
of  the  recommendations  of  the  Committee  would  extend 
far  beyond  the  space  at  our  disposal,  but  the  following 
are  some  of  the  chief  reforms  of  a  purely  medical 
character  which  the  Committee  advise.  Among 
general  improvements  in  poorhouse  hospitals,  smaller, 
but  more  numerous  wards,  observation  wards  for  cases 
of  threatened  insanity,  isolation  accommodation  for 
infectious  diseases  pending  removal,  and  also  for 
treating  such  cases  as  the  local  authority  cannot  deal 
with,  and  properly  equipped  operating  rooms  in  the 
larger  poorbouses,  come  as  the  chief  innovations 
among  a  series  of  suggestions  on  minor  points,  all 
tending  to  raise  the  standard  of  the  poorhouse  hospital 
accommodation  to  that  of  the  general  hospital.  The 
segregation  ot  phthisis  and  malignant  and  other 
offensive  diseases,  and  the  open-air  treatment  of  the 
former  should  be  carried  out  as  far  as  possible  where 
sUght  alterations  in  unoccupied  buildings  would 
render  them  suitable  for  these  purposes.  The  general 
scale  of  the  dietary  ought  to  be  varied  and  improved, 
and  the  general  supervision  of  this,  as  well  as  the  power 
of  framing  special  dietaries,  and  the  duty  of  regularly 
revising  dietaries  and  orders  for  stimulants  should 
form  part  of  the  work  of  the  medical  officer.  The 
medical  officer  ought  to  have  increased  power  in  the 
management  of  the  wards,  should  have  facilities  for 
obtaining  additional  advice  or  nursing,  and  have 
power  to  send  special  cases  to  general  hospitals. 
Pauper  nursing  should  be  abolished,  and  the  standard 
raised  to  a  minimum  of  two  years'  training,  while  the 
appointment  of  nurses  of  three  years'  training,  as  well 
as  those  specially  trained  to  work  under  Poor-law 
conditions,  should  be  encouraged.  The  Committee 
appear  to  have  devoted  great  attention  to  detail  in 
framing  the  recommendations  in  the  report ;  their 
general  tendency  seems  to  us  to  be  one  which  will  make 
the  position  of  a  parochial  medical  officer  much  more 
satisfactory  to  hold  than  at  present,  for,  though  the 
duties  are  increased,  freedom  from  interference  is 
ensured.  The  alteration  in  the  tenure  of  office  is 
perhaps  the  most  important  modification  and  one  which 
will  go  far  to  make  the  Service  less  unpopular.  This 
reform,  however,  cannot  be  effected  without  legis- 
lation. 

Commemoration  Day  at  Glasgow  University. — 
The  first  commemoration  day,  a  new  event  in  the 
history  of  the  University,  the  object  of  which  is  to 
bring  the  graduates  together  once  a  year,  was  cele- 
brated on  April  19th.  The  programme  began  with  a 
religious  service,  followed  by  an  oration  recalling  the 
memory  of  some  distinguished  man  connected  with 
the  University,  then  honorary  degrees  were  conferred 
and  a  banquet  in  the  evening  concluded  the  festival. 
All  the  gatherings  took  place  in  the  Bute  Hall,  where, 
after  a  short  but  impressive  religious  service,  Sir 
William  Ramsay,  the  principal  guest,  delivered  an 
address  on  Joseph  Black,  M.D.  Scotland,  during  the 
latter  half  of  the  eighteenth  century,  was  the  home  of 
many  great  men — Adam  Smith,  Hume,  Hutton,  the 
geologist,  and  James  Watt.  All  of  these  were  friends 
of  Black's.  His  early  history  was  not  even  remotely 
adventurous.  Born  near  Bordeaux,  he  went  to 
Belfast  to  school  at  12,  and  six  years  later  crossed  to 
the  Glasgow  University.  His  taste  for  science  was 
fostered  by  Professors  Dick  and  Cullen,  on  whose 
advice  he  studied  medicine  in  Edinburgh,  and  graduated 
in  1754.  He  succeeded  Dr.  Cullen  as  lecturer  on 
chemistry  and  anatomy,  posts  which  he  exchanged 
for  the  chair  of  medicine  and  medical  practice.  When 
Cullen  in  his  turn  vacated  the  chair  of  chemistry  at 
Edinburgh,  Black  succeeded  him,  and  devoted  the 
rest  of  his  life  to  teaching.  The  oration  was  followed 
by  the  conferring  of  honorary  D.D.  and  LL.D.  degrees, 
among  those  who  received  the  latter  being  Mr.  Choate, 
U.S.  Ambassador,  Professor  Stirling,  Owens  College, 
Sir  William  Taylor,  Director-General  A.M.S.,  and 
Mendeleeff,  the  celebrated  Russian  chemist  (in  absentia). 
At  the  banquet  Sir  William  Ramsay  was  the  chief 


462     The  Medjcal  Press. 


OBITUARY. 


guest,  and  Mr.  Choate  replied  for  the  new  graduates. 
Jt  was  agreed  on  all  hands  that  the  proceedings  were  an 
unqualified  success. 


April  27,  iqq4. 


Correspondence. 

TWe  do  not  hold  ourselves  responsible  for  the  opinion  of  the  corres- 
pondents] 


ALOPECIA  AND  DENTAL  CARIES. 


THE  INFANTS'  HEALTH  SOCIETY. 
To  the  Editor  of  The  Medical  Press  and  Circular 
Sir. — May  we  ask  you  to  kindly  draw  attention  in 
your  columns  to  this  society,  which  was  founded  on 
February  nth,  1904?  Its  objects  are  to  spread  a 
knowledge  of,  and  to  put  on  an  organized  basis,  the 
best  methods  of  systematically  dealing  with  the  chief 
factors  affecting  the  health  and  life  of  infants;  to 
encourage  the  formation  of  institutions  such  as  milk 

-r    ,l     r?Jt       1  T       ™     «"   W  1  deP°ts-  dispensaries,  &c,  for  the  purpose  of  supplying 

To  the  Editor  of  The  Medical  Press  and  Circular.  I  food  adequate  in  quantity  and  quality  for  the  needs 

0  SlR*~ifuln,  ?eSI!,mng  a  dLS5us?lon  ™\h      Medicus    of  each  infant ;    and  to  co-operate  with  other  bodies 
Senex     I  had  laid  down  as  a  fundamental  proposition    public  or  private,  having  similar  objects  in  view 
that  the  earth  is  flat  and  the  centre  of  the  solar  system,         It  is  impossible  to  exaggerate  the  importance  of'thus 

1  doubt  whether  he  would  have  felt  disposed  to  de-  combating  at  the  very  fountain  head  the  present 
monstrate  the  fallacy  of  the  statement.  He  would  terrible  waste  of  infant  life  and  the  physical  degeneracy 
probably  have  referred  me  to  current  scientific  text-  of  so  many  of  the  survivors,  evils  which  have  occupied 
books.  Similarly,  when  Medicus  Senex  harps  upon  |  the  attention  of  the  public  recently  both  from  the 
the  suggestion  that  enamel  and  dentine  are  capable  of  ;  point  of  view  of  the  general  welfare  of  the  community 
physiological  and  pathological  activity,  £  refer  him  to  I  and  of  Army  recruiting. 

Pending  the  general  extension  of  the  movement  on 
the  lines  indicated,  the  society  has  appointed  a  special 
committee  to  carry  on  the  Infants'  Hospital,  at  present 
situated  in  Denning  Road,  Hampstead,  which  waj. 
established  in  March,  1903.  This  hospital  serves  as  a 
nucleus  for  the  propagation  of  the  society's  ideas,  and 
an  object-lesson  of  the  results  which  can  be  obtained 
by  the  treatment  of  cases  of  malnutrition  in  infants  on 
scientific  lines. 

The  funds  of  the  society  will  in  the  first  instance  be 
used  for  the  upkeep  of  the  hospital,  but  it  is  hoped  that 
sufficient  support  will  soon  be  received  to  generally 
further  the  principles  of  the  society. 

The  present  size  and  situation  of  the  Infants'  Hospital 
are  temporary.  The  hospital  will  be  moved  to  a 
central  situation  as  soon  as  possible,  and  the  estab- 
lishment of  a  hospital  fitted  with  every  arrangement 
for  the  saving  of  infant  life  and  the  furtherance  of 
scientific  knowledge  pertaining  to  this  end  is  now  under 
consideration. 

The  committee  confidently  expect  that  they  will 
receive  a  large  measure  of  encouragement  and  support 
from  the  ever-increasing  number  of  their  fellow- 
countrymen  who  take  a  serious  view  of  their  respon- 
sibilities with  regard  to  the  physical  and  moral  welfare 
of  the  people.  Special  donations  and  annual  sub- 
scriptions are  also  invited  for  the  hospital. 

Further  particulars  can  be  obtained  by  application  to 
the  Secretary,  Infants'  Health  Society,  120,  Victoria 
Street,  S.W.,  who  will  gratefully  acknowledge  all  con- 
tributions. 

We  are,  Sir,  yours  truly, 
Portland,  Mansfield,  W.  H.  Goschen, 
Frederick  Maurice,  Harold  Boulto.w 
Henry  Ashby,  J.  S.  Fletcher. 
23rd. 


current  manuals  of  dental  science.  He  has  cited 
Sewill's  "  Dental  Anatomy  and  Surgery."  I  know  of 
no  book  which  explains  more  briefly  and  clearly  the 
fundamental  facts  of  these  subjects.  If  "  Medicus 
Senex  "  will  read  that  book,  or  any  up-to-date  treatises 
on  the  subjects,  he  will  find  easily  where  his  errors 
arise  ;  but  I  do  not  see  the  use  of  prolonging  this  dis- 
cussion until  he  gives  evidence  of  the  elementary 
knowledge  he  now  assuredly  lacks.  I  am  sorry  if  I  vex 
"  Medicus  Senex."  Let  him  follow  my  advice,  and 
he  will  acknowledge,  I  am  sure,  that  it  is  not  owing  to 
my  fault  but  to  his  own  obstinacy.  "  Medicus  Senex  " 
confuses  every  simple  fact.  A  foreign  body  embedded 
in  living  tissues,  e.g.,  a  catgut  ligature,  may  be  absorbed 
and  carried  away  gradually,  through  the  medium  of  its 
vascular  surroundings.  The  foreign  dead  body  has 
not  become  living  during  the  process  ;  it  has  remained 
passive.  So  with  the  dentine  of  the  roots  of  tem- 
porary teeth  undergoing  absorption.  The  wasting  of 
the  tissue  is  brought  about  by  the  activity  of  the 
vascular  and  cell  elements  around.  This  is  another  of 
the  facts  demonstrated  by  the  late  Sir  John  Tomes 
over  forty  years  ago.  The  absorption  resembles  the 
same  process  as  it  occurs  in  bone,  but  with  the  essential 
difference  that  bone  has  a  free  vascular  supply  and  is 
largely  made  up  of  active  cell  elements,  whereas  vessels 
do  not  penetrate  dentine,  and  its  substance  is  devoid 
of  active  physiological  elements,  so  that  it  is  incapable 
of  reacting  to  external  influences  or  of  displaying 
intrinsic  phenomena  of  waste  and  repair. 
I  am,  Sir,  yours  truly, 
April  20th,  1904.  M.R.C.S.,  L.D.S. 


"  PALMAM  QUI  MERUIT  FERAT."— A  PROTEST. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — Antiseptic  and  aseptic  surgery  are  based  upon  | 
fundamental  facts  first  demonstrated  by  Pasteur.  He  | 
proved  that  fermentation  and  putrefaction  are  caused 
by  germs  floating  in  the  atmosphere.  Lister  perceived 
that  to  prevent  septic  processes  in  wounds  it  would 
be  necessary  to  destroy  the  germs  of  putrefaction  and 
fermentation  in  the  wounds,  and. to  prevent  their  entry. 
These  fundamental  facts  and  their  application  con- 
stitute what  may  be  called  Listerism.  The  "  runs  of 
luck  "  which  Dr.  Granville  Bantock  boasts  of,  when  he 
and  the  late  Mr.  Lawson  Tait  had  between  them  two 
or  three  hundred  consecutive  ovariotomies  without  a 
death,  would  need  strict  scientific  investigation  before 
they  could  be  accepted  as  proof  of  much.  Would 
they  have  been  possible  in  a  hospital  whose  atmosphere 
was  septically  polluted,  and  would  not  antiseptic  pre- 
cautions under  those  conditions  have  vindicated  their 
efficacy  ?  Dr.  Granville  Bantock,  if  my  memory  does 
not  play  me  false,  has  on  previous  occasions  altogether 
denied  the  existence  of  germs,  and  has  disputed  other 
of  the  demonstrated  facts  of  bacteriological  science. 
If  recognition  of  his  claims  to  the  laurel  crown  has  been 
delayed  it  may,  perhaps  be  partly  accounted  for  by 
the  curious  anti-scientific  attitude  he  seems  to  have 
assumed. 

I  am,  Sir,  yours  truly, 

April  21st,  1904.  Ignoramus. 


April 


®bttuarg* 


SIR  HENRY  THOMPSON,  Bart.,  M.B.,  F.R.C.S. 

By  the  death  of  Sir  Henry  Thompson,  after  a  short 
illness,  at  his  London  house  in  Wimpole  Street,  the 
medical  profession  has  lost  one  of  its  most  prominent 
and  well-known  members.  He  was  born  at  Fram- 
lingham  in  August,  1820,  and  came  of  a  Baptist 
family,  so  strict  in  their  views  that  the  profession  of 
medicine  was  condemned  on  account  of  its  materialis- 
ing tendencies.  Being  delicate  as  a  boy,  he  received 
private  tuition,  but  was  eventually  permitted  to  enter 
University  College  as  a  medical  student.  He  was  then 
28  years  of  age.  He  won  the  Gold  Medal  in  anatomy, 
at  the  intermediate  examination  in  medicine  of  the 
University  of  London  in  1849,  and  that  in  surgery  in 
1 85 1.  He  won  the  Jacksonian  prize  in  1852  for  an 
essay  on  the  pathology  and  treatment  of  the  urethra: 
and  took  the  Fellowship  of  the  English  College  of 
Surgeons  in  1853.  Two  years  after  his  marriage  with 
Miss  Kate  Loder,  a  pianist,  he  was  appointed  assis- 
tant surgeon  to  University  College  Hospital.  In 
i860  he  won  the  Jacksoiian  prize  a  second  time  with 
an  essay  on  the  healthy  and  the  morbid  anatomy  of 


April  27.  1904. 


PASS  LISTS. 


The  Medical  Press.     463 


the  prostate.     He  subsequently  wrote  two   books  or 

the  prostate,  which  ran  into  four  and  six  editions. 
The  turning  point  of  his  professional  career,  however, 
came  with  his  operation  of  lithotrity  on  the  late 
King  of  the  Belgians  in  1863.  His  Majesty,  when 
staying  at  Buckingham  Palace  in  1862,  consulted  Sir 
Benjamin  Brodie,  who  diagnosed  a  stone  in  the  bladder. 
He  advised  Civiale,  of  Paris,  as  the  operator,  and  a 
partially  successful  operation  was  performed  by  that 
distinguished  surgeon,  who  had  first  shown  in  1824 
that  a  stone  could  be  removed  without  any  cutting 
operation.  Some  fragments  were  left  behind  in  the 
bladder,  and  the  king  determined  to  have  an  English 
surgeon.  Mr.  Henry  Thompson  was  selected,  and  in 
recognition  of  his  services  was  appointed  Surgeon- 
Extraordinary  to  King  Leopold  I.,  an  office  continued 
by  his  successor,  and  he  was  made  an  Officer  of  the 
Order  of  Leopold  in  1864,  and  a  Commander  in  1876. 
In  1867,  in  his  own  country,  he  received  the  honour  of 
Knighthood.  In  July,  1872,  he  was  consulted  by  the 
late  Emperor  Napoleon  III.,  who  would  not,  however, 
permit  exploration.  An  operation  was  performed  in 
January,  1873,  under  most  unfavourable  conditions, 
and  the  Emperor,  who  suffered  from  extensive 
kidney  disease,  succumbed  shortly  alter  the  second 
operation.  When  the  American  surgeon,  Bigelow, 
perfected  lithotrity  by  removing  all  the  fragments  at 
one  sitting.  Sir  Henry  Thompson  at  once  recognised 
the  value  of  the  innovation,  which  he  subsequently 
practised  extensively.  In  1892  he  became  surgeon  to 
University  College  Hospital,  a  post  which  he  held 
until  1877,  when  he  was  made  Consulting  Surgeon 
and  Emeritus  Professor  of  Clinical  Surgery.  He  was 
created  a  baronet  in  1899,  and  is  succeeded  in  the  title 
by  his  son,  who  is  a  barrister-at-law.  His  death  took 
place  at  the  ripe  age  of  84. 

Sir  Henry  Thompson  was  emphatically  a  many- 
sided  man.  He  was  an  artist  of  no  mean  order,  and 
exhibited  many  pictures  in  the  Royal  Academy 
between  1865  and  1885.  He  was  also  an  enthusiastic 
collector,  of  Japanese  and  Chinese  china,  of  which  he 
made  an  extensive  collection.  He  wrote  a  "Handbook 
to  the  Public  Picture  Galleries  of  Europe,"  and  was  the 
author  of  two  novels.  He  steadily  advocated  the  use 
of  horseflesh  as  an  article  of  popular  diet,  and  gave  a 
famous  dinner  on  one  occasion  at  the  Langham  Hotel, 
when  all  the  dishes  were  derived  from  horse-beef. 
He  was  the  founder  and  President  of  the  Cremation 
Society,  and  wrote  several  books  on  the  subject  of 
Cremation. 

By  his  death  a  most  able  and  versatile  man,  of 
strenuous  character  and  high  moral  and  intellectual 
fibre  has  been  removed  from  our  midst. 


MONTAGU  H.  C.  PALMER,  M.R.C.S.,  L.R.C.P. 
The  sudden  death  has  been  announced  of  Mr. 
Montagu  H.  C.  Palmer,  a  well-known  physician  at 
Newbury,  on  the  22nd  inst.  He  was  a  member  of  the 
Newbury  Corporation,  and  Honorary  Curator  of  the 
Newbury  Museum.  Some  years  ago  Mr.  Palmer 
succeeded  to  the  practice  of  his  late  father,  who  was 
at  one  time  Mayor  of  the  town.  The  practice  was 
originally  established  by  Mr.  Palmer's  grandfather, 
Dr.  Silas  Palmer,  an  accomplished  antiquary  and  local 
historian.  Mr.  Palmer  studied  medicine  at  Cambridge 
University  and  London  Hospital,  and  took  the  M.R.C.S. 
and  L.R.C.P.  in  1894. 


Aedical     Views. 

Medical  Mltsiontry  Aaiodatlon. 
The  annual  meeting  of  the  Medical  Missionary 
Association  was  held  on  the  18th  inst.  at  Exeter  Hall, 
London.  Mr.  James  E.  Mathieson  presided.  The 
annual  report,  which  was  then  submitted,  stated  that 
Dr.  J.  L.  Maxwell,  after  eighteen  years  of  strenuous 
work  in  building  up  the  association  and  promoting  the 
establishment  of  medical  missions,  had  resigned  the 
positions  of  general  secretary  and  superintendent  of 
the  Training  Home,  but  retained  the  editorial  secre- 
taryship. Dr.  Henry  Soltau  had  been  appointed 
general  secretary  and  superintendent.  There  were  now 
eleven  students  in  training,  of   whom   eight   were  in 


I  residence  at  Highbury  Park.  During  the  year  six 
I  students  had  qualified  for  the  practice  of  medicine  and 
I  surgery,  of  whom  three  were  now  actively  engaged  as 
medical  missionaries  in  London  and  the  other  three 
were  studying  for  further  University  degrees.  Two 
had  left  for  the  Chinese  and  Indian  fields  respectively  of 
the  Baptist  Missionary  Society.  One  of  those  now 
working  in  London  was  to  leave  for  the  East  this  year 
in  connection  with  the  Church  Missionary  Society. 
The  applications  lately  received  showed  a  noticeable 
quickening  of  interest  in  medical  missions  ;  and  one 
of  the  newly-accepted  students  came  from  Canada. 
In  connection  with  the  Islington  Medical  Mission  752 
cases  had  been  treated  in  their  own  homes,  and  there 
had  been  7,845  attendances  at  the  dispensary.  The 
chairman  expressed  an  opinion  that  as  many  medical 
men  as  ordained  missionaries  should  be  engaged  in  the 
work  of  missions.  Dr.  W.  N.  Whitney,  of  Tokio, 
described  the  medical  mission  work  carried  on  by  him 
among  the  Japanese,  who,  if  they  never  forgot  an 
injury,  never  forgot  a  kindness.  Dr.  Walter  Fisher, 
from  Central  Africa,  having  spoken,  Dr.  Preston 
Maxwell,  from  China,  denied  that  medical  missionaries 
neglected  their  evangelistic  work.  An  evening  meeting 
was  held  at  the  same  place. 

The  Plague. 
The  following  telegram  from  Lord  Milner,  High 
Commissioner  for  South  Africa,  was  received  on 
April  1 6th  at  the  Colonial  Office :— One  hundred  and 
fifty-eight  suspected  cases  of  plague  reported  up  to 
date,  140  coloured  and  18  white.  Seventy-five  have 
terminated  fatally,  68  coloured  and  seven  white. 

PASS  LISTS. 
Royal  University  of  Ireland. 

The  following  candidates  have  passed  the  Second 
Examination  in  Medicine,  Spring,  1904 : — 

Upper  Pass. — John  A.  Black,  James  B.  Butler, 
Cecil  R.  Crymble,  Charles  H.  Harbinson,  John  F. 
Neary,  James  J.  O'Neill,  Maria  Rowan,  James  A. 
Shorten. 

Pass. — Samuel  Acheson,  Thomas  Arnold,  Matthew 
F.  Caldwell,  Joseph  P.  Carolan,  William  F.  A.  Caison, 
Francis  T.  Dowling,  Edward  FitzGerald,  Jane  McC. 
Fulton,  John  W.  Garry,  Charles  E.  L.  Harding,  William 
T.  Henderson,  John  J.  Hickey,  John  Hughes,  Francis 
Keane,  Joseph  Kilgarriff,  Morgan  Leave,  John  E.  A. 
Lynham,  John  S.  McCombe,  Jerome  B.  Murphy,  John  F. 
O'Brien,  Joseph  A.  O'Halloran,  Patrick  O'Hart, 
Herbert  H.  Prentiss,  William  Riddell,  Daniel  T. 
Sheehan,  James  Sinclair,  William  M.  Thomson,  Stan- 
dish  J.  Watson. 

Tne  following  candidates  to  be  exempt  from  further 
examination  in  Practical  Chemistry : — Arthur  R. 
Boyd,  Alexander  W.  Connolly,  Mary  Cowhy,  James 
Dooley,  Joseph  G.  Johnston.  ^ . 

University  of  Durham. 

The  following  candidates  have  passed  the  Second 
Examination  for  the  degree  of  Bachelor  in  Medicine  : — 

Anatomy,  Physiology,  and  Materia  Medica. — David 
Ranken  (with  second-class  honours). 

Pass  List :  Thomas  Henry  Bishop,  M.R.C.S., 
L.R.C.P.,  Sydney  Havelock,  B.Sc,  Camilla  Lucy 
Heckrath,  Hector  Graham  Gordon  Mackenzie,  M.A., 
Ernest  Lacey  Markham,  Jessie  Jean  Martin  Morton. 
Bertha  Mary  Mules,  Jessie  Margaret  Murray,  Howard 
Bewlay  Stephenson,  Frank  Whitby,  Cuthbert  Rex 
Wilkins,  James  Leslie  Wilson,  M.A. 

Royal  College  of  Burgeons  of  England. 

Mr.  W.  H.  A.  Jacobson  has  been  elected 
an  examiner  in  dental  surgery,  in  the  vacancy 
caused  by  the  resignation  of  Mr.  Henry  Morris.  Mr. 
Edward  Ward,  Professor  of  Surgery  in  the  Yorkshire 
College,  Leeds,  was  elected  a  Fellow,  he  being  a  member 
ot  twenty  years'  standing. 

We  understand  that  the  Central  Midwives  Board 
is  about  to  take  into  consideration,  if  it  has  not  already 
done  so,  the  unsatisfactory  nature  of  its  relations  with 
the  Irish  maternity  hospitals,  and  that  it  will  probably 
recommend  such  changes  in  its  rules  as  will  bring  them 
into  conformity  with  the  principles  which  govern  the 
training  of  midwives  in  large  hospitals. 


464    The  Medical  P«ess.       NOTICES  TO  CORRESPONDENTS. 


April  2;,  1404. 


Jtotices  to 
Correspondents,  ghort  fetters,  &c 

IV  Oobempohdihtb  requiring  a  reply  in  this  column  are  particu- 
larly requested  to  make  use  of  a  distinctive  tignaturt  or  initial,  and 
avoid  the  practice  of  signing  themselves  "Reader/'  "Subscriber," 
"Old  Subscriber,"  Aw.  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

Original  Articles  or  Lbttkrs  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

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

Raranrrs.— Reprints  of  articles  appearing  in  this  journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

W.  Patsrsok.— Radium  will  cure  the  rodent  ulcer,  if  the  patient  be 
not  too  exhausted  to  allow  of  the  necessary  reaction.  Moreover,  radium 
of  the  purest  aiod  is  not  required  for  the  purpose,  as  a  quality  much 
inferior  in  radio-activity  is  able  to  produce  the  required  results. 

Scotsman.— (I)  A  case  of  acute  perforation  of  the  appendix  due  to  a 
large  stercolith  was  shown  at  the  Liverpool  Medical  Society  by  Dr. 
Blair  Bell  on  April  22nd,  1903.  (*)  Calculus  in  pancreatic  duct  is 
extremely  rare— there  is  a  specimen,  we  believe,  with  the  stone  in 
situ  at  the  College  of  Surgeons  in  Lincoln's  Inn  Fields.  If  not  fount 
there  we  can  ascertain  where  the  preparation,  probably  unique,  is  to 
be  found. 

Da  8.  C— We  should  advise  our  correspondent  to  demand  pay- 
ment for  his  services  at  the  usual  rate. 

FOREIGNERS  IN  GERMAN  UNIVERSITIES 

Among  the  87,881  matriculate  1  students  in  German  Universities 
are  3003  foreigners  attracted  to  the  Fatherland  from  all  quarters  of  the 
globe.  Of  these  722  belong  to  the  medical  faculties,  26  to  the  dental 
and  IS  to  the  pharmaceutical  departments.  From  the  European 
countries  come  2,620  students,  and  473  from  other  continents. 
Russia  sends  the  greater  number— 986,  Austria-Hungary  cornea- 
next  with  588,  Switzerland  318,  England  162,  Bulgaria  78,  Boumaril* 
69,  France  64,  Greece  60.  Servia  65,  the  Netherlands  40,  Turkey  47, 
Italy  43,  Luxemberg  33,  8weden  and  Norway  33.  There  nrr  tiri  iism 
Montenegro  and  one  each  from  Monte  Carlo  and  the  Principality  of 
Liechtenstein.  From  America  come  310,  mostly  from  the  United 
States  :  from  Asia  133,  mostly  Japanese,  from  Af rice  19,  and  from 
Australia  2.  In  addition  to  these  matriculated  students  over  2,0<H> 
foreigners  attend  lectures,  of  whom  80  are  from  England.— Prom /A* 
Leisure  Dour  for  May. 

M.R.C.8.— Caution  should  certainly  be  observed  in  the  internal 
administration  of  turpentine,  where  the  case  is  complicated  with 
albuminuria. 

Physician  (Leeds).— Boric  Acid,  as  an  intestinal  antiseptic  has  been 
proved  to  be  valueless. 

Mr.  H.  M.  (Tiverton).— Your  bookseller  has  given  you  the  correct 
information,  the  numbers  of  this  journal  containing  Professor 
Taylor's  address  are  quite  out  of  print. 

Ms.  W.  F.  (Nottingham).— We  do  not  charge  for  an  opinion  in 
these  columns,  and  are  not  likely  to  give  one  on  the  subject  sought. 

<4tteeting0  of  the  gocietiw,  lectures,  &c. 

WsDVtaDAT,  April  27th. 
Huntkriah  Society  (London  Institution,  Finsbury  Circus.  E.C.).— 
8  p.m.    Council  Meeting.  8.30  p  m.   Papers. 

Mbdicil  Graduates'  Collbgh  and  Polyclinic  (22  Chenies  Street, 
W.C.).-4  p.ni.    Mr.  P.  Paton  :  Clinique.    (Surgical.) 
Thursday,  April  28th. 
Drrmatolooical  Society  op  Great    Britain   and    Ireland    (20 
Hanover  Square,  W.). — 4.30  p.m    Meeting. 

Medical  Graduates'  Colls© b  and  Polyclinic  (22  Chenies  6treet 

W.C.).— 4  pm.     Mr.  Hutchinson  :  Clinique.    (Surgical.)    5.15  p.m. 

Mr.  H.  L.  Barnard  :  The  Principles  of  Abdominal  Diagnosis. 

Friday,  A  i*ril  29th. 

Medical  Graduates'  College  and  Polyclinic  (22  Chenies  Street, 

W.C.).— 4  p.m.    Dr.  D.  Grant :  Clinique.     (Ear.; 

Bajcanrie*. 

Leicester  Infirmary.— House  Physician.     Salaiy  £100  per  annum, 

with   board,  apartments,  and  washing.     Applications   to  the 

Secretary,  24  Friar  Lane,  Leicester. 
Lincoln  General  Dispensary.— Resident  Medical  Offloer.   Salary  £200 

per  annum,  with  furnished  apartments,  fire,  and  gas  provided. 

Applications  to  William  Dean,  Secretary,  Board  Room,  Linco'n. 
Liverpool  Mill  Road  Infirmary.— Assistant  Medical  Officer.    Salary 

£120  per  annum,  with  board  and  apartments.     Applications  to 

Harris  P.  Cleaver.  r 

Liverpool  Stanley  Hospital— Second  House  Surgeon.    Salary  £80 

per  annum,  with  board,  residence,  and  washing.      Applications 

to  the  Chairman,  Medical  Board. 
Norfolk  and  Norwich  Hospital.— House  Physician.    Salary  £80  per 

annum,  with   board,  lodging,  and  washing.     Applications  to 

Frank  Haxel. 
Nottingham  General  Hospital— Assistant  House  Surgeon.— Salary 

£100  per  annum,  with  board,   lodgiog,   and    washing    in    the 

Hospital.  Applications  to  the  Secretary. 


Royal  Halifax  Infirmary.— Third  House  Surgeon.    Salary  £80  per 

annum,   with  residence,  board,  and  washing.    Applications  to 

Oates  Webster,  Secretary. 
Sussex   County    Hospital,    Brighton.    Stephen  RalH    Memorial- 
Pathologist.    Salary  £300  a  year.    Applications  to  the  Secretary 

of  the  Hospital. 
Westray  Parish  Council.— Medical  Officer  and  Public  Vaccinator. 

Salary  £03  per  annum.     Applicat.ons  to  the  C.erk  to  Parish 

Council. 
Westmoreland  Lock  Hospital,  Dublin.— Visiting  Surgeon.     Salary 

£100  per  annum.     Immediate  application  to  the  Chairman  of 

Board  of  Governors.    (See  Advt.) 
Worcester  General  Infirmary  —House  Physician.     8nltry  £80  per 

annum,  with   board   and  residence.    Applications  to  W.lliam 

Btallard,    Secretary,  Worcester  Chambers,    Pelrpoint    Street, 

Worcester. 
York  Dispensary.—  Resident  Medical  Officer.     Salary  £190  a  year, 

with  ooanl,  lodging,  and  attendance.  Applications  to  W.  Draper, 

Esq.,  De  Grey  House,  Ycrk. 


^ppointmentfi. 

Adam,  J.  Wilson,  M.B..  CM  Glas.,  Medical  Physician  to  the  Aberdeen 

Dispensary. 
Anderson,  C.  A  ,  M.B.,  M.S.Edin  ,  Assistant  House  Surgeon  to  the 

Portsmouth  Hospital. 
Burnet,    James,   MA.,    M.B.,    M.RC.P.Edin.,  Registrar  to    tbe 

Royal  Hospital  for  Sick  Children.  Edinburgh. 
Cowte.  James,  M..  M.D  Aberd.,  D.P  H  ,  Medical  Offloer  of  Health  and 

Public  Analyst  for  the  County  Borough    f  Burton-upon-Tiest 
Ellis,    L.    Erasmus,    M.D.Brux.,   M.RGSEng.,    L.B»C.P.Lond\ 

L.8.A.,  Clinical  Assistant  at  8t  John's  Hospital  for  Diseases  of 

the  Skin,  Leicester  Square.  London,  W.C. 
GREoe,  R  Asiileiob,  If  B..  D.P.H.Edin.,  Assistant  Medical  Officer  n 

Health  of  Leith,  and  Resident  Physician  to  Leith  Public  Health 

Hospital. 
Lloyd,  William,  F.R  0.8  ,  Surgeon  in  Charge  of  the  Nose.  Ear,  and 

Throat  Department,  St.  Pancras  and  Great  Northern  Dispensary, 

W.C. 
Moir,  D.  R  ,  M.A.,  M.B.Aberd.,  Visiting  Surgeon  to  the  Hull  and 

Sculcoates  Dispensary. 


girths. 

KuTHUtrotD.— On  April  2tnd,  at  2,  Victoria  Roid,  Uppe-  Norwood, 
the  wife  ol  Alfred  E.  B.  Eutberiord.  L.B.O.P.,  M.  K.C.8..  of  a  wo. 

geailts. 

Gowiko.-Oo    April    10th.    at    Stocksbridge,   Sheffield,  Benjamin 

Chaston  Gowing,  M.R.C.8.Eng  ,  L.8.A. 
Taylor.— April  20th,  at  The  Island,  Melksham,  Arthur  James  Taylor, 

MEC.8.,   LR.C.P.,    fifth    son  of  the  late  Mr.   John  Taylor, 

aged  32  years. 

OPERATIONS.—  METROPOLITAN 
HOSPITALS. 

WEDNESDAY.— 8t.  Bartholomew's  (1.80  p.m.),  University  Collm 
(2  p.m.).  Royal  Free  (2  p.m.),  Middlesex  (1.30  p.m.),  Chans? 
Cross  (8  p.m.),  St.  Thomas's  (2  p.m.),  London  (2  p.m.),  Kinr'* 
College  (2  p.m.),  8t.  George's  (Ophthalmic,  1p.m.),  St.  Marys 
(2  pm.).  National  Orthopedic  (10  a.mJ,  St  Peter's  (2  p.m.). 
Samaritan  (9.30  a.m.  and  2.80  p.m.),  Gt  Ormond  8treet  (9.» 
a.m.),  Gt  Northern  Central  (3  80  p.m.),  Westminster  (2p.nU 
Metropolitan  (2.80  p.m.),  London  Throat  (9.30  a,m).  Cancer 
(2  p.ni.).  Throat,  Golden  Square  (9.80  a.m.),  Guy's  (1.80  p.m.), 

THURSDAY.— St.  Bartholomew's  (1.80  p.m.),  St.  Thomas's  (3.80 
p.m.),  University  College  <2  p.m).  Charing  Cross  (3  p.m.),  St 
George's  (1  p.m.),  London  (2  p.m.).  King's  College  (2p.m.).  Middle- 
sex (1.30  p.m.),  St  Mary's  (2.80  p.m.),  Soho  Square  (2  p.m.), 
North-West  London  (2  p.m.).  Chelsea  (2  p.m.)  Great  Northern 
Central  (Gj-naecological,  2.80  p.m.),  Metropolitan  (2.80  p.m.), 
London  Throat  (9.80  am.).  St.  Mark's  (2  p.m.),  Samaritan  (9.30 
a.m.  and  2.30  p.m.),  Throat,  Golden  Square  (9.80  a.m.),  Guy'i 
(1.80  p.m.). 

FRIDAY.— London  (2  p.m.),  St  Bartholomew's  (1.80  p.m.).  St. 
Thomas's  (3.30  p.m.),  Guy's  (1.30  p.m.),  Middlesex  (1.30  p.m.), 
Charing  Cross  (3  p.m.).  St.  George  s  (1  p.m.).  King  s  College  (2 
p.m.),  St.  Mary '8  (2  p.m.),  Ophthalmic  (10 a.m.),  Cancer  (2  pm.) 
Chelsea  (2  p.m.),  Great  Northern  Central  (2.30  p.m).  West 
London  (2  30  p.m.),  London  Throat  (9.80  a.m.),  Samaritan  (9.80 
a.m.  and  2.80  p.m.),  Throat,  Golden  Square  (9.80  a.m.),  (Sty 
Orthopaedic  (2.30  p.m.),  Soho  Square  (2  p.m.). 

SATURDAY.— Royal  Free  (9  a.m.),  London  (2  p.m.),  Middlesex  (L30 
p.m.),  St.  Thomas's  (2  p.m.),  University  College  (9.15  a.m.), 
Charing  Cross  (2  p.m.),  St.  George's  (1  p.m.),  *t  Mary's  (10  p.m.) 
Throat.  Golden  Square  (9  30  a.m.),  Guy  s  (1.80 p  m.). 

MONDAY.- London  (2  p.m.),  St.  Bartholomews  (1.30  p.m.),  St 
Thomas's  (3.30  p.m.),  St.  George's  (2  p.m.),  St  Mary's  (2.30 
p.m.),  Middlesex  (1.80  p.m.).  Westminster  (2  p.m.),  Chelsea  (2 
p.m.),  Samaritan  (Gynaecological,  by  Physicians,  2  pjn.),  Soho 
Square  (2  p.m.),  Royal  Orthopaedic  (2  p.m.),  City  Orthopaedic  (4 
p.m.).  Great  Northern  Central  (2  30  p.m ),  West  London  {2.30 


p.m. j,  London  Throat  (9.30  a.m.),  Royal  Free  (2  p.m.),  Guy's  (UO 

TUESDAY.— London  (2  p.m.),  St  Bartholomew's  (1.80  p.m.),  St 
Thomas's  (3.30  p.m.),  Guy's  (1.80  p.m.),  Middlesex  (1.30  p.m  ), 
Westminster  (2  p.m.),  West  London  (2.80  p.m.),  University 
College  (2  p.m.),  St  George's  (1p.m.),  St.  Mary's  (1pm.)  St 
Mark's  (*.30  p.m.),  Cancer  (2  p.m.).  Metropolitan  (130  pjn.), 
London  Throat  (9.80  a.m.),  Royal  Bar  (3  p.m.),  Samaritan  (9.30 
a.m.  and  2.30  p.m.),  Throat,  Golden  Square  (9.80  a.m.),  Sobo 
Square  (2  p.m.) 


Ik*  fUcdital   f rcss   Mil   (firrulur. 


M8ALU8   POPULI    SUPRBMA    LEX." 


Vol.  CXXVIII. 


WEDNESDAY,    MAY   4,    1904. 


No.    18. 


Original  Communtcattons* 
INTRACRANIAL  RESECTION 


SECOND 


OF     THE 

DIVISION 


OF     THE 


FIFTH    NERVE 

FOR 

EPILEPTIFORM  NEURALGIA.(a) 

By  J.  HUTCHINSON,  Jun.,  F.R.C.S., 

Surgeon  to  the  London  Hospital. 

Some  three  years  ago,  in  a  paper  on  excision  of 
the  Gasserian  ganglion,  I  advanced  the  proposal 
"  that  the  so-called  excision  of  Meckel's  ganglion 
(always  a  very  difficult  and  uncertain  proceeding 
involving  disfigurement  of  the  face)  should  be 
given  up  in  favour  of  intracranial  division  of  the 
superior  maxillary  trunk  just  above  the  foramen 
rotundum."  (b) 

The  recommendation  was  based  on  the  following 
considerations : — 

1 .  The  more  central  the  operation,  the  nearer  to 
the  brain,  the  more  certain  is  the  prospect  of  per- 
manent cure.  In  almost  every  case  of  peripheral 
operation,  including  removal  of  Meckel's  ganglion, 
the  neuralgia  has  returned  after  an  interval  of  a 
few  months  or  years. 

2.  The  surgeon  who  works  through  the  walls  of 
the  antrum  to  the  pterygo-maxillary  fossa  is 
greatly  hampered  by  the  depth  of  the  wound  and 
by  haemorrhage  from  the  internal  maxillary  artery. 
He  may  be  successful  in  defining  the  trunk  of  the 
superior  maxillary  nerve  in  the  upper  part  of  the 
fossa,  but  he  is  very  likely  to  fail. 

3.  A  depressed  scar  in  the  middle  of  the  cheek  is 
much  more  disfiguring  than  one  hidden  by  the  scalp 
in  the  temporal  region. 

In  the  middle  fossa  of  the  skull  the  whole  of  the 
superior  maxillary  trunk,  before  it  has  given  off  any 
branches,  can  be  exposed.  Here  it  can  be  not  only 
divided,  but  a  considerable  portion  of  it  can  be 
excised,  so  that  there  will  be  no  chance  of  subse- 
quent union. 

The  amount  of  the  nerve  available  at  this  point 
for  excision  varies  somewhat  in  different  subjects, 
but  from  one-third  to  half  an  inch  can  be  resected. 

The  accompanying  figure  will  make  this  plain  ; 
the  trunk  should  be  divided  just  at  the  foramen 
rotundum  and  again  where  it  leaves  the  Gasserian 
ganglion,  as  shown. 

Cases  in  which  such  an  operation  is  justified  are 
not  numerous,  and  it  was  only  about  a  year  ago 
that  one  presented  itself  to  me. 

(a)  Paper  rejd  before  the  Clinical  8ociety,  March  11th,  1904. 
('»)  Medical  Society's  *•  Transactions,"  vol.  xxiii. 


A  ship's  officer,  aet.  nearly  60,  but  of  fine 
constitution,  had  suffered  for  several  years  from 
intense  pain  in  the  right  cheek  and  upper  jaw. 
The  neuralgia  was  typically  epileptiform,  the 
attacks  becoming  more  and  more  frequent  during 
the  last  four  years.  He  had  had  a  number  of  teeth 
removed  without  the  slightest  relief,  and  medicines 
were  equally  unavailing.  He  struggled  on  with  his 
duties  on  board  a  Cape  liner,  and  about  Christmas,, 
1902,  he  consulted  Sir  Frederick  Treves  with  regard 
to  operative  measures,  who  kindly  sent  him  to  me 
with  a  note  suggesting  removal  of  Meckel's  ganglion 
and  the  infra-orbital  nerve.     The  distribution  of 


Intracranial  resection  of  the  superior  maxillary  nerve.  AJ5., 
portion  of  the  nerve  excised.  C.D.,  wall  of  temporal  fort*  cut 
away  in  the  operation.  O.D.,  ophthalmic  division.  G.,  Gasserian 
ganglion. 

the  neuralgia  was  always  the  same,  and  the  parts 
were  very  tender,  though  during  an  attack  some 
relief  was  obtained  by  the  patient  violently 
grasping  the  tissues  of  the  cheek.  The  lower  eyelid, 
both  sides  of  the  cheek,  the  palate  and  the  gums 
on  the  right  side  formed  the  area  involved.  Lachry- 
mation  and  congestion  of  the  right  eye  were  fre- 
quent. 

It  might  be  suggested  that  exposure  on  deck 
to  wind  and  wet  was  a  predisposing  cause  of  the 


466    The  Medical  Press.  ORIGINAL  COMMUNICATIONS. 


May  4,  1904. 


neuralgia,  but  the  attacks  were  equally  severe 
when  he  was  on  land,  and  they  occurred  both  by 
<lay  and  night.  He  had  the  aspect  of  great  suffer- 
ing and  depression. 

My  friend,  Mr.  T.  Crisp  English,  assisted  me  at 
the  operation,  which  was  performed  with  the 
patient  fixed  in  a  dentist's  chair,  in  order  to  lessen 
the  trouble  from  venous  haemorrhage.  A  horse- 
shoe flap  was  turned  down  from  the  temporal 
region,  having  its  base  at  the  zygoma,  the 
flap  including  part  of  the  temporal  muscle 
and  the  pericranium.  With  a  large  trephine 
and  cutting  forceps  the  subjacent  bone  was  re- 
moved and  the  dura  mater  exposed.  As  in  the 
operation  for  removal  of  the  Gasserian  ganglion 
the  dura  mater  and  temporo-sphenoidal  lobe  were 
then  carefully  pushed  upwards  and  inwards,  making 
for  the  foramen  rotundum  as  the  first  landmark. 
In  this  respect  the  two  operations  differ,  as  in 
dealing  with  the  Gasserian  ganglion  the  foramina 
spinosum  and  ovale  are  first  sought  for.  Consider- 
able difficulty  was  met  with  owing  to  the  thin  and 
fragile  character  of  the  dura  mater,  and  some 
■cerebro-spinal  fluid  escaped.  Ultimately,  the 
trunk  of  the  superior  maxillary  division  and  part  of 
the  Gasserian  ganglion  were  thoroughly  exposed, 
a  broad  spatula  of  soft  metal  being  used  to  retract 
the  dura  mater  and  brain.  The  whole  of  the  nerve 
was  then  removed,  a  small  drain  was  subsequently 
inserted  and  the  flap  sutured  in  position.  None  of 
the  bone  removed  was  replaced.  Primary  healing 
followed,  and  no  complication  of  any  sort  occurred. 
The  patient  returned  a  month  later  to  his  duties, 
and  has  made  regular  voyages  to  and  from  the 
Cape  ever  since.  I  have  waited  twelve  months 
before  reporting  the  case  in  order  to  ascertain  that 
the  relief  is  permanent,  and  am  glad  to  state  that 
he  has  not  had  the  slightest  recurrence.  The 
anaesthesia  is  most  marked  over  the  cheek  and  right 
superior  maxillary  bone,  it  involves  also  the  soft 
palate  and  lower  eyelid.  He  can  eat  and  talk  with 
perfect  comfort,  whereas  before  the  operation 
both  acts  brought  on  spasmodic  pain.  The  scar 
is  hardly  to  be  noticed,  the  gap  in  the  bone  has 
practically  filled  up,  and  there  is,  of  course,  no 
paralysis  of  masticatory  muscles  on  that  side, 
such  as  follows  removal  of  the  Gasserian  ganglion. 

I  am  confident  that  no  recurrence  is  likely  to 
take  place. 

It  would  be  erroneous  to  suppose  that  the 
operation  is  an  easy  one  :  the  depth  of  the  nerve 
trunk  (three  centimetres  or  more  from  the  wall  of 
the  temporal  fossa)  and  the  troublesome  oozing  in 
a  narrow  space  where  it  is  essential  to  see  and  define 
a  nerve-trunk  of  small  size  prevent  this.  But 
having  had  the  opportunity  of  assisting  my  col- 
league, Sir  Frederick  Treves,  in  several  operations 
on  Meckel's  ganglion  I  can  safely  assert  that  the 
intracranial  route  is  at  least  as  easy  as  the  facial 
one ,# and  I  believe  it  affords  the  more  certain  access. 

It  will  be  remembered  that  the  superior  maxillary 
nerve  immediately  on  entering  the  pterygo- 
m axillary  fossa  gives  descending  branches  to  the 
palate  and  bone  with  internal  branches  to  the 
cavity  of  the  nose.  It  is  easy  to  follow  up  and 
remove  the  infra-orbital  nerve  from  in  front,  but 
very  difficult  to  remove  the  trunk  and  all  its 
branches  in  the  fossa.  Moreover,  even  if  this  is 
accomplished  the  evidence  is  strong  that  recurrence 
of  the  neuralgia  is  only  a  matter  of  time.  In  Sir 
Frederick  Treves'  five  cases  it  recurred  within 
twelve  months  in  two  ;    a  third  patient  died  (of 


cancer)  within  six  months  of  the  operation ;  in  the 
remaining  cases  recurrence  was  observed  in  two 
and  three  years  respectively. 

Mr.  Chavasse  collected  twenty-two  cases  of  what 
is  often  termed  Carnachan's  operation ;  in  only 
three  was  the  relief  stated  to  be  lasting. 

With  regard  to  operations  on  the  Gasserian 
ganglion,  properly  carried  out  (this  may  be  em- 
phasised without  going  into  details  here),  the 
evidence  is  conclusive  that  the  neuralgia  is  perma- 
nently cured. 

There  are  other  methods  of  approaching  the 
superior  maxillary  trunk  which,  I  venture  to  think, 
compare  most  unfavourably  with  the  temporal 
route.  In  Professor  Lucke's  operation  the 
masseter  muscle  is  divided,  the  zygoma  cut  through, 
and  an  extensive  scar  left  on  the  side  of  the  face. 
The  zygoma  may  not  unite  again  and  movements 
of  the  lower  jaw  may  be  interfered  with. 

Nussbaum  and  Billroth  employed  osteoplastic 
resection  of  upper  jaw,  Kocher  and  others  methods 
involving  a  temporary  resection  of  the  outer  orbital 
wall.  Not  one  of  these  methods  or  their  modifica- 
tions afford  access  to  the  trunk  where  it  comes  off 
from  the  Gasserian  ganglion.  In  Sir  F.  Treves' 
words  :  "  These  various  measures  are  all  needlessly 
severe,  and  involve  wounds  of  great  and  unnecessary 
magnitude." 

It  is  well  known  that  in  cases  of  epileptiform 
neuralgia  of  the  fifth  nerve  one,  two,  or  three 
divisions  of  the  nerve  may  be  involved.  In  some 
patients  the  pain  is  mainly  limited  to  one  division, 
usually  the  inferior  or  the  superior  maxillary,  with 
radiations  into  the  ophthalmic  branches,  or  even 
the  cervical  plexus.  Experience  has  shown  that  a 
thorough  operation  on  the  central  part  primarily 
involved  will  almost  always  cure  the  lesser  and 
more  widely  distributed  neuralgia.  Supposing  the 
inferior  maxillary  division  to  be  alone  or  mainly 
affected  it  is  open  to  question  whether  an  intra- 
cranial removal  of  the  lower  part  of  the  ganglion 
and  inferior  maxillary  trunk  would  not  be  pre- 
ferable to  the  elaborate  operations  usually  per- 
formed below  the  foramen  ovale.  The  conditions 
here  are  not  so  favourable,  however,  as  exist  in  the 
superior  maxillary  trunk,  where  about  half  an  inch 
of  the  nerve  can  be  exposed  and  removed.  Codi- 
villa,  an  Italian  surgeon,  has  performed  this  opera- 
tion twice  with  success — his  first  case  was  in  1897. 
When  both  second  and  third  divisions  are  mainly 
involved  I  am  sure  the  removal  of  the  lower  half  of 
the  ganglion,  leaving  the  ophthalmic  division 
intact,  is  the  best  operation.  As  a  series  of  cases 
have  shown,  going  back  from  two  to  seven  years, 
no  recurrence  of  neuralgia  need  be  feared  in  the 
ophthalmic  part  that  has  been  left  intact.  But 
where  the  superior  maxillary  division  alone  is  con- 
cerned the  operation  described  may  be  advocated 
in  preference  either  to  Carnachan's  method  or  the 
more  complete  operation  on  the  Gasserian  ganglion 
itself. 

Note. — When  the  foregoing  paper  was  read  at 
the  meeting  of  the  Clinical  Society,  Mr.  Stanley 
Boyd  related  a  case  in  which  he  had,  about  the 
same  time  as  myself,  performed  intracranial 
resection  of  the  second  division  of  the  fifth  nerve 
for  epileptiform  neuralgia  limited  to  that  distribu- 
tion. The  result  had  been  complete  relief  for  about 
a  year — at  the  end  of  which  time  slight  neuralgia 
was  again  reported,  though  its  localisation  was 
uncertain. 


May  4.  19°4- 


ORIGINAL  COMMUNICATIONS.         Th*  Mewajl  P**s$.    4&7 


Kotes  on  ZTberapeuticB  anD  Aateria 
flDe&lca. 

By  DAVID  WALSH,  M.D.Edm., 

Senior  Physician,  Western  Skin  Hospital,  London,  W. 

CHRONIC     RHEUMATISM— SULPHUR- 
SULPHIDE  OF  CALCIUM. 

Chronic  rheumatism,  if  we  may  judge  from 
the  number  of  remedies  advocated  in  its  treatment, 
is  one  of  the  maladies  rebellious  to  the  physician. 
As  a  matter  of  fact,  although  some  cases  of  chronic 
rheumatism  do  well,  yet  others  are,  apparently,  al- 
most as  much  outside  the  grasp  of  the  physician 
as  the  allied  condition  of  osteo-arthritis.  The 
typical  form  of  chronic  rheumatism  comes  on 
slowly  in  middle  life,  with  little  change  in  the 
joints,  but  with  much  crippling  from  changes  in 
muscles  and  nerves.  It  is  often  independent  of 
former  attacks  of  acute  or  subacute  rheumatism, 
and  the  salicylates  are  useless.  Next  comes 
the  important  fact  which  must  be  admitted  by 
every  practical  physician,  that  in  nine  cases  out 
of  ten  internal  remedies  are  of  little  or  no  use. 

Methylene  blue  has  been  advocated  for  the 
treatment  of  chronic  rheumatism.  It  is  a  some- 
what powerful  drug,  and  colours  the  urine  blue,  so 
it  is  likely  to  have  a  psychical  effect  upon  patients. 
Although  this  drug  has  been  before  the  profession 
tor  some  time,  its  value  or  otherwise  in  the  treat- 
ment of  chronic  rheumatism  has  not  been  deter- 
mined. An  exact  investigation  of  this  point  would 
be  desirable,  inasmuch  as  it  would  tend  to  throw 
light  upon  the  therapeutics  of  an  obscure  condition. 
It  would  not  be  difficult  to  form  a  tolerably  exact 
opinion  as  to  the  action  of  methylene  blue  in 
chronic  rheumatism  by  means  of  a  collective  in- 
vestigation. Meanwhile,  the  practitioner  who 
is  called  upon  to  treat  that  malady  may  or  may 
not  feel  it  his  duty  to  prescribe  it. 

Turning  to  those  old-fashioned  remedies,  sulphur 
and  guaiacum,  the  question  suggests  itself  whether 
we  may  not  have  overlooked  their  virtues  to  some 
extent.  The  wisdom  of  our  forefathers  led  to 
the  famous  "  Chelsea  pensioner/'  of  which  those 
particular  drugs  formed  the  chief  ingredients. 
Has  sulphur  ceased  to  be  as  useful  now  in  the 
treatment  of  chronic  rheumatism  as  it  was  in  a 
bygone  generation  ?  It  has  certainly  not  been 
driven  out  by  any  remedy  more  potent  or  more 
specific  as  regards  that  most  intractable  of  com- 
plaints. Some  patients,  and  some  few  medical 
men,  sing  the  praises  of  sulphur  used  internally  in 
chronic  rheumatism,  but  it  is  for  the  most  part 
ignored  as  a  popular  and  professional  remedy. 
It  is  a  curious  fact  that  medical  science  has 
not  come  to  a  definite  conclusion  as  to  the  value 
of  sulphur  internally  in  this  complaint,  although 
sulphur  has  been  used  in  that  way  for  generations 
past.  Recently  the  man  in  the  street  has  been 
reminded  of  his  ancient  belief  by  the  widespread 
advertisement  of  a  particular  preparation  of 
sulphur  in  the  form  of  a  lozenge. 

Possibly  those  who  have  found  sulphur  wanting 
in  the  cure  of  chronic  rheumatism  have  not  per- 
severed for  a  sufficiently  long  time  in  its  adminis- 
tration. Small  doses  extended  over  a  long  period 
are  best,  according  to  Dr.  C.  D.  F.  Phillips,  who 
adds  the  suggestive  remark  that  "  remedies  cal- 
culated to  produce  diaphoresis,  such  as  vapour 
baths,  should  be  generally  combined  with  its  use." 

The  good  effect  of  sulphur  on  the  skin,  when 
•taken  internally,  in  acne  rosacea  and  some  other 


maladies,  is  well  recognised.  In  its  crude  form, 
however,  dermatologists  place  but  little  faith  in 
its  healing  virtues,  although  they  use  it  most 
extensively,  namely,  in  two  other  preparations 
ichthyol  and  calcium  sulphide.  Ichthyol  appears 
to  be  readily  absorbed  into  the  circulation,  where 
the  splitting  up  of  the  ammonium  sulpho-ichthyo- 
late  of  which  it  is  composed  releases  sulphur, 
which,  by  its  excretion,  acts  beneficially  upon  the 
skin.  As  yet  no  satisfactory  explanation  has 
been  furnished  of  the  chemico-vital  changes  thus 
induced.  The  medicinal  use  of  ichthyol  there- 
fore rests  more  or  less  upon  empirical  observation. 
Its  merits  must  be  positive  if  we  may  judge  from 
the  extent  to  which  it  is  used  by  general  prac- 
titioners as  well  as  by  dermatologists. 

Calcium  sulphide  appears  to  be  a  somewhat 
neglected  drug.  It  certainly  exerts  a  marked 
influence  upon  the  formation  of  pus,  and  a  boil 
may  sometimes  be  aborted  by  six  or  seven  two- 
hourly  doses  of  a  quarter  of  a  grain  of  that  drug. 
It  appears  to  act  like  sulphur,  only  that 
it  is  capable  of  more  ready  absorption,  and  there- 
fore of  much  more  rapid  action.  In  all  cases, 
whether  used  externally  or  internally,  sulphur  is 
inert  until  it  becomes  converted  into  a  more 
soluble  or  absorbable  form.  Sulphur  ointment 
does  not  destroy  scabies  for  days  together. 
The  acari  of  scabies,  for  instance,  are  not  killed 
by  several  days'  residence  in  sulphur  ointment 
(Kuchenmeister,  quoted  by  Phillips).  The  ob- 
vious inference  is  that  sulphur  kills  the  itch  para- 
site only  when  it  has  been  altered  by  combination 
with  some  of  the  skin  excretions.  When  taken 
into  the  stomach,  sulphur  is  probably  converted 
into  alkaline  sulphides,  which  are  partly  decom- 
posed into  sulphuretted  hydrogen  and  partly 
oxidised.  The  administration  of  calcium  sul- 
phide is  a  readier  way  of  introducing  the  sul- 
phuretted hydrogen  into  the  circulation.  To  be 
of  use  it  must  be  freshly  prepared.  Much  of  the 
non-success  of  practitioners  with  this  drug  is 
probably  due  to  the  fact  that  patients  have  been 
supplied  with  pills,  tablets  and  so  on  that  have 
lain  by  for  months  or  years. 

Calcium  sulphide  is  worth  trying  in  nearly  all 
purulent  discharges  occurring  in  children,  such  as 
otorrhoea  and  scrofulous  ophthalmia,  in  quinsy, 
in  mammary  abscess,  in  bubo,  in  boils  and  car- 
buncles, and  even  in  the  pustular  stages  of  small- 
pox. 

FURTHER  NOTES  ON 

GLYCOSURIA  IN  INSANITY,  (a) 

BY  W.  R.  DAWSON,  M.D.,  F.R.C.P.I., 
Medical  Superintendent,  Farnham  House,  Ftaglas,  Dublin. 
About  two  years  ago  (6)  I  had  the  honour  to  bring 
before  you  a  short  study  of  seven  cases  in  which 
glycosuria  was  associated  with  insanity.  These 
cases  were  classed  in  two  categories,  viz.,  those  in 
which  the  insanity  appeared  to  be  caused  by  the 
glycosuria  {i.e.,  cases  of  true  diabetic  insanity), 
and  those  in  which  the  morbid  excretion  of  sugar 
was  probably  a  symptom,  parallel  with  the  insanity, 
of  the  underlying  disorder  of  the  nervous  system. 
Since  then,  owing  to  a  system  of  periodical  testing, 
twelve  additional  cases  have  come  under  my  notice, 
all  belonging  to  the  second  category.  Of  these 
I  now  propose  to  give  a  short  account. 

(a)  Bead  in  the  Section  of  Medicine,  Royal  Academy  of  Medicine 
in  Ireland,  April  8th,  1904. 
(6)  The  Medical  Press  and  Cibcclar,  January  1st,  1902. 


468    Tbb  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


May^  4,  1904^ 


In  seven  of  the  cases,  sugar  was  found  upon  a 
single  occasion  only,  and  was  sometimes  present 
in  barely  appreciable  amount.  They  were  as 
follows  : — 

Case  I. — An  old  demented  woman,  aet.  67,  whose 
emotional  tone  is  mostly  neutral,  showing  neither 
exaltation  nor  depression.  An  extreme  fondness  for 
sweets  is  the  only  point  about  the  patient  bearing  at 
all  upon  the  glycosuria,  which  was  very  slight. 

Case  II. — A  male  chronic  maniac,  aet.  60.  His 
general  mental  attitude  is  one  of  contentment,  but 
he  is  at  times  liable  to  fits  of  angry  excitement,  of 
which  there  were  a  good  many  about  the  time  when 
sugar  was  detected. 

Case  III. — A  man  of  77,  who  had  suffered  for  years 
from  systematised  delusions,  largely  of  an  unpleasant 
type,  and  who  had  been  confined  to  bed  for  some  months 
owing  to  anasarca  from  chronic  nephritis.  His 
tone  of  mind  was  one  of  depression.  Very  large 
amounts  of  albumin  were  being  excreted. 

Case  IV.— This  was  a  case  of  secondary  dementia 
in  a  man  of  42,  who  was  generally  good-humoured 
and  contented.  He  had  been  getting  a  little  thin  for 
some  months  before,  but  his  general  health  was,  and 
is  still,  good,  except  for  a  tendency  to  constipation. 

All  four  cases  had  been  for  many  years  inmates 
of  the  institution,  and  were  hopelessly  incurable 
from  a  mental  point  of  view. 

Case  V. — A  slightly  weak-minded  woman  of  44, 
suffering  from  her  sixth  attack  of  delusional  melan- 
cholia. The  glycosuria  appeared  while  she  was  under- 
going thyroid  treatment,  and  was  therefore  probably 
due  to  the  drug  ;  but  as  many  cases  go  through  a  course 
of  this  treatment  without  excreting  sugar,  it  must  be 
supposed  that  some  predisposition  existed. 

Case  VI. — A  female  case  of  katatonia,  aet.  30,  at 
about  the  beginning  of  the  third  stage.  She  was  in 
a  state  of  stupor  with  marked  negativism,  and  under 
the  dominion  of  delusions,  which,  at  times  at  all  events, 
were  of  an  unpleasant  character.  Sugar  was  found  on 
the  morning  after  admission  (June  12th,  1902),  but 
not  since,  and  she  has  now  very  much  improved. 

Case  VII. — Sugar  was  also  found  on  the  morning 
after  arrival  in  the  case  of  a  male  patient  suffering 
from  paranoia,  as  the  result  of  alcoholism.  He  was 
very  miserable  and  full  of  depressing  delusions.  Sugar 
has  not  since  been  found  during  the  two  months  since 
his  admission. 

In  every  instance  the  urine  was  examined  a 
considerable  number  of  times  without  any  sugar 
being  found,  and,  of  course,  no  special  diabetic 
treatment  was  considered  necessary. 

Two  further  case3  had  what  may  be  considered  a 
single  attack  of  glycosuria,  but  in  each  of  these 
sugar  was  present  for  at  least  a  month,  though  in 
varying  quantity,  and  with  two  intermissions  in  one 
case  and  three  in  the  other.  In  both  these  cases 
the  symptom  passed  off  under  dietetic  treatment. 

Case  VIII. — The  first  was  that  of  a  lady,  aged  about 
62,  who  had  suffered  for  about  three  years  from  a 
mental  illness  which  began  as  acute  melancholia  and 
then  passed  into  secondary  dementia  with  stupor, 
in  which  state  she  was  when  sugar  was  first  detected 
in  May,  1902.  About  a  fortnight  later  she  was  dieted, 
and  the  sugar  began  to  decrease.  It  had  completely 
disappeared  in  August,  and  has  not  since  returned. 
At  first  there  was  some  urethritis,  but  it  cannot  be  said 
that  any  mental  change  was  noted. 

Case  IX. — This  was  a  case  of  hebephrenia  in  a  lad 
of  19,  which  has  been  published  elsewhere,  (a)  He 
came  as  a  voluntary  boarder  in  March,  1902,  improves 
greatly  under  treatment,  and  was  discharged  in  six 
weeks,  but  soon  relapsed,  and  returned  by  his  own 
wish  on  May  24th.  On  readmission,  sugar  was  found, 
and  from  the  end  of  May  he  was  put  on  diabetic  diet, 
which  was  continued  after  the  sugar  had  disappeared 
(by  June  18th).  On  his  return  he  was  brooding, 
suspicious  and  depressed,  but  improved  slightly  as 
(a)  Journ,  of  Mentil  science,  April,  1903,  p.  303. 


the  sugar  disappeared,  so  that  the  glyesemia  may  have 
had  some  influence  on  his  mental  state.  Improve- 
ment stopped  there,  however,  and,  as  in  most  cases  of  this- 
disease,  the  prognosis  is  very  gloomy.  There  was  no 
subsequent  return  of  the  sugar  as  long  as  he  remained 
with  us.  « 

In  the  next  two  cases  sugar  was  found  on  more 
than  one  occasion,  but  always  as  a  transitory 
occurrence. 

Case  X. — The  first  case  is  one  of  chronic  delusional' 
melancholia  of  over  twenty  years'  standing,  is  a 
woman,  aet.  59,  whose  general  physical  health  i* 
excellent,  and  who  has  now  become  so  far  demented 
that  the  depression  is  of  a  very  mild  character.  In 
August,  1 90 1,  she  complained  of  pain  in  the  region 
of  the  kidneys,  and  at  the  same  time  a  trace  of  some 
reducing  substance  appeared  in  the  urine.  Early  in 
1902  she  had  a  rather  severe  cold,  possibly  influenzal 
in  nature,  and  on  two  occasions  in  the  following  May 
sugar  was  detected,  and  again  once  in  December  last. 

Case  XI. — A  male  patient,  aet.  52,  suffering  from  a 
form  of  recurrent  mania,  with  stupor  and  unpleasant 
delusions,  which  dates  from  adolescence.  The  interval* 
of  comparative  lucidity  are  very  short,  as  a  rule,  and 
occur  at  extremely  irregular  intervals.  Sugar  was 
found  on  three  consecutive  occasions  in  June,  1903. 
during  an  insane  period  which  lasted  from  early  in 
the  year  until  October  1st,  and  again,  in  small  amount, 
on  December  12  th,  by  which  date  he  had  relapsed 
again. 

In  none  of  these  cases,  except  perhaps  the 
eighth  and  ninth,  can  any  particular  importance 
be  attached  to  the  glycosuria,  and  in  none,  again, 
with  those  two  exceptions,  was  any  special,  treat- 
ment adopted.  The  last  case  which  I  have  to 
describe  is,  however,  a  much  more  interesting  one, 
and  would  appear  to  be  an  instance  of  genuine 
though  mild  diabetes,  (a)  occurring  in  the  course  of 
chronic  nervous  disorder  : — 

Case  XII. — A  male  case  of  minor  epilepsy,  vet.  32,  was 
admitted  on  February  nth,  1899,  having  suffered  from 
this  ailment  since  early  adolescence,  or  possibly  even 
longer.  Shortly  after  his  arrival  he  had  an  ephemeral 
attack  of  acute  excitement  with  delusions,  at  first  oi 
an  ecstatic  character,  but  later  very  depressing,  the 
whole  lasting  only  two  or  three  days.  After  this  his 
mental  state  was  one  of  mild  depression,  becoming 
more  acute  occasionally,  as  especially  in  June,  1899. 
Notwithstanding  numerous  varieties  of  treatment, 
the  fits  have,  it  may  be  stated  at  once,  continued  up 
to  the  present.  They  are  mostly  of  a  severe  minor 
type,  but  occasionally  there  is  a  somewhat  atypical 
major  seizure.  Sometimes  there  are  intermissions  of 
several  days,  or  even  a  week  or  two,  but  usually  one 
or  two  fits  occur  daily,  and  it  has  generally  been  found 
that  the  patient  is  happier  and  better  mentally  when 
a  moderate  number  occur  regularly.  For  some  time 
past  the  drug  used  has  been  mainly  bromipin,  which 
does  not  depress  or  inconvenience  him  as  do  the 
alkaline  bromides,  and  seems  to  be  quite  as  effective 
for  routine  purposes.  On  one  occasion  triritrin 
administered  regularly  greatly  lessened  the  number  oi 
attacks  when  bromipin  seemed  to  be  losing  its  effect; 
but,  unfortunately,  the  urine  was  not  examined  while 
this  drug  was  being  taken.  There  was,  however,  no 
sugar  on  February  17th,  1902.  On  June  2nd,  1902, 
trinitrin  was  again  ordered,  but,  as  melaena  appeared, 
was  stopped  on  the  5th.  On  the  nth  sugar  was  found 
in  the  urine,  and  on  the  12th  the  quantity  excreted 
1  was  said  to  be  about  390  gr.,  but  this  was  probably  an 
over-estimate.  At  this  period  the  patient  became 
depressed,  and  continued  so,  with  some  alternations  of 
excitement,  for  about  a  month.  He  was  dieted,*  but 
the  absence  of  sugar  seemed  to  be  adding  to  his  depr.es 
sion,  while  not  stopping  the  glycosuria,  and  after  a 
few  weeks  the  dieting  was  discontinued.     From  this 

(a)  It  should  be  stated,  however,  that  this  patient  possesses  sgrest 

fondness  for  sugar  aud  sweets  and  that  the  total  quantity  of  a"11* 

,  passed  in  twenty-four  hours  has  been  leas  than   normal  whenever 

'  collected ;  nor  has  there  been  any  excessive  hunger  or  thirst  noted- 


May  4.  1904. 


ORIGINAL  COMMUNICATIONS. 


The  Mbdicajl  Press.    469 


time  sugar  has  been  present  in  varying  amount  in  the 
urine  almost  without  intermission  up  to  the  present, 
U„  for  some  twenty-one  months.  On  January  6th, 
1903,  131*6  gr.  were  excreted,  and  on  this  day 
he  was  put  on  10  gr.  doses  of  aspirin  thrice  daily, 
as  that  drug  had  recently  been  highly  recommended 
for  use  in  diabetes.  Nine  days  later  the  output  of 
sugar  dropped  to  11*7  gr.,  and  on  January  27th, 
it  was  1 8*4  gr.  Unfortunately,  an  attack  of  acute 
excitement  (similar  to  that  after  admission,  and  to  one 
which  he  had  about  the  same  date  in  1902,  but  more 
protracted),  which  came  on  in  February,  necessitated 
the  discontinuance  of  the  drug.  Its  administration  was 
not  again  resumed,  as  the  diminution  in  the  sugar 
excreted  did  not  then  seem  to  produce  any  mental 
or  other  improvement.  In  June,  1903,  there  was 
another,  but  slighter,  attack  of  excitement,  the  sugar 
still  persisting,  though  not  in  large  amount.  In  July 
it  was  decided  to  try  Poehl's  cerebrin  (a)  for  the 
seizures,  which  had  been  highly  lauded  for  epilepsy, 
and  this  was  accordingly  given  for  about  three  months, 
daring  most  of  which  time  the  patient  had  compara- 
tively few  fits,  and  was  very  well  mentally,  and  the 
sugar  in  the  urine  was  small  in  amount  or  absent.  The 
drug  seemed  then  to  lose  its  effect  on  the  seizures, 
and  was  discontinued  until  December  5  th,  1903,  when 
the  sugar  had  reappeared.  Since  then  it  has  been 
slight  or  absent,  but  the  seizures  have  not  benefited 
so  much,  and  last  February  there  was  another  attack 
of  excitement,  though  not  so  severe  as  that  in  the 
previous  year.  The  cerebrin  has  since  been  dis- 
continued, but  there  is  still  only  a  bare  trace  of  sugar 
in  the  urine.  Comparing  the  periods  before  and  after 
the  appearance  of  trie  sugar  in  this  case,  we  find  that 
whereas  there  were  only  two  attacks  of  insane  excite- 
ment in  the  period  of  three  years  and  four  months 
previously  during  which  the  patient  was  under  obser- 
vation, there  have  been  no  less  than  four  attacks  in 
the  twenty-one  months  since  the  sugar  first  appeared. 
Nevertheless,  the  patient's  general  mental  state  cannot 
be  certainly  said  to  have  deteriorated  more  rapidly 
daring  the  latter  period,  while  at  times,  as  in  last 
August  and  September,  he  has  been  exceptionally 
well.  Further,  the  number  of  seizures  shows  an  actual 
decrease,  for  whereas  the  monthly  average  for  nineteen 
months  up  to  June  1st,  1902  (when  sugar  appeared), 
was  about  thirty-eight,  the  monthly  average  for  nine- 
teen months  since  that  date  has  been  only  about 
twenty-five.  The  patient's  physical  health  has  not 
suffered,  and  he  actually  shows  a  tendency  to  put  on 
weight. 

Looking  over  the  cases  as  a  whole,  the  same  pre- 
ponderance of  depressed  states  of  mind  is  noticed 
as  in  the  previous  series.  Of  the  twelve  cases, 
eight  were  either  cases  of  melancholia  or  were  more 
or  less  depressed  (owing,  in  most,  to  the  nature 
of  their  delusions),  while  of  the  two  cases  of  chronic 
mania,  one  was  certainly  not  happy,  and  the  other 
doubtfully  so,  and  both  somewhat  demented. 
The  remaining  two  patients  suffered  from  advanced 
dementia.  In  all  the  cases,  therefore,  except 
perhaps  the  last,  the  glycosuria  may  probably  be 
put  down  as  alimentary,  and  due  to  the  disorder  of 
metabolism  in  the  insane,  as  it  has  been  found 
that  the  power  of  assimilating  sugar  is  markedly 
diminished  in  melancholic  and  demented  states. 
In  one  of  the  earlier  cases  and  in  the  last,  a  certain 
amount  of  mental  depression  may  have  been  de- 
pendent on  the  glycaemia,  but  upon  the  whole  the 
conclusion  seems  to  be  justified  that  provided 
glycosuria  is  transient  it  possesses  no  particular 
significance. 

Finally,  it  may  be  pointed  out  for  what  it  is 
worth  that    in    nine  of  the  cases  the  glycosuria 

(a)  A  ho  called  jBhrenotln,  and  stated  to  be  a  eerebroalde  poesees- 
of  the  ttmnote  CTO  Ht«o  N«0„.  It  was  first  used  in  epilepsy  by 
Hon,  of  Samara,  on  the  th  ory  that  it  might  have  an  antitoxic 
effect  on  aatotoxins  specific  for  nerve  tissue. 


appeared  or  commenced  in  the  months  of  May  and 
June,  and  in  the  tenth  a  second  appearance  took 
place  in  May. 


CARDIAC   ASTHMA. 

By  Professor  MERKLEN. 

[SPECIALLY   CONTRIBUTED    By   OUR   PARIS 
CORRESPONDENT.] 

Under  the  term  "  cardiac  asthma/'  Professor 
Merklen  comprises  every  degree  of  dyspnoea,  more 
or  less  derived  from  heart  affections,  and  cites  a 
case  in  point. 

A  stoker,  aet.  57,  a  large  eater,  who  drank  nearly 
three  quarts  of  wine  daUy,  suffered  for  some  time 
from  oppression  at  the  least  effort.  Sometimes 
the  attacks  were  prolonged  for  two  or  thiee  hours, 
and  followed  by  fro  thy  expectoi  ation .  One  day  be 
was  seized  in  a  tramcar  with  a  particularly  violent 
attack,  and  was  carried  to  the  hospital  in  a  critical 
condition.  Pronounced  dyspnoea,  body  covered 
with  clammy  perspiration,  small  pulse,  crepitant 
tdles  in  both  lungs,  prostration.  The  heart  was 
slightly  hypertrophied,  albumin  was  absent. 

Under  the  regimen  of  milk  and  water  (a  quart 
and  a  half  in  the  twenty-four  hours)  and  diuretic 
agents,  such  as  theobromin  and  digitalin,  the 
troubles  diminished  gradually.  In  eight  days  the 
patient  lost  six  pounds  in  weight,  and  feeling 
well,  asked  to  be  allowed  a  more  generous  diet,  but 
the  dyspnoea  returned  as  soon  as  he  regained  the 
weight  he  had  lost.  Placed  again  on  the  lactohy- 
dric  regimen,  the  symptoms  improved,  and  finally 
the  patient  was  able  to  understand  that  his  salva- 
tion depended  on  living  on  as  low  a  diet  as  possible. 

In  cardiac  asthma  two  elements  are  recognised, 
a  mechanical  element  resulting  from  distension  of 
the  blood-vessels  of  the  lungs,  finally  producing 
oedema,  and  a  nervous  element  caused  by  the 
irritation  of  the  nerve  centres  by  a  badly  haema- 
tosed  blood.  Clinically,  during  the  attack  dila- 
tation of  the  heart  is  observed  with  signs  of  acute 
emphysema  and  exaggerated  resonance  of  the  lungs. 

The  acute  emphysema  observed  in  such  cases  is 
derived  from  two  causes  :  inspiratory  spasm  dilat- 
ing to  the  fullest  extent  the  thoracic  walls  ;  dis- 
tension produced  by  the  blood  engorging  the  vessels 
of  the  lungs. 

There  were  still  other  signs  :  a  tracheal  rdle,  heard 
at  a  distance ;  frequency  and  irregularity  of  the 
pulse ;  bruit  de  galop,  indicating  weakness  of  the 
heart ;  pain  resembling  angina.  These  pains  may 
be  found  under  three  conditions  :  excess  in  tobacco 
smoking,  violent  physical  or  mental  strain,  in- 
flammation of  the  coronary  artery,  producing  a 
decrease  of  the  arterial  irrigation  of  the  myo- 
cardium. In  all  these  cases  the  heart  is  affected. 
The  distension  of  the  heart  produced  bv  one  or 
other  of  the  above  causes  is  the  origin  of  the  pain 
complained  of.  Once  begun,  it  is  rare  that  the 
malady  does  not  return.  If  the  patient  consents 
to  follow  an  appropriate  regimen,  he  can  live  for 
years,  retarding  irremediable  dilation  of  the  right 
heart,  which  frequently  ends  the  aflection.  The 
treatment  is  curative  and  preventive.  In  cases 
of  cardiac  action  a  triple  indication  must  be  ob- 
served :  diminish  the  pulmonary  engorgement 
(blood-letting,  wet  cupping,  mustard  applica- 
tions to  the  chest) ;  calm  the  nervous  excitement 
(injections  of  morphia,  ether,  camphorated  oil, 
small  doses  of  chloral,  valerian)  ;  give  tone  to 
the    heart    (caffein,    theobromine,     digitalin     in 

D 


47°    Th*  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


May  4,  1904. 


doses  of  one-tenth  of  a  milligramme  daily  for  twelve 
days).  The  preventive  treatment  might  be  re- 
sumed under  one  heading — alimentary  regimen. 
M.  Huchard,  who  is  an  authority  on  such  subjects, 
insists  particularly  on  the  importance  of  the  milk 
diet  and  the  deprivation  of  salt.  The  presence  of 
salt  in  the  tissues  calls  for  water  to  dissolve  it, 
and  where  there  is  retention  of  the  chlorides, 
oedema  is  produced.  A  patient  who  takes  no  salt 
does  not  need  to  drink  large  quantities  of  water, 
which  is  an  advantage. 


HYDROMETRA.  (a) 

By  J.  FURNEAUX  JORDAN,  F.R.C.S. 
Mrs.  K.,  aet.  63,  was  first  seen  by  me  on  August 
23rd  of  last  year,  in  consultation  with  Dr.  Ware,  of 
Kings  Heath.     Her  history  was  that  she  had  been 
married  forty-three  years,  had  had  five  children — 
youngest     aged    twenty-eight — and    had    always 
enjoyed  good  health  until  she  was  fifty,  when  a  large 
tumour    developed    in    the   abdomen.     She    was 
admitted  into  the  Birmingham  Hospital  for  Women 
by  Dr.  Savage,  and  had  a  large  ovarian  cyst  re- 
moved.    Five  and  a  half  years  ago  a  second  tumour 
formed  ;  she  was  operated  upon  in  Dr.  Savage's 
private  hospital .     She  was  told  that  she  had  a  cystic 
tumour  of  the  womb  and  that  an  abscess  had  been 
opened.    The  tumour  was  not  removed,  but  has 
been   growing  slowly  ever  since.     For   the  last 
two  or  three  weeks  the  tumour  had  been  excessively 
painful  and  tender,  and  a  localised  swelling  had 
formed  at  the  seat  of  the  old  scar.     This  was  the 
history  I  got  when  I  saw  her,  and  I  found  a  thin, 
almost  emaciated  little  woman  lying  on  her  back, 
knees  fully  drawn  up,  and  abdomen  enormously 
distended.     Below  the  umbilicus  there  was  a  tense 
red  oedematous   swelling,    obviously   an    abscess 
nearly  about  to  burst.     The  abdominal  swelling — 
larger  than  a  full-sized  pregnancy — was  very  tense 
and  tender,  and  a  distinct  thrill  could  be  detected 
all  over  it.     On  internal  examination  the  large 
cystic  swelling  was  found  to  bulge  down  into  the 
pelvis.     The  cervix  of  the  uterus  could  not  be  felt, 
nor  could  I  make  out  any  distinction  between  the 
tumour  and  the  uterus.     Her  general  condition 
was   bad — temperature   over    1020,   quick   pulse, 
thick,  dry  fur  on  the  tongue  and  constipation. 

I  admitted  her  to  the  Women's  Hospital  on 
August  25  th,  and  when  I  saw  her  the  next  day 
found  that  the  abscess  in  the  old  scar  had  burst, 
whereby  she  was  much  relieved,  and  through 
the  small  opening  (formed  by  its  bursting)  a 
watery  fluid  containing  cholesterin  crystals  exuded. 
Her  general  condition  was  improved — bowels  open, 
pulse  slower  and  regular,  temperature  normal. 
Urine  acid,  and  no  albumin.  Through  the  courtesy 
of  Dr.  Smallwood  Savage  I  was  able  to  see  his 
father's  notes  on  the  case.  These  showed  that 
she  had  had  a  pyometra,  which  had  been  opened, 
and  the  opening  into  the  uterus  had  been  sutured 
to  the  abdominal  wound  and  the  cavity  drained. 
I  still  could  find  no  sign  of  any  cervix,  the  vagina 
being  stretched  underneath  and  behind  the  lower 
part  of  the  tumour.  You,  Mr.  President,  very 
kindly  saw  the  patient  with  me,  and  we  decided 
that  it  was  a  hydrometra,  and  that  it  should  be 
removed. 

On  August  27th  I  operated,  assisted  by  Dr. 
Smallwood  Savage.  Even  in  the  lithotomy  posi- 
tion I  failed   to  find  any  trace  of  cervix.     The 


(a)  Head  at  a  meeting  of  the  British  Gynecological  Society,  April 
4th,  1904, 


bladder  was  small  and  pushed  away  to  the  right 
side  behind  the  pubes.  I  tapped  the  cystic  swelling 
through  the  anterior  vaginal  wall  to  ascertain 
the  nature  of  its  contents,  which  proved  to  be  a 
light  brown  fluid  with  abundance  of  cholesterin 
crystals.  I  then  opened  the  abdomen,  and 
after  dividing  some  dense  adhesions  of  omentum 
and  bowel  to  the  upper  part  of  the  tumour,  found 
the  tumour  firmly  adherent  to  the  old  place  of 
suture,  and  this  necessitated  the  removal  of  that 
part  of  the  abdominal  wall  containing  the  old  scar. 
The  distension  of  this  uterine  tumour  was  so  great 
that  the  upper  part  of  it  appeared  as  bluish,  fibrous 
tissue,  almost  like  an  ovarian  cyst.  I  tapped  it, 
and  then  was  able  to  pull  the  bulk  of  it  through 
the  incision.  But  the  whole  of  the  lower  part  was 
embedded  in  dense  fibrous  adhesions,  which  it 
took  a  long  time  to  separate.  I  ligatured  the  broad 
ligaments  and  the  uterine  arteries,  and,  just  above 
the  level  of  the  ureters,  amputated  the  uterus. 
After  establishing  a  gauze  drain  from  the  remains 
of  the  cavity  into  the  vagina,  I  sutured  the  edges 
of  the  cut  uterus  with  fine  silk.  The  part  remain- 
ing was  about  the  size  of  a  smallish  virgin  uterus. 
The  left  ureter  was  dilated  to  the  size  of  one's 
finger,  the  right  one  appeared  normal. 

She  stood  the  operation  remarkably  well,  and 
the  next  day,  when  I  saw  her,  the  temperature  was 
990,  pulse  100  ;  the  bowels  had  acted,  there  was 
no  sickness,  and  she  felt  very  well.  This  good 
progress  was  maintained  until  the  fifth  day,  when 
she  complained  of  feeling  very  weak  and  unable 
to  sleep.  She  had  had  very  little  sleep  the  night 
before.  On  the  sixth  day  she  passed  less  urine 
than  before,  and  on  examining  it  I  found  albumin 
and  a  small  quantity  of  pus.  The  condition  of  the 
urine  did  not  improve  in  spite  of  treatment  and 
washing  out  of  the  bladder  ;  in  fact,  the  quantity 
of  pus  increased.  She  gradually  got  weaker  and 
weaker,  and  on  the  eleventh  day  became  semi- 
comatose. She  continued  in  this  condition  until 
the  fourteenth  day,  and  then  died.  Temperature 
only  once  rose  to  ioo°,  and  never  above  it. 

Post-mortem. — No  peritonitis.     On  the  left  side, 
the  stump  of  the  appendages  shows  a  stitch  abscess 
containing  1 5  minims  of  pus.     The  remnant  of  the 
uterus  closely  adherent   to  bladder,   the  cavity 
very  wide,  substance  of  walls  thickened  and  fibrous. 
Kidneys  unequal  in  size,  left  one  two-thirds  of  the 
normal  size,  the  right  one  nearly  double  the  normal 
size,  both  greatly  diseased,  with  adherent  capsules, 
rough  surfaces  showing  many  cysts,  some  of  which 
are  suppurating,  dilated  calices  lined  with  a  thick 
pyogenic  membrane  and  containing  urine  and  pas, 
and  in  the  left  kidney  numerous  small  concretions. 
The  renal  tissue  shows  evident  degeneration,  but 
little  fibrosis.     Bladder,  chronic  cystitis.    Cause 
of  death,  renal  disease,  result  of  long-continued 
suppuration  previous  to  operation. 
Double  Hydrosalpinx. 
Mrs.  P.,  aet.  39,  married  fifteen  years,  two  chil- 
dren,   youngest    aged    thirteen.     For    ten   years 
has  suffered  from  attacks  of  pain  in  the  abdomen, 
and  has  been  told  several  times  that  she  has  in- 
flammation of  the  bowels.     Menstruation  for  the 
last  two  years  too  often  and  loses  far  too  much, 
acute  pain  causing  her  to  He  up  on  the  third  day 
of     the    period.     On    examination,    a    distinct, 
freely  movable  tumour  is  to  be  felt  in  the  lower  left 
part  of  the  abdomen.     No  connection  with  the 
uterus  and  entirely  above  the  pelvis.    Pato  °* 
I  pressure  in  the  right  fornix  of  the  vagina.  I  thought 


May  4.  1904. 


TRANSACTIONS  OF  SOCIETIES.       The  Medical  Press.    471 


it  was  on  ovarian  tumour  with  a  long  pedicle. 
On  March  10th  last  I  operated  and  removed  a 
hydro-salpinx  from  each  side  ;  this  larger  one, 
from  the  left  side,  was  lying  above  the  level  of  the 
uterine  fundus  and  had  no  adhesions.  The  small 
right  one  was  adherent  to  the  back  of  the  right 
broad  ligament.  She  made  an  uninterrupted 
recovery,  and  went  home  on  March  28th. 

Transaction*  ot  Societies* 

HARVEIAN  SOCIETY  OF  LONDON. 

Clinical  Evening. 

Meeting  held  April  15TH,  1904. 


Dr.  C  Theodore  Williams,  President,  in  the  Chair. 


DR.  Leonard  Guthrie  showed  a  man,  aet.  38,  a 
tailor,  who  during  three  years  had  gone  through  the 
following  phases  of  "  Insular  Sclerosis."      In  1881,  a 
temporary  attack  of  hemianaesthesia  ;   in  1894.  pares- 
thesia of  hands  and  feet  with  loss  of  power  in  all  ex- 
tremities.    Recovery   in   a   fortnight.     In    1895,    ad- 
mitted to  the  National  Hospital,   Queen  Square,   with 
weakness  of  lower  limbs  and  difficulty  in  micturition 
{sphincter) ;    right-sided  hemiparesis,  with  loss  of  sen- 
sation,  tactile  and  painful,    in    front  of  thighs  was 
found  ;    no  nystagmus  or  affection  of  cranial  nerves, 
speech  normal,  knee-jerks  brisk,  no  ankle-clonus ;  optic 
discs  normal.     Recovery  was  apparently  complete  in 
about  three  months.     In  1898.  weakness  of  legs  re- 
appeared,  and  in  1900  he  could  not  walk  without  help, 
but  again  he  improved  and  was  able  to  return  to  work. 
In  January,  1901,  he  was  readmitted  to  hospital  with 
loss  of  power  and  slight  inco-ordination  in  hands,  ataxic 
stic  gait,  exaggerated  deep  reflexes,  and  extensor 
a  tar  reflexes ;  no  ankle-clonus  or  other  symptoms, 
sation  to  pain  and  touch  blunted  below  umbilicus. 
Patient  improved    steadily  at    first,  and    anaesthesia 
practically  disappeared.    Then  he  had  a  relapse,  and 
became    unable    to    walk  without   assistance,   whilst 
there  was  marked  increase  in  spasticity.     Once  more 
he  improved  steadily,  and  could  walk  without  help. 
At  the  end  of  190 1.  he  was  slowly  getting  worse,  and 
gait  was  very  ataxic  and  spastic.     At  present,  there 
was  very  slight  nystagmus  on  lateral  deviation.     The 
optic  discs  were  normal.     Speech  was  stuttering,  but 
not  scanning  nor  syllabic.     No  wasting  of  muscles, 
sensation  normal.     Muscular  powers  of  upper  extre- 
mities fair.     Very  slight  "  intention  "  tremors  ;  abdo- 
minal and  back  muscles  were  paretic  at  times.     Lower 
extremities  not  wasted,  ataxic,  or  spastic,  but  muscles 
showed    varying    degrees    of    weakness    of    different 
groups.     Gait  neither  spastic  nor  ataxic,  but  weak 
and  uncertain.     Knee-jerks  active,  not  exaggerated  ; 
ankle-clonus  (spurious)  at  times ;  plantar  reflexes  some- 
times absent,   sometimes  extensor,  on  one  or  both 
sides.    Electrical    reactions    normal.    The    muscular 
paresis  varied  greatly  and  was  worst  under  influence 
of  emotion,  or  after  fatigue.     If  left  alone  he  could 
get  up,  wash  and  dress  himself,   and  walk  about  with 
the  aid  of  sticks,  and  he  seldom  fell.     But  if  notice  was 
taken  of  him,  he  became  flurried  and  nervous  with 
walking,  and  presently  fell  like  a  tree,  and  became 
completely   paraplegic   and   exhausted    for   the    time 
being.    The  influence  of  emotion  in  increasing  general 
paresis  was  so  marked  that  he  (Dr.  Guthrie)  had  re- 
garded the  condition  as  one  of  functional  myasthenia, 
until  the   history   clearly  pointing   to   relapsing   and 
remittent  insular  sclerosis  was  forthcoming. 

Dr.  Risien  Russell  and  Dr.  Wilfred  Harris  took  part 
in  the  discussion. 

Dr.  Risien  Russell  showed  a  case  of  "  Myasthenia 
Gravis"  in  a  young  woman,  aet.  28,  whose  illness 
began  about  a  year  ago,  and  in  whom  many  of  the 
characteristic  phenomena  of  the  affection  were  present, 
including  the  myasthenic  reaction  on  faradic  excita- 
tion by  the  muscles.  The  symptoms  were  not,  how- 
ever, always  made  worse  by  muscular  exertion,  nor 
were  they  Jiorc  pronounced  at  the  menstrual  period 


and  they  disappeared  in  a  remarkable  manner  ten 
months  ago,  but  returned  eight  months  later.  Some 
impairment  of  resonance  over  the  manubrium  sterni 
suggested  the  possibility  of  enlargement  of  the  thymus 
gland. 

Dr.  Guthrie  called  attention  to  the  association  of 
thymic  and  mediastinal  growths  with  myasthenia 
gravis. 

Mr.  Jackson  Clarke  showed  a  girl,  aet.  7,  on  whom, 
over  two  and  a  half  years  ago,  he  performed  costo* 
transversectomy  for  obstinate  paraplegia  due  to 
tuberculosis  at  the  lever  of  the  fourth  dorsal  vertebra. 
The  patient  was  shown  at  the  Clinical  Society  two 
years  ago,  since  when  the  mode  of  treatment  has  been 
successfully  followed  in  similar  cases.  Paraplegia  in 
spinal  disease  frequently  yielded  to  rest  and  general 
treatment,  but  there  were  two  indications  for  opera- 
tion :  First,  when  total  motor  and  sensory  paralysis, 
including  the  bladder,  supervened  rapidly ;  and 
secondly,  when,  in  the  more  ordinary  type  of  case  in 
which  the  paralysis  was  chiefly  motor,  rest  had  been 
|  given  a  fair  trial  without  success.  If  performed  with 
due  care,  costo-transversectomy  was  less  dangerous 
than  laminectomy,  and  on  other  grounds  was  prefer- 
able to  it.  In  the  present  case  there  was  no  return  of 
paralysis  after  the  operation,  and  the  patient  was 
allowed  to  walk  with  the  spine  well  supported  by  a 
modified  Chance's  splint. 

Dr.  Edmund  Cautlby  showed  a  case  of  "  Cerebral 
Syphilis."  A  man,  aet.  22,  who  had  been  admitted  to 
the  Metropolitan  Hospital  for  lassitude  and  headache 
of  three  months'  duration,  and  vomiting  for  three 
weeks.  He  was  treated  at  the  Lock  Hospital  for 
eighteen  months,  and  still  showed  the  remains  of  a 
specific  rash.  His  hair  came  out  a  year  ago,  and  on 
admission  he  was  almost  bald.  His  mental  condition 
is  dull  but  has  distinctly  improved  under  a  month's 
treatment,  and  there  is  a  free  growth  of  white  hair 
becoming  dark  in  places.  The  knee-jerks  are  exag- 
gerated, there  are  no  ocular  changes,  and  the  headache 
has*  ceased.  The  condition  is  doubtless  due  to  a  mild 
form  of  endarteritis. 

Dr.  Wilfred  Harris  showed  two  cases  of  "  Lead 
Paralysis."  1  hese  cases  illustrated  two  types  of  lead 
paralysis.  Both  showed  the  ordinary  form  of  wrist- 
and  finger-drop  with  escape  of  the  supinator  longus 
and  the  extensor  ossis  and  primi  internodii  muscles  of 
the  thumb.  In  addition  one  had  complete  paralysis  of 
the  two  deltoids  and  supra-  and  infra-spinatus  muscles, 
the  remaining  arm  muscles  escaping,  while  the  other 
case  had  complete  atrophy  of  the  intrinsic  muscles  of 
both  hands,  a  condition  due  to  a  symmetrical  subacute 
poliomyelitis,  and  which  is  permanent ;  while  the  forearm 
and  upper  arm  paralyses  are  due  to  neuritis,  and  will 
almost  certainly  recover. 

Mr.  T.  Crisp  English  showed  three  cases :  One,  a 
case  of  Goitre  with  unusual  symptoms  in  which  he 
had  removed  hypertrophied  lateral  and  middle  lobes. 
The  patient,  a  girl,  aet.  17,  had  had  exophthalmos, 
tachycardia,  palpitations,  and  tremor,  while  there  had 
been  also  a  myxedematous  condition  of  the  skin.  The 
operation  had  been  performed  on  account  of  severe 
dysphagia ;  this  combination  of  symptoms  is  rare. 
The  general  conditions  had  improved.  (2)  Case  of  a 
large  gumma  of  the  knee-joint,  which  was  of  old  dura- 
tion and  was  sloughing.  (3)  A  case  of  encephalocele  in 
the  left  frontal  region,  which  was  increasing  rapidly  in 
size  and  demanded  early  treatment  if  such  were  ad- 
visable. 

Mr.  Percy  Paton  considered  the  interesting  feature 
of  the  case  was  the  thickening  of  the  synovial  mem- 
brane and  possibly  cartilage  changes,  which,  under 
other  circumstances,  might  lead  to  an  erroneous  dia- 
gnosis of  osteo-arthritis. 

Mr.  £.  Laming  Evans  showed  a  case  of  ■'  Congenital 
Absence  of  the  Fibula  "  in  a  female,  aet.  4  months. 
The  whole  leg  was  small,  and  the  characteristic  curve 
in  the  lower  third  of  the  tibia  with  a  depressed  scar  or 
dimple  at  the  point  of  maximum  convexity  was  pre" 
sent.  The  metatarsal  and  phalangeal  bones  of  the 
fifth  toe  were  absent,   the  toot  was  in  well-marked 


472     The  Medical  Prkss.        TRANSACTIONS  OF  SOCIETIES. 


May  4,  19041 


equino-varus.  A  skiagram  confirmed  the  complete 
absence  of  the  fibula.  No  history  ot  deformity  in  the 
family,  nor  of  injury  during  pregnancy,  was  obtainable. 

ROYAL  ACADEMY  OF  MEDICINE  IN  IRELAND. 
Section  of  State  Medicine. 
Meeting  held  Friday,  April  22nd,  1904. 


Sir   John  Moore,  President  of  the  Section,  in   the 
Chair. 


POISONING  BY  CANTHARIDES. 

Dr.  Martley  brought  forward  a  case  in  which  an 
elderly  woman  had  been  poisoned  by  this  substance. 
About  an  ounce  of  the  powdered  drug  had  been  ad- 
ministered to  her  in  a  glass  of  rum,  but  in  spite  of  the 
amount  having  been  so  large,  she  survived  for  thirty- 
one  and  a  half  hours. 

ON  THE  CASES  OF  POISONING  BY  COAL-GAS  THAT  HAVE 
OCCURRED  IN  DUBLIN  SINCE  THE  ADDITION  OF 
CARBURETTED  WATER-GAS  TO  THE  ORDINARY  COAL- 
GAS. 

A  paper  on  this  subject  was  read  by  Prof.  E.  J. 
M'Weeney,  M.D.  The  first  person  to  draw  attention 
to  the  increased  percentage  of  carbon  monoxide  in 
the  Dublin  coal-gas  was  Prof.  Emerson  Reynolds, 
who,  in  a  paper  read  before  the  Royal  Dublin  Society, 
in  1900,  communicated  the  result  of  a  number  of 
analyses  made  by  him,  which  went  to  show  that 
the  ordinary  percentage  of  C  O,  viz.,  6  per  cent.,  had 
been  more  than  doubled  during  February  and  March, 
1900,  and  this  increase  he  accounted  for  by  the  addition 
of  carburetted  water-gas.  Some  analyses  kindly 
made  for  the  speaker  during  the  past  few  days  by 
Mr.  Holmes  Pollok,  of  the  Royal  College  of  Science, 
showed  17*2,  16*8  and  14*6  per  cent,  of  C  O  respectively. 
The  speaker  then  proceeded  to  recount  in  detail  the 
circumstances  attending  the  seven  fatal  cases  that 
had  come  under  his  notice  during  the  past  three  years. 
Special  features  of  interest  attached  to  each.  In  the 
first  group  the  family  of  four  lived  in  a  house  where 
gas  was  not  used,  and  there  were  no  fittings.  The 
gas  had  penetrated  into  it  from  a  broken  main  in  the 
street,  with  the  result  that  one  of  the  persons  was 
found  dead  and  the  others  more  or  less  collapsed. 
The  haemoglobin  in  the  fatal  case  was  73  per  cent., 
saturated  with  carbon  monoxide.  In  the  second  group, 
a  clumsy  attempt  had  been  made  to  defraud  the  gas 
company  by  "  short-circuiting  "  the  gas  into  the  house 
so  as  to  eliminate  the  meter.  The  rubber  tube  used 
in  the  attempt  had  slipped  off,  with  the  result  that 
the  family  of  three  persons  were  asphyxiated  in  their 
sleep.  The  third  group  of  cases  was  that  of  a  man  and 
his  wife,  who  were  suffocated  in  their  bedroom  at  a 
Dublin  hotel  by  gas  escaping  from  a  wall-bracket,  the 
stop-cock  of  which  was  half  open.  The  room  had  a 
cubic  capacity,  after  deductions,  of  only  1,034  cubic 
feet,  and  was  without  a  fire-place.  The  window  was 
closed  and  the  ventilation  openings  amounted  to 
only  sixteen  square  inches.  The  danger  of  such  bed- 
rooms was  pointed  out.  The  last  case  was  that  of  a 
young  man,  who  was  asphyxiated  in  his  bath  by  the 
C  O  containing  fumes  escaping  from  a  badly-con- 
structed and  unventilated  "  geyser."  The  haemo- 
globin in  this  case  was  877  per  cent.,  saturated  with 
C  O.  The  speaker  concluded  by  emphasising  the  need 
for  increased  caution  imposed  by  the  more  deadly 
nature  of  the  gas  now  supplied.  He  had  in  each  case 
applied  the  usual  spectroscopic  and  chemical  tests 
for  C  O  with  positive  results.  The  findings  at  the 
autopsy  of  each  case  were  typical.  He  had  also  made 
blood  counts  and  differential  leucocyte  counts  in  the 
cases  that  had  recovered,  but  the  results  were  con- 
flicting. 

Professor  Tichborne  said  that  in  the  last  case  it 
was  evident  that  the  C  O  did  not  come  from  the  com- 
bustion of  the  gas,  as  it  would  then  have  been  con- 
verted into  C  02,  but  must  have  got  into  the  room 
as  C  O.  He  suggested  that  as  the  accident  had  hap- 
pened about  9.30  p.m.,  a  time  when  there  was  great 
pressure  in  the  mains,  the  C  O  might  have  escaped 
through  the  air  inlets  in  the  Bunsen  burners. 


Dr.  Beveridge,  referring  to  the  case  which  occurred 
in  an  hotel,  considered  that  the  rooms  in  hotels  should 
be  on  the  same  footing  as  the  berths  in  passenger 
steamers,  which  were  subject  to  inspection,  to  ensure 
that  suitable  accommodation  had  been  provided  for 
each  passenger. 

Dr.  Delahoyde  felt  that  a  good  deal  of  the  ill- 
health  among  the  working  classes  was  to  be  put  down 
to  the  use  of  penny-in-the-slot  meters  and  gas  cooking 
stoves,  which  were  not  connected  with  a  flue. 

Dr.  Kirkpatrick  thought  it  remarkable  that  C  0 
gas  was  escaping  at  such  a  rate  as  to  poison  a  man, 
and  saturate  his  haemoglobin  to  the  extent  of  8  per 
cent,  and  yet  that  it  did  not  explode,  though  the  gas 
jet  was  lighted  all  the  time. 

After  remarks  from  Dr.  Caning  ton,  Dr.  M'Vittie, 
and  Dr.  Bewley,  Prof.  M'Weeney  replied. 

Dr.  Martley  then  read  a  short  paper  on  "  The  Duties 
of  Medical  Men  at  Coroners'  Inquests,"  a  subject  that 
had  been  suggested  by  events  which  had  been  reported 
by  the  press  to  have  occurred  at  a  recent  inquest. 
It  appeared  that  a  man  had  been  brought  dead  into 
a  hospital,  at  which  he  had  attended  as  an  out-patient 
more  than  six  months  previously.  The  coroner  asked 
the  house-surgeon  to  give  his  opinion  as  to  the  cause 
of  death,  without  making  an  autopsy.  This  he 
declined  to  do,  whereupon  the  coroner  directed  the 
jury  to  find  a  verdict. 

The  following  resolution  was  then  adopted  unani- 
mously by  the  Section  : — "  Resolved  that  the  Council 
of  this  Section  be  requested  to  communicate  to  the 
Council  of  the  Academy  the  facts  relative  to  the  case 
in  which  one  of  the  Dublin  coroners  recently  called 
upon  a  member  of  the  medical  profession  to  certify 
to  the  cause  of  death  of  a  patient  who  was  brought 
dead  into  the  Royal  City  of  Dublin  Hospital,  with  a 
recommendation  that  those  facts,  as  well  as  the 
relation  of  the  profession  to  Coroners'  Courts,  should 
be  brought  under  the  notice  of  the  authorities." 

WEST  LONDON  MEDICO-CHIRURGICAL  SOCIETY 
Clinical    Meeting    held    (at    the    West    London 

Hospital)  April  8th. 
The  President,  Dr.  Seymour  Taylor,    in    the  Chair. 


Dr.  P.  S.  Abraham  showed  (1)  a  case  of  Molluscum 
Contagiosum  in  a  girl,  aet.  8.  The  lesions,  which  were 
quite  typical,  pearly  in  appearance  and  the  larger  ones 
umbilicated,  were  seen  chiefly  on  the  face,  only  a  few 
being  on  the  body.  Dr.  Abraham  referred  to  the 
difficulties  met  with  in  diagnosis  when  the  lesions  were 
profuse  and  widely  scattered  over  the  body,  and 
described  the  typical  microscopical  appearances  of  the 
molluscum  bodies.  (2)  A  case  of  Creeping  Linear 
Dermatitis.  The  patient,  a  delicate,  ill-nourished  girl, 
aet.  7i,  had  suffered  shortly  after  birth  from  an  abscess 
in  the  right  breast,  which  had  gradually  travelled  right 
across  the  chest,  leaving  a  serpiginous,  slightly  pig- 
mented, irregular  line  marked  by  numerous  whitish 
pits,  evidently  the  sites  of  the  little  abscess.  The  case 
strongly  resembled  the  "  creeping  eruption  "  described 
by  Dr.  Lee  in  1884  and  1892,  and,  to  some  extent,  those 
cases  due  to  the  subcutaneous  burrowing  of  a  cestrus 
larva.  The  term  "  larva  migrans  "  had  been  applied  to 
all  these  cases  of  creeping  linear  lesions,  in  Dr.  Abraham's 
opinion  incorrectly,  as  a  certain  number,  like  the  case 
shown,  had  nothing  to  do  with  a  migrating  larva. 
Excision  of  the  advancing  end  of  the  creeping  hne,  and 
careful  microscopic  examination,  was  the  treatment 
proposed. 

Dr.  Campbell  Pope  referred  to  a  case  of 
molluscum  contagiosum  recently  under  his  care  in  an 
adult  in  which  there  were  a  large  number  of  xnollnsca 
scattered  over  the  body.  The  case  had  at  first  been 
considered  to  be  one  of  varicella,  but  the  duration  of 
the  eruption  and  the  typical  appearance  of  the  tumours 
led  to  a  correct  diagnosis.  The  application  of  pore 
carbolic  acid  to  the  individual  tumours,  a  few  at  a  tunc, 
effected  a  rapid  cure. 

The  President  showed  a  young  woman,  **• 
23,  who  had  been  admitted  for  extreme  emaciation. 
She  had  steadily  refused  food  except     under    great 


May  4,  1904 


TRANSACTIONS  OF  SOCIETIES.        The  Medical  Press.     473 


persuasion  for  a  period  of  six  months.  Her  mental  condi- 
tion was  noteworthy.  She  was  perverse,  suspicious  and 
obstinate,  and  at  times  refused  to  reply  to  any  questions. 
There  was  no  evidence,  on  careful  exam  nation, 
of  physical  disease,  and  the  case  was  considered  to  one 
of  anorexia  nervosa.  At  first  forced  feeding  by  nasal 
tube  was  necessary,  but  gradually  the  patient  was 
induced  to  take  a  fair  quantity  of  nourishment.  Such 
cases  usually  recovered  under  Weir-Mitchell  treatment, 
but  the  mental  condition  of  many  was  such  as  to  justify 
one  in  regarding  the  sufferers  as  being  on  the  border- 
line of  insanity. 

Dr.  Campbell  referred  to  similar  cases  that 
had  come  under  his  own  notice.  In  one,  a 
lady  of  neurotic  tendencies,  who  had  become  extremely 
emaciated,  removal  to  fresh  surroundings,  efficient 
nursing  and  careful  feeding  had  proved  successful. 
In  this  case  a  condition  of  fragilitas  ossium  existed  in 
a  marked  degree.  In  two  other  cases,  a  mother  and 
daughter  both  suffered  from  anorexia  nervosa  with 
emaciation.  The  condition  in  the  mother  was  appar- 
ently induced  by  the  worrry  and  anxiety  connected 
with  her  daughter's  illness. 

Dr.  Leslie  Thorne  Thorne  believed  that  patients 
who  had  been  apparently  successfully  treated  by  the 
Weir-Mitchell  method  frequently  relapsed.  In  a  case 
occurring  in  his  own  practice,  the  cure  at  first  seemed 
complete,  but  relapse  occurred  in  a  comparatively  short 
time  after  she  returned  to  her  family. 

Mr.  R.  W.  Lloyd  drew  attention  to  the  difficulty  of 
excluding  with  certainty  local  pathological  causes  of 
the  emaciation  in  such  cases,  and  quoted  the  case  of  a 
patient  presenting  extreme  wasting  in  whom  a  post- 
mortem examination  unexpectedly  revealed  the  pre- 
.  sence  of  an  old-standing  duodenal  ulcer.  The  medico- 
legal aspect  of  this  class  of  case  was  also  referred  to. 
1  Dr.  J.  D.  Mortimer  was  inclined*  to  go  further  than 

j  the  President  in  considering  these  cases  as  on  the 
borderland  of  insanity.  He  was  accustomed  to  arrange 
for  unremitting  supervision  in  undertaking  their  treat- 
ment, as  it  was  impossible  to  foretell  whether  sudden 
suicidal  impulse  might  not  arise.  The  association 
between  melancholia  and  malnutrition  was  a  close  one, 
and  he  agrees  with  Dr.  Clouston  as  to  the  necessity  for 
"  feeding  up  "  and  "  fresh  air  "  in  such  conditions. 
There  was  also  a  close  connection  between  the  mental 
symptoms  in  certain  cases  and  organic  disease,  as 
abdominal  cancer,  the  former  being  frequently  out  of 
all  proportion  to  the  extent  of  the  visceral  lesion. 

Dr.  J.  B.  Ball  showed  ( 1 )  a  case  of  Melanotic  Sarcoma 
of  the  Soft  Palate.  The  patient,  a  man,  aet.  53,  had 
noticed  black  patches  on  the  roof  of  his  mouth  for  about 
two  years,  and  about  fifteen  months  later  a  growth  ap- 
peared on  the  soft  palate.  This  caused  no  inconvenience 
till  three  weeks  ago,  when  haemorrhage  caused  him  to 
seek  medical  advice.  On  admission,  a  dark,  flattened 
mushroom-like  growth  was  seen  on  the  middle  of  the 
soft  palate,  with  numerous  pigmented  patches  on  the 
hard  and  soft  palate,  and  on  the  gums  of  the  upper  jaw. 
Melanotic  sarcomata  were  rare  in  this  situation  as 
primary,  but  not  uncommon  as  secondary,  growths. 
In  this  case,  however,  the  length  of  time  since  the  pig- 
mentary patches  appeared,  together  with  the  absence 
of  any  discoverable  growth  elsewhere,  seemed  to  point 
to  the  palate  as  the  primary  seat  of  the  disease.  Various 
opinions  had  been  expressed  as  to  the  treatment  of  the 
case.  Operation  was  considered  useless  by  some,  others 
recommended  free  removal  of  the  growth,  and  others 
advised,  in  addition,  removal  of  all  the  soft  parts 
on  which  the  patches  of  pigment  were  present. 
(2)  A  girl,  aet.  17,  who  had  come  under  his  care  four 
weeks  previously  complaining  of  swelling  of  the  left 
cheek.  This  had  been  gradually  increasing  for  about 
three  months,  and  had  been  painless.  The  canine  fossa 
was  found  to  be  occupied  by  a  soft,  fluctuating  swelling, 
the  anterior  wall  of  the  antrum  being  absorbed.  There 
was  marked  swelling  of  the  palate  on  the  left  side  from 
downward  protrusion  of  the  floor  of  the  antrum.  This 
swelling  was  also  soft  at  one  point  from  absorption  of 

bone.  The  left  nasal  passage  was  almost  completely 
obstructed  owing  to  the  parts  on  the  outer  wall  of  the 
aasal  fossa  being  pushed  towards  the  septum.     On 


electric  transillumination  this  side  of  the  face  showed 
a  marked  shadow,  and  an  exploring  syringe  introduced 
through  the  canine  fossa  withdrew  dark  brownish 
fluid  containing  cholesterin  crystals.  Treatment 
consisted  in  evacuation  of  the  fluid  through  the  anterior 
wall  of  the  antrum.  A  large  opening  was  then  made 
through  the  nasal  wall  of  the  antrum  into  the  nose 
near  the  floor,  and  the  wound  in  the  canine  fossa 
allowed  to  close.  Recovery  was  rapid,  without 
deformity  of  the  face,  and  the  left  nasal  passage  was 
free.  The  case  was  considered  to  be  one  of  antral 
cyst. 

Mr.  C.  B.  Keetley  believed  that  the  prognosis  was 
bad  with  or  without  operation,  but  considered  that  local 
cure  might  possibly  be  obtained  by  free  removal  with  a 
wide  margin  of  apparently  healthy  tissue.  The  pigment 
patches  he  would  not  interfere  with  as  they  were 
probably  accompanied  by  other  foci  not  yet  visible, 
which  would  appear  if  the  patient  lived  long  enough. 

Mr.  Garry  Simpson  showed  a  case  of  Chloasma 
affecting  the  neck.  The  patient,  a  young  woman, 
aet.  18,  when  first  seen  a  fortnight  earlier  showed 
pronounced  pigmentary  deposit  of  liver  tint  on  tht 
left  side  of  the  neck,  and  to  a  much  less  extent  on  tin 
right  side.  She  had  been  exposed  to  cold  wind  a  few 
days  before  the  discoloration  appeared.  The  chief 
interest  in  the  case  was  its  sudden  onset  and  its  rapid 
disappearance  under  treatment.  Iodine  and  iodide 
of  potash  ointment  locally,  and  the  administration  of 
bromides  internally,  were  the  chief  measures  adopted. 

THE  ULSTER  MEDICAL  SOCIETY. 

Meeting  held  in  the  Medical  Institute,  Belfast, 

April  22ND,  1904. 


The  President,  Dr.  John  Campbell,  F.R.C.S.,  in  the 
Chair. 


Dr.  V.  G.  L.  Fielden  read  a  paper  on 

ETHYL     CHLORIDE     AS     A     GENERAL     ANESTHETIC. 

This  drug  was  used  as  an  anaesthetic  by  Richardson  as 
far  back  as  1867,  but,  owing  to  faulty  storage  and 
administration,  it  was  considered  a  failure.  As  lately 
as  1 901,  Hewitt  only  gave  it  one  page  in  his  book  on 
anaesthetics,  and  Luke  in  1902  said  it  was  most  un- 
trustworthy, though  he  has  since  modified  this  opinion. 
The  reason  of  many  of  the  failures  with  it  was  that 
Brewer's  mask  was  used,  which  admits  too  much  air, 
so  that  the  drug  is  too  dilute.  Also  in  it  the  cotton- 
wool steeped  in  ethyl  chloride  often  freezes,  and  the 
apparatus  ceases  to  work.  Dr.  Fielden  first  saw  this 
anaesthetic  used  a  year  ago,  and  since  then  has  used  it 
very  frequently.  He  showed  three  forms  of  inhalers 
for  it,  the  one  he  preferred  being  Lucas*  ether  inhaler, 
which  shuts  off  all  air.  Into  this  he  sprays  about 
5  c.c.  of  ethyl  chloride,  using  no  gauze,  but  simply 
letting  the  liquid  evaporate  on  the  sides  of  the  glass 
ball.  The  drug  was  used  in  various  forms.  Killene 
was  said  to  be  pure  ethyl  chloride,  and  narcotile  the 
same,  with  the  addition  01  a  small  quantity  of  methyl 
chloride.  Somnoform  contained  60  per  cent,  ethyl 
chloride,  35  per  cent,  methyl  chloride,  and  5  per  cent, 
ethyl  bromide.  The  tendency  at  present  was,  Dr. 
Fielden  thought,  to  use  pure  ethyl  chloride.  NarcotUe 
was  rather  less  pleasant  to  inhale,  otherwise  he  did  not 
find  it  to  differ  from  the  pure  drug  in  use.  One  great 
advantage  of  ethyl  chloride. was  the  rapidity  with 
which  narcosis  was  produced.  He  had  seen  it  once  in 
twenty  seconds,  but  generally  it  was  from  thirty  to 
sixty  seconds  in  children,  and  up  to  ninety  in  adults. 
The  duration  of  the  narcosis  after  removal  of  the  mask 
was  commonly  two  to  three  and  a  half  minutes ;  the 
advertisements  stating  that  it  was  five  to  ten  minutes 
were  quite  misleading.  The  rapidity  of  recovery  from 
the  narcosis  was  not  affected  by  tne  duration  of  ad- 
ministration ;  he  had  seen  a  man  to  whom  he  had 
administered  it  for  nine  minutes  answer  questions  one 
minute  after  removal  of  the  mask.  The  dose  of  the 
anaesthetic  used  was  5  c.c.  to  7  c.c.  for  an  aoult,  and 
2  c.c.  to  3  c.c.  for  a  child.  Narcosis  was  snown  by 
laxity  of  the  limbs,  stertorous  breathing,  loss  of  con- 
junctival, and   then  of  corneal  reflex  and  generally 


474    Th«  Medical  Pmss.        TRANSACTIONS  OF  SOCIETIES. 


May  4,  1904- 


contraction  of  the  pupils.  Complete  muscular  re- 
laxation was  the  rule  in  children,  but  is  not  invariable 
in  adults,  though  three  times  he  had  given  it  to  men 
for  reducing  a  dislocated  shoulder,  each  time  un- 
successfully. He  had  seen  spasm  of  the  jaw  in  three 
cases,  only  one  really  alarming,  but  that  was  in  a  case 
of  tetanus.  The  after-effects  were  generally  slight. 
He  had  found  that  there  was  vomiting  in  26  per  cent, 
of  his  cases,  but  it  was  not  generally  prolonged  or 
severe.  Several  charges  of  criminal  assault  had  been 
made  after  the  administration  of  ethyl  chloride,  so  it 
behoved  the  administrator  to  take  such  precautions 
as  would  avoid  such  a  risk. 

As  regards  safety,  ethyl  chloride  has  now  been  given 
in  many  thousands  of  cases  with  only  four  or  five  fatal 
results,  all  cases  of  grave  visceral  lesions.  The  con- 
sensus of  opinion  seemed  to  be  that  it  was  certainly  as 
safe  as  ether,  the  fatalities  being  put  at  1  in  15,000  or 
16,000.  Not  only  alone  was  ethyl  chloride  a  most 
useful  anaesthetic,  but  also  as  a  preliminary  to  ether,  in 
whicn  case  one  could  get  complete  ether  narcosis  in 
as  little  as  three  minutes. 

Summing  up,  Dr.  Fielden  said  he  had  now  given 
ethyl  chloride  in  140  cases  alone,  in  76  before  ether,  and 
in  two  before  chloroform,  and  he  had  every  reason  to 
be  satisfied  with  it. 

Dr.  Cecil  Shaw  said  that  Dr.  Fielden  had  given  this 
anaesthetic  nearly  forty  times  for  him,  chiefly  for  the 
removal  of  tonsils  and  adenoids,  but  also  for  some 
minor  operations  about  the  eye  and  nose,  and  he  con- 
sidered it  much  the  most  satisfactory  anaesthetic  in 
use  for  short  operations.  As  a  general  rule  both  tonsils 
and  adenoids  could  be  removed  with  one  dose  of  the 
anaesthetic,  but  a  second  could  easily  be  given  if  needed. 

Dr.  Kblvin  spoke  of  its  great  use  in  dental  practice, 
and  Drs.  Rusk,  Craig,  and  Killen  also  made  remarks  on 
the  paper. 

Mr.  Fullerton  showed  a  stomach  from  a  case  of 
"  Ruptured  Ulcer  "  in  an  hour-glass  stomach,  treated 
by  suture  and  gastro-gastrotomy,  who  died  a  month 
after  operation.  The  cause  of  death  could  not  be  dis- 
covered at  the  partial  examination  which  was  all  that 
was  possible.  I  he  patient  had  seemed  to  be  getting 
on  very  satisfactorily. 

Dr.  Cecil  Shaw  showed  microscopical  preparations 
from  some  unusual  cases  of  "  Catarrhal  Conjunctivitis," 
of  which  he  had  seen  several  in  the  last  two  months. 
They  were  characterised  by  great  swelling  of  the  lids 
and  profuse  discharge,  and  secondary  spots  of  impetigo 
on  the  arms  and  legs,  where  the  patients,  who  were  all 
young  children,  had  scratched  themselves.  Ihe 
microscope  showed  a  mixed  infection,  streptococci  and 
two  forms  ot  staphylococci  being  present. 

Dr.  W.  L.  Storey  read  a  paper,  entitled  "  Under- 
graduate Days  :  Random  and  Personal  Recollections 
of  Class  Room  and  Ward."  The  paper,  which  was  an 
exceedingly  witty  and  entertaining  one,  dealt  with  the 
teachers  ol  the  Belfast  Medical  School  about  the  year 
1886,  and  hit  off  the  various  characters  and  peculiarities 
of  the  men  most  happily,  in  a  way  that  could  offend 
none.  As  the  paper  was  not  one  that  lent  itself  to 
criticism,  a  hearty  vote  of  thanks  to  Dr.  Storey  was 
passed  by  acclamation. 

NORTH     OF     ENGLAND     OBSTETRICAL     AND 

GYNECOLOGICAL   SOCIETY. 

Meeting    held    at    Manchester,    Friday,    April 

15TH,    1904. 


Dr.  W.  J.  Sinclair,  President,  in  the  Chair. 

The  meeting  was  devoted  to  a  discussion  on  Abortion. 
Dr.   W.  E.  Fothekgill  (Manchester)  brought  for- 
ward some  points  regard  ng  the 

PATHOLOGY     OF     "  HABITUAL  "     AND     INCOMPLETE 
ABORTION. 

"  Habitual  "  abortion  was  denned  as  a  term  applied  to 
the  consecutive  occurrence  of  from  three  to  five 
abortions  in  the  same  patient,  without  any  sign  of 
syphilis.  He  had  examined  a  large  number  of  speci- 
mens from  such  cases,  and  had  found  that  there  was 
onstautly     present    thrombosis    of    the    intervillous 


spaces,  to  an  extent  sufficient  to  cause  death  of  the 
ovum.  Regarding  the  use  of  the  chlorate  of  potash 
in  such  cases,  he  asked  if  the  drug  diminished  the 
coagulability  of  the  blood.  Speaking  on  incomplete 
abortion,  with  reference  to  the  fate  of  portions  of 
ovuline  tissue  left  in  the  uterus  in  non-septic  cases, 
he  said  that  of  course  in  many  instances  breaking  down 
and  discharge  ot  the  tissue  occurs,  but  in  others  he 
suggested  that  the  decidual  cell  acts  in  some  degree 
as  a  phagocyte,  eating  up  the  ovuline  tissues.  He 
further  suggested,  on  the  ground  of  microscopical 
observation,  that  the  decidual  cell  is  an  active  phago- 
cyte with  the  function  of  repelling  invasion  by 
chorionic  villi.  When  the  decidual  cells  failed  to 
check  the  activity  of  the  foetal  villous  growth  deci- 
duoma  malignum  might  result. 

Dr.  J.  B.  Hellier  (Leeds)  introduced 

THE    MEDICAL    INDICATIONS    FOR    INDUCTION. 

To  establish  an  imperative  indication,  the  patient's 
life  must  be  seriously  threatened  and  the  operation 
must  be  likely  to  do  good.  In  advanced  cardiac 
disease  induction  in  the  early  months  of  pregnancy  is 
hardly  ever  the  correct  treatment,  and  strong  reasons 
were  adduced  against  the  performance  of  the  operation 
in  cases  of  pulmonary  tuberculosis  and  of  insanity. 
On  the  other  hand,  Dr.  Hellier  recognised  its  value  in 
three  classes  of  diseases  : — (1)  Hyperemesis  gravidarum 
of  the  "  pernicious  "  kind,  in  which  early  induction 
is  necessary  to  obtain  a  successful  result.  A  pulse 
rate  of  120  implies  a  serious  condition,  one  of  130  to 
140  means  a  doubtful  prognosis  in  any  case.  Women 
who  before  conception  have  had  symptoms  of  gastric 
ulcer,  although  the  symptoms  may  nave  ceased  for 
some  time,  are  liable  to  suffer  severely  from  vomiting 
in  pregnancy.  (2)  Certain  cases  of  chorea  gravidarum 
in  which  serious  nervous  and  constitutional  symptoms 
appear.  (3)  Cases  of  albuminuria  and  anasarca  due 
to  nephritis.  When  the  toxaemia  is  due  to  the  preg- 
nant state,  the  termination  of  the  latter  leads  to 
cessation  of  the  production  of  the  toxic  material. 
But  this  effect  is  not  instantaneous  ;  time  is  required 
before  improvement  can  be  obtained,  and  therefore 
induction  must  not  be  delayed  too  long. 

Dr.  J.  E.  Gemmell  (Liverpool)  brought  forward 

THE  METHODS  OF  INDUCTION. 

Bearing  in  mind  the  haemorrhage  and  sepsis  arising 
from  incomplete  natural  abortion,  the  method  chosen 
should  be  that  in  which  these  complications  are  best 
guarded  against.  The  time  selected  should  therefore 
be  before  the  end  of  the  fourth  month  ;  the  method, 
that  of  dilatation  by  means  of  Hegar's  dilators, 
curettage  and  gauze  packing,  after  the  same  prepara- 
tions and  under  the  same  conditions  that  are  usual 
in  any  other  surgical  operation  by  the  vaginal  route. 
By  this  method  the  whole  field  of  operation  is  under 
control  from  beginning  to  end  :  the  difficulty  of  extrac- 
tion of  the  foetus  is  overcome  by  the  use  of  ovum 
forceps,  or,  if  necessary,  by  removing  the  foetus  piece- 
meal. Dr.  GemmeU's  experience  was  of  six  cases 
in  eighteen  years: — (1)  At  third  month:  use  of 
sponge  tents  followed  by  finger  and  ovum  forceps. 
(2)  At  third  month  :  gum  elastic  bougie  and  gauze 
packing  of  vagina  ;  expulsion  in  twenty-four  hours ; 
sequela :  pelvic  cellulitis  and  abscess.  (3)  At  third 
month,  for  cancer  of  cervix  :  bougie,  wnich  was  ex- 
pelled in  twenty-four  hours  ;  second  placed,  followed 
by  expulsion  of  ovum  forty-eight  hours  later.  [4} 
At  second  month  :  for  haemophilia,  which  has  led  to 
nearly  fatal  post-partum  haemorrhage  at  each  of  three 
previous  labours  ;  passage  of  sound  and  separation  of 
membranes ;  expulsion  at  end  of  thirty -six  hours ; 
(5  and  6)  Dilatation  and  curettage  at  one  sitting.  If 
pregnancy  be  allowed  to  advance  to  the  fifth  month, 
induction  is  of  doubtful  value  to  the  patient.  If  it 
be  necessary,  the  method  of  dilatation  followed  by 
gauze  packing  or  the  smaller  Champetier  de  Ribes" 
bag  is  the  safest  line  of  treatment. 

Dr.  W.  Walter  (Manchester)  introduced 

THE  TREATMENT  OF  INCOMPLETE  ABORTION, 

dealing  with  both  the  non-septic  and  septic  states/ 


Mav  4,   1904. 


FRANCE. 


Thb  Medical  Press.    475 


Dr.  W.  Macfik  Campbell  (Liverpool)  introduced 

THE     TREATMENT     OF     ABORTION. 

After  briefly  reviewing  the  prophylactic  measuies, 
Dr.  Campbell  said  that  the  treatment  of  threatened 
abortion  was  simple  and  unsatisfactory,  although  he 
had  occasionally  been  surpiised  by  the  good  results  from 
ergot,  which  had  been  given  to  empty  the  uterus. 
With  inevitable  abortion  arose  the  question  of  whether 
treatment  should  be  expectant  or  active.  The  first 
requires  time,  carries  a  constantly  increasing  risk  of 
sepsis,  and  has  depressing  effects  upon  the  patient's 
mental  state.  There  were  also  the  possibilities  of 
retention  of  portions  of  placental  tissue,  and  the  need 
for  subsequent  interference.  In  active  treatment,  if 
tamponnement  of  the  vagina  did  not  lead  to  the  empty- 
ing of  the  uterus,  he  preferred  dilatation  followed  by  j 
digital  or  instrumental  clearing  out.  He  had  found  1 
digital  removal  a  difficult  procedure,  unless  the  ovum 
was  almost  extruded,  and  therefore  he  preferred  to  use  i 
the  ovum  forceps.  With  care  and  gentleness  the  pain  | 
was  trifling,  and  extraction  generally  easy.  If  the 
finger  discovered  some  attached  tissues,  he  employed 
Donald's  flushing  curette.  Bleeding  sometimes  goes 
on  after  removal  or  curetting,  and  it  was  then  necessary 
to  pack  the  uterine  cavity. 

Dr.  Lloyd  Roberts  (Manchester)  held  that 
"  habitual  "  abortion  was  due  to  syphilis.  He  ad- 
vocated early  abortion  in  cases  of  serious  cardiac 
disease,  in  nephritis  and  especially  in  hyperemesis,  in 
which  he  had  never  regretted  the  performance  of  the 
operation. 

Dr.  Donald  (Manchester)  considered  induction 
justifiable  in  cases  of  moral  insanity.  He  carried  out 
the  induction  at  one  sitting,  dilating  up  to  No.  16 
(Matthews  Duncan),  and  then  using  the  flushing  curette. 
Recovery  followed  without  a  bad  symptom. 

Dr.  J.  M.  H.  Martin  (Blackburn)  thought  that 
"  habitual "  abortion  was  due  chiefly  to  malpositions 
of  the  uterus  or  to  neurotic  conditions.  In  hvper- 
emesis  it  was  absolutely  wrong  to  abstain  from  inter- 
vention. 

Dr.  E.  O.  Croft  (Leeds)  took  a  middle  position  in 
regard  to  induction.  He  advocated  preliminary 
treatment  by  instrumental  separation  of  the  ovum 
or  by  packing  the  cervix  with  gauze.  As  a  result  the 
cervix  became  softer  and  was  more  easily  dilated 
subsequently.  Surgical  methods,  he  thought,  were 
advisable  only  in  urgent  cases. 

Dr.  E.  T.  Da  vies  (Liverpool)  supported  Dr.  Donald's 
remarks  anent  moral  insanity  on  the  ground  of  a 
similar  case  in  his  practice. 

CORK  MEDICAL  AND  SURGICAL  SOCIETY. 
Meeting    held    Wednesday,    April    27TH,     1904. 


and  Stimulants,"  in  which  he  condemned  the  habit  of 
giving  alcohol  in  various  diseases  without  sufficiently 
clear  indications  for  its  use. 
A  discussion  on  this  paper  followed. 


Dr.   J.  Cotter,  President,  in  the  Chair. 

The  President  read  notes  of  a  case  of  "  Wry-neck  " 
in  a  child,  aet.  6,  treated  by  the  open  method  of  opera- 
tion, with  a  very  satisfactory  result,  and  showed  the 
patient. 

Dr.  P.  T.  O'Sullivan  showed  a  boy,  aet.  8,  suffering 
from  pseudo-hypertrophic  muscular  paralysis. 

Dr.  T.  Gelston  Atkins  read  a  short  paper  on  the 
value  of  "  Catheterisation  of  the  Ureters  and  Skia- 
graphy of  the  Kidneys,"  in  the  diagnosis  of  renal 
calculus,  and  read  notes  ot  a  successful  case  of  nephro- 
lithotomy to  illustrate  his  remarks. 

Dr.  Atkins  also  read  notes  of  a  series  of  eight  success- 
ful cases  of  "  Gastrojejunostomy,"  undertaken  for 
chronic  gastric  ulcer  or  gastric  dilatation  which  had 
not  responded  to  medicinal  treatment.  The  results  had 
been  most  satisfactory  in  every  instance.  He  also 
showed  a  boy,  aet.  11,  on  whom  he  had  performed 
excision  of  the  elbow  for  extensive  tuberculous  disease. 
Several  surgeons  had  advised  amputation  in  the  case, 
and  he  had  given  the  same  advice  himself,  but  the 
boy's  parents  would  not  consent.  The  result  of  the 
operation  performed  had  come  on  him  more  or  less 
as  a  surprise,  as  the  boy  had  practically  perfect  move- 
ment in  the  limb. 

Dr.  John  Booth  read  a   paper  on    "  Stimulation 


jfrance* 

[from  our  own  correspondent.] 

Paris,  M»y  1st,  1904. 
Treatment  of  Affections  of  the  Knee. 
Certain  rather  frequent  affections  of'the  knee-joint 
are  characterised  by  pain  in  the  articulation. 

Hitherto  these  affections  have  been  classed  under  the 
denomination  of  "  articular  neuralgia."  But  the 
progress  of  pathological  anatomy  on  the  one  hand, 
and  of  surgical  asepsis  on  the  other,  have  shown  that 
these  affections  were  not  simple  neuralgia,  and  that 
the  pain  complained  of  by  the  patients  possessed  an 
objective  substratum.  Four  distinct  lesions  can  be 
incriminated  in  such  cases:  (1)  Muscular  atrophy 
consecutive  to  an  articular  affection  of  the  knee. 
(2)  Internal  disturbance  of  the  joint.  (3)  Intra- 
articular lipoma.  (4)  Foreign  bodies  in  the  joint. 
It  is  possible  with  a  little  attention  to  make  a  differen- 
tial diagnosis  of  these  lesions  and  thereby  institute 
a  rational  and  efficacious  treatment. 
k>  Here  is  an  example  of  muscular  atrophy  of  articular' 
origin.  A  man  ot  robust  health  falls  on  his  knee*; 
haemarthrosis  is  produced,  the  joint  swells,  and  the 
patient  suffers. 

Treatment.—* Rest  in  bed,  compressive  bandage,  later 
massage.  At  the  end  of  a  week  the  patient  quits 
his  bed  and  returns  to  work,  although  still  suffering 
somewhat ;  the  joint  is  bound  with  a  flannel  bandage. 
The  massage  is  continued  ;  nevertheless  the  pain  does 
not  yield  ; .  it  is  always  localised  at  the  internal  side 
of  the  joint,  beneath  the  patella. 
As  the  massage,  baths,  compression,  and  warm  poultices 
have  not  effected  a  cure,  the  patient  consults  a  surgeon. 
A  careful  examination  will  show  tnat  there  exists  no 
trace  of  inflammation  in  the  joint,  but  marked  atrophy 
of  the  neighbouring  extensor  muscles  is  noticed. 
The  quadriceps  is  flaccid,  soft,  and  diminished  in  size, 
while  the  vastus  internus  seems  to  be  particularly  atro- 
phied towards  the  inguinal  region. 

Tne  lesion  ot  the  quadriceps  is  the  cause  of  the 
suffering  experienced  by  the  patient.  The  muscles- 
being  the  tensois  of  the  capsule  of  the  joint,  when? 
atrophied,  the  capsular  tension  is  diminished,  and  h* 
these  conditions  it  easily  happens  that  it  is  pinched 
between  the  condyles  and  the  patella,  and  thus  pro- 
vokes the  suffering. 

As  regards  treatment,  it  suffices  to  apply  massage 
and  gymnastic  exercise  to  the  quadriceps  to  obtain 
a  normal  tension  and  the  cessation  of  pain  at  the  end 
of  six  weeks.  In  the  internal  disturbance  of  the 
joint,  the  symptoms  are  about  the  same,  and  the 
trouble  consists  in  luxation  of  one  or  both  semilunar 
cartilages.  It  happens  that  under  the  influence  of 
certain  exertions  these  cartilages  are  torn  from  their 
anterior  and  posterior  insertions.  In  reality  it  is  not 
a  case  of  true  luxation,  but  simply  a  rupture  of 
their  ligaments.  Most  frequently  it  is  the  anterior 
insertion  of  the  internal  edge  of  the  cartilage  that  is 
torn  from  the  tibia.  Having  become  particularly 
mobile,  the  cartilage  moves  backwards  or  forwards  in 
the  articulation. 

To  produce  this"  accident  very  great  exertion  is  not 
necessary  ;  a  more  or  less  violent  movement  of  rotation 
of  thejeg  (gymnastics,  wrestling,  football,  &c).  or  even 


47&    The  Mbdical  Pekss. 


GERMANY. 


May  4.  1904. 


loss  intense  but  repeated  traumatism,  as,  for  instance, 
the  workmen  who  work  on  their  knees. 

The  clinical  picture  of  the  rupture  of  these  semi- 
lunar cartilages  is  particular  striking.  After  the 
accident  the  patient  suffers  and  the  knee  swells  ;  he 
cannot  extend  the  leg,  and  he  walks  on  his  toes. 
On  both  sides  of  the  patella  a  soft  elastic  tumefaction 
is  found,  which  becomes  very  painful  to  the  touch 
and  to  motion.  By  rest,  poultices,  and  massage  the 
morbid  symptoms  diminish  in  intensity,  and  the 
function  of  the  joint  becomes  easier.  However,  the 
articulation  has  not  returned  to  its  normal  condition  ; 
•characteristic  pains  are  felt.  At  more  or  less  long 
intervals  the  patient,  under  the  influence  of  a  sudden 
movement,  a  long  walk,  &c,  is  seized  with  pain  in  the 
joint,  which  he  is  obliged  to  keep  bent  for  a  certain 
time ;  he  falls  and  experiences  the  sensation  of  a 
foreign  body  in  the  knee. 

In  examining  the  patient,  the  articulation  is  gener- 
ally found  to  be  very  healthy  ;  there  is  no  trace  of 
effusion  nor  of  tumefation.  On  the  other  hand,  the 
knee  is  frequently  flexed  with  rotation  of  the  leg  out- 
wards if  the  internal  cartilage  in  ruptured,  with 
rotation  inwards  if  the  external  cartilage  is  injured. 
A  study  of  the  groove  between  the  femur  and  the  tibia 
furnishes  characteristic  signs.  At  this  point,  the 
place  occupied  by  the  ruptured  cartilage  is  particularly 
painful ;  this  is  a  very  important  sign  for  the  diagnosis. 
It  is  possible  sometimes  to  distinctly  feel  the  cartilage 
as  a  fine  and  hard  band  which  becomes  prominent 
during  extension  of  the  leg,  and  disappears  in  flexion  of 
the  knee. 

When  the  surgeon  is  consulted  immediately  after 
the  accident,  an  effort  can  be  made  to  put  the  cartilages 
into  place.  This  object  is  effected  by  extension  and 
'  sudden  flexion  of  the  leg  while  the  thumb  is  placed  on 
the  articular  groove,  so  as  to  push  them  into  position. 
If  not  successful,  a  cure  can  be  obtained  by  rest, 
bandages,  and  massage.  It  frequently  happens,  however, 
in  chronic  cases  that  an  operation  for  extirpation  of 
.  the  cartilages  is  necessary. 

"  Articular  neuralgia  "  can  also  be  caused  by  intra- 
articular lipoma  or  fatty  tumours  of  a  certain  volume 
<cherry,  walnut,  hen's  egg),  which  develop  under  the 
synovial  membrane  and  more  particularly  on  the  inner 
aide  of  the  joint.  This  affection  is  ^consecutive  to 
a  traumatism,  or  to  a  chronic  irritation  of  the  articula- 
tion, such  as  might  be  produced  by  a  foreign  body. 
These  fringes  insinuate  themselves  between  the  femur 
and  the  tibia. 

Walking  is  much  hindered  and  pain  is  provoked  at 
intervals. 

The  objective  signs  of  the  affection  are  characteristic. 
Besides  the  muscular  atrophy  and  a  particular  crack. 
*ng  of  the  joint,  an  elastic  swelling  is  observed  on  each 
side  of  the  patellar  ligament,  by  which  the  latter  is 
^bulged  forward. 

To  treat  the  affection,  painting  with  iodine,  massage, 
.compression,  &c,  aie  generally  tried,  but  without 
much  success.  The  only  rational  treatment  is  extir- 
pation. 

Germans. 

[from  our  own  correspondent.] 


Medical   Societv, 


Biblim,  April  SOth,  1904. 
Hr.   Orth   discussed    the 


At   the 
4mbject  of 

Heredity, 
more  especially  with  regard     to     tuberculosis.      If  a 
tetus  in  idero  acquired  tuberculosis  from  its  mother 


it  was  not  an  inheritance,  but  placental  infection. 
Both  paternal  and  maternal  parts  of  the  foetus  must 
have  an  equal  capacity  for  heredity.  If  the  mother, 
however,  during  the  whole  of  intra-uterine  life  had 
the  power  to  convey  disease,  she  would  have  a  greater 
influence  than  the  father.  The  chick  in  the  egg  that 
suffered  from  outside  injuries  would  be  like  the  foetus 
that  became  diseased  tn  utero.  Now,  the  chick  had 
been  experimentally  infected  with  tubercle  through 
the  shell,  but  no  one  would  think  of  calling  that  kind 
of  infection  heredity.  Not  all  that  was  in  the  semen 
at  the  time  of  copulation  was  inherited.  A  tubercle 
bacillus  might  be  mixed  up  with  otherwise  healthy 
semen  and  subsequently  infect  the  ovum.  This, 
however,  would  not  be  heredity  but  germinal  infection, 
for  both  semen  and  ovuli  were  healthy.  If  disease 
was  carried  in  the  germ  cells  and  was  a  part  of  their 
base,  that  was  heredity.  There  could  not,  therefore, 
be  any  such  thing  as  inherited  infectious  disease. 
Were  there  any  inherited  diseases  ?  Possibly  this 
was  the  case  with  the  weakly  children  of  old  people  or 
in  the  dystrophy  of  children  of  syphilitic  parents. 
Otherwise  onlv  disturbances  of  constitution  and  ten- 
dencies towards  disease  were  inherited. 

According  to  Weismann  peculiarities  of  the  germ 
plasma  were  the  foundation  of  the  peculiarities  of 
inheritance.  Two  properties  of  germ  plasma  were 
characteristics  of  it — its  continuity,  through  which  the 
species  was  kept  up,  and  its  variableness,  which  formed 
the  basis  of  its  further  developments.  An  exception 
to  this  was  bastardy  ;  here  the  germ  cells  were  normal 
but  of  different  kinds,  and  by  copulation  a  new  kind, 
differing  from  both,  was  formed. 

Variation  of  the  germ  plasma  rested  probably  on  the 
action  of  external  causes.  There  were  two  kinds  of 
germ  variation — (a)  primary,  through  direct  change  of 
the  germ  plasma,  and  (6)  secondary,  which  came  to 
pass  from  changes  in  the  whole  body. 

The  fact  observed  in  fish  culture  that  many  more 
failures  in  the  later  deposited  ova  than  in  the  earlier 
was  an  instance  of  the  first.  The  secondary  variations 
were  the  basis  of  the  inheritance  of  the  acquired  pro- 
perties of  the  "  soma."  The  question  was  whether 
there  really  were  such  variations,  when  no  explanation 
could  be  found  for  them.  Weismann  completely 
denied  the  inheritance  of  acquired  properties,  but  there 
were  various  kinds  of  inherited  properties.  First 
mutilations  ;  an  inheritance  of  these  had  never  been 
seen.  Nor  had  a  woman  ever  been  born  without  a 
hymen,  although  the  hymen  had  been  destroyed 
through  thousands  of  generations  of  women  ;  nor  had 
any  boy  been  born  without  a  prepuce.  Boys  had  been 
indeed  born  with  ill-developed  prepuces,  but  they 
might  be  in  families  in  which  circumcision  was  not 
practised.  There  were  cats  with  short  tails  from 
parents  with  normal  ones,  as  well  as  from  those  with 
short  ones.  The  attempt  to  produce  rats  with  short 
tails  had  failed. 

With  mutilation  of  internal  organs  it  was  somewhat 
different.  Brown-Sequard  believed  that  the  off- 
spring of  guinea-pigs,  the  brains  of  which  he  had 
destroyed,  had  a  kind  of  epilepsy.  It  had  been  stated 
that  when  the  spleen  was  extirpated  through  several 
generations  a  congenital  absence  of  development 
occurred.  The  truth  of  these  statements  had  not  been 
proved,  however. 

It  had  also  been  stated  that  the  breasts  of  women, 

generations  in  series  of  whom    had  been  not  given 

such,  became  smaller,  but  this  also  had  not  been  proved. 

Finally   it    had    been    hoped    that   immunity  was 

hereditary.     There  was,  indeed,  a  congenital  immunity  f 


May  4.  1904. 


AUSTRIA. 


The  Medical  Press.    477 


but  this  always  arose  through  the  mother,  and  never 
from  the  father,  and  this  was  in  favour  of  its  being 
uterine  and  not  hereditary. 

Hitherto  there  had  been  no  pioof  that  acquired 
properties  could  be  inherited.  It  was  possible  that 
certain  chronic  properties  could  be,  but  further  studies 
in  the  region  of  cellular  chemistry  were  required  before 
this  could  be  known. 

Hr.  Kossmann  was  not  one  of  those  who  believed 
that  degeneration  of  the  mamma  was  a  result  of 
want  of  use ;  he  would  rather  attribute  it  to  Darwin's 
law  of  selection  ;  amongst  animals  or  savage  races 
the  coild  would  die  with  insufficient  food  from  the 
breast,  but  with  cultured  people  a  substitute  for 
maternal  food  was  possible  and  therefore  a  reversion  as 
regarded  the  mamma  might  be  possible. 

Hr.  Hirschberg  observed  that  although  man  was 
in  his  original  state  far-sighted  there  are  many  short- 
sighted people  now.  This  change  in  the  structure  of 
the  eye  was  possibly  due  to  heredity. 

Hr.  Hausemann  had  frequently  extirpated  the 
spleen  of  animals  even  through  many  generations,  but 
no  change  had  ever  been  found  in  the  organs  in  their 
young. 

Hr.  Bend  a  had  previously  shown  that  when  tubercle 
developed  in  the  testes,  the  formation  of  spermatozoa 
ceased.  He  did  not  think  it  conceivable  that  a  tubercle 
bacillus  could  penetrate  into  the  ovum  along  with  the 
spermatozoa,  e.g.,  infection  would  rather  take  place 
later  through  the  membranes.  It  might  be  mentioned 
further  that  diseased  spermatozoa  were  unsuitable  for 
impregnation  at  all. 

Hr.  Pagel  showed  that  in  Jewish  families  boys 
were  occasionally  born  without  a  prepuce,  and  the 
Talmud  gave  certain  regulations  for  the  case. 

Hr.  M.  Wolff  agreed  with  the  first  speaker  that 
congenital  infection  was  extremely  rare. 

Hr.  Orth,  in  his  reply,  repeated  that  according  to 
our  present  knowledge  no  case  had  been  proved  of 
the  inheritance  of  any  acquired  peculiarity  or  property. 


Bustcia- 


[from  our  own  co-respondent.] 


Vmhva.  April  30th,  1004. 
"  VOLKSKUCHBNVEREIN." 

The  "  Volkskuchenverein  "  is  a  new  institution  in 
Vienna,  and  was  formally  opened  on  March  28th.  Its 
objects  are  charitable  in  providing  suitable  food  for 
the  infirm  and  convalescent  at  a  nominal  sum  for 
those  who  can  pay,  and  free  for  those  unable  to  afford 
anything.  For  this  purpose  the  medical  men  are 
provided  with  cards,  which  they  sign  and  give  to 
the  deserving  patient.  It  is  generally  understood 
that  the  food  be  taken  away  from  the  kitchens,  but  a 
few  rooms  are  fitted  up  for  convalescents  who  can 
travel  so  far.  This  is  the  first  institution  of  the  kind 
in  Vienna,  and  will  be  watched  with  considerable 
interest  as  a  philanthropic  enterprise. 
Hydrophobia. 

The  results  of  1902  for  the  Cracow  institution  have 
just  come  to  hand,  giving  the  number  of  entries  for  the 
Institute  as  516.  Out  of  this  number  16  persons  were 
found  to  be  bitten  by  healthy  animals.  Of  the  remain- 
ing 500  inoculated  8  died,  which  is  somewhat  less 
than  the  preceding  year.  The  inoculations  were 
performed  with  new  needles  in  every  case,  the  parts 
washed  with  sterilised  water,  and  the  matter  itself  steri- 
lised under  the  effects  of  steam.  A  large  number  of 
*hese  had  been  cauterised  by  local  practitioners  before 


admission.  The  infection  was  transmitted  in  483 
cases  by  the  bites  of  dogs,  21  by  cats,  and  3  through 
horses  and  cows,  and  the  remainder  by  badgers, 
foxes,  swine,  and  carves,  but  two  of  these  were  trans- 
mitted by  infected  children. 

Dysentery  in  Children. 
Jehle  gives  a  lengthy  report  of  his  bacterio- 
logical research  in  a  series  of  dysenteric  children. 
At  the  same  time  he  conducted  a  variety  of  experi- 
ments on  the  stools  of  diarrhoea  and  those  under  normal 
conditions.  His  results,  he  said,  somewhat  resembled 
Charleton's.  In  the  first  group  he  had  five  typical 
cases  of  dysentery,  wherein  he  found  the  true  Shiga 
and  Kruse  bacilli.  In  each  of  these  cases  he  also 
found  a  bacilli  with  a  high  agglutinating  power  when 
brought  in  contact  with  the  blood  serum  of  the  patient. 
In  one  of  the  cases  this  experiment  was  conducted  at 
the  post-mortem,  in  two  others  it  was  obtained  by 
cultures.  Kruse's  dysenteric  bacilli  were  found  in 
two  of  these  cases,  while  Flexner's  bacilli  were  also 
found  in  two.  The  dysenteric  bodies  coagulated 
blood  serum  within  the  first  two  weeks  of  the  disease. 
In  addition  to  these  he  recorded  two  cases  of  meat 
poisoning,  which  produced  a  form  of  endemic  dysentery 
in  hospital.  In  all  of  these  the  Flexner  bodies  re- 
sembling the  bacteria  were  found.  The  blood  serum 
of  the  children  was  agglutinated  by  the  whole  of  this 
group,  as  well  as  by  an  original  Flexner  body.  The 
Kruse  and  Shiga  bodies  were  not  present,  as  in  the 
first  group.  Taking  the  third  group,  i.e.,  the  diarhrcea 
and  normal  stools,  Jehle  records  two  cases  of  simple 
diarrhoea,  and  one  of  constipation,  in  which  he  found 
morphological  bacteria  differing  from  the  Flexner 
type  of  bacilli.  He  concluded  his  observations  by 
assuring  the  meeting  that  the  etiology  of  dysentery 
was  not  a  simple  pathological  condition,  but  had 
different  agents  for  its  production.  There  was  no 
real  line  of  demarcation  between  genuine  dysentery 
and  pseudo-dysentery,  as  the  morphology  of  the 
dysenteric  bacilli  were  similar,  and  also  resembled 
those  in  simple  diarrhoea  and  the  normal  stool.  The 
agglutination  of  the  dysenteric  bodies  were  limited,  as 
well  as  the  agglutinating  power  ot  the  bacilli,  many 
of  which  gave  negative  results,  and  are,  therefore,  of 
no  diagnostic  power. 

A  Hydrodynamic  Problem. 
w  At  the  Physical  Gathering,  Leube  demonstrated  from 
a  quantity  of  fluid  which  had  been  taken  from  the 
bowel.  The  patient  was  a  male  about  middle  life,  and 
since  1900  had  four  to  twelve  stools  a  day,  some  of 
which  were  small  and  consisting  of  mucus  and  water, 
increasing  to  four  litres  at  a  time.  This  fluid  must 
have  come  from  the  lower  part  of  the  gut,  where  slight 
inflammatory  action  must  have  existed,  or  it  may  be 
from  a  diverticula  of  the  bowel,  as  a  normal  firm  stool 
often  came  away  in  the  interval  and  never  exceeded  twice 
a  day.  The  chemical  examination  of  the  fluid  proved 
it  to  be  a  secretion  of  mucin  and  holding  no  albuminous 
matter  in  solution.  The  sediment  was  mucous,  with 
mucoid  and  bowel  epithelium.  A  similar  case  is  on 
record  by  Sick,  which  he  designates  or  diagnoses  as 
enteritis  nervosa.  No  other  explanation  can  be  given 
for  the  phenomenon. 

Pus  in  Urine. 
Muiler  records  a  test  which  is  a  modification  of 
Doune  for  discovering  pus  in  urine.  It  is  founded  on 
the  action  of  the  alkali  with  the  leucocytes.  Five  or 
ten  c.cms.  of  the  suspected  urine  is  taken  and  dropped 
carefully  into  the  official  liquor  potass.  After  every 
addition  the  test  tube  is  well  shaken  to  admit  of  the 
metamorphosis  of   the   corpuscle.     After  restmg  the 


478    The  Medical  Pkess. 


OPERATING   THEATRES. 


May  4,  1904, 


shaken  tube,  the  air  bubbles  on  the  surface  of  the 
viscous  fluid  remain  a  long  time  if  pus  be  present. 
A  cloudiness  also  appears  in  a  positive  reaction.  It  is 
calculated  that  1,200  leucocytes  in  1  c.cm.  give  a  de- 
finite reaction.  It  may  be  noted  that  after  a  time  the 
potass  solution  converts  the  viscous  mass  into  a  fluid 
condition,  therefore  causing  a  transitory  reaction 
only.  Urine  with  flat  epithelium  casts  or  bacteria 
give  no  reaction. 


3be  ©perattna  Gbeatre** 

ACTON  HOSPITAL. 
Myomectomy  and  Ventro-Fixation. — Dr.  Arthur 
Giles  operated  on  a  woman,  aet.  52.  The  patient  had 
been  under  the  care  of  Dr.  Thornton,  who  had  had  her 
under  observation  for  some  time.  Her  symptoms 
were :  bearing-down  pain  and  weight  in  the  vagina, 
pressure  on  the  bladder  and  frequency  of  micturition. 
Dr.  Thornton  had  found  that  she  had  a  retroversion 
of  the  uterus  complicated  by  fibroids.  For  some  time 
he  had  treated  her  by  means  of  pessaries.  As  the 
svmptoms  were  not  satisfactorily  relieved  by  this  means, 
and  the  pessaries  set  up  irritation  and  discharge,  Dr. 
Thornton  advised  an  operation.  With  this  view  Dr. 
Giles  concurred  when  he  saw  the  patient,  and  suggested 
that  it  might  be  possible  to  remove  some  of  the  myo- 
ma ta  and  fix  the  uterus  to  the  abdominal  wall.  The 
patient  was  accordingly  admitted  to  the  hospital. 
Dr.  Garrett  administered  the  anaesthetic,  and  Dr. 
Thornton  assisted  at  the  operation.  On  opening  the 
abdomen,  the  uterus  was  found  somewhat  wedged  in 
the  pelvis,  and,  on  lifting  it  out,  it  was  discovered  that 
there  were  several  small  fibroids  in  the  substance  of 
the  anterior  wall  as  well  as  a  semi-pedunculated  tumour 
the  size  of  an  orange  springing  from  the  summit  of  the 
fundus.  This  tumour  was  removed  by  subperitoneal 
myomectomy,  and  another  fibroid  the  size  of  a  walnut 
was  enucleated  from  the  anterior  wall,  after  which  the 
uterus  was  fastened  to  the  abdominal  parietes  by 
means  of  three  silkworm-gut  sutures  in  such  a  way 
that  the  uterine  wound  lay  against  the  abdominal  wall. 
The  abdomen  was  closed  in  three  layers.  Dr.  Giles 
remarked  that  the  case  was  a  particularly  suitable  one 
for  this  operation.  When  only  two  or  three  fibroids 
were  present,  and  especially  when  any  of  them  were 
subperitoneal,  myomectomy  could  be  performed  with 
less  risk  than  hysterectomy.  If  the  patient  had  a 
fibroid  inside  the  uterus  causing  haemorrhage,  hysterec- 
tomy would  probably  be  the  better  operation.  In  this 
case  the  patient  had  no  haemorrhage,  and  was,  in  fact, 
two  years  past  the  menopause.  With  regard  to  ventro- 
fixation, he  pointed  out  that  it  had  been  stated  as  an 
objection  to  the  operation  that  it  might  interfere  with 
subsequent  pregnancy,  but  whatever  force  such  an 
objection  might  have  in  a  young  married  woman,  it 
could  not  possibly  be  brought  forward  in  a  case  such 
as  the  one  just  operated  upon.  It  was  furthermore  an 
advantage,  he  said,  that  when  a  myomectomy  was 
done  involving  the  anterior  wall  of  the  uterus,  the 
uterine  wound  should  be  fixed  under  the  abdominal 
scar,  because  in  the  event  of  haemorrhage  or  other 
trouble  supervening,  the  scar  was  practically  extra- 
peritoneal and  was  readily  accessible. 

The  patient  made  an  uneventful  recovery  and  on 
leaving  the  hospital  was  quite  relieved  from  her 
symptoms. 

THE    ROYAL    EAR    HOSPITAL. 

Operation  for  Dislocated  Septum. — Mr.  Macleod 

Yearsley  operated  on  a  boy,  aet.   13.     The  history 

was  that,  some  years  before,    a   dog  had  sprung  at 

him  and  bitten  his  nose,  after  which  a  -'  lump  "  had 


appeared,  which  had~~now  fgrown  large""enough  to 
obstruct  the  left  nostril.  On  examination  the  "  lump '" 
proved  to  be  a  dislocation  of  the  cartilaginous  septum 
from  the  columella.  Chloroform  was  administered  by 
means  of  a  Junker's  inhaler  by  Dr.  Snell,  the  nose  having 
been  plugged  for  a  quarter  of  an  hour  previously  with 
wool  soaked  in  a  1  in  1,000  solution  of  hemisine. 
Mr.  Macleod  Yearsley  made  an  L-shaped  incision 
through  the  mucous  membrane  and  perichondrium 
over  the  dislocated  septum  opposite  the  free  edge  ol 
cartilage.  This  was  dissected  up  by  means  of  an 
Asch's  separator,  after  which  the  dislocated  cartilage 
was  separated  from  the  mucous  membrane  of  the 
opposite  side  in  the  same  way.  The  whole  of  the 
redundant  dislocated  cartilage  was  then  removed  with 
scissors  and  a  punch,  the  muco-perichondrial  flap 
replaced  and  kept  in  position  by  means  of  a  Lake's 
indiarubber  splint.  Mr.  Macleod  Yearsley  pointed 
out  that  such  dislocations  of  the  anterior  end  of  the 
septum  from  the  columnar  cartilage  are  common,  and 
often  associated  with  some  deflection  of  the  end  of 
the  nose  to  the  opposite  side.  They  may  be  idiopathic 
or  the  result  of  an  injury.  These  dislocations,  he 
said,  were  easy  to  remedy,  provided  it  was  remembered 
that,  owing  to  the  edge  of  the  septum  being  free,  there 
is  always  a  considerable  amount  of  redundant  car- 
tilage from  its  unobstructed  growth,  and  that  as 
much  as  possible  must  be  removed.  Some  rhinologists, 
he  pointed  out,  notably  Blandin,  Rosen,  and  Ru- 
precht,  have  employed  an  Instrument  on  the  principle 
of  a  ticket  punch,  which  simpl}  cuts?  a  piece  out  of 
the  septum,  and  allows  the'air  to  pass  into  the  opposite 
nostril.  Such  an  operation,  he  considered,  -was 
distinctly  bad  in  principle.  Hi  thought  the  method 
he  had  employed  in  this  case  was  the  best.  There 
was  no  need  to  suture  the  flap,  asjt  fell  naturally  into 
its  place,  and  could  be  easily  kept  in  position  by  the 
wearing  of  a  rubber  splint  for  a  week  or  so.  He  pointed 
out  the  great  convenience  of  hemisine  in  these  opera- 
tions, and,  in  fact,  in  all  manipulations  in  the  nasal 
cavities  which. necessitated  the  use  of  cutting  instru- 
ments. As  had  been  seen  in  this  case,  it  rendered  the 
whole  operation  practically  bloodless. 

Oonjolnt  Board  of  the  Boyal  OoUaso  of  FhyttcUiis  of  Wui- 
burfh.  Boyal  Collogo  of  Swgooni  of  Beftnburgh,  ait 
Faculty  of  Pnyalciaiu  and  iurgtana  of  Glmagow. 
At  the  April  meetings  held  in  Glasgow,  the  following 
candidates  passed  the  respective  examinations  for  the 
triple  qualification  : — First  Examination — Owen 
Thomas  Jones,  Bangor,  North  Wales  (with  distinction); 
Fred.  Grant  Allen,  Whaley  Bridge,  Cheshire.  Second 
Examination — Norman  Bennington  Watch,  Ports- 
mouth ;  John  Henry  Morris  Jones,  Waeniawr,  North 
Wales  ;  Hugh  Watson,  Lochwinnock ;  John  Francis 
O'Brien,  Ballincollig,  co.  Cork;  Thomas  M'Clure, 
Randalstown  ;  Jamsetji  Pallonji  Bamboat,  Bombay ; 
Jeremiah  Joseph  O'Callaghan,  Cork  ;  William  Church 
Mann,  Castledawson  ;  Evan  Alan  Sevill  Shaw,  Callao, 
Peru  ;  William  Frederick  Fismer  Durr,  Cape  Colony ; 
Gavin  Watson  Hill,  Lesmahagow.  Third  Examina- 
tion— David  Edward  Anderson  Buchanan,  Australia; 
Harold  Salter  Gettings,  Lutterworth  ;  Thomas  Percy 
1  Cox,  Norwich ;  William  Watkin  Neilson  Knox, 
Glasgow  ;  William  Wallace  Dempster,  Dublin  ;  James 
Joseph  Egan,  Galway  ;  Thomas  Graham  Campbell, 
Glasgow ;  Beatrice  Fanny  Board,  East  Pennard ; 
Percy  Bateman,  Cork  ;  Walter  Emery  Davies,  Owens 
College,  Manchester;  John  Wylie,  Glasgow.  Final 
Examination  (and  admitted  licentiates)— Maud 
Varley  Everett,  Rushmere,  Ipswich  ;  Richard  Henry 
Rigby.  Low  Ackworth,  Pontefract ;  William  Henry 
Williams,  Liverpool ;  Edgar  Nesbitt  Coutts,  Paisley ; 
John  O'Brien,  Lismore,  co.  Waterford ;  Beatrice 
Fanny  Board,  East  Pennard,  Shepton  Mallet;  Eve 
Mary   Handley,   London ;    and   Stephen  McCarthy. 


May  4,  1904. 


LEADING  ARTICLES. 


The  Medical  Peess.    479 


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SALUS  POPULI  SUPREMA  LEX. 


WEDNESDAY,  MAY  4,  1904, 


THE    LAYMAN    IN    MEDICAL    PRACTICE. 
The   inroads   of   unqualified   medical   practice 
have  nowadays  attained  an  audacity,  a  cunning, 
and  an  elaboration  of  method  that  suggest  the 
urgent  need  of  legislative  suppression.     Formerly 
they  deprived  the  general  practitioner  only  of  his 
legitimate  patients,  but  now  they  compete  with 
every  kind  of  specialism  and  of  medicine.     So  far 
the  charlatans  have  shrunk  from  extensive  surgical 
operations,  such  as  those  involved  in  opening  the 
cavities  of  the  abdomen  and  the  skull.     Minor 
surgical  operations,  however,  such  as  electrolysis, 
the  destruction  of  naevi,  the  treatment  of  fractures, 
dislocations  and  deformities,  and  even  delicate 
and  highly  technical  cosmetic  operations  upon  the 
face,  have  enabled  not  a  few  notorious  persons  to 
amass  fortunes  at  the  expense  of  the  public,  no 
less  than  of  the  medical  profession.     In  the  West 
End  of  London  at  the  present  moment  are  various 
persons  carrying  on  an  unqualified   practice  as 
nerve  and  skin  specialists,  bone-setters,   and  so 
on,  at  fees  ranging  up  to  a  guinea  or  more  for  con- 
sultation, and  one  to  three  guineas  a  visit.    Latterly 
the  ranks  of  the  charlatans  have  been  swollen  by  a 
rush  of  medically  unqualified  electricians  into  the 
field.    The  evil  began  soon  after  the  introduction 
of  Rontgen  ray  work  into  the  fields  of  medicine 
and  surgery.     At  the  outset  it  was  in  the  power  of 
medical  men  to  exclude  the  layman  from  that 
important  and  fruitful  branch  of  professional  work. 
The  bulk  of  X-ray  work,  however,  was  handed  over 
to  instrument-makers,  chemists  and  non-medical 
workers,  a  statement  that  applies  not  only  to 
private  practice  but  to  the  hospitals  themselves, 
many  of  which  to  this  moment;  in  all  parts  of  the 
kingdom,  entrust  the  care  of  their  electrical  depart- 
ments   to   unqualified   electricians.     The   results 
have  been  disastrous.     With  the  rapid  extension 
of  Rontgen  ray  methods  as  regards  diagnosis  and 
therapeutics,  there  has  been  almost  simultaneously 
a  rapid  development  of  other  radio-active  and 


physical  remedies.  In  every  town  of  any  size 
may  be  found  nursing  homes,  institutes,  and  other 
establishments,  public  and  private,  where  electrical, 
X-ray,  light  cure,  "  high  frequency,"  and  other 
modern  special  treatment  is  administered  by 
medically  unqualified  persons.  The  extent  to 
which  this  danger  has  grown  has  been  well  described 
by  Dr.  Lewis  Jones,  the  well-known  Medical  Officer 
of  the  Electrical  Department  at  St.  Bartholomew's. 
In  an  article  published  in  the  British  Medical 
Journal  for  April  23rd,  1904,  he  gives  a  plain  state- 
ment of  facts  as  to  the  intrusion  of  the  layman  into 
medical  practice  that  should  arouse  widespread 
attention.  The  subject  deserves  earnest  discussion 
in  every  assemblage  of  medical  men  available  for 
the  purpose.  Medical  men  have  by  their  laxity 
in  the  past  been  to  a  great  extent  answerable  for 
the  present  deplorable  state  of  affairs.  Let  them 
once  make  up  their  minds  to  discountenance 
all  nursing  homes  where  electrical  or  other  special 
treatment  is  practised.  Let  them  find  out  if  any 
black  sheep  in  the  medical  profession  are  openly 
or  indirectly  concerned  with  the  proprietorship  or 
with  the  conduct  of  such  places.  That  would 
be  one  step  in  the  right  direction.  Another  would 
be  to  send  no  more  patients  to  laymen  for  electrical 
or  other  diagnostic  treatment.  The  moral  of  Dr. 
Lewis  Jones'  contribution  is  that  medical  men  are 
their  own  worst  enemies  in  the  matter.  "  Our 
difficulty,"  he  writes,  "  is  not  so  much  with  the  old 
one — and  still  present  one — of  the  common 
impostor,  but  a  new  difficulty  of  the  voluntary 
surrender  of  medical  work  to  laymen.  In  con- 
sidering this  matter  we  must  not  be  too  ready  to 
impute  prejudice  or  other  unworthy  motive  to  the 
medical  men  who  employ  the  lay  operators.  I 
am  sure  that  the  harm  done  is  often  due  to  thought- 
lessness, or  sheer  ignorance.  .  It  is  high 
time  for  the  medical  profession  to  awake  to  the  fact 
that  electro-therapeutics  demand  serious  attention, 
that  many  applications  of  electricity  are  of  great 
value  in  medical  practice,  and  that  the  carrying 
out  of  electrical  treatment  for  the  sick  is  a  matter 
for  medical  men  and  not  for  irresponsible  laymen." 
That  clear  and  forcible  presentation  of  the  case, 
most  medical  readers  will  probably  agree,  errs  on 
the  side  of  moderation.  Medical  men  must  bestir 
themselves  if  they  do  not  want  to  be  deprived  of 
the  remainder  of  their  legitimate  professional 
practice.  New  legislation  is  needed  both  to  widen 
the  basis  of  constitution  of  the  General  Medical 
Council  and  so  render  it  a  representative  body, 
and  at  the  same  time  to  furnish  the  Council  with 
additional  and  compulsory  powers  to  suppress 
unqualified  medical  practitioners.  That  touches 
the  root  of  the  matteri  However  desirable  free  dis- 
cussion of  illegal  practice  may  be,  it  is  well  not  to 
lose  sight  of  the  fact  that  the  goal  to  be  kept 
steadily  in  sight  and  to  be  demanded,  in  season  and 
out  of  season,  is  the  passing  of  a  new  Medical  Act — 
on  the  lines  above  indicated. 


^TYPHOID  AND  RAILWAYS. 
Some  years  ago  it  was  generally  thought  that  the 
one  important  source  of  typhoid  infection  was 


4&>    The  Medical  Press. 


LEADING  ARTICLES. 


May  4,  1904. 


contaminated  drinking  water.  At  the  present 
time,  however,  though  the  necessity  of  a  pure  water 
supply  is  every  day  more  impressed  upon  us,  yet 
we  find  many  cases  of  typhoid  occurring  where  the 
water  is  above  suspicion,  and  we  have  to  look  round 
for  other  channels  of  infection.  Thus  in  India 
dust  from  latrines  is  coming  to  be  regarded  as  a 
serious  danger,  and  we  meet  cases  where  infection 
has  occurred  by  means  of  ice,  ice-cream,  milk,  or 
other  food.  A  source  of  typhoid  fever  hitherto 
unnoticed  has  been  investigated  by  an  American 
physician,  Dr.  Barringer,  of  Charlotte  ville. 
Both  in  this  country  and  in  the  States  family 
physicians  have  frequently  observed  the  occur- 
rence of  typhoid  fever  within  a  couple  of  weeks  of 
the  patient's  having  undertaken  a  railway  journey. 
In  most  cases  this  has  been  thought  to  be  due  to 
drinking  impure  water  while  away  from  home. 
Dr.  Barringer  shows,  however,  a  grave  danger  to 
public  health  in  the  present  sanitary  arrangements 
on  railway  trains.  The  custom  is  to  discharge  faeces 
directly  on  the  track  either  mixed  with  water  or  in 
natural  condition.  Obviously,  if  persons  suffering 
from  typhoid  fever  make  use  of  these  conveniences, 
as  by  necessity  they  must,  typhoid  germs  will  be 
scattered  broadcast  along  the  line.  In  the  one 
case,  the  faeces  are  quickly  reduced  to  dust,  which 
is  set  in  rapid  motion  by  every  passing  train.  In 
the  other,  they  are  sodden  into  the  earth, 
where  the  bacilli  quickly  multiply,  and  are  after- 
wards swept  about  in  dust.  It  has  been  noted  that 
a  class  particularly  liable  to  typhoid  fever  is  that 
section  of  railway  employees  known  as  "  track 
hands  "  ;  the  figures  of  large  railway  hospitals 
show  that  nine  out  of  ten  of  their  typhoid  patients 
come  from  this  class.  Their  duty  is  the  repair  of 
the  line,  and  in  working  with  the  ballast,  shifting 
sleepers,  and  so  on  they  are  constantly  exposed 
to  direct  inhalation  of  dust.  In  addition,  every 
passing  train  raises  clouds  of  dust  which  envelop 
not  only  the  men  along  the  track,  but  their  supply 
of  food  and  water.  The  interior  of  the  train  itself 
is  by  no  means  free  from  the  same  plague  of  dust, 
as  everyone  accustomed  to  American  or  Conti- 
nental travelling  knows.  The  danger  does  not 
even  stop  there,  but  spreads  to  the  water  of  rivers 
which  are  crossed.  No  attempt  is  made  to  shut  off 
the  water-closet  while  a  train  is  crossing  a  bridge, 
and  faeces  fall  freely  into  the  stream,  although  the 
water  supply  of  large  towns  may  be  drawn  off  just 
below.  We  have  said  enough  to  show  the  danger 
to  public  health  resulting  from  the  present  careless 
method  of  disposing  of  railway  sewage ;  luckily, 
the  remedy  is  simple.  All  that  is  necessary  is  the 
substitution  of  a  system  of  closed  closets  for  the 
present  open  ones,  with  careful  disinfection  and 
regular  clearance  of  the  contents.  The  present 
system  is  little  short  of  a  disgrace  to  civilisation. 


A  "  RETURN"  CASE  OF  SCARLET  FEVER. 
The  question  of  the  infectivity  of  patients 
discharged  from  fever  hospitals  clearly  has  a 
crucial  bearing  upon  the  future  prevention  of 
zymotic  disease.  Broadly  speaking,  the  success 
of  the  national  health  service  depends  on  the 


popularity  which  its  administration  enjoys  with 
the  public  at  large.     In  other  words,   sanitary 
authorities  are  servants  and  not  masters  of  the 
community.     If    it    can    be    shown,    therefore, 
that  a  radical  defect  exists  in  an  important  branch 
of  practical  hygiene,  then  the  authority  and,  in- 
deed, the  existence  of  that  particular  part  of  the 
official   system   is  in  jeopardy.     Applying  these 
general  propositions  to  scarlet  fever  we  find  that 
the  preventive  measures  of  notification,  isolation 
and  disinfection  have  not  made  any  appreciable 
reduction  in  the  incidence  of  that  malady,  although 
they  have  been  applied  for  many  years  throughout 
the  length  and  breadth,  of  the  land.     More  than 
that,  it  is  asserted  in  many  quarters  that  the  sys- 
tem fails  in  its  great  essential  aim  of  preventing 
the    spread    of    the  disease  by  isolation.     Some 
years  ago  Dr.  Killick  Millard  showed  that  in  a 
considerable    number    of    cases    fever  -  hospital 
patients  were  sent  back  to  their  homes  apparently 
cured,  whereas  really  they  were  still  active  centres 
of  infection.     That  statement  has  been  confirmed 
by    other    authorities    no    less    experienced   and 
eminent.     It   constitutes   not   only   a   grave  in- 
dictment of  the  present  infectious  hospital  sys- 
tem, but  endangers  that  popularity  which  is,  so 
to  speak,  the  life-blood  of  the  public  sanitary 
service  among  our  countrymen.    The  special  risk 
thus  indicated  has  been   recently  brought  into 
general  notice  by  a  law  case  tried  last  week  by 
Mr.  Justice  Ridley  and  a  special  jury  at  the  Court 
of  the  King's  Bench.     The  plaintiff  in  that  case 
brought  an  action  for  damages  against  the  Metro- 
politan Asylums  Board  because  of  their  alleged 
negligence  in  allowing  his  son  to  be  discharged  from 
the  Grove  Hospital,  Tooting,  while  still  in  an  in- 
fectious condition.     As  the  result,  other  members 
of  plaintiff's  family  contracted  scarlet  fever.    The 
evidence  showed  that  the  boy  was  taken  to  the 
Grove    Hospital,   suffering    from    scarlatina,   on 
March  29th.     After  a  stay  in  hospital  of  five  weeks 
and  four  days,  plaintiff  was  notified  that  the  child 
could    return    home.       The     boy   was    fetched 
from  the  hospital  on  May  9th.     A  week  later  his 
mother   sickened,  and    developed  scarlet    fever, 
and  she  was  removed  to  hospital  on   May  18th. 
Another  child  sickened  on  May   19th,  and  two 
others  on  June  10th.     On  May  23rd  it  was  found 
that  the  original  patient  had  a  nasal  secretion, 
which  presumably  was  the  source  of  origin  of  the 
later  series  of  disasters.     Reading  between  the  lines 
of  this  case,  it  seems  reasonable  to  assume  that  the 
first  patient  was  actually  discharged  by  the  hospital 
authorities  in  an  infectious  condition.     Nor  can 
we  be  accused  of  harshness  in  concluding  that  the 
subsequent  cases  in  the  plaintiff's  household  were 
due  to  the  return  home  of  an  infectious  patient. 
If  that  be  the    case    the    system    of    hospital 
isolation   has  once  more  proved  a  failure,  and  it 
behoves  the  scientific  sanitarians  to  devise  some 
more      perfect      plan    of     testing    the    specific 
infectivity  of  patients  under  their  charge.    As  a 
sound  general  rule  it  is  wise  to  assume  that  scarlet 
fever  convalescents  suffering  from  any  nasal  or 
aural  discharge,  or  from  any  lingering  catarrh  of 


May  4,   1904. 


the  upper  air  passages,  are  potential  agents  of 
infection.  The  whole  situation  with  regard  to  the 
efficiency  of  our  hospital  isolation  system  de- 
mands urgent  investigation.  It  is  of  such  public 
importance  that  we  propose  at  any  early  date  to 
discuss  the  subject  in  the  full  light  of  authori- 
tative opinion.  As  a  matter  of  fact,  the  plaintiff 
lost  his  case  on  legal  grounds,  as  it  would,  of  course, 
be  impossible  to  prove  any  wilful  negligence 
against  the  hospital  authorities.  It  need  hardly  be 
pointed  out  that  the  indictment  against  the 
isolation  system  rests  on  scientific  grounds,  and 
does  not  assail  either  the  general  competency  or 
the  bond  fides  of  the  present  administration. 


NOTES  ON  CURRENT  TOPICS.  The  MedicauP»ess.    481 


Wote*  on  Current  topics. 

Pharmaceutical  Formulae. 
It  was  suggested  in  these  columns  a  short  time 
back  that  the  book  of  formulae  recently  published 
by  the  Pharmaceutical  Journal  would  be  largely 
referred    to    by    the    prescribing    chemist.     This 
anticipation  is  being  amply  fulfilled,  though  the 
penny-halfpenny  Government  stamp  is  still  used 
by  the  proprietors  of  those  preparations  that  have 
a  wide  and  ready  sale  among  people  who  enjoy 
taking  their  medicine  with  their  eyes  shut  to  what 
it  may  contain.     But  there  is  another  class  to 
whom  this  book  is  proving  a  veritable  godsend, 
namely,  the  "  doctors  "  who  give  advice  to  sufferers 
through  the  medium  of  the  columns  of  second-rate 
journals  for  ladies.     These  sagacious  beings,  and 
probably  their  readers  too,  get  somewhat  tired  of 
the  repetition  of  the  same  formula  for  the  same 
sort  of  complaint  every  week,  and  now  that  the 
ten  thousand  prescriptions  put  forward  in  this 
book  are  available,  they  are  able  to  find  all  sorts 
of  new  medicines  to  recommend  to  "  Distressed 
Mother,"  "  Mabel/'  and  "  Dyspeptic."     There  are 
presumably  people,  more  or  less  sane,  who  follow 
out    the  advice    thus  tendered,  but  who   know 
nothing  of  the  riches  of  the  Pharmaceutical  Journal 
"  Formulae. ' '     But  the  weight  which  attaches  to  the 
suggestion  that  the    prescriptions  published  are 
those  recommended  by  a  professional  body  pro- 
bably eases  the  mind    of    many   readers  of  any 
qualms  they  might  feel  if  they  were  dealing  with 
an  acknowledged  quack.     Now  many  of  the  pre- 
parations that  gain  currency  in  this  manner  are 
highly  poisonous,  such,  for  instance,  as  solutions  of 
corrosive  sublimate,  and  yet  this  may  be  freely 
obtained  and  used  by  the  readers  of  the  journals  in 
question  by  merely   copying  out   the   formulae. 
From  the  public  point  of  view  this  is  a  serious  matter ; 
from  the  medical  point  of  view  it  is  a  happy  circum- 
stance— that  is,  if  a  circumstance  that  increases 
the  work  of  the  medical  practitioner  can  be  con- 
sidered happy. 


Poisoning  by  Eggs. 
From  time  to  time  one  hears  of  a  case  of  idiosyn- 
crasy in  regard  to  white  of  egg  of  such  a  nature 
that  the  egg  acts  as  a  violent  poison.  It  is,  of 
course,  a  very  rare  condition,  and  is  usually  re- 
garded as  a  toxicological  curiosity.     That  it  may, 


however,  on  occasion,  give  rise  to  a  series  of 
puzzling  and  alarming  clinical  phenomena  is 
shown  by  a  case  recently  reported  by  Dr.  Clemens, 
of  St.  Louis,  (a)  During  the  course  of  whooping- 
cough,  a  child  of  fourteen  months  was  suddenly 
attacked  by  acute  urticaria  and  alarming  collapse, 
the  head  being  swollen  and  the  radial  pulse  absent! 
For  two  days  the  child  was  in  a  grave  condition, 
and  antipyrin  was  held  in  suspicion.  Two  weeks 
later,  however,  an  exactly  similar  attack  occurred, 
and  it  was  impossible  to  discover  any  cause.  A 
month  later,  on  partaking  of  some  custard,  the 
child  was  seized  with  violent  vomiting  and  purg- 
ing, accompanied  by  acute  urticaria.  On  one 
further  occasion,  after  munching  some  ginger- 
bread, in  the  manufacture  of  which  eggs  had  been 
used,  similar  symptoms  occurred,  and  were  accom- 
panied by  oedema  of  the  feet.  The  diagnosis 
was  now  clear,  and  simple  purgative  treatment 
brought  about  speedy  recovery. 

Death  Due  to  a  Sedative. 

Medical  practitioners,  male  and  female,  can- 
not use  too  much  caution  in  prescribing  medicines 
containing  poison  when    they    are    intended  for 
administration  to  children.     While  there  is,  per- 
haps, little  danger  if  the  directions  on  the  bottle 
are  strictly  obeyed,  one  should  always  remember 
that,  among  the  more  ignorant  classes,  at  any  rate, 
but  little  attention  is  paid  to  mere  written  direc- 
tions,   unless    they   are   supported   by  emphatic 
cautions.     In  many  cases  either  the  dose  is  greatly 
increased,  or  the  medicine  is  given  to  children  for 
whom  it  was  not  intended.    The  latter  was  what 
happened  in  a  case  investigated  by  the  Coroner  of 
Manchester  on  the  15th  of  last  month.     A  lady 
physician  had  prescribed  for  a  child  with  whoop- 
ing-cough a  medicine  containing  in  each  dose  two 
drops  of  tincture  of  belladonna  and  five  of  chloro- 
dyne,  together  with  ipecacuanha  wine,    tincture 
of  tolu,  and  oxymel  of  squills.     The  bottle  was 
not  marked  "  poison,1 '  and  the  label  was  placed 
lengthwise.     Several  doses  of  the  mixture  were 
given  to  an  infant  a  year  old,  with  the  result  that 
he  soon  fell  asleep,  and  although  brought  to  a 
medical  man,  died  in  a  few  hours.     The  medical 
man  appears  to  have  made  no  attempt  to  discover 
from  what  poison  the  child  was  suffering,  and  did 
not  even  examine  its  eyes.     He  was  censured  by 
the  coroner,  though,  in  our  opinion,  more  blame 
was  due  to  the  lady  physician  and  the  apothecary 
who  dispensed  the  mixture. 


Suicide  in  Hospitals. 
A  gruesome  tragedy  at  all  times,  the  crime  of 
self-destruction  appears  doubly  outrageous  when 
perpetrated  within  the  walls  of  an  institution  of 
which  the  preservation  of  life  is  the  foremost  object. 
In  asylums  such  an  occurrence  might  more  naturally 
be  expected,  knowing  the  suicidal  tendencies 
which  characterise  many  of  the  forms  of  insanity. 
It  is  just  because  this  possibility  is  constantly 
borne  in  mind  by  those  who  have  charge  of  the 

(a)  Medical  News,  *ew  York,  April  6th,  1901. 


482  Th*  Medical  Press.  NOTES    ON    CURRENT    TOPICS. 


May  4.  1904. 


insane  that  all  means  and  appliances  that  might 
suggest  suicide  are  carefully  removed  from  their 
sight,  and  nurses  and  attendants  are  trained  to  be 
specially  watchful  over  any  patient  who  may 
•exhibit  self-destructive  propensities.  In  a  large 
general  hospital,  on  the  other  hand,  there  is  a 
danger  of  ignoring  altogether  the  mental  aspect 
of  the  cases  and  of  concentrating  the  entire  atten- 
tion upon  their  bodily  ailments.  And  yet  the 
influence  of  the  body  upon  the  mental  faculties  is  so 
well  known  that  a  description  of  the  possible  cere- 
bral symptoms  which  may  occur  in  the  course  of  any 
disease  are  usually  given  in  every  text-book  of 
medicine.  The  post-operative  psychoses,  the 
wild  delirium  accompanying  many  of  the  acute 
febrile  diseases,  or  as  a  result  of  alcoholism,  are  only 
some  of  the  forms  of  mental  derangement  com- 
monly seen  in  the  medical  and  surgical  wards  of 
hospitals.  In  these  cases  a  special  nurse  or  male 
attendant  is  seldom  necessary  unless  the  patient 
should  become  unduly  violent,  and  even  the  timely 
removal  of  a  spittoon  charged  with  carbolic  acid 
from  the  locker  by  the  bedside  is  not  always  thought 
of.  Many  are  the  ways  and  means  devised  by  the 
craftiness  of  the  would-be  suicide  for  his  own 
destruction,  which  can  only  be  forestalled  by 
intelligent  supervision.  Even  when  all  has  appa- 
rently 1  been  done  |  to  guard  against  a  catastrophe 
a  delirious  patient  may  suddenly  surprise  his  atten- 
dants, rush  to  the  window,  and  take  a  fatal  leap 
therefrom,  as  unfortunately  happened  the  other 
day  at  University  College  Hospital. 


Death  in  the  Pot ! 
In  these  days  when  disease-germs  threaten  and 
toxins  flourish,  it  is  a  fortunate  thing  for  his  peace 
of^mind  that  the  aveiage  individual  does  not 
trouble  himself  in  the  least  about  the  composition 
oi  his  food.  •  Neither  does  its  mode  of  preparation 
disturb  his  tranquillity,  for  does  he  not  commit 
himself  unreservedly  to  the  tender  mercies  of  his 
cook  ?  Gastronomic  fastidiousness,  except  in  the 
confirmed  dyspeptic,  is  generally  regarded  as  a  sure 
and  certain  indication  in  either  sex  of  af  ussy  nature. 
Be  this  as  it  may,  there  can  be  no  doubt  that  the 
unseen  risks  that  are  daily  run  at  the  table  are 
multitudinous  and  great.  The  opinion  is  some- 
times expressed  by  those  who  take  little  interest 
in  such  matters  that  medical  men  seem  to  take  a 
special  delight  in  condemning  wholesale  one  article 
of  food  a/ter  another  simply  because  a  particular 
sample  01  specimen  has  happened  to  be  con- 
taminated. Now,  this  is  exactly  what  science 
does  not  do  ;  she  rarely  or  never  generalises 
from  the  particular.  The  Medical  Press  and 
Circular  has  always  lifted  up  its  voice  in  the 
past,  and  it  will  still  continue  to  do  so  in 
the  future,  against  wilful  adulteration  where 
the  bodily  nutrition  of  the  public  is  at  stake. 
The  physician  does  not  desire  his  patients  nor  him- 
self to  lead  the  life  of  an  ascetic,  and  in  the  matter 
of  food-contamination  he  is  never  a  false  alarmist. 
Bui  apart  from  the  decomposition  or  adulteration 
of  food,  there  is  another  way  in  which  its  con- 
sumption may  be  fraught  with   actual   danger. 


The  question  of  individual  idiosyncrasy  has  to  be 
sometimes  taken  into  account.  Many  people  are 
greatly  upset  after  partaking  of  a  dish  which  is 
flavoured  in  a  certain  manner,  or  contains  certain 
articles,  such  as  eggs.  It  would  seem  that,  where 
susceptibility  is  great,  even  the  minutest  trace  of 
egg-albumen  in  the  gastro-intestinal  tract  may 
give  rise  to  considerable  irritation,  or  toxic  sym- 
ptoms, which  might  be  wholly  unaccountable 
unless  such  peculiarity  has  been  previously  recog- 
nised. 


The  Diminishing"  Birth-Bate. 
The  vital  subject  of  childless  marriages  which 
has  lately  been  brought  so  prominently  before  the 
notice  of  the  medical  profession  at  last  shows  signs 
of  awakening  public  interest.    The  paper  read  by 
Professor    John    W.    Taylor   before    the    British 
Gynaecological    Society,    and    published  in  The 
Medical  Press  and  Circular  of  March  2nd  and 
9th,  has  been  read  by  all  classes  with,  it  is  hoped, 
beneficial    results.     A   decline   in   the   birth-rate 
similar  to  that  in  our  own  country  has  been  found 
in  the  Australian  Commonwealth,  for  the  Report 
of  the  New  South  Wales  Commission,  issued  since 
the  publication  of  Professor  Taylor's  paper,  testifies 
to  the  unwelcome  fact  that  the  birth-rate  in  Aus- 
tralia has  diminished  to   the  extent  of   30  per 
cent,  during  the  last  twenty  ye  ars.    The  Bishop  of 
Ripon  has  now  taken  up  the  cudgels,  and  in  the 
course  of  an  address  delivered  at  Leeds  he  expati- 
ated at  length  and  with  much  force  upon  this 
growing  public  evil  which,  in  his  own  words,  is  fall 
of   "  terrible "  possibilities  for  the  nation  as  a 
whole.     It  is  a  good  sign  when  the  Church  works 
hand  in  hand  with  medicine  in  the  cause,  of  public 
health  and  safety.    The  influence  of  the  cleric 
and  the  medical  practitioner  in  their  respective 
spheres  of  labour  can   hardly  be  over-estimated 
as  a  moral  force  which,  if  each  has  one  common 
cause  at  heart,  must  react  favourably  upon  the 
lives  and  habits  of  the  people.     The  popular  belief 
that  the  reduction  in  birth-rate  is  productive  of 
better  children,  physically  and  mentally,  is,  un- 
fortunately, not  borne  out  in  the  slightest  degree 
in  actual  practice.     On  the  contrary,  the  evidence  is 
apparently  in  the  opposite  direction,  for  it  is  gene- 
rally believed  that  the  standard  of  physical  efficiency 
has  been  lowered,  while  insanity  has  also  increased 
during  the  same  period  of  time.    There  is  yet  time, 
before  the  national  sense  of  duty  is  destroyed,  for 
public  and  individual  consideration  to  be  given  to 
this  all-important  topic. 

The  Limits  of  Medical  Aid. 

The  recent  unveiling  of  the  Blackmore  Memorial 
uT"Exeter  Cathedral  is  an  eloquent  testimony  to 
the  supreme  dramatic  qualities  possessed  by  the 
celebrated  author  of  "  Lorna  Doone."  His  were 
the  purest  ethical  ideals,  and  though  he  ever  sought 
to  depict  humanity  in  its  brighter  and  more  en- 
nobling aspects,  yet  he  was  not  afraid  to  paint  the 
gloomier  outlines  of  life  in  their  more  sordid  details. 
His  medical  characters,  though  not  specially 
brilliant,  are  true  representations  of  the  genial, 


May  4,   1904. 


NOTES    ON    CURRENT    TOPICS.       The  Midical  Peess.    483 


hard-working,  country  ^practitioner  of^the  mid- 
Victorian  period.  We  are  reminded  in  "  Perly- 
cross,"  somewhat  ironically,  that  "  one  of  the  very 
few  things  that  can  be  done  by  medical  knowledge 
is  that  it  can  tell  us  (when  it  likes)  that  it  is  help- 
less." This  is  a  truism  which  enters  keenly  into 
the  soul  of  the  pursuer  after  science,  like  a  cold 
sword-thrust.  No  one  is  so  painfully  conscious 
as  the  physician  or  surgeon  of  the  limitations  of  his 
art,  and  there  are  few  sadder  sights  on  this  earth 
than  "  a  wise  physician,  skilled  our  woes  to  heal," 
standing  with  bowed  head  and  helpless  hands  by 
the  bedside  of  a  hopeless  case.  Judgment  has  been 
given,  the  verdict  pronounced,  and  slowly  from  the 
couch  of  sickness  turns  the  man  or  woman  of  whom 
physical  redemption  was,  humanly  speaking, 
expected.  But  it  is  not  in  cases  where  the  need  for 
medical  aid  is  obviously  past  that  the  limitations 
of  the  healing  art  are  most  apparent.  There  are 
many  affections  of  the  nervous  system  and  diseases 
of  the  internal  viscera,  both  medical  and  surgical, 
in  which  treatment  of  any  kind  is  of  but  little  use. 
It  is  just  here  where  the  question  so  often  arises 
of  the  propriety  of  communicating  to  the  patient 
or  his  friends  the  hopelessness  of  the  case,  its  pro- 
gressive nature,  and  of  explaining  to  them  the 
inutility  of  remedies.  The  quack  will  urge  the 
importance  of  adhering  rigorously  to  his  treatment, 
however  remote  the  possibility  of  cure  may  be. 
The  wise  practitioner,  on  the  other  hand,  will,  with 
all  sincerity  of  heart,  acknowledge  his  inability  to 
effect  a  cure,  while  he  may  yet  be  able  to  hold  out 
some  promise  of  relief. 

School  Health. 
The  report  of  the  Inter-Departmental  Committee 
appointed  to  inquire  into  the  subject  of  physical 
exercises  in  schools  has  just  been  issued.    It  is 
satisfactory  to  find  that  the  net  result  of  their 
labours  is  to  condemn  the  "  model  "  course  adopted 
some  three  years  ago  for  use  in  elementary  schools. 
The  essence  of  this  course  was  the  military  bent  of 
the  prescribed   exercises,   the    movements   being 
transferred  almost  entirely  from  the  "  red  book," 
which  lays  down  the  law  as  to  the  training  of  sol- 
diers.   The  Committee  was  composed  of  a  number 
of  experienced  educationalists,  and  their  conclu- 
sions are  both  sane  and  practical.     They  insist 
that  "  physical  education  is  essentially  part  of  the 
broad  question  of  school  and    personal  hygiene, 
and  that  the  attention  of  those  who  map  out 
courses  of  exercises  should  be  directed  to  counter- 
actingthedef  ects  that  are  most  common  in  children/ ' 
Thus  breathing  exercises  will  help  to  abrogate  the 
evils  of  mouth  breathing,  and  will  draw  the  teachers1 
attention  to  those  children  who  are  suffering  from 
nasal  obstruction,  whilst  movements  such  as  rising 
on  the  heels  and  bending  backward  will  counteract 
tendencies  to  flat-foot  and  stooping  respectively. 
The  importance  of  training  teachers  to  give  instruc- 
tion in  these  matters  is  insisted  on,  as  is  the 
guidance  which  should  be  exercised  over  defective 
and  sickly  children.    These  considerations  bring 
the  Committee  to   the   point  that  no   form   of 
educational  organisation  can  be  considered  com- 


plete that  does  not  make  provision  for  the  syste- 
matic reference  of  questions  of  school  hygiene 
and  individual  treatment  to  medical  experts? 
The  physique  and  state  of  nutrition  of  each  child 
should  be  taken  account  of  in  each  class,  and  the 
incapable  ones  weeded  out  and  referred  to  the 
doctor  for  an  opinion  as  to  how  they  would  be  best 
dealt  with.  The  whole  report  is  simple,  temperate, 
and  convincing,  and  one  can  only  hope  that  the 
Board  of  Education  will  give  the  recommendations 
the  effect  which  they  undoubtedly  deserve.  The 
child  is  father  to  the  man,  and  healthy  men  make 
a  prosperous  nation. 

The  Sanitary  Inspection  of  Restaurants. 

The  importance  of  the  sanitary  control  of 
restaurants  and  other  places  where  food  and  drink 
are  sold  to  the  public  is  self-evident.  There  is 
room  to  doubt,  however,  whether  that  kind  of  super 
vision  is  not  more  often  honoured  in  the  breach 
than  the  observance.  Few  medical  men  in  general 
practice  could  not  furnish  gross  instances  of  public 
houses,  milk  shops,  eating  houses,  and  the  like 
which  had  proved  centres  of  zymotic  infection. 
With  these  facts  in  view,  it  is  satisfactory  to  note 
that  Dr.  Collingridge,  the  energetic  Medical  Officer 
of  Health  for  the  City  of  London,  is  turning  his 
attention  to  this  point,  which,  in  the  midst  of  a 
densely  crowded  day  population,  becomes  more  than 
ever  important.  In  his  last  report  Dr.  Collingridge 
stated  that  at  a  restaurant  near  the  City  boundary 
an  employe  was  found  suffering  from  small-pox 
while  actively  engaged  in  preparing  food,  and 
another  young  woman  had  just  returned  jto  work 
after  an  attack  of  influenza  and  chicken-pox. 
The  small-pox  patient  was  sent  to  a  hospital,  the 
restaurant  closed,  the  premises  disinfected,  and 
the  entire  staff  vaccinated.  This  example  is 
worthy  of  note  by  medical  officers  of  health  in  all 
parts  of  the  United  Kingdom. 


Reverence  in  Medical  Practice. 
The  impossibility  of  a  successful  study  of  the 
mysteries  of  life  and  death  and  of  the  physical 
secrets  of  Nature  in  anything  but  a  reverent  spirit 
has  become  almost  a  truism.  Yet  there  is  a  danger 
lest  this  privileged  familiarity  with  physical  in- 
comprehensibilities should  dull  the  sense  of  respect, 
or  even  of  awe,  which  should  ever  characterise  the 
physician's  mental  attitude  towards  the  science 
to  which  he  has  devoted  his  life.  The  unknown 
and  the  unknowable  will  ever  demand  the  homage 
and  admiration  of  the  finite.  There  is  much, 
however,  in  the  practice  of  medicine  to  shatter 
one's  ideals  and  to  discount  faith  in  humanity 
at  large,  but,  as  Ruskin  says  of  knowledge,  "  That 
man  is  always  happy  who  is  in  the  presence  of 
something  which  he  cannot  know  to  the  full, 
which  he  is  always  going  on  to  know."  As  there 
can  hardly  be  a  more  progressive  science  than  that 
of  medicine,  the  practitioner's  happiness  should  be 
secured,  at  least  in  theory.  But  while  it  may  be 
desirable  to  cultivate  this  aspect  of  reverence, 
its  more  homely  application  is  equally  necessary.* 
There  is  a  sense  in  which  a  due  appreciation  on  the 
!  part  of  the  physician  of  his  patient's  peculiarities 


484      Thk  Medical  Press.      NOTES    ON    CURRENT    TOPICS. 


May  4.  1904. 


and  habits  of  life  is  essential,  for  unless  the  latter 
be  respected  and  given  way  to,  the  treatment  of  a 
given  case  is  apt  to  be  less  efficient,  and,  what  is 
even  more  important,  that  harmonious  relation- 
ship of  entire  confidence  which  should  exist  be- 
tween doctor  and  patient  may  be  disturbed.  It  is 
reverence  towards  little  things  which  may  appear 
only  as  trifles  that  will,  perhaps,  determine  the 
success  or  failure  of  the  practitioner.  This  aspect 
of  medical  practice  is  not  learnt  in  hospital  wards 
so  much  as  in  private  practice,  where  people  have 
greater  opportunities  to  dilate  upon  their  ailments. 

Plumbers1  Registration. 
After  a  period  of  hibernation  the  Plumbers' 
Company  have  come  to  the  front  with  their  regis- 
tration scheme.  Thev  have  held  an  examination 
of  plumbers  with  a  view  to  certification  under  their 
scheme  of  national  registration.  Out  of  twenty- 
three  candidates  five  only  succeeded  in  passing  the 
examination,  which  was  held  last  week  at  King's 
College,  London,  and  of  which  details  will  be  found 
in  another  part  of  our  present  issue.  The  desire  of 
the  Company  to  test  the  competency  of  plumbers 
is  laudable  enough,  but  the  shoe  pinches  not  so 
much  at  the  point  of  competency  as  of  conscience. 
Certification  affords  no  guarantee  that  the  indi- 
vidual plumber  will  do  his  work  with  more  skill 
and  thoroughness  than  that  displayed  by  his  un- 
certificated brethren.  It  is  tolerably  certain, 
however,  that  the  public  would  in  the  long  run 
have  to  pay  more  for  their  plumbing  were  certifi- 
cation to  become  at  all  general.  It  is  clearly 
to  the  interest  of  the  Plumbers'  Company  to 
swell  its  revenues  and  regain  some  of  its  ancient 
power  of  authority  by  the  apprenticeship,  training, 
examination  and  certification  of  plumbers.  The 
scheme  is  well  enough  so  long  as  registration  remains 
voluntary.  The  policy  of  the  Plumbers'  Company, 
however,  for  many  years  past  has  been  to  render 
registration  compulsory.  Such  a  result  could  only 
be  attended  with  disaster  by  the  creation  of  a 
costly  monopoly  with  all  its  privileges  and  eco- 
nomic waste,  the  burden  of  which  would  fall  upon 
the  general  community.  The  point  is  one  that  inti- 
mately concerns  the  medical  profession,  inasmuch 
as  good  plumbing  is  essential  to  good  sanitation. 
Were  the  cost  of  plumbers'  work  to  go  up  materi- 
ally, as  it  inevitably  would  in  the  case  of  compul- 
sory registration,  the  national  health  would  at  once 
suffer.  In  many  ways  wealth  is  needful  to  secure 
health,  and  this  detail  of  sound  plumbing  affords 
a  good  illustration  of  that  general  proposition. 

Skipping. 
"  To  skip  or  not  to  skip  ?" — that  is  the  question 
which  Dr.  Bond,  the  Medical  Officer  of  Health  for 
Gloucestershire,  asks  in  his  recent  brochure,  "  A 
Plea  for  the  More  General  Practice  of  Skipping." 
Dr.  Bond,  as  the  energetic  secretary  of  the  Jenner 
Society,  has  certainly  shown  his  ability  to  make  the 
anti-vaccinators  skip,  but  whether  he  will  succeed 
in  inducing  the  general  public  to  do  so  remains  to 
be  seen.  The  grounds  on  which  he  urges  its  adop- 
tion are  that  it  is  an  unsurpassed  form  of  home 


gymnastics,  an  admirable  aid  in  the  cultivation  of 
bodily  vigour,  in  the  maintenance  of  health,  and 
the  treatment  of  some  forms  of  disease.  There 
is  no  doubt  that  skipping  as  a  form  of  exercise  has 
many  advantages,  it  requires  no  apparatus  except 
a  rope,  it  may  be  practised  in  the  open  air,  and  it 
induces  both  muscular  exercise  and  feelings  of 
exhilaration.  Moreover,  it  is  available  for  old  and 
young,  rich  and  poor,  male  and  female.  Why, 
then,  do  medical  men  neglect  to  advise  their 
patients  to  skip  ?  Perhaps  it  is  from  lack  of 
imagination,  or  perhaps  from  fear  that  their  advice 
may  not  be  followed.  Yet  how  happy  and  healthy 
would  be  a  community  of  skippers* !  The  gloom  of 
the  London  fog  would  fail  to  depress  the  clerk  who 
skipped  to  the  City,  and  the  cares  of  office  would  sit 
lightly  on  the  statesman  who  proceeded  to  West- 
minster in  a  fashion  that  would  make  the  per- 
formances of  the  liveliest  kangaroo  pale  by  com- 
parison. And  if  skipping  came  into  vogue  might 
not  many  other  hygienic  sports  follow  in  its 
train  ?  How  healthy  would  be  the  lot  of  the 
medical  man  who  went  his  rounds  trundling  a  hoop, 
or  of  the  clergyman  who  beguiled  the  time  between 
his  parochial  visitations  by  flying  a  kite  !  But, 
seriously,  if  Dr.  Bond  wishes  us  to  skip,  will  he 
not  break  the  ice  that  habit  has  frozen  around  us 
by  showing  us  the  way  ?  The  combined  districts 
of  Gloucestershire  should  give  ample  scope  for  the 
exhibition  of  agility.  Let  him  have  the  courage 
of  his  opinions,  and  be  like  Mr.  Gilbert's  Discon- 
tented Sugar  Broker,  who,  we  know, 

"  Braved  the  gay  and  guileless  laugh 
Of  children  with  their  nusses, 

The  loud  uneducated  chaff 
Of  clerks  on  omnibuses." 
And,  with  another  poet,  we  will  say — 

"  When  next  he  takes  his  walks  abroad, 

May  I  be  there  to  see." 


Fatal  Forceps  in  the  Abdomen. 

A  most  unhappy  professional  misadventure  at 
the  West  London  Hospital  has  recently  occupied 
the  attention  of  a  coroner's  jury.  An  abdominal 
operation  was  recently  performed  on  a  female 
patient,  who  died  some  little  time  afteiwards. 
Death  was  due  f  to  [suppurative  peritonitis, 
resulting  from  a  pair  of  forceps  being  left  in 
the  cavity  of  the  abdomen  and  afterwards 
removed  by  a  second  operation.  An  accident 
of  this  kind  is  not  unknown  in  surgical  prac- 
tice, and,  indeed,  may  occur  in  the  practice  of 
the  f  most  Tcaref ul  and  conscientious  operator. 
The  classical  advice  to  count  sponges  and  instru- 
ments before  and  after  abdominal  operations  was 
evidently  framed  to  prevent  so  untoward  an 
occurrence  as  that  in  question.  In  not  a  few 
details  the  busy  surgeon  is  perforce  obliged  to 
trust  to  his  assistants  and  nurses.  In  the  present 
instance  our  fullest  sympathies  are  with  the  sur- 
geon, Mr.  Stephen  Paget,  who  is  well  known  as  a 
thoroughly  experienced,  able,  and  conscientious 
operator.  Needless  to  say,  a  similar  accident 
might  occur  at  any  moment  to  any  surgeon  work- 
ing under  similar  conditions.     It  is  somewhat  to 


May  4,  1904. 


PERSONAL. 


The  Medical*  Press.     4^5 


be  regretted  that  Mr.  Paget  was  abroad  at  the 
time  of  the  inquest,  and  therefore  unable  to  give 
his  version  of  the  unfortunate  occurrence  to  the 
jury.  The  inquiry  has  been  adjourned  in  order 
that  he  may  attend.  He  cannot  fail  to  secure 
the  warm  sympathy  and  support  of  the  whole 
medical  profession  under  the  trying  circumstances 
in  which  he  has  been  so  suddenly  and  unexpectedly 
plunged. 


Antivaccinationist  Scheme  Thwarted* 
A  judgment  delivered  by  Mr.  Justice  Channell 
last  week  should  be  of  some  value  as  an  example 
to  antivaccinationist  guardians.  The  Battersea 
vaccination  officer  brought  an  action  to  recover 
costs  incurred  in  connection  with  vaccination  de- 
faulters. The  majority  of  the  defendant  Wands- 
worth and  Clapham  Board  of  Guardians  were 
conscientious  objectors,  and  declined  to  pay.  One  of 
their  number  went  so  far  as  to  circulate  a  poster 
urging  the  public  not  to  comply  with  the  order  of 
the  vaccination  officer,  and  stating  that  a  well- 
known  barrister  would  defend  them  in  court. 
The  vaccination  officers  therefore  prosecuted,  and 
engaged  legal  assistance  for  the  purpose.  They 
acted  in  the  matter  under  pressure  from  the  Local 
Government  Board.  Their  contention  was  that 
under  the  Act  it  was  for  the  vaccination  officer 
alone  to  decide  whether  legal  assistance  was 
necessary,  and  that  the  guardians  were  bound  to  pay 
the  costs.  That  view  was  confirmed  by  the  judge, 
who  pointed  out  that  while  boards  of  guardians 
put  themselves  in  opposition  to  the  law  under 
which  they  were  elected,  and  thereby  incurred 
unnecessary  costs,  the  people  who  were  foolish 
enough  to  appoint  them  must  pay  for  it. 


The  Royal  College  of  Science  for  Ireland. 

The  most  interesting  event  that  occurred  during 
his  Majesty's  recent  visit  to  Dublin,  at  least,  so 
far  as  the  medical  profession  is  concerned,  was 
the  laying  of  the  foundation  of  the  new  College 
of  Science  at  Leinster  Lawn.  This  ceremony  took 
place  on  Thursday  last,  and  was  the  occasion  of  a 
brilliant  function.  A  special  pavilion  was  erected 
on  the  site  of  the  College,  in  which  the  King  was 
received,  and  in  which  the  ceremony  took  place. 
Their  Majesties,  on  arriving  at  the  pavilion,  were 
received  by  the  Chief  Secretary  for  Ireland,  who 
is  the  President  of  the  Department  of  Agriculture 
and  Technical  Instruction.  Sir  Horace  Plunkett, 
the  Vice-President,  the  Secretary,  the  Com- 
missioners of  the  Board  of  Works,  and  the  Dean 
of  the  College,  Professor  W.  N.  Hartley,  had  the 
honour  of  being  presented.  Their  Majesties  were 
then  conducted  to  the  pavilion,  in  which  the  cere- 
mony was  to  be  performed,  and,  having  taken  their 
places  on  the  dais,  the  Vice-President  of  the  De- 
partment read  an  address,  describing  the  origin 
and  objects  of  the  College,  to  which  the  King  was 
then  graciously  pleased  to  read  a  reply.  The 
Chairman  of  the  Board  of  Works  next  handed  to 
the  King  a  statement  of  the  origin  of  the  building, 
together  with  a  collection  of  coins  of  the  present 


year,  and  copies  of  newspapers  of  the  day,  which* 
his  Majesty  deposited  beneath-  the  stone.  A 
trowel  having  been  handed*  to  the  King,  he  de- 
clared the  stone  to  be  well  and  truly  laid.  The 
new  College  of  Science  is  destined  to  replace  the 
old  building  in  St.  Stephen's  Green,  which  has  be* 
come  quite  unsuited  to  the  purposes  for  which  it 
is  required.  The  building  has  had  an  interesting 
history.  In  1 845 ,  an  institution  called  the  Museum 
of  Irish  Industry  was  founded  in  Dublin,  and  two 
years  later  was  extended  so  as  to  include  the 
"  Government  School  of  Science  as  Applied  to 
Mining  and  the  Arts."  This  school  was  located 
in  the  present  College  of  Science,  by  which  it  was 
absorbed  in  consequence  of  the  recommendations 
of  a  Royal  Commission  in  1867.  At  this  time, 
the  college  was  under  the  control  of  the  South 
Kensington  Department  of  Science  and  Art,  and 
was  so  controlled  up  to  the  year  1900,  when  it  was 
transferred  to  the  new  Department  of  Agriculture 
and  Technical  Instruction.  The  College  is  now 
the  principal  institution  connected  with  the  sys- 
tem of  technical  instruction  through  the  country, 
and  when  it  is  housed  in  more  ample  and  fitting 
quarters  it  will  be  able  to  occupy  a  still  more  im- 
portant position. 

The  Kind's  Visit  to  Ireland. 
Ireland  has  been  within  the  past  week  honoured 
by  a  second  visit  from  his  Majesty  King  Ed- 
ward VII.  Although,  on  this  occasion,  the  visit 
was  of  a  semi-private  character,  still  the  several 
functions  their  Majesties  attended  caused  a  very 
welcome  stir  and  excitement  through  the  country. 
The  most  interesting  event  from  a  medical  point 
of  view,  to  which  we  have  already  alluded, 
was  the  ceremony  of  laying  the  foundation 
stone  of  the  new  College  of  Science.  His  Majesty 
left  Dublin  on  Saturday,  and  proceeded  to  Kil- 
kenny, from  where  he  travelled  to  Waterford 
on  Monday  on  his  way  to  the  Duke  of  Devonshire 
at  Lismore  Castle. 


PERSONAL. 


Last  week  Mr.  G.  F.  Goodhart,  son  of  Dr.  J.  F. 
Goodhart,  of  London,  was  called  to  the  Bar  of  the  Inner 
Temple. 

The  resignation  is  announced  of  Sir  John'Sibbald 
from  the  post  of  Medical  Adviser  to  the  Edinburgh 
District  Lunacy  Board. 

Dr.  Arthur  Shad  well  and  Dr.  Ralph  Vincent  gave 
evidence  last  week  before  the  Physical  Deterioration 
Committee  now  sitting  in  the  House. 


Dr.  James  Edwards,  of  Liverpool,  has  been  ap- 
pointed to  the  important  posts  of  Medical  Officer  to 
the  D.  and  E.  Divisions  of  Police,  Liverpool. 


We  are  glad  to  learn  that  Dr.  E.  M.  Smith,  Medical 
Officer  of  Health  for  York,  has  again  resumed  his 
duties  after  a  prolonged  absence  due  to  typhoid  fever. 


We  are  glad  to  learn  that  the  rumours  concerning 


May  4,   1904. 


CORRESPONDENCE. 


The  Medical  Press.     486 


the  health  of  Mr.  C.  B.  Lockwood,  the  popular  surgeon 
of  St.  Bartholomew's  Hospital,  are  without  foundation. 

The  Charles  Murchison  Scholarship  in  Clinical 
Medicine  was  awarded  to  Mr.  W.  H.  Harwood-Yarred, 
of  St.  Thomas's  Hospital. 

Dr.  B.  A.  Whitelegge,  C.B.,  will  preside  at  the 
annual  dinner  of  the  Epidemiological  Society,  to  be  held 
at  the  Grand  Hotel,  Trafalgar  Square,  London,  on 
May  1 2  th.  

A  meeting  of  Dr.  Traill's  former  pupils  has  decided 
to  make  a  presentation  to  him  to  commemorate  his 
recent  appointment  to  the  Provostship  of  Trinity 
College,  Dublin.  * 


The  Right  Hon.  the  Lord  Mayor  of  London  will 
preside  at  the  festival  dinner  of  the  City  of  London 
Hospital  for  Diseases  of  the  Chest  on  May  nth,  at  the 
Hotel  Cecil,  London. 


Sir  Chas.  Cave,  Bart.,  has  resigned  the  Presidency 
*of  the  Bristol  Royal  Infirmary,  an  institution  with 
which  he  has  been  connected  as  President  and  Treasurer 
for  nearly  twenty-five  years. 

Sir  Jas.  Crichton-Browne,  M.D.,  F.R.S.,  will 
preside  at  the  annual  meeting  of  the  Association  of 
Asylum  workers,  to  be  held  in  the  rooms  of  the  Medical 
Society  of  London,  on  Tuesday,  May  17th. 

Dr.  Edwin  Fullerton  Hatton,  Superintendent  of 
the  Lunatic  and  Pauper  Asylums,  and  Medical  Officer 
•of  No.  2  District  of  the  Island  of  Grenada,  has  been 
officially  gazetted  to  be  an  Official  Member  of  the 
Legislative  Council  of  that  Island. 

At  the  1904  British  Association  meeting,  to  be  held 
at  Cambridge.  Professor  C.  S.  Sherrington,  F.R.S.,  of 
Liverpool,  will  preside  over  the  Section  of  Physiology, 
Mr.  Henry  Balfour  over  that  of  Anthropology,  and 
Mr.  Francis  Darwin,  F.R.S.,  over  that  of  Botany. 

Sir  Robert  Finlay,  K.C.,  M.P.,  Lord  Rector  of  the 
University  of  Edinburgh,  will  preside  at  the  May 
dinner  of  the  Edinburgh  University  Club/ to  be  held  at 
the  Criterion  Restaurant,  London,  on  May  nth.  Mr. 
Justice  Darling,  Mr.  J.  M.  Barrie,  Captain  Robert 
Marshall,  and  other  distinguished  Edinburgh  graduates 
will  be  present. 


At  the  annual  dinner  of  the  West  London  Medico- 
Chirurgical  Society,  which  takes  place  at  the  Trocadero 
this     (Wednesday)     evening,      silver    bowls    will    be 

-presented  to  Mr.  Percy  Dunn,  and  Mr.  McAdam  Eccles, 
late  editor  and  editorial  secretary  respectively  of  the 
Society's    Journal,     for    their    service    in    connection 

-therewith.  Mr.  Percy  Dunn  organised  and  edited  the 
Journal  for  eight  years  from  its  commencement. 

At  a  meeting  of  the  Censors  of  the  Royal  College  of 
Physicians  of  London,  on  the  28th  ult.,  the  following 
were  elected  Fellows  of  the  College  : — Edward  John- 
stone Jenkins,  M.D.Oxon.,  Sydney,  New  South  Wales  ; 
William  John  Gow,  M.D.Lond.,  London;  Thomas 
Robert  Bradshaw,  M.D.Dub.,  Liverpool;  Edmund 
Henry  Colbeck,  M.D.Camb.,  London  ;  Arthur  John 
Hall,  M.B.Camb.,  Sheffield  ;  John  Francis  Harpin 
Broadbent,  M.D.Oxon.,  35  Seymour  Street,  London,  W. ; 
Bertram  Louis  Abrahams,  M.B.Lond.,  14  Welbeck 
Street,  London,  W.  ;  Charles  Arthur  Mercier,  M.B. 
Lond.,  London  ;  William  Cecil  Bosanquet,  M.D.Oxon., 
London;  Arthur  Carlyle  Latham,  M.D.Oxon.,  London. 

Correspondence. 

"THE     APPLICATION     OF     PESSARIES     AND 

THEIR  DANGERS." 
Xo  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — A  natural  taste  and  interest  in  mechanical 


appliances  must  be  my  excuse  for  comment,  (I  trust  ih 
a  friendly  way)  on  some  of  the  statements  and  quota- 
tions given  by  Dr.  Macnaugh  ton  -Jones  in  his  valuable 
and  comprehensive  paper  in  The  Medical  Press  uu> 
Circular  of  April  27th.  It  is  quite  a  truism  that 
"  every  mobile  and  reducible  uterus  should  be  treated 
in  the  first  instance  bv  a  support  which  should  be 
worn  for  a  space  of  time  proportionate  to  the  ten- 
dency there  is  on  the  part  of  the  uterus  to  revert  to 
the  backward  position,"  or,  may  I  add,  any  other 
abnormal  position  (italics  mine). 

I  do  not  observe  one  word  abou  t  any  local  or  general 
treatment  to  restore  the  tone  and  consistence  of  the 
uterine  muscle,  nor  can  I  agree  with  the  statement 
that  "  displacements  which  are  associated  with 
inflammatory  states  of  the  endometrium  until  such 
endometritis  be  cured  contra-indicate  the  use  of  any 
pessary."  On  the  contrary,  I  believe  that  a  property 
adjusted  vaginal  pessary,  by  straightening  the  uterus, 
will  allow  of  freer  exit  for  the  abnormal  secretions. 
restore  the  circulation  interfered  with  by  the  flexion, 
and  materially  assist  in  the  cure  :  the  existing  endo- 
metritis and  the  flexion  to  be  treated  at  the  same  time. 
A  healthy  uterus  cannot  become  retro  flexed;  hence  the 
importance  of  endeavouring  to  restore  the  health  of 
that  important  organ  when  lost,  the  primary  cause 
of  the  misplacement. 

The  great  value  of  the  vaginal  pessary  if  properly 
selected  and  adjusted  is  the  immediate  relief  to  the 
patient,  giving  her  confidence,  putting  the  womb  to 
bed.  as  it  were,  and,  while  worn,  assisting  in  the  other 
local  and  general  treatment. 

The  pessary  is,  like  the  scaffolding  of  a  building,  only 
temporary,  and  removed  "  when  the  repairs  are  exe- 
cuted." 

The  men  who  constantly  decry  the  pessary  are  those 
who  are  quite  unable  to  use  them  with  advantage. 
"A  bad  carpenter  never  had  a  good  plane."  With 
regard  to  Dr.  Jones'  statement :  "  When  the  position 
of  the  uterus  is  such  that  a  pessary  can  be  taken  out 
and  replaced  by  the  woman  herself  (italics  mine)  it  is 
well  that  it  should  be  of  such  a  form  as  will  enable  her 
to  do  this  easily,"  may  I  ask  what  possible  use  coukl 
such  a  form  of  pessary  be,  and  what  form  of  displace- 
ment can  this  advice  apply  to  ? 

Women,  as  a  rule,  are  only  too  glad  to  find  excuse 
for  non-attendance,  by  stating  that  the  "  period  "  came 
on.  How  much  more  likely  to  add  this  new  excuse  for 
non-attendance  if  they  find  they  can  remove  anl 
re-introduce  the  pessary  when  they  please  ? 

I  strongly  suspect  that  almost  all  the  advantages  of 
ventro-fixation  or  suspension  could  be  attained  in 
the  greater  number  of  cases  by  reposition  of  the 
womb  and  a  properly  fitted  pessary,  combined,  of  course, 
with  other  local  and  general  treatment  And  I  should 
think  that  one  of  the  great  advantages  of  that  operation 
is  the  keeping  of  the  uterus  in  correct  position  long 
enough  to  allow  it  and  the  ligaments  concerned  to  regain 
their  tone  (italics  mine).  Combined  with  the  long 
rest  necessitated  by  the  healing  of  the  wound,  and  the 
forming  of  adhesions  (stated  by  Dr.  Japp  Sinclair  to  be 
"  one  month  or  six  weeks  in  bed,  and  to  lead  invalid 
lives  for  several  months  !  ") 

Surely  a  well-fitted  pessary  with  other  local 
general  treatment  would  be  the  lesser  evil. 

As  to  the  use  of  the  stem  pessary,  I  never  use  one 
in  cases  of  flexion  as  a  cure  (my  own  design  included), 
and  should  feel,  like  Dr.  Jones,  "very  uneasy"  if  I 
dared  to  do  so. 

I  have  found  the  hollow,  flexible  stem  of  great  value 
in  cases  of  stenosis,  and  also  of  chronic  endometritis, 
acting  as  a  drainage-tube  and  so  materially  assisting 
in  the  treatment,  combined  with  the  support  (5 
necessary)  of  vaginal  pessary  in  addition. 

I  cannot  agree  with  the  statement  above  that  "  dis- 
placements which  are  associated  with  inflamma ton- 
states  of  the  endometrium,  until  such  endometritis  be 
cured  contra-indicate  the  use  of  any  pessary,"  as  I  have 
found  the  hollow  spiral"  stem,  by  giving  free  exit  to 
the  abnormal  secretions,  helps  in  a  great  measure  to 
restore  the  tone  and  muscular  power  of  the  uterus,  com- 


May  4,   1904. 


OBITUARY. 


The  Medical  Press.     487 


bined  with  the  support  of  a  vaginal  pessary  in  addi" 
tion  and  if  the  patient  will  do  as  directed,  and  keep  the 
vagina  as  clean  as  possible,  the  uterus  may  need  little 
or  no  other  treatment.  Such  is  my  experience,  and 
I  have  never  felt  in  the  least  anxious  while  my  patient 
has  worn  the  hollow  spiral-wire  flexible  stem,  nor  have 
I  heard  any  complaints  of  its  presence. 
I  am,  Sir,  yours  truly, 

Alexander    Duke,    F.R.C.P.I. 
Gloucester  Terrace,  W. 
April  28th,  1904. 


THE  INFANTS'  HEALTH  SOCIETY. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — The  foundation  of  the  Society  named  above, 
announced  in  The  Medical  Press  and  Circular 
of  April  27th,  is  surely  a  move  in  the  right 
direction.  It  seems  certain  that  a  great  proportion 
of  the  people  of  this  country  and  of  some  of  our  Colonies 
following  the  evil  example  of  our  French  neighbours 
are  more  and  more  adopting  the  practice  of  restricting 
the  number  of  their  offspring  by  artificial  means.  The 
birth-rate  is  from  this  cause  steadily  declining,  and 
at  the  present  rate  will,  in  a  few  years,  land  us  in 
the  same  position  as  tne  French.  We  shall  not  have 
enough  men  for  the  requirements  of  home  ;  we  shall 
not  have  any  emigrants  to  send  to  the  vast  millions  of 
fertile  square  miles  across  the  seas  now  calling  out  for 
inhabitants  to  develop  and  fill  them.  In  France 
the  death-rate  among  infants  and  young  children  is 
higher  than  with  us,  enormous  as  is  the  mortality  in 
our  islands,  and  it  is  nearly  all  preventable.  The 
deaths  from  measles  alone  in  England  and  Wales  in 
one  year  now  average  between  1 5 ,000  and  20,000.  Measles 
can  hardly  be  truly  said  to  be  a  fatal  disease  among  the 
well-to-do  and  the  wealthy.  The  mortality  increases 
with  the  poverty  of  the  parents,  and  the  greater  part 
of  this  frightful  waste  of  life  might  be  evidently  pre- 
vented. Inquiry  would  show  that  the  same  remark 
applies  to  whooping  cough  and  scarlet  fever,  and,  of 
course,  the  death-rate  is  an  index  to  the  numbers  of 
survivors  with  damaged  constitutions  or  permanent 
disabilities  of  one  kind  and  another.  The  evils  arising 
from  artificial  limitation  of  the  number  of  offspring  by 
parents  might,  so  far  as  the  State  is  concerned,  be 
largely  diminished  if  the  right  proportion  of  all  the 
infants  born  were  preserved  alive  ;  and  these  evils 
might  perhaps  be  altogether  put  an  end  to  if  the 
diminishing  mortality  were  accompanied  by  an  in- 
creasing marriage  rate.  If  a  large  number  of  men 
between  the  ages  of  25  and  35  would  marry  women  of 
a  similar  age,  and  if  all  these  extra  couples  would 
procreate  and  keep  alive  a  few  children,  the  population 
might  be  kept  to  the  level  which  will  be  needed  if  the 
Empire  is  to  be  maintained  and  expanded,  and  if  the 
Anglo-SaxoH  race  is  to  maintain  the  supremacy  it 
has  so  far  upheld. 

I  am,  Sir,  yours  truly, 

A  Student  of  Sociology. 
April  29th,  1904. 


inform  any   of    your   readers    who   desire    to    have 
particulars. 

I  am.  Sir,  yours  truly 

T.  Kyffin  Freeman. 
Blairgowrie.  Whitehall  Park,  London,  N. 
April  23rd,  1904. 


THE  QUESTION  OF  EXERCISE. 

To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir,— Under  the  title  "  The  Question  of  Exercise/' 

there  was  an  article  in  The  Medical  Press  and 

Circular,    June    7th,     1899— in    which    the    views 

expressed    by   Dr.    Warre   are   anticipated.     In  that 

1  article  we  find  the  following  : — "It  is  well  for  us  to 

'  consider  carefully  what  are,  or  ought  to  be,  the  objects 

of  exercise,  and  whether  it  is  the  mental,  the  moral. 

I  or  the  physical    development  that  we  seek  for  when 

■  exercise  is  encouraged."    In  that  article  the  "  science  " 

I  of  this  question  is  clearly  stated,  and  it  is  pleasant  to 

:  find  the  views  of  the  headmaster  of  a  great  school  like 

|  Eton  agreeing  with  those  set  forth  some  time  ago  in  The 

I  Medical  Press  and  Circular. 

I  am,  Sir,  your  truly, 

R.  L. 


STERILISED  MILK  FOR  CHILDREN. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — I  have  recently  read  your  correspondent's 
(Vienna)  view  on  the  undesirability  of  sterilised  milk 
for  children.  He  is  unquestionably  correct,  and  his 
opinion  is  not  only  confirmed,  as  you  say,  by  Behring, 
to  whose  judgment  most  medical  men  would  defer, 
but  the  practical  experience  of  those  who  have  pre- 
scribed sterilised  milk,  and  have  found  infants  and 
invalids  suffering  ill-effects  therefrom  (or  at  best  not 
thriving)  has  materially  reduced  the  quantity  con- 
sumed in  many  districts.  There  is  a  system  now 
coming  to  the  forefront  which  effectively  preserves 
the  milk  without  boiling  it ;  it  also  destroys  disease 
g«rms,  and  has  saved  life  and  health  in  a  remarkable 
"ay*  I  had  a  striking  instance  of  this  in  a  recent 
voyage  to  Newfoundland,  when  bottles  of  milk  thus 
treated  saved  the  life  of  an  infant,  I  having  a  supply 
•for  my  own  use  on  board  ship.     I  shall  be  pleased  to 


Obituary 

DR.  AUSTIN  MELDON,  DUBLIN. 

With  the  deepest  regret  we  have  to  announce  the 
death  of  Dr.  Austin  Meldon,  D.L.,  J.P.,  Fellow  and 
ex-President  of  the  Royal  College  of  Surgeons  in 
Ireland,  who  passed  away  from  cardiac  failure  on 
April  28th.  He  was  but  59  years  of  age,  but  in  those 
years  he  crowded  a  great  deal  of  good  professional  work. 
He  was  a  most  successful  physician  and  surgeon.  His 
patients  loved,  honoured,  and  respected  him,  and  he 
had  a  very  large  practice.  Notwithstanding,  he  found 
time  to  contribute  considerably  to  the  literature  of 
medicine  and  surgery.  Among  the  best  known  of 
his  works  were  "  A  Treatise  on  Gout,  Rheumatism, 
and  Chronic  Rheumatic  Arthritis,"  "  Treatment  of 
Tetanus,"  "  Transfusion,"  "  Cases  of  Tapping  Peri- 
cardium," "  Pasteur  and  Hydrophobia,"  and  a  very 
interesting  address  on  "  Cancer.'  delivered  at  Jervis 
Street  Hospital  shortly  before  his  resignation  of  the 
visiting  surgeoncy,  and  his  acceptance  of  the  office  of 
consulting  surgeon  to  that  institution.  He  was  for 
over  thirty  years  attached  to  this  hospital,  and  carried 
out  some  brilliant  surgery  there.  In  his  earlier  years 
he  obtained  numerous  prizes  and  medals,  one  of  the 
latter  being  the  gold  medal  of  the  old  Pathological 
Society  of  Dublin,  now  merged  in  the  Royal  Academy 
of  Medicine  in  Ireland. 

For  many  years  he  served  as  Councillor  of  the  Royal 
College  of  Surgeons  and  was  President  in  years  1889-90. 
His  business-like  qualities  and  despatch  of  work  were 
greatly  appreciated  by  his  colleagues  on  the  Board. 
He  was  President  of  the  Irish  Medical  Association  three 
times,  and  ever  gave  its  affairs  his  most  earnest  atten 
tion.  His  hospitality  was  superb  and  graceful.  His 
kindness  and  charity  to  the  poor  were  unostentatious  but 
genuine.  He  was  always  welcome  and  carried  with 
him  an  atmosphere  of  geniality  which  no  one  could 
resist.  In  all  lelations  of  life  his  conduct  was  of  the 
highest  character.  Affectionate  and  beloved  at  home, 
in  the  world  with  its  constant  trials  he  never  made  an 
enemy,  and  if  perchance  he  suffered  an  injury  his 
heart  was  large  enough  to  forgive  and  forget.  His  was  a 
remarkable  personality  in  many  ways,  possessed  as  he 
was  of  a  marvellous  fund  of  good  humour  and  good 
nature,  coupled  with  a  keen  insight  into  human  nature. 
He  always  upheld  the  honourable  traditions  of  his 
profession,  and  won  fame  and  friendship  everywhere. 
If,  as  we  are  assured,  this  life  is  but  a  preparation  for 
a  better  one,  we  must  hope  and  believe  that  his  reward 
will  be  great  indeed. 

GEORGE  WATSON  BEATTIE,  M.D.ABERD. 
We  regret  to  announce  the  death,  on  April  25th  last, 
of  Dr.  George  Watson  Beattie,  medical  officer  of  health 


488    The  Medical  Pkess. 


LITERATURE. 


May  4,  1904. 


and  the  Prestwich  Union  medical  officer  and  public 
vaccinator  for  the  township  of  Failsworth.  Ine 
deceased  wasM.B.,  CM.,  of  Aberdeen  University,  1870, 
and  M.D.AberJ..  187^  He  was  a  member  of  the 
British  Medical  Association.  Prior  to  coming  to 
Failsworth,  he  was  in  practice  at  Ballater. 

Xabotatots  Hotee. 

* 

THE  "  ENULE  "  BRAND  SUPPOSITORIES. 
The  excellent  series  ol  suppositories  introduced  by 
Messrs.  Burroughs  Wellcome  and  Co.  promise  to  be  of 
widespread  value.  Their  superiority  Ues  in  attention 
to  a  number  ot  details,  such  as  shape,  keeping  qualities, 
and  accuracy  of  dosage.  Among  others  may  be 
mentioned  as  most  likely  to  be  generally  useful  are  :-» 
"-  Enule"  Quassin  (Amorphous),  gr.  \,  an  anthelmintic 
for  use  in  cases  of  ascaris  lumbricoides.  One  "  Enule  " 
product  is  administered  for  twelve  successive  nights. 
"  Enule  "  Soap  Compound  ;  each  contains  curd  soap 
gr.  vij,  and  dried  sulphate  of  sodium,  gr.  vij.  a  combina- 
tion for  the  relief  ot  constipation.  "  Enule  "  hemisine, 
containing  the  active  principles  of  adrenalin,  a  valuable 
remedy  in  piles 

Each  suppository  is  enclosed  in  a  sheath  of  pure 
tin-foil,  which  keeps  it  free  from  contamination  and 
septic  influences  until  the  moment  when  it  is  required 
for  use.  The  sheath  is  then  easily  stripped  off,  and 
the  suppository  inserted  in  the  ordinary  way.  This 
sheath  also  enables  "  Enule  "  suppositories  to  resist 
atmospheric  changes  to  a  degree  hitherto  impossible. 
All  the  agents  ordinarily  employed  in  rectal  medication 
are  issued  as  "  Enule  "  products. 

From  the  illustration  given  it  will  be  seen  that  the 
"  Enule"  is,from  its  shape,  calculated  to  do  all  that  is 
claimed  for  it.  Hemisine  is  sent  out  by  the  same  firm 
in  various  convenient  forms.  As  a  soloid  it  is  prepared 
in  two  different  strengths  of  i-soth  and  i-i2th  of  a 


CEZ 


J3K2I3 


grain,  for  the  preparation  of  solutions.  There  are 
two  "tabloids"  of  hemisine,  the  first  , contains 
1 -200th  grain  for  internal  administration,  and  the 
other  i-iooth  as  an  ophthalmic  remedy.  The  future 
value  of  adrenalin  is  hardly  yet  gauged,  but  must  be 
considerable.  It  should  be  in  the  hands  of  every 
practitioner,  and  in  the  preparations  of  hemisine  as 
above  set  forth  will  be  found  convenient  in  form  and 
accurate  in  dosage. 


Xiterature* 


PHILLIPS  ON  MATERIA  MEDICA  AND  THERA- 
PEUTICS, (a) 
We  have  much  pleasure  in  recording  the  appearance 
of  the  third  edition  of  Dr.  C.  D.  F.  Phillips'  well-known 
work  on  •-  Materia  Medica,  Pharmacology,  and  Thera- 
peutics," a  book  which  is  as  well  known  in  America 
and  the  Colonies  as  in  England.  The  first  edition  was 
published  in  1882,  and  it  has  long  been  recognised  as 
the  standard  work  on  the  subject.  It  is  more  scientific 
than  Wood,  and  more  trustworthy  and  comprehensive 
than  Ringer.  The  present  volume,  which  is  devoted 
to  inorganic  substances,  is  dedicated  to  Sir  Thomas 
Fraser,  of  Edinburgh,  and  we  arejinlormed  that  the 
second  volume  on  the  Vegetable  and  Animal  Compounds 
is 'already  far  advanced  and  4wiil  shortly  be  published. 
The  present  work,  which  is  complete  in  itself  and  com- 
prises nearly  1,000  pages,  will  afford  the  aveiage  reader 
ample  food  for  study  for  some  time  to  come.  It  is 
adapted  to  the  requirements  both  of  the  general 
practitioner  who  wishes  to  keep  abreast  with  modern 
treatment  and  of  the  advanced  student  preparing  for 
the  higher  examinations.  The  author's  long  experience 
as   a   lecturer   at   the   Westminster   Hospital   and   as 


(a)  "Materia  Medica,  Pharmacology,  and  Therapeutics.— Inowmic 
Substances."  ByC.  D.  P.  Phillips,  M.D.,  LL.D.Aberd.  and  Edin., 
F.R  8.  and  F  R  C  S.Edin.,  late  lecturer  in  Materia  Medica  at  West- 
minster Medical  School,  &c.  Third  Edition.  London  :  Longmans, 
Ureen  and  Co.     1904.    Price  2ls. 


examiner  in  the  Universities  of  Edinburgh,  Glasgow,, 
and  Aberdeen,  especially  fits  him  for  the  production  ol 
a  work  of  this  magnitude.  The  subjects  are  not 
limited  to  drugs,  for  there  are  chapters  on  "Baths  and 
Mineral  Waters,"  on  "  Radiant  Heat  and  Light,"  and 
on  "  Antitoxin  in  Diphtheria  and  Other  Diseases." 
To  the  subject  of  waters  in  various  forms  nearly  130 
pages  are  devoted,  a  very  full  description  being  given 
not  only  ol  the  various  forms  of  bath?,  but  of  different 
health  resorts  in  various  parts  of  the  world.  The 
author  i  1  most  cases  apparently  speaks  from  personal 
knowledge  of  the  localities,  and  if  so  must  have  tra- 
velled extensively.  With  regard  to  drugs.  Dr.  Phillips 
by  no  means  confines  himself  to  the  narrow  limits  of 
the  "  British  Pharmacopoeia,"  but  revels  in  prepara- 
tions of  French  and  German  origin,  many  of  them  but 
little  known  in  this  country.  For  example,  under  the 
head'of  "  Iron,"  he  describes  the  compounds  of  Tisj, 
Creuse,  Robequet,  and  Van  den  Corput,  and  refers 
incidentally  to  the  use  of  "  Spinach -iron  "  and  other 
vegetable  forms  of  the  drug.  In  this  article  we  find  a 
full  discussion  on  the  differential  action  of  the  pro  to- 
and  the  persalts.  Quevenne's  experimental  obser- 
vations with  gastric  fluid  withdrawn  through  a  fistula 
from  the  stomach  of  a  dog,  are  criticised,  whilst  ample 
justice  is  done  to  Stockman's  clinical  records  in  cases 
of  anaemia  and  chlorosis.  Mercury  is  treated  in  an 
equally  liberal  and  comprehensive  manner,  and  many 
useful  hints  are  given  as  to  the  best  modes  of  treating 
cases  of  syphilis  not  readily  yielding  to  ordinary 
preparations.  There  is  no  better  remedy  for 
functional  amenorrhoea  than  the  different  salts  of 
manganese,  and  the  modes  of  administration  of  the 

Permanganate  and  the  binoxide  are  clearly  indicated, 
t  is  not  only  necessary  to  know  the  appropriate  remedy 
in  any  departure  from  normal  health,  but  if  a  successful 
result  is  to  be  obtained  to  give  it  according  to  certain 
definite  rules.  For  example,  permanganate  of  potas- 
sium is  a  powerful  escharotic,  and  if  administered  on 
an  empty  stomach  will  assuredly  excite  gastric  irri- 
tation and  possibly  cause  perforation.  Given  imme- 
diately after  meals' it  is  safe  and  excites  no  irritation. 
Again,  if  given  with  a  vegetable  extract  it  forms  an 
explosive  mixture,  but  if  dispensed  with  kaolin  in 
the  form  of  a  pill  it  is  free  from  this  objection.  Nitrate 
of  sodium,  which  many  years  ago  attracted  a  con- 
siderable amount  of  attention  as  a  vaso-dilator,  has 
fallen  into  undeserved  neglect,  and  it  is  interesting  to 
have  references  to  a  now  almost  forgotten  controversy 
in  which  some  of  the  most  distinguished  pharmaco- 
logists of  the  day  took  a  prominent  part.  The  popu- 
larity of  remedies  is  a  matter  difficult  of  explanation, 
but  it  often  happens  that  one  particular  member  of  a 
series  is  almost  universally  prescribed  to  the  exclusion 
of  others  of  equal  value.  Speaking  of  gastric  ulcer- 
Dr.  Phillips  says  that  it  may  be  given  in  *•  full  doses, 
but  does  not  indicate  to  what  extent  it  may  be  ad- 
ministered with  safety.  In  dysentery,  however,  he 
speaks  of  230  to  300  grains,  increased  to  1,000  grains 
daily.  At  one  time,  many  years  ago,  the  carbonate 
was  notoriously  impure  and  often  contained  arsenic; 
but  now,  with  increased  care  in  preparation,  it  is  devoid 
of  toxic  action  and  may  be  administered  with  confi- 
dence. Dr.  Phillips  seems  to  have  a  regard  for  the 
soluble  preparations  of  bismuth,  and  thinks  that  thev 
represent  the  activity  of  the  drug  independently  ol 
their  mechanical  action.  This  view  is  held  by  many 
pharmacologists,  and  there  is  much  to  be  said  w 
its  favour.  It  is  interesting  to  find  a  reference  to 
Ferrier's  snuff  as  a  remedy  for  coryza  and  other 
catarrhal  conditions.  Cerium  is  a  remedy  now 
rarely  prescribed,  but  in  the  days  of  Sir  James 
Y.  Simpson  it  was  in  constant  use  as  a  means 
of  alleviating  the  vomiting  of  pregnancy.  Its  thera- 
peutical effects  are  well  established,  and  it  is  as  effi- 
cacious as  ever,  the  only  difference  being  that  old 
remedies  are  forgotten  and  that  thete  is  an  increasing 
tendency  to  employ  drugs  advocated  by  the  enter- 
prising chemical  manufacturer.  We  owe  Dr.  Philup 
a  debt  of  gratitude  for  bringing  us  to  our  bearings  in 
such  matters,  and  for  maintaining  a  high  standard  » 


May  4,    1904. 


LITERATURE. 


The  Medical  Press.     489 


pharmaceutical  morality.  We  have  tested  his  work 
in  many  -ways,  and  have  not  been  able  to  detect  a 
single  inaccurate  reference.  The  material  is  admirably 
arranged,  space  is  economised,  and  any  given  subject 
can  be  consulted  with  the  minimum  of  trouble.  It  is 
not  only  a  work  on  materia  medica,  but  it  is  an  excellent 
guide  both  to  pharmacology  and  therapeutics.  A  very 
useful  feature  is  the  Index  of  Diseases  and  Remedies. 
This  is  in  itself  a  complete  epitome  of  medical  treat- 
ment, and  includes  remedies  dealt  with  in  the  com- 
panion volume.  It  is  a  question  whether  at  some 
future  time  it  should  not  be  published  separately. 
There  is  also  an  Index  of  spas  and  waters,  which  will  be 
found  useful  for  purposes  of  references.  It  has  been 
a  great  pleasure  to  us  to  read  this  work,  for,  on  the 
whole,  it  is,  perhaps,  the  best  book  on  materia  medica, 
pharmacology,  and  therapeutics  in  the  English  language. 

SYMES'  BACTERIOLOGY,  (a) 
A  second  edition  of  this  excellent  handbook  has 
"been  called  for,  the  first  large  issue  having  been  rapidly 
exhausted.  In  its  present  form  it  is  practically  a  new 
work,  as  many  portions  have  been  entirely  recast, 
while  fresh  material  has  been  added  on  such  subjects 
■as  the  mode  of  preparing  and  staining  blood  films, 
influenza,  &c.  An  interesting  description  together 
with  a  good  illustration,  is  given  of  that  most  modern 
imection.  trypanosomiasis.  The  illustrations  have  been 
increased  in  number.  The  book  is  eminently  suited  to  the 
requirements  of  the  general  practitioner  who  wishes  to 
keep  his  knowledge  thoroughly  up  to  date.  Students 
will  also  find  it  a  most  suitable  introduction  to  the 
larger  works  on  bacteriology.  We  can  confidently 
Tecommend  this  new  edition  as  a  thoroughly  trust- 
worthy guide  to  the  subject.  It  is  written  in  a  style 
I  which  is  singularly  free  from  technicalities,  and  there- 

fore readily  understood  by  those  uninitiated  in  the 
mysteries  of  this  science.  The  style  is  crisp,  clear 
and  concise,  and  this  little  volume  forms  a  handy 
booklet  of  reference  for  the  study  table. 


YOUNGER'S  INSANITY.  (6) 
There  must,  indeed,  be  few  general  practitioners  who 
do  not,  at  some  time  or  other  in  the  course  of  their 
work,  come  across  cases  of  mental  derangement. 
Although  the  diagnosis  and  treatment  of  these  cases, 
■as  a  rule,  are  left  to  the  specialist,  still  it  is  befitting 
that  the  family  physician  should  be  able  to  recognise 
the  type  of  case  with  which  he  is  dealing,  its  causes, 
prognosis,  and  general  treatment.  This  he  will  be 
enabled  to  do  when  he  has  thoroughly  mastered  the 
contents  of  this  brief  monograph.  The  first  part  deals 
in  an  able  manner  with  the  causes  and  early  symptoms 
of  insanity,  and  contains  a  section  on  the  examination 
•of  insane  patients  with  a  view  to  certification,  together 
with  a  good  account  of  the  legal  bearings  of  such  cases. 
In  the  second  part  the  various  types  of  insanity  are 
briefly  but  accurately  described,  while  the  special 
forms  of  mental  disease  are  carefully  detailed. 

This  volume  fills  up  the  gap  which  has  hitherto 
existed  in  the  text-books  on  general  medicine,  which 
usually  contain  only  a  passing  reference  to  mental 
•diseases.  Dr.  Younger*s  book,  therefore,  supplements 
the  ordinary  works  on  medicine,  and  it  will  serve  as  a 
useful  introduction  to  the  larger  treatises  on  insanity. 
We  congratulate  the  author  on  adding  such  a  well- 
written  handbook  to  this  practical  and  up-to-date 
series.  Practitioners  and  students  alike  are  strongly 
advised  to  make  themselves  familiar  with  its  contents, 
a  knowledge  of  which  will  save  many  a  mistake  in 
practice.  It  presents  the  subject  of  mental  diseases 
in  a  readily  comprehended  manner,  so  that  no  diffi- 
-culty  will  be  experienced  in  mastering  the  writer's 
statements.     This  little  book  is  emphatically  good  of 


(«)  "  The  Bacteriology  of  E  very-Day  Practice."  My  J.  Odary  Symes. 
M.D.LODd..  D  P.H.,  &c  Medical  Monograph  Series,  No.  II.  Second 
Edition.  Pp.  108.  with  11  illustrations.  Crown  8vo.  Price  2s.  6d. 
net.    London  :  Bail  Here   Tindall  and  Cox. 

(6)  'Insanity  in  Every-Day  Practice."  By  E.  O  Younger,  M.D, 
Brux.,  M.B.C.PLond.,  D.P.H.,  &*».,  Senior  Physician,  Finsbury 
Dispensary  &c.  Medical  Monograph  Series,  No  viii.  Grown  8vo,  pp. 
JW.   Price  fis.  6d.  net.    London  :  Bailliere,  Tindall  and  Cox.    1904. 


its  kind,  and  will  be  found  an  invaluable  and  unerring 
guide  alike  to  the  busy  practitioner  and  the  burdened 
student. 


THE  MEDICAL  ANNUAL,  (a) 
This  excellent  annual  has  attained  and  maintains 
its  popularity  with  the  medical  profession  by  the 
care  bestowed  on  its  production  by  the  publishers 
who  spare  no  expense  in  illustrations  and  so  forth, 
and  in  a  staff  of  sectional  editors,  each  of  whom  has 
attained  first  rank  in  his  speciality,  who  ensure  that 
the  reader  is  provided  with  trustworthy  reports  on 
the  most  recent  advances  in  medical  science.  The 
characteristic  feature  of  the  present  volume  is  the 
series  of  stereoscopic  views  which  greatly  facilitate 
the  study  of  structures.  The  volume  also  contains 
a  series  of  plates  showing  the  nature  and  distribution 
of  the  eruption  in  small-pox  and  other  infectious 
diseases.  We  are  glad  to  note  that  throughout  the 
volume  the  wants  of  the  practical  physician  are  kept 
well  in  view,  and  in  the  section  on  practical  thera- 
peutics, the  practitioner  will  find  many  useful  hints 
that  will  prove  serviceable  at  the  bedside. 

SUTHERLAND'S  DISPENSING  MADE  EASY.  (6  J 
Lest  the  title  should  prove  misleading,  we  may 
explain  that  this  manual  is  not  written  for  druggists, 
but  for  medical  men  who  do  their  own  dispensing. 
It  contains  innumerable  time-saving  and  economical 
wrinkles.  Thus  the  section  headed  "  How  to  Cut  Down 
the  Drug  Bills,"  is  well  worth  the  attention  of  country 
practitioners,  as  in  it  the  author  points  out  how  quite 
a  small  fortune  might  be  saved  by  substituting  the  less 
expensive,  but  quite  as  efficacious  preparations  of  the 
B.P.  in  dispensing.  Various  formulae,  gathered  from 
different  quarters,  are  given,  which  the  general  prac- 
titioner will  do  well  to  study  and  adopt.  Throughout 
this  little  book  are  many  hints  on  dispensing  for  con- 
tract or  club  patients.  The  latter  usually  expect  to 
receive  ten  times  as  much  as  they  pay  for,  and  accord- 
ingly Mr.  Sutherland  meets  the  exigencies  oi  the  case 
in  a  thoroughly  practical  manner.  The  closing  pages 
ol  the  book  are  taken  up  with  parish  prescriptions,  a 
number  of  suitable  formulae  being  given  which  combine 
the  maximum  of  economy  with  the  maximum  of  effi- 
ciency. No  medical  practitioner,  however  experienced 
in  dispensing  he  may  be,  can  afford  to  be  without  this 
handy  guide.  It  is  the  work  of  a  man  who  knows  his 
subject  well,  and  we  can  endorse  much  of  what  he  says. 
The  book  is  well  bound,  and  contains  a  number  ot 
blank  pages  for  private  formulae  and  notes. 

SAWYER'S  PRACTICAL*  MEDICINE,  (c) 
This  is  a  fourth  and  thoroughly  revised  edition  of  a 
collection  of  medical  essays  written  by  one  who  is  a 
master  of  his  subject.  Since  its  first  appearance  nearlv 
eighteen  years  ago  this  book  has  been  well  received 
by  the  profession,  and  consequently  we  need  not  now 
enter  into  any  detail  regarding  it.  We  may  mention, 
however,  that  the  author  has  improved  these  papers 
in  many  respects  and  brought  them  thoroughly  up  to 
date.  For  instance,  the  volume  now  contains  a  re- 
print of  his  paper  on  •'  Diet  in  Diabetes,"  which  ap- 
peared quite  recently  in  the  British  Medical  Journal. 
and  in  which  he  advocates  the  addition  of  potatoes 
to  the  diabetic  patient's  menu.  On  the  whole  there 
are  few  men  whose  writings  will  bear  collecting  to- 
gether in  book  form  as  do  those  of  Sir  James  Sawyer. 
It  is  a  genuine  pleasure  to  read  once  more  these  classical 
essays  which  are  full  of  suggestiveness  and  practical 
bearing  on  the  subjects  of  which  they  treat. 

(a)  "A  Year  Book  of  Treatment  and  Practitioner's  Index,  1904." 
Twenty -second  year.  Bristol :  John  Wright  and  Co.  London : 
Simpkm,  Marshall  and  Co. 

(61  '  Dispensing  Made  Easy  :  with  Numerous  Formal©  and  Prac- 
tical Hints  to  Secure  Simplicity,  Rapidity,  nd  Ecooomy."  By  Wm. 
G.  Sutherland,  M  B.Aberd.  Pp.  viii  102.  Price3s.6d.net.  Bristol: 
John  Wright  and  Co.    1904. 

(c»  ••  Contributions  to  Practical  Medicine/'  By  Sir  James  8awyer, 
M.D.,  Senior  Consulting  Physician  to  the  Queen's  Hospital,  Birming- 
ham. Fourth  Edition.  Pp.  247.  3s.  net.  Birmingham :  Cornish 
Brothers.    1904. 


49°     The  Medical  Press. 


MEDICAL  NEWS. 


May  4,  1904^ 


NEW   BOOKS   AND   NEW  EDITIONS. 


examination  questions  included  the  subjects  of  con- 


The  following  have  been  received  since  the  publication  |  tamination  of  drinking  water  from  faulty  connections, 

of  our  last  list  : —  roof  covering,  arrangement  of  bath,  sink,  and  closet 

The  Albion  Printing  Press  (Buenos  Aires).  wastes,    drainage   of    town   houses,    and    disconnection 

Aseptic  Duties  of  a  Surgical  Nurse  or  Dresser.     By  John  O'Conor,      from    sewers.      There    were    also    tests    of    efficiency  in 

Af.A.,M.D.,  Senior  Medical  Officer  British  Hospital,  Buenos  Aires     practical   plumbing   work.     The    examiners   were  Mr 

Joseph  Johnson  and  Mr.  Charles  Thomerson,  master 
plumbers  ;  and  Mr.  W.  Smeaton  and  Mr.  F.  Wyatt, 
lepresenting  the  United  Operative  Plumbers  Associa- 
tion of  Creat  Britain  and  Ireland.  Five  candidates 
passed    the   examination. 

The  Late  Mr.  Barclay. 

A  neat  brass  tablet  has  been  placed  in  the  chapef 
of  the  Bristol  General  Hospital  as  a  memorial  to  the 
late  Mr.  Wilfred  Martin  Barclay,  F.R.C.S.  It  bears 
the  following  inscription  : — "  To  the  honoured  memory 
of  Wilfred  Martin  Barclay,  F.R.C.S.,  born  1863,  died 
1003.  Connected  with  this  hospital  as  student,  assis- 
tant house  surgeon,  assistant  surgeon,  and  surgeon  from 
1882  to  1903.  This  memorial  has  been  placed  here  by 
the  medical,  surgical,  and  nursing  staff,  and  students 
past  and  present  of  this  hospital,  in  affectionate  appre- 
ciation ot  the  skill  and  devotion  with  which  he  dis- 
charged the  arduous  duties  of  his  several  appointments, 
and  of  the  high  character  and  the  personal  charm  which 
endeared  him  to  his  colleagues,  and  to  all  with  whom 
he  was  associated  in  the  work  of  this  institution." 
It  may  be  added  that  this  inscription  was  the  last 
literary  production  of  the  late  Canon  Ainger,  who,  if 
his  death  had  not  intervened,  would  have  unveiled  the 
tablet.  No  unveiling  ceremony  will  now  take  place. 
The  Bar  Golfing  Society  v.  Medical  Golfers. 

Teams  representing  the  Bar  Golfing  Society  and 
Medical  Golfers,  played  a  match  at  the  Burnham 
Beeches  Club  on  Saturday.  Play  was  by  singles  in 
the  morning  and  by  foursomes  in  the  afternoon,  each 
individual  round  counting  one  point.  The  singles 
were  well  contested,  each  side  scoring  four  points. 
In  the  afternoon,  however,  the  doctors  lost  the  four- 
somes by  2 J  points  to  1  J.  On  the  day's  play,  therefore, 
the    Bar   Golfing   Society    proved    successful    by  one 


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Spottiswoode  &  Co.  (London). 
The  Dentists  Register,  1904.     Pp.  347.     Price  3s.  4d. 
The  Medical  Register,  1904.     Pp.  1737.     Price  10s.  6d. 


p  Jill l. 

The  Bar  Golfing 

Medical  Golfers. 

Society                  Pts. 

Pts. 

Mr.  T.  Mansfield  Hunter  1 

Dr.  H.  J.  F.  Simson 

i 

Mr.  H.  W.  Beveridge        i 

Dr.  W.  G.  Howarth  . . 

0 

Mr.  J.  CrabbWatt            } 

Dr.  A.  W.  Daniel      . . 

i 

Mi.  J.  B.  Dyne           ..      1 

Dr.  H.  Dane 

0 

Mr.  A.  Macpherson          0 

Dr.  Carruthers 

1 

Mr.  F.  S.  Jackson      . .      1 

Dr.  Webb 

a 

Mr.  F.  Russell           . .     0 

Dr.Hawkins.. 

1 

Mr.  Cracroft  . .          . .     0 

Dr.  Carruthers 

1 

Total 


Total 


Dr.  Simson  was  unable  to  play  in  the  foursomes  in  the 
afternoon,  and  his  place  in  the  medical  team  was 
taken  by  Dr.  Low.     The  scores  were  : — 


The  Bar  Golfing 

Society. 
Mr.  Mansfield  Hunter 

and  Mr.  Russell     . . 
Mr.  Crabb  Watt  and 

Mr.  Jackson 
Mr.  Beveridge  and  Mr. 

Macpherson 
Mr.  Dyne  and  Mr. 

Cracroft 

Total 


Pts. 


Medical  Golfers. 
Pts. 

Dr.  Dane  and  Dr.  Chit- 
tenden       . .  . .     o 

Dr.  Howarth  and  Dr. 
Low  . .  . .     o 

Dr.  Daniel  and  Dr. 
Hawkins    . .  . .     J 

Dr.  Carruthers  and 

Dr.  Webb  . .  . .     1 


Total 


1* 


ADeMcal  Dews. 

Plumbers'  Registration  Examination. 

Twenty-three  plumbers  applying  for  registration 
under  the  National  Registration  of  Plumbers  were 
examined  at  King's  College  on  April  23rd  by  the  Wor- 
shipful Company  of  Plumbers.     The  candidates  were 


Dinner  at  the  Royal  College  of  Surgeons,  Bngland- 

Last  Friday  the  President  (Mr.  John  Tweedy, 
F.R.C.S.)  and  Council  entertained  at  dinner  a  number 
of  distinguished  guests,  among  whom  were  the  Port- 
uguese Minister,  the  Earl  of  Onslow,  the  Bishop  ot 
St.  Albans,  the  Bishop  of  Stepney,  Sir  Herbert  Maxwell, 
Sir  William  Church  (President,  Royal  College  of 
Physicians),  Mr.  Justice  Grantham,  Sir  James  Reid. 
Sir  William  Broad  bent.  Sir  Thomas  Smith,  Sir  Harry 
Johnston,    Sir    John    Kirk,    Sir   Patrick   Manson,   Sir 


from  various  parts  of  London  and  the  provinces.     The  ,  William  H.  White,   Sir  Lambert  Ormsby  (President 


May  4,   1904. 


PASS  LISTS. 


The  Medical  Press.    491 


Royal  College  of  Surgeons  in  Ireland),  Sir  Halliday 
Macartney,  Major  General  Sir  Frederick  Maurice, 
Mr.  Briton  Riviere,  R.A.,  Mr.  C.  F.  Gill,  K.C.,  Mr. 
Almeric  FitzRoy,  Mr.  H.  G.  Wells,  Dr.  Roswell  Park, 
of  Buffalo,  &c.  The  members  of  Council  present  in 
addition  to  the  President,  included  Mr.  Henry  Morris 
and  Sir  Alfred  Cooper  (Vice  Presidents),  Mr.  Thomas 
Bryant.  Mr.  Lang  ton,  Mr.  Mayo  Robson,  Mr.  Butlin, 
Mr.  Edmund  Owen,  Mr.  Godlee.  and  Mr.  Watson 
Cheyne,  with  the  Secretary,  Mr.  Foirest  Co  well. 

Toe  Recent  Appointment  of  R  M.S.  at  Balllnas loe  Asylum. 
The  following  question  was  asked  in  the  House  of 
Commons  on  Thursday  last.  The  answer  returned  by 
Mr.  Wyndham  shows  that  the  appointment  of  the 
junior  medical  assistant  is  still  sub  judice : — Mr.  Sloan 
asked  the  Chief  Secretary  to  the  Lord  Lieutenant  of 
Ireland  whether  he  could  explain  in  what  circumstances 
the  committee  of  the  Ballinasloe  District  Lunatic 
Asylum  had  appointed  the  junior  medical  assistant  to 
be  resident  medical  superintendent  and  refused  the 
appointment  to  the  acting  medical  superintendent ; 
whether  he  could  say  what  were  the  superior  quali- 
fications of  the  junior  medical  assistant  that  the  acting 
medical  superintendent  did  not  possess  ;  and  whether  he 
would  take  steps  that  the  appointment  be  not  sanc- 
tioned until  the  merits  of  each  case  had  been  duly 
considered.  Mr.  Wyndham  replied  :  The  appointment 
of  resident  medical  superintendent  of  the  asylum  is 
vested  by  law  in  the  asylum  committee,  but  subject 
to  the  concurrence  of  the  Lord  Lieutenant.  The  papers 
connected  with  the  appointment  in  the  present  case  are 
now  before  the  Lord  Lieutenant. 

Meath  Hospital,  Dublin. 
The  annual  meeting  of  the  Governors  of  this 
Hospital  was  held  last  week  in  the  Board  room  of  the 
Hospital,  Mr.  Andrews  in  the  chair.  The  annual 
report  stated  that  every  department  of  the  hospital 
during  the  past  year  had  been  maintained  in  efficient 
order,  and  the  work  done,  both  intern  and  extern, 
compared  favourably  with  past  years.  The  portion 
r  of  the  report  dealing  with  finance  showed  that  at  the 

commencement  of  the  financial  year  there  was  a 
debit  balance  of  ^2,361  2s.  8d.  The  total  expenditure 
was  £6,173  4s.  4d.,  and  the  ordinary  income 
/5.604  17s.  id.,  showing  a  deficiency  on  the  year  of 
^568  7s.  3d.,  and  leaving  at  the  close  a  balance  against 
the  hospital  of  £2,929  9s.  1  id.  The  committee  express 
regret  at  this  unsatisfactory  condition,  which  has 
been  mainly  caused  by  their  desire  and  efforts 
to  meet  to  the  utmost  the  great  and  increasing  demand 
made  by  the  sick  poor  who  daily  seek  admission  and 
the  relief  which  the  hospital  is  capable  of  giving  them. 
'  During  the  year  1,349  patients  were  admitted,  making, 

I  with  those  already  in  the  institution,  1,472.     Ot  these 

I  1,281   were   discharged,    cured   or   relieved  ;   75   died, 

and  116  remained  on  March  31st,  1904,  the  mortality 
being  only  5.53  per  cent,  on  the  total  treated  to  a  ter- 
mination. In^ addition  there  were  7,051  accident 
cases  treated  as  out  patients;  and  the  dispensary  cases 
numbered  10,027.  There  was,  therefore,  a  total  of 
18,550  persons  who  received  medical  or  surgical 
treatment  during  the  year.  After  the  reading  oi  the 
report  it  was  proposed  and  adopted  "  That  the  thanks 
of  this  meeting  are  due,  and  are  hereby  given,  to  the 
Dublin  County  Council  and  the  Dublin  Corporation 
for  their  grants  ;  to  the  Distribution  Committee  ot  the 
Dublin  Hospital  Sunday  Fund  for  their  award,  and  to 
all  who  have  contributed  to  the  support  and  efficiencv 
of  the  institution." 


PASS  LISTS. 
Cambridge  University. 

Sanitary  Science  Examination. — The  following  can- 
didates have  satisfied  the  Examiners  in  both  parts  of 
w  Examination  :— Edward  Baines  (Caius),  Wilfred 
W.  0.  Beveridge,  Basanta  Kumar  Chatterjee,  Thomas 
A.  Clinch,  Myer  Coplans,  Ernest  K.  Gawn,  Edward  S. 
Gorman,  Arthur  E.  Horsfall,  Henry  L.  P.  Hulbert 
(Trinity),  A.  C.  Ingram  (St.  John's),  James  C.  Jameson 
Kamsay  Millar,  Thomas  Rnind,  and  Eliot  Swainston.  ' 


Thelfollowing ^degrees  were  conferred  on  Monday 
last :— . 

Doctors  in  Medicine. — Francis  A.  Bainbridge  and 
Otto  F.  F.  GrQnbaum  (Trinity),  Ambrose,  Emerson 
(Gonville  and  Caius). 

Bachelors  in  Medicine. — Francis  R.  Carroll  and 
Henry  M.  Joseph  (Trinity).  Harry  C.  Sidgwick  (Clare). 
Ralph  D.  Smedley  (Pembroke),  Samuel  L.  O.  Young 
(Christ's),  Eric  A.  Wright  (Selwyn). 

Bachelors  in  Surgery. — Francis  R.  Carroll  and  Henry 
M.  Joseph  (Trinity),  Samuel  L.  O.  Young  (Christ's), 
Eric  A.  Wright  (Selwyn). 

The  Royal  University  of  Ireland. 

The  Examiners  have  recommended  that  the  follow- 
ing candidates  be  adjudged  to  have  passed  the  M.B.H 
B.Ch.,  B.A.O.  Degree  Examination  : — 

Upper  Pass.—  Ernest  Clements,  *  William  M.  Crofton, 
B.A.,  *Percival  T.  Crymble,  Hugh  P.  DevUn.  Marie  E. 
Hayes,  *Thomas  Lyle,  Richard  G.  Meredith,  Samuel 
Stockman.  Those  marked  thus  (*)  may  present 
themselves  for  the  further  examination  for  honours. 

Pass. — Anna  E.  Adderley,  Arthur  P.  Barry,  Joseph 
Corker,  William  A.  Davis,  Lillie  E.  Dunn,  Maurice 
FitzGerald,  Mary  K.  Gibson,  Daniel  Gleeson,  Joseph 
C.  McHugh,  Joseph  C.  McPherson,  George  Madden, 
John  W.  Pitt,  Pierce  Power,  Patrick  Quinn,  Mary  E. 
Simms,  John  Thompson,  Thomas  Walsh,  B.A.,  Samuel 
H.  Whyte,  James  E.  Wilson. 

The  following  candidates  have  passed  the  Third 
Examination  in  Medicine  : — 

Upper  Pass. — John  L.  Dunlop,  William  A.  McKee, 
B.A.,  Maurice  P.  Scanlon.  The  above  candidates  may 
all  present  themselves  for  the  further  examination  for 
Honours. 

Pass. — Madeleine  S.  Baker,  James  A.  Beamish,  John 
A.  Boyd,  George  F.  Campbell,  Hold  en  Carson,  Nicholas 
M.  Donnelly,  John  Finnegan,  Hugh  J.  Forbes,  James 
Gaston,  James  R.  Hackett,  James  J.  Hollywood, 
Robert  F.  Kennedy,  Denis  F.  MacCarthy,  William 
McKee,  Albert  V.  McMaster,  Timothy  Meagher,  John 
P.  Moore,  James  W.  Murphy,  Jeannie  R.  Murray, 
Gabriel  V.  Ryan. 

Confof nt  Examination  In  Ireland. 
Candidates  have  passed   the   Second   Professional 
Examination  as  undernoted  : — 

A.  Honours  in  order  of  Merit. — Geo.  Sheppard.Thos. 
T.  O'Farrell,  R.  M.  Bronte. 

B.  Passed  in  all  subjects. — Miss  H.  O.  D.  Beamish^ 
T.  A.  Buchanan,  T.  Crowley,  H.  J.  Raverty,  R.  O. 
Kelly. 

C.  Completed  the  Examination.— P.  W.  Carroll,  J. 
Daniell,  M.  J.  Kelly,  B.  C.  A.  Leeper,  J.  H.  Lyne, 
J;  G.  McGreal.  H.  V.  McKeogh,  James  O'Brien,  W.  B. 
Soady,  M.  Walters. 

In  the  list  of  Honours  at  the  First  Professional  Exami- 
nation recently  published.  Mr.  H.  E.  S.  Martin's  name 
was  inadvertently  omitted,  Mr.  Murray's  name  having 
been  inadveitently  substituted  therefor. 

London  School  of  Tropical  Medicine. 

Of  the  students  of  the  above  school  who  presented 
themselves  tor  the  examination  at  the  end  of  January. 
April  session,  1904,  the  following  have  passed  : — 

Norah  Lenwood,*  A.  L.  Hoops,*  W.  M.  Eaton* „ 
J.  B.  Cleland,*  Olive  McDougall,*  K.  McGahey,* 
J.  Eldon,  J.  E.  M.  Brown,  M.  E.  Leicester,  A.  E.  E. 
iwynam,  R.  L.  Roe,  H.  G.  McKinney,  G.  F.  Whyte* 
C.  T.  Costello,  and  C.  W.  Somerville. 

*  Passed  with  distinction. 

Conjoint  Examinations  In  Ireland. 

The  following  candidates  have  passed  the  first  pro- 
fessional examination  : — 

A.  Honours. — James  Murray  and  E.  Waide. 

B,  Pass.— P.  H.  Black,  S.  Blake,  A.  Curry,  E.  Evans. 
H.  S.  Johnston,  G.  S.  Levis,  F.  Mahony,  A.  E.  S. 
Martin,  Richard  Power,  G.  W.  Stanley,  and  J.  P. 
Zeederberg. 

Completed  the  Examination. — W.  Breen,  R.  J. 
Brookes,  P.  Ferguson,  J.  P.  Grainger,  C.  A.  O'Burne 
Ryan,  G.  G.  Stephenson,  and  P.  J.  Williams. 


492    The  Mbwcal  :  B.ess.       NOTICES  TO  CORRESPONDENTS. 


May  4,  1904. 


i|Urtiet0  to 
tiotttzpovibtnts,  Short  %etttts,  &c. 

If^P"  OoRRJsroitDEjrrs  requiring  a  reply  in  this  column  are  particu- 
larly requested  to  make-  nee  of  a  dUtinctite  rignatmrt  or  initial,  and 
avoid  the  practice  of  signing  themselves   **  Reader,"    "  Subscriber/' 

-  "Old  Subscriber,^  Ac.  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

OaiaiMAL  Articles  or  Litters  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and » must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

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

RiPRiirrs.— Reprints  of  articles  appearing  In  this  journal  can  be  had 
-at  a  reduced  rate  providing- authors  give  notice  to  the  publisher  or 
printer  before  the  type -has  been  distributed.    This  should  be  done 
when  returning  proofs. 

W.  C.  C— At  the  Pasteur  Institute  in  Paris,  among  the  cases  of 
inoculation  under  treatment  for  the  bite  of  rabid  dogs,  the 
moitality  has  averaged  one-half  of  1  -.percent.  Of  those  not  receiv- 
ing the  inoculation  treatment  the  mortality  has  been  stated  to  be  18 
percent. 

FACIAL  ORNAMENTS. 

Tub  DailyT*Ugr*pk  reports  that  at  the  last  weekly  meeting  of  the 
Walsall  Guardians,  a  workhouse  inmate  applied  to  be  provided  with 
an  artificial  nose,  on  the  ground  that  the  absence  of  that  organ  pre- 
vented him  from  procuriig  employment.  It  was  stated  that  the  cost 
would  be  £5,  but  the  board  decided  to  comply  with  the  request,  and 
it  was  agreed,  amidst  some  laughter,  to  allow  the  workhouse  medical 
officer  to  select  the  shape  of  the  nose. 

Westphalia.— Cycling  when  not  indulged- in  to  excess  is  beneficial 
where  varicose  veins  are.  present. 

Student  (Edinburgh).— One  of  the  most  useful  of  the  text-books  on 
eye  diseases  is  that  by  Mav  (3rd  Edition  \  published  by  Messrs. 
Bailliere,  Tindall  and  Cox. 

Pars  Ciliaris.— We  have  no  know  ledge  of  the  matter,  neither  can 
we  find  any  reference  to  it  among  the  authorities  whose  works  we 
have  consulted. 

House  Suroeox.  -Until  the  law  is  altered  our  correspondent  has 
no  redress. 

«  Mrs.  W.  (Harrogate).— The  case  is  obviously  one  in  which  an 
ophthalmic  surgeon's  advice  should  be  taken/  as  has  already  been 
recommended  by  the  practitioner. 

8t»iBO.— If  our  correspondent  is  desirous  of  giving  evidence  before 
'  the  Physical  Deterioration  Committee  it  is  only  necessary  for  him 
to  write  to  the  chairman  thereof,  and  request  permission  to  do  so. 

4&teimg0  sA  the  gorietiee,  %utmtBf  &t. 

Wednesday.  Mat  4th. 
Obstetrical  Socirrr  op  London  (20  Hanover  Square.  W.).— 8  p.m. 

*  Specimens  will  be  shown  by  Dr.  Ho*  rooks.  Dr.  E.  E.  Taylor,  Dr.  Lock- 
yer,  Dr.  Fairbairn,  and  Mrs.  Boyd,  M.D.  bhort  Communications  :— 
Dr.  H.  C.  Bartlett  (introduced  by  Dr.  Boxall) :  A  Case  of  Li  thopaxiion 
of  14 years'  duration.  Laparotomy,  Recovery.— Dr.  F.  B  Taylor:  Two 
Cases  of  Enlarged  Wandering  Spleen  forming  Pelvic  Tumours  in 
Women.  Paper:— Mr.  A.  Doran  :  Hematoma  and  Hematocele,  a 
Study  of  Two  Cases  of  Early  Tubal  Pregnancy. 

Medical  Gradi  atrs'  College  a*d  Polyclinic  (22  Chen  lea  Street* 
W.C.).-4pju.    Mr.  M.  Collier  :  riinique.    (Surgical,)   5.15  p.m.  Dr. 

•  O.  H.  Savage  :  The  Relationship  of  Syphilis  to  Insanity. 

Thursday.  Mat  6th. 
Roxtoen  Socibtt  (10  Hanover  Square,  W.).—h  30  p.m.,  Meetiug 
of  the  Medical  Section.  Paper  :  J  r.  L.  H.  Harris <Sydney,  NJ3.W.) 
Three  Years*  'X  -Ray  Work. —(20  Hanover  Square,  W.).— 8.30  p.m. 
i Paper  :-Mr.  J.  J.  Vesey  :  The  Rontgen  Society,  its  Past  Work  and 
Future  Prospects.  Mr.  F.  H.  Qlew :  Some  Experiments  with  Alpha 
Bay  8. 

OrilTKALMOLOOtCAL   SOCIRTT    OF   THM  UNITED  KINGDOM  (11  ChandoS 

Street,  Cavendish  Square,  W.).— 8  p.m.  Specimens  and  Cases  will  be 

shown  by  Mr.  A.  L.  Whitehead,  Mr.N.  B.  Harman,  Dr.  A.  Bronner,  Mr. 

R.  W.  Dome,  Mr.  J.  H.  Parsons,  Mr.  J. Lawford,  Mr.B. B.  Bickerton, 

and  Mr.  M.  S.  Mayou.    8.30  p.m.  Papers :  Mr.  M.  8.  Mayou :   The 

Retina  and  Optic  Nerves    in   Anencephaly.       Mafor  H.  Herbert: 

Trachomatous  Pannus  and  its  Associated  Corneal  Changes.    Dr.  W. 

C.  Bockliffe  :  (1)  Optic  Atrophy  and  Primary  Amenorrhea  ;  <2)  Optic 

Neuritis  following  Concussion  of  Globe  ;  -3)  Unusual  Sequence  in 
'  Cataract  Extraction  ;  (4 »  Peculiar  Outbreak  of  Granular  Ophthalmia. 

— M-.  W.  E.  Cant :  Trichiasis  and  Operations  for  Trichiasis. 
Medical  Graduates'  College  and  Poltclikic  (22  Chenies  Street. 

W.C.).— 4  p.m.     Mr.  Hutchinson  :  Clinique.    (Surgical.)    5.15  p.m, 

Mr.  J.  C  larke  :    Some  Surgical  Emergencies. 

Mount  Vernon  Hospital  for  Consumption  axd  Diseases  of  tiir 

Cubst  -7  Fitzroy  Square,  W.h- &  p.m.  Introductory  Address:— 
*  Professor  G.  Sims  Woedhead  :  The  Morbid  Anatomy  of  Pulmonary 

Tuberculosis  in  Relation  to  the  Clinical  History  of  the  Disease.  (Post- 

Graduate  Course.) 

Fridat,  Mat  0th. 
West  Kent  Mkdico-Ciiiruroical  Socibtt  {Royal  Kent  Dispensary, 

Greenwich  Road,  8  E.).—  8.45  p.m.  Presidential  Address.— Dr.  R.  E. 
:  Scholetteld  :  Some  Considerations  on  the  Causes  and  Treatment  of 

Anaemia.    Following  by  a  emoking  Concert  by  invitation  of  the 

President. 
We«t  London  MEDico-CiiiRrRoicAL  Societt  (West  London  Hos- 
LPJtal,  Hammersmith    WA  —  S.SOp  m.    Papers  :  Mr.  L.  A.  Bkiwell  .• 


The  Operative  Treatment  of  Pancreatitis.— Mr.  W.  McAdam  Eafes 
Lessons  from  a  Year's  Fatalities. 

Laryngo logical  8octtTr  of  London  20  Hanover  Square,  W.  - 
5  p.m.  l  ases  and  Specimens  will  be  shown  by  Dr.  StCiair  Thomson 
Dr.  L.  H.  Pegler,  Dr.  H  J.  Davis,  Dr.  W.  H.  Kelson,  Dr.  A.  Bronner 
and  others. 

Socirrr  for  Tiir  Stult  of  Disease  ist  Childrbm  (11  Chandos, 
Street,  Cavendish  Square,  W.).— 5.80  p.m.  Dr.  G.  Carpenter  :  A  Case 
of  Chronic  Intestinal  Obstruction  for  Diagnosis.  Papers:— Mr.  W.  W. 
Cheyne  and  Dr.  H.  H.  W.  Wilbe  :  A  Case  of  Perfo  ated  Gastric  Ulcer 
in  a  Boy.— Mr.  H.  J.  Stiles  (Edinburgh)  and  Dr.  8.  McDonald 
(Edinburgh)  :  Deayed  Chloroform  Poisoning  (with  lantern  demon- 
stration). 

Medical  Graduates'  College  amdPolicllnic(22  Chenies  Street, 
W.C.). -4  p.m.    Dr.  H.  TUIey.  Clinique.  (Thxoat.j 


TBzc&nthB. 

Leicester  Infirmary.— House  Physician.  Salojy  £100  per  annum, 
with  board,  apartments,  and  washing.  Applications  to  the 
Secretary,  24  Friar  Lane,  Leicester. 

Nations!  Hospital,  Batterse*  Park.— Resident  House  Surgeon.  8alsrr 
£60  per  annum,  with  board.  Con  tabs  SO  beds  with  out-patient 
department.    Full  p  articular*  of  the  Secretary.    (tteeAdVt.) 

Norfolk  and  Norwich  Hospital.— House  Physician.  Salary  £80  per 
annum,  with  board,  lodging,  and  washing.  Applicationi  to 
Frank  Hasel,  Secretary. 

Nottingham  General  Hospital.— Assistant  House  Surgeon.— Ealar\ 
£100  per  annum,  with  board,  lodging,  and  washing  in  the 
Hospital  Applications  immediately  to  the  Secretary. 

Monkwearmoutn  and  Southwick  Hospital,  Sunderland.— House 
Surgeon,  Salary  £80  per  annum,  with  board,  lodging  and  wash- 
ing.   Applicat  ons  to  the  Secretary. 

Parish  of  8t  Leonard,  Shoreditch.-  Medical  Officer.'  Salary  £900  per 
annum,  with  furnished  apartments,  board,  washing  and  atten- 
dance. Applications  immediately  to  Robert  Clay,  clerk  to  the 
Guardians,  Clerk  s  Office.  218  Kingsland  Road,  N.E. 

Perth  District  Asylum,  Murthl v.  —Assistant  Physician.  8a'ary  £llo 
per  annum,  with  board  and  apartments,  Ac.  Applications  to  Dr. 
Bruce.  Physician-Superintendent.  Mutiny  Perthshire. 

St  Pancras,  London.— Assistant  Medical  Superintendent  of  the  South 
Infirmary.  Cook's  Terrace,  Pancras  Road,  and  Assistant  Medtcsl 
Officer  of  the  Workhouse  adjacent.  Salary  £135  per  annum,  with 
residential  allowances.  Applications  to  A  fred  A.  Miilward, 
Clerk  to  the  Guardians,  Town  Hall,  Pancras  Road,  N.W. 

Settlement  of  Women  Workers  (Canning  Town  Medical  Mission 
Hospital \— Senior  Resident  Medical  Officer,  for  Hospital  and 
Dispensary.  Salary  £100  per  annum.  Applications  to  the  Boa. 
Sec.,  Miss  C.  Spicer,  Montclair,  Woodfoid  Green  Essex. 

Sussex  County  Hospital,  Brighton.  Stephen  Ralli  MemoriaL- 
Pathologist  Salary  £300  a  year.  Applications  to  the  Secretary 
of  the  Hospital. 

York  Dispensary.— Resident  Medical  Officer.  Salary  £1&>  *  W 
with  board,  lodging,  and  attendance.  Applications  to  W.  Draper, 
Esq.,  De  Grey  House,  Ycrk. 


JLppomtmems. 

Elus,    L.    Erasmus,    M.D.Brux.,    M.R  OS  Eng..    L.B.aPXond, 

L.8.A.,   Clinical  Assistant  to  the  East  London    Hospital  lor 

Children,  Shadwell,  E. 
HiciiENB.  William,  L.R.C.P.Lond.,  M.R.C.S.,  Public  Vaccinator  for 

Redruth  (Cornwall). 
Spbhcb*,  A.R.  ,  M.B.Lond.,   M.R.C.8.,  L.B.CPLond.,  Resident 

Medical  Officer  at  the  Hospital  for  Epilepsy  and  Paralysis,  Maid* 

Vale. 


girths. 

Grbsbe.— On  April  24th,  at  Crossbrook  Street,  Cbeshunt,  Herts.,  the 

wife  of  W.  A  Gi  eene.  M.R  O.8.,  of  a  daughter. 
Kociimah v.— On   April  30th.  at  6  I  angland  Gardens,  Hampstead,  the 

wife  of  M.  Kochmann,  M.D  ,  of  a  daughter. 
Picaro.  -On  April  21th,  at  39  Boundary  Road,  N.W.,  the  wife  of 

A.  W.  Kirkpatrick  Pioard,  M.D.,  of  a  daughter. 


4&arria$t6. 

England— SrrniBBSOir.— On  April  30th,  at  16  Randolph  Crescent, 
Edinburgh,  Humphrey  England,  B.A.  Cantab.,  M.RCS^og., 
L.B.C.P  Lond.,  of  22  West  Kensington  Mansions,  London, 
younger  son  of  the  late  Dr.  England,  of  Winchester,  to  Mar) 
Douglas,  second  daughter  of  Richard  Stephenson,  J.P.,  of 
Chapel,  Du»  s,  N.B. 

Krltkacr— McLaren— On  April  27th,  at  St.  Stephen's,  East  Putney 
by  the  Rev.  Innes  B.  Wane,  M.A.,  rector  of  Castle  Ashbr, 
Northampton,  assisted  by  the  Rev.  Canon  Barker,  M.A.,  vicar  of 
St.  Maryfebone  and  Hon.  Chaplain  to  the  King,  and  the  Rev.  A. 
Rouse.  M.A.,  vicar  of  8t.  Stephen's,  T.  N.  Kelynack,  M.D... 
M.R  C.P.,  of  120  Harley  8treet,  Cavendish  Square,  WM  eWestson 
of  the  Rev.  Nicholas  Kelynack.  to  t  lara  Violet  McLaren,  M.B., 
Ch.B.Edin.,  only  daughter  of  the  late  James  Grieve  McLaren,  of 
Calcutta,  and  granddaughter  of  David  McLaren,  J. P.,  D.L.,  of 
Rydal  House,  Esst  Putney,  &W. 

Mirrat— Robertson.— On  April  26th,  at  the  Church  of  St.  Nichowj. 
Thames  1'itton,  Charles  Molteno.  eldest  son  of  Charles  K.K. 
Murray.  M.D..  of  Kenilworth,  Cape  Colony,  to  Hilda  Florence, 
younger  daughter  of  Herbert  Manwaring  Robertson,  of  Boyle 
Farm,  Thames  Ditt  n.  .... 

SwoRDER-GREY.-On  April  27th,  at  the  Church  of  St.  Mary  Magdalen, 
bt.  Leon  arda-on -Sea,  Ernest  George  Swo.  der,  M  .RCambndye. 
son  of  T.  Swoider,  Esq.,  of  Holly  Lodge,  Luton,  to  Gen"** 
Lilian  Grey,  granddaughter  of  Mrs.  Charles  Woodgste,  of  «• 
Leonards.  " 


ik*  ®§diml  §tm  m&  MtmUv. 


"SALUS   POPULI   8UPREMA    LEX-1 


Vol.  CXXVIII. 


WEDNESDAY,    MAY  n,    1904, 


No.   19. 


(Pttfltnal  Communication*. 

THE  CHOICE  OF  A  TABLE 
WATER. 

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

fhytWan  to  the  WettBtntttr  Hospital  and  Joint  Lecturer  on 

Medicine. 

The  selection  of  a  table  water  for  ordinary 
daily  consumption  is  a  subject  on  which  medical 
men  are  often  consulted,  and  it  must  be  admitted 
that  it  is  not  always  easy  to  find  one  adapted  to 
the  especial  requirements  of  the  individual  patient. 
The  consumption  of  table  waters  is  enormous, 
amounting  in  this  country  alone  to  something 
like  3,600  million  half  bottles  a  year.  It  must  be 
remembered  that  they  are  habitually  drunk,  not 
only  by  those  suffering  from  some  departure 
from  the  normal  state  of  health,  but  by  numerous 
people  who  consume  them  either  alone  or  mixed 
with  wine  or  spirits  as  a  pleasing  beverage.  The 
reason  for  tins  popularity  is  easily  explained. 
Most  people  have  a  wholesome  dread  of  enteric 
fever,  and  a  deep-rooted  distrust  of  the  purity  of 
the  drinking  water  supplied  to  them  in  most 
country  towns  and  villages,  especially  abroad. 
They  argue  that  it  may  be  admirably  adapted 
for  the  purposes  of  ablution,  but  in  the  absence  of 
any  guarantee  to  the  contrary  it  is  not  a  safe 
beverage.  Rather  than  run  any  risk  they  prefer 
spending  a  few  pence  at  each  meal  on  the  purchase 
of  some  effervescing  water,  the  name  of  which  is 
rendered  familiar  to  them  by  constant  advertise- 
ment, and  the  analysis  of  which,  in  more  or  less 
unintelligible  language,  is  given  on  the  label. 
The  investment  they  probably  regard  in  the 
nature  of  an  insurance  against  illness,  and  it  must 
he  confessed  that  the  money  is  well  spent.  Others 
who  are  less  thoughtful  or  less  provident  resort 
to  effervescing  waters  from  a  dislike  to  the  plain 
unadulterated  article.  Even  the  most  ardent 
total  abstainer  fights  shy  of  cold  water  with  his 
meals.  It,  to  us  a  popular  expression,  "sits 
heavy  on  the  stomach/'  it  is  not  very  readily  ab- 
sorbed, and  so  far  from  promoting  digestion, 
retards  it.  People  not  of  robust  physical  health, 
who  from- a  gouty  diathesis,  or  some  similar  cause, 
Are  compelled  to  abstain  from  alcohol,  find  that  the 
appetite  and  powers  of  assimilation  fall  off  when 
they  take  only  cold  water  as  a  beverage  at  meals. 
They  suffer  from  a  sense  of  weight  and  discom- 
fort in  the  stomach,  followed  not  infrequently 
by  intermittent  diarrhoea,  due  to  the  passage  of 
Partly  digested  food  into  the  intestines.  It  is 
true  that  the  Americans  are  addicted  to  the  use 
<*  large  quantities  of  iced  water,  but  it  is  doubtful 
^  the  custom  is  a  good  one,  and  it  is  probable 


that  much  of  the  dyspepsia  from  which  they  suffer 
is  due  to  this  cause.  The  difficulty  is  to  some 
extent  overcome  by  the  use  of  effervescing  waters, 
which  readily  disengage  carbonic  acid  gas  in  the 
stomach.  Whilst  still  waters  have  a  mawkish 
taste,  waters  containing  natural  carbonic  acid 
gas  exert  a  stimulating  action  on  the  sensory  and 
gustatory  nerves,  producing  a  pleasant  prickling 
sensation  in  the  mouth  which  stimulates  the  flow 
of  saliva.  Considerable  attention  has  been  de- 
voted to  the  investigation  of  the  pharmacological 
action  of  carbonic  acid  gas  administered  in  solu- 
tion in  water,  both  in  the  form  of  natural  "  acidu- 
lous "  waters  and  artificially  prepared  drinks. 
Apart  from  its  action  in  the  oral  cavity,  it  pro- 
duces in  the  stomach  a  feeling  of  warmth  and  com- 
fort due,  it  is  said  by  some,  to  a  stimulating  action, 
whilst  by  others  it  is  ascribed  to  a  sedative  effect 
on  the  nerve  endings.  Whether  it  stimulates  the 
secretion  of  the  gastric  juice,  and  if  so,  to  what 
extent,  is  a  moot  point,  but  there  seemsjto  be  good 
evidence  that  it  promotes  peristaltic  action.  That 
it  acts  as  a  diuretic  and  increases  the  flow  of 
gastric  juice  is  an  undoubted  fact.  Many  years 
ago  H.  Quincke,  of  Berne,  made  a  series  of  ob- 
servations on  this  point,  both  Jon  man]and  dogs. 
The  patients  were  normal  individuals,  or,  at  all 
events,  were  not  suffering  from  any  complaint 
which  would  invalidate  the  experiments.  The 
carbonated  water  was  given  in  quantities  of  about 
a  pint  in  the  morning  before  breakfast,  and  it  was 
found  that  the  urine  secreted  was  far  in  excess  of 
that  passed  when  the  patient  was  taking  the  same 
quantity  of  plain  water.  How  the  carbonic  acid 
acts  has  not  been  established.  It  may  be  that  it 
is  absorbed  by  the  blood,  and  acts  as  a  direct 
stimulant  to  the  renal  substance.  It  may  act 
directly  on  the  vaso-motor  or  secretory  nerves 
of  the  kidney,  or  it  may  act  reflexly  on  them  by 
stimulating  the  mucous  membrane  of  the  stomach. 
Again,  it  may  act  simply  by  increasing  the  ra- 
pidity of  absorption  of  fluid  from  the  stomach,  or 
possibly  it  may  have  more  than  one  of  these  ac- 
tions. Its  influence  on  the  excretion  of  carbonic 
acid  by  the  lungs  was  found  difficult  of  investiga- 
tion, and  yielded  no  definite  results,  whilst  the 
influence  on  the  respiratory  and  pulse  rates  was 
not  more  than  could  be  accounted  for  by  a  tem- 
porary condition  of  plethora,  due  to  the  ingestion 
of  the  fluid.  Apart  from  these  experimental  ob- 
servations, practical  experience  extending  over  a 
long  series  of  years  has  shown  that  carbonic  acid 
waters  are  powerful  therapeutic  agents,  and  are 
amongst  the  best  of  diuretics,  provided  always  that 
they  are  of  low  mineralisation.  Otto  Leich- 
tenstern  points  out  that  their  sphere  of  action  can 
be  summed  up  in  very  few  words.    They  are 


494    The  Medical  Peess. 


ORIGINAL  COMMUNICATIONS. 


May  ii,  1904^ 


pleasant  refreshing  drinks  and  are  popular  as 
articles  of  enjoyment.  They  are  suitable  for 
dyspeptic  conditions,  especially  acute  dyspepsia 
accompanied  by  nausea.  They  promote,  he  thinks, 
the  secretion  of  gastric  juice,  and  they  must  be 
credited  with  the  power  of  stimulating  the  peri- 
staltic action  of  the  stomach  and  intestines.  They 
produce  an  increase  of  the  secretions  and  a  fluidi- 
fying and  easier  removal  of  mucus.  Sir  Lauder 
Brunton  has  pointed  out  the  value  of  water  in 
the  treatment  of  gall-stones  and  renal  gravel 
and  calculi.  "  It  tends  to  wash  away  the  waste 
products  from  the  cells  of  which  our  organs  are 
composed,  to  clear  out  the  uric  acid,  urea  and 
phosphates  through  our  kidneys,  and  thus  pre- 
vent renal  or  vesical  calculi,  and  also  to  wash  out 
our  liver  and  prevent  gall-stones,  whilst  it  helps 
to  keep  the  bowels  in  action." 

Although  we  all  recognise  the  value  of 
the  "  akratothermae "  or  indifferent  thermal 
waters,  our  patients,  unless  we  are  accurate 
prescribers,  rarely  get  them,  and  are  content 
to  accept  some  artificial  substitute,  a  water 
of  more  or  less  purity  impregnated  with  a 
chemically  prepared  gas.  In  this  category 
must  be  included  "  soda  water  "  and  the  popular 
syphons.  Some  difference  of  opinion  exists 
as  to  what  constitutes  "  soda  water."  Strictly, 
it  is  a  definite  pharmaceutical  compound  prepared 
"  by  passing  pure  washed  carbonic  acid,  as  much 
as  can  be  introduced  by  the  pressure  of  seven 
atmospheres,  into  a  solution  of  bicarbonate  of 
sodium,  thirty  grains  to  the  pint  of  water,  cork- 
ing and  tying  over."  As  ordinarily  sold,  however, 
soda  water  contains  no  carbonate  of  sodium,  but  is 
simply  water  impregnated  with  carbonic  acid  gas 
under  pressure.  Some  of  the  syphons  even  con- 
tain no  carbonic  acid  gas,  but  simply  water  into 
which  atmospheric  air  has  been  introduced  under 
pressure.  This  laxity  is  to  be  deplored,  for  mere 
effervescence  is  no  test  of  quality,  and  carbonic 
acid,  as  we  have  seen,  possesses  distinct  thera- 
peutic properties.  This  opens  up  the  question 
as  to  whether  natural  carbonic  acid  and  carbonic 
acid  prepared  chemically  by  the  action  of  an  acid 
on  marble  or  chalk,  or  some  other  form  of  car- 
bonate of  lime,  have  identical  physiological  actions. 
Oscar  Liebreich  is  probably  right  in  saying  that 
"  even  the  best  manufactured  artificial  mineral 
waters  differ  from  the  natural  ones  in  taste  and 
value."  Henriot,  of  Paris,  whose  opinion  on  all 
subjects  connected  with  mineral  waters  will  be 
received  with  respect,  maintains  that  there  is  an 
essential  difference,  and  finds  that  whilst  two  litres 
of  artificial  carbonic  acid  gas  are  absorbed  with 
difficulty  and  produce  distension  of  the  stomach, 
thirty-five  litres  of  the  natural  gas  are  immediately 
absorbed  without  inconvenience.  This  is  in 
accordance  with  analogy,  for  we  know  that  patients 
suffering  from  acute  rheumatism  who  do  badly 
on  synthetically  prepared  salicylic  acid  often 
improve  rapidly  on  salicylic  acid  obtained  from 
oil  of  winter-green. 

The  question  then  arises  of  the  feasibility  of 
obtaining  a  palatable  water  impregnated  with  its 
own  natural  carbonic  acid  gas.  Such  waters  are 
few  in  number  and  by  no  means  of  common  occur- 
rence either  in  this  country  or  abroad.  Dr. 
C.  D.  F.  Phillips,  in  his  well-known  "  Materia 
Medica  and  Therapeutics,"  says  there  are  few 
springs  which  contain  only  a  small  amount  of 
saline  ingredients  with  so  much  gas  that  they 
may   be   called  simple  acidulated  or  carbonated 


waters,  and  none  of  these  are  active  enough  to"  be 
in  demand  beyond  their  own  immediate  locality. 
It  is  clear,  however,,  that  it  is  exactly  these  waters 
which  are  especially  adapted  for  habitual  use  as 
table  waters,  and  there  seems  to  be  no  reason  why 
they  should  not  be  bottled  and  imported.'  The 
waters  of  the  alkaline  group  Vab  and  Vichy,  for 
example,  are  not  suitable  for  this  purpose,  for 
although  the  amount  of  bicarbonate  of  sodium 
contained  in  each  bottle  may  not  be  great,  even 
small  medicinal  doses  constantly  repeated  must 
of  necessity  exert  some  therapeutic  action,  which 
although  beneficial  in  certain  cases,  are  not 
adapted  to  the  physiological  requirements  of 
everyone.  The  alkaline  carbonates  taken  at  the 
commencement  of  a  meal  stimulate  the  secretion 
of  the  gastric  juice,  but  ultimately  interfere  with 
its  natural  production.  Taken  towards  the  ter- 
mination of  a  meal  they  neutralise  the  hydro- 
chloric acid  which  plays  so  important  a  part  in  the 
process  of  digestion  and  retard  its  secretion. 
What  is  required  is  a  natural  water  containing  no 
active  drug,  and  one  which  is  (i)  free  horn 
organic  matter  and  medicinal  substances ;  (2) 
strongly  aerated  with  its  own  natural  carbonic  acid 
gas  ;  and  (3)  of  low  mineralisation  and  free  from 
added  saline.  The  presence  of  fractional  quan- 
tities of  iron,  tithia,  argon  or  helium  cannot  be 
regarded  as  of  serious  import.  The  discovery  of 
radium  in  the  waters  of  Bath  in  no  way  affects 
their  properties  or  enhances  their  reputation, 
which  rests  on  the  foundation  of  practical  ex- 
perience extending  over  many  centuries.  Apart 
from  these  trivialities,  it  may  be  said  that  table 
waters  are  feebly  mineralised  waters  containing 
much  free  carbonic  acid  gas,  that  is,  "simple 
gaseous "  or  "  simple  acidulated  waters." 

Sir  Hermann  Weber  and  Dr.  F.  Parkes  Weber, 
in  their  book  on  the  "  Mineral  Waters  and  Health 
Resorts  of  Europe,"  include  in  this  category 
ApoUinaris  near  Neuenahr,  the  Johannis  spring 
at  Zollhaus,  Gerolstein,  and  Berresborn,  in  Rhenish 
Prussia,  Adonis,  in  Belgium,  and  some  others 
the  names  of  which  are  quite  unknown  in  England. 
Berresborn,  they  point  out,  contains  as  much  as 
28  grammes  of  bicarbonate  of  sodium  in  10  litres, 
and  is  therefore  rather  strongly  alkaline  for  an 
ordinary  table  water,  whilst  Bilin  (33  grammes 
in  the  10  litres)  and  Fachingen  (35  grammes)  also 
contain  too  much  carbonate  of  sodium.  Ap- 
pollinaris,  on  recent  analysis,  was  found  to  contain 
at  the  spring  267  grammes  of  saline  carbonate 
in  10  litres  of  water,  whilst  as  supplied  to  the 
customer  it  contained  from  35*8  to  37*4  grammes 
in  the  10  litres,  the  difference  being  accounted  for 
by  the  addition  of  chloride  of  sodium.  At  the 
spring  there  were  only  4*2  grammes  of  chloride  of 
sodium  in  the  10  litres,  whilst  in  the  product  as 
sold  there  were  from  13-5  to  13-8  grammes,  that 
is,  about  twice  as  much  salt  was  added  as  was 
contained  in  the  original  water.  The  addition  of  the 
salt  is  said  to  be  necessary  to  provide  against  thede- 
composition  of  the  sulphate  of  sodium,  although  this 
is  not  very  readily  explicable  on  chemical  grounds. 
To  many  people  the  marked  saline  taste  is  objec- 
tionable. Evian  water  (Source  Cachat)  is  not  un- 
commonly served  as  a  table  water  in  France. 
Evian  is  in  Haute-Savoie,  on  the  south  bank  of 
Lake  Geneva,  The  treatment  at  Evian  is  essen- 
tially a  cure  de  diurtee.  The  great  point  about 
the  water  is  its  low  mineralisation,  not  more  than 
5  grammes  in  10  litres,  but  it  is  poor  in  gas,  and 
whilst  gaseous  can  hardly  be  called  effervescing. 


May  n,  1904. 


ORIGINAL  COMMUNICATIONS. 


Th«  Medical  Press.    495 


St,  Galmier  is  a  popular  water  on  the  Continent, 
and  all  the  St.  Galmier  springs  are  now  the  pro- 
perty of  "  L'Etablissement  de  St.  Galmier,"  the 
output  of  which  is  said  to  exceed  one  hundred 
million  litres  per  annum.     The  Source  Badoit  and 
the    Source  Remy  are  both  highly  mineralised. 
The   Remy,  according  to  the  analysis  of  Bouis, 
in  1864,  contains  18*5  grammes  of  solid  constituents 
in  10  litres,  and  the  Badoit,  from  an  older  analysis, 
nearly   29  grammes.     Another  of  these  springs, 
the    Noel,  contains   16*22  grammes  in   10  litres. 
These  waters,  although  excellent  in  many  respects, 
are  too  highly  mineralised  to  suit  everyone.     The 
term  "  seltzer,"  as  applied  to  mineral  waters,  is 
used   somewhat  vaguely.     There  are  the  Neder 
seltzers  and  the  Ober  seltzers,  and  there  are  nu- 
merous  imitations   made   artificially   effervescing 
by  the  introduction  of  chemically  prepared  car- 
bonic acid  gas.     The  analysis  of  Neder  seltzer  by 
Fresenius  shows  that  it  contains  no  less  than  nine- 
teen   ingredients,    the    chief    constituent    being 
chloride  of  sodium,  whilst  the  Ober  seltzer  has  been 
found  by  Mohr  to  contain  260  grammes  of  solid 
constituents  in  the  gallon,  or  about  37  grammes 
in    10  litres.     Rosbach  water  is  said  to  contain 
121*3  grains  in  the  gallon,  or  about  17  grammes  in 
10  litres,  so  that  it  is  comparatively  highly  mine- 
ralised.    Gerolstein,  drawn  from  an  artesian  well 
in  the  Eifel  Mountains,  contains  22*9  grammes  in 
the    10  litres,  and   Taunus   water  44   grammes. 
Malvern  is  probably  not  a  natural  effervescing 
water.     Dr.  Horton-Smith  says  that  it  contains 
only  traces  of  mineral  ingredients  and  cannot  be 
regarded    as    possessing    any    special    medicinal 
properties.     St.  Ronan's   is   a  weak   mineralised 
water  from  Innerleithen,  on  the  Tweed,  about  six 
miles  below  Peebles,  but  whether  it  is  a  natural 
carbonic  acid  water  is  not  clear.     The  muriated 
waters  of  Bridge-of-Earn,  a  mile  and  a  half  from 
Perth,  are  sold  under  the  name  of  Pitkeathly, 
and  contain  free  carbonic  acid  gas.     Salutaris  is 
frankly  an  artificial  aerated  water,  and  need  not 
be  discussed. 

Source  Pcrrier,  now  so  commonly  drunk  on 
the  Riviera,  comes  from  Vergeze,  a  few  miles  from 
Nlmes,  in  the  department  of  Gare,  France.  It  is 
a  natural  carbonic  acid  spring  which  arises  in  a 
remote  country  district  far  removed  from  any 
town  or  village,  so  that  there  is  no  possibility 
of  organic  contamination.  It  is  not  only  gaseous, 
but  actively  effervescing,  with  its  own  natural 
carbonic  acid  gas.  Dr.  Wilson  Hake  finds  that 
it  is  an  absolutely  pure  water  of  low  mineralisation, 
containing  only  3*81  grammes  of  total  solid  con- 
stituents to  10  litres.  It  is  palatable,  and  is  one 
of  the  best  types  of  natural  mineral  water. 

The  subject  of  the  choice  of  a  table  water  is  a 
complex  one,  and  it  must  be  admitted  that  most 
of  us  prescribe  waters  of  this  class  without  any 
real  knowledge  of  their  composition  or  properties. 


In  the  Commons  last  week,  the  Secretary  of  State 
for  War,  in  reply  to  a  question  by  Dr.  Farquharson, 
said  that  a  Royal  Warrant  would  shortly  be  issued 
under  which  the  salary  of  a  nurse  was  fixed  at  £40  a 
year,  rising  to  £45,  instead  of  £30  to  ^35  as  at  present ; 
whilst  the  pay  of  the  higher  classes  of  sister,  matron, 
and  principal  matron  were  correspondingly  increased. 
Under  the  new  regulations  the  matron-in-chief  would 
receive  ^300  a  year  rising  to  £$$0,  The  pensions  de- 
pended on  the  rates  of  pay,  and  were  accordingly 
increased  in  proportion. 


ADRENALIN      IN      NEUROTIC 
HEART. 

By  A.  S.  MYRTLE,  M.D.,  J  .P., 
Harrogate. 

Nothing  has  been  more  forcibly  impressed  on 
my  mind  during  the  last  fifteen  years  than  the 
great  and  steady  increase  of  heart  cases  of  a 
neurotic  origin.  On  examining  such  in  a  quies- 
cent state,  one  discovers  nothing  abnormal 
with  heart  or  pulse.  The  attack  generally  comes 
on  suddenly  without  apparent  cause — the  patient 
feeling  perfectly  well,  detects  a  little  flurry  in 
heart's  action  with  a  sense  of  oppression  or  weight — 
the  pulse  is  feeble,  very  irregular  and  intermittent, 
beating  rapidly  for  a  second  or  two,  then  halting, 
missing  a  beat  after  every  third,  fifth,  or  seventh. 
Respiration  is  hurried  and  shortened,  but  not  re- 
markably so,  and  a  full  deep  breath  can  be  readily 
taken.  Early  attacks  pass  off  generally  as  quickly  as 
they  appear  with  rest  and  a  glass  of  brandy,  whisky 
or  other  stimulant ;  they  can  frequently  be  traced 
to  errors  of  diet,  over-fatigue,  mental  excitement, 
or  functional  derangement  of  the  liver.  As  time 
goes  on  they  become  more  frequent  and  per- 
sistent, demanding  active  treatment.  I  have  found 
full  doses  of  strychnine,  1-20  gr.,  hypodermically 
or  by  the  mouth,  most  trustworthy,  and  with  this5 
1- 1 50  gr.  to  1- 1 25  gr.  strophanthin  is  combined 
with  marked  advantage ;  in  severe  cases  I  have 
resorted  to  ether  inhalations  without  permanent 
good.     I  have  long  discarded  digitalis  as  useless. 

Recently  I  met  with  two  cases  lasting  for  days 
where  the  above  measures,  with  plenty  of  brandy, 
&c,  had  absolutely  no  effect 

Case  I. — The  first,  a  gentleman  over  seventy 
years  of  age,  had  been  very  bad  for  four  days  and 
nights,  when  my  son  suggested  a  trial  of  adrenalin. 
He  had  been  using  this  (to  me  a  new  therapeutic 
agent)  in  cases  of  haemorrhage,  internal  and  ex- 
ternal, at  the  infirmary  and  in  private.  He  had 
noticed  that  in  cases  where  he  had  found  the  heart 
weak,  the  pulse  feeble  and  irregular  before  the 
adrenalin  was  given,  after  its  use  the  heart's 
action  got  stronger,  the  pulse  steadier,  and  whilst 
admitting  that  the  improvement  in  these  cases 
might  reasonably  be  accounted  for  by  the  cessa- 
tion of  the  bleeding,  he  advised  a  trial  of  the  drug 
in  this  case,  and  prescribed  20  min.  of  adrenalin 
chloride  solution  every  six  hours ;  the  pulse  was 
so  rapid,  feeble,  and  irregular  that  it  could  not  be 
counted,  the  patient  complained  of  a  dull  pain 
with  sense  of  weight  over  the  heart,  his  expression 
anxious,  the  face  and  ears  ashen,  the  extremities 
cold,  and  the  voice  reduced  to  a  whisper.  After 
the  second  dose  a  little  improvement  was  noticed, 
and  this  continued  without  a  check  after  each 
dose  ;  after  the  fifth  the  patient  fell  asleep  in  his 
chair,  and  in  a  couple  of  hours  awoke  feeling 
quite  himself,  but  very  shaky. 

Case  //.—-Shortly  afterwards  a  similar  case 
came  under  our  care — a  gentleman  close  on  eighty 
years  of  age,  of  gouty  habit.  He  had  been  liable 
to  heart  attacks  for  many  years.  After  reading 
a  highly  sensational  blood-and-thunder  novel, 
the  heart  suddenly  gave  in  ;  he  began  passing 
large  quantities  of  pale  urine,  for  an  hour  and  a 
half  he  had  to  empty  his  bladder  every  fifteen 
minutes.  He  was  put  on  the  same  course  as  the 
other  patient,  and  after  the  third  dose  was  relieved 
of  all  discomfort. 

In  neither  of  these  cases  did  any  unpleasant 


496    The  Medical  P»w.         ORIGINAL  COMMUNICATIONS. 


May  ii,  1904. 


effect  follow.  In  milder  cases  we  have  given  small 
doses,  5  min.,  with  1-125  gr.  of  strophanthin,  with 
the  most  satisfactory  results.  I  feel  scarcely 
warranted  in  bringing  this  new  remedy  as  a  cardiac 
tonic  to  the  front  on  such  limited  experience, 
but  having  watched  its  action  most  carefully, 
I  am  convinced  of  its  value,  and  place  it  before 
the  profession  believing  it  will  prove  of  great 
benefit  in  cases  of  heart  failure  such  as  I  have 
described.  I  am  all  the  more  encouraged  to  do 
so  after  reading  the  original,  bold  as  well  as  success- 
ful results  obtained  by  Dr.  James  Barr,  of  Liver- 
pool (a)  in  dealing  with  the  very  worst  cases  of 
serous  effusion  in  the  cavities  of  the  bodv,  where 
complications  of  the  gravest  kind  had  to  be  faced. 

notes  on  Cberapeuttcs  and  dDaterla 
jflDeWca. 

By  DAVID  WALSH,  M.D.Edin., 

Senior  Physician,  Western  Skin  Hospital,  London,  W. 

INFLUENZA— PREVENTION. 

The  general  prevalence  of  influenza  at  the  present 
time  is  well  known  to  medical  men.  Although, 
happily,  its  type  is  for  the  most  part  mild,  there 
nevertheless  remains  a  considerable  margin  of 
preventable  mortality  from  that  disastrous  malady. 
The  last  great  pandemic,  as  everyone  knows, 
came  to  the  United  Kingdom  in  1890,  and  fourteen 
years  later  is  still  with  us  in  epidemic  and  endemic 
form.  Persistence  of  this  kind,  in  the  face  of  the 
whole  resources  of  modern  scientific  medicine, 
suggests  a  careful  revision  of  the  field  of  campaign 
in  order  to  And  out,  if  possible,  the  weak  point  in 
our  strategy.  At  the  end  of  fourteen  years  it 
seems  somewhat  humiliating  to  have  to  confess 
that  we  are  not  able  to  exterminate  a  disease  of 
which  the  causative  bacillus  was  discovered 
simultaneously  by  Pfeiffer,  Kitasato,  and  Canon 
in  1892.  Judging  by  the  light  of  past  history  it 
seems  not  unlikely  that  time  alone  will  rid  us  of  the 
pest  as  the  wave  of  influenza  recedes  gradually 
from  our  shores. 

The  demonstration  of  the  specific  organism  of 
influenza  will  make  the  great  epidemic  of  1890 
always  memorable.  Sooner  or  later  it  may  be 
confidently  hoped  that  the  discovery  of  the  cause 
will  enable  the  physician  or  the  sanitarian  to  intro- 
duce rational  means  both  of  cure  and  of  prevention. 
So  far  as  remedial  measures  are  concerned  the 
general  verdict  appears  to  have  been  unfavourable 
to  physic  except,  of  course,  in  the  treatment  of 
complications  such  as  high  temperature,  sickness, 
vomiting,  and  lung  complications.  The  majority 
of  medical  practitioners,  looking  back  on  the 
experience  of  the  past  fourteen  years,  would  agree 
that  the  most  marked  symptom  of  influenza  is 
prostration,  and  that  the  patient's  safety  is  to  be 
found  in  lying  abed,  with  the  administration  of 
plenty  of  good  food  and  stimulants.  Some  day 
an  efficient  anti-influenzal  serum  may  be  dis- 
covered, but  meantime  the  golden  rule  of  practice 
is  to  send  to  bed  at  once  all  patients  found  to  be 
suffering  from  influenza,  no  matter  how  mild  the 
attack.  To  the  philosophical  observer,  indeed, 
there  can  hardly  be  imagined  a  more  instructive 
study  than  that  of  the  powers  and  the  limitations 
of  modern  scientific  medicine  with  regard  to  in- 
fluenza. He  will  seek  to  get  at  the  starting-point 
of  the  evil,  which  appears  to  be  in  some  far-away 

(»)  Brit.  Mtd.Joum.,  March  10th. 


part  of  Eastern  Russia  or  of  Asia.  Thence  the 
influenza  quickly  reaches  Moscow,  two  months  later 
it  is  in  Berlin,  a  month  later  in  London,  and  a  few 
weeks  later,  again,  in  New  York.  A  pandemic  wave 
of  influenza  takes  about  a  year  to  get  round  the  world. 
The  chief  outbreaks  during  the  nineteenth  century 
were  in  1830,  1836,  1847,  18S9.  IQ  the  intervals 
between  the  storms  the  influenza  must  be  endemic 
somewhere  in  the  East.  When  our  systems  for 
the  prevention  of  communicable  diseases  are  more 
perfect,  it  may  be  that  we  shall  be  able  to  control 
the  disease  in  its  place  of  origin.  Before  that 
desirable  end  and  aim  could  be  attained,  however, 
medical  science  will  have  to  discover  some  means 
of  throttling  the  disease. 

Needless  to  remark,  the  ordinary  preventive 
methods  of  notification,  isolation,  and  disinfection 
are  of  little  practical  use  in  this  particular  instance. 
By  isolating  patients  the  distribution  of  a  certain 
amount  of  infection  would  be  avoided.  Many 
persons,  however,  do  not  know  they  are  suffering 
from  influenza,  and  spread  the  malady  broadcast 
in  clubs,  churches,  concerts,  Turkish  baths  and 
other  places  of  common  resort.  The  mischief  is 
done  by  them  before  they  recognise  the  nature  of 
their  malady.  Indeed,  it  is  in  not  a  few  instances 
extremely  difficult  to  distinguish  their  complaint 
from  an  ordinary  sharp  catarrh. 

Many  years  of  notification,  hospital  isolation, 
and  disinfection  have  not  reduced  the  incidence  of 
scarlet  fever  or  of  diphtheria.  That  failure  is 
possibly  due  to  the  difficulty,  which  often  occurs, 
not  only  of  detecting  the  disease  in  its  early  stages, 
but  also  of  saying  when  the  infectiveness  of  the 
patient  has  definitely*  ceased.  It  is,  moreover, 
due  in  some  measure  to  the  special  facilities  for  the 
spread  of  infection  arising  from  the  seat  of  infec- 
tion in  the  upper  air  passages.  Scarlet  fever, 
diphtheria,  measles,  whooping-cough,  and  influenza 
as  a  rule  have  their  starting-point  in  the  upper 
respiratory  tract,  whence  their  virus  is  readily 
distributed  by  coughing,  sneezing,  speaking,  kissing, 
the  use  of  knives,  forks,  spoons  and  drinking 
vessels,  and  in  other  familiar  ways.  It  is  suggestive 
that  the  five  diseases  named  are  those  which  it 
seems  most  hopeless  to  attempt  to  control  by  the 
ordinary  preventive  methods  which  have  proved  so 
successful  in  such  cases  as  small-pox,  enteric 
fever,  typhus,  and  puerperal  fever.  To  exterminate 
these  five  subtle  and  dangerous  infections  science 
will  have  to  devise  fresh  weapons.  It  is  impossible 
to  detect  and  isolate  patients  suffering  from  diseases 
of  so  short  an  incubation.  The  only  hope  appears 
to  be  in  the  discovery  of  some  antidote  to  each 
disease,  which,  indeed,  has  been  done  more  or  less 
in  the  case  of  the  antitoxin  treatment  of  diphtheria. 
It  is  curious  that  medical  science  knows  compara- 
tively little  about  either  measles  or  whooping- 
cough,  two  of  the  commonest  and  deadliest  of  our 
zymotic  complaints.  As  to  their  specific  causative 
organisms  and  the  means  of  cure  we  are  still 
groping  in  the  darkness  of  assumption  and  of 
empiric  method. 


In  the  Commons  on  the  3rd  inst.,  Dr.  Thompson 
asked  the  President  of  the  Local  Government  Board 
if  he  would  consent  to  appoint  a  small  select  committee 
to  consider  the  advisability  of  the  State  registration 
of  nurses.  Mr.  Long  replied  that,  generally  speaking, 
the  subject  of  nursing  was  not  within  the  province  of 
his  department,  which  was  only  concerned  with  the 
nursing  in  Poor-law  institutions.  He  was  not  in  a 
position  to  consent  to  the  proposal. 


May  ii.  1904. 


ORIGINAL  COMMUNICATIONS.         Th»  Mkdicai.  Pmss-  497 


SOME 

EXPERIMENTS    ON    DRUGS 

WHICH  ARE  SAID  TO  INCREASE 

THE  NUMBER  OF 

LEUCOCYTES  IN    THE    BLOOD,  (a) 

By  HERBERT  FRENCH,  M.B*  B.Ch.Oxon., 

Late  GiUson  Ret—rob  Scholar,  Apothecaries'  Society. 

Without  entering  into  great  detail  upon  the 
reasons  for  experiments  of  this  nature,  a  few  words 
of  introduction  seem  necessary. 

The  functions  of  the  leucocytes  of  the  blood 
in  health  are  even  yet  but  imperfectly  understood, 
but  one  of  them  is  held  to  be  that  of  protecting,  or 
helping  to  protect,  the  body  from  certain  infections, 
particularly  those  due  to  micro-organisms.  In 
some  cases  the  microbial  attack  is  local,  and  the 
leucocytes  seem  able  to  engulf  or  devour  the  bac- 
teria, the  process  being  termed  phagocytosis. 
Metchnikoff  is  the  strong  champion  of  this  view 
of  leucocytic  function.  In  other  cases  the  infection 
is  general  throughout  the  body,though  the  microbes 
themselves  may  still  be  local ;  for  example,  in 
pneumonia,  where  the  pneumococci  seem  confined 
to  the  lungs,  and  yet  the  whole  system  is  affected 
by  the  poisons  they  produce.  In  yet  other  cases 
the  microbes  themselves  are  disseminated  every- 
where as  in  cases  of  septicaemia,  and  in  other  cases, 
such  as  scarlet  fever,  the  body  is  poisoned  in  some 
way  though  no  microbes  have  been  found.  Prob- 
ably the  nature  of  the  process  of  recovery  is  not 
always  the  same  in  these  different  varieties  of  in- 
fection ;  but  in  some,  at  least — for  instance,  in 
pneumonia — the  leucocytes  appear  to  play  some 
part.  In  pneumonia  and  in  cases  of  deep-seated 
pas  formation,  to  take  two  examples,  there  is  fre- 
quently a  great  increase  in  number  in  the  leucocytes 
in  the  blood  ;  instead  of  the  more  usual  5,000  to 
10,000,  they  may  number  30,000,  50,000,  or  even 
more  to  the  cubic  millimetre.  This  can  hardly  be 
the  case  unless  they  are  actively  taking  part  in 
resistance  to  the  infection,  and  in  helping  to 
restore  the  patient  to  health.  How  they  do  this 
is  quite  uncertain.  Metchnikoff  believes  his 
phagocytic  theory  covers  every  case.  Walker, 
\  following  up  Ehrlich's  theory  of  immunity,  believes 
that  they  act  in  another  way,  and  a  word  or  two 
may  be  said  in  regard  to  this.  To  put  the  matter 
in  a  somewhat  crude  form,  it  seems  that  when  a 
human  body  is  infected  by  a  microbial  poison  or 
toxin,  that  human  body  may  contain  plenty  of  the 
antidote  or  antitoxin,  and  yet  may  perish  unless 
there  be  something  else  present  as  well.  This 
something  else  is  variously  styled,  one  of  the  names 
for  it  is  "  complement  "  ;  and  the  "  complement  " 
is  regarded  as  a  sort  of  go-between  or  coupling 
which  attaches  itself  both  to  the  "  toxin  "  and 
to  the  "  antitoxin,"  and  enables  these  two  to 
neutralise  each  other. 

Now  Walker  has  published  experiments  which 
indicate  that  the  "  complement  "  is  derived  from 
leucocytes,  and  he  believes  that  this  function  of  the 
^cocytes,  complement  function,  is  most  im- 
portant in  many  cases,  at  least,  of  recovery  from 
infectious  diseases. 

I  do  not  wish  to  enter  further  into  the  complicated 
question  of  immunity  ;  I  think  I  have  said  enough 
to  show  how  important  it  may  be  to  know  the 
therapeutic  agents  by  which  an  increase  in  the 
leucocytes  of  the  blood  may  be  brought  about.    Of 


(«)  Bead  at  the  April  meeting  of  the  Therapeutical  Society,  1904. 


course,  ft  does  not  follow  that  because  a  given  drug 
win  produce  an  increase  of  leucocytes  it  will 
necessarily  be  of  benefit  in  any  particular  disease. 
A  drug,  for  example,  might  be  capable  of  doubling 
the  number  of  leucocytes,  or  of  doubling  the  amount 
of  complement,  but  it  might  be  that  the  whole  of 
this  increase  was  necessary  in  order  to  neutralise 
the  other  effects  of  the  drug  itself;  leaving  no 
surplus  of  either  leucocytes  or  complement  to 
deal  with  the  infective  material  of  the  disease  from 
which  the  patient  was  suffering.  On  the  other 
hand,  it  seems  not  impossible  that  a  drug  might  be 
discovered  whose  action  was  to  stimulate  leu- 
cocyte and  complement  production  to  such  an 
extent  that  the  patient  might  have  an  increased 
power  of  resisting  and  overcoming  the  infective 
process.  In  conditions  such  as  infective  endocardi- 
tis such  a  drug,  if  known,  would  be  invaluable. 
The  first  point,  and  that  in  which  this  Society  wilt 
be  chiefly  interested,  is  to  discover  what  drugs  will 
increase  the  leucocytes  in  healthy  man,  and  it  will 
be  a  subsequent  research  to  test  the  value  of  this 
action  in  particular  diseases.  To  take  an  analogy,, 
the  discovery  of  those  drugs  which  will  produce 
diuresis  was  important  in  itself  ;  it  is  a  subsequent 
application  of  this  discovery  to  use  those  drugs 
in  medical  cases  where  increased  urine  secretion 
seems  indicated ;  the  present  experiments  were 
confined  to  the  drug  production  of  increased  leu- 
cocytes in  healthy  man. 

A  certain  amount  of  work  has  already  been  done 
in  the  same  direction.  Mayer,  in  Von  Jaksch's 
clinic  in  Prague,  reports,  from  a  series  of  experi- 
ments lasting  nine  days,  an  average  increase  in 
leucocytes  of  over  75  per  cent,  on  the  three  days 
when  nuclein  was  administered.  Halm,  of  Munich, 
and  Hofbauer,  of  Vienna,  state  that  they  have 
obtained  similar  results,  with  none  but  beneficial 
effects.  Batty  Shaw,  using  an  emulsion  of  }  gramme 
of  cinnamate  of  soda  in  sterilised  normal  saline, 
and  injecting  it  into  cats,  caused  a  leucocyte 
increase  of  from  31  per  cent,  to  192  per  cent. 
Richter  and  Spiro  have  obtained  similar  results. 
I  have  other  references  to  the  use  of  turpentine,, 
potassium  chlorate,  pyrodin,  collargol,  and  ether, 
where  injections  hypodermically  produced  similar 
slight  increases  ;  but  in  all  cases  in  animals.  The 
facts  that  the  experiments  were  made  on  animals 
is  important,  because  it  is  well  known  how  readily 
the  numbers  of  leucocytes  may  be  made  to  vary  in. 
them,  even  by  very  slight  causes.  It  is  important, 
further,  that  the  increase  was  always  slight ;  for  the- 
normal  figure  is  well  known  to  be  variable,  and  the 
increases  in  many  of  the  recorded  cases,  even  on. 
animals,  were  almost  within  the  limits  of  normal 
variation. 

The  present  experiments  were  all  carried  out  upon 
myself,  and  I  cannot  find  reference  to  others  of  a 
similar  nature  carried  out  upon  a  healthy  man.  I 
was  living  my  usual  life,  with  the  usual  meals ^ 
all  the  time ;  previous  to  the  drug  administra- 
tion I  counted  the  leucocytes  in  the  morning,  at 
mid-day,  in  the  evening,  and  at  night,  over  a. 
week's  period,  in  order  to  find  the  healthy  varia- 
tions. These  were  considerable — namely,  from  a. 
minimum  of  5,000  to  a  maximum  of  13,000 
per  c.mm.  I  conclude,  therefore,  that  no  leu- 
cocyte count  following  a  drug  administration  in 
myself,  and  not  exceeding  13,000,  can  be  regarded 
as  an  increase  due  to  the  drug. 

I  then  carried  out  a  series  of  experiments  with 
nuclein,  kindly  supplied  by  Parke,  Davis,  and  Co. 

D 


498    The  Medical  Press.        TRANSACTIONS  OF  SOCIETIES. 


May  tt,  1904. 


This  was  the  same  as  that  which  Mayer  has  stated 
to  produce  leucocyte  increase  in  cats.  For  a 
week  I  took  3j  oi  their  nuclein  solution  No.  2, 
four  times  a  day,  counting  the  leucocytes  at  inter- 
vals. They  never  exceeded  11,000,  and  were 
usually  far  less.  For  the  next  week  I  took  #j, 
the  full  dose,  in  the  same  way,  with  exactly  the 
same  result.  I  then  took  their  dry  nuclein  in 
capsules,  four  capsules  a  day  for  the  first  week, 
with  a  maximum  count  of  13,125  ;  eight  capsules 
a  day  for  the  second  week,  with  a  maximum  count 
of  1 1,875.  No  ill  effects  followed,  there  was  at  no 
time  an  excess  of  leucocytes  in  the  blood.  I  then 
used  their  nuclein  solution  No.  1,  and  injected  it 
hypodermically  in  increasing  doses — ic  c.c. ; 
20  c.c. ;  and  30  c.c. — on  successive  days.  It  was 
painful,  there  was  a  slight  local  erythema  upon  the 
fourth  day,  and  much  local  itching  of  the  skin  ;  but 
no  leucocyte  increase  at  all.  I  could  not  conclude 
that  nuclein,  either  by  mouth  or  hypodermically, 
caused  any  artificial  leucocytosis. 

I  next  tried  injection  of  5  grains  of  sodium 
cinnamate  suspended  in  normal  saline,  as  Batty 
Shaw  had  done,  but  the  leucocytes  showed  no 
increase  exceeding  the  maximum  found  in  myself 
under  normal  conditions. 

I  then  tried  collargol  hypodermically  in  a  similar 
way,  as  the  result  of  seeing  a  reference  to  experi- 
ments with  it  in  Germany.  The  collargol  was 
sterilised  by  boiling,  and  full  aseptic  precautions 
were  taken,  and  the  results  were  as  follows  : — 

After  injecting  15  mg.,  no  untoward  effects 
occurred,  but  there  was  no  increase  in  the  leuco- 
cytes. After  injecting  30  mg.,  there  was  no  rise 
for  10  hours  afterwards .  the  leucocytes  then 
reached  14,375,  which  is  slightly  in  excess  of  my 
healthy  maximum,  they  rose  to  16,250  at  the  end 
of  24  hours,  and  I  then  began  to  feel  unwell,  with 
lassitude,  pain  in  the  back  and  limbs,  and  head- 
ache ;  but  without  loss  of  appetite,  and  without 
loss  of  pleasure  in  tobacco-smoking,  in  which 
two  latter  respects  the  condition  differed  entirely 
from  influenza,  which  the  other  symptoms  at  first 
suggested.  I  had  no  shivering.  My  temperature 
was  990  30  hours  after  the  injection  ;  at  40  hours 
it  was  1010;  at  48  hours  ioo°;  and  at  60  hours  again 
normal.  The  arm  did  not  become  inflamed, 
though  it  was  tender  at  the  site  of  inoculation,  the 
headache,  which  was  of  the  variety  which  is  absent 
when  the  head  is  kept  absolutely  still,  but  is  very 
evident  on  the  slightest  movement,  persisted  for 
four  days,  for  the  first  two  of  which  I  could  not  work. 
The  leucocytes  reached  a  maximum  of  22,187  at 
30  hours  from  the  inoculation,  and  then  rapidly 
fell  to  normal. 

This  was  the  last  experiment  I  did  upon  the 
subject  under  discussion.  It  frightened  me,  and 
those  about  me,  and  it  has  impressed  upon  me  very 
much  the  danger  of  taking  hypodermic  injections. 
The  drug  collargol  certainly  was  followed  by 
leucocytosis,  and  to  that  extent  was  satisfactory. 
But  the  concomitant  symptoms  render  it  unlikely 
to  be  of  benefit  in  treating  a  patient  who  is  already 

ill. 

I  am  afraid,  therefore,  gentlemen,  that  my  ex- 
periments add  little  to  your  knowledge,  though  the 
personal  experience  is,  I  think,  worth  telling. 
None  the  less,  I  still  believe  some  patients  might 
be  benefited  could  we  find  a  non-noxious  leuco- 
cyte-increasing drug.  I  think  experimental  results 
in  animals  cannot  be  inferred  to  be  true  of  man,  as 
I  have  shown  in  the  case  of  nuclein  ;  I  think  that 
hypodermic  injections  in  bulk  are  highly  dangerous, 


and  to  be  avoided  in  the  case  of  little-known  drugs 
such  as  collargol,  and  I  come  to  the  Therapeutical 
Society  for  information,  or  for  suggestions  for 
further  investigations,  upon  drugs  which  they 
think  might  stimulate  leucocyte  production 
without  concomitant  noxious  effects,  and  which 
may  be  giverr  not  hypodermically,  but  by  the 
mouth. 


^Transactions  of  Societies. 


ROYAL  ACADEMY  OF  MEDICINE  IN  IRELAND. 
Section  of  Pathology. 
Meeting  held  Friday,  April  2qth,  1904. 


The  President,  Dr.  Earl,  in  the  Chair. 


Dr.  T.  G.  Moorhead  showed  three  slides  in  which 
the  Leishman-Donovan  bodies  appeared,  giving  a 
description  of  the  cases  from  which  they  were  taken, 
and  a  history  of  the  discovery  of  the  bodies  and  their 
relation  to  malaria. 

punctate  basophilia. 

Prof.  E.  J.  McWeeney  showed  specimens  of  blood 
from  a  case  of  pernicious  anaemia  exhibiting  this 
condition.  Many  of  the  red  corpuscles  were  thickly 
sprinkled  with  granules  of  strongly  basophilic  character, 
which  could  be  detected  in  preparations  stained  by 
Jenner's  and  Prdscher's  modifications  of  Romanowsky's 
stain,  as  well  as  in  triacid  preparations.  He  was 
inclined  to  look  upon  the  granule  as  due  to  raryorrhexia. 

TRYPANOSOMAS  IS. 

Prof.  E.  J.  McWeeney  showed  slides  of  rabbit's 
blood  containing  the  nagana  parasite  ;  also  of  human 
blood  containing  the  parasite  of  sleeping  sickness. 
These  latter  had  been  given  him  by  Dr.  MacCarthy, 
travelling  scholar  in  Pathology  of  the  Royal  University, 
who  had  obtained  them  from  the  Pasteur  Institute 
where  he  had  been  working.  The  nagana  or  surra 
disease  had  been  propagated  for  a  number  of  genera- 
tions in  exhibitor  s  own  laboratory,  starting  from  a 
white  rat  brought  from  Paris  by  Dr.  MacCarthy. 
He  also  exhibited  the  Trypanosoma  Lewisii,  which 
infects  the  ordinary  sewer  rat  in  Dublin.  Out  of 
thirteen  rats  examined  he  had  found  it  in  six.  The 
morphology  of  the  parasite  was  demonstrated  by 
means  of  photographs  and  coloured  sketches  pro- 
jected on  the  screen,  and  the  speaker  concluded  by 
referring  to  Prof.  Minchin's  application  of  the  name 
trypanosome  to  a  stage  in  the  evolution  of  the  malarial 
parasite. 

Dr.  Neville  showed  the  following  specimens,  giving 
a  description  of  each: — (a)  Sloughing  flbro-myoma  ot 
uterus ;  (b)  tubo-ovarian  cyst ;  (c)  tubal  pregnancy, 
showing  decidual  cells  and  hydatiform  degeneration  ot 
villi ;  (d)  sarcomatous  degeneration  of  a  fibro-myoma. 


LIVERPOOL  MEDICAL  INSTITUTION. 
Meeting   held   April   28th,    1904. 


Dr.  James  Barr,  President,  in  the  Chair. 


Mr.  K.  W.  Monsarrat  related  a  case  of  "  Stran 
gulated  Inguinal  Hernia  "  with  an  unusual  complication. 
The  patient  was  a  man,  aet.  45,  and  the  hernia  was 
operated  upon  twenty-four  hours  after  the  onset  oi 
the  symptoms  oi  strangulation.  The  gut  was  intensely 
congested,  but  except  for  a  greyish  purple  patch  on 
the  entering  coil  at  the  neck  of  the  sac,  it  did  not  show 
evidence  of  marked  damage.  At  the  end  oi  the  follow- 
ing week,  the  patient  complained  of  vague  general 
abdominal  pains,  and  this  was  accompanied  by 
evening  pyrexia.  The  pain  became  localised  to  the 
right  iliac  fossa,  and  during  the  seventh  week  after 
operation  symptoms  of  chronic  intestinal  obstruction 
commenced.  The  abdomen  was  opened  in  the  right 
iliac  region,  and  a  mass  of  coiled  small  intestine  was 
found  bound  to  the  parietal  peritoneum  by  a  dense 
adhesion,  and  there  were  numerous  other  adhesions 


May  ii,  1904; 


TRANSACTIONS  QF  SOCIETIES.       The  Medical  Pare.    499 


between  the  coils,  one  of  which  was  causing-  a  definite 
Compression.  The  adhesions  were  divided,  the  omen- 
tum used  to  cover  some  oi  the  raw  surface,  and  the 
abdomen  closed.  This  operation  was  followed  by 
subsidence  of  all  morbid  symptoms. 

Mr.  Litlkr  Jokes  related  a  case  of  "  Richter's 
Hernia  "  in  a  woman,  aet.  73,  who  was  admitted  into  the 
Royal  Infirmary  with  a  history  of  four  days'  pain  and 
abdominal  discomfort,  with  slight  distension  and  a 
small  lump  in  the  right  femoral  region.  There  was  no 
constipation  nor  vomiting,  neither  was  there  a  history 
of  hernia.  A  strangulated  femoral  hernia  being 
diagnosed,  operation  was  proceeded  with.  The  pit 
was  adherent  to  the  sac,  which  contained  foul-smelling 
fluid ;  the  protrusion  was* the  size  of  a  half-inch  marble, 
of  an  ashy  grey  colour,  too'far  gone  for  recovery.  The 
constriction  being  divided,  the  gut  was  gently  pulled 
down,  and  the  diverticulum  in  vagina  ted  into  the 
umen  of  the  bowel.  Lembert's  sutures  of  fine  silk 
were  used  to  secure  the  peritoneum.  The  sac 
was  removed,  the  wound  washed  with  an  anti- 
septic, a  small  drain  used,  deep  sutures  to  attempt 
a  radical  cure  inserted,  and  the  patient  put 
back  to  bed.  An  uninterrupted  recovery  fol- 
lowed, the  patient  leaving  the  hospital  in  the  fifth 
week.  This  was  the  second  case  that  had  come 
under  his  care,  the  other  requiring  enterectomy,  and 
being  in  the  inguinal  region.  The  bud-like  process 
in  the  latter  case  was  about  half  the  lumen  of  the 
bowel ;  fourteen  inches  were  removed.  The  patient 
was  a  man,  aet.  48,  and  also  made  a  good  recovery. 

Dr.  W.  Blair  Bell  read  a  note  on  a  method  of 
treatment  which  he  had  adopted  in  two  cases,  in 
which  children,  aet.  18  months  and  4},  had  swallowed 
foreign  bodies— the  one  a  brooch  and  the  other  a 
bed-knob.  He  had  given  the  children  absorbent 
cotton-wool,  teased  finely,  in  their  food.  The  result 
had  been  extremely  satisfactory  in  each  case,  the 
swallowed  body  being  passed  in,  at  most,  eighteen 
hours,  enveloped  in  the  wool.  In  reply  to  Mr.  Litler 
Jones,  Dr,  Blair  Bell  said  that  so  far  as  he  knew  the 
method  was  a  new  one  and  that  he  could  find  no 
record  of  a  similar  treatment,  although  "  hair  "  had 
been  recommended,  since  it  had  a  faculty  for  forming 
hair-balls. 

Dr.  Carter  read  a  note  on  -"  Digestants,"  and  re- 
lated a  number  of  experiments  illustrating  the  relative 
values  of  recent  and  old  pepsin  and  of  papain  as 
digestants  of  proteids.  He  also  mentioned  other 
experiments  showing  the  influence  of  antiseptics  on 
both  peptic  and  pancreatic  digestion,  and  the  contrast 
between  oxidising  antiseptics  and  others.  Lastly  he 
pointed  out  that  though  the  Bacillus  typhosus  did  not 
influence  digestion,  and  though,  as  a  rule,  antiseptics 
had  no  restraining  influence  on  the  bacillus,  yet 
peroxide  of  hydrogen,  lysol,  and  formalin,  in  such 
degrees  oi  dilution  as  admitted  of  their  administration 
internally,  had  a  marked  effect,  both  inhibiting  the 
growth  of  and  killing  the  bacillus. 

Dr.-  R.  J.  M.  Buchanan  read  a  paper  on  the  inter- 
pretation of 

physical  signs  in  pleural  empyema. 
He  drew  attention  to  the  frequent  occurrence  in  cases 
of  pleural  effusion  of  auscultatory  signs,  the  same  as 
those  obtaining  over  solid  lung.  He  considered 
Bacelli's  sign  unreliable  as  a  distinction  between 
serous  and  purulent  effusions.  The  auscultatory  signs 
over  purulent  effusion  resemble,  in  his  experience, 
those  over  consolidated  lung  more  than  over  serous 
effusion,  and  he  offered  an  explanation  in  support  of 
his  view,  based  upon  a  series  of  illustrative  cases. 
He  was  of  opinion  that  serous  effusion  exercised  a 
selective,  rather  than  a  wholly  inhibitive,  influence 
over  the  transmission  of  vocal  vibrations.  He  pointed 
out  the  danger  of  errors  in  diagnosis  in  cases  of  the 
acute  pneumonic  types  of  pleuritis,  and  the  pro- 
bability that  in  such  cases  purulent  effusion  may  be 
present  from  the  onset.  In  concluding.  Dr.  Buchanan 
emphasised  the  necessity  for  a  more  careful  study 
aod  interpretation  of  the  physical  signs,  so  as  to 
establish  strong  grounds  in  practice  tor  advocating 
exploratory  puncture. 


Dr.  A.  G.  Gullan  mentioned  a  case  in  which  the 
vocal  fremitus,  breath  sounds  and  vocal  resonance 
were  transmitted  through  a  purulent  effusion.  The 
patient  was  a  man,  aet.  about  40,  who  was  supposed 
to  have  a  thickened  pleura,  as  he  had  a  previous  history 
of  pleurisy  on  the  affected  side.  His  temperature, 
night  sweats,  and  general  appearance  were  considered 
by  the  physician  in  charge  to  be  due  to  large  tuber- 
culous cavities  which  existed  at  both  apices.  After 
death,  however,  the  upper  parts  of  the  lungs  were 
affected  by  marked  tuberculosis,  but  pus  was  found  in 
the  pleural  cavity. 

Drs.  Glynn,  Warrington,  Hubert  Armstrong,  and 
B.  T.  Davies  also  spoke. 

NORTH-EAST  LONDON  CLINICAL  SOCIETY. 
Meeting  held  Thursday,  May  5th,  1904. 

Dr.  J.  W.  Hunt,  President,  in  the  Chair. 

Dr.  F.  J.  TresiliaK  (Enfield)  read  a  paper  on  "  The 
Influence  of  Certain  Drugs  in  the  Treatment  of  Chil- 
dren's Diseases."  an  abstract  of  which  will  be  published 
later.     In  the  discussion  which  followed, 

Dr.  A.  J.  Whiting  said  that  although  arsenic  was 
probably  the  most  valuable  drug  in  chorea,  yet  it  re- 
quired to  be  given  with  great  caution,  as  arsenical 
poisoning  might  be  worse  than  the  original  disease. 

The  President  thought  that  alcohol  was  often  best 
administered  in  medicinal  doses  from  a  bottle,  espe- 
cially if  a  trained  nurse  was  not  in  attendance.  With 
regard  to  the  use  of  belladonna  in  children's  com- 
plaints, he  had  found  it  somewhat  uncertain  in  its 
action,  probably  on  account  of  variation  in  the  different 
specimens,  and  he  had  used  atropine  itself  instead  in 
small  doses.  He  was  surprised  that  little  mention  had 
been  made  of  bromide  of  potassium,  which  was  a  drug 
of  great  utility,  and  one  which,  according  to  the  late 
Dr.  Moxon,  was  of  service  in  almost  every  disease  of 
childhood. 

Dr.  E.  A.  Lerhitte  communicated  a  paper  on  "  The 
Administration  of  Hypnotics  in  Neurasthenia." 

Dr.  A.  J.  Whiting  considered  that  it  was  of  great 
importance  to  find  out  the  time  element  in  insomnia, 
as  this  often  affected  the  question  of  a  repetition  of 
the  hypnotic.  He  thought  that  paraldehyde  was  of 
great  value,  and  pointed  out  that  it  also  possessed  a 
vigorous  expectorant  action.  He  had  found  some  of 
the  synthetic  coal-tar  preparations,  such  as  antifibrin 
or  phenacetin,  very  useful  in  the  treatment  of  simple 
insomnia. 

Dr.  Horace  Wilson,  in  speaking  of  the  influence  of 
suggestion  in  producing  sleep,  uttered  a  word  of  caution 
against  employing  this  remedy  too  freely  in  cases  where 
the  insomnia  was  due  to  the  presence  of  some  gross 
organic  disease. 

The  President  stated  that  he  had  found  trional  of 
signal  benefit,  and  this  drug  was  also  free  from  bad 
after-effects. 

Mr.  R.  Philip  Brooks  exhibited  a  specimen  of 
"  Sarcoma  of  the  Choroid  "  from  a  female  patient,  aet.  49, 
in  whom  he  had  performed  enucleation  of  the  globe. 
The  growth  was  encroaching  upon  the  sclerotic  and 
consisted  chiefly  of  spindle-cells. 

THE  SOCIETY  FOR  THE  STUDY  OF    DISEASE 

IN    CHILDREN. 

Meeting   held    April    15TH,    1904. 


Dr.  C.  O.  Hawthorne  in  the  Chair. 


Dr.  James  Taylor  showed  a  boy,  aet.  5,  with  con- 
genital proptosis  and  meningocele.  The  mental 
condition  was  defective,  recently  his  eyesight  had  been 
failing,  and  nystagmus  and  optic  atrophy  were  also 
present. 

Mr.  Sydney  Stephenson  said  that  in  all  the  cases 
of  steeple-skulled  children  which  he  had  met  with 
there  was  also  a  condition  of  pallor  of  the  optic  discs 
which  seemed  to  be  secondary  to  neuritis.  He  thought 
a  mechanical  factor  was  probably  the  cause  of  the 


500    Tee  Medical  Press. 


LUNACY  DEPARTMENT. 


May  ii.  1904. 


neuritis,  as  well  as  of  the    proptosis  and  divergence 
of  one  eye,  which  were  constant  features  of  such  cases. 

Dr.  Anderson  Smith  (introduced)  showed  a  girl, 
aet.  5,  who  at  the  height  of  an  attack  of  measles  de- 
veloped cerebral  symptoms,  namely,  vomiting,  squint- 
ing, head  retraction,  photophobia,  and  unconsciousness. 
At  the  end  of  five  days  the  acute  symptoms  subsided, 
but  she  was  found  to  be  aphasic,  resented  being 
touched,  and  wasted  rapidly.  There  was  no  optic 
neuritis  or  ear  trouble.  A  month  later  she  was  stiU 
aphasic,  could  not  sit  up  in  bed,  moved  her  limbs  in 
an  ataxic  manner,  and  appeared  to  have  general 
cutaneous  anaesthesia.  There  was  slight  rigidity  of 
the  limbs,  ankle-clonus,  and  exaggeration  of  the  knee- 
jerks.  More  recently  there  had  been  gradual  improve- 
ment in  the  motor  power,  she  could  say  a  few  words, 
the  ankle-clonus  had  disappeared  and  sensation  was 
improving. 

Dr.  Hawthorne  thought  the  evidence  of  meningitis 
was  not  clear,  and  suggested  that  the  symptoms  might 
have  been  due  to  some  form  of  toxin.  He  recalled  a 
somewhat  similar  condition  in  an  adult  after  influenza. 

Dr.  Farquhar  Buzzard  thought  that  all  the  sym- 
ptoms could  be  attributed  to  a  lesion  of  the  cerebrum, 
without  any  involvement  of  the  spinal  cord,  and  that 
there  had  probably  been  encephalitis  produced  by  the 
measles  toxin.  As  the  improvement  had  been  so 
marked,  there  was  reason  to  hope  for  a  good  ultimate 
result. 

Dr.  James  Taylor  agreed  as  to  the  good  prognosis, 
and  as  to  toxaemia  connected  with  the  measles  being 
the  probable  cause. 

In  reply  to  questions,  Dr.  Anderson  Smith  said  he 
had  thought  of  the  possibility  of  the  rash  and  other 
symptoms  being  due  to  cerebrospinal  meningitis, 
and  had  excluded  that ;  further,  another  member  of 
the  family  had  measles  at  the  same  time. 

Mr.  Sydney  Stephenson  showed  two  cases  of 
microphthalmos,  one  slight,  in  a  boy,  set.  6,  and  the 
other  extreme,  in  a  girl  of  sixteen  months.  He  pointed 
out  that  a  few  years  ago  the  latter  would  have  been 
called  a  case  of  anophthalmos,  because  no  eye  was 
visible  on  opening  the  lids,  and  it  was  only  on  deep 
palpation  that  a  small  pea-like  body  could  be  felt 
towards  the  back  of  each  orbit.  These  small  bodies, 
in  all  probability,  represented  rudimentary  eyeballs, 
containing  more  or  less  immature  nervous  elements, 
and  upon  that  ground  he  preferred  to  regard  the  case 
as  one  of  microphthalmos. 

Dr.  Baumann  showed  two  cases  of  anaemia.  The 
first  was  in  an  infant  of  ten  months,  who  was  obviously 
syphilitic,  and  had  an  enlarged  spleen.  Blood  exami- 
nation showed  merely  the  existence  of  a  severe  secon- 
dary anaemia.  He  considered  the  whole  of  the  sym- 
ptoms as  secondary  to  syphilis.  The  second  case  was 
a  girl,  aet.  ij  year,  without  evidences  of  syphilis, 
but  with  an  enlarged  spleen.  Blood  examination 
showed  a  well-marked  leucocytosis,  and  also  a  large 
number  of  nucleated  red  cells,  a  considerable  pro- 
portion of  which  were  megaloblasts.  He  was  inclined 
to  regard  the  case  as  an  example  of  pernicious  anaemia 
in  infancy. 

Dr.  A.  E.  Jones  agreed  with  the  diagnosis  of  per- 
nicious anaemia  in  the  second  case,  as  the  large  number 
of  nucleated  red  corpuscles  was  very  striking. 

Dr.  A.  Morison  showed  a  case  of  dactylitis  with 
subcutaneous  nodules  in  an  infant  of  sixteen  months. 
He  regarded  the  case  as  tuberculous.  The  case  was 
discussed  by  Mr.  Lockhart  Mummery,  who  recom- 
mended general  treatment ;  by  Mr.  R.  C.  Dun  (Liver- 
pool), who  advised  general  treatment  and  the  fixation 
of  the  hands  in  splints,  so  as  to  secure  immobility  of 
the  fingers ;  by  Mr.  L.  Bid  well,  who  had  often  found 
incision  through  the  periosteum  and  scraping,  and 
later  on  splinting,  a  means  of  shortening  the  duration 
of  treatment ;  by  Dr.  H.  Skelding  (Bedford),  who 
thought  that  the  best  local  treatment  was  by  a  splint  ; 
and  by  Mr.  R.  P.  Rowlands,  who  suggested  that  the 
disease  might  be  syphilitic,  judging  from  the  density 
of  the'shadow  in  the  skiagram. 

Dr.'S.  Verb  Pearson  showed  a  case  of  tuberculous 
nodule   in   the   ponto-medullary   tract.     The  t  patient 


was  a  boy,  aet.  2,  who  was  suffering  from  weakness  in? 
and  disinclination  for  walking,  slight  drowsiness,  and 
squint  in  the  left  eye.  There  had  been  occasional 
retching  and  difficulty  in  walking.  Definite  right- 
limbed  paresis  had  developed  later.  Dr.  Vere  Pearson 
commented  on  the  crossed  paresis,  and  considered  that 
there  was  a  lesion  on  the  ponto-medullary  tract,  pro- 
bably a  tuberculous  growth. 

Dr.  Hawthorne  referred  to  a  case  of  basal  tumour 
in  a  child,  who  developed  third  nerve  paralysis,  and 
who  presented  evidence  of  tubercle  in  other  parts  of 
the  body.  The  tumour  was  found  post-mortem  to  be 
tuberculous. 

Dr.  Farquhar  Buzzard  referred  to  the  rarity  of 
tuberculous  tumours  in  this  region,  and  to  the  lact 
that  they  were  usually  discovered  accidentally  after 
death,  having  produced  no  symptoms  during  life. 
He  was  inclined  to  regard  the  case  as  one  of  pontine 
tumour,  probably  gliomatous. 

Dr.  C.  O.  Hawthorne  showed  a  boy  of  ten  years 
suffering  from  paramyoclonus  multiplex.  There  were 
sudden,  shock-like,  clonic  muscular  contractions 
affecting  both  sides  of  the  body  at  the  same  time. 
The  bilateral  and  isochronous  character  of  the  con- 
tractions was  well  seen  in  the  cremaster  muscle.  The 
muscles  of  the  face,  the  trunk,  and  the  thighs  were 
also  affected.  Dr.  Hawthorne  also  showed  (1)  a  case 
of  opaque  nerve  fibres,  and  (2)  a  case  with  extreme 
changes  in  the  fundus,  following  an  injury. 

The  following  papeis  were  read  : — ■ 

Mr.  Leonard  Bidwell,  a  case  of  gonorrheal  pyo-sal- 
pinx  in  a  girl,  aet.  6,  treated  by  removal  of  the  tubes. 

Dr.  George  Carpenter,  a  case  of  gonorrheal  in- 
flammation of  the  uterine  appendages  in  a  girl,  aet. 
3,  with  spontaneous  recovery. 

Mr.  R.  C.  Dun  (Liverpool),  a  case  of  post-hemi- 
plegic  chorea,  petit  mal,  and  mental  irritability,  treated 
surgically. 

Mr.  Leonard  Bidwell,  two  cases  of  strangulated 
hernia  in  infants  under  one  month,  treated  by  operation. 

Xunacs  department. 

LUNACY  IN  SCOTLAND. 
The  forty-sixth  annual  report  of  the  General 
Board  of  Commissioners  in  Lunacy  for  Scotland  has 
just  been  issued,  and,  as  this  Report  always  does, 
affords  much  interesting  reading.  It  states  that  on 
January  xst,  1904,  there  were  in  Scotland  16,894 
insane  persons.  Of  these,  14,309  were  maintained 
by  parochial  rates,  2,532  from  private  sources,  and 
53  at  the  expense  of  the  State.  As  the  total  number 
at  January  1st,  1903,  was  16,658,  an  increase  has  taken 
place  during  the  past  year  of  236.  The  average  annual 
increase  of  pauper  patients  in  establishments  during 
the  past  ten  years  has  been  293.  The  increase  during 
the  year  has,  therefore,  been  213  below  the  average 
of  the  past  ten  years.  The  number  of  pauper  patients 
in  establishments  has  risen  during  these  ten*  years 
from  8,476  to  11,404,  that  is,  by  2,928.  The  pro- 
portion of  pauper  lunatics  in  establishments  to  popu- 
lation in  1903  was  250.  At  January  1st  of  the  present 
year  it  was  249.  The  Commissioners  have  not,  since 
1883,  had  to  record  a  fall  in  this  proportion.  The 
number  of  pauper  lunatics  in  private  dwellings  has 
increased  during  the  last  ten  years  from  2,565  to 
2,658.  This  increase  of  93  has  not  been  sufficient  to 
maintain  the  proportion  to  population,  which  was 
62  ten  years  ago,  and  is  now  58,  being  the  same  as 
last  year.  In  1895  and  1896  the  proportion  rose  as 
high  as  64.  The  largest  actual  number  of  pauper 
patients  under  private  care  was  attained  in  1900,  when 
it  stood  at  2,703.  The  proportion  per  100,000  of 
population  of  private  patients  in  asylums,  who  include 
a  considerable  number  of  patients  drawn  from  England 
and  Ireland,  has  risen  during  the  past  ten  years  from 
44  to  49,  the  latter  figure  showing  a  rise  of  2  over  the 
proportion  at  which  it  had  remained  during  the 
previous  six  years.  The  proportion  to  population 
of  private  patients  under  care  in  private  dwellings 
has  remained  unchanged  for  many  years.    The  number 


May  ii,  1904. 


SPECIAL    ARTICLES. 


Thx  Medical  Pkbss.    501 


of  private  patients  in  asylums  has  increased  during 
the  past  year  by  1 11,  and  in  private  dwellings  decreased 
by  2,  an  increase  of  109  in  all. 

The  increase  this  year  of  registered  lunacy  is  the 
smallest  recorded  since  1891.  The  Commissioners 
direct  attention  to  some  features  connected  with  the 
smallness  of  this  increase.  Of  the  total  increase  of 
205,  191  arose  from  an  increase  in  the  number  in 
establishments,  and  of  this  number  only  80  were 
pauper  patients.  This  increase  in  the  number  of 
pauper  patients  is  the  smallest  which  has  occurred 
during  the  past  nineteen  years.  Sixteen  counties 
show  a  total  decrease  of  178,  and  the  remaining  seven- 
teen counties  a  decrease  of  98.  The  County  of  Edin- 
burgh is  the  most  prominent  contributor  to  the  increase 
with  48,  or  27  per  cent,  of  the  whole.  The  urban 
counties  of  Aberdeen  and  Renfrew  show  an  increase 
of  29,  or  17  'per  cent.,  while  Inverness,  Ross,  and 
Sutherland  together  show  an  increase  of  41,  or  23 
per  cent,  of  the  whole  increase.  The  largest  contri- 
butor to  the  total  decrease  is  the  mainly  urban  county 
of  Forfar  with  a  growing  population,  which  shows 
21  fewer  than  last  year.  Lanark,  Linlithgow,  Dum- 
barton and  Selkirk,  also  mainly  urban  or  industrial 
counties  with  increasing  populations,  are  the  next 
most  conspicuous  among  those  which  show  a  fall  in 
the  numbers,  and  after  them  the  largest  decrease 
occurs  among  the  most  northerly  group  of  all,  Caith- 
ness, Orkney,  and  Shetland.  The  small  amount  of 
the  net  increase,  taken  along  with  a  population 
which  is  estimated  to  be  rising,  has  had  the  effect  of 
reducing  the  proportion  of  pauper  lunatics  in  estab- 
lishments from  250  per  100,000  in  1892,  to  249  in 
1903.  Twenty-one  years  have  elapsed  since  we  have 
had  to  record  a  similar  fall.  The  Commissioners 
point  out  that  this  is  worthy  of  record,  as  being  possibly 
a  symptom  that  the  production  at  any  rate  of  that 
part  of  pauper  lunacy,  which  has  hitherto  grown  out 
of  proportion  to  the  increase  of  population,  may  be 
at  last  reaching  a  point  beyond  which,  through  fluc- 
tuations may  occur  from  year  to  year,  it  will  not 
materially  rise. 

THE  MEDICO-PSYCHOLOGICAL  ASSOCIATION. 

A  meeting  of  the  Scottish  division  of  the  Medico- 
Psychological  Association  was  recently  held  by  in- 
vitation of  the  Corporation  of  Glasgow,  at  Girgenti 
Inebriate  Home  in  Ayrshire,  Dr.  Clouston  presiding. 
There  was  a  large  attendance  of  members  of  the 
Association,  and  also  of  members  of  the  Corporation 
oi  Glasgow. 

Dr.  Carswell,  who  is  closely  identified  with  the 
treatment  of  inebriety  in  Glasgow,  showed  the  mem- 
bers over  the  Home  and  grounds,  and  afterwards  gave 
a  short  account  of  the  Home,  and  the  results  obtained 
by  the  use  of  such  an  institution.  This  was  followed 
by  a  discussion  upon  "  Habitual  Inebriety,"  and  being 
participated  in  both  by  the  medical  and  lay  element 
present,  afforded  a  most  interesting  discussion. 

The  subject  was  viewed  from  many  aspects,  and 
-while  all  were  agreed  that  it  was  worthy  of  deepest 
consideration,  yet  much  discussion  arose  as  to  the  best 
method  of  treating  this  great  evil. 

The  meeting  at  Girgenti  will  be  remembered  as  one 
of  the  most  enjoyable  and  interesting  meetings  of  the 
Association. 


Special  articles. 

DUTY  OF  MEDICAL  MEN  AS  WITNESSES.— II. 
In  the  Coroner's  Court. — The  Coroners  Act,  1887, 
Sec.  21,  provides  that  where  it  appears  to  the  coroner 
that  the  deceased  was  attended  at  his  death  or  during 
his  last  illness  by  any  legally  qualified  medical  prac- 
titioner, the  coroner  may  summon  such  practitioner  as 
a  witness ;  but  if  it  appears  to  the  coroner  that  the 
deceased  person  was  not  attended  at  his  death  or 
daring  his  last  illness  by  any  legally  qualified  medical 
practitioner,  the  coroner  may  summon  any  legally 
qualified  medical  practitioner  who  is  at  the  time  in 
actual  practice  in  or  near  the  place  where  the  death 


happened,  and  any  such  medical  witness  as  is  sum- 
moned in  pursuance  of  this  section  may  be  asked  to 
give  evidence  as  to  how,  in  his  opinion,  the  deceased 
came  to  his  death.  The  coroner  may,  either  in  his 
summons  for  the  attendance  of  such  medical  witness, 
or  at  any  time  between  the  issuing  of  that  summons 
and  the  end  of  the  inquest,  direct  such  medical  witness 
to  make  a  post-mortem  examination  of  the  body  of 
the  deceased,  with  or  without  an  analysis  of  the  con- 
tents of  the  stomach  or  intestines.  Provided  that 
where  a  person  states  upon  oath  before  the  coroner 
that  in  his  belief  the  death  of  the  deceased  was  caused 
partly  or  entirely  by  the  improper  or  negligent  treat- 
ment of  a  medical  practitioner  or  other  person,  such 
medical  practitioner  or  other  person  shall  not  be  allowed 
to  perform  or  assist  at  the  post-mortem  examination 
of  the  deceased.  If  a  majority  of  the  jury  sitting  at 
an  inquest  are  of  opinion  that  the  cause  of  death  has 
not  been  satisfactorily  explained  by  the  evidence  of 
the  medical  practitioner  or  other  witnesses  brought 
before  them,  they  may  require  the  coroner  in  writing 
to  summon  as  a  witness  some  other  legally  qualified 
medical  practitioner  named  by  them,  and  further  to 
direct  a  post-mortem  examination  of  the  deceased, 
with  or  without  an  analysis  of  the  contents  of  the 
stomach  or  intestines,  to  be  made  by  such  last-men- 
tioned practitioner,  and  that  whether  such  examina- 
tion has  been  previously  made  or  not,  and  the  coroner, 
shall  comply  with  such  requisition,  and  in  default 
shall  be  guilty  of  a  misdemeanour. 

Where  a  medical  practitioner  fails  to  obey  a  summons 
of  a  coroner  he  shall,  unless  he  shows  a  good  and  suffi- 
cient cause  for  not  having  obeyed  the  same,  be  liable 
on  summary  conviction  on  the  prosecution  of  the 
coroner,  or  of  any  two  of  the  jury,  to  a  fine  not  exceeding 
£$.  Where  a  place  has  been  provided  by  a  sanitary 
authority  or  nuisance  authority  for  the  reception  of 
dead  bodies  during  the  time  required  to  conduct  a 
post-mortem  examination,  the  coroner  may  order  the 
removal  of  a  dead  body  to  and  from  such  place  for 
carrying  out  such  examination,  and  the  cost  of  such 
removal  shall  be  deemed  to  be  part  of  the  expenses 
incurred  in  and  about  the  holding  of  an  inquest. 

With  respect  to  scientific  witnesses,  such  as  medical 
men,  who  are  necessarily  called  in  nearly  every  case 
which  comes  before  the  coroner's  jury,  it  is  to  be 
observed  that  they  form  an  exception  to  the  general 
rule  of  law,  which  confines  witnesses  to  a  statement  of 
such  facts  only  as  are  within  their  knowledge.  Scien- 
tific witnesses  are  allowed  to  state  their  opinions  upon  a 
matter  with  which  they  are  conversant,  and  thus  the 
opinions  of  medical  men  may  be  admitted  as  to  the 
cause  of  disease  or  death,  or  the  consequences  of 
wounds,  or  with  respect  to  the  sane  or  insane  state  of 
a  person's  mind  as  collected  from  a  number  of  circum- 
stances. But  the  weight  due  to  this,  as  well  as  to 
every  other  kind  of  evidence,  is  to  be  determined  by 
the  jury,  who  should  form  their  own  judgment  on  the 
matters  before  them,  and  are  not  concluded  by  that 
of  any  witness,  however  highly  qualified  or  respectable. 
Nor  is  this  always  an  easy  task,  there  being  no  evidence 
the  value  of  which  varies  so  immensely  as  this,  and 
respecting  which  it  is  so  difficult  to  lay  down  any  rules 
beforehand.  There  can  be  no  doubt  that  testimony  is 
constantly  received  as  scientific  evidence  to  which  it 
is  almost  profanation  to  apply  the  term ;  in  truth, 
witnesses  of  this  description  are  apt  to  presume  largely 
on  the  ignorance  of  their  hearers  with  respect  to  the 
subject  of  examination,  and  little  dread  prosecution 
for  perjury,  an  offence  of  which  it  is  extremely  difficult, 
indeed  almost  impossible,  to  convict  a  person  who 
only  swears  to  his  belief,  particularly  when  that  belief 
relates  to  scientific  matters.  On  the  other  hand,  mis- 
takes have  occasionally  arisen  from  not  attaching 
sufficient  weight  to  scientific  testimony.  Discrimina- 
tion should  be  exercised,  and  the  means  inquired  into 
which  the  witness  has  had  of  forming  a  judgment. 
It  must  be  conceded  that  our  practice  is  much  too 
loose  in  this  respect,  in  receiving  all  who  are  called 
doctors  as  witnesses,  not  only  physicians,  surgeons,  and 
apothecaries,  but  hospital  dressers,  students,  and 
quacks.     And,   further,   it  often   happens   that   men 


502     The  Medical  Press. 


FRANCE. 


distinguished  in  one  branch  of  a  science  or  profession 
have  but  little  knowledge  of  its  other  branches  ;  the 
most  able  physician  or  surgeon  may  know  compara- 
tively little  of  the  modes  of  detecting  poisons,  or  of 
other  intricate  branches  of  medical  jurisprudence,  so 
that  a  chemist  or  physiologist,  immeasurably  his 
inferior  in  every  other  respect,  might  prove  a  much 
more  valuable  witness  in  a  case  where  this  sort  of 
knowledge  is  required. 

Fees  of  Witnesses. — The  claim  of  medical  practi- 
tioners to  remuneration  for  their  services  until  recently 
stood  on  an  unsatisfactory  footing.  They  were  often 
required  to  give  evidence  in  Courts  of  Justice,  and 
complaints  were  frequent  of  the  inadequate  recompense 
received  for  loss  of  time,  and  for  out  of  pocket  ex- 
penses besides.  Power  to  fix  the  scale  of  fees  allowable 
in  Criminal  Courts  was  given  to  the  Home  Secretary  in 
1851  (14  and  15  Vict.,  Cap.  5s,  Sec.  5),  and  under  it 
the  scale  in  force  until  within  a  few  months  ago  was 
issued  in  February,  1858.  In  December,  1903,  the 
Home  Secretary  issued  some  new  regulations  governing 
the  allowances  payable  to  prosecutors  and  witnesses  in 
criminal  prosecutions. 

By  Sec.  22  of  the  Coroners  Act,  it  is  provided  that  a 
legally  qualified  medical  practitioner  who  has  attended 
at  a  coroner's  inquest  in  obedience  to  a  summons  of 
the  coroner  shall  be  entitled  to  receive  such  remunera- 
tion as  follows  ;    that  is  to  say, 

(a)  For  attending  to  give  evidence  at  any  inquest 
whereat  no  post-mortem  examination  has  been  made 
by  such  practitioner,  one  guinea ;    and 

(6)  For  making  a  post-mortem  examination  of  the 
body  of  the  deceased,  with  or  without  an  analysis  of 
the  contents  of  the  stomach  or  intestines,  and  for 
attending  to  give  evidence  thereon,  two  guineas.  But 
it  further  provides  that  (1)  any  fee  or  remuneration 
shall  not  be  paid  to  a  medical  practitioner  for  the 
performance  of  a  post-mortem  examination  instituted 
without  the  previous  direction  of  the  coroner ;  (2) 
where  an  inquest  is  held  on  the  body  of  a  person  who 
has  died  in  a  county  or  other  lunatic  asylum,  or  in  a 
public  hospital,  infirmary,  or  other  medical  institu- 
tion, or  in  a  building  or  place  belonging  thereto,  or 
used  for  the  reception  of  the  patients  thereof,  whether 
the  same  be  supported  by  endowments  or  by  voluntary 
subscriptions,  the  medical  officer,  whose  duty  it  may 
have  been  to  attend  the  deceased  person  as  a  medical 
officer  of  such  institution  as  aforesaid,  shall  not  be 
entitled  to  such  fee  or  remuneration. 

Under  the  new  regulations  made  by  the  Secretary 
of  State  governing  the  allowances  to  be  paid  to  pro- 
secutors and  witnesses  in  criminal  prosecutions,  prac- 
tising members  of  the  legal  and  medical  professions 
are  to  be  allowed  sums  not  exceeding  the  following 
amounts  : — For  attending  to  give  evidence  in  the  town 
or  place  where  the  witness  resides  or  practises  :  If  the 
witness  attends  to  give  evidence  in  one  case  only,  not 
more  than  £1  is.  per  diem  ;  if  the  witness  gives  evidence 
on  the  same  day  in  two  or  more  separate  and  distinct 
cases,  not  more  than  £2  2s.  ;  for  attending  to  give 
evidence  elsewhere' than  in  any  town  or  place  where 
the  witness  resides  or  practises,  whether  in  one  or  more 
cases,  not  more  than  £2  2s.  per  diem.  There  may  be 
allowed  to  expert  witnesses  such  allowances  for  attend- 
ing to  give  expert  evidence  as  the  court  may  consider 
reasonable,  including,  where  necessary,  an  allowance 
for  qualifying  to  give  evidence.  The  question  whether 
a  railway* fare  in  excess  of  third  class  is  to  be  allowed  in 
any  case  will  mainly  depend  on  what  may  be  reasonably 
supposed  to  be  the  witness'  ordinary  habit  and  prac- 
tice. First  class  fare  is  not  to  be  allowed  even  to  a 
professional  witness  unless  there  is  reasonable  ground 
for  supposing  that  he  ordinarily  travels  first  class. 

Fees  Payable  in  the  Superior  Courts. — Per  diem  :  If 
resident  in  the  town  in  which  the  cause  is  tried,  £  1  is.  ; 
if  resident  at  a  distance  from  the  place  of  trial,  in- 
clusive of  all  except  travelling  expenses  (if  the  witness 
attend  in  more  than  one  cause,  he  is  entitled  to  a 
proportionate  part  in  each  cause  only),  £2  2s.  to 
£$  3s.  For  travelling  expenses,  the  amount  reason- 
ably and  actually  paid  is  allowed,  provided  that  it 
does  not  exceed  is.  per  mile,  one  way. 


May  11,  1904 


In  the  Probate  Court,  if  resident  within  five  mile* 
of  the  General  Post  Ofl&ce,  £1  is.  per  day  ;  otherwise, 
£l  3s.,  including  board  and  lodging.  In  the  House 
of  Lords,  £2  2s.  per  day,  and  £1  is.  total  expenses,  if 
from  home.  Higher  charges  are,  under  special  circum- 
stances, sometimes  allowed.  Sundays  do  not  count  as 
time.  In  the  County  Court,  10s.  to  £1.  For  travelling 
expenses,  the  sum  reasonably  paid,  but  not  more  than 
6d.  per  mile  one  way. 


France. 


[from  our  own  correspondent.} 

Paris,  Haj8tfa,  IMC 
Acute  Leu  c  ami  a. 
The  clinical  history  of  acute  leucaemia,  says  M. 
Hirtz,  is  relatively  simple.  Yet  by  reason  of  the  de- 
velopment of  the  disease  and  the  variability  of  the 
cellular  reactions  which  constitute  its  anatomical 
substratum,  it  is  sometimes  delicate  and  difficult  to 
determine.  In  many  cases  the  hypertrophy  of  the 
ganglions,  splenic  or  hepatic,  is  insignificant  or  even 
absent.  Under  such  conditions,  the  rapid  develop- 
ment, the  high  temperature,  and  the  purpura  spots 
impose  the  necessity  of  a  careful  microscopic  examina- 
tion of  the  red  and  white  elements  of  the  blood. 

A  man,  aet.  57,  a  bill-poster  by  trade,  exempt  from 
any  hereditary  taint,  entered  the  hospital  because 
for  a  month  previously  he  experienced  a  sensation  of 
general  lassitude.  He  complained  of  no  pain,  had 
no  fever,  and  ate  well.  The  skin,  of  sallow  pallor, 
presented  over  the  body  and  the  lower  limbs  small 
spots  of  purpura.  The  ganglions  in  the  axillary 
and  the  inguinal  regions  were  much  hypertrophied, 
forming  irregular,  mobile,  elastic  and  painless  masses. 
The  cervical,  suboccipital  and  epitrochlean  ganglions 
were  slightly  hypertrophied,  while  the  liver  was  en- 
larged and  the  spleen  extended  to  the  umbilicus  and 
was  tender  to  palpation. 

Three  days  after  his  entry  to  the  hospital  the  tem- 
perature increased  slightly,  and  examination  of  the 
blood  made  two  days  later  showed  abundant 
leucocytes.  The  patient  gradually  grew  weaker,  and 
died  twelve  days  after  the  first  examination. 

This  morbid  affection  developed  in  six  weeks  with 
absolutely  classical  signs-~initial  fatigue,  pallor  of  the 
teguments,  hypertrophy  of  the  ganglions,  and  terminal 
haemorrhage. 

Leucsmia  in  a  Child. 
Different  to  the  preceding  is  the  case  of  acute 
leucaemia  observed  by  M.  Jeanselm  in  a  boy,  aet.  7. 
The  little  patient  succumbed  in  three  weeks  to  an 
affection  which  was  characterised  as  follows:— 
Purpura  hemorrhagica  following  an  attack  of  diph- 
theria, and  accompanied  with  hypertrophy  of  the 
ganglions  and  the  spleen ;  high  fever  and  intense 
anaemia.  When  he  was  brought  to  the  hospital  the 
cutaneous  haemorrhage  was  so  marked  that  the  case 
was  diagnosed  as  one  of  purpura  haemorrhagica. 
However,  the  excessive  anaemia  appearing  suddenly 
a  few  days  before,  when  the  child  was  in  the  best  of 
health,  militated  in  favour  of  leucaemia,  and  this  view 
was  confirmed  at  the  autopsy. 

M.  Leclerc  published  a  similar  case  observed  in  a 
girl,  aet.  17.  Numerous  ganglions,  of  which  the 
largest  were  of  the  size  of  a  walnut,  were  found  on 
the  sides  of  the  neck,  in  the  axillae,  and  in  the  inguinal 
regions.  The  abdomen  was  prominent  on  account  of 
considerable  hypertrophy  of  the  spleen,  while  the 
liver  passed  below  the  false  ribs.  The  patient  was 
much  troubled  with  a  cough  of  a  whooping  character ; 


May  ii,  1904. 


GERMANY. 


the  fever  was  high  (1040),  and  the  pulse  120.  The 
pallor  of  the  skin  was  very  marked. 

Rest  in  bed  and  injections  of  cacodylate  of  soda 
(5  to  8  cms.)  were  ordered  daily  for  six  days,  after 
which  from  15  to  20  drops  of  Fowler's  solution.  In 
spite  of  this  treatment,  the  patient  showed  no  signs 
of  progress,  and  a  month  subsequently  she  had  an 
attack  of  haemorrhage  from  the  intestines,  accom- 
panied by  exudation  of  blood  under  the  conjunctiva, 
the  eyelids,  the  neck,  and  part  of  the  thorax.  A  week 
afterwards  oedema  set  in  in  the  legs,  and  rapidly 
approached  the  abdomen.  The  patient  finally  suc- 
cumbed after  a  short  period  of  great  agitation. 

Hitherto,  says  M.  Leclerc,  it  was  believed  that 
leucaemia  was  a  chronic  affection,  covering  from  one 
to  four  or  five  years,  with  an  average  of  two  years. 
Acute  leucaemia  was  not  generally  admitted.  Ebstein 
and  Frankel  were  the  first  to  prove  the  existence  of 
the  acute  form,  which  presents  the  following  characters : 
Sudden  appearance ;  runs  its  course  in  from  two 
to  nine  weeks ;  enormous  increase  of  the  lymphocytes  ; 
a  special  group  of  symptoms  consisting  in  more  or 
less  hypertrophy  of  the  spleen,  liver  and  ganglions, 
and  above  all  the  early  appearance  of  cutaneous, 
mucous  or  visceral  haemorrhage.  If  to  the  above 
symptoms  a  more  or  less  elevated  temperature  be 
added,  we  have  the  picture  of  acute  leucaemia. 

Gilbert  and  Weil  have  described  three  forms  accord- 
ing to  the  predominance  of  one  or  other  of  the  sym- 
ptoms : — 

(a)  An  ordinary  form  in  which  the  spleen  and  the 
ganglions  are  more  or  less  hypertrophied. 

(6)  A  hemorrhagic  form  where  at  the  outset  there 
exists  great  pallor  of  the  teguments,  and  profuse 
haemorrhage,  while  the  hypertrophy  of  the  ganglions 
may  be  slight  or  non-existent ;  this  type  resembles 
pernicious  anaemia  or  purpura. 

(c)  A  pseudo-scorbutic  form,  in  which  the  lesions 
and  gingival  haemorrhage  are  very  marked. 

Germans. 

[from  our  own  correspondent.] 


The  Medical  Press.    503 


Bum*,  May  7th,  1904. 

At  the  Surgical  Congress,  Hr.  Beck,  of  Carlsruhe, 
gave  a  communication  on 

Cardiolysis. 

Three  cases  were  reported  of  attachment  of  the 
pericardium  to  the  chest  wall  as  a  consequence  of 
pleurisy,  in  which  he  separated  t he  attachments.  There 
had  been  ascites,  cyanosis,  irregular  action  of  the 
heart,  with  puckering  of  the  lower  anterior  wall  of  the 
thorax. 

The  first  case  was  that  of  a  boy,  aet.  9,  who  had  had 
pleurisy,  which  had  led  to  empyema.  Examina- 
tion last  year  showed  a  suffering  appearance,  emacia- 
tion, oedema,  shortness  of  breath,  cyanosis,  systolic 
contraction  in  the  region  of  the  apex  with  renal  stasis, 
albumin  in  the  urine,  Ac.  The  speaker,  with  a  view 
to  separation  of  adhesions,  resected  the  fourth,  fifth, 
and  sixth  ribs.  The  adhesions  were  separated,  but 
the  heart's  action  became  so  feeble  that  it  had  to  be 
supported  by  digitalis,  Ac.  A  good  recovery  took 
place.  Three  months  later  all  the  signs  of  disease  had 
vanished.  The  boy  was  now  well  developed  and  could 
perform  gymnastic  exercises  without  trouble. 

The  second  case  was  that  of  a  man,  aet.  26,  who  had 
gone  through  a  similar  illness  and  presented  similar 
features.  There  was  a  feeling  of  illness,  palpitation 
and  shortness  of  breath.  There  was  redness  about  a 
cicatrix  where  thoracentesis  had  been  performed,  and 
there  was  some  discharge  of  pus.    There  were  also 


ascites,  cyanosis,  imperfect  cardiac  action,  and  drawing 
in  of  the  thoracic  wall  over  the  apex.  Cardiolysis  was 
performed.  Complete  recovery  had  taken  place  in 
three  months.  Thoracoplasty  was  then  performed 
after  Schede's  method  with  implantation  of  the  scapula. 
The  patient  was  now  quite  well  and  Ible  to  follow  his 
employment. 

The  third  case  was  that  of  a  man,  aet.  26.  who  had 
had  tuberculous  pleuritis.  In  1902  he  had  oedema, 
albuminuria,  and  engorged  liver.  Here  there  was  no 
contraction  at  the  apex.  The  patient,  when  first  seen, 
was  so  ill  that  no  operation  could  be  thought  oi.  When 
the  general  condition  had  improved,  however,  from 
rest,  digitalis  and  camphor,  cardiolysis  was  performed. 
Here  there  were  tuberculous  metastases  and  tuber- 
culous swellings  on  the  pericardium.  Complete  re- 
covery took  place. 

In  all  three  cases  the  mischief  was  associated  with 
pleurisy,  and  in  all  grave  cardiac  disturbances  had 
been  going  on  for  several  years. 

Hr.  Hoffa  showed  some 

Late  Results  of  Tendon  Plastique. 

He  said  that  several  years  had  now  elapsed  since 
the  first  introduction  oi  this  beneficent  operation  by 
Nikoladoni ;  the  operation  had  been  frequently  per- 
formed, and  it  was  time  to  consider  the  results  of  its 
performance.  The  conditions  for  a  good  result  were 
faultless  asepsis,  careful  arrest  of  haemorrhage,  and 
accurately  adjusted  tension  of  muscle  and  tendon.  As 
a  rule,  the  paralysed  muscles  were  atrophied  and  de- 
generated, and  they  had  to  be  carefully  examined  with 
a  view  to  determining  whether  functional  activity 
could  be  brought  about  again.  In  spinal  infantile 
paralysis  there  was  irregular  fatty  degeneration  of 
muscles,  so  that  in  these  cases  mobility  could  be  re- 
stored. A  various  coloration  of  the  muscle  was  seenr 
from  red]  to  yellow.  It  must  always  be  borne  in 
mind  that  transplantation  could  be  successful  only 
when  there  were  remnants  of  muscle  capable  of  re- 
generation. A  rosy  red  colour  of  the  muscle  was  in- 
dicative of  such  a  favourable  condition.  If  the  con- 
dition was  favourable  positively  ideal  results  were 
obtained.  Suitable  tension  was  to  be  provided  for, 
and  the  elasticity  and  tonus  to  be  raised  by  shortening 
of  the  muscle.  Where  the  paralysis  was  complete  no 
ideal  result  could  be  obtained.  Here  enough  would 
have  been  done  if  the  patients  could  be  freed  from 
their  bandages.  (A  large  number  of  cases  were  shown 
in  which  excellent  results  had  been  obtained.) 

Hr.  Kehr,  Halberstadt,  discussed  some  new 
Operations  on  the  Liver  and  Biliary  System, 
showing  cases.  The  first  was  a  case  of  ligature  of 
the  hepatic  artery  for  aneurysm.  A  man,  aet.  30,  had 
suffered  for  nearly  two  years  from  colic  and  haemor- 
rhage from  the  stomach  and  bowels.  He  was  very 
anaemic  and  emaciated.  A  tumour  of  the  gall-bladder 
was  found  filled  with  concretions.  Free  arterial 
bleeding  followed  the  incision  into  the  gall-bladder, 
but  it  was  arrested  by  ligature.  Behind  the  cystic 
duct  was  an  aneurysm  that  was  extirpated  alter  ligature 
of  the  hepatic  artery.     The  case  did  well. 

2.  Resection  of  the  ductus  choledochus  and  hepaticus 
with  subsequent  hepatico-duodenostomy.  The  patient 
was  a  man,  aet.  45,  who  had  been  jaundiced  forj  years, 
and  was  very  much  emaciated.  A  tensely  filled  gall- 
bladder was  found.  At  the  operation  scirrhus  of  the 
choledochus  was  found.  After  this  the  complete 
operation  was  carried  out.  The  case  did  well,  and 
the  patient  had  gained  18  lbs.  in  weight. 

In  the  next  case  hepato-colangio-enterostomy  was 
performed  for  stenosis  of  the  pylorus  and  choledochus* 

The  next  was  the  restoration  of  a  defect  of  the 


504    The  Medical  Press. 


HUNGARY. 


May  it,  1904. 


•duodenum  following  an  operation.  The  duodenum 
was  severed,  both  ends  closed,  and  simultaneously 
gastroenterostomy  was  performed.  The  case  did  well 
M  fiist,  but  ended  fatally  five  weeks  later. 

The  next  was  a  case  oi  the  implantation  of  a  fistulous 
-tract  ot  a  retention  cyst  of  the  pancreas  into  the  gall- 
bladder, with  later  gastro-cystotomy.  The  patient  had 
-suffered  from  biliary  calculi  lor  twelve  years,  and  also 
from  acute  disease  oi  the  pancreas  with  fatty  necrosis. 
Operation  was  performed,  leaving  two  complete  fistulae, 
one  of  the  gall-bladder  and  the  other  oi  a  cyst  of  the 
.pancreas.  This  fistula  was  implanted  into  the  gall* 
bladder,  and  the  latter  into  the  stomach.  The  case 
did  well,  the  patient  leaving  the  hospital  in  three  and 
a  half  weeks.  The  pancreatic  secretion  now  passed 
into  the  stomach  along  with  the  bile. 


Hustrta. 


[from  our  own  correspondent.] 

VinrNA,  May  7th,  1904. 
Gastric  Perforation. 

At  the  Gesellschaft  der  Aerzte  Lotheissen 
showed  a  patient,  aet.  23,  a  moulder,  on  whom  he  had 
performed  laparotomy  for  ulcus  ventricuii.  On  open- 
ing the  abdomen  the  omenta  ma  jus  and  minus  were 
covered  with  a  plastic  layer.  The  abdomen  was  well 
washed  with  a  sterilised  solution  of  salt  and  then  the 
ulcer  covered  with  the  large  and  small  omenta,  carefully 
closing  up  the  wound  with  a  few  stitches.  The  patient 
speedily  recovered. 

The  result  of  these  cases  is  always  very  unsatis- 
factory, with  a  mortality  of  67  per  cent.  If  the 
operation  be  performed  within  the  first  twelve  hours 
the  operation  seems  to  be  more  successful,  averaging 
90  per  cent.  The  foregoing  case  was  operated  on  about 
one  hour  after  recognising  the  lesion. 

Abscess  in  the  Middle  Ear. 

Alt  next  presented  a  case  to  the  members  where 
he  had  operated  for  an  abscess  in  the  middle  ear.  The 
patient  was  a  male,  aet.  41,  who  had  suffered  with  his 
ears  from  childhood.  About  eight  weeks  before  the 
operation  he  complained  of  severe  pain  in  the  head, 
with  oedema  and  swelling  around  the  mastoid  process. 
This  was  opened  and  a  part  of  the  mastoid  bone 
chiselled  out,  which  freed  the  middle  ear  of  a  great 
quantity  of  matter.  On  closer  examination,  it  was 
found  that  the  dura  mater  of  the  brain  substance  was 
also  infiltrated  with  pus,  where  there  was  a  great  loss 
of  tissue.  The  whole  was  cleaned  out,  and  the  wound 
healed  up  without  any  other  accident.  A  plastic 
operation  finally  cleared  away  all  appearance  of  the 
destruction. 

Lupus  Tumidus. 

Ehrmann  exhibited  two  cases  of  lupus,  one  a  female, 
aet.  18.  the  second  a  male,  aet.  40,  both  ot  which  h 
treated  with  a  33  per  cent,  paste  of  resorcin  and  the 
Rdntgen  rays,  which  produced  an  erosive  action, 
allowing  the  rays  to  penetrate  deep  into  the  tissues 
with  a  perfectly  successful  issue. 

Serum  in  Puerperal  Fever. 

Peham  next  treated  the  members  to  a  long  de- 
scription of  his  experiments  with  serum  in  puerperal 
cases.  The  serum  used  was  the  product  of  the  original 
streptococci  of  puerperal  fever  after  passing  through 
the  horse.  This  serum,  therefore,  differs  from  Mar- 
morek's,  inasmuch  as  the  streptococci  of  the  puerperal 
patient  had  passed  through  an  intermediary  like  the 
horse  before  using  it  on  the  human  subject  as  an  im- 
munising agent.  This  serum,  he  contends,  is  a  specific 
against  the  streptococcic  disease.  His  method  of 
diagnosis  depends  on  the  result  oi  a  bacteriological 


examination  of  the  uterine  secretions,  as  well  as  that 
of  the  blood  corpuscle.  In  very  severe  cases  of  strepto- 
coccic infection  where  the  serum  was  used,  not  a  single 
death  occurred,  even  where  peritonitis  had  set  in. 
His  closing  advice  is  in  the  terms  of  all  other  great 
men  who  meet  with  success— operate  early,  and  use 
ho  less  than  250  cubic  centimetres  of  fluid  in  the 
injection.  This  is  a  large  quantity  to  insert  under  the 
skin,  but  he  assures  us  that  he  never  met  with  one 
adverse  symptom  in  all  his  twenty -nine  cases  treated. 
Rheumatic  Nodules. 

Wick  read  a  long  paper  to  the  members  on  chronic 
rheumatism  and  its  products.  He  affirmed  that  in  2  to  5 
per  cent,  of  cases  of  chronic  and  acute  articular  rheu- 
matism small  nodules,  varying  from  the  size  of  a  pin's 
head  to  a  walnut,  are  constantly  to  be  found  under 
the  skin,  and  around  the  tendons  of  muscles,  par- 
ticularly in  the  flexors  of  the  arm.  Histologically 
these  neoplasms  are  fibrous  tissue  with  a  tendency, 
to  calcification  or  necrosis.  The  acute  form  of  rheu- 
matism has  similar  conditions  as  in  arthritis,  nodosa, 
osteo-arthritis,  deformans,  ankylopoetica,  &c.,  which, 
histologically,  is  the  same  process  which  produces  the 
deposit  in  the  chronic  form,  and  is,  therefore,  iden- 
tical in  origin.  He  considered  these  nodules  patho- 
gnomonic in  a  differential  diagnosis  of  the  disease 
from  the  rheumatism  of  scarlet  fever,  gonorrhoea,  &c, 
as  well  as  the  presence  of  the  uraemic  diathesis. 

Riehl  contended  that  these  nodules  were  not  suffi- 
ciently characteristic  to  differentially  diagnose  the 
arthritic  condition  ot  the  disease,  as  there  were  often 
multiple  tumours  tending  to  calcification  under  the 
skin  in  gouty  conditions. 

Braun  stated  that  such  nodules  were  often  found  along 
the  margins  of  the  ribs,  which  he  thought  was  probably 
due  to  arthritic  rheumatism. 

Radiometric  Practice. 

Freund  reported  that  the  Rdntgen  rays  in  contact 
with  a  2  per  cent,  solution  of  iodoform  and  chloroform 
had  a  chemical  action  which  liberated  free  iodine  and 
produced  a  light  yellow  colour  resembling  in  many 
respects  the  violet  rays.  He  considers  this  an  ex- 
cellent quantitive  measure  of  the  intensity  of  rays 
in  calculating  the  amount  ot  iodine  set  free. 
Tmnue  Cumerinjs. 

Rosenberg  showed  ten  worms  of  the  taeniae'eumerinae 
type,  which  he  had,  curiously  enough,  obtained  irom 
a  child  fourteen  menths  old.  It  is  well  knowa  that 
this  wprm  is  peculiar  to  the  dog  and  cat,  both  of  which 
animals  the  child  had  frequently  played  with.  This 
annelide  is  rarely  found  in  the  human  intestine  except 
in  childhood.  Of  the  1 50  taeniae  which  he  had  obtained 
from  children  this  was  the  first  taenia  cumerina. 
The  treatment  was  with  extractum  filicis  maris  in 
one  gramme  doses,  care  being  taken  that  it  passed  as 
speedily  as  possible  through  the  bowel.  In  children* 
of  this  tender  age  such  drugs  must  be  given  by  means 
of  a  tube. 

Esc  he  rich  asked  how  he  could  get  this  thick  fluid 
through  a  tube  into  the  stomach. 

Rosenberg  replied  that  he  diluted  it  with  a  syrup 
oi  peppermint. 


Dnnoars* 


[prom  our  own  correspondent.] 


Budapest,  May  7th,  1904. 
At    the    recent    meeting   of    the    Budapest   Royal 
Medical  Society,  Dr.  Koresi  read  a  paper  on  the 

Diet  in  Acute  Bright's  Disease. 
The  object  to  be  accomplished  is  to  relieve  the  kidneys 


May  ii,  1904. 


OPERATING   THEATRES. 


Th»  Medical  Pmsss.    505 


of  work  as  far  as  possible.  This  is  done  by  instituting 
a  diet  of  milk  akme.  The  problem  is  not  a  simple 
one.  The  ingestion  of  proteid  substance  cannot  be 
reduced  below  a  certain  point,  because  even  if  the 
diet  is  a  fluid  one  entirely,  the  excretion  of  proteid 
substances  in  the  urine  will  continue.  Also,  if  the 
diet  is  so  limited  the  patient  will  lose  flesh  and  strength, 
and  the  constitutional  symptoms  will  be  aggravated. 
If  milk  is  well  borne,  then  we  can  give  even  three  or 
three  and  a  half  litres  daily,  but  if  it  fails  to  produce 
improvement,  it  is  best  to  allow  a  more  liberal  diet, 
and  to  pay  less  attention  to  the  albuminuria  than  to 
the  general  condition.  As  a  food  preference  is 
.given  to  skim  milk,  as  it  is  more  nutritive.  It  may 
be  necessary  to  depart  from  this  rule  if  the  skim  milk 
is  not  well  borne.  Dr.  Kdresi  recommends  the  following 
fefimen  for  nephritic  cases : — Exclusive  milk  diet 
at  the  start ;  the  albumin  at  first  will  increase,  then 
diminish,  and  then  remain  stationary.  The  result 
should  be  noted,  and  when  the  quantity  of  albumin 
finally  remains  stationary,  then  meat  may  be  allowed. 
Then  the  albuminuric  curve  should  be  noted  again. 
From  these  data  we  may  determine  whether  milk,  milk 
and  vegetables,  or  milk,  meat  and  vegetables  as  a  diet 
is  preferable  in  reducing  the  albumin  to  a  minimum. 
As  regards  the  different  foods,  bread  may  be  allowed, 
alcohol  should  be  prohibited,  beef  and  veal  are  pre- 
ferable to  mutton  and  poultry ;  fish  is  absolutely  to 
be  forbidden,  contrary  to  the  opinion  of  American 
authors.  All  these  remarks  apply  only  to  the  cases 
in  which  a  strict  milk  diet  cannot  be  enforced. 

Dr.  Markely  spoke  about  the  involvement  of  the 
ovaries  in  mumps.  He  has  found  that  the  genital  glands 
were  affected  by  the  epidemic  of  mumps,  infection  oc- 
curring in  twenty-six  cases  out  of  sixty-six  patients.  The 
region  over  the  ovaries  was  sensitive  to  pressure,  and 
more  or  less  painful  He  suggests  that  possibly 
mumps  may  be  responsible  for  some  of  the  patho- 
logical changes  observed  in  later  life.  The  doctor  also 
recommends  that  this  region  should  be  investigated 
in  girls,  and  local  measures  applied  at  once  upon  the 
slightest  symptoms  of  inflammation  of  the  ovaries  or 
their  environment.  By  warding  off  or  dispelling 
inflammation  in  the  early  stage  we  can  safely  guarantee 
that  the  ovaries  will  pass  unscathed  through  the 
disease. 

Dr.  Mandel  read  a  paper  on  "  Psychoses  Associated 
with  Migraine."  Simple  hemicrania  sometimes 
develops  mental  irritation  or  depression,  anger,  or 
slight  hallucinations.  With  migraine  of  an  epileptic 
type,  with  muscular  twitching  or  ocular  manifestations, 
a  visual  aura  can  precede  an  attack  of  migraine  as 
v*U.  True  epileptic  nature  of  the  migraine  is  noted 
when  the  visual  aura  assumes  a  red  colour.  Abortive 
attacks  may  occur  in  both,  or  one  is  substituted  for 
the  other.  Psychical  symptoms  or  a  psychical  equiva- 
lent can  occur  in  either.  A  transitory  psychosis 
sometimes  follows  or  accompanies  migraine.  This  is 
important  from  a  therapeutical  standpoint,  indicating 
the  necessity  of  an  anti-epileptic  treatment  for  migraine. 
In  the  same  way,  the  writer  notes  close  clinical  relation 
between  attacks  of  migraine  and  hysteria  major. 
Several  types  of  cases  are  on  record.  ( 1 )  A  combination 
of  hallucinations  of  sight,  confusion,  amnesia  or 
ataxia,  aphasia,  with  attacks  of  migraine  lasting  six 
hours.  (2)  Confusion,  with  religious  delirium.  (3) 
Hemicrania,  with  temporary  blindness,  paresthesia 
aQd  a  speech  disturbance.  (4)  Hemicrania  after  mental 
SQock,  with  anxious  delirium,  and  disturbance  of 
consciousness  for  three  days.  The  occurrence  of  these 
psychoses  is,  however,  rare. 


Zbe  ®peratftt0  Gbeatrea. 


LONDON  HOSPITAL. 
Operation  for  Subdiaphragmatic  Abscess  on 
the  Left  Side. — Mr.  Frederick  Eve  operated  on*a 
man,  set.  19,  who  had  been  admitted  suffering  from 
subdiaphragmatic  abscess.  The  history  of  the*  case 
was  that  three  weeks  before  admission  the  patient  was 
attacked  with  pain  in  the  upper  part  of  the  abdomen, 
which  "  doubled  him  up."  There  was  no  vomiting, 
but  pain  was  present  on  deep  inspiration,  which  was 
chiefly  referred  to  the  left  costal  margin.  On  examina- 
tion, an  ill-defined  induration  was  felt  below  the  left 
costal  margin,  quite  resonant  and  not  moving  on 
respiration;  there  was  diminished  movement  of  the 
lower  part  of  the  chest  on  the  left  side  and  also  dulness 
up  to  the  sixth  rib  anteriorly  and  to  the  tenth  posteriorly. 
There  was  no  friction  sound.  An  examination  by 
means  of  the  X-rays  and  ftie  fluorescent  screen  showed 
that  the  left  side  of  the  diaphragm  was  motionless  at  a 
point  about  half  ah  inch  below  the  nipple  line.  A 
blood  examination  gave  considerable  increase  of  poly- 
nuclear  leucocytes.  Before  operation  Mr.  Eve  dis- 
cussed the  differential  diagnosis  in  this  case.  In  the 
first  place,  he  said,  it  was  necessary  to  exclude  enlarge- 
ment of  the  spleen,  which  in  some  instances*produced 
(as  he  had  found  on  operating  on  one  case)  distinct 
displacement  of  the  diaphragm  upwards.  A  splenic 
tumour,  he  pointed  out,  would  have  a  well-defined 
margin,  a  ^notch  Jwould  be  felt,  and  it  would  move 
freely  on  respiration,  whereas  in  this  case  the  swelling 
was  ill-defined  and  immovable ;  both  the  general 
symptoms  and  the  physical  signs  pointed  to  sub- 
diaphragmatic abscess,  among  the  general  symptoms 
being  pyrexia,  constitutional  disturbance,  and  leuco- 
cytosis,  the  latter  pointing  especially  to  the  presence 
of  pus.  Among  the  important  local  signs  were  the 
immobility  of  the  left  side  of  the  chest,  the  upward 
displacement  and  immobility  of  the  diaphragm,  and 
the  local  pain  and  tenderness  below  the  costal  margin, 
with  the  presence  of  an  ill-defined  lump.  The  question, 
he  said,  arose  whether  the  subdiaphragmatic  abscess 
was  due  primarily  to  an  intra-thoracic  or  to  an  intra- 
abdominal cause.  It  was  presumed  that  the  latter 
was  the  case,  notwithstanding  the  dulness  in  the  lower 
part  of  the  chest.  This  was  believed  to  be  due  to  dis- 
placement of  the  diaphragm  upwards,  owing  to  the 
absence  of  pulmonary  physical  signs,  such  as  frictional 
rdles  or  crepitations.  The  previous  history,  he  con- 
sidered, threw  no  light  on  the  cause  of  the  intra- 
abdominal trouble.  An  incision  was  made  over  the 
ninth  inter-costal  space  in  the  anterior  axillary  line, 
and  portions  of  the  ninth  and  tenth  ribs  about  three 
inches  in  length  were  removed  after  stripping  them  of 
their  periosteum  with  Doyen's  raspatory.  A  trochar 
was  then  passed  through  the  diaphragm  towards  the 
swelling  in  several  directions,  but  no  pus  was  found. 
Another  incision  was  therefore  made  externally  ver- 
tically downwards  from  the  costal  margin  over  the 
abdominalswelling.  After  cutting  through  the  muscles 
the  peritoneum  was  found  to  be  so  thick  and  adherent 
that  it  was  thought  advisable  to  open  the  peritoneal 
cavity  lower  down,  where  the  peritoneum  was  healthy, 
in-order  to  explore  the  lower  relations  of  the  swelling. 
The  finger  of  the  left  hand  being  passed  into  the  peri- 
toneal ^cavity  below  the  swelling,  a  fine  trochar  was 
inserted  into  the  mass  through  the  upper  part  of  the 
abdominal  wound  so  that  its  direction  could  be  gauged 
by  the  finger  in  the  abdomen.  A  small  quantity  of 
pus  escaped  through  the  trochar ;  the  opening  in  the 
peritoneal  cavity  was  then  closed  with  stitches,  the 


506     T»  MEDICAL  PftESS. 


OPERATING   THEATRES. 


May  ii,  1904. 


lower  angle  of  the  wound  protected  with  gauze  ;  then, 
guided  by  the  trochar,  the  surgeon  made  a  free  opening 
into  the  abscess,  which  was  of  small  extent,  although 
evidently  surrounded  by  a  large  amount  of  inflamma- 
tory tissue.  A  drainage-tube  was  inserted  into  the 
abscess  and  the  wound  in  the  thorax  closed.  Mr.  Eve 
remarked  that  as  a  general  rule  it  might  be  said  that 
the  safest  and  most  convenient  method  of  approaching 
a  subdiaphragmatic  abscess  was  through  the  lower  part 
of  the  chest  and  diaphragm  ;  the  pus,  however,  in 
this  case  did  not  appear  to  be  immediately  below  the 
diaphragm,  although  that  structure  was  pressed  up- 
wards. In  dealing  with  ill- denned  inflammatory 
masses  within  the  abdomen,  it  was  far  safer,  he  con- 
sidered, to  ascertain  the  relations  of  the  swelling  by 
opening  the  peritoneum  where  it  was  non-adherent 
than  to  cut  blindly  through  inflamed  and  matted 
structures  the  nature  of  which  could  not  be  recognised. 
The  subsequent  progress  of  this  patient  was  un- 
eventful. The  discharge  soon  ceased  and  the  man  left 
the  hospital  with  the  wound  healed  in  less  than  a  month. 
The  bacteriological  examination  of  the  pus  in  this  case 
was  of  great  interest.  Dr.  Thresh  reported  that  the 
cultures  constituted  an  apparently  pure  growth  of  a 
bacillus  which  showed  the  morphological  characters, 
staining  reaction,  all  the  culture  characters,  and 
agglutination  reaction  of  the  typhoid  bacillus.  This 
suggests,  Mr.  Eve  thought,  that  the  patient  may  have 
suffered  from  ambulatory  typhoid  followed  after  a 
longer  or  shorter  interval  by  an  intra-abdominal 
abscess,  the  site  of  which  could  not  be  precisely  deter- 
mined. 

GREAT  NORTHERN  HOSPITAL. 
Case  of  Trephining  for  Symptoms  of  Cerebral 
Compression. — Mr.  Peyton  Beale  operated  on  a 
man,  aet.  about  38,  who  had  been  admitted  a  few 
hours  previously  in  an  unconscious  condition  with 
right  hemiplegia.  He  was  engaged  in  a  public  house, 
the  landlord  of  which  gave  the  following  particulars  of 
the  case  : — He  had  been  in  the  habit  of  taking  long 
bicycle  rides — over  a  hundred  miles  at  a  stretch — and 
during  the  last  few  weeks  had  complained  of  feeling 
weak,  with  occasional  shooting  pains  in  the  head,  and 
want  of  sleep.  On  Sunday  he  rode  a  hundred  and  ten 
miles  on  a  bicycle,  coming  home  rather  exhausted  ;  the 
next  day  (Monday)  he  went  about  his  work  as  usual, 
but  at  2  o'clock,  after  his  dinner,  he  sat  down  in  a  chair, 
and  at  2.30  was  found  by  his  master  still  in  the  chair 
and  apparently  asleep.  As  it  was  not  possible  to  rouse 
him,  he  was  taken  at  once  to  the  hospital.  Upon 
examination,  he  was  found  to  have  complete  right 
hemiplegia  and  more  or  less  paralysis  of  the  muscles 
of  the  left  side  as  well ;  there  was  very  indefinite 
anaesthesia  as  tested  with  a  pin  over  the  whole  surface 
of  the  body,  but  as  far  as  could  be  ascertained  most 
of  the  facial  muscles  contracted  when  the  skin  of  the 
face  was  pricked.  Otherwise,  his  symptoms  were  such 
as  were  typically  found  in  a  case  of  cerebral  compres- 
sion. The  symptoms  were  so  indefinite  upon  the  whole 
as  to  exclude  the  diagnosis  of  cerebral  haemorrhage  in 
or  about  the  internal  capsule,  but  Mr.  Beale  remarked 
that  he  had  seen  several  cases  of  this  kind,  and  in  one 
of  them  haemorrhage  around  the  pons  was  found  to  be 
the  cause,  and  in  the  others  a  collection  of  pus  around 
the  medulla  oblongata  ;  in  such  cases,  in  his  experience, 
it  had  been  impossible  to  do  any  good  beyond  trephin- 
ing and  relieving  pressure  symptoms,  such  being  always 
due  in  cases  of  this  kind  to  distension  of  the  ventricles 
of  the  brain  with  fluid,  and  to  oedema  of  the  brain. 
The  man's  condition  was  so  critical  that  a  rapid 
trephining  was  the  only  course  that  could  be  adopted, 
so,  the  head  having  been  shaved  and  the  scalp  cleansed, 


a  flap  of  skin  on  the  left  side  of  the  head  was  turned 
down  and  a  two  inch  trephine  applied  over  the  left 
temporo-occipital  region.  On  removal  of  the  bone,  the 
membranes  bulged  through  the  opening  to  an  almost 
alarming  extent ;  there  was  no  pulsation  of  the  brain 
to  be  seen  or  felt.  A  small  slit  was  made  in  the  dura 
mater,  and  a  grooved  director  pushed  through  the 
brain  substance  with  a  view  of  reaching  the  lateral 
ventricle.  After  one  or  two  attempts  the  director 
entered  the  cavity  and  clear  fluid  spurted  up  along  the 
groove  of  the  instrument.  A  small  drainage-tube  was 
then  insinuated  along  the  groove  into  the  ventricle, 
and  after  a  little  manipulation  clear  fluid  issued  from 
the  end  freely.  It  spurted  at  first  for  a  distance  of  an 
inch  and  a  half  beyond  the  tube  and  about  four  ounces 
in  all  were  evacuated  by  this  means.  After  this  the 
brain  pulsation  was  quite  evident,  and  the  brain  no 
longer  bulged  through  the  trephine  opening.  Prac- 
tically no  anaesthetic  was  administered  after  the  skin 
flap  had  been  made,  but  the  patient's  general  condition 
was  in  no  way  improved  after  relief  of  tension  from  the 
escape  of  fluid.  The  man  was  put  back  to  bed  and 
remained  in  practically  the  same  state  as  he  was  in 
when  admitted  until  his  death,  which  was  due  to 
gradual  failure  of  respiration  about  five  hours  after 
operation. 

At  the  post-mortem  examination,  a  collection  of 
pus  was  found  around  the  medulla  and  pons,  extending 
downwards  around  the  spinal  cord  for  about  an  inch 
and  upwards  into  the  fourth  ventricle.  The  brain 
was  removed,  and  hardened  for  future  examination, 
but  no  evidence  could  be  found  to  show  that  the  pus 
had  extended  from  the  temporal  bone,  or,  indeed  r 
from  any  part  of  the  skull.  It  was  quite  clear  that 
the  condition  was  a  suppurative  basal  meningitis. 
Mr.  Beale  considered  that  it  was  of  the  nature  of  a 
pyaemic  abscess,  and  stated  that  he  had  operated  upon 
three  or  four  cases  of  apparently  precisely  the  same 
nature,  and  had  not  been  able  to  ascertain  the  primary 
seat  of  infection.  It  was  difficult,  he  said,  to  believe 
that  the  meninges  around  the  medulla  could  be  tbe 
seat  of  the  primary  infection.  He  had  also  operated 
upon  an  apparently  similar  case,  but  in  this  a  definite 
track  was  found  leading  from  one  of  the  fissures  m  the 
petrous  portion  of  the  temporal  bone,  the  pus  having 
owed  its  origin  to  an  old  middle-ear  disease.  This 
track  was  only  found  after  very  careful  examination, 
and  he  thought  it  quite  possible  that  these  cases  of 
apparent  primary  suppurative  basal  meningitis  were 
in  reality  secondary  to  old  and  long-forgotten  middle- 
ear  disease. 


In  the  House  of  Commons  last  week,  Mr.  Schwann 
asked  the  President  of  the  Local  Government  Board 
what  steps,  if  any,  had  been  taken  to  deal  with  the 
report  of  the  Departmental  Committee  on  Nursing 
which  was  made  in  November,  1902,  and  whether  the 
recommendations  of  the  Committee  in  that  report 
were  to  be  adopted  as  they  stand.  Mr.  Long  replied 
that,  as  stated  in  the  reply  given  to  the  honourable 
member  by  his  honourable  friend,  the  Secretary  to  the 
Local  Government  Board,  on  April  21st,  after  the  report 
of  tbe  Departmental  Committee  was  made,  he  received 
a  considerable  number  of  representations  on  points 
relating  to  their  recommendations.  He  had  caused 
these  representations  to  be  brought  before  the  Com- 
mittee, who  had  duly  considered  them.  He  was  now 
in  possession  of  the  views  of  the  Committee,  and  would 
shortly  decide  precisely  what  course  should  be  takea 
in  the  matter. 

The  annual  general  meeting  of  the  Medical 
Defence  Union,  Limited,  will  be  held  at  the 
Medical  Society's  Rooms,  11  Chandos  Street, 
Cavendish  Square,  London,  on  May  26th,  at  5  p.m* 


May  ii»  1904. 


LEADING   ARTICLES. 


The  Medical  Pftsss.    5°7 


Rigistxkhd  for  Teahsmubiox  Abroad. 

Xflbe  flDe&tcal  press  an&  Circular* 

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"  SALUS  POPULI  SUPREMA  LEX." 


WEDNESDAY,  MAY  n,  1904. 


THE  STANDARDISATION  OF 
DISINFECTANTS. 
A  striking  feature  of  latter-day  commerce  has 
been  the  growth  of  the  trade  in  disinfectants,  or 
more  properly  in  those  substances  that  are  so  called 
by  their  vendors.  This  development  has  probably 
been  nearly,  if  not  quite,  as  great  proportionately 
as  that  of  the  patent  medicine  business,  to 
which  it  is  closely  allied.  But  there  is  this  differ- 
ence between  the  two,  that  though  the  trade  in 
proprietary  medicine  could  be  extirpated  root  and 
branch  without  anyone,  except  the  proprietors, 
being  a  penny  the  worse,  a  sound  disinfectant  is 
needed  at  some  time  or  another  in  almost  every 
household.  For  the  latter  reason  a  State  guarantee 
of  the  composition  and  efficacy  of  the  preparation 
that  passes  as  a  disinfectant  is  sadly  needed.  The 
ignorance  that  prevails  among  the  public  with 
regard  to  the  use  and  potentialities  of  disinfectants 
is  appalling,  and  it  need  hardly  be  urged  that  dis- 
infectants, like  all  other  powerful  and  poisonous 
substances,  should  only  be  sold  in  response  to 
medical  order.  Such  a  desideratum  is,  however, 
not  likely  to  be  forthcoming  for  many  a  long  year, 
but  in  the  meantime  for  the  prevention  of  disease, 
and  for  the  protection  of  people  from  fraud,  a 
standard  is  needed  to  which  all  substances  that  call 
themselves  disinfectants  should  conform.  A 
disinfectant  is  a  body  that  is  capable  of  destroying 
bacterial  life — whether  in  the  form  of  the  adult 
organism  or  the  spore — if  brought  into  contact  with 
it  for  a  certain  period  of  time.  If  this  simple  fact 
were  generally  appreciated  a  distinct  step  in  ad- 
vance would  have  been  taken.  Most  people  have 
the  vaguest  ideas  of  what  a  disinfectant  can  do, 
and  what  it  can  be  expected  to  do.  In  their 
eyes  it  is  the  modern  homologue  of  the  amulet 
or  the  charm,  and  can  chase  infection  away  by  the 
magic    of    its    presence.     Infection    to    them    is 


closely  allied  to  bad  smells,  and  a  disinfectant 
should,  therefore,  be  a  strong-smelling  substance. 
Recently  there  has  been  somewhat  of  a  revolt 
against  the  old-fashioned  odoriferous  disinfectant,, 
and  a  demand  has  sprung  up  for  something  that  can 
frighten  away  disease-germs  without  producing 
nausea.  The  ingenuity  of  the  trade  has  been 
equal  to  the  occasion,  and  several  pleasant-smelling 
preparations,  free  of  any  notable  germicidal  power, 
have  been  forthcoming,  and  have  commanded 
a  ready  sale.  There  is  only  one  word  to  describe 
the  grandiloquent  claims  of  the  manufacturers  of 
several  such  bodies  ;  unless  they  are  capable  of 
thoroughly  destroying  bacterial  life  in  a  reasonable 
time,  when  brought  into  contact  with  disease- 
organisms,  they  have  no  more  right  to  the  title  of 
disinfectants  than  their  proprietors  have  to  the 
profits  they  make  out  of  them.  There  are,  of 
course,  a  vast  number  of  chemical  bodies  that  are 
more  or  less  inimical  to  the  growth  and  existence 
of  lowly -organised  fauna  and  flora,  but  no  honest 
man  would  countenance  the  sale  of  distilled  water 
as  a  disinfectant  because  bacteria  fail  to  flourish  in 
it.  Nor  should  the  ignorance  and  credulity  of  the 
public  be  allowed  to  be  preyed  upon  because  they 
imagine  that  sprinkling  disinfectant  solutions  on 
the  carpet,  or  leaving  them  exposed  in  saucers  in  a 
room,  can  affect  the  spread  of  disease.  What  is 
required  is, that  all  substances  sold  as  disinfectants 
should  be  distinctly  labelled  with  directions  for  use, 
and  that  such  directions  should  state  truthfully  the 
strength  in  which  the  substance  must  be  employed, 
and  the  length  of  time  necessary,  for  the  destruc- 
tion of  ordinary  pathogenic  organisms  and  their 
spores.  Were  this  insisted  upon,  a  large  number 
of  the  present  preparations  would  disappear  from 
the  market ;  and  a  much  smaller  quantity  of  those 
that  remain  would  be  used.  If  it  were  clearly 
understood  that  the  perfunctory  shaking  of  dis- 
infectant powders  down  evil-smelling  water- 
closets  only  added  one  more  odour  to  those  already 
existing,  and  that  dipping  the  hands  in  "  Health- 
ine  "  or  "  Hygienia  "  was  considerably  less  effica- 
cious than  washing  them  in  soap  and  water,  the 
demand  for  these  preparations  would  suffer 
considerably.  On  the  other  hand,  the  dangers  of 
disease-dissemination  would  be  substantially 
minimised,  for  only  real  germicides  in  potent 
strengths  would  be  employed,  and  then  only  in 
such  ways  as  would  be  likely  to  bring  about  the 
desired  result.  But  the  first  step  in  this  direction 
is  that  a  bacteriological  standard  should  be  set, 
and  that  the  proprietors  of  all  preparations 
should  be  made  to  declare  how  their  disinfectant 
compared  in  germicidal  powers  with  that  standard. 
The  lines  on  which  this  could  be  worked  practically 
have  been  already  demonstrated  by  Dr.  Rideal  and 
Mr.  Ainstie  Walker,  and  the  need  for  the  adoption  of 
some  such  plan  is  no  less  than  for  Government 
standards  for  food  substances — and  drugs.  For 
medical  men,  too,  it  would  be  a  great  convenience^ 
The  practitioner  is  nothing  if  not  up  to  date,  and 
his  advice  is  constantly  sought  as  to  the  use  of  this, 
or  that  disinfectant.     His  knowledge  of  them  at 


508Th»  Medical  Press, 


LEADING  ARTICLES. 


May  ii,  1904. 


present  is  perforce  confined  to  the  claims  made  on 
their  behalf  by  their  owners,  some  of  which  are 
genuine,  and  others,  like  the  report  of  Mark 
Twain's  death, "  grossly  exaggerated."  The  public 
"exposure  of  these  claims  would  involve  an  indi- 
vidual worker  in  an  action  for  damages  that  would 
probably  ruin  him,  and,  moreover,  it  is  not  the 
individual's  business.  %  The^Government  should  see 
that  the  public  are  protected  from  fraud  by  the 
sale  of  worthless  disinfectants  with  at  least  as  much 
assiduity  as  they  display  in  the  prevention  of  fraud 
in  any  other  direction.  For  it  is  a  matter  in  which 
the  public  cannot  judge  for  themselves,  and  their 
medical  advisers  at  present  are  not  always  able  to 
give  them  definite  information. 


PHYSICAL  EDUCATION  IN  SCHOOLS. 
The  report  which  has  just  been  issued  by  the 
Inter-Departmental  Committee  upon  the  model 
course  of  physical  exercises  now  in  use  in  schools 
renders  it  abundantly  clear  that  the  present  sys- 
tem is  not  without  its  imperfections  and  draw- 
backs. Further,  it  is  obvious  that  the  physical 
training  prescribed  for  children  must  differ  in  its 
essential  details  from  that  which  is  intended  for 
recruits,  not  only  in  degree  but  also  in  kind. 
Were  a  system  to  be  devised  and  carried  out  which 
would,  although  compulsory,  be  at  the  same  time 
adapted  to  the  frame  of  a  growing  child  and  effi- 
cient in  developing  those  parts  of  the  body  which 
most  need  training,  the  fear  of  anything  approach- 
ing to  "  militarism  "  would  have  no  grounds  for 
its  existence.  It  is  not  only  the  muscular  system 
of  a  child  which  needs  to  be  regularly  exercised, 
but  the  circulatory  and  respiratory  systems,  and, 
in  fact,  the\whole  physical  being,  which  require 
alike  careful  training  and  skilled  supervision  if 
they  are  to  be  brought  up  to  the  highest  possible 
level  of  efficiency.  The  exact  manner  in  which 
this  supervision  is  to  be  carried  out  is  a  matter 
worthy  of  careful  consideration.  While  it  is,  no 
doubt,  highly  desirable  that  each  individual 
teacher  should  be  certificated  in  hygiene  and 
elementary  physiology,  as  well  as  in  first-aid — 
though  in  the  opinion  of  some  this  is  too  much  to 
expect — yet  there  must  ever  be  constantly  recur- 
ring instances  in  school  life  in  which  the  assistance 
of  a  duly  qualified  medical  practitioner  for  pur- 
poses of  inspection  is  absolutely  necessary.  Thus, 
it  is  stated  in  the  introduction  to  the  report  of 
the  committee  that  nasal  breathing  should  be 
more  cultivated  in  the  child,  which,  considering 
the  great  prevalence  of  nasal  obstruction  at  this 
age  and  consequent  reversion  of  the  functions  of 
the  nose  and  mouth,  is  a  most  excellent  recom- 
mendation. But  the  diagnosis  of  adenoids  or  of  an 
incipient  infectious  disease  characterised  by  a 
catarrhal  or  inflamed  condition  of  the  fauces  or 
of  the  adjacent  parts  can  hardly  be  made 
by  a  school-teacher,  however  well  certificated 
in  hygiene.  This  is  only  one  illustration  of  the 
inadequateness  of  any  school  staff  unless  there  be 
a  medical  practitioner  definitely  connected  with 
the  establishment.  The  ideal  arrangement 
would  be  to  appoint  to  every  school  under  muni- 


cipal  control  a  medical  officer  with  a  fixed  salary 
whose  duties  would  be  those  of  periodical  inspec- 
tion and  visitation  of  the  health  and  physical 
condition  of  the  pupils,  and  to  advise  on  all 
matters  of  sanitation,  exercise  and  so  on  that  might 
arise.  If  cases  of  constitutional  weakness,  from 
whatever  cause,  are  to  be  reported  to  the  local 
authority,  a  medical  practitioner  alone  is  com- 
petent to  make  such  a  report.  Upon  such  an 
officer,  also,  should  rest  the  responsibility  of  ex- 
cluding a  child  from  taking  part  in  violent 
outdoor  games,  or  even  from  going  through 
the  various  physical  exercises  in  vogue  at 
schools.  In  the  conduct  and  arrangement  of  the 
latter  skilled  medical  advice  is,  obviously,  of 
first  importance,  though  it  might  appear  to  a 
casual  observer  that  any  person  trained  in  calis- 
thenics and  possessing  a  more  or  less  rudimentary 
knowledge  of  anatomy  and  physiology  would  be 
sufficiently  qualified  to  undertake  such  duties. 
Now  that  scholastic  control  will  be  vested  in  the 
new  local  authorities,  it  is  to  be  hoped, 
for  the  sake  of  the  future  national  physique,  that 
the  need  for  more  thorough  and  individual  medi- 
cal inspection  will  be  fully  recognised. 

ULTRAMICROSCOPY. 
We  commented  some  weeks  ago  on  the  neces- 
sary limitation  to  the  study  of  small  bodies  by 
means  of  the  ordinary  microscope,  pointing  out 
that  these  limits  were  fixed  by  the  length  of  the 
light-wave.     At  the  same  time  it  was  noted  that 
although  small  bodies  may  be  in  themselves  in- 
visible, yet  they  may,  by  their  reflective  or  re- 
fractive  action   on   light,  subject   themselves  to 
methods   of   examination.     In    the    case    of   the 
germs  of  some  diseases — for  example,  the  foot- 
and-mouth  disease  of   cattle — this   power   shows 
itself  by  giving  the  culture-fluid  a  certain  opales- 
cence.    A  most  ingenious  device  has,   however, 
been  invented  by  Siedentoff  and  Zsyinaudy,  by 
which    the  individual  minute  particles  are  made 
the  subject  of  examination.     The  method  used  is 
one  by  which  light  rays  of  great  intensity  fall  upon 
the  object  in  such  a  manner  that  the  reflected 
rays  only  shall  reach  the  eye  of  the  observer. 
By  this  means,  an  extension  has  been  given  to  our 
powers    of    investigation    of    incalculable    value. 
Under  the  present  methods  of  microscopic  study 
the  limit  of  useful  vision  might  be  taken  as  one- 
thousandth   part   of   a   millimetre,  though  theo- 
retically it  was  somewhat  smaller,  while  by  means 
of  the  new  methods  the  limit  is  lowered  to  one- 
millionth   part  of  a   millimetre.     The   power  of 
the  apparatus   depends  on  the  strength  of  the 
illuminant  used,  and  the  best  effects  have  been 
gained   from   concentrated   sunlight  in  summer. 
The  arc  light  may,  however,  be  substituted.    An 
instrument  embodying  Siedentoff  and  Zsyinaudy's 
principles   has   been   constructed   by   Zeiss,  and 
Herr   Raehlmann   has  published   an   account  of 
the  results  of  some  of  his  observations  made  by 
its  means.     Ordinary  solutions  of  glycogen  usually 
exhibit  a  certain  bluish  opalescence,  although  the 
highest    immersion    lenses    previously  used  have 


May  ii,  1904. 


NOTES  ON  CURRENT  TOPICS.     Thb  Medical  P»bs».     509 


discovered  no  heterogeneity  in  the  fluid.  On 
examination  with  the  "  ultramicroscope,''  if 
we  may  use  such  a  term,  immense  numbers  of 
tiny  bodies  are  seen,  which  in  very  dilute  solutions 
can  be  distinguished  as  individuals.  These  bodies 
are  in  a  continual  state  of  oscillation,  which  in- 
creases as  they  approach  each  other,  and  disappear 
altogether  on  excessive  dilution.  Raehlmann 
makes  the  interesting  suggestion  that  these  move- 
ments are  the  expression  of  the  influence  of 
gravitation  by  which  the  bodies  attract  each  other. 
On  adding  a  few  drops  of  diastase  to  the  solution 
of  glycogen  the  bodies  grow  smaller  and  smaller, 
and  Anally  disappear  altogether.  An  interesting 
practical  discovery  has  also  been  made  by  Raehl- 
mann in  the  examination  of  the  humours  of  an 
eye  enucleated  on  account  of  sympathetic  oph- 
thalmia. With  a  magnification  of  2,400  dia- 
meters rod-shaped  motile  bodies  were  discovered, 
which  seemed  to  be  bacteria.  This  observation 
naturally  leads  to  the  opinion  that  sympathetic 
ophthalmia  is  a  metastatic  infective  process, 
produced  by  micro-organisms.  Not  only,  how- 
ever, is  the  method  suitable  for  investigating 
previously  ultra-visible  bodies,  but  it  gives  a  new 
point  of  view  for  the  larger  bacteria.  For  in- 
stance, a  much  better  examination  of  live  or- 
ganisms can  be  made  by  this  means  than  in  the 
ordinary  hanging-drop.  It  is  not,  of  course, 
suitable  for  investigation  of  tissues,  since  the  object 
to  be  examined  should  be  in  the  form  of  particles 
suspended  in  fluid. 


•Rotes  on  Current  Copies. 

A  Pneumatic  Tourniquet. 
The  despatch  with  which  an  operation  can  be 
conducted,  not  to  speak  of  the  lessened  risk  to  the 
patient,  is  greatly  facilitated  by  rendering  the 
tissues  as  evascular  as  possible  by  the  application 
of  some  external  constriction.  The  india-rubber 
tourniquet,  or  Esmarch's  bandage,  is  most  generally 
adopted  when  it  is  desirable  to  operate  by  the  so- 
called  "  bloodless  method."  Simple  as  this  con- 
trivance is,  there  is  more  bungling  seen  in  its 
application  to  a  limb  by  inexperienced  dressers 
or  nurses  than  in  almost  any  other  preliminary 
process.  Few  things  are  more  annoying  to  the 
spectators  or  more  vexatious  to  the  surgeon  than 
to  see  the  bandage  so  loosely  applied  to  the  limb 
that  the  re-application  becomes  absolutely  neces- 
sary after  the  first  incision,  to  the  great  incon- 
venience of  the  operator  and  the  possible  vitiation 
of  asepsis.  The  opposite  extreme  is  equally 
to  be  deprecated,  for  in  emaciated  subjects, 
or  in  those  whose  integumentary  tissues  possess 
but  feeble  resisting  powers,  troublesome  forms  of 
paralysis  are  apt  to  supervene,  for  the  production 
of  which  the  anaesthetic  may  be  wrongly  blamed. 
The  lack  of  common  sense  sometimes  exhibited 
on  the  part  of  assistants  at  operations  is  per- 
fectly amazing,  for  it  is  not  at  all  infrequent  to 
find  a  tourniquet  being  most  carefully  applied 
without  any  previous  elevation  of  the  limb  or 
firm  stroking  towards  the  heart,  or  else  that  it  is 


taken  straight  from  an  instrument-cupboard, 
hastily  dipped  in  lotion,  and  wound  round  the 
part  in  most  dangerous  proximity  to  the  asep- 
ticalry-prepared  area  of  operation.  Dr.  Harvey 
Cushing,  of  Baltimore,  (a)  has  employed  an  in- 
flatable tourniquet  attached  to  an  ordinary  bicycle 
foot-pump  in  place  of  the  elastic  bandage.  It 
can  be  readily  rendered  aseptic,  and  when  once 
in  place  it  can  be  inflated  by  an  assistant  to  any 
degree  of  constriction  required,  the  compression 
being  everywhere  uniform.  In  cerebral  surgery 
this  form  of  tourniquet  has  been  found  of  great 
service  in  controlling  the  haemorrhage  from  the  skull  - 
flaps,  and  it  can  be  easily  applied  around  the 
fronto-occipital  circumference  of  the  skull.  In 
eighteen  cranial  operations  in  which  the  pneu- 
matic tourniquet  was  used  it  is  stated  to  have 
served  its  purpose  admirably. 

"  Tramp  "  Accommodation. 

The  natural  history  of  the  "  tramp  "  is  likely 
to  attract  a  good  deal  of  attention  from  sanitary 
reformers  in  the  near  future  as  it  has  from  social 
reformers  for  generations  past.  There  is  good 
reason  to  believe  that  our  present  system  with 
regard  to  the  Poor-law  accommodation  of  the 
vagrant  class  is  conducted  on  lines  of  false  eco- 
nomy. The  food  that  is  given  a  tramp  is  not 
enough  to  enable  him  to  undertake  hard  work.  The 
labour  exacted  from  him  in  return  for  poor  fare 
and  lodging  is  utterly  disproportionate,  and  so 
prolonged  and  arduous  as  to  unfit  him  for  further 
effort.  An  Oldham  lady  has  framed  a  fierce  in- 
dictment of  the  way  in  which  he  is  treated  by  our 
Poor-law  administration.  The  lady  in  question, 
Mrs.  Higgs,  gathered  her  information  on  the  spot, 
and  described  her  two  days'  amateur  stay  in  a 
tramp  ward  as  a  descent  into  an  Inferno.  The 
method  of  bathing  she  condemed  as  barbarous, 
inasmuch  as  the  exposure  was  injurious  to  health, 
while  clothes  were  often  spoilt  by  stoving.  She 
pictured  a  man  having  undergone  the  tramp- ward 
treatment  of  "  unmoist  "  food— "  to  eat  which 
was  positive  torture  "—a  cold  bath,  and  a  heavy 
task,  facing  the  foodless  and  prospectless  day  as  he 
emerged  from  the  workhouse.  The  worst  part 
of  this  unhappy  state  of  affairs  is  that  it  falls 
most  heavily  on  the  genuine  working  man  thrown 
"  on  the  road  "  by  undeserved  misfortune.  The 
fact  of  the  matter  appears  to  be  that  the  casual 
ward  system  of  the  whole  kingdom  stands  urgently 
in  need  of  searching  inquiry  and  reform. 

Spasmodic  .Agraphia. 
Of  all  the  so-called  occupation-neuroses  that 
of  writer's  cramp  is,  perhaps,  the  commonest 
and  most  troublesome.  The  peculiar,  spasmodic 
rigidity  which  sometimes  occurs  in  the  hand  and 
arm  muscles  as  a  result  of  much  writing  has  to  be 
carefully  distinguished  from  mere  fatigue  on  the 
one  hand,  and  also  from  ^various  disorders  of  the 
central  nervous  system  on  the  other,  whether 
these  be  functional  or  organic.  Interference  with 
the  finely  co-ordinated   movements  involved 


in 


(a)  Medical  Newt,  March  24th,  1904. 


5^0  The  Mstmcail  Pros*. 


NOTES   ON    CURRENT    TOPICS. 


May  ii.  1904. 


the  delicate  act  of  writing— one  of  those  last  to 
"be  acquired — is  not  wfreq-aently  one  of  the 
•earliest  signs  of  an  incipient  but  steadily  pro- 
gressive nervous  disease,  such  as  general  paralysis 
or  multiple  sclerosis.  The  essential  feature  of 
true  scrivener's  palsy  is,  however,  that  it  is  spas- 
modic, for  though  the  entire  upper  extremity 
may  quickly  become  paretic,  both  the  fatigue  and 
the  paralysis  pass  away  upon  the  cessation  of  the 
movement  or  attitude  which  was  responsible  for 
their  production.  Improper  methods  of  holding 
the  pen  are,  according  to  Gowers,  chiefly  to  blame 
tor  the  causation  of  this  troublesome  affection. 
Its  pathology  is  by  no  means  fully  established. 
Strumpell  draws  an  analogy  between  writer's 
cramp  and  stammering,  both  of  which  are  charac- 
terised by  loss  of  co-ordination  and  the  existence 
of  a  highly  nervous  state.  That  the  condition  is 
chiefly  a  neurosis  is  proved  by  the  fact  that  several 
cases  have  been  completely  cured  by  suggestion 
under  hypnosis  (Bernheim  and  Lloyd  Tuckey). 
In  forty-seven  cases  Dr.  Gustaf  Norstrom,(a)  of 
Hew  York,  has  found  scattered  areas  of  myositis 
in  the  muscles  concerned,  massage  of  which 
caused  a  speedy  return  to  the  normal.  A  reflex 
excitability  of  the  motor  nerves  is  also  stated  to 
accompany  these  inyositic  deposits.  The  em- 
ployment of  massage  or  electricity  in  the  treat- 
ment of  the  malady  has  long  been  recognised, 
"but  they  have  not,  hitherto,  been  supposed  to 
act  by  removing  inflammatory  deposits  from  the 
muscles  themselves. 


The  Bole  of  the  Sense  Organs  in  Disease. 

Indispensable  as  the  organs  of  special  sense 
are  to  the  full  enjoyment  of  life,  there  are  many 
occasions  on  which  the  stimulation  of  one  or 
more  of  them  gives  rise  to  anything  but  pleasurable 
feelings.  The  two  primitive  forms  of  stimuli, 
whether  arising  from  without  or  from  within, 
are  early  recognised  by  the  growing  infant  as 
cither  pleasant  or  unpleasant  As  soon  as  the 
external  environment  has  made  sufficient  im- 
pression upon  the  mind  and  has  become  a  neces- 
sary factor  in  its  everyday  consciousness,  mixed 
varieties  of  stimuli  begin  to  claim  the  attention. 
The  power  of  the  special  senses  to  awaken  a  long 
dormant  chain  of  ideas  and  to  revive  faded 
memories  of  the  past  has  many  a  time  been  a 
theme  for  the  poet's  imagination,  and  it  has  also 
been  utilised  from  the  therapeutic  standpoint 
in  certain  forms  of  mental  disorder.  "  Memory, 
imagination,  old  sentiments  and  associations, 
are  more  readily  reached  through  the  sense  of 
smell  than  by  almost  any  other  channel,"  says 
Oliver  Wendell  Holmes,  and  the  truth  of  this 
statement  is  borne  out  by  the  familiar  feeling 
we  sometimes  experience  of  having  been  in  a  strange 
place  on  a  previous  occasion,  an  illusion  produced 
chiefly  through  the  medium  of  the  olfactory 
sense.  Stimulation  of  the  retino-cerebral  appara- 
tus, perhaps  because  it  is  more  or  less  continuous, 
is  not  so  potent  to  recall  the  past,  yet  hallucinations 
of  vision    are     frequent  among  the  insane.     Im- 

(a)  Xtw  Yort  Med.  Journ.,  March  12th,  1904. 


pressions  received  through  the  auditory  nerve 
appear  to  be  more  often  misconstrued  than  those 
arising  from  stimulation  of  any  other  special  sense. 
Knowing  this,  it  does  not  seem  impossible  that  the 
judicious  presentation  of  pleasant  auditory  stimuli, 
such  as  beautiful  music,  may  have  the  power, 
under  certain  circumstances,  of  bringing  back  a 
11  concatenation  of  ideas  "  when  these  have  been 
wandering. 

Ovariotomy  in  Inoperable  Cancer. 

Fashion  prevails  in  surgical  procedures  no  less 
than  in  every  other  walk  of  life.     Operations  are 
conceived,  executed,  written  about,  practised  for  a 
time,  and    then   fall  into   disuse.     A    few  years 
ago,  castration  was  widely  in  vogue  in  the  treatment 
of  enlarged  prostate  ;  to-day  it  is  hardly  heard  of. 
So,  too,  with  ovariotomy  for  inoperable  cancer. 
Several  cases  were  reported  in  which  striking  and 
unexpected  results  were  obtained,  and  many  sur- 
geons gave  the  method  a  trial.     But  their  experi- 
ence was  disappointing,  and  now  it  is  considered 
barely  justifiable.     That  there  are  some  cases  in 
which  it  can  bring  about  arrest,  if  not  cure,  of  the 
disease  would  seem  to  be  the  fact ;  the  pity  is  that 
there  is  no  means  of  distinguishing  which,  among 
the    vast   number   of   cases    daily  occurring,  are 
amenable    to    the    treatment.     One    remarkable 
instance  has  lately  been  shown  to  the  Academie 
de  Medecine  by  Dr.  Reynds,  of  Marseilles.     The 
patient  was  a  woman,  aged  33,  who  was  suffering 
from  pavement-celled  epitheliomataof  both  breasts. 
The  disease  had  been  going  on  for  nine  years  on 
one  side  and  for  three  on  the  other,  and  there  was 
marked  general  cachexia.     The  disease  was  too  far 
advanced  to  allow  of  excision  of  the  breast,  and 
Dr.  Reynes  decided  to  perform  double  ovariotomy. 
The  result  was  most  gratifying.      Soon  after  the 
operation   the  tumours  began  to   show  decided 
involution,  and  a  large  ulcerated  patch  covering  one 
breast  began  to  heal.      In  two  months  the  process 
was  complete,  and  when  the  case  was  shown  at  the 
Academie   nothing   was   visible   except   a  slight 
cicatrix,  with  a  little  induration.     The  diagnosis 
was  confirmed  by  microscopical  examination,  and 
there  was  no  doubt  as  to  the  genuine  character  of 
the  case.     The  breast,   as  forming  part  of  the 
genital   organs,   would  be  more  likely  to  be  af- 
fected    by   ovariotomy   than     other     structures, 
but  that  malignant  disease  of    such   chronicity 
should   disappear  entirely  is  a  remarkable  fact. 
When  medical  men  are  asked  if  nothing  can  be  done 
for  inoperable  cases  of  cancer,  and  a  patient  is 
likely  to  go  the  round  of  the  quacks,  it  may  be 
well  to  remember  that  this  heroic  form  of  treat- 
ment is  sometimes  successful. 


Canoer  Research. 
The  first  report  by  the  investigators  appointed 
by  the  Cancer  Research  Fund  of  the  Colleges  of 
Physicians  and  Surgeons  has  just  been  issued.  It 
contains  but  thirty-six  pages,  but  these  are  full  of 
interesting  and  valuable  matter  The  first  part 
deals  with  the  distribution  of  cancer  among  the 
lower  animals,  and  though  it  only  confirms  what 


May  si,  1004. 


NOTES  ON  CURRENT  TOPICS. 


The  Medical  Press.     511 


lias  already  been  reported  from  other  sources,  it  puts 
those  reports  on  an  authoritative  basis.  Growths 
having  all  the  histological  features  of  carcinoma 
have  been  found  in  birds,  beasts,  and  fishes — the 
dog,  the  horse,  the  sheep,  the  cat,  the  hen,  the 
parakeet,  the  cod,  the  trout,  and  many  others. 
Sufficient  observations  have  not  been  made  as  yet 
to  determine  in  which  classes  cancer  is  most 
oommon,  but  it  is  worthy  of  notice  that  not  only 
does  it  occur  in  animals  having  no  common  trait 
or  article  of  diet,  but  also  that  it  occurs  in  wild 
animals  as  well  as  in  domestic  ones.  These 
observations  put  out  of  court  many  of  the  silly 
suggestions  that  are  continually  being  made  with 
regard  to  the  origin  of  cancer ;  the  cause  of  the 
disease  is  yet  far  to  seek.  The  possibility  of  in- 
fection is  the  other  notable  feature  of  this  ad- 
mirable research.  Professor  Jensen  had  already 
announced  that  he  had  succeeded  in  transplanting 
•carcinomatous  growths  from  one  mouse  to  another, 
and  he  kindly  sent  specimens  of  growths  to  be  used 
ior  the  purpose.  Inoculations  were  made  in  259 
mice,  and  in  some  sixty  cases  the  disease  took  on 
growth,  the  cells  forming  the  new  tumours  being 
similar  in  character  to  those  introduced.  The 
tumour-material  supplied  could  be  sterilised,  both 
by  breaking  it  up  in  a  mortar  and  by  subjecting 
it  to  a  temperature  of  37°  C.  for  twenty-four  hours. 
Some  mice  appeared  to  be  naturally  immune  to 
cancer  inoculation,  but  the  character  of  the  growth 
itself  seemed  to  be  of  great  importance  in  determin- 
ing whether  it  could  grow  or  not.  A  single  growth 
did  not  confer  immunity,  for  second  inoculations 
•could  be  made  successfully  into  animals  in  which 
growth  had  already  been  taking  place  for  ten 
-weeks.  It  is  greatly  to  be  hoped  that  these 
researches  will  bear  fruit  as  practical  as  the  labours 
of  these  diligent  workers  deserve. 

Vermin  in  Children's  Heads. 
One  of  the  matters  that  may  be  commended 
to  the  notice  of  the  new  education  authorities,  who 
come  to  this  work,  it  is  hoped,  filled  with  zeal  and 
energy,  is  the  question  of  pediculosis  of  the  scalp 
in  children.  How  common,  one  might  almost  say 
universal,  this  condition  is  among  the  children  of 
the  poor  in  large  towns  is  a  fact  which  every 
hospital  medical  officer  knows  well,  and  also  how 
frequently  impetigo  of  the  scalp  and  body  follows 
in  its  train.  That  verminous  heads  are  felt  to  be  a 
disgrace  even  among  the  poorest  is  witnessed  by 
the  fact  that  mothers  will  always  indignantly  deny 
that  the  condition  exists,  and  even  ocular  demon- 
stration will  only  elicit  the  comment  that  the  chil- 
dren must  have  contracted  it  at  school.  In  the 
more  respectable  and  careful  households  there  is 
a  great  deal  of  truth  in  the  contention,  and  it  is 
very  hard  on  those  who  try  to  keep  their  children 
clean  that  they  receive  so  little  encouragement  from 
the  school  authorities,  especially  when  it  is  con- 
sidered that  they  are  obliged  nolens  volens  to  send 
their  children  to  schooL  No  doubt  the  subject  is 
a  large  one  to  tackle,  and  it  is  not  to  be  expected 
that  vermin  can  be  eradicated  from  the  heads  of 
all  the  pupils  at  one  stroke  ot  the  pen,  but  it  is 


incumbent  on  those  responsible  for  the  manage- 
ment of  public  elementary  schools  to  take  precau- 
tions that  the  clean  shall  not  suffer  from  association 
with  the  dirty.  One  of  the  primary  provisions 
that  needs  attention  is  that  each  child  shall  have  a 
peg  for  his  own  cap  and  coat,  so  that  there  is  a 
reasonable  chance  of  each  being  able  to  keep  his 
garments  from  contamination.  A  periodical 
survey  of  the  heads  by  the  medical  officer  should 
be  made,  and  the  parents  informed  of  those  in  which 
lice  were  found.  It  is  doubtful  whether  the 
managers  would  have  power  to  have  the  childrens 
hair  cut  and  the  scalp  treated  with  disinfectants, 
but  the  sense  of  shame  might  be  brought  into  play 
in  the  case  of  most  of  the  parents.  If  this  were 
not  found  to  be  sufficient,  a  one-clause  Enabling 
Act  might  be  put  through  Parliament  without 
opposition.  Filthy  scalps  are  a  disgrace  and  a 
danger,  and  it  would  be  well  for  all  available  pressure 
to  be  brought  to  bear  to  make  them  less  common. 


The  Central  Midwives  Board  and  Irish 
Maternity  Hospitals. 

It  has  now  transpired  that  at  its  last  meeting, 
held  in  London  on  April  28th,  the  Central  Midwives 
Board  had  again  under  consideration  the  extremely 
unpleasant  position  which  they  at  present  occupy 
in  their  relations  with  the  great  Irish  maternity 
hospitals.  It  is  satisfactory  to  learn  that  a  con- 
siderable change  has  taken  place  in  the  feeling  of 
the  Board,  and  that  whereas  a  short  time  ago  only 
two  of  its  members  could  be  persuaded^to'recognise 
the  impossibility  and  unfairness  of  the  regulations 
of  the  Board,  now  the  following  resolution  was 
lost  by  a  majority  of  one  only  : — "  That  in  lieu  of 
the  certificates  of  personal  attendance  upon  twenty 
cases  the  Board  may,  if  they  think  fit,  accept  the 
certificates  of  the  Master  or  chief  resident  medical 
officer  of  a  hospital  or  institution  where  midwives 
are  trained  that  the  candidate  has  attended  the 
course  of  training  prescribed  for^pupil-midwives 
for  the  period  and  in  accordance  with  the  regu 
lations  in  force  in  such  hospital  or  institution.  All 
applications  for  the  recognition  of  such  certificates 
must  be  made  by  the  Master  or  chief  resident 
medical  officer  of  the  hospital  or  institution  apply- 
ing, and  must  be  accompanied  with  a  statement 
of  the  regulations  for  the  time  being  in  force,  and 
of  any  special  circumstances  which  prevent  can- 
didates trained  in  such  hospitals  or  institutions 
from  producing  the  ordinary  certificates  required 
by  the  Board."  We  desire  to  congratulate  Mr. 
Heywood  Johnstone,  who  proposed  this  resolution, 
on  his  changed  attitude  and  on  his  apparent  resolve 
to  carry  through  the  pledges  which  he  gave  to 
different  Irish  bodies.  He  must  recognise  the 
fairness  of,  and  necessity  for,  the  adoption  of 
some  such  resolution  as  that  he  proposed,  and  we 
confess  to  a  feeling  of  sympathy  with  him  when 
the  Frankenstein  he  created  refused  by  a  majority 
of  one  to  adopt  it.  We  think,  however,  that  the 
Irish  hospitals  will  not  be  much  surprised  at  the 
result,  and  as  it  is  obvious  by  this  time  that  their 
demands  will  be  agreed  to,  if  not  now,  at  any  rate 
within  a  short  time,  the  temporary  check  is  of  no 


512    The  Medical  Press.    NOTES    ON    CURRENT   TOPICS. 


May  ii,  1904. 


great  importance.  The  Central  Midwives  Board 
must  secure  the  passage  of  a  Bill  dealing  with  the 
"  financial  question,"  and  one  part  of  the  price 
which  they  will  have  to  pay  for  this  measure  will 
be  such  an  amendment  of  their  regulations  as  will 
ensure  that  justice  is  done  to  the  Irish  training 
centres. 


A  Discharged  Lunatic  Attendant. 
A  case  of  a  remarkable  nature  was  last  week 
heard  at  Lambeth  County  Court,  when  Dr.  F.  H. 
Edwards,  Medical  Superintendent  of  Camberwell 
House,  a  private  lunatic  asylum,  was  sued  by 
John  Kenny  to  recover  damages  for  false  arrest 
and  imprisonment.  The  plaintiff,  who  conducted 
his  own  case,  said  that  while  an  attendant  at 
Camberwell  House,  a  patient  died  from  broken 
ribs,  and  an  inquest  was  held.  Plaintiff  reported 
other  cases  of  ill-treatment,  and  his  life  was  subse- 
quently made  a  burden  to  him.  Finally,  believ- 
ing his  life  to  be  in  danger,  he  left,  and  received 
from  Dr.  Edwards  a  testimonial  saying  he  had 
discharged  his  duties  "in  a  generally  satis- 
factory manner."  He  could  not  get  another 
situation  because  of  this  word  "  generally,"  and 
failing  to  get  it  altered  he  assaulted  Dr.  Edwards 
in  the  street  by  throwing  an  egg  at  him.  A  police- 
man was  called,  and  plaintiff  told  him  he  had 
acted  in  that  way  to  draw  public  attention  to 
his  grievances.  Defendant  did  not  give  him  in 
charge,  but  later  in  the  day  he  was  arrested 
by  the  police  and  taken  first  to  the  station  and 
then  to  the  lunacy  ward  of  Constance  Road 
Workhouse.  The  resident  medical  officer  there 
declined  to  sign  a  certificate  of  insanity,  but  that 
was .  done  by  Mr.  Etherington,  J. P.,  and  Dr. 
Shillingford.  Public  attention  was  drawn  to  the 
case,  and  he  was  discharged  after  ten  days'  con- 
finement. The  police  said  they  arrested  plaintiff 
because  of  his  wild  statements  of  murders  having 
taken  place  in  Camberwell  House.  So  far  as  the 
immediate  County  Court  action  was  concerned, 
the  plaintiff  was  non-suited  because  the  police 
had  acted  on  their  own  responsibility  in  the  arrest, 
for  which  Dr.  Edwards  was  not  responsible.  The 
judge,  however,  added  that  he  felt  bound  to  say 
that  sufficient  facts  had  been  disclosed  to  make 
it  necessary  for  the  proper  authorities  to  inquire 
into  the  matter.  The  Lunacy  Commissioners 
and  the  police  authorities  can  hardly  avoid  a 
searching  inquiry  into  the  whole  of  the  facts  of 
this  curious  case.  Primd  facie  there  are  several 
points  which  it  is  desirable  in  the  public  interest 
to  investigate  in  the  fullest  and  most  open  manner 
possible.  Now  that  the  police  have  seen  their 
mistake  in  arresting  the  ex-attendant,  perhaps  it 
would  be  as  well  if  they  investigated  the  various 
statements  made  by  him. 


A  Quack  Remedy #— Damages. 
The  amazing  credulity  of  the  public  in  medical 
matters  is  shown  by  the  nature  of  the  remedies 
which  are  foisted  off  on  them  by  quacks  and  char- 
latans. Subacute  and  chronic  rheumatism  is 
admittedly   an    extremely   obstinate   and     often 


incurable  affection.  The  resources  of  quackery,, 
however,  rise  to  the  occasion  with  a  ring  of  such 
marvellous  virtues  that  its  wearer  will  be  cured 
of  his  rheumatic  aches  and  pains.  Wonderful 
to  relate,  hundreds  of  apparently  sane  and  well- 
educated  persons  buy  and  wear  these  rings.  An 
enterprising  company,  not  to  be  outdone,  have 
patented  some  appliance  called  "  foot  drafts." 
A  Cardiff  citizen  bought  a  pair  of  these  drafts,, 
and  soon  found  he  had  more  than  he  bargained 
for.  Instead  of  drawing  uric  acid  out  of  his  sys- 
tem through  the  pores  of  his  feet,  the  latter  were 
found  by  a  medical  man  shortly  afterwards  to 
be  "  acutely  inflamed,  with  large  blisters  extend- 
ing from  his  heels  to  the  balls  of  his  toes."  The 
sufferer  brought  an  action  against  the  Good  Health 
Alliance  Company,  vendors  of  the  foot  draft 
Defendants  produced  evidence  to  show  that  there 
was  nothing  injurious  in  the  composition  of  the 
drafts.  More  remarkable  still,  they  produced  a 
"  London  consulting  physician,"  Dr.  Boyd,  to  say 
there  was  nothing  in  the  foot  drafts  which  could 
set  up  a  poisonous  irritation  of  the  feet,  as  it  was 
not  of  sufficient  strength.  Judgment  was  given 
for  the  plaintiff  for  £20  damages.  The  attend- 
ance of  a  qualified  medical  man  to  give  evidence 
on  behalf  of  a  company  such  as  that  indicated 
by  the  title  under  which  defendants  traded  sug- 
gests somewhat  serious  consideration.  Clearly, 
an  action  of  that  kind  lays  the  witness  open  to 
the  disapprobation  of  his  professional  brethren, 
not  to  mention  the  possibility  of  further  proceed- 
ings of  a  disagreeable  nature.  If  there  should  be 
any  circumstances  to  excuse  or  exculpate  the 
gentleman  concerned  an  immediate  disclosure  is 
desirable  in  the  interests  both  of  himself  and  of 
the  profession  to  which  he  belongs.  Perhaps  the 
Medical  Defence  Union,  which  so  often  represents 
the  forlorn  hope  of  the  medical  profession,  will 
take  some  notice  of  the  matter. 


The  Passing  of  the  Coroner. 

Many  people  in  New  York  have  been  congratu- 
lating themselves  on  the  departure  of  "  this  anti- 
quated relic  of  monarchical  government,' '  known 
as  the  coroner,  from  the  city  of  Great  New  York. 
After  four  years  of  effort,  the  Elsberg  Bill  has  been 
passed  and  the  office  is  abolished.  The  Bill  does 
not  affect  those  coroners  who  now  hold  office,  but 
as  vacancies  occur  no  successors  will  be  appointed. 
In  their  stead  are  provided  a  chief  medical  exa- 
miner, and  six  medical  examiners  for  Manhattan 
Borough,  four  for  Brooklyn,  three  for  Queen's, 
and  two  each  for  the  boroughs  of  Bronx  and  Rich- 
mond. These  officers  are  to  be  appointed  by  the 
Mayor,  and  as  far  as  practicable  from  the  coroner's 
physicians  now  in  office.  Their  duty  is  to  make 
reports  in  all  suspicious  cases  to  the  magistrate, 
and  if  they  are  not  satisfied  with  the  result  of 
their  examination  as  to  the  cause  of  death  to  make 
a  post-mortem  examination  in  the  presence  of  the 
district  attorney  and  of  a  policeman.  We  learn 
from  an  American  contemporary  that  the  new 
system  will  effect  a  saving  of  60,000  dollars  a  year, 
besides  putting  an  end  to  the  ignorant  and  corrupt 


May  ii,  1904/ 


NOTES   ON    CURRENT    TOPICS.       The  Medical  Press..  513 


practices  which  have  grown  up  under  the  late 
system.  While  we  do  not  know  that  in  these 
countries  it  is  necessary  completely  to  abolish  the 
office  of  coroner,  a  recent  case  which  we  recorded 
in  these  columns  shows  the  necessity  that  exists 
whereby  the  procedure  in  the  coroner's  court 
should  be  governed  by  fixed  and  sensible  principles, 
and  not  left  entirely  to  the  individual  fancies  of 
the  coroner  for  the  time  being. 


The  Arctic  Region  as  a  Health  Resort. 

The   medical   officer  who   accompanied   Com- 
mander Peary  in  two  of  his  voyages  in  Polar  seas, 
Dr.  Sohan,  has  made  an  interesting  contribution 
to  the  study  of  climatic  hygiene  in  publishing  (a) 
his  views  on  the  advantage  of  the  Far  North  in 
the  treatment  of  tuberculosis.     It  is  not  suffi- 
cient to  cure  a  tuberculous  patient  merely  to  make 
him  live   in  the  open  air.     Important  as  fresh 
air  is,  it  is  by  no  means  the  whole  cure  of  con- 
sumption, but   merely  one    fact   of   the    general 
hygienic    system  of   the   life   the  patient  should 
live.  Among  the  other  factors  of  prime  impertance 
are  solar  rays — not  merely  light  rays — a  proper 
amount  of  exercise  and  invigorating  conditions 
of  life.     Such  a  life  can  be  lived  in  such  Arctic 
regions  as  the  fjords  of  Greenland.     In  addition 
one  has  the  aesthetic  effect  of  beautiful  scenery, 
which  is  by  no  means  to  be  despised  as  a  thera- 
peutic agent,  and  the  stimulus  supplied  by  the 
dry,  keen  cold  of  these  high  latitudes.     Every 
pathologist  knows  how  in  advanced  tuberculous 
processes     the   ravages  of  the   tubercle  bacillus 
are  aided  by  a  host  of  allies — streptococci  and 
staphylococci  of    myriad  varieties.    These    pus- 
forming  organisms  are  often  responsible  for  turn- 
ing a  mild  case  of  tuberculous  disease  into  a  malig- 
nant one.     In  these  lonely  regions,  however,  in 
the  absence  of  dust  and  of  population,  organisms 
are  but  few,  of  low  vitality,  and  they  tend  to  lose 
their   pathogenicity.     As    regards    the    pleasures 
of  life   in   Greenland   fjords,    Dr.   Sohan   is   so 
enthusiastic  that  he  makes  one  long  to  spend  at 
least  one  summer  there. 


Individual  Antipathies. 
There  is  no  more  curious  chapter  in  a  study 
of  psycho-physiology  than  that  treating  of  the 
antipathies  of  various  sorts  to  which  individuals 
are  occasionally  subject.  It  is  well  known 
that  many  persons,  of  whom  Lord  Roberts  is  said 
to  be  one,  cannot  be  comfortable  in  the  presence 
of  a  cat,  while  the  dislike  of  the  average  woman 
to  a  mouse  is  notorious.  Medical  history  is  full 
of  instances,  authentic  or  otherwise,  of  the  re- 
markable effects  on  certain  people  of  particular 
flowers,  smells,  or  tastes.  Many  famous  persons 
are  said  to  have  been  very  unpleasantly  affected 
by  the  sight  or  smell  of  roses.  A  lady  at  the  Court 
of  Queen  Elizabeth  is  said  to  have  had  her  cheek 
severely  blistered  by  having  a  rose  secretly  placed 

(a)  Amvican  Medicine,  April  ttrd,  1004. 


there  during  sleep.  No  less  than  two  cardinals 
are  said  to  have  fainted  whenever  a  rose  was 
brought  near  them,  while  Bishop  Laurentius,  of 
Vratislonia,  died  from  syncope  at  the  smell  of  a 
rose.  Many  people  are  said  to  suffer  from  a 
form  of  hay  fever  on  exposure  to  the  odours  of 
the  same  flower.  Schenck  records  the  case  of 
one  of  his  acquaintances,  a  merchant  of  Antwerp, 
who  swooned  at  the  sight  of  hog's  flesh,  while 
the  physician  Guaianerius  records  that  so  great 
was  his  own  antipathy  to  the  same,  meat  that, 
on  one  occasion,  when  it  was  given  to  him  without 
bis  knowledge,  "  within  an  hour  after  he  fell 
into  a  palpitation  of  the  heart,  and  thence  into 
a  syncope,  and  thence  into  a  vomiting,  in  which 
he  brought  up  pure  blood."  Other  instances  are 
on  record  in  which  the  slightest  quantity  of  egg 
acted  as  a  violent  irritant  poison,  and  this  whether 
the  subject  was  aware  that  he  had  partaken  of 
egg  or  not. 


The  Wearing'  of  Collegiate  Robes. 

We  learn  that  at  a  recent  meeting  of  the  Presi- 
dent and  Fellows  of  the  Royal  College  of  Physicians 
of  Ireland  it  was  resolved  to  sanction  the  adoption 
of  special  robes  to  be  worn  by  the  licentiates, 
Members,  and  Fellows  of  the  college  on  occasions 
when  such  robes  are  customary.  The  robes 
selected  were  as  follows  : — For  Licentiates  :  A 
gown  similar  to  that  worn  by  a  Bachelor  of  Arts 
of  a  University,  with  three-inch  facings  of  royal 
purple  poplin.  For  Members  :  A  gown  similar  to 
that  worn  by  a  TMaster  of  Arts  of  a  University, 
with  four-inch  facings  of  royal  purple  poplin  and 
a  collar  of  the  same  material.  For  Fellows  :  A 
gown  similar  in  shape  to  the  robe  worn  by  a  Doctor 
of  Medicine  of  a  University,  but  made  of  black 
velveteen,  with  purple  collar  and  facings,  and  a 
velveteen  cap  and  tassel.  We  understand  that  in 
the  case  of  the  Fellows  the  use  of  this  robe  is 
optional  and  that  University  costume  with  the 
hood  of  the  respective  degree  may  still  be  worn  as 
college  dress. 

Infectious  Erythema. 
During  the  past  few  years  attention  has  been 
drawn  from  time  to  time,  chiefly  by  German  ob- 
servers, to  the  occurrence  of  a  severe  erythema 
of  infective  nature.  In  most  cases  outbreaks  of 
the  disease  have  been  associated  with  epidemics 
of  measles  or  German  measles,  and  some  writers 
have  believed  the  condition  to  be  a  locally  modi- 
fied form  of  one  of  these  diseases.  Further  ex- 
amination shows,  however,  that  the  condition 
is  a  distinct  clinical  entity  with  definite  course 
and  symptoms.  In  appearance  the  rash  some- 
what resembles  that  present  in  erythema  multi- 
forme, but  there  are  marked  differences.  The 
latter  disease  affects  the  whole  body  at  once,  lasts 
some  weeks,  and  never  occurs  as  an  epidemic, 
while  the  former  affects  certain  positions  in  de- 
finite order,  lasts  nine  days  only,  and  occurs  as  an 


514     The  Medical  Press.      NOTES    ON    CURRENT    TOPICS. 


Mat  ii,  1904. 


epidemic.  The  usual  course  of  the  eruption  is  in 
the  order  of  face,  limbs,  and  trunk,  and  there  are 
rarely  any  general  symptoms,  though  in  some 
epidemics  initial  rise  of  temperature,  uniform 
scarlet  rash,  and  pains  in  the  limbs  have  been 
noticed.  The  disease  seems  to  occur  usually  in 
the  months  of  April  and  May,  and  it  would 
be  interesting  to  find  if  it  has  been  noticed  by 
physicians  in  this  country. 


An  Epileptic  in  Custody. 

At  the  Lambeth  Police  Court,  on  the  7th  inst., 
upon  the  name  of  an  actor,  Harry  Colbourn, 
being  called  out,  the  police  stated  they  were 
satisfied  the  defendant  was  a  confirmed  epileptic  ; 
therefore  they  proposed  not  to  offer  any  evidence. 
It  appears  that  Colbourn  was  seized  with  a  fit 
on  the  stage,  and  was  taken  to  St.  Thomas's 
Hospital,  where  he  was  pronounced  drunk,  and 
taken  off  by  the  police  in  an  insensible  con- 
dition. Next  morning  the  unfortunate  man 
had  another  fit  and  was  taken  to  the 
Camberwell  Workhouse.  In  the  police  court 
the  medical  man  who  sent  Colbourn  in  the  first 
instance  from  the  theatre  to  the  hospital  de- 
sired to  make  a  statement,  but  was  not  allowed 
to  do  so  by  the  magistrate.  The  unfortunate 
man  was  therefore  dismissed  without  explanation 
or  apology.  This  incident  adds  one  more  to  the 
long  list  of  deplorable  and  disastrous  errors  of 
diagnosis  made  by  the  authorities  of  our  Metro- 
politan hospitals  in  cases  where  there  is  no  rea- 
sonable excuse  for  not  recognising  the  real  state 
of  affairs .  A  careful  examination  by  an  experienced 
medical  man,  with  a  prolonged  period  of  observa- 
tion in  doubtful  cases,  would  reduce  the  margin 
of  error  to  a  minimum.  To  jump  at  a  hasty 
diagnosis  of  drunkenness  in  all  cases  of  insensi- 
bility brought  to  hospital  by  the  police  is  the 
mark  of  the  hopeless  amateur  in  medicine.  An 
occurrence  of  the  kind  under  consideration  casts 
an  unavoidable  and  unnecessary  slur  upon  the 
good  name  of  a  great  charity. 


PERSONAL. 


Dr.  Roux,  who  received  the  Nobel  prize  of  £4,000 
two  years  ago,  has  been  appointed  successor  to  the 
late  Professor  Duclaux  at  the  Pasteur  Institute. 


A  Police-Court  Vaccination. 
A  recent  incident  at  the  Todmorden  Police 
Court  has  lent  a  little  novelty  to  the  humdrum 
annals  of  compulsory  vaccination.  The  wife  of 
a  man  in  the  neighbourhood  of  the  Southall 
Small-pox  Hospital  was  engaged  as  a  servant  in 
that  institution.  Under  the  influence  of  drink 
the  husband  went  to  the  hospital  and  demanded 
his  wife,  and,  being  refused,  straightway  broke  a 
window.  After  a  violent  struggle  he  was  then 
secured  and  handed  over  to  the  police  by  the 
attendants.  The  magistrates  were  placed  in  a 
quandary  when  the  prisoner  was  brought  before 
them,  and  it  was  pointed  out  that  it  would  not 
be  safe  to  send  him  to  a  public  prison  after  he 
had  been  in  contact  with  small-pox  attendants. 
The  difficulty  was  overcome  by  vaccinating  him, 
and  sending  him  to  the  hospital  for  a  fortnight's 
quarantine,  in  addition  to  the  ordinary  fine  of 
five  shillings  and  costs. 


Dr.  J.  J.  Buchan,  M.D.,  D.P.H..  of  Hamilton, 
has  been  appointed  Medical  Officer  of  Health  of  St. 
Helens. 


M.  Waldeck  Rousseau,  the  ex-President  of  the 
French  Republic,  last  Thursday  underwent  a  grave 
operation,  and  still  lies  in  a  serious  condition. 


Sir  William  Turner,  K.C.B.,  will  preside  at  the 
forthcoming  Session  of  the  General  Medical  Council, 
to  begin  on  Wednesday,  May  25  th. 


Dr.  Somerville  will  deliver  the  Oration  at  the 
122nd  Harveian  Festival  of  the  Edinburgh  Royal 
College  of  Physicians  on  Friday,  May  27th  next. 

The  Murchison  Scholarship  of  the  Royal  College  of 
Physicians,  London,  has  been  awarded  to  Mr.  W.  H. 
Harwood-Yarred,  a  student  of  St.  Thomas's  Hospital. 


Sir  William  Church,  as  President  of  the  Royal 
College  of  Physicians,  has  been  elected  an  ex-o0do 
member  of  the  Council  of  the  Lister  Institute. 


Dr.  William  Stirling,  Professor  of  Physiology  in 
the  Victoria  University  of  Manchester,  has  been 
appointed  Dean  of  the  Medical  School. 

The  Professor  Tom  Jones  Exhibition  in  Anatomy 
of  the  Victoria  University  has  been  gained  by  Mr. 
G.  T.  W.  Todd. 


Dr.  George  Meldon  has  been  elected  Visiting 
Surgeon  to  the  Westmoreland  Lock  Hospital  in  Dublin, 
in  succession  to  the  late  Dr.  Donnelly. 


Dr.  W.  Page  May,  on  Wednesday  last,  delivered 
the  first  of  a  course  of  ten  advanced  lectures  on  the 
Tracts  of  the  Brain,  at  University  College,  London. 

Lady  Clark  has  presented  the  London  Royal  Col 
lege  of  Physicians  with  a  bust  of  her  late  husband, 
Sir  Andrew  Clark,  Bart.,  executed  in  marble  by  H. 
Bain  Smith,  1888. 


M.  C ambon,  in  presiding  at  the  annual  dinner  of  the 
French  Hospital  in  London,  said  that  the  entente 
cordiale  was  mainly  due  to  the  commercial  classes  of 
France  and  of  England. 

Lord  Egerton  of  Tatton  will  preside  at  the 
seventh  annual  meeting  of  the  Childhood  Society, 
to  be  held  at  7  St.  James's  Square,  London,  S.W., 
on  May  1  ith,  at  3  p.m. 

The  Croonian  Lecture  on  Bright's  disease  will  be 
delivered  before  the  London  College  of  Physicians 
by  Dr.  J.  Rose  Bradford,  on  June  7th,  9th,  14th  and 
1 6th,  at  5  p.m.  each  day. 

Dr.  G.  E.  Shuttleworth  will  deliver  an  address 
on  "  Degeneracy  :  Physical,  Mental  and  Moral,"  at 
the  annual  meeting  of  the  Childhood  Society  in  London, 
on  May  nth. 

Deputy  Inspector-General  of  Hospitals  and 
Fleets  Evelyn  Richard  Hugh  Pollard  has  been  pro- 
moted to  the  rank  of  Inspector-General  o*  Hospitals 
and  Fleets  in  His  Majesty's  Fleet. 

Major  W.  Duncan,  M.D.,  F.R.C.S.,  Obstetric  Phy- 
sician  to   the  Middlesex  Hospital,   has  been  elected 
Worshipful   Master   of   the   first   Yeomanry  Masonic 
Lodge,  which  was  recently  consecrated  in  connection 
1  with  the  Middlesex  Yeomanry. 


May  ii,  1904 


CORRESPONDENCE. 


The  Medical  Press.     5*5 


Mr.  Rockefeller,  the  well  -  known  New  York 
millionaire,  has  contributed  $500,000  to  make  good 
the  damages  sustained  by  the  Johns  Hopkins  Hospital 
in  the  recent  great  fire  at  Baltimore. 

Dr.  H.  Macnaughton-Jones,  formerly  Professor  of 
Obstetrics  and  Gynaecology  in  Queen's  College,  Cork, 
has  been  elected  a  Corresponding  Fellow  of  the  Munich 
Gynaecological  Society. 

Mr.  F.  Conway  Dwyer,  M.D.,  F.R.C.S.,  Professor 
of  Surgery  in  the  Royal  College  of  Surgeons  in  Ireland, 
and  Surgeon  to  Jervis  Street  Hospital,  has  been  elected 
Visiting  Surgeon  to  the  Meath  Hospital  vice  the  late 
Sir  Philip  Smyly,  F.R.C.S. 

Sir  William  Blunden,  Bart.,  who,  on  the  recent 
Royal  visit  to  Ireland  in  his  capacity  of  High  Sheriff  of 
the  county,  attended  their  Majesties,  is  M.D.Dub., 
M.R.C.P.I.  He  is  domiciled  at  Blunden  Castle,  and 
at  Temuka,  Canterbury,  N.Z.  The  original  Blunden 
got  a  patent,  says  the  Pall  Mall  Gazette,  20  Car.  ii. 
by  virtue  of  which  he  acquired  Glanmore,  and  other 
property,  M  to  be  for  ever  called  Blunden* s  Castle." 
The  son  of  his  grandson  was  a  barrister  of  renown, 
and  M.P.  for  Kilkenny.  For  one,  or  both,  of  these 
reasons,  he  was  created  a  baronet  in  1766.  His  grand- 
nephew,  another  barrister,  and  third  baronet,  was  the 
father  of  the  present  medical  graduate,  who  is  fourth 
holder  of  the  title. 


Special  correspondence* 

[from  our  own  correspondent.] 


BELFAST. 
Mater  Infirmorum  Hospital. — The  report  of  this 
hospital  for  last  year,  just  issued,  shows  a  largely  in- 
creased amount  of  work  done.  The  new  hospital, 
built  at  a  cost  of  over  ^50,000,  was  opened  in  1900.  In 
1 901,  the  intern  patients  numbered  900,  in  1902  they 
were  1,074,  and  last  year  1,508 — a  very  satisfactory 
record.  Of  the  number  named,  932  were  medical 
cases,  and  576  were  surgical,t382  operations  being  per- 
formed. In  the  Gynaecological  Department  107  opera- 
tions were  performed,  including  25  intra- peritoneal,  with 
one  death. 

Proposed  Consumptive  Sanatoria. — It  is  stated 
that  in  reply  to  their  advertisement  for  sites  for  a 
sanatorium,  the  Belfast  Guardians  have  obtained 
about  thirty  offers  of  ground,  which  are  being  inquired 
into.  At  the  last  meeting  of  the  Corporation,  strong 
opinions  were  expressed  at  the  folly  of  having  two 
sanatoria,  one  run  by  the  guardians  and  another  by 
the  Corporation,  and  a  resolution  was  passed  to  the 
effect  that  the  city  authorities  should  co-operate  with 
the  guardians  in  securing  a  site. 

Health  of  Belfast. — During  the  last  four  weeks, 
132  cases  of  zymotic  disease  have  been  notified,  in- 
cluding 39  cases  each  of  scarlatina  and  erysipelas,  35  of 
typhoid  and  simple  continued  fever,  12  diphtheria, 
and  4  small-pox.  No  fresh  cases  of  small-pox  had 
occurred  in  the  preceding  fortnight.  The  deaths  from 
zymotic  disease  numbered  70,  from  phthisis  in,  and 
from  other  diseases  of  the  respiratory  system  204. 
The  annual  death-rate  from  all  causes  was  25*0  per 
1, coo  of  the  population. 

Since  the  publication  of  this  report  several  fresh  cases 
of  small-pox  have  occurred,  so  that  it  is  clear  that  the 
city  is  not  yet  free  from  the  disease.  An  outbreak  has 
also  occurred  at  Magilligan,  a  village  on  the  Atlantic 
coast  between  Coleraine  and  Londonderry,  where  some 
half-dozen  cases  have  been  discovered.  The  infection 
is  believed  to  have  been  carried  from  Glasgow  or 
Greenock. 


(Correspondence. 


THE  DIMINISHING  BIRTH-RATE. 
To  the  Editor  of  Tub  Medical  Press  and  Circular. 
Sir,— By  bringing   this   subject   to   the  front  and 


keeping  it  there  you  are  doing  a  real  service  to  the- 
State.  No  medical  journal  is  more  fully  and  frequently 
quoted  in  the  lay  papers  than  The  Medical  Press  and- 
Circular,  and  the  necessity  for  discussion  of  the 
question  by  the  people  and  their  leaders  is  becoming: 
more  urgent  as  time  flies  by.  No  doubt  you,  Sir. 
have  helped  to  disseminate  information  which  is  rousing, 
religious  teachers  to  recognition  of  their  responsibilities 
in  this  matter  ;  and  it  is  satisfactory  to  note  that  the 
Bishop  of  Ripon,  foremost  among  wise  and  eloquent 
Anglican  prelates,  is  making  his  voice  heard  among 
his  people.  It  will  require  the  united  influence  of 
every  moral  agency  to  stay  the  progress  ot  the  evil, 
which  has  already  spread  so  widely  in  our  midst.  It 
is  discouraging  to  reflect  that  the  voice  of  the  religious 
teacher  has  been  almost  altogether  disregarded  in 
France,  a  land  where  the  great  majority  of  the  women 
have,  at  any  rate  until  quite  recent  years,  been  under 
the  close  spiritual  guidance  of  priestly  directors. 
Limitation  of  the  number  ot  offspring  by  artificial  means 
can  no  doubt  be  justified  on  grounds  of  prudence  in  a 
large  number  of  instances.  What  is  destructive  to 
the  characters  of  the  parents  as  well  as  of  the  children,, 
and  what  must  lead  to  the  decay  of  every  nation  in 
which  the  evil  becomes  fully  developed,  is  the  growth, 
of  the  narrow  egotism  which  sacrifices  everything  in 
the  pursuit  of  4ase  and  pleasure,  and  regards  toil  and 
self-sacrifice  as  the  sources  merely  of  pain  and  un- 
happiness.  The  falsity  of  this4  belief  can  surely  be 
proved  both  by  science  and  religion.  If  the  effort  be 
not  made  to  bring  home  the  truth  to  the  masses,  or  if 
it  fail,  no  one  who  has  studied  the  question,  no  one 
who  has  examined  seriously  the  results  produced 
among  the  French  by  the  carrying  out  of  their  vast 
experiment  almost  universally  to  its  logical  termina- 
tion, can  doubt  that  the  doom  not  only  of  the  Anglo- 
Saxon  race  but  of  all  Western  civilisation  is  sealed. 
The  nations  will  go  to  ruin  like  the  peoples  of  antiquity  ; 
but  with  the  difference  that  they  will  go  not  blindly 
but  with  their  eyes  open,  with  full  knowledge  of  the 
inevitable  results  of  their  moral  obliquity. 
I  am,  Sir,  yours  truly. 
May  4th,  1904.  A  Lay  Reader. 


THE      INTRA  -  UTERINE       APPLICATION      OF 
SUPER-HEATED  STEAM  (ATMOCAUSIS).— A 
SUGGESTION. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir,— The  application  of  superheated  steam,  H5°C.^ 
to  the  uterine  cavity  as  a  cure  for  persistent  haemorrhage 
from  the  unimpregnated  organ  has  been  found  a  useful 
proceeding  in  a  number  of  cases. 

This  plan  was  first  suggested  by  Professor  Snegirew_ 
and  adopted  by  Pincus  of  Dantzig,  who  succeeded  in 
showing  that  the  proceeding  was  safe,  and  possessed 
valuable  therapeutical  effects. 

Pincus  has  placed  on  record  833  cases  treated  by 
his  method  of  application,  with  749  returned  as  either 
cured  or  much  improved. 

The  application  of  the  steam  should  be  painless,, 
and  only  used  while  the  patient  is  conscious,  so  as  to 
be  able  at  once  to  stop  should  any  pain  be  complained 
of. 

Its  value  appears  to  be  as  a  substitute  for  the 
curette  or  in  cases  where  failure  has  followed  the  use 
of  that  instrument.  It  has  also  been  found  of  value 
in  cases  of  inoperable  malignant  disease  of  uterus, 
safely  and  painlessly  destroying  the  part  acted  on. 
When  carried  to  excess,  the  whole  uterus  may  be* 
destroyed,  or  merely  a  shell  left,  which  leads  me  to 
suggest  its  value  in  cases  of  total  prolapse  (procidentia), 
as  the  effect  could  be  watched,  and  when  the  organ  had 
been  sufficiently  melted  away,  or  atrophied,  the- 
patient  should  not  suffei,  at  any  rate,  from  the  weight 
or  inconvenience,  i.e.,  pressure  on  bowel  and  bladder, 
the  trouble  generally  complained  of,  and  for  which 
relief  is  sought. 

I  have  as  yet  not  had  an  opportunity  of  putting  my 
suggestion  into  practice,  which  I  intend  to  do,  but 
should  be  pleased  if  other  gynaecologists  will  give  it  a» 
trial 


5*6     The  Medical  Press. 


LITERATURE. 


May  ii,  1904. 


I  can  imagine  a  number  of  cases  of  uterine  prolapse 
whose  only  means  of  reHef  is  the  constant  wearing  of 
a  pessary,  and  perhaps  belt  in  addition,  who,  if  assured 
they  would  suffer  no  pain,  would  gladly  submit  with  a 
view  to  radical  cure,  and  at  least  be  enabled  to  dispense 
with  any  uterine  support.  The  proceeding  seems  to 
have  the  great  advantage  ol  being  painless  and  devoid 
of  risk  if  judiciously  carried  out,  and  my  suggestion,  it 
proved  to  be  of  value,  may  considerably  extend  the 
sphere  of  its  usefulness. 

I  am.  Sir,  yours  truly, 

Alexander  Duke,  F.R.C.P.I. 

$Mtuar$. 

WILLIAM  FOTHERGILL  TUCKETT,  M.R.C.S.Eng., 
L.R.C.P.Edin.,  L.S.A.,  J.P. 
Mr.  William  Fothergill  Tuckett  died  at  Bath, 
on  April  27  th,  at  the  ripe  age  of  87.  His  medical 
education  was  received  at  St.  George's  Hospital, 
London,  whence  he  took  the  qualifications  of  M.R.C.S. 
Eng.  and  L.S.A.  in  1841,  and  that  of  L.R.C.P.Edin. 
in  i860.  Mr.  Tuckett  practised  first  at  Abergavenny 
and}  then  at  Bath.  He  was  first  elected  on  the  Bath 
Town  Council  in  1880,  and  sat  continuously  since  that 
year.  In  1888  he  was  placed  on  the  commission  of 
the  peace,  and  in  1892  became  an  alderman.  Mr. 
Tuckett  did  much  useful  work  in  Bath,  where  he  was 
held  in  the  highest  esteem,  and  where  his  loss  will  be 
ielt  amongst  a  wide  circle  of  friends  and  acquaintances. 


\ WILLIAM  ALEXANDER  HEPBURN, 
M.D.St.  And.,  L.S.A. 
We  regret  to  announce  the  death  of  Dr.  W.  A. 
Hepburn,  of  Cox  hoe,  Durham,  on  April  1 5  th,  at  the  early 
age  of  56.  Dr.  Hepburn  came  to  the  district  as  assistant 
to  the  late  Dr.  Carnes,  whose  daughter  he  married, 
and  to  whose  practice  he  afterwards  succeeded.  He 
took  the  L.S.A.  Lond.  in  1880,  the  F.F.P.S.  Glasgow  in 
1 88 1,  and  the  M.D.St.  Andrews  in  1890.  In  addition 
to  six  collieries  and  to  private  practice,  he  held  several 
public  appointments,  being  Medical  Officer  of  Health 
for  Cornforth  Parish,  the  Southern  District  of  the 
Durham  Union,  and  the  Eastern  District  of  the  Durham 
Rural  District  Council ;  he  was  also  Public  Vaccinator 
ior  the  same  districts,  and  Medical  Officer  of  the 
Houghall  Small-pox  Hospital. 

FREDERICK  BULLIN,  L.D.S.,  RX.S.Eng.,  |J.P. 
We  regret  to  announce  the  death,  in  his  71st  year, 
•of  Mr.  Bullin,  of  Chester,  on  April  12th,  at  Southport, 
Mr.  Bullin  was  born  in  Bath,  and  took  the  diploma 
•of  L.D.S.  in  1 861.  He  was  for  a  quarter  of  a  century 
Honorary  Dental  Surgeon  to  the  Chester  General 
Infirmary.  In  1887  he  was  President  of  the  Midland 
Branch  of  the  British  Dental  Association. 


Xiterature. 


•GUIDE  TO  THE  NAUHEIM  TREATMENT,  (a) 
The  importance  of  scientific  text-books  should  not, 
it  need  hardly  be  remarked,  be  estimated  by  bulk  or 
weight ;  and  the  veracity  of  this  usually  platitudinous 
aphorism  was  brought  forcibly  to  our  minds  while 
•examining  Dr.  Thome's  booklet  on  the  "  Nauheim 
Treatment."  All  our  readers,  of  course,  know  that  it 
is  now  a  good  many  years  since  this  form  of  cardiac 
therapy  was  first  introduced  into  Great  Britain,  but 
-a  large  proportion  of  general  practitioners  have  not 
had  the  opportunity  of  studying  the  original  methods 
of  its  practice  at  the  Nauheim  baths  ;  and,  as  a 
necessary  corollary,  have  not  been  able  to  make  them- 
selves acquainted  with  the  modifications  which  British 
climate  renders  desirable  when  the  practice  is  carried 
out  at  home.  It  is  for  the  benefit  oi  such  readers  that 
this  little  volume  appears  to  have  been  composed,  and 


(a)  "A  Practical  Guide  to  the  Administration  of  the  '  Nauheim  ' 
Treatment  of  Obronic  Diseases  of  the  Heart  in  England/ '  By  Leslie 
Thorne  Thorne,  K.D.,  B .8. Durham,  M. B.C. 8. En*.,  L.R.C.P.Lond., 
Medical  Examiner  to  the  London  County  Council  Technical  Educa- 
tion Board.    London:  BailHere,  Tindall  and  Cox.    1904. 


we  have  the  fullest  confidence  in  strongly  recom- 
mending it  to  their  notice.  The  methods  by  which 
the  Nauheim  treatment  may  be  best  carried  out  in 
England  are  here  graphically  and  lucidly  described, 
and,  as  the  author  deservedly  claims,  "  in  such  detail 
that  medical  men  who  have  had  no  previous  practical 
knowledge  of  it  may,  by  carefully  following  the  direc- 
tions given,  avail  themselves  of  this  valuable  thera- 
peutic agent  for  the  treatment  of  chronic  affections  oi 
the  heart."  The  importance  of  the  medicinal  treat- 
ment and  the  general  management  of  chronic  diseases 
of  the  heart,  so  generally  phenomenal  in  their  chronicity, 
and  so  rarely  tending  to  terminate  by  the  sudden  death 
with  which  popular  wisdom  is  so  prone  to  associate 
them  ;  so  very  prone  to  prove  the  professional  life- 
burden  of  the  medical  practitioner,  as  they  must 
necessarily  prove  the  physical  life-burden  of  those 
afflicted  patients,  such  importance  forms  the  first  item 
in  the  claim  of  Dr.  Thome's  booklet  on  the  attention 
of  our  readers.  The  second  is  that  the  writer  com- 
municates his  "  own  gained  knowledge  "  fully,  freely, 
and  clearly,  with  the  full  confidence  of  a  past-master 
of  his  subject  and  the  crystalline  lucidity  of  an  artist 
in  the  scientific  department  of  language.  We  make 
no  extracts,  as  we  consider  it  to  be  the  duty  of  our 
readers  to  make  themselves  acquainted  with  the  whole 
contents  of  the  original. 

WIGGINS  ON  MIDWIFERY,  (a) 
This  is  a  nicely  written  and  handy  little  book,  and 
on  the  whole  the  teaching  it  contains  is  sound,  although 
it  may  be  objected  to  on  account  of  its  brevity.  We 
are  glad  to  find  that  the  author  does  not  advise  the 
midwife  to  douche  the  vagina  with  a  Higginson's 
enema,  as  appears  to  be  the  rule  of  thumb  by  many 
authors  of  similar  works.  It  is  a  mistake  to  group 
septic  infection  occurring  during  labour  under  the  head 
of  "  puerperal  fever,"  as  the  use  of  such  a  term  is 
sure  to  make  the  nurse  believe  that  the  condition  is 
one  peculiar  to  puerperal  women.  We  would  suggest 
to  Dr.  Wiggins  that  compression  of  the  cervix  is  "  not 
unsuitable  treatment  for  accidental  haemorrhage," 
and,  though  it  is  vain  to  say  so,  that  it  does  not  cause 
concealed  haemorrhage. 

MARTIN'S  PATHOLOGY.  (*) 
This  excellent  manual  is  manifestly  the  work  ol  a 
pathologist  who  has  not  ceased  to  view  disease  from 
its  clinical  aspect.  There  is  a  tendency  in  certain 
text-books  of  pathology  to  treat  tlie  subject  as  one 
purely  pertaining  to  biology  and  to  dissociate  it 
from  its  human  interests.  Professor  Sidney  Martin 
has  wisely  remembered  that  the  student  of  to-day  is 
to  become  the  practitioner  of  to-morrow,  and  in  these 
pages  has  provided  an  admirable  foundation  for  the 
rational  study  and  the  reasonable  practice  of  medicine. 
The  bases  of  the  work  are  the  lectures  which  the 
author  has  delivered  at  University  College  during  the 
past   five  or  six  years. 

Dr.  Martin  has  succeeded  in  presenting  in  a  short 
space  a  definite,  comprehensive  and  thoroughly  up-to- 
date  account  of  the  processes  of  disease.  It  is  made 
clear  that  the  study  of  general  pathology  must  go 
hand  in  hand  with  that  of  medicine,  and  be  preceded 
by  practical  work  in  morbid  histology  and  anatomy, 
and  to  some  extent  in  bacteriology. 

It  cannot  be  denied  that  the  work  is  somewhat 
unequal.  After  a  brief  introduction,  "  inflammation  " 
is  dealt  with,  and  considering  the  peculiar  difficulties 
which  surround  a  discussion  of  this  subject  in  this 
period  of  transition  in  thought  and  expression,  the 
matter  is  well  expressed  ;  this  portion  of  the  book  is 
fairly  well  illustrated.     Chapter  II.,  which  deals  with 


(a)  ••  Midwifery  for  Midwives.*  By  W.  Denfoon  Wiggins,  It R.C.8., 
L  B.C.P.,  Assistant  Medical  Superintendent  of  the  Greenwich  I* 
firmarv.  London  :  Bailliere,  Tindall  and  Cox,  1904.  Pp.  xv.  and  »9. 
Price  8s.  6d.  net. 

(6)  "A  Manual  of  General  Pathology  for  Students."  By  Sidney 
Martin,  M.D.,  F  B.8.,  F.R.C.P.,  Professor  of  Pathology  at  UniverntJ 
College  ;  Physician  to  University  College  Hospital.  Pp.  502  With 
numerous  Woodcuts  from  Micro-Photographs  and  a  Coloured  PUte. 
London :  John  Murray.     1904.    Price  16s.  net. 


May  ii,  1904. 


LITERARY  NOTES  AND  GOSSIP.        The  Medical  Press.    517 


pyrexia,  strikes  us  as  much  too  meagre  considering  the 
clinical  importance  of  the  subject. 

The  sections  devoted  to  infection  are  particularly 
good,  and  Dr.  Martin  shows  himself  particularly  happy 
when  describing  the  chemical  products  of  bacteria 
and  their  action.  The  subject  of  immunity  is  handled 
with  much  discretion,  and  the  findings  of  recent 
researches  into  protective  mechanism  are  well  ex- 
pressed. The  chapter  on  the  blood  is  good  and 
excellently  illustrated.  We  cannot  find  any  reference 
to  "  growths/'  "  neoplasms,"  "  tumours  "  or  "  sar- 
coma "  in  the  index.  The  descriptions  of  new  growths 
are  conspicuous  by  their  absence.  As  a  scientific 
introduction  to  the  serious  study  of  disease  the  work 
is  excellent.  It  is,  however,  hardly  complete  enough 
to  meet  all  the  requirements  of  the  modern  student 
in  the  examination  room,  and  we  therefore  venture 
to  think  it  will  not  easily  displace  the  older  student's 
manuals. 

The  work,  however,  is  one  which  may  well  be 
studied  with  advantage  by  every  practitioner  desirous 
of  conducting  his  work  in  the  light  of  present  day 
conceptions  of  morbid  processes. 


KEEN  AND  WHITE'S  SURGERY,  (a) 
Keen  and  White's  "  Surgery  "  is  too  well  known  in 
this  country  to  need  much  commendation  from  the 
critic.  The  names  of  the  surgeons  who  have  collabo- 
rated with  the  editors  in  its  production  are  guarantees 
for  the  worth  of  the  material  produced.  Nancrede, 
Roswell  Park,  Collins  Warren,  btimson,  Pilcher,  and 
Nicholas  Senn  are  names  held  in  esteem  in  all  surgical 
circles,  and  the  present  volume  rs  a  splendid  token  of 
the  thoroughness  and  healthy  virility  of  American 
surgery.  The  revision  has  been  more  complete  and 
the  changes  introduced  have  been  more  extensive  than 
on  any  previous  occasion,  the  result  being  that  about 
100  pages  have  been  added  to  the  book,  but  its  weight 
has  been  kept  down  by  utilising  a  better  and  thinner 
paper,  whilst  several  of  the  chapters  have  been  put  into 
small  print.  The  arrangement  of  the  work  remains 
practically  the  same  as  before,  but  six  entirely  new 
chapters  have  been  added  dealing  with  military  and 
naval  surgery,  with  tropical  surgery*  with  the  examina- 
tion of  the  blood  as  it  affects  surgical  work,  with 
immunity,  and,  finally,  with  the  surgery  of  the  pan- 
creas. As  to  the  value  of  the  first  two  of  these  m  a 
work  intended  ior  practitioners  and  students,  one  may 
he  allowed  to  express  one's  doubts,  whilst  that  devoted 
to  immunity  would  perhaps  take  its  place  better  in  a 
text-book  of  pathology  or  bacteriology  than  in  one 
devoted  to  surgery.  The  remainder  oi  the  new  mate- 
rial is  scattered  widely  through  the  book,  and  there  are 
but  few  of  the  more  modern  improvements  which  have 
not  been  suitably  noticed,  whilst  a  good  many  old 
ideas  have  been  removed. 

At  the  same  time  one  cannot  but  feel  that  there  are 
sundry  things  which  might  be  improved  on  or  modified 
with  advantage.  Thus  as  to  general  arrangement : 
Whilst  erysipelas,  septicaemia,  tetanus,  tuberculosis, 
and  other  microbic  diseases  are  rightly  accorded 
separate  chapters,  anthrax,  actinomycosis,  glanders, 
and  hydrophobia  are  relegated  to  the  lag  end  of  a 
lengthy  chapter  dealing  with  contusions  and  wounds. 
Then,  too,  it  is  unnecessarily  irritating  to  break  off 
Volume  I  abruptly  in  the  middle  of  a  description  of 
spinal  caries,  so  that  the  second  volume  starts  in  the 
middle  of  a  chapter,  the  number  of  which  is  not  even 
stated.  The  chapter  dealing  with  fractures  is  good, 
and  a  number  of  illustrations,  borrowed  from  Scudder's 
work,  add  to  its  value ;  but  the  X-ray  pictures  are 
decidedly  poor,  and  there  is  but  little  reference  to  the 
importance  and  value  oi  the  open  operative  treatment 
01  simple  fractures,  which  one  would  certainly  have 
expected  to  be  commented  on,  even  if  the  authors  did 
not  approve  of  it.     The  operative  treatment  of  talipes 

fMLl'£'%£:})00KSt£*r*try  ,or  *r»«titioiieri  and  Student*" 
mSJtXS^S^'SHV'  M;D..LLJ>.,  F.B.C.8.(Hon.).  and  J. 
fe  JiS^i  ite»  *£•>  Ph,U  vFoann  Edition,  revised  and  enlarged, 
ta  two  volwnea.  Pp  1,868  with  551  illustrations  and  S9  plates. 
jTjee  aOa.  net.    Phi  adeJphia  and  New  York :  W.  B.  8auideraar.d  Oo. 


might  also  be  improved  with  advantage ;  it  seems 
strange  that  in  an  American  text-book  there  should  be 
no  reference  to  Phelps'  operation,  or  to  tarsectomy. 
Coxa  vara  occupies  the  anomalous  distinction  of  being 
included  under  the  section  devoted  to  tuberculous 
diseases  of  special  joints.  In  this  relation  we  notice 
that  but  little  attention  is  drawn  to  the  influence  of 
age  in  determining  what  ought  to  be  done  in  tuber- 
culous arthritis ;  especially  is  this  the  case  in  the 
knee-joint,  where  the  patient's  age  plays  a  very  im- 
portant part  in  settling  whether  an  excision  should  be 
undertaken  or  not.  The  question  of  dealing  with 
displaced  semilunar  cartilages  in  the  knee  is  also  but 
poorly  represented,  and  the  frequency  of  the  complaint 
merits  more  attention  than  is  granted  to  it.  In  gastric 
ulcer  no  notice  is  taken  of  the  distinctions  that  arise 
according  to  whether  the  lesion  is  acute  or  chronic, 
either  as  to  symptoms  or  to  prognosis.  Apart  from 
some  blemishes  such  as  these  (and  we  have  merely 
alluded  to  some  that  we  have  noticed),  the  work  is 
sound  and  may  well  be  consulted  by  those  who  would 
know  what  modern  ideas  of  surgery  are.  The  section 
devoted  to  abdominal  lesions  is  particularly  full,  and 
the  improvements  that  have  been  introduced  here  are 
judicious  and  manifold.  In  conclusion  one  has  only 
to  mention  the  fact  that  the  work  is  as  well  mounted 
and  illustrated  (with  the  sole  exception  of  defective 
representations  of  skiagrams),  as  is  usual  with  American 
works,  so  that  reading  it  is  a  pleasure,  whilst  the  charac- 
ter of  the  letterpress  renders  its  perusal  profitable. 


Xtteran?  notes  ant>  eossip. 

Surprise  has  often  been  expressed  that  Professor 
Kraepelin's  classic  work  on  '■  Clinical  Psychiatry " 
had  not  been  translated  into  English,  there  being 
nothing  in  our  language  which  traversed  the  same 
ground.  The  reason  assigned  has  usually  been  that 
the  number  interested  in  the  subject  was  too  limited 
to  repay  the  cost  of  production,  either  to  translator 
or  publisher.  This  difficulty  has  at  last  been  solved 
by  Dr.  Thos.  Johnstone,  of  Leeds  and  Ilkley,  who 
will  publish  this  week,  through  Messrs.  ttailliere, 
TindaU  and  Cox,  an  authorised  English  edition,  of 
which  alienists  and  all  earnest  students  of  mental 
disease  in  its  multiple  forms  will  doubtless  be  glad 
to  avail  themselves. 

*** 

The  ninth  edition  of  Dr.  Macnaughton  -  Jones* 
work  on  "  Diseases  of  Women  "  is  announced  as  in 
the  press.  Dr.  Rentoul  has  issued  a  monograph  on 
"  Trachoma."  Professor  Allen  Starr,  author  of  !!  Brain 
Surgery,"  has  finished  an  exhaustive  treatise  on 
"  Organic  Nervous  Diseases."  This  work  has  just 
reached  us,  and  a  casual  glance  through  its  pages, 
which  are  full  of  original  illustrations  and  coloured 
plates,  impresses  us  with  its  value.  Dr.  Herbert 
French,  medical  registrar  of  Guy's  Hospital,  publishes 
a  handy  guide  of  "  Medical  Laboratory  Methods  and 
Tests,"  which  will  be  found  of  distinct  value  in  the 
elucidation  of  some  of  the  puzzles  that  beset  dia- 
gnoses. The  sixth  edition  of  Dr.  Galabin's  "  Manual 
of  Midwifery  "  is  announced  for  the  16th  inst. 
••• 

Dr.  Lionel  Taylor  is  publishing  with  Messrs. 
Smith,  Elder  and  Co.,  on  the  16th  instant,  a  work 
entitled  "  Some  Aspects  of  Social  Evolution."  In 
this  he  proceeds  from  a  general  review  of  heredity,  as 
the  basis  of  physical  evolution,  to  the  differentiation 
of  special  types  corresponding  to  certain  classes  of 
the  social  organism.  Accepting  the  principle  of  in- 
dividual variation  with  unmodifiable  structure,  he 
rejects  that  of  progress  by  use-inheritance  ;  but  finds 
in  natural  selection,  which  constantly  accelerates  the 
development  of  a  given  variation,  a  sufficient  cause 
to  produce  new  types  of  humanity. 

*** 

We  have  received  a  signed  artist's  proof  of  Mr.  I. 
Snowman's  picture,  "  The  Leopard  Skin,"  which  was 


5*8    The  Medical  Press. 


MEDICAL  NEWS. 


May  ii,  1904. 


exhibited  in  the  Royal  Academy  last  year.  The 
picture  is  the  "  bonus  picture  "  which  has  just  been 
issued  to  their  clients  by  Bovril,  Limited.  Purchasers 
of  Bovril  receive  coupons  to  face  value  varying  with 
the  size  of  the  bottle  purchased  until  coupons  to  the 
aggregate  face  value  of  a  guinea  have  been  accumu- 
lated, when  they  can  exchange  them  for  a  copy  of  the 
picture.  The  picture,  it  may  be  remembered,  re- 
presented the  various  emotions  aroused  in  a  highly 
decorative  group  of  children  upon  first  being  con- 
fronted with  the  new  drawing-room  hearthrug — a 
leopard  skin,  head,  claws,  and  tusks  complete.  The 
reproduction  has  been  finely  executed  and  the  pur- 
chasers of  Bovril  are  to  be  congratulated  on  the  oppor- 
tunity of  obtaining  this  beautiful  work  of  art. 


Mr.  Lewis,  agent  for  the  New  Sydenham  Society's 
publications,  announces  an  "  Atlas  of  Clinical  Medicine, 
Surgery,  and  Pathology,"  now  being  issued  in  folio 
*ize,  uniform  with  the  Society's  "  Atlas  of  Illustrations 
of  Pathology."  Subscription  of  five  guineas  secures 
the  Atlas  1or  six  years.      4 


Among  the  weekly  journals  published  in  the 
English  language  which  travellers  find  at  most  of 
the  hotels  on  the  Continent  is  the  Anglo-American 
Gazette,  Originally  it  appeared  as  a  small  daily  at 
Geneva,  for  the  convenience  of  the  Anglo-American 
colony  which  concentrated  from  various  parts  of 
France  in  the  summer  of  1871  during  the  Franco- 
German  War,  and  it  speedily  became  the  recognised 
official  and  social  organ  of  the  Anglo-Saxon  community 
on  the  Continent.  It  is  published  during  the  winter 
{November  to  April)  in  the  Riviera,  at  Nice.  Its 
Geneva  summer  edition  was  suspended  for  some  years, 
but  will,  we  understand,  be  resumed  there  this  year  from 
June  to  October.  This  will  doubtless  be  good  news 
to  the  numerous  English,  American,  Indian,  and 
Colonial  visitors  on  the  Continent,  as  it  contains  the 
latest  intelligence,  which  one  is  so  anxious  to  read 
when  away  from  home. 

*♦* 

"  Some  Physicians  of  Victorian  Fiction  "  forms  the 
subject  of  an  article  in  the  last  number  of  the  Medical 
Book  News,  In  it  the  writer  remarks  that  Anthony 
Trollope's  "  Dr.  Thorne  "  is  one  of  the  most  notable 
instances  of  a  medical  hero  of  fiction,  drawn  with  that 
faithfulness  and  quiet  humour  for  which  this  author 
was  distinguished.  But  many  other  novelists  of  the 
nineteenth  century  introduced  doctors.  Charles 
Reade,  who  hated  "  mad  doctors,"  had  a  high  opinion 
of  Dr.  Samuel  Dickson,  author  of  the  "  Fallacies  of  the 
Faculty  and  the  Chrono thermal  System  of  Medicine," 
whose  representative  in  "  Hard  Cash "  diagnoses 
love-sickness  when  others  had  only  thought  of  liver. 
Wilkie  Collins  has,  on  the  other  hand,  supplied  both 
villainous  and  virtuous  specimens.  Charles  Kingsley, 
the  self-assertive  yet  trustworthy  Tom  Thurnall  in 
44  Two  Years  Ago."  Marryat  has  kindly  sketches  of 
naval  surgeons.  The  immortal  "  Rab  and  His  Friends  '' 
of  Dr.  John  Brown  gives  a  vivid  picture  of  hospital 
life,  and  in  a  few  graphic  words  describes  students  and 
physicians  of  the  modern  type  without  the  humorous 
exaggeration  of  Dickens  or  the  coarse  realism  of 
Smollett.  The  picture  of  the  eager  but  sympathetic 
students  and  low-voiced,  skilful  surgeon  about  the 
operating  table  where  lay  the  beautiful,  patient  old 
Ailie  will  always  be  a  classic  in  the  opinion  of  doctors. 
To  the  physician  whose  lot  it  has  been  to  practise  in 
a  small  town,  the  country  doctor  described  by  Ian 
Maclaren  in  "  Beside  the  Bonnie  Brier  Bush  "  will 
always  be  an  ideal.  Many  practitioners  could  recall 
scenes  like  those  described  in  this  story ;  the  long 
drives  or  rides  in  the  storm,  the  grateful  family  and 
friends  of  the  patient  and  even  the  faithful  old  horse 
are  to  many  of  us  here  to-day  familiar  and  pleasant 
recollections.  In  this  story  is  found  one  of  the  best 
descriptions  of  the  self-sacrificing,  devoted  physician 
in  all  literature. 


AeMcal  news* 


Medical  Cyclist  Volunteer*, 

Sanction  has  been  given  for  the  London  Volunteer 
Companies  of  the  Royal  Army  Medical  Corps  to  form 
a  cyclist  section  of  one  officer  and  twenty-two  non- 
commissioned officers  and  men.  The  section  will  be 
similar  to  that  of  the  Woolwich  Companies  of  the 
corps. 

Medical  Slekasss  sad  Accident  Society. 

The  usual  monthly  meeting  of  the  Executive  Com- 
mittee of  this  Society  was  held  on  the  29th  ult.  There 
were  present  Dr.  De  Havilland  Hall  (in  the  chair), 
Dr.  Fredk.  S.  Palmer,  Dr.  J.  W.  Hunt,  Mr.  F.  S. 
Edwards,  Dr.  M.  Greenwood,  Dr.  A.  J.  Rice  Oxley, 
Mi.  Fred.  R.  Wallace.  Dr.  W.  Knowsiey  Sibley, 
Dr.  St.  Clair  B.  Shadwell,  Dr.  F.  J.  Allan,  Mr.  Edward 
Bartlett,  Dr.  A.  S.  Gubb,  Mr.  H.  P.  Symonds  (Oxford). 
Dr.  F.  R.  Mutch  (Nottingham),  and  Dr.  J.  B.  Ball 
The  Committee  examined  the  annual  report  of  the 
Society  for  1903,  which,  together  with  the  report  of 
the  quinquennial  valuation,  will  be  distributed  to  the 
members  in  the  course  of  a  few  days.  The  accounts 
for  the  year  are  very  satisfactory,  showing  a  large 
increase  in  the  reserves  and  in  the  number  of  members. 
The  total  sum  paid  to  the  members  as  sickness  benefit 
is  the  largest  yet  disbursed  in  any  year  since  the 
business  commenced  in  1884,  but  is  under  the  amount 
expected  and  provided  for.  At  the  annual  general 
meeting,  to  be  held  on  19th  inst.,  the  Committee  will 
suggest  a  plan  by  which  the  large  amount  of  manage- 
ment savings  will  be  returned  to  those  members  who 
have  most  largely  contributed  to  it.  Prospectuses 
and  all  information  on  application  to  Mr.  F.  Addiscott. 
Secretary  Medical  Sickness  and  Accident  Society, 
33  Chancery  Lane,  London,  W.C. 

■t.  Thomas's  Hospital  Msdleal  School. 

The  following  prizes  for  the  Winter  Session  have 
been  awarded  :— First  Year's  Students  :  J.  A.  Clark, 
the  William  Tite  Scholarship,  £2$  ;  R.  W.  Rix,  College 
Prize  £20.  Second  Year's  Students  :  H.  J.  Nightingale, 
the  Peacock  Scholarship,  £35  ;  A.  C.  F.  Turner,  College 
Piize,  £20  ;  H.  G.  Bennett,  College  Prize,  £10.  Filth 
Year's  Students :  A.  G.  Gibson,  Medicine,  £10 ; 
H.  A.  Kisch,  Surgery,  £10 ;  C.  E.  Palmer,  Mid- 
wifery and  Disease  of  Women,  £10  ;  A.  G.  Gibson. 
Pathology,  the  Haddon  Prize,  £10  ;  K.  Takaki,  Phar- 
macology and  Therapeutics  ;  F.  A.  Broadribb  and  E. 
W.  Parry,  Forensic  Medicine  and  Insanity,  £$  each. 
The  Mead  Medal  for  proficiency  in  medicine,  pathology 
and  hygiene  was  awarded  to  K.  Takaki  ;  the  Wain- 
wright  Prize,  £10,  and  the  Seymour  Graves  Toller 
Prize  to  A.  G.  Gibson,  of  Christ  Church,  Oxford ;  the 
Cbeselden  Medal  for  proficiency  in  surgery  and  surgical 
anatomy  to  H.  A.  Kisch. 

Boyal  College  of  Surgeons  in  Ireland.— General  Meeting  sad 
Election  of  Officers. 

A  meeting  of  the  Fellows  will  be  held  on  Saturday. 
June  4th,  at  1  o'clock,  to  receive  the  annual  report  of 
the  Council.  A  meeting  will  also  be  held  on  Monday. 
June  6th,  at  1  o'clock,  pursuant  to  the  provisions  of 
the  Charters,  to  elect  a  president,  vice-president, 
council,  and  secretary  of  the  college  for  the  ensuing 
year.  Fellows  who  may  desire  to  have  their  names 
printed  on  the  list  of  candidates  for  office  will  please 
signify  their  wish  by  letter  to  the  Registrar,  at  the 
college,  on  or  before  Tuesday,  May  24th,  as  it  is  neces- 
sary to  include  the  names  in  the  voting  papers  which 
are  forwarded  to  the  Fellows ;  and  no  candidate  is 
eligible  unless  his  application  is  received  within  the 
!  date  specified. 

The  Waterloo  Festival  Dinner. 

His  Grace  the  Duke  of  Argyll,  P.C.,  K.T.. 
G.C.M.G.,  G.C.V.O.,  &c,  will  preside  at  the  festival 
dinner  to  be  held  on  Monday,  June  20th  next,  at  the 
Savoy  Hotel,  in  aid  of  the  Royal  Waterloo  Hospital 
for  Children.  It  is  hoped  that  any  ladies  or  gentlemen 
willing  to  attend  the  dinner  as  stewards  or  to  act  as 
hosts  and  hostesses,  and  bring  their  own  parties,  wil 


May  ii«  1904^ 


PASS  LISTS. 


Thk  Medical  Press.    519 


kindly  send  in  their  names  as  early  as  possible.  There 
will  be  no  payment  for  dinner  tickets,  and  separate 
tables  to  accommodate  any  number  of  friends,  from 
two  to  fifty,  can  now  be  reserved,  without  charge. 
The  Ladies*  Committee,  the  chairman  of  which  is 
H.R.H.  the  Duchess  of  Albany,  are  giving  their  co- 
operation and  support. 

Horia. 

We  have  received  from  the  Hovis  Bread-Flour 
Company  the  annual  report  to  end  of  March,  from 
which  we  learn  that  so  greatly  has  appreciation  of  the 
merits  of  their  flour  and  bread  extended  among  the 
medical  profession  and  the  public  that  additional  mills 
have  to  be  built,  and  as  further  practical  proof  of 
prosperity,  a  dividend  of  14  per  cent,  has  been  declared 
lor  the  last  half  year  on  the  Ordinary  shares.  We 
congratulate  the  directors  and  shareholders  on  the 
result. 

Dublin  Sanitary  Association. 

The  following  resolution  was  adopted  by  the  Council 
of  the  above  Association  at  its  last  meeting  : — "  That 
the  attention  of  the  Local  Government  Board  be  drawn 
to  the  unsatisfactory  manner  in  which  the  Infectious 
Diseases  Notification  Act,  1889,  is  still  being  worked 
in  the  Dublin  Metropolitan  District.  For  example, 
chicken-pox  is  notifiable  in  all  the  townships,  but  not 
in  the  city ;  whooping-cough  (at  present  epidemic 
and  very  destructive  to  child  life)  is  notifiable  in 
Pembroke,  but  in  none  of  the  other  districts  nor  in 
the  city  ;  and  measles  is  not  notifiable  in  some  of  the 
districts,  whereas  it  is  scheduled  as  notifiable  in  others. 
The  effect  of  this  uncertainty  in  practice  is  to  throw  a 
serious  obstacle  in  the  way  of  notification."  The  usual 
routine  business  having  been  transacted,  the  Council 
adjourned. 

Royal  College  of  Surgeons  in  Ireland. 

At  a  meeting  of  the  President,  Vice-Presidents 
and  Council,  held  on  the  3rd  inst.,  the  following  were 
elected  to  examine  for  the  various  Courts : —  In 
Anatomy — Ambrose  Birmingham,  Alexander  Fraser. 
In  Surgery — F.  Conway  Dwyer,  Andrew  Fullerton, 
Thomas  E.  Gordon,  R.  Lane  Joynt.  In  Physiology 
and  Histology — E.  L'E.  Ledwich,  Charles  Coppinger. 
In  Biology — John  J.  Burgess.  In  Ophthalmology — 
Arthur  H.  Benson,  Patrick  W.  Maxwell.  In  Pathology 
and  Bacteriology— Arthur  Hamilton  White.  In  Patho- 
logy— Robert  Allen.  In  Midwifery  and  Gynaecology — 
Frederick  W.  KidcL  In  Sanitary  Law  and  Vital 
Statistics — Caleb  J.  Powell.  In  Dental  Surgery  and 
Pathology— Daniel  L.  Rogers,  William  G.  Story. 
In  Mechanical  Dentistry—George  M.  P.  Murray, 
William  Booth  Pearsall.  In  Chemistry  and  Physics 
—Edwin  Lapper,  Robert  J.  Montgomery. 

PASS  LISTS. 
University  of  Edinburgh. 

The  following  is  the  official  list  of  passes  at  the 
recent  professional  examination  for  degrees  in  Medicine 
and  Surgery : —  <  t 

Third  Professional  Examination. — Thomas  Addis, 
Francis  Aitken.  D.  C.  Alexander,  J.  C.  D.  Allan,  A.  C 
Alport,  A.  G.  Anderson.  William  Anderson,  G.  S. 
Banks,  D.  M'F.  Barker,  J.  M.  Barkley,  W.  J.  E.  BeU, 
C.  E.  Blair,  D.  P.  Blair,  George  Blair,  R.  A.  Blake, 
Herbert  Brown,  J.  W.  Cairns,  T.  F.  Campbell,  H.  M. 
Cargii,  Marjorie  Duake,  Cohen,  H.  P.  Cook,  James 
Craw,  D.  C  Crole,  J.  A.  Cruickshank,  A.  B.  Darling. 
Thomas  Davidson,  M.A.,  J.  M.  Dickson,  H.  A.  Edwards, 
C  E.  Elliston.  F.  E.  Field.  C.  N.  Finn,  N.  C.  Forsyth, 
R.  S.  Frew,  W.  G.  Frohlich,  Jessie  H.  Gellatly,  William 
Gemmill,  Eleanor  A.  Gorrie,  J.  M.  Grant,  Joseph  Green, 
C  Rose  Greenfield  (with  distinction),  J.  C.  Grieve, 
James  A.  Gunn,  M.A.,  B.Sc,  George  Hadden,  J.  D. 
Harmer,  Ada  A.  Hatchard,  A.  S.  Hendrie,  W.  M. 
Hewetson,  Jean  S.  Hogg,  J.  R.  Holgate.  Joseph  Ings, 
T.  Scoresby  Jackson.  J.  P.  S.  Jamieson.  J.  H.  H. 
Joubert,  G.  P.  Joy,  M.A..  Solomon  Kark,  Ethel  Landon, 
J.  M.  Lauder,  James  Lindsay,  W.  L.  Locke,  John 
MacDonald,  Peter  M'Ewan,  M.A.  (with  distinction), 
T.  A  MacGibbon,  J.  D.  M'Kelvie,  K.  W.  Mackenzie, 
Mardo  Mackinnon,  A.  C.  M'Master,  Stewart  M'Naugh- 


ton,  Charles  M'Niel,  M.A.,  N.  N.  G.  C.  M'Vean,  S.  E. 
Martin,  E.  S.  Massiah,  Alexander  Mathieson,  D.  M. 
Mathieson,  M.A.,  A.  I.  Miller,  O.  M.  Mirylees,  C.  E.  S. 
Mitchell,  J.  S.  Mitchell,  H.  B.  Morris,  D.  L.  Morrison, 
R.  R.  Murray,  A.  W.  Neiil.  G.  P.  Norman,  A.  J.  R. 
O'Brien,  A.  A.  Ollivierre,  D.  H.  Paul,  H.  E.  Rawlence, 
Charles  Reece,  A.  E.  Carey  Rees,  B.A.,  A.  O.  P. 
Reynolds,  W.  E.  Reynolds,  W.  G.  Robertson,  M.A., 
W.  Latto  Robertson,  J.  Z.  H.  Rousseau,  B.A. 
(with  distinction),  Alexander  Sandison,  W.  M. 
Scott  (with  distinction),  W.  J.  B.  Selkirk,  D.  W. 
Sibbald,  E.  S.  Simpson,  Oliver  Smith  (with  dis- 
tinction), S.  A.  Smith,  T.  R.  Smith,  A.  G.  V. 
van  Someren,  A.  B.  Spence,  J.  R.  Tannahill,  J.  A.  R. 
Thompson,  R.  B.  Thomson,  Nettie  B.  Turnbull, 
Edward  Valenzia,  A.  N.  J.  Vizarat,  Frances  M.  Wake- 
field. R.  C.  Walker.  H.  E.  A.  Washbourn,  H.  C.  Weber, 
J.  D.  Wells,  W.  H.  Welsh.  F.  P.  Wernicke.  Elsie  B. 
Wilkie,  H.  C.  Wilson,  "and  James  Young. 
University  of  Durham. 

The  following  candidates  have  passed  the  Third 
Examination  for  the  Degree  of  Bachelor  in  Medicine  : — 

Honours — First  Class. — James  Glenny  Gibb. 

Honours — Second  Class. — Wilfrid  Fairclough  and 
Robert  Joseph  Willan. 

Pass  List. — George  Nixon  Biggs.  John  Frederick 
Bridge,  Horsley  Drummond,  Hamilton  Drnmmond, 
Archibald  Finlay,  Sebert  F.  St.  Davids  Green, 
M.R.C.S.,  L.R.C.P.,  Capt.  R.A.M.C..  Arthur  Beresford 
Jones,  John  Charles  Norman,  John  Cuthbert  Pearce, 
Leslie  Martin  Rosten,  Robert  Rutherford,  Richard 
Geoffrey  Shaw  Simpson,  Alan  Ayre  Smith,  M.RX.S., 
L.R.C.P..  Robert  Joseph  Weidner,  James  Leslie 
Wilson,  M.A. 

The  following  candidates  have  passed  the  First 
Examination  for  the  Degree  of  Bachelor  in  Medicine  : — 

1. — Elementary  4natomy  and  Biology,  Chemistry  and 
Physics.  Honours — First  Class. — Frank  Rawlinson 
Dudderidge. 

Honours — Second  Class. — Charlotte  Purnell. 

Pass  List. — Frederick  William  Cheese,  M.R.C.S,, 
L.R.C.P.,  Helen  Mary  Gurney,  Gertrude  Ethel  O'Brien, 
Hubert  Shield,  Joseph  Albert  Sacco,  Herbert  James 
Slade,  M.R.C.S.,  L.R.C.P..  Charles  Sim  Thompson. 

2. — Elementary  Anatomy  and  Biology. — Kenneth 
Bruce  Allan,  Harold  Ernst  Bloxsome,  Leonard  Foster 
Browne,  Lionel  Knipe  Edmeades,  Elizabeth  Niel 
Havelock,  Hedvig  Christina  Kellgren,  Thomas  Harold 
Vessey  King,  Elizabeth  Patteson,  Francis  Aidan 
Robinson,  Rev.  Robert  Henry  Smallwood,  M.A., 
Basil  Taylor,  John  Franklin  Young. 

It  is  announced  that  a  delegation  of  Canadian  mxii- 
cal  men  have  come  to  Europe  for  the  purpose  of  in- 
vestigating the  hospital  system  prevalent  in  the  various 
European  countries.  Among  the  delegates  are  four 
medical  men  who  have  been  directly  connected  with 
the  hospital  organisation  of  the  Dominion,  and  who 
believe  that  it  is  capable  of  a  considerable  improve- 
ment on  British  lines.  Among  centres  to  be  visited 
are  Birmingham,  London,  Manchester,  Liverpool,  and 
Glasgow. 


In  his  report  to  the  Manchester  Education'  Com- 
mittee on  the  special  schools  for  defective  children,  Dr. 
Ashby  says  that  periodical  examination  of  the  scholars 
has  convinced  him  of  improvement  all  along  the  line, 
not  only  in  industrial  occupations,  but  also  in  the 
acquisition  of  knowledge,  including  articulation,  read- 
ing, and  writing.  But  the  home  conditions  of  many 
of  the  children  are  unfavourable,  and  he  fears  that  the 
future  of  some  of  them  is  anything  but  bright  without 
the  help  of  some  after-care  association  to  keep  in  touch 
with  them  and  help  them  to  find  employment. 

The  Medical  Society  of  London  announce  their 
annual  conversazione,  which  is  to  take  place  at  their 
rooms,  11  Chandos  Street,  Cavendish  Square,  on 
Monday  next,  May  16th,  when  Sir  Isambard  Owen, 
M.D.,  F.R.C.P.,  will  deliver  an  oration,  the  subject 
being  "  The  Future  of  Medical  Education  in  London." 


5*>    Tn*  Medical  P«ess.       NOTICES  TO  CORRESPONDENTS. 


Jtatitw  to 
€or«sp<ml>rote,  $hort  %tikT&t  &i 

.  WGF*  OOMtMfJJtiro  requiring  a  reply  in  this  oofomn  are  particu- 
larly requested  to  make  nNota  didiwctft*  Signatmn  oriniikU,  and 
avoid  the  i>ractioe  of  signing  themselves  "Reader/*  "Subscriber," 
4  Old  Subscriber,"  Ac.  Moch  oonfasion  will  be  spired  by  attention1 
to  this  rale. 

Oemwal  Abticlrs  or  Lbttrrs  intended  for  publication  shooid  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
-  with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

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

Rrfrirts.— Reprints  of  articles  appearing  in  this  journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should,  be  done 
when  returning  proofs. 

Dr.  B.  (Camberwell).—  We  understand  that  the  matter  isunder 
the  consideration  of  the  Colonial  Office. 

T.  B.  Y.— Our  correspondent  should  not  accept  the  patient's  state- 
ment as  correct  until  he  has  heard  the  statement  from  the  other 
side. 

Novicb.— Vai  loose  veins  on  the  lege  are  not  made  worse  by  cycling. 

Lbsatbb.— We  fear  the  books  and  instruments  of  your  medical 
relative  have  onlv  a  small  market  value.  Medical  works  for  the 
most  part  soon  lose  their  value  from  the  vendor's  point  of  view. 
The  surgical  instrument*  too,  being  somewhat  old-fashioned,  are 
practically  unsaleable.  Like  many  other  thingi  in  the  medical 
world  the  introduction  of  aseptic  surgery  and  methods  has  worked 
a  revolution  in  methods  and  appliances. 
•  J.  J.  Smith.— If  the  firm  is  an  honourable  one,  there  need  be  no  fear 
s  bout  the  fee.  In  any  case,  however,  it  is  desirable  to  obtain  con- 
firmation by  letter  of  the  agreement,  naming  the  nature  of  evidence 
required  and  the  amount  of  fee  to  be  paid  on  first  and  on  succeeding 
days  (if  any).  

Jfocthtg*  of  the  gotietu*,  JLtttmtB,  4ct. 

Wsdbbbday,  Hat  11th. 

South-Wrst  Lovdor  Mrdical  80CIETT  (Bolingbroke  Hospital, 
Wandsworth Common).*8.46 p.m.  Paper:— Dr.  E.F.  Potter:  Obser- 
vations oa  the  Bemoval  of  Adenoids. 

Debmatoloqical  Society  op  Lordov  (11  Chandos  Street,  Cavendish 
Equate,  W.).— 5.15  p.m.  Demonstration  of  Cases  of  Interest. 

Mrdical  Grab*  atm'  Collbsj*  aha  Poltcubic  (22  Chenies  Street, 
W.C.L— 4  pan.  Mr.  J.  Cantlie:  Clinique.  (Surgical.)  5.16  pun.  Dr. 
L.  Williams  :  Personal  Hygiene. 

Thursday,  Mat  12th. 

Harybxam  Soctftt  of  Lokdo*  (Htafford  Rooms,  Titchborne  Street, 
Edgware  Bead,  W.).  -8.30  p.m.  Papers :— Dr.  J.  Taylor  :  Combined 
Sclerosis  in  the  Spinal  Cord  associated  with  Blood  States.— Dr.  E. 
Squire :  Common  Errors  in  the  Physical  Examination  of  the  Chest. 

British  Gtji^oolocucal  Socrtrr  (to  Hanover  Square/ W.).  8  p.m. 
Specimens  will  be  shown  by  the  President  and  others.  Discussion  on 
Dr.  Maonaughton-Jonespaper  on  the  Dangers  of  Pessaries. 

Medical  Graduates'  Gdllbqb  akd  Poltclihic  (22  Chenies  Street, 
W.CM.— 4  p  m.  Mr.  Hutchinson  :  Clinique.  (Surgical.)  6.16  p.m, 
Mr.  H.  L.  Barnard  ;~The  Principles  of  Abdominal  Diagnosis. 

Mourt  Vrrror  Hospital  for  Corsumftior  axd  Disrasrs  of  tor 
Curst  \7  Pltsxoy  Square.  W.).-6  p.m.  Dr.  J.  E.  Squire :  The 
Physical  Examination  of  the  Chest  (Illustrated  by  Cases).  (Post- 
Graduate  Course.) 

Fridat,  Mat  18th. 

British  Lartkoolooical,  Rhivolooical,  axd  Otolooical  Asbocia- 
tiox  (Medical  Society's  Booms,  11  Chandos  Street,  Cavendish  Square, 
W.).— Cases,  Specimens, and  Instruments  will  be  shown  by  Dr.  F. 
bpicer,  Dr.  Kelson,  Dr.  Lumsden,  and  others.  Notes  on  a  Case  of 
Acute  A b- cess  of  the  Thyroid  Body  after  Influenza.  Adjourned 
Discussions  on  Mr.  M.  Collier's  paper  on  Latent  or  Intermittent 
Nasal  Obstruction  (opened  by  Dr.  S.  Wallace  and  Dr.  H.  Pegler). 
Communications  .—Dr.  W.  J.  Home  :  Pachydermia  Laryngis  (with 
lantern  demonstration). 

Epidxmiolooial  Society  or  Loxdox  (11  Chandos  Street,  Caven- 
dish 8quare,  W.).— 8.30  p.m.  Meeting. 

Cubical  Society  op  Lordon  (20  Hanover  Square,  W. ).— 8.30  p  m . 
Papers  :— Dr.  S.  Green  and  Dr.  W.  H.  Brook  :  Cases  Illustration  the 
Value  of  the  Bontgen  Bays,  ss  a  Factor  in  the  Diagnosis  of  Early 
Pulmonary  Tuberculosis.— Dr.  E.  A.  Peters  (introduced  by  Mr.  C.  J. 
Symonds) :  Notes  of  Two  Cases  Illustrating  Some  of  the  Advantages 
and  Disadvantages  of  X  Bay  Tieatment  in  Recurrent  Breast  Cancer. 
'  —Dr.  H.  E.  Thompson  and  Dr.  C.  U.  Aitchison  (introduced  by  Dr.  P. 
Kidd):  Two  Cases  of  Tumour  of  the  left  Auricle  Simulating  Mitral 
Stenosis.  . 

Mrdical  Graduates'  Colleqr  axd  Polyclinic  (22  Chenies  Street, 
W.C.).— 4  p.m.    Mr.  E.  Clarke.    Clinique.  (Eye.; 

tkantcixs. 

Evelina  Hospital  for  Sick  Children,  Southward— House  Surgeon. 

Salt r t  JESO  per  snnum,  with  board,  residence,  and  washing. 

Applications  to  the  Committee  of  Management  at  the  Hospital. 
Glasgow   Parish  Council.— Medical  Officer.    Barnhill  Poor   House, 

Sprngburn.    Salary  £250  per  annum,  with  board  and  lodging. 

Application  to  Jas.   R    Motion,  Inspector  and  Cerk,  Parish 

Council  Chambers,  266  George  Street,  Glaigow. 


May-  ii,  1904 


Lebanon  HosoitaJ  for  the  Insane,  Beyxsjut,  8yria.- Medical  Snperin. 

tendant.  Salary  £260  per  annum,  wilh  board,  lodging,  attenaW 

washing,  flringAaad  righting.  AimUcatwnstoFrs^C.&amng 

Secretory,  86  Oueen  Victoria  Street,  London,  B.C.  ^' 

Miller  Hospital  and  Royal  Kent  Dispensary.  Greenwich  Road,  S.E.- 

Junior  Resident  Medical  Officer.    Salary  480  per  annum,  with 

board,    attendance,    and  washing.       Applications   to   James 

Marks,  Secretary.  ^w 

Norfolk  and  Norwicn  Hospital.— House  Physteiau.    Salary  480  per 

annum,  with   board,  lodging,  and  washing.     Applications  to 

Frank  Hasel,  Secretary. 
NoKh.Eastern  Hospital  for  Children.  Hackney  Road,  Bsthnal  Greta, 

E.— House  Physician.  Salary  460  per  absjum,  with  board,  real. 

dence,  and  laundry  allowance.       Application*  to  T.  Glen ton- 

Kerr,  Secretary. 
Nor^*B?e**r». Hospital  *°r  ChiWren,  Hackney  Road.  Bothnal  Green, 

£-Two  Houae  Suigeons.    Salaries  £00  per  annum,  with  board, 

Residence,  and  laundry  allowance.   Applications  to  T.  Gknton- 

Kerr,  Secretary. 
Perth  District  Aaytam,  Murtb'y.  -Assistant  Physician,     Salary  £110 

per  annum,  with  board  and  apartments,  Ac.  Applications  to  Dr. 

Bruce,  Murthly  Perthshire. 
South    Devon    and  East   Cornwall  Hospital,    Plymouth.— H  case 

Surgeon.    Salary  £100  per  annum,  with  boird,  residence,  sad 
-.   T^**?]0*-    Applications  to  P.J.  Langdon,  Secretary. 
The  Children  s  Hospital,  Temple  Street,  Dublin.— House  Surgeon. 

Salary  Fifty  guineas  per  annum,  with  apartments,  in,  Bght,  and 

attendance.    Application  to  H.  C.  Mooney,  Hon  Sec.  Medical 

Boaid.  (BeeAdvt.) 
Tottenham  Hospital— House    Surgeon.     Salary  £90  per  annnm, 

together   with    board,  residence,  and  laundry.       Application* 

itnmediatoly  to  Fredk.  Drswitt.  Secretary. 
Valkenberg  Aaylum,  near  Cape  Town.— Assistant  Medical  Officer. 

Salary   £260  per  annum,  with   board,  lodging,   and   washirr. 

Applleatlansto  the  Agent-General  for  the  Cape  of  Good  Hope. 

100  Victoria  Street,  London,  8.W.  ^^ 

Westminster  General  Dispensary.  TResideat  Medical  Officer.    Salary 

£120  per  annum,  with  rooms, gas,  coal,  and  attendance.  Applica- 
tions to  Fredk.  Dawkins,  becretary,  0  Gerrard  Street,  Soho. 
West  Suffolk  General  Hospital,  Bury  St.  Edmunds.— House  Burgeon. 

Salary  £100  per  annum,  with  board,  and  lodging.    Application* 

to  John  H.  Bonner,  Secretary. 
York  County  Hospital.— House  Physician.  Salary  £100  per  annnm, 

with  board,  residence,  and  washing     Applications  to  Fredk. 

Neden,  Secretary  and  Manager. 


Boxwrxl.  WM.JUR.aP.,  L.R.C.8.L,  Clinkal  Assistant  to  the  Heath 

Hospital,  Dublin. 
Btrorss,  Mildred  M.,  M.B.Lond.,  House  Surgeon  to  the  Royal  Free 

Hospital,  Gray's  Inn  Road,  London,  W.C. 
Clarrr,  William,  M.B.Toronto,  Clinical  Assistant  to  the  Chelae* 

Hospital  for  Women. 
Ellis,    L.    Erasmus,    M.D.Brux.,  M.R.GSEng.,    LJLCP.Lond., 

LU3.A.,   Clinical    Assistant  to  ;the  Hospital   for  Consumptioo 

and  Diseases  of  the  Chest,  Brompton,  London,  8.  W. 
Gow  P.,  M.B.C.8.Eng.1  L.R.C.P.Lood.,  Senior  House  Surgeon  of  the 

Stanley  Hospital,  Liverpool. 
Haymar,  Charles  AuousTors.  M.D.8t.  And.,  F.R.O.B.,  L.R.C.P.IreU 

L.Dv8.RC.8.s»f..  Honorary  Assistant  Dental  Surgeon  to  the 

Bristol  Royal  Infirmary. 
Hurt.  Alfred  William  Durbiro,  LJt.C.P.Lond.  .M.R.C.8.,  Medial 

Officer  for  the  Chrgford  District  by  the  Okehampton  (Devoa) 

Board  of  Guardians. 
McCash,  Jambs,  MB.,  C.M.Glasg.,  House  Surgeon  to  the  Bojal  Eye 

Hospital.  South  wark. 
Robbrtsor,  MORiCA  L.  M..  M.B.,  B.S.Durh.,  House  Physician  to 

the  Boyal  Free  Hospital,  Gray  s  Inn  Road,  London,  W.C. 


$irtti0- 


Acrlrrlbt.— On  Mag  4th,  at  Crete  House,  Surblton,  the  wife  of 

Richard  Aakerty,  MLB.,  of. a  dhaghtor. 
Bai.SRRaoN.-On  May  7th*  at  80  Park  Roadu  Forest  HiH,  8.E.,  the 

wife  of  Robert  Balderston,  M.B.Lond.,  of  a  daughter. 
Lb  Gbyt.— On  May  6,  at  66  D^vid  Place,  Jersey,  the  wim  of  Edward 

Le  Geyt,  M.B.C.S.Bng.,  L3.CP.Lond.,  of  a  son. 


Dbmsham— SopRR.-On  April  30th,  at  All  Saints'  Church,  Devonshire 
Road,  S.W.,  Alec  Densham,  M.B.Lond.,  of  Woodville.  Worthlor, 
son  of  Benjamin  Denshun,  Bramley  Croft,  Hindhead,  to  Alice 
Marian,  daughter  of  William  Soper,  M.R.C.S.,  I^S.A.,  of  307 
Clapham  Road,  8.W. 

FuRRn-ALL— MacBbar.— On  April  6th,  at  the  Church  of  St.  Mary  of 
Bethany,  Qoetta,  India,  Capfc.  Charles  Hilton  Furnivsll, 
R.A.H.C.,  to  Daisey,  second  daughter  of  Duncan  Mac  Bean,  Ess,. 
Quetta.  ^ 

Prrrt— McFarlarb.— On  April  30th,  at  St.  James's  Church,  Tan- 
bridge  Wells,  Cranley  Marten  Perry.  M.R.C.3..  LR.C.P.. 
A.K.C..  eldest  son  of  Marten  Perry,  M.D.,  of  Spalding,  to  Mi» 
Norah  McFarlane,  younger  daughter  of  the  late  Daniel  McFarlaae, 
of  Glasgow,  of  Rusthall  Beacon,  Tunbridge  Well. 


Wraths. 


Fitzpatricr.— On     May  6th,     at   Coimbaftore,  Lansdown    Boad, 

Cheltenham,  8urg.Lieut.-CoL  J.  F.  Fitspatrick.  retired  LM  & 
Morro.— On  May  6th.  at  Cotham  Watford.  Herta,  William  Charlei 

Monro,  third  son  of  the  late  Henry  Monro.  M.  D.,  aged  54. 
8iwBLL.-On  May  1st,  at  Rosemonnt,  Helensburgh,  ScotlandV Jesne 

Cruikshanks  Whitelaw,  in  her  49th  year,  beloved  wife  of  William 

B.  Sewell,  M.D. 


lb   fttlcdiral  f rcss   Mil    Circular. 


"SALUS   POPULI   SUPREMA    LEX-* 


Vol,  CXXVIII. 


WEDNESDAY,    MAY   18,    1904. 


Mo.    20. 


Original  Communications. 
SOME    POINTS    OF    INTEREST 

IN 

SUPPURATIVE  APPENDICITIS. 

By   PEYTON   T.    B.    BEALE,    L.R.C.P.,  la) 

Surgeon  to  the  Hospital ;  Surgeon,  Oat-Patients,  King's  College 

Hospital. 

It  may  be  well,  in  the  first  place,  to  describe 
what  I  mean  by  the  term  "  suppurative  appendi- 
citis." I  include  all  cases  in  which  suppuration 
occurs  within  or  outside  the  peritoneum,  or 
around  the  caecum  or  colon,  and  which  is  the  direct 
result  of  an  acute  or  chronic  inflammatory  process 
starting  in  some  part  or  tissue  of  the  vermiform  appendix. 
This  suppuration,  practically  speaking,  occurs,  first, 
when  the  bacillus  coli  or  other  organism  passes  out 
from  the  appendix  through  some  lesion  in  its  mucous 
membrane,  and,  secondly,  when  the  appendix  is  the 
seat  of  tuberculous  disease  not  spreading  to  it  from 
other  parts  or  organs.  I  particularly  exclude  all  cases 
in  which,  although  suppuration  occurs  near  the  appen- 
dix, that  suppuration  is  merely  the  spreading  of  some 
inflammatory  process  from  a  neighbouring  part  or 
organ,  such  as  takes  place  in  some  cases  of  tuberculosis, 
or  during  or  after  typhoid  fever. 

With  regard  to  the  anatomy  of  the  appendix,  I 
do  not  propose  to  weary  you  with  an  account 
of  it,  but  there  are  certain  facts  which  are 
of  great  importance  surgically,  and  these  I  will 
touch  upon.  The  appendix  is  entirely  surrounded 
by  peritoneum,  and  has  a  mesentery  derived  from  the 
mesentery  of  the  ileum,  and  not  from  that  of  the 
caecum.  The  mesentery  is  triangular  in  shape,  and 
does  not  extend  more  than  two-thirds  of  the  length  of 
the  organ,  so  that  the  terminal  third  is  free  and  often 
bent  at  an  angle.  The  appendix  has  a  good  arterial 
supply  from  a  branch  of  the  ileo-caecal  artery.  It 
always  seems  to  me  to  have  a  much  better  arterial 
supply  than  is  generally  described.  Between  the 
mucous  membrane  and  its  muscular  layers  there  is 
a  large  amount  of  lymphoid  tissue,  and  many  lymphatic 
vessels  pass  into  the  mesentery.  The  orifice  by  which 
it  opens  into  the  caecum  is  normally  very  small,  and 
guarded  by  a  little  valve  like  structure  known  as  the 
"  valve  of  Gerlach."  There  are  several  variations  in 
the  position  of  the  appendix  : — (a)  The  foetal  form,  in 
which  it  takes  up  the  position  of  a  gradually  narrowing 
tube  prolonging  the  caecum  downwards ;  (6)  it  may 
lie  in  front  of  the  caecum  ;  (c)  it  may  he  behind  the 
caecum ;  (d)  it  may  vary  from  two  inches  to  five  or 
six  inches  in  length. 

As  regards  the  literature  of  the  subject,  its  amount 
is  simply  appalling.  I  fear  I  know  very  little  of  it, 
but  I  feel  confident  that  the  surgeons  of  this  hospital 
are  having  a  practical  experience  which  must  be  quite 
as  great  if  not  greater  than  that  obtainable  at  any 
hospital  in  London.  So  far  as  the  literature  of  appen- 
dicitis generally  goes,  most  writers  are  agreed  as  to 
its  symptoms,  progress  and  treatment.    But  when  we 

W)  Presidential  Address  delivered  at  the  Great  Northern  Central 
Hospital  on  Thursday.  April  14th,  1004,  before  the  North  London 
■edtco-Chirurgical  Society. 


come  to  the  literature  of  suppurative  appendicitis 
it  is  very  different.  There  is  very  little  agreement 
among  writers  as  to  how,  and  especially  as  to  when, 
an  operation  should  be  undertaken.  I  believe  this  is 
due  in  a  great  measure  to  imperfect  experience.  When 
a  surgeon  has  had  under  his  care  a  dozen  cases,  he 
rather  imagines  he  is  able  to  generalise,  and  many  of 
us  frequently  do  so  in  writing.  When,  however,  he 
has  had  experience  of  many  dozens,  he  begins  to  feel 
that  it  is  almost  impossible  to  generalise  at  all.  So 
various  are  the  symptoms  that  one  patient  may  be 
moribund  and  another  actually  able  to  walk  about 
when  the  abdomen  is  full  of  pus.  The  more  cases  of 
this  kind  one  sees,  the  less  is  one  inclined  to  make  any 
dogmatic  statements  in  writing.  Not  many  months 
ago  one  of  the  surgeons  of  this  hospital  had  six  cases 
of  the  kind  admitted  under  his  care  in  one  week,  and 
it  is  quite  a  usual  occurrence  for  three  or  four  cases  of 
this  kind  to  be  admitted  in  one  week.  They  appear 
to  come  in  batches ;  we  get  several  eases  together, 
and  then  no  more  for  perhaps  a  fortnight.  I  have  never 
been  able  to  account  for  this  fact  on  the  assumption 
that  any  atmospheric  conditions,  wind,  or  season  of 
the  year  can  play  any  part,  but  I  have  noticed  that 
we  get  more  of  them  in  the  late  autumn  and  the  early 
spring.  At  these  periods  of  the  year  north-easterly 
or  easterly  winds  are  usually  prevalent,  and  so  there 
is  a  good  deal  of  dust  in  the  air,  which  may  account 
for  it  to  some  extent.  In  the  year  1903,  in  the  months 
of  March  and  October  together,  we  had  twenty-eight 
cases  of  suppurative  appendicitis ;  that  is  to  say, 
nearly  one-quarter  of  all  the  cases  admitted  during  the 
whole  year  came  in  those  two  months.  *4 

The  history  of  suppurative  appendicitis. — It  has 
often  been  stated  that  these  cases  of  suppurative 
appendicitis  occurred  just  as  frequently,  or  nearly  as 
frequently,  years  ago  as  they  do  now,  but  that  they 
were  not  recognised  and  were  stated  to  be  and  described 
as  cases  of  "  idiopathic  peritonitis."  I  thought  that 
this  was  so  myself  until  recently,  when  I  had  an  oppor- 
tunity of  looking  through  the  case  books  of  a  London 
feneral  hospital,  commencing  about  1840.  At  first 
looked  at  reports  of  surgical  cases,  but  I  found  that 
when  a  surgeon  had  such  a  case,  or  any  case  which  was 
thought  to  be  peritonitis,  he  promptly  handed  it  over 
to  the  physicians  for  treatment,  and  clearly  looked  upon 
it  as  a  purely  medical  case.  Now,  in  the  reports  of 
the  medical  cases,  the  greatest  pains  were  taken  in 
writing  the  case  notes  and  post-mortem  reports. 
From  1840  to  1865  I  was  unable  to  find  a  single  case 
which  died  of  peritonitis,  local  or  general,  in  which 
there  was  any  mention  of  a  diseased  appendix.  Now, 
in  all  the  cases  of  this  kind  which  did  die  the  cause  was 
clearly  defined,  and  it  was  specially  observed  and  stated 
that  the  caecum  was  normal.  I  think  it  must  be  ad- 
mitted that  the  pathologists,  or  those  who  acted  as 
such  in  those  days,  would  have  noticed  a  swollen  or 
gangrenous  appendix.  There  are  several  cases  of 
typhlitis  or  perityphlitis,  as  one  would  have  supposed 
them  to  be  from  the  recorded  symptoms,  and  in  a 
few  pus  is  noted  as  having  burst  into  the  bowel. 

I  remember  quite  well  the  first  case  of  suppurative 
appendicitis  which  was  operated  upon  in  King's 
College  Hospital.    One  of  the  surgeons  had  under  his 


522    The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


May  i  8,  1904. 


care  in  the  year  1889  a  girl  of  about  twenty,  who  was 
suffering  from  tuberculous  sacroiliac  disease  on  both 
sides.  She  had  been  in  hospital  for  some  months,  and 
the  surgeon  had  opened  several  abscesses  and  scraped 
out  both  joints  several  times.  This  girl  had  a  sudden 
rise  of  temperature  one  night,  with  rigors  and  pain 
about  the  umbilicus.  Next  day  there  was  a  large 
mass  to  be  felt  on  the  right  side  in  the  region  of  the 
caecum,  and  as  she  had  high  temperature  and  great 
pain,  and  as  neither  could  be  accounted  for  by  the 
sacroiliac  disease,  it  was  decided  to  cut  down  on  the 
mass  and  explore  it.  This  was  done,  and  a  large 
abscess  in  which  there  was  a  gangrenous  appendix  was 
found.  The  appendix  was  excised,  and  it  created  no 
little  interest  for  some  time  afterwards.  After  this 
case  I  cannot  find  evidence  of  another  in  King's  College 
Hospital  for  about  one  and  a  half  years.  At  this  time 
I  was  a  house  surgeon  there,  so  I  am  perfectly  certain 
of  the  facts. 

As  far  as  the  Great  Northern  Central  Hospital  is 
concerned,  I  can  find  no  records  of  suppurative  appen- 
dicitis, or  of  any  case  which  might  have  been  suppura- 
tive appendicitis,  until  the  year  1890.  In  this  year 
there  were  two  cases,  and  they  have  steadily  increased 
until  the  present  time.  Between  the  years  1891  and 
1900,  there  have  been  more  than  200  such  cases,  and 
in  the  year  1903  there  were  very  nearly  100  cases,  so 
that  it  is  clear  that  they  are  steadily  increasing. 

There  can  be  little  doubt  that  the  immediate  cause 
of  suppurative  appendicitis  is  the  escape  of  bacillus 
coli  from  the  appendix,  through  some  abrasion  of  the 
mucous  membrane  lining  the  organ,  into  the  sub- 
mucous lymphoid  tissue.  In  a  few  cases  the  bacilli 
pass  from  the  lymphoid  tissue  straight  into  the  peri- 
toneal cavity,  but  in  far  the  majority  of  cases  I  believe 
they  invade  the  lymphatic  vessels  which  lead  from 
the  lymphoid  tissue  of  the  appendix,  and  so  are  carried 
along  the  mesentery  of  the  appendix  and  the  meso- 
colon to  the  subperitoneal  tissue  generally.  A  fact 
that  I  shall  speak  of  presently,  namely,  that  in  very 
many  of  the  cases  of  suppurative  appendicitis  the  pus 
can  be  reaohed  and  evacuated  without  cutting  through 
or  opening  the  parietal  peritoneum  of  the  abdomen, 
favours  this  view  very  strongly;  moreover,  by  this 
view  the  paths  taken  so  frequently  by  the  pus,  upwards 
towards  the  liver,  downwards  towards  Poupart's 
ligament,  inwards  towards  the  bladder,  and  into  the 
lumen  of  the  colon  itself,  are  easily  explained. 

The  next  thing  is  to  account  for  the  abrasion  of  the 
mucous  membrane  of  the  appendix.  In  many  cases 
(but  by  no  means  in  all)  this  is  caused  by  a  concretion 
present  within  its  lumen.  These  concretions  vary  much 
in  consistency — some  are  soft  and  almost  wholly 
faecal,  some  are  hard  and  formed  evidently  very  slowly, 
chiefly  of  salts  deposited  round  some  nucleus  (commonly 
a  foreign  body),  but  all  are  ovoid  in  shape  and  are 
rarely  found  at  the  tip  of  the  appendix,  but  generally 
about  the  middle  or  two- thirds  down,  where  the  appen- 
dix is  often  sharply  bent  owing  to  the  attachment  of 
its  mesentery. 

Now,  are  these  concretions  formed  in  the  appendix, 
or  are  they  formed  elsewhere,  and  then  passed  into 
the  appendix  ?  I  believe  that  in  many  cases  they  are 
formed  in  the  caecum,  possibly  in  the  pouch  of  the 
valve  of  Gerlach,  and  then  get  pushed  into  the  appendix. 

It  would  be  obviously  unreasonable  to  suppose  that 
the  cause  of  the  abrasion  in  the  mucous  membrane  of 
the  appendix  was  one  which  acted  upon  that  portion 
only  of  the  digestive  tract.  If  we  could  prove  that 
cases  of  irritation,  abrasion,  and  ulceration  of  the 
mucous  membrane  of  the  digestive  tract  as  a  whole 
had  been  more  frequent  during  the  years  that  appen- 
dicitis has  become  more  evident,  then  the  case  would 
be  a  strong  one.  Without  going  into  statistics,  I 
think  we  shall  be  agreed  that  during  the  last  ten 
years  or  so  such  conditions  as  gastric  catarrh  and  ulcer, 
enteritis  and  colitis,  have  been  much  in  evidence.  Is 
it  not  reasonable  to  suppose  that  all  these  affections 
may  be  due  to  some  common  cause,  such  as  an  irritant 
introduced  into  the  digestive  tract  in  one  of  our  daily 


and  staple  foods,  and   one  which  is  common  to  all 
classes? 

From  what  I  have  already  said,  I  think  it  must  be 
admitted  that  suppurative  appendicitis  began  to 
affect  people,  or,  at  any  rate,  became  very  much  more 
common,  in  or  about  the  year  1800.  or  between  1888 
and  1802.  In  order  to  explain  it,  we  have  to  find 
something  which  will  account  for  abrasions  or  ulcers 
of  the  mucous  membrane  of  the  appendix,  and  which 
was  not  present  before  the  year  1889. 

Of  course,  there  is  a  predisposing  cause  for  appen- 
dicitis generally,  and  that  is  constipation,  which  may 
be  put  down  in  a  great  measure  to  lack  of  exercise— 
at  any  rate,  of  walking  exercise.  The  people  in  towns 
can  be  carried  to  and  from  their  work  by  cheap  trains 
and  trains  faster  than  they  can  walk,  so  they  do  not 
walk  as  much  as  they  used  to. 

But  I  strongly  believe  there  is  some  quite  different 
exciting  cause  at  work — very  likely  it  may  be  some- 
thing in  the  food  which  is  eaten  by  the  community 
at  large,  for  there  is  every  reason  to  believe  that 
suppurative  appendicitis  is  affecting  persons  in  every 
class  of  life,  whether  they  live  in  towns  or  in  the 
country  far  away  from  towns. 

It  has  been  put  down  to  the  use  of  enamelled  cooking 
utensils— chips  of  enamel  being  swallowed  and  entering 
the  appendix,  but  if  this  is  the  cause,  the  chip  would 
be  found  without  much  difficulty. 

Now,  there  has  been  a  very  great  change  in  the  staple 
everyday  food  of  life,  namely  bread,  during  recent 
years.  One  of  my  colleagues  spent  some  years  at  his 
life  in  "a  large  flour  mill,  and  I  am  indebted  to  him  for 
what  I  am  now  going  to  say.  Prior  to  the  year  1885. 
practically  all  wheat  was  ground  into  flour  between 
stones,  mill-stones  such  as  are  now  used  in  windmills 
only.  The  husk  of  the  wheat  was  also  ground  up 
with  the  grain.  Between  1885  and  1891  practically 
all  the  flour  mills  substituted  rotters  for  stones.  This 
change  started  at  Vienna  and  spread  first  to  the  United 
States  and  then  to  England.  In  roller  mills,  the  wheat 
is  first  cracked  between  steel  rollers,  and  the  husk 
completely  separated  from  the  grain.  The  cracked 
grains  are  then  rolled  between  roughened  porcelain 
rollers  until  the  flour  is  fine  enough  for  use.  These 
porcelain  rollers  become  soon  polished,  and  are  then 
ineffective,  and  have  to  be  again  roughened  on  the 
surface. 

Then  another  change  has  occurred.  A  good  deal  of 
wheat  has  come  during  the  last  ten  or  fifteen  yean 
from  Egypt  and  India,  and  is.  I  am  told,  mixed  with 
American,  Canadian,  and  English  wheat.  This 
Egyptian  and  Indian  wheat  is  very  dirty — often  con- 
taining sand,  stones,  and  lumps  of  earth,  which  are,  to 
some  extent,  removed  by  fanning  and  washing  before 
the  wheat  is  rolled,  and  so  made  into  flour.  This 
wheat  contains  also  various  seeds  from  plants  growing 
only  among  the  corn  of  Egypt  and  India,  and  some 
of  these,  of  course,  are  crushed  and  rolled  with  the 
wheat. 

Flour  from  about  the  year  1889  and  up  to  the  present 
time,  therefore,  contains  traces  of  three  things  which 
it  did  not  possess  before  that  time— porcelain,  foreign 
earth,  and  foreign  seeds  in  a  finely  divided  form. 

Is  it  possible  that  one  or  more  of  these,  or  possibly 
some  bacteria  contained  in  the  two  latter,  may  account 
for  abrasion  or  ulceration  in  the  mucous  membrane 
of  the  appendix,  such  as  would  allow  of  the  passage 
of  bacillus  coli  through  it  ? 

But  there  is  another  point  well  worth  considering. 
American  flour  is  sent  over  to  this  country  packed  in 
wooden  barrels,  and  the  millers  here  obtain  it,  and  mix 
it  with  a  certain  amount  of  English  or  Black  Sea 
flour  and  then  sell  it  to  the  bakers.  I  am  told  the 
reason  for  this  is  that  satisfactory  bread  cannot  be 
made  from  pure  American  flour — I  suppose  owing  to 
a  deficiency  of  gluten,  or  the  precursor  of  gluten,  which 
it  contains.  It  is  not  improbable  that  this  flour  con- 
tains small  particles  of  wood  from  the  barrels  in  which 
it  is  packed,  and  these  particles  of  wood  might  well 
act  as  irritants  to  the  mucous  membrane  of  the 
digestive  tract.     Some  years  ago  I  had  a  theory  that 


May  i8,  1904. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press.    523 


appendicitis  was  due  to  this  very  cause,  as  I  found 
wood  splinters  as  the  nucleus  in  three  concretions 
removed  during  operation  for  suppurative  appendicitis 
but  ^  I  then  believed  these  splinters  came  from  dust 
arising  from  the  wood  pavements  of  our  streets.  I, 
however,  could  get  no  evidence  to  show  that  cases 
were  more  frequent  during  spells  of  dry  windy  weather, 
when  such  dust  would  be  in  excess  and  would  gain 
access  to  everyday  foods.  I  nevertheless  continued 
to  examine  the  nuclei  of  concretions  removed  from 
appendices,  and  continued  to  find  small  wood  splinters 
in  very  many.  These  are  quite  unmistakable  under 
the  microscope,  the  pitted  or  dotted  vessels  (woody 
vessels  with  pits)  being  at  once  recognisable.  I  have 
also  found  these  small  splinters  in  appendices  which 
have  not  contained  any  concretions,  and  which  have 
been  removed  during  a  period  of  quiescence  between 
acute  attacks  of  appendicitis. 

Of  course,  one  finds  many  other  substances,  spiral 
vegetable  vessels,  such  as  are  found  in  cabbage  leaves 
and  stalks,  fibres  of  cotton,  linen,  and  jute,  and  hairs 
of  various  kinds  from  woollen  and  flannel  garments. 
The  particles  of  jute  are  of  interest,  as 'they  probably 
come  also  from  the  bread,  the  flour  from  which  bread 
is  made  being  now  commonly  sold  to  the  bakers  in 
jute  bags  containing  100  tb. 

As  regards  the  symptoms  of  suppurative  appen- 
dicitis, I  can  only  give  you  the  symptoms  of  the  more 
common  types  of  cases — anomalous  cases  are  always 
turning  up — and  the  more  cases  one  sees  the  more 
difficult  does  it  become  to  say  exactly  what  the  sym- 
ptoms of  the  affection  are.  Now  I  think  all,  or 
nearly  all,  the  case  of  typhlitis,  or  perityphlitis  as  they 
are  sometimes  termed,  really  start  by  inflammatory 
disturbance  in  the  lymphoid  tissue  of  the  appendix 
brought  on  as  I  have  before  mentioned  by  infection 
with  bacillus  coli  or  other  organism,  and  one  would 
reasonably  suppose  that  the  main  symptoms  would  be 
more  or  less  localised  to  the  region  of  the  organ,  but 
this  is  certainly  not  the  case,  and  this  is  the  very  fact 
which  often  makes  the  diagnosis  of  the  condition 
so  difficult.  It  seems  to  me  that  the  diversity  of  the 
symptoms  is  not  difficult  to  account  for  if ,  as  I  believe 
to  be  the  case,  the  pus  which  is  formed  first  in  the 
lymphoid  tissue  of  the  appendix  'spreads  subperi- 
toneally  to  neighbouring  and  often  distant  parts. 
Of  course,  there  are  some  cases  in  which  it  bursts 
through  the  peritoneum  covering  the  appendix  at 
once,  and  so  gives  rise  to  a  general  suppurative  peri- 
tonitis. These  are  the  most  fatal  cases,  and  happily 
are  not  very  common.  We  need  not  trouble  about  the 
symptoms  of  these,  as  they  are  the  usual  symptoms  of 
very  acute  peritonitis,  and  are  such  as  call  for  imme- 
diate laparotomy. 

We  may  conveniently  describe  the  symptoms  under 
three  headings : — 

1 .  When  the  infection  of  the  tissues  of  the  appendix 
occurs,  and  before  pus  is  formed. 

2.  When  pus  is  formed  and  spreads  to  some  near 
or  distant  part. 

3.  When  pus  has  been  present  for  some  days  and 
septic  toxins  are  being  absorbed  by  the  blood. 

In  the  first,  there  is  pain  of  a  burning  or  stabbing 
character  in  the  region  of  the  appendix,  worse  on 
straining,  nausea  and  frequently  vomiting,  most  marked 
when  the  patient  attempts  to  walk.  Temperature — 
between  ioo°  and  1020  as  a  rule,  with  slight  shivering. 
or  sometimes  actual  rigors.  Rigidity  of  the  abdominal 
muscles.  Under  an  anaesthetic,  if  the  patient  be  not 
fat,  the  thickened  appendix  may  be  felt  within  the 
abdomen. 

In  the  second,  the  pain  is  generally  referred  to  some 
part  of  the  abdomen  other  than  the  appendix.  The 
umbilicus  is  most  common,  then  the  transverse  colon, 
the  descending  colon,  and  the  bladder,  and  the  pain  is 
of  a  throbbing  Character,  much  worse  on  straining. 
There  is  also  griping  pain,  and  peristalsis  evident  on 
inspection.  Vomiting  is  very  common,  and  the 
abdomen  is  distended,  and  there  is  constipation. 
Temper ature  np  to  1049  or  105°  at  night — ioo°  to  1020 
by  da/.     Rigidity  of  abdomen  very  marked,  and  under 


an  anaesthetic  a  lump  or  ill-defined  swelling  (possibly 
fluctuating)  can  be  felt  in  the  region  of  the  caecum  by 
abdominal  or  rectal  palpation.  There  is  very  often 
oedema  of  the  skin  of  the  abdomen,  over  a  small  area 
immediately  superficial  to  the  appendix.  There  is 
very  often  indeed  severe  pain  on  micturition. 

In  the  third,  pain  is  very  often  nearly  or  quite  absent, 
owing  to  the  affection  of  the  nerve  centres  by  the 
toxins  absorbed  by  the  blood  from  the  pus.  Very 
often  the  patient  is  delirious  at  night.  Vomiting 
continues  and  is  often  stercoraceous.  The  vomiting 
is  more  of  the  nature  of  a  sudden  pumping  action  of 
the  stomach,  the  intestine  being  often  paralysed. 
Temperature  is  not  much  raised,  often  subnormal. 
Rigidity  and  distension  of  abdomen  very  marked . 
Fluctuation  may  be  detected  in  various  regions — 
(1)  in  the  region  of  the  ascending  colon  and  hepatic 
flexure ;  (2)  in  the  pelvis,  behind  and  around  the  rectum  ; 
(3)  in  the  peritoneal  cavity.  I  have  remarked 
before  that  it  is  only  rarely  that  pus  bursts  from  the 
appendix  at  once  into  the  peritoneum.  My  belief 
is  that  in  the  great  majority  of  cases  pus  burrows 
beneath  the  peritoneum,  and  may  be  detected  in 
various  situations,  and  then  may  burst  into  the  peri- 
toneal cavity,  as  being  the  line  of  least  resistance 
when  it  is  at  considerable  tension. 

The  pupils  are  often  dilated,  and  if  one  sees  a  case 
for  the  first  time  in  this  stage,  one  may  be  inclined  to 
give  a  good  diagnosis  because  the  patient  is  free  from 
pain  and  tenderness  on  pressure,  and  looks  and  seems 
fairly  well.  A  patient  m  this  state,  if  not  operated 
upon,  generally  becomes  suddenly  delirious  and  dies. 

In  this  stage  one  of  the  most  noticeable  features 
is  the  entire  absence  of  [pain  and  the  fact  that  the 
patient  may  appear  fairly  well,  and  may  even  be  able 
to  walk  about  in  spite  of  the  fact  that  the  abdomen 
is  full  of  pus.  Such  cases  might  well  be  called  "  ambu- 
latory appendicitis."  I  have  come  across  three  such, 
and  will  briefly  relate  the  two  most  striking  ones. 

The  first  occurred  in  a  youth,  aet.  19,  whom  I  was 
asked  to  see  one  Sunday  night,  and  whose  history 
was  as  follows :  Just  one  week  previously  he  had 
been  seized  with  a  typical  attack  of  appendicitis.  It 
was  recognised  and  treated  promptly,  the  patient 
being  kept  in  bed  for  three  days.  On  the  Wednesday 
evening,  apparently  quite  recovered,  he  got  up  and 
went  to  his  work  in  the  City,  and  this  he  continued  to 
do  on  the  Thursday  and  Friday.  Each  of  these  days 
he  walked  at  least  six  miles,  and,  although  not  feeling 
perfectly  well,  was  able  to  do  his  work.  On  the 
Saturday  his  doctor  found  that  he  had  great  pain  in 
the  region  of  the  bladder,  and  supposing  that  he  had 
cystitis,  he  washed  the  bladder  out  two  or  three  times ; 
but  there  was  no  appearance  of  cystitis,  and  the  pain 
became,  if  anything,  worse.  This  went  on  until  the 
Sunday  evening,  when  I  was  asked  to  see  him.  I 
found  him  with  a  rather  sallow  complexion,  dilated 
pupils,  with  rigid  but  not  distended  abdomen.  He 
got  out  of  bed  and  passed  water,  but  evidently  with 
much  pain.  I  gave  him  an  enema  myself,  and  it 
acted  thoroughly.  This 'appeared  to  relieve  his  pain, 
and  he  said  he  was  quite  comfortable,  and  he  walked 
about  the  room  in  my  presence.  I  did  not  like  the 
look  of  his  face,  and  so  gave  a  guarded  diagnosis, 
but  I  did  not  suppose  that  he  was  seriously  ill;  On 
Monday  morning  I  received  a  telegram  saying  that  he 
had  suddenly  jumped  out  of  bed  at  three  o'clock  in 
the  morning  in  a  state  of  delirium,  and  had  promptly 
died.  We  made  a  post-mortem  examination  the  same 
afternoon,  and  found  his  abdomen  quite  full  of  pus, 
and  the  appendix  gangrenous.  %      £4    fb  9l 

The ''second  case  was  that  of  a  lady,  aet.  aboutTso, 
who  had  had  an  attack  of  appendicitis  about  four  days 
previously,  but  she  had  so  far  recovered  that  on  the 
day  before  I  saw  her  she  had  walked  two  or  three 
miles,  and  had  bathed  in  the  sea — she. was  staying  on 
the  Devonshire  coast.  She,  however,  had  a  tem- 
perature of  1 02 °,  and  a  distended  abdomen,  but  she 
w  as  quite  free  from  pain.  An  immediate  laparotomy 
w  as  performed,  the  abdomen  being  found  quite  full 
of  pus. 

D 


524    The  Medical  Pew.         ORIGINAL  COMMUNICATIONS. 


May  18,  19041 


I  have  not  entered  into  fall  details  of  these  cases ; 
the  facts  in  both  of  them  are,  practically,  that  the 
patients,  although  suffering  from  acute  suppurative 
peritonitis  following  upon  an  attack  of  appendicitis, 
were  in  apparently  fairly  good  health  and  able  to  walk  ; 
in  other  words,  in  such  a  condition  that  it  was  very 
difficult  to  believe  they  were  at  death's  door. 

The  third  case  of  this  kind  was  that  of  a  man  who 
walked  into  this  hospital,  and  in  this  case  the  pelvis 
was  full  of  pus,  but  I  rather  think  the  abscess  burst 
into  the  pelvis  after  he  arrived. 

I  have  not  said  anything  concerning  tuberculous 
appendicitis.  The  chief  characteristics  of  this  are 
its  chronic  nature  and  the  fact  that  pus  burrows  in 
several  directions  and  for  a  considerable  distance. 

As  regards  the  treatment  of  suppurative  appen- 
dicitis, I  shall  only  deal  with  three  points: — (1)  the 
method  of  reaching  the  appendix  itself  and  the  pus ; 
(2)  the  use  of  enemata ;  (3)  the  use  of  purgatives. 

During  the  early  stages  of  acute  suppuration,  the 
pus  is,  as  I  have  before  stated,  between  the  mucous 
membrane  and  the  peritoneal  covering  of  the  appendix, 
at  any  rate  in  the  majority  of  cases.  It  spreads  by 
burrowing  beneath  the  peritoneum,  and  may  then 
come  forwards  and  point  beneath  the  skin  of  the  abdo- 
men at  McBurney's  spot,  or  above  or  below  Poupart's 
ligament.  It  may  travel  backwards  or  outwards 
around  the  caecum  and  so  reach  the  loin.  In  these 
cases  the  abscess  is  fairly  easily  recognised,  for,  as  it 
jeaches  the  surface,  there  is  the  typical  inflamed  and 
oedematous  skin,  with  a  soft  fluctuating  spot  in  its 
centre.  The  abscess  is  opened,  washed  out,  and  the 
cavity  stuffed  or  drained  with  a  tube. 

In  other  cases  the  pus  makes  its  way  beneath  the 
peritoneum,  backwards  and  inwards  to  the  base  of 
the  bladder,  into  the  pelvis,  and  around  the  rectum, 
eventually,  perhaps,  bursting  into  the  bladder  or  into 
the  rectum.  These  are  the  cases  which  are  so  difficult 
to  deal  with  surgically,  and  if  they  are  not  dealt  with 
promptly  there  is  very  great  risk  of  the  pus  bursting 
into  the  peritoneal  cavity,  and  setting  up  local  or 
general  peritonitis.  In  very  many  cases  while  the 
pus  is  still  beneath  the  peritoneum  a  local  peritonitis 
is  set  up  without  the  pus  actually  bursting  through, 
then  lymph  is  poured  out  and  adhesions  are  formed 
which  often  prevent  further  danger  to  the  general 
cavity  of  the  peritoneum,  but  it  is  very  unsafe  to 
wait  until  this  occurs  or  to  wait  hoping  that  it  may 
occur.  Directly  we  have  reason  to  believe  that  pus 
has  actually  formed,  we  ought  to  evacuate  it  without 
delay. 

To  attempt  to  reach  it  by  performing  laparotomy 
always  appears  to  me  a  highly  dangerous  proceeding, 
for  when  one  has  reached  it,  it  must,  of  course,  infect 
the  peritoneal  cavity.  I  am  quite  prepared  to  admit 
that  the  peritoneum  is  a  long-suffering  membrane, 
it  will  stand  a  great  deal  more  in  the  way  of  infection 
than  is  generally  supposed;  but  that  is  no  reason  for 
wilfully  infecting  it,  as  must  result  if  we  attempt  to 
reach  pus  which  is  behind  it  by  performing  laparotomy. 
The  proceeding  which  appears  to  me  to  be  the  best 
is  to  make  a  vertical  or  curved  incision  about  one 
inch  anterior  to  the  usual  incision  for  lumbar  colotomy, 
to  cut  through  the  muscles,  and  then  insert  a  finger 
into  the  subperitoneal  fat  and  search  for  the  pus. 
Very  often  one  finds  it  easily,  in  some  cases  the  finger 
feels  the  peritoneum  bulging  in  one  spot  and  can  be 
easily  pushed  through,  and  is  found  to  pass  into  a  sac 
containing  pus,  which  is  really  a  part  of  the  general 
peritoneal  cavity  shut  off  by  adhesions  and  containing 
the  ulcerated  or  gangrenous  appendix.  This  sac  or 
cavity  is  then  washed  out  and  drained,  preferably  by  a 
gauze  plug.  If  no  abscess  can  be  reached  in  this  way, 
the  best  thing  is  to  stuff  the  wound  with  gauze,  and 
wait  for  the  pus  to  find  its  own  way  into  the  cavity, 
which  it  does,  as  a  rule,  within  twenty-four  hours. 
In  the  majority  of  cases  of  suppurative  appendicitis, 
the  pus  only  bursts  into  the  peritoneal  cavity  as  a 
last  resort,  as  it  were — if  you  give  it  a  chance  of  getting 
out  by  opening  up  the  subperitoneal  tissue  it  will 
take  that  chance  rather  than  enter  the  peritoneal 


cavity.  The  operation  is  a  safe  and  easy  one,  and  is 
the  one,  in  my  opinion,  which  should  always  be  per- 
formed when  deep  pus  is  diagnosed  or  when  pus  is 
suspected,  for  if  the  wound  be  kept  open  by  plugging, 
the  pus  has  a  ready  means  of  exit.  There  are  other 
advantages  also: — (1)  A  wound  in  such  a  situation 
is  easy  to  irrigate  and  to  keep  irrigated  and  drained— 
there  is  little  fear  of  the  pus  "  pocketing  "  ;  (2)  the 
liability  to  hernia  after  the  wound  is  healed  is  much 
less  than  after  laparotomy. 

It  always  seems  to  me  that  the  practice  of  perform- 
ing laparotomy  is  order  to  find  pus  around  or  near  the 
appendix  is  a  most  dangerous  proceeding,  for  it  involves 
the  certain  infection  of  the  general  peritoneal  cavity 
if  the  pus  is  found.  I  want  to  make  it  quite  dear 
that  I  am  referring  to  cases  in  which  pus  from  a  sup- 
purating appendix  has  not  already  burst  into  the 
general  peritoneal  cavity. 

It  is  urged  as  a  disadvantage  that  if,  during  this 
operation,  the  appendix  is  felt,  it  may  be  very  difficult 
to  ligature  and  remove  it  through  such  a  lumbar 
incision.  This  is  quite  true  in  many  cases,  but,  as  a 
rule,  the  appendix  has  already  sloughed  off,  and  there 
is  nothing  left  of  it  to  remove ;  moreover,  its  base  is 
generally  so  rotten  that  any  attempt  at  ligaturing 
it  ends  promptly  in  a  faecal  fistula  being  made.  If  the 
appendix  has  not  sloughed,  then  the  safe  and  proper 
procedure  is  to  do  a  laparotomy  at  a  later  date  when 
suppuration  has  ceased,  and  remove  the  appendix 
as  one  would  in  an  ordinary  case  of  appendicectomy. 

The  greatest  misfortune  in  suppurative  appendicitis 
is  paralysis  of  the  intestine  leading  to  great  distension 
and  complete  obstruction.  This  paralysis  seems  one  of 
the  most  hopeless  affections  to  treat  successfully. 
If  any  distension  is  present  when  the  operation  is 
performed  I  generally  dilate  the  anus  fully  when  the 
operation  is  completed,  and  then  wash  out  the  rectum 
freely  with  very  hot  salt  solution  by  means  of  an 
irrigator.  Not  only  does  this  tend  to  promote  peri- 
stalsis, but  it  combats  shock,  for  if  the  rectum  and 
descending  colon  be  left  full  of  fluid,  the  latter  is 
rapidly  absorbed  and  assists  the  heart  quite  as  effi- 
ciently as  intravenous  injection. 

I  should  like  to  remark  here  that  shock  after  ab- 
dominal operations,  and,  indeed,  after  any  operation, 
is,  in  my  opinion,  very  largely  due  to  exposure  of  the 
tissues  to  air  at  a  comparatively  low  temperature. 
I  believe  that  if  we  could  perform  severe  operations 
in  a  room  the  air  of  which  was  at  about  100  degrees 
Fahrenheit,  our  patients  would  suffer  little,  if  at  all, 
from  shock.  The  objection  to  the  proceeding  would 
be  that  those  performing  or  assisting  at  the  operation 
would  probably  succumb  to  the  effects  of  the  heated 
air  before  the  operation  was  completed,  so  that  it  is, 
of  course,  impossible  to  carry  it  out.  At  the  same  time 
one  has  repeatedly  observed  the  very  great  benefit 
derived  by  placing  the  patient  upon  a  heated  table, 
and  by  using  very  hot  lotions  with  which  the  parts 
exposed  are  irrigated 

Another  great  trouble  which  is  the  result  of  a  para- 
lysed intestine  is  severe  distension.  Directly  distension 
is  observed  in  an  abdominal  case  it  is  advisable  to 
administer  some  salol  by  the  mouth,  five  grains  three 
times  a  day.  It  is  easily  retained,  does  not  appear 
to  induce  vomiting,  and  certainly  checks  putrefaction 
in  the  digestive  tract. 

With  regard  to  purgatives  in  suppurative  appen- 
dicitis, there  is  great  difference  of  opinion.  Personally 
I  always  administer  calomel  by  the  mouth  from  the 
onset,  and  continue  it  together  with  hot  soap  and  water 
enemata  until  the  bowels  are  freely  opened.  By  this 
procedure  I  feel  certain  I  have  checked  many  cases 
which  would  have  become  serious.  By  so  doing,  I 
do  not  know  of  any  case  in  which  the  purging  has 
caused  an  ulcerated  appendix  to  rupture,  though 
other  have  said  that  this  is  a  real  danger.  I  consider 
it  much  more  risky  to  keep  the  intestine  absolutely  at 
rest,  for  I  cannot  help  feeling  that  there  is  always 
danger  in  any  f ormof  appendicitis  when  coastipati  on 
is  present. 


May  18,  1904* 


ORIGINAL  COMMUNICATIONS. 


Tn  Mkdical  Press.    525 


DEGENERACY:     PHYSICAL, 
MENTAL,  AND  MORAL,  (a) 

By    G.     E.    SHUTTI.EWORTH,    B.A.,    M.D., 
M.R.C.S.Eng., 
Vice-chairman  of  Council  of  Childhood  Society. 

Dr.  Shuttleworth  disavowed  the  pessimistic 
views  held  by  some  as  to  the  extensive  prevalence 
of  degeneracy  in  the  nation,  and  confessed  him- 
self unable  to  accept  all  that  Nordau  had  written 
as  to  genius  being  mainly  degenerate,  and  Lom- 
broso's  and  Benedict's  theories  as  to  specialised 
criminal  types  of  brain.  Yet  the  subject  was  one 
calling  for  scientific  observation,  and  strenuous 
measures  of  counteraction  where  detected  ;  and 
in  this  direction  the  work  of  the  Childhood  Society 
might  be  most  valuable  to  the  country  at  large. 

How  to  detect  early  signs  of  deviation  from 
the  normal  in  physical  and  mental  development 
was  one  of  the  questions  which  this  society  had 
set  itself  to  solve.  The  report  on  the  examination 
of  100,000  children  in  schools,  issued  under  its 
auspices  in  1895,  was  a  most  valuable  contribu- 
tion to  the  problem,  and  set  an  example  which 
might  advantageously  be  followed  in  schools 
throughout  the  country.  Anthropometric  ob- 
servations of  the  growing  child  were  also  of  im- 
portance ;  and  these,  unfortunately,  were  too  few 
and  far  between.  The  child  being  "  father  to 
the  man,"  such  observations  would  have  national 
value  in  relation  to  the  alleged  physical  deteriora- 
tion of  Army  recruits  ;  and  it  was  only  by  com- 
bating adverse  conditions  in  the  incipient  stage 
that  good  could  be  effected. 

Dr.  Shuttleworth  then  reviewed  the  alleged 
evidence  of  physical  deterioration,  and  pointed 
out  that  even  if  it  were  proved  it  would  apply  only 
to  the  lowest  stratum  of  the  community.  He  re- 
ferred to  the  inquiries  made  previous  to  factory 
legislation  in  1832,  and  remarked  that  then,  as 
now,  unwholesome  conditions  of  town  life  and  of 
indoor  labour  were  undoubted  factors  in  physical 
deformity.  The  transmissibility  of  defects  was 
then  considered,  and  it  was  argued  that  much 
depended  upon  environment  as  well  as  upon  here- 
dity. Passing  to  the  subject  of  mental  de- 
generacy, its  close  co-relation  with  physical 
degeneration  was  pointed  out ;  and  the  coinci- 
dence of  physical  deformity  with  moral  defect 
has  been  noted  from  the  most  ancient  times. 

In  conclusion,  the  causes  and  possibilities  of 
prevention  of  degenerate  states  were  briefly 
considered.  The  restriction  of  the  marriage  of 
the  unfit  was  of  prime  importance,  but  formed  a 
difficult  social  problem ;  ante-natal  care  in  rela- 
tion to  female  labour  was  desirable ;  maternal 
nursing  instead  of  bottle-feeding  should  be  con- 
sidered a  social  duty  wherever  practicable. 
School  methods  should  be  brought  into  harmony 
with  physiological  principles,  and  with  this  view 
all  teachers  should  be  trained  in  that  part  of  phy- 
siology and  psychology  which  had  a  direct  bearing 
on  their  work.  Growing  children  should  be  pro- 
tected from  overstrain,  mental  or  physical,  and 
their  conditions  of  life  rendered  as  favourable 
as  possible  by  legislative  restrictions  of  premature 
employment  out  of  school  hours,  as  well  as  by 
sanitary  homes,  sanitary  schools,  and  (if  needs 
be)  by  supplementing  scanty  nutriment.  The 
falling  birth-rate  was  briefly  alluded  to,  and  a  hope 
expressed  that  woman,  while  aspiring  to  share 


(«)  Abstract  of  Address  at  the  annual  meeting  of  the  Childhood       la)  Abstract  of  Paper  read  before  the  North-E 
Society,  May  11th,  1904.  Society,  Kay  5th,  1904. 


what  used  to  be  considered  the  responsibilities 
and  employments  of  men,  would  not  forget  that 
the  sacred  duties  of  motherhood  must  not  be 
shirked,  for,  as  Lord  Rosebery  once  pithily  put  it, 
"it  is  of  no  use  having  an  Empire  without  an 
Imperial  race  1  " 

ON  THE  VALUE  OF  CERTAIN 

DRUGS  IN  MEDICINAL  TREAT- 
MENT OF  DISEASE  IN 
CHILDREN,  (a) 

By  FRED  J.  TRESILIAN,  M.D.,  F.R.C.P.Ed. 

Moxon's  dictum  that  "  a  doctor  without  physic 
is  like  a  priest  without  a  creed  "  is  especially 
applicable  to  children.  A  hesitating  and  casual 
doctor,  relying  on  expectant  treatment  only 
for  sick  children,  will  find  that  unbelieving  mothers 
will  frequently  change  their  faith.  Moreover, 
it  is  in  children  that  one  gets  the  quickest  and 
most  encouraging  results  from  treatment,  as 
they  respond  readily  to  properly-directed  thera- 
peutic measures. 

The  drug  list  available  for  children  is  a  small 
one  in  comparison  with  that  of  adults. 

Alcohol  and  cod-liver  oil  are  more  properly 
foods  than  drugs.  Alcohol  is  most  valuable  in 
the  treatment  of  pneumonia,  zymotic  diarrhoea, 
and  severe  chorea.  It  must  not  be  pushed  too  far, 
as  it  generally  is  by  parents,  who  do  not  recog- 
nise the  symptoms  of  overdose  ;  it  must  be  given 
in  regular  doses  and  stopped  as  soon  as  possible. 

Antimony  is  the  most  valuable  of  all  drugs  in 
the  treatment  of  acute  bronchial  and  pulmonary 
disease,  acute  lobar  pneumonia,  acute  laryngitis 
and  bronchitis,  and  early  stages  of  catarrhal 
pneumonia,  and  children  bear  it  well.  It  may 
be  combined  with  aconite  or  acetate  of  ammonia. 
It  is  also  useful  in  acute  eczema. 

Arsenic. — The  method  of  curing  chorea  in  a 
week  with  large  doses  of  Fowler's  solution  is, 
I  think,  to  be  condemned.  Smaller  doses,  spread 
over  a  larger  interval  and  gradually  increased,  are 
preferable.  Arsenic  is  also  useful  in  asthma 
and  the  lymphadenomatous  and  leukaemic  condi- 
tions of  children. 

Belladonna  is  very  valuable  in  acute  catarrhal 
or  broncho-pneumonia,  its  effects  in  stopping  the 
(Edematous  secretion  being  sometimes  very  strik- 
ing. It  is  also  useful  sometimes  in  pure  neurotic 
enuresis,  and  it  may  be  pushed  and  combined 
with  quinine,  strychnine  or  bromides.  In  whoop- 
ing-cough as  well  as  in  enuresis  it,  however, 
frequently  fails.  It  is  valuable  as  an  external 
application  in  appendicitis  and  in  the  non-tuber- 
culous forms  of  peritonitis. 

Mercury. — The  days. of  universal  use  of  hyd. 
c.  creta  and  calomel  are  declining.  Jenner's  dic- 
tum, "  When  you  see  a  sick  child,  don't  think 
only  of  grey  powder,"  was  a  wise  one.  Small 
doses  of  hyd.  c.  creta  are  very  useful  in  the  treat- 
ment of  digestive  troubles  of  bottle-fed  infants. 
The  inunction  of  mercury  is  most  valuable  for 
producing  rapid  effects  in  the  treatment  of  con- 
genital syphilis,  especially  interstitial  keratitis 
and  labyrinthine  disease,  where  the  mischief  must 
be  checked  as  soon  as  possible.  In  these  conditions 
the  action  of  grey  powder  and  the  solution  of  the 
perchloride  are  much  too  slow.  Mercurial  inunc- 
tion is  also  useful  in  tuberculous  peritonitis.     The 


;  London  Clinical 


526     Thb  Medical  Press.         ORIGINAL  COMMUNICATIONS. 


Mat  i  8,  1904. 


external  and  internal  administration  of  mercury  in 
combination  is  sometimes  the  best  in  non-tubercu- 
lous forms  of  meningitis,  which  are  generally 
posterior  basic,  but  they  frequently  fail  to  pro- 
duce any  effect  whatever. 

Salicylates  do  not  exert  the  same  depressing 
effects  in  children  that  they  do  in  adults,  either 
upon  the  nervous  or  circulatory  systems,  and  they 
do  not  affect  the  labyrinth  in  the  same  way.  They 
have  a  tendency,  however,  to  cause  hematuria. 
Not  only  in  acute  rheumatism  and  acute  erythe- 
matous symptoms,  but  in  chronic  mucous  catarrh 
of  the  intestines,  with  papular  urticaria  in  bladder 
affections,  such  as  cystitis  and  uric- acidemia, 
in  headaches,  in  the  rheumatic  forms  of  tonsillitis, 
in  acute  summer  diarrhoea,  and,  combined  with 
belladonna,  in  appendicitis,  they  sometimes  give 
most  striking  results.  The  salicylate  of  bismuth 
is  a  most  valuable  drug  for  children  ;  it  does  not 
cause  haematuria,  and  is  most  useful  in  diarrhoea 
and  colic. 

Antipyrin  and  phenacetin  are  useful  in  acute 
pain,  such  as  ear-ache,  in  painful  dentition,  night 
terrors,  and  laryngismus. 

Opium. — Opium  in  small  doses  in  the  form 
of  nepenthe  or  Dover's  powder  can  be  used 
with  safety  in  colic,  appendicitis,  intussusception, 
and  acute  diarrhoea. 

Chloral  is  the  best  hypnotic  for  children,  and 
is  useful  in  tetany,  convulsions  and  allied  con- 
ditions. 

Purgatives. — For  young  infants  those  which  will 
be  found  of  most  service  are  manna,  small  gly- 
cerine suppositories  or  injections,  the  stick  of 
soap  dipped  in  glycerine  ;  and  for  older  children 
pilules  of  aloin  and  belladonna,  cascara  bonbons, 
Rubinat  and  Franz  Joseph  waters,  and  so  on. 


THE    ADMINISTRATION    OF 

HYPNOTICS  IN 

N  EURASTHENIA.   (a) 

By  EDWARD  A.  LERMITTE,  M.B.,  B.S., 
M.R.C.S.,  L.R.C.P.    *v^'~*       <-'*'.fc.*4> 

It  is  not  my  intention  to  cover  the  whole  ground 
of  the  treatment  of  that  very  troublesome  sym- 
ptom of  neurasthenia,  namely,  insomnia,  but 
merely  to  point  out  the  results  obtained  from  the 
use  of  some  drugs  which  I  have  constantly  em- 
ployed during  the  past  ten  years.  Undoubtedly, 
much  can  be  done  to  relieve  this  insomnia  by  the 
rest-cure  and  the  Weir-Mitchell  treatment,  but 
there  exist  a  vast  number  of  patients  who  either 
cannot  or  will  not  afford  the  time  or  money  which 
these  somewhat  expensive  measures  involve. 
Consequently,  the  practitioner,  deprived  of  these 
means,  is  compelled  either  to  disregard  the  sleep- 
lessness of  his  patients  or  to  resort  to  the  use  of 
some  hypnotic,  and  probably  in  the  majority  of 
his  cases  he  will  have  to  adopt  the  latter  course. 
If  this  be  granted,  then  the  choice  of  a  hypnotic 
becomes  an  important  question  of  almost  daily 
recurrence. 

There  are  some  hypnotics  which  the  public 
have  appropriated,  and  which  they  are  in  the 
habit  of  taking  without  medical  advice.  This 
we  are  powerless  to  prevent,  but  when  the  patient 
seeks  our  advice,  it  may  be  laid  down  as  an  axiom 
that  one  of  the  worst  things  we  can  do  is  to  place 
in  his  hands  a  hypnotic  to  which  he  can  resort 

(«)  Abstract  of  a  Paper  read  at   a  meeting   of  the  North-East 
London  Olisical   Society,  Maj  6th,  M04. 


at  will.  The  disastrous  results  of  telling  a  patient 
that  he  may  take,  for  example,  tabloids  of  sul- 
phonal  when  he  is  unable  to  sleep  must  be  known 
to  all  of  us. 

The  four  drugs  I  have  used  are :  (1)  a  bromide 
mixture,  each  drachm  of  which  contains  pot.  brom., 
chloral  hydrat.  aa  gr.  xv ;  tinct.  hyoscyam.  n\^  xx, 
and  which,  with  the  exception  of  one-eighth  of  a 
grain  of  the  extract  of  cannabis  indica,  is  equiva- 
lent to  a  drachm  and  a  half  dose  of  bromidia. 
(2)  Chloralamide.  (3)  Chloretone.  (4)  Paral- 
dehyde. I  propose  to  give  you  the  results  which 
I  have  obtained  from  their  administration. 

The  following  table  has  been  compiled  on  the 
results  obtained  in  197  cases,  in  which  the 
bromide  mixture  was  given  in  in  cases,  chloral- 
amide  in  65,  chloretone  in  15,  and  paraldehyde 
in  6  cases : — 


Drug. 


Bromide  Mix. 
Chloralamide 
Chloretone 
Paraldehyde 


I. 

M. 

9O 

45 
32 
23 


II. 

III. 

IV.  1 

V. 

VI. 

H.  M. 

H.  If. 

M. 

H.  M. 

H.  It. 

4  5 

3  IS 

15 

5  45 

2  0 

4  40 

2  0 

*5 

5  45 

3  0 

5  40 

0  55 

20 

5  55 

3  IS 

5  23 

0  35 

20 

6  5 

'  5  5 

Column    I. — Average    time    taken    to    act.     II. — 
Average    period    of    induced    sleep.     III. — Maximum 
time  taken  to  act.        IV. — Minimum  time  taken  to 
act.     V. — Maximum  period  of  sleep.     VI. — Minimum 
period  of  sleep. 

Chloralamide  has  been  specially  recommended 
as  a  hypnotic  in  neurasthenic,  spinal  and  cardiac 
cases.  It  possesses  no  analgesic  effects,  and  it  is 
said  to  be  unsuitable  for  the  treatment  of  in- 
somnia in  phthisis.  With  regard  to  the  mode  of 
administration,  it  is  most  advantageously  given 
in  a  weak  alcoholic  solution,  and  in  doses  of  from 
20  to  50  grains.  It  is  not  readily  soluble,  but, 
unlike  sulphonal,  we  cannot  call  heat  to  our  aid, 
as  chloralamide  is  decomposed  by  a  temperature 
of  1200  F.  Taken  in  the  form  of  a  powder,  it 
is  slow  and  uncertain  in  its  action.  I  have  not 
observed  any  unfavourable  results  from  its  ad- 
ministration, and,  in  fact,  it  seems  to  be  pecu- 
liarly devoid  of  after-effects. 

Cappilletti  has  reported  the  results  obtained 
by  him  from  the  administration  of  chloretone  in 
twenty-five  cases  of  mental  disease,  in  which  the 
duration  of  sleep  varied  from  two  to  five  hours. 
As  far  as  I  have  been  able  to  observe  its  effects, 
chloretone  does  not  influence  the  pulse  or  res- 
piration, nor  does  it  upset  the  digestive  system. 
I  have  only  seen  unpleasant  after-effects  in  one 
case  in  which  diplopia,  drowsiness,  and  headache 
supervened. 

Paraldehyde  is  an  extremely  objectionable  drug 
to  take,  having  a  very  pungent,  ethereal  taste 
and  odour.  Another  drawback  to  its  use  is 
that  it  imparts  an  odour  of  garlic  to  the  breath. 
It  is  said  to  considerably  increase  the  flow  of  urine, 
but  this  statement  I  have  been  unable  to  verify. 
It  has  been  said  that  paraldehyde  does  not  pro- 
duce headache  on  the  day  following  its  adminis- 
tration, but  my  own  impression  is  that  it  does, 
although  it  is  difficult,  when  treating  neuras- 
thenics, to  feel  certain  that  the  drug  is  the  cause 
of  the  headache  of  which  the  patient  complains. 
It  certainly  does  not  derange  the  stomach  as 
might  be  expected  from  its  extremely  disagreeable 
flavour,  nor  have  I  seen  it  produce  skin  rashes. 

If  we  compare  the  results  obtained  from  the 
administration  of  these  four  drugs  we  arrive  at 


May  i  8,  1904, 


TRANSACTIONS  OF  SOCIETIES. 


the  following  conclusions  : — First,  with  regard 
to  the  average  time  taken  to  induce  sleep,  the 
bromide  mixture  acted  the  slowest.  (Column  I.) 
The  maximum  and  minimum  times  taken  to  act 
are  seen  in  Columns  III  and  IV.  As  far  as  the 
maximum  of  induced  sleep  is  concerned,  there  is 
but  a  matter  of  twenty  minutes  to  choose  be- 
tween the  four  drugs,  paraldehyde  winning  by 
that  amount,  but  in  the  minimum  of  sleep  there 
is  a  difference  of  over  three  hours  between  the 
sleep  obtained  by  the  bromide  mixture  and  that 
from  paraldehyde.  On  the  whole  the  results  ob- 
tained from  the  latter  drug  are  the  most  satis- 
factory, but  I  think  there  will  be  few  of  us  who 
will  succeed  in  inducing  our  patients  to  continue 
to  take  it  for  any  length  of  time. 

Clinical  IRecor&s* 

DIPHTHERIA  FROM  AN  EXAMINATION 
HALL. 

Under  the  care  of  J.  C.  Mc Walter,  M.A.,  D.P.H. 
M.D.   Brux. 

Whilst  the  Intermediate  Examinations  were  being 
i  conducted  in  Dublin  last  year.  I  was  asked  to  see  a 
young  girl.  set.  14,  whose  mother  reported  that  she 
had  been  up  for  the  Intermediate  Examinations  for 
the  past  three  days,  but  had  suddenly  got  a  very 
bad  sore  throat.  Inspection  of  the  patient  showed 
a  typical  case  of  diphtheria  in  the  earlier  stages- 
fever,  headache,  malaise,  flushed  face,  ulcerated 
tonsus  adenitis,  &c,  and  she  was  transferred  to 
Cork  Street  Fever  Hospital,  where  the  diagnosis  was 
confirmed.  The  attack  was  rather  a  grave  one,  so 
much  so  that  her  life  seemed  at  one  period  to  be  in 
jeopardy,  but  eventually  she  made  a  good  recovery. 

The  importance  of  this  case  lies  in  the  fact  that  it 
shows  how  necessary  it  is  that  in  future  every  school- 
room or  building  used  as  a  centre  for  the  purposes  of 
the  Irish  Intermediate  Examinations— or  any  public 
examinations — should  be  thoroughly  disinfected  before 
being  used.  There  was  no  diphtheria  in  this  girl's 
family,  in    her   school,  or  among  her  friends.      She 

had  none  when  she  presented  herself  at  the  Centre 

which  was  a  schoolroom  for  young  pupils,  who  had 
recently  been  sent  on  their  holidays.  She  was,  of 
course,  anxious  on  account  of  her  ordeal,  and  eating  but 
little,  but  those  are  the  conditions  which  prevail  in 
most  girls  who  present  themselves  for  public  examina- 
tions, and  which  make  them  almost  certain  victims 
to  the  germs  of  diphtheria,  if  such  happen  to  be  present. 
As  this  patient  lost  her  examination,  her  year,  and  her 
chance  of  an  exhibition  owing  to  a  sickness  conse- 
quent on  the  unhealthy  state  of  the  examination 
room,  it  seems  as  if  the  Commissioners  of  Intermediate 
Education  would  be  held  responsible  for  any  future 
cases  of  a  like  kind  which  might  occur  after  their 
attention  has  been  pointedly  drawn  to  the   subject. 

ttbe  ®nt*patient  Departments* 

METROPOLITAN     HOSPITAL. 
Under  the  Care  of  W.  Langdon  Brown,  M.A.,  M  D 
M.R.C.P.  *    " 

CARDIAC    DROPSY    IN    CHILDREN. 

Case  J. — A  little  girl,  set.  4,  who  was  known  to  have 
had  rheumatic  fever  ten  months  previously,  had  been 
attending  the  hospital  with  signs  of  mitral  stenosis, 
with  regurgitation  and  some  oedema  of  the  legs.  Her 
mother  now  stated  that  she  had  noticed  the  child's 
face  to  be  swelling  during  the  last  three  davs,  that  she 
was  getting  very  short  of  breath,  and  that  the  urine 
was  scanty,  thick,  and  muddy. 

On  examination,  the  child  was  found  to  be  cyanosed 
and  generally  oedematous ;  the  pulse  was  132  and 
irregular.  The  heart's  apex  was  in  the  sixth  inter- 
space, one  and  a  half  inches  outside  the  nipple  line ; 
the  impulse  was  very  diffuse  and  preceded  by  a  thrill. 
The  cardiac  dulness  extended  upwards  to  the  third 


The  Medical  Press.     527 


At  the  apex  presystolic  and  systolic  murmurs 
were  Heard,  the  latter  loud  and  musical,  conducted  into 
the  axilla  and  heard  behind  at  the  angle  of  the  scapula. 
*  *~f  P?!?101181^  base  the  second  sound  was  accen- 
tuated. There  was  some  bronchitis,  and  the  liver 
was  palpable.  The  urine  showed  a  heavy  deposit 
of  urates,  but  only  a  trace  of  albumin  and  no  blood  nor 
casts. 

On  the  rapid  development  of  the  general  oedema, 
involving  the  face,  a  very  unfavourable  prognosis  was 
given.  Events  fully  justified  this,  for  the  child,  who 
was  admitted  at  once,  died  the  next  day.  Unfor- 
tunately a  necropsy  was  not  permitted,  but  the  con- 
dition of  the  urine  made  it  fairly  certain  that  the  kidneys 
were  not  the  cause  of  the  general  dropsy. 

In  the  following  case,  however,  a  post-mortem 
examination  was  made. 

Case  II. — A  boy,  aet.  7,  was  brought  to  the  hospital 
for  shortness  of  breath  with  orthopnoea.  Ten  months 
previously  he  had  suffered  from  rheumatic  fever,  and 
was  ill  for  four  months.  On  examination,  his  heart's 
apex  was  felt  in  the  sixth  interspace,  three-quarters  of 
an  inch  outside  the  left  nipple  line.  The  impulse 
was  preceded  by  a  thrill.  The  cardiac  dulness  was 
not  increased  upwards.  A  presystolic  and  a  musical 
systolic  murmur  were  heard  at  the  apex.  The  pulse 
was  rapid,  feeble,  and  irregular.  The  urine  contained 
less  than  '05  per  cent,  of  albumin. 

He  was  admitted  to  the  hospital,  and  two  days  later 
he  became  cyanosed  ;  there  was  a  rapid  development 
of  anasarca,  in  which  the  face  shared  to  a  marked 
degree.  This  occurred  within  a  few  hours.  The 
tongue  was  very  furred,  and  a  urinous  smell  was  noted 
in  the  breath.  Yet  in  twenty-four  hours  the  boy 
passed  forty  ounces  of  urine,  acid  in  reaction  and  con- 
taining only  a  trace  of  albumin.  No  casts  could  be 
found.  Though  he  improved  slightly  for  a  time,  he 
died  rather  suddenly  a  week  later.  The  necropsy 
revealed  double  mitral  disease,  with  infarcts  in  the 
lungs.     The  kidneys  were  merely  congested. 

Remarks. — Such  cases  are  not  very  unusual,  but  in 
the  text-books  very  little  attention  is  directed  towards 
them.  Dr.  Lees  and  Dr.  Poynton,  in  their  paper  on 
"  Dilatation  of  the  Heart "  ("  Medico-Chirurgical  Trans- 
actions," 1898),  state  that  out  of  100  fatal  cases  there 
was  *§  much  or  considerable  "  dropsy  in  twenty-five, 
in  nine  of  which  it  was  quite  recent.  They  conclude 
that  there  is  usually  a  decided  valvular  lesion  in  cases 
of  marked  dropsy.  Dr.  Dickinson,  in  Prof.  Allbutt's 
"System  of  Medicine,"  vol.  v.,  contrasts  the  gradual 
spread  of  the  oedema  upwards  in  cardiac  cases  with 
the  early  oedema  of  the  face  in  renal  cases.  These  are 
the  principal  references  to  the  subject  that  I  have  been 
able  to  find. 

The  development  of  oedema  in  other  than  de- 
pendent parts  may  be  caused  either  by  the  increased 
permeability  of  the  vessel  wall  (as  in  Bright's  disease), 
or  by  sudden  venous  engorgement ;  and  it  is  note- 
worthy that  in  both  the  cases  here  recorded  the 
oedema  was  accompanied  by  cyanosis.  This  sudden 
venous  engorgement  implies  a  marked  failure  of  com- 
pensation due  to  rapid  dilatation.  Such  rapid  dilata- 
tion is  always  of  grave  prognosis,  especially  in 
children,  who  are  notoriously  bad  at  re-establishing 
compensation.  Indeed,  this  condition  has  proved 
fatal  within  a  few  days  in  all  the  cases  I  have  seen 
in  children. 


transactions  of  Societies, 

CLINICAL  SOCIETY  OF  LONDON. 
Meeting  held  Friday,  May  13TH,  1904. 

Dr.  Frederick  Taylor,  President,  in  the  Chair. 


Drs.   A.   Stanley  Green  and  W.  H.  B.  Brook 
(Lincoln)  communicated  a  paper  upon  the 

VALUE  OF  THE  X-RAYS  AS  A  FACTOR  IN  THE~DlAGNOSIS 
OF  PULMONARY  TUBERCULOSIS, 

which  was  illustrated  by  lantern  slides.     The  authors 
had  examined  a  large  number  of  chests  during  the 


528    The  Medical  Press.        TRANSACTIONS  OF  SOCIETIES. 


May  i  8,  1904. 


past  two  and  a  half  years,  in  nearly  every  one  of  which 
the  physical  signs  were  carefully  elicited.  Skiagraphs 
were  shown  illustrating  the  conditions  of  many  of  the 
cases  before  and  after  sanatorium  treatment.  The 
skiagrams  were  all  taken  by  the  plate-to-back  method 
with  the  tube  twenty  to  twenty-four  inches  from  the 
plate,  the  exposure  varying  from  thirty  to  sixty 
seconds.  It  was  in  the  early  cases  of  pulmonary  tuber- 
culosis that  it  had  proved  of  great  value  as  a  diagnostic 
agent,  for  by  means  of  a  screen  examination  it  was 
possible  to  see  that  unilateral  limitation  of  movement 
of  the  diaphragm  occurred.  The  transradiancy  of  the 
lungs  or  the  presence  of  scattered  areas  of  shadow 
were  indications  of  the  health  or  disease  of  these 
organs.  The  shape  and  slope  of  the  ribs  and  the 
width  of  the  intercostal  spaces  were  also  important 
points  to  note.  The  presence  of  cavities  could  be 
shown,  and  even  fibrosis  could  be  recognised  under 
certain  conditions.  In  bilateral  cases,  an  X-ray 
examination  was  able  to  demonstrate  the  presence 
and  extent  of  the  disease  in  many  cases  before  it  was 
recognisable  by  ordinary  methods  of  examination. 
It  was  necessary,  however,  in  order  to  obtain  the  full 
value  of  skiagraphy,  to  regard  it  as  an  adjunct  to  the 
older  methods  of  physical  examination  and  micro- 
scopical examination  of  the  sputum. 

Dr.  William  Ewart  considered  that  the  best  thanks 
of  the  Society  were  due  to  the  readers  of  the  paper  for 
bringing  such  an  important  matter  to  the  front.  Con- 
sidering how  necessary  it  was  for  the  sake  of  the  patient 
to  diagnose  phthisis  as  early  as  possible,  he  hoped  that 
the  time  would  come  when  skiagraphy  would  be  far 
more  generally  employed  for  this  purpose. 

Dr.  Theodore  Williams,  while  welcoming  the 
X-rays  as  a  diagnostic  agent,  uttered  a  word  of  caution 
against  the  idea  that  they  could  supplant  careful 
physical  examination.  He  thought  that  the  art  of 
auscultation  was  in  danger  of  being  less  thoroughly 
studied  than  its  merits  deserved. 

Dr.  G.  B.  Batten  considered  that,  as  a  means  of 
realising  more  vividly  the  physical  condition  than  was, 
perhaps,  possible  by  auscultation,  the  X-rays  were  to 
be  welcomed  in  the  diagnosis  of  phthisis,  and  also  for 
recording  the  progress  of  the  disease  in  its  different 
stages. 

Dr.  Herbert  French  inquired  as  to  the  extent  of 
fibrous  tissue  present  which  could  be  seen  in  a  skia- 
graph. 

Mr.  Cecil  R.  C.  Lystbr  asked  what  methods  were 
adopted  for  measuring  the  output  of  the  tube,  and 
also  if  the  X-rays  could  be  utilised  to  distinguish 
between  bronchitis  and  tuberculosis. 

Dr.  William  Pasteur  inquired  as  to  the  relative 
transparency  to  the  rays  of  enlarged  bronchial  glands. 

The  President  considered  that  ocular  demonstration 
of  the  morbid  condition  was  most  valuable,  but,  at  the 
same  time,  shadows  were  not  always  infallible,  and 
required  to  be  interpreted  with  care. 

Dr.  Green  and  £>r.  Brook  replied. 

Dr.  A.  E.  Peters  (introduced)  described  two  cases 
of 

RECURRENT    CARCINOMA    OF    THE    BREAST, 

in  which  X-ray  treatment  had  been  employed.  In 
the  first  case  the  original  operation  had  been  per- 
formed by  Mr.  Charters  Symonds.  Radiography  was 
pursued  for  twenty-two  months.  The  subcutaneous 
nodules  and  ulceration  both  disappeared  under  the 
treatment,  only  to  return,  however,  in  a  condition 
of  diminished  activity  on  its  cessation.  Eventually 
the  growths  appeared  under  the  skin  at  the  back  of  the 
thorax,  and  these  nearly  disappeared  after  exposure 
to  the  rays.  The  breast  and  glands  of  the  opposite 
side  became  involved.  Considerable  relief  from  pain 
was  experienced  by  the  patient.  In  the  second  case 
both  the  subcutaneous  nodules  and  pleuritic  thickening 
improved  greatly  under  a  month's  treatment,  but  the 
patient  died  shortly  afterwards  from  thoracic  involve- 
ment. A  tendency  for  scar-tissue  to  break  down  while 
under  the  treatment  was  noticed. 

Dr.  Lewis  Jones  said  that  the  whole  question  of 
the  treatment  of  recurrent  mammary  cancer  by  X-rays 


was  one  of  great  importance,  though  he  did  not  con- 
sider that  it  was  by  any  means  the  final  treatment. 
Superficial  improvement  often  occurred  and  yet  the 
patient  would  succumb  from  secondary  deposits  else- 
where. There  was  no  doubt  that  the  rays  possessed 
the  property  of  changing  the  characters  of  a  growth 
or  even  of  preventing  its  tendency  to  recur. 

Dr.  G.  B.  Batten  referred  to  a  case"  of  recurrent 
cancer  of  the  breast  in  which  the  nodules  had  been 
removed  as  fast  as  they  had  recurred,  but  upon  the 
seventh  occasion  he  had  exposed  the  part  to  the  X-rays 
with  the  result  that  the  nodule  had  completely  dis- 
appeared. The  X-rays  appeared  to  have  a  selective 
effect  both  upon  degenerating  and  also  upon  actively- 
growing  epithelial  cells. 

Dr.  A.  E.  T.  Longhurst  asked  whether  the  rays 
might  not,  at  times,  excite  the  local  condition  and  so 
give  rise  to  a  rapid  development  of  the  disease. 

Mr.  A.  Bowlby  had  no  doubt  whatever  that  the 
X-rays  were  by  far  the  most  potent  agent  at  our  com- 
mand for  the  treatment  of  recurrent  cancer  of  the 
breast.  On  the  other  hand,  they  might  produce  con- 
siderable inflammatory  reaction. 

Mr.  Lyster  expressed  the  opinion  that  excision  was 
still  the  best  method  of  dealing  with  cancer,  when  it 
was  discovered  early  enough,  but  that  in  inoperable 
cases  relief  of  pain,  comfort  to  the  patient,  and  re- 
moval of  recurrent  nodules  could  be  brought  about 
through  the  rays. 

Dr.  Peters  replied. 


ROYAL  ACADEMY  OF  MEDICINE  IN    IRELAND. 

Surgical  Section. 

Meeting  held  May  6th.   1904. 


Professor  E.   H.   Bennett  in   the  Chair. 


Mr.  John  Knott  exhibited  to  the  Academy  a 
series  of  the  long  bones  of  the  human  skeleton,  showing 
the  various  epiphyses,  and  pointed  out  the  peculiarities 
of  their  ossification  and  final  junction  with  their 
respective  shafts.  The  clavicle,  which  a  novice  would 
naturally  place  among  the  group  of  long  bones,  -pre- 
sented several  peculiarities  of  ossification.  There  is 
no  epiphysis  for  the  acromial  'extremity ;  the  centre  of 
ossification  for  the  shaft  is  the  first  to  appear  in  foetal 
life,  while  the  (sternal)  epiphysis  is  usually  the  last 
in  the  skeleton  to  unite  with  its  shaft.  This  epiphysis 
is  also  distinguished  by  its  peculiar  thinness — making 
it  the  "  battered  sixpence  "  of  anatomical  similitude, 
and  placing  it  quite  beyond  the  possibility  of  the  con- 
servative resection  of  early  life.  The  upper  epiphysis 
of  the  humerus,  which  exactly  includes  the  head 
and  tuberosities,  has  long  been  familiarly  known; 
but  the  lower  has,  till  very  recently,  been  always 
misrepresented.  The  best  English  text-books  of 
surgery  used  to  represent  an  "  epiphysary  fracture " 
as  including  both  condyles  in  the  lower  fragment. 
The  specimen  exhibited  showed  that  the  epiphysis 
was  a  mere  osseous  crust,  the  removal  of  which  hardly 
diminished  the  prominence  of  the  condyle.  The  upper 
end  of  the  ulna  presents  a  supplemental  epiphysis, 
placed  on  top  of  the  recognised  one,  which  has  re- 
mained hitherto  undescribed,  except  by  the  exhibitor 
at  a  former  meeting  of  the  Royal  Academy  of  Medicine. 
The  lower  epiphysis  of  the  ulna  presents  no  peculiarity, 
nor  do  either  of  those  of  the  radius.  The  upper  end 
of  the  femur  presents  three  epiphyses — for  head  and 
either  trochanter — approximately  in  the  same  stage 
of  fusion  with  the  shaft,  That  for  the  head  is  thinner 
than  is  usually  thought ;  when  detached  it  is  but  a 
concave  shell  of  bone.  That  for  the  lesser  trochanter 
is  very  seldom  found,  its  abrupt  prominence  and 
small  surface  of  junction  causing  it  to  be  almost  always 
lost.  The  epiphysis  of  the  lower  end  of  the  femur 
is  of  immense  importance  in  connection  with  growth 
and  development.  As  its  centre  of  ossification  appears 
immediately  before  birth,  its  presence  constitutes  the 
best  test  of  the  maturity  of  the  foetus — no  other 
epiphysis  of  the  skeleton  developing  an  osseous  centre 
during  intra-uterine  life.     And  the  future  gigantism 


May  i  8,  1904. 


FRANCE. 


The  Medical  Press.    $2Q 


or  dwarfism  depends  more  on  this  epiphysis  than  on  the 
whole  of  the  rest  of  the  skeleton.  Most  anatomists 
place  its  junction  with  the  shaft  at  the  age  of  twenty  ; 
this  is  too  early  for  many  cases.  Till  it  fuses  with  the 
shaft,  growth  continues,  and  the  height  of  a  giant  will 
he  found  to  depend  very  largely  on  the  length  of  the 
femur.  The  terminal  epiphyses  of  the  tibia,  being 
thin,  call  for  great  care  on  the  part  of  the  surgeon  in 
the  operation  of  excision.  Those  of  the.  fibula  present 
no  peculiarity,  except  the  well-known  one  of  the  early 
ossification  of  the  lower  one. 
Mr.  Alexander  Blayney  read  a  paper  on  the 

REMOVAL  OP  THE  CSCUM  AND  ASCENDING  COLON, 

and  detailed  the  notes  of  a  case  which  was  sent  to  him 
with  symptoms  resembling  those  of  recurrent  appen- 
dicitis. A  tumour  could  be  felt  somewhat  above  the 
appendix  region,  which  proved  to  be  a  malignant 
growth  infiltrating  the  beginning  of  the  ascending 
colon.  The  caecum  with  a  small  portion  of  the  ileum 
and  the  greater  part  of  the  ascending  colon  were  re- 
moved. The  opening  in  the  colon  was  closed  by  a 
double  row  of  sutures,  and  the  lower  end  of  the  ileum 
was  implanted  on  the  transverse  colon,  a  Murphy's 
button  being  used  to  effect  the  junction.  There  was 
some  leakage  from  the  colon  for  a  few  days.  The 
button  was  removed  from  the  rectum  at  the  end  of  a 
fortnight.  The  patient  recovered  rapidly,  and  was 
quite  well  six  months  afterwards,  when  the  paper  was 
read. 


slice  of  the  anterior  surface,  it  was  not  to  be  advised, 
while  in  these  very  cases  rest  offered  the  prospect  of  a 
movable  joint. 

BRITISH  LARYNGOLOGICAL,   RHINOLOGICAL, 

AND    OTOLOGICAL    ASSOCIATION. 

Meeting    held    May    13TH,    1904. 

The   President,   Mr.   Bark,   F.R.C.S.,   in   the  Chair. 


The  President  remarked  that  the  Association  had 
sustained  a  serious  loss  through  the  death  of  Sir  Philip 
Smyly,  of  Dublin,  and  he  proposed  that  a  letter  of 
condolence  be  sent  to  Lady  Smyly  and  family. 

This  was  seconded  by  Dr.  Dennis  Vinracb,  and 
carried  unanimously. 

As  the  centenary  of  the  inventor  of  the  laryngoscope. 

Dr.  Manuel  Garcia,  will   be  reached    in    March,  1905, 

it  was  arranged,  on  the  motion  of  Dr.  Dundas  Grant, 

that  a  special  meeting  be  held  to  consider  the  desira- 

i  bility  of  appropriate  celebrations  of  the  event. 

Dr.  W.  H.  Kelson  and  Mr.  Mayo  Collier  showed 
cases,  and  Dr.  T.  Lumsden  exhibited  an  improved 
nasal  dilator. 

The  adjourned  discussion  on  Mr.  Mayo  Collier's 
paper  on  "  Latent  Intermittent  Nasal  Obstruction  " 
was  then  proceeded  with.  Full  report  of  the  pro- 
ceedings of  this  meeting  will  appear  in  our  next. 


EDINBURGH  MEDICO-CHIRURGICAL  SOCIETY. 
Meeting  held  May  4th.   1904. 


Professor  Chienb  in  the  Chair. 


Mr.  Cotterill  showed  specimens  of  (1)  giantism 
of  foot,  (2)  osteoma  of  the  frontal  sinus  causing  necrosis 
of  the  frontal  bone,  and  abscess  in  the  frontal  lobe, 
and  (3)  bilateral  tuberculous  disease  of  the  testis — 
castration  on  the  one  side,  and  removal  of  focus  from 
the  epididymis  on  the  other. 

Mr.  A.  A.  Scot  Skirving  showed  an  unusually  large 
horn  growing  from  the  ear  of  a  woman. 

Mr.  T.  W.  Struthers  showed  (1)  bones  from  a 
;  recent  fracture  of  tibia  and  fibula  ;  (2)  prostate  gland 
;  of  unusual  size,  removed  supra-pubically ;  and  (3) 
bladder  and  enlarged  prostate. 

Mr.  Alexis  Thomson  showed  two  prostates  removed 
f      by  supra-pubic  operation. 

Mr.  Robert  Jones,  of  Liverpool,  gave  (by  special 
invitation  of  the  Council)  a  paper  and  demonstration, 
"  Clinical  Notes  on  Tuberculous  Arthritis  in  the 
Young,"  which  we  hope  to  publish  in  our  next  issue. 

Mr.  Jones'  paper  was  discussed  by  Professor 
Chiene,  who,  while  he  congratulated  the  author  on  his 
results,  said  he  could  not  go  so  far  in  the  direction  of 
conservative  surgery  as  Mr.  Jones. 

Mr.  MacGillivray  referred  to  the  difficulty  which 
instrument-makers  seemed  to  have  of  making  Thomas' 
splints  properly. 

Mr.  Wallace  referred  to  the  difficulty  of  diagnosing 
tuberculous  arthritis  early.  Would  a  focus  in  the  head 
of  a  bone,  before  the  joint  was  involved,  give  that 
rigidity  to  which  Mr.  Jones  alluded  ?  In  particular, 
bow  was  sacro~iliac  disease  excluded  ?  The  time 
element  was  an  important  factor  in  the  treatment 
of  these  cases. 

Mr.  Thomson  said  that  he  thought  that  in  bad  cases 
of  disease  of  the  elbow  and  knee  there  was  much  to  be 
said  in  favour  of  excision,  which  gave  as  good  results 
as  rest,  and  in  a  shorter  time. 

Drs.  Cathcart,  Taylor,  and  Watson  also  discussed 
the  paper. 

In  reply,  Mr.  Jones  reiterated  the  great  diagnostic 
value  of  limitation  of  movement.  The  aver- 
age duration  of  treatment  was  about  two  years. 
In  adults  he  quite  agreed  that  excision  was 
often  advisable ;  not  in  children.  He  had  seen  so 
much  of  the  after  effects  of  excision  in  the  way  of 
shortening  that  he  thought  that,  unless  the  operation 
*as  done  early,  and  required  only  the  removal  of  a  thin 


jfrance. 

[from  our  own  correspondent.] 

Paris,  May  15th,  1904. 
Diuresis  and  Reduction  of  Liquids. 

Considerable  advantage,  says  Dr.  Huchard,  is 
obtained  in  certain  cases  of  cardiac  dilatation  from 
reducing  the  quantity  of  liquids  absorbed  by  the  patient. 
When  in  a  patient  with  a  very  dilated  heart  the  oedema 
increases  in  spite  of  a  digitalis  and  milk  regime,  there  is 
not  a  minute  to  lose,  and  the  quantity  of  liquid  absorbed 
must  be  diminished.  Dr.  Huchard  prescribes  in 
such  cases  one  quart  of  water  and  one  pint  of  milk 
mixed  together  and  a  wineglass  given  every  one  or 
two  hours.  From  the  first  day  the  diuretic  action  is 
manifest,  and  increases  for  three  or  four  days.  In 
the  meanwhile  the  patient  eliminates  large  quantities 
of  chlorides  from  the  tissues,  which,  passing  into  the 
urine,  bring  with  them  the  water  which  held  them 
in  solution,  and  thus  the  oedema  disappears.  This 
treatment  thus  becomes  one  of  dechloridation. 

A  man,  aet.  5 1 ,  a  heavy  smoker,  suffered  from  oppres- 
sion for  six  months.  The  heart  was  hypertrophied, 
its  point  beating  much  beyond  the  nipple ,-  the  liver 
was  enlarged  and  the  legs  much  swollen.  Milk  diet 
was  prescribed,  but  the  condition  of  the  patient  became 
worse,  oedema  and  dyspnoea  increasing.  A  week  later 
he  was  put  on  the  restricted  diet  mentioned  above, 
and  one- tenth  of  a  milligramme  of  digitalin  was 
ordered  daily,  and  an  injection  of  gr.  v  of  caffeine. 

The  first  day  the  patient  urinated  only  a  pint,  but 
the  following  days  polyuria  set  in,  he  eliminating  a  great 
abundance  of  chlorides.  In  a  fortnight  the  patient 
had  lost  twelve  pounds  in  weight,  while  the  oppression 
and  the  oedema  had  disappeared. 

Another  case  was  that  of  valvular  disease  of  the 
heart.  The  man  was  aet.  38,  and  for  the  previous  twelve 
months  had  suffered  greatly  from  oppression.  The 
heart,  much  dilated,  revealed  to  auscultation  a 
systolic  bruit  seated  at  both  the  mitral  and  tricuspid 
valves.  The  case  was  probably  one  of  mitral  organic 
insufficiency  due  to  a  former  attack  ofXrheumatism 
and  tricuspid  functional  insufficiency  fromMilatation 


53°     The  Medical  Press. 


GERMANY. 


May  i  8,  1904. 


of  the  right  heart.  The  liver  was  very  enlarged,  and 
oedema  was  present  at  the  base  of  both  lungs  and  in 
the  lower  limbs. 

The  patient  was  treated  by  wet-cupping  over  the 
liver,  milk  diet  and  digitalin ;  the  oedema  increased, 
however,  alarmingly,  as  did  also  the  oppression.  At 
this  period  the  patient  was  put  on  a  reduced  quantity 
of  [liquid,  as  in  the  former  case,  and  gr.  x  of 
theobromin  was  administered  three  times  daily,  and 
an  injection  of  gr.  v  of  caffeine.  On  the  third 
day  of  this  treatment  the  amount  of  urine  eliminated 
was  nearly  two  and  a  half  quarts,  and  at  the  end  of  the 
eighth  day  the  oedema  had  almost  disappeared,  and 
the  liver  had  diminished  in  volume. 

Sometimes,  however,  the  results  are  not  so  brilliant. 
In  certain  patients,  arrived  at  the  extreme  point  of 
their  cardiac  affection,  the  heart  and  kidneys  are  no 
longer  able  to  react,  in  spite  of  the  remedies  and 
reduction  regimt  combined. 

Such  was  the  case  of  a  patient,  set.  52,  who  suffered 
from  a  double  aortic  bruit ;  the  ordinary  treatment 
(digitalin,  theobromin,  milk),  which  had  succeeded 
for  months,  had  finally  lost  all  effect.  The  liver  was 
large  and  the  legs  greatly  distended.  The  regimt  of 
restricted  liquids  was  employed,  but  without  the  usual 
success.  The  diuresis  being  less  than  the  quantity  of 
liquid  absorbed,  acupuncture  was  performed  in  five 
or  six  places  on  each  leg.  The  improvement  was 
rapid  and  considerable ;  in  a  few  days  the  patient  was 
freed  from  the  oedema,  while  all  the  other  symptoms 
had  also  improved. 

The  reduction  of  liquids  in  diminishing  the  peri- 
pheric obstacles  by  the  dehydration  of  the  tissues 
constitutes  a  tonic,  although  indirect,  to  the  heart. 
It  does  not  act  on  the  organ  itself,  but  relieves  its 
work.  It  can  happen  that  the  heart  strengthened 
in  this  manner  can  be  afterwards  toned  up  directly 
by  digitalis.  An  essential  point,  however,  is  to  give 
small  doses  for  fear  that  a  too  strong  stimulation 
should  produce  immediate  depression  ;  one  -tenth  of  a 
milligramme  of  digitalin  during  ten  days  is  sufficient. 

The  conclusions  of  Dr.  Huchard  arenas  follows  : — 
Reduction  of  liquids  constitutes  one  of  the  most 
powerful  weapons  we  possess  to  resuscitate  or  con- 
siderably improve  patients  who  otherwise  would 
succumb  in  a  very  few  days. 

The  regtmt  should  be  ordered  thus  : — The  first  day 
one  quart  of  water  and  one  pint  of  milk  are  prescribed. 
The  second  and  third  days,  three  pints  of  milk,  and 
at  the  same  time  'an  injection  of  gr.  v  of  caffeine. 
On  the  fourth  and  following  days,  the  lacto-vegetarian 
diet  without  salt  may  kbe  ordered,  and  gr.  x  of 
theobromin  three  times  a  day.  From  the  first  day 
the  diuresis  increases,  and  continues  eight  or  ten  days 
with  rapid  improvement  in  the  condition  of  the  patient. 
In  patients  whose  limbs  are  greatly-  distended  from  the 
oedema,  tthus  lessening  the;  means  of  absorption, 
acupuncture  is  necessary  before  diuresis  will  set  in. 


German?. 


[from  our  own  correspondent.] 


Bbrlw,  May  14th,  1904. 
At     the     Surgical    Society's    meeting    Hr.    Graser 
related  a  case  of 

Traumatic  Rupture  of  the  Liver. 
The  patient  presented  himself  complaining  of  vague 
gastric  symptoms,  and  examination  showed  the  pro- 
bability of  a  tumour.  Nine  weeks  later  the  man  came 
again,  and  now  there  was  a  distinct  tumour  in  the 
region  of  the  liver,  which  reached  to  the  spine,  and 


which  could  not  be  differentiated  from  the  liver. 
Fluctuation  could  be  felt.  A  large  sarcoma  that  had 
melted  down  was  suspected,  but  puncture  showed 
greyish-yellow  pus.  The  swelling  was  now  incised, 
and  a  large  cavity  was  found  filled  with  pus  and  large 
balls,  which  proved  to  be  pieces  of  liver.  These  were 
removed.  The  history  now  showed  that  a  year  and  a 
half  ago  he  had  fallen  from  a  shed  on  to  his  abdomen 
from  a  height  of  sixteen  feet,  and  that  he  became  un- 
conscious after  the  fall.  The  liver  injury  must  have 
taken  place  at  this  time.  Apoplexy  of  the  liver 
might  have  taken  place,  but  the  absence  of  symptoms 
of  haemorrhage  was  rather  against  this  view.  It  was 
wonderful  that  such  haemorrhage  had  not  taken  place. 
There  are  also  cases  recorded  in  which  with  total 
rupture  of  the  liver  there  had  been  no  blood  in  the 
exudate,  although  bile  was  present.  The  veins  were 
not  so  brittle  as  the  liver  substance,  and  they  might 
give  way  later  on  after  thrombosis  had  taken  place. 
The  great  shock  the  patient  suffered  from  the  fall 
would  also  help  to  prevent  haemorrhage.  As  regarded 
the  question  of  infection  taking  place  nine  months 
afterwards,  we  had  to  assume  that  it  was  haemato- 
genous.  There  could  be  scarcely  any  doubt  that  the 
blood  in  the  portal  vein  sometimes  contained  bacteria. 
Certainly  toxins  entered  the  blood  from  the  intestinal 
canal,  and  in  all  probability  bacteria  also.  The 
following  case  supported  this  view : — A  young  girl 
was  operated  on  for  purulent  peritonitis  without 
taking  away  the  vermiform  appendix.  Fever  set 
in,  possibly  from  thrombosis  of  the  mesenteric  artery, 
and  an  abscess  formed.  Puncture  always  gave  hepatic 
venous  blood,  and  this  was  examined  bacteriologically. 
It  contained  streptococci  from  the  first,  although 
none  were  found  in  blood  from  a  vein  in  the  arm. 

The  liver  case  gave  no  further  trouble  after  the 
operation.  It  showed  the  risk  of  infection  after  such 
an  injury  to  the  liver. 

Hr.  Riese  related  a  case  of 

Gunshot  Wound  of  the  Abdomen, 
and  showed  the  patient. 

A  woman,  aet.  26,  was  brought  into  hospital  00 
June  3rd,  1903,  with  a  gunshot  wound  in^the  abdomen. 
There  were  great  anaemia  and  partial  unconsciousness. 
The  point  of  entrance  was  just  under  the  costal 
arch  on  the  left  side.  Operation  was  performed  three 
hours  after  receipt  of  the  injury.  The  opening  in  the 
anterior  wall  was  closed  by  suture,  as  well  as  the  exit 
opening.  A  wound  in  the  spleen  was  tamponnaded, 
and  one  in  the  left  lobe  of  the  liver  was  united  by  suture,, 
and  a  wound  in  the  diaphragm  was  also  closed  by 
suture.  The  bullet  was  removed  by  Simon's  incision. 
The  twelfth  rib  was  resected  and  the  kidney,  which 
was  torn  in  two  in  the  upper  half,  was  tamponnaded. 
Recovery  took  place.  The  patient  improved  visibly, 
but  on  the  sixth  day  infection  of  the  surface  wound 
took  place,  and  a  subphrenic  abscess  formed,  and  was 
emptied.  Then  the  course  was  interrupted  no  further,, 
except  that  a  small  fistula  still  remained  posteriorly. 

As  regarded  the  treatment  of  haemorrhage  from  the 
liver  the  speaker  had  always  sutured,  and  with 
complete  success.  Catgut  was  the  best  material.  He 
always  drained  in  addition  to  the  suture  for  the  pur- 
pose kof  avoiding  infection.  In  laceration  of  the 
liver  tampcnnade  arrested  the  haemorrhage  more 
quickly. 

Hr.  Neugebauer  spoke  on  the 

Surgery   of   the   Diaphragm, 
and  showed  a  case.     A  man  had  received  a  punctured 
wound  in  the  left  side.     The  mucous  membrane  of  the 
stomach  could  be  seen  in  the  lower  part  of  the  wound. 


May  18,  1904. 


AUSTRIA. 


The  Medical  Press.     55t 


Operation. — The  anterior  wall  of  the  stomach  was 
wounded,  and  a  greater  part  of  the  stomach  had 
passed  into  the  pleural  cavity,  through  a  wound  in  the 
diaphragm,  and  had  there  emptied  its  contents.  The 
wound  in  the  stomach  was  closed  by  suture,  the  pleural 
cavity  washed  out,  the  stomach  replaced,  and  the 
wound  in  the  diaphragm,  4  cm.  in  length,  closed 
by  suture.  On  opening  the  peritoneum,  no  injury 
was  seen  on  the  posterior  wall  of  the  stomach.  The 
case  did  well. 

Such  punctured  wounds  were  rare  in  Germany,  as 
knife  thrusts  were  much  rarer  there  than  in  the  Roman 
countries.  The  overlooking  of  the  passage  of  food  into 
the  pleural  cavity  always  terminated  in  the  death  of 
the  patient.  The  speaker  had  seen  that  in  a  case  of 
gunshot  wound  of  the  stomach  and  diaphragm.  It 
had  been  recommended  by  an  Italian  surgeon  to 
always  pass  the  finger  over  the  diaphragm  ;  but  that 
was  unnecessary,  and  it  always  carried  with  it  the  risk 
of  pneumothorax,  and,  moreover,  such  a  displacement 
might  occasionally  be  overlooked.  It  was  better  and 
safer  to  open  the  abdomen  and  to  operate  transpleurally, 
if  there  was  any  injury.  Such  an  operation  gave  good 
results.  In  hernia  of  the  diaphragm  the  transpleural 
operation  was  also  indicated,  and  not  the  trans- 
abdominal, as  this  had  hitherto  always  been  fatal. 
Hr.  Brentano  showed  a  preparation  of  a 
Double  Perforation  of  the  Abdominal  Aorta 
from  a  gunshot  wound,  the  patient  surviving  six  days. 
The  canal  of  the  wound  lay  behind  the  peritoneum. 
When  laparotomy  was  performed  two  hours  after  in- 
fliction of  the  injury,  there  was  scarcely  any  blood 
in  the  abdomen.  The  next  day  the  pulse  was  144, 
and  the  patient  improved  slowly,  but  died  suddenly 
on  the  seventh  day.  The  autopsy  showed  an  enormous 
quantity  of  blood  in  the  bursa  omentalis  and  in  the 
mediastinum  from  double  perforation  of  the  aorta. 
The  haemorrhage  had  at  first  been  prevented  by  the 
9hock,  only  to  come  on  when  that  passed  off,  and  when 
stimulants  were  given. 

Busttta, 


[from  our  own  correspondent.] 


Vicvna,  Hay  14th,  1004. 
Prussic   and   Phosphoric   Acid   Vapours. 

At  the  Physical  Gesellschaft,  Lehmann  gave  an 
account  of  his  experiments  on  animals  with  the  vapours 
of  prussic  and  phosphoric  acid,  which,  he  affirmed,  were 
in  perfect  accord  with  those  of  Wayschall  and  Yakote 
Prussic  acid,  when  given  in  the  strength  of  0*03  to  0*04. 
per  cent.,  has  no  effect  on  cats  after  four  or  five  hours' 
exposure.  As  soon  as  the  strength  of  the  vapour  is 
raised  to  0*05  and  the  animal  immersed  in  it  for  one 
hour  and  a  half,  grave  symptoms  appear,  such  as  deep 
lung  respirations,  saliva  running  from  the  mouth, 
dilation  of  the  pupils,  cramp,  and  vomiting.  If  the 
animal  is  kept  in  this  atmosphere  for  from  two  and 
a  half  to  five  hours,  death  ensues.  If  the  strength  of 
the  vapour  be  raised  to  0*12  or  0*15  per  cent.,  death 
takes  place  within  thirty  minutes,  accompanied  by 
the  foregoing  symptoms.  When  calculating  the 
amount  of  prussic  acid  necessary  to  destroy  life,  the 
dose  is  found'  to  vary  from  1  milligramme  of  the  acid 
to  5  milligrammes  per  kilogramme  of  the  animal. 
For  man  it  is  calculated  that  60  milligrammes,  or 
o*8  to  1  milligramme  per  kilogramme  of  the  subject 
would  be  a  minimum  lethal  dose. 

For  phosphoric  acid  or  P  H*  it  is  found  that  doses 
of  o*6  to  0*4  per  cent,  for  a  quarter  of  an  hour  leave 
the  animal  quiet  and  still.    After   twenty  minutes' 


immersion  the  saliva  is  emitted  from  the  mouth  with 
vomiting,  feebleness  and  unsteady  movements,  while 
half  an  hour  is  sufficient  to  produce  death.  If  the 
animal  be  allowed  to  remain  fifteen  minutes  in  the 
saturated  receptacle  it  would  take,  the  next  two  days 
in  the  open  air  to  recover.  He  concluded  this  part  of 
his  inquiry  by  saying  that  P  H3  is  ten  times  more  fatal 
than  had  formerly  been  estimated,  which  he  attributed 
to  more  exact  observation  in  the  experiments. 
Hemoglobin  in  the  Muscles. 

Lehmann  further  gave  the  meeting  the  result  of 
his  experiments  in  estimating  the  amount  of  haemo- 
globin in  the  muscles,  which,  he  stated,  was  generally 
in  proportion  to  the  work  performed  by  that  organ  ; 
that  the  haemoglobin  contained  in  red  muscle  is  twenty 
times  greater  than  that  contained  in  white,  and  that 
the  cardiac  muscle  being  the  reddest  in  the  body  con- 
tained the  greatest  amount  of  haemoglobin.  This  is 
not  true  in  all  animals,  as  the  dog  has  the  greatest 
amount  in  the  muscles  of  the  back,  the  calf  in  the 
diaphragm,  which  is  also  true  of  the  foetus.  The 
full-grown  cow  is  usually  paler  in  the  cardiac  muscle 
than  the  diaphragmatic.  The  skin  is  five  times  less 
red  than  any  of  the  other  muscles. 

Actinomycosis  of  the  Lung. 

Sternberg  exhibited  a  few  anatomical  preparations 
which  he  had  takep  from  the  lung  of  a  bricklayer's 
labourer,  aet.  59,  who  was  received  into  hospital 
December  30th,  1903.  For  several  years  past  he  had 
suffered  from  a  slight  cough,  night  sweats,  and  haemo- 
ptysis. Four  weeks  before  admission  a  swelling  had 
been  observed  on  the  back,  which  was  gradually  in-, 
creasing  and  diagnosed  as  a  cold  abscess  that  had  been 
incised.  On  examining  a  piece  of  the  tissue  taken 
from  the  wall  of  the  abscess,  it  was  found  to  contain 
actinomycotic  granulations.  In  the  lung  after  death 
the  typical  actinomycotic  glands  were  found.  At  the 
post-mortem,  the  whole  of  the  left  lung  seemed  to*be 
involved,  having  the  appearance  of  chronic  induration 
after  pneumonia.  The  pharynx  and  larynx,  as  well 
as  the  alimentary  tract,  were  quite  free  as  proved  at 
the  post-mortem,  but  in  the  left  intercostal  space  near 
the  spinal  column  the  growth  had  made  its  way  directly 
outwards,  penetrating  under  the  scapula  and  appearing 
at  the  acromion.  This  fistulous  canal  was  found  to 
contain  a  large  quantity  of  actinomycotic  pus  and 
fungoid  growths.  Schrotter  asked  if  he  could  account 
in  any  way  for  the  etiology  of  the  disease  in  this  case, 
but  Sternberg  said  he  could  not,  as  no  ears  of  any 
vegetable  matter  could  be  found  in  the  bronchi, 
vesicles,  or  lung  tissue. 

Nothnagel  asked  if  a  chronic  pneumonia  could  not 
have  existed  for  some  time,  and  that  later  the  foreign 
body  be  taken  into  the  lung,  where  its  growth  would 
commence. 

Sternberg  replied  that  this  would  be  very  unlikely 
in  a  cirrhotic  and  hardened  lung,  as  the  actinomyces. 
would  have  a  very  unfavourable  media  to  extend. 
He  further  observed  that  the  actinomyces  usually 
avoids  both  in  men  and  beasts  localities  which  are 
hard  or  indurated. 

Lymphoid  Leucocythjbmia. 

Reitter  showed  a  boy,  aet.  12 ,  suffering  from  acute 
lymphoid  leucocythaemia.  Four  weeks  before  recep- 
tion in  hospital,  his  mother  observed  reddish-blue  spots 
on  the  body,  while  the  boy  appeared  to  be  feverish. 
After  admission,  on  February  1st,  the  gums  began  to 
bleed,  with  blood  in  the  urine  and  continued  fever. 
On  the  5  th  the  disease  was  diagnosed  as  morbus 
maculosi  of  Werlhofii,  as  the  symptoms  with  enlarged 
spleen  and  all  the  glands  conclusively  proved.     There 


532     ^bk  Medical  Press. 


LEADING   ARTICLES. 


Mat  18.  1904. 


was  pain  on  simple  pressure  on  all  the  long  bones,  as 
well  as  the  lymphatics.  Examination  of  the  blood  was 
conclusive. 


XTbe  $peratttt0  TTbeatres. 


ST.  PETER'S  HOSPITAL  FOR  STONE,  Ac. 
Enucleation  of  the  Prostate  and  Suprapubic 
Lithotomy. — Mr.  S  win  ford  Edwards  operated  on  a 
man,  aet.  about  67,  who  had  had  symptoms  of  urinary 
obstruction  for  the  last  two  or  three  years,  and  now 
and  then  the  patient  had  complained  of  pain  on  mic- 
turition, and  he  had  at  times  seen  a  trace  of  blood.  It 
was  found  that  the  quantity  of  residual  urine  amounted 
to  about  half  a  pint.  When  he  had  presented  himself 
in  the  out-patient  department  he  was  sounded  and  a 
stone  was  felt.  He  was  therefore  admitted  for  further 
•examination.  Seeing  that  his  symptoms  were  appa- 
rently more  due  to  prostatic  obstruction  than  to  the 
presence  of  a  vesical  calculus,  Mr.  Edwards  started  by 
•examining  the  bladder  with  the  cystoscope,  when  he 
found  the  prostate  bilaterally  enlarged,  the  enlarge- 
ment evidently  being  of  the  adenomatous  type.  In 
the  posterior  prostatic  pouch  was  to  be  seen  a  calculus 
about  the  size  of  the  ungual  phalanx  of  the  thumb. 
Mr.  Edwards  said  that  it  would  no  doubt  be  quite  easy 
to  perform  litholapaxy  on  this  patient,  but  he  would 
then  only  be  removing  the  lesser  of  the  two  evils  from 
which  the  patient  was  suffering.  He  therefore  pro- 
posed to  remove  both  the  prostate  and  the  stone  by 
means  of  a  supra-pubic  cystotomy.  The  region  had 
already  been  prepared  in  view  of  this  eventuality,  so, 
after  having  distended  the  bladder  with  about  eight 
ounces  of  boracic  solution,  the  usual  incision  was 
made  above  the  pubes  in  the  middle  line ;  the  recti 
muscles  were  rapidly  separated.  The  finger  having 
been  passed  into  the  prae- vesical  space,  the  peritoneum 
was  carefully  pulled  upwards  and  further  distension  of 
the  bladder  made  through  the  inlying  catheter.  The 
anterior  wall  of  the  bladder  being  clearly  seen,  a  knife 
was  plunged  into  it,  carefully  avoiding  one  or  two 
tortuous  veins  which  were  apparent  on  its  surface. 
The  finger  having  been  passed  into  the  bladder,  the 
diagnosis  made  by  the  aid  of  the  cystoscope  was  con- 
firmed. The  calculus  was  now  removed  and  the 
operator  proceeded  to  the  enucleation  of  the  prostate, 
which  he  carried  out  by  the  method  initiated  and  so 
well  described  by  his  colleague,  Mr.  Freyer.  No 
instrument  other  than  the  finger  was  used.  The  prostate, 
which  was  of  about  the  size  of  a  large  Tangerine  orange, 
was  somewhat  adherent  to  its  sheath  and  required  a 
considerable  amount  of  muscular  effort  for  its  enuclea- 
tion ;  in  fact,  the  operator  found  that  after  he  had 
freed  the  right  side  of  the  prostate  by  his  right  index 
he  had  to  go  round  to  the  patient's  left  side  and  work 
on  the  left  part  of  the  prostate  by  means  of  his  left 
index,  as  his  right  forefinger  was  almost  benumbed 
through  the  effort  of  freeing  the  right  side.  The 
usual  amount  of  haemorrhage  followed  the  removal  of 
the  prostate,  but  this  seemed  to  yield  readily  to  hot 
boric  irrigation.  A  large  red  rubber  drain  an  inch  in 
diameter  was  inserted,  and  the  skin  wound  brought 
together  with  a  few  silkworm-gut  sutures.  The 
catheter,  of  course,  had  been  removed  prior  to  the 
irrigation,  another  having  been  introduced  for  the 
last  washing  out.  An  examination  of  the  enucleated 
prostate  showed  that  it  had  been  removed  en  masse 
with  the  prostatic  urethra  running  through  its  centre. 
There  was  one  adenomatous  tumour  the  size  of  a  large 
marble,  which  had  evidently  burst  through  the  pros- 
tatic   capsule.     This    had    been    removed    separately 


during  the  operation.  The  bulk  of  the  prostate  showed 
that  it  was  encased  by  the  capsule  over  which  in  parts 
a  few  muscular  fibres  were  to  be  discerned,  showing,  the 
operator  thought,  that  this  had  been  a  true  extra- 
capsular enucleation. 

A  week  after  the  operation  the  patient  was  doing 
well.  He  had  never  really  suffered  from  shock,  nor 
had  there  been  any  particular  rise  of  temperature.  The 
urine  had  remained  sweet,  and  the  suprapubic  wound, 
after  the  removal  of  the  drain  on  the  third  day,  looked 
healthy.  It  is  expected  that  the  patient's  urine  will 
begin  to  pass  naturally  in  another  week  or  ten  days. 


BieimtD   FOB   TAAMSXISMOff   AttOAD. 

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SALUS  POPULI  SUPREM A  LEX. 


WEDNESDAY,  MAY  i8t  1904. 


THE  DEATH-RATE  IN  THE  SOUTH 
AFRICAN  MINES. 
The  question  of  the  conditions  of  native  labour 
in  the  Rand  mines  is  to  a  great  extent  one  that 
has  to  be  decided  on  medical  grounds.  The 
average  mortality  of  miners  in  the  United  King- 
dom is  known,  and,  weighed  in  the  light  of  ex- 
perience, can  be  appealed  to  as  a  standard. 
Moreover,  we  know  how  the  percentage  of  deaths 
under  former  unwholesome  conditions  compares 
with  that  registered  under  modern  sanitary  con- 
trol. With  the  advent  of  a  proper  system  ot 
ventilation  and  kindred  hygienic  measures  the 
mortality  from  phthisis  and  other  diseases  was 
greatly  reduced.  Tatham's  tables  of  occupation 
mortality  in  England  and  Wales  for  the  three  years 
1890-92  give  the  comparative  rates  among  males 
from  twenty-five  to  sixty-five  years  of  age. 
Taking  the  figures  of  average  for  all  males  at 
1,000,  we  find  that  of  the  coal-miners  925,  of  the 
lead-miners  1,310,  and  of  the  tin-miners  1,409.  In 
other  words,  while  the  coal-miners  were  rather 
under  the  average  mortality  rate,  the  lead-miners 
died  at  the  rate  of  1,310  to  every  1,000  of  the 
rest  of  the  male  population  between  twenty-five 
and  sixty-five,  and  the  tin-miners  at  the  rate  of 
1,409.  If  we  take  the  three  classes  together, 
we  see  thatj3,644  miners  die  where  3f,oooj>fJall 


Mat  i  8,  1904 


LEADING  ARTICLES. 


The  Medical  Press.    533 


males  would  have  died.  The  excess  of  644  does 
not  by  any  means  represent  the  excess  of  deaths 
over  a  wholesome  occupation,  but  only  that  over 
the  mortality  of  all  occupations  taken  together, 
and  therefore  including  such  extremely  unhealthy 
trades  as  that  of  file-makers,  with  a  comparative 
rate  of  i,8io,  of  innkeepers  with  1,642,  of  coster- 
mongers  with  1,652,  and  of  dock  labourers  with 
1,829,  If  we  take  an  average  death-rate  of  16 
per  1,000  living,  that  of  the  three  classes  of  miners 
works  out  roughly  at  26.  The  figures  among 
South  African  miners  would  naturally,  under  any 
circumstances,  be  somewhat  higher,  in  view  of  the 
less  advanced  standards  of  public  health  attain- 
able in  a  comparatively  young  Colony.  That 
natural  excess,  if  so  it  may  be  termed,  is  more 
than  doubled  among  the  natives  employed  in  the 
Rand  mines.  According  to  the  statement  made 
in  the  House  of  Commons  on  the  nth  instant 
by  Mr.  H.  Lyttelton,  the  Colonial  Secretary, 
the  average  in  "  the  earlier  months  of  1903  was 
at  the  rate  of  57  per  1,000,"  a  figure  that  rose 
"  during  the  whole  year  up  to  April  to  66." 
These  figures  represent  an  appalling  waste  of 
human  life.  There  are  some  750,000  men  em- 
ployed in  the  mines.  Let  us  take  30  per  1,000 
as  a  high,  but  not  unreasonable  rate  of  mortality 
for  that  particular  occupation,  and  we  have  an 
unnecessary  mortality  of  more  than  double  that 
figure.  Mr.  Lyttelton's  estimate,  moreover,  ap- 
pears to  have  understated  the  general  facts.  The 
Daily  News  of  May  12th  publishes  certain  statistics 
compiled  by  the  Witwatersrand  Native  Labour 
Association  that  may  well  give  pause  to  every- 
one concerned  in  the  mine  administration  of 
South  Africa.  The  figures  for  the  twelve  months 
of  last  year  are  given  as  follows  : — 

Ho.  of 

D**tha, 
January     ....     287 

February 207 

March     252 

April 255 

May   447 

June 523 

July   629 

August 503 

September 450 

October ...:..  436 

November ....  503 

December  ....  520 


Total 


5»oi2 


Mo  Em- 

FOr  1.000 

ploytd. 

per  annua 

49»5°6 

. .      6948 

52.472 

. .     47*28 

56,218 

•  •      5376 

59»28o 

•  *      53^4 

62,502 

. .      85*80 

64,454 

•  •     97*32 

66,662 

..    130-16 

68,228 

. .     88-44 

68,466 

•  •     7^*34 

68,968 

..     75*84 

69.3" 

. .     8700 

68,841 

..     oo*6o 

754.908    . .    80-63 

"  The  earlier  months  of  the  year  "  is  a  vague 
phrase,  which  might  be  applied  to  the  first  five 
months,  for  which  the  average  was  nearly  62 
per  1,000.  If  we  take  the  first  six  months,  it 
was  67-76,  and  it  rose,  in  the  second  half,  to 
88*88.  In  the  individual  month  of  July  it  reached 
the  appalling  figure  of  113-16.  Of  the  total  no 
fewer  than  3,003  deaths  were  due  to  pulmonary 
diseases ;  583  deaths  are  ascribed  to  abdominal 
diseases  ;  400  to  cerebro-spinal ;  enteric  carried 
off  219  men  ;  there  were  205  fatal  accidents,  and 
four  cases  of  suicide.  Mr.  Macfarlane,  the  general 
manager  of  the  Native  Labour  Association,  in 


his  report  to  the  Board  of  Management,  enclosing 
the  figures  from  which  we  quote,  points  out  that 
"  the  death-rate  is  greatest  during  the  first  three 
months  of  their  service.  Since  the  beginning 
of  the  present  year  an  experiment  has  been  started 
by  which  inspectors  have  examined  all  incoming 
gangs,  rejecting  those  unfit  for  mine  work,  and 
detaining  for  treatment  natives  temporarily 
unfit  for  work.*'  From  this  report  it  would  seem 
that  the  necessity  of  some  elementary  attention 
to  the  laws  of  health  is  at  length  being  recognised. 
In  conclusion,  it  need  hardly  be  said  that  with 
the  political  aspects  of  the  question  we  are  not 
concerned.  As  a  medical  journal,  however, 
we  feel  it  a  duty  to  draw  public  attention  to  a 
preventable  mortality  that  constitutes  nothing 
short  of  a  disgrace  to  our  boasted  humanity  and 
civilisation.  The  death-rate  is  in  itself  an  un- 
failing indication  of  the  standard  of  wholesomeness 
prevailing  in  any  given  mine.  We  do  not  hesitate 
to  assert  that  the  returns  from  the  Rand  mines 
are  a  blot  upon  the  national  escutcheon. 


THE  PROBLEM  OF  THE  VAGRANT. 
The  propagation  of  infectious  disease  by  wander- 
ing and  destitute  individuals  is  a  question  which 
has  long  exercised  the  minds  of  sanitarians  and 
legislators.  During  the  last  small-pox  epidemic 
it  was  found  that  in  many  instances  the  disease 
was  introduced  into  a  town  or  village  solely  through 
the  agency  of  some  infected  vagrant.  These  un- 
fortunate waifs  and  strays  will  tramp  for  many 
miles  in  the  hope  of  escaping  detection  and  in 
search  of  some  unmolested  spot  where  they  may 
obtain  shelter  for  the  night  without  fear  of  a 
peremptory  order  to  "  move  on."  The  report 
which  has  recently  been  issued  by  Dr.  Armstrong 
upon  the  relation  of  small-pox  to  vagrancy, 
based  upon  the  returns  of  the  provincial  medical 
officers  of  health,  plainly  shows  that  the  connec- 
tion between  the  two  is  even  more  intimate  than 
was  at  first  supposed.  The  public  press  has  lately 
called  attention  afresh  to  another  danger  to  the 
community  from  the  presence  of  the  members 
of  the  "  great  unwashed  "  family  in  their  midst, 
namely,  the  risk  of  contracting  some  contagious 
disease  from  the  seats  or  grass  upon  which  these 
filthily-dressed  loungers  have  lain  or  sprawled. 
The  return  of  warm  weather  not  unnaturally 
attracts  such  individuals  towards  the  great  open 
spaces  of  the  metropolis,  where  they  may  receive 
the  bounties  of  Nature  without  let  or  hindrance. 
This  method  of  airing  themselves  cannot  be  com- 
mended from  a  sanitary  point  of  view.  The 
presence  of  dirt  in  any  shape  or  form  is  always 
obnoxious  to  lovers  of  decency  and  order,  but 
when,  in  addition  to  its  obtrusiveness  it  may 
harbour  disease  germs  and  parasitic  organisms, 
its  immediate  removal  then  becomes  a  matter  of 
necessity.  The  open  forest  and  the  desolate 
common-land  doubtless  afford  good  shelter  to 
tramps  and  other  homeless  wanderers,  and  here 
the  risks  of  infection  to  the  community  at  large 
are  almost  infinitesimal  It  is  otherwise,  however, 
when  the  limited  areas  of  the  parks  and  public 


534  Thi  Medical  Press. 


LEADING  ARTICLES. 


May  i  8,  1904. 


gardens  are  daily  contaminated  by  clothing  of 
the  filthiest  description,  and  the  seats  are  be- 
grimed in  a  similar  manner.  Should  the  vagrant, 
by  way  of  good  luck,  chance  to  earn  a  copper  on 
the  road,  what  is  more  natural  than  that  he  should 
enter  the  public  room  of  a  wayside  inn,  there  to 
refresh  his  worn-out  energies  and  possibly  to  dis- 
cuss his  adventures  with  other  loafers  of  a  like 
calibre  ?  The  whole  party  will  probably  meet 
together  at  a  favourite  "  doss-house  "  ora  casual 
ward  later  in  the  day,  and  in  these  ways  it  is  quite 
conceivable  that  such  an  infectious  disease  as 
small-pox  might  be  spread  rapidly  from  town  to 
town,  and  this  is  precisely  what  has  happened 
in  the  past  and  is  still  going  on  to-day.  But  it 
is  one  thing  to  point  out  a  public  danger  and 
another  to  suggest  a  remedy  that  shall  be  at  the 
same  time  practical  and  efficient.  The  recom- 
mendations adopted  by  the  Conference  of  Sani- 
tary Authorities,  convened  by  the  London  County 
Council  in  1894,  were  most  salutary,  and  had  these 
been  carried  out  to  the  full  a  great  deal  of  trouble 
might  have  been  prevented.  A  more  thorough 
inspection  of  the  casual  wards  and  of  the  lodging- 
houses  is  urgently  needed,  and  where  cases  of 
infectious  disease  present  themselves  powers  of 
isolation  and  detention  should  be  given  to  the 
authorities.  Routine  baths  and  systematic  dis- 
infection of  clothing  would  also  be  most  desirable, 
but,  after  all,  vaccination  and  re-vaccination 
should  be  made  compulsory  upon  all  the  inmates 
of  lodging-houses  and  other  places  where  the  genus 
tramp  is  to  be  found.  The  matter  is  not  simply 
one  of  violation  of  some  sentimental  idea  of  pro- 
priety, but  it  is  one  which  vitally  affects  the  public 
health.  As  Dr.  Armstrong  suggests,  a  second 
conference  upon  the  subject  would  now  be  most 
opportune. 

SCIENTIFIC  RESEARCH  IN  RATE-SUP- 
PORTED HOSPITALS. 

A  notable  step  was  taken  at  a  meeting  of  the 
Metropolitan  Asylums  Board  at  the  end  of  last 
month  ;  a  step  which  it  is  much  to  be  hoped  may 
prove  a  precedent  for  many  others  in  a  similar 
direction.  A  resolution  was  submitted  to  the 
Board  by  the  chairman  of  the  Hospitals  Com- 
mittee asking  that  they  should  be  empowered 
to  sanction  a  series  of  investigations  into  the  origin 
and  nature  of  small-pox  at  the  new  Joyce  Green 
Small-pox  Hospital.  Without  dwelling  on  the  un- 
fortunate necessity  for  maintaining  this  enormous 
institution  for  the  benefit  of  those  who  fail  to 
protect  themselves  from  small- pox  byjvaccination, 
or  animadverting  upon  the  abundance  of  clinical 
material  likely  to  be  available  for  the  purposes 
61  the  investigations,  one  [may  say  at  once 
that  the  recognition,  tardy  though  it  be,  of  the 
benefit  that  will  accrue  to  the  community 
at  large  from  properly-organised  research  in 
publicly-controlled  hospitals  is  in  every  way  to 
be  commended.  The  exact  nature  of  the 
proposal  submitted  to  the  Board  was  that 
an    understanding    arrived    at    meanwhile    be- 


tween the  superintendent  of  the  hospital  and 
Dr.  Martin,  of  the  Lister  Institute,  should  have 
the  countenance  of  the  Board,  and  that  the  two 
institutions  should  jointly  take  up  the  work 
of  endeavouring  to  advance  our  knowledge  about 
small-pox  from  the  clinical  and  bacteriological 
sides  respectively.  The  crux  of  the  whole  matter 
lay  in  tie  necessity  entailed  by  such  a  scheme 
of  the  hospital  being  licensed  under  the  Ex- 
periments on  Animals  Act.  The  experiments, 
it  was  pointed  out,  would  consist  entirely  in  in- 
oculations, but  the  very  idea  of  "vivisection" 
brought  letters  of  protest  from  five  metropolitan 
boards  of  guardians  and  heated  speeches  from 
their  representatives  on  the  Asylums  Board. 
Happily  the  Board  vindicated  their  reputation 
for  common  sense,  and  adopted  the  resolution  in 
favour  of  the  proposal.  It  is  not  to  be  expected 
that  a  specific  cure  for  small-pox  will  be  forth- 
coming immediately,  nor  that  the  cause  of  this 
obscure  disease  will  emerge  from  the  laboratory 
in  six  months'  time  to  take  its  place  in  the  hierarchy 
of  germs,  but  it  may  confidently  be  anticipated 
that  years  of  methodical  and  patient  investigation, 
reflection  and  experiment  will  place  us  in  a  more 
favourable  position  with  regard  to  dealing  with 
the  manifestations  of  variola,  both  in  the 
community  and  in  the  individual.  It  is  not  un- 
likely that  even  our  present  antidote  to  small-pox 
infection,  namely  vaccination,  will  be  superseded, 
and  a  method  causing  less  inconvenience  and 
opposition  be  substituted  for  it.  The  anti- 
vaccinators  should,  therefore,  welcome  the  scheme 
warmly  if  they  are  amenable  to  rational  considera- 
tions, but  that  this  should  be  the  case  is  hardly 
to  be  anticipated,  as  the  "  anti  "  mind  may  be 
trusted  to  oppose  anything  founded  on  pure  reason. 
No  doubt  a  great  deal  more  will  be  heard  of  the 
licensing  of  Joyce  Green  for  "  vivisection," 
but  we  hope  the  Board  will  stick  to  their  guns, 
and  not  pander  to  any  ill-informed  or  ignorant 
clamour  that  may  arise.  It  is  lamentable  to  re- 
flect that  every  year  in  rate-supported  hospitals 
there  are  congregated  masses  of  patients  suffering 
from^every  kind  of  disease,  who  get  well  or  die 
without  any  opportunity  being  afforded  for  then- 
sufferings  to  benefit  their  fellows,  or  for  the 
prevention  of  similar  misfortunes  to  others. 
The  rich  stores  of  material  presented  by  the  large 
infirmaries  and  fever  hospitals  are  not  only  almost 
wholly  unworked,  but  are  also  unworkable 
under  the  prevailing  conditions  of  constitution. 
It  need  hardly  be  pointed  out  that  if  the  relief 
of  human  suffering  be  an  object  of  these  institu- 
tions, the  organisation  of  research  work  into  the 
nature  and  cause  of  the  diseases  that  necessitate 
their  existence  is  as  beneficent  a  way  of  spending 
money  as  is  the  payment  of  their  drug  bill ;  whilst, 
especially  in  the  case  of  fever  hospitals,  an  outlay 
in  research  plant  and  salaries  to  investigators 
is  the  best  investment  for  money  that  can  be  got; 
for  it  is  not  unduly  optimistic  to  hold  that  all 
zymotic  diseases  are  eventually  preventable. 
The  prime  object  of  fever  hospitals  is  to  reduce 
the  spread  and  prevalence  of  fevers,  and  if  the 


May  i 8,  1904. 


NOTES  ON  CURRENT  TOPICS. 


The  Medical  Press.     535 


actual  cases  were  used  to  the  best  advantage  and 
studied  by  the  best  men  with  the  best  appliances, 
there  would  be  reasonable  hope  that  the  number 
of  candidates  for  admission  to  their  wards  would, 
in  the  near  future,  be  sensibly  reduced.  The 
principle  of  applying  public  money  to  medical 
research  is  already  recognised  by  the  London 
County  Council  in  its  pathological  department, 
and  at  the  present  day,  when  the  desirability 
of  expending  money  for  objects  a  little  way  ahead 
is  shown  by  the  sums  sunk  in  elementary  and 
secondary  education,  is  it  too  much  to  ask  that  a 
dole  be  given  out  of  the  public  income  to  those 
who  would  save  people  from  disease  and  death  ? 
But  it  is  a  day  of  small  things — medically  speak- 
ing. The  enthusiast  for  the  public  health  must 
be  content  with  the  crumbs  that  fall  from  the 
table.  As  it  is,  there  are  many  eager  and  anxious 
workers  who  ask  only  for  the  opportunity  for 
pursuing  investigations,  and  do  not  demand  salaries 
for  doing  so.  The  resolution  of  the  Metropolitan 
Asylums  Board  to  permit  such  investigations  is 
a  straw  which  shows  which  way  the  current  of 
opinion  is  setting,  and  a  straw  for  which  we  are 
deeply  grateful.  For  it  shows  that  people  are 
becoming  alive  to  their  own  best  interests. 

Vlotes  on  Current  Tropics. 

Vegetarians  as  Soldiers. 

It  is  more  than  (vegetarian)  human  nature  could 
stand  to  let  the  initial  successes  of  the  Japanese 
pass  by  without  attributing  their  assumed  su- 
periority as  soldiers  to  the  fact  that  their  diet 
is  a  non-fleshy  one.  The  victories  that  they  have 
gained  hitherto  have  been  due  to  their  courage, 
endurance,  and  dash,  which — so  it  is  claimed — 
can  be  attained  only  by  eschewing  beef  and  mutton 
and  eating  roots  and  fruits.  If  the  carnivorous 
Russians  pick  up  and  win  eventually  it  will,  of 
course,  be  due  to  causes  other  than  their  diet, 
which  is  at  present  as  dead  a  weight  on  their 
constitutions  as  it  is  on  their  commissariat  wag- 
gons. One  would  be  loth  to  spoil  the  moral  and 
unadorn  the  tale  by  pointing  out  that  the  Japanese 
eat  eggs,  and  fish,  and  fowl — when  they  can  get 
them.  Every  nation's  diet  is  controlled  by  two 
factors,  the  products  which  their  country  is 
capable  of  turning  out,  and  the  price  at  which 
they  can  buy  foreign  commodities.  A  nation 
that  can  get  fish  and  rice  and  eggs  and  fruit, 
and  is,  moreover,  poor,  naturally  eats  fish,  rice, 
eggs  and  fruit,  and  might  do  much  worse.  That 
that  nation  also  furnishes  an  army  of  capable  and 
daring  soldiers  is  not  to  be  wondered  at  if  its  in- 
dividuals are  capable  and  daring  in  themselves. 
The  absence  of  "  Maconochie's  rations "  from 
their  commissariat  shows  nothing  more  than 
that  they  either  do  not  know  of  Maconochie 
(which  is  absurd),  or  that  they  can  get  cheaper 
and  better  food  nearer  home.  But  is  the  reason 
not  further  to  seek  ?  We  know  from  statements 
recently  made  by  certain  anti-vaccinators  that 
Japan  is  a  badly  vaccinated  country.  Is  not 
their  success  due  to  their  not  having  their  blood 


contaminated  by  the  putrifying  juice  of  diseased 
calves  ?  It  is  at  least  as  likely,  and  Russian  failure 
may  possibly  be  claimed  by  some  vegetarians  as 
an  obscure  effect  of  flesh  nutrition. 


The  Nocturnal  Restraint  of  Infants, 
Mechanical  restraint,  especially  at  a  tender 
age,  is  rightly  condemned  as  being  an  unjustifiable 
method  of  dealing  with  a  superabundance  of 
animal  spirits,  whether  natural  or  pathological. 
That  kind  of  restraint  is  always  deeply  resented 
by  a  child,  to  whom  it  appeals  often  more  strongly 
than  the  infliction  of  bodily  pain.  In  the  rest- 
less violence  exhibited  by  the  insane  adult  some 
form  of  restraint  becomes  almost  a  matter  of 
necessity,  but  even  here  the  horrors  which  its 
mechanical  application  recalls  have  rendered 
its  employment  largely  a  thing  of  the  past.  The 
instability  of  the  child's  nervous  system,  while 
predisposing  to  outbursts  of  excitement,  is  the 
chief  factor  which  causes  such  disturbances  to  be 
of  only  short  duration.  There  are  many  other 
conditions,  however,  which  contribute  towards 
nocturnal  restlessness  in  infancy  and  early  child- 
hood. Among  these,  rickets  must  hold  the  first 
place,  for  in  this  complaint  there  is  often  consider- 
able difficulty  in  keeping  the  child  covered  over  at 
night,  or  even  in  preventing  it  from  falling  out 
of  its  cot.  The  constitutional  treatment  of  the 
disease  itself  and  careful  attention  to  the  dietary 
both  make  for  the  natural  disappearance  of  this 
troublesome  symptom.  The  timely  adminis- 
tration of  a  chloral  draught,  or  a  bromide  mixture, 
may  save  the  child  from  developing  habits  ot 
restlessness  and  tossing  themselves  about  at 
night.  If  morbid  sensations  from  the  skin,  such 
as  severe  itching,  threaten  to  destroy  an  infant's 
rest,  or  it  is  feared  that  actual  harm  may  be  done 
to  the  cutaneous  lesions  by  scratching,  the  hands 
may  be  wrapped  up  in  cotton  wool.  Any  ap- 
proach towards  actual  tying-up  is  generally 
most  undesirable,  and  this  practice  should  cer- 
tainly not  be  tolerated  in  the  children's  wards 
of  hospitals.  That  fatalities  may  arise  in  this 
way  has,  unfortunately,  been  proved  by  the 
recent  death  of  a  two-year-old  infant  in  the  Halifax 
Workhouse  Hospital  from  accidental  hanging. 


A  Study  of  Advertisements. 

An  energetic  writer,  who  believes  that  he  can 
find  "sermons  in  stones  and  good  in  everthing," 
contributes  to  one  of  our  contemporaries  the 
results  of  a  scrutiny  of  the  advertisements  which 
have  reached  him  by  post  during  a  period  of  twelve 
months.  As  most  of  us  have  probably  been  in 
receipt  of  the  same  advertisements,  but  have 
disposed  of  them  with  little  consideration  to  the 
waste-paper  basket,  it  may  be  interesting  to  note 
some  of  his  observations.  The  total  number  of 
packets  received  was  three  hundred,  of  which  a 
little  more  than  half  came  from  Great  Britain.  Of 
the  remainder  the  United  States  sent  fifty,  and 
Germany  and  France  thirty-five  and  thirty- 
four  respectively.  •  The  total  weight  avoirdupois 
amounted  to  fifty-seven  and  a  half  pounds,  and  the 


536     The  Medical  Press.      NOTES    ON    CURRENT    TOPICS. 


May  i 8,  1904. 


postage  was  just  under  twenty  shillings.  The 
samples  received  were  very  various,  and  ranged 
from  mineral  water  to  baby's  bottles,  and  from 
whisky  to  soap.  One  of  the  commonest  forms  of 
advertisement,  as  all  of  us  must  have  noticed, 
and  one  of  the  least  useless  is  the  writing  pad. 
Attention  is  drawn  to  the  enormous  flood  of  bogus 
medical  journals  which  reach  us  from  America, 
the  sole  purpose  of  their  existence  being  to  push 
some  nostrum  or  other.  We  have  often  wondered 
what  inducement  there  is  to  pester  orthodox 
medical  men  in  this  way,  as  surely  but  very  few 
take  any  notice  of  such  persuasion,  Assuming 
that  the  writer  has  not  received  more  than  the  usual 
number  of  advertisements  which  fall  to  the  lot  of 
every  medical  man  in  these  countries,  then  on  a 
moderate  calculation  there  must  be  spent  on 
advertisements  of  this  kind,  directed  to  the  medical 
profession  alone,  a  sum  of  fifty  to  a  hundred 
thousand  pounds  per  annum.  The  Post  Office, 
apart  from  all  intrinsic  cost  and  cost  of  packing, 
draws  a  revenue  of  thirty  thousand  pounds  from 
this  class  of  postal  packet  alone. 

Interchange  of  Medical  Teachers* 

Everyone  must  have  noticed  the  constantly 
increasing  intimacy  which  appears  among  men 
of  science  in  our  times,  and  is  not  limited  by 
either  racial  or  geographical  boundaries.  In 
its  essence,  science  was  always  cosmopolitan  and 
catholic,  but  its  catholicity  was  somewhat  obscured 
by  the  partial  views  taken  by  its  worshippers. 
Nowadays  this  state  of  things  is  passing  away,  and 
as  a  sign  of  the  change  one  welcomes  the  growing 
custom  in  schools  of  learning  of  inviting  distin- 
guished men  from  other  schools  to  deliver  courses 
of  lectures.  America  has  taken  the  lead  in  this 
direction,  and  the  different  medical  schools  in  the 
States  have  obtained  for  themselves  the  advantage 
of  the  instruction  at  first  hand  of  many  of  the  best- 
known  teachers  and  investigators  in  Europe.  For 
example,  Professor  Ehrlich  has  just  finished  a 
course  of  lectures  at  the  Johns  Hopkins  Hospital 
on  the  subject  in  regard  to  which  his  name  is 
world-famed,  and  Professor  Sherrington  is  about 
to  pay  a  visit  to  Yale.  Conversely,  it  is  only  a  year 
or  two  ago  since  Professor  Welch  of  Johns  Hopkins 
delivered  a  valuable  series  of  lectures  in  London, 
and  many  other  instances  might  be  mentioned. 
In  like  manner  it  is  now  usual  to  entrust  the 
delivery  of  an  inaugural  address  to  a  distinguished 
visitor  rather  than  to  one  of  the  teachers  at  the 
school  where  the  address  is  to  be  given.  No  one 
can  doubt  that  the  spirit  of  which  these  instances 
are  signs  is  one  of  good  import  for  the  furtherance 
of  science.  The  living  voice  and  the  spoken  word 
incite  with  enthusiasm  where  the  written  page  fails, 
and  the  better  understanding  arising  from  personal 
acquaintance  tends  to  do  away  with  the  petty 
jealousies  which  have  hampered  progress  in  the 
past.  President  Eliot,  of  Harvard,  while  noticing 
these  facts,  makes  the  suggestion  that  an  inter- 
change of  professors  might  be  made  from  time  to 
time  between  seats  of  learning,  so  that,  for  a  period 
of  some  months  or  more,  students  might  be  brought 


under  the  influence  of  strangers.  We  fear  that  this 
plan  is  hardly  quite  practicable,  though  we 
entirely  recognise  the  stimulating  effect  of  an 
infusion  of  fresh  ideas  and  methods  of  instruction 
into  the  routine  of  medical  study. 

Poet-Graduate  Work  in  Dublin. 

Not  content  with  the  innovations  to  which 
we  have  recently  drawn  attention,  such  as  the 
inauguration  of  service  classes  and  the  establish- 
ment of  a  degree  in  dental  surgery,  the  University 
of  Dublin  is  making  a  further  progressive  step  in 
arranging  for  a  regular  post-graduate  course  of 
study  in  various  subjects.  The  particulars  are 
not  yet  published,  but  it  is  understood  that  the  first 
course,  which  will  last  three  weeks,  will  begin  about 
the  middle  of  June.  Lectures  or  demonstrations 
wil  be  given  in  medicine,  surgery,  physiology, 
pathology,  gynaecology,  and  anatomy.  The  in- 
struction given  will  be  systematic,  as  well  as 
clinical  and  practical.  Among  the  subj ects  treated 
in  lectures  on  medicine  will  be  "  The  Treatment  of 
Typhoid  Fever  "  and  "  Diseases  of  the  Stomach," 
by  Drs.  Bewley  and  Parsons,  while  Dr.  Wallace 
Beatty  will  give  demonstrations  on  diseases  of  the 
skin.  In  surgery,  in  addition  to  courses  in 
clinical  and  operative  surgery,  particularly  of  the 
alimentary  and  uro- genital  systems,  given  by  Mr. 
Gordon  and  Mr.  Edward  Taylor,  special  courses 
will  be  given  by  Mr.  Swanzy  on  the  surgery  of  the 
eye,  and  by  Mr.  Woods  on  the  surgery  of  the 
throat  and  ear.  In  gynaecology,  Dr.  Ernest 
Tweedy  will  have  at  his  disposal  the-  great  mass  of 
clinical  material  at  the  Rotunda  Hospital,  of  which 
he  is  Master*  Professors  O'Sullivan,  Thompson, 
and  Dixon  have  charge  of  the  courses  in  pathology, 
physiology,  and  anatomy  respectively.  We 
understand  that  those  taking  the  course  will  be 
provided  with  rooms  in  Trinity  College,  and  will  be 
allowed  to  dine  in  commons. 


A  Medical  X-Ray  "  Born  "  Case. 

The   case  of  Smith  v.  Pare,   tried   in  King's 
Bench  last  week,  hardly  redounds  to  the  credit  of 
the  plaintiff.  Dr.  Cloete  Smith  brought  an  action  to 
recover  fees  for  professional  services  and  damages 
for  assault  from  Air.  Pare.     He  had  been  applied 
to  by  the  defendant  to  treat  his  wife  with  high 
frequency  electrical  treatment,  and  used  X-ray 
treatment  without  being  authorised  to  do  so,  and 
thereby  inflicted  a  serious  X-ray  burn  upon  the 
patient.      Mr.    Pare    admittedly    assaulted    the 
plaintiff.     It  seems  that  his  wife  was  under  Mr. 
Huxley,  the  surgeon,  for  some  eight  or  nine  years, 
and  that  some  four  years  ago  Sir  Victor  Horsley 
operated  upon  her  for  a  condition  that  might  recur. 
Last  year  Mrs.  Pare  became  very  ill,  and  Mr.  Huxley 
advised  her  to  have  the  open-air  cure    at    St 
Leonard's.     Her  husband    saw  a  circular  issued 
by  or  on  behalf  of  Dr.  Cloete  Smith,  and  applied 
for  advice  to  Sir  Victor  Horsley  as  to  the  advisa- 
ability  of  trying  the  high  frequency  treatment. 
The  latter  said  it  would  probably  do  no  good  and 
could  no  no  harm,  but  no  mention  was  made  to  him 
of  X-ray  treatment.     Sir  Victor  Horsley  expressed 


May  18,  1904. 


NOTES  ON  CURRENT  TOPICS.     Th»  Medical  Press.     537 


himself  very  strongly  in  the  witness-box  as  to  the 
extensive  Rontgen  -  ray  dermatitis.  In  his 
opinion  "  no  reasonably  intelligent  medical  man 
could  have  anticipated  any  beneficial  result  from 
the  treatment  in  question."  The  jury  found  that 
Dr.  Smith's  treatment  was  improper,  negligent, 
and  unskilful,  and  while  they  awarded  him  two 
pounds  for  the  assault  they  found  a  verdict  for 
^100  in  favour  of  the  defendant's  counter-claim. 
At  this  time  of  day  it  would  be  impossible  to 
defend  either  the  deliberate  or  the  accidental  pro- 
duction of  a  deep  focus-tube  burn. 


The  London  Street  Ambulance  Scheme. 

The  new  scheme  for  the  provision  of  an  adequate 
street  ambulance  system  for  the  metropolis  has 
been  duly  laid  before  the  London  County  Council 
by    a    powerful    representative  deputation.     Dr. 
Arthur  James,  the  originator  of  the  movement, 
is  to  be  congratulated  upon  its  recent  develop- 
ments.    Briefly   stated,   the   essence  of   the  new 
proposal  is  to  graft  the  ambulance  service  upon 
the    Fire    Brigade    organisation  already  existing 
under   the  control  of   the  Council.     Dr.    James, 
in  explaining  his  views,  stated  that  there  was  no 
intention  of  putting  more  work  on  the  present 
Fire  Brigade  staff,  but  rather  that  a  sufficient  num- 
ber  of    men,    horses,    and    ambulances   to    deal 
with    the    15,000    casualties    requiring    removal 
each  year  should  be  added  to  the  Fire  Brigade, 
and  these  extra  men  be  practised  in  fire  drill,  so 
that  they  could  be  u3ed  for  fire  work  if  required 
in    the    event    of    any    unusual    emergency.     It 
would  not  be  necessary  to  place  ambulances  at 
all  the  ninety  fire  stations,  but  only  in  about  thirty 
of  them.     To  begin  with,  an  addition  of  two  men, 
one  horse,  and  one  ambulance  to  each  selected 
station    would    be    enough,    as    most    of    them 
already   had   sufficient   accommodation    for   this 
increase,  and  only  a  few  stations  would  require 
enlarging.     Questioned  as  to  cost,  he  said  that 
it  must  be  obvious  to  everyone  that  there  would 
be  enormous  saving  of  expense  in    utilising   the 
Fire  Brigade  machinery,  &c,  and  that  experience 
of  other  cities  proved  that  this  could  be  done 
with  actual  advantage  to  each  service,  and  that 
no  inconvenience  arose  from  using  Fire  Brigade 
telephones  for   ambulance  purposes   also.     It  is 
to  be  hoped  that  a  progressive  body  like  the  London 
County  Council  will  rise  to  the  occasion,   and, 
whether  the  combination  of  the  ambulance  and 
the  Fire  Brigade  services  be  considered  feasible 
or  otherwise,  they  will  see  to  it  that  Londoners 
are    henceforth    provided    with   a  practical    and 
scientific   system   for   the   necessary   carriage   of 
sick  and  injured  citizens. 


turbance  of  the  brain  substance  from  gross  cere- 
bral lesions,  especially  haemorrhage  into  its 
various  parts,  is  prone  to  give  rise  to  considerable 
alterations  in  the  bodily  temperature.  This 
may  be  absolute,  or  it  may  be  more  marked  on 
one  side  of  the  body.  In  cerebral  haemorrhage 
the  temperature  usually  falls  at  first,  and  the 
depression  may  continue  until  death,  or,  after 
twenty-four  hours,  it  may  rise  slightly  along  with 
the  inflammatory  changes  that  often  set  in  in  the 
immediate  neighbourhood  of  the  extravasation. 
Post-mortem  elevations  of  temperature  are  com- 
mon. When  the  haemorrhage  occurs  in  the  pons 
or  medulla  an  initial  rise  of  1040,  or  more,  is  not 
infrequent.  Should  the  temperature  remain  per- 
sistently high  the  prognosis  is,  in  almost  all  cases, 
bad,  even  if  unaccompanied  by  other  grave  sym- 
ptoms. The  study  of  temperature  in  relation 
to  head  injuries  is  most  interesting,  as  it  assists 
in  throwing  some  light  upon  the  subject  of  ther- 
motaxis.  Thus,  in  concussion  of  the  brain,  the 
rectal  temperature  is  generally  lowered,  and  there 
is  no  difference  observed  between  the  surface  tem- 
perature of  the  two  sides  of  the  body.  In  cere- 
bral compression,  on  the  other  hand,  hyper- 
pyrexia may  be  observed  with  the  increase  in 
intra-cranial  pressure,  and,  as  a  rule,  the  surface 
temperature  is  raised  on  that  side  of  the  body 
opposite  to  the  lesion.  Fracture  of  the  skull  is 
almost  invariably  accompanied  by  concussion  or 
compression,  or  both,  but,  as  Mr.  McAdam  Eccles 
has  stated,  the  prognosis  is  always  bad  if  the 
temperature  rushes  up  through  five  or  six  degrees 
within  a  few  hours  of  the  time  of  injury. 


The  Temperature"in  Head  Injuries. 
The  existence  of  a  special  heat  centre  or  centres 
in  the  brain  is  now  universally  acknowledged. 
The  exact  manner  in  which  these  cells  preside 
over  the  mechanism  of  heat-production  is  not 
yet  perfectly  understood,  but  there  can  be  no 
doubt  that  some  are  inhibitory  in  function,  while 
others    exercise    a    restraining    influence.     Dis- 


The  Therapeutics  of  Music. 
In  a  County  Court  case  last  week  there  was  a 
dispute    about    a    certain    musical    instrument 
called  a  "  polyphone,"  and  in  the  course  of  the 
evidence  it  was  alleged  that  the  doctor  had  pre- 
scribed a  course  of  melody  from  this   equivocally 
named    construction  to  soothe    the  brain  of  a 
delirious  child.       From  the  report  of  the  pro- 
ceedings it  does  not  appear  whether  the  desired 
result  was  attained,  but  knowing  the  partiality 
of  the  gutter  urchin  for  the  polyphonic  discords 
of  the  street  barrel-organ,  it  may  be  surmised 
that,  as  the  strains  of  the  instrument  in  question 
could  scarcely  be  less  harmonious  than  those  of 
his  favourite  street-piano,  and  might  certainly  be 
much  more  so,  the  little  one's  mind  might  have 
been  soothed  where  a  more  musicianly  patient 
would  only  have  been  incited  to  wilder  struggles. 
Since  the  days  of  Tubal  Cain  music  has  been  highly 
esteemed  by  the  sick  for  its  calming  and  sedative 
action  on  the  nervous  system,  but  its  position 
in  the  therapeutical  gamut  has  never  been  decided 
authoritatively.     We  all  know  its  alleged  power 
over  the  savage  breast,  and  if  the  myth  of  Orpheus 
be  founde  d  on  any  substratum  of  fact,  over  wild 
beasts  also,  but  we  do  not  yet  employ  it,  as  David 
did  with  Saul,  as  an  hypnotic.     That  it  may  have 
a  sphere  of  usefulness  in  such  a  direction  may 
quite  well  be  the  case,  but  hitherto  the  difl&culty 
of  getting  any  portable  instrument  into  the  sick- 


538    The  Medical  Press.    NOTES    ON    CURRENT    TOPICS. 


May  i  8,  1904. 


* 


room,  except  the  dulcet  but  not  very  powerful 
musical-box,  has,  perhaps,  been  one  of  the  greatest 
obstacles  in  the  way.  The  late  Mr.  Abingdon 
Baird  had  a  beautiful  automatic  orchestra  fitted 
up  at  his  seat  at  Newmarket,  and  he  found  its 
music  very  conducive  to  sleep  when  over-tired 
or  excited.  With  the  progress  of  mechanical 
aids  to  the  production  of  good  music,  such  as  the 
pianola  and  the  pianotist,  it  may  be  that  it  will 
be  possible  in  the  near  future  to  use  good  auto- 
matic instruments  in  the  bedroom  to  produce 
lullabies  and  sleeping-songs,  whose  influence  on 
the  patient  will  be  as  effective  as  bromides  and 
sulphonal,  but  without  their  after-effects.  The 
polyphone  may  be  a  step  in  this  direction ;  but 
one  hardly  imagines  it  is  the  final  one. 

Domestic  Aninrmlft  and  Infection. 

Considered  as  fomites,  there  can  be  little 
doubt  that  many  of  the  domestic  animals  play 
an  important  part  in  the  dissemination  of  in- 
fectious disease.  Parasitic  disorders,  especially 
ringworm,  are  not  seldom  conveyed  through  the 
medium  of  cats  and  dogs.  When  it  is  remem- 
bered that  feline  visitors  to  the  nursery  com- 
monly remain  as  playmates,  it  is  a  wonder  that 
children  do  not  catch  more  diseases  from  them, 
seeing  that  these  furry  creatures  are  hugged  and 
petted.  Fur  is  a  good  absorber  of  odours  and 
dirt  of  all  kinds,  including,  of  course,  the  ubiqui- 
tous microbe  which  may  happen  to  be  pathogenic 
or  not.  Numerous  instances  have  arisen  where 
in  otherwise  inexplicable  outbreaks  of  tricophytic 
disease  the  infection  has  been  traced,  upon  care- 
ful investigation,  to  a  household  pet.  In  obscure 
cases  of  suspected  ringworm  of  the  body,  the 
diagnosis  may  sometimes  be  cleared  up  by  ex- 
amination of  any  domestic  animal  with  which 
the  patient  has  had  to  do.  With  regard  to  zy- 
motic disorders,  the  danger  is  even  greater. 
Even  the  common  cold  in  the  head  may  be  pro- 
pagated through  an  entire  household  by  means 
oi  an  innocent  cat  who  has  been  fondled  and 
breathed  upon  by  one  individual  who  is  suffering 
therefrom.  Worse  than  this  is  the  possibility 
of  the  transmission  of  diphtheria,  or  any  of  the 
acute  exanthemata  by  a  domestic  animal,  not  that 
they  may  necessarily  be  affected  themselves, 
but  on  account  of  the  infection  clinging  to  their 
coats.  As  Sir  James  Crichton-Browne  has  said, 
"  Even  when  a  cat  coughs,  it  is  well  to  take  care  !  " 
To  show  what  little  importance  the  majority  of 
people  attach  to  this  question,  it  may  be  men- 
tioned that  these  animals  have  been  seen  nestling 
up  against  a  small-pox  patient  and  rubbing 
against  the  pustules  in  a  most  affectionate  manner 
Had  they  not  been  disinfected,  they  might 
have  been  responsible  for  an  extensive  outbreak, 
of  the  disease.  Other  domestic  animals  also 
may  be  sources  of  danger  to  human  beings  unless 
special  precautions  be  taken. 

Cicatrices  Treated  by  Thiosinamin. 
There  are  no  more  troublesome  conditions  to 
treat  than  those  caused  by  the  contraction  of  scar- 


tissue.  When  the  skin  or  subcutaneous  tissues 
have  been  destroyed  by  burns,  or  large  areas  have 
been  removed  by  operation,  the  cicatrices  that 
result  invariably  contract,  and  frequently  lead, 
in  spite  of  all  treatment,  to  unsightly  deformities 
or  permanently  useless  limbs.  The  methods 
usually  adopted  to  combat  such  contractions  are 
massage  and  exercises,  but  when  the  scar  is 
large  and  deep  they  are  seldom  of  much  avail. 
No  drug  treatment  has  hitherto  been  of  the  slightest 
use,  and  one  finds  it  difficult  to  imagine  how  any 
medicine  can  be.  Within  the  last  few  months, 
however,  from  Germany  come  reports  from  medi- 
cal men  of  standing  reporting  favourably  of  a 
body  named  thiosinamin  (allyl-thio-urea),  pre- 
pared by  heating  under  pressure  an  alcoholic 
solution  of  mustard  with  ammonia.  This  drug 
is  said  to  have  the  property  of  softening  cica- 
tricial tissue,  and  of  thus  rendering  it  more  supple 
and  pliable.  On  what  this  property  depends 
seems  to  be  a  matter  of  doubt,  but  after  trials  in 
the  hands  of  a  good  many  practitioners,  promising 
and  gratifying  effects  have  shown  themselves. 
The  drug  is  administered  in  an  alcoholic  solution 
by  subcutaneous  injection,  and  after  some  weeks 
the  scar-tissue  is  found  to  yield  readily  to  exercise 
and  traction.  The  exhibition  of  the  drug  must 
be  accompanied  by  active  and  passive  movements, 
but  when  once  the  pliability  of  the  tissue  has  been 
established  there  does  not  seem  to  be  much  ten- 
dency to  relapse.  So  far  no  long  time  has  elapsed 
since  restoration  of  function  has  taken  place, 
but  two  cases  of  Dupuytren's  contraction  treated  in 
June  last  remained  cured  eight  months  after  treat- 
ment had  ceased.  Lengemann,  who  reported  these 
cases,  has  since  had  a  patient  whose  thumb  had 
become  useless  in  consequence  of  the  contraction 
of  a  scar  after  an  accident,  and  this  has  yielded 
equally  well  to  thiosinamin  and  exercises.  A 
still  more  significant  result  was  obtained  by  Hartz 
who  had  a  case  of  cicatricial  contraction  of  the 
pylorus,  in  which  gastroenterostomy  seemed  to 
offer  the  only  chance  of  cure.  The  patient  ob- 
jected to  operation,  and  Hartz  tried  thiosinamin 
without  much  hope  of  success.  To  his  surprise, 
after  twenty- three  injections  all  the  symptoms 
disappeared.  The  credentials  of  this  drug  seem 
good  enough  to  warrant  a  trial  of  its  properties 
in  this  country. 

Medicine  as  a  Diplomatic  Instrument, 

Science  has  no  native  land,  and  it  is  the  boast 
of  medicine  that  it  knows  no  distinction  of  class, 
creed,  or  race.  All  are  welcome  to  its  benefits, 
and  the  world  is  its  country.  For  this  reason  the 
honest  and  disinterested  practice  of  medicine 
has  done,  and  can  do,  more  to  bring  into  play 
that  touch  of  nature  which  makes  the  whole  world 
kin  than  all  the  forces  of  law  or  of  arms. 
Thus,-too,  is  it  with  diplomacy.  Two  nations  have  op- 
posing interests,  and  their  rulers  are  doing  their 
best  to  reconcile  them  and  avert  appeal  to  force. 
The  way  is  beset  with  difficulties,  till  illness  occurs ; 
the  doctor  enters,  and  all  is  settled  informally. 


May  i  8.   1904. 


NOTES    ON    CURRENT    TOPICS.     The  Medical  Press.    539 


The  attitude  of  the  present  Ameer  of  Afghanistan 
is  the  most  anxious  problem  of  the  moment  for 
the  rulers  of  India,  and  they  would  probably  do 
anything  consistent  with  their  dignity  to  gain  his 
good-will  and  place  him  under  an  obligation.  The 
opportunity  has  come  most  unexpectedly.  In 
the  middle  of  April  the  Ameer  was  out  shooting, 
when  his  gun  burst  and  his  left  hand  was  severely 
injured.  Suppuration  set  in,  and  the  local  Afghan 
surgeons  do  not  seem  to  have  been  skilled  in  the 
use  of  antiseptics.  His  Highness  suffered  much 
pain,  and  could  get  but  little  sleep,  so,  in  despair, 
he  sent  to  Lord  Curzon  for  surgical  help.  The 
Viceroy  replied  by  despatching  his  own  medical 
attendant,  Major  Bird,  who  found  an  abscess  in 
the  palm,  and  promptly  opened  it.  The  relief 
afforded  by  this  operation  was  immense,  and  the 
Ameer  had  the  first  sleep  after  it  that  he  had 
enjoyed  for  many  nights.  He  is  now  filled  with 
gratitude  to  his  benefactor  and  the  Government 
who  sent  him,  and  one  may  confidently  assume 
that  negotiations  will  be  far  easier,  and  his  ob- 
ligations to  this  country  greatly  strengthened 
by  this  Httle  incident.  Major  Bird  may  not  re- 
ceive any  great  recognition  for  his  services,  but 
his  surgical  skill  has  probably  done  more  to  cement 
our  relations  with  Afghanistan  than  an  expedition 
of  a  hundred  thousand  soldiers  could  have  accom- 
plished. 

Military  Patients  in  Workhouse  Hospitals. 
The  Chief  Secretary,  in  answering  a  question  of 
Mr.  Farrell  in  the  House  of  Commons  on  the 
evening  of  the  9th  instant,  said  that  "  there  was  no 
obligation  on  the  part  of  Poor-law  guardians  to 
admit  military  patients  to  workhouse  hospitals. 
He  was  informed  by  the  War  Department  that  in 
all  instances  where  arrangements  were  made  with 
the  local  authorities  for  the  reception  of  infectious 
cases,  occurring  among  troops  or  their  families, 
the  charges  agreed  upon  for  their  maintenance 
were  defrayed  by  the  department."  To  this  we 
may  remark  that  if  the  military  authorities 
Temove  troops  from  all  the  garrison  towns  of  the 
provinces  in  which  they  have  made  no  provision 
for  the  treatment  of  infectious  diseases  and  in  which 
the  local  authorities  refuse  to  admit  any  individual 
wearing  the  uniform  of  his  Majesty,  the  local 
authorities  would  soon  find  that  the  taxpayers  of 
the  affected  towns  would  quickly  change^  the 
personnel  of  the  board  of  guardians. 


A  Millionaire's  Quackery. 

The  death  of  a  Newcastle  millionaire,  Mr. 
George  Handyside,  recalls  a  curious  side  of  his 
character.  His  fortune  was  founded  mainly  in 
his  business  as  a  boot  and  shoe  manufacturer. 
Part,  however,  of  the  completed  fabric  of  his 
million  of  money  was  gained  from  the  sale  of  a 
41  cure  for  consumption,"  a  preparation  of  his 
own  devising,  which  was  vended  over  the  greater 
part  of  the  Kingdom  in  a  famous  painted  van. 
It  is  sad  to  think  of  the  pyramids  of  false  hopes 
that  must  have  been  piled  up  by  that  quack 
enterprise.    There  is  little  compensation  to  be  found 


in  the  fact  that  the  owner  of  that  vampire  van 
bequeathed  £100,000  to  hospitals  and  charities. 
Scientific  medical  men  who  devote  their  whole 
lives  to  research  in  the  interests  of  their  fellows 
are  often  constrained  to  live  and  die  in  the  grip 
of  poverty.  Were  a  tithe  of  their  abilities  to  be 
expended  in  the  unworthy  design  of  preying  on 
the  ignorance  of  the  community,  they  might 
readily  exchange  the  meagre  purse  of  honesty 
for  the  gilded  halls  and  splendour  of  the  patent 
medicine  proprietor.  Contrast  the  moderate 
means  of  Koch,  the  immortal  discoverer  of  the 
specific  organism  of  consumption,  with  the 
million  obtained,  more  or  less,  from  the  sale  of  a 
quack  cure  for  the  same  disease.  Fortunes  are 
being  made  every  day — directly  or  indirectly — by 
unqualified  persons  out  of  the  brains  of  medical 
men. 


The  Antiviviseotion  Hospital. 
The  existence  of  a  sick  hospital  that  did  not 
profit  by  the  discoveries  due  to  experiments  on  the 
lower  animals  would,  in  the  opinion  of  ninety- 
nine  out  of  a  hundred  medical  men,  be  an  im- 
possibility. To  found  a  hospital  on  the  basis 
of  antivivisection,  therefore,  is  to  kick  away 
the  ladder  which  has  rendered  the  position  available. 
These  facts  may  be  commended  to  the  notice  of 
the  Antivivisection  Hospital  at  Battersea,  London, 
of  which  it  is  announced  in  the  Daily  News  of 
May  10th  : — "  This  hospital  represents  a  principle  : 
First,  that  the  torture  of  animals  is  unjustifiable 
in  the  interests  of  science.  Secondly,  that  ex- 
periments on  animals  have  led  to  experiments  on 
human  beings,  and  that  vivisection  is  absolutely 
useless  for  the  cure  or  alleviation  of  disease  and 
suffering.  Thirdly,  that  these  experiments  have 
had  the  poor  and  defenceless  for  their  victims,  have 
taken  place  in  hospitals  supported  by  the  charity 
of  the  public,  and  have  retarded  real  progress." 
This  proclamation  stigmatises  the  medical  men 
attached  to  the  other  hospitals  as  hopelessly  brutal 
to  their  fellows  and  to  the  lower  animals.  Only 
within  the  walls  of  the  antivivisection  hospital 
will  suffering  humanity  be  safe,  and  there  they 
will  be  exposed  only  to  the  essays  of  the  electrical 
ward,  fitted  up  with  every  modern  requisite  to 
carry  out  what  is  clearly  the  most  actively  and  ag- 
gressively experimental  of  all  therapeutic  methods. 
Following  another  great  example,  a  fitting  motto 
for  the  institution  would  be :  "  Consistency, 
Battersea." 


District  Nurses  in  Ireland. 
It  is  just  twelve  months  since  Lady  Dudley,  wife 
of  the  Lord  Lieutenant  of  Ireland,  made  a  public 
appeal  for  funds  to  establish  district  nurses  in  the 
poorest  parts  of  Ireland.  A  generous  response 
ensued,  with  the  result  that  nine  nurses  have  been 
established  during  the  year,  and  the  report  of  the 
first  year's  work  encourages  to  further  effort. 
All  the  nurses  employed  belong  to  the  Queen 
Victoria's  Jubilee  Institute,  and  in  addition  to  full 
medical  and  surgical  training,  have  had  special 
training  in  district  nursing.    Those  sent  to  agri- 


54°    The  Medical  Press. 


PERSONAL. 


May  i  8.  1904. 


agricultural  districts  hold  also  certificates  in 
midwifery.  The  Central  Committee,  in  deciding 
on  the  districts  to  which  nurses  were  to  be 
despatched,  were  aided  by  the  advice  of 
the  local  doctor  and  priest,  who  had  in 
most  cases  already  appealed  for  assistance. 
Where  possible  a  local  subscription  was  raised  to 
help  in  bearing  the  expenses,  and  the  Committee 
held  their  hand  until  they  were  satisfied  that  the 
locality  had  done  its  utmost.  In  some  of  the  very 
poorest  districts,  of  course,  no  local  effort  was 
possible,  and  the  central  body  had  to  bear  all 
expenses.  The  advantage  to  the  poor  of  a  country, 
where  medical  aid  is  scanty  and  distant,  of  having 
the  assistance  in  times  of  sickness  and  childbirth 
01  a  competent  nurse  is  hard  to  over-rate,  and  her 
educational  influence  on  the  people  is  of  primary 
importance.  No  one  knows  her  value  more  than 
the  country  doctor,  whose  toil  she  shares,  and 
whose  responsibility  she  relieves.  We  turn  with 
some  interest  to  the  estimation  of  the  expense  of 
maintaining  a  nurse  in  agricultural  districts,  and 
we  find  that  the  average  amount  is  £110  a  year. 
It  is  worthy  of  note  that  this  sum,  while  by  no 
means  too  large  to  secure  the  services  of  a  woman 
of  skill  and  trust,  is  higher  than  the  average 
salary  of  the  Poor-law  medical  officer,  and  this, 
too,  in  districts  where  private  practice  is  entirely 

absent.  .     

The  Bellevue  Hospital. 
The  proposed  Bellevue  Hospital,  which  is  about 
to  be  undertaken  by  the  city  of  New  York,  will 
be  by  far  the  largest  hospital  in  the  world.  It  will 
take  ten  years  to  build,  and  its  cost  is  estimated 
at  eleven  million  dollars.  This  does  not  include 
an  electric  light  plant  which  will  cost  one  million 
dollars,  nor  the  expenditure  necessary  in  buying 
up  and  clearing  the  site,  and  filling  in  a  portion  of 
the  East  River.  The  building  will  occupy  ground 
now  covered  by  three  whole  blocks  and,  when  com- 
plete, will  consist  of  twelve  pavilions.  In  the 
middle  will  be  a  large  dome,  in  which  accommoda- 
tion for  the  resident  staff  will  be  provided.  The 
number  of  residents  is  naturally  large,  and  the 
house  room  at  their  disposal  at  present  exceedingly 
narrow.  Forty- three  physicians  have  to  fit  them- 
selves into  sixteen  rooms.  The  wards  are,  of 
course,  equally  crowded,  as,  on  an  average,  125 
patients  are  admitted  each  day.  With  the  amount 
of  work  that  this  number  of  patients  entails,  it  is 
no  wonder  that  the  health  of  the  house  officers  has 
been  very  unsatisfactory,  and  that  many  of  them 
have  fallen  victims  to  tuberculosis. 


PERSONAL. 


Sir  George  Hare  Philipson,  M.D.Cantab.,  M.D. 
Durh.,  D.C.L.,  LL.D.,  has  been  elected  president  of 
the  Newcastle  Royal  Infirmary. 


Dr.  Barr  will  preside  at  the  next  meeting  of  the 
Otological  Society  of  the  United  Kingdom,  to  be  held 
at  the  Glasgow  University  on  Saturday,  May  21st. 

The  Harveian  Oration  will  be  delivered  on  Tuesday, 


June  2 1st,  by  Dr.  Richard  Caton,  at  the  Royal  College 
of  Physicians  of  London,  Pall  Mall  East,  at  4  p.m. 


Dr.  J.  C.  Wilson,  of  Philadelphia,  will  preside  at 
the  twenty-first  annual  meeting  of  the  American 
Climatological  Association,  which  will  be  held  in  that 
city  on  June  2nd,  3rd,  and  4th. 

At  a  meeting  of  the  Court  of  Governors  of  St.  Bartho- 
lomew's Hospital,  held  on  April  28th,  Dr.  Morley 
Fletcher,  M.A.,  M.D.Camb.,  F.R.C.P.Lond.,  was  elected 
Assistant  Physician  to  the  hospital. 

Dr.  Joseph  O'Carroll  has  been  elected  President 
of  the  Leinster  Branch  of  the  British  Medical  Asso- 
ciation, and  Sir  Thomas  Miles  has  been  nominated  as 
President-Elect. 


Mr.  Chance,  F.R.C.S.,  Vice-President  of  the  Royal 
College  of  Surgeons  in  Ireland,  has  been  nominated 
for  the  Presidency  of  the  College  for  the  ensuing  year, 
and  Mr.  Swanzy  for  the  Vice-FTesidency. 


We  regret  to  hear  that  Sir  Francis  Lovell  has  had  a 
bad  spill  from  a  rickshaw  at  Singapore.  He  is  well 
known  as  the  Dean  of  the  London  School  of  Tropical 
Medicine,  in  whose  behalf  he  is  travelling  in  the  East. 

Dr.  Clifford  Allbutt,  F.R.S.,  Regius  Professor  of 
Physic  at  the  University  of  Cambridge,  on  the  10th 
inst.  opened  the  new  Dispensary  at  Leeds,  an  institu- 
tion said  to  be  one  of  the  finest  of  its  kind  in  existence. 


Lieutenant-Colonel  J.  G.  MacNeece.  Royal  Army 
Medical  Corps,  now  stationed  in  Dublin,  has  been 
appointed  Principal  Medical  Officer  on  the  Dublin 
District  Staff,  vice  Lieutenant-Colonel  G.  A.  Hughes, 
D.S.O. 


An  International  Congress  on  School  Hygiene  was 
opened  at  Nuremberg  on  April  5  th  by  Prince  Ludwig 
Ferdinand  of  Bavaria.  All  the  European  States  were 
represented,  and  Japan  also  sent  a  delegate.  The 
Congress  lasted  four  days. 


Professor  Hyslop.  of  Columbia  University,  has 
announced  that  a  hospital  for  the  hypnotic  treatment 
of  diseases  will  shortly  be  established  at  New  York. 
A  well-known  millionaire  has  agreed  to  give  a  large 
sum  of  money  for  this  purpose. 

His  Grace  the  Duke  of  Argyll,  P.C.,  K.T., 
G.C.M.G.,  G.C.V.O.,  &c,  will  preside  at  the  festival 
dinner  of  the  Royal  Waterloo  Hospital  for  Children 
and  Women,  to  be  held  on  Monday,  June  20th  next, 
at  8  p.m.,  in  the  new  rooms  at  the  Savoy  Hotel. 

A  meeting  of  the  Ambidextral  Culture  Society  will 
be  held  in  the  rooms  of  the  Medical  Society,  Chandos 
Street,  Cavendish  Square.  W.,  to-day  (Wednesday)  at 
5  p.m.,  when  a  lecture  on  Ambidexterity  from  the  Medi- 
cal Point  of  View  will  be  delivered  by  Dr.  James  Shaw. 

The  Medical  Society  of  London  held  a  comer- 
sazione  at  their  rooms,  11  Chandos  Street,  W.,  on 
Monday  last.  A  reception  by  the  President  took 
place  at  8.30  p.m..  and  at  8.45  Sir  Isambard  Owen 
delivered  an  oration  on  "  The  Future  Prospects^  of 
Medical  Education  in  London." 


The  Right  Hon.  Chas.  Scott  Dickson,  K.C.,  M.P., 
Lord  Advocate  for  Scotland,  will  preside  at  the  dinner 
of  the  Glasgow  University  Club,  London,  to  be  held 
on  Friday,  June  3rd,  1904,  at  the  Cafe  Royal,  Regent 
Street.  Applications  for  tickets  should  bV  made  to 
the  Hon.  Secretary,  63  Harley  Street,  W. 

At  a  general  monthly  meeting  of  the  members  of 
the  Royal  Institution,  held  on  May  9th,  the  Duke  <fi 
Northumberland,  K.G.,  President,  who  was  in  the 
chair,   announced   that   he   had  nominated  Sir  Felix 


May   18,   1904. 


SPECIAL  CORRESPONDENCE. 


The  Medical  Press.    541 


Semon    and    Sir    James   Crichton-Browne  (treasurer), 
among  others.  Vice-presidents  for  the  ensuing  year. 


The  annual  dinner  of  the  Indian  Medical  Service  will 
be  held  at  the  Cafe  Monioo.  Piccadilly  Circus,  on 
Thursday,  June  9th,  at  7.45  o'clock,  under  the  chair- 
manship of  Surgeon-General  Sir  Colvin  Colvin-Smith, 
K.C.B.  Officers  who  intend  to  be  present  should 
communicate  with  the  Hon.  Secretary,  Lieutenant- 
Colonel  P.  J.  Freyer,  46  Harley  Street,  W. 


A  meeting  of  the  Sociological  Society  was  held 
in  the  School  of  Economics  and  Political  Science 
(University  of  London),  Clare'  Market,  W.C.,  on 
Monday,  May  16th.  at  5  p.m\,  at  which  a  paper  on 
"  Eugenics  :  Its  Definition,  Scope,  and  Aims,"  was 
read  by  Mr.  Francis  Galton,  D.C.L..  Sc.D.,  F.R.S. 
The  chair  was  taken  by  Professor  Karl  Pearson, 
F.R.S. 


A  general  meeting  of  the  Epidemiological  Society 
will  be  held  at  5  p.m.  to-day  (Wednesday),  at 
20  Hanover  Square,  W.,  when  an  address  will  be 
delivered  by  Sir  Dyce  Duckworth,  M.D.,  LL.D., 
F.R.C.P.,  entitled,  "  Some  Observations  on  British 
Winter  Resorts."  The  annual  dinner  will  take  place 
later  in  the  evening  at  the  Criterion  Restaurant, 
Piccadilly,  at  7.30  p.m. 

Mr.  Howard  Marsh,  F.R.C.S.,  Professor  of  Surgery 
in  the  University  of  Cambridge,  will  deliver  the  Hun- 
terian  Lecture  in  the  theatre  of  St.  George's  Hospital 
Medical  School,  at  8.30  p.m.,  on  the  25th  inst.  The 
subjects  announced  are  (a)  "  Intermittent  Hydrops 
of  the  Joints  "  ;  (6)  "  The  Influence  of  Growth  on 
Deformities."  All  members  of  the  profession  are 
specially  invited  to  this  lecture  by  the  Dean  of  the 
Medical  School. 


We  do  not  often  have  the  pleasure  of  congratulating 
members  of  our  own  profession  on  reaching  high 
ecclesiastical  dignity,  though,  if  we  mistake  not, 
medical  men  have  before  now  sat  on  the  Episcopal 
Bench.  The  Rev.  Francis  Clarke,  who  has  just  been 
appointed  Archdeacon  of  Elphin,  is  a  graduate  in 
Medicine  of  Dublin  University,  and  practised  for 
many  years  in  Drogheda  before  taking  holy  orders. 
We  believe  his  medical  neighbours  still  sometimes  seek 
his  advice  in  consultation. 


The  late  Sir  Henry  Thompson,  Bart.,  left  an  estate 
of  the  value  of  ^226,298  gross,  and  /223,74s  net.  He 
stated  that  he  had  written  and  comptted  a  work  which 
he  had  designated  "  My  Personal  Recollections," 
the  same  being  in  manuscript  and  unpublished,  and 
he  gave  it  to  his  trustees,  to  retain  for  ten  years  after 
his  death  and  not  to  divulge  the  contents  or  any  part 
thereof  during  that  period,  and  then  to  cause  the  same 
to  be  printed  and  published  by  some  London  firm  of 
publishers,  taking  steps  to  secure  the  copyright. 


CENTRAL  MIDWIVES   BOARD.— IMPORTANT 
IRISH  BUSINESS. 

At  a  meeting  of  the  Central  Mid  wives  Board,  held 
on  April  28th  and  adjourned  to  May  nth,  the  following 
business  was  transacted  : — 

Present  on  April  28th :  Dr.  Champneys,  Mr.  J. 
Ward  Cousins,  D»r.  Cullingworth,  Mr.  J.  H.  Johnstone, 
M.P.,  Miss  Paget,  Dr.  Sinclair,  Miss  Wilson,  Mr.  E. 
Parker  Yourig.  Present  on  May  1 1  th  :  Dr.  Champneys, 
Miss  Paget,  Dr.  Sinclair,  Miss  Wilson,  Mr.  E.  Parker 
Young. 

Dr.  Chair  pneys  was  re-elected  Chairman  for  the 
ensuing  year.  Mr.  J.  H.  Johnstone,  M.P.,  was  re- 
elected Hon.  Treasurer. 

Letters  were  read  from  the  secretary  of  the  Rotunda 
Hospital,  Dublin,  the  general  secretary  of  the  Royal 
Academy  of  Medicine  in  Ireland,  the  Master  of  the 
Coombe  Hospital,  Dublin,  and  Dr.  Byers,  Physician  to 
the  Incorporated  Belfast  Maternity  Hospital,  asking 
the  Board  to  reconsider  its  decision  as  to  an  alteration 


of  its  rules,  so  as  to  allow  pupil-midwives  teamed  in 
the  chartered  maternity  hospitals  of  Ireland  to  be 
placed  on  the  same  footing  as  candidates  for  the 
examination  of  the  Board  producing  the  certificate* 
prescribed  by  Forms  III  and  IV  in  the  Schedule  to 
the  Rules  of  the  Board.  Resolved,  that  it  is  desirable 
to  reconsider  the  Rules,  so  far  as  regards  the  applica- 
tion contained  in  the  letters  now  read. 

It  was  moved  and  seconded  : — "  That  in  lieu  of  the 
certificates  of  personal  attendance  upon  twenty  cases 
the  Board  may,  if  they  think  fit,  accept  the  certificates 
of  the  master  or  senior  medical  officer  of  a  hospital  or 
institution  where  midwives  are  trained  that  the  can- 
didate has  attended  the  course  of  training  prescribed 
for  pupil-midwives  for  the  period  and  in  accordance 
with  the  regulations  in  force  in  such  hospitals  or 
institutions.  All  applications  for  the  recognition  of 
such  certificates  must  be  made  by  the  master  or  senior 
medical  officer  of  the  hospital  or  institution  applying, 
and  must  be  accompanied  by  a  statement  of  the  regu- 
lations for  the  time  being  in  force,  and  of  any  special 
circumstances  which  prevent  candidates  trained  in 
such  hospitals  or  institutions  from  producing  the 
ordinary  certificates  required  by  the  Board."  On  a 
division  there  voted,  for  the  motion,  3  ;  against  the 
motion,  5.  The  motion  was  accordingly  lost.  The 
further  consideration  of  the  matter  was  then  adjourned 
to  May  26th. 

After  consideration  of  applications  for  certificates, 
the  names  of  1 ,037  women  were  passed  under  Section  2 
of  the  Act,  and  ordered  for  entry  on  the  roll.  The 
following  table  shows  the  separate  numbers  of  the 
various  qualifications  at  present  appearing  on  the  roll : 
Royal  College  of  Physicians  of  Ireland  . .  1  1 
Obstetrical  Society  of  London        ..  ..    1,213 

Rotunda  Hospital 55 

Coombe  Hospital 23 

Queen  Charlotte's  Hospital 73 

Liverpool  Lying-in  Hospital  . .  . .        20 

British  Lying-in  Hospital 3 

Glasgow  Maternity  Hospital  . .  . .        39 

St.  Mary's  Hospital,  Manchester   . .         . .        78 
Manchester  Maternity  Hospital      . .  . .  1 

City  of  London  Lying-in  Hospital  . .  7 

Royal  Maternity  Hospital,  Edinburgh      . .  6 

Salvation  Army  Maternity  Hospital         . .  4 

National  Maternity  Hospital,  Dublin        . .  1 

Women  in  bona  fide  practice,  July,  1901  . .   2,928 

Total  enrolled  . .  . .  4AS^ 
Resolved,  that  it  is  desirable  to  appoint  an  inspector 
to  visit  and  report  on  institutions  applying  for  recog- 
nition of  certificates  or  approval  as  training  schools, 
in  cases  where  it  so  appears  advisable  to  the  Board. 
The  consideration  of  the  scheme  of  examinations  to 
be  instituted  by  the  Board  was  further  proceeded  with, 
and  adjourned. 

Special  correspondence. 

[from  our  own  Correspondents.] 
SCOTLAND. 


Edinburgh. — Medical  Officer's  Annual  Health 
Report. — The  death-rate  for  1903  was  15*15  V*r 
1,000  (excluding  "country  deaths,"  i.e.,  of  persons 
temporarily  resident  in  the  medical  institutions  of 
the  city),  this  being  the  lowest  figure  yet  reached. 
The  infantile  death-rate,  that  is,  the  proportion  of 
deaths  under  one  year  to  1,000  births,  was  117,  as 
compared  with  119,  143,  and  132  in  the  preceding 
triennium.  The  zymotic  death-rate  was  1*13  per 
1 ,000,  slightly  below  the  average  of  the  past  five  years. 
Otoe  of  five  cases  of  small-pox  occurring  in  1903  proved 
fatal.  Measles  accounted  for  91  deaths,  or  '27  per 
mille — considerably  less  than  the  average.  Scarlet 
fever  has  been  more  prevalent  than  in  former  years 
with  a  corresponding  excess  of  deaths.  Whooping 
cough  was  very  prevalent  during  1903,  and  caused 
148  deaths,  as  compared  with  97,  284,  58,     and     102 


542     The  Medical  Press. 


CORRESPONDENCE. 


May  i  8,  1904. 


in  the  four  previous  years.  These-  figures  indicate  a 
cliennial  epidemicity,  there  being  a  markedly  increased 
mortality  every  second  year.  The  city  was  practically 
free  from  typhus  fever  during  the  year,  and  the  mor- 
tality from  typhoid  (22)  is  the  least  recorded.  The 
low  mortality  was  not  due  to  diminished  prevalence  of 
the  disease,  but  to  the  fact  that  214  out  of  the  237 
cases  were  treated  in  the  fever  hospital,  where  the 
•conditions  were  much  more  favourable  than  in  the 
houses  of  most  patients.  The  death-rate  at  hospital 
was  only  7  per  cent.,  whilst  among  cases  treated  at 
home  it  was  26  per  cent.  Tuberculous  diseases  were 
responsible  for  698  deaths,  467  being  due  to  phthisis. 
Of  the  latter  34  per  cent,  occurred  in  houses  under 
£10  rental,  26  per  cent,  in  houses  from  ^10  to  £1$  ; 
15  per  cent,  in  houses  from  £i$  to  £20  ;  and  17  per  cent, 
in  houses  above  £20.  Deaths  from  diseases  of  the 
respiratory  organs  amounted  to  759  of  which  bronchitis 
and  pneumonia  accounted  for  693.  The  suicides, 
amounting  to  40  (25  males  and  15  females),  were 
above  the  average.  The  method  employed  was : — 
Firearms,  5  cases ;  cut  throat,  7  ;  drowning,  5 ;  hang- 
*&&•  5  >  poison,  11  ;  other  methods,  7.  The  poisons 
taken  were  : — Laudanum  in  6  cases ;  carbolic  acid, 
2  ;  arsenic,  1  ;  oxalic  acid,  1  ;  chloral,  1.  Discussing 
the  distribution  of  infectious  diseases  throughout  the 
city,  Sir  Henry  Littlejohn  speaks  in  sanguine  terms  of 
the  gradual  but  continuous  process  of  extermination 
which  typhoid  fever  is  undergoing.  This  he  ascribes  to 
general  sanitary  improvements,  to  the  prevention 
of  outbreaks  arising  from  milk  supplies,  and  to  hospital 
isolation.  Diphtheria,  on  the  other  hand,  is  on  the 
increase,  an  increase  which  is  not  wholly  due  to 
improved  diagnosis.  While  it  is  a  disease  associated 
with  new  property  and  the  well  to  do  classes,  typhoid  is 
the  corresponding  disease  connected  with  old  houses 
and  the  poorer  districts.  Only  the  first  four  cases  of 
the  present  epidemic  of  small-pox  came  within  the 
scope  of  this  report ;  they  are  all  directly  traceable 
to  the  original  focus  at  the  Talla  waterworks,  and  the 
difficulty  in  dealing  with  them  is  due  to  the  class 
among  whom  they  occur — navvies  inhabiting  common 
lodging  houses.  Two  epidemics  of  scarlet  fever 
occurred,  one  in  February,  which  was  clearly  traced 
to  an  infected  dairy,  and  in  which  76  persons  took  the 
disease  within  four  weeks.  It  is  Sir  Henry  Littlejohn's 
experience  that  a  striking  feature  of  scarlet  fever 
outbreaks  caused  by  milk  is  the  large  number  of 
adults  affected  ;  when  this  occurs  suspicion  is  at  once 
directed  to  the  milk  supply.  In  the  second  outbreak 
no  cause  was  found  ;  it  was  probably  due  to  school 
infection.  The  whole  report,  which  is  replete  with 
statistical  material,  both  in  the  form  of  tables  and 
charts,  is  well  worthy  of  perusal  and  a  credit  to  the 
energetic  medical  officer  of  health,  whose  years  rest  so 
lightly  on  him. 

The  late  Dr.  William  Knox,  Edinburgh. — Dr. 
William  Knox,  who  died  on  May  4th,  in  his  91st  year, 
wras  a  lineal  descendant  of  the  Rev.  William  Knox, 
the  first  Prbtestant  minister  of  Cockpen,  and  a  brother 
of  the  great  reformer.  Dr.  Knox,  who  lived  a  some- 
what retired  life,  was  not  well  known  to  the  general 
community,  but  had  high  intellectual  gifts,  which  he 
retained  to  the  last.  His  likeness  to  the  best  authentic 
portraits  of  John  Knox,  both  as  regards  features  and 
beard,  was  very  striking. 

BELFAST. 
Medical  Golf  Match. — The  silver  challenge  cup 
recently  presented  to  the  Ulster  Medical  Society  by 
Professor  Lindsay,  to  be  competed  for  by  the  golfing 
members  of  the  Society,  has  been  won  by  Dr.  H. 
Bailie,  of  Belfast.  The  match,  which  excited  much 
interest,  was  played  at  the  links  of  the  Malone  Golf 
Club,  though  it  is  intended  to  play  on  different  links 
each  year.  The  preliminary  competition  by  strokes 
resulted  in  the  survival  of  eight  gentlemen,  whose 
scores  were  as  follows : — Dr.  Thomas  Houston, 
97—24,  73;  Dr.  J.  E.  White,  88—12,  76;  Dr.  W. 
Monypeny,  90 — 22,  77  ;  Dr.  H.  Bailie,  88 — 10,  78  ; 
Mr.  Robert  Campbell,  102 — 24,  78  ;  Dr.  J.  E.  Mac- 
llwaine,     102 — 22,     80;     Professor    Lorraine    Smith, 


100 — 20,  80;  Dr.  Gardner  Robb,  97 — 16,  81.  In  the 
next  round  Macllwaine  beat  Campbell,  Lorraine 
Smith  beat  Robb,  White  beat  Monypeny  (absent), 
and  Bailie  beat  Houston.  In  the  tie  semi-final  Mac- 
llwaine beat  Lorraine  Smith,  and  Bailie  beat  White, 
and  in  the  final  Bailie  beat  Macllwaine  by  four  up  and 
two  to  play. 


Correspondence- 


I      [We  do  not  hold  ourse' ves  responsible  for  the  opinion  of  our  correa- 
pondenti  ] 


PALMAM  QUI  ,MERUIT   FERAT.— 
A    PROTEST. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — It  appears  to  me  that  very  few  words  will 
suffice  to  dispose  of  "Ignoramus" — my  old  "friend 
the  enemy." 

He  says,  "  Lister  perceived  that  to  prevent  septic 
processes  in  wounds,  it  would  be  necessary  to  destroy 
the  germs  of  putrefaction  and  fermentation  in  wounds, 
and  to  prevent  their  entry."  I  commend  to  him  the 
perusal  of  Lister's  addresses  at  Berlin  and  Liverpool. 
In  the  former  Lister  confessed  his  shame  at  having 
invented  the  spray ;  he  showed  how  it  could  not  possibly 
have  had  the  effect  he  had  intended,  and  stated  that 
the  "  germs  in  the  atmosphere  might  be  totally  dis- 
regarded." At  Liverpool  he  further  explained 
himself  by  saying  that  it  was  the  grosser  forms  of 
septic  mischief  rather  than  microbes  in  the  attenuated 
condition  in  which  they  existed  in  the  atmosphere 
that  we  had  to  dread  in  surgical  practice.  Has 
"  Ignoramus,"  like  Rip  van  Winkle,  been  asleep  all 
these  years  ? 

' '  Ignoramus ' '  cavils  at  my  statistics.  Perhaps  it  may 
interest  him,  with  his  peculiar  views  as  to  "  septically 
polluted  atmospheres,"  to  know  that  during  the  three 
and  a  half  years  in  which  I  was  doing  those  ninety 
operations,  the  mortality  on  the  antiseptic  side  of 
the  hospital  was  very  considerable. 

"  Ignoramus'  "  memory  does  play  him  false  when  he 
attributes  to  me  the  denial  of  the  existence  of  "  germs  " 
(synonymous  with  microbes,  bacilli,  bacteria,  cocci). 
The  difference  between  us  is  that  I  put  a  totally  different 
construction  on  their  effects  from  his. 

His  view  of  what  is  scientific  is  represented  by  the 
celebrated  definition  of  orthodoxy  and  heterodoxy. 
Is  it  scientific  (how  this  word  is  misapplied  !)  to  say 
that  germs  produce  disease,  but  antiscientific  to  say 
that  they  are  the  product  of  disease  ?  (What  a  dif- 
ference the  substitution  of  one  letter  of  the  alphabet 
produces  !) 

"  Ignoramus "  will  find  it  difficult  to  establish  his 
position. 

I  am,  Sir,  yours  truly, 

Geo.  Granville  Baktock. 

April  29th,  1904. 

[This  letter  was  held  over  last  week  through 
pressure   on    space. — Ed.] 


THE  VALUE  OF  ETHYL  CHLORIDE  IN 
DISLOCATIONS. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — Might  I  be  allowed  to  correct  a  mistake  your 
correspondent  has  made  in  his  synopsis  of  my  paper  on 
"  Ethyl  Chloride,"  read  before  a  meeting  of  the  Ulster 
Medical  Society,  and  published  on  pages  473-4  of  The 
Medical  Press  and  Circular,  of  May  4th?  He 
has  stated  (or  perhaps  it  was  a  printer's  error)  that  I 
had  used  this  anaesthetic  three  times  for  reducing  a 
dislocated  shoulder,  each  time  unsuccessfully.  As  a 
matter  of  fact,  I  had  marked  success  in  the  three  cases. 
The  men  were  aged  respectively  54,  58,  and  28,  and  I 
noted  in  my  paper  that  it  was  worthy  of  report  that 
in  the  youngest  man  an  unsuccessful  attempt  had  been 
made  to  reduce  the  dislocation  under  nitrous  oxide 
the  evening  before  I  gave  ethyl  chloride.  I  have 
found  that  relaxation  of  the  muscles  is  frequent  in 
adults,  but  that  muscular  spasm  results  sometimes 


May  18,  1904. 


LITERATURE. 


The  Medical  Press.     543 


even  when  the  anaesthetic  is  pushed  till  corneal  reflex 
is  abolished. 
Thanking  you  for  publishing  a  synopsis  of  my  paper, 
I  am,  Sir,  yours  truly, 

Victor  G.  L.  Fielden. 
Belfast,  May  12  th,  1904. 


VERMIN  IN  CHILDREN'S  HEADS. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — In  your  issue  of  this  morning  you  have  a 
note  on  vermin  in  children's  heads.  In  it  you  say 
"  a  periodical  survey  of  the  heads  should  be  made  by 
a  medical  officer."  It  may  interest  you  to  know  that 
some  years  ago  I  wrote  to  the  School  Board  Journal, 
and  made  the  same  suggestion.  The  answer  I  received 
was  that  it  would  be  too  great  an  interference  with 
the  Kberty  of  the  subject.  I  trust  you  may  succeed 
where  I  failed,  and  get  this  disgrace  and  danger  looked 
after. 

I  am,  Sir,  yours  truly, 

V.  R.  H.  Stewart, 
Aural  Surgeon,  Great  Northern  Central  Hospital. 
42  Devonshire  Street,  Portland  Place,  W. 
May  nth,  1904. 

$bitnar£. 

DR.  WILLIAM  O'NEILL. 
We  regret  to  announce  the  death  of  Dr.  William 
O'Neill,  of  Mitchelstown,  co.  Cork,  at  the  patriarchal 
age  of  ninety  years.  He  belonged  to  a  family  of 
physicians,  and  his  earliest  experience  of  medical 
practice  was  acquired  in  the  dreadful  epidemic  of 
typhus  and  famine  fevers  that  followed  on  the  failure 
of  the  potato  crop  in  the  forties.  Having  obtained 
the  degree  of  M.D.  of  the  Edinburgh  University  in 
1842,  he  then  went  for  a  couple  of  sessions  to  walk 
the  Paris  hospitals,  and  enjoyed  the  benefits  of  the 
clinical  teaching  of  Louis  and  Dupuytren.  On  his 
return  to  Ireland,  he  found  himself,  under  the  care  of 
his  father.  Dr.  Eugene  O'Neill,  introduced  to  practice — 
fever  practice  in  the  cabins  of  the  dense  population 
of  the  neighbourhood,  where  the  remaining  years  of  his 
long  life  were  to  be  spent.  When  the  Poor  law  system 
was  introduced  his  was  one  of  the  earliest  appoint- 
ments, and  for  many  years  he  was  a  dispensary  medical 
officer  of  the  Mitchelstown  district,  and  afterwards 
medical  officer  of  the  workhouse.  He  resigned  this 
latter  appointment  on  the  Jubilee  anniversary  of  his 
entrance  into  the  medical  profession,  some  twelve  years 
ago.  And  it  may  be  said  with  confidence  that  during 
his  medical  career,  extending  over  three  score  odd  years, 
his  conduct  reflected  credit  on  himself  and  upheld  the 
honourable  traditions  of  the  ancient  family  to  which  he 
belonged. 


MR.  ADRIAN  HOPE. 
We  regret  to  announce  the  death  of  Mr.  Adrian 
Hope,  which  occurred  on  the  12th  inst.  at  St.  Thomas's 
Hospital,  after  an  operation  for  appendicitis.  A  son 
of  the  late  Colonel  W.  Hope,  V.C.,  he  entered  the  Bank 
of  England,  but  ill-health  necessitated  his  leaving,  and 
he  went  out  as  private  secretary  to  the  late  Sir  James 
Longden,  G.C.M.G.,  then  Governor  of  Ceylon.  Re- 
turning soon  afterwards,  he  accepted  the  secretaryship 
of  the  Hospital  for  Sick  Children,  Great  Ormond  Street. 
It  seems  difficult  to  realise  that  when  that  institution 
was  founded,  largely  by  the  efforts  of  the  late  Earl  of 
Shaftesbury,  in  185 1,  there  was  not  a  single  children's 
hospital,  not  in  London  alone,  but  in  all  Great  Britain. 
A  start  was  made  in  Great  Ormond  Street  with  twenty 
beds. 


RICHARD  SISLEY,  M.D.Lond.,  M.R.C.P. 
The   death   is  announced   of   Dr.    Richard   Sisley,  1 
M.D.,  of  Saunton  Braunton,  North  Devon,  formerly  j 
practising   in   London,   which   occurred  at   Florence,  I 
at  the  age  of  47.     Receiving  his  education  at   the  | 
medical  school  of  St.  George's  Hospital,  at  Guy's,  at 
University  College,  and  at  King's  College,  London,  he 
was  admitted  a  Licentiate  of  the  Royal  College  of 


Physicians,  London,  and  of  the  Society  of  Apothe- 
caries in  1880,  after  having  taken  honours  in  botany 
at  the  University  of  London  in  1876,  and  in  organic 
chemistry  in  1879.  In  1882  he  was  house  physician 
at  St.  George's  Hospital ;  in  1883  took  honours  in- 
medicine  at  the  London  University,  graduating  M.B.  ; 
and  the  following  year  was  admitted  a  member  of  the 
Royal  College  of  Physicians,  London.     From  1885  till 

1887  h^  was  curator  of  the  museum  at  St.  George's- 
Hospital,  and,  taking  his  M.D.  degree  in  1888,  from 

1888  till  1890  medical  registrar.  He  received  the 
M.D.  degree  in  State  medicine  in  1892.  Dr.  Sisley, 
who  was  a  member  of  the  Medical  and  Epidemiological 
Societies,  was  the  author  of  several  works  on  epidemic 
influenza. 


,  WILLIAM  KNOX,  M.D.Edin.,  L.R.C.S. 
Dr.  William  Knox,  who  died  on  the  4th  inst.,  was 
a  lineal  descendant  of  the  Rev.  William  Knox,  the 
first  Protestant  minister  of  Cockpen,  and  a  brother  of 
the  great  reformer.  His  father  was  Major  Knox,  of 
the  Koyal  Artillery,  who  died  many  vears  ago,  while 
stationed  at  Leith  Fort.  Born  on  February  3rd,  18 14, 
the  deceased  doctor  had  attained  the  age  of  ninety 
years  and  three  months.  Living  a  somewhat  retired! 
life,  he  was  not  well  known  to  the  general  community, 
but  he  had  strong  mental  powers,  which  he  retained  to» 
the  last.  His  likeness  to  the  reformer,  as  shown  by 
the  best  known  portrait,  both  as  regards  features  and 
beard,  was  very  striking.  Dr.  Knox  graduated  M.D. 
of  Edinburgh  University  in  1839,  and  became  L.R.C.S. 
Edin.  in  1842. 


MR.  P.  J.  HAYES,  M.D.R.U.I.,  F.R.C  S.E. 
We  much  regret  to  record  the  death  of  Mr.  P.  J. 
Hayes,  a  former  surgeon  to  the  Mater  Misericordiae- 
Hospital  in  Dublin,  which  occurred  at  his  residen  e  at 
Blackrock  during  the  past  week.  Mr.  Hayes  had 
a  long  and  distinguished  career.  In  1859  he  obtained 
the  licence  of  the  Royal  College  of  Surgeons  in  Ireland, 
and  in  i860  the  licence  of  the  Royal  College  of  Phy- 
sicians of  Edinburgh.  In  1879  he  was  made  a  Fellow 
of  the  Edinburgh  College  of  Surgeons,  and  in  1885  he 
became  an  M.D.  and  an  honorary  M.Ch.  of  the  Royal 
University  of  Ireland.  Mr.  Hayes  had  held  many 
appointments,  chief  amongst  which  were  the  Consulting 
Surgeoncy  to  St.  Michael's  Hospital,  Kingstown,  and 
to  St.  Joseph's  Hospital  for  Sick  Children ;  Visiting 
Surgeon  to  St.  Patrick's  College,  Maynooth;  Senior 
Surgeon  to  the  Mater  Misericordiae  Hospital ;  Fellow 
and  Examiner  in  Surgery  to  the  Royal  University  of 
Ireland ;  and  Professor  of  Surgery  in  the  Medical  School 
of  the  Catholic  University  School  of  Medicine.  His 
contributions  to  medical  literature  were  mostly  made 
in  the  form  of  articles  in  the  medical  press,  and  were 
numerous  and  important.  A  couple  of  years  ago  Mr. 
Hayes'  health  commenced  to  break  down,  and  to  the 
extreme  regret  of  a  large  circle  of  friends  he  was- 
obliged  to  relinquish  his  different  appointments.  A 
short  time  afterwards  he  gave  up  his  residence  in» 
Men-ion  Square  and  retired  from  practice. 

literature* 


CROCKER  OF  DISEASES  ON  THE  SKIN,  (a) 
The  appearance  of  a  third  edition  of  Crocker's  well- 
known  treatise  marks  an  era  in  the  progress  of  British 
dermatology.  During  the  present  generation,  espe- 
cially during  its  latter  half,  the  study  of  diseases  of  the 
skin  has  undergone  an  immense  development.  The 
great  principle  of  asepsis  and  the  discoveries  of  bac- 
teriology have  profoundly  influenced  the  attitude  of 
the  modern  worker  in  the  field  of  therapeutic  derma- 
tology. The  author  presented  to  his  readers  a  faithful 
picture  of  a  subject  that,  in  spite  of  vast  progress,  still 
lacks  the  generalisations  that  must  one  day  come  to 
lighten    the    pathway    of    the    learner.       With    that 

(«)  "  Diseases  of  the  Skin  :  their  Description. Pathology,  Diagnosis 
2!?d  T*e**ment"  By  **•  **dcliffe  Crocker.  M.D.Lond..  P.B.C.P. 
Third  Edition.  In  2  vols.,  large  8vo,  price  28s.  net.  London  :  H.  K~ 
Lewis. 


544     Th«  Medical  PRESS. 


MEDICAL    NEWS. 


Mat  i  8,  1904. 


reservation  in  view,  the  student  will  find  in  this  book 
perhaps  the  most  trustworthy  guide  in   the  English 
language   to   the  complex  subject  of  diseases  of  the 
skin.     Under    the     heading    of     "  Treatment  "     the 
Rdntgen  rays  are  mentioned  as  being  useful  in  lupus, 
epithelioma,  coccygenic  sycosis,  and  in  epilation  ;  but 
we  venture  to  think  that  the  list  given  does  not  do 
justice  to  the  efficacy  of  this  new  agent  in  many  chronic 
skin  affections.     Then,  again,  the  "  high  frequency  " 
electrical   current  is  discussed   in   a   few   lines.     The 
success  claimed  by  various  observers  for  the  value  of 
this  form  of  treatment  by  Freund,  d 'Arson val,  and 
Oudiil,  in  eczema,   psoriasis,   tertiary  syphilides,   and 
various  ulcerations,  suggests  that  a  powerful  thera- 
peutic agency  has  been  thereby  placed  in  our  hands. 
The  author,  however,  has  omitted  little  that  is  essen- 
tial in  his  comprehensive  account  of  modern  methods, 
and  has  been  careful  in  most  instances  to  give  the  name 
of  the  inventor  or  discoverer  of  any   special  agency. 
The  classification  of  skin  diseases  has  always  been  the 
despair  of  dermatologists,  and  it  is  possible  to  hope  for 
a  really  scientific  solution  of  that  difficult  problem  in 
a  future  when  scientific  workers  have  penetrated  the 
many  obscurities  of  etiology  and  of  pathology  with 
which  they  are  at  present  confronted.     Dr.   Croker 
accepts  the  position  and  adopts  the  system  of  Hebra, 
which  applies  the  general  principles  of  pathology  to 
skin  diseases,   and   makes  a  convenient  if  arbitrary 
division   of    the   subject    into    nine    classes,    namely, 
(1 )  disorders  of  secretion  ;   (2)  hyperemias  ;   (3)  exuda- 
tions ;     (4)    haemorrhages  ;     (5)    hypertrophies ;     (6) 
atrophies  ;    (7)  new  growths  ;    (8)  neuroses  ;  (9)  para- 
sites.    There  is  no  need  to  cavil  at  this  classification, 
or  to  point  out  that  symptomatically  a  single  malady 
might  with  more  or  less  justice  be  placed  under  various 
of    the    foregoing    subdivisions.     Take    the    rash   of 
small-pox,    which   is   a   specific   inflammatory    lesion 
dependent    on    some    unknown    factor,    probably     a 
specific  pathogenic  organism.     In  a  scientific  classi- 
fication  the  place  of  small-pox  would  probably  fall 
under  that  ot  specific  bacterial  infections.    As  etiology 
advances    the   value   of   symptomatic   manifestations 
decreases.     The     scabies     parasite     causes     papules, 
vesicles,  pustules,  and  sometimes  scars,  results  that  tally 
with  those  of  small-pox.     It  is  not  unreasonable  to 
imagine  that  the  ultimate  cause  of  small-pox  may  be 
just  as  definite  as  that  of  scabies.     In  some  future 
edition  of  Dr.  Crocker's  book  it  is  not  impossible  that 
some  generalising  mind,  either  his  own  or  that  of  some 
fellow-worker,  will  enable  him  to  set  forth  the  long- 
sought    plan    of   a    full    and    adequate    classification. 
Some  day,  in  other  words,  dermatologists  will  be  able 
to  see  the  wood  instead  of  the  leaves,  and  will  desert 
the  old  tradition  that  scientific  dermatology  consists 
in  the  minute  description  and  differentiation  of  morbid 
conditions  of  the  skin.     For  the  descriptive  part  of  the 
book  we   have  nothing   but  praise.     Some  excellent 
coloured  plates  have  been    added,    and    among    the 
other  new  illustrations  is  an  extremely  good  and  clear 
picture  of   the  various    forms    of    ringworm    fungus. 
We  find  no  mention,  by  the  way,  of  calcium  chloride 
in  the  treatment  of  pruritus.     The  remedy  has  been 
so  much  vaunted  that  one  would  liave  expected  a  note 
upon  its  action,  real  or  alleged.    n  his  book  is  valuable 
as  a  reference  to  all   medical  practitioners,  as  it  is,  of 
course,  essential  to  all  who  make  a   special  ttudy  of 
diseases  of  the  skin. 

DIVINE  HYGIENE,  (a) 
This  ponderous  work  bears  testimony  to  remarkable 
industry  and  much  painstaking  research.  It  is  truly 
monumental,  and  as  a  work  of  reference  will  doubtless 
prove  of  considerable  service.  Many  minds  will 
probably  find  a  peculiar  attractiveness  in  the  study 
of  these  pages.  But,  judged  from  the  standpoint 
of  the  modern  scientist  and  considered  in  the  light 
of  recent  Biblical  research  and  medical  investigation, 


Dr.  Rattray's  volumes  can  scarcely  claim  a  right  to 
serious  consideration. 

The  title,  we  fear,  must  be  considered  unfortunate, 
but  it  aptly  expresses  the  attitude  of  the  author.  Dr. 
Rattray  would  seem  to  be  a  true  believer  in  the  verbal 
inspiration  of  the  Scriptures,  and  seems  to  consider 
the  medico-hygienic  matters  presented  in  the  Bible  as 
"  given  in  the  very  words  of  Jehovah."  Serious  con- 
troversy with  an  author  who  adopts  this  view,  is  of 
course,  impossible.  But  while  the  author's  material 
is  wearisome  in  its  abundance,  and  his  manner  of 
exposition  peculiarly  irritating  to  a  mind  trained  in  the 
science  of  logic  and  cognisant  of  the  results  of  modem 
hygienic  study,  much  of  his  material  is  rich  in  sug- 
gestiveness,  and  his  descriptions  of  Israeli  tic  hygiene 
and  sanitation  of  the  Mosaic  code  full  of  interest.  We 
commend  these  volumes  to  the  study  of  patient,  un- 
prejudiced physicians,  who  need  a  pastime  for  duty  less 
days.  The  ordinary  practitioner  busy  with  the 
material  interests  of  his  mundane  life  will,  we  fear, 
find  but  little  direction  for  a  sanitation  fitted  for  to-day 
in  these  remarkable  volumes. 


INFECTION  AND  IMMUNITY,  (a) 
This  excellent  work  is  one  of  the  latest  additions  to 
the  valuable  "  Progressive  Science  Series,"  edited  b\ 
Mr.  F.  E.  Beddard  and  Professor  J.  McK.  Cattell.  Dr. 
Sternberg  has  addressed  himself  to  non-medical  readers, 
but  we  have  no  hesitation  in  saying  that  the  book  will 
be  of  much  service  to  many  busy  practitioners  desirous 
of  keeping  abreast  with  the  results  of  modern  methods 
of  research.  As  far  as  possible,  technical  terms  are 
avoided,  but  the  chief  points  connected  with  infection 
and  immunity  are  succinctly  but  accurately  presented. 
Discussion  of  theories  has  been  wisely  avoided,  and 
very  judiciously  no  attempt  is  made  to  give  an  account 
of  the  results  of  recent  investigations  with  reference  t . 
"antitoxins,"  "  agglutinens,"  "precipitens,"  "  bac- 
teriolysms,"  and  the  like,  and,  as  we  quite  agree 
Ehriich's  "  side-chain  theory  "  does  not  "  seem  suitable 
for  popular  treatment."  In  the  second  part  of  the 
work  descriptions  of  the  more  important  infectious 
diseases  are  given.  Much  historical  matter  of  con- 
siderable interest  is  presented,  and,  as  might  be  ex- 
pected, statistical  returns  of  the  United  States  are 
largely  quoted.  It  would  have  been  well  if  Dr.  Stem- 
berg  had  associated  himself  with  an  English  editor 
who  could  have  incorporated  facts  and  figures  repre- 
senting British  experience.  The  work  has  been  well 
planned  and  excellently  executed,  and  may  be  com- 
mended to  the  careful  consideration  of  both  laymen  and 
medicals. 


ADeMcal  Hews- 


(a)  "  Divine  Hygiene :  or  the  Sanitary  Science  and  Sanitation  of 
tbe  Sacred  Scriptures  and  Mosaic  Code." 
M.D.Ed  in.    With  Map  and  Plans.     la  two 
viii-748     London :  James  Nisbet  &  Co.,  Ltd. 


science  ana  oaniui«uu  ui 
By  Alexander  Rattray. 
»  volumes;  pp.  xvi-665aud 
d.    1903.    Price  32s. 


Medico-Psychological  Association  of  Groat  Britain  and 
Ireland. 

The  next  general  or  quarterly  meeting  of  the  Medico- 
Psychological  Association  of  Great  Britain  and  Ireland 
will  be  held  in  London  to-day  (Wednesday),  under  the 
presidency  of  Dr.  Ernest  W.  White,  at  the  Langham 
Hotel,  at  4  p.m.  The  following  papers  will  be  read  :— 
"  Quantitative  and  Qualitative  Leucocyte  Observa- 
tions in  Various  Forms  of  Insanity,"  by  Dr.  Lewis 
C.  Bruce,  Physician  Superintendent,  and  Dr.  A.  E.  M. 
Peebles,  Assistant  Physician,  Perth  District  Asylum, 
Murthly  ;  "  A  Statistical  Note  on  the  Social  Causes  of 
Alcoholism,"  by  Dr.  W.  C.  Sullivan  ;  "  The  Psychology 
of  Hallucinations,  with  diagrammatic  illustrations;' 
by  Dr.  W.  H.  B.  Stoddart ;  "  Notes  of  a  Case  of  Com- 
bined Spinal  Degeneration  with  Unusual  Mental 
Symptoms  with  microscopical  sections  of  the  cord," 
by  Dr.  J.  Kennedy  WiU.  The  members  will  afterwards 
dine  together  at  6.30  p.m.  at  the  Cafe  Monico. 

(a)  ••  Infec  ion  and  Immunity,  with  Special  Reference  t*>  the 
Prevention  of  Infectious  Diseases."  By  George  M.  tttsnbenr,  M.Jin 
LL.D.,  Surgeon-General  U.S.  Army  (Retired).  Pp.  193,  and  IS  fig* 
London:    John  Murray     1903.    Price6s.net. 


May   i  8,  1904. 


PASS  LISTS. 


The  Medical  Press.    545 


The  Plague. 
The  plague  returns  from  Johannesburg  up  to  May 
14th  show  that  11  .whites  and  77  coloured  persons 
have  died  of  the  disease,  and  that  24  whites  and  114 
coloured  persons  have  either  been  proved  or  have  been 
suspected  to  be  suffering  from  plague.  The  following 
telegram  from  the  Officer  Administering  the  Govern- 
ment of  Mauritius  has  been  received  at  the  Colonial 
Office  : — "  No  case  of  plague  for  the  week  ending 
May  1 2th." 

The  Boyal  University  of  Ireland. 

At  the  examinations  in  the  Faculty  of  Medicine, 
Spring,  1904,  the  following  exhibitions  and  honours 
have  been  awarded  by  the  Senate  at  the  undermen- 
tioned examinations  respectively; — 

The  Second  Examination  in  Medicine.  Exhibition — 
First  Class,  £25. — James  B.  Butler.  Second  Class. — 
James  A.  Shorten. 

Honours — First  Class. — James  B.  Butler.  Second 
Class. — James  A.  Shorten. 

Upper  Pass.^- John  A.  Black,  Cecil  R.  Crymble, 
Charles  H.  Harbinson,  John  F.  Neary,  James  J. 
O'Neill,  Maria  Rowan. 

The  Third  Examination  in  Medicine.  Exhibition — 
First  Class,  £30.— William  A.  M'Kee,  B.A. 

Honours— First  C/ass.— William  A.  M'Kee,  B.A., 
Second  Class. — None. 

Upper  Pass. — John  L.  Dunlop,  Maurice  P.  Scanlon. 

The  M.B.,  B.Ch.,  B.A.O.  Degrees  Examination. 
Exhibitions — First  Class,  £40. — William  M.  Crofton, 
B.A.     Second  Class,  £25. — Thomas  Lyle. 

Honours.— First  Class.— Wm.  M.  Crofton,  B.A., 
Thos.  Lyle.     Second  Class. — None. 

Upper  Pass.  —  Ernest  Clements,  Percival  T. 
Crymble,  Hugh  P.  Devlin,  Marie  E.  Hayes,  Richard 
G.  Meredith,  Samuel  Stockman. 

The  Senate  of  the  University  met  on  Thursday 
last.  May  12th,  when  the  Secretaries  reported  the 
death  of  George  Johnston  Allman,  LL.D.,  D.Sc, 
F.R.S.  The  following  resolution  was  then  passed 
unanimously  : — "  The  Senate  desire  to  express  their 
deep  regret  at  the  death  of  Dr.  Allman,  who  has  been 
a  member  of  their  body  from  the  foundation  of  the 
University ;  and  they  wish  to  place  on  record  then- 
sense  of  the  great  benefits  which  the  University  has 
derived  from  Dr.  Allman' s  scientific  attainments  and 
wide  educational  experience,  his  strict  integrity  and 
his^devotion  to  the  interests  of  the  University  for  so 
many  years." 

The  reports  of  the  examiners  upon  the  recent  spring 
medical  examinations  were  considered  and  honours 
and  exhibitions  awarded. 

It  was  resolved  that  the  degree  of  D.Sc.  be  conferred 
Honoris    Causd    upon    Sir    William    Crookes,    F.R.S. , 
and  upon  Professor  James  Dewar,  F.R.S. 
Hospital  Sunday  Fund. 

On  May  10th  a  meeting  of  the  Council  of  the  Hospital 
Sunday  Fund  was  held  at  the  Mansion  House,  under 
the  presidency  of  the  Lord  Mayor.  A  letter  was 
read  from  Mr.  George  Herring,  of  Hamilton  Place, 
Piccadilly,  stating  that  he  was  willing,  as  on  previous 
occasions,  to  give  either  £10,000  to  the  fund  or  to 
add  one  quarter  to  the  amount  collected  in  places  of 
worship  on  June  12th,  limiting  this  to  a  collection  not 
exceeding  £100,000.  He  made  that  offer,  as  he  feared 
that  the  demands  of  the. charitable  for  building,  &c, 
might  deprive  many  deserving  hospitals  of  part  of  their 
present  income  and  so  compel  the  closing  of  some  of  the 
wards.  Sir  Edmund  Currie  stated  that  Mr.  Herring 
in  the  past  five  years  had  contributed  in  all  £53.000 
towards  the  fund,  namely,  £10,000  a  year  for  three 
years,  and  subsequently  sums  of  £11,000  and  £12,000, 
representing  a  quarter  of  the  amounts  collected  in 
churches  and  chapels  on  Hospital  Sunday.  Prebendary 
Ridgeway  proposed  a  cordial  vote  of  thanks  to  Mr. 
Herring,  and  the  Council  accepted  his  proposition  to 
add  one  quarter  to  the  collections  in  places  of  worship. 

The  fifty-fifth  annual  meeting  of  the  American 
Medical  Association  will  be  held  in  Atlantic  City,  New 
Jersey,  on  June  7th,  8th,  9th,  and  10th. 


The  Chemittt  Exhibition. 

The  tenth  annual  exhibition  organised  by  our 
energetic  contemporary  the  British  and  Colonial 
Druggist,  was  held  at  Argyll  Street,  London,  from 
Monday  to  Friday  last  week.  The  "  show "  was 
more  than  usually  successful,  and  was  crowded  daily. 
A  diagnostic  (electric)  lamp  was  shown  by  Messrs. 
Christy.  The  new  elements,  radium,  polonium  and 
thorium,  were  shown  by  Mr.  Martindale,  the  emanation 
of  which  is  being  tried,  on  the  recommendation  of 
Mr.  F.  Soddy,  as  a  cure  for  phthisis.  A  recent  an- 
aesthetic, somnoform,  was  shown  by  Messrs.  de 
Trey  and  Co.  ;  and  a  powerful  germicide  for  internal 
use,  acetozone,  by  Messrs.  Parke.  Davis,  and  Co. 
Some  additions,  among  them  "  r6nine."  are  made  to 
the  sale  of  medicinal  waters,  and  much  is  claimed  for 
the  new  Anturic-bath  salts,  for  the  cure  or  ameliora- 
tion of  gout.  A  striking  attraction  of  the  Photo- 
graphic Section  was  the  exhibit  of  Messrs.  Johnson 
and  Sons— crystals  of  chloride  of  gold  weighing  620 
ounces  and  worth  £1,305,  and  crystallised  nitrate  of 
silver  valued  at  £34.  The  editor  and  the  staff  of  the 
British  and  Colonial  Druggist  may  be  congratulated 
on  the  brilliant  success  of  their  tenth  public  appear- 
.aacn 

Registration  of  Vnnee  in  America. 

A  Bill. for  the  registration  of  trained  nurses,  with 
the  title  of  "  R.N.,"  has  been  introduced  into  the 
State  Legislature  of  Maryland. 

Pasteurism  in  the  United  States. 

The  Pasteur  method  for  the  treatment  of  persons 
bitten  by  dogs  has  been  recently  err  ployed  for  the 
first  time  in  the  State  of  Philadelphia. 

The  BeUevue  Hospital,  Hew  Tork 

This  institution,  we  learn,  is  to  be  rebuilt  by  the 
City  on  a  magnificent  scale.  It  is  estimated  that  the 
total  cost  may  amount  to  no  less  than  £2,800,000. 
When  finished  it  will  accommodate  2.500  patients, 
and  quarters  will  be  provided  for  more  than  100 
resident  physicians  and  surgeons. 

PASS  LISTS. 
University  of  Durham. 

Degrees  in  Medicine  and  Surgery  were  conferred 
on  the  .following  candidates  who  had  previously  passed 
the  various  examinations  : — 

Doctor  in  Medicine. — Charles  Fisher,  M.B.,  B.S., 
Durh..  Robert  Bond  Greaves,  M.B.,  B.S.,  Durh.. 
Laurence  McNabb,  M.B.,  B.S.,  B.Hy.,  D.P.H.,  Durh., 
Maurice  Frederick  Squire,  M.B.,  B.S.,  Durh.,  Mar- 
maduke  Cordeux  Wetherell,  M.B.,  B.S.,  Durh. 

Doctor  in  Medicine  for  Practitioners  of  Fifteen 
Years'  Standing.  —  John  Bradford,  L.R.C.P.E. 
L.F.P.S.G.,  Myer  Akiba  Dutch,  L.R.C.S.I.  L.K.Q.C.P.I., 
D.P.H..  George  Belben  Flux,  M.R.C.S.,  L.R.C.P., 
Harold  Hendley,  M.R.C.S.,  L.R.C.P.,  L.S.A.,  Alfred 
Hooper,  M.R.C.S.,  L.S.A..  Alan  Rigden  M.R.C.S., 
L.R.C.P.,  William  Swanson  Sprent,  L.R.C.S.I. 
L.K.Q.C.P.I. 

Bachelor  in  Medicine  (M.B.). — Thomas  Engelhart 
Amyot,  Robert  Story  Brown,  Herbert  Christal, 
Edgar  Fletcher  Edmunds,  Arthur  Henry  Fullerton, 
William  Gibbons,  Albert  James  Gilbertson,  Walter 
Haward,  W.  G.  T.  Hepplewhite,  Leonard  Mont- 
gomery Markham,  L.D.S.,  William  John  Phillips, 
B.Sc.,  Mary  Raw,  Frederick  William  Ritson,  Constance 
Charlotte  Robertson,  John  Malcolm  Shaw,  Fred 
Stoker,  Otho  Boyle  Travers,  William  Frank  Wilson, 
Hermann  Wolfe. 

Bachelor  in  Surgery  (B.S.). — Thomas  Engelhart 
Amyot,  Robert  Story  Brown,  Herbert  Christal,  Edgar 
Fletcher  Edmunds,  William  Gibbons,  Albert  James 
Gilbertson,  Chella  Mary  Hankin,  M.B.,  Walter  Haward, 
W.  G.  T.  Hepplewhite,  Leonard  Montgomery  Markham, 
L.D.S.,  William  John  Phillips,  B.Sc,  Mary  Raw, 
Frederick  William  Ritson,  Constance  Charlotte  Robert- 
son, John  Malcolm  Shaw,  Fred  Stoker,  Otho  Boyle 
Travers,  William  Frank  Wilson,  Hermann  Wolfe. 

Bachelor  in  Hygiene  (B.Hy.). — William  Edwin 
Peacock,  M.D.,  B.S.,  D.P.H.  Durh.,  Robert  Stobo, 
M.B.,  CM.  Glasg. 


546    Tm»  Medical  Peess.       NOTICES  TO  CORRESPONDENTS. 


Mat  18,  1904 


Jtoticts  to 
(kBtttzporibtnte,  &hatt  $etta«,  &t 

|»9*  OoBJtBsroNDBKTS  requiring  a  reply  in  this  column  are  particu- 
larly requested  to  make  use  of  a  distinctive  Signature  or  initial,  and 
a  void  the  practice  of  signing  themselves  "Reader,"  "Subscriber/ 
"  Old  Subscriber,"  Ac-  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

Original  Aeticlss  or  Lottos  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

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

Reprints.— Reprints  of  articles  appearing  In  this  journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.    This  should  be  done 
when  returning  proofs, 
wn     *""*"""*  kthe  DOCTOR'S  TELEPHONE. 

The  following  impromptu  is  sent  us  as  a  souvenir  of  the  recent 
dinnerof  Old  Corkoniansk  London: 

'Tie  the  ring  of  the  telephone  bell. 

The  doctor  he  knows  it  well  ! 

They  say  •*  'Tis  laid  on  in , 

To  signal  each  funeral  knell." 

'Tis  the  ring  of  the  telephone  bell, 
Borne  horrible  news  to  tell, 
And  he  has  had  many  a  sell 
By  a  call  from  a  telephone  bell. 


Tis  the  ring  of  the  telephone  bell, 
Helter-skelter,  pell-mell ! 
Was  ever  a  sound  so  fell 
As  the  tinkle  of  telephone  bell? 


H.  M.  J. 


Scotus.— The  idea  of  treating  acute  rheumatism  by  salicin  first 
occurred  to  tlie  late  Dr.  T.  J.  Maolagan  in  November,  1874.  His 
famous  paper  on  the  subject  was  published  in  the  Lancet,  March 
4th,  1876.  We  are  glad  to  see  that  the  appreciative  obituary  notice 
published  by  Tux  Medical  Press  and  Circular  has  been  quoted  by 
the  Editor  of  the  Nineteenth  Century  under  the  title  "  Dc.  Maclagan 
and  his  Great  Work  "  (see  May  number  of  the  present  vear).  Mac- 
lagan  was  one  of  our  great  men. 

Malta.— The  L.M.9.  of  Bombay  is  a  registrable  diploma  by  the 
English  General  Medical  Council.  The  American  University  degree 
mentioned  is,  however,  not  so  recognised. 

Hastings.— The  insect  bites  are  not  those  of  "  fleas,"  as  they  would 
not  be  found  in  the  open  near  the  sea  front.  They  are  probably  due 
to  some  species  of  ant. 

H.  Preston.— (1)  The  influenaa  bacilli  are  exceedingly  minute, 
sintrle  noncapsulated  rods.  They  stain  with  carbol  fuchshie  and  with 
carbol  methylene  blue,  but  not  by  Gram's  method.  (2)  Yes,  it  is  a 
rational  method  to  spray  the  nostrils  and  pharynx  with  an  antiseptic 


solution.  

Jfteetmjje  of  the  goodies,  hectares,  ■&*, 

Wednesday,  Mat  18th. 

British  Balvbolooical  and  Climatolooical  Socirtt  (SO  Hanover 
Square  W.).— 5  p.m.  General  Meeting.  Election  of  Officers  and 
Council  for  the  Year  commencing  October,  1904.  5.80  p.m.  Address  : 
—Sir  Dyce  Duckworth  :  Some  Observations  on  British  Winter 
Resorts.  7.30  p.m.  Annual  Dinner  at  the  Criterion  Restaurant, 
Piccadilly.  Followed  by  a  Smoking  Concert. 

Botal  Microscopical  Socirtt  (20  Hanover  Square,  W.).— 8  p  m. 
Exhibition  of  Flower  Seeds  under  Microscopes  :— Mr.  C.  Beck. 
Paper  :— Mr.  E.  M.  Nelson  :  Note  on  Grayson's  Rulings. 

Ambidbxtbal  Culture  Socibtt  (Medical  Society  Rooms,  11  Chan- 
doe  8treet,  Cavendish  Square,  W.).  5  p.m.  Paper  :— Dr.  J.  Shaw  : 
Ambidexterity  from  the  Medical  Point  of  View. 

Medical  Graduates'  Oollbom  and  Polyclinic  (22  Chenies  Street 
W  CA— 4  PJU.  Mr.  A.  H.  Tubby  :  Clinique.  (Surgical.)  5.15  pjn. 
Mr  W  Stuart-Low  :  Aural  Sepsis,  its  Pathology  and  Treatment. 

M*BDICO-P8YC110LOGICAL  ASSOCIATION  OF   GRXAT  Britain  and  Ire- 
land (Langham  Hotel).-4  p.m.  Quarterly  Meeting. 
Thursday,  Mat  19th. 

Medical  Graduates'  Collbob  and  Polyclinic  (22  Chenies  8treet, 
W  C  ).— 4  p.m.  Mr.  Hutchinson  :  Clinique.  (Surgical.)  5.15  p.m, 
Mr  H  L.  Barnard  ;  The  Principles  of  Abdominal  Diagnosis. 

Mount  Vkrnon  Hospital  for  Consumption  and  Diseases  op  tub 
Chbst     i7    Fltsroy    8quare,     W.).-5  P.m.     Dr.    J.    E.    Squire  : 
Differential  Diagnosis  of  Pulmonary  Lesions  (Illustrated  by  Cases). 
(Post-Graduate  Course.) 
v  Friday,  Mat  20th. 

Medical  Graduates'  Collbob  and  Polyclinic  (22  Chenies  Street, 
W  C  )  — 4  P.m.    Mr.  P.  R.  W.  de  Santi :  Clinique.   (Ear.) 
"'  Saturday  May  218T. 

Otolooical  Sochcty  of  thb  United  KINGDOM  (Glasgow  Uni- 
versity). —10.30  a.m.  Meeting. 

Bradford  Rjyal  Infirmary.— Dispensary  Surgeon.  8alary  £100  per 
annum,  with  board  and  residence.  Applications  to  William 
Maw,  Secretary. 


Ebbw  Yale  Workmen's  Medical  Fund.— Assistant  Medical  Officer  at 

Beaufort,  and     Assistant  Medical  Officer  at  Victoria.    Salary 

£200  per  annum.    Applications  to  Dr.  Keith  Campbell,    Tfce 

Lyncombes.  Ebbw  Vale. 
Finchley  Urban  District.— Medical  Officer  of  Health.     Sa'ary  £20O 

per  annum.    Applications  to  E.  H.  Lister,  Clerk  to  the  Council* 

Council  Offices,  Church  End.  Finchley. 
Glasgow   Parish  Council.— Medical  lOfficer,   BamhUl  Poor   House, 

Storing-burn.    Salary  £250  per  annum,  rising  ultimately  to  £350, 

with  board  and  lodging.    Applications  to    Jas.    R     Motion, 

Inspector    and  C  erk,  Parish  Council  Chambers,  286    George 

Street,  Glasxow. 
Lanark  County  Council.— Assistant  Medical  Officer  of  Health.  8alary 

£140   per    annum,    with    travelling  expenses.     Applications 

to  the  County  Medical  Officer,  Hamilton,  N.B . 
The  Leeds  Public  Dispensary.— Junior  Resident   Medical  Officer 

Salary  £100  per  annum,  with  board  and  lodging.    Applications. 

immediately  to  the  Secretary  of  the  Faculty,  PubKc  Dispensary, 

North  Street,  Leeds. 
Royal  College  of  Surgeons  of  England.— Election  of  Professors  and 

Lecturers.    Applications  to  S.  Forrest  CowelL  Secretary. 
South'   Devon    and  East   Cornwall  Hospital,    Plymouth.— House 

Surgeon.    Salary  £100  per  annum,  with  board,  residence,  and 

washing.    Applications  to  P.  J.  Langdon,  Secretary. 
Valkenberg  Asylum,  near  Cape  Town.— Assistant  Medical  Officer. 

Salary  £260  per  annum,  with   free  board,  lodging,  and  washing. 

Applications  to  the  Agent-General  tor  the  Cape  of  Good  Hope, 

100  Victoria  8treet.  London,  8.  W. 
West  Suffolk  General.Hospital,  Bury  St.  Edmunds.— House  Surgeon. 

Salary  £100  per  annum,  with  board  and  lodging.    Applications 

to  the  Secretary. 
Westminster  General  Dispensary.— Resident  Medical  Officer.    Salary 
£120  per  annum,  with  rooms,  gas,  coal,  and  attendance.  Applica- 
tions to  the  Secretary,  0  Gerrara  Street,  Soho. 
York  County  Hospital.— House  Physician.,  Salary  £100  per  annum, 
with  board,  reskienoe,  and  washing.    Applications  immediately 

to  Fredk.  Neden,  Secretary  and  Manager. 
York  Dispensary.— Resident  Medical  Officer.  Salary  £120  a  year,  with 
board,  lodging,  and  attendance.     Applications  immediately  to 
W.  Draper,  Esq.,  De  Grey  House,  York. 


QpVQintmtnxs. 


L.B.C.P.Lond., 


Bbvan,     Arthur,     M.D.Loud.,      M.R.CS.Eng., 

Anaesthetist  to  8t.  Thomas's  Hospital. 
Brown,  A.  T.  F..  M.B.Durh.,  Certifying  Surgeon  under  the  Factory 

Act  for  the  Chatham  District  of  the  County  of  Kent. 
Dingle,  C.  V.,  M.D.Durh.,  Medical  Officer  to  the  Teee  Port  Sani- 
tary Authority. 
Fletcher,  H.  Morlby,  M.D.,  F.R.C.P.Lond.,  Assistant  Physician  te- 
st. Bartholomew's  Hospital. 
Hornbr,  W.  E.  L.,  M.D.,    B.S.Lond.,  M.R.C.8..  L.B.C.P.Lond., 

Medical  Officer  of    Health  to  the    United  Urban  District  of 

Wolstanton,  8toke-on-Trent. 
Kennedy,  A.  J.,  L.8.A.,  Certifying  Surgeon  under  the  Factory  Act 

for  the  Shepley  District  of  the  County  of  York. 
Lee,  W.H.,M.R.C.S.,L.R.C.P.Lond.,  Medical  Officer  to  the  new 

Isolation  Hospital  at  Morton.  Yorkshire. 
MacGbbqob,  D.  A.,  M.B.,  M.8.Edin.,  Certifying  8ur*eon  under  the 

Factory  Act  for  the  Denby  Dale  District  of  the  County  of  York. 
Bebd,  J.,  M.B.,  M.S.Aberd.,  Certifying  Surgeon  under  the  Factory 

Act  for  the  Portsoy  District  of  the  County  of  Banff. 
Robbrtshaw,  W.  M.,  M.B.,  M.8.tMin,,  Certifying  Surgeon  under  the 

Factory  Act  for  the  Stocksbridge  District  of  the  County  of  York. 
Shaw,  W.  F.,  M.B..  Ch. B.Vict,  Resident  Medical  Officer  to  St 

Mary's  Hospital  for  Women  and  Children,  Manchester. 
Smftu,  Enid  Marian,  M.B..  B.S.Lond.,  Senior  House  Surgeon  at 

the  Victoria  Hospital,  Hull. 
Ttvy,  Cecil  B.  F..  M.B.,  B.Ch.,  B.A.O.R.U.I.,   Assistant    House 

Surgeon  to  the  Staffordshire  General  Infirmary,  Stafford. 


girths. 


Brierlet.— On  May  12th,  at  7  Dumfries  Place,  Cardiff,  the   wife  of 

Edward  Edelsten  Brierley,  M.B.,  F.R.C.8.B.,  of  a  son. 
Fleming.— On  May  11th,  at  10  Chester  8treet,  Edinburgh,  the  wife 

of  Robert  A.  Fleming,  M.D.,  F.B.C.P.B.,  of  a  son. 
Markbt.— On  May  16th.  at  High  Street,  Morley,  Yorks,  the  wife  of 

Herbert  Markby,  M.B.C.S  Eng.,  L.R.CP.Lond.,  of  a  son. 
Newton.— On  May  11th,  at  Verona  House,  Tonbridge.  the  wife  of 

Isaac  Newton,  M.R.C.8.Eng.,  L.R.C.P.Lond.,  of  a  son . 


Blood— Higos. — On  May  11th,  at  St.  Thomas's  Church.  Dudley, 
Frederick  Walter  Blood,  of  Edgbaston.  to  ABce  Maude,  second 
daughter  of  Thomas  Frederick  Higgs,  M.D.,  J. P.,  of  Beaconsfield 
House,  Dudley. 

Murphy— Lind.— On  March  24th,  at  St.  Andrew's  Cathedral,  Singa- 
pore, James  Lloyd  Murphy,  youngest  son  of  the  late  Major 
Robert  Murphy.  R.A.TC.  to  Margaret  Mabel,  second  daughter 
of  Mr.  G.  A.  Land,  of  Singapore. 

Wuarry— Hills.— On  May  11th,  at  8t.  Peter's  Church,  Whitfield,. 
Charles  J.  Wharry,  Esq.,  M.D..  of  Surbiton.  to  Dorothy  Clare, 
daughter  of  E.  Hills,  Esq.,  J.P.,  of  Cambridge  House,  Whitfield, 
Kent 


$txth*. 

Hbnslbt.— On  May  15th,  at  Weymouth,  Charles  Carringtoo, 
Hensley,  the  youngest  son  of  the  late  Henry  Hensley,  ED.,  of 
22  The  l^rcus,  Bath,  aged  44.  „„     n 

Holt.— On  May  *9th,  at  40  Montagu  Square,  W..  Sarah  Margaret* 
widow  of  Barnard  Wight  Holt,  F.R.C.S.,  aged  78. 


Wht  gtdtral   f rtss   and    tfirrular. 


"8ALUS   POPULI   SUPREMA    LEX-" 


Vol.  CXXVIIL 


WEDNESDAY,    MAY  25,    1904, 


No.   21. 


Original  Communications. 


INDUCE 


ON    PLANTS   WHICH 
ECZEMA. 

By  J.  H.  MAIDEN, 
Government  Botanist  and  Director  of  the  Botaoio  Gardens,  Sydney 

Rather  more  than  twelve  months  ago  I  had  the 
misfortune  to  contract  a  severe  attack  of  eczema 
through  coming  into  contact  with  a  growing  plant 
of  Rhus  radicans  {toxicodendron)  in  these  gardens. 
Discussing  the  matter  with  the  physician  to  whom 
I  owed  speedy  recovery,  I  found  that  but  little 
was  known  about  plants  which  induce  this  dis- 
tressing complaint,  of  which,  of  course,  many  kinds 
are  known  to  physicians. 

Careful  search  on  my  part  shows  that  the  matter 
has  probably  escaped  the  attention  of  botanists. 
I  enumerate  the  eczema-inducing  plants  known  to 
me  in  botanical  sequence,  but  the  list  is  so  scanty 
that  no  conclusion  can  be  come  to  as  the  result  of 
scanning  this  list,  except  that  at  present  the  genus 
Rhus  has  unenviable  notoriety.  Perhaps  the 
publication  of  this  list  may  draw  attention  to  the 
subject  and  we  may  thus  obtain  the  data  that  we 
at  present  lack. 

I  have  not  referred  to  mere  urticating  or  stinging 
plants,  such  as  the  nettle.  If  we  know  but  little 
as  to  the  plants  which  cause  irritation,  we  know 
less  of  the  active  principles  concerned.  If  we  can 
make  a  comprehensive  list  of  well-authenticated 
plants  the  active  principles  will  be  ascertained, 
I  feel  sure,  without  delay. 

Rut  ace  jr. 

1.  Phebalium  argenteum,  Sm. — This  has  been 
called  the  "  Western  Australian  blister  plant," 
and  Dr.  Alex.  Morrison  (a)  has  shown  that  it  blisters 
the  human  skin  if  handled.  It  has  also  been  sus- 
pected of  poisoning  stock,  though  no  details  of  this 
are  available.  It  probably  owes  its  acridity  to  an 
essential  oil,  as  do  so  many  plants  of  the  natural 
order  to  which  it  belongs. 

Meliace/e. 

2.  Dysoxykn  Richii,  C.D.C.  (D.alliaceutn,  Seem.), 
is  found  in  several  Polynesian  islands.  Dr.  Funk, 
of  Apia,  Samoa,  informs  me  that  the  wood  "  causes 
sickness,"  which  I  understand  to  be  in  the  nature 
of  skin  irritation. 

3.  Dysoxyhn  Mueller i,  Benth.  "  Red  bean." 
This  well-known  furniture  wood  of  New  South 
Wales  has  been  accused  as  follows :  Some  cabinet- 
makers report  that  after  working  at  it  for  "  four  or 
five  days  they  begin  to  suffer  from  a  virulent  form 
of  influenza,  accompanied  by  violent  fits  of  vomit- 


ing and  bleeding  of  the  nose,  while  if  they  cut 
themselves  in  handling  the  timber,  blood-poisoning 
almost  inevitably  ensues.  Remarkably  enough, 
the  more  seasoned  the  wood  is,  the  worse  it  becomes. 
It  appears  to  me  that  the  language  of  exaggeration 
has  been  here  employed.  So  far  as  I  can  glean, 
the  wood,  and  particularly  the  sawdust,  is  ex- 
ceedingly irritating  to  some  people,  and  it  has 
induced  severe  eczema  and  also  irritation  of  the 
mucous  membrane. 

Anacardiacbje. 
The  following  are  the  best  known  of  the  Poison- 
ivies  of  North  America  : — 

4.  Rhus  radicans,  Linn.  The  Poison -ivy. 
{Rhus  toxicodendron,  non-Linn.). 

5.  Rhus  diver siloba,  Torr  and  Gray.  The 
Poison-oak. 

6.  Rhus  vernixt  Linn.  The  Poison-sumac  or 
Poison-elder. 

The  best  account  of  these  plants  known  to  me 
is  that  by  V.  K.  Chesnut.  (a)  R.  radicans  is  best 
known,  and  has  formed  the  subject  of  a  research, 
Dr.  Franz  Pfaff,  of  Harvard,  having  shown  that  the 
poison  is  a  non-volatile  oil.  The  poison  is  des- 
troyed, as  Pfaff  has  shown,  by  an  alcoholic  solu- 
tion of  acetate  of  lead  (sugar  of  lead).  It  is  recom- 
mended not  to  use  strong  alcohol,  but  alcohol  of 
50  to  75  per  cent.  To  this  the  powdered  sugar  of 
lead  is  added  until  no  more  will  easily  dissolve. 
The  milky  fluid  should  then  be  well  rubbed  into  the 
affected  skin.  The  itching  is  at  once  relieved  and 
the  further  spread  of  the  eruption  is  checked. 
"  The  remedy  has  been  tried  in  a  large  number  of 
cases  and  has  always  proved  successful." 

There  is  an  excellent  article  on  "  The  Poison- 
Ivy — a  Dangerous  Plant,"  by  the  Earl  of  Annesley, 
in  the  Journal  of  the  Royal  Horticultural  Society, 
and  a  lengthy  digest  of  it  in  the  Garden  of  March 
14th,  1903,  p.  174.  The  eczema-producing  nature 
of  this  plant  is  well  described,  a  number  of  striking 
instances  being  cited. 

In  the  Botanic  Gardens,  Sydney,  we  have  a  plant 
of  it  growing  on  a  stonewall, out  of  reach  of  visitors. 
It  occasionally  requires  pruning  and  the  pruner 
generally  protects  himself  with  leather  gloves. 
In  the  course  of  years  we  have  found  some  men 
immune  to  its  effects,  while  others  are  exceedingly 
sensitive.  In  fact,  we  cannot  say,  except  as  the 
result  of  experience,  whether  a  man  will  be  affected 
by  it  at  all. 

j  Leguminace^e. 

1  7.  Castanospertnum  australe,  A.  Cunn.  "  The 
black  bean."  This  well-known  furniture  timber 
of  New  South  Wales  and  Queensland  has,  like  the 


(a)  Chsmitt  and  Druggist,  July  8th,  1899,  p.  63. 


(a)  "  Thirty  tfoisonoat  PlanU  of  the  United  States.' 
Bulletin,  No.  86,  of  the  U.S.  Dept.  of  Agriculture  (1898). 


Fon&er'$ 


548     The  Medical  Press.  ORIGINAL  COMMUNICATIONS. 


May  25.  1904. 


Red  Bean  (Dysoxylon  Muelleri),  been  accused  of 
injuriously  affecting  the  health  of  workmen. 
Myrtace^. 

8.  Eucalyptus  tnaculata,  Hook.  The  "  spotted 
gum."  In  parts  of  Queensland,  timber-getters 
and  sawyers  who  handle  spotted  gum  are  some- 
times affected  with  a  rash  called  "  spotted  gum 
rash."  I  asked  a  number  of  timber  experts :  Do 
you  know  any  district  in  which  this  skin  complaint 
prevails,  and  can  you  furnish  any  particulars  in 
regard  to  it  ?  Most  questionees  never  heard  of  it, 
but  Mr.  A.  Vogele,  Mt.  Douglas,  Paterson,  N.S.W., 
reports  :  "  Spotted  gum  rash  prevails  here  ;  some 
are  affected  more  than  others.  One  of  my  neigh- 
bours that  worked  with  me  in  the  bush  for  years 
felt  its  influence  if  only  working  beside  a  spotted 
gum  ;  to  work  one  up  was  out  of  the  question. 
If  persisting  in  doing  so  he  would  itch,  and  after- 
wards break  out  in  pimples.  Every  occasion  he 
got  affected  more — at  length  had  to  sell  his  selec- 
tion on  account  of  it." 

9.  Eucalyptus  hemiphloia,  Fr.  M.  "  White  or 
grey  gum."  I  have  heard,  on  one  occasion,  of  this 
timber  causing  a  rash  in  a  man,  or  at  least  of  a  rash 
being  attributed  to  this  timber. 

Composite. 

10.  Cassinia  aculeata.  R.Br.  This  shrub  is 
sometimes  known  as  "  dogwood."  and  Dr.  A.  W. 
Finch  Noyes,  F.R.C.S.,  Surgeon  in  Charge  of  the 
Skin  Department  of  the  Melbourne  and  Alfred 
Hospitals,  read  a  paper  {a)  before  the  Medical 
Society  of  Victoria  on  this  plant,  which  is  attri- 
buted as  the  cause  of  eczema. 

Details  are  given  of  seven  cases,  several  of  which 
suffered  only  when  the  dogwood  was  in  flower, 
and  the  patient  had  come  in  contact  with  it  by 
brushing  through  the  scrub  and  other  ways.  The 
symptoms  indicate  that  minute  particles  of  some 
land,  such  as  pollen  from  the  flowers,  or  irritating 
particles  from  the  bark,  get  between  the  clothing 
and  the  skin,  and  where  there  are  loose  folds  of 
clothing  in  contact  with  parts  of  the  skin  inflam- 
mation is  often  produced.  The  eruption  is  often 
scaly,  with  great  irritation,  and  a  feeling  described 
in  some  cases  as  if  fire  were  running  through  the 
part.  In  one  case  a  resident  of  Gippsland  was 
driven  from  the  district  twelve  years  ago,  and  six 
months  ago  returned.  He  had  a  second  attack  of 
the  eruption,  which  was  relieved  when  he  left  the 
district.  He  determined  to  live  down  his  sus- 
ceptibility, and  went  back,  but  returned  a  few 
weeks  ago  with  an  eruption  similar  to  that  in  pre- 
vious attacks. 

11.  Pyrethrum  (chrysanthemum)  parthenium, 
Sm.  "  Fever  -  few."  The  late  Rev.  H.  E. 
Thomson,  of  Murrumburrah,  N.S.W.,  could  never 
tolerate  this  plant,  which  always  produced  an 
eczematous  swelling  on  his  face.  He  was  fond  of 
gardening,  and  proximity  to  this  plant  always  dis- 
tressed him.  He  tried  to  resist  the  effects,  and 
finally  had  to  remove  all  such  plants  from  his 
garden. 

Primulace^. 

12.  Primula  obconica,  Hance.  Dr.  S.  A.  L. 
Swan  records  (b)  two  cases  which  came  under  his 
notice  in  Ireland  in  which  the  symptoms  produced 
by  handling  this  plant  resembled  those  of  acute 
eczema  or  erysipelas.  The  effect  of  this  plant  on 
human  beings  is  now  well  recognised  by  gardeners, 

(a)  Cktmitt  and  Druggist  of  Australasia,  August  1*99,  p.  240. 
(b)  Lancet,  April  26th,  1891,  p.  960;  Pharm.  Journ.,  May  2nd, 
1891,  p.  981. 


and  references  to  it  in  horticultural  literature  are 
frequent ;  for  example,  Gardeners9  Chronicle,. 
April  9th,  1892,  p.  469.  At  the  same  time  some 
people  are  not  affected  by  it.  This  is  the  case,, 
however,  with  mo6t  plants  which  are  irritant. 

It  is  alleged  that  Dr.  Riehl,  of  Vienna,  has  ascer- 
tained that  the  irritation  is  caused  by  the  tiny  hairs 
on  the  leaves  and  stalks  (Gardeners*  Chronicle, 
May  4th,  1895,  p.  558). 

13.  Primula  sinensis,  Sabine.  Eczema  of  the 
hands  and  face  has  been  caused  through  handling 
this  primrose.  It  appears  to  be  less  virulent  than 
P.  obconica  (Gardeners*  Chronicle,  January  12th* 
1895,  P-  47  J   January  26th,  1895,  P-  IX^)- 

Euphorbiacea. 

14.  Excacaria  agallocha,  Linn. 

15.  Excacaria  parvi flora,  Muell.  Arg.  These 
two  yield  an  acrid  juice  which  is  more  or  less 
volatile,  and  which,  if  it  gets  into  the  eyes,  will  pro- 
duce temporary  loss  of  sight  and  other  local  irrita- 
tion. 

Conifer®. 

16.  Thuja  Douglasii,  Carr.  "  A  curious  case  of 
a  woman  being  poisoned  by  handling  the  branches 
and  leaves  of  this  tree  while  gardening  is  recorded 
by  Neudorffer  in  the  Centralb.  f.  inner e  Medizin.  (a) 
The  symptoms  were  spasmodic  convulsions,  dys- 
pnoea and  coma.  Other  persons  appear  to  have 
been  more  or  less  affected  who  were  working  at  the 
same  employment.  It  appears  probable,  there- 
fore, that  the  tree,  which  is  cultivated  for  orna- 
mental purposes,  contains  some  poisonous  ingre- 
dient, to  which  some  persons  are  more  susceptible 
than  others." 

I  admit  this  plant  to  the  present  list  with  doubt. 

But  attention  should  be  widely  drawn  to  such  a 

well-known  tree  in  order  that  we  may  ascertain 

what  are  the  real  facts  of  the  danger  of  handling  it. 

Liliace®. 

17.  Hyacinthus  orientalis,  Linn.  ;  and  Varieties. 
(The  common  hyacinth  of  gardens.)  "  Forms  of 
eczema  (b)  were  said  to  have  been  produced  in 
persons  handling  and  cleaning  these  bulbs.  Al- 
though the  fact  was  familiar  to  gardeners,  the  cause 
did  not  appear  to  have  been  clearly  traced.  Ex- 
periments and  observations  at  the  Godrell  Labora- 
tory at  Kew  had  shown  that  both  dry  and  moist 
scales  were  capable  of  producing  considerable 
irritation  in  certain  cases  when  applied  directly 
to  the  skin.  There  was  little  doubt  that  the 
raphides  were  the  prime  agents.  These  needle- 
shaped  crystals  (composed  of  oxalate  of  lime) 
varied  from  one-hundredth  to  one  two-hundredth 
of  an  inch  in  length,  and  were  arranged  in  close 
bundles,  easily  dispersed  by  rubbing  the  dry  scales. 
In  the  growing  plants  they  were  doubtless  protec- 
tive, as  snails,  for  instance,  avoided  hyacinth  bulbs, 
but  attacked  others  growing  close  by.  Roman 
hyacinths  (var.  albulus)  were  understood  to  cause 
greater  irritation  than  other  varieties. 

Dr.  D.  H.  Scott  described  some  experiments 
which  he  had  tried,  tending  to  confirm  the  conclu- 
sion that  the  irritation  of  the  skin  produced  by 
contact  with  the  bulb  scales  of  hyacinths  is  due 
immediately  to  puncture  by  the  numerous  raphides. 
Aroide^. 

18.  Richardia  cethiopica,  Spreng.  "  Lily  of  the 
Nile  "  (of  gardeners')  ;  the  common  "  arum  lily  "* 
of  Australian  gardens.     Mr.    J.   Y.    Johnson,  (c) 

(a J  Nouv.  Rem.,  1903,  65.  Quoted  in  Pharm,  Journ.,  Much  Slst, 
1903,  r.  422.  w  %ottm 

(6)  Dr.  Morris,  C.M.O.,  io  M  Proa  Linn.  Soc,"  November  5tb,  19*. 
(c)  ••  Proc  Lipn.  Soc"  January  21et,  1897. 


Hay  25,  1904. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press.    549 


of  Funchal,  Madeira,  shows  that  this  plant  is,  like 
hyacinthus,  responsible  for  a  form  of  eczema. 

The  laundresses  of  Funchal  had  tried  to  utilise 
the  starch  obtainable  from  the  conns,  but  com- 
plained of  the  irritation  in  the  hands  produced  by 
it,  which,  on  examination,  was  found  to  result  from 
the  presence  of  numerous  needle-shaped  raphides. 


NOTES    ON     CASES    OF 

W    STRANGULATED      HERNIA 

AND 

SUCCESSFUL    EXTENSIVE 
ENTERECTOMY; 

(2)  BROAD  LIGAMENT  CYST  ENUCLEATED 
FROM  THE  VAGINA  ;  AND  (3)  TUBO-OVA- 
RIAN  CYST  REMOVED  BY  POSTERIOR 
VAGINAL  CELIOTOMY,  (a) 

By    Professor    JOHN    W.    TAYLOR,    M.Sa, 
F.R.C.S.,  &c,  &c. 

My  first  specimen,  gentlemen,  is  a  loop  of 
semi-gangrenous  intestine  (together  with  its  solid, 
undigested  contents)  successfully  excised  from 
an  old  lady,  aet.  77,  who  had  been  suffering  for 
twenty- four  hours  from  a  strangulated  hernia 
in  the  middle  line  of  the  abdomen.  The  hernia 
was  one  of  the  cicatrix  after  abdominal  section 
and  partial  hysterectomy  for  fibroids,  performed 
by  one  of  my  old  colleagues  twenty-three  years 
previously  (April  22nd,  1879). 

This  original  operation  was  regarded,  and  most 
rightly  regarded,  as  one  of  the  most  signal  triumphs 
of  abdominal  surgery  at  that  date.  I  have  as- 
sumed in  my  notice  that  it  was  done  by  the  clamp 
or  "  serrenoeud,"  but  the  old  records  are  imperfect, 
and  the  exact  method  of  operation  employed 
appears  to  be  doubtful.  In  any  case,  whether 
by  clamp  or  otherwise,  in  the  course  of  several 
years  the  bowel  became  very  adherent  to  the  scar, 
and  at  the  lower  end  of  this  a  large  callous  open- 
ing was  to  be  felt  in  the  abdominal  wall,  through 
which  a  certain  amount  of  bowel  frequently  pro- 
truded. No  appliance  could  apparently  be  worn 
with  comfort  or  even  endured,  and  at  the  time 
the  strangulation  occurred  nothing  was  being 
worn  except  a  belt  bandage.  About  4  p.m. 
on  April  4th,  1902,  the  patient  was  seized  with 
severe  abdominal  pain  and  vomiting,  which  con- 
tinued all  night.  On  the  5  th  she  was  seen  by 
Dr.  Clark,  who  found  a  very  tense,  red,  hard  and 
glazy  swelling  (like  a  coil  of  distended  bowel), 
projecting  from  the  abdomen  across  the  lower 
part  of  the  cicatrix.  It  was  quite  irreducible. 
No  time  was  then  lost  in  arranging  for  the  patient's 
admission  to  hospital,  where  I  saw  her  at  4  p.m., 
and  operated.  On  opening  the  sac  it  was  seen 
that  the  tumour  was  formed  by  one  loop  of 
bowel  bent  into  the  shape  of  a  capital  T.  It 
was  distended,  black,  at  one  part  papery  and 
apparently  at  the  point  of  bursting.  It  had,  too, 
the  faint  sour  odour  of  commencing  decom- 
position. After  thoroughly  freeing  the  loop,  the 
ends  were  clamped,  the  bowel  cut  through,  the 
mesentery  nipped  off,  its  vessels  tied,  and  the  loop 
removed.  The  cut  ends  were  then  joined  together 
by  continuous  suture  without  any  bobbin  or 
artificial  aid.  The  primary  suture  was  closed  in  by 
two  other  circles  of  continuous  suture.  An  effort 
was  made  to  close  the  hernial  opening,  but  this 

(a)  Bead  at  a  mating  of  the  British  Gynaecological  Society,  May 
Mfeh,  190*. 


was  found  to  be  impossible.  The  old  circle  of 
cicatricial  tissue  was  quite  rigid  and  unyielding, 
and  an  extensive  excision  of  the  abdominal  wall 
could  alone  have  resolved  this  into  its  separate 
constituents. 

The  patient  was  very  ill  for  two  days,  but  made 
a  perfect  recovery,  and  when  she  was  fully  con- 
valescent a  rubber  air-pad  fitted  underneath  an 
abdominal  truss  gave  her  relief  and  safety.  I 
have  seen  her  several  times  during  the  last  two 
years,  and  she  continues  well  and  is  fairly  vigorous. 

The  specimen  of  intestine  removed,  on  being 
opened,  was  found  to  contain  a  large  quantity 
of  nodules  of  undigested  meat,  which  appeared  to 
be  the  remains  of  a  kidney  pie.  These  seem  to 
be  partially  responsible  for  the  obstruction  and 
strangulation.  At  first  (in  all  probability)  they 
were  able  to  enter  the  loop  of  bowel,  but  none 
could  be  passed  on  through  the  distal  end  of  the 
loop.  Then,  as  the  loop  became  distended  and 
inflamed,  both  ends  were  tightly  nipped  by  the 
callous  margins  of  the  ring,  and  strangulation 
became  complete. 

The  case  seems  to  be  one  of  some  interest,  first, 
as  a  successful  enterectomy  under  difficult  cir- 
cumstances ;  secondly,  as  illustrating  the  far- 
reaching  danger  to  which  a  patient  is  exposed 
after  abdominal  section,  with  that  imperfect 
closure  of  the  wound  which  was  so  common  a 
feature  of  the  old  operation  ;  and  thirdly,  as 
an  illustration  of  the  method  by  which  an  acute 
strangulation  may  take  place  even  with  a  large 
hernial  opening. 

Broad  Ligament  Cyst  Removed  by  Vaginal 
Enucleation,  and  Tubo-ovarian  Cyst  Re- 
moved by  Posterior  Vaginal  Cceuotomy. 

The  other  two  specimens  were  removed  by 
vaginal  section.  The  first  is  one  of  broad  liga- 
ment cyst  removed  by  vaginal  enucleation.  For 
some  years  I  had  been  rather  looking  out  for  a 
suitable  broad  ligament  cyst  to  remove  per 
va gin  am,  but  it  was  not  until  three  months  ago 
that  I  found  the  case.  This  was  a  fixed,  tense 
cystic  tumour  to  the  left  of  the  uterus  reaching 
about  half-way  to  the  umbilicus  above,  dis- 
placing the  uterus  to  the  right,  and  coming  down 
low  enough  somewhat  to  depress  the  left  lateral 
fornix.  The  patient  was  a  single  woman,  aet.  51, 
and  had  ceased  menstruating  for  several  years. 
On  January  12th,  1904,  I  opened  the  vaginal 
vault  on  the  left  side,  extending  the  incision  rather 
behind  the  cervix,  and  readily  found  the  lower 
limit  of  the  cyst.  I  tapped  the  cyst,  removing 
from  one  and  a  half  to  two  pints  of  fluid  con- 
taining cholesterin  crystals,  and  then  finding 
that  I  could  differentiate  the  true  cyst  wall  from 
its  outer  coverings,  I  enucleated  the  cyst  from 
its  bed  by  my  fingers.  The  chief  difficulty  was 
about  the  higher  middle  zone  of  the  tumour, 
When  this  was  passed  the  upper  part  of  the  broad 
ligament  appeared  to  invert  on  traction,  and  the 
manipulation  was  rendered  easier. 

In  the  course  of  the  operation  I  made  a  small 
opening  inadvertently  into  the  peritoneum  just 
anterior  to  the  opening  into  the  broad  ligament, 
so  that  I  could  easily  verify  the  peritoneal  rela- 
tions of  the  envelope.  Both  cavity  and  peri- 
toneum were  drained  with  separate  drains  of 
iodoform  gauze. 

The  patient  did  well,  but  developed  a  high 
temperature — 1040,  with  rapid  respiration  (40) 
and  quick  pulse  (128)  on  the  night  following  the 

D 


550    Tm  Mbpical  Puss.         ORIGINAL  COMMUNICATIONS. 


May  25,  19044 


operation.  This  came  down  in  the  course  of  the 
following  day,  and  it  was  a  question  whether  the 
transient  attack  may  have  been  due  to  iodoform 
poisoning.  The  patient  went  home  convalescent 
on  January  30th. 

The  third  specimen  is  a  real  tubo-ovarian  cyst 
of  the  left  side,  removed  from  a  married  woman, 
aet.  31,  on  January  21st,  1904,  by  posterior 
vaginal  coeliotomy.  I  had  removed  a  smaller 
tubo-ovarian  cyst  of  the  right  side  some  five 
years  previously,  from  the  same  patient,  by  the 
same  method.  There  were  no  adhesions.  The 
fluid  removed  from  the  cyst  was  brownish,  and 
rather  turbid,  as  if  mixed  with  some  blood  or 
secretion  from  the  tube.  The  patient  was  dis- 
charged on  February  5  th,  1904.       4 


CLINICAL  NOTES    ON 
TUBERCULOUS  ARTHRITIS  IN 
THE  YOUNG,  (a) 

By  ROBERT  JONES,  F.R.C.S., 

Burgeon  to  the  Royal  Southern  Hospital,  Liverpool,  Stanley  Hospital, 
Oounty  Hospital  for  Incurable  Diseases  of  Children,  Ac,  Ac. 

The  speaker  first  referred  to  his  long  association 
with  Mr.  Owen  Thomas,  who  having  applied  the 
principles  of  mechanical  and  physiological  rest 
in  fifteen  years  of  practice  to  the  treatment 
of  tuberculous  joints,  had  never  excised  a 
joint.  Mr.  Jones  had  carried  out  Thomas'  line 
of  treatment  for  thirteen  years  with  constant  good 
results,  and  had  seen  no  reason  to  modify  it 
during  all  that  time.  For  the  successful  treat- 
ment of  tuberculous  arthritis  early  diagnosis  was 
of  paramount  importance,  and  the  first  sign  on 
which  he  asked  to  lay  stress  was  rigidity,  which 
was  the  earliest  and  most  trustworthy  symptom,  and 
preceded  pain  and  swelling  of  the  joint.  Rigidity 
affects  the  movements  of  the  tuberculous  joint  in 
all  directions — absence  of  limitation  of  move- 
ment meant  absence  of  disease.  In  the  early 
stages  this  rigidity  was  due  to  tension  of  the  muscles, 
and  must  be  sought  for  without  an  anaesthetic  ; 
in  the  later  stages,  when  due  to  muscular  con- 
tracture, it  persists  under  anaesthesia.  A  limita- 
tion of  movements  in  all  directions  was  more  trust- 
worthy than  any  single  symptom  or  group  of  sym- 
ptoms in  tuberculous  joint  disease.  Being  due  to 
involuntary  muscular  spasm,  it  was  not  so  sudden 
and  absolute  a  check  to  movement  as  bony 
ankylosis,  but  nevertheless  could  not,  like  a 
voluntary  contraction,  be  overcome  by  gentle 
pressure.  The  method  of  testing  limitation  of 
movement  in  the  hip  was  then  demonstrated, 
the  necessity  for  care  in  not  vitiating  the  accuracy 
of  the  test  by  flexing  the  pelvis  on  the  spine  being 
pointed  out.  When  the  patient  was  put  up  in  a 
Thomas'  splint,  and  it  was  desired  to  observe 
the  progress  of  the  case  by  testing  the  amount 
of  limitation  of  movement,  it  was  not  necessary 
to  remove  the  affected  limb  from  the  splint ; 
the  sound  limb  was  taken  and  fixed  on  the  ab- 
domen, and  if  the  affected  hip  was  free  from 
rigidity  the  sound  leg  could  be  fully  flexed,  while 
a  limitation  in  the  degrees  to  which  flexion  was 
possible  indicated  a  corresponding  rigidity  of 
the  affected  hip.  Speaking  of  arthritic  defor- 
mity as  a  sign  of  tuberculosis  the  occurrence  of  a 
slight  degree  of  lateral  curvature  in  the  early  stage 

{a)  Abstract  of  Paper  read  before  the  Edinburgh  Medico-Chlrurgical 
8ocietj,  Hay  4th,  1904. 


of  Pott's  disease  was  mentioned  as  occasion- 
ally misleading.  Here  the  presence  of  limita- 
tion of  movement  distinguished  the  state  of 
matters  from  ordinary  scoliosis.  The  natural 
history  of  an  ordinary  untreated  case  of  tuber- 
culous disease,  say,  of  the  hip  was  that  there  was 
first  rigidity  of  the  joint  with  pain  and  difficulty 
in  walking  ;  then  came  the  typical  deformity, 
the  joint  being  locked  in  the  least  painful  position, 
and  with  this  there  was  muscular  shrinkage 
perpetuating  the  deformity  ;  then  the  tenderness 
began  to  pass  off,  the  patient  walked  about  again, 
and  ultimately  recovered,  but  with  a  deformed 
limb  and  impaired  movement  at  the  joint.  In 
mild  cases  the  treatment  was  simply  to  apply  a 
Thomas'  hip  splint  (if  the  child  was  small,  a 
double  splint),  neither  extension  nor  other  pre- 
liminary treatment  to  do  away  with  flexion, 
which  soon  disappeared  when  the  limb  was  put  at 
rest,  being  needed.  Early  cases  treated  thus 
usually  did  well,  and  recovered  with  movable 
joints.  Worse  cases  were  those  with  marked 
reflexion,  adduction,  and  shortening.  In  these 
he  advised  gentle  reduction  of  the  deformity 
under  an  anaesthetic,  with  tenotomy  if  necessary, 
the  manipulations  being  designed  to  overcome 
flexion  and  adduction  and  to  lower  the  pelvis 
to  correct  the  shortening.  Thomas'  splint  was 
then  applied  as  in  the  previous  group  of  cases. 
He  had  never  seen  dissemination  of  tuberculosis 
result  from  this  treatment.  If  an  abscess  was 
present  he  used  formerly  to  drain  it,  but  had  now 
given  this  up  as  a  routine,  and  preferred  to  leave 
certain  types  alone — if  they  caused  no  symptoms. 
In  opening  abscesses  there  was  always  a  risk  of 
secondary  infection,  while,  if  left  undisturbed 
tuberculous  pus  tended  to  form  granulation  tissue. 
Abscesses  arising  in  connection  with  the  hip  were 
often  nomadic,  and  tended  to  travel  from  their 
point  of  origin,  and  finally  to  get  cut  off  from  the 
joint  altogether.  Where  the  abscess  had  invaded 
the  skin  he  thought  that  the  longer  incision  could 
be  deferred  the  better  ;  where  it  was  inevitable, 
he  simply  opened  the  cavity  and  allowed  the  pus 
to  escape,  but  did  not  scrape  or  use  any  vigorous 
measures.  Early  incision  of  abscesses  was,  he 
thought,  bad.  If,  however,  the  abscess  gave 
rise  to  acute  symptoms,  it  meant  that  there 
was  a  mixed  infection,  and  a  radical  operation 
was  required.  For  dressings  among  very  poor 
patients  nothing  was  superior  to  medicated  saw- 
dust. He  never  admitted  these  patients  to 
hospital  for  a  longer  time  than  was  required  to 
correct  the  deformity.  They  did  much  better 
outside,  the  ideal  residence  being,  of  course,  a 
sanatorium  for  the  outdoor  treatment  of  sur- 
gical tuberculosis.  Hip  cases  were  kept  in  a  splint 
till  all  the  pain  was  gone  and  the  pelvis  was  lowered. 
Abduction  was  the  position  aimed  at.  The  test 
of  cure  was  when  the  angle  which  the  limb  was 
in  when  the  splint  was  removed  did  not  change 
after  the  limb  had  been  used.  He  demonstrated 
the  method  of  testing  this  in  the  elbow,  hip,  and 
knee,  and  then  gave  a  demonstration  of  the  splints 
he  used.  The  chief  points  dwelt  on  were  the  neces 
sity  for  having  the  splints  made  of  malleabl 
iron  which  had  no  spring,  and  which  could  be  readily 
moulded.  It  was  not  necessary  that  they  should 
be  very  light,  for  at  first  the  patient  did  not  carry 
about  the  splint,  but  the  splint  carried  the  patient 
The  importance  of  the  "  bullock  angle,"  especially 
in  these  patients,  was  pointed  out,  as  well  as  the 
need  for  twisting  the  back  strip  of  iron  slightly 


May  25,  1904, 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press.    55 1 


so  that  it  might  be  flat  along  the  skin.  The 
buttock  was  the  only  place  which  required  atten- 
tion to  prevent  chafing,  and  to  obviate  this  the 
patient's  friends  were  instructed  to  move  the 
skin  a  little  night  and  morning,  while  the  splint 
was  being  worn.  Owing  to  the  tendency  of  the 
splint  to  rotate  to  the  outer  side  of  the  limb, 
the  inner  arms  should  first  be  moulded  tightly 
over  the  leg  and  trunk,  and  the  outer  arms  then 
moulded  more  loosely.  It  was  very  important 
to  have  the  arms  of  the  splint  well  flattened  out 
before  applying,  in  order  that  the  contour  of  the 
back  of  the  trunk  should  be  closely  followed. 

Treatment  of  Ankylosis. — Very  often  sound 
ankylosis  was  what  was  desired.  By  sound 
ankylosis  was  meant  the  condition  in  which  use 
did  not  increase  the  range  of  movement.  Double 
ankylosis  of  the  hip,  however,  required  an  opera- 
tion, in  which  case  he  usually  did  an  osteotomy 
on  the  worst  side,  and  resected  a  piece  of  bone  on 
the  other.  To  prevent  osseous  union  metal  foil 
or  a  piece  of  the  adjacent  soft  tissues  could  be 
placed  between  the  ends  of  the  bone.  To  correct 
flexion  deformity  the  best  operation  was  division 
of  the  femur  below  the  lesser  trochanter,  and  to 
facilitate  sawing  he  had  had  a  button  fixed  on  the 
tip  of  an  Adam's  saw,  so  that  it  could  be  used 
with  greater  security  from  the  risk  of  injuring 
the  soft  tissues.  He  warned  his  hearers  of  the 
importance  of  sawing  in  the  proper  direction, 
for  it  was  quite  easy  to  slip  the  saw  into,  the  pelvis 
if  a  wrong  direction  was  taken.  After  any  of 
these  operations  he  used  a  special  abduction  frame 
as  a  splint,  his  object  being  to  equalise  the  length 
of  the  limbs  by  lengthening  the  affected  one  and 
raising  the  sound  side  of  the  pelvis.  To  accom- 
plish the  latter  he  aimed  at  ankylosis  in  the  ab- 
ducted portion.  In  active  disease  of  the  knee, 
flexion  occurred,  and  after  it  had  persisted  for  a 
length  of  time  was  very  difficult  to  remedy. 
Sometimes  resection  of  a  wedge  of  bone  was 
needed.  In  treating  any  tuberculous  joint  disease 
it  was  of  the  greatest  importance,  if  a  movable 
joint  could  not  be  got,  to  have  the  limb  finally 
ankylosed  in  the  position  of  greatest  usefulness. 
Thus  the  elbow  should  be  flexed,  the  knee  extended 
and  the  hip  abducted.  An  angle  of  85 °  was  the 
most  useful  for  the  ankle,  and  he  specially  em- 
phasised the  error  of  treating  the  wrist  on  any 
ordinary  flat  anterior  splint.  Thus  fixed,  it  was 
in  a  position  of  slight  flexion  in  which  the  grasp 
was  very  poor,  whereas  if  it  were  hyperextended 
a  good  grasp  remained.  Similarly,  in  treating 
spinal  caries,  a  convex  splint  should  be  used  to 
prevent  kyphosis  taking  place. 

INSTANCES    OF    IMMUNITY : 

FACTS  AND  HYPOTHESES. 

By  WILLIAM  IL   PEARSE,  M.D.Edin., 
Senior  Physician,  Plymouth  Public  Dispensary. 

In  the  year  1864  I  was  surgeon-superintendent  of 
the  Government  emigrant  ship  Tarquin,  of  685  tons, 
irom  Plymouth  to  Adelaide,  South  Australia.  We 
sailed  on  August  20th,  and  reached  Port  Adelaide 
on  December  3rd,  a  voyage  of  105  days  ;  we  embarked 
137  men,  81  women,  28  male  and  28  female  children 
under  12  yeare  of  age.  One  adult  male  died,  and  one 
boy,  under  twelve  years. 

The  day  after  we  sailed,  a  well-marked  case  of  small- 

x  appeared  ;  it  ran  a  severe  and  confluent  course. 

ie  captain  wished  to  put  back  to  Plymouth,  but  I 
decided  that  we  should  go  on. 

The  forecastle  was  what  is  known  as  a  booby~fore- 
•castle,  occupied  only  by  the  windlass  and  boatswain's 


E 


stores.  The  ship's  crew  lived  in  a  house  on  deck. 
The  booby  forecastle  was  about  four  feet  and  a  half 
in  height. 

I  boarded  off  half  this  low  forecastle  on  the  port  side, 
and  fit  ted  a  swinging  canvas  screen  as  a  door.  Here  I  put 
the  patient,  telling  off  a  man  who  was  well  marked 
with  small-pox  from  early  life  as  nurse  and  attendant. 
The  w.c.  for  the  men  was  about  six  feet  distant  ;  the 
crew  had  constant  access  to  the  other  half  of  the  fore- 
castle for  their  necessary  gear. 

The  105  single  men,  who  were  berthed  in  the  fore-end 
of  the  'tween  decks,  had  access  to  the  upper  deck 
through  the  fore-hatch  only,  and  were  thus  ever  passing 
by  and  near  the  small-pox  sick-bay ;  they  were  also 
restricted,  for  purposes  of  discipline,  on  the  upper 
deck,  to  the  fore-end  of  the  ship. 

Of  course,  I  issued  strict  orders  that  no  one  was  to 
enter  the  sick-bay ;  the  man-nurse  and  myself  did  all 
the  cleaning,  feeding,  and  other  attentions,  but  I 
found  constantly,  when  in  the  stormy  southern 
latitudes,  and  when  running  down  our  1600  of  Easting, 
and  during  a  period  of  nearly  two  months,  that  men 
would  enter,  out  of  the  stormy  winds  and  seas,  and 
stay  with  the  patient  and  nurse,  in  order  to  smoke 
their  pipes. 

No  other  case  of  small-pox  happened  during  the 
voyage. 

I  kept  a  minute  record  of  all  my  vaccinations,  but 
that  record,  in  the  vicissitudes  of  travel,  has  been 
lost.  I  lately,  however,  found  a  letter,  of  date  Decem- 
ber 22nd,  1864,  in  which  I  wrote  from  Adelaide  to  my 
father,  a  medical  man,  as  follows  : — 

"  We  had  a  long  voyage  of  105  days,  and  had 
scarlet  fever  and  small-pox  amongst  the  emigrants. 
I  re- vaccinated  about  300  times — 136  were  successfully 
re- vaccinated." 

Many  of  the  300  vaccinations  were  twice  in  the  same 
individual.  I  started  re-vaccination  at  once  after  the 
appearance  of  the  case  of  small-pox.  I  had  both  points 
and  tubes,  supplied  by  the  Government  authorities. 
As  soon  as  I  got  one  or  more  successful  arms,  I  mustered 
men  and  women  on  deck,  and  did  as  many  vaccinations 
as  the  vaccine  vesicles  could  supply.  I  thus  kept  up 
a  succession  of  arm-to-arm  successful  vaccinations. 

There  was  a  good  deal  of  difficulty  in  getting  the 
men  to  submit  to  re-vaccination,  but  by  combined 
persuasion  and  authority,  I  obtained  the  result  already 
named,  viz.,  300  re- vaccinations,  136  of  which  were 
successful.  I  well  remember  passing  St.  Paul's 
Island,  8o°  EX.,  400  S.L.,  on  a  Sunday  morning,  when 
90  days  at  sea,  and  suspending  for  a  quarter  of  an 
hour  my  vaccination  work,  that  we  might  all  get  a 
good  view  of  that  interesting  but  desolate  rocky 
little  island.  It  is  important  to  mention  this  fact, 
as  it  shows  that  I  had  a  series  of  successful  arms  up 
to  ninety  days  at  sea,  and,  a  fortiori,  according  to 
current  theories,  this  same  series  of  people  were  sus- 
ceptible to  small-pox. 

It  should  be  mentioned  further  that  I  had,  with  great 
care,  inspected  the  vaccination  marks  of  every  emi- 
grant before  embarkation  ;  no  emigrant  was  allowed 
to  embark  without  either  marks  of  having  had  small- 
pox, or  who  had  not  good  vaccine  marks. 

I  have  thought  it  right  to  enter  into  the  facts  of 
the  voyage  and  its  interesting  surroundings,  as  they 
form  an  inseparable  part  of  the  conditions  of  the 
profound  and  difficult  biological,  pathological,  and 
even  cosmical  phenomena  which  are  involved  in 
this  instance  of  immunity. 

But  in  viewing  this  great  field  and  phenomena  of 
immunity,  involving  and  co-relating  with  the  cosmic 
laws  and  order  of  the  evolution  of  the  organic,  we 
may  be  justified  in  advancing  approximative  hypo- 
theses ;  we  may  recall  the  saying  of  Herschel  ("  PreL 
Dis.,"  par.  10) :  "  As  truth  is  single  and  consistent 
with  itself,  a  principle  may  be  as  completely  and  as 
plainly  elucidated  by  the  most  familiar  and  simple 
fact  as  by  the  most  imposing  and  uncommon  pheno- 
menon. .  .  .  The  situation  of  a  pebble  may 
afford  him  evidence  of  the  state  of  the  globe  he 
inhabits,  myriads  of  ages  ago,  before  his  species  became 
its  denizens." 


55 2    The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


May  2$,  1904. 


And  surely  the  transportation  of  a  body  of  300  men, 
women  and  children  from  their  habituated  and 
ior  ages  tmcestral  environment,  from  500  N.L.,  through 
the  Tropics,  and  through  1600  of  S.Long. ;  with  its 
ceaseless  gales  of  westerly  winds,  and  in  the  midst  of 
the  innumerable  cataracts  of  breaking  waves,  which 
ever  must  be  giving  forth  energy  in  all  its  modes, 
electrons,  &c,  surely  such  is  an  experiment  on 
bioplasm  which  no  laboratory  devices  can  equal ; 
the  behaviour  of  bioplasm  under  such  changed  con- 
ditions must  be  of  great  interest,  and  if  rightly  observed, 
of  great  value,  as  illustrating  universal  organic  laws 
or  Forms. 

I  may  remark  that,  however  important  may  be  the 
laborious  researches  of  the  bacteriologists  and  bio- 
chemists, yet  that  the  field  of  the  simple  observer,  the 
right  observation  and  interpretation  of  empirical 
human  experience,  are  true  parts  of  philosophic  and 
scientific  method  ;  and  thus  I  would  venture  some 
approximative  hypotheses  on  this  Tarquin  experience, 
which  one  may  perhaps  class  under  the  category  of 
Bacon's  "  prerogative  glaring  instances."  (a) 

It  is  obvious  that  the  immunity  of  the  people  was 
not  due  to  my  re-vaccinations,  as  these  were  gradually 
done,  week  after  week,  even  up  to  the  fourteenth 
week.  Nor  can  I  assert  that  the  immunity  was  due 
to  this  community  of  emigrants  having,  in  general,  at 
embarkation,  good  marks  of  early  life  vaccination, 
because  out  of  274  emigrants  on  board,  of  whom  56 
were  under  12  years  of  age,  I  obtained  136  successful 
arms  ;  the  vaccine  prophylaxis  was  thus,  in  general, 
greatly  expired.  The  fact  remains  that  this  crowded 
community,  whilst  susceptible  to  vaccine  lymph,  was 
immune  to  small-pox  contagion  or  infection.  Were 
my  people  in  one  of  their  periodical  cycles  of  natural 
immunity,  which,  more  or  less,  are  common  to  all 
the  infective  fevers,  or  was  there  some  subtle  stability 
of  their  bioplasmic  molecular  bonds,  produced  by  the 
unknown  but  vast  changes  of  environment  involved  in 
being  launched  from  their  habituated  conditions  and 
co-relations  to  the  sea  climates  ? 

Changes  of  environment  are  found  to  be  the  occasions 
both  of  the  evolution  and  disappearance  of  febrile 
and  infective  diseases  ;  we  are  in  such  instances  carried 
into  a  wider  view  of  disease  than  is  covered  by  the 
germ,  into  the  region  of  the  contained  suscepti- 
bility or  variability  of  bioplasm.  I  do  not  feel 
competent  to  judge  whether  my  people,  so  susceptible 
to  vaccine,  were  in  a  cycle  of  stable  bonds  and  immunity, 
during  which  the  bioplasm  and  system  could  not  take 
on  small-pox  molecular  motions,  or  whether  the  change 
to  the  sea,  to  different  latitudes,  and  to  different 
atmospheric  modes,  gave  bioplasmic  stability.  I 
do  not  think  that  we  have  risen  to  a  sufficient  grasp 
of  what  is  contained  in  change  ;  changes,  infinitely 
subtle,  but  ever  in  operation  and  all  powerful,  have 
determined  the  differences  between  the  palaeontolo- 
gical  fauna  of  plants  and  animals,  and  those  now 
existing  have  determined  the  differences  between  the 
Sikh  and  Afghan  and  the  Bengalee,  &c.  ;  changes 
of  the  cosmic  environment  in  which  we  live,  and  of 
which  we  are  a  reciprocating  part,  are  ever  in  operation, 
determining  both  our  immunity  and  our  capacity  to 
take  on  the  "  motions "  and  conditions  of  disease 
germs. 

In  the  "  prerogative  glaring  instance "  of  the 
Tarquin,  it  is  far  better  to  confess  our  ignorance,  to 
be  "  practised  in  doubting  "  and  not  "  forward  in 
asserting,  .  .  as  of  a  thing  already  discovered, 
le3t  we  be  fit  only  to  confound  things  with  words, 
reason  with  madness,  .  .  but  not  to  interpret 
the  works  of  Nature  "  (Bacon). 

May  I  say  that  though  I  have  but  one  very  indistinct 
vaccine  mark  I  seem  to  be  immune  both  to  vaccine 
lymph    and    small-pox  ?     On    board   the    Tarquin    I 

(a)  Bacon  says  of  "glaring  instances  "— "  .  .  .  They  are  such  as 
show  the  nature  searched  after  naked  and  standing  alone,  and  this 
in  an  eminent  manner ...  as  being1  freed  from  all  impediments. 
.  .  ."  He  adds,  "But  in  these,  caution  must  be  used,  and  the 
alertness  of  the  understanding  repressed,  for  whatever  boasts  the 
form,  and  obtrudes  it,  so  as  that  it  sf  ems  to  meet  the  understand* 
ing,  should  be  held  suspect,  and  recourse  be  had  to  a  careful  and 
severe  exclusion." 


often  re-vaccinated  myself  as  an  example  and  per- 
suader  to  the  people,  but  my  arm  never  "  took."  In 
1872  I  was  in  charge  of  the  Vauxhall  Street  Small-pox 
Hospital,  Plymouth.  I  admitted  ninety-five  cases, 
of  which  twenty  died ;  the  type  was  severe ;  sixteen 
cases  were  of  hemorrhagic  and  purpuric  type.  Of 
the  total  ninety-five  admissions,  thirty-three  had  never 
been  vaccinated,  three  were  doubtful,  fifty-nine  were 
vaccinated.  Of  the  eight  fatal  hemorrhagic  cases, 
six  were  vaccinated,  one  not,  and  one  doubtful;  one 
of  the  fatal  purpuric  cases  had  five  good  vaccine  marks. 
As  this  was  an  emergency  hospital,  I  had  to  spend  some 
hours  daily  in  presence  of  small-pox ;  my  old  immunity 
remained. 

The  experience  of  the  ship  Tarquin  carries  us  more 
into  the  realm  of  constitutional  resistance,  of  harmonic 
stable  bioplasmic  bonds,  than  into  the  minor  region  of 
the  different  molecular  modes  and  "  motions  "  of  the 
unicelled  bacilli. 

Coleridge  tells  us  that  mere  facts  are  barren  without 
their  true  co-relative  ideas.  Coleridge  strove  for 
"  some  master  ideas  "  which  should  give  birth  to  wide 
general  laws.  To  grope  towards  such  "  illuminating 
ideas  "  and  laws,  and  to  put  the  facts  of  the  ship 
Tarquin  in  their  true  place  and  relativity,  I  will  cite  some 
illustrative  and  allied  well-known  instances  of  immunity. 

Cholera. — Sir  R.  Martin  says  : — "  In  the  European 
General  Hospital  at  Calcutta,  in  which  I  served  as 
assistant-surgeon  and  surgeon,  it  was  well  known 
that  of  the  five  native  keepers  and  washers  of  clothes 
who  had,  during  twenty-five  years,  kept  and  washed 
the  hospital  clothing,  not  one  had  cholera,  nor  had 
those  who  assisted  them.  The  same  immunity 
attended  the  native  dressers,  averaging  from  twenty 
to  thirty  men,  who,  during  the  same  number  of  years, 
were  in  constant  and  close  attendance  on  the  cholera- 
sick  all  day  and  all  night ;  nor  were  the  sweepers,  who 
washed  and  dressed  the  patients,  and  who  removed 
the  matters  vomited  and  ejected  by  stool,  ever  affected 
with  cholera." 

This  striking  experience  was  prior  to  the  introduction 
of  a  purer  and  distant  water  supply  to  Calcutta. 
In  Sir  R.  Martin's  day  the  water  used  by  the  natives 
was  taken  from  surface-supplied  tanks  filled  by  the 
rains  ;  yet,  further,  there  was  no  underground  drainage. 
Many  of  the  large  native  staff  of  the  hospital  lived  in 
the  neighbouring  suburb  of  Kiddapore,  a  large  village 
of  huts,  trees,  with  many  such  surface-drained  tanks. 
It  should  be  said  that  the  native  allows  his  tanks  to 
be  grown  over  with  a  film  of  green  vegetation,  and 
clears  this  off  only  at  a  spot  where  the  women  go  down 
to  get  water.  It  is  probable  that  such  vegetation  is  a 
purifier  of  the  water.  The  natives'  practice  is  based 
on  a  wide  empiricism  and  the  experience  of  ages. 
But  in  face  of  all  this  great  contact  with  cholera  and  of 
the  water  drank — always  unboiled — and  of  the  entire 
absence  of  Western  methods  of  hygiene,  the  natives 
had  an  absolute  immunity  from  cholera.  These 
native  servants  must  have  habitually  drunk  myriads 
of  comma  bacilli  with  impunity. 

Contrast  such  an  experience  with  that  of  Dr.  Norman 
Che  vers,  who  says  : — {the  italics  are  his)  "In  cholera 
outbreaks,  he  who  enters  the  epidemic  or  endemic  area 
encounters  special  dangers it  is  dan- 
gerous to  travel  in  the  cholera  area the 

greatest  and    speediest    incidence    of  a  cholera  outbreak 
is  always  upon  those  newly  arrived  in  a  cholera  area.'* 

We  are,  in  these  instances,  carried  into  far  wider 
biological  regions  than  the  bacillus  covers,  into  a 
view  of  the  infinitely  delicate  modes  of  bioplasm,  of 
its  sometimes  stable  bonds,  and  sometimes  recurrent 
instability  ;  we  are  in  presence  of  generic,  even  cosmic 
laws.  We  are,  at  present,  relatively  immune  from 
cholera  in  Britain,  but  the  immunity  is  not  absolute, 
for  every  summer  we  have  the  sporadic  fatal  cholera 
cases.  Baly's  table  for  the  Metropolis  gives  for  eight 
years: — 

Quarter    Quarter        Quarter       Quarter 
ending      ending  ending         ending 

March.       June.       September.  December. 

Annual  average        3*5         5*5  76*25         986 


May  25,   1904. 


ORIGINAL  COMMUNICATIONS.       The  Medical  Press.    553 


But  we  may  even  a  priori  predicate  that  the  bio- 
plasmic  instability  in  Britain  will  at  intervals  recur, 
and  cholera  again  evolve  or  appear  in  epidemic  form. 

The  generic  basis  of  cholera  is  well  seen  in  the  history 
of  the  Broad  Street  epidemic  of  1854  : — 


1854. 

August. 

SirrsMBia. 

29  |  80 

81 

1 

8 

8 

4 

5 

6 

7 

8 

Deaths        from 
Cholera  daily, 
in  the  Perish 
of  8t  James, 
8000.  

t 

8 

4 

72 

127 

76 

71 

45 

40 

84 

801 

80 

Deaths        from 
Cholera  daily, 
in  the  rest  of 
London  

185 

186 

807 

817 

888 

258 

884 

222 

219 

185 

Whatever  may  have  been  the  effect  of  the  Broad 
Street  pump  on  the  sudden  increase  of  cholera  in  Soho, 
we  have  far  more  to  consider  the  great  generic  re- 
current instability  of  bioplasm  in  general  in  London, 
for  we  see  that  the  Broad  Street  outburst  was,  in 
rise  and  fall,  absolutely  synchronous  with  a  parallel 
and  wider  rise  and  fall  in  London.  We  are  carried 
from  the  captivating  rest  in  "  single  causes,"  into  the 
widest  co-relations  of  the  biological  revolution.  Forty 
years  ago,  from  my  experience  with  natives  of  India, 
I  adduced  facts  which  justified  the  hypothesis  of  the 
de  novo  evolution  of  cholera,  on  change  of  environment, 
and  from  what  we  approximatively  call  "  shock  "  to 
the  system.  As  a  corollary  to  such  hypotheses  and 
experience,  I  strongly  advocated  that  immunity  from 
outbreaks  of  cholera  could  be  best  reached  by  giving 
the  native  rest,  warmth,  quiet,  and  protection  from 
the]  "  shock  "  inseparable  from  changing  seasons  and 
latitudes.  I  viewed  cholera,  not  as  a  "  disease," 
not  as  a  demarked  "  specific "  objective  existence, 
but  as  an  orderly  natural  evolution.  Immunity  was 
thus  to  be  sought  in  conserving  his  vital  and  bio- 
plasmic  modes,  in  gently  habituating  him  to  recurrent 
changes  of  climate  and  season.  It  seems  to  me  to  be 
the  bane  of  pathology  that  we  should  ever  be  asserting 
on  "  single  causes "  as  the  occasion  of  disease,  be 
that  disease  cholera  or  phthisis,  &c.  We  need  to 
follow  larger  method  in  pathology,  as  we  do  now  in 
other  sciences.  We  are  being,  in  pathology,  out- 
stripped in  method  by  the  biologists,  chemists,  phy- 
sicists, philologists,  comparative  mythologists,  Ac. 

The  generic  nature  of  immunity  is  well  shown  by 
frr.  Russell's  table  of  typhus  in  Glasgow.  Taking 
decades  : — 


Years.. 


1855   1866 


1875 


1885  1894 


Death-rate  per  million. 

Typnus....     1,291    2,749       192       28         13 


Do.    Small-pox. 


570 


60 


11 


The  possible  influence  of  vaccination  may  have  aided 
the  small-pox  decadence,  but  it  is  no  less  just  to  see 
that  the  great  generic  conditions  which  led  to  the 
immunity  of  the  people  from  typhus  may  have  no  less 
operated  in  the  lessened  small-pox  incidence.  Bio- 
plasmic  stability  had  arisen  in  the  race  or  community. 
My  Tarquin  people  became  immune  to  small-pox 
coincident  with  changed  environment.  Some  occult 
changes,  without  or  within  the  system,  led  to  im- 
munity from  typhus,  and  perhaps  to  small-pox. 

The  influence  of  change  of  environment  on  bioplasm, 
and  of  re-establishing  immunity,  has  been  often  seen. 
Thus,  Dr.  Bobadilla.  at  Gibraltar,  when  yellow  fever 
prevailed,  foretold  truly  that  with  ".  .  .a  north  wind 
which  lasted  seven  days,  and  which  purified  the  atmo- 
sphere completely — the  disease  ceased  "  (the  italics  are 
pr.  Bobadilla's).  Dr.  Blair  says  of  yellow  fever 
in  Demerara,  "  The  return  of  dry,  clear,  cool,  elastic 
atmosphere,  with  sweeping  Trade-winds  from  the 
ocean,  was  always  followed  by  mitigating  effects." 

Innate  immunity  is  seen,  in  that  the  South  Austra- 


lian aborigines  seem  incapable  of  taking  scarlet  fever. 
Livingstone  says  of  the  tsetse  fly  : — "  .  \  .  the 
bite  of  this  poisonous  insect  is  certain  death  to  the  ox, 
horse  and  dog,  and  refers  to  its  harmlessness  to  man 
and  wild  animals,  and  even  to  calves,  so  long  as  they 
continued  to  suck  cows.  .  .  .  The  mule,  ass,  goat, 
enjoy  the  same  immunity  from  the  tsetse  as  man 
and  the  game." 

These  varied  instances  will  open  the  wide  field  of 
immunity  as  a  part  of  biology. 

During  the  past  twenty-five  years  I  have  been  in 
view  of  a  great  stream  of  phthisical  and  praephthisical 
cases.  I  will  not  now  enlarge  on  the  co-relations, 
both  of  structure  and  function,  of  phthisis,  nor  of  the 
atavism  both  of  structure  and  function,  and,  yet  further, 
of  their  alternation,  for  I  have  often  enlarged  on  these 
subjects  in  your  columns,  but  will  now  only  remark 
that  certain  types  of  men  and  women  are  immune  from 
phthisis,  one  may  almost  say  cannot  pass  into  phthisis, 
whilst  others,  almost  inevitably,  will  pass  on  into 
phthisis.  The  experienced  eye  and  receptive  medical 
mind  can  usually  prophesy  aright,  but  so  exquisitely 
delicate  and  kaleidoscopic  is  the  play  of  function 
and  structure  that  no  experienced  and  wise  man  would 
assume  the  rdle  of  prophet.  None  the  less,  nothing  is 
more  true  than  that  men  and  women  of  certain  types 
of  structure  and  function  will,  whilst  others  will  not, 
pass  into  phthisis.  Here  we  see  immunity  co-relating 
with  atavism,  and  alternation  of  structure  and  function, 
extending  back  many  generations.  How  wide  and 
deep,  then,  is,  in  this  instance,  the  basis  of  immunity  ! 
How  infinitely  delicate  in  composition  and  co-relation 
must  be  the  differences  ot  the|bioplasm  of  the  two 
groups,  and  yet  more  so  when  we  see  that  these 
usually  well-marked  types  sometimes  merge,  that  the 
types  graduate,  now  and  then,  into  each  other. 

If  I  desired  to  carry  on  an  immunity  in  any  case 
which  appeared,  by  the  failure  of  one  or  more  functions, 
hovering  towards  phthisis,  I  should  think  it  a  narrow 
philosophy  and  unwise  treatment  to  mainly  fight  the 
bacillus;  I  should  seek,  by  a  well-balanced  tonic 
regimen  all  round,  by  an  adjustment  of  function, 
in  harmony  with  the  powers  and  functions  of  the 
system  generally,  to  balance  into  harmony  the  complex 
system  ;  e.g.,  I  should  give  warmth  at  night,  with 
fresh  air,  but  should  avoid  extreme  night  exposure.  I 
should  view  it  as  the  archetype  of  narrow  view  and 
medical  folly  to  keep  young,  delicate  girls,  of  prae- 
phthisical type,  sitting,  in  our  winters,  in  rooms  with- 
out fires,  or  send  them  to  bed  with  cold  feet  and  shivering 
bodies.  The  delicate  plant  needs  pure  air  and  full  sun- 
shine, and  no  less  the  delicate  patient  needs  warmth  in- 
doors, and  especially  at  night.  Radiant  heat  from  a  good 
fire  is  "  energy,"  both  physical  and  vital ;  warmth  in 
bed  is  the  conservation  of  energy,  physical  and  vital. 
I  should  study  the  special  foods  each  case  longed  for, 
should  avoid  iron  in  any  great  amount,  where  the 
monthly  functions  were  naturally  scant.  I  should 
view  immunity,  in  such  cases,  as  due  to  a  right  balanc- 
ing of  the  complex  and  varied  functions  and  co-re- 
lations of  the  system. 

Alike,  in  the  case  of  the  Tarquin  and  in  the  prae- 
phthisical, how  infinitely  delicate  must  be  the  potential 
differences  of  modes,  between  those  who  pass  into 
disease  and  those  who  remain  immune. 

It  seems  important  that  whilst  clearly  seeing  single 
instances  and  well-marked  differences  in  phenomena, 
we  should  no  less  see  the  wider  forms  and  genera- 
lisations which  embrace  seemingly  different  pheno- 
mena. This  greater  method  is  to-day  common  in 
all  the  sciences.  Thus,  I  may  advance  the  hypothesis, 
that  the  most  extremely  opposite  instances  of  in- 
fectivity  and  immunity  are  parts  of  one  great  bio- 
logical Form  or  principle.  That  Nature,  in  the  realm 
of  disease,  is  often,  in  instances  of  seeming  great  differ- 
ence, in  reality  in  one  orderly  unbroken  continuity. 
To  illustrate  this,  I  will  cite,  as  illustrating  the  extreme 
susceptibility  to  infection  of  "  virgin,"  or  as  yet  un- 
expended modes  of  bioplasm,  the  devastation  in  Fiji, 
in  1874-5,  after  the  introduction  of  measles  from 
Sydney  by  H.M.  ship  Dido  ;  the  outbreak  of  cholera 


554    The  Medical  Press.        TRANSACTIONS  OF  SOCIETIES. 


May  25,  1904. 


at  Kurachi  in  1846  ;  the  outbreak  of  cholera  in  Britain 
in  1832  ;  in  Soho,  1854,  &c.  Such  waves  of  bio- 
plasmic  deviation,  in  these  instances,  seem  to  exhaust 
those  biochemical  modes  which  are  capable  of  passing 
into  those  changes  essential  to  cholera ;  for  after  such 
epidemics,  the  community  is  for  a  long  period  immune. 
Sir  R.  Martin's  instance  of  the  absolute  immunity  of 
the  host  of  native  servants  at  the  General  Hospital, 
Calcutta,  belongs  to  the  same  category  as  do  the 
instances  I  have  quoted  of  the  extreme  libration 
into  or  outbursts  of  cholera ;  all  the  strongly  con- 
trasted phenomena  are  parts  of  one  revolving  circle  of 
the  potentialities  of  bioplasm.  But  we  must  allow 
time  in  the  laws  and  phenomena  of  pathology,  just 
as  we  now  do  in  the  sciences  of  philology,  palaeontology, 
&c. 

Nature  was  infinitely  delicate  in  her  changes  and 
co-relations  in  the  whole  systems  of  Sir  R.  Martin's 
hospital  nurses  ;  nor  less  so  in  the  entire  systems  of 
the  people  in  the  ship  Tarquin. 

It  is  better  to  confess  our  ignorance  than  to  mistake 
the  great  scaffolding  of  our  nomenclatures  for  the 
abiding  and  finished  temple  of  medicine.  All  analogy 
from  other  sciences  points  towards  wide  generalisations, 
and  forms  in  common.  We  are  just  now  in  a  prae- 
Keplerian  stage  of  biology  and  pathology,  waiting 
for  the  expression  of  the  law  of  evolution  of  a  cell 
and  cell-contents.  Deductive  a  priori  ideas  are  as 
essential  towards  the  light  as  are  inductive.  We  are 
just  now  seemingly  crushed  by  masses  of  unmet  ho- 
dised  facts.  In  Caley's  beautiful  researches  on  "  Trees," 
he  shows  mathematically  "  that  theoretically,  for 
a  body  whose  formula  is  Cj8  Hag,  there  exist  799 
Homeric  bodies.  It  is  worthy  of  remark  that  the 
mathematical  theory  agrees  with  experiments  for  the 
first  five  bodies,  thus  affording  strong  confirmation  of 
the  truth  of  the  remainder."  (a) 

In  this  direction  of  research  we  may  be  aided  toward 
the  path  of  pathological  law. 


^Transactions  of   Societies* 


BRITISH  GYNAECOLOGICAL  SOCIETY. 
Meeting    held    Thursday,    May    12th,    1904. 


Professor  John  W  Taylor,  President,  in  the  Chair. 

The  President  showed :  ( 1 )  A  loop  of  semi-gan- 
grenous intestine  removed  from  a  strangulated  hernia 
of  the  abdominal  cicatrix  some  years  after  a  hysterec- 
tomy by  the  clamp  ;  (2)  a  cyst  of  the  broad  ligament 
enucleated  by  the  vagina ;  (3)  a  tubo-ovarian  cyst 
removed  by  posterior  vaginal  cceliotomy ;  and  read 
notes  of  the  cases,  which  will  be  found  on  page  549. 

Dr.  Hey  wood  Smith  asked  what  hindrance  there 
had  been  to  cutting  away  the  cicatricial  ring  of  the 
hernia  and  bringing  the  parts  together ;  would  that 
have  involved  the  sacrifice  of  too  much  of  the  abdo- 
minal wall  ? 

Dr.  H.  Macnaughton-Jones  said  that  the  important 
point  in  regard  to  the  President's  second  case  was  that 
of  diagnosis.  If  it  were  certain  beforehand  that 
one  had  to  deal  with  a  simple  cyst  of  the  broad  liga- 
ment one  might,  no  doubt,  by  attacking  it  by  the 
vagina,  avoid  an  abdominal  cceliotomy,  and  that  would 
be  an  obvious  advantage ;  but  should  there  be  adhe- 
sions or  other  complications  above  the  broad  ligament, 
there  might  be  great  difficulties  in  operating  by  the 
vagina,  just  as  there  were  in  the  vaginal  removal  of 
some  forms  of  ovarian  cyst.  He  had  seen  Schauta 
remove  by  the  vagina  an  ovarian  cyst  of  considerable 
size,  but  he  had  known  most  experienced  men  meet 
with  complications  that  they  had  not  detected  in 
making  their  diagnosis,  and  be  compelled  to  abandon 
the  vaginal  for  the  abdominal  route.  The  diagnosis 
was  much  harder  in  case  of  a  broad*  ligament  cyst,  and, 
personally,  bearing  in  mind  the  risks  of  unknown  com- 
plications and  the  many  points  that  made  the  diagnosis 

(o)  Naiurt.    Vol.  Xil.  483.  «' Report  of  British  Association,  1875." 


obscure,  he  would,  on  the  whole,  prefer  to  attack  a 
broad  ligament  cyst  by  the  abdominal  route. 

The  President,  in  answer  to  Dr.  Heywood  Smith, 
said  that  there  were  two  reasons  for  not  doing  more  than 
he  did  in  the  case  of  hernia  :  First,  the  condition  of  the 
patient,  which,  with  a  gangrenous  bowel  strangulated 
for  four  and  twenty  hours,  was  necessarily  most  critical ; 
indeed,  it  was  a  question  whether  there  was  time  to  do  the 
excision  of  the  bowel  while  she  was  alive  ;  secondly, 
the  induration  and  thickening  of  the  scar  tissue 
were  so  marked  and  so  extended,  as  they 
often  were  in  such  cases,  that  to  have  been  able  to 
distinguish  the  various  constituents  of  the  abdominal 
wall  it  would  have  been  necessary  to  excise  some  inches 
on  both  sides  of  the  original  wound,  and  there  would 
not  have  been  enough  tissue  left  to  close  the  abdomen 
afterwards.  He  did  not  think,  after  the  lapse  of  so 
many  years,  that  there  was  any  possibility  of  restoring 
the  condition  as  it  was  at  first,  unless  the  abdomen  had 
been  so  lax  that  a  considerable  amount  of  the  wall  could 
have  been  sacrificed.  With  regard  to  the  broad 
ligament  cyst,  and  Dr.  Macnaughton-  Jones'  re- 
marks on  its  removal  by  the  vagina,  the  opera- 
tor could  very  easily  recognise  any  complications, 
not  detected  beforehand,  through  the  vaginal  roof, 
and  could,  if  necessary,  alter  his  route  to  the  abdo- 
minal one  ;  moreover,  in  nearly  every  case  in  which 
there  were  such  complications,  the  opening  of  the 
vaginal  vault  would  be  of  help,  for  the  vaginal  drain 
would  be  of  service.  No  simple  uncomplicated  case 
required  drainage,  but  if  the  route  had  to  be  altered 
to  the  abdominal  one,  the  operator  would  probably  be 
glad  of  the  vaginal  drain. 

ADJOURNED   DISCUSSION  ON   THE  DANGERS  OF 
PESSARIES. 

Dr.  H.  Macnaughton-Jones,  before  the  opening  of 
the  discussion  upon  his  paper  on  "  The  Dangers  of 
Pessaries  "  (see  The  Medical  Press  and  Circular, 
April  27th,  1904),  illustrated  the  method  of  making 
supports  to  suit  individual  cases  by  moulding  several 
pessaries  from  the  semi-transparent  celluloid  rings  re- 
commended by  Schultze,  which,  he  pointed  out,  were 
not  only  the  lightest  and  strongest  made,  but  never 
altered  in  form  from  the  shape  so  given  them. 

Dr.  Heywood  Smith  thought  that  as  regarded  the 
dangers  of  pessaries  the  great  pitfall  open  to  practi- 
tioners was  the  mistaken  idea  that  the  application  of 
a  pessary  in  a  case  of  retroversion  was  sufficient  to 
cure  the  displacement ;  indeed,  it  was  not  unsuual  to 
meet  with  cases  of  backward  displacement  in  which 
pessaries  had  been  inserted  without  any  previous 
attempt  to  place  the  uterus  in  its  proper  position.  AD 
that  a  pessary  could  do  was  to  support  the  uterus 
during  the  process  of  cure,  which  sometimes  took 
eighteen  months  or  two  years,  during  which  time  the 
patient  had  to  be  kept  fairly  quiet  so  that  no  relapse 
should  occur.  The  Hodge  pessary  and  its  modifica- 
tions were  the  instruments  most  used  in  this  country. 
The  Smith-Hodge,  when  first  brought  out,  though 
almost  flat,  had  a  slight  curve  at  each  end.  Unknown 
to  each  other,  Dr.  Ambrose  Smith,  of  Philadelphia, 
and  he  himself,  had  devised  the  curve,  which  Dr. 
Macnaughton-Jones,  in  a  slightly  exaggerated  shape, 
called  his  S-shape.  There  were  cases  in  which  the 
uterus  could  not  be  kept  in  position  by  the  Smith- 
Hodge  pessary  unless  the  vaginal  wall,  especially  the 
upper  portion  of  it,  was  put  upon  the  stretch ;  if  the 
pessary  were  too  short,  on  the  least  strain  or  exertion 
by  the  patient,  the  uterus  would  bend  over  the  upper 
arm  of  the  instrument  into  an  increased  retroflexion, 
and  there  would  be  irritation  and  congestion  at  the 
seat  of  the  bend.  When  there  was  congestion  and 
endometritis  it  was  often  best  to  put  the  patient  to 
bed,  bleed  the  uterus,  and  apply  tampons  and  hot 
douches  until  the  uterus  would  bear  reposition  and 
the  support  of  a  pessary.  Dr.  Macnaughton-Jones 
seemed  to  imply  that  bimanual  replacement  had  alto* 
gether  superseded  reposition  by  the  sound  ;  in  that 
he  could  not  concur,  but  considered  that  when  the 
uterus  had  become  fairly  insensitive  and  the  sound 
could   be   passed    without    causing   any   discomfort, 


May  25.  1904. 


TRANSACTIONS  OF  SOCIETIES.       Thb  Medical  Peess.    555 


reposition  by  the  sound  was  a  great  advantage,  as  by  it 
the  fundus  could  be  brought  on  to  the  pubes  and  the 
uterus  placed  in  a  position  of  exaggerated  ante  version 
from  which  it  was  less  likely  to  fall  back  into  retro- 
version. Every  woman  wearing  a  pessary  should  be 
kept  under  observation  to  make  sure  that  the  instru- 
ment kept  its  place.  The  patient  should  not  be  en- 
couraged to  remove  and  replace  it  herself  ;  no  doubt,  if 
carefully  instructed  she  might  take  out  and  replace  a 
ring,  but  a  Smith-Hodge  was  a  different  matter  ;  even 
medical  men  sometimes  put  them  in  wrongly.  More- 
over, if  the  uterus  had  fallen  back,  the  patient  could 
not  replace  it,  and  the  introduction  of  a  pessary  below 
a  displaced  uterus  was  worse  than  useless.  For  ante- 
flexion he  was  sure  that  no  pessary  outside  the  uterus 
was  of  any  benefit ;  some  form  of  intra-uterine  stem 
must  be  employed.  The  patient  should  be  prepared 
by  a  week  or  two  in  bed,  the  cervical  canal  dilated,  and 
a  stem,  preferably  of  glass  with  a  large  button,  slipped 
in.  The  stem  should  be  neither  too  long  nor  too  short, 
and  should  be  retained  in  the  position  by  rest  in  bed 
till  after  the  next  period  was  passed.  He  disapproved 
of  any  string  being  attached  to  the  stem,  as,  when 
soiled  by  discharges,  it  would  form  a  likely  source  of 
septic  trouble.  For  prolapse,  an  elastic' ring  was  the 
best  support,  and.  if  sufficiently  large,  would  often 
obviate  the  necessity  for  a  serious  operation. 

Dr.  C.  H.  F.  Routh  had  no  doubt  that  the  ingenious 
method  described  by  Dr.  Macnaughton-Jones  would  be 
very  useful  in  many  cases,  but  there  was  an  objection 
in  the  fact  that  celluloid  was  a  very  inflammable  sub- 
stance, and  dangerous  to  be  handled  by  servants. 
He  exhibited  several  specimens  of  the  pessary  he  pre- 
ferred himself — a  Hodge  pessary,  which  he  had  supple- 
mented with  a  ring  carrying  a  hollow  stem,  the  ring  being 
on  an  axis  which  allowed  it  play  for  the  movements  of 
the  uterus,  but  the  instrument  could  not  come  away. 
His  plan  was  to  reduce  the  congestion  by  bleeding, 
by  puncture,  or  even  by  leeches,  and  to  introduce  a  sea- 
tangle  tent  adapted  to  the  curve  of  the  uterus  and 
swathed  in  cotton  wool  dipped  in  pure  carbolic  acid. 
This  caused  some  bleeding  for  a  few  days,  and,  when 
be  found  that  the  inflammation  had  passed  away  and 
the  size  of  the  uterus  had  diminished,  he  applied  the 
instrument  and  generally  left  it  in  situ  for  six  months. 
He  had  never  had  any  evil  results  from  this  method, 
which  had  with  him  been  very  successful,  and  especially 
so  in  curing  sterility.  Seven  women  out  of  eight  from 
one  town,  who  had  been  previously  sterile,  conceived 
after  being  so  treated. 

Dr.  Herbert  Snow  said  that  some  objection  might 
be  taken  to  the  title  of  the  paper,  for  which,  perhaps, 
Dr.  Macnaughton-Jones  was  not  altogether  responsible, 
as  it  seemed  to  be  rather  a  laudation  of  pessaries  than 
otherwise.  He  did  not  think  that  the  mischief  arising 
from  pessaries  improperly  introduced,  owing  to  a 
wrong  diagnosis,  should  be  attributed  to  the  pessaries, 
but,  of  course,  the  dangers  attending  their  use  were  real. 
As  a  student  he  had  seen  a  large  ring  shaped  like  a 
cartwheel,  with  two  ridges  on  its  circumference,  dug 
out  of  a  woman's  vagina,  where  it  had  lain  nearly  a 
dozen  years,  and  caused  ulceration  before  and  behind. 
He  xnought  that  the  forms  of  pessaries  used  were  un- 
necessarily numerous  and  complicated.  They  were, 
he  thought,  used  for  three  purposes :  First,  for  the 
relief  of  pain  ;  a  ring  pessary  would  relieve  the  pain  of 
a  prolapsed  ovary  certainly  for  a  time  ;  it  kept  the 
vagina  taut  and  gave  the  needful  support  to  the  re- 
laxed muscular  walls,  and  no  doubt  had  often  some 
effect  by  hypnotic  suggestion,  though  it  was  not  de- 
sirable to  dwell  too  much  on  that.  The  second  purpose 
was  to  retain  in  their  place  organs  which  otherwise 
would  prolapse,  and  he  was  glad  to  hear  Dr.  Heywood 
Smith  say  that  a  prolapse  could  be  retained  by  the 
same  instrument — an  elastic  ring.  Thirdly,  a  pessary 
was  used  to  rectify  the  position  of  a  retroflexed  or 
retroverted  uterus.  Happily,  ante  version  was  not 
now,  as  in  his  student  days,  looked  upon  as  a 
pathological  condition.  Personally,  he  thought  that 
no  pessary  should  ever  be  employed  for  the  rectifica- 
tion of  a  flexion. 
Dr.  R.  H.  Hodgson  said  that  in  an  experience  of 


twenty  years  he  had  never  met  with  an  instance  in 
which  the  introduction  of  a  suitable  pessary,  or  stem, 
in  a  suitable  case,  had  been  followed  by  serious  con- 
sequences. Of  course,  before  any  pessary  was  intro- 
duced, the  congestion  which  had  probably  contributed 
to  the  displacement  should  be  relieved.  A  neglected 
pessary  might  cause  mischief ;  he  had  known  many 
instruments  retained  for  long  periods,  the  worst  case 
being  one  in  which  an  instrument  inserted  by  an 
eminent  surgeon  in  Paris  had  been  left  in  for  several 
years  and  had  caused  a  vesico-vaginal  fistula.  There 
was  some  contradiction  in  the  paper  in  regard  to  the 
"  stretching  "  of  the  vaginal  walls.  It  was  no  doubt 
indispensable  that  the  pessary  should  keep  the  walls 
of  the  vagina  taut,  and  the  omission  of  the  word 
"  stretch  "  would  probably  put  the  description  right 
for  both  classes  of  cases.  As  to  the  action  of  the 
pessary,  the  upper  end  of  it  elevated  the  posterior 
vaginal  vault  and  thereby  the  cervix  also,  but  he  did 
not  see  how  even  an  S  pessary,  properly  introduced, 
could  press  against  the  fundus  uteri.  It  would  only  be 
in  a  very  extreme  backward  displacement  that  the 
fundus  uteri  could  come  in  contact  with  the  floor  of 
Douglas'  pouch,  and  if,  as  was  to  be  presumed,  the 
normal  position  of  the  uterus  had  been  restored  before 
the  pessary  was  inserted,  the  pessary  would  not  even 
press  against  the  body  of  the  uterus.  He  was  sorry  to 
hear  the  use  of  steins  denounced,  because,  while  he  had 
never  seen  any  harm  from  them,  he  had,  in  a  number 
of  cases,  known  them  relieve  pain  that  had  been  of 
years'  duration. 

Dr.  J.  A.  Mansell  Moullin  agreed  with  much  that 
had  been  said  by  Dr.  Heywood  Smith  and  by  Dr. 
Hodgson,  but  did  not  think  they  had  been  quite  correct 
about  the  exact  action  of  the  pessary.  The  first  effect 
of  the  instrument  was  as  described  in  the  paper.  In 
almost  every  case  of  retroflexion  or  retroversion  there 
was  more  or  less  sinking  of  the  vagina,  and  the  first 
action  of  the  Hodge  was  to  elongate  and  restore  the 
vagina  to  its  normal  shape,  but  not  to  stretch  it  or 
even  make  it  taut.  The  second  action  was  merely 
mechanical.  If  the  posterior  vaginal  vault  was  deep 
enough  for  the  pessary  to  rise  well  behind  the  uterus, 
the  fundus  could  not  fall  backwards.  A  tampon  of 
cotton  wool  would  act  in  the  same  way.  He  thought 
that  the  effect  of  the  pessary  as  a  lever  had  been  greatly 
exaggerated ;  the  idea  of  respiration  acting  first  on 
one  and  then  on  the  other  end  of  the  pessary  was  very 
far-fetched. 

Mr.  Stanmore  Bishop  said  he  was  disappointed  not 
to  see  more  general  practitioners  present,  for  he  thought 
that  they  saw  more  of  the  evil  results  of  pessaries,  and 
were  certainly  more  tempted  to  use  them,  than  hospital 
surgeons.  He  entirely  believed  in  the  lever  action  of 
pessaries,  but  thought  that  as  regarded  their  use  a 
distinction  should  be  drawn  between  flexion,  version, 
and  prolapse.  A  flexion  was  often  due  to  softening  of 
the  uterus  from  endometritis,  and  associated  with  in- 
flammation of  the  adnexa,  and  he  thought  that  pes- 
saries in  such  cases  could  do  very  little  good  and  were 
likely  to  do  much  harm.  Yet  it  was  in  flexions  that 
the  practitioner  seemed  most  inclined  to  apply  a 
pessary  and  omit  to  impress  on  the  patient  the  neces- 
sity of  medical  control.  Version  presupposed  a  firm 
body,  against  which  a  lever  could  act  with  effect.  He 
was  glad  to  find  that  ante  version,  as  a  pathological 
condition,  was  practically  ignored,  and  thought  it 
should  be  known  that  the  British  Gynaecological  Society 
condemned  the  use  of  pessaries  in  young  women,  sup* 
posed  to  be  suffering  from  anteversion,  but  whose 
trouble  was  either  hysterical  or  due  to  some  totally 
different  cause.  He  had  the  strongest  objection  to 
the  use  of  a  pessary  merely  as  a  means  of  hypnotic 
suggestion.  He  had  seen  much  evil  result  from  the 
use  of  pessaries  in  young  unmarried  women  for  sup- 
posed pathological  anteversion.  As  regarded  ante- 
flexion, if  its  effects  were  so  serious  as  graphically  de« 
scribed  by  Dr.  Routh,  should  the  operations  of  Duehrs- 
sen  and  Mackenrodt  be  countenanced  for  any  displace- 
ment of  the  uterus  ?  The  most  difficult  cases  of  pro- 
lapse were  in  women  who  would  not  submit  to  opera- 
tion, and  if  one  put  in  a  ring  big  enough  to  retain  the 


556     The  Medical  Press.         TRANSACTIONS  OF  SOCIETIES. 


May  25,  1904 


uterus,  the  woman  probably  failed  to  report  herself  till 
the  instrument  was  coated  with  foul  deposit. 

The  President  said  that  in  regard  to  the  difficulties 
of  diagnosis,  alluded  to  towards  the  end  of  Dr.  Mac- 
naughton-Jones' interesting  address,  he  admitted 
that  such  difficulties  were  met  with,  but  they  should 
maintain  a  high  ideal,  and  it  would  ill  become  the 
Society  to  admit  that  the  difficulties  were  at  all  in- 
surmountable save  in  the  most  exceptional  cases.  He 
had  little  doubt  that  it  was  some  negligence,  some 
want  of  observation  of  symptoms,  oi  history,  as  well  as 
physical  signs,  which  was  responsible  for  the  mistakes. 
He  was  sorry  that  more  had  not  been  said  as  to  the 
real  dangers  of  pessaries  and  their  continued  use,  which 
in  his  opinion  were  twofold.  In  the  first  place,  after 
a  pessary  had  been  worn  for  some  time,  pelvic  disease 
was  apt  to  develop,  either,  he  supposed,  from  the  re- 
kindling of  an  old  inflammation,  possibly  the  original 
cause  of  the  displacement,  or,  alienated  by  the  presence 
of  the  pessary,  the  husband  after  an  impure  connection, 
infected  the*  patient,  or  the  instrument  itself  became 
the  means  of  infection  from  without.  A  pessary  might 
be  worn  for  years,  especially  by  one  who  was  past  the 
change  of  life,  without  any  harm  resulting,  but,  in 
young  women,  it  was  apt  to  lead  to  some  form  of  infec- 
tion. The  second  danger  he  would  mention  was  from 
stretching.  He  held  with  Dr.  Heywood  Smith  that 
a  pessary,  to  be  of  use  in  retroversion,  must  elevate 
the  vaginal  vault  behind  the  cervix,  and  by  doing  so 
it  hangs  up  the  cervix,  like  the  prop  does  a  clothes-line, 
and  the  fundus  falls.  As  a  temporary  measure  that  is 
very  useful,  but  by  stretching  the  sacro-uterine  liga- 
ments it  does  exactly  the  wrong  thing.  In  his  own 
opinion  pessaries  might  be  applied  in  middle  life  in 
order  to  ascertain  whether  the  symptoms  complained  of 
were  due  to  displacement  of  the  uterus  or  not.  If 
they  were  found  to  be  so,  the  case  was  one  for  opera- 
tion. Many  years  ago,  when  Schultze's  book  was  first 
published,  he  had  procured  celluloid  rings  from  abroad 
and  made  pessaries  in  the  way  described  by  Dr. 
Macnaughton-Jones.  He  had  used  them  extensively, 
but  had  not  found  them  satisfactory.  The  figure-of-8 
especially  seemed  to  cause  much  trouble  with  the 
rectum,  and,  like  Dr.  Macnaughton-Jones,  he  had 
reason  to  prefer  the  Smith-Hodge  or  the  S  pessary. 
Moreover,  though  he  got  his  rings  from  abroad,  he 
found  that,  after  lying  for  four  or  five  weeks  in  the 
vagina,  they  did  alter  their  shape.  The  celluloid  now 
supplied  might  quite  possibly  be  better.  He  had 
found  that  for  prolapse  in  oldish  women  the  best 
pessary  for  keeping  up  the  uterus  was  Tait's  modifi- 
cation of  Simpson's  shelf  pessary,  which  had  all  the 
advantages,  without  the  demerits,  of  Zwanke's. 

Dr.  Macnaughton-Jones,  having  thanked  the 
Fellows  for  the  way  in  which  they  had  received  his 
paper,  said,  in  reply,  that  the  dangers  arising  from 
pessaries  might  be  either  of  a  positive  or  negative 
nature.  The  former  he  had  not  dwelt  on  much, 
because  they  were  obvious  to  everyone,  but  rather  on 
the  latter.  His  contention  was  that  pessaries  were 
often  applied  under  conditions  in  which,  not  only 
were  they  useless  and  possibly  mischievous  in  them- 
selves, but  more  dangerous  because  they  led  to  the 
expectant  treatment  of  inflammatory  states  which 
might  be  arrested  and  cured  by  operative  or  other 
measures,  the  woman's  mind  being,  as  had  been  sug- 
gested, "  hypnotised  "  into  the  belief  that  in  some 
measure  her  affection  was  being  cured  and  her  suffer- 
ings mitigated  by  the  insertion  of  a  pessary.  Serious 
pelvic  complications  thus  increased  in  severity,  en- 
dangering the  woman's  life  and  increasing  her  risk 
from  the  final  operative  interference.  As  to  the  term, 
"  letter  S."  which  Dr.  Heywood  Smith  had  referred  to, 
much  ingenuity  could  not  be  claimed  for  simply  altering 
the  shape  and  curve  of  the  original  Smith-Hodge.  It 
decidedly  was  not  well,  in  the  case  of  certain  pessaries, 
such  as  Fowler's  or  Galabin's,  to  leave  it  to  the  patient 
to  remove  or  replace  them,  especially  the  latter,  nor 
could  she  replace  the  modification  of  the  Smith- 
Hodge  or  Galabin  he  had  moulded.  Those  to  which 
he  was  referring  were  the  ordinary  glycerine  ring,  j 
or    the    Smith   Hodge.     There    were    many    circum- 


stances under  which  patients  might  find  themselves 
when  any  pessary  ought  to  be  removed,  and  under 
these  conditions  they  should  at  least  be  able  to 
withdraw  it,  and  she  should  be  taught  how  to 
do  this.  William  Goodell  was  one  of  the  most  prac- 
tical and  discreet  gynaecologists  of  his  day  in  America, 
and  he  (Dr.  Macnaughton-Jones)  had  purposely  taken 
his  amplification  of  Hodge's  view  of  the  action  of  his 
pessary,  and  had  quoted  this  as  he  believed  it  to  be 
complete  and  correct.  The  opinion  of  Matthews 
Duncan  in  England,  of  Gaillard  Thomas  and  Marion 
Sims  in  America,  as  to  the  dangers  which  accrued 
from  the  misuse  of  a  pessary  was  expressed  in  much 
stronger  language  than  that  used  by  him.  All  he  had 
to  say  of  stem  passaries  was,  that  he  did  not  use  them 
save,  as  he  stated,  only  occasionally  and  under  excep- 
tional circumstances  as  a  post-operative  aid  in  main- 
taining dilatation  after  division  of  the  uterine  canal.  It 
was  then  only  worn  for  a  very  short  time.  The  cellu- 
loid stem  was  safe  and  clean,  and  the  string  of  silk  or 
non-absorbable  cotton  attached  for  withdrawal,  if 
necessary,  did  no  harm.  As  to  the  action  of  the  Smith- 
Hodge  or  its  modification,  which  he  had  depicted  as 
the  S  pessary,  he  totally  differed  from  the  opinions 
which  had  been  expressed  as  to  its  mode  of  action. 
He  still  looked  on  it  as  a  lever,  as  explained  by  Goodell, 
when  properly  applied,  and  this  view  was  the  one  that 
he  had  always  held  and  taught,  as  it  also  was  that  of 
Schultze.  The  celluloin  cushio  was  an  admirable 
pessary,  easily  kept  aseptic,  to  be'worn  after  the  uterus 
had  been  retained  in  proper  position  for  some  time, 
and  where  there  was  a  tendency  again  to  retro  vert. 
Robert  Barnes  it  was  who  first  adopted  the  rubber 
cushion  of  air  or  glycerine.  Braxton  Hicks  also  used 
a  pessary  with  a  celluloid  cushion.  He  (Dr.  Mac- 
naughton-Jones) repeated  that  Galabin's  pessary  was 
one  of  the  most  valuable  of  all  means  of  relieving 
certain  symptoms  due  to  exaggerated  and  abnormal 
anteversion  or  to  anteflexion  of  the  uterus.  It  could  be 
closely  imitated,  as  he  had  shown,  by  the  moulding  of 
a  Schultze's  or  wire  celluloid  ring.  He  did  not  agree 
as  to  the  influence  relatively  of  a  flexion  or  a  version 
in  regard  to  the  comparative  hardness  or  softness  of 
the  uterus  on  the  application  of  a  pessary,  for  in  an  old 
flexion  there  was  frequently  a  greater  degree  of  harden- 
ing than  in  the  simple  retroversion.  As  to  prolapse, 
he  felt  strongly  that  pessaries  should  only  be  used  in 
the  very  earliest  stages,  and  never  advised  when  the 
descent  became  more  apparent,  unless  the  patient 
absolutely  refused  operation.  The  very  class  in  which 
prolapse  most  frequently  occurred  was  that  in  which 
operative  measures  were  most  demanded  in  order  to 
enable  the  sufferer  to  earn  her  bread.  If  we  urged 
operations  of  different  kinds  in  other  forms  of  dis- 
placement, it  was  equally,  if  not  more  important  that 
the  woman  who  suffered  from  prolapse  should  be  made 
aware  of  the  probable  if  not  inevitable  misery  before 
her  should  she  decline  operation,  and  she  should  be 
urged  not  to  postpone  it  until  far  graver  and  more 
serious  procedures  would  have  to  be  carried  out.  With 
regard  to  ideal  diagnosis,  while  this  was  doubtless 
always  to  be  aimed  at,  it  was  frequently  not  attained, 
and  several  of  the  conditions  mistaken  for  retro-dis- 
placements were  difficult  to  differentiate,  and  anaes- 
thesia became  a  necessity.  As  he  had  stated  in  his 
paper,  he  had  seen  every  complication  he  had  men- 
tioned or  depicted,  where  a  pessary  had  been  worn  up 
to  the  time  of  an  operation  that  then  disclosed  the 
actual  nature  of  the  condition  present. 

BRITISH  LARYNGOLOGICAL,    RHINOLCGICAL 

AND    OTOLOGICAL    ASSOCIATION. 

Meeting     held     Friday,     May     13TH,     1904. 


The   President,   Mr.   Bark,    F.R.C.S.,   in   the  Chair. 


The  President  said  that  the  Association  had 
sustained  a  great  loss  through  the  death  of  Sir  Philip 
C.  Smyly,  and  he  proposed  that  a  letter  of  condolence 
be  sent  to  Lady  Smyly  and  family. 

This  was  seconded  by  Dr.  Dennis  Vinrace. 

A  letter  was  read  from  the  Laryngological  Society 


May  25,  1904. 


TRANSACTIONS  OF  SOCIETIES.        The  Medical  Press.    557 


inviting  co-operation  in  the  appropriate  celebration  of 
the  100th  birthday,  in  March,  1905,  of  the  inventor  of 
the  laryngoscope,  Senor  Manuel  Garcia. 

Dr.  Dundas  Grant  proposed  that  a  special  Council 
meeting  be  held  to  consider  this  matter. 

This  was  seconded  by  Dr.  Jobson  Hornb,  and 
•carried  unanimously. 

Dr.  W.  H.  Kelson  showed  a 

CASE   OF   POST-NASAL  CASTS. 

The  patient,  a  man,  aet.  36,  had  for  years  suffered  from 
post-nasal  catarrh.  About  once  a  week  a  tough 
fibrinous  disc  the  size  of  a  shilling  formed  in  the  region 
•of  Luschka's  tonsil.  It  became  loose  after  three  or 
four  days,  and  patient  was  able  to  expectorate  it.  Scrap- 
ing, galvano-cautery,  and  caustics  had  been  tried, 
"but  the  disc  reformed. 

Dr.  Dundas  Grant  said    he   considered  this  case 
resembled   Thorn wald's   disease.     He   advised    trans- 
illumination,   a    bacteriological    examination   of    the    | 
crusts,  and  the  use  of  his  new  sniffing  nasal  douche.        j 

Dr.  Wyatt  Wingrave  said  that  as  all  lymphoid 
-structures  had  disappeared,  he  looked  upon  the  case  t 
as  one  of  atrophic  pharyngitis.     He  advised  diminution 
of  the  enlarged  turbinals. 

The  President  was  struck  with  the  report  of  the 
efficacy  of  Dr.  Dundas  Grant's  sniffing  douche,  and 
advised  the  trial  of  Von  Troltsch's  method  of  gargling 
and  washing  out  the  naso-pharynx. 

Dr.  Kelson,  in  reply,  remarked  that  there  was  no 
•sinus  implication  whatever.  The  peculiarity  of  the 
•case,  which  had  been  under  his  treatment  for  some 
time,  was  the  rapid  reformation  of  the  crusts  in  the 
same  situation,  over  the  arch  of  the  atlas.  Scraping 
and  all  ordinary  applications  had  failed  to  prevent 
this. 

Dr.  Kelson  also  showed  a  case  of 

EPITHELIOMA   OF  THE   LARYNX   AND   (ESOPHAGUS 

in  a  single  woman,  aet.  31.  She  suffered  from  dis- 
comfort in  the  throat  for  one  year ;  was  first  seen  last 
January,  when  an  epithelioma  in  the  cricoid  plate 
region  was  found  ;  removal  of  the  growth  was  not 
considered  advisable.  Tracheotomy  became  necessary 
on  March  25  th,  since  which  patient  has  much  improved 
in  health,  and  swallowed  fairly. 

The  President  said  that  he  had  never  seen  epithe- 
lioma of  the  larynx  in  so  young  a  patient  before,  but 
last  year  he  had  shown  a  case  of  epithelioma  in  the 
oesophagus  in  a  still  younger  instance,  viz.,  a  female 
aet.  28.  He  thought  in  this  case  of  Dr.  Kelson's  the 
original  seat  of  disease  had  been  in  the  oesophagus. 

Dr.  Dundas  Grant  said  that  he  had  seen 
several  cases  of  extra  -  laryngeal  epithelioma  in 
comparatively  young  patients,  and  had  had  to  modify 
his  opinions  as  to  the  earliest  age  at  which  the  disease 
might  commence.  The  early  stages  might  look  quite 
unlike  malignant  disease,  and  even  resemble  tubercle 
in  the  larynx  posteriorly. 

Mr.  Fox  remarked  that  there  was  just  a  possibility 
that  the  case  might  be  one  of  sarcoma. 

Dr.  Kelson  also  showed  a  specimen  from  a  case 
of  cut  throat.  He  said  that  this  was  a  rare  specimen, 
as  the  man  had  survived  two  years  after.  Two 
operations  had  been  done  with  the  object  of  uniting 
the  parts,  but  had  failed. 

Mr.  Mayo  Collier  gave 

NOTES  ON  A  CASE  OF  ACUTE  ABSCESS  OF  THYROID  BODY 
AFTER    INFLUENZA, 

and  said  that  this  patient  was  admitted  to  the  North- 
West  London  Hospital  on  April  18  th,  with  a  large, 
pulsating  swelling  on  the  left  side  of  the  neck.  Trachea, 
Ac,  all  displaced  to  the  right.  Dyspnoea,  cyanosis, 
expectoration  blood-stained ;  sweating.  An  ice-bag 
was  applied,  and  the  patient  kept  in  bed.  History  of 
a  swelling  for  some  years,  with  occasional  attacks  of 
dyspnoea,  which  had  always  subsided.  About  9.30 
p.m.  an  alarming  increase  in  the  symptoms  occurred. 
Operation  performed  by  Mr.  Jackson  Clarke  and  Mr. 
Templeton  at  1 1  p.m.  An  incision  about  three  inches 
long  was  made  in  the  middle  line,  and  the  tumour 
partially  isolated.  There  was  severe  haemorrhage 
from  engorged  veins  during  this  stage  of  the  operation. 


and  the  patient  began  to  show  signs  of  asphyxia. 
The  trachea  was  opened  low  down  in  the  neck,  and  a 
tube  introduced.  Artificial  respiration,  injection  of 
strychnine  and  ammonia  to  nostrils  had  no  effect, 
the  patient  never  breathing  again.  Post-mortem. — 
Swelling  limited  to  the  left  lobe  of  the  thyroid.  When 
opened  it  was  found  to  contain  a  quantity  of  thick, 
chocolate-coloured  pus,  extremely  offensive.  The 
swelling  was  adherent  to  the  carotid  sheath.  The 
rings  of  the  trachea  showed  no  signs  of  atrophy 
from  pressure,  and  both  recurrent  laryngeal  nerves 
were  apparently  sound.  Heart. — Muscle  and  valves 
normal.  Right  side  distended  with  clot.  Lungs. — 
Very  (Edematous.  Bronchi  filled  with  frothy  fluid. 
Other  organs  apparently  normal. 

The  President  remarked  that  if  more  Fellows 
would  bring  forward,  as  Mr.  Mayo  Colllier  had  done, 
their  non-successful  cases  much  would  be  learned. 

Dr.  Dundas  Grant  mentioned  a  similar  case  that 
he  had  had  where  death  took  place  very  suddenly. 
He  advised  the  local  application  of  ice,  and  the  use  of 
the  aspiratory  needle,  but  the  moral  of  these  cases  was 
no  delay  in  the  use  of  operative  measures. 

Dr.  J.  Lumsden  showed  nasal  dilators  for  continuous 
dilatation  of  the  anterior  nares  in  cases  of  nasal  ob- 
struction, and  said : — I  am  anxious  to  submit  to 
your  notice  this  small  instrument  for  the  relief  of 
nasal  obstruction,  when  due  to  swelling  of  the  mucous 
membrane  covering  the  nasal  bones.  The  benefits  I 
have  found  to  result  from  the  use  of  it,  by  those  who 
complain  of  stuffiness  in  the  nose,  are(i)  that  it  allows 
the  nose  to  be  thoroughly  cleared  from  discharge  by 
sniffing  air  backwards.  Usually,  this  means  of  clearing 
the  nose  is  rendered  useless  in  cases  of  nasal  obstruction, 
by  the  indrawing  of  the  alae  nasi,  which  occurs  at  each 
sniff.  The  dilator,  by  keeping  the  nostrils  wide,  allows 
a  powerful  current  of  air  to  be  drawn  in,  carrying  with 
it  the  discharge,  the  removal  of  which  is  of  as  much 
value  in  an  inflamed  nose  as  in  an  inflamed  joint. 
(2)  That  it  allows  nasal  respiration  to  be  comfortably 
carried  on  while  it  is  in  place.  Nine  out  of  ten  patients 
who  come  complaining  of  stuffiness  find  that  they 
can  breathe  more  freely  during  examination  of  the 
anterior  nares  than  usually,  and  I  believe  that  the 
temporary  relief  thus  obtained  as  long  as  the  dilator 
is  in  place  is  of  permanent  value  in  two  ways,  (a) 
The  inspired  air,  by  removing  moisture  from  the  mucous 
membrane  as  it  passes,  tends  to  diminish  swelling  in 
that  tissue.  (6)  There  seems  to  be  a  vicious  cycle 
between  swelling  and  the  state  of  obstruction  or 
stuffiness.  By  relieving  the  obstruction,  the  dilator 
breaks  this  cycle.  The  more  swollen  the  mucous 
membrane  covering  the  nasal  bones,  the  greater  is 
the  resulting  obstruction,  and  I  believe  that  the 
greater  the  obstruction,  the  more  tendency  there  is 
for  the  mucous  membrane  to  swell ;  for  the  greater 
the  obstruction,  the  harder  one  has  to  inspire  to  get 
enough  air  through  the  nose,  and  this  increased  suction 
may  sometimes  be  actually  seen  to  suck  out  the 
membrane  over  the  turbinals  towards  the  lumen  at 
each  inspiration.  The  dilator  removes  the  state  of 
stuffiness  or  obstruction,  and  consequently  the  extra 
suction,  and  the  now  unsupported  swelling  recedes, 
leaving  the  nose  permanently  freer  after  the  removal 
of  the  dilator.  I  suggest  the  use  of  the  dilator  during 
the  night,  and  for  a  few  minutes  during  the  day  when 
required  and  when  convenient.  Even  a  few  minutes 
dilatation  allows  the  clearing  of  the  nostrils,  and  relieves 
the  obstruction  due  to  congestion  after  holding  the 
head  down  over  work  or  to  simple  rhinitis.  I  was 
unaware  until  after  constructing  this  dilator  that  nasal 
dilatation  had  been  used  before  for  collapse  of  the 
alae  nasi,  but  I  must  still  be  deluded  if  the  method 
has  been  used  in  the  way  and  for  the  purpose  I  suggest. 
The  instrument  is  neatly  made  by  Messrs.  Arnold  ; 
it  is  inexpensive  (is.  each),  comfortable,  easily  adjusted 
to  the  required  size,  and  is  very  effective.  I  find  it 
much  more  firmly  retained  than  the  other  dilators,  and 
I  should  be  very  much  pleased  if  others  would  give  it 
a  trial. 


558    The  Medical  Press.         TRANSACTIONS  OF  SOCIETIES. 


Mat  2$,  1904. 


The  President  said  that  the  idea  was  a  very  good 
one,  and  he  would  certainly  give  it  a  trial. 

Dr  Andrew  Wylie  stated  that  he  tried  this  dilator 
and  had  found  that  it  afforded  the  patient  great 
relief. 

Mr.  Stuart  Low  had  employed  the  dilator  for  a 
few  hours  after  nasal  operations,  and  the  patients 
expressed  themselves  greatly  relieved,  as  blood  and 
clots  ceased  to  gather. 

Dr.  Dennis  Vinrace  feared  that  the  dilating  effect 
was  too  limited,  not  extending  far  enough  posteriorly. 

Mr.  Barwei.l  thought  that  the  new  nasal  dilator 
would  be  useful  in  some  exceptional  cases  of  nasal 
obstruction. 

Dr.  Wyatt  Wingrave  deprecated  the  constant 
stretching  of  the  alae  nasi,  and  advocated  the  employ- 
ment of  an  india-rubber  tube. 

Dr.  Jobson  Horne  considered  the  simpler  the 
appliances  the  better,  and  spoke  favourably  of  small 
pieces  of  cotton  wool  tucked  up  into  the  recess  of 
the  vestibule  of  the  nose. 

Dr.  Kelson  objected  to  the  conspicuousness  of 
the  new  instrument. 

Dr.  Lumsden,  in  reply,  urged  Fellows  to  give  the 
dilator  a  trial.  He  did  not  bring  this  forward  for 
the  treatment  of  alar  collapse,  as  the  remarks  of  some 
Fellows  seemed  to  imply,  but  as  an  effectual  method 
of  widening  the  entrance  of  the  nostrils  so  as  to  prevent 
their  being  drawn  in  on  inspiration,  especially  deep 
inspiration.  Thus  the  free  access  of  air  was  facilitated. 
It  was  meant  to  be  worn  at  night  chiefly. 

Adjourned  discussion  on  Mr.  Mayo  Collier's 
paper  on 

LATENT    OR    INTERMITTENT    NASAL    OBSTRUCTION. 

Dr.  Sims  Wallace  said  : — In  what  was  to  me  a 
most  instructive  paper,  Mr.  Mayo  Colher  mentioned 
several  of  the  functions  of  the  nose,  but  I  am  led  to 
believe  he  omitted  one  which  is  of  considerable  im- 
portance in  its  relation  to  this  subject  of  nasal  obstruc- 
tion, I  venture  to  submit  that  the  nose  is  not  only 
a  respiratory  organ,  but  it  is  a  perspiratory  organ  also. 
If  we  consider  what  happens  when  we  breathe,  we 
observe  that  a  large  amount  of  air  which  is  drawn  into 
the  air  passages  never  reaches  the  air  cells  of  the 
lungs  at  all,  but  it  is  broken  up.  forming  eddies  over 
the  various  moist  projections  and  recesses  of  the  nasal 
cavity.  The  air  that  ultimately  does  reach  the  lungs 
gets  moistened,  of  course,  but  so  does  the  greater  amount 
which  is  inhaled  without  even  reaching  the  lungs  at 
all.  When  we  are  at  rest  in  bed  and  well  covered, 
perhaps  too  well  covered,  it  is  obvious  that  the  general 
surface  of  the  body  is  not  so  well  adapted  for  the 
perspiratory  function  as  when  we  are  up  and  moving 
about,  and  when  the  air  is  circulating  more  or  less 
freely  around  us.  In  fact,  when  we  are  lying  at  rest 
the  only  parts  of  the  body  over  which  a  current  of  air 
is  freely  passing  are  the  walls  of  the  nasal  cavity  and 
respiratory  passages.  Thus  it  is  perfectly  natural 
that  if  we  get  warm  in  bed,  the  nasal  mucous  membrane 
will  get  congested,  just  as  the  surface  of  the  body  gets 
congested  when  we  become  overheated.  If  the  nasal 
passage  were  not  unduly  narrow,  only  good  would 
result,  for  the  evaporation  caused  by  the  current  of 
air  through  the  nose  would  help  to  keep  the  body 
temperature  normal.  I  need  not  here  refer  to  the 
harmful  effects  of  an  undue  amount  of  perspiration  at 
night,  or  of  an  undue  rise  of  bodily  temperature. 
What  it  is  of  special  importance  to  note  is  that  the 
nose  is  a  perspiratory  organ,  and  if  the  function  of  i 
perspiration  is  interfered  with  or  unduly  taxed,  various  | 
deleterious  effects  are  certain  to  be  brought  about.  , 
Mr.  Collier  has  referred  to  the  fact  that  it  occurs  when  1 
the  patient  is  asleep  ;  perhaps  we  may  ask  if  this  is  j 
not  due  to  congestion  caused  by  warmth  and  the 
position  of  the  head,  in  people  with  narrow  nasal 
passages.  We  may  ask  if  intermittent  nasal  obstruc-  ' 
tion  is  or  is  not  most  apt  to  be  frequent  in  damp 
localities,  for  if  the  atmosphere  is  damp,  the  perspira- 
tory function  cannot  be  carried  on  so  easily  or  effi- 
ciently as  if  the  air  were  dry.  We  may  ask,  too,  if ' 
in  the  treatment  of  this  condition  a  sparse  or  moderate  . 


covering  of  dry  blankets  and  a  dry  locality  is  bene-; 
ficial  or  otherwise,  In  conclusion,  I  should  say  that 
I  have  advanced  these  speculations  without  any 
intention  of  grumbling  at  Mr.  Collier's  paper.  I 
heartily  appreciate  it,  and  have  derived  much  valuable 
information  from  it.  But  I  put  forward  these  sug- 
gestions as  to  the  perspiratory  function  of  the  nose 
in  the  hope  of  gainmg  even  further  information  from 
Mr.  Collier  in  his  reply. 

Dr.  Pegler  admitted  the  susceptibility  of  the 
septum  to  impressions  upon  its  mucous  surface  by 
soft  turbinal  structures,  and  believed  he  had  recognised 
the  grooving  referred  to  by  Mr.  Maya  Collier,  and 
which  that  observer  had  attributed  to  vascular  tur- 
gescence.-  So  far,  however,  that  objective  sign  had 
not  always  been  associated  with  symptoms  of  much 
importance,  so  that  he  could  not  at  present  regard  it 
as  more  than  an  accessory  sign  of  intermittent  ob- 
struction. He  expected  to  find  more  evidence  of 
intra-nasal  irregularities  when  the  sequential  symptoms 
were  as  severe  as  Mr.  Collier  had  described,  nor  was  he 
aware  of  any  one  of  the  former  that  was  absolutely 
pathognomonic  of  intermittency.  He  urged  a  further 
interchange  of  opinions,  aided  by  illustrative  cases  at 
a  future  meeting. 

Dr.  Wyatt  Wingrave  maintained  that  there  was 
an  intimate  relation  between  nasal  obstruction  and 
the  onset  of  puberty,  and  even  between  some  ob- 
structions of  the  nose  and  menstruation. 

Dr.  Dennis  Vinrace  said  he  had  been  very  interested 
in  this  very  able  and  scholarly  paper.  He  asked  for 
some  guidance  as  regards  treatment.  He  believed  that 
many  of  these  cases  would  be  much  benefited  by 
abstinence  from  tea,  coffee,  tobacco,  and  alcohol,  and 
got  plenty  of  fresh  air. 

Mr.  Fox  and  Mr.  Harwell  also  made  some  remarks. 

In  reply,  Mr.  Mayo  Collier  maintained  the  position 
he  had  taken  up  in  this  matter,  and  defended  it  on 
physiological  grounds.  There  was  undoubtedly  varia- 
tion in  air  pressure  in  the  tympani  and  sinuses  during 
respiration.  He  refused  to  agree  with  the  conclusions 
drawn  by  many  from  the  lycopodium  powder  experi- 
ments, and  considered  them  fallacious  and  irrelevant. 
He  had  gone  carefully  into  the  physiology  of  the  upper 
respiratory  tract  in  a  previous  paper,  and  shown 
incontestably  that  the  whole  contents  of  the  nasal 
cavities  and  sinuses  was  set  in  motion  with  each 
inspiration.  There  was  no  such  stream  as  represented 
by  the  lycopodium  experiments.  A  forced  inspiration 
would  undoubtedly  deposit  some  lycopodium  on  the 
middle  turbinal  body.  This  was  no  new  discovery. 
The  act  of  smelling  was  so  arranged  that  a  forcible 
sniff  would  carry  the  particles  of  odour  to  the  olfactory 
region — the  upper  and  middle  turbinal  bodies.  This 
had  nothing  to  do  with  ordinary  inspiration.  The 
relation  of  nasal  obstruction  to  ear  affections  was  a 
most  important  one.  Any  degree  of  nasal  stenosis 
had  a  direct  effect  upon  the  Eustachian  tube  and  the 
tympanic  contents. 

Dr.  Grant  had  asked  for  an  explanation  on  this 
point. 

Mr.  Collier  said  he  was  glad  to  afford  him  this 
explanation  on  the  authority  of  no  less  a  personage  than 
Sir  Michael  Foster.     It  had  been  laid  down  that  {the 
negative  pressure  in  the  upper  respiratory  tract  during 
a  strong  inspiratory  effort  may  vary  from  30   to  74: 
mm.,  and  the  positive  pressure  of  a  strong   expiration 
from  62  to  100  mm.       In  the  face  of  this  statement, 
amply  corroborated  and  perfectly  well  known  to  alT 
physiologists,    how   is   it    possible    to   deny    that   the 
tympanic  contents  are   affected   by  each  inspiration, 
and  that  there  is  a  respiratory  oscillation  of  the  tym- 
panic  membrane  ?     Moreover,   in  nasal   stenosis  the 
negative  pressure  existing    in   the     post-nasal    space 
must   result    in    vascular   dilatation   of   the   mucoos 
lining    of    the    Eustachian    tube,    andjso    to  Eusta- 
chian     obstruction.       The     existence  1  of     complete 
nasal  stenosis  associated  with  perfect  patency  of  the 
Eustachian  tube  in  no  way  mitigates  the  force  of  this 
argument.      The     amount  I;  of      vascular  *  {dilatation 
will  depend  on   the  constitution  of    the^tissues^and 


May  25.  1904. 


TRANSACTIONS  OF  SOCIETIES.       The  Medical  Press.     559 


many  other  points.  An  undeveloped  atrophic 
mucous  membrane  such  as  exists  in  not  a  small  number 
of  cases  would  not  readily  lend  itself  to  vascular 
dilatation  and  general  swelling,  and  so  would  not 
effect  the  patency  of  the  Eustachian  tubes.  Another 
point :  Dr.  Grant  has  suggested  that  the  vascular 
dilatation  produced  by  the  act  of  inspiration  in  cases 
of  nasal  obstruction  would  be  annulled  and  com- 
pensated by  the  act  of  expiration.  This  would  mani- 
festly not  be  so.  The  vessels  would  have  no  time  to 
regain  their  normal  calibre  before  the  next  inspiratory 
act  took  place,  and  so  would  remain  distended,  and 
the  tissues  engorged..  Mr.  Collier  dealt  with  the 
argument  of  Dr.  Sims  Wallace,  Mr.  Pegler  and  others, 
and  expressed  himself  much  pleased  with  Dr.^Sims 
Wallace's  suggestions. 

[The  full  report  of  the  debate  will  be  published  in 
a  subsequent  number  of  The  Medical  Press  and 
Circular.] 

Dr.  Jobson  Horns  gave  a  lantern  demonstration 
on  Pachydermia  Laryngis. 


ROYAL   ACADEMY  OF  MEDICINE  IN  IRELAND. 
Medical  Section. 
Meeting  held  Friday,  May  13TH,  1904. 


The  President,  Sir  A.  V.  Macan,  in  the  Chair. 


Dr.  Drury  read  a  paper  on  "A  Fatal  Case  of 
Myxoedema."  A  married  woman,  set.  42,  the  mother 
of  ten  children,  had  been  ill  for  an  indefinite  period, 
but  had  been  confined  to  bed  at  home  for  four  and  a 
half  months,  without  having  had  medical  treatment. 
She  was  admitted  to  Sir  Patrick  Dun's  Hospital  on 
February  29th,  1904,  in  a  condition  of  the  most  pro- 
found asthenia,  though'  conscious ;  neither  pulse  nor 
heart  sounds  could  be  made  out,  and  no  available 
clinical  thermometer  would  register  her  temperature. 
She  presented  unmistakable  signs  of  advanced  myx- 
oedema. On  the  second  day  a  suitable  thermometer 
showed  her  temperature  to  be  86°  F. ;  the  pulse  and 
heart  could  be  with  difficulty  made  out,  the  rate  being 
52  per  minute.  Slight  wheezing  was  noticed  in  the 
lungs.  This  developed  during  the  next  two  days  to 
general  bronchitis,  and  she  died  early  on  the  morning 
of  the  fifth  day.  The  highest  temperature  recorded 
was  89*6°  F.,  the  lowest  820  F.  She  was  put  on  thyroid 
extract  ij  gr.  twice  a  day,  at  once.  The  immediate 
cause  of  death  was  considered  to  be  bronchitis,  induced 
by  the  extreme  severity  of  the  weather  of  the  last  day 
of  February,  when  she  was  removed  to  hospital.  No 
post-mortem  could  be  obtained. 

Dr.  James  Craig  said  he  was  interested  in  the 
lumbar  pain  complained  of  by  Dr.  Drury's  patient. 
He  had  seen  a  young  gentleman,  aet.  32,  who  suffered 
great  pain  in  his  back  at  the  onset  of  acute  myxoedema. 
Though  the  case  was  severe  and  acute  a  good  recovery 
was  made  on  thyroid  extract.  Dr.  Craig  questioned 
whether  Dr.  Drury  had  given  sufficient  thyroid  extract 
in  the  fatal  case  recorded. 

Dr.  C.  M.  O'Brien  read  a  paper  on  the  present 
position  of 

radium  in  therapeutics, 
with  a  rtsumi  of  the  Finsen  light  and  X-ray  treatment. 
He  exhibited  two  cases  of  lupus  treated  by  radium 
bromide.  ( 1 )  A  male,  set.  30,  with  a  small  patch  over 
eyebrow  of  two  years'  duration  cured  after  twenty 
applications  of  ten  minutes  each,  extending  over  six 
weeks.  (2)  A  female,  aet.  16,  with  a  patch  on  cheek 
of  seven  years'  standing,  similar  in  size  and  depth  to 
the  preceding.  She  had  received  already  sixty-one  appli- 
cations extending  over  twelve  weeks,  twenty  of  ten 
minutes  without  any  perceptible  change,  twenty  of 
half  an  hour  with  slight  redness  and  itching,  and  six 
of  one  hour's  duration.  Her  condition  improved, 
but  not  cured.  The  same  specimen  of  radium  was 
employed  in  each  case,  and  under  like  conditions.  It 
would  appear  from  the  foregoing  that  personal  sus- 
ceptibility of  patient,  so  important  a  factor  in  both  the 
Finsen  light  and  X-rays,  may  also  have  to  be  reckoned 
with  in  treatment  by  radium  rays.     He  preferred  de- 


tailing what  had  been  achieved  and  how  he  achieved 
it,  rather  than  expressing  an  opinion  on  the  merits  of 
the  metal  which  might  in  any  way  prevent  other 
workers  from  putting  it  to  the  test.  Radium,  to  be  of 
practical  use  in  medicine,  must  be  forthcoming  in 
larger  quantities  of  a  guaranteed  standard  of  activity, 
and  at  a  very  much  cheaper  rate.  He  exhibited  a 
number  of  lupus  cases  treated  by  the  Finsen  light  and 
X-ray  methods,  some  of  whom  he  exhibited  as  cured 
twelve  months  ago,  and  who  have  remained  so  without 
any  treatment  meantime.  He  also  exhibited  cases  of 
lupus  erythematosus,  psoriasis,  and  verruca  plana,  with 
gratifying  results.  His  experience  of  the  X-rays  in 
rodent  ulcer  and  large  tracts  of  ulcerated  lupus,  and 
in  lupus  of  the  nares,  was  very  encouraging.  For 
superficial  circumscribed  lupus,  and  finishing  off  after 
X-rays,  the  Finsen  method  holds  supremacy,  but 
sittings  of  not  less  than  an  hour's  duration  must  be 
enforced. 

Dr.  Kirkpatrick  had  seen  good  results  from  the 
radium  treatment  of  lupus.  He  thought  it  more 
efficient  when  used  in  larger  quantity  than  Dr.  O'Brien 
had  done. 

Dr.  Walter  Smith  recounted  his  experience  of  the 
use  of  radium  in  cases  of  rodent  ulcer.  The  result 
was  good  in  all  his  cases. 


THE   AMBIDEXTRAL   CULTURE   SOCIETY. 
Meeting  held  April  25TH,  1904. 


Mr.  Noble  Smith,  F.R.C.S.,  in  the  Chair. 


The  Rev.  H.  J.  D.  Astley  read  a  paper  on- 
"  Ambidexterity  and  Primitive  Man,"  which  he 
defined  as  meaning  "  Early  or  Prehistoric  Man." 
The  analogy  of  the  quadrumana,  apes,  and 
monkeys  makes  it  probable  that  man,  in  his 
beginnings,  was  ambidextrous.  The  evidences  that 
he  was  so  are  few  but  sufficient.  These  consist  of 
(1)  Flint  implements  from  the  plateaux  of  Kent,  near 
Ightham,  which  date  from  man's  earliest  appearance 
in  Britain,  and  have  been  called  "  Eolithic,"  though  he 
would  prefer  to  call  them  "  proto-palaeolithic."  At 
any  rate,  they  go  back  to  the  first  inter-glacial  period, 
and  are  probably  contemporary  with  the  lilloux- 
Taubach  deposit  in  France.  Among  these,  rude  and 
rough  though  they  are,  scrapers,  hammers,  and  poun- 
ders have  been  found  clearly  adapted  for  use  in  the 
left  hand,  and  these  as  numerous  as  those  adapted  for 
use  in  the  right.  (2)  As  time  went  on,  palaeolithic  man 
learnt  to  heft  his  implements  and  weapons,  hence  it  is 
difficult  to  say  anything  definite  as  to  these.  But  he 
was  an  artist,  on  the  fact  that  his  representations  of 
the  mammoth,  the  reindeer,  horses'  heads,  &c,  were 
drawn  with  equal  facility  from  right  to  left  as  from 
left  to  right,  we  have  evidence  that  he  drew  with  both 
hands  impartially.  (3)  Neolithic  man,  of  course K 
hefted  most  of  his  weapons  and  implements ;  but 
certain  articles  of  domestic  use  were  employed  withcut 
a  handle,  such  as  pounders,  meat-crushers,  hammers, 
knives,  scrapers,  awls,  and  borers ;  and  it  has  been 
found  by  a  study  of  the  flakings  that  those  adapted: 
for  use  in  the  left  hand  are  nearly  as  numerous  as  those 
intended  for  the  right.  But  by  this  time  man  was  losing 
his  primitive  ambidexterity,  and  the  right  hand  was 
becoming  more  and  more  the  active  member  in  the 
economy  of  the  body,  and  the  left  hand  the  passive. 
This  was  due  to  the  fact  that  in  hunting  and  warfare 
the  right  hand  was  used  for  offence,  the  left  for  defence. 
In  spite  of  this  the  evidence  of  early  Greek  and  Roman, 
inscriptions,  written  in  what  is  called  the  "  Boustro- 
phedon  "  style,  i.e.,  alternately  from  left  to  right  and. 
from  right  to  left,  goes  to  show  that  ambidexterity 
was  still  practised  in  writing.  Babies  are  naturally 
ambidextrous,  and  children,  who  commence  conscious 
life  at  the  neolithic  stage  of  culture,  are  so  also,  and' 
would  continue  so,  were  they  not  taught  otherwise. 
It  is  said  that  "  idiots  "  show  a  marked  tendency  to- 
re vert  to  this  type,  and  also  "  persons  of  genius." 


56o     The  Medical  Press. 


GERMANY. 


May  2$,  1904. 


France. 

[from  our  own  correspondent.] 

Paris,  Maj  22nd,  9014. 
Tumours  of  the  Orbit. 
Certain  tumours  of  the  orbit,  says  Dr.  Trousseau, 
•are  so  rare  that     it  is  really  impossible  to  recognise 
them.     Some  varieties  have  only  been  mentioned  once 
or  twice  in  scientific  publications.     For  the  others, 
if  care  be  taken,  the  means  of  arriving  at  a  proper 
diagnosis  are  simple  and  easy. 

The  symptoms  revealing  tumours  of  the  orbit  are  : — 
Exophthalmia,  change  in  the  form  and  loss  of  mobility 
*of  the  ocular  globe,  symptoms  of  compression  of  the 
nerves,  (pain,  paralysis,  diplopia),  of  the  vessels  (oedema 
•of  the  conjunctiva),  and  the  eyelids  (chemosis,  dila- 
tation of  the  subcutaneous  veins),  of  the  globe  mani- 
fested by  a  change  in  the  refraction,  myopia  being  due 
to  lateral  compression,  hypermetropia  to  a  flattening 
from  front  to  back,  while  the  optic  nerve  is  frequently 
found  to  be  atrophied  where  the  compression  is  pro- 
longed. 

All  these  symptoms  can  exist  together  or  singly, 
-and  be  more  or  less  marked  according  to  the  place 
•occupied  by  the  tumour,  but  of  all  these  signs  the  most 
important  is  doubtless  exophthalmia  ;  consequently, 
the  general  symptomatology  of  the  tumours  may  be 
divided  into  three  distinct  periods — (1)  Previous  to 
the  exophthalmia ;  (2)  exophthalmia  exists,  but 
tumour  not  yet  apparent ;  (3)  tumour  apparent. 
Previous  to  exophthalmia. — Lagrange  does  not  admit 
the  existence  of  a  tumour  without  exophthalmia,  as, 
<be  the  neoplasm  ever  so  little"  it  pushes  the  eye  out  of 
the  orbit  in  the  exact  proportion  of  the  place  it  occupies 
'itself.  This  is  evident,  and  too  much  care  cannot  be 
taken  to  discover  exophthalmia,  which  sometimes 
requires  a  very  attentive  examination  of  both  eyes. 

Where  exophthalmia  is  well  characterised,  it  is 
necessary  to  be  assured  that  it  is  the  consequence  of 
a  tumour,  for  exophthalmia  is  not  always  symptomatic 
of  a  tumour  ;  it  can  be  produced  under  other  conditions. 
Inflammatory  lesions  of  the  orbit,  osteo-periostitis, 
abscess,  thrombosis  of  the  sinus,  easily  discovered  by 
the  cerebral  symptoms,  haematoma  of  the  orbit,  which 
appears  suddenly  and  accompanied  sometimes  by 
palpebral  ecchymosis,  emphysema,  confirmed  by  crepi- 
tation. 

In  exophthalmic  goitre,  the  procidence  is  double 
•and  accompanied  by  thyroidian  and  cardiac  symptoms. 
The  benignant  or  malignant  nature  of  the  neoplasm 
will  be  elucidated  by  taking  into  account  the  general 
condition  of  the  patient,  the  more  or  less  rapid 
development  of  the  tumour,  the  pain,  heat,  and  engorge- 
ment of  the  ganglions  which  are  produced.  •  pu. 
Sometimes  a  puncture  or  exploratory  incision  is 
-necessary  to  clear  up  the  diagnosis. 

When  the  tumour  is  visible,  the  diagnosis  can  be 
made  with  precision,  thanks  to  the  personal  character 
•ofj  the  neoplasm  cysts,  vascular  tumours,  osteo- 
tfibroma,  lipoma,  carcinoma,  and  sarcoma. 

The  cysts  are  congenital  or  acquired.  The  former 
'comprise  dermoid  cysts,  serous  meningocele.  They 
are  generally  seated  inside  the  cavity  ;  they  are  mobile 
■and  attached  to  the  bone  by  a  fibrous  tract.  Meningo- 
cele is  observed  at  the  inner  angle ;  it  can  be  easily 
reduced  and  receives  the  pulsations  of  the  pulse  and 
the  respiration  transmitted  from  the  brain  to  the 
tumour.  Acquired  cysts  are  generally  of  lachrymal 
•origin. 

The  vascular  tumours  are  pulsatile  or  non-pulsatile. 
'The  former  are  easy  to  recognise.     The  eye  is  protrud- 


ing, the  vessels  of  the  eyelid,  the  conjunctiva,  and  of 
the  neighbourhood  are  dilated.  The  hand  of  the 
surgeon  feels  distinct  pulsations,  and  if  he  applies  his 
ear  he  perceives  a  whistle,  also  felt  by  the  patient. 
Under  pressure  of  the  hand,  the  eye  recedes  into  the 
orbit,  and  if  the  carotid  is  compressed,  the  exophthal- 
mia disappears  as  well  as  the  whistling. 

Osteoma,  as  the  name  indicates,  is  seated  on  the 
walls  of  the  orbit,  especially  the  frontal,  and  is  recog- 
nised by  its  large  bases  and  its  particular  hardness. 

Fibroma  is  a  hard  tumour  of  slow  development. 
Lipoma  is  an  indolent,  semi-fluctuant  tumour  without 
pulsations  and  never  causes  serious  trouble. 

Carcinoma  of  the  orbit  is  so  rare  that  it  need  not  be 
taken  into  account.  Sarcoma,  on  the  other  hand,  is 
very  common  and  almost  always  requires  interference. 
The  malignant  tumour  may  be  seated  in  the  eye,  de- 
stroying its  envelopes,  or  on  the  periosteum  of  the  roof 
of  the  orbit,  producing  a  painful  swelling  of  the  bone, 
vascular  dilatation  of  the  region,  and  destroying  all 
the  soft  parts  in  its  rapid  development. 

Before  an  operation  is  decided  on  the  direction  of 
the  exophthalmia  should  be  studied  with  care,  the 
nose  and  the  pharynx  should  be  explored,  the  cerebral 
symptoms  weighed,  and,  if  possible,  the  diagnosis 
should  be  cleaerd  up  by  the  aid  of  the  radiograph  and 
the  radioscope. 

Germans. 

[from  our  own  correspondent.] 

BcftLtir,  Kay  Slit,  1»4. 
At  the  thirty-third  meeting  of  the  German  Surgical 
Society,  Hr.  Pels-Lensden  spoke  on 

Injuries  to  the  Spleen  and  Diaphragm. 
and  showed  a  patient.     The  injuries  were  caused  by 
a  discharge  of  small  shot  from  a  shot-gun  at  a  distance 
of  about  nineteen  inches  into  the  pleural  and  abdo- 
minal cavities.     The  speaker  first  saw  the  case  five 
hours  after  the  infliction  of  the  injuries,  and  then  the 
following  conditions  was  present :    The  omentum  had 
partly  passed  out  through  the  opening  of  entrance; 
there  was  pneumothorax,  and  the  heart  was  displaced 
a  good  deal  to  the  right.     An  incision  was  made  from 
the  wound  opening  backwards,   and  a  piece  of  the 
spleen  that  was  torn  off  removed,  and  also  a  portion 
of  rib  that  had  been  shattered.     The    stomach,   the 
transverse  colon,  and  a  portion  of  the  omentum  were 
in    the   thoracic   cavity.     A   lengthened   incision  was 
necessary  before  the  parts  could   be   replaced  in  the 
cavity  of  the  abdomen.     The  bulk  of  the  shot  lay  in 
the  second  half  of  the  spleen  and  was  removed.    The 
diaphragm,  which  was  torn  from  the  centre  backwards, 
was  united  by  suture,  the  lacerated  abdominal  wound 
was  pared  smooth,  and  a  tampon  inserted,  and  the 
thoracic  cavity  closed.     No  symptoms  of  peritonitis 
appeared,  only  a  phlegmon  of  the  abdominal  wall  and 
an  empyema  which  delayed   recovery.     The   patient 
was  still  pale,  but  had  increased  about  five  pounds  in 
weight  in  a  fortnight.     The  pus  from  the  chest  cavity 
was  steadily  diminishing.     A  definite  recovery  would 
have  a  material  influence  on  the  later  judicial  proceed- 
ings. 

*  Hr.  Festig  related  a  case.  A  man  was  crushed  by 
a  horse  against  a  wall.  When  the  speaker  first  saw 
the  case  there  was  jaundice,  the  urine  was  dark- 
coloured,  there  was  great  emaciation  with  peritoneal 
effusion,  and  on  exploratory  puncture  deeply  bile- 
stained  fluid  was  withdrawn.  Laparotomy  was  per- 
formed. The  peritoneum  was  obliterated,  the  intes- 
tines glued  together,  no  injury  of  choledochus.    On 


May  25,  1904. 


AUSTRIA. 


The  Medical  Press.    561 


the  convex  surface  of  the  liver,  however,  there  was  a 
deep  tear,  out  of  which  bile  welled  up ;  but  very 
little  haemorrhage.  The  tear  was  sutured;  a  fistula 
formed,  however,  through  which  sequestra  of  liver 
were  subsequently  passed.  The  patient  had  now  quite 
recovered  and  had  gained  25  lbs.  in  weight. 

Hr.  Thole  reported  the  results  of  experiments  on 
animals  in  regard  to  arrest  of  haemorrhage.  He  had 
examined  the  blood  of  the  portal  vein  thirteen  times, 
and  had  always  found  it  sterile.  According  to  this 
it  was  not  so  impure  as  Langenbuch  had  assumed. 
Possibly  if  pus  was  present  bacteria  would  find  their 
way  into  the  portal  vein  and  into  the  liver,  otherwise 
infection  would  proceed  from  the  bile  passages. 

Hr.  von  Frisch,  Vienna,  had  a  man  under  treatment, 
in  November  last  for  gun-shot  wound  in  the  region 
of  the  stomach.  After  opening  the  abdomen  an 
entrance  opening  was  found  in  the  anterior  wall  of 
the  stomach,  but  no  opening  of  exit  and  no  projectile. 
Recovery  took  place  after  closure  of  the  wound  in 
the  stomach.  Later  on  the  projectile  was  found  in 
the  muscles  of  the  back  ;  it  must,  therefore,  have  passed 
through  the  posterior  wall  of  the  stomach,  although 
no  trace  of  the    opening  could  be  found. 

Hr.  Schlange,  Hanover,  said  that  only  rarely  one 
came  to  the  conclusion  to  operate  on  a  movable  liver. 
There  could  only  be  question  of  such  operation  if  the 
liver  was  very  low  down,  gave  rise  to  grave  symptoms, 
and  could  not  be  supported  by  bandages.  If  an  opera- 
tion had  to  be  performed,  the  liver  must  be  fixed  very 
firmly  or  the  time  spent  on  the  operation  would  be 
wasted.  He  himself  cut  through  the  muscles  at  the 
costal  margin,  fixed  the  peritoneum  on  to  the  posterior 
surface  of  the  liver,  so  that  it  became  attached  to  the 
chest  wall. 

Hr.  Korte,  Berlin,  followed  with  a  paper  on 
The  Connection  between  Diseases  of  the  Bile- 
Passages  and  Inflammation  of  the  Pancreas. 
He  said  that  when  that  part  of  the  bile-duct  that 
passed  through  the  pancreas  was  inflamed  the  peri- 
pancreatic  tissue  and  the  pancreas  itself  might  easily 
suffer  also.  There  were  numerous  lymph  glands  there 
that  became  swollen  and  suppurated,  and  the  inflam- 
mation spread  out  thence  to  tne  pancreas.  The  duct 
became  compressed  by  calculi,  and  the  secretion 
became  blocked,  with  subsequent  inflammation.  The 
papilla  duodeni  emptied  both  the  bile  and  the  secre- 
tion of  the  pancreas  into  the  bowel.  Chronic  pan- 
creatitis was  therefore  not  infrequent  in  cases  of 
cholelithiasis.  He  had  seen  acute  pancreatitis  seven 
times,  abscesses  in  the  head  of  the  gland  twice  (one 
case  fatal),  peripancreatitis  twice  (with  one  death), 
and  once  necrosis  of  the  pancreas.  In  four  cases  there 
were  gall-stones,  once  there  was  cholecystitis  without 
stones ;  here  the  pus  had  passed  into  the  pancreas. 
As  regarded  symptoms  there  was  epigastric  pain  as 
in  gall-stones,  also  peritonitis  of  the  upper  part  of  the 
abdominal  cavity,  and  a  tendency  to  collapse.  The 
chief  symptom  as  regarded  differential  diagnosis  was 
the  presence  of  a  tumour  running  across  the  epigas- 
trium. Of  the  seven  cases,  four  died  and  three  re- 
covered. In  five  cases  only  operation  for  gall-stones 
was  performed  (one  recovered,  there  was  necrosis  of 
the  fatty  tissues  and  packing  with  strips  of  iodoform 
gauze).  In  one  case  there  was  a  calculus  near  the 
papilla  ;  the  choledochus  was  freed  retro-peritoneally ; 
there  was  an  abscess  in  the  pancreas  which  was  opened  ; 
the  stone  was  removed  through  the  duodenum.  The 
patient  recovered.  In  one  case  a  fistula  of  the  pancreas 
remained  behind,  which  closed  up  later.  For  opening 
up  the  pancreas,  he  made  the  incision  like  Riedel  from 
the  ensiform  cartilage  at  the  margin  of  the  ribs  to  a 
little  below  the  umbilicus. 


Austria* 

[from  our  own  correspondent.] 

Vibvva,  May  21st,  1001. 
Elephantiasticum  Vagina. 

At  the  Gesellschaft  der  Aerzte  Reimann  presented  at 
female~with  a  chronic  ulcer,  about  the  size  of  a  crown, 
with  enormous  thickening  of  the  vulvae  of  the  vagina, 
as  well  as  of  the  vagina  itself.  Two  years  after  the 
increased  thickening  commenced,  she  acquired  syphilis, 
which  proves  that  the  origin  of  the  disease  was  not 
due  to  syphilis  in  the  first  place ;  neither  could  the 
ulcer  be  attributed  to  this  disease,  as  it  also  existed 
within  the  vagina  long  before  the  infection. 

Matzenauer  remarked  that  this  case  disposed  of  the 
hypothesis  that  this  kind  of  thickening  was  entirely 
due  to  syphilis,  even  when  that  disease  could  not  be 
proved  to  exist.  There  was  certainly  good  ground 
for  the  supposition,  as  the  ulceration  which  also  existed 
in  this  case  was  almost  positive  proof  that  some 
necrotic  poison  was  at  the  root  of  the  disease. 

Riehl  agreed  with  Matzenauer,  and  considered  that 
this  disease  should  be  recognised  as  sui  generis. 

Neumann  related  the  experience  of  one  of  his  assist- 
ants on  this  subject,  who  had  written  a  monograph, 
on  this  disease  as  one  derived  from  syphilis.  He 
admitted  the  clinical  appearance  to  be  very  similar, 
but  the  facts  of  this  case  were  against  such  a  con- 
clusion. 

Weinlechner  remarked  that  he  had  a  somewhat 
similar  case  of  lupus  hypertrophicus  in  the  genitals, 
where  the  primary  cause  was  tuberculosis.  He 
thought  the  ulcer  in  this  case  pointed  to  the  same 
origin. 

Passive  Immunising. 

Hamburger  and  Dehne  gave  a  record  of  their  ex- 
periments, and  averred  that  it  can  be  demonstrated 
both  in  the  test-tube  and  on  animals  that  the 
injection  of  serum  thrown  into  the  organism  will 
neutralise,  within  two  or  three  days,  its  corresponding 
generator.  This  was  considered  by  them  a  fact  in 
practice  of  considerable  value  as  prophylaxis  could 
often  be  resorted  to  in  the  treatment  of  disease.  They 
go  further  and  affirm  that  different  species  of  animals 
have  sera  that  will  accomplish  the  same  end. 

Pick  thinks  this  can  be  carried  too  far,  as  these 
animal  sera  reduce  the  resistance,  such  as  scarlet  fever, 
that  opens  the  system  to  diphtheria  in  which  case  the 
serum  works  very  badly.  Again,  these  antitoxins 
produce  a  precipitate  in  the  blood  that  acts  as  a  mecha- 
nical irritant  and  a  menace  to  life. 

Hamburger  thought  the  theory  of  reduced  resist- 
ance was  rather  exaggerated,  as  all  his  control  subjects 
were  not  so  exposed. 

Theocin  Exanthemata. 

Pauli  showed  a  case  of  medical  exanthemata  after 
the  use  of  theocin.  The  whole  quantity  administered 
was  only  1*5  grammes,  which  was  spread  over  two  days. 
The  rash  was  associated  with  malaise,  vertigo,  itching 
and  a  rash  resembling  urticaria  over  the  body,  parti- 
cularly the  lower  part.  He  thought  these  skin  erup- 
tions were  not  uncommon  from  theocin  and  their 
allied  derivatives  or  isomers  in  methyl  (C  H3).  In  the 
same  way  antipyrin  by  the  displacement  of  hydrogen 
in  the  amido  group  (H  N2)  to  produce  pyramidon, 
which  is  three  times  that  of  antipyrin,  but  less  irritable 
on  the  skin  than  the  same  combination  of  methyl. 

Weidenfeld  said  this  law  of  methyl  additions  did  not 

always  hold  good, as  he  has  seen  pyramidon  exanthemata 

'  very  frequently,  and  that  also  when  given  in  small 

I  doses.     The  chemical  composition   of   the   drug   was 


562    The  Medical  Press. 


OPERATING   THEATRES. 


May  25.  1904. 


not  so  much  to  be  considered  as  the  colour,  which  was 
peculiar — antipyrin  being  blue,  while  pyramidon  had 
•a  red  exanthemata. 

Ehrmann  thought  these  comparisons  rather  falla- 
cious, as  antipyrin  was  very  much  more  prescribed  in 
practice  than  pyramidon,  and  therefore  more  exan- 
themata must  be  expected. 

Pauli  remarked  that  the  use  of  the  drug  was  not  the 
determining  force  in  the  production  of  the  exanthe- 
mata, neither  was  the  quantity  taken,  but  the  sus- 
ceptibility of  the  individual  was  the  true  measure  to 
be  applied,  and  not  the  quantity. 

Practical  Importance  of  Blood  Pressure. 

Geisbdck  drew  the  attention  of  the  Society  to  the 
importance  of  blood  pressure  in  the  diagnosis  of  disease, 
and  made  a  distinction  between  temporary  and  per- 
manent pressure.  Temporary  low  pressure  was  met 
with  in  acute  infectious  diseases,  and  notably  in  tuber- 
culosis, while  injections  of  tuberculin  have  the  same 
effect.  Chloral  hydrate  does  not  reduce  the  heart  as 
much  as  it  reduces  the  arterial  pressure,  which  becomes 
more  dangerous  after  prolonged  use.  Psychical  irri- 
tation, indulgence  in  tobacco,  alcohol,  &c,  reduce 
pressure.  The  current  notion  that  the  blood  pressure 
is  raised  by  giving  alcohol  during  or  after  labour  is 
fallacious. 

Permanent  high  pressure  is  to  be  found  in  arterio- 
sclerosis and  chronic  interstitial  nephritis.  Along  with 
high  pressure  the  red  blood  corpuscles  are  greatly 
increased,  rising  as  high  as  eight  or  eleven  millions 
instead  of  five  or  six.  This  cannot  be  accepted  as  a 
constant  rule,  as  he  has  met  with  high  pressure  and 
reduced  corpuscles,  which  condition  is  invariably  to  be 
seen  in  nervous  people. 

He  further  demonstrated  a  very  important  case  of 
general  plethora  without  arterio-sclerosis,  but  with 
very  high  pressure  in  vessels. 


TLbc  ©perattng  Gbeatres. 

ROYAL  FREE  HOSPITAL. 
Removal  of  a  Large  Ovarian  Cyst. — Mr.  T.  P. 
Legg  operated  on  a  woman,  aet.  45,  who  had  been 
admitted  with  the  following  history  :  During  the  last 
two  years  she  had  noticed  the  abdomen  getting  steadily 
larger,  but  until  three  months  ago  she  had  not  suffered 
any  marked  inconvenience.  She  then  began  to  have 
vomiting,  pain  in  the  abdomen,  and  some  shortness  of 
breath.  Up  to  a  year  ago  she  had  menstruated  regu- 
larly, but  in  the  last  twelve  months  she  had  only  had 
one  period.  On  examination,  the  abdomen  was  found 
to  be  uniformly  distended.  It  measured  round  its 
greatest  circumference  535  ins.  On  percussion  a  dull 
note  was  obtained  everywhere,  except  in  the  hinder 
part  of  each  flank,  where  there  was  a  well-marked 
resonant  note.  The  dull  areas  did  not  change  on 
moving  the  patient  from  side  to  side.  A  well-marked 
fluid  thrill  was  readily  obtained  over  the  whole  of  the 
dull  area.  The  tumour  reached  as  high  as  the  ensi- 
form  cartilage  and  costal  margins,  which  last  were 
everted  by  the  swelling.  Passing  across  the  upper  part 
of  the  tumour  a  transverse  band  could  be  felt.  Exami- 
nation per  vaginam  showed  that  the  cervix  and  body 
of  the  uterus  were  pushed  towards  the  right.  The 
tumour  could  not  be  felt  in  either  fornix  or  in  Douglas' 
pouch.  The  abdominal  wall  below  the  umbilicus  was 
oedematous ;  there  was  slight  oedema  of  the  feet ; 
the  urine  was  free  from  albumin,  but  was  very  scanty, 
only  eight  to  ten  ounces  being  passed  in  the  twenty- 
four  hours.  The  patient  vomited  frequently,  and 
this  was  her  chief  symptom.  The  circulatory  system 
was  healthy.     The  most  comfortable  position  for  her 


to  lie  in  was  upon  one  or  other  side,  in  either  of  which 
positions  she  had  no  difficulty  with  her  breathing. 
From  the  physical  signs  it  was  clear  there  was  a  large 
encysted  collection  of  fluid  in  the  abdomen,  probably 
of  ovarian  origin.  Three  days  after  admission  the 
patient  was  operated  on.  A  lateral  incision  was  made 
with  its  centre  opposite  the  remains  of  the  umbilicus, 
and  just  to  the  left  of  the  middle  line.  The  rectus 
muscle  was  very  much  atrophied,  and  on  dividing  the 
peritoneum  the  cyst  was  found  to  be  adherent  over 
the  whole  of  its  anterior  aspect  to  the  parietal  layer 
of  peritoneum.  The  walls  of  the  cyst  were  thick  and 
bluish-white  in  colour.  On  a  trochar  and  cannula 
being  passed  into  the  cyst,  a  small  quantity  of  brownish 
fluid  escaped.  It  soon  became  evident  that  only  a 
small  loculus  had  been  entered,  therefore  the  opening 
into  the  cyst  was  enlarged  by  prolonging  the  incision 
upwards.  Many  pints  of  thin  watery  fluid  then  es- 
caped. The  abdominal  incision  was  enlarged  in  an 
upward  direction,  and  the  adhesions  to  the  parietal 
peritoneum  were  separated  without  the  slightest 
difficulty.  The  transverse  colon  and  omentum  were 
adherent  at  the  upper  part,  but  readily  separated  after 
division  and  ligation  of  the  omentum.  There  were  no 
other  viscera  adherent,  and  the  rest  of  the  tumour  was 
lifted  intact  out  of  the  abdominal  cavity.  The  pedicle 
was  about  three  inches  broad.  It  was  ligated  with 
three  inter-locking  ligatures,  and  the  stump  was 
covered  by  peritoneum.  The  right  ovary  was  per- 
fectly healthy.  About  four  pints  of  sterilised  salt 
solution  were  put  into  the  abdominal  cavity,  which  was 
then  closed  by  uniting  the  layers  of  the  abdominal 
wound  in  three  tiers.  The  anaesthetic  was  chloroform, 
and  no  difficulty  or  trouble  was  experienced,  there 
being  no  embarrassment  of  respiration.  After  removal 
the  tumour  was  found  to  be  a  multilocular  ovarian 
cyst  arising  from  the  left  ovary.  It  weighed  25IDS., 
and  with  the  amount  of  fluid  lost  must  have  contained 
between  fifty  and  sixty  pints.  Every  variety  of 
ovarian  fluid  was  found  in  the  various  loculi.  The 
ensiform  cartilage  was  so  pushed  up  as  to  appear  like 
the  peak  of  a  Turkish  saddle.  Mr.  Legg  remarked 
that  this  case  was  a  good  illustration  of  the  enormous 
size  an  ovarian  cyst  could  attain  without  producing 
any  great  inconvenience  to  the  patient.  It  also  was 
a  good  example,  too,  he  said,  of  the  effects  which  are 
produced  by  a  large  ovarian  cyst,  and  the  indications 
for  removing  it,  namely,  the  pressure  effects  on  the 
kidney  and  venous  circulation.  The  case  also  illus- 
trated, he  thought,  the  ease  with  which  even  a  big 
ovarian  cyst  may  be  removed,  providing  there  are  no 
extensive  adhesions  to  the  viscera.  Another  point 
illustrated  was  that  adhesions  do  not  necessarily 
depend  on  the  size  of  the  tumour,  but  on  adventitious 
circumstances,  such  as  peritonitis.  In  this  case  there 
had  certainly  been  no  peritonitis,  and  the  adhesions 
which  were  found  between  the  parietal  peritoneum  and 
the  cyst  were  probably  the  result  of  contact  and 
pressure  by  means  of  the  patient's  clothing.  The 
tumour  had  only  been  giving  serious  symptoms  during 
the  last  three  months  ;  previous  to  this  time  the  woman 
had  been  able  to  do  her  work  (washerwoman),  and 
suffered  only  from  sUght  constipation,  which  was  not 
surprising  when  one  considered  how  all  the  intestines 
were  pushed  into  the  posterior  part  of  the  abdomen, 
and  considerably  compressed.  The  incision  just  to 
one  side  of  the  middle  line  was  used,  he  said,  so  that 
the  rectus  fibres  could  be  split  and  afterwards  replaced 
in  position  to  ensure  a  thick,  firm  scar.  This,  he 
thought,  was  always  a  better  incision  than  one  strictly 
in  the  middle  line.  The  saline  fluid  was  left  in  the 
abdominal  cavity  to  take  the  place  of  the  tumour,  and 


May  25,  1904 


LEADING  ARTICLES. 


The  Medical  Press.    563 


to  diminish  the  amount  o(  shock  and  thirst.  He 
pointed  out  that  the  pedicle  had  been  ligatured  in  the 
way  employed  in  order  to  prevent  any  slipping  of 
the  ligatures,  and  had  been  covered  by  peritoneum 
to  diminish  the  chance  of  adhesions  forming  to  the 
*tump.  Considering  the  size  of  the  cyst  the  smallness 
of  the  pedicle  was,  he  considered,  interesting.  There 
was  practically  no  oozing  from  the  separation  of  the 
-cyst  and  therefore  no  drainage  was  employed. 

The  patient  made  an  uninterrupted  recovery.  She 
never  had  a  pulse-rate  of  more  than  100,  and  that  only 
during  the  first  two  or  three  days  after  the  operation. 
The  amount  of  urine  secreted  rapidly  increased  in 
quantity,  until  on  the  fourth  or  fifth  day  about  eighty 
ounces  were  passed  in  twenty-four  hours.  It  then 
fell  to  about  the  normal  amount.  The  stitches  were 
taken  out  on  the  tenth  day,  and  the  abdominal  parietes, 
which  had  been  very  flaccid,  rapidly  contracted  and 
became  firm.  The  patient  left  the  hospital  one  month 
after  operation  quite  well. 

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"  SALUS   POPULI   SUPREMA  LEX." 


WEDNESDAY,  MAY  25,  1904. 

AN  INADEQUATE  LUNACY  COMMISSION. 
The  efficiency  of  the  Lunacy  Commission  is 
clearly  a  matter  that  affects  the  safety  of  the  com- 
munity. For  some  years  past  it  has  been  evident 
that  the  work  of  the  Lunacy  Commissioners  in 
England,  at  any  rate,  has  been  unable  to  prevent 
the  frequent  occurrence  of  scandals  in  the  'case  of 
lunatics  or  alleged  lunatics  both  in  public  and  in 
private  charge.  The  matter  has  been  recently 
brought  forward  in  the  House  of  Commons  by  Sir 
J.  Batty  Tuke,  one  of  the  most  able  and  experienced 
alienists  in  the  Kingdom.  His  procedure  was  to 
move  a  reduction  of  ^100  in  the  Civil  Service 
Estimates  vote  in  order  to  call  attention  to  the 
constitution  of  the  Lunacy  Commission.  The  state 
of  affairs  he  disclosed  made  out  a  strong  case  for 
inquiry  and  reform.  At  the  outset  he  carefully 
emphasised  the  fact  that  the  Commissioners  were 
hard-working  officials,  eminent  in  their  profession, 
and  not  personally  responsible  for  the  faults  of 
which  he  complained.  The  Commission  consisted 
of  one  unpaid  chairman,  three  or  four  unpaid  Com- 
missioners, and  three  medical  and  three  legal 
Commissioners,  each  receiving  £1,500  a  year.    The 


duties  of  the  unpaid  Commissioners  were  confined 
to  the  office,  whereas  the  paid  Commissioners 
visited  and  reported  upon  1 14,000  certified  lunatics. 
While  in  England  there  is  only  one  medical 
Commissioner  to  very  38,000  lunatics,  in  Scotland 
there  was  one  to  every  4,100.  The  supervising 
power,  therefore,  is  ten  times  as  great  in  Scotland, 
a  country  which  can  hardly  be  regarded  as  over- 
manned. In  the  Northern  country  every  patient 
was  visited  twice  a  year  by  a  medical  Commissioner, 
but  in  England  only  once.  The  natural  outcome 
of  that  disparity  was  the  absence  in  Scotland  of 
those  scares  and  scandals  which  are  unhappily  of 
such  frequent  occurrence  in  England.  The  fault 
lies  in  the  inadequacy  of  the  English  Commissioners 
in  point  of  numbers,  for,  however  competent,  it  is 
physically  impossible  they  should  accomplish  ten 
times  the  amount  of  work  done  by  their  brother 
Commissioners  over  the  Border  and  get  equally 
good  results.  The  numerical  inadequacy  of  the 
English  Commission  is  increasing  by  leaps  and 
bounds.  In  1845  their  number  was  the  same  as 
in  1904,  yet  half  a  century  ago  they  had  to  super- 
vise 25,000  notified  lunatics  as  against  114,000 
at  the  present  day.  The  legal  Commissioners,  in 
Sir  J.  Tuke's  opinion,  are  absolutely  useless  for  the 
purposes  of  inspection,  and  might  be  economically 
replaced  by  the  appointment  of  two  standing 
counsel.  The  first  step,  as  he  wisely  maintained, 
towards  obtaining  public  confidence  in  lunacy 
administration  in  England  is  to  establish  thorough 
supervision,  which  could  be  secured  only  by  break- 
ing up  the  country  into  four  or  five  divisions  for 
lunacy  purposes,  with  a  resident  Commissioner  in 
each.  The  main  reason  for  the  rapid  increase  of 
lunacy  is — according  to  Sir  J.  Tuke — that  we  are 
manufacturing  lunacy  from  day  to  day.  A  re- 
mark of  that  kind  coming  from  such  a  quarter 
should  commend  itself  to  the  earnest  attention  of 
the  community.  His  line  of  argument  was  that 
medical  men  are  precluded  from  treating  the  disease 
adequately  at  two  critical  stages — namely,  the 
beginning  and  the  end.  Those  stages  could  be 
properly  treated  among  the  moneyed  classes,  but 
it  was  not  in  those  classes  that  lunacy  has  increased. 
In  the  case  of  the  poor  it  is  necessary  to  wait  until 
the  malady  was  sufficiently  pronounced  to  warrant 
certification  before  anything  could  be  done.  An 
excellent  illustration  of  what  can  be  done  by  early 
treatment  is  afforded  by  the  institution  founded 
thirteen  years  ago  by  the  County  Council  of  Glas- 
gow for  the  treatment  of  incipient  cases.  Of  the 
patients  admitted  within  its  walls  no  less  than  70 
per  cent,  had  been  cured.  Then  there  is  the  final 
stage  of  mental  disease.  When  a  patient  is  dis- 
charged from  an  asylum  he  is  relegated  to  the 
miserable  conditions  in  which  he  was  first  attacked 
by  insanity.  No  term  for  the  convalescence  is 
allowed,  with  the  natural  consequence  that  the 
percentage  of  asylum  recoveries  is  reduced  by 
relapses  from  40  per  cent,  to  about  35  per  cent. 
There  can  be  no  doubt  that  during  the  past  genera- 
tion a  great  change  has  come  over  our  conception  of 
insanity.    The  conscience  and  the  intelligence  of  the 


564     Th*  Medical  Press. 


LEADING  ARTICLES. 


May  25,  1904. 


nation  have  been  awakened  with  regard  to  tubercu- 
losis and  to  cancer,  both  of  which  diseases  it  is 
striving  to  investigate  if  not  to  abolish.  A  similar 
attitude  is  desirable  towards  insanity,  a  scourge 
that  not  only  attacks  three  out  of  every  1,000  per- 
sons living,  but  transmits  its  disastrous  taint  to 
posterity.  Sir  J.  Batty  Tuke's  presentation  of  the 
facts  to  the  House  was  a  model  of  close  and  well- 
informed  argument.  The  case  he  presented  in 
favour  of  a  Select  Committee  of  Inquiry  into  the 
constitution  of  the  Lunacy  Commission  is  in  our 
opinion  overwhelming  and  unanswerable.  It  is 
most  desirable  that  more  medical  men  of  his  ex- 
perience and  abilities  should  throw  their  weight 
into  the  great  council  of  the  nation. 


THE     NEGLECT     OF     UTERINE     CANCER. 
A  fresh  attempt — this  time  in  Germany — to 
focus  the  attention  of  medical  men,  and  the  public 
in  general,  on  the  terrible  mortality  that  results 
from  the  early  neglect  of  cancer  of  the  uterus  has 
been  made  recently  by  Professor  George  Winter, 
of  Koenigsberg.    Professor  Winter  has  been  fight- 
ing since  1891,  in  the  most  systematic  manner, 
against  the  different  causes  that  militate  against 
early  operation  and  has  at  last  the  satisfaction  of 
knowing  that  his  efforts  have  borne  some  fruit. 
From  his  experience,  he  was  lad  to  the  belief  that 
the  chief  causes  of  neglected  uterine  cancer  were, 
first,  deficient  knowledge  on  the  part  of  medical 
men  ;    secondly,  unconscientiousness  on  the  part 
of  midwives  ;    and,    thirdly,  the  conduct  of  the 
patients  themselves.     Working  on  these  lines,  he 
sent  in  December,  1902,  a  pamphlet  to  every  practi- 
tioner  in    East    Prussia   describing   the   sympto- 
matology and  diagnosis  of  cancer,  and  dwelling 
on  the  importance  of  its  early  recognition.     He* 
also  entered  into  a  detailed  description  of  the 
method  of  examining  patients  and  of  removing 
portions  of  a  suspicious  growth  for  examination. 
He  further  added,  with  considerable    generosity, 
that  he  would  be  glad  to  place  his  laboratory  at 
the  disposal  of  any  medical  man  requiring  the 
examination   of  specimens.     This   pamphlet   was 
followed  by  a  circular,  addressed  to  each  midwife, 
pointing    out    that    gynaecological    diseases    were 
beyond  their  province,  and  urging  on  them  the 
necessity  for  sending  women,  who  consulted  them 
on'account  of  such  complaints,  to  the  nearest  medi* 
caiman.     To  these  two  warnings  Professor  Winter 
added   a  third,   addressed   to  women  in  general, 
in  the  form  of  an  article  published  in  the  leading 
newspapers   of   East   Prussia.     This   was   a   step 
requiring   the    exhibition    of    considerable    tact, 
and  one  for  which  in  these  countries  it  would  be 
impossible  for  any  single  medical  man  to  assume 
responsibility.     Professor    Winter,    however,    did 
it  in  a  most  careful  manner,  and  so  that  no  objec- 
tion could  be  raised  to  it.     These  three  documents 
have    been    republished    as    a    small  monograph, 
the  importance  and  interest  of  which  have  been 
very    greatly    supplemented    by    the    subsequent 
appearance    of    the    Centralblatt  fiir  Gynakolcgie, 
containing  a  report  of  the  results  of   Professor 
Winter's   campaign   for  the  first  year.     We  learn 


that,  so  far  as  the  writer  could  ascertain,  but  one 
medical  man — and  that  one  a  homoeopath — of 
those  to  whom  his  circular  had  been  sent  neglected 
to  make  an  immediate  examination  in  suspected 
cases.  Further,  that  of  seven  midwives  consulted 
by  patients  only  one  behaved  improperly  and 
endeavoured  to  prevent  the  woman  from  seeking 
medical  advice;  that  the  percentage  of  patients 
who  sought  advice  within  three  months  of  the 
appearance  of  the  earliest  symptoms  rose  from 
thirty-two  to  fifty-seven ;  and  that  the  per- 
centage of  patients  who  followed  the  advice 
they  received  rose  from  seventy-eight  to 
ninety.  This  is  an  extremely  satisfactory  result  for 
a  year's  work,  and  should  give  encouragement  to 
the  medical  profession  in  these  countries  to  perse- 
vere in  their  efforts  to  spread  the  knowledge  of  the 
nature  of  uterine  cancer.  We  do  not  know  that 
it  would  be  either  possible  or  desirable  that  any 
single  individual  should  exactly  follow  Professor 
Winter's  method  of  diffusing  that  knowledge,  as 
what  may  be  quite  suitable  in  Germany  would  not 
be  so  here,  but  there  are  many  Bodies  and  Societies 
who  are  quite  competent  to  take  as  direct  measures. 
The  subject  has  not  been  by  any  means  neglected 
in  the  past.  In  1895,  *ne  la*e  ^r-  Knowsley 
Thornton  delivered  a  strong  appeal  to  the  medical 
profession,  so  strong  and  so  well  worded  that  Cullen 
has  thought  it  worthy  of  reproduction  as  an  appen- 
dix to  his  work  on  uterine  cancer.  Similarly,. 
Professor  Japp  Sinclair  and  Dr.  Lewers  have 
written  in  forcible  language  on  the  importance  of  a 
crusade  against  the  present  neglect  of  early  sym- 
ptoms, and  the  latter  has  recommended  the  adop- 
tion of  measures  very  similar  to  those  employed  by 
Professor  Winter.  Still,  there  is  room  for  much 
more  education  of  each  of  the  three  units  to  which 
Winter  attributed  the  neglect  of  cancer,  and  we 
feel  that  we  are  discharging  an  important  duty  in 
bringing  the  subject  repeatedly  to  the  notice  of 
medical  men. 


INFANT  SCHOOLS. 
Reform  and  reorganisation  in  educationa 
methods  are  in  the  air,  and  everyone  interested 
in  the  national  well-being  will  admit  that  both  are 
urgently  needed.  That  the  whole  of  our  chaotic 
educational  system  will  be  welded  into  one  com- 
plete and  harmonious  whole  is  too  much  to  be 
reasonably  expected,  but  the  moment  is  ripe  for 
many  radical  changes  conducing  to  efficiency. 
To  several  of  these  that  are  of  special  concern  to 
medical  men  we  have  lately  drawn  attention,  and 
we  are  glad  to  notice  that  two  at  least  of  them 
— namely,  the  questions  of  the  medical  supervision 
and  physical  training  of  pupils — are  engaging 
much  interest,  and  promise  to  bring  forth  practical 
fruit  in  the  near  future.  It  may  not  be  inap- 
propriate to  discuss  another  very  important  one. 
We  mean  the  age  at  which  children  should  be  sent 
to  school.  It  is  well  to  be  clear  at  the  outset  as  to 
the  real  aim  of  school  instruction.  The  object 
with  which  public  money  is  expended  on  the  educa- 
tion of  the  children  of  the  poor  is  to  prepare  those 
children  in  the  highest  reasonable  degree  to  take 


May  25,  1904. 


NOTES  ON  CURRENT  TOPICS.     The  Medical  Feess.     565 


part  in  the  work  of  society,  giving  them  at  the  same 
time  an  opportunity  of  showing  special  aptitude 
or  predilection,  if  they  possess  such.  The  object 
with  which  schools  are  provided  is  certainly  and 
emphatically  not  to  relieve  parents  of  any  of  their 
obligations.  Schools  are  serious  places,  designed 
for  serious  work,  and  not  mere  herding  grounds, 
where  children  can  be  kept  out  of  mischief  for  so 
many  hours  a  day.  In  order  that  this  work  may  be 
carried  out  only  children  fit  to  benefit  by  instruc- 
tion should  be  allowed  within  their  doors  ;  to 
admit  others  is  not  only  to  waste  money,  but  to 
run  the  risk  of  impairing  them  more  or  less  seriously 
in  their  future  careers.  Now,  can  it  be  maintained 
that  any  educational  good  can  possibly  accrue  to 
the  babies  crammed  into  the  infant  departments  of 
the  elementary  schools  as  they  are  at  present  ?  A 
teacher  of  great  tact  and  experience  may  suceed  in 
maintaining  some  sort  of  order  and  quietness,  and 
even  in  attracting  their  united  attention  to  some 
simple  objects  ;  to  do  more  would  be  obviously 
injurious,  to  do  less  would  be  to  make  the  farce  of 
instruction  even  more  hollow  than  it  is  at  the 
present  moment.  To  extract  a  lisping  ABC  from 
a  row  of  little  tots  under  five  years  of  age  may  be 
evidence  of  a  teacher's  ability  to  triumph  over 
difficulties,  but  it  may  be  gravely  doubted  whether 
the  little  four-year-olds  would  not  be  more  profit- 
ably engaged  in  manufacturing  mud-pies  than  in 
performing  these  feats  of  what  Matthew  Arnold 
would  call  "  mental  gymnastics."  The  young  of 
homo  sapiens  are  more  helpless  and  backward 
than  the  young  of  any  species  in  the  animal 
kingdom,  and  experience  is  all  against  any  early 
forcing  of  their  faculties.  These  must  be  allowed 
to  develop  late  and  slowly.  When  the  brain  is 
ready  for  instruction  its  receptivity  can  be  utilised 
for  the  purpose,  but  it  may  be  stated  unhesitatingly 
that  the  little  mind  that  is  allowed  to  be  fallow 
till  the  seventh  or  even  eighth  year  will  be  none  the 
worse  in  the  long  run,  and  probably  much  the 
better.  This  being  so,  the  infant  school  in  which 
no  harmful  pressure  is  exerted  resolves  itself  into 
a  municipal  creche,  where  the  youngsters  can  be 
dumped  to  relieve  their  mothers  of  some  of  the  re- 
sponsibilities of  maternity.  Desirable,  doubtless,  as 
such  an  arrangement  may  be  for  a  mother  with  her 
hands  full,  it  is  not  only  an  expensive  one  for  the 
State,  but  it  has  proved  itself  a  very  dangerous  one 
for  the  babies  themselves.  No  less  than  three- 
quarters  of  the  total  cases  of  measles  in  the  country 
occur  among  these  elementary  school  infants, 
and  they  furnish  over  00  per  cent,  of  the  deaths 
from  that  disease.  There  was  a  loud  outcry  in  this 
country  when  the  Boer  children  died  from  over- 
crowding in  the  concentration-camps  during  the 
war,  and  yet  a  system  which  allows  nearly  twelve 
thousand  of  these  elementary  school  infants  to 
perish  from  measles  every  year — to  say  nothing  of 
the  mortality  from  scarlet  fever  and  diphtheria — 
is  complacently  regarded  as  desirable.  When  the 
necessity  for  education  arises,  children  must  take 
the  risks  of  school  life,  but  it  is  absurd  to  consider 
as  serious  the  instruction  of  children  who  are  hardly 
able  to  sit  on  their  seats.     Apart,  however,  from 


the  question  of  the  utility  of  this  kind  of  teaching, 
and  apart  from  the  shocking  mortality  effects  of  the 
system  on  its  tittle  subjects,  there  is  yet  another 
point  for  consideration — that  of  cost.  Buildings, 
mistresses,  firing,  and  all  the  paraphernalia  of 
education  have  to  be  forthcoming,  and  a  sum 
amounting  to  a  million  and  a  quarter  per  annum 
has  to  be  found  to  provide  them.  When  the 
burden  of  educational  rates  and  taxes  is  grow- 
ing daily  heavier,  and  when  so  much  that  is  de- 
sirable in  the  interests  of  the  health  of  the  children 
has  to  be  neglected  on  the  score  of  expense,  it  is 
shameful  to  think  of  so  gigantic  a  sum  being 
frittered  away  every  year  in  this  manner.  The 
mental  development  of  the  children  is  but  little, 
if  at  all,  assisted,  and  in  so  far  as  it  is  assisted,  it  is 
prematurely  assisted.  The  mothers  are  relieved 
of  the  duty  of  looking  after  their  young  ones,  and 
the  little  mites  catch  everything  that  is  going  and 
spread  disease  far  and  wide.  Such  are  the  actual 
results  of  the  infant  school,  where  the  pupils  sit 
morning  and  afternoon  every  day  except  Saturday 
and  Sunday  to  earn  "  grants  "  for  the  institution. 
Educational  zeal  is  an  excellent  thing  in  its  way, 
but  when  that  way  leads  to  disease  and  death 
it  is  well  to  speak  out  and  show  the  iniquity 
and  folly  of  expending Jvast  sums  of  public  money 
to  foster  a  system  in  which  everything  is  made 
subservient  to  the  Inspector's  report  to  head- 
quarters. 

flotes  on  Current  Ttopics* 

The  Belgravia  "  Medical "  Institute. 
A  circular  describing  an  institution  has  been 
placed  in  our  hands,  and  it  appears  that  this  docu- 
ment is  being  widely  distributed  .  among  medical 
men.  The  institution  in  question  is  modestly  entitled 
the  Belgravia  Medical  Institute,  apparently  on  the 
lucus  a  non  lucendo  principle,  for  it  is  situated  in 
Pimlico,  and  is  prepared  to  administer  treatment 
without  medical  supervision.  There  is  a  "  prin- 
cipal," who  makes  no  claim  to  any  medical  qualifi- 
cation, British  or  foreign,  a  secretary,  and,  presum- 
ably a  staff,  for  the  circular  is  illustrated  by  photo- 
graphs of  male  and  female  attendants  applying 
the  "  medical  "  treatment  to  lightly-clad  patients. 
The  prospectus,  besides  the  pictorial  adornments 
alluded  to,  comprises  a  choice  assortment  of  falla- 
cious pathology  and  bad  grammar.  The  treatment 
consists  in  a  combination  of  light  and  water  baths, 
purified  air,  and  mechanical  vibration.  It  is  extraor- 
dinary how  many  diseases  are  benefited  by  this 
treatment ;  in  fact,  the  lists  given  are  so  comprehen- 
sive that,  like  Mr.  Jerome  with  his  medical  diction- 
ary, about  the  only  one  we  fail  to  find  is  "  house- 
maid's knee."  There  are  some  pathological 
gems  that  can  hardly  be  allowed  to  pass  without 
notice.  "  In  cases  of  obesity,"  we  read,  "  the 
influence  of  the  active  rays  of  the  arc  light  trans- 
forms the  excess  of  fat,  or  similar  substance  (the 
italics  are  our  own),  to  muscles  of  the  body." 
And  again,  "  vibrations  thus  produced  force  into 
action  the  parts  weakened,  or  impeded,  by  disease 
or   impurities — metabolism."     But  the  principal 


566    Ta*  medical  Prms.    NOTES   ON   CURRENT   TOPICS. 


May  2$.  1904. 


is  capable  of  other  things  than  writing  pseudo- 
scientific  tfash  of  this  kind.  He  has  the  honour 
to  inform  his  patrons  that  in  the  interests  of 
science  he  has  constructed  an  air-purifying  ma- 
chine, which  is  now  in  full  operation  at  the  home. 
"  By  this  machine  the  air  in  the  room  can  be  dis- 
infected, scented,  impregnated  with  oxygen  and 
ozone — equal  to  sea  or  mountain  air — kept  cool 
in  summer  or  warm  in  winter.1'  The  disadvantage 
of  breathing  air  scented  with  ozone  has  been 
thoughtfully  counterbalanced  by  the  provision 
of  the  ••  Encyclopaedia  Britannica  "  for  the  use  of  the 
victims  of  the  unpleasant  odour.  But  there  is 
a  serious  side  to  all  this  disingenuous  nonsense. 
In  this  institute  powerful  arc  lights  and  electrical 
apparatus  are  to  be  used  by  the  principal  and 
his  staff  on  sick  people,  and  their  money  is 
to  be  taken  in  return  for  this  treatment.  The 
use  of  light  treatment  is  undoubtedly  great, 
but  its  dangers  are  many,  and  even  in  the  hands 
of  medical  specialists  unpleasant  results  are  occa- 
sionally produced.  To  leave  the  application  of 
these  potent  remedies  to  any  hands  other  than 
those  of  fully  qualified  medical  practitioners 
is  unjustifiable  in  the  highest  degree,  and 
the  general  practitioner  who  wishes  his  patients 
to  undergo  a  course  of  light  treatment 
for  which  he  has  not  the  requisite  facilities  him- 
self, or  which  he  does  not  feel  himself  com- 
petent to  undertake,  can  always  place  them  under 
the  care  of  a  qualified  and  experienced  brother 
practitioner  who  lays  himself  out  for  work  of  that 
type.  This  circular  emphasises  the  regret  we 
have  always  felt  that  under  our  anomalous  laws 
it  is  impossible  to  prevent  legally  unqualified 
practitioners  from  carrying  on  their  trade.  Were 
the  Medical  Acts  strengthened,  and  the  General 
Medical  Council  given  powers  similar  to  those 
possessed  by  the  Incorporated  Law  Society, 
it  would  be  easy  to  protect  society  from  irregular 
practitioners — and  from  itself.  The  average  per- 
son has  little  or  no  idea  of  the  risk  he  incurs  by 
placing  himself  in  the  hands  of  those  who  run  so- 
called  medical  institutes,  not  presided  over  or 
recognised  by  the  medical  profession,  and  it  is 
incumbent  on  all  practitioners  to  warn  the  public  of 
the  danger  and  folly  of  doing  so.  Light-treat- 
ment should  no  more  be  left  to  be  exploited  by  the 
unlearned  and  unskilled  than  should  the  ad- 
ministration of  morphia  or  strychnine.  We  hope 
the  day  is  not  far  distant  when  it  will  be  impossible 
for  it  to  be  so. 


The  Science  of  ^Eugenics. 
It  may  be  confidently  asserted  that  failure  to 
recognise  the  nature  and  trend  of  those  influences 
which  are  slowly,  yet  surely,  altering  the  condi- 
tions of  modern  life  in  all  grades  of  society  is  the 
chief  cause  of  the  almost  universal  indifference  to  all 
sociological  matters.  Any  science  which  aspires 
to  investigate  these  influences,  in  an  exhaustive 
and  critical  manner,  is  worthy  of  cultivation  by  all 
who  long  to  see  the  British  race  rise  on  the  stepping- 
stones  of  hygiene  to  a  higher  plane  of  physical 
perfection.     The  ascent  may  seem  difficult  or  even, 


in  some  classes  of  society,  impossible,  but  when  once 
the  fallow  ground  of  ignorance  has  begun  to  be 
broken  up  no  thought  of  going  back  can  be  enter- 
tained for  a  single  moment.  The  formation  of  a 
Sociological  Society  for  the  examination  and  dis- 
cussion of  those  laws  which  are  in  constant  opera- 
tion upon  the  growth  of  the  race  augurs  well  for  the 
renewed  interest  which  is  being  taken  by  many 
thoughtful  minds  in  the  physical  welfare  and 
improvement  of  the  race.  The  paper  read  by  Dr. 
Francis  Galton,  F.R.S.,  with  the  imposing  title  of 
"  Eugenics :  its  Definition.  Scope,  and  Aim," 
at  its  first  meeting,  may  be  considered  as  the  key- 
note of  the  Society's  work,  constituting  as  it  does 
the  study  of  all  the  various  hereditary  influences 
which  are  at  work  upon  the  individual  in  every 
grade  of  society.  Such  subjects  as  the  declining 
birth-rate,  unsuitable  marriages  from  a  physical 
point  of  view,  and  the  feeding  of  infants  among  the 
poorer  classes,  among  others,  will,  doubtless,  receive 
a  full  share  of  attention  on  the  part  of  this  learned 
body.  Whether  the  sterilisation  of  failures  will 
ever  become  a  fait  accompli  in  this  country  is  an 
open  question,  but  the  dissemination  of  the  know- 
ledge whereby  the  number  of  the  physically  un- 
successful will  be  reduced  is  of  greater  practical 
importance. 


Water-Oreas  and  Disease. 

Numerous  are  the  unseen  dangers  which  lurk, 
all  unexpected,  amid  the  common  objects  of  every- 
day life.     It  would  seem  as  if  each  article  of  food 
were  bacterially  haunted  in  its  own  special  way. 
From  the  circumstances  of  its  growth,  it  has  long 
been  known  that  water-cress  {Nasturtium  officinale) 
is   liable   to   contamination    by    certain    specific 
organisms.     Not   all   of   these   are   bacteria,  for 
higher  biological  forms,  such  as  the  taenia  echino- 
coccus,  sometimes  render  this  usually  innocent  plant 
a  source  of  danger  when  taken  as  a  food  into  the 
human  body.        This  latter,  no  doubt,  is  almost 
always  an  accidental  occurrence,  nevertheless  it 
is  one  which  needs  to  be  very  carefully  guarded 
against  by  thorough  washing  of  the  cress  before 
being  served.     The  growth  of  the  hydatid  cyst 
in    some    vital  organ  may  necessitate  a  serious 
operation,  or  may  even  sacrifice  the  life  of  the 
individual.     Last    autumn    the    Public    Health 
Committee  of  Hackney  traced   an   outbreak  of 
enteric  fever  in  the  district  to  the  consumption 
of    sewer-polluted    water-cress.     Considering   the 
fact  that  the  plant  will  flourish  vigorously,  and  that 
it  is  usually  grown  in  shallow  water,  it  is  not  difficult 
to  imagine  that  the  chances  of  such  water  being 
contaminated   by   sewage  are  not  very  remote. 
To  obtain  the  best  results,  the  cress  should  be 
exposed  to  the  gentle  but  continuous  action  of  a 
current  of  water,  but  it  will  thrive  almost  equally 
well  in  a  ditch.  Rubbish  and  mud  are  apt  to  collect 
among  the  young  shoots,  and  if  this  be  specifically 
infected  with  pathogenic  organisms  the  consump- 
tion of  the  plants  from  such  a  source  must  be  at- 
tended with  grave  danger.     At  Hackney  the  drains 
opened  directly  into  the  beds.     The  Committee 
recommended  that  the  Local  Government  Board 


May  25,  1904. 


NOTES   ON    CURRENT    TOPICS.     Th*  Medical  Prim.    567 


should  hold  an  inquiry  as  to  the  sources  of  the 
water-cress  supply  of  the  metropolis,  and  it  must 
be  acknowledged  that  an  official  inspection  of  the 
beds  and  a  report  thereon  is  imperatively  required 
in  the  interests  of  the  community  of  the  whole  of 
London. 


Sterilised  Milk. 
During  the  past  few  years  many  of  the  more 
progressive  municipalities  have  established  depdts 
for  the  distribution  of  milk  for  infants,  and  in  these 
it  is  the  custom  to  prepare  the  milk  for  use  by  a 
process  of  "  sterilisation  "  by  heat.  Ten  years  ago 
Professor  Flugge,  of  Berlin,  pointed  out  the 
unsatisfactory*  nature  of  most  of  this  so-called 
sterilisation,  and  the  dangers  that  result  from  the 
false  sense  of  security  to  which  it  gives  rise. 
Following  Flugge's  lines,  Dr.  Robertson,  of  Leith, 
has  recently  examined  the  milk  supplied  by  the 
Leith  Corporation  at  the  Infants'  Milk  Depot 
over  a  large  number  of  days  last  winter.  In  all,  he 
examined  ninety  specimens  of  milk,  and,  having 
incubated  them  for  two  days  at  980  F.,  bacteria 
were  found  present  in  no  less  than  seventy-six. 
The  number  of  sterile  bottles  received  on  some 
days  was  much  higher  in  proportion  than  on 
others,  pointing  plainly  to  varying  sources  of 
contamination.  It  would  appear,  then,  if  Leith 
is  at  all  typical,  that  the  term  "  sterilised  milk  " 
should  be  given  up,  and  some  such  term  as  "  milk 
prepared  for  infants  "  substituted.  In  this  way 
the  name  will  be  more  accurate,  and  undeserved 
confidence  will  not  arise.  At  the  same  time, 
Dr.  Robertson  is  not  at  all  in  favour  of  giving  up 
the  preparation  of  infants1  milk,  for  imperfect  as 
the  present  method  is,  it  is  better  than  entire 
absence  of  system.  In  fact,  if  the  milk  at  present 
distributed  at  the  depdts  be  kept  in  a  cool  place, 
and  consumed  on  the  day  of  purchase,  it  is  very 
safe.  The  whole  question  of  the  milk  supply  of 
large  towns  is,  however,  one  of  enormous  import- 
ance, and  its  solution  is  still  almost  unattempted. 


Medicine  as  a  Factor  in  Folitios. 

We  are  credibly  informed  that  at  the  recent 
municipal  elections  in  France  the  local  political 
spirit  ran  high  in  a  certain  town,  as  there  was 
likely  to  be  a  close  fight  between  the  contending 
parties.  It  so  happened  that  the  local  practi- 
tioner belonged  to  what  in  England  would  be 
termed  the  Conservative  camp  thought,  as  he  was 
alone  he  was  called  upon  to  attend  voters  on  both 
sides.  Allowing  the  political  factor  to  get  the 
better  of  his  professional  duty  he  actually  declared 
a  number  of  Socialist  voters  under  his  care  to  be 
suffering  from  scarlet  fever,  thus  precluding  their 
going  to  the  poll  and  securing  the  success  of  his  own 
candidate  by  a  narrow  majority.  This  is  a  manner 
of  bringing  medical  influence  to  bear  on  politics 
probably  not  contemplated  by  the  discontented 
members  of  our  profession  who  persistently  urge 
upon  their  brethren  the  duty  of  assisting  in  the 
return  of  candidates  who  will  interest  themselves 
in  medical  and  medico-social  problem  reforms, 
and  it  is  certainly  not  one  which  can  be  com- 


mended. The  French  press  appear  to  think  it  a 
good  joke,  but  a  more  prosaic  British  jury  might 
well  deem  such  an  error  of  diagnosis  a  ground  for 
swinging  damages  if  the  motive  could  be  brought 
home  to  the  delinquent. 


Verminous  Heads  in  Children. 

Last  week  a  correspondent  drew  attention  to  the 
fact  that  some  years  ago  he  had  suggested  in 
the  School  Board  Journal  the  desirability  of  a 
periodical  survey  of  the  heads  of  all  board  school 
children  by  a  medical  officer.  He  will  be  doubless 
gratified  at  finding  the  good  seed  has  not  been 
choked  among  thorns,  although  its  fruition  is  not 
yet  perfect.  As  an  aural  surgeon  the  part  played 
by  pediculi  in  the  causation  of  a  host  of  near  and 
remote  troubles  in  children  has  been  impressed 
upon  his  mind  in  the  out-patient  room.  The 
dermatologist  could  tell  a  similar  tale  of  woes 
due  to  parasitic  irritation  of  the  scalp.  Enlarged 
glands  of  the  neck,  abscess,  eczema,  acute  and 
chronic  seborrhcea,  pustular  dermatitis,  contagious 
impetigo,  general  septic  dermatitis,  conjunctivitis, 
external  auditory  coccal  invasion  with  secondary 
middle  ear  involvement,  reflex  neuroses,  and  so  on 
indefinitely.  Given  the  first  irritant  in  the  shape  ot 
pediculi,  dirt,  scratching,  and  secondary  infection 
do  the  rest.  Beyond  a  doubt,  the  school  authorities 
of  the  future  will  have  to  reckon  with  verminous 
heads  just  as  they  will  with  ringworm,  granular 
lids,  and  all  other  communicable  diseases.  Re- 
sponsibility does  not  end  with  physical  drill  and 
the  grammar  book. 


Infectivity  of  Acute  Rheumatism. 

We  drew  attention  some  time  ago  to  the  very 
interesting  and  suggestive  series  of  investigations 
into  the  causation  and  nature  of  rheumatic  fever 
in  which  Drs.  Poynton  and  Paine  have  been  for 
some  time  engaged.  Their  view,  borne  out  by 
many  clinical  and  experimental  observations,  is 
that  the  disease  is  a  specific  infective  fever,  caused 
by  a  diplococcus  which  they  claim  to  have 
separated.  The  disease,  however,  is  not  limited  to 
what  is  commonly  called  rheumatic  fever,  but  in- 
cludes all  those  clinical  manifestations  which  are 
grouped  under  the  wide  term  "  rheumatism,"  and 
in  addition,  chorea,  pericarditis,  a  form  of  broncho- 
pneumonia, iritis,  and  tonsilitis.  This  is  a  start- 
ling reversal  of  ancient  beliefs,  but  it  must  be 
admitted  that  Dr.  Poynton  makes  out  a  good  case. 
He  has,  in  all,  investigated  twenty-five  cases,  the 
last  of  which  he  recently  reported  to  the  Medical 
Society  of  London.  The  illness — a  prolonged  one, 
showing  in  turn  the  symptoms  of  rheumatic  fever, 
rheumatic  arthritis,  chorea,  and  endocarditis, 
terminated  fatally,  and  he  had  the  unusual 
opportunity  of  an  immediate  autopsy.  The 
characteristic  organism  was  found  in  large  quanti- 
ties in  the  vegetations  on  the  mitral  valve,  while  it 
was  separated  by  culture  in  pure  form  from  the 
valve,  the  spleen,  and  the  kidney.  It  was  also 
obtained  from  the  lungs,  but  mixed  with  other 
organisms.  Inoculation  experiments  were  then 
made  by  Dr.  Shaw  on  rabbits  and  monkeys — 


568    The  Medical  Peess.         NOTES  ON  CURRENT  TOPICS/ 


May  25,  1904. 


with  the  formation  of  the  typical  lesions  of  rheu- 
matic fever  associated  with  endocarditis  in  both 
animals.  From  these  lesions  the  same  organism 
was  again  separated.  The  facts,  as  we  have  related 
them,  are  all  in  favour  of  Dr.  Poynton's  hypothesis, 
but  nevertheless,  it  must  not  receive  too  rash  an 
acceptance.  Even  if  his  argument  be  admitted, 
as  far  as  the  nature  of  the  endocarditis  and  other 
lesions  of  acute  rheumatism  is  concerned,  we  still 
have  left  the  very  varied  conditions  of  chorea  and 
tonsillitis,  with  regard  to  which  proofs  are  not  so 
convincing.  It  is,  however,  at  worst  a  very  good 
working  hypothesis,  and  it  may  safely  be  left  to 
the  test  of  further  experiment  and  wider  observa- 
tion. 


The  Medical  Defence  Union. 
It  is  with  much  pleasure  we  draw  the  attention 
of  our  readers  to  the  nineteenth  annual  report  of 
the  Medical  Defence  Union.  The  wise  step  of 
imposing  an  entrance  fee  has  yielded  the  substan- 
tial sum  of  ^234  1  os.  During  the  year,  ^1,000  has 
been  added  to  the  invested  funds.  The  latter  act 
is  satisfactory,  as  it  points  to  the  strengthening 
of  the  Society  in  a  direction  that  cannot  fail,  sooner 
or  later,  to  play  an  important  part  in  its  future  pro- 
gress and  influence.  The  accumulation  of  a  sub- 
stantial reserve  fund  may  be  regarded,  indeed,  as 
almost  a  sine  qud  non  of  ultimate  survival.  iThe 
year  1003  has  been  an  eventful  one  in  the  history 
of  the  Union,  inasmuch  as  it  has^witnessed  much 
discussion  upon  the  question  of  the  consolidation 
and  absorption  of  the  various  medical  defence 
associations  and  of  the  development  of  co- 
operation of  a  similar  movement  in  the  British 
Medical  Association.  The  Medical  Defence  Union, 
as  the  pioneer  society  of  the  kind,  may  be  con- 
gratulated on  the  universal  attention  and  interest 
that  have  been  aroused  in  the  profession  with  regard 
to  self-defence.  We  propose  to  deal  more  fully 
with  the  Report  in  a  future  number. 


The  Hay  Fever  Season. 

The  advent  of  summer,  with  it  accompaniment 
of  flowers,  will  soon  bring  to  consulting  rooms  all 
over  the  land  the  usual  crop  of  sneezing,  distressed 
patients  whose  nasal  mucous  membranes  are  sus- 
ceptible to  the  poison  and  irritation  of  pollen. 
Most  of  these  sufferers  will  have  tried  everything 
in  the  way  of  cures,  from  cauterisation  of  the 
mucous  membrane  to  a  sea-voyage,  and  the  prac- 
titioner will  often  be  at  his  wits'  end  to  suggest 
some  new  method  of  relief.  Under  these  circum- 
stances the  antitoxin  of  Dunbar  is  well  worth  a 
trial.  It  is  a  scientifically-conceived  preparation, 
and  has  already  established  its  claim  to  recognition 
as  a  worthy  and  innocuous  substitute  for  the 
common  drugs  in  use.  The  testimony  as  to  its 
value  is  not  unanimous,  but  there  is  a  large  body  of 
evidence  to  show  that  in  certain  cases,  under  cer- 
tain conditions,  it  is  both  prophylactic  and  curative. 
Its  failure  in  some  cases  was  attributed  last  year  in 
America  to  the  fact  that  the  antitoxin  was  only 
specific  as  regarded  toxins  from  pollen  of  like  nature 
to    that   from   which    it    was   produced,    but    it 


seems  now  that  the  toxins  contained  in  most 
pollen  grains  are  closely  allied,  and  that  the  cases 
which  Dunbar's  serum  fails  to  alleviate  are  those 
in  which  the  irritant  is  not  pollen  itself,  but  some 
other  body,  such  as  dust.  The  serum  may  be  used 
in  liquid  form  for  application  to  the  conjunctiva  or 
nose,  and  also  as  a  powder,  consisting  of  the  serum 
dried  and  pulverised,  which  can  be  employed  as  a 
snuff.  The  patient  should  use  these  on  rising  in  the 
morning,  and  again  whenever  irritation  is  felt 
throughout  the  day,  by  which  means  severe  attacks 
ought  to  be  prevented  altogether.  If  an  attack 
be  well  established,  marked  amelioration  ought  to 
follow  their  application  to  the  same  surfaces.  The 
method  deserves  to  be  widely  tried,  and  all  medical 
men  who  avail  themselves  of  it  should  record  the 
results  of  their  experience,  as  no  drug  has  hitherto 
proved  of  universal  application  in  this  tiresome 
complaint,  and  the  charlatans  have  made  fortunes 
out  of  their  reputed  specifics. 


Memory. 

Perhaps  there  is  no  single  gift  that  would  be 
more  appreciated  by  the  absent-minded  and  forget- 
ful than  that  of  a  good  memory,  and  it  is  with 
envious  wonder  that  one  regards  a  man  like 
Macaulay,  who  found  it  difficult  to  forget  anything. 
Many  people  have  good  memories  for  retaining 
facts,  but  bad  ones  for  reproducing  them  at  the 
right  moment.  Others  can  remember  well  for  a 
short  time,  but  cannot  retain  their  acquired  know- 
ledge for  any  length  of  time.  Still  others  possess 
the  subconscious  type  of  memory  that  absorbs 
impressions  without  noting  that  it  is  doing  so.  and 
brings  them  out  long  afterwards,  much  to  the  sur- 
prise of  the  owner,  who  cannot  remember  whether 
the  phenomena  actually  occurred  or  whether  he 
dreamt  them.  The  most  valuable  memory  will 
always  be  the  encyclopaedic  one,  that  collects, 
stores,  and  catalogues  all  the  information  it  requires 
under  different  headings,  and  is  never  at  a  loss  for 
a  series  of  facts  to  reinforce  any  argument  or  to 
lend  point  to  any  observation.  A  good  memory 
does  not  always  connote  intellect  of  a  high  order ; 
in  fact,  the  reverse  is  very  often  the  case.  This  is 
especially  so  with  the  visual  memory,  which  seems 
able  to  convey  facts  and  figures  direct  to  the  nerve- 
cells  without  the  intervention  of  any  intellectual 
process.  On  the  other  hand,  when  great  powers 
of  visual  memory  are  associated  with  considerable 
ability  in  some  particular  direction,  the  result  may 
be  as  astonishing  to  the  bystanders  as  it  is  gratify- 
ing to  the  subject.  A  remarkable  instance  of  this 
was  related  at  the  recent  Congress  on  Experimental 
Pyschology  at  Giessen  by  Professor  Muller  of 
Gottingen.  A  certain  person,  whom  he  called 
Doctor  "  K,"  possessed  mathematical  aptitude 
of  a  high  order,  combined  with  a  remarkable  visual 
memory.  Not  only  could  he  learn  and  repeat  by 
heart  a  row  of  two  hundred  and  four  figures 
in  twelve  and  a  half  minutes,  but  he  could  extract 
the  square  root  of  a  number  containing  twenty-five 
figures  in  ten  minutes.  Of  the  two  hundred  and 
four  figures,  Dr.  "  K  "  could  remember  So  per 
cent,    three  days    later,   and    75    per    cent,  at 


May  25,  1904. 


NOTES  ON  CURRENT  TOPICS.  The  Mbdical  Press*    5^9 


the  lapse  of  thirteen.  Professor  Muller  asserted 
that  the  previous  record  time  for  learning  two 
hundred  and  four  figures  was  seventy-five  minutes, 
so  that  Dr.  "It's"  performance  was  a  noteworthy 
one  indeed.  How  many  of  us  would  take  seventy- 
five  hours  and  then  not  remember  them  ? 


Epilepsy  and  Crime. 
The  field  of  scientific  criminology  offers  a  rich 
harvest  to  future  workers.  At  the  same  time 
it  is  capable  of  producing  results  of  the  utmost 
value  to  the  community.  To  take  the  single  point 
of  the  relation  of  epilepsy  to  crime,  the  formulation 
of  any  sound  general  conclusions  upon  the  subject 
would  enable  the  conduct  of  criminal  trials  tobe 
regulated  on  logical,  just  and  truthful  lines  ;  in 
other  words,  action  would  become  scientific. 
Much  more  has  to  be  learnt  about  the  psychical 
form  of  epilepsy.  Spratling,  of  New  York,  has 
done  some  good  work  in  this  direction.  He  has 
directed  attention  (a)  to  the  "silent"  form  of 
epilepsy  in  which  the  ordinary  grand  mod  is  replaced 
by  its  psychomotor-epileptic  equivalent,  with 
its  chief  characteristic  of  psychomotor  violence, 
or  he  has  a  purely  psychical  attack.  Apprehen- 
sion, comprehension,  memory  and  reasoned  action, 
are  impaired  in  these  cases.  A  common  symptom 
is  lapse  of  memory  for  a  long  period  of  time, 
during  which  the  patient  may  lose  his  identity  and 
recover  consciousness  in  some  distant  place.  They 
have  become  simple  non-violent  automata. 


X-Rays  in  the  Diagnosis  of  Phthisis. 
The  importance  of  early  diagnosis  of  pulmonary 
tuberculosis  is  a  point  upon  which  all  are  agreed. 
And  yet  it  is  a  well-known  fact  that  it  is  sometimes 
extremely  difficult  to  ascertain  with  absolute  cer- 
tainty the  presence  of  the  disease  in  the  early  stages. 
Physical  signs  may  be  wanting  or  may  escape  obser- 
vation at  a  first  examination,  subjective  symptoms 
may  be  conspicuous  by  their  absence,  or  even  if  the 
suspicions  of  the  medical  examiner  be  well  founded, 
there  may  be  no  sputum  available  to  confirm  his 
view.     The   bacteriological   test,   when   positive, 
is  one  of  the  most  conclusive  known  to  modern 
medicine,  and,  moreover,  it  does  not  require  any 
elaborate  apparatus  or  long  technical  training  for 
its  performance.     If  it  cannot  be  applied  and,  in 
addition,  the  physical  signs  are  not  very  definite, 
the  diagnosis  of  phthisis  can  only  be  made  provi- 
sionally.    On  the  other  hand,  the  disease  may  have 
existed  for  a  considerable  period  and  may  have 
caused  more  or  less  extensive  destruction  of  lung- 
tissue  without  being  detected  during  fife  by  the 
physician  or  suspected   by  the   patient  himself. 
The  revelations  of  the  post-mortem  room  have 
proved  this  over  and  over  again.     The  application 
of  radiography  to  medicine  promises  to  be  of  the 
greatest  assistance  in  the  practical  diagnosis  of 
pulmonary  disease,  both  in  the  detection  of  early 
phthisis  and  also  by  providing  ocular  demonstra- 
tion of  the  extent  and  distribution  of  the  malady. 
At  the  last  meeting  of  the  Clinical  Socety  of  London, 


a  report  of  which  appeared  in  our  last  week's  issue, 
Drs.  A.  S.  Green  and  \V.  H.  B.  Brook,  of  Lincoln, 
showed  very  clearly  the  value  of  the  X-rays  as  a 
factor  in  the  diagnosis  of  pulmonary  tuberculosis 
Especially  to  be  noticed  is  the  unilateral  limitation 
of  movement  of  the  diaphragm  which  can  be 
seen  by  the  screen  method  in  early  cases,  and  in 
bilateral  cases  these  observers  have  shown  that  the 
presence  of  tuberculous  disease  may  be  demon- 
strated in  many  instances  before  it  is  recognisable 
by  ordinary  methods  of  examination. 

A  Dietetic  Transformation. 
Everyone  has  his  own  theory  of  diet  nowadays, 
and  the  doctor  who  fails  to  leave  instructions  as  to 
a  patient's  food  is  thought  worse  of  than  one  who 
forgets  to  leave  a  prescription.  People  have  a 
firmly-rooted  idea  that  it  is  that  which  goeth  into 
a  man  that  defileth  him,  and  every  pathological 
sin  of  omission  or  commission  is  laid  at  the  door 
of  some  dietetic  indiscretion  or  error.  But  the  diet 
has  not  yet  received  the  recognition  it  deserves 
as  a  factor  in  the  formation  of  moral  character, 
and  anyone  who  doubts  that  it  is  such  a  factor 
should  ponder  over  the  remarkable  case  of  Julius 
Wiltrax,  which,  although  it  comes  from  New  York, 
seems  to  be  fairly  well  authenticated.  A  little 
boy  of  four  years  of  age  was  found  murdered  last 
year,  and  after  the  case  had  been  in  the  hands  of 
the  police  for  some  time  enough  evidence  was 
accumulated  to  enable  them  to  charge  a  bar- 
keeper named  Wiltrax  with  having  committed  the 
crime.  In  the  course  of  the  trial  the  chief  witness 
against  the  prisoner  was  his  little  son  Julius,  who 
confessed  with  charming  boyish  naivete,  that  his 
father  had  killed  the  child.  Wiltrax  was  found 
guilty  and  imprisoned.  A  millionaire,  Mr.  Van 
Vlissingen,  who  was  much  interested  in  the  case, 
formed  the  impression  that  a  miscarriage  of  justice 
had  taken  place,  and  obtained  permission  to  isolate 
Julius  from  his  surroundings,  and  feed  him  liber- 
ally on  the  best  of  food.  After  a  course  of  this 
modified  Weir-Mitchell  treatment,  the  boy  con- 
fessed that  his  evidence  was  perjured  ;  that  it  had 
been  manufactured  by  the  police,  who  made  him 
learn  it  by  heart  and  repeat  it  under  threats.  It  is, 
of  course,  still  open  to  question  whether  the 
(apparently)  reformed  Julius  is  not  as  big  a  liar  as 
he  was  before  the  treatment,  and  a  fresh  trial  is 
likely  to  be  forthcoming  at  which  his  new  evidence 
will  be  sifted.  If  it  prove  that  isolation  from  his 
unhealthy  surroundings  and  the  administration 
of  a  generous  dietary  have  wrought  the  transforma- 
tion they  appear  to  have  done,  the  makers  of  the 
now  fashionable  food  preparations  will  have  a 
new  argument  to  add  to  the  many  whereby  they 
seek  to  call  attention  to  their  wares. 


(a)  New  York  Med.  Journ.,  November  8th  and  15th,  1902. 


Prognosis  in  Tuberculous  Affections. 
The  prognosis  of  tuberculous  affections  is  a 
matter  of  interest  to  all  members  of  the  medical 
profession.  Their  protean  aspect  can  be  properly 
appreciated  only  by  a  general  acquaintance  with 
the  diseases  of  special  regions  of  the  body.  In  this 
way  the  physician,  the  surgeon,  the  ophthalmic 


57°    Ths  Medical  Press. 


CORRESPONDENCE. 


May~25.  1904, 


surgeon,  the  dermatologist,  the  alienist,  the 
gynaecologist,  the  aurist,  in  a  word,  every  medical 
man,  whatever  the  nature  of  his  practice,  has  to 
be  on  the  alert  against  obscure  tubercle,  just  as 
he  is  about  obscure  syphilis.  Of  late  years  there 
is  no  need  to  remark  that  our  ideas  have  undergone 
a  revolution  with  regard  to  pulmonary  tuber- 
culosis. The  open-air  treatment  marked  one  of  the 
great  advances  in  scientific  medicine.  With  regard 
to  surgical  tuberculosis  the  frequent  healing  of 
tuberculous  abdominal  affections  after  simple  inci- 
sion opened  up  another  line  of  advance.  In  spite  of 
surgical  progress,  however,  certain  tuberculous 
affections  are  still  regarded  as  practically  hope- 
less. Tubercle  of  the  choroid  usually  heralds  a 
rapidly  fatal  termination,  but  cases  of  that  affection 
have  been  recorded  in  which  the  patient  has  lived 
for  years,  or  has  ultimately  recovered.  This  inter- 
esting subject  has  received  considerable  attention 
at  the  Society  for  the  Study  of  Disease  in  Children, 
and  will  be  found  fully  reported  in  the  "  Transac- 
tions "  of  that  body. 

PERSONAL. 


His  Majesty  the  King  has  been  pleased  to  appoint 
Sir  Charles  Bent  Ball,  M.D.,  F.R.C.S.,  Regius  Professor 
of  Surgery,  University  of  Dublin,  to  be  one  of  His 
Majesty's  Honorary  Surgeons  in  Ireland,  in  the  room 
of  Sir  Philip  Crampton  Smyly,  M.D.,  deceased. 

It  is  announced  that  Professor  Koch,  who  is  re- 
turning from  South  Africa  after  investigating  the  causes 
of  mortality  among  horses,  believes  he  has  discovered 
a  remedy  against  the  disease. 

Dr.  Arden  Messitter,  J. P.,  has  been  for  the  third 
time  elected  President  of  the  Medical  Defence  Union. 


The  annual  address  of  the  Balneological  Society 
was  delivered  on  the  18th  inst.  by  Sir  Dyce  Duckworth. 


Lord  Glenesk  last  week  presided  at  the  annual 
general  meeting  of  the  Hospital  for  Women,  Chelsea, 
London.  

Sir  Isambard  Owen,  Deputy  Chancellor,  presided 
last  week  at  the  annual  meeting  of  the  Welsh  Uni- 
versity at  Holyhead. 


Mr.  John  W.  Hughes  has  generously  presented  the 
Royal  Southern  Hospital,  Liverpool,  with  a  full  equip- 
ment for  the  X-ray  room. 


The  Duke  of  Fife  will  preside  at  the  annual  meeting 
of  the  London  Hospital  for  Sick  Children,  Great 
Ormond  Street,  on  May  26th,  at  5  p.m. 

It  is  announced  that  Lord  Wolverton  will  preside 
at  the  Festival  Dinner  of  the  Metropolitan  Hospital 
at  the  Whitehall  Rooms,  London,  on  June  25th  next. 

Dr.  Joseph  O'Carroll  delivered  an  address  dealing 
with  the  Poor-law  Dispensary  System  at  the  annual 
meeting  of  the  Leinster  Branch  of  the  British  Medical 
Association.  

The  Duchess  of  Westminster  last  week  presided 
at  the  annual  general  meeting  of  the  University  College 
Hospital  Ladies'  Association,  which  now  numbers 
386  members. 


Mr.  T.  C.  Langdon,  F.R.C.S.Eng.,  has  been  pre- 
sented with  a  handsome  service  of  plate  in  recognition 
of  forty  years'  devoted  service  as  surgeon  to  the  Royal 
Hants  County  Hospital. 


Dr.  Noguchi,  a  Japanese  physician,  recently 
announced  the  discovery  ot  a  serum  antidote  to  rattle- 
snake poison  at  the  annual  dinner  of  the  American 
Physicians'  Association  at  Washington. 

Dr.  A.  F.  Street,  of  Westgate,  President  of  the 
Balneological  and  Climatological  Society,  took  the 
chair  at  two  most  successful  social  functions  of  that 
association  on  the  18th  inst.,  namely,  the  annual 
dinner  and  smoking  concert. 


Dr.  R.  H.  Bakewell,  who  is  now  over  seventy 
years  of  age,  is  said  to  be  the  only  man  in  the  Army 
who  is  entitled  to  wear  the  Crimean  and  the  South 
African  medals.  As  a  young  man  he  served  in  the 
Crimea,  and  was  under  Lord  Raglan  as  Staff- Assistant- 
Surgeon.     He  has  seen  service  in  New  Zealand. 


Correspondence. 

[We  do  not  hold  ourselves  responsible  for  the  opinion  of  our  corres- 
pondent* ] 


VERMIN  IN  CHILDREN'S  HEADS. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — Your  correspondent,  Mr.  W.  R.  H.  Stewart,  is 
to  he  congratulated  on  the  anticipation  of  reform  that 
prompted  his  suggestion  that  the  heads  of  all  board 
school  children  should  be  examined  by  a  medical  officer 
as  a  matter  of  routine.  As  an  aural  surgeon  he  has 
no  doubt  traced  scores  of  more  or  less  serious  ear 
troubles  to  their  ultimate  origin  in  irritation  of  the 
scalp  by  pediculi.  In  skin  practice  one  is  constantly 
impressed  by  the  extent  and  sometimes  the  gravity  of 
cutaneous  troubles  due  to  the  same  cause.  Indeed,  a 
philosophic  description  of  a  great  proportion  of  skin 
affections  might  be  based  on  the  history  of  near  and 
remote  effects  of  the  pediculi  that  haunt  the  human 
scalp.  In  feeble  children  the  results  are  often  disas- 
trous. 

It  is  to  be  hoped  that  Mr.  Stewart  will  live  to  see  his 
suggestion  carried  out  in  every  rate-supported  or  rate- 
aided  school.  Wisely,  he  has  left  the  supervision  to  a 
medical  officer.  None  but  those  who  have  spent  years 
at  skin  work  can  realise  the  amount  of  patience,  skill 
and  experience  often  needed  to  detect  the  presence 
of  pediculi.  I  am.  Sir,  yours  truly, 

D.  Walsh. 

Hanover  Street,  London,  W.,  May  19th,  1004. 


PALMAM  QUI  MERUIT  FERAT.— A  PROTEST. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — Probably  the  vulgar  phrase, ' '  a  large  order," 
could  never  more  properly  be  applied  than  to  the  claim 
which  Dr.  Granville  Bantock  put  forth  in  his  first  letter 
under  the  above  heading  some  month  or  so  ago.  In 
that  letter,  as  I  understood  it,  he  suggested  that  he, 
not  Lord  Lister,  deserved  to  bear  the  palm  for  the 
advance  in  surgical  practice  known  as  Listerism  ;  and 
that  Lord  Lister  had  accepted  the  honours  unani- 
mously conferred  upon  him  by  the  whole  scientific  and 
unscientific  world  well  knowing  he  had  no  real  claim 
to  them,  and  knowing,  indeed,  that  they  belonged  to 
Dr.  Granville  Bantock.  This  is  a  truly  colossal  order, 
and  it  seems  to  me  should  be  fully  justified  or  with- 
drawn by  its  author.  That  is  the  question.  I  do  not 
think  it  woukj  interest  your  readers  to  revive  and 
rehearse  the  controversy  I  held  with  Dr.  Bantock  and 
the  late  Mr.  Lawson  Tait  in  your  columns  in  1896. 
In  turning  to  the  correspondence,  however.  I  find  that 
in  a  letter  in  The  Medical  Press  and  Circular  of 
October  7th  in  that  year,  Dr.  Bantock  wrote :  "  No 
one  has  ever  seen  a  germ  ;  and  if  he  believes  in  germs 
he  has  no  means  of  proving  their  presence  or  absence." 
He  now  writes  that  my  memory  plays  me  false  when 
"  I  attribute  to  him  the  denial  of  the  existence  of 
germs."  Some  things  evidently  have  happened  in 
Dr.  Bantock's  experience  since  1896  ;  no  doubt  he  can 
explain  them  and  make  his  position  clear  if  he  please. 
For  myself  I  may  say  it  will  be  interesting  to  hear  Dr. 
Bantock's  explanations ;    but  not  the  slightest  atten- 


May  2$    1904. 


MEDICAL  NEWS. 


The  Medical  Press.    571 


tioo  having  so  far  been  paid  to  his  writings  on  the 
subject  in  question  by  the  scientific  world  in  general. 
I  am  not  quite  certain  whether  his  contributions  will 
be  equally  acceptable  to  those  of  your  readers  who  do 
not,  like  myself,  sign  themselves  in  good  faith, 

Yours  truly, 
May  28th,  1904.  Ignoramus. 

®bttuarv. 

GEORGE  H.  C.  WAY,  M.D.Lond.,  B.S. 
We  regret  to  announce  the  accidental  death  of 
Dr.  George  H.  C.  Way,  who  for  seven  years 
practised  at  Romsey.  He  hid  announced  his 
intention  of  going  for  a  bathe  in  the  river.  Three- 
quarters  of  an  hour  later  a  keeper  saw  his  body  in 
eight  feet  of  water.  Another  doctor  plunged  in  and 
got  the  body  out,  but  life  was  extinct.  The  deceased 
was  an  expert  diver  and  swimmer,  and  it  is  supposed 
that  he  was  overtaken  by  cramp.  The  career  thus 
cut  short  was  full  of  brilliant  promises.  Dr.  Way 
was  a  student  of  University  College  Hospital,  whence 
he  took  the  M.B.Lond.  and  B.S.  in  1894,  and  the 
M.R.C.S..  L.R.C.P.,  in  the  same  year.  He  acted  as 
House  Phvsician  at  University  College,  and  at  the 
Great  Orm'ond  Street  Hospital  for  Children. 

AcMcal  flews. 

The  Royal  University  of  Ireland. 

His  Majesty  the  King  has  been  graciously  pleased 
to  present  to  the  Roval  University  of  Ireland  a  signed 
portrait  of  himself "  through  the  Chancellor  of  the 
University,  the  Right  Hon.  the  Earl  of  Meath.  Their 
Majesties  the  King  and  Queen  are  hon.  graduates  of 
the  Royal  University. 

University  of  Durham.— Health  Scholarship. 

The  scholarship  founded  in  accordance  with  the 
will  of  the  late  Professor  G.  Y.  Heath,  M.D.,  D.C.L., 
F.RC.S.,  President  of  the  University  of  Durham 
College  of  Medicine,  has  been  awarded  by  the  Professor 
of  Surgery  in  the  University  of  Durham  to  Mr.  W.  G. 
Richardson,  M.B.,  F.R.C.S.,  of  Newcastle-upon-Tyne,  for 
his  essay  on  "  The  Development  and  Anatomy  of  the 
Prostate  Gland,  together  with  an  account  of  its  injuries 
and  diseases,  and  their  surgical  treatment."  This 
scholarship  is  awarded  every  second  year,  and  is  of 
the  value  of  £200.  A  further  grant  from  the  scholar- 
ship funds  to  the  extent  of  £50  was  awarded  to  Mr. 
Richardson,  half  of  which  is  for  the  purpose  of  repro- 
ducing the  drawings  which  accompanied  the  essay, 
\  and  the  other  half  to  enable  Mr.  Richardson  to  mount 
satisfactorily  his  valuable  collection  of  wet  specimens, 
nearly  seventy  in  number,  which  illustrated  the 
essay.  These  will  form  an  important  addition  to  the 
Museum  of  the  University  of  Durham  College  of 
Medicine,  Newcastle-upon-Tyne. 

Death  Under  an  Anaesthetic. 

Last  week  Mr.  John  Troutbeck  held  an  inquest  at  the 
Westminster  Coroner's  Court,  London,  touching  the 
death  of  Sydney  Renaut,  aged  58  years,  lately  living 
at  HummunYs  Hotel,  Covent  Garden,  where  he  was 
employed  as  manager.  The  evidence  showed  that 
deceased  was  removed  to  the  Charing  Cross  Hospi- 
tal. It  was  then  found  that  he  was  suffering 
from  a  strangulated  hernia,  and  that  an  operation 
was  necessary.  Dr.  Hood  administered  an  anaesthetic 
and  twenty  minutes  later,  whilst  the  operation  was 
proceeding,  patient  was  noticed  to  be  looking  blue. 
Restoratives  were  administered,  and  he  rallied  a 
little  but  sank  and  died  in  a  quarter  of  an  hour.  Dr 
Freyberger,  whose  opinion  is  necessary  to  the  formal 
verdict  of  any  Westminster  inquest,  attributed  death 
to  heart  failure  whilst  deceased  was  under  the  influence 
of  an  anaesthetic.  The  jury  returned  a  verdict  of 
"  Death  by  Misadventure." 

The  Fifteenth  International  Congress  of  Medicine. 

This  congress  will  be  held  at  Lisbon  from  April 
19th  to  26th,  1006,  and  will  be  representative  of 
the  various  sections  as  usual,  with  an  additional 
section  on  "  Colonial  and  Naval  Medicine."  The 
executive  committee  of  the  Congress  has  the  intention 
to  print,  before  the  reunion,  all  the  official  reports; 


it  is  necessary  that  they  shall  be  given  before  Septem* 
ber  30th,  1905,  to  the  General  Secretary,  or  at  the* 
very  latest  before  December  31st,  1905,  if  the  authors, 
desire  that  the  conclusions  should  be  printed  before* 
the  opening  of  the  Congress.  The  official  language- 
is  the  French.  In  the  general  assemblies,  as  in  the. 
sections,  the  English,  German,  and  French  may  be* 
used.  We  see  the  committee  has  excluded  the  Por- 
tuguese from  the  languages  permitted,  with  the* 
intention  of  diminishing  the  number  of  languages 
spoken.  The  president  of  the  committee  of  organi- 
sation is  Dr.  M.  da  Costa  Alemao  ;  the  general  secretary. 
Dr.  Miguel  Bombarda ;  all  the  adhesions  must  be 
addressed  to  the  latter  at  the  Hospital  de  Rilhafollest 
Lisbon.  Mr.  D'Arcy  Power,  F.R.C.S.,  is  the  hon. 
secretary  for  England. 

New  Home  for  Consumptives. 

The  Duchess  of  Montrose  opened  last  week  the. 
Lanfine  Home  at  Kirkintilloch,  Dumbartonshire,  the 
first  institution  in  Scotland  where  consumptive  patients, 
who  are  beyond  the  point  at  which  treatment  in  a 
sanatorium  would  be  likely  to  prove  beneficial  will 
be  attended  to  during  the  remaining  period  of  their- 
fllness.  The  Duchess  of  Montrose,  in  declaring  the- 
home  open,  said  that  at  the  present  day,  when  they 
heard  on  all  sides  that  fresh-air  homes  were  being 
established  in  different  parts  of  the  country,  the  public 
were  apt  to  think  that  all  that  was  necessary  was 
being  done,  not  always  realising  that  these  fresh-air- 
homes  were  only  available  for  those  who  were  in  the 
first  stage  of  consumption,  and  who  happily  could  be 
permanently  cured.  There  still  remained  an  urgent 
need  for  homes  for  more  advanced  cases  who  were, 
liable  to  become  centres  of  infection.  By  that  method 
alone  could  the  disease  effectually  be  combated.  The 
Lanfine  home  was  provided  for  incurable  cases  only. 
She  hoped  that  the  public  would  subscribe  and  not 
disappoint  the  director  who  had  taken  the  grave 
responsibility  of  carrying  into  operation  the  bequest 
of  the  donor,  Miss  Martha  Brown,  of  Lanfine,  Ayrshire 
The  Study  of  Medicine  In  Wales. 

At  the  recent  annual  meeting  of  the  Welsh  University- 
Court,  at  Holyhead,  the  question  of  petitioning  for  a 
supplemental  Charter,  which  should  include  provision 
for  enabling  the  LTniversity  to  grant  degrees  in  medicine, 
surgery,  and  obstetrics  was  raised.  The  following 
letter  from  Sir  Arthur  Bigge,  Private  Secretary  ta 
the  Prince  of  Wales,  Chancellor  of  the  University,  was. 
read  : — "  Marlborough  House,  May  9th. — His  Royal 
Highness  has  read  your  letter  of  the  7th,  and  is  glad 
to  hear  of  the  large  improvement  on  your  estimate 
for  the  year,  which  seems  to  him  creditable  to  those 
who  manage  the  finances  of  the  University.  His  Royal 
Highness  quite  approves  of  including  in  the  petition 
for  the  power  of  granting  degrees  in  medicine,  the 
supplemental  Charter  you  contemplate  applying  for 
for  the  affiliation  of  the  Colleges." 

Irish  Medical  Schools  and  Graduates*  Association. 

A  special  meeti  g  cf  this  association  will  be  held 
to-day  at  4.30  p.m.,  at  11  Chandos  Street,  for  the 
purpose  of  discussing  the  grievances  of  the  members 
of  the  Irish  Poor-law  Medical  Service.  The  meeting 
has  been  summoned  in  response  to  a  requisition  signed 
by  twenty-one  members  of  the  association. 

Trinity  College  Dublin.— Trinity  Term,  1904. 

Final  in  Surgery. — James  G.  Wallis,  Herbert  St.  M. 
Carter,  Henry  M.  Crawford.  Wright  Mitchell,  Arthur  W. 
Goldsmith,  Charles  J.  Coppinger,  David  Gray.  John  W. 
Leech,  James  H.  C.  Thompson,  Frederick  W.  Bury, 
John  A.  Sibthorpe,  Wilfrid  Thunder,  Harold  T. 
Marrable,  Wilfred  L.  Myles,  George  B.  M'Caul. 
Royal  College  of  Surgeons  In  Ireland. -Fellowship 
Examination. 

The  following  candidates  having  passed  the  neces- 
sary examination,  have  been  admitted  Fellows  of  the 
college  :— L.  E.  Hardy,  M.S..  &c,  Univ.  Edin.  ;  J.  F.  L. 
Keegan,  L.R.C.S.I.,  Ac.  ;  R.  H.  Kennan.  M.Ch.,  Ac. 
Univ.  Dub.  ;  J,  C.  Lavertine.  L.R.C.S.I..  &c.  ;  J.  M.  S. 
Levjs,  L.R.C.S.I.,  &c.  ;  J.  J.O'Hagan,  L.R.C.S.I.,  &c.  ;- 
and  H,  Stevenson.  B,Ch„  &c„  Roy,  Univ,  Ire!. 


57  *    Tub  Medical  Pus?.       NOTICES  TO  CORRESPONDENTS. 


May  25,  1904. 


Jtottce*  to 
€oxxtBpor(btxttB9  Short  %tttix*f  &l 

MG&*  Correspondents  requiring  a  reply  in  this  column  are  particu 
larly  requested  to  make  use  of  a  dUtinctive  Signatwrt  or  initial,  and 
avoid  the  practice  of  signing  themselves  "Reader,"  "Subscriber," 
"  Old  Subscriber/'  Ac  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

Original  Articles  or  Lbttkrs  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

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

Reprints.— Reprints  of  articles  appearing  in  this  journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

Dr.  J.  W.  Martin  is  thanked  for  his  communication,  which  is 
marked  for  early  insertion. 

Mr.  Dawson.— Recent  statistics  reveal  the  fact  that  a  good  many 
fallacies  surround  the  subject.  We  are  at  present  completing  a  series 
of  analytical  investigations,  which  we  hope  to  publish  shortly  in  these 
columns. 

THE  RED  CROSS  IN  WAR. 

From  the  last  number  of  our  medical  contemporary,  the 
Sn-i'Kwai,  of  Tokio,  we  learn  that  the  President  of  the 
Nursing  Association  of  Japan,  is  H.LH.  Princess  Komatsu, 
the  membeis  are  all  ladies,  and  the  manager  is  Marchioness 
Nabeshima.  All  the  members  are  trained  in  the  duties  of  nurse,  and 
their  work  is  consequently  of  the  greatest  assistance  to  the  Red 
Cross  8ociety.  Bandages  and  many  other  surgical  necessities  are 
sent  to  the  field  by  the  Association.  Its  members  visit  the  wounded 
men  in  the  hospitals,  and  also  work  as  nurses  there.  Some  of  them 
even  go  to  the  front.  They  also  keep  in  close  touch  with  the  regular 
nurses  of  the  Red  Cross,  seeing  them  off  when  they  start  for  the  field, 
welcoming  them  when  they  return,  sending  presents  and  comforts  to 
them  during  the  discharge  of  their  arduous  functions,  and  seeking 
otherwise  to  encourage  and  assist  them.  It  will  thus  be  seen  that 
the  work  done  by  the  Association  is  wide  and  very  helpful.  Though 
its  operations  are,  so  to  speak,  subordinate  to  the  larger  work  of  the 
Red  Cross,  it  usefully  supplements  the  latter,  and  la  plso  entirely 
self-supporting. 

Edinburgh  Student. — We  have  seen  no  announcement  to  the 
effect,  and  we  take  it  that  the  present  edition  is  not  likely  to  be 
superseded  by  another. 

Rev.  R.  Symonps.— The  numbers  of  Tin  Medical  Press  and 
Circular  containing  Prof.  Taylor's  address  on  "  The  Diminishing 
Birth-Rate  "  are  out  of  print.  * 

Dr.  Franze  rCNauheimK— We  hope  to  have  space  for  your  note  on 
"Alternating  Electrical  Currents"  In  our  next. 

detectings  of  the  goaetiM,  lectures,  &t. 

Wednesday.   Mat  25th. 

Dermatolooical  Society  or  Great  Britain  and  Ireland  (20 
Hanover  Square,  W.). — 4.30  p.m.  Annual  Meeting  and  Conference. 
Oration:— Dr.  H.  A.  G.  Brooke:  The  Clinical  Relationships  of 
SeborrhoD*. 

Medical  Graduates'  College  and  Polyclinic  (22  Chenies  Street, 
W.C.).— 4  p.m.  Mr.  T.  P.  Lejrg:  Oliniqne.  (8urgical.)  5.15  p.m. 
Dr.  A.  P.  Luff :  The  Forms  of  Diabetes  and  the  Differential  Exami- 
nation of  the  Urine. 

Thursday,  Mat  26th. 

Medical  Graduates'  College  and  Policlinic  (22  Chenies  Street, 
W.O.— 4p.m.  Mr.  Hutchinson:  Clinique.  (Surgical).  5.15  p.m. 
Dr.  T.  W.  Eden  :  Purulent  Endometritis. 

Mount  Vernon  Hospital  for  Consumption  and  Diseases  op  the 
Chest  (7  Fitzroy  Square,  W.)— 5  p.m.  Dr.  J.  E.  Squire:  General 
Principles  of  Treatment  of  Respiratory  Affections.  P-st-Graduate 
Course.) 

Friday,  May  27th. 

6ociETY  for  the  Study  of  Diseask  in  Children  (11  Chandoa 
Street,  Cavendish  Square,  W.I. —5  30  p.m.  Cases  will  be  shown  by 
Dr.  E.  Cautlev,  Mr.  F.  Jaffrey,  Mr.  W.  Edmunds,  Mr.  H.  Ted,  Dr 
W.  Emery,  Mr.  H.  Balme,  Mr.  A.  D.  Beid,  and  Mr.  T.  Walker' 
Papers:  Mr.  W.  W.  Cheyne,  Dr.  R.  H.  W.  Welbe,  and  Mr.  L.' 
Mummery. 

Clinical  Society  of  London  (20  Hanover  Square,  W.)— 8.30  p.m. 
Annual  General  Meeting.  Election  of  Officers  for  8ession  1904-5. 
Papers :— Dr.  D.  W.  Finlay :  A  Case  of  Pneumothorax  treated  by 
Incision  and  Removal  of  Ribs.  Dr.  H.  E.  Thompson  and  Dr.  0.  U. 
Aitchison  (introduced  by  Dr.  P.  Kidd) :  Two  Cases  of  Tumour  of  the 
Left  Auricle  simulating  Mitral  Stenosis.  Mr.  H.  B.  Robinson  • 
Pernor  al  Aneurysm  in  Hunter's  Canal,  Ligature  of  Superficial  Femoral 
and  Popliteal  Arteries,  Cure  of  Aneurysm,  Death  from  Cardiac  Dis- 
ease Ten  Weeks  later.  Mr.  C.  B.  Keyser:  Case  of  Congenital 
Elevation  of  the  Scapula. 

Medical  Graduates'  College  and  Polyclinic  (22  Chenies  Street. 
W.C.).— 4  p.m.    Dr.  L.  Lack :  Clinique.    (Throat.) 
Monday,  May  30th. 

Odontolooical  Society  of  Great  Britain  (20  Hanover  Square, 
w.  .-8  p.m.  Mr.  William  Rushton  :  Total  Absence  of  Dentition  in 
a  Boy,  art.  16.  Mr.  Leonard  Matheson :  Some  Debateable  Methods 
in  Everyday  Practice. 


City  of  Nottingham  Workhouse  Infirmary.— Junior  Resident  Medical 

Officer.    Salary  £120  per  annum,  with  apartments,  bosrd,  wash- 
ing, and  attendance.    Applications  to  G.  Muncaster  Howard 
Derbyshire    Royal    Infirmary.— Resident  House  Surgeon.     Sa'ary 

£100  per  annum,  with  apartments  and  board.    Applications  to 

Walter  G.  Carnt,  Secretsrj -Superintendent,  Royal  Infirmary. 

Derby. 
Ebbw  Vale  Steel,  Iron,  and  Coal  Co.,  Limited.— Resident  Medical 

Man  (F.B.C.S.).    Salary  £500  per  annum.    Applications  to  the 

Secretary  of  the  Firm,  Ebbw  Vale,  B.8.O.,  Mon 
Evelina  Hospital  for  Sick  Child. eD,  Southward— House  Surgeon 

Salary  £80  per  annum,   with  board,  residence,  and  washing 

Applications  to  the  Committee  of  Management  at  the  Hospital 
Incorporated  Dental  Hospital  of  Ireland.— Anesthetist.    Immediate 

application  to  W.  Athea,  J.P.,  Registrar.    (See  advert.) 
Lanark  County  Council.— Assistant  Medical  Officer  of  Health.  Salarv 

£140    per    annum,    with    travelling  expenses.     Applications 

to  the  County  Medical  Officer,  Hamilton.  N.B. 
New  Ross    Union  —Medical  Officer.    Salary  £106  per  annum  with 

usual  fees  for  Vaccination,  Registration,  Ac,  also  to  act  as  Medi- 

cal  Officer  of  Health  at  a  salary  of  £i±     Immediate  application 

to  P.  A.  Pope,  Clerk  of  Union.    (8ee  advt. ) 
Roscommon    Union.— Medical    Officer.     Salary   £150   per   annum, 

together  with  £15  under  the  Public  Hedth  Acts,  and  about  £7 

Vaccination  Fees.     Immediate  application  to  T.  J.  O'Keeffe,  bee. 

(See  advert.) 
Rotherham  Hospital  and   Dispensary.— Assistant  House   Surgeon. 

8alary  £80  per  annum.      Application  to  E.  8.  Baylies,  19  Moor- 

ga'e  Street,  Rotherham. 
Sheffield  Chi  dren's  Hospital  .—Lady  House  Surgeon .    *  alary  £80  per 

annum,  with  board,  lodging,  and  washing.    Application  to  Mr. 

Frederick  Gill,  Secretary,  14  Norfolk  Row,  Sheffie'd. 
West  Suffolk  General  Hospital,  Bury  St.  Edmunds.— House  Surgeon. 

Salary  £100  per  annum,  with  board  and  lodging.    Applications 

to  the  Secretary. 
Western  General  Dispensary,  Marylebone.— Second  House  Fiugeon. 

Salary  £90  per  annum,  with  board,  residence,  and  laundry. 

Applications  immediately  to  the  Hon.  Secretary. 
York  Dispensary.— Resident  Medical  Officer.  Salary  £120  a  vesr,  with 

board,  lodging,  and  attendance.     Applications  immediate'y  to 

W.  Draper,  Esq.,  De  Grey  House,  York. 


JlppomtmeniB. 


Brtdon,  Jambs,  M.D.Edm.,  Police  Surgeon   to   the   Borough  of 

Hawick. 
Clarke,  J.  Jackson,  M.B.Lond.,  F.B.C.S.,  Surgeon  to  the  Cty 

Orthopaedic  Hospital. 
Hayzs,  J.  R.,  M.D.,  M.Ch.B.U.I.,  Medical  Officer  to  the  County 

Kerry  Fever  Hospital. 
Hill,  Philip  E.  M.R.C.8.,  L  8  A.,  Medical  Officer  to  the  Post  Office, 

Crickhoweu. 
Hopor.  G.,  M.B  ,  C.M.Glasg.,  Assistant  Physician  to  the  Dumfries 

and  Galloway  Royal  Infirmary. 
Hughes,  Hdoh  Lewis,   L.R.C.P.  &  S.Edln.,  L J\P.S.Glssg  ,  Medical 

Officer  to  the  Post  Office,  Dowlais. 
Johnston,  J.,  MD.Edin.,  L.S.A.,  Medical  Officer  to  the  Casual 

Wards,  Bolton  Union. 
McKsllar,  Gborsb,  M.  D.Ed  in.,  Medical  Officer  of  the  Borough  of 

Hawick. 
Moopir.  D,  L.R.C.P.,    L.B.C.S.Xdln.,  L.F.P.S.Glasg.,   Certifrin? 

Surgeon  under  the  Factory  Act  for  the  Ooxhoe  District  of' the 

County  of  Durham. 
Orr,  Robert,  MR,  Ch.B.Glasg,,  Certifying   Surgeon    under  the 

Factory  Act  for  the  Ceres  District  of  the  oountv  of  Fife. 
Parsons,  J.  Herbert,  B.8.,  D.8c. ,  F.B.C.8.,  Assistant  Ophthalmic 

Surgeon  to  University  College  Hospital. 
ScaoriRLO,  F.  W.,  M.B.,  Ch.B.Vict.,   House  Surgeon  to  the  Boy*! 

Infirmary.  Bradford. 
8evillb,  C.  F..  M.R.C.S.,  L.S.A..  Certifying  Surgeon  under  the 

Factory  Act  for  the  Rothwell  District  of  the  county  cf  York. 
Snell.  E.  H..  M.D.  l.ond.,  D.P.H.,  Honorary  Sanitiry  Officer  to  the 

Coventry  and  Warwickshiie  Hospital. 

#itth0. 

Irwik-Moore.— On  May;  16th  at  80a,  Wimpole  Street,  W.,  the  wife 
#»f  J.  L.  Irwin-Moore,  M.B.,  CM.,  prematurely  of  a  daughter 
(stillborn). 

Ransome.— On  May  19th,  at  Bungay,  Suffolk,  the  wife  of  Gilbert 
Ransome,  M.R.C  8.,  L.R.C.P.,  of  a  daughter. 


4ttatriages. 


Jackson-Chippbrfielo.— On  May  4th,  at  All  Saints,  Oxbow,  Assa, 
Canada,  Allan  Shand  Jackson,  youngest  son  of  the  late  Alex* 
ander  Jackson,  M.D.,  F.R.C.P.  Edin.,  to  Bertha  Louisa  Chipper- 
field,  Esq.,  of  Romford,  Essex,  England. 

James— Shkpherp.— On  May  18th,  at  St.  Msry's  Chapel,  Aberdeen, 
Frederick  Charles  James.  M.B.,  eldest  son  of  Frederic  James,  of 
Tregunter  Road,  South  Kensington,  to  Leila,  eldest  daughter  of 
the  late  James  Shepherd,  of  Aidie,  Aberdeenshire. 


garths. 

Moore.— On  May  18th,  at  Warneford  House,  Moreton-in-Marsb,  John 
New  Moore,  J.P  ,  M.R.C.S.,  sged  63. 

Thin.— On  May  18th,  at  93,  Pitt  Street.  Edinburgh,  Robins  Jane 
White,  widow  of  the  late  George  Thin,  M.Dn  late  of  68,  Barley 
Street,  London. 

Wood. — On  May  17th,  suddenly,  at  Kvnance  Cove,  near  Lizard.  Corn- 
wall. Thomas  Wood,  B.A.,  M.B.B.C.  (Cantab.),  F.B.C.P.,  •«* 
M.E.CS.   Lond.),  aged  29. 


Wb  ffHedital  %§tm   m&   tfirrulur. 


"8ALU8   POPULI   8UPBEMA    LEX/ 


Vol.  CXXVIII. 


WEDNESDAY,    JUNE   i,    1904. 


No.   22. 


Original  Communications, 
THE     SURGICAL  TREATMENT 

OF 

SHORT  SIGHT. 

By  ARTHUR   H.    BENSON,     M.A.,   M.B.Univ. 

Dub.,  F.R.C.S.I., 
Surgeon  to  the  Boy al  Victoria  Eje  and  Ear  Hospital,  Dublin;  Oph- 
thalmic and  Aural  Surgeon  to  the  Royal  City  of  .Dublin  Hospital. 

The  domain  of  operative  surgery  is  ever  extend- 
ing, and  what  is  the  dream  of  to-day  becomes  the 
reality  of  to-morrow. 

Nearly  200  years  ago  it  was  noted  that  after 
the  removal  of  cataract  in  cases  of  high 
myopia  the  patients  sometimes  saw  well  without 
any  glasses,  but  the  idea  of  artificially  producing 
cataract  in  a  myopic  eye,  in  order  to  remove  it,  and 
thus  diminish  the  amount  of  the  myopia,  was  not, 
as  far  as  we  know,  seriously  considered  until  about 
fifty  years  ago.  When  Adolf  Weber,  in  1858, 
reported  a  successful  case  to  the  Heidelberg  Con- 
gress, Von  Graefe,  Donders,  Arlt,  and  many  of  the 
leaders  of  the  ophthalmologic^  world  condemned 
the  idea,  and  in  such  strong  language  that  the  opera- 
tion fell  into  disgrace  till  revived  in  1889  by 
Fukala,  who  reported  sixteen  cases  before  the  Medi- 
cal Society  in  Vienna.  Since  then  the  operation  has 
been  more  or  less  widely  done  in  Europe,  though 
many  of  the  American  text-books  still  fail  to  men- 
tion it,  or  do  so  in  such  a  way  as  to  show  that  the 
authors  have  no  personal  knowledge  of  the  subject. 
The  operation  formed  the  subject  of  a  special 
discussion  by  the  Ophthalmological  Society  of  the 
United  Kingdom  in  1899,  anc*  though  there  are 
still  some  who  continue  to  regard  it  as  unjustifiable, 
a  large  majority  seem  to  have  agreed  that  the 
operation  was  not  only  justifiable,  but  that  it  was 
henceforth  to  be  regarded  as  a  most  valuable  means 
of  improving  the  comfort  and  usefulness  of  a  hither- 
to incurable  class  of  individuals  ;  and  though, 
as  Richardson  Cross  has  said,  "  a  few  may  think 
that  nothing  in  the  way  of  operation  is  justifiable 
even  if  practical  good,  amelioration,  or  cure 
appears  to  follow  interference,  and  may  support 
those  who  have  said '  No  scientific  jargon  can  screen 
the  recklessness  of  causing  traumatic  cataract  in 
healthy  eyes,'  and  also  cannot  conceive  how  any- 
one can  resort  to  such  a  procedure  as  to  expose 
seeing  eyes  to  the  danger  of  producing  total  blind- 
ness for  the  sake  of  modifying  an  error  of  refraction, ' ' 
yet  the  operation  has  undoubtedly  come  to  stay. 
Myopia,  or  short  sight,  is  found  in  every  degree, 
from  those  slight  amounts  which  hardly  cause  the 
subject  any  serious  inconvenience  up  to  degrees 
which  render  him  practically  useless  for  any  kind  of 


work.  It  is  for  these  latter  very  high  degrees  of 
myopia  that  the  operation  is  done. 

A  myope  of,  say,  20  dioptres  has  an  abiding 
misery.  Without  his  glasses  he  can  see  nothing 
clearly  more  than  a  couple  of  inches  from  his  eye, 
and  if  he  chances  to  leave  his  glasses  out  of  his 
hand  he  has  much  difficulty  in  finding  them  again  ; 
with  his  glasses  he  is  like  one  looking  through  the 
wrong  end  of  an  opera  glass :  things  look  small  and 
distant,  and  his  field  of  vision  is  ever  so  restricted,  so 
that  he  finds  much  difficulty  in  seeing  things  to  the 
side  of  or  below  him. 

He  finds  it  almost  impossible  to  get  any  employ- 
ment, for  he  is  useless  as  a  mechanic  in  most  trades, 
and  employers  have  a  not  unnatural  objection  to 
employing  such  a  man,  even  at  low  wages,  since 
the  Employers'  Liability  Act  renders  them  liable 
in  case  of  accident. 

.  Myopia,  or  short  sight,  is  essentially  a  matter  of 
antero-posterior  diameter.  The  normal  length  of 
the  antero-posterior  diameter  of  the  emmetropic 
eye  is  about  22*819  millimetres.  In  myopia  it  has 
been  known  to  increase  to  33*5  millimetres.  The 
consequence  is,  that  the  focus  of  parallel  rays 
entering  such  an  eye  lies  a  long  way  in  front  of  the 
retina,  and  consequently  the  clear  image  is  formed 
in  the  vitreous,  not  on  the  retina,  and  the  details 
of  the  object  are  indistinct.  The  higher  the  degree 
of  myopia  the  further  the  image  is  found  from  the 
retina,  and  the  more  blurred  is  the  sensation  con- 
veyed to  the  brain. 

The  object,  then,  of  glasses  is  to  throw  back  the 
image  to  the  surface  of  the  retina,  and  this  glasses 
can  accomplish ;  but  the  higher  the  myopia  the 
stronger  the  glasses  required,  and  the  greater  are 
the  disadvantages  already  alluded  to— viz., 
diminished  size  of  the  image,  diminished  field, 
increased  apparent  distance  of  the  objects,  and  the 
weight  of  the  glasses. 

The  same  result,  without  the  disadvantages,  can 
be  obtained  by  removal  of  the  lens,  and  so  the 
operator  replaces  the  optician,  and  claims  another 
victory  for  surgery.  To  reduce  the  amount  of  the 
myopia  by  the  removal  of  the  lens  gives  the  patient 
a  far  better  optical  instrument  to  work  with  than 
to  correct  the  high  myopia  with  glasses.  Many 
patients  after  removal  of  the  lens  are  able  to  do 
without  glasses  altogether  for  their  work,  and  those 
who  still  require  glasses  can  use  much  weaker 
ones  than  before,  and  consequently  suffer  pro- 
portionately less  from  the  inconveniences  insepar- 
able from  the  use  of  strong  glasses. 

The  operation  itself  is  an  extremely  simple  one. 
Having  dilated  the  pupil  with  atropin,  and  anaes- 
thetised the  cornea  with  cocaine,  a  spear-pointed 
needle  (the  so-called  cataract  needle)  is  passed 


574    Th*  Mkdical  Press. 


ORIGINAL  COMMUNICATIONS. 


June  i,  1904. 


through  the  cornea  at  its  periphery,  and  the  point 
of  the  needle  made  to  penetrate  the  capsule  of  the 
lens.  The  needle  is  then  moved  about  so  as  to 
rupture  freely  the  anterior  capsule,  and  stir  up  some 
of  the  more  superficial  parts  of  the  lens.  The 
needle  is  then  withdrawn,  and  as  the  aqueous  gets 
access  to  the  lens  fibres  through  the  ruptured  cap- 
sule, the  lens  fibres  swell  up  and  become  cataractous. 
You  have  produced  a  traumatic  cataract. 

The  next  step  is  to  get  rid  of  the  cataract  which 
you  have  just  produced.  In  young  subjects  ab- 
sorption of  the  lens  will,  in  time,  take  place  without 
anything  more  than  a  repetition  of  the  stirring  up 
with  the  needle,  but  this  takes  a  good  time,  and 
the  older  the  individual  the  longer  the  time  ; 
so  that  it  is  usual  (and  I  have  done  it  in  all  the 
eleven  cases  the  results  of  which  I  am  now  bring- 
ing forward)  after  a  few  days  to  make  a  small 
incision  in  the  cornea  and  allow  the  broken  up 
lens  substance  to  escape,  and  thus  save  many  weeks 
or  months,  for  absorption  of  lens  substance  is  always 
slow  and  may  be  extremely  so. 

It  is  not  usual  to  operate  on  old  people  for 
myopia,  but  when  it  has  to  be  done  it  is  necessary 
to  get  rid  of  the  lens,  not  as  above  described,  but 
by  an  ordinary  extraction  operation,  as  done  for 
senile  cataract.  I  have  not,  myself,  done  any 
such.  Detachment  of  the  retina,  fluid  vitreous, 
and  extensive  disease  in  the  macular  region  are 
valid  contra-indications  to  operation. 

Detachment  of  the  retina  is  common  enough  in 
high  degrees  of  myopia,  and  some  hold  that 
removal  of  the  lens  increases  the  danger  of  its 
occurrence.  ;So  far,  the  evidence  on  this  point  is  not 
conclusive,  and  no  such  fear  would  deter  me  from 
operating  if  the  case  were  otherwise  suitable. 
One  of  the  most  remarkable  facts  in  connection 
with  this  procedure,  and  the  one  which  makes 
the  operation  so  largely  applicable,  is  the  fact  that 
the  optical  effect  of  removal  of  the  lens  is  not 
constant.  It  is  less  in  low  degrees  and  greater 
in  high  degrees,  so  that  cases  of  myopia  from  about 
12  dioptres  upwards  are  materially  benefited  by 
removal  of  the  lens.  I  will  give  the  explanation 
in  the  words  of  Mr.  Adams  Frost,  who  states  the 
case  very  clearly : — The  effect,  he  says,  of  the 
operation  is  to  change  the  character  of  the  eye  as  an 
optical  instrument.  The  aphakic  eye,  i.e.,  the 
eye  from  which  the  lens  has  been  removed,  is  a 
much  weaker  optical  instrument  than  the  com- 
plete organ  ;  hence  identical  .alterations  in  its 
length  produce  less  effect.  We  may  compare  the 
two  conditions  to  the  high  and  low  powers  of  a 
microscope :  with  the  high  power  (corresponding  to 
the  complete  eye)  a  very  slight  alteration  of  the 
fine  adjustment  will  blur  the  image  ;  a  similar 
alteration  with  the  low  power  (corresponding 
to  the  aphakic  eye)  will  not  be  noticed.  The 
matter  may  be  reduced  to  figures,  and  has  been 
so  reduced.  In  the  complete  eye  every  millimetre 
of  length  corresponds  to  3*1  D.  of  myopia  ;  in  the 
aphakic  eye  every  millimetre  of  length  corresponds 
to  only  1  38  D.  of  myopia. 

Or  to  invert  the  statement,  to  produce,  1  D.  of 
myopia  in  the  complete  eye  0321  of  a  millimetre 
would  suffice,  while  to  produce  a  dioptre  of  myopia 
in  the  aphakic  eye  the  length  would  have  to  be 
increased  by  07235.  In  other  words,  the  effect  of 
removing  the  crystalline  lens  is  to  diminish  the 
value  of  the  length  of  the  eye  as  a  factor  in  the  pro- 
duction of  myopia.  If,  then,  we  take  a  series  of 
complete  eyes  ranging  from  emmetropia  to  30  D.  of 
myopia,   they  will   show  a  definite    progressive 


increase  in  length.  If  these  same  eyes  be  deprived 
of  their  lenses,  not  only  will  their  absolute  refraction 
be  diminished  by  about  10  D.,  but  as  we  pass  up  the 
series  the  rate  of  increase  of  the  myopia  will  be 
diminished,  for  the  length  of  the  eye  is  still  the 
determining  factor  in  the  production  of  the 
myopia,  and  its  value  has  been  diminished.  Of 
course  it  is  understood  that  we  are  dealing  with  the 
myopia  only  so  far  as  it  is  axial — i.e.,  due  to  ab- 
normal length  of  the  eye.     To  calculate  the  diminu- 


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tion  in  the  myopia  to  be  expected  from  removal 
of  the  lens  many  rules  have  been  made  out,  varying 
in  complexity  and  accuracy,  by  Oswalt,  Eperon, 
Frost,  and  Otto.  Oswalt's  rule  is :  take  half  the 
amount  of  the  myopia  in  dioptres  and  from  this 
subtract  +  1 1  D.  A  myopia  of  — 22  D.  would  thus, 
after  removal  of  its  lens,  have  emmetropia.  Any 
higher  than  22  D.  would  have  some  myopia,  and 
any  lower  than  22  D.  would  have  some  hyperme- 
tropia  after  removal  of  the  lens.  This  is  a  fairly 
good  clinical  working  rule,  though  not  infallible. 
With  regard  to  the  increase  in  the  size  of  the  retinal 


June  it  1904. 


ORIGINAL  COMMUNICATIONS. 


Thb  Medical  Press.     575 


image,  it  depends  on  the  relative  distance,  before 
and  after  operation,  of  the  second  nodal  point  from 
the  retina,  which,  in  turn,  depends  upon  the  strength 
of  the  correcting  lenses  and  their  distance  from 
the  first  nodal  point.  .  .  .  The  retinal  image 
after  operation  may  be  two  and  a  half  times  the 
size  of  that  in  the  corrected  eye  before  operation, 
or  even  more. 

The  following,  and  table  on  preceding  page,  is 
an  analysis  of  the  cases  I  have  operated  on  : — 

The  ages  of  the  patients  on  this  list  vary  from 
ten  to  twenty-four ;  seven  right  and  four  left 
eyes;  the  refraction  varied  from — 10  D.  to  over 
22  D.,  but  the  amount  over  20 D.  was  not,  inmost 
cases,  noted.  In  all  except  one  of  which  we  have  a 
record  the  corrected  vision  was  measurably  better 
after  the  operation.  The  above  results  do  not 
probably  show  anything  like  the  full  advantage 
gained,  for  they  were,  for  the  most  part,  taken  while 
the  pupil  was  still  dilated,  and  before  the  eye  had 
time  to  fully  recover  from  the  operation.  A  subse- 
quent careful  correction  with  glasses  would  no 
doubt  greatly  increase  the  relative  improvement. 
Three  of  the  cases  retained  low  degrees  of  myopia, 
four  were  hypermetropic,  and  one  was  emmetropic, 
whilst  in  three  the  refraction  was  not  recorded. 
Presumably  these  required  no  glasses,  as  otherwise 
a  record  would  probably  have  been  made  by  the 
house  surgeon. 

Perhaps  the  most  gratifying  circumstance  in 
connection  with  this  operation  is  the  fact  that 
patients  in  whom  one  eye  has  been  operated  on 
almost  invariably  desire  to  have  the  other  eye 
similarly  treated,  for  the  registered  vision  tests 
give  but  a  very  imperfect  idea  of  the  full  subjective 
advantages  which  accrue  to  the  patient  by  the 
reduction  of  his  myopia  to  reasonable  limits.  The 
gratitude  exhibited  by  patients  for  this  operation 
exceeds,  I  think,  that  felt  even  after  a  successful 
removal  of  senile  cataract. 

I  have  intentionally  omitted  any  mention  of 
many  points  which  arise  in  connection  with  the 
subject,  for  to  attempt  a  complete  consideration 
of  the  whole  subject  would  exhaust  my  audience 
long  before  I  exhausted  the  subject. 


COMMON    CAUSES    OF  ERROR 

IN    EXAMINATION   OF   THE 

CHEST,   (a) 

By  J.  EDWARD  SQUIRE,  M.D., 

Physician  to  the  Monnt  Vernon  Consumption  Hospita'.  Ac. 

Dr.  Squire,  in  his  paper,  drew  attention  to  some 
errors  which  had  come  within  his  own  knowledge, 
the  causes  of  which  he  discussed  under  the  two 
headings  of  (1)  incomplete  examination,  including 
want  of  method  ;  (2)  faulty  interpretation  of  signs. 
He  emphasised  the  importance  of  examining  the 
chest,  when  symptoms  point  to  the  possibility  of 
some  disease  of  the  heart  or  lungs,  without  wait- 
ing for  symptoms  to  develop.  The  importance 
of  early  treatment,  and  therefore  of  early  diagnosis, 
in  pulmonary  tuberculosis  illustrates  the  wisdom 
of  this.  Errors  may  arise  from  neglecting  to 
complete  the  full  examination  of  the  chest  when 
evidence  of  disease  has  been  found  in  one  part. 
Examination  through  the  clothing,  or  even  with 
insufficient  removal  of  the  clothing,  may  cause 
errors.  Want  of  method  in  examination  may 
result  in  the  omission  of  one  or  more  of  the  stages 

(«)  Abstract  of  a  Paper  read  before  the  Hairelan  {Society  of  London- 
May  12th,  1904. 


of  examination — inspection,  palpation,  percussion, 
and  auscultation — with  the  result  that  important 
evidences  of  disease  may  be  overlooked.  Ex- 
amination may  need  to  be  repeated  so  as  to  follow 
the  course  of  the  disease  processes,  and  in  order 
that  complications  may  be  detected  as  early  as 
possible.  Thus,  in  the  course  of  pneumonia, 
fluid  may  accumulate  in  the  pleural  sac  undetected, 
if  examination  be  not  repeated  when  the  primary 
existence  of  pneumonia  has  been  determined. 
Faulty  interpretation  of  signs  is  a  more  common 
and  more  excusable  source  of  error.  The  im- 
possibility of  fixing  any  standard  of  the  physical 
signs  of  a  healthy  lung  which  would  hold  good  for 
individuals  of  different  sex,  age,  build  and  physical 
development  adds  to  the  difficulty  in  detecting 
slight  divergences  from  health  by  examination 
of  the  chest.  Dr.  Squire  briefly  summarised  the 
results  of  an  examination  of  100  healthy  chests, 
with  special  reference  to  percussion  note,  breath 
sounds,  vocal  resonance  and  vocal  fremitus  over 
the  upper  part  of  the  chest.  In  comparing  the 
two  sides  of  the  chest  his  observation  showed  that 
there  was  some  slight  difference  in  the  percussion 
note  in  45  per  cent,  of  healthy  persons,  usually 
a  slight  deficiency  of  resonance  over  some  portion 
of  the  right  apex  as  compared  with  the  left.  In 
27  per  cent,  of  the  cases  there  was  some  difference 
in  the  breath  sounds  when  one  side  was  compared 
with  the  other,  and  in  about  78  per  cent  the  vocal 
resonance  and  fremitus  were  more  marked  on  the 
right  than  on  the  left  side.  These  physiological 
differences  may  occasionally  be  erroneously  taken 
to  indicate  commencing  disease,  and,  on  the  other 
hand,  the  signs  of  slight  consolidation  of  the  apex 
of  the  lung  may  be  attributable  to  the  variations 
compatible  with  health.  To  avoid  such  errors 
more  careful  attention  should  be  paid  to  the  rela- 
tion between  the  inspiratory  and  the  expiratory 
portions  of  the  breath  sounds,  both  with  regard  to 
intensity  and  duration,  and  less  to  the  loudness  of 
the  breathing  or  slight  differences  in  the  percussion 
note.  Emphysema  round  a  patch  of  consolida- 
tion may  mask  the  evidences  of  the  solidified 
lung,  and  thus  cause  this  to  be  undetected.  The 
detection  of  cavities  in  the  lung  is  not  always  easy  ; 
their  localisation  is  often  difficult.  This  latter 
difficulty  arises  from  the  signs  of  cavity  being  heard 
most  plainly  where  solidified  lung  reaches  the 
surface  and  conducts  the  sound,  not  necessarily 
immediately  over  the  situation  of  the  cavity. 
The  detection  of  fluid  is  in  many  cases  a  matter  of 
great  difficulty,  especially  in  young  children,  or 
where  the  fluid  is  imprisoned  by  adhesions,  or 
where  the  pleural  membrane  is  much  thickened. 
Even  with  a  large  effusion  displacement  of  organs 
(e.g.,  the  heart)  may  be  prevented  by  adhesions 
or  counteracted  by  the  traction  of  a  retracted  lung. 
In  the  heart,  as  in  the  lungs,  faulty  interpre- 
tation of  physical  signs  may  lead  to  error,  as  when 
a  murmur  originating  outside  the  heart  is  mis- 
taken for  the  sound  produced  at  one  of  the  orifices. 
In  this  way  a  cardio-respiratory  murmur,  pro- 
duced by  the  air  current  in  the  lung,  has  been  mis- 
taken for  a  mitral  or  an  aortic  murmur. 


Society  of  Apothecaries  of  London. 
The  L.S.A.  Diploma  of  the  Society  was  granted  to 
the  following  candidates  after  the  final  May  examina- 
tions, entitling  them  to  practise  Medicine,  Surgery, 
and  Midwifery  :— W.  S.  Gibson,  F.  W.  Higgs,  and  F.  P. 
Rose. 


57^    The  Medical  Press.         ORIGINAL  COMMUNICATIONS. 


June  i,  1904. 


PRELIMINARY  NOTE  ON  THE 

INFLUENCE  OF  THE 

SINUSOIDAL      ALTERNATING 

ELECTRICAL  CURRENT 

ON  THE 

ORGANS      OF     CIRCULATION. 

By  PAUL  C.  FRANZE,  M.D., 

Nauheim,  Geimaoy. 

It  has  been  alleged  of  late  years  that  ordinary 
fresh  water  baths  through  which  the  sinusoidal 
alternating  current  is  conducted  have  a  marked 
influence  on  the  debilitated  heart,  and  that  such 
baths  are  a  trustworthy  means  of  curing  dilatation, 
with  muscular  weakness. 

Having  recently  investigated  the  action  of  such 
baths  on  the  volume,  frequency  and  tension  of  the 
pulse,  on  the  outlines  of  the  heart,  and  on  blood 
pressure,  I  feel  justified  in  publishing  a  preliminary 
note  on  the  results  obtained. 

The  research  was  carried  out  in  the  following 
manner  : — In  a  number  of  cardiac  cases  and  in  a 
few  healthy  persons  I  determined  immediately 
before  and  after  each  electrical  bath  the  area  of 
cardiac  dulness,  the  frequency,  volume,  tension, 
rhythm  of  the  pulse  and  the  blood-pressure.  The 
temperature  of  the  water  was  350  or  360  C,  thus 
excluding  all  thermal  influences.  The  duration 
of  each  bath  was  ten  minutes.  The  following 
symptoms  were  observed  : — On  an  average  the 
pulse-rate  diminished  after  the  bath  by  five  beats 
per  minute,  and  blood-pressure  rose  by  8  milli- 
metres of  quicksilver.  The  largest  fall  in  the 
number  of  systoles  per  minute  amounted  to  twelve, 
and  the  greatest  rise  of  blood-pressure  to  25  mm.  hg. 
I  uniformly  noticed  an  increase  in  the  tension  of 
the  arteries  ;  their  tone  was  increased.  I  must, 
however,  mention  that  I  only  had  an  opportunity 
of  examining  cases  of  previously  diminished  tonus. 

With  regard  to  the  important  question,  whether 
a  single  electrical  application  of  the  above  type 
can  remove  a  certain  amount  of  cardiac  dilatation, 
I  found  that  in  a  small  degree  this  question  can  be 
answered  in  the  affirmative.  I  especially  would 
advert  to  one  of  my  cases,  an  aortic  insufficiency, 
with  very  marked  dilatation  to  the  left  and  heaving 
apex  beat,  which  permitted  of  the  precise  localisa- 
tion of  the  left  border  by  palpation.  Here  I 
could  satisfy  myself  that  after  the  bath  sinistral 
dilatation  was  distinctly  reduced,  the  apex  beat 
being  less  violent  and  having  appreciably  receded. 

In  briefly  comparing  the  effects  with  those  of  the 
effervescent  brine  baths  of  Nauheim,  we  must  bear 
in  mind  that  the  capillary  dilatation  during  the 
period  of  "  reaction  "  in  the  latter  is  of  great 
value.  This  follows  from  the  physiological  con- 
sideration of  the  conditions  applicable  to  the 
current  in  the  vessels — viz.,  the  velocity  of 
the  current  in  a  certain  vascular  area  depends 
upon  the  difference  between  the  pressure  at  the 
beginning  and  at  the  end  of  the  area.  Therefore, 
the  decrease  of  peripheral  resistance  increases 
the  velocity  of  the  current.  In  the  above  elec- 
trical bath  no  reaction  ensues.  But  in  arterio- 
paralysis  the  improvement  in  tension  and  in  cardiac 
contraction  suggests  the  method  as  a  valuable  ad- 
junct in  the  treatment  of  such  cases. 

Therefore,  I  propose  to  use  the  type  of  elec- 
trical treatment  under  consideration  in  cases  in- 
dicating it,  supplemental  to,  but  not  in  lieu  of, 
the  standard  Nauheim  treatment  by  mineral  baths, 


massage,  and  resistance  exercises.  I  have  already 
observed  in  many  cases  most  favourable  results 
from  such  a  combination. 


CHRONIC    PANCREATITIS,   (a) 

By  LEONARD  A.  BIDWELL,  F.R.C.S., 

Surgeon  to  the  West  London  Hospital. 

Two  types  of  the  malady  were  described  :  (1) 
The  interlobular  variety,  in  which  there  was  cell 
infiltration,  and,  later,  deposition  of  fibrous  tissue 
between  the  lobules,  in  the  interlobular  tissue, 
the  islands  of  Langerhaus  being   unaffected,  ex- 
cept  in    the   latest   stage ;     and   (2)    interacinar 
pancreatitis,  in  which  there  was  cell  infiltration 
and  fibrous  tissue  formation  within  the  lobules 
and  inside  the  islands  of  Langerhaus.     The  second 
type  was  the  less  frequent  variety,  and  was  not 
commonly     associated    with     duct    obstruction, 
but  was  accompanied  by  glycosuria.     The  inter- 
lobular variety  was  met  with  in  association  with 
obstruction  of  the  pancreatic  duct  by  pancreatic 
calculi,  biliary  calculi  impacted  in  the  ampulla 
of  Vater,  cancer  of  the  bile  papilla  or  stenosis  of 
the  opening  by  inflammatory  changes  originating 
either  in  the  bile-duct  or  in  the  duodenum.     In 
cases  of  impacted  gall-stones  there  was  a  consider- 
able amount  of  colangitis  set  up,  which,  owing 
to  the  communication  between  the  bile-  and  pan- 
creatic ducts,  spread  to  the  latter  duct.     There- 
after, there  being  no  outlet  for  the  inflammatory 
products,  the  substance  of  the  pancreas  became 
involved  in  the  inflammatory  changes  and  chronic 
interstitial  pancreatitis  resulted.     Active  cell  in- 
filtration of  the  tissues  about  the  duct  and  acini 
produced  swelling  of  the  organ,  and  if  the  changes 
advanced    to  a  great  extent,  a  condition  of  cir- 
rhosis arose  which  might  easily  be  mistaken  for 
malignant  disease.     This  condition  might  subside 
completely,  but,  on  the  other  hand,  it  might  pass  on 
to  abscess  formation  with  secondary  suppuration 
of  lymphatic  glands.     The  symptoms   resembled 
those  exhibited  by  the  slighter  cases  of  subacute 
pancreatitis.     The  onset  was  usually  gradual,  but 
an   acute    attack  of  pain  in  the  epigastrium  re- 
sembling that  of  gall-stone  colic,  and  followed  by 
jaundice,  might  usher  in  the  attack.     The  par- 
oxysms of  pain  were  repeated  rather  irregularly, 
but  the  jaundice,  when  it  occurred,  tended  to  be- 
come  intense   and   permanent.      The    pain   dif- 
fered from  that  produced  by  gall-stones  in  that 
it  was  felt  in  the  epigastrium  and  under  the  left 
scapula,  and  the  tenderness  was  most  marked  just 
above  the  umbilicus,  and  not  in  the  situation  of 
the  gall-bladder.     Loss  of  flesh  and  strength  were 
prominent  features,  and  in  some  cases  vomiting, 
associated    with   flatulence   and    dyspepsia,    was 
present.    Diarrhoea  with  offensive,  colourless  stools 
containing    free    fat    were    common.     Slight   al- 
buminuria and,  in  long-standing  cases,  glycosuria 
have   been  noted,  but  the  latter,  owing  to  the 
chief  implication  of  the  pancreas,  was  not  com- 
mon.     In   most  cases   a  distended   gall-bladder 
could  be  felt,  but  this,  as  pointed  out  by  Robson, 
was  not  tender,  the  contrary  being  the  case  if 
gall-stones  were    present.     The    emaciation   and 
weakness  steadily  increased,  and  a  fatal  result  if 
no  operation  were  undertaken  was  almost  certain. 
These  cases  had  to  be  distinguished  from  gall- 
stones, cancer  of  the  head  of  the  pancreas,  cancer 
of  the  liver  and  ducts,  and  cancer  of  the  stomach, 


(•)  Abstract  of  Paper  read  before  the  West 
gical  Society,  May  6th,  1904. 


London  Medico-Cbimr 


June  i,  1904. 


TRANSACTIONS  OF  SOCIETIES.       The  Medical  Press.    577 


and  the  points  of  differential  diagnosis  were  dis- 
cussed. The  treatment  recommended  was  lapar- 
otomy. A  certain  number  of  cases  had  re- 
covered after  simple  palpation  of  the  pancreas, 
but  many  surgeons,  among  whom  was  Mr. 
Mayo  Robson,  advised  that  the  gall-bladder 
should  be  drained  in  all  cases.  This  acted  (1) 
by  curing  any  cholecystitis  or  colangitis  that 
might  be  present ;  and  (2)  by  taking  off  the  pres- 
sure of  the  bile  in  the  common  duct,  which  of  itself 
acted  as  an  obstruction  to  the  outflow  from  the 
pancreatic  duct.  Removal  of  any  stone  found 
in  the  ampulla  of  Vater  was  also  necessary.  The 
narration  of  four  cases  of  chronic  pancreatitis 
which  had  come  under  the  author's  own  observa- 
tion concluded  the  paper. 


Clinical  ftecorte* 


CASE  OF  IODOFORM  IDIOSYNCRASY. 
By  Chas.  Helfield,  M.A.,  M.B.,  L.M.S.,  Bombay. 

With  a  vie  v  to  illustrate  the  increased  sus- 
ceptibility some  individuals  have  to  iodoform,  I  shall 
cite  a  single  case  out  of  the  many  that  have  occurred 
in  our  clinique  and  experience. 

A  young  man,  aet.  30,  was  suffering  from  a  papular 
eruption  located  round  the  inside  of  the  thighs  and 
pubes,  extending  to  the  hypogastrium,  attended  with 
intolerable  itching,  insomnia,  weakness,  disarexy,  and 
general  cachexia,  and  declared  by  his  medical  atten- 
dants to  be  septicaemia  produced  by  a  deep  wound  on 
the  wrist  near  the  ulnar  artery.  I  was  called  in  to  see 
the  patient  after  the  lapse  of  a  month  from  the  first 
symptoms  of  eruption,  and  when  all  sorts  of  remedies 
had  been  tried  by  his  medical  attendants  without  any 
obvious  benefit.  After  having  taken  a  minute  account 
of  the  patient's  history,  and  after  careful  examination, 
I  discovered  a  ringworm  on  the  inside  of  the  thigh,  and 
on  questioning  the  patient  I  was  told  that  he  had  also 
used  iodoform  ointment  for  the  ringworm.  I  then  con- 
cluded that  the  said  eruption  was  caused  by  iodoform 
idiosyncrasy.  My  first  step  was  to  stop  all  iodoform 
dressing  for  the  wound  of  the  wrist,  and  to  use  instead 
a  solution  of  acidum  benzoicum.  Furthermore,  I 
ordered  a  sitz-bath  with  starch  every  time  the  patient 
felt  severe  itching,  with  amylum  et  cocainae  2  per 
cent.,  as  a  dusting  powder,  and  internally  a  tablespoon- 
ful  of  citrate  of  magnesia  three  times  a  day,  placing  the 
patient  on  soup  and  milk  diet.  After  two  weeks  the 
patient  got  well.  What  I  wish  to  point  out  is,  that  the 
eruption  was  neither  eczeraatous  nor  erythematous, 
but  it  was  a  clustered,  yellow-scaled  pustular  eruption 
passing  into  scabs,  and  I  believe  it  to  have  been  im- 
petigo. 

I  find  that  the  routine  fashion  of  dressing  cavities 
and  wounds  by  iodoform  without  having  learnt  the 
patient's  susceptibility  for  the  drug,  or  otherwise  learnt 
whether  the  patient  is  predisposed  to  eruptions,  is  not 
only  dangerous  but  absurd.  In  practice  I  and  my 
brothers,  as  well  as  Drs.  Zuchodoller,  Pistis,  and 
Caribdis,  use  the  following  compound,  suggested  by 
me  in  nearly  all  cases  of  dressing,  with  excellent  result : 
Iodoform um,  6  ;  acidum  benzoicum,  2  ;  sodii  bicar- 
bonas,  2. 


blood  count,  I  concluded  that  patient  was  suffering 
from  a  deficiency  of  the  individual  corpuscles  in  haemo- 
globin caused  by  iodism.  I  furthermore  have  to 
remark  that  patient  was  married  and  had  several 
children  of  healthy  type.  On  the  basis  of  my  exami- 
nation and  finding  that  patient  had  actually  no  syphi- 
litic symptoms  whatever,  I  prescribed  for  him  Pilula 
hydrargi  subchloridi  com  posit  a  gr.  iv,  doses  every 
other  night  for  two  weeks,  and  the  following  mixture  : 
ft.  Syrupi  ferri  phosphatis  cum  quininia  et 
strychnina.  $iss  ; 

Tincturae  hydrastis  Rhizomae,  5ss ; 

Tincture  ignatiae  amarae,  5ss  ; 

Tincturae  lupuli,  5l  •* 

Olei  caryophylli,  $j  ; 

Tincturae  calumbae,  5j. 
Mix.     Forty  drops  to  be  taken  in  a  little  water  three 
times  a  day. 

I  saw  the  patient  two  months  after  and  he  told  me 
that  he  was  well  and  could  have  coitus  twice  a  week, 
and  that  the  other  symptoms  disappeared  as  well. 
The  above  prescriptions  have  been  tried  by  me  for 
same  complaints  on  several  patients,  and  with  the 
same  success. 


transactions  of  Societies. 


CLINICAL  SOCIETY  OF  LONDON. 
Annual  Meeting  held  Friday,  May  27TH,    1904. 


Dr.    Frederick    Taylor,    President,    in    the   Chair. 


A  CASE  OF  ANAPHRODISIA. 
By  Chas.  Helfield,  M.A.,  M.B.,  L.M.S.,  Bombay. 
N.N.,  aet.  38,  consulted  me  some  time  ago  com- 
plaining of  anaphrodisia.  I  examined  the  patient  but 
could  find  nothing  abnormal.  Patient  told  me  that  he 
had  been  under  treatment  for  over  four  years,  but  with 
r.o  apparent  benefit.  On  questioning,  I  found  that 
patient  had  suffered  from  syphilis  about  twelve  years 
ago,  and  that  three  years  afterwards  he  was  attacked 
by  the  above  complaint.  On  closely  watching  the*, 
patient  for  about  a  week,  I  detected  him  to  be  of  a 
sleepy  nature,  dull,  suffering  from  shortness  of  breath 
and  paramnesia.     After   a   second   examination   and 


I      Professor  D.  W.  Finlay  (Aberdeen)  read  the  notes 
1  of  a  case  of 

PYOPNEUMOTHORAX     TREATED     BY    INCISION     AND 
REMOVAL    OF    RIBS. 

The  patient  was  a  boy,  aet.  17,  admitted  into  the 
Aberdeen  Royal  Infirmary  suffering  from  tuberculous 
pneumothorax  on  the  left  side,  the  apex  of  the  right 
lung  also  showing  the  ordinary  signs  of  tuberculosis. 
Effusion  was  present,  at  first  serous,  but  later  on 
becoming  purulent.  After  preliminary  tapping,  free 
incision,  with  removal  of  portions  of  two  ribs,  was 
practised  (the  signs  at  the  right  apex  having  subsided), 
and  a  large  quantity  of  pus  was  evacuated.  On  two 
occasions  subsequently  considerable  portions  of  the 
fifth,  sixth,  seventh,  and  eighth  ribs  were  resected, 
and  the  boy  was  treated  for  many  months  in  the 
open  air  on  the  balcony  of  the  ward.  The  result  had 
been  that  a  fair  measure  of  health  was  regained,  where 
by  he  was  enabled  to  resume  his  occupation  of  garden- 
ing, but  there  was  still  a  discharging  sinus  and  a 
cavity  of  the  capacity  of  an  ounce  and  a  half,  the  daily 
discharge  of  pus  being  about  a  drachm.  The  tuber- 
culous process  at  the  right  apex  had  been  completely 
arrested,  but  for  some  time  the  urine  had  con- 
tained albumin,  suggesting  the  necessity  for  further 
operative  procedure.  The  view  was  put  forward  that 
the  radical  treatment  of  such  cases  offered  a  fairer 
prospect  of  benefit,  as  in  cases  of  ordinary  empyema, 
than  the  practice  hitherto  generally  adopted  of  leaving 
the  fluid  alone  or  of  removing  it  by  repeated  tappings, 
having  regard  more  especially  to  recent  improvements 
in  the  mode  of  treatment  of  pulmonary  tuberculosis. 
Two  other  cases  were  referred  to  in  which  free  evacua- 
t  on  of  pus  was  practised.  In  one  of  these  the  patient 
seemed  to  be  neither  better  nor  worse  for  the  operation  ; 
in  the  other  such  an  improvement  was  obtained  that 
he  was  able  to  return  to  his  employment. 

Dr.  J.  Porter  Parkinson  thought  that  the  argu- 
ment for  operation  in  these  cases  was  not  very  strong. 
He  had  always  been  much  struck  by  the  opinion 
advanced  by  the  late  Dr.  Fagge,  who  had  related 
several  cases  of  recovery  from  pyopneumothorax 
without  operation.  He  rather  questioned  whether  it 
was  worth  while  going  through  such  a  great  deal  in 
order  to  obtain  comparatively  little  benefit. 

Dr.  Percy  Kidd  considered  that  medical  prac- 
titioners were  apt  to  be  unduly  influenced  by  the  older 
methods  of  treatment.    The  difficulty  was,  in  many 

D 


578    The  Medical  Press.        TRANSACTIONS  OF  SOaETIES. 


June  i,  1904. 


cases — apart  from  the  surgical  aspect — to  make  up 
one's  mind  exactly  how  much  disease  was  present. 

Professor  Finlay  replied. 

Dr.  H.  T.  Thompson  and  Dr.  C.  U.  Aitchison 
(introduced  by  Dr.  Percy  Kidd)  communicated  a  paper 
upon  two  cases  of 

TUMOUR    OF    THE    LEFT    AURICLE    SIMULATING    MITRAL 
STENOSIS. 

The  first  case  occurred  in  a  girl,  aet.  15,  who  was  under 
the  care  of  Dr.  Percy  Kidd  in  the  London  Hospital, 
into  which  she  had  been  admitted  for  pains  in  the 
chest  and  dyspnoea.  She  had  had  good  health  until 
twelve  months  before  admission,  when  pain  and  short- 
ness of  breath  appeared,  afterwards  followed  by  occa- 
sional vomiting  and  oedema  of  the  legs.  There  was 
no  history  of  rheumatism  or  chorea.  On  examination, 
the  heart  was  enlarged,  and  pre-systolic  and  systolic 
murmurs  were  heard  at  the  apex.  The  liver  was  en- 
larged and  tender.  The  case  was  considered  to  be  one 
of  mitral  stenosis,  and  was  treated  accordingly.  An 
attack  of  thrombosis  of  the  left  subclavian  vein  occurred 
two  months  after  admisson,  followed  by  symptoms  of 
obstruction  in  the  right  dorsalis  pedis  artery.  Six 
months  later  she  died  of  subacute  nephritis.  The  pre- 
systolic, murmur  disappeared  towards  the  last.  At 
the  autopsy,  a  pedunculated  tumour  was  found  hanging 
from  the  auricular  septum  and  protruding  between  the 
curtains  of  the  mitral  valve.  Microscopically,  it  was 
a  fibroma. 

The  second  case  was  that  of  a  woman,  aet.  51,  under 
the  care  of  Dr.  Warner.  She  had  suffered  from 
dyspnoea  for  five  years.  The  heart  was  much  enlarged, 
and  a  pre-systolic  and  a  systolic  murmur  were  heard 
at  the  apex.  Ascites  and  albuminuria  were  present. 
A  week  after  admission  to  hospital  she  was  seized  with 
a  right-sided  hemiplegia  and  died.  At  the  post-mortem 
a  rounded  mass  was  found  attached  to  the  auricular 
septum  in  the  situation  of  the  fossa  ovalis,  which 
microscopically  consisted  of  myxomatous  tissue. 
Several  cases  were  recorded  in  the  literature,  some  of 
which  showed  how  tolerant  the  heart  was  of  these 
tumours.  Dr.  Leon  Berthenson  regarded  the  following 
points  as  suggestive  of  an  intra-cardiac  tumour : 
(1)  Absence  of  rheumatic  history  and  of  evidence  of 
progressive  endocarditis  ;  (2)  signs  of  cardiac  failure 
together  with  embolic  symptoms.  A  well-marked  pre- 
systolic murmur  had  been  observed  in  the  case  reported 
by  Sir  W.  T.  Gairdner,  in  which  a  fibroma  of  the  right 
auricle  was  found  at  the  autopsy. 

Dr.  William  Pasteur,  while  remarking  upon  the 
rarity  of  the  condition,  referred  to  a  case  under  the  care 
of  Dr.  Kingston  Fowler,  which  was  reported  at  the 
Pathological  Society  of  London  in  1893.  A  large 
pedunculated  clot  was  found  in  the  left  auricle  attached 
close  to  the  foramen  ovale,  which  was  the  most  common 
situation  for  these  tumours  to  be  found. 

Dr.  W.  H.  Chapman  inquired  if  the  vomiting  were 
likely  to  be  accounted  for  by  the  condition  of  the 
kidneys. 

Dr.  William  Ewart  described  a  similar  case  in 
which  he  had  diagnosed  mitral  stenosis  during  life, 
and  in  which  a  pedunculated  clot  was  found  post- 
mortem in  the  left  auricle  which  was  capable  of  causing 
an  intermittent  blocking  action  of  the  mitral  valve. 

Dr.  J.  Porter  Parkinson  referred  to  a  specimen 
that  he  had  exhibited  before  the  Society  for  the  Study 
of  Disease  in  Children,  in  which  there  were  three  orga- 
nised thrombi  situated  in  the  right  auricle,  one  of 
them  being  pedunculated. 

Mr.  Stephen  Paget  exhibited  a  case  of  "  Osteitis 
Deformans." 

The  Report  of  the  Council  and  the  treasurer's  state- 
ment of  accounts  having  been  presented,  the  following 
gentlemen  were  elected  to  hold  office  for  the  year 
1904-5  :— 

President. — Frederick  Taylor,  M.D. 
Vice-Presidents. — Sir    William    R.    Gowers,    M.D., 
F.R.S.,    F.    De   HaviUand   Hall,    M.D.,    J.    Kingston 
Fowler,   M.D.,   Henry  Morris,   M.B.,   C.   H.   Golding- 
Bird,  M.B.,  H.  T.  Butlin. 

Treasurer. — G.  H.  Makins,  C.B. 

Council.—  F.    E.    Batten,    M.D.,    Harry    Campbell, 


M.D.,  J.  Walter  Carr,  M.D.,  W.  S.  Colman,  M.D., 
Norman  Dalton,  M.D.,  Lee  Dickinson,  M.D.,  E.  W. 
Goodall,  M.D.,  F.  H.  Hawkins.  M.D.,  Percy  Kidd,  M.D., 
Hector  Mackenzie,  M.D.,  F.  W.  Strugnell,  Herbert  W. 
Allingham,  Anthony  A.  Bowlby,  C.M.G.,  Walter 
Edmunds,  M.C.,  Sir  Alfred  Fripp,  C.B.,  M.V.O.,  M.S., 
J.  Hutchinson,  jun.,  T.  H.  Kellock,  B.C.,  B.  G.  A. 
Moynihan,  M.S.,  C.  S.  Wallace,  M.B.,  F.  C.  Wallis,  B.C. 
Honorary  Secretaries. — William  Pasteur,  M.D.,  W.  G. 
Spencer.  M.S.,  M.B. 


EDINBURGH  MEDICO-CHIRURGICAL  SOCIETY. 

Clinical  Meeting. 

Held  in  the  Royal  Hospital  for  Sick  Children 

on  May  i  8th,  1904. 


Professor  Chiene  in  the  Chair. 


Dr.  Burn  Murdoch  showed  (1)  a  case  of  scurvy 
rickets  in  a  child,  who  had  been  reared  exclusively  on 
modified  milk  sterilised  at  a  temperature  of  2120  F. 
for  half  an  hour.  On  admission,  the  patient  had  a  painful, 
brawny  swelling  of  the  lower  end  of  the  left  femur 
accompanied  by  pseudo-paralysis.  There  was  also 
slight  thickening  of  the  lower  end  of  the  right  femur, 
some  hematuria,  a  little  blood  in  the  motions,  and  a 
trace  of  sponginess  of  the  gums  near  the  central  incisors 
—the  only  teeth  which  had  appeared.  Within  a  few 
days  of  admission  the  upper  end  of  the  left  humerus 
became  affected  and  a  separation  of  the  epiphysis  took 
place  here,  as  also  at  the  lower  extremity  of  the  right 
femur.  The  case  was  in  every  respect  a  most  character- 
istic one,  and  had  responded  rapidly  to  treatment  with 
fresh  milk  and  orange  juice. 

(2)  A  girl,  aet.  8,  with  very  well  marked  rheumatic 
nodules  on  almost  all  the  usual  site  — scalp,  elbows, 
wrists,  fingers,  knees,  ankles  and  ears. 

(3)  A  case  of  cerebral  tumour  in  a  boy,  aet.  6,  the  sub- 
ject of  chronic  pulmonary  mischief.  The  child  suffered 
from  very  severe  paroxysms  of  headache  of  about  a 
quarter  of  an  hour's  duration ;    these  were  accom- 

?anied  by  pallor,  rapid  feeble  pulse  and  prostration, 
here  was  well-marked  double  optic  neuritis. 

(4)  A  child,  aet.  5,  who  for  three  years  had  suffered 
from  the  following  symptoms:  unsteady  staggering 
gait,  lalling  speech,  tremors  of  the  arms  increasing  on 
exertion,  strabismus  and  nys'agmus,  increased  knee* 
jerks  and  ankle-clonus,  and  optic  neuritis  now  passing 
into  post-neuritic  atrophy.  These  symptoms  seemed 
to  point  to  a  cerebellar  lesion,  and  the  crucial  point  in 
favour  of  tumour  was  the  optic  neuritis  and  post-neuritic 
atrophy.  The  long  duration  of  the  symptoms  was  & 
curious  fact,  but  was  thought  to  be  due  to  the  lesion 
being  a  latent  tuberculous  nodule. 

Mr.  Stiles  showed  (1)  a  child  with  the  rare  deformity 
known  as  Sprengel's  abnormality,  or  congenital  eleva- 
tion of  the  scapula  due  to  a  fibrous  band  or  bony  process 
uniting  the  bone  to  the  cervical  spine. 

(2)  A  boy  after  cuneiform  osteotomy  of  the  femur 
for  coxa  vara.  The  effect  of  the  operation  was  to  allow 
of  the  limb  being  abducted  so  as  to  get  compensatory 
lowering  of  the  pelvis  and  lengthening. 

(3)  A  girl  after  operation  for  an  unusually  large 
hydatid  cyst  of  the  liver.  The  cyst  gave  the  rare  sign 
of  hydatid  fremitus.  As  in  most  cases  in  children  the 
cyst  wall  was  readily  shelled  out. 

(4)  A  child  of  2£,  four  months  after  excision  of  a 
large  cystic  sarcoma  of  the  kidney.  The  tumour 
was  removed  by  a  circular  incision  extending  from  the 
umbilicus  into  the  loin,  the  peritoneal  cavity  being 
opened.  Enlarged  retro-peritoneal  glands  were  neces- 
sarily left  behind,  but  so  far  there  was  no  appearance 
of  any  recurrence. 

(5)  A  child,  after  arthrodesis  of  the  ankle  and  knee 
for  infantile  paralysis.  To  obtain  a  firm  ankylosis  at 
the  ankle  was  always  difficult,  and  until  he  had  begun 
to  use  a  very  long  nail  running  up  into  the  substance 
of  the  tibia  to  fix  the  astragalus  he  hid  not  succeeded 
in  these  cases. 

(6)  A  girl  after  the  second  operation  (nailing  an 
aluminium  plate  to  the  ends  of  the  bone)  for  ununited 
fracture  of  the  humerus. 


June  i,  1904, 


TRANSACTIONS  OF  SOCIETIES.      Tin  Medical  Pies*.     579 


Dr.  John  Thomson  showed  (1)  a  peculiar  congenital 
deformity  of  the  frontal,  nasal,  and  superior  maxillary 
bones  in  the  imbecile  child  of  a  mentally  defective 
woman.  The  upper  part  of  the  nose  was  broad  and 
flat,  showing  a  slight  central  depression  running  verti- 
cally down  it ;  the  eyes  were  thus  so  widely  separated  as 
to  render  binocular  vision  impossible.  The  only  other 
deformity  was  a  notch  on  each  eyelid.  The  resemblance 
to  the  face  of  an  early  foetus  was  very  striking,  but  Dr. 
Thomson  thought  that  the  condition  (of  which  he  had 
seen  two  other  instances)  was  what  was  described  by 
French  authors  as  rhinodyme,  and  was  really  due  to  a 
fusion  of  the  halves  of  two  separate  heads.  In  some 
cases  resembling  his  there  were  two  partially  fused  noses 
— in  his  case  this  was  only  indicated  by  the  undue 
breadth  of  the  nose  and  the  vertical  groove  down  it. 

(2)  A  child  suffering  from  congenital  cerebellar 
ataxia  of  the  type  described  by  Dr.  F.  E.  Batten.  The 
earliest  symptoms  were  rotatory  movements  of  the 
head  and  nystagmus,  the  latter,  however,  differing 
from  that  of  ordinary  spasmus  nutans  in  being  conju- 
gate, not  convergent.  There  was  also  tremor  and 
unsteady  gait. 

Mr.  Stiles  and  Dr.  Thomson  showed  three  cases  of 
congenital  hypertrophy  of  the  pylorus  after  operation 
(one  after  Loreta's  operation,  one  after  gastroenteros- 
tomy, and  one  in  which  gastro-enterostomy  was  success- 
ful after  Loreta's  operation  had  failed).  Originally 
in  such  cases  Mr.  Stiles  had  performed  gastroenteros- 
tomy, but  a  case  which  was  fatal  from  haemorrhage 
had  deterred  him  from  repeating  the  operation. 
Loreta's  operation  was  then  employed  successfully  on 
more  than  one  case  until  (in  the  third  patient  shown) 
he  had  had  a  recurrence  of  the  symptoms  three  weeks 
after  the  operation.  To  give  the  patient  a  chance  he 
then  performed  gastroenterostomy  successfully,  and 
it  was  now  the  operation  he  preferred.  He  found 
that  children  bore  it  quite  well,  and  its  great  advantage 
was  that  the  patient  could  be  fed  at  once  afterwards,  dis- 
pensing with  the  saline  injections,  &c,  which  had  been  re- 
quired after  simple  stretching  of  the  pylorus.  If  Loreta' s 
operation  was  done  it  was  essential  to  tear  through  the 
peritoneum  so  as  to  be  sure  that  the  dilatation  was 
successful.  G astro-en terostomy  had  the  further  advan- 
tage of  allowing  the  pylorus  functional  rest  with  the 
possibility  of  disappearance  of  the  hypertrophy,  while 
in  Loreta's  operation  it  was  not  improbable  that  second- 
ary stenosis  and  dilatation  of  the  stomach  might 
ensue. 

Dr.  J.  S.  Fowler  showed  (1)  a  case  of  dwarfed 
growth  in  a  child  of  8£  years.  The  patient's  height 
was  37  ins.,  some  12  inches  below  the  average,  or,  in 
other  words,  about  the  stature  of  a  child  of  3$  years.  The 
parents,  and  several  of  the  patient's  brothers  and  sisters, 
were  under-sized — in  their  cases  from  rickets.  The 
patient  had  always  been  small,  had  walked  at  the  age  of 
four,  and  had  begun  to  get  teeth  at  fourteen  months.  His 
general  appearance  suggested  a  mild  degree  of  cretinism, 
the  features  being  heavy,  the  hands  square,  and  the 
belly  prominent,  with  a  small  umbilical  hernia.  On 
the  other  hand  he  was  not  constipated,  the  second 
dentition  was  not  delayed,  the  temperature  was  not 
subnormal.  The  thyroid  gland  could  not  be  felt,  but 
there  was  a  good  deal  of  fulness  on  either  side  of  the 
neck  and  in  front  of  the  axilla?.  The  ossification  of 
bones  of  the  hand  was  that  of  a  child  of  3  or  4.  There 
was  no  sign  of  pancreatic  disease,  and  on  the  whole  the 
condition  seemed  most  closely  to  resemble  what  was 
described  as  larval  myxcedema  or  myx&dtme  fruste. 

(2)  A  child  of  5  years  2  months  who  had  suffered  from 
severe  fits  for  ten  days  after  birth.  She  had  never 
walked,  spoken,  or  taken  the  slightest  notice  of  any- 
thing, had  never  been  able  to  suck,  and,  in  fact  led  an 
almost  purely  vegetative  existence.  In  addition  to  this 
very  low  grade  of  idiocy  there  was  general  spastic 
rigidity  and  extreme  rickety  deformity.  The  points 
to  which  attention  were  directed  were  (1)  the  super- 
ficial resemblance  to  microcephalus.  Her  head 
measured  only  1 5i  ins.  in  circumference  and  gave  her, 
to  some  extent,  the  appearance  of  a  case  of  that  form  of 
imbecility.  The  mental  defect  was,  however,  much 
greater  than  in  microcephaly,  and  the  history  of  fits  and 


the  presence  of  spastic  rigidity  suggested  that  the  case 
was  one  of  severe  gross  cerebral  lesion  which  had  checked 
the  development  of  the  brain  and  growth  of  the  skull. 
The  second  point  of  interest  was  the  marked  rhachitic 
bending  of  the  bones  in  a  paralysed  child.  This  was 
ascribed  partly  to  posture,  partly  to  muscular  contrac- 
tion, and,  in  the  case  of  the  thorax,  to  adenoids  and 
recurrent  attacks  of  bronchial  catarrh. 

Dr.  W.  B.  Drummoud  showed  a  case  of  microcephaly. 

Dr.  Scott  Carmichael  showed  a  patient  with  con- 
genital malformation  of  the  bones  of  the  forearm. 

Dr.  Burn  Murdoch  showed  photographs  of  a  case  of 
double  congenital  dislocation  of  the  hip  and  a  rare 
condition  of  both  knees,  the  external  condyles  of  the 
femora  being  undeveloped  and  the  patellae  absent. 

Mr.  Stiles  showed  (1)  small  round-celled  sarcoma 
of  the  femur  removed  by  disarticulation  at  the  hip. 
(2)  Large  hydrocephalic  head.  (3)  Hydatid  cyst  of  the 
liver.  (4)  Gold  brooch  recovered  from  the  oesophagus 
of  an  infant  by  median  oesophagotomy.  (5)  Large 
sarcoma  of  kidney. 

Dr.  Fowler  showed  specimens  and  drawings  of  the 
blood  from  a  case  of  "mixed-cell"  leukaemia  in  a  girl, 
aet.  5,  the  change  being  the  presence  of  many  myelocytes 
plus  an  excess  of  large  lymphocytes. 

Dr.  Scott  Carmichael  showed  (i)  congenital  absence 
of  first  and  second  parts  of  rectum  with  sac-like  dilata- 
tion of  the  colon.  (2)  Necrosis  of  the  os  calcis,  the 
result  of  a  septic  wound  of  the  foot.  (3)  Recent 
ileo-colic  intussusception. 

Dr.  John  Thomson  showed  (1)  bones  of  the  lower 
limb  from  a  case  of  infantile  scurvy  (Barlow's  disease). 

(2)  Diplococci  from  a  case  of  posterior  basic  meningitis. 

(3)  Photographs  and  drawings  of  rheumatic  nodules  in 
various  positions. 


WEST  LONDON  MEDICO-CHIRURGICAL 

SOCIETY. 

Meeting  held  May  6th,  1904. 


The  President,  Dr.  Seymour  Taylor,  in  the  Chair. 


Mr.  L.  A.  Bidwell  read  a  paper  on 
chronic  pancreatitis, 
an   abstract   of   which   appears   in   another   column, 
page  576. 

In  the  discussion  that  followed. 

The  President  referred  to  the  diagnostic  value  of 
rigors  in  cases  of  jaundice  due  to  gall-stone  obstruction, 
and  suggested  that  if  further  observation  showed  that 
they  were  rare  or  absent  in  chronic  pancreatitis,  their 
occurrence  would  be  an  important  differential  point 
in  favour  of  gall-stone  impaction. 

Mr.  McAdam  Eccles  had  had  the  opportunity  of 
observing  two  of  the  cases  referred  to  by  Mr.  Bidwell. 
A  point  of  great  interest  was  the  occurrence  of  clear 
unclouded  mucus  in  the  gall-bladder.  In  nei  her  case 
was  there  any  sign  of  calculi  in  the  biliary  ducts.  He 
felt  sure  that  in  some  instances  in  which  a  patient 
suffered  from  what  appeared  to  be  biliary  couc  and 
showed  evidence  of  sugar  in  the  urine,  the  pancreas 
was  the  seat  of  the  real  lesion.  In  such  cases  the 
glycosuria,  instead  of  negativing  operation,  was  rather 
a  condition  indicating  the  necessity  for  exploration. 

Mr.  E.  Percy  Paton  considered  that  in  two  of  Mr. 
Bidwell' s  cases  there  was  a  good  deal  of  uncertainty 
as  to  the  diagnosis,  as  in  neither  had  a  microscopic 
examination  of  the  pancreas  been  made.  The  course 
of  malignant  disease  in  any  part  of  the  body  was  often 
very  variable,  nowhere  more  so  than  in  the  abdomen, 
and  it  seemed  to  him  that  in  both  of  the  cases 
the  true  nature  of  the  disease  might  have  been  carci- 
noma. 

Mr.  Bidwell  replied. 

Mr.  McAdam  Eccles  read  a  paper  on 

LESSONS    FROM    A    YEAR'S    FATALITIES. 

In  all,  nineteen  cases  were  referred  to,  and  in  all  death 
was  due  to  lesions  of  the  head  or  trunk,  a  fact  which 
illustrated  one  of  the  advances  of  modern  surgery, 
namely,  that  operations  o  the  extremities  were  fraught 
with  but  little  danger  provided  that  sepsis  were  ex- 
cluded.    No  less  than  fourteen  of  the  fatalities  were 


580    The  Medical  Pmsi.         GENERAL  MEDICAL  COUNCIL. 


June  i,  1904. 


due  to  abdominal  lesions.  Of  the  other  five  cases,  one 
was  due  to  fracture  of  the  base  of  the  skull,  one  to 
haemorrhage  into  the  mid-dorsal  region  of  the  spinal 
cord,  and  one  to  fracture  of  the  ribs  with  injury  to  the 
heart  wall.  This  last  case  was  specially  interesting. 
The  patient,  a  boy,  aet.  14,  was  crushed  between  two 
vans.  On  admission  he  was  collapsed,  livid,  with 
very  laboured  respiration,  and  much  frothing  of  mucus 
in  the  larynx  and  mouth.  Examination  showed 
fracture  and  depression  of  the  fourth,  fifth,  and  sixth 
left  rib  cartilages.  A  grave  prognosis  was  given,  but 
the  boy  made  steady  improvement.  Sixteen  days 
after  the  accident,  while  sitting  up  in  bed,  he  died 
suddenly.  Post-mortem  examination  revealed,  in 
addition  to  the  fractures  above  noted,  bulging  and 
perforation  of  the  left  ventricular  wall  in  a  position 
immediately  under  the  fractured  fifth  rib.  There  had 
apparently  been  a  partial  laceration  of  the  ventricle, 
and  the  wall  had  gradually  thinned  and  eventually 
ruptured,  causing  the  fatal  issue.  The  other  two 
fatalities  were  due  to  carcinoma  of  the  mammary 
gland,  and  in  both  pulmonary  infection  was  the  imme- 
diate cause  of  death.  Of  the  fourteen  abdominal  cases, 
death  was  due  to  abdominal  tubercle,  gastric  haemor- 
rhage, haemorrhage  from  the  hepatic  artery  in  the  floor 
of  a  duodenal  ulcer,  carcinoma  of  the  sigmoid  flexure, 
internal  strangulation  by  a  band,  strangulated  femoral 
hernia,  and  multiple  hepatic  abscesses  in  one  instance 
each  ;  to  intussusception  in  three  cases,  and  to  lesions 
of  the  vermiform  appendix  in  four  cases.  A  study  of 
these  fatalities  from  appendicitis  tended  to  confirm 
Mr.  Eccles  in  his  view  that  in  all  cases  in  which  there 
was  strong  suspicion  that  the  appendix  had  been 
inflamed  it  was  safer  to  remove  it  than  to  wait  for 
subsequent  attacks,  any  one  of  which  might  prove 
disastrous. 

The  President  considered  that  the  rise  of  tempera- 
ture after  head  injuries  illustrated  by  Mr.  McAdam 
Eccles'  case  was  in  all  probability  due  to  loss  of  control 
of  the  higher  cortical  centres  over  the  minor  physio- 
logical centres  below,  a  parallel  example  being  the 
exaggeration  of  reflexes  when  the  cord  centres  were 
cut  off  from  the  higher  Rolandic  centres. 

Mr.  E.  Percy  Paton  endorsed  the  opinion  expressed 
by  Mr.  Eccles  as  to  the  advisability  of  removing  the 
appendix  after  one  clear  attack  of  inflammation  of 
that  organ.  He  had  seen  most  satisfactory  results 
from  operation  in  tuberculous  peritonitis  similar  to 
the  case  quoted,  in  which  there  had  been  large  masses 
in  the  abdomen,  together  with  very  little  peritoneal 
effusion. 

Mr.  F.  G.  Lloyd  was  unable  to  agree  with  Mr. 
McAdam  Eccles'  conclusion  as  to  the  necessity  for 
operation  in  all  cases  of  appendicitis  after  a  first 
attack.  Statistics  showed  that  a  very  large  proportion 
of  cases  recovered  under  medical  treatment,  that  the 
more  serious  varieties  of  the  malady  could  not  be 
anticipated,  and  that  after  repeated  attacks  recovery 
might  be  complete. 

Mr.  McAdam  Eccles,  in  reply,  expressed  his  belief 
that  hyperpyrexia  in  head  injuries  and  in  cerebral 
haemorrhage  was  more  probably  due  to  some  dis- 
turbance of  the  nervous  vaso-motor  mechanism  than 
to  mere  loss  of  control  of  the  higher  centres  over  the 
lower. 


LARYNGOLOGICAL    SOCIETY    OF     LONDON. 
Meeting    Held    Friday,    May   6th,    1904. 


Mr.  J.  Charters  Symonds  in  the  Chair. 

Dr.  StClair  Thomson  showed  a  case  of  complete 
submucous  resection  of  a  deflected  septum,  and  Dr. 
L.  H.  Pegler  four  cases  showing  results  of  Noure's 
operation  for  deflected  septum.  These  cases  were 
shown  as  a  contrast  in  methods  of  operation  for 
deflected  septum  to  the  series  of  cases  shown  by 
Mr.  Tod  at  the  former  meeting.  The  general  op  nion 
of  the  members  was  that  certain  cases  should  be 
submitted  to  the  different  operations  according  to 
the  amount  of  deformity,  and  that  no  one  operation 
suited  all  cases. 


Dr.  H.  W.  Kelson  showed  a  case  of  ulceration  of  the 
epiglottis  and  vocal  cord  in  a  boy,  aet.  12,  and  a  parotid 
swelling  in  a  boy,  aet.  14. 

Dr.  H.  J.  Davis  showed  a  woman,  aet.  39.  with  linear 
perforation  of  the  left  vocal  cord.  The  condition  was 
looked  upon  as  of  great  rarity.  He  also  showed  a  case 
of  a  woman,  aet.  40,  who  had  suffered  from  chronic 
cough  for  eight  years  and  had  marked  pharyngitis  atro- 
phica with  hypertrophic  glandular  patches.  He  also 
showed  a  case  of  globular  swelling  of  the  right  side  of 
the  larynx  in  a  man,  aet.  29  (previously  shown  in 
April,  1003),  and  another  case  of  partial  paresis  of  the 
soft  palate  with  paralysis  of  the  left  vocal  cord. 

Dr.  A.  Bronner  showed  a  specimen  of  angeioma  of 
the  maxillary  antrum  in  a  woman,  aet.  60. 

Dr.  Scanes  Spicer  showed  a  case  of  soft  vascular 
growth  (angeio-sarcoma)  attached  to  the  cartilaginous 
septum  nasi  in  a  woman,  aet.  38,  with  recurrence  six 
weeks  after  removal.  Also  a  case  of  sarcoma  (  ?  endothe- 
lioma)  of  the  maxillary  antrum  and  ethmoid  with  empy- 
ema and  cholesteatoma  in  a  woman,  aet.  50.  She  had  been 
submitted  to  operation,  and  there  had  been  no  recur- 
rence for  over  six  months  up  to  the  present  time.  The 
tumour  debris  and  a  slide  of 4 the  growth  were  shown. 
He  also  showed  a  case  of  epithelioma  of  the  soft  palate 
in  a  man,  aet.  84,  which  had  been  excised  and  there 
had  been  no  recurrence  for  five  months  from  the  time 
of  operation.  The  tumour  and  microscopic  slide  were 
exhibited. 

Dr.  F.  Potter  showed  a  case  of  fixation  by  infiltra- 
tion of  the  left  vocal  cord  in  a  man,  aet.  60,  with  a  his- 
tory of  syphilis. 

Dr.  H.  Tilley  showed  a  case  of  lupus  of  palate, 
pharynx  and  larynx.  The  case  was  brought  forward 
for  the  question  of  treatment. 

Dr.  J.  Donelan  showed  a  tumour  of  the  palate  in  a 
woman,  aet.  33.  The  general  opinion  was  that  the 
tumour  was  of  a  mixed  character  (probably  fibro- 
sarcoma), and  its  removal  was  advised. 

Mr.  P.  de  Santi  showed  a  man,  aet.  63,  with  paralysis 
of  the  left  vocal  cord,  and  there  was  a  history  of  hoarse- 
ness and  difficulty  in  swallowing  of  one  month's  duration 
only.  Physical  examination  of  the  chest  revealed 
nothing  abnormal.  Since  showing  the  case,  a  skia- 
gram had  shown  marked  dilatation  of  the  aorta.  He 
also  showed  a  case  of  bilateral  haematoma  of  septum 
nasi  in  a  child,  aet.  7. 

Dr.  F.  W.  Bennett  showed  a  case  of  post-pharyn- 
geal  swelling  and  doubtful  infiltration  in  the  region  of 
the  upper  part  of  the  larynx.  The  diagnosis  was  open 
to  question,  but  it  rested  between  post-pharyngeal 
abscess  and  tuberculsus  trouble. 


SEVENTY-NINTH  SESSION  OF  THE  GENERAL 
MEDICAL  COUNCIL. 


The  President,  Sir  William  Turner,   K.C.B.,  M.B., 
in  the  Chair. 


FIRST   DAY. — Wednesday,   May    25TH,    1904. 

Full  meeting.  All  members  present  with  the  ex- 
ception of  Mr.  Tomes  (ill). 

Mr.  Henry  Morris,  as  representative  of  the  Royal 
College  of  Surgeons  of  England,  was  introduced  to  the 
Council  by  Dr/Norman  Moore  ;  and  Dr.  Richard  Caton, 
as  representative  of  the  University  of  Liverpool,  by 
Mr.  A.  H.  Young. 

The  Presidential  Address. 

After  a  few  preliminary  remarks,  the  President 
spoke  of  the  great  loss  the  Council  would  sustain  by 
the  retirement  of  Mr.  Bryant.  Every  member  of 
Council,  he  said,  was  familiar  with  his  unfailing  genial- 
ity, but  those  who  were  more  specially  engaged  in  the 
executive  work  of  the  office,  both  during  session  and 
in  the  interval  between  sessions,  could  speak  from 
direct  personal  knowledge  of  his  loyalty  to  the  Council, 
and  could  testify  that  he  spared  neither  time  nor  labour 
in  the  transaction  of  its  business.  The  Council,  he 
continued,  would  recollect  that  the  severe  illness, 
followed  by  the  death,  of  Sir  George  Duffey  prevented 
the  inspection  during  last  year  of  the  final  examinations 


June  i,   1904. 


GENERAL  MEDICAL  COUNCIL.         Thk  Medical  Press.    581 


of  the  universities  in  Scotland,  and  delayed  the  com- 
pletion of  the  series  of  inspections  in  which  the  Council 
was  then  engaged.  The  arrangement  for  the  appoint- 
ment of  an  inspector  to  succeed  Sir  George  Duffey  was 
referred  to  the  Executive  Committee.  The  retirement 
of  Mr.  Bryant  from  the  Council,  assuming  that  he 
were  disposed  to  undertake  the  duties,  appeared  to 
offer  the  opportunity  of  obtaining  the  services  of  an 
inspector  who,  both  on  personal  and  on  professional 
grounds,  was  admirably  fitted  for  the  office.  He 
accordingly  put  the  matter  before  that  gentleman  on 
behalf  of  the  Executive  Committee,  and  after  giving 
it  consideration  Mr.  Bryant  consented  to  under- 
take the  duties  during  the  present  year,  and  the 
Commission  of  appointment  as  inspector  had  been 
issued  to  him.  It  had  also  been  arranged  that  at 
each  final  examination  he  will  be  accompanied  by  a 
Fellow  of  a  College  of  Physicians  as  visitor,  and 
the  "Reports"  for  the  present  year  will  thus  be 
framed  by  experts  in  the  two  great  branches  of  the 
profession.  The  President  next  referred  to  the  Report 
of  the  Examination  Committee  on  the  questions  raised 
in  the  Reports  of  the  inspector  and  visitor  of  the  Pre- 
liminary Scientific  examinations  of  the  three  Conjoint 
Boards  and  the  Apothecaries'  Society  of  London,  and 
intimated  his  intention  to  hold  a  meeting  of  the  Com- 
mittee to  make  a  final  adjustment  of  the  various  points 
under  consideration.  Having  an  intimate  bearing  on 
this  Report  is  the  Amended  Scheme  of  Professional 
Study  for  students  of  the  first  year,  and  the  subjects  of 
and  mode  of  conducting  the  First  Professional  Exami- 
nation of  the  Conjoint  Board  in  England,  which  had 
been  adopted  by  the  Royal  Colleges  of  Physicians  and 
Surgeons  in  London,  and  was  intimated  to  the  Council 
three  weeks  ago.  The  President  remarked  that  he  did 
not  propose  to  anticipate  the  statement  which  the 
representatives  of  the  two  Colleges  intended  doubtless 
to  make  on  the  amended  scheme,  further  than  to  say 
that  the  Report  of  the  Council's  Visitors  to  the  First 
Professional  Examination  of  the  Conjoint  Board  had 
obviously  been  carefully  considered  by  the  Colleges, 
and  that  the  suggestions  made  therein  had  been  in 
several  particulars  adopted.  Certain  Bills  had  been 
introduced  into  Parliament  bearing  on  the  Medical 
Acts.  Among  these  were  the  attempts  made  to  pro- 
mote the  establishment  of  reciprocal  relations  between 
the  Dominion  of  Canada  and  the  United  Kingdom  in 
regard  to  practice  and  admission  to  their  respective 
"  Medical  Registers."  Up  to  this  time,  notwithstanding 
the  efforts  that  had  been  made  both  in  Canada  and  in 
the  Parliament  at  home,  a  working  scheme  had  not 
been  arrived  at.  Bills  had  also  been  introduced  during 
the  present  Session  of  Parliament  to  facilitate  the 
adoption  of  metric  weights  and  measures  in  this 
country  in  substitution  for  our  present  methods.  The 
interest  which,  as  a  Council,  we  have  in  such  Bills  is  in 
connection  with  the  "Br.tish  Pharmacopoeia,"  and  it  is 
not  unlikely  that  the  Pharmacopoeia  Committee  may 
refer  to  the  subject  in  their  Report.  Mr.  Jackson  had 
also  given  notice  of  a  motion  calling  the  attention  of 
the  Council  to  this  matter.  He  then  called  attention 
to  a  statement  relating  to  the  financial  position  of  the 
Council,  which  he  made  to  the  Executive  Committee  on 
February  22nd,  and  which  was  embodied  in  the  Camera 
Minutes  of  that  date.  These  had  been  circulated  among 
the  Council,  which  would  doubtless  desire  to  express 
an  opinion  on  the  matter.  The  President  continued  : — 
Copies  of  a  decision  of  the  High  Court  of  Justice  in 
Ireland  on  a  question  submitted  to  the  Court,  whether 
the  word  "  person  "  in  Section  3  of  the  Dentists  Act, 
1878,  means  exclusively  natural  person  or  includes  an 
artificial  person,  such  as  a  corporation  or  company, 
have,  I  understand,  been  sent  to  each  member  of  the 
Council.  The  question  arose  in  connection  with  the 
case  of  O'Duffy  v.  Jaffe,  when  it  was  contended  that 
the  practice  of  dentistry  could  not  be  pursued  by  a 
company  entitled  Jaffe,  Surgeon  Dentists,  Limited. 
The  Court  decided  that  the  Dentists  Act  as  worded  is 
directed  against  a  natural  person  only  and  not  against . 
a  Company.  The  effect  of  this  judgment  is  to  show 
that  a  company  practising  dentistry  cannot  be  pro- 


secuted under  the  Dentists  Act.  Since  the  judgment 
in  the  case  of  O'Duffy  v.  Jaffe  was  given  another  case 
relating  to  the  practice  of  dentistry  by  companies  has 
been  before  the  High  Court  of  Justice  in  Ireland. 
The  case  arose  on  an  application  for  the  issue  of  a 
mandamus  to  compel  in  Ireland  the  Registrar  of  Joint 
Stock  Companies  to  register  under  the  Companies  Act, 
1862,  the  memorandum  of  a  company  to  be  styled 
"  S.  G.  Rowell,  Dentist,  Limited."  An  elaborate 
judgment  on  the  case  was  delivered  by  Chief  Baron 
Palles,  who,  with  his  colleagues,  declined  to  grant  the 
mandamus.  The  questions  involved  in  these  cases 
before  the  High  Court  of  Justice  in  Ireland  will  be 
brought  before  the  Council  by  Sir  Charles  Ball,  who 
will  move  that  the  Council  take  action  in  terms  of  his 
motion. 

Dr.  MacAlister  proposed,  and  Dr.  Norman  Moore 
seconded,  that  the  thanks  of  the  Council  should  be  given 
to  the  President  for  his  address  (carried  by  acclama- 
tion). 

After  a  Business  Committee  had  been  appointed  with 
Dr.  MacAlister  as  Chairman,  the  latter  moved  that  the 
Council  do  adjourn  at  4  p.m.  to  enable  certain  Com- 
mittees to  meet  for  the  completion  of  their  Reports. 

The  Registrar  then  presented  eight  yearly  tables 
showing  the  results  of  various  professional  examinations 
in  1903.  three  the  results  of  competitions  (Navy,  Army, 
and  I.M.S.)  in  1904,  and  one  the  answers  sent  by 
medical  authorities  as  to  the  exemptions  granted  by 
them  in  any  part  of  their  examinations  during  the 
year  1903. 

These  were  entered  on  the  Minutes. 

Sir  Patrick  Heron  Watson  then  proposed,  and  Dr. 
McVail  seconded,  that  the  thanks  of  the  Council  be 
conveyed  to  the  Director-General  of  the  Medical  De- 
partment of  the  Royal  Navy,  the  Director-General  of  the 
Army  Medical  Service,  and  to  the  Under-Secretary  of 
State  for  India  respectively  for  the  returns  which  they 
have  respectively  again  furnished  to  the  Council,  with 
the  request  that  these  returns  may  in  future  continue 
to  be  furnished  to  the  General  Medical  Council 
(carried). 

Sir  Hugh  Beevor  proposed,  and  Mr.  Morris 
seconded,  that  Mr.  Chas.  Stonham.  F.R.C.S.,  be 
appointed  as  assistant  examiner  in  surgery  to  the 
Apothecaries'  Society  of  London  for  a  period  of  four 
years  vice  Mr.  Marmaduke  Shield,  who  retires  by 
rotation  (carried). 

Moved  by  Dr.  MacAlister,  seconded  by  Sir  Christo- 
pher Nixon,  and  agreed  to,  that  the  Report  of  the 
Executive  Committee  that  they  have  appointed  Mr. 
Bryant  to  be  Inspector  of  Final  Examinations  during 
the  year  1904  be  received  and  entered  on  the  minutes, 
and  that  they  recommend  that  his  salary  as  Inspector 
be  raised  to  ^250,  as  he  will  have  the  work  of  a  year  and 
a  half. 

Sir  Victor  Horsley  did  not  recollect  that  this  im- 
portant appointment  was  relegated  to  the  Executive 
Committee.  With  every  respect  for  Mr.  Bryant,  he 
(Sir  V.  Horsley)  must  enter  a  protest  against  Mr. 
Bryant's  appointment,  as  he  (Sir  V.  Horsley)  considered 
that  a  man  should  be  appointed  who  was  in  touch  with 
the  schools  and  hospitals,  and  it  should  be  remembered 
that  it  is  fifteen  years  since  Mr.  Bryant  resigned  from 
Guy's. 

Mr.  George  Brown  said  he  agreed  with  Sir  Victor 
Horsley,  but  thought  Mr.  Bryant's  appointment  was 
made  merely  to  fill  a  gap. 

The  President  said  Mr.  Bryant's  appointment  was 
to  complete  the  cycle  after  Sir  George  Duffey's  death. 

Moved  by  Dr.  MacAlister,  seconded  by  Dr.  Lindsay 
Steven,  and  agreed  to,  that  the  report  from  the  Execu- 
tive Committee  on  the  Dental  Business  transacted  since 
the  last  meeting  of  the  Council  be  received  and  entered 
on  the  minutes. 

The  Report  was  to  the  effect  (1)  that  the  prescribed 
conditions  having  been  duly  fulfilled  in  each  case,  the 
names  of  the  undermentioned  persons  have  been  restored 
to  the  "Dentists' Register,"  from  which  they  had  been 
erased  in  conformity  with  the  provisions  of  Section  12 
of  the  Dentists  Act,   1878:— Reuben  Davis,   George 


582    The  Medical  Press.        GENERAL  MEDICAL  COUNCIL. 


June  i,  1904. 


Neep,  Ellis  Parsons,  William  H.  Sleigh,  Alice  Wilkinson. 
(2)  Referred  to  the  General  Council  on  application  from 
Mr.  James  Dickson-Hamilton,  a  registered  dentist  of 
New  South  Wales,  requesting  that  his  name  might  be 
placed  on  the  Colonial  list  of  the  "Dentists'  Register," 
and  directed  that  Mr.  Muir  Mackenzie  should  frame  an 
answer  for  the  consideration  of  the  Council.  (3)  Re- 
ferred to  the  Dental  Education  and  Examination 
Committee  for  consideration  a  report  to  the  General 
Council  during  the  present  session  an  application  from 
Mr.  Edwin  Burton  Roper,  a  dentist  of  British  nation- 
ality, but  domiciled  in  France,  requesting  that  his  name 
might  be  placed  on  the  Foreign  list  of  the  "Dentists' 
Register"  in  virtue  of  his  French  Diploma  of  Chirurgien 
Dentiste,  which  he  had  obtained  after  passing  three 
examinations  held  by  the  Faculte  de  Medecine  de  Paris. 
(4)  The  Committee  received  from  the  Privy  Council 
Office  a  copy  of  a  circular  respecting  a  dental  congress 
at  St.  Louis  to  be  held  in  August  next.  (5)  The  Com- 
mittee received  from  the  Colonial  Office  a  copy  of  an 
Ordinance  of  the  Orange  River  Colony  on  the  subject 
of  the  registration  of  Medical  Practitioners,  Dentists, 
Chemists,  and  Druggists,  Midwives,  and  Nurses  in  that 
Colony,  which  embodied  the  provisions  contained  in  a 
Proclamation  which  had  been  transmitted  to  the  Council 
in  1902.  (6)  The  Committee  received  from  the  Colo- 
nial Office  a  copy  of  an  Act  to  consolidate  and  amend 
the  law  relating  to  Dentists  in  Tasmania  and  entered  it 
in  its  minutes.  (7)  The  Committee  received  from  the 
Irish  branch  of  the  British  Dental  Association  a  com- 
munication calling  attention  to  a  judgment  in  regard  to 
medical  or  dental  joint  stock  companies. 

It  was  then  moved  by  Dr.  MacAlister,  seconded  by 
Sir  V.  Horsley,  and  agreed  to,  that  the  communication 
referred  to  the  General  Council  by  the  Executive  Com- 
mittee from  the  Irish  branch  of  the  British  Medical 
Association  concerning  the  case  of  O'Duffy  v.  Jaffe 
be  received  and  entered  in  the  minutes. 

The  Council  then  considered  in  earner  A  a  Resolution 
of  the  Executive  Committee  respecting  the  Council's 
premises. 


SECOND   DAY.— Thursday,   May   26th,    1904. 

Sir  William  Turner,   President,   in   the  Chair. 

Absentees — Mr.  Power,  Mr.  Tomes. 

The  Minutes  of  last  meeting  were  read  and  confirmed. 
Penal  Cases. 

The  Council  proceeded  to  the  consideration  of  the 
case  of 
Richard  Henry  Darwent,  of  Rokeby,  Newington, 

Hull,  Yorks, 
registered  with  the  triple  qualification  of  Scotland, 
*893.  wno  had  been  summoned  to  appear  before  the 
Council  to  answer  the  following  charge,  as  formulated 
by  the  Council's  solicitor : — "  That  you  abused  your 
position  as  a  medical  man  by  committing  adultery 
with  a  patient,  namely,  Mrs.  Spink,  a  married  woman, 
whom  you  had  been  and  were  attending  professionally, 
of  which  adultery  you  were  found  guilty  by  the  Decree 
of  the  Probate,  Divorce,  and  Admiralty  Division 
(Divorce)  of  the  High  Court  of  Justice,  made  on  the 
29th  day  of  October,  1902,  in  the  cause  of  Spink  1/. 
Spink,  Benson,  and  Darwent,  in  which  you  were  one  of 
the  co-respondents." 

Mr.  Darwent  attended  to  answer  his  notice.  He  had 
with  him  as  counsel  Mr.  Muir.  instructed  by  Mr.  J.  W. 
Hill,  solicitor,  agent  for  Mr.  H.  Gough,  of  Hull. 

Mr.  M.  P.  Oldfield,  of  Oldfield,  Bartram,  and  Old- 
field,  solicitors,  appeared  on  behalf  of  Mrs.  Spink, 
the  complainant,  who  was  not  present. 

Mr.  Winterbotham,  having  read  the  notice,  Mr. 
Oldfield  opened  the  case,  but  at  the  very  outset  of  his 
speech  Mr.  Muir  objected  to  the  admission  of  evidence 
by  Mrs.  Spink,  as  she  was  not  to  be  called  as  a  witness, 
and  said  that  matters  relating  to  her  personal  conduct 
should  be  excluded. 

Mr.  Oldfield  said  Mrs.  Spink  objected  to  be  present. 

Mr.  Muir,  whilst  sympathising  with  her,  said  that  it 
was  a  question  of  law,  and  that  he  declined  any  refer- 
ence bemg  made  to  an  absent  person. 


Mr.  Muir  Mackenzie  advised  the  Council  to  accept 
only  Mrs.  Spink's  statutory  declaration. 

Mr.  Oldfield  then  continued  his  speech,  and  read  the 
confessions  made  by  Mr.  Darwent  in  the  divorce  pro- 
ceedings.  He  then  called  Mr.  Arthur  Smith,  a  clerk 
to  the  firm  of  solicitors  who  acted  for  Mr.  Spink  in  the 
divorce  proceedings,  and  examined  him. 

Mr.  Muir  cross-examined  Mr.  Smith,  and  proposed  to 
put  to  him  a  statement  made  by  Mrs.  Spink  reflecting 
on  other  parties,  which  statement  she  had  subsequently 
withdrawn. 

Mr.  Muir  Mackenzie  advised  the  Council  not  to 
admit  this  evidence,  but  Mr.  Muir  argued  in  support 
of  its  admission. 

The  Council  then  deliberated  this  point  in  earner &. 

On  strangers  being  re-admitted,  the  President 
announced  :  "  The  Council  rule  that  cross-examination 
and  evidence  must  be  confined  to  the  question  raised 
by  the  notice  of  inquiry,  i.e.,  whether  Mr.  Darwent 
committed  adultery  with  a  patient  whom  he  had  been 
attending  professionally,  and  that  the  Council  cannot 
receive  in  evidence  the  facts  alleged  in  Mrs.  Spink's 
answer  alleging  misconduct  by  other  persons." 

Mr.  Muir,  after  asking  a  few  questions,  then  asked 
that  the  hearing  might  be  adjourned  in  order  that  he 
might  take  steps  for  the  prohibition  of  the  inquiry. 

After  the  Council  had  deliberated  in  camerd. 

The  President  announced,  after  the  re-admission 
of  strangers,  that :  "  The  Council  adjourn  the  case 
until  next  Session  to  give  counsel  for  the  defence  an 
opportunity  of  taking  such  steps  as  he  may  think 
necessary  to  question  the  Council's  ruling." 

The  Council  next  proceeded  to  the  consideration  of 
the  case  of 
Harold  Augustus  Easton,  of  92  Brigstock  Road, 

Thornton  Heath. 
registered    as    M.R.C.S.Eng.,     1902,     L.R.C.PXond., 
1902,  who  had  been  summoned  to  appear  before  the 
Council  to  answer  the  following  charge  as  formulated 
by  the  Council's  solicitor  : — 

"  That  you,  being  a  registered  medical  practitioner, 
had  systematically  sought  to  attract  to  yourself 
patients  by  the  employment  of  persons  to  canvass  on 
your  behalf  for  subscribers  to  a  medical  club  instituted 
by  you  and  by  the  distribution  of  the  rules  of  the  said 
club." 

Before  the  case  was  opened,  the  President  inti- 
mated that  any  members  of  the  Council  who  belonged 
to  the  London  and  Counties  Protection  Society  should 
not  take  part  in  the  proceedings. 

Mr.  Easton  conducted  his  own  case. 

Mr.  Winterbotham  read  the  notice  to  attend. 

Dr.  Hugh  Woods  proceeded  to  open  the  case  on  the 
part  of  the  London  and  Counties  Protection  Society, 
the  chief  question  put  forward  being  whether  Mr. 
Easton  had  gone  or  sent  to  houses  asking  people  to 
belong  to  his  medical  club.  In  support  of  this,  Dr. 
Woods  called  several  witnesses  and  examined  them  as 
to  the  declarations  they  had  made,  principally  with 
regard  to  a  Mr.  Brisley  having  canvassed  for  Mr. 
Easton's  club. 

Mr.  Easton  did  not  cross-examine  any  of  the  witnesses, 
but  a  few  questions  were  put  to  them  from  the  Chair 
and  by  several  members  of  the  Council,  especially  by 
Dr.  McVail. 

Mr.  Easton,  in  his  defence,  denied  that  he  had  tried 
to  attract  members  to  his  club,  which  had  been  started 
at  the  suggestion  of  Mr.  Brisley,  who  was  an  insurance 
agent.  He  had  told  Mr.  Brisley  not  to  canvass.  He 
had  been  written  to  by  the  Medical  Defence  Union,  to 
whom  he  had  written  to  deny  that  he  canvassed  for 
patients,  and  since  then  he  had  heard  nothing  more 
from  the  Medical  Defence  Union.  He  only  knew  the 
same  afternoon  that  the  London  and  Counties  Pro- 
tection Society  had  taken  up  the  case.  Mr.  Easton 
went  into  the  witness-box  and  answered  questions  from 
the  Chair  and  from  Dr.  McVail,  and  was  cross-examined 
by  Dr.  Woods. 

Mr.  Brisley  was  called  in  support  of  the  defence, 
and  also  Mr.  Easton's  housekeeper,  who  was  cross- 
examined  by  Dr.  Woods. 


June  i,  1904. 


After  Dr.  Woods  had  spoken  a  few  words  in  reply, 
The  Council  deliberated  in  earner d,  and  on  strangers 
being  re-admitted,  the  President  announced  the 
decision  of  the  Council  as  follows :  "  That  the  facts 
alleged  against  Mr.  Harold  Augustus  Easton,  i.e.,  that 
he  had  systematically  canvassed  for  patients,  had  not 
been  proved  to  the  satisfaction  of  the  Council."  The 
President  added  that,  probably  owing  to  his  youth 
and  inexperience,  he  had  narrowly  avoided  infringing 
the  Council's  resolution  in  regard  to  canvassing,  and 
that  he  should  be  warned  by  the  day's  proceedings  to 
be  very  careful  in  regard  to  his  professional  conduct 
in  the  future.  (N.B. — The  words,  "  his  professional 
conduct  in  "  were  deleted  when  the  minutes  were  read 
on  May  27  th.) 

The  Council  then  proceeded  to  the  consideration, 
adjourned  from  November  26th,  1903,  of  the  conviction, 
proved  to  the  satisfaction  of  the  Council,  of 

Robert  Fawcitt  Granger, 
registered  as  of  85  Church  Street,  Whitby,  with  the 
triple  qualification  of  Scotland,  1889,  who  had  been 
summoned  to  appear  before  the  Council  in  consequence 
of  his  conviction  at  Plymouth  in  August,  1003,  of 
having  unlawfully  and  wilfully  neglected  his  three 
children,  for  which  he  was  sentenced  to  two  months' 
imprisonment  in  the  second  division. 

Mr.  Granger  attended  in  answer  to  his  notice,  and 
tendered  as  evidence  of  his  conduct  in  the  interval  a 
letter  from  Dr.  Robert  Milne,  of  Bow  Road,  London,  E., 
in  which  district  Mr.  Granger  had  been  living  the 
greater  part  of  the  time,  and  also  a  letter  which  he  had 
himself  written.  He  also  stated  that  he  had  adhered 
to  the  pledge  which  had  been  given  at  the  previous 
consideration  of  his  case. 

The  President  said  :  "  Mr.  Granger,  the  Council 
have  had  before  it  Dr.  Milne's  letter  and  a  letter  from 
an  inspector  of  the  Royal  Society  for  the  Prevention 
of  Cruelty  to  Children,  and  having  deliberated  on  your 
case  has  decided  not  to  direct  the  Registrar  to  erase 
your  name  from  the  'Medical  Register.' "  The  President 
expressed  the  hope  that  the  proceedings  which  had 
been  taken  would  be  a  warning  to  Mr.  Granger  and 
that  he  would  give  no  cause  for  complaint  as  to  his 
conduct  in  the  future. 

An  application  was  then  read  from  the  solicitors  in 
Sydney  of 

Mr.  James  Dickson  Hamilton, 
for  his  Registration  as  a  dentist  of  the  United  Kingdom 
under  Section  8  of  the  Dentists  Act,  1878,  the  grounds 
of  the  application  being  that  he  was  already  registered 
under  the  Dentists  Act  of  New  South  Wales.  This 
application  had  been  considered  by  the  Executive 
Committee  on  February  22nd,  1904,  and  by  them 
referred  to  the  General  Council,  and  also  that  Mr.  Muir 
Mackenzie  be  instructed  to  frame  an  answer  for  the 
consideration  of  the  Council. 

Moved  by  Sir  Victor  Horsley  and  seconded  by  Dr. 
MacAlister  :  "  That  the  answer  to  the  application 
of  Mr.  James  Dickson  Hamilton  be  in  the  terms  ot 
the  answer  drafted  by  Mr.  Muir  Mackenzie." 
Answer  of  Mr.  Muir  Mackenzie : — 
41  Gentlemen, — In  reply  to  your  letter  of  November 
23rd,  1903,  I  have  to  inform  you  that  the  application 
of  Mr.  James  Dickson  Hamilton,  and  the  documents 
which  accompanied  it,  and  your  letter,  have  been  con- 
sidered by  the  General  Medical  Council.  The  Council 
does  not  recognise  that  the  certificate  under  the 
Dentists  Act  of  New  South  Wales  (No.  45  of  1900),  of 
which  you  have  forwarded  a  copy  to  the  Council, 
furnishes  sufficient  guarantee  that  a  holder  of  the 
certificate  possesses  the  requisite  knowledge  and  skill 
for  the  efficient  practice  of  dentistry  or  dental  surgery. 
The  Council  does  not  recognise  a  certificate  issued  under 
the  Dentists  Act,  1887  (Victoria),  to  a  person  who  has 
no  dental  diploma  or  qualification  other  than  the 
qualification  of  having  practised  dentistry  before  the 
passing  of  that  Act.  An  application  by  the  holder  of 
such  a  certificate  to  have  his  name  registered  in  the 
Colonial '  Register '  was  refused  by  the  General  Medical 
Council  on  the  ground  that  the  Council  could  not 
recognise  the  certificate.  The  applicant  appealed 
from  the  Council's  refusal  to  the  Privy  Council,  and 


GENERAL  MEDICAL  COUNCIL.       The  Medical  Pmss.    583 


the  appeal  was  dismissed.  The  case  will  be  iound, 
recorded  in  the  published  Minutes  of  the  Council  for 
1896  (pp.  73,  152),  1897  (pp.  186,  193),  1898  (pp.  98, 
274).  With  reference  to  the  case  of  Mr.  Oldfield,  his 
name  was  not  registered  in  theColonial'Register'on 
the  ground  that  the  Council  had  determined  to  recog- 
nise a  certificate  under  the  Dentists  Act,  1887  (Victoria), 
issued  to  a  person  whose  qualification  was  that  he  had 
practised  dentistry  before  the  passing  of  the  Act. 
Mr.  Oldfield  made  two  applications  for  registration, 
the  first  of  which  was  refused,  but  the  second  of  which 
was  granted,  in  the  special  circumstances  stated  in 
the  second  application,  a  special  order  being  made  for 
the  registration  of  the  name.  The  facts  relating  to 
Mr.  Oldfield's  applications  will  be  found  in  the  pub- 
lished Minutes  of  the  Council  for  1897  (pp.  216,  242, 
162  and  247),  1898  (pp.  98  and  274),  1900  (p.  68). 
The  application  of  Mr.  Hamilton  has  therefore  been 
refused  by  the  Council  on  the  grounds  above  stated." 
It  was  then  moved  by  Dr.  MacAlister  and  seconded 
by  Dr.  Norman  Moore  :  "  That  the  nominations  for 
the  following  Committees  be  adopted  : — ( 1 )  Examina- 
tion Committee. — (a)  By  the  English  Branch  Council : 
Dr.  Pye  Smith,  Dr.  Payne,  Mr.  Young.  (6)  By  the 
Scottish  Branch  Council :  Sir  Patrick  Heron  Watson, 
Dr.  Finlay,  Dr.  McVail.  (c)  By  the  Irish  Branch 
Council :  Sir  Charles  Ball,  Dr.  Little,  Sir  Wm.  Thomson. 

(2)  Education  Committee. — The  following  members  had 
been  nominated  (a)  By  the  English  Branch  Council : 
Dr.  Norman  Moore,  Dr.  MacAlister,  Dr.  Windle  ;  (6)  by 
the  Scottish  Branch  Council :  Sir  John  Tuke,  Dr. 
McCall  Anderson,  Dr.  Mackay  ;  (c)  by  the  Irish  Branch 
Council :  Dr.  Bennett,  Sir  C.  Nixon,  Sir  Wm.  Thomson. 

(3)  Public  Health  Committee. — The  following  members 
had  been  nominated  (a)  by  the  English  Branch  Council : 
Sir  G.  Philipson,  Mr.  Power,  Mr.  Jackson  ;  (6)  by  the 
Scottish  Branch  Council :  Dr.  Lindsay  Steven,  Dr. 
McVail,  Dr.  Bruce  ;  {c)  by  the  Irish  Branch  Council : 
Sir  Charles  Ball.  Mr.  Tichborae,  Dr.  Bennett." 

Moved  by  Dr.  MacAlister,  seconded  by  Dr.  Norman 
Moore,  and  agreed  to :— (a)  "  That  the  following  be 
the  members  of  the  Dental  Committee  ;  The  President 
(Chairman),  Sir  Charles  Ball,  Sir  Patrick  Heron  Watson, 
Mr.  Tomes,  Mr  Henry  Morris."  (b)  "  That  the  follow- 
ing be  the  members  of  the  Dental  Education  and 
Examination  Committee :  Mr.  Tomes,  Dr.  Finlay, 
Mr.  Brown,  Sir  Charles  Ball,  Dr.  Lindsay  Steven,  Dr. 
Bennett,  Mr.  Henry  Morris."  (c)  "  That  the  following 
be  the  members  of  the  Pharmacopoeia  Committee  :  Dr. 
MacAlister,  Dr.  Norman  Moore,  Dr.  Payne,  Sir  George 
Philipson,  Sir  John  Batty  Tuke,  Dr.  McVail,  Sir  John 
Moore,  Mr.  Tichborae."  (d)  "  That  the  following  be 
the  members  of  the  Students'  Registration  Committee  ' 
Sir  Hugh  Beevor,  Dr.  MacAlister,  Sir  John  Batty  Tuke, 
Dr.  Mackay,  Dr.  Bennett,  Sir  William  Thomson." 


THIRD    DAY.— Friday,  May    27TH,    1904. 

Sir  William  Turner,  President,  in  the  Chair. 

Absentees  Mr.  Power  and  Mr.  Tomes. 

The  Minutes  of  the  last  meeting  were  read,  seconded, 
and  confirmed. 

Dr.  Norman  Moore,  after  remarking  that  the 
.  Report  carried  important  information  from  practically 
all  the  Licensing  todies  of  the  United  Kingdom,  besides 
many  other  scientific  institutions,  and  pointing  out  that 
the  answers  were  singularly  of  one  complexion,  moved 
that  the  Report  from  the  Committee  on  Preliminary 
Scientific  Education  be  received  and  entered  on  the 
minutes  (seconded  by  Dr.  Windle,  and  agreed  to). 

It  was  moved  by  Dr.  Norman  Moore,  seconded  by 
Dr.  Windle,  and  agreed  to,  that  recommendations 
of  the  Report  be  adopted  as  follows  :  (1)  That  the 
examination  in  chemistry,  in  order  to  be  sufficient, 
should  comprise  a  written  paper,  a  practical  examina- 
tion, and  an  oral  examination. 

Moved  by  Dr.  Norman  Moore,  seconded  by  Dr. 
Windle,  and  agreed  to  :  that  recommendation  2  of 
the  Report  be  adopted  as  follows :  That  in  respect 
'of  chemistry,  a  synopsis  or  syllabus  of  subjects  should 
be  issued  by  each  Licensing  Body,  and  that  the  scope  of 
the  examination  in  chemistry  should  not  fall  below 
that  which  has  been  indicated  in  the  Report  of  the 


584    The  Medical  Press.         GENERAL  MEDICAL  COUNCIL. 


Juke  r,  1904, 


visitors,    and   has   been   generally   approved   by    the 
Licensing  Bodies. 

Moved  by  Dr.  Norman  Moore,  seconded  by  Dr. 
Windle,  that  recommendation  3  be  adopted  as  follows  : 
That  the  examination  in  practical  chemistry  should  not 
be  limited  to  simple  quantitative  analysis,  but  should 
include  easy  preparations  and  simple  experiments 
illustrating  important  principles. 

Mr.  Tichborne  moved  as  an  amendment,  seconded 
by  Dr.  Bruce,  to  insert  "  simple  volumetric  analysis  " 
after  the  word  "  preparations. "and  after  a  few  remarks 
from  Sir  V.  Horsley,  Dr.  Pye  Smith,  Dr.  Payne,  Mr. 
George  Brown,  Sir  Hugh  Beevor,  and  Sir  J.  W.  Moore, 
in  support,  the  amendment  was  accepted  by  Drs. 
Norman  Moore  and  Windle  and  the  or  ginal  motion,  as 
amended,  was  agreed  to. 

Moved  by  Dr.  Norman  Moore,  seconded  by  Dr. 
Windle,  and  agreed  to,  that  recommendation  4  be 
adopted  as  follows :  That  an  examination  in  physics, 
in  order  to  be  sufficient,  should  comprise  a  written  paper 
and  an  oral  examination,  the  latter  to  include  practical 
questions  on  the  use  of  physical  instruments  and 
apparatus. 

Moved  by  Dr.  Norman  Moore,  seconded  by  Dr. 
Windle,  and  agreed  to,  that  recommendation  5  be 
adopted  as  follows :  That  in  respect  of  physics  a 
synopsis  or  syllabus  of  subjects  should  be  issued  by  each 
licensing  body  and  should  include  the  elementary 
mechanics  of  solids  and  thirds  and  the  rudiments  of 
heat,  light,  and  electricity. 

With  regard  to  the  subject  of  biology  (recommenda- 
tions 6,  7,  and  8),  after  Dr.  Mack  ay  had  made  a  few 
remarks  in  support  of  his  contention  that  biology  should 
be  excluded  from  examination  subjects  and  that  the 
student  should  be  allowed  to  take  this  subject  at  any 
time  of  the  curriculum,  it  v  a*  moved  by  Dr.  Norman 
Moore,  seconded  by  Dr.  Windle,  and  agreed  to, 
that  the  Couneil  go  into  committee  of  the  whole 
Council  to  consider  recommendations  6, 7,  and  8 — viz., 
(6)  That  elementary  biology  should  be  retained  in  the 
curriculum  ;  (7)  that  an  examination  in  elementary 
biology,  in  order  to  be  sufficient,  should  comprise  a 
written  paper  and  an  oral  examination,  the  latter  to 
include  practical  questions  on  specimens  and  dissections 
and  on  methods  of  microscopical  investigations  ; 
(8)  That  in  respect  of  elementary  biology  a  synopsis  or 
syllabus  of  subjects  should  be  issued  by  each  licensing 
body. 

Committee    of   the    Whole    Council. 
Moved    by  Dr.   Norman  Moore,  seconded   by  S  r 
Victor  Horsley,  and  agreed  to,  that  the  Committee 
consider  recommendations  6,  7,  and  8  together. 

Moved  by  Sir  Victor  Horsley,  seconded  by  Sir 
Charles  Ball,  that  the  further  consideration  of  recom- 
mendations 6,  7,  and  8  be  suspended  and  that  the 
committee  on  preliminary  scientific  education  be  re- 
appointed and  instructed  to  report  upon  the  courses  of 
study,  and  synopsis  of  subjects  for  the  preliminary 
scientific  examination  with  especial  reference  to  the 
branches  of  biology  as  subjects  of  study  and  examina- 
tion. 

After  a  discussion,  in  which  Dr.  Little,  Dr.  MacAlister, 
Sir  W.  Thomson,  Sir  Chas.  Ball,  Sir  Christopher  Nixon, 
Dr.  Pye  Smith.  Dr.  Windle.  and  Dr.  Thos.  McVail  took 
part,  the  following  amendment  was  moved  by  Dr. 
Norman  Moore,  and_  seconded  by  Mr.  Morris,  that 
instead  of  postponing  the  consideration  of  the  report 
of  the  Committee,  recommendations  6,  7,  and  8  be 
approved  by  the  Council  in  Committee. 

This  amendment  was  carried,  and  on  being  put  as  a 
substantive  motion,  was  agreed  to. 

Moved  by  Dr.  Norman  Moore,  seconded  by  Mr. 
Morris,  and  agreed  to,  that  the  Council  now  resume. 

After  the  Chairman  of  the  Business  Committee  had 
reported  that  the  Committee  of  the  whole  Council  had 
passed  the  following  resolutions :  "  (a)  That  the  Com- 
mittee of  the  whole  Council  considers  recommendations 
6,  7,  and  8  together  ;  (b)  that,  instead  of  postponing  the 
consideration  of  the  report  of  the  Committee,  recom- 
mendations 6,  7,  and  8  be  approved,"  he  moved  that 


recommendations  6,  7,  and  8  be  adopted  by  the  Council. 
Seconded  by  Dr.  Norman  Moore  and  agreed  to. 

Moved  by  Dr.  Norman  Moore,  and  seconded  by 
Mr.  Morris  and  agreed  to,  that  the  resolutions  1  to  8 
adopted  by  the  Council  be  communicated  to  all  the 
Licensing  feodies. 

Moved  by  Dr.  Mack  ay,  seconded  by  Sir  J.  Tuke,  that 
the  Preliminary  Scientific  Committee  be  re-appointed 
and  that  the  following  suggestion  be  referred  to  them 
for  report :  "  That  the  subject  of  biology  should  be 
retained  in  the  curriculum,  but  that  it  should  not  be 
regarded  as  necessary  that  a  professional  examination 
in  the  subject  should  be  demanded,  provided  that  the 
student  has  attended  and  duly  prepared  the  work  of  a 
satisfactory  course  of  instruction  m  the  subject  as  parts 
of  the  curriculum  of  a  university  or  duly  recognised 
college  or  school  of  medicine/' 

Dr.  Finlay  moved  the  following  amendment, 
seconded  by  Mr.  Morris,  that  the  Preliminary  Scientific 
Committee  be  re-appointed  and  instructed  to  consider 
and  report  as  to  the  advisability  of  dispensing  with 
examinations  in  the  case  of  any  of  the  subjects  in  which 
courses  of  study  are  prescribed  by  the  Licensing  Bodies. 

After  a  few  words  of  adverse  criticism  on  the  amend- 
ment from  Drs.  Bennett  and  McVail,  and  Sir  Victor 
Horsley,  the  previous  question  on  the  amendment  was 
moved  by  Dr.  Bennett,  seconded  by  Dr.  McVail,  as 
follows  :  that  the  Council,  instead  of  proceeding  to  deal 
with  the  amendment,  do  pass  to  the  next  item  on  the 
programme  of  business. 

The  previous  question  on  the  amendment  was  lost— 
14  to  13;  3  did  not  vote.  Therefore,  Dr.  Finlay's 
amendment  was  put ;  it  was  carried — 16  to  12  ;  2  did 
not  vote. 

The  amendment  was  next  put  as  a  substantive 
motion,  but  was  lost — 15  to  13  ;   2  did  not  vote. 


FOURTH  DAY.— Saturday,    May  28th,    1904. 
The  President,  Sir  W.  Turner,  in  the  chair. 

Absent,  Mr.  Tomes  (ill). 

The  minutes  of  the  last  meeting  were  read  and 
confirmed. 

Moved  by  Dr.  Norman  Moore,  seconded  by  Mr. 
Morris,  and  agreed  to,  that  the  communications 
referred  to  the  General  Council  by  the  Executive 
Committee  from  the  Royal  College  of  Physicians, 
London,  and  the  Royal  College  of  Surgeons  of  England, 
in  regard  to  the  curriculum  and  examination  in  scien- 
tific subjects  be  received  and  entered  in  the  minutes. 

The  communications,  which  were  identical  for  the 
two  Colleges,  were  as  follows  : — 

Courses  of  Instruction. 

1.  That  a  minimum  length  of  courses  be  required  in. 
chemistry,  physics,  and  biology  before  candidates  are 
admitted  to  examination  in  these  subjects. 

2.  That  the  minimum  course  in  the  several  subjects 
be  :  In  chemistry,  180  hours'  instruction  and  laboratory 
work  ;  in  physics,  1 20  hours*  instruction  and  laboratory 
work  ;  in  biology,  120  hours'  instruction  and  laboratory 
work. 

3.  That  these  courses  need  not  run  concurrently  nor 
be  completed  within  one  year. 

4.  That  these  courses  may  be  commenced  or  attended 
before  the  required  preliminary  examination  in  general 
education  is  passed. 

5.  That  study  at  an  institution  other  than  a  recog- 
nised medical  school  be  counted  for  not  more  than  six 
months  of  the  curriculum. 

6.  That  the  study  of  anatomy  and  physiology  be 
not  recognised  until  after  the  first  examination  in 
chemistry,  physics,  and  biology  has  been  passed. 

7.  That  no  student  be  admitted  to  examination  in 
medicine  and  surgery  until  he  has  completed  five  years 
of  professional  study  after  passing  the  preliminary 
examination  in  general  education,  towards  which  six 
months'  study  at  a  recognised  institution  may  be 
counted,  if  taken  subsequently  to  passing  such  pre- 
liminary examination. 

First  Professional  Examination. 
That  Part  I.  (chemistry),  Part  II.  (physics),  Part  III. 
(biology),  and,  at  the  option  of  the  candidate,  Part  IV. 


June  i,  1904. 


GENERAL  MEDICAL  COUNCIL.        Thb  Medical  Press.    5q5 


(practical    pharmacy)    be    the    subjects   of    the    first 
examination. 

Chemistry. 

1.  That  the  paper  in  chemistry  do  consist  of  nine 
questions,  six  to  be  answered  and  no  more,  for  which 
three  hours  shall  be  allotted. 

2.  That  the  time  for  the  practical  examination  be 
extended  from  two  to  three  hours. 

3.  That  the  use  of  books  and  tables  be  allowed  in 
the  practical  examination. 

Physics. 

4.  That  there  be  a  separate  paper  in  physics  con- 
sisting of  six  questions,  four  to  be  answered  and  no 
more,  for  which  two  hours  shall  be  allotted. 

5.  That  there  be  a  viva  voce  examination  on  the  use 
of  physical  instruments. 

6.  That  candidates  be  required  to  pass  in  both 
chemistry  and  physics  at  one  and  the  same  time  ; 
that  the  marks  awarded  in  chemistry  and  physics  be 
considered  together ;  and  that  candidates  who  obtain 
40  per  cent,  of  the  total  of  the  two  subjects  shall  pass, 
provided  that  they  obtain  not  less  than  20  per  cent, 
in  either  subject. 

Biology. 

7.  That,  in  addition  to  the  viva  voce  examination, 
there  be  a  paper  in  biology,  for  which  two  hours  be 
allotted,  consisting  of  six  questions,  four  to  be  answered 
and  no  more. 

8.  That  each  candidate  be  examined  orally  for  fifteen 
minutes. 

Then  follow  Synopses,  also  lists  of — 

1.  Schools  other  than  medical,  recognised  by  the 
R.C.P.L.  and  R.C.S.Eng.,  for  instruction  in  the  above 
subjects. 

2.  Recognised  medical  schools. 

3.  Recognised  preliminary  examinations  in  subjects 
of  general  education. 

Sir  V.  Horsley  made  some  remarks  on  the  courses 
of  study,  criticising  3,  4,  5,  6.  and  7,  especially  7,  which, 
he  thought,  evaded  the  curriculum  by  making  it  four 
and  a  half  years  instead  of  5. 

The  subject  was  also  discussed  by  Dr.  MacAlister, 
Mr.  Brown,  Drs.  Windle,  Mackay,  Norman  Moore, 
Sir  P.  Heron  Watson,  Dr.  McVail,  Sir  Wm.  Thomson, 
and  Dr.  Bruce. 

Sir  V.  Horsley  then  moved  that  the  courses  of 
study  laid  down  in  the  new  Regulations  of  the  Examin- 
ing Board  in  England  by  the  R.C.P.London  and  the 
R.C.S.Eng.,  taking  effect  in  March,  1905,  are  in  the 
opinion  of  this  Council  insufficient. 

Seconded  by  Sir  William  Thomson. 

This  motion  was  lost — 22  against,  6  f or ;  3  did  not 
vote.  1  absent. 

Moved  by  Mr.  G.  Brown,  seconded  by  Dr.  Bruce, 
that  the  scheme  of  courses  of  study  contained  in  the 
new  Regulations  of  the  Examining  Board  in  England 
by  the  R.C.P.Lond.  and  the  R.C.S.Eng.  be  referred 
to  the  Education  Committee  for  consideration  and 
report  at  the  November  session. 

This  motion  was  lost — 13  against,  11  for;  7  did  not 
vote,  1  absent. 

Moved  by  Sir  P.  Heron  Watson,  seconded  by  Dr. 
McVail,  that  the  following  recommendation  by  the 
Examination  Committee  be  adopted  by  the  Council : 
44  That  the  Council  complete  the  visitation  of  the 
preliminary  scientific  examinations  held  by  the  bodies 
mentioned  in  Schedule  A,  by  appointing  visitors  to 
visit  these  examinations  in  the  Universities." 

After  some  remarks  from  Dr.  MacAlister,  Dr. 
Mackay,  Sir  J.  Tuke,  Drs.  N.  Moore,  McVail.  and 
Pye  Smith,  all  (with  the  exception  of  Drs.  McVail 
and  N.  Moore)  being  against  the  motion,  an  amend- 
ment was  moved  by  Dr.  MacAlister,  and  seconded  by 
Dr.  Windle,  that  the  inspection  and  visitation  of  the 
University  examinations  in  chemistry,  physics,  and 
biology  be  not  continued  until  after  the  inspection  and 
visitation  of  the  final  examinations  had  been  com? 
pleted.  : 

The  amendment  was  carried — 19  for,  10  against ; 
2  did  not  vote,  1  absent. 


The  amendment  was   then  put  as  a  substantive- 
motion  and  carried. 

Same  division  as  on  the  amendment. 

Moved  by  Dr.  McCall  Anderson,  seconded  by  Dr. 
Bruce,  that  the  Registrar  be  instructed  to  communi- 
cate with  each  of  the  Licensing  Bodies  recommending  a 
uniform  system  of  marking,  in  all  cases,  in  connection* 
with  their  examinations. 

After  some  remarks  from  Drs.  MacAlister.  Finlay, 
Payne,  N.  Moore,  Sir  Victor  Horsley,  Sir  J.  Moore, 
and  Sir  Heron  Watson,  an  amendment  was  moved 
by  Dr.  MacAlister,  and  seconded  by  Sir  Chas.  Ball, 
that  the  subject  of  Dr.  McCall  Anderson's  motion  be- 
referred  to  the  Examination  Committee  for  considera- 
tion in  connection  uith  their  final  report  on  the  com- 
pletion of  the  cycle  of  visitation  and  inspection. 

Both  the  amendment  and  the  motion  were  by  con- 
sent withdrawn. 

Sir  John  Tuke's  and  Sir  V.  Horsley's  motions  were- 
by  consent  postponed  to  Monday. 

After  a  motion  by  Dr.  Mackay,  seconded  by  Dr. 
N.  Moore,  had  been  put, 

It  was  moved  by  Sir  V.  Horsley,  seconded  by  Dr.. 

MacAlister,  and  carried,  that  Clause  1  of  Chapter  IV. 

of  the  Standing  Orders  be  suspended  until  a  vote  had 

been  taken  on  the  motion. 

Division — 13  for,  1 1  against ;  4  did  not  vote,  4  absent.. 

(The  Report  of  the  concluding  days  of  the  session 
will  appear  in  our  next.) 


The  British  Medical  Temperance  Association. 

The  twenty-eighth  annual  meeting  of  this  associa- 
tion was  held  on  May  26th  at  the  London  Temperance 
Hospital  (by  kind  permission  of  the  Board),  the  Presi- 
dent, Professor  G.  Sims  Woodhead,  M.D.,  F.R.S.E., 
being  in  the  chair.  The  report  of  the  Council  showed 
that  the  association  is  slowly  but  surely  making  its- 
voice  heard  among  the  ranks  of  the  medical  profession. 
The  President  remarked  that  the  British  Medical 
Temperance  Association  was  by  no  means  an  inactive 
body,  but  that  it  had  markedly  strengthened  the  cause 
of  temperance  in  this  country.  The  importance  of  all 
practitioners  being  thoroughly  at  one  with  regard  to* 
the  effects  of  alcohol  could  hardly  be  over-estimated. 
In  seconding  the  adoption  of  the  report,  Dr.  James 
Stewart  laid  stress  upon  the  importance  of  the  main- 
tenance of  a  strictly  scientific  attitude  on  the  part  of 
the  profession  as  being  the  best  corrective  of  platform 
"  teetotal  clap-trap,"  the  effect  of  which  was  often 
more  injurious  than  otherwise  to  the  temperance 
cause.  The  treasurer,  Dr.  T.  Morton,  then  presented 
the  balance-sheet,  which  showed  the  finances  of  the 
association  to  be  in  a  fairly  satisfactory  condition. 
Hearty  votes  of  thanks  having  been  accorded  to- 
Professor  Woodhead  for  presiding,  and  to  the  honorary 
secretary,  Dr.  J.  J.  Ridge,  the  business  portion  of  the 
meeting  terminated.  A  conversazione  then  followed, 
a  good  musical  programme  being  provided.  After  a 
lantern  demonstration  of  photography  in  natural 
colours  by  Mr.  W.  Chataway,  an  address  was  delivered 
by  A.  Pearce  Gould,  Esq.,  M.S.  The  speaker  said  that 
there  were  two  distinct  points  of  view  from  which  the 
medical  practitioner  should  regard  the  temperance 
question — the  social  and  the  scientific.  The  latter  was 
pre-eminently  the  one  from  which  the  subject  should 
be  approached  when  dealing  with  patients.  At  the 
same  time,  the  importance  of  the  social  aspect  could 
not,  of  course,  be  underrated. 

Epsom  College-Election  for  Penstonshlps. 

At  the  annual  general  meeting  held  on  Friday  last 
at  the  office  of  the  College,  in  Soho  Square,  the  following, 
candidates  for  pensionships  and  foundation  scholar- 
ships were  reported  by  the  scrutineers,  Dr.  Felce,  Dr. 
Hoi  man,  and  Mr.  Purnell.  to  have  obtained  the  largest 
number  of  votes,  and  were  declared  to  be  duly  elected  : 

Pensioner  ships. — Rebecca  E.  Sudlow,  5.969  ;    Caro- 
line E.  Thurgar,  5,875  ;   Eliza  Elliott,  4,381. 

Foundation  Scholarships. — Charles  L.  W.  Sheperd,. 
8,138  ;  William  J.  G.  Walker,  7,534 ;  Hilary  A.  H.  S. 
Kenny,  7,284 ;  William  K.  Mortlock,  6,827 ;  H.. 
Norman  Bright,  5,434;    Eric  V.  Corry,  4,536. 


5^6     The  Medical  Press. 


GERMANY. 


June  i,  1904. 


france. 


[from  our  own  correspondent.] 

Paris,  Maj  29th,  1904. 
The  Diagnosis  of  Zona. 
Nothing  seems  more  easy,  says  Dr.  Paul  Fabre, 
than  the  diagnosis  of  zona.  A  vesicular  eruption 
following  the  tract  of  a  nerve,  rarely  of  several  nerves, 
and  almost  always  accompanied  by  more  or  less  intense 
pain,  is  generally  sufficient  to  inform  the  practitioner  of 
the  nat  ure  of  the  affection.  Yet  in  certain  cases  the  dia- 
gnosis is  far  from  being  easy.  If  it  is  easy  to  distinguish 
the  malady  when  it  shows  itself  on  the  thorax  or  the 
limbs,  it  is  quite  otherwise  when  the  eruption  appears 
on  the  head,  neck,  feet,  or  hands.  The  typical  zona 
may  be  recognised  by  the  patient  himself,  but  even 
here  the  medical  attendant  is  liable  to  fall  into  error. 
Called  to  a  patient  complaining  of  pain  in  the  side,  he 
contents  himself  by  placing  his  ear  over  the  painful 
region,  neglecting  to  make  an  inspection  of  the  cuta- 
neous surface.  Finding  nothing  wrong  with  the  lungs 
or  the  pleura  he  pronounces  the  case  to  be  one  of  inter- 
costal neuralgia  and  writes  a  prescription  accordingly, 
and  the  patient  continues  to  suffer.  Yet  the  prac- 
titioner is  not  always  to  blame.  With  a  man  or  a  ch  Id 
he  has  no  scruple,  especially  if  he  is  at  the  bedside,  but 
in  his  consulting  room,  in  the  presence  of  a  young  woman 
or  girl  complaining  of  pain  in  the  side,  is  it  not  natural 
that  the  physician  coes  not  oblige  her  to  undress,  con- 
tenting himself  with  a  superficial  examination  ? 

A  short  time  ago,  a  woman,  aet.  70,  who  had  suffered 
for  four  days  from  pain  in  the  right  hypochondriac 
region,  called  in  a  young  doctor,  who,  after  auscultation 
and  percussion,  thought  he  had  to  do  with  a  nervous 
old  woman  and  prescribed  sedatives.  The  following 
day  the  patient  herself  discovered  the  real  nature  of 
her  suffering. 

Some  years  ago,  Mr.  Fabre  was  called  to  a  maiden 
lady,  aet,  55,  who  three  days  previously  was  seized  with  a 
-violent  rigor,  followed  in  the  night  by  pain  in  the  left 
side.  The  pulse  was  112  and  the  temperature  ioo°. 
The  patient  was  much  oppressed  and  coughed  a  little. 
Applying  the  ear  to  the  region,  he  perceived  subcrepi- 
tant  rdles,  but  the  patient  compla  ning  of  pain  from  the 
pressure  of  his  ear,  M.  Fabre  raised  up  the  chemise 
and  discovered  to  his  astonishment  a  typical  case  of 
zona. 

Pain  is  one  of  the  most  important  symptoms  of  herpes, 
as  will  be  seen  from  the  following  case :  A  woman  of 
nervous  temperament  complained  of  intolerable  pain 
in  the  left  parietal  region  causing  complete  insomnia  ; 
the  left  eye  was  inflamed  and  a  vesicle  appeared  on  the 
cornea  ;  it  was  a  case  of  ophthalmic  herpes  which  might 
have  been  easily  mistaken  for  something  else.  After 
appropriate  treatment,  relief  was  obtained,  but  the 
pain  reappeared  at  the  next  monthly  period  in  the  same 
region,  the  eye  was  injected  again,  but  there  was  no 
vesicle,  and  periodically  for  several  months  the 
neuralgia  returned. 

The  pain  is  generally  seated  at  the  point  of  the  erup- 
tion, where  the  burning  sensation  and  itching  is  most 
marked,  but  it  is  not  always  so,  especially  as  regards  the 
lancinating  pains  which  frequently  follow  the  whole 
tract  of  the  nerves  of  the  affected  region.  Frequently 
a  double  pain  is  perceived,  one  deep-seated  near  the 
vertebral  column,  where  the  nerve  emerges,  the  other 
superficial,  pertaining  to  the  eruption.  It  must  be 
admitted,  however,  that  the  eruption  is  more  character- 
istic of  the  malady  than  the  pain,  which  is  sometimes 
absent.  (Out  of  231  cases  observed  by  M.  Fabre,  57 
were  painless). 


In  the  majority  of  cases,  the  eruption  is  accom- 
panied by  insomnia,  nocturnal  restlessness  and  malaise, 
and  this  insomnia  is  hardly  eyer  in  proportion  with  the 
intensity  of  the  eruption  nor  of  the  fever,  constituting 
one  of  the  most  characteristic  signs  of  zona.  Although 
the  real  origin  of  this  curious  affection  is  not  well 
understood,  yet  it  is  admitted  by  all  that  the  nervous 
system  plays  a  preponderating  r3le  in  its  production. 

Germany. 

[from  our  own  correspondent.] 


Berllx,  May  28th,  1904. 
At    the    Surgical    Congress,    Hr.    Barth,    Dantzic, 
related  a  case  of- 

Indurative  Pancreatitis. 

A  gentleman,  aet.  54,  had  suffered  for  a  period  of 
two  years  with  symptoms  indicative  of  biliary  colic. 
In  October,  1903,  acute  cholecystitis  came  on  with 
violent  fever.  The  gall-bladder  was  opened,  but  it 
contained  no  stone,  nor  was  there  any  in  the  bile-duct, 
nor  was  there  later.  After  the  operation  the  fever 
subsided,  and  all  symptoms  passed  away.  Six  weeks 
later  colic  returned  with  vomiting,  but  without  fever. 
A  permanent  feeling  of  pressure  remained  in  the 
epigastrium  with  frequent  vomiting.  The  symptoms 
became  worse,  and  in  January  the  pain  became  very 
acute ;  everything  taken  was  returned,  and  the  patient 
became  very  much  emaciated.  The  temperature  and 
urine  remained  normal.  Laparotomy  was  performed 
on  January  18  th.  The  gall-bladder  appeared  normal; 
the  bile  was  clear ;  but  the  pancreas  from  its  head  to 
its  middle  was  hard.  A  piece  was  excised  and  the  part 
sutured.  At  first  the  pain  continued,  but  later  on  it 
ceased,  until  death  took  place  a  fortnight  later,  after 
uncontrollable  vomiting,  from  which  the  abdominal 
wound  opened  afresh,  the  bowels  escaped,  and  erysipe- 
las came  on.  Microscopic  examination  of  the  pancreas 
revealed  the  following :  The  pancreas  was  normal  in 
size,  the  hardening  in  the  upper  part  had  partly  dis- 
appeared, there  was  no  inflammation  in  the  region 
about  the  pancreas,  the  ductus  Wersingianii  was  absent, 
the  ductus  Santorini  was  easy  to  find,  and  it  was  per- 
meable to  the  tail  part.  The  structure  of  the  pancreas 
in  the  middle  was  converted  into  fibrous  tissue,  the 
exit  passages  remained  as  well  as  Langerhaus'  islands. 
The  great  pain  and  the  vomiting  were  caused  by  the 
pancreatitis.  There  were  no  calculi.  It  was  to  be 
observed  that  the  solar  plexus  had  its  seat  below  the 
neck  of  the  pancreas,  and  that  it  was  from  here  that 
the  pains  radiated. 

Hr.  Ehrhardt,  Konigsberg,  read  a  paper  on 
Peritonitis  proceeding  from   the   Bile- Pass  ages. 

He  said  it  had  been  determined  experimentally  that 
normal  bile  in  the  peritoneum  set  up  no  peritonitis. 
This  had  also  been  shown  to  be  the  case  after  acci- 
dental injuries  to  the  gall-bladder.  If,  on  the  other 
hand,  the  bile- passages  were  inflamed,  a  second  agent 
was  introduced — bacteria.  In  ulceration  in  typhoid, 
in  inflammations  in  the  bowels,  we  found  bacteria  in 
the  lower  end  of  the  bile-duct. 

He  had  endeavoured  to  determine  whether  bile 
diminished  the  virulence  of  bacteria.  He  flooded  the 
peritoneal  cavities  of  five  guinea-pigs  with  B.  coli, 
mixed  with  bile,  and  those  of  five  other  guinea-pigs 
with  pure  cultivation  of  B.  coli.  The  control  animals 
all  died  within  twenty-four  hours,  but  of  the  others  the 
first  died  after  twice  or  three  times  twenty-four  hours— 
a  proof  that  the  bile  had  a  weakening  influence  on 
the  virulence  of  the  bacteria. 

As  regarded  the  clinical  question,  the  symptoms 
followed  the  experimental  experiences.     If  perforation 


TUNE    I,    I9O4. 


AUSTRIA. 


The  Medical  Press.     5^7 


of  a  bile- passage  took  place  in  a  chronic  case,  the  bile 
as  a  rule  flowed  into  a  dependent  part,  where  adhesions 
had  taken  place  in  consequence  of  the  chronic  inflam- 
mation, and  no  peritonitis  took  place.  But  even  if  the 
bile  flowed  into  the  open  peritoneum  foudroyant 
symptoms  of  peritonitis  never  supervened,  but  the 
inflammation  had  mostly  a  bland  character.  The 
•commencement  was  mostly  insidious,  then  the  sym- 
ptoms gradually  got  worse,  and  later  encapsulation 
frequently  took  place.  In  cases  in  which  no  encap- 
sulation took  place,  the  inflammation  almost  always 
took  on  a  chronic  course. 

Hr.  V.  Mikulicz-Radecki  spoke  on 
Increasing   the   Resistance   of   the   Peritoneum 
against  Infection   in  Stomach  and  Intestinal 
Operations. 

He  pointed  out  how  all  techniques  failed  when  the 
stomach  and  intestines  contained  pathogenic  organisms, 
as  they  always  did,  and  although  the  most  varied 
means  of  preventing  infection  had  been  recommended 
none  had  been  attended  with  much  success.  Bacteria 
might  pass  through  even  the  smallest  openings  in  the 
intestines ;  the  danger  of  infection  was  dependent  on 
the  size  of  the  opening  and  the  depth  at  which  the 
operation  was  performed.  And  even  if  the  peritoneum 
was  much  more  resistent  than  was  formerly  believed, 
and  could  take  care  of  a  certain  quantity  of  bacteria, 
large  quantities  overcame  its  resisting  powers. 

There  was  no  prospect  of  lessening  the  virulence  of 
bacteria  through  the  intestinal  tract  by  antiseptics 
given  by  the  mouth,  but  we  might  try  to  heighten  the 
resisting  power  of  the  peritoneum  itself.  In  this  we 
had  two  means,  one  by  specific  immunisation,  but  not 
much  could  be  gained  in  this  way.  A  second  means 
was  the  general  raising  of  the  resisting  power  by  arti- 
ficial hyperleucocytosis,  therefore  by  supporting  and 
aiding  phagocytosis.  This  means  had  already  been 
employed  in  combating  a  pneumococcus  invasion,  but 
after  invasion  had  already  taken  place  not  much  could 
be  done,  as  the  organism  had  by  that  time  lost  much  of 
its  power.  Better  results  might  be  expected  if  we 
could  make  use  of  the  hyperleucocytosis  before  the 
invasion. 

At  his  suggestion  a  series  of  experiments  had  been 
made  in  the  Breslau  Klinik,  and  had  led  to  very  re- 
markable results.  Attempts  had  been  made  to  produce 
hyperleucocytosis  by  local  application  of  various 
materials,  such  as  physiological  saline  solutions  and 
nuclein  acid.  Coli  bacilli  had  been  injected  into  the 
peritoneum  of  animals  after  they  had  been  previously 
treated  by  the  above-named  means,  and  it  was  found 
that  the  resisting  power  had  been  much  raised  by 
them,  and  that  in  the  case  of  guinea-pigs  forty  times  the 
lethal  dose  was  required  to  bring  about  the  fatal  result. 
The  contents  of  intestine  and  stomach  were  emptied 
into  the  peritoneal  cavity  ;  five  control  animals  died 
in  a  few  hours,  but  the  whole  of  the  ten  animals  that 
had  been,  prepared  recovered.  Even  a  short  time  after 
the  injection  a  powerful  leucocytosis  with  phagocytosis 
had  been  set  up  so  that  in  a  short  time  all  the  bacteria 
had  been  cleared  off.  Flugge  had  pronounced  the 
opinion  that  the  preparations  were  convincing. 

How  far  was  this  applicable  to  the  human  subject  ? 
The  application  of  the  method  was  suitable,  and  by  its 
aid  we  should  be  able  to  do  a  little  more  than  we  were 
able  hitherto.  In  thirty-four  cases  injections  had  been 
made,  in  each  case  of  50  c.cm.  of  a  2  per  cent,  solution 
of  nuclein,  and  under  the  skin  of  the  chest.  No  marked 
local  or  general  symptoms  appeared,  only  a  slight  locaj 
reaction  and  a  short  raising  of  the  temperature  to 
380  C.     No  change  was  found  in  the  urine.     In  all 


cases  a  typical  hyperleucocytosis  was  observed,  reach- 
ing its  maximum  twelve  hours  after  the  injection. 
Soon  after  the  injection  a  hypoleucocytosis  took  place, 
whereupon  a  gradual  increase  in  the  leucocytes  followed. 
Among  the  injected  cases  were  seven  resections  of 
the  stomach,  fifteen  gastroenterostomies  and  gall- 
stone operations,  and  not  one  of  them  had  died  in 
the  first  week  after  operation.  Generally  speaking, 
the  whole  course  of  the  operation  was  more  favourable. 
Saline  infusion  was  a  supporting  agent  that  led  to 
hyperleucocytosis.  He  now,  therefore,  although  for- 
merly a  supporter  of  dry  operations,  washed  out  the 
peritoneum  with  physiological  saline  solution  at  opera- 
tions in  the  abdominal  cavity. 

Bustcia* 


[from  our  own  correspondent.] 

Viibna,  May  28th,  1904. 
Gram-Positive  Mycosis. 

Schmidt  exhibited  a  number  of  preparations,  both 
anatomical  and  bacteriological,  to  the  Gesellschaft 
fur  innere  Medizin  on  the  subject  of  positive  results 
by  Gram's  method  in  a  form  of  mycosis.  During  life 
the  clinical  symptoms  were  those  of  hepatic  and  splenic 
disease  of  a  protracted  nature,  as  liver  and  spleen  were 
intumescent  and  the  blood  "  leucopenic "  with  the 
diazoreaction.  "  Leucopenia  "is  a  term  introduced 
into  laboratory  experiments  by  Loewit,  who  found 
simple  reduction  of  heat  in  an  animal  brought  about 
a  temporary  reduction  in  the  circulating  white  cor- 
puscles of  the  blood.  The  disease  being  sus- 
pected to  be  infectious  led  to  a  thorough  bacterial 
examination  of  the  excretions.  The  stomach  was 
washed  out,  and  in  the  rinsings  Gram's  positive 
bacillus  was  first  observed,  which  morphologically  re- 
sembled the  lactic  acid  bacillus.  Strange  to  say  nothing 
was  found  in  the  sputum.  The  blood  contained  3,380,000 
erythrocytes,  1,800  leucocytes,  and  45  per  cent,  of 
haemoglobin.  Dried  preparations  had  the  same  results. 
The  post-mortem  revealed  a  hard  condition  of  the  liver, 
which  was  spotted  from  hemorrhagic  centres  which 
extended  through  the  organ  when  cut.  In  the  section 
were  also  to  be  found  yellowish- white  points  like  lentils, 
with  surrounding  infiltration  very  much  resembling 
tubercle,  and  histologically  were  found  to  have  necrotic 
centres.  There  was  also  acute  hyperplasia  of  the  portal 
lymphatics ;  and  subacute  hyperplasia  and  necrotic 
centres  in  the  spleen.  On  opening  the  stomach  three 
large  ulcers  were  present  on  the  smaller  curvature  near 
the  pylorus  with  highly  raised  margins  resembling  the 
carbuncles  of  anthrax.  The  bacteriological  examina- 
tion of  the  spleen  gave  the  same  results  with  Gram's 
staining  as  did  the  washings  of  the  stomach.  When 
injected  into  mice  and  guinea-pigs,  the  same  patho- 
genic condition  and  bacilli  were  to  be  found  in  these 
animals.  When  the  bacilli  were  cultivated  and  again 
injected,  the  results  were  the  same  in  the  liver,  stomach, 
and  spleen,  which  left  no  doubt  in  his  mind  concerning 
the  nature  of  the  disease. 

Escherich  asked  if  this  could  be  a  case  of  strepto- 
trichia,  which  was  not  an  uncommon  pathogenic 
disease.  It  might  be  interesting  to  observe  whether 
the  bacilli  formed  ramifications  on  the  nutrient  media 
in  the  cultures. 

Schmidt  replied  that  he  had  particularly  searched 
for  this  condition,  but  could  find  nothing  to  confirm 
the  diagnosis  of  a  streptotrichia. 

Morbus  Basedowii. 

Jellinek  gave  the  meeting  a  long  history  of  the 
morbid  condition  of  exophthalmia,  and  avowed  that 


588    The  Medical  Press. 


OPERATING   THEATRES. 


June  i,  1904. 


the  trias  was  not  the  only  confirmatory  mark  of  the 
disease,  as  there  was  a  diffuse  pigmentation  around  the 
eyes  that  was  invariably  present,  particularly  at  the 
commencement  of  the  disease,  when  the  diagnosis  was 
more  difficult  to  confirm.  To  demonstrate  this  sign  he 
presented  a  girl,  aet.  17,  who  has  suffered  from  the 
disease  since  June,  1903.  The  exophthalmic  glands 
and  heart  left  no  doubt  about  the  nature  of  the  disease 
now,  while  the  deep  pigmentation  around  the  eyelids 
has  existed  from  the  very  first. 

He  exhibited  another  case  to  prove  the  symptom  at 
the  same  time,  another  patient,  aet.  12,  suffering  from 
cirsoismus  vinosus  in  inguino  sinistro.  He  particu- 
larly drew  the  attention  of  the  meeting  to  a  fact  that 
he  said  was  often  overlooked  here.  In  the  pelvis  along 
the  left  side  is  to  be  found  a  network  of  veins,  some  as 
large  as  a  goose's  quill,  that  become  dilated  and  vari- 
cose. The  anastomosis  extended  to  the  hip-joint, 
half-way  down  the  femur,  and  upwards  to  th*  fourth 
or  fifth  rib,  where  it  becomes  lost.  Compression 
anywhere  in  this  area  is  sure  to  produce  the  morbid 
condition  of  varicocele  as  may  often  be  proved  by  the 
flow  of  blood  from  the  "  caput  Medusae,"  or  circular 
plexus  around  the  umbilicus.  Cirsoismus  is  therefore 
often  found  to  be  a  congenital  anomaly  and  must  be 
treated  as  such. 

EXTRA-SVSTOLIC    IRRITATION. 

Berall  showed  a  man,  aet.  39,  whom  he  had  treated 
for  an  extra-systolic  state  of  the  ; heart  after 
taking  a  meal.  This  arhythmia  had  existed  for  nine 
months  before  his  admission  into  hospital.  The  pulse 
curves  showed  this  typical  extra  systolic  action  of  the 
heart.  The  urine  analyses,  which  were  often  made, 
pointed  to  a  condition  of  uraturia,  indicanuria  with 
increased  ether  sulphates,  which  exhibited  an  abnormal 
state  of  the  metamorphosis,  with  a  production  of 
toxins.  Th»  treatment  indicated  was  a  rational  diet  for 
a  neurasthenic  condition,  with  tonics,  such  as  quinine, 
to  raise  the  general  state  of  the  organism.  It  was 
evident  from  experiments  that  the  systolic  disturbance 
was  of  a  ventricular  character,  as  digitalis  and  &tro- 
phanthus  aggravated  the  circumstances,  probably 
from  the  increased  blooi  pressure,  which  would  act  as 
a  further  irritant.  During  these  experiments  a  con- 
stant series  of  pulse  tracings  were  taken,  which  showed 
that,  after  the  quinine  and  diet  treatment  the  cardiac 
action  was  improved,  and  in  a  short  time  he  increased 
in  weight  about  five  kilogrammes. 
Rhachitic  Dwarf. 

Knoepfelmacher  showed  a  child  with  rhachitic  sup- 
pression of  growth.  It  was  aet.  13,  and  84  cms.  in 
length.  Four  years  ago  it  was  98  cms.  in  length. 
This  shortening  appears  to  be  due  to  the  bending  in 
the  thorax  and  vertebral  column,  as  well  as  in  the  long 
bones.  The  swelling  of  the  epiphyses  of  th>  knee- 
joints  and  elbows  were  also  contributory  to  the  re- 
duction. There  was  great  thickening  of  the  phalanges 
of  th?  fingers  and  lower  jaw,  with  inability  to  walk. 

Kassowitz  remarked  that  this  case  resembled  those 
that  were  presented  on  a  former  occasion  by  Hofsinger, 
who  had  twelve  cases  of  rhachitic  children,  who  were 
unable  to  stand  or  walk,  but  under  the  treatment  of 
phosphorus  and  cod-liver  oil  they  began  to  move  about 
in  a  relatively  short  time. 

ZTbe  Operating  XTbeatree- 

KING'S  COLLEGE  HOSPITAL. 
Amputation    at    the    Hip -Joint. — Mr.    Carless 
operated  on  a  boy,  aet.   10,  who  was  the  subject  of 
tuberculous    peritonitis    and    advanced    tuberculous 


disease   of    the  hip-joint.     Eighteen  months  ago  the 
patient  had  been  sent  up  from  the  country  with  dis- 
tension of  the  abdomen,  pain,  and  fever,  which  had 
lasted  three  or  four  weeks.     There  was  no  obvious 
localised  cause  for  this  in  the  shape  of  tenderness  over 
the  appendix  or  limited  rigidity  of  the  abdominal  wall. 
The  distension  was  obviously  due  to  intra-peritoneal 
fluid,  and  hence  an  acute  attack  of  tuberculous  peri- 
tonitis was   diagnosed  ;     for   this   the   abdomen  was 
opened,  a  large  quantity  of  serous  fluid  evacuated,  and 
the  diagnosis  confirmed.     The  boy  improved  for  a  time, 
out  a  re-collection  of  fluid  in  the  upper  part  of  the 
abdomen   necessitated   a   second   incision    above  the 
umbilicus.     The  boy  was  sent  home  much  improved 
in  general  health,  but  returned  to  the  hospital  a  few 
months  back  with  manifestations  of  hip  disease,  with, 
an   abscess  behind   the  great   trochanter.     This  was 
opened,   and   a   considerable   amount   of   tuberculous 
material,  in  shape  of  large  membrane-like  masses  sus- 
pended in  a  thin  purulent  fluid,  was  removed.    The 
cavity,  which  apparently  communicated  with  the  hip- 
joint,  was  scraped  out,  filled  with  iodoform  emulsion, 
and  closed.     It  remained  healed  for  a  time,  but  increase 
of  pain  and  fever  indicated  extension  of  the  mischief, 
and  the  wound  had  to  be  reopened,  rescraped,  and 
drained.     In  spite  of  this  the  symptoms  progressed,, 
and  subsequently  an  incision  was  made  in  front  opening 
the  hip-joint,  and  a  large  communication  was  effected 
with  the  posterior  wound.     The  head  of  the  bone  was 
found  to  be  carious,  and  was  scraped.     In  spite  of  the 
thorough    drainage    thereby    secured,    together   with 
constant  irrigation,   the   pain  in  the  limb  continued, 
and  the  boy's  general  condition  steadily  deteriorated. 
An  important  evidence  of  this  fact  was  given  by  the 
breaking  down  of  the  two  abdominal  cicatrices.     These 
were  scraped,  and  it  was  found  that  ajcommunication 
existed  between  them,  evidently   under   the  muscles 
and  in  the  peritoneal  cavity.     A  considerable  quantity 
of  tuberculous  material  was  removed  by  a  sharp  spoon 
through  these  openings.     It  was  obvious  that  unless 
some  means  could  be  taken  to  improve  the  general 
condition  the  outlook  was  becoming  very  grave.    The 
choice  therefore  presented  itself  between  excision  of 
the  head  of  the  femur  and  amputation  through  the 
hip-joint.     The  former  made  a  serious  and  prolonged 
call  on  the  reparative  powers  of  the  patient,  and  would 
not  facilitate  in  any  way  his  early  removal  from  hospital 
to  better  hygienic  surroundings.     In  favour  of  ampu- 
tation was  the  shortening  of  the  period  during  which 
be  would  have  to  stay  in  hospital,  and  although  the 
immediate   risk   of   operation   was   greater,    the  sub- 
sequent chances  of  the  patient  would  be  much  im- 
proved.    The  removal  of  the  limb  would  reduce  the 
patient's  expenditure  and  provide  a  great  amount  of 
nutrition  to  the  rest  of  the  body,  and  it  might  therefore 
be  hoped  that  the  general  condition  of  the  boy,  and 
particularly    the    abdominal    lesions,    might    benefit 
appreciably  by  the  increased  blood  supply  subsequently 
available.     The  boy  was  carefully  wrapped  up  in  order 
to  minimise  shock,  and  a  nutrient  enema  of  beef  tea 
and  brandy  was  given  a  short  time  before  the  adminis- 
tration of  the  anaesthetic.     The  anterior  incision  was 
carried  downwards  and  prolonged  round  the  limb,  its 
posterior   portion    extending   well   below    the   lowest 
portion  of  the  posterior  incision.     The  skin  and  sub- 
cutaneous  tissue   were   dissected   up   all   round,   the 
muscles  were  divided  seriatim,  and    bleeding  points 
picked  up  as  they  were  divided.     The  head  of  the  bone 
was  set  free,  and  the  limb  rapidly  removed.    After  the 
bleeding  had  been  satisfactorily  checked,  the  aceta- 
bulum was  carefully  examined.     It  was  found  that  the 


June  i,  1904. 


LEADING  ARTICLES. 


The  Medical  Pkess.      589 


Y  cartilage  had  disappeared,  and  that  portions  of  the 
ischial  segment  of  the  cavity  were  loose.  A  small 
sharp  spoon  was  introduced  into  the  fissure  left  by 
the  removal  of  the  cartilage,  and  portions  of  necrotic 
bone  filled  with  tuberculous  debris  were  detached. 
The  opening  thereby  provided  enabled  the  index  finger 
to  be  passed  through  the  acetabulum  into  the  pelvic 
cavity,  demonstrating,  the  existence  of  a  tuberculous 
focus  within  the  pelvis,  which  was  curretted,  and  then 
packed  with  gauze  soaked  in  iodoform  emulsion.  The 
lower  portion  of  the  incision  was  then  closed  by  sutures 
n  the  ordinary  way,  but  the  upper  portion  was  left 
open  and  stufted  with  gauze,  as  also  the  former  posterior 
incision.  The  wound  was  dressed  and  the  boy  sent 
back  to  bed. 

Comparatively  little  blood  was  lost  in  this  proceed- 
ing, and  Mr.  Carless  pointed  out  that  he  had  purposely 
not  tied  the  common  femoral,  but  had  secured  t  the 
superficial  and  profunda  and  other  branches  before  or 
after  they  were  divided  in  order  to  give  the  flaps  as 
much  nourishment  as  possible.  The  condition  of  the 
acetabulum  was  such  that  no  measure  less  than  ampu- 
tation through  the  hip- joint  would  have  enabled  it  to 
be  dealt  with  at  the  time  or  dressed  subsequently  in  a 
satisfactory  manner.  He  had,  he  said,  been  driven  to 
remove  the  limb  completely  in  quite  a  number  of  cases 
of  hip  disease,  and  had  always  been  immensely  im- 
pressed with  the  rapid  and  satisfactory  recovery  which 
followed  if  the  patients  were  not  too  far  gone,  and  he 
anticipated  not  only  that  this  boy  would  get  over  the 
shock  of  the  operation,  but  also  would  improve  as  to 
his  general  health  in  a  marked  and  rapid  manner. 


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SALUS   POPULI  SUPREMA  LEX. 


WEDNESDAY.  JUNE  1,  1904. 

THE  TREATMENT  OF  THE  CRIMINAL. 
With  the  broadening  of  medical  knowledge 
that  has  been  so  marked  a  feature  of  the  last  half- 
century,  more  and  more  subjects  come  within  the 
purview  of  the  profession,  and  there  is  now  scarcely 
a  department  of  the  State  where  medical  advice 
is  not  sought  and  welcomed.  Some  of  the  Govern- 
ment offices,  it  is  true,  profess  to  get  on  well  enough 
by  themselves ;  but  it  is  often  just  these  very  offices 
which  would  derive  most  profit  from  giving  ear 
to  the  teachings  of  experience  that  medicine  has 
accumulated.  The  recently-published  Blue  Book 
•on  crime  and  the  discussions  that  it  has  given  rise 


to  in  several  of  the  magazines  serve  to    remind 
one  forcibly  of  the  advantage  that  might  accrue 
to  the  State  and  to  the  criminal  if  an  intelligent 
and  instructed  view  were  taken  of   the  classifica- 
tion of  malefactors.     At   present  all  those  who 
violate  the  laws  of  the  land  are  treated  alike, 
or  rather  as  the  temperament  of   the   individual 
judge  or  recorder    moves  him,  and  when  sentence 
has  been  passed  the  criminal  is  drafted  off  to 
prison  to  undergo  his  punishment  along  with  others 
who  may  differ  from  him,  mentally  and  morally — 
toto  coelo.     It  would  be  thought  that  so  unscientific 
a  plan  would  have  defeated  itself  by  its  own  inep- 
titude, and  so  indeed  it  does  ;  but  the  Commis- 
sioners of  Prisons  and  the  governors  of  gaols  and 
those  who   are  responsible  for  the  policy  pursued 
either  do  not  see  it  or  are  unwilling  to  act.     The 
work  of  Lombroso  and  other  ardent  criminolo- 
gists  has  established  beyond  doubt  the  fact  that 
the   habitual  criminal  is   far   more   than  a  mere 
mauvais  sujet ;  he  is  a  degenerate  being,  a  men- 
tally oblique  man,  a  person  only  in  degree  removed 
from  the  frank  lunatic.     Yet  year  after  year  he 
moves  in  and  out  of  prison  with  the  regularity 
of  the  stars  in  their  courses,  and  those  who  sentence 
him  and  guard  him  in  confinement  continue  to 
look  upon  him  simply  as  a  tiresome  person  suffer- 
ing from  the  effects  of  a  double  dose  of  original  sin. 
If  the   fight  of  medical  science  could  be  thrown 
into  those  dark  places — the  minds  of  people  who 
think  thus — not  only  might  the  country  be  relieved 
of  much  expense,  but  a  vast  deal  of  crime  and 
suffering   might   be    averted.     Perhaps  the  most 
striking  feature  in  the  Blue  Book  referred  to  is 
the  curt  statement  of  fact  that  of  9,138  persons 
convicted  at  assizes  and  quarter  sessions,   5,768 
had  been  previously  convicted.     In  other  words, 
two- thirds  of  the  total  criminals  for  the  year  were 
persons  who  either  were.,  or  were   on  the  way  to 
become,  chronic  gaol-birds.     This  fact  is  by  itself 
so  eloquent  in  its  condemnation  of  our  system  of 
dealing  with  crime  that  comment  on  it  is  almost 
superfluous.     It  is  as  necessary,  however,  to  dis- 
tinguish in  matters  of  crime  between  the  "  habi- 
tual "  criminal  and  the  "  professional  "  criminal, 
as  it  is  in  classifying  alcoholics  to  divide  the  ine- 
briate from  the  drunkard.     The  difference  has  been 
well  insisted  on  by  Sir  Robert  Anderson.     The 
professional  criminal  is  a  sharp,  clever,  unprincipled 
blackguard  who  plans  robberies  with  forethought 
and  care,  and  carries  them  out  with  daring  and 
skill.    The  habitual  criminal  is  a  weak-minded  crea- 
ture who  steals  because  it  is  his  habit  to  steal, 
and  because  he  knows  no  better.     The  professional 
criminal  will  give  up  his  profession  when  he  finds 
that  the  arm  of  the  law  is  too  strong  for  him  ; 
the  habitual  criminal  has  lost  all  self-control  and 
returns  to  his  old  fife  on  release  from  prison  as 
a  homing-pigeon  returns  to  its  cote  when  let  out 
of  a  bag.     Now  the  low  type  of  brain  of  the  habi- 
tual criminal  and  his  complete  loss  of  moral  con- 
trol class  him  with  the  inebriate,  as  the  enemy 
of  himself  in  the  first  place,  and  of  the  community 
in  the  second.     Terms  of  penal  servitude  have  as 
much,  or  as  little,  effect  on  him  as  temporary 


590     Tot  Medical  Peess.         NOTES    ON    CURRENT    TOPICS, 


June  i,  1904 


detention  in  a  home  has  on  an  inebriate,  and  his 
condition  of  moral  asthenia  calls  for  treatment  by 
the  alienist  no  less  than  does  any  other  mental 
aberration.      Though    mentally    perverted    he   is 
capable  of  physical  work,  and  a  colony,  on  the 
model  of  an  epileptic  colony,  where  he  could  be 
supervised,  preserved  from  temptation,  and  dis- 
tracted in  a  kindly  way  would  not  only  be  the 
humane    but    also    the    scientific     and    rational 
method  of  treating  his  moral  delinquencies.     The 
professional  criminal  is  a  more  dangerous  person. 
Whilst  much  might  be  done  by  the  reform  of  our 
prison  system  towards  showing  him  that  there 
are  other  ideals  in  life  than  living  by  one's  wits, 
and  other  happinesses  than  bringing  off  a  success- 
ful coup,  if  a  prison  system  planned  to  reclaim  him 
failed  in  its  object,  the  professional  criminal  should 
be  dealt  with  as  the  criminal  lunatic  is  dealt  with, 
by   incarceration   in   some    asylum    during    His 
Majesty's  pleasure.     Our  prison  system  has  not 
developed  pari  passu   with   the   growth   of   hu- 
manitarian   impulses    and    the    intellectual     en- 
lightenment of    the  times  as  our  insane  asylum 
system  has  developed,  mainly  because  of  the  lack 
of  public  interest  in  the  question.     We  have  long 
passed  the  days  of  keeping  lunatics  in  chains, 
and  exhibiting  their  antics  to  the  sight-seers  on 
Sunday  afternoons,  but  we  have  not  yet  succeeded 
in    introducing     wise,     humane,    and    scientific 
methods  into  our  prisons.     To  medical  men,  with 
their  appreciation  of  mental  disease  and  moral 
perversion,  the  subject  of  the  criminal,  his  re- 
formation and  his  treatment,  is  one  of  peculiar 
interest,  for  the  science  of  criminology  belongs, 
more  than  any  other  department  of  anthropology, 
to  the  domain  of  medicine.     And  it  is  to  medicine 
in  both  its  preventive  and  curative  branches  that 
society  must  look  to  introduce  those  principles 
of  carefully-reasoned  humanitarianism  that  alone 
can   protect   them   from   the   criminal,   and   the 
criminal  from   himself.     It  is  not  sufficient  for 
the  prison  doctor  to  be  employed  in  looking  after 
sick     convicts,   and    detecting   malingerers ;    his 
function  is  at  the  head  of  the  institution,  as  it 
is  of  the  lunatic    asylum,  controlling  its  policy, 
directing  its  administration,  and  treating  its  in- 
mates by  the  light  of  his  science. 


HEMOPHILIA. 
Obvious  as  the  fact  of  coagulation  of  the  blood 
has  ever  been,  and  of  the  utmost  practical  im- 
portance* yet  its  explanation  has  puzzled  great 
minds  for  centuries.  And  if  the  phenomenon  of 
coagulation  has  been  so  difficult  to  understand, 
even  more  so  is  the  apparent  exception  to  it 
which  is  commonly  known  as  haemophilia,  yet 
haemophilia  is  no  newly-observed  fact,  but  one 
which  has  been  known  to  the  profession  since 
classic  times.  For  instance,  an  excellent  natural 
history  of  haemophilia  is  given  by  Albukasema, 
an  Arabian  physician  of  celebrity,  who  flourished 
eight  hundred  years  ago.  And,  indeed,  although 
during  the  last  century  it  has  attracted  the 
attention  of  many  acute  inquirers,  one  can  hardly 


say  that  we  have  yet  got  beyond  the  merely 
descriptive  stage.     It  is  true  that    we  have  now 
got  a  very  fair  and  complete  natural  history  of 
the  condition,  which  must  prove  of  fundamental 
importance  in  the  construction  of  any  rational 
explanation.     The  feature  which  has  most  usually 
attracted  attention,  and  which  is  best  established, 
is  the  undoubted  hereditariness  of    haemophilia. 
But,  like  the  rights  of  property  among  primitive 
peoples,  it  descends  in  the  female  line.     It  rarely 
happens  that  a  male  belonging  to  a.  family  of 
"  bleeders,"   whether  himself  a  sufferer  or  not,, 
transmits  the  weakness  to  his  children.     On  the 
other  hand,  a  woman  of  similar  taint  is   almost 
certain,  if  she  have  offspring,  to  produce  "  bleeders." 
Curiously  enough,  in  spite  of  this  tendency  to 
travel    in    the    female    fine,    haemophilia    rarely 
affects    women.     Thus    in    200    tainted    families 
observed   by   Grandidier,    there   were    609   male 
bleeders,  and  only  49  female,  making  between  the 
sexes  a  proportion  of  thirteen  to  one.     Curiously, 
also,     families     affected     with     haemophilia    are 
unusually  prolific  ;  the  average  of  births  in  normal 
families  is  five  ;  Wachmuth  calculates  it  among 
affected  families  as  nine.     Attempts   have  been 
made  to  show  the  greater  susceptibility  of  certain 
races  to  the  condition,  but  like  the  attempts  to 
connect  it  with  definite  specific  diseases,  they  are 
somewhat  unconvincing.     As  might  be  expected, 
the  discovery  of  the  condition  is  nearly  always 
accidental.     For  instance,  among  Jews  and  other 
Eastern    peoples,  the   operation    of    circumcision 
may  give  rise  to  sufficient  haemorrhage  to  prove 
fatal.     Or  immediately   after  birth,   death  may 
occur     from     oozing     from    the     divided     um- 
bilical cord.     The  chances  of  life  are,    of  course, 
bad,    and   most    "  bleeders "    die    in    childhood, 
while  hardly  any  live  beyond  early  adult  life. 
Some  women  of  haemophiliac  tendency  have  died 
of    uncontrollable    haemorrhage    at    child-birth. 
Most  dentists  of  wide  experience  have  met  cases 
where  the  loss  of  blood  after  extraction  of  a  tooth 
has  been  very  alarming,  if  not  fatal.     As  to  the 
causes  of  the  condition,  but  little  can  yet  be  said. 
A  debate  still  rages  as  to  whether  the  blood  or 
the  vessels  are  at  fault.     The    former    view   is 
perhaps    the    most    generally    received,   but  the 
latter    received   the    support    of    Virchow,    who 
regarded  haemophilia  as  due  to  a  co-existence  of 
a  small  heart  with  thin-walled  vessels.     Reckling- 
hausen cuts  the  knot  by  referring  to  a  neuropathic 
diathesis,   while   Koch  thinks  different  infective 
toxins,  such  as  those  of  scurvy  and  tuberculosis, 
are  to  blame. 


Dotes  on  Current  Copies. 

The  General  Medioal  Council. 

Last  week's  meeting  of  the  General  Medical 
Council  has  proved  somewhat  uneventful. 
The  address  of  the  president,  Sir  William  Turner, 
dealt  in  a  clear  business-like  way  with  matters  of 
substantial  interest  to  the  profession.  After 
prolonged  inquiry  and  negotiation,  the  Conjoint 
Board  of  the  English  Royal  Colleges  of  Surgeons 


June  i,  1904. 


NOTES    ON    CURRENT    TOPICS.        The  Medical  Press.    591 


and  Physicians  have  adopted  an  amended  scheme 
of  professional  study  for  students  of  the  first  year, 
and  of  conducting  their  first  professional  examina- 
tion. That  announcement  is  clearly  of  consider- 
able future  importance  to  London  students.  The 
President  referred  to  a  Bill  to  be  brought  before 
the  Canadian  legislature  by  General  Laurie. 
Should  the  proposal  be  adopted,  it  will  empower 
medical  practitioners  of  the  United  Kingdom 
to  practise  in  the  provinces  of  Canada  and  in  other 
Colonies  that  also  possess  a  local  legislature  of 
their  own.  The  question  of  the  proposed  adoption 
of  metric  weights  and  measures  in  this  country 
will  probably  be  brought  forward  by  the  Phar- 
macopoeia Committee.  The  President  alluded 
to  the  recent  decision  of  the  High  Court  of  Justice 
in  Ireland  as  to  whether  the  word  "  person  " 
in  Section  3  of  the  Dentists  Act,  1878,  means 
exclusively  a  natural  person  or  also  includes  an 
artificial  person,  such  as  a  company.  Chief 
Earon  Palles  declined  to  issue  a  mandamus  to 
the  Registrar  of  Joint  Stock  Companies  in  Ireland 
to  register  under  the  Companies  Act,  1862,  the 
memorandum  of  a  company  to  be  styled  "  S.  J. 
Rowell,  Dentist,  Limited."  The  potentialities 
involved  in  that  decision  are  clearly  considerable, 
and  in  their  wider  issues  may  profoundly  affect 
the  future  welfare  of  the  medical  profession  in  the 
United  Kingdom.  The  penal  cases  to  be  heard 
by  the  Council  are  fewer  than  the  usual  number. 


A  Study  of  Ankle-Clonus. 

A  thorough  examination  of  the  various  super- 
ficial and  deep  reflexes  is  one  of  the  most  important 
parts  of  the  investigation  of  a  case  of  nervous 
disease.  The  presence  or  absence  of  the  knee- 
jerk  may  prove  to  be  the  determining  factor 
which  will  influence  the  whole  diagnosis.  In  a 
similar  manner,  the  phenomenon  known  as  ankle- 
clonus,  which  is  only  a  special  manifestation  of 
increased  tendon  excitability,  may  afford  most 
valuable  information  as  to  the  nature  of  the  lesion 
under  consideration.  When  well-marked  and 
persistent  it  is  usually  regarded  as  indicative  of 
an  increased  excitability  of  the  motor  path  in  the 
lumbo-sacral  segment  of  the  spinal  cord.  It  is 
very  rarely  present  in  healthy  people,  but  a  variety 
of  pseudo-clonus  is  occasionally  met  with  in  cases 
of  hysteria,  though  it  may  be  distinguished  from 
true  clonus  by  the  fact  that  it  is  apt  to  be  initiated 
by  a  voluntary  movement  on  the  part  of  the 
patient,  and  also  by  its  irregularity.  The  exact 
degree  to  which  the  muscles  concerned  respond 
to  external  excitation  varies,  of  necessity,  with  the 
position  and  extent  of  the  lesion,  and  also  perhaps 
with  the  nature  of  the  stimulus  and  the  methods  of 
producing  it.  It  would  be  well  if  some  means 
were  devised  for  measuring  the  amount  of  the 
excursion  which  forms  the  visible  part  of  the 
reflex.  Dr.  Augustus  A.  Eshner  (a)  has  succeeded 
in  obtaining  graphic  records  of  the  movements  of 
the  ankle  in  clonus  with  a  view  to  determining, 
if  possible,  the  extent  of  the  reflex  with  something 


(o)  Jour*.  Artur.  Med.  j4$»oc.,  May  7th,  1904. 


approaching  to  mathematical  precision.  The 
results  of  his  observations  show  that  there  exists 
a  considerable  variation  in  the  rate  of  the  move- 
ments, the  normal  rhythm  being  about  7 -6  per 
second.  In  hemiplegia  the  rate  is,  as  a  rule, 
slower,  being  under  7,  while  in  myelitis  the  move- 
ments are  rather  more  frequent.  The  effects  of 
"  reinforcement  "  were  not  always  apparent  in 
the  curves  obtained. 


Patent  Medicines  and  Press  Criticisms. 

It  is  not  often  that  the  proprietor  of  a  patent 
medicine  shows  fight  when  his  nostrum  is  exposed 
by  some  energetic  newspaper  writer.  He  usually,  in 
Mr.  Chamberlain's  expressive  language  "  takes  it 
lying  down. "  It  is  with  all  the  more  interest ,  then , 
that  we  look  to  the  suit  which  has  been  brought 
in  the  United  States  by  the  "  R.  E.  Pierce  Com- 
pany," proprietors  of  a  patent  medicine  "  Dr. 
Pierce's  Favourite  Prescription,"  against  the 
Ladies'  Home  Journal.  The  editor  of  that  maga- 
zine, Mr.  Edward  Bok,  in  a  recent  number,  took 
up  the  cudgels  against  the  patent  medicine  curse. 
He  examines  a  list  of  thirty-six  well-known 
nostrums,  nearly  all  of  which  contain  large 
quantities  of  alcohol.  Special  reference  is  made 
to  the  article  we  have  mentioned,  and  its  analysis 
is  published,  with  the  result  that  an  action  for 
$200,000  damages  has  been  started.  It  is  hardly 
likely  that  the  action  is  anything  more  than, 
again  to  quote  Mr.  Chamberlain,  "  bluff,"  for 
the  manufacturer  is  hardly  willing  to  stand  cross- 
examination  as  to  the  composition  of  his  nostrum. 
It  is  a  pity  that  the  newspaper  press  does  not 
more  often  take  the  line  Mr.  Bok  has  done,  but 
it  is  to  be  feared  that  the  subsidy  received  through 
the  advertising  columns  does  not  allow  the  editorial 
department  a  free  hand.  Mr.  Bok  notices  in  the 
States,  as  we  have  often  done  here,  that  the 
greatest  offenders  in  the  matter  of  advertising,  not 
merely  proprietary  drugs  of  bad  reputation,  but 
frequently  nefarious  and  offensive  preparations, 
are  the  smaller  religious  prints.  We  understand 
that  the  Dr.  Pierce  Company  has  long  had  a 
branch  in  Great  Britain. 


Literary  Expression, 
All  of  us,  whom  either  inclination  or  necessity 
induces  to  the  perusal  of  many  scientific  papers, 
must  have  noticed  the  lamentable  lack  of  style 
which  in  general  marks  their  composition.  In- 
deed, as  regards  the  expression  of  English  scien- 
tific thought  at  the  present  day,  one  may  say  that 
style  is  absent,  and  that  slovenliness  of  diction 
prevails.  It  is  perhaps  too  much  to  expect  that 
men  of  science  will  cultivate  literary  expression 
with  the  care  that  is  considered  necessary  among 
other  writers,  but  nevertheless  one  can  hardly 
over-rate  the  increase  of  pleasure  given  when  a 
work  of  scientific  value  is  expressed  in  correct, 
vigorous,  and  clear  language.  With  the  single 
exception  of  Sir  Michael  Foster,  we  do  not  know 
in  England  any  medical  writer,  since  the  death  of 
Sir  James  Paget,  whose  works,  apart  from  their 
intrinsic  value,  it  is  a  pleasure    to  every  man  of 


592    Ta»  Mcmcal  Press.    NOTES    ON    CURRENT    TOPICS. 


June  i,  1904. 


-taste  to  read.  In  pure  science,  no  one  has  suc- 
ceeded to  the  place  of  Huxley  and  Tyndall,  re- 
garded merely  as  literary  men.  In  America,  it 
is  true,  there  is  still  a  cult  of  style  among  the 
better  class  of  medical  writers,  of  whom  Dr.  Osier, 
Dr.  Weir  Mitchell,  and  the  late  Oliver  Wendell 
Holmes  are  good  examples.  French  writers  are, 
as  a  rule,  peculiarly  happy  in  their  manner  of  ex- 
pressing themselves,  but  whether  this  is  due  to  the 
felicity  of  the  French  language,  or  the  esprit  and 
taste  of  the  writers  themselves,  it  is  difficult  to 
decide.  On  the  other  hand,  the  reading  of  scien- 
tific work  published  in  German  is  one  of  the  most 
painful  experiences  a  zealous  student  has  to  under- 
go. It  should  not  be  forgotten,  however,  that 
some  of  the  greatest  masters  of  English  prose 
have  been  medical  men.  In  any  history  of  style 
the  names  of  Sir  Thomas  Browne,  Oliver  Gold- 
smith, and  Dr.  John  Brown  will  always  take  a 
high  place. 

Tuberculous  Infection  in  Children. 

A  few  years  ago  we  thought  we  knew  most  things 
that  were  to  be  known  regarding  the  methods  of 
infection  by  the  tubercle  bacillus.  This  self- 
satisfied  opinion  received  its  greatest  shock  when 
Koch  expressed  his  views  on  the  relation,  or  lack 
of  relation,  between  human  and  bovine  tuber- 
culosis, using  as  one  of  his  arguments  the  state- 
ment that  primary  intestinal  tuberculosis  was 
so  rare  as  to  be  practically  negligible.  On  the 
other  hand,  Behring's  view  was  equally  novel 
when  he  declared  in  sensational  manner  last  year 
that  we  are  all  tuberculous,  t  he  channel  of  infection 
being  the  alimentary  canal  during  infancy.  In 
view  of  these  contrary  opinions  from  men  of  the 
highest  authority,  it  is  important  to  notice  all 
well  recorded  facts  and  figures  helping  to  elucidate 
the  subject.  Dr.  William  Hunter,  of  Hong  Kong, 
has  just  made  an  important  contribution  (a)  of 
this  kind.  In  classifying  the  results  of  5,142 
consecutive  autopsies,  amid  a  population  where 
tuberculous  disease  is  very  rife,  he  finds  only  ten 
•cases  of  tuberculous  lesions  of  the  intestines  or 
mesenteric  glands  in  children.  It  should  be  said 
that  more  than  one-third  of  the  bodies  examined 
were  children.  In  most  cases  there  were  tuber- 
culous lesions  elsewhere  in  the  body,  and  there 
•was  evidence  to  sbow  that  the  intestinal  lesion 
•was  not  primary.  In  face  of  such  facts  as  these 
it  is  difficult  to  know  on  -what  basis  Behring's 
^theory  can  rest. 


Anti- Vaccinationist  Tricks. 

In  this  country  we  are  accustomed  to  regard  the 
:anti-vaccinationist  as  rather  a  stupid,  though 
decidedly  noxious,  enthusiast.  There  is  but  little 
variety  in  his  manoeuvres,  and  his  tricks  are 
usually  obvious.  In  America,  however,  as  might 
*be  expected  in  such  a  smart  country,  the  "  anti- 
vack "  has  developed  a  "  slimness  "  to  which  we 
in  this  stolid  land  are  quite  unused.  For  instance, 
it  seems  to  have  become  the  practice  among 
objecting  parents  to  produce  sham  scars  in  order : 

(a)  '&rit.  Med  /©urn.,  M%y  11th.  1HW. 


to  delude  the  school  and  health  authorities  who 
insist  on  vaccination.  A  medical  paper,  issued 
by  a  drug-manufacturing  company,  recently 
published  an  article  giving  details  as  to  the  best 
method  of  producing  scars  on  the  arm  which 
would  pass  as  vaccination  marks.  Even  more 
outrageous  is  the  conduct  of  a  legally  qualified 
practitioner,  a  homoeopath,  in  Cleveland.  During 
the  height  of  a  small-pox  epidemic  there  a  couple 
of  years  ago,  he  had  the  effrontery  to  write  to  one 
of  the  public  papers  stating  that  his  own  practice 
was  to  substitute  vesication  for  vaccination.  As 
he,  in  common  with  other  homoeopaths,  did  not 
believe  in  the  utility  of  vaccination,  it  was  his 
custom  when  a  child  was  brought  to  him  for  the 
purpose  to  produce  scars  by  vesication,  and  then 
fill  a  certificate  of  successful  vaccination. 

Degenerate  or  Deviate? 
Following  on  his  startling  proposal  for  the 
rapid  extinction  of  degenerates  as  a  class  by  sterili- 
sation, Dr.  Rentoul,  of  Liverpool,  very  soon  got 
embroiled  in*  a  squabble  as  to  the  meaning  of  the 
term"  degenerate."     In  order  to  free  himself  from 
the  difficulty,  Dr.  Rentoul  appealed  to   Dr.  Max 
Nordau,  as  being  in  a  position  to  make  the  most 
authoritative  definition.      Clear    as  Dr.  Nordau's 
statement  is,  however,  it  rather  cuts  the  ground 
from  under  Dr.  Rentoul's  feet.  "  What  differentiates 
degeneracy  from  other  deviations  of  the  generic 
type  is  this  :  the  degenerates  tend  towards  ex- 
tinction  by   rapid   diminution   of   the    power  of 
reproduction.'*     This  being  the  case,  where  is  the 
need  of  Dr.  Rentoul's  heroic  method  ?     It  seems 
very    unnecessary    to    sterilise    what    is    rapidly 
becoming  impotent.     Apart  altogether,  however, 
from    Dr.    Rentoul's    contention,    an    American 
writer,  Dr.  Walton,  of  Boston,  enters  recently  (a) 
a  strong  protest  against  the  current  use  of  the 
word  "  degenerate.*'     Many  authors,  for  instance, 
use  the  word  without,  primarily,  at  any  rate,  any 
derogatory  meaning.     For  instance,  Dana  defines 
degeneration  as  '*  a  condition  in  which  there  is  a 
marked    deviation    from    the    average    normal." 
Nordau  and  Lombroso  usually  associate  the  word 
with  notions  of  decadence  and  crime,  though  they 
believe    it    applicable    to    men    of    genius.    For 
degenerates  of  this  latter  class,  the  absurd  and 
self-contradictory    term    "  superior    degenerate " 
has  been  coined.     It  would   seem  much  better, 
as  Dr.  Walton  suggests,  to  substitute  the  colourless 
term  "  deviate  "  for  "  degenerate  "  in  the  wide 
sense,   keeping  the  latter  for  what   now,  by  a 
clumsy  pleonasm,  has  to  be  designated  "  inferior 
degenerate." 

Causation  of  Constipation. 

Whatever  views  have  been  held  as  to  the 
importance  of  chronic  constipation  as  one  of  the 
factors  of  disease — and  they  have  been  very 
varied— there  has,  up  till  recently,  been  but 
little  difference  of  opinion  as  to  the  nature  of  the 
cause  at  work.  Primary  habitual  constipation 
has  been  almost  universally  attributed  to  a  lack 

(a)  Boiton  Med.  and  Surf.'Joun.,  January  21at,  1904. 


JUNB    I,    I9O4. 


NOTES  ON  CURRENT  TOPICS. 


The  Medical  Peess.    593 


of  muscular  tone  in  the  intestinal  wall  resulting 
from  some  abnormality  in  its  nerve  supply.  A 
couple  of  years  ago,  however,  Strassburger  put 
iorward  the  view  that  the  diminished  peristalsis 
was  due,  not  to  any  change  in  innervation,  but 
to  a  change  in  the  intestinal  contents.  The  normal 
stimulus  to  contraction  is,  he  believes,  irritation 
of  the  wall  of  the  intestine  by  acids,  soaps,  and 
gases,  the  products  of  bacterial  decomposition. 
In  the  faeces  of  constipated  persons,  it  has  been 
found  that  bacteria  are  peculiarly  few  in  number, 
and  Strassburger  believes  that  the  cause  of  this 
is,  not  any  antiseptic  properties  of  the  intestinal 
contents,  but  a  decrease  in  the  quantity  of  suitable 
pabulum.  It  has  long  besn  known,  of  course, 
that  a  very  useful  mode  of  treatment  of  chronic 
constipation  was  the  supply  of  large  quantities 
of  indigestible  food  of  the  nature  of  vegetable 
fibres.  The  explanation  previously  offered  of 
its  success  was  that  the  mass  by  distending  the 
intestine  acted  as  a  mechanical  irritant.  Strass- 
burger corrects  this  notion  and  maintains  that 
its  true  function  is  to  supply  plentiful  food  for 
the  beneficent  bacteria  to  work  on.  The  cause, 
then,  of  habitual  constipation  would  be  a  too 
complete  utilisation  of  the  ingested  food,  and 
the  cure  a  larger  supply  of  indigestible  material. 

Miners  Phthisis  in  the  Transvaal. 

The  shockingly  high  mortality  returns  for 
the  Transvaal  mines,  referred  to  in  our  last  week's 
issue,  has  continued  to  engage  the  attention  of 
those  who  wish  to  see  steps  taken  to  remove  so 
serious  a  reproach  from  the  industry  on  which 
so  much  of  the  future  prosperity  of  South  Africa 
hangs.  The  greatest  excess  showed  itself  in 
pulmonary  affections,  these  constituting  three- 
fifths  of  the  causes  of  death — a  proof,  if  such  were 
wanted,  that  it  is  due  to  the  conditions  of  their 
occupation  that  so  many  of  the  labourers  perish. 
Miner's  phthisis,  so-called,  is  a  well-enough  recog- 
nised disease  in  this  country,  and  in  spite  of  the 
attention  paid  to  ventilation  and  similar  preven- 
tive measures,  still  claims  its  toll  of  victims. 
The  Home  Office  recently  appointed  Dr.  Haldane, 
along  with  Mr.  Martin  and  Mr.  Thomas;  to  hold 
an  inquiry  on  the  subject  in  Cornwall,  and  their 
report  is  now  completed,  and  will  be  issued  shortly. 
It  appears  from  an  inquest  lately  held  on  a  Cornish 
miner,  at  which  Dr.  Haldane  gave  evidence, 
that  in  his  opinion  the  use  of  a  water-jet  in  con- 
nection with  rock-drilling  was  capable  of  obviating 
to  a  great  extent  the  dangers  incidental  to  the 
creation  of  clouds  of  hard  rock-dust.  It  is  the 
nature  of  the  dust  produced  by  industrial  occupa- 
tions that  is  the  important  factor  in  producing 
fibrotic  conditions  in  the  lung,  for  workers  in  coal 
mines,  when  the  dust  is  soft  and  little  irritating, 
suffer  far  less  than  those  in  which  the  particles 
inhaled  are  hard  and  sharp.  If  the  introduction 
of  a  water- jet  will  enable  these  particles  to  be 
deposited  before  reaching  the  mouth  of  the  worker, 
mining  in  quartz  and  rock  will  lose  half  its  terrors. 
It  is  to  be  hoped  that  the  suggestion  will  receive 
the   attention    it   deserves    from   the   Transvaal 


Chamber  of  Mines,  and  that  experimental  jets 
will  be  established  at  once.  The  subject  is  one 
in  which  the  mine-owners  should  be  interested 
as  much  for  their  own  sake  as  for  that  of  their 
employes,  but  they  have  already  shown  their 
good-will  in  the  matter  by  offering  prizes  for  the 
best  suggestion  and  devices  for  solving  the  diffi- 
culty. The  full  report  of  Mr.  Haldane's  com- 
mittee will  be  awaited  with  great  interest. 


Auscultatory  Percussion  of  the  Stomach, 
The  improved  methods  of  examination  of  the 
stomach  that  have  lately  come  into  vogue  have 
added  greatly  to  accuracy  of  diagnosis  in  diseases 
of  that  important  viscus,  and  patients  nowadays 
are  becoming  more  and  more  accustomed  to  put 
up  with  thorough  and  searching  examination 
than  they  were  a  few  years  ago.  The  disagree- 
ableness  of  having  the  stomach-tube  passed  is 
cheerfully  accepted  by  most,  and  even  the  dis- 
comfort of  artificial  dilatation  is  submitted  to 
when  its  object  is  explained,  with  a  resignation 
that  would  have  surprised  one  a  few  years  ago. 
But  there  are  some  nervous  and  restive  people 
who  cannot  be  induced  to  put  up  with  anything 
tiresome  or  uncomfortable,  and  for  these  it  is 
comfort  to  have  a  method  to  fall  back  upon  which 
gives  nearly  as  trustworthy  information,  if  carefully 
carried  out,  as  artificial  inflation,  and  certainly 
does  not  cause  so  much  disturbance  to  the  subject. 
This  is  the  method  of  auscultatory  percussion. 
The  plan  followed  is  to  give  the  patient  a  tumbler- 
ful of  soda-water  to  drink  and  then  to  make  him 
lie  down  on  his  back  with  his  shoulders  raised. 
The  stomach  being  somewhat  dilated  by  this 
simple  draught,  if  the  stethoscope  be  placed  over 
the  epigastrium  and  the  neighbouring  areas  tapped 
with  the  fore-finger,  a  note  of  particular  quality 
is  produced  when  the  stomach  is  in  contact  with 
the  abdominal  wall,  whilst  the  note  heard  when 
the  finger  strikes  over  neighbouring  viscera  is 
dull  and  flat.  If  the  outline  of  the  area  where 
resonance  is  heard  is  marked  off  with  a  dermo- 
graphic  pencil,  a  good  representation  of  the  size 
and  shape  of  the  stomach  is  obtained.  This  plan 
gives  pretty  accurate  results,  and  is  so  simple  and 
free  from  objection  that  it  should  always  be  tried 
in  preference  to  administering  powders  of  acid 
and  alkaline  salts  to  inflate  the  stomach,  for  not 
only  is  this  always  uncomfortable,  but  in  cases 
of  gastric  ulcer  and  cardiac  disease  it  is  not  without 
some  danger. 

Small-pox  in  Germany. 

The  anti-vaccinationists — or  anti-vaccinists,  as 
they  seem  to  prefer  to  call  themselves — are  great 
on  the  subject  of  isolation  in  small-pox.  It  is, 
of  course,  the  only  preventive  method  left  to 
them  for  dealing  with  the  disease  when  it 
occurs,  and  they  are  therefore  keen  advo- 
cates of  the  erection  of  small-pox  hospitals.  It 
may  be  of  interest  to  them  to  read  the  report  re- 
cently issued  by  the  Local  Government  Board 
of  Dr.  Bruce  Low's  observations  and  experiences 
in  Germany  with  regard  to  the  management  of 


594    The  Medical  Puss.       NOTES    ON    CURRENT    TOPICS. 


June  i.  1904. 


small-pox.  It  is  a  matter  of  common  knowledge 
that  Germany  is  one  of  the  best  vaccinated  coun- 
tries in  the  world,  and  Dr.  Bruce  Low's  visit  was 
arranged  owing  to  "  conflicting  statements 
having  been  made  from  time  to  time  in  the  public 
press  as  to  the  methods  employed  in  Germany 
in  dealing  with  small- pox  patients."  Dr.  Bruce 
Low  started  his  inquiry  by  visiting  the  Central 
Imperial  Health  Office  in  Berlin  to  ask  permission 
to  see  any  small-pox  patients  undergoing  isolation. 
This,  however,  was  not  of  much  avail,  as  there 
was  no  small-pox  in  the  whole  of  the  Empire. 
Now  that  vaccination  and  re- vaccination  is  uni- 
versally compulsory  in  Germany,  small-pox  is 
not  known  except  through  isolated  importations 
into  sea-port  and  frontier  towns.  However,  Dr. 
Bruce  Low  proceeded  to  ten  representative  towns 
to  see  for  himself  the  arrangements  that  were 
made  for  treating  the  cases  that  do  crop  up  in 
this  manner.  He  found  a  notable  state  of  things. 
Small-pox  accommodation  is  provided  for  in  the 
ordinary  general  hospitals  in  special  pavilions, 
which  are  situated  in  a  proximity  to  the  other 
wards  and  to  neighbouring  houses  that  would 
make  our  authorities  shudder.  The  isolation,  as 
isolation,  is  a  farce,  because  the  Germans,  with 
their  good  sense  and  past  experience  to  guide 
them,  have  found  that  in  a  land  like  theirs,  where 
re- vaccination  is  universal,  there  is  no  need  to 
worry  about  strict  isolation.  Infection  arrives 
rarely,  and  when  it  does,  it  will  not  spread  any 
more  than  fire  will  in  the  absence  of  air.  It  is 
sad  to  comment  on  the  state  of  feeling  over  here 
with  regard  to  the  preventive  value  of  thorough 
vaccination  that  it  is  deemed  necessary  for  us  to 
build  and  maintain  large  hospitals  for  small-pox, 
which  -would  be  quite  superfluous  if  Jenner's 
countrymen  had  a  little  of  that  quiet  old  general 
practitioner's  common  sense. 


The  Triumph  of  the  Picturesque. 

Though  it  may  not  be  always  strictly  true  that 
"  Science  grows  and  beauty  dwindles,"  there 
exists  an  antagonism,  apparent  or  real,  between 
things  which  are  of  practical  use  and  those  which 
only  minister  to  man's  aesthetic  sense.  The 
picturesque  and  the  sanitary  are  seldom  found 
truly  combined  without  one  or  the  other  suffering 
in  consequence.  There  is  no  need  to  go  far  in 
order  to  prove  the  truth  of  this  assertion.  A  very 
attractive  costume  does  not  often  confer  upon  its 
wearer  those  benefits  for  which  all  clothing  was 
principally  designed,  namely,  warmth  and  pro- 
tection. A  hospital  ward  may  look  bright  and 
homely  with  its  walls  decked  with  dust-collecting 
pictures,  and  with  every  available  nook  occupied 
by  an  obtrusive  ornament  or  flower- vase,  but  in 
the  practice  of  modern  aseptic  surgery  it  is  ab- 
solutely essential  that  all  unnecessary  furniture 
be  sacrificed  in  favour  of  plain,  non-absorbent 
surfaces,  devoid  of  angles  and  corners.  That  it 
is  quite  possible  to  be  aseptic  and  yet,  at  the  same 
time,  to  preserve  an  attractive  appearance  can 
be  seen  by  a  visit  to  some  of  the  more  newly- 
constructed    wards    in    our    children's    hospitals. 


Again,  the  charming  cottage  in  the  country  may 
have  been  immortalised  by  the  brush  of  a  Constable, 
whereas  its  sanitary  appliances  are,  in  all  pro- 
bability, wofully  out  of  date.  The  multitudes  of 
pigeons  which  congregate  upon  nearly  every 
important  building  of  the  metropolis,  where  they 
have  flourished  for  generations,  are  now  receiving 
much  attention  from  the  sanitary  authorities. 
It  would  appear  that  however  desirable  the 
destruction  or  removal  of  these  birds  might  appear 
on  grounds  of  hygiene,  such  a  course  is  practically 
impossible,  as  they  have  no  actual  [owners.  Legally, 
this  is,  of  course  a  good  excuse,  but  the  conserva- 
tive public  health  conscience  is  slow  to  be  con- 
vinced, so  that  here  also  the  picturesque  will 
triumph  over  the  sanitary  until  such  time  as  a 
definite  outbreak  of  disease  may  be  traced  to  this 
cause. 


Dejeuner  a  la  Pourchette. 
That  delicate  piece  of  mechanism,  the  human 
body,  is  as  accommodative  at  some  times  as  it 
is  refractory  at  others,  and  it  resembles  women 
and  horses  in  the  uncertainty  that  attaches  to  its 
behaviour  under  trials.  One  man  may  swallow 
a  pin  and  be  dead  in  a  week,  whilst  another  can 
eat  a  fork  without  much  apparent  harm.  At 
least,  so  it  seems  from  a  remarkable  case  that  oc- 
curred at  the  East  Sussex  County  Asylum  the 
other  day.  At  an  inquest  held  on  a  woman  who 
died  in  the  institution,  it  came  out  that  the 
medical  man  in  charge  had  found  that  some  time 
previously  she  had  a  swelling  of  the  abdominal 
wall  from  which  a  little  discharge  was  issuing. 
The  woman  told  him  that  she  had  swallowed  a 
fork  three  years  before  at  another  asylum,  and 
truly  enough,  he  found  the  prongs  of  a  fork 
being  forced  through  the  skin  by  the  movements 
of  respiration.  The  swelling  was  incised  and  a 
fork  such  as  was  in  use  at  the  other  asylum  was 
delivered  from  the  wound.  Communication  with 
the  institution  in  question  revealed  the  fact  that 
in  November,  1898,  she  had  complained  to  the 
officials  that  she  had  swallowed  a  fork,  but  after 
observation  they  came  to  the  conclusion  that  she 
was  suffering  from  a  delusion,  as  there  were  no 
signs  of  visceral  disturbance.  At  the  operation 
the  abdominal  wound  was  found  to  communicate 
with  the  stomach,  and  it  resisted  all  efforts 
made  to  close  it.  Death  finally  followed  from  ex- 
haustion. The  handle  of  the  fork  had  been  eaten 
away  by  the  gastric  juice,  and  it  was  as  sharp  as 
a  razor,  but  the  prongs  were  but  little  affected. 
Cases  as  curious  as  this  have  been  recorded  pre- 
viously, and  all  alienists  know  of  lunatics  who 
have  eaten  stones,  pipe-stems,  glass,  and  such 
things,  but  the  woman  must  have  had  a  stomach 
of  ostrich-like  powers  to  have  not  only  retained 
the  fork  so  many  years,  but  to  have  experienced 
so  little  inconvenience  from  it.  If  she  had  only 
suffered  from  indigestion  now  and  again,  one 
could  have  forgiven  her,  but  it  is  too  bad  to  upset 
all  our  accepted  theories  of  diet  in  the  way  she 
did.  Poor  Frances  Guy  is  certainly  worth  a  little 
niche  in  the  temple  of  medical  curiosities. 


JUNB    I,    I904» 


NOTES    ON    CURRENT    TOPICS.     The  Medical  Press.    595 


Prepared  Air  in  Hospitals. 

A  discovery  in  the  treatment  of  liquid  air  made 
by  Professor  Pictet,  of  Geneva  University,  pro- 
mises to  have  a  considerable  commercial  value.  He 
has  demonstrated  the  possibility  of  separating  that 
product  into  its  essential  component  parts — oxygen 
and  nitrogen — by  fractional  distillation.  It  seems 
likely  that  the  industrial  applications  of  this 
process  may  be  of  considerable  value,  but  the 
same  can  hardly  be  said  of  its  proposed  use  in 
providing  hospitals  and  other  large  buildings  with 
an  abundant  supply  of  richly  oxygenated  air. 
The  main  element  in  unwholesome  air  is  carbonic 
acid  gas,  which  would  not  be  affected  by  an  excess 
of  oxygen.  Moreover,  it  remains  to  be  shown  that 
free  and  efficient  ventilation  would  not  effect  the 
whole  object.  It  seems  somewhat  gratuitous 
to  assume  that  an  excess  of  oxygen  in  air  must 
necessarily  be  good  for  the  lungs  of  persons  inside 
a  great  building.  On  a  similar  principle  it  would 
be  easy  to  affirm  that  brandy  is  better  to  drink 
than  wine.  So  with  air,  if  supplied  in  sufficient 
quantity  from  the  outside  atmosphere,  it  is  suffi- 
cient for  all  reasonable  purposes,  even  in  the  heart 
of  mighty  London.  Were  it  not  so,  how  would  the 
great  city  hospitals  manage  to  keep  down  their 
mortality-rates  ? 

Artificial  Lunacy. 
In  the  present  day  the  British  citizen  is  wont  to 
plume  himself  on  the  perfection  of  his  safeguards  as 
regards  lunatics  at  large  and  lunatics  in  charge.  In 
spite  of  the  Commissioners  and  the  legal  machinery 
involved  in  the  certification  of  insane  persons  it  is 
doubtful  whether  there  is  not  a  great  deal  of  room 
for  improvement  in  our  methods.     In  the  House 
of  Commons  recently  so  cautious  and  responsible 
an  authority  as  Sir  J.  Batty  Tuke  moved  to  reduce 
the  Lunacy  Commission  vote  in  the  Civil  Service 
estimates.    The  reasons  he  alleged  were  that  there 
were  not  enough  Commissioners  and  that  the  poorer 
lunatics  were  not  well  looked  after.     Then  followed 
Dr.  Farquharson,  who  declared  "that  persons  might 
be  examined   and  cross-examined  into  lunacy." 
We  agree  with  Sir  J.  Batty  Tuke  that  the  Com- 
missioners' work  is  often  imperfect,  and  that  the 
pauper  lunacy  administration  is  often  scandalous. 
The  revelations  from  time  to  time  of  what  takes 
place  in  unlicensed  houses  show  that  the  Com- 
missioners net  is  not  an  inclusive  one.     The  recur- 
rence of  suicides  in  the  padded  room  at  Mile  End 
Workhouse,  to  take  a  single  instance,  is  a  blot  upon 
the   Poor-law    lunacy    system    of    the    kingdom. 
Then,  again,  many  obvious  lunatics  are  sent  to 
prison  from  our  criminal  courts  of  law.     If  the 
Commissioners  have   not  a  watching  brief  over 
these  unfortunate  beings  the  sooner  the  law  extends 
their  function  the  better.     By  all  means  let  the 
nation  have   the   Royal  Commission   of   Inquiry 
suggested  by  Sir  J.  Batty  Tuke. 

A  New  Test  for  Typhoid  Bacilli. 

When  in  the  directions  for  the  treatment  of 
any  condition  we  note  in  the  text-books  a  long 
list  of   alternative  methods,  we  may  rest  assured 


that  none  of  them  is  quite  satisfactory.  Simi- 
larly in  bacteriological  study,  when  we  find 
that  many  tests  are  enumerated  to  aid  in  dis- 
tinguishing one  species  of  bacteria  from  another,, 
we  may  be  certain  that  no  one  of  them  is  by  itself 
sufficient  for  diagnosis.  In  the  case  of  no  or- 
ganism is  this  more  true  than  in  that  of  the  ty- 
phoid bacillus  and  its  relations  to  the  colon  groupr 
and  in  the  case  of  none  is  accurate  knowledge 
more  necessary.  While  one  is  shy  of  adding 
another  to  the  already  long  list  oi  "  distinguishing^ 
characters  "  of  these  organisms,  yet,  in  the  ab- 
sence of  any  true  expefimentum  cruris,  we  have 
to  make  the  best  of  the  signs  at  our  disposal,  and 
without  extended  trial  it  cannot  be  discovered 
whether  a  fact  is  of  real  importance  or  not.  Dr~ 
Walter  Stevenson,  of  Dublin,  has  just  called 
attention  (a)  to  a  hitherto  unnoticed  property  of 
the  colon  bacillus  which  will,  we  hope,  receive 
further  investigation,  and  may  prove  of  important 
diagnostic  value.  Having  prepared  both  cultures 
of  typhoid  and  of  colon  ba&ilhV  small  areas 
of  an  ordinary  photographic  plate  were  wetted 
with  the  fluid.  In  every  case  of  some  twenty-four 
experiments  the  culture  of  colon  bacillus  mark- 
edly reduced  the  silver,  while  the  typhoid  culture 
had  an  inhibitive  effect  even  when  the  piate  was 
exposed  to  red  light.  The  result  was  the  same 
when  sterilised  cultures  were  used,  and  the  age 
of  the  culture  made  no  difference.  The  experi- 
ments open  up  a  line  of  chemical  investigation 
hitherto  untouched,  and  whatever  be  its  ultimate 
value,  it  should  not  be  lightly  neglected. 

Staphylococcus  Vaccine  in  the  Treatment 
of  Acne* 

Two  years  ago  Professor  Wright,  then  of  Netley, 
drew  attention  to  the  possibility  of  successfully 
treating  staphylococcus  infections  of  the  skin  by  ai 
process  of  vaccination  similar  to  that  which  he 
has  introduced  in  the  case  of  typhoid  fever. 
During  the  period  that  has  elapsed  since  that  time- 
he  has  had  further  opportunity  of  testing  the 
method,  and  in  a  recent  communication  (a)  very 
encouraging  results  are  made  public.  Fourteen 
additional  cases  have  been  treated,  the  common 
feature  of  all  being  a  chronic  staphylococcus 
infection,  though  clinically  the  manifestations 
were  various — as  furunculosis,  sycosis,  acne.  In 
all  the  cases  there  was  considerable  improvement,, 
and  in  most  of  them  complete  cure.  The  principle 
underlying  the  treatment  is  the  same  as  in  anti- 
typhoid inoculation,  and  the  sequence  of  events 
is  very  similar.  There  is  first  a  negative  phase, 
soon  followed  by  a  positive,  and  the  attainment 
of  the  desired  result  depends  on  the  cumulative 
effect  of  a  series  of  properly  interspaced  injections. 
The  action  is  radically  different  from  that  which 
takes  place  in  ordinary  anti-diphtheria  inocula- 
tion, where  we  supply  the  patient  with  a  quantity  of 
antitoxin  ;  in  the  present  case  we  stimulate  the  cells 
of  the  patient  to  produce  their  own  bacterioscopic 
substance.    A  vaccine   of  standardised    strength 

(a)  Brit.  Med.  Jour*.,  April  30th.  1904. 
(•)  Brit.  Mtd.Joum.,  May  7th,  1904. 


596    The  Medical  Press. 


PERSONAL. 


June  i,  1904. 


should  always  be  employed,  and  the  effect  of  each 
injection  on  the  patient's  blood  should  be  judged  by 
a  count  of  leucocytes.  In  severe  cases  it  may  be 
necessary  to  employ  a  vaccine  made  with  the  par- 
ticular strain  of  micro-organisms  by  which  the 
patient  has  been  infected. 

The  "  What  is  Brandy"  Case. 

The  importance  of  denning  the  nature  of  brandy 
from  the  medical  point  of  view  can  hardly  be  over- 
estimated. The  decision  of  a  London  Magistrate, 
therefore,  inflicting  a  fine  on  a  spirit-dealer  for 
selling  as  brandy  an  article  containing  60  per  cent, 
of  spirit  derived  from  a  source  other  than  the  grape, 
assumes  a  position  of  the  utmost  importance. 
The  report  of  the  case  reaches  us  as  we  are  going 
to  press,  but  we  hope  to  comment  on  the  decision 
fully  in  an  early  issue. 


The  Proceedings  of  the  Central  Midwivee' 
Board. 

As  we  go  to  press  we  learn  that  an  important 
change  has  been  adopted  by  the  Central  Midwives' 
Board  with  regard  to  the  publicity  of  its  procedures. 
Up  to  this,  reporters,  even  from  medical  journals, 
have  been   refused  admission,  and  the  press  has 
been  furnished  with  a  report  of  the  proceedings 
of  each  meeting,  which  report  was  carefully  edited 
to  suit  the  wishes  of  certain  members  of  the  Board. 
Our    readers    will   remember   that   on    a   recent 
occasion  this  "  editing  "  led  to  gross   inaccuracy, 
and  that  an  important  resolution  dealing  with  the 
demands  of    the  Irish  maternity  hospitals  was 
stated   in   the    "  official "   report   to   have   been 
"  unanimously  adopted,"  when,  as  a  matter  of 
fact,  two  members  of  the  Board  voted  against  it. 
It  was  a  distinct  oversight  that  the  Act  did  not 
contain  a  clause  making  it  compulsory  on  the 
Board  to  admit  reporters,  and  we  are  very  pleased 
to  learn  now  that,  largely  or  entirely  due  to  the 
firm  stand  taken  by  Professor  Japp  Sinclair  and 
Mr.  Ward  Cousins,  the  Board  has  been  brought 
to  recognise  that  efforts  at  the  concealment  of  its 
proceedings  are  liable  to  create  the  belief  that 
there  is  something  that  it  is  necessary  to  conceal. 
We  can  quite  believe  that  it  was  very  much  easier 
to   reply   to   the   resolutions   of   the  Royal  Irish 
Academy  of  Medicine,  and  the  requests  of  the 
Irish  maternity  hospitals,  in  the  set  form  which 
the  Board  adopted,  when  the  hospital  authorities 
and  the  general  public  were  ignorant  of  the  dis- 
cussions at  the  Board,  than  it  would  have  been 
if  these  discussions  had  been  published.   At   the 
same  meeting  of  the  Board  it  was    resolved  to 
ask  the  Privy  Council  to  sanction  the  appending 
of  the  following  note  to  Rule  Ci  (2) : — 

"  A  certificate  to  the  effect  that  the  candidate 
has  nursed  twenty  lying-in  women  during  the 
eight  days  following  labour  will  be  accepted  in 
place  of  the  above  in  cases  (1)  where  the  course  of 
special  training  in  a  hospital  has  extended  over  a 
period  of  six  months,  or  (2)  where  a  course  of  three 
months'  special  training  in  a  hospital  has  been  pre- 


ceded  by  a    full   course  of    training   in  general 
nursing." 


PERSONAL. 


H.R.H.  Princess  Christian  presided  at  last  week's 
meeting  of  the  Ladies'  Committee  of  Guy's  Hospital. 

Sir  Lauder  Brunton  has  been  elected  Consulting 
Physician  to  the  Infants'  Hospital,  at  Hampstead 
Heath. 


Dr.  Jameson,  the  Premier  of  Cape  Colony,  will  sail 
from  Cape  Town  on  July  20th  for  a  month's  holiday 
in  England  and  Scotland. 


Dr.  Bo  wen  Davies,  J. P.,  of  Llandrindod  Wells, 
has  been  elected  President  of  the  British  Balneological 
Society  for  the  ensuing  session. 

Mr.  C.  H.  Evitt,  J. P.,  has  generously  presented  a 
fully-equipped  modern  operating  theatre  to  the 
Princess  Alice  Memorial  Hospital,  at  Eastbourne. 

The  Secretary  of  State  in  Council  has  appointed 
Dr.  F.  W.  N.  Haultain,  of  Edinburgh,  Examiner  in 
Midwifery  and  Diseases  of  Women  for  the  Indian 
Medical  Service. 


Sir  Wm.  Broadbent,  Bart.,  Dr.  Nathan  Raw,  and 
Dr.  A.  P.  Hillier,  were  the  delegates  of  the  British 
National  Association  for  the  Prevention  of  Consump- 
tion at  the  International  Conference  held  at  Copen- 
hagen last  week. 


Dr.  Richard  Caton,  consulting  physician  to  the 
Liverpool  Royal  Infirmary,  Emeritus  Professor  of 
Physiology  in  University  College,  Liverpool,  has  been 
elected  representative  of  Liverpool  University  on  the 
General  Medical  Council. 


Mr.  Charles  Stonham,  F.R.C.S.  senior  surgeon  to, 
and  Lecturer  on  Surgery  at,  Westminster  Hospital,  has 
been  appointed  by  the  General  Medical  Council  an 
assistant  examiner  in  surgery  to  the  Apothecaries' 
Society  of  London  for  a  period  of  four  years. 

An  illuminated  address,  handsomely  framed,  was 
presented  last  week  to  Dr.  Clothier  of  Highgate,  with 
the  following  inscription  : — "  It  is  with  the  greatest 
cordiality  that  his  colleagues  wish  him  in  his  retire- 
ment from  public  work  long  life  and  happiness." 

Dr.  Ernest  White,  Resident  Physician  and  Super- 
intendent of  the  City  of  London  Asylum  at  Stone  for 
the  last  seventeen  years,  has  sent  in  his  resignation  to 
the  City  Corporation,  he  having  completed  the 
requisite  length  of  service  under  the  provisions  of  the 
Lunacy  Act  of  1890. 

Mr.  Henry  Morris,  F.R.C.S.,  Surgeon  to  the 
Middlesex  Hospital,  senior  vice-president  of  the 
Court  of  Examiners  of  the  Royal  College  of  Surgeons, 
England,  has  been  elected  to  succeed  Mr.  Thos.  Bryant 
F.R.C.S.,  as  representative  of  the  College  on  the  General 
Medical  Council. 


The  Council  of  Liverpool  University  have  appointed 
Mr.  F.  G.  Donnan,  Ph.D.,  M.A.,  to  the  Chair  of  Physical 
Chemistry.  He  is  a  graduate  of  the  Royal  University 
of  Ireland,  and  has  had  special  training  in  Continental 
laboratories,  as  well  as  at  the  London  University.  He 
is  at  present  Lecturer  in  Chemistry  in  the  Royal  College 
of  Science,  Dublin. 


Although  Mr.  Bryant  decided  not  to  seek  re- 
election when  his  term  of  office  expired,  his  connection 
with  the  General  Medical  Council  has  not  entirely 


June  i,  1904. 


CORRESPONDENCE. 


The  Medical  Press.  ^  597 


ceased,  as  he  will  carry  out  on  behalf  oi  that  Body 
the  Inspection  of  Examinations  during  the  current  year, 
for  which,  on  account  of  his  familiarity  with  the  subject, 
he  is  eminently  qualified. 

The  retirement  of  Mr.  Bryant  as  the  accredited 
representative  of  the  Royal  College  of  Surgeons, 
England,  on  the  General  Medical  Council,  will  be  uni- 
versally regretted.  For  very  many  years  he  has  been 
one  of  the  most  consistent  and  hardest  working  mem- 
bers of  that  august  body.  Always  courteous  to 
opponents,  he  nevertheless  was  an  uncompromising 
advocate  of  the  claims  of  the  College  he  represented. 

Dr  Dan  Powell,  of  Cardiff,  was  presented  last  week 
with  a  very  handsome  solid  silver  cigar  case,  as  an 
acknowledgment  of  valued  professional  services 
rendered  to  Mr.  F.  H.  Bennett,  of  Hartlepool  who  was 
taken  seriously  ill  at  Cardiff  Docks  a  few  days  ago. 
Mr.  Bennett,  not  knowing  the  medical  man  who  had 
attended  him  in  the  emergency,  sent  this  present  to  his 
friends  at  the  Docks,  with  a  wish  that  it  should  be 
handed  to  the  doctor. 

The  decision  of  the  London  County  Council  to  place 
a  tablet  on  the  former  residence  of  Dr.  Thomas  Young 
at  No.  48  Welbeck  Street,  will  probably  give  nse  to 
the  question  by  present-day  readers  as  to  the  former 
position  of  the  recipient  of  this  posthumous  honour. 
We  may  anticipate  this  by  stating  that  Dr.  Young, 
who  died  in  1829,  was  an  eminent  physician  and  a 
very  acute  Egvptologist.  He  deciphered  the  hiero- 
glyphic inscriptions  on  the  famous  Rosetta  stone,  now 
in  the  British  Museum  ;  he  was,  moreover  in  his  day 
an  accepted  authority  and  author  of  several  works  on 
medical  and  scientific  subjects. 


Correepon&ence. 


Spectal  correepoitoence. 

[from  our  own  correspondent.] 

BELFAST. 
The  Board  of  Guardians  and  Medical  Matters. 
—In  a  discussion  on  their  financial  affairs  at  tneir 
last  meeting,  the  Belfast  Guardians  had  before  them 
some  interesting  statistics  of  the  medical  work  done 
under  the  Board.  In  the  infirmary  and  hospital 
there  are  1,600  beds  in  constant  use,  with  four  resident 
and  four  visiting  doctors.  The  cases  treated  last  year 
were  14.250,  at  a  cost  of  £1,926  for  medicines  and 
appliances,  as  against  4.693  in  *9°2>  before  the  special 
inquiry  into  the  cost  of  medicines  and  appliances  was 
held.  There  are  also  ten  dispensaries,  fifteen  medical 
officers,  and  five  relieving  officers.  The  number  of 
tickets  issued  in  1903  was  45. 0°°  and  200,000  prescrip- 
tions were  made  up.  The  total  charges  of  these 
dispensaries,  with  salaries,  medicines,  and  vaccination 
fees,  were  £<;,888.  The  Board  received  a  gentle  snub 
from  the  Local  Government  Board  over  the  use  of 
igazol,  which  they  wished  to  experiment  with  on  their 
consumptive  cases,  thanks  to  the  advice  of  some  enter- 
prising medical  man  to  some  members  of  the  Board. 
The  Local  Government  Board  wrote  that  as  the 
General  Medical  Council,  representing  the  views  of  the 
medical  profession,  had  not  thought  fit  to  include  this 
drug  in  the  British  Pharmacopoeia,  they  much  doubted 
the  wisdom  of  the  guardians  in  incurring  the  expense 
of  the  purchase  of  it.  A  discussion  on  the  proposed 
consumptive  sanatorium  took  place,  but  was  chiefly 
devoted  to  efforts  to  disabuse  the  public  mind  of  the 
idea  that  some  of  the  guardians  have  tried  to  do  a  little 
business  in  landed  property  in  connection  with  it. 

Prosecution  under  the  Pharmacy  Act. — At  the 
Petty  Sessions  at  Templepatrick,  co.  Antrim,  last  week 
a  grocer  was  prosecuted  for  selling  laudanum.  It 
appears  that  he  sold  it  without  any  special  label  or 
precaution  at  twopence  an  ounce.  The  defence  was 
that  he  did  not  know  he  was  doing  any  harm,  and  had 
not  sold  much  of  it.  He  was  fined  £$  and  costs  for  each 
of  two  offences. 


[We  do  not  hold  oune'ves  responsible  for  the  opinions  of  J  our  Cor- 
respondents.] 


D  EBATE  ON  THE  DANGERS  OF  PESSARIES. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — The  report  in  your  issue  of  May  25th  of  my 
remarks  made  at  the  last  meeting  of  the  British  Gynaeco- 
logical Society  so  far  misrepresents  my  statement  and 
views  that  I  feel  sure  you  will  kindly  grant  me  space 
to  correct  any  misapprehension  which  might  arise 
therefrom. 

What  I  did  say  was  that  an  S  pessary  did  not  come 
in  contact  with  the  fundus,  and  therefore  did  not,  as 
stated  by  most  writers  upon  the  subject,  push  up  and 
forward  the  fundus  of  a  retroverted  uterus.  Of  course, 
I  assumed  that  no  man  would  put  in  a  pessary  for 
retroversion  until  he  had  replaced  the  fundus.  That 
the  action  of  an  S  pessary  is  to  raise  the  vault  of  the 
posterior  cul  de  sac  and  thereby  draw  backwards  the 
cervix,  to  raise  the  floor  of  Douglas's  pouch,  and  thus, 
by  lessening  the  curve  therein,  to  lengthen  the  antero- 
posterior diameter  of  that  pouch,  whereby  the  back 
traction  on  the  fundus  is  lessened,  to  push  back  by 
means  of  the  convex  surface  of  the  upper  end  of  the 
pessary  the  posterior  vaginal  wall  and  correspondingly 
draw  backwards  the  anterior  wall,  and  as  the  lower 
end  of  the  anterior  wall  is  prevented  from  rising  by  the 
lower  end  of  the  pessary,  the  drawing  backwards  of 
the  upper  end  of  the  anterior  wall  of  the  vagina  draws 
down  the  anterior  vault  and  with  it  the  anterior  surface 
of  the  uterus,  the  lessening  of  the  backward  tension 
of  Douglas's  pouch  and  the  drawing  downwards  of  the 
anterior  cul  de  tac  being,  in  my  opinion,  the  chief  factors 
which  enable  an  S  pessary  to  retain  the  uterus  in  its 
normal  position.  Therefore  it  follows  that  an  ill-fitting 
pessary  or  a  pessary  in  an  abnormally  relaxed  vagina 
fails  to  give,  the  relief  sought. 

I  am,  Sir,  yours  truly, 

Robert  Hugh  Hodgson. 

Peckham  Rye,  May  27th,  1904. 


PALMAM  QUI  MERUIT  FERAT. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — Is  it  possible  that  "  Ignoramus  "  can  have 
read  my  letter  ?  He  says  :  "  As  I  understood  it,  he 
suggested  that  he,  not  Lord  Lister,  deserved  to  bear  the 
palm  for  the  advance  in  surgical  practice  known  as 
Listerism."  I  have  no  desire  to  claim  anything  of  the 
kind,  for  Listerism  is  as  dead  as  Queen  Anne,  and 
"  Ignoramus  "  does  no  honour  to  Lister  by  reviving 
this  question.  What  I  did  say,  and  have  proved,  is 
that  Lord  Lister  has  no  claim  to  the  so-called  "aseptic" 
system  in  surgical  practice — which  is  a  totally  different 
thing.  There  is,  therefore,  no  need  that  I  should 
further  justify,  and  certainly  not  withdraw,  my  "  co- 
lossal order  "  for  fair  play. 

But  I  do  not  expect  fair  play  on  the  part  of  "  Igno- 
ramus." for  he  isolates  a  sentence  from  its  context, 
which  made  my  meaning  clear  at  the  time  he  refers 
to. 

If  you  will  be  good  enough  so  grant  me  space  I  will 
re-state  the  argument  in  as  few  words  as  possible. 
I  pointed  out  that  the  word  "  germ  "  was  misused,  in 
the  sense  of  the  fully-developed  microbe  (the  proper 
word),  for  I  presumed  that  these  microbes  underwent 
a  certain  amount  of  development  from  the  "  germ  "  or 
seed,  and  did  not,  like  Topsy,  come  in  the  world  fully 
fledged,  and  j-imply  "  growed."  It  was  of  the  primary 
stage  of  these  microbes  that  I  was  treating,  and  there- 
fore said  no  one  had  ever  seen  a  germ,  and  if  he  did 
believe  in  germs  he  had  no  means  of  proving  then- 
presence  or  absence  in  the  course  of  an  operation.'* 

In  this  matter  my  views  have  undergone  no  change 
since  1 896.  Nor  have  I  ever  departed  from  the  practice 
of  signing  my  name  to  whatever  views  I  have  desired 
to  express.  I  despise  the  man  who  has  not  "  the 
courage  of  his  opinions,"  even  regarding  it  as  a  cowardly 
act  to  make  an  attack  on  anyone  over  a  nom  de  plume. 

Whatever     •"  Ignoramus "      may     think     of     my 


5Q8     The  Medical  Press. 


MEDICAL  NEWS. 


"  writings,"  they  have  at  least  gained  me  the  Hon. 
Fellowship  of  a  good  round  half-dozen  societies,  which 
1  prize  much  more  than  I  should  even  the  good  opinion 
•of  "  Ignoramus." 

I  am,  Sir,  yours  truly, 

Geo.  Granville  Bantock. 
May  27  th,  1904. 

Xtterature. 


•LINDSAY'S    DISEASES    OF    THE    LUNGS    AND 
HEART,  (a) 

Dr.  Lindsay  tells  us  in  his  preface  that  we  owe  this 
book  to  a  desire  expressed  by  his  former  pupils  to  have 
his  teaching  in  a  permanent  form,  and  we  wish  at  the 
outset  to  tender  our  thanks  to  his  pupils  for  the 
admirable  book  which  is  the  result  of  this  wish.  We 
welcome  it  not  only  for  the  large  amount  of  valuable 
information  which  it  contains,  but  also  as  an  expression 
of  the  teaching  of  the  School  of  Medicine  of  Belfast. 

The  twenty-one  lectures  of  which  the  book  is  com- 
posed naturally  fall  into  three  groups,  dealing  re- 
spectively with  the  theory  and  method  of  clinical  ob- 
servation in  general,  with  tae  application  of  this  method 
to  the  diseases  of  the  lungs  and  diseases  of  the  heart, 
with  some  observations  on  the  treatment  of  these  con- 
ditions. The  introductory  chapters  on  the  method  of 
clinical  observation  will  prove  of  particular  value  to 
the  student,  and  the  more  so  because  this  very  import- 
ant subject  is  usually  neglected  in  the  ordinary  text- 
book, and  is  of  too  general  a  nature  to  lend  itself 
readily  to  elaboration  at  the  bedside,  yet  it  forms  the 
groundwork  of  all  clinical  investigation. 

The  author  next  proceeds  to  describe  and  explain 
the  processes  adopted  in  the  physical  examination  of 
the  lungs  and  pleura.  The  difficult  subjects  of  per- 
cussion and  auscultation  are  described  and  explained 
in  detail.  The  difficulty  which  the  student  experiences 
in  grasping  the  intricacies  of  terminology  in  both  these 
methods  of  investigation  are  well  known,  and  we  agree 
with  West  in  thinking  that  the  difficulty  is  one  of 
words  only. 

The  mind  becomes  confused  between  the  multitude 
of  terms — terms,  too,  which  are  not  always  used  with 
the  same  meaning  by  different  authors.  The  con- 
fusion becomes  more  aggravated  when  the  physical 
signs  described  by  these  terms  are  directly  interpreted 
as  indicating  pathological  conditions.  All  the  varia- 
tions in  quality  in  the  sounds  elicited  both  by  per- 
cussion and  auscultation  can  be  demonstrated  in  the 
normal  chest,  and  it  is  only  when  these  normal  sounds 
are  heard  in  abnormal  places  that  they  become  of 
pathological  significance.  We  fail,  however,  to  find  in 
the  work  before  us  a  clear  statement  of  this  important 
fact,  and  its  absence  appears  to  us  to  detract  consider- 
ably from  the  value  of  this  part  of  the  work  from  a 
teaching  point  of  view.  The  lectures  dealing  with 
pleurisy,  with  the  diagnosis,  prognosis  and  treatment 
of  pulmonary  phthisis,  are  admirable  both  from  the 
point  of  view  of  the  student  and  practitioner.  With 
regard  to  the  question  of  asthma,  Dr.  Lindsay's  ex- 
perience appears  to  differ  from  that  of  many  modern 
•observers.  He  says  :  "I  have  seen  nothing  to  con-  1 
vince  me  that  asthma  of  the  classical  type  is  ever  due  to  \ 
nasal  or  pharyngeal  causes,  or  is  ever  cured  by  opera-  [ 
tion."  Such  a  statement  is  1  ardly  consistent  with  the 
'experience  of  modern  nose  and  throat  specialists,  and 
we  believe  that  anyone  who  neglected  in  a  case  of 
asthma  to  have  his  patient's  naso-pharynx  properly 
'examined  as  a  preliminary  to  treatment  would  be 
guilty  of  negligence. 

The  last  eight  lectures  in  the  book  deal  with  the 
'examination  of  the  heart  and  the  diagnosis,  prognosis 
and  treatment  of  cardiac  affections.  With  regard  to 
these  chapters,  we  have  nothing  but  praise  to  give  ; 
•thev  are  -admirable  in  their  clearness  and  filled  with 


June  i,  1904. 


sound  and  practical  clinical  observations.  The  illus- 
trative cases  which  are  given  as  diagnostic  problems 
in  Lecture  XIX  are  most  useful,  and  would  be  of  more 
help  to  a  student  in  his  estimation  of  a  case  than  many 
pages  of  mere  clinical  description. 

•MANUAL  FOR  STUDENTS  OF  MASSAGE,  (a) 
Massage  cannot  be  taught  by  mere  book  instruction, 
but  such  a  work  as  that  of  Miss  Ellison's  is  capable  of 
affording  much  information  regarding  the  principles  of 
the  procedures  and  valuable  suggestions  relating  to  the 
practice  of  the  art.  The  first  sixty-eight  pages  deal  with 
elementary  anatomical  and  physiological  points.  Only 
two  chapters  are  devoted  to  practical  massage.  Sepa- 
rate sections  deal  with  Weir-Mitchell  treatment  and 
the  so-called  Swedish  system.  A  tabular  list  is  given 
of  the  more  important  muscles.  There  are  numerous 
diagrams,  but,  strange  to  say,  none  of  thern  illustrate 
the  actual  methods  of  modern  massage.  Dr.  H.  N. 
Hulbert  contributes  an  appreciative  preface  and  the 
book  is  dedicated  to  Mrs.  Mary  Scharlieb,  M.D. 

TROPICAL  DISEASES,  [b) 
Sir  Patrick  Manson's  manual  may  well  take  rank 
as  a  classic.  It  is  beyond  reach  of  reviewer's  praise  or 
blame.  As  the  work  ot  a  scientific  pioneer  it  stands 
unrivalled.  It  is  peculiarly  suited  to  the  needs  of  the 
hour.  The  first  edition  appeared  in  1898,  but  since 
that  date  the  development  of  tropical  medicine  has 
been  phenomenal.  Much  advance  in  knowledge  has 
been  made.  All  important  discoveries  are,  however, 
dealt  with  in  this  new  and  thoroughly  revised  edition. 
No  practitioner's  library  can  be  considered  complete 
without  this  work,  and  no  medical  man  called  upon  to 
face  disease  in  foreign  climes  can  afford  to  exclude  this 
manual  from  his  armamentarium. 


©bttuars* 


PROFESSOR  ETIENNE  JULES  MAREY. 
The  death  is  announced  of  Etienne  Jules  Marey, 
Professor  of  Natural  History  at  the  College  de  France, 
and  doyen  of  the  Medical  and  Surgical  Section  of  the 
Academy  of  Sciences,  and  of  the  Anatomical  and 
Physiological  Section  of  the  Academy  oi  Medicine. 
M.  Marey,  in  1878,  replaced  Claude  Bernard  as  Pro- 
fessor at  the  College  de  France.  His  scientific  work 
was  great  and  varied.  He  will  be  remembered  as 
the  inventor  of  the  sphygmograph,  which  records  the 
pulsations  of  the  heart  and  of  the  respiratory  functions. 
The  methods  of  taking  instantaneous  and  successive 
photographs  to  show  the  flight  of  birds,  the  galloping 
of  horses,  &c,  were  first  studied  by  him,  and  he  was 
one  of  the  originators  of  the  cinematograph. 


AeMcal  Hews. 


The  Medical  and  Hygienic  Eihibi  on  Association. 

The  annual  display  of  this  Association  was  held  last 
week  in  London  at  the  Queen's  Hall,  but  whether  it  be 
that  the  medical  profession  have  had  a  surfeit  of 
exhibitions  or  that  exhibitors  do  not  find  them  re- 
munerative is  a  question  we  are  not  called  upon  to 
decide,  but  the  fact  is  indisputable  that  they  do  not 
attract  as  formerly,  and  that  at  this  the  latest  show  a 
considerable  amount  of  space  was  unoccupied,  and,  to 
be  candid,  there  was  very  little  that  was  new  to  attract 
medical  men.  One  of  the  few  exhibits  we  do  not  re- 
member to  have  seen  previously  was  that  of  the  Denver 
Chemical  Company,  Antiphlogistine,"  a  decidedly 
useful  antiseptic   absorbent,   which,   as  explained  in 


(a) 


Diseases  of  the    Lungs    and    Heart.    Lectures, 


'Lindsay's    _.   .  _.    

.chiefly  Clinical  and  Practical  on  Diseases  of  the  Lungs  and  Heart." 
By  Alexander  Lindsay,  M.D.,  F  R.CP.LondM  Professor  of  Medicine 
•Queen's  College,  Belfast.    Pp.  viii.  and  447.    ~ 
.London :  Baillere,  Tindall  and  Cox. 


Demy  8vo.    9s.  net. 


(a)"A  Manual  tor  Student*  of  Massage."  By  Mary  Anne  Ellison. 
Member  of  the  Incorporated  Society  of  Trained  Masseuses.  8econd 
Edition,  revised  bv  Gulielma  Manley1.     Pp.  xii.  and  12«.  and  50  illut- 

j  tration*.  Demy  Svo  London:  Bailliere  Tindall  and  Oox.  1904. 
Price  3s.  6d.  net.  _, 

(b)  "  Tropical  Diseases :  A  Manual  of  the  Diseases  of  Warm  Cli- 
mates." Bv  Patrick  Manson.  O.M.O.,  M.D..  LL  D  ,  F.R.C.P.,  F.R.&, 
Ac.  Pp.  756,  with  130  illustrations  and  two  coloured  plates.  New 
and  lie  vised  Edition.    London :  Cassell  and  Co;    1003.  Price  10s.  6d. 

*  ner. 


June  i.  1904. 


MEDICAL   NEWS. 


Thb  Medical  Press.     599 


these  columns  in  October  last,  exerts  peculiarly  ano-  I  the  dinner  a  smoking  concert  was  provided  for  the 
dyne  effects,  tending  to  promote  the  subsidence  of  local  I  Fellows  in  the  King's  Room,  by  the  President,   Dr. 

inflammatory  mischief ,  with  relief  of  pain  and  swelling,     ***---««•-- »~«  *  ■« 

and  with  a  minimum  of  trouble  in  application.  Another 
novel  exhibit    was    that    of    Somnoform,    by  Messrs. 


De  Trey  and  Company,  the  invention  of  Dr.  Rolland 
Dean   of    the    Bordeaux    Dental    School,    which    is 
claimed  to  be  "  the  quickest,  most  simple,  and  safest 
of  all  general  anaesthetics,"  an  original  paper  on  which 
appeared  in  these  columns  a  few  weeks  since.     There 
were  also  some  novelties  in  physical  therapy,  such  as 
Messrs.   Cox's  display  of  X-ray  and  high  frequency 
electric  apparatus,  the  Dowsing  Company  with  their 
radiant    electric   heat    appliances,    and    the    Marconi 
Wireless  Telegraph  Company,  with  several  improved 
X-ray  and  high  frequency  apparatus,  a  tube  shield  as 
a  safeguard  for  both  patient  and  operator,  and  an 
X-ray    hospital    ward    trolley.     The    great    bulk    of 
exhibits  were,  however,  those  of  old  friends,  especially 
of  foods  and  mineral  waters,  needing  no  fresh  descrip- 
tion.    The  former  were  represented  by  Bovril,  Lemco, 
and  Oxo,  Hovis  Bread,  Plasmon,  Robinson's  Barley 
and     Groats,    Maltico,    Maltova,    Manhu,    Marraite, 
Mellin's  Food  for    Infants  and   Invalids,   and  Food 
Biscuits,   Nestle's  Food,   Condensed   Swiss  Milk  and 
Viking  "Milk  (condensed  milk  without  sugar),  Protene 
preparations,  Shredded  Wheat,  Van  Abbott's  Diabetic 
Bread  and  Biscuits,  Virol,  &c,  constituting  altogether 
a  widely  diversified  catalogue  of  dietetics  for  the  choice 
of    medical   men    in   dealing   with   a   chameleon-like 
clientele  of  patients.     Of  mineral  waters,  the  variety 
was  almost  as  great,  the  lead  being  taken  by  Messrs. 
Ingram  and  Royle  with  Vichy,  Carlsbad,  &c. ;    Oppel 
and    Company    with    the    well-known    Friedrichshali 
Natural  Aperient  Water ;    Idris  and  Company  with 
several   attractive   sparkling    table-waters ;     Camwal, 
Limited,   with   Fontalis,    a    Harrogate   natural    table 
water,    fruit    syrups,    &c.     The    surgical    instrument 
department  was  poorly  represented.     Of  medical  books 
there  were  but  few,  and  these  mostly  of  American 
origin.     Messrs.  Parke,  Davis  and  Company,  Messrs. 
Burgoyne,    Burbidge,    and    Company,     and    Messrs. 
Newbtry  and   Sons    made  a  good  show  as  manufac- 
turing chemists.        J  eyes'  Sanitary  Compounds  Com- 
pany,  with   "  Cyllin "    (the   new   name   for    creolin), 
J  eyes'   Disinfectant   Powder  and  Soaps,   and  Messrs. 
Newton,  Chambers  and  Company,   with   "  Izal,"   re- 
presented the  world  of  disinfectants ;   whilst  clothing 
was  exhibited  by  the  Cellular  Company,  which  had  an 
interesting  display  of  their  new  Aertex  underwear,  the 
use  of  which,  especially  in  hot  weather,  is  a  decided 
advance  in  the  therapeutics  of  health. 

British  Balneological  Society. 
A  general  meeting  of  this  Society  was  held  at 
No.  20  Hanover  Square,  London.  W.,  on  Wednesday, 
May  18th,  the  President,  Dr.  Alfred  F.  Street  (West- 
gate)  in  the  Chair.  The  officers  and  council  for  the 
ensuing  session  were  elected,  the  President  Elect  being 
Dr.  Bowen  Da  vies,  J. P.,  of  Llandrindod  Wells.  The 
report  of  the  Council  was  read,  and  showed  the  flourish- 
ing condition  of  the  Society,  the  Fellows  now  numbering 
about  400.  Sir  Hermann  Weber,  M.D.,  F.R.C.P.,  was 
elected  the  Honorary  President  of  the  Society  in  suc- 
cession to  the  late  Sir  Edward  Sieveking,  who  had 
acted  as  Honorary  President  since  the  foundation  of 
the  Society  in  1895.  Sir  Dyce  Duckworth  then  gave 
an  address,  entitled  "  Observations  on  British  Winter 
Resorts,"  which  proved  of  great  interest  to  the  Fellows, 
and  will  be  published  in  the  Journal  of  Balneology  and 
Climatology.  On  the  same  evening  the  annual  dinner 
of  the  Society  was  held  at  the  Criterion  Restaurant. 
Dr.  Wm.  V.  Snow  (Bournemouth)  proposed  the  toast 
of  the  guests,  to  which  Sir  Dyce  Duckworth  responded. 
Sir  Hermann  Weber,  in  proposing  the  toast  of  the 
Society,  referred  to  the  excellent  work  it  had  accom- 
plished in  the  past,  and  spoke  in  high  terms  of  praise 
of  British  health  resorts,  at  the  same  time  intimating 
the  necessity  for  still  further  improvements  in  some 
of  the  towns,  especially  with  regard  to  simple  amuse- 
ments, in  order  that  they  may  compare  favourably 


Alfred  Street.     The  next  meeting  of  the  society  will  be 
held  in  October. 

Royal  College  of  Surgeons,  Ireland. 
The  authorities  of  the  College  have  recently  adopted 
the  following  regulations  for  academical  costume  : — 
The  general  body  of  the  Fellows  are  authorised  to  wear 
a  black  stuff  master  of  arts  gown,  faced  with  a  St. 
Patrick's  blue  Irish  poplin  border,  five  inches  in  width, 
narrowing  round  the  collar  behind,  and  extending  to 
each  end  of  the  gown  in  front.  Inside  of  the  blue 
poplin  there  shall  be  a  crimson  Irish  poplin  lining,  five 
inches  in  width,  and  of  similar  extent  as  the  blue.  A 
black  velvet  college  cap,  with  St.  Patrick's  blue  and 
crimson  tassel.  This  gown  and  cap  may  be  worn  at 
all  public  functions,  college  ceremonials,  State  and 
civic  public  meetings,  and  on  all  occasions  when 
academical  costume  is  worn  by  the  general  body  of 
the  Fellows  of  the  Royal  Colleges  of  Surgeons  of 
England  and  Edinburgh. 

The  general  body  of  the  licentiates  are  authorised 
to  wear  a  black  stuff  master  of  arts  gown,  faced  with 
a  St.  Patrick's  blue  Irish  poplin  border,  two  inches  in 
width,  not  extending  round  the  collar  behind,  but  con- 
tinuing to  each  end  of  the  gown  in  front.  Inside  of  the 
blue  poplin  there  shall  be  a  crimson  Irish  poplin  lining, 
two  inches  in  width,  and  of* similar  extent  as  the  blue. 
A  black  cloth  college  cap  with  black  tassel.  This  gown 
and  cap  may  be  worn  at  all  public  functions,  and 
college  ceremonials,  as  before  mentioned. 
Army  Medical  Militia. 
A  partial  reorganisation  of  the  Royal  Army  Medical 
Corps  (Militia)  has  been  decided  on.  In  future  the 
2nd  South-Eastern  District  Company  will  be  known  as 
the  Thames  District  Company,  with  headquarters  at 
Chatham.  The  1st  South-Eastern  District  Company 
will  become  the  South-Eastern  District  Company,  the 
headquarters  being  at  Dover  instead  of  Aldershot. 
The  Southern  District  Company  will  have  its  head- 
quarters at  Portsmouth  instead  of  at  Netley. 

Society  for  the  Relief  of  Widows  and  Orphans  or  Medical 
Men. 


At  the  annual  general  meeting  of  this  Society  held 
last  week  under  the  presidency  of  Mr.  Christopher 
Heath,  F.R.C.S.,the  report  read  by  the  secretary  showed 
that  twelve  new  members  had  been  elected  in  1903, 
four  had  died  and  three  resigned,  leaving  297  members 
at  the  end  of  the  year.  Two  widows  had  been  elected, 
and  three  had  died,  fifty-three  were  in  receipt  of  grants 
at  the  end  of  the  year.  Six  orphans  had  been  granted 
assistance,  one  had  become  ineligible,  leaving  fifteen 
receiving  grants.  A  sum  of  £3,308  10s.  had  been  dis- 
tributed in  1903.  The  expenses  of  the  year  were 
£244  1  os.  9d.  The  receipts  available  for  payments 
had  been  £3.302  is.  iod.,  a  deficit  of  £251  17s.  ud. 
on  receipts  and  payments,  owing  to  change  of  invest- 
ments and  half  a  year's  interest  only  paid  on  the  new 
stock.  A  small  legacy  of  £25  had  been  received.  A 
vote  of  thanks  to  the  Editors  of  the  medical  journals 
was  passed  unanimously.  The  following  gentlemen  were 
elected  to  fill  the  vacancies  in  the  court  of  directors  : 
Mr.  A.  W.  Green,  Mr.  E.  G.  C.  Snell,  Mr.  E.  H.  May, 
Dr.  C.  Godson,  Mr.  W.  J.  N.  Bell,  Dr.  W.  C.  James,  and 
Dr.  Samuel  West. 

Trinity  College,  Dublin. 

The  following  list  of  candidates  passed  the  final 
examination  in  midwifery,  Trinity  Term,  1904 : — 
James  G.  Wallis,  Arthur  W.  Goldsmith,  Robertson  S. 
Smyth.  Wilfrid  Thunder.  John  A.  Sibthorpe,  William  J. 
M'lvor,  Washington  P.  Tate,  Charles  E.  Fawcett, 
Wright  Mitchell,  Gerrard  A.  Crowley.  B.A.O.  Degree  : 
Robert  Moore. 

Conjoint  Board  In  Ireland. 

Thb  following  candidates  have  passed  the  examina- 
tion for  the  Diploma  in  Public  Health : — G.  H.  Car- 
rington,  M.R.C.S.  (honours).  Major  S.  F.  Clark,  M.B.  ; 
P.  A.  MacDermott,  F.R.C.S.I.  ;  B.  M.  M.  Coffey, 
L.R.C.P.     and      S.I.  ;      W.   G.    Jordan,    M.B.R.U.I.  ; 


with  certain  foreign  spas  and  watering  places.     After  '  J.  F.  Hodgson,  M.B.,  ;   F.  W.  Martin,  M.R.C.S. 


6<x>    The  Medical  P«ess.      NOTICES  TO  CORRESPONDENTS. 


r  June  i,  1904. 


JUrtixee  to 
(Eorrtspmt&ettts,  $Itort  %ttttx&,  &r. 

1*9*  OoJtawroifDiiiTS  requiring:  a  reply  in  this  oohimn  are  partlcu 
'lariy  requested  to  make  use  of  a  distinctir*  8igndtwrt  or  initial,  and 
avoid  the  practice  of  signing  themselves  "Reader,"  "Subscriber/ 
•  Old  Subscriber,"  6c  Much  confusion  will  be  spared  by  attention 
o  this  rule. 

Orioinal  Articles  or  Lbttrrs  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

Contributors  are  kindly  requested  to  send  their  communications, 
if  resident  in  England  or  the  Colonies,  to  the  Editor  at  the  Losslpn 
office ;  if  resident  in  Ireland,  to  the  Dublin  office,  in  order  to  save  time 
in  re-forwarding  from  office  to  office.  When  sending  subscriptions 
the  same  rule  applies  as  to  office ;  these  should  be  addressed  to  the 

Publisher. 

WAR  MEDALS  FOR  SURGEONS. 

We  are  asked  *>y  the'  War  Office  to  announce  that  a  number  of  war,, 
medals  for  civil  surgeons  who  served  with  troops  during  the  cam- 
paign in  South  Africa  are  awaiting  claimants,  but  cannot  be 
forwarded  as  the  present  addresses  of  the  gentlemen  to  whom  they 
have  been  awarded  are  unknown.  Civil  Surgeons  who  have  not 
received  their  medals  are  requested  to  make  application  to  the 
Secretary,  War  Office,  68  Victoria  Street,  Westminster. 

Me.  Ht.  Sbwill'8  letter  is  unavoidably  held  over,  owing  to  pres 
sure  on  our  space  by  reports  of  the  General  Medical  Council. 

A  Cobvalbscbbt.— Buxton  will  be  the  best  place  for  you  to 
recoup  after  your  severe  attack.  Its  air  is  decidedly  bracing,  and  the 
little  town  and  surrounding  country  offer  many  attractions  to 
visitors.  Moreover,  it  is  governed  by  sn  intel  igent  and  broad- 
minded  Council,  which  spares  no  effort  to  make  the  soloutn  of 
invalids  and  residents  alike  as  agreeable  and  healthy  as  possible. 

Liverpool  Studbmt.— We  know  of  no  book  answering  the  exact 
requirement.  The  neaiest  approach  is  "The  After  Treatment  of 
Operations,"  by  Mr.  Mummery. 

Erratum.— The  word  "  Homeric,"  in  the  last  paragraph  of  Dr. 
Pearse's  Paper  on  Immunity,  which  appeared  in  our  last  issue, 
should  have  read  "  Isomeric/' 

THE   BOLINGBROKE  PAT-HOSPITAL. 
To  the  Editor  of  the  Mbdical  Pbjess  axd  Circular. 

Sir,— 1  am  instructed  by  the  Council  of  the  South- West  London 
Medical  Society  to  forward  you  the  following  resolution  passed  by 
them  to-day  :— That  having  seen  the  adverse  opinion  recently  passed 
on  Bolingbroke  Hospital,  the  Council  of  the  Society  would  like  to 
take  this  opportunity  of  expressing  their  appreciation  of  the  atten- 
tion and  treatment  the  patients  receive  from  the  medical  officers  and 
matron. 

I  am,  Sir,  yours  obediently, 

M.  Mackintosh,  Hon.  Sec 

Cum  Gbavo  Saxis.— The  newspaper  cutting  you  enclose  as  news, 
having  your  strong  disapproval,  is  an  advertisement,  pure  and 
simple,  of  the  Institution,  cleverly  worded  to  avoid  detection. 
When  the  highest  class  newspapers  insert  paid  paragraphs  of  this 
nature,  the  abbreviated  word  "  advert."  is  usually  placed  at  the  end, 
and  to  this  there  can  be  no  objection,  considerable  latitude  of  de- 
scription and  expression  being  accorded  to  advertisers  in  the  public 
press.  We  would  suggest  that  you  communicate  your  views  to  the 
editor  of  the  paper  in  question :  it  might  have  for  effect  the  discon- 
tinuance of  the  reprehensible  practice. 

Mr-  E.  Wilsoh.— The  gentleman  referred  to  is  not  a  doctor  of 
medicine,  but  holds  the  hon.  degree  of  Ph.D. 

Jfeethtgs  of  the  Societies,  $tcture0,  &c. 

Wednesday,  June  1st. 

Obstetrical  Soctxty  or  Loudon  (20  Hanover  8quare.  W.).— 8  p.m. 
Specimens  will  be  shown  by  Dr.  Lockyer,  Mr.  Bland-Sutton,  end  Dr. 
H.  R.  Spencer.  Short!  Communication  :— Dr.  J.  M.  M.  Kerr:  Cer- 
tain Details  regarding  the  Operation  of  Ceesarean  Section  in  Cases  of 
Cootracted  Pelvis  based  on  a  Series  of  26  Cases.  Papers  :— Dr.  T.  W. 
Eden :  A  Case  of  Primary  Hydatid  Disease  (Echinocooous)  of  she 
Fallopian  Tube.— Dr.  C.  J  CuWngworth  and  Mr.  H.  H.  Clutton  : 
Notes  on  a  Case  of  Hydatids  of  Both  Ovaries,  Bight  Broad  Ligament, 
Liver,  Omentum,  Mesentery,  and  Other  Parts. 

Mbdical  Graduatm'  Collsob  and  Polyclinic  (22  Chenies  Street, 
W.C.).-4p.m.    Mr.  P.  J.  Frayer :  Clinique.    (Surgical.)    5.15  p.m. 
Dr.  C.  O.  Hawthorne  :  Pulse  Tracings  and  their  Clinical  Significance. 
Thursday,  Juhb  2nd. 

ROKTOBV  80CIETT  (20  Hanover  Square,  W  ).— 8.30  p.m.  Paper  : 
Dr.  C.  A.  Wright :  Experiments  to  Determine  the  Effects  of  Form 
and  Winding  upon  Resonance  Phenomena. 

Mbdical  Graduates'  College  axd  Polyclinic  (22  Chenies  Street, 
W.C.).— 4  p.m.  Mr.  Hutchinson :  Clinique.  (8urgical.)  5.15  p.m. 
Dr.  C.  0.  Hawthorne  :  Pulse  Tracings  and  their  Clinical  Signifi- 
cance. 

Mount  Vxrnow  Hospital  for  Consumption  and  Disbasbs  or  thb 
Chbbt  (7  Fitsroy  Square,  W.)— 5  p.m.    Dr.  G.  Johnston  :  Nervous 
Affections  of  the  Respiratory  System.     (Prst-Graduate  Course.) 
Friday,  Junb  3rd. 

Wbst  London  Medico-Chi  surgical  Society  (West  London  Hos- 

Sital,  Hammersmith,  W.).-  8.30  p.m.    Papers :— Mr.  J.  J.  Clarke  : 
biects    and    Limits    of    the  Surgical  Treatment    of     Paralytic 
Deformities.— Dr.  C.  H.  Fennell. 

Larthoological  Society  or  London  (20  Hanover  Square,  W.).— 
b  p.m.  Cases  and. Specimens  will  be  shown  by  Dr.  StCUir  Thomson, 
Mr.  Wsggett.  Dr.  Kelson,  Mr.  C.  Baber,  Dr.  S.  Spioer,  Dr.  A.  B. 
Kelly  and  others. 


Mbdical  Graduates'  Collxob  and  Polyclinic  (22  Chenies  Street* 
W.C. X— 4  p.m.    Mr.  L.  Paton:  Clinique,    (Eye.) 

Bradford  Boyal  Infirmary. -Dispensary  8urgeon.  Salary  £100  per 
annumjjrith  board  and  residence.    Applications  to  WQham 

Brighton,  Hove,  and  Preston  Dispensary.— House  Surgeon.  8alary 
£160  per  annum,  furnished  rooms,  coals,  gas.  and  attendance. 
Applications  to  C.  Somen  Clarke,  Hon.  Secretary,  113  Queen's 
Road,  Brighton.  ^ 

City  of  London  Hospital  for  Diseases  of  the  Chest,  Victoria  Park, 
E.--Pathologist.  Salary  £110  per  annum.  Applications  to  H. 
Dudley  Ryder,  becretary. 

Derbyshire  Royal  Infirmary.— Resident  House  Surgeon.  8a!sry 
£100  per  annum,  with  apartments  and  board.  Applications  to 
Walter  G.  Carnt,   Secretary-Superintendent,  Royal  Infirmary, 

District  fcunatic  t Asylum,  Ballinasloe.— Assistant"  Medical  Officer. 
Salary  £140  per  annum,  with  cash  allowance  of  £52  in  lieu  of 
rations,  Ac.  Applications  to  J.  St.  L.  Kirwan,  Resident  Medical 
Superintendent     (See  Advt.) 

Ebbw  Vale  Steel,  Iron,  and  Coal  Co.,  Limited  —Resident  Medical 
Man  (F.R.C.8.).  Salary  ££00  per  annum.  Excellent  prospects. 
Applications  to  the  Secretary. 

Kent  and  Canterbury  Hospital.— A  House  Physician.  Salary  £100  a 
year,  with  board  and  lodging.  Applications  to  J.  Lancaster, 
Secretary. 

Parish  of  Birmingham.— Workhouse  Infirmary.— Assistant  Resident 
Medical  Officer.— Salary  £104  per  annum,  withffurnished  apart- 
ments, rations,  coal,  gas,  laundry,  and  attendance.  Applications 
to  Charles  Fletcher,  Clerk  to  the  Guardians,  Parish  Offices, 
Edmund  Street. 

Parish  of  Saint  Leonard,  Shoreditch.— Senior  Resident  Assistant 
Medical  Officer.  Salary  £160  per  annum,  with  rations,  furnished 
apartments,  ard  washing  in  the  Infirmary.  Applications  to 
Robert  Clay,  Clerk  to  the  Guardians,  Clerk's  Office,  213  Kings- 
land  Road. 

Perth  District  Asylum.  Murthly.— Assistant  Physician.  Salary  £1*0 
per  annum,  with  board,  apartments,  washing.  Ac  Applications 
to  Dr.  Bruce,  Murthly.  Perthshire. 

Rochdale  Infirmary.— Resident  Medical  Officer.  Salary  £100  per 
annum,  with  board,  residence,  and  washing.  Applications  to 
Henry  Booth.  Secretary.  68a    Yorkshire  Street,  Bochdsle. 

Royal  Free  Hospital,  Gray's  Ion  Road,  W.C. -Senior  Resident 
Medical  Officer.  8alary  £100  per  annum,  with  board,  residence, 
and  washing.    Applications  to  the  Secretary. 

Settlement  of  Women  Workers,  Canning  Town,  E.— Medical  Mission 
Hospital.— Senior  Resident  Medical  Officer.  Salary  £100  per 
annum.  Application  to  Hon.  Sec.,  Miss  C.  Spioer,  Montdair, 
Woodford.  Green.  K 

West  Riding  Asylum,  Wadsley,  near  Sheffield.— Fifth  Assistant 
Medical  Officer.— Salary  £140  per  annum,  with  board,  Ac. 
Application  to  the  Medical  Superintendent. 


JlppoitttmeniB. 

Brunton,  8ia  Laudbr,  F.R.S.,  Consulting  Physician  to  the  Infants' 

Hospital,  London,  N.W. 
Chastbl  ob  Boikvillb.  Vivian.  M.B.,  CK  B.Ed  In.,  Assistant  [Director 

of  Cancer  Research,  Liverpool  University. 
Clares,    J.     Jackson,    M.B.Lond.,    F.B.C.8.,    Surgeon    to    the 

North- West  London  Hospital. 
Macksmkue,  John  Alexander,  M.A..  M.B.,  Ch.B.Aberd..  Resident 

Medical  Officer  at  the  General  Infirmary,  Oldham. 
Siblxt,   W.  Knowslsy.  M.u.Camb.,  M.R.C.P.,  Physician  to  the 

North- West  London  Hospital. 
8utubrlaitd.  G.  A.,  M.  D.Ed  in.,  F.RX.P.Lond.,  Physician  to  the 

North-West  London  Hospital. 
Tsmplbton,     Gbobob,  M.B.Edin.,  F.RX.S.Eng.,  Surgeon  to   the 

North- West  London  Hospital. 
Wars,  A.  M..M  D.Oantab.,  Clinical  Assistant  to  the  Chelsea  Hos- 
pital for  Women. 


girths. 


Harrison.— On  May  25th,  at  8  Waterloo  Place,  Brighton,  the  wife  of 
William  W.  Harrison,  L.R.C.P.,  M.B.C.8.,of  a  son. 

Waklkt.— On  May  27th,  at  10  Hyde  Park  Gate,  8.  W.,  the  wife  of 
Thomas  Wakley,  Jun.,  of  a  son. 

Williams,— On  May  26th,  at  Holyrood  House,  Beckenham,  Kent,  the 
wife  of  J.  Lawson  Williams,  M.D.,  of  a  son. 

<fc>LLiBewooD- 8mith.— On  May  25th.  at  St.  Mildred's,  Lee,  Cape 
Percy  Hildebrand  CoUingwood,  R.A.M.C.,  eldest  son  of  the  kite 
Major-General  Clennell  Collingwood,  Royal  Artillery,  to  Ellen, 
eldest  daughter  of  Mr.  Charles  Smi'h,  the  Laurels,  Good  Easter. 

Ellis  Edwards.— On  May  25th,  at  Holy  Trinity,  Upper  Tooting, 
Clarence  Isadore  Ellis,  M.D.  and  C.M.Abeid.,  and  L.A.S.Lood., 
fifth  son  of  John  Frederick  Ellis,  of  Teignmouth,  Devon,  to  Mar- 
garet Edwards,  only  child  of  the  late  John  Edwards  and  Mrs. 
Edwards,  of  Mayfleld,  St.  Nicholas  Road,  Upper  Tooting. 

-Berths. 

D'Estxrrx.— On  May  26th,  at  her  residence,  6  Ulster  ITerrace, 
Stillorgan  Park,  county  Dublin,  Julia  Anne,  widow  of  the  late 
Arthur  Henry  D'Esterre,  M.D.,  Limerick,  and  daughter  of  the 
lace  Samuel  D'Esterre. 

Lynch.— On  May  26th,  at  Sudburv,  Suffolk,  Jane  Elisabeth,  w.dow 
of  John  Cox  Lynch,  M.R.C.8.,  and  daughter  of  the  late  Charles 
James  Beverly,  Surgeon  R.N.,  sged  78  years. 


Ih*  ®§dM  grttf   Mil   (fcwto*. 


"SALUS   POPULI   SUFREMA    LEX-1 


Vol,  CXXVIII. 


WEDNESDAY,    JUNE  8,    1904. 


No.   23. 


Original  Communications. 

PERITYPHLITIS   SIMULATING 
MALIGNANT    DISEASE-r 

COMPLETELY  RELIEVED  FOR  NINETEEN 
MONTHS  BY  LATERAL  ANASTOMOSIS- 
FOLLOWED  BY  ACUTE  APPENDICITIS 
ABSCESS— APPENDECTOMY— CURE. 

By    SEPTIMUS    SUNDERLAND,    M.D..    M.R.C.P., 

Physician,  Royal  Waterloo  Hospital   for  Children •  and   Women ; 

Ooetetric  Physician  to  the  French  Hospital,  London,  6c., 

AND 

H.  J.  CURTIS,  B.S.,  F.R.C.S., 

Surgeon  to  the  Memorial  Hospital,  Bulawayo ;  late  Assistant- 
Sargeon,  Royal  Waterloo  Hospital  for  Children  and  Women ;  aod 
Surgeon,  North-Eastern  Hospital  for  Children. 

The  patient,  a  hospital  nurse,  aet.  38,  was  admitted 
to  the  Royal  Waterloo  Hospital  for  Children  and 
Women  on  the  night  of  September  19th,  1901,  with  a 
temperature  of  ioi'6°  F„  and  a  tender  and  painful 
swelling  in  the  right  iliac  fossa. 

The  history  was  as  follows :— On  August  24th,  190 1, 
the  patient  began  night  duty  at  a  private  case.  Her 
weight,  including  clothes,  was  then  9  st.  6  lbs.  For 
two  or  three  months  there  had  been  some  tenderness 
and  discomfort  in  the  right  iliac  fossa  when  the  patient 
■  was  over-tired,  but  no  definite  pain  before  the  present 
*         attack. 

On  August  31st,  severe  cutting  pain  in  the  right  side 
came  on  suddenly,  with  diarrhoea  and  sickness.  The 
pain  became  worse  during  the  next  two  days,  and 
then  began  to  improve.  There  had  always  been  a 
tendency  to  constipation,  but  this  did  not  become 
worse  during  this  time  of  pain,  nor  had  it  been  more 
marked  recently.  The  pain  lasted  about  six  days, 
and  the  patient  had  a  loathing  for  food  and  noticed  she 
was  losing  flesh.  Between  August  24th  and  Septem- 
ber 16th,  she  actually  lost  a  stone  in  weight. 

After  a  few  days'  intermission,  on  September  15th 
the  pain  began  again,  was  very  acute,  and  gradually 
got  worse.  It  was  associated  with  some  elevation  of 
temperature. 

On  September  16th,  after  a  Seidlitz  powder  in  the 
morning,  there  was  an  action  of  the  bowels.  On 
completing  night  duty,  the  patient  went  to  bed,  and 
•rested  for  ten  hours.  Fomentations  were  applied,  and 
iodine  painted  over  the  abdomen.  Light  nourishment 
was  taken.  For  the  next  two  or  three  days  there  was 
a  good  deal  of  vomiting. 

On  September  17th,  two  grains  of  cascara  extract 
were  taken  without  effect.  On  going  to  bed,  the 
patient  found  a  lump  in  the  right  side. 

On  September  18th  and  19th  the  pain  was  almost 
unbearable,  and  little  food  was  taken. 

Up  to  this  time  the  patient  had  not  consulted  a 
medical  man.  On  the  morning  of  the  19th,  she  wrote 
to  Dr.  Sunderland  asking  him  to  visit  her.  He  called 
the  same  afternoon,  and  as  the  history,  symptoms,  and 
signs  pointed  to  appendicitis  and  abscess,  he  sent  the 
patient  within  a  few  hours  to  the  Royal  Waterloo 


Hospital,  and  arranged  with  Mr.  Curtis  (in  the  absence 
of  Mr.  Pendlebury)  to  meet  him  at  ten  o'clock  the 
following  morning  with  a  view  to  operation. 

With  regard  to  the  personal  history,  she  had  always 
been  healthy,  although  not  very  robust.  The  family 
history  indicated  nothing  of  importance. 

The  condition  on  admission  to  the  hospital  was  as 
follows : — She  was  thin,  but  not  obviously  anaemic ; 
the  tongue  thickly  coated,  and  the  bowels  constipated. 
The  temperature  on  admission  at  7  p.m.  was  10 1 '6°, 
the  pulse  being  104  per  minute.  Great  pain  was 
complained  of,  referred  to  the  right  iliac  fossa.  The 
right  half  of  the  abdominal  wall  moved  imperfectly. 
A  firm,  elastic  swelling,  about  as  large  as  a  medium- 
sized  orange,  could  be  felt  in  the  right  iliac  fossa, 
extending  for  nearly  a  hand's-breadth  above  Poupart's 
ligament,  from  near  the  right  anterior  superior  iliac 
spine,  downwards  and  inwards  into  the  hypogastric 
region,  but  not  passing  beyond  the  middle  line.  The 
physical  signs  were,  in  fact,  almost  exactly  those 
obtained  in  the  case  of  an  ordinary  acute  appendicitis 
abscess  of  some  five  or  six  days'  duration.  The  heart 
and  lungs  were  normal. 

Next  morning  the  physical  signs  were  unaltered 
after  the  successful  use  of  castor  oil  and  enemata  of 
turpentine  and  soap  and  water  ;  the  temperature  was 
102*2°,  and  the  pulse  was  104  per  minute. 

After  the  consultation,  concluding  the  condition  to 
be  one  of  appendicitis  abscess,  operation  was  deemed 
advisable  without  further  delay,  and  was  performed 
at  10  a.m.,  September  20th,  1901,  by  Mr.  Curtis. 

Operation. — A  four-inch  incision  was  made  parallel 
with  the  outer  third  of  Poupart's  ligament,  commencing 
about  one  and  a  half  inches  internal  to  the  right 
anterior  superior  iliac  spine,  so  as  to  lie  over  the  long 
axis  of  the  swelling. 

On  opening  the  peritoneal  cavity,  though  a  little 
serous  fluid  escaped,  there  were  no  adhesions  or  other 
signs  of  peritonitis  anywhere,  the  intestines  generally 
at  first  sight  presenting  a  normal  appearance.  On 
examining  the  caecum,  its  anterior  wall  was  thin  and 
lax,  and  of  normal  consistence,  but  was  crossed  trans- 
versely by  numerous  tortuous  vessels  of  small  size, 
The  relaxed  anterior  wall  lay  in  contact  with  a  soft, 
doughy  mass  of  light  yellowish  tint,  apparently 
springing  from  the  inner  aspect  of  the  posterior  wall 
of  the  caecum.  The  mass  could  be  seen  through  the 
thin  anterior  wall,  and  the  entire  posterior  wall  of  the 
caecum  was  felt  to  be  increased  to  a  thickness  of  a 
quarter  of  an  inch.  Directly  continuous  with  the 
rounded  swelling  felt  involving  the  posterior  wall  of 
the  caecum  was  a  second  well-defined,  rounded  mass 
of  similar  consistence,  extending  from  the  caecum 
downwards  and  inwards,  the  smooth  rounded  edge 
ending  rather  abruptly  at  the  brim  of  the  pelvis.  The 
outline  of  these  two  continuous  masses  formed  a  sort 
of  figure-of-8.  The  position  of  the  appendix  itself 
could  not  be  clearly  made  out ;  what  was  thought  to 
be  its  probable  point  of  origin,  from  the  caecum,  alone 
being  visible,  the  remainder  being  apparently  buried 
in  the  swelling  at  the  back  of  the  caecum.  Subsequent 
events,  occurring  one  and  a  half  years  later,  made  it 
seem  probable  that  it  lay  concealed  in  the  well-defined 


602    The  Medical  Puts. 


ORIGINAL  COMMUNICATIONS. 


June  8.  1904. 


lower  mass  ending  abruptly  at  the  brim  of  the  pelvis. 
The  swelling  involving  the  posterior  wall  of  the  caecum 
appeared  to  extend  round  the  region  of  the  ileo-caecal 
valve,  and  the  orifice,  examined  by  invaginating  the 
lax  anterior  wall  of  the  caecum,  seemed  distinctly 
smaller  than  normal,  admitting  only  the  index  finger 
tip,  and  being  surrounded  by  firm  and  much  thickened 
margins.  There  was  nowhere  any  sign  of  adhesions, 
congestion,  or  thickening  of  the  peritoneum  or  adjacent 
omentum,  and  not  the  slightest  evidence  of  any  collec- 
tion of  pus  ;  no  enlarged  lymphatic  glands  were  seen 
anywhere,  and  no  deposit  of  tubercles  was  detected  in 
the  peritoneum.  The  appearance  of  the  mass  through 
the  anterior  wall  of  the  caecum,  the  feel  of  the  con- 
stricted orifice  just  described,  the  thickened  condition 
of  the  posterior  wall  of  the  caecum,  and  the  adjacent 
firm  (non-fluctuating)  mass,  the  whole  of  which  was 
thought  at  the  time  to  be  retro-peritoneal,  especially 
in  the  entire  absence  of  adhesions,  recent  or  old,  or 
enlarged  glands,  seemed  to  negative  any  acute  or 
chronic  inflammatory  mischief. 

The  absence  of  tubercles  in  the  peritoneum,  and  of 
enlarged  lymphatic  glands  in  the  region  of  the  cae- 
cum (though  these  may  have  been  present,  lying 
concealed  behind  it),  and  of  physical  signs  in  the 
chest,  also  appeared  to  point  decidedly  in  favour  of 
malignant  disease  of  the  caecum,  the  appearance  of  the 
primrose-yellow  mass  seen  through  the  anterior  wall 
strongly  suggesting  columnar  carcinoma  springing 
from  the  mucous  lining  of  the  posterior  wall  of  the 
caecum. 

Beginning  to  attach  greater  significance  to  the  some- 
what prolonged  constipation,  concluding  it  to  be  the 
result  of  the  partially  occluded  condition  of  the  ileo- 
caecal  orifice,  and  that  this  was  dependent  on  malignant 
disease  of  the  caecum,  the  only  chance  of  relieving  the 
patient  appeared  to  be  by  establishing  a  lateral  anasto- , 
mosis  of  healthy  portions  of  the  bowel  above  and  below 
the  affected  area. 

This  was  readily  done,  a  Murphy's  button  being  used 
to  approximate  the  ileum  (at  a  point  about  five  or  six 
inches  up  from  the  ileo-caecal  valve)  to  the  correspond- 
ing point  of  the  ascending  colon. 

The  wound  was  closed,  and  healed  by  primary  union. 
On  September  28th,  the  evening  of  the  eighth  day  after 
the  anastomosis,  the  button  was  safely  passed. 

At  no  time,  before  or  after  the  operation,  was  pus 
ever  seen  in  the  stools. 

From  the  day  of  operation  (September  20th)  to 
October  7  th,  pain  and  insomnia  were  relieved  by 
morphia,  at  first  daily,  then  every  day  or  two.  As  re- 
gards the  bowels,  relief  was  obtained  on  the  third  day 
after  operation,  night  and  morning,  by  enemata,  and 
these  were  repeated  every  day  or  two  afterwards ;  cas- 
cara  was  given  later. 

On  October  nth,  1901,  a  second  operation  was  per- 
formed with  the  hope  of  excising  the  affected  portion 
of  bowel  (caecum).  The  scar  of  the  incision  made  at 
the  former  operation  was  cut  out,  and  the  peritoneal 
cavity  thus  laid  open.  Numerous  adhesions  were  now 
found,  binding  down  the  caecum.  The  union  produced 
by  the  lateral  anastomosis  was  drawn  well  up  almost 
out  of  sight,  at  the  upper  angle  of  the  wound,  but 
appeared  sound  in  every  respect.  The  substance  of 
the  right  psoas  muscle  appeared  on  digital  examination 
to  be  infiltrated  with  growth,  spreading  outwards  so  as 
to  reach  nearly  to  the  crest  of  the  ileum,  just  behind 
the  anterior  superior  iliac  spine,  and  extending  inwards 
over  the  brim  of  the  pelvis.  The  growth  originally 
seen  and  felt  in  connection  with  the  caecum  seemed,  in 
fact,  to  have  flattened  out  in  an  outward  direction, 
spreading  retroperitoneally.  This  suggested  the  pos- 
sibility that  the  original  growth  was  a  retroperitoneal 
sarcoma  rather  than  a  carcinoma,  and  that  it  might 
have  affected  the  caecum  secondarily. 

One  had  no  doubt  at  the  time  that  there  was  a 
malignant  growth,  spreading  out  retroperitoneally, 
and  involving  the  psoas  muscle  externally,  and  spread- 
ing over  the  brim  of  the  pelvis  internally.  The  in- 
cision was  therefore  closed,  and  a  hopeless  prognosis 
given  to  the  friends,  mentioning,  however,  the  bare 


chance  of  the  disappearance  spontaneously  of  such  a- 
growth. 

The  wound  healed  by  primary  union,  and  a  wel! 
defined  mass  of  firm,  consistence,  about  the  sixe  of  at 
small  clenched  fist,  could  be  felt  immediately  beneath. 
But  daily  examination  of  the  swelling  showed  it  to  be 
slowly  but  steadily  diminishing  in  size,  until  it  com- 
pletely disappeared,  and  on  the  date  of  discharge  from 
the  hospital,  November  4th,  1901,  twenty-four  days 
after  the  second  operation,  there  was  only  a  sense  of 
greater  resistance  than  on  the  left  side,  doubtless  due 
to  the  adhesions  around  the  caecum,  &c.  The  general 
condition  had  markedly  improved,  the  weight  had 
increased,  and  the  temperature  had  come  down  to, 
and  remained  at,  normal,  both  day  and  night.  The 
patient  was  able  to  sit  about  and  slowly  walk  by 
herself  by  the  date  of  discharge  (November  4th,  1901). 

Convalescence  was  rather  slow,  anaemia  and  debility 
remaining  for  several  months.  During  part  of  this 
time  she  was  under  the  care  of  Dr.  Goulder,  at  Dudley, 
but  returned  to  London  on  December  16th,  1901,  on 
her  way  to  Brighton,  on  which  date  some  obscure 
resistance  could  be  detected  at  the  junction  of  the 
inner  and  middle  thirds  of  the  line  joining  the  umbilicus 
to  the  right  anterior  superior  iliac  spine.  By  this  date 
(December  16th)  her  weight  was  9  St..  a  net  gain  of 
16  lbs.  within  six  weeks  of  her  discharge  from  the 
hospital,  her  usual  weight  when  in  health  having  been 
9  st.  6  lbs.  Slight  oedema  of  the  left  leg  had  appeared 
and  continued  for  some  months.  Eventually  the 
patient  returned  to  private  nursing  in  February,  1902, 
and  remained  fairly  well  till  February,  1903,  nineteen 
months  after  the  first  operation. 

Remarks. — These  facts  compelled  one,  therefore,  to 
reconsider  the  question  of  the  diagnosis.  One  could 
exclude  almost  certainly  the  possibility  of  the  con- 
dition being  one  of  simple  appendicitis  abscess,  in 
which  the  swelling  might  have  disappeared  as  the 
result  of  the  abscess  opening  into  the  bowel.  No  pus 
was  at  any  time  evident  in  the  stools,  and  at  the  initial 
operation  there  was  certainly  no  evidence  of  a  collection 
of  pus.  The  subsequent  steady  recovery  of  weight 
lost  before  the  lateral  anastomosis,  taken  with  the 
patient's  return  to  good  health,  strongly  negatives 
malignant  disease,  so  few  properly  substantiated 
tumours  of  this  nature  having  been  known  to  dis- 
appear spontaneously,  though  a  good  many  so-called 
"  typical  sarcomata,"  as  judged  by  the  clinical  appear- 
ance, have  vanished  in  this  mysterious  fashion,  one 
such  case  being  known  to  one  of  us  (H.  J.  C). 

One  alternative,  the  most  probable  according  to  the 
views  of  Mr.  Curtis,  is  that  the  condition  was  really 
one  of  tuberculous  perityphlitis,  which  completely 
cleared  up  under  the  rest  obtained  for  the  diseased 
area  by  means  of  the  lateral  anastomosis  established. 
The  effect  of  laparotomy  on  two  occasions  must  also< 
be  taken  into  account,  as  in  cases  of  undoubted  tuber- 
culous peritonitis  this  "  open-air  "  method  of  treat- 
ment, as  it  may  be  termed,  has  undoubtedly  been  very 
successful. 

Another  alternative,  now  the  opinion  of  Dr.  Sunder- 
land, after  careful  consideration  of  both  the  medical 
and  surgical  aspects  of  the  case  and  its  subsequent 
history,  is  that  the  original  swelling  was  a  mass  of 
inflammatory  exudation  arising  from  simple  appen- 
dicitis, which  subsided  without  the  formation  of  pus. 
partly  as  the  result  of  the  intestinal  anastomosis,  and 
which  possibly  would  have  disappeared  if  no  operation 
had  been  undertaken,  to  recur  later  if  the  appendix 
were  not  removed  in  the  quiescent  stage.  Such  cases 
one  saw  occasionally  in  early  days  when  operation  was 
not  resorted  to,  and  when  there  was  often  no  evidence 
of  the  formation  of  pus,  the  tumour  gradually  dis- 
appearing, but  possibly  recurring  later.  In  the  pre- 
sent day  the  appendix  would,  of  course,  be  removed 
by  most  surgeons  in  the  quiescent  stage.  Also  he 
considered  it  possible  that  there  might  have  been  a 
very  small  quantity  of  pus  deeply  situated  in  the  mass 
of  exudation,  which  also  became  absorbed. 

Second  Stage. — The  happy  condition  of  affairs  did 
not  continue  for  more  than  a  year  after  the  patient 


June  8,  1904. 


ORIGINAL  COMMUNICATIONS.         The  Medical  Pmss.    603 


resumed  her  work,  for  in  the  afternoon  of  March  17  th, 
1903,  whilst  nursing  a  case  for  Dr.  Sunderland,  she 
•complained  to  him  of  pain  and  extreme  tenderness  in 
the  right  iliac  region.  He  sent  her  that  same  evening 
to  the  Waterloo  Hospital,  where  she  gave  the  following 
history : — 

On  February  16th,  1903,  whilst  staying  at  East- 
bourne, she  took  a  long  walk  to  the  top  of  Beachy 
Head  and  over-tired  herself.  Severe  aching  of  limbs 
and  general  tired  feelings  remained  for  several  days. 
On  March  8  th,  she  suffered  from  what  she  called  "  a 
very  bad  bilious  attack/'  with  excessive  pain  at  the 
top  of  the  head,  and  down  the  right  side  of  the  abdomen. 
This  lasted  for  three  days.  On  March  17th,  she  had  a 
slight  pain  in  the  right  side  of  the  abdomen,  but  towards 
the  afternoon  it  began  to  get  much  worse.  She  also 
stated  she  had  been  free  from  pain  since  the  previous 
operation,  but  had  never  since  felt  quite  strong,  and 
latterly  had  had  a  good  deal  of  constipation.  The 
temperature  was  980  F.,  the  pulse  being  80  per  minute. 

A  very  tender,  ovoid  mass,  as  big  as  a  bantam's  egg, 
could  be  made  out  in  the  right  iliac  region,  in  imme- 
diate proximity  with  the  deep  aspect  of  the  scar.  No 
fluctuation  could  be  detected  anywhere. 

In  the  first  fortnight  after  admission  a  daily  evacua- 
tion of  the  bowels  was  secured  by  means  of  an  enema. 
•Glycerine  of  belladonna  fomentations  relieved  all  pain, 
-and  the  diet  consisted  of  milk  and  beef- tea  for  the  first 
week. 

On  March  19th,  two  days  after  admission,  the  tem- 
perature rose  to  99*4°  F.,  the  pulse  varying  from  84 
to  06.  For  the  next  five  days  the  temperature  was 
norma!,  the  pulse-rate  being  generally  about  72-80  per 
minute.  Milk,  pounded  fish,  eggs,  and  Plasmon  were 
then  given. 

On  March  27th,  the  temperature  rose  to  996°  F., 
pulse  80.  For  the  next  four  days  the  temperature 
steadily  rose  to  101*4°  F.,  being  ioi°  F.  on  the  morning 
•of  March  31st,  when  the  patient  was  operated  on.  The 
pulse-rate  was  80,  only  occasionally  rising  to  90  or  96 
per  minute.  During  the  previous  day  or  so  the  swelling, 
which  had  seemed  very  gradually  to  have  been  ap- 
proaching the  surface,  immediately  beneath  the  thinner 
central  part  of  the  scar,  gave  for  the  first  time  evidence 
of  some  fluctuation. 

Operation,  March  $ist,  1 903. — The  peritoneal  cavity 
was  laid  open  by  an  incision  made  through  the  scar  of 
the  original  wound.  There  were  numerous  adhesions, 
matting  together  the  coils  of  small  intestines  in  the 
neighbourhood  of  the  wound,  and  the  right  half  of  the 
brim  of  the  pelvis.  Further  investigation,  after  care- 
ful separation  of  the  more  superficial  adhesions,  re- 
vealed the  entire  length  of  the  appendix,  now  for  the 
Hrert  time  visible,  being  slightly  curved  upon  itself,  and 
with  the  apex  a  little  above  the  brim  of  the  pelvis,  just 
-outside  the  right  sacroiliac  joint.  Though  its  serous 
coat  was  opaque  and  obviously  thickened,  the  appendix 
was  only  slightly  larger  than  normal-;  in  length,  it 
measured  about  2}  ins.  In  separating  the  matted 
intestine  around  its  distal  inch  and  a  quarter?  a  collec- 
tion of  dirty  greenish-grey,  almost  odourless  pus,  about 
a  dessert-spoonful,  was  evacuated  from  a  cavity  about 
the  size  of  a  peeled  walnut,  formed  by  the  matting 
together  of  the  coils  of  intestine  around  the  appendix. 
No  glands  or  miliary  tubercles  were  evident.  The 
meso-appendix  was  a  little  thickened  and  of  mace- 
yellow  tint.  Appendectomy  was  done  in  the  usual  way. 
Gauze  drainage  of  the  cavity  through  the  centre  of  the 
incision  was  used. 

By  the  following  day,  April  1st,  when  two  small 
drainage-tubes  were  substituted  for  the  gauze,  the 
temperature  had  fallen  to  99*4°  F.,  and  thereafter  re- 
mained normal,  until  the  date  of  discharge  on  April  25  th, 
1903.  The  stitches  were  removed  on  April  7th,  and 
drainage  finally  abandoned  on  April  17  th.  The  bowels, 
opened  on  the  third  and  fourth  days  by  enema,  acted 
regularly  afterwards  without  enema  usually  being 
required. 

The  patient  left  the  hospital  feeling  well  and  with 
the  wound  nearly  healed  on  April  25  th,  twenty-five 
days  after  appendectomy. 


Remarks. — The  points  of  interest  about  this  second 
phase  of  the  case  are  two-fold  :  (1)  The  easy  isolation 
of  the  thickened  appendix,  invisible  at  the  first  opera- 
tion ;  (2)  the  nature  of  the  abscess,  whether  simply 
septic  or  tuberculous. 

(1)  At  the  first  operation,  only  the  probable  position 
of  origin  of  the  appendix  could  be  surmised.  It  seems 
almost  certain  now  that  at  the  original  operation  the 
rounded  swelling  extending  to  the  brim  of  the  pelvis 
from  the  region  of  the  caecum,  thought  to  be  sub- 
peritoneal and  directly  continuous  with  the  thickening 
involving  the  posterior  wall  of  the  caecum,  must  really 
have  been  inflammatory  in  nature,  and  have  concealed 
within  it  the  missing  appendix. 

The  alternative  route  for  the  passage  of  food  pro- 
vided for  by  the  lateral  anastomosis  allowed  the  in- 
flammed  ileo-colic  valve,  caecum,  and  swelling  around 
the  appendix  complete  physiological  rest,  and  with  the 
subsidence  of  surrounding  inflammation  the  appendix 
thickened  only  in  respect  of  its  serous  coat,  once  more 
became  isolated,  and  uncoiled  itself. 

(2)  The  nature  of  the  present  attack — acute  appen- 
dicitis abscess — is  somewhat  obscure.  Important  data 
are  the  dessert-spoonful  of  dirty  grey  pus,  non-faecal  in 
odour,  no  enlarged  glands,  no  obvious  miliary  tubercles. 
One  possible  cause  is  the  escape  of  a  little  irritating 
faecal  matter  into  the  cul-de-sac — the  caecum  and 
appendix — left  out  of  the  more  direct  circuit  by  the 
establishment  of  the  lateral  anastomosis  between  the 
ileum  and  ascending  colon.  The  history  given  by 
the  patient  of  getting  over-tired  after  a  walk  to  Beachy 
Head,  with  subsequently  a  severe  "  bilious  "  attack, 
points  to  a  catarrhal  affection,  probably  typhlitis,  as 
being  the  immediate  precursor  of  the  abscess  around 
the  appendix,  whatever  its  real  nature,  whether  simply 
septic  (infection  with  B.  colt,  for  instance)  or  tuber- 
culous in  nature.  The  pus,  being  inoffensive  and  prac- 
tically odourless,  was  unlike  that  generally  observed  in 
non-tuberculous  appendicitis  abscesses. 

Bacteriological  investigation  was  not  made  at  this 
stage.  Mr.  Curtis  considers  the  course,  previous  and 
subsequent  phases  of  the  case,  especially  its  chronicity 
and  greatly  delayed  convalescence,  however,,  pointed 
strongly  to  the  condition  being  essentially  tuberculous, 
rather  than  simply  septic  in  nature. 

Dr.  Sunderland  considers  there  might  have  been  a 
small  quantity  of  pus  around  the  appendix  since  the 
first  operation,  which  would  also  account  for  the  de- 
layed convalescence  and  the  recurrence  of  symptoms, 
and  as  the  patient  had  taken  charge  of  a  maternity 
case  for  a  week  previous  to  the  second  attack,  and  had 
been  lifting  a  heavy  patient  and  nursing  an  enormous 
infant,  he  believes  the  exertion  thereby  entailed  might 
have  caused  rupture  of  some  adhesions  around  the 
appendix,  thus  producing  the  acute  symptoms. 

Subsequent  History. — The  patient  left  the  hospital  on 
April  25  th  with  the  wound  not  quite  healed,  and  re- 
mained at  Dudley  under  the  care  of  Dr.  Goulder.  On 
June  28th.  Mr.  Curtis  slit  up  the  existing  sinus  to  the 
floor  of  the  right  iliac  fossa,  under  eucaine,  without 
finding  any  collection  of  pus,  and  on  August  9th  Dr. 
Goulder  again  enlarged  the  wound,  under  ethyl 
chloride.  On  August  25th,  the  patient  came  to  London 
looking  ill,  wasted,  and  anaemic.  She  was  sent  to 
Swanage,  whence  she  returned  to  London  on  October 
22nd  in  much  better  condition,  weighing  9  st.  $£  lbs., 
but  the  sinus  persisted  in  spite  of  different  kinds  of 
treatment,  which  had  been  advised  from  time  to  time, 
including  nitrate  of  silver  lotion  and  perchloride  lotion. 

As  it  was  important  that  the  patient  should  work  for 
her  living,  a  further  operation  was  performed  under 
gas  and  ether  by  Mr.  Curtis  on  October  30th.  A  cord- 
like  structure  about  i\  ins.  in  length,  and  as  thick  as 
an  appendix,  was  found  continuous  with, .though  almost 
at  right  angles  to,  the  sinus  passage  through  the  abdo- 
minal wall,  and  extended  to  the  peritoneal  cavity, 
where  a  smoothly  lined  pouch  or  canal  about  2  ins.  in 
length  was  found  extending  again  in  an  opposite  direc- 
tion. The  cord-like  structure  which  was  proved  by 
microscopical  examination  to  be  sinus-tissue,  was  re- 
moved,   the   parts   were   cleansed   and   packed   with 


6<M    The  Medical  Peess.         ORIGINAL  COMMUNICATIONS. 


June  8,  1904. 


gauze,  and  in  six  weeks'  time  (December  5th),  when 
Mr.  Curtis  left  England  for  Bui u way o,  there  was  a 
narrow  track  leading  through  the  abdominal  walls 
from  which  only  a  few  drops  of  yellow  purulent  dis- 
charge escaped. 

This  discharge  was  stained  for  tubercle  bacilli,  and 
inoculated  subcutaneously  into  a  guinea-pig  on  Decem- 
ber 1  st.  No  bacilli  were  discovered,  and  the  guinea- 
pig  was  found  quite  healthy  when  killed  on  Decem- 
ber 30th.  The  discharge  sent  for  examination  was, 
however,  received  on  a  strip  of  iodoform  gauze,  and 
had  remained  in  contact  with  the  antiseptic  for  twenty- 
four  hours  before  inoculation. 

The  patient  was  left  in  the  surgical  charge  of  Mr. 
H.  S.  Collier,  and  shortly  afterwards  was  sent  to 
Hastings. 

At  the  beginning  of  March,  1904,  two  and  a  half 
years  after  the  first  operation,  the  patient  reported 
herself  as  cured  (though  feeling  weak),  the  sinus 
having  quite  closed.  She  was  then  advised  to  go  to 
her  home  in  Scotland  and  to  live  a  quiet  open-air  life 
for  six  months  before  resuming  work. 

Remarks. — This  case  serves  to  emphasise  the  diffi- 
culty which  may  occasionally  be  experienced  in  deciding 
what  is  the  exact  nature  of  an  abdominal  tumour, 
even  when  the  abdomen  has  been  opened  and  the  swell- 
ing inspected  and  palpated. 


By 


SOME  POINTS  IN  THE 

SURGICAL    TREATMENT 

OF 

ACUTE     GE  NERAL 
PERITONITIS,  (a) 

R.  CHARLES  B.  MAUNSELL,  M.B.,    B.Ch. 

Univ.    Dub.,    F.R.C.S.I., 

Surgeon  to  Mercer's  Hospital,  Dublin ;  Examiner  in  Surgery, 
,'.  University  of  Dublin,  Ac.,  Ac 

In  the  following  remarks  upon  the  treatment 
of  acute  peritonitis  I  do  not  pretend  to  bring 
forward  anything  original ;  every  measure  advo- 
cated by  me  has  been,  more  than  once,  advocated 
by  others,  and  yet  the  general  body  of  surgeons 
do  not  appear  to  grasp  the  necessity  of  some  of 
these  measures  in  cases  which  they  attempt  to 
save,  or  else  refuse  to  operate  in  advanced  cases, 
being  sceptical  of  their  power  to  do  good  when 
certain  well-known  symptoms  have  appeared. 

A  few  years  ago  I  remember  how  despondently 
we  approached  a  case  in  which  intestinal  distension 
was  marked,  and,  after  operation,  how  often  we 
stood  by  whilst  the  distension  yet  further  in- 
creased in  spite  of  purgatives  and  enemata  ;  how 
the  purgatives  were  vomited  and  the  enemata 
retained,  thus  adding  more  to  the  distress  of  the 
patient ;  then,  when  the  dreaded  black  vomit 
appeared,  gulped  up  without  much  effort,  how  we 
turned  away  from  further  interference,  being  tho- 
roughly convinced  that  in  this,  at  least,  we  had  an 
infallible  sign  of  fast-approaching  and  inevitable 
death. 

About  two  years  ago  my  attention  was  directed 
to  the  possibility  of  doing  good  in  cases  which  had 
developed  typical  "  black  vomit."  I  had  operated 
upon  a  man  for  acute  peritonitis  following  per- 
forated gastric  ulcer  ;  after  the  operation  vomiting 
continued,  and  was  Tt  black."  The  patient  showed 
signs  of  enteritis  with  collapse,  and  died  as  if  from 
ptomaine  poisoning.  At  the  post-mortem  the 
peritoneal  cavity  appeared  clean,  but  the  stomach 
was  greatly  distended  with  fluid  dark  in  colour 
and  putrid.     This  fluid  appeared  enough  to  kill 

<a)  Read  before  the  Surgical  Section  of  the   Royal  Acaiemy   of 
Medicine  in  Ireland,  March  25th,  1904. 


any  human  being,  quite  apart  from  peritonitis, 
so  I  determined  in  future  to  try  the  efficacy  of 
the  stomach  tube  in  similar  cases.  Not  very  long 
after  this  a  patient  upon  whom  I  had  operated 
for  appendicitis  developed  signs  of  peritonitis, 
with  troublesome  distension  and  copious  vomiting 
of  typical  character.  The  stomach  was  douched 
clear  every  few  hours  for  several  days  and  the 
patient  recovered.  Since  then  I  have  had  a  similar 
experience  in  gastric  perforation  cases,  but  I  will 
not  mention  them  in  detail,  as  I  have  already 
dealt  with  this  form  of  peritonitis  at  a  previous 
date. 

The  method  of  dealing  with  advanced  intestinal 
paresis  was  also  learned  by  watching  and  following 
to  the  post-mortem  room  a  series  of  futile  opera- 
tions. It  is  now  allowed  that  the  prognosis  of  peri- 
tonitis arising  from  gastric  perforation,  if  operated 
upon  thoroughly,  is  not  bad  ;  but  I  regret  to  say 
that  the  prognosis  of  general  acute  peritonitis  from 
other  causes  has  up  to  the  present  been  very 
gloomy. 

The  following  three  cases  which  have  been  under 
my  care  in  Mercer's  Hospital  within  the  past  two 
months  will  serve  as  an  example  of  the  procedures 
which  I  have  come  to  adopt,  and  as  a  text  for  any 
further  remarks.  The  first  case  ended  fatally  on 
the  tenth  day  after  operation,  but  as  it  illustrates 
many  points,  I  have  included  it. 

Case  I. — P.  McD.,  aet.  25,. police-constable,  was 
admitted  January  9th,  1904,  suffering  from  acute 
peritonitis    following    appendicitis.     I    saw   him, 
with  my  colleague,  Dr.  Lumiden,  under  whom  he 
had  been  admitted,  and  found  temperature  ioo°, 
pulse  96,  and  poor  quality ;  facial  expression  dull, 
and  colour  dusky  ;    history  of  onset  of  agonising 
pain  about  fourteen  hours  previously,  supervening 
upon  a  lesser  pain  referred  to  the  right  iliac  fossa. 
The  abdomen  was  very  rigid,  and  the  diaphragm: 
much  pushed  up  by  distension  of  the  intestines. 
Immediate  operation  was  advised.     Whilst  pre- 
paration  was  being  made  for  this  he  vomited  a 
quantity  of  mixed   "  black  "  and  "  faecal  M  ma- 
terial.    Operation :     The    ordinary    oblique    in- 
cision was  made,  and  an  intensely  inflamed  and 
perforated  appendix  was  readily  found  and  re- 
moved.    A  few  drachms  of  thin  faecal  material 
and  pus  were  mopped  up  with  gauze,  and  the  in> 
mediate     neighbourhood     cleansed     with     saline 
solution.     Having  re-cleansed  my  hands,  the  in- 
testines were  pushed  aside  and  a  large  quantity  of 
faeculent   fluid   removed    from    the   pelvis.     The 
oblique  wound  was  temporarily  closed  with  forceps, 
and,  an  incision  having  been  made  in  the  mid-line 
above  the  umbilicus,  the  renal  fossae  and  hollows 
of  the  diaphragm  were  found  full  of  a  fluid  similar 
in  character  to  that  which  had  filled  the  pelvis. 
The   abdomen   was   next   douched   with   several 
gallons  of  warm  saline  solution  poured  from  a  jug* 
a  hand  being  passed  well  above  and  behind  both 
liver   and   spleen   to   ensure   thorough   cleansing 
of  the  diaphragmatic  region.     The  distended  large 
intestine   was   incised   and   thoroughly   deflated,, 
and  the  small  intestine  and  stomack  were  similarly 
dealt  with.     The  incisions  in  the  intestines  and 
stomach  having  been  closed  with  a  single  continuous 
suture  of  fine  silk,  the  abdominal  cavity  was  re- 
douched,    the   parietal   wounds    partially    closed,, 
leaving  space  for  gauze  drains  to  the  pelvis  and 
renal  pouches. 

The  patient  passed  a  good  afternoon  and  night, 
a  large  quantity  of  salt  solution  and  serum  draining. 


June  8,  1904. 


ORIGINAL  COMMUNICATIONS. 


The  Medical  Press.    605 


away.  Next  morning,  January  10th,  pulse 
1 08,  respiration  30,  temperature  98*4°.  During 
the  day  the  pulse  and  temperature  rose,  and 
vomiting  returned;  so  on  two  occasions  I  douched 
out  the  stomach,  removing  a  large  quantity  of 
stinking  "  black "  material.  On  January  nth 
the  puke  and  respiration  being  still  frequent,  the 
stomach  was  douched  as  before  morning  and  even- 
ing, the  colon  washed  out  by  enema  and  the 
gauze  drains  were  removed.  From  this  date 
vomiting  ceased,  the  temperature  soon  fell  to 
normal,  the  pulse  gradually  reduced  in  frequency, 
and  the  only  thing  causing  anxiety  was  the  peculiar 
hysterical  condition  the  patient  assumed,  shout- 
ing, often  refusing  food  or  medicine,  and  fighting 
vigorously  with  his  nurses,  although  not  in  a  con- 
dition of  true  delirium.  On  the  evening  of  January 
17th,  nine  days  after  operation,  I  had  every  reason 
to  believe  he  would  recover,  but  during  the  early 
morning  of  the  18th  he  struggled  violently  with 
those  attending  him,  and  a  large  amount  of  in- 
testine prolapsed  through  the  lower  wound,  which 
had  given  way  under  the  strain.  The  accident  was 
not  noticed  until  the  binder  was  changed-  some 
hours  later,  when  I  was  telephoned  for  and  returned 
the  intestines,  but  the  patient  steadily  sank  during 
the  day,  and  died  at  9  p.m. 

Although  this  patient  was  not  "  out  of  the 
wood,"  yet  I  had  very  reasonable  grounds  to  hope 
for  his  recovery  if  this  unfortunate  accident  had 
not  occurred. 

Case  II. — W.  M.,  male,  aet.  14,  was  admitted 
to  Mercer's  Hospital,  March  3rd,  1904,  at  5.30  p.m., 
with  the  following  history.  He  had  been  em- 
ployed cleaning  a  window  in  a  large  boot  factory. 
Close  to  the  window  was  the  shaft  of  a  leather- 
stamping  machine,  in  which  his  apron  became 
entangled.  The  apron  was  rapidly  wound  up, 
and  the  boy,  held  firmly  with  his  lumbar  region 
against  the  shaft,  was  whirled  around  as  if  upon 
a  horizontal  bar.  At  each  revolution  his  legs 
and  head  alternately  struck  the  window  frame. 

When  brought  to  hospital  he  was  in  a  condition 
of  profound  shock,  merely  moaning  and  com- 
plaining of  pain  in  the  abdomen  when  roused.  The 
right  frontal,  malar  and  nasal  regions  were  deeply 
bruised,  and  showed  superficial  abrasions  ;  the 
right  conjunctiva  was  raised  up  by  haemorrhage, 
and  a  stream  of  blood  flowed  from  the  right  ear. 
The  legs  and  feet  were  covered  with  jagged  cuts, 
some  of  which  exposed  the  bones  and  ligaments. 
The  eighth,  ninth,  and  tenth  ribs  on  the  left  side 
were  broken  at  about  their  middle,  and  the  per- 
cussion note  and  position  of  the  heart-beat  pointed 
to  a  moderate  amount  of  pneumothorax.  The 
abdomen  was  very  tense  and  tender,  and  a  very 
slight  abrasion  was  present  above  and  to  the  left 
of  the  umbilicus. 

The  boy  was  put  to  bed,  hot  jars  applied,  and 
the  ear  cleansed  and  packed  with  iodoform  powder. 
Temperature  99*4°,  pulse  104,  and  very  weak, 
respiration.  24.  I  strongly  suspected  intestinal 
or  other  visceral  rupture,  but  in  presence  of  a 
fractured  base  and  fractured  ribs  I  considered 
it  necessary  to  wait  for  more  complete  consciousness 
to  return  before  giving  a  definite  opinion.  I  left 
word  that  if  the  pulse-rate,  &c,  increased  mar- 
kedly during  the  night,  I  should  be  sent  for. 
When  I  saw  him  next  morning,  at  10  a.m.,  the 
record  on  the  chart  showed  temperature  99*4°, 
pulse  108,  but  when  I  felt  the  radial  pulse  it  was 
so  weak  and  running  that  it  could  only  be  counted 
by  exercising  the  greatest  care,  and  a  stethoscope 


revealed  the  fact  that  the  true  rate  was  156  per 
minute.  As  the  boy  was  now  more  conscious 
and  the  abdomen  more  rigid  I  determined  to 
operate  immediately. 

An  incision  in  the  mid-line  below  the  umbilicus 
disclosed  a  quantity  of  blood-stained  fluid  and 
greatly  distended  intestines  ;  a  short  search  re- 
vealed undigested  potato,  &c,  and  intestinal 
contents  free  in  the  peritoneal  cavity.  The  in- 
cision was  rapidly  extended  upwards,  and  a  tear 
found  in  the  jejunum  almost  completely  severing 
the  gut,  a  haematona  as  large  as  a  fist  was  also 
present  in  the  mesentery.  Having  satisfied  my- 
self that  the  circulation  in  the  injured  intestine 
was  good,  I  mended  the  tear  with  a  double  row 
of  silk  suture,  and  then,  having  searched  for  any 
other  lesion  which  might  be  present,  thoroughly 
douched  out  the  peritoneal  cavity.  I  next  opened 
the  transverse  colon  and  deflated  it,  then  the  ilium 
fairly  low  down,  and,  lastly,  the  distended  stomach, 
which  appeared  at  the  upper  angle  of  the  parietal 
incision.  When  the  stomach  and  intestines 
were  perfectly  flaccid  the  incisions  were  sutured, 
the  abdomen  again  douched  and  the  parietal 
wound  closed  except  at  its  lower  angle,  through 
which  a  gauze  drain  was  carried  into  the  pelvis. 

The  drain  was  removed  on  the  second  day, 
and  the  case  ran  an  uneventful  course,  except 
for  diarrhoea  on  the  fourth,  fifth,  sixth  and 
seventh  days,  which  was  due  to  irritations  from 
nutrient  enemata  and  was  checked  by  starch  and 
opium  enemata. 

The  boy  is  now  well,  and  has  been  on  full  diet 
for  the  past  week,  but  will  have  to  be  detained 
until  the  lacerated  wounds  on  his  feet  have  com- 
pletely granulated.  (Since  this  was  written  the 
boy  has  returned  home  perfectly  well.) 

Case  III.— G.  C,  aet.  19,  van  driver,  was  sent  to 
me  March  nth,  1904,  with  the  following  history  : — 
Three  days  previously,  in  the  afternoon,  he  had 
been  thrown  from  a  spring  van,  falling  with  his 
legs  between  the  horse  and  the  shaft  and  his  ab- 
domen across  the  shaft.  He  experienced  great 
pain,  and  shortly  afterwards  vomited.  He  pro- 
ceeded home  to  bed,  and  the  pain  and  vomiting 
increasing,  a  doctor  was  called  in,  who  administered 
a  hypodermic  of  morphia. 

Urine  was  passed  naturally  next  morning,  but 
now  the  pain  and  vomiting  became  intolerable, 
and  the  urine  had  to  be  removed  by  catheter  on 
two  occasions.  The  bowels  had  not  moved  since 
the  accident.  I  saw  him  in  hospital  on  the  morn- 
ing of  the  fourth  day  after  the  injury.  His  pulse 
was  1 10  and  poor,  temperature  ioo°,  respiration  24, 
face  dusky,  tongue  dry  and  brown,  abdomen  very 
much  distended  and  tender.  A  diagnosis  of 
general  peritonitis  was  easily  made,  and  im- 
•  mediate  operation  advised.  Before  operation  the 
stomach  was  douched  out,  removing  a  very  large 
quantity   of   "black,"   foul-smelling   fluid. 

The  abdomen  was  opened  in  the  mid-line  below 
the  umbilicus,  revealing  tremendously  distended 
intestines  and  a  uniformly  inflamed  peritoneum. 
The  distension  was  so  great  that  even  when  the 
iacision  had  been  enlarged  no  methodical  search 
could  be  made  for  the  lesion  which  had  caused  the 
peritonitis.  The  large  intestine,  and  subse- 
quently the  small  intestine,  was  drawn  out,  freely 
incised  and  emptied,  but  the  stomach  was  not 
opened  in  this  case.  A  further  search  revealed 
a  haematoma  in  the  mesentery  and  transverse 
mesocolon,  and  a  generally  inflamed  peritoneum, 
which  bled  in  many  places  when  handled,  but  no 


606    Tai  Medical  Press.         ORIGINAL  COMMUNICATIONS. 


June  S.  1904. 


rupture  (a)  of  any  viscera  could  be  demonstrated, 
so  I  determined  to  thoroughly  douche  out  the 
cavity  and  drain  as  in  the  previous  case.  After 
operation  a  catheter  was  passed,  and  drew  off 
urine,  which  contained  a  slight  amount  of  blood. 
The  urine  obtained  during  the  next  thirty-six  hours 
gave  a  faint  reaction  with  the  guaiacum  test,  and 
then  became  normal. 

The  patient  passed  a  good  afternoon,  but  during 
the  night  vomited  a*  quantity  of  dark  green  ma- 
terial Next  day  the  pulse  ranged  between  100 
and  112,  and  frequent  and  copious  vomiting  of 
*'  black  "  fluid  set  in.  The  stomach  was  douched 
clean  at  2.30  p.m.,  and  again  in  the  evening,  when 
vomiting  had  recurred.  During  the  early  part  of 
the  night  vomiting  again  recurred,  and  the  stomach 
was  douched  on  two  occasions.  The  history  sub- 
sequent to  this  was  uneventful,  and  the  boy  is 
now  quite  well  and  allowed  to  sit  up.  (Since  this 
was  written  the  boy  has  returned  to  work.)  In 
describing  the  treatment  of  these  cases  I  have 
not  referred  to  the  ordinary  stimulants,  enemata, 
&c,  which  are  known  to  all,  and  are  given  accord- 
ing to  indications,  but  I  wish  to  draw  attention 
to  a  few  measures  which  are  not  generally  adopted. 
Advice  which  I  have  often  heard,  and  which  I 
used  to  give,  was  :  (1)  If  a  patient  who  suffers  from 
general  peritonitis  is  in  fairly  good  condition,  do  a 
thorough  cleansing  operation,  but  if  the  patient 
shows  signs  of  advanced  infection,  either  do  nothing 
or  else  open  and  drain,  doing  little  more  for  fear 
of  hastening  death.  (2)  If  you  cut  down  upon  a 
perforated  appendix  or  stomach,  and  find  what 
appears  to  be  localised  extravasation,  mop  it  up, 
and  do  not  explore  the  whole  peritoneal  cavity 
for  fear  of  carrying  infection  to  parts  that  might 
possibly  be  clean.  (3)  Having  operated,  let  the 
patient  alone  as  much  as  possible,  and  if  Nature 
does  not  cure,  let  him  die  as  easy  as  morphia  can 
render  him. 

My  answer  to  advice  of  this  kind  now  is  :  ( 1 ) 
Every  patient  who  suffers  from  general  peritonitis 
requires  a  thorough  operation.  The  worse  the 
symptoms  are,  the  more  we  must  do  to  relieve 
them.  When  a  patient  is  very  bad  we  must  not 
do  less,  but  work  more  speedily.  It  is  no  use  in- 
terfering if  we  put  a  patient  back  to  bed  with  a 
half-cleansed  peritoneum  and  intestines  full  of 
poisonous  and  paralysing  gases.  (2)  To  merely 
mop  up  what  we  hope  may  be  a  local  extravasa- 
sion,  and  trust  to  luck,  is  not  surgery  in  my  opinion. 
There  is  far  less  danger  in  re-cleansing  the  hands 
and  exploring  the  pelvis  and  upper  abdomen  if 
the  symptoms  have  been  at  all  general,  and  if  the 
limiting  adhesions  appear  light  in  character. 
(3)  After  operation,  give  as  little  morphia  as 
possible,  and  douche  out  the  stomach  repeatedly 
if  vomiting  or  flatulent  distension  of  the  stomach 
is  present. 

With  regard  to  drainage.  In  cases  arising  from 
stomach  perforation,  if  they  have  been  thoroughly 
cleansed,  drainage  need  not  be  used,  but  in  infec- 
tion from  other  sources  drainage  by  means  of 
gauze  is  necessary,  and,  in  spite  of  what  many 
authorities  say,  large  quantities  of  fluid  drain 
away  for  twenty-four  to  forty-eight  hours.  The 
drain  can  be  withdrawn  on  the  second  day  after 
operation  and  the  sutures  tied. 


(a)  It  it  very  possible  thai  the  peritonitis  fen  this  case  was  due  to 
injury  of  the  pancreas,  which  at  operation  lay  behind  the  hema- 
toma described  as  being  in  the  mesentery  and  transverse  mesocolon. 


DELAYED   CHLOROFORM 
POISONING,  (a) 

By  HAROLD  J.  STILES,  M.B.,  F.R.C.S.Ed.. 
Surgeon,  Hospital  tor  «c*  Children.  Edinburgh,  Ac,  Ac.. 

AND 

stuart  Mcdonald,  m.b.,  M.R.c.p.Ed., 

Assistant  Pathologist,  Royal  loflnnary,  Btfnborf hr  Ac,  Ar. 

Mr.  Stiles,  on  behalf  of  himself  and  Dr. 
McDonald,  said  although  the  occurrence  of 
delayed  chloroform  poisoning  had  long  been 
recognised  in  Germany,  Dr.  Leonard  Guthrie 
was  the  first  to  direct  attention  to  the  subject  in 
this  country.  His  paper  in  1894  was  entitled 
"Some  Fatal  After-Effects  of  Chloroform  in 
Children."  In  a  second  paper,  published  in 
1903,  Guthrie  brought  forward  further  obser- 
vations in  support  of  his  contention  that  the 
fatty  changes  met  with  in  delayed  chloroform 
poisoning  are  not  due  to  the  action  of  chloroform 
alone  ;  he  maintains  that  the  liver  is  in  an  ad- 
vanced state  of  fattiness  previous  to  the  ad- 
ministration of  the  chloroform,  and  that  the  latter, 
by  diminishing  oxidation,  already  deficient,  deter- 
mines the  state  of  functional  inadequacy  which 
sets  up  an  auto-intoxication  due  to  the  accumu- 
lation of  ptomaines  or  toxins. 

Mr.  Stiles  then  described  the  clinical  history 
and  pathological  changes  in  two  children  who 
died,  the  one  three  days  after  operation  for  the 
radical  cure  of  hernia,  and  the  other  twenty- 
six  hours  after  an  osteotomy  for  knock-knee. 
It  was  shown  that  death  could  not  have  resulted 
either  from  carbolic  acid  poisoning,  from  fat 
embolism,  or  from  sepsis.  In  the  osteotomy  case 
the  fat  emboli  in  the  lungs  were  only  present  in 
the  smallest  vessels,  and  were  so  scarce  that  death 
could  not  be  attributed  to  them.  It  was  interesting 
to  note  that  some  of  the  sublobular  and  hepatic 
veins  contained  a  considerable  amount  of  oil,  for 
the  most  part  in  free  droplets,  but  occasionally 
in  the  interior  of  what  were  evidently  disintegrated 
liver-cells.  No  fat  was  demonstrated  in  branches 
of  the  hepatic  artery,  nor  could  any  be  discovered 
on  the  aortic  side  of  the  circulation.  It  was 
evident,  therefore,  that  the  fat  in  the  lungs  was 
derived  from  that  which  had  gained  access  into 
the  hepatic  veins  from  the  disintegrated  liver- 
cells.  « >  4qg| 

The  possibility  of  sepsis  was  carefully  considered. 
Lantern  slides  and  microscopical  specimens  (ob- 
tained from  a  child  who  died  from  a  gangrenous 
inflammation  of  the  oesophagus  following  operation 
for  perityphlitis^  were  demonstrated  to  show 
how  closely  the  degenerated  changes  in  the  liver, 
kidneys,  and  heart  resembled  those  which  are 
said  to  be  characteristic  of  delayed  chloroform 
poisoning.  In  neither  condition  were  there  any 
inflammatory  changes  in  the  glomeruli.  The 
fact  was  emphasised  that  the  same  degenerative 
changes  are  sometimes  present  in  patients  who 
have  died  after  operations  for  septic  conditions, 
especially  of  abdominal  origin,  as  are  found  in 
patients  who  have  died  from  delayed  chloroform 
poisoning  uncomplicated  with  sepsis. 

The  hope  was  expressed  that  pathologists  would 
inquire  more  closely  into  the  nature  and  causation 
of  the  degenerative  changes  to  be  found  in  the 
above-mentioned  organs  in  surgical  cases. 

Unfortunately  the  pathology  and  symptoms  of 

(a)  Abstract  of  a  Paper  read  at  the  tiociety  for  toe  (ttudy  of  Dis- 
ease in  Children,  May  20th,  1904. 


June  8.  1904. 


delayed  chloroform  poisoning  had,  up  to  recently, 
been  either  overlooked  or  wrongly  interpreted, 
so  that  the  mortality  could  not  be  estimated  until 
the  condition  had  become  generally  recognised 
by  surgeons  and  pathologists.  With  one  excep- 
tion the  cases  recorded  in  this  country  had  all 
occurred  in  children  while  under  treatment  either 
in  the  Paddington  Green  Children's  Hospital  or 
in  the  Royal  Edinburgh  Hospital  for  Sick  Children, 
these  being  two  hospitals  where  special  attention 
had  been  directed  to  the  condition.  In  Germany, 
on  the  other  hand,  almost  all  the  reported  cases 
had  been  in  adults,  and  the  greater  proportion 
of  these  had  occurred  after  a  somewhat  severe 
operation  for  infective  abdominal  conditions,  such 
as  suppurative  salpingitis,  appendicitis,  &c.  The 
element  of  sepsis  with  which  these  cases  are 
complicated  renders  it  difficult,  in  the  present  state 
of  our  knowledge,  to  say  how  far  they  help  to 
solve  the  problem  of  delayed  chloroform  poisoning. 
If  it  could  be  shown  that  the  critical  condition 
(persistent  vomiting  of  a  more  or  less  hemor- 
rhagic type ;  small,  rapid,  and  often  irregular  pulse ; 
extreme  restlessness,  collapse,  &c.)  in  which  they 
occasionally  found  patients  forty-eight  hours  or 
so  after  operation  is  in  any  way  brought  about 
by  degenerative  changes  set  up  by  the  chloro- 
form, the  question  of  substituting  ether  would 
have  to  be  seriously  considered  even  in  the  case 
of  children  Unfortunately,  however,  the  mor- 
tality in  children  from  the  effects  of  ether  on  the 
respiratory  tract  "would  probably  be  as  great,  if  not 
greater,  than  that  due  to  the  after-action  of 
chloroform. 

►  It  was  not  thought  that  Dr.  Guthrie  had  brought 
forward  sufficient  evidence  to  show  that  the  fatty 
change  here  described  was  the  essential  predis- 
posing factor,  and  that  the  chloroform  merely 
acted  as  the  "  last  straw."  It  was  thought  much 
more  probable  that  the  fatty  change  was  entirely 
due  to  the  chloroform  acting  on  a  previously 
healthy  liver ;  indeed,  experimental  evidence 
seemed  to  give  strong  support  to  this  possibility. 
Moreover,  while  the  changes  in  the  liver  were  so 
striking  it  must  not  be  forgotten  that  other  organs 
gave  evidence  of  a  general  toxic  poisoning,  and 
it  seemed  hardly  justifiable,  therefore,  to  attribute 
the  fatal  result  to  hepatic  insufficiency.  Fatal 
cases  of  delayed  chloroform  poisoning  were  un- 
doubtedly very  rare,  and  it  would  appear,  there- 
fore, that  idiosyncrasy  was  the  main  factor  in  their 
causation  just  as  it  was  in  the  irreducible  minimum 
of  deaths  which  occur  during  chloroform  anaethesia. 
As  regards  the  treatment  of  delayed  chloroform 
poisoning  the  authors  entirely  agree  with  Guthrie 
in  strongly  condemning  the  use  of  morphia. 
Rectal  and  subcutaneous  injections  of  normal 
saline  solution  and,  if  necessary,  intravenous 
injections  must  be  employed.  If  the  vomiting 
were  copious  the  stomach  should  be  washed  out, 
and  an  endeavour  should  be  made  to  get  it  to 
retain  some  calomel  or  grey  powder.  Cardiac 
stimulants  must  be  used,  but  in  moderation 


THE  OUT-PATIENT  DEPARTMENTS.   The  Medical  Press.    607 


XTbe  ®ut*pattent  Departments. 

WEST  LONDON  HOSPITAL. 

Dermatological   Cases   under  the  Care   of   Dr. 

P.  S.  Abraham. 

(Reported  by  Dr.  G.  N.  Meachen.) 

Case    I. — Herpes    Zoster     following     Injury. — The 

patient  was  a  little  boy,  aet.  4,  who  came  with  an 

eruption  upon  the  left  elbow  and  hand.     The  history 


was  that  he  had  cut  the  left  forefinger  with  a  knife  a 
week  ago.  Three  days  after  the  injury  "blisters" 
were  noticed  upon  the  elbow  and  finger,  the  little  fellow 
being  at  the  same  time  restless  and  feverish. 

On  examination,  a  typical  herpetic  eruption  was 
seen  covering  the  back  of  the  elbow,  and  discrete, 
grouped  vesicles  were  present  upon  the  extensor  sur- 
face of  the  left  index  finger,  the  skin  over  which  was 
erythematous.  The  forearm  itself  was  free  from  any 
rash.    The  axillary  glands  were  not  enlarged. 

The  case  is  interesting  as  tending  to  illustrate  the 
close  connection  that  exists  between  herpetic  eruptions 
in  general  and  affections  of  the  nerve-trunks.  Since 
the  announcement  of  the  neurotrophic  theory  by 
Barensprung  many  cases  of  herpes  zoster  have  been 
recorded  in  which  the  association  with  various  forms 
of  nerve  disorder  has  been  more  than  accidental. 
What  the  exact  tnateries  morbi  which  affects  the  pos- 
terior spinal  root  ganglia,  and  sometimes  the  Gasserian 
ganglion,  may  be  is  as  yet  doubtful,  but  it  is  a  definite 
clinical  fact  that  the  eruption  frequently  appears  upon 
areas  of  the  skin  the  trophic  condition  of  which  has 
been  impaired  by  the  presence  of  some  nerve  lesion, 
whether  this  be  functional  or  organic.  In  the  case  of 
this  boy,  we  have  a  direct  history  of  injury,  the  shock 
of  which  may  have  been,  and  in  all  probability  was, 
the  exciting  cause  of  the  outbreak.  The  lesions  gra- 
dually resolved  under  the  application  of  a  simple 
ointment. 

Case  II. — Alopecia  Areata  with  Hyphogenic  Sycosis. — 
A  man,  aet.  40,  came  with  a  bald  patch  upon  the  left 
side  of  the  back  of  his  head  which  had  been  present 
for  three  months.  For  the  last  six  weeks  he  had  also 
suffered  from  an  irritable  eruption  of  the  chin  and  neck, 
accompanied  with  the  formation  of  numerous  pustules. 
He  was  not  in  the  habit  of  shaving  himself. 

On  inspection,  he  was  seen  to  have  an  extensive 
condition  of  sycosis  affecting  the  beard-region  and 
adjacent  parts.  Some  of  the  hairs  were  observed  to 
be  of  a  stumpy  character,  and  on  epilation  their  sheaths 
were  greatly  thickened.  Under  the  microscope  a 
dense  network  of  tricophytic  mycelium  was  found  both 
in  the  sheath  and  also  upon  the  hair-shaft.  There  was 
a  patch  of  typical  alopecia  areata,  about  three  inches 
in  diameter,  in  the  left  parieto-occipitai  region  of  the 
scalp.  The  surface  of  this  was  quite  smooth.  A  few 
hairs  at  the  margin  of  the  patch  were  of  the  "  point  of 
exclamation  "  type,  but  none  were  found  to  contain 
any  spores. 

As  an  example  of  the  co-existence  of  two  entirely 
different  cutaneous  lesions  this  case  is  worthy  of  note. 
Both  conditions  are  affections  of  the  hair  system,  but 
it  is  only  the  sycosis  that  is  of  a  parasitic  nature.  The 
whole  scalp  presents  some  evidences  of  seborrhoea. 
therefore  it  is  safe  to  assume  that  in  the  case  of  this 
man  the  alopecia  is  of  microbic  origin.  In  many  cases 
of  the  latter  disease  the  same  micro-bacillus,  definitely 
associated  by  Unna  with  seborrhoea,  has  been  found  in 
alopecic  hairs  and  also  in  the  hair-follicles  themselves. 
The  frequency  with  which  parasitic  affections  of  the 
beard-region  can  be  traced  to  a  visit  to  the  barber, 
especially  in  poor  districts,  furnishes  the  strongest  argu- 
ment for  the  establishment  of  the  aseptic  system  in  all 
hair-cutting  saloons.  Happily,  the  importance  of  this 
principle  is  at  last  beginning  to  be  recognised  by  the 
more  enlightened  members  of  the  tonsorial  craft. 
This  patient  was  given  an  ointment  of  carbolic  and 
salicylic  acids  for  inunction  into  both  the  scalp  and 
the  face,  and,  in  addition,  a  paint  of  cinnamon  oil  for 
the  bald  patch. 

Case  III. — Pruritus  of  the  Scalp. — A  single  woman, 
aet.  7$,  complained  of  great  itching  of  her  scalp  com- 
bined with  a  sensation  as  if  "  something  were  moving 
about "  in  her  head.  She  had  a  very  nervous,  frigh- 
tened aspect.  She  had  had  influenza  twice.  There 
was  some  exophthalmos.  The  pulse  was  not,  however, 
specially  rapid,  and  it  was  quite  regular.  The  tongue 
was  normal,  and  there  was  no  oedema  of  the  feet. 
Nothing  objective  whatever  could  be  seen  upon  the 
scalp,  for  there  were  no  evidences  of  seborrhoea  or 
pediculi  capitis.     The  thyroid  gland  was  not  enlarged. 


6o&    The  Mxdical  Pibss. 


TRANSACTIONS  OF  SOCIETIES. 


June  8,  1904. 


Itching  of  the  scalp  unaccompanied  by  any  cutaneous 
lesion,  as  in  this  case,  is  not  common.  It  is  often  of 
the  nature  of  a  neurosis,  and,  considering  the  patient's 
nervous  condition  it  is  probable  that  this  is  the  ex- 
planation of  her  trouble.  The  possibility  that  it  may 
be  an  early  symptom  of  Graves'  disease  must  also  be 
borne  in  mind,  for  in  that  affection  disturbances  of 
sensation  in  the  shape  of  pruritus  are  not  unfrequently 
encountered.  A  little  dilute  white  precipitate  oint- 
ment was  prescribed  for  local  application,  rather  for 
its  moral  effects  than  for  any  therapeutic  purpose. 

Transactions  of  Societies. 


SOCIETY  FOR  THE  STUDY  OF  DISEASE  IN 

CHILDREN. 

Special  Meeting,  held  May  20TH,  1904. 


Mr.    Watson    Cheyne,    C.B.,    F.R.S.,    in    the  Chair. 

A  CASE  OF   CONGENITAL   DILATATION  OF  THE  COLON 

in  a  boy,  aet.  6,  was  shown  by  Dr.  George  Carpenter. 
The  child  had  suffered  from  chronic  constipation  since 
birth,  and  its  abdomen  had  increased  in  size  from 
a  year  old.  The  child  was  ruddy,  thin,  and  with 
somewhat  pinched  features.  The  abdomen,  which 
was  large  and  tympanitic,  measured  twenty-seven 
inches,  and  large  coils  of  moving  intestines  were 
visible  under  the  abdominal  walls.  An  expression 
of  (opinion  was  asked  as  to  the  advisability  of  surgical 
interference. 

•  *Mr.  Watson  Cheyne  was  in  favour  of  simple 
colotomy. 

A  communication  on  Delayed  Chloroform  Poisoning 
was  read  by  Mr.  Harold  Stiles  and  Dr.  Stuart 
McDonald.  An  abstract  of  this  paper  will  be  found 
on  page  606. 

The  Chairman  (Mr.  Watson  Cheyne)  said  that  he 
was  still  not  quite  convinced  that  the  chloroform 
was  the  only  causative  factor  in  these  cases,  and  that 
they  must  be  looked  on  as  after-effects  of  the  administra- 
tion of  that  anaesthetic.  Although  he  had  had  two  or 
three  cases  at  Paddington  Green  Children's  Hospital, 
Mr.  Cheyne  thought  it  very  remarkable  that  he  had 
never  met  with  similar  occurrences  either  at  King's 
College  Hospital  or  in  private  practice.  The  extremely 
short  administration  in  some  of  the  cases,  for  example, 
tenotomy,  and  the  minute  dose  administered,  made 
it  very  difficult  to  believe  that  the  chloroform  was  the 
cause  of  the  fatal  result. 

Dr.  Leonard  Guthrie  thought  that  the  frequency 
of  these  fatalities  following  operations  under  chloroform 
upon  children  might  be  greater  than  was  indicated 
by  the  number  of  cases  recorded  in  this  country.  Ten 
years  previously  he  had  published  in  the  Lancet  a  series 
of  ten  cases,  nine  of  which  had  happened  at  the  Children's 
Hospital,  Paddington  Green.  Since  then,  three  more 
had  occurred  at  the  same  institution.  He  doubted 
whether  such  experience  was  unique.  Possibly  a 
search  in  the  archives  of  other  children's  hospitals 
might  reveal  more  cases  of  a  similar  nature.  The  case 
against  chloroform  was  that  prolonged  and  repeated 
inhalation  of  that  anaesthetic  produced  in  animals 
profound  fatty  changes,  not  only  in  the  liver  but  in  the 
kidneys  and  other  organs,  and  that  such  changes  were 
almost  constantly  found  in  children  dying  in  the 
manner  described  after  operations  under  chloroform. 
But,  on  the  other  hand,  it  was  difficult  to  conceive  that 
such  extreme  fatty  changes  could  be  induced  by  the 
small  amounts  of  chloroform  absorbed  during  a  period 
of  anaesthesia  which  in  some  cases  did  not  exceed  a 
quarter  of  an  hour  or  twenty  minutes.  Hence  he' 
inclined  to  the  view  that  a  fatty  condition  of  the  liver 
was  pre-exist  en  t  at  the  time  of  operation  in  such  cases, 
that  chloroform,  by  its  deoxidising  powers,  aggravated 
and  intensified  the  fatty  changes  present,  and  thus 
rendered  the  liver  incapable  of  dealing  with  toxins 
entering  the  portal  system  from  the  intestines.  The 
result  was  that  such  toxins  passed  into  the  general 
circulation  and  could  not  be  eliminated  on  account  of 
the  specific  action  of  the  chloroform  on  the  kidneys 


The  r6le  of  the  chloroform  was  therefore  that  of  the 
"  last  straw."  The  existence  of  such  fatty  livers  might 
be  suspected  though  it  could  not  be  proved  by  the  his- 
tory of  so-called  "  bilious  attacks,"  characterised  by 
vomiting,  headache,  epigastric  pain,  diarrhoea,  or 
constipation,  associated  with  the  odour  of  acetone  in  the 
breath  and  urine.  When  such  a  history  was  obtained, 
ether  should  be  the  anaesthetic  used,  as  experiments 
on  animals  showed  that  ether  possessed  the  power  of 
inducing  fatty  changes  to  a  far  less  extent  than  chloro 
form. 

Dr.  Hewitt  had  never  seen  any  cases  at  all  com- 
parable to  these.  He  supported  Dr.  Guthrie's  request 
for  an  inquiry,  on  account  of  the  extreme  importance 
of  the  subject  to  the  profession.  He  suggested  that  one 
of  the  children's  hospitals  change  its  customary 
anaesthetic  for  one  or  two  years  to  a  mixture  of  chloro- 
form and  ether,  in  order  to  observe  the  results. 

Mr.  Burgh ard  remarked  that  in  one  of  Dr.  Guthrie's 
case3  at  Paddington  Green,  on  which  he  had  operated, 
the  notable  thing  was  that  death  occurred  after  the 
second  time  of  operating.  The  case  was  one  of  a  very 
large  naevus  of  the  chest  and  arm,  and  the  first  operation, 
which  had  taken  place  several  weeks  before,  was  much 
the  longer  and  more  severe  of  the  two  ;  nevertheless  the 
child  recovered  without  a  symptom  of  any  sort  referable 
to  chloroform  administration. 

Dr.  Silk  confessed  that  he  had  been  very  sceptical 
with  regard  to  Dr.  Guthrie's  first  paper  ten  years  ago ; 
he  was  now  very  astonished  to  find  that  it  had  been 
discovered  in  Edinburgh,  of  all  places,  that  quite 
possibly  chloroform  might  produce  some  ill-effects.  He 
commented  on  the  occurrence  of  the  condition  only  in 
older  children,  in  spite  of  the  fact  that  chloroform  was 
given  to  very  large  numbers  of  infants.  It  was  strange 
also  that  no  relation  could  be  established  between 
the  size  of  the  dose  administered  and  the  production  of 
the  condition. 

Mr.  Noble  had  administered  two  of  the  anaesthetics 
in  Dr.  Guthrie's  cases.  Perhaps  these  cases  were 
commoner  than  was  usually  supposed.  He  now 
thought  that  two  deaths  he  witnessed  at  Great  Ormond 
Street,  when  house  surgeon  there,  were  probably  due 
to  this  condition. 

Mr.  McCardie  (Birmingham)  had  never  seen  a  case, 
although  he  remembered  the  death  of  a  patient  on  the 
fourth  day  after  similar  symptoms ;  however,  no 
autopsy  took  place.  Froster  had  described  two  cases 
of  parenchymatous  degeneration  due  to  chloroform 
administration,  and  showing  slight  albuminuria, 
vomiting,  and  collapse  before  death.  Fatty  changes 
were  found  in  the  heart,  liver,  and  kidneys.  That 
author  lays  stress  on  the  kidney  lesions,  especially 
on  the  fact  that  they  were  more  advanced  in  the 
tubules  than  in  the  glomeruli,  which  was  a  diagnostic 
feature.  He  wondered  whether  such  conditions  were 
more  apt  to  occur  in  lymphatic  children,  as  they  stood 
most  adverse  influences  worse  than  other  children. 
The  moral  was  to  always  use  ether  in  children. 


THE    MEDICO-PSYCHOLOGICAL    ASSOCIATION 
OF  GREAT  BRITAIN  AND  IRELAND. 

At  the  spring  meeting  of  this  Association,  held  in 
Dublin,  after  the  completion  of  election  of  officers  and 
other  formal  business,  Dr.  Drapes  read  a  paper  on 
a  case  of 
acute  hallucinatory  mania  op  traumatic  origin. 

The  patient,  a  man,  aet.  36,  healthy  save  for  some 
left-sided  deafness  and  otorrhoea  (the  result  of  accident), 
received  a  blow  on  the  head  while  playing  hockey.  He 
experienced  difficulty  in  walking  next  day  and  began 
to  suffer  from  severe  occipital  headache,  with  rise  of 
temperature.  These  passed  off  in  a  few  days,  and 
about  a  fortnight  later  he  was  able  to  go  into  the 
country.  He  at  once  became  worse,  the  headache  re- 
turned, he  was  restless,  and  in  a  week  was  delirious, 
with  hallucinations,  though  all  through  he  was  rational 
at  times.  He  gradually  recovered,  and  was  mentally 
well  about  six  weeks  after  the  onset  of  mental  symptoms. 
He  was  able  to  give  a  most  vivid  account  of  his  hallu- 
cinations, which  assumed  the  shape  of  orderly  sequences 


Junk  S,  1904. 


TRANSACTIONS  OF  SOCIETIES.      The  Medical  Press.    609 


of  events,  somewhat  like  dreams,  but  more  vivid. 
The  latter  took  the  form  of  startling  adventures,  mostly 
terrifying  and  unpleasant,  which  involved  combined 
hallucinations  as  real  to  the  patient  as  the  events  of 
ordinary  life.  Dr.  Drapes  was  of  opinion  that  the 
pathological  condition  was  a  slight  meningo-cerebritis, 
which  acted  by  abolishing  the  higher  mental  centres, 
while  the  lower  were  irritated  into  increased  activity. 
The  prevalence  of  delusions  of  persecution  and  suspicion 
he  considered  to  be  explicable  as  a  reversion  to  primeval 
conditions. 

Dr.  Conolly  Norman  was  of  opinion  that  as  the 
patient  was  able  at  times  to  concentrate  his  attention 
and  to  reply  rationally  when  addressed,  it  was  incom- 
patible with  Dr.  Drapes'  theory  of  the  genesis  of  the 
hallucinations.  It  was  interesting  that  some  of  the 
hallucinations  so  strongly  resembled  those  of  toxic 
origin. 

The  paper  was  also  discussed  by  Drs.  Rainsford, 
Eustace,  and  Leeper ;   and  Dr.  Drapes  replied. 

EPILEPTIFORM   SEIZURES. 

Dr.  Rainsford  described  two  cases  in  which  epilepti- 
form seizures  had  occurred.  The  first  was  that  of  a 
lady,  aet.  57,  suffering  from  attacks  of  recurrent  mania 
at  intervals  of  three  or  four  months.  In  one  of  these 
epileptiform  seizures  appeared,  and  she  had  282  in  all, 
and  was  thought  to  be  dying  for  four  days.  The  fits 
ceased  under  hypodermic  injections  of  morphine,  but 
were  followed  by  a  six  weeks'  attack  of  acute  mania. 
Since  then  she  had  remained  physically  well  for  three 
years,  but  was  slightly  demented.  The  other  case  was 
that  of  an  imbecile  boy,  aet.  13^,  who  suddenly  deve- 
loped fits  at  school.  He  was  sent  to  hospital,  where 
the  fits  continued,  but  he  was  so  troublesome  and  in- 
subordinate that  he  had  to  be  discharged.  At  the 
Stewart  Institution,  to  which  he  was  then  admitted, 
the  reality  of  the  fits  was  doubted,  and  the  threat  of 
being  douched  with  cold  water  put  an  end  to  them. 
The  boy  was  now  doing  well. 

Dr.  Drapes  regarded  the  second  case  not  as  one  of 
malingering,  but  as  due  to  a  neurotic  condition. 

Dr.  Norman  considered  the  treatment  of  mania  and 
pseudo-epileptic  states  with  morphine  to  be  dangerous. 

Drs.  Woods  and  Fitzgerald  also  joined  in  the  dis- 
cussion. 

Dr.  Rainsford,  in  replying,  said  that  he  considered 
the  second  case  to  be  one  of  hysteria. 

Dr.  Eustace  read  an  account  of  a  case  of 
dementia  precox. 

The  patient  was  a  boy,  aet.  20,  with  some  neurotic 
heredity,  who  had  always  been  excitable,  idle,  and  con- 
ceited, a  confirmed  masturbator,  and  very  eccentric. 
He  became  restless  six  weeks  before  admission,  and 
then  maniacal,  with  quick  pulse  and  high  temperature. 
Delusions,  chiefly  of  a  religious  and  grandiose  type,  were 
present.  In  about  three  weeks  stupor  appeared,  and 
from  that  time  had  alternated  with  excitement,  while 
various  katatonic  symptoms — verbigeration,  catalepsy, 
""jargon  aphasia,"  mannerisms,  &c— developed  from 
time  to  time.  Thyroid  administration  proved  of  no 
value,  and  after  about  seven  months  the  patient  was 
no  better  mentally,  though  his  memory,  understanding, 
■and  perceptive  powers  were  good.  He  therefore  was 
an  excellent  example  of  this  form  of  mental  disease. 

Dr.  Leeper  expressed  his  opinion  that  the  disease 
was  incurable.  His  experience  with  thyroid  had  also 
been  unfavourable. 

Dr.  Norman  thought  that  too  many  cases  had  been 
classed  as  dementia  precox,  and  therefore  as  of  bad 
prognosis,  but  cases  showing  an  alternation  of  excite- 
ment and  stupor  were  unfavourable.  He  considered 
cases  of  the  melancholic  type  more  likely  to  recover. 

Dr.  Drapes  also  spoke,  and  Dr.  Eustace  replied. 

Dr.  Conolly  Norman  exhibited  two  patients  suffer- 
ing from  unilateral  deafness,  with  auditory  hallucina- 
tions of  the  same  side. 


There  were  twenty-seven  cases  of  plague  and 
twenty-seven  deaths  in  Hong  Kong  for  the  week 
ending  Mav  28th. 


NORTH-EAST     LONDON     CLINICAL     SOCIETY. 
Meeting  Held  Thursday,  June  2nd,  1904. 


Dr.   J.  W.   Hunt,  President,  in  the  Chair. 

Dr.  Norman  Meachbn  showed  a  married  woman, 
aet.  35,  the  subject  of 

SCLERODERMA  AND  ALOPECIA  AREATA. 

She  was  also  an  epileptic.  The  sclerodermic  area 
extended  vertically  across  the  forehead  to  the  left  of  the 
middle  line,  and  at  its  upper  extremity  it  shaded  im- 
perceptibly into  a  small  patch  of  alopecia  areata, 
Pressure  upon  the  lower  end  of  the  band  caused  sensa- 
tions resembling  those  of  an  aura.  The  condition  had 
been  slowly  progressing  for  a  year. 

Dr.  A.  J.  Whiting,  under  whose  care  she  had  been 
for  her  nervous  condition,  considered  that  the  case  was 
closely  allied  to  those  in  which  scleroderma  was  co- 
existent with  facial  hemi-atrophy.  This  patient's 
nasal  septum  was  markedly  deflected  towards  the  left. 

The  President  remarked  upon  the  absence  of  the 
violaceous  tint  sometimes  seen  in  localised  scleroderma. 

Dr.  R.  Murray  Leslie  showed  a  man,  aet.  35,  with  a 
cerebral  tumour  producing  symptoms  of  right  hemi- 
plegia. There  was  tenderness  upon  percussion  over  the 
left  Rolandic  area  of  the  skull,  and  double  optic  neuritis. 
He  had  improved  to  some  extent  upon  the  internal 
administration  of  potassium  iodide. 

Mr.  Herbert  Carson  thought  that  the  case  was  one 
of  gumma,  on  account  of  the  multiplicity  of  the 
lesions,  and  suggested  larger  doses  of  the  iodide. 

Dr.  Whiting  stated  that  improvement  often  took 
place  in  the  earlier  stages  of  sarcoma.  A  pontine  lesion 
might  cause  incontinence  of  urine,  such  as  this  man 
presented,  but  not  a  lesion  of  the  Rolandic  area  of  the 
cortex.  Moreover,  his  facial  paralysis  was  most 
marked  upon  smiling,  which  rather  tended  to  indicate 
a  lesion  of  the  basal  ganglia.  He  thought  that  an  opera- 
tion should  be  undertaken,  in  view  of  the  increasing 
failure  of  vision. 

Dr.  Leslie  also  showed 

TWO   CASES    OF   DEXTROCARDIA. 

The  first  was  in  a  man,  aet.  64,  who  also  had  a  deficiency 
of  the  third  and  fourth  ribs  upon  the  left  side  (?)  of 
congenital  origin.  The  second  occurred  in  a  man, 
aet.  48,  as  the  result  of  the  contraction  of  an  old  phthisi- 
cal cavity  at  the  right  apex. 

Dr.  Arthur  E.  Giles  suggested  that  the  absence  of 
the  ribs  opposite  to  the  heart  was  of  a  compensatory 
nature. 

The  President  asked  if  subcutaneous  resection  of  the 
ribs  might  not  have  been  performed  in  childhood  for 
empyema,  as  the  rib-cartilages  could  be  felt  and  there 
was  deficient  expansion  of  the  lung  upon  that  side. 
There  was  also  a  faint,  though  distinct,  scar  in  the 
depression  in  the  chest  wall. 

Mr.  Herbert  Carson  exhibited  an  old  lady,  aet.  79, 
previously  the  subject  of  recurrent  carcinoma  mammae, 
in  whom  he  had  twice  performed  laparotomy,  the 
first  time  for  strangulation  of  a  Meckel's  diverticulum, 
and  secondly  for  a  malignant  stricture  of  the 
descending  colon,  causing  acute  intestinal  obstruction. 
With  the  exception  of  a  slight  bronchitis  after  the 
second  operation  she  never  had  a  bad  symptom. 

Dr.  R.  B.  Marjoribanks  showed  a  little  girl,  aet.  4, 
with  cervical  ribs.  A  skiagraph  revealed  that  the  one 
on  the  right  side  was  fractured,  the  outer  fragment  being 
bent  downwards.  The  position  of  the  head  was  un- 
affected, though  at  one  time  there  was  a  suspicion  of 
some  torticollis. 

.Dr.  Giles  exhibited  (1)  a  specimen  of  tuberculosis  of 
the  Fallopian  tubes  which  he  had  removed  from  a  girl, 
aet.  12,  who  had  presented  symptoms  of  a  localised 
peritonitis  ;  (2)  a  specimen  of  an  early  tubal  abortion 
showing  the  mole  in  situ.  At  the  operation  blood 
was  seen  to  be  freely  oozing  from  the  fimbriated  extre- 
mities of  the  tubes. 

Dr.  Giles  also  showed  specimens  of  uterine  myomata 
illustrating  various  complications.  In  one  case  the 
tumour  had  almost  completely  severed  its  connection 
with  the  uterus,  with  the  exception  of  a  small  adhesion. 


6io    The  Medical  Press.        GENERAL  MEDICAL  COUNCIL. 


Juke  8.  1904, 


which  was  rather  to  be  regarded  in  the  light  of  a  pedicle, 
and  had  contracted  numerous  adhesions  to  the  over- 
lying intestines.  In  another  instance,  the  fibroid  was 
associated  with  a  left  pyo-salpinx. 

SEVENTY-NINTH  SESSION  OF  THE  GENERAL 
MEDICAL  COUNCIL. 


The  President,  Sir  William  Turner,  K.C.B.,  in  the 
Chair. 


FIFTH  DAY.— Monday,  May  30TH,  1904. 

After  the  Minutes  of  the  last  meeting  had  been 
read  and  confirmed, 

It  was  moved  by  Dr.  MacAlister,  and  seconded 
by  Dr.  Lindsay  Steven,  that  the  Council  sit  in  earner & 
for  the  President  to  make  a  statement  to  the  Council 
before  it  proceeded  to  consider  the  motion  of  which 
Sir  John  Tuke  had  given  notice. 

Registers  of  Medical  and  Dental  Students. 

On  the  readmission  of  strangers,  it  was  moved  by 
Sir  John  Batty  Tuke,  and  seconded  by  Sir  Victor 
Horsley,  that  the  Lord  President  of  the  Privy  Council 
be  requested  to  introduce  into  Parliament  a  Bill  to 
confer  on  the  General  Medical  Council  statutory  power 
to  establish  and  maintain  Registers  of  Medical  and 
Dental  Students,  and  to  impose  a  fee  not  exceeding  £1 
for  registration  therein.  The  proposer  of  the  motion 
said  that  the  General  Medical  Council  needed  money, 
but  he  hoped  for  a  reduction  in  its  expenses.  He 
considered  the  tax  proposed  on  students  a  reasonable 
one.  He  thought  that  up  to  the  present  time  a  not 
inconsiderable  number  of  students  neglected  registra- 
tion, but  if  the  Bill  passed  the  General  Medical  Council 
would  be  made  responsible  for  the  registration  of 
students,  and  would  also  have  the  power  of  making 
conditions.  Five  years  of  study,  of  which  there  was 
no  official  assurance  at  present,  would  thus  be  assured  ; 
again,  the  Council  would  be  able  to  make  certain  that 
each  student  passed  a  satisfactory  examination  in  arts. 
All  causes  of  friction  would  disappear  for  the  student, 
as  all  the  Licensing  Bodies  would  come  into  line. 

Sir  Victor  Horsley,  in  seconding,  said  that  he  did 
so  solely  from  the  point  of  view  that  the  motion  was 
of  material  interest  both  to  the  profession  and  to  the 
public.  He  considered  registration  of  medical  students 
as  essential.  He  pointed  out  that  the  autonomy  of  the 
Licensing  Bodies  would  not  be  touched  by  the  Bill, 
and  that  with  regard  to  the  General  Medical  Council 
they  had  no  autonomy. 

Dr.  Payne  considered  the  motion  as  satisfactory  in 
its  general  aspect,  but  thought  that  compulsory  registra- 
tion was  going  too  far. 

Dr.  Norman  Moore  questioned  how  the  public  would 
be  served  by  increasing  the  powers  of  the  General 
Medical  Council.  He  hoped  the  General  Medical 
Council  would  never  get  supreme  power.  He  con- 
sidered that  the  Universities  were  much  better  able 
to  judge  questions  of  medical  education  than  the 
General  Medical  Council.  He  opposed  the  motion 
because  it  would  increase  the  power  of  the  General 
Medical  Council,  and  because  it  proposed  a  fee  for 
students  with  no  return  either  to  them  or  to  the  public. 

Sir  William  Thomson  thought  the  motion  did  not 
tend  so  much  to  increase  the  power  of  the  General 
Medical  Council  as  to  bring  in  more  funds  which  were 
necessary.  He  asked  if  Dr.  Norman  Mcore  had  any 
other  scheme  for  the  latter  purpose. 

Dr.  Norman  Moore  said  that  one  scheme  was  that 
members  of  the  Council  should  not  be  paid. 

Sir  W.  Thomson  was  of  opinion  that  work  done 
should  be  paid  for,  and  besides  that,  non-payment  of 
members  of  the  Council  would  be  especially  hard  for 
those  members  who  did  not  live  in  London.  He 
pointed  out  that  a  large  number  of  the  members  of 
the  Council  were  teachers,  and  he  submitted  that  the 
Council  had  a  duty  to  discharge,  and  was  quite  as 
capable  of  discharging  it  as  any  individual  Licensing 
Body. 

Mr.  Morris  thought  the  motion  would  tend  to 
^linimise  the  powers  of  the  Licensing  Bodies  and  con- 


sidered that  the  expenses  of  the  Council  might  be  cut 
down.  He  deprecated  any  idea  of  hostility  on  the 
part  of  the  Licensing  Bodies,  and  said  that  the  Royal 
College  of  Surgeons  of  England  always  received  any 
suggestions  of  the  Council  with  deference. 

Dr.  Bennett  said  a  few  words  in  opposition. 

Dr.  MacAlister  would  have  preferred  raising  the 
fees  for  registration  of  medical  practitioners,  but 
failing  this  he  was  in  favour  of  the  motion.  With 
regard  to  the  powers  of  the  Council,  he  instanced  the 
view  taken  of  the  General  Medical  Council  at  Cam- 
bridge, where  it  is  regarded  as  a  voice  which  cannot 
be  neglected. 

Dr.  Little  was  in  support  of  the  motion.  He 
thought  the  most  important  thing  was  to  find  out  when 
a  student  begins  his  studies  and  whether  the  aspirant 
is  fit  for  them,  therefore  registration  was  very  necessary. 

Sir  Christopher  Nixon  strongly  supported  the 
motion,  and  said  that  what  the  Council  was  concerned 
in  was  that  all  persons  put  on  the  Register  should  be 
sufficiently  educated. 

Dr.  Pye  Smith  opposed  the  motion. 

Dr.  MacKay,  Mr.  Brown,  Sir  John  Moore,  and 
Sir  Hugh  Beevor  all  supported  the  motion,  especially 
with  regard  to  registration. 

The  President,  having  said  a  few  admirable  and 
temperate  words  in  favour  of  the  motion,  it  was  carried, 
22  for,  6  against,  3  absent.     The  President  did  not  vote. 

It  was  then  moved  by  Sir  Victor  Horsley,  seconded 
by  Mr. -Jackson,  and  agreed  to,  "That  the  Preliminary 
Scientific  Committee  be  re-appointed  and  instructed 
to  consider  and  report  upon  the  existing  ccrorsesXof 
study  in  the  branches  of  Elementary  Biology."  As  a 
corollary  to  this  motion,  it  was  moved  by  Dr.  McVail, 
seconded  by  Mr.  Jackson,  and  agreed  to,  "That  Sir 
Victor  Horsley  be  added  to  the  Committee." 

Moved  by  Sir  Patrick  Heron  Watson,  seconded 
by  Dr.  Little,  and  agreed  to,  "That  the  Report  from 
the  Examination  Committee  on  the  Inspection  of  the 
Final  Examination  held  by  the  Apothecaries'  Hall, 
Dublin,  in  January  last,  be  received  and  enteredxin 
the  Minutes." 

(This  Report  was  from  Mr.  Alexis  Thomson  and  Sir 
Henry  G.  rfowse  [the  Inspectors]  and  was  favourable.) 

Moved  by  Sir  Patrick  Heron  Watson,  seconded 
by  Dr.  Little,  and  agreed  to,  "That  the  Report  from 
the  Examination  Committee  on  the  Inspection  of  the 
Final  Examination  (April,  1904)  of  the  Apothecaries' 
Hall.  Dublin,  be  adopted." 

Moved  by  Sir  Patrick  Heron  Watson,  seconded  by 
Dr.  FiNLAY.and  agreed  to,  "That  the  Report  from  the 
Examination  Committee  be  received  and  entered  on 
the  Minutes."  The  Report  was  on  a  communication 
from  the  Royal  College  of  Surgeons  of  England,  having 
reference  to  the  last  Report  of  the  Visitor  and  Inspector, 
on  the  Final  Examinations  of  the  Examining  Board 
in  England.  ««•      *     • 

Moved  by  Sir  Patrick  Heron  Watson,  seconded 
by  Dr.  Finlay,  and  agreed  to,  "  That  the  Recommenda 
tion  in  the  Report  of  the  Examination  Committee  be 
adopted."  The  recommendation  was  to  the  effect.that 
the  Report  already  presented  by  V.e  Examination 
Committee  should  be  entered  in  the  Minutes  of  the 
Council  for  future  reference. 

Moved  by  Mr.  George  Brown,  seconded  by  Dr. 
Lindsay  Steven,  and  carried,  "That  the  Further  Reply 
of  the  Royal  College  of  Surgeons  of  England  to  the 
Report  of  the  Visitor  and  Inspector  of  the  General 
Medical  Council  on  the  Third  or  Final  Examination 
of  the  Conjoint  Examining  Board  in  England  be 
referred  to  the  Examination  Committee  for  further 
consideration  and  report." 

Moved  by  Sir  John  Batty  Tuke,  seconded  by  Dr. 
Norman  Moore,  and  agreed  to,  "  That  the  Report  from 
the  Education  Committee  be  received  and  entered  in 
the  Minutes."  The  Report  was  on  (1)  Ages  of  medical 
students  at  the  date  of  registration  ;  (2)  recognition  of 
certain  preliminary  examinations  ;  (3)  conference  with 
the  Consultative  Committee  en  school  lea ving examina- 
tions. 

Moved  by  Sir  Hugh  Beevor,  seconded  by  Dr.  Little, 


June  g,  1964. 


GENERAL  MEDICAL  COUNCIL. 


The  Medical  Press.    61 1 


and  agreed  to,  "  That  the  Report  by  the  Students'  Regis- 
tration Committee  be  received  and  entered  on  the 
Minutes." 

The  Resolution  in  the  Report  was  to  the  effect :  (a) 
That  the  Huddersfield  Technical  College  (day  classes) 
be  added  to  the  list  of  recognised  instituti  :ns  approved 
by  the  Council ;  (6)  (with  reference  to  the  Simon 
Langton  Schools,  Canterbury)  that  the  Committee  is 
not  empowered  by  the  Council  to  add  secondary 
schools  to  the  list  of  approved  institutions. 

Moved  by  Sir  Hugh  Beevor,  seconded  by  Dr. 
Little,  and  agreed  to,  "  That  the  Report  of  the  Students' 
Registration  Committee  be  approved." 


SIXTH  DAY.— Tuesday,  May  31ST,  1904. 

The  President,  Sir  Wm.  Turner,   K.C.B.,  in  the 

Chair. 

Moved  by  Sir  Victor  Horsley,  seconded  by  Dr. 
McVail,  and  carried,  that  Mr.  Jackson's  name  be  added 
to  the  Preliminary  Scientific  Committee.  The  Com- 
mittee then  considered  the  Report  of  the  Education 
Committee.  Moved  by  Sir  John  Tuke,  seconded 
by  Dr.  Windle,  and  carried,  that  the  Report  be 
adopted. 

The  Report  had  reference  in  Section  I  to  the  ages 
of  medical  students  on  registration.  Only  24  students 
out  of  a  total  of  1,422  in  Great  Britain  and  Ireland 
begun  professional  study  before  the  age  of  sixteen  and  a 
half,  and  in  these  circumstances  the  Committee  did 
not  think  it  necessary  at  present  to  advise  the  Council 
to  raise  the  age  at  which  registration  is  allowed.  The 
recent  increase  in  the  Council's  requirements  as  regards 
preliminary  education  had  evidently  been  effective 
in  preventing  premature  registration.  It  might  be 
inferred  that  those  registering  at  from  sixteen  to  seven- 
teen years  of  age  were  clever  or  industrious  students, 
to  whom  it  might  be  a  hardship  to  delay  the  com- 
mencement of  professional  study.  Sections  II  and 
III    dealt  with  Preliminary  Examinations. 

The  treasurer,  Dr.  Pye  Smith,  then  read  his  Report, 
which,  seconded  by  Dr.  Bennett,  was  at  once  carried. 

The  Council  then  unanimously  elected  Mr.  Tomes 
second  treasurer  with  Dr.  Pye  Smith,  Sir  P.  Heron 
Watson  and  Dr.  Bennett  being  elected  on  the  Finance 
committee,  with  the  president  and  treasurers. 

The  following  Executive  Committee  was  elected  : 
England — Dr.  MacAlister,  Dr.  Pye  Smith,  Dr.  Payne, 
Mr.  Tomes.  Scotland.— Sir  John  B.  Tuke,  Sir  P. 
Heron  Watson.  Ireland.— Sir  Chas.  B.  Ball,  Sir 
Christopher  J.  Nixon. 

The  following  Penal  Cases  Committee  was  elected  : 
England. — Sir  Victor  Horsley,  Dr.  Windle,  Mr.  Tomes, 
Sir  Hugh  R.  Beevor.  Dr.  MacAlister  tied  with  Sir 
Hugh  Beevor,  but  withdrew.  Scotland. — Dr.  Finlay, 
Sir  P.  H.  Watson.  Ireland. — Sir  Christopher  J.  Nixon, 
Sir  William  Thomson. 

Moved  by  Dr.  Bruce,  seconded  by  Sir  Chas.  Ball, 
and  carried,  that  the  Report  from  the  Pharmacopoeia 
Committee  be  received,  entered  on  the  Minutes,  and 
adopted. 

The  Report  was  to  the  effect  that  it  would  be  un- 
necessary this  year  to  print  a  fresh  issue  of  the  Pharma- 
copoeia, and  contained  also  the  notice  of  a  motion 
which  had  been  placed  on  the  Council's  programme  by 
Mr.  Jackson  referring  to  the  metric  system. 

Moved  by  Mr.  Jackson,  seconded  by  Mr.  Tichborne, 
and  carried  unanimously,  that  the  President  (with  the 
Chairman  of  the  Pharmacopoeia  Committee)  be 
requested  to  inform  the  Lord  President  of  the  Privy 
Council  that  in  the  opinion  of  the  Council  it  is  desirable 
that  after  a  sufficient  period,  to  be  fixed  by  law,  the 
metric  system  of  weights  and  measures  should  become 
the  one  legal  system  for  the  preparation  and  dispensing 
of  drugs  and  medicines ;  that  the  Council  would  view 
with  favour  the  passing  into  law  of  a  Bill  such  as  that 
now  before  Parliament  entitled  "  Weights  and  Measures 
(Metric  System)  Bill,"  and  that  in  that  event  the 
Council  would  be  prepared  to  take  all  necessary  steps 
to  give  effect  to  the  law  by  making  the  proper  [modifica- 
tions in  the  British  Pharmacopoeia. 

Moved  by  Sir  Chas.  Ball  (in  the  absence  of  Mr. 
Tomes),    seconded    by    Dr.    Lindsay     Steven,    and 


carried,  that  a  Report  be  received  from  the  Dental 
Education  and  Examination  Committee.  The  Report 
was  recommended  and  agreed  to. 

Moved  by  Sir  Chas.  Ball,  seconded  by  Mr.  Tich- 
borne, and  carried,  and  put  on  the  Minutes,  that  (1) 
copies  of  the  judgments  in  the  cases  O' Duffy  v.  Jaffe, 
Surgeon  Dentists,  Limited,  and  the  King  (Rowell)  v. 
Registrar  of  Joint  Stock  Companies,  together  with  the 
following  resolutions  of  the  General  Medical  Council,  be 
sent  to  the  Lord  President  of  the  Privy  Council  for  his 
information.  (2)  That,  in  view  of  the  judgment  of 
Chief  Baron  Palles,  the  General  Medical  Council  hope 
that  the  Government  take  such  steps  as  may  be 
necessary — (a)  To  restrain  the  Registrar  of  Joint 
Stock  Companies  from  registering  any  new  company 
Unlawfully  using  the  term  dentist  or  any  similar  title 
which  would  be  likely  to  lead  the  public  to  believe 
that  the  members  of  such  company  were  registered 
dentists  when  such  is  not  the  case.  (6)  To  prevent 
companies  already  registered  from  continuing  unlaw- 
fully to  use  the  term  dentist  or  any  similar  title  which 
would  be  likely  so  lead  the  public  to  believe  that 
the  members  of  such  companies  were  registered  dentists 
when  such  is  not  the  case,  (c)  To  in  Uke  manner 
prevent  the  use  by  companies  of  unlawful  titles  which 
would  be  likely  to  lead  the  public  to  believe  that  the 
members  of  such  companies  were  registered  medical 
practitioners  when  such  is  not  the  case. 

Moved  by  Dr.  MacAlister,  seconded  by  Sir  Victor 
Horsley,  received,  carried,  and  put  on  the  Minutes, 
communication  from  the  Privy  Council  as  to  General 
Laurie's  Bill  to  amend  the  Medical  Act,  1886.  (1)  For 
the  purposes  of  the  Medical  Act,  1886,  where  any  part 
of  a  British  possession  is  under  a  central  and  also  under 
a  local  legislature,  His  Majesty  may,  if  he  thinks  fit, 
by  Order  in  Council,  declare  that  the  part  which  is 
under  the  local  legislature  shall  be  deemed  a  separate 
British  possession.  (2)  This  Act  may  be  cited  as  the 
Medical  Act  (1886)  Amendment  Act,  1904. 

Moved  by  Dr.  Lindsay  Steven,  seconded  by  Mr: 
Brown,  and  withdrawn  for  the  present,  that  it  be 
remitted  to  the  Executive  Committee  to  consider 
and  report  to  the  next  session  of  the  Council  upon  what 
should  be  regarded  as  systematic  canvassing  on  behalf 
of  a  medical  practitioner  for  subscribers  to  a  medical 
club  instituted  by  himself  and  involving  the  employ- 
ment of  a  paid  collector  of  the  entry  money  and  the* 
subscriptions  to  the  club,  which  would  be  looked  upon, 
by  this  Council  as  constituting  the  practitioner  so* 
acting  to  have  been  guilty  of  infamous  conduct  in  a 
professional  respect.  *  ** 

Mr.  Brown's  motion  was  withdrawn.  * 

It  referred  to  the  competitive  examinations  of  the 
Royal  Navy,  of  the  medical  staff  of  the  Army,  and  the 
Indian  Medical  Service. 

Sir  Victor  Horsley's  motion  with  reference  to  the  issue 
of  medical  certificates  contrary  to  the  Medical  Acts 
was  brought  forward  in  his  absence  by  Mr.  Jackson, 
seconded  by  Dr.  Bruce,  but  was  lost. 

Moved  by  Dr.  MacAlister,  seconded  by  Dr.  Norman 
Moo  re,  and  carried,  that  in  answer  to  a  letter  the 
Council  would  be  glad  to  receive  a  written  communica- 
tion from  the  County  of  Durham  Medical  Union  ;  the 
Council  would  then  be  in  a  condition  to  decide  if  any- 
thing more  would  be  necessary. 

Mr.  Henry  E.  Allen  was  reappointed  Registrar  by 
acclamation.  A  vote  of  thanks  to  the  President  was 
then  proposed  by  Dr.  Norman  Moore,  seconded  by 
Sir  William  Thomson,  and  carried  unanimously  and 
heartily. 


A*~  telegram  received  at  the  Colonial  Office 
from  the  Cape  states  : — Plague  return  for  the 
week  ending  May  28th  is  as  follows  : — Total 
number  of  fresh  cases  reported  since  May  21st 
is  five,  all  coloured.  Five  cases  have  been  found 
not  to  be  plague,  making  present  total  of  suspected 
and  proved  cases  140 — 24  whites,  116  coloured. 
Total  number  of  deaths  reported  since  May  21st 
is  three,  all  coloured. 


612     The  Medical  Peess. 


FRANCE. 


June  8,  1904. 


Continental  DealtblResorte. 


[from  our  special  correspondent.] 

LOUECHE-LES-BAINS. 

Loueche-les-Bains,  otherwise  known  as  Leukerbad, 
is  a  village  of  about  700  German-Swiss,  situated  4,700 
feet  above  ocean-level  in  the  Dala  Valley,  Canton 
Valais,  Switzerland.  The  nearest  railway  station  is 
at  Loueche-Souste,  on  the  Jura-Sim plon  route  from 
Geneva  and  Lausanne  to  Viege  (the  junction  for 
Zermatt)  and  Brigue,  the  railroad  terminus  in  the 
upper  Rhone  Valley.  From  Loueche-Souste  station 
is  a  most  picturesque  drive  through  the  old  town  of 
Loueche.  of  two  and  a  half  to  three  hours,  to  the  bath 
village. 

Passengers  from  Lyons  and  Southern  France  come 
to  Loueche  through  Geneva.  Those  from  Paris  and 
the  Channel  ports  through  Dijon  and  Lausanne.  From 
Holland  and  the  North  of  Europe  vid  Basle  and  Lau- 
sanne. A  most  attractive  route  is  by  the  very  fine 
Lake  steamers  from  Geneva  to  Villeneuve,  continuing 
up  the*Rhone  valley  by  rail  past  Algle-les  Bains,  Bex- 
les-Bains,  St.  Maurice,  Martigny,  Sion,  and  Sierre  to 
Loueche-Souste.  Express  trains  run  from  Villeneuve, 
and  the  line  ascending  the  valley  from  the  Lake  is 
extremely  picturesque,  traversing  scenes  of  ancient 
and  historic  interest. 

Loueche-les-Bains  lies  near  the  foot  of  the  cele- 
brated Gemmi  Pass  into  the  Bernese  Oberland,  and 
is  almost  encircled  by  high  mountains,  as  the  Gemmi, 
7,685  feet  altitude  ;  the  Torrenthorn,  9,900  feet  ;  and 
Balmhopi,  12,500  feet.  The  views  in  every  direction 
are  of  unsurpassed  beauty,  the  mountain  air  pure  and 
light,  dust  absent,  and,  in  summer,  fogs  absolutely 
unknown.  Pine  forests  and  rich  flora  enrich  the 
atmosphere,  which,  from  the  sheltered  position  of 
Loueche-les-Bains,  can  be  easily  enjoyed  by  many 
who  cannot  elsewhere  pleasantly  and  healthily  bear 
such  a  high  altitude.  Apart  from  its  valuable  mineral 
springs,  this  fact  makes  Loueche  a  most  desirable 
resort  as  a  mountain  "  air-cure."  The  village  lies  on 
grassy  slopes,  well  exposed  to  the  southern  sun. 
Excellent  paths  lead  into  the  forests,  where  invalids 
can  be  readily  wheeled,  to  benefit  by  the  beautiful 
shade  and  salubrious  surroundings. 

As  an  Alpine  climatic  cure,  Loueche  can  be  stro  n 
recommended  for  certain  chest  diseases :  nervous 
asthma,  chronic  catarrh,  premonitions  of  bronchitis, 
tendency  to  and  early  stages  of  tuberculosis,  pneumonia 
and  influenza  sequelae ;  convalescence,  anaemia.' neuras- 
thenia, and  overwork  of  all  kinds.  The  chief  advan- 
tage of  Loueche  is,  nevertheless,  its  unrivalled  baths, 
which  have  been  famous  from  time  immemorial. 
More  than  a  score  of  hot  springs  rise  all  over  the 
village  site,  the  most  prominent  being  the  St. 
Laurent,  yielding  330  gallons  per  minute,  of  over 
1 24°  F.  Its  water  is  clear,  limpid,  without  smell,  and 
almost  without  special  taste.  It  is  used  unmixed  in 
the  baths,  being  cooled  to  any  temperature  prescribed 
without  any  admixture  of  other  water.  By  Lunge's 
analysis,  the  St.  Laurent  water  contains  to  the  gallon 
30*4  grains  of  various  salts,  amongst  them  sulphate  of 
lime,  22*6  grains  ;  sulphate  of  magnesia,  4*2  grains  ; 
sulphate  of 'soda,  1*3  grain;  carbonate  of  lime,  1*5 
grain  ;  carbonate  of  magnesia,  0*3  grain  ;  chlorides, 
sodium  and  potassium,  0*015  grain;  salicylic  acid, 
03  grain. 

The  Loueche  spring,  therefore,  closely  resembles  that 
of  Bath,  at  a  rather  superior  temperature.  But 
Loueche  far  surpasses  our  justly-celebrated  English 
resort  in  the  clearness  and  purity  of  its  mountain 
asmosphere,  and  as  offering  in  addition  to  its  beneficial 
waters  all  the  advantages  of  an  "  Alpine  cure  "  of  high 
excellence. 

At  Loueche  are  four  first-class  bath-houses — the 
Bains  des  Alpes  (adjoining  the  Grand  Hotel  des  Alpes, 
and  specially  reserved  for  its  guests)  ;  the  Grand  Bain 
(connected  with  the  Hotel  Maison  Blanche  and  Hotel 
Grand  Bain) ;  the  Bain  Werra  (connected  with  the 
Hotels  Bellevue,  France,  and  Union)  ;    the  Bain  Neuf 


St. 


(contiguous     to    Hdtel    Freres    Brunner).    The 
Laurent  Bath  is  a  second-class  establishment. 

The  mineral  water  is  almost  exclusively  used  ex- 
ternally in  baths,  varying  from  twenty  minutes  to  six 
hours'  duration.  These  long-duration  baths  (two  to 
six  hours)  are  the  special  feature  of  a  "  Loueche  cure." 

The  baths  can  be  taken,  as  preferred  by  each  patient, 
in  ordinary-sized  individual  bath-rooms  ;  or  in  family 
baths  for  two,  four,  or  six  persons ;  or  in  combina- 
tion, in  common  with  many  other  bathers.  In  these 
large  baths  the  ladies  and  gentlemen  are  in  separate 
piscines,  but  in  one  room.  Much  variety  of  taste 
and  style  is  manifested  in  the  cut  and  fashion  of 
the  bathing  costumes,  and  on  the  top  of  the  constantly- 
running  waters  are  floating  small  tables  available  for 
reading,  writing,  games,  and  meals.  The  "  long- 
duration  "  treatment  passes  the  more  pleasantly  in 
the  combined  baths,  where  the  conversation,  chiefly  in 
French,  is  often  agreeably  animated  (political  and 
theological  topics  being  rigidly  tabooed),  and  occasion- 
ally interspersed  by  some  competent  vocalists  acceding 
to  unanimous  requests  for  songs.  As  a  rule,  those 
patients  who  select  the  individual  bath-rooms  at  the 
commencement,  of  their  "  cure "  of  twenty-one  or 
twenty-five  days  usually  migrate  to  the  social  piscines 
before  their  terms  of  sojourn  have  finished. 

The  Loueche  combined  bathing  and  climatic  treat- 
ment gives  the  best  results  in  the  following  cases  :— 
Chronic  gout  and  rheumatism  ;  stiff,  deformed,  and 
swollen  joints  ;  muscular  pains  and  stiffness  ;  articular 
contractions,  traumatic  and  surgical ;  rheumatic 
neuralgia  and  paralysis ;  nervous  excitement ;  overwork ; 
chronic  abdominal  enlargements,  chronic  metritis ; 
chronic  uterine  congestions  ;  ovaritis  ;  vaginismus  ; 
pruritus  ;  dysmenorrhea  ;  eczemas,  lichens,  psoriasis, 
acne,  &c. 

During  the  summer  season  there  are  thoroughly 
competent  physicians  (some  speakmg  English)  resident 
at  the  Loueche  baths  who  are  well-experienced  in  the 
use  of  the  waters.  Eight  good  hotels  (at  various 
pension  prices),  belonging  to  the  Loueche  Company, 
are  under  admirable  management.  Large  public  hall 
for  entertainments,  kursaal  with  Italian  orchestra, 
reading-rooms,  concerts,  balls,  fetes,  tennis,  croquet, 
children's  gymnasium,  &c,  &c. 

For  English  and  American  visitors  and  for  tourists, 
the  Grand  H6tel  des  Alpes  is  the  favourite  house.  It 
has  all  modern  improvements,  stands  in  its  own  grounds 
and  possesses  its  own  mineral  spring  and  separate 
bath  establishment. 


france. 

[from  our  own  correspondent.] 

Paris,  June  4th,  1904. 
Mastoiditis. 

Prof.  Kermisson,  an  authority  on  the  subject, 
holds  the  opinion  that  otitis  of  the  middle  ear  is  very 
frequently  divided  into  acute  and  chronic  otitis.  The 
former  more  particularly  supervenes  after  infectious 
maladies  (scarlatina,  measles,  grippe,  or  typhoid  fever). 
Sometimes,  however,  the  malady  is  of  purely  local 
origin,  as,  for  instance,  adenoid  vegetations  compli- 
cated with  pharyngitis.  In  all  these  cases  of  infec- 
tious diseases  or  local  lesions,  inoculation  is  trans- 
mitted by  the  Eustachian  tube  into  the  middle  ear. 

Mastoiditis  is  a  frequent  complication  of  otitis.  It 
generally  accompanies  a  discharge  from  the  ear,  the 
result  of  acute  or  chronic  otitis.  But  this  discharge 
is  not  indispensable  ;  it  is  sometimes  absent.  A  pain- 
ful swelling  appears  behind  the  auricle,  tumefaction 
occurs,  due  to  mastoiditis,  although  the  ear  may  not 
have  suppurated.  At  other  times  tthe  ear  suppurates, 
but  this  generally  follows  some  acute  disease.  A 
chronic  malady,  as  tuberculosis,  can  equally  give  rise 
to  otitis,  but  in  this  case  it  is  essentially  chronic. 
Tuberculosis  attacks  the  ear  in  two  ways — either  by 


June  8,  1904. 


GERMANY. 


The  Medical  Press.    613 


the  mucous  membrane  in  producing  suppuration  of  the 
internal  ear,  or  by  the  bone,  creating  a  primary 
osteitis  of  the  petrous  portion. 

Besides  mastoiditis,  other  complications  may  succeed 
otitis.  The  conformation  of  the  middle  ear  easily 
explains  these  accidents.  Inflammation  of  the  mem- 
branes of  the  brain,  paralysis  of  the  facial  nerve,  in- 
flammation of  the  lateral  sinus,  phlebitis  with  ulcera- 
tion and  haemorrhage  of  the  sinus.  Mastoiditis  is  the 
frequent  link  between  the  lesion  of  otitis  and  all  these 
complications.  However,  the  affection  may  be  absent  ; 
cases  of  meningitis  have  been  observed  independent  of 
any  mastoiditis.  General  meningitis  can  follow  in- 
flammation of  the  ear  without  mastoiditis  ;  in  such 
cases  surgical  treatment  gives  no  result.  It  succeeds 
better  in  local  meningitis  adjacent  to  a  limited  osseous 
lesion.     Trephining  can  be  useful  in  such  a  case. 

Surgical  interference  is  also  attended  with  good 
results  in  other  circumstances — when  pus  is  collected 
between  the  sinus  and  the  dura  mater,  or  where  the 
abscess  is  seated  at  a  distance  in  the  brain  or  the 
cerebellum.  In  these  cases  a  puncture  may  effect  a 
cure.  Prof.  Kermisson  had  seven  successful  cases  of 
that  kind.  A  child  of  two  years,  operated  on  for 
mastoiditis  on  the  right  side,  presented  shortly  after- 
wards paralysis  of  the  left  arm.  There  was  neither 
fever  nor  vomiting.  Trephining  was  practised  above 
the  diseased  mastoid  bone,  and  a  needle  was  pushed 
into  the  motor  zone ;  pus  flowed  out  and  the  child 
recovered. 

Another  case  was  that  of  a  boy,  aet.  13,  who  had 
shortly  before  suffered  from  mastoiditis  and  never 
completely  recovered.  He  had  no  fever,  but  there 
existed  partial  paralysis  of  the  opposite  side  of  the 
face.  A  trepan  was  placed  on  the  mastoid  and  an 
enormous  abscess  was  evacuated.  The  patient  got 
well.  Grave  complications  have  been,  however,  re- 
corded— ulcerations  of  the  carotid  artery.  In  a  child, 
some  years  ago,  this  accident  took  place.  At  first  the 
haemorrhage  was  abundant,  but  yielded  to  plugging. 
It  returned,  and  the  child  succumbed. 

The  symptoms  of  mastoiditis  are  known — lancinating 
pain,  redness,  tumefaction  which  effaces  the  retro- 
auricular  groove  pushing  forward  the  auricle.  In 
children  the  tumefaction  is  in  general  more  marked 
than  in  the  adult,  and  this  may  be  found  in  the  exis- 
tence of  osteo-myelitis  of  the  temporal  region.  When 
the  swelling  exists,  it  must  not  be  confounded  with 
adenitis  of  the  retro-mastoidian  ganglion.  This  latter 
is  generally  the  consequence  of  impetigo  of  the  scalp. 
Different  signs'clear  up  the  diagnosis.  Firstly,  the  exis- 
tence of  the  impetigo,  then  the  commencement  of  the 
tumefaction  by  a  little  hard  mass  rolling  under  the 
fingers,  and,  above  all,  its  situation.  The  ganglion  is 
situated  rather  behind,  its  inflammation  does  not  efface 
the  retro-auricular  groove  and  does  not  project  the 
auricle  forward. 

Treatment  is  simple  enough.  A  superficial  incision 
with  the  bistouri  is  not  sufficient ;  it  must  be  carried 
to  the  periosteum.  Sometimes  this  simple  operation 
suffices,  but  in  general  trephining  ought  to  follow.  A 
long  incision  is  made  through  the  retro-auricular 
groove  to  the  bones.  Abundant  haemorrhage  will  be 
the  result,  but  can  be  controlled  by  plugging. 

The  mastoid  apophysis  is  then  denuded  with  a 
nigine,  while  the  gouge  and  mallet  attack  the  bone  as 
high  as  possible  in  young  children. 

In  children  under  five  years  of  age  the  gouge  and 
mallet  are  not  necessary.  Volkman's  curette  will 
open  the  bone  sufficiently.     The  surgeon  should,  as  a 


general  "rule,  operate  above  and  in  front  so  as  not  to 
wound  the  facial  nerve  below  and  the  lateral  sinus 
behind. 


Oermang* 

[from  our  own  correspondent.] 

Bsrliv,  Jane  4th,  1904. 

At  the  Surgical  Congress,  Hr.  Muksam  spoke  on 
Rontgen  Dermatitis. 

He  said  that  people  who  had  to  do  with  Rontgen 
rays  were  subject  not  only  to  the  three  degrees  of  burn, 
but  to  a  chronic  skin  disease  ;  the  skin  became  brittle 
and  cracked,  the  nails  became  unhealthy  and  fell  out, 
rhagades  formed  and  the  whole  affection  was  extremely 
painful.  These  symptoms  appeared  in,  a  medical 
gentleman  who  had  been  working  with  Rontgen  rays 
since  1897,  after  about  three  years.  Although  he 
ceased  working  with  the  rays  the  symptoms  did  not 
disappear.  On  the  contrary,  a  panaritium  appeared 
beneath  the  nail,  which  required  its  extraction.  The 
wound  formed  did  not  heal,  but  formed  a  large  painful 
ulcer  that  was  still  there  two  years  later.  At  the  urgent 
entreaty  of  the  patient,  the  joint  was  amputated  by 
Sonnenburg,  but  the  wound  left,  although  it  did  not 
suppurate,  took  ten  weeks  to  heal.  The  speaker 
examined  the  amputated  joint  with  the  microscope, 
and  found  changes  in  the  vessels  near  the  ulcer  (distinct 
softening  of  the  intima  and  perivascular  infiltration). 
The  case  showed  the  importance  of  prophylaxis,  as 
recovery  from  the  affection  was  so  extremely  difficult. 

Hr.  Bail  related  a  case  of  supposed 
Cerebral  Tumour. 
In  September,  1903,  a  boy,  aet.  9,  was  admitted  into  the 
Augusta  Hospital.  A  year  before  he  had  fallen  forwards, 
but  no  symptoms  were  immediately  observed.  A 
fortnight  later  a  gradually  progressing  paralysis  of  the 
right  arm  appeared,  soon  after  spasms  of  the  right  half 
of  the  body  followed  with  disturbance  of  consciousness, 
lasting  several  minutes.  These  convulsive  attacks  re- 
peated themselves  several  times  a  week,  but  once  the 
left  side  was  attacked,  and  the  seizure  lasted  several 
hours. 

The  intellect  of  the  boy  was  normally  developed  on 
admission.  Percussion  of  the  skull  was  painful  where 
the  left  parietal,  temporal,  and  occipital  bones  met. 
There  was  slight  paresis  of  the  right  facial,  flaccid 
paralysis  of  the  arm,  dragging  of  the  left  leg.  Exag- 
gerated reflexes  on  the  right  side,  no  ankle-clonus,  no 
--  Babinski,"  and  no  disturbance  of  sensibility. 

Concluding  that  a  cerebral  tumour  was  present,  a 
portion  of  the  parietal  bone  was  raised.  The  dura  mater 
was  tense,  but  there  was  no  pulsation.  After  incision 
of  it,  the  brain  projected  into  the  posterior  part  of  the 
opening.  The  vessels  of  the  pia  mater  were  so  highly 
developed  that  a  bystander  remarked  that  there  was  a 
commencing  angioma  of  the  part.  The  chief  vessels 
were  ligatured.  The  brain  here  was  normal  to  the 
touch.  Nothing  was  revealed  by  either  puncture  or 
incision,  so  the  skull  covering  was  replaced.  The 
paralysis  disappeared,  the  eye  symptom  also,  and  the 
convulsions  did  not  return.  After  this,  distinct  im- 
provement took  place.  There  was  no  cerebral  tumour 
in  any  case.  More  probably  there  was  commencing 
angioma  of  the  pia  mater  that  had  been  checked  in  its 
advance  by  the  ligature  of  the  vessels. 

Necrosis  op  Fatty  Tissue. 

Hr.  Selberg  communicated  a  note  on  this  subject. 
A  patient  with  inoperable  carcinoma  of  the  pylorus 
had  a  lateral  duodenostomy  performed  by  Hr.  Krause 


614    The  Medical  Press. 


OPERATING   THEATRES. 


June  8.  1904* 


at  which  some  of  the  contents  of  the  duodenum  flowed 
into  the  peritoneal  cavity.  The  patient  died  three  days 
after  the  operation  from  "  cardiac  weakness." 

At  the  autopsy  necrosis  of  the  fatty  tissue  of  the 
omentum  was  present  as  far  as  this  had  come  into 
contact  with  the  duodenal  contents  at  the  operation. 
The  pancreas  itself  was  completely  unchanged. 

Hustrta. 


[from  our  own  corrbsponbnt.] 


Vim**,  Jane  4th.  1904. 
Physiological  Laboratory. 

This  week  the  Gesellschaft  der  Aerzte  met  by 
invitation  in  the  lecture-room  of  the  superb  new 
Physiological  Laboratory,  under  the  presidency  of 
Hofrath  Exner,  who  conducted  the  members  through 
the  various  departments.  The  most  interesting  part 
of  the  building,  and  where  the  members  lingered  longest, 
was  the  skiopical  room,  where  a  series  of  demonstra- 
tions were  conducted. 

Chrobak,  speaking  for  the  Gesellschaft,  expressed 
perfect  satisfaction  with  the  complete  arrangement  for 
the  teaching  of  this  department  of  medicine,  and  con- 
gratulated the  medical  faculty  of  the  University  in 
their  successful  efforts  in  further  adding  to  this  another 
institution  for  clinical  instruction. 

Puerperal  Paralysis. 

At  the  meeting  fur  innere  Medizin,  Zappart 
showed  a  six  months'  child  with  both  arms  paralysed 
from  the  effects  of  parturition.  Both  arms  were  so 
strongly  rotated  inwards  that  the  palms  of  the  hands 
were  quite  turned  out ;  no  atrophy  was  present.  Massage 
and  faradisation  had  greatly  improved  the  condition 
within  the  last  few  months.  The  right  arm  can  now 
be  rotated  inwards  with  slight  movement  in  the 
shoulder.  This  was  the  result  of  a  cross-birth  affecting 
both  arms,  which  is  rare,  although  one  arm  is  not  un- 
common. 

Morbus  Barlow. 

Lehndorff  next  showed  a  case  of  morbus  Barlow,  a 
female,  aet.  7  months,  who  had  been  fed  two  months  at 
the  breast,  but  after  this  time  received  one  litre  of  milk 
and  half  a  litre  of  "  Kneipp  "  caf6  daily.  Up  till  ten 
days  ago,  the  child  was  healthy  and  strong,  when  a 
swelling  was  observed  to  commence  on  the  upper  part 
of  the  tibia  and  fibula  of  the  left  leg.  The  skin  was 
pale  over  the  swelling  and  the  soft  parts  cedematous. 
This  swelling  entirely  surrounded  the  head  of  the  bone, 
which  was  tender  to  pressure.  In  a  few  days  this 
swelling  extended  along  the  whole  shaft  of  the  tibia. 
The  gums  were  unaffected.  An  aspirating  needle 
brought  only  a  drop  of  blood.  Two  days  later  a 
similar  swelling  commenced  on  the  distal  end  of  the 
right  humerus.  The  Rontgen  rays  showed  no  diminu- 
tion or  abnormal  loss  of  lime  in  the  bones,  while  the 
contour  of  the  bone  was  well  marked  and  no  lamellar 
ossification. 

Butter-Milk  for  Infants. 

Knoepfelmacher  continued  the  discussion  on  the 
success  of  feeding  infants  with  butter-milk.  He  re- 
lated the  history  of  twenty  children  with  chronic  bowel 
trouble,  who  have  quite  recovered  from  the  disease. 
His  explanation  is  that  this  relatively  rich  albuminoid 
diet  is  poor  in  fat.  Even  watered,  new  milk  is  not 
nearly  so  easily  digested  according  to  the  laboratory 
experiments,  which  is  proved  by  the  fine  coagula  found 
in  the  stomach  and  the  rapidity  with  which  the  child 
improves. 

Riether  said  that  he  quite  agreed  with  the  praise 
bestowed  on  butter-milk,  but  a  little  care  was  required 
in  commencing  the  treatment,  as  in  many  of  the  cases 


it  could  not  be  easily  borne  for  a  few  days.  His  method 
of  commencing  the  treatment  was  to  give  a  tablespoon- 
ful  of  the  butter-milk  once  a  day  before  a  meal,  then 
gradually  to  increase  it  after  a  few  days  until  an  entire 
meal  could  be  borne.  If  there  be  difficulty  in  supple- 
menting the  diet  the  child  can  again  be  brought  back 
to  its  former  regimen  without  any  perceptible  danger. 
The  age  and  condition  of  the  infant  must  determine 
the  quantity,  both  for  commencing  and  full  diet. 
Where  there  is  great  dystrophia  in  breast-fed  children, 
teaspoonfuls  of  butter-milk  added  to  its  diet  often 
greatly  improved  the  child.  The  stools  after  com- 
mencing this  diet  become  normal  and  the  previous 
dyspepsia  disappears.  This  treatment  should  be 
adopted  where  there  is  any  atrophy,  dyspepsia,  or 
dystrophia  present,  particularly  after  acute  visceral 
catarrh,  cholera  infantum,  or  other  infantile  dyspepsia. 
Escherich  thought  the  efficacy  of  butter-milk  de- 
pended entirely  on  its  acid  reaction  in  the  stomach. 


Ztbe  ©perattno  Ttbeatres. 

NORTH-WEST  LONDON  HOSPITAL. 
Radical  Cure. — Mr.  Mayo  Collier  operated  on  a 
man,  aet.  40,  for  complete  inguinal  rupture  on  the  left 
side.  The  man  had  never  worn  a  truss,  and  had  been 
content  to  go  about  with  the  rupture  down  until 
advised  to  apply  for  relief.  Mr.  Collier  said  this  was 
a  case  in  which  undoubtedly  an  operation  was  advisable. 
The  sac  was  large,  and  the  hernia  had  been  down  more 
or  less  continuously  for  eighteen  months,  rendering  the 
internal  and  external  abdominal  rings  and  the  inguinal 
canal  quite  patulous.  He  commenced  the  operation  by 
making  an  oblique  incision  externally  over  the  canal 
from  above  the  internal  to  below  the  external  abdo- 
minal ring.  The  coverings  of  the  sac  were  divided  in 
the  same  direction  as  the  external  incision.  The 
contents  of  the  sac  were  reduced  into  the  abdomen, 
and  the  neck  of  the  sac  isolated  from  its  surroundings. 
The  sac  was  not  as  much  thickened  as  might  have  been 
expected.  The  neck  of  the  sac  was  divided  and  the 
upper  portion  carefully  separated  as  far  as  the  internal 
ring.  A'stout  silk  ligature  was  adjusted  round  the  sac 
at  the  internal  abdominal  opening,  and  tied  so  as  to 
completely  obliterate  the  depression  of  the  sac.  The 
two  arms  of  the  ligature  were  next  threaded  on  curved 
needles  ;  the  lower  was  passed  through  the  internal 
oblique  and  Pou part's  ligament,  and  the  upper  through 
the  margin  of  the  conjoint  tendon,  and  the  two  tied. 
Next  the  conjoint  tendon  was  adjusted  to  Poupart's 
Ugament  by  four  separate  interrupted  sutures,  the 
external  abdominal  ring  was  partly  closed  by  two 
sutures  at  its  upper  angle.  The  external  wound  was 
closed  in  the  usual  way.  Mr.  Collier  remarked  that 
this  was  apparently  a  strong,  healthy  fellow,  who  came 
to  the  hospital  with  the  most  absolute  belief  and  faith 
that  some  simple  operation  could  be  performed  on 
what  he  says  is  a  rupture  in  the  left  groin,  so  that  he 
will  never  have  to  wear  a  truss  again,  and  never  be 
troubled  with  a  return  of  his  complaint.  In  short,  he 
wanted  the  radical  cure  done  in  the  belief  that  the 
radical  cure  will  do  all  for  him  that  he  thinks.  This 
is  the  general  belief  amongst  the  lay  public  on  the 
subject  of  the  operations  for  the  relief  of  rupture. 
It  need  hardly  be  said  that  this  view  is  incorrect. 
The  first  question  to  be  answered  is  this  :  Why  an 
operation  at  all  ?  Why  not  a  comfortable  and  well- 
fitting  truss  ?  This  question,  he  thought,  must  be 
answered  from  several  points  of  view,  and,  firstly. 
there  are  seven  classes  of  cases  where  a  truss  cannot 
be_  relied  upon,  and  an  operation  is  most  certainly 


June  8.  1904- 


LEADING  ARTICLES. 


Tub  Medical  Pmws.    615 


indicated  : — (1)  Cases  of  irreducible  hernia  ;  (2)  cases 
of  strangulated  hernia ;  (3)  cases  where  the  hernia  is 
not  controlled  by  a  truss  ;  (4)  cases  of  hernia  with 
ectopia  testis ;  (5)  cases  where  rupture  unfits  for  the 
public  service  ;  (6)  hernia  in  incompetent  and  ignorant 
people  ;  (7)  very  large  hernia  hampering  the  move- 
ments of  the  patient,  and  threatening  the  personal 
comfort  seriously.  In  all  these  cases  it  would  be  the 
surgeon's  duty  to  prefer  and  advise  an  operation  in 
preference  to  outside  mechanical  support.  In  other 
cases  it  is  quite  certain  that  hundreds  of  thousands  of 
persons  pass  through  their  lives  with  comfort  and 
safety  with  the  assistance  of  a  well-fitting  truss,  but 
the  surgeon  most  certainly  should  not  refuse  to  perform 
the  radical  cure  for  a  person  who  was  anxious  to  be 
relieved  of  this  truss,  and  who,  from  a  sentimental 
point  of  view,  objected  to  the  mechanical  support. 
A  point  of  considerable  importance,  Mr.  Collier  said,  in 
the  after-care  of  patients  who  had  undergone  the 
radical  cure  had  been  completely  overlooked  as  far  as 
he  knew  by  all  writers  on  this  subject.  It  is  this  : 
The  method  and  position  and  preparation  for  the  act 
of  defecation — straining  at  stool.  How  often  have 
house  surgeons,  or  those  in  large  practices,  heard  this 
voluntary  statement,  attributed  as  a  cause  by  the 
patient  when  afflicted  with  rupture  in  its  various  forms  ? 
The  act  of  defalcation,  as  Nature  intended  us  to  perform 
the  same,  is  in  the  natural  position  with  the  extremities 
and  trunk  all  flexed  to  an  acute  angle,  the  thigh  flexed 
on  the  abdomen  so  that  the  knee  shall  be  in  contact 
with  the  chest,  the  back  of  the  leg  touching  the 
hams,  and  the  arms  folded  round  the  knees.  No 
pressure  that  was  ever  exerted  in  this  attitude  could 
affect  the  inguinal  or  femoral  openings.  They  are  com- 
pletely shut  up  and  supported.  The  modern  artistic 
w.c.  -imposes  the  necessity  of  sitting  with  the  body 
erect  and  the  thighs  at  a  right  angle  to  the  trunk.  In 
this  attitude  the  inguinal  and  femoral  openings  stand 
the  whole  pressure  of  the  abdominal  contents  in  strain- 
ing during  defalcation.  Therefore  after,  if  not  before, 
the  operation  for  radical  cure  direct  the  patient  to 
return,  so  far  as  the  act  of  defalcation  is  concerned,  to  a 
state  oifera  natura.  There  is  no  doubt  that  the  civilised 
position  in  the  act  of  defalcation  is  responsible  for  a 
large  percentage  of  ruptures.  He  would  most  cer- 
tainly advise  all  persons  who  have  a  tendency  to  hernia 
or  weak  abdominal  walls  to  stand  upon  the  seat  of  the 
[  w.c,  not  sit  upon  it.  This,  he  thought,  was  a  point 
»         of  the  utmost  importance  in  the  prevention  and  cure  of 

hernia.  

London  Small-Pox. 
j  Two  cases  of  small-pox — from  Sou thwark  and  Bethnal 

J  Green  respectively — have  been  admitted  to  the  metro- 
politan small-pox  hospitals.  On  May  27th,  1.19 
patients  remained  under  treatment. 

Metropolitan  Asylums  Board. 
A  letter  was  read  from  the  Local  Government 
Board  approving  of  the  adaptation  of  Belmont  Asylum 
and  authorising  an  expenditure  of  £1 5,000 on  the  works. 
the  loan  for  that  amount  to  be  repayable  in  ten  years. 
A  letter  was  read  from  the  Hampstead  Guardians 
protesting  against  the  managers'  decision  of  April  30th, 
in  the  matter  of  experimental  work  in  connection  with 
the  causation  of  small-pox.  Mr.  Beurle  stated  that  so 
far  fourteen  of  the  metropolitan  boards  of  guardians 
had  sent  in  copies  of  resolutions  against  the  Board's 
proposal,  whilst  only  two  boards  of  guardians  had  passed 
resolutions  in  favour  of  these  experiments.  It  was 
decided  that  the  Hampstead  resolution  should  be 
acknowledged.  From  the  usual  statistical  returns  it 
appears  that  during  the  fortnight  57  fresh  cases  had  been 
admitted,  as  against  32  in  the  previous  fortnight, 
and  118  patients  remained  under  treatment,  as  against 
03  in  the  previous  fortnight,  and  60  in  the  corresponding 
fortnight  of   1903. 


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Vbe  fl&e&ical  press  and  Circular. 


"  SALUS  POPULI  SUPREMA  LEX." 


WEDNESDAY,  JUNE  8,  1904. 


WHAT  IS  BRANDY  ? 
The  recent  decision  of  a  London   magistrate 
as  to  what  should  be  the  standard  composition  of 
brandy  is  of  importance  alike  to  the  public    and 
to  the  medical  profession.      What  he  has  done 
is  in  effect  to  make  a  legal  definition  of  the  term 
"  brandy,"  whereby  in  future  public  health  au- 
thorities may  be  enabled  to  test,  and  thereby  con- 
trol,  the  purity  of  that  particular  spirit.     The 
case  originated  in  a  summons  taken  out  by  the 
Islington   Borough   Council   under   Section   6  of 
the  Food  and  Drugs  Act  of  1875.     The  defendant,  a 
local  wine  and  spirit  dealer,  was  proceeded  against 
for  selling  as  brandy  an  article  certified  by  the 
Public  Analyst  to  contain  60  per  cent,  of  spirit 
derived  from  a  source  other  than  the  grape  ;  and, 
consequently,  not  of  the  nature,  quality,  and  sub- 
stance   demanded    by    the    purchaser.     It    was 
proved  in  evidence  that  a  bottle  of  liquor  labelled 
"  Fine  Old  Pale  Brandy  "  was  sold  by  defendant 
to  a  customer  for  the  sum  of  three  shillings.     On 
analysis  the  liquor  was  found  to  contain  60  per  cent, 
of  spirit  not  derived  from  the  grape.     The  matter, 
therefore,  hinged   on   the   question   whether   the 
customer  who  was  supplied  with  that  particular 
admixture  received  what  he  had  asked  for,  and 
might  reasonably  expect.     Unfortunately,   there 
is  no  standard  whereby  an  answer  might  be  given 
off-hand,  and  the  peculiar  value  of  the  recent  de- 
cision lies  in  the  fact  that  it  establishes  a  basis  for 
j  future  action.     Little  aid  is  to  be  derived  from 
j  dictionaries  and  encyclopaedias,  inasmuch  as  al- 
I  though,  on  the  one  hand,  they  agree  that  brandy 
j  is  an  ardent  spirit  derived  from  the  wine  of  the 
;  grape,  yet,  on  the  other  hand,  they  modify  that 
!  statement  by  adding  that  mixtures  of  grape  and 
j  grain  spirits  are  sold  as  brandy.     A  point  that 
evidently  influenced  the  magisterial  decision  was 
J  the     "  British    Pharmacopoeia's  "     definition    of 
•  brandy,  that  it  was  derived  exclusively  from  the 


616     The  Medical  Press. 


LEADING   ARTICLES. 


June  8,  1904. 


wine  of  the  grape.  That  definition  was  important, 
it  was  remarked,  because  of  the  common  know- 
ledge among  buyers,  sellers  and  consumers 
that  brandy  was  largely  used  as  a  medicine.  It 
is  precisely  that  aspect  of  the  subject  that  renders 
the  purity  of  brandy  a  matter  of  concern  to  mem- 
bers of  the  medical  profession.  The  value  and 
place  of  brandy  as  a  therapeutic  remedy,  and  the 
vital  necessity  of  maintaining  a  high  and  unalterable 
standard  was  abundantly  proved  by  the  medical 
evidence  tendered  in  the  Islington  case.  Dr. 
Macnaughton  Jones,  the  chief  medical  witness, 
showed  that  no  artificial  brandy  can  properly 
be  regarded  as  medicinal.  There  can  be 
little  doubt  that  the  confidence  of  the  public; 
as  well  as  of  the  medical  profession,  in  brandy  as  a 
remedy  has  been  to  a  great  extent  shaken  by  the 
deleterious  practice  of  modern  manufacturers,  who 
produce  a  so-called  brandy,  of  which  50  to  70 
per  cent,  is  derived  from  rice,  grain,  potato,  or 
other  extraneous  spirit.  In  a  word,  the  only 
official  test  hitherto  adopted  has  been  one  that 
relates  to  the  alcoholic  strength  of  any  given  spirit, 
apart  from  its  other  qualities.  Much  useful  in- 
formation upon  the  whole  subject  may  be  found 
in  a  recently-issued  brochure,  namely,  "  The 
Analysis  of  Potable  Spirits,"  By  Mr.  Archibald 
Vesey.  (a)  That  writer  has  pointed  out  that  it 
is  quite  obvious  that  under  such  a  regime  it 
matters  little  whether  a  given  spirit  be  called 
brandy,  whisky,  rum  or  gin  ;  the  Public  Analyst 
would  record  any  single  member  of  the  series  as 
genuine  so  long  as  it  conformed  to  a  certain 
alcoholic  strength.  Clearly  that  state  of  things  is 
unsatisfactory,  nor  can  it  be  in  the  public  interest 
when  we  consider  that,  properly  speaking,  brandy 
should  be  the  produce  of  distilled  wine,  whisky 
of  malt,  rum  of  sugar,  and  so  on,  each  spirit  pos- 
sessing its  own  special  characteristics.  The 
motive  of  the  distiller  in  substituting  coarse  spirit 
for  wine  spirit  is  obviously  to  reduce  cost  of  pro- 
duction. It  is  to  be  hoped,  however,  that  the 
Islington  decision  has  put  an  end  to  that  sort  of 
commercial  fraud.  The  magistrate  in  that  case 
defined  brandy  as  an  alcoholic  liquid,  the  spirit  of 
which  was  obtained  by  the  distillation  of  wine 
from  the  grape.  The  standard  having  been  fixed, 
there  was  no  difficulty  in  convicting  the  defendants, 
who  were  fined  £$  and  £20  costs.  Some  attempt 
was  made  by  the  defence  to  upset  the  analysis, 
but  the  evidence  of  the  analyst  for  the  prosecution 
was  accepted  by  the  magistrate.  Fortunately, 
modern  chemistry  is  able  to  estimate  the  con- 
stituents of  various  spirits  with  sufficient  ac- 
curacy to  warrant  an  absolute  statement  as  to  the 
sources  of  ultimate  origin.  The  Islington  case, 
founded  on  that  fortunate  circumstance,  has  hence- 
forth placed  another  obstacle  in  the  path  of 
drink  adulteration.  Henceforth  it  will  be  the 
duty  of  the  medical  man  to  insist  that  when  he 
orders  brandy  for  a  patient  the  proper  article 
is  supplied,  and,  failing  a  standard,  to  call  the 
attention  of  the  local  authorities  to  the  matter. 


(a)  ''Guide  to  the  Analysis  of   Potable  Spirit*." 
Bail  here.    London.    1904. 


8.  A.  Veaey. 


THE  LIFTING  OF  THE  VEIL. 
The  readers  of  Watts-Dunton's  "  Aylwin " 
will  doubtless  remember  the  celebrated  picture  by 
the  mad  Wilderspin  representing  the  lifting  of 
the  veil  of  Isis,  and  the  caricature  of  that  picture 
drawn  by  Cyril  Aylwin  in  which  the  lifted  veil 
revealed  not  the  face  of  the  Egyptian  goddess, 
but  that  of  Mother  Gudgeon.  In  our  present 
issue,  a  somewhat  similar  picture  is  placed  before 
our  readers.  It  was  drawn  by  Parliament,  it  was 
retouched  by  the  Incorporated  Mid  wives'  Institute, 
the  veil  was  placed  in  position  by  the  Central 
Midwives'  Board,  reluctantly  it  was  raised,  and 
behind  is  found  not  the  fair  picture  of  the  trained 
nurse,  but  the  decrepit  visage  of  Mother  Gamp, 
We  speak  in  metaphor,  and  yet  there  is  no  need, 
for  truth  is  stranger  than  fiction.  A  Board  is 
appointed  by  Parliament  to  secure  the  better 
training  of  midwives,  and  to  regulate  their  practice, 
because  in  the  past  the  office  of  midwife  has  been 
discharged  by  incompetent  and  untrained  women 
to  the  detriment  of  the  King's  subjects.  It  is 
presumably  a  responsible  and  a  dignified  Board, 
that  will  discharge  its  duties  without  fear  or 
favour,  and  whose  well-considered  procedures, 
governed  by  logical  reasoning,  will  tend  to  the 
justification  of  its  existence.  If  its  members  are 
not  possessed  of  the  necessary  practical  experi- 
ence to  constitute  them  at  once  a  legislative  and  aa 
executive  body,  they  will  doubtless  be  guided 
by  experts  who  will  prevent  them  from  failing  into 
the  more  obvious  pitfalls.  And  even  if  its  inexperi- 
ence is  at  first  too  marked  to  prevent  mistakes, 
it  will  at  all  events  be  sufficiently  judicial  in  its 
action  to  maintain  its  apparent  dignity  in  the  eyes 
of  the  public.  The  veil  is  lifted,  and  what  do  we^ 
see  ?  The  dignified  and  logical  Board  vanishes, 
and  instead  we  find  a  composite  body,  meeting 
for  afternoon  tea,  discussing  important  questions 
with  a  partizan  spirit,  eagerly  smoothing  the  path 
by  which  the  untrained  Gamp  becomes  the 
registered  midwife,  placing  difficulties  of  an 
insurmountable  nature  in  the  way  of  the  trained 
nurse,  and  wildly  swaying  from  one  ill-considered 
resolution  to  another.  We  cannot  give  sufficient 
credit  to  Dr.  W.  J.  Sinclair,  who,  with  characteristic 
courage  and  independence,  has  brought  the 
precedure  of  the  Board  directly  before  the  public. 
Space  forbids  us  to  recapitulate  the  various  points 
he  brings  forward,  they  are  patent  to  our  readers 
in  his  letter.  As  we  have  said,  the  veil  is  lifted 
and  Mother  Gamp  peers  forth  at  her  astonished 
spectators,  and  behind  Mother  Gamp  stands 
another  figure,  the  Incorporated  Midwives'  In- 
stitute. This  surprising  body,  whose  thinly- 
veiled  interference  appears  behind  each  action 
of  the  Board,  was  up  to  the  time  of  the  passing  of 
the  Midwives  Act  but  little  known.  It  appar- 
ently was  a  society  of  women  who  met  and  dis- 
cussed subjects,  the  relation  of  some,  at  least,  of 
which  to  the  practice  of  midwifery  it  would  be 
difficult  to  determine.  Of  many  subjects  dis- 
cussed one  may  be  mentioned.  It  was,  as  we 
remember,  in  the  form  of  a  paper,  and  was  en- 
titled "  Malthusianism,  or  Tired  Ovaries."    It  i* 


June  8,  1904. 


NOTES  ON  CURRENT  TOPICS. 


strange  that  so  learned  a  body  should  now  appear 
as  the  sponsor  of  the  uneducated  woman,  and  the 
advocate  of  her  claims  to  be  constituted  a  member 
of  a  "  profession."  We  learn  from  Dr.  Sinclair's 
letter  that  an  even  more  important  question  than 
tired  ovaries  is  now  perplexing  the  child  of  the 
Incorporated  Midwives'  Institute.  It  is  appar- 
ently this,  "  Are  we  going  to  climb  down,"  and 
recognise  the  claims  of  the  Irish  maternity  hos- 
pitals ?  We  do  not  know  what  answer  the  Board 
returned  to  this  inquiry,  but  we  fancy  that  the 
near  future  will  answer  the  question  in  the  affirma- 
tive .  Already,  part  of  the  "  climbing  down  " 
has  occurred.  A  short  time  ago  the  Board  in- 
formed the  Royal  Irish  Academy  of  Medicine  that 
it  was  impossible  to  reconsider  its  regulations. 
At  its  last  meeting  it  decided  to  ask  the  per- 
mission of  the  Privy  Council  to  alter  the  regulation 
requiring  the  pupil-midwife  to  nurse  women  for 
the  ten  days  following  labour.  This,  however,  as 
Dr.  Sinclair  points  out,  is  a  very  trivial  point, 
although  a  necessary  one.  The  main  point  at 
issue  still  remains  unsettled.  The  Central  Mid- 
wives'  Board  have  decided  to  admit  to  examination 
the  -woman  who  has  delivered  twenty  cases  under 
the  supervision  of  a  midwife.  It  has  refused  to 
admit  the  trained  nurse,  who  may  not  have  per- 
sonally delivered  twenty  women,  but  who  has 
seen  hundreds  of  properly  conducted  labours, 
who  has  been  regularly  taught,  and  has  been  under 
hospital  supervision  for  six  months  or  even  more 
The  duty  of  the  heads  of  the  Irish  maternity 
hospitals  is  plain.  They  must  in  the  first  place 
make  it  obvious  to  the  Board,  that  the  so-called 
concession  made  at  its  last  meeting  is  wholly 
insufficient,  and  they  must  not  relax  their  previous 
efforts.  We  commend  two  points  to  the  notice 
of  both  parties — first,  that  the  Board  was  ap- 
pointed to  secure  the  better  training  of  midwives, 
and,  secondly,  that  up  to  this  the  discussions  of  the 
Board  have  been  conducted  in  private.  In  future 
it  -will  be  interesting  to  learn  how  the  Board  re- 
conciles its  existence  with  its  refusals  to  recognise 
nurses  trained  at  the  most  important  centre  for 
obstetrical  teaching  in  the  United  Kingdom. 

notes  on  Current  Copies, 

The  Schoolboy's  Beer. 

The  influence  of  surroundings  and  early  habits 
upon  the  future  character  and  physical  well-being 
of  the  young  is  a  subject  of  the  most  vital  interest 
alike  to  parents  and  to  pedagogues.  In  the 
majority  of  instances  the  child  is  in  the  position 
of  the  tender  sapling  which  needs  to  be  suitably 
guided,  bent,  or  pruned,  if  need  be,  in  order  that 
it  may  attain  the  highest  degree  of  perfection. 
Here  and  there  one  may  be  found  which  will 
develop  in  the  right  way  with  little  or  no  assist- 
ance from  without,  and,  on  the  other  hand,  in 
spite  of  the  most  careful  training,  another  will  fall 
lamentably  short  of  the  grower's  expectations, 
no  matter  how  good  the  stock  may  be  from  which 
it  is  an  offshoot.  The  school  is  nothing  less  than 
a  vast  habit-factory,  in  which  the  mental  calibre 


The  Medical  Press.     617 

and,  to  a  great  extent,  the  bodily  shape  are  gradu- 
ally formed,  not  by  tools  of  iron,  nor,  happily, 
by  a  bundle  of  twigs,  but  by  the  subtle  processes 
of  imitation  and  repetition  which,  combined, 
will  assuredly  leave  their  mark  upon  the  impression- 
able mould  of  the  child's  nature.  In  matters  of 
diet  much  can  be  done  to  influence  the  physique 
of  the  young,  and  it  is  encouraging  to  note  that 
scholastic  authorities  have  paid  far  more  attention 
to  their  catering  departments  than  was  formerly 
the  case.  The  net  result  has  been  decidedly 
beneficial.  Whether  schoolboys  should  be  allowed 
beer  or  other  alcoholic  beverages  for  supper  or 
dinner  is  a  question  which  is  at  present  causing 
much  heart-searching  in  certain  quarters.  The 
subject  was  brought  up  before  the  Parents' 
Educational  Union  at  the  annual  conference  held 
in  Edinburgh  on  May  28th,  in  a  paper  read  by 
Dr.  Leslie  Mackenzie.  Considered  from  the  point 
of  view  of  its  food-value,  it  would  certainly  com- 
pare unfavourably  with  milk  or  cocoa,  both  of 
which  latter  beverages  are  distinctly  more  suited 
to  young  and  growing  frames  than  malt-liquors. 
We  cannot  believe  that  alcohol  in  any  shape  or 
form  is  a  daily  necessity  at  any  age,  still  less  for 
growing  children,  who  require  special  protection 
against  the  development  of  possible  habits  o£ 
intemperance  in  after-life. 


A  Welsh  M.D. 
It  was  hardly  to  be  expected  when  the  University 
of  Wales  was  instituted  that  the  Principality 
would  remain  content  with  the  powers  then 
conferred  with  regard  to  degrees.  The  University 
movement  has  taken  strong  hold  on  people's 
imaginations,  and  with  Liverpool,  Birmingham, 
and  Manchester  possessing  their  own  Uni- 
versities and  granting  degrees  in  all  the  faculties, 
Wales  is  feeling  itself  left  somewhat  out  in  the 
Cold.  Their  present  arrangements  enable  them 
to  provide  instruction  only  in  such  preliminary 
sciences  as  chemistry,  biology,  anatomy,  and 
physiology,  so  that  their  students  have  later  to- 
be  wafted  off  to  London,  or  some  other  large 
recognised  centre,  for  clinical  training.  Moreover, 
when  they  have  received  this,  their  Alma  Mater 
is  unable  to  give  them  her  hall-mark,  by  granting 
them  a  degree.  The  Cardiff  people  argue  that 
they  have  their  own  University  College,  their 
own  Infirmary,  and  their  own  auxiliary  institu- 
tions— such  as  a  fever-hospital  and  lunatic 
asylum,  and  that  with  such  an  equipment  they 
should  be  able  to  organise  a  well-furnished  and 
complete  medical  school.  Why,  therefore,  should 
they  be  denied  the  privilege  of  doing  so,  and  of 
turning  out  M.D.'s.  and  M.S.'s  to  uphold  and 
perpetuate  the  traditions  of  their  country  ? 
When  the  establishment  of  provincial  universities 
has  reached  the  point  that  it  has  already  done, 
it  is  difficult  to  say  that  any  place  that  so 
wishes  should  not  have  its  own  university,  but  it. 
may  nevertheless  be  doubted  if  this  multipli- 
cation of  teaching  schools  is  really  a  good  thing. 
The  apparatus  and  staff  required  for  the  equipment 


618    The  Medical  Peess.       NOTES    ON    CURRENT    TOPICS. 


June  8.  1904. 


of  a  medical  school  are  becoming  more  and 
more  elaborate  and  expensive  every  day,  and  it  is 
practically  impossible  to  provide  these  at  any- 
thing like  self-supporting  rates  for  schools  with 
sixty  or  seventy  students.  It  therefore  behoves 
those  who  wish  for  fresh  schools  to  consider  very 
carefully  if  there  is  not  more  to  be  gained  by 
amalgamating  and  extending  present  institutions 
than  by  forming  fresh  ones.  The  London  medical 
schools  have  found  that  they  cannot  teach  all 
the  preliminary  subjects  at  paying  rates,  and  wish 
to  establish  a  central  institute  of  medical  sciences. 
The  patriotic  aspirations  of  provincial  centres 
seeking  for  universities  of  their  own  should  be 
carefully  balanced  against  the  commercial  pros- 
pects of  such  concerns. 

Antiseptic  Shaving. 

Dr.  Collingridge  has  signalised  his  tenure  of 

office  as  medical  officer  of  health  to  the  City  by 
much  good  work,  and  not  the  least  admirable  of 
his  characteristics  is  his  originality.  He  never 
fears  to  depart  from  the  beaten  track  if  he  finds 
an  abuse  that  can  be  remedied  or  a  trade  that 
stands  in  need  of  regulation.  It  is  certainly  none 
too  soon  that  he  has  drawn  the  attention  of  the 
City  Fathers  to  the  desirability  of  instituting  rules 
to  be  observed  by  barbers.  Since  surgery  ceased 
to  be  a  subordinate  department  of  the  hair- 
dressing   business  and  came  to  rank  as  a  science 

•of  equal  importance  to  that  of  medicine,  the  barber 
has  been  left  to  pursue  his  calling  as  seemed  best 
in  his  own  eyes.  But  shaving  and  hair-cutting 
are  really  minor  surgical  operations,  and  though 
no  one  would  be  found  to  suggest  that  the  F.R.C.S. 
of  -the  present  day  should  include  proficiency  in 

"these  crafts  among  his  accomplishments,  there  is 

mo  reason  why  the  barber  should  not  observe  the 
same  principles  of  cleanliness  that  are  found  to  be 
of  such  moment  in  the  conduct  of  other  surgical 
procedures.  On  the  other  hand,  there  is  every 
reason  why  he  should  ;  for  t  hough  the  free  use  of 
hot  water  and  soap  in  his  work  doubtless  prevents 
the  spread  of  skin  diseases  among  his  customers, 
there  is  still  a  great  deal  to  be  desired  in  the  way 

<of  precaution.  Tinea  tonsurans  and  sycosis  are 
common  diseases,  which  in  some  cases  can  be 
traced  to  the  practice  of  shaving  with  common 
razors,  and  it  is  exceedingly  easy  to  convey  the 

<  ova  of  vermin  by  the  use  of  scissors  from  one  head 
to  another.  On  the  Continent,  Listerian  prin- 
ciples have  long  been  recognised  as  pertaining  to 
the  business  of  ^hair-dressing,  and  antiseptic  solu- 
tions are  in  free  use  there.  It  surely  is  time  that 
the  country  which  gave  birth  to  antisepticism 
and  asepticism  should  enjoy  the  advantage  of 
having  these  systems  introduced  into  the  practice 
of  the  barber.  Dr.  Collingridge  perhaps  asks 
rather  too   much   when    he  suggests   that  every 

.assistant  should  have  a  clean  apron  for  each  cus- 
tomer. It  would  be  hardly  reasonable  to  expect 
this  unless  a  higher  price  were  charged  for  shaving 
and" hair-cutting,  but  that  they  should  use  a 
different  packet  of  soap  for  each  person  and  that 
the  brushes  should  be  sterilised  are  demands  that 


do  not  err  on  the  side  of  extravagance.  It  is  to 
be  hoped  that  the  City  will  adopt  his  proposals, 
and  that  its  example  may  be  universally  followed 
by  other  municipalities. 

Mercer's  Hospital,  Dublin. 

Last  week  all  Dublin  was  engaged  in  a  huge 
bazaar  and  fancy  fair  in  aid  of  Mercer's  Hospital, 
from  the  results  of  which  it  is  hoped  to  receive 
enough  funds  to  re-open  several  wards,  as  well 
as  to  furnish  a  modern  surgical  theatre.  Although 
one  of  the  oldest  of  Dublin  hospitals,  Mercer's  has 
never  been  rich.  Founded  in  1734,  without  any 
endowment  except  a  free  house,  it  has  always 
been  dependent  on  the  charity  of  the  public  for 
its  maintenance.  At  present,  although  situated 
centrally  in  the  city,  and  with  a  great  demand  on 
its  beds,  it  has  many  of  the  wards  closed.  Never- 
theless, in  spite  of  being  continually  hampered  for 
want  of  funds,  last  year  no  fewer  than  21,790 
patients  received  advice  and  treatment.  In  order 
to  carry  on  its  work  efficiently,  and  by  the  most 
modern  methods,  there  is  need  not  only  for  a  new 
theatre  and  for  repairs  to  many  of  the  wards,  but 
also  for  rooms  fitted  for  the  application  of  Rontgen 
rays  and  electricity  for  diagnostic  and  therapeutic 
purposes.  -  We  trust  that  a  large  enough  sum  has 
been  realised  to  start  Mercer's  on  its  third  century 
of  beneficent  work. 


What  is  Seborrhoea  ? 
The  precise  nature  and  classification  of  those 
affections  of  the  skin  comprised  under  the  term 
"  seborrhoeic  "  have  long  exercised  the  minds  of 
dermatologists  and  physicians.  Alterations  in 
the  secretion  of  the  sebaceous  glands  are  capable 
of  giving  rise  to  sundry  and  manifold  cutaneous 
disorders,  the  clinical  appearances  of  many  of 
which  are  but  little  suggestive  of  their  true  origin, 
except  to  the  expert.  Two  varieties  of  the  disease 
are  recognised,  the  first  in  which  oiliness  is  the 
most  marked  feature,  seborrhoea  oleosa,  and  the 
second  in  which  scale  formation  predominates, 
seborrhoea  sicca,  formerly  known  as  pityriasis. 
Over-activity  of  the  sebaceous  glands  plays  the 
most  important  part  in  the  process,  though 
Unna  states  that  the  sweat-glands  also  secrete 
oily  matter,  and  are,  in  fact,  primarily  involved. 
The  pouring  out  of  an  increased  amount  of  sebum 
remains,  however,  the  essential  feature  of  the 
malady,  the  cause  of  which  is  believed  by  Sabou- 
ra  ud  to  be  a  micro-bacillus,  whose  favourite  habitat 
is  the  upper  portion  of  the  hair-follicle.  The 
modern  conception  of  the  seborrhoeic  process  has 
thus,  according  to  Besnier,  revolutionised  the 
whole  of  dermatology.  With  regard  to  the 
clinical  aspects  of  the  disease,  it  not  only  assumes 
many  different  forms,  but,  as  Dr.  H.  A.  G.  Brooke 
remarked  in  the  course  of  the  Annual  Oration 
delivered  before  the  Dermatological  Society 
of  Great  Britain  and  Ireland,  on  May  25  th,  other 
cutaneous  eruptions  are  often  materially  influenced 
by  seborrhoea.  The  connection  of  alopecia  areata 
with  a  scurfy  condition  of  the  scalp  is  believed 
by  many  to  be  more  than  accidental,  while  the 
association  of  seborrhoea  oleosa  with  acne  vulgaris 


June  8.  1904. 


NOTES    ON    CURRENT    TOPICS.        The  Medical  Press.    619 


of  the  face  or  trunk  is  quite  commonly  observed. 
Could  seborrhcea  be  wiped  out  from  the  category 
of  skin  diseases,  the  dermatologist  would  suffer 
the  loss  of  half  of  his  practice  ! 

Foreign  Bodies  in  the  Brain. 

The  tolerance  of  even  the  brain  to  foreign 
bodies,  provided  that  these  are  aseptic,  and  do  not 
interfere  in  any  way  with  the  vital  centres,  is 
remarkable.  Living  tissue  of  all  kinds  possesses 
more  or  less  power  to  resist  the  effects  of  the 
intrusion  of  a  foreign  substance  by  surrounding 
it  with  an  impermeable  fibrous  capsule.  The  white 
matter  of  the  cerebrum  or  cerebellum  may,  when 
occasion  requires,  encyst  a  foreign  body  in  this 
way,  whether  it  be  a  deposit  of  tuberculous 
material,  a  bullet,  or  a  parasite.  Those  portions 
of  the  brain  which  are  not  essential  to  animal 
existence,  such  as  the  frontal  and  parts  of  the 
temporal  and  parietal  lobes,  may  harbour  extra- 
neous substances  without  doing  much  harm  to  the 
organism  as  a  whole,  as  long  as  they  do  not  intro- 
duce with  them  septic  germs,  or  divide  any  large 
vessels  in  their  entrance.  Thus,  in  the  recent 
stabbing  case  which  occurred  in  the  East  End, 
three  inches  of  knife-blade  were  found  to  be 
embedded  in  the  anterior  portion  of  the  cerebrum, 
the  weapon  having  penetrated  the  left  temple. 
With  this  foreign  body  in  situ  the  victim  walked 
to  a  police-court,  gave  an  account  of  his  assault, 
and  answered  questions  in  an  intelligent  fashion. 
He  also  expressed  his  ability  to  walk  to  the  London 
Hospital  rather  than  be  conveyed  thither  in  the 
ambulance  which  was  provided  for  him.  To  the 
physiologist  who  understands,  though  imperfectly, 
the  functions  of  the  several  parts  of  the  brain, 
such  a  sequence  of  events  presents  no  special 
mystery,  for  many  cases  are  recorded  where  the 
anterior  part  of  the  cerebrum  has  been  destroyed 
by  accident  without  detriment  to  the  general 
health,  and,  in  a  few  cases,  without  much  impair- 
ment of  general  intelligence.  Experimental  re- 
moval of  the  same  area  of  brain  substance  in 
animals  is  similarly  followed  by  comparatively 
little  bodily  disturbance. 


Vital  Statistics  in  Ireland. 
A  valuable  return  bearing  on  the  vital  statistics 
of  Ireland  has  just  made  its  appearance  as  a 
Parliamentary  paper.  It  is  a  Supplement  to  the 
Registrar-General's  Annual  Report,  and  gives  the 
figures  of  births,  deaths  and  marriages  for  the 
ten  years,  1 891- 1900.  One  hears  so  much  of  the 
decreasing  population  of  Ireland,  that  it  is  well  to 
be  reminded  that  the  decrease  is  due  to  one  cause 
alone.  The  causes  which  are  at  work  in  France, 
America,  Australia,  and,  to  some  extent,  Eng- 
land, have  no  effect  in  Ireland.  Were  it  not  for 
the  annual  drain  produced  by  emigration,  the 
population  would  be  increasing  at  a  regular 
healthy  rate.  It  is  satisfactory  to  find  that  the 
number  of  emigrants  is  tending  to  diminish, 
though  the  rate  in  proportion  to  the  entire  popu- 
lation keeps  pretty  constant.  Compared  with 
the  previous  decade,  the  marriage-rate  has  slightly 


increased,  while  the  death-rate  remains  constant. 
As  in  other  countries,  the  average  age  of  marriage 
in  gradually  going  up,  the  number  of  minors- 
married  becoming  very  small.  For  instance,  in 
1900,  only  1  50  per  cent,  of  the  males  married 
were  under  age,  being  somewhat  less  than  half 
what  it  was  forty  years  ago.  In  1864  nearly  20' 
per  cent,  of  the  women  marrying  were  minors, 
while  at  present  the  number  is  about  8  per  cent. 
As  might  be  expected,  there  are  more  juvenile 
marriages  in  Ulster,  which  contains  practically 
all  the  manufacturing  districts,  than  elsewhere; 
while  in  Connaught  marriage  of  minors  is  almost 
unknown. 


Poisoning  by  Illuminating  Gas. 
The  narrow  escape  of  a  well-known  footballer; 
who  had  to  be  admitted  into  the  Chatham  Hospital 
suffering  from  the  effects  of  coal-gas  intoxication, 
affords  an  illustration  of  the  great  danger  which; 
results  from  its  inhalation,  and  also  of  the  length 
of  time  that  may  elapse  before  the  recovery  of  the 
patient.  The  stability  of  the  compound  which 
carbon  monoxide,  the  chief  toxic  constituent  of 
illuminating  gas,  forms  with  the  haemoglobin  of 
the  red  blood  corpuscles  is  a  mechanico-chemical 
obstacle  to  rapid  resuscitation.  In  a  series  of 
experiments  made  by  Darrah  some  years  ago  upon 
the  restoration  of  animals  thus  poisoned,  it  was- 
found  that  in  spite  of  saline  infusions,  many  of 
them  died  owing  to  the  slowness  with  which  the 
poison  was  eliminated.  At  the  recent  annual 
meeting  of  the  Association  of  American  Physicians, 
held  in  Washington,  May  10th,  Dr.  W.  Gilman 
Thompson,  of  New  York,  read  a  paper  upon  the 
symptoms,  complications,  and  treatment  of  poison- 
ing by  illuminating  gas,  ninety  cases  of  which  he 
had  analysed.  He  finds  that  leucocytosis  is 
invariably  present,  and  when  of  a  high  degree  the 
prognosis  is  unfavourably  influenced.  The  tem- 
perature is  elevated  in  nearly  all  cases,  and  the 
pulse  is,  as  a  rule,  disproportionately  rapid. 
Convulsions  are  stated  to  occur  in  about  7  per 
cent,  of  the  cases,  while  coma  is  generally  a  marked 
feature,  lasting  sometimes  several  days.  One 
case  is  reported  by  Dr.  George  Peabody  as  having 
recovered  after  being  comatose  for  four  weeks. 
In  the  greater  number  of  fatal  cases,  death  is 
caused  through  cerebral  lesions,  such  as  haemor- 
J  rhage  or  softeiiing.  Pneumonia  is  not  often 
observed.  Dr.  Thompson  considers  that  the  most 
satisfactory  mode  of  treatment  is  a  combination  of 
venesection  with  saline  infusion,  a  procedure  which 
is  also  efficacious  in  coma  resulting  from  the 
absorption  of  other  toxic  agents  into  the  blood. 
The  inhalation  of  pure  oxygen  gas  may  also  be  of 
assistance  in  resuscitating  the  patient. 


1  Voyages  d'Etudes  Medioales. 

We  have  pleasure  in  calling  attention  to  the 
sixth  annual  medical  excursion  to  French  watering- 
places  and  health-resorts,  organised  by  Dr. 
Carron  de  la  Carriere,  which  will  take  place 
between  September  3rd  and  15  th  of  this  year. 
As  heretofore,  the  scientific  part  of  the  programme 


620    The  Medical  Press.     NOTES    ON    CURRENT    TOPICS. 


June  8,  1904. 


will  be  in  the  hands  of  Professor  Landouzy. 
The  trip  will  include  visits  to  the  stations  of 
Central  France  and  Auvergne,  beginning  with 
Neris,  passing  on  to  La  Bourboule,  Mont  Dore, 
Royat,  Vichy,  Pougues,  &c.  The  special  pro- 
perties of  the  waters  of  each  will  be  described  by 
Professor  Landouzy,  and  ample  opportunities 
will  be  afforded  for  members  to  become  acquainted 
with  the  resources  of  hydro- therapeutics  as  under- 
stood in  France.  The  social  side,  however,  has 
not  been  lost  sight  of,  and  arrangements  will  be 
made  for  the  due  entertainment  of  the  visitors. 
Foreign  medical  men  and  their  wives  and  medical 
students  are  eligible  to  participate  in  the  ad- 
vantages. They  will  be  entitled  to  a  50  per  cent, 
reduction  in  railway  fares  from  the  frontier  to 
the  place  of  meeting  (Lamotte-Beuvron)  and 
back,  and  the  cost  of  the  entire  trip  thence  to 
Pougues,  inclusive  of  travelling,  hotels,  luggage, 
carriages,  &c,  has  been  fixed  at  250  francs  (£10) 
for  the  twelve  days.  Applications  must  be  sent 
in  at  latest  by  August  15th,  to  Dr.  Carron  de  la 
Carriere,  2  rue  Lincoln,  Paris.  We  have  always 
thought  very  highly  of  the  idea  which  underlies 
these  annual  excursions,  and  have  more  than 
once  expressed  our  surprise  that  no  concerted 
effort  has  so  far  been  attempted  in  this  country 
for  the  purpose  of  familiarising  practitioners  with 
our  own  watering-places,  though  the  indifference 
>of  the  public  to  native  resources  is  complained  of. 


Practioe  by  Companies. 

The  recent  judgments  delivered  in  Dublin  in 
the  case  of  O'Duffy  v.  Jaffe,  and  the  King  (Rowell) 
v.  The  Registrar  of  Joint  Stock  Companies,  were 
brought  to  the  notice  of  the  General  Medical 
Council  by  Sir  Charles  Ball  at  the  recent  meeting 
of  that  body.  The  importance  of  these  judg- 
ments for  the  purpose  of  preventing  fraudulent 
imposition  on  the  public  cannot  be  over-estimated, 
and  therefore  we  are  glad  to  learn  that  the  Council 
decided  to  forward  copies  of  them  to  the  Lord 
President  of  the  Privy  Council,  with  the  request 
that  the  Government  would  take  such  steps  as 
may  be  necessary  to  restrain  the  Registrar  from 
registering  any  more  such  companies,  and  to 
prevent  companies  already  registered  from  using 
titles  which  would  lead  the  public  to  believe 
that  they  were  composed  of  registered  dentists. 
From  the  remarks  made  by  Sir  Charles  Ball  we 
learn  that  one  of  the  Law  Officers  of  the  Crown 
has  expressed  the  opinion  that  there  would  be  no 
difficulty  in  putting  an  end,  without  fresh  legis- 
lation, to  the  ingenious  infringements  of  the 
Medical  and  Dental  Acts  which  have  occurred, 
and  it  is  to  be  hoped  that  immediate  steps  will 
be  taken  in  that  direction.  Any  such  steps  will, 
however,  be  incomplete  unless  they  succeed  also 
in  preventing  the  use  of  bogus  titles  by  already 
registered  companies. 


else,  and  the  wise  man  will  be  he  who  avails  him- 
self  of  the  natural  force  thus  ready  to  hand  and 
uses  it  to  his  own  purposes.  Dr.  Kohnke,  the 
medical  officer  of  New  Orleans,  is  certainly  one  of 
these  wise  man.  He  knows  that  boys  like  to 
hunt  and  to  destroy  as  surely  as  a  duck  takes  to 
the  water,  and  on  those  lines  he  has  enlisted  a 
corps  of  school  children  to  help  him  exterminate 
the  anopheles — that  most  pestilential  mosquito 
which  spreads  malaria  over  the  face  of  the  earth. 
He  has  already  succeeded  in  enrolling  a  large 
number  of  boys  in  neighbouring  cities ;  and  instead 
of  marbles  and  robbers  beguiling  the  Saturday 
afternoons  of  the  youngsters,  they  now  sally  out 
to  seek  and  destroy  the  larvae  of  the  mosquito. 
The  idea  is  a  capital  one.  The  plan  combines  the 
fun  of  botanising  and  of  bird-nesting  with  the 
ever-present  joy  of  killing  something,  which  is 
one  of  the  most  deeply  rooted  instincts  not 
only  in  the  heart  of  the  school-boy,  but  also  of 
mankind  of  maturer  age.  It  is  a  pity  that  our  own 
hygienic  foes  do  not  as  readily  lend  themselves 
to  extermination.  If  microbes  were  only  of 
the  size  of  butterflies  bacteria-catching  expedi- 
tions and  collections  of  bacilli  might  be  as  popular 
as  rabbiting  and  collecting  stamps,  and  be  pursued 
with  the  same  zest.  As  it  is,  our  warfare  has  to 
be  carried  on  by  medical  officers  of  health  and 
sanitary  inspectors,  who,  however  keen  they  may 
be  on  the  duties,  do  not  find  them  remarkably 
exhilarating. 


A  Sanitary  Volunteer  Force. 
That  boys  will  be  boys  is  a  maxim  that  may 
as  well  be  accepted  once  and  for  all — for  good  or 
-evil.     It  is  no  use  trying  to  make  boys  anything  I  So   far,  the   scheme   has   awakened   the  keenest 


The  Association  of  Medical  Diplomates  of 
Scotland* 

The  medical  profession,  by  slow  but  steady  steps, 
is  approaching  the  goal  of  organisation.  On  all 
hands  flourishing  societies  have  been  founded  for 
the  mutual  advance  or  protection  of  professional 
interests.  The  most  recently  formed  is  that  of 
the  Medical  Diplomates  of  Scotland,  that  is  to 
say,  of  holders  of  the  qualifications  granted  by 
the  Royal  Colleges  of  Surgeons  of  Edinburgh, 
and  by  the  Faculty  of  Physicians  and  Surgeons 
of  Glasgow.  At  a  special  meeting,  held  on  May 
19th,  in  London,  the  Association  was  formally 
started  and  rules  drawn  up  for  its  future  guidance. 
An  excellent  first  President  was  chosen  in  the 
person  of  Mr.  C.  St.  Aubyn-Farrer,  of  London. 
Nine  Members  of  Council  were  elected,  namely, 
Drs.  David  Walsh  and  H.  FitzGerald  Powell, 
Messrs.  Sydney  Stephenson,  P.  H.  Parsons, 
F.  E.  Fen  ton,  Alexander  Ross,  Robert  Thomson, 
E.  N.  Fere,  all  of  London,  and  Mr.  F.  B.  Lewis, 
of  St.  Leonards-on-Sea.  The  aim  of  the  Asso- 
ciation is  to  bring  together  Scotch  diplomates 
into  close  touch  upon  social  and  professional 
matters.  More  particularly  there  are  certain  dis- 
advantages as  regards  the  holding  of  public 
appointments  and  other  things  that  a  strong 
association  of  the  diplomates  might  do  much  to 
remove.  The  Scotch  diplomates  are  a  large  and 
powerful  body,  and  a  wide  field  of  achievement  lies 
before  them  if  they  can  rally  under  one  banner 
and  summon  the  requisite  amount  of  enthusiasm. 


June  8,  1904. 


CORRESPONDENCE. 


The  Medical  Putts.    6  21 


sympathy  amongst  diplomates  in  all  parts  of  the 
United  Kingdom.  It  is  obvious  that  under  pru- 
dent management  the  interests  of  the  Scotch 
diplomates,  both  collectively  and  individually, 
may  be  materially  strengthened  by  such  an 
association.  All  Licentiates,  Members  and 
Fellows  of  the  Colleges  concerned  should  join 
forthwith.  Further  particulars  may  be  obtained 
from  the  Hon.  Treasurer,  W.  Bell,  Esq.,  2  Gros- 
venor  Gardens,  Willesden  Green,  London,  N.W., 
or  of  M.  E.  Leicester,  Esq.,  Hon.  Sec.,  16  Kildare 
Terrace,  Bayswater,  London,  W. 


PERSONAL. 


Dr.  £.  White,  the  Resident  Physician  and  Superin- 
tendent of  the  City  of  London  Asylum  at  Stone,  a 
position  he  has  held  since  1887,  has  sent  in  his  resigna- 
tion to  the  City  Corporation. 


Sir  William  Collins,  M.D..  Chairman  of  the 
Education  Committee  of  the  London  County  Council, 
•opened  a  new  Nature  Study  Museum  in  St.  George's 
Recreation  Ground  on  Friday  last. 


Major  Bird,  the  Viceroy  of  India's  Surgeon,  who  has 
been  attending  the  Ameer,  left  Kabul  en  the  25th  ult. 
It  is  stated  that  the  Ameer  is  now  convalescent,  and 
the  wound  in  his  Highness'  hand  is  practically  healed. 

Dr.  W.  E.  A.  Cummings,  of  Cork,  has  been  authorised 
by  the  Local  Government  Board  of  England  to  give 
certificates  of  qualification  in  the  practice  of  vaccina- 
tion. 


Mr.  Francis  Heuston,  F.R.C.S.,  Surgeon  to  the 
Adelaide  Hospital,  has  been  appointed  Consulting 
Surgeon  to  the  Rotunda  Hospital,  in  succession  to 
the  late  Sir  Philip  Smyly. 

Professor  G.  Sims  Woodhead  will  preside  at  the 
commemoration  day  proceedings  of  Livingstone  College, 
Ley  ton,  on  June  Qt  a,  at  3.30'p.m.,  and  will  formally  open 
the  new  laboratory  which  has  been  arranged  in  the 
College. 


The  Bolingbroke  lecture  of  the  South- West  London 
Medical  Society  will  be  delivered  on  Thursday,  June 
9th,  by  Dr.  W.  H.  AUchin,  on  "  Some  Special  Features  of 
Diseases  of  the  Colon,"  at  the  Municipal  Buildings, 
Lavender  Hill,  at  8.45  p.m. 

Inspector-General  H.  Mackay  Ellis  has  been 
selected  for  the  appointment  of  Director-General  of 
the  Medical  Department  of  the  Royal  Navy,  in  suc- 
cession to  Inspector-General  Sir  H.  F.  Norbury,  who 
will  shortly  relinquish  the  post. 

The  prize  distribution  at  the  medical  school  of  St. 
Thomas's  Hospital  will  be  held  in  the  Governors'  Hall 
of  the  hospital  on  Friday,  June  24th,  at  3  p.m.,  when 
Sir  Thomas  Barlow.  Bart..  K.C.V.O.,  M.D.Lond., 
will  give  an  address  and  a  garden  party  will  follow 
in  the  grounds. 

Professor  Ferdinand  Hueppe,  M.D.,  Director 
of  the  Hygienic  Institute  of  Prague,  will  deliver 
an  address  on  tuberculosis  (in  English)  at  the  Folkestone 
Congress  of  the  Royal  Institute  of  Public  Health,  to  be 
held  in  Folkestone  from  July  21st  to  the  26th. 

At  the  same  meeting  Surgeon-General  G.  J.  H. 
Evatt,  C.B.,  M.D.,  will  lecture  upon  •'  The  Personal 
Health  of  the  Citizen  in  Relation  to  National  Efficiency." 


Visiting  Surgeon  to  Jervis  Street  Hospital,  Dublin,  in 
succession  to  Mr.  Conway  Dwyer,  appointed  Visiting 
Surgeon  to  the  Meath  Hospital 

The  Duchess  of  Albany  recently  laid  the  memorial 
stone  of  the  Walton,  Hersham  and  Oatlands  Cottage 
Hospital,  which  has  been  founded  to  commemorate 
the  Coronation.  

Lord  Armstrong  last  week  presided  at  the  Annual 
meeting  of  the  Newcastle-upon-Tyne  and  Northum- 
berland branch  of  the  National  Association  for  the 
Prevention  of  Consumption. 

Mr.  A.  C.  Scovell  has  been  appointed  to  succeed 
Sir  R.  M.  Hensley  as  Chairman  of  the  Metropolitan 
Asylums  Board,  while  Mr.  P.  M.  Martineau  follows 
Mr.  J.  G.  Talbot,  M.P.,  in  the  vice-chair. 


Dr.  James  MilwaRd  is  the  first  Welshman  to  be 
elected  President  of  the  National  Poor-law  Officers* 
Association.  

Mr.  Herbert  M.  Turnbull,  M.A.,  M.B..  Magdalen 
College,  Oxford,  has  been  elected  to  a  Radcliffe  travel- 
ling fellowship  for  three  years. 

We  regret  to  say  that  the  distinguished  surgeon. 
Sir  P.  Heron  Watson,  has  been  made  the  defendant 
in  a  trial  for  slander,  an  annoying  incident  that  must 
be  accepted  now  and  then  as  inevitable  to  the  career 
of  medicine.  

Dr.  Edwin  Rickards  has  resigned  his  post  as  Senior 
Physician  of  the  jBirmingham  General  Hospital. 

Dr.  W.  P.  Herringham  and  Mr.  Anthony  Bowlby, 
C.M.G.,  have  resigned  their  respective  positions  as 
Consulting  Physician  and  Surgeon  to  the  Wanstead 
Orphan  Infant  Asylum  in  consequence  of  their  dis- 
approval of  the  action  of  (he  management  with  regard 
to  nursing  and  to  isolation  accommodation. 


Mr.   Denis    Kennedy,    F.R.C.S.,   Surgeon    to   the 
Children's  Hospital,  Temple  Street,  has  been  elected 


Professor  von  Mikulicz,  of  Breslau,  will  deliver  the 
Cavendish  Lecture  before  the  West  London  Medico- 
Chirurgical  Society  at  the  Town  Hall,  Hammersmith* 
on  Friday,  the  24th  inst.,  at  8.30  p.m.  The  annual 
conversazione  will  be  held  at  the  same  time  and  place. 


As  soon  as  the  Select  Committee  on  the  Tuberculosis 
(Animals)  Compensation  Bill  has  been  appointed,  Mr. 
Channing  will  move  that  it  be  an  instruction  to  the 
Committee  to  consider  under  what  conditions  and 
from  what  sources  compensation  may  be  given  to  the 
owners  of  dairy  and  other  stock  condemned  to  be 
slaughtered  on  account  of  tuberculosis. 


DAMAGES  FOR  SPONGE  IN  ABDOMEN. 
An  action  to  recover  damages  against  a  lady  doctor 
practising  in  London  has  resulted  in  a  verdict  for  the 
plaintiff  with  £2$  damages  and  costs.  The  defendant 
performed  an  abdominal  operation  upon  plaintiff  and 
a  sponge  was  inadvertently  left  in  the  abdomen  and 
removed  by  another  surgeon  some  time  after.  The 
decision  is  of  vital  importance  to  the  medical  profession, 
as  it  upsets  previously  accepted  views  as  to  what  con- 
stitutes "  reasonable  "  care  and  skill. 


Correspondence* 

CENTRAL  MID  WIVES'  BOARD. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — It  will  be  satisfactory  to  many  of  your  readers 
to  learn  that  at  the  meeting  of  this  Board  on  Thursday 
last  a  resolution  was  carried  to  the  effect,  "  That 
reporters  of  the  recognised  medical  and  nursing  journals 
be  invited  to  attend  the  meetings  of  the  Central' Mid- 
wives'  Board."  But  for  the  adoption  of  this  resolution 
I  should  have  felt  compelled  to  raise  the  veil  which  has 
so  long  concealed  proceedings  affecting  so  many 
important    interests,    and    to  assume  the    duties  of 


622     The  Medical  Pejus. 


CORRESPONDENCE. 


JuneS,  1904. 


descriptive  writer  until  relieved  by  professional  reporters 
from  the  self-imposed,  but  ungrateful  task.  Now  that 
reporters  are  to  be  admitted,  it  seems  to  me  to  be  suffi- 
cient to  state,  with  your  permission,  my  estimate  of 
the  existing  position  of  affairs  while  explaining  some 
facts  and  recent  incidents  which  have  produced  the 
present  situation.  In  future  your  readers  interested  in 
the  administration  of  the  Midwives  Act  will  be  able 
to  follow  events  by  the  perusal  of  what  they  can  con- 
fidently assume  to  be  incontrovertibly  accurate  and 
unbiassed  reports  of  proceedings. 

The  Midwives  Act,  1902,  was  a  sadly  defective 
piece  of  legislative  work.  It  incorporated  in  an  Act 
of  Parliament  the  policy  of  the  Midwives*  Institute 
as  distinct  from,  and  even  in  opposition  to,  the  interests 
of  the  medical  profession  and,  as  I  strongly  believe,  the 
interests  of  the  working-class  public  of  England  and 
Wales.  The  amendments  suggested  by  the  medical  pro- 
fession in  Great  Britain  could  be  ignored  by  the  sponsors 
of  the  BUI,  while  for  reasons  transparently  clear  at 
the  time  of  the  final  Parliamentary  struggle,  the 
opposition  of  the  Irish  members  was  weakened  by 
illusory  and  temporary  concessions  to  the  Irish  schools 
of  midwifery. 

One  of  the  most  obvious  defects  in  the  Act,  which 
at  the  same  time  clearly  revealed  the  influences  at 
work,  was  the  constitution  of  the  Central  Midwives* 
Board,  created  to  administer  the  Act.  The  Board 
proposed  in  the  Bill  of  1900  would  have  been  repre- 
sentative, strong  and  efficient ;  the  most  zealous  partizao 
supporter  of  the  Act  of  1902  could  hardly  say  the  same 
of  the  now  existing  Board.  This  Board,  created  to 
control  purely  medical  affairs,  was  so  constituted  that 
three  at  least  of  its  members  must  be  non-medical 
women,  and  of  the  total  of  nine  members  five  might 
not  belong  to  the  medical  profession.  For  purposes  of 
representation,  the  Incorporated  Midwives'  Institute 
was  placed  on  a  footing  of  equality  with  the  Royal 
College  of  Physicians. 

The  Act  contains  provisions  which  imply  the  most 
tender  solicitude  for  the  midwife  ;  it  is  ominously  silent 
where  the  interests  of  the  medical  profession  are  con- 
cerned. The  midwife,  having  made  her  own  arrange- 
ments with  her  client,  is  required  to  send  for  medical 
assistance  under  certain  contingencies,  but  there 
is  not  a  word  about  the  remuneration  of  the  medical 
practitioner  who  responds  to  the  summons,  and  comes 
to  the  rescue.  Contrast  this  with  the  explicit  enactment 
with  regard  to  legal  expenses  incurred  in  the  adminis- 
tration of  the  Act  (Clause  15). 

Again,  the  authors  and  sponsors  of  the  Bill  obviously 
contemplated  that  the  Central  Midwives'  Board  should 
consist  of  merely  a  London  coterie,  for  there  is  no  pro- 
vision for  the  payment  of  expenses  incurred  by  mem- 
bers, as  in  the  case  of  the  General  Medical  Council ; 
and  no  regulations  with  regard  to  meetings  of  the 
Board  are  even  hinted  at.  Consequently,  the  two 
country  members  must  submit  to  mere  harassment  or 
fail  to  perform  the  duties  which  they  have  undertaken. 
They  are  required  to  attend  once  a  month,  or  oftener, 
meetings  of  the  drawing-room  type,  with  afternoon  tea, 
for  a  short  time  after  lunch,  to  sacrifice  a  day's  work 
when  called  upon,  and  pay  all  the  contingent  expenses. 
It  may  be  objected  that  these  are  paltry  domestic 
details,  any  reference  to  which  should  be  beneath  the 
notice  of  a  member  of  the  Board.  I  hold  a  different 
opinion,  else  I  would  not  mention  them.  They  seem 
to  me  to  be  of  the  essence  of  the  efficiency  of  a  Board 
created  to  administer  an  Act  of  Parliament  affecting  the 
whole  of  England  and  Wales  ;  and  I  maintain  that  the 
proceedings  of  a  statutory  Board  ought  to  be  arranged 
for  and  conducted  in  a  manner  adequate  to  the  dignity 
of  its  origin. 

When  the  Board  thus  constituted  commenced  to 
frame  rules  and  regulations  for  midwives  the  policy 
underlying  the  Act  soon  became  evident.  The  fee  for 
the  enrolment  of  certain  classes  of  midwives  was  fixed 
at  the  paltry  sum  of  ten  shillings,  the  fee  for  examina- 
tion at  one  guinea.  This  decision  was  certainly  in  the 
spirit,  and  partly  in  compliance  with  the  letter,  of  the 
Act ;  but  it  should  be  remembered  in  judging  Act  or 
Rules  that  these  sums  included  the  total  expense  of 


obtaining  a  privileged  position  which  was  to  secure 
special  advantages  for  earning  a  professional  income. 
Let  us  now  look  for  some  of  the  evidence  of  a  policy  in 
certain  Rules  which  were  framed  by  the  majority  of  the 
Board, even  if  some  of  them  had  to  be  greatly  modified  or 
abandoned  before  the  completed  Rules  were  forwarded 
to  the  Privy  Council  for  approval  They  refused  to 
sanction  any  rule  requiring  pupil-midwives  to  prove 
the  possession  of  some  definite  standard  of  common 
school  education  ;  fixing  any  minimum  period  of  train- 
ing ;  specifying  the  minimum  number  of  lectures  or 
lessons  comprised  in  a  course  of  systematic  instruction  ; 
giving  clear  and  exact  instructions  with  regard  to  the 
contingencies  which  would  demand  an  appeal  for 
medical  assistance  during  parturition  or  in  the  course 
of  the  puerperium.  On  this  last  head,  the  matter  was 
to  be  left  to  the  judgment  of  the  midwife  ;  she  was 
to  send  for  a  medical  practitioner  only  when  in  her 
opinion  the  progress  of  the  woman  or  child  was  "  not 
satisfactory."  Under  such  loosely-framed  regulations 
it  would  have  been  next  to  impossible  to  make  even  the 
most  ignorant  and  negligent  midwife  answerable  for 
her  conduct.  On  the  other  hand,  some  regulations  origi- 
nally framed  to  magnify  the  office  of  midwife  were 
definite  enough.  She  was,  for  example,  required  to 
baptise  feeble  babies  in  certain  events,  and  she  was 
always  to  produce  conjunctivitis  by  irritants,  introduced 
even  before  complete  birth,  as  a  prophylaxis  against 
gonorrhceal  ophthalmia. 

Several  of  thp  worst  defects  in  the  Rules  were  reme- 
died owing  to  the  acceptance  by  the  Privy  Council  of 
suggestions  embodied  in  a  "  Minority  Report  "  signed 
exclusively  by  medical  members  of  the  Board.  But 
still  the  Rules  are  permeated  by  the  spirit  of  the  Bills 
which  have  orginated  from  time  to  time  in  the  same 
quarter  ;  they  are  stamped  with  the  policy  of  the  Mid- 
wives'  Institute  ;  it  is  to  be  made  cheap  and  easy  for  a 
humble  and  illiterate  class  of  female  persons  to  become 
midwives,  when  so  disposed ;  and  they  are  to  be 
relieved,  as  far  as  a  sympathetic  and  benevolent  inter- 
pretation of  the  Act  will  permit,  from  irksome  restric- 
tions inserted  in  the  interests  of  mere  child-bearing 
women  of  the  working  classes. 

Owing  to  an  accidental  interruption  at  this  stage  of 
my  letter,  I  have  had  the  timely  opportunity  of  reading 
in  the  Lancet  of  to-day  (May  28th,  p.  1.543)  a  concise 
report  of  the  proceedings  of  the  "  Association  for 
Promoting  the  Training  and  Supply  of  Midwives." 
Kindly  permit  me  the  liberty  of  making  some  short 
quotations  from  this  instructive  report :  "  The  chair 
was  taken  by  Miss  Wilson,  president  of  the  Midwives' 
Institute,  and  member  of  the  Central  Midwives' 
Board.  .  .  .  Free  or  assisted  training  was  given 
by  the  Association.  .  .  .  Reference  was  made 
to  the  Training  Home  at  East  Ham  in  connection  with 
the  Plaistow  Maternity  Charity  started  by  the  Associa- 
tion last  year.  .  .  .  The  sum  of  £1,000  would 
train  fifty  midwives."  This  report  is  to  me  a  curious 
revelation  of  fact,  explaining  the  antagonism  of  princi- 
ples in  the  Central  Midwives'  Board  which  has  hitherto 
been  only  a  distressing  phenomenon — on  the  one  hand, 
the  benevolence  of  a  certain  largely  non-medical 
contingent  towards  illiteracy  and  inefficiency  generally  ; 
on  the  other,  the  futile  struggle  of  a  medical  minority 
to  raise  the  standard  of  education  so  as  to  secure  a 
better  quality  of  midwife  in  the  future.  During  the 
long  agitation  to  obtain  an  Act  of  Parliament  for  the 
education,  registration,  and  medical  supervision  of  mid- 
wives,  who  ever  heard  a  complaint  about  the  lack  of 
women  ready  to  assume  the  name  and  functions  of  a 
midwife  ?  Every  argument  in  favour  of  every  Bill 
was  founded  tacitly  or  explicitly  on  a  promise  to  eradi- 
cate for  ever  the  ignorance  and  consequent  incompe- 
tence which  were  the  roots  of  all  the  worst  scandals 
arising  from  the  practice  of  midwives.  But  the  policy 
and  methods  of  the  Midwives'  Institute  do  not  possess 
even  the  germs  of  progress.  What  good  to  the  com- 
munity can  come  from  encouraging  a  class  of  women 
who  develop  a  thoughtful  turn  of  mind  only  owing  to 
their  inability  to  read  ?  We  may  well  despair  if  the 
midwife  of  the  future  is  to  be  turned  out  in  fourteen 
weeks  at  the  average  cost  of  /20  a  head ! 


June  S,  1904. 


CORRESPONDENCE. 


The  Medical  Press.    623 


Coming  now  to  the  present  situation,  as  far  as  the 
actual  proceedings  of  the  Central  Midwives'  Board  are 
concerned  it  appears  to  me  that  the  first  question 
demanding  attention  and  solution  is  the  dispute  be- 
tween the  Dublin  lying-in  hospitals  and  the  Central 
Midwives'  Board.  There  are  two  points  at  issue  :  (1) 
The  efficiency  of  the  practical  teaching  of  pupil-mid- 
wives,  narrowed  down  to  a  question  as  to  the  number 
of/patients  to  be  personally  and  exclusively  delivered 
by  the  individual  pupil  before  she  can  receive  certain 
certificates;  and  (2)  the  number  of  days  after  labour 
during  which  the  pupil  must  have  the  patient  nnder 
observation,  so  as  to  gain  sufficient  knowledge  of  the 
puerperium. 

(1)  For  a  clear  understanding  of  this  difficulty  the 
wording  of  the  Rules  of  the  Central  Midwives*  Board 
must  be  kept  in  mind.     One  of  the  certificates  which 
the  candidate  must  put  in  before  admission  to  the  ex- 
amination is  to  the  effect  that  she  has,  under  approved 
supervision,   "attended  and  watched  the  progress  of 
not  fewer  than  twenty  labours,  making  abdominal  and 
vaginal  examinations  during  the  course  of  labour,  and 
personally  delivering  the  patient."     (Rules,  Form  III.) 
Such   a   rule   as   this,  applied,  as  it  has  been,  to  the 
exclusion  of  the  Dublin  schools  of  midwifery,  is,  in  my 
opinion,  impracticable  and  even  mischievous.     It  has 
been     interpreted     literally    to  •  imply     that     each 
individual    pupil     has     attended     at     least    twenty 
cases,   no     one    of    which    has     been    reckoned    for 
the  certification^  of  any  other  pupil.     It  is  not  con- 
ceivable that  this  rule  could  ever  have  been  so  framed 
and    interpreted    and     enforced    by   a    Board   con- 
sisting   of    medical   men    or  women    experienced   in 
the  details  of  the  training  in  obstetrics  of  students  of 
medicine    and    midwife-pupils,     and    capable,    from 
professional  experience,  of  appreciating  the  reasons  for 
some  rule.     Such  a  rule,  interpreted  literally,  is  not  in 
force  in  any  school  of  midwifery  in  Europe  or  America  ; 
it  almost  compels  evasion,  or  at  least  interpretation 
according  to  the  dictates  of  practical  common  sense. 
Everyone  engaged  in  the  actual  clinical  teaching  of  mid- 
wifery must  know  that  two  or  even  three  pupils  learn 
more  individually  from  a  single  case  than  the  solitary 
student ;    they  sharpen  one  another's  wits  by  conver- 
sation about  the  case,  and  by  comparison  of  observa- 
tions ;     and   there  is,   consequently,    constant   exact 
sustained  attention,  and  no  shirking  or  apathy.     The 
training  of  midwives  at  the  Dublin  lying-in  hospitals 
is  notoriously  the  best  in  the  United  Kingdom.     The 
-pupils  "  reside  for  a  period  of  six  months  in  the  hospi- 
tal," and  receive  systematic  instruction  during  the  whole 
term  of  residence  far  superior  to  the  requirements 
•of  the  Central  Midwives'  Board.     Probably  m  the  con- 
sciousness of  this  superiority,  the  Master  of  the  Rotunda 
Hospital  replied  to  interrogatories  in  a  frankly  truthful 
fashion  ;   and  the  consequence  is,  that  on  this  narrow 
technical   point   in   a  rule  recently   formulated    the 
Dublin  hospitals  are  declared  by  a  majority  of   the 
•Central  Midwives*  Board  to  be  disqualified  from  granting 
to  their  pupils  the  certificates  necessary  to  enable  them 
to  enter  for  examination.     The  unfitness  of  the  Board 
as  at  present  constituted  to  exercise  judicial  functions 
is  well  illustrated  by  the  somewhat  irrelevant  but  sug- 
gestive remark  of  one  of  the  members  during  the  dis- 
cussion of  the  question,  to  the  effect  that  the  Dublin 
-people  send  out  too  many  midwives ;    and  by  the 
rhetorical  question  in  the  course  of  a  formal  speech  by 
another  member  :   "  Are  we  going  to  climb  down  ?  " 

(2)  The  second  point  to  which  I  wish  to  call  attention 
in  the  difficulty  with  the  Dublin  institutions  is  a  very 
attenuated  difference  indeed.  The  Central  Mid- 
wives'  Board,  in  drafting  its  rules,  thought  that  ten  days 
was  a  reasonable  time  for  a  pupil-midwife  to  be  required 
to  nurse  her  twenty  patients  in  the  puerperium.  As 
medical  practitioners  know,  there  is  no  special  scientific 
sanction  for  ten  days.  The  period  finally  fixed  was 
t  he  result  of  a  compromise.  Accordingly,  the  candidate 
before  admission  to  the  examination  must  send  in  a 
certificate  that  she  has  "  nursed  twenty  lying-in 
women  during  the  ten  days  following  labour."  (Rules. 
JormlV.)      Now,  this  rule  was  framed  in  blank  ijnor- 


1  ance  of  an  important  fact  with  which  the  Board  became. 
I  acquainted  for  the  first  time  only  on  hearing  a  letter 
!  read  from  the  Master  of  the  Rotunda  Hospital,  writing 
in   his  official  capacity.     He  stated,  inter  alia,   "  It 
<  would  be  impossible  for  our  resident  nurses  to  follow 
the  co  irse  of  the  puerperium  for  ten  days,  as  Irish- 
women will  not  remain  in  the  hospital  for  more  than 
eight  days."     I  cannot  believe  that  a  single  medical 
member  of  the  Central  Midwives'  Board  would  have 
voted  in  favour  of  fixing  ten  days  a3  the  minimum 
period  of  nursing  in  the  puerperium,  if  it  had  been 
*  known  at   the   time  of  framing  the  Rules  that  the 
I  Dublin  lying-in  hospitals  would   have  been  excluded 
in  consequence.     But   now,  "  are  we  going   to  climb 
down  ?  " 

The  Dublin  grievances  were  discussed  after  the 
reading  of  a  letter  from  the  President  of  the  Royal 
Academy  of  Medicine  in  Ireland  at  a  meeting  of  the 
Board  held  on  Februrary  25th,  when  eight  of  the  nine 
members  were  present.  To  a  mere  non-possumus  reso- 
lution to  the  effect  that  "  the  Rules  .  .  .  having 
been  approved  by  the  Privy  Council  it  is  impossible 
for  the  Board  to  alter  them,"  one  of  the  usual  minority 
proposed,  and  another  seconded,  an  amendment, 
regretting  that  the  Board  was  not  made  aware  of  the 
circumstances  of  the  midwifery  training  schools  in 
Ireland  before  the  Rules  were  sent  to  the  Privy  Council 
for  approval,  and  stating  "  that  this  Board  sympathises 
with  the  Irish  institutions  in  their  difficulties,  and  will 
give  every  assistance  in  order  to  obtain  a  revision  of 
the  Rules  by  the  Privy  Council."  For  this  amend- 
ment only  the  proposer  and  seconder  voted  ;  against  it 
five  members.  For  the  •"  it-is-impossible  "  resolution 
then  put  substantively  there  voted  six ;  against  it, 
the  same   two. 

Owing  to  the  persistence  of  the  authorities  of  the 
Dublin  lying-in  hospitals,  the  question  came  up  again 
on  April  28th,  and  although  an  excellent  way  out  of 
the  difficulty  was  proposed  in  a  resolution  by  one  of  the 
lay  members,  the  result  was  practically  the  same. 
The  subject  was  again  under  consideration  on  Thursday 
last  (May  26th),  on  a  motion  which  appeared  to  indi- 
cate a  weakening  of  the  opposition,  but  in  reality 
offering  no  practical  help  to  the  Irish  institutions. 
For  an  amendment,  once  more  offering  sympathy 
and  assistance,  there  voted  only  the  same  old  two ; 
all  the  rest  were  opposed.  That  is  how  this  question 
stands  at  the  present  moment. 

Yet  the  Central  Midwives'  Board  is  not  always  so 
pedantically  exact  in  guiding  its  conduct  by  its 
own  Rules.  In  the  printed  minutes  of  the  meeting 
of  March  24th,  which  I  was  unable  to  attend,  I  read  the 

following  record :    "  Mrs.  H stated  that  she  had 

not  undertaken  cases  without  doctors,  but  had  been 
advised  by  a  medical  man  that  she  need  not  be  afraid  to 
do  so,  and  added  that  she  herself  did  not  feel  in  any  way 
afraid  of  so  acting."  Curious  and  by  no  means  lucid 
as  the  diction  is,  the  Board  appears  to  have  grasped 
the  intention  of  the  applicant,  and  "  resolved  that  in  the 

opinion  of  the  Board  it  is  desirable  that  Mrs.  H 

should  be  certified,  as  it  appears  from  her  letter  that  she 
is  quite  prepared  to  take  a  case  alone  " — an  example 
of  the  proverbially  fatal  mistake  of  assigning  the  reason 
for  a  judgment  I  What  untrained  midwife  was  there 
ever  yet  who  was  not  "  quite  prepared  "  to  undertake  a 
case,  and  preferably  "  alone  "  ? 

This  episode  appears  to  have  taken  its  origin  and 
reached  its  remarkable  conclusion  under  the  item 
"  Correspondence  "  on  the  Agenda  paper  received  by 
the  members.  "  A  letter  was  read  from  the  deputy 
clerk  "  of  a  County  Council  enclosing  an  inquiry  from 

this  Mrs.  H ,  and  the  resolution  quoted  above  was 

put  without  more  ado.  The  printed  minutes  re- 
ceived a  month  later  afforded  me  the  first  and  only 
information  regarding  this  almost  incredible  violation  of 
the  Rules.  One  of  the  certificates  which  such  an  appli- 
cant for  admission  to  the  Midwives'  Roll  is  required  by 
the  Rules  to  supply  with  her  application  is,  according  to 
Form  VIII :  "I  hereby  claim  to  be  certified  under 
Section  2  of  the  Midwives  Act,  on  the  ground  that  I 
have  been  in  bond  fide  practice    as    a  midwife  since 


624     .The  Medical  Press. 


CORRESPONDENCE. 


June  8,  1904. 


..."  (one  year  at  least  before  July  31st,  1902); 
and  the  application  must  be  supported  by  a  certificate 
in  Form  IX,  that  she  "  has,  to  my  personal  knowledge, 
been  in  bond  fide  practice  as  a  midwife  since  .  .  ." 
(one  year  at  least  before  July  31st,  1902),  •'  and 
that  she  is  trustworthy,  sober,  and  of  good  moral 
character."  But  this  applicant  appears  to  have 
produced  no  evidence  whatever  except  a  statement  as 
to  her  own  mental  condition,  that  of  self-confidence, 
and  a  second-hand  opinion  from  an  anonymous  medical 
man  ;  moreover,  she  testified  to  the  Board  against 
herself  to  the  effect  that  she  was  practising  as  a  monthly 
nurse,  and  had  not  been  at  any  time  in  bond  fide 
practice  as  a  midwife.  Contrast  the  levity  and  in- 
consistency of  the  resolution  of  the  Board  in  this  case 
with  its  persistently  correct  and  severe  attitude  towards 
the  Dublin  lying-in  hospitals.  The  resolution  of  the 
Board  to  dispense  with  certificates  when  the  applicant 
is  avowedly  a  monthly  nurse,  "  quite  prepared  to 
undertake  a  case  alone/'  is  a  breach  of  its  own  Rules; 
it  contravenes  or  evades  the  intention  of  the  Act, 
and  but  for  the  imbecility  of  the  definition  ofa"  mid- 
wife "  contained  in  the  Midwives  Act,  it  would  have 
been,  without  question,  in  direct  contravention  of  the 
Statute. 

To  another  grave  decision  of  the  Central  Midwives* 
Board  I  desire  to  call  the  attention  of  the  medical  pro- 
fession without  further  delay.  At  the  meeting  of  the 
Board,  held  on  April  28th,  a  resolution  was  introduced 
by  a  lay  member  to  the  effect  that  the  Board  consider 
it  desirable  "  to  appoint  an  inspector  to  visit  institu- 
tions applying  for  recognition,  and  to  report  thereon." 
The  proposer  of  this  resolution  explained  that  by  the 
term  inspector  she  meant  "  a  trained  woman."  It  is 
fair  to  assume  that  the  intention  was  to  appoint  a  mid- 
wife. A  few  months  ago  it  was  proposed  from  the  same 
quarter  that  midwives  be  authorised  to  give  the 
courses  of  systematic  instruction  to  pupil-midwives. 
The  proposal  was  not  carried  ;  and,  consequently,  no 
one  can  be  authorised  to  give  the  systematic  instruc- 
tion in  midwifery  who  is  not  a  registered  member 
of  the  medical  profession,  but,  by  the  recent  re- 
solution, the  "  trained  woman "  who  is  to  be 
appointed  and  sent  to  inspect  will  have,  no  doubt, 
to  report  on  the  efficiency  of  the  teaching  of  those 
qualified  men  and  women  who  are  engaged  in  giving 
systematic  instruction  to  midwives  in  our  lying-in 
hospitals,  on  the  character  of  the  equipment  and 
organisation  for  systematic  and  clinical  teaching,  the 
sufficiency  of  the  staffs,  the  sanitary  arrangements  of  the 
hospitals,  including  the  air  space  per  bed  and  other 
cognate  matters.  It  was  strongly  objected  by  one  of  the 
minority  that  such  an  appointment  was  not  likely  to 
result  in  efficient  inspection  and  reliable  reporting,  that 
it  would  be  a  slight  to  the  medical  profession  generally, 
and  an  insult  to  the  individual  lecturer  to  have  an 
inferior  order  of  non-professional  person  thrust  upon 
him  or  her  as  a  reporter.  It  was  also  pointed  out,  in 
opposition  to  the  resolution,  that  the  County  Councils 
and  County  Borough  Councils  have  almost  universally 
appointed  their  medical  officers  of  health  as  executive 
officers  for  the  administration  of  the  Midwives  Act, 
and,  considering  the  local  knowledge  and  the  inde- 
pendent position  of  such  medical  officers,  confidential 
reports  from  them  concerning  institutions  within  their 
areas  could  be  entirely  relied  upon  by  the  Central 
Midwives'  Board  as  unbiassed,  accurate,  and  trust- 
worthy. 

On  the  other  hand,  the  irresponsible  report  of  the 
"  trained  woman  "  could  not  be  relied  upon  unless  it 
was  intended  for  publication,  and  probably  not  even 
then.  On  a  vote  being  taken,  with  seven  members 
present,  three  voted  for  the  resolution,  two  of  them 
being  non-medical  members,  and  one  voted  against  it. 
Three  members — two  of  them  medical  men — declined  to 
vote.  So  the  resolution  was  carried.  None  of  the 
proceedings  of  the  last  eighteen  months  more  thoroughly 
demonstrates  the  defective  composition,  and  the  conse- 
quent bias  and  sort  of  moral  incompetence  of  the  Central 
Midwives'    Board.     On    an    important    question    Of 


principle  like  this,  involving  a  kind  of  degradation  of 
the  medical  profession  and  magnifying  the  midwife's 
office,  three  men  out  of  five  present,  not  taken  at  una- 
wares, because  the  motion  had  been  repeatedly  on  the 
Agenda  paper,  refused  to  vote,  and  so  this  serious  de- 
cision was  carried  by  the  votes  of  one-third  of  the 
whole  Board,  only  one  of  the  four  medical  members 
present  recording  his  vote  against  it. 

But  there  appears  to  be  even  a  worse  thing  in  store 
for  us.  Probably  at  the  next  meeting  in  June,  the 
report  of  the  Standing  Committee  on  the  Examinations 
to  be  instituted  by  the  Board  will  come  up  finally  for 
consideration.  The  meeting  of  the  Standing  Committee 
which  sent  its  unanimous  recommendations  to  the 
ordinary  meeting  of  the  Board  consisted  of  four  London 
members,  two  of  them  being  medical  men.  There  are 
still  two  non-medical  members  in  reserve,  so  at  a 
full  meeting  a  majority  supporting  the  Standing  Com- 
mittee will  be  almost  certainly  secured.  Inter  alia, 
they  recommend,  under  the  head  of  "  examinations," 
that  "  one  or  more  women  who  hold,  or  have  held,  the 
post  of  matron  of  a  lying-in  hospital,  or  midwife,  if 
otherwise  qualified,  may  be  appointed  examiners." 
The  only  reason  for  this  decision  that  I  have  heard 
stated  in  the  Board  is  that  it  will  be  necessary  to 
include  "  bed-making "  among  the  subjects  of  ex- 
amination !  So  at  the  beginning  of  the  administra- 
tion of  an  Act  of  Parliament,  which  was  brought  into 
existence  because  of  the  notorious  ignorance  and  in- 
competence of  English  midwives,  it  is  seriously  pro- 
posed to  grant  to  the  Midwives'  Institute  the  privilege 
of  nominating  as  Examiners  its  own  protegees,  women 
with  untrained  intellects,  and  equipped  with  only 
midwife — Scottice  "howdy" — knowledge  and  experience, 
to  set  the  standard  of  examinations,  and  take  their 
places  on  examining  boards  on  equal  terms  with 
qualified  practitioners  and  teachers  of  midwifery. 
Surely  the  examining  boards  and  reporters  on  ex- 
aminations ought,  in  the  early  stages,  at  least,  to  be 
exclusively  composed  of  medical  men  and  women.  The 
professors  of  bed-making  might  gracefully  postpone  the 
assertion  of  their  claims,  and  wait  a  bit  until  the  system 
of  examinations  in  mere  midwifery  has  been  set  on  its 
legs  and  had  a  fair  start. 

The  medical  profession  should  keep  a  critical  eye  on 
the  recognition  by  the  Central  Midwives'  Board  of 
institutions  as  training  schools,  and  of  individuals 
as  teachers  of  midwife-pupils.  An  abuse  of  consider- 
able magnitude  appears  to  be  in  course  of  creation. 
To  the  credit  of  the  Board  it  may  be  recorded  that  ther* 
is  some  hesitation  with  regard  to  workhouse  infirmaries, 
but  on  the  other  hand  it  seems  that  hardly  any  one 
of  the  "  ladies'  charity  "  type  of  institution  is  too  ill- 
organised,  inefficient,  or  untried  and  paltry  to  escape 
recognition  as  a  School  for  the  Training  of  Midwives. 

As  to  the  professional  instructors  or  lecturers  or> 
midwifery  I  have  so  far  failed  to  discover  any  principle 
guiding  the  decisions  of  the  Board  either  in  the  recogni- 
tion or  rejection  of  applicants.  As  matters  are  shaping 
at  present,  there  must  be  at  no  very  distant  time  a 
teacher  of  midwifery  in  every  township. 

The  only  satisfaction  in  contemplating  extravagant 
proceedings  is  the  rather  remote  prospect  opening  out 
behind  them  that  a  reconstituted  Board  must  act  on 
diametrically  opposite  principles,  and  reverse  the  policy 
of  their  predecessors  by  compelling  aspirants  for 
privileges  which  will  secure  most  of  them  a  professional 
income  for  life  or  good  conduct  to  seek  their  professional 
training  within  efficiently  equipped  institutions  in  the 
great  centres  of  population  and  of  intellectual  activity. 
There  is,  however,  still  some  room  for  the  hope  that 
wiser  counsels  may  yet  prevail  under  the  enlightened 
and  benevolent  criticism  of  the  medical  profession, 
now  at  last  enabled  to  watch  events,  and  by  un- 
official advice  and  assistance  minimise  the  injury  to  the 
public  interests  by  the  inadequate  representation  oi 
their  profession  on  the  Central  Midwives*  Board. 
I  am,  Sir,  yours  truly, 

W.  J.  Sinclair,  M.LX 

Manchester,  May  28,  1904. 


June  8,  1904. 


MEDICAL   NEWS. 


The  Medical  Press.     625 


HOSPITAL  SUNDAY. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — Hospital  Sunday  is  this  year  fixed  for  June 
1 2th,  and  I  venture  to  hope  that  the  advanced  copy  of 
the  Hospital  Sunday  Supplement  of  the  Hospital 
which  I  enclose  will  prove  interesting  and  useful  to  you 
editorially. 

The  splendid  munificence  of  Mr.  George  Herring, 
who  has  already  contributed  ^53,000  to  the  Hospital 
Sunday  Fund,  has  been  emphasised  this  year  by  his 
offer  to  add  one  quarter  to  the  amount  collected  in 
places  of  worship  on  June  12th,  limiting  this  to  a 
collection  not  exceeding  £100,000.  The  Hospital 
in  co-operation  with  the  London  newspaper  press, 
desires  to  co-operate  with  Mr.  George  Herring  by  the 
issue  of  this  special  supplement  and  so  to  show  the 
clergy  and  ministers  of  all  denominations  that  they  have 
behind  them  the  hearty  support  of  the  laity  in  then- 
efforts  on  Hospital  Sunday.  The  Hospital  Sunday 
Supplement  contains  an  excellent  portrait  of  Mr. 
George  Herring,  which  must  have  a  great  interest  for 
everybody. 

I  hope  that  you  may  be  willing  to  devote  a  little 
space  in  furtherance  of  this  effort.  As  a  resident  in 
the  metropolis  of  the  Empire,  too,  I  am  confident  you 
will  do  your  utmost  very  cheerfully  to  make  this 
necessary  work  for  all  classes  a  complete  success. 
I  am,  Sir,  yours  truly, 
Henry  C.  Burdett. 


ADeMcal  flews. 

Royal  College  of  Surgeons,  Ireland. 

The  annual  meeting  of  Fellows  was  held  on  Saturday 
last,  June  4th,  the  President,  Sir  Lambert  H.  Ormsby  in 
the  chair.  The  Report  of  the  Council  was  submitted 
and  adopted  ;  it  was  explained  by  the  President  that  the 
receipts  were,  with  two  exceptions,  the  best  for  the 
past  ten  years.  The  c  ollege  had  recently  expended 
over  j£i,20oin  painting,  &c,  this  was  paid  off.and  at  the 
date  of  the  Report  the  college  was  entirely  free  from 
debt,  and  had  a  bank  credit  of  nearly  £1,400.  The 
Investment  account  stood  at  £10,407  7s.  nd.,  and  the 
Trust  Fund,  £4.917  2s.  3d.,  making  a  total  of 
£55,324  ios.  2d.  During  the  year  ten  candidates, 
having  passed  the  examination,  were  admitted  Fellows, 
1 5  received  the  diplomas  in  surgery  and  midwifery  ;  24 
the  conjoint  diploma  in  public  health  ;  8  the  licence  in 
dental  surgery,  and  43  passed  the  preliminary  entrance 
examination.  There  are  at  present  living  435  Fellows, 
2,834  Licentiates.  181  diplomates  in  public  health, 
and  515  licentiates  in  dental  surgery. 

The  annual  election  of  officers  took  place  on  Monday 
last  with  the  following  results  : — 

President  ;  Arthur  Chance.  Vice-President ;  Henry 
R.  Swanzy.  Secretary  of  the  College ;  Sir  Charles  A. 
Cameron,  C.B.  Council;  Edward  Hallaran  Bennett, 
William  Stoker,  Sir  Charles  Alexander  Cameron,  C.B.. 
John  B.  Story,  Sir  William  Thomson,  C.B.,  Sir  Charles 
B.  Ball,  Sir  Thomas  Myles,  John  Lentaigne,  Richard  D. 
Purefoy,  Sir  Lambert  Ormsby,  Henry  G.  Sherlock, 
R.  Bolton  M'Causland.  John  S.  McArdle,  Robert  H. 
Woods,  Thomas  Donnelly,  William  Taylor,  Edward  H. 
Taylor,  G.  Jameson  Johnston,  R.  Charles  B.  Maunsell. 
Central  mdwtW  Board. 

At  a  meeting  of  the  Board  on  May  26th,  the  following 
business  was  transacted  : — 

Present. — The  Chairman  (Dr.  F.  H.  Champneys),  Mr. 
J.  Ward  Cousins,  Dr.  Cullingworth,  Miss  Oldham,  Miss 
Paget,  Dr.  Sinclair,  Miss  Wilson,  Mr.  E.  Parker  Young. 

1.  The  further  consideration  was  resumed  of  letters 
from  the  Royal  Academy  of  Medicine  in  Ireland,  the 
Rotunda  Hospital,  Dublin,  the  Coombe  Hospital 
Dublin,  and  the  Belfast  Maternity  Hospital,  asking  for 
a  modification  of  the  Board's  rules  so  as  to  facilitate  the 
admission  of  Irish  trained  pupil-midwives  to  the 
Board's  examinations. 

After  discussion  it  was  resolved  that  the  Privy 
Council  be  asked  to  sanction  the  appending  of  the 
following  Note  to  Rule  C.  I.  (2) : — 

Note. — "  A  certificate  to  the  effect  that  the  can- 
didate has  nursed  twenty  lying-in  women  during  the 


eight  days  following  labour  will  be  accepted  in  place  of 
the  above  in  cases  ( 1 )  where  the  course  of  special  train- 
ing in  a  hospital  has  extended  over  a  period  of  six 
months,  or  (2)  where  a  course  of  three  months'  special 
training  in  a  hospital  has  been  preceded  by  a  full  course 
of  training  in  general  nursing." 

It  was  also  resolved  that  the  Privy  Council  be  asked 
to  sanction  an  alternative  form  of  certificate  under 
Form  IV.  in  the  Schedule,  to  meet  the  modification  con- 
templated by  the  above  Note. 

2.  Resolved,  that  reporters  of  the  recognised  medical 
and  nursing  journals  be  invited  to  attend  the  meetings 
of  the  Board. 

3.  The  Chester  Benevolent  Institution  was  approved 
for  the  training  of  midwives. 

4.  The  following  were  approved  as  teachers  :  P.  E. 
Barber,  M.R.C.S.,  Robert  Boxall.  M.D.,  H.  Spencer 
Browne,  M.R.C.S.,  H.  Caudwell,  L.R.C.P.,  Francis 
Chown,  M.B.,  F.  W.  S.  Culhane,  M.R.C.S.,  J.  W. 
Fordham,  sen.,  M.R.C.S.,  G.  R.  Harcourt,  M.B.,  David 
Charles  Rayner,  F.R.C.S.,  William  Shaw,  L.R.C.P., 
A.  L.  Hall  Smith,  M.R.C.S. 

5.  After  consideration  of  applications  for  certificates 
the  names  of  878  women  were  passed  under  Section  2 
of  the  Act,  and  ordered  for  entry  on  the  Roll. 

The  following  table  shows  the  separate  numbers  of 
the   various   qualifications   at   present   appearing   on 
the  Roll :— • 

Royal  College  of  Physicians  of  Ireland     . .  1 

Obstetrical  Society  of  London  ii434 

Rotunda  Hospital    . .  . .  64 

Coombe  Hospital      . .         . .  . .  28 

Queen  Charlotte's  Hospital  99 

Liverpool  Lying-in  Hospital  57 

British  Lying-in  Hospital  . .  . .  4 

Glasgow  Maternity  Hospital  49 

St.  Mary's  Hospital,  Manchester..  85 

Manchester  Maternity  Hospital    . .  1 

City  of  London  Lying-in  Hospita  10 

Royal  Maternity  Hospital,  Edinburgh    . .  11 

Salvation  Army  Maternity  Hospital        . .  5 

National  Maternity  Hospital,  Dublin      . .  2 

Women  in  bond  fide  practice,  July,  1901  . .     3,480 

K  Total  enrolled       —  . .     5,330 

University  of  Aberdeen. 

At  a  recent  meeting  of  the  University  of  Aberdeen 
Anatomical  and  Anthropological  Society,  Professor 
R.  W.  Reid  being  in  the  chair,  Dr.  G.  Stoddart  read  a 
paper  entitled"  Statistics  Obtained  from  Observations 
of  the  Eyes  of  400  Students."  The  observations  had 
been  made  in  the  anthropometrical  laboratory  at 
Marischal  College  for  the  most  part  by  Dr.C.  H.  Usher, 
and  with  his  assistanceDr.  Stoddart  has  made  a  com- 
pilation which  is  unique  in  the  history  of  British 
anthropometry.  Dr.  Stoddart  reviewed  the  subject 
under  several  heads.  As  regards  acuteness  of  vision 
the  statistics  compared  favourably  with  those  obtained 
by  other  observers.  The  proportion  of  Aberdeen 
students  with  short  sight  was  shown  to  be  much  smaller 
than  that  found  by  similar  observations  in  German  and 
American  universities — namely,  187  per  cent.,  as 
compared  with  28  per  cent,  in  some  American  uni- 
versities, and  59  per  cent,  at  the  University  of  Breslau. 
Another  interesting  point  brought  out  by  the  observa- 
tions was  that  short  sight  was  much  more  frequently 
found  in  students  coming  from  towns  than  in  those 
from  country  districts.  The  prevalent  idea  that  in 
short-sighted  eyes  the  pupil  was  usually  larger  than  in 
eyes  with  normal  vision  was  contradicted  by  these 
observations,  which  showed  a  larger  average  pupil  in 
long  sight  than  in  short  sight.  With  regard  to  the 
colour  of  the  eye,  it  was  shown  that  dark  eyes  pre- 
dominated in  persons  having  dark  hair  and  skin.  In 
the  group  of  those  with  red  hair  a  larger  proportion  of 
the  eyes  were  of  a  grey  colour  than  in  the  other  groups. 
Acuteness  of  vision  was  found  to  depend  little,  if  at  all, 
on  the  si  e  of  the  pupil  or  the  colour  of  the  eye.  Light- 
coloured  eyes  were  found  to  have  a  slightly  larger  pupil 
than  dark  or  grey-coloured  eyes.  Three  per  cent,  of  the 
students  were  found  to  be  colour-blind. 


'6*6    Tub  Medical  Press.      NOTICES  TO  CORRESPONDENTS. 


JPNE  8,    I904 


Jtotias  to 
Qtamsponbtnte,  $hort  %tlUxa,  &t 

J|sj^*  Ookeb8POHDB»i»  requiring  a  reply  in  this  column  are  particu- 
larly requested  to  make  use  of  a  distinctive  Signaturt  or  initial,  and 
arokl  the  practice  of  signing  themselves  "Header,"  "Subscriber/ 
'  Old  Subscriber,"  ice.  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

Original  Article*  or  Letters  intended  tor  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
1  tion,  but  as  evidence  of  identity. 

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

.  Reprints.— Reprints  of  articles  appearing  in  this  journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

A  GOVERNMENT  ATTACK  ON  PATENT  MEDICINES. 

We  understand  the  Post  Office  Department  of  the  United  States 
has  decided  to  establish  a  censorship  over  newspaper  advertisements 
:  in  an  endeavour  to  prevent  the  publication  of  those  of  an  offensive  or 
fraudulent  character.  Newspapers  pr  nting  such  advertisements  will 
be  barred  from  the  post.  The  advertisements  aimed  at  are  chieflv 
those  of  the  lowest  class  of  patent  medicines,  about  twenty  of  which 
are  being  examined,  .by  the  Bureau  of  Chemistry  to  see  if  they  cor- 
respond with  the  claims  of  their  proprietors.  This  censorship  has 
been  for  some  time  in  existence  in  Germany,  and  it  is  one  long  since 
advocated  in  these  columns  as  a  public  necessity. 

Dr.  Cusack.— Your  letter  was  late  for  the  last  Poor-Law  Supple- 
ment, and  will  be  dealt  within  our  next  issue. 

Letters  to  Editor  from  Mr.  8ewill,  Dr.  Robert  Lee,  Dr.  Hamilton, 
and  Dr.  Rentoul  have  been  held  over  owing  to  pressure  of  space. 

K.  8.  S.  (Rutlands)  writes  us  pointing  out  the  pertinent  fact 
that,  although  Professor  Koch  was  the  actual  discoverer  of  the 
tubercle  bachlus,  he  nevertheless  advanced  claims  for  the  powers 
of  tuberculin  that  were  incapable  of  support.  The  latter  attitude 
was  hardly  that  of  a  consistently  strong  scientific  mind,  and  it 
appears  to  have  been  followed  by  a  somewhat  similar  lafisui  in  the 
esse  of  the  thunderbolt  launched  last  year  in  London  to  the  effect 
that  human  and  comparative  tuberculosis  were  two  absolutely  dis- 
tinct maladies. 

LwcofcH's  I ww.— We  can  imagine  no  better  authority  for  your  pur- 
pose than  the  book  you  mention— Martindale's  Extra  PharmacopsBia, 
which  deals  fully  with  all  or  nearly  all  reputable  proprietary  prepara- 
tions of  known  formula?. 

Kebtwicr.— Sodium  oinnamate  (otherwise  Hetol)  has  been 
advocated  as  a  remedy  in  phthisis.  It  is  injected  intravenously  in  a 
sterilised  solution  of  1  in  20  of  distilled  water  or  of  normal  saline 
fluid.    Private  patients  are  not  likely  to  adupt  this  plan. 

^fttteihuj*  (rf  the  £oaetiee,  JLtctoxt*,  &t. 

Wkdhrsdat.  Jurr  8th. 
Drrmatoloqical  Socibtt  or  lordoh  (11  Chandos  Street,  Cavendish 
Square,  W.).— 6.15  p.m.  Demonstration  of  Oases  of  Interest. 
Mrdical  Graduates'  Colleoe  akd  Polyclihic  (24  Chenies  Street, 
*  W.C.).— 4  p.m.     Mr.  R.  Harrison  :  Clinique.    (Surgical.)    5.15  p.m. 
Mr.  T.  Cclttns  :  On  Affections  of  the  fcyeuds. 
Thursday, -Juhx  9tb. 
South-Wrst    Lohdov    Medical  Society   (Muiiicipal  Buildings, 
Lavender  Hill,  Clapham  Junction).    8.45  p.m.  Dr.  W.  H.  Allchin  : 
.  8ome  Special  Features  of    Diseases  of  the  Colon.    (Bolingbroke 

Ofhthalmological  Society  of  tiir  Uhited  Kivodom  (11  Chandos 
Street,  Cavendish  Square.  W.).-8  p.m.  Specimens  will  be  shown  by 
Dr.  L.  Werner,  Mr.  E.  B  Henderson,  and  Mr.  G.  W.  Roll.  8.80  p.m. 
Papers  :  Mr.  8.  Snell :  Brief  Noes  on  (I)  Optic  Atrophv  in  a  Youth 
< file  cuttei)  from  lead ;  (2)  Optic  Atrophy  after  Uteiiie  Haemor- 
rhage :  (8)  Glioma,  Two  Cases  in  One  Family— One  in  each  Eye  :  and 
(4)  Glioma  in  each  Ey«»,  both  Enucleated. -Mr.  S.  Mayou:  On 
Microphthalmos  (Three  Eyes). ,_  „  _  __ .    _ 

British  Gynecological  8octety  (20  Hanover  Square,  W.).  8  p.m. 

Specimens  will  be  shown  by  Mr.  B,  Jessett.  Paper  :— Mr.  8.  Bishop  : 

.  On  the  Prevention  of  Postoperative  Ventral  Hernia. 

Royal  College  of  Physiciahb  of  London  (Pall  Mall  East). -5  p.m. 

Dr.  J.  R.  Bradford  :  Blight's  Disease  and  its  Varieties.    (Croonian 

Medical  Graduates*  College  ard  Polyclihic  (22  Chenies  Street, 
W.C.).-4p.m.  Mr.  Hutchinson :  Clinique.  (Surgical.)  5.15  p.m. 
Mr.  M.  Gunn :  Glaucoma.  ^  

Mount  Verkoh  Hospital  for  Consumption  akd  Diseases  or  the 
Chest  (7  Fitsroy  Square,  W.)~ 5  p  m.    Dr.  G.  Johnston  :  Nervous 
Affections  of  the  Heart.    ( Post-Graduate  Course. ) 
Friday,  June  10th. 

Mrdical  Graduates'  College  axd  Polyclinic  (22  Chenies  Street, 
W  CA— 4  p.m.    Dr.  St.  Claii  Thomson  :  Clinique.    (Throat.) 
Tuesday,  Joke  14th. 

Medico-Legal  Bocirty  (20  Hanover  Square,  W.).— 8.15  p.m.  Mr. 

R.  Henslowe  Wellington  will  read  a  paper  on     Suicide  whilst  tern- 

i  porarily  insane  "—a  fallacy.      Dr.  W.  McCallin  :    A  note  on  legal 

procedure  in  Lunacy.    Earl  Russell :  The  limitations  of  Medical 

Evidence.    Medical  visitors  are  specially  invited. 


Jlppointttums. 


Carson,  Herbert  W.,  F.RC.&Eng.,  Surgeon  to  the  Tottenham  Hew- 

pital. 
Cusack,  B.,  Certifying  Surgeon  under  the  Factory  Act  for  the  Csshel 

District  of  the  county  of  Tipperary. 
Ellis,  L.  Erasmus.  M.D.Brux.,  M.R.C.8.,  L.R.C.P.Lond.,  L.8.A., 

Clinical  Assistant  to  the  National  Hospital  for  Diseases  of  the 

Heart,  Soho  Square,  London,  W. 
Greek.  T.  A.,  M.D.,  CM.  Ed  in  ,  Surgeon  to  the  Out-patients  »t  the 

Bristol  Royal  Hospital  for  Sick  Children  and  Women. 
Keogh,  8m  Certifying  8urgeon  under  the  Factory  Act  for  the  Don- 
drum  District  of  the  county  of  Tipperary 
MrrcRELL,  Qn  Certifying  Surgeon  under  the  Factory  Act  forme 

Templemore  District  of  the  county  of  Tipperary. 
Mitchell,  Mm  Certifying  Burgeon  under  tbe  Fa 

Tullaroan  District  of  the  county  of  Kilkenny. 


Act  for  the 


flhrthe. 

Brown.— On  May  81  st,  at  Carlton  House,  Gloucester,  the  wife  of 

Walter  Brown,  M.B.,  of  a  daughter. 
Corner.— On  June  2nd,  at  Harley  House,  the  wife  of  Edred  M, 

Corner,  F.R.C.8.,  of  a  daughter. 
Wioglrbworth.— On  June  3rd,  at  Kirkham,  Lancashire,  the  wife  of 

Sidney  Wigglesworth,  L.R.C.P.,  M.R.C.S.,  of  a  daughter. 


Bell— Pewgle.— On  June  2nd,  at  St.  John's  Church,  Blackheato, 
George  Bell,  son  of  George  Bell,  Esq.,  15  Vanbrugh  Park  Road, 
Blackheath,  to  Madeline  (Maud)  charlotte  Priogte,  daughter  of 
the  late  Lieut -Colonel  Robert  Pringle,  M.D.,  and  Mrs.  Print  l*. 
of  Lewisham. 

Howlrtt— Smith.— On  June  2nd,  at  Holy  Trinity  Church,  Netting- 
ham,  Bernard  F.  Howlett.  M.R.G.S.,  L.R.C.P.,  of  Kingston-on- 
Thames,  to  8tella  Isabel,  youngest  daughter  of  John  Jft.  Smith, 
of  Bouthport. 

Puckle— Harris.— On  June  4th,  at  St.  Ethelburga's,  Bisbopsgate 
8treet  Within,  London,  Raymond  Aufrere.  youngest  son  of  the 
late  Robert  Arthur  Puckle.  Esq.,  Duppas  HuU  Croydon,  to 
Emily  Eleanor,  elder  daughter  of  the  late  Henry  Harris, 
M.R.C.S.Eng.,  of  Denmark  Hill,  and  of  Mi  8.  Ada  Harris,  of  19 
De  Crespigny  Park,  8.E. 

Rorrlts—  Barry.— On  June  2nd,  at  St.  Luke's  Ramsgate,  Rev. 
David  Roberta,  senior  curate  of  St.  Peter's,  Islington,  to  EU*»- 
beth,  daughter  of  the  late  8urgeon  Major  D.  Paterson  Barry, 
M.D.,  and  Mrs.  Barry,  Danecote,  Ramsgate. 

Scott -Geo  bob.— On  June  1st,  at  St.  Michael's  Church,  Bourne- 
mouth, Maitland  Bodley  8cott,  F.R.O.S.,  son  of  Mr.  T.  B.  Scott. 
Aldington,  West  Bournemouth,  to  Hilda  Durance.only  daughter 
of  Mr.  and  Mrs.  Durance  George,  of  Alderholt,  West  Bourne- 
mouth. 


deaths. 


Atkinson-Morley's  Convalescent  Hospital,  Copse  HiU,  Wimbledon.  1 

Resident  Medical  Officer,   t  alary  £100  per  annum.   Applications 
to  the  Secretary  of  Sc  George's  Hospital,  London. 

Brighton,  Hove,  and  Preston  Dispensary.— House  Surgeon.  Sato? 
£160  per  annum,  with  furnished  rooms,  ooals,  gas,  and  atten- 
dance. Applications  to  G  Somen  Clarke,  Hon.  Secretary.  113 
Queen's.Road,  Mrighton. 

City  Asylum,  Birmingham.— Junior  Assistant  Resident  Medical 
Officer.  Ba'ary  £150  per  annum,  with  board,  lodging,  asd  wash- 
ing.   Applications  to  the  Medical  Superintendent. 

Cumberland  and  Westmorland  Asylum,  Garlands,  Carlisle.— Junior 
Assistant  Medicai  Officer.  8alary  £180  per  annum,  with  board 
lodging,  and  washing.  Applications  to  the  Medical  Superinten- 
dent. 

Liverpool  Dispensaries.— Assistant  Surgeon.  Salary  £100  per 
annum,  with  board  and  apartments.  Applications  to  8am.  B. 
Leicester,  Secretary. 

Liverpool  Infirmary  for  Children.— House  Surgeon.  Salary  £100 per 
annum,  with  board  and  lodging.  Applications  to  the  Hon. 
Secretary. 

Parish  of  Birmingham.— Workhouse,  Infirmary.— Assistant  Resident 
Medical  Officer.  Salary  £104  per  annum,  with  furnished  apart- 
ments, rations,  coal,  gas,  laundry,  and  attendance.  Applications 
to  Charles  Fietcher,  Clerk  to  the  GuardUns,  Parish  Offices, 
Edmund  Street. 

Royal  Free  Hospital,  Gray's  Inn  Road,  W.C. -Senior  Resident 
Medical  Officer.  Salary  £100  per  annum,  with  board,  reudence 
and  wsshing.    Applications  to  the  Conrad  W.  Thies.  Secretary, 

Stamford,  Rutland  and  General  Inflrmtry.— House  Surgeon.  Salary. 
£100  per  annum,  with  board,  lodging  and  washing.  Application* 
to  V.  G.  btapleton,  Secretary,  The  Infirmary,  Stamford. 

University  of  Birmingham.— Second  Demonstr  atorship  in  Anatomv 
Salary  £160  per  annum.  Applications  to  Geo.  H.  Morley, 
Secretary. 

West  Herts  Infirmary,  Hemel.  Hempstead— House  Surgeon.  8alary 
£100  per  annum,  with  furnished  rooms,  board,  fire,  lights, 
attendance,  and  washing.  Applications  to  Percy  Hall,  Hon.  Sec. 

West  Riding  Asylum,  Wadsley.  near  Sheffield.— Fifth  Assistant 
Medical  Officer.— Salary  £140  per  annum,  with  board,  4c. 
Applications  to  the  Medical  Superintendent. 


Ardrew.— On  Miy  31st,  at  2  Atholl  Crescent,  Edinburgh,  Fanny,  wife 
of  James  Andrew,  M  D.,  and  eldest  daughter  of  the  late  John 
Haigh,  of  Scarborough. 

Owrk.— On  June  2nd,  R.  E.  Owen,  L.M..  M.R.G.S ,  L.S.A,  at 
Valetta  House,  Beauma-is,  in  his  62nd  year. 


®he  fjlftliral   f ttss   Mil   Circular. 


"8 ALUS   POPULI   SUPREME    LEX.* 


Vol.  CXXVIII. 


WEDNESDAY,    JUNE   15,    1904. 


No*   24. 


Original  Communications. 
CANCER  AND    URIC  ACID; 

OR, 

URIC  ACID  AS  A  CAUSE  OF  THE 

IRRITATION   WHICH 

PREDISPOSES  TO  CANCER. 

By  ALEXANDER  HAIG,  MA.  and  M.D.Oxon., 

F.R.C.P., 

Physician  to  the  Metropolitan  Hospital  and  the  Royal  Hospital  tor 
Children  and  Women. 

Mr.  Henry  Morris,  in  his  recent  Eradshaw 
Lecture  {Brit.  Med.  Journ.,  1903,  vol.  ii,  p.  151 1), 
says :  "  But  in  any  case  we  can  reasonably  hope  and 
expect  that  the  organised  researches  now  com- 
menced by  the  Colleges  will  in  time  yield  much 
information  as  to  how  to  prevent  cancer,  by  teach- 
ing us  what  are  the  real  agencies  which  stimulate 
it  into  existence/ '  My  object  in  this  paper  is  to 
do  what  lies  in  my  power  to  draw  attention  to  the 
claims  of  uric  acid  to  be  one  of  these  agencies. 
The  possibility  of  this  I  have  for  some  years  been 
mentioning  in  succeeding  editions  of  my  work, 
"  Uric  Acid  as  a  Factor  in  the  Causation  of 
Disease/'  and  in  the  sixth  edition  I  brought 
forward  a  further  series  of  facts  and  arguments  to 
support  it.  The  evidence  that  uric  acid  causes 
local  irritation  is  so  abundant  I  need  hardly  devote 
much  space  to  it.  No  one  can  inject  it  either  in 
solution  or  suspension  under  the  skin  without 
having  ample  evidence  of  its  irritant  effects,  and 
the  common  association  of  eczema  with  gout  is 
alone  strong  evidence  of  its  irritant  effects  on  the 
skin,  just  as  the  frequent  association  of  fibrous 
irritation  and  fibromata  with  gout  and  rheumatism 
is  evidence  of  its  effects  on  all  fibrous  tissues, 
and  over  and  over  again  I  have  seen  such  fibrous 
thickenings  and  tumours  diminish  and  disappear 
as  the  result  of  the  treatment  of  uric  acid  arthritis 
by  uric-acid-free  diet ;  then  the  effects  on  the 
fibrous  tissues  of  nerves,  muscles,  intestines,  &c, 
are  mentioned  again  and  again  in  many  parts  of 
my  book  (previous  reference),  and  are  almost 
equally  well  known,  so  that  we  see  that,  uric 
acid  is  an  irritant  of  the  body,  from  the  skin 
outside,  to  the  fibrous  tissues  of  the  viscera,  and 
the  bones  and  cartilages  within.  That  uric  acid 
is  the  cause  of  very  chronic  irritation  is  again  well 
known,  for  patients  often  suffer  from  eczema  and 
arthritis  for  twenty,  thirty  or  even  forty  years, 
and  during  all  this  time  the  increase  and  thicken- 
1  ing  of  many  neighbouring  fibrous  tissues  may  be 
1  obviously  going  on.  The  substances  that  increase 
I     the  local  irritant  action  of  uric  acid  are,  for  the 


most  part,  those  that  precipitate  it  into  the 
tissues,  as  acids,  mineral  acids  and  their  salts, 
substances  such  as  lime  and  most  metals  which 
form  insoluble  compounds  with  uric  acid.  The 
effect  of  all  these  substances  is  to  hold  it  back  in 
the  body,  and  also  to  precipitate  it  into  the  tissues, 
where  it  remains  partly  in  solution,  partly  in 
suspension,  and  partly  deposited  as  the  biurate. 
In  suspension,  and  most  of  all  in  solution  (see 
"  Uric  Acid,"  previous  reference),  it  is  a  powerful 
local  irritant.  Each  of  these  little  separate 
deposits  in  the  tissues  forms  what  I  have  called 
a  uric  acid  filter,  and,  consequently,  either  attracts 
further  uric  acid  to  itself,  or  gives  out  uric  acid 
to  the  circulating  and  tissue  fluids,  according  to 
the  more  or  less  alkaline  reaction  of  these  latter 
and  the  amount  of  uric  acid  they  already  hold  in 
solution.  The  result  is  that  in  these  little  tissue 
deposits  the  effect  of  the  uric  acid  is  never  the 
same  from  day  to  day,  or  even  from  hour  to  hour. 
There  is  a  constant  going  and  coming  of  uric  acid, 
and  a  corresponding  change  in  the  amount  of 
local  irritation  (see  "Uric  Acid,"  previous  reference). 
Then  we  must  add  on  to  those  substances  that 
increase  the  irritant  action  of  uric  acid  exposure 
to  cold,  as  that  both  directly  and  by  its  action  in 
diminishing  the  alkalinity  of  the  blood  is  also  a 
precipitant  of  uric  acid.  The  substances  that 
tend  to  diminish  the  local  irritation  produced  by 
uric  acid  are  those  that  dissolve  uric  acid  or  form 
soluble  compounds  or  combinations  with  it,  and 
among  these  we  need  only  mention  alkalies  and 
salicylates  and  heat,  which  last  has  the  reverse 
action  to  cold,  and  increases  the  alkalinity  of  the 
blood.  The  effect  of  these  substances  is  to 
diminish  the  local  deposits  as  more  and  more  uric 
acid  is  given  up  from  the  deposits  to  the  blood 
and  tissue  fluids,  and  while  uric  acid  is  in  solution 
In  these  fluids  it  is  constantly  being  passed  quite 
freely  from  the  kidneys,  and  thus  the  uric  acid 
in  the  body  is  constantly  being  diminished  by  the 
action  of  these  solvent  substances  and  of  heat, 
which  acts  as  a  solvent,  and  this  is  the  reason  of 
the  well-known  fact  that  gout  is  a  disease  of 
winter  and  of  cold  climates,  and  not  of  summer 
and  of  warm  climates.  And  I  must  add  one  more, 
the  most  important  factor,  to  those  that  diminish 
local  irritation,  and  that  is  diet — a  uric-acid-free 
diet,  which,  by  diminishing  the  intake  of  uric 
acid  diminishes  the  amount  the  blood  has  to  hold 
in  solution,  and,  consequently,  the  blood  and 
circulation  fluids  come  at  once  into  a  condition 
to  take  up  uric  acid  from  local  deposits  and  to 
diminish  these  and  the  amount  in  the  body  by 
passing  it  out  in  the  urine.  Now,  if  this  local 
irritant  action  of  uric  acid  is  to  any  important 
extent    a    cause    which    stimulates    cancer    into 


628    The  Medical  Press.         ORIGINAL  COMMUNICATIONS. 


JUNB    15,    I904. 


existence,  we  should  expect  that  the  precipitant 
group  of  drugs,  along  with  cold,  will  be  found  in 
action  where  cancer  incidence  is  greatest,  and  the 
solvent  group  of  drugs,  along  with  heat,  where  it 
is  least,  and  that  the  uric-acid-free  diet  would  act 
like  the  solvent  group,  only  more  so,  as  it  is  not  only 
a  solvent,  but  also  withholds  uric  acid  from  the 
body.  Another  point  I  may  as  well  mention  here 
is  the  very  wide  expanse  of  the  field  of  modern 
life  in  which  one  is  liable  to  come  into  contact 
with  retentive  substances.  But  a  few  instances 
must  here  suffice,  such  as  lead  and  lime  in  drinking 
and  cooking  water,  lead,  mercury,  copper,  zinc, 
and  tin  in  many  preserved  foods ;  and  several  of 
these  metals  are  used  in  contact  more  or  less 
directly  with  preserved  foods,  as  in  tinned  foods, 
and  in  the  cooking  and  preserving  of  foods,  and 
lastly,  the  use  of  many  of  these  metals  in 
medicine,  as  of  zinc,  copper,  silver  and  gold  in 
nerve  diseases,  of  lead  as  a  styptic,  and  of  iron 
as  a  treatment  for  anaemia.  In  those  people  who 
are  full  of  uric  acid  in  every  tissue  there  is  almost 
no  end  to  the  local  precipitation  that  these  sub- 
stances may  produce,  and,  as  I  said  before,  each 
small  local  deposit  acts  as  a  uric  acid  filter  until 
all  has  been  completely  redissoived  and  removed, 
and  in  certain  not  uncommon  conditions,  e.g., 
those  of  high  feeding  and  high  acidity,  years  may 
elapse  before  this  removal  is  complete.  As  I 
shall  have  presently  to  point  out,  it  is  in  the  well- 
fed  and  highly  nourished  (query  overfed)  that  the 
greatest  liability  to  cancer  is  found. 

My  attention  was  first  directed  to  this  point  by 
reading  an  interesting  article  written  by  Mr. 
D'Arcy  Power  (Brit.  Med.  Journ.,  1893,  vol.  ii, 
p.  830),  and  a  further  article  of  his  in  the  same 
journal  (1895,  vol.  i,  p.  910),  and  about  this  time 
I  discussed  with  him  an  instance  in  which  a  heavy 
cancer  mortality  seemed  to  have  fallen  on  a  small 
number  of  houses  in  a  district  which  I  knew  well. 

In  this  case  I  may  say  that  what  appeared  to 
us  to  be  a  very  high  cancer  mortality,  raising 
questions  in  our  minds  of  cancer  houses  and  of 
infection,  was  found  in  association  with  a  very 
hard  drinking  water  containing  excess  of  lime, 
and  also  with  high  feeding  and  free  indulgence  in 
rich  food  and  wine,  that  is  to  say,  both  with  free 
introduction  of  uric  acid  and  with  conditions 
tending  to  precipitate  it.  I  also  point  out  ("  Uric 
Acid,"  previous  reference,  p.  462)  that  Sir  W. 
M.  Banks  has  noticed  the  relation  between  an 
increasing  cancer  death-rate  and  richer  and  more 
abundant  food,  which,  of  course,  means  a  larger 
uric  acid  intake  and  less  uric  acid  solubility  in  the 
body,  with  increase  of  local  precipitation  of  uric 
acid,  and  so  an  increase  in  the  number  of  foci  of 
local  irritation.  I  also  refer  to  a  record  by  Sir 
W.  Macgregor  that  natives  of  some  vegetable 
feeding  nations  get  cancer  when  they  begin  to  eat 
meat  like  Europeans,  and  this  without  any  ap- 
parent possibility  of  cancer  infection  ;  he  also 
shows  that  only  those  who  eat  meat  get  cancer. 
I  also  point  out  that  Dr.  Braithwaite  has  suggested 
that  excess  of  salt  in  the  diet  is  a  factor  in  the 
causation  of  cancer  ;  and  here  again  we  are  dealing 
with  the  salt  of  a  powerful  mineral  acid  which 
is  introduced  into  the  body,  and  no  doubt  hinders 
the  solution  and  favours  the  precipitation  of  uric 
acid.  The  same  author  attributes  cancer  among 
the  natives  of  India  to  this  cause,  but  quite  leaves 
out  of  account  the  enormous  introduction  of  uric 
acid  in  the  pulse  which  they  consume.  But  here 
again    I   would  point  out   that    in  the   case   of 


the  high-feeding  and  well-nourished  contingent  of 
this  country  we  get  both  a  large  introduction  of 
uric  acid,  and  its  deficient  solubility  in  the  blood 
and  tissue  fluids,  associated  in  the  records  of 
several  observers  with  a  large  and  increasing 
tendency  to  cancer.  One  would  expect,  then, 
that  under  just  the  opposite  conditions,  small 
intake  of  uric  acid  and  a  good  supply  of  solvents 
preventing  its  precipitation  in,  and  favouring  its 
elimination  from,  the  body,  we  should  find  a  low 
cancer  death-rate  ;  and  this  also  is  the  case,  for 
the  death-rate  in  Kerry  on  a  diet  of  butter-milk, 
Indian  meal,  and  potatoes  is  less  than  one-fourth 
of  that  in  Armagh  on  a  mixed  and  animal  diet ; 
and  the  point  about  the  potato  is  that  it  contains 
much  alkali,  and  thus  is  a  solvent  of  uric  acid, 
and,  consequently,  aids  its  removal  from  the 
body  and  prevents  its  precipitation,  (a)  Then 
Mr.  Roger  Williams  points  out  in  the  Brit.  Med. 
Journ.,  1902,  vol.  ii,  p.  917,  that  a  low  cancer 
death-rate  in  Egypt  goes  with  a  low  consumption 
of  uric-acid-containing  foods,  and  what  I  myself 
observed  when  in  Egypt  for  a  few  weeks  in  1902 
led  me  to  believe  that  the  diet  of  the  natives  is 
largely  free  from  uric-acid-containing  food,  and 
that  both  their  blood  decimal  and  their  circulation, 
as  well  as  their  development  and  physical  power, 
are  greatly  superior  to  those  of  the  uric  acid 
consumers  of  this  country.  The  natives  appeared 
to  be  all  strong  and  healthy,  and  could  walk  or 
run  all  day  without  fatigue,  while  the  miserable, 
pale  Europeans  who  passed  them  on  the  steps  of 
the  Cairo  hotels  were  walking  museums  of  patho- 
logy* and  appeared  by  contrast  to  suffer  from 
almost  constant  fatigue  and  lethargy. 

Some  points  of  great  interest  are  also  mentioned 
by  Dr.  R.  Kirk,  Brit.  Med.  Journ.,  1903,  vol.  ii, 
p.  1528,  where  in  a  short  article  on  Paraffin 
Cancer,  he  shows  that  contact  of  the  skin  with 
naphtha  mixture  causes  first  of  all  intractable 
eczema,  second,  small  pimples  which  tend  to 
become  boils  and  then  ulcers,  and  third,  that  of 
the  ulcers  so  formed  "  a  considerable  proportion 
took  on  malignant  characters."  He  concludes 
his  paper  as  follows  : — "  These  tumours  were  all 
epithehomata,  and  the  conclusion  one  must  come 
to  is  that  long-continued  irritation  certainly  does 
predispose  to  the  production  of  malignant  disease." 

Here,  then,  we  have  one  more  instance  of  chronic 
irritation  assisting  in  the  production  of  cancer, 
and  after  what  has  been  said  above  about  the 
causation  of  eczema  by  uric  acid,  is  it  to  be  doubted 
that  a  gouty  man,  or  one  whose  blood  is  most 
heavily  charged  with  uric  acid,  would  suffer  most 
from  the  paraffin,  and  that  the  local  lesion  once 
produced  would  be  in  him  also  least  ready  to 
heal  (see  "  Uric  Acid,"  previous  reference),  for  uric 
acid  not  only  produces  local  irritation,  but  adds 
itself  on  to  and  so  increases  and  prolongs  any 
local  irritation  otherwise  produced  ?  It  also 
interferes  with  the  nutrition  of  the  skin,  and  so 
hinders  the  healing  of  wounds  of  all  kinds.  The 
mention  of  boils  also  is  interesting,  for  these  are 
often  contagious,  and  are  probably  due  to  the 
inoculation  of  the  irritated  skin,  and  it  is  at  least 
possible  that  the  cancer  which  develops  later  on 
is  also  due  to  an  inoculation  of  the  ulcers,  which 
remain  open  and  exposed  to  all  kinds  of  dirt  for 
so  long  a  time.     Then  in  "  Uric  Acid  "  (previous 


(«)  His  onlv  right  to  say  that  the  general  average  death-rate  of 
Kerry  bears  about  the  same  ratio  to  that  of  Armagh  as  the  cancer 
death-rate  does  ;  but  this  may  merely  show  that  the  inhabitants  of 
Kerry  gain  in  many  directions  from  their  natural  diet. 


June  is.  1904* 


ORIGINAL  COMMUNICATIONS. 


Tm  Medical  Press.    629 


reference),  I  have  pointed  out  that  there  is  at 
least  one  contagious  disease,  namely,  a  common 
cold,  which  effects  an  easy  lodgment  in  the  mucous 
membranes  of  those  whose  circulation  is  loaded 
with  uric  acid,  but  which  often  does  quite  fail 
to  affect  those  who  are  relatively  free  from  this 
substance.  Further,  if  acute  rheumatism  were 
to  prove  to  be  in  any  way  connected  with  a 
microbe  it  would  be  a  parallel  instance  of  the  same 
thing,  that  is,  the  microbe  could  not  affect  those 
who  were  free  from  uric  acid,  and  we  already 
know  that  acute  rheumatism,  or,  as  I  prefer  to 
call  it,  "  acute  uratic  arthritis,"  can  be  produced 
or  precipitated  bj'  several  different  kinds  of 
microbes,  e.g.,  those  of  scarlet  or  enteric  fever  or  of 
influenza,  and  when  cases  of  infectious  acute 
rheumatism  are  described  it  probably  means  that 
one  of  these  microbes  has  passed  from  person  to 
person  and  produced  prominent  arthritic  sym- 
ptoms in  each.  In  each  case  it  affected  the  excess 
of  uric  acid  in  their  body,  and  my  point  is  that 
those  whose  blood  and  tissues  are  free  from  excess 
of  uric  acid  are  not  so  affected  by  microbes.  If 
this  is  so  we  can  at  once  see  how  an  excess  of  uric 
acid  in  the  body  may,  by  favouring  chronic  local 
irritation  and  ulceration,  pave  the  way  for  the 
incidence  of  cancer.  I  do  not  wish  to  assert  that 
cancer  is  due  to  a  parasite,  and  the  facts  mentioned 
above  as  being  recorded  by  Sir  W.  Macgregor 
are  against  this  causation  to  some  extent,  but  I 
do  desire  to  suggest  that  the  facts  which  I  have 
mentioned  above  in  mere  outline  should  not  be 
entirely  neglected  in  any  investigations  that  have 
for  their  object  the  clearing  up  of  the  causation  of 
cancer. 

I  would  sum  up  these  points  as  follows  : — 
(1)  Cancer  tends  to  affect  seats  of  local  irritation 
or  ulceration.  (2)  That  uric  acid  is  responsible  for 
more  widespread  and  chronic  local  irritation  in 
all  the  tissues  of  the  body  than  any  other  known 
substance.  (3)  That  insurance  statistics  seem 
to  show  that  cancer  is  increasing  side  by  side 
with  many  other  diseases  which  are  no  doubt  due 
to  uric  acid,  as  more  and  more  uric  acid  is  poured 
into  the  body  in  flesh,  soup,  meat  extracts,  tea 
and  coffee,  all  of  which  are  consumed  much  more 
largely  at  the  present  day  than  they  were  thirty 
years  ago.  (4)  Countries  where  the  diet  is,  to  a 
considerable  extent,  uric-acid-free,  suffer  but  little 
from  cancer,  while  there  is  some .  evidence  tend- 
ing to  show  that  when  uric  acid  is  present  in 
excess,  first  in  the  diet,  and  as  a  result  in  the  blood, 
the  incidence  of  cancer  is  increased  by  substances 
which  tend  to  precipitate  uric  acid  in  the  tissues 
and  is  diminished  by  substances  which  aid  its 
solution  and  removal  from  the  body.  (5)  Lastly, 
I  would  point  out  that  if  further  statistics  support 
those  I  have  mentioned  above  in  showing  that 
there  is  a  definite  relation  between  cancer  inci- 
dence and  the  amount  of  uric  acid  in  the  body, 
we  need  not  wait  till  heaven  and  earth  have  been 
microscoped  to  find  a  possible  parasite,  but  can  at 
once  diminish  the  destructive  power  of  cancer  by 
cutting  off  supplies  of  uric  acid  and  giving  solvents, 
just  as  is  already  being  done  with  success  in  many 
other  disease  conditions  which  are  more  clearly 
and  obviously  due  to  uric  acid. 


The  Royal  Commission  of  Inquiry  into  the  mor- 
tality-rate of  the  Cornish  miners  have  reported  that 
the  main  cause  is  a  form  cf  phthisis  which  could  be 
prevented  by  the  prohibition  of  hard-rock  drilling 
without  the  use  of  water. 


THE 

POSITION    OF    THE   MEDICAL 

ATTENDANT  IN  CRIMINAL 

CASES,  (a) 

By  W.  DUNCAN,  M.B. 

The  criminal  cases  that  appear  from  time  to 
time  in  the  courts  where  the  crux  of  the  charge 
rests  on  the  evidence  of  the  medical  attendant 
seldom  fail  to  bring  into  prominence  the  unsatis- 
factory state  of  things  at  present  prevailing  in 
regard  to  medical  attendants  coming  forward  with 
suspicions  of  foul  play  which  they  may  entertain. 

If,  as  in  the  Maud  Marsh  trial,  the  Judge  or  the 
jury  comment  adversely  on  the  fact  of  the  medical 
attendant  not  having  given  information  earlier,  the 
publicity  given  to  such  comments  brands  the 
practitioner  as  incompetent  in  the  eyes  of  quite  a 
number  of  the  public  and  of  his  patients.  If,  on 
the  other  hand,  he  does  communicate  his  sus- 
picions to  the  police  as  soon  as  they  are  aroused 
(and  while  the  patient  in,  say,  a  supposed  poison- 
ing case,  is  still  alive),  the  suspicions  expressed 
will  almost  certainly  reach  the  ears  of  the  party 
concerned.  Should  they  be  well  founded,  a  crime 
may  be  frustrated  ;  but,  should  the  symptoms 
be  capable  of  an  innocent  explanation,  the  medical 
man  finds  himself  in  an  awkward  fix  indeed  ;  and 
even  if  no  legal  proceedings  are  taken  against  him, 
he  is  bound  to  alienate  a  large  number  of  his 
patients,  and  may  have  to  leave  the  district  alto- 
gether. 

The  knowledge  of  the  above  may  well  make  a 
man  put  off  saying  anything  from  day  to  day,  in 
the  hope  that  each  day  will  bring  clearer  evidence, 
till  perhaps  the  patient  dies  ;  and,  while  still 
discussing  with  himself  the  pros  and  cons,  and 
unable  to  be  certain  that  the  symptoms  are  not 
capable  of  a  natural  explanation,  he  signs  a 
death  certificate  bearing  the  most  prominent 
symptom,  and  his  unspoken  suspicions  remain 
unsolved. 

This  is  not  as  it  should  be.  In  the  interests 
of  justice  it  is  essential  that  a  medical  attendant's 
suspicions  should  be  voiced  at  once ;  in  the 
interests  of  the  practitioner  it  is  also  essential 
that  while  those  suspicions  are  being  weighed  and 
sifted  there  should  be  no  possibility  of  anything 
leaking  out  till  the  suspicions  become  practical 
certainties  ;  while,  in  the  event  of  their  proving 
unfounded,  they  would  remain  as  if  they  had  been 
unspoken. 

Such  a  state  of  things  can  be  easily  attained  by 
the  appointment  of  "  Crown  Consultants,"  selected 
and  paid  by  the  Home  Office,  not  by  the  local 
authorities.  They  would  be  in  every  centre,  and 
would  be  drawn  from  the  ranks  of  medical  men 
who  have  made  themselves  specially  proficient  in 
forensic  medicine.  It  would  be  open  to  the  per- 
plexed practitioner  to  discuss  his  case  with  one  of 
these  Consultants,  and  be  guided  by  expert 
advice.  If  the  suspicious  symptoms  cleared  up,  or 
could  be  explained  away  by  the  Consultant,  there 
would  be  an  end  of  the  matter.  If,  on  the  other 
hand,  the  Consultant  saw  grounds  for  supposing 
criminal  intent,  he  would,  as  soon  as  his  suspicions 
were  confirmed,  inform  the  police,  and  take  the 
responsibility  for  doing  so. 

The  foregoing  will  make  it  clear  in  what  cases  it 
would  be  intended  for  the  practitioner  to  make  use 

(a)  Paper  ditcotted  at  the  Chesterfield  Branch  of  the  Midland 
Medical  Union,  February  9th ,  1004.     See alao  correspondence,  p.  647. 

D 


630    The  Medical  Pmsts.         ORIGINAL  COMMUNICATIONS. 


JUKK   IS,    1904. 


of  the  services  of  the  Crown  Consultant,  viz.,  in 
those  cases  where  a  crime  is  being  committed 
under  his  nose,  and  in  which  an  attempt  is  being 
made  to  use  him  as  a  covering  instrument.  In  other 
cases  where  he  is  consulted  openly  and  straight- 
forwardly, and  where  no  attempt  is  being  made  to 
interfere  with  the  medical  man's  first  duty — the 
cure  of  the  sick  or  injured — any  information 
gleaned  in  a  professional  capacity  would  be  under 
the  seal  of  professional  secrecy,  as  at  present. 

THE 

IRISH      POOR-LAW     MEDICAL 
SERVICE,  (a) 

By    R.    F.    TOBIN,    F.R.C.S., 
Surgeon  to  St.  Vincent's  Hospital,  Dublin. 

My  first  utterance  on  rising  from  this  chair  must 
be  words  of  thanks  to  you  for  having  conferred 
on  me  a  position  essentially  honourable  in  itself, 
and  one  made  still   more   honourable,   first,    by 
the  unanimous  and  unsolicited  manner  in  which 
you  have  called  me  to  it ;  secondly,  by  the  ability 
and  high  standing  of  those  who  have  gone  before, 
and  by  the  difficult  and  critical  nature  of  the 
problems  which  we  are  at  this  time  called  upon  to 
solve.     Happily,  we  •  are  not  responsible  for  the 
question  which  will  chiefly  concern  us  to-day,  i.e., 
the   present  position    of    the   Poor-law   Medical 
Service  in  Ireland-     Happily  also,  we  are,  by  our 
mode   of   life,    peculiarly   fitted   to   consider   it. 
What  we  desire  for  the  Irish  Poor-Law  Medical 
Service  is  to  put  it  in  its  true  position — the   first 
service  in  the  land.     That  is  how  it  should  stand. 
That  is  where  it  will  stand  when  more  enlightened 
views  prevail.     What  is  the  first  asset  of  a  state 
and  its  inhabitants  ?     If   they   are   great,   it   is 
great.     A  country  is,  what  its  people  make  it. 
What  is  the  first  asset  of  an  individual  ?     His 
health,,  and  by  his  health  I  mean  the  condition 
of  being,  and  remaining  for  as  long  as  possible, 
in     the  highest    state    of  development.      What 
is  a  medical  doctor  ?     He  is  a  minister  of  health. 
These  statements  may  sound  to  you  truisms,  but 
they  are  not.     A  truism  is  a  truth  that  is  widely 
accepted  ;  these  are  only  received  in  a  partial  and 
half-hearted   way,   which   robs   them   of   general 
efficiency.     The   value   of  health   is   grasped   by 
cultured  persons  individually,  but  in  their  public 
capacity  they  put  it  on  one  side.     An  educated 
and  well-to-do  man  considers  for  his  own  imme- 
diate   circle    health    before    everything — before 
education,  before  worldly  advancement.     He  says : 
I  would  rather  see  my  children  well  developed  and 
sound  than  with  any  other  endowment,  and  he 
acts  accordingly  ;  but  when  he  comes  to  deal, 
in  Lis  public  capacity,  with  a  question  of  general 
health  and  the  medical  treatment  of  the  poor, 
he  looks  at  things  and  behaves  in  a  totally  different 
fashion..    Health  is  put  last.     There  is  no  public 
purse-opening  force  in  his  programme,  and  what 
should  be  one  of  the  great  questions  of  the  State 
is   dealt  with  by  means  of  bazaars  and   other 
eleemosynary  methods.     If  this  were  not  so,  the 
position  of  the  medical  officers  of  the  State — 
such    as    are    the     Poor-law    medical    officers — 
would   to-day  be  very  different  from  what  it  is. 
Contrast  it  with  that  of  the  officers  of  the  Church — 
I  mean  the  Established  Church — in  England,  with 
its  endowments,  its  social  and  legislative  prestige. 


(a)  An  Address  delivered  at  the  Annual  Meeting  of  the  Irish 
Medical  Association. 


Contrast  it  with  that  of  the  officers  of  the  law, 
bearing  in  mind  the  appointments  open  to 
barristers  and  the  honours  bestowed  upon  them. 
While  they  and  their  descendants  are  crowding 
one  another  in  the  House  of  Lords,  m  the  Privy 
Council,  and  other  offices  of  State,  the  unhappy 
officer  of  health  wearies  through  Kfe  at  an  im- 
possible task,  and  if  in  his  department  yon  look 
for  the  trappings  of  success*  you»  see  them  worn 
by  the  diseases  that  walk  jubilant  over  the  land. 
When  we  are  quarrelling  with  Rxjr-law  guardians 
as  to  our  status  we  should  bear  these  facts  in 
mind.  The  all-embracing  nature  of  our  work 
no  doubt  accounts  to  some  extent  for  this  esti- 
mation. There  is  no  service,  however  menial, 
which  a  fellow-creature  in  distress  cannot  claim 
at  our  hands,  or  which  we  consider  ourselves  as 
above  giving.  We  surrender  ourselves  in  a  most 
complete  way  to  the  service  of  humanity,  and  for 
us  there  is  no  high  or  low  in  what  we  do.  Surgeon 
Tobin  then  dealt  with  the  views  of  certain  men 
on  questions  of  reform.  One  was  the  "  Report 
on  the  Poor-law  Medical  System  in  Ireland,"  by 
Surgeon  -  General  Evatt.  Continuing,  Surgeon 
Tobin  said:  If  Sir  Horace  Plunkett  is  wise  he 
will,  with  Surgeon-General  Evatf s  leave,  which 
I  know  will  be  readily  granted,  include  this 
excellent  report  in  the  next  edition  of  his  work. 
He  owes  some  such  reparation  to  what  will  be, 
before  the  new  century  is  old,  the  most  important 
service  in  the  State.  Gentlemen,  had  I  time  to 
continue  the  study  of  the  lay  mind  I  would  make 
plain  to  you  two  lessons.  First,  the  necessity  of 
educating  the  educated  public  ;  second,  that  if 
we  are  to  play  in  life  the  part  it  behoves  us  to  do 
in  the  interests  of  ourselves  and  the  public,  we 
must 'not  calmly  accept  any  position  assigned  to 
us,  but  we  must  formulate,  as  I  am  now  trying  to 
do,  what  our  true  position  is,  and  by  every  means 
in  our  power  try  and  attain  that  position,  and 
having  attained  it,  worthily  five  up  to  it.  When 
a  body  of  men  are  about  to  move  in  any  effort,  the 
question  of  organisation  should  first  claim  atten- 
tion. For  this  purpose  the  Irish  Medical  Associ- 
tion  exists  ;  and  our  first  act  at  every  meeting 
should  be  to  number  our  ranks  till  we  find  that 
they  include  every  registered  practitioner  in 
Ireland.  To  do  this  effectually  we  should,  I 
think,  be  better  acquainted  than  we  are  with  the 
names  of  those  who  are  in  the  Association  and  of 
those  who  are  not.  Surgeon  Tobin  dealt  at  length 
with  the  grievances  of  the  Poor-law  Service.  He 
advocated  that  the  members  should  recognise 
the  democratic  spirit  of  the  age,  and  continued: 
The  position  of  an  officer  of  health,  like  that  of  a 
priest,  must  be  founded  in  the  respect  and  esti- 
mation of  the  people.  You  cannot  improve  a 
man's  body,  any  more  than  his  soul,  against  his 
will.  The  first  condition  in  carrying  out  our 
work  is  that  the  people  believe  in  us.  Which  of 
us  ever  forced  our  views,  even  on  a  friend  whom 
we  sought  to  benefit,  with  satisfactory  results? 
The  position  of  our  profession  must  stand  on  the 
broad  basis  of  the  people's  goodwill.  As  things  are 
now  in  Ireland  that  is  not  compatible  with  a 
Civil  Service;  I  do  not  consider  why,  but  I  state 
a  fact.  It  may  not  be  always  so.  A  time  may 
come  when  the  policeman  will  be  honoured  in 
the  streets  of  every  village.  I  pray  for  that  time, 
and  also  for  that  when  the  peasant  will  think  so 
highly  of  the  blessing  of  health  that  the  getting 
of  it  will  weigh  down  all  other  considerations. 
He  may  then  turn  round  and  say — This  thing  may 


June  15,  1904. 


ORIGINAL  COMMUNICATIONS.         The  Medical  Press.    631 


better  be  worked  as  a  State  service  than  as  it 
now  is.  An  ideal  state  of  things,  in  my  mind, 
would  be  one  in  which  there  was  no  more  a  question 
of  a  fee  for  the  doctor  from  the  sick  man  than 
there  is  for  a  fee  for  the  policeman  from  the 
malefactor.  In  that  good  time  the  doctor  paid 
by  the  State  will  rule  the  district,  and  every  case 
of  illness  not  due  to  age  will  be  an  offence  for 
which  somebody  will  be  called  to  account ;  but 
these  days  are  not  yet,  and  so  we  have  to  make  our 
way  into  the  minds  of  the  people,  and  centre  our- 
selves on  their  good  judgment. 

A   doctor  living  in  the  country — I   can't  see 
if  he  is  here  present,  but  he  is  a  member  of  our 
Association  —  was    awakened    one    night    by    a 
knock  at  his  door.     He  went  down  and  found 
two  men  standing  outside,  one  of  whom  said  to 
him  :  "  I  want  you  to  come  to  see  my  son."     "  All 
right/'  said  my  friend,  "I'll  be  with  you  in  a 
minute."     "  But  you  must  come  for  the  same 
fee  as  Dr.  So-and-So,"  mentioning  the  name  of  a 
new  arrival  who  had  started  a  low  scale  of  fees, 
and  who  happened  not  to  have  been  very  success- 
ful with  his  first  few  cases.      "  No,  thank  you," 
said  my  friend,  and  having  shut  the  door,  he 
turned  into  his  study  to  get  a  book.     The  window 
was  open,  and  he  could  hear  the  two  men  talking 
outside.     "  What    would    you    do  ? "    said    one. 
'*  Faith,"  said  the  other,  "I'd  give  him  what  he 
asks.     Shure  the  funeral  'ud  cost  ye  more  than 
the  differ."     With  this  they  came  back,  knocked 
again,  and  the  difficulty  was  at  an  end.     This  is 
the  lesson  in  a  nutshell — the  costliness  of  funerals, 
the  blessings  of  health,  the  progress  of  medicine, 
the  interest  of  the  people  in  this  progress,  the 
facts  that  sanitary  science  is  now  exact  and  that 
most  diseases  are  preventable — teach  it  to  them, 
and,   believe   me,  there  will  soon  be  a  change  in 
the  new  economy — undertakings  that,  although 
flavoured    by    philanthropy,    are    after    all    but 
ventures,  will  be  relegated  to  "  Gigas  "  bazaars 
and  such  wind-raising  methods,  and  an  efficient 
medical    service  for  the  poor,   and  an  efficient 
public  health  service  for  all,  will  become  a  first 
•charge  on  the  public  purse.     In  the  meantime 
rest  assured  that  you  will  have  the  teachers  in 
every  school  in  the  Three  Kingdoms  with  you. 
Don't  be  afraid  of  beginning  with  small  demands, 
and  that  these  being  granted  there  will   be    an 
end.     You  do  not  think  the  men  assembled  in 
this     room  have  come  together  to  wring  a  few 
pounds  out  of  the  ratepayers,  and  that  we  are 
organising  the  whole  profession  for  such  a  paltry 
end.     No !  Our  end  is  a  position  in  which  we  can 
efficiently  and  honourably  do  the  work  to  which 
our  lives  are  devoted.     When  that  is  attained  we 
shall  rest,  but  not  till  then.     Let  it  not  be  thought, 
however,  that  because  we  are  making  these  efforts 
for  our  efficiency  we  are  not  grateful  to  our  fellow- 
countrymen  for  what  they  have  done  for  us  in 
the  past,  and  for  what  many  of  them  are  still 
doing.     Things  are  out  of  shape,  but  that  is  due 
to  the  fact  that  medical  science  has  grown  fast 
•of  late,  and  society  has  not  yet  adjusted  itself 
to  the  new  condition.     "  The  old  order  changeth, 
giving  place  to  hew,  and  God  fulfils  Himself  in 
many  ways."     We  have  suddenly  come  in  for  a 
great   inheritance.     Our   claims   are   undoubted, 
and  we  are  a  little  irritated  because  there  is  some 
hesitation  in  these  claims  being  allowed.     However, 
*f  we  only  press  forward  temperately  and  firmly  all 
will  come  right,  because  although  we  may  differ 
;as  to  details,  we  are  all  animated  by  the  same 


spirit  and  striving  for  the  same  end ;  because 
hearts  are  hearts,  and  Irishmen  are  Irishmen, 
and  because  we  belong  to  a  profession  which, 
while  it  recognises  neither  North  nor  South,  nor 
upper  class  nor  lower  class,  should  make  us  at 
one  and  the  same  time  the  servants  and  the 
masters  of  all. 


tfrencb  Cltmcal  Xectures. 

THE  DIFFERENT  KINDS  OF 

TYPHOID  FEVER  RELAPSE. 

By  Dr.  MAURICE  COSTE. 

Physician  to  the  Marseilles  Hospitals. 

[specially  reported  for  "the  medical  press  and 

circular."  ] 

Hutinel  in  his  thesis  divides  the  relapses  of  typhoid 
fever  into  four  different  classes — simple  and  pyretic 
on  the  one  hand,  anomalous  relapses  and  relapses 
associated  with  wide  oscillations  of  temperature  on 
the  other. 

The  simple  relapse  recalls  in  its  course  an  ordinary 
attack  of  enteric  fever,  but  the  symptoms  are  generally 
less  severe  and  less  marked.  This  so-called  simple 
form  presents  several  varieties  in  respect  of  tempera- 
ture, which  may  rise  suddenly  to  its  maximum  ( 103*5° 
to  1040  F.),  or  it  may  rise  rapidly,  but  "  staircase 
fashion,"  and  attain  its  maximum  in  about  thirty-six 
or  forty-eight  hours.  Sometimes  the  rise  is  slower  and 
the  maximum  is  not  reached  till  the  fifth  or  the  seventh 
day,  or  it  may  be  suddenly  manifested  by  rigors  and 
sweating. 

The  fastigium  may  also  present  several  types,  the 
oscillations  being  regular,  as  in  an  ordinary  attack  of 
typhoid  fever — a  comparatively  rare  form — or  it  may 
be  of  the  irregular  remittent  or  regular  remittent  type. 
Jaccoud  called  attention  to  the  fact  that  the  maximum 
temperature  of  the  relapse  is  always  less  than  that  of 
the  original  attack,  but  that  it  may  rise  to  1040  or 
105 *5°  F.,  which  is  usually  reached  about  the  sixth 
day,  though  sometimes  earlier.  The  period  of  de- 
fervescence shows  the  least  variation.  In  a  large 
proportion  of  cases  it  takes  place  by  lysis  within  from 
twenty-four  to  thirty-six  hours,  although  in  some  it 
may  take  several  days. 

Some  observers  base  their  prognosis  on  these  varia- 
tions in  the  temperature.  Wunderlich  concludes  that 
if  the  rise  be  sudden  and  rapid,  the  relapse  is  usually  of 
short  duration,  and  that,  on  the  contrary,  the  relapse 
is  often  of  protracted  duration  when  the  rise  has  been 
slow.  Jaccoud  holds  that  the  mildness  of  the  relapse 
is  dependent  on  the  maximum  being  attained  early,  and 
that  it  is  quite  unaffected  by  the  maximum  qud  maxi- 
mum. The  eruption  in  cases  of  relapse  appears  earlier 
than  in  the  original  attack,  generally,  indeed,  between 
the  second  and  fifth  days.  The  duration  of  the  regular 
type  of  relapse  is  from  three  to  four  weeks. 

The  pyretic  relapse  differs  from  the  form  just  de- 
scribed in  the  absence  both  of  typhoid  symptoms  and 
complications.  It  is  manifested  by  a  rapid  rise  of 
temperature  during  convalescence — 103*5°  to  io4°  F« — 
the  chart  being  very  similar  to  that  of  simple  relapse. 
The  temperature  can  only  be  accounted  for  by  the 
action  of  the  typhoid  poison  on  the  system.  These 
relapses  might  easily  be  mistaken  for  cases  of  typho- 
bacillosis,  by  which  we  understand  a  typhoid  condition 
caused  by  a  tuberculous  infection  preceding  the  phase 
of  localisation,  which  only  occurs  a  good  deal  later. 

In  the  anomalous  relapses,  the  temperature  curve 
may  present  still  greater  oscillations  of  temperature, 
and  it  contrasts  m  many  important  respects  with 
those  observed  in  an  ordinary  attack  of  typhoid  fever. 
In  this  variety  of  relapse,  which  is  by  far  the  com- 
monest, the  temperature  rises  continuously  and  attains 
its  maximum  about  the  fifth  day,  between  which  and 
the  eighth  day  it  remains  steady ;  but  on  the  ninth 
day  it  suddenly  drops  several  degrees  and  may  even 
become  subnormal,  though  it  subsequently  rises  again 
to  its  previous  level.     The  temperature  remains  slightly 


632    The  Medical  Pees*.         ORIGINAL  COMMUNICATIONS. 


June  15.  1904. 


raised  until  the  fifteenth  day,  when  it  again  falls 
suddenly,  and  oscillates  slightly  till  the  twenty-first 
day,  when  convalescence  sets  in.  The  temperature, 
however,  does  not  always  follow  this  course,  and 
examination  of  the  charts  shows  how  very  variable  may 
be  the  curves.  There  may,  for  instance,  be  a  sudden 
rise  followed  by  many  falls,  and  it  may  be  by  per- 
sistently low  readings  both  in  fastigium  and  during 
defervescence.  In  this  kind  of  relapse  the  tempera- 
ture may  rise  to  1040  F„  and  whatever  the  duration 
of  the  relapse  the  maximum  is  reached  during  the  first 
ew  days.  This  contradicts  Jaccoud's  law,  according 
to  which  the  relapse  is  usually  of  short  duration  when 
the  maximum  temperature  is  attained  early.  Wunder- 
lich's  theory  that  a  rapid  and  sudden  rise  precedes  a 
short  relapse  is  also  invalidated  by  our  charts. 

The  characteristic  feature  of  this  form  of  relapse  is, 
therefore,  an  anomalous,  i.e.,  an  irregular,  course  of 
the  temperature  and  the  late  appearance  of  the  erup- 
tion (tenth  day).  The  pulse  may  be  120,  though  it 
usually  oscillates  between  60  and  80  per  minute.  It 
is  especially  in  this  type  that  shivering,  vomiting,  and 
constipation  are  present  from  the  onset.  The  average 
duration  is  from  three  to  five  weeks. 

In  the  relapses  associated  with  wide  oscillations,  the 
difference  between  the  morning  and  the  evening  tem- 
peratures may  amount  to  from  40  to  6°  F.  The 
temperature  during  convalescence  rises  to  103  5°  or 
1040  F.,  in  about  three  days,  and  then  by  wide  oscillations 
returns  to  normal  in  from  eight  to  ten.  The  rise,  the 
fastigium,  and  the  decline  may  all  show  these  oscilla- 
tions. 

After  the  temperature  has  reached  its  maximum  it 
may  be  followed  by  a  fastigium  of  ten  days*  duration, 
showing  marked  regular  oscillations  just  as  during  the 
rise,  and  this  is  followed  by  a  crisis,  or  the  oscillations 
present  during  the  period  of  decline  of  the  primary 
attack  may  continue,  but  less  pronounced ;  or  the 
temperature  takes  about  four  days  to  reach  its  maxi- 
mum, this  is  succeeded  by  a  fastigium  of  twenty  days, 
in  which  a  few  irregular  oscillations  occur.  The  period 
of  decline  may  be  prolonged  for  ten  to  twelve  days 
more,  and  the  temperature  then  comes  down  by 
oscillations,  some  of  which  are  large  and  others  small, 
and  the  normal  is  reached  in  ten  to  twelve  days.  The 
maximum  temperature  in  this  relapse  may  be  1040  F., 
or  even  higher.  It  will  be  seen  that  the  date  at  which 
the  maximum  is  reached  and  the  form  of  the  thermo- 
metric  curve  have  no  influence  on  the  duration  of  the 
relapse. 

The  pulse  rarely  exceeds  100,  and  more  often  than 
not  it  ranges  between  70  and  00.  The  spots  are 
occasionally  absent,  sometimes  they  appear  only  on 
the  seventh  day  ;  in  fact,  apart  from  the  high  tem- 
perature, the  symptoms  are  ill-defined. 

Devic  thinks  this  kind  of  relapse  is  not  observed  in 
patients  who  have  been  treated  by  baths,  but  I  do  not 
agree  with  him  on  this  point,  because  it  happened  in 
just  such  a  case  that  I  witnessed  this  form  of  relapse. 
The  duration  is  frequently  three  weeks  and  sometimes 
longer,  indeed,  it  may  be  as  long  as  thirty  days. 

Yet  another  variety  is  that  known  as  an  abortive 
relapse,  which  derives  its  name  from  its  short  duration. 
This  variety  is  frequent  in  epidemics.  The  tempera- 
ture chart  varies  with  every  patient,  the  rise  may 
take  place  by  regular  oscillations  in  three  or  four  days, 
and  then,  without  any  transition,  defervescence  sets  in 
and  the  normal  is  reached  in  about  four  days  by 
regular  descending  oscillations. 

The  oscillations  of  the  rising  temperature  may  be 
rregular,  but  the  duration  is  very  much  the  same  as  in 
the  previous  case.  This  is  succeeded  by  a  fastigium 
of  twelve  hours,  which  in  its  turn  is  followed  by  a  fall 
by  irregular  oscillations  lasting  four  days ;  or,  again, 
the  maximum  is  reached  slowly  on  the  seventh  day, 
and  the  fall  is  by  crisis  ;  or  the  rise  is  sudden  and  the 
fall  by  lysis,  the  normal  being  attained  in  a  week. 

These  are  the  main  types  of  abortive  relapse,  and  it 
will  be  seen  that  they  differ  a  good  deal  from  one  another 
n  their  evolution,  and  appear  to  have  practically 
nothing  in  common  except  their  duration,  which  in  all 
cases  is   short.     The  maximum    temperature   in    this 


kind  of  relapse  is  about  103*5°  F.,  but  the  pulse  may 
be  1 20,  though  usually  about  90.  The  spots  are  some- 
times seen  as  early  as  the  first  day.  usually  not  till  the 
eighth,  although  this  date  may  coincide  with  the  end 
of  the  period  of  defervescence.  In  one  of  my  cases 
the  spots  appeared  on  the  ninth  day,  twenty-four  hours 
after  the  temperature  had  reached  normal. 

In  the  majority  of  cases  the  typhoid  symptoms  are 
unimportant,  but  they  are  occasionally  of  extreme 
severity.  In  a  case  of  this  kind  under  my  own  obser- 
vation, the  relapse  was  preceded  by  sudden  pain  inr 
the  spleen  followed  by  a  rapid  rise  of  temperature, 
tenderness  in  the  right  iliac  fossa,  diarrhoea  and  epi- 
staxis. 

After  forty-eight  hours  the  symptoms  subsided  in 
great  measure,  the  attack  abated  and  convalescence 
set  in  on  the  seventh  day.  These  relapses  seldom  last 
longer  than  a  week,  and  from  their  short  duration  and 
the  course  of  the  temperature  one  is  rather  inclined  to 
look  upon  them  as  recrudescences.  This,  however,  is 
not  the  case,  because  a  period  varying  from  three  to 
twenty-three  days  elapses  between  the  actual  attack 
and  the  fresh  rise  of  temperature.  They  are  con- 
sequently genuine  relapses.  This  is  further  proved  by 
the  reappearance  of  the  spots. 

Other  forms,  called  abnormal  relapses,  exist,  besides 
those  mentioned,  and  these  may  be  easily  overlooked 
and  so  give  rise  to  errors  in  diagnosis.  In  the  previous 
varieties  the  relapse  was  fairly  easy  of  diagnosis  by 
reason  of  the  persistence  of  a  high  temperature,  but 
in  these  abnormal  cases  the  rise  of  temperature  does 
not  obtain.  The  temperature  may  go  up  for  a  short 
time  and  be  followed  by  fairly  long  periods  of  apyrexia. 
but  in  some  cases  even  this  fugitive  rise  does  not  take 
place,  and  the  point  on  which  we  must  rely  for  the 
diagnosis  is  the  appearance  of  the  spots.  This  class 
of  relapses  has  not  hitherto  been  described,  yet  it  is 
comparatively  frequent.  There  are  two  varieties 
thereof.  In  one  the  typhoid  symptoms  are  ill-defined, 
and  the  relapse  is  characterised  by  an  occasional 
nocturnal  rise  of  temperature,  with  long  apyretic 
intervals.  In  two  of  my  cases  it  simulated  a  quartan 
fever,  in  a  third  case  there  were  two  apyretic  intervals- 
separating  the  rises  in  temperature,  one  of  nine  days'r 
and  the  other  of  three  days',  duration,  and  in  the  fourth 
case  the  relapse  comprised  an  initial  and  a  final  rise 
of  temperature  separated  by  a  period  of  normal  tem- 
perature. 

In  only  one  case  was  the  initial  rise  followed  imme- 
diately by  another  similar  rise,  this  phenomenon 
recurring  at  the  end  of  the  relapse.  The  maximum 
temperature  never  exceeded  990  to  1030  F.,  and  this 
was  sometimes  attained  in  the  first  instance,  while  in 
others  only  with  the  final  rise. 

The  lenticular  spots,  which  are  the  only  characteristic 
symptom  of  this  kind  of  relapse,  usually  appear  between 
the  first  and  fourth  days,  and  coincide  more  or  less  with 
the  rise  of  temperature.  In  one  case  a  second  eruption 
appeared  after  the  final  rise  of  temperature,  showing 
that  the  relapse  is  not  absolutely  limited  to  these  two 
elevations  of  temperature.  The  typhoid  symptoms 
were  generally  slight  and  consisted  mainly  of  diarrhoea 
and  redness  of  the  tip  of  the  tongue. 

In  three  cases  these  relapses  followed  an  attack  of 
typhoid  fever  of  from  fifteen  to  thirty  days*  duration ; 
in  one  the  relapse  of  thirteen  days  followed  an  attack  of 
forty-nine  days.  The  interval  of  apyrexia  separating 
the  attack  from  the  relapse  varied  from  five  to  seven 
or  fourteen  days,  and  the  relapse  itself  lasted  from 
six  to  seventeen  days.  The  second  variety  of  the 
abnormal  type  is  the  apyretic  form,  and  this  has  been 
seen  to  follow  an  apyretic  form  of  typhoid  fever,  but 
the  two  are  by  no  means  always  associated,  for  the 
relapse  may  follow  a  typical  attack,  in  which  the 
maximum  has  been  104°  F.  The  relapse  in  this  case 
began  with  a  trifling  rise  of  temperature  to  oo°  F.r 
which  subsequently  fell  to  normal  and  remained  there. 
The  lenticular  spots  varied  in  the  time  of  their  appear- 
ance  ;  in  one  case  they  appeared  three  days,  and  is 
another  thirteen  days,  after  the  initial  rise.  In  the 
latter  patient,  a  second  series  of  spots  appeared  nine 


June  is.  1904. 


TRANSACTIONS  OF  SOCIETIES.      The  Medicax,  Fww*-   635 


days  later.  In  the  remaining  three  patients,  after  the 
subsidence  of  the  original  attack  the  temperature 
remained  at  98  °  F.  Yet  spots  appeared  from  seven  to 
eight  days  after  the  temperature  had  returned  to 
normal,  the  original  attack  having  lasted  from  eighteen 
to  thirty  days.  In  each  of  these  cases  there  was  only 
one  eruption.  In  this  variety  the  only  typhoid  sym- 
ptoms were  diarrhoea  and  redness  of  the  tongue.  The 
pulse  never  exceeded  72.  It  is  rather  difficult  to  state 
the  duration  of  the  relapse,  inasmuch  as  there  is  no 
temperature  to  guide  us,  but  reckoning  from  the  time 
at  which  the  spots  appeared  it  is  thought  to  have 
been  from  one  to  three  weeks. 

In  these  abnormal  types,  the  typhoid  symptoms 
and  the  temperature  chart  do  not  help  us  in  the  least 
in  arriving  at  a  diagnosis,  but  there  is  no  doubt  that 
we  were  dealing  with  a  genuine  relapse,  as  shown  by 
the  spots.  The  latent  relapses  are  therefore  very  easily 
overlooked,  and  from  a  practical  point  of  view  they 
•deserve  to  be  made  known. 

We  see,  therefore,  that  the  relapses  do  not  reproduce 
the  typical  typhoid  chart,  and,  moreover,  considerable 
differences  exist  between  the  relapses  themselves 
first  in  respect  of  their  course,  duration,  severit ,  and 
even  of  their  symptomatology.  The  temperature 
after  an  attack  of  typhoid  may  be  caused  either 
by  a  relapse  of  the  complications,  such  as  bronchitis 
or  pneumonia. 

The  relapses  showing  wide  oscillations  must  not  be 
confounded  with  the  oscillations  of  temperature,  lasting 
two  to  four  days,  accompanied  by  shivering  and  sweat- 
ing due  to  septicaemia,  secondary  to,  for  instance, 
otitis  media,  to  furunculosis,  or  to  erythema,  nor  must 
they  be  confused  with  oscillations  of  temperature  due 
to  pyaemia.  In  pyaemia,  the  oscillations  are  more 
irregular,  and  the  patient  has  rigors,  loses  flesh,  and 
soon  acquires  a  jaundiced  tint  of  the  skin.  In  this 
oase  one  must  look  for  the  source  of  the  mischief, 
which  may  be  due  to  the  formation  of  an  abscess, 
frequently  in  the  muscles,  and  especially  those  of  the 
buttock.  Again,  the  rise  may  be  due  to  periostitis 
of  one  of  the  long  bones  or  to  a  patch  of  pneumonia, 
which  may  become  the  seat  of  an  abscess.  The  urine 
should  be  examined  daily  for  evidence  of  pyonephritis. 
The  temperature,  again,  might  be  attributed  to  a 
typho-bacillosis  or  to  a  tuberculous  infection,  but  in 
these  cases  the  typhoid  symptoms  are  absent  and  the 
chart  is  different.  The  temperature  is  not  very  notice- 
able during  the  day  but  begins  to  rise  at  night,  and  is 
accompanied  by  cold  sweats,  cough,  expectoration, 
and  other  symptoms  of  tuberculosis,  together  with  a 
history  of  wasting.  Examination  of  the  chest  will 
then  reveal  dry  forms  of  tuberculous  mischief,  but  if 
•one  be  not  on  the  look  out  for  this  the  temperature  may 
be  taken  to  represent  an  irregular  or  abortive  relapse. 

Rises  of  temperature  due  to  an  abscess  or  to  erysipe- 
las may  simulate  an  abortive  relapse.  Constipation 
may  simulate  a  relapse  by  producing  a  rise  of  tem- 
perature, diarrhoea  from  irritation  of  faecal  masses  to 
gurgling  in  iliac  fossa,  and  in  some  cases  it  may  be 
accompanied  by  distension  and  so  come  to  resemble 
closely  an  ordinary  attack  of  typhoid  fever,  from  which 
it  may  be  distinguished  by  the  pain  noticed  along  the 
course  of  the  large  intestine.  During  convalescence 
the  temperature  may  rise  and  remain  from  2°  to  6°  F. 
higher  than  normal.  This  is  called  by  the  Germans 
"  secondary  fever,"  and  it  cannot  be  accounted  for. 
It  is  of  rare  occurrence,  but  it  may  resemble  an  inter- 
mittent or  a  remittent  fever.  It  may  resemble  the 
abnormal  relapse,  but  is  unaccompanied  by  an  eruption 
of  lenticular  spots.  And  if,  when  convalescence  seems 
to  have  set  in,  diarrhoea  still  persists  and  the  tongue 
remains  slightly  red  at  the  tip,  one  must  wait  a  week 
or  two  to  be  sure  that  it  is  not  an  apyretic  relapse. 

This  subject  has  been  but  little  studied,  and  from 
the  small  number  of  observations  at  my  disposal,  it 
would  be  premature  to  say  what  influence  the  attack 
of  typhoid  exercises  on  the  relapse.  Jaccoud  calls 
a  relapse  precocious,  when  the  apyretic  interval  is 
only  three  days,  and  delayed  if  this  interval  exceeds 
ten  days,  reserving  the  name  of  ordinary  relapse  for 
relapses  occurring  between  three  and  ten  days.     From 


the  consideration  of  cases  under  my  care,  $3  per  cent, 
were  late  in  appearing,  32  per  cent,  appeared  at  the 
usual  time,  ana  1  5  per  cent,  were  early,  leading  me  to 
conclude  that  "  abortive  relapse  "  supervenes  after  the 
tenth  day.  An  abortive  relapse  generally  indicates  the 
finality  of  the  attack. 

The  treatment  of  the  relapse  does  not  differ  from  that 
of  the  original  attack ;  cold  baths  or  sponging  may  be 
necessary  if  the  temperature  is  high,  otherwise  mere 
dieting  will  be  sufficient. 


^transactions  of  Societies* 


EDINBURGH  MEDICO-CHIRURGICAL  SOCIETY. 
Meeting  held  June  ist,  1904. 


Professor  Chienb,  C.B.,  in  the  Chair. 


Dr.  Norman  Walker  showed  (1)  three  cases  of  lupus 
complicated  by  epithelioma.  In  one  case  the  malignant 
growth  had  developed  before,  and  in  the  other  two 
after,  treatment  of  the  lupus  by  X-rays.  In  the  first 
case  the  rays  had  been  used  in  the  treatment  of  the 
epithelioma  with  good  results.  (2)  A  case  of  psoriasis 
treated  by  the  X-rays,  in  which,  after  fourteen  ex- 
posures, the  disease  had  practically  disappeared. 

Mr.  Geo.  Chiene  showed  (1)  a  man  after  operation 
for  rupture  of  the  middle  meningeal  artery  and  lacera- 
tion of  the  temporal  lobe.  Two  days  after  receiving  an 
injury  he  was  admitted  to  the  infirmary  on  account 
of  difficulty  in  walking.  Hemiplegia  and  aphasia 
then  developed.  At  the  operation  the  bleeding  was 
found  to  come  from  a  point  low  down,  being  evidently 
due  to  intra-dural  rupture  of  the  vessel.  The  artery 
was  ligatured,  and  recovery  gradually  took  place, 
though  some  mental  instability  still  remained.  (2) 
An  infant  who  had  been  operated  on  for  acute  in- 
tussusception when  forty  days  old.  (3)  A  child  in 
whom  two  operations  for  acute  intussusception  had 
been  performed  successfully — the  first  at  4^  months, 
the  second  at  22  months.  The  patient  still  suffered 
from  constipation,  which  had  probably  caused  the 
strangulation. 

Dr.  Allan  Jamibson  showed  a  woman,  aet.  26, 
suffering  from  keloid  in  the  scar  resulting  from  an  ulcer, 
due  to  the  application  of  acetic  acid  as  a  counter-irri- 
tant to  the  breast.  Forty-four  exposures  of  five 
minutes'  duration  to  the  X-rays  had  brought  about 
an  almost  complete  recovery.  (2)  A  case  of  naevus 
pilosus. 

Dr.  John  Stevens  showed  a  case  of  extensive 
atrophy  of  the  muscles  of  the  arms,  resulting  from  old 
poliomyelitis  acuta. 

Dr.  Edwin  Bramwell  showed  a  case  of  lesion  of  the 
eighth  cervical  and  first  dorsal  roots  (Klumpke's 
paralysis),  due  to  a  fall  on  the  shoulder.  There  was  a 
band  of  anaesthesia  down  the  inner  side  of  the  arm, 
little  finger,  and  ulnar  half  of  the  ring  [finger,  with 
paralysis  of  the  interossei  muscles  of  the  thenar  and 
hypothenar  eminences  and  the  two  long  flexors 
and  flexor  carpi  ulnaris. 

Dr.  Geo.  Gibson  showed  a  case  of  hypertrophic 
pulmonary  arthropathy  in  a  man  suffering  from 
emphysema ;  the  skin  over  the  finger-tips  was  sodden, 
moist  and  hairless.  Skiagrams  of  the  case  were  also 
shown. 

Dr.  J.  M.  Cotterill  showed  a  patient  after  opera- 
tion for  extensive  lipoma  nasi. 

Mr.  Scot  Skirving  showed  a  prostate  removed  from 
a  man,  aet.  86,  by  Freyer's  method. 

Dr.  Cotterill  showed  (1)  tuberculous  testicle 
from  a  child,  aet.  2;  (2)  amputation  at  the  shoulder- 
joint  for  malignant  disease  of  humerus. 

Dr.  David  Waterston  read  a  paper  on — 

SOME  POINTS  IN  THE  ANATOMY  OF  THE  PELVIC  FASCIA 
IN  THE  MALE  IN  RELATION  TO  THE  SURGERY  OF  THAT 
REGION. 

Recent  methods,  both  of  section  and  dissection,  gave 
a  clearer  idea  of  the  relations  of  the  parts  on  the  floor 
of  the  pelvis  than  was  formerly  attainable  ;  the  paper 
was,  in  the  main,  a  demonstration  of  lantern  slides 


634    The  Medical  Peesi.  TRANSACTIONS  OF  SOCIETIES. 


June  15,  1904. 


of  formalin  preparations,  the  chief  points  considered 
being  access  to  the  prostate,  the  musculature  of  the 
perineum,  and  the  relation  of  the  urethra  to  the  prostate 
gland.  The  superficial  layer  of  the  triangular  liga- 
ment was  not  intimately  related  to  the  urethra,  being 
attached  round  the  margin  of  the  bulb,  to  the  deep 
aspect  of  which  Cowper's  glands  are  in  close  relation, 
not  separated  from  it  by  a  strong  membrane.  These 
facts  explained  the  course  of  extravasated  urine  in 
rupture  of  the  membranous  urethra.  The  musculature 
of  the  part,  which  had  been  thoroughly  investigated 
about  a  century  ago,  was  of  extreme  complexity,  and 
very  difficult  to  demonstrate ;  it  was  therefore  often 
omitted  from  text-books.  Owing  to  recent  advances 
in  operative  surgery,  however,  renewed  attention  had 
been  directed  to  this  region,  and  the  surgical  importance 
of  the  muscle  passing  from  the  anal  canal  to  the  mem- 
branous urethra,  of  the  thick  anterior  portions  of  the 
levator  ani,  and  of  the  strength  of  the  deep  layer  of  the 
triangular  ligament,  had  been  pointed  out.  The  last- 
named  structure  was  pierced  by  the  urethra,  and  sup- 
ported the  prostate.  The  sheath  of  the  prostate  derived 
from  the  vesical  pelvic  fascia,  from  which  the  gland 
could  be  shelled  out  in  the  manner  first  described  by 
Dr.  Stoney,  was  also  demonstrated.  In  some  cases  of 
even  moderate  enlargement  of  the  gland,  the  urethra, 
covered  with  a  layer  of  prostatic  tissue,  could  be 
torn  out,  and  in  the  same  way  it  was  possible  to  enu- 
cleate a  considerable  amount  of  gland  tissue,  leaving 
the  urethra  uninjured. 
Mr.  Alexis  Thomson  read  a  paper  on — 

THE  ANATOMY  OF  THE  ENLARGED  PROSTATE  SO  FAR 
AS  IT  BEARS  ON  THE  OPERATION  OF  PROSTATECTOMY. 

Enlargement  of  the  gland  was  due  to  diffuse  hyper- 
plasia of  the  gland  tissue  in  the  form  of  a  new  growth 
of  buds  of  epithelium  from  the  acini  into  the  surround- 
ing stroma.  There  was  also  dilatation  of  the  old 
glandular  spaces  from  accumulation  of  retained  and 
altered  secretion,  dibris,  corpora  amylacea  and  even 
calcareous  concretions.  Hyperplasia  of  the  fibro- 
muscular  stroma  was  unusual,  and  occurred  only  to  a 
limited  degree  ;  the  stroma  usually  underwent  rare- 
faction and  absorption  from  the  predominance  of  the 
glandular  elements.  In  examining  forty  prostates 
he  had  never  found  encapsulated  tumours,  and  doubted 
whether  they  ever  occurred ;  he  did  not,  therefore, 
agree  with  those  who  spoke  of  shelling  out  independent 
tumours.  The  prostate  had  a  capsule,  least  developed 
at  its  vesical  surface,  composed  chiefly  of  non-striped 
muscular  fibres,  and  which  arose  from  a  condensation  of 
the  fibro-muscular  stroma  of  the  organ.  Under 
normal  circumstances  this  capsule  was  so  firmly  united 
to  the  gland  as  only  to  be  removable  by  cutting,  while 
in  ordinary  hyperplasia  the  gland  could  easily  be 
shelled  away  from  the  thinned-out  capsule  by  the 
finger.  In  cancer  of  the  prostate  this  enucleation  could 
not  be  effected  any  more  than  under  normal  circum- 
stances. In  enucleating  an  ordinary  hypertrophied 
prostate  the  line  of  separation  was  within  the  capsule, 
either  between  its  layers  or  in  the  peripheral  part  of 
the  gland  ;  a  variable  amount  of  prostatic  tissue 
was  therefore  left  behind.  In  intra-capsular  enuclea- 
tion the  minimum  of  force  was  needed :  the  periprostatic 
plexus  of  veins  and  the  seminal  vesicles  ran  no  risk  of 
injury,  as  the  finger  never  came  in  contact  with  them 
or  with  the  pelvic  fascia.  Owing  to  the  intimate 
connection  of  the  prostatic  urethra  with  the  stroma 
of  the  organ,  hyperplasia  of  the  glandular  elements 
led  to  a  thinning-out  of  the  urethral  wall  until  it  was 
represented  only  by  a  delicate  mucous  membrane. 
Enucleation  en  masse  meant  that  the  urethra  also  was 
removed,  while  if  the  organ  could  be  enucleated  in 
two  halves  separated  by  the  mesial  plane,  the  urethral 
wall  remained  more  or  less  uninjured.  By  the  supra- 
pubic route  the  finger-nail  tore  through  the  mucous 
membrane  covering  the  vesical  aspect  of  the  organ,  and 
in  the  perineal  method  that  of  the  prostatic  urethra. 

The  President  suggested  that  the  term  prostate 
"  sheath "  should  refer  only  to  the  fascial  covering 
of  the  gland,  and  the  term  •'  capsule  "  to  the  fibro- 
muscular   coat. 


Professor  Cunningham  agreed  with  the  President's 
suggestion. 

Mr.  Nichol.  Mr.  Wallace,  and  Mr.  Stiles  also  spoke. 


WEST  LONDON  MEDICO-CHIRURGICAL 
SOCIETY. 
Meeting  held  June  3rd,  1904. 


The  President,  Dr.  Seymour  Taylor  in,  the  Chair. 


A  paper  was  read  by  Mr.  J.  Jackson  Clarke  on— 
Paralytic  deformities  :  their  modern  treatment. 
A  wide  range  of  nerve-lesions,  whether  cerebral,  spinal 
or  peripheral,  led  to  disabilities  and  deformities  that 
required  surgical  treatment.  The  range  and  scope  of 
surgery  had  of  late  years  been  so  markedly  increased 
that  it  had  become  necessary  to  consider  very  care- 
fully what  were  the  aims,  and,  as  far  as  possible,  what 
were  the  limits,  of  such  surgical  treatment.  Infantile 
paralysis  and  cerebral  spastic  paralysis  provided  the 
two  largest  groups  of  paralytic  deformities :— (1) 
Infantile  paralysis.  The  chief  point  in  the  natural 
history  of  this  malady  was  its  tendency  to  improve. 
After  about  nine  months  this  improvement  ceased, 
and  therefore  medical  treatment  should  not  be  pro- 
longed beyond  that  period.  Some  surgeons  had  re- 
cently stated  that  the  medical  stage  of  infantile  para- 
lysis should  be  limited  to  the  first  few  days ;  and  it 
would  be  wise  for  the  medical  man  to  secure  the  loyal 
co-operation  of  a  competent  surgeon  early  in  any  case 
where  deformity  threatened,  as  the  judicious  use  of 
simple  apparatus  often  assisted  recovery  and  prevented 
deformity  and  the  need  for  future  surgical  interference. 
The  danger  of  inefficient  surgery  in  these  cases  was 
alluded  to.  In  paralytic  equinus.  for  example,  a 
simple  tenotomy  of  the  tendo  Achillis  was  apt  to  be 
followed,  from  lengthening  of  the  scar  tissues,  by  a 
worse  deformity,  talipes  calcaneus,  which  required 
further  operative  measures  for  its  correction.  In  some 
cases  of  infantile  paralysis  a  talipes  equinus  was  an 
advantage,  and  should  not  be  interfered  with ;  in 
these  cases  there  was  a  fair  amount  of  power  in  the 
muscles  of  both  sides  of  the  leg,  and  the  equinus  com- 
pensated for  the  shortening.  Tendon  transplantation 
should  be  limited  to  cases  in  which  there  was  a  fair 
residuum.of  muscular  power,  and  in  which  the  deformity 
could  be  corrected  at  the  time  the  transplantations 
were  made.  Lange's  artificial  tendons  of  silk  were  of 
great  assistance  in  some  case  of  tendon  transplanta- 
tion. The  case  of  a  young  mao,  aet.  27,  who  had  been 
deformed  for  twenty  years  was  quoted.  A  good  result 
was  obtained  by  transplanting  the  long  head  of  the 
biceps  and  the  semi-tendinosus  to  the  front  of  the  joint, 
after  section  of  all  the  hamstrings  and  of  the  fascia 
in  the  popliteal  space.  Arthrodesis  was  of  most  use 
in  the  case  of  the  ankle  joint.  (2)  Cerebral  spastic 
paralysis  offered  a  gratifying  field  to  the  surgeon,  the 
aim  being  to  obtain  an  equalisation  of  power  in  the 
opposed  groups  of  muscles.  In  the  slighter  cases  suit- 
able instrumentation  following  muscle  stretching  under 
anaesthesia  was  sufficient ;  but  in  the  more  pronounced 
grades  tendon-lengthening,  tenotomy,  tenectomy  or 
myectomy  were  necessary.  The  Erbe-Duchcnne  type 
of  paralysis,  Friedreich's  disease,  some  forms  of  pro- 
gressive muscular  paralysis,  as  well  as  other  nerve 
affections,  offered  scope  for  surgery  if  careful  selection 
of  cases  were  made. 

The  President  deprecated  any  active  treatment  is 
infantile  paralysis,  so  long  as  pyrexia  existed,  as  this  in- 
dicated that  active  cell  injury,  and  possible  destruction, 
was  still  present,  and  the  full  extent  of  the  resulting 
injury  unknown.  After  the  temperature  had  sub- 
sided, active  measures— electricity,  massage,  and  the 
like— -should  be  commenced,  and  if  no  improvement 
ensued  surgical  procedure  should  be  resorted  to  without 
undue  delay. 

Mr.  E.  Percy  Paton  agreed  with  Mr.  Jackson  Clarke 
that  it  would  be  well  if  the  surgeon  had  an  opportunity 
of  seeing  infantile  palsy  at  an  earlier  date  than  was 
usual,  so  that  deformity  might  be  prevented,  as  it 
often  could  be,  by  early  splinting.     No  operation  should 


June  15.  1904. 


FRANCE. 


The  Medical  Press.    635 


however,  be  done  until  all  pyrexia  had  subsided  for 
some  time.  It  was  a  most  important  point,  as  noted 
in  the  paper,  not  to  perform  arthrodesis  on  both  hip 
and  knee  in  cases  of  flail-like  lower  limb  ;  but  rather  to 
fix  the  ankle  and  rectify  the  trouble  in  the  knee  by 
some  such  means  as  tendon-grafting,  and  give  the  in- 
creased support  that  might  be  necessary  by  means 
of  a  well-devised  instrument. 

Mr.  Laming  Evans  considered  that  the  cases  of 
tendon-contraction  might  still  be  divided  into  (a) 
simple,  and  (6)  severe  In  the  former,  simple  tenotomy 
might  be  employed  with  excellent  results,  at  the  same 
time  avoiding  the  more  severe  operation,  and  the 
necessity  of  in-patient  treatment ;  in  the  latter,  tendon 
elongation  was  necessary.  He  had  recently  corrected 
a  case  of  severe  equinus  by  lengthening  the  tendo 
Achillis  2±  inches.  The  uniting  medium  was  firm 
and  massive  in  four  weeks.  This  operation  in  pro- 
nounced cases  saved  time  to  the  patient,  ensured  a 
more  certain  correction,  and  avoided  the  risk  of  a 
weak  aponeurotic  union.  He  agreed  with  Mr.  Jack- 
son Clarke  that  in  cases  requiring  tendon  transplanta- 
tion the  deformity  should  be  corrected  first.  Unless 
this  were  done  it  was  impossible  to  estimate  the  part 
played  by  the  transplanted  muscle  in  increasing  the 
power  of  a  partially  paralysed  muscular  group,  by 
reason  of  the  resistance  offered  by  a  contracted  tendon 
or  tendons  of  the  opposing  group.  In  the  great  ma- 
jority of  cases  of  spastic  paraplegia  he  preferred 
exsection  of  the  adductor  tendons  to  simple  tenotomy, 
but  in  spastic  equinus  lengthening  of  the  tendo  Achillis 
gave  the  best  results.  He  had  lately  performed 
arthrodesis  of  the  shoulder-joint  in  a  case  in  which  all 
the  muscles  between  the  shoulder  girdle  and  the 
humerus  were  completely  paralysed,  the  trapezius 
and  serratus  magnus  being  active.  Three  months  after 
the  operation  satisfactory  movement  of  the  arm  was 
obtained. 

Mr.  Jackson  Clarke  replied. 


Special  articles. 


BRITISH  SANATORIA  FOR  CONSUMPTION.— XL. 


[by  our  special  medical  commissioner.] 


DUNSTONE   PARK   SANATORIUM,     PAIGNTON. 

South  Devon  has  long  been  favoured  as  a  district 
suitable  for  pulmonary  disease,  and  although  the 
results  of  a  well-directed  treatment  in  accordance  with 
modern  methods  have  conclusively  shown  that  con- 
sumption may  be  arrested  in  all  sorts  and  conditions  of 
climate  provided  hygienic  necessities  be  provided,  it 
is  nevertheless  clear  that  certain  parts  of  Devon  can 
offer  many  advantages  peculiarly  welcome  to  the 
phthisical.  At  the  present  time  there  are  two  private 
sanatoria  in  Devonshire. 

The  so-called  Dunstone  Park  Sanatorium,  of  which 
Dr.  T.  Carson  Fisher  is  the  proprietor  and  resident 
physician,  is  situated  at  an  elevation  of  5  50  ft.  above 
sea  level,  on  Marldon  Hill,  about  a  mile  and  a  half 
behind  the  rapidly  growing  sea-side  town  of  Paignton. 
It  is  on  elevated  ground,  with  extensive  and  attractive 
views  over  sea  and  land.  Torbay  lies  open  to  the 
south,  while  inland  the  Dartmoor  uplands  can  be  seen 
across  a  wide  reach  of  fertile  and  undulating  country. 
The  position  is  somewhat  exposed,  and  although  many 
opportunities  for  good  walks  can  be  obtained,  there  is 
somewhat  of  a  lack  of  suitable  shelter.  The  situation, 
however,  undoubtedly  presents  many  advantages. 
The  aspect  is  sunny  and  cheerful,  and  delightful 
panoramic  views  are  presented.  The  subsoil  is  of 
gravel  and  red  sandstone,  and  rapidly  dries  after  rain. 
The  grounds  in  connection  with  the  sanatorium  are 
limited  and  the  shelters  available  are  not  of  the  most 
modern  construction. 

The  main  building  is  a  modified  ordinary  residence, 
and  although  in  many  ways  suitable  for  its  present 
purpose  cannot  claim  the  conveniences  of  a  specially 


constructed  sanatorium.  Some  of  the  rooms  have 
verandahs,  and  efforts  have  been  made  to  make  the 
various  apartments  suitable  for  the  class  of  patient 
occupying  them.  W 

Dr.  Fisher  informed  us  that  he  had  enjoyed  wide 
general  experience  both  at  home  and  abroad,  and  had 
also  devoted  several  years  to  the  practical  study  of 
open-air  treatment  in  various  sanatoria.  Both  he  and 
his  wife  share  the  life  of  the  patients.  The  lady 
superintendent  is  a  duly  certificated  nurse.  The  terms 
are  from  three  to  four  guineas  a  week.  "  The  only 
extras  are  stimulants  and  medicines  (rarely  required), 
and  personal  laundry.  Also,  if  any  patient  has  to  be 
kept  in  bed  for  more  than  a  week  at  a  time,  half  a 
guinea  per  week  extra  is  charged." 

The  nearest  railway  station  is  Paignton,  which  is 
the  next  station  west  of  Torquay.  Paignton  is  on  the 
Newton  Abbott  to  Dartmouth  branch  of  the  Great 
Western  Railway,  and  can  be  reached  from  London  in 
about  five  hours. 


tf  ranee- 


[from  our  own  correspondent.] 

Paris,  June  12th,  1904. 
Treatment  of  Terminal  U  rami  a. 

Frequently  in  cases  of  cardio-renal  affections  the 
practitioner,  after  religiously  applying  the  usual 
treatment — rest,  milk  diet,  diuretics  (theobromin), 
sudorifics,  blood-letting,  drastic  purgatives — with  more 
or  less  success  for  a  time,  is  appealed  to  by  the  patient 
to  relieve  sudden  attacks  of  dyspnoea  which  threaten 
to  speedily  terminate  life.  In  such  uremic  seizures, 
morphia,  says  Dr.  Huchard,  is  the  best  remedy  at  hand. 
However,  before  administering^it,  it  would  be 
well  to  prescribe  the  rtfqime  recommended  by  M. 
Renon  :  two  or  three  quarts  of  water  or  diuretic  in- 
fusion in  twenty-four  hours.  By  this  means  diuresis 
sets  in,  and  the  danger  is  warded  off.  In  cardiac  in- 
sufficiency with  dilatation  of  the  heart,  the  quantity 
of  liquid  injected  must  be  less,  three  pints  in  the  twenty- 
four  hours.  This  reduction  of  liquid  is  often  sufficient  to 
produce  the  desired  result,  as  has  been  already  pointed 
out  by  M.  Huchard.  On  the  other  hand,  cardiac 
tonics  may  be  employed  according  to  his  method: 
one-tenth  of  a  milligramme  of  digitalin  during  ten 
consecutive  days,  then  convallaria  majalis  with  spar- 
tein  for  five  days,  followed  by  strophanthus  for  five 
days  more,  when  the  digitalin  may  be  recommenced. 

The  formula  employed  by  M.  Huchard  is  as  follows : 
Ex.  of  convallaria,  3J  i 
Sulph.  of  spartein,  gr.  v ; 
Syrup,  5j  ; 
Water,  %v. 
Four  tablespoonfuls  daily  for  five  days,  after  which 
extract  of  strophanthus  in  granules  of  1  milligramme, 
two  or  three  daily,  for  another  five  days. 

In  spite  of  all  this  treatment,  the  heart  remains 
dilated,  diuresis  is  insufficient,  oedema  reappears,  and 
with  it  the  syndroma  usually  called  uraemia.  In  this 
syndroma,  as  proved  by  the  researches  of  Widal  and 
Javal,  the  physical  element  plays  a  large  part ;  re- 
tention of  chlorides  exists,  and  their  presence  in  the 
tissues  attracts  the  water  of  the  blood,  and  thus  oedema 
is  formed.  The  signs  of  uraemia  are  imputed  to  deep 
seated  oedema  of  brain  or  lungs,  resulting  from  the 
retention  of  the  chlorides.  The  patient  is  in  manifest 
danger,  and  claims  immediate  assistance  ;  an  injection 
of  morphia  or  heroin  may  be  made  without  fear,  to 
the  great  relief  of  the  alarming  symptoms.  But  the 
dose  must  be  small :  one-tenth  of  a  grain  of  morphia 
or  one-thirtieth  of  a  grain  of  heroin,  to  be  repeated  in 


636     The  Medical  Pkess. 


GERMANY. 


JONE    15,    1904, 


a  few  hours  if  necessary.  Dr.  Huchard  prefers  em 
ploying  heroin  as  the  name  is  less  known  to  the  public, 
and  if  the  patient  succumbed  after  an  injection  of 
morphia  the  relatives  might  accuse  the  medical  atten- 
dant of  hastening  his  death. 

The  following  is  the  formula  of  the  injection  : — 
Heroin,   gr.  j  ; 
Water,  3j  ; 
Alcohol,  5j ; 
Sulphuric  ether,   />iss. 
In  jest  half  a  syringe. 

It  must  be  remembered  that  the  continuation  of  the 
remedy  is  not  without  danger,  as  under  its  influence 
the  diuresis  diminishes  and  the  oedema  increases ; 
if  the  patient  is  naturally  nervous  and  the  oedema 
occupies  the  brain,  the  danger  is  manifest.  The  patient 
experiences  a  feeling  of  anguish,  is  afraid  of  the 
coming  night,  is  agitated,  implores  his  end,  is  restless, 
gets  up,  lies  down,  groans  continually,  and  is  finally 
prostrated. 

What  is  to  be  done  ?  He  is  too  weak  for  a  warm 
bath  ;  the  initial  doses  of  heroin  are  no  longer  sufficient 
to  produce  sleep.  As  soon  as  he  closes  his  eyes,  he  is 
suddenly  awakened  by  want  of  air  ;  he  either  wants  to 
sleep  or  stop  awake,  and  the  doses  of  heroin  or  mor- 
phine are  no  longer  able  to  bring  on  sleep,  and  yet 
hinder  the  patient  from  remaining  fully  awake.  The 
situation  is  very  painful.  Inhalations  of  ether  can 
produce  an  improvement,  and  may  be  repeated  during 
two  or  three  days,  but  require  the  constant  presence  of 
the  attendant. 

Lemoine,  of  Lille,  recommends  the  internal  adminis- 
tration of  ether,  two  or  three  teaspoonfuls  in  the 
twenty-four  hours  in  water.  At  this  terminal  period 
of  the  malady  the  ingenuity  of  the  physician  is  put  to 
the  test.  The  remedies  must  be  varied  more  to  respond  to 
the  appeals  of  the  patient  rather  than  to  any  confidence 
he  possesses  in  their  efficacy.  Among  these  agents 
may  be  mentioned  chloral,  trional,  camphorated  oil, 
caffein  (5  grs.  three  times  a  day),  occasional  wet-cup- 
ping over  the  cardiac  region  once  or  twice  a  week,  pur- 
gatives, inhalations  of  oxygen,  &c.  But  superior  to 
any  of  these  remedies  is  the  hydric  rtgime,  and  if  the 
patient's  heart  is  dilated,  reduction  of  liquids  (three 
pints  daily)  will  excite  diuresis.  However,  the  patient 
cannot  be  kept  indefinitely  on  this  water  diet — at 
most  three  or  four  days,  and  that  by  the  aid  of  a  little 
tea,  after  which  milk  will  take  its  place.  Such  are 
the  lines  laid  down  by  Dr.  Huchard  in  the  treatment 
or  uraemia,  acute  or  chronic. 


Germany 

[from  our  own  correspondent.] 


Berlin,  June  11th,  1004. 

At  the  Surgical  Congress,  Hr.  Kuster,  Marburg, 
read  a  paper  on 

The   Systematic    Prone   Position    in    the    After- 
Treatment  of  Septic  Peritonitis. 

He  said  that  among  the  mechanical  aids  in  the 
treatment  of  septic  inflammations  of  the  peritoneum, 
that  of  the  prone  position  (bauchlage),  already  recom- 
mended by  himself,  had  been  unjustifiably  neglected 
by  surgeons.  According  to  the  experience  of  many  it 
had  been  very  efficacious,  especially  as  regarded  the 
outflow  of  secreted  fluid  material.  The  chief  thing 
was  that  the  opening  in  the  abdomen  should  always 
be  the  lowest  point.  If  there  should  be  any  fear  of 
prolapse  of  intestine,  this  could  be  avoided  by  reducing 
the  opening  to  a  mere  slit,  and  fitting  in  a  tampon. 
The  speaker  had  treated  six  cases  in  this  way,  of  which 
two  had  died.     In  one  of  the  fatal  cases,  however,  the 


cause  of  death  was  pneumonia,  and  at  the  autopsy  it 
was  found  that  the  peritonitis  had  nearly  all  dis- 
appeared,  and  in  the  second  fatal  case  the  operation 
was  not  performed  until  four  days  after  perforation  of 
the  bowels,  and  even  then  the  patient  lived  several 
days.  He  had  an  impression  of  the  immediate  efficacy 
of  the  position,  as  in  a  Case  of  rupture  that  came  under 
treatment  thirteen  hours  after  receipt  of  the  injury, 
and  when  peritonitis  was  already  set  up,  the  patient 
was  laid  on  his  abdomen,  and  distinct  improvement 
was  noted  at  once.  Naturally  the  opening  must  be 
small  and  a  drain  should  be  inserted.  The  position 
should  be  maintained  even  when  the  dressings  were 
changed.  The  abdomen  should  be  swung  as  much  as 
possible  ;  a  thick  roller  should  be  placed  under  the 
chest,  and  the  pillows  should  be  arranged  so  that  the 
patient's  head  should  rest  comfortably,  and  if  necessary 
a  roller  should  also  be  placed  under  the  pelvis.  Many 
patients  would  keep  in  that  position  a  long  time; 
others  soon  complained  of  it.  In  this  latter  case  they 
would  have  to  be  allowed  to  turn  to  the  dorsal  position 
for  a  time,  but  the  prone  position  should  be  at  once 
reverted  to  if  the  symptoms  got  worse.  Washing  out 
the  abdomen  could  well  be  associated  with  the  prone 
position. 

Subcutaneous    Nourishment    in    Peritonitis    and 
Gastric  Operations. 

Hr.  Friedrich,  who  introduced  this  subject,  believed 
that  many  cases  of  intestinal  operations  and  peritonitis 
died  from  inanition.  For  the  avoidance  of  this  the 
surgeon  must  make  use  of  some  of  the  means  of  the 
physician.  The  cases  he  had  in  mind  were  those  in 
which  food  could  not  be  given  either  by  the  mouth, 
the  rectum,  or  by  means  of  fistula*  (gastric  or  intestinal). 
Two  years  ago  he  spoke  on  this  subject,  and  recom- 
mended the  use  of  subcutaneous  injections  of  water. 
But  actual  food,  as  a  matter  of  fact,  could  be  introduced 
in  the  same  way  ;  60  to  70  grammes  of  sugar  could  be 
introduced  into  the  system  daily  by  this  method.  None 
of  it  would  be  found  in  the  urine,  so  it  was  burnt  up. 
Further,  fat  could  be  given  in  the  form  of  olive  oil 
up  to  80  to  100  grammes  daily,  and  the  two  would 
make  up  a  total  of  1,300  calorics.  As  carbohydrates 
alone,  however,  were  not  sufficient  to  maintain  life  he 
had  added  albumen,  a  peptone  free  from  albumose,  and 
a  pepsine-peptone.  Experiments  performed  on  animals 
had  been  successful,  but  not  more  than  20  grammes  of 
pepsine-peptone  could  be  given,  whilst  the  daily  re- 
quirement was  80.  In  very  bad  cases  he  had  fed  patients 
in  this  way  twelve  to  fourteen  days,  and  had  so  carried 
them  over  the  critical  period.  The  part  should  not  be 
massaged  after  an  injection  of  oil.  The  pepsine-peptone 
was  very  soluble  up  to  40  per  cent.,  but  it  was  not 
necessary  to  go  higher  than  8  per  cent.  He  recom- 
mended the  following  solution :  0*2  sod.  chloride, 
3*5  grape  sugar,  67  peptone,  water  to  100. 

Hr.  Kader  observed  that  two  and  a  half  years  ago 
his  assistant,  V.  Magenski,  had  gone  into  the  subject 
of  raising  the  resistant  power  of  the  peritoneum.  He 
had  assumed  the  possibility  of  avoiding  an  operative 
peritonitis  by  injecting  a  serum.  A  serum  was  injected 
into  rabbits,  and  twenty-four  hours  later  they  were 
given  a  virulent  dose  of  streptococcus  culture.  These 
animals  survived,  all  the  control  animals  died.  These 
operations  were  performed  on  the  stomach  and  in- 
testines, the  contents  of  both  being  allowed  to  escape 
into  the  abdominal  cavity  ten  hours  after  injection 
of  the  serum,  and  the  animals  survived.  If  the  serum 
was  injected  less  than  ten  hours  before  the  operation 
some  of  the  animals  died  and  some  recovered.  In 
consequence  of  this  the  serum  had  been  in  regular  use 


June  15,  1904. 


AUSTRIA. 


The  Medical  Puss.    637 


in  the  hospital  for  two  and  a  half  years,  and  especially 
in  commencing  peritonitis.  Thus  a  gangrenous  hernia 
with  peritonitis  already  commencing  was  pulled  through 
"by  injection  of  streptococcus  serum,  and  free  infusion 
•of  bouillon  and  salt.  Probably  the  appearance  of 
^phagocytes,  of  which  there  were  two  kinds,  acted 
beneficially.  The  first  kind  appeared  after  ten  hours 
and  disappeared  a  few  hours  later.  The  other  kind 
appeared  after  twenty-four  hours  and  these  remained 
and  performed  their  functions  up  to  seventy-two  hours. 
Various  serums  from  mixed  streptococci  had  been 
made  use  of  in  general  infection.  The  temperature 
could  be  reduced  with  certainty  by  these  means,  and 
if  the  infection  had  not  reached  too  high  a  pitch,  re- 
covery might  be  brought  about.  Possibly  by  means  of 
a  preliminary  inoculation  individuals  who  were  likely 
to  be  exposed  to  infection,  such  as  soldiers  previous 
to  battle,  might  be  protected  from  subsequent  infection 
of  their  wounds. 


Bustrta- 


[from  our  own  corresponent.] 


Viisna.  June  11th,  1904. 

At  the  Gesellschaft  der  Aerzte,  Lotheissen  ex- 
hibited a  patient  who  suddenly  developed  an  abscess 
in  the  lung,  which  soon  localised  itself,  and  was  opened 
at  the  fifth  rib  in  front,  leaving  a  hole  about  the  size  of 
a  man's  fist  in  connection  with  the  large  bronchus. 

After  washing  and  tamponing  with  iodoform,  the 
lung  healed  rapidly,  contrary  to  expectation,  as  the 
mortality  in  such  cases  was  20  per  cent.  He  thinks 
the  relationship  of  lung  and  pleura  has  a  great  in- 
fluence on  the  recovery  in  such  cases.  The  clinical 
diagnosis  of  one  cavity,  or  many,  must  also  be  a  potent 
factor  in  the  future  of  these  cases  Where  adhesion 
of  the  pleura  with  the  parietes  exists,  simple  opening 
and  evisceration  of  the  morbid  accumulation  is  all  that 
is  necessary. 

Schlesinger  said  these  abscesses  in  the  lung  were  more 
frequent  than  was  generally  acknowledged  in  our  text- 
books. He  questioned  very  much  if  every  one  of  these 
protracted  pneumonic  cases,  particularly  where  the 
fever  lingered  longer  than  usual,  were  not  due  to 
abscess  formation.  Many  of  them  ejected  large 
quantities  of  purulent  matter,  rising  often  to  three- 
quarters  of  a  litre  of  sputum  in  a  day.  In  the  clinical 
diagnosis,  however,  neither  the  fever  nor  the  amount 
of  sputum  can  be  relied  upon  as  pathognomonic  of  an 
abscess,  although  it  goes  a  long  way  to  confirm  sus- 
picion. Vigilance,  repeated  auscultation,  and  per- 
cussion are  indispensable  for  a  correct  diagnosis. 
Penholder     in     the     Sigmoid     Flexure. 

Exner  presented  a  youth,  aet.  19,  from  whom  he 
recovered  a  penholder,  18  centimetres  long,  from 
the  sigmoid  flexure.  The  diagnosis  leading  to  the 
discovery  was  an  attack  of  perityphlitis,  which,  when 
operated  on,  was  found  to  have  originated  from  this 
foreign  body.  He  showed  other  things  that  had  been 
Temoved  from  the  bowel  at  other  times,  such  as  long 
pieces  of  wood,  matches,  Sec. 

Sycosis  Parasitaria. 

Ullmann  recorded  the  history  of  a  patient  with  a 
hard,  infiltrated  swelling  on  the  cheek  and  chin,  which 
apparently  had  been  the  result  of  infection  conveyed 
in  a  barber's  shop.  The  induration  was  immovable 
and  knotty  to  the  touch.  In  the  hair  sheaths  were 
pustular  elements  and  trichophyton. 

Prophylaxis  should  be  rigidly  enforced  in  these 
shops,  and  more  care  taken  by  washing  everything  in 
hot  soda  and  water,  using  paper  serviettes,  and  finally 


giving  the  customer  plenty  of  clean  cold  water  to  wash 
himself.  This  patient  is  treated  with  a  constant  neat 
at  400  C. 

Vitiligo  and  Licren. 

Ehrmann  showed  a  case  of  vitiligo  in  common  with 
lichen  simplex  chronicus.  No  nervous  changes  could 
account  for  the  production  of  either  of  the  diseases,  as 
is  usually  the  case,  but  there  were  extensive  inflam- 
matory disturbances  along  the  course  of  the  vessels, 
evidently  arising  from  visceral  auto-intoxication  in  the 
bowel. 

Carcinoma  and  Strumbctomy. 

Eiselsberg  brought  forward  a  man,  aet.  44,  who  had 
been  operated  on  for  carcinoma  in  the  neck,  which  had 
eaten  into  the  trachea.  After  the  operation,  which 
necessitated  a  resection  of  a  large  piece  of  the  trachea, 
the  wound  could  not  be  induced  to  heal.  An  effort 
was  made  to  draw  the  ends  of  the  trachea  together  with 
stitches,  but  in  vain.  A  hole  that  would  admit  the 
thumb  still  persisted ;  this  was  finally  closed  by  a  flap 
of  periosteum  from  the  sternum. 

Grossmann  thought  this  operation  would  have 
succeeded  at  first  if  the  rings  of  the  trachea  had  been 
entirely  removed,  as  he  had  frequently  done  in  dogs, 
and  never  had  the  slightest  trouble,  as  the  two  ends  of 
the  tube  can  be  brought  accurately  together  and  firmly 
co-apted.  He  had  performed  the  same  operation 
many  times  on  sheep  and  goats  with  perfect  success. 
He  was  not  prepared,  however,  to  be  dogmatic  with 
the  human  operation,  as  this  commonly  set  up  severe 
bronchitis,  associated  with  cough  that  would  inevitably 
tear  the  stitches  and  produce  deliquescence. 
Reflex  Facial  Paralysis. 

At  the  Gesellschaft  fur  innere  Medizin,  Stejskal 
presented  a  patient  with  facial  paralysis,  who  was  ad  • 
mitted  to  hospital  on  November  27th,  1902.  The 
patient  was  a  joiner,  aet.  21,  who  received  a  wound 
from  a  chisel  above  the  left  ear.  There  were  no  sym- 
ptoms of  shock  at  the  time,  but  from  this  onward  the 
hearing  was  very  bad.  In  February,  1903,  the  patient 
became  very  giddy,  and  continued  in  this  state  for  four 
weeks.  In  November  of  the  same  year  this  giddy  con- 
dition was  renewed  with  headache,  and  continued  for 
three  weeks.  On  all  these  occasions  there  was  no 
vomiting.  After  a  short  time  the  patient  felt  well  again, 
and  went  to  his  work  till  February  29th,  when  he  was 
again  suddenly  attacked  during  the  night  with  the 
same  intensified  giddiness  with  severe  pain  in  the  head 
as  before.  On  March  4th,  double  vision  set  in,  and 
on  the  8th,  or  four  days  later,  while  reading  a  letter 
he  discovered  that  he  could  not  move  his  eyes  laterally. 
No  history  of  alcoholism  or  syphilis  could  be  discovered. 

When  he  was  received  into  hospital  he  complained 
of  severe  headache,  giddiness,  and  inability  to  stand  ; 
both  bulbi  stood  prominently  out  without  power  to 
move  them,  and  a  distinct  horizontal  nystagmus.  Con- 
vergence was  slow,  while  external  vision  was  free. 
Pupillary  reaction  was  good,  and  dilation  normal. 
The  following  day  there  was  no  double  vision,  and  no 
lesion  could  be  discovered  by  subsequent  examinations 
in  either  the  cerebral  or  peripheral  nerves.  On 
March  16th  this  disturbed  vision  continued,  although 
the  internal  rectus  was  more  aggravated  than  the 
external,  and  it  was  then  discovered  that  the  reflex 
action  was  abolished.  Now,  it  must  be  remembered 
that  bilateral  paralysis  of  vision  may  be  produced  by 
paralysis  of  both  cortical  centres  for  the  movement  of 
both  eyes,  by  the  supra-nuclear  paralysis  of  both  dorsal 
columns  in  the  pons  varolii,  and  lastly  by  a  direct 
paralysis  of  the  bilateral  centre.  The  etiology  of  the 
present  case  appears  to  be  due  to  encephalitis,  multiple 
sclerosis,  or  possibly  syphilis.     By  exclusive  reasoning 


638    Th*  Medical  Pmss. 


LEADING  ARTICLES. 


June  15,  1904. 


all  these  were  negatived,  and  a  strong  assumption 
entertained  that  a  labyrinth  disturbance  was  the  sole 
cause  of  the  existing  paralysis. 

XCbe  ©perattnu  ttbeatres. 

ST.  THOMAS'S  HOSPITAL. 
Operation  for  Pyo-Nbphrosis  secondary  to 
Renal  Calculus. — Mr.  Battle  operated  on  a  woman, 
aet.  27,  who  had  been  re-admitted  for  pyo-nephrosis  on 
the  right  side.  She  had  previously  been  under  his 
care  in  October,  1903,  and  he  had  operated  and  re- 
moved a  small  oxalate  calculus  from  the  pelvis  of  the 
kidney.  She  then  gave  a  history  of  lumbar  pain, 
without  characteristic  signs  of  renal  colic,  spread  over 
a  period  of  three  years,  and  in  the  summer  of  that  year 
had  been  in  another  London  hospital  for  pyelitis  and 
acute  cystitis.  At  the  time  of  the  operation  in  October, 
the  kidney  could  be  felt  to  be  enlarged  and  was  rather 
tender,  whilst  the  urine  contained  a  large  quantity  of 
pus,  but  was  acid  in  reaction.  At  that  operation, 
although  the  pelvis  of  the  kidney  was  dilated,  it  was 
thought  that  it  might  possibly  recover,  so  nephrectomy 
was  not  performed,  but  the  kidney  was  drained  for  a 
time  through  the  loin  and  the  patient  was  kept  in  for 
five  weeks  after  the  operation.  At  that  time  it  ap- 
peared as  if  the  treatment  was  successful,  for  the 
amount  of  pus  diminished,  and  then  ceased  entirely. 
However,  a  few  weeks  afterwards  pus  was  again  pre- 
sent in  the  urine,  and  she  had  a  certain  amount  of 
aching  pain  in  the  kidney.  She  was  re-admitted  to 
the  hospital,  and  again  improved,  so  that  operation 
was  postponed,  but  after  her  return  home  her  condition 
again  caused  anxiety,  so  she  again  was  re-admitted. 
Nephrectomy  was  done  by  the  lumbar  method,  and 
the  incision  made  along  the  line  of  the  previous  wound. 
When  the  capsule  of  the  kidney  was  reached  it  was 
widely  opened,  and  the  enlarged  kidney  removed  from 
within  it.  There  was  some  escape  of  pus  during  this 
part  of  the  operation  from  tearing  of  the  thin  cortex 
of  the  kidney,  but  the  organ  shelled  out  with  com- 
parative ease  and  was  removed  after  section  of  the 
pedicle  ;  in  this  pedicle  the  ureter  was  not  visible,  and 
the  main  artery  was  comparatively  small.  The  kidney 
when  examined  was,  as  usual,  irregularly  dilated,  and 
the  cortex  irregularly  thinned,  but  nowhere  was  there 
any  evidence  of  renal  calculus.  The  entrance  to  the 
ureter  was  greatly  contracted.  The  nephrectomy  was 
unusual,  insomuch  that  only  one  vessel  required 
1  igature  during  the  whole  operation.  A  drainage-tube 
was  inserted  after  the  wound  had  been  washed  out 
with  saline  solution,  and  the  incision  was  closed  with 
interrupted  sutures  both  superficial  and  deep.  Mr. 
Battle  said  that  the  case  was  a  very  good  example  of 
the  evils  attending  procrastination  in  the  treatment  of 
renal  calculus ;  this  was  probably  owing,  in  the  case 
of  this  patient,  to  the  comparatively  slight  amount  of 
pain  that  the  woman  had  suffered  from,  but  it  was  not 
uncommon  to  find  many  cases  in  which  typical  sym- 
ptoms of  renal  calculus  had  been  endured  repeatedly 
without  a  recommendation  of  operation  having  been 
made.  Had  the  first  operation  been  done  some  months 
earlier,  the  kidney  might  have  been  saved.  He  con- 
sidered that  in  most  of  these  cases  of  renal  calculus  in 
which  pyo-nephrosis  had  been  produced,  the  removal 
of  the  stone  did  not  cure  the  pyo-nephrosis,  and  a  later 
operation  was  required.  The  diagnosis  in  this  instance 
was  between  renal  calculus  and  tubercle,  and  the 
decision  was  given  in  favour  of  calculus  because  the 
pain  appeared  to  have  been  greater  than  is  usually 
the  case  in  tuberculous  disease.  The  patient,  although 
thin,  exhibited  no  signs  of  disease  of  the  lungs  or  of 
tubercle  elsewhere. 


For  a  few  days  after  the  operation  the  patient  had 
bronchitis  with  expectoration  of  thick  yellow  tena- 
cious mucus,  as  seen  in  cases  of  bronchitis  due  to  ether 
inhalation.  Otherwise  she  made  a  rapid  and  unevent- 
ful recovery. 


RlQMTBUD   FOR   TRA2WfIMI0Jf   ABROAD. 

ZCbe  Aetrtcal  press  an&  Circular. 

Pobiiabed  erery  Wednesday  morning,  Prioe  5d.      Poet  free,  6}d. 

AUVJUtTlBKMEMTS. 

0*1    iKtwmoH  :— Whole  Page,   £6    Ok     (ML  ;     Half  Pafe, 
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"  SALUS   POPULI   SUPREMA  LEX." 


WEDNESDAY,  JUNE  15,  1904. 

THE  "  SPONGE  "  CASE  AND  MEDICAL 
RESPONSIBILITY. 

The  recent  decision  awarding  damages  against 
a  lady  doctor  for  inadvertently  leaving  a  sponge 
in  the  abdomen  raises  issues  of  vital  importance 
to  all  members  of  the  medical  profession.  Follow- 
ing closely  a  somewhat  similar  accident  whereby 
a  pair  of  forceps  left  in  the  abdominal  cavity 
proved  fatal,  the  interest  of  the  public  has  naturally 
been  excited  to  a  somewhat  abnormal  degree, 
that  is  to  say,  beyond  the  extent  warranted  by 
the  facts  of  the  case.  Happily,  the  sponge  was 
detected  and  removed  in  time  to  avert  serious 
consequences.  In  spite  of  the  fact  that  the  lady 
doctor  in  question  performed  an  arduous  uterine 
operation  gratuitously,  she  was  nevertheless 
mulcted  in  costs  and  damages  on  the  ground  that 
she  had  not  exercised  reasonable  care.  Hence- 
forth, if  that  verdict  stands,  no  medical  man 
will  be  safe  in  carrying  out  his  daily  work.  At 
every  and  any  moment  he  will  be  liable  to  an 
action  for  damages  on  account  of  this,  that,  or 
the  other  failure  in  the  treatment  of  his  patients, 
be  they  gratuitous  or  otherwise.  Were  members 
of  the  medical  profession  influenced  by  the  rules 
that  guide  the  man  in  the  street  they  would  at 
once  cut  off  all  free  treatment.  It  is  a  little  too 
much  to  expect  a  medical  man  to  give  his  skilled 
services  to  the  poor  without  fee  or  reward  when 
he  knows  that  his  kindness  may  be  at  any  time 
repaid  by  a  costly  and  perhaps  ruinous  law-suit. 
Hitherto  the  legal  attitude  with  regard  to  medical 
malpraxis  has  been  reasonable  and  just,  and  on 
the  whole  has  worked  in  practice  with  satisfactory 
results.  The  law  has  declined  to  punish,  at  the 
request  of  a  patient,  any  medical  man  who  could 
show  that  he  had  exercised  a  reasonable  amount  of 


June  15,  1904. 


LEADING  ARTICLES. 


The  Medical  Passs.     639 


care  and  skill.  In  this  way  he  was  still  liable  at 
law  for  acts  of  gross  negligence  or  for  lack  of 
ordinary  professional  knowledge.  By  the  legal 
decision  as  to  the  sponge  this  wise  attitude  has 
been  upset,  and  the  surgeon  or  the  physician 
may  henceforth  be  held  responsible  for  every 
accident  that  may  occur  in  his  professional 
relationship  to  patients.  The  position  thus  in- 
dicated is  impossible.  It  places  every  medical 
practitioner  at  the  mercy  of  any  litigious  client 
who  imagines  himself  to  have  been  wrongly 
treated.  The  medical  man,  if  we  interpret  the 
situation  correctly,  who  in  all  good  faith  makes  a 
mistaken  diagnosis  will  no  longer  be  shielded  by 
the  law,  for  it  is  clearly  no  less  pardonable  for 
him,  say,  to  take  appendicitis  for  enteric  fever  than 
to  leave  a  sponge  in  an  abdomen.  To  demand 
infallibility  from  a  medical  man  is  to  seek  for  a 
thing  that  can  never  be.  While  human  nature 
is  constituted  on  its  present  lines,  so  long  will 
there  be  an  inseparable  margin  of  error.  That 
fact  has  hitherto  met  with  a  gracious  recognition 
at  the  hands  of  the  law.  If  the  recent  decision 
be  allowed  to  stand  the  results  to  the  public  are 
likely  to  be  somewhat  disastrous.  Medical  men 
will  be  compelled  to  a  great  extent  to  abandon 
their  independent  individual  attitude,  and  will 
become  the  slaves  of  convention.  Should  the 
personal  responsibility  of  the  medical  man  for 
every  trivial  error  be  once  accepted  as  a  legal 
principle,  the  Medical  Defence  Union  and  its 
associate  societies  are  likely  to  need  a  large 
extension  of  income  wherewith  to  carry  on  their 
work.  From  the  sentimental  point  of  view,  the 
action  brought  against  the  lady  doctor  was  stamped 
with  gross  ingratitude  and  with  narrow  and  churl- 
ish intolerance,  but  sentiment  is  no  factor  in  a 
legal  judgment.  In  view  of  the  importance  of 
the  case,  it  is  to  be  hoped  that  an  appeal  will  be 
made  to  the  Higher  Courts  on  the  point  of  law. 
Should  the  Medical  Defence  Union  see  its  way 
to  help  an  appeal  it  would  add  substantially  to 
the  debt  of  gratitude  already  owing  it  by  the 
profession.  The  sympathy  of  all  medical  men 
must  be  with  the  defendant  in  that  action,  who, 
in  fighting  for  her  own  defence,  has  fought  for 
one  of  the  most  wise  and  salutary  legal  principles 
that  have  hitherto  safeguarded  the  complex  and 
the  delicate  relationships  that  must  necessarily 
exist  between  members  of  the  medical  profession 
and  their  clients. 


HOSPITALS  AND  THEIR  SCHOOLS. 
Things  have  changed  much  during  the  past 
fifty  years  in  the  relations  that  once  existed 
between  hospitals  and  the  students  who  were  at 
work  in  them.  In  the  days  of  Abernethy,  Astley 
Cooper,  and  later  of  Brodie  and  Lawrence,  the 
schools  were  like  the  great  school  of  the  Hunters. 
They  were  under  the  personal  control  of  physicians 
and  surgeons,  and  were  independent  of  the 
hospitals.  At  St.  George's  there  were  two  schools, 
the  Lane  and  the  Brodie,  and  that  led  to  the 
former  leaving  Hyde  Park  Corner  and  starting 
the  Hospital  of  St.  Mary's.     The  schools  were  not 


incorporated  with  the  hospitals,  and  the  relations 
between  them  now  are  very  different  from  what 
they  once  were.  How  to  make  a  school  attractive 
to  students  is  a  matter  of  interest  to  many  who 
are  surgeons  or  physicians  to  hospitals  that  have 
schools  attached.  Hospitals,  like  colleges  at  our 
Universities,  vary  much  in  the  number  of  students 
they  may  have ;  and  this  depends  greatly,  if  not 
entirely,  on  the  personal  character  of  those  who* 
are  engaged  in  the  direction  of  the  teaching  of 
students.  One  man  in  a  school  may  make  or 
mar  it.  It  seems  now  as  if  the  Prize  Day  at  our 
hospitals  were  beginning  to  take  precedence  of 
the  Introductory  Lecture,  and  as  if  the  attractions- 
of  a  school  were  going  to  take  a  different  form 
from  the  serious  ceremonial  of  the  gathering  of 
the  old  and  the  novitiates  on  October  1st. 
The  prize-giving  day  is  to  be  the  attraction,  and 
friends  are  to  be  invited,  speeches  to  be  made, 
and  tea  and  coffee  and  refreshments  provided  ; 
a  garden  party,  in  fact,  is  to  take  the  place  of 
the  old  autumnal  gathering  in  the  dreary  lecture 
room.  It  may  be  well  that  this  change  is  coming,, 
and  that  our  young  students  are  introduced  to  the 
profession  in  a  cheerful  and  happy  way.  The 
ceremony  at  St.  Thomas's  ought  to  be  a  success, 
for  the  position  of  the  hospital  lends  itself  well  to 
a  garden  party.  Ladies  are  invited,  and  that  is- 
of  some  weight  where  medical  students  are  con- 
cerned ;  and  to  have  the  prizes  presented  by  a 
Court  physician  is,  of  course,  a  further  assistance. 
To  some  extent,  we  think,  however,  that  the  char- 
acter of  a  school  depends  to-day,  as  it  did  in  the 
time  of  the  Hunters,  on  the  way  in  which  the 
education  of  the  students  is  conducted.  If  the 
teaching  is  poor,  the  student  will  go  elsewhere  ; 
and  there  can  be  little  reasonable  doubt  but  that 
the  teaching  generally  in  our  schools  is  open  to 
improvement.  Why  it  is  so  we  will  not  consider  ; 
but  it  may  be  noticed  that  in  this  country  somehow 
there  is  no  encouragement  given  to  good  education, 
and  our  students  in  many  lines  of  work  have  to 
go  abroad  to  get  what  they  want.  Garden 
parties  may  be  very  well,  but  it  is  rather  sad  to 
see  their  attempted  achievement  by  different 
methods  if  the  question  of  education  and  the  true 
character  of  our  medical  schools  is  regarded 
seriously. 

THE  GENERAL  MEDICAL  COUNCIL. 
The  late  session  of  the  General  Medical  Council 
brings  once  again  into  prominence  the  defects 
and  disabilities  of  the  governing  body  of  the 
profession.  There  are  those  who  maintain  that 
nothing  much  can  be  done  to  reform  the  Council 
till  its  constitution  is  altered  in  such  a  way  as  to 
make  it  fairly  representative  of  the  profession. 
No  one  can  say  that  it  is  representative  at 
present,  and  the  sooner  it  becomes  so  the  sooner 
can  radical  operations  be  put  in  hand  for  setting 
the  administration  of  the  affairs  of  the  profession 
on  a  business-like  and  satisfactory  footing.  How- 
ever, that  day  is  not  yet,  and  the  question  upper- 
most at  the  present  moment  is  whether  the 
Council,  as  it  is,  is  doing  its  work  in  an  independent 


640    The  Mwmcal  P**ss.       NOTES    ON    CURRENT    TOPICS. 


June  15,  1904. 


tind  efficient  manner,  and  if  not,  whether  some 
words  of  advice  cannot  be  given  to  it  by  those 
whose  business  it  transacts.  Now  the  first  source 
of  complaint  against  the  Council  is  that  it  lives 
beyond  its  income.  This  year  it  spent  more  than 
two  thousand  pounds  over  income,  and  there 
-seems  every  prospect  that  it  will  continue  to  do 
-so  unless  it  can  find  some  fresh  source  of  revenue. 
This  it  hopes  to  do  by  charging  a  fee  of  £1  for 
-every  student  registered — a  perfectly  fair  pro- 
posal— but  is  there  any  guarantee  that  it  will 
not  be  found  exceeding  its  revenue  again  in  the 
•course  of  a  few  years'  time  ?  At  the  same  time 
we  think  a  yearly  registration  fee  from  medical 
men  would  prove  a  more  satisfactory  source  of 
income,  provided  they  were  given  in  return 
adequate  representation  on  the  Council,  and 
adequate  protection  of  their  professional  interests. 
What  strikes  one  about  the  proceedings  of  the 
Council  is  that  they  are  becoming  more  and  more 
like  those  of  the  House  of  Commons,  which  is 
another  way  of  saying  less  and  less  business-like. 
A  display  of  energy  on  the  part  of  members  is 
naturally  commendable,  but  if  this  energy  were 
displayed  unostentatiously  in  committee  instead 
of  ostentatiously  in  the  Council  meetings  t  much 
;time  would  be  saved.  At  present  there  is  a 
'growing  tendency  to  debate  at  great  length 
proposals  that  have  a  certain  interest,  direct  or 
indirect,  for  the  profession,  but  as  to  which  all 
members  of  the  Council  have  made  up  their 
Tninds  long  before  they  enter  the  Council  chamber. 
One  cannot  say  that  the  time  is  absolutely  wasted, 
as  the  reports  of  the  debates  convey  to  practitioners 
all  over  the  country  the  various  aspects  of  the 
questions  at  stake,  butf  on  the  other  hand,  it 
cannot  be  maintained  that  the  time  of  the  Council 
is  spent  to  the  best  advantage  in  discussing  them 
:so  fully.  Each  day  means  a  large  expense,  and 
the  coffers  of  the  Council  do  not,  or  should  not, 
.allow  of  luxuries.  Dr.  Payne  is  to  bring  forward 
a  motion  at  the  next  session  to  the  effect  that  it  is 
•desirable  that  a  time-limit  should  be  placed  on 
speeches,  and  it  is  greatly  to  be  hoped  that  it 
will  be  accepted.  If  another  motion  limiting  the 
number  of  speeches  on  any  particular  question 
were  also  passed,  it  would  also  be  a  great  advantage. 
Then,  too,  much  of  the  discussion  is  interrupted 
and  many  of  the  debates  prolonged  by  members 
rising  to  points  of  order,  a  proceeding  which  gives 
everyone  a  chance  of  dilating  at  great  length  on 
side  issues  of  subordinate  importance.  If  the 
Council  consisted  of  wealthy  men  who  worked 
irom  motives  of  public  spirit,  and  whose  time  was 
their  own,  little  objection  could  be  taken  to 
proceedings  of  this  kind,  but,  unfortunately, 
this  is  not  so,  and  it  would  be  a  great  satisfaction 
to  the  profession  to  see  the  debates  easily  and 
rapidly  disposed  of,  and  the  sittings  of  the  Council 
occupying  fewer  days  than  they  do  now.  It  is, 
.and  must  be,  annoying  to  registered  practitioners 
in  general  to  see  the  funds  they  furnish  frittered 
away  in  providing  for  discussions  between  their 
xepresentatives  and  the  representatives  of  rich 
corporations,  who  pay  nothing  towards  the 
Council's  expenses,  on  such  subjects  as  to  whether 


the  antiquated  charters  of  these  corporations  are 
being  encroached  upon.  For  good  or  for  evil, 
the  Council  is  the  supreme  authority  in  matters 
of  medical  education,  and  it  would  be  well  to  see 
it  enforce  its  views  of  what  is  right  without  being 
deterred  by  selfish  objections  from  the  English 
Colleges  of  Physicians  and  Surgeons,  who  fear 
that  their  province  will  be  invaded.  The  Colleges 
have  been  superseded  as  the  chief  authorities  in 
medical  education,  partly  by  the  efflux  of  time, 
and  partly  ^  perhaps^  by  their  own  dilatoriness,  and 
it  causes  them  much  chagrin  to  find  a  superior 
authority  to  whose  wishes  they  must  conform  if 
they  want  their  diploma  to  be  registrable.  But  in 
these  matters  the  Council  is  timid,  and  afraid  of 
asserting  its  own  authority,  with  the  consequence 
that  days  of  valuable  time  are  spent  every  year  in 
trying  to  persuade  the  Royal  Colleges  that  its 
views  are  not  unreasonable  ;  when,  as  a  matter  of 
fact,  it  has  only  to  lay  down  the  law  for  the 
Colleges  to  submit,  or  cease  to  make  their  huge 
annual  profits  out  of  examination  fees.  It  is 
little  enough  that  the  Colleges  do  for  their  licen- 
tiates and  members,  after  they  are  qualified,  and 
the  general  practitioner  may  well  grumble  at 
seeing  his  money  wasted  on  giving  them  the 
opportunity  of  opposing  the  majority  of  the 
Council.  If  reforms  are  to  be  carried  out  in  the 
profession,  it  is  only  through  the  Council  that  they 
can  come,  and  it  is  only  by  the  Council  reforming 
itself  that  it  can  hope  to  start  reforming  the  pro- 
fession. There  are  far  too  many  representatives 
of  educational  corporations  on  the  Council,  and 
far  too  few  of  general  practitioners — a  state  of 
things  that  will  have  to  be  altered  some  day; 
but  in  the  meantime  if  the  Council  were  less 
talkative,  more  business-like,  and  more  sure  of 
itself,  it  would  be  better  able  to  execute  the  wishes 
of  the  profession,  it  would  save  a  good  deal  of 
money,  and  it  would  command  greater  respect. 


notes  on  (torrent  Copies. 

The  Importation  of  Chinese  Labourers. 

It  is  satisfactory  to  note  that  the  strong  oppo- 
sition raised  in  many  quarters  against  the  im- 
portation of  Chinese  labourers  into  the  Transvaal 
has  had  the  effect  of  making  the  Governments 
concerned  alive  to  the  dangers  to  health  involved 
in  the  traffic,  and  that  strict  precautions  and 
regulations  are  being  employed  by  them  to  avoid 
disease  being  taken  to  South  Africa  by  the  coolies. 
The  plan  that  was  recommended  in  these  columns, 
namely,  that  the  labourers  should  be  kept  under 
supervision  in  isolated  quarters  before  shipment, 
has  been  adopted,  and  though  at  present  native 
quarters  are  being  hired  in  Kowloon  for  the  pur- 
pose, a  large  permanent  depot  is  being  built  four 
miles  out  from  the  town.  At  this  depot  the  coolies 
will  be  detained  under  medical  supervision  after 
arrival,  and  before  embarkation,  so  that  the  danger 
of  epidemic  disease  breaking  out  on  the  transports 
will  be  greatly  minimised.  The  length  of  the 
voyage  itself  is  such  that  the  incubation  period  of 
any  of  the  infectious  maladies  will  be  exceeded 
by  it,  and  there  is  therefore  good  reason  to  hope 


June  15.  1904- 


NOTES    ON    CURRENT   TOPICS.       Tb«  Midical  p«.ss.    641 


that  no  person  suffering  from  any  contagious  or 
infectious  disease  will  be  able  to  land  in  Natal. 
Of  course,  in  this  business,  as  in  every  other,  much 
depends  on  the  men  appointed  to  supervise  and 
administer  the  arrangements,  and  it  is  much  to 
be  hoped  that  individuals  are  being  chosen  who 
are  independent  of  the  commercial  side  of  the 
undertaking,  as  it  is  notoriously  difficult  for  officers 
to  work  in  opposition  to  those  who  pay  their 
salaries.  The  disadvantages  at  which  medical 
officers  of  health  in  provincial  districts  are  placed 
when  their  duty  clashes  with  the  interests  of  local 
councillors  is  well  recognised,  and  the  decision  to 
hold  up  a  transport  containing  many  hundreds  of 
coolies  because  of  a  case  of  plague  or  cholera  might 
not  be  very  acceptable  to  the  mine-owners,  who 
would  lose  heavily  by  it.  The  regulations  and 
arrangements  as  projected  seem  to  be  conceived  in 
an  enlightened  and  liberal  spirit  ;  one  can  only 
hope  that  the  principles  governing  the  selection 
of  the  staff,  and  the  positions  accorded  to  the 
medical  officers,  will  be  laid  down  on  similar  lines. 


Intra-epinal  Antisepsis  in  Cerebrospinal 
Meningitis. 

Cerebro-spinal  meningitis  is  a  disease  which 
justifies  heroic  measures.  It  is  hard  to  fix  on  any 
trustworthy  mortality-rate,  for  the  figures  given 
in  different  epidemics  vary  from  25  to  70  per  cent., 
and  in  no  disease  do  we  feel  greater  therapeutic 
poverty.  Impressed  by  this  fact,  Osier  some 
years  ago  practised  laminectomy  with  washing- 
out  of  the  spinal  canal,  but  his  success  was  not 
encouraging.  More  recently,  repeated  lumbar 
puncture  has  been  practised,  and  some  good 
results  were  noted.  A  year  or  more  ago,  however, 
Seager  published  a  method  which  he  practised 
with  considerable  success  in  epidemics  at  Lisbon, 
and  his  results  have  been  confirmed  by  others. 
His  treatment  consisted  in  lumbar  puncture  and 
withdrawal  of  a  considerable  quantity  (up  to 
50  cc.)  of  spinal  fluid,  injection  of  artificial  serum, 
and  lastly  injection  of  from  9  to  12  cc.  of  a  1  per 
cent,  solution  of  lysol.  Comparing  the  cases 
so  treated  with  those  treated  on  ordinary  lines, 
the  recoveries  were  more  numerous,  and  ,  what  is 
of  equal  importance,  were  complete.  Dr.  Manges, 
of  New  York,  has  tested  the  treatment  recently 
in  a  small  number  of  cases,  with  excellent  results, 
and  thinks  very  highly  of  its  future  success, 
while  no  ill-results  have,  at  any  time,  followed 
the  injections.  In  view  of  the  desperate  character 
of  the  disease,  and  the  lack  of  trustworthy  thera- 
peusis  at  present,  a  method  promising  so  well 
deserves  very  thorough  trial. 


Rapid  Detection  of  Ankylostomiasis* 
Mr.  Akers-Douglas  has  shown  himself  a  wise 
and  benevolent  Home  Secretary  in  all  that  per- 
tains to  the  health  and  well-being  of  those  whose 
conditions  of  life  are  supervised  by  his  department. 
The  scare  of  ankylostomiasis  that  threatened  to 
deal  a  grave  blow  to  the  mining  industry  he  has 
done  his  best  to  soothe  by  prompt  investigation 
into  its  cause  and  method  of  prevention.  An 
interesting  report  was  made  to  him  by  Mr.  A.  E. 


Boycott,  M.B.,  on  a  plan  that  was  devised  by 
himself  for  discovering  which  of  the  miners  were 
actually  infected  by  ankylostomiasis,  and  this  has. 
been  recently  published  as  a  Parliamentary  paper. 
The  diagnosis  of  the  condition  is  difficult  in  the 
early  stages,  and  examination  of  the  faeces  is  a 
long,  tedious,  and  not  very  satisfactory  business. 
But   Mr.    Boycott   noticed    that   the   eosinophil  - 
leucocytes  in  the  blood  are  greatly  increased  in 
ankylostoma  infection,  and  he  has  adopted  this  as- 
a  criterion  for  determining  which  are  the  infected 
units   in    a    man.     Mr.    Boycott's   plan    was    to- 
assemble  the  miners  and  to  take  a  drop  of  blood 
from  each  on  a  slide,  stain  the  blood  at  his  leisure, . 
and  notice  if  there  was  any  relative  increase  in 
the  eosinophile  leucocytes.     In  normal  blood  these 
vary  from   a  half   to    4  or  5   per  cent,  of  the 
white  cells,  but  in  ankylostomiasis  this  percentage 
increases.     Anything  over  5  per  cent,  he  regards, 
as  suspicious,  whilst  8  per  cent,  and  upwards  he 
considers    to  establish    infection    to    a    practical 
certainty.     The  report  describes  the  various  steps 
to  be  taken  in  collecting,  preserving,  and  staining 
the  films,   and  in   conducting  the   microscopical 
examination.     Mr.  Boycott  himself  is  able  to  per- 
form these  operations  so  quickly  that  he  regards . 
his  method  as  by  far  the  easiest  and  most  practical 
for  arriving  at  a  diagnosis  when  numbers  of  men 
have  to  be  examined.     It  certainly  deserves  the 
greatest  publicity  in  order  that  the  hands  of  those 
dealing  with  this  plague  in  every  country  may  be 
strengthened. 


Vaccination  Marks. 

It  is  a  pity  that  vaccination  marks  cannot  in 
themselves  convey  definite  information  as  to  their  - 
age,  for  patients'  statements  are  untrustworthy, 
even  when  they  endeavour  to  tell  the  truth  to  the 
best  of  their  recollection.  It  is  often  of  im- 
portance to  make  out  if  an  individual  has  been 
vaccinated  recently,  and  if  the  operation  was  suc- 
cessful. It  often  happens,  however,  that  the  scars 
are  so  much  mixed  up  together,  and  the  patient's . 
memory  is  so  faulty,  that  no  definite  decision 
can  be  arrived  at.  A  sensible  proposal  has  lately 
been  put  forward  that  a  uniform  system  should 
be  adopted  in  the  arrangement  of  the  punctures 
when  the  operation  is  being  performed,  so  that 
each  quinquennial  period  of  life  should  have  its 
scars  disposed  on  a  regular  pattern.  Thus  a 
triangle  with  the  apex  downwards  would  indicate 
that  the  vaccination  had  been  performed  between 
one  and  five  years  of  age  ;  a  triangle,  apex  up- 
wards, between  five  and  ten  years  ;  the  scars . 
arranged  in  a  horizontal  line,  between  ten  and 
fifteen  ;  in  a  vertical  line,  between  fifteen  and 
twenty  ;  and  so  on.  This  plan  has  been  sub- 
mitted to  the  Local  Government  Board,  and  it 
may  be  hoped  that,  as  it  would  add  nothing  to  the 
duties  of  the  public  vaccinators,  and  would  convey 
valuable  information  in  after  years,  it  will  receive 
its  favourable  consideration.  For  such  a  sug- 
gestion to  be  of  value  it  would  have  to  be  univer- 
sally known  and  accepted,  and  if  the  public  vac- 
1  cinators  lead  the  way,  there  would  be  good  reason  ^ 


642     The  Medical  Press. 


NOTES  ON  CURRENT  TOPICS. 


June  15,  1904. 


to  expect  that  the  profession  would  follow.  The 
plan  is  so  simple,  and  yet  so  helpful,  that  it  is  well 
worthy  of  being  brought  to  the  notice  of  all  those 
whom  it  affects,  with  a  view  to  gaining  their  sup- 
port. 

The  Modern  Treatment  of  Paralytic 
Deformities. 

r  Bodily  deformities  resulting  from  disease  of 
the  cerebro-spinal  nervous  system  have  not 
offered  much  encouragement  to  the  surgeon  in 
the  past.  The  limitations  of  surgery  have,  per- 
haps, been  more  obvious  in  this  than  in  almost 
any  other  department  of  practice.  It  is  just  here, 
also,  that  the  surgically  unskilled  mechanic 
of  the  quack  type  has  stepped  in,  and,  in  many  in- 
stances, has  built  up  quite  a  reputation  among 
the  public  for  the  treatment  of  deformities.  In  a 
valuable  paper  upon  the  subject  read  before  the 
West  London  Medico-Chirurgical  Society  on 
June  3rd,  by  Mr.  Jackson  Clarke,  it  was  conclu- 
sively shown  that  the  progress  of  surgery  has  been 
as  marked  in  the  sphere  of  orthopaedics  as  in  most 
other  branches  of  the  art  during  the  last  twenty 
years.  The  results  of  division  of  the  tendo 
Achillis  in  cases  of  infantile  paralysis  have  not, 
certainly,  always  been  productive  of  as  much 
good  as  was  expected,  but  this  is  often  owing  to 
the  fact  that  the  after-treatment  is  neglected. 
Whether  the  surgeon  should  be  called  in  earlier 
than  has  hitherto  been  the  custom  in  infantile 
palsy  is  a  point  to  consider.  Most  clinical  ob- 
servers are  agreed  that  as  long  as  the  tempera- 
ture is  high  nothing  should  be  done  in  a  surgical 
direction.  On  the  other  hand,  timely  bandaging 
or  splinting  of  the  affected  feet  may  do  much  to 
prevent  serious  deformity,  while  this  simple  pro- 
cedure could  not  in  any  way  affect  the  nervous  sys- 
tem injuriously.  The  transplantation  of  tendons 
or  the  introduction,  in  suitable  cases,  of  an  arti- 
ficial tendon,  as  adopted  by  Langer,  is  sometimes 
of  great  value.  In  the  spastic  paralyses  of  child- 
hood, the  so-called  cerebral  palsies,  the  aid  of 
surgery  in  correcting  deformities  of  the  limbs  has 
also  been  invoked  with  signal  benefit.  All  hope 
of  restoring  the  functions  of  a  limb  deformed 
through  paralysis  need  not  now,  happily,  be 
entirely   abandoned. 


The  Treatment  of  Paralysis  Agitans. 

Of  all  hopeless  diseases,  perhaps  there  is  none 
that  taxes  the  physician's  resources  more  severely, 
and  yields  him  less  satisfaction  in  treatment,  than 
paralysis  agitans.  This  is  all  the  more  depressing 
to  him  and  to  the  patient  in  that  the  disease  is 
not  one  that  in  itself  affects  longevity,  and  there 
would  seem  to  be  no  reason  why  useful  and  happy 
life  should  not  be  restored  to  the  patient  if  the 
symptoms  could  be  brought  under  control. 
Hitherto  the  only  drug  that  has  been  found  to 
effect  any  amelioration  of  the  tremor,  namely, 
hyoscin,  has  only  been  capable  of  giving  tem- 
porary relief,  and  it  is  not  without  danger  on 
account  of  its  depressing  action  on  the  circulation. 
Whilst  the  pathology  of  the  affection  is  shrouded  in 


so  much  obscurity,  it  is  impossible  to  devise  a 
mode  of  treatment  that  will  instantly  commend 
itself  to  the  profession,  but  Friedlander,  («)  acting 
on  the  more  modern  view  that  the  lesion  of  the 
disease  is  peripheral  and  not  central,  has  been  at- 
tempting to -relieve  the  muscular  tremor  and  ri- 
gidity by  graduated  exercises  and  passive  move- 
ments. To  obtain  any  result  it  is  necessary  to 
persevere  for  a  long  time,  especially  in  cases  in 
which  the  disease  is  of  long  standing,  but  he  has 
found  immediate  though  fleeting  relief  follow  the 
early  application  of  his  methods.  Starting  with  a 
few  passive  movements  and  light  massage,  he 
continues  to  lengthen  the  sittings  from  week  to 
week  till  some  benefit  is  apparent.  When  this  is 
so,  he  enlists  the  patient's  powers  of  will  and 
finds  that  he  is  gradually  able  to  establish  an 
amount  of  voluntary  control  that  gradually  in- 
creases as  it  is  exercised  more  and  more  fully. 
Faulty  positions  are  corrected  by  holding  the 
limbs  in  their  normal  positions  for  longer  periods 
each  time,  and  when  the  tremor  and  muscular 
rigidity  are  in  abeyance  he  devotes  himself  to  the 
gait  and  practises  the  patient  in  walking  for- 
wards and  backwards.  Friedlander  does  not 
claim  more  for  the  treatment  than  that  the  sym- 
ptoms gradually  improve,  and  that  the  further 
progress  of  the  disease  is  arrested.  If  others  are 
able  to  confirm  his  observations,  it  may  be  that 
some  avenue  of  hope  will  be  opened  up  to  sufferers 
from  this  terrible  malady. 

The  Intercostal  Muscles  in  Thoracic 
Disease. 

The  extension  of  an  inflammatory  process  to 
adjacent  structures  is  a  very  common  patho- 
logical phenomenon.  In  some  cases  the  secon- 
dary effects  so  produced  are  more  conspicuous, 
and  give  rise  to  greater  pain  and  discomfort,  than 
the  primary  trouble  itself,  as,  for  instance,  the 
difficulty  in  micturition  sometimes  seen  in  the 
early  stages  of  appendicitis  from  extension  of  the 
inflammation  to  the  peritoneum.  The  acute  pain 
of  pleurisy  is,  of  course,  due  to  the  irritation  of  the 
pleural  nerves  by  the  inflammatory  exudation,  and 
it  is  naturally  intensified  by  the  pulmonary  move- 
ments. The  question  of  the  involvement  of  the 
intercostal  muscles  in  disease  of  the.  thoracic 
viscera  has,  curiously  enough,  received  but  scant 
attention  on  the  part  of  clinical  observers.  It  is 
quite  reasonable  to  suppose  that  muscles  engaged 
in  constant  work,  especially  when  they  are  con- 
tiguous to  an  inflamed  part,  may  themselves  be 
affected.  Yet  pain  or  tenderness  to  pressure  of 
the  fleshy  chest  wall  is  not  a  prominent  symptom 
in  acute  pleuro-pneumonia.  Dr.  W.  M.  L.  Cop- 
lin,  (6)  Professor  of  Pathology  at  the  Jefferson 
Medical  College,  Philadelphia,  has  examined  the 
intercostal  muscles  in  seven  cases  of  acute  thoracic 
disorders,  including  pneumonia,  pleurisy,  and 
empyema.  The  earliest  sign  of  pathological  in- 
volvement which  could  be  distinguished  under 
the  microscope  was  some  cloudy  swelling  of  the 

«a"»  Zeit.f.diai.mHdpkyt.Thtrmp. 
(b)  Amer.  Journ.  Med.  Sci.t  May,  1904. 


June  i$,  1904* 


NOTES    ON    CURRENT    TOPICS.    The  Medical  Press.    643 


muscular  fibres  accompanied  by  a  poor  staining 
reaction.  These  changes  are  considered  to  be, 
however,  common  to  other  parts  of  the  muscular 
system  as  the  result  of  an  infective  process.  The 
hyaline  degeneration  described  by  Zenker,  and 
well  known  as  occurring  in  the  abdominal  muscles 
in  typhoid  fever,  was  observed  in  some  cases.  In 
the  later  stages,  actual  dissociation  of  muscular 
fibres  with  fragmentation  and  necrosis  was  seen. 
A  chronic  or  sclerosing  myositis  may  ultimately 
become  established.  The  author  is  inclined  to  the 
view  that  the  muscles  became  affected  through 
the  lymphatic  channels,  in  the  same  way  as  the 
diaphragm  is  known  to  suffer. 


Iron  as  a  Drug. 

There  is,  perhaps,  no  drug  in  the  Pharma- 
copoeia which  can  claim  seniority  over  iron. 
As  far  back  as  anything  is  known  of  the  use  of 
drugs,  iron  has  been  employed  for  much  the  same 
purposes  as  at  present.  It  would  seem,  indeed, 
that  the  original  ground  for  administering  iron 
was  the  conception  of  it  as  possessing  strength, 
some  of  which  it  was  able  to  give  up  to  the  weakly. 
It  was  long  after  this  that  iron  was  discovered 
to  be  a  regular  constituent  of  the  tissues,  and  this 
discovery  seemed  to  offer  a  rationale  for  its  use 
which  has  only  been  recently  discredited.  What- 
ever be  its  mode  of  action,  it  is  certainly  not 
employed  in  directly  supplying  the  haemoglobin 
which  is  deficient  in  cases  where  it  is  most  of  use. 
Many  observers  believe  that  the  main  action  of 
iron  in  anaemia  is  by  its  stimulating  effect  on  the 
digestive  and  absorptive  processes  in  the  intestines  t 
while  it  has  recently  been  remarked  that  iron  has 
no  more  effect  than  one  of  the  other  heavy  metals, 
for  instance,  cobalt  or  mercury.  Just  as  in  the 
days  of  Pliny,  iron  is  still  an  empirical,  not  a 
rational  remedy. 


The  Way  to  Prolong  Life. 
The  desire  to  enjoy  long  life  and  to  "  see  many- 
days  "  is  one  of  the  primitive  instincts  of  man. 
It  is  considered  unnatural,  or  possibly  even  mor- 
bid, to  wish  to  "  shuffle  oft  this  mortal  coil  "  be- 
fore one's  allotted  time.  Except  for  the  suffering 
and  afflicted,  life  consists,  in  the  vast  majority  of 
cases,  of  one  incessant  struggle  to  ward  off  the 
approach  of  old  age.  The  state  of  senility,  though 
absolutely  inevitable,  is  still  regarded  by  those 
who  lead  a  butterfly  existence  as  the  one  thing 
above  all  others  against  which  to  fight.  Could 
some  rejuvenating  essence  be  found — and  this  has 
long  been  the  dream  of  philosophers  in  every  age — 
which  would  postpone  the  fearful  event,  its  dis- 
coverer would  become  rich  beyond  all  imagination, 
Science  has  something  to  say,  however,  with  re- 
gard to  the  means  of  prolonging  life,  for  while 
she  does  not  look  upon  old  age  as  a  disease,  she 
holds  out  some  prospect  of  staving  off  its  onset 
if  her  dicta  arc  obeyed.  Premature  senility  is 
a  natural  consequence  of  living  at  high  pressure, 
which,  in  modern  times,  many  are  compelled  to  do. 
The  plea  for  a  simpler  mode  of  living  has  many 
times  been  put  forward  by  social  and  medical  re- 


formers, but  the  rules  which  these  enthusiasts 
have  laid  down  for  the  guidance  of  their  would-be 
followers  have  generally  been  quite  impracticable 
and  ill-suited  to  the  physical  and  mental  require- 
ments of  their  contemporaries.  A  wider  know- 
ledge among  all  classes  of  society  of  the  principles 
of  hygiene,  rudimentary  and  insufficient  as  they 
are,  has  not  been  without  a  favourable  reaction 
upon  the  mean  duration  of  human  life.  The  in- 
fluence of  diet,  occupation  and  worry  upon  the 
span  of  human  existence  was  not  long  ago  pointed 
out  by  Sir  Hermann  Weber  in  a  lecture  before  the 
Royal  College  of  Physicians.  Professor  Metch- 
nikoff  has  recently  thrown  out  the  idea  that, 
after  all,  the  whole  process  of  senility  may  be 
microbic  in  origin,  the  large  intestine  being  the 
chief  stronghold  of  these  organisms.  The  com- 
parative longevity  of  birds  is  instanced  as  being 
possibly  due  to  the  fact  that  this  portion  of  the 
alimentary  canal  in  them  is  either  absent  or  func- 
tionless. 


Sewage  in  Drink. 

Some  months  ago  considerable  sensation  was 
caused  by  a  medical  paper  publishing  an  article 
with  the  title  "  Pus  as  a  Beverage,"  commenting 
on  an  outbreak  of  sore  throat  due  to  suppurative 
mammitis  in  cows.  A  workhouse  master  in 
Ireland,  however,  seems  to  have  some  original 
tastes  in  the  matter  of  drinks,  if  we  are  to  judge 
by  his  recent  exploits.  It  appears  that  the  Naas 
guardians  are  in  the  habit  of  buying  spirits  for 
use  in  the  house  considerably  over  proof,  so  that 
it  is  necessary  for  an  Inland  Revenue  officer  to 
attend  periodically  to  perform  the  necessary 
dilutions.  After  his  last  visit  it  was  discovered 
that  the  water  used  for  the  purpose  had  been 
taken  from  a  stream  flowing  through  the  grounds, 
into  which  the  baths  and  lavatories  of  the  in- 
stitution discharge.  On  examination  of  the  diluted 
whisky  it  was  found  to  contain  about  1  per  cent, 
of  chlorine,  and  to  be  swarming  with  bacteria. 
The  master  of  the  workhouse  is  reported  to  have 
stated  that  he  thought  the  stream  the  proper  water 
to  use,  and  that  he  did  not  know  that  sewage 
discharged  into  it,  although  one  of  the  guardians 
stated  that  it  was  a  common  sewer.  It  would  be 
interesting  to  learn  what  is  the  ordinary  water 
supply  of  the  institution. 

The  Drug  Treatment  of  Trypanosomiasis. 

Seeing  that  it  is  such  a  short  time  since  try- 
panosomes  were  first  discovered  as  human  para- 
sites, it  is  natural  enough  that  but  little  attention 
has  been  paid  to  the  therapeutics  .of  trypanoso- 
miasis. Bearing  in  mind,  however,  'the  great 
probability  that  trypanosomes  are  of  importance 
in  African  sleeping  sickness,  it  is  right  some  re- 
searches should  be  made  on  the  subject.  The 
example  of  quinine  in  malaria  is  so  encouraging 
that  inquiries  have,  naturally  enough,  been  made 
along  similar  lines.  Thus  Laveran  and  Mesnil 
reported  success  in  the  treatment  with  sodium 
arseniate  of  mice  suffering  from  nagana,  but  the 
effect   was   only   temporary.     Ehrlich,    however, 


644    The  Medical  Piess.    NOTES    ON    CURRENT    TOPICS, 


Juice  15,  1904. 


seems  to  have  hit  on  a  more  promising  remedy. 
Using  a  dye  of  the  benzo-purpurin  series,  to  which 
he  has  given  the  name  "  trypan-red,"  he  has  been 
able  to  protect  mice  against  infection  with  blood 
containing  the  trypanosomes  of  the  South  Ameri- 
can horse-sickness  known  as  tnal  de  coder  as. 
The  good  results  occurred  whether  the  dye  were 
injected  or  administered  by  the  mouth.  Outside 
the  body  the  trypan-red  had  no  effect  on  the  para- 
sites, so  that  Ehrlich  explains  its  action  as  due 
to  its  exciting  the  production  of  antiparasitic 
bodies.  If  this  is  so,  the  bodies  soon  disappear, 
for  the  good  result  only  lasts  while  the  dye  is 
circulating  in  the  body. 

Protozoa  and  Disease. 

Although  the  connection  of  certain  protozoa 
with  particular  diseases  has  now  been  known 
for  a  considerable  time,  there  has  not  been  at  all 
the  same  progress  in  protozoan  as  there  has 
been  in  bacterial  pathology.  The  cause  of  this  is 
obvious  enough,  since  for  many  reasons  the  study 
of  protozoa  is  by  no  means  so  easy  as  that  of 
bacteria.  The  impossibility  of  growing  them  on 
culture  media  makes  Koch's  requirements  of  proof 
of  causation  impracticable,  while  their  delicate 
structure  and  variability  towards  stains  make 
their  manipulation  difficult.  More  important 
than  any  of  these  points,  however,  is  the  multi- 
plicity of  forms  adopted  by  one  organism 
in  its  life-cycle,  rendering  it  impossible  in  the 
early  stages  of  inquiry  to  discover  whether  one 
individual  or  several  be  under  observation.  And, 
again,  it  is  probable  that  the  protozoa  are  much 
more  limited  in  the  variety  of  their  hosts  than 
are  bacteria.  At  the  present  time,  however, 
and  particularly  in  America,  there  appears  to  be  a 
tendency  to  introduce  protozoal  causation  for 
those  diseases  where  bacterial  inquiry  has  proved 
negative.  The  conclusions  of  Councilman  in 
regard  to  small-pox  seem  to  have  received  a  fuller 
acceptance  there  than  in  Europe,  and  his  supposed 
success  has  acted  as  a  stimulus  to  research  on 
similar  lines  in  other  diseases.  For  instance, 
Mallory  has  described  certain  structures  found  in 
the  skin  in  scarlet  fever,  which  he  believes  to  be 
protozoa,  and  of  causal  importance.  Similarly, 
Wilson  and  Chowning  maintain  that  they  have 
discovered  a  protozoon  which  is  the  specific  para- 
site of  spotted  fever,  and  the  protozoal  theory  of 
cancer  seems  to  hold  the  field.  A  real  advance, 
indeed,  in  the  methods  of  the  study  of  disease  is 
the  success  of  Novy  and  McNeal  in  cultivating  the 
trypanosome. 

The  Tragedy  of  Child-Workers. 

The  conditions  of  child-labour  in  our  crowded 
cities,  and  the  influence  which  such  work  must  have 
upon  the  physique  of  the  coming  generation,  has 
more  than  once  been  alluded  to  in  the  columns  of 
The  Medical  Press  and  Circular.  We  revert 
to  it  again  not  because  we  wish  to  work  upon 
anybody's  feelings,  nor  is  it  our  intention  in  the 
least  to  exaggerate  facts,  but  it  will  be  acknow- 
ledged   that    an  acquaintance    of    more    than  a 


passing  character  with  the  real  tragedies  and  hard- 
ships  of   the   children   from   among  the   poorer 
classes  of  society  is  one  of  the  best  ways  of  be- 
coming   familiar    with    those    present-day    ten- 
dencies which  make  for  the  deterioration  of  the 
national  physique.     The  recent  disclosures  at  a 
Battersea  inquest  upon  the  death  of  a  little  girl 
of  nine  from  burns,  inflicted  while  she  was  working 
about  the  house  for  her  mother,  who  was  lying 
in  bed  recovering  from  a  bout  of  alcoholism,  reveal 
a  state  of  things  which  is,  unfortunately,  only 
too    prevalent.     Habits    of    laziness    and    self- 
indulgence  on  the  part  of  parents,  brought    on 
in  the  first  place  from  physical  incapacity  caused 
by  drink,  are  apt  to  become  chronic,  leading  to  a 
gradual  shifting  of    household  work,  with  some 
of  its  responsibilities  in  addition,  on  to  the  shoulders 
of  their  helpless  offspring.     Children  of  tender  age 
are  set  to  "  mind  "  others  but  little  younger  than 
themselves,  while  those  who  are  somewhat  older 
are  put  to  some  arduous,  fatiguing  task,  such  as- 
selling  papers  or  going  round  with  milk,  and  this, 
in    addition    to    ordinary    school    work.     Stage- 
children   are,    perhaps,    more   jealously  -guarded, 
but  only  because  the   public   eye  is  upon  thenu 
In  a  similar  way  restrictions  are  rightly  placed  upon 
the  hours  of  duty  and  nature  of  the  work  performed 
by  children  in  factories,  an  age-limit  being  also* 
prescribed.     But  it  is  far  more  difficult  to  put 
any  check  upon  the  improper  bringing-up  of  the 
young,  or  upon  their  employment  for  unsuitable 
or  laborious  domestic  work.      This  can  be  accom- 
plished  only   by    a   wider   dissemination    of   the 
knowledge  of  hygiene. 


The  Monotony  of  Convalescence. 

The  period  of  recovery  after  a  long  illness 
often  proves  more  irksome  to  the  patient  himself 
than  the  original  disease,  while  it  often  causes 
no  small  anxiety  to  the  medical  attendant.  It 
is  difficult  for  the  convalescent  to  realise  that  he 
has  been  far  removed  from  a  condition  of  health 
and  it  is  hard  for  him,  especially  when  young, 
to  understand  why  he  should  be  deprived  of  this, 
that,  or  the  other  thing  to  which  he  was  accus- 
tomed before  his  illness.  And  yet  the  proper 
management  of  the  convalescent  state  is  of 
supreme  importance  if  a  sound  recovery  is  to  be 
made.  Ignorance  of  the  dangers  that  may  be 
incurred  during  this  period  by  want  of  caution 
in  such  matters  as  diet  and  exercise  is  the  chief 
cause  of  trouble.  The  ill-timed  gift  of  a  bun  to  a 
convalescent  typhoid  fever  patient  has  proved 
fatal  before  now.  It  is  true  that  only  those  who- 
have  had  enteric  fever  know  fully  \yhat  is  meant 
by  the  necessary  semi-starvation  for  some  time 
after  the  temperature  has  become  normal,  and 
they  alone  can  truly  sympathise  with  the  agonising 
craving  for  solid  food  which  is  experienced  by 
those  who  are  recovering  from  this  disease.  There 
are  always  restrictions  during  convalescence,  and, 
in  the  patient's  own  interests,  it  is  right  that  there 
should  be,  but  the  degree  in  which  they  are  felt 
depends     largely     upon     the    individual's    owm 


JUNB   IS.    19Q4. 


PERSONAL. 


The  Medical  Press.    645 


particular  temperament.  Thus,  the  literary  man 
complains  most  of  the  curtailment  of  his  time 
for  reading  and  of  the  paucity  of  his  books  and 
papers,  while  the  music-lover  bewails  his  inability 
to  handle  the  keys  of  his  much-loved  instrument. 
The  clockwork  appearance  of  meals,  however 
delicately  prepared,  the  sounds  in  the  house  or 
the  hospital  ward,  even  the  doctor's  visit,  be  he 
never  so  cheerful,  are  events  repeated  with  almost 
mathematical  periodicity,  and  tend  unavoidably 
to  the  monotony  which  to  some  natures  is  quite 
unendurable.  Mr.  George  Back,  in  a  recent 
lecture  upon  the  subject,  has  suggested  that, 
in  suitable  cases,  the  narrating  or  reading  of 
interesting  stories  to  the  convalescent  would 
greatly  assist  in  relieving  this  monotony,  by 
diverting  the  patient's  thoughts  into  different 
channels.  The  style  of  the  narrative  would  have, 
of  course,  to  be  adjusted  with  some  discrimination 
to  his  mental  habit  and  tastes. 


The  Position  of  the  Medical  Man  in 
Criminal  Cases- 

The  interests  of  the  medical  practitioner 
demand  constant  and  vigilant  protection.  They 
are  often  assailed,  for  instance,  in  courts  of  law, 
where  it  might  be  expected  that  persons  not 
present  would  be  safe  from  innuendo.  Experience 
-shows,  however,  that  the  reputation  of  many  a 
medical  man  is  seriously  damaged  by  cowardly 
and  irresponsible  statements  made  in  coroners' 
or  in  criminal  courts.  Under  these  circumstances, 
it  is  with  pleasure  that  we  draw  the  attention  of 
our  readers  to  a  short  paper  on  the  subject  from 
a  Chesterfield  medical  man,  Mr.  W.  Duncan,  M.B., 
which  we  publish  elsewhere  in  our  columns, 
page  629.  The  subject  is  well  worthy  the  attention 
of  all  bodies  engaged  in  the  maintenance  or  defence 
of  the  dignity  and  the  material  interests  of  the 
profession. 

PERSONAL. 

His  Majesty  the  King  has  graciously  consented  to 
lay  the  foundation-stone  of  the  new  buildings  of  St. 
Bartholomew's  Hospital  during  the  course  of  next 
month. 


On  June  8th,  the  Prince  and  Princess  of  Wales, 
Grand  President  and  Lady  Grand  President  of  the 
League  of  Mercy,  gave  a  garden  party  at  Marlborough 
House  to  which  a  large  number  of  the  presidents,  vice- 
presidents,  and  members  of  the  League  of  Mercy  were 
invited. 


The  Cavendish  Lecture  of  the  West  London  Medico- 
Chirurgical  Society  will  be  delivered  by  Professor  von 
Mikulicz,  of  Breslau,  on  Friday,  June  24th,  at  8.30  p.m., 
in  the  Town  Hall,  Hammersmith,  on  "  The  Immu- 
nisation of  Operation  Wounds." 


At  the  annual  meeting  of  the  Incorporated  Medical 
Practitioners'  Association,  Mr.  Robert  Ambrose, 
Member  of  Parliament  for  the  Western  Division  of 
County  Mayo,  was  elected  President  for  the  ensuing 
year. 


At  a  meeting  of  the  Senate  of  the  University  of 
London  on  June  8th,  Dr.  Philip  Henry  Pye-Smith, 
F.R.S.,  was  re-elected  Vice-Chancellor  for  the  year 
1904-05. 


Dr.  W.  T.  Connell,  of  Kingston,  has  been  appointed 
Assistant  Bacteriologist  for  Ontario. 

Lieut. -Colonel  Macpherson,  R.A.M.C,  the  Medi- 
cal Attache  appointed  by  the  English  War  Office,  is  at 
Tokyo. 


Dr.  Joseph  Frank  Payne  has  been  re-elected  a 
Representative  of  the  University  of  Oxford  upon 
the  General  Medical  Council.  Sir  Arthur  V.  Macan 
has  been  appointed  an  Examiner  in  Midwifery,  Dr. 
William  Williams  an  Examiner  in  Preventive  Medi- 
cine, and  Dr.  Marcus  Seymour  Pembrey  in  Physi- 
ology  in  the  first  B.M.  examination  pre  hoc  vice. 

Sir  George  Newnes  formally  opened  the  new  water 
supply  for  Lynton  and  Lynmouth  on  May  28th.  The 
water  is  brought  from  West  Lyn.  about  one  and  a  half 
miles  from  Lynton.  The  polarite  system  of  nitration 
is  used.  The  cost  of  the  undertaking  has  been  about 
£2.500. 


Dr.  W.  I.  de  C.  Wheeler  has  been  elected  a  Visiting 
Surgeon  to  Mercer's  Charitable  Hospital. 


Dr.  Trevor  N.  Smith,  late  Assistant-Master  of  the 
Coombe  Hospital,  has  been  selected  by  the  committee 
appointed  to  recommend  a  Secretary  to  the  Conjoint 
Board  of  Management  of  the  Royal  Colleges  of  Phy- 
sicians and  Surgeons  of  Ireland,  in  succession  to  Mr. 
Greenwood  Pirn,  who  has  been  compelled  to  retire 
owing  to  ill-health. 


Mr.  W.  McAdam  Eccles,  M.S.Lond.,  F.R.C.S.Eng., 
has  been  appointed  Examiner  in  Anatomy  for  the 
Fellowship  of  the  Royal  College  of  Surgeons  of  England. 

Mr.  F.  J.  Donnan,  Ph.D.,  M.A.,  who  was  recently 
appointed  to  the  Chair  of  Physical  Chemistry  at  the 
University  of  Liverpool,  lately  founded  by  Sir  John 
Brunner,  Bart.,  is  a  graduate  of  the  Royal  University 
of  Ireland  and  was  trained  in  the  laboratories  of  Leipsic 
and  Berlin.  He  was  afterwards  associated  with  Sir 
William  Ramsay,  of  University  College,  London,  and 
is  now  Lecturer  at  the  Royal  College  of  Science,  Dublin. 


During  the  recent  stay  of  the  Lord  Lieutenant  of 
Ireland  in  Belfast  he  visited,  on  June  3rd,  the  Royal 
Victoria  Hospital,  where  the  following  members  of 
the  medical  staff  were  presented  to  him  :  Mr.  J.  W. 
Browne,  Sir  W.  Whitla,  Professor  J.  W.  Byers,  Dr. 
H.  L.  McKisack,  Dr.  W.  Calwell.  Mr.  A.  Fullerton.  and 
Dr.  W.  Rankin.  His  Excellency  also  visited  the  Mater 
Innrmorum  Hospital,  where  Dr.  A.  Dempsey,  Dr. 
P.  O'Connell.  Dr.  J.  B.  Moore,  Dr.  J.  W.  Killen.  Dr. 
W.  J.  Maguire,  Mr.  P.  J.  H.  MulhoUand,  and  Mr.  W. 
McLorinan,  members  of  the  visiting  medical  staff,  were 
presented  to  him.  In  both  institutions  he  made  a 
careful  inspection  and  expressed  himself  as  much 
pleased  with  all  that  he  saw. 

Dr.  Clifford  Allbutt,  Regius  Professor  of  Physic, 
University  of  Cambridge,  will  present  the  prizes  at  the 
London  (Royal  Free  Hospital)  School  of  Medicine  for 
Women  on  Thursday,  the  23rd  inst.,  at  4  p.m. 

His  Grace  the  Duke  of  Argyll.  P.C.,  K.T., 
G.C.M.G..  G.C.V.O.,  will  preside  at  the  festival  dinner 
of  the  Royal  Waterloo  Hospital  for  Children  and 
Women,  to  be  held  on  the  Monday  after  Ascot  (June 
20th)  at  8  p.m.,  in  the  new  rooms  at  the  Savoy  Hotel. 


Dr.  Sherrington,  Professor  of  Physiology  in  the 
University  of  Liverpool,  has  been  elected  a  Member  of 
the  Imperial  Academy  of  Medicine,  Vienna. 

Mr.  Mayo  Robson  will  be  a  guest  of  the  Canadian 
Association  as  well  as  Mr.  J.  W.  Mayo,  of  Rochester 
(Minn.),  and  probably  Professor  Marmorek,  who  is  to 
be  in  Montreal  during  the  summer. 


646     Tbx  Medical  Press. 


CORRESPONDENCE. 


June  15,  1904. 


The  Duchess  of  Sutherland,  who  presided  last  week 
at  the  conference  organised  by  the  Invalid  Children's 
Aid  Association,  read  an  interesting  paper  on  "  The 
Work  of  the  Potteries'  Cripples  Guild." 


We  regret  to  learn  that  Sir  Henry  Burdett  has  met 
with  a  serious  carriage  accident  in  the  country.  His 
horse  took  fright  at  a  motor-car  and  overturned  the 
carriage,  and  in  the  upset  he  sustained  several  fractures 
about  the  shoulder.  His  progress  has  been  most 
satisfactory. 


Mr.  James  C.  Mc Walter,  M.A.,  M.D.,  D.P.H., 
of  Dublin,  has  been  appointed  delegate  to  the  Folke- 
stone Congress  of  the  Royal  Institute  of  Public  Health 
by  the  Faculty  of  Physicians  and  Surgeons,  Glasgow. 


Special  Correspondence* 

[from  our  own  correspondents.] 


SCOTLAND. 


International  Home  Relief  Conference  (Assist- 
ance Familiale). — Thanks  in  no  small  degree  to  the 
efforts  of  Sir  John  Sibbald,  M.D.,  F.R.C.P.,  the  fourth 
annual  congress  of  workers  to  discuss  methods  "  by 
which  "  (in  the  words  of  the  President,  Lord  Balfour 
of  Burleigh)  •'  help  can  best  be  given  to  our  weaker 
and  less  fortunate  brethren,  without  relegating  them 
to  special  institutions  where  recipients  of  relief  are 
congregated  together,"  held  its  sittings  in  Edinburgh 
during  the  past  week.  The  idea  of  the  Congress  was 
originated  by  Dr.  Marie,  Villejuif  Asylum,  Paris,  who 
was  present  at  the  Edinburgh  meeting,  along  with 
many  other  English  and  foreign  delegates.  The  work 
of  the  Congress  was  conducted  in  general  and  sectional 
meetings.  Of  the  former,  there  were  three — an  address 
by  the  President,  on  June  7th  ;  a  discussion  on  labour 
colonies  and  farm  colonies  v.  workhouses,  on  the  8th  ; 
and  a  discussion  on  the  home  care  of  mentally  defective 
and  backward  children  on  the  10th.  Section  I  dealt 
with  children,  II  with  old  age,  III  with  iable-bodied 
adults,  IV  with  sick  adults,  V  with  insane  and  epi- 
leptics, the  subjects  discussed  being  the  feeding  of 
infants  and  school  children,  the  prevention  of  cruelty 
to  children,  boarding-out  of  pauper  children,  the 
organisation  of  home  relief  for  cripples,  old-age  pensions, 
Danish  and  German  systems  of  relieving  the  aged, 
Scottish  experience  of  boarding-out  paupers,  hereditary 
paupers,  crime  and  criminals,  model  lodging-houses, 
inebriate  retreats,  attendance  on  parturient  women  in 
large  towns,  home  treatment  of  phthisis,  relation  be- 
tween hospital  relief  and  the  sick  poor,  home  care  of 
the  insane,  after  care  of  asylum  patients,  and  epileptic 
colonies.  The  conference  was  in  every  way  a  great 
success,  and  we  hope  in  a  future  issue  to  give  a  synopsis 
of  some  of  the  questions  of  more  specially  medical 
interest  under  discussion  by  the  members. 

Royal  Edinburgh  Hospital  for  Incurables.— 
By  receiving  a  bequest  of  £20,000  for  that  object,  the 
managers  of  the  Longmore  Hospital  now  are  in  a 
position  to  proceed  with  the  erection  of  a  hospital  for 
incurable  cases  of  phthisis.  The  building,  which  will 
accommodate  about  thirty-four  patients,  is  now  in 
process  of  erection  in  Liberton.  a  suburb  of  Edinburgh. 

University  News. — Sir  John  Jackson,  LL.D.,  has 
generously  endowed  the  Physical  Laboratory  of  the 
University  of  Edinburgh  with  an  income  of  £250  per 
annum,  to  be  applied  to  promoting  practical  physical 
research.  The  donation  is  to  be  a  permanent  memorial 
of  the  late  Professor  Tait. — In  reply  to  the  petition  of 
the  medical  women  of  Glasgow  and  the  students  of 
Queen  Margaret  College  to  open  all  University  classes  to 
women,  the  Senate  of  the  Glasgow  University  state  that 
while  the  present  was  an  unfavourable  time  for  any 
general  pronouncement  on  mixed  classes,  the  question 
might  be  considered  in  any  department  in  which  a 
change  might  be  specially  desired  on  present  arrange- 
ments. 


BELFAST. 

Medical  Witnesses  in  Courts  of  Law. — At  a 
meeting  of  the  Belfast  Division  of  the  British  Medical 
Association,  recently  held,  an  interesting  discussion 
took  place  on  the  question  of  the  desirability  or  other- 
wise of  medical  witnesses  meeting  in  consultation.  All 
the  speakers  were  agreed  that  the  present  plan,  where 
medical  men  so  constantly  express  diametrically  opposed 
views,  even  on  matters  of  fact,  is  little  less  than  a 
scandal,  but  much  difference  of  opinion  arose  as  to  how- 
it  could  be  avoided.  Dr.  Dempsey  said  that  in  his 
experience  talking  over  a  case  might  only  lead  to  your 
opponent  making  use  of  all  your  points  to  the  advantage 
of  his  side.  While  Sir  Wm.  Whitla,  Dr.  Morrow,  Dr. 
Coates,  and  others  supported  the  scheme  for  con- 
sultations between  the  witnesses,  Professor  Byers 
and  Dr.  Cecil  Shaw  seemed  to  think  that  the  present 
difficulty  would  be  better  met  by  some  scheme  that 
would  allow  the  presiding  judge  to  call  in  an  independent 
medical  assessor  in  cases  where  the  medical  witnesses 
showed  marked  differences  of  opinion. 

Gift  to  the  Royal  Victoria  Hospital  from  an 
Old  Student. — Dr.  Lowry,  of  the  Chinese  Customs 
Service,  has  sent  a  beautifully  embroidered  Chinese 
silk  banner  to  the  Royal  Free  Victoria  Hospital,  Bel- 
fast, with  the  request  that  it  may  be  hung  in  one  of 
the  wards  of  Mr.  J.  Walton  Browne,  whose  resident 
pupil  he  was  when  a  student  at  the  old  Belfast  Royal 
Hospital. 

Small-pox  in  co.  Derry. — As  noted  in  this  column, 
small-pox  was  introduced  into  the  Limavady  district 
about  a  month  ago  by  some  persons  from  Glasgow. 
Notwithstanding  the  most  vigorous  efforts  of  the  local 
authorities  to  stamp  out  the  infection,  cases  are  on 
the  increase,  four  fresh  ones  having  been  discovered  in 
the  last  few  days.  It  is  believed  that  the  people  try 
to  hide  the  cases,  and  the  fact  that  they  have  been  in 
contact  with  them,  and  Dr.  Watson  has  appealed  to 
clergymen,  guardians,  and  others  to  use  their  influence 
in  overcoming  the  "  obstinate  stupidity  "  of  the  people 
in  hiding  the  disease  and  refusing  to  be  vaccinated. 

The  Belfast  Guardians  and  Medical  Fees. — Dr. 
Donnan,  of  Holy  wood,  has  had  the  great  satisfaction 
of  making  the  Belfast  guardians  climb  down  in  a  matter 
of  medical  fees.  In  a  doubtful  case  of  small-pox  he 
called  in  Dr.  Robb,  who  is  in  charge  of  the  small-pox 
hospital,  and  claimed  a  fee  of  two  guineas  for  him. 
The  guardians  not  only  refused  the  fee,  but  their 
chairman  used  most  insulting  language  concerning  the 
medical  profession  generally,  accusing  the  members  of 
that  profession  in  Belfast  of  spending  their  time  drinking 
in  the  Medical  Institute,  and  not  even  having  the 
common  decency  to  apologise  when  told  that  no  in- 
toxicants were  allowed  in  the  institute.  The  Local 
Government  Board  has  now  informed  the  guardians 
that  Dr.  Donnan  was  right  in  claiming  the  fee  for  Dr. 
Robb,  and  the  former  gentleman  has  written  to  the 
local  press  asking  for  the  same  publicity  for  this  fact 
as  was  given. to  the  uncalled-for  remarks  of  the  chair- 
man of  the  guardians  when  the  matter  was  first  dis- 
cussed. 


Correspondence. 

[We  do  not  hold  ourselves  responsible  for  the  opinions  of  our  Cor- 
respondent*]. 


AMENDMENT  OF  MEDICAL  LAW. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — In  an  editorial  note  in  your  issue  of  May  25th 
you  express  the  hope  that  it  may  be  possible  before 
long  to  bring  about  such  an  alteration  in  the  law  as 
shall  effectually  put  a  stop  to  the  practice  of  medicine 
by  unqualified  or  fraudulent  pretenders,  and  the  draft 
of  a  Medical  Act  Amendment  Bill  by  which  it  is  hoped 
this  desired  consummation  may  be  achieved  is  pub- 
lished in  the  British  Medical  Journal  of  May  28  th.  If 
this  project  of  law  be  accepted  and  taken  up  by  the 
Government  it  may  perhaps  be  discussed  in  Parlia- 
ment ;  but  that  it  should  in  its  present  form  under 
present  circumstances  find  a  place  on  the  Statute-book 


June  15,  1904. 


CORRESPONDENCE. 


The  Medical  Press.    647 


is  unbelievable  by  anyone  who  has  closely  watched 
the  progress  of  medical  legislation  during  the  pas.t 
thirty  years.  Proposed  legislation  of  the  kind  is  at 
present  looked  upon  as  a  trades'  union  move  for  selfish 
ends  by  the  doctors.  It  will  be  necessary  to  bring  the 
real  facts  home  to  the  minds  of  our  legislators  before 
the  smallest  chance  for  the  acceptance  of  a  drastic 
scheme  of  medical  law  can  be  created.  This  might 
be  done  through  the  medium  of  a  Royal  Commission 
empowered  to  inquire  into  the  whole  subject  of  un- 
qualified practice  and  quackery,  including  the  manu- 
facture and  sale  of  quack  medicines.  The  Commission 
ought  to  have  power  to  call  witnesses  and  examine 
them  on  oath.  Such  an  inquiry  would  prove  and 
make  plain  that  legislation  directed  against  fraudulent 
quackery,  although  it  might  do  something  to  the 
advantage  of  the  profession,  would  do  a  thousand  times 
more  for  the  stupid,  ignorant,  or  too  confiding  masses 
whose  sufferings  and  weaknesses  now  render  them  an 
easy  prey  to  cynical  knavery.  It  could  be  easily  proved 
that  quackery  forms  a  potent  factor  in  deterioration 
of  the  public  health,  and  thus,  from  the  sordid  point  of 
view,  is  ultimately  a  source  of  profit  rather  than  loss 
to  the  legitimate  practitioner.  There  exist  vast  classes 
of  invalids  with  ailments  entirely  manufactured  or 
aggravated,  and  rendered  chronic  by  quackery.  Of 
these  the  great  majority  gravitate  in  the  end  into  the 
hands  of  qualified  men,  and  thus  money  which  would 
not  otherwise  be  earned  is  put  into  the  pockets  of 
the  profession.  If  the  unselfishness  of  the  profession 
in  seeking  to  put  an  end  to  the  more  glaring  of  the 
abuses  which  at  present  exist  cannot  be  proved,  it 
can  at  any  rate  be  demonstrated  that  stringent  laws 
would  act  if  not  alone  at  least  in  the  main  for  the 
benefit  of  the  weak,  afflicted,  and  helpless  classes  who 
have  most  claim  upon  the  guardianship  of  the  State. 
Everyone  who  knows  anything  about  the  history  of 
medical  legislation  must  recognise  that  without  the 
education  in  the  question  which  members  of  Parlia- 
ment almost  entirely  lack,  no  House  of  Commons  will 
listen  with  patience  to  a  Medical  Act  Amendment  Bill, 
and  I  venture  to  prophesy  that  if  the  Bill  of  the  British 
Medical  Association  be  presented  without  the  prelimi- 
nary action  which  I  suggest,  it  will  not  have  the  smallest 
chance  of  favourable  consideration,  albeit  backed  as  it 
may  be  by  the  united  voice  of  20,000  practitioners. 
I  am,  Sir,  yours  truly, 

Henry  Sewill. 
Cavendish  Square,  June  5th,  1904. 

A    COMMON-SENSE    VIEW   OF   CONSUMPTION. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — You  will  probably  have  made  a  note  in  your 
mind  on  the  reference  to  Consumption  in  Southey's 
"  Life  of  Nelson." 

"  The  Boreas  arrived  in  England  in  June.  Nelson, 
who  had  many  times  been  supposed  to  be  consumptive 
when  in  the  West  Indies,  and  perhaps  was  saved  from 
consumption  by  that  climate,  was  still  in  a  precarious 
state  of  health  ;  and  the  raw  wet  weather  of  one  of  our 
ungenial  summers  brought  on  cold  and  sore  throat,  and 
fever  ;  yet  his  vessel  was  kept  at  the  Nore,  &c,  &c." 

Those  who  take  a  common-sense  view  of  consump- 
tion will  not  agree  with  the  microbial  theory  as  some 
put  that  forward.  They  will  not  admit  that  consump- 
tion belongs  to  the  same  class  of  diseases  as  typhoid, 
small-pox,  scarlatina,  and  such  like.  Climate  has  to  be 
considered,  and  hereditary  tendencies  quite  as  much  as 
a  specific  microbe. 

Those  who  expect  to  cure  consumption  by  discovery 
of  a  bacillus  must  be  prepared  for  disappointment. 
Some  good,  of  course,  may  come  out  of  that  kind  of 
work,  but  not  in  the  way  expected.  We  do  not  hear 
much  now  of  the  Berlin  craze  and  the  anti-tuberculin 
treatment.  It  is  the  open-air  treatment  that  is  now  in 
the  ascendant,  and  that  will  probably  come  down. 

There  is  no  doubt,  however,  that  one  of  the  ques- 
tions of  interest  at  the  present  time  is  the  careful  study 
of  climates  in  their  relation  to  health ;  and  one  of  the 
advantages  that  the  Imperial  Federation  system  offers  I 
is  the  possibility  it  affords  many  of  our  younger  and  i 


more  delicate  progeny  to  escape  from  "  the  raw  wet 
weather  of  one  of  our  ungenial  summers,"  and  we  might 
add  the  unwholesome  atmosphere  of  our  great  cities, 
and  go  and  live  in  a  colony  where  health  and  safety  are 
provided  by  the  natural  conditions  of  atmosphere  and 
soil  that  are  offered  to  them. 

am,  Sir,  yours  truly, 

R.  L. 


THE  POSITION  OF  THE  MEDICAL  ATTENDANT 

IN  CRIMINAL  CASES,  (a) 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — I  am  desired  by  the  Council  of  the  Midland 
Medical  Union  to  submit  to  you  for  publication  : — 

1.  A  note  on  the  above  matter  prepared  by  W. 
Duncan,  Esq.,  M.B.,  of  Clay  Cross,  near  Chesterfield. 

2.  Copy  of  resolution  passed  by  the  Chesterfield  and 
Mansfield  branches  of  the  Midland  Medical  Union  : 
"  That  a  statement  setting  out  the  unsatisfactory 
position  of  the  medical  attendant  in  criminal  cases  be 
submitted  to  the  British  Medical  Association  and  the 
General  Medical  Council,  together  with  a  suggestion 
that  a  memorial  be  presented  to  the  Home  Secretary  ; 
that  Crown  Consultants  be  appointed  and  paid  by 
the  Home  Office,  the  duty  of  such  Crown  Con- 
sultants being  to  undertake  the  responsibility  of 
examining  in  cases  of  suspicion  and  of  reporting  to 
the  police  authorities." 

3.  Copy  of  resolution  passed  by  the  Nottingham 
Branch:  "That  (1)  the  Nottingham  Branch  of  the 
Midland  Medical  Union  is  'of  opinion  that  the  note 
prepared  by  Dr.  W.  Duncan  is  worthy  of  consideration, 
but  the  branch  does  not  definitely  adopt  his  particular 
suggestion.  (2)  The  branch  is  further  of  opinion  that 
the  whole  question  of  the  relation  of  medical  men  to 
criminal  cases  needs  investigation  and  is  specially  drawn 
to  the  conclusion  by  observation  of  the  alarming  increase 
of  the  practice  of  using  preparations  of  lead,  such  as 
diachylon,  for  the  purpose  of  procuring  abortion." 

I  am,  Sir,  yours  truly, 

George  S.  O'Rorke,  LL.D., 
Secretary. 
(Countersigned)  Geo.  Booth,  M.D., 
President  of  the  Midland  Medical  Union. 
June  8th,  1904. 

WHAT  IS  BRANDY  AND  WHAT  IS  WHISKY  ? 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — It  seems  a  great  pity  that  the  recent  decision 
of  a  London  magistrate  in  the  case  commented  upon 
in  your  excellent  leader  of  June  8th  was  not  taken  to 
the  High  Court.  The  judgment,  being  elaborate  and 
well  reasoned,  may,  perhaps,  be  taken  as  a  guide  by 
other  magistrates  in  similar  cases  ;  but  until  argued 
and  decided  before  the  judges  of  the  King's  Bench  will 
have  no  binding  effect.  To  obtain  a  final  decision  of 
such  a  kind  ought  surely  to  be  worth  the  while  of  those 
manufacturers  and  dealers  who  make  and  purvey  real 
brandy  only ;  and  it  ought  not  to  be  beyond  their 
powers  to  achieve  such  a  consummation.  If  it  is 
settled  that  the  vending  of  concocted  mixtures  as 
brandy  is  illegal,  it  may  even  be  possible  to  obtain  a 
similar  judgment  with  regard  to  other  spirits,  and 
especially  Irish  and  Scotch  whisky.  There  can  be 
no  doubt  that  the  great  bulk  of  spirits  disposed  of  by 
the  small  retailer  is  of  only  one  origin.  It  is  all  manu- 
factured from  silent  spirit  of  the  cheapest  and  crudest 
kind,  and  made  into  brandy  and  whisky,  &c,  by  the 
addition  of  colouring  and  flavouring  matters.  Such 
spirit  is,  of  course,  mostly  unsophisticated  poison.  It 
helps  towards  the  more  quick  ruin  of  the  minds  and 
bodies  of  the  poorer  classes  of  drunkards,  who  mainly 
consume  liquor  of  this  quality,  and  does  more  harm 
than  good  to  the  invalids  of  the  same  classes  to  whom 
small  doses  of  spirit  of  good  quality  may  sometimes 
be  needed  as  a  most  important  item  in  medical  treat- 
ment. Manufacturers  of  genuine  spirits  are  under 
obligations  to  The  Medical  Press  and  Circular  for 
its  frequent  articles,  analyses,  and  reports  on  alcoholic 

(a)  Dr.  Duncan's  note  will  be  found  on  page  629  of  our  present 
issue. 


648     Ths  Medical  Pkbss. 


CORRESPONDENCE. 


June  15,  1904, 


beverages.  These  have  helped,  no  doubt,  to  educate 
the  public,  including  our  magistrates,  in  the  subject 
and  its  bearing  upon  the  public  health.  The  article 
of  June  8th,  which  calls  forth  this  letter,  adds  to  the 
obligation. 

I  am,  Sir,  yours  truly, 
June  9th,  1904.  S.  H. 


THE  LUNACY  LAWS  AND  PROFESSIONAL 

RESPONSIBILITY. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — It  might  be  well  to  consider  whether  prac- 
titioners should  not  be  required  to  notify  cases  of 
mental  derangement  when  they  come  under  their 
notice.  It  would  simplify  matters  much  if  this  were 
done.  At  present  we  cannot  expect  a  practitioner  to  do 
anything,  especially  if  he  is  likely  to  provoke  ill-feeling 
on  the  part  of  a  patient  or  the  friends,  and  injure  him- 
self by  taking  action.  If  legally  compelled  to  notify, 
as  in  cases  of  infectious  disease,  he  would  not  incur 
injury  to  himself  by  doing  so. 

I  am,  Sir,  yours  truly, 

R.  L. 


"  PALMAM  QUI  MERUIT  FERAT." 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — By  "  Listerism  "  I  did  not  mean  the  earlier  ex- 
perimental methods  which  Lord  Lister  invented,  based 
upon  the  fundamental  discoveries  of  Pasteur.  I  meant 
the  system  of  practical  surgery  which  has  been  evolved 
from  these  basic  discoveries  and  tentative  experiments, 
a  system  which  gives  to  the  surgeon  almost  infallible 
means  of  preventing  the  septic  phenomena  which 
previously  were  not  in  the  least  understood  and  were 
therefore  beyond  the  control  of  surgical  art.  This 
system  owes  its  origin  and  evolution  entirely  to  the 
teaching  of  Lord  Lister,  and  therefore  may  rightly  be 
styled  "  Listerism."  If  there  are  any  number  of  practical 
surgeons  who  agree  with  Dr.  Bantock,  they  must  form 
a  very  small  minority.  The  majority,  if  they  do  not 
now  talk  so  much  of  "  Listerism,"  acknowledge  that  the 
term  aseptic  does  not  properly  apply,  and  ought  not  to 
be  used  as  opposed  to  antiseptic.  Every  surgeon, 
except,  perhaps,  Dr.  Bantock  and  his  followers,  uses 
antiseptics.  All  surgeons  use  them  to  purify  their 
own  hands,  the  patient's  skin,  and  the  instruments ; 
they  apply  dressings  to  prevent  septic  germs  from 
entering  the  wound  ;  they  all  practise  strict  anti- 
.  septicism   as   regards   materials   used   in   ligation   of 


Dr.  Bantock  thinks  "  no  one  has  ever  seen  a  germ, 
and  if  he  does  believe  in  germs  has  no  means  of  proving 
their  presence  or  absence  in  the  course  of  an  operation." 
He  thinks  it  matters  much  that  in  quoting  nim  I  left 
out  the  italicised  words.  I  do  not  stop  to  question  the 
statement  that  bacteriological  examination  of  the 
secretions  on  the  surface  of  an  operation  wound  would 
not  reveal  the  presence  of  germs  did  these  exist ;  it  is 
enough  that  we  know  that  septic  changes  cannot  begin 
in  the  wound  unless  septic  infection  by  germs  from 
without  takes  place.  The  surgeon  does  not  search  the 
wound  for  germs  ;  he  adopts  measures  to  prevent  their 
entry  or  activity.  He  knows  that  without  such 
measures  septic  changes  will  probably  ensue. 

Dr.  Bantock  writes  as  though  all  surgery  consisted 
of  operations  in  which  the  parts  are  naturally  aseptic. 
He  leaves  out  such  cases  as  injuries  like  compound 
fractures,  where  tissues  are  crushed  or  bruised  or  de- 
prived of  blood  through  laceration  of  vessels  and  would 
be  certain  to  become  gangrenous  and  putrid,  malig- 
nantly septic,  without  the  treatment  based  on  the 
principles  evolved  from  Lord  Lister's  generalisations. 
He  leaves  out  also  cases  of  foul  abscess,  once  hardly 
amenable  to  treatment,  which  are  nowadays  in  so  many 
instances  perfectly  under  the  control  of  surgery. 

Dr.  Bantock  says  he  achieved  his  results  by  "  clean- 
liness," before  Lister  and  after ;  and  with  greater 
success  than  Lister's  followers.  Has  he  ever  told  the 
world  what  exactly  he  means  by  "  cleanliness,"  and 
how  it  differs  from  antisepticism  and  asepticism  ?  Has 
he  ever  explained  whether  he  invented  his  methods  as 


the  result  of  experiments  the  rationale  of  which  he  was 
ignorant  of,  or  whether  he  discovered  fundamental 
principles  upon  which  he  based  his  procedures  ?  Has 
he  ever  explained  these  principles,  and  does  he  deny 
the  truth  of  Pasteur's  discoveries  as  to  the  causation 
of  fermentation  and  putrefaction  by  the  action  of 
germs  floating  in  the  atmosphere  ?  If  he  cannot 
demonstrate  the  falsity  of  Pasteur's  discoveries,  he 
cannot  dispute  the  essential  facts  upon  which  what  I 
will  still  call ' '  Listerism ' ' — present  day  surgical  methods 
— is  based  ;  nor  can  he  diminish  the  honours  which 
the  world  confers  upon  Lord  Lister  for  what  it 
recognises  as  his  enormous  services  to  mankind.  It 
seems  a  pity  that  instead  of  attempting  to  disparage 
Lord  Lister  and  to  ask  for  himself  honours  which  the 
scientific  world  has  not  thought  of  bestowing  upon  him. 
Dr.  Bantock  has  not  been  content  with  the  distinction 
as  an  uncommonly  successful  operator  in  a  special  de- 
partment, to  which  the  profession  has  all  along  suffi- 
ciently recognised  his  claim. 

I  am,  Sir,  yours  truly. 

June  3rd,  1904.  Ignoramus. 

P.S.— The  British  Medical  Journal  of  June  4th 
contains  a  paper  by  Dr.  Ballantyne  on  "  Asepsis  in 
Obstetric  Practice."  I  commend  this  to  the  attention 
of  Dr.  Bantock.  If  he  would  publish  in  your  columns 
a  critical  examination  of  that  paper  it  would,  I  am 
sure,  prove  intensely  interesting  ;  and  if  he  does  so, 
I  trust  he  will  not  overlook  the  final  paragraph.  The 
vast  majority  of  obstetric  authorities  agree  with  the 
principles  and  practices  adopted  by  Dr.  Ballantyne. 
It  would  evidently  be  a  kindness  to  them  if  Dr.  Ban- 
tock would  make  clear  what  a  terrible  waste  of  force 
their  procedures  involve. 


THE    CENTRAL    MIDWIVES'    BOARD. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — The  members  of  the  medical  profession  are 
much  indebted  to  Professor  Sinclair  for  his  letter  in 
your  issue  of  June  8th  on  the  proceedings  and  conduct 
of  business  of  the  Central  Midwives*  Board,  and  no  time 
is  to  be  lost  before  entering  our  protest  against  this 
method  of  interpreting  an  Act  of  Parliament  which 
was  intended  to  improve  the  education  and  to  provide 
suitable  medical  supervision  of  midwives. 

It  was  hoped,  and  confidently  expected,  that  the 
Central  Midwives'  Board  would  so  frame  their  regula- 
tions as  to  admit  only  the  more  intelligent  of  the  class 
of  women  who  seek  a  midwifery  training,  and  that  the 
instruction  and  training  required  should  tend  to  an  in- 
crease of  efficiency,  and  thus  be  of  material  value  to 
the  poor  women  whom  they  would  be  called  upon  to 
attend. 

Apparently  the  policy  is  the  reverse  of  this,  and  we 
are  to  add  on  registration  to  inefficiency,  unless  the 
policy  is  altered. 

It  is  hardly  necessary  to  encroach  upon  your  space 
by  discussing  the  absurdity  of  the  latest  propositions 
as  to  the  appointment  of  midwives  as  inspectors  of 
training  institutions  and  as  examiners,  but  it  is  of 
such  gravity  as  to  at  once  call  for  a  protest  from  those 
of  us  who  are  interested  in  carrying  out  the  Act  for 
the  improvement  in  training  and  consequent  benefit 
to  the  poor. 

I  am,  Sir,  yours  truly. 

J.     E.    Gemmell. 
Hon.  Med.  Officer,  Ladies'  Charity  and  Lying- 
in  Hospital,  Liverpool. 

12  Rodney  Street,  Liverpool, 
June  8th,  1904. 

HUMOUR  IN  PRACTICE. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — The  routine  life  of  a  general  practitioner 
is  so  often  sad,  melancholy,  and  depressing  that  one 
may  be  pardoned  for  extracting  what  little  humour 
is  capable  of  being  got  out  of  it.  In  offering  these  few 
gems  I  hope  I  am  not  transgressing  any  ethical  rules. 
For  some  years  I  have  been  in  the  habit  of  jot  ting  down 
curious  and  interesting  statements  of  patients  which, 
although  new  to  me,  may  no  doubt  be  ancient  chestnuts 


JUNE    15,    I904. 


MEDICAL   NEWS. 


The  Medical  Pexss.    649 


to  many  of  your  readers.  I  do  not  record  such  common- 
places as  the  person  who  is  caustic  or  has  an  ulster, 
as  these  are  so  common,  but  I  have  not  seen  any  of  the 
following  mentioned.  An  old  lady,  now  dead,  in- 
variably informed  me  on  each  visit  that  "she  was  very 
prostituted  to-day."  A  young  woman  gravely  informed 
me  that  she  was  supposed  to  have  an  anthem  in  her 
head,  and  that  she  had  been  sent  by  one  dentist  to 
another  well-known  dental  surgeon,  to  see  whether  he 
could  find  it.  But  he  failed  to  do  so.  A  young  woman 
consulted  me  recently  saying  she  wanted  something 
to  open  her  corsets,  and  on  inquiring  how  long  they 
were  closed,  she  said  three  weeks.  Mist,  ferri  lax. 
did  the  trick.  An  old  gentleman  who  was  paralysed 
suffered  from  insomania.  I  regret  to  say  he  now  sleeps 
peacefully. 

An  old  lady  informed  me  that  all  her  brutal  husband 
supplied  her  with  and  all  she  had  during  the  Christmas 
festivities  was  one  skipper.  This,  I  regret  to  say, 
proved  too  indigestible,  as  she  has  since  died — but  not 
from  the  skipper. 

A  woman  informed  me  (and  this  is  a  grave  accusa- 
tion against  the  hospital)  that  she  had  been  attended 
by  a  hospital  doctor  in  her  last  confinement,  and  that 
he  gave  her  a  "  juice  "  and  she  caught  cold  through  it. 
A  fond  mother  recently  informed  me  that  the  teacher 
said  her  little  boy  was  a  perfect  Jesus  at  drawing.  I 
have  many  more  notes,  but  your  space  is  limited. 
I  am,  Sir,  your  truly, 

James  Hamilton,  M.D.,  Q.U.I. 

60  Sydney  Street,  Chelsea,  S.W.,  June  8th,  1904. 


Brighton  Throat  and  Ear  Hospital,  and  he  took  great 
interest  in  this  institution. 

LOUIS  LEOPOLD  JENNER. 
We  regret  to  announce  that  the  death  has  occurred  of 
Dr.  Louis  Leopold  Jenner,  of  the  Lister  Institute  of  Pre- 
ventive Medicine.  Dr.  Jenner  was  the  fourth  son  of 
the  late  Sir  William  Jenner.  He  was  thirty-eight 
years  of  age.  He  was  educated  at  St.  Thomas's,  and 
took  theM.B.,  B.Ch.Oxon.,in  1894;  and  the  M.R.C.P. 
Lond.  in  1859. 


©Mtuaq?* 

SIR  DAVID  PALMER  ROSS,  C.M.G.,  M.D.ED., 
F.R.C.S.ED.,  BRITISH  GUIANA. 
The  death  is  announced  of  Sir  David  Palmer  Ross, 
Surgeon-General  of  British  Guiana,  which  occurred  at 
Georgetown  after  a  long  illness.  Sir  David  entered 
the  Colonial  Civil  Service  thirty-eight  years  ago  as  a 
medical  officer  in  Jamaica,  and  after  reaching  the 
position  of  Senior  Medical  Officer  in  that  colony  became 
Colonial  Surgeon  of  Sierra  Leone  in  1885.  He  was 
promoted  to  the  office  of  Surgeon-General  of  British 
Guiana  in  1894,  and  was  to  have  retired  on  a  pension  in 
August  next.  He  took  his  qualification  of  M.R.C.S. 
Eng.  in  1864,  F.R.C.S.  in  1875,  and  M.D.  of  Edin- 
burgh University  in  1863. 

SURGEON-GENERAL  THOM,  I.M.S. 
The  death  occurred  somewhat  suddenly  at  Jersey, 
on  the  10th  instant,  of  Surgeon-General  William 
Thorn,  I.M.S.,  in  the  85th  year.  The  deceased  officer 
had  resided  on  the  island  for  many  years.  Deceased, 
who  leaves  no  family,  retired  in  1877. 
ROBERT  EDWARD  OWEN,  M.R.C.S.ENG.,  L.S.A., 
OF  ANGLESEY. 
The  death  took  place  at  Beaumaris,  on  June  2nd, 
of  Mr.  R.  E.  Owen,  a  member  of  an  old  and  well-known 
Anglesey  family,  and  one  of  the  oldest  medical  prac- 
titioners in  the  county.  He  was  until  recently  and  for 
a  long  period  a  medical  officer  to  the  Bangor  and 
Beaumaris  Union,  the  training  ship  Clio  and  Trinity 
House,  and  had  held  the  appointment  of  analyst  for  the 
county,  besides  many  other  offices.  He  was  at  one 
time  hon.  secretary  to  the  Anglesey  Hunt.  Mr.  Owen 
was  sixty-one  years  of  age,  and  had  been  failing  in 
health  for  several  years.  The  funeral  took  place  at 
Beaumaris  on  June  4th.  Mr.  Owen  was  a  student 
at  Guy's  and  at  Queen's  College,  Birmingham,  and 
took  the  diploma  of  the  English  College  of  Surgeons  in 
1864. 

JOHN  MILTON  SCATLIFF,  M.D. 
We  regret  to  announce  the  death  of  Dr.  J.  M.  E. 
Scatliff,  of  Brighton,  whose  death  occurred  at  Sher- 
manbury,  near  Henfield,  last  week.  The  deceased 
gentleman  was  fifty-four  years  of  age  and  had  been  in 
practice  in  Brighton  for  thirty  years,  where  he  had  an 
extensive  circle  of  friends.  Deceased  was  educated 
at  St.  George's  and  Aberdeen,  and  took  the  degree  of 
M.D.  in   1876.     He  was  one  of  the  founders  of  the 


fl&e&fcal  news. 


The  Fifteenth  International  Congress  of  Medicine. 
At  a  recent  meeting  of  the  National  Committee  for 
Great  Britain  and  Ireland,  Dr.  Pavy,  F.R.S.,  in  the 
chair,  Sir  William  Church,  Bart.,  Sir  Dyce  Duckworth, 
Mr.  Reginald  Harrison,  and  others  present,  it .  was 
resolved  "  that  in  view  of  the  confusion  and  disorder 
attending  the  last  assemblage  of  the  Congress — attri- 
butable, it  is  considered,  to  the  deviation  from  former 
procedure  in  admitting  as  members  of  the  Congress 
others  than  members  of  the  medical  profession  and 
savants — this  Committee  deems  it  important,  in  order 
to  avert  threatened  disastrous  consequences,  to  call 
the  attention  of  those  entrusted  with  the  organisation 
ot  the  forthcoming  Congress  at  Lisbon  to  the  matter, 
and  to  urge  that  no  departure  from  the  rule  relating 
to  membership  in  force  at  the  Paris  Congress  in  1900 
should  be  permitted  to  occur."  This  resolution  was 
forwarded  to  the  President  and  Secretary-General  of 
the  fifteenth  Congress,  which  will  be  held  at  Lisbon  in 
April,  1906.  The  rules  governing  the  Congress  have 
just  been  issued,  and  it  is  satisfactory  to  find  that  the 
rule  as  it  stood  at  the  time  of  the  Paris  Congress  has 
been  restored.  The  recommendations  of  the  sub- 
committee as  to  the  future  constitution  of  the  National 
Committee  were  approved,  and  it  was  decided  that  in 
future  the  Committee  should  consist  of  a  President  and 
two  secretaries,  who  should  invite  the  co-operation  of 
(a)  His  Majesty's  chief  medical  advisers  in  the  Navy, 
the  Army,  the  Indian  Army,  Lunacy,  and  Local 
Government  Boards,  (b)  The  President  for  the  time 
being  of  each  medical  corporation  in  the  United  King- 
(  dom.  (c)  The  President  of  the  General  Medical  Council. 
(d)  A  professor  of  the  Faculty  of  Medicine  from  each 
University,  (e)  The  President  for  the  time  being  of 
the  Royal  Medical  and  Chirurgical  Society  of  London, 
of  the  Royal  Academy  of  Medicine  in  Ireland,  and  of  the 
Medico-Chirurgical  Society  of  Edinburgh.  (/)  The 
President  for  the  time  being  of  the  Incorporated  Society 
of  Medical  Officers  of  Health,  (g)  A  representative  of 
the  National  Medical  Press  Association,  (h)  Eight 
persons  practising  medicine  and  surgery  in  England, 
including  Wales  ;  four  general  practitioners  practising 
in  Scotland,  and  four  general  practitioners  from  Ire- 
land, (i)  Such  other  persons  as  it  may  be  found  de- 
sirable from  time  to  time  to  invite  to  the  National 
Committee.  Dr.  Pavy  was  asked  to  continue  in  the 
j  office  of  President,  and  Mr.  D'Arcy  Power  as  secretary. 
J  Dr.  Horton-Smith  regretted  that  he  was  unable  to  act 
;  as  secretary  to  the  Committee.  His  resignation  was 
j  accepted  with  regret,  and  a  cordial  vote  of  thanks  was 
tendered  to  him  for  his  services.  Dr.  Clive  Riviere  was 
nominated  in  his  place.  It  was  proposed  by  Dr. 
Sutherland  that  "in  order  to  allay  the  feelings  of 
irritation  and  disappointment  rankling  in  the  minds  of 
those  who  attended  the  Madrid  Congress,  and  to  re- 
assure these  and  others  who  may  contemplate  attending 
the  Lisbon  Congress,  the  honorary  secretaries  be  in- 
structed to  send  a  note  to  the  medical  journals  to  the 
effect  that  the  British  National  Committee  intend  to 
take  steps  by  which  they  hope  to  prevent  or  reduce  to 
a  minimum  at  the  Lisbon  meeting  the  annoyance,  dis- 
comfort, and  disappointment  experienced  in  Madrid 
in  regard  to  travelling  facilities,  lodging  accommoda- 
tion, &c,  and  to  attain  this  end  it  is  desirable  to  have 
a  local  British  Committee  at  Lisbon  to  keep  in  touch 
with  the  executive  of   the  Lisbon   Congress."      The 


650   The  Medical  Press. 


MEDICAL  NEWS. 


proceedings  terminated  with  a  vote  of  thanks   to   the 
Medical  Society  for  its  kindness  in  putting  the  Society's 
rooms  at  the  disposal  of  the  National  Committee. 
Asylum  Workers'  Association. 
The  annual  report  for  1903  shows  a  diminution  in  the 
number  of  ordinary  members  but  an  increase  in  sub- 
scriptions.    Fluctuations   of   this    sort    must   be   ex- 
pected until  better  inducements  are  offered,  as  regards 
permanence  of  service,  to  asylum  staffs.      Provisions 
for  securing  adequate  pensions  will  be  urged  by  the 
Association     upon     Parliamentary     candidates.      To 
encourage   long   and   meritorious   nursing   service   in 
asylums  two  gold  and  two  silver  medals  are  awarded 
annually    by  the    Association.     The    proposed    State 
registration   of   nurses   has   been   considered   by    the 
executive   committee,  and   the  claims   of  both   male 
and  female  mental  nurses  to  consideration  have  been 
successfully  urged  upon  the  promoters  of  each  of  the 
Bills  now  before  the  Commons.     The  financial  state- 
ment for  1903  showed  that  the  total  receipts,  with  last 
year's  balance,  amounted  to  £472  10s.  76..,  and  that  the 
payments   amounted    to   £385    15s.   4d.     Twenty-one 
nurses  and  attendants  received  grants  from  the  "  Home 
of  Rest  "  Fund.     By  this  fund  members  are  enabled 
to  stay  at  health  resorts  in  any  part  of  the  kingdom. 
The  Reading  Union  promotes  the  study  of  standard 
liiterature  amongst  asylum  workers.     Mr.  Rider  Hag- 
gard has  given  a  special  prize  in  this  connection.     The 
services  of  the  retiring  president  for  the  past  seven  years. 
Sir  James  Crichton-Browne,  are  gratefully  referred  to, 
and  Sir  John  Batty  Tuke  has  been  chosen  as  his  suc- 
cessor. 

Cardiff  Infirmary. 

The  Committee  of  the  Cardiff  Infirmary  Sunday 
Fund  announces  that  as  a  result  of  the  collections  on 
41  Infirmary  Sunday  "  (April  24th)  the  sum  of  £590  has 
been  handed  to  the  institution.  The  committee, 
however,  will  keep  the  fund  open  until  December  31st, 
so  that  any  congregation  which  had  not  been  able  to 
arrange  for  a  collection  on  April  24th  may  have  an 
opportunity  of  doing  so. 

Ambidextral  Culture  Society. 
At  the  meeting  of  this  society  held  on  June  1st,  Miss 
Werner,  of  King's  College,  delivered  a  lecture  on 
"  Ambidexterity  among  the  Zulus  and  other  African 
Tribes."  She  said  that  unfortunately  she  had  very 
little  direct  evidence  on  the  subject.  In  general,  so 
far  as  her  information  went,  the  right  hand  was  the 
one  used  by  preference  for  actions  which  required  one 
hand  only  or  chiefly.  There  were,  however,  indications 
that  the  proportion  of  left-handed  or  ambidextrous 
persons  was  larger  in  Central  Africa  than  in  Europe, 
but  sufficient  facts  were  not  at  hand  to  say  precisely 
what  that  proportion  was.  The  linguistic  evidence, 
drawn  from  the  expressions  used  in  various  Bantu 
languages  for  the  right  and  left  hand  respectively,  went 
indirectly  to  show  that  a  preference  was  on  the  whole 
given  to  the  right  hand,  which  was  known  as  the 
41  eating "  or  the  "  throwing,"  sometimes  as  the 
44  great  "  or  the  "  male,"  hand.  The  left  was  some- 
times called  the  "  female  "  hand,  but  in  some  languages 
it  was  denoted  by  a  word  of  which  it  was  not  easy  to 
discover  the  meaning,  and  which  might  not  denote 
inferiority.  It  was  worth  noting  that,  according  to 
the  Rev.  H.  Barnes,  of  the  Universities'  Mission  to 
Central  Africa,  the  Chinyanja  words  set  down  in  his 
vocabulary  for  44  right  "  and  44  left  "  hand  respectively 
were  really  used  for  the  more  and  less  used  hands  which- 
ever these  might  happen  to  be.  This  implied  a  certain 
prevalence  of  left-handedness  but  not  of  ambidex- 
terity. 

University  of  Wales  and  Medical  Degrees. 
The  thirty-fourth  annual  meeting  of  the  South 
Wales  and  Monmouthshire  Branch  of  the  British 
Medical  Association  was  held  at  Newport.  Drs. 
Lynn  Thomas,  Cardiff,  and  Pearson  Cresswell,  Dowlais, 
were  elected  representatives  oq  the  Central  Council  of 
the  Association.  On  the  motion  of  Dr.  Wallace, 
seconded  by  Dr.  Lynn  Thomas,  the  following  resolution 
was  passed  : — 44  That  this  meeting  heartily  approves 


June  15,  1904. 


the  application  of  the  Court  of  University  of  Wales 
for  a  supplemental  charter  to  grant  degrees  in  medicine ; 
it  further  appreciates  the  fact  that  the  application  is 
supported  by  H.R.H.  the  Prince  of  Wales,  the  Chan- 
cellor of  the  University,  and  records  its  opinion  that  by 
the  granting  of  such  a  charter  much  benefit  will  accrue 
to  the  people  of  Wales."  Dr.  Marsh  presided. 
Isolation  Hospital  for  Telgnmouth. 
A  Local  Government  Board  inquiry  was  held  at 
Teignmouth  (Devon)  on  June  2nd  into  the  application 
of  the  urban  district  council  for  sanction  to  borrow 
£7,100.  £2.471  are  required  for  the  erection  of  an 
isolation  hospital,  and  the  remaining  sum  for  the 
purchase  of  a  recreation  ground  and  other  improve- 
ments. 

Royal  Institution. 
At  a  general  monthly  meeting  of  the  members  of 
the  Royal  Institution,  held  on  June  6th,  the  sincere 
thanks  of  the  members  were  returned  to  Mr.  Andrew 
Carnegie  for  his  donation  of  £1,200,  to  enable  Professor 
Dewar  and  Mr.  R.  A.  Hadfield  to  prosecute  their 
joint  investigation  on  the  physical  properties  of  steel 
and  other  alloys  at  low  temperatures,  and  to  Dr. 
Frank  McClean  for  his  donation  of  £100  to  the  research 
fund  of  the  Royal  Institution. 

Donations  and  Bequests. 
Under  the  will  of  Miss  Esther  Steel  the  Western 
Ophthalmic  Hospital,  Marylebone  Road,  London,  W.. 
has  been  bequeathed  the  sum  of  £1,000. — Mrs.  E.  A. 
Williams  has  by  her  will  bequeathed  £500  to  the  Cancer 
Hospital,  Fulham  Road/S.W. ;  £200  each  to  the  London 
Hospital  and  the  Poplar  Hospital  for  'Accidents ;  and 
£100  to  the  Victoria  Cottage  Hospital  at  Romford. 
Livingstone  College. 
At  the  Commemoration  Day  proceedings  at  Living- 
stone College  on  June  9th,  about  200  visitors  were  pre- 
sent at  the  meeting  in  the  garden,  including  among 
others  Drs.  G.  Sims  Wood  head,  Symes  Thompson, 
Heywood  Smith,  Wise,  Coutts,  Panting,  Goldie. 
Soltau,  Churchill,  and  Wat  kins.  The  Principal,  Dr. 
C.  F.  Harford,  made  a  statement  concerning  the  pro- 
gress of  the  College.  He  referred  to  the  brilliant  ad- 
vances which  had  been  been  made  during  the  past  year 
in  the  department  of  research  in  tropical  medicine, 
which  offered  a  steadily-growing  argument  in  favour 
of  the  work  of  Livingstone  College.  He  contended  that 
the  College  played  a  humble  but  important  part  in 
the  work  of  hygienic  and  sanitary  reform,  both  by  the 
missionaries  trained  within  its  walls  and  by  its  various 
publications.  The  treasurer,  Mr.  R.  L.  Barclay,  gave 
a  statement  with  regard  to  the  financial  position  of  the 
College.  He  referred  to  the  gift  of  ,£4.000  which  had 
been  made  during  the  past  year  by  the  Principal  and 
Mrs.  C.  F.  Harford,  and  to  the  fact  that  part  of  this 
generous  benefaction  had  been  devoted  to  the  equip- 
ment of  the  new  laboratory  (which  was  opened  by 
Professor  Sims  Woodhead  that  day)  and  to  the  pur 
chase  of  apparatus  for  same. 

The  Medical  Benevolent  Fund  of  Ireland. 
The  sixty-second  annual  meeting  of  the  Royal 
Medical  Benevolent  Fund  Society  was  held  on  the 
8  th  inst.  in  the  Royal  College  of  Surgeons.  The  Pre- 
sident of  the  College  presided.  The  report  of  the 
Central  Committee  regretted  the  great  loss  sustained  by 
the  deaths  of  Mr.  H.  Gray  Croly,  Sir  Philip  Crampton 
Smyly  and  Sir  George  J.  Duffey.  Dr.  Conolty  Norman 
and  Dr.  Richard  Hayes  had  been  elected  to  fill  the 
vacancies  on  the  committee.  Ten  applications  for 
grants  were  considered  in  anticipation  of  the  regular 
annual  distribution,  and  grants  amounting  to  £80 
were  made.  Eighty-six  applications  were  considered 
during  the  year,  of  which  seventy-six  were  from  widows 
of  medical  men  ;  £1,167  was  tne  amount  recommended 
since  last  distribution.  The  amount  given  in  grants 
was  so  large  that  the  resources  were  strained.  The 
hon.  treasurer's  report  showed  that  during  the  year  the 
grants  paid  by  the  Central  Committee  were  £1,204  ios- 
which  was  less  by  £100  than  the  last  amount  previously 
distributed.  More  than  half  the  annual  income  was 
derived    from    investments.     The    subscriptions  paid 


June  15,  1904. 


PASS  LISTS. 


The  Medical  Press.  651 


through  the  central  treasurer  were  £164  14s.,  and  the 
branch  treasurers  forwarded  £325  17s.  ud„  which  was 
£200  less  than  that  of  the  previous  year.  The  Presi- 
dent of  the  College  of  Physicians  moved  the  adoption 
of  the  report  and  statement  of  accounts.  He  agreed 
with  the  suggestion  of  Dr.  Kidd,  of  Carlow,  that  every- 
one should  be  made  aware  that  the  question  of  religion 
in  no  way  entered  into  the  consideration  of  the  applica- 
tions. It  was  a  question  of  want  of  sympathy  with 
others  that  prevented  more  from  subscribing,  and  he 
appealed  to  members  in  the  country  especially  to  be- 
come subscribers.  Sir  Thornley  Stoker  seconded. 
Mr.  R.  T.  Tobin,  President  of  the  Irish  Medical  Asso- 
ciation, pointed  out  that  religion  never  entered  the 
minds  of  the  Executive  when  considering  the  applica- 
tions. He  would  be  glad  if  it  were  generally  known 
that  while  the  majority  of  subscribers  were  Protes- 
tants, the  majority  of  the  recipients  were  Catholics. 
The  motion  was  carried.  Dr.  Leonard  Kidd  moved  a 
resolution  conveying  the  thanks  of  the  meeting  to  the 
committee  and  officers  of  the  parent  society,  as  well  as 
those  of  the  provincial  branches,  for  their  zeal  in  the 
society's  beneficent  work.  The  meeting  shortly  after 
terminated. 

The  Medical  Golf  Tournament. 
At  North  wood,  on  the  9th  inst.,  the  annual  Medical 
Golf  Tournament  was  decided.  Play  was  against 
bogey.  The  course  was  in  splendid  order,  and  some 
good  play  was  witnessed.  Dr.  Louis  Macpherson 
( 4- 1 ),  in  Class  I,  won  the  first  prize  with  4  up  on  bogey. 
He  partnered  Dr.  Bryce  (handicap  12)  in  the  four- 
somes, and  the  couple  made  the  winning  return  of  1  up. 
The  second  prize  in  the  singles  was  secured  by  D.  F. 
Curtis  Webb  (9),  who  finished  "  all  square."  The 
prize  for  the  best  score  over  the  last  9  holes  went  to 
Dr.  Bruce  Hamilton  (5),  who  was  3  up.  Dr.  Curtis 
Webb,  who  was  four  up  over  the  last  9  holes,  was  de- 
barred from  taking  the  prize  owing  to  his  other  win. 
In  Class  II  Dr.  Gordon  Watson  (14),  "all  square," 
and  Dr.  F.  R.  Bishop  (16),  2. down,  were  the  prize- 
winners. Dr.  E.  W.  Rough  ton  (16),  1  up,  won  over 
the  last  9  holes. 

St.  Thomas's  Hospital— House  ADpointmesM. 
The    following    gentlemen    have   been    selected    as 
house  officers  for  the  ensuing  three  months : — 

Resident  House  Physicians  :  G.  C.  Adeney,  M.R.C.S., 
L.R.C.P.(Extn.) ;  E.  A.  Ross,  M.B.,  B.C.Cantab. 
(Extn.);  H.  C.  Lecky,  M.A.,  M.B.,  B.Ch.Oxon ; 
C.  H.  Latham,  M.R.C.S.,  L.R.C.P.  House  Physicians 
to  Out-Patients :  B.  Higham,  M.R.C.S.,  L.R.C.P. ; 
W.  Hawaid,  M.B.,  B.S.Durh.,  M.R.C.S.,  L.R.C.P. 
Resident  House  Surgeons :  W.  L.  Harnett,  M.A., 
M.B.,  B.C.Cantab.,  M.R.C.S.,  L.R.C.P.  (Extn.); 
H.  I.  Pinches,  M.A.,  M.B.,  B.C.Cantab.,  M.R.C.S., 
L.R.C.P.  (Extn.) ;  T.  Guthrie,  M.A..  M.B.,  B.C.Can- 
tab., M.R.C.S.,  L.R.C.P.  (Extn.);  L.  E.  Wigram, 
M.A.,  M.B.,  B.C.Cantab.  (Extn.)  House  Surgeons  to 
Out-Patients:  H.  S.  Bennett,  M.R.C.S.,  L.R.C.P. 
(Extn.) ;  N.  C.  Carver,  B.A.,  B.C.Cantab..  M.R.C.S., 
L.R.C.P.  fExtn.);  A.  C.  Birt,  M.R.C.S.,  L.R.C.P. 
<Extn.) ;  G.  T.  Birks,  M.A.,  M.B..  B.C.  Cantab.(Extn.). 
Obstetric  House  Phvsicians :  (Senior)  C.  N.  Sears, 
M.B.,  B.S.Lond..  M.R.C.S.,  L.R.C.P. ;  and  (Junior) 
J.  P.  Hedley,  M.A.,  M.B.,  B.C.Cantab.,  M.R.C.S., 
L.R.C.P.  Special  Departments  :  Throat :  W.  Ibbot- 
son,  M.R.C.S.,  L.R.C.P.  (Extn.) ;  and  G.  R.  Rickett, 
M.A.,  B.C.Cantab.  Skin:  G.  R.  Rickett,  M.A., 
B.C.Cantab.  Ear :  W.  Ibbotson,  M.R.C.P.,  L.R.C.P. 
<Extn.). 


PASS  LISTS. 


University  of  Cambridge. 

The  degree  of  Master  of  Surgery  has  been  conferred 
on  Professor  Howard  Marsh,  M.A. — The  following  have 
been  appointed  examiners  for  the  final  M.B.  examina- 
tions in  the  next  academical  year  : — Medicine  :  Dr.  L. 
Humphry,  Dr.  S.  West,  Dr.  W.  Hale  White,  and  Dr. 
J.  .Rose  Bradford.  Midwifery :  Dr.  M.  Handfield- 
Jones  and  Dr.  G.  E.  Herman.  Surgery :  Mr.  C.  T. 
Dent,  Mr.  E.  Owen,  Mr.  C.  W.  Mansell  Moullin,  and 


Sir  Hector  C.  Cameron. — Dr.  Ole  Bull,  of  Christiania, 
has  presented  to  the  University  two  valuable  portfolios 
of  drawings  illustrating  the  diseases  of  the  eye  and  of 
the  ear.  Professor  T.  Clifford  Alibutt  has  received 
permission  to  exhibit  the  drawings  at  Oxford  during 
the  approaching  meeting  of  the  British  Medical  Asso- 
ciation. 

University  of  London. 
At  the  May  examinations,  the  following  passed  the 
M.B.  Examinations : — 

First  Division. — Henry  Harold  Greenwood,  Beatrice 
Mary  Kidd,  Ernst  George  Pringle,  Philip  Rees,  B.Sc., 
Herbert  Douglas  Smart,  and  Sidney  Maynard  Smith. 

Second    Division.  —  Frederick      Hugh     Alexander, 
Joseph  Hugh  Arthur,  Oliver  Francis  H.  Atkey,  John 
Gerald  Atkinson,  Sophie  Grace  Banham,  B.Sc,  Alice 
Marian  Benham,  Victoria  Evelyn  M.  Bennett,  Ruth 
Levy   Bensusan.    Athelstan    Jasper   Blaxland,    Agnes 
Maud   Brown,    Harry   Hunter   Carter,    John    Hunter 
Clat worthy,  Ernest  Langford  Clay,  Helen  Mary  Collen, 
John  Moore  Collyns,   Philip  Claude  T.   Davy,   John 
Thomas   D'Ewart,   Laetitia    Nora   Ede,   Raoul   Felix. 
Joseph  Anthony  Ferriere,  John   William  Fox,  Philip 
Anthony  M.  Green,  Philip  William  Hamond,  George 
Montagu   Harston,   Bernard  Hart,   W.   H.   Harwood- 
Yarred,  B.Sc.,  Geoffrey  Seccombe  Hett.  Charles  Dyson 
Holdsworth,  Margaret  Hudson,  B.A.,  Charles  Edward 
,  Iredell,  John  James,  Frederick  Arthur  Johns,  Smeeton 
Johnson,   Charles   Herbert    Farley    Johnston,    Ernest 
!  Williams  Jones,  Frederic  Wood  Jones,  B.Sc.,  Herbert 
I  Stanley  Jones,   Rustamjee  M.   Kalapesi,   H.   Ratcliff 
Kidner,  B.Sc.,  Elizabeth  Knight,  Kate  Knowles,  Jessie 
I  Augusta  Lewin,  Alfred  Lewthwaite,  Maurice  George 
1  Lonisson,     Charles    Ernest     Wheatley     Lyth,     Fred. 
'  Champ  McCombie,  Norman  Macfadyen,  Ernest  Charles 
1  Mackay,  Harold  Chas.  Corry  Mann,  James  Alexander 
!  Milne,  Bernard  Moiser,  Edgar  Coningsby  Myott.  Percy 
Alfred  Peall,  Charles  Burnage  Penny,  Francis  Baldwin 
I  Pinniger,  Kate  Anne  Piatt,  Marian  Theresa  Pool,  John 
1  Jekyll  Rainforth,  John  Evans  Richards,  Charles  Michael 
Roberts,    Gerald   Warren   Russell,    Arthur   Campbell 
Stark,  Louisa  Graham  Thacker,  Ernest  Frank  Travers, 
■  Laura  Sobey  Veale,  Charles  Richard  Verling-Brown, 
Ada  Miles  Whitlock,  Sydney  Rice  Williams.  William 
Bamford    Winston,    B.Sc,    Robert    Stanton    Woods. 
Fred.  Robert  Elliston  Wright,  and  Samuel  Zobel. 
Trinity  College,  Dublin. 
The  following  candidates  passed  the  Final  Examina- 
tion in  Medicine  during  Trinity  Term,  1904  : — James  G. 
Wallis,  Georare  B.  M'Caul,  Hugh  Stewart,  William  M. 
Wade,  Washington  P.  Tate,  Thomas  Wilson,  Charles  J. 
Coppinger,  Harold  T.  Marrable,  Edward  G.  Scroope. 

The  following  passed  the  Final  Examination  in 
Medicine  during  Trinity  Term,  1904  : — Section  A  :  Wm. 
G.  S.  Haughton  (passed  on  high  marks),  John  D.  Sands, 
Percy  B.  Egan,  Thomas  T.  H.  Robinson,  William  F. 
Samuels,  William  J.  Thompson,  Francis  J.  Usher, 
William  C.  MacFetridge,  Thomas  B.  W.  MacQuaide, 
Alfred  C.  Elliott.  Edward  D.  Atwell,  George  Dougan, 
James  M.  Harold.  Ernest  C.  Phelan. 

The  title  of  Emeritus  Professor  of  Ophthalmic 
Medicine  and  Surgery  has  been  conferred  on  Mr.  John 
Tweedy,  F.R.C.S.,  Ophthalmic  Surgeon  to  University 
College,  London,  President  of  the  Ophthalmological 
Society. 

The  Atkinson-Morley  Scholarship  of  University 
College  for  "  proficiency  in  the  theory  and  practice  of 
surgery  "  has  been  awarded  to  Mr.  G.  Hall,  and  the 
Atchison  Scholarship  "  for  the  best  work  during  the 
last  two  sessions  and  the  greatest  proficiency  as  a 
student  of  the  medical  faculty  and  hospital,"  to  Mr. 
Thomas  Lewis. 

At  the  meeting  of  the  American  Medical  Asso- 
ciation now  being  held  in  Atlantic  City,  Professor 
Ayres,  of  the  Post-Graduate  Hospital  in  New  York, 
announced  that  he  believed  Bright's  disease  could 
be  cured  in  its  early  stages.  He  had  effected 
cures  in  forty-three  cases  out  of  ninety-eight,  and 
only  one  had  failed  to  respond  to  the  treatment. 


652    Tn*  Mbdical  Puis.       NOTICES  TO  CORRESPONDENTS. 


JUNB   IS.   I904 


Jtotice*  to 
QtotttspovibtvdB,  $hsrt  %tttzxB,  &t 

JMsV*  OoftsnPOXDBiTB  requiring  a  reply  in  thii  column  are  particu- 
larly requested  to  make  use  of  a  distinctive  Siffnatur*  or  initial,  and 
aroid  the  practice  of  signing  themselves  "  Reader,"  "  Subscriber," 
'•  Old  Subscriber/'  Ac,  Much  confusion  will  be  spared  by  attention 
to  this  rule. 

Original  Amicus  or  Letters  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  necessarily  for  publica- 
tion, but  as  evidence  of  identity. 

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

Dr.  R.  Jones  (Monmouthshire).— The  University  of  Wales  has 
applied  for  a  supplemental  charter  to  include  the  medical  faculty. 
This  step  has  resulted  mainly  from  the  efforts  of  Sir  Isambard  Owen 
and  Sir  John  Williams. 

J.  E.  T.— The  librarian  at  the  Boyal  College  of  Surgeons  will 
probably  be  able  to  furnish  you  with  the  names  of  the  chief  books  of 
reference  you  need. 

C.  M.  Robertson.— (1)  There  are  various  portable  operation  tables 
msde.  One  in  particular  we  remember  was  invented  oy  a  Birming- 
ham surgeon.  It  was  extremely  light  and  oou'd  be  packed  up  in 
small  compass,  yet  was  firm  snd  portable,  snd  often  extremely  useful 
in  operations  at  private  houses.  (2)  The  glass  vaginal  speculum 
has  many  excellent  qualities  :  it  is,  for  instance,  inexpensive  and 
readily  sterilisable. 

H.  V.  W.  (Birmingham).— The  report  to  which  our  correspondent 
refers  has  not  come  under  our  notice.  If,  however,  the  facts  are,  as 
stated,  our  correspondent  would  be  justified  in  pursuing  the  course 
which  he  suggests. 

M.  T.  K.  Statistic*  so  farihave  shown  that  Armagh  has  the  highest 
cancer  mortality  of  all  the  Irish  counties.  See  the  "  Special  tteport 
on  Cancer  in  Ireland :  Supplement  to  the  Thirty-eight  detailed 
Annual  Report  of  the  Registrar-General  in  Ireland." 

Dr.  Stbvbics.— We  are  of  opinion  that  no  breach  of  ethical  law  has 
been  committed. 

Ignoramus  —The  suggestion  is  not  one  which  we  can  entertain. 

M.R.C.8.— The  symptoms  point  to  "Fowl  Cholera"  the  bac- 
teriology of  which  was  worked  out  by  Pasteur.  The  "runs"  in 
which  the  fowls  have  died  should  be  closed  and  thoroughly  dis- 
infected, and  not  used  sgain  for  at  least  six  months. 

Da.  S.  M.— An  Insurance  Company  is  perfectly  within  its  rights  in 
nominating  whom  it  pleases  to  examine  a  patient  on  its  behalf. 

Da.  Rentoul.— Your  letter  is  unadvoldably  held  over. 


<$0LtttmQ,s  of  the  gotieliee,  hectares,  <&c 

Wednesday,  June  15th. 

Royal  Microscopical  Society  (20  Hanover  Square,  W.).— 8  p.m. 
Paper  :— Prof.  J.  D.  Everett :  A  Direct  Proof  of  Abbe's  Theorems  on 
the  Microscopic  Resolution  of  Gratings.— Mr.  F.  W.  Millett: 
Report  on  the  Recent  Forsminifera  of  the  Malay  Archipelago  (Part 
XVI.).— Lecture  :  Mr.  F.  Enock :  Nature's  Protection  of  Insect  Life 
(with  lantern  demonstrations). 

Royal  Meteorological  Society  (70  Victoria  Street,  Westminster, 
6  W.).— 4.30  p.m.  Papers :— Rev.  C.  F.  Box  :  Effects  of  a  Lightning 
Stroke  at  Earl's  Fee,  Bowers  Gifford.  Essex,  April  18th,  1904.— Mr. 
A.  L.  Botch :  An  Instrument  for  Determining  the  True  Direction 
and  Velocity  of  the  Wind  at  8ea. 

Medical  Graduate'  College  and  Polyclinic  (22  Ohenies  Street, 
W.C.).— 4  p.m.  Mr. D. Armour:  CHniqne.  (Surgical.)  5.16  p.m. 
Dr.  F.  J.  McCann :  Diseases  and  Injuries  of  the  Female  Bladder  and 
Urethra. 

Thursday,  Juke  16th. 
Royal  College  of  Physicians  of  London  (Pall  Mall  East).— 5  pjn. 
Dr.  J.  R.  Bradford  :  Blight's  Disease  and  its  Varieties.    (Croonian 
Lecture.) 

Medical  Graduates'  College  and  Polyclikic  (22  Chenies  8treet, 
W.C.).— 4p.m.  Mr.  Hutchinson:  Clinique.  (Surgical.)  5.15  p.m. 
Dr.  J.  M.  H.  Macleodt  Some  General  Principles  of  Local  Treatment 
in  Dermatology. 

Mount  Vernon  Hospital  for  Consumption  and  Diseases  op  the 
Cuesi    (7    Fltsroy  8quare,  W.)— 5   p  m.    Dr.    F.    Price :    Aortic 
.Stenosis  (Illustrated  by  cases).  (Post  Graduate  Course.) 
Fridat,  June  17th. 

Medical  Graduates'  College  and  Polyclinic  (22  Chenies  Street, 
W.C.).— 4  p.m.    Mr.  B,  Lake :  Clinique.    (Ear.) 


Birmingham.— Workhouse  Infirmary.— Assistant  Resident  Medical 
Officer.  Salary  £104  per  annum,  with  furnished  apart- 
ments, rations,  coal,  gas,  laundry,  and  attendance.  Applications 
to  Charles  Fletcher,  Clerk  to  the  Guardians,  Parish  Offices, 
Edmund  Street. 

Carmarthenshire  Infirmary. —Resident  Medical  Officer.  Salary  £100 
per  annum,  with  furnished  apartments,  board  attendance,  fire, 
gas,  and  washing.    Applications  to  Howell  Howell,  Secretary. 

Cumberland  and  Westmoreland  Asylum,  Garlands,  Carlisle.— Junior 
Assistant  Medical  Officer.  Salary  £130  a  year,  with  board, 
lodging,  and  washing.  Applications  to  the  Medical  Superin- 
tendent. 


Kent  and  Canterbury  Hospital.— House  Physician.  Salary  £90  a  year, 
with  board  and  lodging.  Applications  to  A,  J.  Lancaster, 
Secretary. 

Liverpool  Dispensaries.— Assistant  Surgeon.  Salary  £100  per 
annum,  with  board  and  apartments.  Applications  to  Secretary, 
Sam.  B.  Leicester,  56  Vauxhall  Read,  Liverpool 

Liverpool  Infirmary  for  Children.— House  Surgeon.  Salary  £100  par 
annum,  with  board  and  lodging.  Applications  to  the  Hon, 
Secretary. 

Mercers  Hospital.— House  Surgeon.  Immediate  application  to  John 
Robinson,  Registrar. 

Stamford,  Rutland  and  General  Infirmary.— House  Surgeon.  Salary. 
£100  per  annum,  with  board,  lodging  and  washing.  Application* 
to  V.  G.  btapleton,  Secretary,  The  Infirmary,  Stamford. 

St.  Mary's  Hospital  Medical  School,  Paddington,  W.— Lecturer  00 
Chemistry.  Salary  £150  per  annum.  Applications  to  H.  A. 
Caley.  M.D..  F.R.U.P.,  Dean. 

University  of  Birmingham.— Second  Demonstratorship  in  Anatomy. 
Salary  £160  per  annum.  Applications  to  Geo.  H.  Morley, 
Secretary. 

Wandsworth  Union  Infirmary,  St.  John's  Hill,  near  Clapham  Junc- 
tion.—Junior  Assistant  Medical  Officer.  Salary  £100  per  annum, 
with  board,  lodging  and  washing.— Applications  to  Medical 
Superintendent. 


£ppomtment0. 

CaicirroN,  Harry,  M.D.,    aS.Durh.,  Assistant  Surgeon    to   the 

Infirmary,  South  Shields. 
Da  vies,  H.  E.,  L.R.C.P.Lond„  M.R.C.S.,  Certifying  Surgeon  under 

the  Factory  Act  for  the  Lutterworth  District  of  the  county  of 

Leicester. 
Evans,  B.  D..M.R.C.P.Edin.,  L.8.A.,  J.P.,  Medical  Officer  to  the 

Blaenau  Festiniog  Postal  District. 
FiBLDMAN,    W.  M.,    M.R.C.8.,    L.R.C.P.,  Surgeon  to  as.  Merlon 

.(American  Line). 
Hunter.  James  Hm  M.D.,  B.8.,  B.Hy.Durh.,  Assistant  8urgeon  to 

the  Infirmary,  South  Shields. 
Lindset,  Eaic  C.,  M.R.C.S.,  L.R.C.P.Lond.,  Surgeon  to  the  General 

Hospital,  Hereford. 
Macdonald,   John,   M.B.,  C.M.Edin,,   Assistant    Surgeon    to  the 

Infirmary,  South  Shields. 
Smyth,  J.,  MB..  C.M.Glasg.,  Clinical  Assistant  to  the  Chelsea  Hos- 
pital for  Women. 
Thorns,  J.  M.,  M.B.C.8.,  L.R.C.P.Lond.,  Clinical  Assistant  to  the 

Chelae*  Hospital  for  Women. 


#irtha. 


Erhardt.— On  June  8th,  at"  Fernbank,"  Crossbills,  near  Kdghley, 
Yorks,  the  wife  of  C.  C.  J.  Erhardt,  M.R.G.S..  L.R.O.P.,  of  s 
daughter. 

Ptrbbr.— On  June  11,  at  20  Lower  Baggot  Street,  Dublin,  the  wifeof 
Francis  C.  Purser  of  a  daughter. 


<4&arnages. 

Beamish— Chapman.— On  June  0th,  at  St.  Stephen's  Church,  South 
Dulwioh,  Robert  Talbot  Beamish,  Lieut. -Colonel,  late  B.AM.C, 
to  Eveline  Margaret,  only  daughter  of  Thomas  Horatio  Chapman, 
of  "  Hurstbourne,"  Sydenham  Hill,  Kent. 

Burt—  Blackstone.— On  June  J  lth,  at  St  Mark's  Church,  Regenfi 
Park,  Sir  John  Mowlem  Burt,  of  Westminster,  '•  Durlston," 
Elsworthy  Road,  Hampstead,and  8wansge,  Dorset,  to  Grace  Emms, 
only  daughter  of  the  late  Joseph  Blackstone,  M.R.C.8.,  and  of 
Mrs.  Blackstone,  of  Albert  Terrace,  Regent's  Park. 

Dillon— Monk.— On  June  7th,  at  the  Pro-Oathedral,  Marlborough 
Street,  by  the  Rev.  J.  Flavin,  C.C.,  assisted  by  the  Rev.  Ber- 
nard Brady,  P.P.,  Dunboyne,  and  the  Rev.  E.  Ryan,  O.P„  Dr.  T. 
F.  Dillon,  Dunboyne,  son  of  Bernard  Dillon,  Greevagh,  Kelb, 
00.  Meath,  to  Teresa,  daughter  of  E.  P.  Monk,  J. P.,  T.C.,  Caven- 
dish House,  Rutland  Square  Dublin. 

Dowsett— Webb  On  June  8th,  at  the  Parish  Church,  Walteo-on- 
Thames.  Ernest  Blair  Dowsett,  L.R.O.PXond,,  M.R.0  SJEsa;., 
L.D.S.Eng.,  only  son  of  George  Harris  Dowsett,  Esq.,  of  LevUnd 
Road,  Lee,  and  1  Gloucester  8treet,  Portman  Square,  WM  to 
Ethel  Ellen  Sarah,  elder  daughter  of  Percy  H.  Webb,  aTsq.,  of 
Walton-on-Thames. 

Hosii— Webb— On  June  7th,  at  8t.  John's,  Waterloo  Road,  Lambeth, 
Major  A.  Hosie,  M.D.  R.A.M.C.,  to  Sarah  Emily,  second  daugh- 
ter of  the  late  Richard  Webb,  of  Dunderrow  House,  Kinsale. 


deaths. 


Brown.— On  June  10th,  at  27  Wmckley  Square,  Preston,  Lancashire^ 

Dorothy  Jane,    eldest   daughter  of  the    late  Robert  Brown, 

F.R.C  S.Eng.,  aged  71. 
Cutting.— On  June  0th,  at  Stalham,  Norfolk,  Ernest  John,  second 

son  of  Ernest  H.  Cutting,  M.B.C.S.,  L.R.C.P.,  aged  7  years  and 

seven  months. 
FroLLioTT.— On  June  8th,  at  White  Lodge,  Hove,  BriR*de-8urgeon 

William   ffolliott,  F.B.C.8.I.,  late  Boyal  Army   Medical  Corps, 

from  heart  failure  following  an  attack  of  influenza,  aged  65. 
Hices.— On  June  9th,  at  Longmead,  Buntingford,  Herts,  Caroline 

Mary,    widow  of    the  late  Francis  Edward   Hicks.  F.R.CA, 

formerly  of  Longmead,  and  7  Henrittta  Street,  London,  W. 
O'Farrell.— On  June  8th.  1904,  at  his  residence,  Portumna,  County 

Galway,  Henry! OFarreli,  L.R.C.S. and  C.P.l.,aged  54  years; 

deeply  regretted.    RIP. 
SWAYNB.— On  June  9th,  at  Glsnbervie  Bray,  Charles  John  Swayne* 

M.D.,  T.C.D.,  eldest  and  dearly  loved  son  of  John  B.  8wsyne, 

aged  31  years.    B.I. P. 


ill*  fttrdiml  *§vm  m&   dirrular. 


"8ALU8   POPULI   SUPREMA    LEX.' 


Vol.  CXXVIII. 


WEDNESDAY,    JUNE  22,    1904. 


No.   25. 


(Prigtnal  Communications. 

THREE  CASES  OF 

APPENDICITIS  WITH 
PERFORATION— 
OPERATION— RECOVERY. 

By  ARTHUR  CONNELL,  F.R.C.S.Edin., 

8argeoa,  Koyal  Inlnmary,  Sheffield ;  Lecturer  on  Operatire  Surgerj 
and  Surgical  Pathology,  Univertitj  College,  Sheffield. 

These  three  cases  have  been  chosen  from  a  series 
of  cases  operated  upon  this  year,  up  to  the  end  of 
April.  They  illustrate  well  the  acute  fulminating 
character  of  both  the  subjective  symptoms  and 
the  objective  signs,  as  well  as  the  pathological 
lesion  found  at  operation,  and  emphasise  the  ex- 
pediency of  immediate  operative  interference. 

Case  /. — W.  L.,  aet.  28,  an  engineer's  labourer, 
was  admitted  to  the  infirmary  on  February  27th, 
complaining  of  pain  "  all  over  the  belly,"  but 
not  of  a  severe  type.  His  present  attack  began 
the  evening  before,  when  he  was  compelled  to  go 
to  bed  early,  owing  to  a  feeling  of  faintness.  He 
was  awakened  about  two  o'clock  in  the  morning 
by  severe  pain  at  the  pit  of  the  stomach  and  in- 
tense nausea.  The  epigastrium  was  poulticed, 
which  gave  relief,  the  pain  locating  itself  about  the 
umbilicus.  He  was  advised  by  his  doctor  to  go  to 
the  infirmary,  and  was  admitted  during  the  evening 
of  Saturday  (27th).  The  note  made  by  Mr.  Hallam, 
the  house  surgeon,  runs  as  follows  : — "  He  com- 
plains of  slight  pain  in  the  region  of  the  umbilicus. 
The  pulse  is  of  good  quality  and  68  per  minute  ; 
temperature,  97*8°  F.  ;  tongue  slightly  furred." 
Ordered  a  turpentine  enema,  which  was  followed 
by  a  good  result.  February  28th,  he  passed  a 
good  night,  during  which  he  had  no  pain  ;  but 
at  half-past  eight  in  the  morning  the  pain  re- 
appeared, and  grew  rapidly  worse.  As  I  was  in 
the  building  I  was  asked  to  see  him,  and  found 
Mm  in  very  great  pain,  so  much  so  that  he  was 
tossing  about  the  bed,  groaning  constantly. 

On  examination,  there  were  no  movements  of 
the  abdominal  wall,  which  was  somewhat  retracted, 
nor  was  there  a  local  tumour,  and  on  palpation 
the  abdominal  wall  was  found  extremely  rigid 
and  acutely  tender  in  every  direction,  but  es- 
pecially so  over  the  pelvic  portion  of  the  ab- 
dominal surface.  There  was  dulness  on  per- 
cussion up  to  two  inches  above  the  symphysis  pubis. 
Immediate  operation  was  decided  upon,  and  the 
man  taken  to  the  theatre.  Ether  was  administered 
and  the  skin  was  then  thoroughly  prepared.  The 
abdomen  was  again  palpated  as  soon  as  he  was 
fully  anaesthetised,  but  the  marked  rigidity  of  the 


abdominal  muscles  remained  in  spite  of  the  fact 
that  the  knees  were  fully  flexed  during  this  mani- 
pulation. 

On  opening  the  peritoneum  the  caecum  and 
part  of  title  ascending  colon  presented.  The  latter 
was  reduced,  and  the  area  was  surrounded  by  a 
long  strip  of  dry  sterile  gauze.  The  surface  of 
the  gut  was  extremely  moist,  suggestive  of  free 
fluid  in  the  abdomen.  The  appendix  was  felt 
lying  under  the  caecum,  and  was  easily  brought 
into  the  wound,  on  examination  of  which  it  was 
found  to  possess  two  perforations  opposite  the 
mesenteric  attachment.  It  was  immediately  am- 
putated. 

As  the  gauze  strip  was  found  so  wet  on  removal,  a 
Keith's  glass  drainage-tube  was  passed  downwards 
and  inwards  to  the  bottom  of  the  pelvis,  from  the 
lower  end  of  the  wound.  Immediately  a  large 
quantity  of  cloudy  turbid  serum  gushed  up,  laden 
with  flakes  of  lymph.  The  small  intestine  lying 
in  the  pelvis  was  covered  in  places  by  soft  or- 
ganising lymph.  Sterile  salt  solution  was  then 
used  to  flush  out  the  pelvis. 

In  order  to  facilitate  this  manipulation  he 
was  raised  into  the  semi-recumbent  position  and 
turned  over  on  to  the  right  side  somewhat.  He 
bore  the  operation,  which  lasted  half  an  hour, 
well.  At  six  in  the  evening  the  temperature  was 
1010  F.,  and  the  pulse  112  ;  he  was  now  quite 
free  from  pain.  He  was  given  10-ounce  rectal 
injections  of  saline  every  four  hours. 

Next  day  the  abdomen  was  markedly  distended, 
and  there  was  constant  vomiting  during  the  earlier 
part  of  the  day,  but  this  yielded  to  one-grain  doses 
of  calomel  given  every  hour  for  four  doses,  by 
the  mouth.  At  five  o'clock  he  was  given  a  tur- 
pentine enema,  which  was  followed  by  a  very  good 
result.  He  passed  a  very  comfortable  night. 
Next  day,  March  1st,  the  temperature  was  97-8°  F., 
and  the  pulse  84.  The  distension  had  all  dis- 
appeared, and  the  Keith  tube  was  removed,  as 
there  was  no  appreciable  discharge.  The  subse- 
quent course  of  the  case  is  quite  uneventful. 
He  had  had  four  previous  attacks  of  abdominal 
pain,  but  none  of  such  severity  as  the  present 
attack. 

Case  II. — E.  T.  is  a  laundrymaid,  aet.  19,  who 
is  employed  in  the  infirmary  laundry  at  the  special 
machine  for  ironing  collars,  &c.  Her  illness  began 
on  Sunday,  April  24th,  when  she  said  a  "  funny 
feeling  came  over  her  right  side  "  after  her  mid- 
day meal,  which,  however,  was  a  small  one, 
owing  to  the  fact  that  she  was  out  of  sorts  and 
suffering  from  a  severe  headache.  At  one  o'clock 
in  the  morning  she  was  awakened  by  great 
pain  referred   to   the  right  iliac   fossa,  and  anv 


654    The  Medical  Press.         ORIGINAL  COMMUNICATIONS. 


JPMB  22,   1904, 


movement  of  right  lower  limb  intensified  the  pain. 
April  25th. — This  morning  the  right  leg  felt 
stiff,  and  there  was  slight  pain  on  walking.  She 
did  her  work  as  usual,  although  feeling  very  ill, 
and  had  absolutely  no  meal  for  the  day  until  nine 
o'clock  in  the  evening,  when  she  had  some  boiled 
bread  and  milk.  She  passed  a  sleepless  night. 
On  attempting  to  get  up  next  morning — the  26th — 
she  fell  backwards  in  a  faint  on  to  the  bed,  so  great 
was  the  pain  on  assuming  the  erect  posture.  She 
was  seen  by  the  house  surgeon,  who  immediately 
warded  her.  She  was  seen  by  myself  at  11.30, 
and  the  condition  found  was  as  follows  : — She  is 
a  well-nourished  girl,  face  flushed  and  moist,  ex- 
pression anxious  and  face  pinched,  pulse  106,  small 
and  soft ;  temperature,  98-4°  F.  She  lies  on  her 
back  with  both  legs  drawn  up.  The  abdomen  is 
full  but  not  distended  ;  there  are  no  movements. 
On  palpation  the  musculature  is  extremely 
rigid  and  unyielding  ;  there  is  marked  tenderness 
over  the  right  iliac  region  and  the  pelvic  portion 
of  the  abdomen.  The  tongue  is  thickly  coated 
with  a  brown  fur.  She  looks  desperately  ill.  There 
has  never  been  an  attack  of  pain  on  the  right  side, 
but  she  has  had  much  pain  in  the  left  side,  owing 
to  obstinate  constipation.  She  takes  purgatives 
constantly  and  is  a  big  tea-drinker.  Her  work 
entails  continuous  standing  throughout  the  day. 
She  was  immediately  taken  to  the  theatre  and 
anaesthetised.  After  thoroughly  cleaning  the  skin, 
the  abdomen  was  opened  by  splitting  the  sheath 
of  the  right  rectus.  On  opening  the  peritoneum 
several  ounces  of  serous  fluid  escaped.  The  ex- 
amining finger  discovered  the  appendix  under  the 
caecum.  The  latter  was  brought  to  the  surface, 
and  lying  attached  to  its  posterior  and  under  sur- 
face was  the  appendix  pointing  upwards  towards 
the  liver,  with  the  tip  gangrenous  and  with  a  per- 
foration which  would  admit  the  point  of  a  large- 
sized  probe.  The  appendix  was  promptly  am- 
putated, and  a  Keith's  glass  drainage-tube  passed 
downwards  into  the  pelvis.  The  manipulation 
was  followed  by  a  further  outflow  of  serous, 
muddy  fluid  laden  with  flakes  of  lymph.  Salt 
solution  was  poured  into  the  pelvis  and  the  wound 
closed,  except  for  the  part  giving  passage  to  the 
glass  tube.  A  flank  drain  was  inserted,  owing 
to  the  high  position  of  the  tip  of  the  appendix. 
The  subsequent  history  of  the  case  is  uneventful. 
Convalescence  was  quickly  established. 

Case  III.— H.  B.,  an  auctioneer,  aet.  20,  came  to 
my  rooms  on  the  morning  of  May  3rd  complaining 
of  pain  across  the  abdomen.  On  examination, 
there  was  much  tenderness  over  the  right  iliac 
fossa,  and  the  tongue  was  so  thickly  coated  that 
he  was  advised  to  go  home  and  to  bed.  This  he 
refused  to  do,  and  left  my  rooms  declaring  he  was 
going  to  work,  but  he  evidently  thought  better  of 
it,  and  went  home.  He  had  some  sleep,  and  on 
awaking  and  finding  that  the  pain  was  easier, 
he  went  to  his  office.  He  had  pain  during  the 
night  sufficient  to  cause  a  restless  night.  In 
the  morning  he  went  to  his  office,  in  spite  of  the 
pain,  which  was  more  severe  than  during  the  night. 
Soon  after  his  arrival  there  he  was  suddenly  seized 
with  a  violent  rigor  which  lasted  some  considerable 
time ;  he  returned  home  at  once  and  got  to 
bed,  and  it  was  not  until  then  that  the  rigor 
ceased.  He  was  seen  at  once,  when  it  was 
found  that  he  had  a  temperature  of  101-2°  F., 
and  pulse  104,  soft  and  small.  The  abdomen  was 
full,  but  not  distended  ;   there  was  acute  tender- 


ness in  the  right  iliac  region,  with  marked  rigidity 
of  the  abdominal  musculature.  Operation  was 
decided  upon,  but  as  his  parents  were  out  of  town 
the  necessary  permission  had  to  be  obtained. 
The  abdomen  was  opened  at  three  o'clock  in  the 
afternoon  of  the  4th.  On  cutting  through  the 
peritoneum,  two  or  three  ounces  of  semi-purulent 
fluid  gushed  out.  The  parts  were  carefully  pal- 
pated, and  the  appendix  was  found  lying  quite 
superficially,  hanging  down  towards  the  pelvis, 
without  a  vestige  of  an  adhesion  near.  It  was 
brought  out  of  the  wound  quite  easily.  The 
appendix  was  considerably  thickened,  and  the  tip 
quite  black,  with  a  zigzag  perforation  on  one  side 
of  the  tip,  not  unlike  the  illustration  of  forked 
lightning.  The  fringe  of  the  great  omentum 
was  intensely  injected.  The  lower  portion  of  the 
abdomen  was  thoroughly  washed  out  with  sterile 
salt  solution,  and  a  Keith's  glass  drainage-tube  in- 
serted at  the  lower  end  of  the  wound  penetrating 
to  the  bottom  of  the  pelvis. 

After  the  operation  this  case  made  such  rapid 
and  phenomenally  good  progress  that  a  study  of 
the  combined  temperature  and  pulse  curves  are 
of  great  interest.  It  has  been  my  good  fortune 
to  operate  on  eighty-nine  cases  of  appendicitis 
in  its  various  forms  within  the  last  three  years, 
but  on  referring  to  my  notes,  I  cannot  find  a  single 
acute  case  in  which  convalescence  was  so  rapidly 
established.  Temperature  fell  to  normal  on  the 
third  day. 

Remarks. — In  reviewing  these  cases  the  points 
which  emphasise  themselves,  and  which  it  is  essen- 
tial should  claim  serious  attention,  are,  first,  the 
character  of  the  pulse,  the  severity  of  the  pain, 
the  extreme  tenderness  of  the  iliac  fossa,  the 
absence  of  tumour,  finally,  and  of  great  importance, 
the  extreme  rigidity  of  the  abdominal  musculature. 
In  each  case  there  has  been  a  previous  history  of 
abdominal  pain,  and  what  is  commonly  spoken 
of  as  "  bilious  attacks  " — whatever  they  may  mean. 
As  is  so  well  known,  no  one  individual  presents 
similar  symptoms  with  identical  lesions,  and  I 
venture  to  suggest  that  it  is  well  brought  out  in 
these  three  cases. 

In  Case  I  the  predominant  subjective  symptom 
was  pain,  the  objective  signs  were  marked  tender- 
ness and  rigidity  of  the  abdominal  wall. 

In  Case  II  the  pulse  was  the  surest  indication 
of  serious  mischief,  whilst  one  was  able  to  couple 
with  it  the  physical  aspect  of  the  abdominal  wall 
and  its  extreme  tenderness. 

Case  III,  on  the  other  hand,  is  pregnant  with  signs, 
any  one  of  which  would  suffice  to  warn  one  not  to 
delay  in  taking  very  prompt  measures.  The  rigor, 
of  all  things,  comes  first,  coupled  with  which  are 
the  pulse-rate  and  its  quality,  the  temperature, 
and  the  tenderness  with  rigidity. 

One  sees  cases  where  there  is  considerable  diffi- 
dence shown  in  arriving  at  an  early  diagnosis, 
because  the  classical  symptoms  have  been 
awaited — which  never  turned  up— whilst  the 
patients  have  reached  such  an  advanced  state  that 
operative  interference  is  not  infrequently  a  means 
of  causing  a  speedy  end  to  such  sufferings.  The 
appendix  must  inevitably  furnish  a  varied  and 
unusual  group  of  widely-differing  physical  signs 
and  symptoms  when  one  takes  into  account 
its  varying  positions  and  anatomical  relations- 
multiplied  if  the  patient  happens  to  be  a  female- 
its  many  pathological  lesions  and  the  pre- 
carious blood-supply  of  its  distal  inch  or  more. 


June  22,  1904. 


ORIGINAL  COMMUNICATIONS.         Th«  Medical  Pems.    655 


Too  much  importance  is  placed  on  such  things 
as  the  presence  of  a  tumour,  a  rise  of  temperature, 
the  absence  of  constipation  and  the  absence  of 
vomiting,  whilst  too  little  notice  is  taken  of  the 
characteristics  of  the  pulse,  the  rigidity  of  the  ab- 
dominal wall,  the  aspect  of  the  patient,  the  con- 
dition of  the  tongue  and  the  acute  character  of  the 
onset.  Each  case  must  be  judged  on  its  merits, 
hut  it  is  giving  the  case  a  far  better  chance  of 
recovery  if  operation  is  done  as  soon  as  the  pre- 
dominant signs  and  symptoms  have  been  summed 
up,  and  not  to  wait  either  for  a  subsidence  of  the 
grave  signs,  or  for  the  appearance  of  such  classical 
-signs  as  are  to  be  found  in  the  text-books.  No 
surgeon  has  ever  regretted  opening  the  abdomen 
in  the  earliest  phase  of  this  disease,  for  he  in- 
variably finds  a  more  advanced  pathological  con- 
dition than  he  anticipated. 

SOME  CLINICAL 

ASPECTS  OF  DIPHTHERIA. 

By  CHARLES  E.  P.  FORSYTH,  M.B.,  M.RX.P.Lond., 
Formerly  Assistant  Mtdioal  Officer,  Eastern  Ferer  Hospital  (Metro- 
politan Asylums  Board),  Homerton,  London,  £0. 

The  early  diagnosis  of  infectious  disease  is  a  question 
of  supreme  importance  in  medical  practice.  In  all 
infections  it  is  important  for  the  sake  of  the  com- 
munity as  a  whole,  while  in  some,  in  addition,  early 
diagnosis  becomes  a  matter  of  urgency,  to  the  end  that 
the  course  of  the  disease  in  the  individual  may  be 
favourably  influenced  by  treatment.  Notably  is  this 
the  case  in  diphtheria,  where  the  early  administration 
•of  the  specific  antitoxin  has  been  found  to  mean  so 
much  in  leading  to  a  favourable  termination. 

It  cannot  be  necessary  at  this  time  of  day  to  state 
any  part  of  the  mass  of  evidence  that  exists,  proving 
chilly  that  the  earlier  in  the  disease  is  antitoxin  ad- 
ministered the  greater  are  the  patient's  chances  of 
Tecovery.  So  much  is  this  the  case  that  it  may  be  said, 
with  aU  safety,  that  given  immediate  diagnosis  and 
active  treatment  the  case-mortality  would  come  down 
to  practically  nil,  and  diphtheria  would  soon  cease 
to  be  the  much-dreaded  disease  it  is  at  present  in  the 
lay  mind.  The  table  compiled  by  MacCombie  from 
the  records  of  the  Brook  Fever  Hospital,  "  Metropolitan 
Asylums  Board  Reports,"  1902,  illustrates  this  in  a 
most  striking  and  convincing  way,  and  the  statistics 
by  Biggs  and  Guerard,  quoted  by  Northrup  in  Nothna- 
gel's  "  Encyclopaedia,"  bring  out  the  same  point  per- 
iectly. 

The  primary  lesion  in  diphtheria  may  be  faucial, 
nasal,  or  laryngeal.  From  any  of  these  points  the 
disease  may  spread  up  or  down,  as  the  case  may  be, 
and  may  ultimately  affect  the  whole  of  the  respiratory 
tract.  Faucial  diphtheria  is  the  most  common,  and 
the  next  in  frequency  is  faucial  combined  with  nasal. 
Then  may  be  placed  in  order  of  greater  occurrence 
faucial .  diphtheria  combined  with  laryngeal,  nasal 
•diphtheria,  and  laryngeal  diphtheria.  As  the  least 
common  of  the  group,  those  in  primary  tracheal  and 
bronchial  diphtheria  —  ascending  diphtheria ;  and 
this  is  said  when  it  occurs,  usually  to  follow  measles 
<Monti).  Conjunctival,  buccal,  valvar,  and  skin 
diphtheria,  while  not  very  uncommon,  are  comparatively 
tare. 

Faucial  diphtheria  is  the  type  from  the  present  point 
of  view,  and  •omitting  bacteriological  or  so-called 
41  catarrhal  **  -diphtheria,  it  may  be  divided  into  two 
varieties. 

It  may  wise,  first,  from  a  pure  infection  with 
the  Klebs-Loeffler  bacillus,  or  it  may  result,  secondly, 
from  a  mixed  infection,  and  then  is  due  to  septic 
organisms — strepto-  or  staphylococci-  acting  along 
with  the  specific  bacillus. 

The  clinical  signs  and  symptoms  differ  in  each  case. 
In  the  former  or  pure  form  on  examination  we  find  the 
typical  diphtheritic  throat,  snowing  at  first  a  thin, 
vhitish-grey  pedicle  on    one  or  both  tonsils,  which 


later  increases  in  thickness  and  tends  to  spread  in  all 
directions  from  its  edges.  The  well-recognised  features 
of  the  exudation  are  its  peculiarly  membranous 
character  and  its  liability  to  leave  a  somewhat  raw, 
bleeding  surface  on  the  mucous  membrane  with  rapid 
reformation  when  forcibly  removed.  Important,  also, 
to  observe  is  that  the  surrounding  inflammation  is  not 
at  all  commensurate  with  the  apparent  amount  of 
exudate.  The  inflammatory  reaction  is  small — there 
may  be  no  swelling  and  very  little  redness  of  the  neigh- 
bouring tissues.  The  only  abnormal  appearances  in 
the  throat  are  the  patch  or  patches  themselves,  and 
they  are  seemingly  superimposed  on  a  healthy  mucous 
membrane.  This,  of  course,  is  not  always  the  case, 
even  when  the  organism  present  is  pure  on  culture, 
but  it  is  so  in  the  majority  of  instances,  and  in  every  case 
it  can  be  seen  at  once  that  the  inflammatory  reaction 
relative  to  the  amount  of  exudate  is  extremely  small. 
Discharge  from  the  throat  is  scanty  or  absent,  and  the 
cervical  glands  may  or  may  not  be  enlarged.  They 
usually  are  affected,  but  never  to  any  great  extent. 
Most  frequently  they  are  little  more  than  palpable. 
The  temperature  may  be  normal,  and  is  of  no  value 
whatever  in  the  estimation  of  the  gravity  of  a  case. 

In  ordinary  mild  cases  the  symptoms  are  few,  and 
the  insidious  nature  of  the  disease  remarkable.  A 
child— or  even  an  adult — may  go  about  for  days  with 
quite  a  large  amount  of  membranous  exudation  in  the 
throat,  with  no  indications  symptomatic  of  its  presence. 
Finally,  some  slight  discomfort  in  swallowing  may  be 
complained  of,  and  only  on  examination  is  the  true 
state  of  matters  recognised.  Indeed,  the  onset  of 
paralysis  may  be  the  first  sign  that  the  patient  has 
lately  suffered  from  primary  diphtheria.  In  these 
cases,  then,  the  following  points  should  be  noted  in  the 
diagnosis — the  absence  or  slight  character  of  the  accome 
panying  inflammation  and  oedema ;  the  slight  glan- 
dular enlargement ;  the  trivial  pain  and  the  absenc- 
of  dysphagia ;  the  clean  or  thinly-coated  tongue ; 
the  absence  of  fever,  and  the  few  signs  of  constitutional 
disturbance.  Then  the  disease  can  be  readily  differ- 
entiated from  a  simple  acute  tonsillitis  ox  septic  sore 
throat. 

The  second  type,  that  of  a  mixed  infection,  presents 
greater  difficulty.  Here  the  diagnosis  of  diphtheria 
may  be  much  obscured  by  the  signs  and  symptoms 
of  a  septic  infection.  The  exudate  consists  largely  of 
a  quantity  of  soft,  loose  pultaceous  material,  and  it  may 
require  very  careful  examination  to  show  adherent 
membrane  in  any  part  of  the  affected  area.  It  is 
present,  however,  in  the  great  majority  of  cases,  and 
it  is  this  only  upon  which  reliance  can  be  placed  in 
reaching  a  diagnosis  clinically.  The  accompanying 
adenitis  is  severe,  not  infrequently  going  on  to  suppura- 
tion, an  event  common  in  scarlet  fever,  but  not  occur- 
ring in  pure  diphtheria.  Pain  may  be  very  severe, 
with  dysphagia  ;  the  temperature  high,  and  the  general 
constitutional  disturbance  great,  in  this  way  altogether 
simulating  a  pronounced  attack  of  acute  tonsillitis.  It 
is  in  these  cases  that  the  bacteriological  diagnosis  is  of 
the  utmost  value,  and  often  its  verdict  must  be  awaited 
before  a  decision  can  be  arrived  at.  The  presence  of 
anything  like  adherent  membrane  should  be  regarded 
with  the  greatest  suspicion,  and  there  is  no  question 
that  in  all  doubtful  cases  the  indication  is  to  inject 
antitoxin  at  once  in  proper  dose.  Waiting  for 
bateriological  report  may  be  only  a  waste  of  valuable 
time,  while  all  the  same  no  harm  can  be  done  if  the  report 
happens  to  be  negative.  The  absence  of  a  rash  would 
contra-indicate  scarlet  fever,  and  its  presence,  of  course, 
would  be  an  important  aid  in  the  diagnosis.  It  must 
always  be  borne  in  mind,  however,  that  the  two  diseases 
may  coincide  in  time  in  the  same  subject.  That  a  rash 
ever  occurs  in  diphtheria  itself,  unless  from  extraneous 
causes,  and  always  excepting  the  rash  of  the  haemor- 
rhagic  form  of  the  disease,  is  sufficiently  doubtful  to  be 
left  out  of  consideration.  The  rashes  described  have 
all  been  most  probably  septic  rashes,  occurring  in  cases 
due  to  a  mixed  infection.  It  seems  clear  that  the  fever, 
the  constitutional  disturbance,  the  marked  glandular 
enlargement,   and^the   inflammatory  reaction    f  the 


656    The  Mbdical  Pim,         ORIGINAL  COMMUNICATIONS. 


June  22,  1904. 


faucial  tissues  depend  on  the  number  of  septic  or- 
ganisms actively  present,  or  in  the  susceptibility  of  the 
patient  to  septic  invasion,  and  are  not  dependent  on  the 
presence  and  action  of  the  diphtheria  bacillus.  The 
toxaemia  of  pure  diphtheria,  though  it  is  devoid  of  the 
ordinary  septicemic  appearances,  is  none  the  less 
dangerous.  Its  intensity  is  directly  proportional  to  the 
amount  of  membranous  exudate  present,  putting 
aside,  that  is,  special  contributing  factors,  such  as  age ; 
the  mild  attack,  as  described  above,  with  only  a  thin, 
whitish  pedicle  on  one  or  both  tonsils,  though  it  may 
later  give  rise  to  considerably  severe  paralysis,  has 
usually  practically  no  constitutional  symptoms.  The 
exudate  may  increase,  however,  in  the  absence  of  treat- 
ment until  it  forms  thick,  leatherylplaques,  grey-white  in 
colour,  and  later  becoming  black  from  admixture  with 
blood.  As  it  increases  in  thickness,  so  also  it  spreads, 
and  before  long  may  involve  the  soft  palate  and  uvula, 
line  the  pharynx,  extend  up  into  the  nasal  fossa?,  and 
down  into  the  larynx.  It  may  ultimately  involve 
the  whole  of  the  respiratory  tract — spreading  into  the 
trachea,  bronchi,  and  bronchioles  into  their  smallest 
branches,  and  thence  into  the  alveoli,  producing  broncho- 
pneumonia. The  hard  palate,  buccal  mucous  mem- 
brane, or  oesophagus  are  rarely  attacked.  It  is  very 
true  that  in  diphtheria  the  apparent  amount  of  exudate 
often  gives  no  idea  whatever  of  the  real  amount 
actually  present.  Clinical  examination  shows  mem- 
brane on  the  tonsils,  perhaps  also  on  the  anterior 
surface  of  the  soft  palate,  the  uvula,  and  the  base  of 
the  tongue,  but  it  is  only  post-mortem  that  we  see  the 
full  extent  of  the  affected  area  in  these  bad  cases.  Here 
the  diagnosis  is  only  too  plain — even  apart  from  the 
faucial  appearances.  The  general  toxaemic  symptoms 
are  distinctive,  and  not  at  all  of  a  septic  type.  The 
patient  is  pale — later  becoming  of  a  waxy  hue,  or  of  an 
ashy  grey  colour.  The  skin  is  cold,  the  temperature 
is  normal,  or  subnormal,  and  the  general  depression  is 
extreme.  The  heart's  action  is  irregular  in  rhythm 
and  force,  and  evidence  of  dilatation  is  soon  present. 
The  disturbance  of  the  cardiac  rhythm  is  profound. 
The  pulse  may  be  slow  or  frequent,  but  is  always  most 
irregular,  or  very  soon  becomes  so.  There  is  diminu- 
tion in  the  quantity  of  urine — which  may  go  on  to 
complete  suppression — and  there  is  albuminuria. 
Vomiting  that  is  quite  uncontrollable  may  come  on 
from  the  fifth  to  the  eighth  day,  and  in  the  worst  cases 
there  are  subcutaneous  haemorrhages  scattered  in  the 
trunk  and  limbs,  epistaxis,  and  bleeding  from  the 
bowel  and  vagina. 

The  child  vomits  and  retches  almost  continuously, 
and  when  it  occurs  at  this  period  of  the  disease  vomiting 
is  absolutely  indicative  of  a  fatal  issue.  Albumin  in 
the  urine  is  present  in  large  amount.  It  occurs  in  all 
but  the  mildest  cases,  and  usually  appears  about  the 
fourth  day.  The  quantity  of  albumin  is  of  the  utmost 
Significance  as  regards  prognosis.  It  is  usually  in 
direct  proportion  to  the  amount  of  membrane.  In 
the  rapidly  fatal  cases  of  pronounced  toxicity,  with 
vomiting  and  early  cardiac  involvement,  it  is  always 
present  in  large  amount,  but  in  cases  of  less  severity, 
when  albumin  occurs  in  any  quantity,  one  may  be 
certain  that  paralysis  will  follow  later — that  the  patient, 
though  surviving  the  early  toxaemia,  will  most  surely 
have  to  face  the  late  effects  and  the  larger  amount, 
and  the  more  persistent  the  albuminuria,  the  more 
severe  will  the  paralysis  be.  The  cases  that  die  from 
the  eighth  to  the  thirteenth  day  may  be  said  to  do  so 
from  an  "  early  paralysis."  There  seems  no  doubt  that 
the  cardiac  state,  the  vomiting,  and  the  profound 
depression  are  due  to  the  overwhelming  action  of  one  or 
other  of  the  diphtheritic  toxins  on  the  nervous  system, 
in  all  probability  to  its  direct  action  on  the  medullary 
centres.  The  albuminuria  that  occurs  in  so  many  cases, 
and  the  distinctive  purpuric  eruption  and  bleeding  from 
the  mucous  membrane  of  the  haemorrhagic  form,  seem 
to  be  due  to  an  additional  toxin,  or  perhaps  the  same, 
acting  directly  on  the  blood.  If  the  patient  gets  over 
the  thirteenth  day,  he  will  probably  recover,  though, 
it  may  be,  only  to  succumb  to  the  paralysis  that  is  bound 
totf oilow  on  all  these  pronounced  cases.     The  prognosis, 


however,  even  in  the  worst  cases  of  paralysis,  is  nofby 
any  means  hopeless.  Cases  with  the  typical  persistent 
vomiting  and  anuria,  or  haemorrhagic  cases/always 
die  before  then — usually,  from  the  seventh  to  the 
twelfth  day. 

Attacks  due  to  a  pure  infection  occur  in  all  degrees 
of  severity,  as  also  do  cases  due  to  a  mixed  infection"; 
and  whether  the  specific  toxic  or  septic  symptom  pre- 
dominates is  due  to  the  greater  abundance,  or  to  the 
greater  virulence,  of  the  respective  organisms,  or  perhaps 
in  some  instances  to  the  special  idiosyncrasy  of  the 
patient.  In  both  classes  the  administration  of  diph- 
theria antitoxin  is  the  great  indication,  absolutely  so  in 
pure  diphtheria,  and  to  a  very  great  extent  so  in  the 
mixed  cases.  It  is  in  pronounced  septic  cases  that  it  is 
least  likely  to  be  of  great  value,  but  even  then  when- 
given  early  it  works  wonders  by  almost  at  once  closuring 
the  action  of  the  diphtheria  bacillus,  but  it  would  seem 
even  that  in  these  cases  antistreptococcic  or  anti- 
staphylococcic  serum  should  be  given  also.  Probably 
this  would  not  be  very  advantageous  in  many  cases, 
considering  the  present  imperfect  state  of  the  coccat 
sera,  but  it  would  be  so  in  some,  at  least,  and  should 
be  tried  in  all,  where  the  diphtheria  antitoxin  does  not 
seem  to  give  early  relief. 

In  the  majority  of  anything  like  pronounced  attacks 
of  faucial  diphtheria,  the  nasal  passages  are  affected  at 
the  same  time,  but  nasal  diphtheria  may  occur,  and  does 
occur,  quite  frequently  without  any  implication  of  the 
fauces.  Often  the  membrane  can  be  readily  seen  on 
inspection  of  the  anterior  nares,  or  portions  of  mem- 
brane may  come  away  in  whole  or  partial  coats  of  the 
fossae.  In  other  cases  neither  of  these  signs  may  be- 
present,  and  the  only  evidence  obtainable  may  be  a 
nasal  discharge.  The  rhinorrhoea  in  diphtheria  is  at 
first  of  a  thin,  acrid  nature  and  readily  excoriates  the 
anterior  nasal  orifices  and  upper  lip.  Later  it  tends  to 
become  thicker,  and  more  muco-purulent  in  appearance, 
and  at  this  stage  it  is  often  blood-stained,  while  epistaxis 
is  quite  common.  The  distinction  between  epistaxis. 
of  this  kind,  due  probably  to  separation  of  membrane, 
and  the  epistaxis  occurring  in  pronounced  toxaemic  or 
haemorrhagic  cases,  should  be  noted.  Still  later  the 
discharge  becomes  again  watery,  and  it  is  during  all  its 
course  highly  infectious.  Indeed,  it  is  this  discharge- 
which  seems  the  most  fertile  cause  of  the  spread  of  the 
infection,  and  as  long  as  it  continues  to  the  slightest 
degree  the  patient  should  be  rigidly  isolated.  Cases 
of  persistent  rhinorrhoea  of  this  character  should  be 
viewed  with  the  greatest  suspicion,  and  a  bacteriological 
report  sought  early.  In  the  many,  rhinoscopic  or 
laryngoscopy  examination  of  the  posterior  nares  would 
reveal  membrane,  but  these  methods  are  difficult,  often 
impossible,  of  application  in  children. 

The  same  remark  as  to  the  difficulty  of  laryngoscopic 
examination  in  cases  of  suspected  laryngeal  diphtheria, 
without  obvious  implication  of  the  fauces,  is  quite  as 
true.  In  the  majority  of  cases  of  "  croup  "  it  is  im- 
possible, indeed,  to  state  exactly  whether  the  symptoms, 
are  due  to  membranous  or  congestive  obstruction.  In 
the  case  of  the  laryngitis  of  measles,  occurring  as  it 
does  in  the  catarrhal  stage  of  the  disease,  before  the- 
advent  of  the  rash,  the  presence  of  Koplik's  spots  is  a 
most  useful  sign,  and  in  all  cases  of  laryngeal  obstruction, 
without  the  appearance  of  diphtheritic  membrane  on 
the  fauces,  or  without  an  obvious  cause,  these  should  be* 
looked  for  as  a  routine  measure.  The  differentiation 
of  diphtheritic  laryngitis  from  the  laryngitis  of  measles- 
is  important,  of  course,  from  the  point  of  view  of  their 
specific  infectivity,  and  it  is  also  important  from  the- 
point  of  view  of  treatment  if  the  case  progresses  so  as  to 
require  operation.  Tracheotomy  is  equally  well 
applicable  to  both  forms,  whether  to  membranous  or 
congestive  laryngitis,  but  intubation,  which  is  so  valu- 
able in  the  former,  used  always  in  conjunction  with 
antitoxins,  is  of  little  use  in  the  latter.  In  almost 
every  case  it  fails  to  give  relief,  and  recourse  has  to  be 
had  very  soon  to  tracheotomy.  Measles  being  excluded* 
it  is  a  good  rule  in  a  child  to*  consider  and  treat  as- 
diphtheritic  every  case  of  laryngitis  that  is  in  any  way 


JUNE  32,    I9O4. 


ORIGINAL  COMMUNICATIONS. 


Th»  Medical  Press.    657 


progressive.     Antitoxin    should    be    given    early    in 
large  doses,  and  soon  repeated  if  at  all  necessary. 

The  whole  treatment  of  the  disease  is  summed  up  in 
the  one  word — antitoxin.  Special  local  applications  to 
the  throat  are  all  now  things  of  the  past.  Any  one 
or  any  variety  of  lotion  or  spray  may  be  used  which 
fancy  dictates — while  we  always  recognise  that  they 
are  useful  only  mechanically — to  wash  away  dtbris 
and  to  cleanse  from  mucus.  Thus,  plain  warm  water 
or  a  simple  alkaline  lotion  is  as  valuable  as  any,  and 
has  the  advantage  of  doing  least  harm  if  the  youthful 
patient  swallows  the  fluid,  an  event  which  is  not 
uncommon. 


Paris  Clinical  Xectures. 

p  ri  mary"¥uscular 

TUBERCULOSIS    WITH 
MULTIPLE    DISTRIBUTION. 

By  Professor  F.  LEJARS,  M.D., 

Snrffton  to  the  Paris  Hospital*. 

[specially  reported  for  this  journal.] 

It  must  be  understood  that  this  term,  "  muscular 
tuberculosis,"  is  to  be  construed  in  a  purely  clinical 
sense  because,  although  the  tuberculous  foci  are  em- 
bedded in  the  muscle  substance,  although  they  simu- 
late muscle  tumours  properly  so  called,  histological 
research  has  conclusively  proved  that  the  muscle  fibre 
is  not  the  initial  habitat  of  the  pathogenic  germ  nor 
the  seat  of  the  specific  lesions,  and  that  the  "  tubercle," 
the  tuberculous  gumma,  starts  and  develops  in  reality 
in  the  connective  tissue  of  the  perimysium.  This 
point  possesses  more  than  a  merely  pathological  in- 
terest, since  it  confirms  the  view  as  to  the  special  re- 
sistance of  "  muscle  "  to  the  tubercle  bacillus.  I  shall 
show  that  the  form,  the  evolution,  and  the  prognosis 
of  intra-muscular  tuberculosis  furnishes  many  proofs 
of  this  resistance,  and  it  even  paves  the  way  to  certain 
operative  indications. 

Nor  is  there  any  reason  to  suppose  that  tuberculosis 
of  the  muscles  is  ever  really  primary :  the  term  is  of 
purely  clinical  significance.  It  stands  in  the  same 
rank  as  the  current  terms  primary  tuberculosis  of  the 
glands,  joints,  and  bones.  It  emphasises  the  distinc- 
tion between  the  two  forms  of  tuberculous  myositis — 
secondary  myositis  by  invasion,  which  is  rare,  and  the 
so-called  primary  myositis.  These  tuberculous  gummata 
of  the  muscles  start  and  develop  independently 
of  other  foci,  and  subsequently  assume  the 
characters  of  a  distinct  morbid  entity.  That  even  in 
the  most  circumscribed  types  there  must  have  been  an 
initial  infective  lesion,  distant  it  may  be  and  obscure, 
cannot  be  doubted  ;  nevertheless  the  so-called  primary 
tuberculosis  of  the  muscles  presents  a  clinical  aspect  of 
its  own,  and  requires  to  be  studied  closely  in  order  to 
be  recognised. 

A  man,  aet.  53,  strongly  built  but  thin  and  pale,  was 
admitted  in  March  last  to  be  operated  upon  for  a  series 
of  tumours  distributed  in  the  manner  I  shall  describe. 
When  aet.  46,  he  had  "  inflammation  of  the  lungs," 
and  since  then  he  has  coughed  during  the  winter.  Some 
months  since  he  began  to  have  night  sweats,  but  he 
has  never  spat  blood,  and  on  auscultation  only  a  little 
crackling  is  audible  at  the  apices. 

Five  months  ago,  without  any  traumatism  or  other 
assignable  cause,  he  noticed  a  small,  hard  induration 
on  the  antero-superior  surface  of  the  right  thigh.  At 
first  it  increased  rapidly  in  size,  then  remained  sta- 
tionary for  a  time,  having  attained  the  size  of  a  child's 
fist.  At  about  the  same  time  a  similar  localised  in- 
duration made  its  appearance  on  the  upper  and  inner 
side  of  the  left  thigh ;  the  latter  did  not  increase  much 
in  size,  indeed,  the  patient  is  under  the  impression 
that  it  became  smaller  after  a  few  weeks.  Ten  days 
later  a  third  nodule  on  the  upper  and  outer  surface  of 
the  right  forearm  made  its  appearance,  just  below  the 
elbow,  which  grew  rapidly  to  the  size  of  an  apple,  then 
softened  and  became  red.  A  fortnight  later  a  fourth 
nodule  appeared  on  the  posterior  surface  ol  the  lower 


third  of  the  left  arm,  which  soon  attained  the  size  of 
an  egg,  causing  some  pain  and  functional  disturbance. 
Matters  had  proceeded  thus  far  on  his  admission 
to  hospital.  The  "  tumours  "  all  presented  the  same 
general  characters.  They  were  not  adherent  either  to 
the  skin  or  to  the  subjacent  bone.  They  were  mani- 
festly intra-muscular,  movable,  were  situated  trans- 
versely, and  became  harder  and  fixed  when  the  muscle 
was  made  to  contract.  The  tumour  on  the  right  thigh, 
which  measured  ten  centimetres  in  length  and  six  in 
width,  had  undergone  softening  and  was  obscurely 
fluctuating  when  the  muscle  was  relaxed  ;  that  on 
the  right  forearm  was  prominent,  ovoid  in  shape,  and 
covered  with  reddened  skin,  not,  however,  adherent. 
It  appeared  to  be  embedded  in  the  mass  of  the  long 
supinator  muscle,  and  was  clearly  fluctuating.  That 
in  the  left  arm  was  hard,  of  somewhat  irregular  outline 
and  apparently  situated  in  the  triceps  brachialis;  it 
moved  upwards  and  downwards  with  the  contraction 
of  the  muscle.  The  nodule  in  the  left  thigh,  the  size 
of  the  thumb,  elongated  and  hard,  followed  the  course 
of  the  internal  rectus,  with  which  it  was  identified. 
The  intra-muscular  distribution,  the  consistence,  the 
slow  evolution,  and  the  concomitant  condition  of  the 
lungs  in  this  case  suggested  to  me  at  once  the  dia- 
gnosis of  multiple  muscular  tuberculosis,  recalling  as 
it  did  other  cases  of  the  kind  to  which  I  shall  presently 
refer. 

On  March  28th,  I  extirpated  all  these  "  tubercles  " 
en  bloc,  and  you  will  note  that  each  of  them  was  im- 
bedded in  muscle  and  was  covered  by  the  aponeurosis- 
still  intact.  The  wounds  all  healed  without  com- 
plication. 

The  bacteriological  and  histological  examination 
confirmed  my  view  as  to  the  nature  of  these  tumours. 
They  contained  numerous  tubercle  bacilli  and  on 
section  one  sees,  from  within  outwards,  a  layer  of 
embryonic  tissue  with  disseminated  tuberculous  follicles, 
some  of  which  contained  well-marked  giant-cells.  This 
zone  was  continuous  with  a  fibrous  layer,  also  infil- 
trated with  embryonic  cells,  these  cells  being  arranged' 
principally  along  the  vessels,  which  were  thickened  and 
sclerosed.  Externally  was  muscular  tissue,  the  fibres 
most  adjacent  being  atrophied,  degenerated,  and 
segmented,  some,  indeed,  having  undergone  total 
destruction.  Further  afield  the  muscle  fibres  were* 
normal. 

I  would  point  out  that  in  every  case  of  the  kind  it  is 
indispensable   that    the   tissues   should   be   examined) 
microscopically  for  "  cold  "  intra-muscular  abscesses,, 
that  is  to  say,  indolent  collections  running  a  chronic 
course    are  not  always  tuberculous.     In  the  absence 
of  such  histological  examination  a  certain  number  of 
cases  which  appear  to  fall  into  this  category  cannot  be 
utilised    because    the    observations    are    incomplete. 
Nevertheless,  the  history  of  muscular  tuberculosis  is 
now  established  on  sufficiently  trustworthy  data  to 
possess  a  clinical  and  anatomo-pathological  individua- 
lity of  its  own.     Three  varieties  are  usually  described, 
the  gumma,   the  cold  abscess,   and   the  tuberculous 
infiltration.     The    first    two    represent    the    normal 
evolution  of  the  tuberculous  nodule,  at  first  "  crude," 
hard,   and   compact,   then  undergoing  softening  and 
abscess  formation  ;    the  third,  of  much  rarer  occur- 
rence, manifests  a  remarkable  tendency  to  confluence 
of  the  nodules,  which  ultimately  invade  the  muscle 
extensively  or  it  may  be  entirely.     Here  again,  there 
are  consecutive  stages  and  intermediate  varieties,  and 
alongside  this  infiltration  en  masse  may  be  placed  the 
form  of  tuberculosis  with  large,   multiple,   confluent 
nodules.     In  one  of  my  cases  the  entire  supra-patellar 
region,   for  a  distance  of  five  fingers'   breadth,  was 
strewn  with  nodules  the  size  of  a  hazel  nut/ an*olive, 
or  a  pea,  rounded  or  ovoid,  which  underwent! harden- 
ing, fixation,  and  became  less  perceptible  when  the 
muscle  was  contracted.     When  I  raised  a  large  flap 
of  skin,  exposing  to  view  the  tendon  of  the  triceps  and 
the  lower  part  of  the  two  vasti,  it  was  seen  that  the 
muscle  substance,  both  within  and  without,  outside 
the   tendon,  was  permeated  by  nodules,  some  hard, 
yellow,  and  crude,  others  softened  and  caseous.     One 


658    Tax  Medical  Pmi  ORIGINAL  COMMUNICATIONS. 


June  22,  1904, 


large  nodule  was  situated  in  the  substance  of  the  tendon 
itself,  while  to  its  inner  side  several  large  caseous 
masses  had  coalesced  and  stood  out  prominently, 
occupying  the  whole  of  the  corresponding  part  of  the 
vastus.  I  freely  removed  the  infiltrated  zone,  cutting 
through  the  muscle,  and  I  enucleated  the  large  nodule 
in  the  tendon.  The  specimen  was  examined  by  Pilliet, 
who  based  thereon  a  description  of  muscular  tuber- 
culosis which  has  not  since  been  modified.  You  will 
remember  that  he  described  tuberculosis  of  the  large 
connective  tissue  spaces  of  the  muscle,  lesions  of  the 
muscle  bundle  itself,  and  lesions  of  the  muscle  fibre. 
It  is  in  these  peri-  and  intra-muscular  connective  tissue 
spaces  that  tuberculosis  starts  and  spreads.  It  follows 
particularly  the  vasculo-nervous  sheaths  which  fill  these 
spaces,  and,  as  elsewhere,  it  is  much  less  pronounced 
around  the  arterioles.  The  tendons  are  attacked 
through  their  meso-tendons,  the  tuberculous  infiltra- 
tion following,  as  it  always  does,  the  blood-vessels. 
The  invasion  of  the  muscle  bundles  follows  the  same 
course,  the  sheath  of  the  central  artery  of  the  bundle 
becomes  thickened,  then  the  arteriole  itself ,  and  around 
it,  in  the  centre  of  the  bundle,  accumulate  a  large 
number  of  embryonic  cells  with  large  nuclei.  They 
form  a  nodule  which  surrounds  the  vessel,  though 
usually  more  on  one  side  than  the  other.  The  nearest 
muscle  fibres  are  invaded  and  isolated,  and  soon  dis- 


a  large  tumour  of  the  right  thigh.  It  was  deeply  seated, 
intra-muscular,  and  not  adherent  to  the  skin ;  tense, 
almost  hard,  but  vaguely  fluctuating.  Pressure  was 
painful,  there  was  marked  interference  with  movement, 
and  it  rapidly  increased  in  size.  He  first  noticed  it  in 
the  previous  September,  and  I  ascertained  that  in 
April  he  had  had  typhoid  fever,  from  which  he  was  con- 
valescent early  in  Tune.  Although  nothing  was  com- 
plained of  in  the  thigh  for  three  months  we  felt  justi- 
fied in  ascribing  the  abscess  to  the  attack  of  typhoid 
fever.  On  December  10th,  I  opened  the  abscess,  which 
was  deeply  seated  in  the  muscular  mass  beneath  the 
aponeurosis  and  separated  by  a  layer  of  muscle  from 
the  periosteum.  It  had  no  connection  with  the  bone 
or  the  joint.  The  pus  proved  to  contain  a  true  culture 
of  the  Eberth  bacillus,  and  the  patient's  serum  deter- 
mined well-marked  agglutination.  After  complete 
recovery  from  the  abscess  the  agglutinating  property 
of  the  serum  remained  the  same. 

In  presence  of  the  multiple  tuberculous  myositis  the 
difficulties  are  somewhat  different.  In  a  case  reported 
by  Habermaas,  a  man,  aet.  54,  thought  to  be  suffering 
from  Pott's  disease,  presented,  on  the  limbs  and  trunk, 
a  dozen  or  more  small  tumours  which  were  imbedded 
in  muscle.  These  were  removed  and  found  to  be 
tuberculous,  several  being  caseous.  In  a  case  of  M. 
Delorme's  the  pect oralis  was  first  invaded,  then  the 


appear  in  the  nodule,  and  thus  we  get  a  tuberculous  j  right  brachial  triceps  in  its  entirety,  then  the  anterior 


nodule,  without  giant-cells  of  connective  tissue  origin 
and  without  epithelioid  cells. 

Lastly,  the  muscle  fibre  itself  is  subject  to  three 
distinct  lesions — atrophy  pure  and  simple,  swelling 
with  loss  of  muscular  fibrillation  and  transformation 
into  cells  with  multiple  nuclei.  To  recapitulate,  we 
see,  first  of  all,  the  connective  tissue  invaded,  with  the 
formation  of  small  cavities,  then  the  muscle  bundle, 
and,  last  of  all,  transformation  of  the  fibre  proper. 

The  invasion  starts  and  develops  around  the  vessels, 
a  fact  which  confirms  the  haematogenous  origin  of 
muscular  tuberculosis  ;  it  does  not  originate  in  a  local 
infection,  for  the  infection  obviously  reaches  the  muscle 
vid  the  circulation.  This  mechanism,  of  course,  infers 
the  existence  of  a  distant  focus  of  infection  to  account 
for  the  metastatic  dissemination  and  the  formation  of 
multiple  muscular  tuberculosis. 

But  how  are  we  to  explain  this  unexpected  "  fixa- 
tion "  in  a  particular  muscle  without  obvious  cause, 
without  any  history  of  traumatism,  &c.  ?  This  ques- 
tion does  not  admit  of  a  plausible  answer.  It  may  be 
remarked,  however,  that  tuberculosis  displays  a  pre- 
ference for  the  "  working  "  muscles,  the  muscles  upon 
which  fall  the  burden  of  life — the  anterior  rectus  cruris, 
the  brachial  triceps,  the  supinator  longus,  the  palmaris 
longus,  the  deltoid,  &c. ;  also  that  the  tuberculous 
nodule  not  infrequently  originates  in  or  near  the  ex- 
tremity of  the  muscle  just  where  the  muscle  blends 
with  the  tendon.  These  two  facts  appear  to  authorise 
the  conclusion  that  rupture  and  detachment  of  the 
fibres  may  not  improbably  prepare  the  way  for  infec- 
tion. 

However  this  may  be,  it  is  the  mono-muscular 
gumma  or  cold  abscess  that  is  mostly  observed,  and 
that  has  served  as  the  basis  of  most  descriptions.  It 
may  be  well  for  me  to  mention  en  passant  the  dia- 
gnostic difficulties  to  which  they  may  give  rise.  Even 
if  the  muscular  "  tumour  "  is  distinctly  isolated,  moves 
with  the  muscle,  is  free  from  adhesions  to  the  bone, 
glands,  and  skin,  several  hypotheses  suggest  them- 
selves. It  may,  for  instance,  be  a  hydatid  cyst, 
sarcoma,  or  fibro-sarcoma,  lipoma  or  a  syphilitic 
gumma.  We  must  not  forget  either,  certain  other 
chronic  indolent  intra-muscular  collections  which  recall 
word  for  word  the  classic  cold  abscess.  I  am  referring 
to  old  suppurating  haematomata,  with  thick  capsule, 
deeply  buried  in  the  muscle,  the  origin  of  which  is  often 
quite  forgotten,  dating,  as  it  may  do,  months  or  years 
back.  This  form  is  by  no  means  uncommon.  Then, 
too,  there  are  the  "  Eberthian  "  abscesses  consecutive 
to  an  attack  of  typhoid  fever,  long  since  it  may  be. 
I  remember  the  case  of  a  young  man,  aet.  20,  admitted 
to'the  Beaujon  Hospital  on  December  4th,  1897,  w*tn 


muscles  of  the  left  forearm.  The  disease  subsequently 
became  generalised  and  the  patient  succumbed  a  year 
later. 

Dr.  Zeller  records  a  case  of  a  girl,  aet.  9,  suffering 

from  strumous  eczema,  who,  for  three  months,  had  had 

a  fistulous  abscess  of  the  thumb.     In  the  course  of 

four  or  five  weeks  a  number  of  intra-muscular  tumours 

made  their  appearance  in  different  parts  of  the  body, 

and  some  of  them  were  removed.     They  proved  to  be 

intra-muscular,  with  a  layer  of  muscular  tissue  on  their 

under  surface,   and   covered   by   aponeurosis  outside. 

j  Histologically  they  proved  to  be  tuberculous.     She  re- 

'  covered  and  remained  free  from  recurrence  for  at  least 

I  ten  months. 

j  In  this  case  the  history  facilitated  the  diagnosis,  but 
very  frequently  no  such  assistance  is  forthcoming,  and 
the  difficulty  of  the  diagnosis  is  correspondingly  in- 
creased. Take,  for  instance,  the  case  recorded  by  Dr. 
Steinbach.  In  February,  1900,  a  first  nodule  appeared 
on  the  front  of  the  right  thigh  in  the  triceps,  which 
rapidly  grew  to  the  size  of  a  fist ;  another  nodule 
appeared  a  few  days  later  on  the  right  leg,  above  the 
external  malleolus,  and  at  about  the  same  time  a  third 
made  its  appearance  just  opposite  the  elbow  in  the 
supinator  longus.  The  patient's  general  condition  was 
good.  They  discussed  the  chances  of  the  tumours 
being  due  to  sarcoma,  actinomycosis,  syphilis,  lyra- 
phangitic  collections  and  tuberculosis,  without  being 
able  to  arrive  at  a  definite  conclusion.  On  April  7th 
some  of  the  tumours  were  extirpated  and  were  found 
to  be  tuberculous,  but  in  May  and  June  other  nodules 
appeared,  and  in  July  five  more  were  excised.  The 
metastatic  process  continued  nevertheless,  and  further 
tumours  were  removed  in  November,  and  then  only 
did  the  process  appear  to  have  come  to  an  end. 

The  very  multiplicity  of  the  tumours  constitutes  an 
important  element  in  the  diagnosis.  An  outbreak  of  sar- 
comatosis  or  multiple  hydatid  cysts — rare  occurrences, 
both  of  them — could  hardly  occur  without  marked 
depreciation  of  the  general  health ;  moreover,  the 
variable  consistence  of  the  different  nodules,  the 
softening  and  fluctuation  of  some,  the  resistance  and 
firm,  irregular  surface  of  others,  afford  data  which, 
intelligently  observed,  will  greatly  assist  in  the  dia- 
gnosis. If  required,  the  exploratory  puncture  of  one 
of  the  fluctuating  nodules  will  enable  us  to  decide  the 
question  of  diagnosis,  and,  incidentally,  to  discard  the 
hypothesis  of  its  being  a  case  of  actinomycosis.  The 
fact  remains,  however,  that  the  clinical  interpretation 
is  often  of  exceeding  difficulty,  and  for  that  reason  it  is 
well  to  direct  one's  attention  more  particularly  to  this 
form  of  muscular  tuberculosis  with  multiple  distri- 
bution. 


■  JoNK  33,   IgOj. 


THAKSACTIONS  OF  SOCIETIES.      Th«  Midicai.  Ptsss.  '«$ 


You  would  be  wrong  in  inferring  from  the  appearance 
of /generalised  infection  that  this  form  is  one  of  any 
special  malignity.  Obviously  it  is  a  very  grave  mani- 
festation when  it  occurs  at  an  advanced  stage  of  pul- 
monary or  peripheral  tuberculosis,  and  under  any  cir- 
cumstances the  "  massive  "  form  of  tuberculous  poly- 
myositis, described  by  Delorme,  is  of  grave  significance. 
In  the  ordinary  form  of  gummata  or  cold  abscesses  you 
will  have  seen  from  the  cases  I  have  related  that  it  may 
be,  and  remain,  inactive  for  long  periods,  or,  at  any  rate, 
appear  to  do  so,  in  the  sense  that  it  is  not  associated 
with  any  other  obvious  bacillary  localisation,  and  is  not 
incompatible  with  robust  general  health.  You  must, 
however,  bear  in  mind  that  even  in  these  cases  the 
so-called  primary  muscular  tubercles  must  somewhere 
have  a  common  starting-point,  an  initial  focus  which 
remains  to  be  discovered,  that,  in  fact,  there  is  always 
tuberculosis  "  elsewhere  "  which  must  be  sought  for. 
Even  admitting  the  metastatic  origin  of  these 
tumours,  we  need  not  on  that  account  hold  our  hands, 
for  the  contra-indication  which,  in  regard  to  certain 
neoplasms,  results  from  their  generalisation  does  not 
here  hold  good.  We  ought  always  to  remove  these 
tumours,  whether  single  or  multiple  ;  that  is  the  lesson 
taught  by  recorded  observations.  The  operation, 
indeed,  is  now  almost  a  matter  of  routine.  We  must 
not  scrape  or  curette,  but  remove  the  tumour  or  nodule 
en  bloc  by  cutting  through  muscle  fibre.  We  must  not 
shrink  from  excising,  where  necessary,  large  pieces  or 
sheets  of  muscle  ;  we  make  good  the  loss  of  substance 
to  the  best  of  our  ability,  and  the  removal  of  even  large 
portions  of  muscle  does  not  usually  determine  serious 
functional  trouble.  We  ought,  indeed,  to  take  advan- 
tage of  the  isolation  and  position  of  these  intra-mus- 
cular  tumours  to  practise  their  complete  ablation,  for 
if  left  they  will  not  remain  indefinitely  intra-muscular. 
They  may  invade  and  perforate  the  aponeurosis,  and 
spread  into  the  subcutaneous  planes ;  sometimes,  too, 
they  run  along  the  muscle  to  the  tendon  and  the  sheath, 
and  vid  the  tendon  to  the  neighbouring  synovial  sac. 

The  total  and  complete  ablation  of  "  muscular 
tubercles"  appears,  therefore,  to  be  perfectly  justifiable, 
whatever  their  number,  and  the  operation  must  be 
repeated  should  a  further  outburst  take  place  after  the 
excision  of  the  first  series.  Without  losing  sight  of  the 
pathological  significance  of  their  metastatic  origin,  we 
must  remember  that  we  are  dealing  with  strictly 
localised  tuberculous  lesions,  which  admit  of  ready 
removal,  and  that  the  patient  has  everything  to  gain 
from  their  removal  since  even  the  original  focus  of 
infection  wiU  stand  a  better  chance  of  recovery  thereby. 


Clinical  Uecor&s* 


THREE  INSTRUCTIVE  CASES  OF  HEAD  INJURY. 

By    Stephen    J.    Ross,    M.D., 

Assistant  Surgwm  to  the  Bedford  County  Hospital. 

The  three  following  cases  of  head  injury  are  not 
without  points  of  interest,  and,  I  think,  are  worthy  of 
record  : — 

A  faseof  Laceration  of  the  Frontal  Lobes  of  the  Brain. — 
Hyperpyrexia. 

The  patient  was  a  man,  aet.  72,  who  fell  from  a 
ladder  a  distance  of  eight  feet  upon  the  back  of  his 
head.  For  three  days  he  developed  no  symptoms, 
then  his  temperature  rose  to  1040,  and  continued  to 
rise  until  a  temperature  of  1070  was  registered.  There 
was  no  paralysis.  Cold  sponging  had  no  effect  in 
reducing  the  temperature.  Coma  supervened  and  the 
patient  died.  Post-mortem,  an  extensive  laceration 
of  both  frontal  lobes  of  the  brain  was  discovered. 
There  was  no  fracture  of  the  skull. 
Case  of  Fracture  of  the  Middle  Fossa  of  the  Base  of  the 

Skull. — Apparent  Recovery. — Suicide  by  Drowning. 

The  patient  was  a  man,  set.  45,  who  fell  from  a  cart. 
When  first  seen  he  was  concussed.  There  was  bleeding 
and  escape  of  cerebro-spinal  fluid  from  the  left  ear. 
He  had  evidently  fractured  the  middle  fossa  of  the 
base  of  ,the  skull.  He  was  kept  in  bed  for  eight  weeks, 
and  in  hospital  four  weeks  subsequently.     When  he 


left  hospital  he  had  apparently  recovered  completely. 
A  week  after  leaving  hospital  he  developed  suicidal 
tendencies,  and  his  wife  sought  his  re-admission  to 
hospital.  She  was  promised  immediate  admission. 
However,  when  his  wife  returned  home,  she  discovered 
that  he  had  taken  the  law  into  his  own  hands,  and 
drowned  himself  in  the  river.  There  was  no  history 
of  alcoholism  in  this  case,  as  the  man  had  been  a  life- 
long total  abstainer. 
Case  of  Severe  Kick  of  Head  with  Facial  Paralysis. 

The  third  case  is  that  of  a  patient,  set.  54,  who  was 
thrown  from  the  shaft  of  his  cart,  and  then  kicked 
upon  his  head  by  the  horse.  When  I  saw  him  he 
was  unconscious,  and  blood  and  cerebro-spinal  fluid 
were  escaping  from  both  ears.  This  discharge  lasted 
for  ten  hours,  when  he  gradually  recovered  conscious- 
ness. He  was  kept  in  bed  and  placed  upon  a  mUk  diet. 
Twenty-one  days  after  his  accident  he  developed  left- 
sided  facial  paralysis,  which  cleared  up  entirely  in 
two  months.  His  recovery  was  complete.  Now  at 
(he  end  of  twelve  months  he  is  perfectly  well.  For 
nine  months  after  the  accident  he  was  greatly  troubled 
with  occipital  headache.  This  symptom  has  entirely 
disappeared. 

Remarks. 

The  first  case  is  of  interest,  1  think,  (1)  on  account 
of  the  severe  laceration  of  the  brain  without  fracture 
of  the  skull ;  (2)  on  account  of  the  delayed  onset  of 
symptoms ;  (3)  on  account  of  the  persistent  and  fatal 
hyperpyrexia ;  (4)  on  account  of  the  position  of  the 
lesion — by  contrecoup. 

The  second  case,  I  think,  is  a  warning.  It  proves 
how  very  careful  we  must  be  in  our  treatment  of 
cases  of  fracture  of  the  base  of  the  skull.  It  is  not 
infrequent  for  such  cases  to  develop  complications  a 
long  time  after  the  injury.  Melancholia  is  by  no  means 
a  rare  sequela.  Quite  recently  I  have  been  acquainted 
with  a  case  of  fracture  of  the  middle  fossa  of  the  base 
of  the  skull,  in  which  the  initial  symptoms  were  very 
slight.  Rest  was  maintained  for  six  weeks,  and  the 
patient  apparently  completely  recovered.  A  fort- 
night after  his  apparent  return  to  normal,  he  suddenly 
developed  coma,  and  died  within  forty-eight  hours  of 
its  onset. 

The  third  case  is  of  interest  on  account  of  the  severity 
of  the  injury  and  the  completeness  of  recovery ;  also 
from  the  fact  that  he  developed  left-sided  facial  para- 
lysis, which  completely  disappeared,  pointing,  I  think, 
to  the  fact  that  it  was  caused  by  the  pressure  of  blood- 
clot  and  its  disappearance  by  its  subsequent  con- 
traction. The  persistence  of  headache  for  nine  months 
is  also  of  interest,  with  its  total  disappearance  sub- 
sequently. Concerning  the  cause  of  headache  in 
head  injuries,  I  shall  have  further  remarks  to  make 
later,  with  illustrative  cases. 


transactions  of  Societies. 


BRITISH  GYNECOLOGICAL  SOCIETY. 
Meeting  held  Thursday,  June  9TH,  1904. 


Professor  John  W.  Taylor,  M.D.,  F.R.C.S.,  President, 
in  the  Chair. 


GIANT   MYOMATA. 

Mr.  Charles  Ryall,  in  the  absence  of  Mr.  Bowre- 
man  Jessett,  exhibited  an  enormous  soft  myoma 
undergoing  calcareous  degeneration.  The  patient 
was  past  the  menopause,  but  as  the  tumour  was  con- 
tinuing to  grow,  Mr.  Jessett  decided  to  remove  it, 
though  an  attempt  to  do  so  in  one  of  the  London 
general  hospitals  had  been  abandoned.  The  tumour 
was  adherent  for  at  least  three  inches  on  each  side  of 
the  middle  line  from  the  pubes  to  above  the  umbilicus, 
the  capsule  being  intimately  blended  with  the  parietal 
peritoneum.  The  patient  suffered  from  considerable 
shock,  for  which  she  received  intravenous  transfusion, 
and  saline  solution  was  also  left  in  the  abdominal 
cavity  ;  otherwise  she  bore  the  operation  well.  The 
tumour  weighed  about  26  lb. 

Dr.  Macnaughton-Jones  said  "giant  myomata  were 

D 


660     The  Medical  PftSSS. 


TRANSACTIONS  OF  SOCIETIES. 


.fow»  *a,  1904. 


not'always  more  difficult  to  remove  than  small  tumours. 
Four  years  ago  he  had  removed  one  weighing  28*5  lb., 
which,  besides  its  attachment  to  the  uterus,  had  a  large 
pedicle  to  the  broad  ligament  and  was  also  adherent  to 
the  bladder.  The  bladder  was  opened  during  the 
operation,  but  immediately  stitched  up  and  the  patient 
did  well,  and  is  now  in  perfect  health. 

Dr.  C.  H.  F.  Routh  mentioned  that  he  had  success- 
fully removed  a  tumour  weighing  22*5  lb. 

The  President  asked  whether  the  pelvis  was  free 
or  whether  any  portion  of  the  tumour,  which  was 
interesting  not  only  from  its  size  but  from  its  situation, 
had  to  be  enucleated  from  the  pelvic  cavity. 

Mr.  Ryall  replied  that  the  tumour  was  not  at  all 
adherent  to  the  pelvis. 

Dr.  Macnaughton- Jones  read  a  paper  on  "  Electro- 
thermic  Haemostatic  Angiotribes,"  which  will  be  pub- 
lished in  our, next  issue. 

Mr.  £.  Stanmore  Bishop  then  brought  forward  the 
question  of  the 

PREVENTION     OF     POST-OPERATIVE     VENTRAL     HERNIA, 

and  briefly  gave  details  of  the  four  cases  which  had 
occurred  in  his  list  of  more  than  350  abdominal  sec- 
tions. After  emphasising  the  necessity  of  securing  the 
firm  union  of  the  peritoneum,  fascia,  and  skin,  especi- 
ally of  the  fascia,  the  combined  tendons  of  the  trans- 
versalis  and  oblique  muscles,  he  discussed  the  various 
methods  which  had  been  or  might  be  employed  for 
this  purpose,  including  Milton's  method  and  a  modifi- 
cation of  it  which  eliminated  the  difficulties  sometimes 
caused  by  kinking  of  the  secondary  thread,  and  illus- 
trated his  remarks  by  diagrams.  He  then  discussed 
the  various  materials  employed  for  sutures  and  ex- 
hibited some  glass  stretchers  he  had  had  made  for 
sterilising  and  preserving  them  by  Messrs.  Woolley, 
of  Manchester,  by  the  aid  of  which  a  perfectly  straight 
thread  was  obtained  for  each  suture  or  ligature,  while 
the  sterilising  medium  had  free  access  to  all  parts  of 
the  material.  He  also  showed  a  copper  case  made 
watertight  by  asbestos  packing,  for  boiling  catgut 
sutures  in  cumol  or  xylol. 

Dr.  Macnaughton- J  ones  said  that  while  all  opera- 
tors acknowledged  the  importance  of  securing  as 
perfect  an  abdominal  toilet  as  possible,  different 
surgeons  gave  preference  to  different  methods,  and 
each  generally  considered  his  own  the  best.  Mr. 
Stanmore  Bishop  accurately  represented  in  his  diagram 
the  method  he  (Dr.  Macnaughton- J  ones)  usually 
followed  of  closing  the  abdominal  wait  It  was  prac- 
tically the  same  as  that  originally  advised  by  Noble, 
of  Philadelphia.  He  showed  by  diagram  another 
method  of  mattress  suture  recently  introduced  by 
Noble.  His  (Dr.  Macnaughton- Jones)  method  in- 
cluded closure  of  the  peritoneum  by  a  fine  continuous 
cumol-gut  suture,  and,  after  dissection  of  the  fascia  from 
the  rectus  muscle,  it  was  united  by  a  continuous  suture 
passing  through  the  fascia  and  looping  up  the  muscle 
at  either  side,  before  penetrating  the  fascia  at  the 
opposite  side,  and  thus  closing  the  wound  either  by 
complete  adaptation  or  slight  overlapping  of  the 
aponeurosis  through  its  entire  extent.  Any  appa- 
rently weak  points  were  then  secured  by  an  inter- 
rupted suture,  the  skin  was  stitched  with  celloidinzwirn. 
In  the  largest  ventral  hernia  he  had  ever  seen,  in  which 
there  was  a  huge  protrusion  over  the  pubes,  he  had 
adopted  the  following  plan  with  complete  success  :  The 
necessary  dissections  having  been  made  to  sever  the 
adhesions  of  the  bowel  and  omentum  to  the  skin,  and 
to  separate  these  from  the  dense  fascia  which  had 
formed  in  the  middle  line,  as  also  to  clear  the  recti 
muscles,  mattress  sutures  of  silver  wire  were  carried 
alternately  from  one  side  to  the  other,  from  the  outer 
border  of  the  rectus  at  one  side,  including  its 
fascia,  under  the  dissected  central  fascia  and 
including  it,  and  were  brought  out  through  corre- 
sponding points  on  the  opposite  side.  There  were 
thus  three  loops  and  three  double  strands  at  either 
side,  and  a  strong  suture,  also  of  silver,  was  passed 
at  the  upper  and  the  lower  ends  of  the  wound,  which 
extended  from  just  below  the  umbilicus  to  the  pubes. 
These  silver  sutures  were  buried,  and  the  skin  closed 


over  them  with  silkworm-gut.  The  closure  was  com- 
plete and  permanent,  and  has  remained  so  up  to  the 
present  time  without  giving  rise  tojany  trouble.  Bumm, 
of  Berlin,  lays  special  stress  in  these  cases  of  large 
hernia  on  the  importance  of  flexion  of  the  trunk  while 
suturing,  and  of  complete  separation  of  the  rectus 
sheath  from  the  muscle,  so  as  to  relieve  the  tension 
in  the  adjustment  of  the  fascia.  His  own  (Dr.  Mac- 
naughton-J  ones)  experience  of  post-operative  hernia 
was  limited  to  three  cases.  In  the  first  case,  the  wound 
had  been  twice  deliberately  opened  by  the  patient, 
who  was  mentally  afflicted,  but  was  finally  and  per- 
fectly closed  by  a  third  operation.  The  second  was  a 
very  small  protrusion,  so  slight  that  the  patient  refused 
to  have  it  interfered  with  three  years  after  the  opera- 
tion, and  the  third  he  had  seen  this  year,  in  which 
there  was  an  opening  at  the  lower  end  of  the  wound, 
in  a  case  in  which  the  operation  was  performed  under 
desperate  conditions,  and  where  it  was  absolutely 
necessary  to  close  the  wound  with  through-and-through 
sutures.  If  there  had  been  hernia  in  any  other  cases 
of  his,  he  had  never  heard  of  it.  In  872  cases  of 
abdominal  section  reported  by  Charles  Noble,  there  was 
suppuration  in  only  ten  and  hernia  in  only  two.  Paul 
Zweifel,  in'cases  of  fat  women,  and  where  there  was  a 
doubt  as  to  the  security  of  his  special  interlacing  suture, 
passed  with  his  large  needle  three  strong  strands  of 
chromicised  cumol-gut  as  through-and-through  sutures, 
at  even  distances,  and  tied  these  finally.  He  (Dr. 
Macnaughton-Jones)  had  himself  pursued  this  method 
in  some  similar  cases. 

Mr.  Charles  Ryall  remarked  that  while  our  aim 
in  closing  the  laparotomy  incision  must  be  to  bring 
the  parts  as  nearly  as  possible  into  their  original 
anatomical  position  by  uniting  each  layer,  the  essential 
thing  was  to  see  that  the  aponeurosis  was  united 
throughout  the  whole  length  of  the  wound.  The 
union  of  muscle  would  not  prevent  hernia,  and  that 
of  the  peritoneum  did  not  add  much  strength  to  the 
cicatrix,  though  it  was  important  in  preventing  adhe- 
sions. The  posterior  sheath  of  the  rectus  was  prone 
to  retract  with,  but  more  than,  the  peritoneum,  and 
this,  he  thought,  led  to  imperfect  union  and  consequent 
hernia  in  some  cases.  An  important  prophylactic 
measure  was  prolonged  rest,  and  this  the  hospital 
surgeon  could  not  always  give  his  patients.  He 
thought  that  post-operative  hernias  were  not  by  any 
means  invariably  reported  to  the  operator. 

Dr.  Macnaughton- Jones,  jun.,  remarked  that  as 
both  ends  of  the  sutures  passed  through  the  skin  on 
the  same  side,  in  the  method  of  suturing  suggested  by 
Mr.  Stanmore  Bishop,  the  edges  of  the  fascia  would  be 
drawn  beneath  the  skin  on  that  side,  and  the  operator 
would  have  a  difficulty  in  seeing  whether  they  were  in 
accurate  apposition.  This  difficulty  would  be  greater 
when  securing  sutures  after  a  number  had  already 
been  tied. 

Dr.  J.  J.  Mac  an  said  that  it  was  a  matter  for  regret 
that  those  Fellows  of  the  Society  who  were  in  the  habit 
of  using  the  through-and-through  suture,  and  who  were 
known  to  obtain  good  results  by  it,  were  not  present 
to  take  part  in  the  discussion.  A  recent  inquiry  by 
Dr.  W.  H.  Swaffield  had  shown  that  among  upwards  of 
fifty  of  the  most  distinguished  surgeons  in  Germany  and 
Austria,  less  than  a  dozen  adhered  to  the  simplethrough- 
and-through  suture  in  median  laparotomies,  and  three 
of  those  modified  the  practice  in  some  way.  The  re- 
maining forty-six  preferred  some  method  of  suture  in 
layers.  There  could  be  little  doubt  that  since  the 
almost  general  adoption  of  suture  in  layers,  post- 
operative hernia  had  been  less  frequent  and  less  severe 
than  formerly. 

The  President  expressed  hkappreciation  of  the  prac- 
tical manner  in  which  Mr.  Bishop  had  treated  a  subject 
of  extreme  interest  to  all  operating  surgeons,  and  said 
that  he  concurred  in  the  opinion  that  immediate  union 
of  the  peritoneum,  as  well  as  of  the  tendon,  was  of  service 
in  the  solidity  of  the  abdominal  cicatrix.  On  that 
point  he  must  join  issue  with  Mr.  Ryall,  for  he  had 
found  in  the  post-mortem  room  that  a  union  which 
externally     appeared     perfect    might    be   absolutely 


JPN*  33,    I9044 


SPECIAL  ARTICLES. 


Tbb  Medical  Pins.    661 


incomplete  on  the  peritoneal  surface,  and  the  only  points 
of  union  be  where  the  suture  passed  through  the  holes 
of  the  abdominal  wall,  gaps  being  left  almost  inviting 
the  omentum  to  protrude.  For  the  last  eight  or  nine 
years  he  had  employed  a  simple  method,  which,  in  his 
experience,  had  not  been  followed  by  hernia.  He 
united  the  peritoneum  with  a  continuous  suture  of  the 
finest  silk,  generally  figured  No.  000,  and  sterilised  by 
boiling  in  a  benzine  solution.  He  then  passed  sutures 
at  short  intervals  of  about  half  an  inch  through  skin, 
fascia  and  muscle,  without  including  the  peritoneum, 
but  before  tying  these  he  united  the  fascia,  for  the 
whole  length  of  the  wound,  with  a  close  continuous 
suture  of  the  same  fine  silk  used  for  the  peritoneum, 
over  which,  if  desirable,  a  suture  of  horsehair  could  be 
tied  and  passed  through  the  skin.  The  interrupted 
sutures  remained,  to  support  the  fine  ones,  for  ten 
days,  and  were  then  withdrawn ;  the  silk  ones  were 
left,  and  he  had  found  indications  of  them  two  months 
after  the  operation  in  a  patient  who  died  of  slow  sepsis 
after  a  supra-vaginal  hysterectomy,  but  in  another,  in 
whom  he  reopened  after  about  a  year  for  obstruction 
by  a  band,  the  silk  had  been  completely  absorbed.  In 
only  three  instances  had  the  silk  given  any  trouble, 
and  these  occurred  before  he  knew  the  best  mode  of 
sterilising  the  silk,  or  used  benzine. 

Mr.  Stanmore  Bishop,  in  reply,  said  that  in  his  ex- 
perience cases  of  hernia  after  operation  did  come  back 
to  the  operator,  and  he  had  no  reason  to  suppose  that 
he  had  failed  to  hear  of  any  single  case  of  his  own.  In 
regard  to  the  material  for  sutures  they  were  all  agreed 
that  all  buried  sutures  should  be  absorbable,  that  is  to 
say,  after  they  had  done  their  work.  Neither  catgut 
nor  wire  were  so  ;  and  catgut  was  apt  to  give  way,  or, 
if  used  of  the  thickness  (No.  8)  sometimes  employed, 
was  almost  impossible  to  sterilise.  Of  course,  if  one 
could  rely  on  catgut  being  absolutely  germ-free,  the 
difficulty  would  vanish.  The  view  that  post-opera- 
tive hernia  might  be  due  to  overlooking  the  posterior 
sheath  of  the  rectus  merited  serious  consideration. 
It  was  a  mistake  to  suppose  that  in  his  method  there 
was  any  difficulty  in  obtaining  a  clear  view  of  the  fascia  ; 
it  was  perfectly  easy  to  assure  oneself  by  sight,  still 
more  satisfactorily  by  touch,  that  the  aponeurosis  had 
been  properly  united  for  the  whole  of  its  length. 

THE  MEDICO-LEGAL  SOCIETY. 

Meeting  held  June  14TH,  at  20  Hanover  Square,  the 

President,  Sir  Wm.  Collins,  being  in  the  Chair. 

Mr.  Henslowe  Wellington  criticised  the  common 
verdict  "  Suicide,  whilst  temporarily  insane."  The 
word  "  suicide  "  appears  first  in  1654  and  means  self- 
murder,  not  merely  self-killing.  Juries  disliked  to 
declare  felo  de  se,  on  account  of  the  pristine  posthu- 
mous consequences.  There  is  no  legal  or  canonical 
authority  for  "  consecrating "  buildings  or  burial 
grounds. 

Dr.  Cla ye  Shaw,  as  apsychologist  andalienist  believed 
that  the  large  majority  of  suicides  were  the  climax  of 
stress  and  worry,  which  had  led  to  mono-ideaism ; 
the  fatal  act  was  often  the  first  patent  symptom  of  the 
onset  of  insanity. 

Mr.  J.  Troutbeck  thought  that  juries,  considering 
the  social  side  of  the  case,  strive  to  soften  the  blow  to 
relatives,  and  in  so  doing  ignore  technicalities. 

Dr.  F.  J.  Smith  regarded  legal  formulae  as  too  fixed 
and  rigid. 

Dr.  Wm.  McCallin  read  a  noteonthevaryingmethods 
of  certifying  lunacy.  The  reasons  for  the  differing 
forms  were  not  obvious,  especially  as  they  had  no 
corresponding  reference  to  clinical  conditions. 

Earl  Russell  saw  an  explanation  in  the  need  for 
safe-guarding  the  well-to-do  under  detention. 

Mr.  Troutbeck  and  Dr.  Claude  Taylor  criticised 
the  action  of  the  Metropolitan  Asylums  Board  in  treat- 
ing demented  senile  paupers  without  certification. 

Earl  Russell  dealt  very  practically  with  "  the 
Weight  to  be  attached  to  Medical  Evidence."  The 
value  of  skilled  testimony  has  increased  pari  passu 
with  the  intellectual  development  of  the  modern  jury 
and  with  the  intrinsic  advance  of  the  knowledge  and 


capacity  of  scientific  witnesses.  Medical '  certificates 
must  ultimately  be  judged  by  medical  men.  Medical 
assessors  should  be  appointed  to  assist  judges  puzzled 
by  conflicting  medical  opinions.  With  regard  to  the 
sterilisation  of  the  medically  certified  "  unfit " :  "  If 
the  educated  classes  understood  the  question,  they 
would  act,  that  is,  if  the  community  was  sufficiently 
educated  to  allow  it."  A  keen  discussion  followed  and 
was  sustained  by  the  President,  Dr.  R.  J.  Collie.  Mr. 
S.  B.  Atkinson,  and  others. 

The  Society  will  shortly  publish  a  volume  of  Trans- 
actions. 


Special  articles. 

BRITISH  SANATORIA  FOR  CONSUMPTION.— XIX 


[by  our  special  medical  commissioner.] 


THE  WESTERN  HOSPITAL,  TORQUAY. 
Although  the  Western  Hospital  for  the  Treatment 
of  Consumption  in  its  Early  Stages  cannot  claim 
a  foremost  place  among  modern  institutions  carrying 
out  the  so-called  open-air  methods,  yet  since  it  is 
accomplishing  much  for  the  consumptive  poor  in 
supplying  hygienic  management  as  far  as  is  possible 
with  an  old  building  placed  in  a  not  altogether  ideal 
situation,  we  venture  to  include  it  in  this  series. 

The  Western  Hospital  was  established  at  Torquay 
in  1850,  when,  of  course,  our  knowledge  of  the  patho- 
logy of  tuberculosis  was  very  incomplete,  and  when 
many  erroneous  views  governed  the  manner  and  method 
of  its  treatment. 

According  to  the  last  report  of  the  Hospital,  a  copy 
of  which  was  given  us  at  the  time  of  our  visit,  the 
institution  was  established  •'-'  with  the  laudable  desire 
of  affording  to  the  labouring  classes,  on  a  limited  scale, 
advantages  similar  to  those  enjoyed  by  their  wealthier 
fellow-creatures ;  of  passing  the  winter  months  in  a 
climate  so  well  calculated  to  prevent  chest  complaints 
and  incipient  affections  of  the  lungs  from  degenerating 
into  confirmed  consumption,  as  that  of  Torquay." 

The  building  is  old-fashioned,  and  cannot  be  made 
to  conform  to  modern  ideals.  The  dormitories  are 
clean,  airy  and  by  no  means  overcrowded,  as  judged 
by  customary  standards.  The  day-rooms  are  also 
used  for  meals,  which  is  an  arrangement  which  has 
manifest  disadvantages. 

Small  balconies  serve  to  provide  the  best  means  for 
comfortably  conducting  open-air  treatment  for  certain 
of  the  cases. 

Unfortunately,  the  ground  in  the  immediate  vicinity 
of  the  Hospital  is  very  limited. 

We  hope  it  may  not  be  long  before  a  generous  public 
or  some  benevolent  friend  of  the  people  will  supply 
means  for  the  transference  of  this  valuable  institution 
for  the  British  poor  to  the  near  heights  of  Dartmoor, 
a  district  peculiarly  suited  in  many  respects  for  the 
hygienic  treatment  of  phthisis. 

The  Western  Hospital  provides  accommodation  for 
forty  patients,  twenty  men  and  twenty  women. 
"  Those  only  are  admitted  whose  cases  appear  to  the 
medical  staff  to  warrant  the  belief  that,  if  not  absolutely 
curable,  they  may  be  more  or  less  permanently  bene- 
fited and  restored  to  a  condition  of  usefulness  by  a 
winter's  residence  under  such  favourable  conditions 
as  to  air,  food,  lodging,  and  medical  treatment  as  the 
Hospital  ensures." 

The  institution  is  governed  by  trustees,  whose  ad- 
ministrative powers  are  delegated  to  a  local  Board  of 
Management,  and  House  Committee.  There  are  four 
honorary  physicians  and  an  honorary  dentist.  There 
is  a  capable  matron,  but  no  resident  medical  officer. 

Patients  are  received  on  October  1st  in  each  year, 
and  the  Hospital  is  closed  from  June  1st  to  the  end 
of  September,  a  fact  which  seems  clearly  to  indicate 
that  Torquay  cannot  be  considered  a  desirable  centre 
for  a  sanatorium  for  the  consumptive  poor.  Annual 
subscribers  are  entitled  to  nominate  one  patient  for 
four  months  for  every  two  guineas  given.  Each 
nomination  paper  must  be  signed  by  the  subscriber 


66a     The  Medical  Press. 


GERMANY. 


or  doaor,  and  be  supported  by  a  duly  qualified  medical 
practitioner.  A  sum  of  three  pounds  must  be  deposited 
with  the  matron  on  the  admission  of  a  patient.  Patients 
hare  also  to  pay  towards  their  maintenance  a  sum  of 
seven  shillings  and  sixpence  per  week  in  advance 
monthly. 

We  have  carefully  studied  the  "  rules  and  regu- 
lations/' which,  although  in  many  ways  old-fashioned, 
are  evidently  designed  for  the  comfort  and  benefit  of 
the  patients.  Some*  however,  are  distinctly  mediaeval, 
as,  for  instance,  "  That  all  books  brought  by  the 
patients  to  the  institution,  except  the  Bible  and  Book 
of  Common  Prayer,  shall  be  submitted  to  the  Chaplain 
lor  his  approval." 

The  number  of  patients  admitted  from  October  ist, 
1902,  to  May  31st,  1903,  was  77,  and  of  these  37  are 
reported  as  "  much  improved."  While  the  largest 
number  of  cases  come  from  Devon,  cases  are  admitted 
from  Scotland,  Ireland,  and  the  various  other  counties 
of  England. 

According  to  the  report  of  the  honorary  medical 
staff,  "  It  is  to  the  •  open-air  treatment '  rather  than 
to  any  special  form  of  drug  that  the  medical  staff 
attribute  the  very  marked  improvement  which  has 
been  observed  in  so  large  a  number  of  cases." 

It  is  interesting  to  note  that  "  the  cost  per  week  per 
patient,  including  all  expenses,  amounts  to  16s.  40!., 
towards  which  the  patient  pays  73.  6d.  with  a  nomina- 
tion from  a  donor  or  subscriber,  and  12s.  6d.  without. 

The  Western  Hospital  for  Consumption  may  almost 
be  considered  a  national  institution,  and  merits  general 
support,  and  we  trust  ways  and  means  may  speedily 
be  forthcoming  whereby  this  valuable  establishment 
for  the  indigent  consumptive  may  be  re-cast  in  a  form 
and  on  a  site  fitted  to  the  requirements  of  a  thorough 
and  complete  conduct  of  open-air  treatment. 

f  ranee. 

[from  our  own  correspondent.] 

Paris,  June  19th,  1904. 
Chronic    Nephritis    in    Children. 
The  prognosis  of  chronic  nephritis  in  children  ought 
to    be  revised,  according  to  Prof.  Mery.     The  text- 
books tell  us  that  it  is  a  very  grave  affection  ;  they  are 
mistaken,  for  the  gravity  of  these  maladies  has  been 
•  greatly  exaggerated,  as  they  are  frequently  amenable 
to  medical  treatment. 

Heubner,  who  had  insisted  on  the  long  duration  of 
chronic  nephritis  in  children,  has  published  two  cases 
which  had  been  radically  cured.  M.  Mery  has  seen 
four  children  in  the  Hdpital  des  Enfants  Malades  return 
to  perfect  health,  and  for  several  years  no  death  took 
place  from  nephritis  in  the  hospital. 

The  onset  of  chronic  nephritis  is  generally  insidious., 
It  is  by  the  swelling  of  the  teguments  that  the  evil  is 
recognised,  but  certain  infectious  maladies  had  pre- 
ceded and  opened  the  way  for  it.  Syphilis  was  ob- 
served in  one  or  two  cases;  tuberculosis,  scarlatina, 
grippe,  mumps,  and  measles  in  others.  Yet  for  the 
three  last  named  it  is  difficult  to  attribute  the  re- 
sponsibility, as  nearly  every  child  has  suffered  from 
one  or  the  other.     The  question  is  complex. 

In  the  symptomatology  of  the  disease,  M.  Mery 
had  noticed  several  special  points.  The  patients  *do 
not  present  any  cerebral  symptoms,  nor  grave  dilatation 
of  the  heart,  as  happens  in  (acute  nephritis ;  the 
diuresis  is  not  accompanied  by  a  •  corresponding 
decrease  in  the  oedema.  The  children  urinate  abun- 
dantly, but  the  oedema  persists.  The  urine  is  very 
poor  in  saline  principles ;  the  salt  remains  fixed  in  the 
tissues,  and  anasarca  is  the  consequence  of  the  re- 
tention. 

The  first  child  [treated  successfully  by  M.  Mery 
was    aet.     7.       The    oedema    was    distributed    over 


JPMB  22.   iq 


the  body ;  he  passed  very  little  urine,  which  was 
oaded  with  albumin.  Under  the  influence  of  theo 
bromin,  the  urine  increased  to  a  quart  daily,  but  the 
oedema  persisted.  The  patient  was  immediately  put 
on  milk  diet  and  improved,  but  after  some  months 
the  milk  was  diminished  and  raw  meat  ordered.  The 
child  finally  got  completely  well,  and  although  two 
years  have  passed,  no  relapse  has  taken  place. 

Another  child  was  received  into  the  ward  suffering 
from  considerable  anasarca,  while  a  large  quantity  of 
albumin  was  found  in  the  urine.  Digitalis  and  theo- 
bromine were  given  three  times  a  day,  and  by  this 
treatment  the  urine  amounted  to  three  pints,  but 
contained  very  little  chlorides.  The  patient  was 
deprived  as  much  as  possible  of  salt,  and  the  quantity 
of  milk  was  diminished ;  an  immediate  improvement 
took  place,  the  oedema  became  absorbed  and  a  year 
subsequently  the  patient  left  the  hospital  cured. 
A  third  and  fourth  child  got  well  in  a  similar  manner. 
All  these  children  began  to  improve  as  soon  as  the 
quantity  of  milk  was  diminished. 

The  milk  presents  the  inconvenience  of  insufficiently 
nourishing  a  growing  child;  moreover,  taken  in 
abundance,  it  encourages  the  production  of  oedema, 
and  determines,  by  its  elimination,  an  irritation  of  the 
renal  epithelium  (von  Noorden). 

The  best  treatment  is,  after  a  few  days  of  rigid 
milk  diet,  to  institute  a  regime  without  salt,  with  raw 
meat,  potatoes,  vegetables,  bread  without  salt,  and 
a  quart  of  milk  as  a  drink. 

As  to  medical  agents,  theobromine  (ten  grains 
daily)  is  the  best  diuretic. 

The  success  obtained  by  the  medical  treatment  of 
chronic  nephritis  in  children  should  make  one  wary 
of  surgical  attempts  (nephrotomy,  decortication  of 
the  kidney)  to  cure  the  disease. 

(Bermanp. 

[from  our  own  correspondent.] 

Berldc,  June  18th,  1901. 
At  the  Surgical  Congress  Hr.  Riedei  discussed 
Ulcer  of  the  Lesser  Curvature  of  the 
Stomach. 
He  said  that  surgeons  generally  occupied   themselves 
with  ulcer  of  the  pylorus,  for  which  gastroenterostomy 
was  performed.     The  cases  usually  came  into  notice, 
however,  after  perforation  had  taken  place  and  peri- 
tonitis had  arisen,  and  by  that  time  two-thirds  of  the 
cases  could  not  be  saved.      Cases  of  acute  bleeding 
nearly  all  died,  as  we  could  only  act  conservatively,  as 
patients  who  had   lost  much  blood  could   not  bear 
laparotomy.     It  was,  therefore,  of  the  greatest  import- 
ance to  diagnose  the  ulcer  early.     Of  fifty-eight  cases 
observed   during   recent    years,    in    twenty-eight   the 
ulcers  were  isolated,  and  in  thirty  they  were  multiple. 
Ulcers  of    the  lesser  curvature  ate  up  not  only  the 
wall  of  the  stomach,  but  they  spread  out  and  attacked 
both  the  anterior  and  posterior  walls.     When  an  ulcer 
was  about  to  burst  through  the  serous  covering  nothing 
could  save  it  but  the  liver  in  contact  in  front,  and  the 
pancreas  behind  it.     Mostly  attachments  took  place 
on  both  sides,  and  then  a  large  tumour  was  formed. 
If  there  was  no  tumour,  the  stomach  lay  in  the  middle 
line,  but   if    there  was   a    tumour  it  sank  to  the  left 
and  the  pain  was  seated  under  the  left  ribs.     When 
those    symptoms    were    present,    the    diagnosis    was 
certain.     But   the  condition  might  be  diagnosed  even 
before  the  formation  of  a  tumour,  by  the  continuous 
left-sided   pain   and   occasional   attacks  of  vomiting. 
When  the  diagnosis  was  formed,  we  should  first  try 


JUNB  33,    1904. 


AUSTRIA. 


The  Medical  Press. 


<*3 


to  treat  the  case  by  dieting.  If  this  did  no  good,  the 
surgeon  should  operate,  when  there  was  a  chance  of 
removing  the  nicer  without  great  danger  to  the  patient. 
The  stomach  was  to  be  washed  out ;  a  left-sided 
longitudinal  incision  made,  the  stomach  seized  behind 
by  forceps,  and  drawn  forwards,  the  ulcer  excised, 
and  the  part  then  united  by  suture,  commencing  at 
the  posterior  part  of  the  incision. 

Double  Resection  of  the  Stomach. 
Hr.  Francke  showed  a  patient,  aet.  37.  who  first 
came  to  him  in  November  last  in  a  very  miserable 
and    emaciated    condition.     The    symptoms   pointed 
to  carcinoma  of  the  pylorus.     In  December  he  did 
an  anterior  gastrotomy,  and  dared  not  go  further  as 
the  patient's  condition  was  so  extremely  bad.    The 
case  did   well,   however,   and   the  general  condition 
improved  so  much  that  the  completion  of  the  operation 
was  undertaken.     This  time  the  pylorus  was  resected 
and  recovery  took  place  without  interruption.    The 
incision   for  gastroenterostomy  need   not   be   longer 
than  six  to  seven  centimetres.     He  commended  the 
divided  operation  to  his  hearers'  notice  in  cases  of 
extreme  debility. 
At  the  Medical  Society,  Hr.  Kossman  discussed 
Goldspohn's  Operation. 
It  appears  that  gynaecologists  are  satisfied  that  retro- 
displacements    really  require    surgical  treatment  at 
times — in  other  words,  that  not  all  cases  can  be  treated 
successfully  by  pessaries.  Goldspohn  takes  the  position 
that    the    fixations    hitherto   made  use    of — ventro- 
fixation,   vaginal  fixation,  shortening  of  round  liga- 
ments— all  leave  something  to  be  desired.     He  pro- 
poses to  perfect  Alexander's  operation,  and  advance 
it  a  step  further,  ana  Dy  uoing  so  ne  claims  that  the 
operation  will  then  be  everything  that  could  be  desired. 
When  the  round  ligaments  have  been  found  and  drawn 
out  the  proper  distance,  he  would  then  enlarge  one 
or  both  openings,  so  that  the  finger  can  be  passed  in. 
In   this  way  everything  in  the  way  of  adhesions  that 
fixes  the  uterus    in    an  abnormal  position  can  be 
separated,  and  the  uterus,  when  thus  freed,  can  easily 
be  retained  in  its  artificial  .position.    Compared  with 
ventro-  and  vaginal  fixation,  he  claims  that  his  operation 
has    great    advantages.    After    ventro-fixation,    the 
assumed  position  is  abnormal,  and  in  vaginal  fixation 
if  the  finger  is  passed  in  it  may  not  be  able  to  separate 
adhesions  high  up,  and,  moreover,  succeeding  preg- 
nancies may  be  affected  injuriously  by  either  operation. 
That  shortening  of  the  round  ligaments  predisposes 
to  hernia  he  denies ;  this  is  only  possible  when  suppura- 
tion has  taken  place,  instead  of  union  by  first  intention. 
Hr.  Duhrssen  was  with  the  speaker  as  to  compli- 
cation, even  with  a  mobile  uterus.    The  objections  to 
vaginal  fixation  were  unfounded ;  the  whole  posterior 
surface  could  be    touched  and  felt  by  it.     Delivery 
might  be  prejudiced  if  the  operation  was  not  carried 
out  properly.     He  had  performed  Goldspohn's  opera- 
tion, and  thought  it  justified  in  cases  where  there  was 
a  hernia  already,  which  could  be  radically  treated  at 
the  same  time. 

Bornyval. 
The  preparation  to  which  the  name  of  bornyval 
has  been  given  is  claimed  to  contain  the  active  prin- 
ciples of  valerian  root,  and  it  is  a  valerianic  acid  ester 
of  borneol,  and  is  said  to  be  a  specific  of  the  highest 
rank  for  the  large  array  of  nerve  diseases.  There  was 
already  a  number  of  preparations  of  valerianic 
acid,  but  one  important  component  was  neglected, 
vit.,  borneol.  This,  according  to  Jos.  Mdller,  has  the 
property  of  reducing  reflex  irritability.  It  only  re- 
mained now  to  combine  the  two  constituents,  which  are 
present  in   the  root  in  the  form  of  esters,  into  one 


preparation,  and  this  has  been  done  by  the  firm  of 
J.  D.  Riedel,  Berlin,  who  have  brought  it  into  the 
market  in  the  form  of  elastic  gelatine  pearls,  containing 
0*25  grammejof  the  new  combination.  It  is  said  to  have 
greater  power  than  any  other  preparation  of  valerian. 
By  its  use  cardiac  neuroses  are  said  to  disappear 
sometimes  after  a  single  dose ;  whilst  objectively  the 
pulse  improves.  Whether  the  symptoms  were  due  to 
valvular  disease,  arterio-sclerosis,  or  dilatation,  the 
result  was  the  same.  In  the  case  of  traumatic  neuroses 
the  pains,  which  had  ceased  under  the  influence  of  the 
drug,  tecommenced  on  its  discontinuance,  but  ceased 
finally  after  a  more  lengthened  use  of  it. 

Some  cases  of  nocturnal  incontinence,  and  some  of 
nervous  gastric  trouble,  were  cured  by  it. 

In  hysteria,  cases  of  cardiac  palpitation  with  pain, 
shortness  of  breath,  loss  of  speech,  anxiety  and  distress, 
with  loss  of  sleep,  were  materially  improved,  and  by 
improvement  in  vitality  the  condition  was  considerably 
ameliorated. 

Insomnia  without  hysteria  was  also  improved. 
Menstrual  and^climacteric  troubles  were  also  relieved 
by  it. 


BuBtrta. 


[from  our  own  corresponent.] 

ViraxA.  June  18th,  1904. 
Sea  Hospice  for  Tuberculosis. 

A  meeting  of  the  Medical  Society,  under  the  pre- 
sidency of  Graf  Sylva-Tarouca,  reports  that  696 
children  have  been  treated  at  these  hospices  with 
beneficial  results  of  83  per  cent,  perfectly  cured  in  one, 
and  45  per  cent,  mortality  in  the  San  Pelagia,  while 
it  was  still  more  favourable  in  the  Salzbach  institution, 
where  the  recoveries  are  recorded  as  84  per  cent,  and 
the  mortality  figure  2*5  per  cent. 

Professor  Monti,  in  proposing  the  report,  said  this 
society  had  been  instrumental  in  saving  much  life 
since  its  inauguration  eighteen  years  ago  by  the 
Erzherzogin  Maria  Theresa,  to  whom  they  were 
deeply  indebted  for  her  philanthropic  assistance. 
During  the  last  eighteen  years  many  remedies  had  been 
devised  to  combat  this  fiend  of  the  human  race,  but, 
unhappily,  few  of  them  had  survived  the  infantile 
period  of  their  existence.  Pure  fresh  air  was  the 
remedy  prescribed  by  this  society  when  tuberculosis- 
was  first  pronounced  curable,  and  it  is  now  universally 
accepted  as  the  sovereign  antidote  for  this  contagious 
disease.  Monti  said  that  he  had  seen  a  large  number 
of  these  little  ones,  both  before  leaving  hospital  and 
on  their  return  from  the  Sea  Hospice,  and  was  now 
convinced  in  his  own  mind  that  hygienic  treatment  in 
suitable  surroundings  was  the  most  effectual  remedy 
to  check  the  disease. 

At  San  Pelagia,  systematic  excursions  are  carried  out 
for  the  strong,  so  that  as  soon  as  the  patient  is  able 
to  move  about  he  is  encouraged  to  take  short  sails  in 
a  small  steamer  and  landed  on  shore  at  regular  inter- 
vals to  walk  along  the  shore  or  climb  the  hills  as  the 
patient  becomes  more  vigorous.  T.iis  exercise,  com- 
bined with  sea-bathing,  has  a  wonderfully  beneficial 
effect  on  the  metabolic  changes  of  the  organism. 
During  their  recovery  education  is  not  neglected,  as 
fully  one-half  of  the  patients  go  to  school  or,  rather,  take 
part  in  the  educational  pursuits  provided  for  them  when 
health  and  circumstances  permit. 

Since  the  inauguration  of  these  institutions,  85,193 
young  patients  have  returned  to  their  friends  able  to 
commence  life  as  healthy  citizens,  who  in  all  probability 
would  otherwise  have  died  in  limine  vivo. 


664    Trb  Medical  Press. 


OPERATING  THEATRES. 


June  22.  1904. 


Like  other  great  jworks  these]efforts  require^money. 
The  year's  expense  of  the  two  soviet  es  ' has  1  been 
242, 38 1 '95  kronen,  or  £13  10s.,  per  child. 

Arterial  Sclerosis. 

At  the  Congress  for  innere  Medizin,  the  discussion 
on  arterial  sclerosis  was  continued  by  Kisch,  who 
affirmed  that  he  had  often  observed  this  condition  of 
the  vessels  coincident  with  lipoma  or  the  lipomatose 
condition,  which  he  had  found  present  after  sudden 
deaths  from  cerebral  haemorrhage.  The  most  trust- 
worthy symptom  for  the  clinician  is  the  bradycardia 
with  the  irregularity  of  the  pulse. 

Klemperer  confirmed  the  opinion  of  many  others 
who  have  spoken  on  the  subject,  that  arterial  sclerosis 
is  very  frequent  in  the  representatives  of  the  medical 
profession,  and  described  the  disease  as  an  over-culture 
morbidity,  a  continued  state  of  exhaustion,  or,  in  classic 
language,  a  fatigatio.  Arterio-sclerosis  was  not  neces- 
sarily a  fatal  disease  as  some  of  his  colleagues  had  re- 
presented it  to  be,  neither  could  he  defend  it  as  a  healthy 
condition.  Its  approach  was  sometimes  heralded  by 
a  febrile  attack  appearing  without  any  real  cause. 
Lime  in  the  treatment  may  or  may  not  be  adminis- 
tered, but  milk  diet,  as  many  others  had  proposed,  was 
always  the  best.     Alcohol  should  never  be  given. 

Gumprecht  said  he  had  used  the  plethysmography 
method  like  Romberg  in  the  diagnosis  of  sclerosis, 
and  found  the  influence  of  cold  and  warmth  sometimes 
produced  contraction,  but  sometimes  they  did  not, 
and  as  often  were  found  normal.  He  also  met  with 
case3  where  the  blood  pressure  was  raised.  He  pre- 
scribed iodide  in  small  doses  with  good  results. 

Hirschfeld  admitted  the  danger  to  life  in  many  cases 
of  arterio-sclero3is,  but  that  arising  from  nephritic 
gout  might  be  accepted  as  a  benign  form  of  the  disease. 

Noorden  affirmed  that  high  pressure  in  the  blood- 
vessels of  arteriosclerosis  was  always  a  dangerous 
monitor.  The  treatment  he  relied  on  was  10  milli- 
grammes daily  of  nitro-glycerine.  The  calcareous  de- 
posit in  arterio-sclerosis  did  not  differ  from  the 
normil  elsewhere.  It  was  a  mistake  to  suppose  'that 
Urns  could  not  be  eliminated  from  the  body  by  the  use 
1  of  glycerinated  pho3phate3,  lecithin,  &c,  while  a  non- 
calcareous  diet  was  quite  unnecessary. 

Schott  said  he  had  seen  cases  of  aortic  failure  from 
a  sclerotic  condition  of  the  vessels  below  the  age  of  20, 
and  is  of  opinion  that  the  abuse  of  nicotine  in  youth 
has  much  to  answer  for  in  the  production  of  the  disease 
as  an  etiological  factor.  His  experience  is  that  the 
blood  pressure  is  frequently  accentuated  or  normal, 
but  Hardly  ever  low.  The  best  treatment  is  careful 
dieting  with  everything  in  moderation. 

Hofbauer  spoke  of  the  ■'  symptom-complex "  of 
cardiac  asthma  and  cardiac  dyspnoea. 

Ageron  said  that  many  of  the  speakers  had  searched 
in  vain  for  the  real  or  true  etiological  cause,  which  to 
his  mind  was  nothing  else  but  gluttony  and  ebriety. 
The  great  quantities  of  rich  albuminous  food  with 
arterial  stimuli  soon  brought  about  all  the  conditions 
of  old  age,  inactivity,  and,  finally,  cardiac  death. 

Jaksch  thought  the  sclerosis  of  the  vessels  had  a 
nervous  origin,  as  these  cases  improved  rapidly  on 
carbonic  acid  baths.  Iodide  is  best  given  in  food 
without  salt.  Digitalis  should  never  be  given ;  and 
nitro-glycerine  should  be  administered  with  the  greatest 
care. 

Fraenkel  recommended  digitalis  and  ^morphia  in 
cardiac  asthma,  while  others  condemned  it. 


Ube  Operating  Ubeattes/ 

MIDDLESEX  HOSPITAL. 
Excision  of  Upper  Jaw  por  Malignant  Tumour.— 
Mr.  Andrew  Clark  operated  on  a  man,  set.  between  60 
and  70,  who  had  been  admitted  with  a  rapidly-growing 
tumour  of  the  left  maxilla.  The  patient  stated  that 
about  ten  weeks  ago  he  had  noticed  some  fulness  of 
the  left  cheek ;  he  went  to  a  doctor  who  ordered  him 
some  medicine,  and  told  him  to  show  himself  again 
in  about  a  week.  He,  however,  allowed  five  weeks  to 
elapse,  and  on  his  second  visit  was  told  that  it  was 
a  serious  condition,  and  was  advised  to  lose  no  time  in 
getting  admission  to  a  hospital  in  London.  On 
admission,  the  following  notes  were  made : — The 
patient  was  a  well-built,  healthy-looking  man ;  the 
left  cheek  was  prominent,  and  on  manipulation  this 
was  found  to  be  due  to  a  growth  involving  the  upper 
jaw,  and  extending  nearly  to  the  malar  bone.  On 
looking  inside  the  mouth,  there  was  no  prominence  of 
the  palate,  but  a  growth  projected  from  the  alveolus 
at  the  seat  of  the  bicuspid  and  first  molar  tooth;  the 
whole  of  that  side  of  the  jaw  was  edentulous.  The  skin 
was  freely  movable  over  the  tumour,  and  the  growth 
did  not  appear  to  extend  beyond  the  maxilla.  There 
was  no  evidence  of  any  enlarged  glands.  Excision  of 
the  jaw  was  decided  upon,  and  accordingly  the  patient 
having  been  anaesthetised,  an  excision  was  made  from 
the  inner  angle  of  the  jaw  along  the  ala  of  the  nose, 
down  to  the  lip,  which  was  divided  in  the  middle  line  ; 
an  incision  was  next  made  along  the  lower  border  of 
the  orbit ;  the  flap  of  skin  thus  marked  out  was 
carefully  dissected  back  and  the  whole  of  the  tumour 
exposed.  The  three  bony  attachments,  namely,  the 
junction  with  the  other  maxilla,  the  junction  with  the 
nasal  and  lachrymal  bones  at  the  inner  angle  of  the 
orbit,  and  with  the  malar  bone  at  the  outer  angle 
of  the  orbit,  were  then  divided,  the  saw  being  used 
for  three  parts  of  each  division,  each  being  completed 
with  bone  forceps,  the  periosteum  of  the  orbit  having 
been  first  carefully  raised  with  a  raspatory.  The 
maxilla  so  far  freed  was  then  seized  with  lion  forceps, 
torn  from  its  posterior  attachments,  and  the  soft 
palate  divided.  Pressure  forceps  were  immediately 
put  on  the  branches  of  the  internal  maxillary  artery, 
and  a  careful  examination  showed  that  the  whole  of  the 
growth  had  come  away.  The  vessels  were  ligatured 
and,  owing  to  some  continued  oozing,  the  surface  was 
seared  with  the  actual  cautery.  The  cavity  was  then 
stuffed  with  iodoform  gauze,  and  the  reflected  flap  of 
skin  carefully  returned  to  its  former  position,  two 
harelip  pins  being  used  for  the  lip,  and  the  rest  of  the 
incision  being  united  by  interrupted  silk  sutures. 
The  wound  was  covered  with  cyanide  gauze  and  collo- 
dion. Mr.  Clark  said  that  excision  of  the  upper  jaw 
was,  he  thought,  now  a  rare  operation — at  any  rate, 
he  had  not  come  across  a  suitable  case  for  some  time, 
nor  had  he  heard  of  many  in  the  hospital.  This  case, 
he  considered,  was  eminently  suited  for  such  an  opera- 
tion, the  disease  apparently  commencing  in  the 
alveolus  and  being  confined  entirely  to  the  maxilla. 
It  was  evidently  a  very  rapidly  growing  tumour,  and 
the  microscope  would  detect  its  nature  ;  if  it  turned  out 
to  be  an  epithelioma,  the  chances  of  its  rapid  recurrence 
were  very  great,  otherwise,  as  it  was  freely  extirpated, 
it  might  be  hoped  that  there  would  be  immunity  for 
a  considerable  time.  The  chief  dangers  of  the  opera- 
tion, he  thought,  were  shock  and  haemorrhage;  the 
patient  had  suffered  but  little  from  the  former,  and, 
fortunately  the  branches  of  the  internal  maxillary 
artery  were  secured  without  difficulty,  so  that  an 
undue  amount  of  blood  was  not  lost.    The     parts 


June  aa,  1904. 


LEADING  ARTICLES. 


The  Medical  Piess.    665 


being  very  vascular,  union,  he  pointed  out,  is  generally 
very  rapid,  and  the  edges  of  the  wound  being  brought 
accurately  together,  but  little  deformity  would  be 
noticed  on  the  convalescence  of  the  patient. 

ITALIAN  HOSPITAL,  QUEEN  SQUARE. 
New  Method  of  Excision  of  Tongue. — Mr. 
Lbnthal  Cheatlb  operated  on  a  man,  act.  54,  who  had 
been  admitted  for  a  small  squamous  epithelioma  on  the 
left  side  of  the  tongue  opposite  the  first  molar.  The 
whole  tongue  was  in  a  very  advanced  stage  of  syphilitic 
leucoplaxia,  and  it  was  made  certain  that  the  ulcer  was 
a  squamous  epithelioma,  as  a  small  piece  had  been 
submitted  to  microscopic  examination.  The  patient's 
mouth  and  teeth  having  been  deliberately  cleansed 
by  a  brush  with  1  in  60  carbolic,  and  a  daily  injection 
of  10  ex.  of  antistreptococcic  serum  having  been  given 
for  three  days  before  the  operation,  the  man  was  pre- 
pared and  anaesthetised.  An  incision  was  then  made, 
which  began  immediately  below  the  globe  of  the  ear 
at  the  level  of  the  hyoid  bone ;  it  was  continued  forwards 
until  the  middle  line  was  reached,  then  gently  curved 
upwards  to  the  lower  border  of  the  inferior  maxilla ; 
next,  starting  from  the  point  from  which  the  first 
incision  began,  another  curved  incision  was  made  up- 
wards to  the  posterior  border  of  the  sterno-mastoid  ; 
the  flap  thus  formed  was  turned  upward,  being  wrapped 
up  in  double  cyanide  gauze  and  kept  in  position  by 
means  of  retractors.  The  platysma  and  superficial 
fascia  were  then  dissected  off  the  mylo-hyoid,  the 
submaxillary  gland  was  removed,  and  the  anterior 
belly  of  the  digastric  and  the  mylo-hyoid  were  exposed. 
The  lingual  artery  was  next  ligatured  just  as  it  dis- 
appears behind  the  mylo-hyoid  muscle.  The  lym- 
phatic glands  in  this  neighbourhood  were  also  removed. 
The  posterior  beily  of  the  digastric  and  the  stylo-hyoid 
were  pulled  downwards  and  backwards  by  means  of 
a  retractor ;  the  anterior  belly  of  the  digastric  and  the 
mylo-hyoid  were  pulled  directly  forwards  by  means  of 
another  retractor,  exposing  the  hyo-glossus  on  which  is 
lying  the  hypoglossal  nerve,  which  last  was  removed. 
The  hyo-glossus  was  defined  and  pulled  downwards, 
thereby  putting  extension  on  the  stylo-glossus  muscle, 
which  was  cut  through  as  near  the  styloid  vessels  as 
possible.  The  hyo-glossus  was  then  cut  as  near  to 
the  hyoid  bone  as  possible  and  turned  up,  exposing  the 
inferior  lingualis  muscle  and  the  genio-hyo-glossus. 
An  attempt  was  now  made  to  define  and  remove  the 
ill-defined  attachment  of  the  inferior  lingualis  muscle  to 
the  hyoid  bone ;  the  attachment  of  the  genio-hyo-glossus 
to  the  hyoid  bone  was  left  intact,  but  a  separation  was 
made  between  the  genio-glossal  fibres  and  the  genio- 
hyoid fibres  of  the  genio-hyo-glossus ;  the  genio-hyoid 
was  left  intact.  Now  two  ligatures  were  put,  one  on 
either  side  at  the  tip  of  the  tongue,  and  the  [organ 
divided  longitudinally  along  the  median  raph6  as 
far  back  as  the  epiglottis,  the  attachment  of  the 
mucous  membrane  to  the  lower  jaw  was  cut  away,  and 
the  attachment  of  the  tongue  to  the  anterior  pillar 
of  the  fauces  was  removed.  All  the  structures  still 
holding  the  organ  were  then  divided  and  half  the  tongue 
removed.  The  wound  was  left  open,  no  stitch  whatever 
being  inserted  and  no  stuffing  employed.  Mr.  Cheatle 
said  that  he  considered  Whitehead's  operation  for  the 
removal  of  the  tongue  was  too  limited,  and  it  seemed 
to  be  planned  on  the  idea  that  it  was  only  necessary  to 
remove  those  parts  of  the  muscles  of  the  tongue  which 
are  covered  by  mucous  membrane.  He  said  he  had 
examined  the  tissues  left  in  two  cases  that  died  im- 
mediately after  Whitehead's  operation.  In  these 
two  cases  secondary  deposits  of  cancer  were  found  in 
the  hyo-glossus  muscle  a  quarter  ofan  inch  above 


the  hyoid  bone,  although  at  the  time  of  operation  the 
operator  was  convinced  he  had  removed  all  the  disease ; 
no  secondary  deposits  could  be  found  in  the  inferior 
lingualis  or  the  genio-hyoid  attachments  of  the  genio- 
hyo-glossus.  Alter  he  had  found  this  in  these  two  cases 
Mr.  Cheatle  determined  in  his  next  operation  to  give 
up  Whitehead's  method,  or  rather  to  combine  some  of 
its  procedures  with  a  more  definite  attack  on  the 
extrinsic  muscles  of  the  tongue,  most  particularly  upon 
the  hypoglossal  nerve;  in  future  operations  of  this  kind 
he  saw  no  reason  why  the  hypoglossal  nerve  supply 
to  the  genio-hyoid  should  not  be  saved. 

Mr.  Cheatle  considered  that  free  drainage  is  the  most 
important  factor  in  the  after-treatment  of  these  cases, 
and  free  drainage  is  obtained  by  neither  inserting 
plugs,  drainage-tube,  nor  stitches ;  in  fact,  any  tube  or 
plug  in  this  patient  would  have  been  evacuated  the 
very  first  time  the  man  vomited  through  his  wound. 
Mr.  Cheatle  said  he  had  been  working  on  the  morbid 
anatomical  distribution  of  cancer  of  the  tongue  in  the 
same  methodical  way  Mr.  Styles  and  Heidenheim  had 
worked  out  the  distribution  of  cancer  in  the  breast.  He 
felt  sure  that  if  his  own  work  is  confirmed  by  other 
observers,  greater  attention  will  be  paid  to  the  careful 
and  complete  removal  of  the  hyo-glossus  muscle,  the 
genio-hyoid  fibres  of  the  genio-hyo-glossus  and  in 
certain  cases  the  inferior  lingualis  and  the  fascia  of  the 
genio-hyoid.  Other  important  points  on  the  distribu- 
tion of  cancer  of  the  tongue.  Mr.  Cheatle  said,  he  hoped 
to  shortly  bring  before  the  profession. 

The  patient  was  walking  about  ten  days  after  the 
operation,  the  wound  having  almost  entirely  healed  up. 

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"  SALUS  POPULI  SUPREMA  LEX." 


WEDNESDAY,  JUNE  22,  1904.     . 

THE  GOVERNMENT  LUNACY  BILL. 
The  condition  which  the  House  of  Commons 
has  reached  during  the  last  few  years  with  regard 
to  the  transaction  of  business  has  precluded 
innumerable  measures  of  secondary  interest  and 
importance  from  passing  into  law,  and  about  the 
only  chance  a  Bill,  not  one  of  the  chief  Govern- 
ment measures  of  the  Session,  has  of  being 
eventually  placed  on  the  Statute-book  is  for 
it  to  be  short  and  non-contentious.  The 
limited    time  available   for   disposing    of     such 


666    Th*  Midical  Pm|E|f; 


LEADING  ARTIOLB& 


June  22,  1904. 


measures  can  be  easily  filled  up  by  a  lew 
members  who  are  opposed  to  it*  and  the  will  of 
the  House  may  be  rendered  nugatory  by  one  or 
two  loquacious  individuals  M  talking  out "  a  Bill 
to  which  they  have  objections.  It  is  much  to 
be  hoped  that  the  useful  little  measure  amending 
the  Lunacy  Acts  that  has  just  been  introduced  by 
the  Law  Officers  of  the  Crown  will  not  be  allowed 
to  suffer  this  fate.  There  is  a'good  deal,  doubtless, 
that  may  lend  itself  to  argument  with  regard  to 
its  provisions,  but  the  intention  is  so  beneficent, 
and  the  safeguards  against  abuse  so  ample,  that 
it  would  be  a  thousand  pities  if  it  were  to  suffer  the 
fate  of  the  Lord  Chancellor's  Bill,  of  which  it 
originally  formed  part,  and  made  to  perish  from 
the  too  great  assiduity  of  those  who  discuss  it. 
The  principle  of  this  short  Act  is  one  that  has  been 
contended  for  by  most,  if  not  all,  of  those  interested 
in  the  treatment  of  sufferers  from  mental  disease, 
and  one  which  has  been  warmly  championed  by 
Sir  William  Gowers.  This  principle  is  one  that 
really  gives  greater  security  to  the  individual, 
although  at  first  sight  it  appears  to  sanction  a 
method  that  removes  some  of  the  safeguards  now 
imposed  by  the  Lunacy  Acts.  It  is  on  this  latter 
score  that  one  fears  some  vigorous  champions  of 
liberty  may  found  objections  to  its  easy  passage. 
With  great  respect  to  those  who  think  thus,  and 
their  feelings  are  worthy  of  every  consideration, 
we  would  ask  them  to  take  a  broad  view  of  the 
whole  question  and  not  to  decide  against  the 
measure  till  they  are  acquainted  with  the  full 
bearings  of  its  proposals.  All  medical  men  in 
general  practice  are  now  and  then  placed  in  the 
awkward  dilemma  of  meeting  with  cases  of  incipient 
mental  disease  in  patients  who  have  up  to  that 
time  been  perfectly  sane.  To  form  straight  off  a 
diagnosis  as  to  the  nature  of  the  disease,  and  to 
prognose  the  course  it  is  likely  to  follow,  are 
beyond  the  power  of  human  skill  till  after  a  certain 
period  of  observation  has  elapsed,  and  the  sym- 
ptoms have  developed.  The  trouble  may  be  mild 
and  temporary,  or,  on  the  other  hand,  may  rapidly 
run  on  into  stark  insanity  with  delusions,  suicidal 
or  homicidal  impulses,  and  outbreaks  of  violence. 
Faced  with  these  possibilities  the  course  to  be 
followed  by  the  practitioner  is  fraught  with  the 
greatest  anxiety  and  difficulty.  The  doctor 
hesitates  to  certify  the  patient  as  insane  and  order 
his  removal  to  an  asylum,  while  he  is  equally  loth 
to  leave  him  with  his  family,  where  he  is  without 
restraint,  and  may  at  any  moment  get  out  a  razor 
and  cut  all  their  throats.  People  are  notoriously 
chary  of  admitting  that  their  relation  is  insane,  and 
nothing  short  of  a  severe  fright  will  lead  them  to 
consent  to  his  being  M  put  away,"  as  they  term  it. 
At  present,  if  a  patient  such  as  we  have  described 
consents,  he  can  be  placed  under  supervision,  but 
not  under  restraint ;  whilst  if  he  be  obdurate,  there 
is  no  alternative  to  an  asylum,  with  its  inevitable 
stigma  and  its  often  inj  urious  associations.  Now  no 
well-informed  or  fair-minded  person  will  be  found 
to  maintain  that  the  power  of  certification  is 
abused  at  the  present  day,  or  that  medical  men  are 
not  alive  to  the  tremendous  responsibility  that 


rests  on  them  in  signing  certificates.    If -only  for 
their  own  sakes  they  shrink  from  placing  them- 
selves in  a  position  that  is  sure  to  be  severely 
criticised    from    every   side,   and  may    end  by 
their  having  to  defend  an  action  at  law.    To  its 
credit  it  may  be  said  that  there  is  no  duty  the  pro- 
fession performs  more  tactfully  and  wisely  than 
the  delicate,  difficult,  and  dangerous  one  of  de- 
priving those  who  are  in  need  of  care  and  restraint 
of  their  cherished  liberty.     The  Government  Bill 
seeks  to  provide  a  much-needed  hiatus  between 
the  home  and  the  asylum,  by  allowing  a  patient, 
on  medical  certificate,  to  be  placed  in  the  house  of 
a  doctor  as  a  single  patient  till  a  limited  period 
has  elapsed,  during  which  the  nature  of  the  disease 
and  course  it  is  likely  to  follow  can  be  determined* 
Ample  security  against  possible  recklessness  or 
malevolence  is  granted  by  the  provision  that  the 
certifying  practitioner  shall  not  be  the  one  who 
receives  the  patient  into  his  house,  and  that  prompt 
notice  of  the  condition,  whereabouts,  and  move- 
ments of  the  patient  is  to  be  furnished  to  the  Com- 
missioners in  Lunacy.   From  the  point  of  view  of 
society  it  furnishes  them  with  a  guarantee  that 
no  temporary  mental  aberration  need  land  its 
victim  within  the  four  walls  of  an  asylum,  and, 
from  the  point  of  view  of  the  patient,  it  ensures 
that  he  shall  receive  every  opportunity  of  quiet 
cure  in  a  private  house  under  medical  care.    To 
the  medical  practitioner  it  grants  a  welcome  relief 
from  the  unpleasant  duty  of  having  to  hurry  a 
patient  into  an  asylum  or  risk  the  lives  of  the  re- 
latives by  leaving  him  untended  at  home.    Those 
who  may  be  inclined  to  see  in  this  Bill  a  menace 
to  individual  freedom  may  reassure  themselves  by 
the  reflection  that  the  possibility  of  a  halt  in  a 
half-way  house  of  this  description  will  deprive  any 
malignant  person  of  any  excuse  for  rushing  an 
inconvenient  person  into  an  asylum.     The  Bill  is 
wholly  beneficent  in  it  s  scope  and  aims,  and  though 
there  are  modifications  which  we  should  like  to 
see  introduced  into  its  clauses,  we  trust  that  no 
well-meant  but  ill-advised  opposition  will  prevent 
it  from  becoming  law  this  session. 

LEUCOCYTOSIS  AND  APPENDICITIS. 

It  is  now  some  fifteen  years  since  Hayem  drew 
attention  to  the  helpfulness  of  blood  examinations 
in  the  diagnosis  of  suppurative  affections  of  the 
peritoneal  cavity  in  general,  and  of  the  appendix 
in  particular.  Later  on  Cabot  and  others  pointed 
out  that  there  was  commonly  a  marked  increase 
in  the  number  of  leucocytes  coincident  with  the 
formation  of  pus  in  connection  with  acute  in- 
flammatory conditions,  particularly  of  the  peri- 
toneal cavity.  As  an  application  of  this  truth, 
Curschmann  introduced  the  systematic  counting 
of  leucocytes  during  the  course  of  appendicitis 
as  a  guide  to  the  diagnosis  of  suppuration*  During 
the  two  years  which  have  elapsed  since  the  pub- 
lication of  his  observations,  his  views  have  received 
very  general  support,  and  it  has  become  the  prac- 
tice of  surgeons  all  over  the  world  to  place 
reliance  on  a  leucocytic  count  as  a  deciding  point 
in    the    diagnosis    of    abscess   of    the    appendix. 


JUMg  23,   IQQ4« 


LEADING  ARTICLES. 


The  judical  Piasa.     667 


Sufficient  time  has  now  been  given  to  permit  of  a 
critical  examination  of  the  current  practice  being 
undertaken  to  see  whether  it  is  as  universally 
trustworthy  as  is  generally  supposed,  and  if  not, 
to  lay  down  proper  limits  for  its  application.  This 
is  what  is  attempted  in  very  useful  contribu- 
tions to  the  current  number  of  the  Practitioner, 
by  Dr.  Herbert  French,  of  Guy's  Hospital,  and 
by  Drs.  Maurice  Gazin  and  Edmond  Gros,  of 
Paris.  The  former  bases  his  arguments  on  his 
experience  of  eighty-three  cases  observed  in 
Guy's  Hospital,  and  the  latter  give  not  only  a 
critical  examination  of  their  own  cases,  but  of  the 
literature  of  the  subject  in  general.  In  the  main 
the  English  and  French  critics  are  in  agreement, 
so  that  their  conclusions  may  for  the  present 
be  regarded  as  justified.  As  is  natural  with  any 
new  discovery  which  is  of  real  value,  there  is, 
as  soon  as  its  worth  is  known,  a  tendency  to 
exaggerate  its  importance,  and  to  neglect  the 
limits  of  its  applicability.  Unless  this  tendency 
is  corrected  in  time,  there  is  likely  to  be  a  serious 
recoil  of  opinion,  tending  to  bring  what  may  be  a 
point  of  considerable  value  into  undeserved  neglect. 
This  is  what  would  probably  happen  in  the  case 
of  the  leucocyte  count  in  appendicitis,  so  that  it 
is  well  to  have  our  hasty  conclusions  corrected 
by  comparison  with  a  sufficient  number  of  cases. 
Some  important  points  appear  frqm  such  com- 
parison. In  the  first  place,  leucocytosis  must  not 
in  any  case  be  regarded  as  an  absolute  sign  of  the 
presence  of  pus,  but  must  take  its  place  as  one 
among  many  clinical  conditions.  The  rule  which 
is  said  to  govern  some  surgeons,  to  operate  if  the 
leucocytes  number  15,000,  would  lead  to  improper 
and  unjustifiable  interference  with  the  abdominal 
cavity.  A  leucocytosis  of  25,000  may  occur 
without  pus  being  present,  or,  on  the  other  hand, 
pus  may  need  evacuation  where  the  leucocytes  have 
never  numbered  12,000.  Again,  it  would  seem 
that,  differing  from  earlier  opinions,  an  absolute 
leucocytosis  is  not  in  itself  of  great  diagnostic 
importance.  What  is  of  importance  is  a  rising 
leucocyte  count,  and  it  is  only  positively  that  this 
is  of  value.  That  is  to  say,  a  rising  leucocyte 
count  usually  points  to  the  presence  of  pus,  but, 
on  the  other  hand,  a  large  abscess  may  be  present 
without  this  feature.  It  seems  agreed  that  a 
moderate  degree  of  leucocytosis  is  a  fairly  con- 
stant sign  of  peritoneal  inflammation,  either  local 
or  general,  so  that  in  all  cases  of  suspected  appen- 
dicitis, a  leucocyte  count  should  be  made.  The 
best  practice  would  seem  to  be  that  such  count 
should  be  made  periodically  once  or  twice  a  day 
during  the  course  of  the  illness,  and  any  marked 
increase  in  the  number  of  leucocytes  would,  in 
conjunction  with  other  signs,  suggest  the  presence 
of  pus. 


SERUM-THERAPY    IN   TUBERCULOSIS. 

There  has  been  no  innovation  in  modern 
therapeutics  comparable  in  importance  to  the 
introduction  of  serum- therapy.  Other  discoveries 
of  importance — indeed,  as  regards  certain  diseases 


of  prime  importance — have  been  made,  but  they 
have  all  been  on  the  old  traditional  lines  of  drug 
treatment,  and  consequently  are  not  so  suggestive 
of  further  development.  To  use  a  Baconian 
phrase,  they  are  merely  fruit-bearing,  but  not 
light-bearing,  Of  this  class  is,  for  instance,  the 
discovery  of  the  use  of  salicylic  acid  in  rheumatism, 
which,  though  in  itself  a  discovery  of  immense 
practical  value,  does  not  give  promise  of  any  further 
knowledge.  Of  entirely  different  class,  and  of  value, 
perhaps  more  as  suggestive  than  in  immediate 
practical  application,  are  the  discoveries  that  have 
been  made  by  following  out  the  lines  of  immuni- 
sation. The  sudden  and  almost  startling  success- 
which  attended  the  use  of  prepared  serum  in 
certain  diseases,  such  as  diphtheria,  tetanus,  and 
hydrophobia,  led  to  perhaps  too  optimistic  a 
view  of  its  speedy  application  to  the  prevention 
or  cure  of  other  infectious  diseases.  We  have, 
indeed,  no  reason  to  believe  that  these  hopes  will 
not  be  ultimately  justified,  but  only  that  the  path 
to  their  accomplishment  is  not  so  straight  and 
plain  as  was  at  first  supposed.  The  case  of  tuber- 
culosis is  in  this  respect  fairly  typical  of  many 
diseases,  for  hopes  of  satisfactory  serum-therapy 
have  many  times  been  raised  high,  only  to  be 
dashed  to  the  ground.  Various  methods  of  anti- 
tuberculous  inoculation  have  from  time  to  time 
been  vaunted,  but  none  of  them  has  as  yet  been 
generally  accepted.  One  of  the  most  influential 
believers  in  an ti- tuberculous  serum  treatment  is 
Maragliano,  of  Genoa,  who  has  consistently 
maintained  its  practicability  for  many  years. 
In  a  recent  lecture  delivered  in  Philadelphia,  he 
has  given  descriptions  of  the  various  methods  he 
has  adopted  in  the  treatment  and  prophylaxis 
of  the  disease.  At  first  he  was  in  the  habit  of 
treating  man  by  the  administration,  subcutane- 
ously  or  by  the  mouth,  of  sera  obtained  from 
immunised  animals.  These  sera  contain  bodies, 
which  may,  for  convenience,  be  grouped  as  anti- 
toxins, antibodies,  and  agglutinins.  It  is  assumed 
that  these  are  present  in  fairly  constant  relative 
proportions,  so  that  agglutinins  being  compara- 
tively easy  of  estimation,  they  may  be  taken 
as  the  standard  of  the  other  bodies  present.  The 
resistance  of  the  immunised  animal,  then,  to  in- 
fection may  be  measured  by  the  degree  of  agglu- 
tination his  blood  exhibits.  By  the  clinical  history  of 
several  cases,  as  well  as  by  the  character  of  the  blood, 
Maragliano  sufficiently  justifies  his  procedure. 
More  recently,  however,  he  has  been  led  a  step 
further,  and  he  believes  that  he  is  now  able  to 
produce  an  efficient  vaccination  against  tubercle. 
His  principle,  whatever  variety  of  method  may  be 
necessary,  is  to  create  a  peripheral  focus  of  tuber- 
culous inflammation  without  living  tubercle 
bacilli,  and  bring  about  by  this  means  the  active 
production  of  defensive  materials.  With  lower 
animals  he  has  entirely  succeeded,  and  he  believes: 
he  has  done  so  with  man,  but,  of  course,  the 
difficulties  of  verification  are  enormous.  They  are, 
moreover,  difficulties  which  can  only  be  removed 
by  wide  observations  extending  over  lengthy 
periods  of  time. 


668    The  Medical  Press.    NOTES    ON    CURRENT    TOPICS. 


June  22,  1904. 


"notes  on  Current  Uopics* 

What  is   Gyn»oology? 

The  curiously  anomalous  position  of  gynae- 
cology in  England  is  shown  by  the  agenda  paper 
of  the  coming  meeting  of  the  British  Medical 
Association  at  Oxford.  The  meeting  will  consist 
of  some  fourteen  sections,  each  of  which,  with  one 
exception,  will  deal  with  the  subject  with  which 
it  is  especially  concerned.  This  exception  is  the 
section  of  "Obstetrics  and  Gynaecology."  Every- 
one at  the  present  day  admits  that  the  science  or 
art — whichever  it  may  be  called — of  gynaecology 
is  mainly  surgical,  yet  when  we  come  to  inspect 
the  agenda  paper  we  find  that  while  the  section 
which  was  created  to  deal  with  gynaecological 
subjects  proposes  to  concern  itself,  like  the 
Incorporated  Mid  wives'  Institute,  with  "  tired 
ovaries "  or  a  kindred  subject,  the  Section  of 
Surgery  is  to  discuss  the  subject  of  "  hysterec- 
tomy "  in  all  its  bearings.  And,  further,  that  it 
is  to  be  explained  to  the  audience  "  that  the 
efforts  of  surgeons  made  a  proper  clinical  and 
pathological  investigation  of  uterine  diseases 
possible."  Now  we  have  not  the  least  objection 
to  referring  to  the  gynaecologist  as  a  surgeon,  but, 
if  such  a  course  is  considered  advisable,  why  have 
a  Section  for  "  Gynaecology  "  ?  Or,  if  it  is  con- 
sidered that  the  various  "  -ologists "  should 
confine  themselves  to  the  purely  medical  side  of 
their  "  -ology,"  and  that  the  surgical  side  should 
be  discussed  at  the  Surgical  Section,  by  all  means 
let  such  a  course  be  adopted.  It  would  be  absurd, 
but  it  would  not  be  so  absurd  as  to  occupy  the 
Ophthalmological,  Laryngological  and  Otological 
Sections  with  the  discussion  of  surgical  subjects, 
and  to  bring  a  discussion  on  hysterectomy — of 
all  subjects — before  the  Surgical  Section.  We 
do  not  know  what  particular  clique  of  that  august 
body,  the  British  Medical  Association,  may  be 
responsible  for  the  arrangements  which  have  been 
made,  but  we  do  know  that  to  such  stupid  jea- 
lousies is  largely  due  the  poor  repute  in 
which  the  English,  as  distinct  from  the  British, 
school  of  gynaecology  is  held. 


The  Dublin  Hospitals  and  the  CM  B. 

The  Report  which  is  furnished  annually  by 
the  Board  of  Superintendence  of  the  Dublin 
Hospitals  to  His  Excellency  the  Lord  Lieutenant 
-contains  one  of  the  strongest  protests  which  has 
yet  been  made  against  the  arbitrary  action  of  the 
Central  Midwives'  Board  in  excluding  Irish- 
trained  nurses.  In  the  portion  of  the  report 
referring  to  the  Rotunda  Hospital,  the  following 
paragraph  appears  : — "  As  a  training  school  for 
maternity  nurses  the  most  thorough  and  careful 
instruction  is  given,  which  makes  them  welcome 
and  helpful  aids  at  all  obstetric  cases.  It  was, 
therefore,  with  surprise  that  we  learned  that  the 
"*  Central  Midwives'  Board,'  in  framing  their  rules, 
took  no  account  of  the  Rotunda  and  Coombe 
Hospitals,  and  rushed  through  the  Privy  Council 
■a  set  of  rules  which  exclude  all  Irish- trained 
midwives.  We  trust  that  the  objectionable 
-clauses   that  bear  on  this  subject  may  soon  be 


deleted  ;  and  we  cannot  help  observing  that  it 
would  have  been  more  courteous  and  wise  for 
the  'Central  Midwives'  Board'  to  have  com- 
municated with  the  masters  of  our  maternity 
hospitals,  and  elicited  their  opinion  on  the  rules 
that  had  been  drawn  up,  before  presenting  them 
to  the  Privy  Council  for  approval."  We  trust 
that  His  Excellency  will  take  note  of  this  protest, 
and  will  cause  it  to  be  brought  to  the  attention  of 
the  proper  authorities.  We  would  also  suggest 
that  the  Irish  hospital  authorities  should  have  a 
question  asked  in  Parliament  with  the  object  of 
directing  attention  to  the  report  of  the  Board, 
and  more  especially  with  the  object  of  having  it 
brought  to  the  notice  of  the  Lord  President  of  the 
Council.  We  are  sure  that  Mr.  T.  P.  O'Connor, 
who  has  already  shown  the  interest  he  takes  in  the 
Irish  hospitals,  would  be  willing  to  again  raise  the 
question  in  the  House.  The  Board  of  Super- 
intendence have  also  drawn  attention  to  the  want 
of  the  installation  for  the  use  of  X-rays,  the  radium 
light,  and  the  Finsen  light  in  the  different  hos- 
pitals, and  make  the  very  practical  suggestion 
that,  in  order  to  assist  the  hospital  authorities 
in  meeting  the  expense,  a  grant-in-aid  should  be 
given,  not  to  exceed  one-half  of  the  outlay  in- 
curred in  the  purchase  and  installment  of  the 
necessary  plant. 


Chloroformed  Calf  Vaccine. 

Dr.  Monckton  Copeman's  discovery  of  the 
value  of  glycerine  in  freeing  vaccine  from  ex- 
traneous organisms  whilst  preserving  its  efficacy 
created  little  less  than  a  revolution  in  the  prepara- 
tion of  material  for  vaccination  when  he  an- 
nounced it  some  years  ago.  The  process  was  a 
long  one,  and  the  expense  of  preparation 
great;  but  so  obvious  were  its  benefits  that  the 
manufacture  of  glycerinated  lymph  was  under- 
taken by  the  Government  laboratories,  and  it  is 
now  the  only  lymph  issued  to  public  vaccinators. 
Since  this  important  discovery  Dr.  Alan  Green 
has  found  another,  and  no  less  efficacious,  means 
of  treating  lymph  to  purify  and  preserve  it, 
namely,  by  subjecting  it  to  the  influence  of  chloro- 
form. The  preliminary  work  was  embodied  in 
a  paper  communicated  to  the  Royal  Society  last 
year,  and  after  another  twelve  months'  experi- 
menting his  experience  is  as  satisfactory  as  ever. 
Dr.  Green  finds  that  by  passing  chloroform  and 
air  through  emulsions  of  pulp  and  water  the  micro- 
organisms in  the  pulp  are  rapidly  destroyed, 
the  best  temperature  for  the  purpose  being  one 
between  180  C  and  230  C.  The  same  result  was 
arrived  at  in  passing  air  and  chloroform  through 
broth  emulsions  of  various  bacteria,  some,  such 
as  Bacillus  tuberculosis  and  Bacillus  mallei,  being 
very  resistant  organisms.  None  of  the  bacteria 
experimented  with  could  withstand  eight  hours' 
exposure  to  the  vapour.  With  regard  to  the  pre- 
servative influence  of  chloroform  on  the  vaccine, 
he  noticed  that  those  emulsions  treated  at  io°C, 
retained  the  highest  potency  for  the  longest  time, 
and  that  this  potency  was  about  equal  in  chloro- 
formed and  glycerinated  vaccine.    Chloroformed 


June  aa.  ioo4» 


NOTES   ON    CURRENT    TOPICS.      The  Medical  Peess.        669 


vaccine  has  been  used  for  the  inoculation  of  calves 
with  very  good  results,  and  some  from  which 
the  chloroform  was  removed  and  glycerine  added, 
for  ordinary  human  vaccination,  after  it  had  com- 
plied with  all  the  necessary  bacteriological  tests. 
In  two  cases  it  retained  its  strength  for  two 
months,  and  was  quite  free  from  organisms  at  the 
end  of  that  period.  Dr.  Green's  method  promises 
to  be  a  useful  and  trustworthy  one. 

Pauper  Children. 
In  our  unsatisfactory  Poor-law  system  there 
is  perhaps  no  feature  more  worthy  of  attention 
and  remedy  than  that  of  the  treatment  of  pauper 
children.  At  present  there  are  three  methods  in 
vogue — retention  of  the  children  in  the  work- 
houses, placing  them  in  huge  "  barrack  schools," 
and  boarding  them  out  in  cottages.  When  the 
State  takes  upon  itself  the  duty  of  caring  for  pauper 
children,  it  has  one  clear  course  to  pursue — 
namely,  to  make  them  become  useful  citizens  at 
the  earliest  reasonable  moment.  This  is  not  only 
{he  humane,  but  the  economical  plan,  and  for- 
tunately it  is  the  one  that  is  being  brought  more 
and  more  into  play.  But  there  are  still  many  inert 
and  cheese-paring  boards  of  guardians  who  are 
content  to  follow  the  old  routine,  unstirred  by  the 
example  of  their  more  progressive  fellows.  Any- 
thing more  detrimental  to  the  development  of  a 
child's  mind  or  to  his  health  than  constant  work- 
house associations  could  scarcely  be  conceived, 
and  only  a  little  less  hurtful  to  both  is  the  barrack- 
schooL  The  dangers  of  infectious  diseases,  ring- 
worm and  ophthalmia  in  these  segregation  in- 
stitutes are  far  from  fanciful ;  everyone  who  has 
had  experience  of  these  schools  knows  what  hot- 
beds of  disease  they  are  and  must  be.  Moreover, 
the  system  on  which  they  are  conducted  tends 
to  sap  all  initiative  in  the  children,  and  when 
they  are  turned  out  into  the  world  they  are  as 
helpless  as  sheep  separated  from  the  flock.  The 
only  sensible  system  from  the  point  of  view  of 
future  independence  and  physical  health  is  the 
boarding-out  one.  The  children  are  placed  in 
families,  either  natural  families  or  artificially- 
created  ones,  with  ad  hoc  parents,  and  are  allowed 
to  grow  up  under  home  influences,  and  to  attend 
the  ordinary  elementary  schools  of  the  district. 
In  no  other  way  can  the  real  well-being  of  the 
children  be  assured,  and  it  would  be  gratifying 
to  find  the  Local  Government  Board  insisting 
more  strongly  on  its  adoption  than  it  does  at 
present. 


Report  of  the  Milk-Borne  Diseases. 
The  report  of  the  Royal  Commission  on  Tuber- 
culosis certainly  bears  out  the  general  view  held 
in  Great  Britain  that  milk  from  tuberculous  cows, 
especially  those  having  tuberculous  lesions  of  the 
udder,  is  capable  of  transmitting  the  disease  to 
human  beings.  At  the  same  time  the  number 
of  deaths  from  primary  tuberculosis  of  the  intes- 
tinal tract  has  probably  been  greatly  over- 
estimated in  the  past.  In  focussing  attention  on 
the     tubercle  -  bearing     potentialities     of     milk 


in  the  manner  that  recent  discussions  have  done* 
there  is  considerable  risk  of  other  dangers  passing 
unnoticed,  and  these  risks  are  considerably  greater 
in  their  sum-total  than  those  of  tuberculosis. 
Infantile  diarrhoea  is  due  to  a  great  extent  to  the 
inhibition  of  unsound  and  dirty  milk,  and  scar- 
latina and  diphtheria  are  not  infrequently  spread 
by  its  agency.  Less  prominent  than  these,  and 
more  obscure,  are  epidemics  of  sore-throat  of 
anomalous  nature  that  occur  from  time  to  time, 
and  that  are  sometimes  traced  to  milk  infection. 
Doubtless  there  are  many  of  these  outbreaks 
that  are  never  run  to  earth,  and  still  greater  num- 
bers of  sporadic  cases  whose  source  of  origin  is 
never  discovered.  Very  striking  in  this  connection 
is  the  account  given  by  Dr.  Chalmers,  Medical 
Officer  of  Health  for  Glasgow,  of  a  series  of  cases  of 
sore  throat  that  occurred  among  the  staffs  of  the 
small-pox  and  fever  hospitals  at  Belvedere. 
Dr.  Chalmers'  suspicions  led  him  to  investigate 
the  milk  supply,  and  he  found  that  a  new  cow 
was  added  to  the  herd  from  which  the  milk  for 
the  hospitals  was  derived  the  day  before  the 
cases  began.  This  cow  suffered  from  a  teat 
eruption,  and  in  due  course  many  of  the  other  cows 
associated  with  it  fell  a  prey  to  the  same  disease. 
Moreover,  half  the  milkers  suffered  from  a  similar 
eruption  on  the  hands.  The  organisms  found  in 
the  eruption  and  in  the  throats  were  all  pyogenic 
in  character,  and  Dr.  Chalmers  had  no  doubt  that 
their  existence  revealed  an  etiological  "relationship 
between  the  two  outbreaks.  Fortunately,  all 
the  cases  were  mild.  Medical  men  are  often  at  a 
loss  to  account  for  benign  cases  of  sore  throat 
occurring  in  households  and  individuals;  it  is 
well  to  remember  that  suspicion  should  always  be 
directed  to  the  milk  they  have  been  drinking. 


A  Disputed  Diagnosis. 

It  is  obvious  enough  that  the  proper  adminis- 
tration of  the  Infectious  Diseases  Acts  must 
ultimately  depend  to  a  great  extent  upon  the 
harmonious  relationship  of  the  general  practitioners 
with  official  medical  men.  A  case  like  that 
recently  reported  from  Staffordshire,  if  the  facts 
be  correctly  stated,  affords  a  good  illustration  of 
how  things  ought  not  to  be  done.  Dr.  Bull,  of 
Great  Haywood,  attended  the  last  Staffordshire 
Rural  Council  monthly  meeting,  and  related  the 
following  experience:  On  March  15th,  he  sent  a 
child  suffering  from  scarlet  fever  to  the  fever 
hospital.  After  the  discharge  of  that  child  a 
second  one  became  ill  and  was  sent  to  the  hospital. 
Sixteen  or  seventeen  davs  later  a  post-card  was 
sent  to  the  parents  saying  the  child  was  to  be 
removed,  as  it  was  suffering  from  measles,  and  not 
from  scarlatina.  The  child  was  taken  home,  and 
the  mother  subsequently  developed  scarlet  fever. 
Meanwhile,  the  child's  father  became  wroth  with 
Dr.  Bull  and  threatened  to  bring  a  claim  against 
the  latter  for  keeping  him  from  work,  to  say 
nothing  of  his  wrong  diagnosis.  Dr.  Bull  had, 
fortunately,  called  in  another  medical  man  to 
the  second  child,  and  his  diagnosis  was  confirmed. 


670    Tm  Medical  Pies*       NOTES   ON    CURRENT   TOPICS. 


JUNB  Z2,   1904. 


This  extraordinary  story  seems  hardly  credible. 
The  nature  of  the  first  case  was  not  disputed — 
even  if  the  second  were  atypical,  yet  on  grounds 
of  ordinary  prudence  it  would  have  been  wiser  to 
treat  the  latter  as  scarlet  fever,  which,  read  in  the 
light  of  the  infection  of  the  mother,  it  undoubtedly 
was.  It  may  safely  be  said  that  if  a  similar 
arbitrary  course  were  adopted  by  the  medical 
officers  of  fever  hospitals  generally  the  isolation 
system  of  the  United  Kingdom  would  be  either 
seriously    undermined   or    destroyed     within    a 

twelvemonth.  

Welsh  Infantile  Mortality. 
It  is  well  to  remember  that  increase  of  popu- 
lation depends  not  only  on  the  number  brought 
into  the  world,  but  also  on  those  who  survive. 
Were  the  present  excessive  rates  of  infantile 
mortality  reduced,  the  people  of  the  United 
Kingdom  would  multiply  as  the  sand  on  the  sea- 
shore. The  national  loss  from  this  source  is 
enormous,  and  for  the  main  part  preventable. 
The  Welsh  people  have  recently  been  much 
perturbed  in  mind  by  the  recent  returns,  which 
show  a  high  rate  for  Wales  generally,  and  for 
Glamorgan  in  particular.  The  most  likely 
explanation,  so  far  as  the  county  in  question  is 
concerned,  may  be  found  in  the  fact  that  it  con- 
tains a  large  mixed  mining  and  industrial  popu- 
lation. Speaking  generally,  the  rate  is  invariably 
higher  under  such  conditions  as  compared  with 
agricultural  and  non-commercial  sections  of  the 
community.  Dr.  Williams,  the  Glamorgan- 
shire Medical  Officer  of  Health,  appears  to 
attribute  the  high  infantile  rate  of  the  county  to 
the  ordinary  causes  of  overcrowding,  early  mar- 
riages, and  ignorance  of  mothers.  In  one  of  his 
reports  he  writes  : — "  The  rate  of  infant  mortality 
is  a  valuable  test  of  the  sanitary  condition  of  a 
district.  The  diseases  most  fatal  to  infants  are 
chiefly  of  a  preventable  nature,  and  are  probably 
connected  with  improper  feeding,  exposure  to 
cold,  and  want  of  cleanliness."     Vet  bum  sap. 


The  Personal  Equation  in  Diet. 
The  medical  profession  has  been  charged  by  a 
contemporary  with  falling  into  somewhat  narrow 
grooves  in  the  matter  of  the  prescribing  of  diets. 
To  some  extent  this  accusation  is  true,  because 
medical  practitioners,  like  other  mortals,  are 
more  or  less  creatures  of  habit.  They  have  been 
accustomed  from  their  student  days  upward  to 
associate  certain  diets  with  particular  types  of 
disease,  and  having  prescribed  them  for  their 
patients  according  to  the  most  approved  regula- 
tions, they  are  unwilling  to  depart  from  them. 
The  subject  of  sick-room  dieting  and  cookery 
is  one  to  which  more  attention  might  well  be  paid 
in  our  medical  schools,  for  even  in  the  wards  of 
hospitals  the  chilling  frost  of  routine  is  apt  to 
creep  in  and  to  destroy  or  blunt  all  efforts  at 
originality  or  experiment  in  connection  with  this 
most  important  matter.  Much  can  be  learnt  in 
this  direction  from  a  skilful  and  long-experienced 
nurse,  and  there  are  not  a  few  practitioners  who 
remember  with  gratitude  the  useful  and  practical 


"  tips  "  thus  learnt  in  the  way|qf ^flavouring  the 
necessary  but  distasteful  draught  of  milk  for  a 
typhoid  patient,  or  of  concocting  a  nourishing 
"  feed  "  out  of  a  judicious  combination  of  eggs 
and  broth.  But  it  is  not  only  in  the  dietetic 
management  of  acute  febrile  cases  that  the  per- 
sonal factor  is  so  important,  it  is  in  the  dieting  of 
a  chronic  dyspeptic  or  diabetic  that  the  greatest 
scope  exists  for  the  display  of  originality  and  skilL 
And  here  it  is  the  patient's  personal  equation 
which  must  be  taken  into  account  if  the  highest 
measure  of  success  is  to  be  attained.  This  requires 
close  observation  and  some  experience  so  as  to- 
enable  the  patient's  own  whims  to  be  utilised  for 
his  good.  Individual  idiosyncrasy  is  a  factor 
which  cannot  afford  to  be  neglected,  and  the 
chances  of  recovery  are  generally  greater  if  the 
sick  person  is  receiving  that  which  is  nutritious 
and  easily  absorbed,  and  yet  which,  at  the  same 
time,  he  or  she  thoroughly  enjoys. 


Quackery  in  America. 

We  have  often  commented  4 on  the  superior 
cleverness  shown  by  American  ^mountebanks  in 
devising  modes  of  trickery  which  are  most  likely 
to  delude  the  public,  and  we  have  been  surprised 
at  the  great  conservatism  shown  in  the  main  by 
their  English  brethren.  For  instance,  in  this 
country  we  do  not  remember  seeing  anything  so- 
ingenious  as  the  prospectus  issued  recently  in  the- 
States  by  "a  world-wide  experienced  trained 
nurse/1  It  has  been  distributed  to  anxious- 
husbands,  who  are  supposed  to  be  sadly  in  need 
of  sons  and  heirs  to  inherit  their  estates  and 
fortunes.  The  writer  describes  herself  as  "  middle- 
aged,  and  has  two  handsome  sons — gentlemen." 
Apparently  she  promises  similar  progeny  to  all 
her  clients.  She  charges  no  fee,  but  leaves  the 
value  of  the  secret  she  disposes  of  to  the  "  genero- 
sity "  of  the  prospective  father,  and  she  altogether 
declines  to  consult  with  any  mother.  The  names 
of  several  well-known  people  follow,  who  are  said 

to  owe  their  sons  to  Mrs.  *s  advice.    It  is 

unfortunate  that  no  hint  is  given  as  to  the  nature 
of  the  great  secret  beyond  the  cryptic  remark 
that  "  a  gardener  does  not  plant  an  onion  and 
expect  a  potato  to  grow  from  it."  We  hope 
some  few  gentlemen  in   the  States  will  refrain 

from  consulting  Mrs.  ,  as  otherwise  there  is 

danger  of  the  race  dying  out  from  a  plethora  of 
males. 


Cobra  Venom. 

Although  the  series  of  clinical  phenomena 
occurring  in  poisoning  by  cobra  venom  has  long 
been  well  known,  it  is  only  comparatively  recently 
that  serious  attempts  have  been  made  to  investigate 
the  pathological  phenomena  which  are  their  source. 
It  is,  consequently,  no  wonder  that,  up  to  the 
present,  there  has  been  but  little  consensus  of 
opinion  on  the  subject.  Brunton  and  Fayrer^ 
followed  later  by  Weir  Mitchell  and  ReicherU 
believed  that  the  chief  toxic  action  of  cobra 
venom  was  directed  toward  the  cerebro-spinal 
nerve  centres,  especially  to  the  respiratory  centre. 


June  aa,  1904* 


NOTES  ON  CURRENT  TOPICS. 


The  Mkdical  P*»*s-     671 


They  thought  also  that  the  cardiac  muscle  was 
directly  affected,  and  they  noted  the  fact  of  high 
l)lood  pressure  being  caused  by  arterial  con- 
traction. They  placed  most  importance  on  the 
nervous  channels  supposed:  to  be  affected  by  the 
poison,  while,  on  the  other  hand,  Cunningham 
maintained  strongly  that  cobra  venom  affected 
the  respiration  through  the  blood,  and  not  through 
nervous  influence.  The  most  complete  investiga- 
tion yet  made,  however,  is  that  recently  under- 
taken by  Captain  Elliot,  acting  under  orders  from 
the  India  Office.  As  might  be  expected,  his  results 
<io  not  altogether  agree  with  those  of  previous 
inquirers,  while  in  various  points  he  is  in  harmony 
with  one  or  another.  He  finds  experimentally 
that  snake  venom  powerfully  affects  the  muscles 
of  the  vessel  walls  and  the  heart  muscle,  probably 
both,  by  direct  action  on  the  muscular  tissue,  and 
"by  the  intermediation  of  the  nerve  endings.  In 
the  case  of  the  vessels  the  contraction  of  the 
muscular  coat  causes  a  great  increase  of  blood 
pressure.  In  that  of  the  heart,  apparently  the 
inhibitory  fibres  of  the  vagus  are  affected  as  well 
as  other  nerve-endings  and  the  muscle  itself, 
•so  that  the  heart  stops  in  systole.  Captain  Elliot 
produces  evidence  also  to  show  that  cobra  venom 
directly  paralyses  the  respiratory  centre,  so  that 
if  the  heart  should  escape,  death  by  asphyxia 
probably  will  occur. 

The  Hsematogen  Trial. 

The  well-known  firm  of  Hommel  recently 
brought  an  action  in  the  King's  Bench  Division  of 
the  High  Court  against  Gebruder,  Bauer  and 
-Company,  who  had  sold  in  England  a  product 
under  the  name  of  -4  Haematogen."  Hommel  sought 
relief  under  two  heads— first,  as  proprietor  of  a 
trade  mark  which  had  been  infringed,  and  secondly, 
because  the  defendant  was  substituting  other 
goods  and  endeavouring  to  pass  them  off  as  the 
goods  of  plaintiff.  The  judge  ruled  that  the  word 
haematogen  was  known  in  England  before  being 
registered  by  the  plaintiff,  and  in  response  to  the 
cross-motion  he  ordered  the  mark  to  be  struck  off 
the  Register.  The  learned  j  udge  also  ruled  against 
plaintiff  with  regard  to  the  substitution,  but  gave 
leave  to  appeal.  This  decision  may  be  strictly 
legal,  but  it  is  difficult  to  reconcile  it  with  the 
principles  of  ordinary  non-legal  j  ustice.  The  name 
was  certainly  mentioned  in  one  or  two  remote 
passages  in  English  books  prior  to  the  registration 
by  Hommel.  The  word  is  well  known  to  medical 
men  and  to  the  public  in  the  United  Kingdom  as 
Hommel's  preparation  of  haemoglobin,  and  it  has 
no  other  meaning.  The  injustice  arises  out  of  the 
English  system  which  allows  any  trade  mark  to 
be  registered  but  grants  it  no  subsequent  autho- 
rity or  support.  If  Hommel's  mark  is  bad  now 
it  was  bad  at  the  time  of  registration.  Why 
should  an  honourable  firm  be  permitted  to  spend 
large  sums  of  money  in  introducing  a  legitimate 
article,  recognised  by  the  medical  profession,  only 
to  find  out  in  the  course  of  a  costly  trial  in  the 
High  Courts  that  their  trade  mark  may  bemused 
by  any  unscrupulous  competitor? 


Messrs.  Hom- 


mel, however,  will  probably  find  some  other  way 
of  keeping  their  product  on  the  British  market. 

St.  George's  Hospital. 

Those  who  have  studied  the  various  changes 
that  have  taken  place  during  the  past  two  or  three 
centuries  in  the  City  of  London  could  easily  show 
how  certain  periods  of  time  have  passed  quietly, 
and  then  there  has  been  a  great  move,  generally 
from  East  to  West,  and  things  have  wonderfully 
changed.  When  the  Fire  and  the  Plague  happened 
there  was  a  great  move.  A  century  ago  the  West 
End  was  open  country,  and  that  corner  where  St. 
George's  Hospital  now  stands  was  really  more 
rustic  than  almost  any  place  within  the  twelve 
mile  radius.  When  the  question  of  whether  a 
hospital  like  St.  George's  should  be  moved  or  not 
comes  under  discussion  it  is  well  to  have  some 
principle  to  guide  us  in  our  opinions  and  decisions. 
Those  who  are  familiar  with  the  old  painting  of 
St.  George's  in  the  time  of  the  Hunters  can 
realise  how  vastly  Hyde  Park  Corner  has 
changed.  To  keep  things  as  they  are  is  a  wish 
that  we  respect.  But  where  in  London  has  it 
been  possible  to  keep  alive  these  associa- 
tions ?  The  College  of  Surgeons,  the  College 
of  Physicians,  the  Post  Office,  indeed,  well- 
nigh  all  the  great  buildings,  are  , transplan- 
tations from  a  crowded  centre, to  a  wider  area 
where  they  could  expand  as  required.  Hospitals 
are  not  well  placed  when  situated,  like  St.  George's, 
in  the  most  fashionable  part  of  London.  It  is 
inconsistent  to  intrude  sickness  and  its  surround- 
ings into  public  notice  wherever  we  are.  Medical 
schools,  museums,  post-mortem  rooms,  as  well  as 
the  sick  wards  of  the  hospital,  are  better  kept  out 
of  such  a  spot  as  the  corner  of  Grosvenor  Place ;  and 
considering  that  a  hospital  is  meant  for  the  poor 
there  is  little  to  be  said  in  favour  of  keeping  such 
a  doleful-looking  building  as  St.  George's  in 
the  neighbourhood  where  it  now  stands. 

Non-Recognition  of  Edinburgh  University. 
The  Honourable  Society  of  the  Inner  Temple, 
London,  is  an  ancient  legal  body,  possessing  rights 
and  privileges,  real  and  assumed,  of  a  somewhat 
multifarious  and  extensive  nature.  Among  other 
things  their  regulations  as  to  payments  by  students 
on  admission  demand  £40  us.  for  stamps  and  fees, 
with  a  deposit  of  £100,  returnable,  without  interest, 
on  call,  death,  or  withdrawal.  This  deposit  is 
waived  in  the  following  instances  : — «'  Members  of 
the  Scotch  Bar  are  not  required  to  make  this 
deposit,  nor  are  the  members  of  the  Universities 
of  Oxford,  Cambridge,  Dublin,  London,  or  Durham 
or  of  the  Victoria  University,  Manchester,  or  the 
Royal  University  of  Ireland,  provided  that  before 
call  they  take  a  degree  or  produce  a  certificate  of 
having  kept  two  years'  terms."  It  will  be  noticed 
that  the  Universities  of  Edinburgh,  Glasgow, 
Aberdeen,  and  St.  Andrew's  are  not  recognised  by 
the  Inner  Temple  authorities.  There  may  pos- 
sibly at  one  time  have  been  some  sort  of  excuse 
for  this  arrogance  of  attitude.  Another  possible 
explanation     may     be     that      the     Universities 


672    Ths  Medical  Pi  ess. 


PERSONAL. 


June  22,  1904. 


concerned  have  never  applied  for  recognition* 
Curiously  enough,  the  Scotch  Universities  are 
recognised  by  the  Middle  Temple  and  by  Lincoln's 
Inn.  Now  that  public  attention  has  been  called 
to  the  matter  it  is  to  be  hoped  this  invidious  re- 
striction will  be  forthwith  removed. 


Toys  and  Tetanus. 
The  speedy  oncoming  of  the  "  Glorious  Fourth  " 
Anniversary  in  America  is  causing  the  usual 
outburst  of  medical  advice  as  to  the  prevention  of 
tetanus.  For  many  years  it  has,  of  course,  been 
noticed  that  following  on  the  fire-work  celebra- 
tions of  July  4th,  there  is  a  regular  series  of 
cases  of  tetanus.  The  cause  usually  is  the  burst- 
ing of  a  squib  in  the  hand,  carrying  street  mud 
deep  into  the  tissues  of  the  palm.  The  wound 
receives  a  superficial  dressing,  and  tetanus  deve- 
lops. A  contemporary  has  recently  published  a  list 
of  the  casualties  that  occurred  last  "  Fourth," 
and  it  is  truly  an  appalling  roll.  The  deaths 
from  wounds,  with  or  without  the  occurrence  of 
tetanus,  were  475  in  number.  Ten  persons  were 
made  totally  blind,  while  no  less  than  303  lost 
an  eye,  arm,  leg,  hand,  or  one  or  more  fingers. 
In  addition,  3,670  painful  minor  accidents  were 
reported.  It  is  caustically  remarked  that  the 
American  loss  at  Bunker's  Hill  was  only  449. 
In  view  of  this  appalling  annual  hecatomb  to  silly 
custom,  it  is  surely  time  that  severe  legislative 
measures  were  adopted  to  put  a  stop  to  the  useless 
destruction  of  life  and  limb. 


"No  Hats." 
The  Leeds  Physical  Culture  Society  is  pur- 
suing a  crusade  against  objectionable  articles  of 
dress  with  all  the  energy  that  the  Tykes  can  put 
into  a  cause  they  espouse.  They  have  condemned 
corsets,  in  which  they  will  have  the  support  of 
most  medical  men,  and  garters,  which  are  almost 
equally  objectionable,  but  now  that  they  have 
directed  their  efforts  to  the  abolition  of  the  hat 
professional  support  may  not  be  so  unanimous. 
Nevertheless,  there  is  a  great  deal  to  be  said 
against  head-gear  in  general  as  a  utilitarian  ad- 
dition to  the  costume.  The  habit  of  pre-Adamic 
man  of  walking  bare-headed  to  the  suns  of  summer 
and  the  storms  of  winter  is  still  honoured  by 
the  boys  of  Christ's  Hospital,  and  one  does  not 
hear  that  they  suffer  abnormally  from  colds  in  the 
head,  but  as  they  fall  into  line  with  other  civilised 
beings  as  their  years  advance  there  is  no  means  of 
judging  whether  or  not  hat-wearing  conduces  to 
baldness.  The  question  of  the  utility  of  hats 
was  nearly  solved  for  us  some  few  years  ago  by 
the  West  End  milliners,  who,  setting  their  faces 
against  "  Gainsboroughs  "  and  "  picture  hats," 
reduced  their  victims  to  wearing  little  more  than 
a  bow  of  ribbon  where  the  toque  and  "  French 
sailor  "  now  rest.  But  the  pendulum  swung  back, 
and  the  Gordian  knot  is  yet  to  cut.  Whether  for 
use  or  ornament,  it  may  be  unhesitatingly  affirmed 
that  nothing  could  be  less  well  adapted  to  its  pur- 
pose than  the  top-hat,  which  is  ugly,  unhygienic, 


and  embarrassing.  Its  sole  claim  to  support  is 
the  appearance  of  respectability  it  gives,  and  it 
is  to  be  feared  that  this,  and  this  only,  is  the  reason 
that  medical  men  hesitate  to  obey  the  dictates 
of  their  consciences  and  consign  it  to  well-merited 
oblivion.  If  only  a  few  medical  baronets  would 
drive  to  their  consultations  in  Panamas  and  cloth 
caps  they  would  break  the  tyranny  of  habit  over 
health  and  comeliness,  and  at  the  same  time  earn 
the  undying  gratitude  of  their  humbler  confrhes. 

The  Royal  Medical  Benevolent  Fund. 

We  regret  to  learn  from  the  annual  report  of  the 
Royal  Medical  Benevolent  Fund  that  it  is  not  in 
as  healthy  a  condition  as  it  deserves  to  be.  The 
Treasurer  gives  warning  that  unless  a  material 
increase  is  made  in  the  subscriptions  during  the 
current  year,  the  present  scale  of  distribution  will 
have  to  be  reduced.  During  the  past  year  there 
was  in  country  contributions  a  falling-off  of  no 
less  than  two  hundred  pounds,  a  sum  which  would 
go  far  to  relieve  the  necessity  of  some  medical 
man's  family.  As  one  of  the  speakers  at  the 
meeting  pointed  out,  no  question  of  religion  or 
influence  is  ever  discussed  in  regard  to  any  appli- 
cation for  help.  The  only  questions  ever  con- 
sidered are  the  necessities  of  the  applicants  and 
their  want  of  means.  A  fund  such  as  the  Bene- 
volent Fund  deserves  the  heartiest  support  of  all 
members  of  the  medical  profession.  Whether 
they  can  afford  large  or  small  subscriptions, 
they  should  become  regular  contributors.  To 
put  it  on  the  most  selfish  grounds,  none  of  us 
knows  what  day  he  himself  may  be  incapacitated 
by  illness  and  misfortune,  or  his  family  deprived 
of  their  bread-winner,  so  that  he  or  they  may  have 
to  rely  on  the  charitable  help  of  the  profession 
for  very  sustenance. 


PERSONAL. 


Dr.  Edwin  Rickards,  who  is  resigning  the  post  of 
Senior  Physician  to  the  Birmingham  General  Hospital 
has  been  connected  with  that  institution  for  more  than 
thirty-four  years,  in  thirty  of  which  he  has  been  Senior 
Physician. 


Surgeon-General  Sir  Annesley,  C.  C.  db  Renzy, 
K.C.B.,  presided  at  the  recent  annual  dinner  of  the 
Indian  Medical  Service  at  the  Cafe  Monico,  London. 

Dr.  Sombr  ville,  of  Galashiels,  last  week  delivered  an 
eloquent  oration  on  the  Edinburgh  Medical  School 
I8S5  to  1859,  at  the  122nd  Harveian  Festival,  held  in 
the  hall  of  the  Royal  College  of  Physicians  of  Edinburgh. 

Sir  William  Broadbent  took  a  number  of  shares  in 
a  company  at  the  suggestion  of  a  patient,  and  has  lost 
a  subsequent  action  for  the  recovery  of  the  money 
invested  and  for  damages  for  fraudulent  misrepresenta- 
tion which  he  brought  against  Lord  Dunmore,  Count 
Max  Hollander  and  others. 


Dr.  T.  Orme  Dudfield,  the  Medical  Officer  of  Health 
for  Kensington,  has  drawn  official  attention  to  the 
dearth  of  santatoria  for  consumptive  persons  in  the 
Borough,  and  points  out  that  1,850  beds  are  lying  idle 
at  the  small-pox  hospitals. 


Sir  Alfred  Jones  presided  last  week  at  a  meeting 


June  22,  1904. 


SPECIAL  CORRESPONDENCE. 


The  Medical  Pant.   ■  673 


of  the  Liverpool  School  of  Tropical  Medicine,  which 
has  raised  and  spent  about  £36.000  during  the  four 
years  of  its  existence,  and  is  now  urgently  in  need  of 
additional  funds. 


Dr.  Walford,  Medical  Officer  of  Health  for  the 
County  Borough  of  Cardiff,  recently  reported  an 
infantile  mortality  equal  to  120  per  1,000  births  regis- 
tered. This  rate  compares  favourably  with  the  far 
heavier  infantile  mortality  of  the  surrounding  county 
of  Glamorgan. 


Dr.  T.  Vincent  Dickenson,  the  President,  took 
the  chair  at  the  recent  annual  dinner  of  the  Chelsea 
Clinical  Society. 


Colonel  Trevor,  the  Principal  Medical  Officer  of  the 
Scottish  District,  leaves  this  month  for  India,  and  will 
be  succeeded  in  his  present  office  by  Colonel  G.  A. 
Hughes,  D.S.O.,  of  the  Royal  Army  Medical  Corps, 
who  was  recently  Principal  Medical  Officer  at  Hong- 
Kong.  Colonel  Hughes,  who  was  born  in  185 1,  is  a 
graduate  of  Dublin  University,  and  has  been  about 
twenty-seven  years  in  the  Army  Medical  Service. 

In  consequence  of  the  death  of  Sir  David  Palmer 
Ross,  and  the  vacancy  thus  caused  in  the  office  of  Sur- 
geon-General of  British  Guiana,  Dr.  J.  E.  Godfrey,  who 
for  the  past  six  years  has  been  the  Medical  Inspector  of 
that  colony,  has  been  promoted  to  the  higher  office.  He 
entered  the  service  of  British  Guiana  in  1883,  and  has 
already  acted  as  Surgeon-General  on  several  occasions. 

Dr.  T.  K.  J.  Fulton,  Government  Medical  Officer  of 
the  Wallaroo  Hospital,  South  Australia,  has  succeeded 
Dr.  F.  Goldsmith,  who  has  resigned,  as  Medical  Officer 
of  the  Northern  Territory  of  that  State. 

The  King  has  given  and  granted  to  Dr.  Donald 
Harvey  Attfield,  principal  medical  officer  of  the  Suez 
Quarantine  Office,  the  Royal  licence  and  authority  to 
accept  and  to  wear  the  Imperial  Ottoman  Order  of  the 
Osmanieh,  Fourth  Class,  conferred  upon  him  by  His 
Highness  the  Khedive  of  Egypt,  authorised  by  His 
Imperial  Majesty  the  Sultan  of  Turkey,  "in  recognition 
of  valuable  services  rendered  to  His  Highness." 


The  Right  Hon.  Lord  Alverstone,  G.C.M.G.,  Lord 
Chief  Justice  of  England,  will  distribute  the  prizes  to  the 
students  of  St.  Mary's  Hospital  Medical  School,  London, 
at  the  annual  distribution  on  Wednesday,  June  29th, 
at  4.45  p.m. 

Mr.  Chamberlain  is  to  be  entertained  at  dinner 
by  the  Royal  Institute  of  Public  Health  at  the  Criterion, 
on  the  30th  inst.,  in  recognition  of  his  services  while 
Colonial  Secretary  to  preventive  and  tropical  medicine. 
Tickets  for  the  dinner  may  be  obtained  at  19  Blooms- 
bury  Square,  W.C. 


Mr.  William  Fairbank,  Surgeon  to  His  Majesty's 
household  at  Windsor  Castle,  and  Surgeon-in-Ordinary 
to  Their  Royal  Highnesses  Prince  and  Princess 
Christian,  has  been  appointed  by  the  Lord  Chancellor  a 
magistrate  for  the  county  of  Berks. 

Mr.  Robert  Russell  Sewell,  M.B.Lond.,  J.P., 
who  died  on  June  2nd  at  Sandhurst  Vicarage,  the  resi- 
dence of  his  nephew,  Canon  Sewell,  was  one  of  the  oldest 
graduates  of  the  University  of  London  and  formerly 
practised  for  many  years  at  Bridgwater,  of  which 
borough  he  was  on  the  commission  of  the  peace.  The 
deceased  was  in  his  eighty-sixth  year  and  since  his  retire- 
ment had  lived  with  Canon  Sewell. 


The  Duke  of  Argyll  presided  at  a  most  brilliant 
festival  dinner  of  the  Waterloo  Hospital  for  Women 
and  Children  at  the  Savoy  Hotel,  London,  on  the 
20th  inst. 


the  Royal  College  of  Physicians  of  London,  will  take 
the  chair  at  a  meeting  to  be  held  at  the  College,  on 
Thursday.  June  23rd.  at  5  p.m.,  to  consider  the  arrange- 
ments which  should  be  made  to  receive  the  party  of 
French  physicians  and  surgeons  who  propose  to  visit 
London  in  October  next. 


Dr.  Voelcker,  F.R.C.P.,  of  the  Middlesex  Hospital, 
has  been  elected  an  examiner  in  medicine  for  the 
Society  of  Apothecaries  in  place  of  Sir  Hugh  Beevor, 
F.R.C.P.,  who  retires  by  rotation. 

Special  dorrespon&ence- 

[from  our  own  corresponents.] 


Sir  William  Church,  Bart.,  K.C.B.,  President  of 


BELFAST. 

The  Small-pox  Epidemic. — The  outbreak  of  small- 
pox in  Belfast  has  now  assumed  rather  serious  pro- 
portions, fifteen  new  cases  having  been  admitted  to 
the  small-pox  hospital  at  Purdysburn  during  the  last 
week,  making  a  total  of  seventy-eight  cases  since  the 
beginning  of  the  outbreak  on  October  28th  last.  The 
small-pox  hospital  is  built  to  accommodate  thirty-two 
patients,  and  as  there  are  now  thirty-four  cases  under 
treatment  there,  it  is  quite  full.  Four  of  Wilson's 
"  health  tents "  have  been  erected,  and  to  these 
the  convalescent  patients  will  be  transferred  if  new 
cases  come  in ;  each  tent  will  hold  three  patients 
comfortably.  Of  these  seventy-eight  cases  which  have 
come  under  treatment  at  the  hospital,  not  a  single  one 
has  proved  to  be  in  a  re-vaccinated  person,  and  in 
every  case  the  severity  of  the  disease  has  been  inversely 
proportional  to  the  clearness  of  the  first  vaccination 
marks.  There  have  been  two  fatal  cases  in  the  hospital, 
one  in  a  child  of  five  who  had  never  been  vaccinated, 
and  the  other  in  a  man  who  had  been  drinking  heavily, 
and  who  was  only  just  recovering  from  an  operation  for 
amputation  of  some  fingers. 

There  are  at  present  some  sixty  or  eighty  contact 
cases  under  observation  at  the  Twin  Island  isolation 
station,  and  some  of  these  may  reasonably  be  expected 
to  develop  the  disease.  The  history  of  this  last  group 
of  cases  is  very  instructive.  About  the  last  week  in 
May  a  man  working  in  the  rope  works  in  Ballyma- 
carrett,  where  several  cases  had  occurred,  was  taken  ill. 
He  was  seen  by  a  medical  man  who  believed  the  case 
to  be  one  of  scarlatina,  but  was  not  satisfied  about  it, 
and  advised  him  to  go  into  hospital.  The  next  day 
he  heard  that  another  medical  man  was  in  charge  of 
the  case,  and  when  it  proved  fatal  this  latter  certified 
it  as  scarlatina.  An  old  woman  who  had  seen  the  man 
declared  emphatically  that  the  doctors  might  say 
what  they  liked,  but  she  knew  the  man  had  small-pox, 
and  some  whisper  of  this  reaching  the  Public  Health 
authorities,  they  sent  to  the  house  and  disinfected 
it  thoroughly  before  the  body  was  removed  for  burial. 
The  medical  man  who  had  signed  the  certificate 
protested  against  this  in  the  City  Council,  of  which 
body  he  is  a  member.  The  man  had  been  very  popular, 
and  a  huge  wake  was  held,  about  100  persons  attending 
it.  The  next  thing  that  occurred  was  that  the  widow 
was  admitted  to  the  Union  Hospital  about  ten  days 
later,  and  transferred  to  Purdysburn  the  next  day, 
suffering  from  small-pox,  and  then  from  the  12th  to 
the  1 8th  fifteen  new  cases  were  admitted,  almost  all 
of  whom  had  attended  the  wake. 

Much  alarm  was  caused  by  the  occurrence  of  a  case 
in  the  Royal  Victoria  Hospital,  but  all  patients  and 
nurses  who  were  near  the  case  were  promptly  re- 
vaccinated,  and  no  other  case  has  occurred,  though 
the  time  limit  has  now  quite  expired.  The  patient 
was  a  country  girl,  who  developed  the  disease  on  the 
thirteenth  day  of  her  sojourn  in  hospital,  so  it  is  prob- 
able that  she  got  the  infection  in  the  train  or  tramcar 
on  her  way  to  the  hospital.  Needless  to  say,  re- 
vaccination  is  being  carried  out  very  vigorously  in 
Belfast  at  present,  and  as  public  feeling  in  the  matter 
is  aroused,  it  is  hoped  that  it  will  become  impossible 
to  conceal  cases  in  the  future  as  has  undoubtedly  been 
done  in  the  past. 


674  T«  Medical  Pwss.  INTERNATIONAL  HOME  RELIEF  CONGRESS,    June  32, 1904. 


Pharmaceutical  Prosecutions  in  Belfast. — 
The  Pharmaceutical  Society  has  again  been  active  in 
Belfast,  and  last  week  succeeded  in  obtaining  con- 
victions in  two  cases  against  chemists  for  compound- 
ing medical  prescriptions,  they  not  being  registered 
under  the  Act  as  pharmaceutical  chemists.  In  each 
case  a  fine  of  £$  and  costs  was  imposed. 


international  Dome  IRelief  Congress. 

SECTIONAL  MEETINGS. 

Section  I. —  Children. — Miss  Horn,  school  mana- 
ger under  the  London  School  Board,  read  a 
paper  on  "  The  Feeding  of  Infants  and  School 
Children/'  in  which  it  was  claimed  that  the  feeding  of 
children  from  the  school  as  a  centre  was  a  bad  method 
of  relief,  tending  to  discourage  self-respect  and  in- 
dependence, the  majority  of  parents  claiming  food 
tickets  simply  because  these  were  to  be  had  for  the 
asking,  and  not  because  they  could  not  feed  their  children 
properly  at  home.  Experience  proved  that  energetic 
and  enlightened  home  visiting  ensured  that  no 
child  requiring  relief  failed  to  get  it,  and  secondly,  that 
private  charity  was  sufficient  to  meet  the  demands  for 
relief  in  schools.  The  establishment  of  committees  to 
promote  hygiene,  thrift,  and  apprenticeship,  and  to 
administer  relief  when  necessary,  acting  by  constant 
and  intelligent  visiting  of  the  parents  of  school  children, 
a  greater  interest  taken  by  school  managers  in  the 
housing  of  the  poor  in  their  neighbourhoods,  and  the 
systematic  teaching  of  girls  and  women  of  the  elements 
of  domestic  hygiene  and  the  care  of  children  would 
do  more  good  than  any  system  attempting  merely  to 
meet  obvious  needs  at  the  expense  of  deterioration  of 
character. 

Eye  Diseases  in  Children. — Dr.  W.  Wright  Thomson 
(Glasgow)  read  a  paper  on  home  relief  in  relation  to  this 
subject.  He  showed  that  educational  methods  tended 
to  produce  myopia,  and  that  the  defect  was,  or  ought 
to  be,  a  barrier  against  entry  into  certain  dangerous 
trades.  In  childhood  the  future  course  of  myopia  could 
be  influenced  by  wearing  glasses,  resting  the  eyes,  and 
improving  the  general  health.  The  boarding  out 
system  was  beneficial  both  in  these  cases  and  in  strumous 
ophthalmia.  Dr.  Robertson,  Leith,  urged  the  im- 
portance of  the  due  feeding  of  infants  and  described 
the  operations  of  the  Leith  milk  depot,  from  which 
about  eighty  children  a  day  were  being  supplied  at  a 
cost  to  the  parents  of  is.  6d.  a  week.  At  the  end  of 
the  year  they  found  that  the  death-rate  amongst  these 
children  was  practically  ntl.  Dr.  Bruce  Ronald  son, 
Haddington,  urged  the  necessity  of  attending  to  the 
feeding  of  children  at  country  schools,  on  account  of  the 
long  distances  many  of  them  had  to  come.  Dr.  Chalmers 
(Glasgow)  and  Dr.  Leslie  Mackenzie  both  contested 
the  idea  that  there  was  any  actual  evidence  of  deteriora- 
tion of  the  race. 

The  remainder  of  the  first  day's  proceedings  in  this 
section  was  occupied  with  a  discussion  on  the  protection 
afforded  to  children  by  existing  Poor-laws,  &c,  and  the 
prevention  of  cruelty  to  children.  The  medical  aspects 
of  the  subject  were  discussed  by  Dr.  T.  S.  Clouston,  who 
remarked  on  the  effects  of  alcohol  in  weakening  the 
moral  faculties,  including  the  parental  affections.  He 
moved  an  amendment  to  the  present  Inebriates  Acts 
providing  for  the  committal  of  a  parent  or  guardian 
.guilty  through  intemperance  of  habitual  neglect  of 
children  to  a  home  for  inebriates.  The  second  day's 
proceedings  in  this  section  were  devoted  to  a  discussion 
on  the  boarding  out  of  pauper  children,  and  the  third 
day's  work  consisted  in  a  series  of  papers  on  the  organ- 
isation of  relief  for  cripples.  From  a  medical  point  of 
view  this  was  one  of  the  most  interesting  meetings  of  the 
congress.  Miss  Burgwin,  superintendent  of  special  schools 
under  the  London  School  Board,  said  that  no  class  of 
children  required  help  more  than  cripples.  By  "  help  " 
she  meant  systematic  education  and  training  to  assist 
the  cripple  to  make  the  best  use  of  life  and  to  enable 
it  to  fill  a  useful  niche  in  the  world.  The  ordinary  school 
was  out  of  the  question  for  most  cripple  children  on 


account  of  its  equipment  being  unsuitable,  and  on 
account  of  the  difficulty  of  locomotion  to  and  from 
school,  while  too  often  the  cripple  attending  an  ordinary 
school  was  made  by  the  teacher  an*  object  lesson  for 
pity  and  generosity  instead  of  proper  attention  being 
directed  to  developing  its  capacities.  The  first  cripple 
school  was  opened  in  1899,  and  there  were  now  eleven 
such  schools,  accommodating  700  scholars.  Only  the 
physically  defective  were  admitted ;  if  mentally 
defective  also  they  were  educated  in  special 
schools  for  deficient  children.  Mrs.  Burgwin  de- 
scribed the  ambulances  in  which  these  children  are 
brought  to  school  under  the  care  of  a  trained  nurse,  the 
equipment  of  the  schools,  and  the  subjects  taught. 
The  school  day  was  from  ten  to  three,  with  one  and  a 
half  hour's  interval  for  dinner,  which  was  provided  by 
voluntary  effort  at  2d.  per  head.  Special  stress  was  laid 
on  art  training,  as  many  cripples  had  unusual  talent 
in  this  direction.  Eight  scholarships  in  the  various 
London  art  schools  were  held  by  former  pupils  from  these 
special  schools.  Miss  Evans  contributed  a  paper  de- 
scribing the  work  done  by  the  Fine  Needlework  Asso- 
ciation for  invalid  women  and  girls  in  London.  Mr. 
Leckie,  founder  of  the  Edinburgh  Cripple  and  Invalid 
Children's  Society,  estimated  that  there  were  about 
1,000  cripples  in  Edinburgh.  Advantage  should  be 
taken  of  the  new  Education  Bill  for  Scotland  to  deal 
with  these  children  either  by  the  society  founding  one 
or  two  special  schools,  which  would  be  eligible  to  receive 
grants  from  the  School  Board,  or  by  the  School  Board 
adopting  the  London  system  and  in  friendly  co- 
operation with  the  Cripples'  Aid  Society  founding 
special  schools.  Miss  Dendy  (Manchester)  contended 
against  the  founding  of  special  schools.  In  visiting 
these  she  had  always  found  that  one  section  of  the  pupils 
while  technically  cripples  (old  spinal  cases  and  the  like) 
were  yet  quite  able  to  attend  ordinary  schools,  and 
should  not  be  deprived  of  the  enormous  advantages 
of  associating  with  their  fellows,  while  the  remainder  of 
the  pupils  were  unfitted  for  ordinary,  education  at  all 
and,  by  reason  of  their  physical  health,  would  be  much 
better  dealt  with  in  country  sanatoria,  where,  under 
proper  medical  treatment,  their  disease  would  be  a  first 
consideration  and  education  secondary.  She  very 
strongly  urged  that  to  found  cripple  schools  was  merely 
touching  the  fringe  of  the  whole  question.  Boarding 
out  in  the  country  under  medical  supervision  was  her 
remedy  for  the  treatment  of  the  majority  of  cripples, 
while  those  who  did  not  need  this  should  be  encouraged 
to  mix  with  their  fellows  and  not  be  deprived  of  the 
advantages  of  the  companionship  of  the  healthy.  Dr. 
Shuttleworth  (London)  thought  that  the  reconciliation 
between  the  apparently  conflicting  views  of  Miss  Dendy 
and  Mrs.  Burgwin  was  to  be  found  in  a  careful  discrim- 
ination between  cases  able  to  attend  day  schools  in 
town  and  those  requiring  to  go  to  an  institution  in 
the  country.  The  discussion  was  continued  by  Mrs. 
Munro,  with  a  paper  on  the  work  of  the  Invalid 
Children's  Aid  Association  in  London,  Mr.  Guiland, 
Edinburgh  School  Board,  Mr.  Mc Keith,  Glasgow,  and 
others. 

The  Care  of  Mentally  Defective  Children  was  the  sub- 
ject of  a  general  discussion  introduced  by  a  paper  from 
Miss  Dendy,  Her  contention  was  that  it  was  useless 
to  expect  any  benefit  to  the  child  or  the  community 
from  the  home  care  or  school  education  of  a 
defective  child.  The  State  should  take  perma- 
nent care  of  every  weak-minded  child  whose  parents 
could  not  guarantee  its  life-long  segregation.  The 
most  important  factor  in  keeping  up  the  supply  of 
these  weaklings  was  heredity,  and  in  most  cases  the 
home  conditions  of  the  weak-minded  child  of  mentally 
unstable  parents  were  the  very  worst  conceivable.  It 
was  of  no  use  blinking  the  fact  that  when  a  child  was 
really  weak-minded  it  could  not  be  cured.  Preventive 
means  alone  remained — definite  segregation  for  their 
lives  of  the  sufferers.  All  mentally  weak  children 
should  be  medically  supervised  and  the  imbecile  and 
feeble-minded  transferred,  while  they  were  yet  children, 
to  a  labour  colony,  there  to  end  their  days.  There 
were  already  in  England  100,000  weaklings  in  addition 


June  22,  1904.    INTERNATIONAL  HOME  RELIEF  CONGRESS.    Thb  Medical  Prbss.    675 


to  certified  idiots,  imbeciles  and  lunatics,  and  these 
100,000  were  at  present  being  taken  care  of  in  work- 
"houses  and  jails  ;  to  segregate  them  in  labour  colonies 
would  diminish  their  production  and  throw  no  greater 
"burden  on  the  rates  than  now. 

Dr.  Ashly  (Manchester)  said  that  the  cases  suitable 
'for  special  schools  were  not  the  obviously  defective, 
T>ut  the  upper  strata  of  such — the  children  who  were 
simply  backward  and  sat  at  the  foot  of  their  classes. 
These*  improved  in  special  schools — for  imbeciles  and 
the  weak-minded  some  permanent  home  for  the  rest 
of  their  lives  was  needed. 

Dr.  Fletcher  Beach  (London), aft  ex  giving  an  historical 
-sketch  of  what  had  been  done  in  England,  corroborated 
the  previous  speakers  as  to  the  insufficiency  of  home 
oare.  The  law  providing  for  those  suffering  from 
mental  disease  did  not  extend  to  epileptics — a  deplor- 
able state  of  matters  which  required  alteration.  Dr. 
Carswell  (Glasgow)  did  not  think  that  the  segregation 
-of  deficient  children  would  affect  the  number  of 
adolescent  criminals.  These  were  psychologically  ab- 
normal, but  showed  no  stigmata  nor  signs  of  degeneration 
dn  childhood.  Dr.  Sutherland  pointed  out  that  there 
were  in  Scotland  1,300  imbeciles  boarded  out  in  private 
houses  without  any  bad  consequences.  In  many  cases 
their  capacity  for  usefulness  would  be  as  well  developed 
under  a  capable  housewife  as  in  any  institution. 

Dr.  John  Thomson  said  that  the  only  class  of  men- 
ially deficient  children  for  whom  home  care  was  always 
best  was  that  of  little  children.  In  older  children  with 
slight  mental  defect  the  neurotic  heredity  meant  that 
little  help  could  be  got  from  the  mothers,  but  many  of 
the  children  who  showed  weak-mindedness  in  baby- 
hood were  suffering  from  disease  or  injury  at  birth 
with  which  heredity  had  nothing  to  do,  and  their 
mothers  were  often  intelligent  and  estimable  women. 
For  such  cases  special  dispensary  hours  ought  to  be 
arranged  and  they  should  be  periodically  visited  at  their 
own  homes. 

Section  IV. 

Sick  Adults. — The  first  topic  was  the  home  treatment 
of  pulmonary  tuberculosis,  introduced  by  Dr.  Philip 
(Edinburgh).  After  referring  to  the  important  work 
done  by  sanatoria,  he  said  they  dealt  with  only 
•one  aspect  of  the  question.  The  tuberculosis 
dispensary  in  Edinburgh  was  the  first  attempt  to 
deal  in  a  systematic  way  with  the  great  crowd 
•of  tuberculous  city  poor.  In  recommending  an  exten  - 
sion  of  the  dispensary  system,  benevolence  was  not 
to  be  relied  upon,  but  the  institutions  should  be  muni- 
<cipal  and  placed  under  the  medical  officer  of  health. 
Such  a  department  would  include  a  dispensary  to  which 
patients  with  phthisis,  chronic  colds,  or  persistent  ill- 
health  were  invited  to  come  and  to  which  consumption 
would  be  sent  from  the  waiting  rooms  of  hospitals,  &c. 
There  they  would  receive  information  regarding  the 
prevention  and  treatment  of  phthisis.  Printed  in- 
structions would  be  issued,  spittoons  and  disinfectants 
•supplied,  patients  too  ill  to  come  to  the  dispensary  would 
be  attended  at  home,  rooms  would  be  disinfected, 
the  home  condition  of  the  patient  studied,  while  the  dis- 
pensary would  also  form  a  centre  for  the  voluntary  noti- 
fication of  a  great  deal  of  phthisis,  and  would  draft 
suitable  cases  to  sanatoria  or  incurable  hospitals. 

Professor  Calmette  (Lille)  contributed  a  paper  on 
very  similar  lines,  and  Professor  Lindsay  (Belfast)  urged 
the  need  for  intelligible  teaching  as  to  the  means  of 
combating  tuberculosis,  the  value  of  fresh  air,  &c. 

Dr.  Jane  Walker  spoke  of  the  desirability  of  obtaining 
light  work  for  patients  when  they  came  out  of  sanatoria. 
Colonies  on  a  large  enough  scale  where  open-air  work 
was  carried  on  could,  she  believed,  be  made  self-support- 
ing, and  the  knowledge  that  they  had  a  chance  of  being 
lucratively  employed  would  make  working  men  far  less 
reluctant  to  come  forward  before  they  were  hope- 
lessly ilL  The  discussion  was  continued  by  Dr.  Gulland, 
who  emphasised  the  need  for  constant  disinfection  by 
the  authorities  of  infected  houses,  Dr.  Ogilvie  Grant, 
Dr.  Caverhill,  who  urged  compulsory  notification,  and 
others.  —  , 


Home  Attendance  on  Parturient  Women  in  Large 
Centres. — This  discussion  was  introduced  by  Dr.  W. 
Japp  Sinclair,  who  said  that  any  alteration  in  the  prac- 
tice of  midwifery  among  the  poor  must  be  gradual  and 
come  from  within  the  medical  profession.  It  was 
much  to  be  desired  that  the  profession  should  be 
relieved  of  certain  duties  in  connection  with  midwifery, 
without  appreciably  diminishing  their  practice,  as  at 
present  there  was  a  constant  temptation  to  hurry 
through  unremunerative  cases,  and  to  give  the  minimum 
of  attendance  during  the  puerperium.  Something  in 
the  direction  of  the  custom  in  Germany  was  required, 
where  qualified  men  do  not  attend  cases  of  labour  at 
low  fees,  but  leave  them  to  well- trained  midwives. 
The  new  midwife  must  belong  to  a  higher  class  socially 
than  the  old.be  better  educated, and  more  highly  trained, 
she  should  have  had  some  general  training  as  a  nurse. 
The  rules  of  the  Central  Midwives'Board  were  not  nearly 
stringent  enough  as  regards  qualifications  ;  he  thought 
that  all  efforts  to  improve  the  status  and  training  of 
midwives  must  begin  in  the  maternity  hospitals,  which 
ought,  either  individually  or  in  conference,  to  frame 
regulations  for  the  practice  of  their  staffs  far  ahead  of 
the  modest  minimum  of  education  and  training  required 
by  the  Central  Midwives'  Board.  In  a  communication 
read  by  Miss  Macgregor,  Dr.  Scharlieb  gave  as  her 
opinion  that  every  midwife  should  have  a  good  general 
education,  two  years'  training  in  general  nursing,  and 
such  instruction  in  midwifery  as  would  satisfy  the 
Central  Midwives'  Board.  Professor  Thomson 
(Aberdeen)  said  that  the  necessarily  intermittent 
attention  of  trained  midwives  was  a  danger  which 
could  be  met  by  having  a  corps  of  kindly,  capable 
women  in  each  town  who  could  supplement  the  atten- 
tion given  by  the  nurses.  The  discussion  was  con- 
tinued by  Dr.  Berry  Hart,  who  pointed  to  the  import- 
ance of  ensuring  more  prolonged  rest  after  parturition, 
by  Dr.  Elsie  Inglis,  who  would  have  the  whole  matter 
of  attendance  on  women  of  the  poorer  classes  under  the 
care  of  a  central  authority,  by  Dr.  Jessie  Macgregor, 
who  spoke  of  the  need  of  women  to  take  charge  of  the 
cases  between  the  nurses'  visits,  and  by  Mr.  Chalmers 
Watson,  M.D.,  who  had  found  from  experience  that 
the  employment  of  midwives  under  medical  supervi- 
sion was  quite  practicable.  The  remainder  of  this 
sectional  meeting  was  devoted  to  Hospital  Reform. 
Section  V. 

Insane  and  Epileptics. — The  first  topic  discussed  was 
the  boarding  out  of  insane  persons,  the  general  con- 
sensus of  opinion  being  that  an  extension  of  this 
system  was  desirable.  The  after-care  of  friendless 
patients  was  discussed  by  Dr.  Carlyle  Johnstone,  whose 
experience  was  that  the  statutory  removal  on  probation 
acted  well  if  the  parish  authorities  and  the  asylum 
superintendents  worked  loyally  together.  A  judicious 
use  of  this  procedure  both  conferred  a  benefit  on  poor 
persons  returning  to  social  life  after  detention  in  an 
asylum,  and  shortened  the  period  of  residence  in 
asylums. 

Dr.  Clouston  (Edinburgh)  said  that  the  effect  of 
removing  quiet  cases  from  an  asylum  for  the  purpose 
of  boarding  them  out  was  two-fold  ;  the  asylum  lost 
the  good  workers  and  those  who  set  an  example  to  the 
other  inmates  ;  it  gained  by  being  less  over-weighted  by 
incurable  cases  and  by  the  medical  officers  having  less 
administrative  work  to  do.  The  new  Bill  to  permit  of 
cases  of  doubtful  or  incipient  insanity  being  sent  to 
private  homes  for  a  period  of  not  more  than  six  months 
without  the  formality  of  certification  was  welcomed 
on  a  motion  by  Dr.  Sutherland;  but  after  some  dis- 
cussion there  seemed  to  be  differences  of  opinion  on  the 
question  of  notification,  and  the  section  resolved  not  to 
petition  in  favour  of  the  Bill. 

The  third  day's  proceedings  of  this  section  were 
occupied  by  papers  on  epileptic  colonies. 

Dr.  Milsom  Rhodes  said,  though  there  were  70,000 
cases  of  epilepsy  in  Great  Britain  there  was  not  a  single 
State  institution  for  the  care  of  the  sane  epileptic.  The 
only  bodies  which  could  provide  for  these  patients  were 
the  guardians,  and  nearly  all  of  these  boards  who  were 


676    The  Medical  Press. 


CORRESPONDENCE. 


June  22,  1904. 


intending  to  take  the  matter  up  proposed  to  adopt 
the  colony  system,  which  admitted  of  adequate  scientific 
treatment  and  suitable  occupation. 

Dr.  F.  Beach  read  a  paper  on  the  Chalfont  Colony  for 
Epileptics,  and  Dr.  Fraser  on  the  proposed  colony  at 
Bridge-of-Weir,  Scotland.  The  Rev.  J.  L.  Brooks 
(Lingneld)  said  he  was  strongly  of  opinion  that  the 
epileptic  colony  would  never  be  self-supporting.  He 
had  a  home  containing  70  epileptic  children ;  no 
bromide  was  used  in  a  chronic  way ;  the  epileptics 
had  no  animal  food,  or  very  little ;  they  had  plenty 
of  fresh  air  and  sleep.  In  the  remainder  of  the  dis- 
cussion considerable  reference  was  made  to  the  colony 
at  Bielefeld,  Westphalia,  and  to  the  backward  state 
of  matters  in  Scotland  in  the  treatment  of  epilepsy ; 
this,  however  being  partly  due  to  the  homelike  con- 
ditions, the  structural  character,  and  the  surroundings 
the  institutions  where  poor,  insane,  and  epileptic  are 
housed. 

Speakers  from  France  and  Belgium  described  the 
methods  in  vogue  in  these  countries,  while  Dr.  Shuttle- 
worth  emphasised  the  need  for  physical  and  mental 
education,  not  book  education,  and  plenty  of  out-door 
recreation. 

The  proceedings  of  Section  II,  which  dealt  with  the 
problem  of  relief  for  the  aged,  would  not  be  of  special 
interest  to  medical  readers ;  while  in  Section  III — 
able-bodied  adults — only  one  topic  calls  for  note  here. 
Dr.  Donald  read  a  paper  "  What  to  Do  with  Our  In- 
ebriates," in  which  he  emphasised  the  fact  that  in- 
ebriety was  a  disease,  not  merely  a  vice.  Once  a 
person  suffered  from  dipsomania  in  an  acute  form  he 
remained  an  inebriate  for  the  rest  of  his  life  ;  he  might 
not  continue  in  a  state  of  inebriety,  but  the  tendency 
always  remained.  The  cure  of  inebriety  after  drug 
treatment  was  short-lived,  and  after  relapse  the  patient 
was  in  a  more  hopeless  state  than  before.  The  only 
treatment  was  compulsory  detention  in  an  inebriate 
retreat;  and  as  the  law  was  at  present  useless,  he  sug- 
gested as  a  mode  of  procedure  it  should  be  made  legal 
for  a  magistrate,  on  the  representation  of  two  persons 
that  a  patient  was  an  inebriate,  to  order  an  inquiry 
by  two  independent  person,  one  a  medical  man,  and 
if  these  reported  that  the  patient  was  an  inebriate  he 
should  be  detained  in  a  home  for  a  year. 

Dr.  Carswell  (Glasgow)  said  that  two  points  had  to  be 
impressed  on  legislators — first,  habitual  inebriates 
must  be  segregated,  and  second,  they  can  only  be  dealt 
with  by  the  institution  method.  There  was  no  escape 
from  this,  and  it  must,  even  at  the  cheapest,  be  costly. 
Councillor  Burgess  (Glasgow)  opposed  the  contention 
that  there  was  no  case  for  drug  treatment,  and  Dr. 
Sutherland  opposed  the  idea  of  herding  together  in- 
ebriates, as  he  held  they  had  a  bad  influence  on  each 
other.  Dr.  Branthwaite  (London)  sympathised  with 
the  idea  of  avoiding  congregating  inebriates  together, 
but  said  that  of  the  last  1 ,000  committals  from  English 
courts  he  did  not  think  one  case  could  have  been  sent 
to  a  private  house  for  control.  Drs.  Nicholson,  Dunlop, 
Haddon,  and  Wilson  continued  the  discussion,  the 
general  trend  of  remark  being  that  inebriety  was  a 
disease,  its  prognosis  not  too  hopeful,  and  that  in- 
stitutional treatment  alone  was  feasible,  though  pos- 
sibly the  ideal  institution  had  not  yet  been  discovered. 


Gorrespon&ence* 

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


WHAT  IS  A  DEGENERATE  ? 
Sir, — In  your  issue  of  June  1st  you  refer  to  my 
work  lately  issued,  "  Proposed  Sterilisation  of  Certain 
Degenerates,"  and  you  state  that  I  "  have  got  em- 
broiled in  a  squabble  as  to  the  meaning  of  the  term 
degenerate."  Let  me  assure  you  that  there  has  been 
no  "  squabble,"  and,  consequently,  no  "  embroiled," 
unless  such  exist  in  the  mind  of  your  leader  writer. 
Next  you  state  that  "  in  order  to  free  himself  from  a 
difl&culty  "  I  asked  Dr.  Max  Nordau  for  a  definition  of 
"  degenerate.'       I  did  not  appeal  tt>  Nordau  so  as  to 


free  myself,  and  I  think  I  need  not  say  that  it  is  my 
nature  to  shirk  responsibility.  Dr.  Mercier  asked  for  a 
definition,  and  I  suggested  that  it  is  better  not  to  go 
in  for  definitions  in  my  proposal  of  sterilisation,  but 
to  draw  up  a  schedule  containing  the  names  of  those 
mental  and  physical  conditions  which  should  render 
the  degenerate  liable  to  be  sterilised.  Such  a  list  I 
give  in  the  above  work. 

May  I  just  add  that  we  would  get  more  to  the  reality 
of  things  if  we  put  a  stop  to  that  modern  medical 
jargon — a  thing  very  akin  to  quackery  in  its  worst 
forms— of  creating  new  names  and  new  definitions  ? 
Parliament  now  generally  adopts  the  schedule  plan. 
This  is  a  practical  method,  and  so  gives  the  best  results. 
I  am.  Sir,  yours  truly, 

Robert  R.  Rentoul. 


THE  CRIPPLE  AT  THE  CORNER. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — To  stand  at  Hyde  Park  Corner  and  look  around 
is  very  interesting.  It  has  changed  much  since  the 
Great  Duke's  time.  It  has  improved  greatly,  and  the 
only  sore  point  is  the  Hospital  of  St.  George.  It  looks 
like  a  poor  cripple  holding  out  a  dirty  hand  for  alms, 
and  crying  to  the  passers-by  to  help  it.  The  question 
with  many  of  its  supporters  is  whether  it  is  not  better 
for  it  to  take  up  its  crutch  and  try  and  walk  than  sit 
begging  as  it  does.  It  has  brought  itself  to  a  miserable 
state  by  following  a  policy  that  never  answers.  Those 
countries  where  beggars  abound  are  not  prospering,  for 
true  charity  turns  from  the  noisy  beggar  and  seeks 
other  objects  which  make  no  great  show  of  want. 
How  St.  George's  has  brought  itself  to  its  present  state 
is  another  question.  That  it  would  do  so  sooner  or 
later  has  been  foreseen  by  some. 

I  am.  Sir,  yours  truly. 

Retrospective. 


WHAT  IS  ALCOHOL  ? 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — Those  who  have  read  your  leader,  "  What  is 
Brandy  ?  "  will  see  that  at  last  the  question  of  the 
use  of  alcoholic  liquids  is  going  to  be  treated  in  a 
scientific  spirit.  The  process  of  fermentation  is  a  very 
important  and  very  interesting  one  ;  and  if,  as  some 
think,  for  the  simple  reason  that  alcohol  is  one  of  its 
products,  it  is  therefore  improper  to  ferment  anything, 
it  would  be  well  to  consider  the  subject  carefully. 
What  is  bread  but  the  result  of  the  process  of  fermen- 
tation ?  And  if  we  are  going  to  admit  that  because 
alcohol  is  a  product  of  fermentation,  morally  and 
legally  it  ought  not  to  be  allowed,  we  had  better  put 
aside  the  legal  and  moral  till  we  have  settled  the 
physiological  and  scientific  part  of  the  question. 
I  am,  Sir,  yours  truly, 

R.  L. 


THE     LUNACY     LAWS     AND     PROFESSIONAL 

RESPONSIBILITY. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — The  idea  of  your  correspondent  "  R.  L."  as 
to  the  notification  of  insanity  I  fear  is  impracticable 
for  the  following  reasons  : — ( 1 )  A  person  legally  insane 
already  notifies  himself  to  his  friends  and  to  the  world 
at  large  by  his  conduct  and  ideas,  and  is  amenable 
to  law  for  the  purpose  of  being  placed  under  restraint 
if  necessary,  and  hence  affords  sufficient  stimulus  to 
the  friends  in  the  vast  majority  of  cases  to  set  the 
law  in  motion. 

(2)  On  the  other  hand,  a  medical  man  notifying 
in  any  equivocal  case  would,  supposing  such  case  not 
to  amount  to  insanity  in  the  legal  sense,  render  (I 
further  apprehend)  the  practitioner  liable  for  an 
action  at  law  for  libel ;  consequently,  so  far  from  simpli- 
fying matters,  as  your  correspondent  suggests,  the 
position  of  medical  men  would  be  rendered  more 
embarrassed  and  responsible. 

There  are,  be  it  observed,  some  who  regard  every 
mind  as  insane ;  and  viewing  insanity  in  its  strictly  logi- 
cal sense,  that  is  to  say.denning  insanity  as  a  greater  or 
less  deviation  from  rr<isi w.^the  proposition  might  be 


JUNB   22,    I904. 


LITERATURE. 


TBS  Medical  Press.    677 


hardly  tenable,  but  practitioners  holding  those  ideas 
tend  to  take  an  exaggerated  and  too  precise  idea  of  any 
mind  presented  to  them  for  examination  which  might 
bring  them  in  dangerous  touch  of  the  law ;  and,  indeed, 
as  a  matter  of  fact,  English  juries  at  the  present  time 
are  wont  to  regard  medical  men  with  suspicion  on 
the  score  of  pronouncing  persons  insane  whom  they 
may  regard  otherwise. 

The  same  difficulty  in  one  sense  occurs  with  regard 
to  the  notification  of  phthisis,  that  is  to  say,  to  deter- 
mine the  precise  stage  at  which  it  might  be  expedient 
on  the  ground  of  public  convenience  or  policy  to  notify 
the  complaint. 

A  few  years  ago  a  certain  medical  officer  of  health 
suggested  the  notification  of  influenza;  but  here  again 
the  diagnosis  in  the  absence  of  any  pathognomonic 
symptoms  (as  far  as  I  am  aware)  renders  the  diagnosis 
so  obscure  that  an  infinite  number  of  cases  of  a  purely 
catarrhal  nature  would  be  certain  to  fall  within  the  net. 
I  submit,  therefore,  that  only  infectious  diseases  of  a 
short  and  definite  character  are  suitable  for  notification. 
I  am.  Sir,  yours  truly. 

Clement  H.  Sers. 

Brighton,  June  1st,  1904. 

HUMOUR  IN  PRACTICE. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Dear  Sir, — Dr.  Hamilton's  amusing  experiences  led 
me  to  refer  to  my  Promus,  where  the  following  (mostly 
first-hand)  malapropisms  are  noted  :  "  flexibles  of  the 
knee,"  ' '  sarcasm  on  the  brain,"  "  waiting  for  the  eyes 
to  be  diluted,"  "  ultra-violent  rays,"  "  congenial  syshi- 
lis,"  "  ulster  on  the  eye,"  *'  strained  the  ligatures," 
"  bursters  "  (bursae),  "  carbucle,"  "  curious  teeth," 
"purple  fever"  "  electric  jam  "  {Conf.  Senna),  "  hari- 
cot veins,"  "  mixed  demeanours "  (myxoedema), 
"  armonia,"  "  affritus  "  (nephritis),  "  bronical  tubes," 
"  pedestal  "  (pessary),  "  oil  of  Jupiter,"  "  Jonas  " 
(jaundice),  "  scurrilous  liver,"  "  fractured  his  frivola," 
"  situs  vitus  "  (synovitis),  "  she-ulcer,"  "  hysophisites." 
"  diaphoretic  throat,"  "  locomotive  attack,"  "  silver 
knife  "  (silver  nitrate),  "  caramel  "  (calomel),  "  brown- 
titis "    (bronchitis),    &c. 

I  am.  Sir,  yours  truly, 

Stanley  B.  Atkinson. 

10  Adelphi  Terrace,  W.C.,  June  17th,  1904. 


I  therefore  end  as  I  began,  by  maintaining  that,, 
whoever  deserves  the  credit  of  the  so-called  aseptic 
method,  it  is  not  Lord  Lister. 

Thanking  you  for  your  courtesy  in  granting  me  so- 
much  of  your  valuable  space, 

I  am,  Sir,  yours  truly, 

Geo.   Granville  Bantock. 
June  18th,  1904. 
[This  correspondence  must  now  cease. — Ed.] 


"  PALMAM  QUI  MERUIT,  FERAT." 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — If  "  Ignoramus  "  cannot  see  the  difference 
between  the  so-called  antiseptic  or  Lis terian  method, 
which  aimed  at  the  destruction  of  microbes  (I  do  not 
use  the  multiple-meaning  and  senseless  word  "  germs  ") 
that  might  gain  access  to  a  wound  from  the  air,  and 
the  so-called  aseptic,  which  aims  at  their  exclusion, 
it  is  useless  to  continue  the  argument,  Nor  does  the 
introduction  of  a  number  of  side  issues  tend  to  illumi- 
nation. 

Lord  Lister  is  an  honest  man  if  a  mistaken — as 
proved  on  the  highest  authority,  his  own — and  a 
candid  man  to  boot,  for  he  has  not  hesitated  to  confess 
his  error.  Nor  has  he  ever  claimed  credit  for  the 
aseptic  method.  Would  that  his  followers  followed 
his  example  1 

Even  if  the  "  whole  world  " — which  is  far,  and  daily 
becoming  farther,  from  being  the  case — accepted  his 
views,  it  does  not  follow  that  they  are  right,  and  such 
a  state  of  things  would  not  be  of  the  nature  of  evidence. 

The  history  of  the  world,  especially  the  medical, 
with  the  successive  rise  and  fall  of  innumerable 
doctrines,  should  have  prevented  "  Ignoramus  "  from 
the  use  of  such  an  argument. 

In  reply  to  his  suggestion,  it  is  not  my  intention  to 
ask  you  for  space  to  explain  my  method,  and  how  I 
came  to  adopt  it.  This  has  been  done  fully  more  than 
once,  and  if  he  will  take  the  trouble,  and  do  me  the 
honour  of  reading  what  I  have  written,  especially  in 
"  Hyperpyrexia  after  Listerian  Ovariotomy,"  "  Lis- 
terism :  its  Past,  Present,  and  Future,"  and  "  On  the 
Modern  Doctrine  of  Bacteriology,"  &c,  he  will  find  a 
full  exposition  of  my  views. 


Xtterature* 


WARING  ON  OPERATIVE  SURGERY,  (a) 

In  this  work  on  operative  surgery  there  are  some- 
things which  might  be  left  out  without  in  any  way 
lessening  its  value,  and  many  things  which  could  be 
added  with  great  advantage.  For  instance,  we  are 
told  how  to  construct  an  operating  theatre,  but  there 
is  'no  mention  of  anesthesia.  Further,  some  elemen- 
tary anatomy  might  be  eliminated,  such  as  that  which 
tells  us  that  the  innominate  artery  is  a  large  branch 
of  the  aorta.  Few  surgeons  will  relish  the  idea  that 
removal  of  their  shirt  is  necessary  as  a  preliminary  to- 
an  aseptic  operation. 

The  chapter  on  the  operative  surgery  of  the  stomach 
and  intestines  is  poor.  No  mention  is  made  of  the 
use  of  Doyen's  clamps  in  pylorectomy  or  partial 
gastrectomy  ;  nor  of  the  union  of  intestine  by  primary 
through-and-through  suture,  nor  of  the  advantages  of 
continuous  suture  in  these  cases.  Anterior  gastro- 
enterostomy is  the  operation  recommended  where 
gastro-enterostomy  is  required,  but  the  operation  is 
badly  described.  Posterior  gastro-enterostomy  is 
barely  mentioned,  and  but  a  poor  diagram  is  given 
of  the  operation.  The  use  of  opium  is  recommended 
after  intestinal  operations.  The  author  speaks  of 
"  digital  reduction  "  of  intussusception  before  opera- 
tion. It  would  be  interesting  to  know  how  the 
"  digital  reduction."  is  carried  out.  In  giving  the 
methods  of  radical  cure  for  hernia  an  operation  is 
described  as  Keeker's,  which  Kocker  himself  says  he 
has  abandoned  for  another  method. 

In  the  chapters  on  the  surgery  of  the  kidney, 
bladder,  prostate,  and  urethra  there  is  much  omitted 
that  one  would  like  to  see  in  an  up-to-date  book  on 
operative  surgery.  No  mention  is  made  of  the 
operative  surgery  of  the  prostate  gland.  The  chapters 
on  excisions,  amputations,  and  ligation  of  vessels  are 
certainly  sound.  Many,  however,  prefer  to  cut  the 
sole  flap  in  a  Lisfranc  or  Chopert's  amputation  differ- 
ently from  the  method   described  by  the  author. 

It  may  be  said  of  the  work  on  the  whole  that  there 
are  many  sins  of  omission,  few  of  commission.  The 
operations  described  are  treated  in  a  manner  that 
enables  them  to  be  easily  followed  and  understood. 
The  book  can  be  recommended  to  senior  students,  if 
aided  by  a  teacher  who  would  supply  its  shortcomings. 
While  it  cannot  be  said  to  be  a  work  of  reference  for 
practitioners  or  operating  surgeons,  anyone  will  find 
much  useful  information  on  the  subjects  treated. 

TAYLER  ON  SOCIAL  EVOLUTION,  (b) 
This  excellent  volume  is  full  of  suggestive  interest 
to  the  philosophical  medical  man.  It  is  the  work  of 
a  writer  who  has  evidently  mastered  the  literature  of 
an  ever-widening  subject.  One  of  the  most  interesting 
parts  of  the  book  is  that  describing  various  tempera- 
ments, the  text  of  which  is  illuminated  with  some 
artistic  drawings.  The  discussion  of  these  tempera- 
ments and  types  of  face  are  full  of  suggestion  and 
interest,  and  are  worthy  the  study  of  every  medical 
practitioner.  The  style  of  the  book  is  clear  and  easy, 
full  of  information  and  suggestiveness.  It  is  a  good 
book. 

(a)  *•  Manual  of  Operative  Surgery  "  By  J.  Waring,  M.8.,  M.B.. 
B.-kj  Lond..  F.R.C.t.,  Assistant-Surgeon,  Lect.  on  Surgical  Aoatomy 
and  Demonstrator  of  Practical  Surgery.  8t.  Bartholomew's  Hospital ; 
Member  of  Board  of  Examiners,  Royal  College  of  Surgeons,  England. 
Second  Edition.    Edinburgh  and  London.   Young,  J.  Pentland.    1904. 

(*)  "  Aspects  of  Social  Evolution."  By  J.  Lionel  Tayler,  M.B.C.8. 
London  :  Smith,  Elder  and  Co.     1004.    Price  7s.  6d. 


678     The  Medical  Press.  LITERARY  NOTES  AND  GOSSIP. 


June  22,  1904. 


THE  MATHEMATICS  OF  HYGIENE,  (a) 
The  mathematical  side  of  sanitary  work  is  by  no 
means  the  least  interesting,  since,  unless  the  student 
be  in  possession  of  certain  data,  and  especially  of  cer- 
tain formulae'  he  will  be  hopelessly  unable  to  pass  certain 
•examinations  and  to  resolve  many  problems  of  funda- 
mental importance.  Very  often,  moreover,  these 
formulae  and  data  are  difficult  to  obtain  when  required, 
hence  the  convenience  of  having  them  tabulated  in 
•one  small  volume,  e.g.,  Dr.  Ferguson's  "  Aids  to  the 
Mathematics  of  Hygiene,"  a  second  edition  of  which 
is  now  before  us.  This  useful  little  book  will,  of  course, 
be  familiar  to  those  who  have  already  completed  their 
•course  of  training  in  this  branch,  but  even  by  them  the 
•convenience  of  having  these  figures  readily  available 
will  be  appreciated.  There  is  hope  that  we  may  shortly 
be  able  to  avoid  the  confusion  of  arithmetical  calcu- 
lations conducted  partly  by  the  metric  system, 
partly  in  inches,  grains  and  cubic  feet.  The 
author  is  not  responsible  for  the  confusion,  but 
it  exists,  and  this  being  so  we  would  suggest  a 
much  more  extensive  table  of  equivalents  in 
weights  and  measures  than  he  has  given  us.  We  have 
tried  to  establish  the  relationship  of  a  cubic  metre  to 
a  thousand  cubic  feet  by  the  present  table,  and  we 
ultimately  achieved  it.but  only  by  a  tedious  process.  As 
•examples  are  always  given,  no  difficulty  will  be  ex- 
perienced in  applying  the  various  formulae. 

THE  EXTRA-PHARMACOP(EIA.(6 ) 
When  in  1883  the  "Extra-Pharmacopoeia"  made 
its  first  appearance  the  members  of  the  medical  pro- 
fession quickly  recognised  that  the  daintily-bound 
little  pocket-book  was  just  what  the  busy  physician 
wanted.  And  now  that  the  book  has  attained  its 
majority,  it  has  become  more  popular  and  more  fre- 
quently consulted  than  ever.  Each  edition  as  it  comes 
•out  finds  ready  purchasers  among  those  who  possess 

-  copies  of  the  previous  issues.  The  reason  of  this 
growing  popularity  is  the  careful  editing  of  the  book; 
it  is  always  abreast  of  the  most  recent  advances  in 
medical  science.  The  present  volume  contains  a 
section  on  surgical  dressings  and  apparatus.  The 
applications  of  radium,   Rontgen  rays,  high  frequency 

"Currents,  Finsen  lamp,  and  radiant  heat,  in  their  im- 
portant applications  to  therapeutics  are  introduced  for 
the  first  time  in  the  section,  radiography.  We  know 
no  subject  in  either  surgery  or  medicine  in  which  the 
book  may  not  be  consulted  with  advantage.  We 
might  just  add  that  each  succeeding  edition  marks  the 

^progress  of  medicine  as  a  healing  art,  both  by  its  elimina- 
tion of  drugs  found  wanting,  and  by  new  additions  to 
the  list  of  therapeutics  agents.  The  editors  give  a  Ust  of 
fifty-nine  journals  and  books  consulted  by  them  and 
referred  to,  a  stupenduous  task  ;  but  we  regret  to  find 
that  such  well-known  books  as  Howe's  '*  Practical 
Therapeutics,"  Allen's  "  Handbook  of  Local  Thera- 
peutics," Gould  and  Pyles'  "  Pocket  Cyclopaedia," 
Gillet's  "  Formulaire  des  Medications  Nouvelles,"  and 
H.  Bocquillon-Limousin's  "  Formulaire  des  Medicaments 
Nonveaux "  are  not  included.  Withal  the  "  Extra- 
Pharmacopoeia  "  is  indispensable  to  the  busy  practi- 
ioner. 

Xlterarg  notes  an&  Gossip. 

The  late  Dr.  Corfield,  Professor  of  Hygiene  and 
Public  Health  in  University  College,  London,  was  a 
well-known  collector  of  rare  and  standard  works. 
His  library  came  under  the  hammer  lately,  realising 
•over  eleven  hundred  pounds. 

•** 
We  have  received  the  "  Pharmacopoeia  of  the  North- 
Eastern    Hospital   for   Children."     Besides   giving    a 
useful  series  of  prescriptions,  it  contains  diet  lists,  re- 
fa)  "Aids  to  the  Mathematics  of  Hygiene."     By  R.  Bruoe  Fer- 
Eson,   M.A.,    M.D..    B.O.Oantab.,    M.R.C.8 ,    L.R.O.P.      Second 
ition.    Pp.  104.     Price  2s.  6d.    London:  Bailiiere,  Tindall  and 
Cox. 

(A)  «•  The  Exfcra-PharmacopcBia  of  Martindale  an  Westcott."  Re- 
vised by  W.  Harrison  Martindale,  Ph.D.,  F.O.S.,  aod  W.  Wynn 
Westcott,  M.B.Lond.,  D.P.S.,  H.tf  .8  Coroner  for  South-Kant  Lon- 
don.   Eleventh  Edition.    London  :  H.  K   Lewis.  1904. 


cipes  for  the  preparation  of  special  foods,  directions 
for  feeding,  as  well  as  advice  in  the  management  of 
rickety  children.  It  is  neatly  bound,  and  will  prove 
useful  to  many  practitioners  who  have  to  treat  the 
ailments  of  infancy  and  childhood. 

♦♦♦ 

Applications  for  the  John  Lucas  Walker  Student- 
ship of  the  annual  value  of  ^200,  tenable  under  certain 
conditions  for  three  years,  are  now  invited.  These 
must  be  sent  in  to  Professor  G.  Sims  Woodhead, 
Pathological  Laboratory,  Cambridge  University,  not 
later  than  the  27th  inst.  The  holder  must  devote 
himself  (or  herself)  to  original  research  in  pathology. 
Further  particulars  will  be  found  on  reference  to  our 
advertisement  columns. 

The  perennial  question  of  spelling  such  words  as 
honour,  favour,  centre,  sceptre,  &c,  is  again  to  the 
fore,  and  Dr.  Bo  wen,  an  American  philologist, 
comes  forward  in  defence  of  the  method  adopted  in  that 
country  of  omitting  the  u  in  words  ending  with  our, 
and  transposing  the  final  re  in  words  ending  thus  to  er. 
His  defence  of  such  words  as  "  honor  "  is  that  it  is 
nearer  the  original  Latin,  but  his  difficulties  are  in- 
surmoun  table  when  dealing  with  those  endingjwith  "re, " 
and  he  does  not  condescend  to  inform  his  readers  how 
he  would  deal  with  such  words  as  "  hour." 

**♦ 

Under  the  title  of  "  Elementary  Lectures  "  (Medi- 
cal Times  Co.,  Ltd.,  price  2s.  6d.),  Mr.  H.  B.  Grimsdale 
stands  parent  to  a  little  work  on  "  Errors  of  Refraction 
and  their  Correction."  The  author,  however,  goes 
quite  far  enough  for  the  average  medical  student, 
indeed,  one  wonders  what  more  he  could  have  said  on 
the  subject  had  he  tried.  We  note  here  and  there  that 
the  author  once  or  twice  indulges  in  that  horrid  prac- 
tice of  raising  a  question  without  giving  his  own  opinion 
thereon.  For  instance  (page  27),  is  the  suggestion 
to  make  use  of  periscopic  lenses  worthy  of  adoption  or 
not  ?  There  is  a  very  useful  chapter  on  the  selection 
of  the  lens  frame  qud  spectacles,  a  point  too  often  over- 
looked by  authors  and  practitioners  alike.  This  little 
work  can  be  cordiallv  recommended. 

Mr.  W.  J.  Abel's  little  brochure  on  "  School  and 
Home  Hygiene "  (Longmans)  presents  precisely  the 
qualities  and  drawbacks  one  could  expect  from  a  bar- 
rister-at-law  writing  on  school  hygiene.  The  object 
in  view,  e.g.,  the  education  of  school  teachers  and 
•  families  in  the  elementary  principles  of  hygiene,  is 
good ;  the  execution,  moreover,  is,  on  the  whole, 
sound.  But  the  author  falls  into  the  common  error 
of  advising  that  a  doctor  should  be  sent  for  when  a 
child  is  seriously  ill,  while  taking  upon  himself  to 
advise  a  preliminary  treatment.  He  prescribes,  for 
example,  a  lotion  of  sulphate  of  zinc  or  sugar  of  lead 
for  ophthalmia,  a  mixture  of  sulphurous  acid  and  water 
for  ringworm,  and  so  on.  With  regard  to  the  latter, 
the  chances  are  that  in  10  per  cent,  of  the  cases  of 
self-medication  sulphuric  acid  will  be  obtained  instead 
of  the  "  ous."  There  is  a  useful  chapter  on  the 
examination  of  the  eyesight  by  school  teachers,  but 
after  all,  such  investigations  had  best  be  left  to  skilled 
hands. 

The  Board  of  Inland  Revenue  quite  recently  notified 
to  chemists  that  medicines  referring  to  ailments  of  the 
human  body  became  dutiable  on  and  after  March  31st, 
1904,  but  if  such  remedies  are  sold  by  registered  phar- 
maceutical chemists  as  "  known,  admitted  and  ap- 
proved remedies  they  are  exempt  from  stamp  duties." 
immediately  on  the  publication  of  this  decision  of 
the  Inland  Revenue  Board  the  trade  journals  of  che- 
mists and  druggists  hastened  to  publish  formula  of 
"  known,  admitted  and  approved  remedies,"  which 
were  approved  of  the  Revenue  authorities,  and  the  book 
before  us,  "Pharmaceutical  Formularies"  (London: 
office  of  the  Chemist  and  Druggist),  is  a  resultant  By 
using  them,  proprietary  preparations  can  be  put  up 
by  the  chemist,  who  can  by  this  scheme  advertise  and 
freely  sell,  without  paying  stamp  duty,  preparations 


June  22,  1904 


OBITUARY. 


The  Medical  Press.    679 


for  all  the  ills  that  flesh  is  heir  to.  The  book  meets 
the  wants  of  the  prescribing  chemist,  and  its  formulae 
are  sanctioned  as  approved  by  the  Customs  authorities. 
But  one  and  all  of  them  labours  under  the  disadvantage 
of  prescribing  for  a  disease  and  not  for  an  individual. 
We  suppose  that  counter-prescribing  will  continue 
as  long  as  foolish  people  are  found  to  consult  chemists 
on  diseases,  and  it  is  therefore  just  as  well  for  the  physi- 
cian, when  he  is  subsequently  called  in,  to  know  what 
the  "  lung  balm/'  "  stomach  elixir/'  and  "  sweet  little 
liver  pills  "  are. 


ROYAL  COLLEGE  OF  SURGEONS  OF  ENGLAND. 
An  ordinary  meeting  of  the  Council  was  held  on 
June  9th,  Mr.  John  Tweedy,  the  President,  being  in 
the*  Chair. 

A  report  was  read  from  the  committee  on  the 
Relations  of  the  Medical  Profession  to  the  Coroner's 
Court.  It  was  approved  and  entered  on  the  minutes. 
The  committee  had  inquired  into  the  matter  and  had 
examined  the  recommendations  put  forward  by  the 
British  Medical  Association  and  by  the  London  County 
Council,  and  had  found  ample  proofs  of  the  desirability 
of  alterations  in  the  present  laws,  but  the  questions 
involved  are  varied  and  include  matters  of  administra- 
tion, such  as  the  rearrangement  of  coroners*  districts, 
with  which  the  medical  profession  is  not  immediately 
concerned.  Having  regard  to  the  various  interests 
concerned  and  to  the  failure  of  other  institutions  to 
induce  the  Government  to  initiate  legislation,  the 
committee  was  of  opinion  that  it  would  not  be  ex- 
pedient for  the  College  to  take  any  action  in  the  matter 
at  the  present  time. 

The  President  laid  before  the  Council  a  letter  which 
he  had  received  from  the  Home  Secretary,  and  reported 
that  he  proposed  to  recommend  Dr.  William  Henry 
Willcox,  of  St.  Mary's  Hospital,  as  official  analyst  to 
the  Home  Office  in  the  vacancy  occasioned  by  the 
resignation  of  Dr.  A.  P.  Luff.  The  Council  approved 
of  the  recommendation. 

A  letter  was  read  from  Mr.  Henry  Morris  reporting 
the  proceedings  of  the  General  Medical  Council  at  its 
recent  session.  The  thanks  of  the  Council  were  given 
to  Mr.  Morris  for  this  letter. 

It  was  resolved  that  the  revised  regulations  for 
study  in  chemistry  and  physics  shall  apply  to  those 
who  register  as  dental  students  as  well  as  to  those 
registering  as  medical  students  on  or  after  June  1st, 
1904,  and  that  the  new  synopsis  of  the  examinations 
shall  take  effect  in  and  after  March,  1905. 

A  petition  was  read,  signed  by  264  candidates  for 
the  diploma  in  dental  surgery,  asking  the  Council 
to  take  into  consideration  the  following  suggestions  : — 
(1.)  The  publication  of  a  reasonably  detailed  syllabus 
giving  the  general  range  of  knowledge  required  in 
(a)  surgery,  (6)  anatomy,  and  (c)  physiology,  as  has 
been  done  in  the  subjects  of  chemistry  and  metallurgy. 
(2.)  The  institution  of  a  quarterly  examination  as 
for  the  M.R.C.S.  diploma.  Half-yearly  examinations 
enforce  an  unnecessarily  long  interval  after  failure, 
entail  extra  expense,  and  tend  to  engender  a  dilatory 
spirit  in  the  candidates.  The  petition  was  referred 
to  the  Board  of  Examiners  in  Dental  Surgery  to 
consider  and  to  report. 

A  report  was  read  from  the  committee  on  Diplomas 
in  Tropical  Medicine  in  favour  of  instituting  an  exa- 
mination and  a  diploma,  and  it  was  decided  to  invite 
the  Royal  College  of  Physicians  of  London  to  appoint 
representatives  to  confer  with  representatives  of  the 
College  on  this  subject. 

A  letter  was  read  from  a  Fellow  of  the  College  sub- 
mitting a  statement  m  regard  to  a  case  of  sudden 
death  to  which  he  was  called,  and  the  action  of  the 
coroner  for  the  south-western  district  of  the  county 
of  London  in  reference  thereto,  and  asking  the  Council 
to  take  such  steps  as  shall  appear  proper  to  it  to  defend 
the  College  from  the  inferential  aspersion  cast  upon 
it  by  this  coroner  that  a  Fellow  of  the  College  is  not 
competent  to  give  evidence  in  his  court  or  to  perform 
a  necropsy. 

The  following  examiners  were  appointed  : — 


Board  of  Examiners  in  Anatomy  and  Physiology  for 
the  Fellowship. — Anatomy  :  Louis  Albert  Dunn,  Arthur 
Keith,  Christopher  Addison,  and  William  McAdam 
Eccles.  Physiology  :  Edward  Waymouth  Reid,  Ernest 
Henry  Starling,  Leonard  Erskine  Hill,  and  De  Burgh 
Birch. 

Conjoint  Examining  Board. — First  Examination — 
Elementary  Biology:  Herbert  Willoughby  Lyle,. 
Walter  G.  Ridewood,  Thomas  George  Stevens,  and 
Henry  William  Marett  Tims.  Second  Examination — 
Anatomy :  Holburt  Jacob  Waring,  Arthur  Keith, 
Christopher  Addison,  and  James  Ernest  Lane.  Physio- 
logy :  William  Henry  Thompson,  Thomas  Grigor 
Brodie,  and  John  Beresford  Leathes.  Third  Exa- 
mination— Midwifery  :  William  Duncan,  James  Henry 
Target t,  George  Francis  Blacker,  and  Arthur  Hamilton 
Nicholson  Lewers. 

Examination  in  Public  Health. — Part  I.  :  Alexander 
G.  R.  Foulerton.  Part  II. :  Herbert  Timbrell  Bul- 
strode. 

In  response  to  a  letter  from  Sir  R.  Douglas  Powell,. 
Bart.,  the  Council  granted  permission  to  the  Royal 
Medical  and  Chirurgical  Society  to  hold  a  conver- 
sazione at  the  College  in  May,  1905,  in  connection 
with  the  celebration  of  the  centenary  of  the  society. 

A  vote  of  thanks  was  given  to  Mr.  Thomas  Bryant 
for  his  long  and  zealous  services  to  the  College  as  a 
member  of  the  Council. 


©bituare* 

ROBERT  IVES,  M.R.C.S.ENG.,  L.R.C.P.E. 
By  the  death  of  Robert  Ives,  of  Portswood,  South- 
ampton, has  lost  one  of  its  oldest  medical  practitioners,. 
Mr.  Ives  came  of  a  long  line  of  medical  men  at  Chert sey,. 
being  the  fourth  in  direct  descent  to  enter  that  profes- 
sion. He  studied  at  St.  Thomas's  Hospital,  whence 
he  took  the  diploma  of  M.R.C.S.  and  L.M.,  in  1857,  and 
in  i860  took  the  L.R.C.P.  of  Edinburgh  and  started 
practice  at  Portswood.  He  has  left  a  widow  and  two 
daughters  to  mourn  his  loss,  as  well  as  a  son,  who  has 
carried  out  the  family  traditions  by  entering  the  medical 
profession.  Mr.  Ives  retired  from  active  practice  some 
eight  years  ago. 

C.    KELLY,   M.D.LOND.,    F.R.C.P. 
*  The  sudden  death  of  Dr.  Charles  Kelly,  Medical 
Officer  of  Health  for  the  districts  of  West  Sussex,  oc- 
curred on  the  1 6th  inst.,  at  hi « residence,  Grawick  Road, 
Worthing.     Deceased  was  present  at  a  meeting  of  the 
Sanitary  Committee  of  the  Worthing  Town  Council  a  few 
days  before,  apparently  in  his  usual  health.     Deceased, 
who  was  fifty-nine  years  of  age,  obtained  the  degrees  of 
M.B.  and  M.R.C.S.  (England)  in  1866,  and  in  the  follow- 
ing year  became  M.D.  of  London,  and  carried  off  the 
gold  medal  for  the  year,  while  his  F.R.C.P.  (London> 
was  obtained  in  1880.     He  was  also  at  one  time  Pro- 
fessor of  Hygiene  and  Public  Health  at  King's  College. 
On  taking  up  his  appointment  as  Medical  Officer  of 
Health  for  the  combined  sanitary  districts  of  West 
Sussex,  nearly  thirty  years  ago,  the  deceased  resided 
for  some  little  time  at  Horsham,  but  finding  the  coast 
to  be  more  convenient  for  his  work  he  ultimately  re- 
moved to  Worthing,  in  which  town  he  had  resided  ever 
i  since.  As  a  medical  man  he  was  a  believer  in  the  curative 
I  properties  of  fresh  air,  and  in  his  treatment  of  the 
!  patients  who  came  under  his  charge  at  the  Worthing 
Isolation  Hospital  at  Swandean  he  never  ordered  drugs 
or  stimulants  unless  they  were  absolutely  necessary. 
1  He  was  th?  author  of  several  well-known  works  and 
I  articles  on  medical  subjects,  while  his  annual  report 
as  Medical  Officer  of  Health  for  West  Sussex  invariably 
1  provided  interesting  reading.     Of  genial  and  courteou  r- 
disposition,  his  unexpected  death  will  be  mourned  by 
a  large  circle  of  friends,  not  only  in  Worthing,  but 
throughout  the  whole  of  West  Sussex. 
j  RICHARD  J.  DEARDEN,  L.R.C.S.EDIN., 

I  M.RC.S.ENG. 

I      We  regret  to  announce  the  painfully  sudden  death, 
;  in  his  forty-sixth  year,  of  Mr.  Richard  Jessap  Dearden, 
of  Oxford  Street,  Manchester,  which  took  place  on  the 


68o    The  Medical  Press. 


LABORATORY  NOTES. 


June  12.  1904. 


nth  instant.  For  a  number  of  years  he  had  been  the 
-surgeon  to  the  "  A  "  and  "  B  "  divisions  of  the  Man- 
chester city  police  force.  He  attended  a  post-mortem 
examination  last  week,  after  which  he  became  ill,  and 
•despite  prompt  and  constant  medical  attention  blood 
poisoning  supervened,  and  he  died.  Deceased,  who 
was  well  known  and  much  respected  in  medical  circles 
in! Manchester,  was  a  member  of  the  British  Medical 
Association  and  of  the  Manchester  Medical  Ethical  Asso- 
tion,  and  formerly  was  honorary  surgeon  to  the  Chorlton- 
•on-Medlock  Dispensary,  and  house-surgeon  to  the 
Manchester  Royal  Infirmary.  Mr.  Dear  den.  who  was 
a  Manchester  student,  won  the  M.R.C.S.Eng.  in 
1879,  and  the  L.R.C.S.Edin.  in  1881. 

laboratory  notes. 

PERRIER— A  NEW  SPARKLING  TABLE  WATER. 

The  springs  that  can  furnish  a  perfect  sparkling 
water  for  the  table  are  indeed  few  and  far  between. 
Without  mentioning  names,  it  may  be  stated  generally 
that  they  are  open  to  objection  on  the  ground  of  taste, 
of  heavy  mineralisation,  of  artificial  manufacture, 
or  of  some  other  more  or  less  serious  defect.  It  is 
with  real  pleasure,  therefore,  that  we  direct  the 
attention  of  our  readers  to  a  French  table  water  that 
promises  as  near  an  approach  to  perfection  as  may  be 
reasonably  expected  from  anything  obtainable  from  the 
earth,  or,  rather  from  the  waters  under  the  earth. 
This  water,  Perrier  by  name,  already  favourably  known 
in  some  parts  of  England,  has  established  a  great 
reputation  in  the  Riviera  and  other  parts  of  the  Conti- 
nent. At  the  request  of  the  proprietors  we  have  made 
an  exhaustive  inquiry  into  the  facts  connected  with 
it  origin,  distribution,  composition,  and  distinguishing 
qualities,  with  the  result  that  we  can  unhesitatingly 
place  it  in  the  first  rank  among  sparkling  table  waters, 
and  we  accordingly  invite  the  attention  of  members  of 
the  medical  profession  to  Perrier  water,  and  we  shall  be 
surprised  if  its  inherent  merits  do  not  quickly  secure 
their  approval.  The  position  of  the  profession  in  such 
a  matter  has  been  admirably  expressed  by  Dr.  Murrell 
in  the  following  passage  : —  (a) 

"  The  selection  of  a  table  water  for  ordinary 
table  consumption,"  he  writes,  "  is  a  subject  on  which 
medical  men  are  often  consulted,  and  it  must  be  ad- 
mitted that  it  is  not  always  easy  to  find  one  adapted 
to  the  special  requirements  of  the  individual  patient. 
The  consumption  of  table  waters  is  enormous,  amount- 
ing in  this  country  alone  to  something  like  3,600  million 
half  bottles  a  year.  It  must  be  remembered  that  they 
are  habitually  drunk,  not  only  by  those  suffering  from 
some  departure  from  the  normal  state  of  health,  but 
also  by  numerous  people  who  consume  them  either  alone 
<3r  mixed  with  wine  and  spirits  as  a  pleasing  beverage. 
The  reason  for  this  popularity  is  easily  explained. 
Most  people  have  a  wholesome  dread  of  enteric  fever, 
and  a  deep-rooted  distrust  of  the  purity  of  the  drinking 
water  supplied  to  them  in  country  towns  and  villages, 
especially  abroad." 

The  obvious  solution  of  the  difficulty  thus  sketched 
in  graphic  fashion  is  to  drink  some  pure  mineral  water 
that  has  been  bottled.  In  this  way  the  use  of  a  good 
table  water  enables  a  temperance  advocate  to  act  up 
to  his  principles  without  running  the  risk  of  contracting 
typhoid  fever.  Nor  is  it  given  to  all  of  us  to  be  able  to 
drink  cold  water  at  meals,  whereas  everyone,  be  he  dys- 

feptic  or  Philistine,  can  assimilate  a  light  sparkling  water 
'errier  water  comes  from  Vergeze,  a  remote  country 
district  in  the  midst  of  a  vast  plain.  It  lies  in  the 
Midi  of  France,  nine  miles  away  from  Nlmes,  in  the 
department  of  Gard.  Its  waters  bubble  up  from  a 
natural  gaseous  spring  of  great  antiquity.  Long 
ago  it  was  known  to  the  Romans,  as  testified  by  the 
numerous  relics  of  their  colonisation  found  not  only 
in  the  neighbourhood,  but  actually  in  the  spring 
itself.  The  interesting  fact  thus  brought  to  light, 
namely,    that    this    spring  was    appreciated    by   the 

(«)  "  The  Choice  of  a  Table  Water."  By  W.  Morrell,  M.D.  The 
Msdical  Prssb  avo  Cieculab,  May  11th,  1904. 


Roman  invaders,  is  in  itself  a  valuable  testimony  to  its 
virtues,  for  that  remarkable  race  always  had  a  keen  eye 
to  the  value  of  Nature's  products. 

In  the  case  of  the  Perrier  water,  the  great  character- 
istic feature  is  the  abundance  and  purity  of  the  carbonic 
acid  gas  which  it  contains.  Its  springs  open  into  a 
pool  that  measures  a  thousand  metres  across,  and  from 
that  large  surface  carbonic  acid  gas  bubbles  so  inces- 
santly as  to  explain  to  the  visitor  forthwith  the  origin 
of  the  local  name,  "  Lea  Bouilleus." 

Perrier  water  has  four  chief  excellencies — pleasant 
taste,  organic  purity,  abundant  carbonic  acid  gas,  and 
light  mineralisation. 

1 .  Pleasantness  of  taste  must  in  the  long  run  be  the 
predominant  factor  in  determining  the  place  of  a  table 
water  in  the  popular  favour.  Perrier  water  has  a  deli- 
cate subacid  and  most  agreeable  flavour  which  gently 
stimulates  and  refreshes  the  palate.  It  does  not  alter 
the  taste  or  colour  of  any  wine  or  spirit  to  which  it  may 
be  added. 

2.  Its  organic  purity  is  that  of  an  absolute  standard. 
To  quote  from  the  words  of  Dr.  Wilson  Hake,  its  organic 
purity  is  equal  to  that  of  the  purest  water  found  in 
Nature.  The  water  is  bottled  straight  from  the  spring 
in  a  state  of  virgin  purity.  Moreover,  the  spring  arises 
in  a  district  of  sparsely  inhabited  vineyards,  so  that  the 
water  is  safe  from  the  sources  of  contamination  that  so 
often  affect  ordinary  wells  and  streams. 

3.  The  abundance  of  natural  carbonic  acid  gas  in  the 
Perrier  spring  is  shown  by  the  large  bubbles  that  are 
given  off  incessantly  from  its  ample  surface.  The 
superiority  of  the  natural  over  an  artificial  gas  is  so  well 
known  that  there  is  no  need  to  enlarge  upon  the  point 
here.  Suffice  it  to  say  that  Henriot,  of  Paris,  whose 
opinion  is  entitled  to  all  respect,  has  shown  that  there  is 
an  essential  difference  in  physiological  action  between 
natural  carbonic  acid  and  the  artificial  product  pre- 
pared chemically  from  the  hydrochloric  acid  in  chalk.  The 
former  is  absorbed  promptly,  whilst  the  latter  is  with 
difficulty  assimilated  and  produces  distension  of  the 
stomach.  Perrier  water  can  thus  be  taken  at  meals 
when  ordinary  soda  and  other  artificially  charged  effer- 
vescing water  would  cause  discomfort  and  retard  diges- 
tion. In  some  cases  of  atonic  dyspepsia  a  small  quan- 
tity of  mellow  whisky  mixed  with  Perrier  water  forms 
the  most  perfectly  suitable  beverage  with  which  we  are 
acquainted. 

4.  The  light  mineralisation  of  Perrier  water  accounts 
for  much  of  its  virtue.  The  total  amount  of  its  solids, 
according  to.  an  analysis  made  by  Dr.  H.  Wilson  Hake, 
is  less  than  4  grammes  in  10  litres.  "  The  salts  present," 
he  says,  "  consist  almost  entirely  of  bicarbonate  and  a 
very  small  amount  of  sulphate  of  lime  ;  the  remainder 
consist  of  chloride,  nitrate  and  sulphate  of  sodium, 
which,  taken  together,  amount  to  little  more  than  half 
a  gramme  in  10  litres,  and  a  trace  of  silica,  invariably 
present  in  natural  waters.  The  lime  salts  render  it  very 
palatable,  its  agreeableness  in  this  respect  being 
greatly  increased  by  the  faintly  acid  flavour  of  the  pure 
natural  carbonic  acid  which  it  contains,  and  which  is 
free  from  any  other  gas  whatsoever." 

The  minute  trace  of  alkaline  carbonates  present 
renders  Perrier  water  specially  fitted  for  use  at  meals, 
for  it  has  been  shown  that  the  presence  of  a  large  quan- 
tity of  salts  of  that  class  (as  met  with  in  some  other 
table  waters)  retards  digestion. 

On  the  last  point,  Dr.  Murrell  remarks :  "  The 
alkaline  carbonates  taken  at  the  commencement  of  a 
meal  stimulate  the  secretion  of  the  gastric  juice,  but 
ultimately  interfere  with  its  natural'  production. 
Taken  towards  the  termination  of  a  meal  they  neutralise 
the  hydrochloric  acid  which  plays  so  important  a  part 
in  the  process  of  digestion  and  retard  its  secretion. 
What  is  required  is  a  natural  water  containing  no  active 
drug,  and  one  which  is  (1)  free  from  organic  matter 
and  medicinal  substances ;  (2)  strongly  aerated  with 
its  own  natural  carbonic  acid  gas  ;  and  (3)  of  low  min- 
eralisation and  free  from  added  saline. 

Perrier,  strictly  speaking,  is  not  a  medicinal  water.  It 
claims  to  be  a  sound,  safe  and  palatable  drinking  water 
for  the  table,  fitted  alike  for  the  sick  and  for  the  healthy 


June  22,  1904. 


PASS  LISTS. 


Thk  Medical  Press.     681 


At  the  same  time  it  possesses  one  quality  worthy  of  the 
attention  of  the  physician,  namely,  the  power  of  stimu- 
lating the  function  of  the  kidneys.  This  diuretic  action 
renders  it  specially  useful  in  gout  and  in  the  uric  acid 
habit  generally.  In  conclusion,  it  may  be  said  confidently 
that  in  Perrier  water  a  valuable  addition  has  been  made 
to  the  extremely  limited  list  of  table  waters  that  the 
physician  has  hitherto  found  available  for  general  use. 
There  can  be  little  doubt  that  under  judicious  manage- 
ment a  great  future  awaits  this  ancient  Roman  spring 
of  Les  Bouillieus. 


ADeMcal  Hews* 


Boyal  College  of  Surgeons,  Ireland. 

The  Barker  anatomical  prize  for  190$  of  £21  may 
be  competed  for  by  any  student  whose  name  is  on 
the  anatomical  class  list  of  any  school  in  the  United 
Kingdom.  The  prize  is  offered  for  a  dissection  of  the 
left  pneumogastric  nerve,  limited  to  its  pharyngeal 
and  laryngeal  divisions,  and  including  their  connections. 
Each  preparation  must  reach  the  curator  of  the  museum 
before  March  31st,  1005,  marked  with  a  fictitious 
signature  and  accompanied  by  a  sealed  envelope 
containing  the  full  name  of  the  competitor  and  a  de- 
claration that  the  work  has  been  carried  out  by  himself. 
The  form  for  this  declaration  can  be  obtained  on 
application  to  the  curator.  The  dissections  are  to  be 
mounted  in  vessels  fitted  with  glass  covers,  but  the 
covers  must  not  be  sealed  down.  Earthenware  basins 
and  plaster-of-Paris  settings  are  not  compulsory  if  the 
specimens  can  be  better  displayed  and  preserved  by 
other  means.  No  prize  will  be  awarded  unless  suffi- 
cient merit  is  shown,  70  per  cent,  of  the  total  marks 
being  the  minimum.  Those  dissections  for  which 
prizes  are  awarded  become  the  property  of  the 
College.  Where  prizes  are  not  awarded  competitors 
may  be  refunded  such  amount  of  the  cost  of  produc- 
tion as  the  examiners  deem  fit.  The  cost  and  risks 
of  transport  must  be  borne  by  the  student. 
The  Plague. 

The  following  telegram  from  the  Officer  Administer- 
ing the  Government  of  Hong-Kong  has  been  received 
at  the  Colonial  Office  : — Forty-seven  cases  of  plague, 
46  deaths,  for  the  week  ending  June  nth. 

Medical  Mayor's  "  Consumption  Cure." 
Dr.  Richard  Burford  Searlb,  a  retired  Cornish 
medical  practitioner,  and  now  mayor  of  Dartmouth, 
has  published  further  details  of  his  plan  for  the  cure 
of  consumption.  His  remedy  is  to  fight  the  germs 
of  tuberculosis  by  the  aid  of  typhoid  germs.  He 
declares  that  in  his  experience,  and  .the  experience 
of  many  physicians  of  long  standing,  they  have  never 
met  with  anyone  suffering  from  organic  disease, 
consumption,  or  cancer,  dying  from  typhoid  fever. 
He  gives  illustrations  in  which,  when  typhoid  has 
attacked  consumptive  patients,  they  have  invariably 
recovered,  both  from  typhoid  and  tuberculosis.  He 
advocates  inoculation  under  his  system  of  children 
whose  family  history  is  pronouncedly  tuberculous  or 
cancerous. 

University  of  Cambridge. 
The  following  medical  and  surgical  degrees  were 
conferred  on  June  9th  : — Doctor  of  Medicine — W.  P.  S. 
Branson,  Trinity ;  A.  R.  M.  Brenan,  Trinity ;  and 
B.  N.  Tebbs,  Queen's.  Master  of  Surgery — Professor 
Howard  Marsh,  King's.  Bachelor  of  Medicine  and 
Bachelor  of  Surgery— C.  L.  Nedwill,  Trinity ;  C.  R. 
Howard,  Pembroke ;  W.  Hastings,  Christ's ;  and 
■C.  Burrows,  Emmanuel.  Bachelor  of  Medicine — H.  R. 
Fisher,  Emmanuel.  Bachelor  of  Surgery — T.  G.  M. 
Hine,  King's;  R.  E.  Whitting,  King's;  and  B.  N. 
Tebbs,  Queen's.  Dr.  D.  MacAlister  and  Mr.  Strange- 
ways  have  been  appointed  examiners  in  Pharmacology 
and  in  Pathology  respectively  for  the  third  M.B.  Dr.  A. 
Macalister  and  Dr.  Guillemard  have  been  appointed 
members  of  the  new  Board  of  Anthropological  Studies. 
Mr.  Duckworth  has  been  reappointed  University 
Lecturer  in  Physical  Anthropology. 


Infant  Mortality. 
Sir  Walter  Forstbr  last  week  drew  the  attention 
of  the  President  of  the  Local  Government  Board  to  the 
high  infant  mortality  in  the  large  towns  df  the  kingdom, 
and  asked  whether,  with  a  view  to  lessening  this 
mortality,  he  will  inquire  whether  the  facilities  for 
granting  outdoor  medical  relief  are  sufficient  in  the 
great  provincial  towns,  and  in  districts  like  St.  George's- 
in-the-East,  Whitechapel.  Limehouse,  and  Stepney, 
and,  if  not,  whether  he  will  take  steps  to  improve  the 
methods  of  granting  medical  out-reliel  Mr.  Long 
replied  :  "lam  aware  of  the  figures  referred  to  as  to 
infant  mortality.  Except  that  in  some  places  additional 
relieving  officers  might  be  appointed,  I  have  not  at 
present  seen  any  reason  to  suppose  that  the  existing 
faculties  for  granting  outdoor  medical  relief  are  in- 
sufficient ;  but  so  far  as  the  metropolis  is  concerned 
a  special  investigation  is  at  this  moment  being  made 
by  one  of  the  assistant  inspectors  of  the  Department 
as  to  the  arrangements  for  outdoor  medical  relief. 
Quarantine  Conference  at  Barbados*. 

A  Jamaica  correspondent  writes  on  May  18th : — 
The  West  Indian  quarantine  conference,  attended  by 
delegates  from  the  British  West  Indies  and  British 
Guiana,  and  by  Dr.  T.  Thomson,  medical  inspector 
of  the  English  Local  Government  Board,  was  held  in 
Barbadoes  at  the  end  of  April  and  beginning  of  May. 
The  proceedings,  which  were  opened  by  the  Governor, 
Sir  F.  Hodgson,  were  conducted  in  private,  but  it  is 
understood  that  the  results  are  of  a  very  satisfactory 
character.  The  quarantine  arrangements  of  the  various 
colonies  have  been  revised  and  a  uniform  system 
adopted  in  correspondence  with  the  latest  practice 
in  other  countries.  Disinfection  and  inspection  will, 
it  is  said,  be  largely  substituted  for  the  existing  methods 
of  quarantining.  A  series  of  regulations  has  been 
drawn  up  for  general  adoption  according  to  which  each 
colony  will  deal  adequately  with  its  own  cases,  and 
keep  the  others  informed  of  developments,  thus  re- 
lieving the  latter  of  much  of  the  individual  respon- 
sibility which  has  been  at  the  root  of  past  difficulties. 
The  report  has  been  forwarded  to  the  Colonial  Office, 
and,  if  approved,  will  form  the  basis  of  a  West  Indian 
convention  binding  upon  all  the  Colonies.  The  position 
of  the  neighbouring  foreign  countries  was  discussed, 
but  it  was  deemed  advisable  that  the  convention  should 
be  agreed  to  first  by  the  British  Colonies,  and  then,  if 
necessary,  it  could  be  presented  to  the  foreign  Govern- 
ments for  their  acceptance. 

Sanitary  Hairdresstng. 

Dr.  W.  Collingridge,  the  medical  officer  of  health 
for  the  City  of  London,  has  submitted  to  the  Sanitary 
Committee  of  the  Public  Health  Department  a  series 
of  regulations  for  the  formation  of  a  register  of  sanitary 
hairdressers  and  barbers,  it  being  proposed  that  any 
failure  to  comply  with  the  regulations  should  be  followed 
by  the  removal  of  the  name  of  the  offender  from  the 
register.  Dr.  Collingridge  recommends,  among  other 
things,  that  regular  customers  should  provide  their 
own  toilet  requisites ;  that  all  shelves  and  fittings 
should  be  made  of  glass  ;  that  the  use  of  powder  puffs 
should  be  discarded  in  favour  of  powder  pulverisers  ; 
that  a  barber  or  hairdresser  should  refuse  to  serve  a 
customer  who  is  apparently  suffering  from  any  skin 
or  hair  affliction ;  and  that  all  razors  and  combs 
should  be  kept  for  five  minutes  in  a  5  per  cent,  solution 
of  carbonate  of  soda.  The  medical  officer  insists,  also, 
that  hair  curlers  and  tongs  used  in  ladies'  hairdressing 
establishments  should  be  boiled  for  ten  minutes. 


PASS  LISTS. 

Society  of  Apothecaries  of  London. 

The  following  candidates  having  passed  the  necessary 
examination  have  received  the  L.S.A.  Diploma  %oi 
the  Society,  entitling  them  to  practise  medicine, 
surgery,  and  midwifery : — L.  S.  Dudgeon,  J.  tA. 
Renshaw,  N.  O.  Roberts,  and  G.  W.  Rogers. 


68a    Tm  m«dical  Prk»».      NOTICES  TO  CORRESPONDENTS. 


.Ilotkce  to 
flomspmtbente,  Short  getters,  &i 

fs9*  Ooremfohdots  requiring  a  reply  in  this  column  are  particu- 
larly requested  to  make  ueoft  dUtimeHvs  Signatun  orinitUU,  and 
avoid  the  practice  of  signing  themselves  "Reader,"  "Subscriber," 
"  Old  Subscriber,"  Jeo.  Much  oonfusion  will  bo  spared  by  attention 
to  this  rule. 

Oriodtal  Articles  or  Lrtkss  intended  for  publication  should  be 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
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tion, but  as  evidence  of  identity. 

Contributors  are  kindly  requested  to  send  their  communications, 
if  resident  in  England  or  the  Colonies,  to  the  Editor  at  the  London 
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Reprints.— Reprints  of  articles  appearing  in  this  journal  can  be  had 
at  a  reduced  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

LUNACY  AND:  THE  ARCHDEACON'S  BROTHER, 
To  the  Editor  of  The  Medical  Puss  and  Circular. 
Sir,— Permit  me  to  briefly  refer  to  s  case  of  considerable  public  and 
professional  interest.  Last  week  Archdeacon  Potter  applied  at  the 
Wood  Green  Police  Court  for  a  warrant  against  his  brother.  From 
a  report  of  the  case  in  the  newspapers  on  Saturday  it  appears  that 
the  brother  visited  the  house  during  the  applicant's  absence,  and  so 
threatened  the  servants  that  the  gardeners  had  no  alternative 
but  to  eject  bim  from  the  premises.  For  many  years  the  archdeacon 
had  allowed  his  brother  a  reasonable  amount  on  which  to  live,  but 
this  had  not  prevented  him  from  becoming  a  great  trouble  to  the 
family.  He  had  been  convicted  about  twenty  times  for  all  manner  of 
Offences,  mostly  for  violence.  Dr.  Howard  Distin,  of  Enfield,  stated 
in  replying  to  the  Bench,  that "  the  man  was  a  criminal  lunatic,  but 
it  was  one  of  these  cases  where  they  could  not  certify  insanity/  It 
would  be  interesting  to  know  how  Dr.  Distin  distinguishes  between 
cases  of  criminal  lunatics  that  can  and  cannot  be  certified  for. 


Yours  truly, 

B.  L. 

Edbn  Bridgb.— A  stab  in  the  neck  is  more  likely  to  be  homicidal 
than  suicidal.  At  the  same  time  instances  are  on  record  where  a 
person  has  stabbed  himself  fatally  in  the  front  or  the  side  of  the  neck. 
If  the  stab  be  from  behind  it  is  almost  necessarily  homicidal.  Should 
the  cord  be  severed  above  the  third  cervical  vertebra  death  will  be 
instantaneous. 

CAU3B  AND  EFFECTS. 

According  to  an  Antipodean  contemporary,  the  latest  Australian 
bankruptcy  is  that  of  Mary  Anne  O'Bri  en,  of  Yarrawangs,  nurse. 
Liabilities.  £74 10s.  7d. ;  ass*t*  £16  ;  deficiency,  £69  10s.  7d  :  cause 
of  deficiency,  dec  ine  in  the  birthrate. 

Db.  Mb  a  as.— If  possible  in  our  next. 

R.  P.  Ftnss-Clinton  (Midwives  Institute).— Your  communi- 
cation reached  us  as  we  were  at  press,  too  late  for  reference  in 
present  issue 

M.&.C.3.  (3urbiton).  The  question  of  the  cold  bath  is  a  vexed 
one  and  its  proper  solution  must  depend  to  a  great  extent  upon  the 
soundness  of  the  individual  concerned.  Speaking  broadly,  the  cold 
bath  is  a  luxury  for  the  young  and  strong,  and  a  dangerous  depres- 
sant for  the  old  and  weak.  For  all  that,  many  a  man  and  some 
women  enjoy  a  cold  tub  in  the  morning  at  70  or  80  years  of  age  or 
even  more.    Our  advice  is  to  take  it  tepid  as  years  accumulate. 

A  MILK  DI8PENSARY. 
The  medical  staff  of  the  North  Eastern  Hospital  for  Children  have 
recently  made  representations  to  the  Committee  urging  the  estab- 
lishment of  a  milk  "  dispensary."  In  place  of  prescribing  drugs  for 
many  of  their  cases,  they  wish  to  be  able  to  prescribe  pure  milk  and 
milk  preparations  supplied  from  a  source  on  which  they  can  rely 
implicitly,  and  delivered  to  the  patients  in  sealed  bottles. 


Jfoetmjje  of  the  gorielies,  %ttttme,  &t. 

Wednesday;,  Juke  22nd. 

Mtoic^Gbaduatm*  College  and  Polyclinic  (22  Cheniee  Street, 
W-C;)*,r4.P-m-  *r-  J-  Clarke:  Clinique.  (Surgical.)  6.16p.m. 
Dr.  J.  Taylor:  Degenerate  Diseases  oAhe  SpW'conf  and  Some 
Unusual  Forms  of  Nervous  Disease. 

Thursday,  Juke  28rd. 

Medical  Graduates'  Colleoe  and  Polyclinic  (22  Chenies  Street, 
1L'  « 'T74  p,m/  *&•  Hutchinson :  Clinique.  (8urgical.)  5.16  p  m 
Dr.  P.  Horrocks  :  Prolapse  of  the  Uterus?  '  p     " 

Mount  Vernon  Hospital  fob  Consumption  and  Diseases  of  ran 

its  Pathology  and  Diagnosis     (Post  Graduate  Course.)        "•"""• 
Friday,  June  24th. 

Medical  Gbapuatej  Collbor  and  Polyclinic  (22  Chenies  Street. 
W.C.),— 4  p.m.    Mr.  A.  Lawson :  Cliuique.    (Eye  ) 

__  Monday  June  27th. 

Odonotolooical  SociBTYlor  Great  Beitian  (20  Hanover"8quare.  W.). 

^t..^  A  P6*^  J?r. «Meas  u""fir  8mall  Quantities  of  Liquid 
Anaesthetics.  2.--Mr.  E. Preedy  :  A  Case  of  "Irregular  Eruption*  of 
Temporary  Incisors.  B.-Mr.  J.  F.  Colyer  •  A  Case  ■howinVr 
"  Irregularify  of  the  Lateral  Incisors."  The  Chair  will  bTtakeS 
at  8  p.m.    The  Council  meet  at  7  p.m. 


June  22,  1904 


tto&motB. 


^^aSS^^^J'9^  8ohool»  P«>alngton,W.-Lecturer  e» 

BOr2IfivHSiUI  B^^h^.- Junior  Besident  House  Surgeon. 

^retsjyf  ^  **™m'        AW<**<»»     to    the    Honorary 

Clifden  Union.-Medioal  Officer.    Salary  £166  per  annum  and  £10. 

o?  U^  (&iaTt.) Imm€dlate  •"«-«"  *>  *  »Eg7cierk 

Nobles  Isle  of  kan  General  Hospital  and  Dispensary,  Dowlas.  Isle 

^^*^M«»t  House  8u>geon.  SaUry  ^per>S^with 

%£*£? ^IW?*-  ^EP^tions  to deo.  mEwb^ScJ^ 

Hon.  8ec.,  16  Athol  Street,  Douglas,  Isle  of  Man. 

hET4}1  VPUhI  '■flBMI3r»  8t-  John'8  Mill,  near  Oaphain  June- 

w\A'"h^^°ri^i,UBfc  «dlctJO«o«r.  ilary£W0^aiuiumr 

8uSeri^endentWnr  Mld  ™^<-*n*»**»    *    Medical 

Royal  Inflrmary.Newcastle-upon.Tj'ne.— Head  Dispenser.  Salary  £175* 

MIdJf!^ftJmrUm-  /PP^onVtoW.  T.  Oliver, JSeSeEry.^^     ^ 

Middlesex  County  Asylum.  Upper  Tooting,  8  W.— Third  Assistant 

MWicjlOiBcer  .-Salary  $00  wr  annum,  with  board, ^oSggg\ 

tuJSSf^Sl'    ApPiications  to  Medical  Superintendent.    WHn"*- 

StcxjUonwd  Thornany  Mospital,  Stockton^ii.Tees.--House  Surgeon. 

8Wary£260  per  annum.      Applications   to  H.  G.    Sanderson. 

^^SJ^lT^  «<>y»l  Ip«rmsury.—«eDlor  Hcmsw  Styveoii.     8a'ary£M0> 
fPfE^hZPl  apartments,  board,  *c.    Applications  to  Walter 

PnJL  l^^LBf°letMry^VeriaUiixdentiRoya\ Infirmary,  Derby. 
^i-S^iES*1  ,or  *«*"•»*.  Poplar,  E.  -Assistant  House  8urgecn. 
XaL ^»  Per  annum,  with  board  and  residence.   Applications, 
to  Edw.  Feneran,  U.-Col.,  Secretary  and  House  Governor. 


&Wointmznx*. 

**?£&£&  M.R  CA  L.BX.PXond..  Honorary  Anesthetist  to 
the  Manchester  Northern  Hospital  for  Women  and  Children 

Barwrll,  Harold.  M.B.Lond.,  F.R.C.S.Eng..  8urgeon  L»iigolo2ist 
to  the  Mount  Vernon  Hospital  for  Consumption.    *M7a*™*Wr 

Cooper,  Austin  M.D.,  ROh.Dub.,  Honorary  Assistant  Anesthetist 
to  the  St.  John's  Hospital  for  Diseases  of  the  Skin,  Leicester 

Copel^nd/PaulaT.,  M.Bm  Ch.B.Idin.,  Medical  Officer  for  Rousav 

and  Encilshay.  Orkney. 
Eocles,    W.  McAdam,  M.S.Lond.,    F.B.CS.Eng.,    Examiner    in 

Anatomy  for  the  Fellowship  Examination  of  the  Boyal  College  ot 

Surgeons  of  England. 
PRA?i'.K\Jl-5 >*££***?  2  Certifying  Surgeon  under  the  Factory 

Act  for  the  Orrell  District  of  the  county  of  Lancaster. 
Gunn.  Elmareth  C,  M.B.,  Ch.aEdinn  Outdoor  Physician  to  the 

Leith  Hospital 
Hbtorrson,  ^.banor    B.,  M.B.,  Ch.B.EdinM   Resident    Medical 

Officer  at  the  Royal  Hospital  for  Sick  Children.  Edinburgh. 
Hunt,   Albert    W.    Dunning,  LJLC.P.Lond.,    M.R.C.H..   Pubhe 

Vaccmator,for  the  Chagford  District  by  the  Okehsmpton  (DevonV 

Board  of  Guardians. 
Mason,  8.  Hrrbrrt,  M.R.C.S.,  UR.C.P.I^nd,Hoiior»ryABjBsthetist 

to  the  Manchester  Northern  Hospital. 
Mtllbr,  John,  L.R.C  P.Lond..  M.R.CJ3.,  to  the  Medical  Charge  of 

Troops  at  Topsham  Barracks,  Exeter. 
^■S!?0?'  5lA  \i  MB»  ChB.Edin.,  Resident  Medical  Officer  to 

Craiglockhart  Poorhouse. 
8ooTT/  5PH,*T'  B-S-I^wxL,  F.B.CAEng..  Surgeon  to  Out-patienU 

at  Evalina   Hospital    for  Sick  Children,   London;  also   Chief 

Assistant  in  the  Aural  Depirtment,  8t.  Bartholomew's  Hospital 
Wilms,  J.  Hamilton,  L.D.S.,   R.C.8.Esg.,  as  Honorary  Dental 

Surgeon  to  the  St.  John's  Hospital  for  Diseases  of  the  Skin. 

Leicester  Square,  W.C. 


flirthB. 

Crawturd.— On  June  14th,  at  71  Harley  Street,  London,  W.t  the 

wife  of  Raymond  H.  P.  Crawfuid,  M.b.,  F.R.C.P.,  of  a  son. 
Dodd  — On  June  9th,  at  Holies  Street  Maternity  Hospital,  Dublin, 

the  wife  of  Dr.  Wm.  8.  Dodd,  Egmont  Place,   Kantuxk,  of  a. 

daughter. 
O'NRiLL.— On  June  12th,  at  the  Abbey,  Athy,  the  wife  of  Dr.  O^etlL 

of  a  son. 
TORNEY.—On  June  16th,  at  8  Beyrout  Place,  Stoke,  Devonport,  the 

wtfe  of  J.  H.  Torney,  B.  A.,  M.B.,  T.C.D.,  of  a  daughter. 
Turnrr.— On  June  15th,  at  Oundle,  Northamptonshire,  the  wife  of 

B.  Roworth  Turner,  M.B.,  of  a  son. 


BNOLEnRXD-MTLBS. — On  June  14th,  at  Trinity  Church,  Limerick, 
William  Thomas  Englefleld,  r  aling,  to  Letitia  Elisabeth,  eldest, 
daughter  of  the  late  George  Myles,  M.D.,  Limerick. 


garths. 


BELLlfl.— On  June  16th,  at  Eastbourne,  Mary  Etheldreda,  widow  of 
the  late  Dr.  Benjamin  Belli*,  of  Maidenhead,  aged  9s. 
Crole.— On  June  15th,    at  Leven,  Fife,  Angus  Fletcher  Crole. 
L.R.O.P.  and  S.Ed.,  third  surviving  son  of  the  late  David  Crole, 
Esq. 
Kelly.— On  June  16th,  at  EUesmere,   Worthing,  Charles  Kelly* 
M.D.,  F.R.C.P.,  sged  60  years. 


©he   gllcilital  grttf   and   (ftirruhir. 


••8 ALUS   POPUU    SUPREMA    LEX." 


Vol.  CXXVIII. 


WEDNESDAY,    JUNE  29,    1904, 


No.   26. 


Original  Communications- 
ACID    SODIUM    PHOSPHATE 

AND 

ADRENALIN    IN    VESICAL 
DISEASES. 

By  W.  I.  de  C.  WHEELER,  M.D., 
Surgeon  to  Mercers  Hospital. 

In  September,  1903, 1  published  a  short  account 
of  a  case  in  The  Medical  Press  and  Circular 
under  the  above  heading.  Since  then  many  points 
which  seem  to  me  of  interest  have  arisen  in  the 
case  ;  the  condition  of  the  bladder  was  demon- 
strated by  operation,  and  the  patient  unfortunately 
succumbed  to  pneumonia. 

Before  recording  the  progress  of  the  case  from 
the  date  of  my  last  publication,  a  short  epitome 
of  what  has  been  already  published  is  necessary. 

The  patient,  a  gentleman,  aet.  85,  with  a  history 
of  gout,  consulted  me,  with  the  well-known  story 
of  frequency  of  micturition,  especially  at  night, 
depriving  him  of  his  rest  and  comfort.  No  en- 
largement of  the  prostate  could  be  detected  per 
rectum,  and  a  No.  8  catheter  could  be  passed  with 
little  difficulty  ;  about  six  ounces  of  residual  urine 
were  drawn  from  the  bladder  after  the  patient  had 
satisfied  himself  it  was  empty.  Sounding  revealed 
nothing.  The  urine  was  acid,  contained  oxalates 
and  urates,  and  a  quantity  of  blood,  but  no  epi- 
thelial shreds  or  casts.  An  alkaline  medicine 
was  prescribed,  and  the  gout  treated,  with  the  idea 
that  the  haemorrhage  might  be  associated  with 
the  passage  of  "  gravel."  In  this  case  the  use  of 
the  cystoscope  was  not  had  recourse  to  on  account 
of  the  patient's  advanced  years  and  an  extremely 
sensitive  and  nervous  disposition.  Suffice  it  to 
say  that  one  day,  after  drawing  off  the  residual 
urine,  a  violent  haemorrhage  occurred,  notwith- 
standing the  gentleness  practised  in  passing  the 
catheter.  This,  as  it  afterwards  turned  out,  was 
not  due  to  catheterisation,  but  at  the  time  it  ap- 
peared to  me  that  possibly  a  small  portion  of  a 
villous  tumour  or  other  growth  had  been  detached. 
The  haemorrhage  on  this  occasion  was  therefore  not 
treated  locally,  but  continued  for  six  days,  the 
patient  passing  water  every  ten  minutes  laden  with 
blood.  An  operation  was  refused,  so  the  treat- 
ment consisted  in  absolute  rest,  morphia  supposi- 
tories, ice  to  perinaeum,  large  doses  of  calcium 
chloride,  and  hypodermic  injections  of  ergot ; 
at  first  all  these  drugs  were  used  simultaneously, 
each  having  a  distinct  duty  to  perform.  On  the 
third  day  the  haemorrhage  was  at  its  height ;  on 
the  sixth  day  it  had  entirely  disappeared  ;  on  the 


fourth  the  blood  was  passed  in  clots  and  not  so  fre- 
quently, but  with  much  pain.  The  patient  made 
a  good  recovery,  only  to  get  another  attack  at  a 
time  when  no  catheter  had  been  used.  I  at  once 
passed  a  No.  8  French  catheter,  washed  out  all 
blood-clots,  and  injected  a  weak  solution  of 
adrenalin  chloride  of  commerce.  About  half  a 
drachm  in  an  ounce  of  warm  water  was  the  strength 
and  quantity  used.  The  patient,  though  micturat- 
ing frequently  before  I  arrived,  and  passing  quan- 
tities of  pure  blood,  after  the  injection  of  adrenalin 
chloride  had  no  further  trouble.  The  urine  passed 
regularly  and  was  free  from  blood.  An  attack 
similar  to  the  first  would  have  certainly  ended 
fatally.  This  was  only  avoided  by  the  treatment 
adopted.  He  remains  now  for  three  weeks  or  a 
month  without  any  blood  in  the  urine,  then  gets  a 
severe  haemorrhage,  to  be  checked  again  by  three 
or  four  injections  of  adrenalin. 

The  same  patient  in  the  intervals  suffered  from 
a  chronic  cystitis  with  ammoniacal  purulent  urine, 
and  as  in  two  other  similar  cases,  T  have  found 
without  exception  that  the  administration  of  acid . 
sodium  phosphate  NaH2P04  is  most  beneficial, 
especially  when  combined  with  a  urinary  disin- 
fectant. 

B.  Acid.  sod.  phosphat.,  3ij ; 
Urotropin,  3j  ; 
Infus.  urae  uvis,  ad  5vj ; 

Sig.  5s3  t-i.d. 

This  is  the  prescription  employed  with  excellent 
effect  in  three  recent  cases.  The  patients  com- 
plain greatly  of  thirst  when  taking  the  medicine, 
and  it  should  be  given  with  caution  if  there  is  any 
albuminuria.  In  one  case  related  to  me  by  Dr. 
Moorhead,  uraemia  was  supposed  to  have  arisen  in 
consequence  of  employing  the  drug  in  cystitis 
when  the  kidneys  also  were  diseased.  In  the 
above  note  I  only  refer  to  patients  unfit  for  opera- 
tion. A  suprapubic  cystotomy  for  drainage  or 
removal  of  a  tumour,  in  suitable  cases,  is  the  proper 
procedure  for  a  surgeon. 

Care  should  be  taken,  in  ordering  acid  phosphate 
of  sodium,  that  the  chemist  does  not  use  the  official 
sodium  phosphate  Na,HP04,  instead  of  the  acid 
sodium  phosphate,  NaH,P04>  the  normal  urinary 
acidulant.  This  mistake  occurred  in  my  own 
experience,  the  chemist  having  never  before  seen 
the  acid  sodium  phosphate  prescribed.  The  sym- 
ptoms I  detail  above  follow  closely  those  of  villous 
tumour,  i.e.,  intermittent  profuse  haemorrhage, 
with  no  signs  or  symptoms  of  stone  or  malignant 
disease. 

Further  Notes  on  the  Progress  of  the  Case. — Until 
April,  1904,  the  patient  had  enjoyed  life  with 
tolerable  comfort,  that  is  to  say,  for  about  ten 


684    The  Medical  Press.         ORIGINAL  COMMUNICATIONS. 


June  29,  1904. 


months  after  the  original  haemorrhage.  Though 
in  his  eighty-sixth  year  he  was  a  regular  attendant 
at  his  club,  and  carried  out  his  duties  as  director 
of  a  company  with  energy.  Now,  however,  a 
"  break-down  "  in  catheter  life  became  apparent : 
the  urethra  and  bladder  were  so  irritable  that  he 
dreaded  the  thought  of  passing  a  catheter,  and 
suffered  greatly  when  attempts  at  irrigation  were 
made.  For  days  sometimes,  from  fear  of  the  pain, 
he  allowed  the  residual  urine  to  accumulate  and 
decompose  in  the  bladder. 

I  may  here  say  that  the  bladder  was  washed  out 
about  two  hundred  times  during  the  course  of  the 
disease.  Permanganate  of  potash,  carbolic  acid, 
borax,  quinine,  corrosive  sublimate,  protargol; 
and  sterilised  water  were  used  for  douching  the 
bladder  as  they  suggested  themselves,  but  of  all  I 
was  struck  with  the  fact  that  sterilised  water  gave 
the  best  results,  the  patient  remaining  longer  in 
comfort  than  when  the  others  were  used.  The 
suffering  of  the  old  gentleman  became  now  almost 
continuous:  often  when  a  large  catheter  was  passed, 
with  great  pain,  it  failed  to  empty  the  bladder 
owing  to  the  accumulation  of  mucus,  pus,  blood 
and  phosphates,  which  blocked  the  passage  before 
any  urine  flowed  out.  Then  suction,  or  even 
washing  back  the  pus  into  the  bladder  with  a 
syringe  was  alone  effectual. 

When  finally  it  was  emptied  the  neck  of  the 
bladder  seemed  to  "  grip  "  the  catheter,  causing 
exquisite  pain  and  necessitating  the  hasty  injection 
of  fluid  to  distend  the  walls. 

From  the  first  haemorrhage  in  June,  1903,  the 
prudence  of  a  suprapubic  cystotomy  was  dis- 
cussed with  the  patient  and  his  relatives,  but 
the  operation  was  refused.  Nor  did  I  in  the  early 
stages  think  it  my  duty  to  press  it  on  a  man  of 
eighty-six  years.  At  last,  on  Saturday,  June  4th, 
he  consented,  worn  out  with  pain  and  want  of  rest. 

The  operation  was  rapidly  performed  on  Sunday 
morning.  On  passing  a  finger  into  the  bladder  a 
malignant  tumour  was  felt  infiltrating  the  left 
lateral  wall  of  the  bladder  near  the  orifice  of  the 
ureter ;  it  was  adherent  to  the  pelvic  wall,  and 
was  a  flat,  hard  growth.  In  three  days  the  patient 
progressed  as  if  to  recover,  but,  unfortunately, 
what  was  most  dreaded  occurred,  and  hypostatic 
pneumonia  ended  the  patient's  life  one  week  after 
operation. 

Remarks. — The  original  object  in  publishing  a 
note  on  this  case  was  to  call  attention  to  the  use  of 
acid  sodium  phosphate  combined  in  the  way  I  have 
mentioned   in   cases   such   as   that   described. 

The  efficacy  of  adrenalin  in  haemorrhage  needs 
little  comment,  but  it  is  more  admirable  in  some 
cases  than  others.  When  applied  locally  it  is  very 
reliable  as  a  haemostatic,  and  also  as  a  local  anaes- 
thetic, pure  or  mixed  with  cocaine.  Given  inter- 
nally it  seems,  naturally  enough,  to  be  inefficient  in 
haemoptysis  or  other  remote  haemorrhages,  and  in 
haematemesis  the  action  might  almost  be  con- 
sidered "  local  "  ;  yet  in  a  case  under  my  care  of 
violent  haemorrhage  from  a  gastric  ulcer  internal 
administration  did  not  check  the  haemorrhage ;  a 
subcutaneous  injection  of  5  minimsof  the  1  in  1,000 
saline  solution  brought  back  a  pulse  in  three 
minutes  which  was  not  perceptible  in  the  patient 
before.  She  was  blanched,  fainting  on  the  slightest 
movement,  and  in  a  most  critical  condition.  The 
haemorrhage  in  this  case  ceased  on  giving  liquor 
ferri  perchJor.  every  hour  in  4  minim  doses,  and 
occasional  5  minim  capsules  of  turpentine  ;    the 


adrenalin  did  not  check  it ;   in  fact,  it  seemed  to 
aggravate  it.     This  is,  however,  a  digression. 

As  to  the  acid  sodium  phosphate,  I  cannot 
pronounce  definitely  on  its  action  until  I  have 
treated  many  more  cases,  yet  I  am  strongly  of 
opinion  that  it  is  a  good  urinary  acidulant.  This 
I  have  demonstrated  in  the  case  described.  I  also 
have  a  record  of  three  other  cases  whose  urine 
became  acid  after  administration  of  this  drug. 
Hutcheson,  of  London,  first  called  attention  to  its 
value.  Several  of  my  professional  friends  in  Dublin 
have  also  had  success,  and  others  have  promised 
to  try  it  and  give  me  the  benefit  of  their  experi- 
ence. After  all,  theory  must  be  modified  accord- 
ing as  practical  facts  present  themselves,  and  if 
we  find  acid  sodium  phosphate  a  useful  addition 
to  urinary  acidulants,  physiologists  will  soon  pre- 
sent us  with  all  the  scientific  details  of  its  action. 

Lastly,  as  regards  the  tumour  in  this  case, 
either  it  was  a  villous  tumour  (as  diagnosed  in  the 
first  instance),  becoming  malignant  after  a  year's 
progress,  or  else  from  the  onset,  a  year  or  more 
before  operation,  it  was  one  of  those  slow-growing 
hard  epitheliomata  described  among  malignant 
growths  in  the  bladder.  Primary  cancer  of  the 
bladder  is  rare,  dissemination  is  unusual,  pain  is  a 
late  symptom,  and  depends  chiefly  on  cystitis 
the  only  constant  sign  appears  to  be  haemorrhage. 


DOWNES'     ELECTROTHERMIC 
ANGIOTRIBES.  (a) 

By  H.  MACNAUGHTON-JONES,  M.D. 

At  a  meeting  of  the  British  Gynaecological 
Society  on  June  9th,  Dr.  Macnaughton- Jones,  for 
Dr.  Andrew  Downes,  of  Philadelphia,  showed  a 
number  of  electrothermic  haemostatic  angio- 
tribes,  and  said  that  the  Fellows  would  agree  with 
him  that  they  were  very  skilfully  devised  and 
beautifully  constructed  instruments.  So  far  back 
as  1862  Baker  Brown  had  used  the  cautery  in 
the  treatment  of  ovarian  pedicles.  Keith  and 
Lawson  Tait  also  adopted  this  method,  but  the 
credit  of  introducing  the  practice  of  electro- 
haemostasis,  that  is,  the  control  of  haemorrhage  by 
the  combination  of  forci-pressure  with  heat  pro- 
duced by  electricity,  was  due  to  Skene,  of  Brooklyn. 
Jacobs,  of  Brussels,  (6)  in  1899,  recommended  elec- 
tro-haemostasis  as  preferable  to  ligature,  clamp,  or 
forci-pressure  by  lever  ;  the  advantages  he  claimed 
were  that  there  is  no  sloughing  of  the  tissues, 
that  it  enables  us  to  act  on  a  large  surface,  occluding 
the  lymphatics,  and  opposing  an  obstacle  to  the 
spread  of  infection,  and  that  no  bleeding  surface 
is  exposed,  calculated  to  form  adhesions  with 
surrounding  structures ;  moreover,  when  the 
tissues  are  friable,  and  ligature  risky,  haemo- 
stasis is  safe.  Jacobs  used  haemostatic  clamp 
forceps,  and  indicated  their  use  in  various  cases 
of  ovarian  cystoma  and  pan-hysterectomy,  as 
well  as  in  appendicectomy  and  resection  of  the 
omentum,  (c)  He  had  then  (August,  1899)  per- 
formed six  abdominal  hysterectomies  and  two- 
ovariotomies,  besides  other  operations,  without 
an  accident,  and  Skene  over  two  thousand  coelio- 
tomies  without  any  haemorrhage.     The  strength 


(a)  Shown  at  the  British  GynsMoIovical  Society,  Jane  9th.  1901 

(b)  JSU9U4  d*  0y»„  Julj-Auffust,  1-W.  — __ 

(c)  "  Diseases  of  Women  and   Uterine    Therapeutics."    BgMh 
Edition.    Macnaughton-Jooes.    1900. 


June  29,  1904. 


ORIGINAL  COMMUNICATIONS.         The  Medical  Peess.    685 


of  the  current  in  Jacob's  instrument  was  regu- 
lated by  the  interposition  of  a  galvanometer,  the 
time  necessary  for  the  desiccation  being  from 
one-half  to  two  minutes.  The  main  improvements 
aimed  at  by  Dr.  Downes  were,  the  ability  to 
raise  the  heating  points  to  2i2°F.,  the  insuring 
cool  shafts  and  handles  to  the  instrument,  greater 
security  in  the  construction  of  the  blades  for 
resistance  to  heat,  and  increase  in  the  degree  of 
pressure  exerted.  The  outfit  consisted  of  three 
angiotribes  with  blades  of  different  widths 
(0*25,  0*5  and  o*6  of  an  inch),  one  of  them 
being  curved  ;  a  shield  to  protect  the  surrounding 
parts  ;  a  cautery  knife,  cable,  and  coupler  cable  ; 
the  transformer  for  use  with  the  continuous  or 
the  alternating  current,  and  the  necessary  electric 
supply.  A  maximum  current  of  sixty  amperes 
is  necessary,  and  in  all  the  instruments  the 
platinum  has  to  be  of  the  same  weight.  The 
advantage  of  this  high  amperage  is  that  the  blades 
heat  more  rapidly  and  effectually  than  with  a 
weaker  current,  while  there  is  less  risk  of  burning 
out  the  platinum.  The  cable  is  composed  of 
mineral  and  rubber,  and  will  stand  indefinite 
boiling,  while  it  can  be  made  in  two  portions,  so 
that  the  coupler  alone  need  be  sterilised  for  each 
operation. 

Dr.  Macnaughton- Jones  here  showed  the  section 
of  the  heating  blade  of  the  electro-haemo- 
static angiotribe.  The  inner  surface  of  the 
blade  is  made  of  steel,  and  inside  the  blade  are 
two  layers  of  mica,  completely  insulating  the 
platinum.  The  handle  is  connected  with  the 
transformer  of  the  storage  battery.  On  releasing 
the  lever,  the  handles  spring  open.  On  reclosure, 
when  the  lever  is  adjusted  greater  pressure  is 
exerted  on  the  blades.  There  is  a  less  powerful 
angiotribe  without  the  lever.  Dr.  Downes  has 
devised  a  breaker  for  the  control  of  the  current, 
so  that  it  may  be  turned  on  when  required  by 
pressure  of  the  foot.  To  heat  the  instruments  all 
that  is  necessary  is  to  turn  on  the  rheostat  of 
the  transformer  gradually,  until  the  platinum  in 
the  cautery  knife  is  a  bright  red.  The  transformer 
may  be  set  at  this  point  in  the  operating  room, 
thus  securing  the  necessary  electrical  supply  by 
pressure  of  the  foot  at  the  required  time.  Water 
placed  on  the  pressing  surface  of  the  blades  will 
boil  in  from  ten  to  fifteen  or  twenty  seconds, 
according  to  the  width  of  the  blade.  From  ten 
to  thirty  seconds  longer  must  be  allowed  after 
the  application  of  the  instrument  for  the  haemo- 
stasis.  (a)  In  the  latest  reprint  of  his  pamphlet  on 
the  subject,  Dr.  Downes  enters  into  details  of 
operations,  such  as  ovariotomy,  salpingo-odphor- 
ectomy,  herniotomy,  appendicectomy,  and 
various  operations  on  the  stomach  and  intestines, 
which  may  be  performed  by  this  method,  and 
also  describes  its  application  in  abdominal  and 
vaginal  hysterectomy.  He  has  collected  the 
particulars  of  eighty  hysterectomies,  sixteen  of 
which  were  for  cancer,  200  salpingo-odphorec- 
tomies,  one  nephrectomy,  200  appendicectomies, 
and  twenty  ovariotomies  for  cystomata.  Among 
others  who  had  specially  written  on  haemostasis  he 
mentioned  Hirst  and  Charles  Noble,  of  Phila- 
delphia, Bovee,  of  Washington,  Goldspohn  and 
Murphy,  of  Chicago.  He  (Dr.  Macnaughton- 
Jones)  had  no  personal  experience  of  this 
method'  as  he  had  never  adopted  it,  but 
the   results,  reported   by    a    number   of    opera- 


la)  Anur.  Med.,  No.  2*,  Nor.  28th,  IWS ;  Amer.Vwn.,  Only,  1963. 


tors,  proved  it  to  be  one  which  can  be 
followed  with  perfect  safety.  "  Intestinal  re- 
section and  anastomosis,"  says  Dr.  Downes,  "  by 
these  instruments  can  be  ideal,"  and  he  (Dr. 
Downes)  "  had  yet  to  hear  of  haemorrhage  after 
an  operation  in  which  these  instruments  had 
been  used."  At  the  time  of  writing  (November, 
1903)  the  only  accident  that  he  was  aware  of 
was  the  clamping  of  the  right  ureter  during  a 
hysterectomy  for  cancer,  an  operation  in  which  he 
himself  assisted.  He  has  operated  upon  moribund 
cases,  and  during  sixteen  months  he  had  but  one 
death  in  which  his  appliances  were  used,  and  that 
was  unconnected  with  the  method  of  operation. 

TTbe  ftawetan  ©ration. 


EGYPTIAN    VIEWS    OF  THE 
CIRCULATION,  (a) 

By  RICHARD  CATON,  M.D.,  M.R.C.P., 
Consulting  Physician,  Liverpool  Royal  Infirmary. 

After  a  brief  reference  to  recent  benefactions  made 
to  the  College  for  the  advancement  of  medical  science, 
the  Orator  proceeded  to  describe  some  results  of  an 
inquiry  into  the  earliest  records  of  medicine  in  ancient 
Egypt*  particularly  as  regards  the  circulation  of  the 
blood  and  diseases  of  the  circulation : — 

The  information  which  archaeological  research  has 
of  late  afforded,  though  in  a  fitful  and  partial  manner, 
as  to  the  earliest  history  of  medicine,  and  particularly 
in  regard  to  that  department  in  which  our  founder 
laboured,  is  not  unworthy  of  our  attention. 

The  first  evidence  of  definite  inquiry,  in  any  degree 
worthy  to  be  called  scientific,  by  a  body  of  men  specially 
educated  for  medical  service  occurs  in  the  early  history 
of  Egypt.  The  ability,  learning,  and  artistic  skill 
shown  during  the  early  dynasties,  which  all  Egypto- 
logists recognise,  is  paralleled  by  the  remarkable 
interest  then  manifested  in  medicine.  Works  on 
anatomy  and  medicine  are  stated  to  have  been  written 
even  by  the  early  sovereigns  of  Egypt.  At  ho  this,  the 
son  of  Menes,  who  lived  6,000  years  ago,  is  stated  in 
the  Berlin  papyrus  to  have  written  a  book  on  medicine, 
and  I  shall  soon  have  to  quote  from  the  anatomical 
writings  of  the  Pharaoh  Usaphais,  one  of  his  successors. 
Semti,  the  seventh  monarch  of  the  same  dynasty, 
pursued  similar  investigations.  It  is  clear  that  like 
the  Greeks,  these  men,  in  the  childhood  of  the  world, 
believed  that  sanitation  was  the  first  of  the  sciences. 
Thb  Medicine  God,  I-em-hotep. 

During  the  third  dynasty,  about  the  year  4000  b.c. 
there  lived  a  learned  physician,  probably  a  priest  of 
Ra,  the  sun-god,  the  founder  of  a  cult,  whose  eminence 
was  such  that  in  course  of  ageshewasdeified,  and  became 
for  later  generations  the  special  god  of  medicine.  His 
temples  were  places  of  healing  for  the  people.  His 
name  is  I-em-hotep,  meaning  "  he  who  cometh  in 
peace."  According  to  ancient  inscriptions  he  was  the 
son  of  a  certain  architect  named  Kanofer,  but  when 
raised  in  popular  esteem  to  the  rank  of  a  demi-god 
he  is  called  the  son  of  the  supreme  god  Ptah,  the 
Hephaistos  of  Egypt}  and  he  becomes  one  of  the  great 
god-triad  of  Memphis.  I-em-hotep  is  described  as  the 
good  physician  of  gods  and  man,  a  kind  and  merciful 
god,  assuaging  the  sufferings  of  those  in  pain,  healing 
the  diseases  of  men,  giving  peaceful  sleep  to  the  restless 
and  suffering  ;  he  is  called  the  creative  god  who  giveth 
life  to  all  men,  who  comes  unto  them  who  call  upon 
him  in  every  place,  and  who  gives  sons  to  the  childless. 
He  was  great  in  magic  and  all  learning.  He  and  his 
followers  had  to  do  with  the  embalming  of  the  body, 
and  he  protected  the  soul  of  the  dead  man  from  all 
spiritual  enemies  after  it  had  left  the  body.  In  the 
ritual  of  embalmment  the  dead  man  was  encouraged  by 
these   words:    "  Thy  soul  united  itself  to  I-em-hotep 

(a)  Abstract  of  Address  delivered  before  the  Royal  College  of 
Physicians,  London,  June  20th,  1904. 

D 


686    The  Medical  Press. 


ORIGINAL  COMMUNICATIONS. 


June  29,  1904. 


while  thou  art  in  the  funeral  valley,  thy  heart  rejoiceth 
because  thou  dost  not  go  into  the  dwelling  of  Sebek, 
but  thou  art  like  a  son  in  the  house  of  his  father." 

From  the  testimony  of  temple  inscriptions  and 
papyri,  as  well  as  from  the  writings  of  Manetho,  it  is 
clear  that  the  first  temple  of  the  medicine  god  I-cm- 
hotep  was  established  in  early  times  at  Memphis, 
and  there  his  priests  carried  on  the  work  of  healing ; 
similar  temples  were  also  erected  elsewhere.  I-em- 
hotep  was  represented  in  art  as  a  bald-headed  man, 
usually  in  a  sitting  posture,  bearing  on  his  knees  an 
open  papyrus  scroll,  and  holding  in  his  hand  the 
symbol  of  life.  As  the  centuries  and  millenniums 
passed  on,  his  cult  seems  to  have  become  more  and 
more  popular.  In  later  times,  when  Greek  colonists 
appeared  in  Egypt,  they  gave  him  the  name  Imouthes, 
and  applied  to  his  temples  the  Greek  term  Asklepieia. 
clearly  regarding  him  as  alike  in  kind  to  the  Greek 
Asklepias,  and  his  temples  as  hospitals  for  the  sick. 
The  great  temple  stood  outside  the  eastern  wall  of 
Memphis  close  to  the  serapium.  Some  of  us  who  are 
present  to-day,  when  visiting  the  site  of  the  temple  of 
I-em-hotep,  have  naturally  been  impressed  by  the 
thought  that  on  this  spot,  long  before  Asklepias  or 
Hippocrates,  commonly  called  the  father  of  medicine, 
were  born,  probably  before  the  Homeric  poems  were 
written,  before  the  Israelites  were  in  Egypt,  before  the 
Stone  Age  had  passed,  learned  men  devoted  themselves 
to  the  consideration  of  the  nature  of  human  life,  strove 
to  prolong  it,  to  assuage  suffering  and  to  cure  disease. 
They  studied  and  treated  many  of  the  ailments 
familiar  to  us,  such  as  tubercle,  leprosy,  plague,  anaemia, 
and  other  diseases  prevalent  in  Egypt  to-day. 

Near  the  site  of  this  temple,  securely  sealed  in  an 
earthen  vessel  which  had  been  hidden  in  the  sand, 
was  found  one  of  the  medical  papyri  from  which  I 
shall  quote  some  passages.  Doubtless  it  belonged 
to  an  early  physician  who  sought,  perhaps  during  the 
invasion  of  Ethiopian  or  other  barbarians,  to  preserve 
for  mankind  the  precious  knowledge  that  seemed  in 
danger  of  extinction. 

Autopsies  made  by  the  Egyptian  Priests. 

It  is  of  some  interest  to  note  that  these  priests  of 
I-em-hotep,  themselves  learned  men,  not  only  saw 
and  prescribed  daily  for  vast  numbers  of  sick  persons, 
but  also  performed  innumerable  autopsies.  They 
removed  the  heart,  large  blood-vessels,  viscera,  and 
brain  from  the  bodies  of  deceased  persons,  also  from 
the  bodies  of  sacred  animals,  prior  to  embalmment ; 
the  heart  was  placed  in  a  separate  jar,  the  remainder 
of  the  viscera  in  a  larger  vessel ;  thus  these  men  had  an 
opportunity  of  learning  something  of  anatomy ;  they 
may  have  gained  some  insight  into  the  intricate  pro- 
blem of  the  action  of  the  heart,  the  movement  of  the 
blood,  and  the  changes  of  heart  and  vessels  produced 
by  disease ;  no  nation  of  antiquity  had  such  oppor- 
tunities. Did  they  discover  anything  ?  I  think  I 
can  demonstrate  to  you  they  did  obtain  a  partial 
knowledge  of  the  circulation ;  they  did  not  solve  the 
problem,  but  they  approached  it  as  nearly  as  did  the 
Greeks,  and  probably  from  them  the  Greeks  obtained 
such  knowledge  as  they  possessed  in  early  times. 
References  to  the  Circulation  in  the  Medical 
Papyri. 

Certain  of  the  contents  of  the  medical  papyri  are  at 
present  almost  incomprehensible  on  account  of  the 
difficulty  of  translating  technical  terms;  these  parts 
I  shall  not  refer  to  at  all ;  those  portions  which  are 
more  easily  understood  still  present  difficulties,  and 
translations  must  necessarily  be  free,  and  at  times 
vague.  Where  the  sense  is  important  I  have  had  the  help 
of  one  or  two  of  the  most  learned  living  Egyptologists, 
and  here  I  must  express  my  acknowledgments  to 
Dr.  Budge,  Professor  Kurt  Sethe,  Dr.  Brugsch,  Dr. 
Joachim,  Dr.  Leemans,  Dr.  Withington,  Dr.  Sand- 
wich, Mr.  Gars  tang,  Professor  Carrington  Bolton,  and 
others,  for  help  orally  or  from  their  writings,  without 
which,  in  my  ignorance,  I  should  have  done  little. 
Let  me  read  you  one  or  two  extracts  from  the  work  of 
the  Pharaoh  Usaphais,  quoted  in  Ebers'  papyrus  : 
"  Man  hath  twelve  vessels  proceeding  from  his  heart, 
which  extend  to  his  body  and  limbs ;    two  vessels  go 


to  the  contents  of  his  chest,  two  go  to  each  leg,  two 
to  each  arm,  two  vessels  go  to  the  back  of  the  head, 
two  to  the  front  of  the  head,  two  branches  go  to  the 
eyes,  two  to  the  nose,  two  vessels  go  to  the  right  ear, 
the  breath  of  life  goes  through  them,  two  go  to  the  left 
ear,  and  through  them  passes  the  breath  of  death, 
they  all  proceed  from  the  heart."     The  concluding 
sentence  is  the  earliest  example  I  know  of  the  ancient 
superstition  that  the  left  side  of  the  body  is  sinister 
and  evil.     This  is  very  early  anatomy,  professing  to 
be  at  least  6,000  years  old  ;   we  must  not  expect  it  to 
be  quite  accurate.     Turning  to  a  comparatively  recent 
period,    the   only   copy   existing   of   Ebers'    papyrus 
(found  in  the  tomb  at  Thebes)  was  written  in  or  before 
the  sixteenth  century  B.C.     No  doubt  most,  if  not  all, 
its  contents  are  much  older  than  that  date  ;  the  passage 
which  I  am  about  to  read  commences  thus :  "  From 
the  secret  book  of  the  physician,  a  description  of  the 
action  of  the  heart  and  of  the  heart  itself.     From  the 
heart  arise  the  vessels  which  go  to  the  whole  body; 
if  the  physician  lays  his  finger  on  the  head,  on  the 
neck,  on  the  hand,  on  the  epigastrium,  on  the  arm  or 
the   leg,   everywhere  the  motion  of  the  heart  touches 
him,  coursing  through  the  vessels  to  all  the  members 
(the  reference  is  clearly  to  the  pulse) ;    thus  the  heart 
is  known  as  the  centre  of  all  the  vessels.     Four  vessels 
go  to  the  nasal  chambers,  of  which  two  convey  mucus 
and  two  convey  blood ;    there  are  four  vessels  within 
the  skull,   from   these   the  eyes  obtain   their  blood. 
The  four  vessels  divide  inside  the  head  and  spread 
towards  the  hinder  part."     The  Berlin  papyrus  speaks 
of  the  division  into  thirty- two  vessels  within  the  skull, 
and  implies  that  air  traverses  at  any  rate  some  of  them. 
Returning  to  Ebers'  papyrus  :  "  When  the  breath  enters 
the  nostrils  it  penetrates  to  the  heart  and  to  the  in- 
ternal organs  and  supplies  the  whole  body  abundantly." 
This  idea  that  certain  of  the  vessels  convey  air,  you 
will  observe,  is  identical  with  the  Greek  conception  and 
probably   with   its   source.     "  Three   vessels   traverse 
the  arms  and  extend   to   the  fingers ;     three  vessels 
also  pass  down  the  leg  and  are  distributed  to  the  sole 
of  the  foot ;  a  vessel  goes  to  each  testis,  and  one  to  each 
kidney.     Four    vessels    enter    the    liver,    conveying 
fluid  and  air  ;  these  may  be  the  seat  of  various  diseases, 
as  they  are  mixed  with  the  blood  ;  four  vessels  convey 
fluid  and  air  to  the  intestine  and  spleen,  two  go  to  the 
bladder,  and  from  them  the  renal  secretion  is  produced. 
Four  vessels  convey  fluid  and  air  to  the  lower  abdomen, 
going  to  the  right  and  left  sides  ;   from  them  is  formed 
the  alvine  excretion."     These  vessels  here  described 
are  clearly  the  iliac  arteries  and  veins.     "  When  the 
heart  is  diseased  its  work  is  imperfectly  performed; 
the  vessels  proceeding  from  the  heart  become  inactive, 
so  that  you  cannot  feel  them  "  (no  doubt  this  is  a 
reference   to  changes  in  the  pulse).     "  They  become 
full  of  air  and  water.     When  the  heart  is  dilated  the 
vessels  from  it  contain  effete  matter.     If  a  suppurative 
or  putrefactive  disease  occur  in  the  body  (abscess  is 
probably  referred  to)  then  the  heart  causes  it "  (ap- 
parently the  purulent  material)  "  to  traverse  the  vessels; 
lever  or  inflammation  of  various  kinds  occur   in  the 
body,  the  heart  is  in  a  morbid  state  while  the  fever  con- 
tinues. In  heart  disease  there  is  either  disturbance  of  the 
action  of  the  heart,  or  the  heart  is  congested  or  over- 
filled with  blood  ;    the  heart  is  moved  downwards, 
comes  nearer  the  pnecordia,  and  suffers  weakness  and 
nausea.     When  the  disease  affects  the  base  or  lower 
mass  of  the  heart  there  is  shortness  of  breath,  the  heart 
is  displaced  on  account  of  the  volume  of  blood  from  the 
abdomen  "  (probably  the  old  idea  of  the  rush  of  blood 
entering  the  heart  from  the  liver).     "  There  may  be 
fever  or  inflammation  of  the  heart."     Now  here  comes 
a  passage  of  some  therapeutic  interest:     "The  heart 
during  such  disease  must  be  made  to  rest  to  some  extent, 
if  it  be  possible."     Here  we  have  wise  advice  from  the 
ancient  Egyptians,  advice,  the  importance  of  which  we 
have  scarcely  as  yet  recognised,  and  which  we  may 
to-day    follow    with    advantage.     "  If    the    heart   is 
atrophied  (or  wastes  itself)  there  will  be  an  accumulation 
of  blood  within  it.     When  the  disease  of  the  substance 
of  the  heart  is  accompanied  by  dropsy  there  is  a  lessen- 
ing (in  strength  probably)  in  the  ventricle  or  cavity ; 


June  20,  1904. 


ORIGINAL  COMMUNICATIONS.         The  Mmwcal  Press.    687 


when  the  weakness  of  the  heart  is  due  to  old  age  there 
is  dropsy.  When  there  is  raising  or  increase  of  the 
heart  it  presses  towards  the  left  side  ;  it  is  increased  by 
its  own  fat  and  is  displaced ;  there  may  be  much  fat 
contained  within  its  covering  or  pericardium.  If  it  is 
suppurative  disease  the  heart  is  pushed  forward,  it 
floats  or  sinks  in  the  fluid  and  is  misplaced."  Here 
we  surely  have  a  reference  to  pericardial  effusion. 
"  If  the  heart  trembles  or  palpitates,  has  little  power, 
and  sinks  downwards,  the  disease  is  advancing.  When 
there  is  much  beating  at  the  praecordia,  with  a  feeling 
of  weight,  when  the  mouth  is  hot  and  languid  and  the 
heart  is  exhausted,  the  disease  is  a  fever  or  inflamma- 
tion." In  another  place  (folio  102),  the  heart  is  spoken 
of  as  being  full  of  blood  which  comes  or  flows  from  it 
again.  In  folio  39,  after  a  description  of  symptoms, 
follows  a  statement  to  the  effect  that  the  heart  is  dis- 
tended, the  sick  man  is  short  of  breath,  "  because  the 
blood  has  stagnated  and  does  not  circulate."  This  is 
an  interesting  expression,  but  judging  from  other  parts 
of  the  papyrus,  the  word  translated  "  circulate  "  can 
only  have  a  vogue  meaning,  implying  movement  to 
and  fro,  just  like  the  expression  "  periodic  blood  " 
in  the  Hippocratic  writings,  which  seems  to  imply  the 
circuit  of  the  blood,  but  in  reality  has  only  a  similar 
indefinite  meaning.  It  is  evident  that  the  Egyptians 
knew  that  blood  flowed  from  the  heart,  but,  like  the 
Greeks,  they  never  seem  to  have  realised  that  the  heart 
is  a  pump,  nor  did  they  recognise  valves. 

The  Leyden  medical  papyrus  speaks  of  a  paralysis 
or  disturbance  of  some  sort  in  the  blood-vessels  of  the 
head,  causing  blindness  and  disorder  in  the.  body  and 
in  the  limbs ;  this  seems  to  be  a  description  of  the 
results  of  cerebral  haemorrhage.  Remedies  are  sug- 
gested to  subdue  the  vascular  activity  occurring  in 
certain  diseases.  The  various  papyri  from  which  I 
quote  deal,  of  course,  with  practical  medicine,  and 
not  with  physiology.  No  distinct  definition  as  to 
structure  or  function  is  to  be  looked  for  in  them. 
Only  as  associated  with  diagnosis,  prognosis  or  treat- 
ment do  we  get  statements  as  to  the  nature  of  the 
heart,  the  vessels,  and  the  movement  of  the  blood. 
Importance  of  Medicine  and  Sanitation  of 
Ancient  Egypt. 
It  is  clear  from  the  study  of  these  medical  papyri 
that  medicine  advanced  considerably  among  the 
Egyptians,  and  from  them  medical  and  sanitary 
knowledge  has  descended  to  us  by  two  channels,  namely, 
by  the  Greeks  and  through  the  Jewish  race,  while 
probably  much  of  it  was  lost  irrevocably.  Josephus 
quotes  from  Manetho  a  statement  that  Osarsiph, 
who,  Josephus  says,  was  the  great  Hebrew  leader 
Moses,  was  a  priest  at  Heliopolis,  where  medicine  was 
taught.  It  is  highly  probable  that  the  sanitary  laws 
of  the  Jews  were  derived  from  the  Egyptians.  Just 
as  the  Jews  remembered  the  diseases  of  Egypt  (Deut. 
xxviii,  60),  so  they  also  remembered  the  sanitary  and 
remedial  measures  they  had  learnt  there.  Those  of 
us  who  have  seen  in  the  later  excavations  at  Knossos 
the  evidences  of  sanitary  knowledge  of  a  somewhat 
high  type  possessed  by  the  Cretans,  and  exemplified 
among  other  things  by  drainage  pipes,  scarcely  excelled 
by  the  best  of  our  own  to-day,  Knowing  as  we  do  the 
close  connection  between  Crete  and  Egypt,  may 
well  believe  that  there  we  have  an  example  01  sanitation 
derived  from  Egyptian  sources. 

In  England  we  have  overlooked  the  importance  of 
Egypt  as  a  primary  source  of  the  science  and  art  of 
medicine.  If  we  regard  with  reverence  the  dim 
traditional  form  of  Asklepias  as  a  founder  of  our  art, 
and  the  Asklepieia,  where  throughout  Greece  and 
Magna  Grecia  medicine  was  practised  and  taught, 
in  greater  degree  should  we  reverence  the  much  more 
venerable  I-em-hotep,  and  view  with  interest  the 
primeval  medicine  temples  and  hospitals  of  Egypt. 
In  the  ancient  writings  of  the  pseudo-Apuleius,  Hermes 
is  described  as  speaking  to  the  youthful  Asklepias  as 
follows,  "  Thine  ancestor,  the  first  discoverer  of 
medicine,  hath  a  temple  consecrated  to  him  in  the 
Libyan  mountains  near  the  Nile,  where  his  body  lies, 
while  his  better  part,  the  spiritual  essence,  hath  returned 
to  the  heavens,  whence  he  still,  by  his  divine  power, 


helps  feeble  men,  as  he  formerly  on  earth  succoured 
them  by  his  art  as  a  physician." 

Probably  many  of  the  present  audience  have  seen 
in  the  Cairo  museum  the  sepulchral  stole  of  Shemkhet- 
nankh,  a  great  physician  of  the  fifth  dynasty,  who  was 
contemporary  with  King  Sahara,  and  who  is  described 
in  the  stole  as  the  principal  physician  of  the  Royal 
Hospital.  His  name,  which  is  doubtless  a  title  given 
to  him  by  the  monarch,  means  "  he  who  possesses 
the  things  that  give  life."  It  is  interesting  to  find 
that  five  thousand  years  ago  a  hospital  should  exist, 
associated  with  and  under  the  patronage  of  the 
Pharaoh,  and  having  its  own  staff  of  physicians. 
And  it  is  manifest  that  our  calling  held  a  distinguished 
position  at  the  time  when  art  and  learning  in  Egypt 
were  at  their  zenith. 

Testimonies  as  to  I-em-hotep. 

I-em-hotep  rises  before  us  as  one  of  those  intellectual 
giants  who  take  all  knowledge  for  their  province. 
In  his  comprehensiveness  he  surpasses  Leonardo  da 
Vinci,  or  our  own  Linacre ;  he  is  distinguished  as  a 
physician,  a  minister  of  the  King,  a  priest,  a  writer, 
an  architect,  an  alchemist,  and  an  astronomer — great 
in  all,  but  greatest  in  medicine,  in  the  view  of  Egypt 
he  is  a  god. 

In  the  reign  of  Tosorthros,  of  the  third  dynasty, 
some  six  thousand  years  ago,  we  meet  with  the  wise 
I-em-hotep  in  an  inscription  describing  the  seven  years 
of  famine  which  befell  Egypt  in  consequence  of  a 
succession  of  low  Niles,  He  is  there  the  adviser  of 
Pharaoh,  to  him  the  King  applies  in  his  trouble  for 
counsel  and  help. 

In  the  inscriptions  in  the  temple  of  Edfu  he 
is  described  at  length  as  the  great  priest  I-em- 
hotep,  the  son  of  Ptah,  who  speaks  or  lectures. 
Perhaps  his  discourses  or  lectures  were  on  medi- 
cine ?  Elsewhere  he  is  described  as  the  writer 
of  the  divine  books.  It  may  here  be  remarked  that 
probably  Ebers'  papyrus  was  one  of  the  six  divine 
books  attributed  to  Thoth  ceremonially,  but  not 
improbably  in  large  part  the  work  of  I-em-hotep. 
Manetho,  while  speaking  of  his  eminence  as  a  physician, 
refers  to  him  also  as  an  architect,  the  first  to  build  with 
hewn  stone.  Not  improbably  he  built  the  step 
pyramid  of  Sakkara,  the  tomb  of  his  patron  Tosorthros. 
Manetho  also  suggests  that  I-em-hotep  improved  and 
completed  the  hieroglyphic  script  of  Egypt.  In  the 
Hermetic  literature  he  is  famed  for  his  knowledge  of 
astronomy  or  astrology.  The  Westcar  papyrus  des- 
cribes him  further  as  an  alchemist  and  magician. 
These  powers  were  always  associated  with  medicine, 
and  even  to-day  in  the  popular  view  are  not  entirely 
dissociated  from  it. 

What  share  I-em-hotep  may  have  had  m  these 
early  discoveries  of  the  movement  of  the  blood  we 
do  not  know.  It  doe^s,  however,  seem  clear  that  the 
Egyptians  had  discovered  certain  elementary  facta 
and  knew  as  much  as  the  Greeks,  as  much  as  we  find 
in  the  Hippocratic  writings,  or  in  those  of  Aristotle  and 
the  later  Alexandrian  school,  and  the  hypothesis 
seems  a  natural  one  that  the  knowledge  possessed  by 
the  Greeks  was  acquired  from  Egypt. 
Methods  Employed  by  the  Egyptian  Physicians. 

I  may  mention  in  passing  that  although  the  medical 
papyri  which  have  come  down  to  us  are  no  doubt 
only  an  insignificant  fraction  of  those  possessed  by 
the  Egyptians,  we  nevertheless  find  in  them  abundant 
reference  to  medicine  and  surgery.  In  the  Kahun 
papyrus  obstetrics  is  dealt  with.  Gynaecology,  also 
ophthalmology,  materia  medica,  and  dentistry,  are 
dealt  with  in  others,  and  even  veterinary  medicine 
was  treated  of  in  a  papyrus,  a  fragment  of  which  was 
found  by  Professor  Flinders  Pefrie. 

As  regards  materia  medica,  the  Egyptians  possessed 
the  following  drugs  : — Lactuca,  various  salts  of  lead, 
such  as  the  sulphate,  with  the  action  of  which  in  allaying 
local  inflammation  they  were  well  acquainted ;  pome- 
granate and  acanthus  pith  as  vermifuges,  peppermint, 
sulphate  and  acetate  of  copper,  oxide  of  antimony, 
sulphide  of  mercury,  petroleum,  nitrate  of  potash, 
castor  oil,  opium,  coriander,  absmthe,  juniper*  (much 
used  as  a  diuretic),  carraway,  lotus,  gentian,  mustard. 


688    The  Medical  Tress.         TRANSACTIONS  OF  SOCIETIES. 


June  29,  1904. 


ox-gall,  aloes,  garlic,  and  various  bitter  infusions ; 
mandragora,  linseed,  squills,  saffron,  resin,  and  various 
turpentine  products  ;  cassia,  certain  species  of  cucumis, 
cedar  oil,  yeast,  colchicum,  nasturtium,  myrrh, 
tamarisk,  powdered  lapis  lazuli, .  vinegar,  indigo ; 
the  oasis  onion,  mastic  and  various  gums,  mint,  fennel, 
hebanon  or  hyoscyamus,  magnesia,  sebeste  (a  tonic 
and  a  cough  medicine),  lime,  soda,  iron  and  a  great 
number  of  other  agents,  the  names  of  which  no  one 
can  at  present  translate. 

Surgical  instruments  and  the  actual  cautery  were 
in  use,  also  steam  inhalations,  massage,  ointments, 
plasters,  poultices,  suppositories,  injections  and 
emetics ;  and  the  importance  of  temperature  in  disease 
was  recognised  to  some  extent. 

Prescriptions  were  written  out  in  due  form,  and 
sometimes  at  great  length,  fully  equalling  those  of  the 
most  enthusiastic  therapeutist  of  our  own  day.  The 
longest  prescription  I  have  read  contained  thirty-five 
ingredients.  To  read  it  was  a  formidable  task,  though 
preferable  to  taking  it.  Some  prescriptions  are  wise 
and  rational,  a  few  strange  and  repulsive,  some  asso- 
ciated with  charms  and  spells.  Human  nature  is 
the  same  in  all  ages,  hence  one  was  not  surprised  to 
meet  with  hair  invigorators,  hair  dyes,  cosmetics, 
pain  killers,  insect  powders,  and  a  soothing  syrup, 
containing  opium,  for  small  children,  in  use  3,500  years 
ago.  It  was  rather  interesting  to  find  that  the  symbol 
for  a  i  tenat,  often  used  in  their  prescriptions,  is 
identical  with  that  indicating  a  drachm  with  us, 
though  the  amounts  are  not  the  same.  I  trust  the 
drachm  will  soon  be  as  obsolete  as  the  tenat. 


{Transactions  of  Societies. 


OTOLOGICAL    SOCIETY    OF    THE    UNITED 
KINGDOM. 
Meeting  Held  Saturday,  May  21st. 


Dr.    Thomas    Barr,    President,    in 


1904. 
the    Chair. 


The  extra-metropolitan  meeting  of  this  Society  was 
held  at  the  rooms  of  the  Faculty  of  Physicians  and 
Surgeons,  Glasgow. 

THE     DEVELOPMENT     OF     THE     MASTOID     AND     THE 
TYMPANIC    PLATE. 

One  of  the  chief  points  in  this  interesting  demon- 
stration by  Professor  Cleland  was  that  the  external 
surface  of  the  mastoid  was  not — as  generally  described — 
formed  by  a  descending  plate  of  the  squama.  The 
so-called  "  squamo-mastoid  suture  "  was  caused  by  the 
entrance  of  branches  of  the  posterior  auricular  artery 
into  the  mastoid  bone. 

CASE  OF  OTITIC  CEREBELLAR  ABSCESS,  IN  WHICH 
ABSENCE  OF  MASTOID  ANTRUM  FROM  PATHOLOGICAL 
CHANGES    WAS    OBSERVED.  * 

Notes  of  this  case  were  read  by  Dr.  Peter  McBride. 
At  the  autopsy,  in  addition  to  the  cerebellar  abscesses, 
pus  was  found  over  the  tegmen  and  a  small  abscess  in 
the  occipital  lobe.  Owing  to  an  apparent  improve- 
ment following  the  mastoid  operation,  the  brain  was 
not  explored  during  life,  though  another  operation  had 
been  arranged  for  the  day  on  which  death  took  place. 

The  case  was  discussed  by  Prof.  Urban  Pritchard. 
Drs.  Kerr  Love  and  Tilley,  and  Messrs.  Cheatle,  Hugh 
Jones,  and  Ballance.  The  general  opinion  was  that 
in  health  an  antrum  of  some  kind  was  always  present, 
but  that  after  long-standing  osteitis  it  might  be  almost 
entirely  obliterated. 

SECTION   OF  THE  EIGHTH  NERVE   FOR  SEVERE  TINNITUS 
AURIUM. 

Dr.  R.  H.  Parry  said  that  he  undertook  this  opera- 
tion after  clearly  explaining  to  the  patient  that  it  was 
to  be  regarded  as  experimental,  and  after  the  patient 
had  declined  all  minor  operations.  The  ordinary 
methods  of  treatment  had  been  tried  without  avail  by 
several  aural  surgeons.  The  internal  auditory  meatus  was 
reached  by  turning  down  a  bone  flap  immediately  over 
the  ear,  separating  the  dura  over  the  anterior  surface  of 
the  petrous  bone  and  chiselling  into  the  meatus.  The 
result  showed  partial  relief  from  tinnitus  and  complete 
deafness  on  that  side  and  absence  of  vertigo.     Facial 


paralysis  was  caused,  and  for  this  the  operation  of 
facial-accessory  anastomosis  was  performed  with  the 
usual  result. 

Mr.  Ballance  thought  it  was  easier  to  reach  the 
nerve  vid  the  cerebellar  fossa,  and  without  stripping  up 
the  dura.  He  preferred  hypoglossal  anastomosis 
for  facial  palsy,  owing  to  the  centres  being  more  nearly 
related  and  the  associated  movements  being  less 
troublesome.  The  paper  was  also  discussed  by  Dr. 
Kerr  Love,  Mr.  Yearsley,  and  the  President. 

Mr.  Richard  Lake  reported 

A  SUCCESSFUL  CASE  OF  REMOVAL  OF  ALL  THE  SEMI- 
CIRCULAR CANALS  ON  ONE  SIDE  FOR  THE  RELIEF  OF 
VERTIGO. 

There  was  considerable  shock  lasting  for  one  hour  after 
operation.  Cerebral  irritation,  nystagmus  and  in- 
ability to  turn  to  one  side  lasted  for  a  few  days.  In 
four  weeks  the  patient  could  do  anything  without  fear 
of  falling.  Fourteen  weeks  had  now  elapsed  since  the 
operation  and  there  had  been  no  return  of  the  vertigo. 
Tinnitus  was  not  affected  by  this  operation. 

The  President,  Mr.  Cheatle,  and  Dr.  Milligan  con- 
gratulated Dr.  Lake  on  the  brilliant  result.  Dr. 
Milligan  had  performed  the  operation  three  times  with 
one  partial  and  one  complete  success. 

INDICATIONS  FOR  OPERATIVE  INTERFERENCE  UPON  THE 
LATERAL  SINUS  AND  INTERIOR  JUGULAR  VEIN  WITH 
ILLUSTRATIVE  CASES. 

Dr.  Nicholl,  in  this  paper,  classified  the  operations 
as  follows  :— (1)  Obliteration  of  the  sinus  (a)  on  account 
of  some  involvement  of  the  walls  or  contents  of  the 
sinus  itself ;  (b)  on  account  of  some  affection  of  the 
jugular  vein.  (2)  Ligation  with  or  without  excision  of 
the  vein  (a)  on  account  of  some  affection  of  the  vein 
itself — (i)  Wound  of  the  vein  ;  (ii)  to  facilitate  removal 
of  cervical  glands ;  (6)  Disease  or  injury  of  the  sinus. 
(3)  Ligation  of  the  vein  as  a  preliminary  to  some 
mastoid  operations  (a)  where  cervical  glands  are 
enlarged  (tuberculous),  (b)  where  disease  probably  ex- 
tends to  the  sinus. 

Papers  by  Drs.  Brown  Kelly,  Galbraith,  Connal,  and 
Mr.  McLeod  Yearsley  were  held  over  for  want  of  time. 

The  following  cases  and  specimens  were  exhibited  :— 

The  President.  A  case  of  temporo-sphenoidal 
abscess  operated  on  by  Prof.  Macewen.     17  years. 

The  President  and  Dr.  J.  H.  Nicholl.  Cerebellar 
abscess  operated  on  by  Dr.  Nicholl  six  years  ago.  Case 
of  pulsating  tinnitus  unrelieved  by  ligation  of  vessels. 

The  President  and  Dr.  Connal.  Two  cases  of 
removal  of  large  exostosis  of  external  auditory 
meatus,  by  post -auricular  route. 

Dr.  Connal.  (a)  Acute  empyema  of  mastoid  with 
giddiness  and  vomiting.  (6)  Relief  of  facial  paralysis 
by  radical  mastoid  operation. 

Dr.  Brown  Kelly.  Cases  of  insufficiency  of  hard  and 
soft  palate. 

Dr.  W.  S.  Squire.  Radical  mastoid  operations. 
In  one  no  antrum  was  found  ;  in  the  other  packing 
was  discontinued  on  the  twelfth  day  with  good  result. 

Dr.  Fullerton.  Case  after  operation  for  cholestea- 
toma. 

Mr.  Cheatle.  Temporal  bones  showing  variations 
in  positions  of  antrum  and  jugular  fossa. 

Dr.  Kerr  Love.  Stereograms  illustrating  anatomy 
of  the  ear  and  nose. 

Edelmann's  continuous  tone  series.  Chart  of 
examination  of  thirty- three  deaf  mutes. 

Dr.  Albert  Gray.  Microscopic  and  macroscopic 
anatomical    preparations. 

Experiments  to  illustrate  recent  researches  on  the 
physical  nature  of  vowel  tones  and  their  bearing  on 
movements  of  the  tympanic  membrane.  In  the 
absence  of  Professor  McKendrick,  this  demonstration 
was  given  by  Dr.  Colquhoun. 

The  members  and  visitors  were  most  hospitably 
entertained  by  the  President  at  luncheon  and  dinner. 

A  meeting  of  the  Pathological  Society  of  London  will 
be  held  at  the  Lister  Institute,  Queensbury  Lodge, 
Elstree,  on  Saturday,  July  2nd,  in  the  afternoon.  A 
train  will  leave  St.  Pancras  at  1.50,  returning  from 
Elstree  at  6.23,  and  reaching  St.  Pancras  at  7  o'clock. 


June  29,  1904. 


FRANCE. 


Thh  Medical  Press.    6S9 


Special  articles. 


BRITISH    SANATORIA    FOR 
XLII. 


CONSUMPTION.— 


[by  our  special  medical  commissioner.] 


THE 


BROMPTON  SANATORIUM,  HEATHER- 
SIDE,  CAMBERLEY. 
The  new  sanatorium  and  convalescent  home  in 
connection  with  the  Brompton  Hospital  for  Consump- 
tion and  Diseases  of  the  Chest,  although  not  sufficiently 
complete  for  occupation,  was  formally  opened  by  Their 
Royal  Highnesses  the  Prince  and  Princess  of  Wales  on 
Saturday,  June  25th.  At  the  present  time,  for  the 
purpose  of  this  series  of  articles,  it  will  only  be  possible 
to  indicate  the  chief  structural  features. 

The  sanatorium  is  situated  on  the  Cobham  Ridges, 
in  Surrey,  400  ft.  above  sea  level,  30  miles  from 
London,  two  tniles  from  Frimley  Station,  and  three 
miles  from  Camberley.  The  grounds,  20  acres  in 
extent,  overlook  Frimley  Common,  and  afford  views 
of  Farnborough  and  Aldershot ;  and  on  the  horizon 
appear  the  Hog's  Back  and  the  heights  of  Crooksbury 
Ridges. 

The  buildings  are  surrounded  on  all  sides,  except  the 
south,  by  the  pine  woods  of  the  Heatherside  estate. 
These  pines,  which  are  of  several  varieties,  provide 
considerable  shelter  from  the  north  and  east  winds 
and  also  secure  shade  during  the  summer  heat. 

The  soil  is  of  gravel  and  sand,  belonging  to  the  upper 
Bagshot  series.  The  climate  is  said  to  be  dry,  sunny, 
and  bracing.  The  mean  rainfall  is  23  in.,  the  number 
of  rainy  days  183,  the  relative  humidity  82*8  per  cent., 
the  amount  of  clouds  7*4,  the  mean  annual  temperature 
48*6°  F.,  the  mean  maximum  $7'i9  F.,  and  the  mean 
minimum  40*5°  F.,  with  a  range  of  16*2°  F. 

The  sanatorium  has  been  two  years  in  construction. 
The  principal  portion  consists  of  a  two-storeyed  block 
of  stellate  form,  rising  into  three  storeys  in  the  central 
part.  The  buildings  have  much  the  form  of  a  St. 
Andrew's  cross.  The  central  portion  is  mainly  adminis- 
trative, and  includes  board  and  day-rooms,  matron's 
apartments,  consulting  room  and  pharmacy,  together 
with  two  three-bedded  wards  on  the  ground  and  first 
floors.  The  apartments  on  the  third  storey  are  arranged 
for  the  use  of  the  domestic  staff. 

The  four  radial  pavilions  extend  outwards  in  such 
a  way  that  the  patients'  quarters  face  S.,  S.S.W.,  and 
S.S.E.  The  height  of  the  wards  is  10  ft.,  and  the  cubic 
space  per  patient  about  1,300  ft.  In  addition  to  the 
main  staircases,  a  fire-escape  staircase  is  placed  at  the 
outer  end  of  each  pavilion. 

A  detached  sanitary  tower  is  situated  on  either  side 
of  the  central  block  and  between  each  pair  of  radial 
pavilions. 

There  is  accommodation  for  100  patients — twelve 
wards  containing  three  beds  each,  eight  wards  two 
beds,  while  the  remaining  forty-eight  are  single  rooms. 
At  the  north  side  of  each  pavilion  behind  the  wards 
is  placed  a  somewhat  narrow  but  moderately  well-lit 
and  ventilated  corridor. 

The  wards,  although  rather  small,  are  well  designed, 
but  the  window  space  is  too  limited.  There  are  no 
balconies  in  the  front  of  each  pavilion,  except  to  the 
one  on  the  north-west,  and  this  has  apparently  only 
been  added  in  consequence  of  the  slope  of  the  ground. 
The  windows,  however,  of  the  lower  storey  of  most  of 
the  pavilions  allow  of  bed  patients  being  wheeled  out 
into  the  open.  It  should  be  added  that  the  three- 
bedded  wards  at  the  outer  end  of  each  pavilion  are 
particularly  well  constructed,  allow  of  free  cross- venti- 
lation, and  have  in  one  angle  a  circular  sun-recess, 
while  at  the  other  is  a  fire-escape  staircase.  These  end 
wards  on  the  first  floor  have  a  well-constructed  balcony 
which  should  prove  of  much  service. 

To  the  north  of  the  main  building  is  a  belt  of  lawn 
and  flower  beds,  beyond  which  lies  a  second  group  of 
buildings  consisting  of  a  central  assembly  room,  evi- 
dently designed  to  serve  as  a  large  recreation  room, 
with  a  dining  hall  on  either  side.     Behind  these  are 


situated  the  kitchens.  Separate  buildings  have  been 
erected  for  the  medical  officers  and  nurses.  At  another 
part  of  the  grounds  are  laundry,  engine  and  boiler 
house,  mortuary,  post-mortem  room,  and  pathological 
laboratory. 

The  institution  is  ta  be  lighted  by  electricity  gene- 
rated on  the  premises.  Electric  motive  power  will  be 
used  in  the  laundry.  It  is  intended  that  heating  shall 
be  by  hot  water  radiators,  and  only  the  larger  wards 
contain  fireplaces. 

Water  is  obtained  from  the  Frimley  water  works, 
and  the  drainage  is  connected  with  the  Frimley  main 
drainage  scheme. 

The  sanatorium  should  go  far  to  rtieet  an  urgently 
pressing  need,  for  we  understand  it  is  to  be  open  to 
the  indigent  consumptive  without  payment.  It  is 
also  intended  to  serve  as  a  convalescent  home  for  other 
chest  cases  treated  in  the  parent  institution  at  Bromp- 
ton. 

The  design  of  the  sanatorium  is  no  doubt  ingenious, 
and  there  are  many  features  of  interest  aad  much  that 
is  deserving  of  high  praise  ;  but  we  venture  to  think 
that  some  exception  may  be  taken  to  the  site,  and 
certainly  the  plan  of  the  buildings  and  arrangement 
and  construction  of  some  of  the  wards  may  well  be 
subjected  to  criticism.  Many  will  object  to  the  use 
of  radiators.  The  position  of  the  sanitary  blocks  we 
consider  unfortunate.  In  actual  working  we  fear  it 
may  be  found  that  the  stellar  form  of  arrangement  will 
tend  to  the  stagnation  of  air  and  the  blocking  of  light 
while  affording  inadequate  protection  from  winds. 

The  expense  entailed,  including  the  cost  of  the  land 
and  erection  and  furnishing  of  the  building,  amounts 
to  £70,000,  and  it  is  estimated  that  the  maintenance 
of  the  sanatorium  will  require  at  least  £10,000  per 
annum. 

The  architect  is  Mr.  Edwin  T.  Hall,  F.R.I.B.A., 
and  the  contractors  Messrs.  Holliday  and  Greenwood. 


f  ranee. 

[from  our  own  correspondent.] 

Paris,  June  26th,  1904. 
Medical  Treatment  of  Metrorrhagia  from  Fibroma. 

Called  to  a  woman,  writes  Dr.  Huchard,  suffering 
from  a  fibroma,  the  practitioner  cannot  at  the  very 
outset  advise  an  operation.  The  idea  of  an  operation 
always  frightens  the  family,  and  before  hinting  at  3uch 
a  possibility  it  is  better  to  try  medical  means,  which 
consist  chiefly  in  physical  and  therapeutic  agents. 

Among  the  former  may  be  mentioned  hot  irrigations, 
practised  with  pure  boiled  water  at  1130  F.,  by  means 
of  a  douche  containing  from  three  to  five  quarts,  and 
repeated  twice  or  three  times  a  day.  Electricity  can 
be  used  by  any  practitioner.  It  suffices  to  have  a 
battery  of  continuous  current  giving  intensities  of  50  to 
80  milliamperes.  That  of  Darrion,  adopted  by  Lucas- 
Championniere,  is  the  simplest.  The  vaginal  electrode 
is  composed  of  a  platinum  rod  covered  at  its  extremity 
with  a  conic  pad.  The  abdominal  electrode  is  a  large 
disc  of  celluloid  kept  moist  to  diminish  the  resistance 
to  the  passage  of  the  current. 

At  the  first  sitting,  50  milliamperes  should  not  be 
exceeded.  The  current,  at  this  intensity,  is  allowed  to 
pass  five  minutes  and  is  then  gradually  diminished  for 
seven  other  minutes,  when  the  electrodes  are  with- 
drawn and  a  vaginal  injection  terminates  the  stance. 
After  this,  the  patient  rests  a  few  hours  ;  a  slight  bloody 
discharge,  which  sometimes  becomes  sero-purulent,  may 
occur.  These  possible  accidents  can  be  prevented, 
however,  by  antiseptic  injections. 

In  the  second  sitting,  a  week  later,  the  intensity  of 
the  current  can  be  brought  to  70  or  80  milliamperes  for 
five  or  six  minutes,  and  then  gradually  diminished  for 
ten  minutes  more.     In  successful  cases,   the  pain  is 


690    Tax  Mcdical  Press. 


GERMANY. 


June  29,  1904. 


eased,  and  the  haemorrhage  ceases  ;  but  in  many  cases 
the  results  are  not  so  brilliant.  The  electric  treatment 
should  be  continued  for  months,  once  or  twice  a  week. 
The  counter-indications  are — pregnancy,  nephritis, 
diarrhoea. 

Hyper-mineral  treatment. — Waters  containing  chlo- 
rides and  sodium  (Salins,  Salies  de  Beam,  Ac.)  enjoy  a 
deserved  reputation  in  the  treatment  of  fibromata  ; 
but  they  act  less  against  the  haemorrhage  thanjthe 
pain  arising  from  compression.  They  may  be  pre- 
scribed for  fibroma  of  slow  development,  as  those 
observed  at  the  menopause  ;  also  in  cases  of  very  large 
inoperable  tumours.  The  tumours  which  produce 
average  haemorrhages,  at  more  or  less  long  intervals, 
are  those  which  derive  most  benefit  from  the  hydro- 
mineral  treatment. 

For  patients  who  cannot  go  to  the  waters,  compresses 
of  salt  water  should  be  prescribed.  A  towel  steeped  in 
cold  salt  water  (9  oz.  to  a  quart  of  water)  is  applied 
to  the  abdomen  and  covered  with  a  thick  layer  of 
wadding,  with  oiled  silk  or  gutta  percha  leaf  over  all.  The 
compress  will  be  kept  on,  at  first  two  hours,  gradually 
increasing  the  time  until  it  can  be  borne  a  whole  night. 
The  treatment  lasts  one  month,  and  is  renewed  three  or 
four  times  a  year.  The  effect  on  the  uterus  is  fre- 
quently very  evident ;  the  organ  becomes  decongested, 
and  the  haemorrhage  less  abundant. 

The  medical  agents  are  diverse,  but  three  predomi- 
nate—ergot of  rye,  hydrastis  canadensis,  and  quinine. 
Others  less  used  are  cannabis  indica  and  adrenalin. 

The  ergotin  can  be  administered  in  injections, 
mixture,  or  pills.  The  injections  (ergotin  yoon)  are 
easily  done,  and  cause  no  accident,  but  are  not  very 
trustworthy.  Sometimes  it  is  well  to  associate  with 
the  ergotin  hydrastis  canadensis. 

Fluid  extract  of  hydrastis  canadensis,  5j ; 
Ergotin  (yoon),  5j- 
Twenty  drops  three  or  four  times  a  day. 
Injections  of  hydrochlorate  of  hydrastinine  arrest 
haemorrhage  very  promptly. 

Hydrochlorate  of  hydrastinine,  gr.  x  ; 
Water,  &iss. 
V  Inject   one   syringe  (gr.   i)    two   or   three   days   in 
succession. 

^  The  following  pills  are  a  good  combination  : — 
Hydrobromate  of  quinine,  gr.  ij ; 
Hydrochlorate  of  hydrastinine,  gr.  ss : 
Ergotin,  gr.  j. 
For  one  pill ;    two  daily. 
■  These  pills  can  be  prescribed  for  ten  days.     The  ten 
following  days  recourse  can  be  had  to  cannabis  indica 
or  adrenalin.     This  latter  has  frequently  succeeded — 
ten   drops   of   the   solution   (1—1,000)   morning   and 
evening.      Sometimes  accidents   occur :   sensation   of 
anguish  and  cardiac  arhythma.  The  treatment  should  be 
carefully  watched  and  suspended  on  the  slightest  un- 
favourable symptom. 

German?. 

[from  our  own  correspondent.] 

Bbrlih,  June  25th,  1904- 


At  the  Society  for  innere  Medizin,  Hr.  F.  Krause 
reported  a  case  of 

Primary   Diphtheria   of  the  Pelvis  of  a  Kidney 
Cured  by  Operation. 

Such  a  cure  had  not  hitherto  been  recorded  in  surgical 
literature.  A  servant-girl,  set.  24,  in  her  first  pregnancy 
complained  during  the  whole  term  of  pains  in  the 
right  part  of  the  abdomen.  She  was  confined  in  June 
of  last  year.  A  week  after  she  was  ready  for  work  again, 
but  was  taken  ill  again  three  weeks  later,  and  was 
received  into  hospital,  whence  she  was  again  discharged 


a  fortnight  afterwards.     On  September  1 3th  shivering, 
vomiting,  and  high  temperature  were  observed,  and  she 
was  admitted  into  hospital  again  in  a  serious  condition. 
There  was  extreme  sepsis,  but  nothing  pointing  to  any 
locality  except  pain  in  the  region  of  the  right  kidney. 
The  ureteral  catheter  was  used.     There  was  slight  cysti- 
tis, but  not  enough  to  account  for  symptoms,  and  the 
urine  from  the  left  kidney  was  normal.     Not  a  drop  of 
urine,  however,  came  from  the  right  kidney,  not  even 
when  the  catheter  was  advanced  into  the  renal  pelvis ; 
but  some  greasy  stuff  was  adherent  to  the  eye  of  the 
catheter.     The   right   kidney,  therefore,  was  diseased. 
As  the  pulse  was  140,  and  barely  to  be  felt,  and  the 
temperature  was  1050,  and  there  were  violent  rigors, 
the  necessity  of  speedy  operation  was  evident.    The 
kidney  was  exposed  by  the  oblique  loin  operation  and 
was  found  to  be  very  adherent,  especially  in  its  upper 
part.     As  the  adhesion  could  not  be  separated  with 
blunt  instruments,  the    peritoneum  was  opened  and 
the  kidney  was  now  drawn  out  beyond  the  abdomen, 
so  that  it  could  be  opened  without  danger  of  infection. 
Sterile  gauze  was  packed   in  all   round.     The  kidney 
was  not  enlarged,  was  bluish-red,  and  rather  softer  than 
normal.    On  opening,  the  kidney  was  found  to  be  full 
of  a  greyish- white  mass  firmly  fixed,  so  that  it  had  to  be 
removed  with  the  sharp  spoon.     The  mass  felt  gritty 
and  consisted  of  necrotic  tissue  with  uric  acid  salts. 
The  kidney  was  left  open,  stitched    into    the  wound 
and  packed  with  sterile  gauze.     No  antiseptics  were 
used.     The  next  morning,  the  temperature  was  still 
I05°F„  but  fell  to  ioo°  in  the  evening,  and  the  next  day 
all  the  symptoms  had  improved.     A  fistula  remained 
for  some  weeks,  but  the  patient  now  had  every  appear- 
ance of  blooming  health. 

Hr.  Maragliano,  Krause's  assistant,  said  that  a 
microscopical  examination  showed  the  disease  to  be 
diphtheria.  The  wall  of  the  pelvis  of  the  kidney  was 
necrotic.  In  the  renal  substance,  there  were  only 
interstitial  changes,  round-cells,  but  no  abscesses.  It 
was  a  case  of  diphtheroid  inflammation  of  the  pelvis  of 
the  kidney.  Ten  weeks  after  the  operation  examina- 
tion showed  a  very  slow  excretion  of  urine ;  later  it 
became  normal  again,  but  the  urine  contained  traces  of 
pus  and  albumin,  which  had  now,  however,  disappeared. 
After  much  investigation  he  had  come  to  the  conclu- 
sion that  the  disease  was  primary. 

Hr.  Oestreich  said  that  he  had  made  an  autopsy  on  a 
similar  case  a  few  days  ago.     There  were  diphtheritic 
necroses  in  the  pelvis  of  both  kidneys. 
At  the  Medical  Society  a  case  of 
Pressure  Stasis 
was  shown   from    v.   Bergmann's   Klinik.     A  young 
girl  was  squeezed  violently  between  a  washing  machine 
and  the  waU.     She  was  at  once  taken  into  hospital, 
where  she  complained  of  pain  in  her  back,  but  nothing 
like  a  contusion  could  be  found.     On  the  other  hand, 
however,  the  patient  exhibited  a  horrible  appearance : 
the  face  was  swollen,  and  coloured  a  bluish-black,  the 
eyeballs   projected,    the  eyelids  were  swollen  and  the 
conjunctiva  reddened.     Within   the  discoloured  area 
were    punctiform    and    streaky    petechiae.     The   dis- 
coloration ceased  at    a  sharply  defined  line  at  the 
larynx,  but  there  were  extensive  petechias  on  the  neck 
and  arms.     The  fundus  oculi  was  normal.    This  change 
in  the  head  was  a  haemorrhage  at  a  distance  from  the 
part  injured.     It  depended  on  the  fact  that  the  veins 
of  the  head  and  neck  possessed  no  valves,  and  that  an 
increase  of  pressure  in  the  thorax  or  abdomen  was 
communicated  to  the  veins  of  those  parts  and  caused 
extravasation.     Notwithstanding     the     dreadful   ap- 
pearance  the  prognosis  was  favourable  when  there 


June  29,  1904, 


OPERATING   THEATRES. 


The  Medical  Press.    691 


were  ncTcomplications.  It  was  remarkable  how  quickly 
the  symptoms  subsided. 

Hr.  Orth  had  performed  an  autopsy  on  such  a  case, 
and  had  ascertained  that  the  brain  and  its  membranes 
did  not  show  the  least  trace  of  haemorrhage,  whilst  the 
mucous  surfaces  of  the  nose  and  neighbouring  cavities 
were  bluish-black 

Hr.  Wesselz  had  examined  the  fundus  oculi  in  a 
number  of  such  cases  and  had  never  seen  haemorrhage 
in  the  fundus.  The  intra-ocular  pressure  prevented 
-such  extravasations. 


Austria* 


[FROM   OUR  OWN  CORRESPONDENT.] 

VIM**,  June  25th,  1004. 
Gastric  Perforation.  -h 

At  the  Gesellschaft,  Clairmont  recorded  the  history 
-of  six  cases  of  perforation  of  the  stomach  on  which  he 
had  operated  with  three  deaths  and  two  successes.  In 
two  of  the  deaths  peritonitis  appeared  early  after  the 
operation,  while  the  third  succumbed  from  the  dehi- 
scence of  the  su tures.  The  two  recoveries  were  gun-shot 
wounds  that  came  under  observation  soon  after  the 
accidents.  One  of  the  deaths  was  operated  on  for 
ulcus  ventriculi,  which  seemed  to  improve  for  some 
time  but  suddenly  changed  and  died  without  much' 
warning.  In  this  operation  he  has  endeavoured  to 
reduce  accidents  to  a  minimum  by  administering  ether, 
washing  out  the  peritoneum  with  a  solution  of  sodium 
•chloride,  as  well  as  the  stomach,  before  attempting  union; 
For  ulcerative  perforation  he  has  performed  the  plastic 
operation  by  covering  the  opening  with  a  firm  piece  of 
peritoneum.  In  favourable  cases  he  also  practises 
jejunostomy  for  gastric  ulceration  with  even  greater 
success  than  with  flaps,  as  nutrition  can  be  earlier  com- 
menced to  sustain  the  patient.  Another  very  valuable 
adjunct  in  the  treatment  of  these  cases  is  a  liberal  in- 
jection subcutaneously  of  an  infusion  of  common  salt, 
which  should  be  no  less  than  six  or  seven  litres. 

Eiselsberg  thought  that  jejunostomy  was  the  safer 
operation  where  emaciation  was  pronounced,  as  many  of 
these  cases  died  from  inanition  even  when  the  operation 
ran  a  favourable  course. 

Erythema  Infectiosum  ? 

Escherich  exhibited  two  girls  with  an  exanthematous 
eruption  which  was  neither  scarlatina,  measles,  nor 
rdtheln,  yet  epidemic  with  an  incubation  of  fourteen 
to  nineteen  days,  and  occurring  among  children  between 
four  and  ten  years  of  age.  It  begins  on  the  face  in  large 
spots  orexanthems,  having  a  slightly  papular  appearance 
after  developing,  confining  itself  at  first  to  the  naso- 
labial folds  of  the  face  and  subsequently  extending 
to  the  trunk  and  extremities.  The  fever  lingers  eight 
to  ten  days  without  much  general  disturbance  constitu- 
tionally. 

Escherich  said  this  exanthem  had  in  recent  times 
become  more  frequent,  and  should  be  carefully  dia- 
gnosed from  scarlatina,  measles,  &c.  Different  names 
appear  to  have  been  applied  to  the  disease  according 
as  the  differential  diagnosis  struck  the  observer,  such 
as  "  erythema  infectiosum/'  "  megalerythema  epide- 
micum,"  &c. 

Epithelial   Carcinoma    and    Radium. 

Exner  brought  forward  an  elderly  woman,  aet.  73, 
who  had  suffered  for  three  years  with  cancer  on  the 
right  cheek.  Owing  to  the  extent  and  position  of  the 
neoplasm  the  radical  operation  was  quite  out  of  the 
question  when  she  presented  herself.  The  next  form 
of  treatment  that  suggested  itself  was  to  scoop  out  the 
ulcer  as  far  as  could  be  done  and  then  commence  some 
of  the  rays. 


This  was  done  and  the  rays  of  radium  applied  from 
October  1st  to  26th,  1003.  After  this  period  nothing 
was  done,  everything  being  allowed  to  remain 
quiet.  By  this  treatment  the  tumour  began- to  decline 
gradually ;  the  wound  has  healed  up,  and  scarcely  any 
trace  of  infiltration  can  now  be  observed. 

Osteo-Sarcoma    in    the    Spins. 

Schrieber  showed  a  lad,  aet.  18,  with  a  large  sar- 
coma in  the  cervical  region  of  the  spine.  Two  years 
ago  the  lad  commenced  to  complain  of  pain  in  the  back, 
arm  and  left  shoulder.  Later  a  tumour  began  to  form 
about  the -cervical  portion  of  the  spine  which  was  at  first 
firm*  but  subsequently  assumed  a  bony  hardness, 
which  was  finally  proved  to  be  a  dense  psteo-sarcoma. 
Immunhamolysis. 

Kreide  and  Mandl  recorded  the  results  of  their 
experiments  on  the  immunity  of  mother  and  offspring 
by  the  application  of  immunhaemorysin.  They 
find  that  intra-uterine  injectiori  of  the  foetus  with 
extraneous  blood  produces  ithmunhaemolysin  in  the 
blood  of  both  the  mother  and  the  child,  having  a  specific 
character. 

Tuberculous  Inoculation. 

Salzer  next  presented  three  cases  of  inoculated 
tubercle.  The  first  had  the  disease  conveyed  to  the 
right  hand,  skin,  and  glands,  the  second  was  located 
to  the  under  lip ;  while  the  third  was  confined  to  an 
isolated  patch,  or  tuberculous  ulcer,  on  the  left  ala  of  the 
nose,  probably  auto-inoculation  from  the  lung  disease 
which  was  present.  The  two  first  suffered  from  no 
severe  or  general  form  of  the  disease,  but  for  years 
attended  to  tuberculous  patients,  from  whom  the 
disease  must  have  been  transmitted  by  contact. 

Riehl  remarked  that  the  first  two  cases  were  typical 
contacts. 

Fracture  of  Cranium. 

Kirchmayer  presented  a  youth,  aet.  15,  who  had 
been  thrown  from  a  bicycle  and  received  a  star-shaped 
fracture  of  the  cranium  with  rupture  of  the  arteria 
menmgea  media.  After  trepanning,  the  haemorrhage 
could  not  be  checked  till  a  tampon  was  placed.  The 
patient  recovered,  and  the  wound  healed,  being  finally 
closed  by  making  a  plastic  operation  from  the  peri- 
osteum taken  from  the  olecranon  of  a  disarticulated 
arm,  which  has  quite  completed  the  cranial  opening. 
Tuberculous  Meningitis. 

Jellinek  presented  a  young  man,  aet.  24,  who  had 
exhibited  all  the  symptoms  of  tuberculous  meningitis, 
such  as  unconsciousness,  right  facial  paralysis,  pulse 
retardation,  &c,  and  after  fourteen  days  quite  re- 
covered. The  radioscope  revealed  adhesions  in  both 
pleura  as  well  as  enlarged  lymphatic  glands.  The 
cy to-diagnostic  result  revealed  lumbar  fluid,  which 
also  confirmed  the  diagnosis  of  tuberculous  meningitis. 
The  patient  is  now  perfectly  well,  and  has  no  trace  of 
any  pathological  weakness. 

TEbe  Qperattno  TEbeatre*. 

GUY'S  HOSPITAL. 
Two  Operations  for  Discarding  the  Big  Bowel 
from  the  Gastro-intestinal  Tract. — Mr.  Arbuth- 
not  Lane  operated  on  a  woman,  aet.  49  (but  whose 
appearance  was  that  of  65),  for  chronic  constipation. 
She  had  for  many  years  suffered  from  constipation  of 
progressively  increasing  severity.  It  caused  her  much 
pain,  tenderness,  flatulence,  and  distress.  At  a  com- 
paratively early  period  she  manifested  all  the  evi- 
dent symptoms  of  premature  decay  with  which  one  is 
now  so  familiar  as  the  result  of  a  protracted  stay  of 
faecal  matter  in  the  large  bowel.     These  are,  roughly, 


692    Ths  Medical  Puss. 


LEADING  ARTICLES. 


June  29,  1904. 


staining  and  pigmentation,  especially  about   the  eye, 
the  neck,  the  folds  of  the  axilla,  and  at  any  point 
where  even  slight  pressure  is  habitually  exerted  ;    a 
nasty  pasty-white  skin,    flaccid  and  loose  because  of 
the  absorption  of  fat  from  the  subcutaneous  tissue, 
an  unpleasant  smell  from  the  whole  body,  especially 
from  the  flexures  and  folds,  the  teeth  decayed,  and 
the  gums  about  them  swollen,  pus  welling  out  fcom 
about   the  roots,   large  thick   tongue,   the  abdomen 
flaccid  and  loose,  thete  being  little  or  no  evidence  of 
muscle  fibre  in  its  wall,  the  caecum  distended,  elongated, 
and  dilated  and  occupying   almost  the  whole  of  the 
true  pelvis,   that  portion  of  the  colon  which   extends* 
as  high  as  the  hepatic  flexure  being  dilated  and  saccu- 
lated, fixed  to  the  abdominal  wall  externally,  and  very 
sore  on  pressure ;    the  right  kidney  displaced  down- 
wards ^>y  the  drag  constantly  exerted  on  it  by  the 
loaded  cesspool,  while  the  small  intestine  was  abnorm- 
ally full  of  fluid  material,  and  at  times  the  stomach 
had  a  difficulty  in  getting  rid  of  its  contents,  so  that 
nausea  and  sickness  ensued.    The  patient's  hair  was 
dirty  white,  and  her  conjunctiva  yellowish  and  opaque. 
Her  life  had  for  years  been  rendered  miserable  by  the 
distress  she  had  suffered,  in  consequence  of  the  chronic 
obstruction.     Under  these  circumstances  she  willingly 
accepted  the  risks  of  any  operation  likely  to  afford  her 
relief.     Consequently,  Mr.  Lane  opened  the  abdomen 
in  the  left  iliac  region, '  verified  the  conditions  of  the 
bowel    already    referred    to,    freed    the    strangulated 
sigmoid  as  far  as  he  could  from  the  adhesions  which 
bound  it  down  in  the  iliac  fossa,  divided  the  ileum  near 
its  lower  end,  closed  both  extremities,  and  then  made 
a  large  communication  between  the  proximal  part  of 
the  ileum  and  the  sigmoid. 

The  relief  obtained  from  the  operation  was  very 
great,  and  the  patient  looks  already  much  younger 
and  healthier  than  she  did  previously. 

As  a  contrast  to  the  last  case,  Mr.  Lane  operated  on 
a  girl,  set.  25,  for  extreme  constipation.  All  the 
evidence  of  mechanical  changes  in  the  big  bowel  and 
of  the  absorption  of  products  from  it,  described  in  the 
last  case,  were  very  marked  in  this  one,  except  that,  of 
course,  they  were  not  so  advanced.  The  pain  in  this 
case  was,  however,  a  very  prominent  feature,  the  con- 
dition of  her  abdomen  being  a  constant  source  of 
distress  to  her.  The  same  operative  procedures  were 
adopted  in  this  instance.  Besides  the  usual  changes  in 
the  large  bowel,  to  which  Mr.  Lane  has  made  reference 
on  previous  occasions,  there  was  a  certain  amount  of 
adhesions  between  the  coils  of  the  small  intestine. 
When  adhesions  exist  in  this  locality  the  complete 
freedom  from  pain,  he  pointed  out,  does  not  immediately 
follow  the  operation,  the  process  of  recovery  being 
delayed  in  proportion  to  the  interference  of  the  func- 
tion of  the  small  bowel  which  is  producd  by  the 
adhesions.  This,  he  thought,  was  a  very  important 
point  to  be  taken  into  consideration  in  performing 
this  operation,  in  that  it  should  not  be  put  off,  if  possible, 
till  the  mechanics  of  the  small  intestine  had  been 
interfered  with.  When  a  new  operative  procedure  is 
suggested  it  is  natural,  he  remarked,  that  for  some 
time  it  is  confined  chiefly  to  the  most  severe  and 
advanced  cases,  and  it  is  only  after  the  lapse  of  some 
time  that  it  comes  to  be  applied  to  cases  of  medium 
severity.  That  this  treatment  of  a  damaging  condition 
of  constipation  will  become  exceedingly  popular  and 
beneficial  he  has  no  manner  of  doubt,  but,  like  most 
novel  treatments  involving  a  certain  amount  of  skill 


on  the  part  of  the  surgeon  and  risk  on  the  part  of  the 
patient,  it  is  sure  to  be  but  rarely  considered  applicable 
for  a  certain  time  to  come.  At  the  same  time,  an  in- 
creasing familiarity  with  the  operation  and  its  success- 
ful results  will  soon  give  the  surgeon  complete  con- 
fidence in  its  utility.  A  point  of  great  interest  at  the 
present  moment,  he  thought,  was  the  confirmation  by 
Metchnikoff  ("  Etudes  sur  la  Nature  Humaine  "),  from 
an  evolutionary  standpoint,  of  the  uselessness  if  not 
the  serious  disadvantage  of  the  large  bowel  in  our 
present  state  of  civilisation. 

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SALUS  POPULI  SUPREMA  LEX. 


WEDNESDAY,  JUNE  29,  1904. 


PROFESSOR  KOCH'S  PRESENT  POSITION 
ON  DUAL  TUBERCULOSIS. 
Intense  interest  was  last  year  excited  in  the 
United  Kingdom  by  the  startling  announcement  of 
Professor  Koch  as  to  the  duality  of  human  and 
comparative  tuberculosis.  In  spite  of  the  au- 
thority naturally  attached  to  any  utterance 
coming  from  the  discoverer  of  the  tubercle  bacillus, 
that  particular  statement  was  received  with  the 
greatest  possible  incredulity.  The  greatest 
bacteriologists  and  scientific  medical  authorities 
in  this  country  did  not  hesitate  at  once  to  express 
their  doubts  in  public.  Subsequently,  the  Com- 
mission appointed  to  inquire  into  the  matter  has 
returned  a  verdict  absolutely  controverting  Pro- 
fessor Koch's  latest  theory,  and  emphatically 
confirming  the  common  origin  of  tuberculosis 
in  mankind  and  in  the  lower  animals.  It  is  obvious 
that  economic  issues  of  the  greatest  importance 
to  the  community  are  involved  in  the  settlement 
of  this  point.  If  there  be  no  connection  between 
the  two  maladies  then  it  is  no  longer  necessary 
to  fight  consumption  by  the  destruction  of  the 
flesh  of  tuberculous  cattle  and  of  the  sterilisation  of 
the  milk  from  cows  similarly  affected.  Then, 
again,  the  vast  aggregate  of  infantile  tuberculosis 
must  be  accounted  for  by  some  other  than  the 
generally  accepted  explanation  of  infection  by  milk 
through  the  intestinal  tract.  Indeed,  the  whole 
range,  both  of  causative  and  preventive  measures 


June  29,  1904. 


LEADING  ARTICLES. 


The  Medical  Press.     693 


with  regard  to  tuberculosis,  would  have  to  be 
modified  mote  or  less  completely  from  one  end  to 
the  other  if  we  accept  the  later  views  of  Professor 
Koch.  After  deliberate  inquiry  and  experiment, 
a  body  of  our  most  trustworthy  and  highly  scien- 
tific countrymen,  deliberately  chosen  as  best  fitted 
for  the  investigation,  have  pronounced  his  theory 
to  be  fallacious.  It  seems  impossible  to  doubt  the 
accuracy  of  that  finding,  even  after  the  high  au- 
thority of  Professor  Koch  has  been  allowed  the 
highest  possible  weight.  What  can  it  all  mean  ? 
Can  it  be  that  Professor  Koch  has  hit  upon  some 
form  of  tubercle  bacillus  that  is  peculiar  to  some  of 
the  lower  animals,  while  the  British  investigators 
are  dealing  with  a  modified  human  bacillus  that 
is  capable  of  infecting  both  man  and  beast  ? 
It  is  difficult  to  believe  that  so  accurate  and  ex- 
perienced an  observer  as  Professor  Koch  has  not 
some  tenable  grounds  on  which  to  base  so  vital 
a  conclusion.  For  all  that,  it  is  impossible  to  forget 
that  his  tuberculous  treatment,  which  took  the 
world  by  storm  with  all  the  violent  suddenness 
of  a  South  Sea  Bubble,  proved  to  be  an  unsubstan- 
tial figment.  The  curious  part  of  the  situation  is 
that  the  interim  report  of  our  Royal  Commission 
was  received  a  few  weeks  ago  by  the  German 
savants  with  almost  universal  doubt.  Professor 
Koch,  who  has  since  returned  to  Berlin,  is  said 
not  only  to  have  remained  unshaken  by  the  ad- 
verse finding,  but  to  have  even  asserted  that  the 
Commission  confirms  his  views.  He  says,  accord- 
ing to  a  letter  by  a  special  correspondent  of  the 
Daily  News  of  June  24th  :  "  The  report  of  the 
Royal  Commission  does  not  contain  a  single  fact 
to  make  me  change  my  opinion,  which  is  based  on 
very  careful  experiments,  not  only  made  by  myself 
and  my  assistants,  but  also  by  other  medical  men 
of  the  highest  standing.  It  is  for  my  opponents 
to  prove  that  I  am  wrong.  I  have  tried  for  years 
to  find  a  case  in  which  tuberculosis  was  transferred 
from  animals  to  men.  Three  years  ago  the  Prussian 
Minister  for  Public  Instruction,  at  my  request, 
instructed  all  physicians  in  charge  of  the  large 
public  hospitals  to  report  all  cases  which  came 
to  their  notice  of  bovine  tuberculosis  having  been 
transmitted  to  man.  and  up  to  this  day  we  have 
been  waiting  to  hear  of  the  first  case.  As  long 
as  the  Royal  Commission  does  not  show  me  a  case 
in  which  such  infection  is  proved  I  cannot  believe 
in  their  assertions.  Veterinary  surgeons  say  that 
a  half  per  cent,  of  all  cows  have  bovine  tuberculosis, 
yet  the  Royal  Commission  cannot  state  a  case  of 
a  man  being  infected  by  drinking  the  milk  of  such 
cows.  I  lay  such  great  stress  upon  this  fundamental 
question  because  I  should  like  to  prevent  the 
further  enormous  waste  of  money  caused  by  the 
false  views  of  the  possibility  of  bovine  tuberculosis 
being  transmitted  to  man.  How  many  millions 
are  wasted  by  the  killing  of  animals,  the  flesh  of 
which  is  said  to  be  dangerous,  and  for  the  sterilisa- 
tion and  pasteurisation  of  milk*  apart  from 
the  fact  that  the  milk  loses  many  of  its  good 
qualities  by  that  process  ?  If  all  these  millions 
were  saved  and  spent  on  really  practical  means  for 


combating  tuberculosis  one  might  have  a  chance 
of  getting  the  mastery  over  it."  In  spite  of 
these  emphatic  statements  it  will  take  a  great  deal 
to  persuade  scientific  medical  men  in  this  country 
that,  bovine  and  human  tuberculosis  are  not  due 
to  a  common  specific  infection. 

ST.  GEORGE'S  AND  HOSPITAL 
CENTRALISATION. 
The  question  of  hospital  centralisation  has  been 
once  again  brought  prominently  under  the  notice 
of  the  public.  The  determination  of  the  St. 
George's  Hospital  governors  last  week  to  remain 
on  their  present  site  brings  the  whole  matter,  with 
all  its  doubts  and  difl&culties,  within  the  range  of 
arguable  social  politics.  Not  many  months 
have  passed  since  the  authorities  of  that  famous 
London  institution  won  approval  in  many 
quarters  by  deciding  to  remove  from  Hyde  Park 
Corner  to  some  suburb  where  there  would  be  more 
urgent  need  of  a  great  hospital,  where  land  would 
be  less  costly  and  where  the  vicinity  of  a.  poor 
population  demanded  services  of  the  kind. 
Our  own  freely  expressed  opinion  of  the  removal 
scheme  was  one  of  unqualified  approval.  The 
circumstances  of  St.  George's  Hospital,  in  some 
respects  peculiar,  appeared  to  more  than  justify 
the  change  then  contemplated.  The  hospital, 
it  need  hardly  be  pointed  out,  is  situated  in  the 
centre  of  one  of  the  most  fashionable  quarters  of 
London,  within  a  stone's  throw  of  the  King's 
Palace  and  bordering  on  Hyde  Park.  There  is  no 
resident  poor  population  close  at  hand,  although, 
on  the  other  hand,  domestic  servants,  from  the 
circumstances  of  the  case,  furnish  a  considerable 
proportion  of  the  patients  attending  the  institution. 
The  value  of  the  site  is  enormous.  The  money  thus 
locked  up  could,  if  capitalised,  be  made  to  provide 
far  larger  premises  in  a  more  open  neighbourhood 
somewhere  in  the  suburbs,  where  land  is  cheaper 
and  landlords  less  exacting.  St.  George's,  under 
present  conditions  as  to  available  ground  area, 
cannot  hope  to  provide  a  proper  amount  of 
space  and  accommodation  for  patients,  for 
students  and  its  teaching  and  administrative 
staff.  In  other  words,  under  present  conditions 
the  expenditure  of  the  funds  of  the  hospital 
cannot  be  made  to  yield  a  fair  return.  St. 
George's,  however,  in  spite  of  the  vigorous  pre- 
sentation of  these  and  kindred  facts,  has  adopted 
what  we  regard  as  the  retrograde  policy  of  re- 
maining in  its  present  costly  and  fashionable 
neighbourhood.  In  arriving  at  that  decision  it 
has  followed  the  example  of  the  ancient  and 
wealthy  hospital  of  St.  Bartholomew's,  the  reasons 
for  retaining  which  in  the  heart  of  London  at  a 
fabulous  expenditure  of  money  have  never  been 
satisfactorily  given.  The  only  hospital  that  has 
hitherto  had  the  courage  to  act  up  to  the  dictates 
of  reason  and  common  sense  in  the  matter  of 
removal  from  the  central  square  mile  or  so  of  the 
metropolis  is  King's  College.  In  shifting  its 
organisation  to  a  densely  populated  district  of 
South  London  that  institution  has,  we  trust, 
entered  upon  a  fresh  life  of  usefulness  and  activity. 


694    The  Midical  Puss.       NOTES    ON    CURRENT    TOPICS. 


June  29,  1904 


Why  St.  Bartholomew's,  St.  George'9,  Charing 
Cross,  and  Westminster,  to  mention  these  alone, 
should  cling  to  central  London  when  there  is  a  vast 
field  open  to  them  in  greater  London  is  not  alto- 
gether clear.  Sentiment,  no  doubt,  plays  a  con- 
siderable part  in  the  matter,  and  as  such  must  com- 
mand our  respectful  sympathy.  Sentiment  is  out- 
weighed, however,  by  the  need  of  ample  bed-space 
and  fresh  air  for  the  sick,  together  with  the  de- 
sirability of  having  a  hospital  service  as  near 
as  may  be  to  the  doors  of  the  population  which 
is  thereby  relieved.  Perhaps  stronger  than  senti- 
ment is  the  element  of  propinquity.  Nearness  is 
an  attraction  to  the  philanthropists  who  so  nobly 
provide  the  time  and  attention  necessary  for 
the  proper  management  of  charitable  institutions. 
So,  too,  it  is  convenient  for  the  medical  staff. 
But  whether  for  good  or  for  evil,  the  authorities 
of  two  of  our  great  hospitals  have  decided  against 
urgent  proposals  to  remove  from  central  London  to 
the  suburbs.  Some  day  the  outer  metropolis 
will  build  its  own  great  hospitals,  and  then  the 
ancient  central  institutions  may  find  themselves 
more  or  less  in  the  situation  of  Othello,  with 
"  their  occupation  gone."  At  the  root  of  this 
question  of  centralisation  of  the  great  hospitals 
lies  the  wider  one  of  the  combination  of  rival  in- 
terests. Any  great  scheme  of  combined  central 
control  could  hardly  permit  the  crowding  of  three- 
fourths  of  the  great  hospitals  of  London  into  one 
central  mile  to  the  deprivation  of  a  dozen  square 
miles  outside  the  privileged  area.  As  we  have 
frequently  pointed  out,  the  question  of  hospital 
centralisation  which  is  being  threshed  out  to-day 
in  London  must  sooner  or  later  be  presented  to 
most  of  the  great  towns  of  the  United  Kingdom. 
It  is  a  moot  question  whether  the  vast  proportion 
of  hospital  patients  would  not  be  infinitely  better 
off  if  tended  in  country  quarters.  It  is  to  be  re- 
gretted that  the  subject  could  not  be  reported  upon 
by  a  committee  of  sanitary  and  medical  experts, 
somewhat  in  the  manner  of  a  Royal  Commission, 
with  power  to  call  and  to  examine  witnesses. 
Of  course,  the  composition  of  such  a  Commission 
would  have  to  be  absolutely  impartial.  As  re- 
gards particular  hospitals,  the  views  of  the  small 
body,  both  lay  and  medical,  that  nearly  always 
control  policy  are,  as  a  rule,  hopelessly  biassed. 


notes  on  Current  Tropics, 


Beri-Beri  in  South  Africa. 
In  the  House  of  Commons  last  week  Dr.  Hut- 
chinson, the  Member  for  the  Rye  Division,  called 
attention  to  a  matter  possibly  of  vital  interest 
to  the  future  of  South  Africa.  In  the  form  of  a 
question  he  asked  the  Secretary  of  State  for  the 
Colonies  if  he  had  information  of  the  outbreak  of 
beri-beri  among  the  Chinese  coolies  who  had 
recently  arrived  in  South  Africa ;  whether  those 
who  had  developed  the  disease  had  been  actually 
landed  ;  whether  those  who  had  been  exposed 
on  board  ship  to  infection  had  yet  been  sent  up 
country  to  the  compounds  ;  and  whether,  having 
regard  to  the  intensely  infectious  and  dangerous 


character  of  the  disease,  from  which  South  Africa 
is  at  present  free,  he  could  tell  the  House  what 
steps  had  been  taken  to  prevent  the  spreading  of 
the  disease  in  the  colony.  By  one  of  the  mys- 
terious juggles  which  seem  to  form  part  of  the 
inner  life  of  Parliamentary  procedure,  it  was  ruled 
outside  the  competency  of  the  House  of  Commons 
to  discuss  this  urgent  danger.  The  fact  of  the 
matter  is  that  the  first  shipload  of  Chinamen  im- 
ported to  work  the  mines  in  the  Rand  brought 
a  number  of  them  infected  with  beri-berL  If 
that  dread  malady  once  take  root  in  our  South 
African  colony  the  price  that  will  ultimately  be 
paid  for  the  Chinese  importation  is  beyond  the 
power  of  man  to  estimate.  There  can  be  little 
doubt  that  beri-beri  results  from  a  specific  in- 
fection, although  its  ultimate  cause  has  not  yet 
been  isolated.  The  most  recent  researches  seem 
to  point  to  its  probable  origin  in  rice  grain.  The 
epidemic  and  endemic  nature  of  the  fatal 
malady  and  its  curious  combination  of  motor 
and  sensory  palsy  with  other  characteristic 
symptoms  bring  its  infectious  nature  within 
the  bounds  of  tolerably  certain  assumption. 
It  would  be  a  most  undesirable  evil  to  add  to  the 
already  somewhat   full  and  overflowing   burden 

of  South  Africa. 

Innocency  and  Malignancy. 
It  is  coming  more  and  more  to  be  understood, 
by  pathologists,  at  all  events,  that  terms  such  as 
"  innocent  "  and  "  malignant,"  as  applied  to  new 
growths,  are  clinical  and  not  pathological.  For- 
merly, certain  kinds  of  tumours  were  at  a  glance 
described  as  falling  into  one  or  other  class  ;  but 
at  present  the  pathologist  is  becoming  more  and 
more  chary  of  giving  a  decided  diagnosis  on  the 
point.  In  other  words,  the  microscopic  appear- 
ance is  only  one  among  several  conditions  which, 
between  them,  decide  whether  a  tumour  is 
malignant  or  not.  Indeed,  in  very  many  cases 
the  microscopic  appearance  is  valueless  without 
knowing  very  accurately  the  part  of  the  growth 
from  which  the  section  has  been  taken.  But  even 
when  this  is  well  known,  it  is  often  impossible 
without  consideration  of  clinical  characteristics  to 
classify  the  tumour.  Side  by  side  with  this  grow- 
ing reluctance  on  the  part  of  the  pathologist  to  act 
as  the  sole  judge  of  malignancy  is  his  growing 
belief  in  the  absence  of  any  rigid  test  by  which 
the  innocent  can  be  separated  from  the  malignant. 
Mr.  Cathcart,  of  Edinburgh,  who  is  fortunate  in 
the  possession  of  wide  experience,  both  surgical 
and  pathological,  has  just  published  a  paper  (a) 
drawing  attention  to  the  essential  similarity  of 
innocent  and  malignant  tumours.  In  his  opinion 
no  tumour  is  entirely  free  from  associations  with 
malignancy,  though  as  a  rule  its  tendency  to 
malignancy  varies  inversely  with  the  degree  of 
organisation  of  the  tissue  of  which  it  is  composed. 
He  supports  his  conclusions  by  an  appeal  to  many 
well-known  facts  showing  the  transformation  of 
one  class  of  growth  into  the  other  by  the  degene- 
ration of  the  type  of  its  cells,  and  by  a  description 
of  a  series  of  tumours  which  show  an  easy  gradation 

(a)  Brit.  Mtd.  Jmtr*.,  Jane  4th.  1001. 


June  29.  1904. 


NOTES   ON    CURRENT   TOPICS. 


The  Medical  Pesss.     695 


*n  appearance  from  the  typically  innocent  to  the 
typically  malignant. 

Experiments  on  Animate, 

The  yearly  return  of  the  inspectors  under  the 
Vivisection  Act,  relating  to  last  year,  shows  a  con- 
siderable increase  in  the  number  of  experiments 
performed  on  animals  over  the  preceding  year. 
The  total  number  of  experiments  performed  in 
England  and  Scotland  was  something  over  nine- 
teen thousand,  of  which  the  great  majority  were  of 
the  nature  of  inoculations,  and  the  increase  over 
1902  was  entirely  in  this  class.  In  all  cases  serious 
operations  were  performed  under  anaesthetics,  no 
certificate  dispensing  with  anaesthetics  having 
been  granted  during  the  year.  The  remaining 
operations,  done  without  anaesthetics,  were  either 
mere  inoculations,  superficial  venesections,  or 
feeding  experiments.  The  large  increase  in  the 
number  of  inoculations— over  four  thousand — is 
due  to  the  greater  reliance  placed  every  day  on 
biological  tests  as  diagnostic  measures  subsidiary 
to  practical  medicine  and  public  health.  Many 
•county  and  municipal  councils  have  established 
bacteriological  laboratories  for  purposes  of  dia- 
gnosis of  pathological  specimens,  and  in  these  an 
enormous  number  of  experiments  are  performed 
day  by  day.  In  addition,  the  routine  work  of  the 
laboratories  in  connection  with  colleges  and  seats 
of  research  has  been  much  increased  by  their  con- 
tracting with  public  health  authorities  for  the 
performance  of  similar  work.  Restrictive  and 
vexatious  as  are  many  of  the  present  regulations 
concerning  experiments  on  animals,  it  is  well  that 
they  should  be  loyally  obeyed,  if  for  no  other 
reason  but  that  by  such  means  the  confidence  of 
the  public  may  be  won  to  help  in  getting  rid  of  the 
more  obnoxious.  On  this  account  we  are  glad  that 
the  inspectors  note  that  the  licensees  are  desirous 
of  acting  in  every  way  in  accordance  with  the 
spirit  and  letter  of  the  Act.  Only  two  trivial 
irregularities  occurred,  and  neither  of  them  in- 
volved any  cruelty  to  animals. 


Vaccination  Frauds  by  a  Medical  Man. 

The  pressure  of  the  modern  struggle  of  life 
alls  lieavily  upon  the  medical  profession,  owing 
in  a  great  measure  to  its  disorganised  condition. 
Under  such  circumstances  it  is  not  a  little  credit- 
able to  that  particular  profession  to  find  a  high 
general  standard  of  unimpeachable  honour  main- 
tained by  its  members.  Now  and  then  a  weaker 
brother  may  give  way  to  questionable  practices 
under  the  stress  of  temptation,  but  the  occurrence 
is  so  rare  as  to  attract  universal  attention  both 
in  lay  and  in  medical  quarters.  An  unfortunate 
affair  of  this  kind  has  just  been  before  the  Central 
Criminal  Court.  The  defendant,  Hugh  Stanley 
Revell,  was  a  medical  officer  and  public  vaccinator 
in  the  service  of  the  guardians  of  the  Wandsworth 
and  Clapham  Unions,  being  paid  £100  per  annum 
in  respect  of  his  duties  as  medical  officer,  and  by 
fees,  according  to  the  number  of  persons  vaccinated, 
as  vaccination  officer.  It  was  noticed  recently 
that  the  amount  of  his  fees  was  considerably  more 
than  was  paid  to  any  of  the  other  vaccination 


officers  in  the  union,  and  upon  investigation  it 
was  discovered  that  certificates  had  been  issued 
and  fees  charged  for  the  vaccination  of  children 
who  were  unknown  at  the  addresses  given,  for 
children  who  had  not  been  vaccinated  at  all, 
and  for  others  who  were  not  in  a  condition  of  health 
to  be  vaccinated.  In  this  way  the  defendant  had 
obtained  from  the  guardians  sums  in  excess  of 
those  he  was  entitled  to.  The  defence  ad- 
mitted he  had  yielded  to  temptation,  but  he  was 
desirous  of  making  what  restitution  he  could  by 
recouping  the  guardians  some  part  of  the  costs  of 
the  prosecution.  He  appealed  for  the  sentence 
to  be  postponed  until  next  session,  when  possibly 
the  Recorder  nught  be  able  to  take  a  course  which 
would  give  the  defendant  an  opportunity  of  re- 
deeming his  reputation.  The  Recorder,  in  post- 
poning the  sentence  as  desired,  said  he  did  not  by 
so  doing  intend  to  prejudge  the  sentence  he  might 
feel  called  upon  to  pass. 


Substitution  Legalised. 
It  is  not  often  that  the  Courts  are  called  upon 
to  decide  on  the  merits  of  a  case  of  substitution  of 
drugs  in  dispensing  prescriptions,  or  are  asked  to 
assess  damages  for  injuries  received  from  such 
substitution.  A  case  has,  however,  just  been 
decided  in  the  Supreme  Court  of  New  Yorfc  in 
which  a  patient  unsuccessfully  took  action  against 
a  drug  company  for  substituting  morphia  for 
heroin  in  the  dispensing  of  a  prescription.  It 
appears  that  the  patient,  who  was  known  by  her 
family  physician  to  be  specially  susceptible  to  the 
influence  of  morphia,  was  ordered  by  him  a  pro- 
prietary mixture  containing  i-24th  grain  of  hydro- 
chlorate  of  heroin  to  each  dose.  The  druggist, 
not  having  the  mixture  ordered,  substituted 
another,  containing  i-i6th  grain  of  morphia  per 
dose,  and  himself  added  i-i2th  grain  of  heroin. 
As  a  result  of  taking  the  medicine,  the  patient 
suffered  from  acute  opium  poisoning,  which  reacted 
seriously  on  her  state  of  health.  The  judge  who 
heard  the  case  took  the  extraordinary  course  of 
accepting  the  opinions  of  the  person  who  dispensed 
the  medicine  as  those  of  an  expert  witness,  although 
he  had  no  scientific  or  medical  training,  and  on  his 
evidence  alone  decided  to  dismiss  the  case,  stating 
that  there  was  no  evidence  of  an  excessive  dose  of 
morphia  having  been  administered.  We  sincerely 
hope  that  if  such  cases  are  to  find  their  way  into 
the  courts  in  this  country  they  will  receive  a  diffe- 
rent kind  of  consideration. 


Consumption  in  Ireland. 
We  are  glad  to  notice  that  the  claims  of  the 
Royal  National  Hospital  for  Consumption  on  the 
charity  of  the  public  are  receiving  strong  support 
in  the  daily  papers  in  Ireland,  since  it  is  practically 
the  only  charitable  institution  in  the  country  which 
devotes  itself  exclusively  to  the  treatment  of  con- 
sumption. Although  opened  only  eight  years  ago 
with  no  more  than  twenty  beds,  it  has  grown  so 
rapidly  that  no  less  than  a  thousand  patients  have 
been  treated  within  its  walls,  and  at  present  there 
is  accommodation  in  all  for  sixty-seven  patients. 


696    The  Medical  Press.     NOTES    ON    CURRENT    TOPICS. 


June  29,  1904. 


Quickly  as  it  has  developed,  it  has  not  at  all  kept 
pace  with  the  demand  for  admission,  and  the 
Governors  are  at  present  engaged  in  putting  up  a 
building  to  hold  nearly  forty  additional  beds.  As 
a  temporary  measure,  and  until  this  new  pavilion 
is  ready,  twenty  patients  are  at  present  lodged  in 
tents  in  the  grounds.  It  is  said  that  this  venture 
is  working  very  successfully,  and  that  the  tents  are 
most  popular  with  the  patients.  We  understand 
it  is  the  intention  of  the  Governors  shortly  to 
establish  in  connection  with  the  hospital  an  out- 
patient department  in  Dublin,  where  many  old 
patients  could  be  kept  under  observation,  and 
where  patients  unsuitable  for  admission  might 
receive  advice  as  to  treatment,  as  well  as  instruc- 
tion in  hygienic  precautions. 

The  Dkqpiofife  of  Whoopinff-Ccniffh. 
Pertussis  is  a  disease  which,  when  fully 
developed,  cannot  well  be  mistaken  for  anything 
else.  The  characteristic  "  whoop,"  when  once 
heard  by  the  student,  remains  as  a  definite  mental 
impression  indelibly  associated  with  the  malady. 
And  yet  there  are  other  conditions  in  which  a 
somewhat  similar  sound  is  produced  in  the  upper 
air-passages,  notably  in  the  peculiar  noise  heard 
when  a  foreign  body  is  in  the  larynx.  The  so- 
-called "child-crowing,"  or  laryngismus  stridulus, 
differs  from  the  prolonged  drawing-in  of  the  breath 
which  is  absolutely  distinctive  of  whooping- 
cough.  Enlargement  of  the  bronchial  glands  will 
occasionally  produce  a  cough  which  is  not  at  all 
unlike  that  of  pertussis.  Very  young  children  do 
not  whoop,  a  fact  which  is  important  to  be  borne 
in  mind,  for  they  may  be  the  source  of  contagion 
to  others  while  they  are  suspected  to  be  merely 
suffering  from  bronchitis  or  broncho-pneumonia. 
Any  irritation  which  affects  the  intra-arytaenoid 
region  of  the  larynx  is  apt  to  give  rise  to  a  spas- 
modic cough.  The  true  spasm  of  whooping- 
cough^  however,  is  brought  on  almost  invariably 
by  excitement,  which  is  often  of  quite  a  trivial 
nature.  It  is  in  the  early,  or  catarrhal,  stage  of 
the  disease  that  difficulties  are  most  apt  to  arise. 
A  lew  r*les  may  sometimes  be  heard  in  the  chest 
at  this  period,  but  one  of  the  most  suspicious 
signs  is  the  development  of  a  cough  which  gradually 
becomes  more  and  more  noisy,  especially  at  night. 
The  countenance,  too,  of  the  child  undergoes  a 
slight  change,  which  is  regarded  by  some  as 
characteristic  of  whooping-cough.  The  features 
become  swollen  and  somewhat  dusky,  and  the 
eyelids  are  often  of  a  pink  colour.  The  history 
of  a  possible  source  of  infection  will  generally  be  a 
valuable  guide.  Mistakes,  though,  may  arise, 
as  in  a  recent  case  in  which  an  infant  was  sent 
home  from  a  children's  hospital  with  broncho- 
pneumonia and  a  suspicious  "  croupy "  cough, 
which  was  thought  to  be  pertussis. 


Alterations  in  the  Death-Rate- 
If  the  vital  statistics  of   the  State  of  Massa- 
chusetts are  at  all  typical,  there  have  taken  place 
during    the    past  half  century  some  interesting 
and  important  changes  in  the  incidence  of  the 


death-rate.  Dr.  Whitney,  of  Boston,  has  brought 
together  some  of  these  in  a  recent  paper,  (a)  which 
deserves  consideration.  Taken  as  a  whole,  the 
death-rate  at  present  is  at  the  same  figure  as 
fifty  years  ago,  though  at  the  middle  of  the 
period  under  review  it  stood  much  higher.  The 
same  statement  holds  for  the  male  and  female 
rates  separately,  although  the  latter  has  always 
been  the  lower.  In  spite  of  the  general  stationari- 
ness  of  the  death-rate  during  fifty  years,  at  two 
particular  periods  it  shows  a  marked  increase — in 
the  year  of  infancy  and  after  the  age  of  fifty. 
In  other  words,  the  new-born  child  has  a  worse 
chance  of  surviving  his  first  year  of  life,  and  the 
person  of  fifty  has  a  worse  chance  of  living  to  old 
age.  Dr.  Whitney  believes  that  one  of  the  chief 
causes  of  infant  mortality  is  the  increase  of  the 
custom  of  hand-feeding  as  opposed  to  nursing, 
while,  of  course,  it  must  be  remembered  that 
nowadays  overcrowding  is  a  more  serious  evil 
than  half  a  century  ago,  when  the  population  of 
Massachusetts  was  only  a  third  of  its  present 
size.  Taken  in  conjunction  with  the  decreasing 
birth-rate,  the  increased  mortality  among  young 
children  is  a  serious  menace  to  the  stability  of  the 
race. 


Folk  Medicine  in  East  Anglia. 

There  are  few  more  enticing  bypaths  leading  off 
the  main  roads  of  medical  study  than  those  bring- 
ing us  to  the  beliefs  of  primitive  people  in  regard 
to  the  cure  and  prevention  of  physical  evils.  In 
some  cases  we  are  able  to  trace  curious  notions  and 
practices  back  to  obsolete  systems  of  thought, 
which  at  one  time  held  almost  universal  sway, 
while  in  other  customs  we  can  see  but  little  change, 
either  of  development  or  decay,  throughout  many 
centuries.  Medical  men,  especially  those  living  in 
country  districts,  would  find  it  a  pursuit  of  no 
small  interest  to  take  note  of  any  folk-customs  in 
medicine  and  surgery  which  they  from  time  to 
time  observe.  In  the  best  antiquarian  spirit. 
Dr.  Plowright  has  recently  collected  (6)  some  of  the 
survivals  of  mediaeval  medicine  which  he  has 
himself  noticed  in  Norfolk.  Many  of  the 
customs  he  mentions  are  by  no  means  confined  to 
East  Anglia,  nor  even  to  Saxon  countries,  but  are 
very  widely  spread,  as,  for  instance,  almost  all 
those  which  take  origin  from  the  belief  in  witch- 
craft. It  is  not  only  in  Norfolk  that  an  extracted 
tooth  is  carefully  preserved  or  carefully  destroyed 
lest  the  power  of  witchery  might  be  used  by  a 
chance  possessor  against  the  original  owner.  A 
curious  survival  of  the  faith  in  charms  is  the  custom, 
also  widespread,  of  carrying  a  stolen  potato  in  the 
trouser  pocket.  This  is  traced  to  the  ancient 
belief  in  the  efficacy  of  the  mandrake — of  the  same 
natural  order  as  the  potato — against  various  ills. 
Of  medicines  proper,  one  of  the  most  curious, 
mentioned  by  Dr.  Plowright  is  "  syrup  of  foxes' 
lungs,"  said  to  be  useful  for  "  oppressed,  hard- 
drawn  breathing.1'  A  medicine  under  this  title  is 
still  sold  by   country  chemists   in   the   district,. 


[a)  Boston  Med.  and  Surg.  Joum.,  May  19th,  1904. 
>)  BriU  Med.  Journ.,  June  11th,  1904. 


June  29,  1904. 


NOTES  ON  CURRENT  TOPICS.  The  Medical  Peiss.     697 


although  it  retains  nothing  of  the  composition  the 
title  would  infer.  Another  quaint  remedy  is  a 
preparation  of  snails,  supposed  to  have  a  special 
power  in  cases  of  phthisis.  We  suppose  it  is  as 
a  deduction  from  "  the  doctrine  of  signatures  " 
that  net  tie- tea  is  recommended  for  urticaria,  and 
viper  fat  for  viper  bites. 

The  L.C.C  and  Tuberculosis. 
The  London  County  Council  are  making  praise- 
worthy efforts  to  grapple  with  the  administrative 
•difficulties  that  beset  the  path  of  an  authority  at- 
tempting   to   fight    tuberculosis.     In    a   General 
Purposes  Bill  now  before  Parliament  they  are  seek- 
ing for  authority  to  slaughter  cows  whose  udders 
contain  tuberculous  deposits,  and  it  will  be  generally 
conceded,  pace  Professor  Koch,  that  it  is  highly 
desirable  in   the  interests  of  milk-drinkers   that 
they  should  be  in  a  position     to    do    so.      Of 
all  forms  of  bovine  tuberculosis  infiltration  of  the 
udder  is  the  most  dangerous,  for  it  has  been  shown 
time  and  again  that  the  milk  derived  from  cows 
so  affected  contains  actual  tubercle  bacilli.    To 
say  that  such  milk  is  unfit  for  human  consump- 
tion is  a  truism,  and  the  dairyman  who  knowingly 
or  negligently  sells  it  should  be  amenable  to  the 
severest  penalties.    However,  the  Select  Committee 
-of  the  House  of  Commons  seem  to  think  otherwise, 
ior  they  have  inserted  in  the  section  a  clause  that 
the  cows  are  to  be  slaughtered  only  on  condition 
that  if,  after  death,  the  diagnosis  is  confirmed 
the  owner  is  to  be  compensated  to  the  extent  of 
three-fourths  of  the  original  value  of  the  animal ; 
whilst  if  the  post-mortem  shows  that  it  was  not 
suffering   from   tubercle  he  is  to  be  paid  its  full 
value,  plus  twenty  shillings  for  expenses.     With  all 
respect  to  the  rights  of  property,  it  is  difficult  to 
see  how  in  equity  the  owner  of  an  infected  cow, 
which  is  distributing  disease  and  death  among  his 
Majesty's  subjects,  can  be  entitled  to  be  remu- 
nerated by   the  community  when  he  is  caught 
selling  its  milk.     Disease  in  live  stock  is  one  of 
the  risks  of  the  business,  and  one  that  should  be 
insurable  ;    at  all  events,  it  is  the  owner's  risk, 
and  he  should  take  steps  to  guard  against  it.     But 
to  pay  him  out  of  the  public  rates,  and  that  only 
when  he  is  discovered  by  an  inspector,  is  placing 
a  premium  on  a  crime  that  should  be  severely 
punishable. 


This  individual  is  a  miner  in  Scotland,  who  is 
sixty-three  years  of  age,  and  appears  only  lately 
to  have  discovered  his  "  gift."  He  has  enjoyed  a 
local  reputation  for  some  time,  but,  having 
recently  been  consulted  by  an  international  foot- 
ball player,  his  fame  has  spread,  and  he  is  now 
treating  patients  by  the  hundred.  The  village 
of  Blantyre,  where  he  lives,  has  become  a  regular 
Lourdes,  and  every  train  disgorges  crowds  of 
lame  and  impotent  folk  coming  to  be  cured — at 
ten  shillings  a  head.  The  growth  of  his  practice 
seems  to  have  been  too  much  for  Mr.  Rae,  for 
he  is  reported  to  be  ill  in  bed  from  overwork,  so 
that  the  cures  have  to  stand  over  till  the  healer 
himself  is  cured.  Of  course,  the  patients  have 
all  been  under  the  best  doctors  in  the  Kingdom, 
and  have  been  "  given  up."  That  one  expects, 
as  certainly  as  one  does  the  instantaneous  cure  of 
"  spinal  "  disease  and  lameness,  and  such,  indeed, 
is  the  history  of  each  patient  of  whom  reports 
find  their  way  into  the  newspapers.  It  is  to  be 
remarked  that  the  collier  surgeon  treats  bone 
diseases  only,  and  promises  no  cure  where  the 
deformity  is  the  result  of  nervous  disorder. 
One  would  have  thought  he  would  have  been  more 
successful  with  the  latter  class,  but  perhaps  it  is 
only  his  modesty  that  makes  him  distrustful  of 
his  own  skill  among  the  nervous  sufferers. 


Miner  Surgery. 
Of  all  forms  of  illegitimate  practice  none  is 
•quite  so  puzzling  to  the  uninitiated  as  that  of  bone- 
setting.  What  it  is  that  the  bone-setter  does,  or 
rather  what  it  is  that  silly,  credulous  people 
believe  he  does,  is  a  mystery.  That  he  lives  up  to 
his  name  and  sets  bones  is  difficult  of  compre- 
hension, as  the  reduction  of  a  dislocation  is 
generally  performed  by  the  surgeon  nearest  to 
the  scene  of  the  accident,  and  unreduced  disloca- 
tions are  too  rare  to  make  much  of  a  living  out  of. 
But  whatever  he  does,  he  makes  money.  The  star 
•of  the  Huttons,  phe  and  fils,  has  set,  and  "  Pro- 
fessor "  Atkinson  is  no  more,  but  a  new  luminary 
has  arisen  who  promises  to  outshine  them  all. 


Hot  Water  as  a  Remedy. 
The  use  of  simples  in  the  treatment  of  disease 
does  not  often  commend  itself  to  the  mind  of 
the  patient,  even  when  enjoined  by  the  physician. 
Too  frequently  the  sick  prefer  to  be  ordered  those 
remedies  which  are  the  most  difficult  to  procure, 
or  which  happen  to  be  fashionable   at  the  time, 
rather  than  obey  the  direction  to  wash  in  the  Jordan 
of  simplicity  and  homeliness.     The  waters  of  this 
healing   stream   have   no   attractions   for    them, 
however  well  its  virtues  may  be  known  to  those 
who    have    dipped    therein.     We    are    much    in 
danger  nowadays  of  magnifying  the  complex  and 
of  allowing  the  merits  of  the  simple  in  medicine  to 
slip  into  obscurity.     In  such  matters  we  can  well 
afford  to  pause  awhile  and  listen  to  the  precepts 
of  some  of  the  old  masters  of  the  healing  art.  They 
were  content  to  abide  by  Nature's  laws,  and  to 
pay  heed  to  the  dictates  of  common  sense  instead 
of  being  swayed  by  the  fatuous  announcements 
which   accompany    the   entry   of   every    "  new " 
drug  upon  the  market.     We  are  not  by  any  means 
minimising  the  labour  of  the  synthetic  chemist, 
to  whose  experiments,  in  conjunction  with  physic- 
logical  research,  modern  medicine  owes  so  much ; 
we  simply  desire  to  call  attention  to  the  fact  that 
there  exists  the  danger  of  passing  over  the  simpler 
remedies,  or,  at  any  rate,  of  not  beginning  treat- 
ment with  them  first.     The  virtues  of  hot  water, 
both  when  externally  applied  and  also  when  taken 
as  medicine,  have  long  been  known.     It  serves  to 
flush  the  surface  of  the  gastric  mucous  membrane, 
and  it  would  appear  even  to  excite  a  healthy  flow 
of  gastric  juice.     Dr.  George  S.  Keith,  in  his  little 
book,   "  Fads  of  an  Old  Physician,"  lays  stress 
upon  the  value  of  a  copious  draught  of  plafn  hot 


698   The  Medical  Press. 


NOTES  ON  CURRENT  TOPICS. 


June  29,  1904. 


water  in  relieving  a  threatened  attack  of  migraine. 
If  taken  early  in  the  morning  it  will  sometimes 
ensure  a  normal  action  of  the  bowels.  The  stimu- 
lant effect  of  mere  heat  is  also  useful,  and  as  a 
beverage  for  dyspeptics,  under  certain  circum- 
stances, hot  water  is  to  be  recommended. 


Women  and  Medicine. 

Professor  T.  Clifford  Albutt  presented  the 
prizes,  on  the  23rd  inst.,  at  the  London  School 
of  Medicine  for  Women,  Hunter  Street.  In  the 
course  of  an  interesting  address  he  remarked  that 
the  lady  doctor  had  come  to  stay,  and  there  was 
now  no  reason  for  defending  a  school  of  that  kind. 
Women  had  been  wise  in  having  a  school  to  them- 
selves, but  the  time  had  now  come  when  they 
must  take  a  step  forward  and  be  members  of  the 
great  colleges  and  guilds  of  their  profession.  He 
should  be  glad  to  see  women  belonging  to  such 
historic  institutions  as  the  College  of  Physicians 
and  the  College  of  Surgeons,  and  it  was  an  un- 
doubted fact  that  at  the  Congress  of  Physicians 
men  had  derived  great  interest  and  instruction 
from  papers  read  by  women. 


The  Ice-Cream  Man. 
In  these  days  of  panic  at  the  onslaughts  of 
the  everywhere  microbe,  it  is  no  small  comfort  to 
learn  that  some  of  our  fears,  at  any  rate,  may  be 
dismissed.  It  seems  that  bacteria  and  ptomaines 
are  not  the  only  deadly  agencies  in  the  ices  vended 
from  the  Italian  street  barrow.  Cold  is  another 
factor  in  the  question,  and  in  certain  states  of  the 
digestion  the  swallowing  of  solidly  frozen  fluids 
is  apt  to  be  attended  with  serious  or  even  fatal 
results.  That  is  the  view  taken  recently  by  the 
City  of  London  Coroner,  Dr.  Waldo,  at  an  inquest 
held  upon  a  boy,  eight  years  of  age,  who  died 
on  Monday  morning.  It  appears  that  on  the 
Sunday  he  ate  a  "  good  dinner  "  of  salted  pork, 
greens,  potatoes  and  suet  pudding  ;  on  the  same 
afternoon  he  bought  some  acid-drops,  and  in  the 
evening  a  halfpenny  ice,  which  was  served  to  him 
in  paper.  It  seems  somewhat  unfair  in  this  case 
to  attribute  death  to  the  ice,  especially  as  the 
vendor,  one  Pizzofero,  sold  an  enormous  quantity 
on  the  same  day,  but  without  other  reported 
misadventure.  The  Coroner  remarked  that  some 
time  ago  he  had  gone  into  the  question  and  found 
that  the  Italians  nearly  always  boil  the  milk  used 
in  making  their  ices.  The  Italian  conditions 
compare  favourably  with  those  of  some  West  End 
establishments  where  ices  are  made.  It  is  gratify- 
ing to  learn  on  good  authority  that  the  ice-cream 
man  is  not  always  so  black  as  he  is  painted.  The 
merchant  from  whom  he  buys  his  ice  is  often  grossly 
insanitary.  If  ice-creams  are  dubious  there  is 
always  a  judge  of  appeal  at  hand  in  the  person  of 
the   scientific   bacteriologist. 


The  devotees  of  fashion,  however,  do  not  stop 
here,  but  examine  minutely  the  geometrical 
proportions  and  artistic  contour  of  their  features 
in  order  to  improve,  if  possible,  what  Nature  has 
provided.  The  gift  of  featural  perfection  is  not 
lavished  upon  the  human  race,  although  some  of 
the  peoples  of  the  earth  are  better  off  in  this 
respect  than  others,  at  least,  according  to  our 
own  preconceived  ideas  of  what  is  becoming. 
There  are  many  deluded  individuals  who,  forgetting 
that  facial  beauty  is  not  all,  deliberately  endeavour 
to  "  correct "  what  they  are  pleased  to  call  the 
mistakes  of  Nature.  Preying  upon  this  unnatural 
desire,  a  perfect  horde  of  so-called  "  beauty- 
doctors  "  has  arisen,  many  of  whose  methods  we 
have  previously  denounced  in  our  columns.  One 
of  the  latest  novelties  in  this  direction  emanates 
from  Paris  in  the  shape  of  a  special  corset  for  the 
nose.  Whatever  form  this  nasal  bulwark  may 
assume — and  we  have  not  seen  one,  nor  do  we 
particularly  desire  to  do  so — it  is  readily  con- 
ceivable that  prolonged  and  severe  pressure  for 
the  correction  of  a  supposed  malformation  may 
be  most  injurious  under  certain  circumstances. 
Some  forms  of  hypertrophic  rhinitis  would  be 
greatly  aggravated  by  the  wearing  of  such  an 
apparatus,  while  it  is  questionable  if  mere  altera- 
tion in  position  would  have  the  slightest  effect  in 
removing  a ' '  bottle ' '  nose  or  in  overcoming  a  chronic 
blush.  For  mere  cosmetic  effect,  it  is  questionable 
even  if  the  hypodermic  injection  of  paraffin  be  at 
all  times  justified.  To  lower  the  art  of  surgery  to 
the  level  of  mere  facial  beautification  may  be 
sometimes  undignified,  but  to  tamper  with  the 
anatomical  outlines  of  the  human  countenance 
is  one  of  the  most  insidious  forms  of  quackery  when 
undertaken  by  unskilled  hands,  and  for  the  sake 
of  pampering  a  foolish  vanity. 


Tampering  with  Features. 

The  primitive  desire  for  personal  adornment  is 
not  limited  to  matters  of  dress  and  apparel. 
Personal  appearance  in  both  sexes  is  influenced 
greatly  by  different  methods  of  wearing  the  hair. 


Petticoats  as  Bacteria  Traps. 

The  advocates  of  the  rational  dress  will  find 
scientific  support  for  their  crusade  in  the  re- 
searches of  Dr.  Casaguar,  of  Rome,  and  it  is  to- 
be  hoped  they  may  not  have  overlooked  his  report 
on  the  subject,  for  it  will  furnish  fine  material  for 
making  their  erring  sisters'  flesh  creep.  Dr. 
Casaguar  hired  a  number  of  women,  presented 
them  with  long  skirts,  and  bade  them  parade  the 
streets  of  the  Eternal  City  for  the  space  of  one 
hour.  On  their  return  he  divested  them  of  their 
garments,  and  proceeded  to  examine  them  bac- 
teriologically.  His  results  were  startling.  On  the 
skirts  he  found  innumerable  bacteria,  including 
the  bacilli  of  influenza,  typhoid  fever,  and  tetanus, 
and  from  his  discoveries  many  lessons  have  been 
drawn  to  show  how  much  disease  and  misery  may  lie 
hidden  in  women's  nether  garments,  no  matter 
how  attractive  their  shape,  colouring  and  ma- 
terial. Women  will  give  up  wearing  skirts  at 
the  precise  moment  when  they  discover  another 
as  suitable  for  purposes  of  adornment  and  as  '*  fetch- 
ing "  to  the  eye  of  the  male.  That  day  is  not  yet 
with  us,  nor  likely  to  be  for  some  time,  and,, 
taken  all  round,  the  skirt  is  about  the  least  un- 
suitable article  of  the  attire  that  lovely  woman 


June  20,  1904. 


SPECIAL  CORRESPONDENCE. 


The  Medical  Press.     69Q 


dons.  Let  us  therefore  leave  her  in  free  enjoyment 
of  it  while  she  may.  The  boots  of  Dr.  Casaguar's 
ladies  probably  contained  the  same,  if  not  more 
terrible,  microbes,  and  no  one  has  yet  suggested 
that  women  should  give  up  wearing  boots.  After 
all,  one  has  to  take  some  risk  in  one's  daily  goings- 
out  and  comings-in,  and  we  cannot  pass  through 
life  in  a  perfectly  aseptic  condition,  however 
much  we  may  wish  and  strive  to  do  so.  Perhaps, 
on  the  whole,  it  would  be  better  to  let  the  sleeping 
microbes  on  the  ladies'  skirts  he. 


The  New  Brompton  Hospital. 

The  Brompton  Hospital  for  Consumption  and 
Diseases  of  the  Chest  marked  a  new  chapter  in  its 
distinguished  history  on  Saturday  last,  June  25th, 
when  Their  Royal  Highnesses  the  Prince  and 
Princess  of  Wales  opened  the  Sanatorium  and 
Convalescent  Home  at  Heatherside,  Camberley. 
This  step  provides  a  country  retreat  for  the  con- 
sumptive poor,  and  should  do  much  to  further  the 
renown  of  Brompton.  Obviously,  its  supple- 
mentary benefits  prove  of  the  greatest  possible 
benefit  to  many  of  the  cases  requiring  open-air 
treatment.  It  is  encouraging  to  find  the  Bromp- 
ton Hospital  keeping  abreast  of  the  times  and 
taking  a  common-sense  attitude  with  regard  to 
decentralisation.  What  reasonable  being  would 
deliberately  elect  to  keep  his  consumptive  patients 
in  a  crowded  city  ?  A  description  of  the  new 
sanatorium  appears  in  another  part  of  our  present 
issue. 


PERSONAL. 
It  is  announced  that  St.  Bartholomew's  Hospital 
has  benefited  to  the  extent  of  ^609  through  the  concert 
recently  given  by  Signora  Giulia  Ravogli. 


The  prizes  to  the  students  of  the  Royal  Dental 
Hospital  of  London  will  be  presented  by  Sir  William 
Collins,  F.R.C.S.,  on  Wednesdav,  July  13th,  at  8  p.m. 


The  winner  of  the  Warren  Prize  of  £100,  in  the  gift 
of  the  Massachusetts  General  Hospital,  for  the  best 
dissertation  on  a  physiological,  surgical,  or  pathologica 
subject,  has  been  awarded  to  Dr.  Max  Borst,  Professor 
in  Pathological  Anatomy  at  the  University  of  Wurzburg. 

Her  Majesty  the  Queen  attended  the  Bazaar  in 
Aid  of  the  Victoria  Hospital  fdr  Children  held  in  the 
Royal  Albert  Hall,  London,  on  the  24th  inst.  She 
remained  some  time,  and  made  numerous  purchases. 

Dr.  D.  J.  Williams  has  succeeded  the  late  Dr.  J.  W. 
Plaxton  as  Medical  Superintendent  of  the  Lunatic 
Asylums,  Jamaica. 


Dr.  J.  A.  De  Wolf,  Surgeon -General  of  Trinidad,  has 
arrived  in  England  on  leave  of  absence,  during  which 
Dr.  C.  F.  Knox  acts  as  Surgeon-General,  Dr.  J.  W. 
Eakin  as  District  Medical  Officer,  Port  of  Spain  North, 
and  Dr.  E.  I.  Reid  as  District  Medical  Officer,  Port  of 
Spain  South. 


Countess  E.  V.  Schouvaloff  is  providing  a  hospital 
with  100  beds  for  the  seat  of  war  in  the  Far  East,  and 
she  will  maintain  it  at  an  estimated  cost  of  £600  per 
month. 


The  resignation  is  announced  of  Dr.  A.  P.  Luff  from 
the  post  of  Chemical  Analyst  to  the  Home  Office. 

Dr.  Major  Greenwood  *  ill  preside  at  the  annual 


dinner  of  the  Brussels'jMedical  Graduates'  Association, 
at  the  Trocadero,  London,  on  July  5th,  fc       m 

».*» 

Mr.  G.  H.  Makins,C.B.,  presided  at  the  fourth  annual 
South  African  Civil  Surgeons'  Dinner  on  Tuesday, 
June  28th,  at  the  Hotel  Cecil. 


Dr.  F.  M.  Sand  with  has  been  appointed  to  the 
teaching  staff  of  the  London  School  of  Tropical  Medi- 
cine.   

Madame  Macaicne  recently  read  the  first  paper 
communicated  by  one  of  her  sex  to  the  Paris  Academie 
de  Medecine. 


It  is  rumoured  that  Sir  William  Turner,  K.C.B. 
contemplates  resigning  the  Presidency  of  the  General 
Medical  Council  in  the  course  of  the  next  few  months 


BIRTHDAY  HONOURS. 
The  following  were  officially  gazetted  on  Friday  last : 
— Dr.  T.  Stevenson,  Scientific  Analyst  to  the  Home 
Office,  receives  the  honour  of  Knighthood.  A  Knight- 
hood has  also  been  conferred  upon  Kendal  Franks 
C.B.,  M.A.,  M.D.,  F;R.C.S.L,  South  Africa;  and  the 
following  are  promoted  to  Ordinary  Members  of  the 
Military  Division  of  the  Second  Class,  or  Knight 
Commanders  of  the  Bath  : — Surgeon  T.  Ligertwood , 
retired  pay,  late  Physician  and  Surgeon  Royal  Hospital, 
Chelsea,  with  the  local  rank  of  Colonel.  Deputy- 
Surgeon  J.  W.  Thornton,  C.B.,  late  Indian  Medical 
Service ;  and  Surgeon-General  E.  Townsend,  C.B., 
C.M.G.,  Army  Medical  Staff. 

Special  corteapon&ence. 

[from  our  own  correspondents.] 

SCOTLAND. 

Medical  Women  Practising  in  Scotland. — A  pri- 
vate conference  of  medical  women  practising  in  Scotland 
met  in  Edinburgh  on  June  18th.  It  was  summoned 
by  Dr.  Emily  Thomson,  Dundee,  and  was  attended 
by  fifty-three  medical  women  from  all  the  larger 
centres  and  many  of  the  country  districts.  The  sub- 
jects under  discussion  were — first,  the  lines  on  which  the 
future  medical  education  of  women  should  be  carried  on 
in  Scotland,  especially  in  connection  with  the  destina- 
tion of  a  large  sum  of  money  which  has  recently  become 
available  for  the  furtherance  of  that  object  in  Glasgow; 
and,  second,  the  possibility  of  obtaining  for  women 
admission  to  the  Fellowship  of  the  two  Royal  Colleges — 
a  qualification  which  is  necessary  in  order  to  enable 
women  to  compete  for  many  important  hospital  appoint 
ments.  Committees  were  appointed  to  take  the  neces 
sary  steps. 

Small-pox  in  Glasgow.— For  the  fortnight  ending 
June  nth  there  were  33  cases  of  small-pox,  a  diminu- 
tion of  15  as  compared  with  the  preceding  fortnight, 
and  for  the  week  ending  on  the  18th,  16  cases.  The 
continued  prevalence  of  the  disease  and  its  present  dis- 
tribution gives  rise  to  considerable  misgiving  with  re- 
gard to  its  continuance  into  the  autumn  months.  The 
nomadic  habits  of  the  lodging-house  population  places 
the  administration  at  a  great  disadvantage  in  dealing 
with  infectious  disease  among  them,  and  all  will  agree 
with  Dr.  Chalmers,  the  medical  officer  of  health,  in 
thinking  that  until  we  have  a  system  of  national  re- 
vaccination,  the  need  to  restrain  movement  in  certain 
cases  is  as  necessary  as  the  need  to  revaccinate,  and 
the  option  to  extend  both  beyond  the  immediate  area 
of  known  infection  is  desirable.  In  Glasgow  the  greatest 
attack-rate  is  in  Dalmarnock,  where  the  hospital  is 
situated. 

Chalmer's  Hospital,  Edinburgh.— The  hospital  will 
be  closed  for  extensive  alterations  in  the  out-patient 
department  and  operating  theatre  during  July,  August, 
and  September,  at  the  expiry  of  which  period  the 
term  of  office  of  Mr.  Stiles,  the  recently  elected  surgeon, 
begins.  The  directors  have  appointed  Dr.  D.  C.  A. 
McAllum  anaesthetist  to  the  institution. 


700     The  Medical  Press. 


CORRESPONDENCE. 


June  29,  1904. 


Edinburgh  Royal  Infirmary  Residents'  Club. — 
The  tenth  annual  dinner  of  this  club  was  held  in  Edin- 
burgh on  June  10th.  Sir  William  Mitchell  Banks  pre- 
sided over  a  turn-out  of  over  eighty  members.  The 
dinner,  which  was  one  of  the  best  attended  of  all  the 
club  has  had,  owed  no  small  part  of  its  success  to  the 
geniality  of  the  chairman,  whose  reminiscences  of  old 
infirmary  days  charmed  all  his  auditors.  The.  member- 
ship of  the  club  is  now  just  about  400,  and  much  of  its 
popularity  and  vigour  are  due  to  the  energy  of  the 
secretary,  Dr.  Ker,  who  was  mainly  instrumental  in 
founding  it  some  ten  or  eleven  years  ago.  He  has  been 
compelled  to  resign,  and  his  successor,  Dr.  Edwin 
Bramwell,  was  unanimously  elected.  Professor 
Annandale  was  appointed  President  for  the  ensuing 
year. 

Woodburn  Sanatorium  for  Consumption,  Edin- 
burgh.— An  interesting  reunion  of  former  patients 
was  held  at  Woodburn  Sanatorium  on  May  2  5  th.  Some 
thirty  ladies  and  gentlemen  were  present,  all  of  whom 
have  been  under  open-air  treatment  at  some  period 
during  the  last  five  years,  and  no  one  observing  their 
robust  and  vigorous  appearance  would  suppose  that 
all  of  them  had  been  the  victims  of  tuberculosis,  some 
in  an  advanced  stage.  Nearly  all  of  them  are  now  able 
for  the  work  of  life  again — as  clergymen,  doctors, 
.  students,  tradesmen,  or  in  the  not  less  onerous  sphere 
of  domestic  and  social  duty.  Besides  the  thirty  patients 
who  were  present,  letters  were  received  from  as  many 
more  who  for  various  reasons— distance,  pressure  of 
business,  &c. — were  unable  to  attend.  Such  a  reunion 
as  this  seems  a  most  commendable  event  in  sanatorium 
practice,  if  for  no  other  reason  than  the  psychological 
effect  it  must  have  on  those  undergoing  treatment  at 
the  time  by  inspiring  them  with  hope  for  the  future 
through  seeing  fellow-subjects  restored  by  open-air 
treatment  to  active  and  useful  lives. 

Leith  and  Tuberculosis. — At  last  meeting  of  the 
Leith  Council  a  report  (of  which  consideration  was 
delayed)  was  submitted  by  Dr.  Robertson,  the  medical 
officer  of  health.  His  recommendations  are : — Aid 
should  be  given  to  local  practitioners  in  the  bacterio- 
logical diagnoses  of  phthisis.  Voluntary  notification 
should  be  adopted.  Suitable  early  cases  should  be 
isolated  and  treated  ;  he  suggested  that  meanwhile 
they  should  limit  the  number  of  these  to  twelve — six 
male  and  six  female.  He  does  not  advise  the  Council 
to  accept  the  suggestion  of  the  local  practitioners  to  iso- 
late and  treat  advanced  cases  of  phthisis. 


BELFAST. 
The  Small-pox  Epidemic. — During  the  past  week 
five  new  cases  of  small-pox  were  admitted  to  the  hospital 
at  Purdysburn.  For  the  past  five  days  no  new  cases 
have  been  discovered  in  the  Ballymacarett  district  of 
Belfast,  and  it  is  hoped  that  the  last  of  the  cases  infected 
at  the  wake  reported  a  week  ago  have  occurred.  The 
Public  Health  authorities  continue  to  report  that  the 
cases  are  of  a  very  mild  type,  but  unfortunately  the 
exact  contrary  is  the  case,  many  of  them  being  exceed- 
ingly severe.  No  further  fatal  case  has  occurred, 
happily,  but  some  now  in  hospital  are  so  ill  that  they  are 
hardly  expected  to  recover.  A  number  of  medical  men 
and  some  students  have  been  taking  the  opportunity  of 
attending  the  Purdysburn  Hospital  to  become  familiar 
with  the  disease  in  all  stages,  and  in  all  degrees 
of  severity,  such  as  may  now  be  seen  there.  Some 
difficulty  has  arisen  about  accommodation  for  cases 
occurring  in  the  small  towns  around  Belfast,  the  hospi- 
tal at  Purdysburn  being  already  insufficient  for  the 
needs  of  the  city.  At  Lisburn,  where  four  cases  have 
occurred,  the  local  authorities  have  decided  to  keep 
the  cases  in  their  own  fever  hospital. 

The  Corporation,  the  Guardians,  and  the 
Treatment  of  Consumptive  Patients. — For  many 
months  past  the  two  public  bodies  named  have  been 
discussing  the  provision  of  suitable  sanatoria  for  the 
treatment  of  pauper  and  other  consumptive  patients. 
It  appeared  as  if  the  ratepayers  might  have  to  pay  for 
two  separate  schemes,  both  more  or  less  experimental, 
but  happily  the  Local  Government  Board  has  come  to 


their  rescue,  and  in  a  long  and  important  letter  has  laid 
down  for  the  guardians  the  lines  on  which  their  scheme 
ought  to  run.  The  letter  points  out  first  that  though 
the  two  bodies  concerned  have  different  powers  and 
different  duties,  the  funds  for  their  schemes  come  from 
practically  the  same  ratepayers,  and  that  therefore  they 
ought  to  co-operate  or  at  least  confer,  so  as  to  make  the 
best  provision  ( 1 )  for  the  treatment  and  cure  of  suitable 
cases  in  the  early  stages  of  the  disease,  and  (2)  the  isola- 
tion and  care  of  all  other  cases  which  seek  hospital 
treatment.  The  Belfast  Corporation,  as  the  sanitary 
authority,  is  mainly  interested  in  the  question  from  the 
public  health  point  of  view,  and  would  have  as  their 
object  the  prevention  of  the  spread  of  the  disease,  by 
taking  charge  of  the  earlier  and  more  curable  cases  in  a 
sanatorium.  The  guardians,  on  the  other  hand,  deal  with 
a  large  number  of  patients  in  advanced  stages  of  the 
disease,  and  could  not  refuse  to  take  as  many  of  them  as 
were  suitable  for  admission  to  a  workhouse  hospital. 
Pending  a  definite  decision  on  all  points  the  Local 
Government  Board  asks  the  Corporation  and  the 
guardians  to  consider  the  whole  matter  in  the  broadest 
light,  and  to  determine  the  lines  on  which  the  question 
will  be  dealt  with.  The  letter  is  a  most  valuable 
aid  to  the  settling  of  this  important  question  in  Belfast, 
for  coming  from  such  a  source  it  cannot  be  ignored,  as 
sensible  suggestions  of  this  kind  are  only  too  apt  to  be 
by  the  members  of  our  public  boards. 

Correspondence* 

[We  do  not  hold  ourselves  responsible  for  the  opinions  of  oar  Cor- 
respondents]. 

UNIVERSITIES    AND    EXAMINATIONS. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — It  is  well  that  those  who  are  interested  or 
engaged  in  the  developement  of  universities  should 
consider  carefully  what  are  the  objects  and  practical 
uses  of  a  university.  If  a  university  limits  its  function 
simply  to  holding  examinations  and  leaves  the  work  of 
education  to  others  it  is  one  thing.  If,  on  the  other 
hand,  a  university  makes  education  its  chief  work  and 
the  examinations  a  test  only  of  how  the  students  have 
attended  to  what  they  have  been  taught,  is  another 
thing.  A  good  university  combines  the  two,  and  as 
the  work  of  teaching  is  far  the  more  important  and 
difficult,  those  universities  are  to  be  preferred  and 
supported  and  encouraged  which  do  not  shirk  such 
duty.  Now,  there  is  a  great  difference  between  the 
teaching  of  classics,  mathematics,  history  and  certain 
branches  of  science  and  that  of  such  an  art  as  medi- 
cine. The  teaching  of  an  art  which  requires  the  per- 
sonal direction  of  the  hand,  the  eye,  and  technical  de- 
tails is  not  to  be  carried  on  in  the  same  way  as  any 
subject  that  can  be  learnt  only  from  books,  and  by 
mental  work.  The  important  question  at  the  present 
time  is  not  the  examinations  for  medical  and  surgical 
diplomas,  but  how  the  teaching  of  the  various  sub- 
jects that  combine  to  fit  and  make  for  the  practice  of 
the  profession  of  medicine  can  be  best  conducted.  If 
a  university  or  corporate  body  obtain  legal  power 
to  grant  legal  rights  by  granting  diplomas  and  con- 
ferring degrees  to  practise  medicine,  it  may  certainly 
profit  in  a  pecuniary  way  from  the  money  paid  by 
those  who  obtain  the  privilege ;  but  their  ought  cer- 
tainly to  be  some  superior  power  that  can  control  the 
examinations  so  that  they  do  not  abuse  the  legal  rights 
they  enjoy.  We  have  been  drifting  for  some  years  into 
a  system  of  cramming  our  students  for  examinations 
and  making  the  passing  of  them  of  far  more  importance 
than  the  teaching  of  the  practical  science  that  is  the 
basis  of  professional  work.  It  is  the  book  knowledge 
that  examinations  generally  test,  and  not  the  practical ; 
and  the  result  is,  that  when  the  student  has  cleared 
his  examinations,  he  throws  books  aside  and  studies 
his  profession  in  a  proper  way. 

We  do  not  want  to  bring  ourselves  to  the  state  of 
China  by  carrying  on  this  foolish  and  most  injurious 
system  of  examinations,  and  it  is  well  that  some  of  us 
should  use  our  best  endeavours  to  prevent  it. 

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


June  29,  1904. 


CORRESPONDENCE. 


The  Medical  Press.     701 


"  WHAT  IS  A  DEGENERATE  ?  " 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir, — As  a  student  of  sociology  I  scan  your  pages 
every  week,  and  am  rarely  disappointed  in  my  search 
for  mental  pabulum  useful  in  pursuit  of  my  subject. 
From  this  standpoint  I  beg  permission  to  ask — and 
perhaps  Dr.  Rentoul  will  kindly  inform  us — whether 
the  discussion  of  the  proposed  sterilisation  of  certain 
degenerates  is  of  what  is  called  a  merely  academic 
character,  or  whether  the  proposed  measure  is  thought 
to  be  within  the  sphere  of  practical  politics  in  any 
civilised  state.  Must  not  the  definition  of  degeneracy 
and  the  means  of  discovering  and  discriminating  the 
truly  degenerate  be  placed  on  a  solid  scientific  basis 
before  any  practical  action  can  be  taken  ?  If  habitual 
criminality  marks  the  degenerate,  how  is  the  habitual 
criminal  who  is  physically  and  mentally  fit  to  be 
detected  and  sterilised.  There  exists  a  certain  type 
of  criminal  exemplified  in  the  City  shark  and  the  quack 
doctor — I  mean  the  qualified  and  able  quack  doctor — 
who  possess  most  of  the  attributes  of  high-class  man- 
hood. They  are  simply  devoid  of  moral  sense,  and 
without  pangs  of  conscience  devote  themselves  to 
amassing  wealth  by  the  plunder  and  maltreatment  of 
weak  and  suffering  humanity.  They  form  a  large  class  : 
but  it  is  only  rarely  one  of  them  takes  his  deserved 
place  in  the  felon's  dock.  Compared  to  men  of  this 
class  the  professional  burglar,  who,  by  the  way,  is  also 
very  often  a  fine  specimen  of  the  human  animal, 
physically  powerful  and  by  no  means  necessarily  a 
coward,  is  almost  a  brave  and  honourable  gentleman  ; 
his  criminality  not  infrequently  may  be  traced  entirely 
to  the  influence  of  his  environment  during  develop- 
ment from  youth  to  manhood.  On  the  other  hand, 
some  of  the  most  brilliant  leaders  of  intellectual  move- 
ments of  national  or  even  world-wide  importance  have 
been  physically  so  inferior  as  to  claim  in  that  regard 
par  excellence  the  title  degenerate.  It  would  be  easy 
to  name  some  latter-day  examples  of  this  class.  Not 
so  late  an  example  is  Heine.  Much  of  Heine's  finest 
work  was  done  when  he  was  a  bedridden  cripple,  the 
brain  continuing  to  the  very  end  to  work  brilliantly 
in  the  wasted  and  pain-racked  body.  Can  the  State 
be  called  upon  to  devise  measures  for  the  sterilisation 
of  any  class  of  supposed  degenerates  before  the  Govern- 
ment and  the  people  have  discussed  and  put  into  action 
the  means  science  affords  for  the  prevention  of  degen- 
eracy. Moral  and  physical  degeneracy  due  to  pauper- 
ism are  certainly  preventable.  Most  diseases,  like 
syphilis  and  tuberculosis,  which  lead  to  physical 
degeneracy  may  be  stamped  out ;  whilst  science  alone 
or  science  and  religion  together  may  teach  the  majority 
of  men  that  happiness  and  peace  of  mind  are  not  to  be 
gained  by  the  narrow  form  of  egoism,  the  growing 
vice  of  civilised  races,  the  selfishness  which  places  before 
everything  ease,  pleasure  and  luxury,  and  looks  upon 
toil  and  self-sacrifice  with  loathing  and  fear.  Science 
is  giving  to  mankind  the  power  more  and  more  to 
mould  their  physical  and  moral  future.  If  modern 
nations  avail  themselves  of  this  knowledge  they  may  be 
saved  ;  if  not,  in  spite  of  sterilisation  of  degenerate 
members,  they  will  go  to  the  ruin  to  which  all  ancient 
civilisations  finally  drifted  from  similar  causes ;  with  the 
difference  that  they  will  go  not  blindly  but  with  eyes 
wide  open  and  with  full  view  of  their  chosen  and  inevit- 
able destiny. 

I  am,  Sir,  yours  truly, 

A  Student  of  Sociology. 


To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — Will  you  allow  me  to  corroborate  Dr.  Rentoul's 
assurance  that  there  was  no  squabble  between  him  and 
myself  as  to  the  meaning  of  the  term  "  degenerate  "  ? 

Dr.  Rentoul  published  a  book,  proposing  to  sterilise 
degenerates.  When  I  was  a  schoolboy,  I  permitted 
one  of  my  schoolfellows,  at  his  earnest  request,  to  tattoo 
a  letter  on  my  arm.  I  now  find,  to  my  horror,  that  the 
possession  of  a  tattoo  mark  is  an  infallible  sign  of  the 
"  degeneracy  "  of  the  possesssor  ;  and  Dr.  Rentoul's 
proposal  filled  me  with  apprehension  and  dismay.  I 
therefore  asked  him  what  he  meant  by  a  degenerate, 


and  was  relieved  to  find  that,  for  the  present,  I  may  ven- 
ture abroad  without  running  the  risk  of  being  arrested 
and  subjected  to  a  surgical  operation.  I  sincerely 
trust  that  the  schedule  to  what  will  be  known  as 
"  Rentoul's  Act  "  may  be  drawn  with  care  ;  or  the  birth- 
rate, already  diminishing,  may  be  brought  to  the 
vanishing  point. 

I  am,  Sir,  your  truly. 

Chas.  Mercier. 


THE  MIDWIVES'  INSTITUTE. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — In  a  leading  article  of  your  issue  of  June  8th,. 
you  say,  in  speaking  of  the  Midwives'  Institute,  "  of 
many  subjects  discussed  one  may  be  mentioned  ;  it 
was,  as  we  remember,  in  the  form  of  a  paper,  and  was 
entitled,  "  Malthusianism,  or  Tired  Ovaries."  I  ant 
desired  to  ask  you  kindly  to  correct  this  statement  as 
no  such  paper  has  ever  been  read  or  discussed  nor  such 
a  debate  ever  contemplated  by  the  Midwives'  Institute. 
In  the  interest  of  truth  it  would  seem  a  pity  that  the 
writer  of  the  article  did  not  verify  statements  made 
before  publishing  them  as  facts. 

I  am,  Sir,  your  truly, 

R.   P.   Fynes-Clinton. 

Secretary. 

[We  publish  our  correspondent's  letter  as  requested. 
At  the  same  time  we  desire  to  state  that  the  writer  of 
the  article  in  question  himself  saw  an  agenda  paper 
purporting  to  come  from  the  Midwives'  Institute  and 
containing  the  title  of  a  paper  as  above,  which  was  put 
down  for  the  next  meeting.  The  writer  was  impressed 
at  the  time  by  the  apparent  want  of  connection 
between  the  Institute  and  such  subjects.  Will  the 
Secretary  consult  the  agenda  paper  which  was  issued 
to  the  members  of  the  Institute  shortly  before  or 
immediately  after  January  9th,  1898  ? — Ed.] 

LUNACY  AND  THE  ARCHDEACON'S  BROTHER. 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Sir, — The  paradoxical  statement  by  Dr.  Distin,  in 
this  painful  case  to  which  "  R.  L."  calls  attention — viz., 
"  that  the  man  was  a  criminal  lunatic,  but  it  was  one  of 
those  cases  where  they  could  not  certify  insanity," 
furnishes  another  instance  of  the  indefiniteness  of  the 
term  insanity. 

I  remember  a  report  of  a  case  in  the  daily  papers 
which  related  of  a  medical  witness  who,  upon  being 
asked  as  to  what  insanity  was,  replied  something  to 
the  effect  that  it  would  take  him  a  day  or  two  to  define 
it.  Now,  sir,  it  is  evident  that  when  a  medical  man 
enters  the  box  to  give  evidence  on  a  subject  which  he 
cannot  define,  such  a  procedure  must  produce  an  un- 
favourable impression  on  the  jury,  and  hence  preju- 
dice a  case,  and  although  it  is  undoubtedly  extremely 
difficult  and  impossible  to  define  with  geometrical  pre- 
cision mental  conditions  as  we  can  things  material,, 
nevertheless  I  submit  we  might  with  the  general  assent 
of  experts  in  lunacy  law  find  some  rough  and  ready 
practical  definition  of  insanity  which  would  enable  us, 
so  to  speak,  to  shake  our  fists  in  the  face  of  any  bullying 
counsel.  Let  us  suppose,  then,  for  instance,  the 
medical  profession  insist  upon  defining  insanity  for  legal 
purposes  as  a  morbid  condition  of  mind  requiring  super- 
vision I  use  the  word  supervision  advisedly — and  as 
not  necessarily  implying  restraint.  Now,  when  a 
medical  man  is  called  upon  to  determine  the  sanity  or 
insanity  of  any  given  individual  he  clearly  has  to 
decide  in  his  own  mind  to  what  degree  such  individual 
deviates  mentally  from  the  vast  majority  of  individuals 
of  the  same  nationality,  and  he  has  to  differentiate 
between  superstition,  harmless  delusions,  fancies  and 
fads,  on  the  one  hand,  common  to  an  infinite  number  of 
minds,  and  delusions  and  other  conditions  of  mind 
which  may  be  highly  prejudicial  or  detrimental  to  the 
individual  and  the  community  at  large  on  the  other.and 
his  decision  on  the  one  case  or  the  other  carries  with 
it  the  necessity  or  otherwise  of  depriving  a  person  of  his 
legal  liberty  on  the  question  of  sanity  because  after  all 
said,  any  question  at  law  with  regard  to  one's  mental 
state  resolves  itself  at  the  same  time  into  the  question 


702     The  Medical  Phess. 


OBITUARY. 


June  39,  1904* 


of  the  liberty  of  a  subject  or  freedom  of  action.  There 
are  minds,  I  may  be  allowed  to  observe  by  the  way,  which 
•deviate  in  two  different  directions  from  the  great 
majority  of  other  minds — that  is  to  say,  the  same 
mind  may  deviate  in  the  path  of  genius  (I  mean  by 
genius  originality  of  thought  as  applied  to  mechanics, 
mathematics,  literature,  &c.  Sec),  in  one  direction, 
and  at  the  same  time  it  may  be  eccentric  or  otherwise 
deficient  in  other  respects,  and  perhaps  this  considera- 
tion has  given  rise  in  some  to  the  idea  that  genius 
and  insanity,  because  they  may  happen  to  exist  in  the 
same  mind,  are  closely  allied,  whereas  they  are  as  dis- 
tinct as  chalk  is  from  cheese. 

In  conclusion,  lawyers  no  doubt  who  are  notoriously 
at  variance  with  the  medical  profession  on  the  meaning 
of  insanity,  prefer  to  found  their  enactments  on  the 
grandmotherly  hypothesis  of  discriminating  between 
right  and  wrong,  which  merely  premises  that  lawyers 
know  our  business  better  than  we  know  our  own. 
I  am,  Sir,  yours  truly, 

Clement  H.  Sers. 

Brighton,  June  1904. 

MEDICAL  'DIPLOMATES'  SOCIETY  OF  LONDON 
To  the  Editor  of  The  Medical  Press  and  Circular. 

Dear  Sir, — Many  of  us,  old  students  of  the  London 
schools  of  medicine  and  holding  the  English  Conjoint 
Board  qualification,  are  anxious  to  obtain  admission 
to  a  final  examination  in  medicine  which  shall  entitle 
us  to  a  medical  degree.  Our  position  now  is,  that 
although  we  feel  the  necessity  of  obtaining  by  exami- 
nation a  degree  in  medicine,  thus  removing  the  serious 
disabilities  under  which  we  labour,  no  such  examina- 
tion (except  that  of  Durham)  is  open  to  men  in  the 
active  practice  of  their  profession.  We  venture  to 
think  that  you  will  agree  with  us  that  this  is  a  hardship 
which  should,  if  possible,  be  removed. 

The  Medical  Diplomates'  Society  of  London  has 
been  formed  with  the  object  of  gaining  admission  to 
an  examination  for  a  degree  in  medicine,  but  before 
taking  any  active  steps  in  the  matter  we  are  anxious 
to  obtain  the  views  of  the  principal  members  of  the 
staffs  of  the  London  medical  schools.  We  therefore 
venture  to  appeal  to  you  for  advice  and  support.  Any 
suggestions  wnich  you  may  feel  disposed  to  make  will 
be  gladly  received  by  the  Executive  Committee  of 
this  society. 

We  are,  Sir,  yours  truly, 
(Signed)  F.  J.  Smith.  M.D.,  F.R.C.P., 
Physician  to  the  London  Hospital,  President, 
Medical  Diplomates'  Society  of  London. 


View  appliances. 

NASAL  DILATOR  FOR  CONTINUOUS  DILATA- 
TION  OF  THE   ANTERIOR   NARES   IN   NASAL 
OBSTRUCTION. 
By  Thomas  Lumsden,  M.D. 
The  benefits  claimed  to  result  from  the  use  of  this  in- 
strument by  those  who  complain   of    stuffiness  in  the 
nose  are — 

1.  That  it  allows  the  nose  to  be  thoroughly  cleared 
from  discharge  by  sniffing  air  backwards. 


(b)  There  seems  to  be  a  vicious  cycle  between  swelling 
and  the  state  of  obstruction  or  stuffiness. 

The  use  of  the  dilator  is  advocated  during  the 
night,  and  for  a  few  minutes  during  the  day,  when 
required,  and  when  convenient. 

Even  a  few  minutes'  dilatation  allows  the  nose  to  be 
properly  cleared,  and  relieves  the  obstruction  due  to 
congestion  after  holding  the  head  down  over  work,  or 
to  simple  rhinitis. 

The  instrument  is  neatly  and  carefully  made  by  Messrs. 
Arnold  and  Sons,  of  West  Smithfield,  E.C.  It  is  inex- 
pensive, comfortable,  easily  adjusted  to  the  required 
size,  and  is  very  effective.  It  is  more  firmly  retained 
than  other  dilators,  and  the  inventor  would  be 
much  pleased  if  others  would  give  it  a  trial. 

A  New  Aseptic  Vaccination  Pad. 
We  have  received  from  Dr.  Knox  Denham,  the  Head 
of  the  National  Calf  Vaccine  Institute, a  sample  of  a  new 
aseptic  pad  for  use  after  vaccination,  which  has  been 
prepared  in  order  to  meet  the  requirements  of  the 
Local  Government  Board.  The  pad  consists  of  a  thin 
layer  of  cotton  wool  lying  between  two  pieces  of  gauze, 
and  held  in  position  by  a  stitch,  and  is  intended  to  be 
fastened  to  the  arm  by  two  narrow  straps  of  American 
plaister.  It  is  carefully  sterilised  and  enclosed  in  a 
"  germ-proof  "  envelope.  The  pad  itself  appears  to  us 
to  be  excellent,  but  we  are  not  sure  that  the  prolonged 
adhesion  of  the  American  strapping  to  the  infant's 
skin  may  not  cause  excoriation.  The  pads  are  sold  at 
the  very  moderate  price  of  2s.  per  dozen. 

®i>ituar$* 

MR.  ELIAS  BREMRIDGE,  F.P.S. 

Mr.  El ias  Bremridge,  the  well-known  secretary 
and  registrar  of  the  Pharmaceutical  Society  of  Great 
Britain  — a  post  that  he  held  from  1857  to  1884 — died, 
in  London,  last  week,  at  the  age  of  ninety- three.  His 
only  son,  Mr.  Richard  Bremridge,  still  holds  the  position 
of  secretary  of  the  Pharmaceutical  Society.  The 
Pharmaceutical  Journal  reminds  its  readers  of  the 
services  which  Mr.  Elias  Bremridge  rendered  to  phar- 
macists, and  of  the  part  he  played  in  securing  Parlia- 
mentary recognition,  by  the  Pharmacy  Act  of  1868,  of 
the  principle  that  chemists  and  druggists  "  keeping  open 
shop  for  the  sale  of  poisons  "  shall  have  given  proof, 
by  examination,  that  they  are  competent  to  do  so. 
He  was  a  founder  of  the  Pharmaceutical  Society  in  the 
year  1841. 

GEORGE    STANLEY    FOULDS,     M.D.Edin.,     OF 
KIMBERLEY. 

We  regret  to  announce  the  death  of  Dr.  George 
Stanley  Foulds,  under  most  pathetic  circumstances, 
at  the  Basford  Sanatorium  at  Delamere  Forest,  near 
Chester.  Both  he  and  his  son,  aged  five,  were  suffering 
from  scarlet  fever,  and  the  boy  died  half  an  hour  before 
his  father.  Deceased,  who  was  only  thirty- two  years 
of  age,  leaves  a  widow  and  one  child.  He  was  educated 
at  Edinburgh  University,  where  he  took  the  qualifica- 
tion of  M.D. — He  practised  at  Kimberley,  Notting- 
hamshire. 

JOHN  ROLSTON,  M.D.Edin. 

Dr.  John  Rolston  died  somewhat  suddenly  at  his 
residence,  Clarendon  Villa,  Devonport,  on  Saturday 
afternoon  from  heart  disease.  Dr.  Rolston,  who  was 
aged  seventy-six,  had  twice  been  mayor  of  the  borough, 
and  for  many  years  was  chairman  of  the  local  Liberal 
Association.  He  was  educated  at  Edinburgh  Uni- 
versity, and  took  the  qualification  of  M.D.Edin.,  in 

flDe&tcal  flew** 


2.  That  it  allows  nasal  respiration  to  be  comfortably 
'Carried  on  while  it  is  in  place. 

(a)  The  inspired  air,  by  removing  moisture  from  the 
mucous  membrane,  tends  to  diminish  swelling  of  that 
tissue. 


Contaminated  Milk. 
The  Public  Health  Committee  of  the  London 
County  Council  recommended  that  application  be  made 
in  the  next  Session  of  Parliament  for  powers  "  (1) 
enabling  the  Council  to  prohibit  the  supply,  within  the 
county,  of  milk  from  a  dairy  within  or  without  he 
county,  if  the  medical  officer  is  of  opinion  that  infec- 


June  29,  1904. 


MEDICAL  NEWS. 


The  Medical  Press.     703 


tious  disease  is  caused,  or  is  likely  to  be  caused,  by  con- 
sumption of  such  milk,  enabling  the  Council  to  prohibit 
the  supply  within  the  county  of  milk  causing  or  likely 
to  cause  tuberculosis,  providing  for  appeal  against  the 
•decision  of  the  Council  in  the  above  matters,  authorising 
•or  requiring  the  Council,  according  to  the  nature  of  the 
•case,  to  allow  compensation  in  the  event  of  the  milk 
supply  being    prohibited,   enabling  the    Council    to 
take  samples  of  milk  within  the  county,  providing  for 
^penalities  against  persons  who  knowingly  sell,  or  suffer 
to  be  sold  or  used,  for  human  consumption  within  the 
county  the  milk  of  any  cow  which  is  suffering  from 
tuberculosis  disease  of  the  udder,  imposing  upon  dairy- 
men within  the  county  an  obligation  to  notify  cases, 
*or  suspected  cases,  of  tuberculous  disease  of  the  udder, 
requiring  the  isolation  of  any  cow  suffering  from  such 
disease,  and  enabling  the  Council  and  sanitary  authori- 
ties within  the  county  to  deal  with  milk  which  on 
examination  appears  to  be  so  filthy  as  to  be  unfit  for 
human  food  ;   (2)  enabling  sanitary  authorities  to  re- 
quire owners  to  make   reasonable   provision  for  the 
supply  of  water  to  the  tenants  of  each  floor  in  tenement 
houses ;  (3)  enabling  sanitary  authorities  to  undertake, 
if  they  think  fit,  the  collection  and  removal  of  offensive 
trade  refuse,  and  empowering  them  to  require  payment 
of  a  reasonable  sum  by  the  owner  or  occupier  of  any 
premises  from  which  such  refuse  is  removed."     This 
was  agreed  to  without  discussion. 

University  of  London— The  Brown  Lectures. 
In  connection  with  the  University  and  of  the  Brown 
Animal  Sanatory  Institution,  a  course  of  five  lecutres 
will  be  delivered  by  Dr.  T.  Gregor  Brodie,  on  "  The 
Etiology  and  Comparative  Pathology  of  Chronic 
Nephritis  and  of  Uraemii."  The  course  commences  to- 
morrow, Thursday,  and  will  be  continued  each  suc- 
ceeding Thursday,  until  the  end  of  July  at  5  o'clock 
p.m.,  in  the  physiological  laboratories,  at  South  Ken- 
sington, admission  being  free,  according  to  the  will  of 
the  deceased  founder  of  the  Brown  Institution. 
The  West  London  Hospital  and  Post-Graduate  College. 
The  annual  dinner  of  the  past  and  present  members 
of  the  West  London  Hospital  ana  Post-Graduate 
College  was  held  on  June  25  th,  1004,  at  the  Trocadero 
Restaurant.  The  Chair  was  taken  by  Dr.  J.  B.  Ball. 
Among  those  present  were  Professor  von  Mikulicz, 
M.D.,  LL.D.,  of  Breslau,  the  Cavendish  Lecturer  of  the 
West  London  Medico-Chirurgical  Society,  Lieut. -Col. 
E.  M.  Wilson,  D.S.O..  C.M.G.,  Sir  Felix  Semon.  C.V.O., 
Dr.  F.  de  Havilland  Hall,  and  others.  In  proposing 
the  health  of  the  West  London  Post-Graduate  College, 
the  Chairman  remarked  that  the  past  year  had  been  one 
of  gradual  though  steady  progress.  The  College  and 
'the  Hospital  were  to  be  congratulated  in  the  fact  that 
there  had  been  recently  established  a  fully  equipped 
pathological  laboratory,  and  that  there  were  now 
definite  arrangements  made  for  the  efficient  study  and 
teaching  of  bacteriology.  The  present  system  of  post- 
graduate instruction  at  the  West  London  Hospital  had 
gradually  evolved  out  of  a  long  series  of  efforts  which, 
under  the  able  guidance  of  the  Dean,  Mr.  L.  A.  Bidwell, 
had  been  concentrated  and  united  into  one  harmonious 
whole.  In  returning  thanks,  Mr.  Bidwell  said  that 
the  College  owed  its  prosperity  to  the  hearty  support 
and  co-operation  of  the  members  of  the  Hospital  staff. 
He  would  not  forget,  also,  the  many  vauluable  sug- 
gestions which  had  been  offered  from  time  to  time  by 
the  post-graduates  themselves,  whose  criticism  was 
always  welcome.  Especially  he  would  mention  those 
members  of  the  services  who  had  identified  themselves 
with  the  practice  of  the  hospital  and  who  had  largely 
availed  themselves  of  the  opportunities  for  post-gradu- 
ate instruction.  Both  in  numbers  and  in  conviviality 
the  gathering  was  entirely  successful. 

Northumberland  Miners  and  Doctors*  Fees. 
There  has  been  a  conference  between  the  representa- 
tives of  the  Northumberland  miners  and  their  club 
medical  attendants,  at  which  the  miners  represented 
that  since  doctors'  fees  were  raised  to  od.  per  fortnight 
wages  had  fallen  40  per  cent.  In  reply,  the  doctors 
contended  that  wages  had  nothing  to  do  with  the 
matter,  but  that  the  doctors'  fees  must  be  higher  owing 


to  the  increased  cost  of  medical  training,  the  increase  of 
surgical  operations,  and  the  fact  that  unqualified 
assistants  can  no  longer  be  employed.  The  doctors 
concluded  by  issuing  a  manifesto  stating  that  od.  a 
fortnight  is  the  lowest  fee  which  can  be  accepted 
without  lowering  the  quality  of  the  work,  and  the  men 
have  now  retaliated  by  putting  the  matter  in  the  hands 
of  their  associations,  with  instructions  to  take  steps  to 
have  the  present  fees  reduced  by  50  per  cent. 
Royal  University  of  Ireland. 

Two  Royal  Warrants,  bearing  the  date  of  April  2nd, 
1904,  and  dealing  with  certain  proposed  alterations  in 
the  statutes  of  the  Royal  University,  have  been  issued 
by  the  Home  Secretary.  The  most  important  altera- 
tion is  that  changing  the  title  of  the  diploma  in  Sanitary 
Science,  to  Diploma  in  Public  Health— D.P.H.  This 
is  an  alteration  which  has  been  desired  for  some  time, 
and  which  brings  the  title  of  the  degree  into  line  with 
the  title  adopted  for  the  same  degree  by  most  other 
examining  bodies. 

RevaeelnatUm  Bill.    • 

This  Bill  passed  through  Committee  of  the  House 
of  Commons  with  some  slight  amendments.  The 
Marquis  of  Ripon  said  he  did  not  object  to  progress 
being  made  with  this  Bill,  but  he  understood  the  noble 
marquis  the  leader  of  the  House  to  have  said  on  the 
second  reading  that  the  Bill  would  go  no  further. — 
The  Marquis  of  Lansdowne  said  that  on  the  second 
reading  he  had  expressed  the  opinion,  to  which  he  still 
adhered,  that  the  Bill  stood  no  chance  whatever  of 
passing  in  the  present  Session. 

The  Victoria  Hospital  Bazaar. 

The  bazaar  in  aid  of  the  Victoria  Hospital  for  Chil- 
dren, which  was  held  during  three  days  last  week,  at 
the  Royal  Albert  Hall,  closed  with  a  ball.  The  bazaar 
has  resulted  in  the  receipt  of  £11,000,  and  may  be 
regarded  as  most  successful. 

The  Royal  Free  Hospital. 

The  annual  distribution  of  prizes  at  the  London 
(Royal  Free  Hospital)  School  of  Medicine  for  Women 
was  held  on  Friday  last  under  the  presidency  of  the 
Dean,  Miss  Cock,  M.D.— -The  report  stated  that  the 
Entrance  Scholorship,  value  £30,  had  been  awarded 
to  E.  C.  Eaves.  The  St.  Dunstan's  Medical  Exhibition, 
value  £60  a  year  for  three  years,  had  been  won  by  B.  P. 
Lindup.  The  Preliminary  Scientific  Scholarship, 
value  £40,  fell  to  E.  M.  Walters.  The  Mackay  Prizes, 
first  and  second,  of  £20  value  each,  went  to  J.  Coupland 
and  N.  Smith  respectively.  The  Mabel  Webb  Research 
Scholarship,  value  £30  a  year  for  two  years,  was  gained 
by  J.  E.  Lane-Claypon.  The  Bostock  Scholarship 
(University  of  London),  value  £60  a  year  for  four  years, 
was  awarded  to  E.  M.  Walters  ;  and  the  Gilchrist 
Scholarship  (Univeristy  of  London),  value  £40  a  year 
for  two  years,  went  to  E.  A.  Butler. 


Mr.  McArdle,  F.R.C.S.,  has  been  appointed  Surgeon 
to  St.  Patrick's  College,  Maynooth,  in  succession  to 
Surgeon  Hayes. 

Dr.  P.  Phillips  has  been  appointed  head  of  the 
chemical  department  in  the  Thomasson  Engineering 
College,  Rurki,  North-West  Provinces,  India.  Dr. 
Phillips  has  been  for  the  last  two  years  assistant  lecturer 
and  demonstrator  in  chemistry  at  the  Sheffield  Uni- 
versity College. 

Mr.  A.  M.  Connell,  F.R.C.S.Edin.,  has  been  ap- 
pointed lecturer  in  operative  surgery  at  Sheffield 
University  College. 

The  Italian  Umberto  first  prize  for  the  best  work 
or  invention  relative  to  orthopaedic  surgery  is  open 
to  medical  men  of  all  nationalities.  The  prize,  amount- 
ing to  £140,  is  awarded  by  the  Rizzoli  Orthopaedic 
Institute  of  Bologna,  and  competitors  should  com- 
municate with  the  President  of  the  institute.  The 
competition  closes  on  December  31st. 


The  Health  Committee  of  the  Birmingham 
Town  Council  propose  to  pay  a  notification  fee 
of  half  a  crown  to  medical  men  for  each  case  of 
tuberculosis  so  notified. 


704    The  Medical  Press.       NOTICES  TO  CORRESPONDENTS. 


JtotktB  to 


June  29,  1904. 


Uacaitcus. 


t^F  OoEEUPOKDnrrs  requiring  a  reply  in  this  column  are  particu- 
larly requested  to  make  use  of  a  distinctive  Signature  or  initial,  and 
avoid  the  practice  of  signing  themselves  "Reader,"  "Subscriber," 
**  Old  Subscriber,"  Jfco.  Much  confusion  will  be  spared  by  attention 
so  this  rule. 

OmwiffAli  Articles  or  Litters  intended  for  publication  sho  d  Lm 
written  on  one  side  of  the  paper  only,  and  must  be  authenticated 
with  the  name  and  address  of  the  writer,  not  neoessarily  for  publica- 
tion, but  as  evidence  of  identity. 

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

Reprints.— Reprints  of  articles  appearing  in  this  journal  can  be  had 
at  a  reduoed  rate  providing  authors  give  notice  to  the  publisher  or 
printer  before  the  type  has  been  distributed.  This  should  be  done 
when  returning  proofs. 

THE  THORNS  "SPONGE"  CASE, 
The  following  has  been  received  from  a  oorresp indent- 
To  the  Editor  of. Tub  Medical  Press  and  Circular. 

Sir,— Your  leader  of  the  22nd  inst.,  with  regard  to  the  '*  Sponge 
Case,**  justly  emphasises  the  personal  injustice  to  the  lady  doctor 
concerned  and  the  vital  importance  of  the  decision  to  the  future  of  the 
medical  profession.  Would  it  not  be  well  to  mark  the  sense  of 
sympathy  with  Dr.  Mary  Thome  under  these  circumstances  by  the 
organisation  of  a  fund  to  help  towards  defraying  the  heavy  expenses 
of  the  trial? 

Yours  faithfully. 
June  26th  1904.  V  w  a  Voce. 

I  The  above  suggestion  is  a  good  one,  and  we  shall  be  pleased  to  hear 
of  any  persons  interested  who  may  care  to  take  the  matter  up.— 
Ed.  M.  P.  &  C.] 

Mesopotamia. — Our  correspondent  has  plainly  drawn  a  wrong  con- 
clusion from  the  paragraph.  Though  somewhat  ambiguously 
expressed,  the  idea  of  the  writer  was  evidently  to  show  that  he  was 
in  favour  of  the  course  to  which  our  correspondent  has  taken  excep- 
tion. 

M.R.C.8.— Ophthalmic  surgerv  is  now  so  specialised  a  subject 
thst  the  best  plan  would  be  to  advise  the  lay  committee  t>  agree  to 
an  ophthatmio  surgeon  being  added  to  the  staff  of  the  infirmary, 
and  to  endeavour  to  secure  the  services  of  a  surgeon  who  confines 
his  practice  to  this  special  department. 

Btudert.— The  warden  of  the  medical  school  in  question  would, 
on  being  applied  to,  furnish  all  the  necessary  information. 

FLOGGING  IN  TtfE  NAVY. 
To  the  Editor  of  The  Medical  Press  and  Circular. 
Sir,— Is  it  not  remarkable  that  the  Navy  League  should  continue 
to  withhold  its  support  from  the  movement  for  the  abolition  of  the 
cane  and  birch  in  the  Royal  Navy,  as  summary  punishments  In  the 
case  of  boys  and  young  men  convicted  of  comparatively  trivial 
offences  against  discipline  ?  In  view  of  the  fact  that  the  British  Army 
is  now  better  disciplined  without  the  lash  than  ever  beforehand  that 
flogging  is  not  permitted  in  the  Navies  of  other  Great  rowers,  it 
seems  extraordinary  that  the  Navy  League  should  remain  silent  about 
these  disgusting  naval  punishments.  L  >rd  Nelson  detested  flogging, 
and  it  would  be  a  sincerer  compliment  to  his  memory  to  secure  the 
abolition  of  this  barbarous  and  indecent  practice  than  to  decorate 


his  statue  in  Trafalgar  Square. 
Weardale,  June,  1904. 


I  am  Sir,  Your  truly, 


J.C 


Clapton.— There  is  no  punishable  ethical  offence  in  the  decoration 
of  doors  and  windows  of  the  "  surgery  "  you  describe  with  statements 
of  the  various  branches  of  medical  practice  as  dealt  in  by  the  adver- 
tiser (for  such  he  is).  Clearly,  however,  a  respectable  practitioner 
does  not  advertise  his  proficiencies  as  a  tradesman  does  his  wares. 
You  are  'more  than  warranted  in  refusing  to  have  anything  what- 
ever to  do  with  a  medical  man  who  shows  so  little  regard  for  the 
dignity  of  his  profession. 

Modrrhub.— Your  letter  will  appear  in  our  next. 


Actings  of  the  goodies,  Jbctuxte,  &t. 

WEDNESDAY,  JUHK  29th. 

Medical  Graduates'  College  and  Polyclinic  (22  Chenies  Street, 
W.C.).— 4  p.m.  Mr.  C.  Byall :  Clinique.  (8urgical.)  5.15  p.m. 
Dr-  D.  Grant :  Some  Useful  Appliances  in  the  Treatment  of  Diseases 
of  the  Jtar,  Throat  and  Nose. 

Thursday,  June  80th. 

Mrdical  Graduates'  College  and  Polyclinic  (22  Chenies  Street, 
W.C.).— 4  p.m.    Mr.  Hutchinson :  Clinique.    (8urgical.) 

Mount  Veenon  Hospital  for  Consumption  and  Diseases  or  tor 
Curst  (7  Fitxroy  Square,  W.)— 5  p.m.  Dr.  T.  D.  Lister  :  Toe 
Treatment  of  Asthma  (illustrated  by  cases).  (Post  Graduate 
Oouise.) 

Friday,  July  1st. 

Mrdical  Graduate!  College  and  Polyclinic  (22  Chenies  Street, 
W.C.).— 4  p.m.   Dr.  J.  Home  :  Cliuique.    (Throat.) 
Tuesday,  July  7th. 

The  Rontgen  Society  (at  28  Hanover  Square).— 8.90  p  m.  Annual 
General  Meeting,  and  Election  of  Officers  for  the  ensuing  year  . 


Birmingham    City    Asylum.— Junior    Assistant  Besident    Medical 

Officer.    Salary  £160  a  year,  board,  lodging,  and  washing.  AppU- 

cations  to  the  Medical  Superintendent. 
Borough   Asylum,  Canterbury.— Assistant   Medical  Officer.   Salary 

£140  per  annum,  with  furnished  quarters,  board,  and  laundry. 

Applications  to  the  Medical  Superintendent. 
Carmarthenshire  Infirmary.— Resident  Medical  Officer.    Salary  £100 

per  annum,  with  furnished  apartments,  board,  attend tnce,  fire, 

KM,  and  washing.    Applications  to  Howell  Howell,  Secretary. 
East  London  Hospital  for  Children   and  Dispensary  for  Women, 

Shadwell.  E.— Pathologist  and  Registrar.  Salary  £100  per  annum. 

Applications  to  Thomas  Hayes,  Secretary. 
Famngdon  General  Dispensary,  17  Bartlett's  Buildings,  Holborn 

Circus.  B.C.— Resident  Medical  Officer.    Salary  £120  per  inanm, 

with  apartments,  coal,  gas,  and  attendance.    Applications  to  the 

Honorary  Secretary. 
London i  Temperance  Hospital,  Hampstead  Road.   N.W.—  Resident 

Medical  Officer.    Salary  £200  per  annum,  board,  lodging,  and 
%*  J?**^*'    ^PP'ications  to  A.  W.  Bodger.  Secretary. 
Noble  s  Isle  of  Man  General  Hospital  and  Dispensary,  Douglas,  Isle 

of  Man.- Besident  House  Surgeon.  Salary  £82  per  year,  with 

board  and  washing  free.  Applications  to  Geo.  Ridgway  Cookson, 

Hon.  Sec..  16  Athol  8treet,  Douglas,  Isle  of  Man. 
Poplar  Hospital  for  Accidents,  Poplar, ;E.—  Assistant  House  Surgeon. 

Salary  £80  per  annum,  with  board  and  residence.   Applications 

to  Edw.  Feneran,  Lt.-OoL,  Secretary  and  House  Governor. 
Royal  Infirmary,  Newcastle-upon-Tyne.— Head  Dispenser.  Salary  £175 
_      pej»Mum.    Applications  toW.  T.  Oliver,  Secretary. 
Royal  National  Hospital  for  Consumption.  Ventnor.— Two  Assistant 

Resident  Medical  Officers.    Salary  £100  per  annum,  with  board 

and  lodging  in  the  Hospital.    Applications  to  the  Secretary  at 

the  office  in  London.    (See  Advt.) 
Boyal  Orthopaedic  Hospital,  55  Bolsover  Street,  W.— House  8urgeon 

andi Registrar.    Salary  £200  per  annum.    Applications  to    Tate 

S.  Mansford.  Secretary. 
^y»,,S?trBfttlimff  Hospital,  Margate.— Resident  Surgeon.     Salary 

£120  per  annum,  with  board  and  residence.    Applications  to  the 
«.    Bfore*ary'  *-8"H.  Offices,  18  Charing  Cross,  London,  8.W. 
Stamford,  Rutland,  and  General  Infirmary.     House  Surgeon,  Salary 

£100  per  annum,  with  board,   lodging,  and   washing.     ApplU 

<*tions  to  V.  G.Stapleton,  Secretary. 
8t.  Mary'f  Hospital  Medical  School,  Paddington,  W.— Lecturer  on 

Chemistry.    Salary  £150  per  annum.     Applications  to  H.  A. 
o.    ^«y.  M  2^,  P.R.6.P.,  Dein.  W 

Stockton  and  Thornaby  Hospital,  Stockton-on-Tees.— House  Surgeon. 

Salary  £250  per  annum.      Applications   to  H.  G.    Sanderson 
Secretary. 


Swoitttmmx*. 


Bryar,  J.  M.,  M.R.C.8.,  L.R.C.P.Lond.,  Public  Vaccinator  for  the 

St.  Giles's  and  St.   Andrew's   Districts  of    the    Northampton 

Union. 
Ceuickshaotc,  A.,  M.B.,  M.8  Aberd.,  Certifying  Surgeon  under  the 

Factory  Act  for  the  Stonehaven  District  of  the  county  of  Kin- 
cardine. 
David  Gray,  House  Surgeon  to  Jervis  Street  Hospital,  DubUn. 
Davis,  Heurt  J.,  M.A.C*nUb.,  M.R.C.P.Lond.,  Assistant  Physician. 

in  charge  of  the  Throat  and  Ear  Department  of   the   West 

London  Hospital. 
Farqitharson,  D.  A.  R.,  M.B.,  M.S.Aberd..  Certifying  Surgeon  under 

the  Factory  Act  for  the  Washington  District  of  the  county  of 

Durham. 
FiSLDQto-OuLD,  Robert.  M.A.,  M.D.Oxon.,  Pathologist  to  the  City 

of  London  Hospital  for  Diseases  of  the  Chest. 
Johnson,   F.  W.,   MB.  B.S.Vict.,   Certifying  Surgeon  under  the 

Factory  Act  for  the  Bawtry  District  of  the  counties  of  York  and 

Nottingham. 
Keshan,  J.  F.,  M.B.,   B8.R.U.T  ,  Certifying  Surgeon   under  the 

Factory  Act  for  the  Ballinalee  District  of  the  county  of  Longford. 
Maw,G.,  M.B.O.8.,  L.R.C.P.Lond.,  Certifying  Surgeon  under  the 

Factory  Ant  for  the  Ulceby  District  of  the  county  of  Lincoln. 
McCracrbn.   J.  S.,  M.B.,  C.MEdin.,  Honorary  Physician  to  the 

Hospital  for  Sick  Children,  Newcastle-upon-Tyne. 


flirihs. 


Martw.— < pn  June  23rd,  of  Eastbourne,  the  wife  of  Antony  A.  Mar- 
tin, M.D.Lond.,  of  a  son. 

Williams.— On  June  22nd.  at  Harlech  House,  Pembroke,  South 
Wales,  the  wife  of  Dr.  W.  R.  Byton  Williams  of  a  daughter. 


Greek  hill— Wyresmith.—  At  St.  Mary  Abbott's.  Kensington, 
Frederick  William,  eldest,  son  of  the  late  Frederick  Maclean 
Greenhill,  of  Longham  House,  Wim borne,  to  Gwendolyn,  only 
daughter  of  the  late  Walter  Wykesmith,  F.R.C.S.,  of  Whnborne. 

Monro— Atkins.— On  June  23rd,  at  S.  Mary's  Parish  Church, 
Cheltenham,  Donald  George  McLeod  Monro,  M.D.,M.R.OP.Ed., 
to  Eileen  Forsyth  Douglas,  elder  daughter  of  Charles  8.  Atkins 
and  Mrs.  Atkins,  of  Plttville  Lawn,  Cheltenham. 

Sowey-Caddicr.— On  June  23rd.  at  8.  George's  Church,  Newcastle, 
Staffs,  Geo.  H.  Sowry,  M.B.,  F.R.C.8.,  younger  son  of  T.  A. 
Sowry.  Esq.,  of  Leeds,  to  8tella.  eldest  daughter  of  John  Cad- 
dick,  Brampton  Lodge,  Newcastle,  Staffs. 

Bentham.— On  June  25th,  after  a  long  illness,  Emily,  beloved  wife  ot 
Samuel  Bentham.  M.R.C.8.,  of  the  Limes,  Winchester  Road,. 
South  Hampstead,  aged  7L 


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