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A CENTRAL HOSPITAL BOARD FOR BRIGHTON.
1094 staff at the infirmary, workhouse, and children’s home who maybe sick and report thereon to the guardians if required. (The italics are ours.) 2. For every alleged lunatic examined by order of a justice of the peace the officer shall accept a fee not exceeding 10s. 6d. per case. It will be seen that two important issues are here raised-(a) the right of guardians to compel a medical man in their employ to divulge information which he has obtained in his professional capacity ; and (b) the power of control which guardians can exercise over a magistrate in his administraOur English law relating to tion of the lunacy laws. laid down so explicitly as in is not professional secrecy for and its France, example, exposition here would occupy far too much of our space but it appears to us that any applicant for the post under the St. George’s board who signs such an undertaking as is given above will, if he observes it, lay himself open to legal proceedings of an embarrassing character. As to the second condition we may point out, as we have several times done before, that Section 285 of the Lunacy Act of 1890, which deals with the fees payable to medical men for the examination of alleged lunatics, gives to boards of guardians no right whatever to dictate to a justice what is to be regarded as a suitable fee for certifying cases. The stipulation appears to us to be an improper one and it can only be rendered effective by bringing the cases before a magistrate who will forfeit his freedom of action in deference to the wishes of the board. We presume that if the magistrate makes an order for the payment of a guinea, as has been, we believe, the practice at St. George’s and elsewhere, the officer appointed will have to hand over half the amount to the board’s exchequer. If, on the other hand, the justice should for any reason direct a smaller sum than half a guinea to be paid the guardians would have no power, even if they had the will, to increase the amount to that sum. As between the guardians and their medical officer the case is therefore one of " heads we win, tails you lose," and we trust that this aspect of the matter will be appreciated by any
intending applicants.
survived for only one hour. At 9.30 the placenta was expelled after moderate pressure on the uterus. During the labour, and especially after the expulsion of the placenta, there was considerable hoemorrhage. The puerperium was practically normal. The children were of the development of six months and their weights ranged from 500 to 750 grammes. There was a single oval placenta measuring 18-5 by 25 centimetres and weighing 890 grammes. The uterine surface presented no more than the usual lobules. The five cords were inserted into distinct amniotic sacs. Three foetuses were in one chorion and the remaining two were in separate choria. As the cords varied in thickness, shape, and arrangement of vessels it was not difficult to connect each foetus with its own cord: The three sacs inclosed in a common chorion corresponded to the first, second, and fifth foetuses. Thus these arose from one ovum and the other two from separate ova. It is of interest that the three foetuses which arose from one ovum were of the same sex, while those that arose from separate This would seem to support the ova were of different sexes. view that the sex is predetermined in the ovum before fecundation, i.e., that there are male and female ova. Uniovular twins are always of the same sex. Therefore the quintuplets arose from three ova. In the woman’s family several cases of multiple pregnancy had occurred. Her mother once had twins. Two uncles were the fathers of twins and an aunt was delivered of triplets. Professor Nijhoff refers to another Dutch case of quintuplets which occurred in 1719 and he has collected 27 cases from obstetrical literature between the years 1694 and 1900. The case recorded above may be instructively compared with one of quadruplets reported last week in our columns.l The foetuses appeared to be of six and a half months development. Unlike the present case, each had a separate chorion and had therefore developed from one ovum. -
A CENTRAL HOSPITAL BOARD FOR BRIGHTON.
an influential meeting recently held in Brighton it resolved to unite for administrative purposes under a A CASE OF QUINTUPLETS. central board the various local hospitals-namely, those of THE birth of quintuplets is one of the curiosities of Brighton and Hove and the Sussex County Hospital. There medical literature. In the t7bM?’?M of Obstetrics and Gynae- are seven such institutions in the district. Some are special cology of the British Empire Professor G. C. Nijhoff of hospitals and some are not but the lines of demarcation Groningen (Netherlands) has recorded the following case in between their several spheres of activity are not precisely The account of the drawn and there is in consequence a good deal of overwhich he examined the placenta. It has been felt for some time past that labour is furnished by Dr. de Blecourt who attended the lapping. an was a robust woman, endeavour should be made to classify and to disThe mother woman in confinement. aged 34 years, and had been married for eight years. She had tribute the work which falls to them so as to reAfter been delivered seven years before at term of a boy. The last duce expenditure while increasing efficiency. At the conference of several and months of careful investigation beginning period terminated on Jan. 20th, 1903. May there was a discharge of a small quantity of yellow not limited to those immediately interested the Mayor of fluid, at times tinged with blood. This ceased but returned Brighton and his helpers have been able to set before the in the beginning of July. Quickening was first felt early public meeting already referred to a basis for united action. in June. On July 10th severe pains recurring every three The result is the adoption in principle of the central board. minutes began at 8 A.M. At the height of the pains It is not intended that this body shall concern itself with the bag of membranes was visible at the vulva. The the internal management of any hospital. It will act fundus uteri was a hand’s breadth above the umbilicus. rather as an advisory committee and its expressed objects Foetal heart sounds were heard on both sides and in the are : (1) to obviate overlapping of local medical middle of the abdomen. Vaginal examination showed the charities ; (2) to promote economy of administration, paros completely distended and a small foetal head in the first ticularly in connexion with capital outlay on buildings; At soon after the of the 8.30, membranes, and (3) to prevent the abuse of medical charities by persons position. rupture an immature but living female child was born. Ten minutes who are not proper objects of charitable assistance. As later a second female in footling presentation followed. At bearing upon the advantages to be expected from such an 9 a male was born in vertex presentation and was soon arrangement as the above the following facts are instructive. followed by a female in footling presentation. Dr. de At the beginning of the year the Women’s Hospital issued Blecourt was then surprised to find a fifth child concealed in an appeal for a sum of .620,000 to build a new gynascologicat a corner of the uterus and presenting transversely. Some department. After some deliberation with the local authominutes later a female was born in footling presentation. rities and others it was decided to convert the wards. Before the birth of the fourth and fifth children no bag of 1 THE LANCET, Oct. 8th, waters was observed. The five children were all alive but p. 1020. -
AT
was
’
1095 of the Sussex County Hospital devoted to children’s uUUbii L11C Le:"V’plläei;t1 11,,-L111i.L iS taVi:!eu..111 Vi:tMVll Ut l1e diseases into a section for diseases of women and to pleura by disease of the oesophagus is well known to occur p a transfer the children to the existing Children’s Hos- and empyema and pneumothorax resulting from malignant that out the redistribuIt is effects of cl of the oesophagus may be quoted as examples, but disease pointed pital. of the cesophagus from the pleura is certainly .a i: tion in this case are the development of the Women’s involvement increased bed r, much rare event notwithstanding Dr. Jehle’s suggestion as a accommore maternity institution, Hospital t such cases may occur more frequently than they are modation being available for this purpose, the parallel de- that velopment of the Children’s Hospital, the formation of an inde- rrecognised. pendent gynsecological department, and a saving of 20,000. CENTENARY OF THE ROYAL MEDICAL AND Centralisation after this model has much to recommend it. CHIRURGICAL SOCIETY. It has thus far been shown to be inexpensive. It allows of has lack of which fatal to the THE opening meeting of the centenary session of theautonomy, comparative proved less elastic systems. It owes its adoption to the support of Royal ] Medical and Chirurgical Society will be held at the all the medical charities which it is intended to serve, a Society’s f rooms, 20, Hanover-square, London, W., on recognition of its disinterested character., We shall watchTuesday, Oct. 25th, at 8.30 P.M. The two following its further progress with attention and we may express the will be read-viz., the Pathology and Prevention 1 papers that success in the of will its justify. its hope place origin ( of Secondary Parotitis, by Mr. -Rupert T. H. Bucknall, and extension to other populous areas. Mr. B. N. Tebbs, and it is f -
r
A
Symptomatic Parotitis, by anticipated that there will be an exceptionally interesting The society always welcomes the presence of discussion.
CASE OF EMPYEMA COMPLICATED BY AN ŒSOPHAGEAL FISTULA INTO THE PLEURA.
visitors who are invited to take part in the discussions. Persons J. intending to be present will recieve abstracts A CASE of some interest and considerable rarity is recordedcof the papers on application to the secretary, 20, Hanoverby Dr. Alexander Jehle in the Wiener Medicin4cAe Wochen- square, s W. In many ways the society is showing that it is schrift, No. 22, 1904. The patient was a child, aged two aactuated by a progressive spirit. Formerly, even though a and a half years, who six weeks previously had suffered from was received and approved for reading and read at a I paper a right-sided pneumonia. About ten days before admission r meeting of the society, it might not be considered worthy into the Wilhelmina Hospital at Vienna the child, developedcof a place in the Transactions and publication in any journal fever, followed by emaciation and oedema of the lower ex-cof any paper before the issue of the Transactions was protremities, but at no time was colic, hasmatemesis, or vomit- hibited. 1 Wiser counsels have prevailed and at the present ing observed. On admission the pulse and temperature were ttime all papers accepted for reading are published in the normal and there were oedema of the feet and ankles andTransactions and authors are at liberty to publish their some degree of emaciation. Physical examination of the papers in medical or scientific I periodicals immediately after chest showed dulness with weak bronchial breathing on thet are On read. they May 22nd, 1905, the centenary of theright side, while the heart was displaced towards the left, society will be celebrated and at the present time a comthe sounds being normal. Exploratory puncture proved themittee is considering the arrangements for this celebration. presence of pus from which a pure culture of the pneumococcus was obtained on bacteriological examination. The SIR ISAMBARD OWEN. incised in the fifth in was intercostal the pleura space Isambard Sir Owen has been unanimously appointed posterior axillary line and a considerable quantity of thick of greenish-yellow odourless pus was evacuated. The course of principal Armstrong College in the University of Durham Sir Isambard Owen, the case was at first quite satisfactory, the oedema disappeared in place of the late Dr. Gurney. who entered the of his new duties on upon performance by the third day, the patient rapidly improved, and the in is well known for he has till quite re-Oct. 8th, London, empyema cavity became smaller, but about three weeks later been and lecturer on the physician principles and the pus which escaped acquired a sour, pungent odour and cently at of St. George’s Hospital. He is, morephysic contained small cheesy masses like curdled milk. This first practice a Vice-Dean of the Faculty of Medicine of the Universuggested the presence of an oesophageal fistula, which was over, and an examiner in medicine for the Royal of London confirmed by the discovery of seeds in the pus escaping from sity He rendered Medical yeoman service in the Corps. the drainage-tube after their administration by the mouth, Army of and is at the present of the Wales formation University although fluid given by the mouth did not apparently escape of that body. The the senior chancellor moment deputy and clear the into the pleura. The empyema continued to up he in educational which possesses questionsexperience but later small great for a time particles oesophageal fistula closed of food were again found in the pus and this condition renders it peculiarly fitting that he should have been selected recurred at intervals for about four months, after which the to be the principal of an institution such as Armstrong and the city of Newcastle, together with the Unioesophageal fistula closed permanently and the empyema College of Durham, is to be congratulated upon having operation wound healed shortly after, since which time the versity the services of so able a principal for one of their obtained child had remained quite healthy. The explanation put educational foremost institutes. B forward by Dr. Jehle is that the communication between the oesophagus and the pleura was due to a mediastinal THE BRITISH MEDICAL BENEVOLENT FUND. gland infected by the pneumococcus at the time of the IN a letter published in the Times of Sept. 30th Sirpneumonia breaking down simultaneously into the pleura and the oesophagus and not to direct invasion of the oesophagus: William Broadbent states that the British Medical. by the empyema, which he regards as negatived by the: Benevolent Fund is suffering considerably by reason of the interval which elapsed between the opening of the empyema prevailing financial depression and that the sum available and the development of the fistula and by the narrowness for the relief of aged or invalided medical men and of the track which only at times allowed food material to. of widows and children left unprovided for is quite pass and even then in such small quantities as frequently to. inadequate. He truly says that for a large proportion be recognisable only by chemical or microscopical examina- of medical men it is impossible to save much out tion. For treatment he recommends washing out the pleuraL of their earnings and if they die early, which is very with non-toxic solutions to clear away the escaped foodL common, their widows and children may be left on materials, while the thoracic wound is to be kept openi the border of destitution. The fund gives 120 annuities r
,
,
,
.
intending applicants.
survived for only one hour. At 9.30 the placenta was expelled after moderate pressure on the uterus. During the labour, and especially after the expulsion of the placenta, there was considerable hoemorrhage. The puerperium was practically normal. The children were of the development of six months and their weights ranged from 500 to 750 grammes. There was a single oval placenta measuring 18-5 by 25 centimetres and weighing 890 grammes. The uterine surface presented no more than the usual lobules. The five cords were inserted into distinct amniotic sacs. Three foetuses were in one chorion and the remaining two were in separate choria. As the cords varied in thickness, shape, and arrangement of vessels it was not difficult to connect each foetus with its own cord: The three sacs inclosed in a common chorion corresponded to the first, second, and fifth foetuses. Thus these arose from one ovum and the other two from separate ova. It is of interest that the three foetuses which arose from one ovum were of the same sex, while those that arose from separate This would seem to support the ova were of different sexes. view that the sex is predetermined in the ovum before fecundation, i.e., that there are male and female ova. Uniovular twins are always of the same sex. Therefore the quintuplets arose from three ova. In the woman’s family several cases of multiple pregnancy had occurred. Her mother once had twins. Two uncles were the fathers of twins and an aunt was delivered of triplets. Professor Nijhoff refers to another Dutch case of quintuplets which occurred in 1719 and he has collected 27 cases from obstetrical literature between the years 1694 and 1900. The case recorded above may be instructively compared with one of quadruplets reported last week in our columns.l The foetuses appeared to be of six and a half months development. Unlike the present case, each had a separate chorion and had therefore developed from one ovum. -
A CENTRAL HOSPITAL BOARD FOR BRIGHTON.
an influential meeting recently held in Brighton it resolved to unite for administrative purposes under a A CASE OF QUINTUPLETS. central board the various local hospitals-namely, those of THE birth of quintuplets is one of the curiosities of Brighton and Hove and the Sussex County Hospital. There medical literature. In the t7bM?’?M of Obstetrics and Gynae- are seven such institutions in the district. Some are special cology of the British Empire Professor G. C. Nijhoff of hospitals and some are not but the lines of demarcation Groningen (Netherlands) has recorded the following case in between their several spheres of activity are not precisely The account of the drawn and there is in consequence a good deal of overwhich he examined the placenta. It has been felt for some time past that labour is furnished by Dr. de Blecourt who attended the lapping. an was a robust woman, endeavour should be made to classify and to disThe mother woman in confinement. aged 34 years, and had been married for eight years. She had tribute the work which falls to them so as to reAfter been delivered seven years before at term of a boy. The last duce expenditure while increasing efficiency. At the conference of several and months of careful investigation beginning period terminated on Jan. 20th, 1903. May there was a discharge of a small quantity of yellow not limited to those immediately interested the Mayor of fluid, at times tinged with blood. This ceased but returned Brighton and his helpers have been able to set before the in the beginning of July. Quickening was first felt early public meeting already referred to a basis for united action. in June. On July 10th severe pains recurring every three The result is the adoption in principle of the central board. minutes began at 8 A.M. At the height of the pains It is not intended that this body shall concern itself with the bag of membranes was visible at the vulva. The the internal management of any hospital. It will act fundus uteri was a hand’s breadth above the umbilicus. rather as an advisory committee and its expressed objects Foetal heart sounds were heard on both sides and in the are : (1) to obviate overlapping of local medical middle of the abdomen. Vaginal examination showed the charities ; (2) to promote economy of administration, paros completely distended and a small foetal head in the first ticularly in connexion with capital outlay on buildings; At soon after the of the 8.30, membranes, and (3) to prevent the abuse of medical charities by persons position. rupture an immature but living female child was born. Ten minutes who are not proper objects of charitable assistance. As later a second female in footling presentation followed. At bearing upon the advantages to be expected from such an 9 a male was born in vertex presentation and was soon arrangement as the above the following facts are instructive. followed by a female in footling presentation. Dr. de At the beginning of the year the Women’s Hospital issued Blecourt was then surprised to find a fifth child concealed in an appeal for a sum of .620,000 to build a new gynascologicat a corner of the uterus and presenting transversely. Some department. After some deliberation with the local authominutes later a female was born in footling presentation. rities and others it was decided to convert the wards. Before the birth of the fourth and fifth children no bag of 1 THE LANCET, Oct. 8th, waters was observed. The five children were all alive but p. 1020. -
AT
was
’
1095 of the Sussex County Hospital devoted to children’s uUUbii L11C Le:"V’plläei;t1 11,,-L111i.L iS taVi:!eu..111 Vi:tMVll Ut l1e diseases into a section for diseases of women and to pleura by disease of the oesophagus is well known to occur p a transfer the children to the existing Children’s Hos- and empyema and pneumothorax resulting from malignant that out the redistribuIt is effects of cl of the oesophagus may be quoted as examples, but disease pointed pital. of the cesophagus from the pleura is certainly .a i: tion in this case are the development of the Women’s involvement increased bed r, much rare event notwithstanding Dr. Jehle’s suggestion as a accommore maternity institution, Hospital t such cases may occur more frequently than they are modation being available for this purpose, the parallel de- that velopment of the Children’s Hospital, the formation of an inde- rrecognised. pendent gynsecological department, and a saving of 20,000. CENTENARY OF THE ROYAL MEDICAL AND Centralisation after this model has much to recommend it. CHIRURGICAL SOCIETY. It has thus far been shown to be inexpensive. It allows of has lack of which fatal to the THE opening meeting of the centenary session of theautonomy, comparative proved less elastic systems. It owes its adoption to the support of Royal ] Medical and Chirurgical Society will be held at the all the medical charities which it is intended to serve, a Society’s f rooms, 20, Hanover-square, London, W., on recognition of its disinterested character., We shall watchTuesday, Oct. 25th, at 8.30 P.M. The two following its further progress with attention and we may express the will be read-viz., the Pathology and Prevention 1 papers that success in the of will its justify. its hope place origin ( of Secondary Parotitis, by Mr. -Rupert T. H. Bucknall, and extension to other populous areas. Mr. B. N. Tebbs, and it is f -
r
A
Symptomatic Parotitis, by anticipated that there will be an exceptionally interesting The society always welcomes the presence of discussion.
CASE OF EMPYEMA COMPLICATED BY AN ŒSOPHAGEAL FISTULA INTO THE PLEURA.
visitors who are invited to take part in the discussions. Persons J. intending to be present will recieve abstracts A CASE of some interest and considerable rarity is recordedcof the papers on application to the secretary, 20, Hanoverby Dr. Alexander Jehle in the Wiener Medicin4cAe Wochen- square, s W. In many ways the society is showing that it is schrift, No. 22, 1904. The patient was a child, aged two aactuated by a progressive spirit. Formerly, even though a and a half years, who six weeks previously had suffered from was received and approved for reading and read at a I paper a right-sided pneumonia. About ten days before admission r meeting of the society, it might not be considered worthy into the Wilhelmina Hospital at Vienna the child, developedcof a place in the Transactions and publication in any journal fever, followed by emaciation and oedema of the lower ex-cof any paper before the issue of the Transactions was protremities, but at no time was colic, hasmatemesis, or vomit- hibited. 1 Wiser counsels have prevailed and at the present ing observed. On admission the pulse and temperature were ttime all papers accepted for reading are published in the normal and there were oedema of the feet and ankles andTransactions and authors are at liberty to publish their some degree of emaciation. Physical examination of the papers in medical or scientific I periodicals immediately after chest showed dulness with weak bronchial breathing on thet are On read. they May 22nd, 1905, the centenary of theright side, while the heart was displaced towards the left, society will be celebrated and at the present time a comthe sounds being normal. Exploratory puncture proved themittee is considering the arrangements for this celebration. presence of pus from which a pure culture of the pneumococcus was obtained on bacteriological examination. The SIR ISAMBARD OWEN. incised in the fifth in was intercostal the pleura space Isambard Sir Owen has been unanimously appointed posterior axillary line and a considerable quantity of thick of greenish-yellow odourless pus was evacuated. The course of principal Armstrong College in the University of Durham Sir Isambard Owen, the case was at first quite satisfactory, the oedema disappeared in place of the late Dr. Gurney. who entered the of his new duties on upon performance by the third day, the patient rapidly improved, and the in is well known for he has till quite re-Oct. 8th, London, empyema cavity became smaller, but about three weeks later been and lecturer on the physician principles and the pus which escaped acquired a sour, pungent odour and cently at of St. George’s Hospital. He is, morephysic contained small cheesy masses like curdled milk. This first practice a Vice-Dean of the Faculty of Medicine of the Universuggested the presence of an oesophageal fistula, which was over, and an examiner in medicine for the Royal of London confirmed by the discovery of seeds in the pus escaping from sity He rendered Medical yeoman service in the Corps. the drainage-tube after their administration by the mouth, Army of and is at the present of the Wales formation University although fluid given by the mouth did not apparently escape of that body. The the senior chancellor moment deputy and clear the into the pleura. The empyema continued to up he in educational which possesses questionsexperience but later small great for a time particles oesophageal fistula closed of food were again found in the pus and this condition renders it peculiarly fitting that he should have been selected recurred at intervals for about four months, after which the to be the principal of an institution such as Armstrong and the city of Newcastle, together with the Unioesophageal fistula closed permanently and the empyema College of Durham, is to be congratulated upon having operation wound healed shortly after, since which time the versity the services of so able a principal for one of their obtained child had remained quite healthy. The explanation put educational foremost institutes. B forward by Dr. Jehle is that the communication between the oesophagus and the pleura was due to a mediastinal THE BRITISH MEDICAL BENEVOLENT FUND. gland infected by the pneumococcus at the time of the IN a letter published in the Times of Sept. 30th Sirpneumonia breaking down simultaneously into the pleura and the oesophagus and not to direct invasion of the oesophagus: William Broadbent states that the British Medical. by the empyema, which he regards as negatived by the: Benevolent Fund is suffering considerably by reason of the interval which elapsed between the opening of the empyema prevailing financial depression and that the sum available and the development of the fistula and by the narrowness for the relief of aged or invalided medical men and of the track which only at times allowed food material to. of widows and children left unprovided for is quite pass and even then in such small quantities as frequently to. inadequate. He truly says that for a large proportion be recognisable only by chemical or microscopical examina- of medical men it is impossible to save much out tion. For treatment he recommends washing out the pleuraL of their earnings and if they die early, which is very with non-toxic solutions to clear away the escaped foodL common, their widows and children may be left on materials, while the thoracic wound is to be kept openi the border of destitution. The fund gives 120 annuities r
,
,
,
.