MEDICAL SOCIETY OF LONDON. MONDAY, FEB. 19TH, 1872.

258 tum betwEen the combining centre and the muscles of ar- of those who hold that laws like the Contagious Diseases ticulation, as the organ by which the former acted upon Acts of this country have never, and can never, permathe latter. nently diminish the prevalence of venereal disease. Mr. JOHN WOOD inquired how far the method of teaching The PRESIDENT requested the members to confine themthe deaf to speak by watching the lips of others would selves strictly to the subject of the paper, the sanitary harmonise with Dr. Broadbent’s views. effects of the Acts, and to deal with the figures brought forMr. SAVORY accepted the distinction drawn by the author ward, and the deductions drawn from them. between language and words; but objected that, on the Mr. LANE referred to the case of a battalion of Grenadier view propounded, the mechanical act of speech was seated Guards at Windsor, in which during four months there in centres which were comparatively more developed in the were 30 cases of disease ; and during the subsequent four lower animals than in man. If that were so, he should months passed in London the number of cases was 108. expect the faculty of speech to be widely diffused among Also to the case of a battalion of Coldstream Guards, in which the lower animals, instead of being limited to a few birds. during three months at Windsor there were 14 cases ; while Dr. WiLKS expressed his general assent to the views of in another battalion of the same regiment, during the same the author. The acquirement of language was a complex three months in London, there were 68 cases. His own exprocess; and might be imperfect in the sense that some of perience convinced him that not only the amount but the its ordinary factors might be omitted. Thus it was quite severity of syphilitic disease had been diminished by the possible to learn a foreign language by sight only, so as to operation of the Acts. read it by the eye with perfect comprehension ; while yet Dr. DRTSDALE contended that unfaithful husbands were ignorant of its sounds, and unable either to speak it or to sometimes tempted to go to protected towns " to take the understand it when spoken. Acts"; and suggested that, as these Acts Dr. BROADBENT, in reply, said that he had located the would no longer be tolerated, Government should establish mechanical act of speech in the corpora striata, because he hospitals over the country for all kinds of contagious regarded those bodies as the centres of muscular movement diseases, including syphilis. Mr. CTON alluded to Dr. Armstrong’s table (referred to generally. Mr. Savory was mistaken in supposing that they were comparatively more developed in the lower animals by showing an increase of 0’6 per 1000 in the than in man. Their development, throughout the animal case of venereal disease in the navy at home ports between kingdom, followed very closely that of the cerebral hemi- 1866 and 1869, and pointed out that that increase was spheres, and reached its highest point in the human species. attributable to an addition of 17 per 1000 cases of the President first announcing gonorrhoaa, there being an actual decrease of primary and The meeting then that the ordinary meeting for the 27th, the day of Thanksof 16’8 per 1000 This, he contended, giving for the recovery of the Prince of Wales, would not was a most important proof of the efficacy of the Acts, the be held. return relating to 23,400 men. Dr. Taylor, he said, had forgotten to distinguish between gonorrhoea and syphilis, and error of his deductions. With regard to the MEDICAL SOCIETY OF LONDON. tablequoted by Dr. Taylor as showing a slight army MONDAY, FEB. 19TH, 1872. decrease, he (Mr. Acton) was unable to show the causes of DR. ANDREW CLARK, PRESIDENT, IN THE CHAIR. that decrease, as distinctions were not made between primary sores and gonorrhoea; but it no doubt depended DR. BELL TAYLOR read a papar on "The StatisticalL the of gonorrhoea being better looked up. It Results of the Contagious Diseases Acts." He said he proseen, however, from a table in the appendix posed to inquire into the question whether the generallyr (p.815) that syphilis in the protected districts had assumed impression is correct that the Contagious Diseases! diminishednearly one-half. In 1870 the proportion conActs have (whatever other arguments may be used for orr stantly sick with primary venereal sores was only 4-33 per against them) been successful in a sanitary point of view. 1000 of the strength, while in the unprotected districts the The only trustworthy basis of such an inquiry are the proportion was 7’94. The efficacy of the Acts was still returns made from time to time to Parliament respecting more shown by the number of admissions into hosthe health of the army and navy. If the year 1866 be taken1 pital with primary venereal sores, which in the protected -the year in which the first of the Acts at present in forcee districts in 1870 were only 52’5, while in the unprotected was passed, and towards the close of which it began to be e districts they were 113-3 per 1000. put in operation in a few places, the returns for which11 Mr. HENRY LEE, in speaking against the Acts, said that therefore could not be materially affected by the Act-anddif they were extensively adopted, and applied to the whole the last year for which we have returns be compared withb. community, in three-fourths of the suspected cases a it, to what extent will it appear that venereal diseasess medical man would not be able to say whether there was or not. have diminished in the army and navy, taken as a whole ?? Mr. COULSON spoke in support of the Acts, and advocated To this question, two tables, printed in the appendix to the evidence taken before the Royal Commission, enable us to a compulsory examination of all prostitutes throughout the give a simple and decisive answer. On page 815 is a table country. headed thus: Return showing the effect of venereal Dr. WEBSTER spoke in opposition to the Acts, which he diseases on the efficiency of the army serving at home contended were immoral in their tendency. Dr. GIBBON argued in favour of the continuance of the during the ten years from 1860 to 1869 inclusive." It gives the ratio per thousand of men " constantly sick for enthetic Acts. diseases." The number for 1866 was 16 00. The number Mr. BERKELEY HILL referred to a table published in the for 1869 was 14-87. Thus the total gain in the three years appendix showing the number of men constantly in hospital was a diminution of no more than one man and a trifling for primary venereal sores and gonorrhoea at twenty-six fraction in a thousand. It must be noticed at the same stations of troops (distinguishing protected and unprotected) time that the number was higher both in 1867 and 186E from 1866 to 1870. The entries in the unprotected stations than in 1866, being close upon 18 per 1000 in 1867, and ver3 in 1866 were 11!per 1000 ; in 1867, 13; in 1868, 13; in nearly as high in 1868. For the navy we turn to a tabl( 1869, 154 ; in 1870, 12-7. The entries for primary venereal sores for these years were 6-35, 6 95, 740, 9’18, 794; and given on page 816, put in by Dr. Armstrong. This tabl< does not give the number of men constantly sick fo’ for gonorrhoea, 5-17, 6-57, 6-48, 6-21,4 96. In the protected enthetic diseases, but " the number of cases of venerea the entries were, in 1867, 12; 1868, 11 ; 1869, disease contracted by the crews of her Majesty’s ships fron most of gxl 4 8: showing a gradual 1856 to 1869 inclusive, with the ratio per thousand of force.’ which was attributable to venereal sores, which decreased From it we learn that the number of cases of venerea from 6 95 to 4-33. Mr. Hill also called attention to a table disease per 1000 in the navy, at home ports, was 101-3 i (appendix, p. 811) showing the ratio of admission for 1866, and 101in 1869. Consequently, instead of a dim primary venereal sores and gonorrhoea at protected stations, inution there was an actual increase in the three years. I in the year preceding the application of the Act, and in the two intervening years, however, the number was lowe: each subsequent year. In the first group of five stations, in the first year under the Act, the admissions were-venebeing 92-9 in 1867, and 90-1 in 1868. The results laid b< fore the Society are most important. It is impossible t real sores, 86 ; gonorrhoea, 130 ; second year, venereal sores, explain them away. They go far to substantiate the viev 69; gonorrhoea, 129; third year, venereal sores, 58, gonor-

benefit of the all

Dr. Taylor)

adjourned,

secondary syphilis

___________

hence the

on

-

cases

would be

.

clearly

disease

"

stations 87 s 0

diminution,

259 rhoea, 107; fourth year, venereal sores, 54; gonorrhoaa, 103.

occurring in nutrition exclude those induced by the gastric

put in force in the Borough prison, juice. The other points that are successively treated of percentage on the aggregate number of are wounds, hernise, and displacements of the stomach and Ii for syphilis, and 2t for gonorrhoea and bodies in its interior, ulcer and

Before the Acts Devonport, the

were

prisoners was after the passing of

the Act the proportion was a half per cent. for syphilis, and 2 per cent. for gonorrhoea, It had been contended that the disease would be as readily cured under a voluntary as under a compulsory system ; but facts disproved the assertion. At Devonport, for instance, before the Acts were put in force, 25 per cent. of the patients admitted into the Royal Albert Hospital left before they were cured, against the will of the authorities. And at Winchester, when the hospital was rebuilt, the authorities decided to have no venereal beds, there having been so few patients; but after the Acts were in force, of the first batch of women examined 43 per cent. were found to be

foreign

cancer, dilatation and

gastritis, simple spontaneous perforation, and, lastly,

various degenerations. The subject of fever," considering the size of the whole work, is given with remarkable succinctness. This is partly due to the circumstance that the literature and the history of the various doctrines that have been held in bygone times upon the nature of fever have been almost entirely omitted, but partly also to the circumstance that several of the points in the phenomena of fevers are discussed under other heads. M. Hirtz commences his essay with a brief syphilitic. The discussion was continued by Mr. Myers, Mr. Cur- description of the symptoms accompanying (1) the period of genven, Dr. Murray (who spoke from personal experience incubation, (2) that of invasion, (3) that of the fully deof the value of the system of compulsory inspection at veloped affection, (4) of its termination, and, when this Hong Kong), Dr. Hare, Dr. Routh, Mr. Bond, Mr. Weeden has been favourable, (5) of the stage of convalescence. Cooke, Mr. Deakin, and Mr. Carter; and was brought to He then proceeds to point out that the chief features chaa close by a reply from Dr. Bell Taylor. racteristic of fevers consist in disturbance of (1) calorification, (2) of the circulation, (3) of the blood, (4) of the nervous system, (5) of the digestive system, and (6) of the secretions. The first of these, as may be supposed, is given at considerable length, and illustrated by observationsNouveau Dictionnaire de Midecine et de Chirurgie Pratiques. taken in cases of pneumonia, scarlet fever, typhus, typhoid, Tome XIV. ERYS-FL. Paris: J. B. Bailliere. 1871. acute rheumatism, and in intermittent fevers. By numeTnis part contains thirty-six articles by twenty-three rous tables M. Hirtz shows clinically that the varia-contributors, of which the most important are-"Ery- tions of temperature exhibit a period of invasion and of sipelas," by MM. Gosselin and Raynaud, the former of augmentation, a stationary period and one of decline. The course treating of it in its surgical and the latter in its period of invasion precedes the rigor, and, according to his medical or idiopathic aspect; "Esthiomene," or rodent own researches, every subjective symptom. During the ulcer of the female generative organs, to the description of rigor an antagonism becomes apparent between the internal which M. Bernutz devotes a good paper; "Estomac," by temperature and that of the surface, the difference amountM. A. Luton, giving its anatomy, physiology, and pathology , ing in the course of half an hour to as much as 10° C. As very completely, and occupying nearly 150 pages; "Face," the shivering fit subsides, the temperature of the two parts by A. Le Dentu and H. Gintrac -a still longer article; tends to approximate ; but the internal temperature often "Favus," by Hardy; "Fesse and Region Fessiere," by attains its maximum before the shivering has terminated. Maurice Laugier; "Tissu Fibreux and Fibromes," by This is strikingly shown in the tracing of intermittent Alfred Heurteaux; and 11 Fi6vre," by Hirtz. Amongst the fever, and it is thus rendered evident that the shivering is shorter essays are those on "Ethers," "Ectases," H Ex- not a deceptive sensation, but the perception of real cold. humation," Exophthalmie," " Falsification," and Fer." It is, however, only observed in those fevers that make In regard to exhumation, M. Tardieu says, sadly, that their début by a severe access of fever, as in intermittent recent events have caused this subject, and the proper fever, pneumonia, pysemia, variola, scarlet fever, yellow mode in which it should be conducted, to be of great im- fever. In the milder forms of fever, in which the febrile portance to the public health. Where practicable it should temperature requires from three to six days to attain its only be performed when the temperature is low; a large maximum, the shivering is usually absent, and with it the number of workmen should be employed at once, and any strong divergence between the peripheric and the central who sicken should be promptly replaced by others. The temperature. It is, accordingly, not well marked in typhoid spades should have long handles, and disinfectants be fever, measles, and exanthematous typhus. Here there are freely used, as carbolic acid, the salts of iron, and chloride matutinal and vespertinal oscillation of such a nature that of lime. By the committee which met at Brussels, under the evening exacerbation is exceeded by that of the followthe chairmanship of Count Orloff, incremation was success- ing evening, and the remission of one morning by that of£ fully adopted. The Committee of Public Hygiene of the subsequent morning, forming an ascending zig-zag line France, which M. Tardieu presided over, recommended that in the tracings known as 11 I’aseension en terrasse." The a tumulus should be raised over the bodies, and that this stationary period of the temperature varies in duration. should be planted with sunflowers, white mustard, and from an hour or less, as in the periodic fevers and in pyother rapidly growing plants requiring much azote for semic exacerbations, to some days, as in pneumonia, scarlet their nutrition. fever, and typhus; or it may even last for a week or two, as The article "Estomac" is remarkably complete. It in typhoid fever and acute rheumatism. It is to be observed commences with a good description of the anatomy andIthat in all these cases there are morning and evening variaphysiology of the organ, though we can scarcely agree with tions of remission and exacerbation, independently of temthe stat ement that the immunity of the stomach from self- porary increase during pneumonic extension and the devedigestion is the presence of an epithelial lining covered lopment of miliary or erysipelatous eruptions. In the event with mucus. It seems more probable that the separation of a favourable issue, the matutinal remissions become of the acid of the gastric juice from the blood traversing more marked and complete, and the evening exacerbations the capillaries of the organ leaves the blood, and conse- less and shorter. The period of defervescence varies like quently also the tissues, in an hyperalkaline condition, that of the attack, in accordance with the nature and the which effectually shields them from its action; or, as Dr. violence of the disease. During convalescence the and the Dalton maintains, it may be that the catalytic changes rature is often below the normal, not exceeding 36° C. 11

Reviews and Notices of Bo ks.

"

"

Iviolence I isoften belowDuring not egceeding the tempe-