PNEUMONIA, A MULTIPLE AFFECTION.

358 when the

state of affairs as existed at Gloucester, Maidstone, Richamond Asylum, &c., is an impossibility here. What we do ;,and what we have done for the safety of the colony, long before the Venice Conference was ever heard of, is as follows : Whenever an epidemic breaks out in a port that - port is declared infected and the governor in council may prohibit immigration and importation into this colony of all ’Chinese from the place infected ; every vessel from thence is boarded and inspected-not by a custom-house officer (as I once saw done in London) but by a duly qualified medical man. If there are no cases of sickness the vessel is immediately released. If a case of disease exists it is Apromptly landed into an infectious hospital (which I venture to think compares not unfavourably with similar institutions elsewhere), the ship is disinfected and detained for twentyfour hours or longer at the discretion of the health officer of ,the port and if no further cases occur, released. This, I think, is absolutely sufficient and at any rate is all that is properly practicable with 2500 people a day to deal with. I am afraid this letter is a very long one, but I for one take exception to a paper like THE LANCET inferring that this colony is behind the times in matters of sanitation, whereas in fact the responsible officers are men who in addition to professional knowledge bring also to bear on this subject a knowledge of local conditions and requirements .of which the writer of the article in question seems absolutely ignorant. In conclusion, I would mention that we .are so far behind England that the Government actually employs a qualified veterinary surgeon who daily inspects .every animal slaughtered for food and every market in the place and,should much like to know in how many places in England such a very proper and very sanitary measure is I am, Sirs, yours faithfully. ’carried out. J. BELL. Medical Department, Hong-Kong, April lst, 1898. a

climbing,

metatarso-phalangeal joints

must be of

are

bent,

as

in hill-

advantage, I, however, have

not

"paramount value " ; but I opinion that most people use them

claimed for the smaller toes

adhere most fully to my and that, in proportion as

they

I am. Sirs. Gloucester, May 7th, 1898.

a

are

used, they

vours

are

useful.

faithfullv.

T.

S. ELLIS.

THE EARLY DIAGNOSIS OF MEASLES. To the Editors of THE LANCET. SIRS,-During the late epidemic of measles I have made one or two vain attempts to stop the spread of the disease by early isolation and have kept the other members of the family daily under observation trom the time of their separation till they in turn fell ill. For a fortnight at least prior to the appearance of the iniloecza, symptoms, although they seemed to be perfectly well and had a good appetite, the temperature persistently remained at 97°, but it at once commenced to rise directly the running of the nose and eyes commenced. I think that in cases where we are in doubt whether children have taken the infection or not this may be of service in helping us to come to a correct decision. . am

Surbiton, May

Sirs

wnnya

faithfully

F. P. ATKINSON.

6th, 1898.

"THE ROYAL COLLEGE OF SURGEONS OF ENGLAND AND THE CORPORATION DUTY." To the Editors of THE LANCET. to your annotation

on this subject, it is have been unable to publish following extract may be of delivering the judgment of the court in favour of the Crown Mr. Justice Wright said the section provided an exemption for property legally appropriated and applied for the promotion of science On the authorities cited it could not be said that the property of the Royal College of Surgeons was legally appropriated and applied for the promotion of science at the time of the assessment. At the time of the original charter cholera prevalence of 1892-95 and who were treated or science might have been the main object, but the actual ’exactly the lines which he describes as being "toc object at the present day was to be gathered from the later sridiculsus." Then again, Mr. Bell is correct, as hE charters and the by-laws. That object mainly was the grantdesiring to beeome ,surmises he may be, in assigning to the Venice Conventior ing of certificates or diplomas to The balance- sheets showed that the largest source surgeons. a, conclusion which finds no place in that treaty, but hE of income and expenditure was the examinations. The is incorrect as to the diseases with which the Venice Con evidence brought before the court failed to show that the - 4’erence had to do. It was solely concerned with plague promotion of science was the main object." The Council has always met proposals for reform or We are glad to endorse what he says as to the excellent ; for the enforcement of certain by-laws with the requests done work in and know we how abl] Hong-Kong sanitary stock argument that the College is a purely scientific instithe sanitary administration of the colony was utilised in th tution and that its sole object is the promotion of the dast outbreak of plague; but we hold that where such worl science and art of surgery. This fallacy has been exposed and administration exist, the principles of the VenicE over and over again by Mr. Jonathan Hutchinson and others. Convention are adapted to deal with the introduction of suel The Council has, as we know, an immense respect for a when this is in its favour, as ;a disease as plague, although it is highly probable that the; judicial decision, especially was the judgment in Steele v. Savory. We trust, therefore, may need some modification in details.-ED. L. that it will in future be kind enough to remember that the main object of the College as defined by a court of law is " the granting of diplomas to persons desiring to become "THE WALKING VALUE OF THE LESSER surgeons,and that we shall hear no more of the "purely scientific " twaddle. TOES OF THE HUMAN FOOT."

SIRS,—Referring

a

* Whilst gladly printing the above letter we cannot pretend to agree with some of its contentions. The Venice Convention was not intended to apply merely to ports like London, but even as regards that port Mr. Bell describes conditions in Hong-Kong which agree in almost every detail with the arrival in this country - of Russian and German transmigrants who passed through England to the United States during the

of

some regret that you the case in extenso. The interest to some Members : I I In

matter

......

persons

,

,

T

Hm

Sirs

yours

faithfnllv-

To the Editors of THE LANCET. W. G. DICKINSON. May 9th, 1898. SIRS,-Permit me to say, with reference to Mr. Heather Bigg’s quotation from "The Human Foot," that my test as to whether the toes are habitually used is a very simple one. PNEUMONIA, A MULTIPLE AFFECTION. Is the skin of the front part of the sole free from callosities2 To the Editors of THE LANCET. I cannot imagine this condition to exist if much walking be done, unless the toes collectively be used. When the toes SIRS.—In a very interesting annotation on "Strepto.are firmly pressed against the ground the long flexors, which coccic Pneumonia," in THE LANCET of May 7th, p. 1275, .-are to the plantar arch as bowstrings or tie-rods, tend to you observe: " No attempt has been made in this country to include in it the heads of the metatarsal bones and so to differentiate what is ordinarily calledpneumonia,’ which upliftthem. When these are borne down by the weight of is the name of a lesion and not of a disease, into the various the body the place of contact is determined by the position diseases of which it may be a manifestation." That this is of the fixed toes; there is no sliding and therefore no not correct will appear from a reference to a paper which friction. This advantage is of necessity lost when the I read before the Section of Medicine in the Royal Academy tendons are attached to the heads of the metatarsal bones. of Medicine in Ireland on Friday, Nov. 19th, 1897, on Moreover, the extension of the base of support and the "Pneumonia, a Multiple Infection." An abstract of my capacity to press on the ground all across the foot, even paper was published in THE LANCET of Dec. 4th, 1897,,

1359 p. 1459.

The paper itself

was

published

in full in the

iospital,

which is not

invariably

the case, and that

they

British Medical Journal of Jan. lst, 1898, and also in the tre not in excess along the main approaches, which we Dublin Journal of Medical Science for January, 1898. I Ihould have no right to expect, for the people who walk would ask you kindly to quote the two concluding para- in a street are not always those who dwell in it. The eliminaition of this residuum is always a matter of extreme difficulty, graphs of the paper in question.

is has been shown by Dr. Orme Dudfield, Dr. Savill, and In conclusion, I venture to submit that there is clinical evidence to how that a true pneumonitis may occur in any one of the four diseases has taken others, even when the during with which this communication deals-that is to say, erysipelas, in- 1the of an more after a much of progress and enteric fever. it is reasonable to tluen2,,a, tuberculosis, Further, weeks or it is the elimination of in that each case the is due a months, to localisayet complete upon pneumonitis suppose directly tion of the specific poison of the disease in the lung, whether that be a these cases that the of distal aerial infection is based. micro-organism itself or a toxin derived therefrom. Indeed, in respect That the has never been is no argument of the four diseases named, the evidence, from a bacteriological standin its favour for the same might be said of the wonders point, in favour of such a view is incontrovertible. the diviner’s rod. The main As regards enteric fever the influence of season and weather in worked is whether
investigation epidemic,

place lapse

theory

theory

disproved

by theory

question

facts;

surely

machinery

inquiry theory

public

body

It is easy and sometimes convenient to treat matters of ten years ago as ancient history and as of little a moment, but the fact remains that the discussion on -T nm Kira yours faithfully the dangers of small-pox hospitals before the Society of F.R.C.P. Irel. Medical Officers of Health in 1885 is the most imFitzwilliam.square West, Dublin, May 7th, 1898. portant one ever held on this subject and that the difficulties then suggested have never been met. The divergent views held as to the distance through which small-pox virus may be carried through the open air were well shown THE DISTAL AERIAL CONVECTION OF in the Report of the Hospital Commission and more recently SMALL-POX. in the Ossett case, but the point has never been settled even To the Editors of THE LANCET. approximately, nor am I aware of any series of experiments SIRS,—In your impression of April 9th attention is once with a view to its solution. Observations are wanted, more drawn to the question of distal aerial infection from especially in the country, where facts can be ascertained precision than in a populous centre. small-pox hospitals, and it is evident that the last word with much more has by no means been spoken on the subject. Since the There must be many available from medical officers practitioners throughout the theory of distal infection was first propounded by Mr. of healthif and medical only they could be collected. The chief Power and adopted by the Local Government Board as a country "good working hypothesis"it has baen defended from difficulty, however, in accepting the distal infection attack with a persistence which is somewhat suggestive of theory remains to be noticed-viz., the startling immunity which has over and over again been observed in a wavering faith. There can be no doubt that a working hypothesis may be a large bodies of presumably susceptible individuals living very helpful thing, even though it may not be true; the near to small-pox hospitals and among whom, according to atomic theory of light was such a one and it was superseded. the distal aerial theory, small-pox should have appeared "Ibegan," said Harvey, "to think whether there might with an intensity proportioned to their nearness to the mot be a motion in a circle" ; that was his working hypo- centre of infection. No explanation is offered for these thesis, but he did not stop there, for he proceeds to say, remarkable exemptions from the incidence of a disease "this I afterwards found to be true," and that working which (within limits still undefined) is acknowledged to be above all others, and when it is borne in mind hypothesis remains good to this day. Mr. Power and those infectious the that chance discovery of its origin in a single case a by who think with him have as yet attained the first stage only ; clue might be given which would sweep away the better part whether not in are there be a motion a thinking may they or even the whole of the residuum on which the "circle circle, but they have not yet proved that it is so. The recent case of Harrop v. the Corporation of Ossett argument " is based, the conclusion is irresistible that the of distal aerial infection rests on a very imperfect (the Times, March 18th, 21st, and 23rd) shows this very theory that much more evidence is required before it basis and such able for after an hearing clearly, experienced judge, acceptance. exponents of the distal aerial theory as Mr. S. Murphy, Dr. can meet with general I am. Sirs vnnriq faithfully Sinclair White, and Dr. Priestley, is not convinced, while EDWARD T. WILSON, M.B. OXON, F.R.C.P. Lond. the evidence of Dr. T. Orme Dudfield, Dr. Savill, and Dr. May 2nd. 1898. T. F. Ricketts serves to show that an influential body of the medical profession still finds difficulty in accepting the views so tenaciously upheld at Whitehall. That a small-pox hospital in a poor and crowded locality NOTES FROM INDIA. may be, and usually is, a source of infection to the sur(FROM OUR SPECIAL CORRESPONDENT.) rounding neighbourhood is not denied ; it is when we come to inquire for the causes of the spread in its vicinity that doubt and difficulty arise, and it is impossible to agree with Dr. Priestley that so long as a small-pox hospital is allowed The -Decline of Plague Mortality in Bombay.-Important Lecture by the Medical Officer of Health.-The Outbreak to be a source of danger, whether it be by aerial infection OJ at Calcutta.-The Increase of Plague in Kurrachee. it does not concern a officer oi medical by maladministration, health as a matter of fact, for the question is not merely oj THE past week has shown an improvement in the general academic interest, seeing that its solution must be of somE mortality in Bombay, but there has not been a continuance importance, not as an argument for or against placing of that rapid fall in the death-rate which gave so much hope small-pox hospitals in crowded localities, but in view of thE the week previously. About 1200 deaths have been regisselection of a site within a mile of any human dwelling. tered-still continuing more than double the normal number In every small-pox epidemic it is found that a certau -a rate of about 75 per 1000 per annum. A very able and suggestive lecture has been given percentage of cases around a hospital can be traced, apar from any question of maladministration, to ordinary know) on the Plague by Brigade -Surgeon - Lieutenant -Colonel channels of infection, such as the incomings and out T. S. Weir, the medical officer of health of Bombay. In the goings of nurses, staff, tradesmen, patients, and friend course of his address he laid down the following measures of patients, and these are and must invariably be intensified for scientifically resisting the disease : 1. Measures for the as we approach such a centre as a small-pox hospital; bu destruction or immunisation of rats or other carriers of the -even after the most searching inquiry a residuum remains t microbe. 2. Measures for the retreat or escape of the which no clue has been discovered and of these it is sai, population from the area of invasion. 3. Measures for the immunisation or protection of the population against the that they diminish in number as we get further from th In my paper I show that the streptococcus pyogenes plays part that is second to none in the production of influenza-

JOHN WILLIAM MOORE, M.D.Dub.,

believe.