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THE DIAGNOSIS OF MALIGNANT DISEASE.
502 the Council of the Association to appoint a commission to inquire into the question of the results obtained in the treatment of fractures by operative and non-operative We await with anxiety the report of the methods. commission, though doubtless many months must elapse before any report can be ready. It is difficult to overrate the importance to the community of the decision on this matter. The inquiry must include the examination of the results of the older method, both at its best as well as at its worst ; and the same will, of course, apply to the more recent operative method, for it would surely not be fair to compare the best results obtained by so skilful a surgeon as Mr. Lane with the non-operative results of a medical practitioner who has not devoted special attention to this branch of surgery. The collection of material for the report will be a valuable work, and we trust that a very large number of surgeons will cooperate in the carrying out of a valuable investigation.
a bean containing purulent granular material. On pressure pus exuded from the lobes. From the spleen, lymphatic glands, and prostate gland the typhoid bacillus was cultivated. Microscopic examination of the prostate gland showed an acute purulent exudation with breaking down of the glandular cells. The vesiculæ seminales were normal. Dr. Marchildon suggests that after enteric fever the prostate gland and vesiculæ seminales may harbour typhoid bacilli for a long time, and that the bacilli may readily pass into the urine with the semen or prostatie secretion, reach the bladder, and produce typhoid bacilluria. Thus may be explained the recurrence of typhoid bacilluria after suspension of treatment. The importance of this subject in connexion with typhoid carriers is obvious.
size of
CENTRAL
PUBLIC-HOUSE
TRUST
ASSOCIATION.
THE annual report of the association shows that the number of Public-house Trust companies remains the same as last year, 37, while the number of houses under Trust TYPHOID SPERMATOCYSTITIS AND PROSTATITIS. management is now 262. It is satisfactory to note that out IT is now recognised that so-called enteric fever is a the 37 of companies only seven are not yet in the position general infection with the typhoid bacillus, and that the of paying a dividend. The principal development of the " complications" are inflammations produced locally by the Public-house Trust movement during the past twelve. I bacillus. To the long list of these lesions, involving almost rmonth has been in the home counties, the Herts and every structure in the body, Dr. J. W. Marchildon. assistant Essex Trust extended its operations to having Company professor of bacteriology in St. Louis University, working Middlesex, Bedfordshire, Berkshire, Buckinghamshire, Oxford. under Professor Pick at the Stadtisches Krankenhaus in shire, Leicestershire, and Rutland, a plan which saves Friedrichshain, Berlin, has added two-spermatocystitis and preliminary costs and costs of central management. New prostatitis. He has reported the results of his investigation licences have been granted at Crosby (Lincs.), Harden in the American Journal of the Medical Sciences for July. It and Thorne Collieries, and at the Edinburgh corporation has been shown that apparently healthy people markets at Gorgie. We are glad to see that the movement carriers) may have typhoid bacilli in their bladders for years is making steady progress, not only in extension of area and after an attack of enteric fever. It appears that during the in number of houses controlled, but also in the direction of attack they are excreted by the kidney, and that the urine developing the trade in food and non-alcoholics at the becomes a culture medium for them. In some cases cystitis The report calls forcible expense of the alcoholic trade. is produced, in others there is merely bacilluria. Hence it attention to the operation of the Finance Act, and points out has been recommended to give some urinary bactericide that its present provisions penalise improvements designed during convalescence from enteric fever. In some cases so to build up a non-alcoholic trade and to further the pro. treated the bacilli disappear from the urine, but reappear gressive reforms of the Trust Association. The association a few This weeks after the treatment is stopped. recommends that the tax should be not upon the premises result has been attributed to the presence of ulcera(thus penalising tea- and dining-room accommodation), but tive cystitis, which is a source of infection. That upon the trade which is created by the licence-i.e., the this is not the only explanation Dr. Marchildon found trade in alcoholic drinks. It would certainly be regrettable in the two following cases. A lad, aged 17 years, was if it were found that the Finance Act placed a serious admitted into hospital comatose on the fourteenth day of a obstacle in the way of such an excellent movement as that of severe attack of enteric fever, and he died at the end of nine the Public-house Trust Association. days from perforation. At the necropsy Professor Pick found typhoid ulceration of the ileum with perforation, THE DIAGNOSIS OF MALIGNANT DISEASE. with a small -
.,
(typhoid
haemorrhage, fibrino-purulent peritonitis, cystitis IN another column we publish an article by Dr. Elsie M. purulent spermalJocystitis and inflammation of the right ulcer on the epiglottis, parenchymatous Royle on the aid which chemical examination of the urine vas deferens, nephritis with miliary abscesses, obliterative pleurisy, and may afford in the diagnosis of malignant disease. Dr. bronchitis. The seminal vesicles were enlarged and reddened Royle’s investigations have enabled her to prove that in and fluctuated. They contained purulent fluid from which cases of cancer the uric acid is usually higher than is found the typhoid bacillus was cultivated. Microscopic examina- in healthy cases under similar conditions ; further, that the tion of the left vesicle showed that the mucosa was in some output of phosphates in the urine is in the majority of cases places destroyed and in others distorted and infiltrated. The of cancer decreased when compared with healthy individuals; lumina were dilated and filled with an acute cellular exudate and finally, that the ratio of phosphates. is almost invariably which was partly necrotic and showed clumps of typhoid uiic acid bacilli. The prostate was normal. In the second case a reduced in malignant disease. Acting on these results man, aged 28 years, was admitted into hospital with the Dr. Royle suggests that a chemical analysis of the urine may diagnosis of typhoid fever of about ten days’ duration. prove of value as an aid to diagnosis in obscure cases of Death from haemorrhage from the bowel occurred four days cancer, especially when the abdominal organs are the seat The differential diagnosis of malignant later. At the necropsy Professor Pick found typhoid ulcera- of the disease. tion of the ileum, icterus, acute enlargement of the spleen, disease from gall-stones, gastric ulcer, chronic pancreatitis, parenchymatous nephritis with small abscesses, acute purulent and other morbid conditions is frequently very difficult prostatitis, enlarged mesenteric glands, and acute catarrh and any reliable auxiliary test would be welcome. Dr, The prostate gland was enlarged, Royle, however, prudently observes that her investigaof the duodenum. especially in the right lobe. There was an area of the tions are not complete and that this communication is
503 intended as a preliminary one. The cases she has examined point to the proposed test as a useful one, but before the value in diagnosis of the facts proved in her paper can be clearly established it will be necessary to determine how far they are true of other forms of cachexia, and what their relation may be to the secondary ansemia usually present in malignant disease. Dr. Royle is at present engaged in working out these questions, and the results will be awaited with interest. The technique of the chemical tests is not a complicated one.
only
PUBLIC BY W. E.
HEALTH ADMINISTRATION IN HAMBURG. HOME, M.D., B.SC. EDIN., M.R.C.P. EDIN., D.P.H. R.C.P.S. EDIN., FLEET-SURGEON, ROYAL NAVY.
The
Disinfectiny Station.
BY the kind permission of Professor Medizinalrat Dr. Nocht I was recently permitted to learn something of the methods of disinfection practised in Hamburg and to visit THE King has augmented his yearly subscription to King the central disinfecting station. Edward’s Hospital Fund for London from £500 to f:l000, Hamburg is a city of 800,000 inhabitants. All its instituand His Majesty is anxious that the date of augmentation tions are on a large scale, so one is not surprised to find should coincide with that of his first visit to the London that this one department of the sanitary administraof the city employs 214 men. When notification Hospital since the accession. His Royal Highness the Prince tion of a case of infectious disease has been received and of Wales has forwarded E100 to King Edward’s Hospital disinfection ordered, the sanitary authorities send out a Fund as an annual subscription. party of disinfectors dresssed in sterilised overalls, cap, blouse, trousers, and boots, and (in case of plague) gloves, too. THE King has granted to Dr. Hugh Campbell These men collect the articles to be disinfected, sprinkle them medical officer of health at Bangkok, His Majesty’s Royal with disinfectant, and roll them in sheets, over which an licence and authority to accept and wear the Order of the impervious cover is now fastened to confine the infection as White Elephant of the Third Class, which has been conferred much as possible. The room or house is then cleaned, special care being taken to clean the walls and floors of sputa which upon him by His Majesty the King of Siam in recognition of may possibly be tuberculous. After this formalin vapour, valuable services rendered. the is employed. The materials solution, by boiling produced for disinfection are removed to the central station, where the AMONG those to whom His Majesty the King, Sovereign men who have done the work get hot baths and change their of The Order of Mercy, has been graciously pleased to suits. Meanwhile the room, every crevice in which has been is saturated with formaldehyde. When this sanction the award of the Order are Mr. A. T. Scott, pasted up, saturation has continued long enough liquor ammoniæ is M.R.C.S. Eng., and Mr. W. Chearnley Smith, M.B., boiled into the room through a keyhole; thus the acid is C.M. Edin. neutralised and the room can be entered and aired. The disinfecting station to which the fomites are removed ON the recommendation of the Prime Minister, the King is divided into two, the infected side and the clean side. has sent from His Majesty’s Royal Bounty £150 to the fund These departments are divided by a wall 50 yards long, This wall has which Sir William P. Treloar is raising on behalf of the which runs through the establishment. no doors but is pierced by six steam disinfectors and by widow of the late Mr. H. W. Cox and her family. the bath rooms for men and women. Each side has its own and to get from one side to the other it is necessary to staff, Mr. John Hammond Morgan, C. V. O. , F. R. C. S. Eng., has pass through the open air. In this way the attendants are been promoted from Honorary Associate to Knight of Grace prevented from negligently crossing without disinfecting of the Order of the Hospital of St. John of Jerusalem in themselves, and so accidents are avoided. Clothes and furniture for disinfection are examined on arrival at this England. station ; if grossly soiled they are first boiled for an hour, but if fit for disinfection they are carefully numbered and PORTSEA IMPROVEMENT SCHEME.—An admirable labelled. The disinfection is done by a current of steam at scheme for the improvement of Portsea (Portsmouth) has 102° C. and the articles are laid out on the trays of the disbeen drafted by Dr. A. Mearns Fraser, the medical officer of infectors (iron frames with wire meshes which are covered health. The available area is very rigidly bounded, and with coarse sacking) ; at this temperature the clothes are not consists of some 2 acres, on which it is proposed to erect scorched. Five of these disinfectors are large ovals and are 46 houses, roughly 20 houses per acre, to let at rents of worked by current steam at 102° C. ; another smaller circular 7s. and 7s. 6d. (inclusive of rates and taxes) in the case of disinfector is used for delicate materials, for leather, &c. In residences and at 8s. 6d., plus rates and taxes, in the case of this under reduced pressure (water boiling at 80° C.) infected four shops. It is proposed to layout this area as one long articles are exposed to formalin and steam. This method is road, 40 feet wide, stretching from Queen-street to Kent- more expensive, but so far no complaints of damage have street. The road will be planted with trees, the houses set been made. There is also a temporary chamber for the back from the road, and a portion of ground, about 1000 formalin disinfection of articles insufficient in number to fill square yards in area, between the road and the houses one of the large steam disinfectors. A single disinfection will be used as an open space, planted with trees, and in the large apparatus costs 4s. The bath rooms for infected persons run completely across asphalted. Four different types of houses are provided, each being carefully designed to meet the requirements of some the building. They are entered from the infected yard and particular class of tenant. The houses are a great improve- their exit is in the disinfected yard. The bathers enter, take ment on many working-class dwellings, the report stating their clothes off, and send them up in a lift to be disthat the object has been to design "more healthy, more infected. They then spend an hour or so taking their baths. convenient, and more cheerful houses " than has often been A notice which I saw gives very complete directions done. As Dr. Mearns Fraser points out, "it is but little more for the cleansing of hands. The nails are to be cut and costly to make a beautiful than an ugly street," and the scrubbed, the space under the nail and the nail fold are to reconstruction when finished will add a very handsome and be cleaned with the scissors supplied, then the hands are attractive road and effect an extraordinary improvement in scrubbed first with disinfectant and then with spirit. Next Portsea. The report further points out that the scheme may the hair (it was in the temporarily unoccupied ladies’ divibe continued at some future time so as to give St. George’s- sion I read the notice) must be washed and cleaned with square an approach through into Queen-street, and inci- spirit under the supervision of the bath attendant. After dentally transform the worst conglomeration of slum property this a bathing-cap is put on in order that the hair may not in the borough into a model working-class residential neigh- become wet in the ensuing bath. When the bath is combourhood. Improvements of this character must add very pleted the "contact " passes to the clean side, where the now greatly to the health of the district, and Dr. Mearns Fraser is disinfected clothes are received down a lift, and the disto be congratulated on an excellent piece of constructive infecting process concludes. An inventory of the clothes for i disinfection which have been taken from the infected side has work.
Highet,
__
__
a bean containing purulent granular material. On pressure pus exuded from the lobes. From the spleen, lymphatic glands, and prostate gland the typhoid bacillus was cultivated. Microscopic examination of the prostate gland showed an acute purulent exudation with breaking down of the glandular cells. The vesiculæ seminales were normal. Dr. Marchildon suggests that after enteric fever the prostate gland and vesiculæ seminales may harbour typhoid bacilli for a long time, and that the bacilli may readily pass into the urine with the semen or prostatie secretion, reach the bladder, and produce typhoid bacilluria. Thus may be explained the recurrence of typhoid bacilluria after suspension of treatment. The importance of this subject in connexion with typhoid carriers is obvious.
size of
CENTRAL
PUBLIC-HOUSE
TRUST
ASSOCIATION.
THE annual report of the association shows that the number of Public-house Trust companies remains the same as last year, 37, while the number of houses under Trust TYPHOID SPERMATOCYSTITIS AND PROSTATITIS. management is now 262. It is satisfactory to note that out IT is now recognised that so-called enteric fever is a the 37 of companies only seven are not yet in the position general infection with the typhoid bacillus, and that the of paying a dividend. The principal development of the " complications" are inflammations produced locally by the Public-house Trust movement during the past twelve. I bacillus. To the long list of these lesions, involving almost rmonth has been in the home counties, the Herts and every structure in the body, Dr. J. W. Marchildon. assistant Essex Trust extended its operations to having Company professor of bacteriology in St. Louis University, working Middlesex, Bedfordshire, Berkshire, Buckinghamshire, Oxford. under Professor Pick at the Stadtisches Krankenhaus in shire, Leicestershire, and Rutland, a plan which saves Friedrichshain, Berlin, has added two-spermatocystitis and preliminary costs and costs of central management. New prostatitis. He has reported the results of his investigation licences have been granted at Crosby (Lincs.), Harden in the American Journal of the Medical Sciences for July. It and Thorne Collieries, and at the Edinburgh corporation has been shown that apparently healthy people markets at Gorgie. We are glad to see that the movement carriers) may have typhoid bacilli in their bladders for years is making steady progress, not only in extension of area and after an attack of enteric fever. It appears that during the in number of houses controlled, but also in the direction of attack they are excreted by the kidney, and that the urine developing the trade in food and non-alcoholics at the becomes a culture medium for them. In some cases cystitis The report calls forcible expense of the alcoholic trade. is produced, in others there is merely bacilluria. Hence it attention to the operation of the Finance Act, and points out has been recommended to give some urinary bactericide that its present provisions penalise improvements designed during convalescence from enteric fever. In some cases so to build up a non-alcoholic trade and to further the pro. treated the bacilli disappear from the urine, but reappear gressive reforms of the Trust Association. The association a few This weeks after the treatment is stopped. recommends that the tax should be not upon the premises result has been attributed to the presence of ulcera(thus penalising tea- and dining-room accommodation), but tive cystitis, which is a source of infection. That upon the trade which is created by the licence-i.e., the this is not the only explanation Dr. Marchildon found trade in alcoholic drinks. It would certainly be regrettable in the two following cases. A lad, aged 17 years, was if it were found that the Finance Act placed a serious admitted into hospital comatose on the fourteenth day of a obstacle in the way of such an excellent movement as that of severe attack of enteric fever, and he died at the end of nine the Public-house Trust Association. days from perforation. At the necropsy Professor Pick found typhoid ulceration of the ileum with perforation, THE DIAGNOSIS OF MALIGNANT DISEASE. with a small -
.,
(typhoid
haemorrhage, fibrino-purulent peritonitis, cystitis IN another column we publish an article by Dr. Elsie M. purulent spermalJocystitis and inflammation of the right ulcer on the epiglottis, parenchymatous Royle on the aid which chemical examination of the urine vas deferens, nephritis with miliary abscesses, obliterative pleurisy, and may afford in the diagnosis of malignant disease. Dr. bronchitis. The seminal vesicles were enlarged and reddened Royle’s investigations have enabled her to prove that in and fluctuated. They contained purulent fluid from which cases of cancer the uric acid is usually higher than is found the typhoid bacillus was cultivated. Microscopic examina- in healthy cases under similar conditions ; further, that the tion of the left vesicle showed that the mucosa was in some output of phosphates in the urine is in the majority of cases places destroyed and in others distorted and infiltrated. The of cancer decreased when compared with healthy individuals; lumina were dilated and filled with an acute cellular exudate and finally, that the ratio of phosphates. is almost invariably which was partly necrotic and showed clumps of typhoid uiic acid bacilli. The prostate was normal. In the second case a reduced in malignant disease. Acting on these results man, aged 28 years, was admitted into hospital with the Dr. Royle suggests that a chemical analysis of the urine may diagnosis of typhoid fever of about ten days’ duration. prove of value as an aid to diagnosis in obscure cases of Death from haemorrhage from the bowel occurred four days cancer, especially when the abdominal organs are the seat The differential diagnosis of malignant later. At the necropsy Professor Pick found typhoid ulcera- of the disease. tion of the ileum, icterus, acute enlargement of the spleen, disease from gall-stones, gastric ulcer, chronic pancreatitis, parenchymatous nephritis with small abscesses, acute purulent and other morbid conditions is frequently very difficult prostatitis, enlarged mesenteric glands, and acute catarrh and any reliable auxiliary test would be welcome. Dr, The prostate gland was enlarged, Royle, however, prudently observes that her investigaof the duodenum. especially in the right lobe. There was an area of the tions are not complete and that this communication is
503 intended as a preliminary one. The cases she has examined point to the proposed test as a useful one, but before the value in diagnosis of the facts proved in her paper can be clearly established it will be necessary to determine how far they are true of other forms of cachexia, and what their relation may be to the secondary ansemia usually present in malignant disease. Dr. Royle is at present engaged in working out these questions, and the results will be awaited with interest. The technique of the chemical tests is not a complicated one.
only
PUBLIC BY W. E.
HEALTH ADMINISTRATION IN HAMBURG. HOME, M.D., B.SC. EDIN., M.R.C.P. EDIN., D.P.H. R.C.P.S. EDIN., FLEET-SURGEON, ROYAL NAVY.
The
Disinfectiny Station.
BY the kind permission of Professor Medizinalrat Dr. Nocht I was recently permitted to learn something of the methods of disinfection practised in Hamburg and to visit THE King has augmented his yearly subscription to King the central disinfecting station. Edward’s Hospital Fund for London from £500 to f:l000, Hamburg is a city of 800,000 inhabitants. All its instituand His Majesty is anxious that the date of augmentation tions are on a large scale, so one is not surprised to find should coincide with that of his first visit to the London that this one department of the sanitary administraof the city employs 214 men. When notification Hospital since the accession. His Royal Highness the Prince tion of a case of infectious disease has been received and of Wales has forwarded E100 to King Edward’s Hospital disinfection ordered, the sanitary authorities send out a Fund as an annual subscription. party of disinfectors dresssed in sterilised overalls, cap, blouse, trousers, and boots, and (in case of plague) gloves, too. THE King has granted to Dr. Hugh Campbell These men collect the articles to be disinfected, sprinkle them medical officer of health at Bangkok, His Majesty’s Royal with disinfectant, and roll them in sheets, over which an licence and authority to accept and wear the Order of the impervious cover is now fastened to confine the infection as White Elephant of the Third Class, which has been conferred much as possible. The room or house is then cleaned, special care being taken to clean the walls and floors of sputa which upon him by His Majesty the King of Siam in recognition of may possibly be tuberculous. After this formalin vapour, valuable services rendered. the is employed. The materials solution, by boiling produced for disinfection are removed to the central station, where the AMONG those to whom His Majesty the King, Sovereign men who have done the work get hot baths and change their of The Order of Mercy, has been graciously pleased to suits. Meanwhile the room, every crevice in which has been is saturated with formaldehyde. When this sanction the award of the Order are Mr. A. T. Scott, pasted up, saturation has continued long enough liquor ammoniæ is M.R.C.S. Eng., and Mr. W. Chearnley Smith, M.B., boiled into the room through a keyhole; thus the acid is C.M. Edin. neutralised and the room can be entered and aired. The disinfecting station to which the fomites are removed ON the recommendation of the Prime Minister, the King is divided into two, the infected side and the clean side. has sent from His Majesty’s Royal Bounty £150 to the fund These departments are divided by a wall 50 yards long, This wall has which Sir William P. Treloar is raising on behalf of the which runs through the establishment. no doors but is pierced by six steam disinfectors and by widow of the late Mr. H. W. Cox and her family. the bath rooms for men and women. Each side has its own and to get from one side to the other it is necessary to staff, Mr. John Hammond Morgan, C. V. O. , F. R. C. S. Eng., has pass through the open air. In this way the attendants are been promoted from Honorary Associate to Knight of Grace prevented from negligently crossing without disinfecting of the Order of the Hospital of St. John of Jerusalem in themselves, and so accidents are avoided. Clothes and furniture for disinfection are examined on arrival at this England. station ; if grossly soiled they are first boiled for an hour, but if fit for disinfection they are carefully numbered and PORTSEA IMPROVEMENT SCHEME.—An admirable labelled. The disinfection is done by a current of steam at scheme for the improvement of Portsea (Portsmouth) has 102° C. and the articles are laid out on the trays of the disbeen drafted by Dr. A. Mearns Fraser, the medical officer of infectors (iron frames with wire meshes which are covered health. The available area is very rigidly bounded, and with coarse sacking) ; at this temperature the clothes are not consists of some 2 acres, on which it is proposed to erect scorched. Five of these disinfectors are large ovals and are 46 houses, roughly 20 houses per acre, to let at rents of worked by current steam at 102° C. ; another smaller circular 7s. and 7s. 6d. (inclusive of rates and taxes) in the case of disinfector is used for delicate materials, for leather, &c. In residences and at 8s. 6d., plus rates and taxes, in the case of this under reduced pressure (water boiling at 80° C.) infected four shops. It is proposed to layout this area as one long articles are exposed to formalin and steam. This method is road, 40 feet wide, stretching from Queen-street to Kent- more expensive, but so far no complaints of damage have street. The road will be planted with trees, the houses set been made. There is also a temporary chamber for the back from the road, and a portion of ground, about 1000 formalin disinfection of articles insufficient in number to fill square yards in area, between the road and the houses one of the large steam disinfectors. A single disinfection will be used as an open space, planted with trees, and in the large apparatus costs 4s. The bath rooms for infected persons run completely across asphalted. Four different types of houses are provided, each being carefully designed to meet the requirements of some the building. They are entered from the infected yard and particular class of tenant. The houses are a great improve- their exit is in the disinfected yard. The bathers enter, take ment on many working-class dwellings, the report stating their clothes off, and send them up in a lift to be disthat the object has been to design "more healthy, more infected. They then spend an hour or so taking their baths. convenient, and more cheerful houses " than has often been A notice which I saw gives very complete directions done. As Dr. Mearns Fraser points out, "it is but little more for the cleansing of hands. The nails are to be cut and costly to make a beautiful than an ugly street," and the scrubbed, the space under the nail and the nail fold are to reconstruction when finished will add a very handsome and be cleaned with the scissors supplied, then the hands are attractive road and effect an extraordinary improvement in scrubbed first with disinfectant and then with spirit. Next Portsea. The report further points out that the scheme may the hair (it was in the temporarily unoccupied ladies’ divibe continued at some future time so as to give St. George’s- sion I read the notice) must be washed and cleaned with square an approach through into Queen-street, and inci- spirit under the supervision of the bath attendant. After dentally transform the worst conglomeration of slum property this a bathing-cap is put on in order that the hair may not in the borough into a model working-class residential neigh- become wet in the ensuing bath. When the bath is combourhood. Improvements of this character must add very pleted the "contact " passes to the clean side, where the now greatly to the health of the district, and Dr. Mearns Fraser is disinfected clothes are received down a lift, and the disto be congratulated on an excellent piece of constructive infecting process concludes. An inventory of the clothes for i disinfection which have been taken from the infected side has work.
Highet,
__
__