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TRANSFERENCE OF THE HUTCHINSON MUSEUM TO AMERICA.
817
lady, probably not in robust health, who may have suffered from an exaggerated apprehension with regard to German spies, but who hardly on that account alone could have been dangerous to herself or to the public, suffered 52 hours’ confinement as a pauper lunatic. The medical man who attended her in the workhouse did not, it is stated, regard her as insane, but had no power to order her release ; and in due course the magistrate, who, acting in strict accordance with the law, seems to make a practice of attending every three days at the workhouse in question, put an end to a situation which ought never to have arisen. Why there should be no provision for the summoning of a medical man at the earliest possible moment to decide what in some cases may be a simple question, but may in many instances be beyond the scope of the intelligence and training of a constable, relieving officer, or overseer, is by The law as it stands may afford a no means plain. convenient and effective means for placing promptly winder observation or control cases brought to the notice of the police ; but the law would be strengthened not weakened in its effectiveness if the .calling in of a medical practitioner, whenever this was possible, were also enjoined, so as to shift the irespo-usibility to the shoulders best adapted for the burden.
fragments !
of similar membrane were coughed up and rhonchi were heard over the front of the right lung near its root. The expectoration for several ’days was profuse and at first blood-stained. The I voice gradually returned, and the patient was discharged ten days after admission feeling well except for a little huskiness and a slight cough. In plastic bronchitis, according to Dr. William Ewart, the condition is confined to the smaller bronchi"from the tubes of the diameter of a goose-quill (rarely of much larger size) down to the finest ramifications." In this case the trachea, both main bronchi, and the larger tubes on the right side were affected. The smaller bronchi and bronchioles were absolutely free. ____
TRANSFERENCE OF THE HUTCHINSON MUSEUM TO AMERICA.
THE closing of the Polyclinic has been followed by the acquisition of the Hutchinson Museum by the Johns Hopkins Medical School. The loss to this country of the remarkable and unique collection of
____
PLASTIC TRACHEITIS AND
BRONCHITIS.
IN the Medical Journal of Australia of Feb. 13th Dr. H. Laurie and Dr. H. C. Colville have reported a case of a very rare condition-plastic tracheitis and bronchitis. A married woman, aged 45 years, was taken to the Alfred Hospital, Sydney, with the diagnosis of oedema of the glottis due to chronic nephritis. She was of stout build and was suffering ’from urgent dyspncea accompanied by marked whistling stridor. There were cyanosis and retraction of the neck and intercostal spaces. Prepara.tions were made for tracheotomy, but she improved slightly. Her oolour returned and the retraction .diminished, although the whistling stridor was ;still marked. A more thorough investigation was then made. The patient had been well until a " week before admission when she contracted a bad ’cough." This got worse until three days before, She had always been when the dyspnoea began. healthy except for an attack of rheumatism in the previous winter. The temperature was 99° F. and the pulse 100. The heart sounds were inaudible. No adventitious sounds could be detected over the lungs. The vesicular murmur was very weak. The point of maximum intensity of the stridor was ,over the manubrium sterni and not over the larynx, as would have been expected in oedema of ihe glottis. Pulv. jalapee co. was given, and six leeches, followed by a hot pack, were applied to the The patient’s condition re’front of the neck. Jnainedmuch the same for four hours, and then, in a severe spell of coughing, a blood-stained .cylindrical cast about 2 in. long and nearly - in. in diameter was expelled. It appeared to have been formed in the trachea. The dyspnoea at once improved. The question of diphtheria immediately arose. A swab was taken from the throat and found to contain a pure culture of Hoffmann’s bacillus. The breathing continued to improve, and on the following night a similar cast ’was expelled, consisting of a complete mould of the trachea and right and left bronchi. Further improvement followed and the patient could speak im a whisper. During the next few days small .
original drawings, coloured plates, and photographs, which represent the life-work of one of the greatest clinicians of the age, is to be deplored. Though the value of drawings has been recognised since the earliest times of clinical study, excepting the splendid collection of wax models at the St. Louis Hospital, Paris, no previous attempt had been made to illustrate systematically the appearances of disease in the living subject. No practising surgeon has approached Sir Jonathan Hutchinson in the number of types of disease he observed, described, and, whenIn the opening ever possible, illustrated pictorially. address delivered at the Polyclinic in 1900 on PostGraduate Study,1 Sir William Osler said of him: "He is the only great generalised specialist which the profession has produced, and his works are a storehouse upon which the surgeon, the physician, the neurologist, the dermatologist, and other specialists freely draw." The collection consists of: (1) Original coloured drawings, of which there are many hundreds; (2) coloured plates taken from atlases, books, and memoirs; (3) engravings, woodcuts, photographs, and pencil sketches, very often with the letterpress or manuscript notes attached. They illustrate the whole range of medicine and surgery, but particularly the life work of the collector in syphilis and skin diseases. It is " probably the most remarkable iconography on syphilis ever made." Taken at random, the labels on some of the rarer items show the minuteness with which this protean disease is illustrated: circumcision chancres, syphilitic herpes, recurrent chancres, vaccination syphilis, keloid. While regretting the loss to our country of this valuable and unique collection, we are pleased that it has found a home in the most famous of the American medical schools where, perhaps, it may be put to greater use than here, as the teaching which it embodies must be less familiar, but those who’have had the pleasure of seeing the remarkable and enthusiastic man who made this collection employ it in teaching will feel that in its demonstration there will be one irreparable loss. However rare the case sent to Hutchinson he could parallel it from his collection of portraits, and from the vast storehouse of a* most tenacious For the conventional memory relate histories. of a a with name, which is called labelling malady diagnosis, he had almost a contempt. His plan was to take type cases, to describe them in detail, to 1 THE
LANCET, June 12th, 1900, p. 73.
818 illustrate them whenever possible by drawings, and PUBLIC HEALTH OFFICERS AND to place similar cases beside them. His object THE WAR. always was to discover causes rather than to name. With all this minuteness he combined a wide and bold philosophic grasp. No clinician ever focused THE question of granting leave of absence to light from so many sources on a subject. From the medical officers of health, assistant medical officers to the other rare cases of the rare case he passed of health, medical officers of isolation hospitals, and same kind in his knowledge, then perhaps he passed to another field of disease, regarded as entirely tuberculosis officers, who have obtained the perdifferent and showed analogies unsuspected, or he mission of their councils to accept temporary passed to the ordinary and showed that it and the appointments in the army, is one that has exercised extraordinary were only phases of the same process. many of the officers concerned and their authorities, Or, moving still more widely, he illuminated the and frequent allusions to it have appeared in our subject by an illustration from plant pathology or columns. We have made inquiries as to the practice from ordinary life or by a quotation from the poets. of the Local Government Board in giving permission to the officers to take such leave of absence, and the attitude of the Board will be clearly seen by PUNCTURE OF THE CORPUS CALLOSUM AS A what follows. DECOMPRESSIVE MEASURE. The Local Government Board sent the following THE ordinary results of temporal decompression circular letter to the county councils and sanitary for brain tumour are only partially satisfactory; authorities on 12th last :August it is suggested that only 10 per cent. of such Local Government Board, Whitehall, S.W., cases are operated upon with success. There 12th August, 1914. are especially to be considered in these cases the SiR,-The Local Government Board wish to draw the extremely severe headaches and vomiting which attention of local authorities to the great importance of form such distressing features, and any measure maintaining the efficiency of the sanitary service of the which can relieve these symptoms must be country at the present time. In many areas the medical welcomed, whether or not such a procedure officers of health and other officers engaged in public health is associated with more extensive proceedings work will be giving their services to the navy or army, and it will be necessary for the local authority to make other An operadirected to the tumour mass itself. arrangements for carrying on their work. It is essential tion of this nature has been practised with that there should be no relaxation of the activities of local considerable success ; it consists in puncture of authorities in the prevention and control of epidemic the corpus callosum, and the technique is not diseases, the protection of water-supplies from contaminaheld to be very difficult. It has for its object the tion, and the promotion of child-welfare, and in securing the relief of tension in the ventricles in the brain, a wholesomeness of food-supplies and the general sanitary condition which is held to be largely responsible condition of each area. On this account it is important for the symptoms-a condition, in fact, allied to that all vacancies in the minor sanitary staff should be filled up. internal hydrocephalus present in many cases of The actual steps which may be open to local authorities brain tumour. Such relief is effected by allowing to replace medical officers of health who are absent on communication between the ventricles and the naval or military duty will vary in different districts. In subdural space superior to the corpus callosum. many areas adequate temporary arrangements may be made Dr. Elsberg, discussing his results at a meeting of by cooperation between the county and district authorities the American Neurological Association on May 7th, or between neighbouring district authorities. The Board be glad to be informed of each case in which a medical 1914/ stated that he had had 30 cases, and in more will than half of them the general symptoms had been officer of health or chief sanitary inspector or inspector of nuisances has been leave of absence for naval and markedly relieved by the operation. No matter military service, and given of the steps taken to arrange for the what the pressure conditions within the skull the temporary discharge of his duties. I am, Sir, your obedient Servant, operation did good. Where, however, there was internal hydrocephalus the procedure was no (Signed) H. C. MONRO, Secretary. useless. He also stated that radical removal of Since then nearly 100 whole-time medical officers the tumour should be done wherever possible ; of health out of a total of 314 have, with the condecompression has its field as a temporising method, sent of their councils and of the Board, taken or in non-removable or non-localisable intracranial commissions in the Royal Army Medical neoplasms. As regards the dangers of the opera- temporary About the same number of part-time medical tion, these are not great. He quotes von Brahmann Corps. of health and many medical men holding officers as having done 57 operations without any ill effect. and Dr. Elsberg himself had done 39 without other posts under county councils and sanitary authorities have also given their services to the mortality. Further results by more observers army. Each application to the War Office from a; will be awaited with interest. medical officer employed by a local authority is, in accordance with an arrangement made between PARLIAMENT resumed sitting on Wednesday, the two departments, referred to the Local GovernApril 14th. ment Board as to whether the medical officer 1 Journal of Nervous and Mental making the application can properly be spared from Diseases, 1914, vol. xli., p. 726. his civil duties. So far it has not been necessary for the Board to object to the granting of a THE LATE AUGUSTUS WILLIAM DALBY, L.R.C.P., temporary commission to any medical officer who L.R.C.S. EDIN.-Mr. Dalby, a highly respected medical has applied, as in each case temporary arrangepractitioner at Frome, Somerset, died recently at Weymouth. ments have been made for carrying on the officer’s After qualifying as L.R.C.P. and L.R.C.S. Edin. in 1884, work. he commenced practice in Frome, and was for many From the beginning of the war local authorities for the of health Frome rural district. officer medical years and their sanitary officials have rendered valuable He was an enthusiastic Volunteer, and was lieutenantcolonel of the 2nd South-Western Mounted Brigade Field assistance to the military authorities which the Ambulance. Army Council have acknowledged in the following ______________
lady, probably not in robust health, who may have suffered from an exaggerated apprehension with regard to German spies, but who hardly on that account alone could have been dangerous to herself or to the public, suffered 52 hours’ confinement as a pauper lunatic. The medical man who attended her in the workhouse did not, it is stated, regard her as insane, but had no power to order her release ; and in due course the magistrate, who, acting in strict accordance with the law, seems to make a practice of attending every three days at the workhouse in question, put an end to a situation which ought never to have arisen. Why there should be no provision for the summoning of a medical man at the earliest possible moment to decide what in some cases may be a simple question, but may in many instances be beyond the scope of the intelligence and training of a constable, relieving officer, or overseer, is by The law as it stands may afford a no means plain. convenient and effective means for placing promptly winder observation or control cases brought to the notice of the police ; but the law would be strengthened not weakened in its effectiveness if the .calling in of a medical practitioner, whenever this was possible, were also enjoined, so as to shift the irespo-usibility to the shoulders best adapted for the burden.
fragments !
of similar membrane were coughed up and rhonchi were heard over the front of the right lung near its root. The expectoration for several ’days was profuse and at first blood-stained. The I voice gradually returned, and the patient was discharged ten days after admission feeling well except for a little huskiness and a slight cough. In plastic bronchitis, according to Dr. William Ewart, the condition is confined to the smaller bronchi"from the tubes of the diameter of a goose-quill (rarely of much larger size) down to the finest ramifications." In this case the trachea, both main bronchi, and the larger tubes on the right side were affected. The smaller bronchi and bronchioles were absolutely free. ____
TRANSFERENCE OF THE HUTCHINSON MUSEUM TO AMERICA.
THE closing of the Polyclinic has been followed by the acquisition of the Hutchinson Museum by the Johns Hopkins Medical School. The loss to this country of the remarkable and unique collection of
____
PLASTIC TRACHEITIS AND
BRONCHITIS.
IN the Medical Journal of Australia of Feb. 13th Dr. H. Laurie and Dr. H. C. Colville have reported a case of a very rare condition-plastic tracheitis and bronchitis. A married woman, aged 45 years, was taken to the Alfred Hospital, Sydney, with the diagnosis of oedema of the glottis due to chronic nephritis. She was of stout build and was suffering ’from urgent dyspncea accompanied by marked whistling stridor. There were cyanosis and retraction of the neck and intercostal spaces. Prepara.tions were made for tracheotomy, but she improved slightly. Her oolour returned and the retraction .diminished, although the whistling stridor was ;still marked. A more thorough investigation was then made. The patient had been well until a " week before admission when she contracted a bad ’cough." This got worse until three days before, She had always been when the dyspnoea began. healthy except for an attack of rheumatism in the previous winter. The temperature was 99° F. and the pulse 100. The heart sounds were inaudible. No adventitious sounds could be detected over the lungs. The vesicular murmur was very weak. The point of maximum intensity of the stridor was ,over the manubrium sterni and not over the larynx, as would have been expected in oedema of ihe glottis. Pulv. jalapee co. was given, and six leeches, followed by a hot pack, were applied to the The patient’s condition re’front of the neck. Jnainedmuch the same for four hours, and then, in a severe spell of coughing, a blood-stained .cylindrical cast about 2 in. long and nearly - in. in diameter was expelled. It appeared to have been formed in the trachea. The dyspnoea at once improved. The question of diphtheria immediately arose. A swab was taken from the throat and found to contain a pure culture of Hoffmann’s bacillus. The breathing continued to improve, and on the following night a similar cast ’was expelled, consisting of a complete mould of the trachea and right and left bronchi. Further improvement followed and the patient could speak im a whisper. During the next few days small .
original drawings, coloured plates, and photographs, which represent the life-work of one of the greatest clinicians of the age, is to be deplored. Though the value of drawings has been recognised since the earliest times of clinical study, excepting the splendid collection of wax models at the St. Louis Hospital, Paris, no previous attempt had been made to illustrate systematically the appearances of disease in the living subject. No practising surgeon has approached Sir Jonathan Hutchinson in the number of types of disease he observed, described, and, whenIn the opening ever possible, illustrated pictorially. address delivered at the Polyclinic in 1900 on PostGraduate Study,1 Sir William Osler said of him: "He is the only great generalised specialist which the profession has produced, and his works are a storehouse upon which the surgeon, the physician, the neurologist, the dermatologist, and other specialists freely draw." The collection consists of: (1) Original coloured drawings, of which there are many hundreds; (2) coloured plates taken from atlases, books, and memoirs; (3) engravings, woodcuts, photographs, and pencil sketches, very often with the letterpress or manuscript notes attached. They illustrate the whole range of medicine and surgery, but particularly the life work of the collector in syphilis and skin diseases. It is " probably the most remarkable iconography on syphilis ever made." Taken at random, the labels on some of the rarer items show the minuteness with which this protean disease is illustrated: circumcision chancres, syphilitic herpes, recurrent chancres, vaccination syphilis, keloid. While regretting the loss to our country of this valuable and unique collection, we are pleased that it has found a home in the most famous of the American medical schools where, perhaps, it may be put to greater use than here, as the teaching which it embodies must be less familiar, but those who’have had the pleasure of seeing the remarkable and enthusiastic man who made this collection employ it in teaching will feel that in its demonstration there will be one irreparable loss. However rare the case sent to Hutchinson he could parallel it from his collection of portraits, and from the vast storehouse of a* most tenacious For the conventional memory relate histories. of a a with name, which is called labelling malady diagnosis, he had almost a contempt. His plan was to take type cases, to describe them in detail, to 1 THE
LANCET, June 12th, 1900, p. 73.
818 illustrate them whenever possible by drawings, and PUBLIC HEALTH OFFICERS AND to place similar cases beside them. His object THE WAR. always was to discover causes rather than to name. With all this minuteness he combined a wide and bold philosophic grasp. No clinician ever focused THE question of granting leave of absence to light from so many sources on a subject. From the medical officers of health, assistant medical officers to the other rare cases of the rare case he passed of health, medical officers of isolation hospitals, and same kind in his knowledge, then perhaps he passed to another field of disease, regarded as entirely tuberculosis officers, who have obtained the perdifferent and showed analogies unsuspected, or he mission of their councils to accept temporary passed to the ordinary and showed that it and the appointments in the army, is one that has exercised extraordinary were only phases of the same process. many of the officers concerned and their authorities, Or, moving still more widely, he illuminated the and frequent allusions to it have appeared in our subject by an illustration from plant pathology or columns. We have made inquiries as to the practice from ordinary life or by a quotation from the poets. of the Local Government Board in giving permission to the officers to take such leave of absence, and the attitude of the Board will be clearly seen by PUNCTURE OF THE CORPUS CALLOSUM AS A what follows. DECOMPRESSIVE MEASURE. The Local Government Board sent the following THE ordinary results of temporal decompression circular letter to the county councils and sanitary for brain tumour are only partially satisfactory; authorities on 12th last :August it is suggested that only 10 per cent. of such Local Government Board, Whitehall, S.W., cases are operated upon with success. There 12th August, 1914. are especially to be considered in these cases the SiR,-The Local Government Board wish to draw the extremely severe headaches and vomiting which attention of local authorities to the great importance of form such distressing features, and any measure maintaining the efficiency of the sanitary service of the which can relieve these symptoms must be country at the present time. In many areas the medical welcomed, whether or not such a procedure officers of health and other officers engaged in public health is associated with more extensive proceedings work will be giving their services to the navy or army, and it will be necessary for the local authority to make other An operadirected to the tumour mass itself. arrangements for carrying on their work. It is essential tion of this nature has been practised with that there should be no relaxation of the activities of local considerable success ; it consists in puncture of authorities in the prevention and control of epidemic the corpus callosum, and the technique is not diseases, the protection of water-supplies from contaminaheld to be very difficult. It has for its object the tion, and the promotion of child-welfare, and in securing the relief of tension in the ventricles in the brain, a wholesomeness of food-supplies and the general sanitary condition which is held to be largely responsible condition of each area. On this account it is important for the symptoms-a condition, in fact, allied to that all vacancies in the minor sanitary staff should be filled up. internal hydrocephalus present in many cases of The actual steps which may be open to local authorities brain tumour. Such relief is effected by allowing to replace medical officers of health who are absent on communication between the ventricles and the naval or military duty will vary in different districts. In subdural space superior to the corpus callosum. many areas adequate temporary arrangements may be made Dr. Elsberg, discussing his results at a meeting of by cooperation between the county and district authorities the American Neurological Association on May 7th, or between neighbouring district authorities. The Board be glad to be informed of each case in which a medical 1914/ stated that he had had 30 cases, and in more will than half of them the general symptoms had been officer of health or chief sanitary inspector or inspector of nuisances has been leave of absence for naval and markedly relieved by the operation. No matter military service, and given of the steps taken to arrange for the what the pressure conditions within the skull the temporary discharge of his duties. I am, Sir, your obedient Servant, operation did good. Where, however, there was internal hydrocephalus the procedure was no (Signed) H. C. MONRO, Secretary. useless. He also stated that radical removal of Since then nearly 100 whole-time medical officers the tumour should be done wherever possible ; of health out of a total of 314 have, with the condecompression has its field as a temporising method, sent of their councils and of the Board, taken or in non-removable or non-localisable intracranial commissions in the Royal Army Medical neoplasms. As regards the dangers of the opera- temporary About the same number of part-time medical tion, these are not great. He quotes von Brahmann Corps. of health and many medical men holding officers as having done 57 operations without any ill effect. and Dr. Elsberg himself had done 39 without other posts under county councils and sanitary authorities have also given their services to the mortality. Further results by more observers army. Each application to the War Office from a; will be awaited with interest. medical officer employed by a local authority is, in accordance with an arrangement made between PARLIAMENT resumed sitting on Wednesday, the two departments, referred to the Local GovernApril 14th. ment Board as to whether the medical officer 1 Journal of Nervous and Mental making the application can properly be spared from Diseases, 1914, vol. xli., p. 726. his civil duties. So far it has not been necessary for the Board to object to the granting of a THE LATE AUGUSTUS WILLIAM DALBY, L.R.C.P., temporary commission to any medical officer who L.R.C.S. EDIN.-Mr. Dalby, a highly respected medical has applied, as in each case temporary arrangepractitioner at Frome, Somerset, died recently at Weymouth. ments have been made for carrying on the officer’s After qualifying as L.R.C.P. and L.R.C.S. Edin. in 1884, work. he commenced practice in Frome, and was for many From the beginning of the war local authorities for the of health Frome rural district. officer medical years and their sanitary officials have rendered valuable He was an enthusiastic Volunteer, and was lieutenantcolonel of the 2nd South-Western Mounted Brigade Field assistance to the military authorities which the Ambulance. Army Council have acknowledged in the following ______________