- Email: [email protected]
, OXFORD UNIVERSITY AND MEDICAL DEGREES FOR WOMEN.
1114
minutes, some twenty to thirty grammes of anaesthetic being
to call for
special local attention, as in the six weeks 20th the diarrhea rate in this town averaged no less than 10-9 per 1000. The diarrhma mortality during the past summer quarter did not reach its maximum in the twenty-eight towns until the third week of August, and the maximum rate was not recorded in Wolverhampton, Blackburn, Bradford, and Huddersfield until the last week of September. There is still much to learn about the causation and varying incidence of infantile summer diarrhma before the marked variations in the death-rates from this disease in different towns, and in the dates of its intensity, can be fully explained. seems
She recovered sufficiently to open her eyes; two or three minutes later respiration failed, and although artificial respiration, continued for half an hour, started natural breathing for a few seconds, yet eventually the patient succumbed. M. Reynier believes that even if atropine and morphine lessen the danger of reflex syncope, they increase other perils, from the fact that they lessen the elimination of the chloroform and tend to prevent recovery to con. sciousness. Admitting the value of Dastre’s method for dogs, for which but little chloroform is required after a preliminary injection of atropine and morphine, M. Reynier warns against its employment for human beings, as they require large quantities of chloroform even after the pre. A MEDICAL CORONER ON THE VALUE OF liminary injection, and the presence of the alkaloids in the STIMULANTS. circulation seems to increase the feir of poisoning; while DR. CHURTON, holding an inquest at Nantwich on the the dangers of such after effects as vomiting, syncope, body of Joseph Bowker, is reported to have spoken strongly and failure of respiration do not appear to be lessened. on the value of stimulants. He described to the jury the beneficial effects of brandy-and-milk-was it the brandy or DIPHTHERIA IN KENSAL TOWN. the milk ?-in his own recent illness, which he declared had Two reports have been issued by Dr. Seaton as to a saved his life, and which were administered by his daughter, the effects of which very much astonished the doctors. It prevalence of diphtheria in his district, the incidence of this disease being mainly upon the Kensal Town portion of the was said that Bowker had slipped on the stairs, and that Chelsea parish. In one sense the reports differ from administered to him with was effect. We can brandy good form no opinion of the fitness of brandy in this case. And ordinary ones dealing with diphtheria. Dates as to attacks and progress of the disease, the period during which it we venture to think that even the coroner was scarcely entitled in this case to deliver a lecture on the use of stimu- has prevailed, and many other important points having to lants to people suddenly taken ill or on his own case. This do with such occurrences are not given, and it would seem is not the use of inquests. The man died in this instance, that Dr. Seaton’s main object has been to show that none and this did not say much for the efficiency of the treat- of the ordinarily known agents by which diffusion of ment. People are too ready without advice from coroners diphtheria is occasioned can be credited with this special to pour brandy down the throats of those slipping or outbreak. The locality attacked is singular in its conidropping down. Sometimes it is right, but very often it is parative freedom from drain and sewer nuisances, from overbad practice. Supposing, as is often so, the case to be one crowding, and from unwholesome conditions about houses. of apoplexy or epilepsy, the administration of brandy is No suspicion attaches to milk, and the spread was not likely to make matters worse. Coroners, and especially connected with any particular school. This negative medical coroners, should stick to their own duties. One sort of evidence is followed by explanation of the difuseful piece of advice a jury has just given in a case the ficulties in which we are placed owing to our scanty report of which lies before us, where a poor man placed in knowledge of the etiology of diphtheria ; and finally there a police cell for drunkenness passed gradually into apoplexy is a suggestion whether it would not be desirable to direct and died. The excuse was an awful one, and yet not with- the attention of the Local Government Board to the quesout something in it-that 2400 persons bad been charged this tion of the present system of removal of cases of diphtheria year with drunkenness, and n0t one turned out to be a case to hospital, and to the alternative plan of treating them of illness. The jury expressed the opinion that in all such I at home under nurses specially provided by the public We assume the jury authority. It so happens that Dr. Seaton has special cases the doctor should be called. It would be rather hard on the opportunities for giving counsel on this very subject, for, mean in all doubtful cases. in addition to his long and varied experience as a health police surgeon to call him up 2400 times unnecessarily. officer, he is also a member of the only hospital board in this country who have any considerable experience as to ATROPO-MORPHINO-CHLOROFORMISATION. the isolation in hospital of diphtheria cases. There have SPEAKING before the Socicte de Chirurgie, M. Paul Rey- been rumours as to the practice being undesirable when nier gave his experiences of the use of this combination as adopted on a large scale, and Dr. Seaton doubtless has an anaesthetic. Professor Dastre, the distinguished physio- some information bearing on this point. As it is, the logist, had recommended the employment of atropine with reports unfortunately do not help to clear up either this morphine as a preliminary to chloroform in order to avert matter or the cause of the Kensal Town diphtheria. what he regarded as a common source of danger-cardiac paralysis due to vagal inhibition. He experimented upon UNIVERSITY AND MEDICAL DEGREES dogs, and was led to form a favourable opinion of the, OXFORD FOR WOMEN. practice, recommending it to surgeons. M. Aubert of Lyon THE to as whether or not Oxford University the a : question plan, giving hypodermic injection of one adopted should admit to the examination for the degree of and a women half centigramme of morphine hydrochlorate and threeof a Bachelor of was of Medicine of or discussed on Tuesday, and settled fifteen milligramme sulphate atropine quarters the minutes the final in before vote administration of the chloroform. by thirty congregation. In all the preliminary M. Paul Reynier and others speaking at the fame meeting, stages of voting there has been a small majority in favour of the statute. The rejection of the statute was moved by were unable to confirm his favourable experiences ; indeed, M. Reynier stated he had relinquished using the com- Professor Case, who has on various rrrounds consistently bination, as he had lost one patient from its employ- opposed the proposal fiom its nception, alleging, among ment. The patient, a cblorotic girl, who was to undergoother reasons, that the admission of women was not a trifling operation, was chloroformed according to M. required, inasmuch as the London School of Medicine Aubert’s method and the operation safely completed in tent afforded every facility for the study of medical subjects.
ending Sept.
used.
’
,
.
,
.
.
MEDICAL MISSIONS.—FRENCH DIPLOMAS. The other side was championed by the Rev. W. W. Jackson, Rector of Exeter College, and Mr. Arthur
Sidgwick, of Corpus. The rejection carried by a majority of 4, 154 voting. THE KNEE-JERK
J
of the statute
IN TRANSVERSE
1115
FRENCH
DIPLOMAS.
THE officiat, or second grade of practitioners in France, has long been threatened, and appears now to be on the point of extinction. The Chamber of Deputies some time since appointed a committee to examine and report upon the subject, and the result of its deliberations is entirely in favour of suppressing the official. The report presented to the Chamber states that there is every reason to expect that the number of doctors of medicine that will graduate in future will be quite sufficient for the needs of the population, especially if more protection is afforded by the law against the encroachments of quacks and of foreign practitioners. It is also pointed out that not only the great majority of medical men, but of the existing offlciers, are in favour of the suppression of the lower grade. The number of candidates for it has of late decreased considerably, and since 1883 the course of study and the examinations have been raised to a level not very much inferior to those required for the doctorate. The report recommends that the existing officiers be admitted to the doctorate It is greatly to be on passing two clinical examinations. desired that the whole medical profession should possess the same diploma-viz., that of Doctor of Medicine-as is now (according to the committee) the case in Germany, Austria, Italy, Belgium, Holland, and Spain. Here the committee’s information must be considerably at fault, for in Germany, Holland, and Spain practice is by no means confined to M.D.’s.
was
MYELITIS.
SINCE the publication some months ago of Dr. Bastian’s paper on the loss of the knee-jerk in patients suffering from complete transverse myelitis in the dorsal or cervical regions cases have from time to time been published both in this country and abroad in confirmation of the view then advanced. In the Nortlz A rnerican Review, vol. ii., No.8, such a case is recorded. The patient was a man aged fiftyfive, who, after falling backwards over a railing, had complete motor and sensory paralysis of the limbs, with flaccidity and abolition of the deep reflexes. He died on the day after admission into hospital, and at the necropsy it was found that he had sustained a fracture at the level of the third cervical vertebra, and that the cord at this point was completely divided. Such a case, however, can hardly be adduced in support of the view advocated by Dr. Bastian, and long ago propounded by Dr. Hughlings Jackson, as those who take the opposite view allege that the shock accompanying any severe spinal injury not unfrequently causes abolition of reflexes which is only temporary. As tbe patient referred to died on the day after the injury was sustained, those holding the old view would maintain that the loss of knee-jerks was a transient phenomenon, and that they would have returned had the SUBCUTANEOUS RUPTURE OF AN AORTIC patient lived long enough. Nor was there any evidence ANEURYSM that the grey matter in the lumbar region was unIN the Rev7lc Générale de Clinique et Thérapeutique of injured, for the electrical condition of the muscles was not examined, and in the absence of such an examination September there is an account of a case in which a thoracic the loss of knee-jerk proves nothing. It would be well if aoitic aneurysm proved fatal by rupture into the subthose who have opportunities of seeing and examining cases cutaneous tissue of the chest wall. The case, which is dein which there is prolonged absence of knee-jerk after scribed by Drs. Rauzier and Houel, is interesting on spinal injury would carefully test the reactions of the account of the rarity of this mode of termination. The muscles both to the galvanic and faradaic cmrents, for much patient, a woman of sixty years of age, was admitted to the of the value of those cases, at least in reference to this Hopital Saint-Eloi, under the care of Professor Grasset, on April 4th of this year, suffering from a large pulsatiJe point, will depend upon the condition of those reactions. tumour in the upper and anterior part of the right chest. The tumour had first appeared sixteen months before, MEDICAL MISSIONS. when, somewhat suddenly, and on one occasion not long THE Edinburgh Medical Missionary Society has just before admission, she had felt a sudden crack, as if entered on the fiftieth year of its existence. Previously to something had broken in it, during a fit of coughing. She its foundation the idea of associating the healing art with had led a dissipated life. At the time she came under evangelistic effort was not readily accepted, but now, as the care she was suffering much from dyspnoea, cough, and Society’s report reminds us, no department of missionary other symptoms of urgency, and the aneurysm pulsated work has warmer friends or more liberal supporters, no strongly. The skin was not adherent to the aneurysm method is recognised as more Christ-like, and no auxiliary or altered in appearance, but slight pressure produced pain. to evangelistic effort in heathen lands is more valued. More The heart was enlarged, but the contractions were feeble ; than 140 medical missionaries with British qualifications, at the apex there was a loud systolic murmur. There was The symptoms produced by the and at least an equal number from other countries-say, 300 pulmonary oedema. in all-are now labouring in heathen and Mohammedan aneurysm improved under treatment, but the aneurysm On the countries. The Edinburgh Society, whose aim is principally, itself continued to gradually increase in size. though not entirely, to provide education for medical evening of June 2nd, after attempts to cough, the aneurysm missionaries, is much in want of increased accommo gave way suddenly into the subcutaneous cellular tissue; the dation, the "Livingstone memorial," which is the main patient experienced a very painful tearing sensation and the centre of the work, being now far too small. Fresh tumour increased in size, the outline of the aneurysm being vigour has just been imported by the appointment obscured by a fluid cushion which gradually extended towardss of the Rev. Dr. Hoernle, who for many years has the axilla. After the attack of syncope which followed been a medical missionary in Persia, as assistant super- the sudden pain the patient required morphia to relieve her intendent. An interesting feature of the Society’s suffering, which was intense, and accompanied with violent branches consists of an "Invalid’s Auxiliary."" It is dyspnoea. Next day the axilla was filled by the extension found that many persons are so impressed during their of the swelling, which occupied the whole right mammary own attacks of illness with the benefit of efficient medical region ; the radial pulse was absent on the right side in aid that they are readily induced to assist in providing for consequence of pressure on the axillary artery, whilst severe their suffering fellow-creatures in the wilds of Africa, the attacks of pain were felt in the branches of distribution of the brachial plexus. Next day there was jaundice, but the crowded cities of China, and elsewhere. ___
.
I
s
I
minutes, some twenty to thirty grammes of anaesthetic being
to call for
special local attention, as in the six weeks 20th the diarrhea rate in this town averaged no less than 10-9 per 1000. The diarrhma mortality during the past summer quarter did not reach its maximum in the twenty-eight towns until the third week of August, and the maximum rate was not recorded in Wolverhampton, Blackburn, Bradford, and Huddersfield until the last week of September. There is still much to learn about the causation and varying incidence of infantile summer diarrhma before the marked variations in the death-rates from this disease in different towns, and in the dates of its intensity, can be fully explained. seems
She recovered sufficiently to open her eyes; two or three minutes later respiration failed, and although artificial respiration, continued for half an hour, started natural breathing for a few seconds, yet eventually the patient succumbed. M. Reynier believes that even if atropine and morphine lessen the danger of reflex syncope, they increase other perils, from the fact that they lessen the elimination of the chloroform and tend to prevent recovery to con. sciousness. Admitting the value of Dastre’s method for dogs, for which but little chloroform is required after a preliminary injection of atropine and morphine, M. Reynier warns against its employment for human beings, as they require large quantities of chloroform even after the pre. A MEDICAL CORONER ON THE VALUE OF liminary injection, and the presence of the alkaloids in the STIMULANTS. circulation seems to increase the feir of poisoning; while DR. CHURTON, holding an inquest at Nantwich on the the dangers of such after effects as vomiting, syncope, body of Joseph Bowker, is reported to have spoken strongly and failure of respiration do not appear to be lessened. on the value of stimulants. He described to the jury the beneficial effects of brandy-and-milk-was it the brandy or DIPHTHERIA IN KENSAL TOWN. the milk ?-in his own recent illness, which he declared had Two reports have been issued by Dr. Seaton as to a saved his life, and which were administered by his daughter, the effects of which very much astonished the doctors. It prevalence of diphtheria in his district, the incidence of this disease being mainly upon the Kensal Town portion of the was said that Bowker had slipped on the stairs, and that Chelsea parish. In one sense the reports differ from administered to him with was effect. We can brandy good form no opinion of the fitness of brandy in this case. And ordinary ones dealing with diphtheria. Dates as to attacks and progress of the disease, the period during which it we venture to think that even the coroner was scarcely entitled in this case to deliver a lecture on the use of stimu- has prevailed, and many other important points having to lants to people suddenly taken ill or on his own case. This do with such occurrences are not given, and it would seem is not the use of inquests. The man died in this instance, that Dr. Seaton’s main object has been to show that none and this did not say much for the efficiency of the treat- of the ordinarily known agents by which diffusion of ment. People are too ready without advice from coroners diphtheria is occasioned can be credited with this special to pour brandy down the throats of those slipping or outbreak. The locality attacked is singular in its conidropping down. Sometimes it is right, but very often it is parative freedom from drain and sewer nuisances, from overbad practice. Supposing, as is often so, the case to be one crowding, and from unwholesome conditions about houses. of apoplexy or epilepsy, the administration of brandy is No suspicion attaches to milk, and the spread was not likely to make matters worse. Coroners, and especially connected with any particular school. This negative medical coroners, should stick to their own duties. One sort of evidence is followed by explanation of the difuseful piece of advice a jury has just given in a case the ficulties in which we are placed owing to our scanty report of which lies before us, where a poor man placed in knowledge of the etiology of diphtheria ; and finally there a police cell for drunkenness passed gradually into apoplexy is a suggestion whether it would not be desirable to direct and died. The excuse was an awful one, and yet not with- the attention of the Local Government Board to the quesout something in it-that 2400 persons bad been charged this tion of the present system of removal of cases of diphtheria year with drunkenness, and n0t one turned out to be a case to hospital, and to the alternative plan of treating them of illness. The jury expressed the opinion that in all such I at home under nurses specially provided by the public We assume the jury authority. It so happens that Dr. Seaton has special cases the doctor should be called. It would be rather hard on the opportunities for giving counsel on this very subject, for, mean in all doubtful cases. in addition to his long and varied experience as a health police surgeon to call him up 2400 times unnecessarily. officer, he is also a member of the only hospital board in this country who have any considerable experience as to ATROPO-MORPHINO-CHLOROFORMISATION. the isolation in hospital of diphtheria cases. There have SPEAKING before the Socicte de Chirurgie, M. Paul Rey- been rumours as to the practice being undesirable when nier gave his experiences of the use of this combination as adopted on a large scale, and Dr. Seaton doubtless has an anaesthetic. Professor Dastre, the distinguished physio- some information bearing on this point. As it is, the logist, had recommended the employment of atropine with reports unfortunately do not help to clear up either this morphine as a preliminary to chloroform in order to avert matter or the cause of the Kensal Town diphtheria. what he regarded as a common source of danger-cardiac paralysis due to vagal inhibition. He experimented upon UNIVERSITY AND MEDICAL DEGREES dogs, and was led to form a favourable opinion of the, OXFORD FOR WOMEN. practice, recommending it to surgeons. M. Aubert of Lyon THE to as whether or not Oxford University the a : question plan, giving hypodermic injection of one adopted should admit to the examination for the degree of and a women half centigramme of morphine hydrochlorate and threeof a Bachelor of was of Medicine of or discussed on Tuesday, and settled fifteen milligramme sulphate atropine quarters the minutes the final in before vote administration of the chloroform. by thirty congregation. In all the preliminary M. Paul Reynier and others speaking at the fame meeting, stages of voting there has been a small majority in favour of the statute. The rejection of the statute was moved by were unable to confirm his favourable experiences ; indeed, M. Reynier stated he had relinquished using the com- Professor Case, who has on various rrrounds consistently bination, as he had lost one patient from its employ- opposed the proposal fiom its nception, alleging, among ment. The patient, a cblorotic girl, who was to undergoother reasons, that the admission of women was not a trifling operation, was chloroformed according to M. required, inasmuch as the London School of Medicine Aubert’s method and the operation safely completed in tent afforded every facility for the study of medical subjects.
ending Sept.
used.
’
,
.
,
.
.
MEDICAL MISSIONS.—FRENCH DIPLOMAS. The other side was championed by the Rev. W. W. Jackson, Rector of Exeter College, and Mr. Arthur
Sidgwick, of Corpus. The rejection carried by a majority of 4, 154 voting. THE KNEE-JERK
J
of the statute
IN TRANSVERSE
1115
FRENCH
DIPLOMAS.
THE officiat, or second grade of practitioners in France, has long been threatened, and appears now to be on the point of extinction. The Chamber of Deputies some time since appointed a committee to examine and report upon the subject, and the result of its deliberations is entirely in favour of suppressing the official. The report presented to the Chamber states that there is every reason to expect that the number of doctors of medicine that will graduate in future will be quite sufficient for the needs of the population, especially if more protection is afforded by the law against the encroachments of quacks and of foreign practitioners. It is also pointed out that not only the great majority of medical men, but of the existing offlciers, are in favour of the suppression of the lower grade. The number of candidates for it has of late decreased considerably, and since 1883 the course of study and the examinations have been raised to a level not very much inferior to those required for the doctorate. The report recommends that the existing officiers be admitted to the doctorate It is greatly to be on passing two clinical examinations. desired that the whole medical profession should possess the same diploma-viz., that of Doctor of Medicine-as is now (according to the committee) the case in Germany, Austria, Italy, Belgium, Holland, and Spain. Here the committee’s information must be considerably at fault, for in Germany, Holland, and Spain practice is by no means confined to M.D.’s.
was
MYELITIS.
SINCE the publication some months ago of Dr. Bastian’s paper on the loss of the knee-jerk in patients suffering from complete transverse myelitis in the dorsal or cervical regions cases have from time to time been published both in this country and abroad in confirmation of the view then advanced. In the Nortlz A rnerican Review, vol. ii., No.8, such a case is recorded. The patient was a man aged fiftyfive, who, after falling backwards over a railing, had complete motor and sensory paralysis of the limbs, with flaccidity and abolition of the deep reflexes. He died on the day after admission into hospital, and at the necropsy it was found that he had sustained a fracture at the level of the third cervical vertebra, and that the cord at this point was completely divided. Such a case, however, can hardly be adduced in support of the view advocated by Dr. Bastian, and long ago propounded by Dr. Hughlings Jackson, as those who take the opposite view allege that the shock accompanying any severe spinal injury not unfrequently causes abolition of reflexes which is only temporary. As tbe patient referred to died on the day after the injury was sustained, those holding the old view would maintain that the loss of knee-jerks was a transient phenomenon, and that they would have returned had the SUBCUTANEOUS RUPTURE OF AN AORTIC patient lived long enough. Nor was there any evidence ANEURYSM that the grey matter in the lumbar region was unIN the Rev7lc Générale de Clinique et Thérapeutique of injured, for the electrical condition of the muscles was not examined, and in the absence of such an examination September there is an account of a case in which a thoracic the loss of knee-jerk proves nothing. It would be well if aoitic aneurysm proved fatal by rupture into the subthose who have opportunities of seeing and examining cases cutaneous tissue of the chest wall. The case, which is dein which there is prolonged absence of knee-jerk after scribed by Drs. Rauzier and Houel, is interesting on spinal injury would carefully test the reactions of the account of the rarity of this mode of termination. The muscles both to the galvanic and faradaic cmrents, for much patient, a woman of sixty years of age, was admitted to the of the value of those cases, at least in reference to this Hopital Saint-Eloi, under the care of Professor Grasset, on April 4th of this year, suffering from a large pulsatiJe point, will depend upon the condition of those reactions. tumour in the upper and anterior part of the right chest. The tumour had first appeared sixteen months before, MEDICAL MISSIONS. when, somewhat suddenly, and on one occasion not long THE Edinburgh Medical Missionary Society has just before admission, she had felt a sudden crack, as if entered on the fiftieth year of its existence. Previously to something had broken in it, during a fit of coughing. She its foundation the idea of associating the healing art with had led a dissipated life. At the time she came under evangelistic effort was not readily accepted, but now, as the care she was suffering much from dyspnoea, cough, and Society’s report reminds us, no department of missionary other symptoms of urgency, and the aneurysm pulsated work has warmer friends or more liberal supporters, no strongly. The skin was not adherent to the aneurysm method is recognised as more Christ-like, and no auxiliary or altered in appearance, but slight pressure produced pain. to evangelistic effort in heathen lands is more valued. More The heart was enlarged, but the contractions were feeble ; than 140 medical missionaries with British qualifications, at the apex there was a loud systolic murmur. There was The symptoms produced by the and at least an equal number from other countries-say, 300 pulmonary oedema. in all-are now labouring in heathen and Mohammedan aneurysm improved under treatment, but the aneurysm On the countries. The Edinburgh Society, whose aim is principally, itself continued to gradually increase in size. though not entirely, to provide education for medical evening of June 2nd, after attempts to cough, the aneurysm missionaries, is much in want of increased accommo gave way suddenly into the subcutaneous cellular tissue; the dation, the "Livingstone memorial," which is the main patient experienced a very painful tearing sensation and the centre of the work, being now far too small. Fresh tumour increased in size, the outline of the aneurysm being vigour has just been imported by the appointment obscured by a fluid cushion which gradually extended towardss of the Rev. Dr. Hoernle, who for many years has the axilla. After the attack of syncope which followed been a medical missionary in Persia, as assistant super- the sudden pain the patient required morphia to relieve her intendent. An interesting feature of the Society’s suffering, which was intense, and accompanied with violent branches consists of an "Invalid’s Auxiliary."" It is dyspnoea. Next day the axilla was filled by the extension found that many persons are so impressed during their of the swelling, which occupied the whole right mammary own attacks of illness with the benefit of efficient medical region ; the radial pulse was absent on the right side in aid that they are readily induced to assist in providing for consequence of pressure on the axillary artery, whilst severe their suffering fellow-creatures in the wilds of Africa, the attacks of pain were felt in the branches of distribution of the brachial plexus. Next day there was jaundice, but the crowded cities of China, and elsewhere. ___
.
I
s
I