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BILIARY DRAINAGE
692
VITAL STATISTICS.-MEDICAL NEWS
The Murut tribes of Borneo endured such a saturation
infection (the Germans call it
Durchseuchung)
some
to ten years ago, since when their numbers until now I doubt if more than 12,000 are left of the 22,000 numbered in the 1931 census. In my opinion they would have suffered far less, and their numbers would have been maintained, had they been spared what is nothing less than quinine deprivation from the very outset of their first new infection. That these unfortunate but trusting and obedient natives should make long journeys in the hope of obtaining vital supplies of quinine and dressings, only to be put off with two or three quinine capsules, a small strip of lint, one-third of a bandage, and a little liniment in the palm of the hand is very pathetic, and it was distressing to have to refuse them an adequate supply of quinine. The Muruts are interesting to ethnologists, and they are even capable of performing useful labour on estates, when they have received proper treatment for splenomegaly, hookworm, and lesser complaints. Governments would seem to become interested in their aboriginal peoples sometimes only when it is too late to save them, and the Muruts are still going through the stage of being interesting only for revenue purposes. The alternatives to the annual ungraduated cash poll-tax of$1.00-i.e., 2s. 4d.-for every male adult are (1) payment of a fine of five times the tax, " " (2) two weeks’rigorous imprisonment, (3) voluntary heavy work as coolie bearers for three days, for which they must bring their own food. The imposition of
eight have
progressively declined,
poll-tax
on a
To the Editor
arr)
encephalitis, 1 ; encephalitis lethargica, 8 ; dysentery, 12 ; ophthalmia neonatorum, 89. No case of cholera, plague, or typhus fever was notified during the week. The number of cases in the Infectious Hospitals of the London County Council on Sept. 13th was 2641, which included : Scarlet fever, 794 ; diphtheria, 949 ; measles, 44 ; whooping-cough, 403 ;puerperal fever, 32mothers (plus 13 babies); encephalitis lethargica, 27121; poliomyelitis, 14.3 At St. Margaret’s Hospital babies (plus there were mothers) with ophthalmia
neonatorum.
Deaths.-In 121 great towns, including London, there was no death from small-pox or enteric fever, 4 (0) from measles, 2 (0) from scarlet fever, 14 (4) from whooping-cough, 22 (3) from diphtheria, 67 (3) from diarrhoea and enteritis under two years, and 17 (2) from influenza. The figures in parentheses are those for London itself. Deaths from diarrhoea and enteritis were distributed over 28 great towns, the highest numbers being Liverpool 10, Nottingham 8, Hull 7, Birmingham 5, Manchester 4, Leeds and Sunderland each 3, no other great town more than 2. Birmingham reported 2 deaths from measles. Four cases of diphtheria proved fatal at Manchester, 2 at Bradford.
The number of stillbirths notified during the week was 268 (corresponding to a rate of 45 per 1000 total births), including 50 in London.
must accelerate faithfullv. A. J. COPELAND.
of
THE LANCET
interested in
observation made in the article on biliary drainage by Dr. T. Hunt in THE LANCET of last week. He says that the introduction of magnesium sulphate directly into the duodenum is almost always followed by a now of bile from the common bile-duct. If this bile is removed by tube there is seldom diarrhoea (the magnesium sulphate presumably remains in the intestines). This observation adds weight to a theory as to the mode of action of magnesium sulphate which I mentioned in THE LANCET of Jan. 26th, and also mentioned by Dr. Hunt last week in his article. I suggested that it depended on the increased flow of bile which follows its administration by mouth. The purgative action of magnesium sulphate has been proved not to be due to its effect after absorption into the general circulation. It is not due to its osmotic effect because Dr. A. F. Hurst has shown that the watery stool does not contain an excess of sulphate. Also if charcoal is given by mouth a short while before the sulphate the charcoal does not appear in the stool which follows. I find that if fresh bile is given by mouth it acts as a strong purgative and preparations of bile salts which are given with the object of causing a greater flow of bile frequently give rise to diarrhoea. Also fresh ox bile given per rectum increases peristalsis in cases of ileus. These facts suggest that the chief effect of magnesium sulphate may be an increased peristalsis of the large intestine following an increased flow nf 11 -T
N otificaHons.-The following cases of infectious disease were notified during the week : Small-pox, 0 ; scarlet fever, 1924 ; diphtheria, 1003 ; enteric fever, 85 ; acute pneumonia (primary or influenzal), 336 ; puerperal fever, 36 ; puerperal pyrexia, 131 ; cerebrospinal fever, 14 ; acute poliomyelitis, 18 ; polio-
vours
BILIARY DRAINAGE
was
ENGLAND AND WALES DURING THE WEEK ENDED SEPT. 7TH, 1935
declining population
the decline. I am. Sir. Whiston-street, E., Sept. 9th.
SIR,-I
INFECTIOUS DISEASE IN
specially
Cir
-.rOll1’"R
one
f>l.it.l1fll11v
D. LINCOLN LEWIS. Archway Hospital, Highgate, Sept. 17th.
MEDICAL NEWS King’s College Hospital The Duke of York has
King’s College Hospital
accepted the presidency of in succession to the Duke of
Connaught. A Victorian centenary loan exhibition is being planned for the year 1937 to celebrate the centenary of the accession of Queen Victoria. The exhibition will be mainly illustrative of women’s activities during the reign. The proceeds will be given to the hospital, which was founded two years after Queen Victoria’s accession.
of Apothecaries Sir William Willcox has been elected the new Master of this society and Mr. A. P. Gibbons and Mr. Hugh Lett Wardens. Society for the Study of Inebriety The next meeting of this society will be held in the rooms of the Medical Society of London (11, Chandosstreet, London, W.) on Tuesday, Oct. 8th, at 4 P.M., when Dr. Gerald Slot will open a discussion on the medicolegal aspects of drunkenness. Society of Public Analysts A meeting of this society will be held on Wednesday, Oct. 2nd, at the rooms of the Chemical Society, Burlington House, Piccadilly, London, W., at 8 P.M. The papers to be read include one on the chemical examination of furs in relation to dermatitis (identification of vegetable and other dyes) by Mr. H. E. Cox, D.Se. Wireless Sets for Hospitals The King and Queen havegiven f:l50 to the fund to equip voluntary hospitals in Scotland with wireless
Society
sets.
British Red Cross Society Two courses of lectures and demonstrations on antigas precautions and first aid for air-raid casualties will be held at the County of London headquarters of this
society, 9, Chesham-street, S.W.,
on
Fridays,
one
at
2.30 and another at 8 P.M. from Oct. 4th onwards. Each course consists of seven lectures and demonstrations. Applications for tickets should reach the county secretary of the branch not later than Sept. 28th.
VITAL STATISTICS.-MEDICAL NEWS
The Murut tribes of Borneo endured such a saturation
infection (the Germans call it
Durchseuchung)
some
to ten years ago, since when their numbers until now I doubt if more than 12,000 are left of the 22,000 numbered in the 1931 census. In my opinion they would have suffered far less, and their numbers would have been maintained, had they been spared what is nothing less than quinine deprivation from the very outset of their first new infection. That these unfortunate but trusting and obedient natives should make long journeys in the hope of obtaining vital supplies of quinine and dressings, only to be put off with two or three quinine capsules, a small strip of lint, one-third of a bandage, and a little liniment in the palm of the hand is very pathetic, and it was distressing to have to refuse them an adequate supply of quinine. The Muruts are interesting to ethnologists, and they are even capable of performing useful labour on estates, when they have received proper treatment for splenomegaly, hookworm, and lesser complaints. Governments would seem to become interested in their aboriginal peoples sometimes only when it is too late to save them, and the Muruts are still going through the stage of being interesting only for revenue purposes. The alternatives to the annual ungraduated cash poll-tax of$1.00-i.e., 2s. 4d.-for every male adult are (1) payment of a fine of five times the tax, " " (2) two weeks’rigorous imprisonment, (3) voluntary heavy work as coolie bearers for three days, for which they must bring their own food. The imposition of
eight have
progressively declined,
poll-tax
on a
To the Editor
arr)
encephalitis, 1 ; encephalitis lethargica, 8 ; dysentery, 12 ; ophthalmia neonatorum, 89. No case of cholera, plague, or typhus fever was notified during the week. The number of cases in the Infectious Hospitals of the London County Council on Sept. 13th was 2641, which included : Scarlet fever, 794 ; diphtheria, 949 ; measles, 44 ; whooping-cough, 403 ;puerperal fever, 32mothers (plus 13 babies); encephalitis lethargica, 27121; poliomyelitis, 14.3 At St. Margaret’s Hospital babies (plus there were mothers) with ophthalmia
neonatorum.
Deaths.-In 121 great towns, including London, there was no death from small-pox or enteric fever, 4 (0) from measles, 2 (0) from scarlet fever, 14 (4) from whooping-cough, 22 (3) from diphtheria, 67 (3) from diarrhoea and enteritis under two years, and 17 (2) from influenza. The figures in parentheses are those for London itself. Deaths from diarrhoea and enteritis were distributed over 28 great towns, the highest numbers being Liverpool 10, Nottingham 8, Hull 7, Birmingham 5, Manchester 4, Leeds and Sunderland each 3, no other great town more than 2. Birmingham reported 2 deaths from measles. Four cases of diphtheria proved fatal at Manchester, 2 at Bradford.
The number of stillbirths notified during the week was 268 (corresponding to a rate of 45 per 1000 total births), including 50 in London.
must accelerate faithfullv. A. J. COPELAND.
of
THE LANCET
interested in
observation made in the article on biliary drainage by Dr. T. Hunt in THE LANCET of last week. He says that the introduction of magnesium sulphate directly into the duodenum is almost always followed by a now of bile from the common bile-duct. If this bile is removed by tube there is seldom diarrhoea (the magnesium sulphate presumably remains in the intestines). This observation adds weight to a theory as to the mode of action of magnesium sulphate which I mentioned in THE LANCET of Jan. 26th, and also mentioned by Dr. Hunt last week in his article. I suggested that it depended on the increased flow of bile which follows its administration by mouth. The purgative action of magnesium sulphate has been proved not to be due to its effect after absorption into the general circulation. It is not due to its osmotic effect because Dr. A. F. Hurst has shown that the watery stool does not contain an excess of sulphate. Also if charcoal is given by mouth a short while before the sulphate the charcoal does not appear in the stool which follows. I find that if fresh bile is given by mouth it acts as a strong purgative and preparations of bile salts which are given with the object of causing a greater flow of bile frequently give rise to diarrhoea. Also fresh ox bile given per rectum increases peristalsis in cases of ileus. These facts suggest that the chief effect of magnesium sulphate may be an increased peristalsis of the large intestine following an increased flow nf 11 -T
N otificaHons.-The following cases of infectious disease were notified during the week : Small-pox, 0 ; scarlet fever, 1924 ; diphtheria, 1003 ; enteric fever, 85 ; acute pneumonia (primary or influenzal), 336 ; puerperal fever, 36 ; puerperal pyrexia, 131 ; cerebrospinal fever, 14 ; acute poliomyelitis, 18 ; polio-
vours
BILIARY DRAINAGE
was
ENGLAND AND WALES DURING THE WEEK ENDED SEPT. 7TH, 1935
declining population
the decline. I am. Sir. Whiston-street, E., Sept. 9th.
SIR,-I
INFECTIOUS DISEASE IN
specially
Cir
-.rOll1’"R
one
f>l.it.l1fll11v
D. LINCOLN LEWIS. Archway Hospital, Highgate, Sept. 17th.
MEDICAL NEWS King’s College Hospital The Duke of York has
King’s College Hospital
accepted the presidency of in succession to the Duke of
Connaught. A Victorian centenary loan exhibition is being planned for the year 1937 to celebrate the centenary of the accession of Queen Victoria. The exhibition will be mainly illustrative of women’s activities during the reign. The proceeds will be given to the hospital, which was founded two years after Queen Victoria’s accession.
of Apothecaries Sir William Willcox has been elected the new Master of this society and Mr. A. P. Gibbons and Mr. Hugh Lett Wardens. Society for the Study of Inebriety The next meeting of this society will be held in the rooms of the Medical Society of London (11, Chandosstreet, London, W.) on Tuesday, Oct. 8th, at 4 P.M., when Dr. Gerald Slot will open a discussion on the medicolegal aspects of drunkenness. Society of Public Analysts A meeting of this society will be held on Wednesday, Oct. 2nd, at the rooms of the Chemical Society, Burlington House, Piccadilly, London, W., at 8 P.M. The papers to be read include one on the chemical examination of furs in relation to dermatitis (identification of vegetable and other dyes) by Mr. H. E. Cox, D.Se. Wireless Sets for Hospitals The King and Queen havegiven f:l50 to the fund to equip voluntary hospitals in Scotland with wireless
Society
sets.
British Red Cross Society Two courses of lectures and demonstrations on antigas precautions and first aid for air-raid casualties will be held at the County of London headquarters of this
society, 9, Chesham-street, S.W.,
on
Fridays,
one
at
2.30 and another at 8 P.M. from Oct. 4th onwards. Each course consists of seven lectures and demonstrations. Applications for tickets should reach the county secretary of the branch not later than Sept. 28th.