BUMBLEDOM IN AYR.

914 The ravages of small-pox, introduced the less frightful. In the island of Oahu - over 15,000 died and the marshal of the islands informed eme that he superintended the burial of 10,000 victims . of this disease in Honolulu alone-more than one half of its ,entire population." With regard to leprosy Dr. Morrow said: " Nowhere else in the world can be found a parallel to the extraordinary development and rapid spread of this disease - which in the short space of little more than one generation ’has attained such alarming proportions and proved such a terrible menace to the public health." The article in the 4Jedical Record proceeds to state, on the authority of Dr. Burnside Foster, that matters had not changed much for the ’’better since Dr. Morrow wrote in 1889 and that at the present stime 10 per cent. of the Hawaiian natives were lepers. Dr. F. R. Day, a member of the Honolulu Board of Health, while .,dmitting the truth of Dr. Morrow’s statement as regards the first half of the century vigorously denies that matters have not changed for the better, and he gives statistics supsporting his contention. In the Medical Record, however, of Jan. 28th, 1899, Dr. Morrow writes as follows: "As ’t,here has been so much conflicting testimony on the point S send you statistics of the leper settlement since its estab- I lishment which have been carefully compiled from the ceports of the Hawaiian Board of Health."

’terminating fatally.

n 1853,

were none

leprosy in the Sandwich Islands completed his short time ago. From his showing leprosy has decreased but little there and he sounds a note of warning against the dangers of importing leprosy from the Sandwich Islands into the United States. Surgeon Carmichael was greatly impressed with the excellent manner in which the leper settlement at Molokai is managed. There seems to be unanimity of opinion among those best qualified to judge that segregation is the only effective means of out stamping leprosy, and if this system is applied rigorously to Hawaii it should have the desired effect there. report report

on

a

complete

MORE SUNDAY NEWSPAPERS. THE secretary of the Society for the Suppression of Street Noises writes to us on this subject, saying that he hopes that the system of seven-days-a-week newspapers will be strenuously resisted. Everybody should get one day in the week off work. It cannot always be Sunday, but a six-days’ working week is enough for A great objection to Sunday newspapers is any man. the yelling which at present seems inseparable from their distribution. In the matter of street noises the London County Council is willing in spirit but very weak in flesh, for it gave in to the protest of a weekday newspaper owner, or part owner, on the subject. The Government do nothing. Noise, dirt, smoke, and ill-health will go together until severe measures are taken. But when will they be taken ?

BUMBLEDOM IN AYR. THE Town Council of Ayr has at last got to the end of a long fight with the Local Government Board of Scotland. The subject has been the inter-relationships of the medical officer health and the sanitary inspector. That is a which from first to last has caused a good many question north of the Tweed, though these struggles are struggles happily getting fewer, and the proper position of the medical officer is coming to be more and more fully recognised. When the profession succeeded in getting the Public Health (Scotland) Bill of 1897 very much modified and improved in this respect in the course of its progress to the statutebook the battle was in great measure won, but the town councillors of Ayr have been very long in recognising the fact. They were determined that the sanitary inspector should in all matters be practically independent of the medical officer. The Local Government Board were equally determined that this should not be permitted and the town council, after interposing every obstacle and delay which ingenuity and obstinacy could suggest, have at last been forced to yield. That they have done so with a very bad grace only goes to prove their own consistency. It is true that all along a small minority, headed by Councillor W. J. Naismith, M.D. Edin., have upheld the views of the central authority and have urged the council to bend to the inevitable, and we fancy the majority must now regret that they did not follow the advice which they received. They are thus at the end of one fight, but that by no means terminates their troubles with the Local Government Board. It seems that their hospital accommodation is insufficient and unsatisfactory and that with regard to it they have been pursuing the same dilatory course, so that now, after endless correspondence, legal proceedings are being instituted by the central authority to compel the local authority to do its duty. The extraordinary ignorance and perversity of the latter are indicated by the fact that they have proposed to erect a reception house within the curtilage of a smallpox and cholera hospital, and the vigour with which the Board denounces this suggestion is a quite refreshing feature of a purely official document. It is nothing less than marvellous that a place the prosperity of which largely depends

of

"Dr. Morrow appears to be of the opinion that, judging from the foregoing figures, leprosy does not show signs of abating to any great extent in the Sandwich Islands, while Dr. Day holds the opposite view, thinking that the Health authorities are slowly but surely making headway :against the spread of the disease, and he predicts that the ,day is in sight when leprosy will be unknown in Hawaii. C3urgeon D. A. Carmichael of the United States Marine Hospital Service who was appointed by the President to

915

healthy and pleasant sea-coast resi- intense, neuralgic in character, and continuous. To procure governed by a local body whose relief and to obtain sleep large doses of morphia had to be doings are likely to bring it into notoriety as a place which, subcutaneously injected. The jaundice would usually last sanitarily speaking, is ill managed, and which refuses to from four to six days. There was no accompanying gastric accommodate itself to some of the most elementary require. disturbance; the bowels were on these occasions regular and the stools were clay-coloured. The urine showed ments of modern public’health administration. the presence of bile pigment. The hepatic area during a crisis was acutely tender and sensitive to touch-to COMPANIES AND THE MEDICAL PROFESSION. such an extent that even the pressure of her clothing As will be seen by a reference to our Parliamentary was intolerable ; when the attack was over this tenderIntelligence the Lord Chancellor has introduced into the ness disappeared. The treatment wassuspension," House of Lords a Bill to prohibit the profession or business and this she was able to go through when the of physician, surgeon, dentist, or midwife being carried on hepatic crises were over. However, in spite of treatby a company. We have not yet seen the text of this Bill, ment her ataxy increased; the pupils became myotic but we should hope that it is so drafted as to include and exhibited the characteristic Argyll-Robertson phemedical aid societies. These societies in many cases sweat nomenon. There was no optic atrophy or external ophtheir medical officers in the most disgraceful manner, as we thalmoplegia. She gradually lost strength and wasted bave frequently shown in our columns. perceptibly, the hepatic attacks became more and more intense, and she finally died from wasting and exhaustion. THE ASSOCIATION OF ASYLUM WORKERS. The necropsy revealed a normal condition of the heart, lungs, WE have received the annual report and financial state- and viscera generally, excepting the liver. This organ was ment of the Association of Asylum Workers for the year much congested and of the typical mottled or "nutmeg" 1898. The association was formed to look after the interests appearance. The gall-bladder was normal and free from of those working in asylums, both medical and lay. The gall-stones. The spinal cord on preparation by Weigert’s care of the sick is in all cases very trying work and method presented a " sclerosis of the posterior tracts of the the entire cord." No lesion was most length the care of mental disease is one of the exacting throughout in the abdomen or thorax which found could forms of attendance on the sick. The responsibility is very explain the of the liver and " condition to which could nothing great and the constant association with some form or 11 nutmeg the and be attributed severe crises of paroxysmal hepatic other of mental disturbance is apt to react disastrously and jaundice which Dr. Krauss accordingly ascribes to upon the minds of those who attend upon such patients. pain Hence change of air and scene is very necessary for the morbid process within the spinal cord affecting the asylum workers, and we are glad to see that part of the nerves supplying the liver and gall-bladder. To the various good work of the association under consideration is support- crises tabétiques of Charcot-viz., the gastric, laryngeal, cardiac, and rectal-must now be added the hepatic, which a "home of rest fund" by which nurses or attendants with the rare type of vesical, nephralgic, and urethral, and are granted two or three weeks’ holiday at some suitable health resort free of all expense or trouble. The association including in females the clitoric, complete the list of these also looks after the interests of asylum workers in connexion painful and paroxysmal syndromes which may occur in the with proposed legislation, such as the new Lunacy Bill, and course of tabes dorsalis. upon its reputation as a dential town should be

ing

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also trains attendants and nurses for their duties. The financial position of the association is satisfactory, there being a balance of f.137 14s. 3d. The secretary of the association is Dr. G. E. Shuttleworth who will be happy to receive subscriptions or donations.

TABES DORSALIS WITH HEPATIC CRISES. IT is well known that in the course of tabes dorsalis patients are liable to suffer periodically from paroxysmal pains affecting various parts and organs of the body. In the Journal of Nervous and Mental Disease (February, 1899) Dr. W. Krauss of Buffalo records a case of special interest in which the patient suffered from characteristic attacks of hepatic crises-a condition, it would appear, hitherto un!recorded-the importance of which lies in the fact that ehis syndrome" might have been easily mistaken for a separate and independent ailment of the liver were it not that the associated symptoms served to indicate its tabetic origin. The case was that of a woman, aged 44 years, who had hitherto enjoyed good health and was free from syphilitic taint, hereditary or acquired. She menstruated in her fourteenth year and was married at the age of 23 years, At 36 years of age she began to suffer from shooting pains in her legs occurring at intervals and disappearing without obvious cause. Locomotion became gradually difficult and necessitated the use of crutches eventually. Later she suffered from excruciating pains over theI

right hypochondrium, accompanied by a pronounced jaundiced tinge of the skin and mucous membranes; these attacks recurred every four or five weeks and then slowly passed away, leaving her weak and exhausted in bed for several days. The pains were deep-seated, very

THE CREMATION SOCIETY. AT the general meeting of the members of this society held at Grosvenor House on March 15th Sir Henry Thompson who was in the chair moved the adoption of the report and gave an address upon the progress made by the society since its inception in 1874. After detailing the various legal difficulties which the society had to overcome Sir Henry Thompson mentioned that the first body cremated in the society’s crematorium at Woking was that of a lady on March 26th, 1885. In that year the number of bodies cremated was three. In 1898 the number had risen to 240. Sir Henry Thompson then spoke of the efforts made by the society to bring about reforms in the present very loose system of death registration. The report of a Select Committee published in 1893 fully agreed as to the necessity for such reforms, but up to the present nothing has been done to bring such reform about. Besides the ciema. torium at Woking others have been erected at Manchester, Liverpool, Glasgow, and Hull. With reference to examinations into the cause of death which are so necessary before the cremation of a body it was mentioned that Dr. Sidney Martin had accepted the post of pathologist to the society. Sir Henry Thompson concluded by referring to the question as to whether cremation should not sooner or later be made compnJscry in all cases of death caused by acute infectious disease. There are strong arguments in favour of cremation jpplacing earth burial, or rather coffin burial, in all centres of population, but even in rural districts we are of opinion that there is every room for improvement in the method of burial as at present carried out. Perishable coffins should be used and graves should