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BURIAL REFORM AND THE CITY CHURCHES
211 to fsecal accumulation without any external mechanical cause, such as the pressure exerted in labour. In Dr. Genersich’s case an abscess containing meconium had formed under the umbilicus, this abscess communicating with the ileum by means of an infundibuliform passage. The extent and character of the granulations, which had become calcareous in some places, and the firm adhesions in the neighbourhood of the lesion, showed that the perforation must have taken place some time before birth, as the child only lived forty-five hours. It is probable that the pressure during birth and the entrance subsequently of pathogenic bacilli through the alimentary canal caused a sudden increase of the peritonitis as well as the phlegmonous inflammation of the abdominal walls. The spontaneous perforation of the ileum is, as has been well pointed out in this country in somewhat similar cases by Mr. Bland Sutton, intelligible only by referring to the embryology of the intestines. A small Meekel’s diverticulum may have been split on the spontaneous reduction of the normal umbilical hernia, or the obliteration of the physiological umbilicus may have remained incomplete, so that on the retrogression of the umbilical coil of intestine a small aperture was left, from which the meconium percolated into the peritoneal cavity, subsequently becoming encapsulated by adhesions between the intestines, the omentum, and the abdominal walls. The latter view is the one which Dr. Genersich considers the most applicable in the present case, as a most minute examination resulted in finding no vestige of a diverticulum, while the large intestines were found to be rather thin.
rupture is due
counted as formal clinical instruction in the curriculum of study. Dr. Gairdner affirms such kind of instruction to he desirable, and regards it as a modification of the German Poliktinik, or clinique of the town. With his usual precision, he indicates the only limitations to the usefulness of this mode of instruction. The one is the limited number of men fit for such work, and the other is the risk of " hurryscurring" through thirty or forty cases in an hour, as sometimes must occur in the out-practice of hospitals. It is one of the recommendations of more private lessons, .ag in dispensary or general practice, that, being given in the very homes and houses of the patients, there is the more guarantee for that humane and considerate treatment of the patient and for a certain amount of thoroughness on which both Sir Andrew Clark andI Professor Gairdner so properly insist. There are surely among the many thousand practitioners of Great Britain not a few who could give most valuable lessons in the art of detecting and treating disease. The remainder of Dr. - Gairdner’s lecture deals with the importance of right methods of clinical instruction, the place of clinical lectures, the physician and the patient and the ethics of a clinical course, the details of clinical work, the verificatiom of details, and the composition of clinical lectures proper. He thinks that a hospital patient, as compared with a rich man, derives immense benefit from the methodical investigation of his case. He allows that 4’ lecturing" is often overdone in clinical teaching, and he insists, as all good teachers do, on treating the student and It is clear that the even his mistakes with respect. methods of clinical instruction are about to receive more .attention than ever, and they both deserve and need such attention. I
BURIAL REFORM
IS CHELMSFORD WATER-LOGGED ?
AT a recent meeting of the Church of England Burial Reform Association, held in the vestry of St. Edmund the King, Lombard-street, under the presidency of Archdeacon Sinclair, allusion was naturally made to the recent disclosures at the neighbouring church of Sb. Mary, Woolnoth. ’The Rev. F. Lawrence, the indefatigable secretary of the Association, observed that all the officials of the last-named ehurch had suffered from sore-throats in consequence of the ioul air in the church arising from the large number of dead I bodies in the vaults beneath. He quoted the words of Sir John Simon, to the effect that the most successful hermetical ! sealing of dead bodies might retard, but could not possibly prevent, the escape of poisonous gases which mingled with the air in the church above, to the great detriment of those :assembled there. The experience at St. Mary’s only added another example to the several other City churches which had been rendered equally unwholesome. The bodies entombed beneath that church will have to be removed and ’buried in some suburban cemetery, as is generally done now, and as should have been done always.
If ’,
PERITONITIS FROM PERFORATION OF THE INTESTINE IN UTERO. DR. ANTON GENERSICH of Clausenburg recently exhibited at a meeting of a Hungarian Pathological Society .a case of peritonitis occurring in an infant which had doubtless originated from perforation of the small intestine before birth. He referred to Dr. Zillner’s report of several somewhat similar cases where the sigmoid flexure had been ruptured, the explanation proposed by Dr. Zillner being that the rupture was due to distension by meconium of a coil of intestine fixed between the vertebral column and the abdominal walls. He considered that pressure and distension f this kind must occur even in normal parturition ; but this view is combated by Dr. Platauf, who insists that the
AN increase of diphtheria in the town of Chelmsford, together with the now admitted circumstance that the diffusion and maintenance of that disease are in some way related to damp and cold soils, has raised the question as to whether this Essex town is water-logged or not. This is a matter which ought long ago to have been set at rest, for it is no less than twenty-six years since Dr. Buchanan presented to the Privy Coumil Office his classical report on the relation of phthisis to subsoil wetness, and in this he quoted the case of Chelmsford as one of the crucial proofs of his contention. He then showed that in a number of towns where deep sewerage had lowered the subsoil water there had been a remarkable diminution in the rate of phthisis mortality; but when he came to Chelmsford, where works of equal importance had been carried out, no vestige of any corresponding diminution of the phthisis death-rate could be discovered. The explanation, he maintained, lay in the fact that mill-rights, with their corresponding floodgates below the town, held up the river water, and so prevented any reduction of subsoil wetness beneath the If ever there was a case for immediately town. securing the benefits elsewhere obtained by the result of deep drainage it was at Chelmsford, and many have doubtless come to the conclusion that the story of 1866 is a Such observers matter of curious past sanitary history. will be astonished to find that a discussion has recently taken place in the Town Council on the subject, 11 its the town water-logged ?" and that the question still arises in 1892 whether the heading-back of the river water at such places as Moulsham Mill shall be prevented by purchasing the mill rights. The most that could be said at the meeting was that the whole of the soil beneath the town was not water.logged, the South Ward standing upon a comparatively dry surface. But, as regards the remainder of the town, it would seem that matters stand just where they have done all these twenty.six years in which Chelmsford has served as witness to the injurious effects of a maintained high level of subsoil water. Now that the matter is again
taken
AND THE CITY CHURCHES
rupture is due
counted as formal clinical instruction in the curriculum of study. Dr. Gairdner affirms such kind of instruction to he desirable, and regards it as a modification of the German Poliktinik, or clinique of the town. With his usual precision, he indicates the only limitations to the usefulness of this mode of instruction. The one is the limited number of men fit for such work, and the other is the risk of " hurryscurring" through thirty or forty cases in an hour, as sometimes must occur in the out-practice of hospitals. It is one of the recommendations of more private lessons, .ag in dispensary or general practice, that, being given in the very homes and houses of the patients, there is the more guarantee for that humane and considerate treatment of the patient and for a certain amount of thoroughness on which both Sir Andrew Clark andI Professor Gairdner so properly insist. There are surely among the many thousand practitioners of Great Britain not a few who could give most valuable lessons in the art of detecting and treating disease. The remainder of Dr. - Gairdner’s lecture deals with the importance of right methods of clinical instruction, the place of clinical lectures, the physician and the patient and the ethics of a clinical course, the details of clinical work, the verificatiom of details, and the composition of clinical lectures proper. He thinks that a hospital patient, as compared with a rich man, derives immense benefit from the methodical investigation of his case. He allows that 4’ lecturing" is often overdone in clinical teaching, and he insists, as all good teachers do, on treating the student and It is clear that the even his mistakes with respect. methods of clinical instruction are about to receive more .attention than ever, and they both deserve and need such attention. I
BURIAL REFORM
IS CHELMSFORD WATER-LOGGED ?
AT a recent meeting of the Church of England Burial Reform Association, held in the vestry of St. Edmund the King, Lombard-street, under the presidency of Archdeacon Sinclair, allusion was naturally made to the recent disclosures at the neighbouring church of Sb. Mary, Woolnoth. ’The Rev. F. Lawrence, the indefatigable secretary of the Association, observed that all the officials of the last-named ehurch had suffered from sore-throats in consequence of the ioul air in the church arising from the large number of dead I bodies in the vaults beneath. He quoted the words of Sir John Simon, to the effect that the most successful hermetical ! sealing of dead bodies might retard, but could not possibly prevent, the escape of poisonous gases which mingled with the air in the church above, to the great detriment of those :assembled there. The experience at St. Mary’s only added another example to the several other City churches which had been rendered equally unwholesome. The bodies entombed beneath that church will have to be removed and ’buried in some suburban cemetery, as is generally done now, and as should have been done always.
If ’,
PERITONITIS FROM PERFORATION OF THE INTESTINE IN UTERO. DR. ANTON GENERSICH of Clausenburg recently exhibited at a meeting of a Hungarian Pathological Society .a case of peritonitis occurring in an infant which had doubtless originated from perforation of the small intestine before birth. He referred to Dr. Zillner’s report of several somewhat similar cases where the sigmoid flexure had been ruptured, the explanation proposed by Dr. Zillner being that the rupture was due to distension by meconium of a coil of intestine fixed between the vertebral column and the abdominal walls. He considered that pressure and distension f this kind must occur even in normal parturition ; but this view is combated by Dr. Platauf, who insists that the
AN increase of diphtheria in the town of Chelmsford, together with the now admitted circumstance that the diffusion and maintenance of that disease are in some way related to damp and cold soils, has raised the question as to whether this Essex town is water-logged or not. This is a matter which ought long ago to have been set at rest, for it is no less than twenty-six years since Dr. Buchanan presented to the Privy Coumil Office his classical report on the relation of phthisis to subsoil wetness, and in this he quoted the case of Chelmsford as one of the crucial proofs of his contention. He then showed that in a number of towns where deep sewerage had lowered the subsoil water there had been a remarkable diminution in the rate of phthisis mortality; but when he came to Chelmsford, where works of equal importance had been carried out, no vestige of any corresponding diminution of the phthisis death-rate could be discovered. The explanation, he maintained, lay in the fact that mill-rights, with their corresponding floodgates below the town, held up the river water, and so prevented any reduction of subsoil wetness beneath the If ever there was a case for immediately town. securing the benefits elsewhere obtained by the result of deep drainage it was at Chelmsford, and many have doubtless come to the conclusion that the story of 1866 is a Such observers matter of curious past sanitary history. will be astonished to find that a discussion has recently taken place in the Town Council on the subject, 11 its the town water-logged ?" and that the question still arises in 1892 whether the heading-back of the river water at such places as Moulsham Mill shall be prevented by purchasing the mill rights. The most that could be said at the meeting was that the whole of the soil beneath the town was not water.logged, the South Ward standing upon a comparatively dry surface. But, as regards the remainder of the town, it would seem that matters stand just where they have done all these twenty.six years in which Chelmsford has served as witness to the injurious effects of a maintained high level of subsoil water. Now that the matter is again
taken
AND THE CITY CHURCHES