CHRONIC POISONING FROM ESCAPE OF ILLUMINATING GAS.

1272 Aetius and reinvigorated. Nothing escapes him ; betakes stock’ should be examined by means of the dioptra. himself, Paulus of Aegina, and Leonides of Alexandria all of everything, forms his own immediate impressions, reads speak of the use of the dioptra both for rectal and vaginal the journals by himself, so that there is hardly a question

the day which does not interest him or which finds him unprepared. His green old age seems almost miraculous, writers of the Roman period in the sense of a medical or while his lofty intelligence subjects everything to its surgical appliance, although the cognate word" specillum," control." And all this in the case of a nonagenarian meaning a probe, is found. In medical works of theB ecclesiastic who for 25 years has never stirred beyond the sixteenth century onwards, whether original treatises or palace and the garden " on the least healthy of the hills of Latin translations of Arabic originals, the word "speculum Rome and whose "Benedictine assiluity" in the literature is not uncommon, meaning sometimes a dilator having two of his high calling is (in Hallam’s phrase) a rebuke to the or more branches and sometimes a flat mirror, placed" sub languid students of the present day." muliere coram vulva ejus," in which the interior of the vagina might be viewed after its sides were held apart by the CHRONIC POISONING FROM ESCAPE OF dilator. Dr. Deneffe argues that the Pompeiian dilators, of ILLUMINATING GAS. which he gives illustrations, may have had polished surfaces, ACUTE poisoning from escape of illuminating gas is a wellbut there is little doubt that the speculum as we know itaccident, but chronic poisoning from the same cause a or cone a internal namely, cylinder reflecting having not does appear to have received attention. In American surface-is less than 100 years old. Dr. Deneffe has diligently Medicine of August 30th Dr. T. J. Yarrow, jun., states that summarised the literature of his subject and his book will be chronic poisoning frequently occurs and is unrecognised. In appreciated by all who take an interest in the history of the New) ork Medical Journal of April 7th, 1900, he first medicine. described the condition. He points out that gas-fittings are seldom perfect and that persons exposed to a constant slight THE POPE AND HIS BODY PHYSICIAN. leakage of gas grow accustomed to it and soon cease to ONE of our Italian correspondents writes :-In the early notice it. The widespread use of gas for cooking has greatly spring of 1899 Leo XIII. underwent a surgical opera- increased the chances of this form of poisoning, as careless tion for the removal of a cystoid tumour in the lumbar servants often fail to turn the gas off completely. Dr. region and now His Holiness has been receiving daily Yarrow has collected a number of cases of poisoning from bulletins to relieve his anxiety as to Dr. Lapponi, his this source alone. The carbon monoxide of the gas forms body physician. who has just undergone an operation for a stable combination with the hæmoglobin of the blood appendicitis. Professor Mazzoni, the operating surgeon in (carbonyl haemoglobin), the spectrum of which shows either case, has been equally successful in both and must characteristic absorption bands. When a person is exposed now be enjoying the professional satisfaction of having constantly to a leaky gas-pipe the effect on his health preserved two eminently valuable lives-that of the head of is soon apparent. The symptoms are anasmia, frontal the Latin Church and that of the physician to whom the headache (worse on rising in the morning), anorexia, said head owes so much of his prolonged health and energy, tinnitus aurium, vertigo, foul taste in the mouth, physical and mental. Our readers will remember that abdominal pains, constipation, indigestion, and lassitude. before submitting himself to the surgeon the nonagenarian He never feels well but he improves when in the pontiff playfully remarked that he had at least "youth on fresh air-a fact which should arouse suspicion of gas his side," which perhaps explains His Holiness’s solicitude poisoning. Chronic gas poisoning differs from acute in that for his body physician about to undergo an operation at the the florid countenance of carbon monoxide poisoning is "tender years"of the "fifties." Be that as it may, Dr. seldom seen. To examine the blood for carbonyl hæmoLapponi’s condition- acuteappendicitis, with, presumably, globin the ear is pricked and the blood is drawn into "incipient necrosis" of the appendix-called at once for a pipette, diluted with from five to ten cubic centithe intervention of his colleague, and accordingly Professor metres of distilled water, and examined with a spectroMazzoni lost no time in operating, assisted by Professor The absorption bands are noted and their posiscope. Margarucci, and sustained by the affectionate words of the tion is mapped out with a wave-length scale and sodium Pope himself: °’ Keep the patient’s heart up; tell him flame to mark the position of the D line. The absorption to support the ordeal with faith and courage, and that I am bands of carbonyl hæmoglobin, unlike those of hæmoglobin, praying that all may go well." His task completed, with are not reduced by Stokes’s reagent. It is important to full confirmation of the diagnosis, Professor Mazzoni left detect carbon monoxide in the atmosphere of a house when Dr. Margarucci at his patient’s bedside till the evening, the escape of gas is so slight as not to be perceptible by when he found that all the symptoms were as favourable as odour. For this purpose Vogel’s method may be used. - could, by that time, be expected. Subsequent bulletins Fresh normal blood is added to distilled water until the latter report steady progress and it is expected that before many is tinged faintly. About from three to five cubic centimetres - days are over Dr. Lapponi will be once more on duty in are placed in a flask of a capacity of from 100 to 150 cubic master. The whole incident .attendance on his With regaxd to the word "speculum " it is to observe that it does not seem to have been used by

examination.

right

of

"

B

"

known

____

august

throws a pleasant light on the vie iritime of the Vatican, the able physician surmounting a grave malady by the intervention of the not less able surgeon, and both of them valuing each other’s life in the degree in which it can be usefully devoted to that of the Pope. Professor Mazzoni had, it seems, been on the railway most of the night before the operation which he had scarcely performed when he had to proceed to the case of a former colleague’s widow also requiring his immediate attention. "But one forgets all weariness," he said, "in the presence of the Pontifical Nestor. You .cannot believe how he supports the burden of his years. I .never have an audience of him without returning refreshed 1

THE

LANCET, March 11th, 1899, p. 706.

centimetres.

The flask is shaken for several minutes in the saspected atmosphere. If carbon monoxide is present the liquid, it is said, will assume a bright rose tint and give the characteristic spectrum. Dr. Yarrow relates two cases. In the first the patient was a man, aged 52 years, who had not felt well for some years. He complained of frontal anorexia, nausea, headache, colicky pains, indigestion, and obstinate constipation. He had been confined to bed for several days. Noticing the odour of gas when he entered the vestibule of the house Dr. Yarrow examined the blood spectroscopically and found carbon monoxide haemoglobin. It was also present in the blood of the patient’s sister but not in that of the other members of the family. The patient and his sister slept in badly-ventilated rooms, and the others in

1273 ones. On changing his residence the patient rapidly recovered. The other case is the first case on record of carbonyl hasmoglobinuria from chronic gas poisoning. A woman, aged 58 years, was admitted to hospital with marked

well-ventilated

jaw. Gas had been escaping in her She could detect the odour until house for a long time. four or five months before but not since ; she thought that The urine was crimson she had grown accustomed to it. and contained carbonyl haemoglobin ; the blood also contained it. Recovery ensued and the tremor diminished. tremor of the lower

THE

PRICE

OF A

STIMULANT.

IT is interesting and instructive to calculate the relative cost of pure alcohol as represented in the prices of the alcoholic liquors which the public are wont to consume. Thus, assuming that whisky contains about 50 per cent. by volume of alcohol and that approximately two fluid ounces are the usual amount served for 4d., the purchaser would be paying about 2d. per ounce of pure alcohol. Rum at 3d. per two ounces would give him rather more alcohol for the same money-about 1½d. an ounce. On the other hand, when the consumer pays 2d. for his glass of beer he is paying quite 3d. an ounce-over 100 per cent. more-for the alcohol. In the case of claret, reckoning that a large wine-glass contains four fluid ounces and that the charge for it is 4d., the alcohol would be costing as much as ls. per ounce. Sherry, a stronger wine, under the same conditions would cost less, 6d. an ounce, as regards pure alcohol, while port, a still stronger wine, would cost even less-about 4½d. par ounce of alcohol. From the point of view, therefore, of alcohol ardent spirits are cheapest and beer and light wines are most expensive. On grounds of health it is a pity that it is so, and a tendency to a demoralised condition of things is indicated in these facts, for the demand for spirituous liquors is growing apace, and the call for a powerful stimulant at a minimum cost is met with an only too ready response. Apart from their significance from a medical aspect, these observations might well interest the Chancellor of the Exchequer.

INFECTION OF OVARIAN CYSTS DURING TYPHOID FEVER. IN the American Journal oj the Medical Sciences for October Dr. Morris J. Lewis and Dr. Robert G. Le Conte have published two cases of a rare complication of typhoid fever-infection of an ovarian cyst. They have been able to collect from literature only six other cases, of which But it must be refive were observed in Germany. membered that only during the last decade have recognition and cultivation of the typhoid bacillus been extensively practised and that previously to 1890 several cases are recorded in which after an attack of typhoid fever suppurating ovarian cysts were found. In Case 1 a woman, aged 28 years, who had been ill for three weeks, was admitted to hospital with all the symptoms of typhoid fever. In the fourth week of her residence in hospital the character of the temperature changed and assumed a hectic type and she complained of pain and tenderness in the region of the pelvis. Vaginal examination revealed a large, tender, fluctuating mass in Douglas’s pouch. 37 days after admission a vaginal incision was made and about a quart of foetid, greenish pus containing the typhoid bacillus in pure culture was removed. On introducing the finger cartilage and bone were recognised in the cyst wall, thus showing that the cyst was teratomatous. The temperature fell. It rose again in the following week but had lost its hectic character. There was a relapse of the typhoid fever ; the spleen again became palpable and After recovery the cyst was removed rose spots re-appeared. In 2 a woman, aged 30 years, began Case by laparotomy.

to show symptoms of typhoid fever on Dec. lst, 1901. The attack was long and on the thirty-fifth day the temperature reached normal. On the thirty-seventh day it rose again to 102 - 21 F. in the evening. It fell to 97.4° next morning. In the next two days it oscillated widely-between 97.6° and 103.6°. On the tenth day of the supposed relapse there On the twentieth day the temperature was a chilly feeling. was a little over 100°. Next day there was pain on defecation and the lower portion of the abdomen on the left side bulged a little. On the twenty-fourth day vaginal examination revealed bulging in Douglas’s pouch. Pelvic abscess was diagnosed, laparotomy was performed, and a large left ovarian cyst containing grumous, offensive. pus was removed. The pus contained the typhoid bacillus in pure culture. The temperature fell to 99°. On the morning of the fifth day after the operation the tempeJature rose to 104°. Subsequently it remained at about 102°. A rose spot appeared seven days after the onset of the pyrexia. It is remarkable that The relapse ran a course of 14 days. in both cases the relapse occurred five days after the operation. In the other recorded cases no relapse followed the operation and convalescence was uneventful.

OFFICIAL REGISTER OF VACCINATION PARTICULARS IN CASES OF SMALL-POX. IN a leading article in THE LANCET of Oct. 4th, p. 941, we referred to a series of circulars regarding small-pox prevention and vaccination administration which have been issued lately by the Local Government Board. To these is now added another, dated Oct. 28th, 1902, dealing with the manner in which records of the vaccination of small-pox patients should be kept at hospitals maintained by district councils, joint hospital boards, or isolation hospital comIt is pointed out that at. mittees in England and Wales. in form in which vaccinasuch variation exists the present tion particulars are noted that the experience of different hospitals cannot be utilised for purposes of statistics and comparison, and that uniformity in the matter is the more necessary in view of the obligation to keep vaccination records which has been imposed upon small-pox hospital authorities by Section 8 of the Vaccination Act, 1898. Accordingly the Local Government Board has issued a form of register of small-pox patients prepared by its medical officer, together with a " vaccination bedcard" which is to be used for noting at the bedside the particulars which afterwards will be entered in the register. Though at first sight this bedcard is a formidable document to complete fo each case it appears when studied to be a simple and Mr. W. H. Power has set convenient means of record. out on these cards a scheme of classification as regards vaccination, revaccination, and previous small-pox, and in most instances nothing more will be needed than to indicate in the appropriate spaces the position which the individual As regards primary vaccinacase occupies in this scheme. tion, the basis of classification is the presence or absence of cicatrices ; the statement of the patient or his friends, the age at vaccination, and the number and area of scars being also recorded. Broadly the scheme in this respect follows that which has for many years been adopted at the Metropolitan Asylums Board small-pox hospitals and is used in the tables given in the annual reports of that Board’s In the rare instances in which a Statistical Committee. small-pox case is stated to have been at some time or other successfully revaccinated it is unfortunately impossible to. obtain any certain check on the statement from cicatrices. Accordingly, in cases alleged to have been revaccinated, the patient’s statement has been made the primary Mr. Power basis of classification. appears to have considered that where possible revaccination is in question the better plan is for the whole of the evidence