897 the medical officer of the insurance company to which they subscribe. On the other hand, the workmen’ associations have respiratory organs. always claimed the right to choose their own medical man, Treatment of Cerebro-Spinal Fever. and argue that the employers’ medical man is not impartial Since Sept. lst, 1906, every case of cerebro-spinal fever and is always striving to diminish the amount of fees which admitted into the Belfast municipal fever hospital has been the has to pay for adequate attendance on the employer treated with Flexner’s serum, and it is most satisfactory to man. Various associations of medical men have injured hear with good results. The total number of cases is now made common cause with the working men on the ground In the first 50 of these which have been treated to that the over 70. attendant of the working man should not ordinary a died and 37 recovered, giving case mortality be a conclusion 13 deprived of a possible patient by the employer’s medical of 26 per cent. Before using this serum the number of cases man intervening. Unfortunately, various abu.es have arisen ; in the hospital was 275, and the death-rate in these was certain medical men have started regular establishments 72 per cent. It is reported that although the number of for men, and factory hands who injured treating working cases of "spotted fever" in Belfast is much less, there is have met with an accident are directed to these estabno improvement in the type of the disease. lishments by go-betweens. The medical man then sends Milk and Railway Stations. in a certificate giving a greatly exaggerated account of A gentleman has written to the medical officer of health the injury, and when the working man obtains an unof Belfast complaining that when passing through Belfast he fairly large compensation he divides it with the medical had noticed at the Great Northern Railway station milk man. Worse still, some medical men have shown working being transferred from large railway cans into the milk cans men how to simulate accidental injuries. The Syndicate of a dairy company, and that while this was being done a of the Building Trades, which has suffered especially by railway porter was brushing the platform and carriage-ways these practices, set an inquiry on foot and has defiwhich were exceptionally dirty, fhis, he pointed out, was a nitely obtained proofs that uninjured workmen have been common occurrence morning and evening. It was resolved declared to be injured by medical men in return for a fee. by the public health committee to send a letter to the rail- A great scandal has therefore arisen and the matter has been way authorities calling their attention to the subject and taken up with much gusto by the political journals. One to the seriousness of having milk transferred in such paper indeed has interviewed various leading Parisian medical men on the question of whether and by what circumstancep. means the professional morality of medical men can be The Tuberculosis Exhibition in Ballymoney. The President of the Medical Syndicate of the reformed. The Tuberculosis Exhibition was held in Ballymoney from it as his opinion that individual failure of March llth to 14th. The following members of the medical Seine gave should not be held to compromise the profession as morality profession gave lectures:-Dr. Louise McIlroy on Tuber- a whole. Nevertheless, the campaign is already bringing culosis and Sanatorium Life, Sir John Byers on the Influence forth fruits by sowing the seeds of distrust among the public
4’from pneumonia, 2.6from phthisis, and 67 from
diseases of the
of Women in the Prevention of Tuberculosis, Professor T. Sinclair on Surgical Tuberculosis, and Dr. W. Calwell of Tuberculosis (Consumption) : a on the Prevention Chapter on Sanitary Reform. The exhibition was very largely attended and there were crowded audiences at the various lectures.
and
especially among the
affected towards medical
law courts, which
are none
too well
men.
Removal of a Foreign Body from the Œsophagus. At a meeting of the Surgical Society held on Feb. 26th M. Routier showed a child in whose oesophagus a copper Mnrob l7t.h coin (a sozc) had been lodged for the last four years. There was only a slight difficulty in swallowing. A moderate-sized could be passed freely but radiography showed bougie olivary PARIS. the foreign body quite plainly on a level with the third and fourth dorsal vertebrse. It was extracted without difficulty (FROM OUR OWN CORRESPONDENT.) by M. Guisez with the aid of the cesophagoscope and the child made an uneventful recovery. The Transmission of Enteric Terer and Cholera. Treatment of Sciatica and Rheumatism. M. Remlinger and M. Nouri have made some interesting experiments for the purpose of studying whether fish can At a meeting of the Academy of Medicine held on Feb. 25th transmit enteric fever and cholera. They described these M. Lucas-Championniere read an interesting communication experiments at a meeting of the Biological Society held by M. Ménètrel on the treatment of rheumatism and sciatica on Feb. 29tih. The fish used for the experiments were gold- by air at a temperature from 150° to 2000 C. The duration fish, and it was obvious that a fish living in water con- of each application was from 10 to 45 minutes and the taminated by either the cholera vibrio or the bacillus of number of repetitions varied from 14 to 60 times. In 184 Eberth can absorb into its organs, and more especially its cases M. Menetrel obtained 22 complete recoveries and 32 digestive tube, these pathogenic germs. This fact is of no recoveries with slight relapses which were easily checked importance from an alimentary point of view, for the by resumption of the treatment. observers have made it plain that even if the fish are cooked The Therapeutic Use of Cholesterine. entire and without having been gutted the temperature read a paper on this subject before the Iscovesco M. attained by the internal parts is sufficient to bring about He said that cholesterine on March 7th. Biological Society the death of all the micro-organisms. From the epidemiothe red cells of human blood against serums and logical point of view, however, the presence of pathogenic protects microbes in the digestive tube of fishes is of interest, for it hsemolytic agents. This protection is brought about in two is quite possible that such fish may carry pathogenic ways : the hæmolytic power of the serum is reduced and the These observations microbes from a contaminated stream into one hitherto corpuscles are made more resistant. to whether M. Iscovesco cholesterine might encouraged try uncontaminated, and this may be the explanation of certain not have some therapeutic action. He gave it in doses of epidemics of water-borne disease spreading up-stream. from 1- 5 to 2 grammes daily in a case of rheumatic purpura, Treatment of Ocular Fatigue. four cases of chlorosis, eight cases of pulmonary tuberculosis, M. Sardou says he has obtained excellent results in the and seven cases of infantile lymphatism with strumous treatment of ocular fatigue by the use of injections of an glandular infection. All these patients were either cured extract of the whole globe of the eye or by the administra- or markedly benefited after the treatment. tion by the mouth of a dry extract in doses of from two to March 16th. eight drachms. This treatment, however, is of no use in cases where the trouble is very marked or is due to marked disorders of the circulation. It also fails in cases where the COPENHAGEN. eye-strain is due to artificial light. __________________
A
Professional Scandal.
A scandal has just come to light in reference to the law as to accidents to workmen. This law gives an injured workman the right to select his own medical man, whose fees have to be paid by the employer according to a recognised scale; the employers, however, have always protested against this and have always preferred that the workman should employ their own medical man, or the factory surgeon, or
(FROM
The Association
OUR OWN
CORRESPONDENT.)
of Junior Medical Men and the Municipality of
Copenhagen.
THE struggle between the Association of Junior Medical Men and the Municipality of Copenhagen mentioned in my last letter was of far shorter duration than was anticipated. On the invitation of the association practically
898 every one of the 1700 Danish medical men sent in a docuby means of the little lamp of the instrument and the ment in which he engaged himself not to apply for any stomach is seen beautifully transilluminated from within, in appointment on the municipal hospitals of Copenhagen normal cases like a yellow globe, on the surface of which before the association considered the offered remuneration for the ramifications of the vessels running across from the two. service in the hospitals to be satisfactory. So far as could be curvatures, nay, even the different muscular layers, may be ascertained the public at large sympathised with the move- distinguished. In cases of gastritis the globe becomes red ment, and the lay press, to which the incident, of course, was instead of yellow. If some part of the stomach wall is infila welcome topic for discussion, sided without exception with trated (for instance, by a malignant tumour) a dark spot the medical men. Of course, a powerful public body like the stands out against the surrounding normally translucent wall. Copenhagen town council does not take kindly to altering a An ordinary ulcus in healing presents itself as a dark ring, decision once definitely settled by it and will always be the scar in the centre allowing the light to pass easily. found very unwilling to recant. It was therefore feared by Professor Rovsing’s gastrodiaphanoscopy also permits the the profession that the council would make use of the offer examination of the posterior stomach wall by simply made by the association and run the hospitals with locum- lifting up the stomach, &c. The examination is completed tenents in the appointments, though this course would be by gastroscopy-i.e., by studying the view of the inexceedingly expensive. Economy, however, as usual, got the terior of the stomach given by the optical apparatus upper band with the council and as it became evident that of the instrument. This view is very brilliant and clear the profession was not to be divided on this question the on account of the large dimensions of the instrument. The council eventually resolved in a public sitting to grant in full configuration of the cardia and the movements of the pylorus all the wishes of the Medical Association. This victory may be observed with the utmost distinctness, as may, of has considerably enhanced the prestige of the profession, course, also any alteration of the surface of the stomach so that in future the authorities probably will consider walls. In a series of obscure cases Professor Rovsing has twice before going against the wishes of the medical found his method of great diagnostic value. By means of organisation. The more direct and palpable profits a special contrivance the instrument also enables the surgeon accruing to the profession from the victory consist in to perform the retrograde catheterisation of the gullet de an increase in the yearly salary of the medical men There is reason to hope that it will facilitate visu. in the municipal hospitals of Copenhagen of about .E4000. the detection of the bleeding point, so difficult to obtain But scarcely has this conflict ended before a new one in some cases of bleeding from the stomach. Several threatens to occur. A couple of years ago a law was passed speakers congratulated Professor Rovsing on his new and by our legislating body concerning the gratuitous treatment of important method and prophesied a great future for it. venereal diseases. The law rules that anybody, rich or poor, March 14th. suffering from a venereal disease is entitled to free treatment and cure, and it obliges the municipalities to appoint and to ITALY. pay medical men ad hoe. This law, it is easy to see, has a vital importance for the profession, as we meet here face to face OUR OWN (FROM CORRESPONDENT.) with the singular phenomenon that the State monopolises in a way the medical treatment of a certain class of diseases. The next time perhaps those who suffer from tuberculosis or The Psychology of the Child. cancer will be declared entitled to free treatment and cure, LAST Wednesday, in presence of the Queen Dowager and whether they be rich or poor, and so on with other diseases. a distinguished audience which filled the Aula Magna of Our organisation has therefore resolved that the salary paid the Collegio Romano, the well-known medico-psychologist by the municipalities to the medical men appointed ought to Professor Sighele delivered a lecture " Sull’ Anima del, be paid in the form of a fee for every consultation, and that Fanciullo"(On the Mind, or rather Soul, of the Child). it was not permissible for any medical men to accept one Having dwelt on the importance as well as the fascination of of the mentioned appointments if only a fixed yearly sum his theme, Professor Sighele said that the traditional view of insure was offered. This measure was necessary in order to the child resolved itself into two conflicting opinions, one in the same income to the profession from the public treatment which the child was the symbol of moral purity or perfecof a class of diseases as from the usual private treatment of the other that he was the prototype of all human. the same class of ailments. Strange to tell, the municipality tion, Both were exaggerated, equally vitiated by the error defects. of Copenhagen does not seem to have learnt wisdom from its of judging the "anima infantileby adult moral criteria. listen to the recent defeat but appears to be unwilling to "In the child,"says Professor Sighele, "is reproduced the; wishes of the profession and leans towards an appointment of the savage or primitive man, and this by a law with a fixed yearly salary. I shall in a later letter report on psychology nature formulated for the first time by Haeckel-to wit, of the final outcome of the matter. theresurrczione atavica’ (atavic revival), which explains An Original Method of Performing (Gastroscopy and the peculiar interplay of impulses, involving so many Gastrodiaphanoscopy. ’i psychological contradictions which surprise and puzzle us in At the last meeting of the Medical Society of Copenhagen the child." From this point Professor Sighele illustrated the Professor Thorkild Rovsing demonstrated an original and, as mental characteristics of the child ; his glowing imaginait seems, a very valuable method of performing gastroscopy tion and the tendency to falsehood which springs from it, and gastrodiaphanoscopy. Gastroscopy has up to now not his unconscious cruelty, his selfishness, his insensibility-all succeeded in securing any considerable number of advocates of these typified in appropriate anecdotes. But the child is because the view of the interior of the stomach is necessarily at this stage only in transition, these characteristics very incomplete and difficult to interpret when the instrument gradually shading off till in process of time they melt into. is introduced into the stomach through the long canal formed the normal type. Education is, as it were, the golden thread by the mouth, pharynx, and gullet. Gastrodiaphanoscopy has, which, interwoven with the crude tissue, refines, strengthens, as hitherto performed, proved of even less value. Still it and transforms it. But education succeeds in proportion as goes without saying that a visual examination of the stomach it is at pains to understand the "anima infantile," towalls would be a great diagnostic help in all obscure stomach interpret its moral indications, above all in a kindly Even when a laparotomy has enabled the surgeon to spirit which allows for its insensibility to our grievances cases. examine the stomach directly with his fingers it proves often or sorrows and appreciates those peculiar to the child. At. impossible to say certainly whether there is any infiltration this point Professor Sighele diverged into illustration of what of the stomach walls at all, or whether an undoubted in- the child is often made to suffer from misinterpretation filtration is due to a malignant new growth or to a scar of his developing wants-instancing even suicide as one tumour after ulcus. In cases of this description, where the of the "loopholes of escape" sometimes resorted to by diagnosis is wavering even after laparotomy has been per- the little martyr! A reassuring picture was then given of formed, Professor Rovsing’s new method shows its efficacy. the superior opportunities enjoyed by the latter-day child He makes a little opening in the anterior wall of the compared with those of his predecessor a generation ago, stomach, somewhat above the great curvature, and intro- though even here a new source of danger arises-to wit, the duces through the opening an instrument made much like moral and intellectual atmosphere inhaled by the child being such as to induce precocity and the neuroses which bothan ordinary cystoscope, only larger, whereupon he closes the stomach wall so as to be air-tight round the stem cause it and spring from it." In these days," concluded Proof the instrument. Through a channel in the instru- fessor Sighele, "whose sovereign law seems haste-often ’raw ment air is pumped into the stomach, which consequently haste, half-sister to delay’-the child is apt to suffer frompresents itself like an inflated balloon. Light is now turned the premature encouragement of tastes and aptitudes alieno
on
.
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