DISINFECTION OF THE HANDS.

645 demonstrate the success of careful isolation and prompt disinfection. Of the 24,000 immigrants into Havana during the year 21,000 came from Spain, which fact explains the large proportion of Spaniards among the cases of yellow fever. In 1900 Havana had a smaller number of deaths than in any one of the preceding 10 years; 1893 was next with 6697 deaths, some 500 more than last year. The average number of deaths for the 10 years up to 1900 was 10.243. Last year there were 4000 less than this average. The death-rate for 1900 was 2440, while the lowest of the preceding 10 years, 1893, was 30-66, and for the first year of the American occupation, 1899, it was 33-67. It is noticeable in the list of deaths that a large proportion of the fatalities occurred among white males. This is due to the fact that a large portion of the population of Havana is composed of foreigners, and these foreigners are almost entirely white males, the male population of Havana greatly outnumbering the female. The report ends by saying that it is not too much to state, judging from results, that the measures, sanitary and otherwise, which have been taken by the American authorities with a view of improving the health of Havana have been most eminently successful. This work has reduced the death-rate of 1898, the last year of Spanish rule, from 91-03, which represents 21,252 deaths, to 24-40, representing 6102 deaths; and the methods pursued have caused a steady improvement in the sanitary conditions of Havana. Taking the average number of deaths per year for the 10 years at 10,243, which would be for the two years 20,486, as representing what the deaths would have been if the United States had not interfered in Cuban afEairs, and deducting from this the actual number of deaths (14,255) which have occurred in the two years of the American occupation, we have 6231 as the number of lives saved in the city of Havana by the efforts of the American authorities. Too much stress must not, of course, be laid upon such calculations and deductions, but it is undoubted that the United States are to be congratulated upon some sterling sanitary work. -

THE LUMBAR INJECTION OF COCAINE AS AN ECBOLIC IN THE INDUCTION OF LABOUR. A CORRESPONDENT recentlylaid before our readers a summary of American and continental observations of the value of lumbar sub-arachnoid injections of cocaine in surgical practice. We desire now to call attention to the communications of M. Do]6ris to the Académie de Medecine, to the Paris Society of Obstetrics and Gynxcology, and, lastly, on Feb. llth to the Medico-Chirurgical Society of Paris. In these communications M. Do]6ris confirms what had been recognised as the physiological action of cocaine on blood-vessels and on muscular tissue, and in addition to its already proved analgesic properties he refers to its ecbolic powers, or, as he terms them, its action ocytociqve. As regards the uterus, M. Doleris maintains that this power of exciting muscular contraction may be a counter-indication of cocaine when version has to be performed, although Kreis has published a case of podalic version by the VeitSmellie method after a lumbar injection of cocaine. M. Doleris points out that three independent observers, Kreis, Dapaigne, and himself, have now published over 100 cases of the effect and value of cocaine in labour. The anaesthesia persists while the uterine contractions are strong and succeed each other rapidly, the cervix dilates regularly and quickly, and the condition of the child is excellent. These effects were further proved on Oct. 8th, 1900, when M. Do]6ris performed Cassarean section for contracted pelvis in a case in which analgesia was obtained by the injection of one and a half centigrammes of cocaine into the lumbar sub-arachnoid space. The result was strikingly 1

THE LANCET. Jan.

12th, 1901, p. 137.

satisfactory, the uterus remaining firm and contracted after the extraction of the child and while the uterine sutures were being applied. In no previous Csesarean section had M. Doleris observed such thorough and prolonged uterine contraction. In uterine inertia the effect of the injection of one centigramme (about one fifth of a grain) of cocaine is similar. Finally, M. Doleris attempted successfully to prove that such injections sufficed to provoke uterine contraction -apart from all natural commencement of labour. He has given details of two cases of induction of labour by means of the injection of the small dose of one centigramme of cocaine. In the first case a patient was sent to him with the correct diagnosis of a seven months pregnancy, the The patient was feetus being dead and macerated. kept in hospital for three weeks under observation. The cocaine was then injected and 15 minutes later the uterus, which had been inert and limp for about a month, contracted regularly and vigorously for one and three-quarter hours without arousing any pain. The os uteri was then of about the size of a five-franc piece. As the analgesia passed off the uterine contractions became less powerful and labourcontinued normal, being completed in six hours and 20, minutes. This comparative rapidity may be noted in contrast with the slowness of dilatation in most cases of macerated foetus. In the second case the onset of labour was even more rapid. The patient, a multipara pregnant eight months and one week, was in extremis with advanced tuberculosis. Nine minutes after the injection the uterus contracted vigorously, the pains following each other every three minutes, the labour being completed in four and a half hours. M. Doleris thus maintains that the spinal injections ofcocaine act with certainty on the motor nerves of the uterus and form a new method of inducing labour, and that they are of great value in the treatment of uterine inertia. He A considerable amount of has had no accident in 78 cases. confirmatory evidence must be forthcoming before these observations of M. Doleris can be accepted as holding good in all cases. One of the main objections hitherto urged against the use of lumbar injections of cocaine in midwifery is that the drug tends to produce uterine inertia and abolishes the action of the abdominal muscles. It is a pity that the records of cases of parturition treated in this way do not give us fuller details upon this important point. It is a striking fact that in 40 cases Marx had recourse to the M. use of forceps in no less than 16, a very high proportion. Doleris’s present contention is the more striking since in quite a recent communication he advocated the dilatation of the vagina and perineum by the use of hydrostatic bags as a means of hastening delivery in cases of labour in which analgesia had been produced by lumbar injections. DISINFECTION OF THE HANDS. As was recently stated in these columns’ the results obtained with Schleich’s Wachsmarmorsta1lbseife by several observers were all more or less contradictory, and that not only with regard to the claims of the inventor himself but also inttr se. It occurred, therefore, to Dr. Deeleman to inquire into the matter, so that the question might be set at rest once for all, and accordingly he instituted a series of experiments with the discredited preparation and has recorded his verdict in the Deutsche Af-;,Iitiir ärztlicke Zeitsckrift. The conclusions arrived at, although in some respects at variance with Schleich’s assertions, are, nevertheless, on the whole in favour of the efficacy of the compound, which the investigator pronounces to be 11 a remarkable means of disinfection for the hands." It is absolutely necessary, however, that before using it the nails should be cut as short as possible and also that every 1

THE LANCET, Oct.

27th, 1900, p. 1220.

646 endeavour should be made to clear out all fissures and

furrows, whether natural or artificial, and to render the skin In of the hands as soft, smooth, and pliant as possible. order to prepare Schleich’s "mechanical disinfector"750 parts of resinous soap (clear yellow in colour, freshly made, and cut up into small pieces), having been dissolved in 1500 parts of hot water, should be placed upon a fire with 150 parts each of stearine and wax. As soon as the last-named substances are melted 700 parts of powdered marble should be poured in very slowly, the mixture meanwhile being carefully stirred. The loss from evaporation (usually about 300 parts) should next be made good and then boiling be allowed to continue until the mixture becomes of the consistency of syrup, the last part of the process generally lasting about half an hour. As soap produced in this way is said to cause slight epidermic erosions in tender skins it would be prudent to avoid making use of it in laboratories where preventive serums of an infectious disease were being

indeed, many authorities consider that its great advantage in cases of tubercle is not due to any selective action in the bacillus of tuberculosis, but to its preventing fermentative changes in the digestive tract, thereby greatly improving the power of digestion or absorption of food. With regard to its use in pneumonia we prefer to suspend our judgment. The recognised treatment of this affection is mainly expectant-to preserve the patient’s strength as far as possible and to endeavour to lower the temperature should it continue raised too long. We think that creasote might be tried in this country more extensively than it has been, for the evidence brought forward by Dr. Van Zandt is

certainly strong.

-

MILK-SUPPLY AT ASHTON-UNDER-LYNE.

meeting of the town council of Ashton-underimportant step was taken towards reducing one of the factors contributing to the high infant mortality so dismanufactured. creditable to our manufacturing districts. The sanitary committee have been recommended to purchase " two ’Wyvern’ SPECIAL OPHTHALMIC NUMBER OF THE sterilisers complete, one milk receiver, one measuring and "INDIAN MEDICAL GAZETTE." mixing tub, two cream cans, one bottling machine, one IN the January number of the Indian Medical Gazette 3-h.p. boiler, and other apparatus." A shop is to be taken it is announced that a special Ophthalmic Number will for sterilising and humanising milk, and a competent be issued in a few months. Evarything will be done to manageress is to be obtained. Mr. Shaw, in moving the adopmake this forthcoming number representative of ophthalmic tion of the minutes, contended that the proposed scheme was -surgery in India at the present day, and circulars have been closely related to the question of the infant death-rate, and sent by the editor to ophthalmic surgeons throughout India the committee had adopted what they believed to be one inviting information on points of interest in connexion of the best schemes in the country. The milk is to be with diseases of the eye and its appendages, and especially called" modified," not "humanised," and it is to be sold on the subjects of cataract, trachoma, and errors of refracnot only in bottles for infants’ food, but in pints and quarts tion. The replies to these circulars are to be addressed to for general use. The whole of the medical profession in Major W. J. Bachanan, I.M.S., Editor Indian Medical the town are said to support the scheme. Mr. Shaw Gazette, Bhagalpur, E.I. Railway, or to the Editor, Indian anticipated "that eventually it would become a source of Medical Gazette, care of Messrs. Thacker Spink and 00., profit." Indirectly it will almost certainly become profitable Calcutta. On account of the great field for ophthalmic by diminishing sickness and lowering the death-rate, prooperations which exists in India our contemporary’s collec- vided that it is efficiently carried out and made use of by the tive investigation cannot fail to be of practical importance people, and we may wish for it every success. and will form an interesting contribution to ophthalmological literature. Last year the same journal brought out a special i AT the lait

Lyne

an

___

number devoted to the treatment of stone in the bladder, allusion to which has already been made in our columns.1

CREASOTE IN PNEUMONIA. IN a paper read before the Central Texas Medical Association Dr. J. L. Van Zandt drew attention to the advantages to be obtained by the use of creasote or preferably creasotal in pneumonia. After giving his own experience, which he said was satisfactory. Dr. Van Zandt quoted several passages from the writings of other physicians, all speaking highly of this method of treatment. Dr. Van Z3.ndt spoke in enthusiastic terms of the results he had obtained. At first he gave one drop of the drug every three hours, but latterly he had prescribed seven and a half minims of creasotal. This appears to be a large dose, but he states that "others give larger doses with possibly better results or no harm." He adds : "Ihave had cases in which the fever was gone in from 24 to 48 hours, and I am now somewhat disappointed if my patient is not ready for dismissal by the third or fourth day." In conclusion, Dr. Van Zandt expresses his opinion ’’that the use of creasote or carbonate of creasote in the treatment of pulmonary inflammation is one of the greatest life-saving discoveries of the century just ended." We cannot adopt Dr. Van Zandt’s extremely laudatory attitude towards creasote, but in some affections, notably of the gastro-intestinal tract, it is undoubtedly a most useful drug. At one time it was extensively used in pulmonary tuberculosis, but is now not nearly so frequently employed ; 1

THE

LANCET, Jan. 19th, 1901, p. 193.

PUBLIC

HEALTH

THE STRAITS MENTS.

IN

SETTLE-

THE estimated population for the whole of the Straits Settlements for 1899 was 604,916, as compared with an estimated population of 592,587 for 1898. The number of births registered during 1899 was 14 537, and the number of deaths registered was 19,150, giving a birth-rate of 24 03 per 1000 of the population and a death-rate of 31’16 per 1000. In his "Annual Medical Report on the Straits Settlements Civil Hospitals for the year 1899," Dr. Max, F. Simon, the principal civil medical odoer, says that small-pox was the only epidemic disease prevalent during the year, over 300 cases occurring in Singapore. The whole number of admissions to hospital during 1899 was 22,835, and the number of deaths was 3432. The five diseases under which the greatest number of admissions to all the hospitals was returned in 1899 were as follows : venereal diseases, 2523 -(with 88 deaths) ; malarial fevers and cachexia, 2336 (with 148 deaths) ; beri-beri, 1793 (with 589 deaths) ; rheumatism (acute and chronic), 1137 (with two deaths) ; and dysentery, 913 (with 313 deaths). The hospitals in Singapore of which statistics are given are the General Hospital, the Prison Hospital, Tan Tock Seng’s Hospital, the Leper Hospital, the Lunatic Asylum, and the Maternity Hospital. In Singapore the highest shade temperature for the year was 88° F. in May and the lowest was 71° in February. The total rainfall was 103-36 inches. A small outbreak of plague which happened in Penang during May, June, and July is reported on by Dr. T. S. Kerr, the colonial surgeon. There were 49 cases, including 46 Chinese, one Malay, and two Tamils ; 39 died. A large proportion 01