FALSE ECONOMIES IN THE ROYAL ARSENAL HOSPITAL.

1843 that no" water containers " exist capable of harbouring aadmissible. The number of medical officers ’ is to be of r small fish in collections of educed to three and further economies will be effected mosquito larvae. The use also water which cannot otherwise be dealt with is recommended, t)y the reduction of the nursing staff. Henceforth, Lastly, the removal of all unnecessary obstructive vegeta- ttherefore, a workman suffering from hernia, varicose tion and the screening of doors and windows of dwellingseins, chronic appendicitis, fistula, or tumour, instead should be carried out in infected areas. The complete exter- c)f being operated on in the Arsenal hospital, where there mination of mosquitoes, it is admitted, is hardly practicable, aare always expert military surgeons able and willing to but relative extermination is well worth attempting and is rrelieve him, must go to swell the numbers already waiting likely to diminish the danger. In times of serious epidemics ffor admission to Guy’s or some other London hospital. We of yellow fever Dr. Guiteras would go so far as to invoke the ttrust that the Government will pay more heed than it seems i to do to the opinions of its own officials in Woolaid of "martial law," since he regards the present powers inclined .available under the Republican Government to be inadequatewich, and will recognise the tragedies which may follow on to secure house-to-house inspection and compulsory removalany cheeseparing in respect of the surgical equipment of the of all cases to hospital. With "martial law"to sup- Arsenal. port the health officials, he contends that the proABDOMINAL ARTERIO-SCLEROSIS. phylactic measures which he advocates could be better enforced in every detail, and outbreaks of yellow fever ONLY within recent years has the fact been recognisedwould thus be more effectually controlled. In connexion principally in consequence of the work of German observers with Dr. Guiteras’s recommendations it is interesting to note -that arterio-sclerosis of the abdominal arteries may cause that in most of our own West Indian colonies much the same distressing ( abdominal symptoms, an abdominal analogue of measures are now being, and for some time back have been, This fact is important, for abdominal pectoris. angina successfully enforced. From a letter quite recently writtenarterio-sclerosis is not uncommon, and when it produces to the Times by Sir Rubert Boyce, who had been sent to thesymptoms these are misunderstood and regarded as due to West Indies to advise the local governments respecting a gastric and intestinal affections. The diagnosis is not diffit threatened epidemic of yellow fever, we learn that pupil cult if the practitioner bears in mind the possibility of ( teachers, sanitary inspectors, and others are now beingsuch a condition ; if he does not, a mistake is inevittrained by means of lectures, demonstrations, and healthable. In the Journal of the American Medical Association ( June 5th Dr. H. L. Akin has pointed out the freprimers to take part in a determined effort to ridof these colonies of mosquito-carried disease. It is now quency ( with which the symptoms of arterio-sclerosis in the a punishable offence to harbour mosquito larvæ uponabdomen are regarded as due to gastric disorder and has the premises, and already a considerable number of con- reported ] A stockman, aged 56 years, a number of cases. victions have been secured with fines varying from ls. who had enjoyed good health, " began to have trouble with to 40s. A careful study is being made of the local his ] stomach." He took only two meals a day-a hearty breeding-places of mosquitoes, and also investigations astodinner and supper. In the morning he felt well, but after the natural enemies of mosquito larvæ. One of thesedinner or supper if he walked a quarter or half a mile he enemies has been found in the small fish named "millions," ,experienced a feeling of fulness in the epigastrium and pain quantities of which are now being exported to other tropicalunder the ensiform cartilage running down the left arm. He countries on this account. Both Dr. Guiteras and Sir Rubert felt oppressed as if he could not breathe and must stop for a Boyce are convinced that if the measures above indicatedtime. On stopping he belched up much gas and then could were effectually and persistently carried out, yellow fever proceed without further trouble. If he sat still for half an would not often trouble those fair and fertile regions inhour after meals he generally had no symptoms. If he which it so often appears, to the legitimate alarm of thedrank much fluid with his meals, especially ice-water or tea, inhabitants and the detriment of trade and commerce. he generally had an attack. His bowels acted regularly. He see

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meat eater and was subject to attacks The aortic second sound every six months. was accentuated ; the pulse was 90 and of high tension. The urine contained a little albumin, but no casts. The acidity of the gastric juice was normal. As this was the first case of the kind which Dr. Akin observed he regarded it as simply gastric. He prescribed three meals a day, restriction Then a of meat, and rest, which gave temporary relief. the true of showed nature of attack angina pectoris typical the case. In a second case a healthy farmer, aged 55 years, began to have gastric symptoms. After supper his stomach became distended with gas and he had a feeling of oppression so that he could not lie down. Eructation He was treated without effect gave immediate relief. for by many practitioners dyspepsia and then for dilatation of the stomach. Examination showed a double aortic murmur, an enlarged ascending aortic arch, and general arterio-sclerosis. Rest and vaso-dilators followed by potassium iodide gave much more relief than the gastric In other cases the symptoms are intestinal, treatment. and below the umbilicus coming on two or around pains three hours after meals, and tympanites. In such cases Ortner has found after death the aorta thickened and calcified, a thick deposit of lime salts about the mouths of its branches, especially the mesenteric arteries, and the small branches of the latter rigid and contracted. The a large gout about

was

FALSE ECONOMIES IN THE ROYAL ARSENAL HOSPITAL.

WOOLWICH, or at all events that very large portion of the residents who are connected with the Royal Arsenal, is seriously disturbed by a rumour that the medical department of the Arsenal is to be cut down-presumably to save Some years ago the number expense to the War Office. of medical officers was increased from three to four, and the small hospital, which had been almost exclusively used for accident cases occurring in the works, was added to, and surgical cases of all kinds occurring among the employees were admitted and operated upon, greatly to the advantage of the men, as there is no general hospital in the neighbourhood that can be counted upon as certainly available. The Woolwich and Plumstead Cottage Hoson Hill has only a very small number of beds, Shooter’s pital it is fully equipped for the most serious operaalthough tions. At Greenwich, though there is, besides the Seamen’s Hospital, the Miller Hospital, the accommodation is still too limited, and consequently the Arsenal employees have greatly valued the opportunity afforded them of surgical aid within the walls of the Arsenal itself. This accommodation is now, it is understood, to be put an end to, only cases of accident while at work or exceptionally urgent ones, such as strangulated hernia or acute appendicitis, being

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