INTERMITTENT HYDRARTHROSIS.

INTERMITTENT HYDRARTHROSIS.—THE METROPOLITAN WATER-SUPPLY.

1600

here, the foreign diplomas upon which the foreign practitioner claims registration may not, and in many instances do not, represent the same degree of professional training and tested skill that is implied by the diplomas granted by - examining bodies in Great Britain. The proposed regulation is apparently intended to be supplementary to the rules :already existing in Cape Colony as to the admission of foreigners to practise there. Its immediate aim is to exclude ’foreigners qualified under these rules from medical practice in Cape Colony as long as British practitioners are excluded - from practice in colonies of the country to which the foreigners belong, or, let us say, in foreign colonies situate in South Africa. We gather that the exclusion desired in Cape Colony already exists in Natal, but that the precise attitude of the profession in Rhodesia was not known at the meeting at Cape Town, while Orange River Colony and the Transvaal have yet to be reckoned with. In these - circumstances it seems to us that the regulation proposed in Cape Colony may have important local effects in the exclusion of foreign practitioners, but that the establishment of the reciprocity suggested, even locally, between British ’colonies in South Africa and foreign colonies that impinge upon them, must of necessity be for some time delayed, while it is not likely to take place without the diplomatic intervention suggested in the lost amendment to which we such reciprocity should soon become have referred. general between all British colonies and those of any other nation or nations seems to us highly unlikely, while we are not sure that it would be desirable. British practitioners would have more to lose than - to gain, and the standard of medical practice in those colonies which now exclude foreigners would not be raised. There is. however, obvious justice in the protest of the British practitioners in Cape Colony against the admission of foreigners to compete with them without any corresponding privilege being granted in return, and we shall look with interest to see the way in which the Governor deals with the ’matter. There is no doubt a large foreign element to be considered in Cape Colony, but on the other hand, in foreign colonies there are usually large numbers of British residents who would be glad to be attended by their compatriots, but who have to submit to seeing them excluded.

That

of four days. In the intervals there was no disability. The treatment followed in the first case was unavailing, but the condition gradually yielded in the manner of the first case to persistent treatment by arsenic, strychnia, and creasote. In nearly Fixation and local treatment were useless. all of the recorded cases, which amount to 68, a calendarlike regularity of the attacks is described. The joint most frequently affected is the knee. In 41 out of 55 cases one or both knees were involved without affection of other joints. The hip, shoulder, elbow, wrist, ankle, jaw, and spine have been affected. One joint alone may affected for many years, or after a time others may be affected simultaneously or alternately. As a rule local heat and redness are absent and tenderness is often absent. In many cases there was no pain, only discomfort ; in others pain was marked. In a case recently described by -lienda there were for years periodic pains in various joints at monthly intervals before effusion appeared. Much pain may occur in the earlier attacks and less in the later. Languor during and after the attacks is

be

common.

Ileadache, chilliness,

or

slight pyrexia is described

in a few cases. The duration of the attacks varies greatly. The extremes are a case of daily attacks lasting an hour and a case of attacks lasting from 19 to 21 days with intervals of eight days. The duration most often recorded was three or four The time of recurrence was singularly constant. From beginning to beginning of attack the most usual period was 14 days, the minimum was 24 hours, and the maximum was three months. A change of interal is described in some from 30 cases-e.g., days to eight days, from three months to 11 days. from seven days to three days, and from 14 days to 21 days. In some cases this change followed temporary immunity. In a few cases there was progressive shortening or lengthening of the interval. In some cases the periods corresponded to those of menstruation. The average age at the onset was 26 years; the extremes were 12 years and 54 years. As to sex there was a slight preponderance of females. The weak and the robust were appa-

days.

equally affected. rently and lasted for several

Intermissions sometimes occurred years. In five cases the attacks stopped during pregnancy, but such intermission was not constant, even in the same patient. In the majoritv of cases there were no articular signs in the intervals except sometimes a little thickening or laxity of the capsule, or crepitation. Of the pathology nothing is known and therefore a INTERMITTENT HYDRARTHROSIS. The one most accepted is that number of theories exist. ’THE Bostan Medical an(7 Surgical Journal of Oct. 31st the disease is a vaso-motor neurosis. In favour of this are ’contains a report of two cases of this curious and littlethe concurrence of angio-neurotic œdema in some cases and understood condition by Dr. E. G. Brackett and Dr. F. J. of functional nervous disorders in others, and the influence Cotton. In one case a man, aged 30 years, gave a history of mental conditions on the attacks. The remedies recomof good health until four years previously, when he began mended, as might be expected, are numerous. Arsenic and - to suffer from occasional pains in the hips, thighs, and knees. quinine seem to be the best remedies, but the prognosis is Then swelling of the knees occurred periodically for a few not good. days. The trouble gradually increased with greater disability not only at the time of the swelling but in the intervals. THE METROPOLITAN WATER-SUPPLY. Change of residence to various parts of the United States IT is announced that during the next session two Bills proved useless. When he was seen his general condition The knees became swollen alternately will be promoted in Parliament, each of which contains ’wa.-- below normal. ’with perfect regularity. There were first feelings of heat clauses having reference to the purchase of the metropolitan und pain and tenderness of the joint with malaise. In two water companies. Of these Bills one is apparently to be The adopted as a Government measure, the other is promoted by or three days the joint became filled with fluid. swelling gradually disappeared in about four days. One the London County Council. Wedo not propose on the knee was fixed and quinine was given in daily doses of present occasion to consider in detail the provisions of the 20 grains. The intervals between the attacks were Government Bill, but it may be of interest to mention some lengthened by one or two days, then an attack was of the points with which it deals. The great central feature omitted, then the attacks became slighter and less fre-i of the Bill is the formation of a new public authority-a quent, and finally they disappeared. In the intervals the Water Board-which is to be invested with power to purchase only symptoms were weakncss of the knees ancl some limita- the existing metropolitan water companies and the property tion of flexion and extension. In the second case the now vested in the Staines Reservoirs Joint Committee and patient was a woman, aged 35 years, in good general after a certain date to undertake the responsibilities and condition. The nrst attack followed slight injury of the duties of supplying the water within a certain defined area. knee. The joint became swollen every 10 clays fora period It may be remarked that the drafting of the Bill in regard to -