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MODERN LEPROSY.
474 nature of the complaint may or may not be sound, but it seems that in the compulsory notification of ophthalmia neonatorum we have a most effective means of acquiring a knowledge of the incidence of at least one of these diseases without any of the objections to which the direct notification of the
responsible parties might possibly
conduce.
Annotations. "Ne quid nimis."
THE
UNIVERSITY OF LONDON.
THE
Departmental Committee on the University of London, appointed to recommend, after consultation with the bodies and persons concerned, the
specific arrangements and provisions which may be immediately adopted in order that effect may be given to the scheme of the Report of the Royal Commission on University Education in London, have now resumed their sittings. The committee have invited the observations of the Senate upon the proposals of the recent Royal Commission with regard to the admission of external students to the examinations of the University for degrees, regard being had to the principles upon which the report is based. The committee would also be glad to receive not later than March 14th reasoned statements bearing upon these proposals from other bodies and persons concerned. MEDICINE "
AND
POLITICS
IN
ITALY.
extension of the suffrage," writes Italian correspondent, " has enlarged the electorate from about 3,000,000 to 8,000,000, and of these latter a large proportion are analfabeti, that is, can neither read nor write. There are an
To-DAY the
profession but the public at large are at one in recognising the justice of his promotion to a legislature before which the question of medical education and, with it, those of scientific research and hygiene, press forward for consideration and solution. His record as professor of comparative anatomy at the Sapienza as well as his intervention in the crusade against malaria are of themselves a " title-deed " to the honour just conferred on him. The second on the list, Dr. Carlo Forlanini, has an equally valid claim to the distinction of Senator. Born some 66 years ago at Milan, and professor of physiology and clinical medicine at the Lombard University (Pavia), he has won an authoritative position in the domain of public health, particularly in the legislation against tuberculosis, while his clinique has been frequented by students from other seats of learning for his special mode of dealing with pneumothorax described some three The third consultant years ago in THE LANCET. now promoted to the Upper Chamber is Dr. Gerolamo Gatti, who holds with much acceptance the chair of surgical pathology in the Florentine Institute, and, while devoted to clinical research and professional teaching, has found time to study social questions, particularly those relating to the condition, moral and physical, of the agricultural labourer. A convinced Socialist, though not enrolled in any of its numerous sectsbeing, indeed, a trenchant critic of the Marxist dogma and practice-he is a representative of the interests of the democrazia rurale, beginning with the physical development of the children and directing, ad hoc, the Hospital for Surgical Pædiatry in Florence. Younger than the majority of his professional brethren in the Senate, he adds to their experience an energy all his own and will contribute effectively to the consummation of that policy, known as socio-medical, which is destined for many years to form an important factor in
Italy’s legislation."
____
questions before the country of even greater MODERN LEPROSY. urgency than the riveting of Italy’s foothold on SANITARY authorities in various parts of Europe the Southern Mediterranean seaboard, and these are now occupying themselves in trying to check are education and, in closest connexion with it, the public health. That so large a proportion of the the spread of leprosy, recently believed to be almost The incidence of the disease is inelectors should be’analfabeti’ is a reproach to extinct. Italy and her legislators which cannot be too creasing surely though slowly and precautions In France especially, soon wiped out-a state of things appealing more can no longer be neglected. sensibly to her amour propre than colonial ex- as appears in our Paris correspondent’s letter tension or even military prestige. Not less (p. 491), considerable disquietude prevails, and urgent and not less vital for her rehabilitation legislation in the matter is being invoked. A and self-respect is the improvement of her hygiene, curious study containing certain considerations, a necessity now more than ever borne in upon her, interesting at least as hypotheses, has been and explaining not only the large proportion of recently published by Dr. Blendeau, who holds medical men among the candidates at the late that the disease had existed in Europe before elections, but the recent accession of distinguished the Crusades, but had become attenuated by a sort consultants to her Upper Chamber. The Italian of racial vaccination. In Palestine the Crusaders Senate, indeed, stands pre-eminent throughout came into contact with another variety of the same Christendom for the number of physicians and microbe, for which they afforded an entirely new This was the grand leprosy of surgeons it can boast of-men who, while pro- culture medium. fessional men devoted to their calling, have not the Middle Ages, brought back by the Crusaders to forgotten that they are also citizens, citizens, their own lands, where the oriental bacillus caused Then, in a similar moreover, of a nationality comparatively new in the most frightful ravages. the State system of Europe. Numerous as they manner, its pathogenic power also diminished, already were in the Senate, the Premier has added, and Europeans once again became refractory to the as your Italian correspondent has already reported, disease. The present reintroduction of leprosy is still more to their strength, and in the 29 new probably due to the more frequent and rapid comnominations has made three who are, each of them, munication in recent decades with the Far East. eminent in medical practice and research. Dr. Ettore About 40 years ago the Chinese carried leprosy into Marchiafava, whose name occurred so frequently Polynesia, where it had been up to that time -Linin the consultations held during the Pope’s grave known. The natives, who afforded a new field for illness last spring, is one of these, and not only the it, contracted it rapidly and contaminated the
475
brought it back to separated bright blood appeared in quantity, bacillus Polynesian appears to be suggesting ectopic gestation. When the blood had Europe. of a dangerous character, for now Europeans who been mopped up grey translucent tubercles were have become leprous there and have returned to seen studding the parietal peritoneum, omentum, Europe convey leprosy to European countries and a mass of intestines densely adherent to the of so virulent and contagious a character as uterus, tubes, and broad ligaments. The adherent to call for vigilant and strenuous protective intestines were roughened, congested, and soddenmeasures. looking. Separation of the adhesions was thus not only difficult but dangerous. The uterus could not be brought clearly into view, but was felt to be TUBERCULOUS PERITONITIS IN GIRLS SIMUsmall and irregular in consistence. Away was at LATING DISEASE IN THE INTERNAL GENITAL ORGANS. length made behind it down into Douglas’s pouch, where the left tube was felt enlarged and densely IN the Australasian Medical Gazette of Dec. 13th, adherent to the broad ligament beneath adherent 1913, Mr. A. J. Nyulasy has reported two interesting intestines. It was considered unjustifiable further to cases of a rare form of tuberculous peritonitis removal of this tube. The right tube was attempt commencing in the Fallopian tubes which simu- found much enlarged and very adherent to the broad lated other diseases. Both occurred in girls, aged and to overlying intestines. The end of 17 years, and in the first case neither the family ligament the tube could be felt in Douglas’s pouch, and on history nor the appearance of the patient suggested separating it some ounces of pale yellow pus oozed tuberculosis. A healthy looking girl was admitted When this had been mopped out the free end into the Perth Public Hospital complaining of pain up. of the tube and an apparently healthy ovary could in the iliac fossae which was of several years’ dura- be partly brought into view. On account of the tion and increased during menstruation. With the friable condition of the involved intestines and the onset of menstruation, five years before, leucorrhcea of the adhesions it was deemed inadvisable extent began and had continued ever since. The abdomen to proceed further in an attempt at salpingectomy. was much enlarged, and dulness extended upwards The operation area was dried out, a pint of saline above the umbilicus and higher on the left side was run in, and the wound was closed than the right. The dull area was indefinitely solution The patient was placed in without drainage. fluctuant. The hymen was unruptured, and the Fowler’s position and saline solution was given uterus was displaced to the right. A tense irregular per rectum. In a couple of days she was taken mass was felt in Douglas’s pouch, and pressure on into the open air and did remarkably well. When the abdomen above was transmitted to the exdischarged some weeks later she had put on amining finger. The temperature was somewhat weight and was looking and feeling well. raised, but the general condition was good. Ovarian cyst was suggested. On opening the abdomen the omentum was found greatly thickened and adherent COÖRDINATION AMONG LONDON HEALTH to the abdominal wall, and forming the anterior ASSOCIATIONS. wall of a fluctuating " cyst," which was tapped, and As the result of a conference held at the Mansion yielded about six pints of straw-coloured fluid. On further separating the omentum from the abdo- House in July of the year before last, at which minal wall tubercles were seen thickly studding representatives of Government departments, public it and the parietal peritoneum. The anterior wall authorities, and voluntary agenciesconcerned with of the "cyst"was found to consist of thickened the health of the metropolis were present, a body omentum and a layer of fibrinous material. known as the " Central Health Committee (VolunPosteriorly the cyst wall was formed by the tary) for London " was constituted. This committee rectum and intestines. The fibrinous material consists of 23 members, and meets in the offices of was removed with difficulty, and the involved area the Local Government Board. As a result of its was then seen to be studded with tubercles, many labours a report, which contains brief particulars of which were caseous and broken. The Fallopian of some of the voluntary societies carrying on tubes were thickened and enlarged, especially at health work in London, has been drawn up, and the outer ends, which were fully two inches across, this report has now been printed and circulated by and they contained much fluid caseous matter. The the Local Government Board. Copies of it have been ovaries appeared to be normal. Both tubes and sent to the mayor of every metropolitan borough the greater part of the omentum were removed, and the chairman of every metropolitan board of caseous matter was cleared away, the pelvis was guardians. An official letter which accompanies the filled with saline solution, and the wound was report emphasises the advantages to be derived from closed without drainage. During convalescence a cooperation between local authorities and voluntary tuberculous sinus formed in the upper end of the workers. It is suggested that in each borough the abdominal wound and was scraped with success. mayor and the chairman of the guardians should Two years later the patient was in good health. convene a conference for the purpose of formulating In the second case a girl, aged 17 years, was some scheme to secure such cooperation. The admitted complaining of abdominal pain of two importance and value of mutual understanding and months’ duration, the hæmorrhage having continued assistance on the part of voluntary societies and since the last menstrual period five weeks pre- local health authorities are unquestionable, for viously. She had the delicate pink colouring and overlapping is thus prevented, and unstopped gaps fine hair suggestive of tuberculosis, but was not are brought to notice. It is therefore gratifying to badly nourished and the family history was good. find that the Local Government Board is cognisant The lower abdomen was tender and somewhat dis- of the need for coördination and prepared to tended. The hymen was unruptured and a rather encourage it. The actual report itself, which firm mass was felt in Douglas’s pouch, apparently stimulated the Board to suggest that the voluncovering an anteverted uterus. On opening the tary workers should undertake the organisation abdomen the omentum was found adherent to the involved, is a somewhat disappointing document. parietes and the parts beneath. When it was It does not pretend to be exhaustive, and is whites, who in their
turn
This
____
responsible parties might possibly
conduce.
Annotations. "Ne quid nimis."
THE
UNIVERSITY OF LONDON.
THE
Departmental Committee on the University of London, appointed to recommend, after consultation with the bodies and persons concerned, the
specific arrangements and provisions which may be immediately adopted in order that effect may be given to the scheme of the Report of the Royal Commission on University Education in London, have now resumed their sittings. The committee have invited the observations of the Senate upon the proposals of the recent Royal Commission with regard to the admission of external students to the examinations of the University for degrees, regard being had to the principles upon which the report is based. The committee would also be glad to receive not later than March 14th reasoned statements bearing upon these proposals from other bodies and persons concerned. MEDICINE "
AND
POLITICS
IN
ITALY.
extension of the suffrage," writes Italian correspondent, " has enlarged the electorate from about 3,000,000 to 8,000,000, and of these latter a large proportion are analfabeti, that is, can neither read nor write. There are an
To-DAY the
profession but the public at large are at one in recognising the justice of his promotion to a legislature before which the question of medical education and, with it, those of scientific research and hygiene, press forward for consideration and solution. His record as professor of comparative anatomy at the Sapienza as well as his intervention in the crusade against malaria are of themselves a " title-deed " to the honour just conferred on him. The second on the list, Dr. Carlo Forlanini, has an equally valid claim to the distinction of Senator. Born some 66 years ago at Milan, and professor of physiology and clinical medicine at the Lombard University (Pavia), he has won an authoritative position in the domain of public health, particularly in the legislation against tuberculosis, while his clinique has been frequented by students from other seats of learning for his special mode of dealing with pneumothorax described some three The third consultant years ago in THE LANCET. now promoted to the Upper Chamber is Dr. Gerolamo Gatti, who holds with much acceptance the chair of surgical pathology in the Florentine Institute, and, while devoted to clinical research and professional teaching, has found time to study social questions, particularly those relating to the condition, moral and physical, of the agricultural labourer. A convinced Socialist, though not enrolled in any of its numerous sectsbeing, indeed, a trenchant critic of the Marxist dogma and practice-he is a representative of the interests of the democrazia rurale, beginning with the physical development of the children and directing, ad hoc, the Hospital for Surgical Pædiatry in Florence. Younger than the majority of his professional brethren in the Senate, he adds to their experience an energy all his own and will contribute effectively to the consummation of that policy, known as socio-medical, which is destined for many years to form an important factor in
Italy’s legislation."
____
questions before the country of even greater MODERN LEPROSY. urgency than the riveting of Italy’s foothold on SANITARY authorities in various parts of Europe the Southern Mediterranean seaboard, and these are now occupying themselves in trying to check are education and, in closest connexion with it, the public health. That so large a proportion of the the spread of leprosy, recently believed to be almost The incidence of the disease is inelectors should be’analfabeti’ is a reproach to extinct. Italy and her legislators which cannot be too creasing surely though slowly and precautions In France especially, soon wiped out-a state of things appealing more can no longer be neglected. sensibly to her amour propre than colonial ex- as appears in our Paris correspondent’s letter tension or even military prestige. Not less (p. 491), considerable disquietude prevails, and urgent and not less vital for her rehabilitation legislation in the matter is being invoked. A and self-respect is the improvement of her hygiene, curious study containing certain considerations, a necessity now more than ever borne in upon her, interesting at least as hypotheses, has been and explaining not only the large proportion of recently published by Dr. Blendeau, who holds medical men among the candidates at the late that the disease had existed in Europe before elections, but the recent accession of distinguished the Crusades, but had become attenuated by a sort consultants to her Upper Chamber. The Italian of racial vaccination. In Palestine the Crusaders Senate, indeed, stands pre-eminent throughout came into contact with another variety of the same Christendom for the number of physicians and microbe, for which they afforded an entirely new This was the grand leprosy of surgeons it can boast of-men who, while pro- culture medium. fessional men devoted to their calling, have not the Middle Ages, brought back by the Crusaders to forgotten that they are also citizens, citizens, their own lands, where the oriental bacillus caused Then, in a similar moreover, of a nationality comparatively new in the most frightful ravages. the State system of Europe. Numerous as they manner, its pathogenic power also diminished, already were in the Senate, the Premier has added, and Europeans once again became refractory to the as your Italian correspondent has already reported, disease. The present reintroduction of leprosy is still more to their strength, and in the 29 new probably due to the more frequent and rapid comnominations has made three who are, each of them, munication in recent decades with the Far East. eminent in medical practice and research. Dr. Ettore About 40 years ago the Chinese carried leprosy into Marchiafava, whose name occurred so frequently Polynesia, where it had been up to that time -Linin the consultations held during the Pope’s grave known. The natives, who afforded a new field for illness last spring, is one of these, and not only the it, contracted it rapidly and contaminated the
475
brought it back to separated bright blood appeared in quantity, bacillus Polynesian appears to be suggesting ectopic gestation. When the blood had Europe. of a dangerous character, for now Europeans who been mopped up grey translucent tubercles were have become leprous there and have returned to seen studding the parietal peritoneum, omentum, Europe convey leprosy to European countries and a mass of intestines densely adherent to the of so virulent and contagious a character as uterus, tubes, and broad ligaments. The adherent to call for vigilant and strenuous protective intestines were roughened, congested, and soddenmeasures. looking. Separation of the adhesions was thus not only difficult but dangerous. The uterus could not be brought clearly into view, but was felt to be TUBERCULOUS PERITONITIS IN GIRLS SIMUsmall and irregular in consistence. Away was at LATING DISEASE IN THE INTERNAL GENITAL ORGANS. length made behind it down into Douglas’s pouch, where the left tube was felt enlarged and densely IN the Australasian Medical Gazette of Dec. 13th, adherent to the broad ligament beneath adherent 1913, Mr. A. J. Nyulasy has reported two interesting intestines. It was considered unjustifiable further to cases of a rare form of tuberculous peritonitis removal of this tube. The right tube was attempt commencing in the Fallopian tubes which simu- found much enlarged and very adherent to the broad lated other diseases. Both occurred in girls, aged and to overlying intestines. The end of 17 years, and in the first case neither the family ligament the tube could be felt in Douglas’s pouch, and on history nor the appearance of the patient suggested separating it some ounces of pale yellow pus oozed tuberculosis. A healthy looking girl was admitted When this had been mopped out the free end into the Perth Public Hospital complaining of pain up. of the tube and an apparently healthy ovary could in the iliac fossae which was of several years’ dura- be partly brought into view. On account of the tion and increased during menstruation. With the friable condition of the involved intestines and the onset of menstruation, five years before, leucorrhcea of the adhesions it was deemed inadvisable extent began and had continued ever since. The abdomen to proceed further in an attempt at salpingectomy. was much enlarged, and dulness extended upwards The operation area was dried out, a pint of saline above the umbilicus and higher on the left side was run in, and the wound was closed than the right. The dull area was indefinitely solution The patient was placed in without drainage. fluctuant. The hymen was unruptured, and the Fowler’s position and saline solution was given uterus was displaced to the right. A tense irregular per rectum. In a couple of days she was taken mass was felt in Douglas’s pouch, and pressure on into the open air and did remarkably well. When the abdomen above was transmitted to the exdischarged some weeks later she had put on amining finger. The temperature was somewhat weight and was looking and feeling well. raised, but the general condition was good. Ovarian cyst was suggested. On opening the abdomen the omentum was found greatly thickened and adherent COÖRDINATION AMONG LONDON HEALTH to the abdominal wall, and forming the anterior ASSOCIATIONS. wall of a fluctuating " cyst," which was tapped, and As the result of a conference held at the Mansion yielded about six pints of straw-coloured fluid. On further separating the omentum from the abdo- House in July of the year before last, at which minal wall tubercles were seen thickly studding representatives of Government departments, public it and the parietal peritoneum. The anterior wall authorities, and voluntary agenciesconcerned with of the "cyst"was found to consist of thickened the health of the metropolis were present, a body omentum and a layer of fibrinous material. known as the " Central Health Committee (VolunPosteriorly the cyst wall was formed by the tary) for London " was constituted. This committee rectum and intestines. The fibrinous material consists of 23 members, and meets in the offices of was removed with difficulty, and the involved area the Local Government Board. As a result of its was then seen to be studded with tubercles, many labours a report, which contains brief particulars of which were caseous and broken. The Fallopian of some of the voluntary societies carrying on tubes were thickened and enlarged, especially at health work in London, has been drawn up, and the outer ends, which were fully two inches across, this report has now been printed and circulated by and they contained much fluid caseous matter. The the Local Government Board. Copies of it have been ovaries appeared to be normal. Both tubes and sent to the mayor of every metropolitan borough the greater part of the omentum were removed, and the chairman of every metropolitan board of caseous matter was cleared away, the pelvis was guardians. An official letter which accompanies the filled with saline solution, and the wound was report emphasises the advantages to be derived from closed without drainage. During convalescence a cooperation between local authorities and voluntary tuberculous sinus formed in the upper end of the workers. It is suggested that in each borough the abdominal wound and was scraped with success. mayor and the chairman of the guardians should Two years later the patient was in good health. convene a conference for the purpose of formulating In the second case a girl, aged 17 years, was some scheme to secure such cooperation. The admitted complaining of abdominal pain of two importance and value of mutual understanding and months’ duration, the hæmorrhage having continued assistance on the part of voluntary societies and since the last menstrual period five weeks pre- local health authorities are unquestionable, for viously. She had the delicate pink colouring and overlapping is thus prevented, and unstopped gaps fine hair suggestive of tuberculosis, but was not are brought to notice. It is therefore gratifying to badly nourished and the family history was good. find that the Local Government Board is cognisant The lower abdomen was tender and somewhat dis- of the need for coördination and prepared to tended. The hymen was unruptured and a rather encourage it. The actual report itself, which firm mass was felt in Douglas’s pouch, apparently stimulated the Board to suggest that the voluncovering an anteverted uterus. On opening the tary workers should undertake the organisation abdomen the omentum was found adherent to the involved, is a somewhat disappointing document. parietes and the parts beneath. When it was It does not pretend to be exhaustive, and is whites, who in their
turn
This
____