MR. CARNEGIE AND MEDICAL HEROES.

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Russia was the only European country in all cases of burns, it is necessary that the dressing should In 1905 the mortality from plague in India fell a be ready to hand. This requirement is well met by picric little below 1,000,000. In Asia its distribution was not acid, which may be kept in the form of dry picric gauze, materially changed. The disease was brought to Liverpool requiring only to be moistened just before it is applied. from Rangoon, to Manchester from Buenos Ayres vii MR. CARNEGIE AND MEDICAL HEROES. Hamburg and Middlesbrough, and to Leith. In 1906 a of took in decrease 332,000 India, place only plague great THE latest of Mr. Carnegie’s apparently inexhaustible deaths resulting, but the following year was marked by a benefactions, which is reported to have brought up the great increase, 1,200,000 deaths being reported. It invaded sum of his gifts for public purposes to something over new territory in Northern Africa, notably in Tunis and in 25,000,000, has, he tells us, been prompted by the success Algeria. The report includes tables, showing the distribu- of the "Hero Fund" in North America. This has been so tion of the disease year by year in countries and in localities, great that its founder has decided to extend its benefits to together with a list of vessels on which cases of plague his own land, and it is now common knowledge that this occurred, with the names of the ports of departure and open-handed millionaire has paused for a moment in hiss arrival. endowments of the libraries and other centres of education over one and one-quarter millions of dollars to THE USE OF PICRIC ACID IN BURNS. the Carnegie Dunfermline trustees for the object which he THE specific action of picric acid in the treatment of burns has set forth in a very characteristic letter. He wishes that at first led to the belief that an ideal curative agent had those many brave men and women who suffer bodily injury been discovered, but it was soon found that when unwisely during efforts to save human life performed in times of used it produced serious toxic symptoms. The treatment British Islands and the waters thereof," shall of burns is highly important because it is necessary to by means of this fund be put in a financial position a little prevent shock as well as to relieve pain. The value of better, if anything, than was theirs before their act of selfpicric acid in this connexion is described by Dr. C. P. sacrifice until they are able to work again. And if a breadMartin in the International Toicrotc7, of Sitrgery for August. winner shall have given his life to save some fellow creature It has been the custom for many years to relieve the pain his widow and children may claim support from the fund resulting from burns by administering morphine, but Dr. until such time as they can support themselves. The fund Martin finds that the severity of the shock may bei may have a higher function than simple compensation, for diminished and the pain relieved by the use of a picric acidl it may actually rehabilitate some obscure hero who has risen dressing without giving morphine. Sterile gauze, soaked inito his opportunity out of a miry past of which he would fain a solution of picric acid containing 60 grains in 16 fluid1 hide the traces. Such a one is to be eligible for his ounces of sterile water, should be applied directly tc3 pension so long as he behaves himself without any questions the burned surface, covered with rubber tissue and cotton1 being raised of his antecedents. Mr. Carnegie deprecates wool, and finally held in position by a bandage. Aftejr strongly any suggestion that his fund shall replace the 48 hours the dressing is renewed unless any infectiortl compensation offered in cases of accident resulting from has occurred, when the surface should be first washed with !-,a heroism by private or public agencies already existing. solution containing ten grains of potassium permanganate iin These should bear their burden willingly, he thinks, JZ fluid ounces of sterile water. Then from day to da;y but he desires to make it absolutely sure that full prothe dressing is renewed until the surface looks hard and dryr, vision may be made for every case. It is not surprising when the dressings are discontinued and the surface iis to anyone who has read the terms of this new trust covered with oxide of zinc, leaving the parts fully exposeld to learn that it has the support and sympathy of to the air. One great advantage in the use of picric act’d the highest in the land, whose word is to be law lies in the fact that the first dressing does not need removinLg in certain questions of its administration. It would, howfor 48 hours, after which time shock need no longer b)e ever, hardly concern us to chronicle it, save inasmuch as feared. The dressing absorbs the discharges from the burm every premium upon courage and self-sacrifice makes and thereby prevents septic absorption. Any dressinig for the well-being of the State, were it not for the which keeps these discharges in contact with the absorbinig fact that Mr. Carnegie in his letter specifies in parsurface of a burn invites the onset of severe constitution:al ticular only two classes as being notably productive of symptoms. Picric acid is sterile and antiseptic ar3.d heroes, although we are quite sure that he makes no stimulates the production of new tissue. The yellow sta,in mental distinction between the bravery displayed in time produced by picric acid may be removed by first washing tlhe of need by, say, the miner whom he does not mention and hands in weak ammonia water and then bleaching them wi.th the railroad employee whom he does. But his most prominent a pure solution of hydrogen peroxide, which may be cominstance is this: "No action is more heroic than that of veniently applied on cotton wool. The staining of fhe doctors and nurses volunteering their services in the case of patient’s clothing need not occur if the cotton wool be so epidemics." We take it for an especial virtue in Mr. arranged that it absorbs the discharges as they escape..As Carnegie that in his benefactions he does not forget the to the fear of poisoning, Dr. Martin believes this to be due to members of a profession the simple exercise of which the use of too concentrated solutions of picric acid. In in the eyes of so large a number of people should regard to oil dressings he points out that oil is bring its own reward, but we must confess to some neither sterile nor antiseptic, and it may form a sulit- surprise at his having chosen out an almost routine duty able medium for the growth of organisms, even if it be of its practitioners for special illustration of the quality sterilised before use. An oily dressing will not absorb dlis- of heroism. It is true that Mr. Carnegie limits his instance to charges and it requires to be changed after 24 hours as itj is medical ministry during epidemics but we can hardly think" then in a septic condition. When the parts have once b!een that he holds less lightly the action of "doctor and nurse" bathed in oil it is almost impossible to clean them thoroug]hly who attend any patient suffering from a dangerous infectious before applying other dressings. Carron oil itself, in :Dr. disorder even though it be not widespread in the community. Martin’s opinion, has no healing properties and requires; to Indeed, it might be said that their service is less heroic be followed by another dressing if rapid and satisfact;ory in attending a rich person at a time when they would be results are to be obtained. In cases of emergency, in ffact liable to the disease, whether they attended him or not, than

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1026 it would be in exposing themselves to the risk of infection at vaccinators, and others," but the results were verified in a time when there would be no likelihood of their taking it general way by Colonel Buchanan himself. The reports that if they held aloof from that one particular case. The idea he received were too numerous and too voluminous for the of a medical practitioner or nurse running away to a non- inclusion of even a brief outline of them all in a short paper, infected area in times of epidemic is, we hope, inconceivable. but it was, he said, "perfectly clear from a perusal of them But we are ready and proud to admit that cases of special that the keeping of cats is the method of preventing medical heroism in such times do occur which are plague."" To all other methods, in his opinion, there are particularly worthy of such practical recognition as objections more or less grave, but to the keeping of cats Mr. Carnegie offers. Ready instances may be quoted from there are next to none. Hindus object to killing rats Ireland where it happens often that a district medical officer because the rat is the S’o7vari (means of locomotion) of their has to treat typhus fever with no available assistance and god Gunpati. Some of them even catch rats in order to let perhaps in opposition to an ignorant and frightened them go free in the fields. Jains, it is true, object to cats, peasantry. Many will recall the death of William Smyth but in small towns they are few in number and in villages In Saur plague was severe seven years ago after his splendid struggle waged against they are rarely to be found. the waves of Donegal and still more against the human among the Bhowani Dhers, but the Mallies, who keep, cowardice that refused him and his brave colleague, buffaloes and consequently cats, which are attracted Dr. McCarthy, any aid in rowing over a crazy boat by the milk, escaped completely. The Dher is not to fetch the patients suffering from typhus fever under allowed to keep cats because when a cat has kittens his charge from their hovels on Arranmore Island to the or dies in his house he is put out of caste. Some Dhers hospital on the mainland where they could be treated living in wattle huts escaped the plague entirely. This properly. It will be remembered how Smyth contracted the at first puzzled Colonel Buchanan until he found that rats do disease and died, a martyr to duty, if ever there was one. not harbour in that kind of structure. Other Dhers living in At that time in appealing for a memorial fund to help his mud huts were severely visited by the plague. So greatly widow and eight children we wrote : "If he ever knew that was the Dher community impressed by these facts that now he had accomplished the work that he set himself to do he died many of them keep male cats, thus avoiding the caste without thought of the praise his deed would earn for his penalty so far as the birth of kittens is concerned. " It is-a memory but only with the consciousness that he was leaving great pity," continues Colonel Buchanan, that the members those he loved to face the world before he had time to make of the recent Plague Commission did not make some " provision for them." That bitterness may now be spared to experiments on the cat as a rat destroyer. Neither the medical man whose life shall be required of him as the the members of the Plague Commission nor Professor price of his admission to the ranks of such heroes. The Haffkine in his recent lecture on the ’Present Methods profession will be no less grateful that their brothers who of Combating Plague ’ have, as far as I have seen, said have suffered severely in the cause of science or humanity a word about the cat. One member of the Commission gives but who have escaped with their lives will be remembered a whole page of figures to show that, in spite of vigorous under the benefits of Mr. Carnegie’s new trust fund, and in efforts for a whole year, the number of rats could not be conthis connexion there will be a general hope that its siderably reduced by traps. He does not tell us whether administration may have the case of Mr. J. Hall-Edwards, there was one trap or fifty, but I can assure him that his whole whose civil list pension is incommensurate with his injuries, argument would be completely upset if a few cats were " brought prominently before them. Whilst he and many introduced." Colonel Buchanan looks upon rat destrucothers have sustained grievous hurt in the legitimate pursuit tion and inoculation as temporary expedients capable in of science it is perhaps well to point out that some have certain circumstances of yielding useful results but both in to show less honourable because unnecessary scars. the main hurtful because they distract, attention from the Impetuous youth, especially, in medicine as in all other only true remedy. ’’ The more attention we give to fields of effort, will continue to mistake carelessness for inoculation," he says in conclusion, "the less we are courage and foolhardiness for devotion to duty. We hope certain to give to the only sound common-sense method of that this fund may not seem to put a premium upon such pro- preventing plague-viz., the keeping of the natural enemy fessional rashness, and we could almost wish that its trustees of the animal that is responsible for spreading the disease." would debar from its benefits any who, for example, suffer direct infection in a bacteriological laboratory through habitual disregard of common-sense precautions, or who MORTALITY FROM TUBERCULOUS DISEASE IN THE UNITED KINGDOM. seek to remove diphtheritic membrane from a a

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tube by sucking it, a proceeding which is quite unnecessary THE annual report relating to 1907 recently issued by the has when proper provision been made for emergency, but Registrar-General for Ireland contains an interesting comone which seemingly has an evergreen appeal to popular parison of the relative death-rates from tuberculous disease sentiment. in England and Wales, Scotland, and Ireland during the 43 years 1864-1906. A diagram in this report shows that in CATS AS PREVENTERS OF PLAGUE. the year 1864 the death-rate from all forms of tuberculous THE Indian Medical Gazette for August prints another cdisease was equal to 3’3 per 1000 of the estimated populaarticle by Lieutenant-Colonel Andrew Buchanan, I.M.S.,1tion in England and Wales and to 3 -6per 1000 in Scotland, advocating the up-keep of cats as the best method of counter-1whereas it did not exceed 2’4 per 1000 in Ireland. We acting plague. The paper is rather discursive, but it never- 1referred to this diagram and to several other points which raised in the communication which follows, but many of a theless contains a large amount of interesting and valuableare information. During the past plague season, says the writer, 1the remarks of our correspondent are interesting, so that we them in spite of the occasional repetitions. In there have been epidemics of plague in 54 towns and villages publish ] l and Wales the annual death-rate from tuberin made have been and Amroati England in district, investigations ( disease has steadily declined during the 43 culous all of these how far or absence of to find the nearly presence the disease could be accounted for by the absence oryears referred to, and had fallen to 16 6 per 1000 presence of cats. The investigations were made by ’’ assistant iin 1905 and in 1906, this decline being equal to’51-55 cent. surgeons, hospital assistants, tahsildars, patwaris, police, per In Scotland the annual death-rate from this ] ___