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NOTES FROM CHINA.
1115 But it is cheap and so the evil has got to be It would be an interesting question to discuss what effect this general and widespread indigestion has upon the character of the people and upon the course of their history." Dr. MacGowan speaks of the Southern Chinese but his experience is borne out by Mr. D. Christie of Mukden in Manchuria, who after 25 years among the Chinese of the North, writing independently, says : "If dyspepsia, indigestible food, and bolting without masticating have any share in the causation of appendicitis, we should have plenty of it here." Dental caries is common among all classes. Dr. P. B. Cousland, of the London Missionary Society, says : "For 20 years I had charge of hospitals and dispensaries in the Swatow district, the beds in the former ranging from 60 to 180. I never operated on a case of appendicitis nor saw any of my colleagues do so." His experience is similar to that of the majority of practitioners in China and, taken in conjunction with the observations of Dr. MacGowan and Mr. Christie, seems to point to the incidence of appendicitis as being one of anatomical peculiarity, as, for example, the racial possession of a longer mesentery than is the case among Anglo-Saxons, when, owing to the natural shortness of themesentely, the appendix is liable to kink and to twist. Two outstanding features of the Chinest dietary as compared with ours are the smaller amount of sugar consumed per head and the general absence of tinned foods. Meat is very rarely indulged in by the poor and agricultural classes, though it is eaten daily by the middle and upper classes who, nevertheless, eat much less of it than do Europeans. Rice is the main article of food and is prepared in two ways-either quite dry, with all the grains separated from each other, or in the form of a watery sweetened compound called congee " by Europeans. This latter form is usually reserved for times of sickness. Coffee is never taken and the tea in use is a much milder infusion than would find favour at home. The ban on human dissection by the Government and on post-mortem examinations by relatives leaves me unable to speak at present with any definiteness on the possible anatomical solution of the question so far as Chinese immunity is concerned, but just as the physical features of Chinese faces differ invariably from those of Europeans the analogy might reasonably be inferred as to difference in the anatomical features and relationships of a Chinese appendix, thus rendering it less prone to inflammatory attacks.
ailment. endured.
as to producing surgical analgesia and also as to the duration of the analgesia; and (4) that attempts at introducing cocaine sometimes failed. In all of Dr. Fischer’s cases the technique of the injections was similar to that adopted by most continental surgeons. The steps were as follows : 1. A preliminary hypodermic injection of one centigramme of morphine was administered. 2. Careful preparation of the lumbar portion of the patient’s back was carried out over an area extending as far as the middle of the crest of the ilium. The patient should be in the sitting posture if possible, with the body bent forward in the cyclist’s scorching position." The fourth lumbar spine was then found by drawing a line from the highest point of one iliac crest to the same point on the opposite side. 5. The needle was introduced just below and to one side of the tip of the fourth lumbar spine and was directed upward, forward, and toward the median line for a distance of between 2 and 3 inches. When the membranes were penetrated a distinct
action, both
diminution of resistance
was
noticed. The
spinal
fluid
usually began to drip from the needle as soon as it entered the spinal canal. At first it might be blood-stained but it If after reaching the canal no fluid soon became clear. escaped its flow might be hastened by inducing the patient to cough. A stylet might be passed into the needle to remove any obstruction that might be present. The Preservation of Milk with Hydrogen Peroxide. Moat methods of rendering milk sterile are objectionable since they require the addition of substances injurious to health or else render the milk less digestible. It has, however, been found that if peroxide of hydrogen is added in the proportion of 0’ 40 part per 1000 the milk will keep for many days and the number of germs present will actually decrease to a very low number. When pathogenic germs, such as those of enteric fever, cholera, dysentery, or tuberculosis, were added to the milk they could not after the lapse of some time be detected by the most searching bacteriological examination. The taste of the milk is in no wise altered and numerous experiments have shown that the digestibility is the same as before. An Epidemic of Typhus Fever in Budapest.
Typhus fever has made its appearance in some districts of Budapest. In the space of a very short time more than 100 cases occurred, and so rapid has been its spread that some public buildings have had to be closed. The source of the been discovered and to suppress it.
epidemic has
measures
have been taken
Shanghai and the Opium Question. There has been a good deal of feeling in Shanghai, with March 28th. regard to the suppression of the opium trade, as to the attitude of some people at home and the late questions in NOTES FROM CHINA. the House of Commons on the subject. The British Government is doing all in its power to reduce the English trade(FROM OUR OWN CORRESPONDENT.) only harm can result from a too rigid insistence on its immediate and total suppression. It should not be forgotten by Appendioitis in China. philanthropists at home that the whole practical question of IN the course of an inquiry which I have recently suppression is fraught with much difficulty. The Shanghai undertaken into the incidence of appendicitis in China municipal council is being asked to adopt the unconI was impressed with the general agreement among stitutional procedure of arbitrarily closing the opium shops medical men practising in all parts of the Empire as to its in the middle of the financial year, without reference extreme rarity. Medical men in charge of native hospitals to the body of ratepayers. Though it is willing to do dealing with large numbers of patients yearly speak of it as a all in its power to abolish these places it is not easy to disease which they almost never meet with. The only hos- adjust quickly a total loss of over £7000 per annum pitals yielding any returns of it are those which treat foreign from licences alone. It has been suggested that the patients. The inquiry could not elicit any definite con- Anti-Opium League in China in return for the support which it has received from the Member for Nottingham sensus of opinion as to the cause of the universal freedom of the Chinese. Observers at home seem inclined, for the most East and others, might memorialise the Home Secretary to part, to attribute the cause to a faulty dietary system introduce total prohibition of alcohol in Nottinghamshire. but a different view is required here. Sir Frederick Correspondents from various parts of the Empire, in writing Treves in his "System of Surgery"says, as regards the to the Shanghai papers, point out the increasing use of apparent exciting causes: " Among the most common may morphine injected hypodermically, and I have recently come be mentioned dyspepsia, the want of efficient masticating across a case of a Chinese who takes one drachm of morphine teeth, the bolting of food, the eating of indigestible food a day by this method. Not infrequently cases come to such as nuts, constipation, diarrhoea, injury to the groin hospital with their bodies dotted all over with the prick region, excessive exertion, exposure to cold." These marks of injection needles. Perhaps the worst feature conpoints are the commonest features of Chinese life. Dr. nected with the suppression question is the crop of opium John MacGowan of Amoy, who has lived during many years "cureswhich have sprung up-most of them prepared by in China, in a recent article in the local press wrote, foreign druggists and nearly all containing morphine as the without reference to appendicitis: "Foreign physicians chief ingredient. A Chinese trying to fight the craving for who have opened hospitals and treated large numbers opium by means of these " cures " would become a hopeless of those who have consulted them have come to the victim to the morphine habit. While I am, of course, entirely conclusion that the large majority of the population are in sympathy with any movement in favour of the eradicabelow par and are suffering from indigestion. Salted turnip, tion of the opium habit, I would urge those members of our which is a popular condiment persistently eaten through all profession at home who may be called upon to express their the months of the year, is very responsible for this latter opinion about it to deprecate any undue haste on the part of ___________________
I I
1116 members of the Anti-Opium League, especially those who have no knowledge of local conditions. The Asiatic temperament must be taken into account and requires very careful treatment in matters of such importance as the regulating of The an appetite for a mental excitant such as opium. pleasant sensations that follow a morphine injection are not likely to remain long a secret to those who, having been rudely divorced from their habitual use of opium, are searching about for some means of satisfying the almost irresistible - craving which their systems feel for it. .March 10th. _________________
,I
The Un’iversity of Sydney. The medical school is expanding so greatly that it has been found necessary to remodel the present school and also to make considerable additions to the building. The new wing will consist of a stone building three storeys in height, the exterior of which will correspond with the existing block, and the cost will be .E20,OOO. The school as rebuilt will be connected by a handsome cloister with the Pathological Museum. On the ground floor of the new wing there will be a bacteriological class-room, laboratory, and preparationroom, with a lecture-room for pathology. The first floor will include class-rooms for materia medica and surgery. A new museum
AUSTRALIA. (FROM
OUR OWN
CORRESPONDENT.)
Ke1/) Lunatic Asylum. THE Government of Victoria has decided that the Kew Asylum grounds shall be sold and the asylum eventually removed. The present building has been long condemned by the official visitors as overcrowded and structurally deficient. A site has been purchased at Heidelberg which is a very picturesque suburb about eight miles from Melbourne. The present building will be retained for benevolent cases until other provision is made. The Site of the Melbourne Hospital. The question of a suitable site for rebuilding the Melbourne Hospital continues to be a fruitful topic of controversy. The choice was considered to lie bstween rebuilding on the present site or moving to what is known as the " pig market "-a larger area about a mile farther from the city. The Premier recently introduced a new factor by offering the hospital committee an area of 15 acres in what is at present a reserve surrounding the Government House set .apart for the Governor-General since the inauguration of the Commonwealth. This site is ideal from the standpoint of natural beautv but it is situated on the south side of the river Yarra and would have three other general hospitals within a radius of one and a half miles. It is objected that if the present site is abandoned the new hospital should be moved to the north, as the northern suburbs contain the great bulk of the poorer population. Another objection which has been strenuously urged is that the Government House reserve should be retained for a pleasure ground. The .medical staff of the hospital decided some time ago by a substantial majority in favour of the " pig-marketsite, but on the Premier’s offer being made a number altered their view ,and a majority is now in favour of moving across the river. The popular objection to this course appears to be so strong, however, that it is possible that the offer may be withdrawn. Meanwhile the hospital committee accepted it subject to the agreement of the Wilson Fund trustees, whose gift of £100,000 carries the right of approval. This approval was withheld and the Premier called a conference of various public bodies interested in the question. No result was arrived at by this meeting and it is now announced that the hospital committee .will itself come to a definite conclusion. Had this been done at the outset a great deal of time and discussion would have been saved, for public opinion was prepared to support the committee in anything decided upon until it weakly .accepted the suggestion to cross the river. Mortality among Boarded-out Infanfs. the recent heat wave in Melbourne it was reported During by a female inspector that several infants in the care of a registered nurse were in a dying condition. They were removed to the depot for neglected children and five of them died there within a week, while another succumbed a few days later. The cause of death in each case was given as colitis or entero-colitis. The nurse in question had no fewer The police inspector than 12 children under her care. reported favourably on his knowledge of the conduct of this place and the coroner eventually concluded that there was no evidence for committal and intimated that the authorities might take further action. The Chief Secretary has directed
prosecution. Munioipal Dispensaries for Sydney. A movement has been made in the city council of Sydney to establish municipal dispensaries. A motion was carried instructing the city solicitor to prepare a clause in the next amending Bill giving the council power to establish dispensaries in the city. .a
of anatomy will also be
provided.
A Remarkable Case. A curious case of mental aberration from overstrain has occurred in one of the suburbs of Melbourne. An old lady, aged 81 years, had been for some two years entirely bed. ridden. She was nursed by a daughter, a woman aged 53 years, and mother and daughter were so attached that neither would permit any other attendant, although such A neighbour noticing an offensive smell was available. communicated with the police, who discovered that the old lady had been dead for more than a week. The daughter was in a dazed condition and could give no account of the occurrence except the statement that she thought her mother was asleep. Relatives had called at the house three or four days previously and had been informed that the patient was sleeping and was not to be disturbed. When visited by the police the daughter had apparently not taken her clothes off for at least three days, nor was there any evidence that she had partaken of any food during that time. She has since entirely recovered her mental balance.
Vital Statistics. population of Sydney district on Dec. 31st, 1907, was 550,600. The birth-rate for the year was equal to 26’ 32 per 1000 of the population, which is the highest rate recorded for many years. 10’ 1 per cent. of these births were illegitimate. The death-rate was 11-45 per 1000; the infant mortality rate was 96’ 3 per 1000 births. The death-rate was unusually high among children, which is accounted for by the effect of a dry season and the prevalence of epidemic whooping-cough. The estimated
The Danysz Microbe. A conference of the chairmen of State boards of public health was held in Sydney to consider the advisability or otherwise of permitting the liberation of the Danysz rabbit microbe on the mainland. The conference consisted of Dr. Frank Tidswell of New South Wales; Dr. W. P. Norris, Victoria; Dr. W. Ramsay Smith, South Australia ; Dr. J. S. C. Etkington, Tasmania; and Dr. Lovegrove, Western Australia. The questions referred for consideration were: (1) whether the microbe found amongst rabbits on the mainland is identical with that suggested by Dr. Danysz for the destruction of rabbits; and (2) whether it is advisable to continue the experiments in the mainland with the Danysz microbe. With regard to the first question the conference concluded "that the microbe suggested by Dr. Danysz is specifically identical with the microbes isolated from rabbits captured on the mainland of Australia." As to the second query the conference concluded that under natural conditions the virus would not injuriously affect animals other than rabbits failing the influence of some circumstances at present unforeseen. After having considered all the evidence the conference found that while there was no reason to apprehend injury to animal life in general neither was there any reason to expect any effective destruction of rabbits by the use of the virus. The importation of the virus being now prohibited by Commonwealth law the conference recommended that the prohibition should be maintained. This means that the Government will not undertake any further experiments, nor will it permit private persons to do so. The scheme may practically be regarded as.defunct.
Sydney Hospital. The annual meeting of subscribers to the Sydney Hospital was held on Feb. 18th under the presidency of Sir Harry Rawson, the State Governor. The past year was the most active and progressive in the history of the institution. 4935 in-patients were treated, of whom 376 died ; the proportion of deaths, after deducting those ocourring within 24 hours after admission, was 5’7 per cent. 2245 operations were
ailment. endured.
as to producing surgical analgesia and also as to the duration of the analgesia; and (4) that attempts at introducing cocaine sometimes failed. In all of Dr. Fischer’s cases the technique of the injections was similar to that adopted by most continental surgeons. The steps were as follows : 1. A preliminary hypodermic injection of one centigramme of morphine was administered. 2. Careful preparation of the lumbar portion of the patient’s back was carried out over an area extending as far as the middle of the crest of the ilium. The patient should be in the sitting posture if possible, with the body bent forward in the cyclist’s scorching position." The fourth lumbar spine was then found by drawing a line from the highest point of one iliac crest to the same point on the opposite side. 5. The needle was introduced just below and to one side of the tip of the fourth lumbar spine and was directed upward, forward, and toward the median line for a distance of between 2 and 3 inches. When the membranes were penetrated a distinct
action, both
diminution of resistance
was
noticed. The
spinal
fluid
usually began to drip from the needle as soon as it entered the spinal canal. At first it might be blood-stained but it If after reaching the canal no fluid soon became clear. escaped its flow might be hastened by inducing the patient to cough. A stylet might be passed into the needle to remove any obstruction that might be present. The Preservation of Milk with Hydrogen Peroxide. Moat methods of rendering milk sterile are objectionable since they require the addition of substances injurious to health or else render the milk less digestible. It has, however, been found that if peroxide of hydrogen is added in the proportion of 0’ 40 part per 1000 the milk will keep for many days and the number of germs present will actually decrease to a very low number. When pathogenic germs, such as those of enteric fever, cholera, dysentery, or tuberculosis, were added to the milk they could not after the lapse of some time be detected by the most searching bacteriological examination. The taste of the milk is in no wise altered and numerous experiments have shown that the digestibility is the same as before. An Epidemic of Typhus Fever in Budapest.
Typhus fever has made its appearance in some districts of Budapest. In the space of a very short time more than 100 cases occurred, and so rapid has been its spread that some public buildings have had to be closed. The source of the been discovered and to suppress it.
epidemic has
measures
have been taken
Shanghai and the Opium Question. There has been a good deal of feeling in Shanghai, with March 28th. regard to the suppression of the opium trade, as to the attitude of some people at home and the late questions in NOTES FROM CHINA. the House of Commons on the subject. The British Government is doing all in its power to reduce the English trade(FROM OUR OWN CORRESPONDENT.) only harm can result from a too rigid insistence on its immediate and total suppression. It should not be forgotten by Appendioitis in China. philanthropists at home that the whole practical question of IN the course of an inquiry which I have recently suppression is fraught with much difficulty. The Shanghai undertaken into the incidence of appendicitis in China municipal council is being asked to adopt the unconI was impressed with the general agreement among stitutional procedure of arbitrarily closing the opium shops medical men practising in all parts of the Empire as to its in the middle of the financial year, without reference extreme rarity. Medical men in charge of native hospitals to the body of ratepayers. Though it is willing to do dealing with large numbers of patients yearly speak of it as a all in its power to abolish these places it is not easy to disease which they almost never meet with. The only hos- adjust quickly a total loss of over £7000 per annum pitals yielding any returns of it are those which treat foreign from licences alone. It has been suggested that the patients. The inquiry could not elicit any definite con- Anti-Opium League in China in return for the support which it has received from the Member for Nottingham sensus of opinion as to the cause of the universal freedom of the Chinese. Observers at home seem inclined, for the most East and others, might memorialise the Home Secretary to part, to attribute the cause to a faulty dietary system introduce total prohibition of alcohol in Nottinghamshire. but a different view is required here. Sir Frederick Correspondents from various parts of the Empire, in writing Treves in his "System of Surgery"says, as regards the to the Shanghai papers, point out the increasing use of apparent exciting causes: " Among the most common may morphine injected hypodermically, and I have recently come be mentioned dyspepsia, the want of efficient masticating across a case of a Chinese who takes one drachm of morphine teeth, the bolting of food, the eating of indigestible food a day by this method. Not infrequently cases come to such as nuts, constipation, diarrhoea, injury to the groin hospital with their bodies dotted all over with the prick region, excessive exertion, exposure to cold." These marks of injection needles. Perhaps the worst feature conpoints are the commonest features of Chinese life. Dr. nected with the suppression question is the crop of opium John MacGowan of Amoy, who has lived during many years "cureswhich have sprung up-most of them prepared by in China, in a recent article in the local press wrote, foreign druggists and nearly all containing morphine as the without reference to appendicitis: "Foreign physicians chief ingredient. A Chinese trying to fight the craving for who have opened hospitals and treated large numbers opium by means of these " cures " would become a hopeless of those who have consulted them have come to the victim to the morphine habit. While I am, of course, entirely conclusion that the large majority of the population are in sympathy with any movement in favour of the eradicabelow par and are suffering from indigestion. Salted turnip, tion of the opium habit, I would urge those members of our which is a popular condiment persistently eaten through all profession at home who may be called upon to express their the months of the year, is very responsible for this latter opinion about it to deprecate any undue haste on the part of ___________________
I I
1116 members of the Anti-Opium League, especially those who have no knowledge of local conditions. The Asiatic temperament must be taken into account and requires very careful treatment in matters of such importance as the regulating of The an appetite for a mental excitant such as opium. pleasant sensations that follow a morphine injection are not likely to remain long a secret to those who, having been rudely divorced from their habitual use of opium, are searching about for some means of satisfying the almost irresistible - craving which their systems feel for it. .March 10th. _________________
,I
The Un’iversity of Sydney. The medical school is expanding so greatly that it has been found necessary to remodel the present school and also to make considerable additions to the building. The new wing will consist of a stone building three storeys in height, the exterior of which will correspond with the existing block, and the cost will be .E20,OOO. The school as rebuilt will be connected by a handsome cloister with the Pathological Museum. On the ground floor of the new wing there will be a bacteriological class-room, laboratory, and preparationroom, with a lecture-room for pathology. The first floor will include class-rooms for materia medica and surgery. A new museum
AUSTRALIA. (FROM
OUR OWN
CORRESPONDENT.)
Ke1/) Lunatic Asylum. THE Government of Victoria has decided that the Kew Asylum grounds shall be sold and the asylum eventually removed. The present building has been long condemned by the official visitors as overcrowded and structurally deficient. A site has been purchased at Heidelberg which is a very picturesque suburb about eight miles from Melbourne. The present building will be retained for benevolent cases until other provision is made. The Site of the Melbourne Hospital. The question of a suitable site for rebuilding the Melbourne Hospital continues to be a fruitful topic of controversy. The choice was considered to lie bstween rebuilding on the present site or moving to what is known as the " pig market "-a larger area about a mile farther from the city. The Premier recently introduced a new factor by offering the hospital committee an area of 15 acres in what is at present a reserve surrounding the Government House set .apart for the Governor-General since the inauguration of the Commonwealth. This site is ideal from the standpoint of natural beautv but it is situated on the south side of the river Yarra and would have three other general hospitals within a radius of one and a half miles. It is objected that if the present site is abandoned the new hospital should be moved to the north, as the northern suburbs contain the great bulk of the poorer population. Another objection which has been strenuously urged is that the Government House reserve should be retained for a pleasure ground. The .medical staff of the hospital decided some time ago by a substantial majority in favour of the " pig-marketsite, but on the Premier’s offer being made a number altered their view ,and a majority is now in favour of moving across the river. The popular objection to this course appears to be so strong, however, that it is possible that the offer may be withdrawn. Meanwhile the hospital committee accepted it subject to the agreement of the Wilson Fund trustees, whose gift of £100,000 carries the right of approval. This approval was withheld and the Premier called a conference of various public bodies interested in the question. No result was arrived at by this meeting and it is now announced that the hospital committee .will itself come to a definite conclusion. Had this been done at the outset a great deal of time and discussion would have been saved, for public opinion was prepared to support the committee in anything decided upon until it weakly .accepted the suggestion to cross the river. Mortality among Boarded-out Infanfs. the recent heat wave in Melbourne it was reported During by a female inspector that several infants in the care of a registered nurse were in a dying condition. They were removed to the depot for neglected children and five of them died there within a week, while another succumbed a few days later. The cause of death in each case was given as colitis or entero-colitis. The nurse in question had no fewer The police inspector than 12 children under her care. reported favourably on his knowledge of the conduct of this place and the coroner eventually concluded that there was no evidence for committal and intimated that the authorities might take further action. The Chief Secretary has directed
prosecution. Munioipal Dispensaries for Sydney. A movement has been made in the city council of Sydney to establish municipal dispensaries. A motion was carried instructing the city solicitor to prepare a clause in the next amending Bill giving the council power to establish dispensaries in the city. .a
of anatomy will also be
provided.
A Remarkable Case. A curious case of mental aberration from overstrain has occurred in one of the suburbs of Melbourne. An old lady, aged 81 years, had been for some two years entirely bed. ridden. She was nursed by a daughter, a woman aged 53 years, and mother and daughter were so attached that neither would permit any other attendant, although such A neighbour noticing an offensive smell was available. communicated with the police, who discovered that the old lady had been dead for more than a week. The daughter was in a dazed condition and could give no account of the occurrence except the statement that she thought her mother was asleep. Relatives had called at the house three or four days previously and had been informed that the patient was sleeping and was not to be disturbed. When visited by the police the daughter had apparently not taken her clothes off for at least three days, nor was there any evidence that she had partaken of any food during that time. She has since entirely recovered her mental balance.
Vital Statistics. population of Sydney district on Dec. 31st, 1907, was 550,600. The birth-rate for the year was equal to 26’ 32 per 1000 of the population, which is the highest rate recorded for many years. 10’ 1 per cent. of these births were illegitimate. The death-rate was 11-45 per 1000; the infant mortality rate was 96’ 3 per 1000 births. The death-rate was unusually high among children, which is accounted for by the effect of a dry season and the prevalence of epidemic whooping-cough. The estimated
The Danysz Microbe. A conference of the chairmen of State boards of public health was held in Sydney to consider the advisability or otherwise of permitting the liberation of the Danysz rabbit microbe on the mainland. The conference consisted of Dr. Frank Tidswell of New South Wales; Dr. W. P. Norris, Victoria; Dr. W. Ramsay Smith, South Australia ; Dr. J. S. C. Etkington, Tasmania; and Dr. Lovegrove, Western Australia. The questions referred for consideration were: (1) whether the microbe found amongst rabbits on the mainland is identical with that suggested by Dr. Danysz for the destruction of rabbits; and (2) whether it is advisable to continue the experiments in the mainland with the Danysz microbe. With regard to the first question the conference concluded "that the microbe suggested by Dr. Danysz is specifically identical with the microbes isolated from rabbits captured on the mainland of Australia." As to the second query the conference concluded that under natural conditions the virus would not injuriously affect animals other than rabbits failing the influence of some circumstances at present unforeseen. After having considered all the evidence the conference found that while there was no reason to apprehend injury to animal life in general neither was there any reason to expect any effective destruction of rabbits by the use of the virus. The importation of the virus being now prohibited by Commonwealth law the conference recommended that the prohibition should be maintained. This means that the Government will not undertake any further experiments, nor will it permit private persons to do so. The scheme may practically be regarded as.defunct.
Sydney Hospital. The annual meeting of subscribers to the Sydney Hospital was held on Feb. 18th under the presidency of Sir Harry Rawson, the State Governor. The past year was the most active and progressive in the history of the institution. 4935 in-patients were treated, of whom 376 died ; the proportion of deaths, after deducting those ocourring within 24 hours after admission, was 5’7 per cent. 2245 operations were