89 numerical order-viz., London, Glasgow, Edinburgh, Manchester (including Salford), Liverpool, Dublin, Birmingham,
Leeds, Brighton, Belfast, Sheffield, Newcastle-on-Tyne, Aberdeen, Bristol, Bradford, Bournemouth, Nottingham, Cardiff, Portsmouth, Hull, Southport (including Birkdale), Clifton, Leicester, and Bath. The above figures are based upon information comprised in the Medical Directory, 1902, which contains in the London list 6292 names, in the Glasgow list 732 names, and in the Bath list 100 names. Some of the medical persons, however, have retired and a few are travelling. -
THE
PREVALENCE OF SMALL-POX.
show the number of patients the various hospitals of the Metropolitan Asylums Board for the dates mentioned : on Saturday, July 5th, there were six fresh cases ; on Sunday, the 6th, there were four fresh cases ; on Monday, the 7th, there were seven fresh cases ; on Tuesday, the 8th, there were 6 fresh cases ; and on Wednesday, the 9th, there were 5 fresh cases. THE
following figures
admitted
to
____
ACROPARÆSTHESIA : AN ANALYSIS OF 100 CASES. AN important study of the somewhat rare nervous disorder known as acroparæsthesia is contributed by Professor Joseph Collins of New York to the Medical Record of May 31st last. Acroparæsthesia is characterised by abnormal sensations in the extremities, principally those of pricking, tingling, "pins and needles," and numbness. The present contribution was based on the study of 100 cases observed during the past five years at the clinic of the New York Post-graduate Medical School. Symptoms allied to acroparassthesia are often associated with such bodily conditions as chronic rheumatism, gout, and other arthritic disturbances, peripheral neuritis, diabetes, and pulmonary phthisis, but such cases were excluded from the present research which concerned itself only with cases where the acroparæsthesia itself was the only manifestation of disease or where other manifestations could not be found. As a typical case among the many cited by the writer A woman, aged 68 years, the following may be given. suffered from symptoms of numbness and tingling of the hands and arms soon after retiring to bed. When the pain or discomfort reached its height she would awake and rub her fingers and hands till relief was obtained and then go to sleep again. This occurred five or six times every night and prevented her sleeping soundly. It was found that she had been overworking herself to the point of fatigue for some time preceding the illness and was also suffering from constipation. The symptoms soon ceased and did not recur. Among the 100 cases the average age when the symptoms appeared was 39 years, most of the patients being between the ages of 30 and 50 years. There were 69 females to 31 males and most of the latter were Jews of the lower class. Among diseases which preceded the ailment were rheumatism, influenza, typhoid fever, pneumonia, or ill-health from alcoholic intemperance, but in not one case was syphilis ascertained to have been present. As regards distribution of the symptoms, in 52 per cent. of the cases they were in the arms and hands, in 10 per cent. in the feet and legs, and in 30 per cent. in both the upper and lower extremities. In the remaining few cases they were present in other parts of the body and only in a single case in the face. Associated gastric disorders were present in many cases-viz., constipation in 32 per cent., anorexia and coated tongue in 15 per cent., and gastro-intestinal fermentation in 10 per cent. of the cases. 14 patients complained of headache and 11 had marked neurasthenic symptoms. The peripheral circulation was slow and feeble, the pulse was small, and the hands and feet were clammy
in 20 per cent., but in no case was sclerodactylia or Raynaud’s disease present in the whole series. The average duration of the symptoms of acroparæsthesia was 14 months. The occupations in which it was most prevalent were those involving overwork with the hands, as in the case of tailors, washerwomen, and laundry workers, but gastric disorder or constipation predisposed to it. The treatment consisted of rest, "tonic baths"(cold-water splashing of the body and limbs at from 65° to 75° F., followed by vigorous rubbing of the back and abdomen), galvanisation of the cervical and brachial plexuses, a diet to correct constipation, and the administration of arsenic and strychnine as nerve tonics. The pathology of the disease remains, adds Professor Collins, as yet obscure. - .
PRESERVED SHRIMPS AGAIN. ON more than one occasion we have referred in our columns to the increasing sale of shrimps imported from Holland preserved with excessive quantities of borax. It that an enormous amount of Dutch are appears shrimps imported for distribution as fresh English shrimps. Apart from the deception which is thus practised the shrimps contain very large amounts of borax or boric acid, equal to about 41 grains per pound of the acid. According to the recommendations of the Departmental Committee on Food Preservatives borax is permitted to be used in cream, butter, and margarine in certain amounts, which are not to be The recommendations, however, do not relate exceeded. to other articles of food, such as shrimps, and, therefore, we may take it that these could be treated with an unlimited amount of borax. Imported shrimps so preserved are obviously, however, not of the nature and substance demanded, as, of course, they are not English shrimps. Such was the view taken by the bench in the case tried recently at Ormskirk. During the hearing of the case it was stated that an old industry was threatened with ruin by the introduction of foreign shrimps. It would be interesting to know what view would be taken in the case of other fish, such as salmon, which, let us assume, was sold as fine Scotch salmon, but which proved to be an imported fish preserved in the same way as are Dutch shrimps.
ON THE USE OF TRIANGULAR DIAGRAMS FOR THE REPRESENTATION AND COMPARISON OF DIFFERENT TYPES OF SKULL. Professor W. M. Flinders Petrie, the Egyptologist, has devised an ingenious method of representing the principal cranial indices by means of a system of diagrams which clearly exhibit their characteristic features even though they may be drawn so small that a threepenny-piece will cover them. The principle is fully explained in the June number of Man, a journal published under the direction of the Anthropological Institute of Great Britain and Ireland. A vertical line is drawn on paper and from its lower extremity two other lines are drawn making with it angles of 1200. The three lines therefore meet in a point, like radii of a circle, and are equally inclined to one another. Any scale of equal parts being taken and the numbers corresponding to the three principal measurements of the skull being found upon it, the vertical line is made equal to the number of divisions representing the height of the skull, the line sloping downwards to the left is made equal to those representing the length of the skull, and the line sloping downwards to the right is made equal to those representing the breadth of the skull. Then by joining the outer ends of these three lines a triangle is formed the inclinations of the three sides of which show the ratios (1) of the length to the breadth, (2) of the length to the height, and (3) of the breadth to the height. The indices of different skulls obviously may be compared
90
by observing the slope of the corresponding sides of the respective triangles-e.g., with a brachycephalic skull the base line will slope downwards from left to right, while with a dolichocephalic skull the base line will slope downwards from tight to left. Moreover, in these triangles the whole area varies with the capacity of the skull, and the area of each of the three triangles within the large one varies with the of the three cross sections of the skull, vertical fore-andaft section being shown by the left-hand inner triangle, vertical cross section by the right hand inner trangle, and horizontal section by the lowest inner triangle. In order that two or more triangles may be comparable with one another it is obvious that the same scale of equal parts must be used in setting out the lengths of the three central radiating lines. Ethnological classifications of a more elaborate kind can be obtained in a graphic and compact form by superimposing these cranial triangles upon paper ruled in squares which in the horizontal direction show the transition from the orthognathous to the prognathous type and in the vertical direction the transition from the wide-nose type to the
area
narrow-nose
THE ON
type.
____
HENRIETTE
RAPHAEL NURSES’
HOME.
the Prince and Princess of Wales visited and opened the Henriette Raphael Nurses’ Home, which was founded by the late Mr. H. L. Raphael in memory of his wife. The erection of the home has cost about 68,000, and towards this sum the late Mr. Raphael The building contains, besides living rooms, gave ;&20,000. In 213 bedrooms, a sick ward, and a swimming bath. reply to an address of welcome by Mr. Bonsor, the treasurer of Hospital, the Prince of Wales said z Mr. Treasurer, my Lords, Ladies, and Gentlemen.--Before I allude to the object for which we are met together to-day I am sure that all who are here will join with me in expressing our feeling of unbounded
July 7th
Guy’s Hospital
Guy’s
thankfulness to God for the merciful recovery of my dear father the
King....... And speaking before the authorities of one of our leading hospitals, I should like to say that we who have watched at the sick bed of the King fully realise how much, humanly speaking, is due to
surgical and medical skill as well as to the patient and highly-trained nursing which it has been His Majesty’s good fortune to So it seems almost fitting that one of the first public enjoy. ceremonies that the Princess and I should take part in since the King’s the eminent
serious illness should be to open this beautiful home for nurses within the precincts of this great hospital which we have just had the pleasure of inspecting. It is only in comparatively recent times that ‘ the role of the- nurse in the sick-room has been fully recognised. But are’there not many here -who, like myself, will throughout our lives remember with the deepest gtatitude the soothing comfort, indeed, I may say, the blessing, of efficient nursing? Recognising, -therefore, the high and indispensable position which nurses occupy, the least that can be done for them is to provide the comforts of a home, where they can enjoy rest and relaxation after their hours of arduous and self-sacrificing work. It was one man who, holding this view, gave practical reality to it by the munificent gift already referred to by the treasurer for the purpose of establishing this home which we to-day inaugurate; and I am glad, as your President, to congratulate Mr. Raphael, who, I am happy to think, is one of our governors, upon the consummation of the work of which his father was the founder and which for all time will bear the name of his mother.... I now have much pleasure in declaring the Henriette Raphael Nurses’ Home open. ......
-
THE REPORT OF THE JOINT SELECT COMMITTEE OF THE TWO HOUSES OF PARLIAMENT ON THE LONDON WATER BILL.
THE "Report and Special Report from the Joint Select Committee of the House of Lords and the House of Commons on the London Water Bill with the proceedings of the Committeehavebeen recently published.1 The gibt of the proceedings and the practical outcome of the report have already been given in THE LANCET and the nature of the special report has been correctly foreshadowed. The information given which is new to us is the way in which the members of the committee voted at the various divisions. The first important division was that which took place on April 30th on the constitution of the proposed Water Board. Lord Balfour of Burleigh proposed that the committee accept in its general lines the composition of the 1
London :
Eyre and Spottiswoode, price 3d.
board as set out in the third schedule," and to this Lord Llandaff proposed an amendment to leave out all the words aftercommittee"and to insert instead the words " delete the representation of the metropolitan boroughs from that schedule." Those who supported the amendment were the Earl of Crewe, Lord de Mauley, Sir William Houldsworth, Sir James Kitson, and Mr. M’Crae. Those in favour of the Government proposal were Lord Balfour of Burleigh, Lord Ludlow, and Sir William Arrol. It will be remembered that the Government made a strong appeal to the committee to reconsider its decision, and the President of the Local Government Board himself was present. On May 6th the committee decided to receive evidence tendered by the metropolitan boroughs with reference to the proposed Water Board. This course practically reopened a question which had been already decided, and those in favour of the proceeding were Lord Balfour of Burleigh, Lord Ludlow, and Sir William Arrol (who were from the first in favour of the Government measure), Sir Edgar Vincent (who was not present in the earlier division), and Lord de Mauley, Sir William Houldsworth, and Sir James Kitson, who practically changed sides. The final decision as to the constitution of the Water Board was made on June llth and the result really depended on the way in which the question was put. Lord Balfour, Lord Ludlow, Sir William Arrol, Sir William Houldsworth, and Sir Edgar Vincent were in favour of the Government proposal, the Earl of Crewe, Viscount Llandaff, Lord de Mauley, Sir James Kitson, and Mr. M’Crae were opposed to it. The special report drawn up by Lord Balfour of Burleigh in regard to the way in which the decision was arrived at is as follows :
question of passing the schedule as a whole the chairman requested to put the question, " That the schedule stand part of but he gave it as his decision that he should not so put the Bill," question, but that if such motion were made he should put the question in the form, ’’That the schedule be disagreed to." The question having been thus put and the numbers being equal the chairman (having in accordance with precedent no casting vote) ruled that the said schedule must stand part of the Bill on the principle that On the
was
the
amendment should be made to the Bill as referred to the Committee by the House after second reading unless there should be a. majority in favour of such amendment. no
THE THE annual
WATER-SUPPLY OF LIVERPOOL.
report of the engineer of the City
of
Liverpool
Waterworks1 has recently been published. A full account of the sources of supply has been given in THE L7CBT The most and on that point nothing need be added. of the is that which present report interesting part relates the difficulties which have occurred owing to the obstruction to the flow of unfiltered water through the which conveys it from Lake Vyrnwy to Oswestry. An elaborate series of experiments has been made and the information which has been obtained from them will be of the greatest service to all those who have the responsibility of conducting upland water for long distances for the supply of cities. It may be of use to state in the briefest, possible manner the difficulties which have presented themselves, the nature of the investigation which was adopted to discover their cause, and the new facts which have been established as a result of the investigation. The trouble arose from the fact that the pipe which conducted the unfiltered water delivered a quantity considerably less in amount than it should have doneroughly speaking, about one-seventh less. Mr. Deacon’s pipe-cleaning apparatus-a specially devised brush-was used with good results and the process of cleaning the pipe occupied about 10 days. The trouble recurred. Experiments were undertaken with a view to determine the exact nature of the obstructing matter and the best method
pipe
1 City of Liverpool Waterworks : Annual Report of the Engineer, Year 1901. Printed in accordance with a Resolution of the Water Committee. Liverpool, 1902.