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PNEUMONIA AND BLOODLETTING.
292 before they have fully made up their own minds. One visit to doubtful cases is quite insufficient to enable or to justify notification. In some cases two will not suffice. We suspect that the overlooking of this fact has not a little to do with the errors that are complained of. The remedy is to take more time. There is no royal road to sound diagnosis. It takes time and a certain development of the disease, and it is infinitely better that two or three days more should be taken to make sure than to decide on insufficient data. Under a notification system the medical man himself is responsible, and cannot transfer his responsibility to the superintendent of the fever hospital. We should be very sorry indeed if this discussion had the effect of preventing Dr. Russell from indicating in future errors of diagnosis. That would be a great misfortune, both for the profession and the public. Dr. Hamilton himself, we are glad to see, says that Dr. Russell’s report is a most interesting one, which ought to be welcomed, and even repeated. We think so strongly; and not in Glasgow alone, but other health officers in other communities will confer a favour by presenting to the medical societies of their neigh. bourhood a periodical report of such a nature. The discussion of errors is one of the best ways of preventing their recurrence. -
THE BERLIN CONGRESS. OUR contemporary the Berliner Klinische Wochenschrift dedicates its issue of the 4th inst. to the Tenth International Congress, in an address of welcome, and in the publication of papers contributed from many countries. Thus the first article is by Professor Dujardin-Beaumetz of the H6pital Cochin, Paris. It is on Dilatation of the Stomach as a cause of Neurasthenia, and is in French. From the Naples clinic Professor Cantani describes the Antifebrile Efl’ect of Abundant Water-drinking and of Coldwater Enemata. From Buda-Pesth Dr. Koryani discusses the Influence of Dress on the Occurrence of Floating Kidney in Women. From the Leyden clinic Professor Rosenstein writes on the Diagnosis of Aortic Aneurysms. Dr. A. C. Bernays of the surgical clinic of the College of Physicians and Surgeons of St. Louis, U.S.A., relates five cases of Gunshot Wound of the Abdomen in which laparotomy was performed, three recoveries, two deaths. Dr. Reeves Jackson of Chicago relates (in English) how Mr. Lawson Tait recently amputated the pregnant uterus. From the Warsaw clinic Dr. Stanislaus Klein details an interesting case of Pseudo-leuksemia with cirrhosis of liver and relapsing pyrexia. Lastly, from Copenhagen there is a contribution by Dr. Faber on the Pathogenesis of Tetanus. It was a happy thought of our contemporary to thus signalise the international gathering in its city.
such articles, and the punishment of their vendors. How far the evil had been allowed to go may be inferred from the fact that one can hardly open an Italian newspaper without coming on one or more announcements of the sequestration of food or liquor stores, which, if permitted to to be sold, must have injured the health of the consumer. The Opinione, for example, a leading Roman journal, tells us that in one fortnight the Officio d’Igiene has sequestrated in that city 245,300 chilogrammes of fish, 12 of vegetables, 2750 of fruit, and 32,700 of mushrooms, while the tradesmen in whose shops these articles were on sale have had their names and addresses published in the most con. spicuous fashion possible. Similar seizures of confectionery and fancy beverages, such as are largely consumed through. out Italy in the summer season, are also reported in a Florentine journal-the Nazione,-again with the names and addresses of the fraudulent vendors. All this should have a salutary effect on the Italian poorer classes, not only in view of cholera invasion, but of the maintenance of health at a high standard. In the memorable visitation of cholera in 1881, the ravages it made among the Neapolitan proletariat were distinctly traced not only to panic, but, primarily, to the unsound macaroni and the putrid vegetables, which made them " candidates" for the disease, Nowthis source of danger is in afair way of being minimisedall the more that, as we see from an official rescript, th personnel of the sanitary office is being rigidly supervised, so as to obviate the temptation-not unknown in poor countries-of the enforcer of the law conniving, for a "consideration," at breaches of the same. Italy, indeed, is doing now what she should have done long ago, and will reap the reward, not only of keeping epidemics at bay, but of receiving a larger measure of that tourist population whom her backward hygienic system has hitherto tended to warn off. .
___
THE LATE SIR WM. HOFFMEISTER. THE funeral of Sir William Hoffmeister, late Physician to the Queen at Osborne, took place on Saturday, Aug. 2nd, at Cowes. Among the large number of mourners, General Sir Henry Ponsonby, G.C.B., attended to represent the Queen; Lord Colville of Culross, the Prince and Princess of Wales ; Sir John Cowell, the Duke and Duchess of Edinburgh ; Colonel Beecher, the Duke and Duchess oi Connaught; Colonel the Hon. H. Byng, Princess Christian, Princess Louise, Princess Beatrice, and Prince Henry of Battenberg, the Duchess of Albany, and Empress Frederick of Germany. Two beautiful wreaths from the Queen, and one from each of the other members of the Royal Family, were among the numerous tokens of esteem and regret.
PNEUMONIA AND BLOODLETTING. CHOLERA PROPHYLAXIS IN ITALY. AMONG the nations of the Continent, Italy has hitherto been conspicuous for her belief in quarantine and sanitary cordons as the most effective means of averting cholera from her shores. And even now, when their efficacy has been shown, by her highest hygienic authorities, to be more than doubtful, she continues to favour them if only for the " sense of security " they give to her uninstructed populace. Concurrently, however, with these traditional, if not exploded, measures, she is developing activity, in a far more promising direction-that is, in a vigilant censorship of the For years past the meat, the vegetables, and the alcoholic beverages have been in many large towns throughout the peninsula sold to the poorer classes when in a state unfit for consumption; but, thanks to the new Sanitary Code, the public health officers have been most stringent in the exercise of the powers given them by that enactment for the confiscation of
food-supply.
M. CROCQ, who has frequently written and spoken ic favour of the revival of venesection, made a powerful speech dealing with this subject at a recent meeting of the Belgian Académie de M6,decine. Speaking of pneumonia, he declared his disbelief in the cause of the disease being either Friedlander’s bacillus or the diplococcus of Fraenkel and Weichselbaum. Inoculation of this latter microbe, he remarked, is said to procure immunity from subsequent inoculations, which is exactly contrary to the effect of an attack of pneumonia, for it rather predisposes the subject to subsequent attacks. Again, M. Crocq injected sputum from pneumonic patients, in which the diplococcus had been found, into the lungs of four rabbits, but none of them con. tracted pneumonia. Lastly, in a doubtful hospital case the sputum was examined and found to contain the diplococcus, but at the post-mortem examination no pneumonia was discovered. M. Crocq has never met with any cases of contagion in pneumonia, and Finckler’s cases he considers
,
293 were not pneumonia at all. Moreover, Fraenkel’s microbe vacant places, so that the Hospitals Commission has got 9s found in affections which are neither pneumonia nor itself into a somewhat unpleasant position. The students contagious. The mortality usually reported by other who have resigned only demand, it seems, that they should that is to say, be free from the control of any person except their own ebservers in pneumonia varies greatly no i-om .5 to 35 per cent. M. Crocq has mortality at chiefs. cases cll. He arrests all his pneumonia by bleeding. DEFENCE OF ILLIBERAL MEDICAL Rheumatic fever, and even puerperal metro-peritonitis, LEGISLATION. e treats in the same way. The latter, he declared-amidst 11 tokens of dissent,-can be thus cured in the great majority GALIGNANI’S MESSENGER" of July 21st, replying to the of cases. "Never," he went on, "have I regretted having arguments of THE LANCET, attempts to defend the probled a patient, though I have often been sorry that I have jected illiberal law of the Republic requiring foreign medical abstained from doing so....... If I were to be forbidden to practitioners, including English, holding diplomas of good Heed, I would give up the practice of medicine." He was repute, to pass a French examination before being allowed of course careful to explain that bloodletting to be of any to practise in France, even among their own countrymen. service must be practised intelligently and not abused, as The attempt is lame and inadequate as regards our diplomas. he fears it may again come to be after the wave of reaction It is chiefly based on three points: first, some of our English bas once more made it popular. examinations are so bad as not to compare with the French. As an illustration of the accuracy of our contemporary’s information we will give one specimen. He speaks WATERED MILK. of the licence of the Apothecaries’ Society being gained by 97 THE failure of the St. George’s (Hanover-square) Vestry per cent. of those who seek it. We know no ground for this o obtain a conviction against a dairy for possessing milk assertion. The facts of the examinations of the Society for largely adulterated with water is a serious miscarriage of last year are before us and are as follows :-At the First astice. The inspector had sent a boy in to buy some milk, Examination 12 were rejected and 17 passed ; at the second when the daughter of the dairyman saw she was 14 were rejected and 25 passed ; at the Final 53 were rewatched, she took the milk back, poured it in a pan under jected and 125 passed. The examinations have been inthe counter, and gave some milk from a pan placed elseby the General Medical Council and declared to be where. The pan under the counter contained milk largely spected sufficient. Our contemporary admits that we practically watered which, the dairyman said, was prepared for a allow Frenchmen to practise in England without let or aker who did not mind the addition of water. This but says that we do so because the privilege is hindrance, was done in the morning, though the baker only came of no such value as the corresponding privilege to English’for the milk at ten in the evening. But what was more men in France. This is ungracious and weak. Let the auspicious is the fact that the baker was not produced, or liberal Republic at least be as liberal as we are and enjoy his name given. Why should a baker, of his own free will, the praise of being more disinterested. Meantime can anyconsent to buy adulterated milk. It might be a little be more ungenerous than to refuse English people, thing - cheaper, but he would have had to use a much larger quan- resident in France, medical advisers of their own country, tity to produce the required effect on the bread. Obviously, certified by its medical authorities. We shall not answer the baker had better add, according to his own idea, the less polite insinuations and even assertions of our conwhatever amount of water, if any, he thought would temporary that, with some few exceptions, English repreimprove his milk for bread-making purposes. Under sentatives of the profession in France are eminently unauch a flimsy pretence as the supposed willingness of a satisfactory. His elaborate argument against their admysterious baker to buy watered milk, an adulterated article mission is a fair presumption that they are no mean comshould not be kept on the premises of dairies where it can petitors for practice even among Frenchmen. accidentally be given to other customers who are not quite so callous as to the proportion of water in milk. CRANIECTOMY FOR MICROCEPHALUS. We fear that Mr. D’Eyncourt, in refusing to convict, has AT a recent meeting of the Académie des Sciences, opened the door for many abuses, and that it will now be M. Lannelongue reported a case of craniectomy in a micromuch easier for dairymen to elude the law. cephalic idiot, which was attended with results so striking that the case is well worthy of careful study. HOSPITAL DEADLOCK IN GHENT. M. Lannelongue’s communication, the gist of which was THOUGH there is unfortunately too little tendency given by our Paris correspondent in THE LANCET of amongst rival practitioners to act in concert regarding July l9oh, p. 152, is printed in full in a recent number of appointments, students occasionally exhibit a large amount L’ Union Médicale. The most salient features of the case of fellow feeling for one another in this matter. A are as follows. The patient was a female child four years The head was remarkable example of concerted action has just occurred old, but looked two years younger. in Ghent, where the students holding hospital appoint- very small, narrow from side to side, and projecting ments-carrying a small salary in some cases-have all at the vertex ; the only diameter which approached ’resigned in a body in consequence of the " insolent atti- the normal was the antero-posterior, all the others were tude " of the director of the Hospitals Commission, in which much below the average. The child was puny, seemed to he is upheld by the Commission itself. They have, how- take no notice of her surroundings, and lay in bed restless, ever, volunteered to look after the patients gratuitously stammering out monosyllables or inarticulate cries. She was while the dispute is being arranged. It appears that unable to stand, and if supported made no effort to walk, they have the countenance not only of the physicians and but stamped her feet with rapidity. The child was a wellsurgeons composing the hospital staffs, many of whom marked example of a microcephalic idiot. M. Lannelongue are university professors, but of all the other students, operated upon her in the following manner. Having made who have pledged themselves not to accept any of the an incision through the scalp and pericranium, just to the left vacant posts for which the Hospitals Commission has adver- of the sagittal suture, a small circle of bone was removed tised for candidates. It is believed, moreover, that none of with a trephine at a point a finger’s breadth from the the qualified men in Ghent, and none of the students of suture; from this as a starting point a narrow strip of other Belgian universities, will consent to supply the bone, nine centimetres long and six millimetres broad, was -
___
FRENCH
but,
s
THE BERLIN CONGRESS. OUR contemporary the Berliner Klinische Wochenschrift dedicates its issue of the 4th inst. to the Tenth International Congress, in an address of welcome, and in the publication of papers contributed from many countries. Thus the first article is by Professor Dujardin-Beaumetz of the H6pital Cochin, Paris. It is on Dilatation of the Stomach as a cause of Neurasthenia, and is in French. From the Naples clinic Professor Cantani describes the Antifebrile Efl’ect of Abundant Water-drinking and of Coldwater Enemata. From Buda-Pesth Dr. Koryani discusses the Influence of Dress on the Occurrence of Floating Kidney in Women. From the Leyden clinic Professor Rosenstein writes on the Diagnosis of Aortic Aneurysms. Dr. A. C. Bernays of the surgical clinic of the College of Physicians and Surgeons of St. Louis, U.S.A., relates five cases of Gunshot Wound of the Abdomen in which laparotomy was performed, three recoveries, two deaths. Dr. Reeves Jackson of Chicago relates (in English) how Mr. Lawson Tait recently amputated the pregnant uterus. From the Warsaw clinic Dr. Stanislaus Klein details an interesting case of Pseudo-leuksemia with cirrhosis of liver and relapsing pyrexia. Lastly, from Copenhagen there is a contribution by Dr. Faber on the Pathogenesis of Tetanus. It was a happy thought of our contemporary to thus signalise the international gathering in its city.
such articles, and the punishment of their vendors. How far the evil had been allowed to go may be inferred from the fact that one can hardly open an Italian newspaper without coming on one or more announcements of the sequestration of food or liquor stores, which, if permitted to to be sold, must have injured the health of the consumer. The Opinione, for example, a leading Roman journal, tells us that in one fortnight the Officio d’Igiene has sequestrated in that city 245,300 chilogrammes of fish, 12 of vegetables, 2750 of fruit, and 32,700 of mushrooms, while the tradesmen in whose shops these articles were on sale have had their names and addresses published in the most con. spicuous fashion possible. Similar seizures of confectionery and fancy beverages, such as are largely consumed through. out Italy in the summer season, are also reported in a Florentine journal-the Nazione,-again with the names and addresses of the fraudulent vendors. All this should have a salutary effect on the Italian poorer classes, not only in view of cholera invasion, but of the maintenance of health at a high standard. In the memorable visitation of cholera in 1881, the ravages it made among the Neapolitan proletariat were distinctly traced not only to panic, but, primarily, to the unsound macaroni and the putrid vegetables, which made them " candidates" for the disease, Nowthis source of danger is in afair way of being minimisedall the more that, as we see from an official rescript, th personnel of the sanitary office is being rigidly supervised, so as to obviate the temptation-not unknown in poor countries-of the enforcer of the law conniving, for a "consideration," at breaches of the same. Italy, indeed, is doing now what she should have done long ago, and will reap the reward, not only of keeping epidemics at bay, but of receiving a larger measure of that tourist population whom her backward hygienic system has hitherto tended to warn off. .
___
THE LATE SIR WM. HOFFMEISTER. THE funeral of Sir William Hoffmeister, late Physician to the Queen at Osborne, took place on Saturday, Aug. 2nd, at Cowes. Among the large number of mourners, General Sir Henry Ponsonby, G.C.B., attended to represent the Queen; Lord Colville of Culross, the Prince and Princess of Wales ; Sir John Cowell, the Duke and Duchess of Edinburgh ; Colonel Beecher, the Duke and Duchess oi Connaught; Colonel the Hon. H. Byng, Princess Christian, Princess Louise, Princess Beatrice, and Prince Henry of Battenberg, the Duchess of Albany, and Empress Frederick of Germany. Two beautiful wreaths from the Queen, and one from each of the other members of the Royal Family, were among the numerous tokens of esteem and regret.
PNEUMONIA AND BLOODLETTING. CHOLERA PROPHYLAXIS IN ITALY. AMONG the nations of the Continent, Italy has hitherto been conspicuous for her belief in quarantine and sanitary cordons as the most effective means of averting cholera from her shores. And even now, when their efficacy has been shown, by her highest hygienic authorities, to be more than doubtful, she continues to favour them if only for the " sense of security " they give to her uninstructed populace. Concurrently, however, with these traditional, if not exploded, measures, she is developing activity, in a far more promising direction-that is, in a vigilant censorship of the For years past the meat, the vegetables, and the alcoholic beverages have been in many large towns throughout the peninsula sold to the poorer classes when in a state unfit for consumption; but, thanks to the new Sanitary Code, the public health officers have been most stringent in the exercise of the powers given them by that enactment for the confiscation of
food-supply.
M. CROCQ, who has frequently written and spoken ic favour of the revival of venesection, made a powerful speech dealing with this subject at a recent meeting of the Belgian Académie de M6,decine. Speaking of pneumonia, he declared his disbelief in the cause of the disease being either Friedlander’s bacillus or the diplococcus of Fraenkel and Weichselbaum. Inoculation of this latter microbe, he remarked, is said to procure immunity from subsequent inoculations, which is exactly contrary to the effect of an attack of pneumonia, for it rather predisposes the subject to subsequent attacks. Again, M. Crocq injected sputum from pneumonic patients, in which the diplococcus had been found, into the lungs of four rabbits, but none of them con. tracted pneumonia. Lastly, in a doubtful hospital case the sputum was examined and found to contain the diplococcus, but at the post-mortem examination no pneumonia was discovered. M. Crocq has never met with any cases of contagion in pneumonia, and Finckler’s cases he considers
,
293 were not pneumonia at all. Moreover, Fraenkel’s microbe vacant places, so that the Hospitals Commission has got 9s found in affections which are neither pneumonia nor itself into a somewhat unpleasant position. The students contagious. The mortality usually reported by other who have resigned only demand, it seems, that they should that is to say, be free from the control of any person except their own ebservers in pneumonia varies greatly no i-om .5 to 35 per cent. M. Crocq has mortality at chiefs. cases cll. He arrests all his pneumonia by bleeding. DEFENCE OF ILLIBERAL MEDICAL Rheumatic fever, and even puerperal metro-peritonitis, LEGISLATION. e treats in the same way. The latter, he declared-amidst 11 tokens of dissent,-can be thus cured in the great majority GALIGNANI’S MESSENGER" of July 21st, replying to the of cases. "Never," he went on, "have I regretted having arguments of THE LANCET, attempts to defend the probled a patient, though I have often been sorry that I have jected illiberal law of the Republic requiring foreign medical abstained from doing so....... If I were to be forbidden to practitioners, including English, holding diplomas of good Heed, I would give up the practice of medicine." He was repute, to pass a French examination before being allowed of course careful to explain that bloodletting to be of any to practise in France, even among their own countrymen. service must be practised intelligently and not abused, as The attempt is lame and inadequate as regards our diplomas. he fears it may again come to be after the wave of reaction It is chiefly based on three points: first, some of our English bas once more made it popular. examinations are so bad as not to compare with the French. As an illustration of the accuracy of our contemporary’s information we will give one specimen. He speaks WATERED MILK. of the licence of the Apothecaries’ Society being gained by 97 THE failure of the St. George’s (Hanover-square) Vestry per cent. of those who seek it. We know no ground for this o obtain a conviction against a dairy for possessing milk assertion. The facts of the examinations of the Society for largely adulterated with water is a serious miscarriage of last year are before us and are as follows :-At the First astice. The inspector had sent a boy in to buy some milk, Examination 12 were rejected and 17 passed ; at the second when the daughter of the dairyman saw she was 14 were rejected and 25 passed ; at the Final 53 were rewatched, she took the milk back, poured it in a pan under jected and 125 passed. The examinations have been inthe counter, and gave some milk from a pan placed elseby the General Medical Council and declared to be where. The pan under the counter contained milk largely spected sufficient. Our contemporary admits that we practically watered which, the dairyman said, was prepared for a allow Frenchmen to practise in England without let or aker who did not mind the addition of water. This but says that we do so because the privilege is hindrance, was done in the morning, though the baker only came of no such value as the corresponding privilege to English’for the milk at ten in the evening. But what was more men in France. This is ungracious and weak. Let the auspicious is the fact that the baker was not produced, or liberal Republic at least be as liberal as we are and enjoy his name given. Why should a baker, of his own free will, the praise of being more disinterested. Meantime can anyconsent to buy adulterated milk. It might be a little be more ungenerous than to refuse English people, thing - cheaper, but he would have had to use a much larger quan- resident in France, medical advisers of their own country, tity to produce the required effect on the bread. Obviously, certified by its medical authorities. We shall not answer the baker had better add, according to his own idea, the less polite insinuations and even assertions of our conwhatever amount of water, if any, he thought would temporary that, with some few exceptions, English repreimprove his milk for bread-making purposes. Under sentatives of the profession in France are eminently unauch a flimsy pretence as the supposed willingness of a satisfactory. His elaborate argument against their admysterious baker to buy watered milk, an adulterated article mission is a fair presumption that they are no mean comshould not be kept on the premises of dairies where it can petitors for practice even among Frenchmen. accidentally be given to other customers who are not quite so callous as to the proportion of water in milk. CRANIECTOMY FOR MICROCEPHALUS. We fear that Mr. D’Eyncourt, in refusing to convict, has AT a recent meeting of the Académie des Sciences, opened the door for many abuses, and that it will now be M. Lannelongue reported a case of craniectomy in a micromuch easier for dairymen to elude the law. cephalic idiot, which was attended with results so striking that the case is well worthy of careful study. HOSPITAL DEADLOCK IN GHENT. M. Lannelongue’s communication, the gist of which was THOUGH there is unfortunately too little tendency given by our Paris correspondent in THE LANCET of amongst rival practitioners to act in concert regarding July l9oh, p. 152, is printed in full in a recent number of appointments, students occasionally exhibit a large amount L’ Union Médicale. The most salient features of the case of fellow feeling for one another in this matter. A are as follows. The patient was a female child four years The head was remarkable example of concerted action has just occurred old, but looked two years younger. in Ghent, where the students holding hospital appoint- very small, narrow from side to side, and projecting ments-carrying a small salary in some cases-have all at the vertex ; the only diameter which approached ’resigned in a body in consequence of the " insolent atti- the normal was the antero-posterior, all the others were tude " of the director of the Hospitals Commission, in which much below the average. The child was puny, seemed to he is upheld by the Commission itself. They have, how- take no notice of her surroundings, and lay in bed restless, ever, volunteered to look after the patients gratuitously stammering out monosyllables or inarticulate cries. She was while the dispute is being arranged. It appears that unable to stand, and if supported made no effort to walk, they have the countenance not only of the physicians and but stamped her feet with rapidity. The child was a wellsurgeons composing the hospital staffs, many of whom marked example of a microcephalic idiot. M. Lannelongue are university professors, but of all the other students, operated upon her in the following manner. Having made who have pledged themselves not to accept any of the an incision through the scalp and pericranium, just to the left vacant posts for which the Hospitals Commission has adver- of the sagittal suture, a small circle of bone was removed tised for candidates. It is believed, moreover, that none of with a trephine at a point a finger’s breadth from the the qualified men in Ghent, and none of the students of suture; from this as a starting point a narrow strip of other Belgian universities, will consent to supply the bone, nine centimetres long and six millimetres broad, was -
___
FRENCH
but,
s