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PSILOSIS? A QUESTION OF DIAGNOSIS.
303 Let the M.B., the M.D.,and the M.Ch. be satisfied with his degree-unless, indeed, he is ashamed of his university. We real " physicians and surgeons " are satisfied with our diplomas and let the L.S.A. be satisfied with his qualification. Let him call himself what he really is-" Licentiate in Medicine and Surgery of the Society of Apothecaries." If he is not satisfied with his L.S.A. let him pay his money, sit at the desk, and go through his examinations the same as we’ bonâ fide and real physicians and surgeons had to do and not try to assume a title which no more belongs to him than does that of M.D. or M.Ch. to us. I strongly commend these remarks to the real" physicians and surgeons" of Great Britain and Ireland, especially to . those physicians and surgeons " who are highly placed in the profession (not M.D.’s, &c.), and especially also to the officials of the Colleges of Physicians and Surgeons in England, Ireland, and Scotland. If any society of "physicians and surgeons " is formed I would gladly subscribe to it. Of a truth, I I important principles are at stake affecting the well-being of a large portion of the profession " and it is about time that the physicians and surgeons " of Great Britain and .Ireland formed line quickly to vigorously defend their legitimate titles against the usurpation of the titlephysician " by university graduates-and the subtle attack on flank and rear contemplated by the L.S.A.’s. The lady who is the victim of an unfortunate blunder has my sincere sympathy, but it is a pity that her misfortune should be made the occasion of an attack on us " physicians and > surgeons " by the claim insinuated in the circular referred to. I am, Sirs, yours faithfully, A PHYSICIAN AND SURGEON. 1899. 24th, July .
.
PSILOSIS? A QUESTION OF DIAGNOSIS. To the Editors of THE LANOET. SiRS,-With reference to Dr. I. Burney Yeo’s clinical lecture on a case of chronic diarrhoea published in THE LANCET of July 22nd, may I be allowed to suggest that the case was undoubtedly one of "psilosis" or 4 sprue"? The history of the case, especially the previous residence in Manila where the disease is common, the nature of the stools, and, above all, the pain, redness, and aphthous ulceration of the tongue and mouth and the rapid recovery on milk diet, all point in an emphatic manner to this assumption. It may be urged that the length of time which had elapsed since the patient’s residence in Manila would not favour this diagnosis, but it is now well known that the disease may lie dormant in the system for a great many years before manifesting itself. I am, Sirs, yours faithfully, l’LEET BUHGEON, It.l’II. July 23rd, ]899.
NOTES FROM INDIA. (FROM OUR SPECIAL CORRESPONDENT.) The
Plague in India.-The Report of the German PZag7e Commission.-Dr. Galeotti and the English Plague Com-
mission. FOR some weeks past I have been able to record a diminution in the number of deaths from plague in nearly every part of India which has been infected and the total number of such deaths had reached a minimum since the epidemic first started in 1896. There were indications, however, in one or two districts of renewed outbreaks and the plague returns for the week ending July lst show a considerable increase in mortality, having risen from 470 in the previous seven days to 733 this week, the advance being due to more deaths in the Bombay Presidency and outside Bombay city. Poona seems doomed to experience another recrudescence and alarm has been created, causing many people to leave the city. Karachi has now nearly got rid of plague as well as cholera, but there are fresh troubles with the Khoja community and the headmen will be required under penalty to maintain the peace. Calcutta records nine deaths only and the weekly returns of the general mortality seem to indicate that just at the present time it is exceptionally healthy. The outbreak in Calcutta may be considered to be practically over for the time being, but there is every probability
that after a temporary period of apparent absence it will break out again. In Bombay, on the other hand, there has not been a clear interval from the time the epidemic first started and the city returns for the past week show 45deaths. Notwithstanding the continuance of the disease in the Punjab it seems to lack virulence and only a few villages are affected. In fact, it can hardly be said that the. Punjab has been seriously invaded at all. The Southern Mahratta country, which has borne the brunt of the epidemic, is again showing signs of distress, and as there has now been a comparatively free interval for some time it, would not be surprising if a recrudescence of the epidemic occurred in this district. One item in the complete report of the German Plague Commission oalls for comment. That report attributes theexemption of the white population to the greater protection afforded by their clothing and it states that the evidence seems to show that it is usually abrasions or perforations of’ the skin even of the most insignificant character that. afford the plague bacillus an entry into the body, whereas the poison is much less readily absorbed through the lungs or the digestive organs. In answerto this it may be stated that abrasions of the skin have been most carefully looked for and investigated and only in a very small proportion of cases has it been, thought possible that the plague bacillus could have found entry by these means. Moreover, the glands of the groin are as. often affected among the white population who clothe theirfeet and legs as among the native population. There is. hardly a single instance to indicate that the poison was absorbed through the digestive organs and the small number of nurses, attendants, ward boys, and relatives and friends of patients who have been attacked shows that it can. seldom be taken in through the lungs. The local inoculation theory would be an easy explanation for the spread of thedisease if it could be shown that it was generally true. At thepresent time only a few cases can be explained on this hypothesis. It must be admitted that the means of spread forthe majority of cases are unknown. Why some villages have been decimated, why the large cities have been attacked at the rate roughly of 1 in 40 of the population, and why other places have escaped lightly are problems which remain to be discovered and are not disposed of by the theory of local inoculation. Dr. Galeotti, who has been working in Bombay with. Professor Lustig’s serum, complains in a letter published’ in THE LANCET of June 17th that I have incorrectly described his opinion about the value of the serum. 1 assert, as I have reported before, that the statistics pub-lished concerning the serum are not only valueless but misleading. The cases were picked and from these picked’ cases certain statistics were compared with the total3 returns of the plague hospitals. The system is unscientific. Dr. Galeotti once more asserts the low mortality of histreated cases as compared with the non-treated patients,. It but he does not say that he selected his cases. has been found that about 33 per cent. of admissions to the large plague hospitals die within 24 hours and that about 50 per cent. die within 48 hours. Moribund as" well as other cases were not treated by Lustig’s serum, so. that there is no wonder his mortality is only 53 per cent. The mortality of the plague hospitals is about 79 per cent., so that if the moribund cases are excluded and those that, die within the 24 hours the percentage of mortality would beactually lower than that recorded for the serum treated I repeat that a fair comparison has not beetv cases. instituted with treatment on other lines. Julv 6th.
AUGUST BANK HOLIDAY
Cheap tickets
ON THE
CONTINENT.-
will be issued to Brussels, available for eight. days, vid Harwich and Antwerp. Passengers leaving London in the evening reach Brussels next morning after a night’s. rest on board the steamer. For visiting The Hague, Amsterdam, and other parts of Holland, the Rhine, North and South Germany, and Basle for Switzerland, special facilities are offered viti the Great Eastern Railway Company’s Royal’ Mail Harwich-Hook of Holland route, through carriages being run to Amsterdam, Berlin, Cologne and Basle, also’ restaurant cars on the North and South German express trains to and from the Hook of Holland. The General Steam Navigation Company’s fast passenger steamers will leave Harwich on August 2nd and 5th for Hamburg, returning on August 6th and 9th.
.
PSILOSIS? A QUESTION OF DIAGNOSIS. To the Editors of THE LANOET. SiRS,-With reference to Dr. I. Burney Yeo’s clinical lecture on a case of chronic diarrhoea published in THE LANCET of July 22nd, may I be allowed to suggest that the case was undoubtedly one of "psilosis" or 4 sprue"? The history of the case, especially the previous residence in Manila where the disease is common, the nature of the stools, and, above all, the pain, redness, and aphthous ulceration of the tongue and mouth and the rapid recovery on milk diet, all point in an emphatic manner to this assumption. It may be urged that the length of time which had elapsed since the patient’s residence in Manila would not favour this diagnosis, but it is now well known that the disease may lie dormant in the system for a great many years before manifesting itself. I am, Sirs, yours faithfully, l’LEET BUHGEON, It.l’II. July 23rd, ]899.
NOTES FROM INDIA. (FROM OUR SPECIAL CORRESPONDENT.) The
Plague in India.-The Report of the German PZag7e Commission.-Dr. Galeotti and the English Plague Com-
mission. FOR some weeks past I have been able to record a diminution in the number of deaths from plague in nearly every part of India which has been infected and the total number of such deaths had reached a minimum since the epidemic first started in 1896. There were indications, however, in one or two districts of renewed outbreaks and the plague returns for the week ending July lst show a considerable increase in mortality, having risen from 470 in the previous seven days to 733 this week, the advance being due to more deaths in the Bombay Presidency and outside Bombay city. Poona seems doomed to experience another recrudescence and alarm has been created, causing many people to leave the city. Karachi has now nearly got rid of plague as well as cholera, but there are fresh troubles with the Khoja community and the headmen will be required under penalty to maintain the peace. Calcutta records nine deaths only and the weekly returns of the general mortality seem to indicate that just at the present time it is exceptionally healthy. The outbreak in Calcutta may be considered to be practically over for the time being, but there is every probability
that after a temporary period of apparent absence it will break out again. In Bombay, on the other hand, there has not been a clear interval from the time the epidemic first started and the city returns for the past week show 45deaths. Notwithstanding the continuance of the disease in the Punjab it seems to lack virulence and only a few villages are affected. In fact, it can hardly be said that the. Punjab has been seriously invaded at all. The Southern Mahratta country, which has borne the brunt of the epidemic, is again showing signs of distress, and as there has now been a comparatively free interval for some time it, would not be surprising if a recrudescence of the epidemic occurred in this district. One item in the complete report of the German Plague Commission oalls for comment. That report attributes theexemption of the white population to the greater protection afforded by their clothing and it states that the evidence seems to show that it is usually abrasions or perforations of’ the skin even of the most insignificant character that. afford the plague bacillus an entry into the body, whereas the poison is much less readily absorbed through the lungs or the digestive organs. In answerto this it may be stated that abrasions of the skin have been most carefully looked for and investigated and only in a very small proportion of cases has it been, thought possible that the plague bacillus could have found entry by these means. Moreover, the glands of the groin are as. often affected among the white population who clothe theirfeet and legs as among the native population. There is. hardly a single instance to indicate that the poison was absorbed through the digestive organs and the small number of nurses, attendants, ward boys, and relatives and friends of patients who have been attacked shows that it can. seldom be taken in through the lungs. The local inoculation theory would be an easy explanation for the spread of thedisease if it could be shown that it was generally true. At thepresent time only a few cases can be explained on this hypothesis. It must be admitted that the means of spread forthe majority of cases are unknown. Why some villages have been decimated, why the large cities have been attacked at the rate roughly of 1 in 40 of the population, and why other places have escaped lightly are problems which remain to be discovered and are not disposed of by the theory of local inoculation. Dr. Galeotti, who has been working in Bombay with. Professor Lustig’s serum, complains in a letter published’ in THE LANCET of June 17th that I have incorrectly described his opinion about the value of the serum. 1 assert, as I have reported before, that the statistics pub-lished concerning the serum are not only valueless but misleading. The cases were picked and from these picked’ cases certain statistics were compared with the total3 returns of the plague hospitals. The system is unscientific. Dr. Galeotti once more asserts the low mortality of histreated cases as compared with the non-treated patients,. It but he does not say that he selected his cases. has been found that about 33 per cent. of admissions to the large plague hospitals die within 24 hours and that about 50 per cent. die within 48 hours. Moribund as" well as other cases were not treated by Lustig’s serum, so. that there is no wonder his mortality is only 53 per cent. The mortality of the plague hospitals is about 79 per cent., so that if the moribund cases are excluded and those that, die within the 24 hours the percentage of mortality would beactually lower than that recorded for the serum treated I repeat that a fair comparison has not beetv cases. instituted with treatment on other lines. Julv 6th.
AUGUST BANK HOLIDAY
Cheap tickets
ON THE
CONTINENT.-
will be issued to Brussels, available for eight. days, vid Harwich and Antwerp. Passengers leaving London in the evening reach Brussels next morning after a night’s. rest on board the steamer. For visiting The Hague, Amsterdam, and other parts of Holland, the Rhine, North and South Germany, and Basle for Switzerland, special facilities are offered viti the Great Eastern Railway Company’s Royal’ Mail Harwich-Hook of Holland route, through carriages being run to Amsterdam, Berlin, Cologne and Basle, also’ restaurant cars on the North and South German express trains to and from the Hook of Holland. The General Steam Navigation Company’s fast passenger steamers will leave Harwich on August 2nd and 5th for Hamburg, returning on August 6th and 9th.