RECOVERY FROM MALIGNANT ENDOCARDITIS.

845 will recognise with what truth the composer has succeeded, in representing nothing, especially in that part of the movement which is allotted to the pizzicato strings. Music, to those who know how to hear, brings home the higher activities of mentality better than any other medium and the psychologist and the thinker may find that abstractions become clear when presented to their minds by the joint art of composers, instrumentalists, and a conductor of such quality as are to be found at Queen’s Hall.

may spend the day under the supervision of some competent person. In Austria the society has done its best to check the spread of epidemic disease, as, for instance, by the provision in 1899 at Landskron (Prague) and Jadendorf (in Silesia) of accommodation and medical care for those suffering from typhus fever. The Spanish branch devotes itself to State hygiene-e.g., combating approaching epidemics by encouraging disinfection-and it has also on occasion brought succour to sufferers from floods and fires. One of the features of the work of the society in Switzerland is the establishment of an employment bureau for nurses, while in Italy the society has done much to check the mortality from malaria by founding in 1901 six ambulance corps to transfer cases from the malarial regions to the hospitals in Rome. Japan in 1883 took up the matter with characteristic thoroughness and its Red Cross has now 600,000 followers who come to the help of those affected by all public calamities whether earthquakes, floods, shipwrecks, railway accidents, or epidemic diseases. France with its colonies has a population of about 75,000,000 but only 120,000 persons among these display a practical interest in the humanitarian schemes of the three bodies which, without really constituting branches of the Red Cross Society, carry on its work. These bodies are : (1) the Societe de Secours aux Blesses’ des Armees, founded about 1864, the utility of which has been greatly impaired by internal dissensions ; (2) the Association des Dames Francaises, which was established in 1879 and from which split off in 1881 (3) the Union des Femmes de France. Dr. Laval’s paper is an earnest appeal to these different agencies to sink their jealousies for the common good and to combine in the construction of a charitable organisation which shall remove the reproach of selfish indifference to the woes of their fellows from the wealthier classes in France.

THE NEW DIRECTOR-GENERAL OF THE MEDICAL DEPARTMENT OF THE NAVY. THE Admiralty has issued the following notice :-" In-’ spector-General of Hospitals and Fleets Herbert Mackay Ellis has been appointed Director-General of the Medical Department of the Navy in the place of Sir Henry F. Norbury, K.C.B., R.N., whose term of office has expired. To date the 12th September, 1904." The new DirectorGeneral served with the battalion of Royal Marine Artillery throughout the campaign in Egypt in 1882, being at the two engagements at Kassassin and at the battle of Tel-el-Kebir. He was mentioned in despatches, promoted to the rank of staff-surgeon, and was awarded the medal with Tel-el-Kebir clasp and the Khedive’s bronze star. He was fleet-surgeon of the 17Victoria when she was rammed by the Camverdo7vn off Tripoli in June, 1893. His last appointment was that of inspector-general in charge of Haslar Hospital. We consider that the Royal Navy Medical Service is to be much congratulated upon this new appoint-

present

ment. ____

RECOVERY FROM

MALIGNANT ENDOCARDITIS.

THE following case, reported in the Boston Medical and Surgical Journal of July 28th by Dr. C. F. Withington, is of interest both because of the rarity of gonorrhceal endocarditis and because it is an example of recovery from THE APPRECIATION OF NOTHING. malignant endocarditis-the possibility of which has been IN the Middle Ages philosophers were acutely divided on questioned. A man, aged 26 years, was admitted to hospital the question as to whether things were really things or only on April 19th, 1904. A first attack of gonorrhoea began on Two weeks later he had measles. names-that is to say, whether they were something or March 8th. During nothing-and the late Lord Iddesleigh when Sir Stafford convalescence from the latter disease he was seized with Northcote once held a village audience in wrapt attention severe pain in the region of the heart and dyspnoea which while he delivered a lecture "On Nothing." The concep- lasted for four hours. Chills, irregular fever, sweating, and tion of nothing is as difficult for the finite mind cough followed and persisted up to the time of admission. as is that of infinite space and perhaps of all the Four days before admission he had pain in the left leg arts the one best adapted to express nothing is thewhich rapidly swelled and turned purple. On admission he highest of the fine arts-namely, music. During the presentj looked very ill. The temperature ranged from 102° to season of concerts at the Queen’s Hall Mr. Wood and his 103° F. and the pulse from 160 to 170 and there was magnificent band have given voice to the thoughts of orthopncea. Cardiac dulness extended three centimetres to three composers who in two cases purposely, and in L the right and 16 centimetres to the left of the middle line. one case apparently, have striven to represent nothing. TheA presystolic thrill was felt below the nipple but no apparent case was a composition by M. Claude Debussy, a murmur was heard at the apex. A short systolic leader in the most modern French school of composition. murmur was heard in the left fourth intercostal space. His " Après midi d’un Faune" goes as near to the audible There was "gallop rhythm." At the bases of the lungs expression of a day-dream as anything audible can, althoughwere limited areas of consolidation. There was marked what a faun, which is not a gazelle, as the critic of a contem- phlebitis of the left leg throughout. The left calf measured porary believes, does think about we should say that no) three inches more than its fellow and the tLigh was only a one knows. Of the other two pieces that by Sir Edwardl little less swollen. There was marked tenderness over the is founded Elgar upon a passage of Lamb which occurs3 popliteal and femoral veins. A leucocytosis of 16,200 was in the essay, "Dream Children,"and which runs: "Wepresent. During the next few days the action of the heart ____

.

,

,

,

.

are not

of

Alice,

nor

of thee,

nor

are

we

children atb

grew less

tumultuous, the

murmur

became

more

distinct,

all........ We are nothing; less than nothing, and dreams. and the pulmonary second sound increased. The temperaWe are only what might have been." The third pieceture ranged between 101° and 103°. Blood taken from the is the amazing scherzo movement from the Fourthi bend of the elbow on April 25th yielded a culture of the Symphony by Tchaikowski of which the composer givess gonococcus, confirming the view that the endocarditis was his own interpretation thus: "In the third movementb gonorrhoeal. The temperature became normal on the 28th no definite feelings find expression. These are butb and two days later the phlebitis was less distinct. On thinks of nothing....... TheseMay 8th the murmur was still present but there were no other capricious arabesques. One are the incoherent pictures which float before the fancycardiac symptoms and the area of cardiac dulness was in fair health divorced from reality." Anyone who hears this movement diminished. Early in June the patient w&s .

846 still heard but the areas of which were thought to be embolic, consolidation, resolved. the

murmur was

___

pulmonary cyanotic, the extremities cold, the pulse weak and rapid, nearly and the expression anxious. She gradually became comatose and died 48 hours after operation. A peculiar sweet odour

were

from the breath led to examination of the urine for acetone’ and diacetic acid which were found. On Dec. 17th two girls with extensive infantile paralysis, aged six and eight years. A brochure on "Ambulance in Civil Life"is again pubOne began to vomit after six were admitted. lished as a sixth edition of the addressdelivered in 1881 respectively, Both became stupid; hours and the other after 15 hours. by Mr. Reginald Harrison as President of the Liverpool there was an odour of acetone from the breath and the urineThe present issue, however, conMedical Institution. and diacetic acid. Both recovered. On contained acetone tains an account of the efforts that are being made by the Dec. 26th a girl, aged four years, was admitted. For six Metropolitan Street Ambulance Association to secure for the she bad been vomiting and the bowels had not acted. County and City of London an improved ambulance service. days The odour of acetone in the breath was very strong and To this end we wish it every success and hope that what was found in the urine. Intestinal obstruction acetone was suggested many years back by the Hon. Francis D. a caused Meckel’s diverticulum was relieved by operation. Leigh in the Nineteenth Century and by Mr. S. Osborn After by recovering from the operation she became unconscious of the St. John Ambulance Brigade will eventually be realised. Without entering into prolonged details and died at the end of 26 hours. Subsequently a sweet odour of what has been done and what is required great from the breath was noticed in a number of patients after credit should be given to Sir John Furley who was operation and acetone was found in the urine. In most of the first to organise any work of this description in them vomiting occurred and some of them showed marked the streets of London. The Metropolitan Corps of the prostration. Only one case was fatal. In the fatal cases St. John Ambulance Brigade with its able body of volunteer the necropsies showed some fatty degeneration of the liver, workers was started 25 years ago and the present chief sur- kidneys, and muscles. Death after anaesthesia with acetonuria has been previously recognised. In 1894 Becker regeon, Mr. S. Osborn, with Mr. J. Brasier and Mr. W. H. Morgan, who then assisted Sir John Furley in his first efforts, still ported from the Bonn clinic three fatal cases after operacontinue to render good service in the streets on all public tion on diabetic subjects whose condition previously had occasions, and with them must rest the honour of being the not caused any apprehension. Brewer in the Annals of first workers in a cause which we should like to see per- Surgery for October, 1902, reported a fatal case of acetonIn THE LANCET fected for constant service by incorporation with some such uria after operation for appendicitis. of Dr. L. G. Guthrie 1903, 10, 4th, July p. published an. body as the Metropolitan Fire Brigade. Of course this article entitled The Fatal Effects of Chloroform on Children would mean the supplementing of that admirable body of a Peculiar Condition of Fatty Liver." The from Suffering workers by a sufficient number of men, horses, and ambuof resembled those the cases described above. He symptoms lances to deal efficiently with the task, but this scheme has that death was due to auto-intoxication brought thought already been fully considered by the Metropolitan Street about three factors--the fatty condition of the liver, the by Ambulance Association.t shock of the operation, and the chloroform. The phenomena of acid auto-intoxication apart from diabetes has been ACETONURIA AND DEATH AFTER studied by von Jaksch, Lorenz, Baginsky, and others. IN the Boston Medical and Surgical Jo2crnczl of July 7th Becker found that after anesthesia in healthy persons a Dr. E. G. Brackett, Dr. J. S. Stone, and Dr. H. C. Low have distinct amount of acetone was present in the urine. But in reported a series of cases observed at the Children’s Hospital, one of the fatal cases now reported and in some of the milder Boston, in which death occurred in peculiar circum- ones the symptoms occurred without operation or auaesthesia. stances. On Oct. 6th, 1903, a boy, aged 10 years, suffering Perhaps the effects on the nervous system of admission ta from infantile paralysis but otherwise apparently well, was hospital-home-sickness, dread of operation, and so on-may admitted. Four days later he began to vomit persistently have affected the metabolism and produced acetonuria. In light green fluid. The bowels had acted freely and the addition to stimulants, bicarbonate of soda was given to abdomen was soft and not distended. The pulse became combat the acid intoxication and seemed to have a beneficial very weak and rose to from 90 to 150 and the temperature effect. Very little is known of acid intoxication and the rose to 105.8° F. He became unconscious and died 20 hours whole subject, as well as its relation to the administration of after the onset of the symptoms. On the same day a girl, chloroform, obviously requires further investigation. aged eight years, was admitted also suffering from infantile paralysis. She seemed delicate but otherwise was sound in ACTION OF RADIUM ON FROGS AND MICE. health. Several times in the preceding year she had had Dr. E. C. London of St. Petersburg, whose early experiattacks of persistent vomiting with collapse. Four days after admission three tendon transplantations were done ments with radium are well known, has, according to ther nnder ether. The operations occupied one and a half Pharmatzevtitcheski Journal, published a work giving details hours and were not severe or attended by haemorrhage. of his latest investigations, having as their object the The child took the ether badly and during the operation had elucidation of the action of radium on animal life. One of 12 hours after recovering from the anaesthetic them was as follows. A solution of radium bromide was, a rapid pulse. she seemed in fair condition. Then she suddenly began to placed in a retort connected by tubing with another glass In the second vomit persistently. The pulse became weak and rose to vessel, both of them being stoppered. 190 and the temperature rose to 106°. The vomiting lasted reservoir he kept live animals, generally frogs or mice, about 30 hours. She gradually sank into a delirious stupor which were preserved from suffocation during the experiand died 42 hours after operation. Six weeks later, on ments by means of the periodical admission of fresh air. Nov. 17tb, a girl, aged five and a half years, with extensive It was found that frogs placed in a vessel with water infantile paralysis had the fascia on the upper and outer in which radium emanations were diffused became part of both thighs divided. She recovered well and was flabby and dull; in six or seven days their breathing comfortable up to 13 hours after the operation. Then she became troubled and their skin showed want of freshbegan to vomit. 24 hours after operation the face became ness. These symptoms became more and more accentuated up to the thirteenth or fourteenth day, when the’ animals 1 THE died. Flakes from their skin floated in the water. On being’ LANCET, May 14th, 1904, p. 1365.

THE AMBULANCE IN CIVIL LIFE.

___

ANÆSTHESIA.

THE