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SACRO-ILIAC SPRAIN.
1314
MENTAL NURSES.-"SMALL-POX AND VACCINATION."
up to the clavicle. The omo-hyoid muscle was divided and the whole subclavian triangle, internal jugular vein, and subclavian arch were cleaned. It was recognised that there was great danger of wounding the duct but there was no evidence of leakage. On the second day after the operation there was pain in the neck and on the fourth day there was a tumour and milky fluid leaked between the stitches. The wound was opened and packed with gauze. After four days the leakage ceased. Convalescence did not appear to have been affected.
sale of woollen fabrics containing arsenic in any quantity beyond a minute trace. The question remains, What is a minute trace7 The limit fixed is 0’0009 per cent. On one occasion a carpet was condemned because it contained onethousandth part of a grain of arsenic in 16 square inches. It is difficult to conclude that such a minute trace of arsenic could cause any harm, especially as it most likely exists, as we have just pointed out, in an insoluble and not easily volatilised form. It can hardly be concluded that a minute trace of arsenic which resists all attempts at extraction by powerful scouring processes can give rise to injury to health. The MENTAL NURSES. question is an important one and one which has given rise to considerable trouble in the English woollen trade. As THE care of patients sutlering from temporary or permafar as we know no definite evidence has been forthcoming of nent mental disorders is frequently a source of anxiety to been caused by the occurrence of this residual medical men, and the existence of institutions for the supply injury having trace of arsenic in wool. Obviously some limit should be of male and female attendants especially trained to nurse the amount and it seems to us that this could such cases supplies a great want. Many of the nursing placed upon be arrived at by estimating the average amount of institutions have on their staff nurses who have had the easily arsenic which remains in wool after repeated washing in required training, but their number is limited. Among the extractive agents. best conducted of the special institutions for the supply of strong mental nurses is the one known as the " Mental Nurses’ " SMALL-POX AND VACCINATION." Cooperation," the offices being situated at 1, New QuebecIT we is, believe, an open secret that the masterly article street, Portman-square, All the nurses, male and female, have been specially trained to the requirements of mental on small-pox and vaccination in the last number of the patients. Another favourable circumstance is that all the Edinburgh Review is from the able pen of Mrs. Garrett There is a peculiar appropriateness, nurses are total abstainers, this being most important Anderson, M.D. Paris. in cases of dipsomania where for obvious reasons it is an both of time and authorship, in the appearance of this article, advantage that the attendant should take no form of alcohol. coming as it does so closely on the heels of a paper on the Especially is this the case in travelling appointments where same subject in the March number of the Contemporaqy temptations to indulge in the prohibited beverages are Revie7v by Mrs. Anderson’s sister, Mrs. Fawcett. Rarely has particularly numerous. It is also useful to the practitioner so good an illustration of the natural sequence of the bane to know where a capable attendant can be at once procured and its antidote been presented to an observant world. And in cases of acute mania so that skilled treatment can be Mrs. Anderson’s article is the more welcome because, promptly applied until, should it be necessary, the patient as we happen to know, the editor of the Contemporary has to be removed to an asylum, and another condition in Review when approached with an offer of a reply in which such training is essential is that of delirium tremens his own columns to Mrs. Fawcett’s clever but insidious occurring in the well-to-do where home treatment can be attack on vaccination expressed his regret that he It is some years was unable to find room for one. carried out. since society was edified by the spectacle of the diverARSENIC IN WOOL. gencies of two gifted brothers, John Henry and Francis like Corydon and Thyrsis in the eclogue, THE question has been raised more than once in these Newman, who, eccntccre pares et respondere parati, so well enforced the fact columns as to the maximum quantity of arsenic which might that community of birth and early training is quite consistent be permitted in a given area of woollen material without with marked discrepancy of intellectual convictions in later injury to health. The occurrence of arsenic in undyed wool And the two no less gifted sisters who have thus in very minute quantities is referable, not to any process of years. descended into the eertamen magnum of the manufacture but to the fact that sheep require to be dipped recently vaccination controversy, which has hitherto been left to the in arsenical wash in order to destroy" tick." Other washes I rude struggle of male athletes, we may hope will succeed in free from arsenic are also employed but their effect does not infusing into it a courtesy of thrust and parry to which it has appear to be so satisfactory, for in addition to effectually des- been for the most part a stranger. troying parasites an arsenical dip improves the fleece. Unfortunately it is impossible by several scourings and by other SACRO-ILIAC SPRAIN. processes with which the elaboration of wool is concerned to remove absolutely the arsenic. It appears to adhere most AT the meeting of the Society Medicale des Hopitaux on tenaciously to the fabric and since it resists all attempts at March 10th Dr. Galliard called attention to this form of extraction by ordinary means the probability is that the sprain which is hardly recognised by surgeons. It is usually minute trace of arsenic thus left in the wool does not lead accompanied by sprain of the symphysis pubis. In 1896 to injury to health. The fact that the arsenic is held so Dr. Deshayes of Orleans described six cases under the title closely would seem to indicate that a compound is formed of "pelvic sprain." A man, aged 31 years, in making an which is quite insoluble in which, therefore, the arsenic has effort to lift a heavy cask felt an acute pain in the posterior been probably rendered non-injurious. It is, indeed, not part of the pelvis on the leftside accompanied by a kind of improbable that the trace which occurs is combined with the crackling in the same region. He fell down and had to be sulphur of the wool, and sulphide of arsenic is innocuous. carried home. On the following day he went to hospital and Wool is said to consist chiefly of an albuminoid sulphur- was cupped ; the diagnosis evidently was lumbago. He containing substance termed keratin, and it is not unreason- could walk only with great difficulty leaning on the arm of The pain was especially able to suppose that the residual trace of’ arsenic con- an attendant or on two sticks. tained in wool after the most drastic washing is the insoluble violent when he supported himself on his left leg. He could compound of arsenic with sulphur. If such be the case not sit ; in bed no position was comfortable and he could not there can be little objection to this excessively minute trace sleep. When examined on the fifth day the seat of pain was which can only be discovered by an exceedingly delicate definitely localised in the left sacro-iliac joint; pressure on chemical analysis. In Sweden there is a law against the all accessible points of this joint produced acute pain; -
___
) A MEDICAL HERO.-THE TREATMENT OF OPHTHALMIA NEONATORUM.
1315
nitrate of silver as a local remedy while he regards with no, favour the use of mercurial solutions. What is of at least. equal importance, he perceives the advantage of soothing. applications such as the compress of boric water and of avoiding superfluous manipulation in applying the caustic. The strength of this latter varies from 1 to 3 per cent, of distilled water. It is applied by M. Kalt on cotton-wool to the everted eyelids, but frequently also by means of a drop-tube. The use of the stronger solutions is followed as usual by washing with 5 per cent. salt solution. Instillation is a method less practised in. purulent ophthalmia than it deserves to be. It implies, of course, the use of weak lotions only and careful regulation of the frequency with which they are used, but it is of much service in the less advanced stages of the disease without corneal abrasion even where there is considerablepurulent discharge. It possesses, moreover, the advantage of obviating much manual interference with a tender and inflamed organ, and it may be employed by a mother or nurse under medical supervision. Irrigation with very weak of or lime-water solution is freely potash permanganate A MEDICAL HERO. in this direction. M. who further Kalt, employed by goes HEROISM is not, we are glad to say, uncommon, and very than most would care to follow him, bathing, practitioners possibly the most heroic deeds are those of which the least the affected conjunctiva by means of a special apparatus is heard. Golden deeds are done in various fields-in battle, with three-quarters of a litre at a time. In this part of his in shipwreck, in civil life, in plague-stricken cities, and treatment he certainly errs, in our opinion, on the side of. in the sick-room. As striking an instance as any thoroughness. recently reported came out owing "to the application of ’’ a lady to THE CONTROL OF THE MANUFACTURE OF presume the death of her father as MEAT PREPARATIONS. having been lost in the Stella. She and her father were standing on the deck and her father made an WE have been gratified to receive communications from appeal to some passengers in a boat to make room several well-known makers of meat extracts in which thefor his daughter. One man promptly climbed back on views which we expressed in an annotation in THE LANCET to the sinking ship and went down with her. No one of April 22nd as to the control of the manufacture of meat knows his name, but his example will surely never be lost preparations are fully endorsed. Indeed, we are glad to sight of. There was not much romance and no excitement learn that in many factories a staff of practical chemistsin this act to make it more easy for the unknown to risk his and food analysts is retained whose duty it is to test life. And this "accident"of non-romance and want of every batch of material by the best scientific methods. excitement is often specially notable in deeds of medical " Any plan to supplement these self-imposed precauheroism. Such acts are generally concerned with circumwrites one firm to us, " by a State-controlled tions," stances which to the lay mind would be positively repulsive of examination of food-stuffs in general would not system and which even to the trained professional man are, to only meet with no opposition on the part of manufacturers say the least of it, unpleasant. On May 3rd a man named of reputation but be welcomed as an official confirmation of’ John Menzies of Sunderland swallowed some phosphorus their statements to the public and would stamp out the purpaste in some beer. The police were informed and Mr. veyors of unfit material." Nothing could be more satisR. J. Burns was sent for and came armed with a stomach factory than this or could afford better assurance to thepump. The pump, however, was unfortunately out of public. It will be remembered that the recent proseorder and so Mr. Burns passed the tube and acted as a cutions upon which we based our arguments for the pump himself-i.e., he sucked the poisonous contents of necessity of control related to an incident in which it Menzies’s stomach through the tube with his own mouth. was shown that the purveyors of so-called "table Menzies recovered temporarily but has since died and Mr. delicacies"had a mass of putrid liver and offal on their Burns suffered from marked symptoms of phosphorus and was the inference irresistible. But in justice premises, poisoning but is now better. A more unpleasant or repulsive to the respectable makers of meat extracts properly so called thing to do we can scarcely conceive and the members of our it should be stated that the fate of this rotten material profession may well be proud of numbering Mr. Burns among would most probably have been paste in the form of what their number. the manufacturers are pleased to call " table delicacies," as pdt6 de foie gras, sausages, ham and chicken, THE TREATMENT OF OPHTHALMIA NEONATORUM. perhaps or even bloater paste. We do not believe that the true THE interest which is associated with the purulent oph-meat extracts on the English market are in any sense open thalmia of infants in the minds of most practitioners is notto reproach. Good wholesome meat is plentiful and cheaplikely soon to die out. It is true that its cause and effects,Ienough and the manufacture of meat essences and extracts as well as the principles of its treatment, are generally wellon I a liberal scale is a benefit of no mean importunderstood ; nevertheless, the subject still possesses in itsance to the profession and to the community at large. clinical aspect something even of the attraction of novelty. We still maintain that the Government should institute a. The reason for this is, no doubt, to be found in the fact that system of control calculated to stamp out meat pastes or method in management and the personal quality which "table delicacies" having the vile origin which we have develops this have much to do with the course and issue indicated, and to bring the productions of honest makers of the disease. It is mainly this fact that impresses the into the prominence which they deserve. reader of a paper published by M. Kalt in the Journal de THE house surgeons of St. Thomas’s Hospital who held Clinique et de ThérapeuUque Infantiles of April 27th. believes in of office the well-established reputation The writer during the period in which Sir William Mac Cormac also pain in the sacrum. There were no physical Lateral compression of the pelvis increased the pain.I signs. Rest in bed, antipyrin, and turpentine embrocations were prescribed. The patient rapidly improved and returned to work in a week. But the pain had not completely disappeared and was re-awakened by pressure on the joint and by movements. There were also radiated pains which extended to the popliteal space ; they manifested themselves when he stooped, sat down, knelt, or turned his foot to the left. If he sat for long he had pain on getting up. At the internal part of the left buttock a small ecchymosis was discovered. A month later there was no sacro-iliac tenderness but the patient complained of weakness in the lower limbs and of pain in the posterior parts of the thighs where there appeared to be some paresis of the muscles. A week later he could stand and walk without pain. Dr. Galliard thought that in addition to the sacro-iliac sprain there had been traction on some branches of the sacral plexus, a complication which had not been described by Dr. Deshayes. there
was
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MENTAL NURSES.-"SMALL-POX AND VACCINATION."
up to the clavicle. The omo-hyoid muscle was divided and the whole subclavian triangle, internal jugular vein, and subclavian arch were cleaned. It was recognised that there was great danger of wounding the duct but there was no evidence of leakage. On the second day after the operation there was pain in the neck and on the fourth day there was a tumour and milky fluid leaked between the stitches. The wound was opened and packed with gauze. After four days the leakage ceased. Convalescence did not appear to have been affected.
sale of woollen fabrics containing arsenic in any quantity beyond a minute trace. The question remains, What is a minute trace7 The limit fixed is 0’0009 per cent. On one occasion a carpet was condemned because it contained onethousandth part of a grain of arsenic in 16 square inches. It is difficult to conclude that such a minute trace of arsenic could cause any harm, especially as it most likely exists, as we have just pointed out, in an insoluble and not easily volatilised form. It can hardly be concluded that a minute trace of arsenic which resists all attempts at extraction by powerful scouring processes can give rise to injury to health. The MENTAL NURSES. question is an important one and one which has given rise to considerable trouble in the English woollen trade. As THE care of patients sutlering from temporary or permafar as we know no definite evidence has been forthcoming of nent mental disorders is frequently a source of anxiety to been caused by the occurrence of this residual medical men, and the existence of institutions for the supply injury having trace of arsenic in wool. Obviously some limit should be of male and female attendants especially trained to nurse the amount and it seems to us that this could such cases supplies a great want. Many of the nursing placed upon be arrived at by estimating the average amount of institutions have on their staff nurses who have had the easily arsenic which remains in wool after repeated washing in required training, but their number is limited. Among the extractive agents. best conducted of the special institutions for the supply of strong mental nurses is the one known as the " Mental Nurses’ " SMALL-POX AND VACCINATION." Cooperation," the offices being situated at 1, New QuebecIT we is, believe, an open secret that the masterly article street, Portman-square, All the nurses, male and female, have been specially trained to the requirements of mental on small-pox and vaccination in the last number of the patients. Another favourable circumstance is that all the Edinburgh Review is from the able pen of Mrs. Garrett There is a peculiar appropriateness, nurses are total abstainers, this being most important Anderson, M.D. Paris. in cases of dipsomania where for obvious reasons it is an both of time and authorship, in the appearance of this article, advantage that the attendant should take no form of alcohol. coming as it does so closely on the heels of a paper on the Especially is this the case in travelling appointments where same subject in the March number of the Contemporaqy temptations to indulge in the prohibited beverages are Revie7v by Mrs. Anderson’s sister, Mrs. Fawcett. Rarely has particularly numerous. It is also useful to the practitioner so good an illustration of the natural sequence of the bane to know where a capable attendant can be at once procured and its antidote been presented to an observant world. And in cases of acute mania so that skilled treatment can be Mrs. Anderson’s article is the more welcome because, promptly applied until, should it be necessary, the patient as we happen to know, the editor of the Contemporary has to be removed to an asylum, and another condition in Review when approached with an offer of a reply in which such training is essential is that of delirium tremens his own columns to Mrs. Fawcett’s clever but insidious occurring in the well-to-do where home treatment can be attack on vaccination expressed his regret that he It is some years was unable to find room for one. carried out. since society was edified by the spectacle of the diverARSENIC IN WOOL. gencies of two gifted brothers, John Henry and Francis like Corydon and Thyrsis in the eclogue, THE question has been raised more than once in these Newman, who, eccntccre pares et respondere parati, so well enforced the fact columns as to the maximum quantity of arsenic which might that community of birth and early training is quite consistent be permitted in a given area of woollen material without with marked discrepancy of intellectual convictions in later injury to health. The occurrence of arsenic in undyed wool And the two no less gifted sisters who have thus in very minute quantities is referable, not to any process of years. descended into the eertamen magnum of the manufacture but to the fact that sheep require to be dipped recently vaccination controversy, which has hitherto been left to the in arsenical wash in order to destroy" tick." Other washes I rude struggle of male athletes, we may hope will succeed in free from arsenic are also employed but their effect does not infusing into it a courtesy of thrust and parry to which it has appear to be so satisfactory, for in addition to effectually des- been for the most part a stranger. troying parasites an arsenical dip improves the fleece. Unfortunately it is impossible by several scourings and by other SACRO-ILIAC SPRAIN. processes with which the elaboration of wool is concerned to remove absolutely the arsenic. It appears to adhere most AT the meeting of the Society Medicale des Hopitaux on tenaciously to the fabric and since it resists all attempts at March 10th Dr. Galliard called attention to this form of extraction by ordinary means the probability is that the sprain which is hardly recognised by surgeons. It is usually minute trace of arsenic thus left in the wool does not lead accompanied by sprain of the symphysis pubis. In 1896 to injury to health. The fact that the arsenic is held so Dr. Deshayes of Orleans described six cases under the title closely would seem to indicate that a compound is formed of "pelvic sprain." A man, aged 31 years, in making an which is quite insoluble in which, therefore, the arsenic has effort to lift a heavy cask felt an acute pain in the posterior been probably rendered non-injurious. It is, indeed, not part of the pelvis on the leftside accompanied by a kind of improbable that the trace which occurs is combined with the crackling in the same region. He fell down and had to be sulphur of the wool, and sulphide of arsenic is innocuous. carried home. On the following day he went to hospital and Wool is said to consist chiefly of an albuminoid sulphur- was cupped ; the diagnosis evidently was lumbago. He containing substance termed keratin, and it is not unreason- could walk only with great difficulty leaning on the arm of The pain was especially able to suppose that the residual trace of’ arsenic con- an attendant or on two sticks. tained in wool after the most drastic washing is the insoluble violent when he supported himself on his left leg. He could compound of arsenic with sulphur. If such be the case not sit ; in bed no position was comfortable and he could not there can be little objection to this excessively minute trace sleep. When examined on the fifth day the seat of pain was which can only be discovered by an exceedingly delicate definitely localised in the left sacro-iliac joint; pressure on chemical analysis. In Sweden there is a law against the all accessible points of this joint produced acute pain; -
___
) A MEDICAL HERO.-THE TREATMENT OF OPHTHALMIA NEONATORUM.
1315
nitrate of silver as a local remedy while he regards with no, favour the use of mercurial solutions. What is of at least. equal importance, he perceives the advantage of soothing. applications such as the compress of boric water and of avoiding superfluous manipulation in applying the caustic. The strength of this latter varies from 1 to 3 per cent, of distilled water. It is applied by M. Kalt on cotton-wool to the everted eyelids, but frequently also by means of a drop-tube. The use of the stronger solutions is followed as usual by washing with 5 per cent. salt solution. Instillation is a method less practised in. purulent ophthalmia than it deserves to be. It implies, of course, the use of weak lotions only and careful regulation of the frequency with which they are used, but it is of much service in the less advanced stages of the disease without corneal abrasion even where there is considerablepurulent discharge. It possesses, moreover, the advantage of obviating much manual interference with a tender and inflamed organ, and it may be employed by a mother or nurse under medical supervision. Irrigation with very weak of or lime-water solution is freely potash permanganate A MEDICAL HERO. in this direction. M. who further Kalt, employed by goes HEROISM is not, we are glad to say, uncommon, and very than most would care to follow him, bathing, practitioners possibly the most heroic deeds are those of which the least the affected conjunctiva by means of a special apparatus is heard. Golden deeds are done in various fields-in battle, with three-quarters of a litre at a time. In this part of his in shipwreck, in civil life, in plague-stricken cities, and treatment he certainly errs, in our opinion, on the side of. in the sick-room. As striking an instance as any thoroughness. recently reported came out owing "to the application of ’’ a lady to THE CONTROL OF THE MANUFACTURE OF presume the death of her father as MEAT PREPARATIONS. having been lost in the Stella. She and her father were standing on the deck and her father made an WE have been gratified to receive communications from appeal to some passengers in a boat to make room several well-known makers of meat extracts in which thefor his daughter. One man promptly climbed back on views which we expressed in an annotation in THE LANCET to the sinking ship and went down with her. No one of April 22nd as to the control of the manufacture of meat knows his name, but his example will surely never be lost preparations are fully endorsed. Indeed, we are glad to sight of. There was not much romance and no excitement learn that in many factories a staff of practical chemistsin this act to make it more easy for the unknown to risk his and food analysts is retained whose duty it is to test life. And this "accident"of non-romance and want of every batch of material by the best scientific methods. excitement is often specially notable in deeds of medical " Any plan to supplement these self-imposed precauheroism. Such acts are generally concerned with circumwrites one firm to us, " by a State-controlled tions," stances which to the lay mind would be positively repulsive of examination of food-stuffs in general would not system and which even to the trained professional man are, to only meet with no opposition on the part of manufacturers say the least of it, unpleasant. On May 3rd a man named of reputation but be welcomed as an official confirmation of’ John Menzies of Sunderland swallowed some phosphorus their statements to the public and would stamp out the purpaste in some beer. The police were informed and Mr. veyors of unfit material." Nothing could be more satisR. J. Burns was sent for and came armed with a stomach factory than this or could afford better assurance to thepump. The pump, however, was unfortunately out of public. It will be remembered that the recent proseorder and so Mr. Burns passed the tube and acted as a cutions upon which we based our arguments for the pump himself-i.e., he sucked the poisonous contents of necessity of control related to an incident in which it Menzies’s stomach through the tube with his own mouth. was shown that the purveyors of so-called "table Menzies recovered temporarily but has since died and Mr. delicacies"had a mass of putrid liver and offal on their Burns suffered from marked symptoms of phosphorus and was the inference irresistible. But in justice premises, poisoning but is now better. A more unpleasant or repulsive to the respectable makers of meat extracts properly so called thing to do we can scarcely conceive and the members of our it should be stated that the fate of this rotten material profession may well be proud of numbering Mr. Burns among would most probably have been paste in the form of what their number. the manufacturers are pleased to call " table delicacies," as pdt6 de foie gras, sausages, ham and chicken, THE TREATMENT OF OPHTHALMIA NEONATORUM. perhaps or even bloater paste. We do not believe that the true THE interest which is associated with the purulent oph-meat extracts on the English market are in any sense open thalmia of infants in the minds of most practitioners is notto reproach. Good wholesome meat is plentiful and cheaplikely soon to die out. It is true that its cause and effects,Ienough and the manufacture of meat essences and extracts as well as the principles of its treatment, are generally wellon I a liberal scale is a benefit of no mean importunderstood ; nevertheless, the subject still possesses in itsance to the profession and to the community at large. clinical aspect something even of the attraction of novelty. We still maintain that the Government should institute a. The reason for this is, no doubt, to be found in the fact that system of control calculated to stamp out meat pastes or method in management and the personal quality which "table delicacies" having the vile origin which we have develops this have much to do with the course and issue indicated, and to bring the productions of honest makers of the disease. It is mainly this fact that impresses the into the prominence which they deserve. reader of a paper published by M. Kalt in the Journal de THE house surgeons of St. Thomas’s Hospital who held Clinique et de ThérapeuUque Infantiles of April 27th. believes in of office the well-established reputation The writer during the period in which Sir William Mac Cormac also pain in the sacrum. There were no physical Lateral compression of the pelvis increased the pain.I signs. Rest in bed, antipyrin, and turpentine embrocations were prescribed. The patient rapidly improved and returned to work in a week. But the pain had not completely disappeared and was re-awakened by pressure on the joint and by movements. There were also radiated pains which extended to the popliteal space ; they manifested themselves when he stooped, sat down, knelt, or turned his foot to the left. If he sat for long he had pain on getting up. At the internal part of the left buttock a small ecchymosis was discovered. A month later there was no sacro-iliac tenderness but the patient complained of weakness in the lower limbs and of pain in the posterior parts of the thighs where there appeared to be some paresis of the muscles. A week later he could stand and walk without pain. Dr. Galliard thought that in addition to the sacro-iliac sprain there had been traction on some branches of the sacral plexus, a complication which had not been described by Dr. Deshayes. there
was
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