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SCHOOL HYGIENE IN ITALY.
643
thus to
ment of suitable remedies, and was then laid on the operating table and a long incision made into the scrotum, a quantity os
sepsis. The bougie was removed when the dilated, if the membranes ruptured, or if there of blood coagula being turned out. The tunica vaginalis con- was hæmorrhage or severe pain, and at all events after tained a small quantity of brownish liquid, the inner sur- the lapse of twenty-four hours, this last being advisable face of the sac being whitish and presenting the appearance from an aseptic point of view. Before its reintroduction of having been cauterised. The testicle was then excised, the patient was encouraged to go to stool and to empty the and the patient ultimately made a good recovery. The bladder, after which a perfectly fresh bougie was introduced. explanation of the disastrous incident in this case was found to be that the
man was
of
a
haemorrhagic diathesis.
"STEAMING" IN LANCASHIRE MILLS. AN important conference has been held at the Westminster Palace Hotel, where working-men representatives of the spinning and weaving trades met members of Parliament and others specially interested in the Lancashire industries. The united factory workers had elected a legislative committee, and Mr. Mawdsley, its president, pointed out that, though they had no wish to dictate, still the time had undoubtedly come for action. Mr. Birtwistle stated that in about 30 per cent. of the whole weaving trade damping and sizing to an injurious extent was the practice, and he added that the operatives were willing to submit to a reduction of wages if their work could be rendered more healthy. It was ultimately agreed that a committee of seven members of Parliament and seven operatives should be appointed to frame the draft of a Billfor the purpose of dealing with such employment of steam in weaving sheds as is injurious to the employés therein." This is undoubtedly a step in the right direction, as all medical evidence goes to show that work in damp, over-heated mills, with the atmosphere heavily charged with sizing, must be most injurious to the workers. The change of conditions experienced on reaching the street after a day’s work in the damp heat of the mill is often productive of serious mischief ; and the workpeople, who are the principal sufferers, are only obeying the first law of nature-the law of self-defence-when they raise this question. Nor could it have been possible for them to move in a more orderly and constitutional manner, and their efforts have met with a warm response. Theworkers and the public are to be congratulated on this favourable result.
In
was
set up
well
where the bougie did not succeed in inducing labour, puncture of the membranes was resorted to. The author is disposed to ascribe the occasional failure of the bougie to the rigour of the antiseptic measures now practised. In former times, when similar precautions were not employed, he thinks the plan very rarely failed, as there was sure to be some septic matter introduced by the nondisinfected instrument, and this of itself was enough to set up the commencement of labour. Of the twenty-eight cases there was only one case of death of the mother, and that was from Bright’s disease. Of the twenty-nine childrenfor one was a case of twins,-eight were stillborn, and in four of these cases the mothers had habitually borne dead children, the post-mortem examination showing the cause to be due to syphilis. In consequence of the very partial success obtained in saving the children in the cases of contracted pelvis, Dr. Strauch remarks that probably Caesarean section would have given them a better chance. cases
SCHOOL HYGIENE IN ITALY.
PROFESSOR Guiro BACCELLi, President of the Accademia Medica di Roma, has accepted the portfolio of Public Instruction in Signor Crispi’s newly formed cabinet ; and all Italians who are interested in State Medicine are looking forward to his tenure of office as of good omen for the cause they have at heart. In the new sanitary code there it an is, seems, extraordinary omission-the absence, that of all is, provision for the hygienic rehabilitation and surveillance of schools. On the Supreme Sanitary Council medical men are very strongly and very properly represented, both as to number and ability; but surely, say Italian hygienists, among the engineers, chemists, naturalists, veterinarians, and lawyers there might have been found room for the practical educationist, for some representative of the Ministry of Public Instruction. How is it, they ask, that amid the minute provisions for the physical and moral wellINDUCTION OF PREMATURE LABOUR. being of adult age, not a thought seems to have been IN the Institute of the Moscow Foundling Hospital there bestowed on childhood and puberty ? Nowhere, they were 54,088 deliveries during the years 1872-1887, of which say, has the code taken account of the duty incumbent on for were induced. The reasons the the State of providing for the harmonious development of artificially twenty-eight were in cases contracted in the pelvis, operation twenty-one body pari passu with the mind. There is ample prethree Bright’s disease, and in four habitual bearing of still- caution taken against the premature employment of juvenile born children. The methods employed were-the faradaic labour, but not a single measure is hinted at for the regulacurrent once, the introduction of Braun’s colpeurynter tion of school hours, examinations, out-door exercises, or twice, the injection of pilocarpine three times (all unsuc- "holiday homes." The framers of the code seem to have cessfully), puncture of the membranes six times, Kiwisch’s inadequately followed up the large-minded conceptions of forcible douche directed against the cervix twenty times, its initiator Bertani, and this the less excusably, as quite and the introduction and retention of a bougie twenty- recently-at the Congresso Freniatrico (or Medico-Psychosix times. In several of the cases one method after logical Congress) at Voghera, for instance-the necessity another had to be tried. The cervical douche was not by for a more scientific, more physiologically inspired training any means always successful, and where it was not and of the young has been discussed and embodied in urgent the bougie had subsequently to be introduced, Dr. Strauch, resolutions. At the Congress above referred to the most the author of the report, states that he found it had interesting paper was that on " L’Educazione nella Prothe effect of lowering the irritability of the uterine nerves, filassi della Pazzia" ("Education in its Prophylactic Relaso that it was impossible to get the bougie to induce tions to Insanity "), and in the discussion it evoked the satisfactory pains. Before introducing the bougie he was leading physicians present were unanimous in their concluvery careful to have the uterus thoroughly washed out by sion that no sanitary code could be adequate to the wants of means of a disinfecting solution: if the instrument passed the nation which omitted the hygienic surveillance of schoola in to nearly its whole length, it was secured by means of a and their periodic inspection by the medically qualified eduplug in the vagina; if not, a piece of thread was tied to it cationist. Over-pressure is a danger to which Italy, in her. which was fastened to the body. Dr. Strauch objects to laudable straining to make up for lost ground in the race of the knee-elbow position for the introduction, as being public instruction, is peculiarly exposed, and it was from a likely to favour the passage of air into the vagina, and well-advised prevision of her risks in that direction that the
644
Voghera Congress gave special prominence to the physical and mental lesions uncorrected and even contracted at school. Italy has no more accomplished or public-spirited sanitarian than Dr. E. P. Paolini, and he has just been reinforcing his brother hygienists of the Alta Italia with a remonstrance of his own addressed to the framers of the Codice Igienico. Before that enactment becomes law, he suggests, let it include a State-controlled inspection of infant schools and primary institutions; let it bring the provincial medical staff into direct relation with the scholastic sr.soM.K.g’ and let it frame whatever regulations it thinks fit for the avoidance of friction between the medical and the teaching authority. Finally, in the composition of the Provincial as in that of the Central Council of State Hygiene, let the scholastic administrator be represented. Education on a national scale should possess national guarantees for its efficiency, and the omission of such guarantees as bear upon the health and the harmonious development, bodily and mental, of the child at school is undoubtedly a grave blot on the newly framed code for Italy. In Dr. Baccelli as Minister of Public Instruction our Italian brethren are well warranted in confiding, as in one who is enlightened enough to see that no prescription of State Medicine will be overlooked in his department, and who is patriot enough to spare no effort to bring the educational system of his country up to the level so honourably maintained by Germany and Switzerland.
Italians are rather fond, on such occasions, of finding an English origin for the outbreak, and certain recent arrivals from Bombay are darkly hinted at as not extraneous to the importation of the malady. But for this surmise I am informed by those in possession of the facts there is not the slightest foundation, and the symptoms may turn out to be caused by some agency much less serious than the dreaded cholerigenous germ. As I write I am told a necropsy is being performed on one of three cases which have terminated fatally, and the results of this, with those of the investigations instituted into the food recently consumed by the patients and into the culinary treatment of the same, will satisfy the profession as to whether or not it is in presence of a genuine manifestation of the Asiatic disease."
MEDICAL CONGRESS AT WIESBADEN.
Congress fiir innere Medicin " takes place April 15th to 18th. Professor von Liebermeister of Tiibingen will preside, and on the first day a discussion upon Ileus and its treatment will be opened by Drs. Curschmann (Leipsic) and Leichtenstern (Cologne). The other subject for general debate is the Nature and Treatment of Gout, which will be opened by Drs. Ebstein (Gottingen) and Emil Pfeiffer (Wiesbaden). Amongst the papers promised are : On the Gastric Functions in Tubercular Phuhisis, by Dr. Immermann (Basle); on Hippocratic Therapeutics, by Dr. Petersen (Copenhagen); on Virile Impotency, by Dr. Fiirbringer (Berlin); on the Preparation and Action of Remedies, by Dr. L. Lewin (Berlin); on Electric Massage, NOCTURNAL MEDICAL EDUCATION. IT is said that no less than from 10 to 15 per cent. of by Dr. Mordliorst (Wiesbaden) ; on Cardiac Dyspnoea, by Dr. medical students in Dublin pursue their medical studies von Basch (Marienbad); on Dilatation of the Stomach and and attend their prescribed courses of lectures at night. its Treatment, by Dr. Klemperer (Berlin); a Demonstration They stick to their business or desk during the day and of Carcinomas artificially produced by Inoculation, by Dr. become medical students at night, with such accommodation Hanau (Zurich); on Air-swillowing, by Professor Quincke as some schools in Dublin provide for them. We cannot (Kiel); on Recent Methods of Treatment of Laryngeal think that such a system is one of true medical education, Tuberculosis, by Dr. H. Krause (Berlin); Tissue Metabolism such as the Medical Council contemplates or could reco- in Cancer, by Dr. F. Muller (Berlin); Rheumati3m and Gout, by Dr. M. Friedlander (Leipsic); and gnise. Four years for the medical curriculum is all too little, Articular on Decrease of Pressure in the Cardiac Cavities Researches and it certainly does not mean that students are to divide and Arteries by Dr. Krehl (Leipsic). their time between commerce and medicine. If such a system were pursued in the United States, it would meet
with severe criticism from all medical educationists here. We do not see that it should be treated with more indulgence because it happens to be a Dublin one. There are instances in other schools of men snatching time to go through the form of studying medicine while engaged in business. But it is not found to answer. And where it is done on a scale that amounts to a system, as in Dublin, it needs attention from the medical authorities, both local and central.
THE
eighth annual
"
at Wiesbaden from
ROGERS’S URETHROTOME.
THIS instrument, which is made by Messrs. Tieman & Co., brought before the Tri-state Medical Association of Mississippi, Arkansas, and Tennessee some four years ago ; and Dr. Rogers brings its meritsl before the profession again after further trial in more than 100 cases. By this instrument a bulb can be formed behind the stricture, not larger a No. 4 at the time of introduction, but capable of increase to the full size of the urethra at any point, the exact measurement being recorded on a dial at the handle CHOLERA PANIC IN FLORENCE. of the instrument. A filiform guide is employed, and the A FLORENTINE CORRESPONDENT, under date March 23rd, instrument follows it easily. It is a urethrotome which writes :-" Considerable alarm was caused throughout the dilates whilst incising. The shaft, which is six inches city on its becoming known that on the night of the 21st has an average diameter of a No. 4 catheter, diminishlong, and 22nd inst. the inmates of the hospitals Bonifazio and Santa Lucia were, to the number of sixty, attacked with ing at the curve to a No. 3. It consists of two cylinders, a solid one, with ring handle. Along the curve the two severe vomiting and diarrhoea, and that three of them had died. The English-speaking colony, which is estimated to cylinders become solid half cylinders, with their flat be at this moment between four and five thousand, was surfaces opposed, thus forming a solid whole cylinder. When the instrument has been passed well into the especially uneasy at the announcement, knowing as it does bladder the hollow cylinder is rotated, causing a separation that such explosions of disease are generally worse than of the two half cylinders of the curve, thus forming (in the they are allowed to appear, the authorities, for reasons more a skeleton bulb of any desirable diameter up to bladder) obvious than creditable, being in the habit of concealing the facts till these become too flagrant for official reticence. that of the full-sized urethra. The size of this bulb is indicated on the metre-plate. This forms a wedge which Inquiries are now in progress on the part of the Pubblica stretches the stricture. The blade lies concealed and the Communal Sicurezza and Council, and in a few days sheathed between the two half cylinders of the curve, and of this the nature and choleraic ____
gravity
seemingly
was
I than
explosion
will be made known under competent professional authority.
1
New York Medical
Journal,
1888.
thus to
ment of suitable remedies, and was then laid on the operating table and a long incision made into the scrotum, a quantity os
sepsis. The bougie was removed when the dilated, if the membranes ruptured, or if there of blood coagula being turned out. The tunica vaginalis con- was hæmorrhage or severe pain, and at all events after tained a small quantity of brownish liquid, the inner sur- the lapse of twenty-four hours, this last being advisable face of the sac being whitish and presenting the appearance from an aseptic point of view. Before its reintroduction of having been cauterised. The testicle was then excised, the patient was encouraged to go to stool and to empty the and the patient ultimately made a good recovery. The bladder, after which a perfectly fresh bougie was introduced. explanation of the disastrous incident in this case was found to be that the
man was
of
a
haemorrhagic diathesis.
"STEAMING" IN LANCASHIRE MILLS. AN important conference has been held at the Westminster Palace Hotel, where working-men representatives of the spinning and weaving trades met members of Parliament and others specially interested in the Lancashire industries. The united factory workers had elected a legislative committee, and Mr. Mawdsley, its president, pointed out that, though they had no wish to dictate, still the time had undoubtedly come for action. Mr. Birtwistle stated that in about 30 per cent. of the whole weaving trade damping and sizing to an injurious extent was the practice, and he added that the operatives were willing to submit to a reduction of wages if their work could be rendered more healthy. It was ultimately agreed that a committee of seven members of Parliament and seven operatives should be appointed to frame the draft of a Billfor the purpose of dealing with such employment of steam in weaving sheds as is injurious to the employés therein." This is undoubtedly a step in the right direction, as all medical evidence goes to show that work in damp, over-heated mills, with the atmosphere heavily charged with sizing, must be most injurious to the workers. The change of conditions experienced on reaching the street after a day’s work in the damp heat of the mill is often productive of serious mischief ; and the workpeople, who are the principal sufferers, are only obeying the first law of nature-the law of self-defence-when they raise this question. Nor could it have been possible for them to move in a more orderly and constitutional manner, and their efforts have met with a warm response. Theworkers and the public are to be congratulated on this favourable result.
In
was
set up
well
where the bougie did not succeed in inducing labour, puncture of the membranes was resorted to. The author is disposed to ascribe the occasional failure of the bougie to the rigour of the antiseptic measures now practised. In former times, when similar precautions were not employed, he thinks the plan very rarely failed, as there was sure to be some septic matter introduced by the nondisinfected instrument, and this of itself was enough to set up the commencement of labour. Of the twenty-eight cases there was only one case of death of the mother, and that was from Bright’s disease. Of the twenty-nine childrenfor one was a case of twins,-eight were stillborn, and in four of these cases the mothers had habitually borne dead children, the post-mortem examination showing the cause to be due to syphilis. In consequence of the very partial success obtained in saving the children in the cases of contracted pelvis, Dr. Strauch remarks that probably Caesarean section would have given them a better chance. cases
SCHOOL HYGIENE IN ITALY.
PROFESSOR Guiro BACCELLi, President of the Accademia Medica di Roma, has accepted the portfolio of Public Instruction in Signor Crispi’s newly formed cabinet ; and all Italians who are interested in State Medicine are looking forward to his tenure of office as of good omen for the cause they have at heart. In the new sanitary code there it an is, seems, extraordinary omission-the absence, that of all is, provision for the hygienic rehabilitation and surveillance of schools. On the Supreme Sanitary Council medical men are very strongly and very properly represented, both as to number and ability; but surely, say Italian hygienists, among the engineers, chemists, naturalists, veterinarians, and lawyers there might have been found room for the practical educationist, for some representative of the Ministry of Public Instruction. How is it, they ask, that amid the minute provisions for the physical and moral wellINDUCTION OF PREMATURE LABOUR. being of adult age, not a thought seems to have been IN the Institute of the Moscow Foundling Hospital there bestowed on childhood and puberty ? Nowhere, they were 54,088 deliveries during the years 1872-1887, of which say, has the code taken account of the duty incumbent on for were induced. The reasons the the State of providing for the harmonious development of artificially twenty-eight were in cases contracted in the pelvis, operation twenty-one body pari passu with the mind. There is ample prethree Bright’s disease, and in four habitual bearing of still- caution taken against the premature employment of juvenile born children. The methods employed were-the faradaic labour, but not a single measure is hinted at for the regulacurrent once, the introduction of Braun’s colpeurynter tion of school hours, examinations, out-door exercises, or twice, the injection of pilocarpine three times (all unsuc- "holiday homes." The framers of the code seem to have cessfully), puncture of the membranes six times, Kiwisch’s inadequately followed up the large-minded conceptions of forcible douche directed against the cervix twenty times, its initiator Bertani, and this the less excusably, as quite and the introduction and retention of a bougie twenty- recently-at the Congresso Freniatrico (or Medico-Psychosix times. In several of the cases one method after logical Congress) at Voghera, for instance-the necessity another had to be tried. The cervical douche was not by for a more scientific, more physiologically inspired training any means always successful, and where it was not and of the young has been discussed and embodied in urgent the bougie had subsequently to be introduced, Dr. Strauch, resolutions. At the Congress above referred to the most the author of the report, states that he found it had interesting paper was that on " L’Educazione nella Prothe effect of lowering the irritability of the uterine nerves, filassi della Pazzia" ("Education in its Prophylactic Relaso that it was impossible to get the bougie to induce tions to Insanity "), and in the discussion it evoked the satisfactory pains. Before introducing the bougie he was leading physicians present were unanimous in their concluvery careful to have the uterus thoroughly washed out by sion that no sanitary code could be adequate to the wants of means of a disinfecting solution: if the instrument passed the nation which omitted the hygienic surveillance of schoola in to nearly its whole length, it was secured by means of a and their periodic inspection by the medically qualified eduplug in the vagina; if not, a piece of thread was tied to it cationist. Over-pressure is a danger to which Italy, in her. which was fastened to the body. Dr. Strauch objects to laudable straining to make up for lost ground in the race of the knee-elbow position for the introduction, as being public instruction, is peculiarly exposed, and it was from a likely to favour the passage of air into the vagina, and well-advised prevision of her risks in that direction that the
644
Voghera Congress gave special prominence to the physical and mental lesions uncorrected and even contracted at school. Italy has no more accomplished or public-spirited sanitarian than Dr. E. P. Paolini, and he has just been reinforcing his brother hygienists of the Alta Italia with a remonstrance of his own addressed to the framers of the Codice Igienico. Before that enactment becomes law, he suggests, let it include a State-controlled inspection of infant schools and primary institutions; let it bring the provincial medical staff into direct relation with the scholastic sr.soM.K.g’ and let it frame whatever regulations it thinks fit for the avoidance of friction between the medical and the teaching authority. Finally, in the composition of the Provincial as in that of the Central Council of State Hygiene, let the scholastic administrator be represented. Education on a national scale should possess national guarantees for its efficiency, and the omission of such guarantees as bear upon the health and the harmonious development, bodily and mental, of the child at school is undoubtedly a grave blot on the newly framed code for Italy. In Dr. Baccelli as Minister of Public Instruction our Italian brethren are well warranted in confiding, as in one who is enlightened enough to see that no prescription of State Medicine will be overlooked in his department, and who is patriot enough to spare no effort to bring the educational system of his country up to the level so honourably maintained by Germany and Switzerland.
Italians are rather fond, on such occasions, of finding an English origin for the outbreak, and certain recent arrivals from Bombay are darkly hinted at as not extraneous to the importation of the malady. But for this surmise I am informed by those in possession of the facts there is not the slightest foundation, and the symptoms may turn out to be caused by some agency much less serious than the dreaded cholerigenous germ. As I write I am told a necropsy is being performed on one of three cases which have terminated fatally, and the results of this, with those of the investigations instituted into the food recently consumed by the patients and into the culinary treatment of the same, will satisfy the profession as to whether or not it is in presence of a genuine manifestation of the Asiatic disease."
MEDICAL CONGRESS AT WIESBADEN.
Congress fiir innere Medicin " takes place April 15th to 18th. Professor von Liebermeister of Tiibingen will preside, and on the first day a discussion upon Ileus and its treatment will be opened by Drs. Curschmann (Leipsic) and Leichtenstern (Cologne). The other subject for general debate is the Nature and Treatment of Gout, which will be opened by Drs. Ebstein (Gottingen) and Emil Pfeiffer (Wiesbaden). Amongst the papers promised are : On the Gastric Functions in Tubercular Phuhisis, by Dr. Immermann (Basle); on Hippocratic Therapeutics, by Dr. Petersen (Copenhagen); on Virile Impotency, by Dr. Fiirbringer (Berlin); on the Preparation and Action of Remedies, by Dr. L. Lewin (Berlin); on Electric Massage, NOCTURNAL MEDICAL EDUCATION. IT is said that no less than from 10 to 15 per cent. of by Dr. Mordliorst (Wiesbaden) ; on Cardiac Dyspnoea, by Dr. medical students in Dublin pursue their medical studies von Basch (Marienbad); on Dilatation of the Stomach and and attend their prescribed courses of lectures at night. its Treatment, by Dr. Klemperer (Berlin); a Demonstration They stick to their business or desk during the day and of Carcinomas artificially produced by Inoculation, by Dr. become medical students at night, with such accommodation Hanau (Zurich); on Air-swillowing, by Professor Quincke as some schools in Dublin provide for them. We cannot (Kiel); on Recent Methods of Treatment of Laryngeal think that such a system is one of true medical education, Tuberculosis, by Dr. H. Krause (Berlin); Tissue Metabolism such as the Medical Council contemplates or could reco- in Cancer, by Dr. F. Muller (Berlin); Rheumati3m and Gout, by Dr. M. Friedlander (Leipsic); and gnise. Four years for the medical curriculum is all too little, Articular on Decrease of Pressure in the Cardiac Cavities Researches and it certainly does not mean that students are to divide and Arteries by Dr. Krehl (Leipsic). their time between commerce and medicine. If such a system were pursued in the United States, it would meet
with severe criticism from all medical educationists here. We do not see that it should be treated with more indulgence because it happens to be a Dublin one. There are instances in other schools of men snatching time to go through the form of studying medicine while engaged in business. But it is not found to answer. And where it is done on a scale that amounts to a system, as in Dublin, it needs attention from the medical authorities, both local and central.
THE
eighth annual
"
at Wiesbaden from
ROGERS’S URETHROTOME.
THIS instrument, which is made by Messrs. Tieman & Co., brought before the Tri-state Medical Association of Mississippi, Arkansas, and Tennessee some four years ago ; and Dr. Rogers brings its meritsl before the profession again after further trial in more than 100 cases. By this instrument a bulb can be formed behind the stricture, not larger a No. 4 at the time of introduction, but capable of increase to the full size of the urethra at any point, the exact measurement being recorded on a dial at the handle CHOLERA PANIC IN FLORENCE. of the instrument. A filiform guide is employed, and the A FLORENTINE CORRESPONDENT, under date March 23rd, instrument follows it easily. It is a urethrotome which writes :-" Considerable alarm was caused throughout the dilates whilst incising. The shaft, which is six inches city on its becoming known that on the night of the 21st has an average diameter of a No. 4 catheter, diminishlong, and 22nd inst. the inmates of the hospitals Bonifazio and Santa Lucia were, to the number of sixty, attacked with ing at the curve to a No. 3. It consists of two cylinders, a solid one, with ring handle. Along the curve the two severe vomiting and diarrhoea, and that three of them had died. The English-speaking colony, which is estimated to cylinders become solid half cylinders, with their flat be at this moment between four and five thousand, was surfaces opposed, thus forming a solid whole cylinder. When the instrument has been passed well into the especially uneasy at the announcement, knowing as it does bladder the hollow cylinder is rotated, causing a separation that such explosions of disease are generally worse than of the two half cylinders of the curve, thus forming (in the they are allowed to appear, the authorities, for reasons more a skeleton bulb of any desirable diameter up to bladder) obvious than creditable, being in the habit of concealing the facts till these become too flagrant for official reticence. that of the full-sized urethra. The size of this bulb is indicated on the metre-plate. This forms a wedge which Inquiries are now in progress on the part of the Pubblica stretches the stricture. The blade lies concealed and the Communal Sicurezza and Council, and in a few days sheathed between the two half cylinders of the curve, and of this the nature and choleraic ____
gravity
seemingly
was
I than
explosion
will be made known under competent professional authority.
1
New York Medical
Journal,
1888.