SIR WILLIAM BARRETT.

1255 faeces from the kitchen staff were all negative except of the disease. Mr. Hayes comes to the conclusion This was found to contain that the best results in carcinoma of the uterus are from the chief cook. " bacilli culturally resembling B. suipestifer, but these reached by a combination of radium and X rays ; have shown no serological affinities with the stock radium for those parts which are accessible, while the B. suipestifer." It is suggested that this officer was deeper-placed disease, such as abdominal and pelvic the source of infection of the food. While this is a glands, is best treated by X rays. Further reports possible hypothesis it is not more than a hypothesis, on his interesting scientific work will be welcome. and there are facts which militate against it. In particular, if this cook suffered from an infection with a living Salmonella strain sufficient to cause a VOLUNTARY BOARDERS AT DARTFORD definite attack of gastro-enteritis it is to be anticipated MENTAL HOSPITAL. that his serum would give a positive agglutination THE report of the visiting committee to the City reaction with the infecting bacillus, whereas his blood reactions were negative. While the larder was kept of London Mental Hospital at Stone, near Dartford, the year 1924, which has just reached us, confirms very clean, the possibility of contamination from dirt, for the announcement alreadv made in these columns1 dust, and flies was not excluded. The outbreak was worked out with great care by that this institution now has the statutory right to The Act conferring Dr. Nankivell and his assistants, and he concludes his receive voluntary boarders. this has also the right permitted all-important change be with recommendations that should steps report " " to mental hospital." asylum taken to exclude dust and flies from the food, that in name from The time is indeed more than ripe for the extension be of habits should known only persons cleanly these privileges to other public institutions in employed in the kitchen, and that it should be an of Since the passing of the Bill in July instruction to all members of the kitchen staff to the country. last five boarders have been in residence voluntary wash their hands thoroughly after defsecation and to wash their hands on coming on duty into the kitchen. at Stone, and their number will no doubt increase steadily. We learn, further, from the report that the principle of allowing patients out on parole has been used with much success in a large number of FURTHER EXPERIENCE WITH RADIUM. cases, and the way to discharge has been paved in IN the May issue of the Irish Journal of .Medical a few instances by granting short leaves of absence, Science Dr. Walter C. Stevenson writes on 174 cases to four nights. A valuable feature in the works up treated by him with radium during the year 1925 at Stone during the year has been the department (evidently a misprint for 1924). The cases treated provision of further open attached to the naturally divide themselves into two classes, the wards, whereby suitable verandahs, can be nursed patients malignant and the innocent. The technique employed entirely in the open air. An operating theatre, in the former is to bury steel needles, and in many pathological laboratory, and X ray room are being cases to reinforce this by the application of radium to added. An increasing number of rate-aided patients the external surface. Dr. Stevenson is a believer in are being fitted out with clothing, made in the hospital the theory that better results are obtained by placing which is similar to that of the private workrooms, the radium at some distance from the skin, and to The resignation of the medical superinpatients. obtain this end he places an empty match-box between Dr. R. H. Steen, after a long period of illthe skin and the applicator. His ideal procedure in a tendent,is a cause of much regret to all who are health, case of carcinoma of the breast is to irradiate the with the valuable services he has rendered acquainted diseased area four days before amputation and, to this important institution. His successor, Dr. immediately after the removal of the breast and William Robinson, lately superintendent of Brentwood axillary contents, to insert tubes of screened radium Mental Hospital, will have a valuable opportunity into the wound, thus giving a further dose to any for to the study and treatment of mental contributing malignant cells that have escaped both the first disease under modern conditions. irradiation and the surgeon’s scalpel. Apart from with malignant tumours Dr. Stevenson has treated " radium such various conditions as fractures, injuries SIR WILLIAM BARRETT. to elbows," lumbago, toothache, colitis, acute sciatica, rather that " to and tonsillitis, stating, Sir William Barrett, whose recent death, at the surprisingly, my mind it is quite rational to use radium in acute age of 81, has already been reported, was one of a pneumonia, in the acute stage." Radium is so steadily distinguished group of scientific men whose observagaining ground in the treatment of many forms of tion was transferred as they grew older from incidental cancer and in not a few forms of non-malignant to transcendental phenomena. Assistant to Tyndall, diseases that unsubstantiated claims are the more to his early discoveries concerned sensitive flames and be regretted. In the same issue of the journal Mr. certain curious properties of iron alloys, while a Maurice R. J. Hayes gives a short but complete 37 years’ long occupancy of the Chair of Physics resume of the modern treatment of rodent ulcers by at the Royal College of Science in Dublin gave him radium ; he has come to the conclusion, after a long abundant opportunity for popularising the growth experience of treating these conditions both by surgery of physical science. Attracted along with Russel and X rays, that radium is the ideal weapon to employ. Wallace and Crookes to the exploration of obscure His experience of carcinoma of the lip is confined to human faculties, he satisfied himself of the existence recurrent growths following operation. Those cases of a faculty of communion or communication between which were treated early, before the disease had individuals independent of the recognised organs of implicated the glands, did well, but those in which the sense. Sir Oliver Lodge, who writes his memoir glands were already infected were not much benefited. in Nature (June 6th), notes that Barrett considered Full details are given of a number of advanced cases of that he might hereafter be regarded as perhaps the and cervix. All chief discoverer of this faculty. His paper read to inoperable carcinoma of the uterus these were rapidly improved by " needling," but the the British Association at Glasgow in 1876 on what was difficulty he has found is in dealing satisfactorily later called " telepathy " did not appear in the printed with the glands. If a method could be devised to proceedings, but a letter of his in Nature five years destroy the malignant cells in the pelvic and later paved the way for the foundation of the Society abdominal glands or to prevent their infection, a very for Psychical Research. Barrett’s other inquiries great advance would have been made in the treat- included the sensitiveness of certain people to magnetic ment of this condition. In none of Mr. Haves’s fields, and the faculty possessed by some for finding cases did a rectal or vesical fistula develop-a fact water or other things by means of an unconscious which goes to show once again that in nine cases physical reaction. He was the recipient of a vast out of ten the formation of a fistula is to be correspondence from all parts of the world, recording blamed, not on the radium, but on the method in which it is employed, if not on the natural progress 1 THE LANCET, 1924, ii., 709. ’

"

I

I

1256

extraordinary happenings, a selection of which appeared in the Proceedings of the Society, which had a branch of its own in Dublin. Barrett’s friends could not always keep up with one whose eagerness to follow clues made companionship stimulating to the point of unrest, but fully recognised the transparent honesty and simplicity of his character and his readiness to undertake any labour to get phenomena properly observed and recorded. He was, as Sir Oliver Lodge reminds us, never deterred by ridicule or opprobrium from following such clues as he could find. Death did not seem to Barrett to be an interrupter of mental continuity, and he did not fear it.

extra chlorination; established for the homeless; made for the removal of refuse; arrangement carcasses of dead animals were burned and buried. One result of the disaster will certainly be an improvement in public hygiene. In our crowded country, with a local sanitary authority in every district, it is difficult to realise the great responsibility thrown upon State departments administering huge sparsely inhabited districts in which there is practically The State Department no local health organisation. of Public Health in Illinois is to be congratulated on the promptitude exhibited in dealing with the effects of the tornado.

organised

tent

subjected to

were were were

camps

____

THE

HYGIENE

OF

A TORNADO.

AT 2.28 P.M. on March 18th last a tornado travelling ,at the rate of 60 miles an hour along a path about a mile wide struck the town of Gorham in Illinois, and crossed five counties, remaining in contact with the ground the whole time. The population of the devastated territory numbered about 200,000, being largely rural with one or two towns of up to 10,000 or 12,000 inhabitants. Among this population the local public health service was mostly in a primitive state, and the Illinois Health News for May gives an account of steps taken by the State Health Department to deal with the problem. The towns of Murphysboro’ and West Frankfort had public watersupplies, but in most parts of the area drinkingwater was obtained from private wells and cisterns, many of the former liable to surface pollution. There was no local control over milk-supplies in the area before the tornado and the only pasteurisation plant was at West Frankfort. At Murphysboro’ and West Frankfort there were public sewerage - system ; otherwise privies were the rule. None of the communities had a system for the collection of - refuse. Many hundreds of horses and cows and -domestic animals were killed by the tornado. Many people were rendered homeless. The first news of the disaster reached Springfield at 8 P.M. on the same day, and a special train left with a rescue party on board, arriving at Murphysboro’ at 2 A.M. the following morning. By the morning of the 20th the five sanitary engineers of the State Department were in the area, and within 36 hours a complete health department was functioning with headquarters at Carbondale. Medical and nursing relief to the :injured was provided, the dangers of communicable -diseases were met by isolation and immunisation, and sanitary measures were adopted. All the work was done in close cooperation with the military authorities, who were charged by Governor Small with the responsibilities of relief and re-habitation. The medical and nursing relief work was turned over to the Red Cross organisation on the second Sunday after the disaster. Temporary emergency work was :followed by organisation on a permanent basis to handle problems which are sure to continue for a year or more. A diagnostic laboratory was established at ’Carbondale, while the sanitary work was extended to include control of the water-supply, the milksupplies, and the disposal of refuse. There has always been an excessive prevalence of typhoid fever and -nalaria in this area, and the prevention of both these diseases received attention. During the first two weeks about 4000 persQns were immunised against typhoid, and probably about 20,000 will have been inoculated before the campaign ends. In the wake of the storm there arose conditions extremely favourable to the development of epidemics, especially typhoid fever. The injured were A month liable to tetanus and gas gangrene. after the disaster no epidemics of any kind had appeared in the affected area. Only five or six deaths resulted from tetanus and gangrene among the thousands who were injured. The activity of the State Health Department in the tornado zone and the success of their operations has created a demand for a permanent local health organisation. Wells and water-supplies which were temporarily dis-

MEDICAL WHO’S WHO. THE seventh edition of this work of reference, dated 1925, has just reached us, regret being expressed for the delay, which is attributed largely to the entire resetting and alteration in size from former editions. The last appearance of the volume was in 1918, when, owing to the death of its then editor, it fell into abeyance. In this volume such consultants and specialists as have returned the forms supplied to them have taken the opportunity of stating precisely the nature of their work, and general practitioners have indicated in many cases the professional studies in which they are particularly interested. At the end is an alphabetical index of towns with the names of practitioners there resident. The volume contains, besides, certain personal data which are otherwise not accessible. The list of questions to practitioners, on the answers to which the book is based, was submitted to the General Medical Council, which took no objection to them. The volume contains no name which does not appear in the Medical Register. It is well printed and produced in handy form for the reference shelf. The price is 30s., from the Grafton Publishing Company, Ltd., 8, Stone Buildings, Lincoln’s Inn, London, W.C. 2. THE

PEMPHIGUS

NEONATORUM.

Two recent outbreaks of pemphigus neonatorum in maternity homes have induced the Ministry of Health to issue a Memorandum1 on the subject. In the first outbreak 23 babies were more or less severely infected, the disease appearing first round the fingernails and spreading thence to other parts of the body. Three mothers suffered from mammary disease, and there were two cases of puerperal fever, one of which proved fatal. In the second outbreak the number of cases was much smaller ; all were slight in degree, and there was no infection among the mothers. There were no fatal cases in either outbreak and in neither could the source of the infection be ascertained. The Memorandum distinguishes between a mild type of pemphigus associated with little or no systemic disturbance and recovering within a few weeks, and a grave type which usually terminates in pulmonary oedema, the latter being the result of infection from an unhealed umbilical wound. No definite pronouncement is made as to the true causal organism, although most authorities consider pemphigus to be an infantile form or variant of contagious impetigo. In the mild type the portal of entry is presumed to be some slight lesion of the skin, the carrier being the mother, nurse, or midwife, either directly or through infected clothing, to which the infective agent seems to adhere with great tenacity. In the majority of outbreaks the attending midwife is the suspect; in one instance a small pustule was found on the midwife’s finger, but examination has often failed to reveal any infective lesion. The first requirement in prevention is early diagnosis, and the Memorandum regrets the lateness in some cases of the report made to the local supervising authority. The midwife or nurse suspected of being the agent of spread should be suspended from practice until 1 Memo. 103 Med.

H.M. Stationery Office. 1d.