- Email: [email protected]
SUDDEN DEATH IN PLEURISY.
THE MEDICAL AID ASSOCIATION treatment in the hospitals. The weekly deaths from diphtheria rose, however, to 62, the highest weekly number on record. The endemic prevalence of diphtheria in the metropolis is one that ;s deserving of the fullest inquiry. Details are to hand concerning the prevalence in different parts of the country of these and other infectious maladies. Thus malignant scarlet fever is reported at Northampton, diphtheria and measles at
Dundee, the latter disease being exceptionally fatal ;a
localised outbreak of
QUESTION.
433
needs too much time and care to be generally applicable. even were it otherwise expedient to adopt it. The army as an occupation is, we imagine, increasing in popularity, on the whole, and if a judicious selection be made from the recommendations contained in the report of Lord Wantage’s Committee there is no reason why it should not advance in this respect. An immense deal has been done during the last twenty or thirty years to improve the soldier’s position, and after all the radical remedy against desertion is to introduce such reasonable changes and reforms from time to time as to make the soldier content with his position and occupation.
typhus fever at the same place, and an extensive, though mild, epidemic of measles at Brechin. It is disquieting, too, to learn that the mortality from influenza (s steadily increasing. Nineteen deaths from this disease occurred in London during the week ended Feb. llth, comNEW BRINE BATHS AT STAFFORD. pared with an average of 15 during the previous three weeks THE Corporation of Stafford have just completed a suite of It is reported to be prevalent at Chatham, Rochester and brine baths, similar to those at Droitwich and Nantwich. Tew Brompton, in which places the public schools are The waters contain 18 393 grains of common salt to the closed. Amongst northern towns, Leeds is suffering a good besides considerable quantities of chloride of gallon, deal from influenza, 9 deaths having taken place during the the sulphates of magnesium, potassium and magnesium tast six weeks, compared with 6 in the whole of the last The is 60° Fahr. In addition to calcium. and quarter of 1892. This increase is said to be partly explain- the brine baths thetemperature includes suite Turkish, needle, slipper to the that attributed fact deaths formerly able by lung salt water swimming baths. fresh and and are now ascribed to influenza. diseases only primarily THE MEDICAL AID ASSOCIATION
RUPTURE OF INTESTINE CAUSED BY A TAPEWORM.
QUESTION.
IT will be seen from our Parliamentary report that IN a recent number of the New York Medical Journal, Mr. Labouchere has put a question in the House of I3r. Fayette Dunlap describes a case of resection of the small Commons to Mr. Acland, the Vice-President of the ntestine for rupture caused by a tapeworm. When he saw Council, as to the legality of the power of the General ,he patient he believed that there was an ectopic gestaMedical Council to declare those practitioners who hold tion with ruptured sac. On the abdomen being opened .affice under a Friendly Societies’ Medical Aid Associatthe pelvis was seen to be filled with recent blood-clot, tion guilty of infamous conduct in a professional respect ; md a tapeworm was found protruding from a large and whether, if the Medical Council did make this declaraT’agged in the small intestine. About twotion, he would take steps to amend the law. The Vice- t;hirds ofrupture the lumen of the intestine was gone, the edges President’s answer to this at least premature question was .vere ragged and gangrenous, but it was quite evident easy and obvious, and will be found in our Parliamentary t;hat theie had been no previous ulceration. The damaged seport. Surely Mr. Labouchere might wait till the comwas ends united by the continuous resected and the mittee appointed by the Council has completed its work and 1part suture after the manner of Lembert. Vomiting was congiven in its report. The function of the Council is judicial, ginuous for thirty hours after the operation and only ceased and until it departs from a judicial attitude it is not fair to after a large enema of an ounce each of glycerine and threaten it as Mr. Labouchere’s question does. For our own sulphate of magnesium and a quart of hot water. From the part, feeling that this matter was under searching and fairabdomen there was removed about eight feet of live tapeinvestigation by a committee of the Medical Council, weworm, and with the enema there came away seventeen feet iiave suspended all further comment on it and on their action. more. Dr. Dunlap thinks the worm had become entangled, It is no secret that the Council intend to give the most comand in the effort to free itself so eroded the wall as to cause tplete hearing to both sides in this controversy, and that both rupture. No antiseptics were used. The patient made a ides are helping the Council to such an impartial hearing. good recovery.
t t ‘
C
‘
-
THE BERTILLON SYSTEM OF ANTHROPOMETRY.
WE learn from the Pioneer Mail that this system has been successfully introduced into several provinces of India. The Inspector-General of Police in Bengal takes a keen interest on the subject and the system promises to work well. It is also stated that some difficulties attending the methods of .application of measurements have been overcome by a simple device. When calipers are the instruments used, for example, for measuring, some varieties in the result may, and in practice frequently do, arise from the differof pressure applied by different individuals in once ’taking the measurements, whereas the instrument is now supplied with a spring which causes it to close with absolutely ’uniform pressure. Suggestions have been made from time to time in the past as to the adoption of some method for ’the identification of a class of men who repeatedly and frauduGently enlist into and desert from the army, or who have !been discharged from the service as bad characters, but no method of a sufficiently simple and practicable kind has been hitherto devised for the purpose, and the Bertillon system of anthropometry, however exact and useful it may be in the case of gaols and criminals, is too complicated and
SUDDEN
DEATH
IN
PLEURISY.
IT is known that patients suffering from pleurisy with effusion occasionally die suddenly and unexpectedly, and this result has been ascribed to the existence of a very larg ; amount of fluid in the chest. That the accident referred to may happen when the amount of fluid is very moderate appears from a case reported by M. Lesueur in L’Annie Medicale de Caen, in which a young woman who had a good constitution and had always enjoyed good health was attacked with pleurisy of the left side. On the eighth fluid the two-thirds of the day occupied pleural cavity. After this it began to diminish and on the twelfth day respiration sounds could be heard all over the affected side and the patient, feeling better, wanted to leave her bed, but was advised not to do so. She still complained of a constant pain on the left side which had existed from the beginning. The same day-being left alone for a time -she got up for a short period, but as soon as she returned to bed she was seized with severe pains and a feeling of sufiocation, so that she called for assistance. Her lips were then found to be blue and her pulse thready, she became less and less able to speak and died in less than
434
LAPAROTOMY IN TUBERCULOUS PERITONITIS.
four hours.
As
disease of the heart or lungs could be the explanation is to be found in arrest of the heart by means of reflex irritation caused by intercostal neuritis acting upon the inhibitory cardiac apparatus, an explanation similar to that suggested in a recent discussion on the subject of sudden death in pleurisy at the French Academy of Medicine. Death may, however, have resulted from an asthenic syncope due to the disturbance of the circulation from premature resumption of the erect position. no
detected, M. Lesueur suggests that
-
LAPAROTOMY IN TUBERCULOUS PERITONITIS.
than the other. If massage was employed the swelling dis-appeared in a few hours. The second patient was a woman of’ forty-seven, who had swelling of any part of her body exposed to cold. The hands were most frequently affected, and now and then the wholebody, although there was no disease of the heart Treatment with drugs-such as nitro-glycerine, or kidneys. ineffectual. The third patient was a woman ergotin &c.-was aged fifty-four with ccdema of the left hand, which was reddish-blue in colour, stiff and painful. The condition is an interesting and unusual one and seems to be the expression of some vaso-motor disturbance, but there is nothing inthe nature of the cases so far to show whether this is the’ result of some morbid change or of some structural)
recently brought before the Lyons Medical interesting case of a little boy nine years of age peculiarity. who was completely cured of chronic tuberculous peritonitis by FOREIGN UNIVERSITY INTELLIGENCE. operative measures. The condition of the child at the time of the operation appeared desperate. He could with difficulty Barcelona.-Dr. Luis Guedea y Calvo of Cadiz has been be got to answer questions, his respirations were short appointed to the chair of Surgical Pathology. and laboured, and his abdomen was enlarged, tender on Bucharest.-Dr. Petrini has been appointed Professor of pressure and evidently contained fluid. Laparotomy was Clinical Dermatology and Syphilis. Geneva.-Dr. F. Buscarlet has been recognised as privatperformed, and about a pint and a half of fluid was obtained, which contained tubercle bacilli ; the parietal docent in Surgery. Madrid.-A beautiful and ingenious operating theatre. peritoneum, as well as the intestines and the mesenfull were of of in size from that which has been designed by the Marques de Busto, an eminent. tery, granules varying a lentil to that of a pin’s head. The intestines were dusted surgeon, has just been opened. In this building the most over with 50 or 60 grains of iodoform and the wound closed. elaborate arrangements are made for keeping septic matter In a month’s time the child was able to get up and in two from gaining entrance into the chamber where the operations. months he was out in the fields looking after the cattle. At are performed. There is an antechamber or laboratory conthe time of the report, five months after the operation, the taining heating apparatus by means of which clothes, dresschild was quite well; there was no trace of ascites, but on ings &c. may be sterilised. The operating chamber is comeach side of the umbilicus systematic pressure produced a pletely shut off from the theatre provided for the students by certain amount of’resistance, as if the intestinal coils, having means of glass which is prevented from becoming clouded by been matted together, had lost some of their suppleness and ingenious contrivances on both sides. There is also another elasticity. ingenious device resembling the concha and auditory meatus. of an ear, by means of which the students in the theatre are DIPHTHERIA AND MEMBRANOUS LARYNGITIS. enabled to hear any remarks made by the operator. The AN interesting series of experiments has been carried out building is styled by its designer "The Chirophan (in Spanish by Dr. Bookeron membranous laryngitis occurring in the El Quirófano)-that is to say, " The Transparent Surgery." JIarseilles.-Dr. Magon has been appointed to the chair of He concludes that course of scarlet fever and other fevers. the of throat that sometimes occur the membranous affections Anatomy. Munich.—Dr. R. Cramer has been recognised as privatin the course of scarlet fever, measles and other infectious diseases often closely resemble clinically the features of docent in Bacteriology. Naples. -Dr. Alfredo Rubino has been recognised as privatdiphtheria, but that they differ in nature and etiology. With in Medical Pathology. docent the exception of the false membrane, the changes found in diphtheria are dependent not upon the direct action of the M. PONCET
Society
an
-
bacilli but upon the alkaloids and other toxic substances to which they give rise. The anatomical changes that attend the formation of membrane in scarlet fever and measles are characterised by the presence of streptococci, producing suppurative processes. A bacteriological examination, therefore, furnishes a certain criterion for the differentiation of diphtheritic and pseudo-diphtheritic processes. Measles and scarlet fever render the tissues a favourable pabulum for the bacillus of diphtheria. The presence of streptococci in membranous laryngitis suggests an etiological connexion, but the organisms are probably not pathogenic of the particular diseases in the course of which they occur.
DEATHS OF EMINENT FOREIGN MEDICAL MEN. THE deaths of the following distinguished members of the medical profession abroad have been announced :—Dr.. Mammert Karpovich, who has for many years been well known in St. Petersburg through his anatomical and pathological’ models.-Dr. Wilhelm Valentiner, formerly privat-docent in Balneology in Berlin.-Dr. Nikolai Menthien, Extraordinary’ Professor of Pharmacy in Warsaw and author of a text-book on the subject.-Dr. Peter Uspenski, privat-docent in Nervous, Diseases in the Military Medical Academy, St. Petersburg.Dr. Ad. Hartung, who had several times been President of the German Dental Association, and was for many years a member of the Dental Examination Commission.
LOCALISED TRANSIENT CEDEMA. UNDER this name Dr. Allen Starr describes in the New York Medical Journal three curious cases which have come under his observation. A short abstract of the paper appears in the Neurologisches Centralblatt. The œdema was acute The first patient was a in its onset and transitory. woman of twenty-eight, who, as soon as she exposed her face to cold, suffered from a swelling on the right side of it, which came on with a feeling of stiffness and lasted for several days. The swollen side then became colder and paler 1
Bulletin of the Johns
Hopkins Hospital, iii., 26, p. 109.
WE
gather from;the Ib’estern News that at a meeting of Plympton Board of Guardians a charge of neglect waE, brought against Mr. Doudney, one of their medical officers,. Mr. Doudney, in his defence, completely exonerated himself, and was ably supported by the Rev. G. B. Berry and a majority of the Board. It transpired during the inquiry that orders signed in advance by the overseer were given to the assistant overseer, a publican, to make use of, and the guardians considered that Mr. Doudney was right in not acting upon such orders emanating from the assistant overseer. the
Dundee, the latter disease being exceptionally fatal ;a
localised outbreak of
QUESTION.
433
needs too much time and care to be generally applicable. even were it otherwise expedient to adopt it. The army as an occupation is, we imagine, increasing in popularity, on the whole, and if a judicious selection be made from the recommendations contained in the report of Lord Wantage’s Committee there is no reason why it should not advance in this respect. An immense deal has been done during the last twenty or thirty years to improve the soldier’s position, and after all the radical remedy against desertion is to introduce such reasonable changes and reforms from time to time as to make the soldier content with his position and occupation.
typhus fever at the same place, and an extensive, though mild, epidemic of measles at Brechin. It is disquieting, too, to learn that the mortality from influenza (s steadily increasing. Nineteen deaths from this disease occurred in London during the week ended Feb. llth, comNEW BRINE BATHS AT STAFFORD. pared with an average of 15 during the previous three weeks THE Corporation of Stafford have just completed a suite of It is reported to be prevalent at Chatham, Rochester and brine baths, similar to those at Droitwich and Nantwich. Tew Brompton, in which places the public schools are The waters contain 18 393 grains of common salt to the closed. Amongst northern towns, Leeds is suffering a good besides considerable quantities of chloride of gallon, deal from influenza, 9 deaths having taken place during the the sulphates of magnesium, potassium and magnesium tast six weeks, compared with 6 in the whole of the last The is 60° Fahr. In addition to calcium. and quarter of 1892. This increase is said to be partly explain- the brine baths thetemperature includes suite Turkish, needle, slipper to the that attributed fact deaths formerly able by lung salt water swimming baths. fresh and and are now ascribed to influenza. diseases only primarily THE MEDICAL AID ASSOCIATION
RUPTURE OF INTESTINE CAUSED BY A TAPEWORM.
QUESTION.
IT will be seen from our Parliamentary report that IN a recent number of the New York Medical Journal, Mr. Labouchere has put a question in the House of I3r. Fayette Dunlap describes a case of resection of the small Commons to Mr. Acland, the Vice-President of the ntestine for rupture caused by a tapeworm. When he saw Council, as to the legality of the power of the General ,he patient he believed that there was an ectopic gestaMedical Council to declare those practitioners who hold tion with ruptured sac. On the abdomen being opened .affice under a Friendly Societies’ Medical Aid Associatthe pelvis was seen to be filled with recent blood-clot, tion guilty of infamous conduct in a professional respect ; md a tapeworm was found protruding from a large and whether, if the Medical Council did make this declaraT’agged in the small intestine. About twotion, he would take steps to amend the law. The Vice- t;hirds ofrupture the lumen of the intestine was gone, the edges President’s answer to this at least premature question was .vere ragged and gangrenous, but it was quite evident easy and obvious, and will be found in our Parliamentary t;hat theie had been no previous ulceration. The damaged seport. Surely Mr. Labouchere might wait till the comwas ends united by the continuous resected and the mittee appointed by the Council has completed its work and 1part suture after the manner of Lembert. Vomiting was congiven in its report. The function of the Council is judicial, ginuous for thirty hours after the operation and only ceased and until it departs from a judicial attitude it is not fair to after a large enema of an ounce each of glycerine and threaten it as Mr. Labouchere’s question does. For our own sulphate of magnesium and a quart of hot water. From the part, feeling that this matter was under searching and fairabdomen there was removed about eight feet of live tapeinvestigation by a committee of the Medical Council, weworm, and with the enema there came away seventeen feet iiave suspended all further comment on it and on their action. more. Dr. Dunlap thinks the worm had become entangled, It is no secret that the Council intend to give the most comand in the effort to free itself so eroded the wall as to cause tplete hearing to both sides in this controversy, and that both rupture. No antiseptics were used. The patient made a ides are helping the Council to such an impartial hearing. good recovery.
t t ‘
C
‘
-
THE BERTILLON SYSTEM OF ANTHROPOMETRY.
WE learn from the Pioneer Mail that this system has been successfully introduced into several provinces of India. The Inspector-General of Police in Bengal takes a keen interest on the subject and the system promises to work well. It is also stated that some difficulties attending the methods of .application of measurements have been overcome by a simple device. When calipers are the instruments used, for example, for measuring, some varieties in the result may, and in practice frequently do, arise from the differof pressure applied by different individuals in once ’taking the measurements, whereas the instrument is now supplied with a spring which causes it to close with absolutely ’uniform pressure. Suggestions have been made from time to time in the past as to the adoption of some method for ’the identification of a class of men who repeatedly and frauduGently enlist into and desert from the army, or who have !been discharged from the service as bad characters, but no method of a sufficiently simple and practicable kind has been hitherto devised for the purpose, and the Bertillon system of anthropometry, however exact and useful it may be in the case of gaols and criminals, is too complicated and
SUDDEN
DEATH
IN
PLEURISY.
IT is known that patients suffering from pleurisy with effusion occasionally die suddenly and unexpectedly, and this result has been ascribed to the existence of a very larg ; amount of fluid in the chest. That the accident referred to may happen when the amount of fluid is very moderate appears from a case reported by M. Lesueur in L’Annie Medicale de Caen, in which a young woman who had a good constitution and had always enjoyed good health was attacked with pleurisy of the left side. On the eighth fluid the two-thirds of the day occupied pleural cavity. After this it began to diminish and on the twelfth day respiration sounds could be heard all over the affected side and the patient, feeling better, wanted to leave her bed, but was advised not to do so. She still complained of a constant pain on the left side which had existed from the beginning. The same day-being left alone for a time -she got up for a short period, but as soon as she returned to bed she was seized with severe pains and a feeling of sufiocation, so that she called for assistance. Her lips were then found to be blue and her pulse thready, she became less and less able to speak and died in less than
434
LAPAROTOMY IN TUBERCULOUS PERITONITIS.
four hours.
As
disease of the heart or lungs could be the explanation is to be found in arrest of the heart by means of reflex irritation caused by intercostal neuritis acting upon the inhibitory cardiac apparatus, an explanation similar to that suggested in a recent discussion on the subject of sudden death in pleurisy at the French Academy of Medicine. Death may, however, have resulted from an asthenic syncope due to the disturbance of the circulation from premature resumption of the erect position. no
detected, M. Lesueur suggests that
-
LAPAROTOMY IN TUBERCULOUS PERITONITIS.
than the other. If massage was employed the swelling dis-appeared in a few hours. The second patient was a woman of’ forty-seven, who had swelling of any part of her body exposed to cold. The hands were most frequently affected, and now and then the wholebody, although there was no disease of the heart Treatment with drugs-such as nitro-glycerine, or kidneys. ineffectual. The third patient was a woman ergotin &c.-was aged fifty-four with ccdema of the left hand, which was reddish-blue in colour, stiff and painful. The condition is an interesting and unusual one and seems to be the expression of some vaso-motor disturbance, but there is nothing inthe nature of the cases so far to show whether this is the’ result of some morbid change or of some structural)
recently brought before the Lyons Medical interesting case of a little boy nine years of age peculiarity. who was completely cured of chronic tuberculous peritonitis by FOREIGN UNIVERSITY INTELLIGENCE. operative measures. The condition of the child at the time of the operation appeared desperate. He could with difficulty Barcelona.-Dr. Luis Guedea y Calvo of Cadiz has been be got to answer questions, his respirations were short appointed to the chair of Surgical Pathology. and laboured, and his abdomen was enlarged, tender on Bucharest.-Dr. Petrini has been appointed Professor of pressure and evidently contained fluid. Laparotomy was Clinical Dermatology and Syphilis. Geneva.-Dr. F. Buscarlet has been recognised as privatperformed, and about a pint and a half of fluid was obtained, which contained tubercle bacilli ; the parietal docent in Surgery. Madrid.-A beautiful and ingenious operating theatre. peritoneum, as well as the intestines and the mesenfull were of of in size from that which has been designed by the Marques de Busto, an eminent. tery, granules varying a lentil to that of a pin’s head. The intestines were dusted surgeon, has just been opened. In this building the most over with 50 or 60 grains of iodoform and the wound closed. elaborate arrangements are made for keeping septic matter In a month’s time the child was able to get up and in two from gaining entrance into the chamber where the operations. months he was out in the fields looking after the cattle. At are performed. There is an antechamber or laboratory conthe time of the report, five months after the operation, the taining heating apparatus by means of which clothes, dresschild was quite well; there was no trace of ascites, but on ings &c. may be sterilised. The operating chamber is comeach side of the umbilicus systematic pressure produced a pletely shut off from the theatre provided for the students by certain amount of’resistance, as if the intestinal coils, having means of glass which is prevented from becoming clouded by been matted together, had lost some of their suppleness and ingenious contrivances on both sides. There is also another elasticity. ingenious device resembling the concha and auditory meatus. of an ear, by means of which the students in the theatre are DIPHTHERIA AND MEMBRANOUS LARYNGITIS. enabled to hear any remarks made by the operator. The AN interesting series of experiments has been carried out building is styled by its designer "The Chirophan (in Spanish by Dr. Bookeron membranous laryngitis occurring in the El Quirófano)-that is to say, " The Transparent Surgery." JIarseilles.-Dr. Magon has been appointed to the chair of He concludes that course of scarlet fever and other fevers. the of throat that sometimes occur the membranous affections Anatomy. Munich.—Dr. R. Cramer has been recognised as privatin the course of scarlet fever, measles and other infectious diseases often closely resemble clinically the features of docent in Bacteriology. Naples. -Dr. Alfredo Rubino has been recognised as privatdiphtheria, but that they differ in nature and etiology. With in Medical Pathology. docent the exception of the false membrane, the changes found in diphtheria are dependent not upon the direct action of the M. PONCET
Society
an
-
bacilli but upon the alkaloids and other toxic substances to which they give rise. The anatomical changes that attend the formation of membrane in scarlet fever and measles are characterised by the presence of streptococci, producing suppurative processes. A bacteriological examination, therefore, furnishes a certain criterion for the differentiation of diphtheritic and pseudo-diphtheritic processes. Measles and scarlet fever render the tissues a favourable pabulum for the bacillus of diphtheria. The presence of streptococci in membranous laryngitis suggests an etiological connexion, but the organisms are probably not pathogenic of the particular diseases in the course of which they occur.
DEATHS OF EMINENT FOREIGN MEDICAL MEN. THE deaths of the following distinguished members of the medical profession abroad have been announced :—Dr.. Mammert Karpovich, who has for many years been well known in St. Petersburg through his anatomical and pathological’ models.-Dr. Wilhelm Valentiner, formerly privat-docent in Balneology in Berlin.-Dr. Nikolai Menthien, Extraordinary’ Professor of Pharmacy in Warsaw and author of a text-book on the subject.-Dr. Peter Uspenski, privat-docent in Nervous, Diseases in the Military Medical Academy, St. Petersburg.Dr. Ad. Hartung, who had several times been President of the German Dental Association, and was for many years a member of the Dental Examination Commission.
LOCALISED TRANSIENT CEDEMA. UNDER this name Dr. Allen Starr describes in the New York Medical Journal three curious cases which have come under his observation. A short abstract of the paper appears in the Neurologisches Centralblatt. The œdema was acute The first patient was a in its onset and transitory. woman of twenty-eight, who, as soon as she exposed her face to cold, suffered from a swelling on the right side of it, which came on with a feeling of stiffness and lasted for several days. The swollen side then became colder and paler 1
Bulletin of the Johns
Hopkins Hospital, iii., 26, p. 109.
WE
gather from;the Ib’estern News that at a meeting of Plympton Board of Guardians a charge of neglect waE, brought against Mr. Doudney, one of their medical officers,. Mr. Doudney, in his defence, completely exonerated himself, and was ably supported by the Rev. G. B. Berry and a majority of the Board. It transpired during the inquiry that orders signed in advance by the overseer were given to the assistant overseer, a publican, to make use of, and the guardians considered that Mr. Doudney was right in not acting upon such orders emanating from the assistant overseer. the