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THE BICENTENARY OF LINNÆUS.
1586 claimed is that vomiting is much diminished by its use. The patient did well for a time but gradually failed and died This method has been extensively employed in Europe but on Dec. 9th. The stone was two centimetres in diameter, has few advocates in Great Britain. Dumont’s ether mask is slightly irregular, semi-translucent, and crystalline. Cultures practically identical with that described by Dr. Davis and has made from the almost colourless fluid in the gall-bladder baen employed in Berne and elsewhere in Switzerland. The and from the centre of the stone showed the typhoid bacillus. plan is wasteful both in the matter of time and material and At the necropsy no typhoid lesions were found in the does not appear to offer any advantages over the nitrous-oxide- intestine. The gall-bladder was contracted and thickened. ether method introduced by Clover. It is, perhaps, easier for The bile-ducts seemed normal and contained no calculi. the advice to be given that the anaesthetist should not allow A positive agglutinative reaction in jaundice may be exhimself to be I I hurried " or "worried"by the operator than it plained as due to the action of biliary substances dissolved is for it to be taken. In busy hospital practice the loss of ten in the serum. But there is much evidence against this view. minutes for every period of induction means a serious leakage The reaction cannot be obtained in many cases in which the of time when six or eight operations have to be performed jaundice is deeper than in those in which the reaction is in an afternoon. present. Normal serum to which bile has been added does not give the reaction. Analysis of the reported cases of WELL DESERVED HONOURS. jaundice with an agglutinative reaction as high as a dilution THE University of Oxford at a Convocation held on of 1 in 50 in 30 minutes shows that they be divided into May 28th conferred the honorary degree of M.D. upon Mr. several classes: (1) those with a history of an attack of Wilfred Thomason Grenfell, L.R.C.P. Lond., M.R.C.S. Eng. typhoid fever; (2) those in which typhoid bacilli are found The honour was given in recognition of the good work carried in the biliary tract ; (3) those in which there is acute infectious out among the fisherfolk of Labrador under Dr. Grenfell’s jaundice ; and (4) those not belonging to any of the preceding supervision. Dr. Grenfell, who was educated at Queen’s classes. The fact that the agglutination reaction persists College, Oxford, and at the London Hospital, qualified in for some time after typhoid fever explains the first class. 1888 and joined the Royal National Mission to Deep Sea When the fever much antedates the jaundice the inference is Fishermen in 1889. At first he worked on board the mission that the bacillus persists in the system. The case recorded vessels in the North Sea but in 1892 he initiated work of a above is an example. A case has been recorded by Droba similar kind among the fishermen in Labrador where, having in which the bacillus was isolated from the gall-bladder 17 obtained his certificats as a master mariner, he commanded years after an attack of typhoid fever. With regard to the his own vessel. ln Labrador and Newfoundland he has second class, several cases of cholelithiasis have been reported in helped establishing four hospitals, besides various with no history of typhoid fever in which the typhoid bacillus cooperative stores and other institutions for the good of , has been found in the biliary tract. The third class inthe inhabitants. Sundry most interesting articles from his cludes the condition known as "Weil’s diseaseand others pen have recently appeared in the columns of our con- which may be examples of atypical typhoid fever. With temporary the Standard, which give a vivid account of the regard to the fourth class, it has been shown that even in hardships of a medical missionary, as well as of the benefits the absence of a history of typhoid fever a person may which his skill and knowledge can confer. We congratulate harbour the typhoid bacillus. The reason for the frequent Dr. Grenfell upon the compliment paid to him by his Uni- association of jaundice with the agglutinating reaction is versity-a compliment which is all the more noteworthy the fact that the gall-bladder is a site of election of the inasmuch as it is the first occasion upon which the honorary typhoid bacillus which often persists there long after an degree of Doctor of Medicine has been conferred. On attack of typhoid fever, possibly producing cholecystitis and May 31st Dr. Grenfell was the recipient of another honour, cholelithiasis. for he was invested by His Majesty the King with the THE BICENTENARY OF LINNÆUS. insignia of a Companion of the Most Distinguished Order of St. Michael and St. George. THE bicentenary of Linnasus, celebrated by the Royal University of Upsala on May 23rd (May 13th, O.S.), has WIDAL’S REACTION IN JAUNDICE. been the occasion of some graceful tributes to the memory SOON after the discovery of the Widal reaction in typhoid of the great Swedish naturalist. Notable among these are fever it was noticed that the serum of certain persons not the addresses forwarded to Upsala by the trustees of the suffering from the disease agglutinated typhoid bacilli. This British Museum and the director of the British Museum of Bat in most cases Natural History. Professor Edwin Ray Lankester makes a was observed particularly in jaundice. a reaction was obtained only in low dilutions and after long happy allusion in the opening sentences of his address to the two to the usual visit of Linnseus to this country in 1736. " There is preserved periods (from eight hours). Judged by standards of the present time such reactions would not be in the British Museum a letter from the celebrated Boerhaave regarded as positive and as any evidence in favour of the introducing to our founder, Sir Hans Sloane, a young Swedish diagnosis of typhoid fever. But there remains a small group friend. ’Linnasus,’ the letter runs,Linnmus qui has tibi of cases of jaundice in which the serum possesses high agglu- dabit literas est unice dignus te videre, unice dignus a te tinative properties. In the Boston Medical and Surgical videri; qui vos videbit simul, videbit hominum par, cui t7oM?’M of April 25th Dr. H. A. Christian has contributed an simile vix dabit orbis."’ Despite this excessive compliment, important paper on the subject. He reports the following or because of it, Sloane is said to have given the young man A man, aged 42 years, was admitted into hospital on of genius a cold reception, little divining what a valuable cise. Nov. 6th, 1906. Five weeks before he was awakened from connexion would in future exist between the learned of sleep by severe pain in the right hypochondrium. Frequent England and of Sweden. " Upon the material foundation of attacks of pain followed and jaundice, with clay-coloured Sloane," to quote the address further, "have arisen the vast stools and dark urine, developed. On admission there were collections of the British Museum; from the genius of Linnaaus deep jaundice and marked tenderness and slight rigidity and have branched out the sciences of descriptive botany and spasm in the region of the gall-bladder. The patient had zoology, enabling us to reduce to order these ever-growing suffered from typhoid fever seven years previously. The collections. And throughout this growth there have ever blood serum agglutinated the typhoid bacillus in a dilution of been conspicuous the cordial intercourse and mutual aid be1 in 50 in 20 minutes. On the 10th choledochotomy was tween the naturalists of our two countries, initiated when performed and a stone was removed from the common duct. Linnseus visited this ’punctum saliens in vitello orbis." ___
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1587 best remembered as a botanist andIprevalent. Much has already been done in this matter, but of the nomenclature named after imuch also remains to be done. It is of good omen that the him, but he was also much more. In the first place, he was (conference unanimously carried the following motion :eminent as a biologist: "he found biology a chaos, he left it That it is desirable that a committee representing universities f be formed which should investigate the question whether it is a cosmos." Then, too, he was a traveller interested in folk-should possible to facilitate the exchange of information as to their courses lore, and wrote an admirable book about the Lapps, amongand standards between the universities of the empire, and to take whom he journeyed for thousands of miles. Nor did he cutaction accordingly. a mean figure as a practising physician. Indeed, his earlier We hope that this is but a prelude to an interchange of associations are chiefly medical, and Stobasus, an eminentIstudents and teachers among the universities of the empire. physician, was one of his kindliest patrons. There is much PEPTIC ULCER FOLLOWING GASTROin the early struggles of Linnseus, his vivid character, his ENTEROSTOMY. brilliant powers of observation, his passionate pursuit of IN the Oleveland Medical Jourrccal for May Dr. C. A. Hamann science, and his enormous originality that reminds us of John Hunter. Both men were destined to conventional has reported a case of peptic ulcer of the jejunum following pursuits and were threatened with apprenticeship to gastro-enterostomy, a lesion which has only recently attracted mechanics. Indeed, Hunter was for a time a cabinet- attention. A man, aged 48 years, suffered for some time maker. Both men early escaped by sheer force of genius from symptoms of gastric ulcer-pain, tenderness, emaciafrom the influence of their environment, achieved an tion, hasmatemesis, and hyperchlorhydria. Anterior gastroinfinity of original work, and at length became shining enterostomy and entero-enterostomy were performed. The stars in the firmament of time. Murphy button was used in both anastomoses. Recovery from the operation was uninterrupted and the smaller button was passed, but on the twenty-second day epigastric pain MR. BALFOUR AND POST-GRADUATE STUDY. began. An indistinct tender mass was felt in the epigastric THE meeting of the Federal Conference on Education, and left hypochondriac regions. The patient was allowed to which was held on May 31st, was occupied with a disgo home as his condition was not regarded as serious. He cussion upon universities and was remarkable in many ways.died rather suddenly 26 days after operation. The necropsy The views which were expressed as to the real function of a showed on the anterior wall of the jejunum just beyond university, of the importance of post-graduate study, and of its junction with the stomach a perforated ulcer about an the necessity for interchange and reciprocity among univer- inch in diameter with a sharply marked border. The button sities were not new, for in point of fact they were a recur- was in situ but the perfect nature of the union and rence to medievalism. But they were revivals. Chief among the position of the ulcer showed that the button could the many excellent speeches was, perhaps, that delivered by not have caused the ulcer by pressure. The ulcer Mr. Balfour, which dealt mainly with the importance of post- was in the position where the highly acid gastric exactly graduate study. After a protest against the tyranny of juice would come into contact with the intestinal mucosa. examinations, he continued :The gastric mucosa showed erosions but no round ulcer. "But, at all events, let us rejoice in common that there is one There was also general peritonitis. The operation of gastrobranch of university work, of growing interest and importance, daily receiving more recognition from all that is best in the intellectual life enterostomy was introduced in 1882 but not until 1899, of the country-I mean the post-graduate course. There the slavery of examinations is a thing of the past, the intellectual servitude in which 17 years later, was the first case of peptic ulcer following it the pupil has hitherto been is a thing he may put on one side ; and he Braun. In an extensive review of the subject is in the happy position of being able to interrogate nature and to study reported by Of these 29 history with the view of carrying out his own line of investigation and Gosset collected 31 cases, mostly German.’ research, instead of being in a perpetual subservience to the idea occurred in males-a preponderance in striking contrast to whether such and such a subject is worth getting up for examination The ulcer purposes, whether he may not have omitted to read with sufficient the greater frequency of gastric ulcer in females. attention something which to him is perfectly useless, perfectly after occurred most often anterior (15 gastro-enterostomy barren, perfectly uninteresting, but on which some question- may be asked by a too curious examiner." It occurred once after Roux’s operation, cases out of 27). And further, he added that it was in connexion with the four times after anterior gastro-enterostomy with enteropost-graduate course that there could be a communication anastomosis, six times after posterior gastro-enterostomy, between ourselves at home and the more distant parts of the and once after this operation with entero-anastomosis. But it must be remembered that the anterior operaEmpire. " If," he said, "we can so arrange the post-graduate course of our universities that tion has been performed more often than the posterior, it will be thought a normal and natural thing for any man who has at any rate in Germany, where most of the cases have the talent and the time to devote his life to investigation, first, to get Mr. A. W. Mayo Robson has pointed out his education at one of the universities of his own country, and then been recorded. to go and conclude that education in a post-graduate course in one of that cases must have been unrecognised because many our colonies, how great will be the advantage, not merely to the student, but to the communities which will be brought together by a perforation did not occur and that in many others death tie which may unite us all in a common interest in these higher must have resulted from abscess formation or in other subjects." the adhesions and other complications obscuring the This is a noble ideal-one, moreover, which there should be ways, so that at the necropsy the true nature of the affection parts, no great difficulty in making a reality. In the Middle Ages was not ascertained. The time after operation at which the universities of Europe were free to all duly authorised of ulceration appeared varied from seven hours to symptoms scholars, and in many instances the teachers of one uni- ten years. Ten of the cases were fatal, 19 terminated in versity were free to teach in any other university. In those and in the remaining two the result is not stated. recovery, days the curse of Babel was removed by the universal In all the was performed for benign disease. Of knowledge of Latin as a language common to learning. If 14 cases inoperation which the method of operation is stated suturing this is so no longer, there exists for British students a was performed in nine, the Murphy button was used in number of universities in far distant lands where their own four, and a bone bobbin in one. In 17 out of 21 cases tongue is spoken, and in addition to the countries under the there was hyperchlorhydria. In consequence of the British Empire there is that great country allied to ourrelation between hyperchlorhydria and post-operaapparent selves-namely, the United States of America. From our tive ulcer the administration of sodium bicarbonate after own particular point of view how much benefit would arise has been recommended. Most, if not all, the to humanity in general from the labours of a band of earnest operation ulcers have occurred in the jejunum. The duodenum seems students who could study the diseases of tropical climates I 1 Revue de in the universities of those lands where such diseases arei Chirurgie, January and February, 1906.
Linnasus is of
course
zoologist, the originator
-
___
1587 best remembered as a botanist andIprevalent. Much has already been done in this matter, but of the nomenclature named after imuch also remains to be done. It is of good omen that the him, but he was also much more. In the first place, he was (conference unanimously carried the following motion :eminent as a biologist: "he found biology a chaos, he left it That it is desirable that a committee representing universities f be formed which should investigate the question whether it is a cosmos." Then, too, he was a traveller interested in folk-should possible to facilitate the exchange of information as to their courses lore, and wrote an admirable book about the Lapps, amongand standards between the universities of the empire, and to take whom he journeyed for thousands of miles. Nor did he cutaction accordingly. a mean figure as a practising physician. Indeed, his earlier We hope that this is but a prelude to an interchange of associations are chiefly medical, and Stobasus, an eminentIstudents and teachers among the universities of the empire. physician, was one of his kindliest patrons. There is much PEPTIC ULCER FOLLOWING GASTROin the early struggles of Linnseus, his vivid character, his ENTEROSTOMY. brilliant powers of observation, his passionate pursuit of IN the Oleveland Medical Jourrccal for May Dr. C. A. Hamann science, and his enormous originality that reminds us of John Hunter. Both men were destined to conventional has reported a case of peptic ulcer of the jejunum following pursuits and were threatened with apprenticeship to gastro-enterostomy, a lesion which has only recently attracted mechanics. Indeed, Hunter was for a time a cabinet- attention. A man, aged 48 years, suffered for some time maker. Both men early escaped by sheer force of genius from symptoms of gastric ulcer-pain, tenderness, emaciafrom the influence of their environment, achieved an tion, hasmatemesis, and hyperchlorhydria. Anterior gastroinfinity of original work, and at length became shining enterostomy and entero-enterostomy were performed. The stars in the firmament of time. Murphy button was used in both anastomoses. Recovery from the operation was uninterrupted and the smaller button was passed, but on the twenty-second day epigastric pain MR. BALFOUR AND POST-GRADUATE STUDY. began. An indistinct tender mass was felt in the epigastric THE meeting of the Federal Conference on Education, and left hypochondriac regions. The patient was allowed to which was held on May 31st, was occupied with a disgo home as his condition was not regarded as serious. He cussion upon universities and was remarkable in many ways.died rather suddenly 26 days after operation. The necropsy The views which were expressed as to the real function of a showed on the anterior wall of the jejunum just beyond university, of the importance of post-graduate study, and of its junction with the stomach a perforated ulcer about an the necessity for interchange and reciprocity among univer- inch in diameter with a sharply marked border. The button sities were not new, for in point of fact they were a recur- was in situ but the perfect nature of the union and rence to medievalism. But they were revivals. Chief among the position of the ulcer showed that the button could the many excellent speeches was, perhaps, that delivered by not have caused the ulcer by pressure. The ulcer Mr. Balfour, which dealt mainly with the importance of post- was in the position where the highly acid gastric exactly graduate study. After a protest against the tyranny of juice would come into contact with the intestinal mucosa. examinations, he continued :The gastric mucosa showed erosions but no round ulcer. "But, at all events, let us rejoice in common that there is one There was also general peritonitis. The operation of gastrobranch of university work, of growing interest and importance, daily receiving more recognition from all that is best in the intellectual life enterostomy was introduced in 1882 but not until 1899, of the country-I mean the post-graduate course. There the slavery of examinations is a thing of the past, the intellectual servitude in which 17 years later, was the first case of peptic ulcer following it the pupil has hitherto been is a thing he may put on one side ; and he Braun. In an extensive review of the subject is in the happy position of being able to interrogate nature and to study reported by Of these 29 history with the view of carrying out his own line of investigation and Gosset collected 31 cases, mostly German.’ research, instead of being in a perpetual subservience to the idea occurred in males-a preponderance in striking contrast to whether such and such a subject is worth getting up for examination The ulcer purposes, whether he may not have omitted to read with sufficient the greater frequency of gastric ulcer in females. attention something which to him is perfectly useless, perfectly after occurred most often anterior (15 gastro-enterostomy barren, perfectly uninteresting, but on which some question- may be asked by a too curious examiner." It occurred once after Roux’s operation, cases out of 27). And further, he added that it was in connexion with the four times after anterior gastro-enterostomy with enteropost-graduate course that there could be a communication anastomosis, six times after posterior gastro-enterostomy, between ourselves at home and the more distant parts of the and once after this operation with entero-anastomosis. But it must be remembered that the anterior operaEmpire. " If," he said, "we can so arrange the post-graduate course of our universities that tion has been performed more often than the posterior, it will be thought a normal and natural thing for any man who has at any rate in Germany, where most of the cases have the talent and the time to devote his life to investigation, first, to get Mr. A. W. Mayo Robson has pointed out his education at one of the universities of his own country, and then been recorded. to go and conclude that education in a post-graduate course in one of that cases must have been unrecognised because many our colonies, how great will be the advantage, not merely to the student, but to the communities which will be brought together by a perforation did not occur and that in many others death tie which may unite us all in a common interest in these higher must have resulted from abscess formation or in other subjects." the adhesions and other complications obscuring the This is a noble ideal-one, moreover, which there should be ways, so that at the necropsy the true nature of the affection parts, no great difficulty in making a reality. In the Middle Ages was not ascertained. The time after operation at which the universities of Europe were free to all duly authorised of ulceration appeared varied from seven hours to symptoms scholars, and in many instances the teachers of one uni- ten years. Ten of the cases were fatal, 19 terminated in versity were free to teach in any other university. In those and in the remaining two the result is not stated. recovery, days the curse of Babel was removed by the universal In all the was performed for benign disease. Of knowledge of Latin as a language common to learning. If 14 cases inoperation which the method of operation is stated suturing this is so no longer, there exists for British students a was performed in nine, the Murphy button was used in number of universities in far distant lands where their own four, and a bone bobbin in one. In 17 out of 21 cases tongue is spoken, and in addition to the countries under the there was hyperchlorhydria. In consequence of the British Empire there is that great country allied to ourrelation between hyperchlorhydria and post-operaapparent selves-namely, the United States of America. From our tive ulcer the administration of sodium bicarbonate after own particular point of view how much benefit would arise has been recommended. Most, if not all, the to humanity in general from the labours of a band of earnest operation ulcers have occurred in the jejunum. The duodenum seems students who could study the diseases of tropical climates I 1 Revue de in the universities of those lands where such diseases arei Chirurgie, January and February, 1906.
Linnasus is of
course
zoologist, the originator
-