THE COLORIMETRIC DETECTION AND ESTIMATION OF BORIC ACID.

185 it was recognised that the hospital must be reconWe arrived in Canton on a Thursday, but, unfortunately, year y, and largely rebuilt so as to provide a perfectly si could not get on to our home that night. We slept in a bed structed one who had six weeks before an e, occupied by equipped modern hospital. For this purpose it was found previously attack of dengue and still had pains. But the bedding, n necessary to raise .610,000, and of this about £2300 have a been subscribed, leaving about £7700 yet to be mattresses, &c., had not been sterilised, although the sheets already had been changed. We met, also, one other person who eight raised. r; The work of renovation has been now completed a the new Fitzroy House contains about 40 rooms, 30 weeks before had an attack and still had pains. Neither of and o of which are bedrooms. The floors have been covered us were bitten by mosquitoes, which are blamed by the with papyrolith, which amongst other things contains Chinese for transmitting the disease. On Friday we returned a to Fatshan and next day my wife suddenly collapsed with all asbestos, This is paper pulp, sawdust, and magnesite. the signs of the disease and in a few hours I followed. My laid like a cement and forms when dry an extremely b and impervious surface. A model operation-room attack was very light and in a week I resumed my hospital hard duties, although rather hampered by pains. Almost all the bhas been provided on the top floor, with a north drugs mentioned in the books I have tried on myself or my vvertical light and a top light in addition. The walls and Chinese patients but with little success. Perhaps ammoniated ceiling of the operation theatre are lined by six-inch c tincture of quinine, in half to one drachm doses, gave the best glass All the rooms are fitted with electric light tiles. g results, but practically nothing touched the pains. But in aand the whole hospital has been decorated and fitted i a very artistic manner. A passenger-lift working by reasoning about the conditions of the disease in our own case in and comparing our experience with that of a colleague who Eelectricity renders easy the removal of a patient from one f to another. In its present condition the building is had returned from Japan with us and escaped I came to floor B suited for the purpose for which it has been designedthe conclusion that we had been infected by sleeping in an well i the nursing at moderate rates of middle-class patients. unsterilised bed. My colleague slept in one not previously namely, free. an infected and has been The fees entirely occupied by person charged are inclusive of everything except medical Then, further, I noticed that when my wife recovered a littleattendance and range from four to ten guineas per week. ’; and went to Canton she was entirely free from pain. I, The hospital is self-supporting-in fact, a very small profit i at an is for the management endeavours to carry it on at continued to have them. She made, home, staying occupied uninfected bed but on the next day after her return heras a low a rate as is possible without incurring a debt, and pains were almost as bad as ever. I therefore concludedyet the patients have all the attractions and comforts and that she was reinfected by sleeping in her own bed. So Imore than all the medical conveniences of a well-appointed I It is pointed out that the hospital is to a certain suggested that we should take a bath in hot water and house. i and that meantime all extent some fairly strong disinfectant, of the nature of a charitable institution, for the should be exposed to the sunmoney for renovating the building has to be provided mattresses, bedding, &c., This the was done. After two days of such 1by donations, but that, inasmuch as the fees charged to the during day. treatment all our pains vanished, nor have they returned patients only just suffice to maintain the hospital, it is We were not taking drugs. This simple line of after-treat- really self-supporting. Certain privileges in the way of ment I have, with entire success, carried out with my priority of admission are granted to those who subscribe Chinese patients, as with medicine water’ it is easy to 20 or 50 guineas. There is, no doubt, a future for institupersuade them to sponge themselves down and to sterilise, in tions such as this when conducted on right principles, the hot sun we have here, all their beds and clothes. I give for the average private house is ill adapted for sick simple tonics when necessary. The treatment is apparently nursing of any kind, and especially for operations. I feel convinced that one reason for It is felt that there is a need for seff-supporting pay as effective as simple. the long continuance of pains is the nightly re-infection. hospitals in which a lower charge is made than four This is quite in keeping with the fact that there is a fine guineas a week, and Sir Henry Burdett suggests that pay desquamation of ’the skin often prolonged over two or three wards should be located in ordinary hospitals and that weeks in some. The sun evidently speedily kills any a two-guinea or a 50s. minimum fee per week would infective germs in the desquamated skin dust." suffice to cover the cost of maintenance, while the patient could select any medical man he preferred, the medical fees being paid out of a fund formed by putting aside 10 per cent. of all moneys received. The question as to whether A HOSPITAL FOR PAYING PATIENTS. this percentage would provide sufficient funds for the ON Jan. 9th the Duke of Northumberland opened the purpose appears to rest on the supposition that in many hospital for paying patients at Fitzroy House, Fitzroy-square, cases more than C210s. would be charged, as the scheme London, W., which has now been partly rebuilt and comsuggests that all the patients should pay what they can pletely renovated. In 1877 Sir Henry Burdett suggested in a but in no case less than the above sum. letter to the Standard that an association should be formed for the purpose of founding a hospital for well-to-do AND ESTIMApatients, to which admission should be by payment only. THE COLORIMETRICOF DETECTION BORIC ACID. TION A little later a public meeting was held at the Mansion SINCE it is probable that some day-and already we House and ultimately the Home Hospital Association for Paying Patients was incorporated in 1878. A sum have waited long-the Government may be led to adopt of over .620,000 was contributed by those interested in the recommendation of the Foods Preservatives Comthe movement and in 1880 the first home hospital was mittee to the effect that the use of boric acid should

afford

in Fitzroy-square. Later the association acquired be altogether prohibited in milk and that the quantity the freehold of the neighbouring house and a lease of of the preservative should be restricted in butter and other adjacent premises. Fitzroy House, as this home hospital cream, it is desirable that we should be in possession was called, has for 22 years done much work for middle-class of a trustworthy process for the detection and estimapatients, for it has always been conducted on a system which tion of boric acid in foods. According to Mr. C. E. provides that each patient shall be charged but little over Cassal and Mr. Henry Gerrans, analysts engaged in the the cost price for his accommodation and shall pay, and be examination of foods under the Sale of Foods and Drugs attended by, his own medical man From first to last 5376 Acts, the old turmeric test may be improved considerably under have been treatment in Fitzroy House. Last by adding oxalic acid. They apply the test for free or patients

opened

186 - combined boric acid in milk or other foods by first drying and burning the residue to an ash. It is well to add a little caustic baryta solution before evaporation and incineration as otherwise small quantities of boric acid might ’be lost. The ash is treated with a few drops of dilute hydrochloric acid, then with a saturated solution of oxalic acid, and, finally, with an alcoholic solution of curcumin or turmeric, and the mixture is dried on the water bath and the residue is taken up with a little spirit. The spirit will be coloured a more or less intense magenta red if boric acid is present. Mr. Cassal and Mr. Gerrans state that they have been able to employ this test for the determination of the actual amount of boric acid present. their observations are confirmed this method should be of ..obvious service.

If

the amendment of the Local Government (Scotland) Act, promoted by the association, was persistently blocked by one of the Scottish Members of Parliament and did not reach the second reading. The Lord Advocate’s Bill to amend the Local Government Act likewise never reached a second reading, having been blocked by the same Member. Both Bills will, however, be introduced again next session. THE

DISTRIBUTION

OF

PLAGUE.

As regards the Mauritius a telegram from the Governor to the Earl of Onslow, acting for the Secretary of State for the Colonies, received at the Colonial Office on Jan. 6th, states that for the week ending Jan. lst there were 9 cases of bubonic plague and 5 deaths from the disease.

____

THE IN

CONTAGIOUSNESS OF CANCER.

leading article in THE LANCET of Dec. 6th, 1902, p. 1558, we reviewed the reasons for thinking that, in spite ’of the fact of our ignorance of the real etiology of cancer, we were justified in looking upon it as contagious and vin taking all those precautions to prevent its spread which that theory of its origin would suggest. Dr. A. T. Brand of Driffield has drawn our attention to the address which he delivered last -May on the occasion of his - installation as President of the East Yorks and North ,Lincoln branch of the British Medical Association. In this address Dr. Brand maintains the contagiousness of cancer - and supports his contention with many of the arguments which we advanced in the leading article referred to, and ’he quotes an instance of apparent contagion occurring It is in the suggestions for within his own knowledge. prophylaxis that Dr. Brand’s address is especially interesting. In addition to most of the precautions which we advocated, such as destruction of the dejecta and dressings, he mentions "notification." This might prove to be a valuable measure as it would enable precautions to be ’taken against the spread of the malady and would give us more accurate information as to the localities where the - disease arises than can be obtained from statistics as to the places of death from cancer. a

THE TREATMENT OF ABDOMINAL CONTUSION WHEN RUPTURE OF THE INTESTINE IS POSSIBLE. WE have

recently called

attention to the difficulty and of diagnosing rupture of the intestine in cases of abdominal injury. The great importance of early led has American operation surgeons to advocate the performance of laparotomy within a few hours of the injury in all serious cases of abdominal contusion. In the Boston Medical and Surgical Journal of Nov. 27the, 1902, Dr. F. B. Lund relates six cases of early laparotomy in rupture of the intestine with four recoveries-eloquent testimony of the value of this treatment. He points out that beyond the fourth or fifth hour after injury every hour adds to the danger, and that the surgeon cannot afford to wait In his successful cases the for certain signs of perforation. interval between the injury and the operation was three, five, nine, and 16 hours respectively ; in his unsuccessful One case presented the cases 18 and 24 hours respectively. remarkable feature that apparently there was no contusion of the abdominal wall but that there was of the back. The patient was a man, aged 40 years, who was taken to hospital six hours after he was struck in the back, below the left shoulder blade, by the shaft of a wagon and knocked down. He felt faint for a time. Severe abdominal pain, chiefly above the umbilicus, followed. He soon got up and A cup of tea was able to walk three-quarters of a mile. SCOTTISH POOR-LAW MEDICAL OFFICERS’ which he drank brought on vomiting and the pain increased. ASSOCIATION. On admission the pulse was 92, thready, and of low tension ; THE report of this association for the year 1902 states the temperature was subnormal ; the lips were pale and the that the a ,that during committee was occupied with period face was ashen. The abdominal wall showed no evidence of number of important questions. The secretary (Mr. W. L. The abdomen was distended and everywhere was Muir, 1, Seton-terrace, Glasgow) was summoned before the injury. and tender. There was no dulness, even in the rigid ’Committee of the Privy Council which has for some time flanks. On the back, over the left tenth rib, about the of the sale of His been considering subject poisons. three inches from the middle line, was a red contused "evidence on that occasion was to the effect that in the area. Immediate operation .was advised but declined. A Highlands, islands, and country districts where there were enema brought away but little faeces. A quarter of a high no druggists it was necessary for medical men to supply the of morphine injected subcutaneously gave only slight grain or it with all and otherwise, public drugs required, poisonous relief. He grew steadily worse and 18 hours after the injury ,was a serious hardship for a medical man to be found guilty "of "infamous conduct"by the General Medical Council consented to operation. On opening the abdomen much dark-brown fluid, evidently bile-stained, and flakes of fibrin because in his absence someone in his surgery had supplied and particles of food escaped. The peritoneum of the small a scheduled poison to a member of the public. The secretary intestine was congested and covered with fibrinous exudawas also summoned before the Scottish Local Government tion. A perforation which easily admitted the forefinger ’Board as a witness in its inquiry as to the medical relief was found in the jejunum opposite the mesenteric attachof The general character his evidence was .oE the poor. downwards from it in the long axis of the that it was absolutely essential that the Poor-law medical ment ; extending bowel was a peritoneal tear one and a half inches long. .,officer should have a more secure tenure of office than at Owing to its position and to abdominal rigidity the perpresent, with an appeal to the Local Government Board foration The patient recovered was sutured with difficulty. that he should the of have .against unjust treatment ; power well from the operation, the pain ceased, and the pulse ..ordering invalid diet, stimulants, and the like, without the improved ; but on the second day after the injury severe same being vetoed by the inspector of poor (an official It was controlled by opium and he diarrhoea began. the clerk to a board of guardians in corresponding to On third the day he again became worse and he ,England) ; and that for all fractures, midwifery, and other improved. 1 THE ..exceptional cases there should be extra fees. The Bill for LANCET, Jan. 25th, 1902, p. 247. even

impossibility