THE CONGRESS OF MEDICINE IN MUNICH.

1008 alterations will have tobeeffected Self- cines in conjunct,ion with residence in mountainous localities cannot be obtained under such conditions. would lie successful. Dr. Zimmermann (Basle) did not agree with Professor As it is there are often small floods in and about the pumping station. Bat it is probable that all the houses in this Bunge’a opinion that the quantity of iron in the food was neighbourhood will be pulled down and replaced by sufficient, and thought that suitable iron preparations were docks when the harbour works are more advanced. The therefore necessary. Dr. Nothnagel (Vienna) advised chlorotic patients to stay abolition or the raising of this district will, however, make the fall of the sewers even less than it is at present. some weeks in bed at the beginning of the treatment. Dr. Edlefsen (Hamburg) recommended the administration Thus an important, a radical alteration for the drainage of a portion of the town will become necessary. Works which were of hydrochloric acid with iron preparations. Dr. Ewald (Berlin) thought that this combination should commenced shortly after 1848 can scarcely be expected to meet modern exigencies and the requirementsof the very great be used only when the gastric hydrochloric acid was ascer. increase of population which bas taken place since that time. tained to be deficient. It will, however, remain to the lasting honour of D.)ver that April prd. this town was among the first to lead the way in effecting THE DEBATE ON THE ANTITOXIN TREATMENT OF those reforms that have so materially contributed to reduce DIPHTHERIA.-(Continued.) the death-rate of the towns of England. Dr. Treupel (Freiburg) reported that he had made injec. tions of 200, 600, 1000, and 1500 antitoxin units on rabbits and dogs. Their general state, the temperature, the respira. THE CONGRESS OF MEDICINE IN MUNICH. tiOD, and the blood pressure remained normal; skin eruptions or changes at the places of injection were not observed, In (Continued from p. 950.) the urine there was for some time after the injection a Emall quantity of albumen, but no microscopical elements, such as April 2nd. that the albumen in the urine consists casts. It is THE THERAPEUTIC ACTION OF FERRUGINOUS COMPOUNDS. of albumose probable or peptone. It is doubtful whether albuminuria PROFESSOR BUNGE (Basle), having referred to the import- is a constant symptom after the injections, whether it is ance of the part played by hsemoglobin in the animal special to antitoxin, or whether it depends merely on the of blood serum in general. economy, said that it is very improbable that iron in the injection Dr. Siegert (Strasburg) had concluded from his experi. into the form of inOIganic salts introduced human body by ments : (1) that the injection of antitoxin produces albumin. the food becomes converted into hæmoglobin by synthesis. uria, diminution of the quantity of urine, and increase of The case is otherwise with organic ferruginous combinations its these symptoms being more aggravated specific gravity, such as are present in the yolk of egg in the form of nucleo- when the kidney is irritated ; (2) that the injection of albumins, from which the hæmatogen originates. Several carbolic acid causes no albuminuria, but an increase of the combinations of iron exist in milk and also in vegetables, the diuresis and of the specific gravity; (3) that an injection of latter containing a considerable amount, but milk only a carbolic acid diminishes the effect of antitoxin ; (4) that small quantity. This SEems to be incompatible with the fact an intravenous injection of 10 cubic centimetres of antitoxin that milk contains all the elements necessary for the growth No. II. is very well tolerated by healthy rabbits; (5) thata of a young organism ; but this deficiency is compensated in subcutaneous injection of defibrinised horse serum kills a young animals by a very large reserve stock of iron derived rabbit in from two to four days, the changes in the urine from the placental circulation, and when this stock is being the same as after antitoxin injections ; (6) that a sub. exhausted they instinctively begin to take vegetable food. cutaneous injection of 10 cubic centimetres horse serum with The iron’ carbolic acid The same is the case in the human subject. produces the same changes, but the animals necessary for her ofE=pring has been in process of accumula- do not die. Dr. Siegert declared that he was far from asserting tion by the mother not only during her pregnancy butthat these results would be repeated in the case of the human ever since her arrival at puberty. Perhaps the appearance of chlorosis is caused by the fact that the solid tissues of ae Dr. Vierordt (Heidelberg) was not of opinion that the woman abstract iron from the blood without giving anythingcourse of the fever in diphtheria, as suggested by Dr in return. This compensation can only be effected by meansHeubner, vas characteristic. He ranked himself anything of organic preparations of iron, which alone are absorbed ;; among those medical men who reserve their judgment as to whether they are assimilated is very doubtful, and, therefore,, methods. Behring’s the best way to provide the human body with the necessary At this point the discussion was closed, and Dr. Heubner’i amount of iron is by the dietetic use of ferruginous vege-motion, given at the end of the report of the first sitting, was table products. Ferruginous drugs only act by suggestion-adodted. the iron which is to be assimilated must be obtained from April 4th. the market-garden, and not from the pharmacy. THE AND TREATMENT OF TYPHLITIS. PATHOLOGY Professor Quincke (Kiel) stated that he had made investiProfessor Sahli (Berne) described typhlitis and perityphlitis gations as to the quantity of free iron in the tissues, and had found that it mcreabes or decreases according to the as inflammations which arise from the interior of theintEStina chemical qualities of the ferruginous preparations ingested. and in course of time attack the walls of the emenm, the According to him there are three varieties of iron compounds vermiform appendix, and the surrounding tissues. This in. present in the human body : (1) that in the tissues ; (2) fection is caused by the presence of pyogenic bacteria in the the reserve stock ; (3) that in the circulation. Ferruginous c=um. The marked swelling in perityphlitis results frcm preparations he divides into six classes : (1) ferrocyanic an infiltration of the tissues round the cæcum, the vermiform combinations, which have no influence on the organism ; (2) appendix, the peritoneum, the omentum, and the fascia transblood, which is usually held in reserve, but may ba usefully versalia. This swelling becomes still more increased by the given in amomia; (3) diluted hæmoglobin; (4) citrate of accumulation of fsces. Every case of typhlitis with palpable iron, which does not coagulate albumen ; (5) insoluble com- swelling is attended by suppuration, but these cases teV/f’ binations, which, if subcutaneously injected, are in course theless often recover, the pus partly being absorbed and partly of time absorbed ; (6) the other oxides and suboxides of fitding its way spontaneously into the interior of the bowel, iron. These form albuminates in the stomach and intestines, The disease at the outset should be treated by opiates and aband are but slightly absorbed in the normal body ; per- solute rest, togetherl with total abstinence from food. Wtf haps more so in anæmia, where thpy became directly there is no improvement within three days an operatien assimilated. He is ptrsuaded of the efficacy of ferruginous becomes necessary. An immediate operation should only be preparations, especimly of the suboxides and albuminates ; performed if the patient suffers from continuous fever, if he is but is not of opinion that organic compounds are preferable seized with shivenng, and if the temperature and the pain to inorganic, the inorganic iron being changed in the intes- suddenly increase after an apparently favourable initial tines into an organic combination. Sufficient experiments stage of the disease. To avoid relapses the vermiform have not yet been made on the therapeutical value of hæmo- appendix must be removed, even if the pus is spontaneonsly globin. He finally remaiked that drugs cannot be dispensed evacuated into the intestines. with in the treatment of chlorosis. Professor Helferich (Greifswald) said that the presenceaf Dr. Heubner (Berlin) said that infants ought not to be fed pyogenic bacteria produces purulent catarrh of the muncons too long upon milk. membrane of the caecum; and if the mucous membrane is

obtained. Here

cleansing

some

sewers

.

subj ect

Dr.

Siegfried (Rippoldsau) thought

that

ferruginous medi-

abraded by the passage of fasoes

the

resulting suppuration

1009 easily penetrates through its walls. As soon as the symptoms of suppuration-f ever, pain, and sweating-are

It would an operation should be performed. be wrong to wait till the abscess becomes palpable or to rely on the possibility of spontaneous care. Above all, the symptoms of approaching perforation of the peritoneum I should be attentively observed. Appendicitis, of course, is often present without any grave symptoms and only becomes manifest by a sudden aggravation of the patient’s general sta’e. Dr. Sannenburg (Berlin) made a distinction between simple and purulent a,ppendicitis. The former he has observed in twelve cases post mortem ; it ii characterisEd by the abence of all grave symptoms affecting the temperature and the pulse, and by a shoit and milcourse. These cases should I Parulent appendicitis, which be treated expectantly. begins with shivering, vomitiog, diarrhoea,, severe pains, &c , should be operated on. Whcxe the abscess has opened through the intestine the vermiform appendix must be removed. Dr. Curschmann (Leipzig) stated that in his experience the mortality was at the rate of 5’4 per cent. in 452 cases. He did not agree with Professor Sihli that all cases were purulent. There is also a sero-fibrinous exudation. The swelling in pentyphtith often arises from accumulation of faeces, sometimes also from a matting together of the infiltrated tissues. He declined to give general rules for operating, for in this disease it is essential to take into consideration the circumstances of each ca’ p. Dr. Aufrecnt (Magdeburg) said that cases should be distinguished according to the ite of the exudation. The disease is less dangerous when the exudation is merely extra- I, peritoneal, and much more dangerous where there is phlegmonous infiltration of the tistues behind the csecum. In the latter case an immediate operation is necessary, but in the former it is permissible to wait till an abscess results. Dr. Qaincke (Kiel) thought that accumulation of fseces is seldom a cause of real typhlitis. Very often the administration of an enema Effectually relieves the patient. This treatment, of course, should only be used when no alarming

recognised

I,

-

;

symptoms are present. Dr. Augerer (Munich) reported some cases where after a comparatively short time symptoms of grave ileus appeared. The post-mortem examination only showed a small intumescence. Dr. Sonnenburg remarked that he bad also seen cases of this kind. He was of opinion that these symptoms arise from an autointoxication of the body by bacteria. Dr. Heubner (Berlin) stated that in fuch cases even a very early operation had not succeeded in averting the death of

the patients.

April Eth. SUBCUTANEOUS NUTRITION.

I

Dr. Leube (Wu zburg) said that for this method of

only fatty substances are suitable. In order to really absorbed and assimilated Dr. Leube injected fifty grammes of butter under the skin of emaciatEd dogs. After the injection fat was once more found to be nutrition

show that fat is

present in the subcutaneous tissues and in the internal organs

of the animals. Chemically it proved to be partly the natural fat of the dog and partly butter. When the animals were kept without food it again disappeared, so that it had evidently been consumed like the natural fat of the body.

Dr. Ott spoke on Nucleo-albumins. Dr. Dehio (Dorpat) diecassed Cardiac Myofibroma and its clinical symptoms. Many other pipers were also read before the Congress, which exigencies of space compel us reluctantly to leave unrecorded in our columns. The arrangements made for the comfort of the visitors were excellent, and the reception on behalf of the profession of Munich was very cordial. It was a subject of general remark that a very great number of visitors came not only from the German Empire, but also from Austria, Switzerland, the Russian Bdltic provinces, and other countries where German

isspoken.

Public Health

and

Poor Law.

LOCAL GOVERNMENT DEPARTMENT. REPORTS OF INSPECTORS OF THE MEDICAL DEPARTMENT OF THE LOCAL GOVERNMENT BOARD.

On tlie water-supply nf the Parish of Lympsham, by Mr. T. W. THOMPSON.-This inquiry was undertaken owing to a complaint by the county council of Somerset to the effect that the then existing rural sanitary authority of Axbridge had failed to provide the parish of Lympsham with a praper water-suppty. The parish is a scattered one. The watersupply is derived from certain wells, and also to a large extent from ponds, ditches, &c.; and so scarce or bad is it at times and in certain places that some people send out of the district for a supply which is brought in by water-carts. Of the wells Mr. Tnompson says that they are of a generally unsatisfactory character ; they contain mere surface water, and they are situated in such proximity to drains, privies, cesspools, and highly polluted ditches that they cannot fail Even the so-called parish well is to become contaminated. situated in a grass field which is occasionally manured, and it has within about ten yards of it an offensive and almost stagnant ditch, into which a privy and the drainage of a It would be bad enough if the cottage discharge. Lympsham people were content with such water for their own consumption and purposes, but they palm it off on others and make money out of the transaction. Thus dairy-tarming is theprincipal local industry; milk is largely produced there, and it is either distributed to large towns or made into cheese. Everyone knows how large a share water-supply bai to do with such operations, and it is well, as far as Lympsham is concerned, that it should also be known that even where Lympsham dairy farmers take the trouble to send elsewhere for their drinkrng-water, and thus evidently admit the unfitness of their local supply for dietetic purposes, they were found to be using that iocal supply for ’’dairy operations," including a so- called cleansing of milkvessels. In one case cans were "cleansed" with water from a dry-steined well alongside a pig-yard. But perhaps the most unsatisfactory circumstance in this Lympsham inquiry is the weak attitude adopted by the now happily deiunct rural sanitary authority, who, having had several schemes of water-supply under consideration, and having informed the Local Government Board that one scheme had been found

THE ABSORBENT POWER OF THE RECTUM. not only the least expensive, but the most feasible, practically Dr. Posner (Berlin) reported that he had injected solutions say that because the parish have rejected it they dare not of aniline colours into the rectum of rabbits, and that in proceed unless the scheme is "ordered to be carried out." from twelve to fifteen minutes they were totally absorbed. We can only hope that the new district council will hold a This fac: fbould make physicians very cautious in giving drugs higher view as to its duties, and that in the evidence before them they will take away the reproach of Lympsham and by the rectum. von Ziemssen and Dr. R!per agreed with Dr. Posner. of those of its inhabitants who imagine that a water-supply Dr. von Noorden recommended the administration of quinine which is subject to the constant risk of very filthy pollutions is good enough for a parish which thrives on tfaoamitting by the rectum in whoopirg cough. dairy products to ndgbbouring populations, and does not OTHER PAPERS. hesitate to use such water in the various operations necessary At the fical sitting Dr. Rampf (Ham burg) read a paper on to the preparation of those products. the treatment of Enteric Fever by itjecuons of cultures of REPORTS OF MEDICAL OFFICERS OF HEALTH. the ba,il!us pyocyaneus. His experiments were of course made on an mals only. Whitechapel Urban Sanitary Listrict.-The condition as Dr. Tnoma (Magdeburg) made some observations on the regards nationality of a considerable proportion of WhiteElastic Tii-sue of the Arterial Walls and on Angeiomalacia. chapel may be judged by Mr. J. Loane’a remark that "a Dr. Noorden described a new means for the early diagnosis stranger comiDg into some of the streets of Spitalfields might of Diabetes Mellitus. He administers glycose to patients who be excused for doubting that he was in the capital of either from natural or hereditary predisposition are suspected England at all " ; and it appears from Mr. Loane’s current to suffer from diabetes, and if this substance appears in the report that in 1894, 1046 foreigners were added to the Whiteurine the case must be treated as diabetic. chapel population. The birth-rate of the district was a high

Dr.