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THE DIRECT ACTION OF COCAINE ON THE SPINAL CORD.
798 to France this year. Moreover it must be remem- of an eighth of an inch, the granulations projecting through bered that the thirteenth International Congress of Medicine, the holes. The second method consists in marking off a an International Congress on Medical Ethics, and other space from one-fourth to one-half of an inch in width around meetings of interest to medical men are to be held in Paris the entire circumference and sowing this field with desiccated next year. Since the above was written there has been epithelial cells ; over these are laid strips of rubber tissue a rumour that Dreyfus will be pardoned. If this rumour extending half a line beyond the margin of implantation. -should prove to be accurate it will be a step in The centre of the ulceration is then filled with strips of the right direction and one that was to be expected gauze and dressings are applied in the usual manner; this - although it can afford but little consolation to a man to be process is repeated until the entire surface is covered. When pardoned"for a crime of which he is innocent; still if the surface does not exceed one and a half or two inches in pardon " means release from prison and restoration to the extent the grafting may be accomplished without resorting to either of these methods. Dr. Wiggins says that in many arms of his family it may also mean the prevention of that total breakdown in health which is imminent and which instances in his own practice he has seen an ulcer measuring in the case of men of less fortitude would inevitably have an inch by an inch and a half completely covered within 24 hours by a thin white film of organised tissue which in 10 - occurred long ago. days made it impossible to distinguish between the old and the new structure. THE REGISTRAR-GENERAL AND DEATH
patients
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CERTIFICATES. WE have been asked about the alleged new instructions of the Registrar-General with reference to the certification of cause of£ death by medical men. According to a has been the round which of the newsgoing paragraph the has instructed his subordinates Registrar-General papers to refuse to register deaths on certificates given by medical men who have not seen the patient within three days previously to the fatal event. There is most urgent reason why the Registrar-General should use his authority in stiffening the conditions of registration of deaths in the direction of measures for securing evidence in all cases of proper medical attendance. The proportion of deaths uncertified, as distinguished from those which are the subject of inquests, is less than it was ten years ago. It was 2’06 per cent. in 1897, according to the Registrar-General’s last report, as against 3’08 in 1888. But it is still far too large. There is reason to believe that both the RegistrarGeneral and the General Medical Council are working together for an improvement in the law of registration, but we are informed on good authority that the paragraph to which we have alluded is entirely without foundation.
SKIN-GRAFTING WITH DRIED EPIDERMIS SCALES.
Chicago Railway Surgeon of August 8th Dr. J. L. of East St. Louis, Illinois, reports some results obtained by him after covering granulating surfaces with -epidermic cells from the sole of the foot, a method of treatment described by Dr. J. T. Hodgen in the St. Louis Medical and Surgical Journal in 1871. Dr. Hodgen sprinkled the unprepared epidermic cells over the granulating surface and claimed to have obtained as good effects as those which followed the application of the ordinary skin grafts recommended by Reverdin. For the purpose of preliminary sterilisation Dr. Wiggins has the foot thoroughly scrubbed to remove as far as possible the outer layer of epidermis and then bathed in strong bichloride solution, after which it is covered with moist boric acid dressing and rubber tissue. At the expiration of 12 hours the dressing is removed and the surface thoroughly .scraped with a dull knife. The cell mass thus obtained is transferred to a mortar placed in a water bath at a temperature of from 110° to 115° F. and the mass is stirred until thoroughly desiccated. The object of this procedure is twofold: first, to permit of trituration so as to separate the particles still further ; and secondly, to divest them of all moisture so as to promote the adhesion of the cells to the moist surface of the ulcer. Dr. Wiggins has used two methods of applying the cells to the granulating surface, and has found each of them under varying conditions equally satisfactorywhere the .surface was large. One was to cover the entire surface with ordinary rubber tissue perforated with holes at intervals IN the
Wiggins
"SECRET COMMISSIONS AND THE MEDICAL PROFESSION." SIR EDWARD FRY has returned in another letter to the Times to his favourite subject, I I Secret Commissions and the Medical Profession," and we are glad to note a decided improvement in the tone of his criticisms. The letters of Dr. Saundby and of Dr. Thomson show conclusively that the existence of any system of such commissions on such a scale as to warrant Sir Edward Fry’s previous letters is contrary to their experience and is unsupported by actual inquiries. Sir Edward Fry refers to our remark on the inadequate action of the General Medical Council in the matter of MacDonald, Sons, and Co. (Limited), and notices our agreement with him on the subject. But he makes no attempt to refute our main charge against him that he has written on the subject in a way not judicial, and which is more worthy of a novel-writer than of a judge. As the writer of a remarkable letter in the Times of Sept. 12th, signing himself "F.R.S.,"says, "To me the strictures of Sir Edward Fry’s letters, in so far as they concerned my profession, seemed to derive their importance entirely from the eminence and uprightness of their author. To reply to them may have been a duty of but "F.R.S.’s" was scarcely a duty of defence." courtesy, extends over of 32 experience years consulting practice, in which he estimates that for 20 years he had 1700 communications a year with medical practitioners and a corresponding acquaintance with dispensing chemists, and he finds no support in this experience to Sir Edward Fry’s charges."The grave suggestion that the doctor maystand in’ with an undertaker seems to me simply grotesque, though I cannot tell what corruption may possibly exist upon the skirts of the medical as of the legal profession." Sir Edward Fry would have been more justified in his critical exercises if he had practised them on some of the scandal of his own profession. But this is not our main point. We insist, with all respect, that he has given entertainment to charges against the medical profession on grossly inadequate evidence and that the only way in which he can atone for such a misuse of his great authority is to use it in procuring for the General Medical Council and the medical corporations the whole of the evidence on which the London Chamber of Commerce based their report. ......
THE DIRECT ACTION OF COCAINE ON THE SPINAL CORD. IN the issue of the Deutsche Zeitschrift für CWirizrgie for April, 1899, Dr. Bier reports the results of some experiments made by him to test the practicability of rendering considerable areas of the body-e.g., both lower limbs-anaesthetic by the action of cocaine injected directly into the spinal canal. The method employed was to introduce a minute quantity of the drug into the subdural space
799
the
of the cord by means of Quincke’s lumbar puncture. By per mille of population being 35’79 as against 36’94 in 1897. The decrease in the birth-rate was anticipated by of of from five to in this 10 milligrammes way employment the Sanitary Commissioner in his last report and is now cocaine hydrochlorate Dr. Bier succeeded in producing anaesby him as due to the low vitality of the people considered thesia of the lower limbs and was able to perform pain- in the preceding year caused by the effect of famine and
lessly such operations as resection of the knee-joint and ankle-joint, sequestrotomy of the tibia, resection of the ischium, treatment of a case of osteomyelitis of the femur, and resection in a case of complicated fracture of the femur. The only drawbacks resulting from this mode of administering the drug were severe headache, nausea, and vomiting, which some of the patients suffered from for several days after the operation. It was then decided that exact experi-
high prices. He points out that the number of births was everywhere considerably higher during the last five months of the year than during the earlier months, and that this was particularly noticeable in those parts of the province which were most severely affected by famine. This explana-
tion, however, does
not seem to be sufficient because the decreased birth-rate does not correspond with the districts where famine prevailed, and some districts which were classed as famine districts actually record a higher rate. It seems to be the normal state of things for an increased ments should be made to determine more precisely the number of births to occur in the later months of the year. effects and for this purpose both Dr. Bier and his colleague Other causes were therefore probably at work. Considerably Dr. Hildebrand submitted themselves to the action of greater accuracy in registration must be attained before cocaine injected into the spinal subdural space in the the vital statistics of the province can be considered as a manner alluded to before. It was found that anaesthesia basis on which definite and satisfactory conclusions can be of the whole of the lower extremities supervened in from founded. Calcutta is as usual at the bottom of the list with a birthfive to eight minutes after the injection and a dose of five rate of 13’98 per mille, the departure of women from fear of milligrammes of the cocaine was sufficient to make this con- plague having doubtless caused the large decrease since last dition of anaesthesia last for about 45 minutes, after which year. It must be remembered, however, that the proportion normal sensibility slowly and gradually returned. The of males to females in Calcutta is more than 2 to 1. The after-effects were, however, not always pleasant and were number of deaths registered in 1898 was 1,888,468, giving a ratio of 26-57 per mille as against 2,341,632 and 32-94 in the like those found in the surgical cases referred to above. Dr. previous year. The mortality from fever and cholera was Bier was even obliged to’remain in bed for some days. It particularly low. Owing to the general absence of epidemics was therefore decided that further experiments should be the death-rate of the towns fell to the remarkably low figure made on animals, so that the effects might be more fully of 27’50, as against 35’09 last year. The death-rate among studied with a view to obviate the disagreeable effects pro- males was 28’75 per mille against the average of 30.87 for the past 10 years. Among females it was 24’40 per duced by the drug and to enhance its undoubted usefulness. mille, against 2668, the average of the preceding 10 years. Registration in the case of females is more The mortality among Mussulmans is given defective. ON Sept. 13th Mr. Justice Cozens Hardy granted anas 29’53 per mille, as against 25’51 among Hindus. application of the Jenner Institute of Preventive MedicineThis difference is unexplained and does not occur every to enable them to alter their Memorandum of Association soyear. No less than 1935 persons were convicted for failure to register and Rs. 3052 were imposed in fines. as to profit by the gift from Lord Iveagh of .6250,000. Registration is probably defective to the extent of 13 per nille in the case of deaths and 11 per mille in the case of WITH reference to medical men willing to serve onlbirths. These are the deficiencies which are discovered by plague duty in India the authorities of the India Office 1the vaccination staff. The influence of the meteorological inform us that no more are required at present, but that a < conditions on the prevalence of fever and cholera is a of discussion. In the present year the list is kept at the India Office of those who are ready to go 1perennial subject from fever has been lower than usual and that nortality if required. f’rom cholera has been the lowest ever recorded in the -
I There appears to be no satisfactory explanation of these THE Colonial Office has received a telegram from the f Inoculation against cholera has been carried on Governor of Mauritius stating that for the week endingfacts. tthroughout the year at the Purulia coolie depôt and while of of which 62 cases 51 7th proved no information is available from Assam as to its results the plague occurred, Sept. fatal. work is obviously a necessary one and is reported to have b been well and carefully conducted. The deaths from smallA TELEGRAM from the Governor of Hong-Kong (Sir H. A. numbered 14,269 as against 19,655 during the previous p pox There was a large falling off in the number of deaths Blake) received at the Colonial Office on Sept. llth reports year. y f from 13 cases of plague with 12 deaths for the last week. dysentery. Expenditure on conservancy increased L in many places apparently from fear of the plague. largely I many towns nothing has been spent on original sanitary In THE nineteenth report of the Inspector of Retreats under v works and the want of proper drains is a deficiency conthe Inebriates Acts, 1879 and 1888, has just been issued. 14 sstantly noticed. Until outside pressure is brought to bear o on some of the municipalities nothing is done. The preretreats are dealt with. cautions against plague consisted in the working of four C large observation camps at Chausa. Chakradharpore, Mairwa, THE British Association have made a grant of and Khurda Road. At Chausa 636,819 persons were inspected towards the expenses of the National Antarctic Expedition. a, and 24,776 were detained. There were five deaths from 177,501 persons were inspected and plague. P.4757 wereAt Mairwa and at Khurda Road 110,083 persons detained, were examined and 3478 were detained. An important ANNUAL REPORT OF THE SANITARY experiment in sewage disposal was inaugurated. The saniwas for on in 1898. engineer tary placed special England duty BENGAL, the purpose of inquiring into the subject and his proposal to carry out experiments on the septic tank principle has THIS report was due on May lst, but the delay in its been adopted by Government. The precautionary measures issue has been occasioned by the Sanitary Commissioner taken against the plague have indirectly drawn increased having necessarily to devote so much of his time to the attention on the part of local bodies to sanitation generally supervision of plague measures. The Inspector-General of and to conservancy in particular. " Should it prove to have Civil Hospitals has appended to it a valuable note in which he thoroughly and permanently awakened the local authorities to the supreme importance of an efficient system of sanitation reviews the salient points in the sanitary history of the year. the plague will have done the people of Bengal a service The number of births which were registered in 1898 was which will go far to counterbalance the trouble and anxiety 2,540,701, against 2,625,844 in the previous year, the ratio which it has caused.’ -
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COMMISSIONER,
patients
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____
CERTIFICATES. WE have been asked about the alleged new instructions of the Registrar-General with reference to the certification of cause of£ death by medical men. According to a has been the round which of the newsgoing paragraph the has instructed his subordinates Registrar-General papers to refuse to register deaths on certificates given by medical men who have not seen the patient within three days previously to the fatal event. There is most urgent reason why the Registrar-General should use his authority in stiffening the conditions of registration of deaths in the direction of measures for securing evidence in all cases of proper medical attendance. The proportion of deaths uncertified, as distinguished from those which are the subject of inquests, is less than it was ten years ago. It was 2’06 per cent. in 1897, according to the Registrar-General’s last report, as against 3’08 in 1888. But it is still far too large. There is reason to believe that both the RegistrarGeneral and the General Medical Council are working together for an improvement in the law of registration, but we are informed on good authority that the paragraph to which we have alluded is entirely without foundation.
SKIN-GRAFTING WITH DRIED EPIDERMIS SCALES.
Chicago Railway Surgeon of August 8th Dr. J. L. of East St. Louis, Illinois, reports some results obtained by him after covering granulating surfaces with -epidermic cells from the sole of the foot, a method of treatment described by Dr. J. T. Hodgen in the St. Louis Medical and Surgical Journal in 1871. Dr. Hodgen sprinkled the unprepared epidermic cells over the granulating surface and claimed to have obtained as good effects as those which followed the application of the ordinary skin grafts recommended by Reverdin. For the purpose of preliminary sterilisation Dr. Wiggins has the foot thoroughly scrubbed to remove as far as possible the outer layer of epidermis and then bathed in strong bichloride solution, after which it is covered with moist boric acid dressing and rubber tissue. At the expiration of 12 hours the dressing is removed and the surface thoroughly .scraped with a dull knife. The cell mass thus obtained is transferred to a mortar placed in a water bath at a temperature of from 110° to 115° F. and the mass is stirred until thoroughly desiccated. The object of this procedure is twofold: first, to permit of trituration so as to separate the particles still further ; and secondly, to divest them of all moisture so as to promote the adhesion of the cells to the moist surface of the ulcer. Dr. Wiggins has used two methods of applying the cells to the granulating surface, and has found each of them under varying conditions equally satisfactorywhere the .surface was large. One was to cover the entire surface with ordinary rubber tissue perforated with holes at intervals IN the
Wiggins
"SECRET COMMISSIONS AND THE MEDICAL PROFESSION." SIR EDWARD FRY has returned in another letter to the Times to his favourite subject, I I Secret Commissions and the Medical Profession," and we are glad to note a decided improvement in the tone of his criticisms. The letters of Dr. Saundby and of Dr. Thomson show conclusively that the existence of any system of such commissions on such a scale as to warrant Sir Edward Fry’s previous letters is contrary to their experience and is unsupported by actual inquiries. Sir Edward Fry refers to our remark on the inadequate action of the General Medical Council in the matter of MacDonald, Sons, and Co. (Limited), and notices our agreement with him on the subject. But he makes no attempt to refute our main charge against him that he has written on the subject in a way not judicial, and which is more worthy of a novel-writer than of a judge. As the writer of a remarkable letter in the Times of Sept. 12th, signing himself "F.R.S.,"says, "To me the strictures of Sir Edward Fry’s letters, in so far as they concerned my profession, seemed to derive their importance entirely from the eminence and uprightness of their author. To reply to them may have been a duty of but "F.R.S.’s" was scarcely a duty of defence." courtesy, extends over of 32 experience years consulting practice, in which he estimates that for 20 years he had 1700 communications a year with medical practitioners and a corresponding acquaintance with dispensing chemists, and he finds no support in this experience to Sir Edward Fry’s charges."The grave suggestion that the doctor maystand in’ with an undertaker seems to me simply grotesque, though I cannot tell what corruption may possibly exist upon the skirts of the medical as of the legal profession." Sir Edward Fry would have been more justified in his critical exercises if he had practised them on some of the scandal of his own profession. But this is not our main point. We insist, with all respect, that he has given entertainment to charges against the medical profession on grossly inadequate evidence and that the only way in which he can atone for such a misuse of his great authority is to use it in procuring for the General Medical Council and the medical corporations the whole of the evidence on which the London Chamber of Commerce based their report. ......
THE DIRECT ACTION OF COCAINE ON THE SPINAL CORD. IN the issue of the Deutsche Zeitschrift für CWirizrgie for April, 1899, Dr. Bier reports the results of some experiments made by him to test the practicability of rendering considerable areas of the body-e.g., both lower limbs-anaesthetic by the action of cocaine injected directly into the spinal canal. The method employed was to introduce a minute quantity of the drug into the subdural space
799
the
of the cord by means of Quincke’s lumbar puncture. By per mille of population being 35’79 as against 36’94 in 1897. The decrease in the birth-rate was anticipated by of of from five to in this 10 milligrammes way employment the Sanitary Commissioner in his last report and is now cocaine hydrochlorate Dr. Bier succeeded in producing anaesby him as due to the low vitality of the people considered thesia of the lower limbs and was able to perform pain- in the preceding year caused by the effect of famine and
lessly such operations as resection of the knee-joint and ankle-joint, sequestrotomy of the tibia, resection of the ischium, treatment of a case of osteomyelitis of the femur, and resection in a case of complicated fracture of the femur. The only drawbacks resulting from this mode of administering the drug were severe headache, nausea, and vomiting, which some of the patients suffered from for several days after the operation. It was then decided that exact experi-
high prices. He points out that the number of births was everywhere considerably higher during the last five months of the year than during the earlier months, and that this was particularly noticeable in those parts of the province which were most severely affected by famine. This explana-
tion, however, does
not seem to be sufficient because the decreased birth-rate does not correspond with the districts where famine prevailed, and some districts which were classed as famine districts actually record a higher rate. It seems to be the normal state of things for an increased ments should be made to determine more precisely the number of births to occur in the later months of the year. effects and for this purpose both Dr. Bier and his colleague Other causes were therefore probably at work. Considerably Dr. Hildebrand submitted themselves to the action of greater accuracy in registration must be attained before cocaine injected into the spinal subdural space in the the vital statistics of the province can be considered as a manner alluded to before. It was found that anaesthesia basis on which definite and satisfactory conclusions can be of the whole of the lower extremities supervened in from founded. Calcutta is as usual at the bottom of the list with a birthfive to eight minutes after the injection and a dose of five rate of 13’98 per mille, the departure of women from fear of milligrammes of the cocaine was sufficient to make this con- plague having doubtless caused the large decrease since last dition of anaesthesia last for about 45 minutes, after which year. It must be remembered, however, that the proportion normal sensibility slowly and gradually returned. The of males to females in Calcutta is more than 2 to 1. The after-effects were, however, not always pleasant and were number of deaths registered in 1898 was 1,888,468, giving a ratio of 26-57 per mille as against 2,341,632 and 32-94 in the like those found in the surgical cases referred to above. Dr. previous year. The mortality from fever and cholera was Bier was even obliged to’remain in bed for some days. It particularly low. Owing to the general absence of epidemics was therefore decided that further experiments should be the death-rate of the towns fell to the remarkably low figure made on animals, so that the effects might be more fully of 27’50, as against 35’09 last year. The death-rate among studied with a view to obviate the disagreeable effects pro- males was 28’75 per mille against the average of 30.87 for the past 10 years. Among females it was 24’40 per duced by the drug and to enhance its undoubted usefulness. mille, against 2668, the average of the preceding 10 years. Registration in the case of females is more The mortality among Mussulmans is given defective. ON Sept. 13th Mr. Justice Cozens Hardy granted anas 29’53 per mille, as against 25’51 among Hindus. application of the Jenner Institute of Preventive MedicineThis difference is unexplained and does not occur every to enable them to alter their Memorandum of Association soyear. No less than 1935 persons were convicted for failure to register and Rs. 3052 were imposed in fines. as to profit by the gift from Lord Iveagh of .6250,000. Registration is probably defective to the extent of 13 per nille in the case of deaths and 11 per mille in the case of WITH reference to medical men willing to serve onlbirths. These are the deficiencies which are discovered by plague duty in India the authorities of the India Office 1the vaccination staff. The influence of the meteorological inform us that no more are required at present, but that a < conditions on the prevalence of fever and cholera is a of discussion. In the present year the list is kept at the India Office of those who are ready to go 1perennial subject from fever has been lower than usual and that nortality if required. f’rom cholera has been the lowest ever recorded in the -
I There appears to be no satisfactory explanation of these THE Colonial Office has received a telegram from the f Inoculation against cholera has been carried on Governor of Mauritius stating that for the week endingfacts. tthroughout the year at the Purulia coolie depôt and while of of which 62 cases 51 7th proved no information is available from Assam as to its results the plague occurred, Sept. fatal. work is obviously a necessary one and is reported to have b been well and carefully conducted. The deaths from smallA TELEGRAM from the Governor of Hong-Kong (Sir H. A. numbered 14,269 as against 19,655 during the previous p pox There was a large falling off in the number of deaths Blake) received at the Colonial Office on Sept. llth reports year. y f from 13 cases of plague with 12 deaths for the last week. dysentery. Expenditure on conservancy increased L in many places apparently from fear of the plague. largely I many towns nothing has been spent on original sanitary In THE nineteenth report of the Inspector of Retreats under v works and the want of proper drains is a deficiency conthe Inebriates Acts, 1879 and 1888, has just been issued. 14 sstantly noticed. Until outside pressure is brought to bear o on some of the municipalities nothing is done. The preretreats are dealt with. cautions against plague consisted in the working of four C large observation camps at Chausa. Chakradharpore, Mairwa, THE British Association have made a grant of and Khurda Road. At Chausa 636,819 persons were inspected towards the expenses of the National Antarctic Expedition. a, and 24,776 were detained. There were five deaths from 177,501 persons were inspected and plague. P.4757 wereAt Mairwa and at Khurda Road 110,083 persons detained, were examined and 3478 were detained. An important ANNUAL REPORT OF THE SANITARY experiment in sewage disposal was inaugurated. The saniwas for on in 1898. engineer tary placed special England duty BENGAL, the purpose of inquiring into the subject and his proposal to carry out experiments on the septic tank principle has THIS report was due on May lst, but the delay in its been adopted by Government. The precautionary measures issue has been occasioned by the Sanitary Commissioner taken against the plague have indirectly drawn increased having necessarily to devote so much of his time to the attention on the part of local bodies to sanitation generally supervision of plague measures. The Inspector-General of and to conservancy in particular. " Should it prove to have Civil Hospitals has appended to it a valuable note in which he thoroughly and permanently awakened the local authorities to the supreme importance of an efficient system of sanitation reviews the salient points in the sanitary history of the year. the plague will have done the people of Bengal a service The number of births which were registered in 1898 was which will go far to counterbalance the trouble and anxiety 2,540,701, against 2,625,844 in the previous year, the ratio which it has caused.’ -
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COMMISSIONER,