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THE DISPENSING OF MEDICINES.
THE SUPPRESSION OF RABIES IN PARIS.
1504
where the lesion must be situated. The centre for the reflex of flexion of the forearm on the arm is situated in the fifth cervical segment, while that for flexion of the fingers is situated in the eighth cervical segment. The conciliston is obvious that inversion of the radial reflex is due to In such a lesion reflex a lesion of the fifth cervical segment. flexion of the forearm on the arm could be abolished, and if the lesion extended to the pyramidal tracts reflex flexion of the digits would be increased. M. Babinski admits that the same phenomenon could be produced by a limited lesion of the peripheral nerves, but he has no experience of a lesion of this kind, and if it occurs he thinks it must be exceptional. From his observations he draws the conclusion that inversion of the radial reflex constitutes a sign which by itself alone allows a lesion of the cervical cord to be affirmed, and points to its exact localisation.
ctearty
____
THE SUPPRESSION
OF RABIES IN
PARIS.
THE report for the year 1909 of the Veterinary Sanitary Service of Paris and the Department of the Seine has just been issued. It is a big book, and as usual contains a great mass of detail concerning the prevalence of various diseases .among cattle and animals of all sorbs. The control of abattoirs and meat markets, the transport of fish and milk, in a word, some of the moat important matters in the foodsupply of the city come under notice. Of the various chapters, the first is in some ways the most interesting. It contains a history of the struggle to suppress rabies, which is still relatively widespread in France. This is all the more serious as there are more dogs in France than in most countries. Thus it appears that per 1000 inhabitants there are 75 dogs in France and only 38 in England, 31 in Germany, and 11 in Sweden. In England and Sweden rabies has been stamped out, and it is very rare in Germany. Dr. H. Martel, Chief of the Veterinary Service and author of the report, considers that the most useful measure is 1;0 destroy all stray dogs. This of late years has been. done rigorously. in Parisand the surrouilding department of the Seine, but not so in the other departments- or counties of- France. Thus in the Seine, which includes Paris, there were 807 cases of rabies among dogs in 1900, and 1964 in the other departments., There had In 1900 been 9691 dogs captured the previous year. more than; 12,000 were taken, and the following years the number of captures amounted to 16,298, 16,856, 14,665, and 15,251. This brings us to the year 1904. The result is that in 1901 there were 846 cases of rabies in the department of the Seine, and 1872 in the other departments ; in 19U2 the figures were respectively 474 and 1852 ; in 1903 there was a further fali to 179, while the figure for the departments rose In 1904 and 1905 the figures for the departto 2184. ments were 2221 and 2248, while for the department of the Seine they were only 172 and 120. The decrease has continued, and in 1906 the number was 74, in 1907 only 43; in 1908 it was 37, and finally last year only 13 cases of rabies were reported, where at the beginning of the decade there had been more than 800. Surely this is a notable achievement. In the departments during the last -four years there are signs of improvement, the figures having fallen to 1971, 1849, 1445 and 1450 for the four years in question. The amelioration achieved in the department of the Seine is set forth in another manner. In 1901 the tax was paid for 140,000 dogs, so that the proportion of cases of rabies was 0.604 per cent. of dogs taxed. In 1909 the tax WitS paid for 185,000 dogs, and as there were only 13 cases of rabies, this was equal to 0.007 per cent. Again, if we take -the first five years of the decade-namely, 1900 to 1904-there were altogether during this time 2478 cases of rabies in the department of the Seine ; while during the second five years, 1905 to 1909, there were only
based on the notifications made the result of diagnosis or of postby veterinary surgeons mortem examination. In the former case errors sometimes occur. There is a tendency to be on the safe side and declare a dog to be mad so that it should be when after all it was not affected by rabies. As far as possible these declarations have been checked by postmortem examinations or by inoculations, but this could If only the cases proved genuine not always be done. at the Pasteur Institute were counted the figures would be reduced by more than half, but the falling-off in the number of cases from year to year would be in the same proportion as that shown by the figures given above. Obviously the best protective for human beings is to keep the dogs healthy. This does not prevent persons who are bitten by perfe0tly healthy dogs from hastening to the Pasteur Institute to undergo the antirabic treatment. There. fore the number of patients treated does not represent the number of bonâ-fide cases of rabies among dogs. Nevertheless, there has been a great reduction of patients, though doubt. less dogs arejust as apt to snap and bite as in the past. At the Pasteur Institute 637 patients underwent the antirabic treatment in 1900 and 623 in 1901. In 1909 the number of persons treated because they had been bitten by dogs that might possibly be suffering from rabias was only 105. As for human cases of rabies these are extremely rare in the department of the Seine, the last one observed dating back to the year 1905. Formerly they were relatively frequent. Dr. Martel insists that the great improvement brought about is due to care taken, when a case of rabies occurs, to destroy not merely the mad dog, but further to destroy, or in any case to closely observe, all the other dogs it may have infected. As, however, this can rarely be done in complete manner, obviously the most effective measure is the capture of all 287 cases. These
figures are as
destroyed
stray dogs. THE
-
DISPENSING OF MEDICINES.
ATTENTION has been directed by a correspondent to a an address delivered by Mr. Richard Winfrey, M,P., whose name appears on the Register of Chemists and Druggists, at a meeting of the Public Pharmacists and Dispensers Association, in the course of which ho said that: (1) authorities appointing dispensers to public institutions should be made to understand the difference between a man who had passed the minor examination of the Pharmaceutical Society and one who had merely passed the Apothecaries’ Hall assistants’ examination ; and (2) the knowledge of pharmacy possessed by the ordinary medical practitioner is very slight indeed, and medical practitioners should not be allowed to dispense their own medicines under With regard to the first their present qualifications. is it not disputed by anyone competent to point, that the diploma granted by the Pharmaceutical judge is of Society greater value than that granted to assistants the Apothecaries’ Society, and there are, we should by imagine, few authorities responsible for the appointment of dispensers who are not aware of the fact. The of the however, possessor superior qualification, expects quite naturally higher remuneration for his services than does the holder of the assistant’s certificate, and very often for that reason vacancies are filled in some institutions by the appointment of dispensers with the latter qualification. In all the great London hospitals and in the majority of the larger provincial hospitals the dispensers appointed are qualified under the Pharmacy Act, and the same rule applies in many of the smaller institutions. In other cases the dispensing is done by holders of the Hall certificate under medical responsibility or by local chemists. In every lunatic asylum under the control of the London County Council in which a
report of
THE DRUG TREATMENT OF PULMONARY TUBEROULOSIS.
dispenser is employed
the dispenser holds the qualification of the Pharmaceutical Society. The appointment of Poorlaw dispensers is subject to the approval of the Local Government Board, whose regulations require the person appointed to possess one of the following qualifications : (1) the Licence of the Society of Apothecaries ; (2) the assistant’s certificate of the Society of Apothecaries ; (3) registration as an army compounder, R. A. M. C. ; (4) registration under the Pharmacy Act, 1868 ; and (5) registration as a pharmaceutical chemist of Ireland. It is hardly necessary to point out that those applicants who hold the highest qualification usually obtain the appointments when vacancies occur. The second point raised by Mr. Winfrey involves a question of considerable difficulty ; for obvious reasons it is quite impracticable for every medical practitioner to employ a dispenser and, under existing conditions, a very large proportion of medical practitioners could not possibly refuse to dispense medicines. If they did so there would be no one else to do At the present time a joint committee of the work. medical practitioners and pharmacists is considering whether it is possible to make any recommendations with regard to The committee is composed of ten this very question. medical practitioners appointed at the last annual meeting of the British Medical Association and ten pharmacists appointed at the last meeting of the British Pharmaceutical Conference, and if it is able to put forward reasonable suggestions as to how medical practitioners can be relieved of what the physicians of two centuries ago described as a "servile and laborious business " the profession will not be ungrateful. But for the present the medical profession must continue to dispense medicines, and, as we point out elsewhere this week, those responsible for the education of our medical students should see that they are duly educated to this end.
1505
and adds : "To suspend the diagnosis unitl bacilli are detected in the sputum is like delaying the diagnosis of cancer until the glands areinvolved." Undoubtedly the earlier treatment is com-menced in cases of pulmonary tuberculosis the better theprognosis, but it is difficult definitely to appraise the value of any treatment until the diagnosis of the disease has been absolutely confirmed by bacteriological evidence. There isalways a possibility of doubt that active tuberculosis was Dr. Lees’s method of treatment should be exnot present. tensively tried, for his results are decidedly encouraging, and the fact that relief can be obtained in other than very early cases is a stimulant for further observations to be madeIn THE LANCET of Nov. 12th we published an article by Mr. J. McElroy on the treatment of pulmonary tuberculosis byintravenous injections of chinosol with formaldehyde. Her recorded three cases in which this method was adopted, and in which satisfactory results were obtained, but the numberof cases is, of course, too small to form a judgment upon. These several therapeutic measures might be further tried inthose cases in which, for various reasons, sanatorium or vaccine treatment cannot be adopted. It would be interesting to know whether other physicians obtain the same results as those who have recorded their cases in o columns.
lung tissue,
tubercle
____
THE
MARKING OF IMPORTED MEAT.
circular THE
Local Government Board has recently issued & addressed to medical officers and sanitary authorities calling attention to the description of a’brand and labels which are declared to be admissible as "official certificates " in respect of pork and other edible portions of the pig which have been subjected to inspection in the State of Queensland. The labels, facsimiles of which are reproduced in the circular, are regarded as evidence that the THE DRUG TREATMENT OF PULMONARY pig has been certified by a competent authority in the TUBERCULOSIS. place of origin to be free from disease at the time of The labels are taken to convey also that theSo much interest has of late years been centred round the slaughter. sanatorium treatment of pulmonary tuberculosis, and still meat has been certified by the like authority to have been dressed or prepared, and packed with the needful more recently round the use of tuberculin, that the use of of all requirements for the prevention of danger observance in this has received but little disease drugs comparatively attention. In the present number of THE LANCET we arising to public health from the meat as an article of’ publish two communications on the results obtained food. The Local Government Board takes the opportunity by the employment of potassium bichromate in the afforded by the issue of the circular of pointing out that diffione instance, and of continuous antiseptic inhalations in culty has been experienced in some cases in extracting from the the other. Dr. James B. Tombleson publishes six casesI annual reports of medical officers of health certain detailstreated by potassium bichromate. The cases all ex- which the Board desires as to quantities of food materials hibited advanced disease, nevertheless the results were condemned at the ports. In some of the annual reports theuniformly good. This is certainly remarkable and indicates required facts are given with considerable fulness, but in that further trial might be made by other observers. The others, although much useful information is set out in regard method has the advantage of simplicity. The drug is given to this matter, details are not recorded in a form which in doses of -gr. (2 minims of a 10 per cent. solution in enables them to be properly classified. The circular contains water), either alone or in combination with a tonic mixture, a category of the foods concerned and the kind of particularssuch dose to be taken in a wineglass of water after food, at which should be given. first twice and later three times a day. Dr. David B. Lees PLAGUE AND THE DESTRUCTION OF RATS advocates the emplovment of continuous antiseptic inhalations. THE Local Government Board, in consequence of cases. He has previously published the results in 30 cases of incipient or early pulmonary tuberculosis in which the treatment had of plague in rats in certain parts of England, has been employed with success. He now gives the further pro- deemed it desirable to confer upon local authorities ingress of these cases and shows that they continued to progress England and Wales powers with regard to the destruction of favourably. In his present article he reports 20 more cases rats in districts where plague in rats is present or suspected, in which the same method of treatment has been used. or in which there is an unusual mortality among rats. The Some of these patients came under observation at a much Board has accordingly issued an Order authorising the local later stage of the disease, nevertheless the results were all authority to take measures for the destruction of rats and for favourable. As Dr. Lees remarks, however, when the more preventing their entrance into buildings and any premises, advanced stages are reached recovery must be comparatively Inasmuch as the risk of infection from plague-stricken rats slow and the final issue may be doubtful. He strongly arises mainly through fleas, it is obviously to the interest of insists that pulmonary tuberculosis is recognisable and ought all persons to do what they can to prevent contamination of to be discovered before there is any breaking down of their dwellings and to remove from the proximity of dwellings. ____
-
1504
where the lesion must be situated. The centre for the reflex of flexion of the forearm on the arm is situated in the fifth cervical segment, while that for flexion of the fingers is situated in the eighth cervical segment. The conciliston is obvious that inversion of the radial reflex is due to In such a lesion reflex a lesion of the fifth cervical segment. flexion of the forearm on the arm could be abolished, and if the lesion extended to the pyramidal tracts reflex flexion of the digits would be increased. M. Babinski admits that the same phenomenon could be produced by a limited lesion of the peripheral nerves, but he has no experience of a lesion of this kind, and if it occurs he thinks it must be exceptional. From his observations he draws the conclusion that inversion of the radial reflex constitutes a sign which by itself alone allows a lesion of the cervical cord to be affirmed, and points to its exact localisation.
ctearty
____
THE SUPPRESSION
OF RABIES IN
PARIS.
THE report for the year 1909 of the Veterinary Sanitary Service of Paris and the Department of the Seine has just been issued. It is a big book, and as usual contains a great mass of detail concerning the prevalence of various diseases .among cattle and animals of all sorbs. The control of abattoirs and meat markets, the transport of fish and milk, in a word, some of the moat important matters in the foodsupply of the city come under notice. Of the various chapters, the first is in some ways the most interesting. It contains a history of the struggle to suppress rabies, which is still relatively widespread in France. This is all the more serious as there are more dogs in France than in most countries. Thus it appears that per 1000 inhabitants there are 75 dogs in France and only 38 in England, 31 in Germany, and 11 in Sweden. In England and Sweden rabies has been stamped out, and it is very rare in Germany. Dr. H. Martel, Chief of the Veterinary Service and author of the report, considers that the most useful measure is 1;0 destroy all stray dogs. This of late years has been. done rigorously. in Parisand the surrouilding department of the Seine, but not so in the other departments- or counties of- France. Thus in the Seine, which includes Paris, there were 807 cases of rabies among dogs in 1900, and 1964 in the other departments., There had In 1900 been 9691 dogs captured the previous year. more than; 12,000 were taken, and the following years the number of captures amounted to 16,298, 16,856, 14,665, and 15,251. This brings us to the year 1904. The result is that in 1901 there were 846 cases of rabies in the department of the Seine, and 1872 in the other departments ; in 19U2 the figures were respectively 474 and 1852 ; in 1903 there was a further fali to 179, while the figure for the departments rose In 1904 and 1905 the figures for the departto 2184. ments were 2221 and 2248, while for the department of the Seine they were only 172 and 120. The decrease has continued, and in 1906 the number was 74, in 1907 only 43; in 1908 it was 37, and finally last year only 13 cases of rabies were reported, where at the beginning of the decade there had been more than 800. Surely this is a notable achievement. In the departments during the last -four years there are signs of improvement, the figures having fallen to 1971, 1849, 1445 and 1450 for the four years in question. The amelioration achieved in the department of the Seine is set forth in another manner. In 1901 the tax was paid for 140,000 dogs, so that the proportion of cases of rabies was 0.604 per cent. of dogs taxed. In 1909 the tax WitS paid for 185,000 dogs, and as there were only 13 cases of rabies, this was equal to 0.007 per cent. Again, if we take -the first five years of the decade-namely, 1900 to 1904-there were altogether during this time 2478 cases of rabies in the department of the Seine ; while during the second five years, 1905 to 1909, there were only
based on the notifications made the result of diagnosis or of postby veterinary surgeons mortem examination. In the former case errors sometimes occur. There is a tendency to be on the safe side and declare a dog to be mad so that it should be when after all it was not affected by rabies. As far as possible these declarations have been checked by postmortem examinations or by inoculations, but this could If only the cases proved genuine not always be done. at the Pasteur Institute were counted the figures would be reduced by more than half, but the falling-off in the number of cases from year to year would be in the same proportion as that shown by the figures given above. Obviously the best protective for human beings is to keep the dogs healthy. This does not prevent persons who are bitten by perfe0tly healthy dogs from hastening to the Pasteur Institute to undergo the antirabic treatment. There. fore the number of patients treated does not represent the number of bonâ-fide cases of rabies among dogs. Nevertheless, there has been a great reduction of patients, though doubt. less dogs arejust as apt to snap and bite as in the past. At the Pasteur Institute 637 patients underwent the antirabic treatment in 1900 and 623 in 1901. In 1909 the number of persons treated because they had been bitten by dogs that might possibly be suffering from rabias was only 105. As for human cases of rabies these are extremely rare in the department of the Seine, the last one observed dating back to the year 1905. Formerly they were relatively frequent. Dr. Martel insists that the great improvement brought about is due to care taken, when a case of rabies occurs, to destroy not merely the mad dog, but further to destroy, or in any case to closely observe, all the other dogs it may have infected. As, however, this can rarely be done in complete manner, obviously the most effective measure is the capture of all 287 cases. These
figures are as
destroyed
stray dogs. THE
-
DISPENSING OF MEDICINES.
ATTENTION has been directed by a correspondent to a an address delivered by Mr. Richard Winfrey, M,P., whose name appears on the Register of Chemists and Druggists, at a meeting of the Public Pharmacists and Dispensers Association, in the course of which ho said that: (1) authorities appointing dispensers to public institutions should be made to understand the difference between a man who had passed the minor examination of the Pharmaceutical Society and one who had merely passed the Apothecaries’ Hall assistants’ examination ; and (2) the knowledge of pharmacy possessed by the ordinary medical practitioner is very slight indeed, and medical practitioners should not be allowed to dispense their own medicines under With regard to the first their present qualifications. is it not disputed by anyone competent to point, that the diploma granted by the Pharmaceutical judge is of Society greater value than that granted to assistants the Apothecaries’ Society, and there are, we should by imagine, few authorities responsible for the appointment of dispensers who are not aware of the fact. The of the however, possessor superior qualification, expects quite naturally higher remuneration for his services than does the holder of the assistant’s certificate, and very often for that reason vacancies are filled in some institutions by the appointment of dispensers with the latter qualification. In all the great London hospitals and in the majority of the larger provincial hospitals the dispensers appointed are qualified under the Pharmacy Act, and the same rule applies in many of the smaller institutions. In other cases the dispensing is done by holders of the Hall certificate under medical responsibility or by local chemists. In every lunatic asylum under the control of the London County Council in which a
report of
THE DRUG TREATMENT OF PULMONARY TUBEROULOSIS.
dispenser is employed
the dispenser holds the qualification of the Pharmaceutical Society. The appointment of Poorlaw dispensers is subject to the approval of the Local Government Board, whose regulations require the person appointed to possess one of the following qualifications : (1) the Licence of the Society of Apothecaries ; (2) the assistant’s certificate of the Society of Apothecaries ; (3) registration as an army compounder, R. A. M. C. ; (4) registration under the Pharmacy Act, 1868 ; and (5) registration as a pharmaceutical chemist of Ireland. It is hardly necessary to point out that those applicants who hold the highest qualification usually obtain the appointments when vacancies occur. The second point raised by Mr. Winfrey involves a question of considerable difficulty ; for obvious reasons it is quite impracticable for every medical practitioner to employ a dispenser and, under existing conditions, a very large proportion of medical practitioners could not possibly refuse to dispense medicines. If they did so there would be no one else to do At the present time a joint committee of the work. medical practitioners and pharmacists is considering whether it is possible to make any recommendations with regard to The committee is composed of ten this very question. medical practitioners appointed at the last annual meeting of the British Medical Association and ten pharmacists appointed at the last meeting of the British Pharmaceutical Conference, and if it is able to put forward reasonable suggestions as to how medical practitioners can be relieved of what the physicians of two centuries ago described as a "servile and laborious business " the profession will not be ungrateful. But for the present the medical profession must continue to dispense medicines, and, as we point out elsewhere this week, those responsible for the education of our medical students should see that they are duly educated to this end.
1505
and adds : "To suspend the diagnosis unitl bacilli are detected in the sputum is like delaying the diagnosis of cancer until the glands areinvolved." Undoubtedly the earlier treatment is com-menced in cases of pulmonary tuberculosis the better theprognosis, but it is difficult definitely to appraise the value of any treatment until the diagnosis of the disease has been absolutely confirmed by bacteriological evidence. There isalways a possibility of doubt that active tuberculosis was Dr. Lees’s method of treatment should be exnot present. tensively tried, for his results are decidedly encouraging, and the fact that relief can be obtained in other than very early cases is a stimulant for further observations to be madeIn THE LANCET of Nov. 12th we published an article by Mr. J. McElroy on the treatment of pulmonary tuberculosis byintravenous injections of chinosol with formaldehyde. Her recorded three cases in which this method was adopted, and in which satisfactory results were obtained, but the numberof cases is, of course, too small to form a judgment upon. These several therapeutic measures might be further tried inthose cases in which, for various reasons, sanatorium or vaccine treatment cannot be adopted. It would be interesting to know whether other physicians obtain the same results as those who have recorded their cases in o columns.
lung tissue,
tubercle
____
THE
MARKING OF IMPORTED MEAT.
circular THE
Local Government Board has recently issued & addressed to medical officers and sanitary authorities calling attention to the description of a’brand and labels which are declared to be admissible as "official certificates " in respect of pork and other edible portions of the pig which have been subjected to inspection in the State of Queensland. The labels, facsimiles of which are reproduced in the circular, are regarded as evidence that the THE DRUG TREATMENT OF PULMONARY pig has been certified by a competent authority in the TUBERCULOSIS. place of origin to be free from disease at the time of The labels are taken to convey also that theSo much interest has of late years been centred round the slaughter. sanatorium treatment of pulmonary tuberculosis, and still meat has been certified by the like authority to have been dressed or prepared, and packed with the needful more recently round the use of tuberculin, that the use of of all requirements for the prevention of danger observance in this has received but little disease drugs comparatively attention. In the present number of THE LANCET we arising to public health from the meat as an article of’ publish two communications on the results obtained food. The Local Government Board takes the opportunity by the employment of potassium bichromate in the afforded by the issue of the circular of pointing out that diffione instance, and of continuous antiseptic inhalations in culty has been experienced in some cases in extracting from the the other. Dr. James B. Tombleson publishes six casesI annual reports of medical officers of health certain detailstreated by potassium bichromate. The cases all ex- which the Board desires as to quantities of food materials hibited advanced disease, nevertheless the results were condemned at the ports. In some of the annual reports theuniformly good. This is certainly remarkable and indicates required facts are given with considerable fulness, but in that further trial might be made by other observers. The others, although much useful information is set out in regard method has the advantage of simplicity. The drug is given to this matter, details are not recorded in a form which in doses of -gr. (2 minims of a 10 per cent. solution in enables them to be properly classified. The circular contains water), either alone or in combination with a tonic mixture, a category of the foods concerned and the kind of particularssuch dose to be taken in a wineglass of water after food, at which should be given. first twice and later three times a day. Dr. David B. Lees PLAGUE AND THE DESTRUCTION OF RATS advocates the emplovment of continuous antiseptic inhalations. THE Local Government Board, in consequence of cases. He has previously published the results in 30 cases of incipient or early pulmonary tuberculosis in which the treatment had of plague in rats in certain parts of England, has been employed with success. He now gives the further pro- deemed it desirable to confer upon local authorities ingress of these cases and shows that they continued to progress England and Wales powers with regard to the destruction of favourably. In his present article he reports 20 more cases rats in districts where plague in rats is present or suspected, in which the same method of treatment has been used. or in which there is an unusual mortality among rats. The Some of these patients came under observation at a much Board has accordingly issued an Order authorising the local later stage of the disease, nevertheless the results were all authority to take measures for the destruction of rats and for favourable. As Dr. Lees remarks, however, when the more preventing their entrance into buildings and any premises, advanced stages are reached recovery must be comparatively Inasmuch as the risk of infection from plague-stricken rats slow and the final issue may be doubtful. He strongly arises mainly through fleas, it is obviously to the interest of insists that pulmonary tuberculosis is recognisable and ought all persons to do what they can to prevent contamination of to be discovered before there is any breaking down of their dwellings and to remove from the proximity of dwellings. ____
-