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THE DRAINAGE OF HAVANT.
1242 had been observed by others before, that the blood so drawn was dark and that it clotted very freely and rapidly, especially when drawn after fits. Control experiments were made with the serum of three healthy persons and it was found that from five to seven cubic centimetres per kilogramme of body-weight injected into rabbits produced no lethal effect. It was found (a) that in epileptics in the period between attacks (five experiments) the toxicity was but slightly raised above that of normal blood in two cases and was about normal in the other three cases; (b) that the blood immediately preceding convulsive attacks was (two experiments) decidedly more toxic than in group a, or than in health ; and (e) that the blood immediately after attacks (six experiments) showed increased toxicity if drawn within a few minutes of the fits and that it produced convulsions and death readily in rabbits. In from one to two hours after, this toxicity slightly diminished. In discussing the results Dr. Cololian points out the analogies of the toxaemia of epilepsy with that of puerperal eclampsia and notes that the occurrence of albuminuria following epileptic fits has been noted in half of the number of cases investigated by MM. Voisin and Peron.4 As regards the exact nature of the toxic substance present in the blood of epileptics nothing further is as yet known, since it has not been chemically separated or analysed. It is believed, however, that it is produced periodically in the body owing to "anomalies of nutritive exchanges" and that from its resultant effects it must be analogous to convulsive agents like absinthe. As contributory causes a renal incompetency with insufficient elimination of the poison and a cerebral predisposition (hereditary or acquired) to respond with undue facility and in the form of convulsions to the toxasmic condition are also indicated. On the whole, the facts ascertained bear out the more recent views regarding treatment for eclampsia and the status epilepticus-viz., limitation of nitrogenous diet, aperients, and in the grave cases venesection and an equivalent injection of sterilised normal saline solution to the extent of from one to
to him and told him that he was a driver of a water" for the corporation ; and that, believing his statement, cart witness had given him a certificate stating that he was, suffering from varicose veins and that he was in want of an elastic stocking. He did so because prisoner told him that if he had a certificate he could get a letter for the Surgical, Aid Society. Witness wrote across the top, ’’ Not to be. used for begging purposes," but this and the date had been torn off. A lady on whom the prisoner had called and to whom he had shown this certificate had replied to. his request for money that it was " a surgical letter" he wanted, but prisoner said, "No, no ; look at this," and showed her a list of the names of other residents who had contribnted. A foreman from the corporation gave evidence. that the man had never been in the employment of the’ corporation in any capacity. If it had not been for the. astuteness of the constable there is practically no limit to the depredations which this impostor might have carried on, starting each day with a fresh list and working a fresh district. In hospital practice nothing is commoner than for patients to ask for a certificate either to enable them ta get sick-pay from a club, a convalescent-home letter, or Grave abuse may arise in any of some surgical apparatus. these directions but in nothing more than in that of sick-pay. Perhaps the patient may be suffering only from dyspepsia, and by slightly magnifying his symptoms he can, in the, rush of out-patient work, induce the physician to sign a. certificate week after week. Great care should be exercised, for not only is grave injury done to the patient by inculcating habits of idleness, but it is also a duty which the. profession owes to the charitable public, who rely so absolutely upon "the doctor’s certificate"as a guarantee not only as to the medical aspect of the case but even as, to its genuineness in other respects. came
THE DRAINAGE OF HAVANT.
THE Local Government Board have notified to the Portsmouth Corporation, the Portsmouth Water Company, and the Havant Urban District Council that as a result of the two pints or even more. inquiry held at Havant in December last they have decided. to issue an Order requiring the Havant Urban District THE ABUSE OF MEDICAL CERTIFICATES. Council to provide efficient sewers for their district. Our MEDICAL men cannot be too careful in giving certificates readers will remember that the exciting cause of the. to hospital patients and persons belonging to the lower inquiry was a report issued by Dr. Theodore Thomson. classes of life. They are often used for illegal purposes in and Mr. Whitaker on the surroundings of the Portsseveral ways and especially as a cloak for begging by idle mouth Water Company’s springs, in which attention was and unprincipled persons. It is not sufficient to write across directed to the risk of pollution from the insanitary state the top of a certificate "Not to be used for begging purposes," of Havant.l On receipt of this report the company come as the incident about to be mentioned shows. A week or two plained to the Local Government Board (under Section 299, ago several of the residents at Croydon received a call from Public Health Act, 1875) that the Havant Urban Sanitary a person who stated that he had been in the service of the Authority had made default in providing their district, corporation for 20 years in the capacity of driver of a with sufficient sewers, and petitioned the Local Government water-cart but was unable to continue his work on Board to limit a time for the performance by that authority account of varicose veins. In proof of this he displayed of their duty in that respect. The inquiry was conducted) a certificate from a well-known medical man practising by Dr. Bulstrode and Mr. F. H. Tulloch, C.E., and in face of’ in the neighbourhood. With this certificate he had the evidence of the insanitary state of Havant then elicited, been from house to house collecting money for elastic strengthened as it was by the previous report of Dr. stockings to enable him, he said, to resume his occupation. Thomson, it is difficult to come to any other conclusions Fortunately, an intelligent police constable, seeing him come than has been arrived at by the Local Government Board. from a house, asked him the purport of his visit, to which The time limit given by the Board is six months, and to. the prisoner replied : " To get a piece of rag to tie up my those acquainted with the ingenious methods of pro-finger." But on inquiry the householder stated that he had crastination often adopted by sanitary authorities forced On his way to the police-station to act come to ask for money. against their inclination this period will seem he attempted to destroy a pocket-book containing a list of too short. The inclusive cost of pro-no means by the generous donors who on the strength of the medical viding an efficient system of sewerage for Havant practitioner’s certificate had given him various sums was stated by Mr. Baldwin Latham at the inquiry toamounting in the aggregate to 18s. The practitioner was be about 10,000, of which sum, by the way, the water summoned to the police-court and he stated that the prisoner The water company’s share as ratepayers is about
4
Archives de
Neurologie, No. 69, 1890.
1
THE LANCET, Jan. 28th, 1899,
p. 244.
1243 company may be congratulated on the successful result of their action and it must also be a source of gratification to the more enlightened of the inhabitants of Havant that their health and the good name of their town are, at any rate so far as they depend on modern drainage, no longer to be left to the mercy of such incapable sanitarians as the Havant District Councillors have proved themse!ves to be.
found in the
peripheral nerves, but not in the spinal cord, posterior root ganglia, or brain cortex. The nerves examined (ulnar and peroneal) showed interstitial neuritis, with an almost entire disappearance In the spinal cord there was found of the myelin. secondary degeneration of the posterior roots and of the columns of Goll (sensory tract). Degenerated nerve fibres were also found within the ganglia of the posterior roots and these were apparently continuous with those occurring SIR WILLIAM TURNER, D.Sc. in the peripheral nerves. The cells of the grey matter of THE following were the words of the Public Orator, Dr. the cord in the anterior cornua were not degenerated. Sandys of St. John’s College, in presenting Sir William Samgin believes that the degenerative process began in the Turner for the honorary degree of Doctor of Science at peripheral ends of the sensory nerves of the skin and passed Cambridge on Thursday, April 27th:upwards into the spinal cord vii the posterior roots, constiVirum regni totius medicorum concilio praepositum, virum tuting thus a degeneration of the entire sensory neuron. The bonoribus academicis plurimis cumulatum, etiam noster seem to be analogous to those occurring in the changes .8enatus titulo suo decorare anno proximo decrevit. Inter Lancastrienses natus, inter Londinienses educatus, inter peripheral neuritis of alcoholism and they suggest the action Edinenses. medicinae in schola celeberrima, quam tot of a toxic agent elaborated by the bacilli during their growth ’coloniae Britannicae studiorum medicorum quasi p:fJTp6rro^L" in the cutaneous and subcutaneous tissues and in the nervevenerantur, anatomiae scientiam per annos plus quam triginta trunks. praeclare professus, non modo Universitati suae aedificiis jiovis instruendae operam insignem dedit, sed etiam studiorum TRADE-STAMPS AND DEFECTIVE SANITARY
I
___
suorum actis per seriem edendis iamdudum maxima cum FITTINGS. laude praefuit. Idem, rerum naturae spoliis olim in Britanniam feliciter reportatis, Australasiae praesertim IN a recent letter addressed by a correspondent to our conanthropologiam opere in magno accuratissime expositam temporary the P1lblic Health Engineer headedTradeluculenter illustravit. Nuper societatis Britannicae scientiarum finibus proferendis praeses in annum proximum Marks " attention is called to the desirability of stamping by designatus, ab eadem disputationibus de anthropologiae some properly constituted authority the various fittings and scientia etiam inter Canadenses habendis haud ita pridem materials used in plumbers’ work. The idea is excellent praepositus, hominum omnium plausus propterea praesertim but not by any means new. At the Congress of meritus est, quod simiarum superbiam recentem repressit et Plumbers and others interested in sanitary matters held in generis humani dignitatem veterem denuo vindicavit. Duco ad vos generis humani vindicem, equitem insignem, London in 1884 the question after considerable discussion formed the subject of a resolution. It was proposed that anatomiae professorem illustrem, WILLELMUM TURNER. Dr. Sandys’s introductory speeches are always conspicuous the ancient practice of marking lead and solder formerly not only for elegant Latinity but also for the happy way exercised by the Worshipful Company of Plumbers should be in which the Public Orator seizes on the salient points in the revived. Since then many by-laws have been passed by various local authorities regulating to some extent the nature career of him whom the University delights to honour. Such honour was never better or more worthily bestowed and quality of material to be used in such work, but very than in the case of Sir William Turner the " vindex humani much still remains to be done. Many if not all the water generis," and we may hope the bearer of this proud title companies stamp or restrict the use of the fittings relating in his capacity of President of the General Medical Council to the water-supply; this does not in all cases tend to will continue his" vindication"as regards the rights and the improvement of the sanitary condition of a building but liberties of that portion of the race which practises or wishes merely to the prevention of waste of water and for this reason is not of much value from a sanitary standpoint. to practise the noble art and science of medicine. The whole question deserves very serious attention, but from its gigantic proportions it is far from being one easy of soluANÆSTHETIC LEPROSY: CHANGES IN THE tion. Even supposing that such a body as the Plumbers’ NERVES AND SPINAL CORD: Company undertook to mark as efficient all sanitary NECROPSY. appliances or materials voluntarily submitted to them they ONLY a few histological investigations of anaesthetic would require depots for the purpose throughout the leprosy have been recorded in literature and examination kingdom, whilst the difficulty of making any such arrangeuf the spinal cord and ganglia has been still rarer. In a ment one of compulsion would be enormous. Apparently with chronic the best case described by Samgin 1 this disease plan would be some increased development of local rhinitis and was soon followed by pain and then byanaesby-laws. thesia in the arms and legs. The body also became almost entirely anaesthetic. The form of the anesthesia in the ’THE DEVELOPMENT OF DENTINE. affected areas was as follows. There were complete analgesia THE Transactions of the Odontological Society of Great and thermo-ansesthesia, but tactile sensibility was retained Britain for March contain a paper by Professor F. T. Paul though in diminished degree. The disease pursued the which throws a good deal of fresh light upon the develop.usual course with smooth desquamative skin changes and ment of hard unvascular dentine. To a great extent the with atrophic patches which in the anaesthetic areas became conclusions arrived at confirm the view held by Mr. J. H. connuent and finally underwent destruction and cicatrisathat the development of dentine is tion. The facial nerve was paralysed on both sides in its Mummery-namely, similar to the formation of bone in mempractically upper part, but there were no bulbar symptoms. Claw- brane. Several interesting points were, however, demon.hand was present on both sides. The peroneal nerves were strated by Professor Paul. Chief amongst these was the paralysed. The ulnar nerves felt thickened and hardened. fact that the young pulp contains a complete fibrous The symptoms pointed on the whole to anaesthetic leprosy basis of delicate wavy fibres interlacing in composed and excluded syringomyelia. The necropsy revealed a direction. These fibres are found to be directly variety of instructive conditions.. In the affected patches derived from the cells and are of a gelatin-yielding of skin lepra bacilli were present and they were also character. He also showed that the first layer of cells 1 Deutsche Medicinische Wochenschrift, No. 30,1898, p. 475. formed on the surface of the pulp beneath the ameloblasts
began
-
every
to him and told him that he was a driver of a water" for the corporation ; and that, believing his statement, cart witness had given him a certificate stating that he was, suffering from varicose veins and that he was in want of an elastic stocking. He did so because prisoner told him that if he had a certificate he could get a letter for the Surgical, Aid Society. Witness wrote across the top, ’’ Not to be. used for begging purposes," but this and the date had been torn off. A lady on whom the prisoner had called and to whom he had shown this certificate had replied to. his request for money that it was " a surgical letter" he wanted, but prisoner said, "No, no ; look at this," and showed her a list of the names of other residents who had contribnted. A foreman from the corporation gave evidence. that the man had never been in the employment of the’ corporation in any capacity. If it had not been for the. astuteness of the constable there is practically no limit to the depredations which this impostor might have carried on, starting each day with a fresh list and working a fresh district. In hospital practice nothing is commoner than for patients to ask for a certificate either to enable them ta get sick-pay from a club, a convalescent-home letter, or Grave abuse may arise in any of some surgical apparatus. these directions but in nothing more than in that of sick-pay. Perhaps the patient may be suffering only from dyspepsia, and by slightly magnifying his symptoms he can, in the, rush of out-patient work, induce the physician to sign a. certificate week after week. Great care should be exercised, for not only is grave injury done to the patient by inculcating habits of idleness, but it is also a duty which the. profession owes to the charitable public, who rely so absolutely upon "the doctor’s certificate"as a guarantee not only as to the medical aspect of the case but even as, to its genuineness in other respects. came
THE DRAINAGE OF HAVANT.
THE Local Government Board have notified to the Portsmouth Corporation, the Portsmouth Water Company, and the Havant Urban District Council that as a result of the two pints or even more. inquiry held at Havant in December last they have decided. to issue an Order requiring the Havant Urban District THE ABUSE OF MEDICAL CERTIFICATES. Council to provide efficient sewers for their district. Our MEDICAL men cannot be too careful in giving certificates readers will remember that the exciting cause of the. to hospital patients and persons belonging to the lower inquiry was a report issued by Dr. Theodore Thomson. classes of life. They are often used for illegal purposes in and Mr. Whitaker on the surroundings of the Portsseveral ways and especially as a cloak for begging by idle mouth Water Company’s springs, in which attention was and unprincipled persons. It is not sufficient to write across directed to the risk of pollution from the insanitary state the top of a certificate "Not to be used for begging purposes," of Havant.l On receipt of this report the company come as the incident about to be mentioned shows. A week or two plained to the Local Government Board (under Section 299, ago several of the residents at Croydon received a call from Public Health Act, 1875) that the Havant Urban Sanitary a person who stated that he had been in the service of the Authority had made default in providing their district, corporation for 20 years in the capacity of driver of a with sufficient sewers, and petitioned the Local Government water-cart but was unable to continue his work on Board to limit a time for the performance by that authority account of varicose veins. In proof of this he displayed of their duty in that respect. The inquiry was conducted) a certificate from a well-known medical man practising by Dr. Bulstrode and Mr. F. H. Tulloch, C.E., and in face of’ in the neighbourhood. With this certificate he had the evidence of the insanitary state of Havant then elicited, been from house to house collecting money for elastic strengthened as it was by the previous report of Dr. stockings to enable him, he said, to resume his occupation. Thomson, it is difficult to come to any other conclusions Fortunately, an intelligent police constable, seeing him come than has been arrived at by the Local Government Board. from a house, asked him the purport of his visit, to which The time limit given by the Board is six months, and to. the prisoner replied : " To get a piece of rag to tie up my those acquainted with the ingenious methods of pro-finger." But on inquiry the householder stated that he had crastination often adopted by sanitary authorities forced On his way to the police-station to act come to ask for money. against their inclination this period will seem he attempted to destroy a pocket-book containing a list of too short. The inclusive cost of pro-no means by the generous donors who on the strength of the medical viding an efficient system of sewerage for Havant practitioner’s certificate had given him various sums was stated by Mr. Baldwin Latham at the inquiry toamounting in the aggregate to 18s. The practitioner was be about 10,000, of which sum, by the way, the water summoned to the police-court and he stated that the prisoner The water company’s share as ratepayers is about
4
Archives de
Neurologie, No. 69, 1890.
1
THE LANCET, Jan. 28th, 1899,
p. 244.
1243 company may be congratulated on the successful result of their action and it must also be a source of gratification to the more enlightened of the inhabitants of Havant that their health and the good name of their town are, at any rate so far as they depend on modern drainage, no longer to be left to the mercy of such incapable sanitarians as the Havant District Councillors have proved themse!ves to be.
found in the
peripheral nerves, but not in the spinal cord, posterior root ganglia, or brain cortex. The nerves examined (ulnar and peroneal) showed interstitial neuritis, with an almost entire disappearance In the spinal cord there was found of the myelin. secondary degeneration of the posterior roots and of the columns of Goll (sensory tract). Degenerated nerve fibres were also found within the ganglia of the posterior roots and these were apparently continuous with those occurring SIR WILLIAM TURNER, D.Sc. in the peripheral nerves. The cells of the grey matter of THE following were the words of the Public Orator, Dr. the cord in the anterior cornua were not degenerated. Sandys of St. John’s College, in presenting Sir William Samgin believes that the degenerative process began in the Turner for the honorary degree of Doctor of Science at peripheral ends of the sensory nerves of the skin and passed Cambridge on Thursday, April 27th:upwards into the spinal cord vii the posterior roots, constiVirum regni totius medicorum concilio praepositum, virum tuting thus a degeneration of the entire sensory neuron. The bonoribus academicis plurimis cumulatum, etiam noster seem to be analogous to those occurring in the changes .8enatus titulo suo decorare anno proximo decrevit. Inter Lancastrienses natus, inter Londinienses educatus, inter peripheral neuritis of alcoholism and they suggest the action Edinenses. medicinae in schola celeberrima, quam tot of a toxic agent elaborated by the bacilli during their growth ’coloniae Britannicae studiorum medicorum quasi p:fJTp6rro^L" in the cutaneous and subcutaneous tissues and in the nervevenerantur, anatomiae scientiam per annos plus quam triginta trunks. praeclare professus, non modo Universitati suae aedificiis jiovis instruendae operam insignem dedit, sed etiam studiorum TRADE-STAMPS AND DEFECTIVE SANITARY
I
___
suorum actis per seriem edendis iamdudum maxima cum FITTINGS. laude praefuit. Idem, rerum naturae spoliis olim in Britanniam feliciter reportatis, Australasiae praesertim IN a recent letter addressed by a correspondent to our conanthropologiam opere in magno accuratissime expositam temporary the P1lblic Health Engineer headedTradeluculenter illustravit. Nuper societatis Britannicae scientiarum finibus proferendis praeses in annum proximum Marks " attention is called to the desirability of stamping by designatus, ab eadem disputationibus de anthropologiae some properly constituted authority the various fittings and scientia etiam inter Canadenses habendis haud ita pridem materials used in plumbers’ work. The idea is excellent praepositus, hominum omnium plausus propterea praesertim but not by any means new. At the Congress of meritus est, quod simiarum superbiam recentem repressit et Plumbers and others interested in sanitary matters held in generis humani dignitatem veterem denuo vindicavit. Duco ad vos generis humani vindicem, equitem insignem, London in 1884 the question after considerable discussion formed the subject of a resolution. It was proposed that anatomiae professorem illustrem, WILLELMUM TURNER. Dr. Sandys’s introductory speeches are always conspicuous the ancient practice of marking lead and solder formerly not only for elegant Latinity but also for the happy way exercised by the Worshipful Company of Plumbers should be in which the Public Orator seizes on the salient points in the revived. Since then many by-laws have been passed by various local authorities regulating to some extent the nature career of him whom the University delights to honour. Such honour was never better or more worthily bestowed and quality of material to be used in such work, but very than in the case of Sir William Turner the " vindex humani much still remains to be done. Many if not all the water generis," and we may hope the bearer of this proud title companies stamp or restrict the use of the fittings relating in his capacity of President of the General Medical Council to the water-supply; this does not in all cases tend to will continue his" vindication"as regards the rights and the improvement of the sanitary condition of a building but liberties of that portion of the race which practises or wishes merely to the prevention of waste of water and for this reason is not of much value from a sanitary standpoint. to practise the noble art and science of medicine. The whole question deserves very serious attention, but from its gigantic proportions it is far from being one easy of soluANÆSTHETIC LEPROSY: CHANGES IN THE tion. Even supposing that such a body as the Plumbers’ NERVES AND SPINAL CORD: Company undertook to mark as efficient all sanitary NECROPSY. appliances or materials voluntarily submitted to them they ONLY a few histological investigations of anaesthetic would require depots for the purpose throughout the leprosy have been recorded in literature and examination kingdom, whilst the difficulty of making any such arrangeuf the spinal cord and ganglia has been still rarer. In a ment one of compulsion would be enormous. Apparently with chronic the best case described by Samgin 1 this disease plan would be some increased development of local rhinitis and was soon followed by pain and then byanaesby-laws. thesia in the arms and legs. The body also became almost entirely anaesthetic. The form of the anesthesia in the ’THE DEVELOPMENT OF DENTINE. affected areas was as follows. There were complete analgesia THE Transactions of the Odontological Society of Great and thermo-ansesthesia, but tactile sensibility was retained Britain for March contain a paper by Professor F. T. Paul though in diminished degree. The disease pursued the which throws a good deal of fresh light upon the develop.usual course with smooth desquamative skin changes and ment of hard unvascular dentine. To a great extent the with atrophic patches which in the anaesthetic areas became conclusions arrived at confirm the view held by Mr. J. H. connuent and finally underwent destruction and cicatrisathat the development of dentine is tion. The facial nerve was paralysed on both sides in its Mummery-namely, similar to the formation of bone in mempractically upper part, but there were no bulbar symptoms. Claw- brane. Several interesting points were, however, demon.hand was present on both sides. The peroneal nerves were strated by Professor Paul. Chief amongst these was the paralysed. The ulnar nerves felt thickened and hardened. fact that the young pulp contains a complete fibrous The symptoms pointed on the whole to anaesthetic leprosy basis of delicate wavy fibres interlacing in composed and excluded syringomyelia. The necropsy revealed a direction. These fibres are found to be directly variety of instructive conditions.. In the affected patches derived from the cells and are of a gelatin-yielding of skin lepra bacilli were present and they were also character. He also showed that the first layer of cells 1 Deutsche Medicinische Wochenschrift, No. 30,1898, p. 475. formed on the surface of the pulp beneath the ameloblasts
began
-
every