- Email: [email protected]
THE END OF THE INSTITUTE OF MEDICAL SCIENCES.
175
immediately accompanied by intense dyspnoea. With difficulty he returned home and from that time was unable to authorities and of the police force. Sir J. Whittaker Ellis work and suffered constantly from cardiac failure (Allpohas sent us a circular letter inclosing a report of a question systolie) with slight variations. During the last fortnight asked by Sir Henry Craik in the House of Commons on before admission especially his legs swelled and he suffered March 24th as to what statutory restrictions are put upon constantly from dyspnoea. On admission he sat up in a state motor omnibuses with regard to the amount of smell, noise, of great dyspnoea. His face was cyanosed, his conjunctivae and vibration which they cause, with Mr. Gladstone’s reply were subicteric, and the veins of his neck were prominent. to deal forthwith with the vehicular users of the roads and streets, each body to have the cooperation of local municipal
that "some check
to unnecessary smell and noise is afforded by regulations of the Commissioner of Police as to the conditions to be fulfilled before a licence is granted." We agree from a prolonged experience of a very busy thoroughfare that the noise of these vehicles is a well-nigh intolerable nuisance. It has been proved that a comparatively silent motor-omnibus can be made, and it is to be hoped that in issuing new licences the police will take full advantage of their powers ; there are, moreover, too many omnibuses now running which ought to be condemned. On the broader question which Sir J. Whittaker Ellis raises, we should welcome the institution of a traffic authority, though we feel constrained to repeat the words which we used when such a board was first proposed that ’’ when it comes into existence it will find itself confronted with a task in comparison with which the labours of Sisyphus 1 may be regarded as mere diversion." We then gave it as our opinion that the decentralisation of the hives of industry into healthier and more open surroundings seemed to offer the best solution for thinning the London traffic. The construction of new streets to accommodate motor traffic on any large scale in the central districts is, we fear, a visionary proceeding, although, of course, in planning new suburbs such special roads might prove practicable. In the meantime there is no doubt that to cross the London streets at the present day requires more alertness and entails greater danger to life and limb than ever before, and in busy thoroughfares an elderly person may be forced to wait for several minutes before seeing a chance of a secure transit. The immediate remedy, as we have suggested recently, would seem to rest in the provision of moreislands " of refuge, although in narrow streets such as parts of the Strand, where the traffic is often well-nigh continuous, it would be difficult to spare road space for their construction. as
TRAUMATIC INSUFFICIENCY OF THE MITRAL VALVE.
TRAUMATIC valvular disease of the heart is very rare ; on the "Medical Aspects of Insurance" Professor Grober of the University of Jena has stated that valvular disease of the heart is never the direct result of injury. However, a few well-authenticated cases have been recorded. In consequence of recent legislation which increases the liability of employers for accidents to their workmen the subject has a special interest just now. At a meeting of the Societe Medicale des Hopitaux of Paris on May 29th M. Claisse and M. Socquet reported
indeed, in a recent work
the following case which shows dramatically the possibility of valvular disease being produced by injury. A mason, aged 48 years, was admitted into La Pitie Hospital on Feb. 7th last with dyspnoea and oedema of the lower limbs. His illness began suddenly on Oct. 24th, 1907, after a violent effort. He was cementing a large block of stone about 100 weighing kilogrammes, which slipped from its place. He endeavoured to stop it with his arms and allowed it to slip on to his chest. He made a violent effort for some seconds to hold it up and, unable to do so, allowed it to fall. At the time of the greatest effort he felt a tearing pain in the præcordial region which was 1
THE
LANCET, Nov. 25th, 1905,
p. 1558.
There was considerable oedema of the lower limbs which extended to the penis and scrotum and even as high as the thorax. The cardiac apex was lowered and displaced to the left. Percussion showed great cardiac dilatation. A loud mitral systolic murmur of puling musical timbre occupied almost the whole of the systolic period and was propagated to the axilla and back. Over the aortic orifice the second sound was a little harsh. The blood pressure to 140 millimetres of mercury and the pulse was from 130 The abdomen was distended was 90, small, and irregular. with fluid. The liver descended six fingers’ breadth below the ribs and was painful and hard. Pressure upon the liver produced a reflux in the jugular veins. At the posterior inferior portion of the right chest there were signs of fluid and puncture yielded sero-fibrinous fluid with the cytological formula of cardiac pleurisy-a few polynuclears, a small number of lymphocytes, and many endothelial plates. From 300 to 500 grammes of high-coloured urine were passed in the 24 hours. It contained albumin. There was no history of rheumatic fever or syphilis. Digitalis and theobromine were given without effect. The dyspnoea was always intense. The oedema increased so much that the skin broke at a spot on the external surface of the left thigh, whence a large quantity of liquid was discharged. The right lower limb became cold and cyanosed and the violet colour of gangrene appeared on the foot and ankle. Later an erosion appeared on the external surface of the thigh from which a patch of From this place a large gangrene rapidly extended. of rose-coloured fluid was quantity discharged. In the meantime the patient became definitely jaundiced ; the urine gave Gmelin’s reaction but the stools remained coloured. Diffuse sonorous rales appeared in the chest and death occurred on March 2nd. The necropsy showed a quantity of serous fluid in the abdominal and right pleural cavities. The lungs were oedematous. There was complete union between the visceral and parietal layers of pericardium but the adhesions appeared to be recent and were easily broken down. The heart was dilated-16 centimetres broad and 14 long. It weighed 635 grammes and contained abundant clots. The left ventricle was hypertrophied and dilated. The mitral valves were sound but the posterior pillar was broken and retracted. The upper fragment floated suspended by the chordae tendinese. It looked like a stump partly cicatrised. In the lower part of the ventricular wall were traces of the tearing away of the pillar-a large granular and haemorrhagic patch. The neighbouring part of the pericardium showed fatty degeneration. The liver was large. The spleen was large and hard. The kidneys were congested but the cortex appeared sound.
THE END OF THE INSTITUTE OF MEDICAL SCIENCES. AT the meeting of the Royal Commissioners for the Exhibition of 1851, held under the chairmanship of the Prince of Wales on July 10th, His Royal Highness, in ntroducing the annual report, expressed his regrets that, .he University of London had decided to abandon the scheme for erecting and supporting an Institute of Medical sciences. The site, he said, will now be added to that already allocated by the Commissioners to the College of
176
Technology. And so there comes to an end the for a worthy but admittedly small charity." Mrs. Campbell -only practical move which has yet been made by the Uni- supported her appeal ad miserioordiatit by the hysterical versity of London towards the consolidation of medical utterances of an American " expert " sent to Europe by his teaching which those who have thought most and most Government to study certain conditions of lower-class life. impartially about the subject believe to be absolutely The I I world-f amousgentleman (for so Mrs. Campbell thinks necessary if the London medical student is to obtain a he is), who prefaces his remarks with I I Wall, I guess," had medical degree upon reasonable terms. gazed at the Barnsbury babies and had been so harrowed by the spectacle that he could not sleep o’ nights, the reason being, according to Mrs. Campbell, that the only place in THE FUNCTIONS OF FUNGI. London which can hold a candle to Barnsbury for sordid THERE seems to be little doubt that certain, if not all, grime and despair"and cruelty to its little ones is a species of fungi possess the power of assimilating nitrogen region in Battersea with the picturesque title of "Little from the atmosphere and some day it may happen that the Hell." We are pleased to see Dr. J. A. Glover, a medical fungus farm will form the basis of a new industry. The man working in North London, and familiar in a way that mushroom is, perhaps, the most familiar form of a fungus the " world-famous" American could not be with the and it is well known that although it contains a con- economics of the situation, refuting this gratuitous attack siderable quantity of moisture yet the dry matter consists upon Barnsbury. Doubtless the district is, as Dr. J. A. llargely of nitrogenous substances. Again, the poisonous Glover says, "a poor and crowded neighbourhood,"but he fungi appear to owe their toxic properties to the presence adds, and we wholly concur with him, that it "maintains its f alkaloids which, of course, are nitrogenous bases. On health in a way which does credit to the motherhood of its the nature of the metabolic process in the fungus depends, humble citizens and to the essential soundness of its saniprobably, whether the nitrogen ultimately resolves into a tary administration." Dr. J. A. Glover supports his contenpoisonous or non-poisonous substance. This at any rate tion with figures comparing the infantile death-rate of serves as a scientific differentiation of poisonous from nonBarnsbury with those of various American cities, figures of a Another interesting example poisonous which the distinguished reformer from across the Atlantic poisonous fungi. which attaches itself to cereals is ergot which is, may find somewhat difficult of digestion. fungus in of course, a powerful drug medicine, its value residing The active in its contracting effects on the arterioles. Science and
well known to be alkaloidal in There is also an instance in which it character. has been found that the fixation of free atmospheric nitrogen by the grass known as lolium temulentum, or darnel, is due to the fungus which infests it. This grass, it is interesting to note, has no symbiotic root organisms, so that its power to assimilate free nitrogen must be traced to other parts of the plant. If no combined nitrogen is given in the food the amount of nitrogen in the plants without the fungus is the same as in the seeds, but in the plants It is just with the fungus it is approximately double. it this action of the that is possible parasitic fungus which to its darnel poisonous properties. The favourite place gives ef growth of darnel is amongst wheat, and occasionally it kas happened that the seeds have been mixed and ground with the wheat in the preparation of flour, and alarming poisonous symptoms have followed the consumption of bread containing these seeds. This power of assimilating atmospheric nitrogen which appears to be possessed by most fungi is of the greatest possible interest and a further study of the subject is certain to yield results of both theoretical and practical importance. The fact that one fungus according to its peculiar metabolism can turn nitrogen into a poison and that another fungus can turn that same element into a food in itself is sufficient to show the desirability of investigation with the view of discovering exactly how such opposite results are brought about.
principles
of
ergot
are
"BARNSBURY BABIES." AN article under this heading, by Mrs. Frances Campbell, appeared in the 1G’cstmirtster Gazett6 of July 10th in support of the Gifford-street Foster Homes Society which we do not doubt does excellent work amongst slum-bred children. But whilst sympathising with the aims of the society we feel constrained to support a protest which appeared in the next day’s issue of the same newspaper from Dr. J. Alison Glover. Dr. J. A. Glover exposed fully the sentimentality with which Mrs. Campbell’s article was infused and reproached her for the blasting of the reputation of "a district as large as .8tockton-upon-Tees for the sake of obtaining a few pounds
A LESSON IN THE USE OF ANIMAL EXPERIMENT. THOSE
wno
are
anxious
to
see
lor
tnemseives
tne
in which the Research Defence Society is setting about its task of educating the public may profitably expend 3d. upon one of its earliest pamphlets, entitled "The Extinction of Malta Fever,"which has been written for the society by Colonel Sir David Bruce who was the chairman of the late Mediterranean Fever Commission of the Royal Society ; and when it has been read it may be handed on with advantage to any antivivisectionist who may be suspected of being open to conversion by a plain statement of an overwhelming case. Colonel Bruce, in driving home his arguments, relies upon neither cauistry nor sentiment but upon the unanswerable logic of facts. These facts we need hardly rehearse as they have only recently been put before our readers in the Milroy lectures. live may say, however, that Colonel Bruce, who attributes the discovery of the specific micro-organism with some modesty to " an army medical officer," tells in non-technical language the way in which by repeated experiments the spread of the disease in Malta was laid to the score of the milch-goats. The charts showing graphically the incidence of Malta fever on the island in 1905 and 1907, in which years there were 643 and seven cases respectively, might almost convince anyone that the blotting out of 75,000 days of illness annually, and the consequent increase of efficiency amongst an important British garrison, make up a sufficient justification for experimental methods. manner
"The Extinction of Malta Fever" (A Lesson in the Use of Animal
1
Experiment). Bv Colonel David Bruce, R.A.M.C., C.B., M.B., D.Sc., LL.D., F.R.S. London : Macmillan and Co. 1908. Pp. 20. Price 3d. net.
CITY COUNCIL.-T118 report of asylum committee of the Exeter city council, which was presented at its last meeting, shows that on Dec. 31st, 1907, the institution contained 371 patients (169 males and 202 females). During 1907, 39 deaths occurred and 82 patients As a result of the favourable working of were discharged. the asylum the sum of .61610 has been paid to the borough fund. It is proposed to provide additional accommodation in the institution for 52 female patients. THE EXETER
the
immediately accompanied by intense dyspnoea. With difficulty he returned home and from that time was unable to authorities and of the police force. Sir J. Whittaker Ellis work and suffered constantly from cardiac failure (Allpohas sent us a circular letter inclosing a report of a question systolie) with slight variations. During the last fortnight asked by Sir Henry Craik in the House of Commons on before admission especially his legs swelled and he suffered March 24th as to what statutory restrictions are put upon constantly from dyspnoea. On admission he sat up in a state motor omnibuses with regard to the amount of smell, noise, of great dyspnoea. His face was cyanosed, his conjunctivae and vibration which they cause, with Mr. Gladstone’s reply were subicteric, and the veins of his neck were prominent. to deal forthwith with the vehicular users of the roads and streets, each body to have the cooperation of local municipal
that "some check
to unnecessary smell and noise is afforded by regulations of the Commissioner of Police as to the conditions to be fulfilled before a licence is granted." We agree from a prolonged experience of a very busy thoroughfare that the noise of these vehicles is a well-nigh intolerable nuisance. It has been proved that a comparatively silent motor-omnibus can be made, and it is to be hoped that in issuing new licences the police will take full advantage of their powers ; there are, moreover, too many omnibuses now running which ought to be condemned. On the broader question which Sir J. Whittaker Ellis raises, we should welcome the institution of a traffic authority, though we feel constrained to repeat the words which we used when such a board was first proposed that ’’ when it comes into existence it will find itself confronted with a task in comparison with which the labours of Sisyphus 1 may be regarded as mere diversion." We then gave it as our opinion that the decentralisation of the hives of industry into healthier and more open surroundings seemed to offer the best solution for thinning the London traffic. The construction of new streets to accommodate motor traffic on any large scale in the central districts is, we fear, a visionary proceeding, although, of course, in planning new suburbs such special roads might prove practicable. In the meantime there is no doubt that to cross the London streets at the present day requires more alertness and entails greater danger to life and limb than ever before, and in busy thoroughfares an elderly person may be forced to wait for several minutes before seeing a chance of a secure transit. The immediate remedy, as we have suggested recently, would seem to rest in the provision of moreislands " of refuge, although in narrow streets such as parts of the Strand, where the traffic is often well-nigh continuous, it would be difficult to spare road space for their construction. as
TRAUMATIC INSUFFICIENCY OF THE MITRAL VALVE.
TRAUMATIC valvular disease of the heart is very rare ; on the "Medical Aspects of Insurance" Professor Grober of the University of Jena has stated that valvular disease of the heart is never the direct result of injury. However, a few well-authenticated cases have been recorded. In consequence of recent legislation which increases the liability of employers for accidents to their workmen the subject has a special interest just now. At a meeting of the Societe Medicale des Hopitaux of Paris on May 29th M. Claisse and M. Socquet reported
indeed, in a recent work
the following case which shows dramatically the possibility of valvular disease being produced by injury. A mason, aged 48 years, was admitted into La Pitie Hospital on Feb. 7th last with dyspnoea and oedema of the lower limbs. His illness began suddenly on Oct. 24th, 1907, after a violent effort. He was cementing a large block of stone about 100 weighing kilogrammes, which slipped from its place. He endeavoured to stop it with his arms and allowed it to slip on to his chest. He made a violent effort for some seconds to hold it up and, unable to do so, allowed it to fall. At the time of the greatest effort he felt a tearing pain in the præcordial region which was 1
THE
LANCET, Nov. 25th, 1905,
p. 1558.
There was considerable oedema of the lower limbs which extended to the penis and scrotum and even as high as the thorax. The cardiac apex was lowered and displaced to the left. Percussion showed great cardiac dilatation. A loud mitral systolic murmur of puling musical timbre occupied almost the whole of the systolic period and was propagated to the axilla and back. Over the aortic orifice the second sound was a little harsh. The blood pressure to 140 millimetres of mercury and the pulse was from 130 The abdomen was distended was 90, small, and irregular. with fluid. The liver descended six fingers’ breadth below the ribs and was painful and hard. Pressure upon the liver produced a reflux in the jugular veins. At the posterior inferior portion of the right chest there were signs of fluid and puncture yielded sero-fibrinous fluid with the cytological formula of cardiac pleurisy-a few polynuclears, a small number of lymphocytes, and many endothelial plates. From 300 to 500 grammes of high-coloured urine were passed in the 24 hours. It contained albumin. There was no history of rheumatic fever or syphilis. Digitalis and theobromine were given without effect. The dyspnoea was always intense. The oedema increased so much that the skin broke at a spot on the external surface of the left thigh, whence a large quantity of liquid was discharged. The right lower limb became cold and cyanosed and the violet colour of gangrene appeared on the foot and ankle. Later an erosion appeared on the external surface of the thigh from which a patch of From this place a large gangrene rapidly extended. of rose-coloured fluid was quantity discharged. In the meantime the patient became definitely jaundiced ; the urine gave Gmelin’s reaction but the stools remained coloured. Diffuse sonorous rales appeared in the chest and death occurred on March 2nd. The necropsy showed a quantity of serous fluid in the abdominal and right pleural cavities. The lungs were oedematous. There was complete union between the visceral and parietal layers of pericardium but the adhesions appeared to be recent and were easily broken down. The heart was dilated-16 centimetres broad and 14 long. It weighed 635 grammes and contained abundant clots. The left ventricle was hypertrophied and dilated. The mitral valves were sound but the posterior pillar was broken and retracted. The upper fragment floated suspended by the chordae tendinese. It looked like a stump partly cicatrised. In the lower part of the ventricular wall were traces of the tearing away of the pillar-a large granular and haemorrhagic patch. The neighbouring part of the pericardium showed fatty degeneration. The liver was large. The spleen was large and hard. The kidneys were congested but the cortex appeared sound.
THE END OF THE INSTITUTE OF MEDICAL SCIENCES. AT the meeting of the Royal Commissioners for the Exhibition of 1851, held under the chairmanship of the Prince of Wales on July 10th, His Royal Highness, in ntroducing the annual report, expressed his regrets that, .he University of London had decided to abandon the scheme for erecting and supporting an Institute of Medical sciences. The site, he said, will now be added to that already allocated by the Commissioners to the College of
176
Technology. And so there comes to an end the for a worthy but admittedly small charity." Mrs. Campbell -only practical move which has yet been made by the Uni- supported her appeal ad miserioordiatit by the hysterical versity of London towards the consolidation of medical utterances of an American " expert " sent to Europe by his teaching which those who have thought most and most Government to study certain conditions of lower-class life. impartially about the subject believe to be absolutely The I I world-f amousgentleman (for so Mrs. Campbell thinks necessary if the London medical student is to obtain a he is), who prefaces his remarks with I I Wall, I guess," had medical degree upon reasonable terms. gazed at the Barnsbury babies and had been so harrowed by the spectacle that he could not sleep o’ nights, the reason being, according to Mrs. Campbell, that the only place in THE FUNCTIONS OF FUNGI. London which can hold a candle to Barnsbury for sordid THERE seems to be little doubt that certain, if not all, grime and despair"and cruelty to its little ones is a species of fungi possess the power of assimilating nitrogen region in Battersea with the picturesque title of "Little from the atmosphere and some day it may happen that the Hell." We are pleased to see Dr. J. A. Glover, a medical fungus farm will form the basis of a new industry. The man working in North London, and familiar in a way that mushroom is, perhaps, the most familiar form of a fungus the " world-famous" American could not be with the and it is well known that although it contains a con- economics of the situation, refuting this gratuitous attack siderable quantity of moisture yet the dry matter consists upon Barnsbury. Doubtless the district is, as Dr. J. A. llargely of nitrogenous substances. Again, the poisonous Glover says, "a poor and crowded neighbourhood,"but he fungi appear to owe their toxic properties to the presence adds, and we wholly concur with him, that it "maintains its f alkaloids which, of course, are nitrogenous bases. On health in a way which does credit to the motherhood of its the nature of the metabolic process in the fungus depends, humble citizens and to the essential soundness of its saniprobably, whether the nitrogen ultimately resolves into a tary administration." Dr. J. A. Glover supports his contenpoisonous or non-poisonous substance. This at any rate tion with figures comparing the infantile death-rate of serves as a scientific differentiation of poisonous from nonBarnsbury with those of various American cities, figures of a Another interesting example poisonous which the distinguished reformer from across the Atlantic poisonous fungi. which attaches itself to cereals is ergot which is, may find somewhat difficult of digestion. fungus in of course, a powerful drug medicine, its value residing The active in its contracting effects on the arterioles. Science and
well known to be alkaloidal in There is also an instance in which it character. has been found that the fixation of free atmospheric nitrogen by the grass known as lolium temulentum, or darnel, is due to the fungus which infests it. This grass, it is interesting to note, has no symbiotic root organisms, so that its power to assimilate free nitrogen must be traced to other parts of the plant. If no combined nitrogen is given in the food the amount of nitrogen in the plants without the fungus is the same as in the seeds, but in the plants It is just with the fungus it is approximately double. it this action of the that is possible parasitic fungus which to its darnel poisonous properties. The favourite place gives ef growth of darnel is amongst wheat, and occasionally it kas happened that the seeds have been mixed and ground with the wheat in the preparation of flour, and alarming poisonous symptoms have followed the consumption of bread containing these seeds. This power of assimilating atmospheric nitrogen which appears to be possessed by most fungi is of the greatest possible interest and a further study of the subject is certain to yield results of both theoretical and practical importance. The fact that one fungus according to its peculiar metabolism can turn nitrogen into a poison and that another fungus can turn that same element into a food in itself is sufficient to show the desirability of investigation with the view of discovering exactly how such opposite results are brought about.
principles
of
ergot
are
"BARNSBURY BABIES." AN article under this heading, by Mrs. Frances Campbell, appeared in the 1G’cstmirtster Gazett6 of July 10th in support of the Gifford-street Foster Homes Society which we do not doubt does excellent work amongst slum-bred children. But whilst sympathising with the aims of the society we feel constrained to support a protest which appeared in the next day’s issue of the same newspaper from Dr. J. Alison Glover. Dr. J. A. Glover exposed fully the sentimentality with which Mrs. Campbell’s article was infused and reproached her for the blasting of the reputation of "a district as large as .8tockton-upon-Tees for the sake of obtaining a few pounds
A LESSON IN THE USE OF ANIMAL EXPERIMENT. THOSE
wno
are
anxious
to
see
lor
tnemseives
tne
in which the Research Defence Society is setting about its task of educating the public may profitably expend 3d. upon one of its earliest pamphlets, entitled "The Extinction of Malta Fever,"which has been written for the society by Colonel Sir David Bruce who was the chairman of the late Mediterranean Fever Commission of the Royal Society ; and when it has been read it may be handed on with advantage to any antivivisectionist who may be suspected of being open to conversion by a plain statement of an overwhelming case. Colonel Bruce, in driving home his arguments, relies upon neither cauistry nor sentiment but upon the unanswerable logic of facts. These facts we need hardly rehearse as they have only recently been put before our readers in the Milroy lectures. live may say, however, that Colonel Bruce, who attributes the discovery of the specific micro-organism with some modesty to " an army medical officer," tells in non-technical language the way in which by repeated experiments the spread of the disease in Malta was laid to the score of the milch-goats. The charts showing graphically the incidence of Malta fever on the island in 1905 and 1907, in which years there were 643 and seven cases respectively, might almost convince anyone that the blotting out of 75,000 days of illness annually, and the consequent increase of efficiency amongst an important British garrison, make up a sufficient justification for experimental methods. manner
"The Extinction of Malta Fever" (A Lesson in the Use of Animal
1
Experiment). Bv Colonel David Bruce, R.A.M.C., C.B., M.B., D.Sc., LL.D., F.R.S. London : Macmillan and Co. 1908. Pp. 20. Price 3d. net.
CITY COUNCIL.-T118 report of asylum committee of the Exeter city council, which was presented at its last meeting, shows that on Dec. 31st, 1907, the institution contained 371 patients (169 males and 202 females). During 1907, 39 deaths occurred and 82 patients As a result of the favourable working of were discharged. the asylum the sum of .61610 has been paid to the borough fund. It is proposed to provide additional accommodation in the institution for 52 female patients. THE EXETER
the