THE GEOGRAPHICAL DISTRIBUTION OF APPENDICITIS.

344 As the forces of respiration act in all directions responsible for the treatment recommended by the there are in the manometer corresponding oscilla- medical officers of the institution. tions of a few centimetres on either side of - 8. If the Insurance Committee recommends an Their range depends on the depth of respiration insured person to attend the Brompton Hospital, and the presence of adhesions in the neighbour- for example, it would not be justified in dictating In his remarks on the to the physician what treatment he might or might hood of the puncture. oscillation when the patient not employ. Neither can the committee dictate to positive pressure he does not take into consideration the the medical officer of a dispensary. ,coughs inertia of the column of water. It seems fairly I am, Sir, yours faithfully, obvious that the sudden application of a considerJ. EDWARD SQUIRE. able though momentary force causes a violent ’oscillation which continues beyond the point at which the force ceases to act, and thus gives the THE WORKING OF THE NATIONAL INtransitory positive reading. This, if it does more SURANCE ACT IN GREAT YARMOUTH. than confirm that the pleural cavity is entered, To the Editor of THE LANCET. tends to show that the lung is not punctured. Valve action of the lung is, of course, an incident SIR,-I am able to confirm from my own in aspirating effusions, but the high negative both the accuracy and the moderation knowledge pressure employed makes the conditions totally of Commissioner’s your report on the above - different. to With subject. regard "contracting out"II The danger of wounding the lung, provided the was within a week or two of the panel present pleura is not adherent, would seem to be avoided being formed, at a meeting of the so-called local by using a blunt cannula. The advantage of a sharp medical committee (before it was legally elected needle, even with a flow of gas, is not obvious, and and formed), and the minutes of the previous if the pleura is adherent surely the blunt instrumeeting recorded that it had been proposed and ment will do less damage. carried that allocation of patients who had not I am, Sir, yours faithfully, chosen their doctors should be immediately MILLER. proceeded with. Two or three of my nonpanel brethren were also present and can confirm my statement, so it was not a case To the Editor of THE LANCET. of "months," but immediately on the formation SIR,-Is it bradypepsia of novelty to say that the of the panel. Dr. Henry Blake, too, at one chances are against Dr. W. Parry Morgan’s new of these early meetings proposed that a floor apparatus being a useful contrivance ? What I of the hospital should be reserved for panel patients look at is this. From 1911 to the present date a and panel doctors, and if the hospital committee great number of artificial pneumothorax cases by did not agree that pressure should be put on it by the puncture method have been done on the con- inducing the Friendly Societies not to continue their tinent. In England, if we except Dr. Lillingston, subscriptions. Dr. J. I. Sankey, one of the three who comparatively very few. Yet on page 589 of the signed the letter in your issue of July 18th, was the tenth part of Therapeutische Monatshefte for 1911 proposer at the final meeting in December that we there is figured an apparatus which is the same to should continue to resist the Act, and made no a T-piece as that now in use, with the one excepmention then of change of attitude on the part of tion of the small manometer- throttle devised by the British Medical Association. However, it will Petersen, of Copenhagen, for the purpose, according neither interest your readers nor do any good by to Saugman, of estimating mean intrapleural pres- going further into the inaccuracies of the letter ; but I think I have shown how the Act and the sure with full regard to the physiological fact that conduct of the panel men to their non-panel lasts twice as as long nearly expiration. inspiration Continental workers, as might have been expected, brethren since its adoption have shattered the have had ideas during this time, but they do not medical union and professional good-fellowship of .seem to have made good with them; and it is there- this town.-I am, Sir, yours faithfully, RAYMOND HENRY SHAW. fore unlikely, until insular experience is a good deal greater, that British workers will succeed in wiping their eye. However, I shall certainly try

W.

Dr.

Morgan’s

new

needle before long. Sir, yours faithfully, W. C. RIVERS.

I am,

THE GEOGRAPHICAL DISTRIBUTION OF

APPENDICITIS. 1’o the jJ;atto’r

TUBERCULIN " ENTHUSIASTS. " To the Editor of THE LANCET.

SiR,—I hope that Dr. Charles Miller’s letter in of July 25th will be noted by the tuberyour issue " culin enthusiasts." Several similar cases have come under my notice, and I am afraid they may be more common than is generally realised. Dr. Miller appears to think the Insurance Committee is to blame in the case he describes; on what grounds is not evident. The committee may recommend a patient to attend some institution approved by the Local Government Board and may pay the fees, but it is surely not therefore to be held

of THE .LANCET.

SIR,-Mr. R. W. Murray’s paper in your issue of July 25th is of great interest to me. For the last six years I have been in medical charge of the for natives at Luxor, Upper Egypt. During this time I have only seen two probable cases of appendicitis, both being inhabitants of the town itself. The poor eat Nile fish, but are chiefly vegetarians of necessity. The better class native eats meat, fowl, eggs, and fish, but always fresh; there is no such thing as cold storage. Two other points have struck me: 1. The relative infrequency of malignant disease. For instance, I have only seen one case of cancer of the breast, and that woman came from a place over 100 miles away from Luxor. 2. Though the population is

hospital

345 riddled with untreated or partially treated syphilis I have never seen a case of aneurysm. I am, Sir, yours faithfully, W. E. NICKOLLS DUNN, M.B. Lond.

I

THE

BRITISH MEDICAL ASSOCIATION. EIGHTY-SECOND ANNUAL MEETING AT ABERDEEN.

THE MEDICAL LOG OF THE "LORD STANLEY."

THE eighty-second annual meeting of the British Medical Association has been held this week in the ancient and picturesque university city of Aberdeen The medico-political proceedings of the Representative Body began on Friday, July 24th, whiles the congress was formally opened on Tuesday afternoon, July 28th, when the annual general meeting of members was held in the Mitchell Hall of Marischal College. The retiring President, Dr. W. Ainslie Hollis, being absent from illness, his. successor, Sir Alexander Ogston, K.C.V.O., M.D.,. emeritus professor of surgery in the University of Aberdeen, was inducted by Dr. J. A. Macdonald. After a vote of thanks to the retiring President had been carried with acclamation, Sir T. Clifford Allbutt was formally introduced as President-Elect for the annual meeting at Cambridge next year.

I

To the Editor of THE LANCET.

SlE,—I wish to make a few remarks upon the I annotation entitled " Diseases Aboard Ship in the

I

Past," in your issue of July 18th, p. 173. First, the complaint only attacked 30 out of 480 slaves, of whom 13 died. Secondly, the log ended

suddenly because of arrival at Grenada and landing of the slaves. Thirdly, I do not think the suggestion that the slaves took poison is a feasible explanation, for many of them had been on board several weeks, after an indefinite time in barracoons on shore, before the complaint developed, and in neither place would there be any opportunity for concealing poison. Ptomaine poisoning might be a more probable occurrence, but only one patient at a time was attacked. I am, Sir, yours faithfully, A. BOWES ELLIOTT, F.R.C.S. Eng.

THE MEDICAL DIRECTORY. ’

To the Editor ot THE LANCET.

SIR,-The annual circular of the Medical Directory has been

The presidential address, to which reference ismade elsewhere in our columns this week, was delivered by Sir Alexander Ogston in the music hall on Tuesday evening before an appreciative audience The President was supported on this occasion by theLord Provost of Aberdeen, who offered a welcome to the British Medical Association on behalf of thecity. After the ceremonial introduction to the President of distinguished foreign guests and delegates from oversea dominions, the Association’s gold medals of merit were presented to Mr. T. Jenner Verrall, the popular chairman of representative meetings, and Dr. Edwin Rayner, who has for many years served as honorary treasurer of the

posted to every member of the medical profession. Another copy will be forwarded on request should the first notice have inadvertently gone astray. We should be glad if practitioners will kindly cooperate in returning the forms to us -promptly, so that the entries may be as accurate as Association. possible. To meet the convenience of purchasers, the The addresses in Medicine and in Surgery, by Dr, Directory will be on sale this year early in the Archibald E. Garrod and Sir John Bland-Sutton, werer month of December. of more than usual interest this year. They were We are, Sir, yours faithfully, delivered in the Mitchell Hall of the magnificent new J. AND A. CHURCHILL. buildings of Marischal College on Wednesday and Thursday afternoon respectively, and they are printed in full in our columns this week by the courtesy of the editor of the British Medical Journal. Marischal THE TECHNIQUE OF ABDERHALDEN’S College, it will be remembered, is one of the twodistinct foundations which, after centuries of more SERUM REACTION. or less complete independence, were united 54 years. To the Editor of THE LANCET. ago to form the modern University of Aberdeen. SIR,—I regret that I allowed an error to creep into As Dr. J. Scott Riddell points out in the very my paper on Abderhalden’s serum reaction which interesting and instructive handbook and guide appeared in THE LANCET of July 25th. In the which he has compiled for the benefit of thislast line of the second column on p. 226 the figures gathering, medicine was then for the first time 0’2 and 0’24 should read 0’02 and 0’024. placed on a satisfactory footing among the UniI am, Sir, yours faithfully, versity faculties of Aberdeen, and since that time W. E. BULLOCK. its development has gone on steadily. ____

Dr. W. A.

Brend has

been

medical referee under the Workmen’s county court circuits Nos. 42 and 44.

appointed

Compensation

a

Act for

Aberdeen offers many attractions to visitors. The grey buildings, the charming way in which they are grouped as seen from the approaches to the city, and the brightness and activity of the principal

BRUSSELS MEDICAL GRADUATES’ ASSOCIATION.- streets

The annual meeting of this association will be held at the Earl’s Court Hotel, Tunbridge Wells, under the chairmanship of Dr. Fielden Briggson Saturday, August 8th, at 1.30 Members are invited to bring ladies for the motor tour and luncheon. Tickets, price 5s. (not including wine), may be obtained from the honorary secretary, Dr. Arthur Haydon, 29, Broadhurst-gardens, Hampstead, N. W.

quickly appreciated. Aberdeen has a. an aspect peculiarly its own. There beauty are few large cities which can boast a position which brings them at the same time into the category of great industrial centres and seasideare

and

health resorts. Within the busiest parts of the

a

few minutes’ tram ride of a broad expanse of sea

city