THE INCUBATION OF ENTERIC FEVER.

1092 to spend) been rated up five years, making the life to be charged as few remarks àpropos of Professor Notter’s lecture, thirty instead of twenty-five. £ s. s. d. ,&bgr; an abstract of which was given in your columns on 17 2 6 premium, age 25, without profits, for £1000 April 26th. One must cordially echo Professor Notter’s Annual 19 18 4 Annual premium, age 30, without profits, for £1000 hope that sufficient area will be given in any new barracks 15 10 to Difference Z2 which are be built. Why soldiers should live and sleep in buildings of three or four storeys with internal stairExpectation of life at age twenty-five is thirty-eight years - cases it is hard to conjecture, unless it be for military and a half. The debt on policy first year is E2 15s. 1M. x reasons. 381= i107 9s. 7d., or sum assured, £892 10s. 5d. ; second The first law of sanitation is " Spread out," and it cannot year, i215s. 10d. x 37½ = i104 13s. 9d., or sum assured, be wise economy not to put this law in force when expensive £895 6s. 3d., and so on, decreasing by jS215s. lOd. each necessities like soldiers are concerned. If it be necessary year until at the expiration of thirty-eight years and a half to build barracks in the centres of large towns, it is impos- the full sum assured of £1000 is payable at death. If, sible to attain any high ideal of sanitation ; but many therefore, the life in his own opinion is a first-class one, ’barracks are in the country where land is cheap, and there and subsequent events prove that it is so, then the life can be no doubt that the physical and moral well-being of suffers no hardship in having peid an extra premium for a the soldier must be, in no small degree, proportionate to second-class life, as, on his living to his expected term of the amount of open space around his dwelling. If, in life, the full sum assured is payable at death, and the addition to the ground occupied by buildings, parade ordinary premium only has been paid for the benefit. Mr. G. S. Crisford, the actuary of the company, has kindly ground, &c., there be a minimum of ten acres land for every thousand men, there would be some chance furnished me with the above figures. of the sanitation of barracks being complete, and a colony I am, Sirs, your obedient servant, of young soldiers would not be obliged to pass on their F. DE HAVILLAND HALL. refuse to be dealt with by an outside authority. The incompleteness of sanitation by water carriage is the To the Editors of THE LANCET. "opprobrium of modern hygiene, and it certainly seems to be unworthy of that proud independence which is the chief SIRS,-Dr. Tyson’s letter, published in THE LANCET of characteristic of the soldier that lie should be allowed to the 3rd inst., on "Albuminuria and Life Assurance " refers pass on his refuse to be a danger and an expense to others to a subject of great interest to both the general public and instead of a profit to himself. the medical profession. I infer from his letter that he is of The "Royal Barracks" at Dublin, according to the opinion that whenever the smallest quantity of albumen is interim report of Mr. Rogers Field, have some three miles found in the urine of persons proposing to insure there is a of underground sewers ; and the sewage of these barracks, probability of an unfavourable opinion being given on the together with the sewage of a neighbouring prison and life, leading to rejection on that ground no matter infectious hospital, flows directly into the Liffey at the how favourable other indications may be. I incline to upper end of the town. What is the good of an Act of agree with Dr. Tyson that there should not be a sweeping Parliament to prevent the pollution of rivers, when those in condemnation of proposers whose urine may give only a the pay of the Government, and living in Government slight indication of albumen, but who, like Dr. Tyson’s buildings, are allowed to set so bad an example ? It patient, are in robust health. I have made notes from is not surprising to find typhoid in a building provided the claim papers of persons who have died insured in with three miles of sewers, because if we know any- the Life Association. On examining these documents Sceptre thing about typhoid, it is that the vast majority of cases for the past fourteen years, ending Dec. 31st, 1889,I find have water - carried excrement as their penultimate that 1025 persons have died. Of these, 44 deaths have been cause. caused by diseases of the organs, or a little over 4 per The question I wish to ask is whether three miles of cent.; but of these 44 onlyurinary 23 have died from Bright’s disease, underground pipes are absolutely necessary for the well- or slightly more than 2 per cent. of the whole, being a very being of a soldier? The training of a soldier at home has small percentage of the total mortality, especially when for its object the rendering him fit to take the field, and compared with the deaths from many other diseases. This what does a soldier do when he finds himself encamped in mortality is remarkably low when we remember how frea foreign country thousands of miles from his underground quently albumen is found in the urine, and would tend to pipes? The proper bestowal of excrement and slops is a encourage the idea that many recover from albuminuria, thing which every soldier must be taught in order that his and that it is not a sufficient cause in all cases for con- camp may be wholesome. Why should he not be taught demnation, but that the proposer should have a chance this important duty at home ? Why should the taxpayer given him on some such terms as indicated in Dr. Tyson’s be burdened with the cost of pipes and other perishable letter. It would be of great service if the medical officers apparatus in order that the soldier may be less fitted of our life assurance companies would give the result of to take the field and that his risk of typhoid may be their experience on this question as a guide, so that, whilst increased ? Surely, the daily burial of excrement and the protecting the interests of the companies by our advice, we due filtration of slops can be managed without much may avoid giving unnecessary pain and disappointment to difficulty if a moderate amount of cultivable ground be proposers for life assurance.-I am. Sirs. vours truly. .provided. In a girls’ school or in a house full of ladies and ROBT. BENTHAM, M.D. ladies’ maids (especially the latter) there might be difficulties, but there should be none in a community of young adult males who are subjected to military discipline. THE INCUBATION OF ENTERIC FEVER. I am, Sirs, your obedient servant, . To the Editors of THE LANCET. G. V. POORE, M.D. SIRS,-A father brought two sons from Portsmouth to a healthy hamlet in the Midlands on Sept. 2nd, 1889. One boy was ailing at the time, and took to his bed on the 4th, ALBUMINURIA AND LIFE ASSURANCE. when I was called in and found his case to be one of enteric fever. The father nursed him assiduously through the To the Editors of THE LANCET. delirium, but on the 14th was obliged to return to PortsSIRS,-With reference to Dr. Tyson’s letter, which mouth, taking with him his second son. On the 23rd, as I ,appeared in your issue of the 3rd inst., may I point out to you learned, the father was taken ill with typhoid, and he that the Rock Life Assurance Company has for some time eventually died. On the 30th, the other boy, after ailing for past adopted the method suggested in the concluding para- some time, was laid up with the same complaint. The quesgraph-viz , to charge any extra premium as a debt on the tions I wish to raise arse :-1. Did the father contract the policy when such extra premium is charged in consequence complaint before leaving home? if so, the incubation must ,of an unfavourable medical report, and this debt is dimi- have been at least twenty-one days; or did he take it from nished each year until at the expiration of the term for an insanitary house on his return, when the incubation which the life may be expected to live the debt is cancelled must have been nine days or less? 2. What was the incuand the sum assured is payable in full on subsequent death. bation in the case of the second son, and where was he As an example, take a life aged twenty-five next birthday infected? 3. Did they both contract the fever from the for £1000, which in consequence of the medical report has first case ? In this case every care was taken as to cleanli. to the

£4,000,000 which the Government is about

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1093 ness, and the excreta were immediately disinfected and buried in the field in which the cottage stood. The cottage

ROYAL MEDICAL BENEVOLENT COLLEGE.

of two at a distance from other habitations. It is To the Editors of THE LANCET. admitted that no case infects except by the am desired to send you a copy of a resolution SIRS,-I excreta, and not through them till they have had time to of the College at their meeting on the Council by decompose. I find from the text books that great uncertainty passed Wednesday-viz. : incubation. exists as to the length of i " That the members of the Council of the Royal Medical I am, Sirs, yours truly, I Benevolent College desire to express their cordial thanks to JOHN EMMERSON. the Editors of THE LANCET for having so warmly supported the best interests of the pensioners and foundation scholars of the College." PYLORECTOMY. They would especially thank the Editors for their gift of To the Editors of THE LANCET. 10,000 copies of the report of the festival. They would also of the conditional SIRS,—In your issue of May 10th is a letter by Mr. F. B. express their warmest appreciation Jessett commenting on the paper read by Sir William Stokes promise of £1000 in aid of the charitable side of the work of before the Medical Society on April 28th, in which he speaks the College. No efforts will be spared to claim the fulfilof the operation of gastro-enterostomy by means of approxi- ment of this most generous promise in the future. I am, Sirs, yours faithfully, mation plates having been performed four times in England, ROBERT FREEMAN, Sec. with success on three occasions. I have now to add another a since to the number, fortnight having elapsed the operation, the wound having healed, and the patient having steadily improved since, being able to take food. I quite BIRMINGHAM. agree with the opinion expressed in the letter that in cancer (FROM OUR OWN CORRESPONDENT.) of the pylorus, unsuitable for pylorectomy, gastro-enterostomy by Dr. Senn’s method is a ready and effectual means of relief. I hope to report my case fully on a later occasion. Hospital Satztrday. I am, Sir?, yours faithfully, THERE is every reason to believe that the total amount A. W. MAYO ROBSON. subscribed by this praiseworthy plan will this year exceed all previous collections. To the present time upwards of £8000 have been recorded, being :EgO in excess of the same To the Editors of THE LANCET. time last year. The many workers who devoted themselves SIRS,-In a letter published in the last issue of THE to the duty involved in this organisation were indefatigable LANCET, Mr. Jessett points out the importance of feeding in their efforts to obtain subscriptions. Ladies were diligent gastro-enterostomy cases at an earlier date after the in urging passers-by to contribute small sums. Nurses in operation with suitable peptonised foods. I wish to uniform adorned some of the standpoints for collecting, and support his suggestion, having, like him, lost a case evidently attracted considerable attention. All pursued the several days after the operation purely from exhaus- quest of coins with commendable zeal and energy worthy tion. The patient, a male aged sixty, admitted under of the cause in which they were engaged. my colleague, Dr. Caton, was operated on by me at the Hospital Abuse. Liverpool Royal Infirmary on Feb. 13th. For a week The committee have issued a series of questions to the he was fed entirely by the rectum with peptonised foods. i During this time he suffered greatly from thirst, and various hospitals and institutions asking for numbers of his emaciation increased. He was evidently living partly cases treated, means taken to prevent imposition, and. similar inquiries. It will take some time for these to be upon his own tissues, for he passed about 250 grains of urea On completion of this preliminary inquiry evieach day. On the 20th, the day on which stomach alimenta- returned. be dence will taken, and subsequently a report issued. The tion was to be commenced, he suddenly failed. Up to this time he had not given us cause for much anxiety, and we system is that of a commission, and though, possibly folbelieved that his recovery was assured. Now, however, the lowing precedent, no recommendations will be made, an stimulant and food were without avail. It was too late, amount of data will be obtained for forming ground for and he slowly died. At the post-mortem the operation ap- future action if such is desirable. Opinion seems to point the conclusion that, while individual instances of abuse peared to have been quite satisfactory. There was good to union. The bone plates had entirely disappeared, and the do occur, they are not nearly so numerous as supposed, and. silk ligatures were hanging loose in the opening. The case that they bear but a very small proportion to the vast aggregate of good distributed over so wide an area. was brought forward at the Liverpool Medical Institution, and will be published in the next volume of the Liverpool African Heroes. Medico-Chirurgical Journal. An invitation has been given to Mr. Stanley to become I am, Sirs, yours faithfully, the guest of the President of the British Medical AssociaF. T. PAUL. tion, along with Surgeon Parke, during the forthcoming meeting in this city. Considerable interest is manifested in the expectation of their presence, and a hearty welcome THE SOCIETY OF APOTHECARIES. promised to the distinguished member of our profession. whose unwearied devotion added so much to the success of To the Editors of THE LANCET. the recent explorations on the Dark Continent. SIRS,—At a Court of Assistants of the Society of Apothecaries of London recently held, it was resolved to make all TVarwick Town Conuncil. At a meeting held on the 13th inst. several members of past, present, and future examiners of the Society, and also the surgical examiners appointed from time to time by the the Council took exception to the remarks made by the Medical Council, members of the corporate body, on pay- medical officer of health, which were reported in a recent ment of a nominal sum ; and also every year to admit a communication to THE LANCET. The Mayor remarked limited number of its licentiates to the same privilege on that much had been done to improve the sanitary condition payment of a moderate sum, and subject to the Court of of the town, and that at present it was not bad as compared Assistants being previously satisfied of their fitness in all with other towns. The effects of the town charities in respects to become members of the Society. The Court tending to pauperise and devitalise the poorer population of Assistants feels that this important departure from were pointed out to have been over coloured, and not so inancient precedent will strengthen and enlarge the basis of jurious as represented. At the same time credit must be the Society, and afford a further proof of its desire to pro- given to the medical officer for his activity and for the care mote the interests of its licentiates. I may take this oppor- he has taken to protect the interests of the community. tunity of stating that it is not only in their behalf, but that Birmingham, May 14th. of the whole nedical profession, the Society is now defraying, at a heavy cost to itself, the putting down of unqualiEVELINA HOSPITAL FOR SICK CHILDREN.-The fied practitioners, with the greatest success. Lord Mayor has consented to take the chair at a dinner to I am, Sirs, yours obediently, be held at the Hotel Metropole on Tuesday, May 20th, at JAMES RICHARD UPTON. 7.30 P.M., on behalf of this hospital. was one

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