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THE LATE MR. GUY ELLISTON.
579 THE
HISTORY OF X
RAYS.
THE CAPITATION
BASIS OF PANEL PRACTICE.
IT is generally admitted that a reconsideration the capitation fee payable by the Insurance Commissioners on account of medical benifit is justified by the unforeseen alteration of conditions matter resulting from the discovery of X rays in which has taken place since the amount of the fee 1895. Their discovery, he said, marked the com- was fixed. Chief of these altered conditions are mencement of a new epoch in physical science, the diminished value of money, increase in the cost for in the attempts which were immediately of carrying on the duties of panel practice, and a made to ascertain the nature of the unknown disproportionate increase in the liabilities imposed radiation attention was directed to the study on panel practitioners. The demand made last year of radiation in general, and new phenomena by the Conference of Local Medical and Panel ComA general investiga- mittees was rebutted by Sir Edwin Cornwall in a soon encountered. were tion of the cathode rays and of the nature letter containing the passageThe case appears to be put forward on the theory that of the discharge of electricity through gases led to as insurance practitioners are paid in part out of the discovery of the electron and to the putting i inasmuch the any shrinkage in the value of their remuneraforward of the ionisation theory by Sir J. J. tionExchequer due to the present national emergency should be made Thomson. Townsend followed with his theory of, good to all of them by the State as between employer and and that their remuneration should thus be ionisation by collision, and 0. W. Richardson employed, at the pre-war level. investigated the emission of ions from incandescent maintained effectively the tenour of this reply, the Whilst protesting against solids. All this work, at first solely of academic and Panel Committees, of Local Medical Conference has come to immense interest, possess practical in London last which met week, decided almost again value. The production of deteeters and amplifiers for wireless telegraphy, the electrical rectifiers and without dissent, in view of the difficult position of oscillators by which radiotelephony across the national affairs, and having no desire to embarrass Atlantic is now possible, and the Coolidge X ray the Government, not to press the claim for an intube, which is destined to play an important crease in capitation fee at the present moment. No part in radiology and in pure science, are some doubt was felt by the conference that the claim of the first-fruits of the new harvest. From was a just one, and the Lancashire representatives the outset X rays and the phenomena of especially were confident that it would be admitted phosphorescence were generally thought to be if pressed. The general feeling was, however, that connected, and it was while in search of invisible such pressure, even if not unpatriotic, would be construed as such by others than the Chancellor of or X radiations from certain phosphorescent salts The Insurance Ac,ts Committee that Becquerel discovered the radio-activity of the Exchequer. uranium compounds. The Curies’ brilliant re- was instructed to press for an additional grant to searches then resulted in the isolation of the cover increased travelling expenses, rural practiradio-active elements, polonium and radium. Other tioners iu particular being asked to furnish inforradio-active elements were brought to light, and the mation for calculating this grant on an equitable ensuing chaos of thought lasted until the intro- basis. In the case of panel practitioners whose duction of the transformation theory by Professor net professional income from all sources is within Soon after some of the the limit observed by the Government in dealing Rutherford himself. difficulties of classification were solved by Soddy, with civil servants, a grant in respect of increased whose conception of the isotope served to explain cost of living is to be applied for. The conference the constitution of substances whose atomic weights is to be congratulated on the large measure of may differ slightly, but which cannot be separated by unanimity which attended the decision on these and highly controversial matters. chemical means. Curiously enough the study of Xrays themselves had no striking advance to record for THE LATE MR. GUY ELLISTON. many years until Barkla obtained evidence of the WE much regret to announce the death, on existence of characteristic radiations from experiments on secondary X rays. His discovery led to the Saturday last, from pneumonia complicated with wave theory of X rays, which was completely subnephritis, of Mr. Guy Elliston, financial secretary stantiated at later dates by the diffraction experi- and business manager of the British Medical ments of Laue, the Braggs, Moseley, and Darwin. Association. He was the third son of the late Barkla’s characteristic rays were shown to be of the Dr. W. A. Elliston, J.P., of Ipswich, and was born in He was educated at Ipswich Grammar same nature as the rays yielding bright line spectra. 1872. The diffraction experiments led to the employment School, and received his business training in a big of the X rays in two further classes of investiga- steamship company and on the managerial side of tion. In the hands of Professor Bragg and his son several well-known journals. In 1898 he became problems of crystal structure were successfully assistant secretary of the British Medical Associaattacked, while the late Mr. Moseley found in them tion, and in 1902 succeeded the late Mr. Francis a powerful method of investigating the constitution Fowke as general secretary. His work for the Assoof the elements. Moseley showed that the critical ciation never flagged and will long be remembered property of an element was its atomic number-i.e., by those who collaborated with him in 20 years of the number of the element in the periodic system- strenuous labour. His zeal won for him among the while its atomic weight was relatively of secondary members many friends who appreciated his qualities importance. The lecturer added that this important as"a man and valued his intimate knowledge of the relationship between the frequency of the K or L business side of professional life. The Medical series of rays and the atomic number of the element Insurance Agency, formed by the British MedicaZ ought in fairness to be called Moseley’s law. At the Journal and The Lancet, owes much of its success conclusion of his address Sir Ernest to the careful organisation of Mr. Elliston as its received from the President, Captain G. W. C. Kaye, secretary and agent; and the distribution of nearly the first of the medals awarded annually to com- .S3500 of its surplus profits amongst medical memorate the lecture. charities, coupled with the sum of .S6500 received
IN the first Silvanus Thompson Memorial Lecture, delivered before the Rontgen Society on April 9th, Professor Sir Ernest Rutherford dealt with the advances in our knowledge of the constitution of
of
.
important
Rutherford
580 J Hall on their prompt recognition, of the by the insured medical men as direct benefit, are Major tributes to the sound judgment of the secretary’s cases observed by them, and we hope their interestmethods as well as to the value of the Agency. ’In iing papers -will draw the attention of medical ’prac his early manhood he took much interest in the titioners and the public health authorities to the Artillery Volunteers, retiring with the rank ofimportance of recognising this condition and 1lealing . senior captain in 1897. Three of his brothers with it. are now serving with the armies abroad, and A Consultative Committee to advise the Ministry he received the probability of joining up in of Pensions on all matters relating to response to the latest conscription Bill with thehas been appointed; with Sir Arthur perfect readiness of one who had been trained for Secretary to the Ministry,as ’chairsuch a contingency. Mr. Elliston, who was buried Parliamentary The members are Colonel Sir man. at Ipswich Cemetery on Wednesday last, leaves A.M.S., Major W. R. Bristow, R.A.M.C., Major R. C. a widow and four daughters, to whom we Elmslie,. R.A.M.C., and Sir John Collie and Dr. extend our sincere sympathy. Fletcher Porter, Director and Deputy Medical Service to the Ministry. ----
-
orthopaedics Boscawen,
Robert Jones,
Director of -
BOTULISM. CASES of food poisoning have a. special interest a THE Local Government Board at the present time, when the national needs new,’Order entitled "The" Public Healtll demand the utilisation of all possible food materials spinal Fever) Regulations, 1918," the and entail the use of preserved, cured, or tinned councils of administrative counties and foods to a greater degree than under normal boroughs to arrange orprovide for: (1) the supply ‘circumstances. We publish in this week’s issue of serum for the treatment of actual or suspected of THE LANCET two important papers to which it cases of cerebro-spinal fever, the is our duty to draw the attention of our readers. necessary apparatus for the use of the serum; and The first of these, by Captain Wilfred Harris, (2) the examination of suspected cases and of deals with seven cases of botulism which " contacts." The considerations which led to the have come under his notice within a fortnight issue of this Order were, firstly, the great mortality in widely separated districtsof the metropolis. He , that atteiids outbreaks of cerebro-spinal fever; and, gives an admirable brief summary of the principal secondly, the favourable reports that have been clinical features of the condition, as published by published in America *andelsewhere as, the Durham in the Clinical Jou1’nal of June 7th, 1899, beneficial results of the prompt use of the adding a clear and instructive account of the most serum treatment. ’ In comparison with the other typical case in his own series. The second infectious maladies that occur in this’ country paper, by Major A. J. Hall. of Sheffield, deals cerebro-spinal fever stands’ out as one ofthe 11 cases characterised asthenia, ophthal- most fatal of them all, its case-mortality moplegia, and paralysis of various cranial nerves, rate ranging from 50 to 80’ per ’ cent. In occurring in Sheffield and other places in the neigh- the serious epidemic which occurred in bourhood. There can be little doubt from the during 1907 the fatality rate was 74’9 per description he gives that these cases are also and inthe equally serious outbreak of the at Glasgow in the same year 72 per cent. of examples of botulism as suggested by him, though he has not yet had the complete oppor- those attacked lost their lives. Another reason for tunity of establishing their nature. Botulism, issuing the new Order was the fact that hitherto allantiasis, or acute infective ophthalmoplegia, medical practitioners in England and Wales have is a form of food poisoning believed to be due to experienced difficulty in obtaining supplies of the infection by the Bacillus botulinus, and first antimeningococcic serum suitable for immediate described by van Ermengem. Although its name use when outbreaks of cerebro-spinal fever suggests poisoning by sausage meat, the bacillus occurred. This difficulty will now be largely has been found in ham, tinned fish, lobsters, oysters, removed by the Order, and we anticipate that as and cheese. Unlike some other forms of food a result of an extended use of the serum the high poisoning due to bacterial agency, botulism is not mortality of the disease will be sensibly reduced. associated with gastro enteritis; indeed, obstinate
has
(Cerebroempowering county
together with
to
with
by
Belfast cent.
disease
is usually a prominent feature in cases of this condition. Its marked tendency to cause severe nervous symptoms, and the fact that it is often afebrile, may lead to its true nature being overlooked except in epidemics. Briefly stated, its main symptoms are internal and external ophthalmoplegia, with paralysis of accommodation, dilatation of the pupils, strabismus, ptosis and diplopia, aphonia, dysphagia, and obstinate constipation. Diminished salivary secretion also occurs in many cases. Facial palsy occurred in some of Captain Harris’s and Major Hall’s patients. Retention of urine was noted in five of those in Captain Harris’s series. The disease is a serious one, and may The treatment suggested by Captain be fatal. Harris is to clear the alimentary tract with calomel and enemata, and to give regular hypodermic injections of strychnine.’ He suggests that the pathological condition produced is an acute polioencephalitis superior, -due to the neurotoxic action of the poison produced by the causal organism. We congratulate Captain Harris and
constipation
ROYAL
MICROSCOPICAL
SOCIETY.-An
ordinary
of this society was held at 20, Hanover-square, W., on March 20th, Mr. J. E. Barnard, the President, being in the chair.—Lieutenant-Colonel L. W. Harrison, R.A.M.C., dealt briefly with the difference between various spirochætes. In distinguishing S. pallida from other varieties the points he laid stress upon were: first, the extreme fineness of the pallida ; secondly, its pallidity. If the focus was shifted, even a little, other varieties assumed a rusty hue, whereas the S. pallida retained its delicate pallor. S. perfringens too, was much more dazzling than S. pallida. Hence the illumination which sufficed fairly well for other spirochætes was not enough for S. pallida. Another feature was the great flexibility of S. pallida, which was very active in The only spirocheeta ’which might’cause a small radius. differential difficulty was S: microdentium, an organism obtained from the mouth of certain cases. But this had black portions on its body, so that it was naturally demarcated into luminous and dark portions, as against the uniform pallor of S.,pallada. Also the body was thicker. He recommended examination of material from the syphilitic papule rather than from any other the patient, to those who were endeavouring to become with the microscopical appearance of S. pallida.
meeting
part familiar of
HISTORY OF X
RAYS.
THE CAPITATION
BASIS OF PANEL PRACTICE.
IT is generally admitted that a reconsideration the capitation fee payable by the Insurance Commissioners on account of medical benifit is justified by the unforeseen alteration of conditions matter resulting from the discovery of X rays in which has taken place since the amount of the fee 1895. Their discovery, he said, marked the com- was fixed. Chief of these altered conditions are mencement of a new epoch in physical science, the diminished value of money, increase in the cost for in the attempts which were immediately of carrying on the duties of panel practice, and a made to ascertain the nature of the unknown disproportionate increase in the liabilities imposed radiation attention was directed to the study on panel practitioners. The demand made last year of radiation in general, and new phenomena by the Conference of Local Medical and Panel ComA general investiga- mittees was rebutted by Sir Edwin Cornwall in a soon encountered. were tion of the cathode rays and of the nature letter containing the passageThe case appears to be put forward on the theory that of the discharge of electricity through gases led to as insurance practitioners are paid in part out of the discovery of the electron and to the putting i inasmuch the any shrinkage in the value of their remuneraforward of the ionisation theory by Sir J. J. tionExchequer due to the present national emergency should be made Thomson. Townsend followed with his theory of, good to all of them by the State as between employer and and that their remuneration should thus be ionisation by collision, and 0. W. Richardson employed, at the pre-war level. investigated the emission of ions from incandescent maintained effectively the tenour of this reply, the Whilst protesting against solids. All this work, at first solely of academic and Panel Committees, of Local Medical Conference has come to immense interest, possess practical in London last which met week, decided almost again value. The production of deteeters and amplifiers for wireless telegraphy, the electrical rectifiers and without dissent, in view of the difficult position of oscillators by which radiotelephony across the national affairs, and having no desire to embarrass Atlantic is now possible, and the Coolidge X ray the Government, not to press the claim for an intube, which is destined to play an important crease in capitation fee at the present moment. No part in radiology and in pure science, are some doubt was felt by the conference that the claim of the first-fruits of the new harvest. From was a just one, and the Lancashire representatives the outset X rays and the phenomena of especially were confident that it would be admitted phosphorescence were generally thought to be if pressed. The general feeling was, however, that connected, and it was while in search of invisible such pressure, even if not unpatriotic, would be construed as such by others than the Chancellor of or X radiations from certain phosphorescent salts The Insurance Ac,ts Committee that Becquerel discovered the radio-activity of the Exchequer. uranium compounds. The Curies’ brilliant re- was instructed to press for an additional grant to searches then resulted in the isolation of the cover increased travelling expenses, rural practiradio-active elements, polonium and radium. Other tioners iu particular being asked to furnish inforradio-active elements were brought to light, and the mation for calculating this grant on an equitable ensuing chaos of thought lasted until the intro- basis. In the case of panel practitioners whose duction of the transformation theory by Professor net professional income from all sources is within Soon after some of the the limit observed by the Government in dealing Rutherford himself. difficulties of classification were solved by Soddy, with civil servants, a grant in respect of increased whose conception of the isotope served to explain cost of living is to be applied for. The conference the constitution of substances whose atomic weights is to be congratulated on the large measure of may differ slightly, but which cannot be separated by unanimity which attended the decision on these and highly controversial matters. chemical means. Curiously enough the study of Xrays themselves had no striking advance to record for THE LATE MR. GUY ELLISTON. many years until Barkla obtained evidence of the WE much regret to announce the death, on existence of characteristic radiations from experiments on secondary X rays. His discovery led to the Saturday last, from pneumonia complicated with wave theory of X rays, which was completely subnephritis, of Mr. Guy Elliston, financial secretary stantiated at later dates by the diffraction experi- and business manager of the British Medical ments of Laue, the Braggs, Moseley, and Darwin. Association. He was the third son of the late Barkla’s characteristic rays were shown to be of the Dr. W. A. Elliston, J.P., of Ipswich, and was born in He was educated at Ipswich Grammar same nature as the rays yielding bright line spectra. 1872. The diffraction experiments led to the employment School, and received his business training in a big of the X rays in two further classes of investiga- steamship company and on the managerial side of tion. In the hands of Professor Bragg and his son several well-known journals. In 1898 he became problems of crystal structure were successfully assistant secretary of the British Medical Associaattacked, while the late Mr. Moseley found in them tion, and in 1902 succeeded the late Mr. Francis a powerful method of investigating the constitution Fowke as general secretary. His work for the Assoof the elements. Moseley showed that the critical ciation never flagged and will long be remembered property of an element was its atomic number-i.e., by those who collaborated with him in 20 years of the number of the element in the periodic system- strenuous labour. His zeal won for him among the while its atomic weight was relatively of secondary members many friends who appreciated his qualities importance. The lecturer added that this important as"a man and valued his intimate knowledge of the relationship between the frequency of the K or L business side of professional life. The Medical series of rays and the atomic number of the element Insurance Agency, formed by the British MedicaZ ought in fairness to be called Moseley’s law. At the Journal and The Lancet, owes much of its success conclusion of his address Sir Ernest to the careful organisation of Mr. Elliston as its received from the President, Captain G. W. C. Kaye, secretary and agent; and the distribution of nearly the first of the medals awarded annually to com- .S3500 of its surplus profits amongst medical memorate the lecture. charities, coupled with the sum of .S6500 received
IN the first Silvanus Thompson Memorial Lecture, delivered before the Rontgen Society on April 9th, Professor Sir Ernest Rutherford dealt with the advances in our knowledge of the constitution of
of
.
important
Rutherford
580 J Hall on their prompt recognition, of the by the insured medical men as direct benefit, are Major tributes to the sound judgment of the secretary’s cases observed by them, and we hope their interestmethods as well as to the value of the Agency. ’In iing papers -will draw the attention of medical ’prac his early manhood he took much interest in the titioners and the public health authorities to the Artillery Volunteers, retiring with the rank ofimportance of recognising this condition and 1lealing . senior captain in 1897. Three of his brothers with it. are now serving with the armies abroad, and A Consultative Committee to advise the Ministry he received the probability of joining up in of Pensions on all matters relating to response to the latest conscription Bill with thehas been appointed; with Sir Arthur perfect readiness of one who had been trained for Secretary to the Ministry,as ’chairsuch a contingency. Mr. Elliston, who was buried Parliamentary The members are Colonel Sir man. at Ipswich Cemetery on Wednesday last, leaves A.M.S., Major W. R. Bristow, R.A.M.C., Major R. C. a widow and four daughters, to whom we Elmslie,. R.A.M.C., and Sir John Collie and Dr. extend our sincere sympathy. Fletcher Porter, Director and Deputy Medical Service to the Ministry. ----
-
orthopaedics Boscawen,
Robert Jones,
Director of -
BOTULISM. CASES of food poisoning have a. special interest a THE Local Government Board at the present time, when the national needs new,’Order entitled "The" Public Healtll demand the utilisation of all possible food materials spinal Fever) Regulations, 1918," the and entail the use of preserved, cured, or tinned councils of administrative counties and foods to a greater degree than under normal boroughs to arrange orprovide for: (1) the supply ‘circumstances. We publish in this week’s issue of serum for the treatment of actual or suspected of THE LANCET two important papers to which it cases of cerebro-spinal fever, the is our duty to draw the attention of our readers. necessary apparatus for the use of the serum; and The first of these, by Captain Wilfred Harris, (2) the examination of suspected cases and of deals with seven cases of botulism which " contacts." The considerations which led to the have come under his notice within a fortnight issue of this Order were, firstly, the great mortality in widely separated districtsof the metropolis. He , that atteiids outbreaks of cerebro-spinal fever; and, gives an admirable brief summary of the principal secondly, the favourable reports that have been clinical features of the condition, as published by published in America *andelsewhere as, the Durham in the Clinical Jou1’nal of June 7th, 1899, beneficial results of the prompt use of the adding a clear and instructive account of the most serum treatment. ’ In comparison with the other typical case in his own series. The second infectious maladies that occur in this’ country paper, by Major A. J. Hall. of Sheffield, deals cerebro-spinal fever stands’ out as one ofthe 11 cases characterised asthenia, ophthal- most fatal of them all, its case-mortality moplegia, and paralysis of various cranial nerves, rate ranging from 50 to 80’ per ’ cent. In occurring in Sheffield and other places in the neigh- the serious epidemic which occurred in bourhood. There can be little doubt from the during 1907 the fatality rate was 74’9 per description he gives that these cases are also and inthe equally serious outbreak of the at Glasgow in the same year 72 per cent. of examples of botulism as suggested by him, though he has not yet had the complete oppor- those attacked lost their lives. Another reason for tunity of establishing their nature. Botulism, issuing the new Order was the fact that hitherto allantiasis, or acute infective ophthalmoplegia, medical practitioners in England and Wales have is a form of food poisoning believed to be due to experienced difficulty in obtaining supplies of the infection by the Bacillus botulinus, and first antimeningococcic serum suitable for immediate described by van Ermengem. Although its name use when outbreaks of cerebro-spinal fever suggests poisoning by sausage meat, the bacillus occurred. This difficulty will now be largely has been found in ham, tinned fish, lobsters, oysters, removed by the Order, and we anticipate that as and cheese. Unlike some other forms of food a result of an extended use of the serum the high poisoning due to bacterial agency, botulism is not mortality of the disease will be sensibly reduced. associated with gastro enteritis; indeed, obstinate
has
(Cerebroempowering county
together with
to
with
by
Belfast cent.
disease
is usually a prominent feature in cases of this condition. Its marked tendency to cause severe nervous symptoms, and the fact that it is often afebrile, may lead to its true nature being overlooked except in epidemics. Briefly stated, its main symptoms are internal and external ophthalmoplegia, with paralysis of accommodation, dilatation of the pupils, strabismus, ptosis and diplopia, aphonia, dysphagia, and obstinate constipation. Diminished salivary secretion also occurs in many cases. Facial palsy occurred in some of Captain Harris’s and Major Hall’s patients. Retention of urine was noted in five of those in Captain Harris’s series. The disease is a serious one, and may The treatment suggested by Captain be fatal. Harris is to clear the alimentary tract with calomel and enemata, and to give regular hypodermic injections of strychnine.’ He suggests that the pathological condition produced is an acute polioencephalitis superior, -due to the neurotoxic action of the poison produced by the causal organism. We congratulate Captain Harris and
constipation
ROYAL
MICROSCOPICAL
SOCIETY.-An
ordinary
of this society was held at 20, Hanover-square, W., on March 20th, Mr. J. E. Barnard, the President, being in the chair.—Lieutenant-Colonel L. W. Harrison, R.A.M.C., dealt briefly with the difference between various spirochætes. In distinguishing S. pallida from other varieties the points he laid stress upon were: first, the extreme fineness of the pallida ; secondly, its pallidity. If the focus was shifted, even a little, other varieties assumed a rusty hue, whereas the S. pallida retained its delicate pallor. S. perfringens too, was much more dazzling than S. pallida. Hence the illumination which sufficed fairly well for other spirochætes was not enough for S. pallida. Another feature was the great flexibility of S. pallida, which was very active in The only spirocheeta ’which might’cause a small radius. differential difficulty was S: microdentium, an organism obtained from the mouth of certain cases. But this had black portions on its body, so that it was naturally demarcated into luminous and dark portions, as against the uniform pallor of S.,pallada. Also the body was thicker. He recommended examination of material from the syphilitic papule rather than from any other the patient, to those who were endeavouring to become with the microscopical appearance of S. pallida.
meeting
part familiar of