THE LIVERPOOL HOSPITAL FOR CONSUMPTION AND DISEASES OF THE CHEST.

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TEMPERATURE, RAINFALL, & SUNSHINE, D]KCEMBER TO MARCH, ]905-1006.

of these substances or their preparations, except upon th( original written prescription of a medical, dental, or veteri nary practitioner. The prescription must contain the i2am( of the patient or in the case of a veterinary prescriptior the kind of animal that it is intended for and must. bl signed by the prescriber. It must be permanently filed by the pharmacist who dispenses it and must only be

south-east coasts of England and much places situated inland.

most

more

sunny than

repeated upon the written order of the prescriber. No duplicate copy may be made or delivered to any person but the original must at all times be open to inspection by the prescriber and by authorised officers of the law. Provision is made for the sale without these restrictions of minimum stated quantities of preparations of these drugs-e.g., preparations containing two grains of opium or one-eighth of a grain of cocaine in one fluid ounce. Exceptions are made also in the case of preparations containing opium when recommended and sold in good faith for diarrhoea and cholera and when the label bears specific directions and a caution against habitual use; other exceptions include Dover’s powder and ointments and liniments plainly labelled "for external use." Section 2 makes it unlawful for a qualified practitioner to supply or to prescribe any of these substances for the use of any habitual user of But the provisions of this section would the same. not prevent any medical practitioner from supplying or prescribing these drugs for a habitual user of narcotic drugs under his professional care, provided that the administration of the same was considered by him to be a necessary part of the treatment. Section 3 provides that any person who shall violate any of the provisions of the Act shall be deemed guilty of a misdemeanour and shall be fined upon conviction for the first offence not less than 25 dollars or more than 50 dollars ; for a second offence not less than 50 or more than 100 dollars ; and for a subsequent offence not less than 100 or more than 200 dollars, and shall be im* No trustworthy averages. prisoned in the county gaol for not more than six months, and if the misdemeanant be a qualified physician, dentist, THE LIVERPOOL HOSPITAL FOR CONSUMPTION veterinary surgeon, or pharmacist his licence shall be AND DISEASES OF THE CHEST. revoked. The remainder of the Bill deals with the machinery have WE received a copy of the forty-second annual report whereby prosecutions shall be set in motion. the Liverpool Hospital for Consumption and Diseases of the Chest, including also that of the sanatorium at KingsTEMPERATURE, RAINFALL, AND SUNSHINE, wood, Delamere Forest. That portion of the report written DECEMBER TO MARCH, 1905-1906. by the resident medical officer of the sanatorium is of IT will be seen from the appended table that during the especial interest. During the year 1905 there were 183 four months December to March the weather generally was patients under treatment ; of these 37 remained at the milder, more sunny, and in most localities also drier than end of the year and will be dealt with in the usual. Places in the south-west and west were naturally report for 1906. Statistics are therefore given of 146 milder than those in the centre and east of the kingdom, patients who left the sanatorium during 1905. On tle mildest being the Scilly Isles (where the sheltered the whole the results have been good and the thermometer never went down to the freezing-point), prognosis of the early cases as compared with those more followed at a respectful distance by Jersey, Falmoutb, advanced is strikingly brought out. Stress is also rightly Pembroke, and Torquay, while the coldest of the localities laid on the educational value of the institution, patients The south-western stations, leaving the sanatorium impressed with the absolutenecesdealt with was Harrogate. although the wettest, were also the brightest, while sity of living a quiet healthy life. The results of the the dullest of all was London, with no more than treatment are given according to Turban’s system of classiThe sunshine records for the fication. Stage I. comprises those cases in which only part 194 hours of sunshine. Scilly Isles and Torquay are rather remarkable, giving, as of one lobe is slightly affected or small parts of two lobes they do, an average daily duration of slightly more are very slightly diseased. Stage II. includes those cases than three hours. Torquay was not quite so equable as in which one lobe only is diseased and not more than most other places but that seems to be due to the warm moderately so, or in which parts of two lobes are day temperature, none of the other resorts having a mean moderately affected. Stage III. includes all cases in which daily maximum of 500. Its nights were no milder than at there is a greater degree of disease than exists in Stage II. Dublin and Llandudno. The mean difference between the Of the 146 cases mentioned above, five are not included in warmth of the night and the day was small over the kingdom the table of results, one patient having remained only two generally, only a little more than 9°, while at Pembroke it days in the sanatorium, and no evidence of tuberculosis was as low as 5° and at Scilly 6°. Bath, which lying in a could be detected in the other four. 33 patients were in basin-like valley is noted for its range of temperature, "Stage 1."of the disease, and of these 31 showed very showed the relatively large difference of 14° between the day great improvementand two "distinct improvement"; 47 and the night. It will be noticed that Dublin with its mean were in "Stage II.,"and 38 exhibited "very great improvetemperature of 43 8° was much milder than the south and ment," and nine "distinct improvement"; 61 were in

of

NATURE OF THE SALIVA IN ITS RELATION TO CARIES OF THE TEETH.

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magnesium sulphate was injected at 3 P.M. After six minutes profuse perspiration occurred and the patient was fretful. After twelve minutes there was motor paralysis from the pelvis downwards and sensibility was diminished but not sufficiently for operation. Chloroform was administered. Only five cubic centimetres were used. This quantity produced unconsciousness and complete relaxation of all the muscles below the waist, but the conjunctival reflex was preserved. In the third, fourth, fifth, and sixth operations chloroform was administered to induce anæsthesia. In the seventh case it was not required. A youth, aged 16 years, had a large intra-muscular abscess of the thigh. At 2.30 P.M. lumbar puncture was performed and about eight cubic centimetres of cerebro-spinal fluid were THE NATURE OF THE SALIVA IN ITS RELATION withdrawn. The same quantity of the solution of magTO CARIES OF THE TEETH. nesium sulphate was injected (about one cubic centimetre IN the investigations that have been made in the pathology to 15 pounds of body-weight). At 2.50 P.M. the legs were and etiology of dental caries but scant attention has so far heavy and the reflexes were absent. At 3.15 P.M. the legs been given to the nature of the saliva although research in were paralysed and analgesic and the operation was this direction is urgently needed. Dr. C. Risa, who has begun. The patient felt nothing and the operation was already done some excellent work in caries, has recorded completed at 3.50 P.M. At 5 P.M. he was comatose; the in the Deutsche Monatssehrift fiir Zahnheilkunde for muscles were relaxed and all reflexes were absent except December, 1905, the result of the analysis of the saliva in the conjunctival ; the pulse was good and the pupils were 219 children of an average age of 13 years. He has small. At 6.30 P.M. and thrice subsequently spinal been able to confirm the views of other investigators to puncture was performed and four cubic centimetres of the effect that there is a distinct relationship between cerebro-spinal fluid were withdrawn and the same quantity dental caries and the alkalinity of the saliva and he of normal saline solution was injected. At 7.10 P.M. the finds that a high alkaline reaction constitutes the best means coma began to diminish. Thus 45 minutes after the injection of combating the development and progress of caries. He there was complete analgesia of the leg and three and a has carried out a considerable number of experiments to half hours after there was complete general analgesia so determine the means by which slightly alkaline or acid that an operation could have been performed on any part. saliva may be modified so as to render its reaction decidedly In this case the dose was the largest used but it was less alkaline. He finds that a diet consisting of foodstuffs rich than one half that used with impunity in monkeys. The in calcium salts increases the alkalinity and quantity of the first two cases showed that such a small dose as one cubic saliva and he believes that such a diet influences in a marked centimetre of the solution to 25 pounds of body-weight could way the quality of the teeth. produce complete analgesia of the lower part of the body, but not until three hours after injection. Vomiting and

" Stage III.,"and 17 manifested "very great improvement," 33 distinct improvement,""ten "slight or no improvement," and one patient died. The true test of these results cannot be determined for three or four years and only then if the subsequent progress of the patients can be ascertained ; doubtless every endeavour will be made to keep in touch with them. The immediate results of sanatorium treatment may be fallacious, as owing to the good diet and hygienic life a large number of patients even in Stage III. improve temporarily, only to relapse on leaving the institution. Nevertheless, the results obtained in those patients who were in the early stage of the disease are very encouraging.

INTRASPINAL INJECTIONS OF SOLUTION MAGNESIUM SULPHATE.

OF

IN 1905 Dr. S. J. Meltzer undertook a series of experiments animals to show that magnesium salts have analgesic properties. The conclusions at which he arrived may be summarised as follows : the application of solutions of magnesium sulphate temporarily abolished the conductivity of nerves ; subcutaneous injections produced analgesia over the corresponding area ; and intraspinal injections of comparatively small doses produced complete analgesia and paralysis of the posterior part of the body. In monkeys these results were stated to be produced with one-quarter of the dose which would prove fatal. In the Journal of the American Medical Association of March 3rd Dr. Meltzer and Dr. H. A. Haubold have advanced the statement that this method is applicable to man. In order to be within the zone of safety the dose of magnesium sulphate first used was only one-third of that which proved efficient and harmless in on

retention of urine occurred in most of the cases. Dr. Meltzer and Dr. Haubold think that as magnesium is a normal constituent of the body it would be better to use it for the production of spinal analgesia than foreign substances such as cocaine. The length of time involved in preparing for trivial operations and the severity of the effects produced seem hardly to recommend the method.

STATUS OF THE HAMPSTEAD GENERAL HOSPITAL. IN another column we give an account of the proceedings at a meeting of the Hampstead division of the British Medical Association which was held on April 6th. Among other matters the management of the Hampstead General Hospital was discussed. This hospital, as was mentioned in a letter from Mr. F. R. Humphreys which appeared in our columns on March 24th, was originally started as a home hospital where local practitioners could themselves continue animals-i.e., 0’02 gramme per kilogramme of body-weight. the treatment commenced by themselves in the patients’ Not expecting to produce complete anaesthesia arrange- own homes under more satisfactory conditions than were ments were made to induce general anaesthesia if neces- possible in the latter. It has now developed into a general sary. In the first case-perineorrhaphy-at 3.15 P.M lumbar hospital with an out-patient department and a staff of puncture was performed and about five cubic centimetres general practitioners, with a few pay beds for the patients of cerebro-spinal fluid were permitted to escape. The same of practitioners not on the staff. But, and this is apparently quantity of a sterile 25 per cent. solution of magnesium the main cause of the trouble, King Edward’s Hospital Fund sulphate was injected. An hour later there was marked I is about to grant a large sum for building purposes and the but insufficient analgesia of the perineum. Chloroform I authorities of the Fund say that they "consider that the was administered and the operation was begun at 4.20 P.M. time has come when the Hampstead General Hospital should and completed at 5 P.M. Only about ten cubic centimetres of secure the services of an honorary medical staff of chloroform were used, which were sufficient to induce com- consulting surgeons and physicians in accordance with plete anæsthesia. At7 P. Ai. there were complete unconscious- the general practice of other hospitals of like imness and no reaction to pain in the lower part of the body. portance." As will be seen by our report of the proceedIn the second case-curettage-the same quantity of ings at the above-mentioned meeting, very many o THE