THE MEDICAL SERVICE OF THE NILE RESERVOIR WORKS.

1444 c The multiplicity of theories reveals our real ignorance of up in the brachial plexus. In -the second case the patient, this condition and we are therefore not in a position to takke a girl, aged 19 years, was seen on April 27th, 1904. Five any measures to avoid its occurrence. Treatment is hardlly years before glands were removed from the left side of the possible when the heamorrhage occurs in a newly-born child1 ;neck without untoward result. Eight months before glands however, the internal administration of one of the preparaa- were removed from the left side of the neck. On recovering tions of suprarenal extract might be tried or the hypoo- from the anae3thetic she found that the left shoulder was dermic injection of a 2 per cent. solution of gelatine. Thie very weak and that she could not raise the left arm at injection of 15 centimetres of such a solution, which hactd all. There was also considerable pain in the neck been boiled for six hours and allowed to cool to abouut which prevented her from turning her head. After 1000 F., was followed by recovery in five consecutive casees two weeks she tried to resume her occupation of stenoin the hands of one observer. grapher but had to desist as the left hand was useless. Examination showed considerable atrophy of the left shoulder girdle. The scapula was everted and rotated THE MILK-SUPPLY OF THE CARDIFF forward. Electrical examination revealed quantitative INFIRMARY. THE secretary of the Cardiff Infirmary has forwarded us a diminution to faradism in the left trapezius. The other is muscles appeared to react normally. The patient was not copy of the tender for milk required from contractors by his seen again until Feb. 17th, 1907, when the left side of the committee, the clauses of which are of such praiseworthy ly neck had lo3t its fulness and there were marked supra- and rseverity as to guarantee a pure milk-supply to the infirinfra-clavicular depressions. The cervical border of the left t mary. They deal with the cows, and the storage, transport, was markedly thinned. The supra- and infratrapezius and quality of the milk. The cows are to be examined and were slightly atrophied and the rhomboids muscles spinatus certified healthy by a veterinary surgeon selected by the in1more so, approximation of the scapula to the spine being 5S firmary and are to be milked in a clean and dustless seriously hampered. The affected muscles showed only ;e place after their udders and the hands of the milkers have loss to faradism. She had resumed her occupaquantitative been washed with soap and water. The milk is to be e tion but the left arm and shoulder soon became tired. In .d strained and cooled to at least 500 F. immediately and the third case a boy, aged 13 years, was seen on Oct. 24th, .n delivered at a temperature of not more than 520 in 1906. Five years previously glands were removed from " churns" belonging to the infirmary which are always to 0 the right side of the neck. After the operation his be kept locked except for filling, emptying, and cleaning. ,. mother thought that he was growing round-shouldered. The milk is to be delivered without delay, is not to contain Examination showed marked shoulder-drop on the right side, n any"preservative " or colouring matter, and must conform and infra-clavicular depressions, thinning of the suprato the chemical standard of the Sjle of Food and Drugs Act. L >’ cervical border of the trapezius, considerable wasting of the The farm is to be open to inspection at any time by the represome atrophy of the supra- and infra-spinatus, and sentative of the infirmary and must be within 15 miles off pectorals, eversion and forward rotation of the scapula. The right arm that institution. Before the tender is accepted the sanitary 9 be raised fairly to a right angle but beyond that with d could adviser of the infirmary is to certify that the conditions laid All other movements of the arm and hand were difficulty. down can be met by the contractor’s arrangements and any 9 Movements of the head and neck were limited on the weak. breach of these conditions will at once terminate the con-y side. The right scapula could not be approximated to 12 right tract, We are informed that " the form is in force with the The affected muscles showed varying degrees of spine. -satisfactory results," and this excellent example might bee loss to faradism. Four months’ treatment by quantitative with advantage widely followed. and massage electricity produced little benefit.

ld

n

r

EXTENSIVE

NERVE INJURY FROM REMOVAL OF CERVICAL GLANDS.

IN the Boston Medical and Surgical Journal of May 2nd Dr. J. W. Courtney has called attention to a serious accidentt in removal of cervical glands-extensive nerve injury. Inn searching for glandular debris behind the sterno-mastoid thee spinal accessory or cervical or brachial plexus may easily bee injured with disastrous results Three cases are reported byy Dr. Courtney. In the first case the patient was a man,, aged 52 years, who was seen on Nov. 30th, 1906. Ona Sept. 1st some enlarged glands were removed from the rightt side of the neck in a hospital. On recovery from the operation he noticed that the right side of his neck drooped. After three weeks he resumed his occupation as a barman,, suffering from pain in the right shoulder and side of the3 neck and weakness of the arm. - On examination the3 shoulder drooped markedly and the muscles above andI below the clavicle were atrophied. Along the inner borderr of the right sterno-mastoid was a scar three inches long,, The right sterno-mastoidI the result of the operation. muscle seemed to have disappeared. The right armi could not be raised from the body above an angle ofE 40°, but the deltoid did not seem particularly atrophied. The right pectoral muscle was markedly wasted. The leftb grip was 100 ; the right only 75 (the patient was righthanded). Electrical changes in the affected muscles were} only quantitative and were in proportion to the degree ofE atrophy. Evidently the spinal accessory and cervical plexus3 were seriously injured and a secondary neuritis had been setti -

.

.

-

THE

I

MEDICAL SERVICE OF THE RESERVOIR WORKS.

NILE

Dr. J. Ferguson Lees, the senior medical officer of the great reservoir works which Messrs. John Aird and Co. are carrying out at Isna, has forwarded the report to his company dealing with the medical arrangements of the Isna Barrage. The provisions for employees suffering from accident or disease appear to be in every way worthy of the splendid engineering scheme with which they are connected ; in January last, from which month this report is dated, the daily average of men employed on the works was 7843, of which number 8 were Europeans and 77fí5 were natives. A completely equipped hospital has been erected capable of accommodating 1& Europeans and 16 natives, the blocks for these being separate. The European wards are of three classes, capable of accommodating from one to four patients respectively, and there are two native wards for eight patients in each ; an out-patient department with a branch building on the opposite bank of the river is included in the scheme. In various parts of the works tents have been erected as dressing stations, with first-aid appliances, and so complete is the equipment that during the summer months certain of these will be provided with baths and ice-boxes for the immediate treatment of cases of sunstroke. The description of the hospital buildings shows them to be well suited to the local conditions; a complete operating theatre has been provided, for which there is an evident need, as appears in the analysis of the cases treated. Dr. Lees reports that the fellaheen come in for

1445

readily

fo1 ollowed an attack of appendicitis but the nature of treatment when suffering from accident far more he connexion cannot be stated. Two cases were assothan they do for sickness, as in the latter case they still have th ci! ,iated with typhoid fever. In one a patient who had more confidence in the skill of the native barber than in the The subordinate staff of rei ecovered from typhoid fever was seized with fatal methods of European medicine. the hospital consists of a native head ward orderly, with pa pancreatitis. In the other case repeated inflammatory disurbances of the pancreas followed recovery from an attack five trained native orderlies who do the nursing, two cleaners, tu )f typhoid fever and typhoid bacilli were demonstrated in of a cook, a gardener, and a laundry woman, the whole being ,he bile. Pancreatitis is a rare but well-recognised metaunder the charge of an English head attendant and’store- th keeper; when special nursing is required English nurses stitasis of mumps-one to be expected when the similarity )f the pancreas to the salivary glands is remembered. Of 652 The report states that the of are obtained from Cairo. ;ases of mumps treated at the hospital of Val-de-Grce bulk of the cases is formed by "injuries, ophthalmia, ca Si imonin has reported that pancreatitis occurred in ten. One and with catarrhal affections of diarrhoea., dysentery, }ase each of pancreatitis has been attributed to boils, malaria, the respiratory system in the winter, and febrile cz conditions due to the heat in the summer months." The g! gastric ulcer, duodenal perforation, syphilis, and tuberpreventive work has been excellently organised; the best CBculosis. Two cases have been attributed to embolism of which one was fatal. Three cases have been ascribed to water- and food-supplies obtainable have been installed, the w trauma. The immediate cause of acute pancreatitis appears meat is inspected before and after slaughtering, and there is tr to ba infection of the duct of Wirsung. The bacillus coli a laboratory for the analysis of other articles of diet. There tc and other pyogenic organisms have been found in the is a plentiful supply of Berkefeld filters in the hospital. A a system of moveable latrines and sewage trenches is under ppancreas. Mr. A. W. Mayo Robson thinks that in the cases o retro-injection of bile the inflammation is due to organisms the control of a sanitary inspector and as a result of these of carried in that fluid. In cases of injury to the pancreas a careful precautions the medical officer is able to state that c: condition favourable to bacterial invasion is obviously pro"the general health of the camp during the period covered by c d Infection may also occur through the blood stream. the report has been good." In the event of an outbreak of duced. infectious disease it is proposed to erect mud shelters for F COLLEGE OF SURGEONS OF ENGLAND: treating cases, which can be destroyed when no longer ROYAL nøøø I THE ORIGINAL NOTES OF JOHN HUNTER’S LECTURES. THE recent presentation by Dr. Thomas James Walker of Peter borough to the Royal College of Surgeons of England ON May 18th a meeting of representatives of certain county of the original notes of John Hunter’s lectures, taken by councils and urban sanitary authorities was held at New- the tb latter’s pupil Mr. Hopkinson, is an interesting addition castle under the presidency of Alderman H. W. Newton, to to the College library. In a letter sent to the College with chairman of the sanitary committee of the Newcastle cor- the tt volume Dr. Walker explains how the book came into his He says : " A hundred years ago Mr. Hopkinson poration. The meeting considered the report of Dr. H. E. possession. p( w Armstrong, medical officer of health to the corporation, on was carrying on the practice which, with Dr. Kirkwood and the problem of tuberculosis, and in the course of a valuable m my son, I now conduct. Mr. Hopkinson was succeeded by address on the urgency of meeting it efficiently the chairman M Mr. Whitsed, who in 1819 sold the practice to my father, Thomas Walker. After introducing my father, Mr. Whitsed brought forward a motion which embodied these proposals :- T w That in the opinion of this meeting it is desirable that a permanent went to Edinburgh, took his M.D. degree, and for a time union of the sanitary authorities of England and Wales be established settled in London; afterwards he moved to Wisbech, SE as a supreme national health authority, with the object of safewhere he practised as a physician and died in the guarding and promoting the public health interests of the people at w large against tuberculosis and other dangers to the public health. e; earlysixties.’ After his death the book remained in This motion was unanimously adopted by the meeting tJ the hands of his daughter for several years and by which then constituted itself a committee for the further- her h it was given to me." At the commencement of the ance of this object with power to add to its numbers, and volume v is an original letter from Mr. Clift, the conservator the chairman announced that the cooperation of all the of the College, dated Sept. 16th, 1835, to Mr. Whitsed con0 sanitary authorities in the country would be invited in theccerning the volume, and a cutting from the Englishman interests of the scheme. We consider that this movement is10newspaper, dated Nov. 9th, 1836. These additions add on the right lines and we welcome its inception; it seems are to be retained in and to the interest of the gift g greatly desirable that an organisation of sanitary authorities maythe t volume at the request of Dr. Walker. The cutting from be formed with a view to winning statutory recognitionthe t Englishman is a statement concerning John Hunter’s and of paving the way to the foundation of such a truly and manuscripts and a reputed conversation-" on I papers national health service as can alone face such giganticthe t road to Kew "-between Sir Everard Home and Mr. Clift problems as those presented by tuberculosis. As announced in THE LANCET r the THE

COÖPERATION

OF LOCAL SANITARY AUTHORITIES.

regarding

THE THE

ETIOLOGY OF ACUTE

etiology

of acute

pancreatitis

PANCREATITIS. is still

a

moot

subject.

Dr. A. Egdahl has contributed to the Johns Hoplains Bulletin for April an important paper consisting of an analysis of the

manuscripts.

last week, the presentation was made to the College by Dr. Walker in commemoration of the completion of the fiftieth of his Membership of the College. -y year EPIDEMIC CEREBRO-SPINAL FEVER.

IN the districts where epidemic cerebro-spinal fever is reported cases in which the cause of the disease is stated or ’suggested. These amount to 105. The preponderating cause Iprevalent the number of cases have shown no great change c the last seven or eight days. In Scotland during the assigned is gall-stones which are supposed to act by during causing obstruction to the flow of bile and its retro-week ended May 18th there were 23 deaths from this cause injection into the pancreatic duct. Gall-stones were the iregistered in Glasgow, 7 in Leith, 5 in Edinburgh, 2 in assigned cause in 44 cases. The next most common Dundee, and 2 in Paisley. In Glasgow the weekly report i issued on May 17th showed that there were at that time cause was gastro-intestinal obstruction which was reIt is announced that in corded in 32 cases. It is noteworthy that in 17 of these 125 cases under treatment. the month of due to or alcohol with Edinburgh during April 43 cases were notified cases there was gastro-duodenitis 36 deaths occurred. In Belfast i and two cases the during the week ended In of alcoholism. a history pancreatitis