THE MYSTERY OF MARGATE AIR.

1285 the efficacy of the medicine may be judged from the following of the lung and thus bring about a favourable soil for the extract from the writings of Murphy, the editor of Johnson’s tubercle bacillus. He believed that narrowing might be works: "The medicines prescribed were so efficacious relieved by resection of a piece of the first rib. He also that in a few days Johnson, while he was offering up his referred to the emphysematous state of the lung which prayers, was suddenly obliged to rise, and in the course of the followed rigid dilatation of the thorax, in which, for purposes day discharged 20 pints of water." It should be added that of relief, pieces of the second to the fifth costal cartilages in Johnson’s day the pint was equal to only 12 ounces. In might be removed. Subsequent speakers confirmed the 1785 Withering introduced digitalis to the notice of the benefits from the above operations. Dr. von den Velden profession, and squill gradually lost the first place as a reported ten cases of operation for rigid dilatation of the diuretic in cardiac affections. Pereira (1850) came near the thorax ; the post-mortem examinations of patients who had truth when he wrote : considered with reference to its succumbed to intercurrent diseases showed that the gap diuretic effect, squill is comparable to digitalis. But it became closed by a bridge of connective tissue which remained exceeds the latter in its stimulant influence over the urinary elastic. Dr. Hirschfeld (Frankfort) reported a remarkable case organs." It was not until 1879, when Merck isolated the in which he had resected the cartilages in a girl suffering glucosides contained in squill, that our knowledge of its from attacks of bronchial asthma, and when this operation pharmacology was placed on a scientific basis. Even yet the had proved insufficient he had performed resection of the action of the drug on the heart is too often forgotten in manubrium sterni, which had been followed by complete recovery. The discussion was a valuable one as indicating writing prescriptions into which it enters. the experience of surgeons who had performed the various IMPURITIES (P) IN TEA. operations and that good permanent results had been obtained. With further trials the true value of the proA CORRESPONDENT writes to us on the subject of teacedures will be placed on a firmer footing, but the operation drinking. The abuse of tea, he says, is well known to give seem to hold out hopeful chances in cases which are most rise to unpleasant symptoms and to produce sundry difficult or perhaps impossible to relieve by other measures. complaints. He suggests that much of the tea sold is impure, and grounds his suggestion upon the following THE MYSTERY OF MARGATE AIR. observations. Some time ago he had occasion for a large THE study of the therapeutics of climate is a difficult one, quantity of infusion of tea, and for this purpose he used a number of samples of well-known brands from various and we can only speak in broad terms as to why a given vendors. In every instance, after a period of from one to place is suitable for various cases. Why, for instance, is three hours, the infusion became turbid with a sediment at one place bracing and another relaxing ?7 There is no exact the bottom of the vessel. " In plain English," he continues, Scientific answer, but the evidence of experience readily I this means that the tea we drink is adulterated or dyed with establishes one or the other qualification, as the case may be. The layman knows perfectly well the difference between a some substance." We fear that our correspondent is drawing a conclusion from insufficient premisses. Infusions of all teas district a stay in which soon gives him a feeling of wellwill become turbid on standing and cooling at various being, an energetic temperament, a sense of restored health and intervals of time. Indian teas become more turbid, and vigour, and one in which his indisposition to rouse himself that after a shorter interval, than do teas from China. The becomes worse, where he soon feels tired and where his mental and bodily fatigue finds no relief. For different cases, of course, cause of the turbidity is the tannin forming a precipitate with the alkaloid, or if very hard water be used with lime in both places may have their advantages. The explanation of In former days Prussian blue was used for the difference as to whether a place is tonic or stimulating addition. colouring green tea, but the practice, we believe, has almost (bracing) or soothing and sedative (relaxing) rests probably entirely ceased, and, in our opinion, tea nowadays is one of more upon physical than upon chemical facts. The late Sir the least adulterated or °6 faked"foodstuffs on the market. James Paget once wrote of Margate : " No one can tell what it Moreover, it is subject to careful examination at the port of is in the air of Margate, but practical experience has proved entry by Custom House experts. Even an infusion of very that none better can be found." Enthusiasts say that, as high-class China teas will show a turbidity after standing appears to be the case on the veldt, the aerial environment Margate is aseptic, so that wounds readily heal and surgical two or three days, but this is not due to any impurity or dye any more than is the heavy precipitate which will cases rapidly mend ; it is certain that some pathological conditions, especially in children, are most remarkably improved come down within an hour or so in an infusion of Indian tea. Our correspondent is anxious to hear the experiences by sojourn in Margate. It is interesting, therefore, to inquire of medical men as to the results of their observations on what it is that confers upon the air of Margate these the subject, but we shall be surprised to learn that there is valuable properties. The chemistry of the air can show but any evidence to support the idea of the widespread adultera- trifling differences from the sea air of other places, its tion of tea being possible. bacteriology is most probably negative as regards septic organisms, while, of course, its physics will be profoundly OPERATION FOR RIGID DILATATION OF THE affected by the great expanse of ocean which practically surTHORAX. rounds the Isle of Thanet. The climate is dry, there is little IN another column we publish the report of an interesting vegetation in the immediate vicinity, the subsoil is chalk, and, discussion on Operation for Narrowing and Rigid Dilatation in the words of the medical officer, Mr. Bertram Thornton, "it of the Thorax which took place at the German Surgical is not improbable that the large area of foreshore, with its Congress recently held in Berlin. It was fortunate that sand and seaweed-covered rocks, may also materially add to Professor Freund was able to open it, since his views on the the salubrity of the air when the wind sets in from the sea." premature ossification of the costal cartilages are well known. So far, however, this salubrity has defied analysis, and we He has previously shown that a hyperplasis with premature still await a scientific explanation of factors which are known ossification of the cartilages brings about a state of rigid to exist, but which we cannot as yet interpret in exact terms. dilatation of the thorax. In his remarks he said that narrow- The subject has suggested itself to us by the unanimous ing of the upper aperture of the thorax was caused by a testimony given in favour of the air of Margate at the defective development of the cartilage of the first rib ; this recent annual dinner of the Margate Chamber of Commerce. might lead to a derangement of the function of the apex when the speakers included some well-known writers and

of

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1286 members of our own profession. A word of praise is due to this body for the excellent way in which it is serving the interests of the visitors. The Chamber recognises that the chief asset of Margate is its remarkably restorative air, but the importance of providing for the comfort and the recreation of those seeking this air is not overlooked.

TREATMENT OF DIABETIC GANGRENE APPLICATION OF HOT AIR.

BY THE

AT a meeting of the Académie de Medecine of Paris on Feb. 15th M. Dieulafoy described a new method of treating diabetic gangrene which was attended with excellent results. On Sept. 14th, 1909, he saw in consultation a man, aged 64 years, suffering from gangrene of the left leg, which extended as high as two finger-breadths below the knee. The leg was cold and livid and no pulsation could be felt in the popliteal or tibial arteries. The symptoms began with severe pain in the leg on the 12th. The patient had suffered from diabetes for 20 years, and in 12 months had lost 46 kilogrammes in weight. Examination of the urine showed that he was passing 82 grammes of glucose and 30 grammes of acetone in the 24 hours. The general condition was too bad for amputation to be entertained. The patient was in a state of prostration bordering on coma and the pulse was 140 and very weak. A strict anti-diabetic reginac, injections of cacodylate of sodium and, to relieve the pain and induce sleep, veronal and morphine were ordered. The gangrenous part was treated by the application twice daily of douches of hot air

The clot was a little organised and contained newly formed blood-vessels and some connective tissue. There was no trace of infection, no small-cell infiltration, In contrast to this case M. and no lymphangitis. a case of diabetic gangrene of the related Dieulafoy foot which after three months became moist and foetid. Amputation was performed in the lower third of the thigh. The femoral artery was not atheromatous and contained no clot. The anterior tibial artery was obliterated by endarteritis and a stratified organised clot. The posterior tibial artery was obliterated by organised clot and its inner coat was completely destroyed. The vessel was both filled and surrounded by small-cell infiltration and was accompanied by lymphangitis. The vascular lesions in the two cases were similar, but in the one treated wit,h hot air the gangrene remained dry and was not followed by infection, while in the other the life was jeopardised by consecutive infection. The hot-air treatment prevents this infection and eliminates the dangers of septic intoxication and septicemia. adherent clot.

LA

REVUE

MÉDICO-SOCIALE:

A STORY OF

TEMPERANCE.

UNDER the editorship of Professor 0. Laurent there is in Brussels a monthly periodical entitled La Bane lFedico-,5’ociczle. It has for its subtitle" Cliniqne et 1-Iygi6ne Sociale." Undoubtedly this title covers a field of news and of research which is of growing importance. At Budapest produced by a special apparatus capable of supplying a last autumn Professor Landouzy spoke of social medicine as current of 50 litres of air per minute at temperatures ranging the newest and most promising development of medical as high as 7000 C. This method has been introduced by science. It was no longer a question of treating a patient M. Bonamy, M. Marot, and M. Vignat, who have used it here or there, but of practising curative as well as preventive with great success in diabetic gangrene limited to one toe medicine on entire communities. Medicine, in so far as it and in perforating ulcer of the foot attended with moist affects not merely individual patients but the inhabitants of gangrene of part of the foot. In the present case air at a a district, a town, or a country, is a subject of study which temperature of 3000 C. was applied to the gangrenous has unlimited possibilities. Whether the publication before parts, the temperature being reduced to 100° C. in the us covers even approximately this ground is another matter. neighbourhood of the living tissues. The jet of air Its contents are largely technical and clinical, whereas was projected a distance of from 5 to 10 centimetres, and an organ dealing with the social measures and reforms each sitting lasted from 30 to 45 minutes. The treatment that act upon the health of the people should cerwas not After a tainly contrive to be understanded of those people. Most very painful and was well borne. week the patient was better, the leg was in a condition of of the articles in what is a sort of review of reviews are dry gangrene, and there was no odour. The amount of extracted from medical contemporaries-whose editors, we sugar in the urine had decreased to 3-28 grammes in the 24 presume, have no objection-and deal with treatment, only a The few being of more general or social interest. On the old hours and the amount of acetone to 9-7 grammes. of the air douche was increased to 4000 and problems of abstinence from flesh food and alcoholic drink a C., temperature on Oct. 17th the gangrenous tissues were reduced in volume, temperate view is taken. Dr. Gottschalk has pointed out that blackish, dry, and odourless. The hot air not only dried vegetarians involuntarily pay homage to the meat eaters by up the surface of the gangrenous part but penetrated trying to imitate meat dishes with vegetable substitutes, but deeply, so to speak "cooking"the limb. On Nov. 17th he found baeuf à la mode 1!égétarien "absolutely execrable." the treatment had to be suspended for two days as the He recognised that there are meat extractives which might apparatus got out of order, and the gangrenous part became excite the nerve cells and acting as stimulants might, if moist and gave off a foetid odour. On the 19th the douches taken regularly, create symptoms similar to alcoholism. were resumed at a temperature of 4000 to 5000 C., and the In this connexion he now says that the morbid craving for gangrene again became dry, the foetor disappeared, and a alcohol is noticeable especiallyamong those who are badly line of demarcation formed below the knee. The line of or insufficiently fed ; and this happens quite as often among demarcation deepened and the gangrenous parts separated vegetarians as among others. A form of total abstinence from the sound ones. The leg and foot retained theiri of which everyone must approve is described-viz., the form, but were much diminished in size, black, and shrivelled manifesto issued by 20,000 Swedish workmen during the up, like the limb of a mummy. The tibia was bare at its recent general strike. Out of a total population of less upper part and a large "window" formed between the than 5,000,000 more than 250,000 workmen remained tibia and fibula. The patient regained his strength, and on on strike for five weeks. The most perfect order preDec. 21st sugar and acetone had disappeared from the urine. vailed the whole time in spite of the animosities and Amputation was performed at the junction of the lower bitterness of feeling resulting from the struggle. At the third with the upper two-thirds of the thigh. The femoral most critical moment the manifesto of the 20,000 workmen artery was found atheromatous and completely blocked by was issued appealing to the working class to abstain comclot. Union of the wound took place by first intention pletely from all alcoholic drinks till the strike was con. and recovery was uneventful. In the amputated limb the cluded. Encouraged by this popular demonstration, the popliteal artery was found obliterated by arteritis and an Swedish Government ventured to advise all the local

published "