THE PYELONEPHRITIS OF PREGNANCY.

614 visits to disinfecting stations, dairy premises, municipal depots, artisans’ dwellings, offensive trades, waterworks, common lodging-houses, sanitary works in progress, and refuse and sewage disposal works. Part II., beginning on Nov. 20th, will comprise lectures on Meat and Food Inspection, including the taking of Samples of Water, Food, and Drugs for Analysis. Practical demonstrations of meat inspection will also be given. Candidates residing within the County of London who attend, or wish to attend, these lectures may enter the competitions for the evening science exhibitions awarded by the Technical Education Board of the London County Council of the annual value of £5, which may, with the approval of the Board, be applied to paying their expenses in attending these lectures. Application forms and particulars of these exhibitions must be obtained of the secretary of the Board, Victoria Embankment, W.C. The fee for Part 1. is £ 2 12s. 6d.;for Part II., £1 ls. ;; or for the complete course, £ 3 3s. Persons desirous of attending the lectures are requested to send in their names to the secretary of the institute at the Parkes Museum. The eighth course of practical training for candidates preparing for the examination for inspectors of meat and other foods, conducted by the Royal Sanitary Institute, will commence on Sept. 29th, at 6.30 P.M. It will consist of systematic practical training in the inspection of meat at a cattle market and will continue for two months. The fee for the two months’ course of practical training will be The institute will also hold a special course of E33s. practical training in food and meat inspection for commissioned officers and professional men preparing for the examination for inspectors of meat and other foods, conducted by the Royal Sanitary Institute. The course will commence on Nov. 22nd and will consist of practical training in the inspection of foods and meat, including demonstration on live cattle and sheep, slaughtering and dressing of animals, names and situations of the organs, diseases of animals, methods of stalling, arrangement of markets and byres, &c., at a cattle market. A demonstration will also be arranged at a knackers’ yard, where instruction regarding the flesh and organs of the horse will be given. The lectures connected with the course will be delivered at the Parkes Museum at 5 or 5.30 P.M. Six will be on meat inspection ; two will be on tinned and potted food, milk, butter, and cheese ; and four will be on a considerable variety of food substances, such as fish, eggs,

to compression of the ureters between the uterus and the pelvis. The urinary tract above the point of compression dilates, as has been shown by

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necropsies. In fatal cases of puerperal eclampsia German writers have frequently found dilatation of the renal pelves and of the abdominal portion of the ureters. At the same time pregnancy causes increased activity of the kidneys and interferes with the return of blood from them, producing passive congestion. All these causes predispose to infection of the urinary tract. Only the microbe is wanting. It may come from without or within. In the former case an ascending infection of the urinary tract is produced usually by the gonococtus or the streptococcus. The symptoms of pyelonephritis are then preceded by those of urethritis or cystitis. But more usually the microbe is brought to the kidneys by the circulation and a descending infection of the urinary tract occurs. The microbe in this Case is generally the colon bacillus, the virulence of which is increased by the constipation which is common of Indeed, the bacillus may produce a general pregnancy. infection with marked symptoms. After a period of septicaemia it may become localised in the kidney and its pelvis-a point of least resistance. Finally, a patient who has suffered from previous disease of the kidneys is predisposed to the pyelonephritis of pregnancy. The pyelonephritis of pregnancy has a predilection for the right kidney. This can be explained by the comparative weakness of this kidney, for it is more frequently displaced than the left and is more often attacked by tuberculosis. Moreover, the greater development of the uterus on the right side during pregnancy and the twisting on its axis bring it into more intimate contact with the right ureter and favour compression of the latter. The left kidney is affected less frequently, later, and less severely than the right. Pyelonephritis generally begins in the later months of pregnancy but one case has been recorded as early as two and a half months after concepCases tion and another three and a half months after. have been observed in which pyelonephritis began after The labour, especially when this has been difficult. onset of the pyelonephritis of pregnancy is insidious and may be unnoticed both by the patient and the practitioner. Indeed, the disease may run its course without attracting attention. In some cases the onset is marked by pains in the lumbar region which radiate into the lower abdomen. If the urine is then examined albumin will be tea, coffee, wheat, rice, potatoes, flour, bread, vegetables and fruits, jams, condiments, prepared, concentrated, and found. In other cases the onset is more striking. The is seized with a rigor which is accompanied by preserved foods, and alcoholic beverages. In addition to patient and lassitude. There are furred tongue, intense headache lectures the the special students may attend lectures in connexion with the course for sanitary officers given in the anorexia, obstinate constipation, and often nausea and Parkes Museum at 7 P.M. from Nov. 20th to 30th. The fee vomiting. The temperature rises from 102° to 104° F. and the will be E44s. for the complete course, or for the demonstra- pulse from 100 to 120. The urine is scanty, dark coloured, and tions on meet inspection only, C22s. Those desirous of slightly albuminous. Probably a general infection such as fever or the gastro-intestinal form of influenza is attending the course are requested to send in their names at typhoid diagnosed. This error is excusable as the general ard the once to the secretary of the institute. gastro-intestinal symptoms predominate and little points to the urinary system, for the lumbar pain is usually not severe. THE PYELONEPHRITIS OF PREGNANCY. There may be frequent or even painful micturition but this THE pyelonephritis of pregnancy has been generally symptom is much less severe than in cystitis. However, recognised only within the last decade. For its discovery after three or four days the symptoms of a general and description we are indebted almost entirely to French infection diminish, while on the contrary the local ones writers and its literature is still almost entirely foreign. As become more definite. Examination then almost always long ago as 1841 Rayer stated in his " Trait6sur les shows pain, both spontaneous and provoked by pressure On Maladies des Reins " that pyelonephritis sometimes occurred in the region of one kidney, usually the right. during pregnancy in women whose kidneys had previously vaginal examination a cord may be felt in the been affected. To Reblaud belongs the honour of, in 1892, lateral fornix-the inflamed ureter. The urine at this "isolating"the pyelonephritis of pregnancy and giving a stage is scanty, high coloured, slightly clouded, and alludescription of it which has become classical. In the Archives minous. Microscopic examination reveals numerous bacteria Générales de Medecine of July llth Dr. Gaussel Ziegelmann and some epithelial cells and casts ; there may be a few pus has published an exhaustive paper on the subject in which corpuscles. Cultures usually show the colon bacillus. If he reports four cases. The pyelonephritis of pregnancy is other microbes such as the streptococcus or staphylococcus numerous

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holy well, the waters of which are held to curative virtues. This well is now dry but people have still been there this August. They arrive each Saturday night during August and seat themselves on the trailing branch of a tree at the edge of the graveyard proper. The branch is bare of bark and has been polished by the many sitters. Seated on the branch the patients take off their bhoes and stockings and watch barefooted during the night. At dawn presumably they make the circuit of the holy well seven times. Cures are said to be frequent, but it must be borne in mind that belief in the wondelful and mysterious is still firmly rooted in the heart of the A banshee, for instance, held to Connemara peasant. be the spirit of some evil-living individual, was heard "roaring every night, begorr," near Welphi lake not 12 years ago. Many heard it. It should be added that a coffin when brought into Salruck "Old Pipe Yard" is carried round it thrice before burial.

found the infection is an ascending one. In the next stage the general condition improves and the urine becomes abundant, amounting in the 24 hours to from 1500 grammes to three litres. Its appearance is characteristic : it is uniformly cloudy when passed but on standing becomes clear and deposits a greenish sediment composed of pus and epithelium. Its reaction is acid, which differentiates it from the urine of cystitis. The amount of albumin present is small. The pyelonephritis usually runs a chronic course and recovery does not take place until after labour. Sometimes complications such as cystitis, pyonephrosis, or perirenal abscess occur. Abortion, or more commonly premature labour, may result. The prognosis of the pyelonephrit’s of pregnancy is usually good but if the disease is bilateral it is more serious. The prophylaxis consists in supervising the functions of the pregnant woman and in giving digestive when necessary. As to treatment, an absolutely aperients milk diet should be prescribed. Rest in bed during the acute stage and the absence of all fatigue afterwards are necessary. Drugs are of less importance. Aperients and intestinal antiseptics given at the onset will remove the cause of the infection ; afterwards the functions of the digestive tract must be supervised. Urinary antiseptics-salol or in doses of one to two grammes-are also urotropine daily mineral such as those of Evian, Alet, Weak waters, given. or Contrexéville, are useful in promoting lavage of the kidneys. In more severe cases surgical treatment may be necessary. Distension of the bladder by the method of Pasteau, though its action is difficult to explain, has given good results in some cases. In serious cases, when the life of the patient is threatened, abortion has been induced, but it does not always cause improvement. On the other hand, when the fœtus has reached the period of viability the production of premature labour gives good results. This procedure is especially indicated when there are signs of toxæmia. If there is pyonephrosis nephrotomy or nephrectomy may be

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"SUMMER ILLS."

CERTAIN maladies are associated with certain seasons of the year. The summer months are, as a rule, more free from serious affections than are the other months of the year, but certain minor diseases are likely then to occur-namely, diarrhoea and tonsillitis, which although mild, as a rule, Diarrhoea is may occasionally give cause for anxiety. in some in most cases due to error the food, probably the of developed by rapid decomposition ptomaines being flesh foods. The eating of unripe fruit is also a cause of diarrhoea with which the public is very familiar, but the occurrence of this is not so frequent as is believed. The " sore-throat" is not so apparent. Some authorities cause of consider that it is due to the presence in the air of microorganisms carried by dust and very possibly derived from The roads paved with wood come dried horse dung. particularly under suspicion. A bacteriological examination of the dust from wood pavements would certainly necessary. prove of interest. If such dust be proved to be infective the manner in which the streets are watered in some ANIMISM AND A MEDICINAL WELL. in London should be taken objection to. Only UNTIL lately an animistic observance has still been districts the sides of the roads receive the attention of the waterprevalent in the Connemara highlands. In the extremely the centre being left dry. We presume the object rude and primitive graveyard of Salruck or Salrock, on the cartc, of this arrangement is to prevent the centre of the roads shore of the Small Killary, it has been the custom from from becoming slippery and so rendering them difficult time immemorial to leave sustenance for the dead upon the to horse traffic. The central dust is allowed to remain tops of the graves. This sustenance at some unknown all without any attempt being made to " lay" period must have consisted of food and drink but later. it. day When there is any wind or any motor traffic the for many years it took the form of tobacco. Later still the dust is scattered in all directions and must be inhaled by , tobacco gave place to pipes alone, it being very properly passers by. Acute lacunar tonsillitis is an infectious disease held by the peasants that a spirit can smoke an empty pipe is which associated with various micro-organisms and some as well as a full one. Until this summer the curious, of these have their origin in, and be disseminated by, the may who visited Salruck were shown little deposits of clay dust from wooden pavements. The fact that the wood lias pipes upon the unhewn slates covering the graves. As numbers of coffins-local tradition says 60 or 70- been treated by some antiseptic previously to laying it would have at various times been crushed down in each gravee have but little, if any, effect upon the dust deposited upon the number of pipes in each deposit was considerable, it. We are of opinion that in dry weather the roads should treated daily with water containing some disinfectant. and were massed in or -

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quantities together pails rustybe cooking-pots, which may still be seen standing upon the tombs. The pipes, however, have been recently ordered THE STERILISATION OF DRINKING-WATER FOR TROOPS IN THE FIELD. away by the priests and are now collected in a box outside AN interesting demonstration of the various methods the sacred precinct, where the faithful still place them after smoking ritualistically on the top of a newly covered in coffin. employed for the sterilisation of drinking-water was given The custom dies hard and on the top of a grave of a woman on August 15th at the Army Service Corps Barracks, said to have died in childbed we found a solitary pipe-bowl. Millbank, and amongst those present was Mr. Arnold-Forster, This was outside the rude circular inclosure where the the Secretary of State for War. The methods of purification majority of the graves are crowded. The priests’ order was illustrated were divided into three sections: (1) those in evidently not in force here. Salruck has long been famous which the water is sterilised by heat; (2) those in which for its healing well, dedicated to St. Roch, who formed the purification is effected by filtration ; and (3) those in Salruck ravine by dint of dragging himself free of the chains which the addition of chemical agents is relied upon to Of the six apparatus illustrating with which the Devil had loaded him while asleep. Victims sterilise the water. of various diseases, including eczema, are in the habit of the sterilisation of water by heat the principle of the