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THE REGISTRATION OF PLUMBERS.
398 to the final letter from the hospital Sir William Treloar, although expressing his sincere congratulations on what has been accomplished by it in the cause of the cripples, did not see his way to a fuller acknowledgement of its claims to priority, in the enterprise which he has so deeply at heart. The excellence of his own cause can surely in no way suffer diminution because Liverpool and not London has first demonstrated its value practically.
they are engaged. The distinction is important, because the prognosis of a sterile effusion is remarkably good. M. Widal and M. Gougerot referred to two cases of pneumonia recently observed by them in which a sterile pleural effusion with intact polynuclear cells developed. Purulent fluid was withdrawn by puncture. Its appearance was the more disquieting as the pneumonia had been severe and occurred in the course of influenza. But the presence of intact polynuclear cells allowed sterile pleurisy to be diagnosed and it regressed spontaneously. In one case defervescence occurred THE LONDON MILK-SUPPLY. on the day after puncture and the signs of effusion disTHE tuberculous milk clauses which are included in theappeared two days later. In the second case 60 cubic centiGeneral Powers Bill of the present year of the Londonmetres of greenish-yellow, very fibrinous pus were withdrawn County Council have now been accepted by Committees ofon the fifth day of an attack of pneumonia. Defervescence both Houses of Parliament and there is every prospect that occurred on the eighth day and the effusion was rapidly they will become law during the present session. The clauses absorbed. Nothing is more striking than to compare the are practically the same as those which are known as the evolution of such an effusion with a pneumococcic empyema. "model clauses." In some small details they have been This was done in the case of two patients in the same ward. altered to meet the views of the County Councils’ Association Both had at the end of an attack of pneumonia a small and are in their application to the circumstances of London turbid effusion. Nothing in the course of the disease or in somewhat modified to meet the exceptional position which the macroscopic appearance of the effusion allowed the two the City of London enjoys. The County Council is to admin- cases to be distinguished, but cytological examination ister these new powers but in respect of the City the City immediately differentiated them. The presence of intact Corporation is to have concurrent powers and be authorised polynuclear cells in one case allowed the rapid disappearance The of the effusion to be foretold. The presence of worn-out polyas to the way in which they should be exercised. City Corporation is sure not to be backward in its desire to nuclear cells revealed the pneumococcic nature of the other, see diminished the risk of tuberculosis among its population. which was confirmed by culture. Defervescence did not The London County Council will be empowered to take occur at the usual time, the fever persisted, the effusion samples of milk, to examine them for the tubercle bacillus, recurred and yielded only to thoracotomy. The contrast to visit farms from which tuberculous milk is received, to between the issues of septic and sterile effusions may examine the cows therein, and to prohibit the supply be noted in the same patient. For exmple, a man had within London of milk derived from cows found to be a subphrenic abscess after appendicitis and right pleural suffering from tuberculous disease of the udder. While effusion developed secondarily by contiguity. The subthe London population will welcome this additional phrenic abscess was purulent and foetid and contained insafeguard to their health the London County Council numerable quantities of various microbes, aerobic and may well be congratulated on the result of its con- anaerobic. The polynuclear cells were damaged. The pleural tinuous efforts to obtain powers of control over the efEusion was small but puriform and turbid, and characterised supply of milk which the recent report of the Royal by intact polynuclear cells. Microscopic examination, culCommission on Tuberculosis believes to be a large tures, and inoculations gave negative results. Thus two very The report of the Royal different collections of fluid were separated by the diacause of disease and mortality. Commission has amply justified the Council in its action, phragm. Their evolution also was very different. The and there is no reason to doubt that in providing a pleural effusion was rapidly absorbed. The subphrenic collecsufficient administration for dealing with this important tion increased and, in spite of operation, proved fatal. A matter the Council will be fully supported by the puriform sterile effusion with intact polynuclear cells ratepayers. Further powers than those which are included may also develop in the course of pleurisy due to a in the General Powers Bill are undoubtedly needed, but pulmonary infarct in heart disease. For example, a man, these will have to be obtained through a Bill introduced by aged 44 years, was admitted into hospital on Jan. 5th, 1907, the Government, which, we are sure, will not be deterred by for heamoptysis. There had been " a stitch " in the side for the Council’s Bill of the present year from proceeding with a three days. The temperature ranged from 99 - 61 to 100’7° F. comprehensive measure for dealing with a matter of so much There was a mitral regurgitant murmur. On the 6th the importance to human health. In the meantime the applica- patient had slight rigors, resembling some which had tion of the " model clauses " to London will play a useful occurred when the pain in the side appeared. There were part. signs of a small left pleural effusion. The urine contained ------
PNEUMONIA AND STERILE EMPYEMAS IN CARDIAC DISEASE WITH INTACT POLYNUCLEAR CELLS. M. F. Widal and M. A. Philibert have shown that puriform, meningeal and pleural effusions may be due to accumulation of intact polynuclear cells and are sterile.l Such puriform pleural effusions, though rarer than septic effusions, deserve to be better known. At a meeting of the Académie de Medecine on July 9th M. Widal and M. Gougerot showed that they may occur during pneumonia or in case of cardiac disease with pulmonary apoplexy and be mistaken for pneumococcic pleurisy. The presence of intact polynuclear cells allows the diagnosis of sterile from septic In septic effusions the leucocytes effusions to be made. are damaged in consequence of the phagocytosis in which 1
THE LANCET,
May 25th, 1907,
p. 1446.
casts and six grammes of albumin per litre. Puncture of the pleura yielded a turbid, whitish, puriform, and fibrinous fluid,
which contained numerous intact polynuclear cells, endothelial cells, and red corpuscles. Sterile pleurisy, consecutive to a superficial pulmonary infarct and of purely mechanical origin, was diagnosed. Rapid improvement occurred. THE
REGISTRATION
OF
PLUMBERS.
THE organisation existing for the registration of competent members of the trade originated, and has been sustained, through the public spirit of the Worshipful Company of Plumbers, which has spent many thousands of pounds on the registration system. It is now, however, about to be taken over by the plumbing trade. A meeting recently convened at the Guildhall to deal with this matter was attended not only by representatives of the trade from all parts of the United Kingdom but also by representatives
399 and tuberculous peritonitis causing perforation both into the stomach and externally. In 1858 Murchison carefully searched the records of three centuries and was able to find reports of only 25 cases of gastro-cutaneous fistula, of which 12 were due to gastric ulcer, six to trauma, one to necrosis of ribs, and six to gastric cancer. Since that time 18 more cases due to gastric cancer have been reported, making 24 in all. In 16 food passed through the fistula and in eight the opening was too small to permit this. In two of the latter, however, gas escaped from the stomach. The fistula occurred spontaneously in 16 cases and was produced by incision of a bulging abscess in the other eight. These fistulas may be produced in two ways. An abscess may form, usually between the stomach, liver, and the Plumbers’ Company, is to be created, which will elect an colon on the one side, and the abdominal wall on the other. executive committee, having* full control of registration, Usually the abscess is produced by gastric perforation, but finance, and all matters relating to the new organisation. sometimes a large abscess develops and perforates into the We have previously on several occasions alluded to the stomach secondarily. Sooner or later, if the patient survives expediency of legislation to enforce the registration of and if the abscess does not discharge into the colon or plumbers and are pleased to see that the movement in its pleura, it produces external bulging, usually in the epifavour has received such material strengthening by the gastrium, and either ruptures spontaneously or is incised. Less frequently there appears to be no abscess cooperation of the trade as a whole. formation at all; the gastric tumour becomes adherent to the abdominal wall, grows through it and appears externally, GASTRIC CANCER PRODUCING GASTROusually at the navel, as a fungous mass. The central portion CUTANEOUS FISTULA. becomes necrotic, and the necrotic process extends both to IN the New York Medical Jozcrnccl of July 13th Dr. A. E. the gastric and the parietal ends of the mass and a fistula Taussig has reported a case of a very rare condition-gastro- lined by cancerous tissue results. A complete gastric fistula cutaneous fistula. A man, aged 53 years, came under obsermay discharge only pus in consequence of the narrowness of vation on Nov 14th, 1906. In the summer of 1905 he began the lumen or on account of its tortuous course. The dimento suffer from a dull ache in the epigastrium, especially after sions of the external orifice vary, sometimes hardly admitting eating. About Christmas a tumour could be palpated in the a probe, sometimes being over an inch in diameter. Death epigastrium, and in the following June exploratory laparo- usually soon follows, the interval varying from 24 hours (in tomy was performed by a local practitioner. Nothing further the case reported above) to 13 months (in a case recorded was done and the wound healed by first intention. He Murchison). rapidly grew weaker and about the end of July a growth appeared in the region of the umbilicus. When Dr. MYIASIS IN ALGERIA. Taussig saw him he was greatly emaciated, very cachectic, AN interesting study in parasitism is afforded by the and white haired, and looked like a man 80 years of age. His temperature varied irregularly from normal to 1010 F. observations of Dr. Edmond Sergent and Dr. Etienne He took only liquid food, but in sufficient quantity Sergent on "Thim’ni," a form of myiasis occurring in and with relish. In the epigastrium was a laparotomy scar Algeria, in a paper published in the Annales de l’Institut extending along the middle line to the umbilicus, where it - P
professional and official bodies interested. It was agreed that the Plumbers’ Company is still to retain a large share in the management of the new body. The work of the plumber is so intimately associated with questions of public health that the public will be gainers by thus raising the new organisation above any exclusively trade interest and this its continued association with the Plumbers’ Company insures. Apparently the recent preference shown in the employment of registered men by many of the water companies, municipal authorities, and others, has led the trade, as a whole, to see that certified efficiency is not without its advantages. The enlarged representation will doubtless stimulate registration and may lead to some statutory recognition. A general council, composed of masters, men, and representatives of
from
externally
by
-
they are engaged. The distinction is important, because the prognosis of a sterile effusion is remarkably good. M. Widal and M. Gougerot referred to two cases of pneumonia recently observed by them in which a sterile pleural effusion with intact polynuclear cells developed. Purulent fluid was withdrawn by puncture. Its appearance was the more disquieting as the pneumonia had been severe and occurred in the course of influenza. But the presence of intact polynuclear cells allowed sterile pleurisy to be diagnosed and it regressed spontaneously. In one case defervescence occurred THE LONDON MILK-SUPPLY. on the day after puncture and the signs of effusion disTHE tuberculous milk clauses which are included in theappeared two days later. In the second case 60 cubic centiGeneral Powers Bill of the present year of the Londonmetres of greenish-yellow, very fibrinous pus were withdrawn County Council have now been accepted by Committees ofon the fifth day of an attack of pneumonia. Defervescence both Houses of Parliament and there is every prospect that occurred on the eighth day and the effusion was rapidly they will become law during the present session. The clauses absorbed. Nothing is more striking than to compare the are practically the same as those which are known as the evolution of such an effusion with a pneumococcic empyema. "model clauses." In some small details they have been This was done in the case of two patients in the same ward. altered to meet the views of the County Councils’ Association Both had at the end of an attack of pneumonia a small and are in their application to the circumstances of London turbid effusion. Nothing in the course of the disease or in somewhat modified to meet the exceptional position which the macroscopic appearance of the effusion allowed the two the City of London enjoys. The County Council is to admin- cases to be distinguished, but cytological examination ister these new powers but in respect of the City the City immediately differentiated them. The presence of intact Corporation is to have concurrent powers and be authorised polynuclear cells in one case allowed the rapid disappearance The of the effusion to be foretold. The presence of worn-out polyas to the way in which they should be exercised. City Corporation is sure not to be backward in its desire to nuclear cells revealed the pneumococcic nature of the other, see diminished the risk of tuberculosis among its population. which was confirmed by culture. Defervescence did not The London County Council will be empowered to take occur at the usual time, the fever persisted, the effusion samples of milk, to examine them for the tubercle bacillus, recurred and yielded only to thoracotomy. The contrast to visit farms from which tuberculous milk is received, to between the issues of septic and sterile effusions may examine the cows therein, and to prohibit the supply be noted in the same patient. For exmple, a man had within London of milk derived from cows found to be a subphrenic abscess after appendicitis and right pleural suffering from tuberculous disease of the udder. While effusion developed secondarily by contiguity. The subthe London population will welcome this additional phrenic abscess was purulent and foetid and contained insafeguard to their health the London County Council numerable quantities of various microbes, aerobic and may well be congratulated on the result of its con- anaerobic. The polynuclear cells were damaged. The pleural tinuous efforts to obtain powers of control over the efEusion was small but puriform and turbid, and characterised supply of milk which the recent report of the Royal by intact polynuclear cells. Microscopic examination, culCommission on Tuberculosis believes to be a large tures, and inoculations gave negative results. Thus two very The report of the Royal different collections of fluid were separated by the diacause of disease and mortality. Commission has amply justified the Council in its action, phragm. Their evolution also was very different. The and there is no reason to doubt that in providing a pleural effusion was rapidly absorbed. The subphrenic collecsufficient administration for dealing with this important tion increased and, in spite of operation, proved fatal. A matter the Council will be fully supported by the puriform sterile effusion with intact polynuclear cells ratepayers. Further powers than those which are included may also develop in the course of pleurisy due to a in the General Powers Bill are undoubtedly needed, but pulmonary infarct in heart disease. For example, a man, these will have to be obtained through a Bill introduced by aged 44 years, was admitted into hospital on Jan. 5th, 1907, the Government, which, we are sure, will not be deterred by for heamoptysis. There had been " a stitch " in the side for the Council’s Bill of the present year from proceeding with a three days. The temperature ranged from 99 - 61 to 100’7° F. comprehensive measure for dealing with a matter of so much There was a mitral regurgitant murmur. On the 6th the importance to human health. In the meantime the applica- patient had slight rigors, resembling some which had tion of the " model clauses " to London will play a useful occurred when the pain in the side appeared. There were part. signs of a small left pleural effusion. The urine contained ------
PNEUMONIA AND STERILE EMPYEMAS IN CARDIAC DISEASE WITH INTACT POLYNUCLEAR CELLS. M. F. Widal and M. A. Philibert have shown that puriform, meningeal and pleural effusions may be due to accumulation of intact polynuclear cells and are sterile.l Such puriform pleural effusions, though rarer than septic effusions, deserve to be better known. At a meeting of the Académie de Medecine on July 9th M. Widal and M. Gougerot showed that they may occur during pneumonia or in case of cardiac disease with pulmonary apoplexy and be mistaken for pneumococcic pleurisy. The presence of intact polynuclear cells allows the diagnosis of sterile from septic In septic effusions the leucocytes effusions to be made. are damaged in consequence of the phagocytosis in which 1
THE LANCET,
May 25th, 1907,
p. 1446.
casts and six grammes of albumin per litre. Puncture of the pleura yielded a turbid, whitish, puriform, and fibrinous fluid,
which contained numerous intact polynuclear cells, endothelial cells, and red corpuscles. Sterile pleurisy, consecutive to a superficial pulmonary infarct and of purely mechanical origin, was diagnosed. Rapid improvement occurred. THE
REGISTRATION
OF
PLUMBERS.
THE organisation existing for the registration of competent members of the trade originated, and has been sustained, through the public spirit of the Worshipful Company of Plumbers, which has spent many thousands of pounds on the registration system. It is now, however, about to be taken over by the plumbing trade. A meeting recently convened at the Guildhall to deal with this matter was attended not only by representatives of the trade from all parts of the United Kingdom but also by representatives
399 and tuberculous peritonitis causing perforation both into the stomach and externally. In 1858 Murchison carefully searched the records of three centuries and was able to find reports of only 25 cases of gastro-cutaneous fistula, of which 12 were due to gastric ulcer, six to trauma, one to necrosis of ribs, and six to gastric cancer. Since that time 18 more cases due to gastric cancer have been reported, making 24 in all. In 16 food passed through the fistula and in eight the opening was too small to permit this. In two of the latter, however, gas escaped from the stomach. The fistula occurred spontaneously in 16 cases and was produced by incision of a bulging abscess in the other eight. These fistulas may be produced in two ways. An abscess may form, usually between the stomach, liver, and the Plumbers’ Company, is to be created, which will elect an colon on the one side, and the abdominal wall on the other. executive committee, having* full control of registration, Usually the abscess is produced by gastric perforation, but finance, and all matters relating to the new organisation. sometimes a large abscess develops and perforates into the We have previously on several occasions alluded to the stomach secondarily. Sooner or later, if the patient survives expediency of legislation to enforce the registration of and if the abscess does not discharge into the colon or plumbers and are pleased to see that the movement in its pleura, it produces external bulging, usually in the epifavour has received such material strengthening by the gastrium, and either ruptures spontaneously or is incised. Less frequently there appears to be no abscess cooperation of the trade as a whole. formation at all; the gastric tumour becomes adherent to the abdominal wall, grows through it and appears externally, GASTRIC CANCER PRODUCING GASTROusually at the navel, as a fungous mass. The central portion CUTANEOUS FISTULA. becomes necrotic, and the necrotic process extends both to IN the New York Medical Jozcrnccl of July 13th Dr. A. E. the gastric and the parietal ends of the mass and a fistula Taussig has reported a case of a very rare condition-gastro- lined by cancerous tissue results. A complete gastric fistula cutaneous fistula. A man, aged 53 years, came under obsermay discharge only pus in consequence of the narrowness of vation on Nov 14th, 1906. In the summer of 1905 he began the lumen or on account of its tortuous course. The dimento suffer from a dull ache in the epigastrium, especially after sions of the external orifice vary, sometimes hardly admitting eating. About Christmas a tumour could be palpated in the a probe, sometimes being over an inch in diameter. Death epigastrium, and in the following June exploratory laparo- usually soon follows, the interval varying from 24 hours (in tomy was performed by a local practitioner. Nothing further the case reported above) to 13 months (in a case recorded was done and the wound healed by first intention. He Murchison). rapidly grew weaker and about the end of July a growth appeared in the region of the umbilicus. When Dr. MYIASIS IN ALGERIA. Taussig saw him he was greatly emaciated, very cachectic, AN interesting study in parasitism is afforded by the and white haired, and looked like a man 80 years of age. His temperature varied irregularly from normal to 1010 F. observations of Dr. Edmond Sergent and Dr. Etienne He took only liquid food, but in sufficient quantity Sergent on "Thim’ni," a form of myiasis occurring in and with relish. In the epigastrium was a laparotomy scar Algeria, in a paper published in the Annales de l’Institut extending along the middle line to the umbilicus, where it - P
professional and official bodies interested. It was agreed that the Plumbers’ Company is still to retain a large share in the management of the new body. The work of the plumber is so intimately associated with questions of public health that the public will be gainers by thus raising the new organisation above any exclusively trade interest and this its continued association with the Plumbers’ Company insures. Apparently the recent preference shown in the employment of registered men by many of the water companies, municipal authorities, and others, has led the trade, as a whole, to see that certified efficiency is not without its advantages. The enlarged representation will doubtless stimulate registration and may lead to some statutory recognition. A general council, composed of masters, men, and representatives of
from
externally
by
-