THE SOCIETY OF TROPICAL MEDICINE AND HYGIENE.

1639 must have been familiar to Dickens. It was a The pulse is rather slowed than quickened, the hospital, at any rate, whereas now offices or other abdomen remains soft, and there is no definite tenderness. The early transference of the pain lay buildings will take its place. from the abdomen to the back and the restlessness make a characteristic picture quite unlike that of THE SOCIETY OF TROPICAL MEDICINE AND any acute abdominal condition except biliary colic. HYGIENE. The nature and distribution of the pain bear a close AT a meeting of the council of the Society of resemblance to the gastric crises of locomotor Tropical Medicine and Hygiene held on Nov. 21st, an ataxy. The only means of giving substantial relief announcement was made concerning the ballot of is the administration of a full hypodermic dose of the Fellows of the society on the proposal to morphine, and to repeat it if necessary. After three amalgamate with the Royal Society of Medicine, days relief is almost complete, although slight Out of the result being 60 in favour of amalgamation and pains in the back are not uncommon. 216 against. Thus by a large majority it has been about 1300 vaccinations performed by Dr. Morton decided that the Society of Tropical Medicine and or under his control abdominal symptoms occurrred Hygiene shall remain as hitherto an independent in ten. In three cases the symptoms were severe society. This question has been most carefully and distressing. All occurred in adults who preconsidered during two successive years by the viously had been vaccinated successfully. Dr. council who are responsible for the management of Morton does not give any explanation of these pains. the affairs of the society, and on each occasion It may be suggested that they are the analogue of it was decided with practical unanimity that it was the backache of variola. contrary to the interests of the society to agree to the proposed amalgamation. On the second occaTUBERCULOSIS NOTIFICATION. sion, however, it was decided to refer the matter for decision by a referendum of the Fellows, this A CORRESPONDENT, who is chairman of the finance being decided upon at the annual meeting on committee of an important district council, has June 20th, 1913. Sir John Kirk and Sir William directed our attention to the frequency with which MacGregor were elected honorary Fellows. Fourteen notification payments have to be made from the new Fellows were elected at the ordinary meeting rates to different medical men in respect of the of the society on Nov. 21st, and 32 names were same case of tuberculosis. The local practitioner, nominated by the council for election at the next he states, often sends the to a consultant patient meeting of the society. All medical men interested who also notifies the case, while frequently also in tropical medicine are warmly welcomed as another notification may be received as a result of Fellows of the society, and the secretaries will be i the having gone independently to a hospital patient glad to give information to any who desire further for treatment. Our correspondent expresses a particulars if they will write to them at 11, Chandos- natural anxiety, not only at the apparently wasteful street, Cavendish-square, London, W. expenditure thus arising, but also as to the effect which the receipt of so many duplicate or triplicate notifications may have on statistics of the prevalence ABDOMINAL PAIN AFTER VACCINATION. of tuberculosis. It seems clear from the terms THE recent epidemic of small-pox in Sydney of the Public Health (Tuberculosis) Regulations, which has been described by our Australian corre- 1912, under which notification is made, that spondent, caused so much anxiety that people were multiple notifications are fully authorised, and vaccinated in large numbers. A sequel of vaccina- by the nature of the disease are necessary if tion which appears to have previously been the object of the regulations is to be achieved and unobserved-abdominal pain-has been described all tuberculous cases are to be brought to the knowin the Australian medicaljournals by several ledge of the medical officer of health of the district writers. Its recognition is important in order to in which the patient lives. The regulations state avoid diagnosing some acute abdominal condition. merely that the practitioner is not bound to notify In the Australian Medical Journal of Sept. 6th if he has reasonable grounds for believing that the Dr. D. Murray Morton, senior surgeon to case has already been notified. Unless the second St. Vincent’s Hospital, has published a paper on practitioner has some facts to go upon he cannot this sequel which has occurred, he says, in a escape his obligation to report.’ It is well, however, definite percentage of cases and in the practice of that the natural objection to paying for repetition many Sydney practitioners. It usually begins in of information already obtained should be borne in the third week after vaccination as a severe pain mind, and we may invite our readers to discuss the deep in the epigastrium. It may be associated possibility of adopting a line of action which would with vomiting. After some hours the pain settles help to meet this objection while conforming with in the back in the mid-dorsal region and is per- the official requirements. One or two suggestions, sistent and agonising. It is aggravated in the for example, occur to us. In modern practice there recumbent position, so that the patient prefers to is seldom advantage in concealing the fact of sit up, stand, or even walk about. Its severity is tuberculosis- from the patient, who in ordinary such that if it’s cause is not suspected biliary circumstances must know of his tuberculous concolic, acute appendicitis, or other grave abdo- dition sooner or later if notification is- sent. Iilinal condition may be diagnosed. In one case, which Dr. Morton saw in consultation, the condition of the patient seemed so alarming that a high intestinal obstruction had been suspected. Sleep is impossible partly from pain and partly from extreme restlessness. Once aware of the occurrence of this sequel the diagnosis is not difficult. The symptoms and signs do not conform with those of the ordinary abdominal conditions.

the practitioner notifying a case of tuberculosis might well make it a habit to tell the patient that he is doing so, and to whom the notification is going; and also before notifying any case he could inquire, as a matter of routine, whether tuberculosis has been already diagnose i and notified to the medical officer of health of the place where the- patient is living.

Consequently

General observance of this

practice should,

we