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THE WINTER EXHIBITION OF THE ROYAL ACADEMY.
45 that they shall not be supplied with milk. Perhaps the Lambeth council will now make it incumbent upon all purveyors of milk to declare openly that the milk sold by them contains preservatives, should it do so, together with the nature of the preIf preservatives are servative and the amount thereof. harmful, and there is doubtless a difference of opinion on the matter, the public should by all means know the fact. If preservatives are not harmful, and in the opinion of milk vendors they are not, and the public like them, then there can be no harm in the public knowing that they are used. We think that the Lambeth borough council is to be congratulated on its new departure, although it has taken a long time to carry out its decision. The scheme will, of course, mean an additional charge on the rates, for hardly any municipal undertaking in London is ever profitable or even self-supporting, but if the appalling infantile mortality of 151 per 1000 can be brought down Lambeth may congratulate itself. We see that the depot is not to be open on Sundays but there is no intimation as to whether a double supply will be given out on the Saturday or whether infants will have to do without municipal milk from Saturday to Monday.
quite feasible to insure adulterated or impure
TYPHOID EPIDURAL ABSCESS. IT is now well recognised that the typhoid bacillus may remain in the system after recovery from typhoid fever and give rise to abscess in various parts, particularly in the bones. At the meeting of the Soci6,6Medicale des Hôpitaux of Paris on Nov. 17th M. F. Raymond and M. J. A. Sicard reported a case in which suppuration took place in a situation in which it does not appear to have been observed previously-the epidural space of the lumbar region. A man, aged 48 years, contracted typhoid fever in January, 1905. During convalescence, at the beginning of March, he felt severe pains in the right hypochondrium, right iliac fossa, and right leg. The iliac fossa was puffy. Progressively the leg became paralysed and the symptoms, sensory and motor, appeared on the opposite side. In May, two and a half months after the onset of the paralysis, there were almost complete paraplegia and paroxysms of pain of intense severity. The legs atrophied and the reaction of degeneration was obtained in the quadriceps and adductors of the right thigh. In the area supplied by the crural nerve byper2stbesia was found at some times and hypo-sesthesia at others. The sphincters were little affected. The knee-jerks and tendo Achillis reflexes were absent. There was no clonus and Babinski’s sign was not present. No particularly painful spot could be found in the lumbo-sacral region. The temperature ranged irregularly between 98’ 6° and 101’ 30 F. As the onset of the symptoms had been marked by swelling and puffiness in the neighbourhood of McBurney’s point extension of disease to the cord by the medium of the lumbar plexus from an infectious appendicular focus (the meta-typhoid appendicitis of Dieulafoy) was suspected. M. Raymond and M. Guillain have published a case of ascending neuritis of the lumbar plexus after appendicitis. Although all the symptoms seemed to point to ascending neuritis and consecutive myelitis it was decided to obtain further information by lumbar puncture. To the great surprise of M. Raymond and M. Sicard, as soon as the needle penetrated the ligament between the third and fourth lumbar vertebras and entered the epidural space drops of pus began to flow. The typhoid bacillus was found in the pus. On the following day laminectomy of the third and fourth lumbar vertebras was performed and half a spoonful of pus mixed with blood escaped from the epidural space. The laminas removed were found to be quite sound. During the operation some fluid with a Pravaz syringe. It was removed cerebro-spinal was clear and devoid of cells. The wound was drained,
good recovery ensued, and the symptoms gradually dis-appeared. At the time of the report all that remained was slight rigidity of the spine. Thus the typhoid bacillus became located in the fatty and cellular tissue which fills. the epidural space and there produced suppuration. THE WINTER
EXHIBITION OF THE ROYAL
ACADEMY. AUAURIV[ Y. THE winter exhibition of the Royal Academy which was opened to the public on Jan. lst is a notable exemplification of the saying, Time brings its revenges. A large number of the pictures exhibited are by masters who during their lifetime were, from the Academy point of view, outside the pale. Burne-Jones, Alfred Hunt, Rossetti, and Simeon Solomon occupy a large space upon the walls and their works form a by no means inconsiderable portion of a collection of extraordinary interest. From our own purely professional point of view the chief picture in the exhibition is the fine portrait This picture, which is of Dr. John Ash by Reynolds. lent by the Birmingham General Hospital which owes its foundation to Ash, was painted in 1788 and represents Ash in his doctor’s gown, wearing a black velvet suit and a wig. He is seated in a chair holding a plan of the hospital, the buildings of which appear in the background. Ash was born in 1723 and educated at Trinity College, Oxford, whence he graduated as M.D. in 1754. He settled in Birmingham and soon acquired a large practice. When at the height of his fame he became melancholic and had to be separated from his family. According to Munk,1 he recovered his mental balance by means of the study of Euclid. Anyway, he did recover and resumed practice with great success in London in 1787. In the same year he was. admitted a Fellow of the Royal College of Physicians in whch, body he held many offices. He died in 1798. Of the other works in the exhibition there are fine examples by Turner,. Hogarth, R. Wilson, de Wint, Romney, Linnell, Van Dyck,, Frans Hals, and many others. Altogether it is a very note-worthy exhibition and is small enough to be seen with.
comfort. ____
IN LONDON ELEMENTARY SCHOOLS. THE report of "The Medical Officer (Education)"for the. year ending March 31st, 1905, was submitted by the education committee to the London County Council on Dec. 13th,, 1905, and now lies before us. The report has a much wider bearing than would appear from the date which it bears, for it. contains the substance of Dr. J. Kerr’s two preceding reports. made to the late London School Board. Previously to the London School Board there had been no such reports, so that from a medical point of view only statistics deal-. ing with the last three years are available, which is much. too short a period of time whereon to found any dogmas as. regards school hygiene and the like. The report now before. us deals very fully with the physical conditions of child lifein London, especially as regards mental activity and educa-. tional fitness or unfitness. In 1903 a scheme was put forward for an inquiry into the relations between (1), ’, educational status ; (2) the physical condition ; and (3) the. social condition of about 50,000 London school children. Cost, however, stood in the way and even a more modest. scheme, " which would not cost more than &300, has been felt to be inopportune and at present is in abeyance." Dr. Kerr considers that an inquiry ought to be carried out, for, as he says, " the vitality statistics of those who are about. to enter on active service in the affairs of life, and whose energy is the chief of the national assets, is surely worth the cost of collection." We quite agree with him but the money should be found by the State and not by the ratepayers..
MEDICAL
MATTERS
I
1
Roll of the
Royal College
of
Physicians
of
London, vol. ii., p. 378.
quite feasible to insure adulterated or impure
TYPHOID EPIDURAL ABSCESS. IT is now well recognised that the typhoid bacillus may remain in the system after recovery from typhoid fever and give rise to abscess in various parts, particularly in the bones. At the meeting of the Soci6,6Medicale des Hôpitaux of Paris on Nov. 17th M. F. Raymond and M. J. A. Sicard reported a case in which suppuration took place in a situation in which it does not appear to have been observed previously-the epidural space of the lumbar region. A man, aged 48 years, contracted typhoid fever in January, 1905. During convalescence, at the beginning of March, he felt severe pains in the right hypochondrium, right iliac fossa, and right leg. The iliac fossa was puffy. Progressively the leg became paralysed and the symptoms, sensory and motor, appeared on the opposite side. In May, two and a half months after the onset of the paralysis, there were almost complete paraplegia and paroxysms of pain of intense severity. The legs atrophied and the reaction of degeneration was obtained in the quadriceps and adductors of the right thigh. In the area supplied by the crural nerve byper2stbesia was found at some times and hypo-sesthesia at others. The sphincters were little affected. The knee-jerks and tendo Achillis reflexes were absent. There was no clonus and Babinski’s sign was not present. No particularly painful spot could be found in the lumbo-sacral region. The temperature ranged irregularly between 98’ 6° and 101’ 30 F. As the onset of the symptoms had been marked by swelling and puffiness in the neighbourhood of McBurney’s point extension of disease to the cord by the medium of the lumbar plexus from an infectious appendicular focus (the meta-typhoid appendicitis of Dieulafoy) was suspected. M. Raymond and M. Guillain have published a case of ascending neuritis of the lumbar plexus after appendicitis. Although all the symptoms seemed to point to ascending neuritis and consecutive myelitis it was decided to obtain further information by lumbar puncture. To the great surprise of M. Raymond and M. Sicard, as soon as the needle penetrated the ligament between the third and fourth lumbar vertebras and entered the epidural space drops of pus began to flow. The typhoid bacillus was found in the pus. On the following day laminectomy of the third and fourth lumbar vertebras was performed and half a spoonful of pus mixed with blood escaped from the epidural space. The laminas removed were found to be quite sound. During the operation some fluid with a Pravaz syringe. It was removed cerebro-spinal was clear and devoid of cells. The wound was drained,
good recovery ensued, and the symptoms gradually dis-appeared. At the time of the report all that remained was slight rigidity of the spine. Thus the typhoid bacillus became located in the fatty and cellular tissue which fills. the epidural space and there produced suppuration. THE WINTER
EXHIBITION OF THE ROYAL
ACADEMY. AUAURIV[ Y. THE winter exhibition of the Royal Academy which was opened to the public on Jan. lst is a notable exemplification of the saying, Time brings its revenges. A large number of the pictures exhibited are by masters who during their lifetime were, from the Academy point of view, outside the pale. Burne-Jones, Alfred Hunt, Rossetti, and Simeon Solomon occupy a large space upon the walls and their works form a by no means inconsiderable portion of a collection of extraordinary interest. From our own purely professional point of view the chief picture in the exhibition is the fine portrait This picture, which is of Dr. John Ash by Reynolds. lent by the Birmingham General Hospital which owes its foundation to Ash, was painted in 1788 and represents Ash in his doctor’s gown, wearing a black velvet suit and a wig. He is seated in a chair holding a plan of the hospital, the buildings of which appear in the background. Ash was born in 1723 and educated at Trinity College, Oxford, whence he graduated as M.D. in 1754. He settled in Birmingham and soon acquired a large practice. When at the height of his fame he became melancholic and had to be separated from his family. According to Munk,1 he recovered his mental balance by means of the study of Euclid. Anyway, he did recover and resumed practice with great success in London in 1787. In the same year he was. admitted a Fellow of the Royal College of Physicians in whch, body he held many offices. He died in 1798. Of the other works in the exhibition there are fine examples by Turner,. Hogarth, R. Wilson, de Wint, Romney, Linnell, Van Dyck,, Frans Hals, and many others. Altogether it is a very note-worthy exhibition and is small enough to be seen with.
comfort. ____
IN LONDON ELEMENTARY SCHOOLS. THE report of "The Medical Officer (Education)"for the. year ending March 31st, 1905, was submitted by the education committee to the London County Council on Dec. 13th,, 1905, and now lies before us. The report has a much wider bearing than would appear from the date which it bears, for it. contains the substance of Dr. J. Kerr’s two preceding reports. made to the late London School Board. Previously to the London School Board there had been no such reports, so that from a medical point of view only statistics deal-. ing with the last three years are available, which is much. too short a period of time whereon to found any dogmas as. regards school hygiene and the like. The report now before. us deals very fully with the physical conditions of child lifein London, especially as regards mental activity and educa-. tional fitness or unfitness. In 1903 a scheme was put forward for an inquiry into the relations between (1), ’, educational status ; (2) the physical condition ; and (3) the. social condition of about 50,000 London school children. Cost, however, stood in the way and even a more modest. scheme, " which would not cost more than &300, has been felt to be inopportune and at present is in abeyance." Dr. Kerr considers that an inquiry ought to be carried out, for, as he says, " the vitality statistics of those who are about. to enter on active service in the affairs of life, and whose energy is the chief of the national assets, is surely worth the cost of collection." We quite agree with him but the money should be found by the State and not by the ratepayers..
MEDICAL
MATTERS
I
1
Roll of the
Royal College
of
Physicians
of
London, vol. ii., p. 378.