UNTRAINED MIDWIVES.

777 that a patient might die on the first day of the illness. When the febrile stage had subsided it might be followed by paralysis of the arms and legs. In some of the patients the paralysis seemed to be permanent and in others it had partially or entirely disappeared; but there were cases, and not a few, where the whole of the beginning of the course of the disease exactly resembled the above named cases yet without the occurrence of any paralysis whatever, During the febrile stage the temperature is usually between 38.5° and 39. 5° C. and the patient, as a rule, exhibits extreme tenderness in the muscles of the back, neck, and shoulders, as well as stiffness and rigidity of the neck. The sensibility is often so great that the patient screams at the least movement of the muscles controlling the parts just named. It does not seem that any state of coma occurs during the last stage of the disease and when the case ends in death full consciousness is usually maintained to the last. Various methods of treatment have been followed but with little apparent benefit. Isolation of the patient is essential for the purpose of checking the spread of the disease. The remarks attributed to Dr. Levin give no information as to any points of resemblance or difference between the disease in question and the epidemic of cerebro-spinal fever which has existed in Central Europe since the latter part of 1904.

THE BAWDEN FUND.

heours journey from Komarom. The water has been exported to this country under the name of ’’ Bitter Purgative Water (ILord Roberts label)." The wells are situated on clay soil. TI’he mud raised from the bottom of one of the wells proved too be considerably radio-active. Further inspection of the m nud showed the presence of crystals which proved to be clhiefly calcium sulphate. On testing the cleavage surfaces oif these crystals for radio-activity such strong impressions w vere obtained and the entire plate was so fogged by the ei emanations that it was considered worth while to make The qiquantitative measurement of the radiating energy. eiifEects are sufficiently marked to show on a reproductition of the photograph. Measurements were subsequently o)btained leaving no doubt of the remarkable radio-activity o )f the calcium sulphate crystals. Crystals of the s: ;ame substance obtained from other sources gave n negative results. Next the bitter water itself was e xamined. The salts obtained by evaporation, after being tbhoroughly dried, were placed upon very thin black paper in a pperfectly dark room upon highly sensitised plates. The pplates were placed in a double light-proof box which conttained also a porcelain cup filled with anhydrous chloride of calcium to keep the salts dry. After three weeks the plates c v were developed and in the case of the salts obtained from T Igmandi Bitter Water showed strong radio-active effects. There were spots which were not uniform but of various

dimensions, some larger, some smaller, some lighter, some Mr. Edgar Speyer, the well-known banker, has been made darker, apparently in accordance with the shape of the dry the almoner of a munificent philanthropist-namely, Mr. d: crystals and the nature of the contact. It is evident from E. G. Bawden of the Stock Exchange. In a letter com- CJ tl research that the Igmandi Bitter Water is decidedly municated to the press Mr. Speyer says that Mr. Bawden has this the activity being characterised chiefly by radio-active, intrusted him with the sum of about £100,C00 "to be emanations. The radio-activity of the water is doubtless applied to purposes of charity and benevolence and for the ei from the d derived salts in solution, amongst which is calcium advancement of knowledge, especially in aid of human Even in bottle the radio-activity is preserved for sulphate. suffering." With the concurrence of the donor Mr. Speyer s’ It will be interesting to learn how far a considerable time. has decided to apportion the money to various institutions in a r’ influences the therapeutic action of the the form of capital to be vested in trustees, to be known in radio-activity salts. p According to recent researches the influence each case as the " Bawden Fund." The sum of £16,000 is purgative of 0 radio-activity in this connexion would appear to be allotted to complete the sum of .6200,000 to bring about the favourable. incorporation of University College in the University of London; E10,000 are allotted for East-end emigration; UNTRAINED MIDWIVES. £31,500 are divided between King Edward’s Hospital Fund AN important inquest was held recently at Kingston on and ten of the metropolitan hospitals ; while much of the tthe death after childbirth of a woman who had been attended remainder of the money is allotted to sundry convalescent k a midwife. A charge oE neglect being brought against homes, holiday funds, and various institutions for homeless by tthe midwife she said that she had been in practice as a and crippled children. Mr. Speyer’s selection is, we think, a rmidwife for 45 years, gave her age as 65 or 66, and further very good one. He has placed a large part of Mr. Bawden’s stated that she was certificated. The baby was born at grand gift in places where it will relieve the maximum of 9o’clock at night and, according to the midwife’s own adhuman suffering. All honour to Mr. Bawden for his noble t there was considerable neglect of the mother. On mission, gift; may it be the precursor of others from those who are 1 being questioned by the coroner as to whether she knew how blessed with this world’s goods. to take the temperature she replied that &he did, she did not know the normal temperature of the body and had no RADIO-ACTIVITY IN MINERAL PURGATIVE thermometer. She was further asked if she understood how THERE appears to be little doubt that radio-activity playsto t stop bleeding and replied No, but that she would send an important r6le in the therapeutics of mineral waters andfor f a medical man. The jury came to the conclusion that this may possibly account for the more favourable action oftthere had been neglect on the part of the midwife and natural mineral waters compared with that of waters artificiallywere of opinion that a woman of her age should not be compounded. In many instances it is difficult to explainallowed to practise midwifery, for they believed she was the therapeutic value of a water merely upon its mineralmuch older than she stated herself to be. They further constituents. Many waters are of distinct value, although ]recommended that the case should be reported to the analysis shows that very little mineral matter enters into Central Midwives Board. When the new Midwives Act was their composition. The waters at Bath, Buxton, Con-introduced it was a matter of great difficulty to know what 9 1 do with the large number of women who were practising trexeville, and Wildbad, may be quoted as examples. These to waters are distinguished, however, by being radio-active andall over the country as midwives and who had never obtained in the gases evolved in certain of them helium, which may bea certificate in midwifery from any recognised institution. It regarded as a product of radium, has been found. In a paperwould have been a great hardship to these women if their read before the Royal Hungarian Society for Natural Sciencemeans of livelihood had been taken away and it was deby M. Bela SzilArd some interesting results are recorded con-termined, therefore, that those of them who had been cerning the radio-activity of a mineral water known as :in bond-fide practice as midwives for 12 months previous to Igmandi Bitter Water. The springs from which this water is ,July 31st, 1902, should be permitted, on application being taken are situated in the commune of Igmand, some twomade to the Central Midwives Board, to have their names ____

‘

WATERS.

,

778

registered on the roll of midwives. In these conditions naturally a number of untrained and ignorant women are practising in various parts of the country as certificated midwives. As time goes on the number of these women will gradually diminish and their places will be taken by properly trained women who have passed the examinations of the Central Midwives Board. It is difficult to see how any other solution of the problem could have been arrived at without a grave injustice being done to certain competent midwives and without depriving the public of a form of necessary assistance. The Board has, of course, the power necessary to take off the roll the name of anyone who is found to be unfitted or who is convicted of negligence, and no doubt will do so in the case of the midwife in this instance if it finds the views of the coroner and his jury just.

stomach. Mr. MayoRobson will deal with the subjects’ of simple ulcer, haemorrhage, adhesions of the stomach to adjoining organs or to the abdominal parietes, perforation, hour-glass contraction, tetany of gastric origin,

dilatation,

gastroptosis,

acute

phlegmonous

gastritis,

stenosis of the pylorus, injury of the stomach, hyperchlorhydria, and persistent gastralgia. Dr. Rotgans will confine himself entirely to gastric ulcer and its complications. He recommends operative treatment when the movements of the stomach are interfered with by conditions such as excessive peristalsis, vomiting, hypertrophy of the wall of the stomach, and retention of its contents. In such cases the cause is usually mechanical-namely, stricture of some part of the stomach or the existence of adhesions. The cause may also consist in troubles dynamo-moteurs, conditions in which the above-mentioned mechanical defects do not exist and gastroptosis is the only anatomical coraTHE BATHS AT HARROGATE. plication. He would also operate in cases of severe pain, AN important addition to the bathing facilities attumours, hæmorrhage, perforation, and emaciation. Dr. Harrogate has recently been completed by the installationMattoli will discuss the surgical treatment of gastroptosis, of the necessary appliances for the carrying out of the pyloric stenosis, circular perforating ulcer, and several other treatment which has hitherto been almost entirely asso- gastric abnormalities. The official languages of the Congress Inare English, French, German, and Italian. During the ciated with the French spa, Plombieres-les-Bains. THE LANCET of April 30th, 1904, p: 1186, we published proceedings a general meeting will be held to appoint the International Committee, to fix the next place of meeting, a paper by Dr. de Langenhagen on the Treatment of and to elect a president. We understand that the Belgian Muco-membranous Colitis in which the methods adopted Rectal irriga-committee will send invitations to fetes in honour of foreign at Plombieres are set forth in detail. tions when properly carried out are without doubt verymembers of the society on hearing from them. Intimations valuable in the condition described by Dr. de Langen-should be sent direct without delay to the general secretary, and also in other diseases of the intestinal Dr. Depage, 75, Avenue Louise, Brussels.

hagen

as catarrhal enteritis and intestinal lithiasis. The treatment has also been recommended for appenTHE SURGEON’S RESPONSIBILITY FOR THE dicitis and in cases of doubtful diagnosis a " hydroDETAILS OF AN OPERATION. mineral cure" may often be tried with advantage. Dr. de A MODERN surgical operation in many instances demands Langenhagen is of opinion that the "intestinal bathing"on the part of the surgeon not only a high degree of should be considered as a real internal dressing"of the manipulative dexterity but also in a considerable measure mucous membrane, and he therefore claims that rectalthe power of organisation. The details of the preparation irrigation is suitable not only in cases of colitis with of the patient, of the dressings, instruments, ligatures, and constipation but also in those cases in which there are so on, take up a good deal of time and require special knowalternations of constipation and of diarrhoea or in cases of ledge, and it may be impossible for the really busy surgeon chronic diarrhoea. Many patients who cannot from financial to attend personally to all these matters. It is true that of or private circumstances proceed to a continental spa can recent years with the gradual replacement of antisepsis by and will go to one in England. This latest addition, then, asepsis these details have been a good deal simplified, but to the baths of Harrogate is likely to prove a most useful the danger to the patient where asepsis is practised is all one and the corporation of Harrogate may be congratulated the greater if by chance any of the procedure is not carried on the enterprise which has just been completed. out with scrupulous accuracy. Whether the surgeon looks after these things himself or is compelled from the pressure CONGRESS OF THE INTERNATIONAL of work to intrust them to others there can be no question OF SURGERY. but that he must be held responsible in the case of any AT the first Congress of the International Society ofaccident occurring. If he has any doubt as to the capability his nurses then it is his duty to see that their work is < Surgery, which will be held in Brussels from Sept. 18th to of 23rd, one of the subjects for discussion will be the Surgical properly supervised and checked. If he does not give clear ] Treatment of Non-Cancerous Affections of the Stomach. Theand definite instructions—and whenever it is possible these discussion will be opened by Dr. A. Monprofit, professorsshould be written-then he is alone to blame if his orders are of clinical surgery in the Medical School of Angers in not executed in their entirety. In hospital practice it is France ; Mr. A. W. Mayo Robson, Vice-President of the (obvious that much must be left to resident officers and Royal College of Surgeons of England ; Dr. J. Rotgans of nurses, but even here it is the duty of the surgeon to inquire Amsterdam ; and Dr. A. Mattoli of Rome. From abstractsfrom time to time into the manner in which these duties of the forthcoming addresses, published by the secretary ofare performed. There is always a tendency on the part of the Congress, it appears that Dr. Monprofit will include in 1the most conscientious man or woman, although inspired his remarks the operations of puncture of the stomach ,with the best intentions, to become a little careless in the through the abdominal wall, paragastric exploratory performance of duties which are of the nature of a routine 1 be carried on quite without superv i,ion. It would seem laparotomy, extragastric and intragastric dilatation of to the pylorus, pyloroplasty, exploratory gastrotomy, gastror- hardly necessary to call attention to such an obvious truth, 1 from time time instances occur in which a surgeon, rhaphy, curetting and cauterisation of gastric ulcers, gastro- but J human fallibility, has trusted too much to others stomy, partial gastrectomy in various situations, gastro- forgetting plasty, gastropexy, gastro-anastomosis, anagastrostomosis,and has neglected to overlook properly their subordinate total gastrectomy, and gastro-enterostomy. This last is work, with disastrous results to the patient. A great the operation which he considers to be the most ]responsibility rests upon every surgeon with regard to all, applicable in the majority of these diseases of theeven the minutest, details of an operative procedure, no

tract, such

SOCIETY

to