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UNUSUAL SYMPTOMS DUE TO GALL-STONES.
1038 wine duties are not to be raised. There is to be a State control of all licensed houses in munition areas, and for this purpose a central board has been created composed of representatives of the Admiralty, War Office, and Home Office. On the whole a wise compromise has been reached and the proposals promise to offer a satisfactory settlement. They should remove; also, all anxiety as to the spirit used for medicinal purposes being further
taxed.
deaths from typhoid fever has always been below 300 per 1,000,000 inhabitants. We have therefore good reason to hope that the prevalence of typhoid fever has been definitely reduced by about twothirds. This is no mean achievement, and the Italian authorities are to be cungratulated. UNUSUAL SYMPTOMS DUE TO GALL-STONES.
IN another column we publish an interesting note of gall-stones described by Dr. A. R. Neligan. NOTABLE REDUCTION OF TYPHOID FEVER The usual symptomatology of cholelithiasis i& IN ITALY. generally recognised, such as paroxysmal pain, IT is only of late years that Italy has begun to vomiting, collapse, jaundice, and the presence of apply large measures of sanitation to her whole gall-stones in the motions, to which may be added united population. To many of us, accustomed to the occurrence of ague-like. attacks. During an the better hygienic environment of our own country, attack of biliary colic the contents of the stomach residence in Italy has always caused anxiety, are first vomited, and bile may also be present, but especially in regard to the possibility of contracting it is only in very rare instances that a calculus is typhoid fever, and in some places this anxiety has vomited. In Dr. Neligan’s case, however, a number been justified. But recently Italy has been very of faceted gall-stones were found (about 30) in the literally setting her house in order, and the risks vomit. We have been unable to nnd a similar record. of typhoid fever have much abated. We are In addition, the patient suffered from intestinal now the more concerned for just possible nght- obstruction ;an operation was recommended but of the Italian ing strength army than for the refused, and after the administration of enemata security of the rare tourists of our own nationality she passed some flatus, liquid faeces, and a hard who may be in Italy, but on both accounts it is good mass which subsequently proved to be a gall-stone. to learn of the general improvement in public health Unfortunately it was broken up before Dr. Neligan indicated by the decline in frequency of typhoid saw it, but apparently it must have been roughly fever. The fighting strength of an army is naturally round in shape and 3 centimetres in diameter, and enhanced if it is recruited from healthy material. must have weighed about 16 grammes. Mechanical When the troops come from towns and villages obstruction of the intestines by a gall-stone is also where typhold epidemics are frequent there is a uncommon, but many cases have been reported. greater danger that the army itself will be infected. Morestinwas able to refer to as many as 242 cases. This is often left out of calculation. the health of Dr. H. D. Rollestonstates that the relative frethose with the colours being considered as quency of this cause to other causes of intestinal though it can be independent of the conditions obstruction has been variously estimated at from In Italy finan- 1 to 13 to 1 to 45. The occurrence of two unusual where the levies are raised. for cial facilities public health works, such as symptoms in the same patient-viz., the vomit of and water-supply drainage, have been greatly many gall-stones and the obstruction of the bowel accelerated by the Public Health Acts of July 13th, by one such stone-is certainly remarkable, making 1905, and June 25th, 1911. It is especially in the record of the case exceptionally interesting. respect to small and poor districts that the State guarantees the interest on the money borrowed for RADIOLOGICAL STUDIES OF THE LARGE sanitary purposes. Thus from July, 1905, to July, INTESTINE. 1911, no less than 337 districts or communes Dr. A. E. Barclay, whose work on the alimentary received State aid for their water-supply works. is well known, contributes some interesting tract During the same period 763 communes obtained observations to the symposium on intestinal stasis financial aid for other public health undernumber of the B1 itish Journal of in the current as the of isolation hostakings, such building is due less, he considers, Constipation Surgery. The result has pitals, improved drainage, &c. kinks intestinal than to an absence of to Lane’s been specially noticeable in regard to the prevahe terms what points d’appui, from which, as fixed lence of typhoid fever. Professor SantoliquidoI movements of the faeces can be mass the points, Thei is responsible for the following figures. urged forward. These points d’apptti appear to be cases of typhoid fever notified in 1888 amountedl to 59,631, and there were 23,869 deaths; but5 variable in their site-they are never seen in the in 1912 the number of cases was reduced to, coecum itself; more commonly such a point is 30,558 and deaths to 7743. This means that whereas; found in the neighbourhood of the hepatic flexure. in 1888 there were 800 deaths from typhoid fever. Under the X rays the mass is found to be pushed Failure of such out of every million inhabitants, the proportion forward from the fixed point. fixed leads to of the large points inability Of it million 221 in 1912. r was course, per only may be said that these were exceptional years, and1 intestine mechanically to propel forwards, in to a certain extent this is true, because they repre- the abrupt occasional and brief manner now sent the highest and the lowest figure. Nevertheless,, recognised as typical, the faecal mass. The cressthe reduction, while showing certain fluctuations,, pool," or loaded cecum, under this view must be has been persistent. Thus the fall was gradual1 regarded less as the cause than the effect of such from 1880 to 1894, when the proportion of deathss inenlcient propelling action. This organ, in fact, per million of the population was only 439; but itt is suggested to be little concerned in the propulsive action ; it is often found to contain bismuth for a, ) rose again the following two years to 498, then to 520. In 1897 it was 491, and the year following:f long time subsequent to its administration; it is not 545. After that the figure never again attained to cleared out so effectively as are other parts within 500; and after the year 1900 dt was always below 1 Bulletin de la Société Anatomique de Paris, 1900. 2 Diseases of the Liver, 1905. 4D0 Finally, after the year 1905 the proportion of ____
on a case
,
-
;
taxed.
deaths from typhoid fever has always been below 300 per 1,000,000 inhabitants. We have therefore good reason to hope that the prevalence of typhoid fever has been definitely reduced by about twothirds. This is no mean achievement, and the Italian authorities are to be cungratulated. UNUSUAL SYMPTOMS DUE TO GALL-STONES.
IN another column we publish an interesting note of gall-stones described by Dr. A. R. Neligan. NOTABLE REDUCTION OF TYPHOID FEVER The usual symptomatology of cholelithiasis i& IN ITALY. generally recognised, such as paroxysmal pain, IT is only of late years that Italy has begun to vomiting, collapse, jaundice, and the presence of apply large measures of sanitation to her whole gall-stones in the motions, to which may be added united population. To many of us, accustomed to the occurrence of ague-like. attacks. During an the better hygienic environment of our own country, attack of biliary colic the contents of the stomach residence in Italy has always caused anxiety, are first vomited, and bile may also be present, but especially in regard to the possibility of contracting it is only in very rare instances that a calculus is typhoid fever, and in some places this anxiety has vomited. In Dr. Neligan’s case, however, a number been justified. But recently Italy has been very of faceted gall-stones were found (about 30) in the literally setting her house in order, and the risks vomit. We have been unable to nnd a similar record. of typhoid fever have much abated. We are In addition, the patient suffered from intestinal now the more concerned for just possible nght- obstruction ;an operation was recommended but of the Italian ing strength army than for the refused, and after the administration of enemata security of the rare tourists of our own nationality she passed some flatus, liquid faeces, and a hard who may be in Italy, but on both accounts it is good mass which subsequently proved to be a gall-stone. to learn of the general improvement in public health Unfortunately it was broken up before Dr. Neligan indicated by the decline in frequency of typhoid saw it, but apparently it must have been roughly fever. The fighting strength of an army is naturally round in shape and 3 centimetres in diameter, and enhanced if it is recruited from healthy material. must have weighed about 16 grammes. Mechanical When the troops come from towns and villages obstruction of the intestines by a gall-stone is also where typhold epidemics are frequent there is a uncommon, but many cases have been reported. greater danger that the army itself will be infected. Morestinwas able to refer to as many as 242 cases. This is often left out of calculation. the health of Dr. H. D. Rollestonstates that the relative frethose with the colours being considered as quency of this cause to other causes of intestinal though it can be independent of the conditions obstruction has been variously estimated at from In Italy finan- 1 to 13 to 1 to 45. The occurrence of two unusual where the levies are raised. for cial facilities public health works, such as symptoms in the same patient-viz., the vomit of and water-supply drainage, have been greatly many gall-stones and the obstruction of the bowel accelerated by the Public Health Acts of July 13th, by one such stone-is certainly remarkable, making 1905, and June 25th, 1911. It is especially in the record of the case exceptionally interesting. respect to small and poor districts that the State guarantees the interest on the money borrowed for RADIOLOGICAL STUDIES OF THE LARGE sanitary purposes. Thus from July, 1905, to July, INTESTINE. 1911, no less than 337 districts or communes Dr. A. E. Barclay, whose work on the alimentary received State aid for their water-supply works. is well known, contributes some interesting tract During the same period 763 communes obtained observations to the symposium on intestinal stasis financial aid for other public health undernumber of the B1 itish Journal of in the current as the of isolation hostakings, such building is due less, he considers, Constipation Surgery. The result has pitals, improved drainage, &c. kinks intestinal than to an absence of to Lane’s been specially noticeable in regard to the prevahe terms what points d’appui, from which, as fixed lence of typhoid fever. Professor SantoliquidoI movements of the faeces can be mass the points, Thei is responsible for the following figures. urged forward. These points d’apptti appear to be cases of typhoid fever notified in 1888 amountedl to 59,631, and there were 23,869 deaths; but5 variable in their site-they are never seen in the in 1912 the number of cases was reduced to, coecum itself; more commonly such a point is 30,558 and deaths to 7743. This means that whereas; found in the neighbourhood of the hepatic flexure. in 1888 there were 800 deaths from typhoid fever. Under the X rays the mass is found to be pushed Failure of such out of every million inhabitants, the proportion forward from the fixed point. fixed leads to of the large points inability Of it million 221 in 1912. r was course, per only may be said that these were exceptional years, and1 intestine mechanically to propel forwards, in to a certain extent this is true, because they repre- the abrupt occasional and brief manner now sent the highest and the lowest figure. Nevertheless,, recognised as typical, the faecal mass. The cressthe reduction, while showing certain fluctuations,, pool," or loaded cecum, under this view must be has been persistent. Thus the fall was gradual1 regarded less as the cause than the effect of such from 1880 to 1894, when the proportion of deathss inenlcient propelling action. This organ, in fact, per million of the population was only 439; but itt is suggested to be little concerned in the propulsive action ; it is often found to contain bismuth for a, ) rose again the following two years to 498, then to 520. In 1897 it was 491, and the year following:f long time subsequent to its administration; it is not 545. After that the figure never again attained to cleared out so effectively as are other parts within 500; and after the year 1900 dt was always below 1 Bulletin de la Société Anatomique de Paris, 1900. 2 Diseases of the Liver, 1905. 4D0 Finally, after the year 1905 the proportion of ____
on a case
,
-
;