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foreign Correspondence. .
(FROM OUR SPECIAL CORRESPONDENT.]
Christmas Day in the Hospital; Dinner to Dr. Collins; Street Accidents in
London ; A Hospital Railway Car; Case of Gumma of Pituitary Body; A Crimean Nurse; The Proposed London University; The Welfare of the Feeble-Minded; Oxygen Treatment.
Dr. Augustus Waller, F. R. S., lecturer on physiology at St. Mary's Hospital Medical School, has been awarded by the French Academy of Sciences the perennial “Parkin" prize of three thousand four hundred francs for a communication on the curative effects of carbon in its various forms in cases of cholera, and of fevers in general.
Christmas day has been observed with all the usual festive observances in the London hospitals. Special fare was served at dinner, and the various wards were gaily decorated, and every thing possible was done to provide for the enjoyment of the inmates. Carols were sung, and various kinds of entertainments were organized, so that the sick and weakly, on the whole, spent an enjoyable day, in spite of their various physical infirmities. One of the most pleasant features of the celebration was the distribution of toys to the children and seasonable gifts to the adults. At Guy's Hospital during the morning the “Disguysed Minstrel Troupe," a body of entertainers whose ranks are recruited from the hospital doctors and students, carried out a varied programme, and the carols, solos, and choruses which they rendered in the different wards were highly appreciated. At all the other London hospitals and infirmaries similar efforts were made to make the day as pleasant as possible for the inmates.
Dr. W. T. Collins, chairman of the London County Council, has been entertained at a complimentary dinner at the Trocadero Restaurant by members of the staff and former students of St. Bartholomew's Hospital. The chair was taken by Mr. Howard Marsh, one of the surgeons to the hospital.
The annual police returns of the London Metropolitan Police show a lamentable loss of life in the streets of London. The fatalities known as thus occurring in 1896 amounted to one hundred and thirty. In the year preceding they were one hundred and fifty-six, and in 1894 they were one hundred and sixty-nine. Cyclists last year killed two. But the returns are necessarily incomplete, the city not being included, and deaths in hospitals being sometimes overlooked. The Registrar General gives higher figures, reporting three hundred deaths from vehicles or horses in London in 1896. The police returns are useful as showing the class of vehicle concerned.
Thus, uncovered vans are charged with twenty-four deaths; covered vans, twenty-one; omnibuses, nineteen; hansom cabs, fifteen, and light carts and heavy carts, fourteen each.
Belgium has just put upon her railway system a specially designed hospital car, which will be available in the case of a serious railway accident. It will also be employed in conveying invalids from one point to another, as, for instance, from the inland towns to the health-giving seaside wateringplaces. The interior of the carriage is divided into a main compartment and two small rooms at the end. In the larger room are twenty-four beds, and each patient lies in front of two small windows, which can be opened at will. A.movable table can be lowered over each bed. There are lockers in the corridors for ice-chests, provisions, and linen. If necessary a part of the saloon can be transformed into an operating chamber. In connection with the hospital is a small chapel for religious services, and the patients will be in charge of a surgeon and nurse.
At the meeting of the Pathological Society Dr. William Hunter said he had recently had under his charge a woman, aged forty-seven, in whom, after death, a gumma of the pituitary body was found. The patient presented during life well-marked signs of syphilitic infection, having nodes of various bones, also caries of the skull. Death was caused by suppression of urine after removal of the right kidney for pyonephrosis. The pituitary body was the size of a small marble. In it were foci which under the microscope showed the changes due to syphilitic disease. There were also typical gummata in the liver. Dr. Hunter said he had only been able to find records of three similar cases, two in foreign literature and one by Dr. Cecil Beadles in the Transactions of the Pathological Society of London. The neighboring nerves were in a normal state, and there were no symptoms of any kind referable to the lesion.
Mrs. Ann Eyre Hely, now an inmate of Ravenstone Hospital, Ashbyde-la-Zouche, and widow of a medical man formerly practicing in that town, has received from the Queen the royal red cross. In 1854 Mrs. Hely left England to join Miss Nightingale's staff of nurses in the Crimea, where she served until the end of the war and all the soldiers were convalscent and ready to return home. She had one hundred and fifty patients under her sole charge. Upon her return she was selected to nurse the late Duchess of Kent, mother of Her Majesty, but the duchess died just before Mrs. Hely could take up her duties. Mrs. Hely, who is in her seventy-eighth year, could not attend at Windsor Castle for the presentation of the order by the Queen in person.
At a meeting of the Medical School of St. George's Hospital the following resolution was unanimously adopted: “The Medical School of St. George's Hospital has taken the London University Commission Bill of 1897 into consideration. The school is of the opinion that the provisions of the bill will need great modification as regards the constitution of the Faculty of Medicine and its Board of Studies if it is to meet the requirements of medical education in London.”
The National Association for Promoting the Welfare of the FeebleMinded is about to increase its sphere of usefulness by acquiring a block of cottage homes near London. The premises include a steam laundry and other accessories, which renders them suitable not only for the maintenance and education of the feeble-minded, but also for the training of matrons and teachers who would be available for other homes. The Lunacy Commissioners refer approvingly in their last report to the work of the National Association in providing suitable provisions for an extensive and necessitous class of persons who are known as “feeble-minded," as distinguished from certifiable idiots and imbeciles.
Dr. Stoker has published a reprint of his series of articles upon the oxygen treatment of ulcers, wounds, and general surgical cures. It may be remembered that Dr. Stoker's attention was first drawn to this line of treatment by the fact of the Zulus taking their wounded to the top of the highest hills, where suppuration at once ceased.
The wife of a pavior at Bolton gave birth to triplets. After living two days the infants died, and at the inquest it transpired that they were fed on brandy and water.
LONDON, December, 1897.
Abstracts and Selections.
THE SERUM REACTION IN COLIBACILLARY INFECTION.-Widal and Nobecourt (Sem. Med.) remark upon the difficulty of obtaining results of diagnostic value with the serum reaction in cases of infection with coli bacilli. This they chiefly attribute to the fact that there are many varieties of coli bacilli, and that the test may be applied with a cultivation of a different variety from that causing the infection. The only method of obtaining certain results is to test the serum with cultivations of the actual bacillus causing the infection, as was done by Achard and Bensaude in a case of pyelo-nephritis. Such a procedure entails the isolation of the bacillus from the tissues of the patient, and would thus deprive the serum reaction of any diagnostic importance. Nevertheless valuable information is thus obtained with regard to the much disputed question of the pathology of coli infections. From this point of view Widal and Nobecourt carefully investigated the case of a phthisical patient who developed an abscess in the region of the thyroid cartilage. From the pus they isolated a bacillus which possessed biological characters intermediate between those of the coli group on the one hand and the typhoid bacillus on the other hand. It most closely resembled the group of the so-called paracoli bacilli, to which belong the psittacosis bacillus of Nocard and the calf septicemia bacillus of Thomassen. Serum obtained from the patient suffering from the abscess
in the proportion of 1 in 1,000 agglutinated the bacillus; but there was no evidence that it possessed bactericidal properties. The same serum had no agglutinative action on the typhoid bacillus nor on the bacillus of calf septicemia. In the proportion of 1 in 150 it agglutinated a paracoli bacillus obtained from the mouth, and in the proportion of 1 in 50 the psittacosis bacillus. Several varieties of the coli bacillus were agglutinated by the serum in the strength of 1 in 20 or 1 in 50, but normal human serum will act in this strength. Serums obtained from different sources were tested with the bacillus above described. Of twelve serums obtained from patients with various diseases, but one produced agglutination, and that only in the strength of 1 in 5. Fourteen serums from typhoid patients were tested. All these, with a power below 1 in 1,000 for the typhoid bacillus, had no effect; while a serum of powder 1 in 8,000 for the typhoid bacillus agglutinated Widal and Nobecourt's bacillus in proportion of 1 in 400. In the case of a patient convalescing from typhoid fever the serum, while only possessing the power of 1 in 20 for the typhoid bacillus, agglutinated Widal's bacillus in the proportion of 1 in 12,000. In this case the author believed that a mixed infection had occurred. From the above experiments the authors conclude that the bacillus isolated by them had imparted to the serum of the patient specific agglutinative properties, and that many varieties of the coli bacillus which resemble one another closely in their biological characters are nevertheless quite distinct.— British Med. Journal.
INJECTIONS OF ALUMNOL IN LARYNGEAL DISEASE.—Dr. Metzerott, of Washington, has had favorable results from the use of this drug in the forms of gargle, spray, atomized solution, and with the laryngeal syringe. He instances with special satisfaction the following case, probably syphilitic in origin, in the September issue of the American Therapist :
In a case of symptomatic edema of the larynx, accompanied with a perichondritis of the crico-arytenoid cartilages, in which there was stenosis of a most severe grade, I was able by means of solutions of alumnol, administered in the form of injections and the steam spray, to defer the performance of tracheotomy for a period of six months. In this particular patient it was really remarkable how quickly the inflammatory edema would be reduced by one or two injections of a solution of alumnol into the larynx, and maintained for a longer time by inhalations of vapor charged with the same remedy. Indeed, it was a pleasure to behold with the laryngoscope how rapidly a laryngeal image of swollen ventricular bands and injected and tumefied vocal cords would change to a picture almost normal. It is immaterial whether this particular case to which I have just alluded was due to cancer, tuberculosis, or what it has the clinical appearance of being now, syphilis, the fact remains that a most powerful impression was made upon the accompanying inflammatory edema, which at the time I took charge of the patient was of such a degree that I myself and the attending physician regarded the case as hopeless without the performance of tracheotomy.
No bad after-effects were noticed, although the steam spray was daily applied for several months. In a case of subglottic laryngitis accompanied with that wave-like fluttering of the vocal cords, a condition usually very stubborn to treatment, I was able to relieve my patient, a singer, in a very short while by using nothing but alumnol in the spray. In another case of chorditis nodosa (singer's nodules) I was able to dispense with instruments by employing strong solutions of alumnol. -- Journal of the American Medical Association.
THE AFTER-HISTORY OF RADICAL CURES OF HERNIA.—Taillens (Rev. Med. de la Suisse Rom., July 20, 1897,) criticises the usual method of estimating the final result in operations for the radical cure of hernia, most of those cases put down as “cures” being seen for the last time on leaving hospital. This applies to the statistics collected even by such authorities as Bassini, Ferrari, etc. Before saying that a radical cure has been successful two years at least must pass. The author has analyzed the cases operated on in Roux's clinic from the beginning of 1890 to the middle of 1894. Of these 401 cases, 324 were followed up for from two to six years after the operation, 288 being inguinal hernia (120 right, 74 left, and 47 double), 22 femoral (13 right, 5 left, and 2 double), and 14 umbilical. Operations (1) for inguinal hernia: During the whole period the first steps were the same, namely, dissection of sac as high as possible, ligature, and excision. The sac was not opened unless adhesions were present. From 1890 to 1893, however, the pillars were sutured, the suture passing through some fibers of the internal oblique so as to leave nothing behind the cord except fascia transversalis (modified Ferrari), while from the middle of 1893 a slightly modified Bassini was used. At present Ferrari's operation is performed. (2) For femoral hernia : After resection of the sac the opening is closed by one or two sutures, which take up all the soft parts down to the bone, that is, the whole of the crural arch on one side and the pectineal fascia and periosteum on the other. (3) For umbilical hernia: In children the sac is rarely resected, but it is in adults; and, after trimming, the abdominal wound is sutured layer by layer. Formerly silk was always used, but more recently catgut, as it has been found that silk is more likely to produce suppuration. After-history: Relapses occurred 48 times in inguinal hernia (equal to 16.7 per cent), six times in femoral (equal to 27.3 per cent), and not once in umbilical. Thus the latter gives the best, and femoral the worst, after-results. The factors influencing relapses are: (a) the state of the abdominal walls, especially flaccidity; (6) the direction of the hernia; thus indirect give much better results than direct inguinal herniæ; (c) the thickness of the cord, a thick cord making it impossible to close the ring satisfactorily except after castration; (d) sex has very little influence, even in inguinal hernia; (e) age, the change of relapses increasing steadily with the age, especially after twenty; (f) the kind of operation : thus, in spite of the theoretical advantage of Bassini's operation for inguinal hernia restoring