Chronicle of Medical Science.

REPORT ON SCANDINAVIAN MEDICINE.

By J. W. MOORE, M.D., M.Ch., Dubl.; Ex-Schol. Trin. Coll., Dubl. ; Honorary Fellow of the Swedish Society of Physicians.

TWELVE months ago, when engaged in compiling a notice of the recent literary labours of our medical brethren in Scandinavia, it was my happiness and my good fortune to have as my fellowlabourer, counsellor, and guide, one who has since been removed by the hand of death. My father, the late Dr. William Daniel Moore, even then prostrate in sickness, was yet able to dictate a considerable portion of that review. To have lost him must be my excuse for the inexperience and the shortcomings of the present article, of the defects of which I am fully conscious.

During the past year a number of communications, on subjects relating to practical, literary, and scientific medicine, fully equal to that of any former similar period, have appeared in the medical journals of Denmark, Sweden, and Norway. Most of these papers are of a very high order of excellence; indeed, all of them are above mediocrity. Within the necessarily narrow limits of a review like the present, it would be quite impossible to do full justice to the opinions advanced by the authors of these works and papers. Accordingly, I have concluded merely to give a brief analytical account of some, amongst many, contributions to the progress of medicine-contributions, which have appeared to me either to possess a certain degree of originality or to have been confirmative of researches already made in other countries.

The publication which naturally takes precedence in the medical literature of Scandinavia is one that represents all the nations included under this designation, namely, Sweden, Norway, Denmark, and Finland.

1. The present volume of the Northern Archives of Medicine,' the journal alluded to, and which, though in only the third year of its existence, has already won a European reputation, opens with an article by Professor W. Boeck, of Christiania, on leprosy in the United States of North America. The author reports the clinical history of eighteen cases of this affection. In nine instances the symptoms became developed in America, at longer or shorter intervals after the arrival of the patients in that country. These intervals varied from two years and a half to fourteen years, and the patients all lived in places where the disease had been quite unknown. The conclusion is obvious that leprosy may become

developed in America in persons who have gone to that country with a disposition to the disease, and that it may show itself even many years after their arrival; in the latter case, too, it may assume a very severe type. From Dr. Boeck's observations it would also appear that the disease, in the case of those already subject to it before they emigrated to America, generally becomes worse, while it is exceptional for it to remain stationary, or to show signs of improvement. Wherever any amelioration did take place, it was only such as might fairly be attributed to judicious treatment in hospital.

The frequency of hereditary or family transmission was well exemplified in these nine cases. Four of the patients inherited the disease directly; four others were members of families in the collateral lines of which leprosy had shown itself; and one only of the nine had no hereditary taint. Among the remaining nine patients, all of whom suffered from the disease while yet in Norway, five had had leprous relations, all in collateral lines; in the remaining four there was no suspicion of an hereditary disposition to the malady.

P. J. Wising, Medical Licentiate, of Stockholm, contributes some investigations on the anatomy and physiology of Balantidium coli, a parasite first described by Professor Malmsten in 1856. In 1869 a labourer, Lars Nilsson, 62 years of age, noticed for the first time the presence of small white worms in the motions from his bowels. About Christmas of that year he suddenly became affected with severe colicky pains, followed by considerable diarrhoea. This at last became so bad that there were as many as twelve stools a day; they were usually of the consistence of thin pea-soup, sometimes with firmer lumps intermixed, sometimes quite watery, and most frequently tolerably small in quantity. There was but slight tenesmus, while after some time the stools were streaked with blood. The microscope showed, in addition to the remains of food, a good many lymphoid cells, a few red blood-corpuscles, vibriones, and Balantidium coli in very large numbers. The treatment consisted in the occasional administration of an enema of oil and opium, and in the persistent exhibition of pills of carbolic acid. Enemata of carbolised water were also used from time to time. A comparative cure was effected after many months. But the more original researches of the author are directed to the question of the reproduction and propagation of the parasite. In a series of beautifully executed lithographs the anatomical structure of the animal, including the peristome, with its adoral ciliæ, nucleus, nucleolus, and contractile vacuoles, the phenomena of coition and the process of reproduction, are represented. The last-named is carried on in this way. The body of the parasite elongates so that its length becomes more than double its breadth, and the nucleus itself, also somewhat elongated, assumes a central position, with its long axis in the direction of that of the body. A tendency to constriction across the middle of both body and nucleus is the next change observed. This increases until the two halves are at last connected by a tiny filament only. The anterior half contains the old peristome quite unaltered, while

in the posterior half new adoral ciliæ begin to develope from the ordinary ciliary layer. At this stage the nucleus parts in two, so as to form a separate nucleus for each half of the body. Usually only one contractile vacuole is now found lying near the back portion of each half, for the anterior vacuole does not generally appear until the separation has been quite completed; both halves of the animal gradually take on a more independent life, and, finally, the connecting filament gives way, and the two halves fall apart as distinct living beings. The anterior half, which contains the original peristome, is a fully developed animal from the time of the separation; but the posterior half is as yet very unlike the full-grown parasite, into which it in time develops.

In 'Some Preliminary Remarks on Retinal Affections in Syphilis,' Dr. O. B. Bull, of Christiania, deals with a subject which is today attracting much attention. His investigations were made in about 200 cases of acquired syphilis, partly at the Christiania Chronic Infirmary, but chiefly, in the skin department of the Royal Hospital, with the assistance of Dr. Scheel.

The most usual objective phenomena presented by the retina in syphilitic patients are a moderate injection of the papilla of the optic nerve, congestion of the retinal veins, and a smoky darkening of those portions of the retina immediately around the optic disc. The injection of the last-named is a symptom which is found most frequently in recent cases, and which disappears after a tolerably short time. Hence its presence is, in some measure, a test of the date of the infection. Retinitis existed in more than 50 per cent. of the cases observed by Dr. Bull, while there was iritis in only twelve instances. On several occasions retinitis proved to be the first symptom of constitutional syphilitis; both eyes were generally affected, but in an unequal degree-more rarely one eye was quite healthy, or both were attacked with equal severity. As atrophy of the retina, with consequent amaurosis, is not a frequent sequela of syphilitic retinitis, the author regards an expectant treatment as especially indicated. He, however, has great confidence in an energetic exhibition of mercurials.

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Under the very modest heading, A Contribution to our Knowledge of Empyema,' Dr. L. F. Toft, of Copenhagen, writes a monograph on this affection. As data for his remarks, he deals with thirty-seven instances of spontaneous primary empyema, which term he applies to those cases where from the first a pus exudation is the consequence of inflammatory action. In addition, 51 cases are referred to, in which the original purulent nature of the exudation could not with certainty be ascertained. In both classes the proportion of male subjects of the disease, was double that of women similarly affected. Of the 37 examples of primary empyema, 25 occurred in men and only 12 in women; of the 51 cases of empyema, in which absolute purulent origin was not a necessary factor, 36 occurred in men, and but 15 in women. The disease was most frequently met with between the ages of twenty and forty years. The effect of season was clearly shown by the statistics of all the

cases; the greatest number of patients being affected during the winter months, and again in April, when the changes of temperature were often excessive, and there was greater exposure from renewed work in the open air. As regards the seat of the effusion, it was double in 4 of the whole 88 cases, on the right side in 47, and on the left side in 37 instances, the respective per-centages being 46, 534, and 42.0.

It is to be regretted that space will not permit of a more detailed notice of Dr. Toft's important observations. He analyses the physical signs of empyema also. On one of the most peculiar of those accompanying pneumo-thorax, he remarks:-" Metallic tinkling appears to arise in two different ways, both of which are dependent on the presence of air in the pleural cavity. Either a bubble of air presses out from the opening into the lung, and bursts in the pleura, or a drop falls from its roof down into the fluid below. The second mode requires more room, and less fluid than the first; the bursting of an air-bubble is caused by, or follows, a respiratory effort, while the fall of a drop depends on the movements of the body."

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'Women as Physicians,' by Dr. A. Jäderholm, of Stockholm, attracts attention in these days of "women's rights." The author gives an historical retrospect of the question, and describes its present status in America and in European countries. "In Finland," he says, "the question has lately been decided. An Imperial ukase of the 1st of May, 1871, declares that women who are desirous of devoting themselves to the calling of physicians are authorised to avail themselves of instruction at the medical faculty of the university,'-a regulation which seems to me to imply equality in studies and competency." "So far as I am aware," he adds, "the question has not been broached in the other Scandinavian countries." Sweden, however, the country from which Dr. Jäderholm writes, it would appear that the matter has attracted a good deal of notice; and, though he is not aware that any Swedish ladies have as yet prepared to enter upon the troublesome and responsible calling of a physician, yet arrangements have been made in accordance with a letter from the king to the Royal College of Health, dated 3rd of June, 1870, to receive lady students in medicine (under certain restrictions) at the Carolinean Medico-Chirurgical Institute, which constitutes the medical faculty of the University of Upsala. According to these arrangements, lady students will have to pass the same examinations as ordinary students, but they are to receive separate instruction in anatomy.

Several other papers in this volume should be mentioned. Two from the pen of Gust. Retzius, Medical Licentiate, of Stockholm, deal with points in comparative and minute anatomy. Of these the first is on the internal limiting membrane of the retina, in connection with which the author describes peculiar supporting filaments, with trumpet-shaped terminal discs; in the second paper Retzius treats of the inner layer of the connective tissue of the eye. Professor Carl Santesson, in 'Some Remarks on the different Methods of Puncturing the Bladder,' strongly advocates an operation through

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the rectum, performed with a fine trocar and canula. The instrument used by the author is a stilet of silver, with a steel point 20 centimètres in length; the canula, also of silver, being somewhat shorter, and having a diameter of about 1 millimètre. No untoward results, such as fistula or ulceration, seem to follow this operation. Professor Faye, of Christiania, reports and remarks on an interesting gynecological case. A large fibro-myoma, springing originally from the urinary bladder, filled up the true and false pelvis of a woman 41 years of age. Under these circumstances pregnancy occurred, and was followed by very difficult labour and death. Professor Carl Rossander, of Stockholm, writes on the treatment of amblyopia by subcutaneous strychnia-injections. At first he employed very weak solutions of nitrate of strychnia, but having gradually acquired greater confidence, he now uses a solu tion of 3 centigrammes of the nitrate in 5 grammes of water. The solution amounts to from 60 to 70 drops, and of it 7 to 8 drops may be injected, or 3 milligrammes (grain) of the alkaloid salt. Nine cases in which the remedy was tried are reported by Professor Rossander. The clinical histories after operation in five of these show that a rapidly occurring improvement may be transitory, and that hope should by no means too hastily be abandoned, even where no good result seems to follow the first injections.

To each number of the Nordiskt Medicinskt Arkiv' is appended a very full report of Scandinavian medical literature, dating from six months before. As an illustration, an abstract of a case detailed by Dr. Chr. Petersen, of scarlatina communicated in a letter,' may be cited. The original paper appeared in the Ugeskrift for Læger,' a medical journal published in Copenhagen. The reviewer, H. F. Trier, writes: "The author (Dr. Petersen) has made the observation, in the case of a girl, aged 17, who contracted scarlatina without the possibility of tracing the infection directly to any person, that a friend of the patient living several miles away had had the disease a month previously, and that this friend had regularly corresponded with the patient during the period of her desquamation. The author regards it as not impossible that scarlatina may be conveyed in this way, separate perhaps microscopical-scales being thrust off the hands on to the paper during the writing of a letter, and the infection being thus carried to the address."

These quarterly reports embrace all subjects connected with (1) normal anatomy and physiology; (2), pathological anatomy, general pathology and therapeutics; (3), special pathology and therapeu tics; (4), surgery; (5), psychiatry; (6), venereal affections and skin diseases; (7), obstetrics and gynecology; (8), pædiatrics; (9), pharmacology and toxicology; (10), questions of education, profes sional matters, state medicine, statistics, hygiene and epidemiology; and (11), reports from medical institutions.

2. The volume of the ' Hygiea' for 1871 is not unworthy to be compared with any of its predecessors in point of merit. In many of the monthly parts of the journal clinical histories are given under the heading "Svensk Kasuistik,' or Cases in Swedish (Medical)