269THE NEW YEAR HONOURS.-A RARE FORM OF WAR NEUROSIS.

impossibly long, lists of patients waiting to go intosanatoriums. But the chronic case is not a respon-sive occupant of sanatorium beds, and the resultsdo not seem to justify his preponderance there. A

report just received by the North Riding InsuranceCommittee is typical of many others. Dr. D.

DuNBAR assures the Committee that only about5 per cent. of the inmates of the Aysgarth Sana-torium are permanently benefited, and it is

becoming clear that sanatorium treatment in thestrict sense is not even necessarily the best treat-ment for the chronic consumptive. Belief is

steadily gaining ground in the increasing value ofdispensary treatment at the hands of an expert

Ituberculosis officer and’of domiciliary treatment by Ithe panel doctor when the advice and collaborationof an expert are available. The Local Government

I

Board evidently had this in mind in the recentissue of the Order for domiciliary treatment, whichcame into force at the beginning of this presentyear. This value is strikingly brought out by Dr.HENRY A. ELLIS, who relates in the same issueof the British Journal of Tuberculosis his favour-able experiences of dispensary work in a largenorthern manufacturing town, contrasting themin frank surprise with his previous work at

Coolgardie, in Australia, under vastly betterconditions of fresh- air and climate. He notesthat for the working population surprisinglylittle increase of care is sufficient to re-

establish their normal powers of resistance, and heis driven to the conclusion that the rigour of a

scientifically directed tuberculosis treatment maybe materially modified and reduced in most earlycases in favour of a carefully conducted super-vision of home conditions. Opinions supporting asimilar view are expressed in the symposium by Dr.G. A. CRACE-CALVERT, who holds that the real treat-ment comes after the sanatorium when the patienthas returned to home and work, and Dr. CECILWALL, who emphasises the necessity for provisionof satisfactory living conditions for those who haveleft sanatoriums and for laying more stress on thecommon-sense adaptation of their limited outputof physical energy in the pursuit of a livelihood.How real is the Scottish awakening to the dangers

of tuberculosis is well illustrated by two occur-rences in the House of Commons this week. A

Supplementary Estimate for 27,000 has been laidbefore the House for the treatment of tuberculosisin Scotland, while a University Court Ordinancehas been presented for the foundation in Edinburghof a Chair of Tuberculosis.

THE LANCET, VOL. II., 1916: THE INDEX.

OWING to the continued shortage in -the paper-supply the Index and Title-page to the volume ofTHE LANCET which was completed with the issue ofDec. 30th, 1916, have been printed separately, andcopies have been supplied gratis to those subscriberswho have intimated to us their wish to receivethem. Other subscribers will be similarly supplied,so long as the stock remains unexhausted, on

application to the Manager, THE LANCET Office,423, Strand, London, W.C. Such applications shouldbe sent in at once. ,

Annotations.

THE NEW YEAR HONOURS.

II IQe quid nimis."

THE list of honours issued at the beginning of theyear was a small one, and included the names of nomedical men in their civilian capacity. A supplemen-tary list issued early this week by the Prime Ministerincludes the names of Dr. Robert Armstrong-

‘

Jones, consulting physician on mental diseases tothe Military Forces in London, who has received aKnighthood; Dr. Arthur Newsholme, C.B., ChiefMedical Officer to the Local Government Board,who has been promoted to a Knighthood in theOrder of the Bath; and Sir Robert WilliamBurnet, physician to His Majesty’s Household, whohas been made a Knight Commander of the RoyalVictorian Order. In the Foreign Office list appearthe names of Dr. John Warnock, Director ofLunatic Asylums, Egypt, and Dr. William A. Betts,Director of Municipal and Local Committees ofEgypt, both of whom have received a C.M.G. Weoffer these gentlemen hearty congratulations.Well-deserved honour has also fallen to Mr. E. M.Clarke, head of the motor ambulance departmentof the Red Cross, and to Mr. J. Grice, a well-known philanthropist and chairman of theMelbourne Hospital, who have received knight-hoods ; and to Mr. J. G. Griffiths, honorary secre-tary of King Edward’s Hospital Fund for London,who has been promoted a C.V.O. Mr. L. J. Otter,Mayor of Brighton from 1913 to 1916, played aleading part in connexion with the war charitiesof the town, and his Knighthood is thoroughlywell earned.

____

A RARE FORM OF WAR NEUROSIS.

THE latest number of the Nouvelle Iconographiede la Salpetriere (No. 1, 1916-1917) contains a well-illustrated article by Madame Rosanoff-Saloff on acurious and uncommon condition supervening incertain neurotic subjects as a result of war trauma,mental or physical. This consists in a marked

spinal curvature in an anterior direction, so thatthe patient comes to resemble the Man with theMuck-rake." Similar cases have been also observedin this country. With this prominent anteriorflexion of the trunk there is occasionally seen alateral inclination. Dr. Souques, of the HospicePaul Brousse at Villejuif, in whose neurologicalservice the cases have been observed, proposes theterm " camptocormia

" for the condition, fromKfi/rTM to bend, and Kopu6s the trunk. From theclinical point of view the attitude of thepatient is identical with an anterior flexion , ofthe trunk in a normal individual; in all cases,however, he exhibits transverse skin folds onthe back of the neck from an effort to hold thehead up and so augment the visual fieldand facilitate walking. The abdominal musclescan be seen to be strongly contracted underneaththe skin. As a rule, most movements of the trunkcan be executed with comparative ease, except thatof extension or posterior flexion, an effort to

perform which often results in a typical generalisedtremor of the lower extremities. On the other

hand, the majority of the cases can lie flat on theirback in bed, and this dorsal decubitus is not evenpainful. If the patient, further, is put on his facein a recumbent position he can on request raise hishead, showing that extension can in reality be

270 THE WORK OF THE BELGIAN WAR REFUGEES COMMITTEE.

performed. As a fact, the spinal column is supple I

enough, nor is there any evidence of local vertebralpain or sensitiveness, with the exception of thatproduced by pressure and palpation of the lumbarmusculature on either side. No other abnormalityof the nervous system is found, while radiographicexamination is invariably negative. The cerebro-

spinal fluid is normal. Madame Rosanoff-Saloff hasexamined some 16 cases of this neurosis and dividesthem into two categories-those with actual woundsand those without. Only two of the series belongedto the first of these groups, and in them thewounds were far removed from the seat ofthe abnormal flexion. The great number ofthe other group occurred in soldiers who hadbeen blown up by a shell or buried, with a loss ofconsciousness of variable duration. Occasionallyactual lumbar ecchymoses were noted. In all theearliest symptom was lumbar pain, violent andcontinuous and aggravated by movement. Fromthe point of view of pathogenesis it may bementioned that the sole position of comparativecomfort adopted voluntarily by such patients isthat of bending the body forward till the head isbetween the knees. After some weeks of gradualrelief from the pain they declare that they cannotget their back straight again, and all sorts of localtreatment are as a rule unavailing. The persist-ence of the attitude is explained by the fact thatthe subjects of the affection are without exceptionneuropaths. The normal subject cannot adoptsuch forced positions for long because of theirdiscomfort, whereas the neuropath maintainsthe attitude from ideational inertia or fromauto-suggestion. Madame Rosanoff-Saloff statesthat the prognosis is perfectly good provided thepatient is removed from the surroundings of theordinary hospital, where little or nothing is likelyto be done to combat the peculiar mentality onwhich the neurosis is erected. She pleads earnestlyfor the removal of such patients to special neuro-logical centres at the front itself (dans la zone desarmees), where appropriate medical treatment withrigorous military discipline soon effects the bestresults. The suggestion is made to place thepatient in a plaster jacket, with or without anansthetic, keeping it in position for 8, 10, or 15days. This treatment, coupled with an atmospherethat of itself suggests cure, and proper discipline,succeeds without fail, according to MadameRosanoff-Saloff’s experience. We find ourselves inentire agreement with the proposal that these andanalogous cases should be treated at the front, ina military-medical environment, and not allowedthe chance of becoming perpetuated by wanderingfrom one hospital to another at home, where it is amere chance they may meet with a physician whois sufficiently interested or leisured to devote him-self to a cure. As Charcot said, " il ne faut paslaisser fianer les contractures hysteriques."

THE WORK OF THE BELGIAN WAR REFUGEESCOMMITTEE.

AMIDST tne cnaos or passion wnicn war producesthe organisation of charity has been particularlynoticeable since the commencement of hostilities,and in no way more so than in the attempts torelieve the Belgian sufferers. When, by the ruthlessdestruction of Belgian towns, thousands of children,women, and men were rendered homeless and

sought succour and shelter in this country, offersof help came from all parts and from all

classes, and in London so great was the demandto be of service that at one time the number of,volunteers for work outnumbered that of therefugees. The report of the War Refugees Com.mittee dated August, 1916, has just been issued,and tells the story of an organisation carried outunder the greatest difficulties which has providedwholly or in part for some 200,000 out of probably250,000 Belgian refugees who have entered thiscountry since the beginning of the war. At the end of1914 there were 2000 local committees engaged in thework, though this number has since been decreasedto 1837. The offers of hospitality received by thevarious local committees made provision for some150,000 people, while up to February, 1915, theBoard of Trade Labour Exchanges had found workfor 8752. The health department, which deals withhospital and convalescent treatment, maternitycases, the provision of surgical appliances, and theinvestigation of consumptives, has ministered to2550 cases, the weekly average of new cases being45. At the dispensary, which is managed by acommittee of English and Belgian doctors assistedby a Voluntary Aid Detachment, 20,852 patientshave received attention and 14,243 prescriptionshave been dispensed at an average cost of 4d. perhead. The domiciliary visits made numbered 550,the surgical appliances provided amounted to 518,and 2200 letters of recommendation to hospitalsand other institutions were procured.

SHELL WOUND OF THE PREGNANT UTERUS.

UNDER me Title ueasarean bection due to a

Shell Fragment," MM. Saint, Goehlinger, andPoire have described a remarkable injury due to thewar of a kind which, fortunately, we are spared inthis country. A woman, aged 33 years, in thesixth month of pregnancy, was taken to hospital,She lived in a town behind the British lineswhich was daily bombarded. While seated at herwindow a shell exploded in the street andwounded her in the lower abdomen. She wasadmitted three hours later. The abdomen wasdistended and a reaction of "peritoneal defence"was already marked on the right side. Theuterus extended two finger-breadths above theumbilicus. The position of the foetus could notbe ascertained by palpation because of the pain produced by examination. There was a wound of entrya alittle below and to the left of the umbilicus and oneof exit 9 cm. away, two finger-breadths above the leftcrural arch. From each wound omentum projectedOn palpation it was evident that the abdominalmuscles were completely divided and that betweenthe two wounds only a bridge of skin remained.Blood was abundantly escaping from the vagina.A digital examination was not performed. The

pulse was 110 and good, and the general conditionsatisfactory. Operation was decided on. The bridgeof skin between the wounds was divided and theusual median incision for laparotomy made belowthe umbilicus. This with the wound due to theinjury itself gave a large triangular flap with itssummit at the umbilicus. A wound in the fundusuteri, 5 cm. long, was found running from themiddle line downwards to the left and forwards.Amniotic fluid and meconium were free in the

pelvis. Without separating the edges of the uterinewound the lumbar region of a foetus couldbe seen on which a small wound was visible.A median incision in the uterus allowed a flapsimilar to that in the abdominal wall to be detached

271RESTRICTIONS ON THE USE OF MEDICINAL GLYCERINE.

and the foetus and placenta to be removed. As thefoetus was thought to be dead attention wasconfined to the mother. The uterine cavity wascleaned out, the heamorrhage arrested, and theuterus sutured. After rapidly examining the coilsof intestines the abdominal wounds were closed.At this moment the foetus, which had been left in abasin, began to cry. It was a female weighing950 grammes and had a superficial wound 2 cm.long in the left sacro-lumbar region. After a warmbath the child was enveloped in cotton-wool, butonly lived for 15 hours after the injury. Themother recovered without untoward incident.Evidently the gravid uterus prevented deeperpenetration of the shell fragment into the abdomenand perforation of the intestine. The presence ofthe foetus may be held to have saved the life ofthe mother.

RESTRICTIONS ON THE USE OF MEDICINALGLYCERINE.

THE Ministry of Munitions announces that owingto additional demands for glycerine for war purposesit has become necessary to place further restric-tions on the issue of medicinal glycerine, and thatsupplies in future will be reserved for the manu-facture of the preparations of the British Pharma-copoeia, and for such uses of special importance asmay be sanctioned by the Ministry of Munitions.These supplies will, however, be small and mustbe used with the utmost economy. Applicationsfor permission to obtain supplies should beaddressed to the Director of Propellant Supplies,32, Old Queen-street, Westminster, S.W., andshould give the following particulars : 1. Quantityapplied for. 2. Stock of glycerine held. 3. Pur-

pose for which supply is required. (In case ofExtra British Pharmacopoeia preparations formulaeshould be given.) 4. Applicant’s average yearlyconsumption of glycerine for above purposes.5. Name and address of proposed suppliers. Themedical profession have been informed of the needfor economy in prescribing glycerine, and it is

anticipated that the requirements for dispensingwill be greatly reduced. The stocks of glycerinein the hands of pharmacists should be sufficient tomeet these reduced requirements, and therefore noglycerine will be issued for dispensing meantime.The surplus stocks held by pharmacists, and allstocks held by retailers who are not in a positionto use them for these restricted purposes, shouldbe disposed of either to other pharmacists who areshort of stock or to wholesale houses for makingB.P. preparations. We published a note last weekon the importance of economising glycerine formedicinal use, and there can be little doubt that inmany cases it can be replaced for dispensing pur-poses, without material disadvantage, by othersubstances.

THE DRESSING OF BURNS WITH PARAFFIN WAX.

Sir Arthur May’s prompt application of theremedy to the requirements of the Navy has drawnfresh attention to the treatment of burns by a pro-prietary preparation called ambrine by its inventor,Dr. Barthe de Sandfort. As, however, the prepara-tion is a secret one controlled by a company inParis, the treatment is not as readily accessible assome of our correspondents desire. We can referthese to the experience of Lieutenant-Colonel A. J.Hull, R.A.M.C., who stated in the British Medical

Journal of Jan. 13th that the results obtained by amixture of home manufacture in a military hos-pital have surpassed those obtained by the use ofambrine or any other preparation. He gives thefollowing formula for its preparation :—

The hard paraffin is first melted and the softparaffin and olive oil are stirred in. The resorcin isnext added dissolved in half its weight of absolutealcohol, and finally the eucalyptus oil when the waxhas cooled to about 55° C. If necessary, the resorcinmay be replaced by a quarter of its weight of

j3-naphthol. Colonel Hull adds that the applicationof this No. 7 paraffin, as it is called, to ulcerationfollowing frost-bite has been as successful as in thecase of burns. Other uses will doubtless suggestthemselves for a soft impervious casing to woundswhich can yet be readily peeled off without painor disturbance to the delicate processes of repair.

BORIC ACID IN CREAM.

IN our issue of Oct. 28th, 1916, we referred to theAmending Order issued by the Local GovernmentBoard in regard to the use of preservatives incream. The Order, as is now announced by theLocal Government Board, comes into operationon April 2nd next. It temporarily forbids an

addition of boric acid to cream of more than0’4 per cent., but a small expert committee is to beappointed to inquire further into the desirability ofusing boric acid at all. In the meantime dealersare asked to make every effort to reduce thepreservative to the smallest possible amount,or even to dispense with its use entirely. Untilthe results of the promised inquiry are knownall prosecutions - will be avoided in respectof the sale of preserved cream which com-

plies with the Regulations as now amended.Further restrictions may possibly be made

dependent upon the findings of the committeereferred to. Instructions are issued as to the formof label which such preserved cream must bear.The presence and amount of boric acid must bedeclared, and the words

"

Not suitable for invalids "

are to be added. A similar provision applies tothe use of peroxide of hydrogen as a preservative,except that the amount present is not demandedto be stated.

____

THE SCIENTIFIC STUDY OF HYDROLOGY.

Dr. Fortescue Fox’s paper on " The Future ofBritish Spas," read last week before the RoyalSociety of Arts, was in effect a plea for the scientificstudy of physical remedies. He reminded hisaudience of the memorial laid before the Universityof London a few days before the outbreak of war,recommending the establishment of a Universitychair in medical hydrology and medical climatology,a proposal which was still before the Senate.

Systematic teaching regarding the action and usesof waters of every kind, both within and withoutthe body, is now available in other Europeancountries. An institute of hydrology has recentlybeen attached to the College de France. And it wasthe opinion of the memorialists in 1914 that authori-tative teaching should be provided in London, as

272 PROF. WALLER: THE UNRESTRICTED DIET OF A SEDENTARY WORKER.

the capital city of an Empire rich in climaticresorts and medicinal waters, for senior studentsand practitioners likely to specialise in thisbranch of practice, as well as for medical menwho came from the country or from distantparts of the Empire. Laboratory facilities forresearch work upon British soil are also desirable.These considerations, already urgent in peace, hadgained, Dr. Fox alleged, in weight and force fromthe experience of the war. He alluded to the

place which physical remedies were taking in therestitution of disabled soldiers, and pictured a

further extension of highly specialised forms oftreatment. But where, he queried, were thespecialists to be found ? The whirlpool bath hasfound wide use for stiff and disabled limbs, and thesuccess of the large

"

sedative pool " bath has beenconsiderable in disordered action of the heart; butit is a mistake to suppose that one or twomethods are applicable to all conditions, andthe need of trained men who have studied theprinciples and practice of hydrological medicineis an immediate one. With Dr. Fox’s views,as we have summarised them, we are in sub-stantial agreement. The command dep6ts up anddown the country are already giving strikingocular demonstration of the value of hydrologicalmethods when dealt with on a scientific basis. Thewar has given a much-needed stimulus to thisstudy, and the results will doubtless remain as apermanent therapeutic asset. Our British spaswith their cool and bracing climate may well offerour friends across the Channel, as Dr. Neville Woodpointed out some years ago, a pleasant andhealthful change from the heat of the continentalsummer. Well equipped with scientific practi-tioners of the whole art of applying water, theyshould offer a great and increasing attraction.

TYPE-READING BY SOUND.

AT the Rontgen Ray Society on Feb. 6th Dr.Fournier d’Albe demonstrated before a largeaudience an instrument which he has named anoptophone, whereby, with practice, blind personsare, he says, enabled to read ordinary print bysound. The instrument depends upon an appli-cation of selenium, and before describing it thedemonstrator dealt in a general way with the

properties of selenium itself, which was dis-covered exactly a hundred years ago by Berzelius.He instanced many ways in which this substancehad been turned to more or less practical account.It has been employed in photometry, in therelease of automatic shutters in cameras, in

multiplex telegraphy, in phototelegraphy (thetransmission of photographic images across thewire), in the photographophone (in which cinemato-graphic images and sounds are synchronised), intelevision, and in the automatic regulation oflights, signals, and buoys. The optophone, inwhich Dr. d’Albe is apparently most interested,is an instrument which he devised first in 1912to enable sightless persons to locate bright lightsor brightly luminous patches by means of the earand to discover shadows intercepting the light.This result was obtained by placing two seleniumpreparations into two arms of a Wheatstonebridge, sending a galvanometer current throughthe telephone and interrupting it by a clockworkmotor. The lecturer explained that the work hadbeen delayed since the war began because of theimpossibility of obtaining Nernst filaments, which

were essential because they gave an intense lineof light; but he added that he had now foundthat the half-watt lamp was available as a sub.stitute. A small, revolving, perforated disc isilluminated by the lamp, and the image of a

line of luminous dots, furnished by this re.

volving disc, projected upon the type to beread; the light thus reflected from the type is

passed to a set of selenium bridges connected by atelephone relay, and sounds corresponding to thevarious letters of the type are carried intothe receiver. The current used is about 1 ma.,but of 60 or 70 volts. Each letter of the printedmatter, as it passes over the small aperturein the slab, gives, he says, a different soundeffect from every other; whatever the differencein shape between any two letters, it expressesitself in a difference of tone which, with practice,the blind person would recognise. This soundalphabet, of course, has to be learned, but withpractice the line of type can be moved across theaperture at the rate of several words a minute, andthe sense becomes intelligible to the hearer. Themaximum sound is heard in the telephone whenthe paper exposed is white and the minimumwhen it is black; therefore, what the sightless’person has to learn are the variations betweenthese two extremes. For demonstration purposesDr. d’Albe used large printed letters, but he saidthat by a focussing arrangement the instrumentcould be adapted so as to make it possible to readtype of ordinary size. ____

THE Hunterian lecture on Paget’s Disease ofthe Nipple will be delivered in the theatre of theRoyal College of Surgeons of England by ProfessorW. Sampson Handley to-day, Friday, Feb. 16th,at 5 P.M.

____

THE Milroy lectures of the Royal College of

Physicians of London are to be delivered on

Feb. 22nd, 27th, and March 1st by Dr. W. J.Howarth, his subject being "Meat Inspection, withSpecial Reference to the Development of RecentYears." On March 13th, 15th, and 20th Dr. G. A.Sutherland will give the Lumleian lectures of theCollege on

" Modern Aspects of Heart Disease," and

the Goulstonian lectures, with "Paratyphoid Infec.tions " as their theme, will be delivered by Dr. C. H,Miller on March 22nd, 27th, and 29th. The time ineach case is 5 P.M.

THE UNRESTRICTED DIET OF ASEDENTARY WORKER.

BY A. D. WALLER, M.D. ABERD., F.R.S.

ABOUT three months ago, at the instigation of my friendSir W. Osler, I took a summary measurement of my dailyfood during three days of my ordinary unrestricted diet.Sir William had banteringly reproached me with eatingtoo much during war-time, saying that I must be a 5000Calories man.The figures for my three days’ trial came out as follows.

The decimals attached to these figures may seem absurd inconnexion with such rough weighings ; their appearance isdue to the- fact that the calculations were made on a

Comptometer by my assistant, Mr. Shapiro. They serve thepurpose of enabling the arithmetic to be checked by seeingwhether horizontal and vertical lines give the identical finalresults in Calories. The first three columns give the per.centages of Protein, Fat, and Carbohydrate assumed forcalculation of the actual quantities of P. F. C. in the materialsswallowed.