841

inflammation. If the skin is injected and at once incisedmuch of the quinine solution escapes into the wound andvery little exudation occurs, and the anaesthesia is of short

duration, though even then it may last a few hours. In

these circumstances the wound heals as if no local ansestbetic

had been used ; therefore, this is the method to be

adopted when a short duration of anaesthesia will suffice andprompt healing of the wound is desired. When, however,primary union is not possible and a more prolonged anues-thesia is wished for it is important that the tissues should notbe incised at once ; in fact, not until the infiltration has

formed, for when this infiltration has occurred the anaesthesiamay last several days. For the mucous membrane a 10 percent. solution may be applied upon pledgets of cotton wool.If the quinine is used for injection, solutions from 2 to 1 percent. should be employed. It may be used either for

infiltration or for "nerve blocking." " After the injection the

operation may begin at once if only temporary anaesthesia isneeded, or after half an hour or more if a more prolongedanxsthesia is desired.

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THE WORKHOUSE INFIRMARY AND THE RECEP-

TION OF URGENT CASES.

A SOMEWHAT unusual incident occurred at Devizes recentlyin connexion with the admission of a sick tramp to the work-house infirmary. A medical man, Dr. A. Vivian Trow,appears to have responded promptly to a summons and tohave found a tramp lying very ill in the roadway, witha sympathetic crowd round him. He was informed bythe man himself that he had taken arsenic, and as the

symptoms were consistent with this explanation and thespasms were severe he decided that the best course in the

patient’s interest was to remove him at once to the work-house infirmary in order that suitable treatment mightbe employed. Accordingly, with the assistance of a

clergyman, Canon Gardner, who allowed the man to

be moved into his garden, a stretcher was obtained, andhe was placed upon it. Dr. Trow went in advance on his

bicycle, but on reaching the workhouse unfortunately failedto attract attention at the door of the master’s house.

According to a letter which he wrote afterwards in explana-tion of his action to the chairman of the house committeehe rang twice, waited four or five minutes, and then pro-ceeded through the workhouse kitchen to the infirmary andrequested the head nurse to prepare a bed. This was done

and the man was placed in it under Dr. Trow’s supervision,as he had been brought there before Dr. Trow couldleave the premises in order to inform the medical officer.

At this stage the master arrived and expressed surprise,which no doubt he felt, at finding an inmate admitted to theworkhouse and installed in it without his knowledge. Dr.

Trow in the letter referred to, complained that the master’smanner was offensive, but the master at the meeting of theboard of guardians at which the incident was discusseddenied this, and maintained that he should have been in-formed and his consent obtained before the tramp was

introduced into the institution. In this assertion the master

was no doubt technically correct ; it was very unfortunate

that he did not learn earlier that his presence was required.Moreover, when he addressed the board on the subject, it

appeared that the tramp had not taken arsenic at all, buthad recovered in due course from the effects of a severe boutof beer-drinking combined with sundry doses of gin. Thislaid Dr. Trow open to criticism on the part of the

guardians, and for this reason the apparently trivial circum-stances are worth noting. Dr. Trow acted with despatch andhumanity, it seems to us, in a difficult position. If the manhad died or had had his life saved with difficulty in the

infirmary Dr. Trow would have been praised ; no doubt if

death had supervened, as it might have done, whether itwere due to arsenic or to alcohol, and if the story had comeout at an inquest, the guardians and the master would haveendured with equanimity credit for their readiness to waiveceremony and to dispense with red tape in the cause ofhumanity. As the case turned out, numerous letters in theWiltshire nmes, including one from Mr. G. S. A. Waylen, themedical officer of the workhouse, have since attested to the

public the difucult position in which a medical man is placedwho has to decide rapidly and to do what is best forhis patient in circumstances of urgency. The correspondencereferred to shows the high opinion entertained by his

colleagues for the active sympathy and zeal evinced byDr. Trow, and it also raises the question of what the medicalman’s duty is when such occasions arise as that described.We may suggest with regard to this aspect of the subjectthat the exceptional character of the incident in questionwas due to the failure of a bell to attract attention.Even if this mischance were to occur again it shouldnot be very difficult, as a rule, to ascertain whetherthe medical officer in charge of the infirmary is presentin the workhouse, or whether the master or matron

is to be found by someone sent in search of them. Naturally,someone in authority must be consulted if it can be

done without undue delay. An institution for the treat-

ment of the sick and injured, whether it be a voluntary hos-pital or a workhouse infirmary, must have its regulations asto the admission of inmates, and a medical man not

connected with it can hardly claim a right to have patientsplaced in its beds on his sole authority. From whatevermotives of humanity he may act or however disinterested hemay be in the course he desires to take, he is obliged to

consider the position of others as well as his own. This, nodoubt, Dr. Trow was prepared to do when he rang the bellto summon the master of the Devizes workhouse, and hedid in fact give the earliest possible notice of what he haddone to the medical officer of the infirmary. Whether a bell

did not ring or a workhouse porter was not at his post on oneparticular occasion we need not inquire or conjecture, for theprecise chain of incidents is not likely to be repeated. Themedical man acted, as members of the medical professionmust act, according to his discretion and with a full sense ofhis responsibility towards a patient thrust upon him bychance, and it is to be regretted that unneeded prominenceshould have been assigned locally to the technical irregularityor a humane deed.

AORTIC REGURGITATION IN INFANCY.

IN another column we publish an interesting communica-tion by Mr. W. Ansley-Young on a case of aortic regurgita-tion in an infant. The child was aged 18 months and wasextremely pale. The physical signs are duly described, but,as Mr. Ansley-Young remarks, the most interesting questionis the cause of the lesion. The mother, aged 28 years, gavea history of two attacks of rheumatism, the first havingoccurred six years before the child was brought for examina-tion and the second two and a half years before. Did thischild contract an endocarditis in utero as a result of therheumatic virus in the mother, or was the case one of

congenital morbus cordis in which the aortic valves weremalformed or deficient ? An attack of rheumatic fever inthe mother during pregnancy or a strong tendency torheumatism in the parents may possibly be a cause of foetalendocarditis, and either the aortic or mitral valves maybe affected. The endocarditis is nearly always of the

chronic or sclerotic variety ; very rarely indeed is it

of the warty or verrucose form. When the aortic orifice

is affected frequently all trace of the segments dis-

appears, leaving a stiff membranous diaphragm perforated

842

by an oval or rounded orifice. In the various forms

of congenital heart disease, when there is some defectof development, the valves of the right side of the heartare more frequently affected than those of the left side.but when there is an error of development of the aorticvalves the condition found is similar to that just described ascaused by endocarditis, and from a pathological examinationonly it might be very difficult to arrive at a conclusion as tothe exact etiology of the lesion. In the case described byMr. Ansley- Young there was a history of rheumatic fever in

the mother, and therefore the conclusion would be justifiablethat the aortic lesion was caused by foeta.1 endocarditis.

A PREHISTORIC SPINAL INJURY.

"NOT long since, in the course of an excursion in the

neighbourlood of Arles-sur-Rhone, in the South of France," ’I

writes Dr. A. S. Gubb from Aix-les-Bains, " I was taken

to see some prehistoric tombs that had recently been

unearthed. One of them had contained no less than a

hundred skeletal remains, among them a human vertebra inwhich was firmly implanted a flint arrow or spear head. As

will be seen from the accompanying photograph, it piercedthe body of the vertebra from the front and then becamedetached from the shaft of the arrow or spear. The bone is

somewhat disintegrated, but it would appear to be a dorsal

vertebra. M. Lacaze Duthiers, professor at the Arles College,informs me that several of these tombs have been discoveredin the neighbourhood, all of them in the commune of

Fontvieille. They all open to the west and, speakinggenerally, they comprise an underground gallery dug out ofthe soft tertiary or Helvetian mollasse (the shell-bearingstone of Fontvieille) with instruments that have not left anytrace on the well-finished walls to show what sort of toolswere used for the purpose. The walls incline inwards aboveso as to reduce the space to be covered in, and this space isfilled by large slabs of stone of the same nature as the walls,and the same as was employed for the covered alleys’anddolmens. This roof is just beneath the surface of the groundand must have been surmounted by a tumulus, remains ofwhich are, in one instance, still visible. One of them (theone at Bounias) indeed presents remains of a cromlech.With regard to the age of the specimen (which has beendeposited in the museum at Arles) the numerous flint arrowand spear heads, polished hard stone axes, rabbits’ tibias finelypointed, serpentine and other stone beads, a gold and pearlplaquette, fragments of pottery, and a bronze dagger-bladeappear to authorise the assumption that the men of unknownrace who built these tombs by hewing out the stone on

plateaux at that time surrounded by water and who, though

they made use of polished stone tools, were acquainted withbronze, belonged to the extreme end of the neolithic age, orpossibly the commencement of the bronze period."

SEAWEED IN DISEASE OF THE THYROIDGLAND.

Dr. Reid Hunt and Dr. Atherton Seidel], in a paperprinted in the J01lrnal of Pharmacology and Experamental1’heralroezstics for August, Washington, believe they havefound in bladderwrack (Fucus vesiculosus) an iodine com-pound which may properly be called thyreotropic-that is, acompound which increases the activity of the thyroid in dosesfar smaller than any other iodine compounds with which theyhave experimented can do. The plan of the experiments wasto determine the smallest amounts of various iodine com-

pounds which when given to animals caused distinct changesin their resistance to aceto-nitrile and also to determine

the maximum effect which could be obtained. If the

hypothesis that certain compounds are thyreotropic is

correct, then these compounds may be expected to cause achange in the resistance in much smaller doses in terms oftheir iodine content than the other compounds. If, further,iodine compounds affect the resistance of animals to aceto-nitrile only through the thyroid gland, then it may be antici-pated that the maximum effect of one compound would differmarkedly from that of others. The experiments appear to bein accord with the hypothesis in both respects. The resultsare thus summarised : 1. The iodine of bladderwrack has a

specific thyreotropic action ; it is from 80 to 200 times asactive as that of any other iodine compound studied (withthe exception of the thyroid). 2. It is possible to dis-

tinguisb, by means of physiological tests, between the iodineof the thyroid and that of bladderwrack and between thelatter and that of other iodine compounds. 3. It is possibleto obtain more marked physiological effects with mixtures ofiodine compounds than with the latter alone.

MALTA FEVER IN UGANDA.

FOR some years a mysterious epidemic malady has been

prevalent in some parts of the Uganda Protectorate, and hasbeen regarded variously as beri-beri, dengue, or possiblykala-azar. While the Sleeping Sickness Commission of theRoyal Society was passing in 1908 through Kampalu, thenative capital of the country, their attention was called tothe disease, locally known as " muhinyo," by Sir ApoloKagwa, K.C.M.G., Prime Minister of Uganda, and as a

result it was decided to make some investigation into thenature of the epidemic malady, Colonel Sir David Bruce

(director of the Commission) and Dr. A. D. P. Hodges(principal medical officer of the Protectorate) proceeding toMasuka, which is situated on the borders of the Ankole

Province, from which muhinyo " has been chiefly reported.

By arrangement with the Prime Minister and a local chiefsome 50 invalids were brought together for examination.The result of this inquiry has been recently published in theProceedings of the Royal Society by Colonel Sir David

Bruce and Captain A. E. Hammerton, Captain H. R.

Bateman, R.A.M.C., and Captain F. P. Mackie, I.M.S.,members of the Sleeping Sickness Commission. Afterdetailed clinical and bacteriological investigation the

diagnosis was reduced to a " continued fever," either entericor Malta fever. Agglutination tests with cultures of bacillustyphosus and m.icrococcus melitensis were applied to

the blood of several patients, the results being negativewith the former but positive with the latter in fairly highdilutions. The spleen in two cases was puncturad, and fromthis material cultures were procured and the organismfound was indistinguishable from micrococcus melitensis, the