61

occurrences as the one detailed below, the account of whichI purposely refrain from translating :-"Un traitement des tumeurs du bras non prevu par les traites de

chirurgie. C’est une brave concierge qui expose la recette devant letribunal on elle poursuit l’auteur pour escroquerie. ’Mon mari et moinous sommes alles consulter Madame. Elle a examine le bras de monmari ; elle a fait dessus des signes de croix en prononçant des motslatins.’ Le president : ’Lesquels?’ Le t,6mciiii: ’Je ne pourrais vous direau juste...Roupioupiou ..trAla]a...bada.boumorum.... Quelque chose dansce genre-la. Ensuite elle a perce la tumeur avec une aiguille.Pendant 1’operation elle faisait tenir à mon mari un poireau cuit danssa main droite et une cliandelle allumee dans sa main gauche. Ce n’estpas tout. Elle a ordonne de graisser chaque matin la tumeur avec unepommade et de laver le bras avec du sang df lapin.’ Le pr6sident: Etvotre mari a ete gueri?’ Le temoin: non. monsieur. Ila fallu leconduire a 1’hopital ou il est encore.’

"

Bacteriology in the Provinces.The newly-elected Academical Council of Paris has just

adopted a proposal advanced by its predecessor to organisebacteriological laboratories in several provincial towns.

-Dipht7teria Statistics at the C’7ihlren’s Hospital.Dr. Sevestre has recentlyl communicated some interesting

figures relative to the cases of diphtheria treated during 1895at the Hopital des Enfants-Malades. In the course of that

year 1140 children were admitted with the probable, but notpositive, diagnosis of diphtheria. Of these 158 died, givinga mortality of 13’85 per cent. Deducting 71 who succumbedwithin twenty-four hours of their admission, we have 1069with 87 deaths, or a death-rate of 8 13 per cent. The casesof pure diphtheria without any other microbe than L6ffler’swere 392 with 39 deaths, or a mortality of 9’94 per cent.Deducting here, again, 23 deaths which occurred withintwenty-four hours of admission, the rate is reduced to 4’33per cent. Diphtheria, with associations of microbes, num-bered 486 cases, giving a mortality of 19’34 per cent.,or, deducting the fatal cases within twenty-four hoursof admission, 12’11 per cent. ; in other words, "asso-ciated" diphtheria was twice as fatal as the simple variety.Dr. Sevestre is convinced that, contrary to the opinion ofseveral of his colleagues, the association with the specificmicrobe of the streptococcus aggravates the prognosis. The

employment in these cases of lB1armorek’s serum does notappear to have been attended with success. So long asRoux’s serum remains transparent it may be safely used,even though it be old. All Dr. Sevestre’s patients were sub-mitted to the usual treatment of diphtheria plzcs injectionsof Roux’s antitoxin, the latter in doses of from 10 c.c. to30 c.c., according to the severity of the case. In mostinstances a single injection proved sufficient, the exceptionsbeing croup and very bad throats, where one or two repeti-tions of injections of 10 c.c. at from twelve to twenty-fourhours’ intervals were frequently necessary. The supple-mentary treatment consisted in douching of the fauces witha 5 per cent. Labarraque’s solution and in the administra-tion of tonics and suitable nourishment. In certain instancestubage or tracheotomy had to be practised. For the formeroperation the short tube was utilised, it being more easy ofintroduction and of removal. In cases of sub-glottic laryn-gitis, however, the long tube is to be preferred. The tubewas kept in situ for three or four days, sometimes notso long ; in other cases it was left without incon-venience for several weeks. The mortality of croupcases treated without operation was 14’11 per cent., or,

deducting those fatal within twenty-four hours of admission,6 04 per cent. The mortality of children intubated was27’07 per cent., or, deducting those dead within twenty-fourhours of the operation, 17’73 per cent., the correspondingfigures for patients tracheotomised after unsuccessful intuba-tion being 87 per cent. and 37 per cent. Dr. Sevestre con-cluded his instructive paper by stating that post-diphtheriticparalysis seemed to him to be a,s frequent after the antitoxintreatment as it was before it was discovered, but that the

paralysis was of a milder type. -11. Netter opines, on thecontrary, that paralysis is less frequent than under the oldtreatment.

1’dlct;tchtaa7‘.zn.y <’//;.’/’ Hyg&Uacute;I/( in Z’//:f.Of late years cases of phosphoric necrosis requiring

surgical treatment have become relatively infrequent in thevarious French establishments devoted to matchmaking-two in 1890, none in 1891, three in 1892, seven in 1893, andthree in 1894. Since 1894 every workman presenting theslightest sign of phosphoric poisoning is reported by themedical attendant as affected with incipient necrosis. The

1 Soci&eacute;t&eacute; M&eacute;dicale des H&ocirc;pitaux. June 19th.

sufferer is then at once removed to a distance from thefactory and subjected to appropriate treatment, for the mostpart in the open air, until the absorbed phosphorus has beeneliminated. During this period, and pending complete con-valescence, the patient receives an allowance for his family.In 1894 fourteen workmen, of whom thirteen came from thefactory at Pantin, were found to be more or less affected;but during the first ten months of 1895 the number rose totwenty-five, no fewer than twenty-four being employed atthe above-mentioned establishment. The amount expendedon sanitary improvements in workshops and the provision ofhygienic appliances, together with the ever-growing alloca-tions to industrial institutes, has now attained to the grandtotal of 1,200,000 francs.June 30th.

________________

BERLIN.

(FROM OUR OWN CORRESPONDENT.)

Chronic Poisoning by Carbon Disulphide.DR. STADELMANN, physician to the City Hospital, recently

drew the attention of the Verein fur Innere Medicin to certain

peculiar symptoms observed in workmen employed in india-rubber factories, and he showed three patients who, afterhaving worked for some weeks in those factories, were seizedwith giddiness, headache, tremors, drowsiness, loss of

energy, and gradual impairment of vision. One of them, aman aged twenty-eight years, complained of xanthopsy, andobjects moving in the street appeared to him as if seenthrough a cloud; he also had painful contractions of themuscles and an increasing difficulty in walking or even instanding. Another patient suffered from stammering andfear of walking in the dark, and a further remarkablesymptom was anaesthesia of certain portions of the skin. Allthese phenomena were due to carbon disulphide liberated inthe factories, and they are quite characteristic, although only a.small number of such cases has been reported up to thepresent time. Some patients declared that their food hada sulphurous taste and in grave cases insanity ensued.Preventive measures had obviously been neglected, and Dr.Stadelmann thinks special regulations very necessary forindiarubber factories. Workmen showing the symptomsabove described ought to be at once removed from the un-wholesome atmosphere.

The Berlin Royal Institution for Infectious Diseases.In 1890, when Professor Koch made his sensational

announcement respecting tuberculin, a special institutionwas founded by Parliament, under the name of the RoyalInstitution for Infectious Diseases, in order that ProfessorKoch might be enabled to continue his researches on thetreatment of such diseases on a larger scale than before,and it was placed entirely at his disposal instead of beingcontrolled by the university, like all the other scientificinstitutions. It was, in fact, a special hospital in which newmethods of treatment were to be tested, and it also con-tained a large laboratory, provided with every requisite,where not only Professor Koch and his staff, but a numberof other medical men carried on scientific work. Temporarypremises were erected at great expense near the ChariteHospital, from which patients with infectious diseases weretransferred, but as the Charit6 Hospital, which is the oldesthospital in Berlin, is to be demolished and reconstructed theInstitution for Infectious Diseases cannot remain where it is.The Government, however, which in 1890 spared no expenseto facilitate Professor Koch’s work on tuberculin, seem nowto be reluctant to spend much money in this way, and themunicipal authorities of Berlin gave an unfavourable replyto a request that they should attach the Institution to one ofthe municipal hospitals. The Government then announced thatthe Institution would possibly be removed from Berlin and thetown council of Frankfurt offered to provide Professor Kochwith ample laboratory and hospital accommodation if hewould agree to settle in their city. A change came overpublic opinion in Berlin when these negotiations were known,the medical as well as the lay press asked the Governmentto take measures to retain this important establishment inthe metropolis, and an arrangement has now been madeaccording to which the Institution is to be attached to thenew Berlin Municipal Hospital at present in course of con-struction. The laboratory department will be built and

62

furnished by the State, whilst the wards for infectious B- diseases belonging to the hospital are to be placed at the disposal of Professor Koch by the municipal authority. Thisarrangement was strongly supported by Professor Virchow,who is a town councillor, and it will undoubtedly havethe approval of the medical men of Berlin, anxious as they s

are not to lose so celebrated a savant as Professor Koch. dI

The Administration of Ovarian Substance for Climacteric lTroubles. h

Professor Landau has been treating climacteric troubles by c

the administration of ovarian substance, and an account of this work has been published by his assistant, Dr. Mainzer. t

The remedy was used not only in pains due to the natural 1-climacteric period, but also in the case of women whose <

ovaries had been removed by operation, in amenorrhoea’from prolonged lactation, and in hysterical subjects. The (

patients who had reached the climacteric age complained (

principally of sensations of fulness in the head, occurring ]

,many times during the day, pains in the back and legs, &c. The dose varied from a gramme to a gramme and a half (from fifteen to twenty-two grains) administered in the formof tablets containing each half a gramme of the ovaries of pigs or cows. After two or three days the sensations of fulness in the head were said by the women to be much less frequent;within a fortnight they had almost totally disappeared.To avoid the influence of suggestion tablets containing noneof the substance were given from time to time, but thesymptoms immediately reappeared and the patients feltworse. The effect, however, lasted only while the ovariansubstance was being taken ; and when it was discontinuedthe symptoms returned after a time. A remarkable effectof the treatment was that in two cases of amenorrhoea it pro-. duced a sanguineous discharge from the genital organs. Pro-fessor Landau believes that disorders of the vasomotor system’due to extirpation of the uterus or ovaries or to the approachof the climacteric period are benefited by the administrationof ovarian substance, that its emmenagogue properties, if

- any, require further investigation, although it acts as a

palliative in primary and secondary amenorrhoea, that itsgood effects are only temporary, and that in general neur-asthenia or hysteria it is inert.,June 29th.

ROME.(FROM OUR OWN CORRESPONDENT.)

The Maragliano Serum in Tuberculosis. AN authentic, well-certified case of treatment of tuber-

culosis by the Maragliano method comes from Spezia. Anative of that seaport, Edilio Mercenaro by name and anable seaman by occupation, bad since 1893 been sufferingfrom phthisical symptoms, and on examination was found to,have both pulmonary apices infiltrated with tubercle. Thedisease was not largely diffused, but it made steady progress,and by the beginning of 1894 the area of destroyed tissuewas considerably increased. Both lungs were very seriouslyaffected and Mercenaro (a young man twenty-one yearsof age) was placed under Professor Maragliano’s treatment inthe clinical wards of the Genoa Hospital. The injection ofthe serum was practised continuously for two months till theclose of Professor Maragliano’s summer course, by whichtime Mercenaro had so far improved as to return to hisnative place. Convinced of the benefit he had receivedhe returned to the ward as a patient in the Novemberof the same year and was once more subjected, under Pro-,fessor Maragliano’s eye, to the serum treatment. The case,though the progress of the malady had been arrested, wasstill a very serious one, and it was not till the close of July,1895&mdash;eight months from the resumption of the treatment-that substantial cure was effected. Several hundred injec-tions had been practised, and in the latter weeks of thetreatment it was evident that Mercenaro was conquering themalady ’ hand over hand." He left the hospital at the endof July, as has been said, absolutely cured, and since ’,,then has for six months been regularly on duty in theservice of the Royal navy. At present he is at Spezia, theobject of no little professional interest, and described by the’-physician who last saw him as &deg;&deg; sano come pesce " (sound asa roach). Professor Maragliano has no severer critics than<among his compatriots, chiefly of the Neapolitan school.

But it is fair to add that even in that quarter testimony infavour of his treatment is gaining in volume and authority.

Lightning-stroke.The thunderstorms that for the last few days have visited

so many of the Italian provinces have done very seriousdamage to property and occasioned much loss of life. TheLigurian seaboard has suffered exceptionally. " Balllightning (the ficlmen globulare of the older meteorologists)has been witnessed several times, the most dangerous anddestructive, fortunately the rarest, form which the thunder-bolt" is known to assume. Providentially, however, it hasthis year numbered no victim in Italy. But the ordinarylightning-stroke has caused much loss of life, to say nothingof many grave lesions more or less permanent. Four

, fatalities are reported from the recent thunderstorm atGenoa, all instantaneous ; and at Ventimiglia in the sacristryof a church where six priests were assembled four were

r killed outright and the two survivors are in a desperate con-dition. As a rule lightning-stroke is most common in the

E open air, generally under the tree to which the victim1 has resorted for shelter, and this circumstance, even

s where only severe injury has been sustained, makesdeath more likely, as the measures for relieving shock and

. restoring the vital energies cannot be put in practice till too:

late. But this year the majority of fatalities from lightning3 have occurred in dwelling-houses. There is no doubt thate for this greater frequency of thunderstorms, as for the moret prolonged drought and such like meteorological visitations ofnlatter years, the steady tree-felling, unbalanced by tree-I planting, is directly responsible. In his memorable plea,t "Pro bilvis," the late Professor Cantani, one of Italy’s

greatest physicians, pointed out the disasters-hygienic,agricultural, and social-to which the kingdom was becoming

n a prey from the reckless diminution of forest areas on itsh surface. Re-afforesting the denuded hillsides is, of course,n the remedy, but year by year this becomes more imprac-if ticable, as the torrential rains, consequent on the disappear-a ance of the woods, wash away the binding soil in which;s young trees can take root and leave nothing but ther- bare rock. Those who can recall Monte Gennaro (the

Lucretilis of Horace) as it was in the early forties speak of" waving woods" where now the limestone is all too visible,with resulting loss of summer coolness and increase ofautumnal rains. Professor Cantani 1 lamented the inadequateprovisions for preventing the fatal tree-felling so prevalentall over Italy. True, there are forestal inspectors who patrolthe wooded districts and keep an eye on the destruction oftimber; but as these officials (like nearly all others in

Italy) are miserably underpaid their duty is performed per-functorily, sometimes not at all. Steps, however, must ere

;r- long be taken to remedy this state of things in the peninsulaand islands, as the atmospheric disturbances it causes-an taking the form of lightning disasters, hail-storms, and pro-]g tracted drought alternating with excessive rainfall-areto pressing more and more heavily on a people terribly over-he taxed and becoming yearly less able to withstand the priva-!s tions and misery which the disastrous weather of the last tenue days has already brought in its train.ly June 27th.

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EGYPT.(FROM OUR OWN CORRESPONDENT.)

; C7tolera Bulletins in Egypt.IN Alexandria the daily cases newly reported still vary

from two to four, while in Cairo there are also droppingcases every day in various quarters of the town, the returnshaving varied during the past week from five to eight. It is

only the deaths and the serious cases which are discoveredby the medical men; the light cases as a rule go aboutunknown to themselves and are capable of transmittingindefinitely the disease. Excluding Cairo and Alexandriawe have an average of 148 new cases daily in the rest ofEgypt from the sea coast up to Assouan. The chief numberof towns and villages attacked is in the Delta, notably atDessouk in the Gharbiyeh province, but no less than339 cases have been reported during the week from theprovince of Fayoum in Upper Egypt. This special con-centration of the cholera at two places makes one fear that

1 Vide THE LANCET, Oct. 13th, 1894, pp. 861-2.