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children of other workmen from other shafts remained well i

though they lived in the neighbourhood of the sick children. s

With regard to coal mine " Neumühl " with two shafts and tcoal mine " Deutscher Kaiser " with four shafts, the 1miners lived in colonies belonging to these mines and also to some extent in private houses. Other workmen also tlived in the colonies which were in close contact. The s

children from various colonies come together at school and 1

play. In ’January, 1906, 23 cases occurred ; the fathers of all of these worked in the Neumuhl mine; there were no cases in the Deutscher Kaiser mine. After Feb. lst, 1906, several miners came from the Neumuhl to the Deutscher Kaiser

. mine and on Feb. 10th the first case occurred in a child of ione of the miners of the Deutscher Kaiser. In the Neumuhl (

epidemic the children of fathers working in certain shafts iwere quite free from disease; from other shafts a few cases occurred ; and from others very many. The dwelling houses of the cases were quite separate. It was found that when miners were transferred from uninfected shafts of the Neumuhl to the Deutscher Kaiser mine no cases occurred (

in the latter, but when they came from infected shafts ’such as No. 15 there was a serious outbreak among ’’

the children of the miners of the Deutscher Kaiser ishaft to which these infected workmen had gone. 4

The conclusion come to by Dr. Jehle was that in mining 4

districts the coal mines played the same part as the school in the spread of other infectious diseases. With regard to -.epidemics of cerebro-spinal meningitis in garrisons, prisons, i

and workhouses the possibility of a naso-pharyngeal 1infection was not to be excluded ; in fact, it was extremely likely. The following seaport towns had been affected by 1

the present epidemic: Glasgow, Belfast, Leith, New York,New Orleans, Boston, Hamburg, Copenhagen, and Antwerp.Other cities have been affected, inland cities, but the numberof seaports involved was certainly noteworthy ; in regard tothis it was at least possible that emigrants played a part inspreading the infection. As to the epidemic in Leith therehad been 83 cases up to May 28th, 1907 (53 deaths). Theconnexion with the docks was very marked indeed, at anyrate at the commencement; the social class affected was thelowest one-the casual labourers and their wives andchildren ; the habits of this class as regards cleanliness werewell known. He referred to the state of the houses visited, tothe conditions under which meals were taken, and to thehabit of hawking and spitting. Dr. Fraser suggested that ina ship below decks conditions to some extent resemblingthose in a coal mine were met with-darkness, moisture, andheat ; the presence of coal dust in certain parts must not beforgotten. 80 per cent. of the patients in the Leith epidemicwere under 16 years of age ; this was just the age at whichnaso-pharyngeal catarrh was most common in connexion withthe presence of adenoid growths in the naso-pharynx. Thechildren themselves did not go down to the docks and if theepidemic had been connected with the docks it was almostcertainly through the fathers. The investigation carried outwas admittedly incomplete and was by no means free fromdifficulty. Dr. Fraser and Dr. Comrie had no compulsorypowers and the parents and children were often frightenedand refused to be examined. The secretion was withdrawnfrom the naso-pharynx by means of a long sterilised

platinum loop, the nostril being dilated by a speculumand the greatest care being taken to avoid touching thespeculum or the vestibule of the nose. The secretionwas then smeared over the surface of a sloped blood

,agar or ascites agar tube and the tubes were all placed inthe incubator within one hour of being taken. Disappoint-ment was felt at not finding the organism in a higher per-centage of the "contacts," especially of the fathers ; it mustbe remembered, however, that only one loopful was takenfrom each case and probably it would have been better tohave examined the fathers, at any rate, on several occasions.Of the 83 cases seven were double cases in one house. Withregard to the prophylaxis, the fact that measures of thisnature taken in other infectious diseases had proved uselessin stopping an epidemic of cerebro-spinal meningitis went farto prove the unusual method of infection in this disease-shutting up the schools, removing the patient to an isolationhospital, and disinfection of the house and contents had prac-tically no influence on the progress of the epidemic. If thetheory of naso-pharnyngeal infection through the fathersor others was the true one, it pointed to the necessity forisolation of all " contacts " and bacteriological examinationof the nose and naso-pharynx, These cavities should sub-sequently be disinfected with very dilute formalin or with

izal, boric lotion, silver nitrate, or potassium permanganatesolution, or pyocyanase. Since Dr. Robertson introducedthis antiseptic treatment of the" contacts at Leith therehad only been one second case in a family, and Dr. Fraserwas informed that this patient was already feeling ill at

the time when treatment was commenced. The " contacts "

should only be allowed to leave the hospital after their noseshad been reported to be free from the meningococcus on twoconsecutive occasions. The objections to this method ofprophylaxis were, first of all, the expense of isolation andexamination and probably also of compensation ; and,secondly, the tendency to secrecy which such a course mightinvolve.-Dr. COMRIE explained how the cultures were madeon blood-film agar or ascitic agar. The meningococcus wasfound in the naso-pharynx of two out of 13 cases of epidemiccerebro-spinal meningitis examined. This small proportionwas probably due to the extreme difficulty of isolating oneorganism from patients who were extremely ill and whosenasal cavities swarmed with many difEerent forms. The

organism was found in the naso-pbarynx of ten out of 69"contacts" with these and other cases. Of these ten fivewere fathers of the cases, and of the 69

" contacts 15 werefathers of cases. While the organism was present in 9 percent. of the mothers, brothers, sisters, and other relatives, itoccurred in 33 per cent. of the fathers. Five of the 15fathers worked in a ship in the dry dock and in exposingPetri dishes containing ascitic agar in various parts of thisship below decks the meningococcus was found in the air ofthe engine-room. The naso-pharynx was examined in 23controls who had no evident connexion with the disease andthe organism was not found in any of them.

EDINBURGH OBSTETRICAL SOCIETY.

Vaginal Cœsarean Section.-Congenital Goitre after Adminis-traction of Potassium Iodide to the Mother.

A MEETING of this society was held on June 12th, Dr.J. W. BALLANTYNE, the President, being in the chair.

Dr. N. T. BREWIS read notes of Six Cases of VaginalCassarean Section. The first patient was operated on for severeand intractable vomiting ; she was in the fifth month of preg-nancy and owing to the vomiting had been brought to acondition of extreme danger. The operation was performedin the patient’s house without any special preparation andwas successful in every way. The second patient was sevenand a half months pregnant; the urine was loaded withalbumin and her feet were swollen. She complained of head-ache, was stupid, and at times only half conscious, while onthe day previous to the operation she was more or lesscomatose and had only passed a very small quantityof urine which solidified on boiling. At the operation aliving child was delivered who survived after much carewith the aid of an incubator. The mother recoveredafter passing through an attack of broncho-pneumonia.Dr. Brewis preferred the operation to that of theclassical Cassarean section as being simpler, safer, andmore quickly performed. The operation was performed atfull time in the third patient for stenosis of the os followingamputation of a hypertrophied cervix. The child was bornalive and the mother made a good recovery. The fourthpatient suffered from mitral stenosis and incompetence withcedema of the lungs. She suffered greatly from breath-lessness with heart pain and insomnia ; her conditionwas very critical. The termination of the pregnancy wasurgently indicated and Duhrssen’s operation was adopted asone calculated to cause the least strain to the heart.The result was most satisfactory, the patient being able tolie down and to rest comfortably on the third day after theoperation. The indication in the fifth case was haemorrhagecaused by premature detachment of a portion of a placentapraevia ; floodings had occurred at intervals. The patientwas about six months pregnant and at the time of theoperation was blanched and in a state of extreme weakness.After transfusion was performed vaginal Caesarean sectionwas done and the uterus was emptied. The patient re-

covered. The sixth case was one of continuous haemorrhagein a patient two and a half months pregnant. Though theuterus might have been emptied by other means Dr.Brewis preferred Duhrssen’s method because it couldbe carried out more quickly and conveniently than byany other procedure. All the mothers recovered. Dr.Brewis said be considered that whenever the element of time

1714

was of importance vaginal Caesarean section was a valuableaddition to their resources. An operation which enabled themto pass the hand with safety into the interior of the uterus ina couple of minutes was one that might reasonably have itsindications extended. It should not be restricted to cases ofa serious nature but might be applied to all cases where the -*

operation could accomplish its object more easily and con-veniently than any other. It was an operation which appealedstrongly to anyone with surgical instincts and those who hadhad experience of it could not do otherwise than commendit.-Dr. J. LAMOND LACKIE, Dr. J. HAIG FERGUSON, and thePRESIDENT made remarks on the paper, and Dr. BREWISreplied.

’ Dr. B. P. WATSON read a paper on Congenital Goitre occurring after potassium iodide had been administered to the mother during pregnancy. The mother had suffered fromsyphilis and had had five miscarriages, two at the thirdmonth and three at the seventh month. During the three succeeding pregnancies she was treated with potassium iodide Iand carried two of the children to full time. The second of r

the children had at birth a large goitre which gradually decreased in size till the child’s death from an intercurrentdisease at the age of three and a half months. Histological examination showed the goitre to be of the parenchymatous 1

variety. Four cases were mentioned where congenital goitre followed the administration of potassium iodide to the (mother during pregancy and one where both the chlorate andiodide had been given.-The paper was discussed by Dr.JAMES RITCHIE, Dr. H. 0. NICHOLSON, Dr. G. KEPPIE

PATERSON, Dr. FERGUSON, and the PRESIDENT, and Dr. ]WATSON replied. :

BRITISH GYNECOLOGICAL SOCIETY.-A meetingof this society was held on June 13th, Mr. W. D. Spanton, the President, being in the chair. The following motionwas adopted :- , !

That we, the Fellows of the British Gynsecological Society, desire toexpress our feelings of deep regret at the loss the society has sus- .tained through the death of our Honorary President, Dr. RobertBarnes. *

Mr. A. W. Mayo Robson gave an address on the Modern Treat-ment of General Peritonitis and said he wished to bring thesubject forward in a general way from the point of view ofpelvic as well as of general surgery. He advised early opera-tion and if undertaken within 12 hours of the onset thisought to result in saving the patient; if within 24 hoursthere was a probability that the patient’s life would besaved; but if later there was only a chance of doing so. Asshort an operation should be done as possible without anydamage to the viscera. If the cause were discovered it

ought to be removed. Sponging and washing should beavoided but as much pus should be removed as couldbe done conveniently. After injection of as much fluidas possible either by the rectum or transfusion the

patient should be propped up in a sitting posture inorder that the septic fluid might gravitate to thelowest part of the abdomen and so be drained away readily.-Sir W. J. Sinclair recommended morphine and largedoses of alcohol combined with flushing of the abdomen withsaline solution, and considered if puerperal patients werewatched and treated well they would not get peritonitis.-Mr. Charles Ryall believed the best form of drainage wasby absorption and this was obtained by free action of thebowels.-Dr. Heywood Smith said large doses of calomelgave excellent results in the prevention of peritonitis.-Mr.Alban H. G. Doran said there was a great deal more to belearned about peritonitis and the best principle on which toact was to avoid it. The treatment with opium was ofquestionable utility.-Dr. Bedford Fenwick found the sittingposture useful when there was a difficulty in getting thebowels to act. He urged the avoidance of drainage and flush-ing.-Dr. H. M. Macnaughton-Jones advised the applicationof ice to the abdomen on the first appearance of symptoms.He preferred small doses of calomel to large ones. Themost important question was whether the abdomen oughtto be opened early or whether the symptoms only should betreated. He advised subclavian or submammary infusionin preference to rectal injections.-Dr. J. H. Dauber con-sidered that the real hope for the future lay in the antitoxinmethod of treatment.-Dr. W. H. Slimon, Dr. H. Beckett-Overy, and the President also spoke and Mr. Robsonreplied.

Reviews and Notices of Books.Alcohol and the Human Body. By Sir VICTOR HORSLEY,

F.R.S., &c., and MARY D. STURGE, M.D. Lond. With a,

Chapter by ARTHUR NEWSHOLME, M.D. Lond., MedicalOfficer of Health of Brighton. With 14 plates and 21illustrations in the text. London: Macmillan and Co.1907. Pp. 370.THE literature already published in reference to alcohol is

so voluminous that it might be doubted whether any newbook was necessary or could be expected to settle once and’or all this much-debated subject. The prominence recentlygiven to the question in medical circles and the scientificeminence of the principal author of the present work will,lowever, doubtless secure for it a wide circle of readers.

rhe book is not specially addressed to the medical professionbut to the public at large and is commendably free fromtechnical expressions. The descriptions of the cells of thebody, of the various tissues, and especially of nervous

structures, as well as of the different functions which the

organs discharge are given in simple language which the layreader will have no difficulty in grappling with.

Sir Victor Horsley’s views on alcohol are fairly well

known; his platform utterances have led most to regard himas an extremist; but in the book before us extravagantlanguage is conspicuous by its absence and its conclusionsgain rather than lose thereby. We are, of course, in

thorough agreement with those portions of the book whichare directed against the misuse rather than the use ofalcoholic beverages. There is no truer friend of temperancethan the medical man. But the list of ailments due toalcoholic excess may surprise even the medical reader by itslength, just as the list of maladies which advertisers pro-claim their patent nostrums are good for is also portentouslyand impressively long. There is no pill which is a universalpanacea for all human ills and there is no single cause towhich nearly every illness can be attributed. The evils dueto excess of alcohol are real and numerous and it is almosta truism to say that the nation’s health and morals would-

improve if the immoderate use of intoxicating liquor was.stopped. The change for the better which has alreadyoccurred is partly due to the gradual evolution of the moralsense of the people ; still, we do not minimise the efforts ofthe teetotal party. Every great reform has had its en-thusiasts and its fanatics. It is often only the fanatic whocan obtain the ear of the people ; too often they are deaf tothe more reasoned voice of the accurate thinkers who can seeboth sides to a question.Alcohol is not taken as a food ; its combustion in the body

may liberate a certain amount of heat and energy, but it isnot for this reason that people take it. We may also freelyadmit that it is a poison and in sufficient doses a dangerouspoison. We should not hesitate to prescribe teetotalism tothose unable to restrain their appetites, to those who have aninherited or other taint in the direction of want of nervous

control, and to those whose limited income should make themhesitate to spend their money in indulgences. But it is a

very different thing to recommend universal abstinence fromalcoholic drink. The tendency of medical practice has beento lessen materially the employment of alcohol as a drug inrecent years ; still, we doubt whether many practitionerswould care to be altogether without it in emergencies. To

expunge alcohol from the Pharmacopoeia because it is a

poison would be only the first step in excluding manyother useful drugs for a precisely similar reason. It is

hardly necessary to point out that the use of a poisonas a drug is a question of dose and that another factorin its employment is the presence of abnormal condi-tions of the body. Sir Victor Horsley and Dr. Mary