944 THE NEW PHOTOGRAPH?.

idle and abused the privileges that they had purchased ;that dressers, having no proper supervision, very usuallyneglected their duties ; that the house-surgeons being chosenfrom these gentlemen were frequently ignorant ; that the

nursing was often bad, and that no proper attention was paidto the diet of the patients ; that the buildings of the hospitalswere sometimes uncleanly and insanitary,-these and otherunpleasant facts he brought to light by his elaborate systemof reporting and treated with proper out-speaking. Can itbe wondered at that within the walls of the hospitals, byall save the students for whom he fought, his name was asynonym for mischief-maker and agitator ? 2

(To be continued.)

THE NEW PHOTOGRAPHY.DIRECT VISION BY MEANS OF THE ROENTGEN RAYS.

BY J. MACINTYRE, M.B., C.M. GLASG., F.R.S. EDIN.

Shadows obtained of the Extremities and Trunk.Si-NcE my last communication I have had several screens

of calcium tungstate prepared, and as a number of experi-menters have asked for information about the preparation ofthe crystalline form, the following notes may be useful. Thelast preparation I mentioned in THE LANCET was made forme by Messrs. Barrs and Sallock, but Mr. J. Frank

Bottomley has kindly given me a larger quantity of the

crystals and he prepares it after Manross’s method. It con-sists in fusing together the anhydrous sodium tungstate andcalcium chloride, the latter in excess. The sodium chlorideand excess of calcium chloride are dissolved out and crystal-line calcium tungstate is left behind to be filtered off and dried.The crystals are a mixture of needles and octahedra, but thelatter can only be seen with the microscope. This makes anexcellent screen, but I still find the potassium platino-cyanidethe best. The following cases for diagnosis have comeunder my observation since last week. In one, a suspectedcase of unreduced dislocation of the phalanx, Dr. Rentonand Dr. Somerville saw distinctly (without photographs) thatthe parts were in proper position. In another I showedto several medical men an old fracture of the forearmwith the fragments of the bones in an altered position.Following up my former experiments, I may say thatnot only do I find it extremely important to preparethe screen properly, but the distance of the Crookes’stube from the object must receive the most carefulattention. By regulating the distance one can get verydistinct shadows, but of course the further off the sourceof the "x" rays (i. e., the Crookes’s tube) the less do we getfluorescence. I have now seen all the bones of the twoextremities, and with such definition as to be quite practicalfor many surgical purposes. What is still more important tonote, I have seen distinct shadows of the vertebral columnand ribs. The sternum is also seen if the Crookes’s tube be

placed behind instead of in front. In the latter case I couldsee the shadows of the buttons on the clothes as well throughthe body. It is an easy matter to penetrate the head, but,as I mentioned in the last article, we still need further im-provement in the source of the rays. A little more powerfrom the tube is what we now require. One of the mostbeautiful results I have got was shown to several of myfriends during the week when the dillerent movements at theelbow were seen. These could be distinctly made out and themovements of extension and flexion were extremely plainlydemonstrated.

____

Mr. George Heaton, F.R.C.S. Eng., surgeon to the GeneralHospital, Birmingham, sends us the following account of acase where a foreign body in the wrist was localised andsuccessfully removed by the aid of Roentgen’s method ofphotography."A man aged thirty-two years, whilst at work on March 18th

was struck by a piece of metal on the ulnar side of the leftwrist, which made a small wound which bled freely. Hewas removed to the General Hospital, Birmingham and thewound examined carefully by the house surgeon on duty.

1 Liebig’s Annalen, vols. lxxxi. and lxxxii.

No foreign body could be detected either by palpation orwith the probe. The wound was dressed antiseptically andthe arm kept at rest in a splint. On March 25th a photo-graph (which I enclose) was taken by Mr. Hall Edwards,exposure of one minute and forty-five seconds being given.The foreign body can be seen distinctly lying in the palmaraspect of the semilunar bone. Even after localisation byRoentgen’s method the foreign body could not be felt throughthe unbroken skin. The same day an anaesthetic was

administered and a small incision made in the situation, asshown in the photograph. The foreign body, a sharp thinpiece of steel, was found at once lying deeply amongst theflexor tendons of the wrist over the semilunar bone. Thewound was closed and has since healed."

*** We do not reproduce the photograph, as it presentsno features differing from numerous other photographs thathave appeared in our pages and elsewhere. The foreignbody is, however, very well shown in it."-ED. L.

EXPERIMENTAL RESEARCHES OF THEROYAL COMMISSION ON

TUBERCULOSIS.

II—MILK.

THE danger to public health arising from the consumptionof tuberculous milk has been generally, and probablycorrectly, estimated to be considerably greater than thatwhich arises from tuberculous meat. Whether the dangeris confined to milk from cows with tuberculous udderdisease or exists also in milk from tuberculous cows withnormal udders is a matter which has given rise to consider.able discussion. Some cases have been reported by ProfessorBang and others where a tuberculous cow with an apparentlyhealthy udder gave demonstrably infective milk. A largenumber of such cases would doubtless be conclusive on

this point, but so far very few have been recorded, andthe possibility that in these cases the bacilli owed theirexistence in the milk to undetected tuberculous depositsin the mammary glands must not be overlooked. The

experimental researches of the Royal Commission on Tuber-culosis tend to show that tuberculous udder disease mustbe established before the milk becomes infective. In PartIII. of his inquiry, Dr. Sidney Martin gives particularsof experiments with milk of eight cows, one with

,

"mild." five with "moderate," and two with "advancedand generalised

" tuberculosis-all shown to be free fromudder disease post mortem. The milk of two cows

was distinctly abnormal: one with "advanced and gene-ralised " tuberculosis gave a yellow milk with con-

siderable excess of fats and deficiency in lactose ; anotherwith "moderate" tuberculosis, gave milk with a largeexcess of albumin and a corresponding deficiency in casein.Milk of the remaining six cows was in no case markedlyabnormal to chemical and physical tests. Tubercle bacilliwere not to be found in the milk of any of the eight cows.The milk of each was tested by inoculating experimentalanimals ; of a total of twenty-eight guinea-pigs and rabbitsthus inoculated none developed tuberculosis. It was alsoused to feed a number of guinea-pigs, each guinea-pigreceiving about a litre of milk. In addition, milk of each offive of these cows was given as food to pigs, which are

peculiarly apt to contract tuberculosis from feeding. Thesmallest amount of milk consumed by any one pig was sevenand a half litres, while as much as fifty-six litres (and thisfrom a cow with advanced and generalised tuberculosis)was given to another. None of the pigs or guinea-pigs thusfed became tuberculous.Two other tuberculous cows had been purchased in the

belief that they had tuberculous udder disease, but examina-tion of the udder post mortem showed that the affection wasa non-tuberculous interstitial mastitis. The milk of thesecows similarly tested proved to be uniformly non-infective.Milk of cows with tuberculous udders, on the other hand,was found to be extremely virulent. Five such cows wereobtained, twenty-one animals were inoculated with milkfrom one or other of them, and all became tuberculous. Inthree cows the virulence of the milk proved as great in the

1 No. I. (Meat) was published in THE LANCET of Feb. 29th, 1896.

945EXPERIMENTAL RESEARCHES OF ROYAL COMMISSION ON TUBERCULOSIS.

feeding experiments, for in each case all the animals fedbecame tuberculous. Tubercle bacilli were found in themilk of each of these three animals. Of the remaining two,the milk of one was infective to three out of the nine

guinea-pigs and to the one pig fed with it, while the milkof the other was consumed by two guinea-pigs only, both ofwhich remained healthy. Bacilli had not been found in themilk of either of the last two cows, although in each casethe infectivity of the milk had been demonstrated by inocu-lation. The disease produced in the test animals was in

every case a rapid form of tuberculosis." The milk of cows with tuberculosis of the udder possesses a viru-

lence which can only be described as extraordinary. All the animalsinoculated showed tuberculosis in its most rapid form, such as it isseen after inoculation with a recent tubercular lesion, and this was thecase even with Cows 8 and 24, the milk of which gave irregular resultswith feeding, so that in one case (Cow No. 8) it was possible to diagnoseas tuberculous a local lesion produced by milk injection, even thoughthe guinea-pig lived only nine days, tubercle bacilli being found in thethickened tissues at the seat of injection."

Dr. Martin found no diminution in virulence to testanimals when this milk was diluted to four times its bulkwith healthy milk; indeed, a dose of even 0’05 to 0.1 C.c.diluted with healthy milk was sufficient to produce tuber-culosis. He also experimented with skimmed milk, butter-milk, and butter prepared from tuberculous milk. Each ofthese products produced well-marked tuberculosis both byfeeding and by inoculation in all the animals experimentedon, and it is important to note that the virulence of skimmedmilk, butter milk, and butter was not notably decreased bya previous addition of healthy milk to the tuberculous milkemployed in their manufacture.We do not get much information from these inquiries as to

the physical characters of the tuberculous udder. Dr.Martin observes :-"Tuberculosis of the udder is a slow, painless growth. A disease of

the udder which is slow in development, taking weeks or months toaffect a large portion of the udder, and occurring in a tuberculousanimal, is in all probability tuberculosis. Anything more definite thanthis cannot be said."

Absence of tenderness in the growth and enlargement ofthe supra-mammary glands are neither diagnostic of thenature of the enlargement. As regards the milk itself,diminution in its quantity, although common in tubercu-losis of the udder, frequently occurs in other morbid con-ditions of the cow; chemical analysis in certain cases candemonstrate some abnormality, but does not in any caseindicate that the abnormality is due to tuberculous udder.Examination of the milk for bacilli might have been expectedto demonstrate the existence of the disease in all cases, yetin the two cows already referred to repeated examination forbacilli, with and without the aid of the centrifugal machine,was made without result, the milk from both cows beingnone the less infective to test animals. In fact, Dr.Martin shows, if tubercle bacilli are not found the only trust-worthy test is the inoculation of experimental animals withthe suspected milk. Obviously this test is not one whictcan be readily applied by the farmer or veterinary surgeon tccases of suspected disease of the udder. Dr. Martin recom.mends, therefore, that a cow affected by any form of diseaseof the udder should be excluded from the dairy farm, not onl3where there is an obvious enlargement (of whatever nature;in any part of the udder, but also when the milk from oneor more quarters is observed to fail either in quantity 0]quality. The diseased cow thus set apart can then b(

thoroughly examined by a person competent to apply th(necessary tests. But, in reality, the question is a wider onefor any tuberculous cow, no matter what the stage of it:tuberculosis, is liable to have its udder affected. As pointecout in these inquiries, the onset of udder tuberculosis iinsidious and may be very difficult of detection. Nothingshort of a knowledge of all the tuberculous cows of a dairytheir separation from other cows, and a frequent inspectionby competent observers would serve to minimise the ris]of the milk they supply-if, indeed, the milk of any tuberculous cow is allowed to be consumed at all.The effect of heat on tuberculous milk forms the subjec

of an elaborate research by Dr. Sims Woodhead (Inquiry III.Parts 8 and 9). He used for experiment both milk frorcows with tuberculous udders and milk rendered tuberculouartificially by intimate admixture of tuberculous sputum oof portions of tuberculous organs very finely divided. Hfound that of the two the natural tuberculous milk in thraw state proved to be more uniformly infective. Dilutio

with healthy milk appeared in some instances to reduce, andin others to make no difference to, the infectivity of tuber-culous milk. Dr. Woodhead accepts as proved that raisingmilk to 100° C. even for a single instant will completely killtubercle bacilli contained in it ; and he adopts the explana-tion of Hodenpyl and Prudden and others that " tubercles

"

produced in animals by inoculation of boiled tuber-culous milk are the result of necrosis round the bodiesof dead bacilli and do not contain the living microbe.In his own experiments he kept tuberculous milk (naturalor artificial) in a water - bath specially contrived forthe purpose for given periods of time at each of a

long series of temperatures from 50° to 90° C. He thentested the milk so treated in each instance by inoculatingand by feeding test animals with it. The results of intra-peritoneal injection of guinea-pigs are instructive. Here theeffect of heating the milk to a temperature short of 100° C.was manifested in two ways. In the first place such partialheating rendered the milk capable of infecting only a small proportion of the test animals, whereas the raw milk hadrendered every animal experimented on tuberculous. Theproportion of animals attacked was smaller as the tempera-ture to which the milk was raised was greater; it wasalso smaller as the time at which the milk had been keptat a particular temperature was longer. In the second placethe test animals attacked under these conditions sufferedfrom a slowly progressing and limited tuberculosis, theslowest progress and the most marked localisation of lesions

being obtained with milk heated to the highest temperatureand for the longest time short of altogether destroying itsinfectivity. Dr. Woodhead found evidence of attenuationof virulence in the way indicated when the milk had been

kept for some time at even as low a temperature as 50° C.

Although the character of the disease produced was

perhaps modified, and although in some cases the pro-portion of test animals affected was small, tuberculosiswas nevertheless produced in guinea-pigs by intra-peri-toneal injection of milk which-to instance a few ofDr. Woodhead’s results -had been heated momentarilyto 90° C., heated for twenty-two minutes to 75° C., forhalf an hour at 70’C., three hours at 65° C., or twelvehours at 50° C. After heating for a longer time at each ofthese temperatures the milk appeared innocuous to guinea-pigs. It was found, however, that the results of feedingpigs with tuberculous milk afforded a still more delicate testof infectivity than inoculating guinea-pigs. The results offeeding pigs are noteworthy and may be gathered from Dr.Woodhead’s table (Ixxv).

Feeding Experiments with Pigs, using Artificial TuberculousJjIaterial heated to Different Temperatecres for VariousTimes.

+ = Where experiments gave positive results.- = Where experiments gave negative results.

Where spaces are left blank no experiments were made.

From this table it will be observed that artificial tuberculousmilk kept at 80° for ten minutes or for a quarter of an hourat 75° still remained infective when given to pigs as food.For any indications to the contrary furnished by theseexperiments, the infectivity to pigs may still exist in milkraised to higher temperatures and heated for longer periods.This is all the more important as the analogy between themanifestations of the modified tuberculosis produced in thepig by this imperfectly heated milk and the strumous" "

glands and other chronic tuberculous lesions of children andadults is an exceptionally close one-a point fully insistedupon by Dr. Woodhead. His experiments suggest doubts ofthe ability of several processes applied to milk under thename of "sterilisation" " or "Pasteurising" " to destroy theinfectivity of tuberculous milk to man.

946 RINGSBÛRY v. HART.—THE AN’GLO-ÈGYPTIAN NILE EXPEDITION.

KINGSBURY V. HART.

THE Fylde Medical Society, of which Dr. Kingsbury isthe Hon. Secretary, held a special meeting in Blackpool onMarch 20th, 1896, to hear an explanation from him of thecharges against him in the British Medical Journal ofJan. 18th, 1896, deeming it more satisfactory that his con-duct should either be vindicated or condemned by membersof his own profession than that the verdict of a lay jury,already given in his favour at the Manchester Assizes, shouldbe accepted as final.

Dr. Kingsbury dealt fully with the anonymous accusationsof "Ethics, and the comments thereon by the editor of theBritish Medical Journal, and gave a detailed account of hislong connexion with both the hydropathic establishments ofBlackpool, and answered all the questions submitted to himby the members of the society.

Mr. Day proposed : ’’ That, having heard the explanationgiven by Dr. Kingsbury, the Fylde Medical Society hereby

unreservedly accepts the same as satisfactory." Mr. Easonseconded the proposition and expressed his perfect confidencein the hon. secretary, who had always taken the keenestinterest in maintaining the ethics of the profession. Theresolution, having been supported by Dr. Brown, Dr. Blun-dell, Mr. Dunderdale, Mr. Lenihan, and Mr. Calvert, wascarried unanimously.

Dr. Stott then proposed: "That, in the opinion of thissociety, the attack of Ethics’ upon Dr. Kingsbury and themethod adopted by I Ethics’ in making such attack are to bestrongly condemned." Dr. McIntosh, having seconded thisresolution, it was also carried unanimously.

Dr. Kingsbury then read a letter dated March 14th, 1896,which he had addressed to the editor of the British MedicalJournal the moment that gentleman had publicly stated thathe accepted the Manchester jury’s verdict as a justone. To this letter an answer was received from the assistanteditor, under date March 19th, 1896, saying : " Your letter ofMarch 14th, addressed to the editor of the BritisA MedicalJournal, has been very carefully considered, but it has

appeared to be on the whole undesirable to publish it in theBritish Medical Journal. In compliance with your requeathe letter is herewith returned."A resolution was then proposed by Mr. Richardson,

seconded by Mr. Lenihan, and unanimously carried, con-demning the action of the British Medical Journal in refusingto publish Dr. Kingsbury’s letter of March 14th, 1896.At the conclusion of the meeting Dr. Kingsbury received

the warmest congratulations of his medical brethren.

THE ANGLO-EGYPTIAN NILE EXPEDITION.

No time is being lost in vigorously prosecuting this ex-pedition. The passage of troops and war material up theNile continues to be actively carried on. It is expected thatthe whole of the force composing the Dongola column willbe concentrated at Sarras, thirty-five miles beyond WadyHalfa, within a month. The railway to Akasheh is beingpushed on and troops and provisions are being rapidlytransported to the front. Those of our readers who are

acquainted with the way in which the Egyptian authoritiespack their troops on board steamers and barges will readilyunderstand the large numbers that can be transported undersuch circumstances compared with those of British soldiers.So far as the present expedition has gone, the organisationand transport arrangements have been working extremelywell. Assouan has been, and still is, a scene of greatactivity, and a large camp exists at this station. Sir H.Kitchener, the Sirdar of the Egyptian Army, is organisingthe expeditionary force at Wady Halfa, where a British regi-ment should have arrived by this time. A body of Dervishcavalry recently reconnoitred in the vicinity of Akasheh,but retired on being fired upon by the Egyptian troops. Thenews of the advance is said to have caused great excitementat Dongola. There are now three battalions of Soudaneseinfantry, with several squadrons of cavalry, a battery ofartillery, and a camelry corps at Akasheh, and additions to theforce at this station are being rapidly made. The health ofthe troops is stated to be very good so far. The heat is only

great at midday, but the hot wind from the south-west-thekhamsun-is due at this season and the temperature anddiscomfort, and probably the inefficiency from sickness,may be expected to increase on its appearance. Largequantities of medical and other stores for the hospital servicehave been forwarded with the expeditionary force, and withthe number of medical officers already in Egypt and thosearriving there from this country it is believed that the expe-dition will be well provided in these respects. The militaryauthorities in Egypt have had a good deal of experience ofmilitary expeditions up the Nile and are practically acquaintedwith their requirements. The major portion of the force,consisting of Soudanese and Egyptian troops, are accustomedto and stand the climate well ; but this cannot, of course,be said of the British troops, although the results of ourprevious expeditions have shown that with proper care andhygienic precautions our soldiers withstand the climate muchbetter than might be anticipated. Everything connectedwith field service arrangements in these respects is muchbetter understood, and much greater care is taken nowadaysin regard to health and sanitation, than was formerly thecase. Still, as everybody knows, the heat in these regions isvery great during the approaching season, and a certainamount of disease must inevitably follow.

Public Health and Poor Law.LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

Crewe Urban District.-Mr.Herbert Jones, the medicalofficer of health of this important district, which has now apopulation of some 37,000, is given by the sanitary authoritysomewhat difficult tasks to perform. To cope with an

epidemic of scarlet fever, or, indeed, of any other disease,without the means of isolation, or even the assistance of theNotification Act, is a thankless and hopeless labour fromwhich we should ask to be excused. Yet this was the taskwhich Mr. Jones was left to carry out in 1895. School closurehad to be resorted to in order to check the spread of thedisease, but, as Mr. Jones observes, this step really tookaway from him the only source of information as to the dis.tribution of the disease which in the absence of notificationhe possessed. It is obviously impossible for the many pointswhich suggest or contra-indicate school closure in any givenepidemic to be ascertained without notification, and we

suspect that much injustice is done to elementary educa-tion by what must, in the absence of notification, bemore or less a step in the dark. The exact distributionof cases in a district is one of the essential pieces ofinformation with regard to any intelligent application ofthe powers vested in the medical otticer of health asto school closure. In the matter of isolation accommo-dation we are glad to be able to record that the towncouncil has now obtained the consent of the LocalGovernment Board to borrow the necessary funds, and thatthere is every prospect of the town being shortly providedboth with a hospital for small-pox and one for other infec-tious diseases. The matter of notification still seems to hangfire, in spite of the fact that Mr. Jones has urged on thesanitary committee upon numerous occasions the necessityfor the adoption of the Act. The committee seem to thinkthat it will be well to delay notification until after the erec.tion of the fever hospital ; in other words, they advocate inprinciple the plan of building stables before the number ofhorses which they will be called upon to provide for isknown.

-kingston-upon-Thames Urban District.-Mr. Beale Collinsreports that the most important event of the year 1895 wasthe severe frost which brought home to the community ofhis district the disabilities under which they labour in notpossessing the control of their own water-supply. Mr,Collins states that during the stoppage of the water by frosthe measured the depth of the main in a certain road andfound it to be but eight inches from the surface, and in noplace in the road in question did the pipes when uncoveredappear to be at a greater depth than eighteen inches. In the

matter of isolation accommodation the sanitary authorityhas purchased a site, and Mr. Collins urgently impresses