894

a suite for the matron. Behind the nurses’ home, iia separate building, is the laundry, which is suppliefwith a destructor, steam steriliser, and all the latest electri(fittings. In another separate building are a small mortuar3and chapel. It may be mentioned that the heating throughout is by the I I Reek " system, by means of radiators easilycontrolled. Now that patients can be moved into the newwing work is to be started at once on the remaining centra:portion of the building, which will contain the new operatingtheatres and should be completed in six months. The wholf

hospital then will be one of the most complete and up-to-dateof its kind, thanks largely to the efforts of Sir George T.Beatson, chairman of the building committee, and Dr.Donald J. Mackintosh, whose services as consulting expertwere secured by the committee from the outset.

Ner/) Infirmary for Perth.A meeting of the subscribers to the City and County of

Perth Royal Infirmary was held in the council chambers onSept. 6th, when it was unanimously agreed to approve of thesite in Western-avenue, Tullyhuish, for the erection of a newinfirmary, and the directors were authorised to acquire it onthe terms mentioned in the draft agreement submitted. Asum of over .615,000 had been subscribed for the re-

construction of the present building, but it was ultimatelydeemed advisable to go on with the erection of a new

infirmary altogether on a different site. The directors havereceived a sketch plan from Mr. James Miller, A.R.S.A.,architect of the Glasgow Royal Infirmary (at present beingre-erected) and the designer of the Glasgow exhibition build-ings. Mr. Miller estimates that a modern, up-to-dateinfirmary, with 120 beds, administrative block, and offices,can be erected on the site for E36,800. To meet that thereis at present in hand or available a sum of £ 32,000. Anendeavour is to be made to induce contributors of L6532to the reconstruction scheme to allow their contributionsto go to the new building, and if that is done there will besufficient to meet the cost of the new infirmary.

A Medical Practitioner’s Bequests.The late Dr. Ferguson, Loftus House, Broughty Ferry, and

formerly of Port Maria, Jamaica, has left a fortune of about.655,000. A very large part of his estate falls to be dividedas public and private bequests. Ministers and churches bulk

largely among the beneficiaries.Sept. 14th.

________ _______

IRELAND.

(FROM OUR OWN CORRESPONDENTS.)

The Home Treatment of Tuberculosis in Dublin.THE quarterly meeting of the Hospitals’ Tuberculosis

Committee was held on Sept. 9th, Sir Arthur Chance beinin the chair and Lady Aberdeen being also present. Th<

report of Mr. J. T. Daniel, who had been placed b3the Women’s National Health Association at the disposalof the committee to attend cases that were receiving ncmedical aid, was considered most satisfactory. It was

felt that in this way a great want was being met. A

report was made on the work done during the last six monthsby the tuberculosis jubilee nurses working in Dublin. 247

patients have been attended ; of these 125 were old casesand 122 were new cases. In all 3504 visits were paid to thepatients’ homes. Almost two-thirds of the patients themselvessought the nurses’ aid, and patients’ friends frequently askfor the disinfection of their homes. This is not to be wonderedat when it is realised what is done for the patients throughthe Samaritan Committee in addition to the actual nursing-help and advice being given which enable patients to carryout medical orders in their own homes. 63 families receivednourishment; 39 families received clothes, shoes, bedding,&c. ; ten families’ rent was paid while the bread-winner wasunder special treatment. 87 children of parents suffering fromtuberculosis were sent to the country through the fresh airfund; three families of children were boarded out while themothers were in hospital; 60 rooms were disinfected; fivefamilies were removed to more healthy homes ; for seven

patients work had been obtained ; and 16 patients had beenadmitted to Newcastle. There were 66 families occupyingone room, and in 35 families more than one member wasaffected. The total earnings of the families attended when

the bread-winner is ill is estimated not to exceed 5s. a weekL on an average. Mrs. A. M. Sullivan presented a report on: the work of the Samaritan Committee, and the nurse

7employed by the Terenure branch of the Women’s National-Health Association also made a report showing that the

7people amongst whom the nurses work are commencing to7understand something about the nature of the disease, andare themselves assisting in trying to stamp it out.

Cork Council and the Notifiecction oj Tuberculosis., At a meeting of the Cork corporation on Sept. 3rd the

report of the medical officer of health recommending theadoption of Part I. of the Tuberculosis Prevention (Ireland)Act, 1909, was considered. This part provides for the com-pulsory notification of pulmonary tuberculosis. On themotion of Sir Edward Fitzgerald, and after a long discussion,the council decided not to adopt Part I. of the Act in spiteof strong expert advice to the contrary.

Mullingar Asylum Committee: Claim of Surcharges.At the monthly meeting of the joint committee of the

Mullingar District Lunatic Asylum, which took place lastweek, a letter from the auditor of the Local GovernmentBoard was read asking why a surcharge of &pound; 415s. made byhim at last audit on some members of the committee had notyet been paid, and intimating that legal proceedings wouldbe taken if the amount were not promptly lodged to thecredit of the accounts by the members who had been sur-charged. A letter was then read from one of the latterstating his refusal to pay. The Chairman (in reply to theMost Rev. Dr. Hoare) explained that a contractor, whosetender for the supply of drapery goods had been acceptedby the committee, subsequently refused to fulfil his con-

tract and was released from his obligation by the com-mittee. The goods were then ordered from anothercontractor, who charged the trade price, which was

somewhat higher than that in the tender originally ac-

cepted. When the question of payment was brought underthe notice of the official auditor he surcharged the difference.The chairman expressed the opinion that it was a monstrous

proceeding on the part of the Local Government Board notto remit the charge. He did not mind the amount, whichwould be about .61 each, claimed from the members sur-

charged ; it was against the principle that they shouldprotest. After expressions of similar opinions from variousmembers, and after it was pointed out that the first contractorhad not signed a bond, the chairman moved:-That this committee is of opinion that the surcharge in this case is

unjust, and we recommend the three members surcharged to refuse topay; and, furthermore, this committee refuses to accept responsi-bility where there are bona fides and an intelligent, honest effort to dowhat is right between the ratepayers and contractors.

This motion was unanimously adopted.The Local Government Board and the Salary of the Medical

Officer of the Trim District School.The committee of management of the Trim District School

has received a letter from the Local Government Board ask-ing for information on the reasons which influenced theboard of management in again increasing the salary of themedical officer, Mr. G. McManus, and pointing out that " norecoupment can be made in respect of any additional salaryowing to the operation of Section 6 (1) of the Local Govern-ment (Ireland) Act, 1902." The committee has unanimouslyrequested the Board to sanction the increase. The factswhich formed the basis of the request were that Mr. McManushas been medical officer of the school from the time of itsinception 19 years ago, during which time he treated over2250 children for various illnesses, including cases of oph-thalmia, measles, scarlet fever, whooping-cough, bronchitis,&c., and that only five children died during that time,the deaths being mostly due to tuberculosis; and thatthe medical officer has by his attention to the welfareof the children prevented any serious developments ofdisease occurring amongst them, thus saving the board ofmanagement a considerable amount yearly in connexion withnursing. It was further pointed out that it is now seven

ears since the medical officer got his increase of salary andhat the earlier age at which children were sent to theschool necessitated more frequent attendance than formerly,with the added consideration that as the medical officerleems not to be entitled to a pension on account of his

:ervices, we consider it only fair that he should be given a

reasonable salary for discharging these duties, and we there-fore consider that the increase ’of .613 a year granted to themedical officer is a very reasonable one." Most reasonablemen will acquiesce in this view. The proposed additionwould make the yearly salary up to &pound; 80, and the admirablerecord of Mr. McManus’s services should surely appeal to theconsideration of the officials of the Local Government Board,among whom, fortunately, are included medical men of highattainments.

Accident to a Belfast Medical Man.Mr. J. S. Bryars (chairman of the Belfast board of

guardians), while driving in Westland Row, Dublin, on

Sept. llth was thrown, owing to the skidding of an

"outside" car on which he was sitting, on the tramwaylines, and as a result had his right arm broken at the wristand at the shoulder. He was able to proceed home in theevening and is progressing favourably.

The Derry Neo. 2 Rural Council and the Dairies Order.On Sept. llth, at the monthly meeting of No. 2 rural

council of Londonderry, it was decided not to adopt theDairies Order.

Sept. 14th.

PARIS.

(FROM OUR OWN CORRESPONDENT.)

Sudden Development of Amawrosis in Typhoad Fever. iAT a meeting of the Societe Medicale des Hopitaux held

on July 30th, M. Widal, M. Joltrain, and M. Weil stated that ja patient under their observation suffering from typhoid fever had manifested unusual symptoms of amaurosis which, ]both in its onset and in its disappearance, was so sudden asto suggest the possibilitv of a hysterical origin. The patient,who was a man aged 20 years, had no previous history ofvisual disorder. He was under treatment for typhoid fever ofthe ordinary type and not associated with any sign of meningeal irritation ; on the ninth day of the illness when he awoke inthe morning his sight was entirely lost. It was then foundthat there was complete bilateral amaurosis with abolition of the motor reflex to light. Examination of the fundusrevealed bilateral oedema of the papilla with marked venousdilatation. Lumbar puncture was followed by the escape of a clear fluid at very high pressure not containing eitheralbumin or cells. An improvement of the visual dis-order commenced two hours after the puncture was

made, and became very obvious at the end oftwo days. The cedema of the papilla had now

almost entirely disappeared, but the venous dilatationremained. A second lumbar puncture showed that the

pressure exerted by the cerebro-spinal fluid, although greaterthan normal, was less than it had been. On the second dayand subsequently the visual power was quite restored andthe fundus was absolutely normal. The results of ophthal-moscopic observation, and the improvement which followedlumbar puncture completely disposed of the hypothesis of aneuropathic origin, and, moreover, showed that the increasedpressure of the cerebro-spinal fluid was the cause both ofthe papillary cedema and of the amaurosis. Finally,by means of observations of the arterial pressure, whichwas always a little below normal, it was possible to

separate this case from the class of transient amaurosesstudied by M. Vaquez in certain toxic conditions, especiallyin lead poisoning, because these amauroses depended on anincrease of the arterial pressure. It was important toremember that in addition to the amaurosis of hysteria andlead poisoning there was an amaurosis of sudden onset andshort duration which might show itself in the course of aninfectious disease such as typhoid fever and was unattendedby increased arterial pressure ; this form of amaurosis wasdue to papillary cedema, as revealed by the ophthalmoscope,with increased pressure of the cerebro-spinal fluid. In suchpatients lumbar puncture not only gave a clue to the patho-logy of the condition but was a therapeutic measure pro-ducing an immediate improvement.Clinical Investigation of the Hepatic and Intestinal Functions

by Means of the Acetio Sublimate Reaction.M. H. Triboulet some time ago called attention to the

importance of the acetic sublimate reaction (Ga r&eacute;action dusublim&eacute; ac&eacute;tique) in the examination of foeces, and lie returned

to the subject at a recent meeting of the Soci&eacute;t&eacute; de l’Internatdes Hopitaux de Paris. He said that this was a simple andrapid process for determining whether a given sample offseces was normal or abnormal. The green colour ofoxidised bilirubin which was always seen in the fsecesof very young suckling infants was replaced sooner or

later by a pink tinge (r&eacute;action ros&eacute;e), which was the normalcolour for the remainder of the individual’s life. Abnormalcolouration might, however, be of many degrees. Completepigmentary acholia yielded a fluid in the test-tubes as whiteas milk, while under different conditions the resulting testfluid might be of a greyish-pink, greyish-green, or yellowishcolour ; there might also be intensifications of the colourwhen an abnormal pigment (pink, red, violet, or brown)was combined with the normal pigment. Control experi-ments have shown that this abnormal pigment of excessiveintensity indicated impairment of the functions of theliver. Weber’s reaction with tincture of guaiacum or

the phenolphthalein reaction indicated an incompletetransformation of haemoglobin into bilirubin. These

pigments were the products of a liver overburdened in

consequence of the existence of pyrexia or toxic con-ditions. Apart from the differences in colour, the fluidfrom which the deposit had settled in the test-tubeswas sometimes turbid, sometimes almost clear, and some-times quite clear. Turbidity, whether attended with coloura-tion or not, indicated that fat was being normally emulsified,and that the bilio-intestinal functions were acting well.The stercobilin reaction took effect principally in theintestinal contents in the neighbourhood of the ileo-cascalvalve, and the reaction of turbidity in those in the upperfour-fifths of the ileum. With the help of these data itbecame possible in cases of digestive trouble or enteritis torecognise approximately the portions of the intestinewhich were implicated. When the acetic sublimate re-

action was employed systematically in children’s diseases,whether acute or chronic, it would be seen that thevarious pathological processes might be referred in a greateror less degree either to the bile-producing function of theliver or to certain segments of the intestine. By means ofthe colour reactions and the variations of turbidity a fairlyexact appreciation of the functional activity of the liver andintestine might be made in the majority of clinical cases. Itwas admitted that the liver and the intestine were thedefensive organs of most efficiency against disease in thehuman subject and that the younger the individual was thebetter was the defence. The prognostic indications basedupon these reactions were therefore likely to be of greatvalue.

Paroxysmal Tachyardia.At a recent meeting of the Society of French Military

Medicine M. Deleuze communicated a paper on ParoxysmalTachycardia, and described the appearances seen at thenecropsy. The attack began suddenly and without

any assignable cause. The symptoms were violent epi-gastric pain, dyspnoea, and a slight deviation of the

pr&aelig;cordial outline without increase of the cardiac dulness.The heart made 246 beats per minute; these were

well defined and regular, without alterations of rhythmor adventitious sounds. The disease lasted for 15 days,at the end of which the patient died from failureof the heart’s action. At no time did the number ofbeats fall below 220 per minute in spite of the variousremedies that were employed, including digitalis, chloral,bromide, and morphine. At the necropsy no lesion either ofthe heart or the pericardium was discovered ; the liver wasslightly atrophied and cirrhosed ; the kidneys and lungsshowed the congestive lesions of asystole. The case was

probably one of essential paroxysmal tachycardia and there-fore a genuine neurosis.

Radical Operation for the Treatment of F&aelig;cal Fistula.Some time ago M. Savariaud communicated to the Surgical

Society a memoir on the successful treatment of faecal fistula,and at a meeting of the society, held on July 27th, M.Reynier presented a report on this memoir. The operation inquestion was not new, as it had been already performed by

: Biondi, by Jeannel, and by Nelaton senior. The spur havingbeen crushed with an enterotome a circular incision wascarried round the opening at a distance of two or three

; centimetres from the cicatricial area. This flap of skinL was then raised and the loop of intestine was carefully