1796

ofone, aged 46 years, underwent a premature menopause. Innone was there any family history of an early menopause.

A "Balloon Cqtre for Tuberculosis.M. Christian Beck read a paper before the Academy of

Sciences on Nov. 25th in which he stated a case for aerostaticexercises in the treatment of tuberculosis. He is of opinionthat by this aerial departure in therapeutics the altitudetreatment can be carried out in a unique manner away fromall crowds, a condition impossible of attainment on terrestrialmountain resorts ; neither vegetable nor mineral particlesare present in the air which is also bacteriologically pure.The " altitude dose " can be adapted to individual needs andthe patient can be lifted up above the fogs which oftendarken the skies of Switzerland in the summer mountainresorts. The constant changing of the air which is experi-enced in "aerotherapy " will, he considers, have a favourableeffect on tuberculosis. The treatment should be carried outdaily.

Congress of Climato-tleerapy and Urban Hygiene.This Congress will be held at Biarritz from April 20th to

April 25th, 1908, under the presidency of Professor Pitres,dean of the Faculty of Medicine of Bordeaux. Among thesubjects put down for discussion are the following: TheIndications for and against Ocean Climates in NeurasthenicConditions ; the Combined Action of a Marine Climate andof Sodium Chloride Medication in Glandular Tuberculosisand in Rickets ; Municipal Health Departments and SanitaryRegulations at Health Resorts; and the Climatology of theGulf of Gascony. The organising committee of the Congresshas its headquarters at Biarritz.

Aviilsion of the Whole Upper Limb and Scapula.At a meeting of the Academy of Medicine held on

Dec. 3rd M. Berger read an account of this case for Dr.Andre of Peronne. The patient was a young man, aged17 years, who had his left hand caught up by a driving-beltand the arm twisted round a shaft revolving 60 times aminute. The whole limb, together with the scapula, wastorn off from the trunk, the clavicle remaining in place. Therewere very little heamorrhage and no very marked shock. M.André cut off the portion of the clavicle which stuck out ofthe wound, tied the subclavian artery, trimmed up the tornmuscles, and stitched up the cutaneous wound. The patientrecovered perfectly in 15 days. M. Berger said that he onlyknew of one other case of such extensive avulsion which hadtaken place and that was the one mentioned by Cheselden inhis Treatise on Anatomy, in which recovery took place in thesame way.

The Treatment of Coxcclgia.At a meeting of the Academy of Medicine held on

Dec. 5th Dr. Calot of Berck read a paper on Coxalgia, forwhich complaint he had introduced a method of treatmentwhich had given admirable results without any lameness.No one has hitherto hoped for such good results. It is wellknown that the destruction of the joint surfaces and theaccompanying ankylosis which is the cause of the lamenessbegin to be produced even so late as four years after thetuberculous infection. If the surgeon, then, can make afairly early diagnosis he has plenty of time to intervene forthe prevention of the distressing complication of lameness,not by the ordinary method of continuous extension but bydirect treatment of the articular surfaces. Dr. Calot’smethod consists in injecting directly into the joint, frompoints which have been very carefully laid down (pointssoigneusement repercs), certain fluids, first of all naphtholcamphor and later iodoform dissolved in ether. The joint is atthe same time immobilised in a plaster splint. By this methodthe duration of the painful affection of the hip-joint ismuch reduced and the patient recovers without anyshortening or lameness.

Dec. 17th. ________________

ITALY.

(FROM OUR OWN CORRESPONDENT.)

State Medicine.LOOKING back on the year now closing I have to note

few accessions made in Italy to medical theory or practiceand not many in the department of research work in thelaboratory. It is in State medicine and in prophylaxisrather than in remedy or "cure" that progress has to be

registered. This is the direction in which, for the present,the activity of the profession in Italy can be most usefullyturned, claiming as it does a kind and a degree ofattention paramount in a young kingdom struggling, aftercenturies of division and oppression, to ’’ the ampler ether,the diviner air " of rehabilitation, moral and material, onconstitutional lines.

Physical Deterioration: : Its Chief Causes.In a powerful, pathetic appeal addressed by the dis-

tinguished statesman and historian, Pasquale Villari, to anaudience lately convened to do him honour on his reachinghis eightieth birthday, the orator dwelt on the alarmingdecline of corporeal development in the Italian proletariat,particularly in the southern provinces. This was shown(among other indications) in the increasing number ofrejections at each successive conscription for military service-only about 60 youths of 20 years of age being fit for theduties out of every 100. But what can we expect, asked SignorVillari, when year by year emigration is depleting the countryof its best blood? In 1906 no fewer than 800,000 Italians,the majority of them young, active, enterprising men,abandoned their native homes to keep soul and body togetherin other climes, in the United States of America especially.In New York alone, the last census gave 400,C00 as thenumber of Italian residents and even there the conditionsunder which they live and work are sufficiently deplorable.Reinforcing the humblest ranks of labour mostly as navvies,often enough as itinerant hawkers, or even shoeblacks, theyare employed in service in which no American and, now,very few Irish will engage, while they herd together indomiciles in which nearly every condition of health islacking. And yet, bad as this life is, it is considered bythe Calabrian or the Sicilian to be a change for thebetter, and he leaves his native land for the UnitedStates in the numbers above indicated by way of "a risein life " I When he does return, as many have done lately,he is in a deteriorated state of health-only less deterioratedthan that of the old or the infirm or the weakly whom hehad left behind to beget their like. The results of thisstate of matters are shown in the conscription returns

already quoted and in the ravages of tuberculosis in thecountry towns of Southern Italy where not many years agothe disease was quite unknown ! Other maladies previouslynon-existent in the same region now find "candidates"

among the stay-at-home population, as also’ among thereturned emigrants, till the said diseases become endemic-the result of an ensemble of conditions auguring a speedy"decline," if not an ultimate "fall," in the manhoodof Italy. Signor Villari, of whose impressive discourseI have merely given an outline, concluded by appealing toall that was enlightened, patriotic, and humane in his

distinguished auditory to combine in an organised endeavourto keep the agricultural population on the land by improvingthe conditions in which it lives and works and by reinforcingin every way the efforts of the public health departmenttowards the same end. As an incentive to the youngeramong his hearers to enter on this veritable crusade withintelligence as well as vigour he publicly announced that the12,000 francs subscribed as a birthday gift to himself wouldbe dedicated by him to a competition, the subject of whichshould be " A Study of the Social Condition of SouthernItaly, with Suggestions for its Amelioration." The generousproposal has already been responded to so far as to placemany of the ablest and most accomplished of young Italianuniversity men on the list of competitors and the prize-winner will have the additional satisfaction of having, provirili parte, coöperated with the best of his compatriots,official and other, towards the solution of a problem first inimportance for his country’s well-being, present and future.

The Lost Ones of Society." Tra Za Perdutcc Gente." Under this title Signor Giovanni

Rosadi, the eminent pleader in criminal cases at the TuscanBar, draws attention to another field for the consideration ofState medicine-crime as the outcome of mental disease. Wehave here an example of a distinguished j jurist looking in nospirit of antagonism to the specialist in psychiatry butrecognising the soundness of his scientific standpoint andinviting his cooperation towards a common end, the preventionof crime. This is a momentous change of attitude betweenthe two professions-the legal and the medical. That thereare what Carlyle called " diseased developments " in themoral world has, "at long last," been so far admitted bythe law in Italy as to affect judicial decisions and verdicts of

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jurymen-the physical condition of the so-called ’’ criminal "

entering into the category of " attenuanti "-that already I

wide and still elastic loophole of escape for " the prisoner atthe bar." The fact, indeed, is a practical acknowledgmentof what criminal anthropology has already put in evidence ;and Signor Rosadi, in the profoundly interesting volumethe title of which I have given, supplies from his unrivalledexperience a number of illustrations of what Lombrosoand his school used alternately to be ridiculed anddenounced for asserting. " Inhibitory paresis "-formerlythe b6te noire of the juridical doctrinaire-he fully re-

cognises as a pathological condition susceptible of proof.At a celebrated trial in Edinburgh some 40 years agothe then professor of practice of physic in the Uni-versity, Dr. Thomas Laycock, when called as a witnessfor the accused-the charge being that of murder-affirmed that with full consciousness of his criminal actand its consequences, a man might yet be without powerof self-control and so commit the crime. Here the judge-the late Lord President John Inglis-interposed : " Gentle-men of the jury, were the Colleges of Physicians of England,Scotland, and Ireland to assert that doctrine on their com-bined authority I would feel it my duty to warn you of itsfallacy." Such was then the opinion of Italian jurists also.It is not so now; and Signor Rosadi’s book is written toshow that crime may be coincident with morbid deviationsfrom physical health in its most refined sense; that thesedeviations are both inherited and acquired; and that theymay to a great extent be guarded against by a State-controlled inspection of infancy carried out by medical men,particularly on the entrance into school life, where byexample and moral contagion the morbid mental conditionis often acquired. Dr. Le Grand du Soul of Paris was apioneer in this field of psychiatry ; but his experience ofParisian crime was not equal to Signor Rosadi’s in Italian.’’Tra la Perduta Gente," indeed, is a volume replete withinterest divided in almost equal parts between the medical,the legal, and the sociological, and if translated into

English would have even more readers than it is now

attracting in Italy.Dec. l6th.

________________

VIENNA.(FROM OUR OWN CORRESPONDENT.)

Celebrations in Honour of Professor Obersteiner and ProfessorWiderhofer.

MEDICAL circles in Vienna bave quite recently had

opportunities of honouring two great men, one who is still

working in our midst and one whose work is still held in

grateful remembrance. The former is Professor Obersteiner,the famous nerve specialist, who has trained so many of theleading neurologists in both hemispheres. The twenty-fifthanniversary of the inauguration of the Institute for Neuro-logy founded by him in 1882 was duly honoured both by thefellow-workers of the founder and by the medical professionin general. The institute consisted originally of a smallroom in the old university but by degrees Professor Ober-steiner succeeded in raising it to a position of such import-ance that the Government has now consented to take it over.More than 150 important contributions to the pathology ofthe brain and nerves have been made by his students, inaddition to numerous shorter essays and monosrraphs. Pro-fessor Obersteiner himself has been appointed Vice-presidentof the Brain Commission of the International Associationof Academies and he is also an honorary D.Sc. of theUniversity of Oxford. By a generous gift of 200,000 kronen(£8000) he has provided the institute with an ampleendowment and he has also handed over to it hislibrary of 26,000 volumes. His bust occupies a prominentposition in the institute. Another unveiling of a busttook place quite recently in the University of Vienna,when a well-executed figure of Professor Widerhofer washanded over to the Senare of the university. He was thefirst medical man in German-speaking countries to devotehimself to the diseases of children. He was soon appointedto a specially erected clinic, in which he continued to workfor 40 years. He was a member of the group, including alsoSkoda, Rokitanf-ky, Hyrtl, and Billroth, which shed suchlustre on the Medical Faculty in Vienna, and his pupilsare now occupying nearly all the prominent positions inchildren’s hospitals in Austria and Germany. Among his

various appointments was that of physician to the childrenof the Emperor Francis Joseph. In the new general hospitalnow in course of building one ward will be named after him,and his kindness to his poor patients is still remembered,although more than ten years have passed since he gave uppractice.

A New Medical Association.A Society for Physical Therapy has been formed in Vienna

and has branched off from the old medical association witha view to include all practitioners who have turned to themodern way of treatment by strictly physical means, such ashydrotherapy, electricity, radiotherapy, orthopaedic con-

trivances, and gymnastic exercises. The new associationhas been very well received by the younger members of theprofession who are attracted by the modern methods oftreatment, whilst some opposition has been aroused amongstthe older men who resent the progress of specialisation.The first two meetings of the new society were a success inevery respect ; the scientific standard of the papers thatwere read was good and the cases that were shown were verysatisfactory.

The Injection Treatment of Sciatica.Dr. Bum has communicated to the Gesellschaft der Aerzte

a paper on the Treatment of Sciatica by means of Infiltrationof the Nerve according to the method introduced by Langeof Leipsic. Dr. Bum at first injected a solution of eucainebut he was soon convinced that the curative agent was notthe chemical but the mechanical component of the procedure.He therefore uses only a solution of chloride of sodiumof 0’ 8 per cent. strength. The technique of his method wasas follows. A point on the flexor side of the thigh was soughtwhere the long head of the biceps cruris muscle was crossedby the lower margin of the gluteus maximus and theinjection was made here because there were no vessels ormuscles to be avoided. An aseptic syringe entirely made ofglass, and having a capacity of 100 cubic centimetres(about 3 fluid ounces) was filled with the saline solutionand thrust in until a sudden pain showed that the nervewas reached. The solution which was now injectedunder continuous pressure expanded the neurilemma andeasily broke down any adhesions which might exist.Experiments made on the dead body with coloured liquidshowed that the neurilemma was detached from themedullary substance for about five or six inches in bothdirections. It was sometimes necessary to repeat theinjection two or three times within a few days. Dr. Bumshowed six patients whom he had treated in this way andwho were all able to work now. Altogether he has treated82 patients by his infiltration method, with 63 per cent. ofcomplete recoveries and 21 per cent. of the cases improved.The contra-indications were symptomatic sciatica, neuritis ofthe nerve roots, a high degree of arterio-sclerosis, andhysteria. He has not treated acute cases in this way.

Xvzbolis7n after Herniotomy.Professor Stoerck showed at the same meeting an unusual

case of widespread embolism, which occurred eight daysafter the performance of an operation for umbilical hernia.The embolus first occluded the pulmonary artery and itsbranches, after which it made its way into the ascendingaorta through a pervious foramen ovale and all the branchesgiven off from the arch of the aorta were blocked. Theright renal artery and a small splenic artery were likewiseaffected. All the veins which might have contained thepoint of origin of the embolism were examined but withoutresult, except that in the vesical plexus thin thrombosedmasses were present in some of the veins. Careful examina-tion of the much twisted embolic masses showed their com-plicated branching and dichotomous distribution and it wasmost likely that their source lay in the veins of the pelvis.The right kidney was necrosed, the upper pole of the spleencontained an anaemic infarct, and the lungs showed similarsmall foci. The existence of these conditions justified theassumption that the formation of the embolism hadcommenced several hours before death, and it maybe remarked that the clinical history recorded a severe

collapse occurring six hours before death, but the obstructionof the pulmonary artery and the "paradoxical" embolismof the aorta must have taken place only a few seconds beforedeath. Looking at the facts from a surgical point of viewin a case like this, where embolism had developed after afew days of very good progress following the operation, Pro-fessor Trendelenburg advised surgical interference. He dis-

tinguished three varieties of embolism of the pulmonary