1733

Dr. LINSER (Tiibii3gen) reported that he had obtain<

good results by injections of normal blood serum in urticarieczema, prurigo, pemphigus, and infectious diseases sucherysipelas. The power of the blood to retard the growingbacteria was considerably increased by the injections. Tlmanner in which this effect was produced had not yet beexplained.

Professor HANSEN (Christiania), in discussing the tranfusion of blood in anaemia, gave a report of 61 transfusion of blood in 16 cases of pernicious an&aelig;mia. In six of the;cases the amelioration was obvious, and after repeated tranfusions was even striking. Apart from the mitigation dyspn&oelig;a and anorexia and the improvement of the patientgeneral state, a prompt absorption of extravasations of blocin the retina was observed. The greatest quantity injectewas 565 cubic centimetres. Symptoms of anaphylaxis dinot appear, nor were h&aelig;molysins formed.

Dr. OTFRIED M&Uuml;LLER (Tiibingen) reported that injectioiof normal blood serum were made by him in children suffe:ing from chronic septic diseases, such as furunculosis, diar rheea, and broncho-pneumonia, the result being that thbactericidal power of the blood became considerablincreased, the furunculi healed, and the various diseaseconditions ran a quicker course.

Dr. BORNSTEIN (Leipzig) said that in his opinion mandiatheses must be ascribed to alcoholism on the part of thpatient’s parents or ancestors, alcohol being specially detri mental to the embryo.

Dr. SCHITTENHELM (Erlangen) said that a relation existed between the metabolism of albuminous substances amdiathesis. The administration of albumin derived from !foreign source produced an alteration of the secretion of thintestinal cells.

The Oatmeal Treatment in Diabetes.Professor MAGNUS-LEVY (Berlin) said that it was not ye

ascertained whether the success of oatmeal in the treatmenof diabetic patients was based on a special quality of th4oat-starch or on a special substance favouring its assimilation. Experiments which had been made with oatmeal groat:did not prove the presence of a special substance in themand pure oat-starch freed from the other substances con.tained in oats and given together with eggs and sanatogerwas just as efficacious as ordinary oats. It was thereforeevident that oat-starch produced an effect different from thatof other kinds of starch. Oatmeal was often beneficialto diabetic patients whose cases were suitable for thattreatment.

Dr. BLUM (Strasburg) expressed the opinion that in themajority of cases wheatmeal was just as efficacious as oat-meal. The good effects of oatmeal treatment were due to theabsence of albuminous substances of animal origin and tothe lowering diet which made the sugar quickly dis-

appear. He maintained that oats had no specific action indiabetes.

Dr. GRUND (Halle) said that he had not found anydifference between barleymeal and oatmeal as far as theirtherapeutic action was concerned, but that wheat-starch wasless efficacious than oat-starch. He had found that oat-starchand oatmeal had the same effect.

Dr. FALTA (Vienna) expressed the opinion that the actionof oatmeal was of a specific nature and not due to therestricted administration of albumin, the effect being the samewhen a greater quantity of albumin was added.

Professor MINKOWSKI (Breslau) remarked on the retentionof urine and the development of cedema brought about bythe oatmeal treatment, these symptoms disappearing whenthe administration of oatmeal was discontinued.

The Action of Salvarsan on the Respiration and Circ2ulation.Dr. RIEHL (Prague) said that some of the preparations

which preceded salvarsan (hyperideal, for instance) had anaction on the circulation 20 times as toxic as the action ofsalvarsan, and that certain deaths which occurred before theintroduction of salvarsan into practice might be explainedby that fact. An alkaline solution made the blood pressuredecrease more rapidly than an acid one. The cause of thatdecrease was due to an alteration of the vascular tonus andnot to cardiac weakness.

Professor NICOLAI (Berlin) said that in his experi-ence no obnoxious action on the heart muscle was

caused by salvarsan, the electro-cardiogram being quiteunaltered.

ed Various Diseases of the Lungs.ia, Dr. K&Ouml;NIGER (Erlangen) read a paper on pleurisy occurringas in tuberculous patients. He had found that in 48 of 49of

cases of primary pleurisy the tuberculous lesions of the lungsbe were considerably benefited, and in 70 per cent. were even

en completely recovered from. Of 29 patients suffering fromsecondary pleurisy 11 were restored to health, and in 5 cases

18- the tuberculosis made no further progress. These goodna results were probably caused not by the mechanical fixationse of the lung, but by a chemical reaction. Puncture of the

pleura should be performed only in primary idiopathicOf pleurisy, whilst puncture in secondary pleurisy was apt tos produce a rapid increase of the tuberculous process. Theinjection of iodoform glycerine gave satisfactory results. By

d the injection of auto-serum the absorption of the exudationid was sometimes accelerated; sometimes, however, an un-

favourable influence on the tuberculous process was observed.ns Professor BRUNS (Marburg), in speaking on artificial

anaemia produced in single lobes of the lungs for thera-peutical purposes, said that tubercle bacilli could not estab-

ie lish themselves in any absolutely atelectatic lobe of ay lung. Atelectasis could be obtained either by inducing’d artificial pneumothorax or by ligature of the pulmonary

vessels. The operation was performed with a good result inthe case of patients suffering from broncbiectatic cavities.

ie Neither gangrene nor anaemia ensued, the bronchial artery1- being conserved ; the operation had also a good effect in the

d early stage of tuberculosis of the apex of a lung. The

technical procedure was not very difficult.Dr. STAUBLI (Basle) spoke on the subject of bronchiala asthma. He said that the asthmatic fits depended on variouse circumstances. Eosinophilia was not connected with the fits,

but was a constant symptom of asthma ; the disease might,therefore, be regarded as an eosinophilic diathesis. Removalto a mountain climate made the fits disappear at once,

t especially in young patients, whereas in elderly personse suffering also from bronchitis an improvement usually6- occurred at a later period. The cause of the good effect ofa high altitudes on asthma had not yet been ascertained., Dr. BAEMEISTER (Tubingen) described some results of- experiments in animals in reference to the development of

tuberculosis. He allowed young rabbits to grow so thatethe superior aperture of the thorax became narrowed.t In these animals an incomplete atelectasis subsequently1 developed and the dust which was inhaled settled there.6An aerogenic infection of the lungs by tubercle bacilli was

not observed, but when the tuberculous virus was conveyed3by the blood a real pulmonary tuberculosis developed in the. animals prepared in the above way. The experiments there-

fore showed that a predisposition to tuberculosis could beproduced by mechanical causes.

In the discussion of the above papers Professor SCHMIDTL(Halle) said that the unquestionable improvement of asthma

in high altitudes was due to the decrease of air pressure and, the partial decrease of oxygen ; hyper&aelig;mia of the lungs was, produced because the alveolar epithelium was irritated by the

diminished inhalation of oxygen.Professor STINTZING (Jena) said that autoserotherapy for

pleurisy had proved unsuccessful in the clinic at Jena. Inhis opinion primary pleurisy in tuberculosis was non-

existent.Dr. K6NIGER said that the occurrence of primary pleurisy

must be taken for granted when it was not preceded by anydiscoverable clinical symptoms of tuberculosis.

MANCHESTER.

(FROM OUR OWN CORRESPONDENT.)

Addition to Crossley Sanatorium.ON May 27th an extension of the Crossley Sanatorium

for Consumption was opened by the Lady Mayoress ofManchester. The extension, which gives additional accom-modation for ten beds for male patients, was providedthrough the generosity of Mr. Alfred Crewdson. Thesanatorium, originally founded in 1905 by Sir W. Crossley,afforded accommodation for 90 beds, and is situated 480 feetabove sea-level in a park of 66 acres of oak and chestnutforest, where the air is especially dry and invigorating. Thirty-six of the 100 beds are set aside for private patients who pay

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from 2 to 3 guineas a week. These patients are accepted onthe sole recommendation of their own physicians, who have theprivilege of visiting their patients. The remaining 64 bedsare reserved for patients of the poorer class suffering fromphthisis in an early stage. They obtain admission only throughthe out-patient department of the Manchester ConsumptionHospital. Dr. J. Niven gave a short address on the help whichthe hospital had rendered in the fight against consumption.Two things, he said, were still required : First, to obtain aknowledge of the ramifications of the disease by searchiugit out in all its haunts, and its varied forms in the young andthe adult. Secondly, to settle what was to be done with thefamilies of consumptives. The value of a sanatorium wouldbe greatly enhanced if the families of poor consumptivescould be supported while their bread-winners were in thehospital. Dr. Niven emphasised the desirability of treat-ment in the early stages. He said we were steadily approach-ing the end of the disease, and he expressed his surprise atthe rapidity with which it was diminishing. In Manchesterin 1899-1900, the death-rate from consumption was 2 per1000. In the year just ended it was 1.5 per 1000-that is,it had diminished one-quarter, or 25 per cent. in 10 years-a most remarkable reduction.

Annual Report of the Medical Offioer of Health of Salford.The annual report for 1910 has been issued by Mr.

0. H. Tattersall, the medical officer of health of Salford.Instead of the population reaching 244,636, as was

computed, the recent Census shows it to be only 231,380,which makes the death-rate about 16 and the birth-rate about 28 per 1000. The death-rate is the loweston record--2108 were males and 1630 were females. In1901 it was 25 per 1000. The infant deaths number 866,equal to a death-rate of 131 per 1000, as compared with anaverage of 149 for the preceding five years. The birthswere 6594-3310 males and 3284 females-showing on 1909a decrease of 184. Illegitimate births formed 3’ 2 per cent.of the total. The death-rate from cancer is steadily in-creasing, being now 8 per 10,000. There is, however, aconsiderable reduction in deaths from consumption andzymotic diseases, while the number of infectious diseasesnotified was remarkably small-only 1508, a decrease of 979below last year, and 438 below the average of the precedingten years. Some interesting facts are given regardingphthisis. Of the 36 Salford cases discharged fromthe Delamere Consumptive Sanatorium in two years, aboutone-half are at present in a satisfactory condition. As todeaths from phthisis in relation to employment, we find out-door workers 147, and of these 89 were labourers and navvies,23 carters, coachmen, hawkers, and cabmen ; indoor maleworkers 244, in 111 of which (including children) no occupa-tion was mentioned, metal workers 21, clerks and warehouse-men 20, printers 8, and to a less degree other trades. Deathsof females were 260, and of these 76 were housewives, 126 ofno occupation, 13 machinists, and 16 workers in textilefactories. There are 56 midwives on the register. Of thetotal births 75’ 6 per cent. were attended by midwives and24.6 per cent. by medical practitioners. There were 24 casesof puerperal fever notified during the year, of which 15occurred in the practice of midwives. Midwives notified 127still-births during the year.

Manchester Royal Infirmary.The board of management at its meeting on May 30th was

informed that Mr. J. W. Smith, one of the surgeons, whomet with a severe accident while out riding some weeks ago,was now convalescent. The infirmary authorities have madeprovision for the admission of qualified medical women toresident posts in the infirmary. The University Court at itsmeeting on May 31st approved of the scheme set forth in thereport of the Council of the University to the Court. Theinfirmary board of management appointed a subcommittee toconsider the position of voluntary hospitals in connexionwith the National Insurance Bill and to report to themanagement committee.

Defective School Children.From the annual report of Dr. J. J. Butterworth, the

medical superintendent of schools under the Lancashire

County Education Committee, it appears that 22,302 boys and22,666 girls were examined medically, and that 10,810 boysand 16,936 girls were found to be defective in some regard.N(arly 700 of these children were under-nou;ishtd, while 72

boys and 48 girls were feeble-minded. Many children whoon first inspection might be regarded as feeble-minded werereally not so, but were suffering from physical defects whichinterfered with their progress at school-namely, adenoidsand defective hearing. The teeth of 2099 boys and 1802girls were very bad. The extent of dental decay is so greatthat anything approaching adequate treatment would be

extremely difficult. Recent observations showed, however,that there had been a great increase in the number ofchildren who used tooth-brushes ; in fact, in some schoolspractically every child now possessed a tooth-brush. Thetonsils of 1476 boys and 1554 girls were enlarged, 735 boysand 667 girls had "the squint," 230 and 233 suffered fromlung diseases, and 908 and 700 from rickets. Eight nurses(the report says) have given instructions to the older childrenin personal hygiene. The more experience the medical staffgain in the work of school hygiene the more convinced theybecome that its ultimate success will depend in largemeasure upon the interest taken by the teachers.

Hom to Deal with the Feeble-minded.

A conference arranged by the Manchester and SalfordSanitary Association was held recently, in Manchester, twodiscuss this question. The subject was introduced first by Mr.A. F. Tredgold, who emphasised the fact that feeble-minded-ness is not the lowest grade of the normal, but a definiteabnormality-in fact, a disease-that idiocy, imbecility, andfeeble-mindedness merge into one another, and that theessential characteristic of feeble-mindedness is its ner-

manence and incurability. Under proper conditions of train-ing and supervision most of these persons would be capableof paying their way. Their presence unsupervised in a com-munity was, he said, a danger to the State as regards perpetrationof crime. He calculated that at least 10 per cent. of thesecases had pronounced criminal tendencies, while 20 per cent.of the criminals of this country were feeble-minded. As to thetraining of these unfortunates, no training, however specialand elaborate, would convert such children into normalcitizens. The training should be manual and technical, andshould be followed by a definite system of after-care. Ifturned adrift to shift for themselves they rapidly degenerated,so that the question was what form should this ’’ after-care "take ? The best form was that given in a colony or institu-tion. A life-long care was essential and there should bepowers of compulsory detention. According to Mr. Tredgold,what was wanted was : (1) That the Defective and EpilepticChildren’s Education Act of 1899, or some other system oftraining, should be made compulsory; (2) that countycouncils should be compelled to provide suitable homes,institutions, or colonies for the reception of mental defectivesafter training; and (3) that power should be obtained forthe detention of mental defectives in these institutions. Thecondition of feeble-mindedness was inborn, and there wasno doubt that segregation of the mental defectives would doa great deal to check the growth of the malady, but evensegregation, though it would certainly check it, would notbe sufficient to prevent the growth of the disease. In thediscussion it was pointed out that though incurable the con-dition might be ameliorated by proper treatment. Miss

Dendy thought that it would be a great mistake to do awaywith the special day schools for these cases. As part of anew system they would make the colonies less expensive bytaking from the colonies the care of little children. Theyacted as safeguards against the setting aside of people whowere not really feeble-minded.

Manchester Water-supply.From the annual report of the town council waterworks

committee I learn that during the year the annual dailyconsumption was 41,679,085 gallons-viz., 24,237,807 fromLongendale and 17,441,278 from Thirlmere-an increase onthe previous year’s consumption of many thousand gallonsper day. A third pipe is being laid from Thirlmere to meetthe ever-increasing demand.

Certificates of Fitness by Certifying Surgeons.Mr. W. F. Dearden, medical officer of the port of Man-

chester, in addressing a joint meeting of the Public Healthand Unemployed Sections of the National Conference on Desti-tution on the work of the certifying surgeon, when dealingwith the conditions regulating the examinations for certi-ficates of fitness, said that the certificate was not necessarilya voucher for perfect bodily health, but it testified that the

1735

applicant was able to undertake the particular employmentsought. The examination, which cost 6d. at the surgeon’s rooms,he thought should be abolished, and instead of this properaccommodation should be provided for the surgeon at eachfactory, in order that the examinations might be efficientlycarried out. The examinations averaged from 350,000 to400,000 per annum, while the rejections for physicalincapacity exceeded 7000, and condition certificates weregranted in 6000 cases.June 17th.

______________

PARIS.(FROM OUR OWN CORRESPONDENT.)

A Concert by the Medical Orchestra.THE medical orchestra gave its third concert on June 13tb

for the benefit of the distressed members of the medical pro-fession. It was highly successful, the hall being inadequate toaccommodate all who desired to be present. The programme,which was of a very varied character, comprised numbersfrom Beethoven, Gluck, C&eacute;3ar Franck, and portions ofMozart’s opera bouffe, Cosi Fan Tutti, sung by medical men and their wives. This institution appears to be henceforthassured of success, being most favourably received by thepublic. The Association of Students also has decided to

organise among its members an orchestra and a choral society.A society has been founded, too, for the purpose of organisingconcerts to be given in the hospitals to the convalescentpatients. From now on, every week at the Hotel Dieu, aconcert will be given in the afternoon. At present the per-formers consist of two vocalists and a pianist. But thesociety is hopeful of being able to make its entertainmentsmore important, for they are greatly appreciated by thepatients, to whom they afford considerable solace.

The Descendants of Napoleon.The minute investigations now being made in regard to

everything relating to the Napoleonic epoch have broughtto light a fact which has important relations to the historyof the world. The accouchement of the Empress Marie Louise was, as is well known, a very difficult one. She allbut died, and it is now known that Corvisard, the Emperor’sphysician, thought it necessary to caution him that she wouldcertainly die if she had another child. Napoleon took heedto this advice, and, as a matter of fact, had no other childthan the King of Rome. Future events showed thatCorvisard was mistaken, for Marie Louise had severalchildren by her other husbands. One cannot help remarkingthat if Corvisard had not laid down this rigorous pro-hibition, and if Napoleon had not complied with it, he mighthave had many heirs, which on the death of the Duc deReichstadt would have materially altered the course ofhistory.

The It’ees of Specialists. A magistrate in the Fifth Arrondissement of Paris

recently rendered a judgment of great interest to

specialists. The fees laid down in the tariff for accidentsof childbirth are undoubtedly too low. The insurance

companies stand upon them, and refuse payment in allcases in which the charge is in excess of that standard. Ina case of this kind this judge has decided that specialistshave a right to a higher rate of remuneration, in consequenceof their longer and more costly period of study and of theexpenses entailed by their special equipment.

The Treatment of Obesity.The Academy of Medicine has inscribed on its agenda a

discussion on the treatment of obesity. Professor Robinrecently made a communication that has made quite a stiramong both the profession and the public. M. Robin promisesthe subjects of obesity a regular loss of 300 grammes a day,while allowing them to eat and drink as much as they desire.His plan is to diminish the appetite by multiplying thenumber of meals a day. His patients take five mealsa day, but only light snacks with a little hot drink ;after each meal he prescribes a walk for half an

hour. He recommends a salad dressed with lemon and theeating of very little farinaceous material, little sleep, andearly rising. Dr. Fleury supplemented M. Robin’s expositionby recommending that only those entirely free from tuber-culosis should undergo this reducing method. There are many

more obese persons threatened with tuberculosis, either directlyor through the intermediary of diabetes, than is generally’supposed. These facts do not upset M. Robin’s doctrine,because one of the most original parts of his communicationconsisted in showing that, contrary to the received opinion,obesity is not a sign of slackened nutrition. By a minuteexamination of the respiratory exchanges M. Robin hasshown that among the obese these exchanges are eitherincreased or not modified. The relations of obesity andtuberculosis are not, therefore, substantially very far apart.The cure of obesity is a matter less of diminishing thequantity of the alimentary ration than of adjusting its com-position so as to assure its complete assimilation.

Lack of Guinea-pigs at the Pasteur Institute.The Pasteur Institute is suffering from a lack of guinea-

pigs, brought about by the enormous number used for itsexperiments, so that certain investigations have had to besuspended. The institute used at least 2500 animals amonth during the past year. But in its establishments atGarches, where the animals are reared, only from 20,000 to22,000 a year are born, notwithstanding the great fecundityof the guinea-pig. It is becoming very difficult to obtainguinea-pigs from the dealers, for the little creatures are

costly to raise and there is not sufficient profit in it. Their

price has reached, and even passed, 1&frac12; francs apiece.The price of mice and rats has increased in like manner.The Pasteur Institute expends annually for the purchase andsupport of the animals used in its work the sum of 400,000francs.June 19th.

VIENNA.

(FROM OUR OWN CORRESPONDENT.)

Reappearance of Cholera in Austria.A FRESH case of Asiatic cholera was discovered in Austria

lately, and the circumstances under which it occurred are,unfortunately, such as to justify a feeling of uneasiness. Aman connected with the Post Office had made a visit toItaly, staying some time in Venice, and when he returned tohis home in Graz he was seized with illness which caused hisdeath after 48 hours. The nature of the disease was sus-

pected at once, and on examination true cholera vibrioswere found in the fasces, the bacteriological diagnosis beingfully confirmed by the results of the post-mortem examination.The strictest measures of prophylaxis and disinfection wereimmediately adopted, all persons who had been in contactwith the patient since his return being isolated. Before theoccurrence of the present case there had been absolute freedomfrom cholera in this country for about six months, and evenat the time when the disease had appeared at various placesin Austria most of the attacks were only sporadic ; there is,therefore, good reason for expecting that the precautions ofthe sanitary officials will be successful. It is unfortunatethat this new case seems to have originated in, or to havebeen imported from, Italy, although there is no recognisedprevalence of cholera there just now. The patient is knownto have indulged in oysters and other shell-fish, and as thereare at present a large number of Austrian tourists in thelocalities visited by him some anxiety is naturally felt withrespect to them.

Professor Eduard Lang and the Treatment of Lupus. To show their esteem and respect for Professor Lang of

Vienna, the pioneer of the modern surgical treatment of

lupus, his friends and pupils have collected a sum of about.82000 to be used as an endowment for the Lupusheim inVienna, an institution in which only cases of lupus arereceived. The interest of the invested capital is to be

employed either for the benefit of patients or for the

encouragement of scientific work on the pathology and treat-ment of lupus during the next two years. Another fund,amounting to about an equal sum, has also been collected bythe same persons, and will be used for completing theoutfit of the institution. Professor Lang was for manyyears head of a dermatological clinic in Vienna, where themajority of the patients under his care were cases of lupus,until a special institution was erected, of which he wasdirector for several years. At present he is honorary seniorsurgeon of this home. His work in connexion with these