181

possibility of such control, and has to admit that,apart from financial or domestic pressure, only per-suasion is open to those interested in these victims.So long as they commit no offence against the lawthey are free to degrade and ruin themselves, theirfamilies, and dependents; only, as a rule, whenresources are exhausted, positions lost, and con-

stitutions ruined, do they consent to place themselvesunder treatment. Earlier control would, Dr. Hoggfeels sure, result, in many cases, in the retention ofposition and fortune. An appendix to the reportgives particulars of a cumulative group of 1645patients consecutively discharged. The occupationof these, in order of frequency, is set down as none,merchants, medical practitioners, military officers,clerks, manufacturers, farmers (including market ’igardeners), solicitors and engineers (equal), distillers(including brewers), clerks in holy orders and civil servants (equal), schoolmasters (including tutors),barristers-at-law, stockbrokers, artists and thetheatrical profession, journalists-no other occu-

pational group numbering as many as 20. The kindof inebriant used was in a vast preponderance ofcases spirits in some form or other, beer aloneoccurring only 44 times and wine alone 40 times outof the total of 1645. The after-history of the casesshows how well repaid is the time and trouble incurred,for Dr. Hogg is able to note that about 40 per cent.of the 1645 are doing well, and another 6 per cent.are improved. The terms for admission to DalrympleHouse are f6 6s. a week for those who remain threemonths or longer. Somewhat higher fees are chargedfor shorter periods. For admission under the Acts thereport reminds those interested that the patient mustsign a request for admission, specifying a period notexceeding two years, in the presence of a stipendiarymagistrate, or better (without publicity) before a

justice of the peace. Two persons of either sex,relations being eligible, must also sign a statutorydeclaration before a justice or commissioner for oaths.There is no necessity for the three signatures to bemade at the same time or place ; one or all can besigned at Rickmansworth, if preferred. The report,of which we have summarised the main features, isa document of great human interest, based uponclinical material observed and recorded now over along period of years. We hope that the time is

coming when the Association will issue a consideredstatement of the methods and results of treatmentof drug-addiction at Rickmansworth.

POST-GRADUATE WORK ON ALPINE CLIMATE.

THE Davos Medical Association announces a post-graduate course for medical men on tuberculosisand the alpine climate, to be held at the DavosResearch Institute during the week August 17th-24th.The course, which is the second of its kind, willbe given in both French and German, a detailedprospectus to be issued later. It is now a little oversix months since the formal opening of the Institutein the presence of a number of distinguished climato-logists, Prof. Loewy being in charge of the physio-logical department and Prof. Dorno in charge of themeteorological. A number of interesting studies havealready originatedfrom’theInstitute, including workon the volume of the blood at high altitudes, thecholesterin-content of the blood in tuberculouspatients, and the mechanism of blood regeneration.A paper appeared recently 1 by Privatdozent P.Gryorgy, of Heidelberg, on the acid-base balance athigh altitudes. Dr. Gryorgy comes to the conclusionthat in patients at rest in Davos there is a loweringof acid excretion in the urine, that climbing givesrise to a perceptible, but not unduly high, increasein the acid-ions eliminated, and that respiratorytetany is more easily induced in the same individualat a height than in the lowland. It is Prof. Loewy’shope that this research institute, the first of its kind

1 Shweizerische Medizinische Wochenschrift, 1924, p. 416.

in the mountains, may prove of definite value tothe practitioner. The question what factors in thealpine climate are responsible for its effects remainsstill unanswered, as well as the cognate questionwhether the effect of insolation is to be explained ona chemical or on a physical basis. A library hasalready been collected at the Institute and is inprocess of cataloguing and classification, and it ishoped that the third department of the Institute-namely, the bacteriological-pathological-may soonbe opened. The Institute is happy in having obtainedthe reversion of the scientific apparatus no longerrequired at the observation station of Muottas-Muraigl, above Pontresina. Among those attendingthe course there may well be some who will be gladto avail themselves of the opportunity for researchalong new and fruitful channels.

MEDICAL WOMEN’S INTERNATIONAL

ASSOCIATION.

THE Medical Women’s International Associationopened its third Conference in London last weekunder the presidency of Dr. Esther Lovejoy, of NewYork. Some 300 members registered their names forthese meetings, including 75 representatives ofcountries overseas ; among these were medicalwomen practising in such diverse parts of the worldas Constantinople, Uruguay, Australia, and Norway.The time of the delegates, representing some 10,000medical women, was largely occupied with business,as this was the first meeting of the fully constitutedrepresentative council under the amended constitu-tion. After a preliminary meeting held in New Yorkin 1919, at which it was decided to form a world-wideassociation of medical women, the constitution wasdiscussed and passed at the second meeting held inGeneva in 1922. At the present meeting the necessaryby-laws have been added. The general meeting of theAssociation was held on Wednesday morning, whenafter the President-elect, Lady Barrett, had beeninducted to the chair, representatives from 15 of the17 countries sending delegates to the meeting toldof the numbers, organisation, and work of the medicalwomen in their respective lands. The speakers were :Dr. Grieg (Australia), Dr. Becher-Reidenhof (Austria),Dr. R. Leacock (Canada.), Dr. Dewetterova (Czecho-Slovakia), Dr. Thuillier-Landry (France), Dr. HeuslerEdenhuizen (Germany), Dr. M. Balfour, C.B.E.(India), Dr. Signe Swensson (Norway), Dr. GraceStevenson (New Zealand), Dr. A. Ilnicka (Poland),Dr. V. Lebedeva (Russia), Dr. Marie Ugon (Uruguay,South America), Dr. Marie Feyler (Switzerland),Dr. Safieh Ali (Turkey), and Dr. Katherine Manion(U.S.A.). It was announced that Dr. Jane Walkerhad been appointed treasurer to the Association.On July 17th a discussion took place on maternalmorbidity, which is reported on p. 185. TheHospitality Committee, under the presidency of Dr.Jane Walker and its hon. secretary, Dr. KathleenLander, had arranged an attractive programmeof entertainments and expeditions for members ofthe Congress. The proceedings opened with a recep-tion and conversazione at the Royal Society ofMedicine on July 14th. On the 15th Miss Aldrich-Blake entertained a large party to luncheon at theLondon (R.F.H.) School of Medicine for Women.In the afternoon of the same day the members werewelcomed by the Archbishop of Canterbury andMrs. Davidson at Lambeth Palace, and in theevening receptions were held by Lady Sybil Smithand by Lady Barrett. On Wednesday a luncheon party,given by the London Association of the MedicalWomen’s Federation at the Botanical Gardens, wasfollowed by a visit to the Royal Free Hospital, andin the evening a large gathering assembled at 10,Downing-street, where the Prime Minister and MissIshbel MacDonald welcomed the visitors on behalfof the Government. On Thursday the variousprovincial associations entertained the foreignguests to luncheon, some of the delegates from the .

ven

182

dominions were present at THE LANCET luncheon todoctors from overseas dominions, and in the afternoonparties were invited to tea on the terrace of the Houseof Commons. In the evening the British MedicalWomen’s Federation held its annual dinner at theTrocadero Restaurant, Piccadilly, for the success

of which the admirable arrangements made byLady Briscoe, M.B., were largely responsible. Alloverseas delegates were invited as guests and over320 members and guests were present. The toast of" The Medical Women’s International Association "was proposed by Prof. Graham Wallas and Mrs.Scharlieb, M.D., and responded to by Dr. EstherLovejoy and Mme. Thuillier-Landry. " The Guests "was proposed by Dr. Jane Walker and replied to byMrs. Fawcett, who was received with musical honours,and by Dr. Thelberg (U.S.A.). The proceedingsconcluded with " The Health of the Chairman,"Lady Barrett, proposed by Dr. Walter Carr. On

Friday morning the British members held theirannual meeting, while a party of foreign delegateswere shown over the museum of the Royal Collegeof Surgeons of England by Sir Arthur Keith. Visitswere paid to the Barbers’ Hall and to the Apothecaries’Hall, and opportunity was provided for the foreigndelegates to see the clinical work in various generaland special hospitals and clinics. On July 19th aparty of delegates was entertained at Bath, on the20th at the East Anglian Sanatorium at Nayland,and on the 21st at Brighton.

RUPTURE OF THE SPLEEN FROMTHERAPEUTIC MALARIA.

THERE is one aspect of the treatment of generalparalysis of the insane by the artificial induction ofmalaria which has not yet received the attention itdeserves. The subjects of general paralysis are oftendebilitated, feeble creatures, incapable of withstandingdiseases which even the young and robust find mostexhausting. In many countries in which malaria isendemic and syphilis is common, general paralysisis comparatively rare, and our knowledge of the actionof one disease on the other is, therefore, very incom-plete. We shall soon know more of this interaction,after more cases of general paralysis have been treatedby the artificial induction of malaria. Together withencouraging results, a few disquieting accounts havebeen published of the effects of tertian malaria on thesubjects of general paralysis. In Le Scalpel for May lOthDr. M. Alexander records the case of a man, aged 50,admitted to hospital on Feb. 8th, 1924, suffering fromgeneral paralysis. For several months there had beenprogressive mental deterioration, with great irritabilityand incoherency. He looked much older than he was,he was easily fatigued, the tendon reflexes were

exaggerated, and the skin reflexes diminished. Theexamination of the cerebro-spinal fluid confirmed theclinical diagnosis, and on April 9th he was given asubcutaneous injection of 5 c.cm. of blood from apatient suffering from tertian malaria. Ten dayslater a bout of fever developed, but it did not conformto type, a rise of temperature occurring every secondday. The patient underwent with apparent impunityand ease eight attacks of fever, the temperaturereaching 39’ C. After the eighth attack he was seento turn pale and to collapse on his bed, where he wasfound to be dead. The necropsy confirmed the diagnosisof general paralysis without, however, revealing anylesion of the brain. The kidneys were intact, whereasthere was some cardio-arterial sclerosis. The abdominalcavity was full of blood derived from a soft spleenwhich had ruptured, the appearance of the spleensuggesting a veritable explosion within it. As longas such an incident is isolated it need not be regardedas more than a clinical curiosity. General paralysisof the insane is such a terrible disease that it isjustifiable to take even great risks in the attempt tocheck its progress, but if the incident just describedrecurs frequently, it is conceivable that treatmentwith malaria may have to be confined to those cases

of general paralysis in which there is a fair margin ofgeneral vitality and recuperative power. In Denmarkadvanced cases of general paralysis have been used ashuman thermostats in order to keep a strain of tertianmalaria alive by frequent passage, and it will beinteresting to learn what effect the malaria hashad on these incurable cases.

MEDICAL STUDIES IN VIENNA.

ADVANCED English medical students have indicateda wish recently to continue their medical studies inthe Medical Faculty of Vienna, and that faculty hasnow decided to allow such students to enter theirschools, and further, will recognise in the case of theunqualified men the studies already attended inEnglish medical schools. Similarly, there will berecognition of the examinations passed in Englandwhich correspond to the Austrian First ProfessionalExamination-namely, physics, biology, chemistry,anatomy, histology, and physiology-but exemptionwill not be granted from the first Austrian examina-tion unless a candidate has passed in all of thesesubjects in England, as they constitute one examina-tion in Austria.

____

DECOMPOSITION OF URINE AND ITSPREVENTION.

IT is often desirable to collect the urine that ispassed during the 24 hours in order that the analysisof such an abnormal constituent as sugar may givecorrect information as to the total daily output ofsugar. To trust to a random sample of urine passedat any hour of the day is to court gross inaccuracy.But the collection of all the urine passed in the 24hours does not get over this difficulty unless its decom-position is prevented by some means or other, forammoniacal decomposition and changes in the sugarcontent of the urine are apt to stultify the resultsof an analysis. In a paper in Norsk Magazinfor Laegevidenskaben for June. Dr. T. Brandt andDr. R. C. Stokstad have published investigationsthrowing light on this problem and providing a simplesolution to it. They have tested a variety of dis-infectants and have found that many of the mostcommon, such as formalin and carbolic acid, are

unsuitable because of their capacity to reduce sugar.They have found toluol act satisfactorily, but notfor longer than 24 hours. The same could be saidof thymol. Xylol proved to be an unsatisfactorydisinfectant, and so did chloroform, probably becauseit was too volatile for the purpose. Perchloride ofmercury in a strength of 0-5 per 1000 preventeddecomposition even for 48 hours, and toluol preventeddecomposition for 24 hours, when 15 c.cm. were added

to a litre and a half of urine and thoroughly shaken. The same effect could be obtained with 15 c.cm. of a 10 per cent. solution of thymol in alcohol. Butb most of these disinfectants possess certain dis-" qualifications. Either they are too expensive for; routine hospital work or they are (with the exceptiont of perchloride of mercury) inadequately soluble inL the urine, which has to- be shaken vigorously toT obtain the desired result. Another objection to toluol is its inflammable properties, and the greasyi coating it leaves on the test-tube. In view of alls this, the authors have abandoned the idea ofs preventing decomposition of urine with the help ofT disinfectants, and they have done so the mores willingly as they have come to the conclusion that1 the problem is one of chemistry and physics as welli as of bacteriology. For, as they point out, the ratei of decomposition of various urines is far from uniform,:; even when the bacterial contamination is uniform.1 Their investigations have shown that the best solutions to this problem, is to be found in a study ofs the hydrogen-ion concentration of the urine, a

o sample with a pH under 5,0 showing practically no

I ammoniacal decomposition even after 24 hours in at thermostat. All that is therefore needed to prevents decomposition of urine is to render it highly acid,