585

Notes, Short Comments, and Answersto Correspondents.

THE TREATMENT OF ADDER BITES.

MEDICAL attention in this country has been recently directed towardsthe treatment of adder bites owing to the severe injury sustainedfrom an English adder by Dr. Herbert Peck, medical officer of

health of Chesterfield, an accident which happily has not been

fraught with such serious results as appeared possible from thereports first published. A medical correspondent whose familyis proceeding for a holiday to a Cumberland dale which is saidto harbour a number of adders has written to us to inquirewhether a serum can be obtained in this country to counteracttheir poison and what other means of treatment are available.We are not aware that a special antivenene is prepared againstVipera berus, the English adder, but we gather from the excellentwork on " Venoms " by Dr. Calmette of Lille that the anti-neurotoxicserum prepared from cobra venom may be partially effective againstviperine venoms. If, however, the particular venom contains muchof the poison known as hsemorrhagin that serum is apparentlyof little use. Dr. Calmette has found it impossible to pro-cure sufficient quantities of venoms of various origins tofurnish each country with the polyvalent serums corresponding toits particular needs, and it could hardly be expected that serumsshould have been prepared against the poisonous snakes of the

temperate European countries, injuries from which are comparativelyrare. The following is a brief abstract of Dr. Calmette’s recom-mendations for the treatment of the bite of a venomous snake :-1. Prevent absorption by a ligature kept tight above the wound fornot more than half an hour. Suck the wound, which can be moreeffec-tively done if a small incision is made over it in the longitudinal axisof the limb. 2. Wash the wound freely with fresh 2 per cent. solution ofhypochlorite of lime, or 1 in 1000 solution of chloride of gold ; if theseare unavailable use a 1 per cent. solution of permanganate of potash.A few cubic centimetres of one of these reagents should be injectedall round the bite punctures. 3. Cover the wound with a dressingdamped with hypochlorite of lime or pure alcohol. 4. Administerserum if available into the loose tissues of the abdominal wall with aPravatz syringe. If serious intoxication has supervened from 10 to20 cubic centimetres may be injected into a vein. 5. Give copioushot drinks, tea or coffee, and induce perspiration by wrapping thepatient in blankets. Dr. Calmette says that ammonia, alcohol, ormorphine are useless, and strychnine may be actually harmful.Whilst this advice is probably the most authoritative that can beobtained, some Anglo-Indian authorities place their chief reliance inthe "Lauder Brunton" method of scarifying the skin about the bitepuncture with a lancet and freely rubbing in crystals of per-manganate of potash.

THE ETYMOLOGY OF "ALCOHOL."

To the Editor of THE LANCET.

SIR,-A recent article in a daily newspaper in discussing theetymology of the word alcohol stated it to be the Arabic al-kohl; ;"al" being the definite article, as in "algebra (the reduction), and"alkali" (the soda-ashes). "Kohl" was no other than the black powderwith which the Eastern beauties stained their eyelids. Then, as we areinformed, the word " alcohol came to be used for any finely trituratedor sublimated powder, and then for sublimated liquids. Alcohol ofwine’ being the most interesting of these, it gradually took the nameentirely to itself." This interesting statement contains a certain

portion of etymological and physical truth, but by no means

the whole. A supplemental physical and physiological fact isthat the Arabian beauties-and even the more well-to-do membersof the coarser sex-used the kohl (or antimonial) black powderas an eyelid stain with a utilitarian object comparable tothat which inspired the construction of the "Venetian blind"; itscreened off the dazzling rays of the sun in a land of perhaps uniquelytrying solar influences. And Arabia, which produced the most successfulof all conquerors and the most rapidly expansive of all creeds, keptburning for centuries the light of science for the gradual illumina-tion of Western Europe. Chemistry, as well as algebra andarithmetic-inclusive of the 10 symbolic "digits" of the latter-emanated from the impenetrable deserts which have ever been so

jealously guarded by the sons of Ishmael. And so little was its

jargon understood in these Western isles of our own that a

sixteenth century English version of the principal works ofGeber, one of the fathers of "al "-chymy, was believed by thegreat Dr. Samuel Johnson to have suggested the invention ofthe new word "gibberish." (It is very evident, indeed, to theskilled reader that the translation had not been made by a scientificexpert-or even by a literary artist.) Then the Arabs-with theirJewish neighbours-were the apostles of medicine to Western Europe.The famous Canon of the Arabian Avicenna was the medical Bible ofEurope for about five centuries. The most precious drugs and spicescame from "Araby" and adjacent localities. And the action of newchemical substances was always tested on the human body, when thenovelty was observed to be a powerful reagent. It was soon found thata fairly dilute alcohol was one of the best of astringent and tonic

collyria. Hence it was used as an adjuvant to kohl, and frequentlyas a substitute. Hence the etymology of alcohol. I may addthat the cosmopolitan diffusion of therapeutic ideas which havelong ceased to be orthodox is illustrated by a story of its use

in a remote Irish dispensary three-quarters of a century or so-

ago. Brandy was dispensed to a case of granular conjunctivitis,with instructions for use after addition of an equal bulk of’water. The patient’s wife was well to the front with the empty"medicine bottle" on the next dispensary day. The medical man, in

pouring out a new supply of the collyrium, asked how the patientfound the medicine to "agree." " Oh, he likes it greatly, yer honour,"was the prompt reply, " but he can never get it any higher than hismouth." I am, Sir, yours faithfully,Dublin, July 28th, 1909. JOHN KNOTT, M.D. Dub.

THE HOSPITAL GAZETTES.

THE Charing Cross Hospital Gazette (July) records a change of editorsand affords a fair example of the lighter sort of hospital journal. Itschief contribution is a readable article dealing with the History of theDrama, but perhaps a collection of Answers to apocryphal corre-spondents and odd aphorisms will have received closer attention at" The Cross." "A little woman is a dangerous thing " is certainly aneat misquotation.—Guy’s Hospital Gazette of July 24th and

August 7th contains an instructive lecture by Dr. Herbert French onSudden Death. In the latter number the editor has set his imagina-tive artist to illustrate a scene from the annals of Guy’s depicting thefarewell between the great Sir Astley and no less great Dupuytren,who had accompanied him round the wards, and who " when he tookleave saluted the worthy baronet on each cheek," an attention verymuch to the fancy of the surrounding Bob Sawyers. We believe thata similar incident happened to a very distinguished medical baroneton the occasion of a banquet given in his honour in Paris not so verymany years ago, much to the embarrassment of the victim. The

same Gazette contains the following delightful piece of nonsense :-" Once upon a time, a man went to a London hospital to have his

eyes cleaned. After one eye had been taken out and placed on thetable the doctors were called away suddenly, and they went offleaving the door open, the patient of course being unconscious.Thereupon the cat came in and ate the eye on the table. Thedoctors returning, killed the cat, and replaced the missing eye withone of the cat’s, and ever after the man could see with one eye inthe light, and with the other in the dark."

-The Clinical Supplement of the London Hospital Gazette for Julyis devoted to the Surgical Aspects of Osteo-arthritis," and is fromthe pen of Mr. H. E. Ridewood, whilst in the body of the

paper is a clinical lecture on Diseases of the Gall-bladder byMr. Frederic Eve, besides a deal of more ephemeral matter. Theaccount of the London Hospital sports reproduces a " snapshot " ofMr. A. C. Palmer winning the long jump, which is a remarkablerecord of muscular action.-To the Middlesex Hospital Gazette (July)Mr. John Bland-Sutton contributes an after-dinner discourse on" Some Facts and Fancies of Modern Medicine," in the course ofwhich he prophesies that whilst the present methods of physicaldiagnosis will ever remain in use, pharmaceutical remedies will bemore and more replaced by vaccines prepared in the laboratory. Healludes later to the extraordinary theory once held and advanced bythe Sardinian Commission, that cretinism might be due to thedrunkenness of one of the parents at the time of conception of thecretin. Mr. H. E. Earle writes on the "Theory of Functions,"illustrated from the pancreas and the liver, and an anonymous bardhymns " The Wily Senna," in strains no less delicate than Bunthorne’s" Hollow apostrophe of Colocynth and Calomel.-St. Bartholomezv’sHospital Gazette (August) presents one of Dr. T. Claye Shaw’s stimu-lating addresses on "The Span of Life," whilst the same journalin its previous month’s issue contained a report of a case of tripletbirth in which Mr. W. Wyllys safely delivered a patient of three livechildren and three placentas.-St. George’s Hospital Gazette (July)continues its chapter from the Hospital’s History and revives thatexcellent old story of the student on the district "who was cock-sure that he had a case of neck presentation to deal with because " hehad the head in ;his pocket."-St. Gary’s Hospital Gazette (July) islargely concerned with a fund which is being raised to buy a newathletic ground for the Paddington school in conjunction withMiddlesex Hospital, and which is, we understand, prospering well.The chief scientific communication is on the Treatment of Neuralgiaand Sciatica, by Dr. Wilfred Harris.-St. Thomas’s Hospital Gazette(July) contains an account of a dream in heroic couplets and needinglocal knowledge for its full appreciation.

A HOLIDAY HANDBOOK.

Mr. Walter Hill has issued a useful shilling guide-book entitled, " TheHolidays: Where to Stay and What to See," to the districts on theline of route of the Midland, London and North-Western, GreatNorthern, Great Eastern, Great Western, and Great Central Railwaycompanies, and gives much useful information respecting the varioustowns served by these companies for the holiday-maker and tourist.There are lists of seaside, farmhouse, and country lodgings, withbrief references to the features of interest in their neighbourhoods.The various maps and illustrations with which the text of the bookis illustrated enhance its value to those fortunate people who havenot yet taken their holidays and are making up their minds whereto go for them.

586

THE FLY NUISANCE.

To the Editor of THE LANCET.

SIR,-1 have been somewhat disappointed in the results of theformalin treatment mentioned in your columns a few weeks ago andshould like to mention the method I employ in dealing with flies.

I use one of the ordinary dome-shaped fly bottles and the solutionemployed is simply the liquid paraffin of the Pharmacopoeia, whichhas the advantage of being inodorous and (except to the insect com-munity) non-poisonous. The addition of a few drops of oil of cloves

prevents putrefaction of the dead flies and keeps the solution free fromany objectionable smell which might otherwise arise. The mixture,however, does not seem to possess any particular attraction for

flies ; and this might appear at first sight a disadvantage, as it is

usually necessary to " first catch your fly " by cautiously lower-ing the bottle over him. But this is where the sporting instinctsare aroused and any hard-worked or impecunious practitionerwho finds it impossible to go grouse shooting on the moors can (as I amdoing) turn his attention to the smaller game of the tea-table, and thusobtain recreation which has certainly the merit of cheapness to recom-mend it, and which (like some advertised modes of increasing one’sincome) can be carried on "without interference of business." On ahot afternoon, with an hour to spare, the " bag" will be mostencouraging. Once a fly touches the greasy solution he never gets outagain, but slides down into it, and very quickly his career is terminatedin what appears to be a comparatively comfortable state of asphyxia.To be thus suddenly provided with a rapid and comfortable death

whilst in the midst of a hearty meal must from the fly’s point of viewbe a decided improvement on the ordinary fate of his fellows.

I am, Sir, yours faithfully,London, August 10th, 1909. IN TOWN ALL AUGUST.

*** The majority of our correspondents have found the formaldehydemethod very efficacious. It might be stated, however, that theaddition has been mentioned of a teaspoonful of a sweet wine, e.g.,port, or of spirit, e.g., whisky, to the formaldehyde, which appears toincrease the attraction of the fluid for flies.-ED. L.

AN EXTRAORDINARY " TYPHOID CARRIER."

IN a recent editorial article in the Boston Medical and SurgicalJournal the most remarkable case of a typhoid bacillus carrier onrecord" was described. The subject was an Irish cook who had beendetained two years at the hospital on the North Brother Island bythe Health Department. It seemed necessary that she should be

quarantined indefinitely as her release would be a menace to thehealth of the community. Frequent examinations showed that

typhoid bacilli were constantly present in her system, and carefulstudies by Dr. George A. Soper and others seemed to indicate thatthey were generated in the gall-bladder and thence disseminated.Repeated experiments were made in order to find some method ofstopping the development of the bacilli without success. It wasseven years since the woman first came under observation. Twenty-six cases of typhoid fever had been traced to her with certainty andthe total number of cases to which she had given rise was probablyvery large. The outbreaks of which she was the cause occurred insuburban well-to-do families in which she was employed as cook. Shehad never shown any signs of enteric fever.

COMPRESSED-AIR ILLNESS.

NOTWITHSTANDING the experience which has been acquired with refer-ence to the action of compressed air on the human body, accidentscontinue to be reported from time to time. The Engineer of

August 6th mentions that during the month of July several menwere taken ill while working under a pressure of six atmospheresbeneath the river Elbe. They all recovered and returned to work,but one of them, an engineer, again collapsed on subjecting himselfto the increased atmospheric pressure, and died soon after beingcarried out.

A CURIOUS CASE.

To the Editor of THE LANCET.

SIR,-A collier, aged 20 years, was pushing a tub of coal before himwhere the roof of the pit is very low. A stone projecting from the roofscratched his back, causing some abrasions of the skin with slight bleed-ing in a few places. The roof of the pit is wet and foul water dropsfrom it. On the fifth day after the accident I saw the case. The skinall along the dorsal vertebree and horizontally to an extent of aboutseven inches was covered with inflamed papules. Two days after thatthese had become pustules and I punctured 30 or 40 of them. As hecould not afford to run up a doctor’s bill he got an order for admissioninto the infirmary from the parish medical officer, who glanced at hisback and then signed the usual form for admission to the infirmary.That was on the eighth day from the accident. In about threeweeks from the date of the accident the collier was practically well.He sued for compensation under the Employers’ Liability Act. Themedical referee from the company called on him for the first time16 days after the accident and reported to the colliery company that itwas not an accident but a case of acne vulgaris. The case came beforethe county court judge and the medical referee testified that it was acase of acne and that he must have been suffering from it for sometime previously. The parish medical officer who saw him only fora moment or so, when filling the form for admission to the infirmary,on the eighth day of the accident, also testified that the case was oneof acne vulgaris, and that he had seen the "typical blackheads." He

also stated that acne was caused by dirt, "because these peopledon’t wash themselves." Ile also stated that he had had fiveor six acne cases in his own practice among colliers. Judgmentwas given far the defendant. I may state here that another collierwho was close at hand saw the accident and gave evidence as towhat happened before the court.The collier is a healthy man with a beautifully clean skin. There was

not a single pimple on head, face, neck, or chest, or anywhere excepton the back, and his father says there was not a single pimple on hisson’s back before the accident. My theory is that it was a case ofartificial acne, the irritant being the dirty water acting on the chafed orabraded skin, and the dirty water was kept in contact with his skin byhis wet shirt.

Is it correct to say that blackheads are "typical" of acne vulgaris,supposing that these were present and that no mistake has been madehere? I am, Sir, yours faithfully,August 2nd, 1909. C. O’H.

*** This case does not appear to be a typical case of acne vulgaris fromits history. A possible diagnosis is septic folliculitis, if it is not, asour correspondent suggests, an artificial acne. But the data are notsufficient t3 form grounds for a diagnosis.-ED. L.

DR. BARNARDO’S HOMES.

THE forty-third annual report of Dr. Barnardo’s Homes for the year1908 has just been issued in the form of a 64-page pamphlet with anappropriate coloured wrapper containing a number of pictures illus-trative of the work of the institution. The number of orphan anddestitute children rescued in 43 years has been 67,634. Last year2518 children were admitted. The death-rate among the childrenboarded out in rural districts was 2’75 per 1000, while the death-ratecovering all the homes was about 9’24 per 1000. On admission 2’6per cent. of the children showed signs of tuberculosis and 30 percent. of the deaths in the homes were due to tuberculosis. It isstated that over 12 per cent. of all cases treated in hospital sufferfrom tuberculous disease in some form. It should be rememberedthat a large number of the children who come under the care of theinstitution belong to the defective or incurable class. A table of

zymotic diseases shows that 41 children suffered from scarlet feverwith 2 deaths, 120 from measles with 3 deaths, 54 from Germanmeasles with no deaths, 60 from whooping-cough with 2 deaths,11 from diphtheria with 4 deaths, 4 from enteric fever with 1 death,54 from chicken-pox with no deaths, 34 from mumps with no deaths,making a total of 378 cases with 12 deaths. Copies of the report canbe obtained, post free for six stamps, on application to the head-quarters of the Homes, 18 to 26, Stepney-causeway, London, E.

Old School.-We agree with our correspondent in some of his strictureson the letter sent out by a candidate for a vacant medical post, butthat letter is by no means a particularly bad specimen of its class. Wethink that the method adopted of forbidding all canvassing and oflimiting the number of testimonials to three or so should be moreregularly adopted.

Library.-We could not give an estimate of the value of the bookwithout seeing its condition and title-page, but such seventeenth-century tracts are not, as a rule, worth more than a few shillings. Ifour correspondent refers to recent numbers of

" Book Prices Current"he may see the work in question quoted if it has a saleable value.

Enamel.-According to our analysis, the preparation is quiteinnocuous, consisting of shellac, wax, and plaster-of-Paris. It con-tains no poisonous metal.

COMMUNICATIONS not noticed in our present issue will receive attentionin our next.

Medical Diary for the ensuing Week.LECTURES, ADDRESSES, DEMONSTRATIONS, &c.POST-GRADUATE COLLEGE, West London Hospital, Hammersmith-

road, W.MONDAY.-10 A.M., Lecture :-Surgical Registrar: Demonstrationof

Cases in Wards. 12 noon, Pathological Demonstration:-Dr.Bernstein. 2 P.M., Medical and Surgical Clinics. X Rays.Mr. Dunn: Diseases of the Eyes. 2.30 P.M., Operations.

TuESDAY.-12.15 P.M., Lecture :—Dr. Pritchard: Practical Medicine.2 P.M., Medical and Surgical Clinics. X Rays. 2.30 P.M.,Operations. Diseases of the Skin. 5 P.M., Lecture :-Dr. G.Stewart: Syphilitic Diseases of the Nervous System.

WEDNESDAY.-10 A.M., Diseases of Children. 12.15 P.M., Lecture :-Dr. G. Stewart: Practical Medicine. 2 P.M., Medical andSurgical Clinics. X Rays. Mr.b . Diseases of the Eyes.2.30 P.M., Operations. Dr. Robinson: Diseases of Women.

THURSDAY.-10 A.M., Lecture:-Surgical Registrar: Demonstrationof Cases in Wards. 2 P.M., Medical and Surgical Clinics. X Rays.Mr. Dunn: Diseases of the Eyes. 2.30 P.M., Operations. 5 P.M.,Lecture :—Mr. B. Harman : Squint.

FRIDAY.-10 A.M., Lecture ;-Medical Registrar: Demonstration ofCases in Wards. 2 P.M., Medical and Surgical Clinics. X Rays2.30 P.M., Operations. Diseases of the Skin.

SATURDAY.-10 A.M., Diseases of Children. Mr. B. Harman: Dis.eases of the Eyes. 2 P.M., Medical and Surgical Clinics. X Rays.2.30 P.M., Operations. Dr. Robinson Diseases of Women.