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Notes, Short Comments & Answers to Correspondents

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829 NOTES, COMMENTS AND ANSWERS TO Medical Diary for the ensuing Week. Monday, April 10. KING’S COLLEGE HOSPITAL.-Operations, 2 P.M.; Fridays and Saturdays, at the same hour. ST. BARTHOLOMEW’S 1.30 P.M. ; and on Tuesday, Wednesday, Friday, and Saturday at the same hour. ST. MARK’S HOSPITAL.-Operations, 2 P.M. ; Tuesday, 2.30 P.M. ST. THOMAS’S HOSPITAL.-Ophthalmic Operations,2. 30 ROYAL LONDON OPHTHALMIC HOSPITAL, daily at 10 A.M. ROYAL WESTMINSTER OPHTHALMIC HOSPITAL.-Operations, 1.30 P.M.; and each day at the same hour. CHELSEA HOSPITAL FOR WOMEN.-Operations, 2 P.M.; Thursday, 2 P.M. HOSPITAL FOR WOMEN, 2 P.M.; and on Thursday at the same hour. METROPOLITAN FREE HOSPITAL.-Operations, 2 P.M. ROYAL ORTHOPAEDIC 2 P.M. CENTRAL LONDON OPHTHALMIC HOSPITAL.-Operations, 2 P.M., each day in the week at the same hour. UNIVERSITY COLLEGE and Throat Department, 9 A.M.; Thursday, 9 A.M. Eye Department, 2 P.M. ODONTOLOGICAL SOCIETY OF GREAT BRITAIN (40, W.C.).- 8 P.M. Casual communications by Messrs. R. H. Woodhouse, F. J. Bennett and others. MEDICAL SOCIETY OF LONDON.-8.30 P.M. Dr. W. R. Gowers: Neurology and Therapeutics. Tuesday, April 11. GuY’s HOSPITAL.-Operations, 1.30P.M., and on Friday at the same hour. Ophthalmic Operations on Monday at 1.30 and Thursday at 2 P.M. CANCER HOSPITAL, BROMPTON.-Operations, 2 P.M.; Saturday, 2 P.M. WESTMINSTER HOSPITAL.-Operations, 2 P.M. WEST LONDON HOSPITAL.-Operations, 2.30 P.M. ST. MARY’S HOSPITAL.-Operations, 1.30 P.M. Consultations, Monday, 2.30 P.M. Skin Department, Monday and Thursday, 9.30 A.M. Throat Department, Tuesdays and Fridays, 1.30 P.M. Electro. theradeuties, same day, 2 P.M. ROYAL MEDICAL AND CHIRURGICAL SOCIETY.-Mr. W. Bruce Clarke: Acute Renal Dislocation.-Mr Henry T. Butlin : On the Removal of a "Pressure-pouch" of the (Esophagus. Wednesday, April 12. NATIONAL ORTHOPEDIC HOSPITAL.-Operations, 10 A.M. MIDDLESEX HOSPITAL.-Operations, 1.30 P.M. ; Saturdays, 2 P.M. Ob- stetrical Operations, Thursdays, 2 P.M. CHARING-CROSS HOSPITAL.-Operations, 3 P.M., and on Thursday and Friday at the same hour. ST, THOMAS’S HOSPITAL.-Operations, 1.30 P.M. ; Saturday, same hour. LONDON HOSPITAL.-Operations, 2 P.M. ; Thursday and Saturday, same hour. ST. PETER’S HOSPITAL, COVENT-GARDEN.-Operations, 2 P.M. SAMARITAN FREE HOSPITAL FOR WOME:1 AND CHILDREN.-Operations, 2.30 P.M. GREAT NORTHERN CENTRAL 2 P.M. UNIVERSITY COLLEGE P.M. Dental Depart- ment, 9.30 A.M. Eye Department, 2 P.M. ROYAL FREE HOSPITAL.-Operations, 2 P.M., and on Saturday. CHILDREN’S HOSPITAL, GREAT ORMOND-STREET.-Operations, 9.30 A.M. Surgical Visits on Wednesday and Saturday at 9.15 A.M. HUNTERIAN SOCIETY.-8.30 P.M. Clinical Evening. Mr. J. F. Woods : (1) Case of Myxoedema treated with Thyroid Extract: (2) Cases illustrating the Treatment of Alcoholism by Dr. . Arthur Davies : (1) Case of Bell’s Paralysis of Twelve Years’ Duration: (2) Case of Hemicranial Diaphoresis.-Dr. ifox: (1) Case of Lymphadenoma ; (2) Case of Myxoedema treated by the Administration of Crude Thyroid Glands. And other cases. Thursday, April 13. ST. GEORGE’S HOSPITAL.-Operations, 1 P.M. Surgical Consultations, Wednesday, 1.30 P.M. Ophthalmic Operations, Friday, 1.30 P.M. UNIVERSITY COLLEGE 2 P.M. Ear and throat Department, 9 A.M. Eye Department, 2 P.M. Friday, April 14. ROYAL SOUTH LONDON OPHTHALMIC 2 P.M. UNIVERSITY COLLEGE HOSPITAL. -Eye Department, 2 P.Di. CANCER HOSPITAL (Fulham-road, S.W.).-4 P.M. Mr. E. Cotterell: Tumours of the Genito- Urinary System. CLINICAL SOCIETY OF LONDON.-Mr. H. Allingham : A case of Gastro- Enterostomy for Cancer of the Pyloric End of the Claude Wilson: A Sequel to some cases showing Hereditary Enlargement of the W. H. Battle : A case of Abdo- minal Section for Rupture of the Spleen.-Dr. Lucas Benham : A case of Piioas Abscesses Fatal through Renal Complications. Saturday, April 15. UNIVERSITY COLLEGE HOSPITAL -Operations, 2 P.M. ; and Skin De. partment, 9.16 A.M. MET E 0 R 0 LOa lOA L (Taken daily at 8.80 a.m. by Steward’s Notes, Short Comments & Answers to Correspondents. EDITORIAL NOTICE. IT is most important that communications relating to the Editorial business of THE LANCET should be addressed THE EDITORS," and not in any case to any gentleman who may be supposed to be connected with the Editorial staff. It is urgently necessary that attention be given to this notice. - It is requested that intelligence of local events a medical interest, or it is desirable to bring under the notice may be sent direct to Office. original articles, and reports should on one side only of the paper. Letters, whether intended for insertion or for private tion, must be by names and addresses their not necessarily for publication. We ccrrrenot prescribe or recomntendpraetitioners. Local papers containing reports or pcuragraphs should marked and the Sub-Editor." Letters to the publication, sale and advertising de- partments of THE LANCET should be addressed To the Publisher. " We cannot undertake to return not used.. PUBLISHER’S NOTICE. IN order to facilitate the work of reference to the volumes of THE LANCET, we have arranged in the future to publish duplicate copies of the Index to each half-yearly volume in a form in which they may be subsequently filed or bound together. We have had a large number of duplicate copies of the Index to the last half-yearly volume printed, and those of our subscribers who may wish to be supplied with loose copies can obtain the same (without extra charge) on making appli- cation to the Publisher of THE LANCET. DOUBTFUL DIAGNOSIS AND INTERVENTION OF MEDICAL OFFICER OF HEALTH. Jfr. Br6tnd -It is not the duty of the medical officer of health sit in judgment on the accuracy of the diagnosis of the medical attendant who has notified an infectious disease. If he had any- good reason for doubt in the matter his duty would be to com- municate directly and in a friendly way with the notifying prac- titioner, on whom the law has placed the responsibility of decision. A CASE OF INTUSSUSCEPTION. To the Editor8 oj THE LANCET. SIRS,-I think it may be worth while to place this case on record, as it appears to be an example of a condition referred to in THE LANCET of Oct. 15th, 1892, as unusual. The patient was a male child of Mohammedan parentage aged nine months, who was brought to me on Nov. 10th, 1892. The illness was said to have begun about noon on the day before-i.e., about twenty- four hours previously, the symptoms observed by the mother being a.. discharge of blood from the anus and a lump in the abdomen. The child had been sick, but how frequently could not be accurately
Transcript
Page 1: Notes, Short Comments & Answers to Correspondents

829NOTES, COMMENTS AND ANSWERS TO

Medical Diary for the ensuing Week.Monday, April 10.

KING’S COLLEGE HOSPITAL.-Operations, 2 P.M.; Fridays and Saturdays,at the same hour.

ST. BARTHOLOMEW’S 1.30 P.M. ; and on Tuesday,Wednesday, Friday, and Saturday at the same hour.

ST. MARK’S HOSPITAL.-Operations, 2 P.M. ; Tuesday, 2.30 P.M.ST. THOMAS’S HOSPITAL.-Ophthalmic Operations,2. 30 ROYAL LONDON OPHTHALMIC HOSPITAL,

daily at 10 A.M.ROYAL WESTMINSTER OPHTHALMIC HOSPITAL.-Operations, 1.30 P.M.;

and each day at the same hour.CHELSEA HOSPITAL FOR WOMEN.-Operations, 2 P.M.; Thursday, 2 P.M.HOSPITAL FOR WOMEN, 2 P.M.; and on

Thursday at the same hour.METROPOLITAN FREE HOSPITAL.-Operations, 2 P.M.ROYAL ORTHOPAEDIC 2 P.M.

CENTRAL LONDON OPHTHALMIC HOSPITAL.-Operations, 2 P.M., each day in the week at the same hour.

UNIVERSITY COLLEGE and Throat Department, 9 A.M.;Thursday, 9 A.M. Eye Department, 2 P.M.

ODONTOLOGICAL SOCIETY OF GREAT BRITAIN (40, W.C.).-8 P.M. Casual communications by Messrs. R. H. Woodhouse, F. J.Bennett and others.

MEDICAL SOCIETY OF LONDON.-8.30 P.M. Dr. W. R. Gowers:Neurology and Therapeutics.

Tuesday, April 11.

GuY’s HOSPITAL.-Operations, 1.30P.M., and on Friday at the same hour.Ophthalmic Operations on Monday at 1.30 and Thursday at 2 P.M.

CANCER HOSPITAL, BROMPTON.-Operations, 2 P.M.; Saturday, 2 P.M.WESTMINSTER HOSPITAL.-Operations, 2 P.M.WEST LONDON HOSPITAL.-Operations, 2.30 P.M.

ST. MARY’S HOSPITAL.-Operations, 1.30 P.M. Consultations, Monday, 2.30 P.M. Skin Department, Monday and Thursday, 9.30 A.M.Throat Department, Tuesdays and Fridays, 1.30 P.M. Electro.theradeuties, same day, 2 P.M.

ROYAL MEDICAL AND CHIRURGICAL SOCIETY.-Mr. W. Bruce Clarke:Acute Renal Dislocation.-Mr Henry T. Butlin : On the Removalof a "Pressure-pouch" of the (Esophagus.

Wednesday, April 12.

NATIONAL ORTHOPEDIC HOSPITAL.-Operations, 10 A.M.MIDDLESEX HOSPITAL.-Operations, 1.30 P.M. ; Saturdays, 2 P.M. Ob-

stetrical Operations, Thursdays, 2 P.M.CHARING-CROSS HOSPITAL.-Operations, 3 P.M., and on Thursday and

Friday at the same hour.ST, THOMAS’S HOSPITAL.-Operations, 1.30 P.M. ; Saturday, same hour.LONDON HOSPITAL.-Operations, 2 P.M. ; Thursday and Saturday, same

hour.ST. PETER’S HOSPITAL, COVENT-GARDEN.-Operations, 2 P.M.SAMARITAN FREE HOSPITAL FOR WOME:1 AND CHILDREN.-Operations,

2.30 P.M.GREAT NORTHERN CENTRAL 2 P.M.

UNIVERSITY COLLEGE P.M. Dental Depart-ment, 9.30 A.M. Eye Department, 2 P.M.

ROYAL FREE HOSPITAL.-Operations, 2 P.M., and on Saturday.CHILDREN’S HOSPITAL, GREAT ORMOND-STREET.-Operations, 9.30 A.M.

Surgical Visits on Wednesday and Saturday at 9.15 A.M.HUNTERIAN SOCIETY.-8.30 P.M. Clinical Evening. Mr. J. F. Woods :

(1) Case of Myxoedema treated with Thyroid Extract: (2) Casesillustrating the Treatment of Alcoholism by Dr.

. Arthur Davies : (1) Case of Bell’s Paralysis of Twelve Years’Duration: (2) Case of Hemicranial Diaphoresis.-Dr. ifox:

(1) Case of Lymphadenoma ; (2) Case of Myxoedema treated by theAdministration of Crude Thyroid Glands. And other cases.

Thursday, April 13.

ST. GEORGE’S HOSPITAL.-Operations, 1 P.M. Surgical Consultations,Wednesday, 1.30 P.M. Ophthalmic Operations, Friday, 1.30 P.M.

UNIVERSITY COLLEGE 2 P.M. Ear and throatDepartment, 9 A.M. Eye Department, 2 P.M.

Friday, April 14.

ROYAL SOUTH LONDON OPHTHALMIC 2 P.M.UNIVERSITY COLLEGE HOSPITAL. -Eye Department, 2 P.Di.CANCER HOSPITAL (Fulham-road, S.W.).-4 P.M. Mr. E. Cotterell:

Tumours of the Genito- Urinary System.CLINICAL SOCIETY OF LONDON.-Mr. H. Allingham : A case of Gastro-

Enterostomy for Cancer of the Pyloric End of the Claude Wilson: A Sequel to some cases showing HereditaryEnlargement of the W. H. Battle : A case of Abdo-minal Section for Rupture of the Spleen.-Dr. Lucas Benham : Acase of Piioas Abscesses Fatal through Renal Complications.

Saturday, April 15.UNIVERSITY COLLEGE HOSPITAL -Operations, 2 P.M. ; and Skin De.

partment, 9.16 A.M.

MET E 0 R 0 LOa lOA L (Taken daily at 8.80 a.m. by Steward’s

Notes, Short Comments & Answers to

Correspondents.EDITORIAL NOTICE.

IT is most important that communications relating to theEditorial business of THE LANCET should be addressed

THE EDITORS," and not in any case to anygentleman who may be supposed to be connected with theEditorial staff. It is urgently necessary that attention begiven to this notice. -

It is requested that intelligence of local eventsa medical interest, or it is desirable to bring

under the notice may be sent direct to Office.

original articles, and reports should on one

side only of the paper.Letters, whether intended for insertion or for private

tion, must be by names and addresses their not necessarily for publication.

We ccrrrenot prescribe or recomntendpraetitioners.Local papers containing reports or pcuragraphs should

marked and the Sub-Editor."Letters to the publication, sale and advertising de-

partments of THE LANCET should be addressed To thePublisher. "

We cannot undertake to return not used..

PUBLISHER’S NOTICE.

IN order to facilitate the work of reference to the volumesof THE LANCET, we have arranged in the future to publishduplicate copies of the Index to each half-yearly volume ina form in which they may be subsequently filed or bound

together.We have had a large number of duplicate copies of the

Index to the last half-yearly volume printed, and those ofour subscribers who may wish to be supplied with loose copiescan obtain the same (without extra charge) on making appli-cation to the Publisher of THE LANCET.

DOUBTFUL DIAGNOSIS AND INTERVENTION OF MEDICAL

OFFICER OF HEALTH.

Jfr. Br6tnd -It is not the duty of the medical officer of health sit in judgment on the accuracy of the diagnosis of the medicalattendant who has notified an infectious disease. If he had any-

good reason for doubt in the matter his duty would be to com-municate directly and in a friendly way with the notifying prac-titioner, on whom the law has placed the responsibility of decision.

A CASE OF INTUSSUSCEPTION.

To the Editor8 oj THE LANCET.

SIRS,-I think it may be worth while to place this case on record, asit appears to be an example of a condition referred to in THE LANCETof Oct. 15th, 1892, as unusual.The patient was a male child of Mohammedan parentage aged nine

months, who was brought to me on Nov. 10th, 1892. The illness wassaid to have begun about noon on the day before-i.e., about twenty-four hours previously, the symptoms observed by the mother being a..discharge of blood from the anus and a lump in the abdomen. Thechild had been sick, but how frequently could not be accurately

Page 2: Notes, Short Comments & Answers to Correspondents

830 NOTES, COMMENTS AND ANSWERS TO

tained, and no fmeal matter had been lie appeared have pain at The infant was a healthy looking child,and did not appear at all collapseci. The face was a little but the temperature was normal. In thn left side of the a tumour could be felt. moat distinct in the iliac region. One end ofit could be just touched by the finger inserted into the rectum,but the other end was not distinctly made out. The abdomen wasnot rigid or distended, and there did not appear to be vetymarked tenderness. I gave chloroform and slo wly injeoted a quantityof warm water into the bowel with a Ifigginson’.4 syringe, the childbeing at the same time held in a half inverted position, as the sphincterany was so lax that it was difficult to prevent the water escaping almostas fast as it was injected. By repeated injections the was gradually reduced, the receding tumour b’’ing t,raced in theintervals between them along the descending and transverse portions

the colon. Finallv, only a small lump, about the of n.small walnut, could be felt in the crec’!.l region ; but one or two furtherinjections, distending the whole colon, to make it disappear.This I supposed to be a small portion of the intussusception which Temained unreduced, and I therefore recommended laparotomy ; but,in spite of endeavours to make them understand the gravity of the- case, the consent of the parents could not be obtained. They went off’to consult with other relatives, taking the child witi them, and I heard-nothing more of the until about a fortnight ago, when I was toldthat he had recovered, having no further bad symptoms from the time i

-of the injections’. On Feb. llth I mvself saw him alive and well.I think there can be no doubt that the condition in this was

identical with that described by Mr. Hilton Pollard in THE T.ANCET ot’Oct. 15th. although the confirmatory evidence afforded bylaparotomy is not forthcoming. The suppo =ition that the small swelling- etill felt after reduction by injection of water was due to the swollen’condition of the ileo-caecal valve affords a satisfactory explanation of its

when the reduction must have been really complete.I am, Sirs, yours truly,

E. M. FARRER, M B., B.S. LOND.Bhiwani, Punjab, India, Feb. 18th, 1893.

THE SALE OF 11 DIPLOIIAS BY THE OBSTETRICAL SOCIETYAND THE LIVERPOOL HOSPITAL.

RENTOUL sends us a communica’ion too long for insertion, Ileprecat-ing the sale to women of "diplomas," as he them, in midwifery,observing that the General Medical Council has " made a rule " to theeffect that these have no legal value The sale of these

diplomas has realised in the case of the Obstetrical Society in the course.of eightern n years .6988 5s., and in the CMC of the Liverpool Lying-in Hos-pital E1000 in eight years. What the General Medical Council did was,we believe, not to "make a rule," but to inform Dr. Rentoul thatsuch certificates are neither licences nor diplomas and possess no legalvalue, and to point out through the President to the "institutionsand persons " who grant such certificates that the certiflcates should’be expressed in’ such a form as not to lead to the impression thatthey are legal qualifications to practise midwifery. It is undoubtedlyunsatisfactory that the granting of such certificates should be asortof business and a source of profit to either societies or individualswho like to take up the work. If the Act of 1886, which requiredfull qualification in medicine, surgery and midwifery, is to be

tampered with, it should be on conditions and by authorities definedby

has not enclosed his name and address.

SANITARY PRECAUTIONS.To the Editors THE LANCET.

page 753 of THE LANCET of last week you note the com-bath system at Kirkby Stephen. I do not wish to draw inordinate

praise upon any of my sanitary authorities, much less on the virtualoriginator of their action, but I may add that at Kirkby Stephen othermeans are adopted which you may think worthy of imitation in otherdistricts—viz., all the sleeping rooms occupied by tramps are dis-infected during the daytime with chlorine and all the clothing of the’tramps is taken from them when they go to sleep, and during the night

also exposed to the chlorine fumes for several hours. Whilst revac-will protect a person who may have been exposed to infection,

it seems to me absolutely necessary that the further means of daily.disinfection of every item of clothing &c. ought to be carried out forthe protection of those who have not been and are not willing to be

Another measure adopted is weekly public an lieu of the usual three weeks in every third month. This is only in

country places, of course, weekly vaccination in the borough ofbeing the regular practice at all times of the year.

I am, Sirs, yours truly,Kendal, April 1st, 1893. R. MUSGRAVE CRAVEN, M.O.H.

CLUB PATIENTS AND RAILWAY ACCIDENTS.

question is a legal one ; but we should have no hesIta-tion in saying that it is unreasonable to expect the surgeon of aclub to attend a club patient for injuries caused by a van belongingto.a company, which company has admitted its liability.

LIMITATION 0)’’ FOR WITH THE

VA(1(11’,N’ATION

ROIII?RT M.D., favours us with a communi.on the above sub’ect. We are unable from want of space to

insert the whole letter, but quote a few sentences, which contain the

gist of his contention."If Mr. says Dr. "and those who agree with

him on the subject of the limitation of penalties for non-compliancewith the Vaccinatinn Acts succeed in carrying their point, the out-come will be the formation throughout the country of insurancesocieties for the payment of the single penalty for non-complianceby a small weekly payment, for a longer or shorter period, accordingto its amount. The result of this will of necessity be the practicalvoluntary acceptance of vaccination, as the rich will aid in payingthe penalty for the very poor, who may be unable to meet even asmall weekly payment. Here lies the whole secret of this urgiug ofthe limitation clause; and it therefore seems to me that this willhave the effect, not only of practically making this acceptancevoluntary, but doing it in a manner which forfeits the onlyjusti.flable plea for the infliction of any penalty for non.complianceand doing it by means of is really a legal evasion obtainableby a fixed payment. If compulsory vaccination is necessary forthe public health there should be no means of evading it, andcertainly no legal ones. If vaccination can he shown to be eithernot necessary or only so at a cost of risk of injury to health outof proportion to the supposed benefit, then let compulsion beabandoned and the acceptance of the prophylactic made voluntary,and the country take the consequences."

Mr. Edgar Waelly should consult the Medical Directory.

HYPERPYREXIA IN A CASE OF INFLUENZA.

To the Editors of THE LANCET.

SIRS,-The following case strikes me as being of some interest onaccount of such an astonishingly high temperature :-A plasterer was taken ill with pains in his limbs, back and head

on Monday, March 13th. I saw him the same day, and found himsuffering from influenza, his temperature being at that time 103’ F. Itnever rose above this (and dropped on two or three occasions to 101’F.)until the Monday following (March 20th). I was called to him at 3 A.M.,when I found him quite insensible, with very pronounced stertorousbreathing, and on taking his temperature I WM extremely astonishedto find it registered 1088’ F. On touching his skin it was

so hot that I could barely keep the back of my hand on it.I immediately ordered him to be sponged all over with cold water,but he succumbed in less thin half an hour. His wife in-formed me he had spoken quite sensibly to her at 2 A.M. and hadtaken some milk. I had carefully examined him throughout his illnessfor any lung, cardiac or cerebral troublp, but could discover nothingamiss. It might be suggested that my thermometer was wrong. I can

only say I had quite recently tested it with several others and havedone so since, but find it to be correct.

I am, Sirs, yours faithfully,W. H. BOGER, M.R.C.S.Eng., L.R.C.P.Edin.

Fowey, Cornwall, March 26th, 1893.

METEOROLOGY.

THE Weather Conference which is to take place at Chicago in the

autumn may or may not result in the formulation of data by whichforthcoming weather may be safely predicted. A little pamphlet,written by Mr. Hugh Clements, sets forth a plan by which this desir-able end may be attained. In view of the very moderate amount of

success achieved up to the present time by experts on meteorology,it is excusable not to indulge in extravagant hopes in the prac-tical outcome of the Conference or in the efficacy of the schemepropounded by the writer referred to.

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

During the week marked copies of the following newspapershave been received :-Leicester Daily Western DailyNews, Blackburn Daily Telegraph, Pontefract Express, LancashireEvening Express, Cork Oban Telegraph, Cheshire EveningEcho, Morpeth Herald, Louth and North Lincolnshire Advertiser,Liverpool Coitrier, North Eastern Daily Gazette, Poole Herald, fhire Post, Jersey Observer, Coatbridqe Express, Gazette,Kentish Mercury, Times, Liverpool Daily Post, Bristol Mercury,Glasgow Herald, Stafford Evening Post, Dundee Courier, Wolver.

Chronicle, Leeds Mercury, biininp Journal,The Morning, Weekly Free Press and Aberdeen Herald, Public Health,West Middlesex Surrey Advertiser, Local

Chronicle, Hertfordshire Mercury, Metropolitan Journal, ScottishLeader, Cape Argus, Sunday Times, Builder, Architect, Observer,Sunday Chronicle (Manchester), Water ford Chronicle, Citizen, WestMiddlesex Advertser, Leith Burghs Pilot, Scotsman, Indian DailNews, Pioneer Mail, Advertiser, 2’ime* of India,

Page 3: Notes, Short Comments & Answers to Correspondents

831NOTES, COMMENTS AND ANSWERS TO CORRESPONDENTS.

Communications, Letters &c. have been

received from-

A.-Dr. W. S. Alexander, Dublin ;Dr. P. H. Abercrombie, Vienna ;Dr. F. P. Atkinson, Surbiton ;Mr. T. Algar, Vienna ; Messrs.

Armour and Co..London; Messrs.Allen and Hanburys, London;A. F. T., Bournemouth ; ArgyleRubber Co., Glasgow.

1. Bourke, London; Dr. C.Bage, Melbourne; Dr. F. Lucas

Benham, London ; Dr. Boxall,London; Mr. A. Baker, London ;Mr. Heather Bigg, London; Mr.C. Birchall, Dr. S.Jex Blake, Edinburgh ; Mr. C.

Ball, St. Leonards ; Mr. F. JeffryBell, London; Mr. W. H. Bennett,London; Messrs. Burgoyne andCo., London; Messrs. Bruce andCo., London; DailyPost, Editor of ; BromsgroveCottage Hospital.

C.-Dr. G. Campbell, Forfarshire ; I

Mr. T. J. Croke, Beverley; Mr. G.Carter, Ilkley ; Messrs. Caqselland Co., London; Messrs J. andA. Churchill, London; Messrs.

- J. A. Carveth and Co., Toronto.

D.-Mr. F. W. Dingle, Bath; D.Sc.,London; Doctor, Hammersmith.

Evatt, Woolwich ; Early ClosingAssociation, London. ]

F.-Sir Joseph Calcutta ;Mr. W. Hay Forbes, TunbridgeWells.

G.-Dr. R. Gennaro-Torre, Annun-ziata ; Mr. W. J. Gant, Hastings ;Mr. G. De G. Griffith, London ;Mr. A. G. P. Gipps, China ;Messrs. Griffin and Co., London.

H.-Dr. G. Halley, London; Mr.

E. G. Hawkings, Plymouth ; Mr. "

C. W. Hoskyns-Abrahall, Shef-

field ; Mr. W. F. Horton, London;Mr. Walter W. Heelas, London ;Mr. J. C. Humphreys, London ;Hereford, London; H. A.

J.-Johannis Co., London.

-

R. Kirk,Glasgow ; Mr. R. C.Kerin, London; Miss Kirkham,Shepherd’s-bush.

L-Dr. Robert Lee, London ; Dr.J. F. Little, London ; Dr. Thos.Glover Lyon, London ; Mr. JohnLane, Kingswood-park ; Mr. H.

Law, Lancashire ; Mr. H ;race

Lowther, isle of Wight.

M.-Dr. J. McD. Mackay, Fortrose;Dr. A.Campbell Munro, Paisley;Dr. James Murphy, Dr.

John Meredith, Somerset ; Mr.

G. Michelmore, Tiverton ; Mr.

R. Mosse, Mr. James

Meeham, Mrs. Monk-

house, Tulse-hill ; Mesfrs. Mac-

niven and Cameron, Edinburgh;hi.D.,!VLR.C.P.,LItC.S.; M.O.,Wal worth ; M. B., C. M Ed. ; Man-chester Royal Infirmary.

H. O’Neill, Belfast ; Dr.

Henry Alston, Trinidad ; Mr. W.Odell, Torquay ; Mr. G. W.

Oownpatrick ; Op-portunity, London.

P.-Dr. H. Penna, Rio de Janeiro ; Brigade-Surgeon Robert Pringle,Blackheath ; Mr. Awdry Peck,London.

Q.-Queen Colleee, Glas-gow.

R.-Dr. C. H. Ralfe, London ; Dr.A. Maithnd Ramsay, ;Prof. Rubino, Napoli ; Mr. U. R.Rudd, Exeter ; Mr. L Preston; Mr. George Redford,Crickldwood, London, N. W. ; ;Messrs. Rowntree and Co., York;Messrs. Robertson and Scott,Edinburgh ; Rotheram Hospital;R. J. F., London ; Royal Collegeof Surgeons.

S.-Dr. Fred. J. Smith, London;Dr. Herbert Snow. London ; Dr.E. M. Skerritt, Bristol ; Surg.-Capt. T. Hbaw, Goona; Mr. J. Bland Sutton, London; Mr. H.

Selh, London ; Mr. J. Swale,Leeds; Mr. T. Seni, Kustendji;Messrs. Street and Co., London ;

Surgeon, London; St. Mungo’sCollege, St. Luke’s

Hospital.T.-Dr. Thresh, Mr.W. B. Tate, Nottingham; MissTaylor, Westminster; Tuson’sDisinfectants Co., New Charlton.

V.-V. C., London.

A.-Dr. W. A.dam, Rainhill; Dr. J. Althaus, London ; Alpha, Bir-mingham; Alpba, London; A.B.,

107, Arundel- avenue, Liverpool.

B.-Mr Bell, Lancaster ; Mr. T. BBrooke, London ; Mr. Beatt,Cavan ; B. B., London.

C.-Mr. W. P. Cox. Leicester ; J.Crawford, Tredegar ; Cornish-

Editor of, Penzance.

N. Davies, Llanrwst ; Dr.W. I)ale, Bishop’s Teignton; Dr.A. M. De Souza, Bombay ; Mrs.

Danby, Lincoln, Deermina.tion,London; Delta, London; D.Sc.,London.

E.-Miss Elliott, Newton Excellent, London; EdinburghSchool of Medicine; E F., South-sea ; E. R. N., London; Eserine,London ; E. L. M , Birkenhead.

R Middleton,Cork; Fylde, London ; Fellow-

ships, Edinburgh ; Felix, London.

G.-Dr. T. H. Gibson, Tebay; Mr.W. Bradford; G. H. B.,London; Golf, London. IH.-Dr. R Hollings, Wake6eldMr. R. Harris, West Bromwich ;Messrs. Hooper and London ;Messrs. Herington & Co., London.

Mahomed Ismail, Hyder-abad ; Ilex, London.

J.-Mr. F. F. Jones, L’anfyllinMessrs. James and Smith, Liur.pool ; Juvenis, London; Justitia,London.

C. Keys, West Bromwich.

W. -Dr. White, Sheffield ; Mr.

I W. N. Willoughby,WeetNorwootl;Mr. F. Woods, Dorset; Messrs.Wright, Dain aud Co., Birming.-ham; Messrs. Whitworth anA

Manchester ; Messrs.

White, Druce & Brown, London

Post, Leeds.

Letters, each with enclosure, are also

acknowledged from-.uuimon.

M.-Dr. J. Montgomery, Birming -ham ; Messrs. Mertens and Co.,.London ; Major, Manchester ;.

Mayfly, Middlesbrough ; Mater,.Denmark-hill; M.D , Liverpool ;,

Medicus, London.

N.-Mr. W. R. Nicholson, York ;Newcastle Cot poration ; Nucleus"London.

0.—Opportunity, London.

P. 0.,.London.

R.-Mr. R. Redpath, Newcastle..on-Tyne ; Mr. W. M. Riley, Here.ford ; Miss Robertson, Hawk-

Messrs. Read and Co.,Bristol; Rusticus, London.

S.-Dr. Smdden, Mr.F. W. Stoddarb, Bri8tol; Messrs,Steel and Jones, Bristol; ScalpEl,.London.

T.-Mr. J. Tibbit, Dunstable ; Mr.Tyte, Minchinhampton; Mr. J.

Thin, T. W., London-

F. W. Underhill, Moseley.

V.-Dr. W. B. Vanderpoll, New-York.

W.-Mr. J. E. Williams, Cheadle ;.Mr. J. C. Warren, New Bromptoit, Miss Worboys, London ; Messrs.Wood and Co, New York ; ford House Hospital, Exeter;. y,Western General Dispensary,London ; Westfield, London :.W. R. A., Oxford.

X.-X. Y. Z., London.

An and novel feature of " THE LANCET General Advertiser " is a special Index to Advertisements on pages a and 4, which not affords a ready means of finding any notice, but is in itself an additional advertisement.

Advertisements (to ensure insertion the same week) should be delivered at the Office not later than Wednesday, accompanied by a remittance,Answers are now received at this Office, by special arrangement, to Advertisements appearing in THE LANCET.Terms for Serial Insertions may be obtained of the Publisher, to whom all letters relating to Advertisements or Subsedptiono should issl

addressed.

THE UHCET can be obtained at all Messrs. W. H. Smith and Son’a Railway Bookskalle throughout the United Kingdom. are also received by them and all other Advertising Agents.

Agent for the Advertisement Department in ASTim. 0auMMOn

Page 4: Notes, Short Comments & Answers to Correspondents

832 THE LANCET SPECIAL COMMISSION ON WATER-SUPPLY OF CHICAGO.

REPORT OF

THE LANCET

SPECIAL SANITARY COMMISSION OF INQUIRYCONCERNING THE

WATER-SUPPLY OF CHICAGO, U.S.A.

city of Chicago has, speaking roughly, two outlets forsewage matters-Lake Michigan and the Mississippi

River-and one source of water-supply-Lake Michigan.The Chicago River, which serves as main sewer’ to the

city, flows naturally into the lake, but in order that its

burden of sewage matters may not be all discharged therea powerful pumping station has been erected some distanceup the stream on its southern branch. From this point the!river water is pumped over a lock into a canal which carriesit far south into the Missouri and eventually into the

Mississippi River. The bulk of the liquid sewage is disposedof in this way. Several sewers serving the Lake shore dis-tricts of the city debouch upon the lake, but their aggregateoutput is estimated at less than 15 per cent. of the total

sewage of the city. Subject to this abatement the Missouriand Michigan Canal receives as its quota of the whole dis-charge the liquid, dissolved and floating matters. The sus-

pended matter which deposits as sludge on the river bottomis removed by dredging and carried out to the lake; which thusreceives these solid matters in addition to the Lake shore

sewers’ discharge as its proportion of the city’s drainage.The water supplied for domestic and other use within the

city is, as already stated, drawn from the Lake, and is con-veyed to the pumping stations, which are distributed at variouspoints throughout the city, by subterranean aqueducts extend-

for distances which vary from one to four miles, under thebottom of the lake. The water is thus taken from points!lying at various but no great distances from the sources ofpollution, and chosen with regard to the observed effect whichthe sewers produce upon the condition of the Lake water. Thewater so obtained is pumped into the city mains and under-goes no filtration or other treatment until it is delivered in the ,,consumer’s house, save such as may result from the mixing ofatmospheric air with it in the pumping operation, and the Ideposition of some greater or lesser proportion of its suspendedmatters in the conduits through which it flows.

In addition to the water of the Lake, waters from threeother sources of supply have been examined in the course ofthis inquiry. These are (1) the water of the WashingtonHeights artesian well, a source of supply for a limited districtwithin the city which need not be considered in this place,and (2) and (3) the waters from the I I Hygeia " and I I Silurian "wells at Waukesha-spring waters which are largely con-sumed for drinking purposes within the city and of which thefirst named, "Hygeia" water, is by means of a special pipeto be brought in large quantities and distributed at a chargeof one cent (one halfpenny) a glass throughout the Woxld’sFair grounds. For the preparation of lake water for drink-

the use of domestic filters is very common in Chicago,and may be said to be universal in the hotels, the form offilter most in favour being that known by the name ofPasteur-in design a very excellent instrument and onewhich, so long as it remains undamaged by fracture or

displacement of its parts, may be relied upon to do its workefficiently.Such in bare outline are the conditions under which water

is supplied to Chicago. Those of our who may beinterested to examine these facts more carefully will find them

detailed in the technical portions of the report of thisCommission. We now proceed to deal here with theresults to which the chemical examination has led. It willof course be understood that the chemical examinationof water deals only with the question of pollution, notwith that of infection. A water that is chemically ofvery high character in respect of purity may by chancebe seriously infected with disease germs, and, on theother hand, a water which is extremely foul may be abso-lutely free from the seeds of specific disease. This questioncan only be positively answered by bacteriological examina-tion and by the study of the effects of the water on those whodrink it. No such bacteriological examination has been practic-able in the present case, because of the length of time neces-sarily consumed in transporting the specimens from Chicago toLondon. The period so occupied would have sufficed for theoccurrence of most important changes in the conditions ofbacterial life upon which such an examination must pro-ceed. The value of chemical analysis is chiefly due to itsaffording a very substantial ground of inference. Typhoid fever,cholera and diarrhoea are the principal disorders which aredisseminated by sewage-contaminated water, and in practicewater receives such germs from sewage only. If, therefore,sewage contamination can be detected by any means, it iscertain that the contaminated water is unsafe for drinkingpurposes, however innocent the actual sewage matter dis-covered may itself be, for the vehicle which conveysinnocuous sewage to-day may convey pernicious germs to-morrow. A water which is chemically impure, if the

impurity be traceable to sewage contamination, must be anobject of distrust; so also must a water which is excrement-ally polluted, even if chemical analysis fails to showevidence of this pollution. It is to the determinationof the sewage-derived constituents that the labours ofMr. Crookes and of our own analyst have been chieflydirected and their detailed technical report has settled therank in the order of purity of every one of the specimensof water subjected by them to analysis. For the citizens of

Chicago and for anybody else who is interested in the elabora-tion of the large schemes of sewerage and water-supply whichmust sooner or later be undertaken by the great and growingcity, their report will possess a permanent interest, and willbe of greatest interest precisely in those passages which arechiefly of theoretical significance-in those, for example,which deal with the condition of the Chicago River and theLake dumping grounds. These, from our present point ofview, may be summed in a very few words. The river isshown to have distinct characters in four different parts ofits course. In the North branch it is satisfactorily pure andperfectly sweet water. In the Southern branch it showsincreasing pollution as one travels back from the mouthtowards the source, and in the branch which turns awaytowards the stockyards and lies apart from the main currentof the river filth has accumulated to an extent which hasconverted the water into a material more offensive thanthe untreated outpourings of an ordinary sewer. Bad asthe river is at this point, it is, however, unnecessary to warnvisitors against frequenting its neighbourhood, for the simplereason that the stench of itis warning enough and no ordinarytraveller through those parts is at all likely to approachthe river unwittingly or to seek its precincts as a matterof choice. It is not at all surprising to find that typhoid


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