1850

THE BATTLE OF THE CLUBS.

STOCKPORT AND DISTRICT MEDICAL SOCIETY.

A SPECIAL meeting of the medical profession was held onDec. 3rd, under the auspices of the above society. The

meeting was called to "consider certain offers of vaiiousclubs " and was well attended. Mr. HOUSMAN (vice-president) occupied the chair in the unavoidable absence ofthe President (Dr. Marriott). The Chairman in introducingthe subject said now that the clubs found that they would bewithout medical officers at the end of the year they were try-ing to approach the medical men of the town. The pro-fession were bound by the scheme which they had signed inJanuary last. Under this scheme the following rules hadbeen adopted :-

1. Minimum payment (men only), 4s. 4d. per annum, on all who havebeen in benefit during the year, and resident within two miles of theclub-house.

2. Members to attend at fixed hours when able. Messages forpatients to be seen at their homes must be left before 9 A.M. Onlyurgent cases seen on Sundays.

3. Night visits and special visits after 9 A.M. may be charged for asprivate visits.

4. Medical attendance to mean advice and ordinary medical andsurgical attendance, exclusive of fractures, dislocations, and severein,iuries and all operations beyond opening superficial abscesses.

5. Venereal diseases excluded.6. Medicine bottles to be provided by patients or paid for.7. Termination of appointment to be three months’ notice on either

side.8. Members with incomes of over P,100 per annum or occupying

houses of R20 rental and over not to be included in medical benefits. -

9. A fee of 2s. 6d. to be paid for examination of any candidate foradmission to a club.

The question now was whether the scheme should be modifiedor whether it should be adhered to as it stood. Certain clubshad offered to pay the 4s. 4d. per annum if all the otheritems of the scheme (eight in number) were abandoned, andit was desirable to know what the profession thought. The

great stumbling-blocks with the clubs were the wage limitand the examination fee, and he thought the former mightbe removed by not making the wage limit retrospective, that Iis, only to apply it to members joining after Jan. lst, 1897.

Mr. ROGERS said a club of 300 members bad offered him4s. 4. a year if all the other items were allowed to fallthrough ; he wished to know the feeling of the other men,and he was prepared to do just as the profession wished.

After a lengthy discussion, in which most members tookpart, Dr. ROGERSON moved that " the scheme be adhered toas it stands." He said the scheme was a reasonable oneand to alter it would show weakness and want of backboneon the part of the medical men.

Dr. SEVILLE seconded the motion.Mr. J. H. 0. GOULDEN moved as an amendment that

Clause 8 of the scheme should read: ’’ All persons who are onDec. 31st, 1896, already benefit members shall be entitled totheir medical benefit provided through their clubs duringthe continuance of their membership irrespective of theirpecuniary position. All members joining after Jan. lst,1897, shall receive medical benefit as if by an annual con-tract between such benefit member and the medical officer,the medical officer having the power to terminate the con-tract on account of the pecuniary circumstances of anymember-viz., being in receipt of more than £2 per week-at the end of any year by giving notice in writing to thateffect to the club secretary before the end of the year. Theindividual members on their part may cease contributing atthe end of any quarter, such cessation to be notified to themedical officer." Also that Clause 9 should read, "No exa-mination fee to be charged to candidates for admission tomedical benefit, but that 2s. 6d. be charged for examinationsto sick benefit only."

Mr. ROGERS seconded, and on the amendment being put5 voted for and 9 against the motion.The original resolution was then put and carried, 9 voting

for and 5 against it.A vote of thanks to the chairman terminated the pro-

ceedings. -

THE POSITION AT YARMOUTH AND GORLESTON.We have been requested by Mr. G. Wilberforce, P.P.G.M.,

Notts Order, Station-road, Beeston, Notts, to insert thiscommunication :-" I enclose announcement of success at Gt Yarmouth here a gentle-

man has been selected from hundreds who applied for the situation

including M.d. and F.H.O.P’s and even three professors. You willalso be suprised to learn that a most highly qualified gentleman hasbeen appointed as dispenser with a proper medical degree. In a fewmonths the town will be catered for on more reasonable terms thanNottingham or Norwich orders or even Foresters could secure fromlocal medicals, against whom there is no ill feeling whatever as statedby you in the remarks on the above question in your paper of the19th inst. I have been one of the promoters of two Institutions andhave found most cordial relations exist between doctors and Committeeand as long as the former do their duty they have nothing to fear fromus but on the contrary good treatment and fair dealing. Our Institu-tions now have a register of men so that any case of insubordinationor inefficiency or npgelct on their part is very easily remedied. Thishappily rarely occurs as we pay them well and by treating them wellwe get better medicine and attendance than under the old systemwhere we had to wait till the private patient was seen first regardless ofthe seriousness of the case.

.. I hope to see these Institutions very general as I believe the-friendlies only shall cater for the publick. I lind that 3 active menand 2 dispensers can cater for 15,000 and at 4/- per head this means.63000 per ann. We can save 800 per ann out of this and the surplusin two years will either build a grand premise or can be put to thebenefit of the members. From this you will see what a grand thingCoperation is for where only one or two suffer many benefit thereby." I hope we shall be able to give employment to feameles to attend

the ladys who natarally prefer a woman to attend private disorders.If our servants do their duty we can afford to make the job worththeir while to stay ani be loyal and true to us.

I am SirYours truly

" SHEPPKRD .AND FOItRESTER."

The authors have the subject near at heart, for they writeon the envelope : " We hope every district in Londonwill have An Institution in less than 3 years." We doindeed see what a grand thing " Coperation " is when thenoble profession of medicine is expected to be at the beckand call of institutions with educated and liberal-mindedpromoters of the sort represented by "Shepperd" and"Forrester ’ at their head. But lest "Sbepperd" and’4 Fort ester," whether gentlemen or "ladys," should get allthe benefit, and the medical profession, whether males or"feameles," endure all the suffering, we advise the medicalprofession to be the ones to .. coperate." To continueemploying the elegant language of 11 Shepperd" and"Forrester," no job can ever make it worth the while ofmembers of the profession to remain the servants of suchmasters, even if their qualification to practise should beavthe comical title of M.d.

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PHLORIDZIN DIABETES.

IN a recent communication to the Physiological SocietyDr. Pavy entered into the subject of phloridzin diabetesand related experiments bearing on a debatable point.Since von Mering, he said, in 1888 showed that phloridzincould produce glycosuria many experiments had been madewith the expectation that they might throw light on thepathology of diabetes. Phloridzin was a crystallisableglucoside obtainable from the bark of the stem and rootof the cherry and some other rosaceous trees. That the

sugar excreted by the urine after its administration was notderived from the glucose of its molecule was, however,clearly established by two facts, either of which would besufficient : (1) that the quantity of sugar passed in the urineis far greater than the total amount of phloridzin adminis-tered ; and (2) the complementary part-phloretin-leftafter the sugar is removed from the glucoside producesglycosuria. Phloridzin, it was to be remarked, produces avery severe form of glycosuria, the quantity of sugar in theurine being 40 to 50, or 80, or even over 100 per 1000.

Phloridzin causes glycosuria whether administered by themouth or by subcutaneous or by intra-venous injection.When given by the mouth the glycosuria lasts until the nextor even until the third day. When administered by sub-cutaneous injection the effect is produced more quickly butceases sooner, the glycosuria frequently being found to havepassed away by the next day. This more rapid disappearanceof sugar from the urine after subcutaneous injection was a.point of importance in interpreting the results of experiments.On the strength of certain experiments by von Mering it hadbeen as,deitex that phloridzin produces glycosuria withoutglycohoemia-sugar in the urine without an increaseof sugar in the blood. In three experiments made ,

by von Mering the estimate of the amount of

sugar in the blood brought it within the normal range.

1 Proceedings of the Physiological Society, Nov. 14th, 1896.

1851

It was pointed out that von Mering made use of a modeof analysis attended with the employment of a largequantity (two litres) of water. Coagulation was effectedby heat, and after filtration the filtrate had to be evaporateddown to a small bulk before the sugar was estimated byFebling’s solution. In another recent communication to thePhysiological Society Dr. Pavy showed that a very large losswas liable to occur when a solution of sugar is subjected toprolonged ebullition. In one experiment in which 0 595gramme of sugar from honey was simply boiled in a flask

r with a litre of water for twelve hours the loss amounted to54 per cent. In another experiment with sugar fromdiabetic urine the loss was 57 per cent. Again, it was importantån order to ensure that all the sugar shall be extracted to

get a coagulum which can be readily and effectively washed.Both requirements are fulfilled by the alcohol process.2The experimenter must be alive to the fallacies which lurkin the analytical methods. If he be properly on his guardagainst these very accurate results might be obtained. Thusin a series of experiments brought to the notice of the

society sugar was added in known quantity to blood andafterwards estimated. The error never exceeded 5 5 percent. and was usually much less. In addition to the fallaciesconnected with the mode of analysis there were others con-nected with the circumstances as regards the state of theanimal at the time of collection and the manner in which thecollection was made which must be guarded against. Bothchloroform and ether led to the presence of an abnormallylarge amount of sugar in the blood. This, unless taken intoaccount, would form a seriously vitiating factor. Speaking.of some experiments of Levene on phloridzin glycosuria itwas pointed out 3 that he had neglected to give considera-tion to this source of fallacy and that he had also

delayed taking the blood supposed to be under theinfluence of the subcutaneous injection of phloridzin tillthe following day, when the opportunity was given for theeffect of the drug to have passed away. Guarding againstthe various sources of fallacy enumerated, Dr. Pavy, experi-menting on the cat, subcutaneously injected 05 gramme ofphloridzin and examined the blood and urine taken at timesof killing from one to five hours afterwards. The table ofresults placed before the society showed that sugar was’found to be present in abnormal amount in the blood, andthat, therefore, it was not correct to gay that there is no

glycohasmia in connexion with phloridzin glycosuria, As in iother cases where sugar is found in increased amount in the

blood the amylose carbohydrate obtainable from the blood-coagulum presented itself in notably larger quantity thanusual.

THE NEW OPERATING THEATRES ATST. GEORGE’S HOSPITAL.

ON Wednesday morning last the new operating theatresand chloroform rooms at St. George’s Hospital were openedby His Royal Highness the Duke of Cambridge. The pro-ceedings were of an informal character. The Duke of

Cambridge was attended by General Bateson and Generalthe Earl of Chelmsford and was conducted to thenew theatres by Mr. T. Pickering Pick (the senior

surgeon of the hospital), Mr. H. Percy Adams (thearchitect), and the surgical staff of the hospital. Mr.Pick showed His Royal Highness the various improve-ments and explained briefly their uses and advantages.Having expressed his approval and admiration of the newarrangements the Duke of Cambridge formally declared thetheatres and their appurtenances open. He then turned tothe assembled students and said that as an old governor of thehospital he took the highest interest in all their concerns.The many advances witnessed during Her Majesty’s longireign had no more marked example than was furnished byadvances in the science of healing, and whether we lookedat home or abroad nothing would be more apparent than thegreat indebtedness of our generation to science. His RoyalHighness exhorted his hearers to carry out the instructionsof their elders, assuring them that they had a great pull

"

over the elder generation in that they had the work of thelatter to build upon. Finally he expressed himself delighted

2 Proceedings of the Royal Society, vol. xxxii., 1881, p. 418.3 Journal of Physiology, vol. xvii., p. 259.

to have had the opportunity of making those few remarksand of seeing the useful adjunct to the work of the hospitalwhich had just been completed.The new theatres are excellent specimens of modern

sanitary architecture. The walls and ceilings through-out are lined with glazed tiles and every angle isrounded so that the whole suite can be washed with afire hose. The floors are of white marble mosaic, andthe benches are entirely composed of white Sicilian marblepolished on the vertical faces. The lighting of the theatreseven on so dull a day as Wednesday last was all thatcould be desired. The ventilation has been carefullyattended to, for the whole of the air in the theatres can bechanged once in six minutes.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN thirty-three of the largest English towns 6434 birthsand 3789 deaths were registered during the week endingDec. 19th. The annual rate of mortality in these towns,which had been 19’4 and 18 9 per 1000 in the two precedingweeks, further declined last week to 18’2. In London therate was 17’2 per 1000, while it averaged 18’9 in thethirty-two provincial towns. The lowest rates in thesetowns were 11’3 in Derby, 13 8 in Halifax ; 14’3 in Birken-head, and 14’6 in West Ham; the highest rates were 21’8in Birmingham, 23’3 in Swansea and in Oldham, 23’5 inLiverpool, and 24’8 in Plymouth. The 3789 deathsincluded 356 which were referred to the principalzymotic diseases, against 364 and 350 in the two pre-ceding weeks ; of these, 86 resulted from diphtheria, 77from measles, 73 from whooping-cough, 55 from scarletfever, 39 from "fever" (principally enteric), and 26 fromdiarrhoea. The lowest death-rates from these diseases wererecorded in Plymouth, Wolverhampton, Halifax, and Shef-field ; and the highest rates in Newcastle-upon-Tyne,Salford, Bradford, and Nottingham. The greatest mortalityfrom measles occurred in Cardiff, Gateshead, Newcastle-upon-Tyne, Bradford, and Nottingham ; from scarlet feverin Leicester and Birkenhead ; and from whooping-cough inBirkenhead, Burnley, Huddersfield, Bristol, Nottingham, andSwansea. The mortality from ’’ fever " showed no markedexcess in any of the large towns. The 86 deaths from diph-theria included 58 in London, 3 in West Ham, 3 in Bir-mingham, and 3 in Hull. No fatal case of small-pox wasregistered during the week under notice either in London orin any other of the thirty-three large towns. There wereno small-pox cases under treatment in the MetropolitanAsylum Hospitals or in the Highgate Small-pox Hospitalon Saturday last, the 19th inst., and no new cases wereadmitted during the week. The number of scarlet feverpatients in the Metropolitan Asylum Hospitals and in theLondon Fever Hospital was 3868, against numbers decliningfrom 4164 to 3971 on the eight preceding Saturdays ; 291new cases were admitted during the week, against 333,350, and 353 in the three preceding weeks. The deathsreferred to ,piseases of the respiratory organs in London,which had declined in the five preceding weeks from 492to 346, further fell last week to 302, and were 193below the corrected average. The causes of 76, or 2’0 percent., of the deaths in the thirty-three towns were notcertified either by a registered medical practitioner or by acoroner. All the causes of death were duly certified inPortsmouth, Nottingham, Bradford, Leeds, and in elevenother smaller towns ; the largest proportions of uncertifieddeaths were registered in Cardiff, Birmingham, Liverpool,Blackburn, and Sheffield.

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HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had been 20-4 and 20 per 1000 in the two precedingweeks, further rose to 21 0 during the week ending Dec. 19th,and was 2’8 per 1000 above the mean rate during thesame period in the thirty-three large English towns. Therates in the eight Scotch towns ranged from 13’5 inGreenock and 16’8 in Aberdeen to 23 5 in Glasgow, and 25 6

i in Perth. The 614 deaths in these towns included 54 which

,

were referred to measles, 16 to diarrhoea, 7 to diphtheria,7 to whooping-cough, 6 to 11 fever," and 5 to scarletfever. In all, 95 deaths resulted from these principal