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ROYAL COLLEGE OF SURGEONS OF ENGLAND.

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275 the eyes of the population, speaking generally, would improve under the stimulus of practice and of reward. I have long advocated that prizes for accurate and extensive seeing should take a recognised place among those given at athletic contests, and there would be no practical difficulty in arranging the conditions of a competition. The first steps in such a direc- tion might well be taken at school; and I am convinced that, if public attention were once called to the natural range and proper capacity of the visual function, its improvement under diligent use would be likely to be at once considerable and progressive. At present not one person out of 500 has the smallest notion what a child ought to be able to see (for example, how large a letter) at 100 feet or at 100 yards; and schoolmasters, in my experience, are especially slow to recognise that what they often call stupidity or obstinacy depends really upon imperfection of sight. I have been crying in the wilderness about this matter for a good many years ; but I do not yet despair of witnessing a reform which has long appeared to me to be at once entirely practicable and eminently desirable." Contagious Skin Diseases in Schools. Dr. P. S. ABRAHAM and Dr. ALFRED EDDOWES, Physicians to the Western Skin Hospital, contributed a paper on Contagious Diseases of the Skin in Schools &c.: the Question of their Prevention. They observed that the delicate skins of children are particularly liable to be attacked by certain parasitic diseases, and that if these are easily inoculable they are likely to spread among children congregated together. With a perfect system of hygiene such diseases are preventable, and with skilled management their spread can always be arrested. Now that school attendance is compulsory and that the well- cared-for children of poor but respectable families often have to associate at school with those of the dirtiest and most careless classes of the community it is a moral duty that all reasonable precautions should be insisted on by the authorities in order to minimise the risk of infection from the diseased to the healthy. A skin disease also, contracted at school, may be taken home to the brothers and sisters. Cases of ringworm of the scalp are often overlooked, and these constitute a specially fruitful source of infection in schools. They are sometimes believed to be cured or mistaken for scurfy heads, eczema, &c., when really the disease is widely disseminated over the scalp. A systematic periodic examination of the school-children’s heads by skilled observers, and strict attention to caps, cloaks, towels, brushes, &c., used by children who are, or have been, affected, and the placing of all cases under expert treatment were recommended. It was considered that under proper treatment, with the heads kept greasy with germicidal ointments and always covered with a closely fitting cap, the children may be allowed to attend school without much risk to the others. With regard to "pedicu- losis," "which is enormously prevalent, especially among the girls of the poorer schools, it was pointed out that the i matter is much more serious than at first sight appears. The constant irritation and scratching promote the inocula- tion of pus-forming and other organisms, giving rise, for z, example, to contagious impetigo which may spread to others, I to abscesses and blood poisoning, and other diseases. Strict i cleanliness, the wearing of short hair among little girls, and periodic examination and treatment are the measures recom- mended. With reference to scabies or "itch," attention was drawn to the fact that it is sometimes mistaken for eczema and allowed to spread when it might easily be cured in the first instance. ___ NAVAL AND MILITARY HYGIENE. In this section an interesting paper was read on Friday, July 27th, by Surgeon-Lieutenant-Colonel J. M. BEAMISH, M.D., D.P.H., on Camp Diarrhoea, in which he noticed, in addition to diarrhoea proper, three other affections which, though clinically related to diarrhoea, especially in the camp and field, were etiologically different from it-namely, enteric fever, cholera, and the affection known as "hill diarrhoea." Camp diarrhoea came under observation in a variety of circumstances connected with military service and climate. On home or foreign service the causes had to be looked for among the ordinary influences which predisposed, directly or indirectly, to intestinal derangements. Impure water-supply was a fruitful source of the trouble, the impurity being referable to errors in source or distribu- tion. Errors at the source were traceable to wells which were not at a sufficient distance from risk of pollution by villages or isolated habitations, or which were not sufficiently protected from fouling agencies in operation within the camping-ground itself. Errors in diet, whether of excess or defect in quantity or quality, deserved notice. He alluded to some of the defects, such as insufficiency of fresh vegetables, predisposing to a scorbutic condition of the system and in this way indirectly promoting digestive derangement ; exposure on night duty or at other times through inadvertence, causing surface chill with con- sequent intestinal flux or enteritis ; and the insanitary con- ditions of the camping ground from fouling of old, or inattention to drainage of new, sites. Cooking utensils should be inspected frequently, once a week at least, as a possible cause of diarrhoea. In India copper vessels are in extensive use for culinary purposes and require tinning periodically. Symptoms of copper poisoning often follow a neglect of this precaution. Impure air from overcrowding or other cause, by interfering with oxygena- tion, must act at least as a predisposing agent, especially if associated with other insanitary conditions. In the public services regulations are definitely laid down regarding cubic space in tents which should not be transgressed. From the analogy now known to exist between the conditions favouring the development of malaria and summer diarrhcea in Eng- land there can be little hesitation in assigning malaria as a frequent cause of diarrhoea. The late Dr. Tomkins, medical officer of health of Leicester,4 has shown that soon after the temperature of the earth, at a depth of one foot, has reached from 59° to 62° F. the causes producing diar- rhoea begin to operate. Influenza should not be overlooked as an agent in the causation of diarrhoea, and in this con- nexion he might refer to a report by Dr. Thresh, medical officer of health for Essex, on an outbreak of diarrhoea at Ford End, near Great Waltham, in the winter of 1892-3, in which it is conclusively shown that an epidemic closely simulating an outbreak of enteric fever was in reality due to influenza. As regards treatment, on the principle that prevention is better than cure the most reliable means of treatment have been already exhausted, and it was only necessary to allude to special remedies. Astringents of the ordinary kind would suffice ; dilute sulphuric acid, with tincture of catechu and tincture of opium in small doses if necessary. In the tropics the early special treatment of diarrhoea is always insisted on, whether this be due to ordinary causes or is the well-known precursor of an epidemic of cholera. Should a scorbutic taint be suspected, fresh vegetables should be given in sufficient quantity, or lime-juice as a substitute. Dysenteric complications should be relieved by ipecacuanha in large or small doses, according to circumstances, large doses being preceded by a dose of tincture of opium, 15 to 20 minims. Dover’s powder in all forms of diarrhoea would probably be found beneficial, and castor oil, with tincture of opium and peppermint water, would probably relieve most derangements traceable to error in diet. Quinine would be indicated in the malarial variety in combination with astringents. ROYAL COLLEGE OF SURGEONS OF ENGLAND. AN ordinary meeting of the Council was held on the 30th ult., the President, Mr. J. W. Hulke, F.R.S., in the chair. The Committee of Management presented a report in which several recommendations were made, the most important being one that "a candidate who is referred in chemistry and physics at the First Examination of the Board be required to produce a certificate that he has received instruction in those subjects at a recognised place of study, to the satisfaction of his teachers, during a period of not less than three months subsequently to the date of his reference, and that this regulation take effect from and afler Oct. 1st next." The report was approved and adopted. It was agreed that the annual meeting of Fellows and Members should be hfld at the College on Thursday, Nov. lst next, at 3 P.M. The Council then proceeded to the 4 Quoted by Dr. C. L. Parkes, Hygiene, third edition, pp. 221-2.
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the eyes of the population, speaking generally, would improveunder the stimulus of practice and of reward. I have longadvocated that prizes for accurate and extensive seeing shouldtake a recognised place among those given at athletic contests,and there would be no practical difficulty in arranging theconditions of a competition. The first steps in such a direc-tion might well be taken at school; and I am convinced that,if public attention were once called to the natural range andproper capacity of the visual function, its improvementunder diligent use would be likely to be at once considerableand progressive. At present not one person out of 500 hasthe smallest notion what a child ought to be able to see (forexample, how large a letter) at 100 feet or at 100 yards; andschoolmasters, in my experience, are especially slow to

recognise that what they often call stupidity or obstinacydepends really upon imperfection of sight. I have beencrying in the wilderness about this matter for a good manyyears ; but I do not yet despair of witnessing a reform whichhas long appeared to me to be at once entirely practicableand eminently desirable."

Contagious Skin Diseases in Schools.Dr. P. S. ABRAHAM and Dr. ALFRED EDDOWES,

Physicians to the Western Skin Hospital, contributed apaper on Contagious Diseases of the Skin in Schools &c.:the Question of their Prevention. They observed that thedelicate skins of children are particularly liable to beattacked by certain parasitic diseases, and that if theseare easily inoculable they are likely to spread amongchildren congregated together. With a perfect system ofhygiene such diseases are preventable, and with skilledmanagement their spread can always be arrested. Nowthat school attendance is compulsory and that the well-cared-for children of poor but respectable families oftenhave to associate at school with those of the dirtiest andmost careless classes of the community it is a moral dutythat all reasonable precautions should be insisted on bythe authorities in order to minimise the risk of infectionfrom the diseased to the healthy. A skin disease also,contracted at school, may be taken home to the brothersand sisters. Cases of ringworm of the scalp are oftenoverlooked, and these constitute a specially fruitful sourceof infection in schools. They are sometimes believed tobe cured or mistaken for scurfy heads, eczema, &c., when

really the disease is widely disseminated over the scalp.A systematic periodic examination of the school-children’sheads by skilled observers, and strict attention to caps,cloaks, towels, brushes, &c., used by children who are, orhave been, affected, and the placing of all cases under

expert treatment were recommended. It was consideredthat under proper treatment, with the heads kept greasywith germicidal ointments and always covered with a closelyfitting cap, the children may be allowed to attend schoolwithout much risk to the others. With regard to "pedicu-losis," "which is enormously prevalent, especially among thegirls of the poorer schools, it was pointed out that the imatter is much more serious than at first sight appears.The constant irritation and scratching promote the inocula-tion of pus-forming and other organisms, giving rise, for z,example, to contagious impetigo which may spread to others, Ito abscesses and blood poisoning, and other diseases. Strict i

cleanliness, the wearing of short hair among little girls, andperiodic examination and treatment are the measures recom-mended. With reference to scabies or "itch," attentionwas drawn to the fact that it is sometimes mistaken foreczema and allowed to spread when it might easily be curedin the first instance.

___

NAVAL AND MILITARY HYGIENE.

In this section an interesting paper was read on Friday,July 27th, by Surgeon-Lieutenant-Colonel J. M. BEAMISH,M.D., D.P.H., on Camp Diarrhoea, in which he noticed, inaddition to diarrhoea proper, three other affections which,though clinically related to diarrhoea, especially in the campand field, were etiologically different from it-namely, entericfever, cholera, and the affection known as "hill diarrhoea."Camp diarrhoea came under observation in a variety ofcircumstances connected with military service and climate.On home or foreign service the causes had to be lookedfor among the ordinary influences which predisposed,directly or indirectly, to intestinal derangements. Impurewater-supply was a fruitful source of the trouble, the

impurity being referable to errors in source or distribu-tion. Errors at the source were traceable to wells which

were not at a sufficient distance from risk of pollutionby villages or isolated habitations, or which were not

sufficiently protected from fouling agencies in operationwithin the camping-ground itself. Errors in diet, whetherof excess or defect in quantity or quality, deserved notice.He alluded to some of the defects, such as insufficiency offresh vegetables, predisposing to a scorbutic condition of thesystem and in this way indirectly promoting digestivederangement ; exposure on night duty or at other timesthrough inadvertence, causing surface chill with con-

sequent intestinal flux or enteritis ; and the insanitary con-ditions of the camping ground from fouling of old,or inattention to drainage of new, sites. Cookingutensils should be inspected frequently, once a weekat least, as a possible cause of diarrhoea. In India coppervessels are in extensive use for culinary purposes and

require tinning periodically. Symptoms of copper poisoningoften follow a neglect of this precaution. Impure air fromovercrowding or other cause, by interfering with oxygena-tion, must act at least as a predisposing agent, especially ifassociated with other insanitary conditions. In the publicservices regulations are definitely laid down regarding cubicspace in tents which should not be transgressed. From the

analogy now known to exist between the conditions favouringthe development of malaria and summer diarrhcea in Eng-land there can be little hesitation in assigning malaria as afrequent cause of diarrhoea. The late Dr. Tomkins, medicalofficer of health of Leicester,4 has shown that soon afterthe temperature of the earth, at a depth of one foot,has reached from 59° to 62° F. the causes producing diar-rhoea begin to operate. Influenza should not be overlookedas an agent in the causation of diarrhoea, and in this con-nexion he might refer to a report by Dr. Thresh, medicalofficer of health for Essex, on an outbreak of diarrhoea atFord End, near Great Waltham, in the winter of 1892-3, inwhich it is conclusively shown that an epidemic closelysimulating an outbreak of enteric fever was in reality dueto influenza.As regards treatment, on the principle that prevention is

better than cure the most reliable means of treatment havebeen already exhausted, and it was only necessary to alludeto special remedies. Astringents of the ordinary kind wouldsuffice ; dilute sulphuric acid, with tincture of catechuand tincture of opium in small doses if necessary. In the

tropics the early special treatment of diarrhoea is alwaysinsisted on, whether this be due to ordinary causes or is thewell-known precursor of an epidemic of cholera. Should ascorbutic taint be suspected, fresh vegetables should be givenin sufficient quantity, or lime-juice as a substitute. Dysentericcomplications should be relieved by ipecacuanha in large orsmall doses, according to circumstances, large doses beingpreceded by a dose of tincture of opium, 15 to 20 minims.Dover’s powder in all forms of diarrhoea would probably befound beneficial, and castor oil, with tincture of opium andpeppermint water, would probably relieve most derangementstraceable to error in diet. Quinine would be indicated inthe malarial variety in combination with astringents.

ROYAL COLLEGE OF SURGEONS OFENGLAND.

AN ordinary meeting of the Council was held on the30th ult., the President, Mr. J. W. Hulke, F.R.S., in thechair.The Committee of Management presented a report in

which several recommendations were made, the most

important being one that "a candidate who is referred in

chemistry and physics at the First Examination of the Boardbe required to produce a certificate that he has receivedinstruction in those subjects at a recognised place of study,to the satisfaction of his teachers, during a period of not lessthan three months subsequently to the date of his reference,and that this regulation take effect from and afler Oct. 1stnext." The report was approved and adopted.

It was agreed that the annual meeting of Fellowsand Members should be hfld at the College on Thursday,Nov. lst next, at 3 P.M. The Council then proceeded to the

4 Quoted by Dr. C. L. Parkes, Hygiene, third edition, pp. 221-2.

276

consideration of the following resolution adopted at themeeting of Fellows on July 5th : "That the Council berequested to take steps for obtaining the opinion of theFellows on the mode of election to the office of President."It was moved by Mr. Bryant, and seconded by Sir T. SpencerWells, "That the Council are not prepared at the presenttime to consult Fellows or solicit their opinion through othermeans than the meetings of Fellows that have been latelyestablished." To this an amendment was moved by Mr.Rivington, and seconded by Mr. Willett, "That, in compliancewith the request of the meeting of Fellows, the Counciltake steps for obtaining the opinion of the Fellows on themode of election to the office of President." This amend-ment having been lost, the original resolution was carried,and the following addendum was then moved and carried :"That the Council would, however, point out that if anyFellow is anxious to test the opinion of the general body ofFellows as to whether it is desirable to make any change inthe present mode of election to the office of President it isopen to him to do so by submitting a motion on the questionto the meeting of Fellows in January or some subsequentmeeting. "A letter was read from Sir George Buchanan resigning his

appointment as Examiner in Public Health, and it was movedand carried that the resignation be accepted, with an expres-sion of regret of the Council at his inability to continue inoffice. The President stated that the vacancy thus occa-sioned would be filled at the quarterly meeting of theCouncil in October.A letter was read from Mr. Thomas Cooke requesting that

certificates of attendance at his school may be recognisedfor the dissections required by Clause 4, Section 1, of theRegulations, relating to candidates for the diploma of Fellow.This was agreed to, but subject to annual revision.

Mr. Pemberton moved : " That it be referred to theNomination Committee to consider and report to the Councilon the advisability and practicability of the meetings of theNomination Committee being so arranged as to take place,when needed, on the same days as the meetings of the

Council, and that Section 15 of the Regulations of theCouncil, relating to the election of examiners, be altered togive effect as far as possible to the foregoing proposal."Mr. Banks seconded, and the motion was carried.

It was moved by Mr. Rivington, seconded by Mr. Langton,and carried : ’’ That it be referred to the committee appointedto draw up the report to the annual meeting to draw up rulesfor the conduct of meetings of the Fellows and Members."

It was moved by Mr. Langton, and seconded by Mr. Mac-namara : "That a standing committee be appointed to inquireinto and report to the Council on the case of any Fellow orMember whose alleged misconduct has brought him underSection 16 of the by-laws of the College." The resolutionwas carried, and the committee was appointed, consistingof the President, the Vice- Presidents, the past Presidents,Mr. Macnamara, and Mr. Langton.

THE HOLIDAY SEASON: RAILWAYFACILITIES.

THE monotony involved in the course of the daily work ofmost people is undoubtedly, if unrelieved by a period of com-plete rest and change of scene, too apt to cause stagnation inall the faculties necessary to a healthy life. Such uniformityof toil is not found in nature ; variety is everywhere apparent,enabling the powers, the vitality, and the working capacityof the individual to be refreshed and strengthened. Celsuswarned his students that health is best preserved by avoid-ing uniformity of life," and even uniformity of climatewas condemned by Hippocrates as "undesirable." Nothingdepresses circulation, relaxes the nervous system, or causesvitality to dwindle so much as the dull, ordinary, unre-

lieved routine of existence. It is the severest punishmentof the prisoner, the torture of the slave. Nothing so muchaccelerates bodily decay and reduces mental power to itslowest ebb as a prolonged sameness of occupation. Thechange, therefore, to which, during the gloomy winter, thecheerless spring, and the sometimes severe summer met within these islands, so many have hopefully looked forwardpresents an opportunity for change of environment the thera-

peutic effects of which are of the highest importance. Theyearly holiday fulfils many requirements, and may, indeed,be looked upon as a necessary of life. It affords an oppor-tunity of visiting friends, and of refreshing mind and bodyby the study of nature in fresh and unaccustomed aspects.Its effects are manifested by the healthy tone, the increasedappetite, the heightened spirits, and a happier view of lifewhich makes work a pleasure and energy more fruitful.We propose, therefore, to indicate to our readers the facilitiesat their disposal for best utilising their too scant period ofleisure and recreation.The London and North-Western Railway Company have

arranged cheap excursions to North Wales, including Rhyl,Llandudno, Bangor, Llanberis (for Snowdon). The train

departs from Euston at 8.15 A.M. every Saturday untilthe end of September. Snowdon can be reached for 22s.This company have also made arrangements for circular toursin Scotland, including the Caledonian Canal, Inverness,Aberdeen, Perth, and the Highlands :-Tour 1 : By rail toStirling, Callander, Loch Awe, and Oban, thence by Mr.D. Ma.cBrayne’8 steamer to Ballachulish, Fort William, andthe Caledonian Canal to Inverness, returning thence by railviic Dunkeld (Highland Railway), Dunblane, and Stirling.Tour 2 : By rail to Stirling, Callander, Loch Awe, and Oban,thence by steamer to Ballachulish, Fort William, and theCaledonian Canal to Inverness, returning thence by rail1JitÌElgin, Mulben, Keith, and Aberdeen, thence by CaledonianRailway via Perth, Dunblane, and Stirling. Tour 3 : byrail to Stirling, Callander, Loch Awe, and Oban, thence bysteamer to Ballachulish, Fort William, and the CaledonianCanal to Inverness, returning by rail vid Elgin and GreatNorth of Scotland Company’s line to Aberdeen. From thelatter place the route is by the Caledonian Railway vitiPerth, Dunblane, and Stirling. Tickets for this route canbe used by either of the following routes between Elgin andAberdeen, at option : by the Moray Firth Coast line, vii

Tillynaught Junction and Grange, or vid Rothes and Craigel-lachie Junction. (By this route passengers obtain views ofthe Valley of the Fiddoch and Spey.) Tour 4 : By rail toGlasgow or Gourock, thence by steamer to Ardrishaig,Crinan Canal, Oban, Ballachulish, Fort William, and theCaledonian Canal to Inverness, returning by rail viti Dunkeld(Highland Railway), Perth, Dunblane, and Stirling. Tour 5 :By rail to Glasgow or Gourock, thence by steamer to

Ardrishaig, Crinan Canal, Oban, Ballachulish, Fort William,and the Caledonian Canal to Inverness, returning by railviti Elgin, Mulben, Keith, and Aberdeen, thence by Cale-donian Railway vii Perth, Dunblane, and Stirling. Tour 6 :By rail to Glasgow or Gourock, thence by steamer to Ardri-shaig, Crinan Canal, Oban, Ballachnlish, Fort William, andthe Caledonian Canal to Inverness, returning by rail vid

Elgin and Great North of Scotland Company’s line toAberdeen. From the latter place the route is by theCaledonian Railway via Perth, Dunblane, and Stirling.Tickets for this route can be used at option by either of thefollowing routes between Elgin and Aberdeen: By the MorayFirth Coast line, viic Tillynaught Junction and Grange, vidRothes and Craigellachie Junction, or ’L’iâ Macduff and BanffBridge. The respective tours may, at the option of the

passenger, be worked in the reverse direction, but passengersmust state at the time of booking the route by which theypropose to travel, and obtain tickets accordingly. Thetickets are available from the date of issue up to and includ-ing Dec. 31st, 1894 ; but the steamer journey of the tourmust in all cases be completed before Oct. 1st, 1894.

- Z’?’/b* the round.

The Great Northern Railway have an express service in con-nexion with the steamers for Norway and Sweden, but as thevessels accordirg to tide, passengers must not re)c uponthe steamers waiting their arrival. The times of sailicg


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