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MEMORANDA:, Summaries of Surgical Pathology

University of South Carolina (USC) - Columbia Surgical Pathology

test for the clinical diagnosis of tuberculosis it has been ... studied medicine at-the New York College of Physicians and Surgeons, taking his degree in ...

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36

TD

JOBL]

I

MEMORANDA.

[FRB.

15,

1905

I

am

greatly

indebted

to

Dr.

Flexner

for

supplying

me

with

the

antiserum

for

use

in

our

cases.

I

fully

appreciate

how

dangerous

it

would

be

to

attempt

to

draw

conclusions

from

a

small

number

of

cases,

and

I

quite

recognize

that

an

estimate

of

the

value

of

this

treatment

can

only

be

made

after

prolonged

trial

and

testing

by

many

observers

and

under

varying

conditions.

In

firt

sending

me

the

serum,

Dr.

Flexner

stated

that

"he

did

not claim

that

it

was

of

great,

or

even

of

any,

value,"

and

I

think

it

will

be

well

not

to

go

beyond

that

position

at

present;

but

from

the

impressions

I

have

formed

from

an

examlnation

of

these

figures,

and

from

watching

the

course

run

by

cases

treated

in

this

way,

I

considered

I

was

justified

in

placing

these

results

before

you.

REFRItENCES.

I

The

Practitioner,

January,

1908.

2

BRITISH

MEDICAL

JOURNAI,

July

27th,

1907.

3

BRITISH

MEDICAL

JOURNAL,

October

26th,

1907,

4.Journal

of

Experimental

Aledicine.

January,

1908.

REPORTS

-

~~ON

MEDICAL

AND

SURGICAL

PRACTICE

IN

THE

HOSPITALS

AND

ASYLUMS

OF

THE

BRITISH

EMPIRE.

JOHANNESBURG

HOSPITAL.

A

CASE

OF

RESEOTION

OF

THE

RIGHT

VAGUS

NERVE

FOR

MALIGNANT

DISEASE.

(Reported

by

H.

TEMPLE

MURSELL,

M.B.,

M.C.,

F,R

C.S.E.,

Assistant

Surgeon.)

THE

Interest

of

the

following

case

'lies

not

so

much

in

the

earlier

operations

carried

out

as

in

the

later,

where,

the

right

vagus

being

involved,

resection

of

2

in.

of

the

nerve

was

demanded

if

complete

removal

of

the

growth

was

to

be

attained.

MEMORANDA:

MEDICAL,

SURGICAL,

OBSTETRICAL.

A

NOTE

ON

CALMETTE'S

OPHTEALMO-REACTION

FOR

TUBERCULOSIS.

EXCEPTIONS

are

said

to

prove

a

rule,

but

the'

exceptions

in

regard

to

the

ophthalmo-reaction

seem

sufficiently

numerous

and

striking

to

greatly

impair

its

value

as

a

clinical test

for

tuberculosis.

Since

Wolff-Eisner

and

Calmette

introduced

this

modification

of

the

tuberculin

test

for

the

clinical

diagnosis

of

tuberculosis

it

has

been

tried

in

many

thousands

of

patients

suffering

from

tuberculosis

and

other

diseases,

but

comparatively

seldom

in

apparently

healthy

persons

engaged

in

their

ordinary

daily

occupations.

From

the

numerous

published

papers

on

the

subject

it

Is

evident,

in

the

first

place,

that

a

positive

result

of

the

test

is

not

always

obtained

in

cases

of

active

tuberculous

disease.

Patients

have

failed

to

react

in

whom

a

subsequentpost-mortem

examination

has

demonstrated

the

presence

of

miliary

tuberculosis

of

the

,cerebral

meninges,

etc.,

and

the

result

has

sometimes

been

found

to

be

completely

negative

In

cachectic

or

-dying

persons

with

undoubted

advanced

tuberculosis

of

the

lungs.

Moreover,

by

some

observers,

in

about

10

per

cent.

or

more

of

apparently

non-tuberculous

hospital

patients

a

positive

reaction

has

been

recorded,

and

I

believe

this

percentage

would

have

been

much

higher

if

the

test

had

been

tried,

not

on

non-tuberculous

hospital

patients

suffering

from

various

complaints,

but

on

-apparently

healthy

persons

who

have

to

Irritate

their

eyes

by

sitting

up

late

every

night

to

read

and

write

by

artificial

light.

I

know

unfortunately

only

five

medical

men

who

have

tried

this

test

or

had

It

tried

on

themselves,

but

In

all

these

appa-

rently

healthy

doctors

a

positive

result

was

obtained;

*in

thiee

the

reaction

was

violent,

and

In

the

other

two

it

was

relatively

slight,

and

occurred

only

after

a

second

Instillation

of

Calmette's

tuberculin,

the

result

of

the

first

test

(in

the

other

eye)

having

been

negative.

I

should

mention

that

one

of

these

five

medical

men

had

a

smaU

tuberculous

nodule

(resulting

from

an

accidental

Tather

deep

inoculation

at

a

podtmorten

examination

on

a

case

of

advanced

pulmonary

tuberculosis)

removed

from

a

finger

seventeen

years

ago,

but

he

has

had

no

symptoms

of

any

form

of

tuberculosis

since

then,

and

Calmette's

test

has

been

proved

to

gfte

a

negative

result

in

cases

of

old,

obsolete,

and

"

cured

"

tuberculous

lesions.

In

regard

to

the

strength

of

the

tuberculin

fluid

used

for

the

test

in

these

cases,

it

was

either

the

1

per

cent.

strength

recom-

mended

by

Calmette

or

considerably

weaker.

In

one

instance

another

drop

of

the

same

tuberculin

fluid

which

excited

a

violent

ophthalmo-reaction

in

a

medical

man

failed

to

produce

any

reaction

whatever

in

the

eye

of

a

man

(a

patient

of

my

own)

with

the

characteristic

clinical

signs

of

active

tuberculosis

of

the

upper

part

of

one

lung.

whose

sputum,

moreover,

contatned

tubercle

bacilli.

I

think

results

of

this

kind

are

worth

recording,

however

exceptional

they

may

turn

out

to

be,

since

I

believe

that

there

has

been

a

tendency

to

magnify

the

value

of

the

Calmette

ophthalmo-reaction

as

a

clinical

diagnostic

test

for

tuberculosis.

Much

light

is

thrown

on

such

anomalous

results

of

the

test

by

a

recent

communication

of

Waldstein

to

a

meeting

of

the

Wissenschaftl.

Gesellechaft

deutscher

Aerzte

In

B5hmen

on

January

15th.

He

has

observed

violent

reactions

as

a

result

of

the

test

in

Fome

cases

of

follicular

conjunctivitis,

and

even

in

ordinary

chronic

conjunctival

catarrh,

whereas

the

result

of

the

test

has

been

completely

negative

in

some

other

affections

of

the

eye,

notably

in

taberculosis

of

the

irls.

F.

PAREaKs

WEBER,

M.D.,

F.R.C.P.,

Physioian

to

the

German

Hospital,

London,

and

the

Mount

Vernon

Hospital

for

Consumption,

Hampstead.

London,

W.

PHTHISIS

TREATED

BY

BOVINE

TUBERCULIN.

TEIE

following

are

notes

of

a

case

of

phthisis

treated

by

hypodermic

injections

of

bovine

tuberculin

as

recom-

mended

by

Dr.

Nathan

Raw

and

manufactured

and

supplied

to

me

by

the

Clinical

Research

Association.

The

opsonic

index

has

not

been

taken,

the

patient

being

in

too

weak

a

condition,

but

Calmette's

ophthalmo-reaction

was

tried

on

January

21st

with

negative

results.

The

patient,

a

lady

aged

30

years,

has

been

under

my

treatment

for

the

past

eighteen

months

suffering

from

tuberculosis

of

the

apices

of

both

lungs

with

cavities.

coming

under

my

care

she

had

been

treated'

by

some

well-known

physician,

also

in

-sanatoriums

abroad

and

at

home,

when

her

sputum

had

been

frequently

examined

and

tubercle

bacilli

always

found.

Her

weight

in

January,

1907,

was

8

st.

12

lb.,

which

gradually

decreased

to

7i

st.

in

September,

after

which

it

was

not

taken,

as

the

disease

was

advancing

so

rapidly,

extending

In

the

left

lung

down

by

the

vertebra

and,

outwards

to

the

angle

of

the

scapula

and

forwards

to

the

apex

of

the

heart,

with

large

crepitations

and

rAles.

She

suffered

severely

from

dyspepsia,

almost

all

food

being

vomited.

She

had

to

take

to

bed

and

was

panting

for

breath.

On

November

17th

her

pulse

was

130,

and

had

been

so

for

a

week

previous;

now

It

varies

from

72

to

80.

Her

digeston

has

vastly

improved,

in

fact

it

is

almost

as

good

as

ever

it

has

been.

She

can

take

full

quantitles

of

ordinary

solid

food,

meat

and

vegetables,

and

at

Chrlistmas

partook

of

the

regulation

pudding

In

good

quantities

without

the

least

ill

effect.

She

gets

up

daily

and

goes

out

for

drives.

The

lungs

at

the

apices

and

the

one

at

the

back

have

dried

up,

and

there

is

not

a

single

moist

sound

to

be

heard;

the

inter-

costal

spaces

after

a

fortnight's

treatment

seemed

to

fall

in,

due,

I

considered,

to

the

lung

contracting,

as

there

have

been

considerable

pleural

adhesions,

but

now

the

spaces

between

the

ribs

are

filling

out

and

the

chest

getting

nicely

covered

with

fat.

She

sleeps

well

and

has

practically

no

cough

or

night

sweats.

I

commenced

the

tuberculin

injections

on

November

16th

and

continued

them

weekly

to

January

20th.

The

evening

temperaturewhen

thetreatmentwascommencedvariedfrom

1000

to

1020.

This

has

gradually

subsided

and

has

now

been

normal

for

the

past

four

weeks,

with

the

exception

of

three

days

when

it

went

up

to

990

and

1000,

but

this

was

easily

accounted

for

by

a

slight

attack

of

influenza.

Of

course

it

is

too

early

to

call

this

a

cure,

but

the

effects

so

far

have

been,

to

say

the

least,

marvellous,

and

I

wish

to

report

the

case

in

hopes

that

we

may

hear

the

results

of

the

treatment

in

other

hands.

I

do

not

propose

to

give

any

more

tuberculin

until

I

see

how

the

case

proceeds,

especially

as

there

has

been

no

reddening

or

injection

of

the

conjunctiva

by

Calmette's

tuberculin

test.

Tadworth,

Ep!om.

A.

CuriFE,

M.D.

Discover Summaries of Surgical Pathology University of South Carolina (USC) - Columbia

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Download MEMORANDA: and more Summaries Surgical Pathology in PDF only on Docsity!

36 TD JOBL]I^ MEMORANDA. [FRB. 15, 1905

I am greatly indebted to Dr. Flexner for supplying me

with the antiserum for use in our cases.

I (^) fully appreciate how dangerous it would be to attempt

to draw conclusions from a small number of cases, and

I quite recognize that an estimate of the value of this

treatment can^ only be made after^ prolonged trial and

testing by many observers and under varying conditions.

In firt sending me the serum, Dr. Flexner stated that

"he did not claim that it was of great, or even of^ any, value," and I think it will be well not to go beyond that

position at^ present; but^ from the^ impressions^ I^ have

formed from an examlnation of these figures, and from

watching the course run (^) by cases treated in this way,

I considered I was justified in placing these results

before you.

REFRItENCES. I (^) The Practitioner, January, 1908. 2 BRITISH MEDICAL JOURNAI, July 27th, 1907. 3 BRITISH MEDICAL JOURNAL, October 26th, 1907, 4.Journal of Experimental Aledicine. January, 1908.

REPORTS

~~ON

MEDICAL AND^ SURGICAL PRACTICE^ IN^ THE

HOSPITALS AND ASYLUMS OF^ THE

BRITISH EMPIRE.

JOHANNESBURG HOSPITAL.

A CASE OF RESEOTION OF^ THE^ RIGHT^ VAGUS^ NERVE FOR MALIGNANT DISEASE. (Reported by H. TEMPLE MURSELL, M.B.,^ M.C.,^ F,R^ C.S.E.,

Assistant Surgeon.)

THE Interest of the following case 'lies not^ so^ much in^ the

earlier operations carried^ out as^ in^ the^ later,^ where,^ the

right vagus being involved, resection^ of 2^ in.^ of^ the^ nerve

was demanded if complete removal of the^ growth^ was^ to

be attained.

MEMORANDA:

MEDICAL, SURGICAL, OBSTETRICAL.

A NOTE ON CALMETTE'S OPHTEALMO-REACTION

FOR TUBERCULOSIS.

EXCEPTIONS are said to prove a rule, but the' (^) exceptions in (^) regard to the (^) ophthalmo-reaction seem sufficiently numerous and striking to (^) greatly impair its value as a

clinical test for tuberculosis. Since Wolff-Eisner and

Calmette introduced this modification of the tuberculin

test for the clinical diagnosis of tuberculosis it has been

tried in (^) many thousands (^) of patients suffering from tuberculosis and other diseases, but (^) comparatively seldom in apparently healthy (^) persons engaged in their (^) ordinary

daily occupations. From^ the numerous published papers

on the subject it Is evident, in the first (^) place, that a positive result of the test is not (^) always obtained in cases

of active tuberculous disease. Patients have failed to

react in whom a subsequentpost-mortem examination has

demonstrated the presence of miliary tuberculosis of the

,cerebral meninges, etc., and the result has sometimes been found to be (^) completely negative In cachectic or

-dying persons with undoubted advanced tuberculosis of

the lungs. Moreover, by some observers, in about 10 per

cent. or more of (^) apparently non-tuberculous hospital

patients a^ positive reaction has been recorded, and I

believe this percentage would have been much higher if

the test had been (^) tried, not on non-tuberculous hospital patients suffering from various (^) complaints, but on -apparently healthy persons (^) who have to Irritate their

eyes by sitting up late every night to read and

write by artificial light. I know (^) unfortunately only

five medical men who have tried this test or

had (^) It tried on themselves, but In all these appa-

rently healthy doctors a positive result was obtained;

*in thiee the reaction was violent, and In the other

two it was relatively slight, and occurred only after a

second Instillation of (^) Calmette's tuberculin, the result of

the first test (in the other eye) having been negative. I

should mention that one of these five (^) medical men had a smaU tuberculous (^) nodule (resulting from an accidental

Tather deep inoculation at a podtmorten examination on a

case of advanced (^) pulmonary tuberculosis) removed from a finger (^) seventeen years ago, but he has had no symptoms of any form of tuberculosis since (^) then, and Calmette's test

has been proved to gfte a negative result in cases of old,

obsolete, and " cured " tuberculous lesions. In regard to

the strength of the (^) tuberculin fluid used for the test in these (^) cases, it was either the 1 per cent. strength recom- mended by Calmette or (^) considerably weaker. In one instance another drop of the same tuberculin fluid which excited a violent ophthalmo-reaction in a medical man

failed to produce any reaction whatever in the eye of a

man (a (^) patient of (^) my own) with the characteristic clinical

signs of active tuberculosis of the upper part of one lung.

whose (^) sputum, moreover, contatned tubercle bacilli. I think results of this kind are worth recording, however exceptional (^) they may turn out to be, since I believe that there (^) has been a tendency to magnify the value of (^) the Calmette ophthalmo-reaction as a clinical (^) diagnostic test

for tuberculosis. Much light is thrown on such anomalous

results of the test by a recent communication of Waldstein

to a meeting of the Wissenschaftl. Gesellechaft deutscher

Aerzte In^ B5hmen on^ January^ 15th.^ He^ has observed

violent reactions as a result of the test in^ Fome^ cases^ of

follicular conjunctivitis, and even in ordinary chronic

conjunctival catarrh,^ whereas^ the^ result^ of the test^ has

been completely negative in some other affections of^ the

eye, notably in^ taberculosis^ of the^ irls.

F. PAREaKs WEBER,^ M.D.,^ F.R.C.P.,

Physioian to the German^ Hospital,^ London,^ and^ the^ Mount Vernon Hospital for Consumption, Hampstead. London, W.

PHTHISIS TREATED BY BOVINE TUBERCULIN.

TEIE following are notes of a case of phthisis treated^ by

hypodermic injections of bovine^ tuberculin^ as^ recom-

mended by Dr. Nathan Raw^ and^ manufactured^ and

supplied to me^ by^ the^ Clinical^ Research^ Association.^ The

opsonic index has not been taken, the^ patient^ being^ in^ too

weak a^ condition, but^ Calmette's^ ophthalmo-reaction^ was

tried on January 21st with^ negative results.

The patient, a lady aged 30 years, has^ been^ under^ my

treatment for^ the^ past^ eighteen^ months^ suffering^ from

tuberculosis of the apices of^ both^ lungs^ with^ cavities.

Previous to coming under my care she had been^ treated'

by some well-known physician, also in-sanatoriums^ abroad

and at home, when her sputum had^ been^ frequently

examined and^ tubercle^ bacilli always^ found.^ Her^ weight^ in

January, 1907, was 8 st.^12 lb.,^ which^ gradually^ decreased

to 7i st. in^ September,^ after which^ it^ was^ not^ taken,^ as the disease was^ advancing^ so^ rapidly,^ extending^ In

the left lung down by the vertebra and,^ outwards^ to^ the

angle of the^ scapula^ and^ forwards^ to^ the^ apex of^ the

heart, with large crepitations^ and^ rAles.^ She^ suffered

severely from^ dyspepsia,^ almost all^ food^ being^ vomited.

She had to take^ to^ bed^ and^ was^ panting^ for^ breath.

On November 17th her^ pulse was^ 130,^ and^ had

been so^ for^ a^ week^ previous;^ now^ It^ varies^ from

72 to 80. Her digeston has^ vastly^ improved,^ in fact

it is^ almost^ as^ good^ as^ ever^ it^ has^ been.^ She^ can

take full quantitles of^ ordinary^ solid^ food,^ meat^ and

vegetables, and at^ Chrlistmas^ partook^ of^ the^ regulation

pudding In^ good^ quantities^ without^ the^ least^ ill^ effect.

She gets up daily and^ goes out for^ drives.^ The^ lungs^ at

the apices and the^ one^ at^ the^ back^ have^ dried^ up,^ and

there is not a^ single moist^ sound^ to^ be^ heard;^ the^ inter-

costal spaces after a fortnight's treatment seemed^ to^ fall

in, due, I^ considered,^ to^ the^ lung^ contracting,^ as^ there^ have

been considerable pleural adhesions, but^ now the^ spaces

between the^ ribs^ are^ filling^ out^ and the^ chest^ getting

nicely covered with^ fat.^ She^ sleeps^ well^ and^ has

practically no cough or night sweats.

I commenced the^ tuberculin^ injections^ on^ November^ 16th

and continued them weekly to^ January^ 20th.^ The^ evening

temperaturewhen thetreatmentwascommencedvariedfrom

1000 to 1020. This^ has^ gradually^ subsided^ and^ has^ now

been normal for the past four weeks, with the^ exception^ of

three days when it went^ up to^ 990 and^ 1000,^ but^ this^ was

easily accounted for by a^ slight attack of^ influenza.

Of course it is too early to call this a cure, but^ the

effects so far have been,^ to^ say^ the^ least, marvellous,

and I wish to report the case in hopes that^ we^ may hear

the results of^ the treatment^ in^ other^ hands.^ I do^ not

propose to give any more tuberculin until I see^ how^ the

case proceeds, especially^ as^ there^ has^ been^ no^ reddening

or injection of^ the^ conjunctiva^ by^ Calmette's^ tuberculin

test.

Tadworth, Ep!om. A.^ CuriFE,^ M.D.

(^402) XM.,,.,J.XINALJ MEDICAL NEWS. (^) [FEB. 15, Igo1.

The committee is further of opinion that the following

precautions outside the contract are all reasonable, and

that in the (^) majority of (^) cases tthere shfould be no difficulty

in carrying them Into effect:

(a) The medical officer of health of the district in which the farm from which the supply of milk (^) comes is situate should be furnished by the (^) hospital in (^) question with a copy of the contract, and should be requested to further as far as possible the (^) carrying out of its terms, so far as they relate to the con- dition ot the cows and the dairy (^) buildings, eto. (b) The hospital should obtain a report, either from (^) the medical officer of health or from a member of (^) the hospital's own staff or^ other expert, as to the state of the sheds, miiking-

places, dairy, and^ water supply^ to the farm. It is,^ of course,

most imporrant that no hospital should be supplied with milk

from a farm without a proper water supply.

(c) Wherever possible the hospital (^) should endeavour to make an arrangement (^) with the medical officer of health of the

district to notify, at a fixed fee, to the hospital, any cases

of contagious or^ infectious Illness in the families of the men employed at the farm of supply. (We find this is already done in some cases at a fee of one guinea for each (^) report. In some cases It may not be practicable, but it (^) could, in our opinion, be achieved in (^) the majority of case;s, with the assent of the contraotor, who oan, of course, require his farmer to agree.) (d) A11 milk should be inspected by some practical official on arrival at hospital. (e) irhe milk snould be chemically (^) analysed at least once a week, but at irregular intervals, to ascertain the (^) percentages of total solids and fats. Where it is thought inexpedient to engage the seryices oi a skilled analyst in the first (^) instance, a Gerber fat tester is recommended as the best apparatus to use. If the results of the test are unsatisfactory, a (^) com- plete analysis should be made. The sample to be (^) analysed should always be taken in (^) duplioate in (^) the presence of the

contractor's representative, and one sample handed to him.

We are advised that it is of little value to (^) take the (^) speclfic gravity of the milk except as part of a fuller analysis,

and that the use of a creamometer is misleading. We are also

advised that there is little practical utility in bacteriological

tests. (f) The (^) employment of an (^) inspector or (^) inspectors to (^) vislt farms and test the milk either there or in transit would be an

expensive undertaking for each hospital to carry out sepa-

rately, but it may be worth while to (^) consider whether the hospitals (^) coulld combine (^) for this purpose. (g) In case of a (^) yearly contract we are advised that the tender should provide two prices-one from October let to March 31st, and one from April lst to September 30th. (In

the event of the contract, at an average price for the year,

having to be terminated prematurely in the summer months, the (^) contractor would gain oonsiderably, while an average

price is unfair to the contractor if for any reason a larger

supply is required in the winter or a smaller supply in the

summer.)

The committee states that one hospital at least has

secured a report upon the condition of the farm from a

member of its visiting staff, who volunteered to undertake

it, and it is^ believed that most other hospitals would

encounter no difficulty in Eecuring similar reports. The

committee recommend that no condition should be

inserted in the contract which it is not intended to

enforce strictly, and observe in conclusion that It is

possible that the strict conditions suggested may have

the effect of slightly increasing the price at which con-

tractors will tender, but in view, of the serious interests

involved, it is coseidered that this risk may justifiably be

Incurred.

MEDICAL (^) INSPECTION OF SCHOOL

CHILDREN. MR. MOK1ENNA, M.P., (^) in reply to a deputation from the County Councils Association to u'rge that a grant from the Exchequer should be made to (^) relieve the rates of the cost of (^) medical inspection of school children, which it was

alleged would prees hardly upon rural districts, said he

considered the claim justifiable, and would recommend it

to the Chancellor of the (^) Exchequer. He hoped, (^) moreover,

that in the Education Bill, which he would introduce in

the course of a few weeks, to be able to put the grant

system, at present in a state of confusion, on a different

footing. The (^) financial arrangement proposed under the new Bill would far more than meet (^) any additional (^) burden

Imposed by'it.

BIRKENHEAD.

The Birkenhead Town Council has appointed (^) Dr. R. Sydney Marsden, M.O.H., (^) to be supervising sch(ol medical officer, at a salary of £76 per year, and Dr. R. Owen Morris school medical (^) officer, to devote the whole

of his time to the duties of^ the^ office, at^ a^ salary of £

a year. Dr. Morris will retain the lectureship on hygiene

at the Corporation Technical School. The Town Council

also intend to^ appoint^ a school^ nurse^ to^ assist^ in^ the^ work

at a salary of 31s. per week and uniform.

CHIESHIRE.

The Cheshire^ Education^ Committee^ has^ appointed^ Dr.

Vacher, county medical officer, to be the^ chief^ medical

Inspector under the education authority. for the county,

and has resolved to appoint also two medical Inspectors

at a salary of £350 each a year, to give their whole time

to the work^ of^ Inspection^ under Dr.^ Vacher's^ genera)

supervision.

LUICESTER.

At a meeting of,the.Midland Branch Council^ which was

held in the Royal Infirmary, Derby, on Thursday, January

23rd, the President of the Branch, Dr. Lorimer of Buxton,

in the chair, a letter was read from Miss H.^ M. Greene^ of

Derby, asking "Would it be feasible for the Branch to

pass some kind of resolution strengthening^ the hands^ of

medical women on the subject of the salaries^ to be^ paid

by certain county councils for the inspectorship of

schoolsP" The followling resolution^ was^ passed^ unani-

mously:

That this meeting of the Council of^ the Midland^ Brancb

considers that in filling public appointments the same

remuneration should beWoffered to female as to^ male

medical practitioners.

MEDICAL NEWS

PROFESSOR VON ESMARCH, of' Kiel, celebrated his 85th

birthday on January 24th. His native town, Tonning, in

Schleswig-Holstein, has erected a statue to him.

AT the meeting of the Royal Microscopical Society at

20, Hanover Square, W., on Wednesday next, at 8 p.m., there will be an exhibition by Mr. C. L. Curties of slides

Jllustrating the life-history of^ some^ diptera,^ and^ Mr.

E. M. Nelson^ will read^ a paper^ on^ eyepieces^ for^ the microscope.

ON January 30th Professor Koch^ delivered^ a^ lecture,

illustrated with^ lantern^ slides^ on^ sleeping siekness^ and the

means of combating the disease, in the presence of the German Emperor and Empress. It is announced that at,

the end of March he intends to statt on a^ voyage round^ the

world which will extend over a^ year.

IT is proposed to erect a hospital in^ St.^ Petersburg,^ tn^ be

called after Peter the Great.^ It was^ originally intended that it should contain 1,000 beds, but it has now been

decided to increase the number to 2,000. A sum of

4,500,000 roubles has already been allocated for the

purpoee, but it is estimated that a million^ more^ will^ be

iequired. The money will be^ raised^ by^ a^ municipal^ loan.

THE1 next quarterly meeting of the^ Medico-Psiychological

Association of Great Britain and^ Ireland^ will^ be^ held^ at

the Warwick County Asylum, Hatton,^ on^ Thursday next,

at 3 p.m.,^ when^ Dr.^ George^ Turner^ will^ give^ a^ lante;n

demonstration on some further observations on^ the

supposed thrombotic origin of epileptic fits, and Dr.

Cunyngham Brown will read^ a^ paper,^ illustrated^ by

lantern views, on^ boarding^ out^ of^ the^ insane^ in^ private

dwellings.

DR. J. A.^ W.^ PEREIRA^ has^ been^ presented^ with^ his

portrait, bearing^ the^ following inscription:^ "Presented^ by

the Chief Constable and members of the Exeter City

Police Force to Dr. J. A. W. Pereira, M.D.,^ M.R.C.S,

L.R.C.P., Police Surgeon, as a mark^ of^ their^ appreciation

of his kindness and attention^ to^ the^ Police Force.^ Feb.^ 6th,

1908." The presentation was made last week by the

Chief Constable, and was suitably acknowledged by the

recipient.

The tour of medical study (Excursions M6dicales Inter-

nationales) will take place this year in^ Italy from^ April

12th to 28th. The^ medical^ and^ sanitary^ institutions^ of

Turin, Milan, Padua, Venice, Bologna, Florence, Rome, Naples, Pisa, Genoa, and San Remo will be visited. The

organization of the tour is in the hands of^ Professor^ Pini,

who has secured the co-operation of Professors^ Baccelli,

Bossi, Mangiagalli, Mya.^ and other^ leading members^ of^ the

medical profession in Italy. A complete programme of

the tour is published in the January number of L'E.M.I.,

which may be got on application to the^ Administration

de l'Oeuvre d'Enseignement Medical^ Compl6mentaire,

8, rue (^) Franqois Millet, Paris^ (16e),^ from^ which^ all^ other

information required on^ the^ subject^ can^ be^ obtained.

(^422) KzDxc& TNAJ NAVTAL AND MILITARY MEDICAL SERVICES. [FzB. 15, (^) 1908.

ROYAL COLLEGE OF PHYSICIANS OF IRELAND.

AT the monthly business meeting of the College, held on Friday, February 7th, the following oandidate was duly admitted as a Litentiate in Medicine of the College: Edward

Patriok Enstace, L.R.C.8.I., L.A.H.

ROYAL COLLEGE OF SURGEONS IN JRELAND.

TEE annual dinner of the Council and Fellows of the Royal College of^ Surgeons was^ held in the^ College. St. Stephen's Green, on Saturday, February^ lst. Sir^ H.^ R. Swanzy (Pre- sident) oooupied the chair, and, In the oourse of his reply to

the toast of "The College," mentioned that the College had

now been in existenoe for 124 years. He referred to the work that had been^ done, and to the Important Improvements^ that had been effected in the school, so^ as to keep^ Its equipments and capacities equal to the demands of modern teaching.

CONJOINT BOARD IN IRELAND.

FINAL PROFESSIONAL EXAMINATION. -^ The following candidates passed this examination In February:

P. Blake, W. 1U. Bomford, F. P. Byrne, T. Frehily, M. J. (Glancy,

R. de S. B. Herrick, P. J. Holmes, 3. Humphreys, P. MacCartly, J. V. (^) O'Hagan, W. (^) H. O'Riordan, J. R. Talbot. DIPLOMA IN PUIBLIC HNALTH.-The following candidates pasesed the examination for this diploma In February: Martha Adams, (^) 1M.B.Glasg.; R. 'Muschamp, L.R.C.P. and S.Edin.; J. J. (^) Scanlan, L.R.C.P. and (^) S.Edin.

APOTHECARIES' HALL OF IRELAND.

AT a special meeting of the court held on Monday, FebrUrTy

3rd, the following candidatea, having passed the necessary examinations, were admitted Licentiates In Medicine,

Surgery, Midwifery, and^ Pharmacy^ of^ the^ Apothecaries'^ Hall

of -Ireland: Synoit Valentine O'Connor,^ John Hargreaves Robinson.

PUBLIC HEALTH AND

POOR-LAW MEDICAL SERVICES.

FOOT AND MOUTH -DISEASE INIEDINBURGH.

A szRious and somewhat alarming outbreak of foot and mouth disease was^ found^ to have occurred^ in^ the^ city of^ Edinburgh towards the end of last week. ln a dairy farm oonsisting of 110 cows and 1 calf, fully one-fourth of the animals were suffering .from this malady. Prompt and energetio measures were taken to limit and deal with the situation. The Board of Agriculture sent down -tbeir chief veterinary adviser along with a staff of assistants. The. local authority, the medical offlier of health, and the chief^ sanitary officer for Edinburgh held consultations with the representatives of the London Board, and the re3ult WAS isolation of the affected herd the

proscribing of various suspected areas in the oounty of

Miidlothian and neighbouring counties, forbidding movement

of animals into,or out of^ these^ presoribed areas, closure of the slaughterhouses, and the decision to slaughter the wbole herd of 111 animals, as well as 81 cows in a closely-contiguous dairy. Of the animals in the (^) dairy in which the disease (^) 'appeared

it was found that 30 were suffering from signs of foot and

mouth disease. These were slaughtered on the spot and buried in lime pIts. The rest of the herd was sent to the slaughter- house after careful inspection by the various veterinary

authorities, and after inspection of the carcasses those that

were fit for^ human^ food^ were^ allowed to be soldto butchers.; The byres, the dung,^ the foodstuffs, the other domestio animals in and'about the byres, such as fowls, cats, dogs, etc., will now be dealt with. The manure removed from the byres has been traced, and^ means^ taken^ to^ prevent contagion from that^ source; straw, hay, and foodstuffs will be destroyed. So far as any feasible theory of the outbreak has^ yet been formulated it

would appear that hay from Rotterdsm was the cause. Since

the destruction of the infected and suspected animals there has been a relaxation of the drastic precautionary measures ado ted by the Board of Agriculture.

The owner of the infected herd will have to be compensated

*- the extent of something like £4,000.

THE PLAGUE.

PREVALENCE 0F THE DISEASE.

INDIA.

DuRING the weeks ended Decesnber 21st and 281h, 1907, and

January 4th and 11th. the deaths from plague In India num-

bered 2,602, (^) 2,741) 2,618, and 2,823 respectively. The (^) mortality during lhe four weeks oecurred as follows: (^) Bombay Presi- dency, 1 002, 832, 858, and (^) 745; Bengal. 238, 220, 354, and 336 ;

United Provinces, 303, 327, 511, and 530; Punjab, 283, 259, 211,

and 221; Rsjputana, 257, 128, 84, and 72; Central Provinces,

128, 110, 262, and 112 ; Madras Presidency, 98, 96. 138, and 114 ;

Mysore State, 304, 363, 404, and 472 ; Burma, 115, 126, 116, and

Plague during the week ended January 4th caused 14 deaths in the North-West Frontier Province, and during the week ended January 11th there were 370 deaths fromthe disease in Hyderabad State. SOUTH AFRICA. No cases of plague were reported between October 21st, (^) 1907, and January 11th, 1908. Rats and^ mice^ continued to be found plague-Infected up to January 11th.

AuSTRALIA. QuWen8land. Briebans.-No case^ of^ plague^ has occurred^ in^ Brisbane between July 26th and December 14th, 1907. Cafrns.-A case of plague occurred at Cairns during the week ended November 30th, and proved fatal. The patient came from Green Island, some distance from Cairns. No evidence of rats being infected with plague were found in Cairns or in Green Island at the time.

GOLD COAST, WEST AFRICA.

From January 11th to 31st the daily deaths from plaeug

have been as follows:-10, 2, 1, 2, 2, 6 4, 1 4 6 2 2, 4, 3, 1, 0

0, 2, 0, 2, 3-equal 57 deaths since the outbreak wasfirst reported on January 11th. On January 31st there were 14 cases of plague under treatment in the plague hospital. Thirty-two persons were at the same date isolated owfng to their being in contact with plague patients.

ROYAL NAVY AND ARMY MEDICAL SERVICES.

INDIAN HOSPITAL ASSISTANTS.

ON sundry occasions during the past decade, and more par- ticularly in^ May, 1905, and December^ 1906,^ we^ have^ drawn attention to the position of^ hospital^ assistants^ in^ India,^ and^ to the feeling among them as to their position and prospects. It seemed, and still seems to us, that the discontent which we noted was well founded, and that these men, without whose assistance the^ general^ medical work of^ the^ Government^ of India, (^) not less than that of the hospitals, would be absolutiely paralysed, deserved and should receive greater consideration than has so far -been shown by the authorities. This- class of medioal workers has been in existence now for over half

a century; it -is a service whioh became evolved from the

necessity of having a^ large number^ of^ subordinates^ to^ assist in the hospitals as dressers and^ compounders,^ but^ little

by littlp the duties of its members have become more

numerous and responsible. There :has been an corre- sponding- improvement in^ the^ machinery^ provided^ for^ their education, and^ a^ good many years ago examinations^ were

imposed and no^ candidate for the service^ admitted^ who^ -had

not undergone a three years' course of instruction in^ a medical

school. Suoh exsminations covered, and still cover,general,

medioal, surgical, sanitary,^ and^ medioo-legal knowledge,^ and

recently the^ tests^ imposed^ have^ been^ increased^ in^ severity.

There is now a preliminary examination in^ general knowledge,

and the course of the training has been extended to four years. Their general title still remains that of "hospital assistants," but this is to some extent a misnomer, since men belpnging to^ .this class^ are^ to^ be^ found wherever^ Government medical work of any kind is^ in. progress, and not infrequently they oocupy positions in which their work is done subject only to merely nominal supervision and control. In spite of these facts their (^) pay and prospects remain precisely what -they were

fifty years ago. The former begins at^25 rupees a^ month, and

the highest scale of pay theycan hope to obtain, after-obtaining promotion a least three times is 70 rupees. Moreover, the

passage from one grade to anotler involves further examina-

tion. Neitber in the case of the junior nor in that of the senior

employls of this servioe do the positions and prospects com-

pare favoutably with those of^ native officials^ in^ other depart-

ments of the Govrernment service, and they are^ notably inferior

to those of the police,-the-excise, the prison, the pubic works,

and the veterinary departments. The tendency is for the

otxpenses of living in India to inerease In such ways as to affect

those whose mode of life^ is^ still Eastern^ in its^ general character, and within recent years most Government depart- ments have been reorganized and employ6s put upon a better

footing as^ regards pay.^ The time^ has^ certainly^ come^ when the

same step should be^ taken^ with^ regard to^ the^ hospital

assistants. Those who work in the province of^ Bengal sub-

mitted last year a petition to Government on the subject which may be regarded as on the whole free from exaggeration of statement. It contains a number of suggestions as to the waYs in which the (^) position and (^) prospects of men belonging to the

service might reasonably be^ improved, and^ the^ many existing

anomalies and the Invidious distinction made between them and other of the (^) employ6s of Government minimized. It Eeems to us that it should meet with the sympathetio considera- tion of the^ Inspector-General of^ Hospitals, and^ that^ some, at least, of the contained requests ehould be^ granted, if^ it^ is desired that this subordinate but important branch of^ the Government service should continue to enjoy the popularity

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36 TD JOBL]I^ MEMORANDA. [FRB. 15, 1905

I am greatly indebted to Dr. Flexner for supplying me

with the antiserum for use in our cases.

to draw conclusions from a small number of cases, and

I quite recognize that an estimate of the value of this

treatment can^ only be made after^ prolonged trial and

testing by many observers and under varying conditions.

In firt sending me the serum, Dr. Flexner stated that

formed from an examlnation of these figures, and from

I considered I was justified in placing these results

before you.

REPORTS

MEDICAL AND^ SURGICAL PRACTICE^ IN^ THE

JOHANNESBURG HOSPITAL.

Assistant Surgeon.)

THE Interest of the following case 'lies not^ so^ much in^ the

earlier operations carried^ out as^ in^ the^ later,^ where,^ the

right vagus being involved, resection^ of 2^ in.^ of^ the^ nerve

was demanded if complete removal of the^ growth^ was^ to

be attained.

MEMORANDA:

MEDICAL, SURGICAL, OBSTETRICAL.

A NOTE ON CALMETTE'S OPHTEALMO-REACTION

FOR TUBERCULOSIS.

clinical test for tuberculosis. Since Wolff-Eisner and

Calmette introduced this modification of the tuberculin

test for the clinical diagnosis of tuberculosis it has been

daily occupations. From^ the numerous published papers

of active tuberculous disease. Patients have failed to

react in whom a subsequentpost-mortem examination has

demonstrated the presence of miliary tuberculosis of the

-dying persons with undoubted advanced tuberculosis of

the lungs. Moreover, by some observers, in about 10 per

patients a^ positive reaction has been recorded, and I

believe this percentage would have been much higher if

eyes by sitting up late every night to read and

five medical men who have tried this test or

rently healthy doctors a positive result was obtained;

*in thiee the reaction was violent, and In the other

two it was relatively slight, and occurred only after a

the first test (in the other eye) having been negative. I

Tather deep inoculation at a podtmorten examination on a

has been proved to gfte a negative result in cases of old,

obsolete, and " cured " tuberculous lesions. In regard to

failed to produce any reaction whatever in the eye of a

signs of active tuberculosis of the upper part of one lung.

for tuberculosis. Much light is thrown on such anomalous

to a meeting of the Wissenschaftl. Gesellechaft deutscher

Aerzte In^ B5hmen on^ January^ 15th.^ He^ has observed

violent reactions as a result of the test in^ Fome^ cases^ of

follicular conjunctivitis, and even in ordinary chronic

been completely negative in some other affections of^ the

F. PAREaKs WEBER,^ M.D.,^ F.R.C.P.,

PHTHISIS TREATED BY BOVINE TUBERCULIN.

TEIE following are notes of a case of phthisis treated^ by

hypodermic injections of bovine^ tuberculin^ as^ recom-

supplied to me^ by^ the^ Clinical^ Research^ Association.^ The

opsonic index has not been taken, the^ patient^ being^ in^ too

tried on January 21st with^ negative results.

The patient, a lady aged 30 years, has^ been^ under^ my

tuberculosis of the apices of^ both^ lungs^ with^ cavities.

Previous to coming under my care she had been^ treated'

by some well-known physician, also in-sanatoriums^ abroad

and at home, when her sputum had^ been^ frequently

January, 1907, was 8 st.^12 lb.,^ which^ gradually^ decreased

the left lung down by the vertebra and,^ outwards^ to^ the

angle of the^ scapula^ and^ forwards^ to^ the^ apex of^ the

heart, with large crepitations^ and^ rAles.^ She^ suffered

severely from^ dyspepsia,^ almost all^ food^ being^ vomited.

She had to take^ to^ bed^ and^ was^ panting^ for^ breath.

On November 17th her^ pulse was^ 130,^ and^ had

been so^ for^ a^ week^ previous;^ now^ It^ varies^ from

72 to 80. Her digeston has^ vastly^ improved,^ in fact

it is^ almost^ as^ good^ as^ ever^ it^ has^ been.^ She^ can

take full quantitles of^ ordinary^ solid^ food,^ meat^ and

vegetables, and at^ Chrlistmas^ partook^ of^ the^ regulation