chelsea clinical society

721

system (including diarrhoea), 1938 admissions, 585 deaths;and diseases of the skin, 4058 admissions. In Tan Tock

Seng’s hospital for paupers in Singapore the number of casesof beri-beri occurring among patients who have been

admitted for other, diseases has attracted the atten-

tion of the Government. In his report on the lunatic

asylum Dr. W. G. Ellis, the medical superintendent, states

that beri-beri has been even more prevalent than in 1896and 1897, and unless the better ventilation of the lower levelsand the use of a small hospital to be built on the sea coastprove more satisfactory than former attempted remedies thequestion of removing the whole asylum to some other sitemust be considered. In 1896, with an average daily numberof 233 patients, there were 85 deaths, 40 of which werefrom beri-beri; in 1897, with an average daily number of

228, there were 81 deaths, of which 48 were from beri-beri ; and in 1898, with an average daily number of 208,there were 95 deaths, of which 55 were from beri-beri.Seven attendants suffered from the disease and two ofthem had to leave the service on account of persistentlyrecurring attacks; the other five made good recoveries.With respect to Singapore Prison Dr. J. Leask, the surgeonin charge, mentions that for a period of 12 years-namely, from 1885 to 1897-only two patients were treatedfor beri-beri, one of whom was suffering from it at the timeof admission. In November and December, 1897, threecases occurred, and in 1898 there were 124 cases, of which 14appeared from the beginning of January to the end of

September, 10 in Ootober, 78 in November, and 22 in

December. Only one death was due to this cause in 1898.Strychnine in large doses was the principal treatment, com- Imencing with five-minim doses and rapidly increased to

15 minims every four hours. In no case was the physio-logical action of the drug observed. Digitalis was given inall cases. Diuretics and purgatives were largely used,elaterium being found the most satisfactory of the latter.For dyspiiae solution of nitro-glycerine in frequently repeateddoses acted admirably. - ,

A GOOD RECORD IN OPERATIONS FORCATARACT.

DR. SAMUEL THEOBALD of Baltimore has recentlypublished in the form of a pamphlet a report on 100 corn-secutive cases of cataract extraction. They were certainlynot selected cases, since they include two eyes on whichiridectomy had been previously performed for glaucoma, twoin which the lens was disloeated through injury, one of highmyopia, and various cases affected with choroiditis. Thesection was in all instances made at the sclero-corneal junc- tion, and in many instances a small conjunctival flap wasmade. In the majority of instances the extraction wascombined with iridectomy, either performed at the time oreffected by a preliminary operation. Still a considerablenumber of cases, 19 in all, were done without iridectomy.Cocaine was used as an anoesthetic in 89 cases, chloroform wasadministered in six, and no anaesthetic was given in the rest.Careful antisepsis was practised. In the after-treatment no

bandage was applied, but the eyes were closed with strips ofisinglass, or in restless patients a pad of cotton-wool wasplaced over each eye and retained by similar strips. The

patient was kept in the bed where he was operatedupon for three days, after which the dressings were changedand a daily instillation of a solution containing four grainsof atropia and ten grains of boric acid to the ounceof water was applied. As a matter of routine 20 grains ofsulphonal or trional were given to the patient on the even-ing of the operation. The results are such as Dr. Theobald

may congratulate himself upon having obtained, and arebetter than he could have anticipated considering that thecases were consecutive and not selected. He counts vision

20/200 to 1. s. as successes, and of these to have had about 90 percent.-a very satisfactory number. There were two losses

from suppuration., The other failures were from collapse ofthe globe consequent on loss of fluid vitreous, detachment ofretina, and choroido-retinal changes. No losses occurred

amongst those in whom the simple operation was performed.

CHELSEA CLINICAL SOCIETY.

Two special meetings of this society will be held in theHoly Trinity Parish-hall, Pavilion-road, Sloane-square, S.W.,on Tuesday, March 13th, and Tuesday, March 20th, at

8.30 P.M. At these meetings the annual clinical debatewill be held and the chosen subject this year is the Treat-ment of Rheumatism, with special reference to Prophylaxisand Cardiac Complications. The debate will be opened onMarch 13th by Dr. William Ewart and the following amongother speakers are announced to take part in the discussion :Dr. T. J. Maclagan, Dr. A. E. Sansom, Dr. Donald Hood,Dr. David B. Lees, Dr. Archibald Garrod, Dr. Pye-Smith, Dr.R. Caton, Dr. Burney Yeo, and Dr. Isambard Owen. SirRichard Douglas Powell, Bart., will give a closing addresson March 20th. The meetings will be open to all membersof the medical profession on presenting their cards.The special subject for debate is to be considered under thefollowing aspects. On March 13th : (1) the general factorsbearing upon the Prophylaxis of Rheumatism: the need fororganised investigation; (2) the general, medicinal, anddietetic treatment of the acute attack and of the rheumatic

tendency; and (3) the relative anti-rheumatic value ofvarious drugs and modes of treatment. On March 20th :

(1) the Special Prophylaxis against the occurrence or

aggravation of Rheumatic Valvulitis : can valvulitis be pre-vented or cured at its early stage ? (2) the methods whichhave been advocated for the prevention or cure of thevalvular affection ; (3) the alkaline treatment and itsvarieties and the salicylic treatment and its varieties :should they be combined ? and (4) the unfulfilled indicationsand requirements.

-

PLAGUE IN THE ARGENTINE REPUBLIC.

ON Jan. 26th the existence of bubonic plague in the cityof Rosario was officially declared by Government decree andon the following day the city was completely isolated fromthe rest of the country, all railway and river traffic beingsuspended. Troops of the line formed a cordon by land andtorpedo destroyers and gun-boats guarded the river, which ismany miles broad. The authorities hope that this completeinvestment by sea and land will prevent the escape,ofthose infected by the terrible bacillus, which is, however,reported to be already in Buenos Ayres, the capitalof the republic. The existence of plague in ROEariohas been suspected for some time and bacteriologicalinvestigations have been carefully carried out, but the

Government hesitated to declare the fact officially-a policy which was a source of embarrassment to foreignministers and consuls, who could not obtain from the

Argentine Government the corroboration requested by theirrespective governments. Rosario is a large city of 100,000inhabitants, and as a port it comes next in rank to

Buenos Ayres. It is the outlet for the great grain regionof Santa Fe and every year sends to Europe over 1,000,000tons of wheat, maize, and linseed, as well as thousandsof tons of wool. It is also a port of call for all

vessels going to, and returning from, Paraguay, wherebubonic plague has been present for some months pastbut not actually in epidemic form. In fact, nowherealong the South American coast has the plague taken astrong hold, a few isolated cases at Rio Janeiro, Santos. Sào

Paulo, and Asunción (Paraguay) being the record up till