congenital idiopathic dilatation of the colon

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should be set on foot without even a single year’s delay."They propose accordingly that the Council’s Welsh schemeshall be again presented to Parliament and that the wholeof the scheme shall be embodied in one Bill. Finally, thecommittee suggest that it is possible that when the RoyalCommission shall have reported the Council may have toreconsider its position, but at the present moment. thecommittee feel that they can only recommend that a Bill bedeposited for compulsory purchase in the same form as thatof last year, subject possibly to certain alterations in detailsas to which the Parliamentary Committee would advise theCouncil at a later period. According to the Finance Com-mittee the latest estimate of the Welsh scheme is givenby the chief engineer at 17,000,000. As the whole

financial question in regard to the acquirement of the

London water undertakings has been gone into by LordLlandaff’s Commission the Finance Committee have not

thought it necessary to have the figures revised with a viewto bringing them up to date.

THE PARISH OF ST. GEORGE, HANOVER SQUARE.

WE have received a copy of the report on the sanitary con-dition of this parish for the year 1898 by Dr. W. H. Corfield,the medical officer of health. Apart from the ordinarystatistics dealing with the sanitary condition of the parish,which is satisfactory, and a tribute to the administrationDr. Corfield publishes in the same number a special report onthe water-supply, together with the correspondence followingupon his animadversion on the quality of the water as

reported by the public analyst which brought repliesfrom the late Sir Edward Frankland and Sir WilliamCrookes. We dealt with this interesting discussionat some length in THE LANCET of May 20th, 1899

(p. 1377). It refers to the relation of the increase in theamount of organic matter to the augmentation of cases ofenteric fever.

A VETERAN POOR-LAW MEDICAL OFFICER.

ON Dec. 1st at the meeting of the Congleton Board ofGuardians a letter was read from Mr. Charles Latham re-

signing the office of medical officer to the union work-

house, Arclid, in the district of Sandbach. Mr. Latham

mentioned that being now in his eighty-fourth year hethought that the time had come for him to retire. For

58 years he had been a public official and he could

truthfully say that throughout that period he had neverreceived an unkind word or look from those to whom he was

responsible. The resignation was accepted with great regret.Mr. Latham was educated at St. Bartholomew’s Hospital andis a nephew of Dr. John Latham, who was President of theRoyal College of Physicians of London from 1813 to 1819.He is probably the oldest member of the Poor-law medicalservice and has practically passed his whole life in Sandbach,where his name is a household word because of his acts ofkindness and charity.

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CONGENITAL IDIOPATHIC DILATATION OF THECOLON.

THE Arnerican Journal oftlw Medical Sciences for Septembercontains an important paper on this rare condition by Dr.J. P. Crozer Griffith. The expression " congenital idiopathhicdilatation of the colon" is applied to cases in which there is aninnate tendency to dilatation not dependent on any organiccause. Thus cases of dilatation secondary to constipationand cases dependent on congenital stenosis are excluded. In

idiopathic dilatation constipation is a result and not a cause."Congenital" is applied not only to cases in which thedilatation is present at birth, but also to those (probably themore common) in which a tendency to dilatation exists.

In some cases there are distension and constipation fromearliest infancy ; in others, less severe, distension is resistedfor a time, but there is always deficient expulsive power ; instill others there are periods of improvement in which dis-tension disappears, although relapses almost always occur.In the absence of a necropsy idiopathic dilatation cannot bedistinguished from dilatation from stenosis, nor when thesymptoms appear late can it always be determined whetherthe constipation is a cause or a result of the dilatation.Dr. Griffith relates the following case. A boy sufferedmore or less since birth from constipation, for which

very strong purgatives were required. At the age offive months distension of the abdomen, accompanied bypain, began. Sometimes for a week there was no action ofthe bowels; diarrhoea then occurred for several days witheven increased distension. Sometimes the distension wasrelieved by a rectal tube which allowed the gas to escape.At the age of three years purgatives and enemata ceased toafford much relief and he was admitted to hospital. He was

a well-nourished slightly pale child. The abdomen protrudedenormously and was tympanitic. It measured 69 8 centi-metres (2’72 in.) in circumference. The umbilicus was pout-ing and peristalsis was visible. At times the outline of the

greatly enlarged colon could be seen. The costal marginswere everted by the pressure. Treatment consisted in hot

fomentations (to relieve pain), the insertion of a rectal

tube, enemata sometimes containing turpentine or assafoetida,.and the administration of strychnine. Watery, greenishdiarrhoea developed ; the temperature rose to 105’2° F. the;

pulse to 140, and the respirations to 37..; As the child grewweaker and the tympanites persisted right inguinal colotomywas performed. After an injection into the opening muchsemi-liquid faeces and gas came away through it andthe abdomen diminished to its natural size. But thechild’s strength failed and he died on the fifth dayafter operation. At the necropsy no stenosis of thecolon was found. Analysis of 24 recorded cases showa very characteristic group of symptoms. The principaland the first to appear are constipation and abdominal dis-tension. In 22 cases one or both were observed within threemonths and generally within a few days of birth. In a small

minority several weeks or even three months elapsed beforeintestinal troubles began. Relief of the constipation bypurgatives or enemata usually produced diminution in thesize of the abdomen. The stools only exceptionally werescybalous. Evidently the colon was unable to propel soft.contents and not blocked by scybala. The prognosis.is bad. Eighteen out of the 24 cases proved fatal; ;.

only two patients are known to have recovered.As to treatment massage and electricity seem indicated.The bowels must be emptied by purgatives or enemata.

Both tend to further weaken the muscular power but theycannot be avoided. The rectal tube by removing the gashas afforded great relief. In three cases the intestines were

punctured with a fine trocar. In one of the cases in which

recovery took place an artificial anus was formed. The

operation performed by Mr. Treves in a case of dilatationsecondary to congenital stenosis-excision of the colon anduniting the small intestine to the anus 1-might be useful

in an idiopathic case. -THE CONTAGIOUSNESS OF INHERITED

SYPHILIS.

DR. Louis KOLIPINSKI of Washington, D.C., describes inthe Marylaib4 Medical Journal of Nov. 25th two instances inwhich a syphilitic infant was the means of conveying thedisease to healthy persons. In the first of these cases a

young man gave syphilis to his wife who a year later was

1 THE LANCET, Jan. 29th, 1898, p. 276.