34 A VISIT OF FRENCH MEDICAL MEN TO LONDON.

health and purse if they had in their youth acquired thehabit of disregarding draughts" " and always admittingplenty of fresh air to their apartments. I

A VISIT OF FRENCH MEDICAL MEN TOLONDON.

Sir William S. Church, Bart., K.C.B., President of the

Royal College of Physicians of London, occupied the chairat the College, Pall.MalL East, .:LaBdaR8.-W., on June 23rdon the occasion of a meeting of representative members ofthe profession in order to consider the arrangements whichshould be made to receive a party of French physiciansand surgeons who propose to visit London on Oct. 10th,llth, and 12th. On the motion of Dr. Frederick T. Roberts,seconded by Mr. Thomas Wakley, Jun., an executive com-mittee, with Sir William Broadbent, Bart., as chairman,containing representatives of the principal hospitals andlaboratories in London which the French visitors might wishto see was appointed. Sir Thomas Barlow, Bart., and Dr.J. Dundas Grant were elected treasurers, the secretarialwork being entrusted to Dr. Dawson Williams and Dr. W.Jobson Horne. A guarantee fund was formed and subscrip-tions were promised by those present.

PARKES MEMORIAL PRIZE.

THIS prize, (which is given triennially and consists of 75guineas and a bronze medal), has been awarded to Major R.Caldwell, R.A.M.C., for the best essay sent in upon"The Prevention of Disease amongst Armies engaged in

Active Operations in the Field, with special Referenceto the Sanitary Organisation of a Field Force." The

essays submitted by Major E. C. Freeman and MajorF. Smith, D.S.O., also of the Royal Army Medical

Corps, were highly commended by the assessors. The

subject of the next prize is "own the Sanitary Require-ments of Naval and Military Units in Peace and War ; withSuggestions for Complete Schemes of Sanitary Organisationsuitable for both the Navy and the Army." The competitionis open to officers of the navy, army, and Indian medicalservices. Essays should be submitted to the secretary ofthe Parkes Memorial Fund, Royal Army Medical College,Examination Hall, Victoria Embankment, London, W.C., onor before Dec. 31st, 1906.

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CEREBRO-SPINAL MENINGITIS OF THEEPIDEMIC TYPE.

DURING the past four or five years much attention hasbeen given to the study of cerebro-spinal meningitis in theUnited States where this disease is often prevalent inepidemic form, the researches of Councilmann who investi-gated the Boston epidemic of over 100 cases, and of Oslerwho investigated the Baltimore epidemic, having served toincrease the interest and importance of the matter. In the

Medical News of New York of June 4th Professor HenryKoplik has published an account of his studies on 77 casesof epidemic cerebro-spinal meningitis carried out by himduring the last five years. 37 of these were bacterio-

logically examined and found to be undoubted cases,cultures of the meningococcus intracellularis of Weichsel-baum being obtained from the patients in every case.

35 of the other cases were found to be due to the

tubercle bacillus, one each to the pneumococcus, the

staphylococcus, and the streptococcus, and two to the

influenza bacillus. 15 other cases of the epidemic formwere also studied by Professor Koplik and from a careful

collation of the records of all these cases and fromothers in literature the following conclusions were drawn.As regards age infants and children are the most liableto be affected. Thus the oldest patient was only 14

years of age, 77 per cent. of the patients were under four

years, and 60 per cent. were under two years of age. " My

own cases," adds Professor Koplik, "are of the primarymeningitic form and include at least one case of so-calledposterior basic meningitis." The clinical types of the-

disease were the ordinary and well-known ones but a few" malignant" cases occurred which were fatal within from24 to 36 hours. These malignant cases were marked byvomiting and subcutaneous hasmorrhages in the face, the-

hands, and the body. In young infants the onset of cerebro-

spinal meningitis was sudden, with general convnlsions, highfever, and vomiting, the fever being of the intermittent or-remittent type and lasting over four weeks. Rigidity of the-neck, general muscular irritability, and incipient wasting-began within a few days or a week of the onset. Babinski’s.reflex was found to be present in 77 per cent. of the cases of,tuberculous meningitis, its constancy in this affection beingattributed to a probable degeneration of the pyramidaltract fibres descending from the affected Rolandic area of

the brain. Kernig’s sign was difficult to elicit in childrenbelow the age of two years but all children above the ageof two years who suffered from cerebro-spinal meningitis.exhibited this sign. Hyperaesthesia of the skin and mentalirritability were observed in all cases in recent epidemics but,were not so universal in previous epidemics. The blood in-

variably exhibited leucocytic changes. The leucocytes wereof the polynuclear type in every case and varied from 20,000’to 50,000 per cubic millimetre, the lowest count being (in one-case) 12,000. The cerebro-spinal fluid drawn off by lumbarpuncture showed in nine out of 13 cases a predominance ofleucocytes, while four showed the normal proportion. Thymost frequent complications of the epidemic forms of the.

disease were otitis media, herpes labialis, and purpura.Treatment consisted of lumbar puncture " which was.

especially indicated in vigorous patients," the puncturebeing repeated after five days if symptoms recurred after(temporary) relief. From 30 to 40 cubic centimetres of fluidwere as a rule withdrawn at the operation but in

exceptional cases where there was much tension double thequantity was withdrawn. Hot baths were found useful for

allaying rigors, sponging was employed to lower the pyrexia,while calomel and the alkaline iodides in full doses were alsoserviceable.

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PROVIDENT MEDICAL DISPENSARIES.

AN interesting letter was read at the annual meeting ofthe Metropolitan Provident Medical Association held 0]))

June 28th at 67, Eaton-square, London, S.W., in which SirWilliam Broadbent, after regretting his inability to attendthe meeting, stated that he had for many years pastgiven close attention to the work of the Metropolitan Pro-vident Medical Association in providing good medical;treatment for the working classes, including attendance-at home. In his opinion the establishment of provident dis-pensaries afforded the true solution of the difficulties

attending the securing of good and efficient medicaladvice for the self-respecting working classes. Accord-

ing to the annual report of the association, which was.

adopted by the meeting, at the end of 1903 there were 12,86Lcards of membership-family and single-representing about.30,000 persons. The payments made by these provident.members in small regular fees amounted to 5836..In his letter Sir William Broadbent observed that,the club system of providing medical treatment byway of insurance was open to serious abuse on bothsides and he considered that it would be a very goodthing if the great benefit societies could affiliate them-selves with the Provident Medical Association. One ofthe objects of the Provident Medical Association is to

relieve the overcrowded hospital out-patient departmentsby a system of cooperation and on that point the opinion of £