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early one morning and badly sprained his ankle, thefoot being slightly inverted when I saw him the same
afternoon. Massage, chiefly squeezing, and movement werethe treatment employed. In two days he was walking witha perceptible limp and on the fourth day the limp haddisappeared although the parts were a little swollen andthere was some discolouration left. The other case was oneof subglenoid dislocation of the humerus. When the mancalled on me he was in a faintish condition and as Iconsidered that his muscles would be partially relaxedI immediately tried to reduce the dislocation by right-angle traction and in this I was successful, the bone
going in with a grating snap. He immediately experiencedgreat relief. He left me without bandage or sling withinstructions to move the joint and not to allow it to get stiff.The patient, who is an engineer, went to his work next
morning at 6 o’clock-nine hours after reduction-and workedat his trade all day. When using the hammer he felt somepain in the joint. I have just seen him now-45 hours sincereduction-and he can move his joint freely in everydirection and says that he feels no pain. He has not beenone hour off his work. This treatment is apparently a greatimprovement on the old treatment when the joint wasrendered immoveable for several weeks and the joint wasleft in a stiff and weakened state.
I am Sirs, yours faithfully,Galashiels, Oct. 17the,1902. WILLIAM DOIG, M. D. Edin.
THE STATE REGULATION OF PROSTI-TUTION.
To the Editors of THE LANCET.
SIRS,-As a member of the recent International Congressfor the Prophylaxis of Syphilis and Venereal Diseases atBrussels and of the one held there three years ago, permit meto draw attention to one point which I think has escaped thewriter of the leading article on the conference in THE LANCETof Oct. 18th, p. 1063. He alludes to the necessity of carefuland efficient control of the regulated houses, which, he
says, will otherwise become virulent sources of infection,but he does not recognise the other horn of the dilemma,which is that wherever the medical control assumes a
certain strictness, with greater frequency of inspection, &c.,the houses are actually dying out and giving place to housesof accommodation where no inspection is carried out. This
question was thrashed out in great detail at the first con-ference. Strange to say, the houses seem to retain their
popularity chiefly where (as in the case of the lower-classhouses in Russia) they are conducted with flagrant careless-ness and are, as your leading article suggests, virulentsources of infection. I am inclined to attribute this to
popular ignorance which does not recognise the danger ofhouses of this kind.
I may add that the general testimony, and especially thatof the most advanced experts, was very strong as to the
misleading nature of certificates of health given to thesewomen. A certificate of health is impossible in the case ofsyphilis as the disease is contagious in its latent periods,when no sign of it can be detected ; and on this groundProfessor Neisser, Professor Finger, Professor Jadassohn,and others urged that an explanation should be printed onthe face of the certificate itself to the effect that it onlyguaranteed the absence of visible disease.I am, Sirs, yours faithfully,
Cubbington, Oct. 21st, 1902. B. LEPPINGTON.
HOW DISEASE IS SPREAD.To the Editors of THE LANCET. ,
SIRS,-The spread of infectious diseases by attendance at ’,school is a matter of such moment that possibly the following I,,facts may be of some interest as showing one of the causes Iat work. Yesterday I was called to a case of scarlet fever Iand was informed by the mother that the patient, aged nine I
years, attends the local board school. On the day previously I,to my seeing her the child was suffering during morning Ischool from vomiting, headache, and sore-throat, and was I,unable to do any work. Nevertheless, the teacher stronglyurged her to attend again in the afternoon in order to qualifyfor an attendance medal, and the child did so attend, quiteunable to do any work, but reting her head upon the deskand, doubtless, infecting her companions. With scarlet feveragain prevalent could not the London School Board draw
the attention of its teachers to the very suggestive nature-I of such a collection of I symptoms? am, Sirs, yours faithfullv.I am, Sirs, yours faithfully.W. HEPTINSTALL MILLAR.
Streatham-hill, S.W., Oct. 19th, 1902.
THE PHYSICAL AND MEDICAL EXAMINA-TION OF CANDIDATES FOR COM-
MISSIONS IN THE ARMY.To the Editors of THE LANCET.
SIRS,-Mr. Kenneth Campbell wishes to know the meaningof " Vision = D. 6 at six metres," which he calls a "cryptic-sign " and allusion to which, he states, is not to be found inthe text-books. If Mr. Campbell can find any ophthalmictext-book, in any language, in which no allusion is made toSnellen’s test-types I shall be much surprised. "Vision= D. 6 at six metres " means, of course, that the six-metre type is read at six metres-i. e., vision = 6/6, or normal.The fractional expression of vision (, 6/12, &c.), though nowalmost universally employed, might possibly not be under-stood by every practitioner ; for this reason the War Officeregulations amplify it, in the case instanced by Mr. Campbell,to "D. 6 at six metres." If Mr. Campbell’s letter is meant tobe taken seriously it is evident that the War Office elucidationof is by no means uncalled for.
I am, Sirs, yours faithfully,T THE WRITER OF mrrrn A RTICLE .
I Oct. 27th, 1902. THE WRITER OF THE ARTICLE.
A NEW SYSTEM OF TREATMENT INPULMONARY PHTHISIS.
To the Editors of THE LANCET.
SIRS,-In THE LANCET of Oct. 18th, p. 1047, certainfigures and "cases" are given as results (obtained byMr. Duncan Turner at Mount Macedon, Australia) of
rubbing cod oil with creasote into the body of tuberculoussubjects. If from half to one ounce be rubbed in dailyfor a year some 24 pounds of oil at the most will be-used and possibly absorbed. The patients are in a sana-torium and treated therefore, presumably, in other respects.with generous diet, rest, exercise, and abundant fresh air.On these, the ordinary sanatorium lines, 24 patients gain eachin the year from four to five stones, bringing their total body-weight to, say, 12 to 14 stones-a very respectable average for-a healthy person. Other 24 patients with cod oil massage in.addition put on from 14 to 15 stones, bringing their individualweights to a total of from 22 to 24 stones-a still more respect-able, if not awful, figure. Even in these days of "remarkable-results " from many various I I methods " these latter figures,seeing that the patients survived the treatment as well asthe disease, seem, up to date, the most remarkable. Mr..Turner would seem to have indeed struck oil " and might-almost, one thinks, ’’ stop boring." Any stray bacillus stillin the field must feel itself " trembling in the balance " andthe accommodation per head, or rather per body, at MountMacedon must be getting small by degrees and beautifullyless," as surely, if slowly, the cubic solid contents waxfatter-perhaps after a year a waning process sets in ?
Unless the fact of the figures being placed in a footnote-indicates your own doubts of their exactness the credit ofour old friend cod oil which was first "taken," later-"injected" with creasote also, and is now "massaged" (a"new" method this is styled) into the tuberculous body,emerges from a partial eclipse. Ought not all this, if true,to stimulate still further inquiry into the vexed question ofits chemical composition and "specific" " or mere "general" "’
(nutritive) physiological action ? Does it kill the bacillus inpure culture as urea is stated to do ? Can it as a solvent.of fat act on the bacillus in situ7 Derived as it is from theliver, where in man urea is formed, has it any connexionwith urea or its metabolites ? Or does it leave the bacillus
severely alone and simply fortify the phagocyte ? Such.questions only show how interesting the subject is.
I am, Sirs, yours faithfully,Oct. 21st, 1902. ADMIRANS.
NOTES FROM INDIA.(FROM OUR SPECIAL CORRESPONDENT.)
, The Increasing Plague Mortality.-The New Army BearerCorps.-The Use of Poisons in India.
THE weekly mortality from plague has now to be recorded
’with five figures, having been 10,718 during the past sevendays-a rise of 742 over the previous week. With the excep-tion of one district the rise is general throughout the infectedareas. The worst affected places are the Bombay districts..and the Mysore territory, but the disease is rapidly increaingin the Punjab and in the State of Hyderabad. In Mysore animportant State function had to be abandoned and in theKolar goldfields the coolies are getting panic-stricken. The
points of importance to note in this week’s returns are the- continued development in the badly infected areas, the
rapid rise in the Punjab and in Bombay city, and the signsof recrudescence in Bengal. The detailed figures published
. are : Bombay Presidency, 7780 against 7384 ; Mysore State,1122 against 1094 ; United Provinces, 736 against 745 ;Madras Presidency, 385 against 322 ; Punjab, 210 againstT122 ; Hyderabad State, 149 against 86 ; Bombay city, 101against 63 ; and Bengal, 52 against 31.The details of the scheme for the new Army Bearer Corps
. are now sanctioned. The corps will form an integral part ofthe Medical Service. The four divisions will each be placedunder the principal medical officer of the command with aspecial staff officer for each to supervise administration,organisation, and recruitment, and to assist in mobilisation.The staff officers will be appointed for five years and willreceive a staff allowance of Rs.400 per mensem. An assistant
surgeon from the subordinate medical department will’be attached to each company. He will also be appointedfor five years and will receive a charge allowanceof Rs.50 per mensem. The subordinate department is tobe increased by 37 assistant surgeons. The new bearer
corps will consist of such men from the existing establish-ment of bearers as may be qualified by caste and fitness,supplemented by recruits. They will be divided into three. grades-sirdars, mates, and bearers. The total strengthwill be 6000, organised in 28 full companies of 200men each and four reduced companies of 100 men
each. The full companies will have two sirdars, sixmates, and 192 bearers. Except during war time men mayclaim discharge after three years’ service. The men will betrained in the following duties stretcher drill, first aid tothe wounded, conveyance of the sick and the wounded, and.camp arrangements. During peace time the bearers may beemployed on any government work suitable to their caste inaddition to their ordinary duties, such as punkah-pulling andwater-carrying.
Poisoning is a common form of crime in India and it is
possible for anybody to go into the bazaar and to buy as muchpoison as he wants. Poison is largely used for murders aswell as suicides. It is probable that but a small number ofthese crimes are actually brought to light. Snake-bite and"cholera are ready excuses to cover a crime and inquests arepractically unknown outside the Presidency towns. Opiumand arsenic are the two chief drugs used-the former forsuicide, the latter for murder. Cattle also are extensively,poisoned for the sake of the hides. There is more arsenicalpoisoning in the Punjab than elsewhere and it probably occursfrom the readiness by which yellow orpiment can be obtainedfrom Chitral. Suicides by opium are committed by the’natives for the most trivial reasons, even children destroyingthemselves after being scolded and wives because their,husbands complain of their dinners. It is difficult to restrainthe purchase of arsenic because it is so largely used in manu-factures, but opium and cocaine could be prohibited for’sale except by licensed dealers. In the country districts,however, the death registration is so lax that even this’would probably be of little benefit.
Calcutta, Oct. 10th.
(FROM OUR OWN CORRESPONDENT.)
Opening of the Heswall Hospital for Tuberculosis by the LordMayor of Liverpool.
ON Oct. 20th, in the presence of -a representative companyof upwards of 100 ladies and gentlemen, the Lord Mayorof Liverpool formally opened the new hospital tor tuber-culosis at Heswall, which is capable of accommodating24 patients of the three Liverpool unions and which isthe first of the kind in the country erected under similarauspices. The Lord Mayor opened the new building witha gold key which was presented to him on the threshold-of the building. The.principal jaart.of the proceedings took
place in the interior. Among many others representing thethree Poor-law combinations specially interested and otherpublic bodies were the respective chairmen of the West
Derby guardians, the Liverpool select vestry, and the Toxtethguardians ; and Mr. Malcolm Morris, the treasurer of theNational Association for the Prevention of Consumptionand other Forms of Tuberculosis, and Mr. Jenner-Fustand Mr. W. M. Moorsom (Local Government Board in-
spectors) were also present. Mr. T. D. Laurence of theLiverpool select vestry, as chairman of the joint hospitalcommittee of the three boards, presided. In introducing theproceedings he gave a history of the foundation of thehospital. On Feb. 22nd, 1899, a conference of represen-tatives of the West Derby union, the Liverpool select vestry,and the Toxteth guardians was held, and after anxiousconsideration as to whether the new treatment of tuber-culosis was so far past the experimental stage as towarrant them in taking the necessary steps to providethis treatment for their poor suffering from tuberculosis, itwas resolved to proceed and to make provision for 24 beds.The foundation stone of the building was laid by the RightHon. Walter Long, the President of the Local GovernmentBoard, on Oct. 25th, 1901. The cost of the land, building,and furnishing was B12.000. It was intended that admissionto the hospital should be confined to cases from theinfirmaries of the three contributing Poor-law authoritiesand each case would be separately inquired into. The costmen ioned appeared to be large for the number of patients itwas proposed to accommodate at first, but it was thoughtto be desirable to proceed cautiously with the buildingarrangements, especially as it was the first hospital of thekind in the kingdom built under the auspices of the Poor-Law authorities. It was planned so as to be capable ofextension at a comparatively small cost. Mr. MalcolmMorris, in an interesting speech, paid a high complimentto the enterprise of the Liverpool unions in inauguratingsuch a useful institution and paid a handsome tribute toDr. Nathan Raw, the medical superintendent of the Mill.road Infirmary, for having induced the Liverpool guardiansto take up the scheme, and said that he had come fromLondon to testify what the association thought of him.
Upon the termination of the proceedings the visitors wereconducted over the building, the airy and comfortably-furnished dormitories being objects of admiration andfavourable comment.
The Proposed Mid-Cheshire Infectious Hospital.An application having been made by the Cheshire county
council for permission to borrow e2000 for the purchase of asite for an infectious hospital in Hartford-lane, Davenham, forthe joint district of the Northwich rural and the Northwich,Winsford, and Middlewih urban councils, an inquiry intothe subject was held last week by an inspector of the LocalGovernment Board at the Northwich workhouse. The
probable cost of the hospital is estimated at £12,000. Itwas explained by the representative of the Cheshire countycouncil that shortly after the passing of the Isolation
Hospitals Act of 1893, the county council found that,whilst three of these urban councils had made inade-quate provbion, the Middlewich council had made no
provision whatever for the isolation of infectious cases.
Acting upon reports of the county medical officers, it heldinquiries and conferences, and the Cheshire county councilarrived at the conclusion that it would be more economicalan i better in every way if a largehospital area was formed.The county council’s proposal of a hospital authority for theNorthwich rural and the Northwich, Winsford, and Middle-wich urban districts was opposed by all the authorities, butit made an order and after inquiry by the Local Govern-ment Board the order was confirmed in every detail, the onlyalteration being that it was to come into force in September,1901, instead of January. The order provided that if a jointhospital were not erected the county council might appointa new committee with a majority of county councitiors asmembers. The county council had noted with satisfactionthat the hospital committee had done everything it couldwith a view to bring the order into operation. The hos-
pital committt e approached the county council in June andasked its approval of a site which the committee had pro-visionally agreed to purchase. Petitions were then lodgedagainst the site, contending that it was unsuitable in manyways and would be in the centre of a thriving village. Thecommittee and the county medical officer of health repliedto these criticisms and the medical officer reported tothe county council that in his opinion it was an