633

To take a single instance. In the case of pyra-midon, which is official in the French Codex, noother name exists except its impracticable struc-tural one of dimethyl-amido-antipyrine, and thecurious situation arises of a valuable syntheticdrug in common use possessing only a foreignregistered name. The Appeal Court recognised theabsurdity of such a position in 1907 and decidedaccordingly against the validity of a trade-mark consisting simply of a name which was

likely to become the usual and necessarydesignation of the drug or synthetic product. Sincethat time a series of 14 such names have beeninserted in the Codea or its supplement-viz. (angli-cised) aristol, aspirin, dermatol, duotal, salophen,sulphonal, trional, and phenacetin in the Codex;and collargol, dionin, heroin, novocaine, urotropin,and veronal in the supplement. It is therefore onlynecessary to write veronal (Codex) and diethyl-malonyl-urea of any reputable make conforming topharmacopoeia! standard will be supplied instead ofthe proprietary article. Dr. Grimbert suggeststhat this practice should now be extended to all ithe synthetic remedies in common use, and that inaddition the protection afforded by a registeredname should be strictly limited to a single period of15 years, instead of being allowed, as at present,to be repeatedly renewed at the expiry of suchperiod. The practical effect of such a measure maybest be gauged by a study of the quantities of thesedrugs used by the hospitals of Paris alone during asingle year (1913). These are given in kilogrammesas follows : aspirin 347, ichthyol 301, urotropin 167,antipyrin 148,dermatol 96, pyramidon 68, phenacetin24, veronal 24, tannigen 17, aristol 17, sulphonal 16,collargol 15, salophen 12, and protargol 8.

THE National Council for Combating VenerealDiseases proposes to organise a comprehensiveeducational compaign to combat venereal diseasesin all suitable ways, and especially along the lineslaid down by the Royal Commission. This willinvolve arrangement for a number of conferencesand courses of lectures, and the immediate issue ofan authoritative summary of the principal con-

clusions of the report. These and other measureswill need financial support, and the ExecutiveCommittee of the Council earnestly beg for theassistance of its efforts.

THE annual discussion of the Hunterian Societywill take place at 1, Wimpole-street, W., on

Wednesday, March 22nd, at 9 P.M. The subjectchosen for debate-the Relationship of the MedicalProfession to the State and the Community-is onewhich should attract a large gathering. The dis-cussion will be opened by Dr. F. J. Smith, who willbe followed by Sir John Collie, Dr. T. D. Lister, andMr. F. Lawson Dodd. ————

Dr. S. G. Moore, medical officer of health of

Huddersfield, in delivering the Milroy lectures atthe Royal College of Physicians of London lastweek, dwelt on the preventable nature of theinfant mortality in this country and on the meanswhich can and should be adopted to reduce thisreckless waste of infant life. Whilst fully recog-nising the effect which general measures of publichealth have exerted on the death-rate of infants asof the population generally, the lecturer attributeda much greater efficacy and a more rapidly appreci-able result to special measures aimed directly atthe saving of the infant life. A carefully reasoneddiscussion of these methods forms the text of thelectures which we shall publish in THE LANCET.

PARIS.(FROM OUR OWN CORRESPONDENT.)

SOME French observers have worked out a.

method of detailed physiological examinationapplicable to beginners in aviation, which hasalready met with high approval. In order totest the degree of self-control and of endurancethe would-be pilot must begin by exertingwith both hands a rhythmic and continuedeffort, which is inscribed on the tambour of aD-

apparatus and automatically added up in kilos bya meter. He is then placed in front of a needlemoved by clockwork one complete turn in a,

second. Immediately the subject is aware of anydeflection of the needle he must arrest it by press-ing on a lever. Finally, a tambour is applied tohis thorax or to the pulse in order to gauge hisrespiratory and circulatory rhythm. He is thensubmitted to a violent and unexpected sensation,visual or tactile-a magnesium flash, a detona-tion, or a douche of ice-cold water. A rigid self-control may ensure no apparent emotion from thesubject, but the tambour of Maret mercilesslyregisters the tremor of his hand, the accelerationof his respiration, the beating of his heart-inshort, the organic impression. The organism thusbetrays itself by the degree of its reflexes and in a.manner more or less the persistence of its sensoryresponse. A pilot should remain imperturbable notonly morally but physiologically. In spite of fatigue,in spite of danger, his system must remain preparedto respond at once not only to the call of hiswill but to the reflexes aquired during his educa-tion and training. Like his machine, he must be a,supple and unfailing organism. From the momentwhen his flight begins he must constantly adjusthis apparatus to the three dimensions of space. If hemisses the moment at which any inclination beginsthe necessary effort will become greater, becausethe acquired inclination will have had time tobecome more pronounced. Fatigue will also tend toincrease, and to bring with it a muscular weaknesswhich renders slower the production of the reflex.These two drawbacks form a vicious circle and themoment will ultimately come in which the apparatusleans beyond the possibility of return. To sum up,what is essential for a good pilot is a combinationin one person of resistance to fatigue, emotionalpassivity, and very rapid motor reaction, and thesefactors should be registered with precision in anytests to which the candidate is submitted. Thereis in this physiological examination, conducted inthe way suggested above, more than an ingeniousadaptation of medical knowledge to the needs ofa special corps. The method offers guarantees forthe individual and for the army as a whole, and ifits employment becomes general may effect a realeconomy of men and material.

Examination of the Aviato3.’s Aptitude.Cu7°e of T1’aumatic Deaf-Mutis1n.

M. Lortat-Jacob and M. Buvat have shown at theMedical Society of the Hospitals a series of sixdeaf-mutes whose condition followed on an explo-sion at a varying time previously. Employmentof all the classical modes of treatment had pro-duced no improvement. Examination of the earrevealed no trouble other than of a hystero-traumaticorder. M. Lortat-Jacob and M. Buvat therefore hadrecourse to the violent action of ipecacuanha onthe glosso-pharyngeal nerve in order to produce asudden return of hearing and of normal voice. This

634

simple emetic method may be tried successfully,resulting in sudden cure in cases which have failedto respond to other methods of treatment.

A New Method of Anscnltation for the EarlyDiagnosis of Phthisis.

It is generally believed that 60 per cent. of casesof pulmonary tuberculosis recover when recognisedand treated at the outset, but early diagnosis is oftendifficult. At this curable stage of the disease anyprocess which assists in revealing the existence ofan early lesion is to be welcomed. Dr. Clover, asthe result of earlier researches on vocal physiology,has demonstrated at the H6pital Beaujon a newclinical application of auscultation of vocal reson-ance at a distance. His method of precise ausculta-tion localises and amplifies the slightest alterationof the normal resonance due to increased densityin the lung affected with tuberculosis and otherinfections, or damaged by wounds of the chest. Bymeans of a novel arrangement the apparatus givestwo simultaneous different sensory impressionswhich can be measured and of which one is thecontrol. The practical character and utility of thisresearch deserve to attract immediate attention.

Dermatitis Produed by Zeppelin Bombs.In the case of several chemists who have handled

substances contained in non-exploded Zeppelinbombs, M. Durelle has observed a dermatitis of

rapid development. It consists of red squamousplaques presenting some fine vesicles and

occurring especially on the face, with a maxi-mum intensity on the eyelids and periocularregions, the conjunctiva remaining intact. Thesame lesions were found in less degree on the fore-head and near the ears. The hands presentedslight alterations, and in one case the externalgenitals were attacked.March 13th.

___________________

SWITZERLAND.(FROM OUR OWN CORRESPONDENTS. )

The Lessons of War Surgery.AT the third annual meeting of the Swiss Society

of Surgery held on March 5th at the University ofZurich under the presidency of Professor Th.Kocher (Bern), Professor Sauerbruch, of Zurich,spoke on various practical questions of war surgery,basing his experience on a stay of nine months atthe German front and two and half months at abase hospital. He said that the stupendous size ofthe present warlike operations had necessitated areorganisation of the whole ambulance servicewhich had taken months to accomplish. As thefirst ambulances are just behind the line of fireand the rear ambulances situated in villages only5-8 miles further back, the ambulance corps wereoften in grave danger in both places from acci-dental shell fire. It proved of vital importance forthe direction of these services to be in well-trainedhands with an organising chief. Surgeons already onthe staff of a clinic in times of peace proved mostcompetent. Prompt supply of food and drink andan ample use of morphia were the chief essentialsin the first aid to the wounded, coupled with rapidremoval to the rear of the slightly wounded men.Those who expected benignant wounds to occur inthis war Professor Sauerbruck found thoroughly inerror. Even rifle fire at the short distances of50-250 yards proved most destructive to bones andsoft tissues owing to the form and velocity of the

projectiles. Such wounds at first caused theerroneous idea that dum-dum bullets had beenused. Shell-fire was most destructive and damagedtissue to such an extent that necrosis ensued.Toxins and bacterial infection found ample scopeand rapidly carried off many. In other cases so-

called gas phlegmon occurred. This could be avoidedby extensive excision of the damaged part, the knifecutting through healthy tissue and the wound leftopen. Thus the necessity for amputation decreased,as also the prevalence of tetanus and of phegmonousprocesses. Antitoxin treatment had proved uselessagainst tetanus, and only the sulphate of magnesiumtreatment afforded a chance of recovery. For woundsof arms and legs proper fixation was of primaryimportance in all cases, even in those apparentlyinvolving only the soft parts. The question of

transport should be determined by an experiencedsurgeon. Abdominal wounds, compound fractures,wounds of the thorax, and all fever cases should betransported as little as possible. The wounds ofthe thorax were generally severe, and the immediatemortality amounted to 40 per cent. A fifth of theremainder still succumbed to later complications atbase hospitals. Abdominal wounds treated conser.vatively did very badly with a mortality of 95 percent. Immediate active interference was desirable.Professor Sauerbruch had operated on 227 cases,among which all except 16 showed haemorrhage ora lesion of the intestine. 44 per cent. of the casesrecovered, and some were even fit for service again.Professor Sauerbruch concluded with the verdictthat the surgery of war could not be improvised, butmust be built up on the experience obtained inhospital practice in times of peace.The Reimplantation of Ovarian and Testicular

Tisstte in Cases of Castration.In the Korrespondenzblatt fur Schweizer Aerzte

of Feb. 12th Dr. S. Stocker, jun., of Lucerne, refersto the manifold detrimental and distressing nervoussymptoms occurring as the result of castration inyoung individuals, some being so severe that suicideis attempted. The administration of organic extracts,first advocated by Dr.Brown-Sequard some 20 yearsago, is expensive and often ineffective. Trans-

plantations have been successfully performed bymany operators (Moris, Glas, Cramer, Dudley, andothers). Some technical details are of importance.Dr. Stocker transplants discs not thicker than1/10 in. to ensure rapid vascularisation. Healthyparts of the tissue alone are used, thus excludingcases of malignant growths. In tuberculosis heventures to transplant parts of tissue that appearhealthy. In all cases interstitial tissue must beincluded, as this contains the vital substances inquestion. After the operation he employs 0’3 c.c.of a 1 per 1000 adrenalin solution to controloozing. Dr. Stocker refers at length to three cases,aged 28, 24, and 30 years respectively, all success-

fully operated two to four years previously. In onecase in which laparotomy was necessary a year ormore later he observed that the disc transplantedhad not shrunk and was well vascularised. Dr.Stocker’s successful work should stimulate othersto try his methods.

Death of Professor Girard.The death occurred at Geneva on March 4th

of Professor Charles Girard, the eminent Swisssurgeon. His condition had given cause for alarmfor a week previously, and an eleventh-houroperation proved unavailing. Professor Girard wasone of the organisers of the first meeting, after the