333

and anaerobically at 37° C. Growth creamy at first,becoming greyish and dryer later on ; faint mousy smell.Milk curdled and digested. The edges of the growth onagar showed little tongue-like projections, which, in commonwith the isolated colonies on agar, showed the beautifulwavy appearance caused by strands of parallel chains ofbacilli which is described and figured in the text-books.Isolated colonies on agar plates presented a very charac-teristic appearance suggestive of tiny three- or four-fingeredstar-fish, or catherine wheels. In texture they looked likelittle bedraggled tufts of wool. In peptone water the woollyappearance was very noticeable in the masses of growthwhich, on gentle shaking, detached themselves from thesurface clumping.The serum of the patient taken on March Sth agglutinated

up to 1/80, with traces at 1/160. The bacillus refused toemulsify very evenly either in normal saline, 0-1 per cent.saline, or distilled water, but controls were set up withnormal saline and with normal human serum, and theresults were definitely positive. The tests were performedwith 0-3 c.cm. unit volumes, and incubated for two hoursat 37° C., two hours at 56° C., and confirmatory readingstaken overnight.

Animal inoculation.A rabbit and three healthy wild rats were inoculated.

The rabbit received two drops of a saline emulsion of thebacillus subcutaneously on 16,3’21. The animal died onthe 18th ; post mortem the spleen was small ; mesentericvessels much injected ; peritoneal cavity contained blood-stained fluid. The heart-blood gave a pure culture of aGram-positive bacillus corresponding in every way with theorganism inoculated. The rats were all inoculated in thesame manner on 12/3/20. Rat 292 was found dead on themorning of 13/3 ; the other two were alive on this date,but were found dead on 14/3/20.

- Pos<-M:o?’<e/Ks.&mdash;Rat 292 : spleen slightly enlarged,injected mesenteric vessels ; small amount of exudate inperitoneal cavity ; heart-blood gave the bacillus in pureculture ; spleen smear showed the bacillus together witha Gram-negative bacillus. Rat 293 : spleen much enlarged ;liver enlarged, soft and friable ; mesenteries injected ;reddish fluid in peritoneal cavity, heart-blood gave thebacillus in pure culture. Rat 294 : spleen and liver notenlarged; gelatinous red-tinged exudate in peritonealcavity ; great injection of mesenteric vessels ; heart-bloodgave the bacillus in pure culture.

Sections of the spleen and kidney of rat 293 showed the Ibacillus more numerous in the spleen. Sections of rat 294showed bacilli in the spleen, but not in the kidney.

Medical Societies.SOCIETY OF MEDICAL OFFICERS OF

HEALTH.

NAVAL, MILITARY, AND AIR FORCE HYGIENEGROUP.

_1 MEETING of this group of the Society of M.O.H.was held at 1, L’pper llontague-street, on June 30th,Lt.-Col. H. R. KENWOOD, the President, being in thechair, when Col. II. W. C’RATTAX, Deputy Director ofHygiene. War Office, read a paper on the

Co6peratioit bet/ceca the C’ir:il and llilitcrry SanitaryAuthol’it’ic8 cliti-i)g a Oreat Saito/wZ Ema[jcncy.Col. Grattan said it was clear that cooperation

would be simplified when both the military and civilsanitary authorities had a good working knowledgeof each other’s administrative machinery and organi-sation. In order to ensure the application of localknowledge it would be necessary for the civil andmilitary to be in practical communication with oneanother-not only at headquarters, but also in theoutlying areas and districts. The following list ofsubjects would require consideration : (a) Inter-notification of infectious diseases ; (b) water-supplies,including extension of water mains ; (c) drainage andconservancy arrangements ; (d) control and accom-modation of cases of infectious disease ; (e) disinfec-tion of clothing and blankets ; (f) arrangements forablution ; (g) destruction of refuse ; (h) supervisionover the preparation of the food-supplies for thearmy ; (i) the prevention of spread of infectious

disease on mobilisation ; and (j) the treatment ofsoldiers discharged from the army on medical grounds.

The secret of success in organisation lay in decen-tra.lisation, and one of the first steps would be toarrange a conference between representatives of theMinistry of Health and the War Office with a viewto coordinated action. Liaison officers would be

required in London, and in the provinces the Ministryof Health should allot medical inspectors to certainadministrative areas, with the special duty of assist-ing cooperation between military and local authori-ties. Instructions might be issued by the ArmyCouncil to commands, and circular letters from theMinistry of Health to civil sanitary authoritiespointing out the means to be adopted to ensure

cooperation. Col. Grattan referred to the circularletter issued by the L.G.B. early in the war to sanitaryauthorities in which the duties of an 1T.O.H. of adistrict containing troops were defined. Difficultiesoccurred later in bringing military and civil sanitaryauthorities into touch, as military officers were

unaware of the boundaries of the civil sanitarydistricts ; similarly --NI.O.H.’s lost time in trackingdown the military officers. The two organisationsdiffered widely, and in order to prevent confusionand overlapping it was essential for a military com-mand to realise the principles on which the civilsanitary organisation of an area was based, otherwisedelay would occur by reference to a central civilauthority having possibly little immediate localjurisdiction. It would undoubtedly be an advantageif the county authority, which controls and adminis-ters measures relating to tuberculosis, small-pox,venereal disease, maternity and child welfare, andthe pollution of rivers, would also take up the ques-tion of cooperation with the troops in matters ofpublic health.’, Lt.-Col. CALDWELL SliTH illustrated from his own

experience the value of cooperation with local authori-ties by personally enlisting the sympathy not onlyof the -AI.O.H. of the area concerned, but also thesanitary inspectors and chairmen of public healthcommittees.I Maj.-Gen. Sir W. G. }L"CPHERSOX said that billet-ing was often unsatisfactory because the police madearrangements without in the first instance consultingthe local sanitary authority. At the beginning ofthe war the L.G.B. gave every assistance to thoseentrusted with maintaining the health of the troopsby sending medical inspectors to different parts ofthe country.

I Col. Sir G. 5ms WooDHEAD said that before thewar no preparation had been made for a real sanitaryservice. This work fell largely upon the R.A.:NLC.(T.F.), with its two sanitary companies, so that whenwar broke out this essential work was carried out bya few men. The time was ripe for organising thesanitary services and the liaison between the armyand the civil services. To illustrate this need heinstanced the erection of a hutted camp, with hutsinadequately ventilated, where later an epidemic ofcerebro-.spinal fever occurred. One way of bringingabout a closer coordination was for responsible civilposts to be made available to service-trained men ontheir retirement.

Surg.-Rear-Admiral Sir P. W. BASSETT-SMiTH,speaking from the naval point of view, said that bythe development of a naval health service a realeffort was being made to bring about closer co&ouml;rdina-tion.Major J. HUTCHINSON 11-OOD considered that

medical officers had too often been overruled by thehigher authorities in local commands, particularly inregard to the selection of camp sites.

Lt.-Col. ANDERSON said the quartering com-

mittees were excellent liaison arrangements, the localM.O.H. being a member of the committee. A schemefor cooperation had actually evolved towards the endof the war.The PRESIDENT endorsed the opinion that full

advantage had not been taken of local knowledge,little opportunity was given for local initiative. It

334

was the peculiar duty of the group to ensure that theoutcome of the discussion should not be lost sight of.The question of county survey was a subject which ’,was receiving consideration by the group, and itwas now proposed to approach the War Office witha view to further the work.

SOCI&Eacute;T&Eacute; DE TH&Eacute;RAPEUTIQUE DE PARIS.

AT a recent meeting of this Society Mr. PIEDALLU madea communication on a case of Uncontrollable HiccoughCured by Aspirin. The patient was an alcoholic man,aged 67, suffering from pneumonia and delirium tremens.The hiccough had lasted for five days and five nights inspite of all the usual antispasmodics administered, such asbelladonna, camphor, bromides, &c. A gramme of aspirinwas then given as recommended by Petges at a previousmeeting of the Society, and within 24 hours the hiccoughwas cured.-Mr. R. HuERRE read a paper on the Solubilityof Sulphur and its Clinical Applications, in which he main-tained that sulpho-carbonate solutions of sulphur shouldbe prepared with precipitated sulphur, and not sublimedsulphur, containing a large proportion of insoluble sulphur.- Mr. HENRY BouRGES read a paper on the Treatment ofAcute and Chronic CTonorrhcea by Permanganate of Silver.The silver salt was used in very dilute solution, which wasprepared with hot water immediately before use, the injec-tions being given as soon as the solution became cool. Inacute urethritis daily lavage with 0’05 g. per 1000 wasemployed, and in chronic urethritis a solution of 0-10 g.was given daily or every other day. In washing out thebladder progressively increasing doses were given, com-

mencing with 0-02 g. at first, and raised the following days sto 0-03, 0-04, and 0’05 g. The silver salt gave better resultswhen employed from the first than permanganate of potash.-In a paper on Opotherapy and Mild Forms of Graves’sDisease MM. MARIE and FOURCADE reported ten cases inwomen, aged from 19 to 47, under treatment for mildattacks of Graves’s disease which were apparently due to ’,emotion and commotion connected with the war, such asair-raids and long-distance bombardments, but reallycaused by old-standing disturbance of the glands of internalsecretion. The diagnosis was connrmed by the improve-ment following treatment by ovarian or pituitary extract.-Dr. NAAME, of Tunis, read a paper on the Treatment of theVomiting of Pregnancy by Thyro-ovarian Extract. Hereferred to his previous paper read before the Society in1905, when he attributed the vomiting of pregnancy toauto-toxemia due to thyro-ovarian insufficiency. Thedisappearance of vomiting about the middle of pregnancywas due to establishment of a glandular equilibrium owingto hypertrophy of the thyroid gland. Thyro-ovarianopotherapy, by favouring the development of this hyper-trophy, caused a rapid cessation of the vomiting. A cachetcontaining thyroidin, 0’05 g., and ovarin. 0-10 g., was

given three or four times a day, half an hour to an hourbefore food. Mr. Xaam’5 stated that he had employed histreatment with success for 19 years.-Mr. AueusTE Lu--LviiiizE,of Lyons, read a paper on Boro-potassic and Boro-sodicTartrates, in which he stated that he had prepared a, boro-sodic tartrate which appeared to possess all the conditionsrequired to obtain the maximum advantages from boricacid with the minimum drawbacks. He claimed that thesubstitution of boro-sodic tartrate for potasso-sodic tartratewas justified on chemical, physiological, and clinical grounds.&mdash;Mr. G. LEVEN read a paper entitled

" General AlimentaryTherapeutics," in which he maintained that there need beno special diet for different diseases. What was harmfulto the dyspeptic was injurious to the cardiac, the renal, thetuberculous, &c. The variations in a particular diet, likethe prognosis, should be determined by the gravity of thedisease and not by its nature.

REVIEW oF PENSION AppEAM.&mdash;The -Alinister ofPensions was recently asked if he was aware of many casesof claims being disallowed by the pensions appeal tribunal,in which the decision had not been in accordance with themedical evidence or had been based on inaccurate and in-sufficient evidence or a faulty record of the medical historyor record of service of the claimant ; and whether anymachinery existed or could be created through which casesof hardship arising on any of the grounds indicated could bereopened and reviewed.&mdash;Major Tryon replied that the

pensions appeal tmibumals were independent statutory bodiesunder the control of the Lord Chancellor, and that theirdecisions were final and binding on both the man and theMinistry. It was the practice to furnish the man with aprecis of the evidence, if he so desired, thus giving him anopportunity of calling attention to any omission which heconsidered might be prejudicial to his claim. )

BRITISH MEDICAL ASSOCIATION.

ANNUAL MEETING AT NEWCASTLE-ON-TYNE.

SECTION OF PATHOLOGY ANDBACTERIOLOGY.

WEDNESDAY, JULY 20TH.At the first session, Prof. MATTHEW J. STEwART

(Leeds), the President, being in the chair, a discussiontook place on

TOMMOc/xroMcos.

Prof. J. SHAW DUNN (Glasgow) said that the termhaemochromatosis had come to be applied to a peculiarmorbid condition, characterised by an accumulationof free iron-containing pigment in certain par-enchymatous organs and in the skin, associated withinterstitial fibrosis of the liver and pancreas, and, insome cases, with glycosuria. The liver, pancreas,and retroperitoneal glands showed a peculiar rustycolour, and gave an intense Prussian-blue reaction.Most other organs, although they might not beobviously pigmented, also gave the iron reactionon testing. Histological examination revealed thepresence of brown granular pigment in proportion tothe strength of the iron reaction seen on testingmacroscopically. If cold hydrochloric acid were

employed, the granules in the liver cells gave anintense blue colour, but the pigment in the fibroustissue coloured a greenish brown. It would thereforeappear that the iron was chemically in a more freecondition when first deposited in the liver cells.In the pancreas, the islets of Langerhans were lesspigmented than the ordinary gland tissue. Apartfrom the liver and pancreas, the iron granules werenot associated with special degenerative phenomenaof the tissues. The disease was usually seen inmiddle-aged patients, and the early stages were

unassociated with symptoms. Neither pigmentationnor cirrhosis were primary symptoms ; both wereprobably due to a common cause. Chemical examina-tion of the organs showed that while there was noevidence of alteration in the total amount of ironin the blood, the excess in various organs was verygreat. The liver contained about 100 times thenormal percentage. Even if all the iron ingested inthe food were retained in the body, it would take atleast three years for the accumulation of the amountseen in haemochromatosis. In point of fact, retentionof iron was not always absolute. None had beendiscovered in the urine by different observers, but acertain amount, though less than normal, was excretedin the faeces. This meant that the period of develop-ment of haemochromatosis must be more than threeyears, and the iron accumulation was in all probabilitygoing on during the whole life of the patient. Theexcess of the iron was not due to an excessive break-down of red cells ; probably the condition was theoutcome of a congenital metabolic peculiarity.

Dr. W. H. MAXWELL TELLING (Leeds) said it wasstill an unsettled question as to whether haemo-chromatosis was a separate disease or just a stage ofdevelopment of certain forms of cirrhosis of the liver,but the main clinical and pathological features wereso distinctive that most observers regarded it as adefinite entity. It occurred between the ages of 30and 60, and was almost exclusively confined to males.The disease lasted two to three years as a rule, andthere was sometimes an alcoholic history. Diabeticphenomena were slight or moderate, and occurred,.if at all, late in the disease. The liver was con-siderably enlarged, and abdominal distension withattacks of diarrhoea, alternating with constipation,were common. The pigmentation of the skin variedfrom a leaden colour to a more definite bronzyappearance. The patients were curiously listless andapathetic in a way that was often seen in Addison’sdisease, to which the pigmentation added anotherresemblance. The disease was uninfluenced bytreatment, and there was progressive cachexia till