663THE PAY OF THE PUBLIC ANALYST.

private workers and scientific missionaries from our univer-sities and schools of tropical medicine in a manner that bearsnew fruit every day. The movement is the direct adjuvantto our rule as an Empire; for only by subjection of the

inimical forces of disease can we as a nation come into

full enjoyment of much territory that bears our name onthe atlas, or discharge our duty as a superior race

to those whom we have invited to depend upon us.

Medical men have sacrificed their lives for this cause ; the

way for the public to make such sacrifices unnecessary is tofacilitate the great object which medical men and sanitarianshave in view, and support the multifarious movements

now taking place to wipe out disease in our tropical Ipossessions. -

THE PAY OF THE PUBLIC ANALYST.

THE remuneration of the public analyst has seldom beenupon a scale consistent with the training, skill, and experi-ence which are required of him, but now that the practiceof adulteration is becoming such a refinement, requiring avery elaborate series of operations for its detection, the scaleof fees in many instances is wholly inadequate. There canbe little doubt that modern methods of adulteration are often

the product of a subtle scientific mind which discreditablyturns its attention to the possibilities of eluding the controlover the purity and quality of food, drugs, and drink

provided by the Sale of Food and Drugs Acts. No analystnowadays, if he is an honest man, dare certify that a sample,say, of butter is genuine without determining not only theamount of butter fat present, but the nature of the fat also,a process which involves considerable skill and attention.

Then he will estimate the amount of water, curd, salt,and will search for preservatives, of which there are so many,and when found he will be bound to estimate the quantity inorder to be able to say whether that is permissible. He is

expected to do all this for, say, 10s. 6d. It may be urgedthat some compensation is arrived at because other sampleswhich come before him may include substances which givevery little trouble so far as their analysis is concerned.

Accepting that for a moment, we noubt then whether the

average fee for analysis is a fair remuneration for the highqualifications now required for the post. The days when10s. 6d. was an ample reward for casting a specimen of

suspect coffee upon the surface of water and notingwhether some of the particles rapidly sank, colouring thewater on their downward way, which meant the presenceof chicory, are gone. The public analyst’s work now is

work of the highest scientific order; it must be done

by a competent and conscientious man, otherwise the

administration of the food laws must soon fall into dis-

repute. Slovenly practice must be impossible if discreditof the public analytical service is to be prevented.And there should be no temptation in the shapeof totally inadequate pay to shirk the carrying out

of a duty in a thorough and effective manner. The

machinery which guards the purity and quality of our

food-supply must be efficient, and it is impossible to

purchase efficiency at rates which are so low as to give norecompense for training, skill, and responsibility. Onlyrecently advertisements have come to our notice which invitequalified analysts to apply for a post which involves theanalysis of 800 samples of foods and drugs per annum, and Ithe remuneration offered is an annual sum of 150. In

another instance the analyst is required to provide and main-tain a laboratory himself, together with apparatus, chemicals,and assistance as are necessary to enable him adeqzcately andcom’Pletely to execute the duties of the office." (The italicsare ours.) The work means examining and reporting upon2000 samples, formal and informal, per year and the remunera-tion offered is 500. The " informal " samples might mean

the performance of some very elaborate analyses indeed,which at 10s. per analysis could not possibly meet the

expenses of the apparatus, chemicals, and assistance " laiddown in the advertisement. The living wage is left entirelyout of the proposition, and such a policy must sooner or

later bring discredit upon a very important department ofpublic service.

-

SUCCESSFUL ARTERIOTOMY FOR EMBOLISM OFTHE FEMORAL ARTERY IN A CASE OF

MITRAL STENOSIS.

I THE recent operation of arteriotomy for embolism has notgiven the results which the remarkable experimentalresearches of Carrel led us to anticipate. Probably this isdue to the fact that most of the operations have been done onaged subjects with diseased arteries containing long adherentclots. At a recent meeting of the Societe de ChirurgieM. F. Lejars, commenting on the failure of the operation inone case, suggested that better results might be obtained inyoung subjects whose arteries were sound. At a meeting ofthe Académie de Médecine on Dec. 19th last M. Mosny andM. Dumont reported the following case in which this provedtrue, and fatal gangrene of the lower limb was prevented. A

man, aged 38 years, was admitted into the Saint-Antoine

Hospital suffering from cardiac dyspnoea. The heart was

dilated and extended two fingers’ breadth to the right of thesternum, the apex beat was in the anterior axillary line, theleft auricle was manifestly dilated, and there was a pre-systolic thrill, but auscultation did not reveal any particularvalvular lesion. The heart’s action was very rapid andirregular. The liver was only slightly enlarged, and therewas no dropsy or albuminuria. The patient gave a

history of dyspnoea on exertion since childhood. Under

rest and digitalis he improved, and a typical double

mitral murmur could then be heard. The heart diminished

in size and the arterial tension rose, but the pulsewas still irregular. One morning, at 6 o’clock, when

he was getting up for the tenth time since his admission, hefelt a severe pain in the left calf, which he compared to anintense cramp. This rendered the whole limb powerless.When seen three hours later there were manifest signs offemoral embolism. The foot and leg, but not the thigh, werecyanosed, livid, and " marbled " in places, particularly on thegreat toe, by whitish completely ischaamic patches. The limbwas cold as high as a well-marked limit four fingers’ breadthabove the patella. Sensibility was abolished up to the kneeand movements of the foot and leg were impossible. No

arterial pulsation could be felt in the limb except in thefemoral artery in the upper part of Scarpa’s triangle,Examination of the artery did not reveal any pain.Embolism in the upper third of the femoral artery, probablyat its bifurcation, was diagnosed, and immediate operationwas decided upon. Six hours after the onset of symptoms.under local novocaine anaesthesia, M. Georges Labey laidbare the artery in its upper third and incised it where it didnot pulsate, and sensation of resistance showed the presenceof a foreign body. The vessel was opened for a distanceof one centimetre, and by compression a bifurcated clotextending from the common femoral into the superficial anddeep femoral arteries was removed. The artery was suturedand the blood current was re-established. The operation,which took only a few minutes, was well borne. The limbwas warmed by hot-air douches. Two hours after the opera-tion the limb was warm and the cyanosis was diminishing.On the following morning the limb had regained its normal

appearance, sensibility and motility had returned, and thepopliteal artery pulsated. Thirty-six hours after the opera-tion pulsation was distinct in the posterior tibial. At the

time of the report (a month after the operation) the goodresult was maintained and the limb was quite sound, but the

664 FEBRUARY AT HOME AND ABROAD.

patient was confined to bed by the condition of his heartwhich was dilated and irregular in action. M. Labey is to becongratulated on this remarkable success, but M. Mosny hasgone too far in claiming this as the first successful case. In1909 Dr. J. B. Murphy, of Chicago, in another case of

mitral stenosis successfully removed an embolus from thecommon iliac artery, restoring the circulation.1 This was

a very daring operation in which it was necessaryto catheterise the abdominal aorta and remove clot

from it. The patient did not come under treatment

until four days after an embolus was arrested at the

bifurcation of the aorta ; the limb was undergoing drygangrene, and a line of demarcation had formed four inchesbelow Poupart’s ligament. Such complete success as in thepreceding case was therefore impossible. Pulsation returned

throughout the femoral artery, and amputation was per-formed at a lower level than would otherwise have been

possible. Another and simpler method of treating arterialembolism has been used with success by French practi-tioners. It consists in breaking up the clot by massage(etrsczre) into small particles which are carried by thecirculation to smaller arteries where a collateral circulationcan be established, and they are no longer a source of danger.We reported a case of femoral embolism from mitral diseasein which this was successfully done by M. Paul Claisse.2It is curious that this eminently rational and simple pro-cedure has been overlooked, and the same treatment for

arterial as for venous obstruction-rest-is recommended inthe text-books. But this treatment could not have been

adopted in the case now reported, because for success it

must be adopted immediately after the embolism occurs.

FEBRUARY AT HOME AND ABROAD.

THE intense cold early in the month occurred when thebarometer was low, a circumstance not usual in this country.Very severe frost sometimes happens with a low barometer,but it is generally quite transient, rarely continuing for morethan 24 hours. But in the present case, although the glasswas low, the pressure distribution was favourable for windsfrom some point between north and east, and the cold was,to a large extent, brought to these islands by the flow of airfrom those quarters. No sooner did the relative positions ofthe highest and lowest barometric pressure areas allow theair to flow from the south-east and south than the tempera-ture rose rapidly to above freezing point, and as throughoutthe remainder of the month there was a continuous flow ofair from between south and south-west the thermometer

remained very high for the time of year, with the result

that, in spite of the almost Arctic cold of the early days,the mean temperature was far in excess of the averagefor February. Very soon after the month began thefrost became so severe that there are few occasions duringthe past 20 years which can furnish a parallel. The lowest

thermometrical reading of the sheltered instrument in theseislands appears to have been 40 above zero at Balmoral, buton the grass or snow the exposed thermometer sank to a

few degrees below zero in several parts of the kingdom. At

Norwich there was a reading of 30 below. Later in

the month the thermometer rose to 50° and above withuncommon frequency for February, and on several occasionsascended to above 550 in the south and south-west of

England, while the high figure of 600 was recorded at GreatYarmouth and at Birr in central Ireland. In the metropolisthe mean temperature of the month was about 4° above the

average. At Westminster and Greenwich the mean of themaximum readings was 490, and at Kew and Hampstead470, while the mean of the minima was 38° at Kew,

1 See THE LANCET, July 17th, 1909, p. 165.2 THE LANCET, Sept. 24th, 1910, p. 962.

Greenwich, and Hampstead, and 400 at Westminster.

These figures prove that as usual the central partsof London were appreciably milder than the outlyingsuburbs. Both at Greenwich and Westminster the thermo-

meter rose to 500 or above on 19 afternoons, at Kew

on 15, and at Hampstead on only 12. Comparatively fewdays were quite rainless, but the aggregate amount of thefall was not very much in excess of the average. The largesttotal was 1 76 inches at Hampstead and the smallest1’ 39 inches at Kew. Over the country as a whole the rain-fall exceeded the average and the sunshine was in default.In the southern and south-western counties of England thisyear has, so far, been very dull. In the metropolis last monththere were 14 hours of bright sunshine in the City, 26 hoursat Westminster, 27 at Hampstead, 35 at Kew, and 38 atGreenwich. Along the south and south-west coasts the

figure, although much higher, was still below the normal,and on several days the sun was not seen at all. In the

southern regions of Europe the earlier days of the month weremore or less rainy, especially on the Riviera and in Spair.At Nice rain fell very frequently during the first nine daysand yielded a total of 5 inches. Subsequently, however,the Riviera enjoyed the bright and warm sunshine

generally associated with that favoured region. At

Nice the mean afternoon warmth was 550 and that

of the night 41°. This is rather warmer than thewarmest part of this country, but at Biarritz the weather wasmore spring-like still, the mean maximum temperature being61° and the mean minimum 46°. On no less than 17 daysthe thermometer in the shade rose to 600 or above, andoccasionally touched 70°, while on the 28th it recorded thesummer figure of 77°. Biarritz and its vicinity was, in fact,much warmer than and generally as bright as the Riviera andexperienced less rain. At Paris the sunshine amounted to as

many as 71 hours, nearly three times that at Westminster, andthe mean maximum temperature equalled 512°. The nightswere, however, colder than in London, the mean minimumtemperature being 37°. In Central Europe the frost of theearly part of the month was more intense and continued

longer than in these islands. Readings below zero Fahren-heit were common, while the maximum warmth of the dayswas below 20°. In Germany the lowest minimum appearsto have been 90 below zero Fahrenheit at Munich.

HYPERTRICHOSIS AND SPINA BIFIDA OCCULTA.

IN the last number of the De1dsche Zeitschriftfiir Yerven-heilkunde is an article by Dr. Erich Ebstein, of the MedicalClinic in Leipzig, on the occurrence of hypertrichosisin association with spina bifida occulta. The first of thetwo cases he describes was that of a young woman, aged16, suffering from chlorosis. On examination it was foundthat over an area of the back corresponding to the third,fourth, and fifth lumbar vertebras there was a lozenge- ordiamond-shaped patch of long fair hair, which had beenpresent since birth, and had often been cut. There was no

abnormal pigmentation of the skin. No central nervous systemsymptoms were to be found. An X ray photograph, however,showed that the spinous processes of the first and secondlumbar vertebras were definitely bifid, while that of the thirdwas displaced a little to one side. The second case con-

cerned another young woman, aged 22, suffering from acuterheumatism. On examination there was found in the middle-

line of the back, over the second dorsal vertebra, a patch ofrather long dark hair. There was no reason to suppose that

the condition had not existed from birth, though the patientwas unable to give any account of it. No symptoms referableto the central nervous system were present. In this instancethe radiographic picture was of considerable interest.The cervical spinal column, the ninth and remaining dorsal