1683NATIONAL SOCIETY FOR THE PREVENTION OF CRUELTY TO CHILDREN.

rigidity of the affected parts. Occasionally there may behemiplegia. The knee-jerks are frequently lost at first butlater they return and may even be exaggerated. As regardsmental symptoms, Dr. Bailey points out that a large pro-portion of patients who die never emerge from the comaimmediately succeeding the injury. The most characteristicmental state is one of semi-coma or stupor with delirium.The patient lies still, resents being disturbed, and if dis-turbed becomes restive and irritable. There is frequentlydeveloped a muttering hallucinatory delirium which may,especially in alcoholic subjects, require watching andmechanical restraint. Sudden impulses to get out of bedand to rush out of the room are very common. Memory ofevents for an hour or for a day or two prior to the accidentmay be entirely lost. Dr. Bailey cites two cases in one ofwhich the memory of events during the half-hour precedinga railway accident, and in the other of the incidents of fourdays preceding the fall from a horse, were abolished. The

duration of serious mental symptoms is variable. Some

patients emerge from the initial coma lucid in mind and

free from any trace of mental affection. Others continue ina state of semi-coma and delirium for days and weeks andin a few cases cerebral and mental disturbances persist longafter physical strength is regained. As regards prognosisthe combined statistical records of Heer, van Nes, Phelps,and the writer give 494 cases with a mortality of 57 percent. Death in the majority of instances is directly due tothe injury, thus, 62 per cent. of the deaths occurred within 24hours and 95 per cent. within five days. Those dying afterlonger periods developed either pneumonia or meningitis.As regards the ultimate prognosis with reference to mentallife 15 out of 29 patients were traced by Dr. Bailey andtheir conditions were carefully studied. The following casesare extracted as typical instances. In Case 1 the patient wasa boy aged seven years at the time of injury (April, 1901).He recovered in a few days. At present (1903) he goes toschool. ’’ He is slightly more irritable and boisterous thanformerly and often becomes uncontrollable." He has no fits.Case 4 was that of a boy aged five years at the time ofthe accident (September, 1901). He recovered but has eversince then been nervous, irritable, and subject to headaches.He has no fainting or convulsive fits. Case 6 was a girlaged 13 years at the time of the injury (December, 1901).There are no untoward symptoms in this case. Case Ewas that of a man, aged 26 years, who had fractured thEbase of the skull in August, 1901. For 12 days he was ina state of semi-coma. He made an excellent recovery. A

present he has slight ptosis and excess of one knee-jerkThere is amnesia for the events of four days preceding theinjury. He is free from headaches or fits and his characteis unchanged. Two other cases cited by Dr. Bailey showeafter recovery a greatly increased susceptibility to alcoholInsanity is rare, concludes Dr. Bailey, after fracture of thbase of the skull as compared with fracture of the vault c

the skull. The mental conditions occurring in the lattEclass of cases are proposed to be dealt with in a subsequerpaper.

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BATTERSEA BLUSTERINGS.

THE borough council of Battersea is a body in no needof advertisement but we may nevertheless call attention toits methods of pursuing the campaign against vaccinationand incidentally express our sympathy with the unfortu-nate general practitioners whose lot happens to be castin the district ruled by that corporation. Those, and

they are probably many, who remember the council’sattitude towards His Majesty the King at the time of theCoronation will be prepared to learn that it displays scantcourtesy in its dealings with such comparatively humblepersons as members of the medical profession. In connexion

with an outbreak of small-pox which, we are not surprisedto find, has occurred in Battersea, the local health committeereported recently that cases have been traced to previouscases of the disease which have been treated by the medicalpractitioners in attendance as cases of disease other thansmall-pox." From the statement of the medical officer ofhealth it appears that in one case a patient was kept underobservation, though not isolated, for four days before it wasdecided that notification was necessary, while in another,which was described as "a very difficult case to diagnose,"the true condition was not recognised for an even longer time.On the strength of these facts, at the meeting of thecouncil on May 27th, several members insisted that

the names of the medical men concerned should be

published. Some of the reasons adduced in support ofthis proposition are worth recording. One gentlemandeclared that " he had no compunction for the doctors ;they had none for the anti-vaccinators." Another "hopedthat they would take the reasonable step of publicity, so thatthey might have a reasonable hope that these offences wouldnot be repeated." A third instanced the depravity of his

own medical adviser, against whom he launched the crushingindictment : " He’s never been paid yet." Undue harshnesswas deprecated by the chairman of the health committeewho regretfully admitted that" whatever their calling theywere all in error sometimes ; he was himself sometimes as a

bricklayer," and eventually it was decided by 27 votes to 16not to publish the names. We are, however, left in somedoubt as to the part which the suggestion that publicationwould lay the council open to legal proceedings played inbringing about this happy ending. Possibly, if Batterseacouncillors had any practical experience of the difficulty ofdiagnosing small-pox they would be a little more charitable ;but however that may be we protest strongly against thedisgraceful attempt to pillory local medical men to which,under the pernicious influence of the anti-vaccination virus,so many members of the council committed themselves.

THE NATIONAL SOCIETY FOR THE PREVENTIONOF CRUELTY TO CHILDREN.

THE annual report of this society has just been published.We learn from it that the progress of the society during thepast year has been on the whole very satisfactory. Thenumber of cases inquired into during this period in England,Wales, and Ireland (a separate report is issued for Scotland)has reached the considerable total of 34,945. This fact

,

alone ought to constitute a sufficient vindication of the

. society’s existence if such were necessary. At the same

time it is encouraging to find in the speech of the

chairman, Lord Ancaster, at the annual meeting a

statement that the number of prosecutions instituted

’ by the society has diminished. On the other hand,

f we note that the convictions obtained have been

more numerous than previously. This apparent paradox isr

explained by the fact that the method always preferred byt the society’s agents where it is available-that of warningdelinquents-has proved in many cases an effectual pre-ventive against the practice of cruelty. Consequently theterm prosecution has become narrowed in its meaning

d and it now includes a larger proportion of those in-

o veterate forms of tyranny which can only result in a

n punitive sentence. It is gratifying to learn on the

i- same authority that the attitude of the judicialst bench is becoming increasingly friendly to the pro-Ld cedure of the society. Lord Alverstone has spoken in

’s high praise of its work, which, in the language of

ie another eminent judge, has been carried on with greatnt prudence and forbearance and without needless and officious

interference. We can cordially indorse these expressions ofapproval. Financially, the society, though not affluent, is in

1684 THE RELATION OF CHOLELITHIASIS TO PANCREATITIS.

a solvent condition. After meeting last year’s expenses it

could show a credit balance of ;E266. The assurance of its

president that all funds intrusted to the managing com-mittee are employed exclusively to the best advantage ofsuffering children requires no confirmation. Those who are

conversant with the history and the administration of thesociety can have no doubt upon this point.

PLAGUE IN BERLIN.

A YOUNG Austrian medical man named Milan Sachs whowas studying bacteriology in Berlin has just died as theresult of an unusual accident. While injecting a rat with aculture of the bacillus of plague he wounded his hand

and contracted plague by inoculation. A hospital attend..ant who nursed Dr. Sachs during his illness has sincebeen unwell but is now believed to show no symptomsof plague. All the persons who came into contactwith Dr. Sachs in any way after his illness declareditself are rigidly isolated in the Charite Hospital. Itwill be remembered that more than four years ago a similaraccident occurred in Vienna and unfortunately resulted inseveral deaths. An account of this occurrence will be foundin several numbers of THE LANCET, commencing with theissue of Oct. 22nd, 1898, p. 1080.

THE RELATION OF CHOLELITHIASIS TOPANCREATITIS.

THE New York Medical Journal of May 16th contains animportant paper by Dr. Joseph Wiener, jun., on the relationof cholelithiasis to pancreatitis. Anatomical facts leadto the conclusion that a close relation must exist betweenaffections of the common bile-duct and of the pancreas. A

.stone which obstructs the common bile-duct near the papilla,

of Vater must obstruct the duct of Wirsung. If the pan-creatic secretion cannot enter the intestine microbes may,make their way from the duodenum and multiply and set up ]

pancreatitis. Moreover, the obstructed secretion may be

forced backward into the parenchyma of the gland produc- ing injurious effects. Opie has collected 32 cases in whichpancreatic lesions and fat necrosis were associated with icholelithiasis. In one case a calculus had found its way intothe pancreatic duct and caused suppuration. In 26 out of the

32 cases there was fat necrosis. In 1889 Thayer reported r

the case of a man, aged 60 years, who in the last 16 months Iof life had repeated attacks of pain in the left hypo- tchondrium and epigastrium followed by jaundice. He became collapsed and died. At the necropsy the thickened h

gall-bladder was found to contain over 100 calculi. The v

common bile-duct was dilated to the size of the little finger C,

.and in the duodenum was a stone of the size of a hazel nut. 4The pancreas was large and reddish-brown and there was tlnecrosis of the surrounding fat. In 1896 Kennan reported Tthe case of a woman, aged 36 years, who was suddenly seized wwith vomiting and pain in the upper abdomen which were sffollowed by collapse. Death occurred in 48 hours. At the st

necropsy a stone of the size of a pea was found projecting fr,from the papilla and other tones were found in the gall- ta

bladder and common duct. The pancreas was enlarged, in- be

tensely congested, and surrounded by local peritonitis. Dr.

Wiener relates the following case. A woman, aged 41 years, viithe mother of three children, was suddenly seized with violent re,

pain in the upper abdomen on Jan. 28th. On Jan. 30th the th

pain had increased and become colicky. The whole abdomen ofwas tender and the right rectus muscle was somewhat rigid. ca:

Appendicitis was diagnosed. In the evening, when Dr. ofWiener first saw the patient, the face was pale and anxious ; the pulse was 120, somewhat irregular, soft, and com- is .

pressible ; and the temperature was 102.5°. The epi- thE

gastrium and right hypochondrium were tender and the right lutrectus muscle was somewhat rigid at the level of the the

umbilicus. In the right flank was moveable dulness. A two-inch incision was made along the outer border of the rightrectus muscle at the level of the umbilicus. On openingthe peritoneum some clear fluid escaped. The omentum was

studded with small opaque yellowish-white patches. The

gall-bladder was distended and there was a large stone inthe cystic duct. It was pushed back into the gall-bladderand cholecystectomy was performed. The head of the

pancreas felt hard but it was not enlarged. Recoveryfollowed. A piece of omentum which was removed for

examination proved to be the seat of fat necrosis.

TOXIC AMBLYOPIA AND OTHER LESIONS DUETO THE USE OF WOOD ALCOHOL.

,e IN the Philadelphia Medical Journal of May 9th Dr. J. W.Sherer gives an account of the dangers due to the consump-tion of methyl or wood alcohol in the case of five persons,

four of whom had taken part in the festivities of a national

holiday, the celebration of the event being marked by theLr free consumption of cheap alcohol largely consisting ofn wood spirits. The host, a man aged 32 years, provided him-d self on July 4th with a considerable quantity of cheap crudeespirits of which he himself and his guests, three in number,

partook freely on the following day. Within 24 hours hesuffered from nausea and attacks of vomiting, headache andvertigo, sweating and partial paralysis, and stiffness of thelegs which lasted for three days. About 24 hours after the

11 debauch his vision began to fail and he could only dimlyaperceive large objects outside the central part of the field of

vision. In the centre of the visual field there was totalabsence of sight (central scotoma) in both eyes. The pupilsreacted to light and accommodation and ophthalmoscopicexamination showed that the fundus in both eyes was

" redder than normal and considerably mottled. The sense

r of colour perception was entirely lost. The characteristicÞ lesions of the eye produced by the drinking of methyl orwood alcohol and of drugs containing methyl alcohol havebeen described by Professor G. E. de Schweinitz and an

account of the same was published in an annotationin THE LANCET of June 7th, 1902 (p 1615). Dr. Sherer

adds that the second man who took part in the drinkirgdebauch was less severely affected. He suffered from

nausea, dizziness, vomiting, and headache. His eyesightbecame dim and this dimness lasted for a few days andthen began to improve until in three weeks’ time visionwas quite normal. The third man drank more deeply thanhis companions, with the result that he had several attacks ofvomiting and became very prostrate ; he grew delirious andcomatose, in which condition he died within a period of48 hours. The fourth man became totally blind in two orthree days and his sight has never been restored since then.The fifth case referred to by Dr. Sherer was that of a womanwho swallowed a "small medicine-glassful " of methylatedspirits in order to obtain relief from pain attending men-struation. Her condition became worse and she sufferedfrom dizziness, vomiting, and severe headache soon after

taking the spirits. At the end of 24 hours her sightbegan to fail and on the third day she could only dimlyrecognise large objects in the margin of the field ofvision. Central vision was absolutely lost. The pupilsreacted to light and to accommodation. Dr. Sherer states

that a search through medical literature revealed 25 cases

of toxic amblyopia due to wood alcohol. In all of these

cases, as in the five cases reported by himself, the losof central or macular vision was complete in character andgenerally permanent in duration. The pathological processis a retrobulbar neuritis of the optic nerve, affecting chieflythe axial bundle of nerve fibres arising from the maculalutea. The perception of red is lost first and thenthe dimness of sight progresses until central vision is