Foreign Correspondence.

LONDON LETTER.

[FROM OUR SPECIAL CORRESPONDENT.]

Chloroform in Dental Surgery; Sir Andrew Clark Memorial; Anarcotine; New Departure in Nursing; Case of Camphor Poisoning; Devonshire Superstitions, etc.

Mr. Hewett, anesthetist to the London Hospital, the Charing Cross Hospital, and the Dental Hospital of London, in a paper read before the British Dental Association, said that chloroform was a valuable and indispensable anesthetic in general surgery, and one which he preferred to ether in most cases; but in view of the fact that dental operations differed very widely from major surgical operations, it was clear that dental surgery required the employment of anesthetics with a wide margin of safety, a quality with which he could not say chloroform was endowed; and with such an alarming death-rate from chloroform, anesthetics should be used only under very exceptionable circumstances, and that when the operation was such that vitrous oxide was inadmissible ether should be used. During inquiries made by him he found but one recorded fatality from ether during 1880 to 1894, and that could be explained by the patient's condition being such that the use of any anesthetic was extremely hazardous. Mr. Hewett summed up by saying that for short operations nitrous oxide should be selected, for longer ones ether, and chloroform should only be used in exceptional cases.

At a recent meeting of the governors of the London Hospital it was reported that the appeal for funds to perpetuate the memory of the late Sir Andrew Clark, physician in that institution, had not met with a very satisfactory response. The amount received and promised being about £3,000. It was decided under these circumstances to change the scheme of the memorial, which will take the form of a building for an erysipelas ward for women, another for isolation cures, and increased accommodation for some of the servants. The cost of these works will be about £4,500, and it is suggested that £1,500 be applied out of the general fund to make up the required amount.

A paper read by Sir W. Roberts in the Pharmacological Section of the British Medical Association was on "Anarcotine, a Neglected Alkaloid of Opium." Anarcotine, generally known as narcotine, was shown to represent the anti-malarial properties of opium. In many cases Sir W. Roberts said it was found to be more efficacious than quinine, it being an anti-periodic of great power, analogous to the latter.

Until recently, upon a would-be nurse joining a London hospital she was at once put to work in one of the wards to observe and gather her knowledge for herself. The London Hospital authorities have for some months been carrying on a new departure in the training of hospital nurses. A large building has been taken, about a couple of miles from the hospital, and fitted up for the accommodation of twenty probationers, where they have to undergo six months' preliminary training under the superintendance of an experienced sister and teachers before being placed for duty in the wards. The training is organized and carried out in every detail upon the exact model of the work awaiting the nurse at hospital. They start with a course of demonstrations of practical nursing, every instrument and apparatus used in the ward or operating theater is explained, and its working practiced by the student. Another departure is the teaching of sick-room cookery by a certificated teacher from South Kensington, including the whole range of invalid diet. Hitherto a great number of nurses have been completely ignorant of invalid cookery. Instruction in anatomy and physiology is given by a medical man. At the end of six weeks, after passing an examination, the nurses enter the wards of the hospital. The whole cost of the training, residence, and maintenance is borne by the London Hospital. Under this new scheme nurses will be drafted, after their preliminary probation, in batches of twenty to their practical work, and the idea is being watched with considerable interest by medical men and nursing experts.

There recently died from the result of an accident, in the Queen's Jubilee Hospital, an enginedriver named Joseph Bell, aged eighty-three. He was the oldest enginedriver in the country, and had been the driver of the "Rocket," Stephenson's first invention.

An interesting case of camphor poisoning occurred at the Bethlehem Hospital for the Insane. A man suffering from hypochondriasis ate about three drams of the drug; about an hour later, when seen by a medical officer, the patient had some twitching of the limbs, the pupils were small and equal, not reacting to light; there was no deviation of the eyeballs; there was marked cyanosis, ultimately followed by intense paleness; unconsciousness lasted about five minutes. The man was put to bed, and, as he gradually grew more collapsed and colder, hot flannels and hot-water bottles were applied, and five drops of brandy were hypodermically injected. Two hours and a quarter after taking the camphor he vomited, the vomit consisting of mucus, camphor, and some food; there was no blood. After this there was decided improvement. There was no retention of the urine. It was not known that camphor had been swallowed until the patient admitted the fact after his recovery.

The first general meeting of library assistants was held in the rooms of the Royal Medical and Chirurgical Society, the object of the society being to promote the social, professional, and intellectual advancement of members. It was considered that the interests of the new association would most wisely be promoted by a series of lectures and occasional meetings.

Dr. R. Ackerley, who has for some years practiced on the borders of Dartmoor in Devonshire, has related some quaint instances of superstitions still prevalent in that western county. In one case a child, suffering from typical infantile paralysis, was thought to have been "overlooked" by a nasty old woman whose husband had quarreled with the child's mother. Another patient, a female, was discharged from hospital. About a week later, after a hearty meal of pork and onions taken after a long walk, the girl was again taken ill and returned to hospital; after a day or so she was again discharged cured. The doctor afterward learned that her rapid recovery was attributed to the brother, who went to a neighboring hamlet and consulted the "white witch." This white witch made a waxen image of human shape, stuck pins into it, and then put it near a fire. The wax represented the person who had ill-wished his patient, and as the wax melted the evil influence was destroyed. A few years ago, when pulling down a cottage, in the chimney was found a heart dried up, covered with soot, and stuck full of pins. In 1879 a farmer, having had sickness among his cattle, sacrificed a sheep, and burned it on the moor above his farm as an offering to the pixies. The cattle at once recovered and did well afterward, nor were there any more cases among them.

Sir Dyce Duckworth will give the Lumleian Lectures at the Royal College of Physicians for the coming year.

LONDON, September, 1895.

Abstracts and Selections.

THE ETIOLOGY OF ARTICULAR RHEUMATISM.-Chvostek (Wien, klin. Wochenschrift, June 27, 1895,) criticises a communication by Singer (ibid., June 20, 1895), who found in the urine of seventeen cases of articular rheumatism staphylococcus albus ten times, staphylococcus aureus once, streptococci three times, staphylococcus albus with streptococci twice, and bacillus coli once. Their constant presence, the number of colonies, the fact that the number of colonies became less or vanished as the clinical symptoms improved, led him to look upon these cocci as the exciting cause of the disease, and to conclude that articular rheumatism has no single exciting cause. Chvostek found, however, that the urine gave negative results in nine out of twelve cases examined by him. In one diplococcus urea was found, in one (when urine was not drawn off by the catheter) staphylococcus albus, and in one a large coccus, probably from the urethra. The cause of these conflicting results was probably the methods employed, as Chvostek found cocci in ten out of eighteen healthy urines when it was not drawn off by the catheter. Kraus proved (ibid., June 27th,) that in various infective diseases bacteria may be present in the urine

which have no etiological relation to the disease but yet disappear with it. Thus Singer was not justified in looking upon these bacteria as the exciting cause of rheumatism. Chvostek further examined the blood, urine, and synovial fluid in twelve cases of acute rheumatism simultaneously, and in a large number of cases the synovial fluid, together with some other organfor example, the tonsil. In every case the results as regards the synovial fluid were negative, unless the joint affection was due to sepsis or gonorrhea. That many observers have obtained positive results in cases of articular rheumatism is to be explained by, (1) cases of sepsis with metastatic joint changes not having been excluded, (2) many of these examinations having been made post-mortem. The author found that in animals an immigration of bacteria into the joints took place very soon after death, and that they were often those normally present in the animal (intestinal, etc.). As regards the question whether bacteria in the blood can reach the joint during life experiments showed: (1) That the walls of blood-vessels not evidently altered anatomically are permeable to bacteria; (2) the anatomical structure of the synovia and its vessels is an obstacle, and bacteria enter the joints considerably later than the kidneys through the renal vessels; (3) the exit of bacteria depends on (a) their kind-thus staphylococcus passes most readily, then streptococcus, and bacterium coli hardly at all; this is probably due to the virulence of the micro-organism for the animal, and also to certain tissues being more liable to certain bacilli than others; (6) their virulence-thus virulent cultures of staphylococci are found in the joint sooner than attenuated ones. In this connection the action of toxines must be considered. (c) Other factors, chiefly nervous; thus cutting the nerves of vessels hastens the exit of bacteria. Conclusions: (1) The cases of articular rheumatism examined were not caused by direct bacterial invasion of the joint, but either by toxines produced directly by microorganisms or by chemico-toxic substances (for example, intestinal); (2) that these substances act in a given case on the joints depends on many factors, such as the structure and exposed position of joints; (3) probably any micro-organism may excite the disease; (4) they may enter the body anywhere, but probably most frequently by the intestines or tonsils.-British Medical Journal.

VARIOLOUS IMMUNITY OF THE FETUS FROM THE MOTHER.-At a recent meeting of the Paris Academy of Medicine M. Hervieux read the report of the following case by Dr. Annet, a military surgeon: A young woman of twenty-four was revaccinated successfully in the fifth month of her first pregnancy; her child was vaccinated at three and at six months, the latter only being successful. "So far," says Dr. Annet, "nothing is unusual, for we know that immunity transmitted from the mother rarely persists beyond five or six months." But the patient became pregnant again in 1894, four years after, and this second child was inoculated at the second, seventh, and eleventh months; all attempts failed, though the vaccine matter had been

used in several other children and always with success. M. Annet expressed the opinion that this immunity could only have been conferred by the blood of the mother. M. Hervieux, in discussing the case, said, we do not recognize this transmission of immunity as one of the possibilities. A more acceptable supposition is that the second child was refractory, not from maternal immunity, but by reason of its individual constitution. We see persons who are repeatedly vaccinated with the greatest precautions, with irreproachable vaccine matter, and always unsuccessfully. But suppose they were inoculated ten times without success; nothing enables us to state that the next time would fail also. So, for the child mentioned by Dr. Annet, a fourth vaccination might have succeeded.

M. Hervieux might have materially fortified his position, had it been necessary, by a reference to that wonderful storehouse of facts and philosophical deductions, "Original Investigations on the Natural History (Symptoms and Pathology) of Yellow Fever," 1854-1894, by Dr. Joseph Jones, of New Orleans. In his second chapter, on the "Communication of Yellow Fever Through the Mother to the Fetus in Utero," he has brought together a number of important observations, covering a period of more than a hundred years, bearing upon the transmission of the poison of smallpox through systems" themselves entirely protected from its influence, and demonstrating the existing of the poison in a potential active state, as shown by the excitation of genuine smallpox in the fetus in the womb of the mother protected by previous inoculation, vaccination, and smallpox." The conclusion is unavoidable that no degree of immunity is conferred upon the fetus through any variolous or vaccinal experience of the mother, and the lesson of Dr. Annet's case, for the sanitarian and health officer, is to repeat vaccination whenever there is exposure to the smallpox contagion, and often enough to demonstrate insusceptibility.-Journal of the American Medical Association.

LUMBAR PUNCTURE.-Stadelmann (Berl. klin. Woch., July 8, 1895,) observes that this procedure is generally easy, it may not be so in the case of restless and semi-unconscious patients. In tuberculous meningitis the fluid drawn off should be clear, with tubercle bacilli in it; in suppurative meningitis, turbid or purulent, with pyogenic micro-organisms in it, and in cerebral abscess, clear and without micro-organisms. Tubercle bacilli have not been found at times by some observers, although Lichtheim has never missed them. Clear fluid without micro-organisms may also exist in tumor cerebri, simple meningitis (Quincke), and even suppurative meningitis. The difficulty of distinguishing at times between cerebral abscess and meningitis is well known. If pus is drawn off by lumbar puncture, suppurative meningitis must be present. Sometimes the fluid has been turbid only, but this is thought by Lichtheim to be exceptional. The author then records a case of suppurative meningitis secondary to fracture of the base, where the fluid was turbid and blood-stained. Too much