other until I learned the number connected with the Pusey family. I think I made out eleven, when I could only count eight of ours. It can be truthfully said that, although there are so many medical men connected with the family, all have stood well, and some have attained a high degree of eminence. "Lives of great men all remind us We can make our lives sublime, Footprints that perhaps another, T. B. GREENLEY, M. D. Notes and Queries. MEDICAL PRACTICE IN ZULULAND.-A gentleman who has recently accepted a Government medical appointment in Zululand has written to us as follows: "Medical practice in Zululand, like all Gaul, is divided into three parts, that by the district surgeons (of whom there are five), that by the Kaffir doctors, and, of course, that by the ubiquitous quack. The two former have to obtain from the Government a license to practice, for which each alike pays a guinea a year. The district surgeons get a salary of £200 per annum and extras, with permission to practice if they take out the license. The practice and extras amount to about £30 a year, as told to me by one of them, who, however, supplements his income by acting as a missionary, and some have £50 a year for conducting a dispensary, at which they must attend all natives at a uniform fee of one shilling. The shilling goes to the Government, which supplies the necessary medicines; the district surgeon, however, is expected to provide surgical instruments. The dispensary system does away with all chance of native practice, which before its institution used to yield a fair income, as the natives can not see why they should pay more than 1s. for private attendance, when they can have attendance and medicine at the surgery for that sum. The term 'extras' means a traveling allowance per mile, outside a six-mile radius, of Is. out and 6d. return, to obtain which the practitioner has to keep one or two horses and a groom, and must frequently sleep at Kaffir stores, where the charges are from 5s. to 7s. 6d. a night for his horse, 2s. 6d. for his bed, and 2s. 6d. for each meal. This item is therefore a source of loss rather than of profit. No allowance is made for evidence in courts of justice, for inquests, or for post-mortem examinations. The white population, including the military, numbered until recently about 700. I do not think that at present it exceeds 500, and the military surgeon at Eshowe takes what private practice he can obtain. No houses are provided by the Government, and the district surgeon must build a hut, sleep in a tent, or provide a dwelling place as best he can. This in the case of a bachelor and a young man (and no other should be appointed to these posts) is not of such consequence; but for an elderly man, a married man, or, above all, one with children, it becomes a serious matter, as a whole family must crowd together in one room which answers for all purposes in a manner which would not be tolerated in the East-end of London, and besides there are no educational advantages whatever. The collapse of the Nondweni gold-fields (at which place there was until recently a resident surgeon) has sent most of the people there away. This was the only place in Zululand which supported a medical man of its own. Since his departure the N'qutu district surgeon easily combines the practice there with his official duties, although the two places are thirteen miles apart. "The cost of living in Zululand, principally on account of the very high rate of freight by rail through Natal and by bullock wagon in Zululand, as well as through the mealie famine, the locusts, and rinderpest in other parts of South Africa, is extremely high, in addition to which the Government salaries are very disproportionate to necessary expenditure and much below what is usually paid by others. Tradesmen even, carpenters and blacksmiths, can get from £28 to 30 a month; horseshoes cost 10s. a set. Even young fellows under twenty are drawing salaries of from 15 to 20 a month at the mines, without any trade or profession whatever. The quacks seem to go on the even tenor of their way here as elsewhere, and do a roaring trade, not only at extracting teeth at Is. each, but at bone-setting, surgery, and the practice of medicine generally, uninterfered with by the Government. Taking one consideration with another the life of a district surgeon in Zululand is, like the policeman's, 'not a happy one.'"-Lancet. IMMATURE INFANTS IN FRANCE.-That the threatening depopulation. of France is a most serious misfortune against which our neighbors are striving in a variety of ways and with greater or less success, can not, unfortunately, be gainsaid, but even in this lamentable case the old proverb, "Tis an ill wind that blows nobody good," may be applied with perfect. accuracy. A persistently diminishing birth-rate might well be looked upon. as an evil out of which no benefit could possibly arise, and yet with respect to one fragile, but by no means unimportant section of the French community, the national unfruitfulness has proved itself to be a veritable blessing in disguise. The heretofore forlorn beings who have thus fortuitously de rived benefit from the general calamity are the newly born infants, who from various causes, but chiefly by reason of their premature appearance on the scene, are peculiarly unfitted to withstand "the thousand natural shocks that flesh is heir to." Formerly no very serious efforts were made to prolong the ephemeral existence of these unwelcome little strangers. They were rather hopelessly allowed to pine away and die, under the impression that they could not possibly survive, but human life has of late become so valuable in France that no breathing waif need now be abandoned as an irretrievable derelict. Little children have ever been esteemed the most precious of human possessions all the world over, but it was reserved for an energetic Frenchman to set the seal upon this preciousness by conserving the immature specimens in glass cases. That this is simply a statement of fact many of our readers are doubtless already aware, but should there be any questioners among them they have merely to pay a visit to No. 26 Boulevard Poissoniere, Paris, in order to obtain resolution of their doubts by ocular demonstration. At that address, under the designation "Œuvre Maternelle des Couveuses d'Enfants," they will find a truly remarkable institution, which owes its inception and development to the zeal and philanthropy of Dr. Alexandre Lion, of Nice. Ruminating one day on the perilous condition of his country from a demographic point of view, it struck this patriotic and humane member of the medical profession that the holocaust among prematurely born infants would be largely diminished if the helpless atoms could only be kept sufficiently warm. Accordingly, in 1891, he invented his couveuse, or modified incubator, which may briefly be described as a woven wire mattrass suspended in a glass case, the latter being heated by a water coil, and kept sweet and wholesome by a constant inflow of purified filtered air. The success attending on this new departure in infant life preservation has been surprising. A prematurely born child, if exempt from hereditary disease, never dies in Dr. Lion's institute, provided it weighs not less than two and a quarter pounds, that is, about one third of the normal standard, and provided, also, that its installation in the couveuse is accomplished with the least possible delay and exposure. At this stage of the untimely bud's frail existence a chill is almost certainly fatal, so that the transfer from the lying-in bed can not take place too soon or be carried out too carefully. The theory that immature infants require exceptional warmth is, of course, not a new one. Every midwife knows the importance in such cases of immediate swaddling; and children born before their time, whose survival was regarded as well-nigh hopeless, have ere now been saved by such devices as enwrapment in newly-flayed skins, the utilization as cradles of freshly eviscerated sheep and goats, etc. The inventor of the couveuse, nevertheless, amply deserves the lion's share of the credit, not merely on account of his ingenious amplification of a well-known principle, but also for his untiring advocacy and capable organization.—Ibid. BROMOFORM POISONING.-Börger (Münch. med. Woch., May 19, 1896,) first gives short notes of twelve cases of bromoform poisoning, and adds an account of two cases under his own care. The age of the patients varied from three months to five and one half years, and the dose of bromoform from 15 to 20 m. up to 6 g., but the larger doses did not correspond to the higher ages. There was one death, and in that case neither the age of the patient nor the dose was known. As regards the symptoms, sudden unconciousness, pallor of the face, and blueness of the lips occurred a few minutes after the taking of the poison. The pupils were contracted, and did not react to light. The muscles were usually flaccid, but the masseters contracted. The heart sounds were feeble, irregular, and frequent. There was a strong smell of bromoform from the mouth. From a pharmacological point of view the action of bromoform has not been thoroughly worked out. Nolden says that the first and most important toxic action is exercised upon the sensorium and respiratory centers, hence the unconsciousness and symptoms of asphyxia. The heart's action is also alarmingly affected. As regards the treatment, attention must chiefly be given to the heart and lungs. The heart is stimulated by injections of ether and camphor. As regards the respiration, the head should overhang, the mouth be kept open, the tongue drawn forward, and the mucus cleared out of the larynx. Artificial respiration and faradization of the phrenic nerves should be adopted. There is no specific antidote, but perhaps small doses of morphine or inhalations of amyl nitrite, as in chloroform poisoning, might be of service; but further experimental research is required in this matter.British Medical Journal. HEMOGLOBINURIC FEVER.-Ferrier (Lyon Medical July 5, 1896,) describes the case of a man who contracted malaria in Madagascar, and, returning to France, died of an acute attack of hemoglobinuric fever. At the necropsy the liver weighed 2,100 g., and showed acute diffuse hepatitis; the spleen-20 X 14 cm. -was enlarged and showed thickened trabeculæ, but contained less yellow pigment than is ordinarily seen in malaria. The kidneys were congested and showed hemorrhages into the uriniferous tubes; in the dilated vessels of the organ some of the blood corpuscles were normal, others had broken down. The lesions had not destroyed the vitality of the organs, and so do not account for death, which was rather the direct result of extensive destruction of red blood corpuscles. The blood destruction does not take place in the kidneys. The liver and spleen being unable to deal with the products of the destruction of the blood cells, the kidneys vicariously excrete the free blood pigment.-Ibid. SILKWORM GUT IN GYNECOLOGY.-Bröse (Zeits. f. Geburts. u. Gynük. ̧ vol. xxxiv, part 2,) removed a double pyosalpinx two years ago, and set free the uterus, which was retroflexed and fixed. The fundus was sutured to the abdominal wall by silkworm gut, which had been disinfected in a fiveper-cent solution of carbolic acid. The abdominal wound did not entirely heal by first intention, although there was no distinct evidence of infection, and the temperature never rose above 101° during recovery. A fistulous track remained. Bröse frequently curetted it, but could find no trace of the suture. He at last opened the parietes close to the cicatrix. The fistula led to a band about half an inch broad, composed of uterine muscular tissue. He excised this band, together with the tissues in the parietes around the fistulous passage. The band contained the silkworm gut. It had only been passed through the parietal peritoneum anteriorly. Olshausen insists that silkworm gut ought to be kept in an antiseptic medium.-Ibid. FRIEDREICH'S ATAXIA.-Zabludowski (Berl. klin. Woch., August 24, 1896,) showed a case of Friedreich's ataxia before the Berlin Medical Society which had been considerably improved by massage. The author refers to the great rarity of this disease as seen in Berlin. The patient was nine years old, and there was no other case in the family. She walked unsteadily, with the legs apart, and had difficulty when eating in carrying the spoon to the mouth. There were choreiform movements in the arms, and under certain conditions a lateral nystagmus. The pupils reacted to the light. The speech was slow and difficult. The knee-jerks were absent. There were no pains and no disturbance of sensation. The rectum and bladder were unaffected. There was no curvature of the spine. By means of systematic massage, combined with passive and active movements, as well as movements against resistance, the use of the limbs was considerably improved. The parts less affected by the disease were thus stimulated to greater activity. Mendel also observed the case during the treatment.-Ibid. THE SERUM TREATMENT OF SYPHILIS.-Prof. Boeck, of Christiana (Archiv für Dermatologie und Syphilis; Wiener Medizinische Blätter), resumed the serum treatment of syphilis in 1894, using the fluid removed from the tunica vaginalis in cases of hydrocele in syphilitic men. He comes to the following conclusions: (1) The symptoms of the primary period are more rapid in their involution than under the expectant treatment. (2) The secondary symptoms are somewhat delayed. (3) They are decidedly mitigated, so that the rash is hardly noticeable and the affections of the mucous membranes are strikingly slight. (4) The general condition is speedily improved. (5) The stage of secondary eruption is shortened. (6) The treatment is the more effective the earlier it is begun. (7) Serum from a person in the tertiary stage is more efficient than that from a person in the secondary stage. Although on the whole the serum treatment is not so effective as the use of mercury and iodine, it is deserving of further trial, and may be regarded as a useful auxiliary.-New York Medical Journal. THE SOUTHERN KENTUCKY MEDICAL ASSOCIATION will hold its fifth semi-annual meeting in the city of Hopkinsville, Ky., Wednesday and Thursday, April 14th and 15th. An interesting program will be arranged. Accommodations on railroad and at the hotels at reduced rates. All physicians are cordially invited to attend. (Signed) B. W. SMOCK, M. D., Secretary. |