MrEOrOR-\ND-A Tim JOURtAL ST97IMEDICAL JOURNAL -9

4gemnorantta:MEDICAL, SURGICAL. OBSTETRICAL.

ACUTE ANTERIOR POLIOMYELITIS ANDLANDRY'S PARALYSIS.

I HAXVE hiad in miy practice this summnier three cases of acUteanterior polionmyelitis and one of Laudry's paralysis. TwYoof the cases of acute antelior poliomyelitis occutrred inchildren under 12 months of age, and were characterizedby very extensive paralysis in the limbs, with weakness ofthe back anid neck. In eaclh case marked improvementresulted, btut more or less permanent paralysis of one leg hasremiained, tlhe other limbs completely reccvering. The thirdlcase was a girl of 18 years, commencinig with a sore throatand hiigh tem-perature, followed a week later by paralysisof one leg and sonme weakness of the back. The legremains alntost completely paralysed. The case ofLanidry's paralysis occurred in a man of 50, and wasfatal in three weeks.The pathologyand symlptoimiatology of Lalidry's paralysis

presents many points of sim-ilarity to those of acuite an-terior poliomyelitis, and possibly they are closely related.All the cases occurred duting1 the liot mlonthls of Juily,Auglust, aiid September.Halifax, F. (C. HAcmK, M.B., Cli.B.

RECURRENT ATTACKS OF BLACKWVATER FEVER.O-N April 12th, 1911, I was called in to see a carpeniter,A. C., aged 34, wlio was suffering fromal an attack of black-water fever- tlhe s cond since his retutrni to Enghaiid inNovemr.ber, 1910. H1e htad been ill tw-venty-fouir bours, beforeI saw himi., aiid( colmimeiiced w%ith a rigor followed by sweat-il(g. Vomiting, appeared 'ooni aft-r. His temperature oii

'y arri-ival was 101, the abdoimicii wvas tenider, anld tIme liveratnd spleeni (listinetly palpable. V'omitinig of bile-stainiedmiiaterial w-as inicessaut; the urinie w\vas por ter-coloured.I u1sed j. graimi miorphliiie s-uppositories., an(l ordered oilepilit saline by recttum every two hours. amid a iiixturle ofbismouth, soda, anid hmydrocyanic acid b)y the mionthevery fouri lhonus. Thi;s treatment,seemed to relieve thevomitiug somewhat, aiid the patieint (lozed for anl hiour or

t\-o (luing the nigllt.The iiext (lay vomiting was-\v a--; bad as ever, aiid( the

mntient becamle jauiii(liced. Caloimlel was given and salineinfusion uinder the breast as well as bv the rectumiii. The11ritne loolked like puLre blood.

This followingr (lay iiutrienlt eniemiiata were tric(l. bIut w-\erereturned each timiie, so that the salimie imijectioiis onily Xw-ereconitinued. Anl occasioiial dose of medicine was retaine(l,but vomaiting was still extremely distressing, niiilk ands-oda water beilng rejected, alid the l)atieiit comuplained oftlirst. The temlperatre was 101.5°, and the uirine deeplycoloured. The patient was wasting rapidly; lie was verydirowsy, btut would answer questions. He looked so ill thatseveral times I tliougiht he was dead. Tlle vomiting con-tinuied u-ntil the seventh day; the urine became clear ontIme fifth day, and after this time patient lihad Benger's food,amid occasionally retained a little. After the vomitingceased iiilproveimienit was rapid, food was takeln, and timeinman was able to sit up. On April 26thi the jaumdice had(lisal)pearled; lie looked anaemnic, and complained of paimiafter fool. Lactopeptiue (10 grains) before eaclh meal wasor-dereed, ami(l no fturthier trouble was complained of. I sawhimi in the mi)iddle of Juine riding a bicycle alid looking quiite-well. TIme histo-y I obtainied was as follows: The mianhlad befeii abhoad nile years; first oim time West Coast ofAfrica, then Paiiaima, anid latterly at Portobello. Wlhilst atthes;e various, stations lie lbad 'dorciis of attacks of

niialaria amid two of blackwvater fever; time last of wllicllcause(l him to bc invalided lhomime. Omi time w-ay lie was S;oseriously ill that hue was sent ilito hospital at Barbadoos fora fortimighlt, and tlhen coimtinued hMi3 jourilev to West;Iairtlepool. Tlhree weeks aft r lie lanlded, lie lia1 aiiattack of blackwvater fever ag,aimi, w-lhichi laid lhilml im) for a-Cek. Siiiee tlheni he lia(l been fairly w%ell u-lp to tlme timl-e

of tlhis last seizurxo, which lie said wXas; tme -nost severe hue

iad(i ecer had. I regret that io b)loo1( exauminatiomi w-asnmadle. 'Tllc temperature was- po<sihmhy huighm tjie first day,

btut I n1ever foulnd it more tlhaii 101.50. No qllininiie wa%given.DoncxTr, E. J. CHAMBERS, M.R.C.S., L.R.C.P,

TEMIPERATURE IN CROUPOUIS PN.EUMONIA.IN the BaITISH MEDICAL JOURNAL Of July 1st, 1911, Dr.Downing describes a case of acute croupous pneuonia,ocelurinig inl a night worker, during tlle coirse of wliclthe temperatuLre assumed an inverse type. On May 5tl,1911, I had ulnder my care a chowkidar (niglht watehman)suiffering from a similar attack. For somu-e days previolusto adlmhission to hospital lie apparently had beeln figlhtingrthe attack. All the classical symptom,.s and pllysical sign'scharacteristic of pneumionia were present save the tempera-ture, which was uipset in a manner very similar to that i.Dr. Downing's case.The acttual tlhermIom-lieter filndins were as follows:

Date. I

MIay 5th .. ... ...

May 6thi ... , O..

May 7th ... .. ...

May 8lth... .. ..

Ma-y 9th ... ,,, .

Morning.

98.2'

10001010

101.20

98.2'

Exculing.(

102'

98'

98.3'

97.9)

97.9'

This table illustrates the nunsual irregularity of tlefever tlhrouiglhout the disease anid tlhe mar'ked inversecharacter of the temiperature. The crisis occIurred duringthe hours of the imiorning and early afternoonl, ratlher tlian,as is muore usual, (luring the night.

Tlhiat anl inverse" occuipatiollnl-amiiely, nii(glht w oik and

(lay sleep-should pr-odtuce aln iniverse type of temperatur,eini (lisease is a feasible solution of the above temperaturiep)heliomieiion, sinice it is well kniiowni that in. such LCopIle(luringit, healtlh the tempelature also tenids to become

So also, since tlhe crisis in pnetumoniia seemsl usually to

occtIr at a time wlhen the symptomis are niiost try ilig aiidtlle temnperature is highest, it miglit, in nig¢ht workers, beexpected to occItr duLring the morning hours wlhen the feverlhas reaclhed its maximuma, rather than during tlle eveniinglhouLrs when it is at a miiiniimum. I cannot uni(lerstanld how-igilt worlk couild explain the unuisual irregularity present

in both tllis and Di. Downing,'s case.A chowlkidar's occupation involves no great physical

straiin. It miierely consists in staving awake at niglit towatch tlec sahib's bungalow and sleeping throughout the

day, ail occupation quite sufficient, I think, to inverselyupset the temperature chart during not only lhealth, butalso disease.

Cliallngli Gali, India.

R. W. G. HIXN(S;TON, M.B.,Indiai Aledical Serv ice.

COMPI'LETE INVERSION OF THE UTERUS.O_ JIunIe 3rd, 1911, I was called to Mrs. L., whlio hlad jtus;tbeen delivered of a perfectly normal lhcaltlhy miiale child.A muidwife in attendance, finding herself in difficulties, lia'summlll1oiie(l iiiy colleague Dr. Morrow to lher aidl. Uponm1y arrival I was informed by Dr. Morrow%v that the uterus-w-as colmipletely inverted, and tllat lie lhad j tst suieceede(d

iii stripping aii adherent placenta frolmi it. 'The paticimjwas sutiffering frolm- profound shock, and had lost niuchlblood.

I lmu-riedily sterilized miy liandls and set to workoredluce the uterus, whiclh was a taskh of somllCe miagnitude.

Tllc os coulld be clistinctly felt thlirougl the abdo-ninmal Nalm I

just belowv the uimilbilicus, and was firjmlv contracted. Lilrst triKd ieduction bv the orthodox method, beg-inniw;with oiie of the cornuia, buit, after a fair trial. w\-as unabl,to stuceec(l. Redutction was, however, effected with sonmo3(liffiheulty b)y the following method: Witli m:ly left hian(d otIme alldoumieii I sueceeded'ini dlilatina tle os sufficientlyenable ne witlh myv riglt lialid to tuck in a smnall portionof the utterus imimiediately adjacent to t:ie ccr-ix; hmavill(loile thlis-. tlhu rest of the uiterus easily follo-\e(d. tlv'-gave a lhot douclec of sterile w ate', elevated tlhc foot uo Lb 3

Nov. 4, T9T j

II98 MEDil.. BRTAI HOSPITAL REPORTS. [Nov. 4, ir.ULDICAJ_R-A I

-[ O - r

bed, anid a dessertspoonftl of brandy was administered bythe mnoutlh; two pinits of normal saline was injectetl intothe rectumln. The patient gave some anxiety for a fewvdays, but subsequently made a good recovery.My only apology for the publication of this case is its

rarity, and that the ortlhodox method of redutiction is notalways the easiest nor the best. My thankls are dtue toDr. Morrow for hiis kiind assistance.Cape Coloniy. A. L. GURNEY, MI.B., Chi.B.Edin.

INTESTINAL STASIS.AT tlle presenllt tilmle, wllen the evils of Wh1at Witas forniierlvcalled chlrolnic constipationi are so fuilly realized, o1e maybe pardone(d for calling attention to a treati-ment whliic, inmy experience, has been very largely suiecessfull. Allied tomassage, I should rather describe it as effective p repml-sih e kineading of the bowel. The benefit received may 1)elargely duie to the displacement of aceumuilated' flatus,thuis allowing a period of rest to tlle overtaxed muiscularcoat. The treatmelnt should be carried otut every mioruingtefore the patient rises or takes food. In the abseiice ofall suispicioni of former or latent appendix trouble, thekneadinig may bc gently commenced over tlhe caeelill.Both lhands mllust be used, onie followinig the otlher, lhalfclosed, deeply and slowly,' as though to prevent a backflow, and cointinluing without olnce remooving botlh lhanids,or relaxing the pressure over the whole coturse of theascendina tranisverse alnd descending colon, a propulsivemovement in this direction being maintained. It is nieces-sary to see that wlhoever undertakes to carry out tImetreatmenit tlhorouglhly understand(ls what is required. aiA(i isable to do it; and, furtlher, to exact a lproiuise that thlemiiorniing lkneadinig shall be continueed without initermniissionfol one imontlh, even thoulgh the bowels begini to act regut-larly before this period lhas expir-ed. The kneadingshlouLld occupy about ten minutes, and( tlle cour-se of thlecolon slhould be traversed fotir or five times.

TIme remnarkable manner in whlicll the bowel inmay recoverits tonie, even in long-stancling cases, is notewvortliv. AMiss B., agedl 30, lhad obstinate constipationi for ninlCe years,the bowels actinig very 9Iighitly every five- or sixI daysuiiiless relievedl by an enema. Miss B.'s sister w-as tatlc>itto knead tlle bow%Tel. Tlhree weeks later the bowels beganto act naturally. Two years later, whell I saw time patienit,there lhad been nio relapse.

Personally, I amii convinced tllat tlle paresis is largelyclependemit upokm miiore or less constant overstretellingr ofthe Ilum-en of the bowel by gas, and that this is favouredb)y excess of fruiit or green vegetables in the diet. Doubt-les.s atonic dyspepsia may often be a starting point of thecondlition, and an acid mixture containing" stryclhnineewould be' useful. The patient slhould solicit an action ofthe bowels daily after breakfast, and may be assured ofrecovery witlh patience ard perseverance. No putrgativeshould be allowedcluring the treatment.Thaba 'Nchui, South Africa. FR1ANiK ELAY.

ONMEDICAL AND SURGICAL PRACTICE IN TiHE

HOSPITALS AND ASYLUMS OF THEBRITISH EMPIRE.

IiIMBERLEY HOSPITAL.FOREIGN BODY IN THE APPENDIX: G-ALL STONES:

APPENDICECTOMY FOLLOWED) IBYCHOLECYSTECTO03Y.

(By E. OLIVn ASHE, M.D.Lond., F.I.C.S.EiE(g.,Surgeon to the Hospital.)

THE followinu case shows how tile presenice of twi-o dis-tinct abdomiiinal diseases may make exact dkicriosis amatter of great difficulty.The patient, a healthy-looking, muscular m-iani of 33. was

first seen on May 23rd, 1910. He was confined to bed, ailicomplained of a severe pain in tile rigllt iliac region, whichliad come on suddenly early in the morninc,, anid of a

dull paini in the riglht hlypochonidriumii wlhich he had lhadfor soimie days. He felt sick, but had not vomited; thobowels hlad acted that morning after the pain began, andhad been acting regularly and well for some time. Thotemperature was 99.5', the tonigue was slightly coated, andthe pulse and respiration were a little quickened. Therewas. no jaundice or discoloration of the urine.For about two years lie had had mnalny similar attacks,

at first sliglt and infrequenit, btut latterly they had becomeimoI-e severe and imiore frequent, the present one beinig themnost severe of all. In nearly all the attacks the doublepaini lhad beei present, sometimes beginniDg in the iliaeregion anld radiating up to the hypochondrium, and some-timues jtust the reverse. Very rarely the pain confineditself to the one region only. FrequLently it came on sud-denily, but at timiies began gradtually, anid usually it seemedjust as acute ini one situation as the other. In a few of theattaclks lie lhad vomnited, but lhe had never been jaundiced,lhad a rigor, or been badly constipated.

TIme abdonmen was sliglhtly disteiided, aiid was teiderall up tlle r'iglht side. im1ore so below tlhan above. Deeppr)essure over -tlc gall bladder was painful, but lnot severelyso. There was rigidity of tlie muscles over the appendixregion, aind a suispicisin of lhardeninig beneatlh them, butonly very ligult presstre cotuld be borne here.The diagnosis seemiied to lie between liepatic colic alnd

appendicitis, tlhouiglh both togetlber -were possible, buit themnus;cular riuidity over the appendix alnd the specialteniderness ii. that reg,ioni decideid miie in favour ofalplenidicitis.The patieiit was talken to hospital, anid his appenidix waas

removed oni 'Max 24tl, 1910, the lBattle incisioii beinlg uised.The appendix w\-as founiid to be acuLtely bent at its miid(dleto ali angle of abouit 20 degrees, the belldlbeing sturroui(ledby firmii a(dlhesionis. TIme tip was swollen anld congaested,aiid coltainie(l a grape stonie. The gall bladder wasexamiined froiim the samiie woundl, anid proved to be verytense ai(l thlick, but owinou to this tensenless o dlefilnite gallstenles couIl(d be immade ouit. The wi-ouniid was close(1 witlhoIItdraimnigye, and(I the patienit ]tiade a (qulick an( uinevenitfulrecoverY~.For abotut teni niontlhs lie enjoyed perfect lhealtlh witlhout

any return of pain, but omi March 18tb, 1911, lie was:su(ldeinly seized wvith acute riglht lhypochlonidriac paiin, and(this w-as accomiipanied by vom-liting. There was greattenderness over tle gall bladder, but neither pain norteinderiiess; in tIme appeildix regioni.

Palliative measures, inclu1ding morphine subcutaneously,were used, anid the)painm quite disappeared ; but oli theeveniing of March 20tlh it returnled with increased severity.The gall-bladder region was- tlherefore explored on March21st. Tlle gall bladder, as before, was founiid to be tenlse amidtlicki, anld w\as, evideiitly fuill of stonies, so cholecystectoimjywasx done witlhotut opening it. This wound was also closcd-without drlainlage, anid the patienit milade aii even betterr'ecover'y tlhani before.The gall bladder was ini. tllick, anid containied 85 stonles,

seinC of the largest the size of a bean, niot faceted butrounded an(d nodular.

DuLrilng this convalesceniec ai iiiterestinig incidelnt oc-culrre(l. Oni April 11th lie lha(l a suddeni very severeattack of pain, exactly like the old gall-stone pain. Th-eopain was so severe tllat a ml-orplhine lhypodermic hlad to begiven. After this he fell asleep, and -when he awoke thlepain lhad gone, and lhas iiever returiied. Tlhis seemed Elikea typical attack of lhepatic colic, so miuchl so that Iwondered wlhetlher I lhad overlooked a stone in one of theducts; btut as iio stone could be found in the stools, anidthe paini di(d miot returni, I concluded that it m-ilust lhavebeeni cauised by the detaclhmenit and passage down tlecomimliion duict of a blood clot wlichll lhad formed at thoetiniie of the chiolecystectoni-.THE Clelsea Climical Society begamn its flfteenlth sessioi

on October 17tlh, whleln its retirinlg lpresident, Dr. T. WV.Parkins-on, h)resente(l the society with a presidentialbadge, aiicl the niew president, Dr. J. A. Mdansell-Moullin,delivered aim openinug a(ldress, (lealing with hysterectomnyalndI its inifluieiiee oni gyimaecological surgery. In futire thlecs;ociety w^ill holdl its; mleetinlgs, nlot inl Chelsea its;elf, bult iithe clubl-roomls o-t St. George's; Hospital Medlical Schlool,w\hich hav-e b)ecim kindlyr placedl at jLs disposal. Thezpresemit honloraryr secretaries of thle ssociety are Drs. J. F'.Halls Daily and( Kennleth Eicktemsteiu.

M

2

E-DICAL JOUIIN 'L]

geiuilli'e ]'cdiLdcl Pir-ctition3ers a.re not allowed to advertise,an(d that those wlho do advertise are not on the Register,nor doctois in the eyes of the ]aw; also that iio remedyor cuirative svstei oThlicIvr flauntedl as a coiae-all canipossibly have anyth itng to do with levitii1miu`o inediciiie ?Prcsiiia.bly tlhe s.ock exchanges (lo not in-cir any legalliability for so clvertisirng, so that I (lo iiot see alnyreason why tbe British Medical Associatiomn slhouIld notdo the same, pa,ticnlarly as it ia tnow undlertaken tow%arn m-ien against ' swve.,ate.d " a)ppointwlents. An adver-tisement of the book See ref AZ.'.edicsmSiniglht appropriately;accompany the iiot:es.-1 .am, eto.,

"G. P.'

ALFRED PETER1 HILLIER, B.A.CAPE U.xrv., M.D.ED.,BI.P. FOlt THE HITCFTTN I)IVISION OF. IIERTS.

BY the deatlh of Dr. Hillier tlc niedical profession has, losta menmber wlho had played a considerable part in publiclife. IHe was a main of largoe knowledge in various fieldsand of wide experience not only in his profession but ingenieral affairs; this.; gave li-n a position in Parliamelntwhich it will not be easy to fill.

Alfred Peter Hillier was tlho son of Mr. P. PlavneHillier, of Shlortwoodl, Glouicesterslhire, anid was born in1858. He was eduicated at King Williamn's College, anid-wenit out to Souitlh Africa at ani early age to learn ostriclhfarming. Studious and amnbitious, Ile gradcuated B.A. atthe Cape University in 1877. In 1878 and 1879 lhe servedas a trooper with the Colonial forces (turingr the Gaika-Galeka wiar and obtained thle lmledal and clasp. I-ethen -stuiidied miiedicinie in thie University of Ediniburgh,-where lie graduiated as M.B., C.?-J1. in 1882, becomll-lug M .1). in 1884. After holding the posts of House-Sturcreon to thle ]Royal Maternity Hlospital, Edinburglh. andthec Weston-super-_Mare Hospital, h1e retuirned to SoultlAfrica, and becamlle Resident SuLrgeonl at East Lonidon, andlafterwards Resident Sturgeoni ancd Honorary Visiting Sulr-geon to the Kimilberley Hospital, and was associated inpractice with Dr. (now Sir Leander Starr) Jameson. In 1893lie was President of the Soutlh African Medical Congress,anid in the sanie year settled in Johanniesburg', anid turnedhis attention to Transvaal politics. He was a promni-:iient member of the Reforin Commlittee, anid wasam11101e those politicians who were coimmitted byPresidlent Kruger to Pretoria Gaol, from whlich he wasreleased in 1896 oni payment of a fine of £2,000. In theprevious year he hiad beenl Vice-President of the TransvaalMedical Society, anld among other appointments lie lheldin Soutlh Africa was Surgeon to the Frere anid KaffrarianRifles. His experiences in South Africa were set out in,several -works. including Thle Antiquity of Man in SouthAfrica and Evoluttion, Raid and iteforut (1897), and South4friicani, Stuidies (1900). He also before returning toEngland publislhe(d a volumiie of short stor-ics entitled,It ttc Vceldt. In 1897 hie settled in London, alnd whNlileretainiing hiis interest in South Africau affairs, as iscvidelnced by the fact that he contributed a nlulmber ofarticles on tlhe suibject to tlle Encyclopaedia Britalnnica,lie gave particular attention to the study of tuber-culosis. He was for some time Secretary of theNatioilal Ass3ciation for the Preventioni of Con-sntiuiptioin, and was one of the delegates appointed-by tlle thienl Prince of Wales to the Berlin Tuber-culosisConigress of 1899, anid was afterwvards Consulting Phlysicianto the London Open-air Sanatoriumr. He was HonorarySecretary of the R.eceptioni Committee of the BritishConlgress oni Tuberculosis in 1901, in which capacity lie,lid mnuch to miiake the congress a suiccess. It was largely4due to Dr. Hillier's eniergy tllat the friendly societiesbecame interestbed in the prevention of conlsumption. Hetook several of tlle societies' officials to Gernmany to see-anatoriurms, anid as a result tllc Benendlen Sanatoriuim-was founded. In 1900 Dr. Hillier published a useful bookon T1u1berculosis, its Natutre, Prcvveition, andz Treatu)ient,'w4ith7 Special Rcferenece to Open-Air Trea;tment of Phthisis,and in 1903 anothler book on the Prevention of Consum?p-tion. His last work was a study of the fiscal quetstion-crtitled, The Comno)ntwea1, or the F'dceral Systrem of

Political Ecovoimi?/. In 1900 lhe contested Stockport in theConservative interest, and in 1906 :he stood for SoutlhBedfordslhire, but oni botlh occasions was, unsuccessful. Heretired from practice at about this time, and settled inHcrtfordshire. He was selected as the Conservativecandidate for the Hitchin Division. He was effective asa public spealier, anld hiis genial manner helped to win him.wide popularity. At the election of 1910hc von a remark-able victory, beinig returned by a large majority, andretained hiis seat at the ensuinig General Electioni. He v;-: salwa.ys listened to in the IHlouse of Communons, w%lherespioke fairly frequently; and (luring thle debates onii fl.National Insurance Bill, of -whichl he lhad made a carefulstudy, mainly w^itlh the view of securing favourable termsfor the profession, lie w-as a,ble to speak witlh specialautlhority. Not long ago lie drew the attention of thleHouse and the country to tlle falling-off in the amount ofvaccination by raising a debate on the subject in ai.excellent speeclh, upon whiclh we colmminented in a leadingarticle published iii the JOURNAL of April 29th, 1911. Hemade many friends duLring hiis short career in the House,aiid hlis death is sincerely regretted by them as well as byhiis friendcs in the miiedical profession, of whose interests hew-as a vigorous supporter, and in his own constituency.

Dr. Hillier married in 1885 the daughter of Mr. F. B.Browni, of Queenistownii, Cape Colony, and leaves a son andtwo daughters.

JAMES NAIPIN McDOUGAL, M%.D.EDIN.,COLDINGEIAM, ]ERIVICKSHIIE.

DR. JAMi.IES NATIRN McDOU(4AL, of Coldincbam, jiied OnOctober 12th. He hald been ailing for somlle time, alnlfor the last tlhree mionths had been entirely confinecl tohis b)edroolm.

Dr. McDougal took the degree of M.D.Edin. in 1860, aindthe diploma of L.R.C.S.Edin. in the followiing year. IIewvas a physician- of long experience anid miiore than ordilnaryshill; a Inan beloved anid revered by the folk of Berwicl-slhire, and lheld in the hihliest respect by those of themiiedical profession privileged to kniow himii. For ovevforty years Dr. McDougal laboured among thle Colding-lhani people and k-new themn as did no otlher person. Hewas more than a plhysician to them; bis lhelp exten(ledbeyond professional aid and skill, andc his secret deeds ofcl arity brouglht com--fort and( hlelp to many sufferers.

Dr. McDouLgral w,as a mani of many parts-education,Churelh matters, volunleering, and all tlhings for publicgood claimed hiis attention. Dr. McDougal was a voraciouis;reader and his library was remarkably well stored, andthe most recernt works oni medical and other subjects wereto be fouind in it. Dr. McDougal's friends included such.miieni as the late Professor Anllandale, the late Dr. JosephBell, Professor Caird, Dr. Berry Hart, Dr. Sim (all ofEdinburgh), J)r. F'airbairn (St. Thonmas's Hospital, Londoni),Rev. Prinicipal Fairbairni (Mansfield College., Oxford), andmnany others. Dr. McDougal retired from practice fiveyears ago, and was on that occasion presented by hiismnany friends w%vith hlis port-rait in oils and witlh a brouglhalnl.He was J.P. for Berwiclslhire, and had held the appoinit-ient of M.O.H. for Coldinglhaimi.Dr. McDougal's deatlh is lamented by the people of tlhe

Berwicksllire village in whichl he laboured so willinglyanid assidluously. Coldingliam cannot remember beigigwithout Dr. McDougal, and in every scheme for its-welfare he tooli a foremost part. He was ever ready tosupport every good cause, and he will be missed whengood causes are seekingb sulpporb andlhe is no more.

DEATHS IN THE PROFESSION ABROAD.-Anong tlle mem-bers of the mnedical profession in foreign clountries wholhave recently die(l are: Dr. Emil Emmert, Lecturer on Eye-Diseases in the Uiniversity of Berne, aged 66; Dr. Nicolas,Surgeoni to thle Hospitals at Marseilles; Professor JuliusCaspary, Director of the Dermatological Clinic of theUniversity of Ki6nigsberg since 1905; Geheim MedizinalratDr. Aschenborn, Assistant in the Medical Department ofthe Pruissian Minister of the Interior, aged 60; and Dr.Getto, of Deideslleimii, believed to be the oldest medicalpractitioner in Germainy, aged 98.

12 Q~ T1m, iRITI-d 1232 J:r.'.kt..rNI UNIVERSITIES AND COLLEGES. rNOvl 4, 19TT.

THE Royal Inistituite of Pubmlic Healtlh hia;s acceplted tlheinx-itation fromii tlbe, Ober-Burgomimeister of Berlimi to 11old( itsannual conigress in 1912 in that city. Time congress xxvillimeet unider the lpresidency of Earl Beauiellaiup), tlle FirstColmiiiiissioner of Works, fronm Jtuly 25tlh to 28tlh inclusix-e.A committee to mllake the necessary local arrangem-leiits liasbeen forime(d consisting of rel)resentatives of tlie Milistryof the Iiiterior, tIme Imperial Board of Healtlh, time City ofBerlin, the Medical Departmlenit of the Ilead QtuartersStaff of time Army an(d Navy, tIme University of Berlini, andthe miiedical and hN-gienic societies in Beriliim. Memilberswill be afforded opportuLnities for visiting(i the varioulspublic lhealth and e(duication-al ilnstitutes ill Berlimii anid tlieoccasioni will offer an opportunity to representatives ofcotuity counlcils, mutinicipalities, and otlher sailitary autlho-rities in the Ullitedl Kingdom of m-laking themtselx-es l)rac-tically acquainted witlh Germaan sanitarl institutions. Thelusiness of the congress vill be condludcte(d imi fixe sec-tions:-State Mcdicinec: Presi(lent, Sir T. Cliffor(d AllbutttBacteriology and Con7pa ra tiv'c Patha1)log,: Presi(leilt, Pro-fessor G. Sims Woodhlea(l; (Child S;tdy anti Sc7hoolHygiC?ne: Presi(lenit, Sir Jaiiies Crichton-Broxne ,M ilitaryj,('0107lial, and Naval : Presi(lelit, Major Sir Rolmal(d Ross;Municipal Engineerinlg, A rch itectrrc, a 0n(1 lotwnl Pl/ainoig:Presi(lent, P. C. Cowani, MI.Inst.C.E.. Clhief Enginmeer oftime Local Govermimiient Boar(d of Irelan(l. Time offlcers ofthe coiigress and( its sectionis will inclulde Geriuiani rel)re-sentatives lholdlilig (listilnguiishle(d scientific ani( mlluiuicipalpiositions.THE usual m-11omitlily mneeting of the Executive Coi11-

immittee of the, Me(lical Sickiness, Amnnuitxy, and( LifeAssuiraance Society xvas held at 429, Strand, Loiidon1, W.C.,Omi October 20tlh, Dr. dle Havillanld-Hall in tlle clhair. Therecords of tlhe business of the society (duiring.9 time cur-renityear shmox that tme sumi disbuirsed in clainis is well iund(lerthe amIlounit alnticipated an(d provi(le(d foir ii the table ofcontributions. A miargin of this kind lhas beeii piroduiced(by the buisiness iii almost ever- -,year of its working sinceit starte(d operationis in 1884, but there is a (listinlcttend(lency slhoxyn for tlhis margin to (lecrease relatively totlle grox-vtlh of the busiiness. As the experienmee of allsickniess societies- wvould lea(l to this result being alntici-p-atcd, the Commiittee lhas niot treate(d time xlvole of thliismlargini as divisible sturpluis, buit lhas set asitle a sul)stantial

pmortioll of it to meet future inlcreases of the sickness claimits,.Fromim otlher soiurces of profit, llowever, time society lhasobtaincd a conisidlerable suirplus, aiid( lhas tlhuis beenieiiab)led to grant liberal bonuses to tlle mienibers. Aprofit is imadc every -year oni the interest ea-rniedl by the-eiii(Id-limo amnounitin1g to about a quarter of a im1illioiisterliiig-amid tme econolmlical umaniier ini which tile opera-tioi1s of time society have beemi alxvays condtucted leavesa considerable immar'gill o0i tIme 10 per cemit. alloxvedl by theri-iles foIr iinamiageii-iclt ex]pemises. Although. tlierefore, tlle1amioumit 1)ai(l axay iii claiiims, am(I especially ii the claiminms

paid to those xv:ho are perumaimently incapacitated is stillgrowing, tIme financial r:esourees of time society are amp)leto mieet every claim that caim be reasonably aniticip)ate(l.Prosplectuses and all furtlher particelars oni applicatioim toMr. F. Addiscott, Secretary, Me(lical Sicknes-s ammd AccidesitSociety, 33, Chaiicery Larwe, Lonidomn, W.C.

UNIVERSITY O1F OXFORD.

TIIE followiiig degrees lhave beeln comiferrediD.MT.-E. L. Keennaway3B.MI., B.Cii.-J. 1. Plenson amid E. L. IPearce-Goild.

UINIVERSITY OF CATMBRII)GE.TimE followving degrees have bmeen coiiferred;

M.B., B.C.-A. G. Atkinson.\I.B.-H. G. Greaves, A. E. M. Woolf.

UNIVERSITY OF LONDON.KING'S COLLEGE.

Npechil Adi-aneed Lecthirts in Phiysilomlfl.A-COuTPSE of four lectures will lie deliv-ered ilL time PhysiologicalLiaborator-, Kimig's College, London, by Dr. F. S. Loclke, onEinergetics, at 4.30 p.m., oii time folloving Mondays; Novemlber13tlm, 20tli, 27tlh, amid Decemnber4tlh, 1911.

The svllabus of the lectures is as follows: Modern Energretics:The work of Helm, Ostwald, and(I othiers. The factors of energy,inteInsitv, anid capacity. T'lhe laws of energetics in relationto living matter. The einergetic clharacteristic of liviig matter.Energretic model of living matter anid its v-arionLs fuinctionalmodifications. The eiiergeties of the metabolism of the enitireorg,anisnm. The work of R-ltner, Atwater, and others. Thelaw of equal surface. T'le law of isodslnamv. The eiergeticsof growth aniid age. The energetics of thle metabolism ofisolate I organs, volunitary muscle, heart, hidney.The lectures are free to all membeis of King's College,

Lonidoni, to all initernal1 stuLdelnts of the UIliversit\ of Lon(loi,to all medical stu(lenits in London, an(l to all me(lical mr;en onpresentationl of their cards.

UNIVERSITY OF SHEFFIELD.TuIE Counicil at its rmeeting oni October 27tlh made tlhe folloWiDgapplointments: (1) Mr. Percival E. Barber, B.A., M.R.C.S.,L.R.C.P., to the Pirofessorshlip) of Midwifery. (2) Mr. Miles E.Phillips, M.B., F.P.C.S., to the post of Lecturer in Gyn&ecology.(3) Mr. Mackenzie Douglas, M.A., M.D., to the post of JuniorDemolnstrator in Pathology. (4) Mr. P. F. Kendall, B.Sc., tothe )ost of Assistant Curator of the Zoological Museum.At the samtie meeting Emeritus Professor R. J. Pve-Smitl xvas

appointed to represelnt the university on the Gelieral MedicalCouncil.

UNIVERSITY OF EDINBURGH.GENERAL COUNCIL.

THE statutory half-yearly general meeting of tlme GeneralCouncil of the University of Ediniburglh vas leldk onOctober 27th.

Assessor3s.The first business was the election of two Assessors to the

University Court, in place of Dr. R. McKelnzie Johllstoln, whoseperiod of office expired oni October 27th, anid Dr. Joseplh Bell,deceased. Dr. McKenzie JohnIston w-as eligible for re-electioin.It was unanimnously agreed to appoint Dr. McKenzie ,Jolhnistonlan(l George Anl(dreas Berry, M.B., C.M., LL. I)., Presidenit of theRoval College of Surgeons.

TIhe luIte Dr. Josep JBell.The report of the Business Committee conitained a tr'ibute to

the late Dr. Joseph Bell, as follows: A greatu surgeon, WhIogracluated in this -university fifty-two years ago, Dr. B3ell waslatterly better known Withill the xvalls of his Almat M1ater as oneof the General Council's representatives oln the Court of thleUnliversity-a pos-ition whicll lie cecupied at the time of hisdeatlh, anid for sixteeni y-ears previouslv. In February Dr. Eellwas talien seriously ill, anid thouigh he improved suflicieiitly tobe moved to the couintry anid to enjoy life in a quiet and v-eryrestricte(l manner, he was obliged to give ulp his xvork anid mostof his appointments. It is, howeever, characteristic of hiisdevotion to wlhat he colnsi(derecl his iymost impnortant duty thatlie refused to albsent himself from his uniiversity duties, and indefianice of his advisers anid against the wislhes of htis family,he motored from the country during tlte suimmer monltlhs toatten(l tIhe meetinfs of the Court, and( was present at tle lastmeetiln in July. During the long period of years in .which lieserve(d his university so faitlhfully and(l the inlterests of theGeeneral Counicil xvith so ImluchI ability and devotion,. it isw-ell knuown that he never allowe(d person-al conveniienceor pirofessional eigagemnciits to interfere withl tIme onerousdutties associate( xvithl the Court anid its committees. His(leath is so recenit that it is difficult as yet to estimate at itstrue worth the iniflueince xwhiclm Dr. Bell exercised in tuniversitv-matters, or to realize the full extemit of our loss. A sclholarhimself, he was dleeply intereste(d in educational matters, andmore especiallv in me(lical questions affecting the uiiiversitywas lhis ripe experience and wivde knowle(dge of special value.Amonigst other sernices wlhich lie reendered to the universit.y wasthat of acting as a Curator of Patronage. The under"radmiatesalso owe lhim much for Ihis useful assistance oni the AtlhleticClub an(i otlher student societies. Dr. Bell was a many-sidedman of conspicuous ability. lie had great busiimess capacitv, asound judgement, a natural quickniess of thouglht and -p)er-ceptioii, combined with a clear crisp mode of expression, whiclhremidered him invaluiable in forwardinDg the niasses of businesswhich come biefore the Court at every meetiiig. His kind,genial face will be sadly missed by his colleaguies in theUimiversity Court, wliile his eminent and highly-appreciatedservices on behalf of thie General Council will caulse hiis miameever to be remembered with gratitude alid affection.

Diplomna. i)1 Psychiatry.The university has recentlv decided to granit a Diploma in

Memital Diseases or Psvlchiatry, and regulations have been drawilup which came ilitO force at tlle beginning of the preseiitsession. The diploma was intended to meet tle requirements ofthose who proposed to devote tlhemselves to this specialbranch of mediciiie. Under the powers conferred by therecenit medical ordinance, this diploma will be opein to any regis-tere(d medical practitioiier wlvo completes the necessary co6rse ofstudy. Under tIme previous ordiniance such diplomas couldlonly be conferred oIi graduates in medicilie of this university.The course of study will extend over olie academic year.During a period of three vears from this date candidates for thediploma who have held responsible positions in asylums for ilotless than two years may be exempted from the couLrse of studyin one or more sul)jects of the curriculum.

NOV. 4 19I1.jI LETTERS, NOTES, AND ANSWERS. MEDICALJOURNAL I 239

New Lectutres/tips.The following new lectureships have recently been instituted

in the university, and lecturers appointed thereto:1. Guen)etics: A. D. Darbishire, M.A. (in the department of

Zoology). 2. Ml?ycology and Bacteriology: Malcolm Wilson,B.Sc. (in the department of Botany). 3. Co)miparatire A4ntatom)1y:Professor 0. C. Bradley, M.D., D.Sc.

Gifts.The following additions to the equipment of the university

were announced:Bequest by the late Professor Daniel J. Cunningham of

his medical and scientific books for the use of the department of.anatomy.

Gift by Emeritus Professor Alexander Crum Brown, for theuse of the department of chemistry as a class library, the bookslent by him for the same purpose on his retiral from office.Gift by Emeritus Professor John Chiene, C.B., of his private

surgical museum, diagrams, and laboratory apparatus.Gift by Dr. Henry Barnes, Carlisle, of a marble bust of

William Harvey.Statistics.

The number of members of the General Council on December31st, 1909, was 10,886; on December 31st, 1910, it was 11,241.The total number of matriculated stuLdents of medicine in six

selected sessions was as follows:1889-90 ... ... ... ... 2,0031897-98 ... ... ... ... ... 1,4051900-1 ... ... ... ... ... 1,3641907-8 ... ... ... ... ... 1,4871908-9 ... ... ... ... ... 1,4401909-10 ... ... ... ... 1,377

RECTORIAL ELECTION.After a rather violent election contest, the Earl of Minto was

on Saturday, October 28th, chosen, by a majority of 222, LordRector of the University of Edinburgh.

ROYAL COLLEGE OF PHYSICIANS OF LONDON.A COMITIA was held on Thursday, October 26th, Sir ThomasBarlow, Bart., K.C.V.O., President, being in the chair.

Admttission of Mlemibers.The following gentlemen, having passed the necessary

examination, were admitted Members of the College:Francis Graham Crookshank, M.D.Lond., L.R.C.P.; George Harold

Cross, M.B.Oxon.; Elkin Percy Cumberbatch, M.B.Oxon.;Robert Skeoch Frew, M.D.Edin.; Horace Bryden Hill, M.B.Lond., L.R.C.P.; Edwin Walter Routley, M.D.Brux., L.R.C.P.;PercyEdward Walton Smith, M.B.Sydney; John Aldren Wright,M.D.Camb.

Licences.Licences to practise physic were granted to 83 gentlemen

-who had passed the requisite examinationis.Common ications.

The following communications were received:1. From the Royal College of Surgeons of England, dated

-July 27th and October 13th, reporting proceedings of the Councilof that College upon July 27th and October 12th last.

2. From the Dean of the Faculty of Medicine, EdinburghUniversity, dated Julv 27th, reporting that the MurchisonMemorial Scholarship had been awarded to Mr. Walter QuarryWood.

3. From the Librarian of the University of St. Andrews,dated September 28th, thanking the college for a gift of books.

Annoiuncemnenits.The President announced: (1) That the nineteenth Jenks

scholarship had beeni awarded to Mr. Arthur Llovd Davies.(2) That Sir David Bruce, being unable to undertake to deliverthe Croonian Lecture in 1913, Dr. Dixon MAann had beenappointed to take his place.

Reports.The President reported on the celebration of the 500th

.aniniversary of the foundation of the Uniyersity of St. Andrews,oIn which occasion he was the delegate of the college. * TheRegistrar (Dr. J. A. Ormerod) read the excellent Latin address-which he had written -for presentation on the same occasion.A report was received from Dr. J. StClair Thomson con-

,cerning the Third International Congress of Laryngology andRhinology.A report was received and adopted from the Committee of

MIanagement dated October 3rd. The report recommended*that the County School, Carnarvon, and Repton School shouldbe added to the list of institutions recognized by the ExaminingBoard in England for instruction in chemistrv and physics.The audited accounts of the college for the year ending Sep-

atember 29th, 1911, and the quarterly report of the CollegeFinance Committee were received and adopted.

Cou,nnittee of allanagemient.Dr. J. A. Ormerod was se-elected a member of the

Committee of Management.Thle Library.

The Harveian Librarian (Dr. Norman Moore) presented a list<of books and other publications which had been presented tothe Library during the past quarter, and the thanks, of thecollege were ordered to be rettirned to the donors.

COMMUNICATIONS respecting Editorial matters should be addressed tothe Editor, 429, Strand, London, W.C.; those concerning businessmatters, advertisements, non-delivery of the JOURNAL, etc., shouldbe addressed to the Office, 429, Strand, London, W.C.

AUITHORs desiring reprints of their articles published in the BRITISHMEDICAL JOURNAL are requested to communicate with the Office,429, Strand, W.C., on receipt of proof.

ORIGINAL ARTICLES and LETTERSforwa rded for publication a 7-eunderstood to be offered to the BRITISH MEDICAL JOURNAL a lotn e unlessthe contrary be stated.

CORRESPONDENTS who wish notice to be taken of their comm-iunica-tions should authenticate them with their names-of course notnecessarily for publication.

CORRESPONDENTS not answered are requested to look at the Notices toCorrespondents of the following week.

MANUSCRIPTS FORWARDED TO THE OFFICE OF THIS JOURNAL CANNOTUNDER ANY CIRCUMSTANCES BE RETURNED.

TELEGRAPHIC ADDRESS.-The telegraphic address of the EDITOR ofthe BRITISH MEDICAL JOURNAL is Aitiology, London. The telegraphicaddress of the BRITISH MEDICAL JOURNAL is Articulate. Londcn-

TELEPHONE (National):-2631, Gerrard, EDITOR, BRITISH MEDICAL JOURNAL.2630, Gerrard, BRITISH MEDICAL ASSOCIATION.2634, Gerrard, MEDICAL SECRETARY.

1 Queries, answers, and communications relating to subjectsto which special departnments of the BRITISH MEDICAL JOURNALare devoted will be found under their respective headings.

QUERIES.

E. J. D. asks for the best treatment, internal or external, forslighlt persistent psoriasis in a young lady; parents perfectlyhealthy.

DR. J. D. WILLIS (Nottingham), referring to the portraits of" Quacks " in the issue of May 27th, asks if any reader of theJOURNAL could put him in the wav of obtaining portraits ofother such celebrities.

RECURRING URTICARIA.COUNTRY PRACTITIONER would be glad to hear of any treat-ment for the following case: A boy aged 5 years suffers fromrecurring attacks of urticaria. For five days of the week heis quite free; on the evening of the fifth day his temperaturebegins to rise; on the sixth and seventh day his body iscovered with an urticarial rash, with itching, etc.; tempe-rature remains at about 1020 F. during these two days, thenafter profuse perspiration the rash disappears and temperaturebecomes normal and remains so for the next five days, whenthe above symptoms are again repeated.

NEURITIS.AXIS CYLINDER asks: What is usually uniderstood by the term" neuritis " ? It seems to me to be somewhat loosely applied.Most people who have an ache or a pain in arm, leg, or else-where are told they are suffering from " neuritis," whereas,according to my lights, "neuritis " is a serious organic lesionassociated with atrophy and paralysis of muscles, alteredelectrical reactions, etc.

*** The following definition is given by Dr. Judson S. Buryof Manchester in his article in Allblutt and Rolleston's Sqsteutof Mledicinie, vol. vii, p. 415:

The name neuritis is usually understood to mean inflam-mation of a nerve; but, as pointed out by Dr. T. Buzzard,this is not its original interpretation. The adjectiveneuritis, the substantive v6orov being understood, signifiesetymologically no more than disease affecting the nerve. Ithas indeed become customary, and eveen necessary, toinclude under the name neuritis not only what is ordinarilycalled inflammation, but also degenerationl, atrophy, and(other lesions of a nerve.

INCOME TAX.J. L. T. has been assessed to income tax for the year 1911-12 oIn£200, less £120 abatement. He took over his present practicein October, 1910, and his first year's receipts were £230, a fewpounds being due to him on account of book debts. He sendsan account of his expenses, which amount to £215, andwishes to know whether he can successfully appeal, as thesurveyor of taxes has informed him that the assessment ison the average of the three years 1906, 1907, and 1908.

* The surveyor's statement must be due to a clericalerror. In any case our correspondent should give notice ofappeal and claim to be dealt with under Rule IV of Nos. 1and 2, Schedule D, a rule which applies to persons succeedingto taxable concerns but not making so large a profit as theirpredecessors. The expenses claimed are quite reasonable,but the £40 "d(eterioration of motor car " will probablyl not