907THE BELGIAN DOCTORS’ AND PHARMACISTS’ RELIEF FUND.

THE BELGIAN DOCTORS’ ANDPHARMACISTS’ RELIEF FUND.

A MEETING of the Committee was held at the offices ofTHE LANCET on Monday, Dtc. 10th, Sir RICKMAN GODLEEin the chair.A letter was read from the medical officer of health of

Milford Haven, referring to the need or otherwise of theBelgian workers at that port being attended by a medicalman of their own nationality. The medical officer explainedthat the Belgian community was zmaller than it had been.and was being attended by the local medical practitionersso that the help of a Belgian practitioner was no longertequi) ed.

Dr. 1)ES VcEUX submitted a financial statement whichshowed the present position of the Fund to be as follows :-

Belgian Doctors’ and Pharmacists’ Relief 1’und.TREASURER’S CASE AccoUNT. 1ST JULY 20 30Ta Nov., 1917.

1917.lat July. To Balance... R5477 13 4 By Relid......... R4012 0 0

" Interest... 34 0 7 Clothes ...... 10 10 0" Administration

expenses...... 2 6" Bounce

Cash at Bank... 1489 1 b

£ 5511 13 11 .E5511 13 11We have examined the above account with the books and vouchers

of the Fund. and , ertify it to bf correct meeording to the books. In ouropinion the receipts a"d payments have been fully recorded, and wehave compared the receipts with the published acknuwledgments andhave had produced to us cert’nctes Ms to the correctness of the balanceas shoB’B-n. CREWDSON, YOUATT, AND H"WARD,

Churtred Accountants, Auditors.70a, Basinghall-street, London, E.C. 2, 5th Dec., 1917.This pecuniary position corresponded with the estimate of

the Committee, earlier in the year. that the funds in handwould enable a mensuality of .E800 to be sent during 1917 toBelgium, but that the end of the year would see the practicalexhaustton of the Fund. It was decided that .B700 shouldbe sent for the month of December, and that the amountavailable for January should later be fixed Dr. Des Voenxalso announced that temporarily the clothes department hadbeen shut up, the premises having been taken over byGovernment, but that he had found a lady willing to

supervise its continuance when the necessary accom-

modation was available. For the moment the clothes havebeen stored.The Committee debated the future prospects of the Fund,

having regard to the fact that the sum remaining at theirdisposal would be exhausted by the mentalities of Decemberand January, and came to the unanimous conclusionthat an attempt should be made, despite all the attend-ant difficulties, to raise more money. A letter from Mr.W. B. Poland, Director for Europe of the Commissionfor Relief in Belgium, who until the outbreak of hostilitiesbetween Germany and America had been resident in

Belgium, was read, which described in moving termsalike the terrible plight of the Belgian middle-class

population and the unbounded gratitude of the medicaland pharmaceutical professions for the assistance whichhad been afforded them by their British colleagues.In the face of -uch a letter the Committee found it a

paramount duty upon them to proceed with the difficulttask of raising further money, and ir. was decided that stepsshould be immediately taken to this end. It was arrangedthat a letter signed by the Committee and placing thesituation before the medical and pharmaceutical professionsshould be published in early 1.suo-s of the medical andpharmaceutical press, and that Mr. Poland’s communication,alluded to above, should also be published in the samejournals and circulated widely in other quarters.

BELFAST MEDICAL STUDENTS’ ASSOCIATION.-OnFriday, Dec. 7th, at Queen’s University, Belfast, Dr. 8.Turkington, President of the Medical Students’ Asso-ciation, having delivered his opening address dealing withthe progress of medicine, Professor J. Lindsay gave alecture on the prospects before the medical student, whichhe described as bright for all. In replying to a vute ofthanks, Dr. Lindsay said the scheme recently adumbratedof free medical treatment for everyone would be a difficultone. It would come up against specialism and medical Iresearch, and would tend to a dead level of mediocrity. t

MEDICAL RESEARCH COMMITTEE.

THE THIRD ANNUAL REPORT.1

WE dealt last week with some of the more general aspectsof the work of the Medical Research Committee, and nowpass on to consider in detail certain departments of it.

The Central Institute and its Departm.ents.The Mount Vernon building used until August last for the

study and treatment of military cases of heart dis- rder isnow to be employed for the care of the special disabilitiesincident on flying, the heart cases having been transferredto larger accommodation at Colchester.Department of Bacteriology.-The department haq con-

tinued to turn out work of the first interest. The diminishedalkalinity of the blood shown to be present in cases of gasgangrene has led to successful treatment of these cases bythe infusion of alkaline solutions. Further work on theemigration of white blood cells and their place in thegeneral physiology of wound healing has been done. Theclassification of cases of war nephritis has been advanced astage, and investigations made into the best methods of skin-grafting, into the various types of B. dysenteriae Flexner, andinto the bactericidal and tissue-destroying effects of certaingroups of antiseptic substances. The special beds at St.Mary’s Hospital set apart for research in connexion withthe Department have had to be abandoned owing to short-ness of staff.Department of Bwchemistry and Plaarnaaeology.-An investi-

gation into the action in experimental dysentery of thealkaloids of ipecacuanha has had practical results, as wellas another into the effect on amoebic infection of theMexican bitter-bush, Castela nicholsont. Work on the natureof shock-like conditions and on the properties and com-mercial preparation of the flavine antiseptics has occupiedmuch attention. In addition, confidential inquiries ofvarious kinds have been carried out for Government depart-ments. One member of the staff has inquired experi-mentally into the physiological actions of alcohol for theCentral Control Board, and the department has benefited bythe help of Dr. A. N. Richards, professor of pharmacologyat Philadelphia University.Department of ApplMd Physio7ogy. -This department has

been decentralised and made partly perambulatory to meetspecial needs, relinquishing its rooms at the London Hos-pital Medical College. Pressing work has been done on thecomposition of workers’ dietaries and on economical methodsof cooking foodstuffs. The principles of ventilation havebeen further investigated by the cata-thermometer and theemission of radiant heat from the human skin accuratelymeasured. Synthetic biochemical processes, especially inrelation to the conversion of the energy of light intochemical energy, have been further studied, as well as thephysiological problems of flying at high altitudes.

Statistwal Department.-In addition to the great task ofpreparing medical statistics of the war, the epidemiology ofphthisis has been studied with the provisional conclusionthat two allied organisms are concerned, one affecting earlyadult and the other middle life, each with a distinctgeographical distribution. Infant mortality, the periodicityof measles epidemics, and the span of human life, as illus-trated in the contributions to the " Dictionary of NationalBiography," have also been subjects of inquiry.Depa1.tment of Clinical Research.-This will now be con.

cerned both with the military cases of heart disorder atColchester as well as with the disabilities due to flying atMount Vernon.

Army Medical Statistics.Work in this field has grown to enormous proportions,

demanding a clerical staff of 103 persons. Since Jan. 1st,1917, the War Office has provided the salaries of typistsand sorting clerks while the Research Committee hassupplied the staff itself and other resources. The recordswill form the statistical basis of the medical history of thewar and, in addition, a source of essential facts for the promptsettlement of all claims for pensions and allowances. Thisfact in itself entitles to a grant of public money. The recordshave already been used in tracing the after-history of largegroups of cases of gas-poisoning, nephritis, gunshot woundsof the chest, and aneurysm. A military officer of highstanding has been appointed to represent the Committee inFrance. with the result that a general system of records hasbeen evolved with complete success. In place of the case-sheet the Army field medical card has been altered to form acontinuous diary of each casualty’s clinical history whileoverseas, which returns with him to the United Kingdomfor the information of any medical officer into whose handshe comes. This card is the same size as the Research

To be obtained through H.M. Stationery Office. Price 6d.

908 MEDICAL RESEARCH COMMITTEE.-PARIS.

Committee’s index cards and can be filed with them. Note-taking forms and blank diagrams have been suppliedby the million, enabling special records to be kept of Ispecial subjects such as abdominal surgery, head andchest wounds, fractures of bones, and injuries to joints. Apathological artist has been engaged to assist the verbaldescriptions of important injuries. Mobile laboratories forbacteriological or chemical work have been further ex-

tended and opportunities afforded of throwing light onproblems of military and medical importance-e.g., in thestudy of changes in the circulation after severe wounds andoperations.

Decentralised Work.The report considers in detail a number of headings under

which special research work has been aided at civil andmilitary hospitals and ambulances. Some of these are : thedisinfection of drinking-water, the chemistry of bacterialgrowth, typhoid and paratyphoid infections, dysentery,cerebro-spinal fever, spirochætal jaundice, trench nephritis,the medical problems of flying. These summaries include a

large part of the most important work of the Committee andwork which gives great promise for the future, but they donot lend themselves to further abstraction, and this is theless necessary as many of the results recorded have been

published in our columns during the last 12 months.The report concludes with an acknowledgment of the vallledhelp and cooperation of the United States of America. Onbehalf of the National Research Council at Washington,Dr. H. D. Dakin gave to the Committee valuableservice in France and the Mediterranean, and after hisreturn to New York is still serving as a personal link betweenthe two organisations. The Rockefeller Institute for MedicalResearch, in the person of its director, Dr. Simon Flexner,has also reciprocated, and Professor W. B. Cannon, of

Harvard, and Professor Tilestone, of Yle, are in this

country collaborating with the British staff. This growingcooperation for the advancement of medical knowledgebetween the English speaking countries is a fortunate event,and one fraught with sreat promise.

PARIS.

(FROM OUR OWN CORRESPONDENT.)

The Inter-Allied Surgical Congress.AT the third Inter-Allied Surgical Congress, which sat

from Nov. 3rd to 8th at the Militarv Section of theVal-de-Grace, under the presidency of M. Justii Godart,Under Secretary of State for the Service de Santé,six questions were raised on which numerous conclusionswere based, some of them of great importance. Withregard to the first-secondary and delayed complications ofwounds of the brain-surgeons agreed that delayed infec-tion of such wounds is much rarer than was commonlysupposed ; that organic disturbances following wounds ofthe brain, e.g., hemiplegia, monoplegia, aphasia, visual dis-turbances, frequently have a tendency to spontaneousimprovement; and that epilepsy, if amenable to surgicalintervention when a foreign body or splinters of bone arepresent, is not so in other ease.s. In cases of cerebral hernialumbar puncture should be avoided during the acute febrilephase in order to avoid the possible dissemination of a localinfection. Foreign bodies tolerated by the brain may beleft. Cranioplasty is only indicated in cases where theextension of the cicatrix is the sole cause for the symptomsobserved, except in the frontal region for esthetic purposes.The second question dealt with the later results of treatmentin the case of fracture of the shaft of the femur. It has

long been generally recognised that results are onlymiddling as regards the extent of the lesions, the in- sufficiency of reduction and of its maintenance, and

especially as to infection of the focus. A primary sterilisa-tion of the wound is the chief factor to realise. Stiffnessof the joints of the knee, hip, and foot can be avoided byearly movement. Adherence of muscles to callus is the

origin of many disturbances of function necessitatingfreeing by surgical methods. Strongly marked deviationis amenable to ostectomy with resection of the callus ifthere is osteomyelitis. The third question referred to opera-tion for injuries to nerves. The Congress admitted that theultimate results are generally middling, especially in thecase of total lesions, and when the operation takes placeamong suppurating tissues. Primary suture of a nerve in amilieu rendered aseptic by modern methods has given better

results. Functional recuperation is slow, occupying monthsor even years, a fact which must be taken into) considera-tion in working out compensation The treatment offracture of the joints (fo/6rtk question) has made greatprogress since primary sterilisation has been the objectaimed at, and operative measures initiated within 10-12hours. Comminution of the epiphysis is to be treated

by gouging out and cleansing followed by immediatesuture of the joint. Early resection is only indicatedin exceptional cases where severe comminution is present.Primary amputation is limited to cases of extreme con-

tusion with destruction of the principal artery. Immediateactive movement gives better results than immobilisation.Thefiftlt question deals with the treatment of chronic osteo-myelitis, which should be mainly preventive and completedeither by immediate closure of the wound after removal ofall sequestra or by chemical sterilisation with secondaryautoplasty. With regard to thoraco-abdominal wounds(sixth question), the Congress gave special attention towounds of the diaphragm. Radioscopic examination is

necessary to recognise hernia of the abdominal organs anddetermine the displacement of the heart. Operation isnearly always indicated, and a transpleural route by way ofthe thorax is generally to be preferred, associated withlaparotomy when desirable.

Frostbite as a llccetor in the Development of Tetanus.Inspector-General Vincent, professor at the military

department of the Val-de-Grâce, discusses in a note to theAcademy of Medicine the favourable action exerted by coldand frost-bite upon the development of tetanus. The facthas long been recognised by French military surgeons;Larrey showed after the battles of Prague, Lützen, andBautzen that exposure to severe cold at night was followedby an abundant crop of tetanus among the wounded menbrought in. Before the war Dr. Vincent showed by experi-ment that tetanus might appear several months after theentrance of the germ when the infected part was placed inice. More recently he established the fact in guinea-pigsthat local, even more than general, humid cold is a conditionfavourable to the rapid development of tetanus. He observedthe division of tetanus bacilli taking place in the in-fected limb two hours after being held under a con-

tinuous jet of cold water. Tetanic symptoms appear aftera very brief incubation and rapidly kill the guinea-pig,sometimes with splanchnic pbenomena. Similar conditions-low air temperature, maceration by water, reduction oftemperature of the limb itself, cedema, trophic disturbancesin the foot-are present in the trenches in winter. The

sowing of the bacillus is effected by means of pre-existenterosions, or excoriati ios, or hy ulceration due to frost. biteitself. At a temperature of 15° C. or below Dr. Vincent hasshown that the leucocytes lose their property of taking uptetanus spores, while the dropsical fluid which infiltratesthe cellular tissue of the foot and leg forms a perfectnutritive medium for the anaerobe to store up its toxin.

Subsequent absorption of the fluid is then the equivalent ofan injection of tetano-toxin. For this reason symptomsappear early in acute cases and may outlast the period ofpassive immunity brought about by injections of serum.

Duration of immunity from a single injection does not,in fact, exceed 10-12 days-it is occasionally less-and canonly be preserved by repeated injection. The protectionafforded by antitetanus serum-therapy has reduced the inci-dence of tetanus as an infectious complication of wounds ingeneral, but it still occurs under the conditions named infulminant form in spite of prophylactic injection, as M.Bacri and M. Chavasse have reported. A certain number oftheir cases had received one, two, or three injections ofserum over a period of 10 or 12 days, some receiving largedoses. Seventeen patients who received three injectionsdied, the majority of acute tetanus. The occurrence ofsplanchnic tetanus was noted in three cases.

TAe Control of Secret Remedies.The Academy of Medicine has been occupied for some

weeks past in discussing the terms of their reply to a ques-tion proposed by the Minister of the Interior on the subjectof the control of the sale of secret remedies. The situationis completely abnormal in France and has long requireddefinite control. In theory the offer for sale of remedies ofunknown composition is strictly forbidden by the law ofApril llth, 1803 those who sell or advertise such remediesbeing liable to prosecution. For many years, however, the