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is considerably diminished thereby. Taking into considera-tion its powerful antiseptic properties, its feeble degree oftoxicity, and the absence of any injurious effects when

used upon animals, Dr. Perez did not hesitate to give tachiolan extensive trial in surgical practice, employing it for

the disinfection of cavities and suppurating sinuses, in

tuberculous lesions, ulcerative processes, and indolent ulcers,and in cases of cystitis, proctitis, endometritis, and urethritis,using solutions of from 1 in 1000 to 1 in 5000 for urethraland vesical irrigation, and of 1 in 100 where a moderatecaustic action was required. Tachiol has also been tried byDr. Carapelle and Dr. Benedetti in ophthalmic practiceand with highly encouraging results, its non-irritatingcharacter rendering it greatly to be preferred for this

purpose to corrosive sublimate.

VIS MEDICATRIX NATURÆ.

A CORRESPONDENT has forwarded to us an account of acase of perforation of the alimentary tract by a woodenskewer, with recovery. The patient was a retriever puppywhich some three months ago was noticed to be in acute

pain. It recovered apparently but at the beginning ofNovember was noticed to be getting thin and seemed to beill. On Nov. 8th a lump was noticed on the puppy’sback which seemed to be acutely tender, and on the 9tha wooden skewer was seen sticking up in the back. This

was pulled out and the puppy soon began to eat and

recovered. Our correspondent mentions that at the same

time he had a case of perforated gastric ulcer in a humanpatient under his care, and this patient also recovered. The

peritoneum in the lower animals is certainly more tolerantthan in human beings, but the passage without permanentdamage of a wooden skewer which probably pinnedtogether some pieces of not strictly aseptic meat is, wethink, a sufficiently striking example of the resistant

powers of the peritoneum to be placed on record. Probablyadhesions formed between the stomach and the abdo-minal wall. We do not recall to mind any exactlysimilar occurrence in the human being but there are

no small number of cases on record in which sharpmetallic bodies have been swallowed, have perforated thestomach wall, and have formed localised abscesses pre-

senting on the anterior wall of the abdomen, from whichthey have been removed after incision. Laussem (" l’hommeà la fourchette") swallowed a fork which ultimately wasremoved from an abscess cavity pointing near the umbilicus,THE PRACTICE OF MEDICINE IN TONG-KING.

A SCHOOL of medicine having now been established at

Hanoi, says Dr. Jules Regnault in the Arcki1JeS de MédecineNczecle for October, it is opportune to inquire in what wayEuropean practitioners can best be able to gain the con-

fidence of the native population. It is supposed by manypeople that the Annamites will at once recognise the supe-riority of Western medical methods, but such, in Dr.

Regnault’s opinion, is far from being the case. In order

to gain the confidence of the inhabitants of the countrythe representatives of Western medicine must first acquirea thorough knowledge of the Chinese systems of pathologyand therapeutics. At present, notwithstanding their dislikeof operations involving the flow of blood, the Annamites

willingly avail themselves of surgical aid at the hands of

foreigners but they never ask for medical advice. Surgery,properly so-called, was unknown in Eastern lands until

imported by Europeans a short time ago, but medicine hasbeen known and cultivated in China and its dependenciesfor upwards of 4000 years. Treatises on semeiology, patho-logy, and therapeutics have existed from time immemorialand the doctrines therein laid down are now universally

accepted and are regarded as immutable. Native practi-tioners without exception all slavishly follow the preceptsof the ancient authors and are careful to avoid even thesemblance of innovation. Annamites of all classes down to

the lowest coolie attach the utmost importance to form andceremony in connexion with medical examination. Theyresent a non-observance of the ritual which they have beenbrought up to consider essential and they are quite unableto appreciate correctly a new-fangled method of procedure.Undressing a patient for auscultatory or other pur-

poses shocks their sensibilities, while they are proneto estimate palpation and percussion as intolerable liberties.To an Annamite physician the investigation of the pulse isa serious business, necessitating the employment of bothhands for a lengthened period, and on no account to be slurredover or shorn of its importance. When a native patientfinds his Western medical attendant content lightly to toucha single radial artery for a few seconds only and with atmost a couple of fingers of one hand, he at once loses allfaith in his skill and promptly stigmatises him far andwide as an ignorant barbarian undeserving of trust. But

although Dr. Regnault insists on a measure of compliancewith the outward forms of Chinese medical practice andcounsels all European practitioners to examine theirnative patients, temporarily at all events, according to thetime-honoured plan they are accustomed to, he byno means entirely discredits the therapeutic systemwhich represents the experience of "thousands of years."It comprises, he says, many drugs supposed to be novelties.Long before the American druggists thought of ingluvintheir Eastern congeners used the gizzards of fowls in

dyspepsia, and in like manner Brown-Sequard was not thefirst to administer glandular extracts in certain cases of

debility. In many nervous affections the Chinese have longprescribed preparations made from the brain and spinal cordof the stag, while they are likewise familiar with hepatic,renal, and pulmonary opotherapy. For ages they have givengelatin made from asses’ skin in haemorrhage, a remedywhich not very long since would have met with ridicule,although its virtues as a haemostatic are now admitted. In

conclusion, Dr. Regnault maintains that, in spite of all thathas been said to the contrary, it is well worth the while ofmedical men on the spot to devote time and study to thepathology and pharmacopoeia of the Far East.

ACHOLURIC ICTERUS.

WE are indebted entirely to French clinicians for the

description of lctère acltolurique-chronic jaundice of slightdegree (subicterus) in which there is no bile in the urine.

Probably some of the cases vaguely described as examplesof I biliousness" are of this nature. The first case appearsto have been described by Schachmann in his These de

Paris, 1887. A man, aged 50 years, apparently in goodhealth, had a large liver and spleen. Icterus had existed for30 years but the urine did not contain bile pigment and thestools were never colourless. All the most important com-munications on the subject have been made to the SociétéMedicale des Hopitaux of Paris. In 1897 M. Legendrereported a case of chronic icterus of 12 years’ duration inwhich the urine did not contain bile, the stools were alwayswell coloured, the liver was of normal size, and the health wasgood. M. Hayem then reported cases in which he regardedthe icterus as a complication of parenchymatous gastritis anddue to secondary infection of the biliary passages. 1 In 1900M. Gilbert, M. Castaigne, and M. Lereboullet communicated apaper on family icterus in which they reported a case ofchronic congenital icterus with paroxysms, slightly enlargedliver, and enlarged spleen. In his These de Paris, pub-lished in 1902, M. Lereboullet described a case of biliary

1 THE LANCET, June 3rd, 1899, p. 1506.

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cirrhosis in a man, aged 50 years. The time of onset wasundetermined but it seemed to have been in infancy. The

urine was high-coloured and contained much urobilin but

no biliary pigments. The blood serum, on the other hand,gave Gmelin’s reaction. In 1901 M. Chauffard reported to thesociety a case of dyspeptic chronic icterus with slight andintermittent choluria. Jaundice had existed for 12 years, theliver was normal, and the spleen was slightly enlarged. At

the meeting of the society on Nov. 21st, 1902, M. F. Widal andM. P. Ravaut described the following case. A man, aged 29years, had had chronic icterus as long as he could remember.His general health was good and he never had any gastrictrouble. The skin was distinctly yellow but a little dark andgave the impression of subicterus rather than icterus. The

conjunctivas were yellow. On the upper lip was a yellowstippling like chamois leather, encroaching on the prolabiumand suggesting xanthelasma. During the six months he wasunder observation there was constant subicterus whichunderwent slight oscillations without ascertainable cause.

The urine was high-coloured and contained much urobilinbut never bile pigment. The fseces were of normal tint. The

blood serum had a dark tint which varied in intensity withthe tint of the skin and mucous membranes. It always scontained bile pigment. The liver was twice found to be

enlarged slightly, extending one and a half fingers’ breadthbelow the false ribs, and the dulness measured 132 centi-metres in the mammillary line, while at an examinationmade a week before it measured 1OJ2- centimetres. M. Widaland M. Ravaut suggested that icterus was due to a con-

genital disorder of the hepatic cells which produced bile inexcess.

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THE BATTLE OF THE CLUBS AT SWANSEA.

THE battle of the clubs is being fought at Swansea withvigour. The medical men of Swansea have issued an

admirable circular to the members of the friendly societiesin the district pointing out that only a very small advance inpayment is being asked from men whose wages have muchincreased, while owing to the expenses of medical educationand medical practice having gone up medical men are placedat a great disadvantage. It is said that a Medical AidAssociation is to be started and that three practitionerswill be imported as a reply to the just demands of the

medical men of Swansea. The latter point out in theircircular that they will unanimously and absolutely refuse tomeet the servants of the Medical Aid Association.

CHOLERA IN EGYPT.

THE figures given below show the distribution of cases of,and deaths from, cholera throughout Egypt during the weekending Dec. lst. 20 cases were reported, against 33 in theprevious week, thus showing a diminution of 13 cases. 17

patients were found dead out of hospital and 1 died in hos-pital, against 24 deaths out of hospital and 6 in hospitalduring the previous week, thus showing a diminution of 12in the number of deaths. During the same week 13 casesoccurred in Alexandria, against 21 in the preceding week.Since Nov. 4th no case of cholera has occurred in Cairo.

CONGENITAL HYPERTROPHIC STENOSIS OFTHE PYLORUS.

AN important paper was communicated by Dr. E. Cautleyand Mr. C. T. Dent and an interesting discussion took placeat a meeting of the Royal Medical and Chirurgical Society onDec. 9th on the treatment of congenital hypertrophic stenosisof the pylorus by operative measures. A full account is pub-lished in another column. First described in 1841, the con-dition has not even yet obtained general recognition, althoughduring the four years that have elapsed since it was brought

] prominently before the society by Dr. Cautley several caseshave been recorded and in 19 an operation has been per-formed. It seems probable that the disease is not so rare

as might be judged from the number of reported casesand that the more general recognition of the condition willprove that it is not uncommon. The disease occurs in infants,is congenital, and is characterised by vomiting, constipa-tion, visible gastric peristalsis, and a pyloric tumour dueto a marked excess of muscular fibres encircling the pylorus.The cause of the condition has yet to be explained ; somehold that it is due to a primary hyperplasia of the musculartissue, an overgrowth due to a fault in development, whileothers consider that the hypertrophy is secondary andresults from over-exertion of the muscles. Other observerscombine these two views, believing that there is some con-

genital hyperplasia of the sphincter of the pylorus and thatspasm supervenes on this. Treatment by various operationswas discussed, preference being given to pyloroplasty andLoreta’s operation, the writers of the paper being in

favour of pyloroplasty while other speakers preferred Loreta’soperation, it being capable of rapid performance withoutshock.

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DUTY-FREE ALCOHOL FOR RESEARCH.

THE following remarks, which appeared in an annct ltion inTHE LANCET of Feb. 2nd, 1895, p. 303 (that is to say,

nearly eight years ago), are of special interest at the presentmoment in view of the very important concessions justgranted by the Board of Inland Revenue in regard to the useof duty-free spirit for research :-There are few agents at the present time which play a more im-

portant or useful r6le in practical scientific operations than absolutealcohol. Indeed, its use is indispensable in the prosecution of

chemical, bacteriological, and physiological researches, to say nothingof the necessity of its employment in the preparation of the fluidsused in sero-therapeutics. Yet all who are activelv concerned inthese important lines of researches are severely handicapped becauseof its excessive price, very nearly the whole of which accrues

to the Excise. On the continent the retail price of absolutealcohol is considerably less than that charged in this country,and there is little doubt that this is one of the sources of the increasedfacilities in research work which obtain there; at any rate, its costhere militates against such progressive work. Surely in the interestsof science and progress the authorities could be induced to grant aspecial concession in this matter to 6o/K:!-de research workers and tothose engaged ill unravelling the mysteries of disease. Why shouldnot a memorial be drawn up and signed by influential members of thevarious scientific societies and presented in the proper quarter ? Wefeel sure that our remarks will appeal to the majority of the membersof the scientific professions.

,

Our readers will see from a letter from Sir Henry E. Rosooeand Professor Harold B. Dixon, which we publishthis week, that the special concession for which we pleadedhas at length been granted. It is difficult to estimate the

importance of this step which must favourably affect all

branches of research by removing the undoubted incon-venience caused by the excessive cost of one of the mostessential agents employed in practical scientific work.

Copies of the regulations for the use of duty-free spirit atuniversities, colleges, and other educational institutionshave been issued by the Inland Revenue authorities.Somerset House.

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STRUCTURE OF NERVE AND GLAND CELLS.

Professor Emil Holmgren contributes an article withillustrations to the Archiv fiir Mikroskopische Anatomie

(July, 1902) in which he gives the details of certain intra-cellular canals and canaliculi that he hap been able to

demonstrate in various kinds of nerve and gland cells andto which he has applied the name of "trophosporigium" "because he considers that they are subservient to the nutri-tion or metabolism of the cells in question. He prepares thetissue by immersing it in a solution of trichlor-lactic acid for24 hours, then placing it in gradually increasing strengths ofalcohol, imbedding in paraffin or Heidenhain’s carbon sul-

phide, staining with fresh Weigert’s resorcin-fuchsin colour,