1416

the year, but under the excellent arrangementsmade for its prevention by the Medical Departmentof the War Office it was kept under control.

Puùlic Health A(lministration and Legislation.Among the more important legal enactments

which have come into force during the year maybe mentioned the Public Health (Shell-fish) Regu-lations, 1915. Machinery is provided by theseRegulations for the closing of shell-fish layingswhere there is evidence to show that the shell-fishfrom such layings have actually caused disease, orare likely to be a source of danger to the publichealth. Legislation of this nature was long over-due, and it is satisfactory that local authoritieshave at last obtained further powers for dealingwith the matter.The Notification of Births (Extension) Act, 1915,

was passed with the object of making universal

throughout the country the system of the adoptiveAct of 1907, under which early notification con-

cerning all births is required to be given to themedical officer of health, and also to enable localauthorities to make arrangements for the care ofmothers, including expectant mothers,’ and youngchildren. In this connexion an important circularletter on maternity and infant welfare was issuedto local authorities by the Local GovernmentBoard on July 30th, indicating the scope of thework which they considered should be undertaken.The Government have agreed to provide, by meansof annual grants to be distributed by the LocalGovernment Board, one half of the cost of thewhole or any part of schemes for maternityand child welfare approved by the Board, andRegulations under which such grants are pay-able were issued on July 7th. The LocalGovernment Board will, however, not pay grantsunder these Regulations in respect of expendi-ture on " schools for mothers," which is eligiblefor aid under the Regulations of the Board ofEducation of July 6th.The Local Government Board regard the saving

of lives of young children suffering from measlesas forming an important part of child-welfare work,and to enable local authorities to adopt adminis-trative measures with this end in view the Boardmade an Order, entitled " The Public Health(Measles and German Measles) Regulatione, 1915,"by which a system of notification of these diseasesis put into force throughout England and Wales.A leading article on the Regulations appeared inTHE LANCET of Dec. 18th (p. 1357), and the subjectneed not be further. considered here.

In February a Memorandum on cerebro-spinalfever was issued by the Local Government Boardfor the guidance of medical officers of health.

Special emphasis was laid upon the importanceof sanitary authorities making arrangements for

assisting medical practitioners to obtain an imme-diate diagnosis in suspected cases of the disease,for isolating patients suffering from it, for dis-infection, and for the supervision of contacts. Inview of the difficulty connected with the accuratediagnosis of the malady, the Board expressed theirwillingness to undertake the examination in theirpathological laboratory of cerebro-spinal fluid sentto them for this purpose. Local authorities werealso advised to make local arrangements with acompetent bacteriologist for the examination ofswabs taken from persons who had been in intimatecontact with a patient suffering from the disease.

2 THE LANCET, Feb. 27th, p. 452.

The Local Government Board sent a circular tometropolitan borough councils in April referring,among other matters, to the additional qualifica-tions which should be required in the case oftuberculosis officers appointed after January, 1915,and stating that facilities to attend the dis-pensaries and other institutions provided by thecouncils should be afforded to medical students andpractitioners in order that they may acquirefamiliarity with the methods of diagnosis andtreatment which are adopted in these institutions.

ANÆSTHETICS.

Many papers of scientific value have appearedindicating that this subject has made progress alongdesirable lines. Professor S. J. MELTZER, of theRockefeller Institute, reviews the present statusof intratracheal insufflation.’ Clinical experiencehas borne out MELTZER’s original experimentalfindings. He points out that as with this methodgas exchange persists even when the lung ceasesto be in contact with the parietes, so it issuperior to both the plus or negative pressuresystems in intrathoracic operations. The dangersof heart collapse, aspiration of fluids from the mouth,and excessive dosage with ether are easily avoidedby a rigid technique. The four or five deathsrecorded, he avers, arose through technical errors.Professor TUFFIER and Professor G. LOEWY havestudied this subject also.The danger to the heart, as judged by Katzenstein’s

functional test, has been the subject of a disserta-tion by J. STRUBE (Berlin), but the demonstrationfails to recognise the distinction between myo-cardium poisoning and simple anaesthetic influence.

D. KULENKAMFF,3 in reviewing our knowledge ofthe effects of inhalational anaesthesia, insists uponprecision in concentration. He suggests 6-7 percent. for ether, 1’7 per cent. (volumes) for chloroform,and avoidance of mixtures, since their constituentsevaporate unequally. With free access of air no

cyanosis need arise and no retention of CO2 occur.Hypnosis to ensure sleep before the inhalation andthe maintenance of a minimal narcosis he regardsas essential. __.

K. F. KEDI4 compares the uses of scopola-morphine and atropine with pantopon and atropine;he prefers the former, but is alive to the dangers ofthirst and o:igopnaea.Much valuable work on the causation of aceton-

uria has been done. G. GELLHORN regards thecondition as more common than is usually admitted.Of 35 gynaecological cases 33 revealdd it withoutconsequential danger. Indeed, J. HARRIS has indi-cated its extreme frequency in the acute exanthe-mata without any anaesthetic having been used.

Dr. G. W. CRILE 5 in several careful researcheslays great stress upon the importance of a studyof the variations in the blood’s alkalinity. Heestimates by H-ion concentration and regardsinhalational anaesthesia as a constant cause ofacidosis. He insists that he has proved that bloodacidity is the product of other " activation " of thebody by an adequate stimulus. Patients withlessened blood alkalinity succumb if they take anan2esthetic. Morphine given before inhalationlessens acidosis, given afterwards retards the returnof alkalescence. Acidity varies directly as the

1 Berl. Klin. Woch., vol. li., pp. 677-743.2 Presse Méd., vol. xxii., p. 52.

3 Deutsche Med. Woch., vol. xli.. p. 708.4 Wien. Klin. Runds., No. 32.

5 Annals of Surgery, vol. lxi., p. 6.

1417

prolongation and depth of anaesthesia. The papersare suggestive, even though their conclusions maynot carry entire conviction.Among other researches we should note the

following: Dr. G. CONSOLI’S histological exa-

mination of the spinal cord of dogs subjected tointrathecal stovainisation. That destructive changesare so produced has been already asserted, and Dr.CONSOLI’S results are instructive. In Dr. C. H.WHIPPLE and Dr. J. S. SPEED’S investigation ofthe effects of anesthetics on the liver function 7

they found that ether depresses the phthalein curvefor 24 hours, as, indeed, do alcohol and paraldehyde.E. L. Ross and P. B. HAvYK find post-anaestheticglycosuria is not caused by lower temperature, I,lessened oxygen-supply, or impurities in ether, butfollows lessened diet and excess of ansthetics ;they found no evidence of " emotional glycosuria."R. H. MILLER and H. CABOT,9 estimating by phenol-sulphonephthalein, report that the urinary functionis lessened by excess in ether, prolonged opera-tions, shock, and advanced age. W. W. C. TOPLEY’Sinvestigations show that ether as liquid or in vapouris bactericidal towards B. coli, staphylococcus albusand aureus, streptococcus, pneumococcus, and B. pyo-genes. This confirms the work of STERNBERG. Dr.E. H. EMBLEY 1° advances weighty clinical evidenceagainst the views which regard chloroform syncopein human subjects as caused by ventricular fibrilla-tion.A number of papers have appeared dealing with

the use of nitrous oxide in midwifery, with localand spinal analgesia, status lymphaticus, and " totalanaesthesia." Many of these are worthy of carefulperusal. We append a few references, L. G.BOWERS,11 J. C. "BVEBSTER,12 A. W. MEYER,’3 P. W.SIEGEL,14 SCANDOLA,15 GFROERER,16 ECKEL,17 J. L.

BAER,18 E. P. DAvIS,1 and H. PRIBRAJB1.20

THE NAVAL, MILITARY, AND INDIAN MEDICALSERVICES.

In dealing with the progress of medicine duringthe past 12 months, including in the term everybranch of our art and science, it will be seen howthat progress has centred round the war. Allmedical literature of every sort and in every tonguehas been largely devoted to developments of

military surgery and to descriptions of therapeuticprocedure dictated by the exigencies of the war orarising out of its terrible experiences and occur-rences. The sanitary lessons arising from a similarorigin have been numerous and valuable, and muchof this material has been published with great free-dom in our columns and in those of our contem-poraries, general and special. It is quite impossible Ito indicate in any summary, such as this, the barefeatures of naval and military medicine during theyear, but every side of the subject has been putupon record, so that the outstanding directions ofprogress are known to all our readers. A medicalhistory of the war is in course of preparations and

6 Atti d. Accad. Givenia di Nat. Sc. in Catalonia, vol. iv., p. 16.7 Jour. Experi. Med., vol. xxi., No.3, p. 193.8 Int. Jour. Med., vol. xiv., No. 6, p. 769.

9 Arch. Int. Med., March.10 THE LANCET, vol. ii., p. 283.

11 Surg., Gyn. and Obst., October, p. 521.12 Ibid., vol. xx., p. 221.

13 Archiv f. Klin. Chir., vol. cv., p. 170.14 Deutsch. Med. Woch., vol. xl , p. 1416.

15 Gazz. d. Osp., vol. xxxvi., p. 50.16 Münch. Med. Woch., 1914, p. 36.17 Wien. Klin. Runds., 1914, p. 30.

18 Jour. Amer. Med. Assoc., Jan. 22nd, p. 1723. 19 Ibid.20 Zeitschr. f. Klin. Med., 1915; Med. Rec., N.Y., vol. i, p. 980 ; Ibid,

p. 288. 1 THE LANCET, April 24th, 1915, p. 886.

having regard to the careful manner in whichselection has been made of an editorial body forthis purpose we may confidently expect that theteaching of these terrible days will be preservedfor our future enlightenment.

ROYAL NAVAL MEDICAL SERVICE.

The history of the Medical Department of the

Royal Navy has outwardly been uneventful duringthe past year. The unceasing watchfulness of thefleet, to which these islands owe their almost

complete immunity from attack, has entailed animmense amount of work on the Medical Service,none the less real because so far unrecorded. TheNaval Medical School at Greenwich Hospital is nowthoroughly established, and has already proved its

efficiency. Its transfer to the metropolitan area hasbeen fully justified, and under its present capableadministrative staff promises not only to continuebut to excel the record of Haslar. The health ofthe fleet has been extremely good-that, at least,can be said.

ARMY MEDICAL SERVICE.

The record of the Army Medical Service duringthe past year has been almost entirely that ofactive operations in the field, on a scale hithertoquite unexampled in history. There have, how-ever, been opportunities for much research, evenunder these circumstances, as will have beengathered from the numberless communications ofhigh scientific value which have been made byofficers of the Royal Army Medical Corps to the

proceedings of learned societies and to themedical press. Great advances have been madein wound treatment by the application of recentlyelaborated scientific methods, bacteriological andchemical, and the work of Sir ALMROTH WRIGHT inthis connexion is familiar to all our readers, asis also Major L. W. HARRISON’s employment oflactic acid in anaerobe-infected wounds. A valuableseries of observations on nearly 700 cases of gaspoisoning was reported by Lieutenant BLACK,Lieutenant GLENNY, and Lieutenant McNEE, andmany other observers have recorded their clinicalexperiences of this new terror for fighting armies.Preventive methods have been studied with success,while treatment can now be carried on upon linesdictated by observation. Cerebro-spinal meningitisin the Salisbury Plain area was investigated byLieutenant C. H. TREADGOLD, and by Surgeon-ColonelR. J. REECE in regard to prevalence of the diseaseamongst the troops in the British Isles, as well asin the general population. The worst outbreakshave been already attended to. One of the greatfeatures of the war has been the freedom of ourarmies from typhoid fever.Very great advances have been made in the

arrangements for removal of wounded from thefield by means of mechanical transport, a motorambulance service on a large scale having beendeveloped. This has been due, as stated by theField Marshal Commanding-in-Chief, to the initia-tive and organising powers of Surgeon-GeneralT. J. O’DONNELL, ably assisted by Major P. EvAs,R.A.M.C. Ambulance trains have also beenorganised, which appear to be complete in everydetail; much good work in their elaboration hasbeen done by Major G. A. MORE, R.A.M.C. Another

very important advance has been the introductionof mobile laboratories for the immediate investiga-tion in the field of outbreaks of disease, especiallyof enteric fever. -