1410

DEMONSTRATIONS OF DR. KOCH’S TREAT-MENT IN LONDON.

PROGRESS OF THE CASES.

(Continued from p. 1252.)

City of London Hospital for Diseases of the Chest.THESE cases are progressing well, and giving rise to <

hopeful expectations. Dr. Heron, having fulfilled Koch’s 1condition of taking, in the first instance, cases of earlyphthisis for the trial of the liquid, now proposes to go onwidening and extending his experience as to how the i

remedy acts in more advanced cases of lung tuberculosis,so that some guide may be obtained to assist in deciding under what conditions a patient is likely to derive benefit or ]otherwise from the remedy. CASE 1.-G. M-, twenty-five; phthisis. The dose

now administered is 0’05, which produces little reaction.The patient is up, and seemed so well that it was deemed Jadvisable to allow him to follow his inclination and goabout in the corridors of the hospital. The sputum is scanty, and very few tubercle bacilli are to be found in it. The patient complains of slight giddiness in the morning.The cough, formerly so troublesome, has now almostentirely ceased.CASE 2.-A. D---, aged forty. This patient now receives

0’035 cc. The sputum remains occasionally tinged withblood, and a few moist sounds can be heard over the rightlung, but decidedly fewer than previously. Night sweats,formerly profuse, have now completely stopped, and thepatient’s breathing is very much better. The feeling oflassitude and weariness has disappeared.CASE *3.-B. W.- As much as 0-03 cc. has been

injected at a dose, and still the patient does not react to the fluid. The sputum contains some dark-yellow lumps of i

muco-pus, and the physical signs remain unchanged. Thepatient expressed himself as improved.CASE 4.-L. F-, aged twenty-one; lupus. The necrotic

patches are giving way, and the healing skin is beginningto run in amongst them. The glands are not nearly so muchswollen as they were. Still a dimly marked redness beyondthe necrotic tissue forms the distinct- boundary of the lupoidtissue. This patient has received five injections, and 0.005was administered. This patient invariably shows muchreaction in response to very small doses of the fiuid.CASE 5.-E. R-, aged twenty. six ; lupus. This case

continues to improve, and the appearance has greatlyaltered for the better.CASE 6.-H. D--, aged fourteen; phthisis. This patient

has had a rather high continuous temperature, which Dr.Heron says does not seem to be in any way connected withthe use of the remedy. The old scar on the hip-jointremains unchanged. Cough is troublesome. The physicalsigns of phthisis remain very marked.CASE 7.-H. B--, aged twenty-eight; phthisis. The

patient has received 0’03 cc., but shows no reaction. Thesputum is very scanty, with few tubercle bacilli in thesputum. She seems to be gaining strength, and is nowable to walk about the wards and corridors. >

CASE 8.-A. B---, eighteen. No reason has yet beendiscovered, although several physicians have carefully goneover this case at various times, to explain why this patientshould react to this remedy. The only symptoms which inany way tend to clear up the mystery are the swelling andtenderness in both knee-joints and tenderness in the right Iankle-joint. The patient now has ceased to react. Therewas a return of uneasiness in the knee-joint, but no swellingon the 15th inst., when a dose of 0’007 cc. was injected.Since then the dose has gradually been raised to 0’03(Monday last), but no symptoms of reaction are yet manifest.The patient has been injected in all fifteen times.

King’s College Hospital.The cases in King’s College Hospital continue under the

care of Mr. Burghard and Mr. Williams. We continue thereports, and are indebted to the house surgeon and to Mr.Whitfield for the use of certain notes of the cases.

CASE 1.-E. C-, aged sixteen, continues to improverapidly.CASE 2.-H. F-, aged fifteen. The patient receives

now 0’024, which produces a ternperature of l00.2&deg;. OnMonday a small abscess in the aailla was opened, probablydue to absorption going on in the lupuf patch on the arm.

CASE 3.-P. F-, aged thirty. Enlarged glands. Sincethe 17th the patient has coughed very much, and the

vomiting has ceased. The glands decreased in size duringthe first two or three injections, and became more distinct andmore easily movable. On the 21st an injection of 0’007produced no reaction beyond a slight flushing of the face.CASES 4, 5, and 6 continue to react to the inoculations.CASE 7.-R. S-, aged twenty-six ; lupus. The use

of the fluid is producing pain in the eyes and legs. Thelupus patches were swollen and very painful. The dose of

0-01 produced again a strong reaction. The tubercularnodules have disappeared.CASES 8 and 9 are reacting very slightly, and in both

instances improvement in the general condition is apparent.,

CASE 10.-M. C-, twenty-six; lupus. On the 21st, adose of 0’013 cc. was administered without producing anyreaction. The affected parts are much clearer, only three

patches being left.; CASE 11.-N. L-, aged twenty. Lupus on both sides.

of the neck, extending considerably over the cheek. Wasl injected the third time, with, however, the dose reduced) from 0’01, which produced so severe symptoms, to 0’002, one-! fifth of the previous doses, on the 17th inst. The reaction,

which followed, however, was severe. The patient hada rigor, accompanied by much pain and flushing of the

face and neck. The temperature rose to 1042&deg; within sixhours, and remained at that point for six hours longer. At

nine o’clock next morning the patient felt very ill, thelupus patches became very much swollen, and exudationt touk place from the left side of the neck. The pulse rose,

to 140, and the respirations numbered 32. At present theright side of the neck is quite healed, and the left sidefis almost in the same condition.

CASE 12.&mdash;Anaesthetic leprosy: aged forty-five. Thispatient received on Friday, the 14th inst., an injection of ae full dose (0’01), and the temperature rose to 103&deg;. The in-f jection produced a good deal of pain in the ulnar nerve ande in the calves of the legs and knees. The left great toe was

much affected and became very red and turgid. Thec temperature became normal in about thirteen hours.

During the reaction three red patches on the left side of11 the back became much deeper. The patient was muchd troublea with cough, sickness, and pain in the limbs,d accompanied with excessive thirst. On the day following5 the reaction the right hand became extremely painful.h The fourth injection was administered on the 17th inst.

The patient was injected at 11. 30 A.M. with a full dose, theeffects of which were great difficulty of breathing, the

y patient complaining of a marked feeling of suffocation.The temperature as before rose rapidly to 103&deg;, and became

it normal in about eighteen hours. The eflect of this injec-r. tion was different from that of the previous ones. The,h woman became very prostrate under the treatment, and wasat in a condition of extreme collapse, the pain, however, beingal absent. The rash came out much more distinctly, and the

middle finger of the left hand was considerably swollen.le A good deal of nausea, headache, and pain in thee chest accompanied these symptoms, and large blebs formede on the right heel and on the left ankle, whereas inw the first injection these appearances were found on the

little toe. On the 18th cough was again troublesome,;n and a large blister appeared on the left leg. On theie following day the feeling of prostration had passed off, andit the patient was much improved in general condition.in On Sunday she was again injected, but her previousad dangerous condition rendered it necessary to administer aat very much smaller dose on that occasion. The samere symptoms appeared, but in a much milder form, the tem-ag perature, however, again rising to 103&deg; in nine horns,d. remaining practically at that point for only two hours.03 In future we consider that it will be sufficient to give fort-It. nightly records of the above cases.

ASSOCIATION OF FELLOWS OF THE ROYALCOLLEGE OF SURGEONS.

AT a meeting of the Fellows’ Association, held on Satur-day, the 20th inst., at 20, Hanover-square, Mr. Pollockpresided.The Chairman said the meeting had been called onaccount of the rapid action of the Council in negotiating ug

. with the University of London because of the pressure put

1411

’upon the University by the Commissioners. He referredto the reception of the deputation by a select com-mittee of the Council of the College. The deputation badpointed out that some change was necessary in the rulest-onnected with the voting papers for the election of the’Council, and had also referred to the question of calling ameeting of the Fellows to consider points of importancethat might come before the Council Letters had been re-ceived from the secretary to the effect that the Council,having considered the rules relating to the voting papers,had determined to make no alteration in them. Thatwas the only question upon which an explicit answer

had been given. At the general meeting, when the question.of the meeting of Fellows to consider any question ofinterest to the College was raised, the Council referred thematter for counsel’s opinion, by which it promised to be.guided. No explicit reply had yet been given on this point.Mr. Holmes moved : " That this meeting desires to recordits emphatic protest against any final settlement betweenthe Council of the College and the Senate of the LondonUniversity, in the matter of the reconstitution of the Uni-versity, without the Council of the College having consultedeither the Fellows of the College or, if they cannot be con-sulted separately, a general meeting of the Fellows andMembers." In moving this resolution he did not wish in.any way to criticise the scheme that had been settled forthe reconstruction of the University. He had seen it.announced that some sketch of a plan had beenforwarded to the Privy Council. A scheme was saidto have been formulated, even as to its details, but towhich many objections had been raised, principally by theprovincial schools of medicine in England. He did notknow, however, whether the scheme had a substantial’existence or not, but negotiations were going on betweenthe Colleges and the University, the issue of which mustseriously affect the position of every Fellow and Memberof the College of Surgeons; and to act in the name of theCollege of Surgeons without communicating any of the details-of the scheme to any person whatever out of their ownbody-to claim the absolute right of concluding a treaty onbehalf of the Fellows and Members with the University ofLondon, was a state of things which, if legal, was quitewrong, and should not be tolerated a moment longer than<could be helped. The Fellows had, he thought, a legaliright to be consulted in affairs of such magnitude affectingthemselves. Some of the Council seemed to think thatby claiming a vote as to the result of the negotiationsthe Fellows were thereby claiming the right to con-

duct the negotiations themselves. He referred to theorigin of the Colh ge, and stated that no City Companywould be allowed to amalgamate with another on themotion and unrestricted action of the master and wardens.The Members of the College appeared to have lost all rights,and to be simply pawns, to be moved about the board bythose twenty-iour gentlemen who formed the Council.Mr. Mayo Robson seconded the resolution, which was

-carried unanimously.Dr. Collins then moved : " That a committee of the Asso

ciation, with power to add to their number, be authorisedto act as a deputation to attend, if necessary, before theLondon University, the Lord President of the Council, andthe Commission of the Teaching University for London."As a Fellow of the College, he knew nothing of the natureof the negotiations now in progress, while as a member ofConvocation of the University he was thoroughly acquaintedwith the details of the scheme and of the many revised- ’schemes which had appeared from time to time. Hepointed out the anomalous position occupied by membersof the Royal College of Surgeons as compared with amember of Convocation in negotiations of this kind, andemphasised the fact that they stood in an inferior positionto any other college or corporation of a similar nature,-and also to the Royal College of Physicians. In afew weeks the Lord President would be master of the:-ituation, and then perhaps suitable witnesses would appearbefore him on behalf of the Fellows in order to preventany serious mistakes that might be made.

Mr. Norton seconded the resolution, which was also’carried unanimously.

The Chairman announced that Lord Cranbrook hadacknowledged the receipt of the resolutions previouslypassed, but had made no observations as to their havingbeen before him.

Dr. Collins: No scheme is before him as yet.

Mr. Tweedy moved : " That a dinner of the Associationbe held in April next." He thought that would strengthenthe interest in the Association. The date would be fixed bythe Committee.The motion was seconded by Mr. Dunn, and carried

unanimously.A few remarks from the Chairman concluded the meeting.

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN twenty-eight of the largest English towns 4935 birthsand 4681 deaths were registered during the week endingDec. 20th. The annual rate of mortality in these towns,which had been 21-5 and 21’3 per 1000 in the precedingtwo weeks, rose again to 25’1 Jast week, a higher ratethan in any week since March last. The rate was 26’0in London and 24’4 in the twenty-seven provincial towns.During the past twelve weeks of the current quarterthe death-rate in the twenty-eight towns averaged 21’1per 1000, and exceeded by 0’3 the mean rate in thecorresponding periods of the ten ears 1880-89. The lowestrates m these towns last week were ]5.2 in Leicester, 16’0in Derby, 16’1 in Hull, and 18’6 in Bradford ; thehighest rates were 28’5 in Plymouth, 29’4 in Cardiff,31-9 in Manchester, and 51-6 in Preston. The deathsreferred to the principal zymotic diseases, which hadincreased from 430 to 483 in the preceding three weeks,further rose last week to 511 ; they included 216 frommeasles, 107 from whooping-cough, 5 from scarlet fever,51 from diphtheria, 47 from "fever" (principally enteric),39 from diarrhoea, and not one from small-pox. The lowestdeath-rates from these diseases were recorded in Leicester,Hull, Norwich, and Derby; the highest in Birkenhead,Bolton, Salford, and Preston. The greatest mortalityfrom measles occurred in Birkenhead, Cardiff, Man-chester, Salford, Oldham, Bolton, and Preston; from scarletfever in Liverpool; from whooping-cough in Halifax,Birmingham, Birkenhead, and Preston ; and "fever" inHalifax and Sunderland. The 51 deaths from diphtheriaincluded 32 in London, 5 in Salford, 4 in Birming-ham, 2 in Liverpool, 2 in Manchester, and 2 inBirkenhead. No death from small-pox was regis-tered in any of the twenty-eight towns ; and no

small-pox patients were under treatment in the Metro-politan Asylum Hospitals or in the Highgate Small-pox Hospital on Saturday last. The number of scarletfever patients in the Metropolitan Asylum Hospitals andin the London Fever Hospital at the end of last weekwas 1752, against numbers declining from 2122 to 1803on the preceding six Saturdays; the patients admittedduring the week were 108, against 151 and 125 in theprevious two weeks. The deaths referred to diseases ofthe respiratory organs in London, which had increased from375 to 487 in the preceding three weeks, further rose to752 last week, and were as many as 282 above the correctedaverage. The causes of 108, or 2-3 per cent., of the deathsin the twenty-eight towns were not certified either by aregistered medical practitioner or by a coroner. All thecauses of death were duly certified in Bristol, Leicester,Bradford, Brighton, and in four other smaller towns. Thelargest proportions of nncertified deaths were recorded inLiverpool, Blackburn, Huddersfield, Halifax, and Hull.

THE SERVICES.

NAVAL MEDICAL SERVICE. -The following appointmentshave been made at the Admiralty:-Deputy Inspector-General Garland W. L. Harrison to Plymouth Hospital(dated Dec. 20th, 1890); Surgeon R. H. T. Browne to theDuke of Wellington, additional (dated Dec. 19bh, 1890);Mr. Ernest W. Skinner to be Surgeon and Agent atWinchelsea, Dog’s-bill, and Haddocks.VOLUNTEER CORPS.- Royal Engineers (Fortress and

Railway Forces) : 1st Durham : John Dickinson Leigh,M.B., to be Acting Surgeon (dated Dec. 20th, 1890).-Rifle: 2nd Volunteer Battalion, the Manchester Regiment:Tho. Carr, Gent., to be Acting Surgeon (dated Dec. 20th,1890).-1st Cadet Battalion, the Queen’s (Royal West