750

by their unfortunate infirmity are precluded from earning aliving, and if these men and women can be reached andtransformed into useful citizens a great work will havebeen accomplished. One thing the projectors of such anundertaking must understand-viz., that the institutionshould have a considerable endowment. Whatever it may

,accomplish in the course of years an industrial colony ofthe character apparently contemplated cannot in its early Idays be self-supporting. We cordially wish the initiators ofthis most promising scheme, who are at the same time thedonors of the munificent gift, the greatest success in their.generous and philanthropic enterprise.

THE CONCILIATION BOARD.

AT the conference held at Manchester upon Medical

’Organisation at the beginning of May Dr. J. G. Gloverannounced that a meeting was about to be held between acommittee of the British Medical Association and the com->mittee of the General Medical Council (of which he, the- speaker, was chairman) with reference to a conciliation- board. The British Medical Association appointed a con-- ciliation board, but the said board has not lasted long, forthe council of the Association has just resolved "that theconciliation board be not re-appointed." The subject does’not seem even to have been referred’ to the Association itself,the resolution being the work of the council. Either theGeneral Medical Council must have been wrong in devotingso much time to the proposal or the council of the BritishMedical Association in devoting so little. Time will perhapsshow where the fault lies.

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CONDITIONS PRODUCED BY THE BACILLUSAEROGENES CAPSULATUS.

THE Bostor ltredical and Surgical Journal of July 26th Icontains an important paper by Dr. Welch of the Johns (Hopkins University on the pathogenetic role of the bacillusaerogenes capsulatus," an organism first described by himin 1891. Dr. Welch has collected 46 cases of emphyse-- matous gangrene in which the bacillus aerogenes capsulatuswas found.l In the great majority of cases the bacillus wasevidently introduced through a wound from without. Those

injuries in which there was much laceration and crushing oftissue, comminution of bone, and grinding of dirt or foreignbodies into the tissues, such as compound fractures andbullet wounds, were the most likely to be followed byemphysematous gangrene. Severe traumatism, however,was not essential. In five cases the gangrene followed

hypodermic injection and infusion of saline solutions. We

have recently referred to cases of gaseous abscesses follow-ing hypodermic injections described at the Societe Medicaledes Hôpitaux of Paris and attributed to an organism termedby Veillon and Zuber the " bacillus perfringens." 2 Thisbacillus Dr. Welch believes to be identical with the onedescribed by him. In three of Dr. Welch’s collected cases

(one of removal of the appendix vermiformis, one of

strangulated hernia, and one of rupture of the rectum)the infection came from the intestine. The prognosisof emphysematous gangrene is now more favourable thanin the pre-antiseptic period ; in Dr. Welch’s series the

mortality was 59 per cent. But when the diseaseis accessible to surgical treatment, is not complicatedby other grave conditions, and is promptly treated the prog-nosis is not unfavourable. Prophylaxis is obvious. The caseswere treated by free incisions, by amputation, or by both.The results were better after amputations than afterdnoisions. In certain uterine infections the gas bacillus hasbeen found, and the occurrence of emphysema in the deadfoetus has been known for centuries. In 1897 Dobbin

1 THE LANCET, July 21st, 1900, p. 205.2 THE LANCET, April 7th, 1900, p. 1021.

published a paper in the Bulletin of the Johns HopkinsHospital on Puerperal Sepsis due to Infection with theBacillus Aerogenes Capsulatus. During the life of the

patient, gas and the gas bacillus were recognised in the

feetus, placenta, and cavity of the uterus ; and after deaththere was general gas formation throughout the body. In

another case in which the patient made a good recoverywithout sep3is, crepitation of the caput succedaneum wasrecognised while the fcetus was in utero. The bacillus

is the chief cause of physometra, which was presentin Dobbin’s first case and is often associated with

emphysema of the dead foetus, but which may occur withoutit, and even in the non-pregnant uterus. Emphysemaof the uterine wall is another and far graver result.

Physometra is a necessary accompaniment unless thecervical canal is open and permits escape of the gas.The urinary tract may be not only a portal of entry of thegas bacillus into the circulation but also the seat of

. infection. In a case of urethral stricture with cystitis

,

treated by perineal section gas bacilli were found three-L

quarters of an hour after death in large numbers in the. bladder, ureters, and renal pelves, and a few bubbles and bacilli were present in the blood of the right ventricle. Gas

: may be found free in the bladder, ureter, or renal pelvis. The’

intestine is the commonest source of the gas bacillus, and

invasion from it may result in the production of gas in theperitoneal cavity. Submucous and subserous gas cysts may

, ’ also be formed. In the pleura the bacillus may give rise to

3

1

pneumothorax without perforation.

HOUSING OF THE WORKING CLASSES ACT,1900.

THE Local Government Board has issued a digest of theprovisions of the several parts of the Housing of the WorkingClasses Act, 1890, as amended by that somewhat meagrepiece of legislation, the Housing of the Working Classes Act,1900. The principal alterations effected by the latter are inrespect of procedures under Part III. of the Act of 1890.This is the part which enables urban sanitary authoritieswith the sanction of the Local Government Board, and ruralauthorities with that of the county council, to purchase landand erect, or contract for the erection thereon, of "lodging-houses for the working-classes "-a phrase which includes" separate houses or cottages for the working-classes, whethercontaining one or several tenements." Part III. does not

in any case come into force in a district until it has been

adopted by the sanitary authority. The Act of 1900 makes

adoption easier in rural districts by doing away with severalof the obstacles created by the Act of 1890 ; moreover,in certain contingencies the county council will now have

power themselves to adopt and enforce Part III. in

any rural district in the county if they are satisfiedthat the district council concerned has been in default in

’’ property exercising their power of adopting and actingunder " this part of the 1890 Act. In the event of land

being purchased compulsorily, and in default of agreement,compensation is now to be settled by a single arbitratorappointed by the Local Government Board. Also it is made

possible for district councils to lease land purchased by themunder Part III. for the purpose of erection of working-classdwellings by private enterprise, subject to certain conditionsbeing complied with. The new Act, it will be remem-

bered, has now made it practicable for an urban authorityto establish or acquire lodging-houses for the working-classesoutside its district-a provision of great importance in thecase of large towns. Whether these amendments will leadto more general use by sanitary authorities of their powers toprovide working-class dwellings remains to be seen. At

present no rural and very few urban districts have done any-thing in this direction. Lord Shaftesbury, some years after