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NOTES, COMMENTS, AND ABSTRACTS

LIVING FISH IMPACTED IN THE THROAT

THOUGH this alarming accident occurs most

frequently in India, Ceylon, and Burma, it mayhappen anywhere in times of drought when drinking-water is drawn from unusual sources. E. W. Gudger 1has collected 38 cases from the literature, the firstbeing recorded in an idyllic poem " The Fisherman "by Theocritus in the third century B.c. The fishusually implicated was the climbing perch, Anabasscandens, which by a peculiar formation of the gillsis enabled to live for a time out of water. In one

case the fish was found alive after being seven hoursin a child’s throat. The gill-covers of this fish arebeset with spines ; these and the sharp dorsal finsmake its withdrawal almost impossible withoutlaceration of the soft parts. Fishermen in the Eastkill fish by biting through the neck; sometimesthe fish shoots out its spines and pricks the mouthof its captor causing an involuntary opening of theteeth which allows the fish to dart into the throat.If large the creature will be caught in the pharynx ;if small it may pass over the epiglottis into theoesophagus. In four of the reported cases the fishwriggled into the trachea causing asphyxia and death.The impacted fish is usually not more than 4 inches

in length, but a sole 8 inches long was found afterdeath lying with its head almost touching the cardiacorifice of the stomach. This specimen, says Mr.Gudger, is in the anatomical museum of EdinburghMuseum. When the fish has wriggled into thetrachea the patient will die if a surgeon is not at handto remove it. If the fish has worked its way into abronchus the danger to life is not so imminent althoughthe patient is in a state of great distress. A muscularItalian who suffered this misfortune struggled so

violently that five people were required to restrainhim; at the post-mortem two-fifths of the fish wasin the right bronchus, the remainder in the tracheawhere the tail was so bent as to form an incompletevalve to the opening of the left bronchus. In anothercase of this nature, where operation had been opposedby relatives and a medical colleague, the surgeonconcerned demonstrated by dissection and extractionof the fish how the patient’s life might have beensaved.Various methods of dealing with the accident are

described. If the fish is in a good position in thethroat the index-finger may be inserted betweenit and the fauces to free them from the spines andfins. If traction is made before the spines are liberatedmuch laceration of the soft parts will result. When thefish is already in the eesophagus a probang is employedto push it into the stomach ; the gastric juices willthen deal with the intruder. Day, in his work on" Indian Fishes," says the treatment for this accident’’ which is constantly occurring " is to cut throughthe fish, if still alive, causing it to die of haemorrhage,then leave it to decompose-a little smell more or lessbeing immaterial to a native of the East.

THE MODERN MICROSCOPEWE have received from Messrs. W. Watson and

Sons, Ltd. (313, High Holborn, London, W.C.1),their new catalogue of microscopes and accessorieswhich is both comprehensive and interesting. Itnot only describes the instruments offered, but itgives useful information on the method of productionand the purpose of many of the components. Modernmachine tool methods have resulted in some changesin design which are of undoubted benefit to theworker. Messrs. Watson have made full use of suchmethods with the result that a higher standard canbe reached and, most important of all, can be main-tained. They also ensure that perfect centration andalignment of optical elements on which the produc-tion of a satisfactory microscope and the formation

1 Amer. Jour. Surg., 1933, xxii., 573.

of a perfect image so largely depend. The objectiveis the heart of a microscope, and most makers haveendeavoured to improve their productions in recentyears. The finest lenses are no better than thebest of a generation past, but here again the standardhas been raised. Thus a position has been reachedwhere objectives can be relied on to do what isexpected of them ; there is a smaller difference inperformance between the best and the worst. Costhas been reduced considerably so that cheap micro-scopes with which good work can be done are againavailable. The price of simple instruments for classpurposes is even less than that of similar pre-warproductions. Messrs. Watson and Sons’ catalogueprovides an ample selection of British-made appliancesof good quality and appearance at competitiveprices.

THE MUNICIPAL YEAR BOOK

WE have received from the Municipal Journal Ltd.(3, Clement’s-inn, London, W.C.2) a copy of theMunicipal Year Book for 1934, edited by Mr. JamesForbes. The Year Book was founded in 1897 by thelate Sir Robert Donald, and from a modest volume ofunder 400 pages has now, in its 37th edition, becomean encyclopaedia of local government. In a prefaceby the Minister of Health, Sir Hilton Young callsattention to two tasks which now lie before localauthorities-namely, slum clearance and water-supply. Section 18 of the Year Book, edited byMr. J. G. Martin, secretary of the National Housingand Town Planning Council, reviews the present andfuture supply of working-class houses in sufficientdetail to allow everyone to see what the variousauthorities are doing in the matter ; the followingSection 19 on slum clearance gives full details ofclearance and improvement schemes, with the nameand official address of the officer responsible for thehousing estates. Section 34 sets out what theseauthorities are doing about supplying water. TheYear Book of course contains all the usual sectionson the public health and mental health services, andon public assistance ; but it is this quality of keepingthe book up to date on the pressing things of themoment without surrendering any of its establishedfeatures that makes it indispensable for reference.The price is 30s.

HEALTH IN EAST AFRICA

THE vital statistics of European officials in EastAfrica show over the last 20 years a materially’improving rate of mortality. During 1910-13 therate stood at 11’2 per 1000 ; during the war yearsit fell to 9’2, and in 1919-25 it declined still furtherto 6-3 ; in 1926-32 it was only 4"9 per 1000, while1932 showed the lowest rate yet recorded-viz.,3-0 per 1000. How far this decline is the result of,improved health and better environmental conditionsin work and leisure it is impossible to determine.During these years the number of officials employedhas increased from less than one thousand to overfive thousand, and it is not unlikely that the age-distribution of the population has changed. Anincrease of the numbers in the younger age-groupwould automatically favour a lower death-rate,and a more careful selection of recruits would have alike effect. How far such factors are operative thereport does not show. They would also influencethe invaliding-rate which from 1918 to 1924 fellsteeply, but since 1924 has remained approximatelyconstant. Of the 16 deaths registered in 1932 fivewere due to diseases peculiar to the tropics-threeto malaria and two to blackwater fever-the averageage at death in these cases being only 34 years. Ofthe 22 cases of invaliding, only two were due to.diseases of a tropical nature, and some half-dozenmight be placed in the psychoneurotic category.

1 Returns for 1932, published by the Crown Agents for theColonies, price 6d.

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The death- and invaliding-rates are given separatelyfor each of eight areas, but the small numbers involveddo not permit of any satisfactory comparison beingmade between their relative healthiness. All showsome improvement in their death- and invaliding-rates.

NEW PREPARATIONSAPLONA.-This preparation is prepared in a

laboratory attached to a private hospital in Munich,at the instigation of the Munich University children’sclinic, and is put on the market by Messrs. Coatesand Cooper Ltd., 94, Clerkenwell-road, London, E.C.Its prescription is a convenient method of applyingwhat may be termed apple therapeutics. Muchliterature is issued with the preparation setting outthe virtues of an apple diet, especially in the treat-ment of diarrhoea, some of the authors beingparticularly enthusiastic as to the results to beobtained from the astringent action of fruit juices,of apples in particular.TONICINE (Reed and Carnrick, Canada. Agents :

Coates and Cooper).-We have received specimensof this gonadal tonic preparation presented in twoforms, Tonicine Male and Tonicine Female. Thepreparations are put up with great neatness. Eachfluid drachm of the male formula contains testicularhormone representing fresh testicle grs. 25 : eachfluid drachm of the female formula contains ovarianhormone representing fresh ovary grs. 5. The dosein each case is two teaspoonfuls. A warning on thebottles points out that the physician should be assuredof the need of the endocrinal agent before the tonicis taken.

ANEPBDEM.—This polyvalent vaccine, which comesfrom the laboratories of the N.O.D. Institute Ltd.in Wimpole-street, has been handed over for distribu-tion by the Institute to British Drug Houses Limited.The vaccine is prepared from mutation forms of theB. coli communis, and is administered by intra-muscular injection. Each ampoule contains 1 c.cm.of the washings of 1000 million mixed micro-organisms,numerous strains of each of the following being usedin its preparation : B. acidi lactici, B. lactis œrogenes,B. pneumoniœ (Friedlander), Streptococcus fmcalis,B. morgagni, B. miaticus, B. œecalis alkaligenes,B. pyocyaneus, B. proteus, B. alkalescens, and thebacillus of epidemic jaundice.

ORGANISED CHARITYTHOSE who seek help for the unfortunate as well as

those who wish to give it wisely will make a good startif they acquire a copy of the Annual Charities Registerand Digest,l which gives a clear and orderly surveyof the scope and purpose of existing charitableinstitutions and organisations. Some slight rearrange-ment in the material has been made since lastyear ; for instance, there is now a complete sectiondevoted to the work of the public assistance committeeof the London County Council, which is set out inconsiderable detail, and all the associations dealingwith animal welfare have also been put togetherand now form a special section. The register givesa valuable analysis of practical charity, exemplifyingthe lines to be found on the title page of the currentvolume:

For everie thing that is begun with reasonWill come by readie meanes unto his endBut things miscounselled must needs miswend."

To-day, when there is so much poverty and needin our world, it is more essential than ever that thedistribution of charity should be efficient and thatwastage, either through overlapping or maladministra-tion, should be reduced to a minimum.

SOUTH AND EAST AFRICATHE Union-Castle Mail Steamship Company have

sent us a copy of the fortieth edition of the South andEast African Year Book and Guide, edited by A. S.and G. G. Brown. It contains information usefulalike to the business man, the emigrant, the tourist,

1 London : Longmans for the Charity Organisation Society.1933. Pp. 515. 8s. 6d.

the sportsman, and the student, while for the invalidthere are articles on climate and some useful notes onSouth Africa as a health resort. Appended to thebook is an atlas by Bartholomew’s containing maps,many of which have been specially drawn for this book,the price of which is 2s. 6d.

A MANUAL ON MILK

A SMALL but useful compendium of information onmilk, of particular use to those interested in thelaboratory and industrial aspects of milk production,testing, and distribution has recently been issued.1The chemical constitution and nutritive value ofdifferent types of milk, methods for examination ofquality, and a number of miscellaneous facts of interestare included. It is curious that in discussing theproduction of clean milk, the author does not mentionthe preliminary washing of the milker’s hands. Asecond edition might usefully contain informationon the extent of infection of the milk-supply withpathogenic organisms, the frequency of milk-bornedisease, and the proportion of milk pasteurised indifferent towns.

THE PROPERTIES OF CORAMINE

M.R.C.P. writes : There seems to be a widespreadbelief that Coramine exerts a direct action upon theheart. The makers of this powerful medullarystimulant have never, I believe, claimed such a

property for it, and the only apparent explanationfor the fallacy is a subconscious association of theword, coramine, with the Latin cor. The dangerof this belief lies in the likelihood that for real syncope,such as occurs in pleural shock, coramine will be used,whereas the only rational and effective medical treat-ment is injection of adrenaline into the heart cavityand muscle. Coramine is invaluable in narcosisand respiratory failure, though here it is pertinentto mention the discovery of W. P. Kennedy and B.Narayana, recently noted by you, that the depressantaction of evipan sodium on the frog’s heart isantagonised by adrenaline. -

MOTHERHOOD : A GUIDE FOR MOTHERS.-Messrs.Cow and Gate Ltd. have brought out a fourthedition of a booklet intended as a guide duringpregnancy and a fund of information on the care andtreatment of children. It is written in simplelanguage, no attempt being made to advise mothersbeyond the ordinary routine of nursery life, butwithin its compass it is conspicuously well done.The illustrations are attractive, the letterpress arreststhe attention, and there is no bias in favour of artificialfeeding. It may be recalled that this firm presentedthe Nurses’ Fund for Nurses in 1926 with a home ofrest for nurses at Clapham which is still being fullyutilised.PRACTITIONERS IN THE UNION OF SOUTH AFRICA.-

Replying to a question in the Union House ofAssembly, Capetown, Mr. Hofmeyr, the Minister ofPublic Health, said that on Dec. 31st last the numberof medical practitioners registered in the Union,and entitled to practise therein, was 2528. Medicalstudents being trained at the University of Capetownnumbered 503, and at the University of theWitwatersrand 422-a total of 925. Forty-twomedical practitioners in overseas were placed on theregister during 1933.

CORRIGENDUM.—In the article on Death-rates inGreat Britain and Sweden which appeared on p. 698of our issue of March 31st the two Figures wereinadvertently transposed. The graph reproducedas Fig. 1 represents the mortality for Scotland whilethe graph called Fig. 2 gives the mortalities forEngland and Wales.FROM April 23rd the address of the west-end

dep6t of the Crookes’ Laboratories (British Colloids,Ltd.) will be 88, Newman-street, W.1.

1 Notes on Milk. By T. J. Stewart, N.D.A., N.D.D. London:H. K. Lewis and Co., Ltd. 1934. Pp. 46. 1s. 6d.