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1041 PARIS. (FROM OUR OWN CORRESPONDENT.) Colloidal Gold in the Treatment of Infected Wounds. M. Cuneo and M. Polland have been using colloidal gold in a whole series of infected traumatisms in which the phenomena of infection persisted in spite of the usual surgical measures. The gold was injected intravenously, intramuscularly, or hypo- dermically in the peripheral zone of the infected region. The clearest and most valuable results have been obtained in large wounds of limbs with infection by anaerobic microbes. In these cases a marked fall of temperature ensues, together with considerable diminution in the number and quality of pulsations and a return towards normal of the arterial pressure. Local modifications may also be observed in the wound; a diminution of the foetid odour and secretion and attenuation of the oedema. These latter phenomena are even more influenced by local injections of colloidal gold. In penetrating wounds of the abdomen medi- cally treated the authors have used this remedy as a preventive measure. In pyogenous infections the results of injections of colloidal gold have been less clear, perhaps because the authors have been led to employ them more in cases of infection of the serous membranes, where a local reaction sufficient to stop the processes of suppuration was not to be expected. The intravascular injections are followed by violent reaction; a severe rigor may last for 40 minutes. Sometimes the countenance becomes slightly cyanosed, the temperature rises, and the pulse is quickened. An abundant perspiration sets in later and may last sometimes several hours. When given intramuscularly colloidal gold gives rise to no reaction. It may be injected by this route up to 50 c.c. at a single time and several days in succession. Used thus the gold has a mode of action milder but also slower than that by the intravascular route. These in- jections may be also made by means of a long needle around the limits of the infected tissue, avoiding the vessels so as not to provoke by the entrance of some drops of the liquid directly into the blood the violent reaction of an intravenous injection. Intravenous injection is definitely indi- cated only where rapid effect is sought. In individuals with lowered tension recourse had better be had, at first at any rate, to the intra- muscular route. Injections around the wound are especially indicated when a local action is desired. Conservative versus Radical Operations in the Surgery of the Limbs. M. Mauclaire has reported to the Societe de Chirurgie on the work of Dr. Lapoi te, who between Oct. 26th and Feb. 7th was at the iront on medical duty, ten miles from the firing line. Here he saw more than 4000 wounded pass through his ambu- lance, and close on 800 operations were done, nearly all by himself. Out of this number, 547 presented fractures, crushings, and lacerations (arrachements) of the limbs. In the upper limb, out of 317 wounded 145 that were not operated on gave 9 deaths ; out of 172 operated on, 104 by conservative operations gave 34 deaths, 68 by radical operations 11 deaths, or a total of 54 deaths. In the lower limb, out of 228 wounded, 90 not operated on gave 11 deaths; out of 138 operated on, 75 conservative operations gave 34 deaths, while 63 mutilating operations gave 28 deaths, or a total of 73 deaths. In the upper limb among the radical operations performed there were 68, with 11 deaths, or a mortality of 16 per cent. Three disarticula- tions of the wrist, 5 amputations of the forearm, 2 disarticulations of the elbow, all primary, had no deaths. Out of 42 amputations of the arm there were 6 deaths, of which 2 out of 33 primary amputations and 4 out of 9 secondary, 16 disarticu- lations of the shoulder gave 5 deaths, of which 2 out of 12 primary disarticulations and 3 out of 4 secondary disarticulations. Total, 4 deaths out of 55 primary radical operations, and 7 deaths out of 13 secondary. In the lower limb 65 mutilations out of 63 wounded, with 28 deaths, mortality 43 per cent. Three economic operations on the foot gave 3 cures; 21 amputations of the leg gave 5 deaths, of which 3 were in 17 primary and 2 in 4 secondary amputations ; 40 amputations of the thigh gave 22 deaths (or 55 per cent.), of which 12 occurred in 25 primary and 10 in 15 secondary amputations. One primary disarticulation of the hip was followed by death. Nearly all the amputations were done by the circular method. For the disarticulation of the shoulder and for some high amputations of the arm and the leg, M. Lapointe employed " racket" " amputation. He left the greater part of the stumps uncovered, because most of the wounds at the time of arrival at the ambulance were very seriously infected. For the sterilisation of instruments and gloves M. Lapointe employs sodium borate. The site of operation and the dressings have been treated in the same method up to the day when M. Lapointe was able to procure trioxymethylene and to prepare dry dressings instead. He has used oxygenated water, permanganate of potash, formol solution, 5 per 1000, and tincture of iodine. Death of Dr. Thoinot. Dr. Thoinot, professor of legal medicine at the Faculte de Medecine, and a member of the Académie de Medecine, has died very suddenly. In 1906 he succeeded his teacher, Brouardel, in the professorial chair. He was physician to the Hopital Laennec, and from the beginning of the war medecin principal at the Val-de-Grace and head of the service of contagious diseases. His writings are of import- ance, while as an expert he was highly esteemed in the judicial world, and his medico-legal work had gained for him an international reputation. May 8th. IRELAND. (FROM OUR OWN CORRESPONDENTS.) An Association of "Medical Advisers." A NUMBER of the " medical advisers " and " certi- fiers " of the Irish Insurance Commission met in Dublin last week to form an organisation in defence of their interests. Having elected officers and a committee, they passed a resolution declaring their wish to assist in a settlement of the certification question, provided their own interests were safe- guarded. It is generally thought that the present system of certification is about to be abandoned. The Medical Profession and the War. A committee has been appointed by the medical profession in Belfast (a) to make arrangements for looking after the practices of those who may become whole-time medical officers under the R.A.M.C., and (b) to form a list of practitioners willing to serve as whole-time officers for a short period.-At a meeting of the board of management of the Benn Ulster Eye, Ear, and Throat Hospital, held in Belfast on May 6th, it was decided to allow Dr. I. A. Davidson and

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1041

PARIS.

(FROM OUR OWN CORRESPONDENT.)

Colloidal Gold in the Treatment of Infected Wounds.M. Cuneo and M. Polland have been using colloidal

gold in a whole series of infected traumatisms inwhich the phenomena of infection persisted in spiteof the usual surgical measures. The gold wasinjected intravenously, intramuscularly, or hypo-dermically in the peripheral zone of the infectedregion. The clearest and most valuable resultshave been obtained in large wounds of limbs withinfection by anaerobic microbes. In these cases amarked fall of temperature ensues, together withconsiderable diminution in the number and qualityof pulsations and a return towards normal ofthe arterial pressure. Local modifications mayalso be observed in the wound; a diminutionof the foetid odour and secretion and attenuationof the oedema. These latter phenomena are evenmore influenced by local injections of colloidalgold. In penetrating wounds of the abdomen medi-cally treated the authors have used this remedy asa preventive measure. In pyogenous infections theresults of injections of colloidal gold have been lessclear, perhaps because the authors have been ledto employ them more in cases of infection of theserous membranes, where a local reaction sufficientto stop the processes of suppuration was not to beexpected. The intravascular injections are followedby violent reaction; a severe rigor may last for40 minutes. Sometimes the countenance becomesslightly cyanosed, the temperature rises, and thepulse is quickened. An abundant perspirationsets in later and may last sometimes severalhours. When given intramuscularly colloidal goldgives rise to no reaction. It may be injected bythis route up to 50 c.c. at a single time andseveral days in succession. Used thus the goldhas a mode of action milder but also slowerthan that by the intravascular route. These in-

jections may be also made by means of a longneedle around the limits of the infected tissue,avoiding the vessels so as not to provoke by theentrance of some drops of the liquid directly intothe blood the violent reaction of an intravenousinjection. Intravenous injection is definitely indi-cated only where rapid effect is sought. Inindividuals with lowered tension recourse hadbetter be had, at first at any rate, to the intra-muscular route. Injections around the wound areespecially indicated when a local action is desired.Conservative versus Radical Operations in the

Surgery of the Limbs.M. Mauclaire has reported to the Societe de

Chirurgie on the work of Dr. Lapoi te, who betweenOct. 26th and Feb. 7th was at the iront on medicalduty, ten miles from the firing line. Here he sawmore than 4000 wounded pass through his ambu-lance, and close on 800 operations were done, nearlyall by himself. Out of this number, 547 presentedfractures, crushings, and lacerations (arrachements)of the limbs. In the upper limb, out of 317 wounded145 that were not operated on gave 9 deaths ; outof 172 operated on, 104 by conservative operationsgave 34 deaths, 68 by radical operations 11deaths, or a total of 54 deaths. In the lowerlimb, out of 228 wounded, 90 not operated on

gave 11 deaths; out of 138 operated on, 75conservative operations gave 34 deaths, while 63mutilating operations gave 28 deaths, or a total of73 deaths. In the upper limb among the radical

operations performed there were 68, with 11 deaths,or a mortality of 16 per cent. Three disarticula-tions of the wrist, 5 amputations of the forearm,2 disarticulations of the elbow, all primary, hadno deaths. Out of 42 amputations of the armthere were 6 deaths, of which 2 out of 33 primaryamputations and 4 out of 9 secondary, 16 disarticu-lations of the shoulder gave 5 deaths, of which2 out of 12 primary disarticulations and 3 out of 4secondary disarticulations. Total, 4 deaths out of55 primary radical operations, and 7 deaths out of13 secondary. In the lower limb 65 mutilations outof 63 wounded, with 28 deaths, mortality 43 percent. Three economic operations on the foot gave3 cures; 21 amputations of the leg gave 5 deaths,of which 3 were in 17 primary and 2 in 4 secondaryamputations ; 40 amputations of the thigh gave 22deaths (or 55 per cent.), of which 12 occurred in 25primary and 10 in 15 secondary amputations. One

primary disarticulation of the hip was followed bydeath. Nearly all the amputations were done by thecircular method. For the disarticulation of theshoulder and for some high amputations of the armand the leg, M. Lapointe employed " racket" "

amputation. He left the greater part of the stumpsuncovered, because most of the wounds at thetime of arrival at the ambulance were very seriouslyinfected. For the sterilisation of instruments and

gloves M. Lapointe employs sodium borate. Thesite of operation and the dressings have beentreated in the same method up to the day whenM. Lapointe was able to procure trioxymethyleneand to prepare dry dressings instead. He hasused oxygenated water, permanganate of potash,formol solution, 5 per 1000, and tincture of iodine.

Death of Dr. Thoinot.Dr. Thoinot, professor of legal medicine at the

Faculte de Medecine, and a member of the Académiede Medecine, has died very suddenly. In 1906 hesucceeded his teacher, Brouardel, in the professorialchair. He was physician to the Hopital Laennec,and from the beginning of the war medecinprincipal at the Val-de-Grace and head of the serviceof contagious diseases. His writings are of import-ance, while as an expert he was highly esteemed inthe judicial world, and his medico-legal work hadgained for him an international reputation.May 8th.

IRELAND.

(FROM OUR OWN CORRESPONDENTS.)

An Association of "Medical Advisers."A NUMBER of the " medical advisers " and " certi-

fiers " of the Irish Insurance Commission met inDublin last week to form an organisation in defenceof their interests. Having elected officers and acommittee, they passed a resolution declaring theirwish to assist in a settlement of the certificationquestion, provided their own interests were safe-guarded. It is generally thought that the presentsystem of certification is about to be abandoned.

The Medical Profession and the War.A committee has been appointed by the medical

profession in Belfast (a) to make arrangementsfor looking after the practices of those who maybecome whole-time medical officers under theR.A.M.C., and (b) to form a list of practitionerswilling to serve as whole-time officers for a

short period.-At a meeting of the board of

management of the Benn Ulster Eye, Ear, andThroat Hospital, held in Belfast on May 6th, itwas decided to allow Dr. I. A. Davidson and

Page 2: IRELAND

1042

Dr. W. A. Anderson leave of absence for one year, ithey having offered their services to the WarOffice, and to keep their positions open for them.As a result the out-patient department will be

open only three days a week.

LUNACY IN EGYPT.THE FINAL REPORT FOR THE YEAR 1914.

RECENTLY we reviewed the delayed reports of :1912 and 19131 dealing with lunacy in Egypt, and inow we have the final report of 1914 before us. As 7in Dr. J. Warnock’s previous reports, we get a most (

complete history of the work carried on. And this 1has been done under trying conditions, as, owing to ]the death of Dr. Pearson, deputy superintendent, 1the administration has been short-handed. There

is again complaint made that there is not sufficient.accommodation for the patients, so that many haveto be discharged before they are really mentally 4

stable; hence relapses are frequent, and criminalacts are done by the unstable convalescents. Inthe main building at Abbassia the recent and acute Icases are received, while at Khanka the more calmand chronic cases are occupied in agriculture. The Ireport is for English readers chiefly interestingfrom the special causes of insanity, and for the

medico-legal aspect of the partly cured patients.Pellagra is a great cause of insanity; in fact, is

given as the chief cause. Of 700 admissions, 132were suffering from pellagrous insanity, 94 fromhashish, and 40 from alcohol. General paralysisprovided 41 cases. A very interesting table is the oneshowing the offences and forms of insanity of the 54male accused persons, and the forms of insanity ofthe 21 male convicted prisoners admitted in 1914. Ofthe 54, 12 were suffering from pellagrous insanity,and 8 from that due to hashish. Of the 75 in whomthere was a history of crime, 10 were pellagrous,and 6 of the insane from hashish were convicted ofmurder or murderous assaults. Every form ofcrime is represented by the pellagrous insane, butviolence is the most common. Thirty-eight deathswere due to pellagra, but others suffering fromtuberculosis had pellagra as well.

Nearly 6 per cent. of the male admissions weresuffering from general paralysis, and 25 of the 125deaths of male patients were due to the samedisease. There was a slight decrease in the numberof patients suffering from hashish insanity. Con-

sidering the prejudice against post-mortem ex-

aminations, it is interesting to find that 56 wereperformed. Dysentery was, as usual, ,nB}>.I’S&bgr;ented,but was only responsible for nine deaths.A pathological laboratory has been started, and

as a result a special ward for observation andtreatment of ankylostomiasis was opened. Onehundred and ten patients were recently examined,and 29 proved to be infected; these were treatedwith thymol. No patient succeeded in committingsuicide. A good many accidents occurred, due toviolence in the overcrowded wards.The report of Dr. H. W. Dudgeon for the Khanka

Asylum is brief, but points to the steady developmentof the subsidiary asylum. It is also the model for a

working asylum which is carried out and developingunder rather trying conditions.The Lunacy Department now being a branch of

the Ministry of the Interior, and having an officialhead in Dr. Warnock, time and money alone are

required to make the work very satisfactory as well.as instructive.

1 THE LANCET, Jan. 30th, 1915, p. 243.

SERVICE MEDICAL OFFICERS AND THEINCOME-TAX.

THERE are no doubt many medical men on war servicewho from one cause or another have not taken up thequestion of their income-tax for the past year and are notacquainted with their rights in regard to any tax that mayhave been paid in excess of their true liability. The servicemedical officer’s position in regard to the income-tax is,moreover, of interest to those whose liability, though notaffected for the year 1914-15, will be affected for the currentyear owing to the interference with their general practice.Before dealing with the matter it may be remarked that anofficer who is in doubt as to the manner in which the taxthat he has paid has been arrived at can obtain full

particulars on application to the Surveyor of Taxes in regardto the private practice, and to the Assessor at the War Officeor Admiralty in regard to official pay and allowances.

Claims for Adjustment.The tax charged on pay and allowances is, of course,

deducted by the paymaster, but unless the recipient hastaken steps to ensure allowance of any relief due to him thetax will have been deducted at the full rate. The import-ance of taking measures to obtain any adjustment that maybe due will be realised from the fact that in the case of earnedincomes it is only where the total income from all sourcesexceeded ,f,2500 that the full rate of ls. M. for the pastyear was payable ; on smaller incomes there was relief of8d. in the ;S. where the total income was not more thanE1000, 6d. where not more than .61500, 4d. where not morethan ,f,2000, and 13d, where not more than &2500. In

regard to this type of relief it must be observedthat it is now too late to make any claim unlessthe officer filled in a statement of total incomefrom all sources before Sept. 30th last, either by wayof a specific claim to the earned income rate or in theordinary course in making his professional return for theyear 1914-15. The possibility to be guarded against is that,while relief has been allowed on the professional assessment,the reduction in the rate has not been extended to the WarOffice or Admiralty pay. Forms were issued to enableofficers to make claims or to declare the address from which

they had already claimed, and in cases where these wereduly completed there is little likelihood of overcharge underthis head ; but it is not too late to obtain relief where anofficer, having duly made his statement of total income fromall sources locally, did not notify the War Office or Admiralty.The original statement will, of course, have proved inaccuratein the light of subsequent events, but it operates as

a notification of claim, and an amended statement may nowbe put in for the purpose of obtaining repayment of anyovercharge.

In this connexion there arises the question of theamount to be regarded as income from the practice forthe year 1914-15 by those who for part of the year wereengaged on war service. This matter was dealt with by thesecond Finance Act of last year. The assessment on the

profits of the practice was originally made on a figureintended to represent the average profits of the three pre-ceding years, but a special provision enacts that wherea person has been serving as a member of the militaryor naval forces, or in any work abroad of theBritish Red Cross Society, St. John Ambulance Associa-tion, or any other body with similar objects, the assess-

ment shall be reduced to the amount of the actual profitsof the year and repayment of duty made where necessary.To secure this adjustment it will be necessary to submit tothe Surveyor of Taxes an account of the receipts and expensesof the practice for the year 1914-15, prepared on the linesindicated in THE LANCET of April 24th, p. 878, and fromthat official may also be obtained the form necessary for anyother repayment that may be due. In cases where thepractitioner usually makes up his accounts to Dec. 31st andnot to March 31st, it will be well to make an adjustment inorder that full effect may be given to any falling off ofreceipts after Dec. 31st. This may be done by subtitut’ngthe receipts in the first quarter of 1915 for those in the firstquarter of 1914, and adding to the expenses of the year 1914a sum representing the extra expense incurred by the employ-ment of a locum-tenent for the first quarter of 1915. If it benot convenient to an officer to go fully into the matter at the