1
835 real estate. With reference to the remarks upon the sale and purchase of invested funds or stock, although in no way justifying, except as a last resource, the sale of invest- ments to meet current expenditure, I hardly think the non- payment of tradesmen’s bills for goods supplied at a low rate under contract would be justified, when it is remembered that a large proportion of the investments has been made from legacies without restrictions, and from donations equally free. In many cases these contributions have been received in excess of the requirements of the time, and have been prudently invested by a committee of management with a view to making use of them when the current receipts fall short of the expenditure. Of course it may be argued that beds should be closed if money is not forth- coming, but I am afraid few committees would be found willing to incur a responsibility so largely affecting the in- terests of the sick poor. It must be remembered that benevolent testators can bequeath legacies for " per- manent" investment, thus placing it out of the power of committees of management to adopt the course you depre- cate. I am, Sir, your obedient servant, NEWTON H. Nixorr, Secretary. t’mMrmtv CnIIem Hn’m!. Nov. flth. 1RS::B. NEWTON H. NIXON, Secretary. " No mention is made of University College Hospital in the legal text-books, nor is the fact of this power to receive real estate brought out by the hospital authorities. This twofold omission has probably led to serious loss to the hospital authorities, and should be remedied. We did not advocate the non-payment of tradesmen’s bills, as Mr. Nixon appears to think. If he will read the article again, he will see that we advocate the opening of a rest or deposit account to which all legacies should be carried in the first instance, and from which the current account should be replenished when needful; the balance of deposit account to be invested, or any overdraft thereon to be made good by sale of stock, if necessary, in February in each year. .. The closing of beds is aweak, unworthy, and expensive method of making both ends meet, and should be avoided.-ED. L. PICRIC ACID AS A URINARY TEST WHEN THE PATIENT IS TAKING QUININE. To the Editor of THE LANCET. SIR,-Some months ago Dr. George Johnson advocated in your columns the use of picric acid as a test for albumen in the urine; and his letter elicited an extensive correspon- dence. It was stated that picric acid was a much more delicate test than either heat or cold nitric acid, and would disclose the presence of albumen where these entirely failed. The requisite conditions are very simple :-An acid reaction and an absence of turbidity, both easily procured by a drop of acetic acid and a piece of filtering paper, if not present already. The suspected urine having been poured into a test tube to the height of tnree or four inches, an inch or so of a saturated watery solution of picric acid is gently floated on its surface; the appearance at once of an opalescent ring at the line of contact of the fluids shows the presence of albumen. One point was mentioned as apt to occasion error; when the urine contains an excess of urates, even though no albumen is present, a reaction occurs, but not till after some minutes, and on close examination it may be seen to be made up of small crystals which disappear on the application of heat, whilst the albumen reaction is granular and is rather increased by heat. An accident has brought under my notice another fact to which attention has, I think, not yet been drawn. I had carefully tested for albumen a urine which was clear, pale acid, and of specific gravity 1006, with negative results (heat and cold nitric acid being used), and was somewhat astonished to find that picric acid at once produced a most copious opalescence exactly resembling that produced by albumen, and showing no crystals under the microscope. A few days later a second sample, of specific gravity 1008 and acid, yielded similar results; and recollecting that the patient Was taking five grains of quinine four times a day, I applied the picric acid test to a dilute solution of that drug, which I found behaved exactly as the urine had done. To corrobo- late the observation two male patients with healthy genito- urinary organs were placed on three-grain doses of quinine every four hours for two days, and their urine then tested. In each instance no trace of albumen could be detected (the specific gravity being 1010 and 1015 respectively), but picric acid at once produced a copious opalescent ring. In each instance the application of heat cleared up the opalescence. Quinine is said to be almost entirely eliminated through the kidneys ; and the reaction above mentioned I take to be due to the presence of this alkaloid. Whatever value may be attached to the picric acid test for albumen, and I believe it to be a very sensitive one, it will be well to recollect this reaction which occurs when patients are taking full doses of quinine; and it may also be an advantage occasionally to be able to demonstrate by this means at the bedside that a patient has recently taken this drug, I am, Sir, yours obediently, Hull, Oct. 30th, 1883. J. FRANK NICHOLSON. J. FRANK NICHOLSON. "MEDICAL BULLETINS." To the Editor of THE LANCET. SiR,-Like Dr. Carpenter, I entirely disapprove of mis- leading or dubious statements, and I quite recognise the necessity of bulletins concerning illustrious individuals to allay public anxiety. My contention is that such bulletins should deal with conclusions, not with the grounds on which those conclusions are based, and of which the public cannot possibly estimate the value. I am glad that Dr. Carpenter is able to tell us that the late Archbishop’s medical advisers were in no way answerable for some very minute details about his illness which found their way into one at least of the daily papers.-I am, Sir, your obedient servant November, 1883. A. R. G. LIVERPOOL. (From our own Oorrespondent.) THE SCHOOL OF MEDICINE. THE recent appointments of Dr. Hyla Greves and Mr. F. T. Paul as medical and surgical tutors respectively, have proved of great benefit. There is an ample supply of subjects in the dissecting-room, and all the classes are well attended. REMARKABLE CASE OF HERNIA. Mr. Banks recently operated in a case of ventral hernia. The patient was a middle-aged collier, who could not work on account of it, so much did it inconvenience him. Mr. Banks cut down upon the sac, and, carefully dissecting it out, proceeded to open it ; he then found a great mass of omen- tum, most of which was adherent. It was carefully sepa- rated and ligatured in several pieces with catgut and silk thread, Over three-quarters of a pound was cut away and the pedicle dropped mto the abdomen. The sac was tied with catgut and cut off close to the orifice. By the fifth day the external wound was sound, without a drop of pus, and the patient has not had a rise of one degree in temperature. Mr. Banks hopes that with an abdominal belt and pad further protrusion will be avoided. THE ALLEGED CASES OF ARSENIC POISONING. An order has been received from the Home Secretary by the local authorities for the exhumation of the body of Margaret Jennings, who died in January last and was buried at Ford cemetery. The death was certified as due to pneu- monia, but it is believed that it was caused by arsenic ad- ministered with a felonious intent. DEATH OF A LOCAL VETERAN. Dr. John McNaught of this city died in London on the 3rd inst. He was born in 1793, and had thus reached the ripe age of ninety. He graduated at King’s College, Aberdeen, taking the M.D. degree in 1815, in which year he also be- came L. R. C. S. Edin. In the earlier part of his life he practised for many years in Jamaica. Returning to England he attended lectures at University College, London, be- coming F.R.C.P.Edin. in 1833. He was a resident in Liverpool for upwards of forty years, was president of the Medical Institution in 1868-9, and for twenty years held the office of physician to the Blind Asylum. On resigning this office he was presented with a valuable piece of plate in recognition of his services.

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835

real estate. With reference to the remarks upon the saleand purchase of invested funds or stock, although in noway justifying, except as a last resource, the sale of invest-ments to meet current expenditure, I hardly think the non-payment of tradesmen’s bills for goods supplied at a low rateunder contract would be justified, when it is rememberedthat a large proportion of the investments has been madefrom legacies without restrictions, and from donations

equally free. In many cases these contributions have beenreceived in excess of the requirements of the time, and havebeen prudently invested by a committee of managementwith a view to making use of them when the current

receipts fall short of the expenditure. Of course it maybe argued that beds should be closed if money is not forth-coming, but I am afraid few committees would be foundwilling to incur a responsibility so largely affecting the in-terests of the sick poor. It must be remembered thatbenevolent testators can bequeath legacies for " per-manent" investment, thus placing it out of the power ofcommittees of management to adopt the course you depre-cate. I am, Sir, your obedient servant,

NEWTON H. Nixorr, Secretary.t’mMrmtv CnIIem Hn’m!. Nov. flth. 1RS::B.

NEWTON H. NIXON, Secretary.

" No mention is made of University College Hospital inthe legal text-books, nor is the fact of this power to receive realestate brought out by the hospital authorities. This twofoldomission has probably led to serious loss to the hospitalauthorities, and should be remedied. We did not advocatethe non-payment of tradesmen’s bills, as Mr. Nixon appearsto think. If he will read the article again, he will see thatwe advocate the opening of a rest or deposit account towhich all legacies should be carried in the first instance, andfrom which the current account should be replenished whenneedful; the balance of deposit account to be invested, orany overdraft thereon to be made good by sale of stock, ifnecessary, in February in each year. .. The closing of beds isaweak, unworthy, and expensive method of making bothends meet, and should be avoided.-ED. L.

PICRIC ACID AS A URINARY TEST WHENTHE PATIENT IS TAKING QUININE.

To the Editor of THE LANCET.SIR,-Some months ago Dr. George Johnson advocated in

your columns the use of picric acid as a test for albumen inthe urine; and his letter elicited an extensive correspon-dence. It was stated that picric acid was a much moredelicate test than either heat or cold nitric acid, and woulddisclose the presence of albumen where these entirely failed.The requisite conditions are very simple :-An acid reactionand an absence of turbidity, both easily procured by a dropof acetic acid and a piece of filtering paper, if not presentalready. The suspected urine having been poured into atest tube to the height of tnree or four inches, an inch or soof a saturated watery solution of picric acid is gently floatedon its surface; the appearance at once of an opalescent ringat the line of contact of the fluids shows the presence ofalbumen. One point was mentioned as apt to occasionerror; when the urine contains an excess of urates, eventhough no albumen is present, a reaction occurs, but not tillafter some minutes, and on close examination it may beseen to be made up of small crystals which disappear on theapplication of heat, whilst the albumen reaction is granularand is rather increased by heat.An accident has brought under my notice another fact to

which attention has, I think, not yet been drawn. I hadcarefully tested for albumen a urine which was clear,pale acid, and of specific gravity 1006, with negative results(heat and cold nitric acid being used), and was somewhatastonished to find that picric acid at once produced a mostcopious opalescence exactly resembling that produced byalbumen, and showing no crystals under the microscope. Afew days later a second sample, of specific gravity 1008 andacid, yielded similar results; and recollecting that the patientWas taking five grains of quinine four times a day, I appliedthe picric acid test to a dilute solution of that drug, whichI found behaved exactly as the urine had done. To corrobo-late the observation two male patients with healthy genito-

urinary organs were placed on three-grain doses of quinineevery four hours for two days, and their urine then tested.In each instance no trace of albumen could be detected (thespecific gravity being 1010 and 1015 respectively), but picricacid at once produced a copious opalescent ring. In eachinstance the application of heat cleared up the opalescence.Quinine is said to be almost entirely eliminated throughthe kidneys ; and the reaction above mentioned I take to bedue to the presence of this alkaloid. Whatever value maybe attached to the picric acid test for albumen, and I believeit to be a very sensitive one, it will be well to recollect thisreaction which occurs when patients are taking full doses ofquinine; and it may also be an advantage occasionally to beable to demonstrate by this means at the bedside that apatient has recently taken this drug,

I am, Sir, yours obediently,Hull, Oct. 30th, 1883. J. FRANK NICHOLSON.J. FRANK NICHOLSON.

"MEDICAL BULLETINS."To the Editor of THE LANCET.

SiR,-Like Dr. Carpenter, I entirely disapprove of mis-leading or dubious statements, and I quite recognise thenecessity of bulletins concerning illustrious individuals toallay public anxiety. My contention is that such bulletinsshould deal with conclusions, not with the grounds on whichthose conclusions are based, and of which the public cannotpossibly estimate the value. I am glad that Dr. Carpenteris able to tell us that the late Archbishop’s medical adviserswere in no way answerable for some very minute detailsabout his illness which found their way into one at least ofthe daily papers.-I am, Sir, your obedient servantNovember, 1883. A. R. G.

LIVERPOOL.(From our own Oorrespondent.)

THE SCHOOL OF MEDICINE.

THE recent appointments of Dr. Hyla Greves and Mr. F.T. Paul as medical and surgical tutors respectively, haveproved of great benefit. There is an ample supply of subjectsin the dissecting-room, and all the classes are well attended.

REMARKABLE CASE OF HERNIA.

Mr. Banks recently operated in a case of ventral hernia.The patient was a middle-aged collier, who could not workon account of it, so much did it inconvenience him. Mr.Banks cut down upon the sac, and, carefully dissecting it out,proceeded to open it ; he then found a great mass of omen-tum, most of which was adherent. It was carefully sepa-rated and ligatured in several pieces with catgut and silkthread, Over three-quarters of a pound was cut away andthe pedicle dropped mto the abdomen. The sac was tiedwith catgut and cut off close to the orifice. By the fifth daythe external wound was sound, without a drop of pus, andthe patient has not had a rise of one degree in temperature.Mr. Banks hopes that with an abdominal belt and padfurther protrusion will be avoided.

THE ALLEGED CASES OF ARSENIC POISONING.

An order has been received from the Home Secretary bythe local authorities for the exhumation of the body ofMargaret Jennings, who died in January last and was buriedat Ford cemetery. The death was certified as due to pneu-monia, but it is believed that it was caused by arsenic ad-ministered with a felonious intent.

DEATH OF A LOCAL VETERAN.

Dr. John McNaught of this city died in London on the3rd inst. He was born in 1793, and had thus reached the ripeage of ninety. He graduated at King’s College, Aberdeen,taking the M.D. degree in 1815, in which year he also be-came L. R. C. S. Edin. In the earlier part of his life hepractised for many years in Jamaica. Returning to Englandhe attended lectures at University College, London, be-coming F.R.C.P.Edin. in 1833. He was a resident inLiverpool for upwards of forty years, was president of theMedical Institution in 1868-9, and for twenty years held theoffice of physician to the Blind Asylum. On resigning thisoffice he was presented with a valuable piece of plate inrecognition of his services.