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Notes, Short Comments, and Answersto Correspondents.

THE PROFESSIONAL ASPECT OF MISSIONARY HOSPITALS.

MISSION hospitals may be regarded as in some sort the outposts of

medical science, for they often afford opportunities for observingdisease under conditions that exclude some of the obscuring factorsincidental to the observation of the same diseases in the complexenvironment of civilised life. For this reason a tentative report ofthe professional work of the Tainan Hospital, Formosa (MedicalReport of the Tainan Hospital, English Presbyterian Mission,Formosa, 1912), by the medical staff-Dr. James L. Maxwell and Dr.G. Gushue-Taylor-is welcome. It is a modest little pamphlet, hardlysuggesting the value of some of the observations it contains. It is

based on a study of the hospital in-patients alone, who in 1912numbered 2734. One-third of these were eye cases, and for the most

part call for no special notice, but a case of interest was that of a youngman with an enchondroma of the frontal sinus, the size of a golf ball,which had pushed the orbital plate downwards, displacing the eyeballdownwards and outwards to an extreme degree, without seriouslyimpairing the visual power, however. After shelling out the tumourit was found that the lower wall of the frontal sinus prevented thereturn of the eyeball. The bone was chipped away, and in a fewmonths the eye appeared quite normal in both vision and movements.An observation on tuberculosis is also very interesting, in view of thedivision made by many observers between the clinical manifestationsin the human of the bovine and the human bacillus respectively; forwhile beef is never eaten and fresh milk almost never used in that

locality, tuberculosis is very rife in all its known forms. In nearly- everyhospital case an examination of the stools was made. Anky-lostomum infection was found in about 20 per cent. of the whole, butit rose to 40 per cent. in farmers and to nearly 100 per cent. inmarket gardeners. Ankylostomiasis, however, was present in onlyabout 10 per cent. of those affected by the worm. Beta-naphthol,which is far less toxic than thymol, gave the authors the best results. Acondition far from rare, and one not mentioned in text-books on tropicalmedicine (unless it is to be regarded as a form of Banti’s disease),is one in which the spleen and liver are enlarged, the latter beingeirrhosed, terminating in an extreme ascites. It appears to correspondwith the condition recently described as Egyptian splenomegalia.Sequestrotomy of one or both jaws for necrosis was performed ninetimes, a considerable proportion out of 2734 patients. The authors attri-bute the frequency to the anaemic sequela of chronic malaria renderingthe patients especially susceptible to septic infection from the teeth.Formidable as the operation appears, they regard it as extremelysimple and safe, and on more than one occasion they have sub-periosteally resected the whole of the necrosed lower jaw on bothsides from within the mouth at one operation. Surgery, even inits simplest form, is practically unknown to the Chinese doctors inthat region, all surgical cases being treated by the application ofcaustics, causing ulceration of the skin-a serious complication in thecases that reach the hospital. Abdominal operations were 70 in

number, mostly gynaecological or obstetrical, but in one case a

bamboo chopstick, 10 inches long, was removed from the stomach andduodenum with an excellent result. Eight ileo-colic anastomosesfor chronic irreducible intussusceptions suggest a case-incidence rareindeed in Western lands. The cause of the trouble seems to have been’the presence of tuberculous masses in the ctcum. In discussing theuse of salvarsan the authors relate a very suggestive case-one ofextreme dyspncea from syphilitic laryngitis, which would formerlyhave been submitted to tracheotomy on admission. An injection ofsalvarsan was given instead, and in a few hours " the case completelycleared up and the patlent left with a healthy and intact larynx."There were two deaths, however, which are believed to have been theresults of the injection itself. They are attributed to the use oftubes bought from a local Japanese firm, for all the other casestreated with this particular batch exhibited abnormal symptoms.Altogether this report is very interesting, and it is to be hopedthat Dr. Maxwell and Dr. Gushue-Taylor will be able to continueand expand their tentative publication, and that other missionaryhospitals in remote places, where diseases must often appear understrange guises and in exaggerated forms, will follow their praise-worthy example.

"THE OYSTER SUPPLY."

"D. T. B." writes to us to point out that the problem of preventing inall tidal rivers and estuaries the oyster beds being contaminatedby sewage emptied into rivers is impossible, in his opinion.’Remedy will only be partial," he says, "while wholesale dischargesof sewers are allowed to be made into the sea from coast towns.

Sewage is like oil, and simply floats on the surface of sea-water forhours before it is absorbed or assimilated, so that directly the tideebbs and falls the sewage drifts into the rivers and gets deposited onthe mud banks. The question is truly national as shown by thewaste of valuable material for the land and the spoiling of food forthe people."

THE MEDICAL GOLFING SOCIETY.

THE annual tournament of this society will be held on Thursday,June 5th, at Oxhey, near Watford, Herts, by kind invitation of OxheyGolf Club. Anyone on the Medical or Dental Registers can join bypayment of the annual subscription of 5s., which includes entranceto the tournament. Cards may be handed in till 6.30 P.M. Play willbe as follows : 18 holes match play v. bogey under handicap. Class 1,handicaps 10 and under. Class 2, handicaps over 10. Handicap limit 18.The Henry Morris Challenge Cup and the Medical Golfing Society’sgold medal will be awarded for the best return under handicap. Afirst and second prize and a prize for the best last nine holes will begiven in each class. A foursome sweepstake will be arranged in theafternoon. Players must send subscription and entry with lowestclub handicap on or before Monday, June 2nd, to Mr. L. Eliot Creasy,M.R.C.S., honorary secretary and treasurer, Medical Golfing Society,36, Weymouth-street, London, W. In addition to the above a week-end meeting of the Medical Golfing Society will be held at Le TouquetGolf Links the last week-end in June. First-class week-end ticketfrom Charing Cross, 30s. Members can leave London on Saturdayafternoon, play two rounds on Sunday, and return Sunday night,arriving Charing Cross 10.45 P.M. The Golf Hotel at Le Touquet,adjoining the first tee, has arranged to take members en pension at16 francs per day.

ESPERANTO.

THE Swiss Esperanto Medical Association has sent an invitation to theUniversal Esperanto Medical Association, asking that the annualcongress of the latter be held in Bern during the Ninth InternationalEsperanto Congress. This will commence on August 24th next, andthe University authorities have granted the use of the Universitybuildings for the purpose. The invitation has been accepted. Therewill be one or two meetings of the Universal Esperanto MedicalAssociation during the Seventeenth International Medical Congressin London.

THE SOUTH SEAS ON THE KINEMATOGRAPH.

THOSE who are fond of travel in generally unknown regions will findnot a little of interest in the matinee kinematograph displays at theVictoria Palace, Victoria-street, S.W., of the " Wonders of the SouthSeas," which constitute a moving picture record of Mr. Jack London’sfour years’ voyage in the Snark. They show scenes and incidents inthe Hawaiian Islands, the Marquesas and Samoa, Fiji, the NewHebrides and the Solomon group, the Sulu Archipelago and NewGuinea, Borneo, Sumatra, Java, and New Zealand. There is much

of anthropological interest in the display.

THE annual meeting of the Children’s Fresh Air Mission will be heldin Staple Inn Hall, Holborn, W.C., by kind permission of the Insti-tute of Actuaries, on Wednesday next, April 30th, at 3.30 P.M., SiWilliam H. Dunn presiding.

ARRANGEMENTS have now been completed for the celebration in Londonof the British Pharmaceutical Conference. There will be a receptionat the Guildhall on July 21st, and scientific meetings and excursionshave been arranged for the three following days.

Hersey inquires for the names and addresses of the publishers of anysatisfactory text-books in English, French, or German dealing withSwedish remedial exercises suitable for medical men or those desirousof giving some study to the matter. The particular point of interestis the treatment of slighter cases of lateral curvature of the spine,also kyphosis and flat foot, knock-knee, and weak ankles ; also suit-able exercises for children with hemiplegia and infantile paralysisaffecting various parts of the body.

L.R.C.P.Ed.-The decision of the Royal College of Physicians ofLondon was published in THE LANCET of Dec. 21st, 1912, p. 1742. The

newspaper cutting sent by our correspondent is not quite accurate.

F.-We can only answer such questions when they are forwarded bythe patient’s medical adviser.

COMMUNICATIONS not noticed in our present issue will receive attentionin our next.

METE OROLOGICAL R E A D I N G S.

(Taken daily at 8.30 a.m. by Steward’s Instrummt8.)THE LANCET Office, April 23rd, 1913.