1501A PRELIMINARY NOTE ON "PERMEATION."

members of the Royal Family, and was opened on

May 19th by H.R.H. Princess Henry of Battenberg, whomade a number of purchases and visited the inoculationlaboratories before leaving the hospital. The stalls were

very tastefully arranged and contained many articles of greatbeauty and variety ; the Regent’s Park Centre contributed aroom full of antique furniture, which perhaps representedthe greatest monetary value, but the stalls stocked by thestudents and their friends and the nursing staff proved thatthe utmost interest and enthusiasm had been displayed intheir furnishing and arrangement by the workers in thehospital. Other notable departments were the bookstall ofthe St. George’s, Hanover-square, Centre, which exhibited a fascinating collection of choicely bound volumes, andthe flower, fruit, and country produce of the MaryleboneCentre. A large number of entertainments and " sideshows " had been arranged, including an exhibition of

microbes, useful and baneful, and the refreshment

stall served an elaborate dinner on each night. Thefête was opened on the second day by the Lord Mayorand Lady Mayoress in state and on the third day by Lady4e Grey. Excellent military bands were in attendance andthe many attractions drew a large company of visitors toSt. Mary’s. We hope that the treasurers of the f 6 te may beable to announce the complete success of its object. The

hospital serves an enormous district of half a million

persons and the need for increased accommodation is

urgent. Although the fête is over we are asked to statethat it is not too late to send cheques to the secretary onbehalf of the fund for opening the Clarence wing.

A PRELIMINARY NOTE ON "PERMEATION."

UNDER the above heading we have received a communica.tion from Dr. G. Scheltema detailing a process whichhe thinks may be of value in certain circumstances. He

states that if a long, thin, and flexible string or tube beinserted into the oesophagus, the end inserted beingthickened, forming a "pilot," the peristaltic movements ofthe alimentary canal will propel the pilot through the entirelength of this canal and expel it per vias naturales. Byusing an elastic tube, armed with a pilot, I I it is possible toinstitute a kind of exploration of a part of, or of the wholeof, the canal. And every inch of this canal is laid open forlocal examination and local treatment." Dr. Scheltema pro-poses to call this method "permeation." He has effected

’complete permeation only twice and the operation proved tobe "successful and harmless." He believes that the method

may render important services to medicine and also to physio-logy and bacteriology. He further suggests that in the acute- or subacute diseases of the gastro-intestinal tract in childrensuch a measure may be useful; likewise that in the evacua-tion of intestinal parasites permeation may prove of value byenabling the physician to destroy ankylostomum duodenale,tæniæ, oxyuris vermicularis, and so on, by using smallerdoses of drugs than is now possible. Dr. Scheltema hopesthat other observers will try this process and states that it ishis intention to publish his future experience after moretrials. Until such communications have been recorded wecannot express any opinion on the value of permeation ; atpresent it seems to us a process of some complexity and’doubtful utility.

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THE BELFAST HEALTH COMMISSION.

Colonel T. Walter Harding, chairman of the recent Belfast Health Commission, has addressed a letter to us withreference to our article on the findings of that Commissionwhich appeared in THE LANCET of May 9th and convicts usof a slip in our review of the report with reference to the usemade by the Commission of its independent estimate ofthe Belfast population in arriving at its verdict in regard

to the death-rate. Colonel Harding says that although it istrue that this estimate has been used for the purpose of

comparing Belfast with itself-that is, for comparing theBelfast death-rate for a given year, or period of years, withthe Belfast death-rate for another year or period of years-ithas not been used for the purpose of comparing the Belfastdeath-rate with that of other towns. Our article certainlysuggests the reverse and we are happy to correct what mighthave been an important error. What the Commission hasdone for the latter purpose is to use official estimates of

population only-namely, the Irish Registrar- General’s ownestimates when comparing Belfast with other Irish towns,and estimates framed according to the method employed bythe English Registrar-General when comparing Belfast withEnglish towns. The necessity for this procedure arose inconsequence of the discrepancy existing between the resultsarrived at by the two official methods of estimating popula-tion and the desirability of comparing Belfast not only withtowns in Ireland but also with towns in England and Scot-land.

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HENOCH’S PURPURA SIMULATING INTUS-

SUSCEPTION.

IN the Scottish Medical and Surgical Journal for AprilMr. David M. Greig has reported a case in which Henoch’spurpura simulated intussusception and led to the perform-ance of laparotomy. As this error has been made severaltimes it is important to be alive to its possibility. The

patient was a boy, aged nine years. On Sept. 22nd hevomited and his parents supposed that he had eaten

something which disagreed with him. On the following dayhe complained of pains in the legs and had some diarrhoea,passing blood and slime. On the 25th he had recovered and

played about. He jumped from a wall and was supposed tohave hurt his left knee, for it became swollen. On the 26ththe knee was well again but at night he complained ofsevere abdominal pain and the diarrhoea returned. His

family physician saw him and found that he was sufferingfrom abdominal pain, vomiting, and diarrhoea, with muchtenesmus and passage of blood. Not unnaturally intus-susception was diagnosed. A few purpuric spots were seenon the legs but their significance was not grasped. On the28th the boy was admitted into the Dundee Royal Infirmaryunder the care of Mr. Greig. His face was pinched anddrawn, he had a distinct "abdominal look," and his eyes werestaring and slightly turned upwards. His pulse was weakand rapid, and his tongue was dry and coated with brownfur. The surface of the body was hot and he lay with hisknees and thighs flexed and groaned as if in pain. At

intervals he vomited small quantities of brownish-yellowoffensive fluid, and he complained constantly of thirst.The abdomen was tense and rigid but not distended. On

palpation resistance was most marked to the right of themiddle line a little below the level of the umbilicus. Underchloroform a small firm tumour was felt there. It was freelymoveable and slipped away from between the fingers. No

purpuric spots were observed and with such a history andphysical signs Mr. Greig naturally accepted the diagnosis ofintussusception. The abdomen was opened in the middleline and the tumour was easily delivered through the wound.It was found to be due to great congestion of the lower endof the ileum which projected like a collar into the caecum.There was no obliteration of the lumen, for the finger couldeasily be passed through the projection by inverting thebowel. It was evident that this collar of ileum had beenmistaken for an intussusception. The abdomen was closedand a small dose of opium was given. On the following daythe condition of the child had improved, the vomitinghad ceased, and there was little abdominal pain. He

complained of thirst and was given sterilised water