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We arrived in Canton on a Thursday, but, unfortunately, y,could not get on to our home that night. We slept in a bed si

previously occupied by one who six weeks before had an e,

attack of dengue and still had pains. But the bedding, n

mattresses, &c., had not been sterilised, although the sheets a

had been changed. We met, also, one other person who eight r;

weeks before had an attack and still had pains. Neither of a

us were bitten by mosquitoes, which are blamed by the o

Chinese for transmitting the disease. On Friday we returned to Fatshan and next day my wife suddenly collapsed with all a

the signs of the disease and in a few hours I followed. My attack was very light and in a week I resumed my hospital b

duties, although rather hampered by pains. Almost all the b

drugs mentioned in the books I have tried on myself or my v

Chinese patients but with little success. Perhaps ammoniated c

tincture of quinine, in half to one drachm doses, gave the best gresults, but practically nothing touched the pains. But in a

reasoning about the conditions of the disease in our own case i

and comparing our experience with that of a colleague who E

had returned from Japan with us and escaped I came to f

the conclusion that we had been infected by sleeping in an B

unsterilised bed. My colleague slept in one not previously i

occupied by an infected person and has been entirely free. Then, further, I noticed that when my wife recovered a littleand went to Canton she was entirely free from pain. I, ’;

staying at home, continued to have them. She occupied an i

uninfected bed but on the next day after her return her apains were almost as bad as ever. I therefore concludedthat she was reinfected by sleeping in her own bed. So I

suggested that we should take a bath in hot water and I

some fairly strong disinfectant, and that meantime all i

mattresses, bedding, &c., should be exposed to the sun

during the day. This was done. After two days of such 1

treatment all our pains vanished, nor have they returnedWe were not taking drugs. This simple line of after-treat-ment I have, with entire success, carried out with myChinese patients, as with medicine water’ it is easy to

persuade them to sponge themselves down and to sterilise, inthe hot sun we have here, all their beds and clothes. I givesimple tonics when necessary. The treatment is apparentlyas effective as simple. I feel convinced that one reason for

the long continuance of pains is the nightly re-infection.This is quite in keeping with the fact that there is a finedesquamation of ’the skin often prolonged over two or threeweeks in some. The sun evidently speedily kills anyinfective germs in the desquamated skin dust."

A HOSPITAL FOR PAYING PATIENTS.

ON Jan. 9th the Duke of Northumberland opened thehospital for paying patients at Fitzroy House, Fitzroy-square,London, W., which has now been partly rebuilt and com-pletely renovated. In 1877 Sir Henry Burdett suggested in aletter to the Standard that an association should be formedfor the purpose of founding a hospital for well-to-do

patients, to which admission should be by payment only.A little later a public meeting was held at the MansionHouse and ultimately the Home Hospital Associationfor Paying Patients was incorporated in 1878. A sum

of over .620,000 was contributed by those interested in

the movement and in 1880 the first home hospital was

opened in Fitzroy-square. Later the association acquiredthe freehold of the neighbouring house and a lease ofother adjacent premises. Fitzroy House, as this home hospitalwas called, has for 22 years done much work for middle-classpatients, for it has always been conducted on a system whichprovides that each patient shall be charged but little overthe cost price for his accommodation and shall pay, and beattended by, his own medical man From first to last 5376

patients have been under treatment in Fitzroy House. Last

year it was recognised that the hospital must be recon-structed and largely rebuilt so as to provide a perfectlyequipped modern hospital. For this purpose it was found

necessary to raise .610,000, and of this about £2300 have

already been subscribed, leaving about £7700 yet to beraised. The work of renovation has been now completedand the new Fitzroy House contains about 40 rooms, 30of which are bedrooms. The floors have been coveredwith papyrolith, which amongst other things contains

asbestos, paper pulp, sawdust, and magnesite. This islaid like a cement and forms when dry an extremelyhard and impervious surface. A model operation-roomhas been provided on the top floor, with a north

vertical light and a top light in addition. The walls and

ceiling of the operation theatre are lined by six-inch

glass tiles. All the rooms are fitted with electric lightand the whole hospital has been decorated and fitted

in a very artistic manner. A passenger-lift working byelectricity renders easy the removal of a patient from onefloor to another. In its present condition the building is

well suited for the purpose for which it has been designed-namely, the nursing at moderate rates of middle-class patients.The fees charged are inclusive of everything except medicalattendance and range from four to ten guineas per week.The hospital is self-supporting-in fact, a very small profitis made, for the management endeavours to carry it on atas low a rate as is possible without incurring a debt, andyet the patients have all the attractions and comforts andmore than all the medical conveniences of a well-appointedhouse. It is pointed out that the hospital is to a certainextent of the nature of a charitable institution, for the

money for renovating the building has to be providedby donations, but that, inasmuch as the fees charged to thepatients only just suffice to maintain the hospital, it is

really self-supporting. Certain privileges in the way of

priority of admission are granted to those who subscribe

20 or 50 guineas. There is, no doubt, a future for institu-tions such as this when conducted on right principles,for the average private house is ill adapted for sick

nursing of any kind, and especially for operations.It is felt that there is a need for seff-supporting payhospitals in which a lower charge is made than four

guineas a week, and Sir Henry Burdett suggests that paywards should be located in ordinary hospitals and thata two-guinea or a 50s. minimum fee per week would

suffice to cover the cost of maintenance, while the patientcould select any medical man he preferred, the medical feesbeing paid out of a fund formed by putting aside 10 percent. of all moneys received. The question as to whetherthis percentage would provide sufficient funds for the

purpose appears to rest on the supposition that in manycases more than C2 10s. would be charged, as the schemesuggests that all the patients should pay what they can

afford but in no case less than the above sum.

THE COLORIMETRIC DETECTION AND ESTIMA-TION OF BORIC ACID.

SINCE it is probable that some day-and already wehave waited long-the Government may be led to adoptthe recommendation of the Foods Preservatives Com-

mittee to the effect that the use of boric acid shouldbe altogether prohibited in milk and that the quantityof the preservative should be restricted in butter and

cream, it is desirable that we should be in possessionof a trustworthy process for the detection and estima-tion of boric acid in foods. According to Mr. C. E.Cassal and Mr. Henry Gerrans, analysts engaged in theexamination of foods under the Sale of Foods and DrugsActs, the old turmeric test may be improved considerablyby adding oxalic acid. They apply the test for free or

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- combined boric acid in milk or other foods by first dryingand burning the residue to an ash. It is well to add alittle caustic baryta solution before evaporation and inci-neration as otherwise small quantities of boric acid might’be lost. The ash is treated with a few drops of dilutehydrochloric acid, then with a saturated solution of oxalicacid, and, finally, with an alcoholic solution of curcuminor turmeric, and the mixture is dried on the water bathand the residue is taken up with a little spirit. The spiritwill be coloured a more or less intense magenta red ifboric acid is present. Mr. Cassal and Mr. Gerrans state

that they have been able to employ this test for the deter-mination of the actual amount of boric acid present. Iftheir observations are confirmed this method should be of..obvious service.

____

THE CONTAGIOUSNESS OF CANCER.

IN a leading article in THE LANCET of Dec. 6th, 1902,p. 1558, we reviewed the reasons for thinking that, in spite’of the fact of our ignorance of the real etiology of cancer,we were justified in looking upon it as contagious andvin taking all those precautions to prevent its spreadwhich that theory of its origin would suggest. Dr. A. T.

Brand of Driffield has drawn our attention to the address

which he delivered last -May on the occasion of his- installation as President of the East Yorks and North,Lincoln branch of the British Medical Association. In thisaddress Dr. Brand maintains the contagiousness of cancer- and supports his contention with many of the argumentswhich we advanced in the leading article referred to, and’he quotes an instance of apparent contagion occurringwithin his own knowledge. It is in the suggestions for

prophylaxis that Dr. Brand’s address is especially interest-ing. In addition to most of the precautions which weadvocated, such as destruction of the dejecta and dressings,he mentions "notification." This might prove to be a

valuable measure as it would enable precautions to be

’taken against the spread of the malady and would give usmore accurate information as to the localities where the- disease arises than can be obtained from statistics as to the

places of death from cancer.

SCOTTISH POOR-LAW MEDICAL OFFICERS’ASSOCIATION.

THE report of this association for the year 1902 states,that during that period the committee was occupied with anumber of important questions. The secretary (Mr. W. L.Muir, 1, Seton-terrace, Glasgow) was summoned before the’Committee of the Privy Council which has for some timebeen considering the subject of the sale of poisons. His

"evidence on that occasion was to the effect that in the

Highlands, islands, and country districts where there wereno druggists it was necessary for medical men to supply thepublic with all drugs required, poisonous or otherwise, and it,was a serious hardship for a medical man to be found guilty "of "infamous conduct" by the General Medical Council because in his absence someone in his surgery had supplieda scheduled poison to a member of the public. The secretarywas also summoned before the Scottish Local Government’Board as a witness in its inquiry as to the medical relief.oE the poor. The general character of his evidence wasthat it was absolutely essential that the Poor-law medical.,officer should have a more secure tenure of office than at

present, with an appeal to the Local Government Board

.against unjust treatment ; that he should have the power of

..ordering invalid diet, stimulants, and the like, without thesame being vetoed by the inspector of poor (an official

corresponding to the clerk to a board of guardians in

,England) ; and that for all fractures, midwifery, and other..exceptional cases there should be extra fees. The Bill for

the amendment of the Local Government (Scotland) Act,promoted by the association, was persistently blocked by oneof the Scottish Members of Parliament and did not reach

the second reading. The Lord Advocate’s Bill to amend the

Local Government Act likewise never reached a second

reading, having been blocked by the same Member. Both

Bills will, however, be introduced again next session.

THE DISTRIBUTION OF PLAGUE.

As regards the Mauritius a telegram from the Governor tothe Earl of Onslow, acting for the Secretary of State for theColonies, received at the Colonial Office on Jan. 6th, statesthat for the week ending Jan. lst there were 9 cases ofbubonic plague and 5 deaths from the disease.

THE TREATMENT OF ABDOMINAL CONTUSIONWHEN RUPTURE OF THE INTESTINE IS

POSSIBLE.

WE have recently called attention to the difficulty andeven impossibility of diagnosing rupture of the intestine incases of abdominal injury. The great importance of earlyoperation has led American surgeons to advocate the per-formance of laparotomy within a few hours of the injuryin all serious cases of abdominal contusion. In the BostonMedical and Surgical Journal of Nov. 27the, 1902, Dr. F. B.Lund relates six cases of early laparotomy in rupture of theintestine with four recoveries-eloquent testimony of thevalue of this treatment. He points out that beyondthe fourth or fifth hour after injury every hour adds tothe danger, and that the surgeon cannot afford to wait

for certain signs of perforation. In his successful cases theinterval between the injury and the operation was three,five, nine, and 16 hours respectively ; in his unsuccessfulcases 18 and 24 hours respectively. One case presented theremarkable feature that apparently there was no contusionof the abdominal wall but that there was of the back.

The patient was a man, aged 40 years, who was taken tohospital six hours after he was struck in the back, belowthe left shoulder blade, by the shaft of a wagon and knockeddown. He felt faint for a time. Severe abdominal pain,chiefly above the umbilicus, followed. He soon got up andwas able to walk three-quarters of a mile. A cup of tea

which he drank brought on vomiting and the pain increased.On admission the pulse was 92, thready, and of low tension ;the temperature was subnormal ; the lips were pale and theface was ashen. The abdominal wall showed no evidence of

injury. The abdomen was distended and everywhere wasrigid and tender. There was no dulness, even in theflanks. On the back, over the left tenth rib, aboutthree inches from the middle line, was a red contusedarea. Immediate operation .was advised but declined. A

high enema brought away but little faeces. A quarter of agrain of morphine injected subcutaneously gave only slightrelief. He grew steadily worse and 18 hours after the injuryconsented to operation. On opening the abdomen muchdark-brown fluid, evidently bile-stained, and flakes of fibrinand particles of food escaped. The peritoneum of the smallintestine was congested and covered with fibrinous exuda-tion. A perforation which easily admitted the forefingerwas found in the jejunum opposite the mesenteric attach-ment ; extending downwards from it in the long axis of thebowel was a peritoneal tear one and a half inches long.Owing to its position and to abdominal rigidity the per-foration was sutured with difficulty. The patient recoveredwell from the operation, the pain ceased, and the pulseimproved ; but on the second day after the injury severediarrhoea began. It was controlled by opium and he

improved. On the third day he again became worse and he

1 THE LANCET, Jan. 25th, 1902, p. 247.