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the Council of the Association to appoint a commission toinquire into the question of the results obtained in the

treatment of fractures by operative and non-operativemethods. We await with anxiety the report of the

commission, though doubtless many months must elapsebefore any report can be ready. It is difficult to overratethe importance to the community of the decision on thismatter. The inquiry must include the examination of theresults of the older method, both at its best as well as atits worst ; and the same will, of course, apply to the morerecent operative method, for it would surely not be fair tocompare the best results obtained by so skilful a surgeon asMr. Lane with the non-operative results of a medical

practitioner who has not devoted special attention to thisbranch of surgery. The collection of material for the reportwill be a valuable work, and we trust that a very largenumber of surgeons will cooperate in the carrying out of avaluable investigation. -

TYPHOID SPERMATOCYSTITIS AND PROSTATITIS.

IT is now recognised that so-called enteric fever is a general infection with the typhoid bacillus, and that the " complications" are inflammations produced locally by the Ibacillus. To the long list of these lesions, involving almost r

every structure in the body, Dr. J. W. Marchildon. assistant professor of bacteriology in St. Louis University, working .,

under Professor Pick at the Stadtisches Krankenhaus in

Friedrichshain, Berlin, has added two-spermatocystitis andprostatitis. He has reported the results of his investigation in the American Journal of the Medical Sciences for July. It

has been shown that apparently healthy people (typhoidcarriers) may have typhoid bacilli in their bladders for yearsafter an attack of enteric fever. It appears that during theattack they are excreted by the kidney, and that the urinebecomes a culture medium for them. In some cases cystitisis produced, in others there is merely bacilluria. Hence ithas been recommended to give some urinary bactericide

during convalescence from enteric fever. In some cases so

treated the bacilli disappear from the urine, but reappeara few weeks after the treatment is stopped. This

result has been attributed to the presence of ulcera-tive cystitis, which is a source of infection. Thatthis is not the only explanation Dr. Marchildon foundin the two following cases. A lad, aged 17 years, was

admitted into hospital comatose on the fourteenth day of asevere attack of enteric fever, and he died at the end of ninedays from perforation. At the necropsy Professor Pickfound typhoid ulceration of the ileum with perforation,fibrino-purulent peritonitis, cystitis with a small haemorrhage,purulent spermalJocystitis and inflammation of the rightvas deferens, ulcer on the epiglottis, parenchymatousnephritis with miliary abscesses, obliterative pleurisy, andbronchitis. The seminal vesicles were enlarged and reddenedand fluctuated. They contained purulent fluid from whichthe typhoid bacillus was cultivated. Microscopic examina-tion of the left vesicle showed that the mucosa was in some

places destroyed and in others distorted and infiltrated. Thelumina were dilated and filled with an acute cellular exudatewhich was partly necrotic and showed clumps of typhoidbacilli. The prostate was normal. In the second case a

man, aged 28 years, was admitted into hospital with the

diagnosis of typhoid fever of about ten days’ duration.Death from haemorrhage from the bowel occurred four dayslater. At the necropsy Professor Pick found typhoid ulcera-tion of the ileum, icterus, acute enlargement of the spleen,parenchymatous nephritis with small abscesses, acute purulentprostatitis, enlarged mesenteric glands, and acute catarrhof the duodenum. The prostate gland was enlarged,especially in the right lobe. There was an area of the

size of a bean containing purulent granular material. On

pressure pus exuded from the lobes. From the spleen,lymphatic glands, and prostate gland the typhoid bacilluswas cultivated. Microscopic examination of the prostategland showed an acute purulent exudation with breakingdown of the glandular cells. The vesiculæ seminales werenormal. Dr. Marchildon suggests that after enteric feverthe prostate gland and vesiculæ seminales may harbour

typhoid bacilli for a long time, and that the bacilli mayreadily pass into the urine with the semen or prostatiesecretion, reach the bladder, and produce typhoid bacilluria.Thus may be explained the recurrence of typhoid bacilluriaafter suspension of treatment. The importance of this

subject in connexion with typhoid carriers is obvious.

CENTRAL PUBLIC-HOUSE TRUST ASSOCIATION.

THE annual report of the association shows that thenumber of Public-house Trust companies remains the sameas last year, 37, while the number of houses under Trustmanagement is now 262. It is satisfactory to note that outof the 37 companies only seven are not yet in the positionof paying a dividend. The principal development of thePublic-house Trust movement during the past twelve.

month has been in the home counties, the Herts andEssex Trust Company having extended its operations toMiddlesex, Bedfordshire, Berkshire, Buckinghamshire, Oxford.shire, Leicestershire, and Rutland, a plan which saves

preliminary costs and costs of central management. Newlicences have been granted at Crosby (Lincs.), Harden

and Thorne Collieries, and at the Edinburgh corporationmarkets at Gorgie. We are glad to see that the movementis making steady progress, not only in extension of area andin number of houses controlled, but also in the direction ofdeveloping the trade in food and non-alcoholics at the

expense of the alcoholic trade. The report calls forcibleattention to the operation of the Finance Act, and points outthat its present provisions penalise improvements designedto build up a non-alcoholic trade and to further the pro.gressive reforms of the Trust Association. The associationrecommends that the tax should be not upon the premises(thus penalising tea- and dining-room accommodation), butupon the trade which is created by the licence-i.e., thetrade in alcoholic drinks. It would certainly be regrettableif it were found that the Finance Act placed a serious

obstacle in the way of such an excellent movement as that ofthe Public-house Trust Association.

THE DIAGNOSIS OF MALIGNANT DISEASE.

IN another column we publish an article by Dr. Elsie M.Royle on the aid which chemical examination of the urinemay afford in the diagnosis of malignant disease. Dr.

Royle’s investigations have enabled her to prove that incases of cancer the uric acid is usually higher than is foundin healthy cases under similar conditions ; further, that theoutput of phosphates in the urine is in the majority of casesof cancer decreased when compared with healthy individuals;

and finally, that the ratio of phosphates. is almost invariably uiic acid

reduced in malignant disease. Acting on these resultsDr. Royle suggests that a chemical analysis of the urine mayprove of value as an aid to diagnosis in obscure cases of

cancer, especially when the abdominal organs are the seatof the disease. The differential diagnosis of malignantdisease from gall-stones, gastric ulcer, chronic pancreatitis,and other morbid conditions is frequently very difficultand any reliable auxiliary test would be welcome. Dr,Royle, however, prudently observes that her investiga-tions are not complete and that this communication is

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only intended as a preliminary one. The cases she has

examined point to the proposed test as a useful one,but before the value in diagnosis of the facts provedin her paper can be clearly established it will be necessaryto determine how far they are true of other forms of

cachexia, and what their relation may be to the secondaryansemia usually present in malignant disease. Dr. Royle isat present engaged in working out these questions, and theresults will be awaited with interest. The technique of thechemical tests is not a complicated one.

THE King has augmented his yearly subscription to KingEdward’s Hospital Fund for London from £500 to f:l000,and His Majesty is anxious that the date of augmentationshould coincide with that of his first visit to the London

Hospital since the accession. His Royal Highness the Princeof Wales has forwarded E100 to King Edward’s Hospital Fund as an annual subscription.

THE King has granted to Dr. Hugh Campbell Highet,medical officer of health at Bangkok, His Majesty’s Royallicence and authority to accept and wear the Order of theWhite Elephant of the Third Class, which has been conferredupon him by His Majesty the King of Siam in recognition ofvaluable services rendered.

AMONG those to whom His Majesty the King, Sovereignof The Order of Mercy, has been graciously pleased to

sanction the award of the Order are Mr. A. T. Scott,M.R.C.S. Eng., and Mr. W. Chearnley Smith, M.B.,C.M. Edin.

__ __

ON the recommendation of the Prime Minister, the Kinghas sent from His Majesty’s Royal Bounty £150 to the fundwhich Sir William P. Treloar is raising on behalf of the

widow of the late Mr. H. W. Cox and her family.

Mr. John Hammond Morgan, C. V. O. , F. R. C. S. Eng., hasbeen promoted from Honorary Associate to Knight of Graceof the Order of the Hospital of St. John of Jerusalem in

England.

PORTSEA IMPROVEMENT SCHEME.—An admirablescheme for the improvement of Portsea (Portsmouth) hasbeen drafted by Dr. A. Mearns Fraser, the medical officer ofhealth. The available area is very rigidly bounded, andconsists of some 2 acres, on which it is proposed to erect46 houses, roughly 20 houses per acre, to let at rents of7s. and 7s. 6d. (inclusive of rates and taxes) in the case ofresidences and at 8s. 6d., plus rates and taxes, in the case offour shops. It is proposed to layout this area as one longroad, 40 feet wide, stretching from Queen-street to Kent-street. The road will be planted with trees, the houses setback from the road, and a portion of ground, about 1000square yards in area, between the road and the houseswill be used as an open space, planted with trees, and

asphalted. Four different types of houses are provided, eachbeing carefully designed to meet the requirements of someparticular class of tenant. The houses are a great improve-ment on many working-class dwellings, the report statingthat the object has been to design "more healthy, moreconvenient, and more cheerful houses " than has often beendone. As Dr. Mearns Fraser points out, " it is but little morecostly to make a beautiful than an ugly street," and thereconstruction when finished will add a very handsome andattractive road and effect an extraordinary improvement inPortsea. The report further points out that the scheme maybe continued at some future time so as to give St. George’s-square an approach through into Queen-street, and inci-dentally transform the worst conglomeration of slum propertyin the borough into a model working-class residential neigh-bourhood. Improvements of this character must add verygreatly to the health of the district, and Dr. Mearns Fraser isto be congratulated on an excellent piece of constructivework. i

PUBLIC HEALTH ADMINISTRATION INHAMBURG.

BY W. E. HOME, M.D., B.SC. EDIN., M.R.C.P. EDIN.,D.P.H. R.C.P.S. EDIN.,

FLEET-SURGEON, ROYAL NAVY.

The Disinfectiny Station.BY the kind permission of Professor Medizinalrat Dr.

Nocht I was recently permitted to learn something of themethods of disinfection practised in Hamburg and to visitthe central disinfecting station.Hamburg is a city of 800,000 inhabitants. All its institu-

tions are on a large scale, so one is not surprised to findthat this one department of the sanitary administra-tion of the city employs 214 men. When notificationof a case of infectious disease has been received anddisinfection ordered, the sanitary authorities send out a

party of disinfectors dresssed in sterilised overalls, cap,blouse, trousers, and boots, and (in case of plague) gloves, too.These men collect the articles to be disinfected, sprinkle themwith disinfectant, and roll them in sheets, over which animpervious cover is now fastened to confine the infection asmuch as possible. The room or house is then cleaned, specialcare being taken to clean the walls and floors of sputa whichmay possibly be tuberculous. After this formalin vapour,produced by boiling the solution, is employed. The materialsfor disinfection are removed to the central station, where themen who have done the work get hot baths and change theirsuits. Meanwhile the room, every crevice in which has been

pasted up, is saturated with formaldehyde. When thissaturation has continued long enough liquor ammoniæ isboiled into the room through a keyhole; thus the acid isneutralised and the room can be entered and aired.The disinfecting station to which the fomites are removed

is divided into two, the infected side and the clean side.These departments are divided by a wall 50 yards long,which runs through the establishment. This wall hasno doors but is pierced by six steam disinfectors and bythe bath rooms for men and women. Each side has its own

staff, and to get from one side to the other it is necessary topass through the open air. In this way the attendants are

prevented from negligently crossing without disinfectingthemselves, and so accidents are avoided. Clothes andfurniture for disinfection are examined on arrival at this

station ; if grossly soiled they are first boiled for an hour,but if fit for disinfection they are carefully numbered andlabelled. The disinfection is done by a current of steam at102° C. and the articles are laid out on the trays of the dis-infectors (iron frames with wire meshes which are coveredwith coarse sacking) ; at this temperature the clothes are notscorched. Five of these disinfectors are large ovals and areworked by current steam at 102° C. ; another smaller circulardisinfector is used for delicate materials, for leather, &c. Inthis under reduced pressure (water boiling at 80° C.) infectedarticles are exposed to formalin and steam. This method ismore expensive, but so far no complaints of damage havebeen made. There is also a temporary chamber for theformalin disinfection of articles insufficient in number to fillone of the large steam disinfectors. A single disinfectionin the large apparatus costs 4s.The bath rooms for infected persons run completely across

the building. They are entered from the infected yard andtheir exit is in the disinfected yard. The bathers enter, taketheir clothes off, and send them up in a lift to be dis-infected. They then spend an hour or so taking their baths.A notice which I saw gives very complete directionsfor the cleansing of hands. The nails are to be cut andscrubbed, the space under the nail and the nail fold are tobe cleaned with the scissors supplied, then the hands arescrubbed first with disinfectant and then with spirit. Nextthe hair (it was in the temporarily unoccupied ladies’ divi-sion I read the notice) must be washed and cleaned withspirit under the supervision of the bath attendant. Afterthis a bathing-cap is put on in order that the hair may notbecome wet in the ensuing bath. When the bath is com-

pleted the " contact " passes to the clean side, where the nowdisinfected clothes are received down a lift, and the dis-infecting process concludes. An inventory of the clothes fordisinfection which have been taken from the infected side has