985

in all probability act like a foreign body and will give riseto peristalsis, and the persistence of this peristalsis will leadto an invagination of the portion of bowel to which theabnormal process is attached, and thus an intussusceptionwill be developed. The museum of the Royal College of tISurgeons of England contains a specimen showing an inverted Sl

Meckel’s diverticulum which led to a fatal intussusception. NAn instance of this rare cause of intestinal invagination liis recorded in this number of THE LANCET and the suc-

a

cessful issue was due to the early recognition of the tl

intussusception by the medical man, Mr. E. L. Hunt of n

Shenstone, and the prompt operative treatment which was d

was adopted by Mr. H. G. Terry at the Bath Royal United I:Hospital. Mr. Carwardine has reported a case in which a tistill rarer morbid condition resulted from the presence of a t,

persistent vitelline duct. A child died when three days old c

and it was found that a large- Meckel’s diverticulum existed i]

and that this had become distended with meconium and t’

had taken a twist of three turns, when complete intestinal t

obstruction had occurred. - 10

a

A DISCUSSION will take place at the Hunterian Societyupon the Present Methods of treating Tuberculosis on the a

evenings of Wednesdays, April 8th and 22nd, commencing at b

8 30. On Wednesday, April 8th, an introduction to the tdiscussion will be made by the President, Dr. Stephen H. t

Appleford. A debate on the Treatment of Tuberculosis in i

Sanatoriums compared to that in Private Practice will be I

opened by Dr. G. Newton Pitt ; Dr. H. G. Felkin will open a 9 tdebate on the Influence of Location ; and Dr. T. N. Kelynack E

t

will open a debate on the Selection and Classification of EPatients in Sanatoriums. On Wednesday, April 22nd, Dr. f

T. H. A. Chaplin will open a debate on Infection, Reinfection, 1’:

and Multiple Infection ; the Surgical Aspect of the Treat- t

ment of Tuberculosis will be discussed by Mr. W. Knight x

Treves ; and Modifications with respect to Comfort, Exer- xcise, Rest, and Recreation will be suggested for consideration {

by Dr. T. Glover Lyon. There will be an exhibition of plans 1

and models of sanatoriums in the theatre of the LondonInstitute, Finsbury-circus, E. C., where the discussion will be I

(

held and where a lantern and screen will be available for the .,exhibition of slides.

_

<- -

j

THE reports by the chemist and the medical officer of C

health, together with a bacteriological report by Dr. F. W.Andrewes, on the condition of the atmosphere of the CentralLondon Railway, have been printed for the London CountyCouncil and published this week. The conclusions are

identical with those upon which we commented in our issueof Feb. 21st, p. 538. While the amount of carbonic acid

gas considerably exceeds that found in the air above the

ground the number and kind of organisms were practicallythe same as those in the outside air. There is no reference

to the existence, origin, or nature of the peculiar sickly smellof the air in the tube.

____

Dr. J. McNaughtan, medical officer of the Scotch Prison

Service, and Mr. N. A. Humphreys, the chief clerk to the

Registrar-General’s Department, have been appointed by theKing as Companions of the Imperial Service Order in

recognition of long and meritorious service in the CivilService.

__

His MAJESTY THE KING has acceded to the request ofthe board of management of the National Hospital for theParalysed and Epileptic (Albany Memorial), Queen-square,Bloomsbury, to accord his patronage to the charity.

Professor W. A. Tilden D.Sc., F.R.S., has been electedPresident of the Chemical Society.

THE ROYAL NAVY MEDICAL SERVICE.

THE First Lord of the Admiralty, Lord Selborne, dis-

ibuted the prizes on March 31st, at Haslar Hospital, to the-iocessful candidates in the instructional course at the Royalavy Medical School. The ceremony took place in the

brary attached to the museum and the company numbered3out 70, chiefly composed of the student surgeons and ofie medical officers from the various establishments in Ports.iouth harbour, from the harbour ships, and from the Marineep&ocirc;ts.Sir H. F. NORBURY, Director-General of the Medical

apartment of the Royal Navy. said that they were all glad) welcome Lord Selborne at Haslar Hospital and proceeded) read the report of the inspector-general on the work andonduct of the students who had attended the course ofistruction ac the school. He was glad to say that the sum)tal of the marks gained compared favourably with the)tals recorded on former occasions.Lord SELBORNE then presented the gold medal and a

licroscope to Surgeon M. J. Laffan, and the silver medalnd some books to Surgeon A. D. Spalding.Lord SELBORNE then proceeded to address those presentnd said : It has been the greatest pleasure to me to comeere to-day to give away the prizes at the end of thisourse. The Haslar Naval Hospital is the headquarters ofhe medical department of the navy, and I always thinkhat one of the great glories of the naval service is thatj takes to itself all the other great professions-the,riest, the soldier, the engineer, and the surgeon-andives to each of them a blend of the sea in addi-ion to his own peculiar professional qualities, and in

very sense he is the better for this blend of the sea.

iometimes I am told that although a man may be the betteror it he is handicapped in his professional career by the,bsence of certain opportunities. Now, to take the case ofhe medical officer, I quite admit that in the navy you willLot have all those opportunities for constant observation andaried practice which your friends, the civil practitioners,nay have. I also admit that in going into the navy you areLbandoning the chance of those great prizes and of the wealthvhich the more fortunate medical man in civil practice mayacquire. But remember that it is not always the man wholeserves success who obtains it and there is many a clevernedical man in civil practice who has never yet achieved thatvealth which his real ability with opportunity should haveenabled him to attain. There are many qualities that make’or success, which is achieved not by ability alone but by a)ombination of many qualities and also by luck. In

leliberately exchanging this chance by entering the navalservice you know that you have achieved for yourself a3erfect certainty of position. You have looked forward into;he future of your life and know exactly what your life canae. You can say to yourself, "If I choose I can serve mycountry with great honour to myself and advantage to theservice." You leave care in its strictest sense behind you andyou know what the future will give you. If you have themerit you can achieve great honour for yourself and yourfamily. Perhaps the Admiralty has not done all that it

might have done in the past towards enabling the navalmedical man to keep pace with the scientific progress andadvance of medicine, but there has been great difficultyin the matter owing to the shortage of medical officer".The navy has expanded by leaps and bounds. Nearly130,000 men will be voted for the navy next year,whereas they had only 60,000 15 years ago. It hasbeen difficult for the medical department of the navyto keep pace with this great expansion, and it hasfollowed that there has not been the number ofofficers to make it possible for the Admiralty to give thestudy leave between commissions which I admit frankly isessential if an officer is to keep abreast with the scientificadvances in his profession. But it is very little after allthat the Admiralty can do for them because a man

is really what he makes himself and not what theAdmiralty makes him or any other body of people can makehim. What you have to ask yourselves all through yourprofessional life is this : ‘ I know the disadvantages which Isuffer from in comparison with my civilian friends, but am Iusing all the advantages I have?" How many of your civilianfriends will have the opportunities of study that you will

986 T

have ? If you choose you can use the time at your disposal 5to keep yourself abreast of advances in medicine by reading c

the literature of your profession. Again, you will have very gpeculiar opportunities of observation which are denied to t

your civilian friends at home. Your special service willgive you special opportunities. I sometimes wish very much c

that the great triumphs of Manson and of Bruce had (

been naval triumphs and whether they were to have a

naval conquest of that sort was as open to the naval lofficer as it was open to Dr. Manson. We are only !’at the beginning of our knowledge in these mattersand although you will not have those opportunities of con- istant study into the mystery of cancer which your friends athome will have yet there is the almost equal mystery ofMediterranean fever which the civilian at home will not havethe opportunity of studying and which is a world of sciencefor you to conquer. You know what work has been doneat Haslar and at Malta-and I may say that at those placesperhaps more has been learned in respect of the true know-ledge of Mediterranean fever than in any other laboratoriesin the world ; still the opportunities that you have of study-ing this subject are very great and you know much betterthan 1 do how much greater they are. Apart, however, fromthese special opportunities of study I want each of youofficers entering the naval medical service to remember thatit is your duty by every suggestion that you can make tocontribute to the welfare of the service and the advancementof medical science. Do not think that suggestions are notwelcome. In my opinion, the man who shuts his ears tosuggestions is a fool ; the man who is successful in his

work, who gets the reputation of always being able to over-come the difficulties of the moment, who has a reputationfor resourcefulness, is in nine cases out of ten a manwho opens his ears to any suggestions that others maybring him. I could not do my work as First Lord of the

Admiralty for one week on my own brain. It is becauseI am only too glad-and my colleagues are only too glad-tohave suggestions in regard to the solution of problems thatthe work is carried on. We never shut our ears to anysuggestions whatsoever. Many suggestions doubtless are

futile and also foolish, but if you are not prepared to listento them you will not get the advantage of any good sugges-tion that may be offered. What I say is that it is the dutyof everyone in responsible positions of authority to receivesuggestions and it should be the ambition of all youngofficers to make suggestions, of course only after carefulthought and accurate observation. If an officer makesrandom suggestions he is destroying, and deservedly so, hisown reputation. The study of these questions applies toevery department of the work that lies before you. Takethe battleship, for instance, in which you will serve. Thereis a problem, as yet unsolved, that has puzzled the brainsof the most capable and experienced officers-the problemof forecasting the conditions under which it will bepossible to deal with the wounded in naval actions. No onequite knows, because the conditions will be so different fromany of which they have had any experience. I was told onlya day or two ago that Sir Frederick Treves had said aboutthe war in South Africa that if a tent could be pitched overevery wounded man where he fell and if he could be treatedthere the loss of life in war would be enormously diminished.The loss of life is from the moving of the wounded manand not so much from the wound received. In a battleshipyou have practically a tent over the man where he falls, butall the men could not be treated immediately. There wouldnot, however, be all that difficulty in dragging him to abase hospital in a cart or heavy wagon causing him tobe torn asunder with pain. The difficulty, however, remainsof how the medical officer is to get at the wounded. I

only put this forward as a kind of idea that occurred to meof the sort of problem I would try to solve if I were a navalmedical officer. The King, the country, and the Board ofAdmiralty mean the navy to be the best navy in the world.That does not mean only the best ships and the greatestnumber of them but that every part of the navy shallbe perfect in every part of its administration. Con-

sequently the naval medical department must be perfectand that depends in the first place on the officers andthen on the appliances which on their advice the Admiraltysupplies. I consider it to be the duty of the Board of Ad-miralty to spare no money which the taxpayer will give toput everything at your disposal that science can suggestto make the naval medical service a pattern to all themedical services in the world. In conclusion I congratulate

you, Staff-Surgeon Bassett-Smith, on the success of thiscourse for which you are chiefly responsible, and I also con-gratulate you on your promotion which I now inform youthat the Board of Admiralty has conferred upon you.

Sir HENRY NORBURY then proceeded to read the marksobtained by the student surgeons attending the instructionalcourse.

Inspector-General R. W. COPPINGER, in charge of HaslarHospital, then expressed the thanks of those present to :LordSelborne for his presence at the gathering.Lord SELBORNE briefly replied, saying that he was much

indebted to them for the kind invitation to be present.The proceedings then terminated.

THE THIRD REPORT OF THE ROYALCOMMISSION ON SEWAGE

DISPOSAL.

I As shown in its third report just issued the labours of

the Royal Commission on Sewage Disposal cannot be con-sidered to be near the end. In fact it is obvious that theCommissioners find that the scope of their inquiry widensas their investigations are pursued. The contamination of

oyster beds is a case in point. It is equally obvious thatthey are gathering information of the most valuable kind

and that the members are a very capable body of menwho mean to make their inquiry as thorough as possible.It will be remembered that the Commission was ap-pointed in 1898 "to inquire and to report what methodsof treating and disposing of sewage may properly be

adopted. " Three years after this appointment was made

an interim report was issued which was dealt with ina leading article in THE LANCET of August 10th, 1901,p. 376. In this report the Commissioners felt justified

in concluding (1) that peat and stiff clay land are gene-rally unsuitable for the purification of sewage ; (2) that itis practicable to produce by artificial processes alone, either

. from sewage or from certain mixtures of sewage and trade refuse, effluents which will not putrefy (this conclusion led: to the Commission expressing the opinion that under properi safeguards the present rule as regards the application ofsewage to land might be modified) ; and (3) that the creation; of a separate commission was demanded or a new department) of the Local Government Board which shall be a supreme} rivers authority dealing with matters relating to rivers and} their purification. In the second report the methods of9 bacteriological analysis adopted by the Commission werei described and at the same time the importance of bacterio-3 logical examination was emphasised in view of the facts that though purification of sewage was undoubtedlyi effected by bacterial agencies, yet the resulting effluentsf were not bacteriologically satisfactory owing to the presencet in them of large numbers of organisms of the colon series.r The third report deals with some very important aspects of1 the inquiry. In the main it relates to the question of the. disposal and treatment of trade effluents. It is well knowni that sewage containing trade effluents is generally morep difficult to purify than is ordinary sewage. The Commissiont finds that these difficulties arise from the fact that tradei effluents may be turned into the sewer at irregular intervalsa and that they may contain large quantities of solid matterso in suspension which tend to choke the purification plant ands that they may be very acid or very alkaline or otherwise

I chemically injurious. In spite of these facts, however, thee results of practical inquiry "fully support the view thatd it is practicable in the great majority of cases to purify<f mixtures of sewage and trade effluents if the manu-

l. facturers adopt reasonable preliminary measures." Theit conclusion follows that the law should be altered so

Ll as to make it the duty of the local authority to providei- such sewers as are necessary to carry trade effluents as

;t well as domestic sewage and that the manufacturer shouldd be given the right, subject to the observance of certain safe-y guards, to discharge trade effluents into the sewers of thet- local authority if he wishes to do so. There are cases, how-.0 ever, in which the local authority should obviously bet relieved of this duty-as, for example, when the effluent

discharged from the manufactory is of a composite character,the greater part of which might with advantage be easily