1
308 "liquid food contains at least 100 calories, exclusive of I alcohol and glycerine, it should not be depended on to I sustain life even for a limited period. The council recom. mends that "liquid foods" should yield at least 8’ 8 per cent. of solids on evaporation and should possess at least as much nutritive value as milk. One-fourth of the nutritive value, exclusive of alcohol and glycerine, should reside in the nitrogenous matter. Further, the protein matter should be converted by enzymes-e.g., pepsin and pancreatin-and not by acids or by heat, as it is held by some observers that the products in the last-named cases may be toxic and dan- gerous. THE STAFF OF THE JOHANNESBURG HOSPITAL. WE learn from the South African Medical Record that the governing board of the Johannesburg Hospital has recently deprived the assistant staff of seats on the board. This has been accepted without opposition but another change that it has proposed is being vigorously opposed by the medical staff. This is that the board shall have power at any time to appoint outside practitioners directly to the senior medical and surgical posts of the hospital. It is claimed that this rule would not ordinarily be exercised but would be held in reserve for the case of some European celebrity who might happen to settle in Johannesburg and whose services should not be lost to the hospital because he was unwilling to pass through the usual period of the drudgery of out-patient work. Our sympathies are with the staff who are hostile to this change ; it seems very unfair that those who have borne the burden and the heat of the day should be ousted from the clinical reward of their labours by the chance advent of a "European celebrity" who is unwilling to follow in their industrious footsteps. RUPTURE OF AN AORTIC ANEURYSM IN A CHILD AGED THREE YEARS. IN the Jourrnal of the Árnerrican Medical Association of July 6th, Dr. R. N. Willson and Dr. A. Marcy have reported the following remarkable case. A male child was born of apparently healthy parents five years after marriage, on Oct. 19th, 1903. The father admitted that he had twice had gonorrhoea but denied that he had ever had a sore on the genitals. But his nose was suggestive of the saddle type and at the age of 21 years he suffered from con- vulsive seizures resembling those of epilepsy. At the age of six weeks the child had bronchitis and while Dr. Marcy was examining the chest he heard a systolic murmur over the aortic cartilage which was so loud that it was audible over the whole chest, front and back. The circulation was good. On Nov. 17th, 1906, the child became ill with vomiting and rigors which recurred again and again. Malaria was suspected and quinine was given but without result. The rigors recurred irregularly and the temperature rose to about 102° F. and occasionally as high as 106°. The intervals were afebrile and then the child was bright and playful. But when the temperature rose he was dull and listless. At times he complained of distress in the epigastrium, occasionally in the upper chest. Sometimes he complained of pain in the neck; at other times the pain would shoot to his feet. He became anasmic and gradually weaker. On Dec. 13th Dr. Willson saw him in consultation with Dr. Marcy. The skin was sallow, almost of a lemon tint, and the mucous membranes were blanched. The cervical, sub- maxillary, axillary, epitrochlear, and inguinal glands were enlarged. In the episternal notch expansile pulsation was evident and a systolic thrill was felt, which extended over the whole upper chest. The upper part of the sternum and adjacent chest were absolutely dull on percussion. A loud, double, almost continuous murmur was heard with greatest intensity over the second right interspace and was transmitted over the entire prseoordia and especially to the right scapular region. The abdomen (including the liver and spleen) seemed normal. Blood examination showed: o red corpuscles, 2,000,000 per cubic millimetre; white cor- puscles, 28,000 per cubic millimetre; and haemoglobin, 40 per cent. The pallor deepened to a dusky hue, the face became puffy, and the left radial pulse almost disappeared. Congenital syphilis was diagnosed. A mass of enlarged bronchial glands, syphilitic or tuberculous, and congenital syphilitic endocarditis were suspected. Aneurysm was considered and but for the age would have been diagnosed. Death occurred on Dec. 26th. The necropsy showed an aneurysm of the ascending and transverse arch of the aorta which had ruptured into the pericardial cavity, advanced stenosis of the aortic orifice, and atheroma of the aorta. The liver was large and hard ; the spleen was large but only con- gested. Dr. Willson and Dr. Marcy suggest that the aneurysm was of intra-uterine origin and due to syphilis. THE ROYAL SOCIETY OF MEDICINE. THE medical section of the Royal Society of Medicine is now fully constituted and is ready to receive papers for reading and discussion in the winter session. The section will hold its first meeting on Oct. 22nd, when Dr. Hector W. G. Mackenzie will open a discussion on the Complications and Sequelae of Pneumonia and the Treatment of Pneumococcal Infections by Serum or Vaccine. The list of officials of the Royal Society of Medicine is as follows :-President : Sir William Selby Church. Honorary treasurers: Dr. F. H. Champneys and Mr. A. Pearce Gould. Honorary librarians : Mr. Rickman J. Godlee, Dr. H. Head, and Dr. Norman Moore. Honorary secretaries: Dr. Arthur C. Latham and Mr. H. S. Pendlebury. Members of council: Sir R. Douglas Powell, Mr. Henry Morris, Mr. J. Warrington Haward, Mr. G. H. Makins, Sir Shirley F. Murphy, Mr. T. L. Read, Sir Felix Semon, Dr. Frederick Taylor, and Dr. T. J. Walker, together with the presidents of the sections and the officers who are ex-officio members of the council. A NOBLE FOUNDATION. UNDER this heading the Times of India gives an interesting account of the Parsee Obstetric Hospital which was founded in Bombay about 20 ago by Dr. R. Temulji Nariman. Until this energetic and determined reformer led the way the treatment of Parsee women in their hour of travail was lamentable. They were isolated on the ground floor, usually in the most insanitary part of the building, and were attended by ignorant old women whose methods can only be described as barbarous. The infantile mortality in these circumstances was naturally very high; even now it is 11 per cent. outside the hospital, whereas inside, where the inmates enjoy all the advantages which the advance of Western science in the hygiene of obstetrics can place at their disposal, it is only 3 per cent. The institution is so highly valued by the Parsee community that the accommodation is always fully taxed. " We draw attention to these facts," says our contemporary, " not because there is anything new in them, the success of the hospital being familiar to the present generation, but because in these hurried days none should forget what lies behind them. This good work was not easily effected. There was a long battle against prejudice and custom in which, although he had the moral support of some leading members of the community, Dr. Temulji Nariman was always in the forefront. The hospital marks the bursting of the social fetters which were keeping the whole of the Parsee community in paralysing subjection; the advantages, direct and indirect, which it has conferred upon the race are

THE ROYAL SOCIETY OF MEDICINE

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"liquid food contains at least 100 calories, exclusive of Ialcohol and glycerine, it should not be depended on to Isustain life even for a limited period. The council recom.mends that "liquid foods" should yield at least 8’ 8 per cent.of solids on evaporation and should possess at least as muchnutritive value as milk. One-fourth of the nutritive value,exclusive of alcohol and glycerine, should reside in the

nitrogenous matter. Further, the protein matter should beconverted by enzymes-e.g., pepsin and pancreatin-and notby acids or by heat, as it is held by some observers that theproducts in the last-named cases may be toxic and dan-

gerous. --

THE STAFF OF THE JOHANNESBURGHOSPITAL.

WE learn from the South African Medical Record that thegoverning board of the Johannesburg Hospital has recentlydeprived the assistant staff of seats on the board. This hasbeen accepted without opposition but another change that ithas proposed is being vigorously opposed by the medicalstaff. This is that the board shall have power at any timeto appoint outside practitioners directly to the senior medicaland surgical posts of the hospital. It is claimed that this

rule would not ordinarily be exercised but would be held inreserve for the case of some European celebrity who mighthappen to settle in Johannesburg and whose services shouldnot be lost to the hospital because he was unwilling to passthrough the usual period of the drudgery of out-patientwork. Our sympathies are with the staff who are hostile tothis change ; it seems very unfair that those who have bornethe burden and the heat of the day should be ousted fromthe clinical reward of their labours by the chance adventof a "European celebrity" who is unwilling to follow intheir industrious footsteps.

RUPTURE OF AN AORTIC ANEURYSM IN ACHILD AGED THREE YEARS.

IN the Jourrnal of the Árnerrican Medical Association of

July 6th, Dr. R. N. Willson and Dr. A. Marcy have reportedthe following remarkable case. A male child was born of

apparently healthy parents five years after marriage, on

Oct. 19th, 1903. The father admitted that he had twicehad gonorrhoea but denied that he had ever had a

sore on the genitals. But his nose was suggestive of thesaddle type and at the age of 21 years he suffered from con-vulsive seizures resembling those of epilepsy. At the age ofsix weeks the child had bronchitis and while Dr. Marcywas examining the chest he heard a systolic murmur overthe aortic cartilage which was so loud that it was audibleover the whole chest, front and back. The circulationwas good. On Nov. 17th, 1906, the child becameill with vomiting and rigors which recurred againand again. Malaria was suspected and quinine was givenbut without result. The rigors recurred irregularly andthe temperature rose to about 102° F. and occasionally ashigh as 106°. The intervals were afebrile and then the childwas bright and playful. But when the temperature rose hewas dull and listless. At times he complained of distress inthe epigastrium, occasionally in the upper chest. Sometimeshe complained of pain in the neck; at other times the painwould shoot to his feet. He became anasmic and graduallyweaker. On Dec. 13th Dr. Willson saw him in consultationwith Dr. Marcy. The skin was sallow, almost of a lemon tint,and the mucous membranes were blanched. The cervical, sub-maxillary, axillary, epitrochlear, and inguinal glands wereenlarged. In the episternal notch expansile pulsation wasevident and a systolic thrill was felt, which extended overthe whole upper chest. The upper part of the sternumand adjacent chest were absolutely dull on percussion. A

loud, double, almost continuous murmur was heard with

greatest intensity over the second right interspace and wastransmitted over the entire prseoordia and especially to theright scapular region. The abdomen (including the liverand spleen) seemed normal. Blood examination showed: ored corpuscles, 2,000,000 per cubic millimetre; white cor-

puscles, 28,000 per cubic millimetre; and haemoglobin,40 per cent. The pallor deepened to a dusky hue, the facebecame puffy, and the left radial pulse almost disappeared.Congenital syphilis was diagnosed. A mass of enlargedbronchial glands, syphilitic or tuberculous, and congenitalsyphilitic endocarditis were suspected. Aneurysm was

considered and but for the age would have been diagnosed.Death occurred on Dec. 26th. The necropsy showed an

aneurysm of the ascending and transverse arch of the aortawhich had ruptured into the pericardial cavity, advancedstenosis of the aortic orifice, and atheroma of the aorta. Theliver was large and hard ; the spleen was large but only con-gested. Dr. Willson and Dr. Marcy suggest that the

aneurysm was of intra-uterine origin and due to syphilis.

THE ROYAL SOCIETY OF MEDICINE.

THE medical section of the Royal Society of Medicine isnow fully constituted and is ready to receive papers for

reading and discussion in the winter session. The sectionwill hold its first meeting on Oct. 22nd, when Dr. Hector W. G.Mackenzie will open a discussion on the Complications andSequelae of Pneumonia and the Treatment of PneumococcalInfections by Serum or Vaccine. The list of officials of the

Royal Society of Medicine is as follows :-President :Sir William Selby Church. Honorary treasurers: Dr.F. H. Champneys and Mr. A. Pearce Gould. Honorarylibrarians : Mr. Rickman J. Godlee, Dr. H. Head, and Dr.Norman Moore. Honorary secretaries: Dr. Arthur C. Lathamand Mr. H. S. Pendlebury. Members of council: SirR. Douglas Powell, Mr. Henry Morris, Mr. J. WarringtonHaward, Mr. G. H. Makins, Sir Shirley F. Murphy, Mr. T. L.Read, Sir Felix Semon, Dr. Frederick Taylor, and Dr. T. J.Walker, together with the presidents of the sections andthe officers who are ex-officio members of the council.

A NOBLE FOUNDATION.

UNDER this heading the Times of India gives an interestingaccount of the Parsee Obstetric Hospital which was foundedin Bombay about 20 ago by Dr. R. Temulji Nariman. Untilthis energetic and determined reformer led the way the

treatment of Parsee women in their hour of travail was

lamentable. They were isolated on the ground floor,usually in the most insanitary part of the building, andwere attended by ignorant old women whose methods

can only be described as barbarous. The infantile

mortality in these circumstances was naturally veryhigh; even now it is 11 per cent. outside the hospital,whereas inside, where the inmates enjoy all the advantageswhich the advance of Western science in the hygiene ofobstetrics can place at their disposal, it is only 3 percent. The institution is so highly valued by the Parseecommunity that the accommodation is always fully taxed." We draw attention to these facts," says our contemporary," not because there is anything new in them, the success ofthe hospital being familiar to the present generation, butbecause in these hurried days none should forget what liesbehind them. This good work was not easily effected.There was a long battle against prejudice and custom inwhich, although he had the moral support of some leadingmembers of the community, Dr. Temulji Nariman was

always in the forefront. The hospital marks the bursting ofthe social fetters which were keeping the whole of the Parseecommunity in paralysing subjection; the advantages, directand indirect, which it has conferred upon the race are