906

regard the immediate aim of their own body as a stepping-stone towards the summum bonum. It is not at all unlikelythat a greater measure of success may attend the

comparatively moderate requirements of ° semi-teetotalism "

than has yet met the efforts of the instigators to

total abstinence. The consumption of alcohol in GreatBritain shows no marked signs of decreasing. The evils

wrought by alcoholic excess remain a serious menace to

our national welfare and a cause of vice and disease

probably unequalled in this country by any other one

thing. Any system that may tend to free the country fromthis widely prevalent and destructive influence must be

welcomed by all who have the good of the nation at heartand to the notice of medical men in particular we wouldrecommend for support the " Semi-Teetotal PledgeAssociation." which has the patronage of Lord Robertsand Lord Alverstone.

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"A CORONER’S COMMENTS. "

IN an annotation which we published recently under thisheading 1 we remarked upon the proceedings at an inquestheld at Bournemouth where an investigation into the causeof death had been undertaken by the medical men in

attendance immediately after the death of the patient.We appear to have received a piece of incorrect in-

formation or to have derived a wrong impression, as

we understood that the patient, who died during the

administration of an anaesthetic, had already an abdominalwound, the commencement of an operation, which wound,with the permission of the parents, was afterwards enlarged.The coroner asks us to state that no abdominal wound

existed at the time of death and that the abdominal incisionwas made entirely after death.

THE CLINICAL VALUE OF MEASURING THEBLOOD PRESSURE.

IT is only within recent years that measurement of theblood pressure with the sphygmometer has begun to takethe place of vague estimation with the finger, an advanceanalogous to measuring the temperature with the thermo-meter instead of estimating it by the hand. In the BostonMedical and Sitrgietzl Journal of Feb. 26th Dr. J. M. Jacksonhas published a number of interesting observations made withGaertner’s sphygmometer which show the value of measuringthe blood pressure. He finds that the blood pressure in

young healthy men ranges from 100 to 130 millimetres ofmercury but may be as high as 150 millimetres and thatin young women it ranges from 90 to 110 millimetres.

Elderly persons have, in consequence of arterial changes,almost always a high blood pressure. Thus in a personaged 50 years a pressure of 175 millimetres neednot cause disquietude. Low pressures are uncommon and

are found principally in cases of shock and collapse.Pressures of 200 millimetres are not infrequent and shouldbe regarded as dangerous, while pressures of 250 millimetresare very dangerous. In the last year five of Dr. Jackson’s

patients with pressures of over 190 millimetres have diedfrom apoplexy. Hence he makes it a rule to warn the familyin such cases. In kidney disease he has sometimes foundvery high pressures. Thus a girl complained of headache anddimness of vision. Considerable enlargement of the heartwas noticed and there was incipient retinitis. The urine

did not contain albumin or casts and there was no dropsy.The sphygmometer registered 250 millimetres, the highestpressure that could be measured. As he was puzzled bythe case he admitted the patient to hospital. For a few

days nothing more was found until slight hsematuriaoccurred. A week after admission she died suddenly.

1 THE LANCET, Dec. 27th, 1902, p. 1797.

The necropsy showed a tuberculous kidney with occludedureter and the other kidney hypertrophied. In this case

the blood pressure was the only danger signal." " In another

case a woman, aged about 60 years, with marked arterio-sclerosis and interstitial nephritis, had been under treatmentfor some time. The blood pressure ranged up to about 210millimetres. One day she complained of headache and thepressure was higher than the sphygmometer registered (250millimetres). While Dr. Jackson was making a third

attempt to take the pressure, in order to be sure that he

was correct, she fell on the floor unconscious. Death from

cerebral haemorrhage occurred in a few minutes.

THE WATER-SUPPLIES OF GLAMORGAN.

WE have received a copy of a report by Dr. W. Williams,the medical officer of health of the Glamorgan countycouncil, dealing with the water-supplies of that county.The report appears to us to be very complete and presentsa good deal of information that will be valuable in regardto existing supplies and possible new sources. It is shownthat an enormous increase is taking place in the population ofGlamorgan owing to the rapid growth of its industrial centres,and that is a fact which justifies giving the subject carefulattention. Dr. Williams deals with this question of theincrease of population and then, after a section devoted tothe physical aspects of the county, refers to rainfall, water-sheds, sources of the water-supplies, and concludes with theresults of the examination of the public water suppliesbased upon chemical analyses undertaken by Dr. W. G.

Savage and Mr. J. H. Sugden, B.Sc., F.I.C. Appended tothe report are four interesting and instructive maps dealingwith (1) the existing and prospective waterworks, gatheringgrounds and pumping stations and their relation to the SouthWales coal field ; (2) the physical configuration of Glamorganand the adjacent counties ; (3) the rivers of Glamorgan andadjacent counties ; and (4) the rainfall for the year 1901 in

Glamorgan and the adjacent counties. We congratulate theGlamorgan county council on the possession of such an

admirable report. It is certainly desirable that the countycouncils and other authorities throughout the country shouldtake steps to gain similarly complete information as to thecharacter and extent of the water-supplies of their owndistricts.

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ACUTE LEUKÆMIA WITH HUGE HÆMATOMA.

AT the meeting of the Societ6 Medicale des H6pitaux ofParis on Feb. 20th M. Ernest Bari6 and M. Salmon relateda case of acute leuksemia in which the rare complication of ahuge hasmatoma of rapid formation was observed. A man,

aged 35 years, who had been ill for six weeks came under

observation. He was extremely pale and complained of

weakness, visual troubles, epistaxis, and diarrhoea. Thelower limbs were oedematous, the spleen was enormous, andthe liver was enlarged. The lymphatic glands were not

affected. The blood was pale and watery. The red

corpuscles amounted to 2,015,000 per cubic millimetre andwere of unequal sizes and deformed. The leucocyteswere greatly increased in number, being in the proportionof one to every two red corpuscles, and varied muchin size, small leucocytes and very large ones being found.Arsenic was given. Some days after admission subcutaneousecchymoses were found on the arms, legs, and abdomen anda tumour of the size of a walnut appeared below the inferiorangle of the right scapula. It was painless and fluctuated.In the evening of the same day it had increased to the size ofa Tangerine orange. On the following day it was larger thana fist and on the third day it was of the size of the head ofa newly born infant. As extension could not be checkedeither by compression or by hasmostatics and the patient wasrapidly becoming worse the tumour was opened in order to