THE DECLINE IN THE CONSUMPTION OF LIGHT WINES

1749THE RESULTS OF COLECTOMY IN CARCINOMA OF THE COLON.

piles, while the intervening portion with its accessoryorgans affords a kaleidoscopic picture of pathologicalchanges exhibiting a selective preference for certainlocalities. Whence this morbid tendency to dry rot andpremature decay 7 Among the many causes which may con-tribute towards the premature degeneration of the digestiveorgans, one is prompted to seek first in the direction oftheir special function to ascertain if the food habituallytaken is calculated to call into play the functional activityof the digestive organs. On the threshold of this inquiryone is met with a negative answer-a great proportionof our food is taken in a liquid, pulpy or soft form;consequently it fails to afford the stimulus necessary to main-tain the teeth and buccal glands in a state of functionalefficiency. The false start anticipates a lame race and a poorfinish to the digestive processes.Milk is the most widely distributed form of liquid food

and affords a convenient example of the scope and limita-tions of liquid foods in general. As a food it has the

following advantages: it is a complete and highly nitro-genous food ; it can be taken easily and rapidly ; moreover,being a natural food, it is not as a rule distasteful to theindividual. But with each of these advantages are asso-ciated certain drawbacks, if we put aside milk drawn at thefountain head in the normal way. Being a complete foodmilk may form an exclusive diet, a purpose for which it is

frequently employed, as in the systematic treatment of renalaffections. In a person thus nourished one frequently findsthe tongue coated, the breath foul, and a condition of habitualconstipation. The diet makes no demand on the functionalactivity of the muscles of mastication nor on the salivary,lingual, and mucous glands ; moreover, apart from theabsence of stimulus to secretion, the mucous surfacesbecome lined with a thin film of milk which blocks theirorifices and forms a nidus for the growth of saprophytes.Hence a foul mouth, coated tongue, and acidity, betrayingfunctional inactivity and initiating structural decay. The

liquid meal pours into the stomach unheralded by nervousreflex and unmingled with stimulating salivary secretion.Consequently no preparation has been made for its reception,its visit is unexpected, and its behaviour renders its presenceunwelcome. The liquid garb of innocence is discarded anddiscloses masses of solid curd, difficult of access to the

gastric juices, causing an irritative flow of mucus and

affording a soil favourable to the growth of a varied

pathogenic flora. The fermenting mass of curd strugglesthrough the pyloric orifice, disturbs the hepatic function,irritates the bowel, evolves gases and refuses to move onwithout the aid of mercurial or saline purgation ; in a

word, it acts the part of the rabid and iconoclastic socialreformer.Such is often the effect of whole liquid milk taken as an

exclusive food. Now, however, it is rarely given withoutdilution or admixture with other ingredients which serve tobreak up the curd or otherwise prepare it for absorption.But in whatever form taken liquid milk retains the essentialdisadvantages of liquid foods in general-viz., that it passesdirect to the stomach without making any demand on thecomplex mechanico-physiological processes of mastication.In contrast with milk in the liquid form its solid derivativesare eminently suitable for human food. Cheese is highlynutritious and in conjunction with butter and wholesomebread it affords a complete and nourishing meal. Its repu-tation for indigestibility is due to the fact that instead ofbeing recognised as affording the nitrogenous element of ameal in itself it is frequently introduced to the stomachat the end of an already complete meal, with theconsequence of an explosive gastric disturbance. Butteris a most useful element of the dietary, it replaces theoil of southern nations and the blubber of the Esqui-maux. Essentially a heat producer, it should be takenin larger quantity in cold weather than in hot; itscombination with farinaceous food serves to subdivide andrender it more accessible to the biliary and pancreaticsecretions.The following summary is based on the argument roughly

traced in the above sketch and conveys my conception ofthe place cow’s milk should occupy as human food. 1. In

infancy : properly prepared and administered it is the bestsubstitute for mother’s milk. 2. In health : when recognisedand used as a food and not as a drink it finds a useful placein the dietary both of children and of adults on the

following conditions: (a) that it be excluded from allmeat meals ; and (b) that it be either diluted or taken with

some form of amylaceous food? 3. In disease: it is a

readily administered complete food and may be usedas such when well diluted or predigested. Its disadvantagesare that it fails to excite buccal secretion, readily undergoesfermentative changes, and tends to produce constipation.It should therefore be given for short periods only and bereplaced by solid food as soon as possible. It will probablyfind a progressively lower place in the dietaries of diseaseas the knowledge of dietetics increases. 4. The solid deriva-tives of milk-viz., cheese, butter, and cream-are essentiallyuseful constituents of the dietary and afford, with bread,potatoes, and other amylaceous products, a complete foodwhich might well take a more important place in thenutrition of the Anglo-Saxon race than it occupies at thepresent Tnnmpnt. Sirs vnnrs fRit,hfllllv

Montreux. STUART TIDEY, M.D. Lond.

THE RESULTS OF COLECTOMY IN CAR-CINOMA OF THE COLON.

To the Editors oj THE LANCET.

SIRS,—In answer to Mr. Bilton Pollard’s letter I am verysorry that during the transcription of my notes into type anerror has crept into my published lecture, which, however,did not occur during its delivery, when I remarked thatMr. Bilton Pollard and Mr. Charles A. Morton had each per-formed seven colectomies for cancer without a death.

In the typewritten copy sent to your journal the sub-

sequent histories of Mr. Morton’s cases have been placedimmediately after Mr. Pollard’s name instead of in their

proper place a few lines below after Mr. Morton’sname. It should read: Mr. Bilton Pollard published inthe British 3-redical Journal of Jan. 23rd, 1904, reportsof seven colectomies without a death and in none of thecases had there been recurrence of the disease. One

patient lived for four years and died from heart disease andthe others were living at periods of four years, two and ahalf years, two years and two months, nine months, six

months, and two months respectively after operation.It adds additional interest to this important series of cases

to know that these patients are still free from recurrenceand it fully bears out my statement that cases in which thedisease is limited ought to be capable of cure by enterectomyif operated on earlv.-I am. Sirs. vours faithfullv.

Park-crescent, W., Dec. 12th, 1904. A. W. MAYO ROBSON.

THE DECLINE IN THE CONSUMPTIONOF LIGHT WINES.

To the Editors of THE LANCET.

SIRS,-Having read the article in THE LANCET of Oct. 8thunder the heading " The Decline in the Consumption ofLight Wines," we, the undersigned members of the UnionSyndicale,l desire to express our appreciation of the interestyou have been good enough to show in the subject of claretdrinking. We have long felt that the disfavour into whichour wines have fallen has been largely owing to a misappre-hension as to their effects on the system from a hygienicpoint of view-a misapprehension which we cannot helpfeeling has been increased rather than allayed by a certainnumber of the medical profession. It is therefore a cause ofgeneral satisfaction among shippers here that a journal ofyour reputation and authority has lent the weight of its in-fluence to restore claret to its former position, to refute theopinion that it is not a wholesome or desirable beverage fordaily use, and to impress on the general consumer the factwhich is absolutely correct that there never was a time whenbetter value could be obtained in claret than now.You have touched the right note, too, in bringing out the

fact that claret is not properly understood by the majority ofpeople in England. There is no doubt an art in wine-

drinking and, unfortunately, it is an art which has of late

years disappeared to a great extent. Claret, even in thecheaper grades, requires a certain amount of trouble andcare if it is to be properly appreciated and it is just thisignorance in handling it which is so much to be deploredand which results in so many persons banishing it from their ,

table, declaring that the wine does not suit them, &c.In conclusion, and while tendering you our sincere thanks

1 Union Syndicale des Négociants en Vins de Bordeaux.

1750 DECLINE IN CONSUMPTION OF LIGHT WINES.—HORSED AMBULANCES.

for the intelligent way (if we may use the expression) inwhich you have brought this matter forward, we should liketo record our opinion that, quite apart from trade prejudice,you have rendered an important service to the public byyour article. At the same time, the respectable members ofthe English wine trade owe you a debt of gratitude, for it isan undoubted fact that their interests lie wholly on the sideof an increased consumption of light wines as against theprevailing fashionable beverage of "whisky-and-soda."With apologies for troubling you and with renewed thanks

for having lent some of your valuable space to this subject,We have the honour to remain, Sirs, yours faithfully,

BARTON ET GUESTIER,JOURNU FRÈRES, KAPPELHOFF AND CO.,J. CALVET AND CO.,NATHL. JOHNSTON AND SONS,AUDINET ET BUHAN,ED. KRESSMANN AND CO.,J. BIGOURDIN,ED. BLANCHY AND CO.,LARRONDE FRÈRES,G. PRELLER AND CO.,LESTAPIS AND CO.,FLOUCH FRÈRES,BOUBÉE FRÈRES,LE VAVASSEUR AND CO.,CUNLIFFE, DOBSON, AND CO,S. LARCHER PÈRE ET FILS, JEUNE,SICHEL AND CO.,H. AND O. BEYERMANN,GADEN AND KLIPSCH,SCHRODER AND SCHYLER AND CO.,AR. LALANDE AND CO.,BLANCHY FRÈRES AND CO.,H. AND C. BALARESQUE AND CO.,J. L. GARROS,HANAPPIER AND CO.,ESCHENAUER AND CO.,ALFRED MORTON AND CO.,H. M. DE PONTAUD ET CIE.,GEO. RÉGIS AND CO.,MESTREZAT AND CO.,E. PARIS AND DAMAS,L. ROSENHEIM ET FILS,J. MANGNEAU AND CO.,AD. SVAHN AND CO.,P. E. PRUDELLE AND CO.,J. MICHAELSEN AND CO.

Bordeaux, Nov. 23rd, 1904.

HORSED AMBULANCES.

To the Editors of THE LANCET.

SIRS,—On behalf of the Metropolitan Street AmbulanceAssociation may I be permitted to endorse the remarksmade by Mr. John Troutbeck, the - coroner for thesouth-western district of the county of London, on the

urgent need of an efficient ambulance service for streetcasualties in London ? Deaths such as Mr. Troutbeck alluded to are of far too frequent occurrence in the metro-polis. Every year not only do people die who might besaved by the prompt arrival of a well-equipped ambulancewith its skilled attendant, but some who would not otherwisedie lose their lives entirely through the faulty method oftheir removal in unsuitable conveyances. During the last25 years great efforts have been made to call attentionto this deplorable state of things. His Majesty KingEdward VII. when Prince of Wales did a great deal toforward the movement. The president of this association,Mr. Reginald Harrison, who was the initiator of the excel-lent Liverpool service, has repeatedly since 1881 pointedout what is necessary for London.

In the October, 1896, number of the Nineteenth Centuryappeared a very able article on horse ambulances by theHon. F. Dudley Leigh who afterwards offered to present aperfectly equipped horse or motor ambulance to any suitableLondon public body that would accept it as an object lessonof what was done elsewhere. Although met with indiffer-ence in regard to his offer he succeeded in interesting someof the members of the London County Council in the

subject, foremost of whom was Sir William Collins, whobecame chairman of the ambulance subcommittee soon

afterwards appointed. Unfortunately the report issued bythis body in 1902 obtained only half-hearted support fromthe other members of the late London County Council, so

that no practical result followed.In January of this year the medical profession took the

matter in hand and formed themselves into the MetropolitanStreet Ambulance Association with a membership which nownumbers nearly 1100 of the most eminent medical men inLondon. This association endeavours to interest the publicgenerally in this subject which so closely concerns everyindividual in the community. It wishes to see established inLondon with as little delay as possible an up-to-dateambulance service summonable by telephone and providedwith rapid transport, so that skilled aid can be quicklybrought to any case of accident or sudden illness

occurring in the streets or public places and the patientremoved to home or hospital in a comfortable ambulance witha watchful attendant at his side. In this the association hasthe support of the St. John Ambulance Association, of Mr.H. L. Bischoffsheim, and of practically everyone interestedin the welfare of the 15,000 severe casualties occurring inLondon each year. The vastness of London and the factthat accidents do not recognise municipal boundaries,necessitate the provision of such a service by a publicbody with the scope of the London County Councilwhich fortunately has ready at hand most of the machineryrequired in its fire brigade organisation. The combinationof these two emergency services .would add to the efficiencyof each and could be worked conjointly far more economi-cally than separately, as has been already proved in manytowns where this arrangement exists. With so manysplendid examples of what is done elsewhere at home andabroad, that London is still without an adequate ambulanceservice for humanely helping those in our streets who

through sudden illness or accident are unable to help them-selves, is a grave reproach to every public-spirited indi-vidual in the metropolis.

I am, Sirs, yours faithfully,ARTHUR JAMES,

Honorary Secretary, Metropolitan Street Ambulance Association.Gloucester-terrace, Hyde-park, W.

THE ETIOLOGY OF MALARIA.70 the Editors of THE LANCET.

SIRS,—On reading in THE LANCET of Nov. 19th, p. 1453,your correspondent’s account of Professor Baccelli’s remarksupon ’the modern doctrines regarding the etiology of malaria ’’at the Fourteenth Annual Congress of Internal Medicine myfeeling was one of astonishment at his attitude in regardto a subject the essential details of which are now beyond

dispute. Such scepticism at this date on the part of anItalian is, to say the least, disconcerting. Why should notthe well-known discoveries of Ross and of Professor Baccelli’sown Italian school "destroy at a stroke the conception ofmalaria which has been handed down to us for generationsand which was founded on observations of physicians of thehighest attainments who dedicated their lifetime to the studyof the subject." What did the said physicians of the

highest attainments" know of parasitology previously toabout 1880, the date of Laveran’s discovery. Does ProfessorBaccelli really mean to doubt the existence of the malarialparasite or that it is the cause of the disease? ProfessorBaccelli contends that the " mosquito theory " fails to throwlight upon certain severe outbreaks connected with ricefieldsand marshes situated at long distances from the haunts ofanopheles. I maintain that he cannot specify a smgle suchoutbreak recorded by any person competent to investigatethe subject. It has, no doubt, often happened that collec-tions of persons working in ricefields or marshes situatedlong distances from the haunts of anopheles have been

subject to outbreaks of malaria if a week or so pre-viously they have been in the region of infected anopheles.Why, Professor Baccelli is reported to ask, should itbe a rule of prophylaxis to keep indoors after sunset in

spite of the fact that anopheles lives by preference in sidedwelling houses ? In regard to this we have yet to learn thatthis is a rule of prophylaxis. It certainly was a popular notionat one time. Then he asks, how account for cases of malaria3n board ship ? Anyone who has travelled by the riversteamboats in the African tropics knows how frequently thecabins are infested with anophrlrs, and others besides myself1ave found infected ones amongst them. May not the