895OPERATIVE TREATMENT OF THE ORCHITIS DUE TO MUMPS.

England, Ireland, and Scotland, but the deaths from

- the different forms of violence are not separated out.

In the annual reports of the Registrar-General theviolent deaths are discriminated thus-(a) deaths from.accident or negligence ; and (b) deaths by homicide, thedeaths under (b) being further differentiated into (1) man-slaughter, (2) murder, and (3) execution. It will be seen atonce that it is an entire misconception of the meaning ofthe official statements and of our summaries to use the figuresrecording the deaths from " violence" " without distinction ofkind, as indicating the amount of criminal violence pre-wailing in different parts of the kingdom. For ourselves, weshould hesitate to accept even a statement of the fatalitiesfrom homicidal violence as evidence of the amount of criminalviolence in a population for the obvious reason that thefatal cases bear no constant ratio to the acts of such lawless-ness, either in time or in place. We are not familiar with

the criminal or judicial records which are presumably neces-sary for police-court purposes ; but if such records are avail-

able they would probably afford better material for the

formation of a judgment on this point than would the.dgures of the National Register Offices, which are prepared.for an entirely different purpose. The figures should obviouslynot be employed for political or social reasons as an indi-

cation of the presence or absence of lawlessness in any

county or district. --------

OPERATIVE TREATMENT OF THE ORCHITIS DUETO MUMPS.

IN the Boston Medical and Surgical Ja2crnal of Sept. 5thDr. George G. Smith has reported two cases of orchitis due-to mumps in which an operation was performed to prevent,if possible, the atrophy which frequently follows. The

method employed was suggested by Dr. Hugh Cabot, and isbased upon the view that atrophy is due to increased intra-testicular pressure caused by the inflammation. At the sametime an opportunity was afforded for studying the patho-logy of the condition. In the first case the patient was22 years of age. On July lst, 1912, the right parotid glandbecame swollen and painful, and a few days later theleft. On the 9th the left testicle began to swell, andfor two days got progressively worse. When first exa-

dined, on the llth, both parotid glands were muchswollen. The left testicle was thrice the size of its fellow,hard, smooth, and moderately tender; the epididymisand vas were normal. The scrotum was contracted andnot reddened. The temperature was 104° F. On the12th the scrotum was red and there was some hydrocele.The testicle was larger and more tender, and the epididymishad become palpable. An operation was advised but declined.,On the 13th the hydrocele had increased and the epididymiswas more involved. The patient requested operation. Under

.ether a two-inch incision was made along the anterior aspect- of the scrotum. The tunica vaginalis was opened and aboutan ounce of turbid yellow fluid escaped. The testicle was

- delivered through the incision. It was thrice the normal

-size, firm and elastic. It was more bluish than normal, and

throughout the tunica albuginea were many minute reddishspecks, probably punctate hsemorrhages. The epididymis wasenlarged but soft, and of a deep red colour, which at theglobus major became almost black. The cord was some-what cedematous. Incisions of not more than a quarterof an inch, parallel to the long axis of the testicle and-extending just through the tunica, were made in a dozenplaces. From these there was considerable oozing, andan artery spurted and. required ligaturing. The tunica

covering the epididymis was also incised in about six

places. The testicle was replaced, a rubber drain was

, left in, and the scrotal wound closed with silkworm

gut. In the second case the patient was 27 yearsof age, and occupied the same room as the first patient,from whom he evidently caught the disease. His con-

dition was similar, and the same operation was performed.A small piece of testicle tissue was removed and preservedin absolute alcohol. Stained sections were made. The

process did not affect the testicular tissue uniformly. Groupsof convoluted tubes were destroyed and distended withexudate. These were separated by areas of normaland slightly affected tubules, containing many mitotic sexualcells, though few mature spermatozoa. The exudate consistedchiefly of polynuclear leucocytes and phagocytic endothelialcells. The cells of the tubules had mostly undergonehyaline degeneration. No organisms could be found in thesections or in films prepared at the time of the operation.Under the conventional treatment-rest in bed and poul-ticing-the acute symptoms of the orchitis of mumps dis-appear in a few days, but atrophy of the testicle follows inmore than 60 per cent. of the cases. The ultimate result in

the present cases cannot, of course, be stated yet. The

operation can be justified by showing fewer atrophiedtesticles one year later than under expectant treatment. Thepresent cases are recorded in the hope that such statisticsmay be gathered.

-

A NEW GREEK MEDICAL MANUSCRIPT FROMEGYPT.

AMONG the many thousands of papyri recovered frontmounds covering the ruins of the ancient city of Oxyrynchus,in the Egyptian Fayoum, one has recently been edited byDr. Arthur S. Hunt, which gives a short selection of

medical recipes. The manuscript dates from early in thefirst century, and upon one side of it is written a com-

mentary upon the " Iliad." The recipes are of a miscellaneouscharacter, similar to other fragmentary papyrus texts

of the same description to be found in the Rylandscollection of papyri at Manchester, and the Tebtunis

papyri, to be preserved, we understand, in the Universityof California. The interest of the new manuscript arisesfrom the ingredients employed for various maladies, whichare as follows: "The yellow salve for discharges, wounds,bruises, and weals : calamus, 4 dr.; white lead, 8 dr.;fine meal, 4 dr. ; purified schist, 1 dr. [this ingredient is

given by both Galen and Dioscorides, the latter recommendingthat obtained from Western Iberia]; saffron, 1 dr. ; opium,3 obols ; gum, 4dr. ; water." The next recipe is for " smalldischarges and wounds " : "Fine meal, 8 dr.; antimony,2 dr. ; opium, 3 ob. ; flake of copper, 3 ob. ; white lead, 2 dr. ;gum, 2 dr. ; water." For leprosy the author advised" cantharides, 1 dr. ; ammi, rocket-seed; nigella [fennell],mustard and cress, and raw pitch. Apply locally." The

next sentence directs for use as a styptic "pounded rockalum which will stop [the blood] at once.

" " To check nasal

bleeding : mix frankincense with onion juice and applyjuice inside. To produce sneezing: pound some white

hellebore and blow it into the nostrils, or use soap wort, orcastor, in the same way. For sores in the nose : rub yelloworpiment smooth, then lay the man on his back, and treat him;or use black hellebore in the same way. For polypus growingin the nostrils : baked soda, 3 ob. ; cummin, 1 dr. ; orris root,1 dr. ; rub them and blow into the nostrils. If the sore israther dry smooth some dry fig bark and blow in. For

quartan fever: juice of silphium, 1 ob. ; myrrh, 1 ob.Another dose (1þwp.urp.a., a word used by Galen in referenceto the feeding of infants): hemlock, 3 dr. ; henbane, 3dr. ;opium, 2 dr. ; castor, 1 dr. ; black hellebore, 1 dr. ; pound andwork them up separately with water and make pastilles ofthe size of an Egyptian bean ; then dry in the shade and givethem to the patient to drink fasting, rubbing them in half a

896 INDUSTRIALISM AND DISEASE.

cotyle of raisin wine; having previously given him

a bath two hours before taking; apply a warm bottleto the feet, and cover him up with blankets. Draughtfor liver patients : sweet flag 1 dr. [the Acorus

calamus, and probably the KXtt/M! apcv,uarmds of

Dioscorides] ; opopanax, 1 ob. ; spikenard, 1 ob. ; parsnip,2 dr. ; to be drunk slowly with raisin wine or honey.Another-tolerably strong : cinnamon ...... myrrh, 10 dr. ;spikenard, 6 dr.; aethiopian seseli, 6 dr. [Laserpitium silerrub smooth separately with egg and work up with juice ofcentaury [Erythræa centaurium], and give a dose of thesize of an Egyptian bean in warm honey and water.""Draught for dropsy patients: mountain parsley .......myrtle, 8 dr. ; bitter almonds, 4 dr. ; parsnip seeds, 6 dr." "

Although these medical memoranda are preserved upon apapyrus in Egypt, and probably were the notes of a localpractitioner, it is quite possible that they are copied from thework of some Greek medical author who resided elsewhere.

TERMINATION OF PULMONARY TUBERCULOSISBY SUBCUTANEOUS AND MEDIASTINAL

EMPHYSEMA.

IN the Progres lIediecl of August 17th M. Léon Bernardand M. A. Cain have reported a case of pulmonarytuberculosis which terminated in an unusual manner-bymediastinal and subcutaneous emphysema without pneumo-thorax. A dressmaker, aged 14 years, was admitted into

hospital on May 24th, 1912. In the previous September shebegan to cough. Emaciation and pains in the chest

followed, and she became so weak that she had to giveup work on May 9th. For a week before admission she had

expectorated. On examination she was much wasted and

pale, and the extremities were slightly cyanosed. The

temperature was irregular and in the evening ranged from103 - 20 to 104° F. All over the chest sonorous and sibilantrhonchi and subcrepitant rules were heard. The apices ofthe lungs were dull on percussion. Tubercle bacillicould not be found in the sputum. The emaciation and

weakness rapidly increased. On the morning of June 8ththe patient was found in an asphyxial state with a subnormaltemperature. The respirations were 50 and the pulse was160 and almost imperceptible. There were orthopnoea andsuprasternal and substernal retraction. The cyanosis wasintense; the face was violaceous and the lips and extremitiesof a blackish tint. The face was agitated by convulsivespasms and the lips were bitten. There was slight rigidityof the lower limbs with exaggeration of the reflexes and

ankle clonus. The neck was the seat of a considerable

tumefaction which extended into the upper part of the chestand the right parotid region. Around the tumefaction

crepitation was felt, symptomatic of subcutaneous emphy-sema, which extended all over the chest and front of the

abdomen and to the lumbar region behind, and also

involved the left upper limb throughout. On auscultation

the respiratory sounds were obscured by fine crepitationswhich occurred under the ear. There were no signs ofpneumothorax. The dyspnoea increased and the patientdied on that morning. At the necropsy, performed36 hours after death, subcutaneous emphysema of the upperlimbs, neck, chest, and abdomen was found. The anteriormediastinum was distended by considerable emphysema.Beneath the visceral pleUl’ae were air bullaa. On sectionthe lungs were found congested and oedematous and showeddisseminated tubercles and emphysematous areas. In the

right lower lobe was a cavity of the size of a cherry openinginto a dilated bronchus. The liver and kidneys containedtubercles. The subcutaneous emphysema was an extensionof the mediastinal, which in turn originated in interlobulai

emphysema consecutive to rupture of pulmonary vesicles.

This curious condition did not escape the penetratingobservation of Laennec. He wrote : " When intoftobularemphysema is near the root of the lung it soon invades

the mediastinum and thence the neck and subcutaneoustissue of the whole body." Subcutaneous emphysema mayoccur in diphtheria, laryngitis stridulus, whooping-cough,pneumonia, and broncho-pneumonia. Why it occurs ex-

ceptionally in cases of tuberculosis, which present nothingexceptional in the lesions, cannot be explained.

INDUSTRIALISM AND DISEASE.

TWO aspects of modern industrialism neea urgent anct.

earnest attention at the hands of social economists and

statesmen, and in each the special experience and know--ledge of the medical profession can be of the greatest assist-ance. These aspects refer to the psychical and the physicaleffects respectively of the novel conditions and environmentthat have been created by the rise of the factory system.Of these the physical aspect is forcibly dealt with by SirThomas Oliver in his admirable address on I I Dust and Fume,Foes of Industrial Life," delivered at the Congress of Hygiene ein Washington, and published in this issue. The effects ofindustrial occupations have to be considered, as Sir ThomasOliver points out, first, in relation to their effect uponthose employed, and, secondly, in regard to their influ-

ence on localities and on the persons dwelling therein.

Dust, smoke, and fume, he says, are the products of

industrial activity to be feared, dust being usually regardedas matter in a state of fine division (though from a

medical point of view it is something more than this);,while smoke and fume differ from dust in being the

products of heat, and from each other, in that smoke

is the outcome of incomplete combustion of hydrocarbons,while fume is, first, the gaseous form of metallic or

other elements and their compounds ; and, secondly, thereturn of these from the gaseous state as solid deposits.Convincing examples are given to show that in the smokyindustrial centres a high non-tuberculous mortality fromacute respiratory diseases predominates, while a high tuber-culous death-rate is more common in towns devoted to,

textile industries. A consideration of the harmful effects,both physical and chemical, of road dust on vegetation andanimal life-effects that attain their maximum in the dust.

of towns-leads Sir Thomas Oliver to take note of the " socialinfluence of dust." " He states that in trying to combat thebegriming effects of dust and fume we have become a well-washed people. He inclines also to accept Saito’s conclusions.from his investigations in Lehmann’s laboratory, that

in regard to the inhalation of dust, by far the largerpart of it finds its way into the alimentary canal ratherthan into the respiratory tract ; and he unhesitatingly addsthe testimony of his own experience-which is considerable-to von Behring’s opinion, that pulmonary tuberculosis ofthe adult is frequently the consequence of the lighting up ofdisease long latent in glands as the result of a probableintestinal infection contracted in childhood. The specialdangers of coal-dust are now well recognised, and SirThomas Oliver devotes considerable space and attention to a

consideration of the explosive effects of such dust and to themethods suggested for the prevention of explosions in coalmines. He makes special reference to a method worked outin his laboratory by Hermann Belger, whereby the oxygen,.carbon dioxide, and other gases are removed from the

coal dust and the dust is kept moist, so that it is converted

into a colloid material and rendered uninflammable. Bythis means the whole mine can be kept free from dust byapplication of the treatment every four to ten weeks. The-

subject ’of phosphorus necrosis in relation to the manu-facture of lucifer matches is considered, and Sir Thomas