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975
Apart from the interest to every patriotic citizen of
all things relating to the security and defence of his
country, both by sea and land, the medical profession hasa twofold link with the army and navy. Not only is therea specialised military medicine, necessitating the existenceof a special corps of military medical officers-using theterm "military" in its generic sense, to cover both the navyand the army-but also to that corps is due a large measureof additions to the common scientific knowledge of the
profession, more particularly in the domains of tropicalmedicine and hygiene and of the surgery of wounds. The
exhibition will naturally include much that is of greatinterest to all medical men in relation to ambulance
and surgery. The Red Cross Hospital will be utilisedfor displays of a specialised training of civilians to fit themto cope with emergencies and the disasters of civil life in
the mass, as well as with individual first aid. In recent
years we have had the eruption of Mont Pelee and the
destruction of Messina as examples of the kind of cata-
strophe that makes the whole world shudder ; and even as
we write we realise that across the Atlantic there
is at this moment another dramatic contest between
man and the elemental forces of nature. It is
in times such as these that we recognise the needfor trained and organised help-a need as great in
this strife of civil life as any need of war. That the
medical aspect will not be neglected we may judge from thepresence on the committee of Surgeon-General Sir JamesPorter, the head of the Navy Medical Department,Surgeon-General Sir Launcelot Gubbins, the head of
the Army Medical Department, and Sir Arthur Conan
Doyle, whose experience in South Africa makes him a
fitting representative of what may be regarded as the
civilian auxiliary to the official medical services. A still
further claim of the exhibition for support lies in the fact
that, should any profits accrue, the service charities will
benefit thereby. -
BACTERIOLOGY FOR PHARMACISTS.
THE revision of the syllabus of the pharmaceuticalexaminations must before long receive attention, and it isperhaps possible to obtain some idea of what is contemplatedby the Council of the Pharmaceutical Society from the factthat under its auspices the last of a series of lectures onbacteriology has just been delivered in the lecture theatre ofthe School of Pharmacy by Professor R. T. Hewlett, of King’sCollege. A knowledge of bacteriology would undoubtedly bea useful acquisition to pharmacists, although it is hardly anessential part of the equipment of the average chemistand druggist. If this be the view of the Pharmaceutical
Council, the subject of bacteriology is more likely to beintroduced into the syllabus of the higher or "major" "
examination than into that of the qualifying or "minor" "
examination, which latter is, for the present, considered bymost pharmacists to be a sufficiently severe test. In hisllnallecture Professor Hewlett outlined a course of instruc-
tion in microbiology, pathological chemistry, and micro-scopy, which he considered might be advantageouslyintroduced into the pharmaceutical curriculum. Thisincluded the principles of sterilisation and the preparationof culture media ; the effects of the development ofbacteria on certain pharmacopceial preparations, and themeans of preserving such preparations ; the principles ofantiseptic and aseptic treatment, and the preparation anduse of curative sera. He estimated that an elementarycourse of this kind would require as a minimum some 20lectures of three hours each, provided the students possessedsome previous biological training and a knowledge of the useof the microscope. As the pharmaceutical student’s acquaint-ance with biology is of a very meagre kind, the 60 hours
suggested would hardly suffice unless a modification of thepresent course in botany were made, diminishing the
amount of systematic botany required, and makingthe course not a course in botany only, but alteringit to one in general biology, including animal formsas well as vegetable ones, somewhat on the lines ofthe old syllabus in biology of the Preliminary Scien-tific (M.B). Examination of the University of London.For advanced students Professor Hewlett suggested a further
course of instruction such as would put the pharmacist in aposition to assist medical practitioners in the diagnosis ofdisease by undertaking the investigation of morbid material.Provided such work entailed no encroachment upon the
functions of the medical practitioner, there seems to be aplace for pharmacists who are trained to undertake investi-gations of this kind, but an increasing number of medicalmen happen at this time to be working in the same
direction. The duty of the pharmacist to whom such
work was entrusted would be, as Professor Hewlett
pointed out, merely to report on his findings and not toattempt to make any deductions therefrom.
POISONING BY PETROL FUMES.
THE danger due to the highly inflammable nature of
petrol fumes is well known, but not the danger due to theirtoxic properties, as very few cases of poisoning have beenrecorded. In the Canadian Medical Association Journal for
February Dr. Guy W. Johnson has reported 42 cases of
poisoning which occurred in the construction of the Montrealtunnel. This tunnel is about 650 feet long, 8 feet high,and 12 feet wide. Ventilation was carried out by a zinc pipe8 inches in diameter, through which air was forced in bya fan, and also by the compressed air used to run the
drills. A petrol motor engine was employed to draw thecars of rock from the face of the tunnel to the bottomof the shaft. As long as the engine was not runningthe ventilation was sufficient to keep the air in the
tunnel fresh, except for a few minutes after blasting.But within an hour after the engine was started the
air became foul, causing throbbing and congestionof the vessels of the head and headache. On
Nov. 22nd two men were overcome by the fumes from theengine and carried out. They suddenly collapsed andbecame unconscious. Dr. Johnson saw them within 20
minutes, when they were recovering. The most notable
feature was extreme flushing of the face. The pulse was100 to 108 and of good volume and tension. Respirationwas 46 and deep. The knee-jerks and the plantar andcremasteric reflexes were absent, but the conjunctival reflexand the pupillary reaction to light were present. The pupilswere moderately dilated. The men could move their arms andlegs but could not speak. There was slight salivation. Con-sciousness was rapidly regained, but the men complainedof severe headache, chiefly frontal. They returned to
work in about an hour, and next day were none the worsefor their experience. On Nov. 24th 16 men suddenlycollapsed within a few minutes of one another without anywarning. They were brought to the surface as quickly aspossible and seen by Dr. Johnson within 20 minutes of theoccurrence. They were in all stages of anæsthesia ; somehad recovered consciousness and showed only headache,muscular weakness, and salivation ; others were shoutingand struggling as in the second stage of ether anaesthesia.A few were unconscious, with complete muscular relaxation.In two there were also clonic spasms of the arms and legs,which came on every few minutes and lasted about a minute.All the men also showed the symptoms described in the
previous two cases. On the next day they were able
to work, but 18 men were overcome in the same
976
way. Spectroscopic examination of the blood revealed
absence of carbon monoxide. Analysis of the air in the
tunnel showed traces of petrol fumes and no carbon monoxide.Four rats were placed in separate bell-jars into which a
little petrol was introduced. They showed the followingsymptoms : first, reddening of the noses and gums ; secondly,salivation ; thirdly, restlessness ; and fourthly, muscular
relaxation and anæsthesia, which came on in 1 to 2
minutes. A stage of clonic spasms, with relaxation betweenthe spasms, followed. The rats were then removed and
recovered in about 30 minutes, but three died without
apparent cause next day. Post mortem their livers seemed
very friable. Two fox-terriers were anæsthetised by inhala-tion of petrol with similar symptoms. After 15 minutes of
anæsthesia the circulation and respiration ceased simul-
taneously without warning, and resuscitation could not be per-formed by any means. At the necropsy the heart was found tohave stopped in diastole, and the right side was dilated. The
veins all over the body were much distended. There was
marked congestion of the liver and of the posterior parts ofthe lung. Thus, the toxic symptoms in man and in the loweranimals are very similar. A noteworthy point is that theconjunctival reflex does not disappear and that the pulse isgood and not very rapid. After the stage of muscular relaxa-tion there are clonic spasms, which Dr. Johnson regards as adanger signal. Dr. C. R. Box has described two cases of
petrol poisoning in chauffeurs who were manœuvring a
motor-car about a closed garage. 1 He noted that in
one case the face was flushed and cyanosed and in
the other pale. In both there were muscular weakness,shivering, and spasms, but no vomiting. The pulsewas rather small and fast, thus differing from Dr.
Johnson’s cases. Mr. M. J. Houghton has reported the
case of a woman who was overcome in three minutes while
washing her head with petrol in a small bathroom. 2 When
seen 15 minutes later she was of an ashy-grey colour. The
conjunctivæ were slightly suffused, the pupils dilated, and thelips slightly cyanosed. The pulse was 90 and thready.Dr. Fraser Gurd has, in a personal communication to Dr.Johnson, described a necropsy on a man who was found
dead in a large tank which he had been cleaning with petrol.Nothing was discovered but venous congestion.
SOME INSANITARY FEATURES OF THE
EXTEMPORISED PICTURE THEATRE.
THE extraordinary popularity of cinematograph exhibitionshas led to the acquisition of scores, even hundreds, of
buildings in which to give the demonstrations. The enter-
tainment is perfectly wholesome and gives a cheap form ofamusement and instruction to large crowds. But the evi-
dence is plain on all sides that the buildings are not alwayswholesome. The cinematograph theatre is often a Black
Hole of Calcutta, with no provision for ventilation at
all. Especially is this the case with the extemporisedtheatre. Almost any old shop, in place of waiting for atrade tenant, can be adapted for the purpose of a
cinematograph show, and there are many such shops in themetropolis, and doubtless in the provinces also. Whena building is specially designed and ultimately con-
structed for the purpose we may fairly assume that the
provisions for ventilation laid down by our health authoritiesfor new buildings are followed. Whether, however, the
place is a new building or an adaptation of an old
shop, it is an essential of the performance to keepthe actual theatre dark. The two factors of health,light and fresh air, can therefore seldom be con-
temporaneous even in the buildings specially designed
1 Brit. Med. Jour., April 4th, 1908, p. 807.2 Ibid., Dec. 12th, 1908, p. 1747.
for the purpose, while it is obvious in the case of certain
of the abandoned shops which have been adapted for theseexhibitions that both light and fresh air are excluded. The
condition of some of these dark and unventilated enclosures
is a grave comment on our modern views of what is healthyenvironment, and the enormous patronage which the picturetheatre receives indicates how widespread may be theeffects of an unhealthy stay within its walls. Evidencehas been produced which suggests that such placeshave been a means of spreading infectious diseases
particularly amongst children. Our sanitary authoritieswould do well to give their special attention to this matter,and initiate steps to ensure the people taking their
recreation and instruction under physical surroundings thatadmit of no hygienic reproach.
PHLEBITIS IN MUMPS.
THE usual conception of mumps as a transient inflamma-tion of the parotid glands attended with slight constitutionaldisturbance can no longer be held. Observations in recent
years, principally by French clinicians, have shown that thedisease may, like other infections, be attended by gravecomplications, such as pancreatitis, meningitis, neuiitis,endocarditis, and pericarditis. For example, at a meeting ofthe Societe Medicale des Hopitaux of Paris M. E. Hirtz andM. Salomon reported a complication of mumps which
does not appear to have previously been noticed—phlebitis.Of this they observed three cases in one household, the
patients being a medical man, his wife, and his sister. The
former was attacked while attending several members of afamily for mumps. There was intense inflammation of the
right parotid gland, and the temperature rose to 101.5°F.,but fell to normal on the following days and the parotitisrapidly diminished. On the seventh day he had a rigor andthe temperature rose again to 101’ 5°. On the eighth andninth days it oscillated between 102’ 50 and 102 - 70 and wasaccompanied by malaise. On the tenth day it fell to 100’70,but pain was felt in the right calf. On the eleventh
day the temperature was again normal, but the pain per-sisted, compelling the patient to remain completely at rest.Examination on the fourteenth day showed a red line in thecourse of the internal saphenous vein, which was tender.The limb was not oedematous. On the fifteenth and sixteentll
days the temperature was normal, but on the eighteenth itrose to 100°, and the femoral vein became painful. Therewas slight oedema over the malleoli. The limb was immo-
bilised in a splint. The left lower limb now became painful,and acutely so in the calf. The whole of the course of the
external saphenous vein was tender to the slightest touch.Recovery slowly took place under massage, electricity, andmechanical therapeutics. The patient was not able to walknormally for nearly four months. His wife, who nursed him,was seized at the time of a menstrual period with pains inthe breasts and in the position of the ovaries. She also had
sensation of weight in the legs. The pains increased so’
much that she had to take to bed. She then remarkedthat for some days the parotid regions were a little
tender, and there was some difficulty in mastication.
In the position of the right femoral, the two rightsaphenous, and the left saphenous veins there was
marked pain. On palpation of the right iliac fossa a painfulswelling was felt in the position of the right ovary. Ovaritisand phlebitis, due to mumps, were diagnosed, and the lowerlimbs were immobilised. The temperature did not rise above99-3°. The affected veins formed hard cords and there was.some oedema of the legs. On the ninteenth day there wasintense pain in the left arm, which was attributed to neuritisdue to mumps. Recovery slowly took place under the same-treatment as in the previous case. The practitioner’s sister,