470

deposited urates except through the slight effect producedby the reduced uric acid content of the blood. Atophanstimulates the kidney not only with reference to the excretionof uric acid, but also with reference to the excretion of othernitrogenous waste products, so that the total non-proteinnitrogen and the urea of the blood also sink in consequence.

There is in my mind not the slightest doubt but that bymeans of chemical investigations of blood, clinical problemsof many kinds will be elucidated to a much greater extentthan has been possible by means of urine analyses, thoughthe two must usually go hand in hand.Boston.

OPHTHALMIC PROGRESS IN EGYPT.1

BY A. F. MACCALLAN, M.D. CANTAB., F.R.C.S. ENG.,DIRECTOR OF OPHTHALMIC HOSPITALS IN EGYPT.

1IN 1903 a sum of RE.41,000 was placed at the disposal of

Lord Cromer, then British Agent in Egypt, for the relief ofsufferers from eye diseases by the liberality of Sir ErnestCassel. It was decided to establish a hospital consisting of a camp of tents to travel round the country districts, remaining four or five months at each place. I came toEgypt to organise and to administer this and other means of ophthalmic relief subsequently inaugurated. These hospitals became a definite branch of the Egyptian Governmentservice in 1906, in which year the first permanent hospitalwas built at Tanta.Between the beginning of the year 1904 and the end of the

year 1913 14 new hospitals will have been inaugurated invarious parts of Egypt. For each of these establishmentsboth the initial outlav and the cost of maintenance areassured. Both permanent and travelling hospitals havetheir place in the Egyptian system of ophthalmic relief, andeach of these types has two or more varieties. The per-manent hospitals which are now being built in the capitaltown of each province by the Government architects haveaccommodation for 14 in-patients. Some of the hospitalspreviously constructed, such as those of Assiut and Mansura,are much more commodious and were to a correspondingextent more costly. But the small type of hospital hasbeen found sufficient for the needs of several of the 14

provincial capitals, since all the commoner operations, suchas those for trichiasis and for trachoma, are performedon out-patients. The initial outlay required, which must beprovided locally either by self-taxation, subscription, or gift,is about RE. 5000. The expense of maintaining such a

hospital, including salaries of two Egyptian surgeons, is

defrayed by the Government at a cost of RE. 1500. Thenumber of patients who can be treated a day is from 200to 300, including 20 new cases. Operations are performeddaily from 9 A.M. to 11 A.M.The travelling hospitals are an important feature of the

system. Each hospital consists of a number of Indian tents,including one especially spacious for the performance of

operations. Each camping-ground is occupied for four tosix months. In this way most of the larger towns in Egypthave been visited. Only poor people are received as

patients and all treatment is gratuitous. It is due to the

popularity of these hospitals that the need for ophthalmicrelief after countless generations of suffering and disabilityis becoming felt by the people of Egypt, a need which wasnot realised until the establishment in 1904 of the first

hospital under my sole surgical charge.The administration and clinical direction of these hos-

pitals are vested in the director, with the assistance of twoBritish and one native inspecting surgeons. The subordinatestaff consists at the present time of 23 Egyptian surgeons,who, having completed the medical curriculum at the Govern-ment Medical School in Cairo, volunteer for ophthalmictraining and service; the average man makes a good andcareful operator for all lid affections; while a few of thesenior men have attained to quite first-class operative abilityin the performance of intraocular operations.Owing to the powerful and sympathetic aid of Lord

Kitchener, who has personally visited most of the hospitals,the annual amount available for ophthalmic purposes nowamounts to RE. 19,000, though even this sum is inadequate.

1 A communication read before the Ophthalmic Section at the

Seventeenth International Congress of Medicine.

In the province of Aswan it is proposed to provide a speciallybuilt dahabeah hospital at a cost of £E 2500 or £E.3000 assoon as this sum can be obtained. Neither the Governmentnor local effort can provide such an amount, and it is anopportunity for someone in England to extend his generosityand his sympathy with the people of this poor province.During a recent visit of a hospital to Aswan more than16 per cent. of the patients examined were found to be blindin one or both eyes, the result of acute ophthalmia.The amount of blindness in Egypt is usually stated by non-professional observers to have largely decreased within thelast 20 years ; nevertheless, out of 43,668 patients examinedduring 1912, 6939 persons were found to be blind in one orbnth eyes-that is, nearly 16 per cent. It is probable thatthere has been a small diminution the result of the enforce-ment of compulsory vaccination, but enough has been saidto show that ophthalmic conditions are still appalling, andno relaxation must be allowed in the efforts to improvethem.The different methods in which ophthalmic relief may be

given have been thoroughly studied, and no time has beenspared in the consideration of the various suggestions whichhave been made. Realising the impossibility of effecting anophthalmic revolution in any finite period, it has been con-sidered all important to put those means of relief which futuregenerations will use and will profit by on a firm and lastingbasis. The means which have been decided on are a permanentbuilt hospital or its equivalent in the capital town of eachprovince provided locally and maintained by the Government,and a travelling tent hospital with accommodation for a fewin-patients provided and maintained by each provincialcouncil. From each of these centres will develop variousbranches of work, including treatment of the pupils in schoolsand kuttabs, lectures on ophthalmic hygiene, distribution ofpamphlets giving instructions for the prevention of infection,provision of first aid in eye diseases in the remoter villages,and talks in simple language to collections of women of thenecessity of cleanliness for their children and of the way itshould be effected. Money, skilled labour, and time willgradually work a vast improvement among a people who areintensely anxious to avail themselves of the small amount ofophthalmic relief which is at present obtainable.

Cairo.

Reviews and Notices of Books.JOURNALS AND MAGAZINES.

The Quarterly Journal of Medicine. Edited by WILLIAMOSLER, J. ROSE BRADFORD, A. E. GARROD, R. HUTCHISON,H. D. ROLLESTON, and W. HALE WHITE. Vol. VI., No. 24.

July, 1913. Oxford : At the Clarendon Press; London, Edin-

burgh, New York, Toronto, and Melbourne : Henry Frowde.Subscription price 25s. per annum. Single numbers 8s. 6d.each.-The contents of this number are: On Auricular

Fibrillation, by A. M. Gossage and J. A. Braxton Hicks.

Four cases are recorded and carefully discussed. The

authors conclude that the exact cause of auricular fibrillation

is as yet unknown, but that it usually comes on in a heartwhere there has been disease of the valves or myocardialchange. In one of their cases, however, the condition

developed suddenly in a heart which had not previouslyshown any evidence of disease, and they suggest, therefore,that it is possible that auricular fibrillation may occur in

previously healthy hearts, and if this is true, that theessential cause must be outside the heart.-Illustrations ofHeart-Sound Records, by Thomas Lewis. A method of

recording the heart sounds by means of a stethoscope, amicrophone, and a string galvanometer is described,and some interesting photographic reproductions ofthe records obtained are given. These illustrate thenormal heart sounds in man and the dog and themodifications produced by disease of the valves and

other conditions. It is interesting to note that Dr. Lewishas found considerable difficulty in recording the systolic

471

apical murmur in a large percentage of cases of mitral

regurgitation. Records are shown of aortic and pulmonary-murmurs, and their time relations and vibration frequencyare examined. The problem of reduplication of the cardiacsounds is shown to be complex and to require careful

investigation by graphic methods.-The Incidence and

Prognostic Value of the Pulsus Alternans in Myocardial andArterial Disease, by J. Davenport Windle. Brief descriptionsare given of the clinical histories of 33 patients withmyocardial and arterial disease, and the author confirms theview expressed by Dr. James Mackenzie that the inceptionof pulsus alternans in aged people is of grave prognosis.-Pseudochylous Body Fluids, by John Marrack. The

characters of two examples of milky-looking ascitic fluidsare carefully examined. It is suggested that in such

fluids some lipoid, not necessarily present in excess,is not in the usual state; possibly in clear fluidsit is combined and in milky ones free.—Cysticercus Cellulosæ in the Central Nervous System, with an

Account of Two Cases, by Rupert Waterhouse. Both cases are very carefully recorded and numerous blood 1

counts are given, showing the eosinophilia. In one case,which subsequently died from meningitis following acute pneumonia, an eosinophilia of the cerebro-spinal fluid was observed. Plates are given showing the appearance of the brain in one case and of an excised cyst from the muscles in the other.-On Pneumothorax Treatment of Tuberculosis of the Lungs, by 0. Amrein and F. Lichtenhahn. The

technique of the procedure as carried out by the Murphy- Brauer method is described, and the results obtained in 11 1cases observed by the authors are stated. The paper is illus- (

trated by some good reproductions of skiagrams.-The Localisation of Function in the Kidney, by W. P. Herringham t

and J. W. Trevan. Some interesting observations upon six (

cases of nephritis, using the method suggested by Schlayer I

for investigating the activity of the tubular and vascular 1

mechanisms of the kidney, are recorded.-The "Specific" (

Use of Salicylate in Acute Rheumatism : a Consideration of 1

Practical Objections, by Reginald Miller. The purpose of r

the author has been to examine certain objections to the i

theory that salicylate diminishes the activity of the rheu- r

matic infection, rather than establish its truth. He finds that 1

these objections are in the main not valid. 1

Jahreskurse fur Aerztliche Fortbildung. Munich: t

Lehmann. June, 1913. Price 18 marks per annum.-Professor Langstein reviews advances in diagnosis and treatment of rthe affections of children. After a brief article on the fartificial feeding of healthy infants, he discusses pyelo- c

cystitis in childhood, which is not uncommon. Error in t

diagnosis may lead to severe illness or even death. In r

sucklings the most prominent symptom is usually arise in the temperature, which may be high at nightbut normal in the morning, or may be continuous, and an apparently causeless fever in a baby should always v

arouse suspicion of this disease. The appetite is often lot. I

and there may be great thirst. It may be possible (to detect some swelling of one or both kidneys. IThe diagnosis is made by the examination of the (urine, which is often turbid and shows leucocytes and (bacteria under the microscope. The urine is usually acid. The commonest organism found is bacillus coli. Sometimes in unilateral cases the ureter from the diseased

kidney may be blocked at intervals, so that the urine is I (

alternately clear and turbid. In older children local o

symptoms, such as bladder pain and frequency, are more n

prominent. The causation is probably a blood infection t

from the alimentary canal, but it may ascend from the urethra. The prognosis is fairly good; many of the cases nrecover, but a few die. It is important to keep the genitals’of children as clean as possible, and to avoid soiling of the

urethra with fsoes, so as to guard against this disease. The

treatment is to supply abundance of fluid, both by themouth and the bowel, to feed well (albuminous fluids givingthe best results), and to administer alkalies and particularlyurotropine, salol, or hippol. Vaccine ’ therapy is mentionedbut not advised. The next subject is chronic nephritis andalbuminuria in children, usually occurring at about the

school age. The forms described are chronic hæmorrhagicnephritis, a chronic nephritis resembling the above in

symptoms and in the development of anasarca but lackingthe hasmaturia, contracted kidney (exceedingly rare in

children), pyelonephritis following on pyelitis, ’’ pædo-nephritis," and intermittent albuminuria. Of these,"pædonephritis " is the most important. The symptomsare often vague and insignificant-loss of appetite, pallor,headache, occasional constipation. The quantity and specificgravity of the urine are normal, but it contains a gooddeal of albumin, a few blood cells, and hyaline and granulurcasts. Some of the cases get well, but they are always indanger of development of a hypertrophied heart, highblood pressure, and urasmia.

Knowledge for August contains several articles which willappeal to the medical reader. In the Streamless Downsand their Dry Valleys, Mr. G. W. Bulman compares the

dry chalk valleys in the south of England with the ouedsof the African deserts, though not, of course, as to their

origin, oueds being rivers buried by the drifting sand, theirwaters still passing along the old channels.-Mr. H. StanleyRedgrove has Some Notes on the History and Significance ofthe Theory of Spontaneous Generation, and Mr. E. Joblin

discusses The Age of the Earth, while Mr. Ruskin Butterfieldpleads for the establishment of a National Folk Museum atthe Crystal Palace. A joint paper, well illustrated, by Mr.C. Ainsworth Mitchell and Mr. R. Morris Prideaux, on theHairs of Animals, in which the authors state that they wouldbe grateful for any authenticated specimens of hairs of out-of-the-way races of mankind that may be sent to them, willbe read with considerable interest. One of the authors

recently stated that, while there was a central canal ormedulla in the hair of the higher apes, one was apparentlynot formed in human hair. Mr. Mitchell and Mr. Prideaux

have been carrying out investigations, the result of whichhas caused them to modify this statement. It occurred tothem that since the axillary hair in man is probably avestige of his former ancestry, it was in such hair that amedulla would be most likely to be found. This was con-firmed by a study of the hair from the arm-pit. The authorsof the paper believe that the hair of human species of lowtype resembles that of some of the higher apes much morenearly than it does the hair of the average European.

DONATIONS AND BEQUESTS.-By the will of thelate John Newton Mappin the testator left, subject to hiswife’s life interest, £1000 each to the London Hospital,Royal Free Hospital, North-Eastern Hospital for Children,Chelsea Hospital for Women, St. John’s Hospital for Diseasesof the Skin, Royal Hospital for Incurables, Epsom CottageHospital, Leatherhead Cottage Hospital, Cobham (Surrey)Cottage Hospital, Royal Sea Bathing Hospital, Margate,Children’s Convalescent Home for Surrey (Bognor),Surgical Provident Appliances Society, Royal Hospital,Sheffield, and the Sheffield Infirmary.-The late Right Hon.William McEwan bequeathed L1000 to the CorstorphineConvalescent Home in connexion with Edinburgh RoyalInfirmary. -Under the will of the late Mr. Benjamin Evans,of Llandovery, the following among other bequests have beenmade : E900 to the Swansea General Hospital, £225 each tothe Swansea Blind Institution and the Swansea Deaf andDumb- Institution, and .EIOO to Earlswood Asylum -Amongthe bequests made under the will of the late Miss MariaMercer, of Clayton-.le-Moors, Lancashire, are the following:65000 to the Blackburn and East Lancashire Infirmary and£3000 to the Victoria Hospital at AccringtoD.