1004

-seems probable that "mild though temporary attacks" ofthe disease which Mr. Marriott apprehends among personsin the dwelling to which a hospital case returns wouldbe at least as likely to occur if the scarlet fever patienthad remained at home throughout his illness. As we

understand Mr. Marriott’s contention, the public and

municipal authorities have been fooled into hospital isola-tion by their medical advisers. But "you cannot fool

;all the people all the time." "

Isolation hospitals by thescore have been established and in full work for many

years in this country. We have never heard of an instance

where a local authority, responsible for the prevention ofinfectious diseases, has attempted to abandon its isolation

hospital. -

THE LECTURES AT THE ROYAL COLLEGE OF

PHYSICIANS OF LONDON.

THE dates for the delivery of the official lectures at theRoyal College of Physicians of London are approachingAs we have already announced in THE LANCET the HarveianOration will be delivered by Dr. D. Ferrier on Saturdaynext, Oct. 18th, at 4 o’clock. The Bradshaw Lecture will be

delivered on Tuesday, Nov. 4th, at 5 o’clock, by Dr. C. J.

Cullingworth. Dr. W. Hale White will deliver the CroonianLectures on the following Tuesdays and Thursdays--Nov. llth, 13th, 18th, and 20th. These lectures were

prepared by the late Dr. J. W. Washbourn, C.M.G., the

appointed Croonian lecturer, whose lamented death took

place this summer. -

"AFFLICTED LONDON."

UNDER the heading of "Afflicted London " Mr. R.

Austin Freeman in Part 25 of Cassell and Co.’s "LivingLondon" gives the first part of a short but interestingdescription of the daily life of those who have been deprivedof the use of one or more of their bodily faculties. In one

way or another a large but decreasing proportion of the

afflicted seek a precarious livelihood in the streets by anappeal to the sympathy of the passer by ; happily, however,there are many institutions where the afflicted poor can anddo seek relief. There is a well-known factory in Tottenham-court-road where about 100 blind persons are employed.Basket-making is carried out in a most satisfactory mannerby persons of both sexes, though women, says the authorof the article, are much less successful than are men.

Women are also employed in the chair-caning departmentbut they are chiefly occupied in the making of hair- andnail-brushes. Men work in the carpenter’s shop where theforeman casts up his accounts and makes calculations bymeans of a metal plate perforated by small holes into whichJarge-headed pins can be stuck. Loom weaving is also

carried on in the building. At the Cripples’ Home for Girlsin the Marylebone-road needlework is taught and dress-

making, hatmaking, and fancy basket-making are carried on.All the inmates of the building are sufferers from diseases ofthe hip or of the spine or some analogous affection. There isa similar institution for boys at Kensington. At both placesthere is a small school for the more backward and illiterate

children. The teaching of crippled children is, however,now being gradually taken over by the London School Board l.and the horse ambulance for conveying ouch cripples to

school has recently been described in our columns. 2 Amongthe institutions for the sightless may be mentioned theBritish and Foreign Association for Promoting the Educa-tion and Employment of the Blind and the Royal NormalCollege for the Blind, while there are also the blind centresof the London School Board and the reading-room for the

1 Vide THE LANCET, Sept. 27th, 1902, p. 880.2 THE LANCET. May 24th, 1902, p. 1483.

blind in the St. George’s Public Library, Cable-street, E.The illustrations include a full-page picture of the interiorof the Church of St. Saviour, near the Marble Arch, with thedeaf and dumb " singing " a hymn.

CHOLERA IN EGYPT.

THE Director-General of the Sanitary Department of Egyptstates that for the week ending Sept. 22nd 6388 cases ofcholera were reported throughout Egypt, against 9466 duringthe previous week-a diminution of 3078 cases. 3394 personswere found dead out of hospital and 2414 deaths took placein hospital, against 4681 deaths out of hospital and 3597deaths in hospital, or a total diminution of 2470 deathsas compared with the previous week. During the week 109cases occurred in Cairo and 240 in Alexandria, against 120in Cairo and 300 in Alexandria during the previous week.Up to the present date 1830 towns, villages, and ezbehs

throughout Upper and Lower Egypt have been notified asinfected.

____

APPENDICITIS DURING PREGNANCY.

THOUGH the child-bearing period covers the ages at whichappendicitis is most common, and though some of the

phenomena of pregnancy--e g. , constipation-are regardedas causes of appendicitis, relatively few cases have beenrecorded of appendicitis during pregnancy and the subjecthas received but little attention. In the Boston Medioal and

Stirgical Jotcrnal of Sept. 4th Dr. Francis D. Donoghuehas published an important paper in which the followingcase is recorded. A woman, aged 36 years, who had beenmarried for three years, had a normal labour in October,1900. She again became pregnant in May, 1901. On

August 9th, at 11 P.,,4., she was seized with severe epigastricpain which was accompanied by vomiting. She had been

constipated. Next day the pain and vomiting continued.The temperature was 1000 F. and the pulse was 90. Therewas marked rigidity of the abdominal muscles, especiallyon the right side. The pain became localised at McBurney’spoint. In the evening the pain had greatly diminished,but the temperature was 100’5°, the rigidity was marked,especially on the right side, and McBurney’s point was verytender. Believing that the cessation of pain without im-provement of the local signs was not favourable Dr.

Donoghue made a three-inch incision through the outer

border of the right rectus muscle. The appendix was darkcoloured, full of concretions, and surrounded by purulentserum which was partially walled off by fresh adhesions ofthe omentum. Cloudy serum also welled up from the sideof the pelvis ; this was carefully sponged out. The appendixwas removed and the wound was closed except so far as toallow gauze drainage. Examination of the specimen showeddiffuse interstitial purulent appendicitis and peri-appendi-citis. Recovery was interrupted only by rhythmical painswhich seemed to threaten abortion but which were con-

trolled by morphia. Normal labour occurred on Feb. 26th,1902. Mixter has reported a case of operation on an

appendicular abscess after premature delivery of a deadchild at seven months.’ Mund62 has described a cae of

premature delivery of a dead child induced by acute

appendicitis. The few cases since recorded give the

impression that appendicitis is the most fatal extra-uterine

complication of pregnancy. In cases operated on previouslyto 1898 a maternal mortality varying, according to differentwriters, from 30 to 85 per cent. and a, foetal mortality vary,-ing from 49 to 90 per cent. have been observed. A few cases

operated on subsequently show better results, due principallyto early operation. The high mortality has been explained by

1 Boston Medical and Surgical Journal, December, 1891.2 Medical Record, 1894;