404

encouraging and in some instances unexpected and remark- and special horn, cost me E42 15s. nett. From the
tool-bag,
able. Persons with extensive consolidation, softening, and of view of a medical officer of health to a large rural
point
occasionally cavities at the apex of the lung, after a few district who has to pay his own travelling expenses this is
weeks’ treatment, lost the distressing urgency of cough, an exceptionally good investment. Two horses at least
expectorated less, were able to sleep, improved in appetite, would be required to do the rounds I sometimes do in one
digestion, and assimilation, and put on weight. It is need- day, but what I still more prefer is the saving of time. I can
less to add that the patients improved the most in whom the easily beat all the ordinary local trains in getting to points
of my district and as an effective aid in obtaining the
disorganising changes and impairment of general health were
least pronounced. At the same time careful attention was prompt isolation or removal of infectious cases to hospital
given to common-sense measures for the improvement of the it is simply invaluable. Within three hours of the receipt
general health by freh air, nutritious diet of an easily of a notification I have had cases en route to hospital from
asimilable kind, rest, personal cleanliness, and general houses nine or 10 miles removed from my centre and from
hygienic surroundings. very outlying districts, and this without any approach to-
Medically, the drugs used were iron, strychnine, and bustle or hurry. The machine doubtless requires a bit of
quinine. Subsequent experience has confirmed me in the attention, but everything that is worth having requires
value of this method of treatment, and that when the lesion attention and well repays it. There is an exhilarating
of the lung is not too extensive and the constitutional dis- fascination in a good long run on a motor which is quite
turbance is moderate in degree, hope of recovery may fairly unlike any other form of pleasurable excitement I have ever
and reasonably be anticipated. Speaking of constitutional experienced and the management of a pulsating, throbbing
disturbance leads me to observe that one occasionally sees 1½ horse-power engine underneath one provides constant
cases where one distressing symptom, dyspnoea, seems alto- interest. The battery recharging has cost Is. 6d. and the
gether out of proportion to the extent of the disorganisation petrol about 20s. That has been practically my total outlay
of the lung. Where there are so many facts in medicine it in getting over the distance mentioned above. I do not agree
is, perhaps, unwise-it is certainly often inexpedient-to with Dr. W. T. Sheppard that those high-priced machines
theorise. But it has occurred to me whether in these cases made by large firms with names are worth the extra money.
.

the bacillar toxins inhibit the heat centres and so, from I raced a medical man the other day who was mounted on a
states of hyperpyrexia, set up the dyspnoea, or, on the; very expensive and well-known motor bicycle (2 h-p.) and
other hand, may the dyspnoea be more directly caused by I literally romped away from him. I must in fairness add
reflex through the pulmonary branches of the pneumo- that he was five stones heavier in weight but against that he
.

gastric to an unstable respiratory centre ? There is nothing had an extra ½ horse-power and he has had quite as much
,

in the method of treatment I now am advocating in con- I experience of motor bicycling as I have.
.

flict with the method described as "the open-air treat- From my own experience I have no hesitation in advising
ment." On the contrary, it plays a part-perhaps the, any one who contemplates buying a motor bicycle to do so.
leading part-not only in pulmonary phthisis but in all A more economical, rapid, and pleasant way of getting over
diseases of a malnutritive type. We possess specifics for fewr the ground will be hard to find.
diseases and those of us with the largest clinical experience I am. Sirs. vours faithfullv.
are the foremost to recognise and to emphasise this truth. A. C. FAUQUHARSON, B. Sc., M. D. Glasg., D. P. H. Cantab.,
It behoves us, therefore, to treat disease from a broad Medical Officer of Health, Auckland Rural District.
and enlightened standpoint. What do I mean by this ? July 31st, 1902.
Simply that it should be our constant aim and endeavour to
balance, so to speak, the discords of disease, to assist the GOLD MINERS IN THE TRANSVAAL.
return to the discharge of the natural and healthy functions
of the body, to favour a healthy interchange between blood To the Editors of THE LANCET.
and tissue, to promote a normal metamorphosis-in short, to
strive after the attainment of the normal standard, spoken SIRS,—I have read with interest the very timely article of
of as health. It is in this direction that healing is accom- Professor T. Oliver in THE LANCET of June 14th, p. 1677,
would ask a little of your space for some remarks which
plished and without it all other means are vain. In this con- and
clusion is nothing new, nothing startling, only the recogni- arise from thinking of the article. Undoubtedly a large
tion of golden truth revealed by time and observation and number of cases of pulmonary disease have arisen in the
the happy possession of men who labour for the good of Transvaal and in South Africa generally. I believe that
others. I am, Sirs, yours faithfully, Professor Oliver is right in regarding these cases as
JOSEPH O. BROOKHOUSE, M.D. St. And., M.R C P. Lond. pulmonary fibrosis. I have seen and observed for weeks
Senior
Physician to the General
Hospital, Nottingham. many such cases and all bear the clinical features described
by Professor Oliver.
I do not desire at present to say anything further of the
disease, but I do want to ask medical men in Britain, in the
MOTOR BICYCLES. mining districts especially, to warn any miners who have the
To the Editors of THE LANCET. slightest tendency to pulmonary weakness against coming to
South Africa to ply their trade. Following the cessation of
SIRS,—I have followed with interest the letters in THE
LANCET re motors and as I have during the last five months
ridden nearly 2000 miles on my motor perhaps I may be
I the war and the consequent opening of the country, large
numbers of men, especially those who have any weakness of
the ches-t, will be for coming here, thinking they can get
allowed to add my impressions to those you have already
health and good work. This country and the two newly
published. My machine was built by a local maker (Messrs. acquired States are the wort places such miners could seek
8haw and Co., Bishop Auckland) and fitted with a Minerva if they have any pulmonary trouble. Hundreds came out
engine of 1-2L horse-power. Being absolutely ignorant of the prior to the war and from among these are the patients Pro-
principles of mechanics generally I took occasion to visit I fessor Oliver, Dr. James Anderson, and others have seen on
the workshops during the construction of the bicycle and by
their return to England since the war began.
the time it was ready for delivery I had acquired a fair theo-
Broken down utterly in health after only a short time here,
retical acquaintance with my motor. It was delivered to me
on a stormy, snowy day in February and so impatient was I
they are terrible examples of the effects of mining in South
Africa on any but the strongest constitutions. Furthermore,
to try it that after a trial run, which gave every satisfac-
men who get sick out here cannot get the nursing, care, and
tion, I attempted to round a very slippery and rather sharp attention their cases require, and after battling with the
corner at a rate probably of 15 miles an hour. The machine
disease they are forced to give in ; they start for England and
"
skidded" and I came down. That was my first and, so the sea-voyage, with its quickly varying climates, puts the
far, last fall. I have ridden the machine in all weathers, up final touch to them. It is an absolute fact that these cases
and down steep hills, through towns, and along back lanes, of fibroid phthisis do very badly on the passage home. I
and up to the present I have nothing but enthusiastic praise
have seen at least 20 of these cases leave Cape Town during
for my mount. My battery ran 823 miles without recharging
the past two years, and their condition on landing in
and up to now has only been recharged twice. I am still
using the same belt which was on the machine at the start ; England was very much worse than when they embarked in
I haB e broken it about eight or nine times, but it can be spite of every care and attention during the voyage. I
would therefore ask my professional brethren in Great
repaired in a couple of minutes, and with these exceptions I
have had absolutely no trouble whatever.
The machine complete with acetylene lamp, extra large 1 THE LANCET, July 26th, 1902, p. 257.

Britain if they are consulted by miners to warn them against
South Africa and to strongly advise them that the miner, to
stand any chance here, must have perfect health, for not
having this any who come to work in the mines come to
certain death. I am, Sirs, yours faithfully,
Cape Town, July 8th, 1902. THOMAS MARSHALL
A NEW METHOD OF KEEPING IN APPO-
SITION THE EDGES OF SURGICAL
INCISIONS AND WOUNDS IN
ORDER TO PROMOTE
UNION.
To the Editors of THE LANCET.
SIRS,—Absence prevented me replying to Mr. Haydn
Brown’s letter of July 12th before now, and surely an answer
is needed. The inventor who resorts to planetary motion as
an explanation of the mode of use of a suture is beyond me.
Let me repeat on my unpretentious level, Who are the
"surgeons of highest rank" who recommend this suture??
If one such be named who can fairly aert that the suture
"
possesses one novel point of utility over my clumsy " inven-
tion of 18 years ago I shall send you any donation in my
power towards any cause you name.
I am, Sirs, yours.faithfully,
Finsbury Pavement, E.C., August 4th, 1902. J. MACMUNN.
NOTES FROM INDIA.
(FROM OUR SPECIAL CORRESPONDENT.)
The Plague Epidemic.-" Kala-azar" " in Assam.-The
Work of the Lady Dufferin Hospitals for Women.-
Inculations for Cholera and Plague in Benqal.
THE small mortality from plague now occurring has greatly
diminished public interest in the disease. In the whole of
India there were only 1158 deaths during the week ending
July 12th. The minimum mortality of the year-viz , 1050-
seems to have been reached in the previous week. The
figures in detail are : Bombay Presidency, 717 ; Punjab, 95 ;
Mysore, 214 ; Bengal districts, 8 ; and Calcutta, 20. Bombay
city now records fewer deaths than at any time since the
On the other hand, there
cocnmencement of the epidemic.
has been an increase in the Bombay districts and in the
Mysore province-areas in which the earliest signs of a
recrudescence may be expected to occur.
The disease known as kala-azar" which has for many
’’
years been raging in certain districts of Assam and upon the
pathology of which there is still so much doubt, has
markedly declined in the two chief districts of the Brahma-
putra valley most affected. There were 5856 deaths recorded
for last year It is interesting to note that while this disease
declined the mortality from fever increased. The district of
Nowgong has decreased in population by 86,147 during
the past 10 years and it is estimated that 54,000 have
succumbed to kala-azar. The disease has recently spread
and effected a lodgment in Sylhet. The unsatisfactory part
of all reports from Assam is that as registration is not com-
pulsory except in municipal areas and in tea-gardens so little
reliance can be placed on the returns, and this applies more
to the Brahmaputra valley, perhaps, than to other districts.
I learn from a recent report that inoculation for small-pox
is still practised in outlying villages of the Sylhet district
and that vaccination generally in Assam has not been very
successful.
The administration of the Lady Dufferin Hospitals for
Women has come in for some apparently undeserved
criticism. While it is true that in some districts com-
paratively few purdah women avail themselves of the
hospitals the general results of the fund are satisfactory.
The cry that men have control and that the workers are not
confined to women is grossly exaggerated. In some of the
hospitals they have had to call in the assistance of the civil
surgeons, but in the main the work is carried on solely by
women. There are 40 lady doctors engaged, of whom
14 are English. Many of the others, though educated in
India, have taken degrees in Europe. The fund is not rich
enough to engage English ladies in larger numbers. The fund
relieved the sufferings of one and a half million women last
405
year and through Lady Curzon’s influence about six lakhs were
collected last year chiefly for the special object of training
midwives. Many prejudices have still to be overcome. -
There are many purdah women who consider it a disgrace to
enter a purdah ho-pital. and in Hajputana the women con-
sider themselves defiled by touching the hands of an English
lady.
From the report of the Sanitary Commissioner for Bengal
I find that inoculation for cholera has lamentably fallen
off. This does not appear to be due to any decline in its
value but to the fact that even in the tea-gardens it is now
entirely optional. It is a mo-t entirely confined to emigrants.
Inoculation for plague is equally under a ban. In Calcutta
only about 40 inoculation" were done during the whole year,
while through personal influence it met with considerable
success in Gaya. The Sanitary Commissioner rightly argues
in favour of inoculation as against disinfection, but higher
authorities are unable to accept his arguments.
Calcutta, July 17th.
THE
SHONE SYSTEM FOR THE THOROUGH
VENTILATION OF SEWERS AND
HOUSE DRAINS.
(BY OUR SPECIAL SANITARY COMMISSIONERS)
MUCH has been said, and justly said, in regard to the
benefits which have resulted from the abolition of cesspools,
of the pail system, and other such contrivances. A consider-
able reduction in the rate of mortality has been attributed
to the introduction of general drainage schemes. Never-
theless, we have not reached perfection and we can only
boast of having substituted a lesser for a greater evil.
Experience has taught that if sewers are better than
cesspools they have also their evils. Sewers were to save
our dwellings from all the dangers and inconveniences
caused by cesspools, portable pails, middens, &c. Hardly,
however, had the system of water-carriage drainage been
introduced on a large scale than our sanitary engineers,
plumbers, and others had to exercise all their ingenuity so
as to protect homes from the sewers themselves. Con-
our
sequently traps devised, and these were at first clumsy
were
contrivances which of late have been much improved. But
now we have to admit that even the best of traps may of
itself become a nuisance. The sewer has saved us from the
cesspool, the trap protects us from the sewer, but what shall
protect us from the trap ? Theoretically, of course, the flow
of air should be through the house-drains to the sewer, but
in practice the reverse not infrequently occurs. If the
water-seal in the traps prevents such currents entering the
house the effluvia from this water must travel upwards.
Of course, it the traps only contained clean water
no harm could ensue, but these traps, especially the larger
intercepter traps at the base of the house and separating the
house from the public sewer, often contain soil and if they
are not frequently and copiously flushed they must give off
dangerous effluvia. At best these emanations are conducted
by a ventilating pipe to the roof of the house. But this is not
satisfactory. It is sometimes noticed that moke will descend
a chimney in which th-re is no fire. This smoke comes from
another chimney. The difference between the indoor and
outdoor temperature causes a down current and thus a
chimney will bring into a room the atmosphere from the roof
of the house, a fact that becomes visible when that atmo-
sphere happens to be charged with smoke. Other portions of
such atmosphere enter by the windows, especially those in
the upper part of the house. The odour of a chimney on
fire only escapes from the top of the chimney, yet it is
detected by persons low down in the basement of the houses
or in the street. It cannot be said, therefore, that the air
from the sewers or drains will not enter the houses because
it has been discharged above the roofs. and e-pecially so
when it happens, as is often the case, that one house is
lower than its neighbour. The only absolutely satisfactory
solution of the problem would be the adoption of a system
by which the air in the house drains would have no means
of escape except into the sewer.
Nevertheless, and even if this principle could be rigorously
applied, it would only transfer the problem from the house