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either singly or in groups in many erythrocytes, sometimesoccupying the centre of the corpuscle and at other times

lying near the periphery. It appeared that they some-times escaped and were found free in the blood plasma.An enumeration of the erythrocytes at this stage is

not of any value owing to the fact that many dis-

integrated cells are likely to be included. Three days laterthe number of degenerating red cells was much lessand on the next day they had entirely disappeared. Thenumber of erythrocytes was then found to be 1,500,000 percubic millimetre and nucleated red blood corpuscles werealso observed to be present. As regards the leucocytes,when the case was first seen Dr. Hirschfeld counted 30,000per cubic millimetre, while four days later their number hadfallen to 15,000. The most noticeable increase was found tobe in the polymorphonuclear leucocytes but myelocytes werealso seen. In regard to the changes observed in the

structure of the leucocytes, as a result of poisoning bychlorate of potassium, only very few observations are onrecord. Krönig observed a fibrillation of the protoplasm ofthe lymphocytes and Jacob stated that a large number

of the leucocytes appeared to be swollen. The former

of these observations Dr. Hirschfeld was not able to

confirm and the latter he explains as due to pressurein the method of preparation as he did not find

the swollen appearance in fresh specimens. Someof the leucocytes may contain the remains of de-

generated erythrocytes. Other cells show variation in their

neutrophile granulations which may be in clumps in someparts, leaving gaps in others. A very noticeable form wasalso a neutrophile cell with several spherical nuclei, a formusually observed in pus, especially that due to gonorrhoea.Other cells were seen which were identical with the pseudo-leucocytes of Ehrlich and were due to breaking up of thepolymorphonuclear cells. Although known to occur in

exudates they have only once before been seen in blood, viz.,in a case of hsemorrhagic small-pox studied by Ehrlich.The interest of this case lies in the great care with whichthe changes in the blood were observed and in the evidenceit affords that potassium chlorate affects the white corpusclesinjuriously as well as the red.

ELECTION TO THE SENATE OF THEUNIVERSITY OF LONDON.

OWING to Dr. Lauriston E. Shaw’s retirement from theSenate there is a vacancy which will shortly be filled by a repre-sentative elected by the Faculty of Medicine. The date of

the election has been figed for Thursday, Nov. 21st, and*already Professor E. H. Starling has issued an address tothe electors. The latest date for sending in the names ofcandidates to the Dean of the Faculty is Nov. 7th. Judgingfrom the great interest taken in the senatorial elections last

spring there seems likely to be another keen contest on thepresent occasion. Until additional candidates are in the fieldit is impossible to forecast the lines upon which the presentelection will be fought. Professor Starling makes the twochief points in his programme the greater accessibility of themedical degree and an increase in the period devoted to clinicalstudy. On both these questions Professor Starling shouldhave the warm support of a very large number of the teachers,though no doubt there will be some who will be drawn intothe opposite camp by the cry that this is an attempt to lowerthe standard of the degree. On the vexed subject of theconcentration of the earlier studies Professor Starling is pre-pared to support what seems to be a reasonable com-

promise affording at once an opportunity for thoseschools which desire to relinquish these subjects to do

so, while bringing no pressure, direct or indirect, uponothers to participate in the movement. This pro-posal, which is likely to commend itself as equitable to i

the majority of teachers, would enable the Senate to extricateitself from the difficult position created by the change offeeling upon this question shown in the Faculty at the last.election. By some it may be considered a disadvantage thatProfessor Starling is not a clinical teacher. It must, how-

ever, be recognised that the reorganisations necessary to,

carry out the immediately pressing reforms in medicaleducation fall within the earlier period of the curriculumof which physiology at present occupies so large a share.

Unfortunately the committee work of the Faculty repre-sentatives upon the Senate is extremely exacting and it is

likely to become increasingly difficult to find physiciansand surgeons able to devote the necessary time to thes&

positions. -

DEATHS UNDER ANÆSTHETICS AT GENERALHOSPITALS.

THE report of an inquest upon a death under chloroformwhich we publish in another column ventilates a question ofgreat importance alike to hospitals and to the general public.The facts of this particular case are briefly these. The

patient suffered from exophthalmic goitre and to relieve herurgent symptoms the surgeon in charge of the case decidedto perform an operation and to do so in two stages. Thefirst stage, that involving the ligation of the arteries to thethyroid gland, was successfully accomplished, a house surgeongiving chloroform, and no dangerous symptoms appeared. Onthe day when the second stage of the operation was to havebeen carried out-the removal of the tumour-another house

surgeon, a recently qualified man who had not previouslyanaesthetised for a case of the kind, undertook the administra-tion of the anassthetic. The patient, however, died when theincision into the skin was made. There appears to have beensome discrepancy in the opinions expressed as to the cause ofthe death. One view advanced was that the retching andvomiting which occurred caused interference with respirationand death arose from suffocation. Another contention was

that the result was due to reflex failure of the heart, while thepathologist who made the necropsy found a persistentthymus and this he regarded as possibly a determining causeof death through syncope. It thus appears that the condi-tion of the patient was recognised as a very grave one and thesurgeon who operated was keenly alive to the special dangerwhich the patient ran through taking an anaesthetic. Local

analgesia was even thought of but had to be given upowing to the nervous condition of the patient. The

question which naturally arose and was strongly insisted

upon by the coroner was : Why did not one of the expertanaesthetists attached to the charity attend for the purpose ofgiving the chloroform instead of a junior house surgeon ofadmittedly small experience ? Authorities were cited which

supported the coroner’s view that in such grave operationsthe anaesthetic should be given by the staff anaesthetist,or at least in his presence. The answer to these contentionsdoes not seem to us to be wholly convincing. Naturallysurgeons in large operative practice must be, in theory at least,cognizant with anaesthetics. Yet it can hardly be admittedthat they can direct the inexperienced anaesthetist or watchhim as he applies each fresh supply of the anaesthetic. In

theory such a shared responsibility is possible; in practicewe doubt whether such supervision can protect the patientfrom grave dangers. If a serious operation has to be per-formed the house surgeon does not, we believe, undertake it,even under the guiding advice of his principal. In cases suchas the one which we are considering the patient’s life was asmuch in jeopardy from the anaesthetic as from the operation,and if the latter required expert performance, is it too muchto say that the conduct of the anaesthetisation should havebeen undertaken by a staff officer of special experience ? It isunfortunately true, as was pointed out at the inquest, thatthe operations performed at the large hospitals af Londom

1177

are so numerous that it is difficult to obtain expert help inthe conduct of the anaesthetics for all of them. All will con-

cede this but it appears to us equally clear that the difficultywoald be met by the appointment of a resident anae ithetist,a man who had acquired more experience than a younghouse surgeon and who had attended some hundreds of caseswith staff anaesthetists and so gained considerable skill andsome special knowledge. We should not labour the matter

except that we feel that the statement that a surgeon cankeep "half an eye" upon the administrd.tion of an anOB3-thetic and can share the responsibility of its administration

with the actual chloroformist is at once dangerous andreactionary. It is justly said that junior men must acquireexperience in giving anaesthetics but it is surely best

not to tax their powers too far, and to restrict theirduties to cases which are not of extreme difficultyand do not involve special risks. It is open to those who

uphold the opposite view to say that the question is one of Iopinion and we see that that is the attitude adopted by awitness at the inquest, a witness whose wide knowledge andgreat reputation must appeal to everyone. In spite, how-ever, of this, we cannot but express a hope that careful con-sideration of the weighty contentions advanced against suchan opinion may modify it and le Ld those who hold it to

refrain from imposing on young and inexperienced shouldersa weight of responsibility which they can hardly bear withimpunity.

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THE SANATORIUM TREATMENT OF ACTIVE

INSANITY BY REST IN BED IN

THE OPEN AIR.

AN interesting paper on the above subject was read by Dr.C. C. Easterbrook, the medical superintendent of the AyrDistrict Asylum, Scotland, at the International Congress ofPsychiatry and Neurology held at Amsterdam in September ofthis year. In the first part of the paper he refers to "the

asylum or outdoor exercise treatment of active insanity,"which was the form of treatment which he himself employedfrom 1894-1902 for all those patients whose physical con-dition did not demand confinement in bed in the asylumhospital. The objection that he found to this method

was that although there was often steady improvementin the physical health of the patient there was decidedretardation of the mental recovery. During 1902-06 Dr.Esterbrook made it a regular practice to receive all new

patients into wards of the hospital type and to prescribea preliminary course of treatment by rest in bed, which isbecoming increasingly the custom in all mental hospitals.He found that although the recovery rate was higher in the"rest" treated patients than in those patients who had beentreated by "exercise," yet in the former there was "aretardation of the improvement in the physical condition,general metabolism, and functional activity of the non-

nervous organs " which was not to be observed in thosetreated by exercise in the open air. In order to obtain thebenefits which each form of treatment seemed to offer hedecided to combine the two methods of "rest cure" "

and "open.air cure." All newly admitted patients at

Ayr Asylum are after examination, unless too weak phy-sically to be moved, placed straightway in the verandahsattached to the reception wards of the hospital, wherethey remain throughout the day. The severity of the

mental symptoms is no contra-indication to this mode- of treatment. He states that "there is a rapid sub-sidence of the active mental and nervous symptoms"

"

usually within three weeks and " the improvement in theeleep is striking and in most cases is distinct within a week."Further, there is a rapid improvement in the physical con-dition of the patient even to a greater extent thanis the case when outdoor exercise has been prescribed.

The condition of the skin improves, the appetite re-

covers, and the increase in bo iy-weight commonlyamounts to from five to seven pounds during the firstthree weeks. The duration of the sanatorium treatmentin the case of new patients varies from one to

four weeks, which is a considerably shorter period than is

usually necessary for those patients who are treated bybeing confined to bed indooril. Although, as Dr. Easter-brook states, it is too soon to speak of the ultimate thera-peutic value of this system it would certainly appear to bean advance in the treatment of the insane. The value of £fresh air as a potent prophylactic and curative agent hasdefinitely been proved in certain forms of disease andin the next decade this range may have widened so as toiacluje the treatment of mental disorder.

THE EMPLOYMENT OF CHILDREN AND STREETTRADING BY YOU NG PERSONS.

ON another page we publish the greater part of a seriesof by-laws recently enacted by the London County Councilthe better to regulate the employment of children in theirhomes or elsewhere and in the streets. As will be seen,

they are especially directed towards insuring for a childattending school a reasonable number of hours of recreationduring each day, limiting his labour on school holidays toeight hours, and forbidding him ever to work before

6 A.11. or after 9 P M. No child under 11 years may now be

employed in any way. With regard to children between 11and 14 years of age realities and not ideals have to be

faced by legislators and any order making the employmentof such children illegal would press hardly upon very manystruggling families. We trust that the new regulationswill be carried out adequately, although the task of in-

spection will be a difficult one so far as it affects indoor

employment. The provisions regarding street employ-ment of children are wisely framed and should be moreeasy of fulfilment, although the age of a London street

arab is often somewhat difficult to determine. Medical menwho employ young lads in the capacity of errand boys andthe like would do well to read these regulations, lest an

, alteration in their arrangements should be rendered necessary

j in consequence of the London County Council’s recent

l action. -

HE ANTISEPTIC AND GERMICIDAL PROPERTIESOF SOLUTIONS OF FORMALDEHYDE AND

THEIR ACTION UPON TOXINS.

Dr John F. Anderson has recently completed an extensiveinvestigation of the antiseptic and germicidal propertiesof formaldehyde in aqueous solution.’ In a review of theliterature he shows that previous workers have obtainedvarying results owing probably to the difficulty experi-enced in accurately determining the strength of solutions offormaldehyde. It is a volatile, unstable substance and

though many methods of analysis have been publishedthey yield varying results. Indted, no analysis should beaccepted without the concordance of figures obtained by atleast two distinct methods. Preliminary experiments weremade with moulds, stable manure, and hay to determinethe restraining influence of formaldehyde on putrefactivechanges. In all the experiments formalin, containing37 2 per cent. of formaldehyde, was employed. It wasfound that the lowest dilution of formalin in which bac-terial growth occurred was 1 to 1000 for moulds, 1 to

5000 for garden earth, and 1 to 4000 for stable manureand hay. Dr. Anderson then made a series of tests to

determine the antiseptic action of formalin on pure culturesof bacteria and found that many of the organisms grew in

1 Bulletin No. 39, Hygienic Laboratory, Public Health and MarineHospital Service ot the United States, 1907, pp. 48.