475

paralysis of muscles following the administration of saponin Ebodies. Coming from a brewing journal and being printed s

in larger type, the suggestion looks not unlike hoisting the s

teetotaler with his own petard but it is made in all serious- rness. ’rhe article concludes with the statement that rubber t

manufacturers can easily produce rubber rings free from i

antimony and yet of equal value to those at present in use. t

We may add that we have received a further communica- 1

tion from Mr. Pond in which he points out that the Austrian êGovernment lias a regulation to the effect that tubes, rings. I

teats, and the like used for feeding-bottles, and rings usedfin bottles for preserve?, which are prepared with antimony E

may only be employed for this purpose when they yield no Santimony on being treated with tartaric acid. !

t

PANCREATITIS IN MUMPS.

THE structure of the pancreas so closely resembles that of the salivary glands that the Germans have called it the v

abdominal parotid." This similarity suggests that the metastases of mumps should include pancreatitis. However glittle has been written on the point. Perhaps the most t im-9 g

portant communication is one by M. Sii-aonin.1 He found c

that symptoms of pancreatitis occurred in ten out of s

652 cases of mumps treated in the military hospital sof Val-de-Grace. The pathology of the pancreatitis is

only a subject of inference, for it generally runs a

benign course and no opportunity is given for examination of the gland. At the meeting of the Société M6di-,ale 1

des Hopitaux of Paris on July 7th Professor G. H. Lemoine E

and M. F. Lapasset reported a case of pancreatitis in mumps fwhich is of great importance, for it is the first on record in t

which a necropsy has been performed. A soldier, a native of ‘

Algiers, aged 19 years, was admitted into hospital on Oct. 2nd, "

1902, suffering from mumps. The only previous illness f

was malarial fever. The case ran a benign course, the tem- ‘

perature not rising above 100’ 2° F. and becoming normal on ]the fifth day. On the eighth day the illness appeared to ’have terminated but on the evening of the tenth day therewas a rigor with a rise of temperature to 103.8° and pain and swelling in the right testicle. The orchitis rapidlysubsided, the temperature became normal on the fourteenthday, and the patient was again pronounced convalescent,but when visited on the morning of the fifteenth day hecomplained that he had not slept and that he vomitedseveral times during the night. Although the temperaturewas normal he appeared to be prostrated. The conjunctivasshowed a slightly icteric tinge. The upper abdomen was

tender, especially in the epigastrium and the region of thegall-bladder. Here the patient had a feeling of weight.The spleen was enlarged and tender. The pulse was

slow (52) and the axillary temperature was 97.3°. An

aperient was given but it was vomited and produced noaction of the bowels. On the sixteenth day the icteric tintinvolved the whole skin and the discolouration of the

conjunctivæ was more marked. Vomiting had become morefrequent and the intolerance of the stomach was absolute, allliquids being rejected. The hepatic and splenic regions werevery painful, with a maximum in the region of the

gall-bladder, which organ appeared to be enlarged. The

temperature and pulse remained the same. An injection of1000 grammes of saline solution was ordered in order to

provoke diuresis, as the kidneys had ceased to act since theprevious day. In the evening the general condition seemedto have improved. Vomiting had occurre only once duringthe day. 80 grammes of brownish-red urine containing onegramme of albumin per litre and abundance of biliarypigments had been passed. The patient continued to bevery prostrate and spoke of his approaching death. In the

night the vomiting recurred and was uncontrollable. At

1 THE LANCET, Sept. 12th, 1903, p. 772.

irst the vomit was black, then it gradually became

anguineous. There was also constipation. On theeventeenth day the hæmatemesis was incessant and the-)atient lot consciousness. The pulse rose to 12’) and

he temperature to 101.5° and the jaundice increasedn depth. Death occurred on this day. At the

.

iecropsy all the tissues had an icteric tinge. The

iver did not appear to be enlarged but it was much con--

gested; on section it looked like a " cardiac liver." Some

obules seemed to be in a state of incipient degeneration. The-;all-bladder was voluminous and oedematous. This œdema.

extended as far as the beginning of the common bile ductvhere an enlarged gland pressed on the latter and appearednechanically to produce the cedema of the gall-bladder and’the icterus. The bile in the gall-bladder was brownish,thick. and very viscid. The stomach contained black fluid ; ;..ts mucous membrane was spotted with fine eccbymosesvhich extended as far as the iirst part of the duodenum.rhe pancreas was greatly enlarged, oedematou-’, and con-

gested. It weighed 190 grammes and was of a reddish-

rey colour. All the region around the pancreas, the

luodenum, and the hilum of the liver contained’i large number of swollen lymphatic glands. The

3pleen was enlarged and weighed 1200 grammes. The

kidneys were a little congested and the capsules wereadherent in places. Microscopic examination of the livershowed proliferation of the connective tissue surrounding thebiliary canaliculi and a number of nodules composed of

embryonic cells. The spleen also contained nodules of’

embryonic cells and its capsule and trabeculæ were

thickened. In the kidneys lesions were limited to the con-voluted tubes, the cells of which showed signs of granulofatty degeneration and the lumen of which was filled withepithelial debns. The cells and acini of the pancreas were

abnormally large but the islands of Langerhans were dimin-ished, being compressed by the turgescent tubes. The nucleiof the pancreatic cells stained bidly and many of them werevesicular. The complexity of this case is noteworthy. Not

only was there epigastric pain which was the principalsymptom of the pancreatitis. but the gall-bladder was-

tender and the spleen was enlarged and tender. The

symptoms of grave icterus-hæmatemesis, prostration, sub-normal temperature, and elevation of temperature at thetime of death-developed. The embryonic nodules found inthe liver and spleen and the cellular degenerations are

common to all infectious processes. Were these lesions due-to the infection of mumps or were they the result of a biliaryinfection consecutive to the obstruction of the bile duct bythe enlarged pancreatic lymphatic glands ? The early appear-ance of the icterus in the case is in favour of the former’

hypothesis. -

MEDICAL APPOINTMENT TO THE METROPOLITANWATER BOARD.

Dr. Alexander Cruikshank Houston has been appointed to’the important post of director of water examinations, Metro-politan yVater Board, at a salary of £1000 per annum. Dr.Houston is an Edinburgh graduate and took the degrees ofM.B., C.M., in 1889 ; B Sc. (Public Health) in 1891 ; andD.Sc. (Public Health) in 1892, being awarded the GunningVictoria Jubilee Alison prize in public health and medicaljurisprudence in the same year. During the past 12 yearshe has carried out special chemical and bacteriological,researches in relation to water-supply for the LocalGovernment Board. His investigations on the sub-

ject of lead poisoning by moorland waters (1893-97)are well known and have received favourable notice inour columns. During recent years his work for the LocalGovernment Baord has attracted considerable attention,both in this country and abroad, and his reports on the=