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INTRAVENOUS TREATMENT OF ARTHRITIC PROCESSES.

THERE are certain positive advantages obvious tothe intravenous methods of giving drugs. One is

precision and accuracy of dosage with the cer-

tainty that the agent used will exert its effectunchanged by the disturbing factors which are

necessarily associated with the ordinary absorptiveprocesses from the gastro-intestinal tract. Theother is rapidity of action. Advantages accruingfrom precision of dosage are especially seen inthe salvarsan treatment, the necessity forsuch accuracy being obvious. The advantage ofquickness of effect is most conspicuously noted,perhaps, in the intravenous inj ection of strophanthusin urgent cases of heart failure due to auricularfibrillation. It is natural that intravenous medica-tion should have been tried in other conditions,and some success is claimed for this method ofgiving salicylates for refractory cases of acuterheumatism. Dr. Albert Comstock records thedetails of this form of treatment in certainarticular diseases in the New -York MedicalJournal (vol. c., 1914, p. 1113). He uses thefollowing prescription :-

1): Guaiacolis-sodii salicylatis, ana gr. 640.Glycerin ............... gr. 640.Aq. destill. et steril....... 2000 c.c.

The conditions for which its intravenous use isindicated are acute articular rheumatism, acute andchronic muscular rheumatism, and acute goutyarthritis. The patient is suitably prepared and anaperient given. The quantity of the solution, at100° to 110° F., used is 250 c.c. (sic). The vein isusually dissected out and the fluid slowly allowedto flow in. The first subjective sign noted is a

tingling sensation, with a coal tar taste in themouth, due to the guaiacol. The face then becomessuffused and congested and perspiration is free.There is generally slight delirium, which may lastfor half an hour. The pain, however, is re-

lieved in a wonderful manner, and within 24hours the patient is better. This relief is mostmarked and most permanent -in acute rheumatism ;in 50 cases there has been no bad result. Inmuscular rheumatism the result is not so good,and in the chronic form two or three injectionsmay have to be made at intervals of three or foui

days. For cases where salicylates given in the ordi.nary way cannot be tolerated by the stomach or inparticularly obstinate cases this intravenous methodis recommended.

____

AT a meeting of the Council of the Royal Collegeof Surgeons in Ireland held on Jan. 21st, Mr.F. Conway Dwyer, President, in the chair, SirArthur Chance was elected to represent the Collegeat the meetings of the General Medical Council.

Dr. George Lovell Gulland, physician to theEdinburgh Royal Infirmary, has been appointed tothe Chair of Medicine in the University of Edinburgh,vacant through the resignation of Professor JohnWyllie. ____

AT a meeting of the Senate of the University ofLondon held on Jan. 27th Dr. Edward Barclay-Smith, M.A., M.D., B.C. Camb:, was appointed to theUniversity Chair of Anatomy at King’s College,London, and Dr. Edward Provan Cathcart, MD.,Ch.B., D.Sc. Glasg., was appointed to the University

. Chair of Physiology (as from April lst next)) tenableat the London Hospital Medical College..

THE CHADWICK LECTURES ON WARAND DISEASE.1

THE second of three Chadwick lectures was delivered ab.the Royal Society of Arts on Jan. 22nd by Colonel F. M.SANDWiTH, M. D. The chair was occupied by Sir FREDERBCK.TREVES, and there was a large attendance.

Presentation of Chadrviok Prizes and Medals.An interesting function preceded the delivery of the-

lecture-namely, the presentation to Fleet-Surgeon ClevelandMunday and Colonel Heaton Horrocks, R.A.M.C., of the-Chadwick Medal and Z50 for distinguished services in

promoting the health of the men in the navy and armyrespectively.

Sir ARTHUR MAY, in thanking the Chadwick trustees forthe honour they had conferred on the navy, said that whenhe entered the navy in 1878 the rate of sickness was 47 per1000; to-day it was only 25, and the invalid-rate was now15 as against 35 in 1878. In the latter year the death-ratein the navy was 6 per 1000, whereas to-day it was 2.. The

improvement was due to sanitation and the education ofthe men, for every sailor in the service attended lectures on.

personal hygiene.Sir ALFRED KEOGH emphasised the importance of the-

health of the troops in the maintenance of an army’s fighting::’strength, and said that Colonel Horrocks was the officer mosresponsible for the very satisfactory health of our army now’in France, and his record extended back many years, theabolition from Malta of undulant fever having been due tenhim. Formerly there were in that island 600 or 700 menstricken with that disease ; and hospitalisation alone cost..,15,000 a year. To-day there was no fever. Colonel:Horrocks had also done much steady work in improving t1’2&bgr;,sanitation of camps and barracks.

Colonel SANDWITH then delivered a lecture on

I The Smdh African and the Russo-Japanese Campaig?f:1’r.He said the Japanese army medical officers held that there-were three grades of illness : (a) comprising wounds or-

disease caused by hardships and exposure incidental to war-fare ; (b) diseases, accidents, or injuries to which’ thesoldier might succumb in circumstances beyond his control :and (e) diseases brought about by disobedience to orders,immorality, the eating of unwholesome food. and thedrinking of dirty water. The victim of the latter received’no sympathy. Before the Russo-Japanese War the indi-vidual Japanese soldier was made to understand how largelyhis health contributed to the fighting efficiency of the army,and this was an important factor in the avoidance by that~nation of serious epidemic disease during the campaign-This lesson had had its good effect on our own army, and’the French admired the British troops in this war for their-

hygienic observances. No illness so dogged the steps of anarmy as did typhoid fever. For many years water contamina-tion was thought to be the cause, but epidemics had occurred’where the water-supply was excellent, and dust and flies-had obviously to be blamed. He particularised the case ofQuetta, which had an admirable water-supply. A strikinginstance was that which occurred in the camp at Modder-River in the South African campaign. The winds covered)the food with grit, and flies multiplied rapidly. The first.case of typhoid fever was recognised on Dec. 18th, 1900’, and!by the end of that month 18 cases had been admittedtinto hospital. The Highland Brigade camp suffered the-least because it was in a wind-protected locality..There was also great danger from the handling of’food by typhoid carriers, some of whom had had)the disease so slightly that it escaped recognition,.

.

especially in view of the necessary huddling of the mentogether in quarters during war time. The typhoid death--rate in civil life varies from 5 per cent. to 20 per cent. ;:

!

among armies in war time the rate is much higher, owing to-. the absence of the best nursing facilities. In the SouthB African War we lost 8022 from this disease, 19,454 were-

invalided, and 30,208 were either returned to duty or other--’

wise discharged. The mortality from typhoid fever in the war, exceeded in number that of the men killed in action. Each?

1 A report of the first lecture appeared in THE LANCET of Jan. 23rd.p. 105.

248

case was under treatment an average of 56 days, and wasnecessarily a source of danger during the whole of that

period. The conditions encountered by the army were

greatly aggravated in the beleaguered city of Ladysmith,where the half-starved garrison had to draw its water-

supply from a river known to be contaminated. During the120 days of siege there were 1280 cases of typhoid fever, with,360 deaths ; and 1841 cases of dysentery, with 105 deaths.When our troops entered Bloemfontein they found twochurches filled with Boers suffering from typhoid fever. Duringthe forced marching tents had to be pitched for the relief ofabout 130 men who collapsed from the effects of the heat.On Feb. 16th one brigade was marching and fighting formore than 15 hours. When the battle of Paardeburg beganthe men had been marching 24 hours, during which somehad nothing to eat. The fighting lasted 12 hours. When,a week later, Cronje surrendered, among his force were 160sick and wounded, including 10 cases of enteric fever. In20 weeks from March to July there were 1134 deaths inBloemfontein, of which 85 per cent. were due to typhoid fever.War could never be waged on land by hygienic methods ;the supreme object was to defeat the enemy ; but in anti-typhoid inoculation we had now a means of circumventing thedanger. It was very gratifying to find that the soldiers werebecoming more and more convinced of the efficacy of thispreventive measure, and the vast majority of those on activeservice were now so protected. Typhoid fever was found to befive or six times as common in the non-inoculated as in theinoculated. At Avignon (France) in 1912 typhoid fever brokeout in barracks containing 2053 men, of whom 1366 were pro-tected. Of the 687 unprotected there were 155 who had thedisease and 21 died, while among the protected there wasnot one case. In 1913 the French Senate resolved that theprotective treatment should be made compulsory throughoutthe army. In Canada, among the camps of the Canadian

Pacific Railway, 3500 men were protected, and onlytwo cases of typhoid fever occurred; while among 4500non-protected men there were 238 cases. In the faceof such facts it was difficult to understand those whowere trying to persuade the soldier not to submit to it.The lecturer proceeded to deal next with the case of

dysentery and cholera, describing the course of thesediseases and their method of spread, remarking that in theSouth African War there were 38,108 cases of dysentery, thechief source having been the water-supply. In her warwith China, Japan had 155,140 cases of dysentery, with38,000 deaths. On Oct. 22nd last 98 cases of cholera were Ireported in Austria and 231 in Hungary. Cholera had also

appeared in some of the Russian towns. Dr. Fleming andothers were sent from this country to the Russian side toascertain what particular kind of cholera bacillus was pre-sent ; they had now returned and were, he believed, engagedin preparing a vaccine. He had words of warm commenda.tion to those British officers, including Sir Francis Wingate,who showed such heroism in combating the Egyptian choleraepidemic. In the Greek army the mortality among unvac-cinated cholera patients was 275 in each 1000 cases ofthe disease ; in the vaccinated 102 per 1000 cases. TheBritish authorities were providing in every possible wayagainst the invasion of cholera among our troops. Thelecture was illustrated by very informing slides, includingphoto-micrographs of disease bacilli.

Sir FREDERICK TREVES, in proposing a vote of thanks toDr. Sand with, emphasised what he said regarding the attitudeto be adopted towards typhoid fever in war. The educationof the soldier on the question was most important. Thesecond line of attack was the improvement of the sanitarycondition of the army. Speaking as a, member of the

Sanitary Committee at the War Office, he could say therehad never been a time in the history of any campaign whenthe wounded or sick soldier had been better looked after.But this was not all, for even medical men, versed in everydetail of personal care and sanitation, had, when in chargeof typhoid camps, contracted the disease. A further pre-caution was necessary-namely, inoculation. Since the

present war began there had been in the British Expedi-tionary Force only 212 cases of typhoid fever, 201 of them inunprotected men, for 173 of them had not been inoculated atall; only 11 of this number had been fully inoculated. Notone inoculated man in the whole force had died from the

2 THE LANCET, Sept. 5th, 1914, p. 639.

disease. In the face of such facts those who tried to

persuade the men not to submit to the measure were playinginto the hands of the enemy. He also alluded, with muchsatisfaction, to the universality of motor transport in thepresent operations near the front. At the actual firing line,however, horse transport could not be dispensed with.The vote of thanks to the lecturer was very heartily

accorded.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.

THE following appointments have been notified :-Staff-Surgeon : N. B. V. Jacob to the Pemùroke, additional, fordisposal. Temporary Surgeons: H. 0. Blanford to theRo.churnTt; S. L. Harke to the Impregnaùle ; and A. M. Gray tothe Woolwich.The undermentioned have been granted temporary com.

missions as Surgeons in His Majesty’s Fleet :-JohnGrandisson Watkins, Purser Davies, Lionel FrederickStrugnell, and David Sutherland.The following Surgeon Probationers, R.N.V.R., have been

entered as Temporary Surgeons, R.N. :-H. G. Moser andL. S. Fry.

ROYAL NAVAL VOLUNTEER RESERVE.

Surgeon Probationers: G. Pearson to the Blake, additional,for the Goldfish; and W. L. Hunter.

ROYAL ARMY MEDICAL CORPS.

Honorary Major Guy N. Stephen to be temporaryLieutenant-Colonel {dated Jan. 10th).To be temporary Captains :-DatedDec. 29th, 1914: Charles

Edward Forbes Mouat-Biggs. Dated Jan. 4th : RobertSturgeon Cooke.Peter Macdiarmid is granted temporarily the honorary

rank of Captain (dated Jan. 27th).To be temporary Lieutenants :-Da.ted Dec. 9th, 1914:

Arthur Vernon Stocks. Dated Dec. 18th, 1914: JamesStewart Hall and Hugh Llewellyn Apthorp. Dated Dec. 22nd,1914: James Edward Cook. Dated Dec. 29th, 1914 : FrederickPearson Fisher. Dated Dec. 31st, 1914 : John Samuel Martin,John Gibson, and Ronald Bute Macfie. Dated Jan. 4th: ArthurHyde Greg. Dated Jan. 5th: James Edmund Rutherfurd,Dated Jan. 6th : Charles Edward Pepper. Dated Jan. 7th:James Donald Finlay, Andrew Grant, George Douglas Sher-wood, Thomas Lister Llewellyn, Bernard Creasy Ewens,John Laing Annan, Wilfred Garton, George Henry Steven,Dudley Forde, Albert Ernest Hodgson, James JosephKeirans, and John Lang. Dated Jan. 8th : Henry PercyHarpur and James Fettes.

SUPPLEMENTARY TO REGULAR UNITS OR CORPS.

Royal Army Medical Corps.The undermentioned to be Lieutenants (on probation) :-

Francis Antrobus Duffield, John Joseph Molyneaux,Frederic Sanders, George Stephen Pirie, Edwin JohnBradley, Frank Oppenheimer, James Walker Wood, andGeorge Macdonald Scott.

TERRITORIAL FORCE.

Honollraùle Artillery Corrtpany."All Battery, 1st City of London Horse Artillery:

Surgeon-Lieutenant-Colonel and Honorary Surgeon-ColonelRichard J. Reece is seconded.

Royal Army Medical Corps.1st Wessex Field Ambulance: Walter Fitzpatrick (late

Captain, Royal Army Medical Corps, Territorial Force) to beCaptain (temporary).2nd Highland Field Ambulance: Lieutenant James A.

Stephen to be Captain (temporary). Thomas StewartSlessor to be Lieutenant.3rd Southern General Hospital: Lieutenant-Colonel

Horatio P. Symonds resigns his commission on account ofill-health.2nd West Riding Field Ambulance: Hartas Foxton to be

Lieutenant.lst London (City of London) Sanitary Company: Robert

Robison to be Lieutenant.West Lancashire Casualty Clearing Station: Lieutenant

William N. W. West-Watson, from 3rd West Riding FieldAmbulance, to be Lieutenant.

-

West Riding Casualtv Clearing Station: David RutherfoidCramb to be Lieutenant.Sanitary Service: ’1’nomas Hamilton Ward (late Lieu-

tenant, Royal Army Medical Corps, Territorial Force) to beCaptain, whose services will be available on mobilisation.Attached to Units other than Medical Units.-Major

Alexander Leitch resigns his commission on account ofill-health, and is granted permission to retain his rank and