691903.

THE LANCET.

LONDON: SATURDAY, JANUARY 3, 1903.

1903. IN approaching the eighty-first year of our issue let us

commence by wishing our readers all happiness and pro-sperity and by assuring them that so far as lies in our powerwe shall endeavour, as in the past, to promote their profes-sional interests and to record for their instruction the

history of medicine as it is made from day to day all

the world over. Hitherto it has been our custom, as

evidence of the range of our ambitions, to present to

our audience in the first number of THE LANCET for

each year a sort of microcosm of medicine and surgery.

In these days it is impossible for the covers of any one

issue of a journal to contain more than samples of workdone in medicine, surgery, and obstetrics-to say nothing ofthe ancillary sciences, but it has been our aim to choose those

samples from fields of widely varying interest in making upthe opening issue of a new year. This year it will at first

sight seem that we have made an entire departure from ourcustom. We have specialised to an extreme degree, for wehave devoted practical’y the whole of our space to the

reproduction of the three essays which recently gainedprizes in the competition in connexion with the KING’S

sanatorium. But the specialisation is more apparent thanreal.

In undertaking to publish these essays we were aware

that unless we were prepared to issue them unabbreviatedand fully illustrated the purpose that both HIS MAJESTY’S

Advisory Committee and ourselves had in view would

be defeated. We have therefore surrendered practicallyall our pages to these essays, feeling sure that our

readers will understand their importance as epitomes of

modern knowledge in its application to the preventionof a terrible and widespread disease. Moreover, these

essays cover a far wider field than merely the preventionand treatment of tuberculosis, while the same may be

said for the circumstances in which they were written.The gift of an immense sum of money for the promotion of

practical therapeutics, the decision by which this sum wasallocated to the construction of a model institution for tuber-

culous patients, and the spontaneous outburst of approvalwhich met the publication of the KING’S decision, all alikeshow that the foundation of a Royal sanatorium has been

regarded by the whole nation, from the Sovereign to the

beggar, as a practical expression of human progress-a proofthat in the twentieth century it is intended by those withriches and power to do their utmost to counteract the evil

influences of disease. When the KING’s sanatorium is in

working order a house of healing will be provided wherethose severely wounded in the fight with tuberculosis may benursed and where those who are on the point of yielding tothe attacks of this ubiquitous and insidious foe may be

trengthened and their defences made doubly sure. Such

n institution will be enormously far-reaching for good if-

n its working it attains only to a fraction of its estimated

value. For not only will the KING’s sanatorium for con-

sumption prove, when its benefits are in evidence, a

)erpetual incentive to similar endeavour, whether on the-

)art of municipalities or of generous plutocrats such as

Sir ERNEST CASSEL ; but it will also convince all thoughtfulpersons that the means of prophylaxis against tuberculosisare in no way different from those against other diseases.Pure air, sunlight, pure water, good food, and a healthyenvironment could, if procurable in a great city, banish

most diseases or cause them to be as rare in this country asare leprosy, plague, and cholera. Every line of the three

prize essays which we publish to-day shows the enormous

importance that is now attached, and for sound scientific

reasons, to a healthy environment in the prevention andtreatment of disease ; and so, special as their subject and

object may be, their lessons are of the broadest possible-medical consequence. -

The purview of modern medical life is so wide that no two

people would agree where the boundaries of scientific medi-cine are set. For more than three-quarters of a century wehave tried, and we think from the generous support accordedto us we may say that we have tried with success, to deal

with the range of subjects included in the word medicine,a range that yearly-almost hourly-embraces more subjectsfor thought and discussion. While medical science properand all those branches of knowledge, the study of whichis inextricably interwoven with the study of medicine,progress so vigorously the practical questions and problemsof professional life multiply in direct proportion. The

relations of the State to the medical profession, the medicalaspect of modern legislation, the attitude of municipalauthorities towards medical men, the position of medical

officers in the navy and army medical services, the medical,side of educational questions created by the action of

school boards, public views on vaccination, and publicneed of pure water-supplies-these things are but examplesof the subjects with regard to which we endeavour week

by week to give the medical profession information thatshould interest or help them, while we accept the graveresponsibility of advising our readers as to the course whichit would be best and safest for them to take in the

many circumstances of difficulty or delicacy which are con-

stantly occurring in the private or public life of a medicalman. These circumstances increase in number pari passuwith the growing complexity of modern life, and we make

no claim to infallibility in respect of our advice, urging onlyour genuine desire to be helpful. The fact that we continue-

to possess the trust of our professional brethren makes usbelieve that our desire is generally realised and inspires usto further efforts for the year upon which we are now entering.And that year will not be an easy one for those who have

the good of their profession at heart. The politico-socialside of medical life is in an unsettled state and the wide

subject of medical reform must continue to engage the

attention of the bulk of the medical profession. The term

"medical reform" has been made a cloak for visionaryschemes and has led to frothy declamation, but while themisuse of hospitals is rife and while the sweating of

70 REMOVAL OF FOREIGN BODIES FROM THE (ESOPHAGUS.

medical practitioners by wealthy confederations of work-

men and tradesmen continues to be successful, there is

plenty of room for sober and serious agitation with a viewto getting such abuses remedied. We are proud to thinkthat the investigations of our Special Commissioner havehad the effect in many parts of the country of defininggrievances and of bringing about solidarity of agitation,with the result that many medical men are now in a

position to resist unfair demands upon their time and

labour, to the benefit of their patients no less than of

themselves. We hope that the year, upon the threshold

of which we now stand, will see a development of the

spirit of professional unity among medical men.

Annotations.

REMOVAL OF FOREIGN BODIES FROM THE

ŒSOPHAGUS.

" Ne quid nimis."

MANY foreign bodies are arrested in the cesophagus.Fish bones are very frequent offenders, but their removal isgenerally not difficult ; by the use of a hair probang they areeither readily drawn up or pushed down into the stomachand nothing more is heard of them. But larger foreignbodies may give rise to great difficulties. Especially trouble-some are coins and tooth plates. Children are very prone to

put coins in their mouths, partly because it is natural at an

early age to test all things with the aid of the taste, and

partly because it seems to them that the mouth is a safe

hiding place for articles of such value as coins. Whatever thereason may be for the practice, a sudden movement or anincautious inspiration sends the coin backwards into the

pharynx, whence it occasionally falls into the larynx, butfar more commonly passes into the cesophagus. Sometimes,if small, the coin progresses uninterruptedly into thestomach and so onwards until it makes its appearance ina motion. Not rarely, however, the coin, especially if it is

as large as a halfpenny, lodges in the oesophagus, failing topass. In adults the denture takes the place as regardsfrequency occupied by the coin in childhood. The tooth

plate is not removed, as it should be, at night and the ownerwakes in the morning to find it gone ; it catches some-where in the oesophagus and for this its shape renders it

peculiarly liable. Both coins and dentures are removedfrom the oesophagus with difficulty. The instrument

chiefly employed, the coin-catcher, easily slips bythe foreign body or when it catches it does not take

iit at the best angle, with the result that the wall of I

the oesophagus is liable to be damaged by the manipula-tion. The use of forceps is even more troublesome. The

Roentgen rays served to locate these bodies and thus affordedmuch help in their extraction, but the full amount of theassistance the rays can render was not appreciated untilthe idea occurred that the fluorescent screen could beutilised during the process of extraction, the shadow of theobject could be seen, and also the shadow of the coin-catcheror forceps employed for its extraction. The foreign bodycould be seized in the most advantageous aspect and couldbe extracted with a minimum of damage to the cesophagealwall. We have published in THE LANCET recently twoinstances of this mode of procedure.l The neck and upper

1 THE LANCET, Dec. 6th (p. 1540) and 13th (p. 1623), 1902.

part of the chest are fairly translucent to a good focus tubeand the foreign body and the instrument can be seen clearly.

COGNAC BRANDY AND ITS SUBSTITUTES.

WE note with satisfaction, in view of the conclusions

recently expressed by THE LANCET Special AnalyticalCommission on Brandy, that at a meeting of the generalcommittee of the Wine and Spirit Association the followingresolution was carried unanimously : " That this associationsuggests to the Syndicat du Commerce des Eaux de Viethe desirability, not only of confining the use of the wordCognac to brandy produced in the Charentes, but of limitingits user to brandy distilled from pure grape juice only." Ifthat should prove to be impossible the alternative, it is

suggested, should be "that the Syndicat should take imme-diate steps to ensure that all pure grape brandies shall beshipped with an official stamp or certificate or other

guarantee of their purity." At the same meeting of theWine and Spirit Association the report of the SpecialAnalytical Commission of THE LANCET 1 on Brandy waslaid upon the table and discussed. It is gratifying to findthat the attitude adopted by this important association isin complete accord with the views expressed in our report.

DEATH TRAPS.

IN THE LANCET of April 26th, 1902, p. 1202, we commentedupon the loss of seven lives from fire in a house in Hackney.The house in question was at the back of a built-out shopand there was no exit from the house but through the shop orover the roof of the shop. Exactly the same thing has nowhappened in Stepney, six lives being lost. The built-out

shop caught fire and cut off exit from, or approach to, thehouse. One inmate only, being awakened early, managed toget out on to the roof of the shop, which was already blazing,and by running along the roofs of the adjoining shops, whichseem to be built in the same way, was able to give an alarm.When the fire-engines arrived, which they did within fiveminutes of the call, the shop was blazing so fiercely thatthere was no chance of getting the escape anywhere nearthe dwelling-house, and this, too, was a mass of fire. In

our former note upon this subject we said that such

erections never should have been allowed. They are

nothing more or less than death traps and althoughwe take it that all such existing buildings cannot be

pulled down yet surely the London County Councilcan prohibit the erection of new buildings designed afterthe same fashion. At this moment, however, there is arow of flats being put up in the Edgware-road with pro-jecting shops on the ground floor and apparently there is

no exit from the flats except through, or rather between, theshops. If these shops should catch fire the inhabitants ofthe flats immediately behind them would be practicallydoomed. If the County Council has no power to prevent thebuilding of such abominations it should apply for powerswithout delay.

-

THE DURBAR HONOURS.

AMONG the recipients of the Durbar Honours will be foundthe following well-known members of the medical professionwhose work has lain in India. Dr. George Watt, C.LE.,officer in charge of the Economic and Art Section of the

Indian Museum, Calcutta, has received the honour of Knight-hood. Surgeon-General William Roe Hooper, President ofthe Medical Board at the India Office, has been appointedKnight Commander of the Star of India. Surgeon-General

1 THE LANCET Special Analytical Commission on Brandy, THELANCET, Nov. 29th, 1902, p. 1503.