1009MUNIOIPAL MUDDLES.-" DIABETIC BREAD."

results differ somewhat from those of Herringham who con-cluded that the outer head of the median nerve alwayscontained filaments from the fifth and sixth roots. Mr. Scottmakes no mention of the nerve to the coraco-brachialis,which Herringham described as distinct from the musculo-cutaneous trunk proper and originating from the seventhroot. The dissection of the posterior cord (decussation C)revealed the circumflex trunk as derived from the fifth andsixth nerves, whilst the fifth, sixth, seventh, and eighth all

entered into the formation of the musculo spiral. The innercord (decussation D) proved to be constituted as follows : theinner head of the median from the eighth and ninth roots,the ulnar from the eighth cervical, first dorsal, and some-times also the seventh cervical; and the internal cutaneousfrom the eighth cervical and first dorsal roots. Herringham’sdissections led him to conclude that the internal cutaneousnerve was more frequently derived from the first dorsal alone.The method of presenting his results adopted by Mr. Scottdoes not give definite information as to the level of originof the nerves throughout each individual p’exus which heexamined. Consequently the paper throws no direct light onthe frequency of the pre- or post-fixed conditions. Neitheris it possible to gather whether, when the upper filamentshad a high origin, a similar displacement obtained in thelower parts of the plexus. It is usually assumed that the dis-placement is uniform throughout the contributing roots, butit is well to bear in mind that in one of Herringham’s obser-vations the representation of the muscles appeared to beginat the ordinary level but was more than usually lengthenedout so that the second dorsal nerve contributed largely to theplexus. ’ The controversy amongst surgeons as to whetherErb’s group of muscles is supplied by the fifth cervical rootexclusively or by the fifth and sixth roots conjointly mayvery well be due to anatomical variations. The practicalrule to be deduced is that when the plexus is exposed foroperation the destination of the nerves should be tested byelectrical stimulation before the repair is attempted

MUNICIPAL MUDDLES.

WE have recently been the spectators of what we as

ordinary citizens consider a remarkable piece of municipalmuddling. Not far from this office some houses are beingpulled down. Soon after 8 o’clcck a four-wheeled cart, Idrawn by a fine cart-horse, and sundry men arrived at the Ihouses in question. Soon after 10 o’clock, owing to thetraffic in the Strand increasing, the cart, the horse, and themen were directed by the police to stand in Bedford-street.Nothing further occurred until half-past three and wethought it would be interesting to make inquiries. Welearned that owing to the owner of the property or the

contractor who was pulling down the houses not havingcomplied with certain requirements of the Westminsterdistrict surveyor, that official applied to the Works

Department of the County Council to supply materialsfor shoring up certain portions of either the condemnedstructure or of the adjacent houses. Hence the arrival ofthe cart. Coincidently apparently with the arrival of thecart the owner of the condemned property or the contractordecided to comply with the requirements which had hithertobeen ignored. We were then inforired that the cart, thehorse, and the men had received orders to wait for instruc-tions. By 4 o’clock the instructions had apparently notarrived, for the cart, the horse, and the men were all there.Now, surely this is an example of pure and simple muddle.Why should three or four men, to say nothing of a valuablehorse, be condemned to stand in a damp and windy streetfor eight hours doing absolutely nothing and with everychance of contracting pneumonia in the case of the men orcolic in the case of the horse ? 7 If the County Council’sshoring apparatus was needed to shore up the house why was

it not put into action If it was not necessary why was it notsent home 7 Surely somebody might have made up his mindbetween 8 o’clock and 12, say, whether the retention ofthe cart, the men, and the horse was or was not necessary.We presume that the expense of the affair will fall upon theowner of the condemned property, but even if it does notthe state of things which could allow such a feckless pro-,ceeding should, we think, be altered. We may add that the

cart, the horse, and the men departed at 4 25 P.M.

"DIABETIC BREAD."

OUR attention recently has been drawn by two cor-respondents, independently of each other, to a so-calleddiabetic bread which has lately been introduced from Franceinto the English market. The bread is called " Brussondiabetic bread," and the sole agents for its sale in this

country state that the bread is " prepared by a specialprocess and according to the direction of several leadingmedical men is largely prescribed in France and Germanyin the treatment of diabetes, obesity, gout, rheumatism, andin cases where food of a highly nutritious character isindicated." It is added that ’’ in introducing it into

England we feel certain it will, in a great measure, over-come the difficulty of dieting diabetic patients owing to theuninviting character of the food hitherto recommended andthe early distaste it causes." It is fair to remark that

nowhere in the circulars which we have received and inwhich the bread is described is it stated to be free fromstarch but it is " an alimentary product (we are quotingfrom one of the circulars) which, whilst retaining the highnutritive property of gluten and prepared according to

medical directions, is agreeable to the taste and can there-fore be taken for a lengthy period of time." Again, " thisbread ...... presents over the ordinary gluten bread the

advantage that it does not swell when baked, is of easymastication and insalivation, and consequently more

digestible." Statements of this kind should serve as a

warning to the practitioner never to prescribe a so-called"diabetic food " unless precise statements as to its com-

position are given. Whether it is justifiable or not to givesome patients suffering from diabetes a proportion of starchin their food must be left to the practitioner and to his

judgment of individual indications. In any case, he shouldbe acquainted with a correct analysis of the food. The"diabetic bread" referred to contained, according to ouranalysis in two specimens examined, not less than 50 and48 per cent. of starch respectively.

THE TREATMENT OF SPRUE.

IN the Jo1t’rnal of Tropical Medicine of Sept. 15th Mr.James Cantlie has published an important article on thetreatment of sprue. The question of a milk 2crses a meatdiet is still debated. Mr. Cantlie has for years advocated a

rigid meat diet. While still adhering to this as the means ofcuring sprue rapidly and Efficiently extended experience hasmodified his view that by this means alone sprue is alwayspermanently cured. He has proved again and again thata patient who appears to be in the last stage-in whichthere is, in addition to emaciation, anaernia, and dropsy, adecided rise of temperature-can be saved by putting himon home-made beef-tea, raw meat juice, and beef jelly,administered in teaspoonful doses every ten minutes,if necessary. Milk in such cases means death; bymeat juices alone can a patient be saved. As the patient’sstrength improves the interval between times of feeding maybe increased, after the first 24 hours, to 20 minutes on thesecond day and to half an hour or an hour on the third orfourth days. By the fifth day pounded beef will be toleratedand enjoyed and the interval may be increased to two hours,

1010 SEX MORTALITY FROM CANCER.-THE OPIUM TRAFFIC.

pounded beef, meat juice, beef-tea, and beef jelly beingtaken seriatim. In a week or a fortnight, if progress is

satisfactory, vegetables, bread, and stewed fruit may be

added with benefit. But at this stage or later a relapseusually occurs and the treatment seems to have failed. A

milk diet, except in the later stages of sprue, will producesolid stools but it does not as a rule cure. A milk and

a meat diet cannot be taken together with advantagebut a patient on a meat diet may abstain every thirdor fourth day from meat and take milk for 24 hours.This Mr. Cantlie has found to be the secret of success

in the prolonged treatment of sprue. Either diet separatelyis attended by relapses and ordinary attemrts to combinethese diets are unsuccessful. The explanation of the successof the method described is difficult. But Sir LauderBrunton has suggested the following explanation. Thebacteria of the intestine can accommodate themselves to

almost any kind of food. If a milk diet has been followeda sudden change to a meat diet places them at a disadvan-tage ; their activity ceases and they largely die out. Then

they recover and multiply and again become virulent. Buton suddenly reverting to milk they are again hampered. Inseveral cases of sprue the patients have returned to thetropics and on one day a week abandoned their usual dietand taken nothing but milk for 24 hours. In this way

persons for whom life in a warm climate would have beenotherwise impossible have been able to enjoy good health.

SEX MORTALITY FROM CANCER.i

ACCORDING to the last issued report of the Registrar-General, relating to the year 1904, the rate of mortality fromcancer in England and Wales in that year was equal to 741per 1,000,000 among males of all ages and to 1006 amongfemales. Compared with the rates recorded seven years-previously, in 1897, the increase of the male death-rate fromcancer was 17 per cent., while the increase of the femalerate did not exceed 8 per cent. Similarly the relative

increase of recorded cancer mortality between 1861-70and 1891-97 was, according to the Registrar-General’ssixtieth report, very nearly twice as great among males asas among females. The importance of the question as tothe proportion of the constantly increasing number of deathsreferred to malignant disease due to improved diagnosis andthe greater accuracy in the certification of causes of deathcannot be doubted. Some of the statistics contained in

the Registrar-General’s report moreover raise questions ofinterest connected with the causation of cancer. Since1889 these reports have from time to time contained usefulstatistics bearing upon the parts of the human body.affected by fatal cancer. The last issued report contains atable in which the 114,130 deaths referred to malignantdisease in England and Wales during the four years 1901-04are classified according to the part affected, as described bythe certifying medical practitioner. It is satisfactory tonote that this information was available for those four yearsin all but 1 per cent. of the fatal cases, whereas in 1897 thisinformation was not ascertained in 5 per cent. of the cases.These recent statistics to a great extent corroborate the con-clusions drawn from somewhat similar statistics publishedin the report for 1889 when it was pointed out that "theincrease (in the 20 years 1868-88) has been comparativelyslight in those organs which are the commonest seats of

malignant growths-namely, the generative and mammaryorgans of women-and has been largest, and this for bothsexes, in the organs of the digestive and the urinary systems,and notably in the intestines, rectum, liver, and urinarybladder." " It was then also pointed out that the fatal

cases of the disease affecting the mouth, the lips, the

tongue, the pharynx, and the fauces showed a verymarked increase among men, whereas among women the

fatal disease affecting those parts showed a decline. The

recently published figures show that in the four years1901-04 the number of fatal cases of cancer affecting thoseparts were no fewer than 7246 among males and only 1667among females. This marked excess of mortality amongmales in this class of case calls for careful investi-

gation and suggests the inquiry whether it may be the

result of nicotine poisoning, as for all other cancer mor-tality in which the figures are fairly comparable the

female rates of mortality considerably exceed the

male rates. The fact that the increase of recorded cancer

mortality in both sexes continues to be most marked in thosecases which present most difficulty in diagnosis throwsdoubt on the alleged large increase in the actual prevalenceof the disease, but throws little light upon the far greaterrate of increase among males, which deserves the carefulattention of the Director of the Imperial Cancer ResearchFund, who appears to have afforded assistance to the

Registrar-General in the classification of the parts of thebody affected by cancer in the recently published tablereferred to above. With regard to the increase in therecorded mortality of persons (of both sexes) from cancerit is satisfactory to note that while it was equal to 15’ 3 percent. between 1881-85 and 1886-90, the increase has steadilydeclined in each successive quinquennium and did notexceed 8’ 0 per cent. between 1896-1900 and 1901-05.

THE OPIUM TRAFFIC.

THE Chinese Imperial edict abolishing the use of opiumafter ten years recalls the action recently taken bythe Transvaal Legislative Council and the Australian

Government, an account of which is given in the Pharma-ce1ltioal Journal of Sept. 29th. The advent of Chineselabourers on the Rand was immediately followed by anenormous increase in the imports of opium. The mine

owners found that opium smoking rendered the coolies

less efficient workmen and chiefly as a result of their

representations the ordinance of Oct. 6th, 1905, was

gazetted, restricting the importation of opium and its

preparations into the Transvaal to registered medical prac-titioners, dentists, and druggists. The ordinance alsomade it unlawful for unqualified persons to be in possessionof any such substance except for medicinal purposes,the penalties for offences being exceptionally heavy.The immediate result of this ordinance was to transferthe opium traffic to illicit channels and smuggling wascarried on to a large extent. Some of the devices adoptedby the smugglers were ingenious, opium having been knownto pass through the Customs disguised as "meat extract"and " food for invalids." In January last the AustralianFederal Government prohibited the importation of opium forthe purpose of smoking and empowered the collector ofCustoms to grant licences to qualified medical practitioners,pharmaceutical druggists, and persons lawfully carrying onbusiness as wholesale druggists, in order that supplies ofopium might be available for medicinal purposes. Thesevarious enactments against the opium traffic raise the

interesting question as to the effect of immediate prohibitionon habitues. The committee appointed by the Govern-ment of the Philippine Islands to make a reporton the opium conditions in the Orient came to theconclusion that immediate prohibition is likely to

cause extreme suffering among those who are alreadyhabitués of opium, as it is exceedingly difficult for

anyone to discontinue the use of the drug at once. As aresult of investigations the committee considered that imme-diate prohibition is practicable only as a preventive measurein communities where the practice of opium smoking hasnever obtained. In those communities where opium is usedand prohibition has been tried it has proved to be a source