1788

half-namely, 25 per cent. of the whole. 5 per cent.

were Germans ; 10 per cent. were Russians and Scandi-

navians ; 10 per cent. were Italians, Spanish, Portuguese,and South Americans ; 4 per cent. were Roumanians, Serbs,and Bulgarians ; and 1 per cent. were Greeks, Turks, Japanese,and Haitiens. By far the greater number of these personswere students of both sexes and after them in order of theirnumbers came professors, medical men, engineers, men ofletters, lawyers and barristers, archaeologists, artists, andjournalists. Some of the professors of the Sorbonne itselffound it useful to consult the great store of practical informa-tion which has been accumulated. Dr. Blondel, in his officialreport of the working of the Bureau, somewhat woefullyrelates the odd experiences to which such an institution isexposed. Thus it often happens that a bevy of young ladiesaccompanied by their mother will enter the office and atonce monopolise all the vacant chairs. Then they will asknumerous and minute questions and it seen becomes evidentthat they have not made up their minds to follow anyparticular line of study but are striving, on the contrary, toget information that will enable them to come to a con-tlusion in the choice of a career. Of the specialtiesabout which the greatest number of questions are askedare those that relate to diseases of the eye, dermatology,nervous diseases, and gynaecology. It is found also that

most of the foreigners are not particularly anxious to

attend gratuitous classes but are, on the contrary, quitewilling to pay. They complain, however, and very

bitterly, that most of these courses extend over a periodof at least six months. They often cannot afford to

remain in Paris for such a long time. At Berlin, at Vienna,and elsewhere there are courses held with the lectures

following each other in rapid succession, and these are

consequently terminated within the limits of a much shortervisit to those capitals. Professor Budin, at the Tarnier

gynaecological clinique, and Professor Lapersonne, at the

opbtbalmological clinique of the Hotel Dieu, have organisedsomething of this sort but they are notable exceptions tothe general rule. The most surprising thing about thisinstitution is that though it does so much and such usefulwork it nevertheless possesses only very slender resources.Thus the director-general of the entire establishment enjoysthe munificent salary of Z4 per annum. Evidently this was amagnanimous attempt to pay his cab fares. The chief

secretary, who has to be there all the time during which theBureau is open and therefore cannot well attend to anyother business, receives £60 a year. The clerk and the

interpreter only receive £48 each, which, with the dearnessof provisions in Paris, does not seem to be a living wage. Itis to be hoped that in the course of time, as the merits of theBureau become still more widely known and appreciated,something will be done to improve the position of those whoare rendering great service annually to many thousandvisitors coming from all parts of the world.

BARBERS AND SURGEONS.

AT the hall of the ancient City Guild of Barbers an Iinteresting event occurred on Dec. 5th. From the earliest

times both in England and on the continent the art ofthe barber walked, so to speak, hand in hand with thatof the surgeon, whilst as evidencing the antiquity of theLondon Guild of Barber-Surgeons they have preserved alist of their Masters from the year 1308. This union was

dissolved by Act of Parliament in 1745, thenceforth theBarbers’ Company retaining the old hall in Monkwell-street,where it had been situate since the days of Richard II.,’together with the corporate property, records, plate, andpictures, whilst the surgeons were created a separatecompany out of which grew the Royal College of

Surgeons of England, and all connexion between the two

bodies absolutely ceased. On Dec. 5th, however, theold association was renewed in a most pleasant mannerat a Court of Assistants of the Barbers’ Company,when Mr. John Tweedy, the President of the RoyalCollege of Surgeons, was admitted to the freedom and

livery of the Company and may thus be truly said to

have become a " barber-surgeon." The charming old hallin which this ceremony took place was designed by InigoJones in 1636 and fortunately escaped the great fire of 1666,its walls being still adorned with many valuable and historicpictures the works of Vandyke, Sir Peter Lely, Sir JoshuaReynolds, Gainsborough, and others, whilst to crown

all is the world-renowned picture by Holbein representingHenry VIII. presenting a charter to the barber-surgeons.Nor has the Company been less fortunate in the preservationof some choice old plate, notably the Tudor Grace cup andcover (plate mark 1519) presented by Henry VIII., the RoyalOak cup presented by Charles II. in commemoration of hisescape at Boscobel, a large silver punch bowl presented byQueen Anne, and numerous other fine specimens of old silver.Surrounded by these delightful reminiscences of the pastthe President was entertained at a banquet in the evening,and in responding to the toast of the "Junior Liveryman"spoke with pride and pleasure of his association with theguild and the hall which had once been the home of so manyof his illustrious predecessors.

TRAUMATIC ULCER OF THE STOMACH.

A CASE of very considerable interest is recorded by Dr,

Fertig of Cassel in the Münchener Jledicinische Wochenschriftof Sept. 12tb. The patient was a man, aged 28 years, whohalf an hour after a heavy breakfast received a kick in themiddle of the abdomen. He was unconscious for a quarterof an hour, at the end of which he complained of abdominalpain and difficulty in breathing. There was no vomiting butfrequent retching. On examination he was found to be

cyanotic and breathing with difficulty. The abdomen was

slightly distended, tender, and very rigid. The percussionnote was tympanitic everywhere except in the flanks. A

perforation of the gut or an internal haemorrhage wassuspected and an exploratory laparotomy was therefore

carried out two and a half hours after the injury butwith negative results, the only condition found beinga small quantity of blood in the region of the gastro-hepaticligament. Two days after the operation a considerabledegree of meteorism developed associated with vomiting;otherwise the patient was comfortable with a full and

strong pulse. The vomit was red in colour but this wasattributed to some red wine which he had been given a shorttime previously. The bowels were relieved and the faeceswere free from blood. On the evening of the fourth day thepatient vomited blood and became very collapsed and pale.Next day the hæmatemesis persisted and the anasmia. becamemore marked. On washing out the stomach a large quantityof blood and blood clot was removed. The diagnosis oftraumatic ulcer of the stomach was then made butthe desperate condition of the patient was held to renderfurther operation inadvisable. Nothing but ice was givenby the mouth, large quantities of normal saline solutionwere infused, and ergotin was administered hypodermically,but without avail ; the vomiting persisted, blood appearedin large quantity in the stools, and death occurred duringthe night. At the necropsy there was no peritonitis and,apart from the conditions found in the stomach, there was nosign of injury. The stomach contained a large cake of bloodclot and along the lesser curvatures of the organ therewere four ulcers, one behind the other. Three of them

were of rounded form, with a diameter of from a half toone centimetre ; the fourth, which was nearest the pylorusbeing about five centimetres from it, was of oval form, three

1789

centimetres long and two broad. The ulcers showed sharplydefined, overhanging edges and involved the whole thick-ness of the stomach walls but were shut off from the

peritoneal cavity by the gastro-hepatic omentum. In the

floor of the largest ulcer the right coronary artery, whichwas eroded, projected and from this the haemorrhagehad occurred. Dr. Fertig discusses the pathogenesis of

traumatic ulceration of the stomach, with interesting refer-ences to other recorded cases and to experimental researches.He states that the diagnosis is not infrequently made butthat it is but rarely established by operation or necropsy,since Jackhl- could only collect eight cases from the litera-ture. The forms of injury which have produced ulcerationin these cases include kicks, blows with the fist, fallingagainst the corner of a table, compression between railwaybuffers, and fall from a height. Dr. Fertig explains theulceration in the case under his care as follows. At the

time of the injury the patient, who had not previouslysuffered from any gastric disease, was digesting a full meal,the distended stomach was forcibly driven against thevertebral column, and some tears in the mucous membraneresulted. The stomach at the time or shortly after wouldbe at its maximum acidity, and hyperacidity, it is believed,is a factor of importance in the genesis of gastric ulceration.Certain experiments of Vanni suggest that there is also amycotic factor in the production of gastric ulcers, so thatit may possibly be that the trauma of the gastric mucousmembrane afforded the opportunity for a bacterial infection.Other investigations also seem to indicate that the lesser

curvature is the most frequent site of lesion in the stomachwhen abdominal injuries are received after a full meal. Dr.

Fertig’s case is noteworthy not only for the clearness withwhich the diagnosis is established but also for the succinctand careful manner in which it is recorded and the criticalnature of Dr. Fertig’s discussion of it.

THE ESSENTIAL CONDITIONS OF STEAMDISINFECTION.

A VERY instructive and interesting correspondence on theimportant subject of disinfection by steam has recentlyappeared in our columns. We are compelled now on con-siderations of space to close this correspondence and weventure to think at the same time that sufficient discussion

has been brought before our readers to guide them as to

what in practice ought to be regarded as the essential con-ditions of steam disinfection. The correspondence prac-tically resolved itself into considering the relative merits ofstreaming steam on the one hand and on the other ofsaturated steam under pressure for practical disinfectingpurposes. The latter, as might be anticipated from its

more powerful mechanical and physical properties, is un-

doubtedly the most certain agent for the purpose, althoughstreaming steam admits of a much simpler application andfor many if not all practical requirements the prolongedexposure of infected articles to a rapid stream of current

steam, especially if that steam is kept a few degreesabove condensation point, secures disinfection if we are to

accept the results of bacteriological experiments made withtypical organisms. The condition of efficiency, however,when using streaming steam is the rate at which the steamis generated and the steam velocity in this method is

admittedly difficult to control. On the other hand, the useof saturated steam under pressure necessarily supplies aconstant and efficient condition which is easy and simpleenough to insure. As is well known, it is essential when

using steam for the purposes of disinfection to expel the airfrom the apparatus, as air, being a poor conductor of heat,tends to insulate the material to be disinfected and to

prevent the steam from coming into direct contact with

1 Langenbeck’s Archiv, Band lxvi., p. 938.

it. That system, therefore, which effectually expels allair is the one in which confidence would be naturallyplaced. At any rate, in practice it has been establishedthat steam under pressure acts more rapidly and moresearchingly than streaming steam at 100° C., partly nodoubt because the former method more effectually expelsnon-conducting air and partly because it is more likely tobreak up greasy envelopes. With exceptionally resistantspores the time taken by saturated steam to sterilise organismsis found to be much shorter than when streaming steam isused. It should be added, however, that if prior to theintroduction of current steam a vacuum or a partial vacuumis produced in the apparatus the penetrative power of theteam is increased, and concurrently a more rapid and

powerful disinfecting action is obtained. There seems to beno reason therefore why, under certain conditions, the twosystems should not be made equally effectual.

THE EXETER DISPENSARY.

IN our issue of Dec. 9th a paragraph appeared from ourWestern Counties Correspondent mentioning that the

honorary medical staff of the Exeter Dispensary had re-signed. We have now received from the medical staff aletter and some documents as to the origin of the disputewhich has led to the resignation. Besides (1) the letterfrom the staff to ourselves we have before us (2) a letterfrom the staff to the governors of the dispensary, and (3)a copy of a letter addressed by the committee of the dis-pensary to the governors. The letter from the staff to

ourselves sums up matters as follows :-1. After a charge of unpunctuality and neglect of duty had been

preferred against the honorary medical officers no opportunity wasgiven them to answer the accusations but the matter was referred toa subcommittee.

2. Charges were made against them in the subcommittee based uponstatistics showing a complete ignorance of the conditions under whichmedical work has to be carried out, implying neglect and supported bylanguage of a most offensive character. No attempt was made by thepiesident or by members of the subcommittee, with one exception, toprotest against the accusation or the language in which it was couched.It was shown by the two members ot the staff present that thestatistics were inaccurate and the deductions false but the membermaking them declared his intention of publishing them if defeated incommittee.

The course of events which have led up to the membersof the medical staff tendering their resignations can begathered from (2) the letter which has been addressed tothe governors of the dispensary by the medical staff. It

appears by the minutes of the last court of governors, heldon Feb. loth, that it was unanimously resolved :-That the best thanks of this meeting be given to the medical officers

for their zealous, kind, and unremitting attention to the patients ofthis charity. whereby the poor and suffering classes of society havebeen so inexpensively relieved.

On Nov. 15th, however, Mr. Knill, a governor, brought aproposal before the committee to consider the desirability ofengaging a permanent medical officer to be in daily attend-ance, so as to relieve the honorary medical staff of part oftheir onerous duties, and to secure more speedy attentionto the patients. This proposal was supported by statisticsgravely impugning the efficiency of the medical attendance.Instead, as has hitherto been the custom in any matter

referring to the medical staff, of submitting this proposalto the medical staff for consideration, it was referred to a

subcommittee the members of which were nominated byMr. Knill. The medical staff hearing of this wrote tothe chairman of the subcommittee, pointing out that intheir opinion the appointment of a paid medical officer wouldnot be desirable and would not obviate the delays complainedof. This letter was read at the meeting of the subcommitteeon Nov. 23rd, to every member of which Mr. Knill had sent astatement embodying the charges which he had made onNov. 15th, but, as we learn from (2), the letter from the staffto the governors, the statement was shown by the medicalmembers of the subcommittee to be inaccurate. The re-

futation printed in pamphlet form was sent to the governors