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out covered with blood.’ It should be borne in mind that

this last was the desperate proceeding of a child under 15years old. Callaway cut away the dressing and proceeded tonew tortures with caustic, and partial relief was only foundunder Joseph Henry Green and Sir Benjamin Brodie, andlater Rigaud in France, merciful men if any were. The

whole thing happened a long time ago and the erewhile

sufferer died at a very advanced age in 1905. The passagein the diary is only cited as proof of the painful and rudi-mentary practice of even famous surgeons before the days ofListerism. "

THE TELEPHONE AND THE SPREAD OFDISEASE.

WE have received from the Post Office a copy of the reportmade by the City medical officer of health some three years.ago upon the possible spread of infection by call-office

telephones. It may be remembered that Dr. W. Collingridgeexamined a considerable number of call-office telephones;and found them to be free from disease germs, but this

fortunate fact does not minimise the importance of the

Teport made in our columns last week by Dr. Francis J.Allan, medical officer of health of Westminster, who

clearly showed that in certain cases call-office telephonesmay be a distinct source of danger to the public. It is quitetrue, as was stated on Monday last by the Postmaster-Generalin the House of Commons, that Dr. Allan found no trace ofdisease germs in five out of six call-office telephones which hetested, and it may be that the sixth instrument where a

dangerous state of things was observed had particularfeatures in its station to account for its condition, but it is

impossible to minimise the fact that Dr. Allan has clearlyproved that the call-office telephone may be a source ofgreat danger.

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THORACOSTOMY IN HEART DISEASE.

WE publish in another part of this issue of THE LANCET

an interesting paper by Dr. Alexander Morison in which

some observations are made concerning an operative methoddevised to afford relief to certain cases of enlarged heart.The enlarged area of pulsation and the forcible thrust

against the chest wall in cases of greatly hypertrophiedheart are familiar features in the clinical picture of certainforms of cardiac disease. Some years ago Dr. Morison

suggested that the severing of pericardial adhesions bysurgical methods might eventually be a practicable pro-cedure, and again in a paper read before the ÆsculapianSociety and published in THE LANCET of July 28th, 1906, hesuggested that the hypertrophied heart needed more room towork in and that it was possible that in the future ameans might be found to provide such increased roomby surgical methods. He now gives references to

the actual carrying out of operations specially devisedfor this purpose with which he has recently becomeacquainted. He finds that as long ago as 1902 Pro-

fessor Brauer proposed that the costopericardial adhesionsin cases of adhesive pericarditis should be separated, andoperations were carried out upon two of his cases byProfessor Petersen and Dr. Simon, pieces of several ribs

being resected in the first case, while in the second case a

portion of the sternum was also removed. A third casewas operated upon by Dr. Simon, and Dr. Morison is

privately informed that a fourth case has been operatedupon under Professor Brauer’s supervision. ProfessorWenckebach has also published a case in which parts ofseveral ribs and their cartilages were removed. Dr. WilliamMackenzie of Melbourne has independently suggestedthe removal of portions of the sternum and ribs in order tofree the heart from costopericardial adhesions. Still more

recently Dr. Morison has developed the principle of affordingrelief to intrathoracic pressure by operative procedure byapplying it to a case of mediastinal tumour involving the heartand to a case of cardiac pain associated with enlarged heartdue to aortic valvular disease with a view to afford

increased room independently of any question of relief

of tethering due to pericardial and costopericardialadhesions. The clinical features of the latter case are

described in detail in his paper. The patient was a clerk,aged 19 years, with aortic valvular disease associated withsevere attacks of pain. After rest and medical treatmenthad failed to give relief Mr. Ewen C. Stabb, at Dr. Morison’ssuggestion, performed on May lst an operation, removingfour and a half inches of the fifth rib and five and a half

inches of the sixth. The results of the operation to dateappear to have been satisfactory and there has been con-siderable relief to the pain from which the patient suffered.It is obvious that the greatly hypertrophied heart has tomake room for itself in the closed thoracic cavity and thebulging of the præcordia in children is an evidence of the forcewhich it exerts upon the more easily yielding thorax in earlylife ; consequently from a theoretical point of view the

suggestion to afford increased room for the heart or to lessenthe resistance which it has to contend against is one whichhas much to commend it. Practically, however, the pro-cedure is a somewhat serious one to recommend to a patientwith grave organic disease of the heart, involving as it

does anaesthesia with a more or less extensive operation.Dr. Morison himself deprecates laying too great stress uponthe result in a single case. Moreover, the time which haselapsed since the operation is very short. We shall await

with interest the further progress of the case, and mean-

while we may congratulate Dr. Morison and Mr. Stabb

upon the result so far obtained. We cannot but feel, how-ever, that the cases submitted to this operation will requiremost careful selection, even should the permanent results

prove as encouraging as those immediately obtained.

A "PSYCHIATRIC CLINIC" FOR THE JOHNSHOPKINS HOSPITAL.

Mr. Henry Phipps, who is a steel magnate of the UnitedStates, makes very good use of his fortune. He has founded

model tenement houses in New York and endowed a specialdispensary for pulmonary tuberculosis in connexion with theJohns Hopkins Hospital at Baltimore. That great centre ofAmerican medical research has benefited recently by afurther gift of$750,000 from the same philanthropist for thepurpose of founding a hospital for the treatment and studyof acute mental disease such as Dr. Henry Maudsley’smunificence has insured recently for London. The intentionsof both benefactors are the same and were set forth in the

leading article in which we discussed Dr. Maudsley’s recentoffer to the London County Council. Mr. Phipps has madea study of the conditions under which the insane are

treated in America and has concluded that the systemis not worthy of his country; he is said to have

been stimulated in his inquiry partly by the allegationsmade against it in that remarkable autobiography, "A Mindthat Found Itself," which we discussed last week in thesecolumns. Be that as it may, he has been convinced that a

hospital is needed urgently in which sufferers from earlymental disease can be treated on general hospital lineswithout the stigma of undergoing certification or the distressof mixing with degraded dements. He wishes the institu-tion to possess a thorough laboratory equipment and to affordevery opportunity for the routine study of psychiatry bystudents of medicine. To these ends he will found a hospital

1 THE LANCET, March 7th, 1908, p. 728.

39

for some 60 patients in the precincts of the Johns HopkinsHospital and will provide for its upkeep, as well as forthe maintenance of a professor of psychiatry, for a periodof ten years. This professor will be the director of the

hospital, and he will be assisted by a resident physicianand two assistant physicians upon the clinical side,and by three physicians in charge of the pathological,chemical, and psychological laboratories upon the purely.scientific side. The director, when he has been chosen,will visit Europe in company with the architect in

order to study the construction and equipment of

approved continental hospitals for the treatment of mentaldiseases. Mr. Phipps announced his splendid gift in a letterto Dr. W. H. Welch, who is credited with having aroused hisinterest and given him much expert advice in the matter. In

the course of this letter he wrote : "It is my hope and ex-pectation that the psychiatric clinic thus founded may serve.as an example of what such institutions should be, and proveto be a stimulus to the establishment of similar hospitals andprofessorships elsewhere." Here is a plutocrat who brings.a clear head as well as a singularly open hand to the bestowalof his charity. We congratulate Johns Hopkins Universityand Baltimore upon so important an addition to their;scientific and humanitarian resources.

DISEASES AND INJURIES OF THE ANCIENTEGYPTIANS.

MEDICAL men who are interested in the history of medicinewill find an opportunity in connexion with the annual ex-hibition of preparations recently added to the Museum of theRoyal College of Surgeons of England on July 2nd, 3rd, and4th, of examining an extensive and remarkable series of

specimens illustrating the diseases and injuries of the ancientinhabitants of Upper Egypt. It is ’not too much to say that

this collection, which is destined to find an appropriate homein the Hunterian Museum, is one of the most importantcontributions ever made to the history of medicine. The

specimens were collected during the exploration of some57 cemeteries in Nubia, just beyond the confines of UpperEgypt, and represent accidents and diseases of every periodof Egyptian history from early predynastic times to the

comparatively recent Roman and early Christian periods.The collection, which embraces over a hundred specimens ofhealed fractures of various bones, was made by Dr. WoodJones, under the direction of Professor G. Elliot Smith, duringthe survey necessitated by the projected raising of the levelof the Aswan dam.

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THE DIRTY CUFF.

FROM an aesthetic point of view the cuff seems to be anindispensable part of the clothing of the neatly and cleanlydressed individual. This assumes, of course, that the cuff is

clean and spotless. Bacteriological refinements are oftendismissed by many people as inadmissible in the common

applications of life, but the exhibition of a dirty or evenfrayed cuff is commonly held to be the mark of slovenlinessand dirt or as an indication that the individual has lost all

regard for his cleanly appearance and condition. There canbe no doubt at all that when the cuff picks up, as

it is so prone to do, dirt from the counter, desk, or tableit picks up also a multitude of micro-organisms. Dirt sofar may be welcomed, inasmuch as it indicates an

insanitary state of affairs. There is therefore a verystrong scientific argument in favour of the wearing ofmaterials which readily exhibit the signs of soiling.The white dress, the drills, and the ducks must neces-

sarily be cleaned at regular intervals because they look

unsightly or are an offence to the eye. The demand ofthe eye thus encourages the preservatioa of the hygienic

state. It is so also with the cuff. No man with anyrespect for himself can wear a dirty cuff, and by keepinghis cuffs religiously clean or by changing them frequentlyhe is reducing his chances of coming into intimate contactwith a collection of bacteriological entities. The adoptionof "dark goods" or of those materials which do not showdirt may therefore be regarded as a retrograde step, for it isobvious that such materials must get soiled just as much asdo those which easily show the defilement. They, however,are not so frequently cleansed because there is no offenceto the eye even after several days’ wear and thus dirtis allowed to accumulate. When a man finds it con-

venient to wear coloured shirts and cuffs he means in

reality that he can carry dirt for a little longer withoutgiving offence than if he wore a spotlessly white material,or at all events a material which readily exhibits the

smear of dirt or grease. The washing bill is, of course,reduced and the terrors diminished of the disintegratingprocess which is involved in an oft-repeated visit to the

laundry. Lastly, it may be mentioned that from the point ofview of hygienic demand the coloured handkerchief is an

abomination when its colour is merely adopted in order toavoid frequent washing.

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IS BERI-BERI IDENTICAL WITH EPIDEMICDROPSY P

Dr. T. Frederick Pearse, the health officer of Calcutta, haslately brought forward weighty evidence in support of thetheory that epidemic dropsy is identical with beri-beri. Theformer disease was observed first in the year 1877 in thesouthern suburbs of Calcutta, and appeared at intervals upto the year 1880, new localities being attacked with eachrecrudescence. 20 years then elapsed before the next

outbreak occurred. The disease was at first thought to beof the same nature as beri-beri but was subsequently heldto be distinct from it. Dr. Pearse has recently stated hisviews that the first impression of the nature of the disease iscorrect. He shows that the combination of symptoms in thetwo complaints is very similar. The greater or less œdema,especially in the shins, the hyperagsthesia and deep-seatedpain in the legs, the cardiac symptoms, and the mode ofdeath are common to both. The dropsy is shown in the samespecial and characteristic manner even to effusion in the

pleural and pericardial sacs ; also the nervous phenomena, ifof less degree in epidemic dropsy, are identical in character-viz., those of peripheral neuritis. The conditions found

post mortem are, although in no way characteristic of eitherdisease, yet similar in both. As Dr. Pearse points out, thecombination of oedema with symptoms pointing to peripheralneuritis with "rheumatic "-like pains and with disorderedheart action, is only known in these two diseases. All the

symptoms in the two diseases are similar in character, ifnot always in degree, and cases occur in outbreaks of eachdisease which are indistinguishable the one from the other.Finally, death is brought about in a similar manner, some-times suddenly and sometimes slowly, by nervous disturbanceof the heart’s action. Reasoning on the above similarityin the course of the two affections, Dr. Pearse states his

opinion to be that we have to look to some specific microbeas the cause of both. He certainly makes out a strongcase in favour of his idea, as there are certain cardinal

symptoms present in both affections-namely, the deep-seated pain and distinct tenderness of the calves, the greatmuscular weakness without absolute paralysis, the cardiactroubles as shown by shortness of breath, palpitation, re-

duplication of sounds, rapid and irregular pulse, and varyingmurmurs. Opponents of this view have pointed out thatthe knee reflex is lost in beri-beri but not in epidemic dropsy.This, however, is not universally true ; in the recent outbreak