1747A RECENT DEVELOPMENT IN ADVERTISING.

of treatment for any disease has given satisfactory t

results it is only just that such therapeutic measures a

should be made known, either through one of the medical a

societies or in the columns of the medical press, but 1

when published in the daily press it can only tend to 1

bring discredit both upon the treatment itself and upon i

the practitioner who seeks such channels to make his 1name known. The drug, which is claimed in this instance as fa " new remedy," is arsenic or one of its derivatives. Two t

names are associated with the drug through no fault of their 1owners-namely, Professor Armand Gautier and Dr. Hoff of 1

Vienna. Arsenic has been used in the treatment of pul- 1monary tuberculosis in this country for a number of years, 1

consequently there is nothing "new" in its employment. 1

Different authorities use varying doses, and it is well known l

that tolerance of the drug is generally speedily estab-lished-witness its use in chorea and children can

without inconvenience take 15 minims of Fowler’ssolution three times a day if the dose is slowlyincreased and the patient is carefully watched. One

preparation of arsenic is comparatively new-namely,cacodylic acid, and it is claimed that the drug can be pushedto its full action more conveniently by this means than byemploying the preparations in ordinary use. Cacodylic acidis arsenic acid in which two hydroxyl groups are replaced bytwo molecules of the methyl group. Our object, however,is to protest against its use being exploited in the lay press,although, as already stated, the two authorities whom wehave mentioned are not in any way to blame for the pro-minence which has been given to their names. Frequentreferences have been made to the drug in previous issues anda list of references will be found in another column.

A RECENT DEVELOPMENT IN ADVERTISING.

So far as its own members are concerned the medical

profession in this country remains true to its ideals

and abhors the practice or permission of advertise-ment. It needs no deep thought to discern the

degradation into which a learned profession must inevitablysink if once success in its ranks comes to depend less uponthe merits than upon the advertising powers, the immodesty,and the assurance of its members. Yet while medical menthus refuse to be active participators in advertisement thereis no class, we suppose, more persistently victimised byadvertisers of all kinds. What practitioner’s waste-paperbasket is spared for a day even from elaborate circulars

describing the particular merits of some outrageously-nameddrug or from presentation copies of periodicals whose pagespresent articles that are but the thinly disguised advertisementof a patent medicine or a proprietary hygiene establishment ? ?We mention the waste-paper basket, but no man’s basketalone can cope with the advertisements that reach him

through the post. He must have, in addition, some reposi-tory for the more substantial waste that is showered uponhim. Bottles of mineral waters from all corners of Europeand America, little boxes of substances that representthe latest enterprise in making medicines palatable, ,,

ointments, lotions, biscuits, and extracts, all alike reachthe medical man who neither requests nor desires this

bewildering accumulation. It may be urged that beyondsome domestic inconvenience this prolific advertisementdoes the medical man no harm and occasionally perhapseven leads him to notice a useful preparation that he mightotherwise have missed. Unfortunately, however, advertise-ment even without encouragement will not stop short at thecomparatively harmless methods we have alluded to. Thesuccess of advertisement from the commercial point of viewis undoubted. Consequently, advertisers are ever on the alertfor some new means by which to catch the eye or to arrest theattention of probable customers until, without ever actually

transgressing the laws of bribery and corruption, methodsare practised that cannot fail to damage the self-respect ofany who may allow themselves to be practised upon. Wehave no fear that such a bait as the "Craigside Hydro,Llandudno," holds out to the medical profession will be

readily swallowed, but as an example of an evil and

perhaps new methcd of ’’ pushing a concern" " we are

glad of the opportunity of alluding to these mattersthat a correspondent puts in our way. This gentle-man, as well as no doubt many others, received

together with a brochure relating to the Craigside Hydro-pathic Establishment a coupon the presentation of which willbe accepted in payment of account for three days’ stay atthe " hydro." Such benevolence on the part of the institutionhas only one significance. It says in effect, " We will payyou for a three days’ holiday here, afterwards send yourpatients who will pay us." We know nothing of the estab-lishment in question ; it may be, and very likely is, in everyother way admirable, but of this we are quite certain, thatsuch a means of advertisement as we have described, so farfrom recommending its object’to medical men, will onlyarouse their suspicions and delay them from seeking itsbenefits either for themselves or for their patients.

ATROPHY OF THE MUSCLES OF THE SHOULDERAS AN EARLY SIGN OF PHTHISIS.

AT the meeting of the Societe Médicale des Hopitaux ofParis on Oct. 26th M. Emile Boix called attention to an earlysign of phthisis which has not received much attention-atrophy of the scapulo-thoracic muscles on the affected side.In advanced cases, of course, such atrophy is well recognised.M. Boix relies on inspection and palpation rather than onmeasurement to detect slight differences between the twosides. Inspection of the shoulders both from the frontand the back must be carefully carried out in a goodlight. If necessary it may also be performed withthe patient lying down, both on his abdomen and, onhis back; or better still, the patient may be seated.

Palpation will corroborate the evidence derived from

inspection. With the tips of the fingers the thickness, con-sistency, and elasticity of the muscles are appreciated andat the same time the habitual tenderness-a sign of the firstimportance-is discovered. The difference between the twosides can also be appreciated by pinching between thefingers the fleshy mass above the clavicle and spine ofthe scapula. M. Boix finds that in phthisis muscular

atrophy is more marked on the side in which the lesions

are more advanced and is unilateral if the lesions are

unilateral. Even when the subject is very emaciated a

difference between the two sides will be found in the

volume and consistency of the supra-spinatus, trapezius,and pectoral muscles, and sometimes of the deltoids.

Muscular atrophy is an early sign, but is not a primarysign, of phthisis. Its value consists in that it draws atten-tion to the affected apex and cor firms the diagnosis at atime when only modified respiratory sounds without adven-titious sounds are present and the disease can only be sus-pected. The atrophy in advanced cases affects more

or less generally the muscles of the shoulder; in the

beginning, on the contrary, it is partial. Sometimes the

supra-clavicular hollow is more pronounced on the affectedside, sometimes the sub-clavicular plane is retracted, andsometimes the supra-spinous mass is less full than on theother side. A source of fallacy is that the muscles of the leftshoulder are generally less developed than are those of the

right ; but a perceptible difference, especially in the form ofthe "partial" atrophy described above, constitutes a pre-i sumption in favour of phthisis. The fact that the right side isgenerally first affected or most affected in phthisis increases’ the value of the symptom of muscular atrophy. As to the

1748 A WORD OF SYMPATHY.-A PROTEOLYTIC FERMENT IN MILK.

pathology of this condition it seems to be analogous tomuscular atrophy of arthritic origin. The following casesare examples of its value as a symptom. Case 1.-A man,

aged 38 years, complained of cough and loss of flesh. Atthe left apex there was slight dulness, inspiration was

jerky, and expiration was prolonged. In spite of the generalemaciation palpation revealed a marked difference betweenthe two supra-spinatus muscles; the left was much more

atrophied than the right. The tuberculosis made rapidprogress and ended fatally. Case 2.-A woman, aged 44years, came under observation. A year previously she hadhad abundant haemoptysis. At the right apex respiration wasscarcely prolonged, and at one point in the supra-spinousfossa fine sub-crepitant rales were heard. On the left side thesupra-spinatus muscle was in well-marked relief ; on the rightthe supra-spinous fossa was flattened. The sub-clavicularand supra-clavicular fossae were more marked on the rightside than on the left. A year later there were signs of exten-sion of the pulmonary disease, but the appearance of themuscles remained the same.

A WORD OF SYMPATHY.

"IT takes the blood of the men and the tears of the

women." So said one of the greatest-minded and mosttender,hearted of men in a well-known passage upon War. The conflict Dow raging in South Africa has brought sorrow tomany a household. All hearts went out to the veteran com-mander now on his way home when he lost his sole survivingson at the hour when he won the coveted decoration which thefather also wears. And now a similar and, if possible, greatersorrow has fallen upon a member of our own profession-Dr. Charles Parsons of Dover. Two sons did he give to theservice of his country-Lieutenant Francis Parsons, killed atDreifontein, whose gallantry had gained him the V.C. ; andCourtenay Parsons, who went as civil surgeon attached tothe 21st Field Hospital, and who died from that scourge ofarmies, enteric fever, at Harrismith. Sympathy to one inbitter grief is all that most of us can offer, and we feelcertain that we only give expression to the thoughts of therest of the medical profession in offering to Dr. Parsons theassurance that his sorrow is ours as well.

THE CANCER RESEARCH LABORATORIES ATTHE MIDDLESEX HOSPITAL.

THE new cancer wing at the. Middlesex Hospital forms aninstitution and is a complete hospital in itself, having a staffof sisters, nurses, servants, and attendants quite distinctfrom the main building. So long ago as in 1791 the originalfounder of the cancer wards (Mr. Samuel Whitbread) gaveto the hospital a sum of f.4000 with the specific directionthat the money should be applied to ’’ the relief of personsaffected with cancer and the investigation of a complaintwhich, though extremely common, is both with regard to its

‘

natural history and cure but imperfectly known." Lateranother bequest was received under the will of DameAlithea Maria Stafford for the purpose of cursing personsaffected with cancer and of investigating and promotingour knowledge of treating that dreadful disease." Afterso long a lapse of time, although the methods of operatinghave been immensely improved, yet we are obliged to confessthat the etiology is still " but imperfectly known." Inthe new buildings, however, fully equipped laboratorieshave been established, and under the direction of Mr.

A. G. R. Foulerton careful and elaborate research work is

being carried on by himself and competent assistants. Wehave already drawn attention to the advantages offered bysuch an institution. A letter in the Times of Dec. lst pointsout the serious financial responsibility which the governors ofthe Middlesex Hospital have taken upon themselves in found-ing these laboratories. The results will affect the whole of

mankind, and it is to be earnestly hoped that sufficient fundswill be forthcoming to render the work as complete aspossible. ___

A PROTEOLYTIC FERMENT IN MILK.

IT has often been conjectured that a peculiar fermentexisted in milk of the nature of the pancreatic ferment, butapparently the investigation of the subject has not led toany very definite results. The point is of considerableinterest in relation to the alteration effected in the dietetic

properties of milk when milk is heated or sterilised. In the

sterilised milk diet of infants, for example, scurvy ricketssometimes results which, however, would appear to be

avoidable by the addition of raw meat juice or the juice of afresh lemon. It is maintained by some that there is an elementof vitality in milk which is essential to its satisfactory assimi-lation and that this life element is destroyed, of course, byheat or by sterilisation. Others regard the alteration to bedue to certain chemical changes brought about in the

proteids by heat. The recent discovery of a definiteferment in milk may, however, throw a new light uponthis question. The ferment known as galactase is similar totrypsin and is present in the milk of all animals. It is more

active in moderately alkaline than in neutral or faintly acidsolutions. It is remarkable that trypsin and pancreatindiffer from galactase in not forming ammonia and differalso from other ferments in that the nitrogen compoundsformed in digestion by its agency are more equally dividedin albumoses, peptones, amides, and ammonia. Further,formalin is found to weaken distinctly the action of galactase,an observation which very pertinently bears upon the

legitimacy of employing at least one preservative in milk, atleast for infant and invalid uses.

ANEURYSM OF THE AORTA TREATED BY

THE INSERTION OF A PERMANENT

WIRE AND GALVANISM.

IN the November number of the Bulletin of the JohnsHopkins Hospital Dr. Guy L. Hunner publishes accounts offive cases of aneurysm of the aorta which have been treatedin the Johns Hopkins Hospital by the insertion of a

permanent wire and galvanism (Moore-Corradi method).The first patient, a man, 27 years of age, was operated onby Dr. Halsted on Nov. 24th, 1897. A median incision madefrom the ensiform cartilage to the umbilicus exposed apulsating mass in the epigastrium which lay behind thelesser peritoneal cavity and could only be reached by pullingdown the stomach and approaching the sac above the lessercurvature. A long aspirator needle was passed into the sacand an unsuccessful attempt made to insert pure silver wire.On a second attempt no more than 17 inches of wire could beintroduced. A larger aspirator needle was now used and38 inches of wire were inserted through it with ease.

A galvanic current of from 30 to 100 milliamperes wasthen passed for an hour and 25 minutes, the anode beingconnected with the end of the wire and the cathode with a

large metal plate wrapped in a towel and placed under theback. The wire was cut off close to the sac and the

posterior peritoneum closed over the site of the puncture.The patient died in 40 hours from rupture of the sac into theleft pleura. Experiments on different kinds of wire werethen made and it was found that a silver alloy, highly drawn,containing 75 parts of copper to 1000, seemed to be the best.The sac should never receive both poles of the galvanicbattery nor should the current be so passed that the

negative electrode is in the sac. The second case, a man,aged 25 years, was operated on by Dr. Finney on

August 27th, 1898. On opening the abdomen the sac wasfound to be almost completely hidden by the flattened-outpancreas. Five feet of the silver-copper wire were passed