1172 WELLINGTON BARRACKS AND THE WAR OFFICE.

paper detailing the results of their experiments theysuggest this procedure in cases of cerebral haemorrliage.Theoretically such a course is both rational and scientific.The objection to it lies in the practical difficulty whichsurrounds the diagnosis of the nature of the lesion in casesof hemiplegia. Embolism would be the natural explanationsought in patients who are the subjects of the heart lesionsusually associated with this condition, but the diflerentialdiagnosis of thrombosis from haemorrhage, especially in theearly stages, when alone operative measures to be successfulmust be undertaken, is a problem of the greatest difficultyand delicacy; and a mistaken diagnosis, if it led to ligatureof the carotid when thrombosis had taken place, or was inprocess of taking place, in a cerebral vessel, would of coursehave the most serious consequences. In some cases it is

conceivable that the diagnosis may be sufficiently clear to

justify operative interference of the kind advocated by Mr.HORSLEY and Mr. SPENCER, and under such circumstancesa good result might be hoped for. If this be so, it offers a

fair prospect that surgery in the future may be able to dealwith a class of cases which, at the best, are but little

amenable to treatment by medicine.

Annotations.

WELLINGTON BARRACKS AND THEWAR OFFICE.

.. Ne quid nimis."

THE evidence given before the coroner at the inquest uponthe two children who were burnt at the fire at WellingtonBarracks on Nov. 12th brought out some astounding revela-tions which are anything but creditable to our War Depart-ment. To some of these we think it well to call attention,in the hope that it may lead to the adoption of a bettersystem. The first important point has reference to the con-struction of the building. Captain Shaw, chief omcer ofthe Fire Brigade, stated that the building was 90 ft. long,30 ft. wide, and 40 ft. high, with passages through thecentre of each floor leading to the rooms on each side.There was but one staircase and no balconies, and a greatdeal of wood in the structure. The fire commenced on thefirst floor, and passed up the staircase to the second withgreat rapidity, thus, of course, cutting off the chief meansof exit. The only other outlet was stated by one of thewitnesses to be a trapdoor in the roof, which was describedas being "twelve feet from the floor, and there was noladder to it." Through this, thanks to the energy of twonon-commissioned officers, twelve women and four childrenwere passed, and ultimately rescued by means of ladders.There appears to have been no fire-escape of any descrip-tion in the building. But, apart from the defective con-struction, there seems to have been no provision forextinguishing a fire in case it occurred. One of the wit-nesses said "lie believed that in the early moments of thefire a few buckets of water would have sufficed to subduethe flames." We were under the impression that all ourpublic buildings (including, of course, the barracks) weresupplied with fire buckets ; but it would seem that themarried quarters, in Wellington Barracks at least, had nosuch provision. But, again, there was a very seriousfailure in connexion with the water-supply. It appearsthat the key of the main-on which of course the use of thefire engines depends—was in charge of a labourer em- i

ployed at the barracks an arrangement made, we pre- . ..

sume, by the barrack department. This he was instructedto keep in his room that it might be handy, buton the alarm of fire "he was so anxious for the safetyof his family that he rushed out of the building andforgot the key of the main, which was the only keythat would turn on the water." ... " He did not supposeit was generally known where the key was kept." It issomewhat difficult to understand the connexion betweenhis anxiety for his family and his rushing out of the building,but the arrangement for the custody of the key is

certainly peculiar ; we should have thought that in a

barrack the guard-room would have been the proper placeto keep it, as the custodian of it--the sergeant of the guard-must always be at hand. We would suggest to the BarrackDepartment to take immediate steps for such an arrange.ment in all their barracks. But, in addition to thesedefects in construction and arrangements, another

very striking circumstance was brought to light. Themedical officer-in- charge deposed that he had on severaloccasions reported on the dangerous character of the

building. Colonel Gascoigne, the commanding officer,had, in accordance with the rules of the service, broughtthis to the notice of the War Office authorities, andhad " made the strongest possible report on the subject ofthe building which was the scene of the fire." So late onlyas May last he had reported it as having been "often andoften condemned. It is quite unfit for human habitation.If a fire occurred there at night there must be many deaths,It is perfectly insanitary, a portion of it being over the cook.house. It admits of no improvement, and should be pulleddown." In consequence of this report the Secretary ofState made a personal inspection of the building, and wecannot doubt had the grievous defects brought fully to hisnotice. But with what result? Nothing whatever hadbeen done to remedy the evils or to ensure the safety of the ,

inmates in the event of a fire. We can easily imagine thetorrent of indignation which would have fallen on the medicaloflicer if he had neglected to report the state of the marriedquarters, and on the commanding otficer if he had not

brought it under the notice of the authorities. But the

Secretary of State, having, we presume, made himself

acquainted with this very unsatisfactory condition of affairs,placidly allowed it to go on at the imminent risk of manyof our soldiers, their wives and children. On whoseshoulders will he lay the responsibility ?

MICRO-ORGANISMS IN PLEURITIC EFFUSIONS.

IN the Arclaiv fiir Exp. Path. und Pharmakol. (xxvii.,Hefte 4 und 5) E. Levy publishes the results of bacterio.logical investigations which he has made on fifty-four casesof pleuritic effusion. Plate and tube cultures were madein addition to the ordinary microscopic examinations. Ofthese fifty-four cases, thirty-seven were serous and seven.teen purulent. Six cases occurred in connexion with typhoidfever, of which five were serous and one purulent ; nineteenwith pneumonia and influenza, ten serous and nine puru.lent ; fourteen cases were tubercular, thirteen serous andone purulent ; acute rheumatism and chronic nephritis con.tributed one case each ; three serous effusions occurredwith new growths, and four in cardiac disease; whilst sixothers were from other causes. In three cases of serous

effusion in the typhoid cases cultivations gave no results;whilst in the two others the staphylococcus albus was found.In the last named the effusion did not become purulent,but subsided without surgical interference. In the one

purulent case in connexion with enteric fever the samemicro- organism was found, and the case did well after thepus was withdrawn. Of the serous exudations of the secord

group-pneumonia &c.,-in three no organism couldbe discovered, in one the staphylococcus pyo npa albus

1173

alone was present, and in another this organism togetherwith the pneumococcus. In the remaining six cases and inall the purulent effusions the diplococcus was separated.In cultivation experiments with the exudation from thetubercular cases no micro-organisms could be found, butthis does not agree with the results published by otherauthors, in which tubercle bacilli have been found,although the fluid was serous throughout the whole of

the case. In four cases of cardiac disease in which theeffusion was hsemorrhagic, the staphylococcus pyogenes albuswas found. In all the other cases the results were nega-tive. Levy concludes as follows :-1. The great majorityof serous-fibrinous pleuritic effusions contain no micro-

organisms. 2. The absence of micro-organisms, when theeffusion is purulent, points to the probability of the casebeing a tubercular one. 3. The presence of the staphylo-coccus pyogenes in serous effusions in no way indicates thatit will become purulent. 4. The discovery of Frainkel’s

pneumococcus in serous effusions in cases of pneumonia,after the crisis has passed, does not make the prognosismore grave, as it does not increase the probability of theoccurrence of an empyema. -

THE ROYAL COLLEGE OF PHYSICIANS ANDPROF. KOCH’S REMEDY.

AT the well-attended special Comitia of the RoyaCoIlegeof Physicians, held on the 21st inst., to consider whetherany official steps should be taken with regard to ProfessorKoch’s discovery, the matter was disposed of, after pro-longed debate, by the "previous question," which wasmoved by Dr. Pye-Smith, seconded by Dr. Pollock, beingcarried by a large majority. No doubt this course hasmuch to justify it, especially at this early period, and itmay be, perhaps, admitted that at present it would be inad-visable for the College to send a Commission to Berlin. Wecan hardly agree, however, that it does not come withinthe province of the College to investigate such subjects-a view which can scarcely be sustained on calm reflec-tion. The College is no longer a mere academic body,entrusted solely with granting diplomas and the guardian-ship of medical ethics. In conjunction with the sisterCollege it has founded a pathological institute, whereinit might be supposed every research would be en-

couraged that bears on the healing art. But no hopewas held out that the College would ever take anysteps to follow up Professor Koch’s investigations, at

least in its "omcial" capacity, although we presumethat its inquiries into leprosy and the like are as muchofficial as would be any authorised investigation into thetruth of one of the most remarkable declarations of moderntimes from one who has earned the right to speak withauthority. We yield to none in discountenancing the useof " secret remedies" of whatever kind ; nor can we thinkthat Professor Koch or his advisers desire that this sub-stance should be regarded in this light. The initiation of

competent bacteriologists into his methods (a point onwhich the College might well have expressed an opinion)seems to us the only way out of a difficulty, which becomesmore serious the longer such reserve is maintained. Itmust not, however, be forgotten that so soon as any dis-closure is made there will certainly be a host of inexpe-rienced imitators, with consequent unsatisfactory results.But surely the use of so potent a remedy could never beadopted by any responsible medical man until he hadassured himself of the reliability of the source whence ithad been derived.

CHRIST’S HOSPITAL.

With reference to the reports which have appeared inthe daily press of the prevalence of disease at Christ’s

Hospital; we are informed by Dr. Alder Smith, medical

oflicer to the institution, that there is no serious cause foranxiety, as there has only been a small outbreak of measlesat the hospital-viz., fourteen cases out of 750 boys,-andit would seem that the trouble is now at an end. Withregard to the fatal case of diphtheria, the facts appear tobe as follows :-A boy was admitted into the infirmary ofthe institution on Nov. 13th with ordinary measles, andwent on well until the evening of the 15th, when thetemperature suddenly rose. On the morning of the 16ththe characteristic cough of croup was noticed, and thepatient was immediately isolated in a special ward, twonurses being engaged to attend to him. The consultingphysician, Dr. James Andrew, saw the boy at midday, butno membrane was seen a,t that time. Membrane was firstdiscovered on the morning of the l7th, and after a consulta-tion it was decided that tracheotomy should be performed ifnecessary. The case very rapidly grew worse; and at 3.30 P.M.the symptoms were so alarming that tracheotomy hadto be resorted to. The operation relieved the boy for somehours ; but he rapidly succumbed to the diphtheritic poison,and died on the 18th. One other boy, who went home onthe 22nd inst., developed a patch of membrane on onetonsil, but the case is reported to be progressing very favour-ably. Diphtheria has been a very rare disease in this largeschool, and for the past twenty years only three isolatedcases have occurred amongst the boys (none fatal), andthose at long intervals. During this term there has been amost unusual number of cases of mild follicular sore-throat;but of course this trouble has not been confined to the in-mates of Christ’s Hospital.

DEMONSTRATION OF DR. KOCH’S METHODOF TREATMENT OF TUBERCULOSIS.

As announced in THE LANCET of last week, Dr. Koch’smethod of treating tuberculosis will be demonstrated inLondon by Dr. Heron and Mr. Watson Cheyne. Dr. Heron’sdemonstrations on medical cases will be given at the City ofLondon Hospital for Diseases of the Chest, Victoria Park, E.The first demonstration will take place on Monday, Dec. 1st,at 8.30 r.M. Mr. Watson Cheyne’s demonstrations onsurgical cases will commence at King’s College Hospital onWednesday, Dec. 3rd, at 9.30 A.M. As it is desirable tolimit the number of visitors, admission will be by ticket.Those who desire to be present at the demonstrations arerequested to apply to Mr. Watson Cheyne and to theSecretary of Victoria Park Hospital respectively ; the lattershould be communicated with at the Offices of the Hospital,24, Finsbury-circus, E.C. -

PURE SALICYLIC ACID.

PROFESSOR DuNSTAN’s researches upon the chemistry ofsalicylic acid cannot fail to be of interest to the medicalprofession, even though they do little more than confirmthe ideas which have been previously arrived at from otherconsiderations. The artificial acid has been long sinceassailed chemically and therapeutically by the late Mr.John Williams and by Professor Latham, while morerecently its physiological action has been the subject ofinvestigations by Professor Charteris. Mr. Williams dis-covered two impurities, and suggested that one of themmight be cresyl-salicylic acid. The specimens he obtainedhave been again examined for the purposes of ProfessorDunstan’s paper, and they have been found to be respec-tively ortho- and meta-cresotic acid. The curious factabout the first of these impurities is that its admixturewith salicylic acid lowers the melting point consider-

ably. Pure salicylic acid melts at 156’8° C., and ortho-cresotic acid melts at 163’C., but equal parts of each

acid, crystallised from alcohol, gave crystals melting at126" C. On employing the lime process for the purification ofthe ordinary salicylic acid, crystals were obtained which