1600 INTERMITTENT HYDRARTHROSIS.—THE METROPOLITAN WATER-SUPPLY.

here, the foreign diplomas upon which the foreign prac-titioner claims registration may not, and in many instancesdo not, represent the same degree of professional trainingand tested skill that is implied by the diplomas granted by- examining bodies in Great Britain. The proposed regulationis apparently intended to be supplementary to the rules

:already existing in Cape Colony as to the admission of

foreigners to practise there. Its immediate aim is to exclude

’foreigners qualified under these rules from medical practicein Cape Colony as long as British practitioners are excluded- from practice in colonies of the country to which the

foreigners belong, or, let us say, in foreign coloniessituate in South Africa. We gather that the exclusion

desired in Cape Colony already exists in Natal, but that theprecise attitude of the profession in Rhodesia was not knownat the meeting at Cape Town, while Orange River Colonyand the Transvaal have yet to be reckoned with. In these

- circumstances it seems to us that the regulation proposed inCape Colony may have important local effects in the exclu-sion of foreign practitioners, but that the establishment ofthe reciprocity suggested, even locally, between British

’colonies in South Africa and foreign colonies that impingeupon them, must of necessity be for some time delayed,while it is not likely to take place without the diplomaticintervention suggested in the lost amendment to which wehave referred. That such reciprocity should soon becomegeneral between all British colonies and those of

any other nation or nations seems to us highly un-

likely, while we are not sure that it would be desirable.British practitioners would have more to lose than

- to gain, and the standard of medical practice in those

colonies which now exclude foreigners would not be raised.There is. however, obvious justice in the protest of the

British practitioners in Cape Colony against the admission offoreigners to compete with them without any correspondingprivilege being granted in return, and we shall look withinterest to see the way in which the Governor deals with the’matter. There is no doubt a large foreign element to beconsidered in Cape Colony, but on the other hand, in foreigncolonies there are usually large numbers of British residentswho would be glad to be attended by their compatriots, butwho have to submit to seeing them excluded.

INTERMITTENT HYDRARTHROSIS.

’THE Bostan Medical an(7 Surgical Journal of Oct. 31st’contains a report of two cases of this curious and little-understood condition by Dr. E. G. Brackett and Dr. F. J.

Cotton. In one case a man, aged 30 years, gave a historyof good health until four years previously, when he began- to suffer from occasional pains in the hips, thighs, and knees.Then swelling of the knees occurred periodically for a fewdays. The trouble gradually increased with greater disabilitynot only at the time of the swelling but in the intervals.Change of residence to various parts of the United Statesproved useless. When he was seen his general condition’wa.-- below normal. The knees became swollen alternately’with perfect regularity. There were first feelings of heatund pain and tenderness of the joint with malaise. In two

or three days the joint became filled with fluid. The

swelling gradually disappeared in about four days. One

knee was fixed and quinine was given in daily doses of20 grains. The intervals between the attacks were

lengthened by one or two days, then an attack was

omitted, then the attacks became slighter and less fre- i

quent, and finally they disappeared. In the intervals the

only symptoms were weakncss of the knees ancl some limita-tion of flexion and extension. In the second case the

patient was a woman, aged 35 years, in good generalcondition. The nrst attack followed slight injury of theknee. The joint became swollen every 10 clays for a period

of four days. In the intervals there was no disability. The

treatment followed in the first case was unavailing, but thecondition gradually yielded in the manner of the first caseto persistent treatment by arsenic, strychnia, and creasote.Fixation and local treatment were useless. In nearlyall of the recorded cases, which amount to 68, a calendar-like regularity of the attacks is described. The joint mostfrequently affected is the knee. In 41 out of 55 cases one orboth knees were involved without affection of other joints.The hip, shoulder, elbow, wrist, ankle, jaw, and spine havebeen affected. One joint alone may be affected for manyyears, or after a time others may be affected simultaneouslyor alternately. As a rule local heat and redness are absentand tenderness is often absent. In many cases there was no

pain, only discomfort ; in others pain was marked. In a

case recently described by -lienda there were for yearsperiodic pains in various joints at monthly intervals beforeeffusion appeared. Much pain may occur in the earlier attacksand less in the later. Languor during and after the attacks iscommon. Ileadache, chilliness, or slight pyrexia is describedin a few cases. The duration of the attacks varies greatly.The extremes are a case of daily attacks lasting an hour anda case of attacks lasting from 19 to 21 days with intervalsof eight days. The duration most often recorded was threeor four days. The time of recurrence was singularly constant.From beginning to beginning of attack the most usual periodwas 14 days, the minimum was 24 hours, and the maximumwas three months. A change of interal is described in somecases-e.g., from 30 days to eight days, from three months to11 days. from seven days to three days, and from 14 days to21 days. In some cases this change followed temporaryimmunity. In a few cases there was progressive shorten-ing or lengthening of the interval. In some cases the

periods corresponded to those of menstruation. The average

age at the onset was 26 years; the extremes were

12 years and 54 years. As to sex there was a slight pre-ponderance of females. The weak and the robust were appa-

rently equally affected. Intermissions sometimes occurredand lasted for several years. In five cases the attacks stoppedduring pregnancy, but such intermission was not con-

stant, even in the same patient. In the majoritv of casesthere were no articular signs in the intervals except some-times a little thickening or laxity of the capsule, or crepita-tion. Of the pathology nothing is known and therefore a

number of theories exist. The one most accepted is that

the disease is a vaso-motor neurosis. In favour of this are

the concurrence of angio-neurotic œdema in some cases andof functional nervous disorders in others, and the influenceof mental conditions on the attacks. The remedies recom-

mended, as might be expected, are numerous. Arsenic and

quinine seem to be the best remedies, but the prognosis isnot good.

-

THE METROPOLITAN WATER-SUPPLY.

IT is announced that during the next session two Billswill be promoted in Parliament, each of which containsclauses having reference to the purchase of the metropolitanwater companies. Of these Bills one is apparently to beadopted as a Government measure, the other is promoted bythe London County Council. We do not propose on the

present occasion to consider in detail the provisions of theGovernment Bill, but it may be of interest to mention someof the points with which it deals. The great central featureof the Bill is the formation of a new public authority-aWater Board-which is to be invested with power to purchasethe existing metropolitan water companies and the propertynow vested in the Staines Reservoirs Joint Committee andafter a certain date to undertake the responsibilities andduties of supplying the water within a certain defined area.It may be remarked that the drafting of the Bill in regard to

1601. OBJECTIONABLE ADVERTISEIIIENTS.

this last matter shows that care has been bestowed on matters

of detail. The area which it is proposed should he under thecontrol of the Water BoarD includes Sunbury, Chcssington,and Cuddington, places which arc at present suppliedwithout parliamentary authorisation. The suggested methodof appointment of the members of the Water Board will

naturally excite interest. They are to represent the councilsof certain counties, boroughs, and urban districts, the Cor-poration of the City of London, the Thames and the Lee

Conservators, "and any other bodies or persons that may benamed in the intended Act." Full provision is made as to themethod of purchase of the present water undertakings, andthe Board are to be enabled to inspect the lands and to examinethe accounts of the companies. A "water stock" is to becreated to enable the Board to acquire the property of thewater companies, and it seems likely that some advice givento the Llandaff Commission by Mr. Banbury on this pointhas not been entirely disregarded. A brief study of the

chief provisions of the Bill shows that a considerable amountof thought and trouble has been bestowed on it and thatit is at least worth ery careful consideration. The London

County Council Bill provides for the purchase of the Metro-politan Water Companies and the Staines Reservoirs JointCommittee’s undertakings by that body. It contains pro-visions as to the manner in which the purchase is to be madeand how the money required is to be raised. Provision is,moreover, made as to the re-sale of part of the undertakingsto county or local authorities whose districts are outside the

county of London. -

OBJECTIONABLE ADVERTISEMENTS.

ADVERTISE III E--N’I’S of the class with which we dealt in our

articles entitled Quacks and Abortion" are beginning tore-appear, after having been for a time less conspicuous thanformerly. It was hardly likely that the prosecution of theChrimes brothers and of I Madame Frain" would cause others

permanently to ahanclon a profitable trade, and it is a tradewhich lives by advertisement and can afford to pay for it.We have before us the November number of Leach’s FamilyDressmaker, and the December. or Christmas, number of

Leraclt’s children’sand Young Ladies’ Dressmaker, two

papers emanating from the same office, which appear,as their names imply, to afford hints and instructions on

needlework and the making of clothes to the female

members of middle-class or lower middle-class households.In both of these we find advertisements of Allen (theIrristum Company) and of Martin’s apiol and steel pillsfor ladies, whose wares and literature we have dealt with

fully in THE LANCET.2 2 In the Family Dressmaker we findthe advertisement of "’Dr.’ Davis’s Famous Pills, a Boonto Womankind," of which also we have written. 3 In

both papers are several other advertisements either

promising cures for obstructions" or otherwise invitingwomen to try quack medicines the object of which is thinlydisgnised or left to the intelligence of the reader to supply.The chief difference between the two papers is that the

Family] Dressmaker appears to group all its advertisements ofthis class on one page, the inner page of its cover, while theother paper scatters them. We cannot say that eithermethod of making such trades known is worse than the

other, but we call attention to the fact that Allen’s adver-tisement and that of I I M. D., to which we shall refer below,appear facing an article in the Children’s and Young Ladies’Dressmaker entitled, "How to Make your own ChristmasCards," which begins : ’’I fancy every girl at some epochin her career cherishes a secret ambition to design her ownChristmas cards "-an article clearly addressed to young girls

1 THE LANCET, Dec. 24th, 1898, p. 1723.2 THE LANCET, Dec. 31st, 1898, p. 1808.3 THE LANCET, Dec. 31st, 1898, p. 1808.

and not to their mothers. Facing this article there also

appears this advertisement :-

To THE MARRIED.-EVERY Married CoupleJL should write at once for mv INVALUABLE BOOK of ADVICE.which contains everything that a wife ought to know. It is sentGRATIS on receipt, of ad.1ress.--Apply, Du MAUR!EB, 110, ClarenceHoad, Clapton, London.

The advertisement of "M.D.,’’ referred to above, is as.

follows :--

To. MARRIED LADIES.—MY Remedy is notJL (langerous drug. hut a wonderful Secret Invention, Neverfails. Yo quackery. Particulars Free to all Applicants on receipt ot dstamped addressed envelope.—Apply to M.D., 217, Graham Road,London, N.E. Caution.—0nly addressAs it was one that we did not remember to have observed

before we caused a letter to be written as from all unmarriedwoman asking for the particulars promised, and received inreply the price-list of "Malthusia.n appliances which so

frequently and so clearly inclicates the object of the

"remedy" offered, together with a leaflet describing the"remedy" itself, which in this case is entitled "Paris

Pills." " ’these are stated to contain secret "power--ful ingredients protected by Government stamp," with

regard to which untrue statement we may point out how nn-desiraltle it is that the taxing of nostrums should so be done

as to enable Government " protection " to be falsely claimedfor them. On the same leaflet appears conspicuously thesentence, ’’Not to be taken in cases of pregnancy or for anunlawful purpose," which is the warning so often found inthe literature connected with these "remedies," a warningwhich in this case again draws attention to the powersclaimed for the "Paris Pills" by the advertiser. From Allen

we have received in reply to a similar application full par-ticulars of the merits of ,. Irristum," Bvith testimonials, which,as far as we see, are the same as, or similar to, those-

which we have had before from the same address.With regard to all these advertisements and to manyothers like them, which, no doubt, the proprietor ofLeach’s journals may from time to time be offered if he

shows himself willing to admit them to his columns, we have-nothing to add to what we have already written on this

subject. They offer drugs in terms which are calculated toinduce pregnant women to buy them in the hopes that theymay be able to produce abortion upon themselves. They areeither incentives to actual crime or, if mere swindles. theycause ignorant persons to attempt crimes which the

drugs themselves are, perhaps, not calculated to enablethem to commit. In any case their nature cannot be-

. said to be concealed by the terms employed, and it

is only surprising that respectable firms should allow

their own advertisements of the goods in which they lawfullytrade to appear in the same paper and on the same page.with such notices as those which we have quoted and com--’ mented upon. AVe note, for example, the advertisement ofMessrs. Alien and Hanbury on the page of the C’hilddren’s and

Dressmaker to which we have drawn special.attention.

____

THE OPEN-AIR TREATMENT OF PHTHISIS AND

THE CONDITION OF THE TEETH.

Ix a recent address to the Odonto-Chirurgical Society Mr..H. B. Ezard drew attention to the very unsatisfactory con--dition of the teeth of many of the patients undergoing the-open-air treatment for pulmonary tuberculosis. In this treat--

ment, as is well known, the feeding of the patient is mostimportant, and to obtain the greatest amount of value-

from the food it is necessary that the act of masticationshould be efficiently carried out. Professional curiosityseems to have led Mr. Ezard to examine the teeth of the

patients in a sanatorium in which he himself was under-

going treatment. The result of his investigation was asfollows : Out of 192 possible molars 12. were in action,