1067

ship of the diseases is not indicated, but it is uselessto cavil over details. There are always some personswho like their mental pabulum served up in small

portions, and for these the author has done his best to

provide.A Dream of the North Sea. By JAMES RUNCIMAN. London:A Dream of the North Sea. By JAMES RUNCIMAN. London: James Nisbet and Co., Berners-street, W.-We have here a

graphic description of the isolation and danger connectedwith a fisher’s life on the North Sea during winter, and asketch in story of the process by which help, moral andmedical, has reached him through the Deep Sea Mission.The hero of the tale is an honours graduate in arts andmedicine of Cambridge, Lewis Ferrier, who foregoes theadvantages of a professorship in order to employ his energiesin organising a system of medical aid for the smacksmen.A yachting cruise introduces him to the storm, sickness,and surgery of the "banks." A perilous January spent incompany with a friend on board a mission smack in thesame bleak region adds greatly to his usefulness and hisexperience of hardship. He runs numerous risks, andtwice at least is nearly drowned, but always carrieshimself with admirable patience and resolution, and returnsto dry land more determined than ever to turn to accountthe lesions learned at sea by providing if possible an

efficient ambulance and hospital service for the hardyseamen whose unspoken sufferings he has dared much toalleviate. Meantime an elderly millionaire on shore hasbecome interested in the work. Several of his friendscatch the infection. An influential company meet to talkthe matter over and to hear the doctor’s narrative of thefishermen’s perils and endurance, with the result thatbefore another winter a small steamship is built and sent tosea as a floating hospital, and a sailing vessel is in processof construction for the same service. Notwithstandingthat the " dream is largely one of stormy weather andhard work, it abounds in lively and chatty passages andtouches of human interest. An appendix reminds thereader that it has to some extent come true, since onecruising hospital is now on the fishing station, andanother is being constructed, while the cost of buildinga third, and partly that of a fourth, has been sub-scribed. When we reflect that in 1888 no fewer than7485 sick and injured fishermen were relieved by thesurgeons and skippers attached to the Mission, we canconcur in the author’s fervent hope that before longfurther provision will be made for the maintenance anddue extension of this most useful branch of medicalservice.

Etude Critique du Traitement des Salpingites, et, enpar-ticulier, du Cttrettage de l’ Utérus dans la SalpingiteCatarrhale. Par ALEXANDRE RISKALLAH. Paris: Jouive.1889.-This is a Paris thesis, the contents of which aresufficiently set forth in the title. The author reviews old-fashioned treatments, and pleads for the restriction of

spaying. In our experience the symptoms of tubal diseaseare far too vague for any certain diagnosis. In the vast

majority of cases diagnosis cannot be advanced beyondsuspicion. The object of treatment is to produce a deriva.tive action in the neighbourhood of the tubes rather thanat a distance from them-e.g., by counter-irritation on theskin. The uterus is dilated, curetted, and injected withiodine. Illustrative cases are appended. May we imploreour French medical brethren to pay a little more attentionto the orthography of foreign names and words ? There is,in this treatise, hardly a foreign proper name or referencewhich does not contain misspellings. One cannot helpasking oneself if those who make such terrible havoc of

foreign orthography are really competent to read and under-stand the works which they so misquote. In the case ofa larger work we should give a list.

New Inventions. AN IMPROVED TRACHEOTOMY DILATOR.

Two years ago, when house-surgeon to Mr. Savory atSt. Bartholomew’s Hospital, I got Messrs. Ferguson tomake me a tracheotomy dilator which I think is a distinctimprovement on the ordinary pattern. Just as in Mr.Walsham’s tracheotomy pilot for rubber tubes, there is amovable catch at the ends of the handles. When once thetracheal opening has been dilated and the dilator fixed atthe proper width, the mere touch of a finger keeps it inposition ; this is valuable in such a short-handed operationas tracheotomy often is, allowing the operator to get afeather or tube and to introduce it with his right handwhile the left holds the dilator-a somewhat troublesomebusiness with the ordinary form, which is always trying toclose ; or, while the right hand holds the dilator, the tubemay be introduced with the left hand, and the little fingerwill release the blades of the dilator. I know of noform of dilator much like this, though the principle is

exactly the same as Mr. Walsham’s, which is in Messrs.Arnold’s catalogue.Lincoln. E. MANSEL SYMPSON, M.B., B.C. Cantab.

THE INVALID’S "ODOURLESS" COMMODE.THIS appears to be a valuable hygienic invention for the

prevention of infection from the germs of zymotic diseases,and from the effects of the noxious gases which are so

often unavoidably inhaled in sick-rooms after the use of thecommodes at present in use. To the patients themselves,to nurses, doctors, and others having in any way to attendthe sick, the advantages of the " Odourless will, oninspection, be at once apparent. By simply pulling ahandle, a sliding screen of air-tight material runs alongprepared grooves, and instantaneously and hermeticallyseals the contents of the pan before the user rises from theseat of the commode. All infectious germs and foul fumesare thus confined therein and prevented from escaping intothe sick-room. The inventor and patentee is Mr. Tyerman,119, Algernon-road, Lewisham, S.E., and the manufacturersare Messrs. H. Rolfe and Co., 33, Snow-hill, London, E.C.

TWO FOUNTAIN PENS.MUCH ingenuity has been expended in the attempt to

produce a writing implement which shall minimise thelabour of penmanship as well as economise the time con-sumed in the operation. Amongst the candidates for publicfavour which have been submitted to our approval are theLacon fountain pen, and that introduced by Dr. Hommel.Each of these inventions possesses advantages, thoughneither of them can be said to be absolutely perfect.One distinguishing merit of Hommel’s pen is theease with which, when the ink in the reservoir hasbecome exhausted, the store may be replenished. Thisresult may be effected by simply turning one sectionof the stem upon the other. To maintain the supply of inkto the nib, however, a slight version in the opposite direc-tion is required at repeated intervals. With the Lacon

pen, which is of somewhat simpler construction, after thefirst filling, the supply of ink is maintained uninterruptedly,so that several sheets of note-paper may be covered withoutremoving the arm from the desk. This instrument, indeed,is one of the best of the kind which has come under our

notice, and, when furnished, as it is intended to be by theinventor, with a transparent barrel to make visible the con.dition of the reservoir, will be as satisfactory as can be desired.We have used the pen and can testify to its excellence. Theinventor is the Rev. E. Lacon of Stockbridge, Hants.

1068 MISS COBBE ON NOTIFICATION OF INFECTIOUS DISEASES.

THE LANCET.

LONDON: SATURDAY, NOVEMBER 23, 1889.

Miss FRANCES POWER COBBE’S letter to The Times on

the defects of the Act providing for Notification of Infec-tious Diseases is not altogether unreasonable, and deservesa serious notice from ourselves. Miss COBBE raises no

objection to the principle of the Act. Evidently she thinksit no true breach of personal liberty to forbid persons withinfectious diseases to be at large and to convey them freelyto other people. More than that, she approves heartily ofthe provision in the Poor Law Act that the hospitals of the

Metropolitan Asylums shall be available, under properregulations, for the purposes of medical instruction in infec-tious cases. But here her criticism begins. She arguesthat the said students will become purveyors of infection,and that this will lead to an indefinite extension of the

diseases whose range it is the object of this legislation tocurtail. Her fears do not stop at medical students. She

wants to know whether a medical man ought to practiseindiscriminately in infectious and non-infectious cases, orwhat interval should elapse before he sees fresh cases,

and by what code of rules, drawn up by the Colleges ofPhysicians and Surgeons, medical men are to regulatetheir conduct and their clothes. There is just a touchof the grandmotherly element in such suggestionsfrom so fresh and original a critic; but we take it all

in good part, and as not at all unreasonable from Miss

COBBE’S point of view. We hope the distinguished menwho now preside over the respective Royal Collegesof Medicine in the different divisions of the kingdomwill notice what is expected of them and of their col-

leagues, and we should think it no unreasonable or

unprofitable occupation of the time of a committee

of their bodies to advise and encourage their diplomatsand associates in the use of all conceivable precautionsagainst what we take to be a very rare event-the con-

veyance of infection in medical or surgical practice. Our

own opinion on this question is very strong. We holdit to be binding on medical men not only to take pains, butto go to some excess of trouble, to avoid even the appearanceof transmitting or conveying the germs of disease; andwhen the disease is a grave one, like small-pox or scarletfever, or puerperal fever, we should esteem the practitionervery culpable who neglected any reasonable precaution.Such accidents of conveyance have occurred. Miss COBBE

seems herself to have had an experience which may wellexcuse her for writing earnestly on the subject. Not

very long ago we had to comment on the painful occur-

rence of six puerperal deaths in the practice of one

midwife, though she was warned at almost every stepby medical men to desist attending on parturient women.We do not, then, differ from Miss COBBE in opinion or inprinciple, nor do we yield to her in the conviction that it isthe urgent duty of medical men to be on their guardagainst the evil and the risk she indicates. But we hopeto satisfy all reasonable people that the notification of the

patient is enough, and that that of the doctor would besuperfluous. First, we must be practical in all our

suggestions. There is a quarantine that is a greaterevil than the plague it would prevent, and it would be

very hard upon people with a non-infectious disease to

forbid them the services of an able physician or surgeon,simply because the practitioner may have seen in the

course of the same day other patients with infectious

diseases. But Miss COBBE seems to think that medical men

who attend infectious cases should be restricted to them

alone. She wants to know, as we have said, whethera medical man ought to practise indiscriminately in

infectious and non-infectious cases. If this principle werecarried out, the public would be deprived of its best

advisers; but the results would be still more absurd, for

evidently the restriction would have to be more developed.The practitioner for measles would not have to attend apatient with scarlet fever, and the small-pox physicianwould have to avoid both those diseases. We beg to

assure Miss COBBE that there is practically no need

for such refinements. In the case of the students

who are to be admitted to the infectious hospitals, weapprehend that every precaution will be taken in their

interest and in that of the public to prevent infection,precautions such as are taken, and have been taken foryears, in the case of visitors to the London Fever Hospital.It is not necessary for us to specify these here. Of course

they will not always protect students. Medical students

and medical men worthy of their profession must take itsrisks. But there need be practically no risk to the public.Miss COBBE will admit that it is to the medical professionthat the public owe all the methods for preventing disease-vaccination, disinfection, and even notification. Medical

men have not only their own strong sense of duty to impelthem to the use of all reasonable precautions, including thediligent use of disinfectants, but they have the sense ofinterest. They have to consider themselves and their ownfamilies, and their own reputation, which is based on curing,and not on conveying disease. It is satisfactory to knowthat a most influential committee of the College of Phy-sicians is actually considering this very question, in view ofthe recent legislation, and in conference with the managersof the metropolitan hospitals. Surely a profession so care-ful, so interested, and withal so credited with its work

in preventive and disinfectant medicine deserves to

be trusted by the public as it is trusted.————————————

THE recent publication by the New Sydenham Society ofthe Pathological Lectures of the late Professor COHNHEIMserves to direct attention to the striking and originalviews of that vigorous thinker regarding many of the

vexed questions of pathology. Foremost among these must

be reckoned his theory of inflammation, the cardinal

question around which so many of the problems of diseasenecessarily group themselves. Three theories of the in-

flammatory process have been at various times widelyaccepted: the neuro-humoral theory of CULLEN, HEINE,and BRÜCKE ; the cellular theory of VIRCHOW ; and thevascular theory of COHNHEIM. It may be of interest

to once more glance at these three theories, at the

evidence upon which they depend, and the difficulties