Om'rent Literature 781

for whom it is written, but is somewhat too curtailed for the use of Captains R.A.M.C. going in for the Specialist's Examination in Midwifery and Gynrecology. R. H. F.

STRETCHER DRILL AND FLAG SIGNALLING FOR WOMEN. By Henry W.

Spaight, Hon. Surgeon and Supt. S. J. A. Brigade. Lander and Son, Helston. Price 3d., 21 pp.

This little manual gives a simple form of stretcher drill suitable for women's voluntary aid detfLchments. Semaphore and Morse signalling are also briefly explained. It should be most useful for instructors and members of women's voluntary aid detachments. C. E. P .

• (tun-ent 1iteraturc.

Cultiya.tion of Malarial Parasites in Yitro.-Bass and Foster (Journ. Exp. ]}fed., October, 1912, p. 567) have obtained growths of plasmodia obtained from twenty-nine maligna:nt tertian, from six benign tertian cases and from one quartan case of ague. Laveran observed parasites in hanging drops of malarial blood for ten days after its abstraction. Sakharov, Rosenbach, Blumer, Hamburger and Mitchel noted that the plasmodia lived for several days in the blood which leeches had drawn from ague patients. Bass and Foster take blood from a vein at the bend of the elbow, mix it with one hundredth of its volume of a 50 per cent. watery solution of dextrose (Merck), defibri­nate it by gently stirring with a glass rod, and incubate at 40° C. The plasmodia grow on the surface of the precipitated cells in a layer :io to la of an inch thick. Those below die. A rather coarse needle should be used for drawing the blood since. aspiration through a fine capillary tube injures the parasites. It is necessary to avoid the admix­ture of air. For subcultures, the leucocytes must be removed, since the merozoites on leaving the corpuscles are englobed by the white cells. The defibrinated blood is centrifugalized until most of the leucocytes are on the surface of the clot. The supernatant serum is withdrawn, and is distributed in small test tubes (t by 5 in.) to the extent of about a ~ to 1 in. column in each. A tenth of a cubic centimetre of red blood cells and plasmodia is taken up from the middle zone of the centrifugalized blood, and is placed at the bottom of the serum in the culture tubes. It is advantageous to make use of flat· bottomed tubes, or in their absence discs of filter paper supported on rings' of glass tubing may be used to receive the layer of cells. Subcultures should be made every forty-eight hours. The plasmodia grow in the red corpuscles. They are destroyed in a few minutes by human serum from any source. They can exist in red cells immersed in Locke's fluid without the calcium chloride. Locke's fluid is a solution of the salts which occur in blood, in the proportion .in which they are present. The asexual cycles in vivo and in vitro are identical. The sexual forms do not appear to grow in cultures. The Plasmodi~{m vi'wx and

Protected by copyright.

on May 18, 2022 by guest.

http://militaryhealth.bm

j.com/

J R A

rmy M

ed Corps: first published as 10.1136/jram

c-19-06-15 on 1 Decem

ber 1912. Dow

nloaded from

782 o lwren t Literature

P. falciparurn are distinct species. The latter is easier to cultivate. The generation period may vary from thirty hours to four days according to the temperature at which the cultures are incubated. Calcium salts added to cultures of the malignant tertian parasite cause lysis of the infected corpuscles. The authors suggest that hffimoglo­binuria may arise from an excess of lime in the blood. 'They state that hremoglobinuria has .disappeared from certain localities when lime·free water has been substituted for a lime containing supply. C, -B.

Vaccine Treatment of Typhoid Fever.-In an article entitled "The Vaccine Treatment of Typhoid Fever," in the Medical Record of June 24, 1911, Dr. James G. Callison, Instructor in Clinical Microscopy and Vaccine Therapy, New York, Post-Graduate Medical School and Hospital, gives an account of the treatment of a series of twenty­four cases of typhoid fever by means of vaccines derived from three different sources. One was a polyvalent vaccine made from SeVe!l recently isolated strains; one was a commercial product; while the third was the ordinary prophylactic vaccine in use in the U. S. Army.

Thirteen cases were treated with the first, two with the second, and nine with the last. .

Apart from subcutaneous injections of the vaccines the cases were treated by what may be called the usual routine methods. His conclusions are as follows;-

(1) The production of antibodies or protective substances in response to the inoculation of a vaccine follows definite fixed laws, regardless of whether the vaccine is given for prophylactic or curative purposes, and the results in treatment must be interpreted in the light of what is known of those laws.

(2) Inoculations of vaccine in typhoid fever prevent relapses and lessen complications, and in some cases probably shorten the original attack.

(3) Stock vaccines should be given in preference to autogenous vaccines in typhoid fever. The older the culture the better.

(4) When given in therapeutic doses such stock vaccines are without injurious effect, and do not interfere with other treatment.

(5) The routine treatment should be continued until the fever process is controlled by the vaccines.

(6) The dosage used by many of those who have treated typhoid with vaccines in the past has been too small to secure the best possible results.

(7) Every case of typhoid fever should receive vaccine treatment as soon as a diagnosis is made, and this should be continued until the temperature becomes normal or it is demonstrated that the case will not'respond to this form of therapy.

With the'majority of these conclusions, we think, most observers will . be inclined to agree, but there are some of them which merit a little

further consideration. In reference to the first, Callison begins his paper with a discussion on

the blood changes produced in a normal man by the injection of vaccine for prophylactic purposes, largely based on the work of Leishman and others in 1904, and the later work of a similar nature by Russell, of the United States Army, by whom it was shown that the formation of anti­bodies begins as a rule about the eighth or ninth day after injection. Taking

Protected by copyright.

on May 18, 2022 by guest.

http://militaryhealth.bm

j.com/

J R A

rmy M

ed Corps: first published as 10.1136/jram

c-19-06-15 on 1 Decem

ber 1912. Dow

nloaded from

Ourrent Literature 783

this in conjunction with the fact that in an attack of the disease, anti­bodies cannot be 'demonstrated in the blood of the patient until after the lapse of a similar period, he makes an assumption which may be considered as scarcely justified in the present state of knowledge, viz., that when these two actions are proceeding simultaneously in the human organism, as, for instance, when the patient is treated with vaccine, the same interval will elapse between the therapeutic injection of the vaccine and the responOfJ in the blood. It must, we think, be considered as at leaElt a possibilIty that the tissues during the course of an infection are in a

. condition of increased susceptibility to the typhoid poison using this term in its widest sense, and that in such a case the interval between inocula­tion and· response may be either shortened or lengthened, probably depending on a balancing of the size of the dose on the one hand and the severity of the infection on the other.

Some clinical evidence of a shortening of the latent period shown in response to an injection within a few hours or a few days was seen in a series of cases reported from India (JOURNAL OF THE ROYAL ARMY

MEDICAL COHPS, 1909, xii, p. 136). It may be said, however, that such speculations are probably of little value, and that the question can only be settled by careful observations of the blood content in antitropic sub­stances in a case under treatment with the vaccine.

As regards the choice of vaccine, Callison is satisfied that the advantage lies with a stock vaccine for two main reasons, viz.: (a) It is always at hand and so ready for use the moment the case is diagnosed. (The necessity for beginning the treatment early is agreed on by all.) (b) For the making of such a vaccine a strain is usually chosen which is low in toxicity or virulence, while its antibody-forming powers are high.

Though we are in agreement on these points they raise the question, also discussed by Callison, as to the rationale of the use of vaccine in treatment, and here we are not in such complete accord. Callison's view is that the patient is suffering from a localized and a blood infection, and that· by subcutaneous injection of vaccine he, the patient, receives the advantage of both intravenous and subcutaneous inoculation, the former being of admittedly less value experimentally qua the production of anti­bodies than the latter. It appears to us that too much stress is laid on the infection of the blood which may be considered to represent nothing more than an overflow into it of bacilli produced at the local nidus, and so practicably negligible.

The view we should be inclined to advance is that during the course of the infection we have multiplying at the local nidus virulent bacteria with the toxic element well in the ascendant, while the antibody-forming powers are at a low ebb. By the subcutaneous injection of bacterial bodies derived from a strain chosen as above, we produce what may be called a complementary action. We, in fact, establish another manufactory whence issue substances of slight toxic action though powerful in bactericidal, opsonic, and possibly other bodies of an antitropic nature.

The amount to be given as a dose is also dealt with. Callison's dosage has varied from 25 to 1,000 millions, and he now recommends an initial dose of 300 millions. Subsequent doses are given at three or four day intervals, with an increase of 100 millions at each dose. He, however, makes no claim that this dosage or this spacing is the best. It may be noted that these doses and spacing agree closely with those

Protected by copyright.

on May 18, 2022 by guest.

http://militaryhealth.bm

j.com/

J R A

rmy M

ed Corps: first published as 10.1136/jram

c-19-06-15 on 1 Decem

ber 1912. Dow

nloaded from

784 Owrrent Literature

arrived at in the Indian series referred to above, but the point is one that needs much further investigation, and until it has been determined quantitatively by means of repeated blood examinations for each stock vaccine used in the treatment of cases, what is its power of causing the formation of antibodies and of beneficially influencing the clinical course of the disease, the question must remain open.

As to the results obtained by Callison, three cases out of his series of twenty-four are excluded for various reasons, leaving twenty-one, among which there were one relapse and three deaths, giving a case mortality of 12·5 per cent.

In the series of cases treated in India, the case mortality rate was 8·3 per cent., and a criticism made at the time was to the effect that, owing to the well-known variability of the virulence of typhoid epidemics, the results obtained by other workers in this field were necessary to the formation of a sound o-pinion as to the effect of vaccine treatment on the mortality rate. This criticism is to some extent replied to by a table which appears in Callison's communication, and which gives the results of twenty-two observers recording a total of 323 cases from different parts of the world. In these 323 cases there were seventeen deaths, a case mortality rate of 5'2 per cent. By what appears to be a similar method of treatment Chantemesse has obtained a death-rate of 4·6 per cent in 1,303 cases.

Both of these show a very marked diminution of death-rate as com­pared with that obtained by the ordinary routine methods of treatment, i.e., where dependence is placed on the unaided resisting powers of the patient, and may, we think, be taken as evidence that these attempts at a "specific" treatment of the disease do effect some good. They certainly point to the desirability of extended trial of the method and emphasize the need for investigation of the blood changes brought about by the therapeutic inoculations of such vaccines. A. B. S.

Gonococcal Vaccine as a Means of Diagnosis.-Reg. Arzt Dr. Lederer (Wien. med. Wochen., No. 40,1912) has published a short account of some work which he carried out conjointly with Hecht. As antigen he used arthigon purchased commercially, as this has the advantage of being standardized. As complement 0'05 cc. of guinea pig's serum was used for each tube containing 0'2 cc. of inactivated patient's serum. Some preliminary tests had shown. that 0'25 cc. of arthigon alone did not fix the complement. Varying amounts of arthigon from 0·2 cc. to 0'5 cc. were therefore employed. In almost all cases of extensions of the gonorrhceal infection to other parts as also with acute posterior urethritis, a marked positive reaction was obtained; in pure anterior urethritis the reaction was usually negative.

An attempt to obtain a cutaneous reaction by injecting a concentrated gonococcal vaccine was not successful. C. E. P.

Inclusions in the Leucocytes of Scarlet Fever. - Doehle (Berl. klin. Wochen., August 19, 1912, p. 1,636), observed bodies in the leucocytes of the blood of scarlet fever patients, when films were stained with Michaelis, azur blue; .Pappenheim, methyl green; Pyronine, or Manson's borax, methylene blue. They are polymorphores, and some­times appear as dots or dashes, rods, or commas. Kretzschmar confirmed

Protected by copyright.

on May 18, 2022 by guest.

http://militaryhealth.bm

j.com/

J R A

rmy M

ed Corps: first published as 10.1136/jram

c-19-06-15 on 1 Decem

ber 1912. Dow

nloaded from

OU1-rent Literature 785

Doeble's findings. In only four out of seventy control blood films did he discover similar structures.

Harriehausen examined the blood of 86 scarlet fever patients. He found inclusions in 76 to 100 per cent. of leucocytes in 16 cases; in 34 to 66 per cent. of the leucocytes in 7; in 1 to 33 per cent. of the leuco­cytes in 33 ; and no inclusions in 29 patients. They are present in largest numbers during the height of the pyrexia, and disappear with the sub­sidence of the fever; they are absent in abortive cases. Unfortunately they are not specific. Harriehausen detected these bodies in films of blood derived from patients suffering from tubercle, pneumonia, empyema, broncbiectasis, whooping cough, and serum rashes. Hence he thinks that their presence is of small diagnostic significance. C. B.

The Mode of Transmission of Spirillum Fever by the Pediculus. -Nicolle, Blaizot, and Conseil (Oornpt~ rend de l'Acad. des Sci., July 19, 1912, p. 1,636) were unable to induce the spirillum fever ,in men or animals by the bites of lice which had fed on infected patients or animals. One person submitted to the attacks of 4,707 pediculi which had sucked spirochffite-infected blood one to twenty-five days previously_ If the lice be examined immediately after their infecting repast, numerous spirocbffites are seen, but seven or eight hours later they disappear. On the eighth to the twelfth days they reappear, and continue to the nine­teenth ,day. These' spirilla are virulent. A monkey inoculated intra­peritoneally with an emulsion of a crushed pediculus which had been infected a fortnight before, contracted the fever after an incubation period of four days. Though the bite of such pediculi is harmless, yet its dejecta are virulent and the host inoculates himself while he is scratching the irritable spot. Two crushed lice which had fed on an infected monkey nine days previously were rubbed gently into a slightly abraded area of skin of a man. Five days later he developed fever.

Two crushed infected lice were placed on the conjunctiva of another man. He contracted the disease after an incubation period of seven days.

The infection in both these patients was cut short by salvarsan. Ova which had been deposited twelve to twenty days after the infecting meal were placed in a moist chamber at 28° C. They began to batch on the seventh day. Fifty-five larvffi and twenty eggs were emulsified and introduced into the peritoneal cavity of a monkey. This animal became infected and showed signs of the disease ten days after the inoculation.

The Pediculus capitis can always convey the disease. Lice, therefore, are the agents of transmission of spirillum fever. In them the infection is hereditary. C. B.

The Destruction of Bugs in Barracks.-Oberstabsarzt Professor Bischoff (Deut. militcirarzt. Zeit., September 20, 1912), after discussing the unsatisfactory methods at present employed for the destruction of bugs in barrack-rooms, describes a newly invented apparatus which he has tested and found to be most satisfactory.

The insecticide employed is called "Salforkose"; it consists mainly of bisulphide of carbon, with some formaldehyde. The manufacturers state that there are two other secret components, one of which is adden. to increase the destructive properties of the mixture; and the other for

Protected by copyright.

on May 18, 2022 by guest.

http://militaryhealth.bm

j.com/

J R A

rmy M

ed Corps: first published as 10.1136/jram

c-19-06-15 on 1 Decem

ber 1912. Dow

nloaded from

786 OmTent Literature

the purpose of reducing the risk of explosion. The fluid is well shaken and then poured into a specially constructed iron vessel supported on tripod legs, and a light applied to the mixture by means of a long taper. The fluid burns briskly and gives off intense fumes with the characteristic smell of burning sulphur. Before using it all air inlets in the room must be carefully sealed up, wardrobes and chests of drawers should be opened, and all articles so arranged as to permit free access of the gases. One apparatus should be employed for each 3,500 cubic feet of space to be disinfected; the quantity of "Salforkose" required for this space is 2 litres (3'5 pints). The gases should be allowed to act for six hours, when all insect life will have been destroyed; at the end of this time the room should be opened up and ventilated for half an hour before being again occupied. Numbers of dead inaects will be found lying on the floor, but beds, &c., should be taken to pieces and the interstices brushed out to remove any dead insects. The apparatus costs £2, and the fluid" SaI£or­kose," Is. 6d. per kilogramme. The cost for a room accommodating ten to twelve men is therefore, roughly, 6s. Extensive tests were also carried out in the emigrant department of the Hamburg Amerika Shipping Com­pany. These gave full satisfaction in regard to the destruction of insect life, but apparently had little or no influence on bacteria. C. E. P.

Affections of the Nervous System after Salvarsan.-Benario (Munch. med. Wochen., No. 40, p. 2172, 1912) criticizes some reported cases of severe affections of the nerves after inJections of salvarsan. He quoted three cases reported by Vollert, each of which had only had oue injection of salvarsan, the dose of which, moreover, was not stated, and concludes from the published history of the cases that the optic neuritis was due to insufficiently treated syphilis and not to salvarsan. At the Neurologists' Congress in Frankfort, 1911, Ehrlich pointed out that in secondary cases of syphilis unless the patient will consent to a full and energetic course of treatment it is wiser not to give any salvarsan at all. With reference to the occurrence of pure syphilitic affections of the eyes, Fehr reported that in the ophthalmic department of the Virchow hospital, 2,636 persons were examined before receiving injections of salvarsan; in 217 cases (= 8·23 per cent) syphilitic changes in the eyes were found. N one of these cases had applied for treatment for eye trouble. In 41 of the cases early optic neuritis was present, and in 17 others some affection of the optic nerve was noted, i.e., in 2·2 per cent of the persons examined the optic nerve was affected by syphilis.

Of the persons examined prior to receiving an injection of salvarsan, only 451 :subsequently attended the eye department. Of these 340 had normal eyes before the injection, and 111 had shown some syphilitic change. Among the 340 who had normal eyes before receiving an injection of salvarsan, 32 had developed some affection of the eyes sub­sequent to being treated by salvarsan. The percentage of patients who developed optic neuritis after salvarsan treatment was 2'4, or almost exactly the same as that found among' patients examined before treatment.

In the other departments of the hospital, salvarsan treatment of syphilis had not yet been introduced, yet these departments sent four­teen cases of optic neuritis for treatment in the eye department. Ehrlich has repeatedly pointed out that in well-developed secondary

Protected by copyright.

on May 18, 2022 by guest.

http://militaryhealth.bm

j.com/

J R A

rmy M

ed Corps: first published as 10.1136/jram

c-19-06-15 on 1 Decem

ber 1912. Dow

nloaded from

Ou'rrent Literatu1'e 787

syphilis a single injection of salvarsan cannot possibly cure the disease, and is likely to aggravate any syphilitic affection of the nervous system. C. E. P.

T.he Tre~tment of Small-pox by Tincture of Iodine.-Newell (Ind~an Medwal Gazette, September, 1912, p. 352) reported most satis­~actory results from the application of tincture of iodine, especially III early cases of confluent small-pox. The B.P. tincture was painted over exposed surfaces, e.g., chin, neck, forehead, and backs of hands, two or three times daily for a few days and then entirely discontinued. The development of the pox was materially retarded and no pitting ensued; the severity of the illness was also reduced. The most im­portant advantage is that when treating natives who refuse to go to hospital, the exposed surfaces are disinfected, thus lessening the chances of aerial infection. C. E. P.

~he Destruction of Mosquitoes by Spraying.-Giemsa (Arch. f. Sch9Js- 1[, Trop. Hyg., August, 1912, p. 565) atomizes by means of an ordmary garden-syringe spray the following mixture, diluted to twenty times its bulk with water.

Tincture of pyrethrum (prepared by extracting 20 parts of powdered pyrethrum in 100 parts

• of methylated spirit) . . 580 parts by weight Soft soap .. .. .. 180 " Glycerine . . 240

He states that this method is effective for the destruction of mosquitoes and other flies. C. B.

Destruction of Mosquitoes by Pyrethrum. (Extract from the Report of the Department of Sanitation of the Isthmian Canal Com­mission for the month of July, 1912.)

REPORT OF BOARD OF HEALTH LABORATORY.

"During some recent experimental work with pyrethrum as fumigant for mosquitoes, an economical mode of ignition was devised, whereby the pyrethrum was completely incinerated and the full value of its effect obtained. When this fumigant is burned in the usual manner, in iron pots, there is an underlying layer of powder in the bottom of the pot which is out of contact with oxygen, is covered with ash, and fails to be consumed. This layer is 10 to 15 per cent of the total amount of the powder used.

"If, however, a layer of sawdust 2 or 3 in. thick is placed in the bottom of the pot, iu the form of a crater, and the pyrethrum laid on the top of this, the ensuing ignition is most complete, for in this instance air is supplied from below through the interstices of the sawdust, and thus permits complete combustion of the fumigant. When the cost of pyrethrum is considered, the saving of 10 or 15 per cent in this way is well worth accomplishing when fumigation is done on a large scale. Recent tests with this method have shown that mosquitoes may be killed with quantities of pyrethrum less than one-third of that required by the United States Army standards when exposed to its fumes for two hours."

Protected by copyright.

on May 18, 2022 by guest.

http://militaryhealth.bm

j.com/

J R A

rmy M

ed Corps: first published as 10.1136/jram

c-19-06-15 on 1 Decem

ber 1912. Dow

nloaded from

788 07lrl'ent Literatul'e

" SANITATION: CANAL ZONE .

. , Owing to topographical changfls due to new construction work, the area of antimalarial work has been considerably extended over that of July, 1911. This is particularly true of the territory between Balboa and Pedro Miguel, at Culebra, and from Las Cascadas northward to the Cbagres River. Numerous breeding places have also been created in the concrete work at the locks and their approaches at Gatun, Pedro Miguel, and Miraflores. Storage yards for supplies are also breeding areas, the control of which is only partially successful, owing to the difficulty of oiling such places.

" New construction work at Balboa has created many new breeding places, and as a result more adult anopheles have been noted in the barracks than during the previous month, and the malarial cases have increased about threefold.

"At Corozal, Paraiso, Empire, and Las Cascadas, the number of anopheles caught at barracks has decreased considerably as compared with the previous month.

"Additional work has been necessary in the large pond at the west of the Pedro Miguel locks, also on the berms of the canal near Culebra, and in the completed portion of the canal between Bas Obispo and Las Cascadas. The low ground near the Gatun reservoir has been eliminated by filling up as an anopheles breeding area.

" Less vegetation has been removed in some districts than in 1911, due to the fact that anopheles breeding areas are under control. At some stations nearly all the employees are living in non-screened houses, and consequently are more exposed to malarial infection than those living in screened quarters. The malarial rate, however, is the lowest on record for July since antimalarial work was started.

"As a rule the highest monthly sick rate occurs in July. The malarial cases admitted to hospitals is taken as an index of health conditions on the zone. Culex adults have increased throughout the zone. The rainfall was normal for this season of the year.

The following table shows the malarial sick rate for July, 1907, the year in which it was the highest, and for the months of July, 1911, and July, 1912 ::-

:MALARIA SICK RATE, BY WEEKS (JULY, 1907, HIGHEST).

July 6,1907 " 13, " " 20, " " 27, "

July 8,1911 " 15, " ,,22, " " 29, "

July 6, 1912 " 13, " " 20, " " 27, "

1·27 per cent 1·18 1·34 1·52 1·06 0·97 1-11 0·97 0·47 i, 0·58 0·41 0·47

Mastisol.--Stabsarzt Dr. Krebser, attached to Professor Hofmeister's Surgical Division, of the Karl-Olga Hospital, Stuttgart, has published an article (Beitr. Z~lr Klin. Chir., Bd. 79, h. 1., 1912) on the "'D se of Ma.stisol as a Dressing for Wounds." Mastisol is a solution of mastiche in benzol; this does not cause any irritation, as sometimes happened with

Protected by copyright.

on May 18, 2022 by guest.

http://militaryhealth.bm

j.com/

J R A

rmy M

ed Corps: first published as 10.1136/jram

c-19-06-15 on 1 Decem

ber 1912. Dow

nloaded from

Ourrent Literature 789

the earlier solution in chloroform, but takes longer to evaporate. When dressing a wound, the mastisol solution is painted on the surrounding skin, without any previous washing, and allowed to evaporate for twenty to thirty seconds. A sterile dressing is then applied to the wound. v. Oettingen uses a gauze dressing cousisting of four layers of gauze, in the centre of which is a smaller pad of gauze containing absorbent cotton wool. The large piece of gauze is folded over the pad so that the four points meet in the centre, somewhat like the back of an envelope. The whole is sterilized. On applying the dressing only the outer surface need be touched, the flaps are lifted and the sterile pad applied to the wound. v. Oettingen, who used this dressing extensively in his field hospital during the battle of Mukden, claims that mastisol acts by: (1) Fixing the bacteria in the skin. (2) Hindering the growth of organisms, by preveuting the access of moisture. (3) Killing many of the micro-organisms. (4) Not interfering with the exudation from the wounds, as this escapes freely through the dressings without affecting the skin, which is rendered waterproof by the resinous varnish.

In Professor Hofmeister's clinic, mastisol has been in general use since 1911. In no case has it caused any irritation of the skin. The dressings were prepared by the ward sister, and cost on an average about one farthing. Mastisol was also used to retain drainage tubes in position by wrapping some gauze round them and sticking this to the skin. In cases of accidental wounds; visible dirt was removed; when the skin was engrained with dirt it was painted with a solution of iodine in benzine, but no washing or other cleansing was undertaken; hffimorrhage was first stopped by pressure. The mastisol solution was painted on the dirty skin, over dried blood or over a hairy surface, and the dressing applied. The dressing is held firmly in position but can be removed by taking hold of one corner and pulling it parallel to the skin; after removal, when the wound has healed, the skin can be cleansed with benzine.

Hofmeister has used the mastisol dressing in about 4,000 cases, including set operations and accidental wounds. In the out-patient department, 959 accidental wounds were treated with mastisol, all healed aseptically except seventeen, and of 167 wounds admitted to hospital all healed without suppurating except five. When suppuration occurred it was probably due to faulty technique.

Mastisol is also useful when applying extension to a limb, or again in cases of furunculosis its application tends to limit the spread of infection. In the treatment of accidental wounds the great advantages of a mastisol dressing are that no painful cleansing is required; the procedure is simple and rapidly carried out; the dressings cannot shift, it affords protection from septic infection, and the cost is very low.

C. E. P. Iodine Solution for Skin Disinfection.-Marine Stabsarzt Dr.

Scheel has designed a special bottle for holding tincture of iodine so that it may always be ready for use. The bottle is made of thick deeply­tinted glass with a wide mouth. The stopper is prolonged in the fo.rm of a thick glass rod reaching nearly to the bottom of the bottle. At the lower end of the stopper a pad of asbestos is attached. To disinfect the skin the stopper is taken out and the tincture of iodine spread by means of the asbestos pad. He claims that with this bottle the iodine solution is always ready for use and that there is little wastage. C. E. P.

53

Protected by copyright.

on May 18, 2022 by guest.

http://militaryhealth.bm

j.com/

J R A

rmy M

ed Corps: first published as 10.1136/jram

c-19-06-15 on 1 Decem

ber 1912. Dow

nloaded from

790 Ourrent liiterature

A New Form of Foot Protector.-Oberstabsarzt Prof. Dr. Bischoff (Deut. milittirarzt.-Zeit., p. 561, August 5, 1912) has an interesting paper on the results obtained in a battalion of Prussian Guards when using a new pattern of foot protector. The device was designed by Oaptain

A B

C

A. Apparatus in position on boot. B. Apparatus adapted for cavalry. C. Foot sketched from a skiagram.

Hinkel, of the Landwehr, for his own comfort when shooting, and is intended to prevent the foot from chafing against the boot. The protector was tried during a thirty-mile army marching competition carrying the full service load, in the summer of 1911, and gave most satisfactory results. One man especially, who, owing to too large boots, became lame

Protected by copyright.

on May 18, 2022 by guest.

http://militaryhealth.bm

j.com/

J R A

rmy M

ed Corps: first published as 10.1136/jram

c-19-06-15 on 1 Decem

ber 1912. Dow

nloaded from

Ourrent Literature 791

and unable to march at the end of the first six miles, when given one of the foot protectors was able to finish the remaining twenty-four miles.

Owing to the favourable reports received, Bischoff obtained 200 pairs of these protectors, and tried them on selected men during the manamvres. The results were most satisfactory, both in regard to preventing the occurrence of blistered feet, and also in enabling men who had developed blisters to continue marching. The device not only prevents gliding movements of the feet inside boots which are too large, but also supports the arch of the foot, and so delays the onset of foot tiredness.

The apparatus consists of two bands of steel, the longer fits round the top of the heel, and is joined by a movable joint to the shorter one, which passes under the instep. A leather strap across the dorsum of the foot fixes the apparatus in place. This strap must not be pulled too tight. It is made in five sizes. When properly fitted, the two steel bands should make an angle of 90°.

The importance of blistered feet as a cause of inefficiency may be gauged by the experience of the German army at the beginning of the Franco-Prussian war. The number of men who had to leave the ranks for sore feet was excessive. Depots were formed where these men were collected and treated for three days. Those not fit to return to duty at the end of this time were sent to hospital for further treatment. In the month of August the German forces numbered 780,752 men; of these, 3,270 = 4'2 per 1,000 had to be admitted to hospital for blistered feet;

(In the German army the long boot is worn; this boot allows much more play for the foot inside the boot than is the case with our lace boot.) C. E; P.

Instruction in Hygiene in Austrian Cadet Schools.-Dr. v. Hosing, Senior Medical" Officer of the Cadet School at Lemberg (Milittirarzt, No. 18, 1912), has published a paper dealing with the instruction given to the cadets on sexual hygiene. The instruction is given by the medical officer. Cadets in their first year receive a few elementary lectures in sexual functions and reproduction of" species generally; those in their second year receive a more advanced course of instruction on the same subject. Cadets in their third and fourth years are fully instructed as to venereal diseases, the risk of contracting infection from prostitutes and the advantages of continence. The senior cadets who care to apply for it are also instructed in personal prophylaxis after exposure to infection.

Prior to this instruction being given, there were usually about seven cases of venereal disease among the cadets annually, equal to a ratio of 35 per 1,000 of strength. Since these lectures have been instituted, only three cases have occurred in five years. C. E; P .

. Australian Army Medical Corps.-(Extract from the Report of the Director-General for the year ending June 30, 1911.)-The strength of the Australian Army Medical Corps was 806, of whom 737 completed the training, and were reported "efficient." The training at present consists of eight days' continuous training in camp, ten whole day parades, ten half-day parades, and four night parades. The D.G., A.A.M.C., states that this does not afford sufficient time for efficient training in all the duties of the corps, and he has proposed an increase in the number of parades. With the exception of Victoria, schools of instruction have been established in all the States.

Protected by copyright.

on May 18, 2022 by guest.

http://militaryhealth.bm

j.com/

J R A

rmy M

ed Corps: first published as 10.1136/jram

c-19-06-15 on 1 Decem

ber 1912. Dow

nloaded from

792 Ourrent Literature

Combatant officers of the Citizen Forces have to pass an examination in sanitation before promotion to Captain. Out of 154 candidates, only twenty failed to pass.

In accordance with the scheme of Universal Military Training,·. 152,995 names were. registered to the end of June, 1911; of these 101,795 were medically examjned, and 95,465 = 93'7 per cent. were found fit. The tables giving the average measurements of recruits for the militia show good all-round physical development. C. E. P.

Austrian Red Cross Society's Vehicles.-The Austrian Army Order, No. 161, dated August 28, 1912 (V.O.B.H., September 7, 1912), defines the conditions under which vehicles provided by the Austrian Red Cross Society to assist the Army Medical Service in war will be employed. The wagons will be detailed to various medical units and reserve depots, and will be placed under the absolute control of the senior medical officer with the unit. The wagons will be marked with a definite number corresponding to the unit to which they are allotted.

In peace time the vehicles will be stored at the places at which their units are mobilized, either in the Society's or in army buildings. Except in Vienna and Brunn, where the Society has its own depot, the wagons will be under the care of the Army authorities; but the Society's

_ delegates may inspect them at intervals. The Society will pay for the up-keep of the vehicles.

When mobilized, a separate inventory will be kept for wagons belonging to the Red Cross Society, which will also pay for all repairs. On demobilization the wagons will be returned to the places at which they are mobilized. An appendix gives a list ,of the equipment which must he provided with each wagon. C. E. P.

Red Cross Society, Wiirttemberg.-The following notes are taken from the annual report of the Wurttemberg division of the German Red Cross Society for the year 1911 (Der. Deut. Kolonnenfilhrer, September 1, 1912). In the case of mobilization the division has a hospital detach­ment consisting of 62 male nurses and 41 female nurses and cooks, and an equipped ambulance train with 31 wagons, capable of transporting 250 patients from the front to their homes. The division also has 97 trained male nurses and 226 female nurses available for fortress hospitals. The division can also provide 39 auxiliary hospitals with a total of 3,841 beds; in addition, it has arranged for beds in civil and private hospitals in various localities affording accommodation for a total of 7,668 beds. There are now 26 detachments with a total personnel of 1,392 men. The Committee for equipment appointed three sub-com­mittees to undertake the equipment of the ambulance train; the women's sub-committee undertook to provide the necessary linen, &c. The Nursing Committee instituted a number of training classes for nurses. The Organization Committee founded several new branches during the year. The total funds of the division amounted to £24,400.

C. E. P. Voluntary Aid Detachment Headquarters in Germany.-At the

annual meeting of representatives of ihe voluntary aid detachments (Der Deut. Kolonnenfiihrer, No. 17, 1912), Arendt read a paper on the

Protected by copyright.

on May 18, 2022 by guest.

http://militaryhealth.bm

j.com/

J R A

rmy M

ed Corps: first published as 10.1136/jram

c-19-06-15 on 1 Decem

ber 1912. Dow

nloaded from

Oorrespondence 793

"Advantages to a Voluntary Aid Detachment of possessing its own Head­quarter house" ; this facilitates the teaching, promotes social intercourse, and gives a sense of solidity to the organization. He gave a sketch of the existing headquarter buildings in eighteen towns. Most of the buildings have cost from £1,000 to £3,000, and the funds were obtained partly by subscription, but largely from the proceeds of lotteries. In many cases the municipal authorities have given the land for the building without making any charge. In Nuremberg the buildings have cost over £13,000, while those in Munich are valued at £19,000. In designing a V. A. D. headquarter building in a large city, Arendt advised the following arrangement :-

On the ground floor a large hall for drill purposes with a smaller hall for lectures adjoining it; these two should be separated by a removable partition. On the first floor there should be a model room and a library, also store·rooms for uniform and equipment.. The upper floor can be used as quarters for a resident member of the voluntary aid detachment. A large room or shed adjoining the courtyard is also required in which to store equipment for the adaptation of railway trains, stretchers, &c. In the basement a small workshop in which to practice the improvisation of apparatus is very desirable. A useful addition is a small loan store from which articles required for nursing serious cases of illness can be lent gratis to poor people. C. E. P .

•

(torreaponbence.

HEAT STROKE.

TO THE EDITOR OF "THE JOURNAL OF THE ROYAL ARMY MEDICAL CORPS."

SIR,-With reference to the article by Major Ogilvie in the issue of our Journal for October, which, I presume, was written for the purpose of inviting discussion on a most important subject, I venture to make the following remarks with a view to furthering that object, by abler pens than mine.

To begin with: Is there no control exercised by the nerve centres over the heat-producing functions of the lungs and the blood? Has the liver no compensating power in modifying the heat-producing apparatus?

I confess that I am unable to accept the inference that evaporation is the only means by which the heat of the body is controlled. I have seen patients in whom a great disappointment and mental worry, while exposed to heat, by no means extreme, and to average physical exhaustion in a fairly dry atmosphere, was followed by a fatal result ascribed to " heat stroke," and I have regarded these cases as caused by nervous exhaustion. On the other hand, I have seen other cases in which there has been more or less a history of alcohol, or of malaise attributable to disturbance of

Protected by copyright.

on May 18, 2022 by guest.

http://militaryhealth.bm

j.com/

J R A

rmy M

ed Corps: first published as 10.1136/jram

c-19-06-15 on 1 Decem

ber 1912. Dow

nloaded from