August 6, 190X] 



NA TURE 



THE BRITISH MEDICAL A.SSOCIATIOX AT 

 SHEFFIELD. 

 A \"ERV successful general meeting' of ihe British 

 •^ .Medical Association was held at Sliellield last week, 

 when, under the most agreeable conditions, a considerable 

 amount of valuable work was accomplished by the associa- 

 tion. 



While there was no dramatic announcement of any 

 epoch-making discovery, or the, often premature, pro- 

 pounding of a theory — such as that relating to the non- 

 transmisjibility of bovine tuberculosis to man — which time 

 would fail to substantiate, yet many subjects were dis- 

 cussed of both theoretical and practical interest to the 

 general public. 



.Among others may be mentioned the problem of infection 

 by typhoid carriers, which was considered in two able and 

 interesting papers by Dr. Ledingham and by Drs. Davies 

 and Walker Hall. 



It has been recognised for some time past that the 

 Bacillus typhosus — latent yet virulent — may exist in the 

 human organism for years after the acute attack has 

 subsided. Still earlier was the bacillus of diphtheria, in 

 like case, tried and found guilty. Mysterious epidemics, 

 which could not be traced either to direct contact or to 

 infected clothing or towels, or to the millc supply, broke 

 out from time to time in various places. Famous among 

 such epidemics was that which occurred at the Charite 

 Hospital in Berlin, when, by a process of elimination, the 

 responsibility was at last found to rest with a nursing 

 sister, who, without exhibiting any of the signs of diph- 

 theria, was found to harbour the virulent germs in her 

 throat. A small dose of antitoxin was administered, the 

 ordinary precautionary measures were taken, and the 

 epidemic ceased. 



Unfortunately, in the case of typhoid, the matter is nol 

 so simple. In the fir.st place, the isolation of the 

 B. typhosus from the stools — when the systematic examina- 

 tion of many suspects is in question — is a far more 

 arduous undertaking than the technique involved in the 

 search for the B. diphthcriae in the fauces. Further, as 

 pointed out by Dr. Walker Hall — and by others before 

 him — the excretion of the bacillus by the carrier is inter- 

 mittent, and it may therefore be missed unless numerous 

 and systematic examinations be made extending over a 

 period of many months. Even when found, the danger to 

 be feared from the carrier as a focus of infection is not 

 entirely averted, as, up to the present, we have no really 

 trustworthy method of destroying the organism in situ. 



Dr. Ledingham rightly laid great stress upon the 

 incidence of gall-stone disease in a carrier. The propor- 

 tion of female to male carriers is three to one — figures 

 which exactly coincide with those appertaining to gall- 

 stone disease ; again, only lo per cent, of the subjects of 

 gall-stone disease show any symptoms, while, curiously 

 enough, lo per cent, of chronic carriers show symptoms 

 of gall-stone disease. 



In view of the above, and of the fact that the 

 B. typhosus has been Isolated from the gall bladder and 

 stones of such cases, any symptom of hepatic trouble in 

 a typhoid convalescent — or even in a person known to have 

 had typhoid previously — should be viewed with the gravest 

 suspicion. This applies all the more strongly to those 

 whose duties bring them into contact with the food supply 

 of their eutouraf^e, as, for example, dairymaids, milk 

 vendors, cooks, &c. In any attempt at prophylaxis, the 

 difficulty lies in enforcing, over a sufhciently lengthy 

 period, the necessary regulations. It Is not yet known 

 how long the infection of typhoid may remain latent, 

 although the dogma has been enunciated, " once a carrier, 

 always a carrier." 



With regard to the periodicity. Dr. Walker Hall showed 

 that a carrier, after remaining Innocuous for many months, 

 might suddenlv again become infectious and spread the 

 disease far and wide. This always occurred after an ill- 

 ness in which the patient showed diarrhoea and a rise In 

 temoerature and pulse rate. An examination of the blood 

 at tiiese times showed a pronounced increase In the number 

 of tnononuclear leucocvtes, and this Dr. Walker Hall con- 

 sidered a most important diagnostic point, as a differential 

 Mood-count can be readilv imdertaken bv the phvsiclan 



NO. 2023. VOL. 7S] 



in attendance. The greatest number of cases resulting 

 from this form of infection occurred in the warm weather, 

 I.e. during the months of July, .'Xugust, and September. 

 It was suggested, in explanation, that it is during the 

 warm weather that the typhoid organism develops most 

 rapidly in milk ; on the other hand, it was pointed out 

 that the lactic acid bacilli are also more active then, and 

 would thus tend to render the milk less suitable a pabulum 

 for the bacillus of typhoid. In conclusion. Dr. Walker 

 Hall presented the meeting with a copy of suggested in- 

 structions to typhoid convalescents, which were admirable 

 In their lucidity and simplicity ; the only Vriticism which 

 suggests itself is that he should specify the disinfectant 

 solutions to be used. 



In the section of pathology, the mornings of Wednesday 

 and Thursday were occupied with a discussion on cerebro- 

 spinal meningitis. From a practical point of view, the 

 most interesting communications were those relative to the 

 brilliant results obtained by serum treatment ; from being 

 almost a hopelessly incurable disease, " spotted fever " may 

 now be regarded as giving a most hopeful prognosis, in 

 view of the reduction in the mortality rate from more 

 than 80 per cent, to between 30 per cent, and 40 per 

 cent. 



In the section of dermatology, an Intensely interesting 

 discourse was given by Prof. Neisser, of Berlin, in which 

 he communicated the results of his work on the experi- 

 mental inoculation and treatment of syphilis. The experi- 

 ments, which were carried out on anthropoid apes in Java, 

 extended over a period of more than three years ; the 

 magnitude of the work may be imagined from die fact 

 that from 600 to 8no animals were always under observa- 

 tion. Prof. Nelsser's results go far to confirm the dicta 

 already promulgated by Metchnlkoff and others, namely, 

 the importance of the prophylactic inunction of a 335 per 

 cent, calomel ointment at the site of Inoculation. Wash- 

 ing with sublimate solution 2 : 1000 and 3 : 1000 also 

 gave good results. The necessity of energetic and pro- 

 longed mercurial treatment was insisted upon, or, better 

 still, the chronic, intermittent treatment by the combined 

 application of atoxyl — or Ehrllch's arsacetin — and iodine, 

 as well as mercury. The minimum period over which the 

 treatment should be continued was given as four years. 

 In this connection we may notice also the excellent collec- 

 tion of microscopical and lantern slides, demonstrating the 

 presence of the Spirochacta pallida In syphilitic lesions, 

 which were exhibited by Dr. Mackenzie in the section 

 of pathology. 



.An important discussion took place on Thursday morn- 

 ing In the industrial diseases section, with regard to the 

 relation of pneumoconiosis to phthisis. -Although Sheffield, 

 as the great centre In England of the " dusty trades," 

 furnished the greatest number of examples, -the questions 

 raised apply equally to all towns where a large number 

 of workmen are subject to the deleterious effects of inhaled 

 dust. Statistics show that in Sheffield the mortality rate 

 from phthisis of adult males engaged in " dusty trades " 

 Is five times greater than the average for the rest of 

 England. .As pointed out by Mr. Edmund Owen in his 

 popular lecture, the process known as " dry grinding " is 

 responsible In gre.-it part for this excessive mortality. In 

 the old days, grinding sheds were placed along the banks 

 of the Don for the sake of the wheel power ; plenty of 

 water was at hand, and it was made to drip unon the 

 wheels. With the advent of steatn power the old river- 

 side sheds were abandoned, ovr'r-crowded, dusty, and ill- 

 ventilated factories took the place of the breezy sheds, and 

 the men became too busy to water their wheels. It is, 

 moreover, asserted that " dry grinding " Is more efficient 

 than "wet grinding." However this may be, the intro- 

 duction of the new process resulted In a startling increase 

 in the mortality rate from phthisis. 



It was pointed out that the qu.alitv of the dust inhaled 

 is a determining factor of no small Imoortance in the 

 causation of tuberculosis : the more irritating the particles 

 the more dangerous the dust. Colliers, for instance, are 

 mrticularlv subject to nnthracosis, and yet the death-rate 

 from phthisis amonar them is not abnormally high. The 

 first effect of Inhnling " Urinder's dust " is to produce 

 rhinitis, followed bv erosions of the mucous membrane 

 and septal ulcers. This, again, is followed by atrophy of 



