'56 



SCIENCE. 



[Vol. XVII. No. 424 



albuminuria alfcogetlier, or willi only a very transient appearance of 

 it; three who had had no symptoms within twenty-five days con- 

 tracted well marked yellow-fever within tliree years; one patient 

 who had a mild attack in consequence of inoculation contracted 

 a severe attack later on, which proved fatal: that is to say, of 

 those who had been inoculated, only about eight per cent con- 

 tracted the disease in a well-marked form, with a mortality of 

 under two per cent. Iq order to enable one to appreciate the 

 significance of these figures, the authors mention that they ob- 

 served sixty-five monks who from time to time arrived in Havana, 

 where they all lived under similar conditions. Thirty-three of 

 these were inoculated, and thirty-two were not. Only two of the 

 inoculated contracted well-marked attacks, which, however, did 

 not jjrove fatal; whereas eleven of those that had not been inocu- 

 lated were severely attacked, no less than five dying. It is re- 

 marked tliat inoculations performed in the cold weather are not 

 entirely trustworthy, and that they should be followed up by a 

 repetition in the spring. 



A New Bleeding Era. 



The discussion which took place at the last meeting of the 

 Eoyal Medical and Chirurgical Society of London was in many 

 respects interesting and noteworthy, says the British Medical 

 Journal of Jan. 31, 1891, editorially. Dr. Pye-Smith is to be 

 congratulated on having so effectually succeeded in directing at- 

 tention to a subject which must always have a real, if even only 

 ah historical, interest. 



The reflections and conclusions contained in the paper were based 

 upon the record of some fifty cases coming under tlie notice of the 

 writer, in which venesection had been resorted to. The range of 

 diseases in whioli it was employed included such acute affections 

 as bronchitis, acute broncho-pneumonia, lobar pneumonia, miliary 

 tuberculosis of the lungs, wich others of more chronic nature, such 

 as valvular disease of the heart with pericarditis, Bright's disease, 

 aneurism, and ejiilepsy. Its value in other conditions, such as 

 hemoptysis, apoplexy, uremic coma, was also considered. 



The discussion which ensued was remarkable, on account of the 

 almost complete unanimity which the speakers expressed in favor 

 of the adoption of this method of treatment in suitable and urgent 

 cases. All testified to the great and immediate relief which vene- 

 section gave under such circumstances, — a relief unattended by 

 any ill consequences on the subsequent progress of the disease. 



Considerable diiferences of opinion, it is true, existed as to the 

 cases most likely to be benefited by the treatment, or, rather, as 

 to the cases which, in the experience of the various speakers, had 

 imost benefited by the treatment; for it was one of the noteworthy 

 features of the discussion that there was a commendable absence 

 ■of recourse to theoretical considerations as a basis for the prac- 

 tice. 



In this respect the subject of venesection occupies a difl:erent 

 position from that held by it in the former "bleeding era,'' to 

 which reference was made in such humorous and instructive 

 fashion by Sir George Humphry and Mr. George Pollock. The 

 practice was then based on the humoral pathology which so long 

 dominated the practice of medicine, — that pathology which 

 ascribes disease to the presence of deleterious agents in the blood, 

 and which seemed, therefore, to justify the withdrawal of a cer- 

 tain quantity of the noxious blood as one of the best ways of curing 

 it. As Dr. Broadbent pointed out, it was because the practice had 

 been based so entirely on theory that it was carried to excess, and 

 fell into such disrepute. 



One of the chief merits of Dr. Pye-Smith's paper and of his sub- 

 sequent remarks was to lay stress on the importance of resorting 

 to venesection; not for the cure of pathological conditions as such, 

 but for the relief of distressing symptoms depending on temporary 

 alterations in the physiological balance of the circulation. As to 

 the first indication laid down for the performance of the opera- 

 tion, — cyanosis with distention of the right side of the heart de- 

 pending on pulmonary or other obstruction to the circulation,— 

 there was a consensus of opinion favorable to the operation ; but 

 Dr. Broadbent did well to point out, that, before resorting to vene- 

 ■ section under such circumstances, there should be evidence, as 

 shown by the disparity betiiveen the strength of the heart's beat 



and the weakness of the pulse, that the right ventricle was still 

 acting powerfully, and able to take advantage of the relief afforded 

 it by the withdrawal of blood. 



As to the second indication, — the pain of aortic aneurism, — the 

 cases mentioned by Dr. Pye-Smith and Mr. Hulke, in which in- 

 stantaneous relief was thus given, were very striking ; and evidence 

 of its curative effect on the aneurism was also incidentally adduced 

 by Mr. Jonathan Hutchinson. Nevertheless, as Dr. Stephen 

 Mackenzie pointed out, it may be doubted whether, in iodide of 

 potassium, nitrite of amyl, and nitro-glycerine, we do not possess 

 remedial agents equally powerful and equally efficacious in reliev- 

 ing the high arterial tension on which such attacks of pain depend. 

 The discussion, indeed, brought out the fact that it is in relieving 

 pain that venesection finds one of its best applications, and more 

 especially in relieving the intense inflammatory pain of pleurisy, 

 pleuro-pneumonia, or the severe pain, with threatening onset of 

 cerebral symptoms, following injury to the skull. 



To those accustomed, as most now are, to regard loss of blood, 

 from whatever source, as an unmitigated evil, the suggestion to 

 follow up an extensive bleeding from the lungs by a further bleed- 

 ing from the arm is starthng. Nevertheless, something can be 

 said, and was adduced by one of the speakers, in favor of its adop- 

 tion in cases in which the patient is in urgent danger of suffoca- 

 tion from the reflux of blood into the bronchi. It is, however, 

 peculiarly open to the objection brought against the operation of 

 venesection generally, — that, in the present state of public opinion 

 as to blood-lettmg, the discredit of a fatal result is too likely to be 

 hastily assigned to the venesection. Apart from such considera- 

 tions, however, the general result of an unusually animated dis- 

 cussion will be to direct attention once more to the possible ad- 

 vantages attending the judicious employment of a mode of treat- 

 ment long condemned as not only useless but dangerous. ' 



NOTES AND NEWS. 



An instrument called the " hsematokrit " has been invented 

 by Herr von Hedin. It is for determining the volume of corpuscles 

 present in blood, and is based on centrifugal action. As described 

 in Nature, a volume of blood and one of MoUer's liquid (which 

 prevents coagulation) are mixed together, and the mixture is 

 poured into small, thick walled glass tubes, graduated in fifty 

 parts. The tubts rest on a brass holder which is fixed on the axis 

 of a rotation-apparatus. After some eight thousand rotations, in 

 five to seven minutes, the process is complete. The separation 

 between the corpuscles and tlie salt-plasma is more distinct, in 

 that a narrow band of leucocytes appears between them. The 

 instrument is useful in comparing the blood of different individu-: 

 als. With a little practice, theT;otal error is not more than one 

 volume ptr cent. 



— ArchsEologists have, of com-se, been profoundly interested by 

 the recent discovery of a vault filled with mummies and funereal 

 coffers at Deb- Elbahiri, near the plam of Thebes. The Cairo cor- 

 respondent of the London Times, telegraphing on Feb. 24, gives 

 the following as the latest details, according to Nature of Feb. 26 : 

 '•The site of the discovery is east of the Temple of Queen Fatasou, 

 in a small spot previoui-ly undisturbed, amidst the excavations 

 made by the late Mariette Bey and Brugsch Pacha. A well-shaft 

 of 15 metres leads to a doorway blocked with large stones, open- 

 ing on a gallery 73 metres long, whence a staircase descending SJ 

 metres conducts one to a lower gallery 13 metres in length, both 

 lying nortli and south. The lower gallery gives access to two 

 mortuary chambers 4 and 3 metres square respectively. At the 

 top of the staircase is a transverse gallery 54 metres long, lying 

 east and west, the object of which is unknown. The total under- 

 ground area is about 153 metres, excavated in the limestone rock 

 to over 65 feet below the surface. The same disorder reigned 

 amongst the contents of the tombs as vvas found when the famous 

 royal mummies were discovered nine years ago. Sarcophagi 

 were piled upon sarcophagi, and alongside were boxes, baskets of 

 flowers, statuettes, funereal offerings, and boxes crammed with 

 papyri. There is every indication that the place, though origi- 

 nally constructed as a vast tomb, was chosen for hurried conceal- 



