1029

freehold, and its rates are now .E870 as against Z50 al Moorfields. The sale of the old site will pay for the erectior THE FERRUGINOUS BATHS OF and equipment of the new building, but the committee SHANKLIN . earnestly appeal for new subscriptions to meet the increased cost of maintenance under the present improved conditions. SHANKLIN in the has long possessed a ferruginous spring of some merit, but like so many other OR SKIN-SHEDDING. KERATOLYSIS meritorious natural mineral waters in this country its value IN the Journal of the American Medical Association off has not been widely recognised. In spite of representations Sept. 1st Dr. R. M. Stone has recorded a case of this curioussto the contrary English people still visit the various affection which is analogous to the moulting of birds. The of the continent, whatever may be the advantages which subject was a strong, healthy man, aged 50 years, who shedI may be had at similar places in this country. Fashion his skin every year. lie was born in May, 1849, andl is doubtless the chief factor which has hitherto been un- shed his skin in the following July, and since thenl favourable to enterprise in regard to the development of every summer. In 1893, 1899, and 1900 he shed his skinI English spas. Yet if a list of the natural springs of Great twice at intervals of a month. The period of shed- Britain be consulted it will be found that almost all kinds ding is ushered in by a feeling of malaise and chilli- of mineral waters occur in this country. We have thermal ness and is followed by fever with a temperature as waters at Bath, sulphur waters at Harrogate and Llanwrtyd high as 103Q F. The skin of the body desquamates, but that in , and saline springs and barium springs in Wales, of the palms, elbows, buttocks, penis and scrotum, knee- not to speak of the chalybeate springs at Tunbridge caps, and feet comes off in a mass. The hair of the head, I Wells, Brighton, and elsewhere. In some instances, of eyebrows, and moustache falls. The patient does not course, great effort has been made to equip these places on a become bald, but the hair falls little by little, as after scale similar to Homburg, Wiesbaden, and Schwalbach on typhoid fever. The nails also participate in the shedding. the continent, but our home resorts do not possess the Daring the period of shedding the patient is able to work. renown of the foreign spas. Individual enterprise has done what it could but patronage has failed. In particular, When the skin begins to be shed ceases and the perspiration however, it would appear that attention has never been epidermis becomes raised and hard so that when struck it seriously directed in this country towards utilising gives off a sound like that of celluloid. The patient’s family ferruginous water for bathing purposes ; at least we history is good and no relative has been similarly affected. know of no installation of this sort, although, as is well known, there are several celebrated chaly- beate waters abroad, as at Schwalbach and Homburg in Up to the time of going to press the following medical Germany and Spa in Belgium, where natural ferruginous candidates have been re-elected Members of Parliament :- water is heated in a specially constructed bath for immersion These waters are for cases of John L.R.C.S. Irel. Sir M. purposes. chiefly employed Dillon, (Mayo East) ; ]1’oster, anaemia and general debility. K.C.B. C. K. D. M.D. Lond., (London University); Tanner, Although in England chalybeate waters are fairly M.D., M.Ch. R.U.I. (Mid Cork) ; and Sir J. Batty Tuke, abundant no attempts have been made to utilise them on M.D. Edin. (Edinburgh and St..Andrews Universities). any scale for bathing purposes, or it may be that the yield of ferruginous water is not consistent with the erection of baths on any important scale. At Shanklin, however, there THE opening address at the London School of Tropical is an abundant supply of pure ferruginous water which Medicine was delivered on the evening of Oct. 3rd, by Sir if circumstances needed could be further developed. William McGregor, K.C.M.G., M.D., the subject being Hitherto the ferruginous waters at Shanklin have been prac- allowed to run to but have Some Problems in Medicine. The address will tically waste, arrangements Tropical been made for the of this water in view of in full in THE LANCET next week. recently storage appear its adaptation to bathing purposes on a plan exactly coincident with that adopted at the " Stahlbrunnen" and the of the scheme have the THE First Hunterian Lecture will be delivered before the abroad ; promoters gone right way to work, for have studied the method Hunterian at the London E.O., Dr. they wisely Society Institution, by in vogue at the continental resorts before deciding to Norman Moore on Oct. 10th, at 8.30 r.M. The subject will embark upon an installation of ferruginous baths at this very be the Clinical Study of Heart Disease. Members of the accessible and healthy seaside resort. The initial difficulty medical profession are invited to attend. is to heat up cold ferruginous water to the necessary tem- perature for a bath without disturbing the natural state of its mineral and gaseous ingredients. As a rule the ferru- WE have raceived the report of the Commissioners inginous waters of this country contain protocarbonate of iron Lunacy for England and Wales for the year 1899. We hope held in solution by the carbonic acid of the water. As soon: as such waters reach the surface oxidation shortly to publish an extended notice of the report. rapid of the iron ensues, red ferric oxide deposits, and carbonic acid gas is set free. This disintegration is hastened A REUTER’S telegram of Sept. 30th from Brisbane stateswhen1 the water is heated and an unsightly mixture is pre- sented to the bather, besides which at that it could not that a case of plague has. been reported at Charters point Towers,be said that he was a bath in the water in Queensland. taking exactly - thet same condition as it flows from his natural source. The promotersI of the Royal Shanklin Spa, as we have said, did WE are informed that a of the Penal meeting Caseswiselyi by gaining the experience of others with regard to Committee of the General Medical Council was held on thet elucidation of this problem and they appointed dele- Oct. 2nd. gatesp to visit the ferruginous spas abroad with a view of - adoptinga the same successful methods at Shanklin. The workv of survey being completed the work of construction BRITISH DENTAL ASSOCIATION. - The annual wasv executed with commendable expedition and there general meeting of the South Wales and Monmouthshire nown exists a system of ferruginous baths at Shanklin branch of the British Dental Association was held at Newport identicalij with those at Homburg, Spa, Schwalbach, and on Sept. 27th. Mr. J. C. Oliver in an interesting address elsewhere.e It is true that at present the installation is on a said that the point as to whether it was legal for an unregis- smalls. scale, but the appointments are excellent and such as tered person to practise dentistry for profit had never been meetn the special requirements of patients in regard both to decided by the law courts. Mr. Graham White was elected comfortc and to general administration. Other kinds of baths president for the ensuing year. It was decided to hold thewhich may be regarded as accessory to the tonic treatment next annual meeting at Cardiff. byb iron baths have also been adopted, the whole installation 1030 consisting of needle baths, brass baths, and vapour shower, or spray, the supplies of which are severally indicated baths. Salt water and fresh water hot or cold are also )y the names on bras plates. Highly mineralised water is supplied. lot employed in the needle baths because of the liability The general plan of the installation will be seen from the )f the orifices to corrode or to choke. The vapour bath accompanying diagram (Fig. 1), which is reduced from ias a steam perforated copper pipe fixed under the seat, the plans of the engineer. The brass baths are four jhe supply of vapour being easily regulated by means of in number and are used for the chalybeate water which he valve. The installation, as will be seen from the plan in is heated in the bath by means of a steam chamber Ifig. 1, includes all the usual accessories of baths, such as hot at the bottom of the bath, the contents being sufficiently cupboards heated by steam batteries for towels and bathirg heated in about from five to six minutes. The baths may Etpparel. Every attention has been directed to the sanitary also be used for fresh and salt water and are fitted with equipment and to the efficient provision of light, ventilation, valves with plates indicating the various supplies. The baths and warmth. ’I he corridors and rooms throughout are lined are of polished brass provided with a brass seat at the head with Roman tiles and the t01/,t ensemble is neat, clean, and of the bath for the patient to rest on. They are heated on artistic. the system known as Schwartz’s system which was first The engineering section of the installation consists of a adopted with complete success at Spa and afterwards at vertical steam boiler working from 30 to 40 pounds pressure Schwalbach and Homburg. The system devised by Schwartz and is of modern design. The boiler is fixed in a chamber with consists of the bath being provided double bottoms below the level of the baths and has a Worthiogton’s feed. heated by steam, care being taken to prevent the steam pump and feed-tank fitted with a ball valve. Two "calori- ’ from coming into actual contact with the bath water. ners " or heaters are placed in the boiler chamber for the As is well known, when steam is turned directly supply of hot fresh or salt water. The heaters are fitted with into ferruginous water in which protocarbonate of iron an automatic steam-controlling apparatus. Steam is sup- is held in solution by carbonic acid gas the water plied from the boiler to these calorifiers and hot water is turns cloudy and deposits its iron chiefly in the form run from these heaters to the various baths. All the con- of finely divided ferric oxide. The space or steam chamber densed water from the various baths from the exhaust steam at the bottom of the baths formed by the double bottom is carried back to the feed-tank and there it is again used for the water-supply to the boiler. The mains have been FIG. 1. tested to 60lb. pressure. The water from the spring flows from an aperture at the base of the cliff immediately behind the baths and the ° Royal Spa Hotel. The water flows at the rate of about 2000 gallons per day. According to our observations the tempera- ture of the water as it issues from the spring is exactly 54’50 F. The water is clear and bright but soon gets opalescent on exposure to the air. It possesses a ferruginous taste, but it is worthy of note that except for the iron salt there is no other taste. It is not perceptibly saline to the taste. This fact distinguishes Shanklin water sharply from the waters of Schwalbach and Homburg, which are loaded with mineral salts such as the carbonates and chloride of sodium ; indeed, it is doubtless owing to the absence of any important quantity of saline constituents except iron that Shanklin water is decidedly less disagree- able to the taste than are many other ferruginous waters. We considered it advisable to test the water in regard to the amount of iron contained in it on the spot, since changes soon set in on exposure to the atmosphere. The proto- carbonate of iron was estimated by means of standard permanganate solution in several samples of water taken directly from the spring, and the test was concluded before many minutes had elapsed from the time the sample was taken. In each case a litre of the water was employed. The results were as follow :- Carbonate of Iron. Sample No. 1 (hotel supply) ...... 3’08 grs. per gallon. " No. 2 (direct from spring) ... 3’12 " " " No. 3 (direct from spring) ... 2’78 " " " No. 4 (hotel supply) ...... 2’78 " " " No. 5 (hotel supply) ...... 294 " "

Plan of the ... baths. " No. 6 (direct from spring) 3’03 " " Mean result of six samples ...... 2’95 " " ,is about two inches deep and extends over the floor of the bath. The steam pipe is connected to a brass pipe These results show that the Shanklin Spa water taken by a three-quarter inch connexion and regulated by a freshly from the head of the spring contains on an average valve having a moveable key which is always in the three grains of carbonate of iron per gallon. In subsequent possession of the bath attendant. The outlet or exhaust samples the total iron never exceeded this quantity, so that .pipe for the steam is at the bottom of the chamber. The the iron present exists entirely in the ferrous or unoxidised double bottom is formed of strong plates supported by state and in the form of protocarbonate of iron (FeC03). metal bars and bolted together with strong bolts and nuts More complete analyses were, however, made in THE LANCET in order to stand the pressure when the steam is turned on. Laboratory, and for this purpose 10 gallons of Shanklin Spa The steam inlet is at the head of the baths and the water were evaporated down carefully to dryness. The - outlet at the foot. Their construction is substantially operation was commenced on the spot in a clean pan of the same as that of the Schwalbach and Homburg baths in about two gallons capacity, and the residue obtained was which chalybeate water is heated. Fig. 2 illustrates one transferred carefully whilst still wet to a platinum basin of the brass baths just descrihed. The deep baths are two in and brought to THE LANCET Laboratory. The basin and number and are substantially the same in construction as contents were then kept at 1200 0. in a drying oven those used at Bath. As will be seen from Fig. 3 they are until constant in weight. The residue, which was -fitted with mixing boxes and valves with brass name-plates of a rich yellow ochreous colour, proved to weigh 16’927 indicating the supplies of hot or cold fresh and salt water. grammes, or 261’28 grains. The residue was then carefully The needle baths are two in number and are made of copper detached from the platinum basin and finally ground, and jau

and quantitative analysis. The residue of salts proved to When the iron present is reckoned as ferric oxide the total have the following percentage composition is 26’128 grains per gallon, for on boiling the water down the ferrous carbonate would be so transformed. Ferric oxide ...... 7’64 per cent. (equal to 11’08 Reckoning carbonate of the iron as carbonate the total would be 27’027 grains per iron) of contains free carbonic Calcium carbonate... 23’23 gallon. The water, course, acid, " and according to one experiment to the extent of 100 cubic Calcium ... 22’40 " sulphate centimetres per litre of the water. This result, however, is Calcium chloride ... 2’72 " probably under-estimated, inasmuch as the carbonic acid gas carbonate 2’80 " Magnesium was not estimated on the spot. Potassium chloride... 2’64 " It should be added here that Shanklin an Sodium chloride ... 30-70 " possesses excellent and abundant The total saline Silica ...... 7-87 " water-supply. constituents in the drinking water amount to 23’52 grains If to this amount 2-89 of carbonate 100’00 " per gallon. grains

FtG. 2.

One of the brass baths for ferruginous water.

According to these results th composition of one gallon of iron be added a total of 26’41 grains is obtained, oi water would be as follows :- which is very close to the total saline contents of£ the ferruginous water. The nature of the mineral con- Carbonate of iron ... 2-894 grains equal to 1-995 lerrio oxide). stituents, however, differs somewhat, but not to the extent that might be imagined, the close proximity of the sea to Calcium carbonate ... 6’067 " the chalybeate spring doubtless accounting for the chief Calcium ... 5’850 sulphate " differences which are referable to the chlorides of sodium, Calcium chloride ... 0.710 " calcium, and potassium. The geological strata of the Isle carbonate 0’731 Magnesium " of Wight are amongst the most interesting to geologists in Potassium chloride ... 0-702 " this country. From Sandown to Bonchurch the formation

... is and and in the Sodiam chloride 8-018 " Atherfield clay ferruginous ands, " Memoirs of the of and Wales" Silica ...... 2-055 " Geological Survey England 1032 it is stated in the volume dealing with the geology of the gallon, but this is associated with a very large quantity Isle of Wight (by Henry William Bristow, F.R.S., F.G.S. : of saline constituents, chiefly chloride of sodium, the total London, Eyre and Spottiswoode) that chalybeate water of which amounts to from 600 to 1000 grains per gallon. The sisues from these strata. "The spring known as Shanklin Kreuznach springs are similarly composed containing a little Chalybeate Spa was first noticed by Dr. Fraser, physician to over three grains of carbonate of iron per gallon. The Charles II." Schwalbach waters contain from four to eight and a half grains It is interesting to compare the analysis of Shanklin Spa of carbonate of iron per gallon with from 27 to 90 grains of water with the analyses of other ferruginous waters both at total mineral ingredients The Stahlbrunnen at Schwalbach home and abroad. The Tunbridge Wells chalybeate water, contain as much as 5-85 grains of carbonate of iron with according to published analyses, contains one grain of 32 grains of total solid constituents. The waters of Spa in carbonate of iron per gallon and a total solid contents of Belgium contain 3’41 grains of carbonate of iron per gallon eight grains per gallon. Brighton chalybeate water with a total solid contents of 35 grains per gallon. Many contains eight grains of carbonate of iron per gallon other continental springs could be quoted, but these associated, however, with 92 grains of other salts. The are sufficient for the purpose as being the most

Fia(, 3.

One of the deep baths.

thermal waters of Bath, according to THE LANCET analyses, important in regard to their application to balneologicat contain nearly two grains of carbonate of iron per gallon practice. with 140 grains of other salts. Most of the other ferruginous It will be seen that Shanklin Spa water compares very springs at home contain iron in the form of ferric sulphate favourably with many of the celebrated ferruginous waters which is generally associated with excessive quantities of abroad : indeed, for some purposes it undoubtedly presents alum which render them very astringent. Such are, for certain advantages. It is not excessively saline and the iron instance, the Sandrock spring in the Isle of Wight, the is the most important constituent. Shanklin ferruginous chalybeate spring at , and various other springs water is on this account more palatable than the strong saline in , Bedford, Bucks, and elsewhere. As regards chalybeates abroad. It is also on the same account less continental mineral waters the Homburg Stahlbrunnen con- ’’sticky " in the bath. The nature and in some particulars the tain from 8’55 grains to 4’82 grains of carbonate of iron per amount of the mineral ingredients of Shanklin Spa water are 1033

not widely different from those of Spa in Belgium and of Macleod has been appointed demonstrator of physio- the Stahlbrunnen at Schwalbach and the Wild bad waters logy in place of Dr. Robert Hutchison. Dr. Dawson has in Wurtemburg (2’63 grains of carbonate of iron per gallon resigned his post of teacher of elementary clinical medicine and 32-50 grains of total mineral matters). Careful search and has been succeeded by Dr. Robert Hutchison. was made for the presence of comparatively rare con- Middlesex ffo.3pital.-Dr. Sidney Coupland and Sir R. stituents, but with the exception of traces of lithium Douglas Powell, Bart., have been appointed consulting none were found. It is an advantage that Shanklin Spa Dr. C. Y. Biss has Dr. W. Pasteur it is physicians ; resigned ; water is free from alum and not accordingly very has been appointed physician ; Dr. F. J. Wethered and Dr. astringent. The iron is present entirely in the unoxidised H. C. Thomson have been assistant state-the of iron formed in the Blaud appointed physicians; protocarbonate Mr. W. Hern has been appointed dental surgeon, Mr. W. S. pill. Nowell assistant dental surgeon, Dr. H. P. Noble assistant Though at present the installation of ferruginous and other anaesthetist, Mr. C. J. Baker casualty medical officer, Dr. baths at Shanklin Spa is only on a small scale, the fact that J. T. Wills casualty surgical officer, Dr. W. Pasteur lecturer an excellent start has been and on lines in made, fully in medicine, Mr. A. Pearce Gould lecturer in surgery, Dr. accordance with balneological practice abroad, deserves W. E. Wynter lecturer in practical medicine, Mr. J. Murray to be The is one of recognised. enterprise worthy lecturer in practical surgery, Dr. A. M. Kellas lecturer in all encouragement, and there is no reason why the vice Dr. and Mr. T. H. at the Shanklin baths should chemistry, Plimpton, deceased, experience ultimately gained Kellock surgical tutor. not yield evidence that this admittedly valuable method London Free School Medicine of treatment in hydro-therapeutics may be carried on (Royal Hospital) of for Wo7nerc.-Dr. Brodie has been lecturer on just as efficiently and with equal satisfaction to the patient appointed phy- vice Dr. Miss M.D. in this country as at health resorts abroad. Ferruginous siology. Starling, resigned ; Ellaby, Paris, has been lecturer on vice Mr. baths are said to be of conspicuous value in debilitated con- appointed ophthalmic surgery, J. G. and Dr. Phear ditions. The advantages of a health resort being easily Mackinlay, deceased; has been appointed at the Free vice Dr. accessible at which a course of treatment by baths may be assistant physician Royal Hospital, pursued and where the action of the sea-air is invigorating, J. Fawcett, resigned. are undeniable. As is well known, Shanklin is situated on 7vens College, Manchester.-The council of the Owens a bracing coast and in addition to this very important source College has appointed Mr. F. A. Southam to be professor of of benefit to persons who are recruiting health it now clinical surgery in place of Mr. W. Whitehead, who has presents a system of medicinal baths of which the equip- resigned. Mr. G. A. Wright has been appointed professor of ments and appointments are not less satisfactory than are in of the late Mr. Jones. These ’ systematic surgery place those of foreign watering-places. appointments are subject to confirmation by the Court of Governors at their meeting in October next. Mr. W Thorburn has also been appointed lecturer on operative surgery and Mr. Joseph Collier has been appointed lecturer on practical CHANGES IN THE MEDICAL SCHOOLS, surgery. University College, Liverpool.-Professor Lodge has re- signed the chair ot Physics on undertaking the Principalship St. George’s Hospital.-The following changes have taken of the University of Birmingham and Dr. E. P. Manby has place in the staff of the hospital and school. The term of resigned the post of assistant lecturer in hygiene and is office of Mr. Warrington Haward, senior surgeon, having replaced by Dr. Mussen. Dr. Willett has given up the post of obstetric assistant. Dr. N. E. Roberts has become expired Mr. W. H. Bennett becomes senior surgeon. Mr. lecturer on infectious diseases and vaccination. Dr. Marmaduke Sheild has been appointed surgeon and Mr. Buchanan has been made assistant lecturer in forensic Herbert Stringfellow Pendlebury assistant surgeon to the medicine. Dr. J. S Macdonald has been made assistant Dr. Fenton has been curator of lecturer and senior demonstrator in Dr. hospital. appointed theI physiology. museum, vice Dr. Lazarus-Barlow, who has become patho- Balfour Stewart has been appointed research assistant in logist to the Westminster Hospital. Dr. Dickson has been bacteriology. appointed medical registrar, vice Dr. Fenton. Dr. Menzies has Anderson’s College Medical Seltool.-Dr. J. G. Connal has been appointed senior anaesthetist, vice Dr. Dickson, and Dr. been appointed to the lectureship in Diseases of the Ear, in room of Dr. Erhkine Professor Carstairs has been Powell has been anoosthetist, vice Douglas Llewelyn appointed junior to the chair of Medical in room of Dr. Menzies. Dr. Penrose has been lecturer appointed Jurisprudence appointed joint Professor R. M. Buchan. Dr. Carroll has the Dr. Isambard in the and practice of resigned (with Owen) principles in Public but no new has vice Dr. Mr. G R. Turner has lecturehip Health, appointment medicine, Ewart, resigned. been made. been appointed joint lecturer (with Mr. Clinton Dent) in the yet principles and practice of surgery, vice Mr. W. H. Bennett, St. Mltngo’s College, Clasyorv.-Dr. McPhail has been resigned. Dr. Cyril Ogle has been appointed lecturer in appointed professor of anatomy, vice Mr. . materia medica and therapeutics, vice Dr. Penrose. Mr. Francis Jaffrey has been appointed lecturer in anatomy, vice Mr. Turner. Dr. J. Howell Evans has been appointed demonstrator in anatomy. Mr. Clinton Dent has been THE WAR IN SOUTH AFRICA. appointed treasurer of the medical school, vice Mr. Warrington Haward. THE warfare in South Africa came to an end with London.-The the regular King’s College, changes during past the of Mr. into and the year have been the retirement of Professor I. Burney Yeo, the flight Kruger Portuguese territory succession to the chair of Medicine of Professor Tirard, and occupation of Komati Poort by our troops, as we had long the appointment of Dr. F. W. Tunnicliffe to the chair of ago surmised would be the case. It now only remains to Materia Medica and Pharmacology ; also additions to the deal with the dispersed bands of the enemy who will no staff of Mr. Leslie and Mr. and Dr. hospital Legg Hugh doubt continue to provide work for some time to come for as and obstetrical and Playfair medical, surgical, registrars the army of occupation and for the 12,000 police to be raised tutors respectively. in the Transvaal Colony and Orange River Colony under -London Hospital Medical College.-On the medical staff the command of General Baden-Powell. There will never- the death of Dr. Charlewood Turner has led to the appoint- theless be a good deal to occupy the serious attention ment of Dr. Percy Kidd in his place as phybician ; Dr. of the newly elected Parliament in connexion with the Robert Hutchison has been appointed assistant physician. wars going on elsewhere, as in China and Ashanti, and the On the surgical staff Mr. H. L. Barnard has been appointed promised reorganisation of our military forces and army as an additional assistant surgeon ; Mr. Farmer succeeds reform. As to army reform, not only has the nation desired Mr. Cunningham as dental surgeon. In the College Mr. A it, but the appointment of Lord Roberts as the new Keith has been appointed joint lecturer on anatomy, still commander-in-chief will ensure it. When the Royal Com- retaining his senior demonstratorship’ on anatomy. Dr. mission have finished their investigations and made their Robert Hutchison has been appointed lecturer on Chemical report on the hospitals in South Africa we shall see how far Physiology and Foods and Dietetics, und Dr. J. J. R. the medical services are likely to be involved in the general