51 Rifle The Queen’s Rifle Volunteer Brigade the Royal Scots (Lothian Regiment) : James William Keay to be Surgeon- Lieutenant (dated Dec. lst, 1906). lst Volunteer Battalion the Queen’s (Royal West Surrey Regiment) : Surgeon- Correspondence. Captain J. Wayte resigns his commission (dated Nov. 24th, 1906). 2nd Volunteer Battalion the Lincolnshire Regiment: "Audi alteram partem." Surgeon-Lieutenant-Colonel and Honorary Surgeon-Colonel Colonel, Medical Reserve of (Surgeon-Lieutenant Army AND Officers) G. F. England resigns his commission, with per- ASCARIS LUMBRICOIDES PER- mission to retain his rank and to wear the prescribed NICIOUS ANÆMIA : GREGARI- uniform (dated Nov. 24th, 1906). 3rd Volunteer Battalion NOSIS IN MAN. the Bedfordshire Regiment: Surgeon-Lieutenant T. D. H. Holmes resigns his commission (dated Nov. 17th, 19C6). To the Editors of THE LANCET. 2nd Volunteer Battalion the Lancashire Fusiliers : Surgeon- Major and Honorary Surgeon-Lieutenant-Colonel W. Pooley SIRS,-Although eminent authorities, Leuckart, Max resigns his commission, with permission to retain his rank Braun, Thomson, and others, deny the existence of grega- rines in I have the to make a state- and to wear the prescribed uniform (dated Nov. 14th, 1906). man, temerity positive lst Roxburgh and Selkirk (The Border) Volunteer Rifle ment. From an examination of over 1600 specimens of Corps: Surgeon-Lieutenant R. W. Meikle to be Surgeon- fæces during the last 15 years I have come to the conclusion Captain (dated July 7th, 1906). 3rd (Dumfries) Volunteer that gregarines are not infrequently present in the fasces in Battalion the King’s Own Scottish Borderers : Surgeon- many forms of intestinal disorder. They are, however, not Lieutenant-Colonel J. Maclachlan is granted the honorary numerous, and are, as a rule, only encountered after a some- rank of Surgeon-Colonel (dated Nov. lst, 1906). Surgeon- what prolonged search. But they occur in numbers when Lieutenant-Colonel and Honorary Surgeon-Colonel J. associated with ascaris lumbricoides-that is to say, when Maclachlan is retired, under the conditions of paragraph 103, the ascaris is itself infected with gregarines. Volunteer with to retain his rank It was in five cases of pernicious anæmia diagnosed as Regulations, permission such and in three of these the blood had been and to wear the prescribed uniform (dated Nov. 2nd, 1906). by specialists, 4th Volunteer Battalion, The Cameronians (Scottish Rifles) : examined by experts, that this association existed. In one Surgeon Lieutenant N. Macnair to be Surgeon-Captain (dated case only had I the good fortune to get the expelled ascaris Nov. 6th, 1906). 2nd Volunteer Battalion, The Welsh and was able to find this sporozoon in the worm. The Regiment: Surgeon-Major D. Hepburn to be Surgeon- gregarines were quite typical. In the fæces the so-called Lieutenant-Colonel (dated Oct. 14tb, 1906). 2nd Volunteer conjugation form is chiefly met with, but the size varies with Battalion, The Sherwood Foresters (Nottinghamshire and the host that ha,rbours them. I here wish to state I am Derbyshire Regiment): Arthur Wilson Shea (late Captain) aware that another sporozoon (coccidium) belonging to the to be Surgeon-Lieutenant (dated Nov. 9th, 1906). The same class is sometimes found in the intestines of man, Prince of Wales’s Own, 12th Middlesex (Civil Service) oftener than is supposed ; but I do not refer to this. Volunteer Rifle Corps : Surgeon-Captain E. M. Callender to The etiology of pernicious anaemia may be roughly con- be Surgeon-Major (dated Nov. 23rd, 1906). 21st Middlesex sidered under two heads : (1) known ; and (2) unknown. Of (The Finsbury) Volunteer Rifle Corps: Surgeon-Lieutenant the former, parasitic infection is one of the recognised C. A. C. Smelt to be Surgeon-Captain (dated Nov. 27th, causes. The ankylostoma duodenale and bothriocephalus 1906). 2nd Volunteer Battalion, The York and Lancaster latus are said to play the important rôle, and I venture to Regiment: Harold Forster Horne to be Surgeon-Lieutenant add to this the infected ascaris lumbricoides. While freely (dated Nov 6th, 1906). lst (Renfrewshire) Volunteer admitting the powers of the ankylostoma duodenale in this Battalion, Princess Louise’s (Argyll and Sutherland High- respect, I take the present opportunity to question that the landers) : Supernumerary Surgeon-Lieutenant-Colonel T. healthy bothriocephalus latus is capable of producing per- Philip (Brigade Surgeon-Lieutenant. Colonel, Senior Medical nicious anæmia. I feel this to be a bold statement, but Officer, Clyde Volunteer Infantry Brigade) is granted the from personal observation and from a careful and prolonged honorary rank of Surgeon-Colonel (dated Nov. 30th, 19C6). consideration both into the life-history and peculiarities of this cestode, as well as a patient and thoughtful perusal of ROYAL ARMY MEDICAL CORPS (VOLUNTEERS). the literature which is by no means scanty, I feel compelled London District: London Companies : Lieutenant-Colonel to cast a doubt on the powers of the healthy bothriocephalus V. Matthews is granted the honorary rank of Colonel (dated latus in producing pernicious anæmia. I hope, however, in Nov. 27th, 1906). Welsh Bearer Company : Lieutenant the near future to be able to show that there is much E. J. R. Evatt to be Captain (dated Sept. 7th, 19C6). evidence to justify what I have said. I am, Sirs, yours faithfully, THE REPORT OF THE SURGEON-GENERAL OF THE UNITED STATES NAVY. A. F. BILDERBECK GOMESS, L.R C.P. Loud., M.R C S. of United Eng., F.C.S., The report of the Surgeon-General the States Late Assistant Pathologist, St. George’s Hospital. Navy for the year ending October, 1906, states that on Dec. 29th, 1906. Jan. lst, 1906, the medical corps of the navy consisted of 15 medical directors, 15 medical inspectors, 87 surgeons, 50 post assistant surgeons, 75 assistant surgeons, and 16 acting THE CURE OF CHRONIC SUPPURATION assistant surgeons appointed for temporary service. The number of officers and men under their care was 43,000. OF THE MIDDLE EAR, WITHOUT The number of qualified candidates for commission as REMOVAL OF THE DRUM OR assistant surgeons was smaller than the demand. The health OSSICLES OR LOSS OF of the navy and marine corps for the calendar year 1905 was good, the ratio of admissions to the sick list per 1000 of HEARING. strength being less than for the year 1904 and for the ten To the Editors of THE LANCET. preceding years. SIRS,—In your issue of Dec. 15th, under the heading of Medical Societies," there is the record of a meeting of the PRESENTATIONS TO MEDICAL PRACTITIONERS.-On British Laryngological, Rhinological, and Otological Asso- Dec. 28th, 1906, at the King’s Head Hotel, Cirencester, Earl ciation (Nov. 9th last), when there were exhibited for the Bathurst, C.M.G., on behalf of 350 subscribers, presented Mr. first time a large number of patients who illustrated "the Oliver Humphrey Fowler, M.R.C.S Eng., with an illuminated Cure of Chronic Suppuration of the Middle Ear without Re- address and a massive silver-gilt double-handled cup of rich moval of the Drum or 0ssicles or the Loss of Hearing"; they workmanship of the period of George II., the date being had, until recently, been suffering from deafness, discharging 1752, as a mark of respect and esteem on the occasion of Mr. ears, perforated drum membranes, polypus in the ear, and Fowler’s retirement after 40 year<’ work in Cirencester and disease of the mastoid antrum, all of which complications the district.-Mr. John Henry Deane, L.R.C.P., L.R.C.S. were the outcome of chronic suppuration of the middle ear Edin., of Trewartha Park, Weston-super-Mare, was on for periods varying from three months to 18 years. These Dec. 21st presented with a solid silver tray, salver, and patients were shown to have been cured of this disease and kettle as a mark of respect and esteem on the occasion of of their deafness, and the perforations of their drum mem- his leaving the town. branes could be seen to have healed ; they were restored to 52 safety and to good hearing by an operation designed by Mr. administered by the mouth an extract of fresh pancreas, the Charles J. Heath, F.R.C.S. pancreas of two pigs being used each week. A fall in the When first the description and results of this operation amount of sugar was observed. Some time later, through were published 1 they attracted little attention, for it was the misunderstanding of an order, the pancreatic extract was not, then, generally realised that such recoveries were discontinued though the secretin was still taken as before. possible; therefore great interest was expressed at the The amount of sugar at once increased. It was diminished meeting above referred to in the evidence there forthcoming. when pancreatic extract was again added and the diminution The advantages of this procedure are already appreciated by became still greater when the amount of pancreatic extract many London and provincial aural surgeons, for it is not so given was doubled. The results are at present insufficient as severe as the radical operation ; the drum membrane and a basis for any conclusion, but they are suggestive and worthy bones are not removed, recovery is more rapid, and its aim is of further investigation. the production of a perfect ear and not a defective one, I am, Sirs, yours faithfully, which is the only possible result of the radical operation Bristol, Dec. 18th, 1906. A. F. STANLEY KENT. hitherto performed for the cure of chronic suppuration in the ear. As surgeon to an ear and throat hospital in London, and SURGICAL TUBERCULOSIS. therefore being familiar with the needs of those suffering To the Editors of THE LANCET. from aural and also with the fact that the records discharge, the last few considerable has of the of societies are not often read the SIRS,-Daring years impetus meetings by busy been to the movement for facilities for the medical man, I feel it a to write this letter in the given providing duty hope of one of bringing to the knowledge of the medical profession open-air treatment pulmonary tuberculosis and still finds in the for funds to build or endow generally the fact that this common disease is now usually lay press appeals if dealt with this before extensive sanatoriums for this excellent object. But is it not time to curable, by method, consider the claims of those sufferers whose tuberculosis is damage has occurred to the drum membrane, but that if not of the but of &c., and whose delayed the radical or that, in addition to some lungs joints, bones, glands, operation, ailments are as rather than more grave may ultimately be needed, which generally regarded surgical proceeding, medical? Such cases as these are treated in the measure, at its best, must leave a mutilated and defective usually wards of the of our cities. ear. This advance is British, and it should be a surgical general hospitals big great of this class are under the care of the British to the merits of our own workers and Many patients duty recognise and of these a small number are and not to that can be made metropolitan hospitals thinkers, imagine progress only afterwards drafted where abroad. I to convalescent homes, open-air am, Sirs, yours faithfully, if it is and varies in the Dec. 1906. FREDERICK SPICER. treatment, exists, only exceptional, Wimpole-street, W., 29th, thoroughness of its administration with the personal views of the nurse-in-charge. Moreover, many of these convalescent THE INDIGESTIBILITY OF PLUMMER’S homes do not profess to make any adequate provision for the nursing of surgical cases and often refuse patients for PILLS. whom the simplest dressing is necessary ; indeed, there are To the Editors of THE LANCET. some convalescent homes which appear to regard robust health as the qualification for admission. is now since I wrote to THE SIRS,-It many years LANCET, The consequence of this is that a proportion, possibly as in soon after the was made from treacle to fact, change large as 25 per cent., of the surgical beds of our metro- castor oil as a material in these binding forming pills, stating politan hospitals are occupied by cases of tuberculosis that when made with castor oil they very frequently, if not which could with advantage be treated in the country, while in a of the large proportion cases, passed unchanged through their place could be filled again and again by an ever- bowels. This does not occur when are made with they up increasing crowd of applicants suffering from a variety of as in the old London and treacle, Edinburgh pharmacopoeias’ ailments for the cure of which surgical measures are formulae. the was made I never could under- Why change nowadays considered necessary. Should the various condi- stand unless it were that a pill mass is more difficult to make tions requiring surgical treatment continue to increase at the with treacle as it is more but if the mass is up friable ; pill present rate it is evident that the strain upon the accom- warm while rolled it can well be made into kept being quite modation on the surgical side of our metropolitan hospitals and as an old to a and pills, personally, apprentice surgeon will soon reach the breaking-point, and there are few hos- a rare survival I have made them apothecary, nowadays, pitals whose managers would view with equanimity the thus and active were. If very many times, extremely they prospect of expansion on their present sites. will back to treacle as a medium in pharmaceutists go making In the more rational treatment of cases of surgical tuber- Plummer’s there will be no more of in- pills complaints culosis I believe we have a means of expansion of our metro- efficiencvin their_- action.-I am, Sirs, yours faithfully, politan hospitals which should commend itself to hospital NorthNorth Shields. ROBERT SEPT. PEART. Shields. managers on the grounds of economy alone. Let each hospital or group of hospitals erect on a site readily SECRETIN AND PANCREATIC EXTRACT accessible from London a small affiliated institution for the open-air treatment of cases of surgical tuberculosis. The IN RELATION TO DIABETES. provision of an administrative block, with an operating room, To the Editors of THE LANCET. offices, &c., and huts for the patients, would not prove so costly as the purchase of sites in crowded business the cases of diabetes thorough- SIRS,-In recorded by Moore, Edie, fares and the erection of stately structures of bricks and and Abram the treatment by means of secretin was com- mortar, while the arrangement suggested would allow of bined with a strict attention to diet. It has since been almost indefinite expansion. The increased facilities of that there is no evidence to show that strict asserted dieting modern locomotion would overcome the difficulties of trans- alone would not have accounted for the disappearance of porting the patients and would also render possible frequent sugar from the urine. More severe cases, where dieting was visits of the staff and students of the parent institution. insufficient to banish from the were treated with sugar urine, I, the medium of your columns, bring this secretin and the results obtained led to the May through by Bainbridge bare outline of a scheme to the notice of our hospital conclusion that there is no evidence to that secretin prove managers and so indirectly to that of the charitable public ? given by the mouth can abolish or influence the glycosuria I , am, Sirs, yours faithfully, of severe diabetes. In view of these observations the follow- Harley-street, W., Dec. 27th, 1906. V. WARREN LOW. ing results may be of interest. A patient, aged about 25 years, had been treated by various recognised drugs for severe diabetes. Ordinary treatment MEAT DIET AND THE TEETH. was discontinued and secretin was the the given by mouth, To the Editors of THE LANCET. extract from about three feet of intestine being prepared D. Chalmers Watson’s to the twice a week for the purpose. No restriction was placed SIRS,—Dr. paper Pathological of London covered so much and dealt with upon the patient’s diet. A short time after the commence- Society ground so and tissues of the that one feels a mence of treatment the total daily output of sugar was 280 many organs body with grammes. At this time there was added to the fuller exposition of his investigation reference to the secretin might have been given but for the limits of time. So 1 THE LANCET, August 11th, 1906, p. 353. teethfar as it goes, however, his conclusions would appear to be