970 THE BRITISH MEDICAL _OURNAL. [Dec. 28, I878. into requisition in the treatment of many medical and surgical cases of disease. HOSPITAL AND DISPENSARY MANAGEMENT. The following case, related by the Gazette des Hc$pitaux, would seem TUNBRIDGE WELLS PROVIDENT DISPENSARY. to afford an illustration of the efficacy of intestinal insufflation of air THE first annual meeting of the Tunbridge Wells Provident Dis- or gas in certain forms of disease. A woman aged 58 had a left pensary was held on the 12th instant. The report, which was read femoral hernia for about twenty years, which was kept in a reduced and adopted, gave a satisfactory account of the progress of the institu- condition by a truss, which one day she neglected to wear, when the tion. There are at the present time more thaul 1,350 members on the hernia returned, and, notwithstanding the proper application of the books. During the year, their payments have amounted to £406, and taxis, purgative enemata, etc., it remained irreducible for five days; of this sum £268 have been divided among the medical officers. This and, urgent symptoms having set in, Dr. Guermonprez of Annappes, is a good beginning, and we trust the dispensary may go on growing in the patient's medical attendant, recollecting that cases of intestinal ob- popularity and prosperity year by year. It is remarkably well situated, struction had been overcome by the administration of lavements of as it occupies premises next door to the infirmary. The leading me- eau de Seltz or ordinary soda-water, resolved to try the remedy in this dical men of the town take a lively interest in its welfare, and several case. He accordingly administered an enema of this liquid ; but, this of them are on its acting staff. There is, therefore, good reason to having failed to produce the desired effect, he administered a second, anticipate for it an useful and successful career. but with no better result. The next day, two more lavements were un- successfully administered, and an operation was decided upon; but, on the third day, when preparations were being made for the operation, the hernia was found reduced, with the exception of a small knuckle of SPECIAL CORRESPONDENCE. omentum, which was reduced by the taxis without any difficulty. The long projected improvements of the School of Medicine to PARIS. which I referred in a former letter are being carried into effect, and, on [FROM OUR OWN CORRESPONDENT.] the 4th instant, the foundation-stone of the 1tcole Pratique, which is a branch of the School of Medicine, was laid by M. Bardoux, the Insufiation of Air iA* the Intestine.-Reduction of Femooral Hernia b9 Minister of Public Instruction, in the presence of the Professors of the Insug7ation.-The School ofMedicine.-Re-establishment of Tonis.- Faculty, a great number of medical students, and some of the higher Sudden DeaenVs. dignitaries of the city. The new school is to be built on the ground SOME of the inaugural theses submitted from time to time to the occupied by the Hopital des Cliniques, which has been pulled down; Faculty of Medicine for the doctorate are remarkable for the perspicacity and its cost is estimated at i2,000,000 francs, or ;£480,000. It evinced by their authors, and the thorough acquaintance possessed by will contain one hundred and eighty tables for dissection, instead of them of the subjects treated of. This remark applies particularly to eighty, which now exist in the old school. There will be six amphi- the thesis lately submitted by Dr. Juan B. Gil, on Recherches Expe,ri- theatres, and the number of professors and teachers will also be consi- mentales sur l'Insuffation d'Air dans /'Appareil Galstro-Intestinal. derably increased. Thus the French are determined to show that they The author, already a doctor of the Faculty of Medical Sciences of will no longer be behind their neighbours in affording every means Buenos-Ayres, had commenced his researches with the view of eluci- and facilities for the extension of the medical sciences; but they will dating the pathogeny of tympanites, in the production of which intes- have to put up with their present position for the next four years, as it tinal paralysis plays a more important part than is generally supposed. is estimated that it will take at least that time before the works are The experiments performed on animals are extremely curious and in- completed. teresting, and the following are the conclusions arrived at by the The re-establishment of the tours is another long-talked-of scheme, author. Insufflation of air into the digestive tube by the rectum reaches to which I had also referred in a previous letter, but which is now the stomach and produces distension of that organ, just as if the in- about to become a realised fact; but, instead of one general tour for sufflation had been practised directlyiby the cesophagus, without the the reception of abandoned infants, there will be one for each arron- ileo-cxcal valve affording the least obstacle to the passage of the air dissement or district. The buildings are to be situated in the most con- but, in order to effect this, it is necessary to stop up the anus, which spicuous places in the public streets, the offices of which will be kept Dr. Gil does by introducing an " obturateur", an apparatus devised by open day and night, and the employ6s are to be sworn to the utmost him, and which is depicted in the thesis. According to Dr. Gil, a dog secrecy, any disclosure being met by a most severe penalty. Every maywithout inconveniencesupport an intestinal tension of 9.2 centirnztres facility will be afforded to mothers and others for depositing infants at of the mercurial column; whereas, in a rabbit, such a pressure would these establishments, which will be provided with a staff of medical produce perforation of the intestine ; and the author noticed 'that, in men, nurses, inspectors, etc., who will be under the immediate control the dog, insufflation of air into the stomach was constantly attended of the Minister of the Interior. with vomiting when that organ attained its utmost limit of distension. Two sudden deaths in rapid succession of husband and wife having This phenomenon is absent in the rabbit; but expulsive contractions lately taken place in Paris, suspicion of poisoning was naturally excited of the abdominal muscles are, nevertheiess, observed. Vomiting is in the minds of some of the friends of the deceased couple, atid the produced even when carbonic acid, hydrogen, or water is injected in- authorities were induced to institute an inquiry into the case. The stead of air, and continues even after section of the pneumogastric result showed that the husband's death was caused by disease of the nerves. The vomiting is reproduced as well by electrically exciting the heart, and that of the wife by the bursting of an aneurism brought on central portions as the peripheric extremities of these nerves, whether by the intense sorrow she experienced by the death of her husband in the stomach is or not previously distended with gas or liquid. Vomit- her arms. These two cases would point to the necessity of having ing from intestinal insufflation does not occur during complete anaes- coroners' inquests, an institution entirely ignored in France. thesia, but it begins as soon as the sensibility of the cornea returns. The convulsive contractions of the abdominal muscles and of the diaphragm which characterise vomiting do not appear to take place during intes- ASSOCIATION INTELLIGENCE. tinal insufflation, when the nerves of the stomach are cut off from their vasculo-nervous connections by a strong ligature. The same thing has BIRMINGHAM AND MIDLAND COUNTIES BRANCH. been observed in animals curarised. Insufflation by the intestine of THE fourth meeting of the Session will be held in the Examination air saturated with the vapours of chloroform produces anaesthesia, as Hall, Queen's College, on Thursday, January gth, I879. The Chair well as by pulmonary inhalation ; but the intestinal anoesthesia is less will be taken by the President, Dr. TIBBITS, at three o'clock P.M. manageable, as absorption continues even after the desired degree of The f6llowing papers are promised. anaesthesia has been obtained. Pulmonary insufflation constantfy lowers x. Mr. Bartleet: Is the Poison of Syphilis single or dual? the arterial tension from 12 to 4centimntres, and even less, of the mercurial 2. Mr. Harmar: The Duality of the Syphilitic Virus. standard; whereas intestinal insufflation always raises it, although but 3. Mr. Furneaux Jordan: The Treatment of Primary, Secondary, slightly. The first raises the venous tension; the second raises it also, and Tertiary Syphilis. but in a slight degree. During the vomiting produced by the injection Members are invited to exhibit patients, pathological specimens, of air into the intestine, the arterial and venous tension increase consi- new drugs, instruments or appliances, at the commencement of the derably. Intestinal insufflation to a pressure of 9. 2 centim4tres of the mer- meeting. curial standard reduces by nearly one-half the capacity of the lungs. Members are requested to pay their subscriptions for I879 to Dr. Sphygmographic tracings, representing the arterial and venous tensions, Malins. are given at the end of the thesis. Such are the important results ob- JAMES SAWYER, M.D., 22, Temple Row, Hon. tained by Dr. Gil with his experiments, which will doubtless be called EDWARD MALINS, M.D., 8, Old Square, Secs. Dec. 28, I878.] THE BRITISH MEDICAL 7OURNAL. 97I views on the importance of efficient outdoor medical relief, as evi- COMMITTEE OF COUNCIL: denced by their early adoption of the dispensary system, have remon- NOTICE OF MEETING.