1883 The Lancet  
in the chair. Dr. G. B. LONGSTAFF read a paper on Phthisis, Bronchitis, and Pneumonia : Are they Epidemic Diseases? The following is an abstract :-The author explained that his object was to examine the Registrar-General's returns in such a way as would make clear their bearing on the solution of the question propounded. As in previous papers, relating to summer diarrhoea and the diseases allied to erysipelas respectively, he exhibited diagrams graphically representing the death-rates for
more » ... ath-rates for England and Wales from the diseases in question, and certain others in various ways allied to them, during a period of twenty-five years ; also showing the same death-rates in London for thirty-three years, compared with a curve expressing the number of cold days in each winter. Many other cufves had been pointed out by the author, but only a few had proved useful for the purpose in hand. One diagram showed that the death-rate curve of phthisis deviates but very little ftom a straight line, resembling in this respect those for cancer, apoplexy, paralysis, convulsions, and fractures. The curves of tubercular meningitis (hydrocephalus), and to a less degree tabes mesenterica, resembled the phthisis curve. The phthisis death-rate had fallen 20 per cent. during the last twenty years. The bronchitis curve exhibited considerable fluctuations, but on the average it had risen 81 per cent. during twenty years. Pneumonia gave a curve closely resembling that of bronchitis in many respects, but the average mortality had fallen 20 per cent. The total mortality from all diseases of the respiratory organs, together with phthisis, showed an increase of 5 per cent., indicating that probably many deaths formerly returned as due to phthisis or pneumonia were now classed with bronchitis. Pleurisy appeared to be more allied to rheumatism than to respiratory diseases. From the curves relating to London deaths, it appeared that bronchitis and pneumonia corresponded with the coldness of the winters, but not so closely as might have been expected. Phthisis was but little affected. Curves derived from Messrs. Buchan and Mitchell's paper on the Influence of Weather on Mortality, showing the average weekly fluctuations of the death-rates from various causes in London during thirty years, strongly confirmed the author's conclusions, with the single exception of tabes mesenterica, which gives an entirely different curve from that of phthisis. In another diagram were exhibited the week-to-week fluctuations of the deaths from bronchitis and pneumonia during the last five winters in London, and their relation to cold; also the same for phthisis during two of the winters. This diagram showed clearly that the pneumonia death curve had a general correspondence with the bronchitis death curve ; but it differed in two particulars-viz., the fluctuations were much less, and while it rose in the autumn as rapidly, it fell in the spring more gradually. In the spring of 1879 there was a prolonged high mortality from both bronchitis and pneumonia out of proportion to the severity of the cold ; and during the whole winter 1878-9 the two curves of bronchitis and pneumonia corresponded less closely than in the others. The effect of two hard winters upon the phthisis mortality was shown to be remarkably slight. It was noted that for every 1000 females who died of pneumonia not less than 1460 males died, whereas in the case oi bronchitis the numbers were 1000 females to 1104 males, and in the case of phthisis 1000 females to 1046 males. Bronchitis caused nearly three times as many deaths in proportion to popula. tion in Lancashire as in Gloucester. The mortality was also very high in metropolitan Surrey and Middlesex, West Yorkshire, Warwick, and Monmouth. It was very low in Cornwall, Sussex, Norfolk, extra -metropolitan Surrey, Cambridge, and Gloucester. Pneumonia was most fatal in Lancashire, Monmoutb, South Wales, West Yorkshire, Stafford, and metropolitan Middlesex and Surrey; least in Susex, Wilta, Ilants, Bucks, Oxford, Noith Yorkshire, and Westmoreland. In eight Jegistration counties pneumonia was found to be comparatively much more fatal than bronchitis -viz., Sjuth Wales, Gloucester, Rutland, extra-metropolitan Surrey, Bedford, Cornwall, Monmouth, and Cambridge. In ten registration counties bronchitis was found to be relatively more fatal than pneu-monia—viz., North Yorkshire. Warwick, Wilts, metropolitan Surrey, Cumberland, Nottingham, Westmoreland, Cheshire, Somerset, and Oxford. The author's main con. clusions were : 1. That the mortality statistics of England and Wales did not give any evidence in favour of the view that phthisis is communicable, but they showed, on the other haud, that weather had very little influence on the phthids death-rate. 2. That while bronchitis and pneumonia were both greatly influenced by meteorological conditions, it was difficult to explain by those conditions alone all the phe. nomena. 3. That common catarrh was a communicable disease, and that it was probable that very many cases of bronchitis and pneumonia might be looked upon as complications of that or some similar disease of mild character when uncomplicated. 4. That the different incidence of bronchitis and pneumonia on the two sexes pointed to some difference in the causation of the two diseases. 5. That there would appear to be some common factor in the causa. tion of phthisis and tubercular meningitis. Malins, President, in the chair. Mr. PRIESTLEY SMITH exhibited a pai ient suffering from greatly impaired Vision. The periphery of the visual field was of normal extent. The central area was nearly blind, as ' demonstrated by charts taken with the perimeter. The optic discs were pale, the retinal arteries small. The man had symptoms suggestive of locomotor ataxy; he had also been a heavy smoker for many years. The central amblyopia pointed rather to the effects of tobacco than to atrophy from spinal disorder, but it appeared that there was a progressive atrophy going on, such as accompanies locomotor ataxy. It was suggested that the atrophic process had affected the central fibres first because they were already damaged by tobacco. Mr. JORDAN LLOYD showed two Hernial Sacs removed for the Radical Cure of Inguinal Hernia. One patient, aged fifty, died on the twelfth day of pneumonia; no peri. tonitis. The second, a child aged two yeais, had made a good recovery.-Mr. LLOYD also showed a Tumour as large as a hen's egg, which he had removed from the bladderof aman, aged thirty-four. Symptoms had existed for twelve months. The patient was progressing favourably. Dr. BARLING exhibited an adult patient who by a fall had torn the ligamentous union of an old fractured patella. By a longitudinal incision over the bone the fragments had been laid bare, refreshed, and then approximated by a single silver wire suture, which was cut off short and left in sÜn. The operation had been performed seven weeks before, and the fragments were in good position, and in the course of time Dr. Barling hoped that a solid osseous union would take place. Dr. LESLIE PHILLIPS exhibited a Heart weighing thirty ounces, the seat of ulcerative endocarditis on the aortic and mitral valves. The aorta was ulcerated through an inch above the valves ; the pericardium contained several ounces of blood, and each pleural cavity half a pint. Dr. T. NELSON showed a calculus, more than half an inch squaie, which had been passed by a woman per urethram. Dr. SiMON, in a paper on the Treatment of Ringworm, advocated thorough and vigorous measures so long asablack spot or a stumpy hair remained; and, when necessary, suitable constitutional remedies. For local application in recent cases sulphurous acid and glycerine and carbolic acid pomade were useful. Epilation was also often necessary. For chronic cases oleate (,f mercury and croton oil, properly applied as directed by Dr. Alder Smith, would generally effect a cuce. Mr. JORDAN LLOYD read a paper on a method of Controlling Haemorrhage in operations at the Hip-joint. After the limo to be operated upon has been emptied of blood, a pad is placed over the external iliac artery, and a double piece of a flat elastic tourniquet applied, so as to pass internal to the tuber ischii across the pelvic ramus, parallel to and above Poupart's ligament, to a point above the iliac crest; the posterior half of the ligature crosses the sciatic notch and
doi:10.1016/s0140-6736(02)37612-8 fatcat:5d33dzetkjhd7hhmq3qj5ysx5m