GASTRIC AND DUODENAL ULCER.

GASTRIC AND DUODENAL ULCER.

93 for all time. Can we omit to declare that one feature of the art’ medica is a power to recognise our daily duties as distinctly Christian services,...

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93 for all time. Can we omit to declare that one feature of the art’ medica is a power to recognise our daily duties as distinctly Christian services, requiring our constant attention to the fact that each patient has an implanted and immortal soul, which cannot live apart from the perishing body ? " Plato said the same thing long ago and it is not less true to-day. Not that the claims of science must be set aside, " these must remain and increase and be wisely applied," but the relation of art to medicine " is purely clinical in practice and is only to be acquired and manifested at the bedside." The art of medicine is a gift not possessed by every medical man ; like other arts, it can be improved by training and practice, but in the words of Sir William Savory, whom Sir Dyce Duckworth quotes, " It is because medicine is not an exact science that the man of observation and experience has so enormous an advantage over others....." Modern medicine may be in danger of thinking of herself rather as a science than an art, and it is well that her votaries should be reminded that the art should go hand in hand with the science. The address from which we have quoted was delivered at the opening of the 185th session of the Royal Medical Society of Edinburgh, a great medical centre at which this canon of medical life has frequently been put before the student since Dr. John Brown, an early member of the society, was fond of describing art in medicine in the terms of Bewick’s tail-piece-the strong blind man on whose shoulders the lame and seeing man was crossing the river. ____

GASTRIC AND DUODENAL ULCER. ULCERATION of that part of the mucous lining of the alimentary tract whose contents are normally acid has long been an interesting pathological problem. We publish to-day two contributions to the knowledge of ulcer in the stomach and 12-finger gut. Dr. Donald Paterson discusses the occurrence of duodenal ulcer in infancy; some 100 cases of this rather rare condition have been reported, Dr. Paterson contributing descriptions of two which have recently come to his notice at the Hospital for Sick Children, Great Ormondstreet. He thinks that the condition would be more frequently discovered if search were made at every autopsy; that only five cases have been reported in the British Isles is suggestive in this respect, and we feel that all babies dying of marasmus or melaena neonatorum should be very carefully examined for the presence of such lesions. But the chief interest of the condition lies in the evidence which it offers of the infective nature of such ulcerativ processes. Miliary tuberculosis, septic infection of superficial burns, gastro-intestinal infection,-these, combined with the lowered general resistance of the marasmic infant, are the important factors in the production of the condition ; and they provide strong clinical support to the theory of septic thrombosis as the origin of gastric and duodenal ulcer, a hypothesis which has received experimental support from the work of Rosenow and others. Prof. Knud Faber, of Copenhagen, calls attention to the distinction, as regards symptomatology and prognosis, which exists between ulceration in the juxtapyloric region and that occurring in higher portions of the stomach. In nearly his last work Albert Mathieu severely criticised the English profession for their ignorance of continental work ; his opinion would, we feel, have been greatly changed had he been able to foretell the work of Moynihan, Bolton, Hurst, and many other recent workers on the subject, but it nevertheless seems probable that we have not even yet called sufficient attention to the importance which attaches to the mere position of a gastric ulcer. Prof. Fabet brings out very clearly the different frequency of incidence in the sexes, and dwells upon the comparative insignificance of symptoms when the ulcer is in the body of the stomach ; his figures as to cicatrices found post mortem suggest that in the latter situation there is a far greater tendency to spontaneous healing. That such is the case is some-

what consoling, for in the experience of most physicians and surgeons no ulcers present such difficulties as the large chronic ones high up on the lesser curvature. the brilliant success which has been recorded of partial gastrectomy, these cases as a whole remain a therapeutic problem ; when treated by gastro-enterostomy the results have cast discredit upon the operation ; the frequent absence of hyperacidity in the condition renders them inappropriate cases for treatment on ordinary medical lines. Earlier diagnosis of ulceration of the lesser curvature of the stomach should diminish the number of these chronic cases, and it is on account of the help which it affords towards recognition of these obscure symptoms that we feel Prof. Faber’s communication to be a timely

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INFLUENZA. form of influenza is prevalent throughout the country. The symptoms are sudden in onset and primarily catarrhal in nature, though the region first to be inflamed is variable. While in a small number of cases nausea and vomiting usher in the disease, in the majority an initial malaise accompanied by headache is the first experience to be recorded. There follow general pains, pyrexia, sore throat and cough, scanty expectoration, often pleuritic friction without serious lung complications or cyanosis, and in most cases a short course followed by rapid convalescence. The mortality in young adults is not high. An unusual rash is reported from some parts of the country and pain and weakness in the lumbar region from other districts. We have nothing to add in the way of prophylactic recommendations to the measures now generally familiar except to ask responsible organs of public opinion not to lay undue emphasis on the ravages of the epidemic or to insist on preventive means whose value has not been definitely established. Such action tends to create an atmosphere of uneasiness and dread in individuals which is in itself one of the more potent predisposing causes of infection. A

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THE REDUCTION OF UNIVERSITY GRANTS. THE Universities of Birmingham, Durham, Leeds, Liverpool, Manchester, and Sheffield have addressed a joint letter to the Prime Minister purging on grounds of national importance the danger of any reduction in the grants now made by Government to themselves and similar institutions. The letter is signed by the Principal of the University of Birmingham, and by the Vice-Chancellors of the other five universities, who point out that in all the seats of education the need for economy has been recognised, outlay closely restricted, personal sacrifices made, and needed developments foregone, while the enormous responsibilities of these institutions towards the development of the country are eloquently set out. " The Universities," they say, " hold the keys of the future," and as they have made every effort of self-help, and in this have been loyally supported by the students and their parents, as well as by private and public benefactors, and by local authorities, to fetter such energy will be lamentable. The letter says :-

(a) We have practised expenditure and in the

economy in all structural maintenance and equipment of

severe

laboratories. (b) We have raised the fees for courses of study and for examination by considerable amounts. This can only be justified as an emergency measure. About a third of the total income of our universities comes from students’ fees. (c) We have collected from private benefactors during the last three years .81,175,000 for the maintenance and, where necessary, the development of the universities. (d) The local authorities of our areas have supported us by increasing their annual grants from .874,268 to .8135,868.

The Government urged the universities to make the efforts which have led to this measure of success by encouraging the hope that what was raised locally would be met by a corresponding increase in Government grants, and retrenchment in the present grant would stultify all the efforts of the past, would threaten seriously existing work, and would prevent