372 plying between Aquila and Sora, and proceeded on foot through deep snow to his native village of Alviso, there Dusk had set in and to receive the...

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plying between Aquila and Sora, and proceeded on foot through deep snow to his native village of Alviso, there Dusk had set in and to receive the parental welcome. at a turn of the well-nigh obliterated road he was

blocks of buildings in various parts of London have for many years been used as places of recreation and for other out-ofdoor purposes. This can easily be done on the small scale and under single ownership but we fear that under the present conditions of property owning in towns there is little chance of large roof playgrounds being introduced.

by famished wolves. On the next day his family, uneasy at his not having turned up, went out in search of him, and found among the little or nothing that could not be devoured, his bloodstained sword which he had THE PRINCIPLES UNDERLYING THE SURGERY That ani a few other ’indicia’ drawn in self-defence !1 OF THE STOMACH AND ASSOCIATED which marked the scene of the struggle, to say nothing of VISCERA. the wild animals’ footprints trending away to the pine wood, THE American Journal of the Medical Sciences for left no doubt as to the poor fellow’s fate. Were the bear not a hibernating beast of prey there are specimens enough January contains a remarkable article on this subject by of it in those wooded uplands to add a fresh dread to that Dr. William J. Mayo. He points out that the study of the of the wolf, which under stress of hunger, like the sea bird embryology of the gastro-intestinal tract illustrates how much under stress of storm, invades the haunts of man. Fortu- more permanent is function than form. The primitive innately an Italian winter, however intense, is of brief dura- testinal canal is composed of three parts-fore-gut, mid-gut, tion, and within a few days’ time even the Austrian slopes and hind-gut-the anatomical distinctions between which are of the Alps in the Venetian territory will be ringing with lost in development. Nevertheless, these parts remain the joyous refrain :— physiologically distinct. From the fore-gut are developed the Der Lenz ist gekommen, pharynx, oesophagus, stomach, and duodenum. Now all Der Winter ist aus.’ these organs prepare food for digestion but absorb it only to a very limited degree. In operating soon URBAN ROOF GARDENS AND ROOF after a meal Dr. Mayo has been struck with the THE physically defective persons who hang about the milky lines of full lacteals in the jejunum while none streets of our great cities all the year round and in the were evident above it. The duodenum-with its wide summer time swarm as tramps on the country roads, form a calibre, fixed position, and delivery point nearly as high as woeful spectacle and social reformers are agreed that its pyloric origin-enables the chyme to be mixed thoroughly nothing should be left undone which may promise a way of with the pancreatic and biliary juices. In the jejunum, coping with this evil. As it is obvious that any scheme of ileum, caecum, and adjacent part of the colon, which are this kind must have the proper upbringing of city children developed from the mid-gut, absorption takes place. Hence for its principal feature Dr. James Dunbar-Brunton has gastro-jejunostomy does not deprive the patient of any written to us suggesting that much would be done towards appreciable absorbing surface. At the ileo-cascal valve the improving the health and physical condition of the juvenile greater part of the nutritive elements of the food have population if all the houses in the poorer quarters were been absorbed and the intestinal contents are still fluid. provided with flat roofs which might be used as playgrounds The cascum absorbs fluid which is held for this purand might be beautified with trees and flowers in tubs and pose between the ileo-casoal valve and a physiological pots. Going more into details, he would have all city muscular contracture (the casco-colic valve). The c2ecal councils, which govern the plans of the builders, insist function explains why cholecystenterostomy into the hepatic that when houses were built for the poor in long rows flexure of the colon is so successful in complete obstruction undetached the whole length should have flat roofs. of the common bile-duct when for any reason the duodenum These would be protected by a parapet and the children cannot be used. The continuous flow of bile seems to prevent would be safe from straying or accident. These flat roofs ascending infection, although the colon contains more would be under the care of the health department of virulent organisms than the duodenum. On the other hand, each large city. They would be free playgrounds, costing when external cholecystotomy is performed the patient loses but little. Each roof should have a covered part where the in the discharge of bile from 20 to 30 ounces of fluid daily, delicate children could find shelter from rain and sun. He is compelled to drink large quantities of liquid, and still further recommends that for every street or series of smallshows signs of dehydration. The value of water in the streets a light hospital should be erected on one of these human economy is testified by its reabsorption in the casoum. roofs. The number of beds would be in proportion to theThe hind-gut begins at the splenic flexure of the colon. The area served. These hospitals could be built of frames andnormal action of the upper colon is antiperistaltic except should have as much glass in their structure as possible. If ,4iuring defalcation. Mr. C. J. Bond has proved that particles it be asked why these hospitals should be built when4of indigo-carmine placed inside the anus are carried there is a difficulty in supporting those which are alreadyupwards by what he calls "reverse mucous currents."1 in use, Dr. Dunbar-Brunton’s answer is that theserhus valuable food elements and fluids are carried back into little hospitals are for the tuberculous children of1bhe casoum. Advantage is taken of this in the adminithe poor, who will then have a better chance ofIstration of saline solution by the rectum. Dr. J. B. Murphy recovery owing to their removal into a purer atmosphere 1aas shown that large quantities of saline solution-from two and the supervising of their food. They would also be1j0 four quarts-introduced very slowly into the rectum are within easy reach of their parents who would feel that thekabsorbed rapidly by being carried by reverse peristalsis to children were almost in the same house as themselves andt;he ca3cum. Adami and Ford have found that leucocytes would therefore put no obstacles in the way of their I3ass out on to the surface of the duodenum and upper removal. The public health authorities would appoint a j ejunum, pick up particles of fat and bacteria of various medical officer whose duty would be the daily inspection of Idnds. and destroy the latter in the neighbouring lymphatics. all roof gardens and hospitals. Each hospital would have a j.3ome bacteria are carried to the liver and there annihilated. The upkeep of these ()thers pass through the liver and are excreted with the bile. nurse who would be a district nurse. hospitals would be small and would be drawn from a special 1l’he bile must therefore be looked upon as always infected fund. The cost of building them would have to be defrayed amd probably an attenuated infection is the cause of gallby public subscription or by private munificence. Theoreti- sstones. In Mikulicz’s clinic it has been shown that a cally the proposal is no doubt excellent and a portion of it 1 THE is not entirely novel because the fiat roofs of some detached LANCET, July 29th, 1905, p. 275. assailed