Acute Glanders in Man
THE QUALIFICATION OF INSPECTOI~S OF MIDWIVEs.--The following communication from the Royal Sanitary Institute has been considered by the British ~l[edieal Association, viz. :-" U n d e r the ]Hidwives Act a large number of midwives are applying for registration, and in many places Inspectors of Midwives are being appointed. " I t is felt that in addition to their qualifications for their special duties, midwives, and more especially Inspectors of Midwives, should have a knowledge of household sanitation, and the evils arising from insanitary conditions, and how such conditions, when they exist, can be remedied. " I n many instances those applying for the office of Inspector of Midwives have obtained the certificate of competency granted by the Royal Sanitary Institute as Inspectors of Nuisances, and this has been recognized as a useful qualification for the purpose referred to. " If you have issued any statement regarding this knowledge, or recognized this certificate as a qualification, I should be much obliged if you would kindly let me know." It was resolved :-" That it be recommended that the Sanitary Institute be informed that the Association disapproves of the appointment of lay persons as Inspectors of Midwives, except under the direct supervision of registered medicaI practitioners, and that this opinion be also communicated to the central Midwives Board.
ACUTE GLANDERS IN MAN. EVEN in the horse the chronic form of glanders, popularly known as farcy, is of more frequent occurrence than the acute, and the use of mullein has shown that the disease may long exist latent and clinically unrecognizable, but in man the acute form is stil! rarer. It is, however, so intensely fatal, and attended by such horrible symptoms, that the utmost caution should be observed in making post-mortem examinations, and indeed they ought not to be undertaken without absolute necessity, and attempts to save the hide for its pecuniary value ought to be strictly prohibited. In the Spitalul, vol. xxiv. p. 349, is a report of a case in the person of a veterinary surgeon who had made a post-mortem examination of a horse that had died of glanders, by Drs. Bucaloglu and Stoicescu, of Buearest. After he had completed the operation he discovered a small cut on the index finger of his right hand, which he at once cauterized freely, and no local symptoms appeared. But on the 19th day he was seized with fever, loss of appetite, and pains in various parts, especially in the right supra-spinal region. The fever and prostration increased rapidly, dullness was early felt over the apex of the right lung, followed by fine moist r£1es ; severe pain and tenderness in the muscles in various parts indicated the formation of deepseated abscesses, while a pustular eruption, varioloid in appearance, broke out over the whole body, and later the skin became deeply jaundiced. The pus from the eruption and from the abscesses contained enormous numbers of the characteristic bacilli of glanders. Death supervened within a week. The autopsy showed hepatization of the right lung with a large gangrenous abscess therein, and others in the liver and muscles, but neither in the hand nor in the lymphatic glands of the axilla of that side were any changes to be seen. The poison had evidently entered the circulation direct, giving rise to a general septic py~mia.