1085

required to evoke secretion of mucus in the colonand in such cases the goblet cells may be stimulatedmechanically as a result of the violent bowel move-ments produced. On the other hand, secretion of

mucus is readily obtained by mechanical or chemicalstimuli applied locally to the colonic mucosa. Accom-panying this secretion there is a local vascular dilata-tion, and it is of interest to study these phenomenain a little more detail in order to see if they may bebrought into line with the results obtained by SirThos. Lewis in local reactions of the skin in the earlystages of inflammation. Lewis has shown that in theskin the vascular and other phenomena of inflamma-tion are brought about through the medium of ahistamine body produced as a result of proteinbreakdown by the noxious stimulus. Florey’sobservations have led him to conclude that thesecretion of mucus and the vascular dilatation areindependent phenomena. He found that the injectionor local application of histamine acetylcholine,adenosine, and peptone solutions failed to stimulatemucus-production from goblet cells. It appears, then,that the goblet cells directly react to the insult of thenoxious agent, in contradistinction to the accom-

panying vascular reaction which, judging from theresults on skin, is due to the liberation of somehistamine-like body.

Florey’s paper is full of interest and his thesis iswell argued. But clinicians, while agreeing that thegoblet cells of the colon pour out their secretion inresponse to local stimulation, will perhaps hesitateto subscribe to his contention that the secretion ofmucus in mucous colitis is independent of the nervoussystem. The setiological factors in mucous colitisare obscure enough, no doubt. It is hardly a clinical,entity, but rather a collection of symptoms in which theunderlying factor is an instability of the reactions of-vasomotor, cutaneous, and sexual systems as well asthe alimentary. That the nervous system takesno part in this symptom-complex is a view thatcannot lightly be accepted on the results of some

negative laboratory experiments.

VICARY’S PREDECESSORS.

Thomas Vicary was Serjeant Surgeon to KingHenry VIII. and Master of the Barber-SurgeonsCompany, whose modern counterpart endows a

lectureship in anatomy or surgery to commemoratehis name. The lecture this year was delivered onNov. 6th, in the theatre of the Royal College of

Surgeons of England, by Prof. G. E. Gask, who tookas the title of his lecture " Vicary’s Predecessors,"his object being to rescue from oblivion the names ofthose men, famous in their day, who had served thesovereigns of this country before Thomas Vicary.The earliest appointment given was that of Baldwin,Abbot of Bury St. Edmunds, who was the medicalattendant of Edward the Confessor and described asa man " gretly expert in the craft of medycyn." Atfirst the royal attendants were described as mediciregis, surgery not having then been divorced frommedicine, but in the reign of Henry III. the appoint-ment bore the title chirurgicus regis. " Master Williamthe King’s Surgeon," was then presented to "theChurch of Houkerinton, in the same diocese (Lincoln)in the King’s gift by reason of the land of Thomas,son of Walter being in his hands." This MasterWilliam may be regarded as the first of Vicary’s prede-cessors, and from this time on there is a continuousrecord of regal surgeons. Of some little is knownbut the name and the salary, ranging from 10 to E40

a year, to which were often added gifts of livingsand lands as a reward of faithful service. Thomas deWeseham, surgeon to Henry III., was remarkableamong other things for being granted a die for mintingsilver pennies, some of which are in the possession ofMr. L. A. Lawrence, F.R.C.S., and were shown bythe lecturer. Expeditions of war during the reignsof Edward I., Edward III., and Henry V. gave theKing’s surgeons functions which foreshadowed thebeginnings of an Army medical service ; the seniorof the King’s surgeons, the- Serjeant Surgeon, wasmade responsible for supplying a surgical staff andfor collecting medical supplies. Prof. Gask illustratedhis lecture with lantern slides of drawings from oldmanuscripts, an interesting exhibit being a surgicalinstrument case of fine craftmanship, lent by Mr.A. E. Williams, bearing the Royal Tudor Arms andthe arms of the Barber-Surgeons Company. This

case, it was suggested, may have been presented toVicary by Henry VIII.

PROPHYLAXIS OF SYMPATHETIC OPHTHALMIA.

Dr. Albert Holdener, assistant in the Biirgerspitalat Zug, gives an account of five cases treated in theeye clinic at Zurich, in which sympathetic ophthalmiaof the sound eye occurred after early enucleationof an injured eye. In the first case the wounded eyewas enucleated 14 days after the injury when thesound eye was completely normal, both to externaland to slit-lamp examination. Twenty-two daysafter the enucleation signs of slight irido-cyclitissupervened, confirmed by the slit lamp, but underenergetic treatment with atropine, mercury, andsalvarsan it ran a mild course without ever materiallyaffecting the vision, and in ten weeks it was practicallywell. The second case was that of a man of 22 whoseleft eye had been blinded by an arrow wound at theage of 10. This eye became irritable and when thepatient was admitted to hospital it was in a con-dition of secondary glaucoma. A trephining wasperformed and following this an extraction of thelens, but the eye got worse and then at last thepatient gave his consent to having it enucleated.After three weeks in hospital the patient was dis-charged, but 12 days later two punctate spots appearedon Descemet’s membrane of the remaining eye. Inanother fortnight, the signs of sympathetic infectionbeing unmistakable, he was readmitted and inten-sively treated as in the previous case with suchsuccess that he was discharged in a month apparentlycured and with normal vision. The third case wasthat of a man of 28 whose right eye was wounded bythe horn of a cow. After three weeks’ treatment,including removal of a prolapse of the iris and suturingof a scleral wound, the eye was removed on account ofsympathetic danger, which pathological examinationproved to be present. At this time there were noabnormal signs in the left eye, but a fortnight afterthe enucleation, spots on Descemet’s membrane weredetected which later on increased along with othersigns of sympathetic infection. After six weeks’energetic treatment, however, the eye was cured andthe patient was discharged with an eye possessingnormal vision. These cases enforce the lesson thatwhen an eye receives a wound involving the ciliarybody, and more especially when the wound is so

serious as to involve total loss of sight in the affectedeye, it is dangerous to postpone enucleation eventhough there may be no sign, detectable by the slitlamp, of commencing infection in the second eye.

1 Schweiz. med. Woch., Sept. 20th, p. 896.