APRIL J, 19I31 SPREAD OF TUBERCULOSIS BY DUST. [MEDI''L JOU AT 605 _~~~~~~~~~~~~~~~~~~~~~~~~~~ cubic feet of air space. The bedclothes are changedl every we6k. Examiining the sputum of 24 of tlle patients, Chausse found from i,ooo to I6o,ooo tubercle, bacilli in i liig. of the moist expectoration, tlhe 3rtttJft fetbtcat 2o urual, average beinig 6o,ooo. He kept a cage containing tlhirteen guinea-pigs for five weeks in the m-iddle of one of these wards; not one of the animals con- tracted tuberculosis, although the cage was close by SATURDAY, APRJLL 3RD, 1915. the bed of a patient who couglhed " enlorm-lously," and brought up a sputum containing I 25,000 tubercle bacilli per milligram. In other experiments Chlauss6' kept cages containing from I4 to I9 guinea-pigs for TIHE SPREAI) OF TUBERCU1OSIS weeks by the side of patients with advanced plhtlhisis BY DUST. in smaller separation wvards with onlv two beds in THE idea that tuberculosis couild be conveyed by the eaclh ward. Here the opportunities for infection inhalation of tuberculous dust -or the pulverized appear to have been greater than they were in sputuin of tuberculous patients must be tlhousands the large wvards. In an experimeint carried out during of the summer, when doors and windows were years old. It was definitely formulated by the freely French opened, i guinea-pig out of Villemin in i868, and was proved 14 contracted tubercu- plhysician beyond losis. A similar experimiient at mid winter, when the thle possibility of doubt by Koch's great series of over doors wei-e kept shut and the windows two hundred inhalation experiments with pure almost entirely closed at niight, resulted in the infection of Io out cultures of the bacillus which he had isolated in the of early eighties. i6 guinea-pigs. Two otlher experiments carried out About five-anid-twenty years ago during the cold weather gave similar results. In Corniet claimed to have proved that it was the dust al1, containing ptulverized tuberculous sputum from the out of 76 guinea-pigs exposed for four or fiv-e weeks inimnediate of plhthisical patients to infection 30 became infketed, and the pathological nieiglhbourlhood that lesions found in them post mortem were always those was the main infecting agent conceried in the spread of an inlhalation tuberculosis. of and years Examiniing eighteen tuberculosis, for the next ten this view specimuens of dust collected in the smaller obtained very general acceptance. But in I 899 wards, Fliigge brought forward argumenits to show that Chauss6 founnd that seven of them (or 38 per cent.) contained virulent tubercle bacilli. But the presence plithisical patients were infectious to others by means of the minute droplets of tuberculous sputum they of the patienlts rendered the sojournl of the allimals in dis- these wards far miiore danigerous to them than did the charge on coughing, ratlher than by the dried sputum in the form of dust tlhev leave them. dust alone. An experiment was conltrived and carried behind Their out for ten weeks, in wlichl the twvo coucghincg, sneezing, and even speaking were alleged to phthisical patients the inhabited one separation ward by day, another by load surrounding air with tuberculous sputum, and night. One cage of I9 (lirectly to endanger all persons wlho came near guinea-pigs kept comipany them witlh the patients day and night for five weeks, durinig the performiance of these acts. Fliigge wrote wlhile another cage i8 of the withi all the autlhority of an containing animals was eminent German bacterio- kept constanitly for ten weeks in the ward left logist; and his tlheory of tuberculous infection by just by the patients. Of the I9 guinea-pigs I5 becamle verspr.itzte Tdipfcheni, or sprayed droplets, is videly believed at the present tuberculous, but of the i8 only 2 were infected. timne. Quite recently, how-. The imnmediate source of to ever, the question has been submitted once more to a danger lies, according Chausse, not in the phthisical patient's coughing so careful experimental re-examination by Chauss6l of much as in his handkerchief. He describes Paris, and, as has so often been the case on experi- previous ments showing that tuberculous sputum dried on a occasions in scientific mlatters, the conclusions of handkerchief preserves some of its virulence an(d thie -French mnan of science flatly contradict those obtained by the Germani. vitality for at least ten davs. The patient's bed- clotlhes and person he believes to be much less Chauss6 brings forward reasons and experimental dangerous sources of infection to to prove that in tuberculosis infection is others, although, as w,.ork exclu- he admits, it wvould be hard to demonstrate this fact sively, or almost exclusively, effected by dry particles. by experiment. He quotes further experiments to Indoors, tubercle bacilli possess sufficient Vitality to show that the dust met with in survive drying; on the other hand, phthisical public places, ancl patients even in so apparentlv infectious a as a third- do not often scatter tuberculous spray, and, when spot class smoking compartment in a French train, only they do, the spray is in the form'i of comparatively rarely in actual practice contains virulent tubercle large drops that fall to the ground close by and bacilli. cannot be inhaled by other persons. He finds that, The general coniclusions to wlhich even when guinea-pigs are made to inlhale the Cliausse comes are of considerable practical importance. The spread air expelled by the phthisical patient in coughing, of tuberculosis must be controlled they- not become by limiting the do infected with tuberculosis. dangers of infection by inhalation to which those taving access to the wards of the H6pital Boucicaut whlo Paris, are brought into contact with phthisical patients itn where Professor Letulle's plhtlhisical indoors are exposed. He discards Fliigge's droplet patients are treated, Cliauss manade numerous experi- hypothesis altogether, zand states that it is only dust -ients to determinie in the first place hlow great the contaminated recently with tubercle baciili that is dangger of living with phtlhisical patients is, and, in seconcd, whlat is the origin of that danger. The dangerous. Until it has clried uLp, tuberculous sputuim t1he is practically harmless because it cannot get into the -hospital is of modern constructioni, well lit, -well air in the form of dust; and after it has been driedl veiitilated ; the tiled floors of the two phthisical and exposed to the light for a few days, the tubercle Iivards, whiclh look attractiye if a little crowded in bacilli it contains lose- their virulence even if a photograph reproduced, are washed down daily. they still survive. He attributes an altogether secondary Each of the 32 patients in eaclh ward has about 1,140 importance to any hereditary tecndency to tuber- I Anntales cle lIuistitut Pasteur, Paris, 1914. xxviii. culosis. TTHE ] 6o6 MEDIC fLBRITTESJOURNAL WORK AS IV iND CURE. [APRIL 3, 19!5 rather wvide generalizations of Drs. Whliite and Fran-z WORK AS MIND CURE. appear to be founded-nor in the cautious conclusions M\H1AT appears to be a lopeful line of 'research, and of the two experitnenters, to show lhow lcng tiem one likely to be followed in time by practical results, newly acquired hiabits and adaptations persist after is outlinecl in Bulletin No. 5 of the Government the cessation of instruction. Even if, however, the Hospital for the Insane at Washington.' In hardly gained adaptations and good habits prove an interesting introcluctory paper Dr. William A. temporary arid entirely- incommen-surate witlh tle Wlhite, the' Medical Superintendent, describes the trouble and expense involved so far as the great origin at his asylumt of the scientific investiga- majority of patients are concerne(d, it cannot be tion of occupation in the treatment of the in- doubted that a clearer insight will be gained into the sane. He became imbued with the belief that much mechanisms and procaesses by wlhicil recovery takes of the deterioration of the inmates of large asylums place in the minority, and the possibility and manner was the re-sult of the environment in whichi thev were of assisting these processes made plainer. Tihere may forced to exist, that is to say, that much of the even be possibilities of adjustment lying fallow in a, deterioration was not an inevitable declension deter- considerable proportion of the permanently invalid mined by internal factors, but was due to th-e patients wvhich will repay a more scientific and discriminating taking their colouring Irom their surroundings--in cultivation than las heretofore been attempted. fact, adjusting themiselves to their environment. The studly of wcrk as a therapeutic agent has been He therefore secured the services of a psychologist carried on at Wasbiingtom. Asylum by griaduiate stu- for tile sole purpose of studying tlle problem of dents of universities under the Scientific Director for hlabit formation. The work done, thoughi confined only tlhree years-a time quite insufflicienit to give to very few patients, wvas extremely suggestive, conclusive results. Nevertheless, Dr. White and his I)r. White says, and very hopeful in its results. colleagues have done well even at -this stage in pub- It was quite remarkable," he tells us, " how patients lisliing a bulletin devoted to this problem, as interest who had been considered absolutely inaccessil)le could in arnd }elpful criticism of a miiovement which be awakened to interest, anid how patients who had seems likely to grow in importance will thuls be been considered almost imipossible to care for because stimulated. of noisy, destructive tendencies, could lhave their discharge of nervous energy drafted into more useful channels." THE DETERMINATION OF SEX. The three essentials for the scientific use of work FEW-biological problems are so fascinating as that of in a large asylum are given in the following order sex determination; none are more baffling. Many of importance by Dr. White: The primary object w-riters on thie sulbject have been influienced by theo- slhould be therapeutic; thle second object slhould be retical conceptions, often based upon inadequate the econoimic advantage of tlle institution; and the statistical evidence, and others have exaggerated the tllird should be -to ensure that all employment of importance of histological or physiological dlis- patients is so conducted and records so kept that the coveries, the significance of which they lhave general- results may be available for scientific analysis. To ized iunduly. An impartial statement of our presenit carry ouit this scheme successfully there must be a pre- knowledge of the subject will be welcomiied by all I liminary examination of each patient to indicate whlat students, and Dr. Doncaster's treatise goes far to their Dr. Wh'ite well terms " the avenue of approach to his satisfy requirements. interests," and the occupation wlhen decided upon The problem, as Dr. Doncaster points out, is com- imust be followed under scientific supervision, and not paratively simple if attention be confined to certain left to shop foremen and instructors in arts and crafts. species and otlhers are neglected. Thuis evidence that IlndividuLalization, and the avoidance of the factory the eggs iiiay determine sex apart from fertilization type of emplovment, furnislh the keynote of success, is afforded by (i) the facts of partlheniogenesis; (2) sex limnited hereditary transmission by the just as in training institutions for the feeble-minded. female There is, of course, notlhing new in the use of work (3) bases in which two kinds of fertilizable eggs, as a therapeutic measure. The value of Dr. White's differing in their chromosomes, are produced. Simi- scheme consists in its scientific application ; in its larly, evidence in favour of sex determination by tlho prescription of the form of labour only after and spermatozoon is afforded bv (i) cases in whliclh .according to the results of psycho-physical analysis unfertilized eggs produce males and fertilizecl eggs mnd its continued scientific scrutiny-in fact in its females; (2) sex limited transmission by the male; extension of the psycho-physical laboratory to the (3) the existence of two kinds of spermatozoa dtiffering farins and worksliops of the asylum. To what extent in respect of their chromosomiies. On the basis of these facts we suclh intensive effort will meet wvith practical reward mlight say that sex depended upon the remains to be seen. presence of a greater or less amount of somo " sex- Dr. Slhephierd Franz, Scientific Director, says that determining substance" in the chromosomel1s, or upon tlhe facts already gathered have demonstrated the the interaction of this substance Nwith thle rest of the ease with which lnew habits may be acquired, and cellular material. Btut this simple explanation is thow soon insane patients may be made useful and rendered doubtful by the existence of facts wlich partly self-supporting in an institution; they lhave suggest that the eggs mnay influence the sex in cases shlown that ithe insane are capable of adjusting them- in which observations on clhromosomes indicate tlhat selves to new conditions, of forming new habits, and the determination should rest with the spermatozoon, of following new methiods of thoughlt. There is and of others whlich point to the possibility that sex notlhing, however, in the carefully described experi- maybe modified after fertilization by influences acting, miients on habit formation in dementia praecox, by on the early emibryo, or even later. Grace IIelen Kent, Ph.D., nor in the account of the In this connexion the experiments of Hertwi(g n.ill. nourse and character of learning in the same dis- the remarkable studies of Geoffrey Smith are ol Drder, by Edwin G. Boring, M.E., A.M.-on which the special importance. Hertwig foundl that over-ripe- ness of the eggs, in the case of frogs, caused a I Government Hospital for the Insane. Washington; D.C. Bulletin No. 5. Edited by William A. White. M.D. Government Printing 1 The Deternmination -of Sex. By L. Doncaster, Sc.D. Caiimbridge: 'Offico, Washington. The University Press. 1914. (Med. 8Vo. Dn. 172; 22 p!ates. 7s. 6d. net.) APRIL 3i 19T51 THE PRESIDENCY OF THE ROYAL COLLEGE OF PHYSICIANS. [ jTBDIlaXInh 607 I Preponderance of miale offspring, but tbat, in. tlle same a graduate of Oxford. Tlle new president, Sir Frederickl species, certain miiales produced a higher percenta^N Taylor, elected last Monday, the day after Palm Sunday of femtale offspring than others whlennmated vith any according to the statutes, is a graduate of London, female. Geoffrey Smiithi found that tlle physiological having taken the degree of M.D. in 1870. He became a condition indcluced in the crab by the parasite SaccIt- Fellow of the College in 1879, was an examiiner at variou's linat wenL fatr towards coniverting a nmale into a periods from 1885 to 1896, was on the council from 1897 femal-e. In the case of maln, fluctuations of the sex to 1899, and Nvas censor in 1904, 1905, and 1910. He ratio caiinot be attributed to influences operative has been the representative of the College on the Senato Uponl the miiale parent alone. It m-ay be obserived of the University of Londlon since 1907. He gave that the study of causes affectingo the sex ratio in man the Lumleian lectures in 1904 oni " Somne Disorders of is extremely difficult, as has beeni showni by the work the Spleen," and was Harveian orator in 1907. He is of, amonig othlers, Heape, Punnett, anld Ewart. physician to Guy's Hospital; hiis predecessor, Sir Thomiias Heape, wvho investigated the subject on the basis of Barlow, was physici-an to University College Hospital. Cuban data, lheld that wvhenl miietabolic activity was Sir Richard Douglas Powell, whlo was president from great femiale ova tended to develop rather thanl male 1905 to 1910. was physician to the Middlesex Hospital; ova, an-d attriiibuted the preponiderating influence to his predecessor, Sir William Clhurchl, was pllysician to the female. Ewart argued that the age of the mother St. Bartholomew's Hospital; Sir Samiiuel Wilks, wlio pre- wvas an imiportatInt factor in sex determination, the ceded him, was physician to Guy's Hospital. Sir J. ratio of miales to females increasing with the age of Russell Reynolds, who was president from 1893 to a the mother. Puiniett found that the ratio of male to few mnonths before his deatlh in 1896, was plhysician to female l)irths was lowest in the poorest class of the University College Hospital; Sir Aidrew Clark, who pre- popuilation, but pointed out that this could not be ceded hiim, was physiciall to the London Hospital; and attributed purely to a nuttritional influence, lnot only hiis predecessor, Sir' Williamu Je-nner, was physicianu to b)ecause thle age of the mother might play a part, but University College Hospital. At the present timne tlhe a Treasurer, the Harveian librariau, anid tlhe Registrar are b)ecause the earlier born children of famiiily tended to members of the staff of St. shlo-v a, higher male to femn-ale ratio than the later Bartlholoniew's Hospital. Thje I)ofll. These iniflttences would both tend to increase longest tenLure of the office of president was that of Ilie ratio iii the case of the wealthier classes, with Sir Henry Halford, who was president from-l 1820 to 1844. thieir highelr average age at marriage and greater The office is an annual one, but is, as a rLile, held for five teudciicy to artificial restrictioln of fertility. years. Dr. Doncaster is inclined to think that sex should be regarded as dependent on a physiological condition PUBLICATION OF FORMULAE OF SECRET consequent uLpon tlle interaction of certain chromo- REMEDIES. somes w-ith the protoplasm of the cells, determined, IF America is tlhe land in whlliel unrestrainedI indivi- in the absence of disturbing factors, by the presence dualism is allowed the largest opportunity of filling private or. absence of these particular chromosomiies. If the pockets at the public expense, it is also distinguislhed by difference betw-een the male and female chromiiosomes the courage witlh whicli its public autlhorities set about is considerable, this will outweiglh any other influence the remedying of demionstrated abuses, regardless of the wlhich might tend to affect the general result, but, as vested interests wlhich mnay siffer by such procedure. We the lifferences becolmie less and less marked, environ- publisled recently the particulars supplied by tlle UT.S. miienital changes become more and more important Department of Agriculture as to tlhe principles oni wlhicl elements in the determiniation. Inisects, birds, and action in regard to patent medicinies would be guided in amphibia perhaps stand in that order when classified future. They seemed to promlise severe repression of ex- -nAccording to the importance of chromosomes as sex cessive claimns as to curative power. In tlle present issue dleterminers. With respect to the possibility of in- (p. 601) will be found some particulars ini regard to the Aluencina or p-eedicting the sex of human offsprinig, regulations recently made by the Department of Healtlh of Dr. Dolncaster tlhilnks we slhould still preserve an open the City of New York requiring that patent medicines miindc, w-ith perhiaps a tencdenlcy towards scepticism. sold witliin tlle city slhall bear a label describing tlho ingredients, or that suclh informationi slhall be filed in the office of tlle Boarld. Needless to say, the proposal lhas arouised the liveliest opposition onl tlIe THE PRESIDENCY OF THE ROYAL COLLEGE part of the nmakers of proprietary medicines, whlo appear OF PHYSICIANS OF LONDON. to liave succeeded in getting, a number of tlle retail flsE Royal Colleg-e of Physicians of London lias liad druggists to attend a meeting to protest. We reproduce niinety-seveni presidentts since Ihenry VIII, in thie tenth an interestingr article froni the Bulletit of the Depart- year of hiis reign, guanted a charter of incorporation. In ment dealingc witlh alteratiolns in the comilposition of pro- grainting thlis cllar-terlhe said tlhat hiis main reason was to prietary articles, and from anotlher issue of the sanie cleek mleii who professed physic rather froni avarice than Butlletit it appears tllat the imieeting of retail druggists in goodl faith, to the damage of credulous people; was worked up, if not actually originated, by a firmii of accordingly, after tie example of othier lnations, lhe had proprietary medlicine mlaliers, and tllat some druiggists determine(d to fotund(i a college of the learned men who liave writtell to the Departmient warmilly supporting tlhe practised plhysic in Loiidon, in the lhope thlat ignorant and new regutlation. The alterationi in the composition of rash practitioners might be restrained or punished. The a patent meldicine is, of cour'se, an occurrence by no means chAarter was granted to John Chamber, Thomas Linacre, peculiar to America. Recently, in reply to a cort-espondent, Wolsey, Arelbislhop of York, and otlhers. The College so we mentionied tllat- tlle nostrum sold as Celimno, vllhe eonststuted first exercised its privilege of electing a presi- analysed liot lonog ago, was found to hiave a comiipositioni deneltby choosing Thomas Linacre for that office in 1518. very different from that showni by tlle analysis publishled Downi to 1876, when Sir George Burrows ceased to be in 1910 and reproduced in 3More Secret B?conedies.' presidlent and was succeeded by Sir James Risdon Bennett, Again, in tlle fsame book, mentioni is made of a gradtuate of Ediniburligh, thepresident liad always been a the great variation fountl in different supplies of graduate of CamibridgeorOxford. Since the spell was broken " Karox Compound," and several otlher inistaances are tlle lhave all been graduates of the University of presidents, I.Secret Bejnetlies: Wltat they Cost andtc What they Contain; and, London, witlh the exceptioin of Sir Andrew Clark, wlho %was Mlore Secret Remtedies: Whtat they Cost anid Whatt they Contain. London: British Medical Association, 429, Strand, W.C. (Price Is. a graduate of Aberdeen, and Sir William Clhurcll, who is .each: postage, 3d. each.) Titz Biunm 6oS MZDIOAI;J*tUNAt ) GONORRHOEALGONORRHOEAt~~~~~ INFECTION IN CHILDR1~~~~~CHILDREI'T. tAPRIL 3, igi,5 ~APRIL 3,19 5I to b.e found in that volume and its predecessor safely be made in the case of millks which have not iunider- Secret Remiiedies. Such variation is, of course, only gone any appreciable souring. Dr. Monier-Williams's one of tlle minor evils attenidin£g the sale of these experiments, carried out witlh about 150 samples of miiilk, remiedies, but th( przX - that lthe forniulla sllhuld appear siow the freezing-point to be from -0.5140 to --0.558", on the label would seeim to be an effective meanis of the mean value found being -0.5345'. Very elaborate pre- dcaling witlh it, as alny vendor selling a lmlediciiie of cautions were taken in tile experiments to eliminate all differenit comiiposition froim that set fortlh on the label sources of error as far as possible, andl tilese figures are would render ljiwself liable to penalties. It will be probably accurate to about '-0.002-. It would scarcely 11( remiiembered that one of the principal proposals put practicable, ill tlle orldinary examiinlation of milk, to adopt forwvard by the British Medical Association before the all the precautions emiployed by Dr. Monier-Williains in. Select Committee of the House of Commnions was for tlho order to obtaini acculrate data, but it is pointed out in tlhe puiblication of the formula; tile Coimmittee recommended repoit that tlhe experimiental procedLure may be greatly that the formula s}iotild be divulged to a Government simplified witlhout appreciable loss of accuracy by using (lepartment, but not tllat it slhould be published on the as a standard a soltution of 9.405 grams of pure caue sugar label, and possibly that method luight prove quite satis- in 100 grams of water, tile freezing-point of wilichl i5 factory if tile Government department exercised stufficient the same as tilat found to be the average freezillg-point vigilance. It will be very interesting to watclh the effect of mlilk. iThe conclusion arrived at is thlat the freezing- of tlle worliing of the new regulation in Newv Yorl, ancd point appears to be tile most constant property exilibited possibly tlle experience tllere gained muay be of use when by genuineneilk, and that the metlhod m-ay, ill certain legislationi on the subject is before the House of Comllmons, circumiistances, be applied with advanitage as a con- as wve hlope it milay in the not too far distant fuLture. firmatory test for the detection of added water ande the approximate estimation of tile aimiounit present. A THE FREEZING-POINT OF MILK AS EVIDENCE formula is included in the report for the calculation of the OF ADULTERATION. probable percentage of added -water frolmi time freezing- A REPORT1 issued recently by the Local Goverinm-lent point found. Board account an contains an of interestiig investigationi GONORRHOEAL INFECTION IN by Dr. G. IV. Monier-Williamns into tile variations of the CHILDREN. of THE subject of gonorrlioeal infection in cllildrel ix freezing-poinit muilk and tile possibility of utilization of importanit not only on account of tlle muoral its as evidence of addition disquietuide determiniation tlle of water. introduced inito the-family circle, but also by reason of tile Attention las been drawn by previous workers to tlle -very constant chronicity of maany cases and tile possible complicationas values obtained- for the freezing-point, and its which may Cnsue. This applies more particularly to determnination is utilized to a considerable extent on the gonococcal vulvo-vaginitis in girls, wlicll is by far tile Continient, but very little work appears to have been done in regard to it in tilis couctry hiitlierto. Maniy determiiinationas more frequent formii of infectioni. The lnajority of articles have published on tilis stubject are by Aucrican writers, but beeni m-lade byvarious workers of tlle oslmlotic pressure this is probably dLue to m-ore tiloroughl inivestigation, for of the blood serLIm of differenit animuals, anid it has been that tllis the colnditioni is certainly coi-nmoii in tilis couniitry. .slhown is practically colnstalnt for anly given Kimisball1 observed 70 cases of vulvo-vaginitis out of species. It is niatturally to be expected tilat different fluids of 600 admissions to tile B3abies' Ilospital in New Yorkl; and the body sliould eitlier possess tlle same osmotic Pollock2 estimiiates tilat from 800 to 1,000 girls are inifectec pressulre, or tilat tilere silould be a constant relation anid it yearly in Baltim-ore. All observers agree tilat tlle great betwveni tileml, has been sh7own tllat tllere is sucll a muajority of thlese cases are duc to gonorriloeal inifectiol, constant relationship between the osumotic pressures of tllo blood and of of tlle wvork but opiniolns differ considerably as to prognosis and the ililk cowvs, mllost wiliell has beell results of treatmiienit. WlWlile somne clain rapid cures by dolle pointing to tile identity of tilese constants.. As is well combined local anid vacciine treatlmlenlt, othlersl state tlat kinown, tlle freezing-point of a solution is a simple nmaniy cases becomue clhroniic in spite of treatment, anid reliable index of its osmotic pressure, and the result alid of work of various that vaceiile treatmilenlt is useless. Taussig," i tlle investigators lhas been to slhow that a recenit report oni 66 cases, takes all intermiediate tile freezing-point of m-ill is independent of differences in position, and says that witlh proper treatim-ellt 75 breed, age, or period of lactationi of tile cows yielding it, - cent. of the cases shouLld whiereas of per be cured in tllhre tile proportions all the conlstituents of milk or four montlis. He a(ldmlits, lhowever, tilat the proof whicll are determined eveni in a tliorougli analysis are liable to variation. of cure is difficult to obtaini, even by nmieans of tle. considerable Tlle osmotic pressuLre, or gonococcal com-lplenient fixation test. The nmetilod -of tlle freezing-point, is a function of tlle ratio of tleniLumber treatmnent lie adoptedl colnsisted in tile inistillation of silver of molecules of dissolved substances to the numiiber of preparations by mueans of an ordiniary rubber-tipped molecules of tile solvent; the variation in tile proportion urethral syrin ge; lie preferred tllis mnetilodi because vaginal of one dissolved colnstitueLnt, tllerefore, as for example, douching does Inot distend the folds of m1ucous m1eibrane. lactose, may be conmpensated by a corresponding variation For tle first twoweeks 25 per cent. argyrol was injected in sense tlle opposite of tile proportion of some otler twice daily; for tile tlird and fourth weeks 1 per cent. soluble constituent. In milks containing less than the silver nitrate daily; for tile fifth and six weeks 2 per cent. normal proportion of solid matter, it is frequently very silver nitrate every other day; fromu tlme seventh to thlo difficult to decide is due to some wlietlher tllis abnormality tenth weeks 4 per cent. silver nitrate once or twice a week. in tile milk itself or to tue presence of added water, and, He regards vaccines as useless in gonordloea of mu1t1cous: for tile reasons just stated, the determination of the membranes, and obtained little beniefit from treatnilenit by amount of lactose or ashnmay be insufficient to settle tlle the lactic acid bacillus. In serious variation in Taussig's series of cases coin- question; any tlle freezing-point ill an phiications were rare -1 case of supposed salpingitis anid upward direction, lowever, points with considerable cer- 1 of artllritis, butt peritollitis has beeni recorded by otler tainty to the additioni of water. The clhief disturbing observers. ComiibyI reported 8 cases of vulvo-vagillitis element in such argumenit is the development of acidity in with varyinga degrees of peritonitis, all of W-hicl tile milli by fermentation of tlle lactose, by wllicll tile recovered witlhout operation, but fatal cases ilave numiiber of lmlolecules of dissolved substance is increased, beeni reported by Iluber anid Bagiiusy. Barnett anid deductions from tile therefore only freezing-point canl I 1 IMeCJ. Record, 1903. Food Peports, No. 22. Price 4d. To be purchased. either directly 2 Buill. Jo/ins Hopkins Hosp.. 2a.1a 19C9. or througlh any bookseller, fromi Messrs. Eyre and Spottiswoode mice jo i-n. lied. Sci., 1914. (London), Alessrs. W'ymiian and Sons, Limnited (London and Cardiff) 4A n. 47emed,.J ?in.foitile, 1914. lIM.A. ,Statiouer3-Office (Edinburgh); or E. Ponsonby, Limited (Dublin). I sAic/. of lkialt ijces, 1913. APRIL 3, THE HEALTH OF [ 1915] BELGIUM lDCA JOURNAL 609 found endo-cervicitis a frequent complication. It is, to the palaeontologist of the Geological Survey, and to thie tllerefore, possible that gonorrhoeal vulvo-vaginitis Geophysical Laboratory of the Carniegie Institution of in childlhood may lead to infection of the uterus and its Washington, and the conclusion was that the lhuman appendaaes, and accotunt for some instances of chronic remains from tlle Lagoa Santa caves could not witlhout tubal disease and sterility which are only discovered later more conclusive proofs be accepted as "belonging to a in life. Gonococcal vulvo-vaginitis is important from the race which lived contemporaneously with the extinct medico-legal standpoint; the source of infection may be species of animals found in the same eaves." As regards immediate by attempts at sextual connexion, constituting a skull taken from the harbour of Butenos Aires, Dr. evidence of rape, btut indirect infection is much more HIrdlicka says that it presents no features which would common. In Taussig's cases tllere was no evidence of justify its classification as a representative of a species of rape, and in only two cases was there gonorrhoea in the ancient primates, premediate forerunners of tlle human mother. This autlhor is of opinion that infection is usually being, the Diprohomno platensis. The skull, in hiis opinion, from cllild to child throuah the medium of the commoni bears no evidence even of having belonaed to an early or lavatory seat. He points out that vulvo-vaginitis is rarely physically primitive man, but to a well-developed and observed after the age of puberty, owing to the protection physically modern-like individual. Our contem-lporary, afforded to the vaginal orifice by the growth of the labia after discussing the evidence in some detail, concludes majora and pubic hair. As regards prophylaxis, he that, while the question of antiquity is undecided, every disease and instruction recommends notification of the of evidence available in North as well as in South Amierica parents and guardians in the sanitary measures to be seems to point to the comparatively recent origin or taken to prevent spread of the infection. occurrence, geologically speakina, of man on the American continent.

INCREASE OF TRACHOMA IN THE NEW WORLD. THE HEALTH OF BELGIUM. SINCE the conclusion of the Spanish-American war WRITING from Brussels at Christmas Dr. Mamiilock, a fre- trachomua has greatly increased in Cuba, and from a note quent contributor to the Detitsche mlediz.inische TIVochen- in the Medical Recor-d (January 30th), it would appear schrift, has sent to that journal an accoutnt of tlhe that the disease is spreading in different sections of North measures adopted by the Belgian and German medical America in a iuanner wlhicll seems to warrant the opinion authorities to safeguard the health of the nation and its that otlher factors more important than immigration were self-imposed guests. It appears that the public health concerned, thoughl immigration played the chief share in department is nominally under the control of the Belgian Cuba. of Porto Rico, has reported a rapid increase King, authorities, but is in reality administered by the Germaus. of trachoma, in no way attributable to immigration., among Galling as this state of affairs must be to our ally, there is the school children in that island. The most potent some comfort in the reflection that, wlheni he comes into factor was, it would seem, the fact that the school system his own again, lie will find the sanitary conditions of tlle lhad expanded from an enrolment of 26,000 in 1899 to country not totally disorganized. At present Belgian and 182,766 in 1913-14, thuis bringing together thousands of German doctors are working together to prevent tlle out- school children who would otherwise scarcely have been break of epidemics, among which venereal disease seemus thrown togetlher at all. On the other hand, trachoma to be a particularly frequent source of anxiety. In tlle has increased in the mouintain regions of Kentucky, province of Namur the notification of infectious diseases Tennessee, and Virginia. where there has been no im- has been carried out with tlle aid of the Belgiani Sisters of migration and no expansion of the attendances in the Charity and the staff of the public health departmueut. Tlle rural whichl are situated in relatively healthy schools, Bacteriological Institute of Namurlhas been available for districts. Helnce, it must be concluded that whilst it is public heal.th work, its Belgian stafflhaving voluntarily certaintlhat trachoma is on the increase in Nortlh America continued their duties. A joint board of Belgiani and anid the West Indies, the cause of this increase remains German doctors meets from time to time to discussmuatters more than doubtful. It happens that tlle disease is of publichealth. With regard to military matte-s, it is appearing in a relatively mild form; but, as our con- to be gathered that after the earlier battles of the war temporary concludes, the purely sociological aspects of Namur was made a clearing place for the casualties, the trachom-a loolm larger than its strictly medical aspects. Belgian hospitals in the town being taken over by the German authorities. As several of the buildings utilized EARLY HUMAN REMAINS IN AMERICA. had originally been convents,maniy alterations had to be THE question of tlle determination of the age of the made. The Germans, Dr. Mamlock states,lhave fittAd up earliesthuman remains found in America is discussed in x-ray departments, batlhs of various kinds (including stn

Jornal Amemrican Medical Association of baths), gymunasiums, sitting-rooms, dental suLrgeries, etc. September 2Ath. Until a few years ago, says our contem- Special quarters are set apart for infectious cases. In porary, North Amnerica was believed to offer the most Chlarleroi, Sedan, and Brussels niuety hospital trains have valuable evidence on this point, though the Bureau of been provided, and every station ontthe lines served by Aluerican Ethnology stated in 1907 that "no specimen these trains is equipped with refreshments and first-aid had come to light in the Northern Continent which from requirements. In BruLssels there is an ambulance depa-t- the standpoint of physical anthropology represented other nent which provides motor cars for the reloval of the than relatively modern mnan." Then some discoveries wounded to hospital. Here, too, many of the hospitals were reported froni the Lagoa Santa caves of Brazil, and have been improvised, and the Palais des Acade'inies, the bones and cultural objects were found in Argentina. As a barracks of the Belgian Carabiniers, and theRoyal result, there was a revival of the story of Atlantis, the Concert Hall have been commandeered for this purpose. origin of the human race being traced from very primitive The greatest considerationhas, Dr. Mamlock says, beein auiLhropoid forms in Southi America. Still inore recently it shown in the execution of these alterations. Be this as it was reporte d that human remains had been found in North may, we hope the time will soon come whlen Belgiutin will

Amei-ica, in an asphalte deposit at Ranchio La Brea in again be able to manage its own affairs, Southlern California. A preliminary account of these remains wasread before thea Maseum of History, Science, and Art RESUSCITATED JOURNALS. of Los Angeles on June 1lthi, 1914, by M1r. John C. IN the BRITISH MEDICAL JOURNALof M1.1arch 27th we aave Merriam. Thle Bureau of American Ethnology sent two a list of Frenchmedeical periodicals whlichl had come to life experts-Dr. Ales Hlrdhicka as anthropologist, and MIr. again after varying, periods of suspended animation follow- Bailey Willis, of the United States Geological Survey-to ing the outbreak of thle var. This week we are pleased to report oa theic dis-Lovcies. The material was submiitted welcome the reappearance of two more. One ofthscse is 6io MIEDICAL JOUeNAL I OUR BELGIAN COLLEAGUES. [APRIL 3, 1915 the Pr ogre8 MeAdical, which, althoughlmaliy of its conitribu- the Aide et Protection aux Medecinis et Pharmaciens tors are on active service, lhas beeni able to mIlake arrange- Sinistres, received a subsidy from the Niational lilief tnents for the renewal of tlleir co-operationi and for tlle Fund a montlh or two ago, but tlhat lhas been exlhausted. carrying on of tlle journal. It deplores the loss of not a few It lhas tlhorouglhly prepared tlle- ground, despite tleo imiemyibers of its staff wlho lhave fallen on the field of immense difficulties under whiclh it has lhad to work. battle. Form-rs lhave been issued to all the doctors and plharmacistts For the present it will be issued lmlontlhly instead of weekly in Belgium, on which tlhey are asked to state frankly their as before, and it vill be largely devoted to the medicine position, that of their famnilies, tlhe loss that they hlave and surgery of war. IThe other periodical wlose re- sustained, alnd the amiiount of money necessary to enablo appearance we are glad to report is the _Ierze Neuro- tllem, at any rate, to tide over their existing terrible logique. It lhas just publislhed its isstue for Jtuly 13th, circumistances. In estinmating the validity of the claims, 1914, wlhich was acttually in thle press when the storm1 tlle Commliittee in Brussels lhas acted in consultation witl cloud' burst upon ELurope. The missing numiibers will the local medical societies througlhout Belgium andl w-ith appear in tlhe eurse of 1915. No numiber of the fournal the Governnment inspectors of plharmiacy, whlo also inspect tlle dispensaries of mnedical men. Those wlho liave 'been of the -Royal Ar)1iy/ Medical Co?ps lhas appeared since relieved include the widows of doctors and plhaimacists Decemiber, buttwe lund&rstand tllat another issue is now in whlo liave fallen figlting', or who lhave been the victinms of the press, and will pr6bably be publishied in about ten days. German ferocity. It -is notewortlhy that sUCh1 money as has been hlitlherto giveni lhas been given entirely to tlew THE PATHOLOGY OF WOUNDS IN WAR. country at large, altlhouglh distribtuted from B3russels; in SIap ALAHROTH WRIGHT'S lecture oU Bruissels tlle better circumstanced doctors and plhirii- Tuesday afternaoon cists have supported tlle fund for the relief of their before the Royal Society of Medicine turned out to be in poorel' colleagues. M!Uany of the forms relating to tleg part a philosoplhical discussion0of -certain fui~lamental plharmrnacists lhave reaclhed tllis country and lhave been problems of surgical pathology, and in part a description submitted to the Execuitive Committee of the Belgiaii of sorme novel and highly ingeniious m-etlhods of seeking a Doctors' and Plarlmacists' Relief Fulnd, and it is hoped later solutioii of some of thent-LTlle war, lhe said, ilnvolving as to receive tlhe foirms relating to tlle medical mien-; but it hlad or would some two million wouinds, all, or nearly all eifogli -eVidence lhas been su1bmitfed tol-tle Exec'uti)Se of thlem, infected f-romil tlhe time of tlleir infliction, pre- Commiittee to enable it to reallze tlhat imimiediate lhelp in senited a bacteriological problem tlhe lilic of in nmoney ouglht to be sent, as this now seenms feasible. Withl wlhiclh, the co:operation of thle banks concerned a surm of monley magnitude at least, lhad never arisein before, tlhe numbers is beilg sent iminmedliately to Belgiuiml to be distributtud by colcerned being greater tllan those involved in tle study -tlhe Aide et Protection aux Me6decius et Pharinacienis of tlle great plague epidemics of India. He insisted on Sinistres in accordance witlh tlle particularized need.s thle essential importance .of an unbiassed study of tlle wlhiclh are now in the hands of that body; and it is p)ro- pbysiologipal processes.occurring in wounds, tlle investiga- posed to send further suns fiom tine to timiie as detailed tion of antiseptics or.of, vaccine therapy being ancilIary to reports from the committee in Brussels and otlher infor- tlhe inore fundaluental inquiry. We lhope to publ-ish- a miation at the disposal of the Executive Committee slhow full report of tlle lectnre in an early issuie. that tlhe money is beinig uisefully expended. Subsciibers to the Fund will see that the Executive Comiiwiittee lias now embarlked upon a definite sclhemiie of OUR BELGIAN COLLEAGUES AT HOME AND large expenditurp, and, gQnerous as the responses liave ABROAD. becie to tle appeal by Britislh doctors alnd plharmacists, it will be necessary that further effort shq'ld be mnade, .aild ABRO.AD. even made witlh greater vigouir than lheretofore. The Fu-nd W)LJEN Professor Jacobs of the U'niversity of. Brussels can clo much with the mi-oney it lhas in lhand, but it is not calne to tllis couintry, at thie enid of October, hle caipe as possible to estimate how long tlhe strain upon it may lhave ,spokesman of' a provision committeen of doctors and to -be muaintainled, and far greater resources than it pharmacists in Belgium. That committee was afterwards possesses will be urgently required.- Celarged as was stated in tlle JOURNAL of January 2nd (P. 34), whlere tlhe namnes alnd offices of its members were GIFT OF IN2STRU3MENTS TO BELGIAN MILITARY ITOSPIIALS. set ou-t. They are represenitative of the unliveisities, At an early stage the Committee miiade ani appeal fqr m-iedical faculties, tlle medical journials, and plharmacists gifts of surgical- instruments to be sent to tile: Master of of Belgium. The President of this commuittee, wlhiell lhas the Apothecaries' Society, Londoni. Tlle inistruments lhate taken the namile of the "Aide et Protection aux Midecins beeii examllined and sorted under* the sutperinitendenice of et Plharmaciens Sinistres," is Dr. Pechlc. professor in the the Mlaster, Dr. Mereditlh Townsencl, and Sir Rickman Unliversity of Brussels, and thle secretary M. Delacre, pre- Godlee, Clhairml.an of the Execuitive Comnmiittee. In sidcent of the General Pharmaceutical Council of Belgiumin. resp)onse to a request received thliough MIr. Samuel When the British Commiittee was formed in Noveiimber Osborn, F.R.C.S., a selection of instruments suitable for last it annouLnced that while it proposed at once to lhelp hospital use were sent for tlle use of the Belgian military refuLaee Belgian doctors and pliarmacists in this countrv, lhospitals, and a cordial letter of thanks lhas been received it ap)pealed to the professioni in tlle lhope 'and expectation froml Captain G. Deffontaine, writing for the Belgian that the work would develop as the conditions of Belgium Military Command in Calais from the Hopital de Passage. permiiitted and wouild be associated with correspondling Mr. Osborn lhas reported to Dr. Townsend that the instru- efforts tllrouglhout Great Britain and Ireland, in the United ments arrived at a particularly opportune moment, wlhen States, and otlher countries which are neutrals or allies in a fire had burnt out the operating theatre of the H6pital the wvar. The expectationi tllat stuell co-operation would Jeanne d'Arc. be given has been fulfilled; commlittees have been formed Tlle Master of the Society of Apothecaries acknow- in Scotland, Ireland, Mainclhester, Liverpool, Birmingham, ledges the receipt of surgical instrunments contributed by Slheffield, and Newcastle, wlhichl lhave beeln stuccessful in Dr. J. Jones of Leiglh, Lancashire. collecting considerable suLmiis of money. SUBSCRIPTION LIsT. Committees hiave been formed in Canada and the Owiing to the earlier date of the publication of the United States, and from tlle former the Britislh Com- JOURNAL due to the Easter holidays a list of subscriptions mittee lhas received importanit donations. It lhas also is not publislhed this week. It is proposed to puLblish a list received generous gifts from the Danish Union of Doctors. for the two weeks in our next issue. Hitlierto the Executive Coimmittee has been lhampered in its work of assisting doctors and plharlmlacists remaining THERE are twventy-five women in the Women's Mledical in Belgiyum by tlle military occupation of the cotuntry, and Service for India, and last year the Central Committee by the whetlher to of the Dufferin Fund, which provides the salary of these uncertainty moilney sent Belgium cotuld wom-en, requested all Provincial Branches to see that be distribuited to the proper persons uinider sutitable con- competent assistant sulrgeons wrere appointed to help the (litions. The Executive Commiiiiittee at its ineeting last mledical women in their hospital wsork. The Central week had before it fturtlher information concerning the Commaittee i.s nlow glad to announ:rce t.hat inl the mzajority o£ iuirgent needs of Belgian doctors and plharmiacists remain- cases this principle ha,s been carried oult, a.nd that it w^ill ing in tlleir own country. lThe Committee in Brussels, shortly be follow-ed in the fewv remaininlg posts.