DURATION OF THE INFECTIVITY OF THE GLOSSINA PALPALIS.

1081 : demonstration. In the troublous times towards The nurse should wear a longanatomical disinfected. the end of the reign of Francis I., Rabelais was living in overall, to be removed on coming from the patient’s The naso-pharynx of the attendants should be frequently Metz and discharging the duties of town physician at a rinsed with a disinfectant solution. Attempts should alsosalary of 120 livres. During this time he was in needy be made to disinfect the naso-pharynx of carriers by means circumstances, but after the death of Francis the clouds of insulations of dried anti-meningococcus serum or of passed and, returning to France, he became is care de They strongly recommend the use of anti- Meudon,"as he is generally known among his own countrypyocyanase. meningococcus serum in the treatment of patients suffering men. From this time until his death, which is supposed tc from the disease. In the Belgian cases it was used for 15 have taken place in 1553, Rabelais was engaged for the most patients, of whom 10 showed successful results, in spite of part upon those literary pursuits which have made his name the fact that in some of them the serum was not given as immortal. The Comite before referred to invite sculptors tc early as is desirable. Of the patients who did not receive submit models before the first day of May next. For thE any serum, 24 out of 36 died, and among those who re- guidance of competitors the Comit6 states that it proposes covered 1 became deaf, 1 was left with strabismus, and 4 to expend 30,000 francs (.61200) on the work. Considering continued to suffer from paraplegia after the acute stage of the fame of Montpellier’s professor, there should be no diffithe disease had subsided. The method of treatment which Dr. culty in obtaining funds for a more ambitious project.

carefully

room. ’ z

Henseval and Dr. Bruynoghe recommend is the withdrawal of 20 cubic centimetres of cerebro-spinal fluid by lumbar puncture and the injection through the same cannula of 20 to 30 cubic centimetres of serum. This process should be repeated for three or four days or even more. Supplies of serum from the Rockefeller Institute at New York and from other sources were placed by the Belgian authorities at the disposal of any medical man requiring it for the treatment of cases of the disease. The report affords an indication of the interest shown in matters of public health in Belgium and is a noteworthy addition to the literature of the disease. The value of the anti-meningococcus serum is illustrated by a case recorded at p. 1068 by Mr. J. J. Weaver, with a note by Dr. Percy Marsh. -

RABELAIS THE

PHYSICIAN.

AMONG the world’s most remarkable

men

must be included

Rabelais, romancist, physician, and ecclesiastic. Few beyond the medical profession associate the author of

"Gargantua"with medicine and surgery, and fewer still In the Jo2irnal des Debats we read, with the Church. "Un Comité vient de se constituer à Montpellier en vae d’61everRabelais un monument commemoratif de son passage dans 1’antique et illustre Faculté de m6decine de In view of this interesting announce. cette Universite." ment it is opportune to recall briefly Rabelais’s connexion with the healing art. Of the early days of " one of the few great humorists of the world," as Mr. Saintsbury terms Francois Rabelais, we have nothing but tradition, but in 1519 we know from a deed of conveyance that he was a Franciscan. Five years later, by an indult of Clement V., he changed In the year 1530 his order and became a Benedictine. his connexion with Montpellier can be traced, and he then appeared in public in the habiliments of a secular priest. From this time his name is inseparably associated with the city, and in the gallery of the former professors of the University his portrait finds its place. He then turned his thoughts to medicine and entered the Faculty of Medicine at Montpellier in September, 1530, and became a Bachelor in the November following. The next year he was lecturing on Galen and Hippocrates. In 1532 he was at Lyons acting as physician to the Hotel Dieu with a yearly salary of 40 livre@, and finding time to edit the medical "Epistles"of Giovanni Manardi," the " Aphorismsof Hippocrates, and Ars Parva"of Galen. In 1534 Rabelais accompanied Jean du Bellay to Rome as his physician. The authorities at Lyons Hospital considering that their physician had absented himself without leave appointed a successor, but, like a commitment order in our courts, the decision was "allowed to lie in the officeuntil his return. Before this took place he was again in Rome with Bellay, who was now a cardinal. In 1537 Rabelais took his doctor’s degree at Montpellier, lectured on Hippocrates, and made a

DURATION OF THE INFECTIVITY OF THE GLOSSINA PALPALIS. IN THE LANCET of Jan. 22nd we furnished our readers with an abstract of Sir H. Hesketh Bell’s official report on the administrative measures which had been carried out in Uganda under his directions with a view to stopping the spread of sleeping sickness. Chief among these measures was the compulsory removal of the entire population at the end of 1907 from the fly-infected zone around the Victoria Nyanza to a new location some miles back from the shores of the lake. It was confidently anticipated that this drastic procedure would have the effect of causing a great diminution of the disease, if not its entire disappearance from the neighbourhood, since in the absence of natives with trypanosomes in their blood the glossina could not become freshly infected, and the formerly infected insects would naturally tend to die out in the course of time. Among the papers which have been presented to the Royal Society recently by the Sleeping Sickness Commission-of which Sir David Bruce, C.B., F.R S., is the leader, and Captain A. E. Hamerton, D S.O., and Captain H. R. Bateman of the Royal Army Medical Corps, and Captain F. P. MackiE of the Indian Medical Service, the co-workers-is one dealing with an investigation into the question of the duration of the infectivity of the glossina palpalis aftei When the inquiry the depopulation of the lake shores. was begun a period of two years had elapsed during which no native had been allowed to live or work within twc miles of the Victoria Nyanza, except at a few cleared landing places, and as regards the population of the islands in the lake they had all been removed for some months prior to the commencement of the investigation. It is obvious that until it had been clearly ascertained that the flies had ceased tc be infective it would be unsafe to permit the zone around the lake to be re-inhabited. For the purpose of testing the con. dition of the glossina as to infection 12 experiments were carried out by feeding on healthy monkeys a large numbel of flies caught on the shores of the lake. In only one instance, where the flies had been collected at or near one oj the cleared landing places, was the result negative ; but in the remaining 11 experiments with flies collected from the vicinity of the lake the disconcerting discovery was made that the glossinse had still the ability to infect, and did actually transmit sleeping sickness in each instance tc the monkeys. Sir David Bruce therefore concludes that glossina palpalis on the uninhabited shores of the Victoria Nyanza can retain activity for a period of at least two years after the native population has been removed. The investigators were not able to account for this apparently prolonged period of infectivity, but they discuss in their a number of possible explanations. Only two of these,

publicIpaper

1082 however, are regarded by them as needing further considera- will bring Italy into line with her more civilised sisters, tion, viz. : (1) that the duration of the life of the glossina is while making her consistent with herself in abolishing more than two years, and that, therefore, flies which became "capital punishment " not only on the scaffold but also on infected before the natives were removed are still alive and the greensward. capable of transmitting sleeping sickness; or (2) that the mammals or birds along the shores of the lake have become SOCIETY OF MEDICAL OFFICERS OF HEALTH: A PRESIDENTIAL ELECTION. infected and so act as a reservoir of the disease. As to this first FOR the latter view there is at present no experimental proof, for the time, we believe, in the history of the Society of Health there has been more than one of Medical Officers injection of the blood of shore-birds and mammals into suscandidate nominated for the position of President of the ceptible animals has so far yielded only negative results. Sir David Bruce and his colleagues, in another paper read before society. At the election which took place on April 8th six the Royal Society, have shown that the proportion of infected Fellows of the society were nominated for the office. They flies to those which are not infected must be small, for by ex- included Dr. A. K. Chalmers, Glasgow; Dr. F. G. Crookperiment it is seen that in artificially infected flies only 1 in 60 shank, Barnes; Dr. T. Eustace Hill, Durham; Dr. E. W. displayed the phenomenon of late infectivity. In nature the Hope, Liverpool; Dr. W. G. Willoughby, Eastbourne ; and proportion, it is thought, must be considerably less, prob- Dr. J. T. Wilson, Lanark. After some discussion as to the ably not much more than 1 in 1000. It appears to us that method of election, which according to the articles of assoif infected flies can live two years or more, there would be ciation of the society must be by ballot, the names of all advantage in instituting measures for the destruction of the the candidates but Dr. Crookshank and Dr. Willoughby were tsetse flies in the zone surrounding the Victoria Nyanza. We withdrawn, and the latter was elected by 55 votes against 29 given to Dr. Crookshank. are aware that Dr. Bagshawe, director of the Sleeping Sickness Bureau, has characterised attempts to reduce the number RECURRENT INTRACRANIAL PSEUDO-TUMOUR. of these flies in any locality as "a labour of Sisyphus." In the light, however, of the facts reported by Sir David Bruce A SHORT time ago we published an annotation on certain and his co-workers we think that fresh consideration might cases of so-called pseudo-tumor cerebri, of which the clinical be given to the subject. In THE LANCET of Feb. 12th we features were indistinguishable from those accepted by all as drew attention to Maldonado’s method for destroying these characteristic of intracranial neoplasms, but where subinsects, and as the process appears easy and costs little a sequent pathological examination failed to reveal any trace of trial might, perhaps, be given to it with a view of attempting the latter. As the simulation of spinal tumour by a localised to get rid of the surviving infected glossina in and around serous meningitis is now, especially since the work of Sir the shores of the great African inland sea. Victor Horsley, more widely recognised, it has been suggested that some such condition may account for at least a section of these intracranial cases, the clinical importance of DUELLING IN ITALY. which we do well not to under-estimate. The latest number I hard THIS "method"" or relic"of barbaiism dies south of the Nettrologiso7tes Centralblatt contains a paper by Dr. of the Alps. A discreditable scene in the Chamber of Heinrich Higier of Warsaw on a seemingly unique case of Deputies in which the good faith of military men and this description, where the symptoms disappeared entirely, Members of Parliament, not excluding their female relatives. and after an interval of 13 years appeared again, to disappear was called in question, drew down on the accusing orator completely once more. There came under the observation of of the a shower of Extreme not only (one Left) indignant Dr. Higier in 1893 a Jewish boy, aged six years, who comfisticuffs in the lobbies of the followed House, plained of paroxysmal headache, vomiting, giddiness, and by protests, but no fewer than four challenges to mortal combat- attacks of transient blindness ; he also suffered from typical In the first of these the pistol as the weapon for vindi- attacks of Jacksonian epilepsy beginning in the right great cating oRended "honour"was ruled out by the seconds toe, and from parsesthesias on the right side of the and the sabre employed. Twenty-four assaults between body. On examination there was right-sided hemiparesis, the principals (General Fecia di Cossato and Signor Chiesa) with diminution of sensibility, and a right ankle clonus; there took place, in the last of which the General was was also paresis of the left sixth cranial nerve, and prowounded and a welcome opportunity afforded for bringing nounced double optic neuritis. Antispecific treatment was the encounter to an end. Ultimately the General and followed by no observable amelioration ; but after about six the civilian (the latter, as usual on these occasions, having months the symptoms gradually disappeared one by one, and proved the superior fencer) were reconciled, embracing and no trace whatever of disease was left. In 1904 the youth was kissing each other in true Southern fashion ; while the three in perfect health, and had been so for ten years. In May, "hostile meetings " still to come off were cancelled as the 1906, after a trip to London, he began to complain again of result of "amicable arrangement." The incident has demon- diffuse headache, lassitude, vomiting, and uncertainty in strated once more the absurdity of the duel-doubly absurd walking. He was found to have again a right-sided hemiin a nationality which prides itself on its respect for humans paresis, with exaggerated deep reflexes and an extensor life, even to abolishing capital punishment, but yet look response, and marked double optic neuritis with diminution calmly, even approvingly, on when two men, of high of visual acuity. Nystagmus, intention tremor, and sphincter social or official standing, deliberately attempt to shoot impairment were all absent. Antispecific treatment was or sabre each other. What chance is there for the crusade energetically applied, but without avail, and an exploratory against the accursed knife," the weapon of the poor, when operation was proposed. Nevertheless, in December of the the upper ten thousand freely resort to the pistol or the same year, for an unexplained reason, the symptoms slowly sword, under the formal conditions of ,.seconds " and but steadily diminished in intensity, and in less than three " umpires," always with lethal intent-often, too, with months the sole indication of any intracranial disease was lethal effect, as in the case of poor Felice Cavallotti, "the residual pallor and fluffiness of the optic discs. In Shelley of Italian statesmen " ? In truth, the better mind June, 1909, the patient reported himself in robust health. of Italy has at last intervened to put a stop to the practice, Of various possible diagnoses that suggest themselves for this and committees of all ranks and of both sexes have organised case there is none that is satisfactory, although the writer a movement which, by making the duel a criminal offence, passes several in careful review. One or two somewhat -