SICILY AS A HEALTH RESORT

THE INDIAN RISING.-SICILY AS A HEALTH RESORT.

610

prevails. Moreover, the strict quantitative 1;mitation of the his opinion that " it appears most probable that in these evening meal must have had, and still does have, a whole- cases the entrance of air into the peritoneal cavity must have some effect at many health resorts. The patients can go to. been the important factor ; that an oxidation of the tuberbed earlier after a light meal-a great advantage when they culin present in the effusion was thus brought about; and have to rise at a very early hour to drink the waters-and inI that it was this ogytuberculin which effected the cure both most persons when free from excessive mental work thei of the local and of the general tuberculosis." Acting upon digestive powers are probably strongest during the middle of this hypothesis the problem of finding a method of oxidising the day. In many persons, also, temporary discontinuance the toxin without completely destroying it presented itself, of strong tea or coffee in the morning can do no harm, and and various methods of accomplishing this result were incan best be carried out at health resorts during periods of vestigated. Dr. Hirschfelder found in the course of his rest from the mental work of ordinary life. The substitution experiments that the peroxide of hydrogen was the substance of farinaceous soup, &o , which formerly constituted the for which he was seeking. He then gave a detailed descrip. meal at various morning spas, might still often be tion of the preparation of his tuberculin and the method of recommended. oxidising it, and remarked that the greatest possible care was necessary in the preparation of this oxytuberculin, for if any THE INDIAN RISING. appreciable quantity should escape oxidation fatal tuberculin of the the THE rapid spread and extension poisoning might result from the large quantities which must rising among be administered. The liquid when injected caused no greater at on the Indian the tribal populations frontier, especially local disturbance than any indifferent fluid would produce. from when India is a only just emerging present time, series of calamities of plague, pestilence, famine, and There was no rise of temperature or any other unpleasant earthquake, is a grave business. The revolt of the tribes constitutional effect. Within a few days the cough and seems to have been quite unexpected by the Indian Governexpectoration diminished, and the most striking effect was the rapid improvement in the appearance of the patient. in that it has a force and ment ; and, notwithstanding large about the frontier, the season is an unfortunate one for He further went on to say : " The patients that have been commencing military operations in a mountainous and very treated by me with the oxytuberclin, those who came in the difficult country, and the transport and commissariat very early stage of the disease before cavities were present, Patients in whom the disease arrangements for such an expedition cannot be made have been rapidly cured without some necessary loss of time. Those who are was moderately advanced have likewise rapidly improved, opposed to the "forward policy" followed by the and some have entirely recovered. Of the very advanced Indian Government will, of course, attribute the cases, many have shown marked improvement, and many insurrection among the hill tribes to this cause, patients that I have declined to treat as being too far and probably with a certain measure of truth, but advanced, but who pleaded so hard for the treatment that what has now to be done is to act and not to argue. The I could not refuse, have impressed me by the wonderful rising must meanwhile be put down, and the Khyber Pass improvement they have shown." Tables were printed at the and that of Kohat secured if we are not to lose military end of the paper giving the number of patients and the prestige and meet with further difficulties and disaffection. treatment at various stages of the disease, and the results as The task is an arduous and expensive one, but it has to be shown were certainly very satisfactory. We cannot comaccomplished. An expedition at this season will, we fear, ment further until more extended observations have been be attended with a good deal of inefficiency on account of made, and meanwhile await with interest the results obtained sickness among the troops, and great demands will be made by other physicians who may use oxytuberculin in the upon the military medical services in India. The strength treatment of tuberculosis, pulmonary and otherwise. and efficiency of the field hospital system of that country will be put to the test. We may add, however, that there SICILY AS A HEALTH RESORT .

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to believe it is in a very different and OUR Rome correspondent, under date Aug. 30fih, writes condition to that which existed at the beginning A mass of correspondence before me attests the impulse, of the last Afghan campaigns. Some difficulty will, we as opportune as it is welcome, given by THE LANCET two imagine, arise from the numerical strength of the medical Sicily’s development as a health resort. The whole island, departments being insufficient to cope with all the work now that its advantages in point of climate, internal that has to be performed in India at the present time. and general attractiveness have received the resource, Malarious fever, often of a severe type, is usually prevalent of medical science, seems to have realised the in the Peshawar valley at this season, and cases of dysentery imprimatur future that lies within its grasp, socially and economiand enteric fever will almost certainly occur among the cally, if only it follows up the indications and suggestions troops. Up to the present time the health of those taking so clearly set forth. Take, for example, that lovely seaboard part in the different expeditions is reported to be good. winding gently inland between Palermo and CefaJu—a. marine exposure rich in attraction of every kind-and TREATMENT OF PULMONARY TUBERCULOSIS. pause for a moment at the balneary station of TerminiFROM the time that Koch startled the medical world by Imerese. It is difficult to say whether the advantages of the discovery of tuberculin numerous attempts have been the place are more pronounced in summer or in winter-the made to purify this substance and so avoid the injurious former season admitting of al fresco bathing under the mOlt. effects produced by it. Hitherto these efforts have not met favourable conditions and for a longer period than elsewith success, although it is too early to speak definitely of where ; the latter with its supply of thermal waters only Koch’s new tuberculin. In the Medical -zveivs (New York) awaiting more effective utilisation than itsStabilimento’ of July 3rd a most interesting paper appeared by Dr. J. 0. microscopico’ (as a correspondent playfully calls it) has Hirschfelder, of San Francisco, detailing certain experiments hitherto vouchsafed. For Termini-Imerese possesses in a He proposed a theory that is certainly degree but partially shared by other thermal resorts in made by him. This theory was not evolved from the therapeutical Italy, and hardly shared at all by its transalpine sisters, original. results of his injections, but " the method of treatment the advantage of being as available for thecur& was a consequence of the biological proposition." He sudorifera’ and for all-round balneary treatment during drew attention to the successful results which had the winter months as during the summer. The oppor. followed operations for tuberculous peritonitis, and stated tunity, indeed, of combining escape from a northern winter

is every

reason

improved

"

CHOLERA IN THE DONGOLA EXPEDITIONARY FORCE, 1896.

and carried out, and included notification, isolation, disinfection of personal effects by boiling, and of dwelling places by disinfectants. The military cases numbered 403, with a, death-rate of 58 per cent. ; the civilians furnished 897 cases of cholera, with the higher death-rate of 82 per cent. It is satisfactory to note that in the Egyptian army of 16, 000 men "not a single attendant on patients contracted the disease."’ Many of our readers will remember that Surgeon-Captain Trask, while on inspection duty, contracted cholera at Ferket on the morning of July 25th, and died the same afternoon.

with the prosecution of a thermo-mineral ’cure ’ is one which many a British sufferer from gout or rheumatic arthritis would eagerly embrace, and Termini-Imerese pre-

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sents this under every desirable condition, essential and accessory, except one, and that is the ’Stabilimento’ itself. As already said, this establishment is on a very small-well-nigh Ijiliputian—scale, sufficient, possibly, for those who have hitherto frequented it, but quite unequal to the clientèle which nature and science clearly mark out for it. As a correspondent suggests, it has remained in this undeveloped condition because, between Cefalu and Solunto, it has always been absolutely without a rival, which is another way of saying that the balneary resources of that exceptionally favoured line of coast have had, like Sicily generally, to await such a demonstration as THE LANCET. has been the first to give. But, as I now learn, it will not long be allowed this excuse for neglect of opportunity. The spirit of competition is awake and abroad, and in selfdefence, if from no other motive, Termini-Imerese will have tomarch with the times’ and add to its accommodation and appointments if it is not to be distanced by more enterprising neighbours. The requirements of civilisation-particularly of English-speaking civilisation-’ che le attrattive del sito e le esigenze dei tempi reclamano a voce alta’ (which the attractions of the situation and the conditions of the times so loudly demand) will have to be complied with ; and then, but not till then, we shall see Termini-Imerese taking its proper place among less favoured rivals in counterpoising by a yet theRiviera Levante’ and theRiviera Ponente " more to be recommended ’ Riviera Siciliana.’

CHOLERA IN THE DONGOLA EXPEDITIONARY FORCE, 1896. WE may safely congratulate Brigade-Surgeon-LieutenantColonel Gallwey not only upon his report,l but also upon the successful way in which he and the medical officers under him treated the cholera epidemic which so inconveniently hampered last year’s military advance upon Dongola. Campaigning in the Soudan means warring against any dervishes who happen to be in that part of the desert, but it means much more-fighting against the elements of nature and getting gunboats through difficult cataracts during the few weeks of high Nile flood. Consequently the expedition had to continue its advance in spite of cholera, and the sanitary duties were necessarily subordinated to the hard work of the campaign. The infection reached Assouan by means of a native servant on June 8th; the first case in the Egyptian army occurred on June 12th and the last on Aug. 31st. The only time the disease became in the least virulent was from the end of June to the end of July, and the whole epidemic spread over 500 miles of river, road, and railway. Details are given of one healthy regiment which reached a cholera-infected barge on June 12th and developed cholera on the 14th; also a second regiment which arrived healthy on June 21st, while cholera broke out in it on the 23rd. We therefore fail to see why the writer in two places states that the incubation stage was usually seven or eight I days. From the experience of three separate outbreaks he points out that the disease may be stamped out in six days in a military camp where early intelligence of the first case is received, where absolute control is possible, and where the water-supply can be efficiently protected from contamination. He is evidently a consistent believer that cholera is a waterborne disease, and though’’it was not possible to boil drinking water for the troops protection of the supply formed the chief point in all camps." The regulations for barge traffic, for camp followers, and for native villagers were well planned 1 Cholera Report Force, 1896 ; pp. 15.

of Frontier Mudiria and

Dongola Expeditionary

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DEATH

OF

DR. ALFRED

WE have to record the death

HALL, OF BRIGHTON.

30th of Dr. Alfred His work was long since done and his age was ripe ; but his stately form, his genial face, and his kind heart were all in evidence till a very recent period-a fact which makes his removal still to seem premature. Dr. Hall attended as physician both the Founder of THE LANCET and his wife, and a link with the past of peculiar interest to ourselves is now broken. We hope next week to give more detailed notice of his life. on

Aug.

Hall, of 75, Lansdowne-place, Brighton.

OXIDE OF IRON IN BACTERIA. THE association of oxide of iron with certain bacteria has been remarked by various observers, and an instance of this phenomenon occurring on a large scale has been investigated by Professor Manabu Miyoshi, who holds the chair of botany in the University of Tokio in Japan. His observations are published in German, and appear in Vol. X. of the Journal of the College of Science, Imperial University, Japan. The material examined by him was a ferruginous mud from the hot springs of Ikao ; it is formed upon stones and earth under the influence of the warm ferruginous’ water which trickles from crevices in the rocks, and on account of its therapeutic properties it is often collected by persons who go to the springs to bathe. This mud consists entirely of bacteria, and can be easily separated from the ferruginous matter which contains few or no bacteria, as it has a pale ochreyellow colour, and a homogeneous, fibrous, slimy consistence, whereas the latter is of a dirty brown colour and a finely granular consistence. Microscopic examination proves that the mud consists entirely of bacteria cells. The smallest possible portion spread evenly on a cover-glass and dried over a spirit lamp shows innumerable yellow, thread-like cells of unequal length, varying from tfl- to 1A in diameter ; they are both straight and curved, and they may be either solitary or grouped in masses. With these thread-like cells there are mingled a number of minute rod-shaped cells. The bacteria seem to resemble the Lfptothrix ochracea of Kiltz ; further observations are necessary in order to determine whether they are a new species or not. When the cells are treated with moderately strong hydrochloric acid they not only lose their yellow colour but their outline disappears without leaving a trace behind, and the subsequent addition of ferrocyanide of potassium produces the blue colour characteristic of iron. If a much weaker acid is applied to one side of the preparation the cells become gradually decolourised, and ultimately there remain hyaline fragments of cells, which are seen with difficulty but become easily visible after staining with fuchsin solution. The action of hydrochloric acid led Professor Manabu Miyoshi to believe that the oxide of iron is not deposited on the walls. of the cells, but is more or less intimately incorporated with them. The cell walls were entirely free from coarse granules, but on careful examination with Zeiss’a immersion lens and No. 4 eyepiece he found extremely minute particles on many cells. In addition to the thread-like and rod-sbaped cells the bacterial mass contained a small number of cells resembling

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