A REPORT ON PELLAGRA IN TRANSYLVANIA.1

164 he was speaking in any other than a private capacity. The British Government has hitherto been indifferent to the endowment of research. Everyone will remember Pitt’s answer to the modest request that the Government would grant a few thousands for the purchase of the Hunterian collection : "We want the money to buy gunpowder," was the only reply. This was in 1793, but it is fair to say that in 1799 the Government did buy the collection for 15,000. Compared, however, with foreign countries Great Britain is sadly deficient in State-aided laboratories or scientific endowment of any kind. At the close of his speech Mr. Balfour implied that he looked to those who already subscribed for the pure medical and surgical work of a hospital to endow research. We ardently trust, however, that his presence at Guy’s Hospital may prove the earnest of a Government grant for research in the future.

comprehensive measure, and it will, there is little doubt, give rise to considerable discussion. The terms, we believe, of its provisions are much in a line with those of the Bill introduced in January, 1897, which was dealt with at some length in a leading article in THE LANCET of March 6th, 1897. We should very much like to see it pass speedily, because webelieve the Bill to be a good one and calculated to check the many fraudulent practices which now so artfully escape punishment under the present rgii)te.

very

DEADLY ICE-CREAMS.

ANOTHER case is reported of a death presumably due to the eating of ice-creams. The victim was a child aged three The medical man in attendance deposed at the inquest ’ years. that on the previous day he had seen two similar cases in the same street in Hoxton. Surely the authorities should do something in the matter. Is the liberty of unlicensed SYPHILIS OF THE STOMACH. killing to continue indefinitely ?7 There is proof, circumSYPHILITIC lesions of the stomach have been but seldom stantial, bacteriological, and positive, of the deadliness described. Possibly, as M. Dieulafoy has recently asserted, of the filthy "hokey-pokey" and it is high time that they are not so uncommon as is supposed, for when they come regulations were made with regard to its manufacture. under clinical observation it is usually as ulcers of the stomach and the symptoms do not differ from those of DR. CORNELIUS HERZ, whose death occurred at Bourneordinary ulcer. Gummata have been found at necropsies, mouth recently, was a medical man, but his place in but as a rule they produce symptoms during life only when science was won by his practical work in electricity. His they ulcerate. A case such as the following, published in death was due to angina pectoris and in its mode of onset La France Médieale, July 1st, 1898, by Dr. Dubuc, is very sufficiently justified the opinion of the well-known English exceptional. In 1880 and 1881 he treated a man for physicians who refused to take the responsibility of saying primary and secondary syphilis and in 1884 for a tubercular that he was in a fit state to appear at the Extradition Court. syphilide on the forearm. In 1891 he detected in the epigastric region a large indurated plaque of the size of the THE Queen has sent a donation of f,20 to the fund for the palm of the hand, with a projection having the volume proposed children’s wards in the Kensington Dispensary. of a pigeon’s egg. It was situated behind the abdominal wall and no doubt in the wall of the stomach. It was DR. LOMBE ATTHILL has been elected an Honorary Fellow separated from the liver by a narrow resonant zone and was of the Edinburgh Obstetrical Society. elevated by the pulsations of the aorta. The patient had wasted, digestion was slow and difficult, and there was pain in the affected region. Mercury and iodide of potassium were given ; the plaque appreciably diminished in a week, and was A REPORT ON PELLAGRA IN found to have entirely disappeared when the patient was TRANSYLVANIA.1 seen four months afterwards. M. Dieulafoy’s advice to inquire for a syphilitic history in all cases of gastric ulcer THE south-eastern part of the Carpathian Mountains forms and to treat accordingly is sound. the boundary between the kingdoms of Roumania and Hungary. Its slopes on both sides are inhabited by the THE PROSPECTS OF NEW LEGISLATION ON Wallachs, now called Roumanians. They have the same POISONS AND FOOD. habits and religion, the only difference being that the people WE must express our satisfaction with the steps which, as on the northern side owe allegiance to Hungary, whilst those announced by Mr. Balfour in the House of Commons on on the southern are subjects of the King of -Roumania. They ’Tuesday, the Government propose to take in regard to are supposed to be the descendants of the legionaries of two measures in the progress of which we are interested. ancient Rome who were stationed in these parts in the These ’The Poisons Bill has been thrown over definitely and, time of the Emperor Trajan and his successors. are very poor and live under highly insanitary people in the words of Mr. Balfour, the Government have I conditions. Pellagra, which, as is generally known, prevails abandoned all hope of passing it into law. Last week we in certain districts of Italy as an endemic disease, has expressed the opinion that the Bill was unsatisfactory and apparently been unknown hitherto in these parts, at any not only so, but likely if passed to interfere with, if not to rate as far as the authorities and the medical profession nullify, the good being done by the present Pharmacy Act. generally are concerned, but it has recently attracted the We take it that the Government found it expedient to drop notice of sanitarians in the shape of an endemic outbreak. To inquire into the circumstances of this outbreak the It this Bill on account of the opposition shown to it. Hungarian Government appointed a Commission, consisting was certainly pushed through the House of Lords by the of Dr. Niedermann, Dr. Eonrad, and Dr. Farkas, which has Duke of Devonshire with extraordinary rapidity. Indeed, it just presented its preliminary report to the Minister of the passed the House of Lords practically without discussion. Interior inat Budapest. The Commission commenced its April last by visiting the villages where the disease As we said last week, if a really protective measure is to labours was known to prevail, and at the termination of this inquiry become law the Bill introduced by the Duke of Devonshire it made the preliminary report referred to above from which must be very seriously altered and amended. We receive, we glean the following. It appears that about fifteen years ago Dr. Takach, of therefore, the announcement of Mr. Balfour with satisfaction And may now hope that a more satisfactory measure will be the county of Eovar, noticed in his neighbourhood some drafted in the future. It is hardly possible that the new 1 A Pellagra: Niedermann Gyula tr., Konrád Jenö tr. és Farkas Jenö Food and Drugs Bill will be passed this session, but tr. jelentése az erdélyi megyékben fellépett pellagra megbetegedésekröl. at any rate it is to be introduced at an early date- (Pellagra: A Report of Dr. Gyula Niedermann, Dr. Jenö Konrád and Dr. Jenö Farkas on Pellagra Cases which occurred in some of the Counties probably next Tuesday. We believe that the new Bill is a of Transylvania.)

165 skin disease which he named pellagra and described it as such in the medical journals ; but owing to doubts expressed by a dermatologist at Budapest as to the correctness of the diagnosis the subject was dropped. Last year, at the International Plague Conference in Venice, the delegate, Dr. Chyzer, met Dr. Felix, a delegate of Roumania, and learning from him that pellagra frequently occurs on the southern slopes of the Carpathians he was induced to visit the provincial hospital of Venice and to study some of the cases of pellagra there. On his return to Budapest he gave directions to the chief physician at Kolosvdr and to the physician in charge of the lunatic asylum in that city to pay special attention to cases of pellagra, and at the same time he entered into correspondence with Dr. Felix of Bucharest and with several medical practitioners in Transylvania. Dr. Takach was the first to send a patient suffering from pellagra from the town of Somkut to the clinique at Kolosvar ; this was on April 19th last. Dr. Lechner, Professor in the University of that city, confirmed the diagnosis and submitted the case to the Commission. The following, taken from their report, may serve as a fair type of cases described. A married man, aged twenty-six years, of feeble constitution, a farmer, was born of healthy parents in the county of Szathmar. When seven years old his foot was injured bv a thorn and periostitis ensued. The part became swollen and he was for a long time under treatment in a hospital, where he underwent an operation, but the suppuration, owing to diseased bones, still continued. At the age of eighteen years he married. His habits were temperate, his ordinary diet consisting of porridge made of Indian corn, wheat-bread, bacon, eggs and milk. Since last autumn his diet has consisted exclusively of In the spring Indian corn mixed with wheat-flower. of 1897 there appeared an affection on the skin at the back of his hands. He became excited, spoke and acted confusedly, and walked about aimlessly, stopping people in the street and saying that he was in search of a wife, although he was already married. By the end of spring the skin disease had disappeared and his brain symptoms had improved, but it was nevertheless thought that he still suffered from hallucinations. In March, 1898, his hands, face, and neck became swollen and erythematous, and his skin grew fissured and knotty and covered with scales and was peeling. He again became excited and spoke and acted in a confused manner and, his agitation increasing, he ran away from home and made attacks on men and on animals. The patient’s restlessness subsided on his admission into the hospital, but he became apathetic and stupid, had illusions, saw spectra, heard strange sounds, and refused to take food. After establishing the diagnosis of the above case as pellagra, other cases of the disease were recognised at the clinique of the University of Kolosvár by Dr. Purjesz and Dr. Marsalko, 11 of which were seen by the Commissioners. On May 20th, 1898, they visited the village of Nagykalota, where in former years the food of the inhabitants was wheat and rye, but this year it was Indian corn. A miller there stated that this year no pure wheat was ground in his mill, he had a good deal to grind, and he although added that° pigs fed better formerly than men do to-day." Last summer many people suffered from malaria and still continue to do so to a certain extent. The village rates amount to 106 per cent. of the ordinary taxes. The Commissioners also examined numerous cases in sixteen different villages with the same result. The symptoms were of the type described above. The disease may be said to be the result of insufficient nourishment aggravated by bad hygienic conditions and by malaria. No cases of pellagra could be detected where the people had good and sufficient food. The Commissioners conclude their report as follows : From the above examinations of many cases we arrived at the conclusion that under similar dietetic and hygienic conditions pellagra in an endemic form will be found in other parts of the country. Before submitting a final report we may place our opinion on record that the exclusive use of Indian corn as food is the ultimate cause of pellagra and the nutriment of the people in those places was this year even worse than usual, because (1) the crop last year was of an inferior quality ; (2) for the last three years there prevailed a murrain among the flocks, particularly among the pigs ; and (3) the flocks of sheep have likewise suffered severely, the consequence being that the people have had no animal food during the winter. All this was aggravated by the continuous rains of last year which produced malaria."

suspicions cases of

Hungarian

considerably

formerly

THE ROYAL COMMISSION ON THE METROPOLITAN WATER-SUPPLY. THE twenty-ninth sitting of the Royal Commissioners was. held at the Guildhall, Westminster, on Monday, July llth. The only Commissioners present were the Chairman (Lord Llandaff), Major-General Scott, Mr. de Bock Porter, and Mr. Robert Lewis. The first part of the sitting was occupied, by taking the evidence of Mr. Andrew Johnston (chairman of the Essex County Council), Mr. W. B. Whittingham (chairman of the Water-supply Committee of the Essex County Council), Mr. William Ivey (Mayor of West Ham), Mr. Frederick Ernest Harris (treasurer of the borough of West Ham), Mr. W. K. Marriott (chairman of the Barking Urban District Council), and Mr. Alfred Plant (accountant to the East Ham District Council). After the adjournment for luncheon evidence was given by Mr. T. L. Knight (chairman of the East Ham Urban District Council) and by Mr. C. G. Musgrave (chairman of the Leyton Urban District Council) ; and Sir John Evans, K.C.B. (vice-chairman of the Hertfordshire County Council), put in a statement on behalf of the county which he represented and was examined at some

length.

Mr. JOHNSTOX, in answer to the CHAIRMAN, said that the population of the geographical county of Essex according to the census of 1891 was 785,445 and that of the administrative county 578,471. The county borough of West Ham was entirely within the limits of supply of the East London Waterworks Company. The county council of Essex and the borough of West Ham had acted in concert with a view to opposing the London County Council’s Water Transfer Bills. They were, however, willing to come to an arrangement with the London County Council on certain conditions and an agreement was drawn up last year but it was never "signed and sealed." The arrangement was, briefly, that the London County Council should hand over to the Essex authorities the supply and distribution of water within that county. In the county of Essex there were besides the county borough of West Ham ten separate local authorities. which were either wholly or partially supplied by the East London Waterworks Company. These districts were Waltbamstow, Leyton, Wanstead, East Ham, Woodford, Buckhurst-hill, Chingford, Waltham Holy Cross, Ilford, and the Epping Rural District Council area (Loughton and Chigwell). The Barking Local Authority was also within the company’s limits of area and might at any time require a supply of water. The witness thought it was not expedient that ten or more separate water authorities should be formed within the Essex district of supply of the East London Waterworks Company, and that might happen if the powers contained in a clause of the East London Waterworks (Purchase) Bill introduced by the London County Council last year had received Parliamentary sanction. Most of the districts of the local authorities which had been mentioned are supplied by mains passing through one or more other sanitary districts, and had one or more of the local authorities availed themselves of the powers prorosed by the London County Council’s Bill and undertaken the distribution of water in their respective districts the arrangements would have become very complicated, and if the various parts of the undertaking became vested in a number of different local authorities they would necessarily have to employ additional officers and servants in each district, and the result would be a very heavy expense which would fall directly on the-

ratepayers.

In answer to Mr. DE BOCK PORTER the witness said that the Essex County Council was not anxious to become the water authority, and they feared that a change from the present arrangement would have the effect of making them pay more for their water. The gross charge for water supplied by the East London Waterworks Company given on an average of six years had been 4’21d. per 1000 gallons and the average cost throughout the whole of the London water companies’ area had been over 6’97d. The witness thought that had the undertakings been purchased by the London County Council they might have tried to charge the Essex district the average price charged for water over the whole of the metropolitan area of supply and in his opinion the East London authorities would be at a disadvantage either in the case of negotiations or