ALCOHOL IN TROPICAL CLIMATES.

1516 "washed his child’s head in two bottles of wine." In banished h om the land. In 1901 there were in Berlin, with 1848 however, the note is more laconic : "Dr. James over 1,888,848 inhabitants, 15 caes of small-pox with Johnson paid his fine of two bottles." The medical three deaths-two being unvaccinated children and one an was started in when it was decided adult aged 44 years vaccinated only in childhood. In this 1841 library "that a medical library be formed and that in future the connexion it may be mentioned that in Germany primary books, instead of being sold, should be deposited therein." vaccination is performed at a later age than is the case in The committee of the infirmary granted the use of the com- this country-i.e., in Germany the child must be vaccinated mittee room and this kind permission is continued up to the before the end of the year next after the year of birth, a present time. In 1877 meetings began to be held for the provision by which any given child may possibly be nearly discussion of subjects of professional interest. The first two years old before being vaccinated. But in Berlin there is paper was given by Dr. Hall on Experience in Midwifery no elaborate system of hospital isolation such as obtains in and the next by Mr. Metcalfe Johnson on the Connexion London. The few cases of small-pox which occur in the The later metropolis of the German Empire are dealt with in the between Insanity and Ganglionic Irritation. history of the club contains little of general interest. The isolation ward of the Charit6 Hospital. With a generally members-33 in number-dine, or rather sup, together each well-revaccinated population and a people alive to the year, meetings for general purposes are held as required, and blessings which science can bestow there is no need to the clinical section meets once a month ouring the winter. dread the proximity of a few cases of small-pox. It is to be hoped that the President of the Local Government Board will, when Parliament next assembles and he introduces his THE COST OF SMALL-POX EPIDEMICS. Bill providing for general revaccination on the same lines as THE admirable letter on vaccination which Mrs. Garrett primary vaccination, tell the House in some detail how these Anderson, M. D. Paris, honorary secretary of the Imperial Vac- things are done in Germany. The highest patriotism is not cination League, contributed to the Times in the early autumn to extol one’s country when she is in the wrong but to has, we are glad to see, now been reprinted in pamphlet persuade her to follow the example of other nations who form. In this shape it should prove very useful to those have already found the light. In the matter of revaccination who are endeavouring to spread over the country the truth there are many people who would gladly support Mr. Long with regard to the control of small-pox. We are rapidly in a little of the mailed-fist policy. approaching the time when definite steps must be taken with respect to the Vaccination Act of 1898 and it is earnestly ALCOHOL IN TROPICAL CLIMATES. to be hoped that Mr. Long will adopt a vigorous policy which will result in our following in this particular the MAJOR FRIBTG, who has served in the Dutch East Indies example of Germany. Mrs. Garrett Anderson’s pamphlet is since 1879 as an army surgeon, is the author of a paper an eminently common-sense document and it brings out with on the influence of alcohol on Europeans in the tropics great clearness the need which obtains for general revaccina- which was read recently at Aix-la-Chapelle. Acclimatisation, tion if we are ever thoroughly to control our small-pox and he says, is the result of a new regulation of the course of to reduce our isolation provision to vanishing point. Although the blood by the vaso-motor system. The use of alcohol in the story told in this pamphlet is for the most part an oft-told a hot climate weakens that system and consequently intertale it will, we fear, have to be narrated in plain terms again feres with the acclimature. Up to 1898 every Dutch soldier and again before the lower classes are able to appreciate serving in the tropics used to receive 100 cubic centimetres the fact that primary vaccination practised in infancy is only of wine daily as part of his ration, but in May of that year protective against death and even attack for an uncertain General van Heutsz, Governor of Atjeh, reduced the allowance number of years and that if epidemic small-pox is to become by one-half and, moreover, permitted the men who were so a thing of the past revaccination must be generally and inclined to draw its value in money instead of the liquor. The systematically performed at or near the age at which the officers, whose daily allowance was half a bottle of red wine children in our elementary schools are about to terminate per head, were also given a similar choice. From that their school career. Until this is done we shall continue to moment, continues Major Fribig, the soldiers, stimulated by employ both primary vaccination and isolation, neither of the example of their officers, became total abstainers in large which is alone sufficient to prevent periodical and extensive numbers and exhibited a power of resistance against disease outbreaks of the disease which necessitate our maintaining and fatigue, as well as an obedience to discipline, such as an elaborate system of accommodation for isolation and never before had been seen during any of the wars and Mrs. expeditions which had occurred in Dutch India. The sickambulance provision during non-epidemic times. Garrett Anderson deals at some length with the question of rate at once began to fall, a remarkable diminution being expenditure and for the details our readers must be referred observable even within the first three months. Major Fribig, to the pamphlet itself. We may, however, add that the who has been a total abstainer since 1894, used formerly to capital sums which have been borrowed to provide isola- indulge in siestas but never does so now. The mid-day heat tion and ambulance accommodation in respect of London has no injurious effect on him and he is able to work during for small-pox alone have amounted in all up to the afternoon with as clear a brain as in the morning. Sept. 30th, 1902, to 902,757. In other sections of While he was a consumer of alcohol exercise under the the pamphlet the writer deals with (1) the actual sums sun’s rays used to exhaust him very quickly, leaving raised year by year for the upkeep and working of the him bathed in sweat and completely worn out. Now he hospitals and for the maintenance of small-pox patients in can support the hardest outdoor work without blenching; 46 years old he lately took part in an arduous epidemic years over and above the current expenditure in non-epidemic years ; (2) the cost to the ratepayers of re- expedition and was able to perform the longest and most marches with comparative ease. It was the same paying the accumulated debt or capital account and for the, current expenditure in epidemic and non-epidemic years ;; with the other abstainers but all who adhered to their wine (3) the economic loss to the community by the loss of life inL suffered severely and in many cases broke down altogether. an epidemic of small-pox ; and (4) the indirect economic losses. Major Fribig knows a great number of officers and men In contrast with this expenditure, which is concisely seti who continue to consume alcohol but are nevertheless out in the pamphlet before us, attention is drawn to Germany able to carry out their duties efficiently in time of peace. with its 56,000,000 people where, by means of systematic: They are therefore looked upon as fit for active service vaccination and revaccination, epidemic small-pox has beenL but no sooner are they put to the test of hard work

although

toilsome

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1517 Their vascular systems are unable petrissccge of the femoral, popliteal, and posterior tibia than they succumb. to withstand the extra strain ; weakness or paralysis arteries until the patient declared that he was relieved. of the heart renders most of them absolutely unfit for The limb was then wrapped up in cotton-wool. On the duty. Many victims of the alcohol habit become moral following day the relief had remained permanent and heat wrecks, losing all energy and initiative. Suicides amongst and sensibility had returned to the limb. The circulation the troops in Dutch India are invariably consumers of evidently was re-established, although there were numbness alcohol. Among the diseases which Major Fribig found far and formication and the pulsation of the dorsalis pedis more virulent and fatal in non abstainers than in abstainers could not be felt until several months later. The patient are palustral fevers, hsematuria, cholera, dysentery, cir- regained complete power in the limb. Probably the massage rhosis of the liver, neurasthenia, cephalalgia, syphilis, and acted by breaking up as well as by moving the embolus surgical injuries. The authorities in Dutch India are fully which was driven towards the periphery to a point where alive to the importance of the alcohol question. An in. arterial obstruction did not, thanks to the collateral circulafluential association has been formed for the encouragement tion, interfere with the nutrition of the limb. of total abstinence. Under its auspices several recreation rooms have been established in which non-alcoholic refreshSTANDARD ELECTRIC CURRENT PRESSURES ments alone are sold, and in the principal garrison town a AND FREQUENCIES. canteen has been opened where the only intoxicating THE electric currents used in medical practice, including beverage provided consists of a light wholesome beer. As the production of the x rays, being very largely taken from an addendum Major Fribig, in conclusion, quotes the views the mains of the various electrical supply companies, many of the following authorities : Dr. E Rudel, Dr. Hugo Hoppe, of our readers will no doubt be interested in questions Dr. Livingstone, Captain Hutton, Count Gotzen, Emin Pasha, relative to the pressures and frequencies of such currents. Sir Henry Stanley, General Galliéni, and Lord Roberts. The At the present time the several electrical lighting and power list could easily have been extended. authorities supply currents at great varieties of pressure and in view of the desirability of obviating this unsatisfactory TREATMENT OF EMBOLISM OF THE LIMBS BY state of affairs the Engineering Standards Committee, the IMMEDIATE AND PROLONGED MASSAGE. offices of which are at 28, Victoria-street, Westminster, has AT the meeting of the Soclété Mé iicale des Hôpitaux of Imade suggestions as to the minimum number of standard Paris on Nov. 6th M. Pierre Merklen called attention to the ]pressures which would best meet present commercial requiretreatment of embolism of the arteries of the limbs byments and at the same time would utilise to the fullest extent massage-a method suggested to him by Professor Paul the consumers existing appliances. The committee recomBerger who thus successfully treated embolism of the mends direct current pressures of 110, 220, 440, and 500 volts, posterior tibial artery. When an artery is obliterated by an measured at the consumers’ terminals, and at the same time embolus a proximal clot forms and extends as far as the it expresses the hope that these pressures will in future be nearest branch given off by the artery ; a distal clot also universally adopted by the engineers advising corporations forms which is more extensive. If it extends very far it and others distributing electrical energy. On the question the establishment of the collateral circula- of frequencies the recommendations of the committee are helps to prevent tion. Hence the indication is to break up the embolus or (1) that 25 periods per second be the standard frequency for to drive it towards the periphery and to prevent the forma systems involving conversion to direct current by means of This result may be achieved rotary converters, for large power schemes over long distion of the secondary clots. spontaneously. Under the title " Histoire dramatique des tances, and for three-phase railway work ; and (2) that 50 Migrations d’un Caillot" Potainrelated a case in which periods per second be the standard frequency for mixed an embolus was first arrested at the bifurcation of the power and lighting on town-supply mains, for ordinary factory aorta, producing complete but transitory paraplegia ; on power plants, and for all medium-size power plant where the following day it had reached the external iliac artery, rotary converters are not employed. leaving the corresponding limb inert ; on the third day it THE FEATURES OF THE EPILEPTIC AURA reached the popliteal artery, which was shown by the return AND ATTACK. of pulsations in the femoral artery and the limitation of the coldness and anaesthesia to the foot, which symptoms DR. B. ONUF, assistant physician of the Craig Colony for M. Galliard has published a case of Epileptics, New York State, has published in the New were transitory. embolism of the axillary artery in which there were severe rork Medical Journal of Oct. 31st an account of the pain in the shoulder and coldness and lividity of the limb; features of the aura and the attack in epilepsy as studied on the third day the pain and circulatory troubles were carefully in 800 patients. The object of this investigation The spontaneous disruption of an was to ascertain as accurately as possible the various confined to the hand. embolus is possible only when the artery is not entirely clinical phenomena and the order of their sequence. Dr. obliterated and the volume and consistence of the clot Onuf states that the nature of the epileptic attack varied permit it to be carried into narrower channels. Perhaps with the patient and that " the picture of the symptoms was also the pulsations of the blood help to break up the clot. not at all that given in the text books, to which he had seen Deroyer has proposed to break up the clot in embolism almost as many exceptions as patients." The points to of the aorta by intermittent pressure on the bifurcation.2 which special attention was paid were the epileptic ’’ cry" M. Merklen related the case of a man suffering from mitral preceding a fit, the character oE the convulsions, the regurgitation which had existed for 22 years. He was pupillary changes, the tendon reflexes after the fit, and suddenly seized with severe pain in one of the lower the state of coma induced by the fit. The epileptic cry limbs which became cold and ansesthetic up to a distance which ushered in the fit was really a "low, tremulous of several centimetres above the knee. The pulsations groan" and when the ear was accustomed to it the of the dorsalis pedis artery were absent but those of cry was readily recognisable. The pupils were not always the femoral artery were retained. For nearly two hours dilated during the epileptic attack ; sometimes they were M. Merklen and a colleague, relieving one another so contracted and insensitive to light and at other times as to avoid interruption of the process, practised energetic they reacted to both light and accommodation. The convulsions were generally preceded by the well-known 1 Semaine Médicale, 1888, p. 65. 2 Gazette des or other sensory aura, the face then grew pale, Hôpitaux, 1880.

epigastric