" FILARIA SANGUINIS HOMINIS AND FEVER."

314 associated with the advent of night, and not depending in any way on the France, Prussia, England, and Saxony. Side by state. however, with this remarkable regularity in the recorded sleeping " Although in the paper I sent you some time ago I refrained from

side,

number of suicides is also brought out with equal dis- speculating on the cause of filarial periodicity (because 1 had nothing but guesses to offer), yet I have thought a good deal about what might be the tinctness the progressive increase of suicides during recent reason of this most remarkable phenomenon, which, as you say, savours years in all countries for which statistics are available. of the marvellous.’ As Dr. Mortimer Granville remarks, it is well the attention of physiologists, for could we ascertain what the The subject; is fully discussed in its "cosmic, ethnic, deserving subtle influence is that sets these creatures circulating in the blood stream arrests them with such military punctuality,’ we probably would let social, intellectual, historical, and individual"aspects. and new light in on many an obscure problem both in physiology and pathology. The variations in the proportional prevalence of suicide It was with the intention of providing myself with a standard with which in different countries is only partially explained by varying to compare the results of observation and experiment that 1 prepared the chart I send you. If it is published it may help others, who are willing to degrees of accuracy in the records of suicide. The result work on this subject, but who may not have the opportunities of the of a comparison of the statistics of forty-five different continuous observation it records. "Dr. Mortimer Granville’s ingenious speculations are based on the countries is to show that only in three cases has the assumption that the phenomenon of periodicity depends in way on either on the mechanical changes in the circul tfion when the body is proportion of suicides declined during the present century- sleep, in the recumbent position, or in the different proportions of oxygen in the in relative alterations of blood and tissue temperatures during the namely, in Norway, Dalmatia, and the city of Frankfort, blood, orand sleeping states. Now, as the embryos begin to appear hours whereas a varying rate of increase is shown in all the other waking before the usual time for repose, and are in no way sensibly affected by in the hours of sleeping and waking, it is evident that the power cases. With regard to the proportion of suicides to the changes fixes them and lets them loose operates independently of the sleeping which that the smallest rates occur in the state. It is associated with the advent of night, but not of sleep. population, it is notable " Part of Dr. Mortimer Granville’s note is so much to the point that I will three southern countries of Itily, Spain, and Portugal, it-’ The change of place may be fairly ascribed to change of state. whereas the largest proportioa occurs ill Central Europe. quote Lookingatthe habits of life in the lowest organisms, it can scarcely be depend on the state or requirements of One of the most trustworthy conclusions that may be drawn supposed that the periodicity canthe the hiariee. It is not likely that parasite needs repose, or that it resorts from Dr. Morselli’s statistics relates to the seasonal distri- to special localities to feed. It seems more probable that the state of the fluid determines the presence or absence of the filaria in the bntion of suicides ; it appears that in nearly all countries circulating The first part of this I main current by night and day respectively.’ the proportion risei s’eaeity from the first month of the quite agree with, but the latter part I am not quite so sure about. What is the ditferenee between the state of the circulating fluid at 4 P.1Il. and 6 P.M. year, reaching a M4XiM’IM in June, and afterwards steadily respectively ? It is evident that something happens between these hours liberates the embryos. I do not know that physiologists have declining again to the c!o-ie of the year. The fact-3 bearing which demonstrated or even supposed some sudden change in the up’m the ethnological variations in the proportion of suicide blood between these hours. Again, the conditions permitting the free are full of interest. In Europe the pure Germanic races circulation of the parasites continue with increasing effect up to midnight, and the restraining influenees which fix them are gradually reapplied from showed the highest proportion of suicides, followed very that time till they effect also complete fixation by nine or ten o’clock next What alteration in the physiological state of the blood or body closely by the Scaud’navian races, whereas the propor- forenoon. corresponds to these hours ? Ifou refer to my chart you will find tions are very low among the Latin races, except in France. generally no explanation in the rapidity of the circulation, nor in the temperature of It is impossible not to admire the thoroughness with the body. For sometimes the pulse is quiek when the embryos are and sometimes it is slow; sometimes the temperature fluctuates which Dr. Morselli has investigated and tabulated the numerous, a degree without apparent effect on the numbers circulating. " Whatever the cause may be it certainly operates through the body, the statistics of suicide with a view fairly to estimate the medium in which the parasites are, but I am very much inclined to think true influence of an infinite variety of factors. There that though operating through the body it is placed outside of it. "Of one thing we may be quite certain-that from the fact of the is, however, nothing very new or very explicit in the periodicity being one of twenty-four hours its remote cause is the rising and .conclusion which the author arrives at with regard to the setting of the sun, or rather the altered relation of the earth’s surface to the every twenty-four hours. Of another thing we may also be laws of suicide, which he expresses in the following words : sun recurring .. certain, that the immediate cause is applied between the hours of five and ’" Suicide is an effect of the struggle for existence, and of seven P.M. What, then, is the phenomenon in nature which, depending on position of the earth’s surface to the sun, begins to operate on the human selection, which works according to the laws of- the human body with the utmost regularity between the hours of five and evolution among civilised people." The proportional relation seven P.M., increases in power up to midnight, wanes towards morning, and ceases to act between nine and ten A.M. 2 " &e. between male and female suicides is pretty constantly be- finally Most of this is of course entirely disposed of by Dr. tween three and four to one. It further appearsthat among Manson’s more recent investigations; in fdct, by putting my both males and females the proportion of suicides is largest ;uggestions to a practical test. In Dr. Stephen Mackenzie’s between the ages of forty-five and fifty-five. It is not sur- ;are the niariae were found chiefly at night, first appearing prising to find that, as with the general death-rate, the rate of ELbout 9 P M., aud beinga more numerous at midnight. At few, filariae could be found. "By suicides is larger both among the unmarried and the widowed 9 A.M. some, but only of the habits the patient, making him eat and inverting than amongthe married. Inconclusion, we have no hesitation work at night, and sleep in the day, the fitarise were made .in speaking highly of Dr. Morselli’s contribution to the to alter their habits, and only appeared by day." If this International Scientificseries. be not a conc)usive proof of the accuracy of my theory of the causation of periodicity, it ia difficult, to imagine what could be. If Dr. Manson and Dr. Mackenzie will refer to mv note appended to Dr. Cobbold’s paper in the Journal of " FILARIA SANGUINIS HOMINIS AND FEVER." the Q«ek*’tt Microscopical Club, they will find that I do To the Editor of THE LANCET. not suggest that the periodicity depends upon the fact of sleep, of the physiological conditions which SiR,-Dr. Patrick Manson is evidently, though perhaps but of the recurrence It ia impossible to insist too strongly, or too accompany sleep. of round to as to my way thinking unconsciously, coming on the importance of the conclmion at which all the physiological explanation of the periodicity of the frequently, practical investigators of the phenomena of sleep must have appearance of filariae in the blood. In his letter of Dec. 21st, arrived, and which has been 100 well expressed by Professor etc., 1881, which appears in THE LAXCET of last week, he says Vulpian : "Les mod’ncations vasculaires, qu’elles soient d’ailleurs (par. 6), "Ihave repeated Dr. Mackenzie’s experiment of ne sont qu’accessoires, adjuvantes, ou ci)ns6(-.utives, et elles ne jouent aucun role keeping a filarious subject awake all night, allowing him concomitautes essentiel dans la physiologic du sommail." The modito sleep during the day, and with the same results. After fications of blood current and presure, of the relative two or three days, during which egress and ingress of embryos amounts of oxygen and carbonic acid received into or were very irregular, periodicity became completely inverted." liberated from the blood, of the relative temperatures of the On August 25tb, 1880, Dr. Patrick Manson wrote to blood and the tissues, and of the chyle current, which are concomitant or consecutive to the sleep-state, are, I believe, Dr. Cobbold as follows :essential to the appearance of the fila, iae iublood : and it is " The reprint from vol. vi. of the Quekett Club Journal I duly in the study of these modifications, to which attention has received, and I thank you for the trouble you have taken in thus bringing forward my work. In reading it I was especially interested in the short been directed by the curious behaviour of the filaria sannote by Dr. Mortimer Granville. Though his speculations are founded on guinishominis, that the most useful and practical information an error, yet I like the scientific style in which he treats the subject. with regard to " periodicity," generally, will be gained. Perhaps you will show him the chart I send you herewith. He would see I am, Sir, yours obedleutly, from it-1st. That the periodicity observed by the filaria embryos is by no J. MORTIMER GRANVILLE. C_!1S‘ILLE. means an exceptional or capricious phenomenon; and, 2nd, that it i3 Welbeek-st., W., Feb. 20, 1882. ...

I1

cardiaques,

THE ROLL OF THE PROFESSION.-THE SUPPORT OF HOSPITALS.

THE LANCET. LONDON: SATURDAY, FEBRUARY 25, 1882. THE great Roll of the medical profession for the year is before us in the form of the Medical Register, in a volume which-induing all recent Medical Acts of Parliament and many carefully compiled statistical tables-has scarcely received so much attention as its importance demands. Wecall it the great Roll both because it includes all others and because it determines the legal position of He may appear in every member of the profession. other lists, and he may there tack on letters and titles and achievements apparently without much let or hindrance, and some of them very irrelevant and immaterial. But in the Medical Register he must appear in unadorned simplicity as a licentiate, member, or fellow of a British medical corporation, or as a graduate in medicine or surgery of a British university. It would be curious to consider why this volume has received so little attention, and is so seldom regarded, except when medical men require an appointment, want lymph from the national vaccine establishment, have to sign an important certificate in their professional capacity to recover charges for medical or surgical attendance, or to give evidence in a court of law. In such circumstances it is tantalising to find oneself, perhaps, with a great number of qualifications, but without any professional status for want of being registered. Registration is optional; but there are few men unregistered from option. Probably most men who wake up some morning and find themselves unregistered have been once registered, and have ceased to be so under the dreadful Fourteenth Clause, which sorely needs revision and amendment in the next Medical Act. Under this clause hundreds are removed every year. If we exclude between five and six hundred names-the actual average annual number for six years is 588-removed yearly "by ascertained evidence of death," there still remains for the last six years an average annual removal of 329 names under the Fourteenth Clause. The rough justice of this removal may be gathered by the fact of the Council having to restore on an average about seventy-eight under this clause. But even this amount of roughness in justice is very trying, and it is impossible to deny that the Fourteenth Clause is highly irritating and hard in its operation, and calls urgently for amendment. Meantime it is not easy to blame the Registrar of the Council, who must be above all things anxious that his record shall be accurate, and whose chief test of accuracy now is this very clause. Until it is amended members of the profession who receive letters from the Registrar inquiring if they have ceased to practise, or have changed their residence, will do well to answer without delay, and with careful accuracy. Liability to imposition is not limited to the compilers of non-official Registers, of which wehave such a valuable specimen in the Medical Directory. While lamenting some recent instances in which glaringly false titles have found insertion in the Directory, and further, we must add, the serious tendency to use it f9r

315

advertising very doubtful and very unimportant personal details, to the exclusion, of course, of valuable information, it must be admitted that the Medical Directory is an indispensable fund of information, and in some instances, even in regard to important facts and registrable qualifications, is a more useful guide than the Medical Register. Take, for medicine is which most honoured wherever a name example, is cultivated as a science-that of Sir WILLIAMJENEE. In the Medical Register of this and other years Sir WILLIAM is credited with only one medical qualification, and that an honorary one, conferred without examination-the Fellow. ship of the Royal College of Physicians, London. The pos. session of the degree of M.D. Lond. by Sir WILLIAM is a fact for which, as well as for a statement of Sir ’YILLIA1B(S great scientific work, we must go to the Medical Directory. The Medical Register does not even mention Sir WILLIAM’s Degree. Still it must be admitted that with a11 the imperfections in the record of the Medical Register, the Registrar is not so liable to be imposed on by fraudulent persons, inasmuch as he deals only with recognised British titles, andhas the means of checking the pretensions of those who apply for registration. It must further be admitted, that under the present Registrar’s hands the Register is annually becoming more valuable and accurate. Though it is his duty to use the Fourteenth Clause freely, and though doing so he has greatly improved the Register, wemay well believe he is fully prepared to give and to take suggestions for its amendment, which will make it at once more effective for its purpose and less offensive to the pro-

by

fession. The Roll of the profession for 1882 includes 23,275 registered persons. This is a larger number, we imagine, than in any previous year. It is larger by 420 than in the previous year, and by 562 than in 1876. As we have recently said, the overflowing numbers on the Register make it quite safe for our legislators to take additional precautions for the stringency of those Examining Boards which give entrance to the profession. THE remarks made last week at the

by the Earl of KIMBERLEY University College Hospital dinner upon the subject

of medical charities deserve more than mere casual notice. His Lordship said he had long thought that the hospitals of this city rest upon a most unsatisfactory basis : not in respect of the eminent men of science connected with them, or in respect of the manner in which they fulfilled their purpose, whether as affording means of teaching in their medical schools or alleviating the sufferings of patients; but unsatisfactory on account of the fitful character of the support they receive from the public. Our hospitals, he

observed,

are

dependent

upon

public charity, and, though

the problem is a difficult one, it is impossible to leave them in the position they now occupy. These institutions, which furnish the supply of medical practitioners for the whole of the Empire, cannot, his Lordship insisted, be left to depend entirely upon voluntary assistance; and, without presenting any definite plan, he suggested that some such system as that adopted in the case of our educational establishments should be tried. Without checking voluntary exertions, private efforts might be supplemented by public aid. At present hospitals are maintained by a comparatively

.