"SHUTTLE-KISSING."

1637 a combination ot several measures might be to suit the local circumstances of certain places.

India ;

required Quinine

febrile reaction after intraperitoneal inoculation with blood from human cases of typhus fever. This consists of a rise of temperature starting after an incubation period of about a week, reaching its maximum in about three days, and falling again to normal in about five days. Their first step

to a free population, it must be is difficult to admitted, carry out in the thorough way which is essential to success. Treatment by quinine of persons suffering from malaria is a measure of the greatest value was to apply this test by inoculating a series of monkeys from the point of view of saving life, preventing suffering, with blood from patients suffering from Brill’s disease ; in and destroying a potent source of infection. Education of i two of these the characteristic reaction occurred, and it was the people is a most important anti-malarial measure, and also possible to inoculate further animals to the fifteenth every effort should be made to secure the cooperation of the generation from those which received the dose of human public, for without this there will be little hope of the blood. The next and most important step was to find out campaign proving successful. Instruction in schools as well whether recovery from typhus fever conferred immunity to as lectures and lantern demonstrations in villages are among Brill’s disease, and vice versd. The monkeys which had the best methods for spreading the needed knowledge ; the recovered from typhus fever were inoculated with blood from information conveyed in this way is more likely to reach the monkeys suffering from Brill’s disease ; the results were people than if presented by pamphlets or posters. The uniformly negative, though of eight control monkeys attention of the Indian Government was drawn by the which had not had typhus fever seven reacted characThis may be interpreted that a previous delegates to the possible danger arising from borrow pits teristically. dng near dwellings, more especially when these excavations attack of typhus fever confers immunity against Brill’s dispermit the presence of standing water in them. While still ease. Conversely, seven monkeys which had recovered from strongly in favour of the prosecution of further scientific febrile attacks following inoculation of blood from cases of researches the conference expressed the opinion that Brill’s disease were found to be absolutely resistant to sufficient was already known of the breeding habits of inoculation from typhus fever patients, though the typical mosquitoes to make it frequently possible for trained reaction followed in every one of nine healthy monkeys used workers to control malaria in an efficient manner. Finally, as controls. The obvious inference is that Brill’s disease the delegates, in view of the possible importation into and typhus fever are identical, since an inoculation with India of yellow fever in the near future from Central either confers immunity against the other. If this be so, we and South America, urged the advisability of having a are faced by the disquieting fact that a mild form of typhus "stegomyia survey " carried out ; and held that steps should fever has been endemic for some years in New York; and be taken to educate the people of India in the best way of what is true of one large city is likely to prove equally true exterminating domestic mosquitoes and destroying their for others. Fortunately, recent work has shown that the breeding places. These unanimous conclusions of the common louse is the carrier of the infective agent of typhus delegates at the conference show the advance which has fever, and this gives reason for the hope that it may be taken place in the official views in India as to the best means possible to prevent transmission of the disease by destruction of fighting malaria; before long wa may expect a large of its intermediary. It is interesting to note that Dr. reduction in the amount of suffering and death caused Anderson and Dr. Goldberger find reason to believe that this insect may also act as a carrier of"Brill’s diseaseor by malaria. (as we must henceforth think of it) of endemic typhus fever. TYPHUS FEVER AND BRILL’S DISEASE.

prophylaxis applied

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"SHUTTLE-KISSING." MUCH interest has been excited in the United States by AN of the papers published by Dr. Nathan E. Brill, New York, interesting report to the Home Office and to the Local Government disease of unknown "an acute infectious Board, upon an inquiry into the alleged danger origin," describing of the transmission of certain diseases from person to person numerous examples of which occurred in his own practice, and which he was able to separate from typhoid fever in weaving sheds by means of shuttle-kissing,_has been because of the brief duration of the pyrexia, the absence of issued as a Parliamentary paper. The matter affects workers the specific agglutination reaction, and the presence of a in the cotton and linen industries, and evidence was taken in distinctive eruption. In 1909 Dr. Brill published an account a number of towns in Lancashire, and in Glasgow, Belfast, of 221 such cases, and the disorder became known as 6’ Brill’s and the north of Ireland. No evidence was found to support disease." Since then it has been a battle-ground of con- the allegations that in certain particular instances trans" .. troversy between those who asserted that the symptoms were mission of disease took place by shuttie-kissing." The " in this committee those of typhus fever, and those who believed it to be a Indeed, we engaged inquiry report: a and further that we and Further have not distinct cases have been step might safely go say entity. separate in found evidence instance which would himself and so far as Dr. Brill others, any justify susby though reported by we know no instance of it has been observed outside New picion that the shuttles had been the means of transYork and Brooklyn. One point that made it difficult mitting infection." They add that they are in hearty to believe this disease identical with typhus fever was its concurrence with the view that the practice is objectionable, very low mortality, about 1 per cent. of the cases recorded and that it is desirable that some other method of shuttleproving fatal. However, the problem was clearly one for threading should be adopted, but this opinion they hold, bacteriological or bio-chemical tests, and as there is as yet apart from the medical or public health aspect of the no certain knowledge of the bacteriology of typhus fever it question, on the ground simply of decency and cleanliness of was necessary to rely on immunity reactions. Experiments habit. As far as cotton is concerned, the committee hold made by Dr. Brill last year were negative so far as they that practical alternatives to the present form of shuttle went, but Dr. Brill himself considered these results incon- should be found and that shuttle-kissingis no longer a clusive. A paper recently read before the Section in Medicine necessity. As regards flax, they were forced to the conof the New York Academy of Medicine, and published in clusion that the hand-threading shuttles, in their present the New York Medioal Journal, May llth, 1912, fills the form, may not be suitable for flax, and there was congap. Dr. John F. Anderson and Dr. Joseph Goldberger, siderable doubt whether the mechanical suckers would pull who have been investigating typhus fever in Mexico City, the stiff fibre through the eye, but they found, on the found that the lower apes displayed a characteristic form of other hand, when they visited Belfast, that in some

1638 sheds slight alterations were being made in the design of not shown any improvement under any other form of treatthe shuttles to enable the weaver to push the thread ment. After about 25 injections all the symptoms had through the eye with finger and thumb. The committee think diminished in seveiity or disappeared, the general nutrition that threading with the mouth (the weaver in the act puts had much improved, and many patients were able to resumethe side of the shuttle to his mouth and uses an inspiratory their occupations. The improvement in the skin lesions thread the suction to draw the through the eye, hence the were as marked as improvement in the symptoms; a term " kissing the shuttle ") might be generally avoided by change for the better was visible after five or six injections, adopting such measures, or by the use of hooks of various and after 12 injections every trace of the scales and erythema forms, similar to a crochet-hook, which can be inserted had disappeared. As to the question of recurrence, only through the eye, and will draw back the weft. While in 2 cases out of 50 in Roumania showed signs of any return of agreement that the present method of threading is uncleanly the disease, and only 1 case of relapse occurred amongst and may even be a possible means of spreading infection, those treated in Italy in 1911, and this in spite of the fact the committee do not think the time is yet ripe for insisting, that the patients had not changed their diet. The results either by regulations or by Act of Parliament, in the abolition seem to be very encouraging, but it is probable that some of of the existing form of shuttle. They feel that the facts the constituents of this very complex serum take no share elicited do not justify drastic legal action at present. The in the result. report is signed by Mr. Gerald Bellhouse (one of the superA TYPHOID CARRIER ON SHIPBOARD. intending inspectors of factories), Dr. W. W. Fletcher and of Local Government the (medical inspector THE danger to others of a typhoid carrier on land are now by Board), Mr. D. J. Shackleton (late senior labour adviser, Home Office). well known. In the Journal of the American Medical AsseDr. H. T. Bulstrode, one of the original members of this cation of May 4th Dr. Wilbur A. Sawyer, director of departmental committee, died before the inquiry terminated. the Bureau of the Hygienic Laboratory of the California board of health, has reported a case which shows the evil THE SCIENTIFIC RESEARCHES FOR THE LOCAL which may be wrought on shipboard, where there are peculiar opportunities for conveying the infection. For GOVERNMENT BOARD. three and a half years it had been noticed at the United THE President of the Local Government Board has States Marine Hospital in San Francisco that a large part of authorised the following special researches to be paid for out all the typhoid cases came from the steamship AO’l7le. a of the annual grant voted by Parliament in aid of scientific vessel carrying lumber from Humboldt Bay to San Francisco nvestigations concerning the causes and processes of Bay and sometimes to San Pedro, the port of Los Angeles. disease :An investigation by the Health Department of San Fran* 1. Further investigations (ct) as to the distribution of tubercle bacilli cisco in children having died between the ages of two and ten years, and the pointed to the winch driver, who had had typhoid special characteristics of such bacilli; and (b) in collaboration with the fever four years ago, as a carrier. But his blood failed General Register Office, on the incidence of different forms of tubercuand the Widal reaction to in to losis different parts of the country, according typhoid bacilli could give age, sex, occupation, and other conditions. in his It was considered that the not be found stools. 2. A continuation of a research into the causes of premature arterial degeneration in man, by Dr. F. W. Andrewes, of St. Bartholomew’s solution of the problem involved work in other cities. Hospital. 3. A joint investigation into the virus of poliomyelitis, by Drs. F. W. The State board of health was notified of this fact and Andrewes and M. H. Gordon, of St. Bartholomew’s Hospital. assigned the investigation to the division of epidemiology of 4. A continuation of an investigation into the micro-organisms known the Bureau of the Hygienic Laboratory. Dr. Sawyer, the as non-lactose fermenters occurring in the alimentary canal of infants, by Dr. C. J. Lewis, of Birmingham University, Dr. D. M. Alexander, director, began work on the problem on Dec. 28th, 1911. of Liverpool University, and Dr. Graham-Smith, of Cambridge The Acme carried no passengers and the crew usually University. 5. A continuation of the investigations by Professor Nuttall, of The ship was not numbered only 21, including the officers. Cambridge University, on fleas and on the range of flight of the domestic and allied flies. less sanitary than most vessels of her kind. The mess-room of the officers was clean and attractive. The crew ate their A NEW TREATMENT FOR PELLAGRA. food sitting on the cargo. The galley was not so clean as Dr. Jean Nicolaidi, of Paris, has devised an original was desirable. The forecastle housed 12 men in very close method of treatment of pellagra, and a paper on the subject, quarters. There were three tiers of bunks and very little which he read at the recent International Congress of Dermato- unoccupied space. The sailors’ water-closet was in a filthy logy at Rome, is interesting. Dr. Nicolaidi holds that the main state, and suggested opportunity for the spread of infection changes in pellagra are due to serious interference with by flies. The food-supply could be excluded as a source nutrition. In order to overcome this nutritional disturbance of infection. Condensed milk was used, and other ships it occurred to him that a serum might be employed in treat- , buying food in the same market were free from the ment, and he prepared a serum, which he calls an "organo- disease. Only two men, the captain and the winchpolymineralised serum " ; its composition is not stated very driver, had been on board during the entire series of definitely, but it is said to contain substances extracted in typhoid cases. Examination of the blood, faeces, and vaC1l,O from horse serum, and organic and mineral substances urine of the captain was negative. As stated above, the same from blood plasma, and it is also made radio-active. The result had previously been obtained in the case of the winchfirst attempts to treat pellagra with this serum were made in driver. However, a search through the records of the Roumania in 1909, and the results are said to have been so United States marine hospitals in San Francisco and good that he was asked by the Roumanian Government Los Angeles pointed to him as the source of infection. In to employ the serum in the following year, and we are January, 1908, a case of typhoid fever was received from told that many patients suffering from the disease were another steamer on which he had previously been employed. rapidly cured or at least much benefited, and in some Since he joined the Aome in August, 1908, during a period of cases patients with severe mental symptoms who were in the 43 months 26 cases of typhoid fever had been received from asylum at Craiova were able to leave the asylum after 20 to it in the hospitals. It was decided to make a thorough 33 injections. During the summer of 1911 Professor Antonini examination of all persons under the slightest suspicion of The captain, chief engineer, and the winchwas asked by the Health Department of Italy to arrange for being carriers. a series of trials of the serum. These trials were made. driver were taken into hospital for 24 hours, so as to ensure Patients were taken who had severe symptoms and who had that all specimens were bond fide and properly taken. They -