THE INFLUENZA EPIDEMIC IN GERMANY.

987 upon the question of criminal responsibility. He states that morphine intoxication rarely lead,3 to a loss of mental power sufficient to allow of a ple’1 of irresponsibility, On the while it never produces irresistible impulses. contrary, morphinomania may lead to profound modifications of the mental state, in the course of which irresistible impulses may occur. This state may even be the result of sudden complete abstinence, or of a delay in the employment of the customary dose. The disease thus becomes of the highest interest, not only from the point of view of the individual, but also on account of its very serious social and medico-legal consequences. It is, moreover, very persistent, extremely difficult to treat, and recurs very readily. Recognising the impossibility of treating morphinomaniacs against their will by seclusion in asylums, even though the condition is so closely allied to insanity, and the dangers almost as great, Dr. Regnier pleads for more stringent legislation to prevent the present facilities for procuring the drug. The question of responsibility for criminal acts is necessarily one of great interest. Extenuating circumstances are so easy to find in most cases of crime that punishment could scarcely ever be enforced if attention were always paid to this plea. Responsibility is not removed-in this country, at least-by the plea of intoxication, even though-the psychical weakness is probably as great as in morphinomaniacs. When all crime is regarded with easy toleration and sympathy, as the result of amiable weakness beyond the power of control, then, and not till then, will the plea of morphinomania be likely t)take the position claimed for it by Dr. Regnier. -

SMALL-POX ON THE CONTINENT.

SMALL-POX attacked no less than 4S3 persons and caused 202 deaths in Madrid last week; the total attacks and deaths since the beginning of the outbreak being now 1933 In certain parts of France, and and 659 respectively. this in disease is also extending, and Brittany, notably M. Proust states that it is practically endemic in the more Breton towns and villages, where both infantile vaccination and revaccination at adult age have long been much neglected. The committee controlling public health in France have unanimously decided that the time has come to make vaccination and revaccination compulsory both prim&ry the country. throughout -

performed, and the judgment exercised in the subsequent management. If membrane is detached and pushed before the tube, the latter must be at once removed, and then the loose membrane will probably be expelled by coughing. The tube should not fit too tightly. In comparing intubation with tracheotomy, he remarks that the latter should be preferred by those who lack the special training or dexterity required for the former operation. (In Dr. Waxham’s own hands success has increased with his experience ; for whereas of his first series of 150 it is

cases the recoveries amounted to 27’33 per cent., in his second series of 135 cases they amounted to 43’70 per cent.) From a large number of statistics he estimates that

tracheotomy yields an average rate of 26 per cent. recoveries, but he admits that there are very great variations in the hands of different operators. INQUEST FEES. OxE of our provincial contemporaries is much amused that the medical officer of a hospital should be entitled to a fee for attending a coroner’s inquest in the case of a patient who died on his way to the hospital, whereas he would not have been entitled to any fee if the patient had arrived at the institution in a moribund condition and died there. The distinction may seem a fine one, but fine distinctions alwaysdo occur when hard-and-fast lines are drawn. In the present instance the medical officer’s light to his fee appears to be clear beyond the possibility of argument. The matter is expressly provided for by the Coroners A:t of 1887, and the general rule is laid down that a medical practitioner attending an inquest at the coroner’s request, for the purpose of giving evidence as to a post-mortem examinafion made by him, shall be entitled to a fee of one gainei. An exception is made which shuts out from the benefit of this rule the medical officer of a public hospital whose duty it was to attend upon a patient who has died in the institution ; but the death in the institution is made the very ground of the exception. Unless the courts are prepared to hold that death on the road to a hospital is a death in the hospital, the medical officer who, by the coroner’s direction, examines a body received dead at the institution to which he i attached is as much entitled as any other medical man to the statutory fee. ___

INTUBATION IN MEMBRANOUS LARYNGITIS. DR. WAXHAM of Chicago, in a paper on the surgical treatment of croup (Journ. Anzer. Med. Assoc., Oct 11th), publishes his recent experience in private practice of the treatment; by intubation, of which he is a strong advocate. To his previous list of 150 cases he now adds 135, and of the total (285) there have been 100 recoveries, or 35 per cent. The ages of the patients ranged from five months to twenty years, and the character of the case from "mild diphtheritic forms to the nl03t malignant." He refutes the objection that intubation is performed so early and unnecessarily that equally good results would have been obtained by tracheotomy, by giving details of several cases where the measure was applied as a last resort, the patients being almost moribund. As to after treatment, he urges the continuance of the same line as that adopted before operation, and speaks highly of the administration of calomel in cases where the pharyngeal symptoms are mild and the disease is manifested mainly in the larynx. (It may be noted that the same number of the Journal contains a paper by Dr. W. H Daly of Pittsburg, advocating the free administration of calomel as an essential part of the medical treatment of diphtheria.) Dr. Waxham justly reniaiks that success from intubation depends largely upon the skill with which

THE INFLUENZA EPIDEMIC TiiE

IN GERMANY.

Medical College of Stuttgart has published a the latest influenza epidemic in the State of Wiirtemberg. According to this highly interesting paper the disease was making insidious advancei among the population as early as the first three weeks of Dacember last. Its attack was mainly directed to the towns, and, if it appeared at all in any of the villages, it did so as an importation from the more populous centres. With the close of the third week in December a sudden change came over its tactics, till, in the first week of January, not a single

report

Royal

on

public ofrice,

not

a

single dwelling-place,

was

spared.

The towns were drawn rather earlier into the range of the disease than the provincial districts. By the last week of January the cases of illness previously occurring en masse suddenly ceased and only isolated cases were recorded. The authors of the report are of the that influenza (so called) was a " niiasmaticoopinion contagious" malady-probably a " morbid excitant," which multiplied within the human body and wandered from place to place in sympathy with the coming and going of the people. It was not merely transferred, however, from man to man, but, after being deposited in a locality by patients, it could maintain itself independently of these, and, under favourable conditions-such as the great drought

specially

988 which prevailed during the above-mentioned period-could then proceed to infect others. Another significant remark made by the authors is this: that persons who kept exclusively or a great deal to their apartment were scarcely touched by the influenza; while those who led an out-of-door life or moved freely in and out were seldom spared. The report indicates that the keynote struck by the malady was throughout distinctly neurotic.

PROFESSOR KOCH’S RESEARCHES. IT is stated that it is the intention of the authorities of the Charite Hospital to place 120 beds at the disposal of Professor Koch after January, for the purpose of treating patients by his germicidal method. It must be borne in mind that his researches, which have been carried on for several years, have had for their aim the destruction of all forms of pathogenic microbes within the body, and can by The no means be limited to the tubercular bacillus. material which he has at length discovered to have this remarkable property is, as will be seen from the letter of our Berlin correspondent, apparently not of the nature of

not prevented, hut it ran a slower course. Pigeons io which the pancreas had been partially or entirely extirpated became, for a time at least, susceptible. The disease waf-contracted in pigeons which had been previously well fed but entirely deprived of food for eight days after inoculation. It thus appears that the virus injected under the skin of pigeons in their normal condition of insusceptibility retains for several days its activity and capacity for infection. Some observations on similar lines were made on fowls, which appeired generally to be rendered susceptible to anthrax infection hy partial starvation for from three to seven days before inoculation. They did not, however, contract the disease if the starvation was only commenced at the time of inoculation. These experiments are especially interesting as bearing on the well-known clinical fact that hunger and fatigue predispose to the contraction of in. fectious disease. It is to be hoped that they will be followed up, as a large field of inquiry appears open in this direction. was

THE SEWERAGE OF CAMBRIDGE.

glad to announce that at last the Town Council Cambridge have decided to deal with the question of the true "lymph," but contains inorganic substances, together with attenuated cultures of the bacillus. It is said to be sewerage of that town according to a plan prepared by difficult and expensive to prepare, and there is reason to fear Mr. Mansergh. Even after the years of delay which have that unless very stringent precautions be taken, less power- occurred in regard to this matter, an attempt was made at, ful agents may be introduced, and the true method thereby the last meeting of the Council to postpone the subject on discredited. It is also declared that Professor Leyden is the ground of undue haste. But the amendment as to this. satisfied of the efficacy of the treatment, whilst Professor was, after a lengthened discussion, rejected by a snb8tantia and the original motion to adopt Mr. Mansergh’s. Nothnagel of Vienna has expressed himself in very hopeful majority, was then passed. scheme terms of the value and importance of the discovery. It is hoped that in the course of next month Professor Koch will MICROBES IN THE STOMACH. describe the method before the Berlin Medical Society and DR. KlANOVSKi details in the last two numbers of the give full details of his experimental observations. ITnaelz some observations he has recently made upon the bacteria contained in the stomach before and during AN OPERATION FOR PROMINENT EARS. digestion, with the object of determining the effect of the AN undue prominence and turning forwards of the pinna gastric juice upon them. He found that the fasting: is a very unsightly deformity that is only with difficulty stomach of a healthy person always contains a larga overcome by the methods usually employed. Dr. Ely, number of microbes, and that in the earlier part of digestion some years ago, treated a case of this kind by removal of the number of these bodies is also considerable, and that it’ an oval vertical segment of the pinna. But Dr. W. W. depends mainly on the number introduced by the food, Keen of Philadelphia has improved upon this by removing saliva, &c. Notwithstanding this, the gastric juice, or an oval piece of the skin of the back of the ear, and rather perhaps the free hydrochloric acid in it, tends tocutting a vertical notch only in the cartilage. The skin exert a decidedly destructive influence upon the microbes. wound is then closed with fine sutures, a bend occurs in the No effect appears to be produced upon the process of pinna where the cartilage has been notched, and so the digestion by these bodies. prominence of the ear is remedied. The advantage of this NECKLACES OF HUMAN TEETH. plan is that it leaves the ear without any scar in frontwithout any visible scar, in fact. The case in which MR. R. H. WooDHOUSE presented to the Odontologica Dr. Keen did this operation is recorded, and the patient Society at its last meeting a necklace of human teeth for figured in the Transactions of the Philadelphia County which he was indebted to the kindness of Mr. H. M. Stanley. Medical Society. The operation in that case was eminently The necklace was found upon a young warrior, a native of WE

are

of

-

-

successful. ___

EFFECT OF HUNGER ON SUSCEPTIBILITY TO INFECTION. DBS. P. CANALIS and B. MORPURGO of Turin have Austrian medical journal some important observations upon the effect of starvation, more or less complete, on susceptibility to infectious disease. The subjects chosen for the principal experiments were pigeons, and the disease malignant anthrax, to which these birds under ordinary circumstances are insusceptible. The observers mentioned, however, found that pigeons partially starved for six days or more before inoculation with the anthrax virus contracted the disease if starvation was continued subsequently. When food was given from the time of inoculation they did not contract anthrax. If the subsequent starvation was continued for two days only, the birds being then fed fully, the appearance of the disease

published in an

a cannibal tribe, upon the Sturi river, who was killed in an attack upon Mr. Stanley’s party, in which Lieut. Stairs was wounded with a poisoned arrow, at the junction of the Ruku and Sturi rivers, 1500 miles from the mouth of the Congo. These necklaces are considered horrible by non-man-eating tribes. Other tribes wear necklaces of monkey or crocodile teeth. This particular necklace consists of thirty-eight teeth, some of which are deciduous, and one molar was observed to be carious. Most of the singlefanged teeth were perfect, but the roots of the molars were more or less broken by the rude method of removal, in order to facilitate which the natives burn the skulls to a. certain extent. Mr. Stanley informed Mr. Woodhouse that many of these necklaces consisted of several rows, and sometimes contained as many as 400 teeth; and, further,

Avisibba,

speaking of the prevalence of

caries amongst the natives of greater than is generally the Emin Pasha Expedition

Africa, which appears

to be far

supposed, stated

during

that