THE TREATMENT OF SCARLET FEVER BY SERUMS.

1024 the opportunity of acquiring a much-needed breathing-space to slip from the control of the committee. There is an " increasing agitation for establishing " an arbour day throughout England which shall be celebrated by the planting of trees for the benefit of future generaThis is an excellent movement and should be tions. supplemented by the attempt to save from the axe as many trees at present existing as may be possible, remembering the old proverb in regard to the tree-feller, that a fool in five minutes can destroy the forethought and work of 50 years. Mr. Thomas A. Cook of the Soap Works, Bow, and Mr. George W. Paton of Fairfield Works, Bow, are the joint honorary secretaries. The joint honorary treasurers are Mr. 0. E. Riche, London and South-Western Bank, Bowroad, and Mr. W. R. Few, London and Westminster Bank, Bow-road. Any of these gentlemen will gladly acknowledge contributions towards the object in question. A

DARWIN CELEBRATION AT CAMBRIDGE.

ARRANGEMENTS are being made by the University of Cambridge to celebrate on Tuesday, June 22nd, Wednesday, June 23rd, and Thursday, June 24th, 1909, the hundredth anniversary of the birth of Charles Darwin and the fiftieth anniversary of the publication of the "Origin of Species." It is proposed to invite representatives of universities and other learned bodies, together with distinguished individuals, to visit the University on the occasion. A programme of the celebration will be issued in the near future. The honorary secretaries to the movement are Mr. J. W. Clark, the Registrary of the University, and Professor A. C. Seward, professor of botany in the University.

THE

INTERNATIONAL

CONGRESS

ON

TUBERCULOSIS, 1908. THE preliminary announcement has been issued concerning the International Congress on Tuberculosis which is to be held this year in Washington, U.S.A., under the organisation of the American National Association for the study and prevention of the disease, of which Dr. Frank Billings is president, and Mr. Theodore Roosevelt, Mr. Grover Cleveland, and Professor William Osler are honorary vice-presidents. We have already announced that the Congress will be held on Sept. 24th and the two following days under the auspices of the United Sates Government, seven of its nine departments having petitioned the House of Congress for authority and means to participate in the conference, while the Department of State has been authorised to invite the governments of other countries, through their ministers, to send representatives to the Congress. The programme is divided into seven sections, which are: (1) Pathology and Bacteriology; (2) Clinical Study and Therapy-Sanatoria, Hospitals and Dispensaries ; (3) Surgery and Orthopaedics ; (4) Tuberculosis in Children, Etiology, Prevention, and Treatment (a full syllabus of the work of this section is given) ; (5) Hygienic, Social, Industrial and Economic Aspects of Tuberculosis ; (6) State and Municipal Control; and (7) Tuberculosis in Animals, and its Relation to Man. An exhibition will gather illustrative material, appliances for treatment and so forth, from all parts of the world, including literature on tuberculosis, and readers of THE LANCET1 have already been informed of the nature and conditions of the prize3 offered in connexion with this exhibition. They may like to be reminded of the terms of membership, for it is our hope that Great Britain, which has throughout been in the van in dealing with tuberculosis, will be well represented at the Congress. Active members will pay a fee of$5 and will receive the full set of published transactions. Associate members, who pay$2 only, do not receive the transactions or vote in 1

THE LANCET, March 21st, 1908, p. 882.

the Congress. An entertainment and a transport committee have been formed, which will enable visitors to the Congress to receive the benefits of special rates of travel, and a tour of many of the principal cities of the Eastern States, lasting from Sept. 21st to Oct. 10th, and including a visit to Niagara, is to be arranged. Those of our readers who have experienced American hospitality will rest assured that they will be welcomed in a very practical manner by their brothers across the ocean if they can spare the time to make an extended summer holiday. Applications for membership or for further information should be made to the Sacretary-General, Dr. John S. Fulton, Colorado Building, Washington, D.C.

THE PURIFICATION

harmless

IN the Union

OF POTABLE WATER.

Pharmaceutique

a

simple

and

apparently

method is given for purifying potable water. The as method, given by M. Celestin Hy, is based on that devised by M. Girard and M. Bordas, The water originally to be purified is first treated with a powder consisting of one equivalent of potassium permanganate and sodium carbonate and slaked lime, of each seven equivalents. After an interval of five minutes eight equivalents of anhydrous ferrous sulphate are added. The method is based upon the fact that potassium permanganate in an alkaline solution oxidises organic matter and destroys micro-organisms, the sodium carbonate precipitates any calcium sulphate that may occur naturally in the water, and the calcium hydrate precipitates any bicarbonate of lime that may be present. On adding ferrous sulphate the excess of permanganate is removed in the form of a dense precipitate. The water as drawn off from the precipitate is very pure and limpid and contains only a very small amouut of the sulphates of potassium and sodium. The presence of these salts is not at all objectionable. In the case of the water of the Seine, containing a great number of bacteria, including the colon bacillus, M. Hy found that this process produced a perfectly sterile water. There is very little danger of using an excess of either of the powders. An excess of the powder containing potassium permanganate would impart to the finished product a noticeable pink colour, while an excess of iron would be precipitated partly by the sodium carbonate and partly by the calcium carbonate resulting from the first reaction. ____

THE TREATMENT OF SCARLET FEVER BY SERUMS.

SEVERAL attempts have been made to treat scarlet fever by serums, the serum of convalescents having been tried without much success and also an anti-streptococcic serum, the latter owing to the belief that the causal agent in the disease It is, however, more probable that the was a streptococcus. found in scarlet fever are a secondary infection, streptococci and though they may be the cause of some of the complications met with in severe cases, and anti-streptococcic it can hardly serum may therefore be of some use, be regarded as a specific remedy. The actual infective agent is at present unknown, the protozoal organisms described by Mallory not being as yet generally accepted.

Recently Marpmann, proceeding on the assumption that the infective agent resided in the scales of the desquamative stage of the disease and that the toxins formed were present in the blood and urine of patients, has used these substances for injecting animals and has obtained from them a serum which, he states, is both protective against the disease and curative of it when it has developed. Two separate serums are manufactured, one prophylactic and the other curative. The difference in the respective modes of preparation is not stated in the articles dealing with the remedy which we have been able to obtain. From the brief account given above the serum would seem

1025 likely to be mainly antitoxic ; though if the causal agent of London. It appears, moreover, that the proportion of the disease is contained in the epidermal scales it might also infant mortality in these dwellings did not exceed 58 per possess some germicidal power. It is called " scarlatin and 1000 births, against 115, the mean proportion in London. is administered by the mouth in doses of three to eight Realising the fact that this fund has more than trebled in minims in milk. Good results are recorded by several con- the 35 years since 1873 it is difficult to over-estimate its tinental writers, of whom the most recent is Professor Monti future effect upon the housing of the poor of London and of Vienna, so that a trial of the remedy in the fever hospitals on their health and sanitary condition. "

of this country would

seem

desirable.

THE PEABODY DONATION

ARTERIO-SCLEROSIS IN THE YOUNG.

FUND.

THE munificent donations and bequest of Mr. Peabody between 1862 and 1873 for the better housing of the working classes in London amounted to .E500,000, and the fortythird annual report of the governors of this donation fund shows that on Dec. 31st last the amount of the fund had increased to .E1,571,252. It is further stated that the fund, with its accumulations since 1873, when Mr. Peabody’s bequest brought his total gift to £500,000, "shows an average profit per annum, at compound interest, of almost exactly Z33 per cent." Thus the governors of the fund, by the investment of the annual net income, have been able to expend £1,500,279 on land and buildings for the purposes of the Trust, or more than three times the amount of the aggregate donations and bequest. The net income of last year from rents and interest, added to capital account, was £41,343, and the expenditure on land and buildings during the The rapid and automatic growth year was £41,543. of this fund is full of interest and cannot fail to prove a most valuable asset for the promotion of the sanitary condition of the metropolis. At the end of the year this fund had provided for the artisan and labouring poor of London 5586 separate tenements, consisting of 12,913 rooms, including 199 cottages of five rooms, 105 tenements of four rooms, 1833 of three rooms, 2550 of two rooms, and 899 of one room. The mean population of these tenements during the year was 19,737, which constitutes, however, the one disappointing feature of the recent reports of the On referring to the twenty-fifth governors of the fund. report on the fund it appears that at. the end of the year 1889 the 11,275 rooms then provided had an occupying population of 20,374 persons, exceeding by 617 the number residing in the buildings provided by the fund at the end of last year. During the 18 years 1889-1907, the number of new rooms provided has not exceeded 1638 ; notwithstanding this addition the number of residents has declined. This decrease appears to be cue : (1) to greater stringency in the prevention of overcrowding in these improved dwellings ; (2) to decrease in the number of young children in families residing therein ; and (3) to the fact that during recent years the additions to the tenements provided by the fund have been mainly those consisting of more than two rooms. For instance, in the report for 1907 it is stated that 117 five-room cottages out of a total of 154 on the Tottenham estate were ready for occupation in June last; and farther, that 64 cottages are in course of erection on the Herne Hill estate and will probably soon be ready for occupation. It seems open to question whether the provision of suburban cottages will, from the point of view of the health of the metropolis, prove as useful as the provision of improved dwellings in central London where so large a proportion of the working poor are bound to reside. Moreover, it is stated in the last issued report that the letting of the five-room cottages on the Tottenham estate " is proceeding very slowly." The beneficial effect of these Peabody Buildings on the health of the residents, in spite of a density of population equal to 605 per acre, may be judged by the fact that the death-rate last year among the nearly 20,000 residents did not exceed 12.2 per 1000, against 14’6 in the whole "

of

IN the American Journal

of the Medical Sciences for

has published an important article on arterio-sclerosis in the young. He reports a case under his own observation and exhaustively reviews the literature of this interesting subject. A male mulatto, aged 32 years, was suffering from obliterative arteritis with gangrene of the toes, which necessitated amputation. His arteries were sclerosed and beaded. He gave a history of syphilis contracted in his eighteenth year. He had a son, aged 12 years, who, by his pinched and haggard appearance, complexion, figure, and carriage, suggested an aged man. Examination showed diffuse sclerosis of all his arteries, with calcification quite as advanced as in his father; the beading could not have been greater at any age. There was no evidence of heart or kidney disease. The boy was mentally bright but physically stunted and thin, and his muscles were undeveloped. The arterio-sclerosis was thought to be due to congenital syphilis. Isolated references to arteriosclerosis in the young may be found in literature since the beginning of the last century. Portal, in his work on anatomy published in 1803, stated that "rarely the arteries of young persons become ossified." InDiseases of Arteries," published in 1815, Hodgson described the temporal artery of an infant, aged 15 months, " converted into a complete tube of calcareous matter." Turning to recent literature, Romberg says that in Germany arterio-sclerosis augments with rapidity after the fifteenth year. In 1477 necropsies performed at all ages and in all conditions he found the arteries diffusely thickened in two subjects at the ages of one and 14 years respectively, and in 5’ 8 per cent. of the subjects between the ages of 15 and 19 years. But not until the recent studies of the pathology of arteriosclerosis by Ortner, Flexner, Thayer, and others have the frequency and importance of arterio-sclerosis in the young been appreciated. These writers have thrown light upon the relation between the acute infections and arterial disease. In 189 persons who had long recovered from enteric fever Thayer found that between the ages of 10 and 50 years 48 per cent. had palpable arteries, as compared with 17 5 per cent. in ordinary healthy individuals. Symnitzky in 138 necropsies on persons under the age of 25 years who died from various infections found sclerotic changes in the aortic wall in 38, or 27 5 per cent. Excluding subjects under the age of two years, in which these changes did not appear, they were found in 48 per cent. As to the etiology of the condition Professor Osler states: " That heredity plays a most important role is shown in the cases to which arteriosclerosis sets in early in life in individuals in whom none of the recognised etiological factors can be found." Congenital syphilis is a well-recognised cause but its importance has been exaggerated by earlier writers who were not aware of the part played by acute infections. Hoffbauer, investigating nodular and diffuse arterio-sclerosis in the tuberculous, says that he " can find no pathological difference in the arterial wall between tuberculosis and nephritis " and that it will be necessary to give up the causal connexion between blood pressure and arterial thickening. Dr. FremontSmith has been able to collect from literature in all 146 cases of arterio-sclerosis in the young. These must represent but a small minority of the cases, for in few necropsies on children

February Dr. F. Fremont-Smith