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limits are 15 minutes for a discourse and five minutes foreither a demonstration or a speech at a discussion. The

reading of printed or written matter is only allowed byspecial permission of the president.

THE CLIMATE OF ST. MORITZ.

WE have received a pamphlet with the above title andwritten by Professor A. Nolda, one of the resident physiciansat St. Moritz, with the collaboration of M. C. Btibrer,director of the Swiss Meteorological Station, Montreux. It

’is pointed out that the particulars previously publishedregarding the climate of St. Moritz have been chiefly basedon observations made at Sils-Maria and Bevers, there beingno continuous meteorological records for recent years at St.Moritz, but both the places named, especially Bevers, have aclimate different in important respects from that of St.Moritz. Some interesting details are afforded in respectto the atmospheric pressure at St. Moritz, the temperatureof the air, the relative moisture, the rainfall, overcloudingand insolation, the duration of sunshine, and the prevailingwinds. The pamphlet ends with words which we hope willnot be substantiated by those responsible for the manage-ment of internal affairs at St. Moritz: "In one pointSt. Moritz has, with sagacious foresight, itself restricted andnarrowed its indications-St. lilo’itz dwlines to become asanatori1tllt for consz7raptives and r;ill therefore not receive anypatients svjfer’ing jrorn ttlber01Ûosis of the l1tngs. We

sincerely trust that this wise decision, so necessary for

the further development of St. Moritz, will be strictlycarried out ! " (The italics are as they appeared in the

pamphlet.) We are of opinion that a great mistakewill be made if such proposals are actually brought intoforce. Not only will a valuable therapeutic measure bedenied to sufferers from tuberculosis but we believe that theauthorities responsible for the enactment will have cause torepent their action. The climatic conditions of St. Moritzare admirably suited for the treatment of tuberculosis andthere is no trustworthy evidence that the assemblage of

patients suffering from the disease in any way affects thehealth of the community if suitable arrangements are madefor the disposal of the sputum.

THE MEETING OF THE BRITISH MEDICALASSOCIATION IN TORONTO.

OUR Canadian correspondent writes :-The medical profes.sion in Toronto is working hard to secure a successful

meeting for the British Medical Association in that cityfrom August 21st to 25th. The various committees aredoing all in their power to make everything run smoothly’and Dr. Reeve, the President-elect, of the medical facultyof the University of Toronto, has the loyal support of his

colleagues. The honorary local secretaries are Dr. F. N. G.Starr, Dr. D. J. Gibb-Wishart, and Professor J. J. McKenzie,and anyone who desires any special information should

apply to them at the Medical Building, Queen’s Park,Toronto. It has been announced that the address in

medicine will be delivered by Sir James Barr and theaddress in surgery by Sir Victor Horsley. The scientific

part of the meeting will be conducted in 12 sections.Those going to Toronto will be assured of an enjoyablevisit and afterwards they may judge of Canadian hos-

pitality. The city has several fine hotels and the accom-modation will be first-class. There will be excursions to

Niagara Falls, to Muskoka, and to the Rocky Mountains.The last are nearly 3000 miles away but Canadians thinknothing of that. The climate is the equal of any in theworld. Toronto itself is an exceptionally fine city ; itsweather is delightful and this season there has not so

far been any snow. It has numerous fine public buildings,a beautiful harbour and island resort, as well as steamboat ! 1

connexion with all the promineht health resorts. Intendingvisitors may be recommended to see Halifax, the Annapolisand the Matapedia valleys in the Maritime provinces ;Quebec city and Montreal and the noble St. Lawrence inthe province of Quebec ; Ottawa, the capital, with its Parlia-ment buildings ; the Thousand Islands, Toronto, and NiagaraFalls in Ontario; Port Arthur, Winnipeg, and the greatwheat belt of Manitoba ; and the Rocky Mountains, Van-couver, and Victoria in British Columbia.

THE medical officer of health of Cape Colony reportsthat for’ the week ending Dec. 30th, 1905, the condition ofthe colony as regards plague was as follows. No case of

plague in man or other animal was discovered anywherethroughout the colony except at Port Elizabeth, where 2.

plague-infected mice were found. For the week endingJan. 6th, 1906, the colony was also free from plague exceptfor 1 plague-infected mouse at Port Elizabeth. As regardsthe Mauritius a telegram from the Governor received at theColonial Office on Jan. 26th states that for the week endingJan. 25th there were 1 case of plague and 1 death from the-disease.

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A COURSE of ten lectures on the Physical Chemistry of-Colloids (with special reference to immunity) is beingdelivered at the London Hospital Medical College, Mile End,E., on Fridays at 4 30 P.M., by Dr, J. A. Craw (BritishMedical Association Research Scholar). Lecture III., whichwill be delivered to-day (Friday, Feb. 2nd), will deal withvarious properties of colloids, ultramicroscopic investigations,diffusion and filtration phenomena, and the influence of

light, heat, and electricity. Any member of a Londonschool of medicine may attend this course.

THE Lettsomian lectures for 19C6 of the Medical Society ofLondon, on Some Points in the Surgery of the Brain andits Membranes, will be delivered by Mr. Charles A. Ballance,on Feb. 5th and 19th and March 5th, at 9 P.M. Lecture I.will deal with Some Points in the Surgery of Meningitis,Lecture II. with Some Points in the Surgery of Brain

Abscess, and Lecture III. with Some Points in the Surgeryof Brain Tumour. The lectures will be illustrated by lantern

slides. -

AN International Congress of Laryngology and Rhinologyis announced to be held at Vienna in 1908, the date, already-selected, being from April 21st until the 25th (Easter week).The date is selected as it is the fiftieth anniversarythe establishment by Tiirck and Czermak of a course of

systematic study of laryngology in Vienna.

THE first of a course of lectures on Food and Nutritionwill be delivered at the Royal Institution, Albemarle-

street, W., on Tuesday, Feb. 6th, at 5 P.M., by ProfessorWilliam Stirling, Fullerian professor of physiology at theInstitution.

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BY the will of the late Mrs. Gant, the wife of a formerpresident, a sum of R100 has been left to the Medical

Society of London.

A FEW REMARKS UPON THE REPORTSOF THE MALTA FEVER COMMISSION.

BY G. MURRAY LEVICK, M.R C.S. ENG., L.R.C.P. LOND.,SURGEON, ROYAL NAVY.

THE Government Commission on Malta Fever working atMalta under the supervision of the Royal Society has issuedthree important reports which have been read with great-interest by all who have studied the disease. There are,

however, some points which require discussion in connexion. with the theory, to which Surgeon E. H. Ross, R.N., and 1

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have been led by a process of exclusion, to the effect thatthe infection may possibly be conveyed by the mosquitoacartomyia Zammitii. I wish particularly to examine someof the experiments of the Commission which tend to lead inanother direction-namely, that infection may be acquiredthrough the respiratory or digestive tract-but which appearto be not so conclusive as might be inferred from the

reports.I will commence at p. 46 in the first publication. Here,

in Experiment I., we find a description of an attempt " todetermine if the inhalation of dust infected with micrococcusMelitensis will give rise to Mediterranean fever in healthymonkeys." We are told that on July 10th, 1904,.monkeyNo. 41 was placed in a cage and "infected dust blownaround him." (This dust was mixed with living cultures ofthe micrococcus Melitensis.) 24 hours later infected dustwas again blown round the monkey and when an hour hadelapsed the animal was taken from the cage, which was thendisinfected. The skin of the monkey, which must by thenhave been liberally sprinkled with living micrococcus

Melitensis, was apparently not disinfected; at any rate,no mention is made of such precaution being taken.For a month or ’so the same procedure was continued daily.On Sept. 6th the monkey was found to be suffering fromMalta fever and the result arrived at by the Commission wasthat" this experiment seems to show that inhalation or

ingestion of infected dust will give rise to the disease." Nowwe know that these animals spend much of their time inscratching themselves and it therefore follows that duringthis experiment monkey No. 41 may have been repeatedlyinoculating himself by scratching living Micrococci Melitensesinto irritated portions of his integument, which must havebeen in a very infectious condition, so that the resultof this experiment may very probably have been merely anexample of the contraction of the disease by inoculation. Itis therefore quite possible that the conclusion arrived at bythe Commission is not warrantable.

Again, under the heading "Experiment II.—to Determineif Injection of Dust Infected with Micrococcus Melitensisinto the Nostrils and Throat will give rise to MediterraneanFever in Healthy Monkeys," we read: "Monkey No. 47-July 9th-injected dry dust containing micrococcusMelitensis into both nostrils." The injection was repeatedon the 10th, llth, 12th, 13th, and 14th. "29th.-Injecteddried infected dust into back of throat; lips covered withcloth and tube passed through a wooden gag." This pro-cedure was repeated daily until August 8th. on which daythe monkey was found to have contracted Malta fever andwe read : ,. Result.-From this and the last experiment it isevident [the italics are mine] that the inhalation and

swallowing of infected dust will give rise to Malta feverin monkeys." Let us review this experiment. Firstof all let it be noted that for six consecutive daysdust mixed with living micrococcus Melitensis was

injected into the nostrils. The dust probably, irritatedthe nasal mucous membrane, so that mucus containingliving micrococci would run on to the lips, &c. Also theposterior nares must have been swarming with living micro-cocci and probably inflamed by the repeated dust injections.Both at this time and later, when from July 29th to

August 8th daily injections into the back of the pharynxwere carried on, I take it the mouth was also in a continuallyinfectious state, so that the precautions adopted with thegag and cloth might have been futile because, as admittedin a note written on August 9th, there was" a very smallabrasion " on the skin of the lower lip. I therefore suggestthat the result of this experiment does not appear to justifythe conclusion that "it is evident that the inhalation orswallowing of infected dust will give rise to Mediterraneanfever in monkeys." It is well known that the disease isinoculable and I think that some undiscovered crack orabrasion of mucous membrane is almost sure to be infectedwhen ’such enormous and unnatural quantities of infectedmaterial are used repeatedly over a considerable length oftime.

Turning now to Experiment III., we find that monkeyNo. 39 was fed for 32 consecutive days upon pure cultures ofmicrococcus Melitensis mixed with boiled potatoes, thefeeding having been commenced on July 10th and discon-tinued on August 10th, on which date the animal’s blood wasfound to give a marked agglutination reaction for micro-coccus Melitensis. Later the monkev was killed with chloro-form and the organism was recovered from the spleen. After adescription of the experiment and result we read: " Result.--

The absorption of M. Melitensis was extremely slow, but themonkey eventually suffered from an acute infection." Ido not follow this argument. Had the monkey been fedonce and contracted the disease 32 days afterwards, itcould have been understood and have been admitted thatthe absorption was slow, or the incubation period possibly32 days. But owing to the way the experiment was carriedout it seems at least as likely that the monkey escapedinfection until (say) August Lnd, giving an incubation

period of about eight days only. This would be a different

thing from "slow absorption" and I mention it as an

important point in the investigation of the disease. Again,if the possibility which I have suggested be the rightone it may be seen that the monkey might have swallowedpure cultures mixed with potatoes for about 24 consecutivedays without becoming infected and this circumstancewould then be a very strong argument against the theoryof infection by the gastro-intestinal tract. The pitcherbeing taken so often to the well may have broken, so

to speak, on the day when a lesion of the mucous membraneappeared.

In a description of Experiment V. we read : 13th August,1904. This monkey is in a box next to monkey 39 and Inoticed, about a week ago, that he ate some of the infectedpotatoes provided for No. 39. Examined blood serum;reacts instantaneously. This experiment is probably an

instance of direct absorption of M. Melitensis through acrack or abrasion of the mucous membrane of the mouth ;the period of incubation and the wave of fever correspondexactly with monkey No. 72 which was infected with M. M.through a crack in the mucous membrane over the incisortooth." If infection was contracted through a crack in thiscase, why not in the other cases ? 7During September, 1904, several of the monkeys kept for

experimental purposes contracted the disease without

apparent cause. Major W. H. Horrocks, R.A.M.C., says inhis remarks that this is probably due to infection conveyedfrom neighbouring monkeys. As diseased and healthymonkeys were kept on the same terrace close to one

another, and mosquitoes also had free access to them all,this certainly seems to be very likely. Continuing hisremarks, it is said : " On the other side of monkey No. 46 ismonkey No. 47 infected by dust blown into the throat-

evidently this monkey has become infected, either bypersonal contact, by urine, or by means of stegomyia." Butwhy stegomyia in particular ? 7 Other species of mosquitoeshad access to the animals.Many other feeding experiments of the same kind were

carried out, and it seems to me that the objections givenabove are applicable to them all. These are: (1) the

monkeys were not isolated ; (2) mosquitoes had access tothem; and (3) it is impossible to say that the mucous

membrane of the mouth and pharynx was free from lesions.With regard to Experiment VI., "to differentiate betweenabsorption from the mouth and throat, and absorption fromthe stomach and intestines." In this experiment infectedmilk was passed into the monkey’s stomach by means of anindiarubber tube. After the milk was introduced to thestomach the tube was presumably hauled up again, so thatthe end of it, being smeared with milk and micrococci, musthave almost certainly infected the oesophagus, pharynx, andmouth. I would suggest that the stomach should be in-fected by means of caps11..les containing the emulsion pusheddown the cesophagus by means of a bougie (under chloro-form if necessary). The capsules would dissolve in thestomach and the upper tract would not be infected.From the " conclusions" " set down at the end of Section 4

I quote the following: " Infection by means of urine secretedby cases of Mediterranean fever readily explains the cases ofMediterranean fever which appear to arise spontaneously inhospitals." I do not agree with this conclusion becausefresh cases do not arise in Haslar Hospital, where old caseshave been kept in the wards for many years. It is only inhospitals in the endemic area that cases arise spon-taneously." Surely this is a most important point.

In Section 5 a description is given of methods for cultiva-tion of the micrococcus Melitensis from the blood of patientsas carried out by Staff Surgeon R. T. Gilmour, R.N. At theend of this description we read the following remark by theeditor: " It is evident from Staff Surgeon Gilmour’sexperiments that the M. Melitensis is present in the majorityof cases examined. Their number is, however, so small thatit seems extremely doubtful if the disease can be carried bybiting insects."

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E The smallest amount of blood from which the Commissionsucceeded in isolating the micrococcus is, according to itsaccount, "2 hth of a cubic centimetre, or approximately fourcubic millimetres of blood. I do not, however, agree thatthis excludes the possibility that the disease can be conveyedto a mosquito in a smaller quantity of blood. On the

contrary, it seems obvious that the mosquito has onlysucked up enough blood to convey one micrococcus toits stomach in order to transmit the disease and I wouldsuggest that the scarcity of micrococci in the blood of

patients (which is not after all very great) explains why thedisease is not contracted by everyone who comes to Malta,as patients are nearly always bitten by hosts of mosquitoes.It is to be noticed that later in the report this escape of themany is mentioned as an argument against the mosquitotheory of transmission but, as I have shown, it is really justas strong an argument in its favour. I think also that a

mosquito may on occasion suck up more than four cubic milli-metres, while, lastly, it is obvious that if a hundred mosquitoesbite a patient suffering from Mediterranean fever, whichsurely often happens, the total amount of blood abstractedby them is likely to be much more than the four cubic milli-metres and may possibly amount to several hundreds ofcubic millimetres, so that in this case not one but many ofthe insects may become infected.

I now come to Part II. of the report. On p. 48 we read :milk is not so closely connected with water in Malta as itis in most other countries, because the great majority of

people get their milk-supply in their own vessels direct fromthe goat." I do not understand why vessels should notbecome contaminated by the water in the homes of thepopulace as much as vessels do in the dairies of othercountries. Experience of the lower orders in Malta goes toshow that they are not much more cleanly in their habitsthan the average goat and we read in the report of theCommission that in one house the occupants used the samebucket for washing the vegetables as they employed forcarrying their excreta to the midden.

In Part III., at p. 37, we read that monkey No. 43 wasrepeatedly given hypodermic injections of broth growthfrom the breaths of Malta fever patients. The injectionswere frequently given from Oct. 27th to Dec. 4th. Theblood of the animal was repeatedly tested for agglutinationreaction with micrococcus Melitensis during the period ofthe experiment. I make the following extracts :-On 7th of November doubtful tendency to agglutination, j, ; on

12th somewhat ailing; on 28th slight agglutination reaction, Ia, ..]15; on5th of December tendency to agglutination in 116 dilution; on 12thno agglutination reaction; on 15th dying, gave chloroform. P.M.Pneumonia and pericarditis. Inoculated slopes from all organs.

. 23rd December no M.M. recovered p.m., but a glucose fermenting +Gram staining coccus was obtained from spleen, liver, and kidneys,nothing from heart’s blood and lungs.

In the remarks upon this experiment we read: " There isto be noticed in both these animal experiments the develop.ment of a low agglutination reaction and here, as in theskin experiments, I should attribute this to the ingestion oiM. Melitensis toxins, as a certain amount of saliva tricklecdown the long entry tube and so into the broth." Iwoulchere point out, whilst admitting the possibi7ity of the aboveconclusion being the right one, that it has been shown thai

agglutinins are not entirely specific in their action-i e.that, in some cases at any rate, treatment with a particularorganism may increase the agglutinating power as affectinÉother varieties of germs (Bosanquet).

In the above experiments the broth injected was shown t(contain germs other than the micrococcus Melitensis ancthe effect of injecting them was seen to be so markecat the post-mortem examination of monkey No. 43 thait is hardly surprising to read that in the serum of theanimal the agglutinating power was increased sufficienthto act with a dilution of 1 in 20 upon the micrococcuMelitensis.

I might add, in conclusion, that Surgeon Ross and I havfrequently suggested to members of the Commission that thtrue agent of infection is very probably the mosquitoacartomyia Zammitii. Our experiments, observations, an<

arguments which lead to this conjecture are given in oupapers in the British illedical Jonrnal of April 1st, 190fand the Journal of the Royal A?’my Medical Corps feAugust and September, 19(,5. It seems a pity that e]

perimer,ts have not been thoroughly undertaken to provwhether or not acartomyia Zammitii is the real agent c

infection.

THE WINES OF THE GIRONDEWITH

SPECIAL REFERENCE TO CLARET.

THE statement which appeared in an annotation in

THE LANCET 1 a little over a year ago that "Bordeauxwines or clarets were never cheaper, more abundant, andpurer than they are in the present day" proves to be wellfounded in view of the results of a practical inquiry whichwe have recently undertaken. It is somewhat remarkable,therefore, that the belief still gains currency that the bulk .of the claret sold at the present time in this country is toocheap to be good and that the genuine produce of theMedoc can only be obtained at relatively high prices. In

giving an immediate answer and denial to this we may aswell state at once that we have purchased wines in the openmarket, in London at all events, at wine merchants, stores,and grocers’ shops at prices varying from Is. to 3s. a bottlewhich have proved to be not only genuine but wines ofexcellent quality also. It is, indeed, highly probable thatas a matter of fact the best value in regard to wines at thepresent time is to be obtained in clarets.As we shall presently point out, the public, speaking

generally, either has uncertain views about claret or,and this is worse, regards it as being deficient in that

stimulating power which is only too freely found in

strong fortified wines or spirits. The view is unfor-

tunately too commonly held that the most trustworthyform of stimulant is whisky or some other spirit andthat these contain alcohol in a pure and harmless form ;therefore it is thought that in the choice of a stimulant it issafer to avoid a light wine the origin and genuineness ofwhich are open to doubt, It is probable also that the use oflight wine as a beverage has fallen into disrepute becauseit has happened occasionally that both the palate and thepocket of the public at some time or other have been trifledwith by unscrupulous dealers ; we are convinced, however,that this is only a fractional reason, although it maywell be accountable for the practical absence of a demandfor light red wines on the hotel table. Nowadays it is

quite exceptional to find claret called for at hotels, for the

; simple reasons that, firstly, the price asked for it is

. exorbitant and, secondly, the wine supplied is frequently ofa very inferior quality, if, indeed, it is not sour and undrink-

- able. In these circumstances it is not surprising that

l whisky and water (plain or aerated), regarded, as it

generally is, as being above suspicion, has come to be the; common accompaniment to a meal at the hotel. We believe,

that if hotel proprietors would undertake to provide theirr patrons with a sound Medoc wine at a reaonable price- say, 2s. or 3s. a bottle-they would find the step very

widely appreciated and a profitable one. The objection] generally urged, however, is that such a scheme would leave1 no margin of profit. This seems to us unlikely when wet call to mind the fact that in almost every little inn in France a bottle of good sound wine can be obtained for a franc or so.Y It may not be a wine of great quality or delicacy but, gene-really speaking, it is at least a " clean," wholesome, andgenuine vin ordinai?’e. The small margin of profit theorye is, moreover, illogical, since a bottle of whisky for whichD5s. or 6s. are charged and which is made to last for perhapsa week, would leave surely a smaller margin of profit thanir r

a bottle of claret ordered with each meal.

ir But there are other factors which have led the public taste:- in this matter to disregard delicate light wines in favour of

s more potent beverages. Good sound claret is the most

1 THE LANCET, Oct. 8th, 1904, p. 1035.