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1362 Annotations. THE PREVALENCE OF INFLUENZA. "Ne quid nimis." THERE has been the usual sharp seasonal rise in the deaths from influenza and respiratory disease, attended with the usual questioning as to the prospect of a serious epidemic of influenza. There is no simple arithmetical rule for prophets, and the only indications at our disposal of an approaching epidemic of respira- tory diseases are (1) deaths ascribed to influenza, and (2) notifications of pneumonia. With regard to (1), there is a relatively heavy increase in the numbers of deaths both in London and the 105 great towns- the number was 103 in the week ended Dec. 8th, as against 68 in the previous week. There are also small but definite increases particularly in the great towns of Lancashire (included, of course, in the total 105 great towns). The age-distribution of these deaths is similar to that observed in the influenzas prior to 1918-19 ; in other words, there is no sign of the sharp change of type which was the most disquieting feature of the great pandemic. With regard to notified pneumonia, there has been a tendency to rise for some weeks, and last week there was a large increase in the North- Western area, while Yorkshire, which is usually affected early by respiratory epidemics, is now reporting many cases. The difference, however, between the notification rate this year and that of 1922 is not very great. So far as this evidence goes, the present may be regarded as a minor recrudescence, probably favoured by the fogs of last month, and perhaps by the crowds associated with the General Election. ÆTIOLOGY OF BLACKWATER FEVER. ALTHOUGH evidence has been accumulated all over the world that the constant factor associated with heemoglobinuric fever is malaria, and, further, that it is the malignant tertian parasite (Plasmodium falciparum) which alone is concerned with the produc- tion of this disease, many observers have attempted to find another causal organism. Various organisms have been described other than malaria as the probable -cause of blackwater fever, but these have all been discarded. More recently spirochaetes or a special species of this group have been suspected, and in 1912 Napier favoured the view that syphilis predisposed to this condition, but Barratt and Yorke (1909), Arkwright and Lepper (1918), and Dudgeon (1921) showed there was no connexion between the two diseases. On the - other hand, there is strong evidence that syphilis is the predisposing cause of paroxysmal hsemoglobinuria. True spirochaetes have been found associated with hsemoglobinuric fever. Ashburn, Vedder, and Gentry, in 1912, and Cook, in 1913, described this disease .associated with relapsing fever, and Schiiffner (1920) described a case complicated with an attack of acute infective jaundice. Noc and Esquier (1920) found numerous spirochaetes in the liver of a fatal case. These findings, however, can only be regarded as the accidental accompaniment of one disease with another. More recently Blanchard and Lefrou in 1922, using a special technique by which the citrated plasma of 10 c.cm. of blackwater fever blood was subjected to triple centrifuging, described leptospira in the deposit from three cases. The deposit from one of these cases inoculated subcutaneously into guinea-pigs produced a fatal disease, and in one of the subinoculated animals haemorrhages were found in the peritoneal cavity and in the bladder. Dr. J. G. Thomson, director of protozoology, London School of Tropical Medicine, who has made two expeditions to Rhodesia in 1922 and 1923 to study haemoglobinuric fever in that area, used Blanchard and Lefrou’s technique in order to confirm the work of these .observers. The result of the investigation of the first six cases proved negative. I Low and Duncan confirmed this work shortly afterwards in one case, and more recently Thomson has brought forward con- clusive evidence that blackwater fever develops as the result of repeated attacks of malignant tertian malaria. The blood of 15 cases of blackwater fever was examined at different stages of the disease from the first day until recovery by Blanchard and Lefrou’s method with universally negative results. The con- clusion arrived at is that the numerous motile filaments seen under the dark ground illumination in all these cases and in normal cases are the well-known artefacts which have so often been mistaken by other observers in the blood of various diseases for the causal organism of such diseases. Subinoculations in guinea-pigs failed to produce any symptoms or pathological changes. From this it is concluded that there is at present no evidence that spirochaetes or a special species of spirochaete are responsible for blackwater fever, and the relationship of malaria to this condition is regarded as undoubted. -- A PIONEER OF PUBLIC HEALTH. I Two years ago the University of Manchester lost a valued fighter in the field of public health through the death of Prof. Delepine, and on Dec. 12th last there was unveiled to his memory a portrait bust, erected in the Public Health Laboratory of the University by former colleagues and students. The bust bore the following inscription: " Auguste Sheridan Delépine. Born January 1, 1855. Died November 13, 1921. Founder and first director of the Public Health Laboratory. Professor of Pathology 1891-1904. Professor of Public Health and Bacterio- logy 1904--21." The unveiling ceremony was per- formed by Sir George Newman, who spoke in feeling terms cf the work Prof. Delepine had accomplished, for the University, for the city of Manchester, and for the public health of the nation. An outline of that work was given in THE LANCET (1921, ii., 1080), and we would here record the personal tribute paid to the worker by the Chief Medical Officer of the Ministry of Health. Prof. Delepine, said Sir George Newman, was a pioneer in associating a university with the training and work of the medical officer of health. He held strong and liberal views, springing from deep and sincere convictions, as to the value to the community and to the nation of the public health service, inculcating high ideals for public medical officers, and extending in various directions the ever- widening sphere of their work. He gathered round him a remarkable group of earnest students who gladly learned at his feet and in after years preached his gospel in various parts of the land. For he was an inspiring teacher, especially to the few, and he won the admiration and affection of his pupils. In the study of disease Delépine was chary of anything which tended to lessen the responsibility of the seeker. In his last published paper he wrote regarding the cause of disease : " I think it is better to attach too little than too much importance to personal pre- disposition, for the doctrine of predisposition has the same influence in medicine as that of predestination in religion ; both tend to make us overlook our responsibilities." Prof. Delépine, of French descent though a natural- ised Englishman, was a man of very original mind, fertile in idea, acute in perception, resourceful in the invention of the ways and means of research, precise in its exercise, and. meticulous in its findings. He was widely read in the literature of medicine and its allied sciences, with a retentive memory and a broad outlook, and able to utilise and apply the knowledge which he acquired. While possessing these excep- tional gifts, Delepine was an indefatigable workman and was laboriously conscientious, reluctant to publish his results until he was satisfied that his conclusions were valid and invulnerable. An enthusi- astic believer in preventive medicine and its potential 1 Brit. Med. Jour., 1923, i., 986. 2 Legislative Council of Southern Rhodesia, White Paper, 1923.
