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had supervened during the secondary period showedmarked lymphocytosis. Of five patients suffering from

syphilitic iritis one only showed lymphocytosis. In allthe patients who showed the cellular reaction the quantityof albumin, which only exists in very small quantity in normalcerebro spinal fluid, was much increased. It would seem,therefore, that these facts prove that in patients affectedwith secondary syphilis there exist together with certaincutaneous reactions nervous reactions which are to be

diagnosed by an examination of the cerebro-spinal fluid andthese nervous reactions would appear to develop on parallellines with those of the skin. The reactions should be

regarded as one of the many manifestations of syphilis andwhen present would appear to show that the treatment should be very thorough.

A Scheme for a Hospital for Infectious Diseases. Among the new buildings included in the great plans

which have been taken in hand by the Assistance Publiqueand which have been approved by the Prefect of the Seineand by the Municipal Council is a hospital for infectiousdiseases which it is intended to build at Ivry-sur-Seine, inthe district of Vitry, a building which is intended to replacea very poor hospital at present in existence at La Porte deFlandre. Here it is intended to treat patients sufferingfrom typhoid fever, from small-pox, from diphtheria, andshould occasion arise thoe afflicted with plague or cholera.The prospect, however, has no charms for the inhabitantsof the neighbouring quarter of Paris-namely, that ofthe Port-a-i’Anglais in the division of Vitry. Theyhave protested for some long time but the Assistance

Publique has taken no heed. This body promises toisolate the building in an absolutely satisfactory fashion,but the promise has not assured those interested in thematter and they have sent a petition to the Prefect ofthe Seine begging him to ask the administration of theAssistance Publique to give up the idea of building ahospital for infectious diseases at a distance of only 250metres from the communal school at Port à-l’Anglais whicheducates no less than 900 pupils. The Assistance Publique,however, declares that the fears of the inhabitants of Ivryare groundless and the best proof which is brought forwardof the harmlessness of the proposed hospital is the fact thatit will be situated almost alongside a large almshouse wherethere are some 2500 aged persons for whom nobody seemsto have any fear.

French Congresses.The sixteenth Congress of the French Association of

Surgery was opened at Paris on Oct. 19th in the largetheatre of the Paris Faculty of Medicine. The seventhcongress of the French Association of Urology will be openedat Paris on Oct. 22nd in the Faculty of Medicine.

A Ne7v Method of Suicide.A nurse at one of the hospitals has just tried

a new way of committing suicide-namely, by swallow-ing two tubes of Eberth’s pure culture of the typhoidbacillus. On the following day and the day after thatshe felt no inconvenience. On the third day she hadsome headache but no fever. On the sixth day shefelt heavy and stupid and experienced great weakness inher legs, being obliged to take to her bed. On the seventh

day her temperature was in the morning 37.6° C. and in theevening 38 60 C. On the eighth day she had two attacks ofepistaxis and her temperature in the evening was 40-20 C.Several ro,e spots were also visible. On the tenth day serumreaction was positive. Otherwise the typhoid fever followedits normal course but it was a very severe attack and the

patient had in all 176 baths. The remarkable points ofthis case are the very short duration of the period ofincubation-namely, only two days-and the rapid appear-ance of the rose spots, eight days after infection. Thephysicians who reported the case-viz., M. Doflocq and M.Voisin-explained the very short duration of the incubationperiod by the large quantity of bacilli which were introducedat one time into the digestive tract.

Oct. 2lst. ________________

BERLIN.(FROM OUR OWN CORRESPONDENT.)

Professor Behring on Tuberculosis.THE most remarkable feature of the recent Congress of

German Naturalists and Medical Men was the address on

tuberculosis delivered by Professor Behring. He com-

menced by remarking that tuberculosis was an extremelycommon and widespread disease. A series of necropsiesmade by Professor Naegeli at the Pathological Institute ofZurich showed that in every instance signs of tuberculosiswere present in persons over 30 years of age, in 96 per cent.of those from 18 to 30 year, in 50 per cent. of those from 14to 18 years, in 33 per cent. of those from five to 14 years,and in 17 per cent. of those from one to five years. Similarresults were obtained in living persons by Dr. Franz, anAustrian army medical officer, who found that 68 per cent.of the men of an Austrian regiment reacted positively tothe tuberculin test. it had been said that everybody wassomewhat tuberculous, and this was true, but tuberculousinfection did not always mean pulmonary phthisis. To pro-duce phthisis two factors were necessary-namely, (1) atuberculous focus and (2) bodily conditions which favouredthe development of tuberculosis. Professor Behring was ofopinion that communication of pulmonary tuberculosis to

’ adults by contagion had not yet been demonstrated. In thecases of butchers, laboratory servants, and others who con-

tracted cutaneous tuberculosis it had never been proved thatpulmonary tuberculosis had ensued. The speaker then alludedto the statistics concerning nurses, prisoners, and otherclasses of the community which were especially liable to

develop phthisis. It was, according to him, not their free’

exposure to infection but the conditions of their life which

predisposed them to phthisis, the process being in realitythe conversion of a latent focus of disease into an activeone. Medical men engaged in laryngological practice wereexposed to continual risks of infection, but neverthelesstuberculosis was not frequent among them because of the

, absence of other prejudicial influences, such as insufficiencyof food. The fundamental theory of Professor Behring isthat tuberculosis nearly always begins at the earliest periodof life and that the germs are communicated to childrenby milk. He said that his views might at first sight appearrather peculiar, for if infants were not suckled by themother the milk on which they were fed when brought up

, by hand was boiled or even sterilised. Adults, on thecontrary, usually drank milk without previously boiling itor taking any other precaution. The cause of the liability

t of infants to become infected was not the contamination of3 the milk alone but in a great degree the condition of theirs gastro-intestinal canal which by reason of its great per-

meability was not capable of protecting their systemsagainst the invasion of germs. Dr. Romer, Professor

f Behring’s assistant, found that in newly born animalse albuminates penetrated through the mucosa into the circula-te tion quite unaltered, just as if they had been directly intro-Iduced into the blood ; in the intestines of adult animals, on

the contrary, the albuminates were transformed into solublepeptonates previously to being absorbed. Attenuated

d cultures of anthrax bacilli given with their food to newly,-

born guinea-pigs appeared afterwards in the blood. Cultures

dof tubercle bacilli administered in the food always pro-t duced tuberculosis of the glands in newly born and veryd young animals ; with older animals, on the other hand, thisoccurred only sometimes and not unless very virulent

n cultures in great quantities had been taken. Although the

h virus was ingested and infection communicated at a veryearly age, iuany years might pass before the disease

of became recognisable by the tuberculin test. Under pre-judicial influences, such as exhausting illness, chills, badfood, unwholesome dwellings and the like, the tuberculous

d infection might then develop into pulmonary phthisis.From this point of view Professor Behring spoke favourablyof the hygienic and dietetic treatment of pulmonary phthisis.His principal object, however, was to discover a method

r- which, like Jenner’s vaccination against small-pox, would actagainst tuberculosis and would eventually render sanatoriumsand other therapeutic measures unnecessary. Speaking of

in the tuberculosis of cattle he stated that this disease was

;d more prevalent in these animals than was generally believed ; ;..

the presence or absence of latent tuberculosis could beascertained by the tuberculin test with absolute certainty.He then alluded to the method devised by him which enabledcattle to be immunised by injections of an antitoxic sub-stance and which was being more and more used by farmers.Immunising substances were found in the milk of immunisedcows and he had reasons for believing in the possibility ofpreserving these immunising substances so that they mightbe sent abroad without losing their efficacy. Concerning

of human tuberculosis Professor Behring stated that hison researches were not yet finished; he said that for the

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prophylaxis of tuberculosis in human beings two ways wereopen-namely, either isopathic immunisation or treatmentby antitoxins. He thought that isopathic immunisationmight be accomplished in the human species by the inocula-tion of a relatively attenuated virus of tuberculosis ; the anti-toxin used for cattle was, however, not fit for that purpose,and even if an immunising substance had been alreadyobtained in that way he would hesitate to inoculate childrenwith it. Among calves treated by the injection of attenuatedcultures of bacteria one in 500 might die in consequenceof the inoculation and in the human subject it wouldbe obviously impossible for such a responsibility to be

accepted deliberately. It was conceivable, however, thatthe isotherapeutic protective immunisation might becomeavailable for children if his experiments succeeded so faras to allow the administration of the attenuated virus oftuberculosis together with food by feeding infants on themilk of immunised cows. As his researches were not yetfinished he was unable to supply a remedy against tubercu-losis. In conclusion Professor Behring criticised the theoriesof Professor Koch on the non-identity of human tuberculosisand perlsucht. From the fact that bacilli of human tubercu-losis did not produce perlsucht in cattle Professor Koch hasconcluded that the two species are not identical : this,however, was erroneous. Jennerian vaccine did not producevariola in the human subject, nevertheless no one believedthat the virus of vaccine and that of variola were different.Professor Koch, moreover, relied on the fact that infants

very seldom contracted intestinal tuberculosis ; this argu-ment has, however, now been refuted by his (ProfessorBehring’s) researches on the permeability of the infant’sintestinal mucosa. Professor Behring was therefore stronglyopposed to any relaxation of the milk control in the mannersuggested by Professor Koch. Finally, he said that althoughsome of Professor Koch’s views might require to be recon-sidered he must ever be regarded as one of the most eminentinvestigators in connexion with tuberculosis.Oct. 20th.

__________________

SWITZERLAND.(FROM OUR OWN CORRESPONDENT.)

S?viss Balneologiaal Society.THE annual meeting of the Swiss Balneological Society

took place on Oct. 4th at the picturesque little town ofRheinfelden, celebrated for its saline baths. The salt bedsabove which Rheinfelden is situated are 114 metres (380 feet)deep and were discovered in 1844. A number of hotelsnow provide for the accommodation of the thousands ofhealth-seekers who annually frequent the place in searchof relief from manifold ailments, such as chlorosis,amenorrhoea, metritis, disease of the uterine adnexa,scrofula, rheumatic and gouty affections, chronic heart

disease, and the various neuroses.-Dr. Keller of Rhein-

felden, well known in the scientific world by hisvarious treatises on the physiological and clinical effects ofsaline baths, spoke on the geological conformation of Rhein-felden and its surroundings. The saline water (Soole) was,he said, the strongest in Europe, containing 311’6 6 partsof chloride of sodium in 1000 parts of flaid, so that thesaline constituent formed 31 per cent. (Sea water containsfrom 3 to 4 per cent. of chloride of sodium.) The strongest Isaline baths on the continent, well known as spas, wereInowrazlaw, in Germany (30 per cent.) ; Bex, in Switzerland(27’ 5 per cent.) ; Hall, in the Tyrol (25 5 per cent.) ; Ischl,in Austria (23’6 6 per cent.) ; Salies de Beam, in France (21.6per cent.) ; and Kreuznach, in the Rhine province (16’4per cent.).-Dr. Theodore Zangger of Zürich spokeon the various indications for the use of weak and

strong saline baths. He distinguished normal baths (upto 3 per cent. strength corresponding to sea water),stronger baths (up to 6 per cent.), and very concentrat6-dones of 8, 10, 12, 25, and even 31 per cent. As theRheinfelden and Bex saline waters were used for bathingpurposes all over Switzerland and were prescribed mostextensively both for home use and in bathing establishmentsit was very desirable that they should be of the properstrength and carefully supervised. Individual treatmentwas indispensable. Of late the higher strengths were muchin vogue but they had to be prescribed with care. TheefEects of 3 and 6 per cent. saline baths differed greatly,as, in fact, Dr. Keller had demonstrated many years

ago by physiological experiments. The former increaseddiuresis by from 10 to 23 per cent. and the excre-

tion of chlorides by from 31 to 42 per cent. ; thelatter reduced diuresis - by 2-7 per cent. and caused onlya small increase of the excreted chlorides (6 per cent.).Such variations should receive clinical investigation. Strongsaline solutions unquestionably had not only their indicationsbut also their contra-indications and the latter deserved tobe carefully studied. They were best prescribed at spas,where the patient had from four to six weeks’ complete restfor a proper course of treatment.-Dr. Keller, in his reply,said that it was impossible to give distinct outlines of theindications with regard to strong saline baths. Somepatients, especially those with long-standing bone affections,with metritis and myomatous tumours, derived the greatestbenefit from them, such as could not be obtained fromweak saline baths. Thus other saline spas on the continent

(Reichenhall, Ischl, and Inowrazlaw) were introducingstronger baths and following the example which the Frenchspas, especially Salies de Bearn in the Pyrenees, had givenfor many years.-After the meeting the members inspectedthe various buildings in connexion with the saline baths ofRheinfelden and assembled at the Grand Hotel for the annualdinner. In 1904 the annual meeting will take place inSeptember at Lugano and Dr. Reali of Lugano has beenelected president.

Ziirich, Oct. 19th. __________________

CANADA.(FROM OUR OWN CORRESPONDENT.)

Canadian Medical Association.THE thirty-sixth annual meeting of the Canadian Medical

Association was held at London, Ontario, on August 25th,26th, 27th, and 28th, under the presidency of Dr. Walter H.Moorhouse of that city, who is dean of the medical depart-ment of the Western University. It proved to be the secondlargest meeting in the history of the organisation, being onlyeclipsed by that of last year which was held at Montreal.Dr. James Newell (Watford, Ontario) read a paper on theSurgical Treatment of Hallux Valgus and Bunions. Dr. R.Ferguson (London, Ontario) presented an interesting speci-men of an Incompletely Developed Uterus and Appendagesremoved from the sac of an inguinal hernia. The patient was32 years of age and was married but had never menstruated.The external genitals and mammary glands were normallydeveloped but the vagina was a mere cul-de-sac withouttrace of cervix or os. Every four or six weeks the patienthad been subject to violent headaches which drove her tothe point of distraction. Four and a half months hadelapsed since the operation and she had been absolutelyfree from the attacks of headache. This finished the fore-noon session of the first day. In the afternoon the meetingassembled in surgical and medical sections. In the formersection Dr. A. B. Atherton (Fredericton, New Brunswick)was appointed chairman and in the latter Dr. R. W. Bruce-Smith (Brockville, Ontario). In the medical section the firstquestion taken up and discussed was the Treatment ofTyphoid Fever, which was opened by Dr. W. P. Caven

(Toronto). In the opinion of Dr. Caven the conditions callingfor active treatment are tympanites and haemorrhage. Forthe former he recommended turpentine and asafoetida andfor the latter morphine. There should be routine spongingin every case, tepid where the temperature was below 102° F.but above that degree cold sponging should be carried out.Dr. John Herald (Kingston, Ontario) continued the discus-sion, stating that he would not employ internal medicationin ordinary cases. In haemorrhage he considered the ice-bagto be as useful as morphine. Dr. H. A. McCallum (London,Ontario) lauded strychnine throughout the attack as themost important agent in the treatment of this disease. Dr.J. T. Duncan (Toronto) next read a paper on the Size of thePupils as an Aid to Diagnosis. Dr. Hornibrook (Cherokee,Iowa, U.S.A.) read a paper discussing the most recent phasesof Auto-intoxication. The paper which exciled the keenestinterest in this section was that by Dr. Jennie Drennan (St.Thomas, Ontario) on the Physiological Generative Oycle inWoman. She stated that evolution was incident to all formsof life. The factors in every phase of life were adaptation toenvironment and heredity. Structure was determined byfunction and function was the product of environment. Thefunction of the female mammal was ovulation, pregnancy,