1242 PARIS.-BERLIN.

North Infirmary in wishing that Dr. Hobart may still havemany years of happiness.

The South Infirmary, Cork.Dr. Patrick J. Cremen has resigned the appointment of

physician to the Cork South Infirmary, a position which he*has held for some years, and the resulting vacancy which it’is expected will occur in the extern department is the-subject of much competition.

Oct. 23rd. ________________

PARIS.

(FROM OUR OWN CORRESPONDENT.)

An Operation on a Double Monster.DR. CHANOT-PREVOST recently reported to the Academy

of Medicine an interesting account of an operation on adouble monster. The operation was performed by himselflast year at Rio Janeiro on a double monster of the femaldsex, aged seven years. One child survived the operation, theother died five days after it. An operation had previouslybeen attempted by another surgeon,’but he had stopped ondiscovering that a bridge of liver formed part of,theunion. Radiography demonstrated clearly the visceral

.independence df the two children. Dr. Chanot-Prevost wasalso enabled by means of radiography to estimate theextreme importance of the bridge of liver-tissue. The

upper portion of the union was formed of skin and osteo-,cartilaginous tissue, then came the liver, and then the twoabdominal cavities coalesced. The two children could walktogether fairly well, but they could not both sit down at the- same time. Iodides taken by the one were eliminated byboth, as was also methylene blue. When one of the children’had an illness the other was not affected and elevation ofthe temperature only existed in the one. The operation tookplace on May 30th, 1899. Chloroform administered to the- one did not put the other to sleep. The skin being incisedand the peritoneum opened Dr. Chanot-Prevost came down’upon the liver. He divided the two umbilical veins. Onone of the children making efforts to vomit the intestinesof both were extruded. The two pericardia were adherentfor some two centimetres by a fibrous band. In one childthe pleura was opened but it was sutured after carefulcleansing. Last of all the connecting band of liver wasdivided, special care being taken to check haemorrhage.One child died five days after the operation and a post-mortem examination verified the fact that perfect haemo.stasis had been procured in the divided liver which wasnormal. The cause of death was pleuro-pericarditis withpneumothorax. The surviving child has dextro-cardia.

The" Mal des Bassines." This is one of the titles of an affection well known among

the workgirls employed in winding silkworm cocoons. It is’also known in the silkworm nurseries by the name of vial-des vers and itis defined by medical men as the dermatitis ofwinders or spinners of silk from the cocoons. M. Fabre, the- eminent entomologist of Avignon, whom Darwin used tohold in such esteem, by means of some recent researches hasbeen enabled to make quite clear the pathology of thisremarkable affection, and M. Vallin gave an account of the’researches at a recent meeting of the Academy of Medicine.’Hitherto the affection had been attributed on the one handto the softening of the epidermis of the workgirls’ fingersowing to prolonged soaking in warm water, and on the other’hand to irritation brought about by the decomposition of

organic matter arising from the chrysalides inside thecocoons being macerated and broken up. M. Fabre, how-ever, has shown the existence of an urticating principlewhich is very irritating to the skin in the fasces of certaincaterpillars and also in those of silkworm moths just escapedfrom the cocoon. M. Fabre brought about intense urticariaby applying these faecal matters to his skin. Hairy cater-pillars are more dangerous to handle than are smooth ones, forthe faeces get entangled in the hairs. M. Fabre set himselfto discover whether the poisonous substance resided in thedigestive or in the urinary products and concluded infavour of the latter. As it is by means of the waterin which the cocoons are soaked that the irritant sub-- stances come into contact with the hands and arms of thesilk-winders, M. Vallin proposes as a preventive to add to the- water a very small quantity of bypochlorites which would

probably neutralise the poison without injuriously affectingthe silk. The water should be frequently changed andreplaced by cold water when the workgirls dip their handsinto the vessels containing the cocoons.

The Experimental Treatment of Tuberculosis by Means of aDiet of Raw Meat.

, Your readers are already acquainted with the experi.ments of M. Richet and M. Hericourt 1 relative to the useof raw meat as a prophylactic and curative substance intuberculosis produced experimentally in dogs. Such treat-ment these observers have called "zomotberapy." M.Salmon of Cannes has been making experiments to verifythe observations of M. Richet and M. Héricourt and hasrecently laid his results before the Society of Biology. Hefed three lots of dogs exclusively on raw meat. The first lotwhich were fed on raw meat for some time before beinginoculated did not live any longer than the control animals.Of the second lot, which only received raw meat 20 daysafter being inoculated, three went up in weight and survivedfor some time. A third lot received the raw meat long afterinoculation, when they were already cachectic, and derivedno benefit whatever. M. Salmon concluded from these experi-ments that raw meat given as a preventive makes an animalmore resistant to tuberculosis but does not prevent thedevelopment of the disease. A dog affected with tuber-culous peritonitis which was apparently cured by theadministration of raw meat was found at a post-mortemexamination to have a large number of active tuberculousfoci. Examination of a number of dogs both healthyand unhealthy at various stages of the zomotherapeutictreatment revealed the interesting fact that this diet causesa great development of fat not only in the healthy dog butin the tuberculous dog also. This fattening appears to bethe cause of the animal being able to offer resistance to theinfection of the tubercle bacillus. M. Bouchard remindedthe meeting that a diet of raw meat had upon manyoccasions given rise to a variety of tuberculous affectioftswithout giving any really good results. The apparent curesobtained by M. Richet and M. Héricourt prove that the dog,a carnivorous animal, is affected by a diet of raw meat

differently to the manner in which a man is affected by thesame diet.

Oct. 24th.

BERLIN.

(FROM OUR OWN CORRESPONDENT.)

The Illness of the Empress Frederick.NOT long ago it was rumoured that the health of the

Empress Frederick was far from being satisfactory, but as shewas seen driving and walking in the neighbourhood of herresidence at Friedrichshof near Homburg and as no reliableinformation was forthcoming the unfavourable reportsgradually came to be looked upon as unfounded. The publicwere therefore the more alarmed when it was eventually madeknown officially that the Empress was so seriously ill thatthe whole Imperial family and the Duke and Duchess ofConnaught had arrived at Homburg. Moreover ProfessorRenvers of Berlin, who had been consulted on several pre-vious occasions, was again asked to see her at once

and to stay at the Castle. An official bulletin describesthe disease as neuralgia with acute cardiac debility coib-bined with bronchitis. The patient’s health has improvedso much that Professor Renvers has returned to Berlin,and she is now attended only by her ordinary physician,Dr. Spielhagen. That beautiful watering-place, Homburg,so well known to English visitors, has now after the termina-tion of the official season again become crowded-not withvisitors in search of health, but with court and state officials,special correspondents, &c., and some of the hotels whichhad just been closed have been re-opened. According to themost recent bulletin the condition of the Empress continuesto be relatively better, the cardiac action being now regular,the temperature normal, and the bronchitis decreasing.

Inarease of Cancer.The marked increase of carcinoma has for several years

been engaging attention in different countries and thestatistics published by Mr. W. Roger Williams in

1 THE LANCET, June 23rd, 1900, p. 1840.

1243BERLIN.-SWITZERLAND.

THE LANCET have induced Dr. Reiche, one of the Imedical officers of health of Hamburg, to inquire into the 1

mortality from this disease in that city. Dr. Reiche has pub- ilished his results in the Deutsche Medieinisclae Wochenschrift I

and the Munohener Medicinische Wocleensohrift. He hasfound that in various years the deaths from carcinoma

proportionately to the population were as follows : in 1872 onein 1396 in 1882 one in 1207, in 1892 one in 1276, and in 1898one in 1022. This implies that of 100.000 persons living 71-63 Idied from carcinoma in 1872, 82-85 in 1882,78.39 in 1892, I

and 97’82 in 1898. The comparative mortality in the twosexes was as follows. From 1872 to 1880 the ratio of malesto females was 1 to 1’46, from 1881 to 1889 it was 1 to 1’49, I

and from 1889 to 1898 it was 1 to 1-29. The mortality fromcarcinoma has therefore increased in Hamburg, and it isremarkable that the death-rate of the male sex bids fair tobecome equal to that of the female sex. With regard tothe organs which were affected by the disease the reportstates that in the male sex the organs of digestion wereinvolved in 85’8 per cent., but in women in 40 per cent.only. In the female sex the preponderance of cancer of thegenerative system was remarkable, as 41’2 per cent. repre-sented cancer of the uterus, the ovary, and the mamma.As to the age of the patients it was found that thegreatest number of deaths from cancer occurred between 60and 70 years of age. During the ’last 27 years there was arelative increase of mortality in males between 40 and 55years of age and in females between the ages of 45and 55 years, whilst there was an absolute increase inmales above 40 years and in females above 45 years. Inanother article attention is drawn to the fact that theimprovement in the quality of the water-supply of Ham-burg which was made in 1894 has had no influenceon the death-rate from cancer. Whilst the general mor-tality, which was between 22-2 and 25’3 per 1000 duringthe period from 1888 to 1891, decreased at once, andwas only from 17-1 to 18’9 per 1000 during the periodfrom 1894 to 1899, the death-rate from carcinoma continuedto increase. It is interesting to compare the death-rate fromtuberculosis with that from cancer. In 1872, when Hamburghad 346,210 inhabitants, 1179 deaths from phthisis and 248deaths from cancer were recorded ; in 1899, when the city had744,132 inhabitants, 1443 deaths from phthisis and 797 fromcancer were recorded, so that the ratio between the two diseaseswas 4-8 to 1 during the earlier period and is now 1’9 to 1.All the circumstances by which the mortality from phthisiswas reduced, such as improvement of the food and thedwellings of the poorer classes of the population, were unableto check the increasing mortality from cancer. Dr. Reicheaccordingly tried to find whether there was any ground forsupposing that a more liberal food-supply might perhaps bethe cause of the increase of carcinoma as suggested by Mr.Williams. To this end he compared the wealth of thepopulation, the general mortality, and the mortality fromphthisis and carcinoma in the different districts of Hamburg.The result was that in the district of Harvestchude, where theaverage income of each inhabitant was 2770 marks and thegeneral mortality was 9’4 per 1000, the mortality from

tuberculosis was 9-4 per 10,000 and the mortality from cancerwas 8.0 per 10,000. In the district of Barmbeck, with anaverage income of 311 marks and a general mortality of25’7 per 1000, the mortality from phthisis was 21-7 per1O,QOO and the mortality from cancer was 8-5 per 10,000.From this it follows that the mortality from tuberculosisis very much less in a wealthy district than in a poor one,whilst in the case of carcinoma such differences do not exist.For phthisis the mortality varied from 25 5 to 9-4 per 10,000,according to the district, but for cancer it varied only from11’2 to 7’1 per 10,000. so that the latter is obviously indepen-dent of hygienic and social conditions. Dr. Reiche finallystates that the ratio of the mortality from cancer of thedigestive organs to the mortality from cancer of the otherorgans has not altered during the last 27 years. The theoryof Mr. Williams that the increase of cancer is connectedwith an increased consumption of food seems, there-fore, to be unfounded. The above results obtained byDr. Reiche are confirmed by the statistics of theGotha Life Insurance Company. In 1875, of 42,552 personsinsured 61 died from cancer (i.e., 1-43 per 1000), but in 1899of 92,732 persons insured 219 died from cancer (i.e., 2-36per 1000). A collective investigation on carcinoma will soonbe made under the patronage of the Government by a special

1 THE LANCET, August 20th, 1898, p. 481.

committee presided over by Professor von Leyden. Lettershave been sent to all the medical practitioners in Germanyasking them to register the cancer patients attended by themon Oct. 15th and to supply certain specified particularsregarding them.

’

The First Female Medical Graduate in Germany.It was in the year 1754 that the degree of M.D. was first

conferred on a woman in Germany. The Vossische Zeitung,of July 18th, 1754, mentions that the medical faculty of theUniversity of Halle had granted the degree of M.D. to Mrs.Dorothea Christiana Erxlebin after she had passed theexamination with distinction. The title of her " dissertation "-

which, according to the custom of that time, was written inLatin, was "Quod nimis cito et jucunde curare saepe fiatcausa minus tutae curationis." This lady’had been anapprentice of her father, a well-known medical practitionerat Quedlinburg, and as she could not matriculate at auniversity she learned medicine by reading only. By aroyal decree of Frederick the Great she was thenrecommended to the Faculty of Halle as a candidate forgraduation, but she presented herself only after the death ofher husband. She also published an essay on the utility oflearning for the female sex.

Oct. 22nd.

SWITZERLAND.(FROM OUR OWN CORRESPONDENT.)

The Swiss Medical Currieitlum.THE new regulations now in force have made the medical,

examinations even stricter than before and have prolongedthe course of medical training to a minimum of five years ;most students, however, devote six or seven years to studybefore going up for their final examination. There are threeexaminations to be passed. The examination in naturalscience embraces physics, organic and inorganic chemistry,botany, zoology, and comparative anatomy. The examina-tion in anatomy and physiology allows four hours fordissection and demonstration ; histological specimens have-also to be prepared, mounted, and described. A writtenexamination in physiology is required, the choice of threesubjects being given ; the oral examination lasts half an hourin each branch-anatomy, histology, embryology, and physio-logy. For the final examination-the Staatsexamen-whichadmits to the title "medical practitioner" (the M.D. being:a superior degree), certificates are required showing that thecandidate has spent five years in medical study and hasattended a stipulated number of lectures and courses. In

pathological anatomy the candidate has to open and examine-at least one cavity of the body and answer questions onpathology; microscopic and bacteriological preparations-have also to be demonstrated and mounted. Both in

pathology and therapeutics and also in surgery one patienthas to be examined, and a detailed account (etiology, dia-gnosis, differential diagnosis, and treatment) has to be-given in writing, for which six hours are allowed.Half an hour’s oral examination supplements this. Insurgery two operations on the dead subject, together with,questions on topographical anatomy, are required. Inobstetrics, gynaecology, and ophthalmology from one to twohours are allowed for examination of several cases, followedby an oral examination. Then there are papers required onhygiene (four hours) and on legal medicine or mental diseases.The final oral examination gives half an hour to each candi--date in general pathology, pathology and therapeutics,surgery, obstetrics and gynaecology, hygiene, legal medicine,mental diseases, and materia medica. More than half of thestudents serve generally in various cliniques as dressers orassistants for one or more terms to initiate themselves intopractical work, the out-patient departments usually receivingspecial attention. The students still attend lectures on

pediatrics, otology, rhinology, dermatology, and courses of-

ophthalmology, which, however, are not examinationsubjects.

Diphtheria and Albuminuria.Dr. Zollikofer, first assistant of the Berne Medical Clinique,

has investigated the connexion between albuminuria and

diphtheria in 338 cases observed from Jan. lst, 1897, toMarch 31st, 1900. Owing to the growing confidence felt bythe public in serum treatment many slight cases are sent to