1249PARIS.-BERLIN.

the mother’s milk and in place of it giving sterilised milk towhich sulphate of soda had been added. Perhaps the milkof another woman might have answered equally well, but asthe people were poor a wet-nurse could not be employed.The good result above mentioned was obtained with threepennyworth of sterilised milk a day. Dr. Variot thoughtthat it was necessary to distinguish two varieties in the so-called uncontrollable vomiting of suckling infants. Oneconsisted merely in regurgitation due to gastric irritabilityof unknown cause ; it was easily checked by giving the childcitrate of sodium before feeding. The other could only bedealt with by changing the source of milk-supply. It would

appear that in some cases, which were not so rare as mightbe supposed, mother’s milk had a toxic effect, but examina-tion of its composition gave no clue to the nature of the

process. ’

The Protebtion of the Public Health.The Minister of Justice has just addressed to all

procurators-general a circular in which he commences byrecalling the fact that for some four years a law has beenin existence formulating a certain number of regulationsthrough which can be brought about the intervention of civilcourts with a view to safeguard public or private interestsas to sanitary matters. The Minister goes on to say that

although this law has not been in working order for verylong it seems to him that it would be interesting to obtainany results which have been procured up to date as to itsworking. The Minister therefore asks that procurators-general shall give him information as to their respectivedistricts in a conjoint report, which report shall be pre-ceded by a detailed inquiry carried out by delegates.This inquiry is to deal more particularly with infractions ofthe sanitary law which have been brought to light and whichhave been followed up by actions at law in which a definitejudgment has been given, and also with any intervention ofthe courts which has taken place with a view to assurethe strict application of the regulations of the law. The

procurators-general are asked also to add any observationswhich the working of the law up to the present date hassuggested and any facts concerning the protection of thepublic health or any instances where the working of thelaw has come into conflict with vested interests or well-established customs. The Minister adds a request that theprocurators-general may inform him of any alterations inthe law which in their opinion may be possible or desirable.

Renal Calouli and Radiography.At a meeting of the French Association of Urology held

during the month of October M. Raffin showed five renalcalculi which had been removed by him after a diagnosismade by radiography. The radiographs were taken byM. Arcelin. The technique was as follows. The patientswere first of all freely purged. The abdominal wall was thendepressed by means of an air cushion which was presseddown by a girth weighted at either end by sand bags. The

electricity was obtained from a 12 plate static machine byDrault. An ordinary tube was used and the sitting lastedfor about 25 minutes. The tube carrier was furnished withan iris diaphragm by Drault and in front of the tube aBlum’s iris tube was placed to cut off the secondary rays.Nephrotomy was performed in four of the patients andpyelotomy in one. All the patients did well.

Oct. 30th. _________________

BERLIN.(FROM OUR OWN CORRESPONDENT.)

Hystcrioal Lethargy.A CASE of lethargy lasting more than two years and

three months is described by Professor Eulenburg in theBerliner Medioinische Kl1nik. The patient was a man

about 45 years of age. He belonged to a nervous

family and was a moderate drinker. He had always beenrather phlegmatic, forgetful, and unable to do much work.During the last four years a marked deterioration of hismental capacity was observed, some of his symptoms beingthat he became more and more apathetic, was drowsyduring meals, and declined to speak to visitors. OnJune 10th, 1904, he fell from a tramcar and was takenin an unconscious state to an ambulance station. Whenhis medical attendant saw him at his (the patient’s)house three hours after the accident he found him

conscious but complaining of giddiness, pains in theneck, and nausea. All these symptoms, however, passedoff except the pain in the neck. On the fifth day afterthe accident a marked condition of somnolence set in ;he answered questions rather shortly, yawned frequently,was difficult to rouse, and has slept continuously sinceJune 20th, 1904, i.e., ten days after the accident. FromSeptember, 1904, to February, 1905, he was an inmate of asanatorium and afterwards was seen frequently by ProfessorEulenburg who always found him in the same state ofsomnolence, his face being pale and his forehead drawntogether in wrinkles. His eyes were habitually closed andwhen an attempt was made to open them the lids closedagain. The pulse was weak and made from 64 to 65 beatsper minute ; the muscles were relaxed and offered no resist-ance to passive movements. Neither pricking with a needlenor faradisation caused pain. He never spoke, noteven asking for food or drink. When food was put in hismouth he swallowed it very slowly and automatically with-out letting it 11 geo down the wrong way." Urine was passedonly when a urinal was placed in position, and it was remark-able that when the urinal was on one occasion forgotten hepassed the next time about four litres of urine. The bowelswere opened every second day by purgatives and when

they were about to act the patient made involuntary move-ments in his bed. He was then taken to the water-closetwhere he sat with his body gradually sinking forward.Professor Eulenburg, after having seen him sitting at thewindow, said that the appearance of his pale face withclosed eyes was ghastly. The patellar reflexes were strongbut the superficial reflexes had disappeared. ProfessorEulenburg considered that the case must be classified asone of exaggerated hysteria. It was very unlikely that graveorganic disease of the brain was present, because of thefunction of the bladder and the patellar reflexes being pre-served. Cases of lethargy in hysterical patients have beendescribed by several authors but the characteristic feature ofthe present case is the length of time for which the lethargicstate has persisted without interruption. The prognosis isnot bad and the patient will probably awake some dayspontaneously.

Medical Officers to Steamships.The obvious decrease of medical students during the last

five years has, of course, not been without its effect on thepass-lists and the supply of recently qualified medical menis not nearly so large as it was a few years ago. Appoint-ments usually held by the younger medical men, such asassistantships at the smaller hospitals and those in the

provinces, are therefore often vacant, and this is also thecase with regard to the appointment of medical officers tosteamships. Ships’ surgeons formerly remained in the servicefor a long time and a great number of candidates were con-stantly waiting for such vacancies as might occur, butcircumstances have now altered so much that advertisementsfor ships’ surgeons frequently appear in the medical journals.The Leipziger Verband, the most important medical unionin Germany, to which allusion was made in THE LANCET ofFeb. 21st, 1903, p. 558, has now fixed the conditions underwhich it will allow its members to accept such appointments.The salary is to be from 175 to 250 marks per month accord.ing to the time of service and 300 marks per month forcoasting vessels in China. Medical men who have gonethrough a course at the Institute for Tropical Medicine inHamburg are entitled to extra pay at the rate of 50 marksper month. If there is an allowance of wine to themedical officer the value of the amount, if any, unused byhim must be paid to him in cash at the end of the voyage.The medical officers are allowed to charge fees for the treat-ment of saloon passengers and the companies have to abstainfrom advertising free medical attendance on board. Themedical officer must rank with a chief officer and if he is

obliged to wear uniform he is entitled to an extra allowancefor the purchase of it. He must have a comfortable cabinand an extra room for the dispensary. He is to be allowedto go ashore in a port on simply informing the captain andwithout needing the special permission of the captain but,of course, on his own responsibility. These demands arequite reasonable and the companies will probably agree tothem.

N’lltrition by S1lbcutaneo1ls Injection.A few years ago Professor Leube recommended the

subcutaneous administration of oil as an addition toartificial feeding by enemata of milk, eggs, and starchysubstances. This method has been favourably regarded by

1250 BERLIN.-SWITZERLAND.-BUDAPEST.

several authorities, as the oil after a few hours disappearedfrom the place of the injection and thus had obviouslybecome absorbed. Dr. Winternitz, of the medical clinic atHalle under Professor von Mering, writing to the 1’lwrapieder Gegenmàrt, has recently published an article on thesame question and has come to the conclusion that of aninjection of 500 grammes of oil not more than from two tothree grammes of fat are assimilated daily, so that somemonths would pass before the whole quantity of fat enteredthe organism. In the course of his experiments he found thatthe fat previously to absorption became emulsified withinthe tissues. He therefore prepared a very fine, sterilised,and unirritating emulsion of fat by aid of gelatine and found Ithe absorbed quantity of fat to be three times, and in someinstances even five times, greater than in non emulsified fat.This fact was, however, more of theoretical than of practicalinterest, because of the great volume of the emulsion whichnecessitated the injection of only one-third of the fat.Moreover, the method was not free from danger as cellulitismight occur, and the same was the case when pancreaticferment was combined with the fat. The subcutaneousinjection of oil was therefore of no value for patients.

l’ulerance of Morphine.Dr. PoTzcht of Burendorf, writing in the Jliinohener

Jledicinische Wvchenschrift, reports a case of remarkabletolerance of morphine by an infant, aged eight months. Themother had by mistake given to the child a powder intendedfor the grandfathlI. When a medical man arrived afterabout an hour he found the child cyanotic with superficialrespiration and extreme contraction of the pupils.Neither diarrhoea nor vomiting was present. The tube ofthe stomach-pump could not be introduced and vomitingcould not be obtained by irritating the pharynx. The treat-ment consisted in the administration of atropine-O’ 0001gramme of atropine-and in friction of the skin. The next

morning the child was well and had a good appetite, but thecontraction of the pupils still persisted. It was found thatthe powder contained 0 02 gramme of morphine.

Precocious Menstruation.A remaikable case of precocious menstruation is described

in the Aerztliclw 8aohverständigen Geitung (Journal of3-redical Experts). A g,rl born in 1901 had shown a normaldevelopment without any illness till her third year. At thistime the nipples became prominent and the mammse beganto swell, a condition which has gone on increasing up to thepresent time. At the beginning of her fourth year therewas a sanguineous discharge from the genitals and this hasrecurred regularly every four weeks for five or six days.The external genitals did not show any abnormality andinternal exploration was, of course, avoided. There was ncdevelopment of hair on the mons Veneris.

Oct. 29th. _________________

SWITZERLAND.

(FROM OUR OWN CORRESPONDENT.)

Diphtheritic Ophthalm’ia.Dr. A. Dutoit, ophthalmic surgeon in Burgdorf, formerly

surgical assistant at the ophthalmological clinique in Ziirich,has published a full account of 42 cases of diphtheriticophthalmia treated during the period 1897 to 1905 at theZurich Ophthalmic Hospital which is in charge of Professor0. Haab. Of these cases, 22 were boys and 20 were girls.23 of them were under treatment for a fortnight and theremainder for a month or more. As regards age, 20 wereunder one year of age, 13 were under two years, and nine Iwere from two to seven years old. The majority of the cases(32) were children inhabiting the working-class suburb of thecity of Ziirich, an area which has a population of 170,000.The orgin of the infection could only be proved in threecases. As regards diagnosis formation of membranes was

always noted ; the diphtheria bacillus was found in 35 cases(83 per cent.). Injections of anti-diphtheritic strum weregiven to 25 patients, 19 of whom made a good recovery ; theremaining six had perforating ulcers of the cornea and twoof them died from pneumonia. Among the other 17 patientswho were not treated with serum there were five dtaths-three from pneumonia, one from diphtheria faucium, andone from glioma cerebri. The local treatment consisted inthe application of antiseptic solutions containing corrosivesublimate (1 in 5000), permanganate of potassium, or boric

mid ; in the later stages solutions of nitrate of silver wereased, having a strength of from 1 to 3 per cent. Strictisolation and proper disinfection were of great importance.

Foreign Students at Siriss Unirersities. :The steady increase of foreign students has occupied the

attention of the authorities at the five Swiss universities forseveral years. These foreigners are, for the most part, ’

students of medicine and Russian by nationality. At Bern, IZiirich, and lately at Lausanne, complaints of overcrowdinghave been sent in to the authorities. The response has

lately come in a series of new regulations for foreignerswith a considerable increase of the very moderate fees forentrance examinations, &c. The authorities expressed theirregret at having to adopt such defensive methods, but thenecessity is obvious when it is considered that during thelast summer te,rm there were 1331 foreigners and only 553Swiss students registered at the five medical faculties. Theincrease of female students of medicine was especially reomarkable as thE 3- now amount to 998 and outnumber the men,.of whom there are only 886. The figures for the severaluniversities are as follows :-

Male students. Female students. Total, ,

Basle ............ 141 ...... 5 ...... 146Bern ............ 160 ...... 338 ...... 498Geneva ......... 184 ...... 159 ...... 343Lausanne ......... 140 ...... 322 ...... 462Ziirich ......... 261 ...... 174 ...... 435

Total ...... 886 ...... 998 ...... 1884-Zurich, Oct. 23rd.

BUDAPEST.

(FROM OUR OWN CORRESPONDENT.)

Sanitary Hairdressing.THE medical officer of health of the city of Budapest has-

submitted to the sanitary committee of the public healthdepartment a series of regulations for the formation of aregister of sanitary hairdressing establishments and it is pro-posed that any failure to comply with the regulations shouldbe followed by the removal of the name of the offender from, ithe register. He recommends, among other things, that ’

regular customers should provide their own toilet requisites ;.that all shelves and fittings should be made of glass; thatthe use of powder-puffs should be discarded in favour ofpowder pulverisers ; that a barber or hairdresser should refuseto attend a customer who is apparently suffering from anydisease of the skin or hair ; and that all razors and combsshould be kept for five minutes in a 5 per cent. solution ofsodium carbonate. He also recommends that hair-curlers-and tongs used in ladies’ hairdressing establishments shouldbe boiled for ten minutes.

Psychoses associated witlt Migraine..At a recent meeting of the Medical Society of Budapest

Dr. Mandel read a paper on Psychoses associated with,Migraine. He said that simple hemicrania sometimes gaverise to mental irritation or depression, anger, or slighthallucinations. An attack of migraine of an epileptic typewith muscular twitchings or ocular manifestations might bepreceded by a visual aura. When the migraine was of thenature of true epilepsy the visual aura assumed a red colour.Psychical symptoms might occur in either. A transitorypsychosis sometimes followed or accompanied migraine.This was important from a therapeutical point of view, forit indicated the necessity of using anti-epileptic treatmentfor migraine. Similarly there existed a close clinical relationbetween attacks of migraine and hysteria major. Severaltypes of cases had been recorded, of which the followingwere examples : (1) A combination of visual hallucinations,amnesia, ataxia, or aphasia, with attacks of migraine lastingsix hours ; (2) mental confusion, with religious excitement;(3) hemicrania, with temporary blindness, paræsthesia, andimpairment of speech ; and (4) hemicrania after mentalshock, with anxious delirium and partial unconsciousnessfor three days. These psychoses, however, were of rare

occurrence.

Le6i.ons caused by the Roentgen Rays.At the same meeting the electrician of the Surgical

Clinic showed several patients who were suffering fromserious lesions which had been produced by the Roentgen.