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in three volumes, was published at varying intervals duringthe years 1595 to 1601.

I am, Sir, yours faithfully, -

THE WRITER OF THE REVIEW.

THE BED ISOLATION OF CASES OFINFECTIOUS DISEASE.

To the Editor of THE LANCET.

SIR,-I have read with interest the discussion in yourrecent issues on the above subj ect. I have not, however, cometo any definite conclusion on the subject. At the same time1 would like to ask if those who are praising the claims of thesystem have considered the fact, and given it its share in theresults attained, that cases of infectious disease are tem-

porarily immune to other infectious diseases. Thus, a case ofenteric has less chance of catching small-pox than it wouldnormally, oeteris paribus; no one usually sees two infectiousdiseases in the same patient at the same time.

I am, Sir, yours faithfully,A. G. NEWELL, M.D. Glasg.

RADIUM EMANATION IN MINERALWATERS.

To the Editor of THE LANCET.

SIR,-I notice that in a paper with the above title by Mr.’T. Pagan Lowe appearing in THE LANCET for April 20th,p. 1051, credit has been given to Dr. W. H. B. Aikins andmyself for certain observations on the effects of radio-active waters. The credit for these observations should be

given to Dr. William Armstrong, of Buxton, England, whopublished them in the Britash Medioal Journal for April 29th,1911, and to whom credit was given by us in our paper,which appeared in the Canadian Practitioner and Revaen forAugust, 1911.-1 am, Sir, yours faithfully,

FREDERICK C. HARRISON.

1* Jjr. liarnson connrms tne claim made oy ur.

Armstrong in THE LANCET of May 4th, 1912, p. 1226.-ED.L.

THE TREATMENT OF RODENT ULCER.To the Editor of THE LANCET.

SIR,-Referring to my paper in THE LANCET of May 18thon the above subject, my attention has been drawn to thefact that I have suggested to the minds of some readers thatrodent ulcer always recurs after treatment by the X rays orradium, or zinc ions.

I hasten to assure any who have gained such an impressionfrom reading my paper that I very much regret havingraised an idea so erroneous. I thought I had made myselfsufficiently clear on this point, for in the last paragraph onp. 1333 I stated : " It is a matter of common knowledgeamong radiologists that numbers of complete and satisfactoryoures of rodent ulcer have been made by all of the first threemethods (viz., the X rays, radium, and zinc ionis3.tion) I havementioned." " Further on in the same paragraph I said: "I Ihave not come here this evening to decry the use of methodsthat have served us well in the past, but I am sure it will beagreed that we do get a certain number of recurrences nomatter how carefully we do our work. It is with the objectof reducing the number of these lecurrences that I am goingto ask you to give a more general trial of a method thatseems to promise well." As there may be others than those

Ifrom whom I have heard who have also mistaken my I

meaning, I am glad to have this opportunity of making mypositon qatte clear.-I am, Sir, yours faithfully,

REGINALD MORTON.

THE ROYAL SANITARY INSTITUTE.-Among theFellows of the Royal Sanitary Institute who have beenelected recently are Dr. Alfred Greenwood and Dr. JohnT. C. Nash. Colonel Guy C Jones (Director-General of theMedical Service of the Militia of Canada), Dr. John F. Johns,Dr. Angns McDonald, Dr. G. D. Porter, and Dr. NormanWilson have also been elected members of the institute.

CHOLERA IN ROME.

(FROM OUR SPECIAL SANITARY COMMISSIONER.)

Rome, May, 1912.The Public Health Department.

WITHOUT attempting to go deeply into the matter, I didnot fail, while attending the International Congress on

Tuberculosis, to make some inquiries as to the prevalence ofcholera which prevented our meeting last September. Itwas not officially stated that the Congress was postponed onaccount of the cholera, but no doubts were entertainedas to the real cause, particularly as other congresseswere also abandoned or relegated to some more pro-pitious moment. The fact was that cholera had beenthreatening for some time. Already, in 1910, some caseswere reported ; 29 cases resulting in 17 deaths are on

the official records, and it is not certain that every casewas duly reported. To deal with such matters there is atRome a Sanitary Department or Bureau of Hygiene. ProfessorTito Gualdi is its chief, and holds a position somewhatanalogous to that of a medical officer of health in England.His department is subdivided into four offices. The firstattends directly to the sick and organises for the help whichthey need and are entitled to receive. The second officewatches over the schools, and especially over the free mealsgiven to the children in all the elementary schools. That thechildren have to be fed is now a well-established principlethroughout Rome. The third office deals with infectiousdiseases, the isolation of the patients, and disinfection of thepremises. The fourth office controls the inspectors ofnuisances, the food-supply, the shops and markets.

There are at Rome four hospitals reserved for the isolationof infectious cases. All that could be done for the cholera

patients was to isolate them and send the people out of thehouse in which the case had occurred. But they came backagain as soon as the house had been disinfected. In manyinstances it was quite obvious that the one effective measurewould be the total destruction of the terribly over-crowdedand insanitary dwellings in which so large a proportionof the cases occurred. In Rome, Milan, and Turin there arequarters for the poor of modern construction. There, in spiteof continued overcrowding, sanitary conditions are much betterand these new quarters have not suffered from cholera. But inNaples, in the older parts of Rome, at Genoa, at Livourna,they have not demolished the old slums. There is no moneyforthcoming, even for this most urgent work. At Naples.four persons at least on an average live in one room insuch districts, and there the cholera could not be checked.It was from Naples that the disease was conveyed to

many other towns. There was cholera there in 1910,and it also came to Rome in that year, but there were only29 cases notified, resulting in 17 deaths. In 1911 thedanger seemed greater. The first case occurred in February,the victim being a young girl who came from thenaval station of Taranto. But nothing followed until theensuing month of May, and this time the patient wasa young man. He had not come from any infectedtown, and all that could be ascertained was that he hadeaten eggs which had been sent from Naples. He lived onthe other side of the Tiber, near the asylum where, fourmonths later, many cases occurred. For the moment, how-ever, nothing happened. Then there was a third case, andin quite a different part of the town. This time it was a

young American lady who had recently arrived at Rome fromNaples. Still nothing alarming happened. A few moreisolated cases were notified, and the disease did not assumean epidemic form till the end of July. Then, on the banksof the Tiber, in the district traversed by the Via Giulia,there was an outbreak affecting a good many people livingthere. A second local epidemic followed in quite anotherpart of Rome known as the Macao and S. Lorer zodistrict. There was a third outbreak in the very heartof the city in the narrow old streets that run between thePiazza Colonna and the Pantheon, and finally there wereclusters of cases in rural outlying districts. Altogether,

. in 1911, the cases notified numbered 297. followed by 163, deaths. Thongh this may seem a large number of cases

it is not very alarming when taken in comparison withI the population. Thus, in 1910, the number of deaths from

tuberculosis registered at Rome was equal to 21 07 per 10,000

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of the population; from the zymotic diseases 17’ 30, and fromcholera 0 30. In 1911 the deaths from tuberculosis fell to20-05 per 10,000, from the zymotic diseases to 11’54; butfrom cholera they rose to 2-96. Nevertheless, and consider-ing only the above figures, it would appear as if the healthof Rome improved as the cholera increased. The totaldeaths in 1910 from tuberculosis, zymotic diseases, andcholera were 38-67 per 10,000; and, though in 1911 thecholera cases increased tenfold, the total from these threecauses fell to 34 - 55 per 10,000.No satisfactory explanation is given as to the principal

channels of cholera infection. Milk contamination is

supposed to have been the cause of the first epidemic out-break and of the 57 cases that occurred in the lunaticasylum. In any case, the first to sicken were personsemployed in a dairy. Then in the Pantheon district a largefamily had all their milk from a particular dairy. No onewas ill except the one member who drank some of this milkbefore it was boiled. In other cases it was also noticedthat only those who drank unboiled milk contracted cholera.On the other hand, although many samples of milkwere bacteriologically examined, the comma bacillus wasnever found. Nor was there the slightest evidence that thewater-supply had been contaminated.But for the intense poverty, the survival of slums and the

dirt that prevails therein, no great fears would be enter-tained. In the present state of affairs there are manyquarters where epidemic disease can easily spread. Yetwhat can be done ? A law against overcrowding is no useunless more suitable dwellings can be provided. As it is, thelaw does fix the number of persons who may live in a newlyconstructed house. The law in this case stipulates for about1000 cubic feet per inhabitant, but the poor cannot pay therent of such spacious dwellings. The re-housing schemes aremaking but very slow progress, and if the cholera scareresults in stimulating this movement, it may end in doing moregood than harm.

CONGRESS OF THE GERMAN SURGICALASSOCIATION.

(FROM OUR BERLIN CORRESPONDENT.)(Concllldedfrom p. 1370.)

The Blood in Cachexia Thyreop’fiva.Professor KocHER (Berne) said that he had described four

years ago a certain condition of the blood which he at onetime believed to be characteristic of Graves’s disease, butwhich afterwards proved to be present also in myxcedema.The difference between these morbid conditions, however,was that the coagulation of the blood was retarded inGraves’s disease, but accelerated in myxcedema, so that adifferential diagnosis was possible by an examination of thecoagulation. This was especially important because casesof alleged Graves’s disease were sometimes in reality maskedmyxoedema, which might be benefited by the administrationof iodine. In doubtful cases myxcedema and Graves’sdisease might be distinguished by a cautious administrationof iodothyrin, the condition of the blood becoming normalunder this treatment in myxcedema but worse in Graves’sdisease. These facts led Professor Kocher to believe that

myxoedema depended on hypothyroidism and that Graves’sdisease depended on hyperthyroidism.

Dr. MEISEL (Constanz) drew attention to the circumstancethat remarkable pigmentation sometimes occurred inGraves’s disease ; he was of opinion that it was caused bya certain relation between the thyroid gland and thesuprarenal glands. He had also sometimes observedcardialgia, which became worse under the administrationof adrenalin, but improved under sodium phosphate.

Operations on the Lungs.Professor CLOETTA (Zurich) reported experiments which he

had made on the respective effects of the use of rarefied airand compressed air (the so-called Ueber- und Unterdruck-Verfahren) in operations on the lungs. Contrary to the

opinion that both proceedings were of equal value, he hadfound by measuring the blood pressure in the right ventricle,the pulmonary artery, and the carotid artery that the circula-tion was much more interfered with by the use of compressedair, and that with rarefied air only one-third of the power

was necessary to obtain the same degree of inflation of a

lung as with compressed air. With rarefied air the inflationwas caused by elastic traction, but with compressed air byan increase of the pressure within the pulmonary tissue. Thelatter condition caused disturbance of the circulation withinthe lung, thereby affecting the right ventricle. In operationsof long duration rarefied air should therefore be used. Thefavourable results obtained in tuberculosis of the lung bycreating an artificial pneumothorax were due to an

improvement of the circulation within the lungs.Professor KAUSCH (Schoneberg) reported a series of cases

of Freund’s operation for tuberculosis of the apex of thelangs. He said that up to the present time nine cases ofchondrotomy of the first rib had been performed, of whichfive were by himself. In two of the cases under his care thedisease of the lungs had extended below the second rib, sothat only temporary amelioration was obtained. The otherthree patients were considerably improved, and as they werestill alive three or four years after the operation they mighteven be considered as having recovered. The number ofcases was, however, too small to allow the formation of adefinite opinion on the subject, but it had been ascertainedthat the operation was harmless, and that the condition ofthe lungs was not made worse by the mobilisation of the rib.No case ought to be operated on when the tuberculosis hadextended below the second rib.

Dr. WILMS (Heidelberg) spoke on the subject of retractionof the lungs in tuberculosis and its treatment by resectionof small pieces of the ribs. He said that surgical intEr-vention was indicated especially in chronic cases, where,notwithstanding retraction of the thorax and shrivelling ofa lung, bsemorrhage and cough with abundant excretion

persisted. He recommended the removal of small pieces ofthe ribs. The more extensive was the tuberculous process inthe lungs the more cautiously must the operation be per-formed, and therefore it should be conducted in two or threestages at proper intervals, so as to allow the lung to accom-modate itself to the new size of the thorax each time afterthe resection of a rib. The operation was, as a rule,obviously successful, cough and secretion disappearing.

Dr. TIEGEL (Dortmund) read a paper on Drainage of theThorax for Infection of the Pleura after Operation. Hesaid that the most remarkable symptom of infection of thepleura as a sequel to operations was the abundant exudationinto the pleural cavity, which mechanically compressed thelung, and thus increased its liability to pneumonia. Theexudation was also a good nutrient medium for bacteria, andcompressed the circulation within the lungs. Post-operativeexudation should therefore be at once treated by drainingthe thorax with a valve drain.

Professor SAUERBRUCH (Zurich) showed three patients onwhom he had operated for severe injuries of both the thoraxand the abdominal organs, periorming thoracotomy and lapar-otomy. The indications for the operation were severe

haemorrhage and pneumothorax. The operation was performedunder compressed air, and the wound in the thorax wasclosed by sutures without drainage. By radiograms heshowed that the ribs had gradually recovered their normalposition so that the intercostal spaces had become again asbroad as before. He afterwards discussed the subject of

ligature of the pulmonary artery for bronchiectasis, an opera-tion which produced a shrivelling of the pulmonary tissue.

Dr. ANSCHUTZ (Kiel) read a paper on resection of the

diaphragm for a malignant growth within the abdomen, whichhad affected that organ. He advised the removal of as muchas possible without having regard to the difficulties of closingthe wound, which according to him might be done by suturingneighbouring organs, liver or spleen, into the fissure.

Operations on the Kidn13Ys.Professor KuMMEL (Hamburg) mentioned that anuria had

been relieved in acute infectious diseases, in various toxicconditions, and in eclampsia by decapsulation of a kidney.In acute purulent nephritis he had performed the same opera-tion as an alternative to nephrectomy. Decapsulation wasperformed in 11 and nephrectomy in 17 instances. Acutepurulent nephritis must always be operated on, recovery byspontaneous discharge of the pus being very rare. Withrespect to chronic nephritis, he distinguished two forms, oneof them being a nephralgic form, on which he had operatedin 13 instances, performing 4 decapsulations and 13

nephrectomies. One patient survived for several years andthe others were relieved. The other form of chronic nephritis