1062 THE PATHOGENESIS OF DELIRIUM TREMENS.

think the suggestion a good one, although such cases areextremely rare. It would be still wiser, however, if a

druggist was not permitted to sell such a plaster without aprescription from a qualified medical practitioner. It is

worthy of note that the emplastrum belladonnso of the newPharmacopoeia is much weaker than that of 1885. Our

correspondent further asks whether a plaster of belladonnaand opium would produce the poisonous effects of the formerdrug. Such a plaster is not official ; it would depend in

great measure upon the relative strengths of the two

ingredients. ---

SOFT WATER AND SOAP.

IT is commonly supposed that the use of soft water-rain-water, for example-for washing purposes economises soap.But while it is perfectly true that the lime salts in hardwater nullify to some extent the soap by forming insolublelime soaps, yet the expenditure of soap, at least in toilet

purposes, will be found to be considerably less than

when rain-water is used, while the cleansing effect is

just as good. The explanation of this is that soap is

so very readily soluble in soft water that considerablymore soap is used than is necessary. Everybody knowsthe slippery feeling of rain-water in which the handshave been washed with soap, and no amount of rinsing ’’,,would appear to remove the soapiness from the skin. In ’,this case it is doubtful when soap is used whether, after ’’all, rain-water or soft water is better for the complexion or z’’

skin than hard tap-water. It is certainly not so refreshing.In manufacturing processes or in the wash-tub it is true the Iuse of soap in soft water is an economy. It is in this way,of course, that the addition of soda, throwing out the lime Isalt, saves soap. It has been estimated that if London were

supplied with soft water the saving of soap would amountto tens of thousands of pounds per annum, and Glasgow isestimated to save ;E36,000 annually in the matter of soapsince using Loch Katrine water. That may be so, but in thematter of personal washing there is a waste of soap producedrather than an economy by using soft water. The factthat a tablet of soap disappears much more (luickly whenrain-water is used instead of hard tap-water is proof of thisassertion.

___

THE PATHOGENESIS OF DELIRIUM TREMENS.

DR. K. BONHGEFFER of Breslau, in a recent communication I

to the Berlirter Elinische Wochenschrift (Xo. 32, 1901), cleals IIwith the pathogenesis of delirium tremens, based upon a ’,atudy of 250 cases of the disease observed during- three years. ’After referring to the conditions present in the disease—viz.. ’,acute hallucinatory mental confusion, transitory albnminuria.dicrotism of the pulse, and in fatal cases intense cerebralhypcrsemia. and even small haemorrhages into the brain- liediscusses the etiological factors of delirium tremens. Sudden

withdrawal of alcohol is one of the factors and injuries(especially cranial injuries) are prone to develop the attack.The presence of epilepsy as a complication increases theliability to delirium tremens in alcoholic subjects. The

most potent causes are, however, first, infectious diseases

affecting the lungs and respiratory organs, and secondly,gastro-intestinal disorders. Jacobsohn in Denmark and

Villiers in Belgium found that 17 or 18 per cent. of

cases of, delirium tremens were complicated with an

acute disease. Tabulating the acute bodily diseases

which thus complicate, or participate in the produc-tion of, delirium tremens Dr. Bonhoeffer found that

20 per cent. were cases of pneumonia, while 28 per cent.included such disorders as acute bronchitis, pleurisy,pulmonary haemorrhage of tuberculous origin, cellulitis (in-cluding erysipelas), paronychia or whitlow, and acute

exanthemata ; 11 per cent. comprised marked gastric dis-order, diarrhoea, and hasmatemesis from cirrhosis of the liver ;10 per cent. were cases of traumatic nature ; and 23 per cent.

were complicated with epilepsy. The remaining acute dis-orders provocative of delirium tremens were rare and

amounted altogether to 8 per cent. As regards the patho-genesis of the disease Dr. Bonhœffer inclines to the view

that it is of a toxic nature, the clinical form being usuallythat of acute hallucinatory mental confusion. He also

recognises distinct pathological changes in the nerve’cells ofthe cerebral cortex in fatal cases of delirium tremens, such as

chromatolysis, pigmentary degeneration, and vacuolation ofthe cells, intense capillary hyperæmia of the cortex with

minute haemorrhages into the grey substance, and a hyper-plasia of the neuroglia cells, as described by him in a recentpublication.l The clinical varieties of delirium tremens notedby him are the same as those observed by Evenson, to whichreference has already been made in these columns. 2

CLINICAL THERMOMETERS AND THE CASUALGERM.

A CORRESPONDENT has addressed us upon ground that

medical men are careless in cleansing their clinical thermo-meters. Thus, he says, they support the Christian Science"doctrine, which seems to us to pertain somewhat to thenature of a "bull," "that there are no germs, but doctorsbring them." Now we should be sorry to believe that this

patient’s experience is at all a common one. Often, he

declares, "the thermometer has been stuck in my mouth

and dropped back into the case again without a wipeor a wach." Anyone, he very reasonably adds, prefers’to see the thermometer washed before and after use.

This is no doubt the general practice ; there can, of

course, be no excuse in any amount of hurry for notat any rate placing the thermometer in water after use ardwiping it dry before returning it to its case. Elaborate

cleansing is not necessary, nor do we need what our corre-spondent appears to hanker after, any attempt at sterilisa-tion. The clinical thermometer is not an object that carriesgross dirt easily, and therefore water and a clean,towel after being used suffice to keep it in decentcondition. As regards microbic accompaniment, we mayallay our correspondent’s fears by assuring him that

any thermometer treated as we suggest will not add

materially to the microbes that already swarm within his

mouth. He is probably in blissful ignorance of the sapro-

phytic condition of his own mucous membrane, and the

comparative purity of a glass thermometer. Indeed, he is farmore likely to give than to receive in this instance, and if a

previous patient also conferred bacterial gifts upon the ther-mometer these are unlikely to have survived the intervening period between the two occasions when it was used. However,we perfectly sympathise with his protest, considering his

unpleasant, and, we trust, unique, experience. After pleadingfor cleanliness our correspondent concludes with the Jane-Austenian observation that "safety and sensibility alike

demand it." We can assure him that the medical pro-fession have no I I Pride and Prejudice " in a contrary opinion.It may also allay his apprehension to remember that notinfrequently medical men place the thermometer in the

axilla rather than in the mouth, although we believe thisto be on the whole a less trustworthy position for recordingthe body temperature, as the instrument is there affected

by conditions of perspiration, want of accurate contact, andpossibly clothing.

WE understand that the Secretary of State for India hassanctioned an increase of 26 oflicers to the Indian MedicalService. This will help to get over the difficulty about leave.

THE autumn dinner of the Edinburgh University Club,London, will be held on Wednesday, Nov. 13th, at theCriterion Restaurant. Professor John Chiene, C.B., M.D.,F.R C. S. Edin., will take the chair.

1 Monatschrift für Psychiatrie und Neurologie, 1899.2 THE LANCET, Sept. 16th, 1899, p. 793.

1063PROFESSOR VIRCHOW’S EIGHTIETH BIRTHDAY.

PROFESSOR VIRCHOW’S EIGHTIETHBIRTHDAY.

PROFESSOR VrRCHOW was born on Oct. 13th, 1821, at ISchievelbein, a village in Pomerania. In 1891 his seventieth

birthday was celebrated with much enthusiasm in Berlin,and now that he has reached the advanced age of 80 years in

the enjoyment of great mental vigour and an amount ofbodily energy unusual at his time of life, the anniversaryhas been attended by manifestations which in their

spontaneity and warmth leave no doubt as to the placewhich he holds in the hearts of his countrymen.Oct. 13th, 1901, was a Sunday. The celebrations beganon the previous day with a reception in the new Patho-

logical Institute in Berlin, where the company includedthe Minister of Education, Herr Studt ; the Chief of the

Imperial Chancellery, representing Count von Billow ; Baror.von Richthofen, the Foreign Secretary ; Count Posadowsky,the Secretary of State for the Interior ; Herr Moller, thePrussian Minister of Commerce; Herr von Thielen, theMinister of Communications ; Dr. von Leuthold, the GeneralStaff Surgeon of the Army ; Herr Kirschner, the ChiefBurgomaster of Berlin ; Dr. Langerhans, the President of theBerlin Municipal Council ; and very many representa-tives of German and foreign medical science. TheMinister of Education, Dr. STUDT, said that the name

of Virchow would be for ever associated with the Patho-

logical Institute, but in order that future generationsmight possess a likeness of its founder he, on behalf of the Ministry of Education, presented the institute with a marblebust of him. Professor VmcHow expressed his thanks incordial terms, and then proceeded to deliver an address onthe Development of Pathology and the special objects of theinstitution in which they were assembled. In conclusion,he claimed for pathology a place among the biologicalsciences. Various micro-organisms were then shown undermicroscopes and as lantern slides by Professor Koch andothers. At 6 P.M. Professor Virchow was entertained at abanquet held in one of the halls of the buildings where thePrussian Diet meets. The company included his wife andseveral other members of his family, eminent Germanand foreign men of science, and representatives of theGovernment. Count POSADOWSKY, the Imperial HomeSecretary, proposed the health of the German Emperor.Dr. KOERTE proposed the health of Professor Virchow,and Dr. ALTHOFF of the Ministry of Education presentedhim with his portrait showing him at the age of seven

years as well as with one of his school certificates. Thechief event of the celebration commenced at 8 P. M. in the

buildings used by the Prussian Chamber of Deputies andwas not concluded till long after midnight. This was the

presentation of addresses by German and foreign delegations.Professor WALDEYER, who presided and delivered an

eloquent address, said that a sum of 50,000 marks (E2500)had been collected for the purposes of the " Virchow Fund

"

for the promotion of scientific research. Dr. STUDT, thePrussian Minister of Education, then read a letter fromthe German Emperor to Professor Virchow, warmly con-

gratulating him on the anniversary of his birthday,and eulogising the great services which he had renderednot only to the scientific side of medicine but to its

practical application for the benefit of mankind. In

conclusion, the Emperor wrote that in recognition of his

distinguished labours he had that day conferred on

him the Grand Gold Medal for Science and now sent itto him. The Imperial Chancellor, Count von Biilow,also sent a letter of congratulation. The address of the

municipality of Berlin was presented by the Chairmanof the Municipal Council, Dr. LANGERHANS, who announcedthat the city had contributed 100,000 marks (£5000) tothe "Virchow Fund." The foreign delegates includedrepresentatives of medical science from Great Britain,France, Russia, Italy, Austria, and other countries. GreatBritain was represented by Lord Lister, who wore thePrussian Order Pour le Mérite ; Sir Felix Semon (RoyalCollege of Physicians of London) ; Mr. Howard Marsh(Royal College of Surgeons of England) ; Dr. RoseBradford (Royal Medical and Chirurgical Society andPathological Society of London) ; Mr. Watson Cheyne(Pathological Society of London) ; Professor Robert Muir

(University of Glasgow) ; and Dr. Graham Brown (RoyalCollege of Physicians of Edinburgh).Lord LISTgH, who spoke in English, and was welcomed

with hearty applause, said :-Revered master, I am hero as a delegate of the Royal Society of

London, oi’ which you are an honoured member, and on behalf ofwhich I have to present to you a loyal address. I have been also.requested to hand you addresses from six other societies which greatlyregret that it has been impossible for them to send special clelegates.They are as follows: (1) the Anthropological Section of theBritish Association for the Advancement of Science; (2) theUniversity of London; (3) the University of Edinburgh : (4) theFaculty of Physicians and Surgeons of Glasgow; (5) the Medical and’Chirurgical Society of Edinburgh ; (6) the Itoyal Academy of Medicineof Ireland. All these bodies join in the recognition of your giganticintellectual powers, in gratitude for the great benefits that you haveconferred upon humanity, and in admiration of your personal’character, your absolute uprightness, the courage which has enabledyou always to advocate what you believed to be the cause of truth,liberty, and justice, and the genial nature which has won for you thelove of all who know you. The astonishing vigour which you displayedin the address to which we listened to-day justices the hope that, whenmany of us your juniors shall have been removed from this scene oflabour, it may be granted to you to celebrate your ninetieth birthdaynot only in health and honour but in continued activity in the service-of mankind.

Sir FELIX SEMOX, who spoke in German, said :—

There are two reasons why I have been selected, dear master, taconvey to you the sincere congratulations of the Royal College ofPhysicians of London. In the first place, the authorities thought itmight be agreeable to you if the good wishes of the College wereexpressed 1)’v an old pupil who when he sat at your feet 30 years agoas a young German student did not suppose that he would one dayhave the honour of representing the venerable College in whose namehe now speaks. In the second place, the College selected a native of £

Germany as its spokesman from a desire to give prominence to thefraternal feeling which has so long existed between German andBritish scientific men and to express thereby their cordial recognitionof tlie beneficial influence which you have exercised upon science in.Great Britain no less than in Germany.His Excellency Dr. GUIDO BACCELLI. Minister of Agri-

culture in the Government of Italy, spoke in Latin asfollows :-

Qtio(I reipublicae medicae per orl)(,in bene vertat, et faustum Ger-maniae felixque sit, tibi, Rodulphe Virchowi hodie, Berolini in novis-simo propemoclum Scientiarum omnium Capitolio, supremi tribuunturhonores. Immortali igitur lauro, fronte tua redimita, neque splen-d idior humanae justitiae. neque jucundior nobis fulsit unquam dies-Quapropter in tanto doctissimorum virorum tibi plaudentium atque-gratulantium Senatu, et ego plaullens atque gratulans, quae per teItalia sentit, promere jubeor.Primnm tibi Victorii Emanuelis tertii, amatissimi Regis nostri,

nomine loquor. qui fortibus et bonis natus praestanti juventute florens-omnigenae virtutis fulgore, undecumque niteat, trahitur suapte natura.Deinde Ministrorum Regis Consilii nomine in quo praesertim et quimedicinam politicam hodie feliciter tuetur; et qui studiis Italici&ingcnio singulari praeest, volunt singulariter memorari.At supereminens omnes, Joseph Zanardellius, libertatis in lege

assertor invictus, Consilii Praesul, tibi gloriosissimo affert sua vota per’me. Et bene est: tu enim cunctis mirificam intulisti laetitiam,octagesimum annum natus. studiis laboribusque nunquam fractus.Quam vero doetrinam disciplinamque Anatomes pathologicae Joannes.

Baptista Morgagnius, felici ausu, primus in Italia instituit ac tradidit,tu singulari sapientia in Germania tua perfecisti, eoque egisti ut.

Magistrorum Magister jure voceris. Hoc Itali picturae traditumvoluere et ego hexametrum supra tabulam scripsi :

" Ut quos corda fovent, praesentes lumina spectent."Io, igitur, triurnphe, Rodulphe Virchowi; Nestoreos vive per annos,

incolumis florens, terque quaterque beatus. Vive, patriae tuae decuset lumen ; vive, humani generis praesidium, vive nationum omniuilladmiratio, vive Italiae amor, vive immortalis !

TRANSLATION.For the prosperity of the Republic of Medicine throughout the world

and for the best interests of Germany the highest honours are vouch-safed to thee, Rudolf Virchow, to-day in Berlin, where Science, inwell-nigh all her branches, holds her latest seat. No day has evershone with purer lustre for the cause of humanity, or with livelierpleasure for ourselves than this, which sees thy brow enwreathed withundying laurel. So amid the plaudits and congratulations of this

august concourse of the learned, I too join in applause and congratula-tions, conveying, on the mandate of Italy, the sentiments sheentertains towards thee.

I speak first in the name of our well-beloved King Victor Emmanuelthe Third who, sprung from brave and honourable ancestors, with thedew of his youth yet upon him, and radiant with the lustre of everymanly virtue, is drawn to thee by his own august nature. Next in thename of His Majesty’s Ministers, among whom, in particular, theMinister who happily presides over State Medicine, and his colleaguewho with rare skill superintends Italian Education, desire to beindividually commended to thee.But, above all, His Excellency Joseph Zanardelli, the indomitable

I vindicator of " Liberty within the Law," the Prime Minister of Italy,

conveys to thee his cordial good wishes through me. Appropriatelyso; for in thy eightieth year, with strength unimpaired by studiousresearch and by energetic action, thou inspirest us all with equalwonder and delight.In truth the theory and practice of pathological anatomy, first in

Italy imparted and diffused with happy initiative by John BaptistMorgagni, has by thee, in thy native Germany, been carried to suchrare perfection that thou hast justly earned the title of Master ofMasters. This achievement Italy desires to commemorate by thepainter’s art and I, on the picture, have ventured to inscribe thehexameter-" that the eye may behold him as present whom the heartcherishes."

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