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furnished by the State, whilst the wards for infectious B- diseases belonging to the hospital are to be placed at the disposal of Professor Koch by the municipal authority. Thisarrangement was strongly supported by Professor Virchow,who is a town councillor, and it will undoubtedly havethe approval of the medical men of Berlin, anxious as they s

are not to lose so celebrated a savant as Professor Koch. dI

The Administration of Ovarian Substance for Climacteric lTroubles. h

Professor Landau has been treating climacteric troubles by c

the administration of ovarian substance, and an account of this work has been published by his assistant, Dr. Mainzer. t

The remedy was used not only in pains due to the natural 1-climacteric period, but also in the case of women whose <

ovaries had been removed by operation, in amenorrhoea’from prolonged lactation, and in hysterical subjects. The (

patients who had reached the climacteric age complained (

principally of sensations of fulness in the head, occurring ]

,many times during the day, pains in the back and legs, &c. The dose varied from a gramme to a gramme and a half (from fifteen to twenty-two grains) administered in the formof tablets containing each half a gramme of the ovaries of pigs or cows. After two or three days the sensations of fulness in the head were said by the women to be much less frequent;within a fortnight they had almost totally disappeared.To avoid the influence of suggestion tablets containing noneof the substance were given from time to time, but thesymptoms immediately reappeared and the patients feltworse. The effect, however, lasted only while the ovariansubstance was being taken ; and when it was discontinuedthe symptoms returned after a time. A remarkable effectof the treatment was that in two cases of amenorrhoea it pro-. duced a sanguineous discharge from the genital organs. Pro-fessor Landau believes that disorders of the vasomotor system’due to extirpation of the uterus or ovaries or to the approachof the climacteric period are benefited by the administrationof ovarian substance, that its emmenagogue properties, if

- any, require further investigation, although it acts as a

palliative in primary and secondary amenorrhoea, that itsgood effects are only temporary, and that in general neur-asthenia or hysteria it is inert.,June 29th.

ROME.(FROM OUR OWN CORRESPONDENT.)

The Maragliano Serum in Tuberculosis. AN authentic, well-certified case of treatment of tuber-

culosis by the Maragliano method comes from Spezia. Anative of that seaport, Edilio Mercenaro by name and anable seaman by occupation, bad since 1893 been sufferingfrom phthisical symptoms, and on examination was found to,have both pulmonary apices infiltrated with tubercle. Thedisease was not largely diffused, but it made steady progress,and by the beginning of 1894 the area of destroyed tissuewas considerably increased. Both lungs were very seriouslyaffected and Mercenaro (a young man twenty-one yearsof age) was placed under Professor Maragliano’s treatment inthe clinical wards of the Genoa Hospital. The injection ofthe serum was practised continuously for two months till theclose of Professor Maragliano’s summer course, by whichtime Mercenaro had so far improved as to return to hisnative place. Convinced of the benefit he had receivedhe returned to the ward as a patient in the Novemberof the same year and was once more subjected, under Pro-,fessor Maragliano’s eye, to the serum treatment. The case,though the progress of the malady had been arrested, wasstill a very serious one, and it was not till the close of July,1895&mdash;eight months from the resumption of the treatment-that substantial cure was effected. Several hundred injec-tions had been practised, and in the latter weeks of thetreatment it was evident that Mercenaro was conquering themalady ’ hand over hand." He left the hospital at the endof July, as has been said, absolutely cured, and since ’,,then has for six months been regularly on duty in theservice of the Royal navy. At present he is at Spezia, theobject of no little professional interest, and described by the’-physician who last saw him as &deg;&deg; sano come pesce " (sound asa roach). Professor Maragliano has no severer critics than<among his compatriots, chiefly of the Neapolitan school.

But it is fair to add that even in that quarter testimony infavour of his treatment is gaining in volume and authority.

Lightning-stroke.The thunderstorms that for the last few days have visited

so many of the Italian provinces have done very seriousdamage to property and occasioned much loss of life. TheLigurian seaboard has suffered exceptionally. " Balllightning (the ficlmen globulare of the older meteorologists)has been witnessed several times, the most dangerous anddestructive, fortunately the rarest, form which the thunder-bolt" is known to assume. Providentially, however, it hasthis year numbered no victim in Italy. But the ordinarylightning-stroke has caused much loss of life, to say nothingof many grave lesions more or less permanent. Four

, fatalities are reported from the recent thunderstorm atGenoa, all instantaneous ; and at Ventimiglia in the sacristryof a church where six priests were assembled four were

r killed outright and the two survivors are in a desperate con-dition. As a rule lightning-stroke is most common in the

E open air, generally under the tree to which the victim1 has resorted for shelter, and this circumstance, even

s where only severe injury has been sustained, makesdeath more likely, as the measures for relieving shock and

. restoring the vital energies cannot be put in practice till too:

late. But this year the majority of fatalities from lightning3 have occurred in dwelling-houses. There is no doubt thate for this greater frequency of thunderstorms, as for the moret prolonged drought and such like meteorological visitations ofnlatter years, the steady tree-felling, unbalanced by tree-I planting, is directly responsible. In his memorable plea,t "Pro bilvis," the late Professor Cantani, one of Italy’s

greatest physicians, pointed out the disasters-hygienic,agricultural, and social-to which the kingdom was becoming

n a prey from the reckless diminution of forest areas on itsh surface. Re-afforesting the denuded hillsides is, of course,n the remedy, but year by year this becomes more imprac-if ticable, as the torrential rains, consequent on the disappear-a ance of the woods, wash away the binding soil in which;s young trees can take root and leave nothing but ther- bare rock. Those who can recall Monte Gennaro (the

Lucretilis of Horace) as it was in the early forties speak of" waving woods" where now the limestone is all too visible,with resulting loss of summer coolness and increase ofautumnal rains. Professor Cantani 1 lamented the inadequateprovisions for preventing the fatal tree-felling so prevalentall over Italy. True, there are forestal inspectors who patrolthe wooded districts and keep an eye on the destruction oftimber; but as these officials (like nearly all others in

Italy) are miserably underpaid their duty is performed per-functorily, sometimes not at all. Steps, however, must ere

;r- long be taken to remedy this state of things in the peninsulaand islands, as the atmospheric disturbances it causes-an taking the form of lightning disasters, hail-storms, and pro-]g tracted drought alternating with excessive rainfall-areto pressing more and more heavily on a people terribly over-he taxed and becoming yearly less able to withstand the priva-!s tions and misery which the disastrous weather of the last tenue days has already brought in its train.ly June 27th.

________________!.rN -&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;&mdash;-

EGYPT.(FROM OUR OWN CORRESPONDENT.)

; C7tolera Bulletins in Egypt.IN Alexandria the daily cases newly reported still vary

from two to four, while in Cairo there are also droppingcases every day in various quarters of the town, the returnshaving varied during the past week from five to eight. It is

only the deaths and the serious cases which are discoveredby the medical men; the light cases as a rule go aboutunknown to themselves and are capable of transmittingindefinitely the disease. Excluding Cairo and Alexandriawe have an average of 148 new cases daily in the rest ofEgypt from the sea coast up to Assouan. The chief numberof towns and villages attacked is in the Delta, notably atDessouk in the Gharbiyeh province, but no less than339 cases have been reported during the week from theprovince of Fayoum in Upper Egypt. This special con-centration of the cholera at two places makes one fear that

1 Vide THE LANCET, Oct. 13th, 1894, pp. 861-2.

63

the general water-supply of Dessouk and the Fayoum provinceis perhaps contaminated. Surgeon-Captain Graham is doingall that is possible in the Fayoum province and RogersPasha is now inspecting there also. The whole number ofcholera cases since October has now reached 5639, and ofthese 4668 have died.

Presence of Cholera Bacilli in apparently Haalthy People.It was during the Hamburg epidemic that German

observers pointed out that a man apparently well andat his usual vocations might yet contain the comma bacilliin his intestines and be a potent means for spreading thedisease. Several cases confirmatory of this have been seenin Cairo this month, and there are now two men in one ofthe cholera hospitals who were sent there on suspicion fromdifferent villages because each of them was seen to vomitonce by a native medical man searching for cholera. Theyboth looked extremely well and complained bitterly at havingbeen brought to hospital among a lot of dying folk. Bothdenied all diarrhoea and previous vomiting, but the stoolsshowed unmistakable bacilli and continued in both cases toshow them a week after admission to hospital. There are

many things yet to be learned about this fell disease.Cholera in the Army of Occupation.

There have now been four cases, all fatal, among theBritish troops, and all have had the same history, though,curiously enough, the patients themselves have been mostreluctant to give any information. They have been employedat headquarters or on military police duty, and just beforetheir fatal illness each of them is known to have spent somehours drinking in the native bazaars. The troops in barracks,forbidden to visit native grog-shops, and furnished withPasteurized drinking-water and sterilised soda-water, have sofar escaped the disease. In 1883 the epidemic attacked thesoldiers in both their hospitals and in the Citadel andKasr el Nil barracks. Among the Cairo troops there were179 cases, of which 130 proved fatal. But the mistake madeupon that occasion was that instead of fighting the diseaseon the spot the authorities adopted the old Indian methodof running away from it. In nearly every case the troopsmoved into cholera camps at a distance for the purpose ofavoiding cholera and yet succeeded in carrying it with them.

Cairo, June 24th.

NEW YORK.(FROM OUR OWN CORRESPONDENT.)

Semi-centennial Anniversary of the American MedicalAssociation.

THE American Medical Association was organised in theyear 1847 and hence its semi-centennial anniversary willoccur next year. Its first session was held at Philadelphia,and it is proposed to hold the meeting of next year at thatcity, with suitable ceremonies. The founder of the Associa-tion was Dr. N. S. Davis, now of Chicago, but then a countrypractitioner in the interior of the State of New York. Dr.Davis is still an active man and has always attended themeetings of the Association and been its guide and faithfulcounsellor in all its varied history. The Association has alarger influence upon the profession than any and all othermedical organisations in this country. It combines the scien- ’’,tific and social elements in such manner as to attract all ’,classes and render its annual meetings extremely popular.Perhaps its most important work has been in connexion withmedical education. This subject has always been foremostin its discussions, and by a paternal influence with the schoolsit has in many ways raised the standard of respectability ofthe profession over the entire country. It is to be hoped thatthis anniversary will be an era in its history.

Title of Army Medical Officers.The Surgeon-General of the United States Army thus defines

the customary title of Army Medical Officers. "Medicalofficers of the army are commissioned as assistant surgeonswith the rank of first lieutenant, assistant surgeons with therank of captain, surgeons with the rank of major, deputysurgeons-general with the rank of lieutenant-colonel, andassistant surgeons-general with the rank of colonel. In allofficial communications they are addressed according to thesedesignations. It is customary in social intercourse to address

# medical officers by their professional title, and in my judg-ment there is no objection to this form of address. Some of

our medical officers, however, insist upon being called bytheir military titles. This is in accordance with the usage inother staff corps. There seems to be no question as to thepropriety of addressing a paymaster or a commissary or anadjutant-general by his military title ; but in the case of amedical officer, upon whom the degree of doctor of medicinehas been duly conferred, it would appear that in social andprofessional intercourse this title should have the pre-ference."

The Marine Hospital Service.The Marine Hospital Service is among the oldest branches

of the public service. It was created in 1797 in imitation ofthe British marine service for the benefit of the sick sailorsof the merchant marine. Its organisation is very perfect andit attracts the most promising of the recent medicalgraduates. Candidates are required to be not less thantwenty-one years of age, and no appointment is made of anycandidate over thirty years of age. They must be graduatesof a reputable medical college and furnish testimonials as tocharacter. Successful candidates having made the requiredgrade are appointed in order of merit as vacancies arise

during the succeeding year. There is at present one

vacancy. A successful candidate, when recommendedfor appointment, is commissioned by the President ofthe United States as an assistant surgeon. After four

years of service and a second examination he is entitledto promotion to the grade of passed assistant surgeon;and to the rank of surgeon, according to priority, on theoccurrence of vacancies in that grade. The salary of anassistant surgeon is$1600 per annum, together with furnishedquarters, light, and fuel ; that of a passed assistant surgeon,$1800 per annum ; and that of a surgeon,$2500 per annum.In addition to the above salaries, after five years of servicean additional compensation of 10 per cent. of the annualsalary for each five years of service is allowed medicalofficers above the rank of assistant surgeons, the maximumrate, however, not to exceed 40 per cent. When an officer ison duty at a station where there are no quarters furnished bythe Government commutation of quarters is allowed at therate of$30 per month for an assistant surgeon,$40 for apassed assistant surgeon, and$50 for a surgeon. Thesuccessful candidates, after receiving appointments, are

usually ordered to one of the larger stations for training intheir duties.

Relations of Medical Examining Boards.Most of the States now have medical examining boards

before which all persons proposing to practise medicinemust appear and submit their qualifications under the lawand obtain licences. In general such applicants are

examined as to their educational qualifications, and it nowappears that in the different States there are differentstandards, and the question has arisen, Shall the licencegranted in one State be received in all the other States asprim&acirc; facie evidence that its possessor is a qualifiedphysician ? At a recent meeting of the National Confedera-tion of State Medical Examining Boards it was proposedthat all of the States should establish a common minimumlevel of requirements below which a physician should not bepermitted to practise. Then a State licence would possessequal value in all of the States. Until all standards areequalised and the lowest brought up to the level of thehighest, inter-State courtesy by official endorsement oflicences should not be required or expected.

Prevention of Contagious Diseases on Railways.The Medico-Legal Society of New York is agitating the

question of requiring railway companies to make stringentregulations in regard to the transportation of contagiousdiseases. It regards the sleeping car as the point of greatestdanger, and urges that compartments which have beenoccupied by a consumptive, or person sick of any contagiousdisease, shall not be occupied until it has been thoroughlydisinfected. As preventive measures the society recommends(1) education of the public through the daily press; (2) legis-lation, state and national; (3) isolation of passengers ; and(4) disinfection of berths and compartments.

Expos2cre of Food to Dnst.The progress of sanitary administration in this country is

well illustrated by the following circular of the health officerof the State of Indiana to the county health officers of theState: "In many cities and towns it is the custom of grocers,butchers, and other vendors of food to expose their goods infront of their shops and stores. Butchers very frequently