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Norway went to support this. In Norway the people ate asmuch fish, salted and otherwise, as they formerly did, yetthe disease was disappearing. Since 1856 lepers had beenisolated, and at that time there were upwards of 2870 lepersin Norway. Since that time there had been a steadydecline in the number of cases until at the present timethere were only approximately 400 cases. In America noneof the Norwegian immigrants, of whom there were an

immense number, had developed leprosy and this provedthat the disease was not hereditary. As regards the portalof introduction, he was inclined to believe it was introducedthrough the skin, probably through an abrasion. The localirritation was very small and the rate of development wasvery slow.

Dr. GEORGE THIN, referring to Mr. Hutchinson’s paper,paid a high compliment to the painstaking inquiries of thatauthor. Dr. Thin referred to the case of leprosy broughtbefore the Medical Society of Dublin by Dr. J. HawtreyBenson in which the patient’s brother who had slept in thesame bed subsequently developed the disease. Mr. Hutchin-son had referred to this case as an unique example of directcontagion, but it was by no means an isolated instance, andDr. Thin mentioned other cases occurring in countries whereleprosy was not endemic which were undoubtedly due todirect infection. Turning to the theory of the conveyance byfood, this same idea had occurred to him when he wasin China, but it was not tenable. Dr. Thin did not believethat leprosy was due either to an excess or to a scarcityof nitrogenous food. The bacillus had been cultivated out-side the body by some Italian observers. It was necessaryto take the bacillus from a patient at a time of fever whenthe microbe was specially active. As to the history of

leprosy in South Africa and the first cases at Stellenboschreferred to by Mr. Hutchinson, he (Dr. Thin) did not think itunlikely that the disease might have been brought from thenorth or from the interior of Africa. The Royal Commissionon Leprosy had investigated the question and had reportedthat leprosy was propagated independently of fish or any kindof food. It was greatly to be regretted that no legislationhad been enacted for the segregation of lepers in India andnow that Mr. Hutchinson had adopted the view of its con-tagiousness Dr. Thin hoped that adequate measures of pre-vention would be carried out. Wherever a leper went leprosywas sure to arise.

Dr. PATRICK MANSON thought they knew little or nothingreally how leprosy was spread, though he entirely supportedthe view of its contagiousness. The disease was, he believed,analogous to tuberculosis. There was a very remarkable

similarity between the two bacilli, but in neither case couldit be proved exactly how the microbe was introduced. Hewould like to ask Mr. Tonkin whether the negroes of theSoudan in the Lake Chad district were in the habit of

eating fish. He agreed with Dr. Thin that neither a

deficiency of nitrogenous food as suggested by Mr. Tonkinnor the salt fish theory propounded by Mr. Hutchinsonwas tenable. Ainhum had no relation to leprosy. The

preliminary lesions of leprosy were by no means alwayssymmetrical and were not always associated with consti-tutional symptoms. He had been informed that the Dutchprisoners of war in Ceylon, in order to pass the time, had beentrying to cultivate the leprosy bacillus and after trying severalmedia they had at last succeeded in cultivating the bacilluson salt fish. He quite agreed with Dr. Thin’s remarks aboutthe necessity of legislation in India. As to the portal ofentrance, Mr. Tonkin’s suggestion about the clothes seemedextremely probable.

Sir WILLIAM KYNSEY had seen a great deal of leprosy inCeylon. Dried fish was used universally in Ceylon. It was

imported in very large quantities and it all went inland, butleprosy was confined to certain foci along the coast. Heasked if the leprosy contagium might not be contained inhuman milk ?

Sir T. LAUDER BRUNTON had been struck by the super-ficial resemblance of leprosy to syphilis, and when he hadcharge of the throat department of St. Bartholomew’s

Hospital he was struck by the resemblance between syphiliticlesions and those of leprosy. His opinion was that leprosyresembled other infectious diseases in this respect, that forthe development of the disease the microbe and a suitablesoil were both equally necessary. Professor Unna of Hamburghad suggested the free administration of hydrochloric acid,as much as 15 grammes per diem in cases of leprosy.Possibly this acted by rendering the blood acid or lessalkaline. The trimethylamine contained in the brine used

for curing fish was a strongly alkaline substance, and whenconsumed it possibly rendered the blood more alkaline thannormal and so acted detrimentally.

Dr. T. M. YOUNG had seen leprosy in Siberia, China, andother places. The motility of the bacillus when examinedunder the microscope suggested to his mind an analogybetween the leprous and malarial organisms. He had notfound that the leprosy bacillus was very common in the opensores of fishermen, and this did not support the view thatthe discharges of the ulcers were the source of contagion.His experience did not support the view that leprosy was inany way proportionate to the fish-eating habits of variouspeoples.

Dr. G. A. HERON regretted the abortive character of theLeprosy Commission. The conveyance of leprosy by saltfish was at present based purely on theory. Such questionsmust be settled in the laboratory. Why had not the bacillusbeen found in the salt fish ? He (Dr. Heron) entirely agreedwith the remarks of Dr. Thin and Dr. Manson. Certain facts

brought out in the inquiries of the Commission still remainedto be answered. For instance, in this report published in1891-92 it was shown that out of 464 lepers in India 99 hadnever tasted fish. In another batch of 200 46 had nevereaten fish. Altogether, there were in India 162 lepers whohad never taken fish.

Dr. A. P. HILLIER, in criticising Mr. Hutchinson’s paper,wished to ask a series of questions. For instance, was itonly salt fish which conveyed the disease ? and, if so, ought itnot also to be conveyed by fresh fish ? The fact that a leperstated that he had never seen other lepers was not one whichrecommended itself as an argument. Dr. Hillier mentionedthe case of a Dutchman in South Africa who contracted thedisease though he had never to his knowledge been anywherenear a leper. Later it was found that the Dutchman’sHottentot groom had been developing the disease without hisown or his master’s knowledge.

Mr. TONKIN, in reply, had never seen ainhum and

leprosy occurring together. As to fish, it was very seldomconsumed in Northern Nigeria and only in a very few tribeswas it customary. It was very difficult to find fish in themarkets of the natives. Fish was certainly a negligibleelement in the spread of the disease in the Soudan.Mr. HuTCHINSON, in his reply, remarked that the trans-

ference by food and contagion pure and simple were thetwo opposing theories. He was living daily in expectation

that the bacillus would be found in fish. This, of course,must be the crucial test of his theory. All the speakers hadpassed over the difficulties of the contagion theory.How was it that, in spite of the numerous attempts, thedisease had never been inoculated ? And yet some of those

, present had stated that scratches constituted the portal of. entry of the disease. The facts against the contagion hypo-

thesis were very strong. If a native’s statement that he hadnot been in contact with a leper could not be believed, so

also they could not trust his statement that he had not eaten fish. Mr. Hutchinson fully admitted the view of stomach; contagion," but whether the bacillus was actually in the fish.

or whether fish stimulated the bacillus to growth he couldl not say. He would not advise the shutting up of lepers.l Instructing them in hygienic principles would be preferable.l A paper by Mr. HASTINGS GILFORD, entitled ’’ An Account

; of a Disease which is Characterised by Conspicuous Delay in

; the Processes of Growth and Development (Ateleiosis)," was, read in abstract by the Secretary.

EPIDEMIOLOGICAL SOCIETY.

A Case of Supposed Haemorrhagic Small-pox.-Syphilisamong a Community of Khonds.

A MEETING of this society was held on May 30th, Mr.SHIRLEY F. MURPHY being in the chair.Papers were read by Mr. SHIRLEY MURPHY and Dr.

E. KLEiN on an obscure case supposed to have been oneof Hxmorrhagic Small-pox in the person of a nurse froma home near the Strand which was reported after death toMr. Shirley Murphy by Sir Hugh R. Beevor, but which had inhis absence been attended by Dr. F. Spicer. The patienthad for three weeks preceding her illness been nursing theproprietor of a restaurant in an adjoining street who wassuffering from acute rheumatism, but together with the othernurse in attendance she had slept and taken her meals at the

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home, there being no accommodation at the house of thepatient. The house was also in such an insanitary con-dition that neither they nor the cooks could eat on

the premises, which swarmed with rats. There beinga suspicion that the case might be one of plague a post-mortem examination was made about 12 hours after deathby Dr. W. H. Hamer and Dr. Young, assistant medicalofficers of health of the County of London, in the presence ofMr. Shirley Murphy, Dr. F. J. Allan, medical officer ofhealth of the City of Westminster, and Dr. Klein whotook specimens of the blood from the right ventricle andsections of the petechias for bacteriological and micro-

scopical investigation. Dr. Spicer reported that she hadbeen taken ill on Dec. 5th, 1901, and that she went to thehome on the next dav. He was not called in until the

evening of the 7th when he found her to be suffering fromall the symptoms of an acute malignant fever like typhusfever and complaining of severe general pain. There werebile staining of the conjunctivas, a peculiar dusky flush of theface, with puffiness extending over the scalp and neck as faras the clavicles, and here and there a hasmorrhagic spot. Onthe front of the chest there was a faint rash like that of earlyscarlet fever or measles, but there were no petechiae or

papules though it was the fourth day of the disease. The

ears, the nose, and the throat were normal. On the 8th shewas evidently moribund and semi-comatose ; the conjunctivaswere of a deep yellow with haemorrhages, the duskiness,now deep brown, extending over the whole trunk which wascovered with haemorrhagic spots, those on the limbs

resembling the rash of typhus fever. She died at 4 A. M.on the 9th, her temperature having five hours previouslyfallen from 104° to 98° F. Dr. Hamer described the

post-mortem appearances as a purpuric eruption from

pin-point petechiae to blotches of the size of a split-pea,especially marked over a triangular area with its base at thelevel of the umbilicus and its apex at the pubes, chains ofpetechiae extending to the axillae and others grouped on thethe arms and the thighs. There were conjunctival haemor-rhages and petechiae on the pericardium, the sac containingseveral ounces of fluid. The appearances of the eruption andof the conjunctivae were, in his opinion, characteristic of

hasmorrhagic small-pox and resembled those of many casesobserved by Mr. Shirley Murphy in the epidemic of 1871.There was, however, no evidence that the patient had beendirectly exposed to infection, though there were at the timemany cases of small-pox in the neighbourhood of the Strandand Drury-lane, and two nurses, friends of the deceased,had been engaged at the hospital ships for the purpose of

gaining acquaintance with that disease. One went to the

ships on Sept. 2nd and passing to the shelter on Nov. 23rd re-turned to the home on the 27th ; the other went on Sept. 23rdand having returned remained at the home from Nov. 23rdto the 27th and then went back to the ships. Whetherthe patient contracted the infection through either of thesewas not known, but the incubation period would have beennot over seven days in the one case and not over 11 days inthe other. On Nov. 13th she had gone to visit a friend

suffering from enteric fever at Gravesend, but there hadbeen no illness among the nurses during the year and noneof them had recently attended any infectious case. As a pre-caution all persons with whom she had been associated werevaccinated on the evening after her death.-Dr. KLEIN thengave an account of his bacteriological examination of theblood illustrated by lantern slides. Film specimens and, betterstill, plate cultures showed (1) the- diplococcus pneumoniaein abundance and (2) a few individuals or colonies of a

hitherto undescribed bipolar bacillus, morphologically closelyresembling that of plague but wholly different in the cultureappearances, which were not unlike those of Friedliinder’sbacillus. It was virulent to mice subcutaneously and toguinea-pigs intra-peritoneally only, but not at all to rats.From the slime with which it was surrounded he suggestedthe name of "bacillus myxoides." In the absence of anyevidence of small-pox infection he considered the presence ofthe two pathogenic bacteria-indeed, that of the enormousnumbers of the diplococcus pneumoniae—sufficient to accountfor all the phenomena of the case. Again, sections of the skinshowed haemorrhages into the lymph channels and corium withpneumococci, but no trace of the changes in the epidermis orof the formation of loculi characteristic of variola, thoughthe fourth day of the disease had been already reached. Asa bacteriologist and microscopist only he was by no meansinclined to the diagnosis of small-pox.-Sir HUGH BEEVOR

insisted on the highly insanitary state of the house in favour

of a septic causation, and pointed to the fact that the vacci.nations of the nurses had been performed too late ; yet,intensely infectious as hasmorrhagic small-pox was, no onehad been attacked, though many of them had not been vacci-nated for 15, 20, or more years.-Dr. SPICER was also doubtfuland he called attention to the black vomit, the bloody stools,and the vaginal discharge.-Dr. HAMER, who believed thatthe case was one of haemorrhagic small-pox, attached littleimportance to the non-appearance of the eruption and Dr.E. F. WILLOUGHBY agreed, though he doubted the correct-ness of the diagnosis, and referred to a case that came underhis notice in 1870 or 1871, in which after eight days, duringwhich it had been taken for one of acute meningitis, theappearance of a copious eruption, all but confluent, was

followed by relief of all the symptoms.-Dr. E. W. GOODALLsaw nothing in the phenomena inconsistent with the

diagnosis, but he believed that many cases so regarded weresimply mixed septic infection.-Dr. H. T. BULSTRODE

thought that this case resembled those of haomorrhagic plaguedescribed by Bogden, but Dr. H. Meredith Richards objectedthat the distribution of the eruption in the three cases of

haemorrhagic plague that he had’ seen was quite differentfrom that in those of haemorrhagic small-pox, though in theformer death occurred before any adenitis appeared and in thelatter before the few papules had time to become pustular.The only difficulty to him was that so infectious a disease ashasmorrhagic small-pox had not spread.-Staff SurgeonW. E. HOME, R.N., and Mr. J. S. C. ELKINGTON referredin like terms to cases of hasmorrhagic small-pox and plaguerespectively that they had met with in the East.-Dr. KLEINcould not agree with M. Maurice that haemorrhagic small-poxwas essentially the product of a mixed infection, though headmitted that a number of various bacteria were present inall cases of small-pox and that there were malignant feversdue entirely to mixed infections in which, as in this case,pneumococci predominated.Captain LEONARD ROGERS, I.M.S., sent a contribution

which was taken as read, on an Outbreak of Syphilis ina small isolated community of Khonds, among whom it

appeared to have been introduced about 20 years agofrom the town of Sonpur, some 30 miles distant, andto have spread unchecked by medical treatment ofany kind and favoured by their low standard ofmorals, overcrowding, and want of cleanliness until thetime that the famine operations brought this obscuretribe under the notice of the authorities. More than half thepopulation of both sexes and all ages were found to be suffer-ing from the disease and its consequences in every stage,from the primary infection to the remotest tertiary symptomsand in either the acquired or the congenital form. Besidesthose sequelae known but now rarely seen in Europe, ulcersand fissures in the horny soles of their bare feet were veryfrequent, especially among the men ; and though the lower-ing of their vitality by famine might have aggravated thesymptoms and led to the frightful mortality, there had beenno evidence of any tendency in the disease to die out.

DERMATOLOGICAL SOCIETY OF LONDON.

Exhibition of Cases.A MEETING of this society was held on May 14th, Dr. J. J.

PRINGLE being in the chair, when the following cases ofinterest were shown.

Mr. MALCOLM A. MORRIS brought forward a girl, agednine and a half years, who was becoming progressivelydisfigured by the appearance of numerous Telangiectases allover the face. There was no deformity resembling truenaevus on any part of the skin and in addition to the dis-figurement it could only be noted that she had rather a feebleperipheral circulation and showed mottled pigmentation ofthe skin on the legs. The changes in the face were stated tohave commenced at three years of age and had beenspreading steadily since then. The question of treatmentby electrolysis or other means was discussed, but it was feltthat the difficulties in the case rendered the prospect of agood result very uncertain.

Mr. MORRIS also brought forward a young woman

who was afflicted with an extraordinarily extensive Pig-mented Mole on the Back and peculiar changes on the

right arm. The pigmented mole on the back occupiedpractically the whole of the left side of the trunk. It was

little raised, showed deep pigmentation, and a slight amount