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the population of Europe, and that the Opposition in

England might not fail to attack the Ministry on theviolence of their conduct towards us." 2 A consideration ofthese sordid political schemes is necessary for a right under-standing of the circumstances of Napoleon’s last illness. On

the one side were his staff and political sympathisers inFrance and elsewhere whose aim was to make out that his

illness arose entirely from the climate of St. Helena. On

the other were the British Government and the Allies whose

aim was to support the view that Napoleon was in goodhealth and was enjoying the " salubrious climate " as far aswas compatible with his position. Napoleon’s own medicalattendants, O’Meara and Antommarchi, diagnosed I liver com-p’aint "-i.e., hepatitis-while Arnott, medical representativeof the British Government at Longwood, said that the diseasewas merely hypochondriasis, and this only eight days beforeNapoleon became moribund. What he really thought willprobably never be known, though it is believed, says Dr.

Chaplin, that the MS. notes of his daily attendance are stillin existence. The post-mortem examination clearly showedthat an extensive malignant growth of the stomach was

present, probably starting from a previously existing chroniculcer. Dr. Chaplin has worked out the history of the casewith great care, and his little book is certainly a valuableaddition to the already vast Napoleonic literature ; althoughhis interpretations of the clinical and pathological datado not accord with those given by Professor Arthur Keithin an interesting communication to the Hunterian Societyof London on Jan. 8th, which will be published in ournext issue. Napoleon was so great a man that even thesmallest details concerning him are of interest, andthe tragedy of his life, the rise from obscurity toworld-wide fame, the fall from the heights of glory .to petty political intrigues and to a death full of pain,weariness, and sorrow is over-full of romance : even the

spots on the sun of his career must always hold the attention.

VACCINE TREATMENT IN PNEUMONIA.

THE current number of the Journal of Vaccine Therapy isthe first of the second volume, and appears under the editor-’

ship of Dr. W. D’Este Emery. It contains an interesting,article upon Vaccine Treatment in Pneumonia, contributed bythe former editor, in the course of which Dr. R. W. Allen, aftersome general observations upon the etiology and baoterio-logy of pneumonia, briefly reviews the pathology of thedisease in its relation to vaccine therapy. iFle affirms his

conviction that in the United Kingdom the percentage ofcases in which pneumococoi persist in the lung after merelycausing an acute bronchial catarrh is very -much -greater thanis commonly imagined and that their presence there is

fraught with danger. In other words, he regards acute

pneumonia as an exacerbation in a chronic infection ofthe bronchial or pulmonary tissues, whether due to the

pneumoeoccus, bacillus influenzæ, streptococcus or bacillus

of Fridländer. Dr. Allen urges the view that no case of

respiratory catarrh due to any of these organisms is

to be regarded as cured so long as there is any

sputum in which the organism can be discovered or

as long as any physical -signs persist in the chest,and maintains that treatment ’by vaccines should be con-tinued until complete disappearance of the infection, if

possible. He admits that at present this end cannot always’be attained, and in this .event he advises that the patient’simmunity should be maintained by repeated short courses ofvaccine therapy. In regard to the use of vaccines in the

course of an attack of acute pneumonia Dr. Allen suggeststhat in the earliest stages of the disease, when the micro-

2 J. H. Rose: Life of Napoleon I., vol. ii., p. 553.

n organism is in the blood stream rather than in the lung, theadministration of the appropriate vaccine in adequate doses

)f is of great value in a very considerable percentage of cases,r- whereas during the period of consolidation, when the micro-n organisms are actively multiplying in the lung tissue itself,n the vaccine is only,indirectly of service in supplying extrais immune bodies to be utilised when the process of resolution

n has begun. Vaccines also afford assistance if resolution be

delayed. Dr. Allen further insists on the importance ofd the nature of the vaccine and the use of adequate,s doses. As might have been expected, an autogenous

vaccine is preferable, but a stock polyvalent vaccinet- of proved immunising powers may be used to com-

e menee with, if the bacteriological cause of the pneu-e, monia has been established. The general directionse ’ given in regard to dosage with pneumococcal vaccines are 11 that a dose of not less than 25 millions of a polyvalent stock" vaccine should be given immediately, and that if there is no-.1 definite response within 36 to 4S hours the dose should be1 repeated, or, preferably, a similar dose of an au,togenouss vaccine given. If there is still no response twice the doseo should be given in from 36 to 48 hours, but if there is a

e response further reinoculation should be deferred for threee days, when it should be carried out at intervals of three or

four days until the patient is well. Dr. Allen then reviewsthe published results of a number of different observers, and

2 coneludes that the evidence ia sufficient to warrant giving ar fair trial to vaccine treatment in cases of pneumonia.

INTRACAPSULAR EXTRACTION OF CATARACT.DURING the last few years there has been a continued

discussion on the operation for removal of cataract. The

usual method of removal after the incision of the capsule’ has been largely given up in some parts of India, where the

operators deal with more cataracts in a week than mostEnglish ophthalmic surgeons in a year, and has been replacedby the expression of the lens- in its capsule. The chief

exponent of this method, Colonel H. Smith, of the Indian

; Medical Service, has operated on a number of cases which,

seems almost fabulous to us in England. It has for themost part been recognised that the operation has many

advantages, but the force necessary to expel the lens is

-sufficient in all but very expert hands to. expel vitreous also,and even in Colonel Smith’s -first records the number of theseaccidents was excessive. It was further felt that details of

’the results were lacking, and therefore it was impossible tocompare the results obtained by him and by the British

ophthalmologists. This last objection has been to a

large extent dispelled by the publication by Colonel Smithin the Indian Medical Gazette of the visual acuity in a seriesof cases. This series shows a very high average. Even

taking into consideration the fact (which other observers haverecorded) that in the clear atmosphere of India the visualacuity is probably 25 per cent. higher than in England,it is probably as good as that obtained by any other-surgeon by any ’method. Colonel Smith may be justlyproud of his results. The question of priority is of little

importance, but it is only just to a great name to recallthat Pagenstecher advised the removal of the lens in its

capsule after an iridectomy by pressure, and that his scoopwas intended to be a secondary instrument only for use afterpressure had failed. This has been forgotten by manyophthalmic surgeons, but it appears quite clearly in

Brudenell Carter’s book on 11 Diseases of the Eye"; here(p. 406) Mr. Carter follows the teaching of Pagenstecherto some extent, though he does not appro-ve of the scoop, forhe -says that it is always worth while, in cases of perfectlymature cataract in old people, in whom clinical experiencehad taught him to expect to find the capsule resistant and

117

the zonule weak, ’’ to make the external wound rather longerthan usual, and after the iridectomy to- see whether the lensand capsule cannot both be extruded by gentle pressure. If

this can be done the eye is left in the best possible state forthe rapid and perfect umion of the incision." Mr. Carter’s

pupils at least knew and* used this method. But this ispurely historical, and there can be no doubt that the opera-tion of which Colonel Smith is so justly proud, and for whichlie makes so high claim), is his own device, suggested by thefact that certain patients expressed their own Lenses at an earlystage of the common operation, with little iparm to themselves ;and the details of this method are solely due to Colonel Smith.The reasons for the cautiousness in undertaking ColonelSmith’s operation, which has been shown by the majorityof ophthalmic surgeons, are probably to be sought in severaldirections. First, there is the innate conservatism of allmen who know that they have an instrument which hasanswered their purpose well for many years. There can be

little doubt that the large majority of cataract operations,’

as ordinarily performed, are successful. Then Colonel Smith’swritings, and those of ’his followers, suggest that it is-

inadvisable for any one to try to follow him who cannotspare the time to go to the Punjab and practise under hisdirection. Ma jor G. T. Birdwood, I.M.S., has told us thatafter doing the operation, from a written- description, some300 times, he gave it up, and found later that he was notreally doing it in accordance with Colonel Smith’s procedure.Lastly, the records of the followers have usually shown alarge percentage of vitreous losses, and this accident Britishophthalmic surgeons are accustomed-wrongly, as- Colonel

Smith holds-to regard as very dangerous. There can belittle doubt that removal of the lens in the capsule is, as-has been laid dewn in various text-books’ of ophthalmicsurgery, a very desirable mode of dealing with cataract,but it is doubtful whether the forcible rupture of the zonuleentailed by Colonel Smith’s operation is the best way of

bringing this about ; and it has always seemed to be moresurgical to expect that in the future ophthalmologists willremove the lens in its capsule, having first, by some methodsuch as that described by Gradenigo, and’ more recentlyindependently by Captain V. B. Nesfield, I.M.S.,1 incised’the suspensory ligament of the lens.

FUNCTIONS OF THE PINEAL BODY.

A REVIEW of our knowledge of the pineal body by Dr.Leonard J. Kidd is published in the Medical Chronicle forDecember, 1912. Comparative anatomy does not throw anyvery clear light on the nature of this organ, but in birds ithas a definitely secretory structure, and the same appearancesare seen in young mammals and in cercopithecus. It con-

tains a large amount of neuroglial tissue and a number ofspecial pineal cells with granular protoplasm. The granulesmay possibly represent an internal secretion. The giand; ifit may be so called, seems to undergo some involution inadult life, the process apparently starting at about the seventhyear, but even in the aged it appears to perform some func--tion, and not to be merely a surviving remnant like theremains of the thymus. Clinical research has been devoted

- chiefly to tumours of the pineal body, of which about

65 cases are recorded. Of these approximately 10 percent. have exhibited symptoms of nutritional change, themost typical being precocity of the genital apparatus-and also to some extent of the mental powers, andmarked adiposity. It has been suggested’that the former is--associated with defect of the pineal secretion, the latter withexcess of it, while total absence may give rise to .a peculiarform of cachexia. From the cases quoted in the review

1 IndIan Medical Gazette, 1911.

before us it would seem that the genital disturbance alwaysoccurred in boys, the only case recorded in a girl showingexcessive adiposity. Experimental researches on the effectsof extracts of the pineal body tend to show that it acts as adiuretic, dilating the renal vessels, and also as a galactagogue.Complete operative extirpation of the gland is not feasible,so that the effeots of ablation cannot be accurately ascer-

: trained, but removal in fowls is said to lead to premature’ manifestations of sexual desire. There seems to be some

antagonism between the pineal and the pituitary bodies, as removal o-t the testicles leads to atrophy of the pineal and tohypertrophy of the pituitary. Dr. Kidd concludes that the

pineal body possesses two separate functions, the first beinga property of restraining the development of the sexual

apparatus and ceasing at puberty, and the second an unknowninfluence exerted on the general metabolism of the body and!1 continuing throughout life.

____

DECEMBER AT HOME AND ABROAD.

NOVEMBER’ was very mild in this country, but December,in relation to its normal temperature, was much milder.

’For about half the period the thermometer recorded readings.between 7° and 9° above the’ December average over a largeportion of the kingdom, and the mean warmth for the

: month as a whole was 5° or 6° above. As generally occurs! with mild weather in winter there were frequent rains andsome very violent wind storms from the south and south-

west, veering to west. The storms which raged about! Christmas- time on the coasts of these islands- and far out on! the Atlantic were of exceptional violence. In the metropolitanarea there was little variation in the temperature, althoughthe central districts- were somewhat milder both during theday and night than the outlying suburbs. At Kew

Observatory the shaded thermometer rose to 500 F. or aboveon 19 days, and the mean maximum for the month wasa fraction’ over 500, while the mean minimum temperature-was 400. The corresponding average figures for December-are no higher than 440 and 35°. At Bath the mean,

maximum and the mean minimum were both 50 above the-normal, the figures being 510 and 390, and in the Midlands,.’as represented’ by Nottingham, the excess of warmth’ was

,almost identical. On the extreme south-west coast and the

small islands the difference from the average was, not so

marked. At Scilly both the days- and nights were 2° warmer

than the normal, and at Jersey 3° warmer. The nights atScilly, and also- at Newquay, were milder than at Jersey.Most’ days brought more or less rain, but the aggregate fallwas not, over the country generally, greatly in excess- of the-normal. At Kew the figure was- Zv 66 itiL, against an’ averageof 2.09 in., and at Nottingham 3’4 in., an excess of 1 - I in.In the most. south-western parts of England there were onlysix, or seven days- without a measurable amount of rain, andthe total fall was- generally heavy at Newquay it was asmuch as- 5’ 6 in. On a large number of days nothing was.seen of the sun, and on many others it was- visible for very-brief intervals At Kew there were 29 hours, against anaverage of 37 hours, and at Greenwich 27 hours-, while at-

Hampstead there were no more than 2Z hours, at West-minster 15½- hours, and’ in the City only 2’ hours. This-last’ figure does- not, however,. give an’ exact idea ofthe number of hours- that the’ sun could be seen inthe City, but. the large amount of dust and mist in theatmosphere so enfeebles- its- rays- that they are too dull to,burn the recording-card. All parts of, the kingdom had lesssunshine than usual in December, but most places in thesouth and south-west were brighter than, London, and thesurrounding area. At Newquay the record was 32 hours, attBath 36 hours, and at Scilly and Jersey 38 and 39 hours-

respectively. The midland- and’ northern towns- were duller