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two days if it has been injected into the blood. In the

dog are obtained results showing the fever to be " aninfective malady due to a micro-organism well definedand susceptible of being cultivated by means of the ordinaryartificial nutrients." The bacillus, moreover, may be isolated,not only from the corpse, but even during the life of thepatient. Once isolated, its bacteriological diagnosis can becompleted in twenty-four hours, possessing as it doescharacters so distinct as to make it readily recognisableamong all the microbes hitherto brought to light. The

scanty number in which it is found in the organism and theviolence of the symptoms point to its action as that of a veryenergetic poison. The dog, as already stated, illustrates thisaction most significantly-scarcely less so the goat, the

ass, and the horse; while the cat is curiously refractory.The fever which he claims to have reproduced in man hasnot a few points in common with typhoid fever, and heemphasises the fact that the diffusion of the virus maybe effected through the air as well as by water, con-

tagion being possible through the respiratory system.The bacillus favours the entrance into the organism ofseptic microbes while its own action on the liver is pecu-liarly energetic, inducing rapid atheromatous degenerationwith other anatomical lesions, to which is due, in somemeasure, the icterus characteristic of the disease. Theliver loses all functional activity. Performing a conservativer6le against the poisons and microbes which would otherwiseattack the organism from the intestines, that P61,p fails whenthese microbes overcome its resisting power. They thusconquer and eliminate from the organism the bacillusicteroides, and in this way Dr. Sanarelli explains those casesin which the bacillus is no longer found on post-mortemexamination, or, if found at all, found only in a medley ofother species of microbes.The bacillus acts on the kidney by inducing inflammation

of peculiar intensity. This is followed by lesions evinced bythe albuminuria characteristic of the last period of the

yellow fever ; then anuria supervenes, the result of a " true

and idiopathic urasmia." Thus it happens that patients whenthey do not directly succumb to the poison and the lesionscaused by the "bacillus icteroides" may die by the secondaryinfection or by ursemia.The modus operandi of the bacillus having thus been

demonstrated Dr. Sanarelli next investigates its mode ofentering the organism. As already stated, he denies that its" sede elettiva " (elective seat) is the alimentary canal. Heis even inclined to doubt (what elsewhere he provisionallygranted) that it may find admission through the water.Atmospheric transmission is the channel he favours. Whiledenying that the alimentary canal is the "elective seat" ofthe malady, he is far from ignoring the possibility of itsbeing a mode of entrance for the bacillus. " The catarrhalprocesses of the liver," he maintains, " to which new-comersin tropical regions are subject, and the apparently triflingdisturbance of the digestive tract may in this case facilitatethe passage of the bacillus into the organism. At this pointhe enlarges on another I fenomeno biologico," which illus-trates the action of the bacillus and the genesis of yellowfever on board-ship. Badly-aired vessels are impregnatedwith a 11 fetid umidita which, with heat and the want ofventilation, forms the " coefficient of epidemics developed atsea." This atmosphere, on experiment, proved particularlyfavourable to the energising effect of the bacillus icteroides.In certain cultures, continues Dr. Sanarelli, when this micro-organism, sown for some time, seemed not to have caughton," the "mufEa" (or air mildew) sufficed to develop the"colonie caratteristiche" of the bacillus of yellow fever,and it is probable that on board-ship the preservation and"pullulazione" (germination) of the bacillus are due lessto moist heat considered as a physical agent than to thegeneration of "muffe" favoured by the condition of

temperature and humidity prevalent in ships at sea. Onthe other hand (Dr. Sanarelli proceeds), the notable resist-ance the bacillus icteroides oiters to the principal factorof natural disinfection, desiccation, to wit, and the greatlongevity it achieves during voyages, sufficiently explain theready acclimatisation of yellow fever and its stubbornpersistence on seaboards which have been visited by it.On the prophylactic and therapeutic aspects of yellow fever

Dr. Sanarelli promises special work. In the latter field hehas, I believe, a serum in contemplation from which heanticipates results not less satisfactory than those -yieldedin diphtheria. Meanwhile, we may echo the congratulationsvoiced by his compatriot, Dr. Alberto Guidi (whose notes

e from Dr. Sanarelli’s monograph I have freely made use of)),n and record our admiration for the thoroughness, the patience,d and the courage with which the young Sienese physician hasy " broken ground " in a difficult and dangerous field.l, June 26th.

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EGYPT.(FROM OUR OWN CORRESPONDENT.)

Pilgrims and Quarantin".THE Q tiarantine Board at Alexandria has had plenty to

occupy it during this month. The discovery of typhusfever among several flocks of recently imported sheepnecessitated the destruction of many hundreds in thequarantine parks. If it is true that typhus fever or

rinderpest can be introduced into Egypt as easily bysheep as by cattle it is a pity that stringent measures

are not adopted to prevent the importation of all sheepfrom infected ports. In 1884 regulations of this kind weremade in Egypt for cattle, and it is noteworthy that.bovine typhus fever has never appeared in this country .

since that date, the last epidemic having been in 1883. Butveterinary diseases are as nothing compared to humancholera and plague. The Board, after several meetingsand much anxious deliberation, decided not to interferewith this year’s pilgrimage in spite of the presence of cholerabacilli at E1 Tor. This decision was apparently based on theidea that when clinical symptoms do not coincide with thebacteriological diagnosis the latter is to be entirely dis-regarded. This is a dangerous precedent and somewhatsubversive of the modern system of allowing bacteriologiststo have a casting vote in cases of doubt. Imagine a manwith a cough, but all other symptoms and signs of doubtfulobscurity. If tubercle bacilli are found in his sputa thecase would surely be treated for the time being as one oftubercle. It does not seem irrational to expect that aman with diarrhoea and cholera bacilli in his dejectashould be considered-temporarily at least-as suffer-ing from cholera. But the Board decided otherwise,and the Bosnian and Herzegovinian pilgrims in ques-tion passed on to Turkey unmolested. The EgyptianGovernment, in spite of the absence of suspicious cases

among Egyptian pilgrims, noted the names and addressesof all returning pilgrims, and had them visited for five daysby the medical man of their own district. Hardly had thecholera scare died away than some cases of plague werereported at Jeddah, and this time the Board promptly settledthat the pilgrimage must be declared "unclean." It isunknown how the plague reached Jeddah, but one of theobvious possibilities is that it was brought there from Assir,the plateau between Hedjaz and the Yemen, where plague issaid to be always endemic. The existence of this districtis an additional reason for starting some bacteriological workin Jeddah or Mecca. A Mussulman might be sent there thisautumn to begin preliminary investigations. In the mean-time Egypt is free from cholera and plague and in manyways prepared to receive these unwelcome visitors ifnecessary.

Infectious Diseases.During the last six weeks three specific fevers have been

reported from the provinces. Small-pox has broken out inmost of the Lower Egypt provinces and half those of UpperEgypt ; 795 cases have been reported and 183 deaths. Typhusfever, including probably a few cases of relapsing fever,has occurred in ten places, causing 35 deaths out of a totalof 195 cases. Measles has been present in five provinces,accounting for the high death-rate of 122 out of 178cases. It must be remembered that the native doctors’diagnosis is often made after death, and should always bereceived with suspicion.

Cairo, June 20th, 1896.

NEW YORK.(FROM OUR OWN CORRESPONDENT.)

Deaths of Dr. J. Lewis Smith and Dr. T6m. Lusk.

l DURING the last week the medical profession of this city

and country has lost by death two of its most prominent-members. Dr. J. Lewis Smith died on June 9th at the

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ripe age of seventy years. His health had been impaired forseveral years, but he still continued the active duties of hisprofession until within a day or two of his death. Dr. Smith- adopted the diseases of children as a specialty at thecommencement of his professional career in 1853, and was"the pioneer in this department of medicine in the UnitedStates. His first contribution to the literature of this subject- appeared in 1854, and from that date to his death he was aprolific contributor to the current medical periodicals, thetotal number of his papers exceeding one hundred and fifty’in number. His work on "The Diseases of Children"

appeared in 1869 and passed through eight editions, the lastof which was recently issued under his personal revision.For a quarter of a century this work has maintained its posi-tion as the accepted text-book of the schools and thefavourite authority of the profession. Dr. Smith was fortwenty years Clinical Professor of Diseases of Children inBellevue Medical College. Dr. Lusk died suddenly on

- June 13th from an apoplectic attack at the age of sixty years.He was dean of the Bellevue Medical College and Professorof Midwifery in that institution. His reputation in the

department of obstetrics rests on his treatise on midwifery,which took the highest rank on the issue of the first edition.’It has been translated into several languages.

Medical Schools fail to Con8olidate.The attempt to consolidate the University Medical College

and the Bellevue Medical College has not succeeded. Thetrouble seems to have arisen when the scheme reached the

point of making up a faculty out of the existing faculties.The friends of the schools are greatly disappointed at theresult, for they anticipated the creation of the best equippedmedical school in the United States.

Food Adulteration in the United States.

According to Dr. Fremkel the extent to which foodadulteration is carried in the United States is a matter of’doubt. The estimates of competent authorities on thesubject vary between from 2 to 15 per cent. There is no

’question that the first figure is too low. The last is given bythe special agent of the Department of Agriculture, who has- examined the subject very exhaustively. Good judges’estimate the value of the food supply of the United States ata minimum of$4,500,000,000 annually. If we take the veryonservative estimate of 2 per cent. the loss to the consumerby adulteration amounts to$90,000,000 per year. Dr.McNeal, of Ohio, estimates the annual loss to the people of"the United States at one and one-third billion dollars ; and tothe state of Ohio. as the result of three years’ investigation, aloss of$78,000,000 annually, or 232,000 per day.Th.e Treatment in a Case Decided to be " Hearsay Evidence. "In a recent case where it was desired to prove that the

plaintiff suffered a severe injury to the spine the attempt was,made to prove that fact, not by the testimony of the physicianwho had attended her, but from the treatment that she hadreceived. Such proof, the appellate division of the Supreme’Court of New York think, was in the nature of "hearsay."The treatment of the plaintiff for a particular disease, itmaintains, was no more than a declaration of the physicianthat she was suffering from such a disease ; and as the- declaration would not be competent the court holds that theproof of the treatment was not competent.

The Anti-vivisection Bill in the United States Senate.Senator Gallinger has reported the Bill to regulate vivi-

section in the district of Columbia. He accompanies the Billwith a very full report which discusses the subject for and.against the Bill from the evidence presented to the committee.He appends a most impressive list of names of some of themost influential people in the country who favour and urgethe passage of the Bill. It is very plain that the efforts of,the vivisectionists to defeat the Bill have attracted unusualattention to this measure, thus arousing a large opposition’from very prominent persons who evidently do not clearlyunderstand the situation, but whose expressed wish andgreat numbers have influenced the Senate committee. TheBill provides-(1) for the use of anaesthetics in all painfulexperiments on living vertebrate animals, the so-calledinoculation experiments, test of drugs and medicines andcases of recovery from surgical procedure being expresslyexempted from this requirement; (2) for the licensing of allexperimenters by the district commissioners, except thosEwho are duly authorised officers of the Government of theUnited States or of that of the district of Columbia; (3) foi

the prohibition of vivisection in the public schools and inexhibitions for the general public ; and (4) for the inspectionof all places of experiment by inspectors to be appointed bythe President of the United States.

Prosecution of Quacks.It appears that since April, 1895, when the law providing

for the criminal prosecution of quacks was restored, the NewYork County Medical Society has caused the arrest of eighty-three persons for practising illegally, and it has obtainedconvictions in fifty-one cases. These persons have paid$3690 in fines, and a number of them have been sent to gaolbesides. The legal department of the society has a largenumber of cases pending. This fact alone is deterrent ofmuch illegal practice, and not only tends to prevent thepretenders from trying to establish themselves in New YorkCity, but also drives some of them to other localities where’the duty of prosecuting offenders is not undertaken by theprofession.

The Hosp’ital Fund of New York.The Hospital Saturday and Sunday Association, the

receipts of which for this year amounted to$61,500, havedistributed of this sum$50,000 among 35 institutions. Thesum of$8200 was designated for special purposes and$3300was reserved for expenses. The collections were$2500 morethan last year, and the number of "free hospital days was690,841.June 16th.

MONTREAL.

(FROM OUR OWN CORRESPONDENT.)

Victorian Order of Nurses.EVERYTHING just now is tinctured with Jubilee, from

politics to postage stamps. The chief scheme for a CanadianColonial commemoration is that of the Victorian Order ofNurses. This ambitious but somewhat visionary project isgreatly exercising the colonial mind, both lay and medical.The main feature of the project is to dot the cities in theDominion with "training centres," and the sparsely populatedparts with residential centres," in which a supply of trainednurses would be housed, to be in readiness to go to sickcalls where skilled nursing is not now available; theremuneration of the nurses to be from an endowment, thefriends of the sick to pay what they are able. The projectis receiving the backing of our highest social circles,and it will need it all to make it go. From a pamphletdealing with the duty and charm of nursing the sick, issuedunder the asgis of Lord and Lady Aberdeen, I take thefollowing : Some of the chief objects of the order will be:To provide skilled nurses in sparsely settled and outlyingcountry districts ; to provide skilled nurses to attend the sickpoor in their own homes in cities ; to provide skilled nursesto attend cases in cities at fixed charges for persons of smallincomes, the charges being paid to the funds of the order ;to provide small lying-in rooms and wards in cottagehospitals or homes ; to prepare trained nurses thoroughlyqualified to carry out these objects. It would not be a prudentthing to have the order started unless provision be madefor perpetuating it. It would take an endowment ofabout £200,000 to insure revenue to make this benefactiona lasting one for all the needy districts of Canada. Shallwe confess ourselves helpless in the presence of this urgentneed and dismiss the cry for help with the remark, ’ Bnt amillion of dollars is a great sum to raise’ ? Certainly amillion of dollars is a great sum to raise, but if the peopleof Canada can be fully informed and thereby awakened tothe greatness and goodness of this movement, a milliondollars will be forthcoming for the commemoration of theDiamond Jubilee of Her Majesty by such means as will causegratitude to grow continually in the hearts of the peopleof Canada towards the memory of Victoria the Goodand her representatives and subjects in Canada who pro-moted the order." The following paragraph from thepamphlet has given offence to some sensitive ones inthe medical profession : "In the sparsely settled partsof Canada what is needed now more than ever beforeis the presence in scores of localities of skilled physicianswho have forgotten the meaning of personal ease-menwho believe that the nobility of living is to help others