185PARIS.

High Death-rate of Children in Belfast.At an inquest recently held in Belfast, where a child died

from being overlain in bed, the coroner animadverted on thehigh death-rate of children in that city. This was thefourth inquest on children he had already held in the

present month, and he was surprised at the parents not

taking even the trouble to get medical relief. The jury intheir verdict said there was neglect on the part of the parents.The coroner administered a severe caution to the parents.He said Belfast was no exception to the rule in the matter ofthe high death-rate of children, for in Liverpool, Leeds,Manchester, and other large towns the death-rate was alsovery large. On examination he had found that a largenumber of those deaths occurred on either Saturday night or iSunday morning, and that it was to be attributed to personsgetting their wages on Saturdays and becoming drunk, and so ’,the children were overlain in bed. He hoped that that casewould be a warning to other parents.

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Jan, 15th,

PARIS.

(FROM OUR OWN CORRESPONDENT.)

Sero-Therapy.IT frequently happens that a discovery ridiculed at the

time is subsequently applied practically by other persons andthe credit transferred from the original discoverer to theselatter individuals. In France sero-therapy is believed t) datefrom the experiments of MM. Richet and Herioourt, alreadyreported by me in the columns of THE LANCET. Thesesavants, relying on the immunity of the dog to tuber-culosis, employed the blood of this animal as a prophylactic.It was only in 1890 that they made use of dogs pre-viously immunised artificially. The earliest communicationsof MM. Behring and Kitasato are dated 1890. There nowcomes forward M. Babès of Bucharest, who, through hisfriend Professor Cornil,l claims precedence in the dis-covery, alleging that his researches, conducted in collabora-tion with M. Lepp, were published in the Annales de1’Institut Pasteur in July, 1889, and that, further, theyapplied the method to human beings in the following year.M, Ba,be3 therefore claims the paternity of the following laws,wrongly denominated Behring’s laws : 1. Immunity against aninfectious disease may be conferred on animals by injections ofthe blood of another animal already strongly protected (arti-ficially) against that disease. 2. The application of thatmethod prevents the development of the disease in animalspreviously inoculated with the virus of that disease. Honourto whom honour is due; but suffering humanity will not beparsimonious in its thanks to both early and late workers ina field that bids fair to revolutionise the healing art andrender the latter years of the present century famous in theannals of medicine.

A Nero Sign of Diabetes and Albuminuria.M. Garel of Lyvn2 claims to have discovered a hitherto un-

recorded physical sign which is almost pathognomonic of eitherdiabetes or albuminnria. He states that many patientscomplain of a slight irritation of the throat-some difficultyof deglutition, a sensation of swelling, and constriction ofthe fauces. The soft palate, its pillars, and the posterior i

wall of the pharynx are found to be red and swollen, and lifrequently covered with a more or less viscid layer of mucus. iIn the majority of such cases examination of the urinereveals the presence of either glucose or albumen. Most ofthese patients present only quite insignificant generalsymptoms, so that M. Garel’s discovery, if it be confirmed,is of considerable value. Of twenty-one individuals affectedwith this particular form of pharyngitis, ten had diabetesand eleven albuminuria, and in three of the cases sugar andalbumen alternated in the urine. I would, however, ask if itbe not the wiser plan to analy se, as a matter of routine, theurine of every new patient, more especially when middle agehas been reached? In my own practice I make it a rule todo so, and I have thus avoided many a fausse piste.

Blood Changes in Myxœdema.M. Lebreton has recently studied the urine and blood of

a myxoedematous child both before and after treatment with

1 Académie de Médecine, Jan. 8th.2 Congrès Francais de Médecine Interne, held at Lyons.

3 Société Médicale des Hôpitaux, Jan. 11th.

thyroid gland. In forty days the treatment had determine(l,considerable improvement in the physical and mental con-dition of the child. The only modification in the urinenoted during treatment was slight and transient albumi..nuria. As regards the blood before treatment it con-

taincd 1,750,000 red and 4500 white corpuscles, as against2,450,000 and 9600 after treatment, the hmmoglobinbeing also increased in the proportion of 68 to 65. Before-treatment the average diameter of the red discs was.

0.1mm, thatof some giant elements reaching 57mm. Treat-ment reduced the diameter of the coloured corpuscles-to0’57mm. In preparations dyed with ha3matoxylic eosinethere were seen some red discs provided with nuclei, whichdisappeared after treatment. The proportion of mono-

nucleated to poly-nucleated leucocytes was raised by treat’ment from 15 to 25 per cent. to 30 and even 40 per cent., thelatter proportion exceeding the normal. A considerablenumber of small lymphocytes present before had almost dis-appeared after treatment. Mucin, said to have been dis-covered by certain authorities in the blood of these patients,was conspicuous by its absence both before and after treat -ment. It would thus appear that myxoedematous blooddiffers from the normal fluid in the persistence of the fœtalhæmapoietic process, characterised by the presence in it ofnucleated corpuscles and by the large diameter of the redelements. M. Lebreton’s researches also show that the cureof myxcodema is synchronous with a leucocytic process of aparticular kind, the increase in the white corpuscles involving.exclusively the large mono-nucleated variety.

Prophylaxis of Ifalaria the Best Forms of Quinine toadminister.

The Société de Tkerapeutique recently appointed a com..mittee (MM. Adrian, Bardet, Berlioz, and Boymond) toreport on the above question. The commission concludes-that the employment of solutions of salts of quinine shouldbe reserved for active attacks of malaria. The best propby-lactic salt of quinine to use is the basic bydrochlorate, it

being the richest in alkaloid and sufficiently soluble. It has-

a less irritating action on the stomach than the sulphate.The hydrobromate should be used only in cases rebellious tothe hydrochlorate. As to the pharmaceutical form in whichthe hydrochlorate should be administered, compressed pre-parations are condemned, and pills made up with a soluble.excipient or perles provided with a gelatinous envelope arerecommended. Pills or perles containing each fifteen centigrammes of the chlorhydrate and given one in the morningand one at night, or else before meals, suffice to keep thesystem under the influence of quinine so as to ward flattacks of fever. In the course of the discussion followingthe reading of the report it was suggested that the WarOffice should be urged to desist from its attempt to manufacture-on a large scale compressed tabloids of quinine for the use ofthe troops, seeing that the report was unfavourable to that-method.

Arrow P. isons.From a work by Dr. Lewin of Berlin, which work wss

analysed by Professor Brouardel at the Academie de Médecine(Jan. 8th), it results that the Scmalisdip their arrows in ablack substance called waba, extracted from a plant ofthe family Apocynaceas. The Walaita employ crystallisedwabaine, a product already studied by Fraser ; other tribes ofCentral Africa use either amorphous wabaine or strophanthus,or a mixture of several other poisons. In Asia the poisonemployed for the purpose is generally aconite. In Tonkir.,several French soldiers were wounded v.ith arrows dipped inthe juice of antiaris toxicaria. M. Berthelot mentioned that-certain tribes employed animal toxines as arrow-poisone,.whilst others covered their arrow-tips with the excrement ofcertain animals.

Up .to date Medical Advertising.Visitors to Paris will be familiar with the advertisements.

with which the walls of the chalets de nccessite and such like:useful structures are liberally supplied. From a perusal otthese they learn that certain diseases can be cured by Dr. X.(dr. Speaks englisb, sie) in a surprisingly short time andwith the greatest ease. But it has been reserved for the-present year to show us the length to which such effronterycan go. On the drop-curtain of a certain theatre there maynow be read, between two other advertisements relating to.beer and pinces-nez, the following : "Docteur-MédecinSpécialistc, 25 annees de pratique, de midi a neuf heurea duesoir." Then follows the address.

Jan. 15th.

186 BERLIN.

BERLIN.(FROM OUR OWN CORRESPONDENT.)

The Debate on the Antitoxin Treatment at the Berlin3ledical Society.

THE mest important event in Berlin medical life hasundoubtedly been during the last few weeks the debate onthe antitoxin question, which has already been alluded toin the pages of THE LANCET ; but its importance warrantsmy returning to the subject. The paper read by ProfessorBehring at the Vienna meeting of the German Association,which was immediately afterwards telegraphed to all partsof Germany, excited public opinion to something the

pitch evoked by the publication of Professor Koch’s resultswith tuberculin. Wherever a child was taken with diph-theria the medical man was compelled by the parents to usethe new remedy they had read of in the newspapers. The

public attention was more awakened by an article ProfessorBehring had published in a widely read political journalentitled "Die Zakunft," in which he attacked Professor’Virchow very severely. In this article he declared Virchow’spathological doctrine obsolete and prejudicial to furtherprogress of medical science. Virchow, he suggested, did not- consider a disease a distinct entity due to one specificcause, and thus to be treated by a specific remedy, but as aconglomeration of symptoms which were each to be curedseparately. As it is, of course, quite unusual for medicalmen to dispute in political journals the astonishment atProfessor Behring’s proceeding was very great and generalhere. When a few weeks later an assistant of ProfessorVirchow, Dr. Hansemann, was announced to reada paper on antitoxin at the Berliner MedicinischeGesellschaft, everybody expected this would be an

answer to Professor Behring’s attack, and it is no wonder- that the hall and the galleries were cvercrowded. Dr. Hanse-mann firstcriticised the importance of Lofiier’s bacillus. Hementioned that it was not yet proved that this bacillus wasthe only cause of diphtheria as clinically recognised. Therewere many cases where the Löffler bacillus was missing ; inthe great majority of cases it has been found together with- other bacilli ; finally, it has been recognised in diseaseslike rhinitis fibrinosa, which were not to be confounded with- diphtheria. Even in healthy persons its presence has beendemonstrated. Concerning antitoxin Dr. Hansemann re-

marked that nobody had yet seen it. We only know thatanimals can be immunised by weakened cultures ofLöffler’s bacillus and that the blood of these can cure

other animals attacked by the disease due to that bacillus.Professor Behling had, in his opinion, committed the error oftransferring to men results obtained with animals in pro-claiming that his remedy immunised, cured, and was harmless.As every practitioner knows, very often only one child in afamily is attacked with diphtheria, whilst the others remainhealthy. Thus it is impossible to say for certain if theimmunity has been the effect of the antitoxin or not. Onthe other hand, several cases have been reported wherepatients have acquired diphtheria although injected veryearly with antitoxin. The remedial effect of the antitoxinwas very doubtful, Dr. Hansemann considered, on the follow-ing grounds : the diminution of mortality in some of thehospitals might have been caused by the minor gravity.of this year’s epidemic ; the presence of L6fflet’s bacillusbeing regarded as sufficient for diagnosis, many cases formerlydenoted as simple tonsillitis, from which the patientswould have recovered without treatment, are now classed asdiphtheria; and cases where, notwithstanding an earlyinjection, the patients have died are not very rare. All, hethought, still agreed that the cases of septic diphtheriaremained hopeless, while finally the remedy cannot be regarded.as harmless, as severe symptoms have been remarked to ensueupon its injection. The discussion which followed Dr. Hanse-mann’s paper lasted not less than three sittings. ProfessorBergmann, who spoke first after Dr. Hansemann, declaredthat he was contented with his results obtained bythe treatment, although he had begun it with a

certain scepticism, natural after his bad experiences withtuberclin and tetanin. He had no doubt that Lofller’sbacillus, found by him in 450 out of 470 cases, was

the cause of diphtheria. Professor Virchow, who rose next,defended with great warmth the new method. The surpriseat this was very great, because it was generally believed-.and natural to believe-that Dr. Hansemann had been mortor less commissioned by Professor Virchow to proclaim his

(Professor Virchow’s) opinion on Professor Behring’s work.Professor Virchow, though he did not agree with thetheoretical views concerning the specificity of Löffler’sbacillus, drew the attention of the society to the fact thatthe mortality in the Friedrich Hospital, of which he himselfis a warden, diminished as soon as the new remedy wasused. Each time the supply of antitoxin failed themortality rose again until a new quantity could be pro.cured. Professor Hahn said that he could see no

difference in the mortality between those who badbeen injected and those who had not, but he keptan open mind on the point because in the hospitalto which he was attached, which is situated in a very poorquarter, children are usually brought in too late to be treatedwith any success. Dr. Baginski paid that he had verysatisfactory statistical records. Professor Liebricb, thepharmacologist of the University, who is known tobe opposed to bacteriology in general and to antitoxinsin particular, invited the scciety to try injections ofpure serum without cultures of bacilli, a method whichhe believed would be successful. Dr. Aronson sug.gested that in many cases where the method failedthe quantity of the antitoxin injected must have beentoo little. To sum up the whole debate, the feeling generallywas that the time has not yet come to pronounce a finaljudgment on this important question, as it could not beclearly proved that the lowering of mortality was due to thetreatment or to the milder character of this year’s cases.But all were agreed that the complications reported by Dr.Hansemann as following upon the treatment were of no

importance, and that no patient had come to any harm bythe injections. It was a subject of general remark that noneof Professor Koch’s or Professor Behring’s assistants said aword in the debate.

The Reform of Medical Service in Berlin MunicipalHospitaZs.

In German hospitals the number of patients treated byone medical attendant is usually far greater than in othercountries. Especially has that been the case in the Berlinmunicipal hospitals. There were until last year only onestaff surgeon and one staff physician in these hospitals, andthey, with the assistance of their resident medical officers,had each the care of 300 patients. They could, of course,not personally see so great a number every day, and werethus compelled to confine their ministrations to the graver ormore interesting cases. Last year this arrangement wasmodified, and twice the number of surgeons and physicianswere appointed to the staffs. At a meeting of the MunicipalCouncil, where this question has been ardently discussed,some members wished to have a larger staff, with sub.divisions in treatment-i.e., special wards for the eye, thethroat, gynæcological purposes, &c.--but the expense wasconsidered too high. It is remarkable that all theEe, andfor that matter other, hospitals in Berlin are not used forpurposes of teaching, which is confined to the Royal Charitéand the University clinics. As the number of students inBerlin increases every year practical study of disease becomesmore and more difficult, and it is hoped that all the hospitalswill be opened to students.Jan. 16th.

ROYAL METEOROLOGICAL SOCIETY.-The annualmeeting of this society was held on Wednesday evening, the16th inst., at the Institution of Civil Engineers, GreatGeorge-street, S.W., Mr. R. Inwards, F.R.A.S., President, inthe chair. Mr. Inwards, in his presidential address, dealtwith the subject of Weather Fallacies, which he treatedunder the heads of Saints’ Day fallacies, sun and moon

fallacies, and those concerning animals and plants. He alsoreferred to the almanac makers, weather prophets, and im-postors who have from time to time furnished the world with

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fit materials for its credence or its ridicule.

i AT a special meeting of the board of manage-i ment of the Chelsea Hospital for Women held on Wed-inesday, the 16th inst., the following appointments werei unanimously made to the medical staff :-Physicians to

3in-patients : Wm. Duncan, F.R.C.S., M.R.C.P., M.D.; andsW. H. Fenton, M.D., 1VLA. Surgeon to in-patients: Robert, O’Callaghan, F.R.C.S.1. Physicians to out-patients : J. Inglise Parsons, M.D., M.R.C,P:, M.R C.S.; A. E. Giles, M.D., B,Sc.,-M.R.C.P.; and T. W. Eden, M.D., C.M., M.R.C.P. Patho’elogist : E. J. Maclean, M.D., C.M. Registrar : G. H. A. C,s Berkeley, M.B., B.C., M.R.C.S.