35

and nauseous taste, is the most active part of the plant,but the leaves and flowers may also be used. A fluidextract is made in the usual manner, the dose of which isone-half to one fluid drachm.

ERGOT.

Ergotinic acid, sphacelinic acid, and cornutine are theactive principles of ergot according to Dr. R. Roberts.Ergotinic acid, even in large doses, did not produce verymarked effects. Sphacelinic acid is a powerful poison, theamount obtained from thirty grammes of ergot being sufficientto kill a fowl, and that from 200 grammes to kill a small pig,death resulting from gangrene; this principle is probablythe cause of the gangrene which sometimes attends the useof ryebread containing ergot. It causes a tetanic action inthe uterus. Cornutine is the only energetic alkaloid thatoccurs in ergot. The ergotinine of Tanret has no physio-logical effect according to Dr. Roberts; but five milli-

grammes of cornutine causes salivation, vomiting, diarrhoea,and active movements of the uterus in warm-bloodedanimals, as well as contraction of the bloodvessels and arise in the blood-pressure. The latter effects are also pro-duced by sphacelinic acid. The only preparations whichshould be used are those containing these two principles.

REPORT OF THE MEDICAL OFFICER OF THELOCAL GOVERNMENT BOARD.

[FIRST NOTICE.]

THIS report is issued as a separate volume forming thesupplement to the Thirteenth Annual Report of the Board,and it deals with the medical transactions of the Board

during the year 1883. Vaccination appears, notwithstand-

ing the noisy agitation of a few, to be making fairly steadyadvance, the children certified to be vaccinated numberingabout twenty times those who, so far as certificates are con-cerned, remain unvaccinated; and with reference to the

prevention of small-pox, it is interesting to note that themortality from that disease amongst the unvaccinatedchildren and the vaccinated was about as 200 to 1. Calflymph continues to be distributed to registered medicalpractitioners, the number of points and tubes sent outduring the year being 9311 and 2151 respectively. Mr.

Shirley Murphy, the Assistant Director of the Calf LymphEstablishment, reports on similar institutions in Holland andBelgium, and he is inclined to regard the results obtained inthe former country as superior to those seen in London, thedifference being in his opinion due to the better age andfiner skins of the calves used in Holland. The animals sentto Lamb’s Conduit-street are at times too young, and theyhave often hardly got over the hardships to which theyhave been exposed by long land and sea journey, and itmust be our endeavour to overcome this and allied diffi-culties if the local results are to be the best that can beobtained. A typical instance is given of the inquirieswhich are made by the Medical Department into allegationsof injury by vaccination. The report is by Dr. Page; itgoes to show that the allegation was wholly groundless, andthat a sickly child which happened to have been in everysense of the word successfully vaccinated, subsequentlysuffered from diarrhoea and sickness, was then drugged withsoothing syrup, and died.The inquiry which is being conducted by Dr. Ballard into

the subject of the prevalence of autumnal diarrhoea inEngland is still in progress, and one very interesting aspectof the investigation is referred to in the report under con-sideration. This has to do with the relationship whichexists between the disease as seen in England (and which isoften called choleraic diarrhoea) and the malady which pre-vails as an endemic in some parts of India, and which attimes spreads over various parts of the world. It is morethan probable that some of the conditions under which thetwo diseases appear are either alike or have much in com-mon, and it is by no means improbable that the differencebetween them has to do with a modification in those con-ditions which is brought about by some such circumstanceas climate. Any light that can be thrown upon this obscurequestion will well repay the long-continued study which isbeing devoted to the diarrhoea investigation. With refer-ence to cholera itself, a brief account of the Egyptian pre-

valence of 1883 is placed on record by Dr. Buchanan, whoexpresses a regret, which many will share with him, thatthe regular examination of prevalences of cholera and otherEastern diseases is no longer maintained. Formerly thiswork was ably carried out by Mr. Netten Radcliffe, and itappears more than strange that the country which, of allothers, has the greatest interest in studying the etiology ofcholera and other Asiatic diseases should maintain at its centralbureau so " limited" a staff that it has become necessary toabandon a work of the highest importance to the interestsand well-being of some millions of its citizens. Readingbetween the lines, it is quite evident that Dr. Buchanandoes not consider that the results of the inquiry which wasinstituted by the British Government into the etiology ofthe Egyptian outbreak were at all conclusive. He points outthat the importation of the disease by means of pilgrimsreturning from Mecca was not even excluded ; he is ofopinion that the mere occurrence of cases of a choleraicdisease in various parts of Egypt by no means justifies theinference that cholera had long been endemic in thatcountry; and he regrets that the application " of thoseinductive methods of investigation which are familiar tothe practised sanitary inquirer of England" were not

brought to bear upon the prevalence in question.The volume contains a number of the more interesting

reports issued by the several medical inspectors, investi-gations as to diphtheria taking a prominent position amongstthose which are thus permanently placed on record. Theyhave all been commented on by us as they have been issued,and we will only add, with regard to them, that we are gladto notice that an increasing number of these reports nowfind their way into the Medical Officer’s Annual Report.The more scientific part of the volume contains a further

contribution by Dr. Burden Sanderson on the products ofputrefaction in relation to the prevention of disease, theinvestigation being conducted in connexion with researcheswhich are being made into the value of different methods ofdisinfection. Dr. Klein also takes part in this inquiry, hisefforts being directed to ascertain how far various substanceshave the ability to destroy that power which the micro-phytes of disease have of directly or indirectly producingdisease. There are few inquiries which are more neededthan this one, for at present but little more is known as tothe respective merits of the various 11 disinfectants thanwhat their inventors choose to assert for them, and in onesense it is to be regretted that the final conclusions cannotmore rapidly be arrived at. The difficulties attendant uponthe investigation are, however, great, and they must bedealt with step by step. Mr. Dowdeswell also contributesto this part of the report a paper on the Etiology of CharbonSymptomatique, and its relations to other allied diseases.For the present we postpone detailed comment on this groupof scientific papers.

REPORT OF THE SPECIAL INDIAN CHOLERACOMMISSION.

THE Gazette of India publishes the following report,dated Calcutta, Nov. 28th, 1884.

From Dr. J. M. Cuningham, Sanitary Commissioner withthe Government of -India, to the Secretary to the Govern-ment of India, Home Department.

I have the honour to submit, for the information of theGovernment, a short preliminary report by the EnglishCholera Commission of the results of their inquiries duringtheir visit to India.

2. Their complete report will be passed through the presswhen they arrive in England, and submitted to the Under-Secretary of State for India.

3. It will be observed that Messrs. Klein and Gibbes’ con-clusions are altogether subversive of the statements advancedby Professor Koch as to the so-called " comma bacillus"

"

being the cause of cholera.

From Drs. E. Klein and Heneage Gibbes to the Surgeon-General and S’anitary Commissioner with the Govern-ment of India. Dated Calcutta, Nov. 27th, 1884.We have the honour to report that the investigations

which we have hitherto carried on in Bombay and Calcuttahave yielded the following results :--

1. The statement of Koch that "comma bacilli" are pre-

36

sent only in the intestines of persons suffering from or deadof cholera is not in accordance with the facts, since, "commabacilli" occur also in other diseases of the intestines-e.g., epidemic diarrhoea, dysentery, and intestinal catarrhassociated with phthisis.

2. The " comma bacilli" in acute typical cases of choleraare by no means present in such numbers and with such’frequency as to justify Koch’s statement that "the ileumcontains almost a pure cultivation of comma bacilli."

3. The " comma bacilli" " are not present in the tissue of £the intestine or elsewhere.

4. The "comma bacilli" in artificial cultivations, carriedout by one of us (E. K.), do not behave in any way differentlyfrom other putrefactive organisms.

5. Mucus flakes of the ileum, taken out soon after deathfrom typical acute cholera, contain numerous mucus

corpuscles, many of them, filled with peculiar minute straightbacilli. The same bacilli occur also outside the mucuscorpuscles. They are never missed even when the " commabacilli" are.

6. These small bacilli have been cultivated by one of us(E. K.), and they do not behave differently from putre-factive organisms. They are not present in the tissues ofthe intestine or any other tissue.

7. No bacteria of any kind, and no organisms of knownform and character, occur in the blood or any other tissue.

8. A good many experiments have been carried out byone of us (E. K.), with the following results:-(a) Mice,rats, cats, and monkeys were fed with rice-water stools,with vomit, with mucus flakes of the ileum, fresh and afterhaving been kept for twenty-four to forty-eight hours.The animals remained normal. (b) Inoculations with recentand old cultivations of "comma bacilli" and the smallstraight bacilli, as well as with mucus flakes, were madeinto the subcutaneous tissue, into the peritoneal cavity,into the jugular vein, and into the cavity of the small andlarge intestine of rabbits, cats, and monkeys; but theanimal remained perfectly well and normal.

9. The material which we have had hitherto at our dis-posal has been very good and abundant, and, as far as themicroscopic work goes, we do not think we shall require anymore material. We therefore propose concluding our in-quiry by the beginning of December, and hope soon after toreturn to England.

THE CULTIVATION OF THE BACILLUS OFTUBERCLE.

DR. CREIGHTON has expanded the criticism passed on

Dr. Koch’s method of cultivating’ tubercle bacillus at thelast meeting of the Royal Medical and Cliirurgical Societyinto a brochure, the substance of which is as follows:-In the first place Dr. Creighton points out that Koch has notavailed himself in such cultivations of the dry" method,whereby alone exclusion of foreign germs can be secured.Koch has sought, not to separate the tubercle bacilli fromadmixture with other organisms, but only to detach themfrom the tuberculous matter in which they occur. He takesa piece of tubercle from the dead-house, strips off its outerlayers, and crushes the surface in corrosive sublimate. Themass thus prepared is placed on the surface of solidifiedblood serum in a test-tube and crushed into fragments, thetube being then kept at a temperature of 98° F. for threeweeks; at the end of that time some of the dried scaleswhich have formed on this surface are transferred to anothertest-tube and treated as before. Dr. Creighton contendsthat, although Koch gives no further information on theprocess, he "has departed from the first principle ofpure cultivation of micro-organisms-namely, the principleof transferring only a minimal or fractional quantityfrom one test-tube to the next." He includes Mr. WatsonCheyne in the indictment, who followed the same process,and who assumed that thereby the original cheesy matteris wholly destroyed, the organisms alone remaining. Thereis no evidence, he maintains, to show that the finalinoculations contained bacilli and nothing else. The sub-stance put into the test-tubes was tubercle " and it cameout tubercle, baked, indeed, to crusts and scales, but still tubercle." Moreover, the method actually employed byKoch hindered the free development of the bacilli, as itprevented the growth of other micro-organisms. Schiiller,

, who adopted fluid cultivations direct from tubercular, matter, obtained cultures of various organisms (which must

have been descended from those originally present in the. tubercle), and yet failed to inoculate animals with the

disease by means of the bacterial fluid thus obtained. Dr.

Creighton’s closing remarks sufficiently indicate his positionand the distrust he has of the bacilli being proved by Koch’s

. experiments to be the specific virus of the tubercle. says:—The truth is that Dr. Koch was scrupulously careful to

keep his bacilli always dry and always cohering in what. he calls ’colonies.’ His attempts to grow them in fluids

were half-hearted; the bacilli were involved in brittle con-glomerates or crusts, after long exposure of the tuberculartissue to heat, and they never had a fair chance to multiply

, in fluid. If they had been set free in a suitable fluid medium,., they would certainly have multiplied, and multiplied with

marvellous rapidity. But they would have been no longeo. motionless rod-shaped organisms. They would have beenmoving bacteria and micrococci ; we know that much fromthe experiments of MM. Toussaint, Klebs, and Schiiller. Tc.retain the bacillar form it is necessary to keep the organisms intubercle always dry. That must have been Dr. Koch’s mainreason for practising a dry method of ’pure’ cultivation,.which resembled his original dry method in little more titanthe name. He certainly succeeded in making the rod-shaped organisms to multiply as rod-sliaped organisms;he avoided the awkward breach in their morphologicalidentity, which would have confronted him if he ,hadlet them multiply in fluids, as they are more thanwilling to do. At the same time he unfortunately retainedin the crusts and scales the detritus of the pieces of tuberclewith which he set out. Thus, under the guise of his drymethod, he not only succeeded in preserving the morpho-logical identity of the bacilli as they mostly occur in tuber-cular degenerations within the body, but he also preservedamong his inoculation material a sufficient quantity of thatwhich we must still consider to be alone infective intubercle-namely, the virus of the tubercular tissue itself."

VITAL STATISTICS.

In twenty-eight of the largest English towns 4353 birthsand 3386 deaths were registered during the week endingthe 27th ult. These registered numbers were, owing to theChristmas holidays, very considerably below the averageweekly numbers. The annual death-rate in these towns,whieh had been equal to 24-4, 22-6, and 21-6 per 1000 in thepreceding three weeks, further declined last week to 20-2.

During the thirteen weeks ending last Saturday the death-rate in these towns averaged 21-4 per 1000, against 23’0 and21-2 in the corresponding periods of 1882 and 1883. Thelowest rates in these towns last week were 13’2 in Birkeil-head, 13’8 in Plymouth, 15’9 in Salford, and 16-2 in

Brighton. The rates in the other towns ranged upwards to26-8 in Hull, 28-3 in Preston, 28-4 in Sunderland, and 32-2 inLeicester. The deaths referred to the principal zymoticdiseases in the twenty-eight towns, which had been 393 and398 in the preceding two weeks, did not exceed 311 in theweek ending last Saturday; these included 69 fromwhooping-cough, 67 from measles, 54 from scarletfever, 36 from small-pox, 34 from " fever (principallyenteric), 28 from diphtheria, and 23 from diarrhoea.No death from any of these zymotic diseases wasreturned last week in Plymouth, Birkenhead, or Hudders-field, whereas they caused the highest death-rates inLeicester, Preston, and Sunderland. The greatest mortalityfrom whooping-cough was recorded in Wolverhampton,,Oldham, and Halifax; from measles in Preston, Cardiff, andLeicester; from scarlet fever in Cardiff and Sunderland ;and from " fever" in Preston and Norwich. The 28 deathsfrom diphtheria in the twenty-eight towns included 20 inLondon, 2 in Norwich, 2 in Liverpool, and 2 in Sunderland-Small-pox caused 47 deaths in London and in its outer ringof suburban districts, 3 in Liverpool, and 1 in Brighton.The number of small-pox patients in the metropolitanasylum hospitals situated in and around London, whichhad been 1019 and 1026 on the preceding two Satur-days,, further rose to 1076 at the end of last week;the . admissions declined, however, to 161 last week, from263, .190, and 2A4in the previous three weeks. The Highgate