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’removed from the wound, and a week afterwards it wascovered by healthy granulations. On Nov. 13th the patienttried to move his arm for the first time, but was unable todo so on account of the rigidity of the muscles. OnNov. 16th Dr. Jacob was sent for in haste and found the

patient in a typical state of tetanus. His face was contracted,trismus and opisthotonos had developed, there were tonicconvulsions of the muscles of the abdomen, the chest, andthe extremities ; respiration and deglutition were difficult;there was retention of urine, the bowels were constipated,and violent convulsions occurred when the patient tried toopen his mouth. The temperature was 37 6°C. (= 996° F.),and the pulse was 160. The urine, which was drawn off witha catheter, was free from albumin and sugar. Morphia andchloral were administered, but without any good result. Onthe following evening five grammes of Behring’s antitoxindissolved in fifty grammes of water were injected at fiveplaces on the right side of the chest and abdomen and onegramme (= 15 grains) of chloral was given. The patientslept for four houis, but in a day or two the paroxysms wereas severe as at first. He could, however, open his mouthbetter and move his right leg. On the evening an exanthemlike scarlet fever appeared on the face, the chest, and thearms. Next day uiine and faeces could be passed freely andthe right arm and the legs could be moved. On Nov. 20thseveral convulsions of the extremities were observed, butthey were not so strong as before. A second injection offive grammes was given on Nov. 22nd, and since that timethe patient’s state obviously became better. On Nov. 24thhe was able to move his head of his own accord and to openhis mouth. On Nov. 25th he could laugh, whistle, and movethe vertebral column, in addition to which the convulsions,though still present, were of less duration. By Dec. llth,when the patient first left his bed, the general attackshad entirely disappeared, but short convulsions ofthe muscles of the face and the left arm continued till theend of December. Dr. Jacob states that the time of in-cubation was about twelve days, and that the illness did notbegin as usual with trismus, but with a contraction of themuscles near the wound. The beneficial action of the anti-toxin was well marked, although it was not possible to givethe first injection sooner than the fifth day after the onset ofthe symptoms, when they had already become severe. Theeffect of the injection was not immediate, but developeditself slowly, a fact in accordance with the observations ofTizzoni and Cattani.

An Epidemic of Trachoma,Eastern and Western Prussia, Posen, and Silesia have

recently been visited by an epidemic of trachoma, and thecases are very numerous, especially in some districts nearthe Russian frontier, where the general standard of living islow. The reports of the medical officers of health showthat in the district of Jobannisburg there are 2343 patients,and in the district of Lyek 3913, of whom 994 are in thetown of Lyek, the remainder being in the country. As thetown contains only 10,000 inhabitants the number of

patients amount to 10 per cent of the total population.In Sensburg there are 913 and in Pillkallen 1322

patients. In the latter district the prevalence amongschool children is egpecially remarkable, no fewer than571 of them having contracted the disease. The Medical

Department of the Government organised a conferenceat Berlin, which was attended by the members of the

Department, by delegates from the local authorities con-cerned, and by the district medical officers of health.It was decided to set apart special wards for trachoma inthe ophthalmic hospital of Konigsberg University and in themunicipal hospitals of Danzig and Konigsberg. Lectures ontrachoma with practical demonstrations will also be deliveredat the above hospitals at the expense of the Government, nofees being charged either to the medical officers of healthor to any medical men who may care to attend. Expertsare to be appointed by the Government to travel throughthe infected districts and to attend the poor in conjunctionwith the local medical men. Trachoma formed the subjectof a paper read before the Berlin Medical Society by Dr.Kirchner of Konigsberg, one of the medical men who hadcome to the conference. He said that the above-namedeastern districts may easily become the focus of an epidemicowing to the carelessness of the population in hygienicmatters. He was of opinion that children should be taughtin school the dangers of this disease, and recommended theestablishment of public dispensaries in the district towns,together with other measures which may enable poor persons

to obtain medical advice and treatment. The districtaffected by this epidemic is the one where leprosy has

recently become prevalent.l .

The Medical Congresses.The programmes of this year’s medical congresses are now

issued. The twenty-sixth Congress of the German SurgicalAssociation will be held at its headquarters, LangenbeckHouse, in Berlin, from April 21st to 24th, under the pre-sidency of Professor von Bruns of Tubingen. The principalpapers to be read are : (1) the Surgical Treatment ofGastric Ulcer, by Professor von Leube of Hamburg andProfessor Mikulicz.of Breslau; (2) the Value of the x Rays inSurgical Practice, by Dr. Iiummel of Hamburg; and (3)Operations for Prostatic Enlargement, by Professor Helferichof Greifswald. An exhibition of surgical apparatus, dress-ing materials, &c., will be arranged as usual in connexionwith the meeting. The Congress .of Internal Medicine willmeet this year in Berlin from June 9th to 12th, underthe presidency of Professor Leyden. Among the subjects ofdisc;ussion are: (1) the Treatment of Rheumatic Arthritis,by Professor Baumler of Freiburg and Dr. Ott of Marienbad ;(2) Epilepsy, by Dr. Unverrich of Magdeburg; (3) Graves’sDisease, by Professor Eulenburg of Berlin ; (4) the Aims ofModern Treatment by Means of Drugs, by Professor Liebreichof Berlin ; (5) the Prognosis of Spinal Diseases, by ProfessorLeyden ; and (6) the Pathology of Diarrhoea in Children, byProfessor Baginsky of Berlin.-The Balneological Associa-tion will meet at Berlin from March llth to 15th.-TheGerman Association of Public Health will meet in Karlsruhefrom Sept. 14th to 17h ; the subjects to be discussed are d(1) the Disinfection of Dwellings from a Scientific andPractical Point of View ; (2) the Diminution of Intemperance;(3) Measures to be taken against Food Adulteration ; (4) onSchool Building ; and (5) the Prevention of Epidemics inHealth Resorts.

Despatch of a Plague Comriticsion to India.The German Commission for the study of the plague will

leave Germany for India next week. The members are Pro-fessor Koch, Professor Pfeiffer of the Institution for InfectiousDiseases, Professor Gaffky of Giessen, Dr. Disuderic andDr. Sticker of the Imperial Health Office. Professor Kochwill travel direct to Bombay on the completion of his

investigations in South Africa, and till his arrival the leaderof the commission will be Professor Gaffky, who was withProfessor Koch in British India during the great choleraepidemic of 1884, and assisted him in the researches whichfinally lead to the discovery of the comma bacillus.Feb.22ad.

ROME.

(FROM OUR OWN CORRESPONDENT.)

The Italian Army Medical Reports.FOR the last few years the army medical reports have

registered a steady improvement in the health and the generalsanitary condition of the Italian troops ; but according to thereport for 1895, which has just appeared, the results recordedin that year were less favourable than ordinarily. In 1894 theaverage mortality was 5’2 per 1000, the sickness was 723 per1000, and the average number of patients in hospital was30 per 1000 ; but for 1895 the corresponding numbers wererespectively 7-0 per 1000, 743 per 1000, and 33 per 1000, thetotal on the sick-list being 157,890, of whom 1100 died. Theleast favourable returns came from the provincial corps andthe most favourable from the carabineers. The unhealthiestmonths of the year, so far as the troops were concerned,were the first four, whereas September, October, andNovember showed the lightest sick-list. The highestdeath-rate occurred in the military division of Turin, and thelowest in those of Perugia, Salerno, Naples, Florence, Leghorn,and Rome. Measles and scarlet fever were most prevalentimmediately after the arrival of the conscripts in quarters ; qtyphoid fever predominated at the close of summer and thebeginning of autumn; and malarial manifestations were mostcommon in July, August, September, and October. Thedeath-rate due to accidents, and also to suicide, reached itsmaximum in the carabineers, but there was no case undereither heading among the bersaglieri, the Alpine regiments,

1THE LANCET, Dec. 5th, 1896, p. 1632.

632

r the engineers. The mean force of the troops under armsn 1895 was 202,913. The manner in which the report is,drawn up is highly creditable to its author, Surgeon-Major’Goria; unfortunately it does not give any account of thehealth of the troops in Africa.

Latest Views on Malaria.

Italy has hitherto maintained a foremost place in the- study of malaria, mainly on the etiological or pathogenic,side, and a notable contribution to our knowledge of its prophylaxis has just appeared from the pen of the sani-tary engineer, Signor Filadelfo Fichera, whose work, "PelRisanamento delle Campagne Italiane rispetto alla Malaria,"has been brought out by the well-known publishers, Hoepliof Milan. It consists of two large volumes, profusely illus-trated. in the first of which, after a survey of the latest’laboratory research, the author proceeds to discuss the meansopen to sanitary engineering for combating the fever, first’in its diffusion and ultimately in its genesis. An ex-

haustive bibliography is appended.Statistics of Sero-therapy in Diphtheria.

The "Society Piemontese d’Igiene,"at a recent meetingunder the presidency of Professor Bizzozero, discussed the.mortality from diphtheria under the new as compared withthe old treatment. From statistics carefully compiled by’Dr. Abba it appears that 55 per cent. was the proportion offatal cases up to 1894, whereas in 1895, when sero-therapywas practised for the first time, it fell to 34 per cent. and in1896 to 31 per cent. Another point made clear by thecliscussion was the superior safety of rectal injections as- contrasted with those practised hypodermically-the former,moreover, being quite as certain as the latter. To savetime, always of primary importance, Dr. Abba would applysero-therapy at once without waiting for bacteriologicaldiagnosis, and longed for the day when families would allow’the medical man far greater power of initiative than henow possesses. There was some objection to the postpone-’ment of bacteriological examination of pseudo-membrane,.as recommended by Dr. Abba; but this was overruled bythe President, who threw the weight of his authority on theside of immediate action.

The Health of t7ie Pope.It is nineteen years almost to a day since Leo XIII.

,ascended the pontifical throne, and on the 2nd prox. he willhave completed his eighty-seventh year. In view of the- celebrations prescribed by either anniversary Dr. Lapponihas been peculiarly vigilant in saving His Holiness all needlessexertion. The fatiguing functions connected with the

-coming canonisations, moreover, are another "rock ahead,"and Dr. Lapponi seeks to obviate their strain by reducingmeanwhile the number of audiences and shortening theirduration. His Holiness is at present in very good health;indeed, till the other day Dr. Lapponi’s visits had been

suspended for weeks at a time. The authors of recentannouncements as to "fainting fits

" and "intestinalcatarrhs" " are not well-inspired in the occasions they selectfor their "industry," as His Holiness invariably stands thewinter well, and it is only when the great heat sets in that anything approaching the " deliquii " in question are to bedreaded. i

Pevision of the " Farmcopea."The Italian Pharmacopoeia, is revised every five years, and

- another revision is imminent. The committee appointedfor this work consists of Dr. Emanuele Paterno, Professor ofApplied Chemistry in our University (who acts as president) ;Dr. Luigi Balbiano, lecturer on Pharmaceutical Chemistryand Toxicology in the" Scuola di Farmacia " and Dr.’Vincenzo Cervello, Professor of Materia Medica in theUniversity of Palermo. The committee has held its first

sitting and important innovations in the text of thePharmacopœia are expected.

Feb. 23rd. _______________

BUDAPEST.

(FROM OUR OWN CORRESPONDENT.)

Scarlet Fever in Budapest.AN elaborate paper on Scarlet Fever in Budapest since

1882 has just bsen read before the Budapest Medical Associa-tion by Dr. E. Jurkiny. No data of any accuracy were

available for the period before 1882 as notification of infec-tious diseases was not made obligatory until that year.From 1882 to 1896 no fewer than 19,952 persons sufferedfrom scarlet fever in Budapest, the average death-rate being13’5 per cent. The number of cases was generally lowest inwinter and highest in autumn, the latter being the season inwhich the public schools are re-opened. Dr. Jurkiny foundthat there was not one single week during the last fifteenyears without an occurrence of scarlet fever, and he was inconsequence led to the conclusion that the disease mustbe considered to be endemic in Budapest. At intervalsits prevalence assumes the proportion of an epidemic,and there have been three such epidemics since 1882.The first began in May 1886 and lasted eight months;the second began in August, 1890, and lasted tillOctober, 1892, that is to say for a period of twenty-six months; the third lasted from October, 1895, tillDecember of the same year, that is three months. A dis-

infecting institute opened in September, 1892, succeeded inquickly putting an end to the second prolonged epidemicand was no doubt the means of reducing the third epidemicto a duration of merely three months. Dr. Jurkiny pointedout several causes which combined to neutralise all efforts tostamp out the disease. I will quote only two. First, it happensoften enough that poor persons do not call in a medical man,partly because they are unwilling to incur expense, butchiefly because they object to their children being compulsorilyremoved to a hospital and fear that their furniture will bedamaged by disinfection. The present system under whicheven the poorer classes of the population are made to paythe heavy hospital expenses for their children does notappear to be a good one, especially in view of the factthat the patients are removed to hospital not so much fortheir own sake as for the benefit of the community at

large. Another factor very influential in promoting thedisease is the really miserable state of the dwellings ofthe poor. The town council may spend large sums in

providing a better water-supply and better drainage, andin carrying out other sanitary reforms, but it will not putan end to the endemic of scarlet fever until it radicallyimproves the housing of the poorer classes.

Intubation preceding Tracheotomy.Professor J. B6kay recommends intubation as a preparatory

operation in difficult cases of tracheotomy, having very oftenfound that tracheotomy was exempt from accidents of anysort when free respiration was provided for by means ofintubation. His first operation of this kind was performedquite independently of others as early as the year 1891, andhe has since then repeated it some sixty times.Feb. 19th.I

RUSSIA.(FROM OUR OWN CORRESPONDENT.)

Corporal Punishment.RESORT to the rod, if one might believe some sensational

writers, is as common in Russia as imprisonment in othercountries. That it was so at one time-or rather, that resortto the rod used to be more frequent in Russia than else-where-may possibly be true. With the unlimited powerformerly possessed by the landowner over the serf, itis not very surprising that this was so, But sincethe great Act of Emancipation in 1861 not only hascorporal punishment come to be much more rarely in-flicted than in the old days, but public opinion, or, more

exactly, the opinion of the intelligentzia or educated classes,has undergone a considerable change in the way it regardsthis question. There has been a growing feeling that theuse of the rod has a degrading and demoralising effect on theindividual submitted to it, apart from the serious and un-justifiable physical injuries it sometimes produces. Thepower of inflicting corporal punishment is now no longerin the hands of the serf-owner, but in those of thezemstvos, and several zemstvos have in recent yearsdecided to abolish entirely this mode of punishingcrime in their district and have even approached theGovernment urging its universal abolition throughout the

country. At the last conference of Russian practitioners inmemory of Pirogof the question was the subject of briefdiscussion, though no formal conclusion was arrived at. Itwas, however, decided to form a committee to collect in-formation bearing on the subject, and this committee has now