1243BERLIN.-SWITZERLAND.

THE LANCET have induced Dr. Reiche, one of the Imedical officers of health of Hamburg, to inquire into the 1

mortality from this disease in that city. Dr. Reiche has pub- ilished his results in the Deutsche Medieinisclae Wochenschrift I

and the Munohener Medicinische Wocleensohrift. He hasfound that in various years the deaths from carcinoma

proportionately to the population were as follows : in 1872 onein 1396 in 1882 one in 1207, in 1892 one in 1276, and in 1898one in 1022. This implies that of 100.000 persons living 71-63 Idied from carcinoma in 1872, 82-85 in 1882,78.39 in 1892, I

and 97’82 in 1898. The comparative mortality in the twosexes was as follows. From 1872 to 1880 the ratio of malesto females was 1 to 1’46, from 1881 to 1889 it was 1 to 1’49, I

and from 1889 to 1898 it was 1 to 1-29. The mortality fromcarcinoma has therefore increased in Hamburg, and it isremarkable that the death-rate of the male sex bids fair tobecome equal to that of the female sex. With regard tothe organs which were affected by the disease the reportstates that in the male sex the organs of digestion wereinvolved in 85’8 per cent., but in women in 40 per cent.only. In the female sex the preponderance of cancer of thegenerative system was remarkable, as 41’2 per cent. repre-sented cancer of the uterus, the ovary, and the mamma.As to the age of the patients it was found that thegreatest number of deaths from cancer occurred between 60and 70 years of age. During the ’last 27 years there was arelative increase of mortality in males between 40 and 55years of age and in females between the ages of 45and 55 years, whilst there was an absolute increase inmales above 40 years and in females above 45 years. Inanother article attention is drawn to the fact that theimprovement in the quality of the water-supply of Ham-burg which was made in 1894 has had no influenceon the death-rate from cancer. Whilst the general mor-tality, which was between 22-2 and 25’3 per 1000 duringthe period from 1888 to 1891, decreased at once, andwas only from 17-1 to 18’9 per 1000 during the periodfrom 1894 to 1899, the death-rate from carcinoma continuedto increase. It is interesting to compare the death-rate fromtuberculosis with that from cancer. In 1872, when Hamburghad 346,210 inhabitants, 1179 deaths from phthisis and 248deaths from cancer were recorded ; in 1899, when the city had744,132 inhabitants, 1443 deaths from phthisis and 797 fromcancer were recorded, so that the ratio between the two diseaseswas 4-8 to 1 during the earlier period and is now 1’9 to 1.All the circumstances by which the mortality from phthisiswas reduced, such as improvement of the food and thedwellings of the poorer classes of the population, were unableto check the increasing mortality from cancer. Dr. Reicheaccordingly tried to find whether there was any ground forsupposing that a more liberal food-supply might perhaps bethe cause of the increase of carcinoma as suggested by Mr.Williams. To this end he compared the wealth of thepopulation, the general mortality, and the mortality fromphthisis and carcinoma in the different districts of Hamburg.The result was that in the district of Harvestchude, where theaverage income of each inhabitant was 2770 marks and thegeneral mortality was 9’4 per 1000, the mortality from

tuberculosis was 9-4 per 10,000 and the mortality from cancerwas 8.0 per 10,000. In the district of Barmbeck, with anaverage income of 311 marks and a general mortality of25’7 per 1000, the mortality from phthisis was 21-7 per1O,QOO and the mortality from cancer was 8-5 per 10,000.From this it follows that the mortality from tuberculosisis very much less in a wealthy district than in a poor one,whilst in the case of carcinoma such differences do not exist.For phthisis the mortality varied from 25 5 to 9-4 per 10,000,according to the district, but for cancer it varied only from11’2 to 7’1 per 10,000. so that the latter is obviously indepen-dent of hygienic and social conditions. Dr. Reiche finallystates that the ratio of the mortality from cancer of thedigestive organs to the mortality from cancer of the otherorgans has not altered during the last 27 years. The theoryof Mr. Williams that the increase of cancer is connectedwith an increased consumption of food seems, there-fore, to be unfounded. The above results obtained byDr. Reiche are confirmed by the statistics of theGotha Life Insurance Company. In 1875, of 42,552 personsinsured 61 died from cancer (i.e., 1-43 per 1000), but in 1899of 92,732 persons insured 219 died from cancer (i.e., 2-36per 1000). A collective investigation on carcinoma will soonbe made under the patronage of the Government by a special

1 THE LANCET, August 20th, 1898, p. 481.

committee presided over by Professor von Leyden. Lettershave been sent to all the medical practitioners in Germanyasking them to register the cancer patients attended by themon Oct. 15th and to supply certain specified particularsregarding them.

’

The First Female Medical Graduate in Germany.It was in the year 1754 that the degree of M.D. was first

conferred on a woman in Germany. The Vossische Zeitung,of July 18th, 1754, mentions that the medical faculty of theUniversity of Halle had granted the degree of M.D. to Mrs.Dorothea Christiana Erxlebin after she had passed theexamination with distinction. The title of her " dissertation "-

which, according to the custom of that time, was written inLatin, was "Quod nimis cito et jucunde curare saepe fiatcausa minus tutae curationis." This lady’had been anapprentice of her father, a well-known medical practitionerat Quedlinburg, and as she could not matriculate at auniversity she learned medicine by reading only. By aroyal decree of Frederick the Great she was thenrecommended to the Faculty of Halle as a candidate forgraduation, but she presented herself only after the death ofher husband. She also published an essay on the utility oflearning for the female sex.

Oct. 22nd.

SWITZERLAND.(FROM OUR OWN CORRESPONDENT.)

The Swiss Medical Currieitlum.THE new regulations now in force have made the medical,

examinations even stricter than before and have prolongedthe course of medical training to a minimum of five years ;most students, however, devote six or seven years to studybefore going up for their final examination. There are threeexaminations to be passed. The examination in naturalscience embraces physics, organic and inorganic chemistry,botany, zoology, and comparative anatomy. The examina-tion in anatomy and physiology allows four hours fordissection and demonstration ; histological specimens have-also to be prepared, mounted, and described. A writtenexamination in physiology is required, the choice of threesubjects being given ; the oral examination lasts half an hourin each branch-anatomy, histology, embryology, and physio-logy. For the final examination-the Staatsexamen-whichadmits to the title "medical practitioner" (the M.D. being:a superior degree), certificates are required showing that thecandidate has spent five years in medical study and hasattended a stipulated number of lectures and courses. In

pathological anatomy the candidate has to open and examine-at least one cavity of the body and answer questions onpathology; microscopic and bacteriological preparations-have also to be demonstrated and mounted. Both in

pathology and therapeutics and also in surgery one patienthas to be examined, and a detailed account (etiology, dia-gnosis, differential diagnosis, and treatment) has to be-given in writing, for which six hours are allowed.Half an hour’s oral examination supplements this. Insurgery two operations on the dead subject, together with,questions on topographical anatomy, are required. Inobstetrics, gynaecology, and ophthalmology from one to twohours are allowed for examination of several cases, followedby an oral examination. Then there are papers required onhygiene (four hours) and on legal medicine or mental diseases.The final oral examination gives half an hour to each candi--date in general pathology, pathology and therapeutics,surgery, obstetrics and gynaecology, hygiene, legal medicine,mental diseases, and materia medica. More than half of thestudents serve generally in various cliniques as dressers orassistants for one or more terms to initiate themselves intopractical work, the out-patient departments usually receivingspecial attention. The students still attend lectures on

pediatrics, otology, rhinology, dermatology, and courses of-

ophthalmology, which, however, are not examinationsubjects.

Diphtheria and Albuminuria.Dr. Zollikofer, first assistant of the Berne Medical Clinique,

has investigated the connexion between albuminuria and

diphtheria in 338 cases observed from Jan. lst, 1897, toMarch 31st, 1900. Owing to the growing confidence felt bythe public in serum treatment many slight cases are sent to

1244 SWITZERLAND.-ROME.

the hospital, but also many severe and hopeless cases have tobe admitted. The cases are thus on an average ratherseverer than those treated in private practice. Trache-otomy was performed in 96 cases, which corresponds to apercentage of 28’4. The mortality only reached 10’5 percent. of all the cases and 18’75 per cent. of the cases

for which tracheotomy was performed. Albuminuria waspresent in 57’8 per cent. of the cases and could not beattributed to the serum injections as it was observed beforethe injections were given. Only in very rare cases of severenephritis could diphtheria bacilli be demonstrated in the

kidney after the post-mortem examination. The albuminuria

proved to be in direct connexion with the extension andpersistence of the diphtheritic membranes. Cases with

gangrenous membranes proved especially severe, and all thesecases, 24 in number, had albuminuria. Six of these cases(20 per cent.) succumbed to the disease. Four cases com-

plicated by otitis media, three by severe sepsis, and 24 byparalysis of the pharynx all had albuminuria and all hadbeen injected two or more days after the commencement ofthe illness. Of the tracheotomy cases 82 per cent. had’albuminuria. Albuminuria is thus of the greatest value as.a prognostic in determining the severity of the disease.

Ziirich, Oct. 22nd. ______________

ROME.

(FROM OUR OWN CORRESPONDENT.)

Observations by Professor Grassi on the Habits of theAnopheles.

ANYTHING from the pen of Professor Grassi relating tomalaria will be read with interest. He has just publishedanother note in the Rendiconti della R. Aceademia dei Lincei,describing some observations made by him in September oflast year and during the past summer at Grosseto with theobject of controlling the results obtained last year in Julyand August by Koch’s expedition. The latter, it may be re-membered, found very few anopheletes but a very greatnumber of culices in this city, although malaria was veryprevalent, and from this fact he considered it likely thatculex pipiens is also an agent in the propagation of malaria.Professor Grassi, on the contrary, has found anopheletesvery abundant in the same houses where Koch hadnoted malaria the previous year, and he concludes fromthis that Koch’s party were inexpert at the work oflooking for mosquitoes and that their search was not madein the proper places, which are the entrances of housesand outhouses and not in the bedrooms. He found thatthe favourite time for the anopheles to feed at Grosseto wasthe 30 or 40 minutes immediately after sunset and, to a muchless extent, the same time before sunrise. They take

long flights in search of food and like to go awayshortly after feeding, for which reason they may be said tochange every 24 hours, at least during the warm weather,only very few (about 1 per cent.) being consequentlyfound infected in the height of summer. As the weatherbecomes colder they remain longer and a larger proportion(about 8 per cent.) are found infected. The infected insectsare apt to be conveyed passively over long distances andso spread infection to fresh localities hitherto exempt.Anopheletes are found in some places where no malaria existsas, e.g., along the Lake of Como. Their larvae live freelyin salt water, and seaside places, though usually exempt, arenot invariably so. Professor Grassi, in conclusion, confirmsthe observations of Christophers and Stephens on theoccasional presence in the salivary glands of the culex ofbodies which resemble, but which he does not believe to be,sporozoites. He calls them pseudo-sporozoites.

The Protective Experiments against Malaria in theAgro Romano.

In a former letter 1 some account was given of the measuresthat were being taken to protect from mosquitoes the

employes along certain sections of railway, as well as thosein the service of the Acqua Marcia and of the electrictraction companies in the Agro Romano. The houses andhuts of Cervelletta and Castelia were also protected, themeans used being similar to those adopted by ProfessorGrassi in his remarkable Albanella experiment.2 Professor

1 THE LANCET, July 14th, 1900, p. 140.2 THE LANCET, Sept. 29th, 1900, p. 977.

Celli, who has had the supervision of the experiments,informs me that the results have exceeded expectation, allthe inhabitants of the houses and huts having remained quiteimmune from fever while those in neighbouring houses, pur-posely left unprotected for the sake of comparison, were allattacked by malaria. Of the 183 railway employes who weresubjected to the test only five contracted the fever, and inall of these the attacks were traceable to neglect of the

simple precautions recommended. The results thus obtainedhave proved so encouraging to the railway companiesand other employers of labour in the Agro Romano that it is

proposed greatly to extend the field of operations nextmalaria season, employing the same system of protection bymeans of wire gauze. The Society for the Study of Malariaintend to bring the matter before Parliament with the objectof obtaining State assistance for dealing with the disease bythe methods which these recent researches have shown to beso efficacious.

Pellagra in the Province of Rome.The occurrence of this mal de misere, the " Mailändische

Rose " of the Germans, though known in Central Italy, hasnever become so prevalent there as in the northern portionof the kingdom. In the province of Rome its very existencehas been unknown to people in general until the publicationof the recent report of Dr. Zampa, the medical officer ofhealth for the province, from which it appears thatwhen the sanitary inspection was made in 1899 some 150cases were discovered distributed throughout the district, butoccurring chiefly at Onano, Piglio, Prooeno, Palestrina,Cave, and Valmontone. More than one-half of these (80cases) were found at Onano, where indeed the diseasehas assumed an endemo-epidemic character. The date ofits first appearance in the province is uncertain, but in 1869it was known to have already existed for some time. In1881 there were only about 30 "pellagrosi," but in 1897 thenumber had risen to over 100, located principally at Onanoand Piglio. No connexion has been traced between thedisease and topographical conditions, the affected communeslying indifferently sometimes in the malarial, sometimes inthe non-malarial, zone. The malady attacks by preterencethe agricultural classes, but in the rural communes does notaltogether spare artisans, even those better off, the explanationbeing partly that less difference exists here than elsewherein the conditions under which the agricultural and artisanclasses respectively live, partly because of the widespreadmisery caused by the deficiency or absence of crops in somelocalities during the last two or three years owing to whichtheir means of subsistence were reduced to maize alone.Onano, where the disease is most prevalent, lies amongst thehills at an elevation of close upon 1800 feet above sea-level,in a situation naturally salubrious, but its houses are so con-structed for the most part as to be nothing better than dampgrottoes, dirty and dark, with no ventilation whatever.The drinking-water is very scarce and after rain it is oftenmuddy, and the only food for the poor people duringthe greater part of the year is

" polenta," a kind of porridgemade of maize meal seasoned with a little salt. The remediesproposed by Dr. Zampa consist in limiting the consumptionand improving the supply of maize by exercising care in

selecting and storing the grain, so that the people may get itsound, dry, and of good quality ; at the same time amelio-rating the insanitary conditions of the houses and their sur-roundings which conduce to the production of the disease;and, finally, by the appointment of a provincial commissionwith communal committees, such as exist in other districtswhere the disease is of old standing, for the purpose ofcollecting information as to its spread, of advising or adopt-ing measures for its prevention, and of organising the dis-tribution of subscriptions from public or private sources

amongst its victims.

Haemorrhagic Small-pox near Salerno.Seven cases of "black" small-pox, one of which has

already proved fatal, are reported from Nocera Inferiore onthe Naples and Salerno line of railway. Much apprehensionis felt lest the disease should spread and precautionarymeasures have been taken by the prefect in regard to theisolation of those attacked and the vaccination of thepopulation of Nocera and its neighbourhood.

The Ostia Experiment.The period assigned to the experiment in the Roman

Campagna planned ’by Dr. Patrick Manson is now so near itsclose that the successful result of this also may be regarded