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In cases of very large schools two or more medical inspectorsmight be employed. With regard to payment, the planwould have to be worked out in detail, as this onlyclaims to be a suggestion.’ In dealing with endowedschools there would be comparatively little cifficulty. A

board school medical inspector might be paid cut of the

rates. One attending a high school might be paid by meansof an extra 4s. or 5s. per annum being charged. Parentswould probably not grudge some small sum for the greaterfeeling of security against infection being brought homefrom school to younger brothers and sisters." The sug-gestion is one that is eminently sensible, and can onlypossibly be objected to on the score of expense. Yet if

ratepayers would only bear in mind that the prevention ofepidemic disease is far more economical than its dissemina-tion, that objection could not be sustained ; whilst schoolmanagers and parents would welcome the introduction ofa system which would safeguard their pupils and childrenfrom infection.

TUBERCULOUS MENINGITIS AFTER HEAD INJURY.

EVERYONE who has seen many cases of tuberculous

meningitis must have been struck with the frequency withwhich the symptoms come on after injury ; but it is not

often so easy to connect the two as in a case recentlypublished by Dr. Buol and Dr. Paulus in the Correspondenz-blatt /M7’ Schweizer Aerzte, of which an abstract appears inthe last number of the Neurokqische3 Centralblatt. A

young, strong man, aged twenty-eight years, received daringa fall an apparently insignificant head injury. Immediatelyafter he developed headache, slowing of the pulse, aphasia,and finally unconsciousness, and he died fourteen daysafter receiving the injury. At the necropsy there was

found very distinct tuberculous meningitis over the convexityof the brain, and in the centre of the tuberculous area werefound two splinters of bone from the inner table. The

tuberculous nature of the disease was confirmed by micro-scopic examination. The patient had suffered in 1893 from.right-sided pleurisy and apical catarrh, .and it seems almostunreasonable to doubt that the injury in this case was themeans of determining the local outbreak of the tuberculousprocess in the brain.

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"PESTIS MINOR."

IN "Some Remarks on Plague," which Dr. Lowson con- ]tributed to THE LANCET of Feb. 13th, the interesting question ]

is raised as to the nature of certain glandular swellings which ]

occurred at Hong-Kong during the recent outbreak of plague in that island. Dr. Lowson is disinclined to argue with Dr. Cantlie that the glandular swellings to which Dr. Cantliereferred in his paper before the Epidemiological Society were of the nature of "pestis minor " or "pestis ambulans. ’Dr. Lowson differentiates in these terms between these twoforms of "pestis." Pestis minor is that bubonic diseasewhich occurs (?) before an outbreak of plague, while pestis ambulans is the designation applied to glandular enlarge-ments occurring during or after an epidemic which may i

probably be due to a less potent infecting power." i

As to the existence or non-existence of "pestis minor" ior "pestis ambulans" " in Hong-Kong, we can but ]

rely upon those observers who were present during the outbreak, and it is unfortunate that there is this 1

difference of opinion. There can, however, be no doubt 1

that the existence of anomalous glandular swellings during (

prevalences of bubonic plague is recognised by many observers and by most writers, and that there should be these 1

anomalous expressions of the plague is what upon general iepidemiological grounds is to be expected. One of the best (

known instances where these glandular enlargements were seen was in the outbreak of plague which occurred in Meso- ]potamia in 1876-77, and of which a most interesting account i

s may be found in part 11, vol. iv. of the Transactions of the1 Epidemiological Society. The account is written by Dr.

E. D. Dickson, physician to the British Embassy at Con-i stantinople, and is compiled largely from the notes of Dr.L Giovanni Cabiadis, which were made by him as the results of his observations at Hillat and Bagdad. In this account

s Dr. Dickson thus writes as to the history of the outbreak :-S " Two or three months previous to the manifestation ofr plague in Mesopotamia glandular swellings free from fever

prevailed in that country. They showed themselves in the- groin, armpit, or neck, and were not accompanied by other

symptoms. They began to appear amongst the inhabitants

’f about the end of autumn and continued through the winter,but towards the end of it the plague broke out and reached its

E acme of intensity in the spring....... On the cessation of- the plague apyretio glandular swellings re-appeared again1 precisely similar to those which had preceded the outbreak,e and they continued to manifest themselves for about two

months longer. These glandular swellings were frequentlymet with and were distinct from the chronic adenitic swell-

ings met with in subjects of scrofulous tendency andevidently unconnected with any special diathesis."It is "pestis minor" or "pestis ambulans" in the abovesense which the medical officers of health in such of our

ports as have communication with India will do well to be’

on the look-out for. ___

"THE EMPIRE AND THE ARMY."

, UNDER this heading the Spectator of Feb. 27th has an

; article with the spirit of which we quite agree. Apropos ofthe proposal to restore the name of the Royal Canadian

, Regiment and place its depot at Toronto, our contemporarysays it would like to see the territorial system ex-

tended to the colonies in order to make them feel, that they form a part with this nation of one and

: the same great organism and are taking their place undera common flag. For this purpose it is suggested that

, the dep6t of a British regiment might be located in

Australia, New Zealand, and the Cape, in addition to onein the Dominion of Canada. Setting aside the idea, which

, is probably destined to develop until it becomes a dominating, idea, of a confederated Empire in which all shall bear a

part, we should be in this way widening the area of ourrecruiting ground, and this is very desirable and will soonbecome necessary if the growing responsibilities of Britishrule are to be fulfilled. Oar Army is a volunteer army andnot maintained by conscription. When work is plentifulrecruits are scarce ; when it is slack recruiting is brisk. But

the Army establishment is fixed by Parliament and cannot beexceeded, and the consequence is that we are constantlyshifting the standard of physical requirements according tothe state of the labour market, instead of taking recruits whenwe can get them of the most desirable kind. The British

Army, it is true, shows no decadence of enterprise and courage.We have had numerous expeditions and little wars of late inwhich our soldiers and sailors have borne themselves as wellas ever they did, but on physiological and medical groundsit is obviously very desirable that we should attract an

increasing number of intelligent and enterprising youngfellows of superior physique into our Army. This proposalpromises to open out a way of effecting this object. Of

course, there are difficulties of an official and financial nature

to be overcome, but they are surely not of an insuperablekind. If we could manage to weld our colonies into closerconnexion with us and get them to bear their shareof responsibilities which are mutual and common to

both all anxiety about the maintenance of land and sea

forces on a scale adequate to our requirements would bedissipated. The statesman who could devise a scheme for

accomplishing this, by opening out a career in the Army andNavy for our young colonists, or, in other words, by suggest-ing a method by which each of our large English-speaking

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colonies and dependencies should contribute its quota to thestrength of the Army and Navy, would most deservedly makefor himself a great reputation. We believe that it could be

done, and the trend of things goes to show that one day itwill be done..

"EARTH TO EARTH BURIAL."

SiR F. SEYMOUR HADBN contributed a paper on " Earth toEarth Burial" last week at a meeting of the Church of EnglandBurial, Funeral, and Mourning Reform Association, held at theWestminster Palace Hotel. Mr. H. D. Greene, Q C., M.P.,presided. Sir F. Seymour Haden in the course of his papersaid it was absurd to enclose the bodies of the dead inhermetical enclosures, which only hindered nature’s process.Properly buried the body rose from the grave in the form ofelements necessary for the renewal and growth of plants.In the case of a body buried a foot deep this process wasaccomplished in a year, and in the case of a greater depth atabout the rate of another year for every foot of depth.

BIRMINGHAM AND THE DIPHTHERIA EPIDEMIC.

WE congratulate the gentlemen who attended the meetingheld at the Birmingham Medical Institute, under the

circumstances described by our Birmingham correspondentin our present issue, upon the eminently satisfactory resultof their deliberations. A disease so generally fatal and soinsidious as diphtheria should be met and fought in everypossible way, and the sooner it is attacked the sooner it will beovercome. Prompt isolation, which connotes prompt diagnosis,is the first line of defence, and the use of a genuine anti-toxic serum at the earliest possible moment is the chief

weapon of attack. If Birmingham, as she is apparentlygoing to do, provides herself with these munitions of war.against disease, she may possibly reduce diphtheria to a

vanishing point. _

HEMIANOPSIA IN ABSCESS OF THE BRAIN.

AN interesting case is related by Lannois and Jaboulay ina recent number of the Gazette Médicale de Paris, in whichthe prominent symptoms were alexia, agraphia, word-blind-ness, right-sided hemianopsia, and facial paralysis. Eardisease was present, and the symptoms pointed to the

presence of abscess. No pus was found at first on operating,but three weeks later puncture was again tried and a

collection evacuated. Eleven days later the patient died,and a large abscess was found in the centre of the left

occipital lobe and diffuse encephalitis affecting the centraland frontal convolutions of the left hemisphere. There wasalso a small purulent collection in the third frontal convolu-tion. The points in the case which are of special interestare that pus was not found on the first occasion, a mishapwhich the writers ascribe to a blocking of the hollow needlewith which the puncture was made. The second point isthe presence of hemianopsia, and they rightly insist uponthe importance of looking for this symptom in all cases ofsuspected abscess. It is not unfrequently present.

RAPIDLY OCCURRING HEMIPLEGIA IN ACUTELEAD POISONING.

DA COSTA’ relates the following case. The patient was awoman, aged thirty-five years, in good health. Some rooms inthe house, but not her bedroom, were painted, and the housebecame filled with the odour. From the first she complainedo headache, which became so severe in three days thather medical attendant was summoned. He found that her

speech was thick, the tongue slowly protruded and deviatedto the right, and that there had been vomiting. Movement

1 American Journal of Medical Sciences, February, 1897.

of the right arm and leg was much impaired, especially ofthe latter. This had been preceded by numbness. Theloss of power increased and she was forced to remain inbed. Shortly, after the right side was affected, numbnessand a sense of coldness on the left side were noticed, butnever motor weakness. Four weeks after the attack, whenhe saw her, the right arm could be feebly moved, but thegrasp was very weak and the leg powerless. There was no

wrist-drop, foot-drop, tremor, or muscular atrophy. Nofacial paralysis existed, and the tongue was protrudedstraight. The knee-jerks were exaggerated, especially theright. There was an increased reflex in the forearm bothon tapping the flexors and extensors. There was no

anaesthesia or tender spots in the course of the nerves.

Tactile sensations were well preserved in the hands.With a strong light a bluish line was found on the

gums, especially round the lower left incisors. Iodideof potassium and sulphate of magnesium were prescribed,and she gradually recovered. The case is remarkable in

many respects. The onset of paralysis three days afterexposure is unprecedented. Tanquerel des Planches 2

mentions three cases in which it occurred in eight days. Theform of paralysis-viz., hemiplegia-is the rarest of all. Theabsence of hemianæsthesia, as far as could be observed, isunusual; so is the affection of the nervous system withoutpreceding colic. In 102 cases Tanquerel found this to havehappened in only fourteen.

PROFESSOR KOCH’S RESEARCHES ONRINDERPEST.

IN a report to the Cape Secretary for Agriculture, datedKimberley, Jan. 31st, 1897," Professor Koch gives anaccount of his investigations upon the rinderpest up to thattime. He first shows that the micro-organisms discoveredby Dr. Edington cannot be the cause of the disease, sinceinoculation with cultures of these microbes did not produceany effects and, further, animals so treated were foundto be just s susceptible to subsequent inoculationwith rinderpe blood. His experimental inoculationson sheep and goats, carried through several generations, didnot result in any evidence that the virus had been markedlyattenuated by this process; indeed, it would rather seem asif, so far as the sheep were concerned, the cultivation ratherincreased the virulence than diminished it. On the other

hand, in the goats there was evidence of a slow attenuation.His observations upon these animals have led him to thebelief that in farms infected by rinderpest sheep andgoats may at first contract the disease in so mild a

form as to escape notice, and that the disease becomes

more virulent by being continuously propagated throughthese animals. This view would explain the discrepantstatements made as to the liability of sheep and goatsto be attacked by the disease. He found that rinder-

pest blood mixed with glycerine or with phenol lost its infec-tive property, and that although in the case of an animalinoculated with the glycerine mixture the animal was stillsusceptible to the disease, there was a marked resistance tothe effects of subsequent inoculation with unmixed rinder-pest blood in an animal treated with the phenol mixture.Dilution with distilled water or normal saline solution carriedeven to an extreme degree did not appreciably affect

the virulence of rinderpest blood. Desiccation of the rinder-

pest blood did, however, deprive it of its infectivity. Themost interesting part of this report is that where ProfessorKoch shows that animals who have recovered from an attackof rinderpest are not only themselves immune from thedisease, as proved by their being unaffected when inoculatedwith rinderpest blood, but that the blood of such immuneanimals exerts a protective power -for an animal

2 Traité de Maladies de Plomb, tome ii., p. 19.