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WILLIAM HOPKIN THOMAS, M.D. ST. AND.,M.R.C.S. ENG.. L.R.C.P. EDIN., J.P.

DR. WILLIAM HOPKIN THOMAS died at his residence,Bronygarn, Maesteg, Glamorganshire, on April 13th, in his59th year. The deceased received his medical education at

King’s College Hospital, London, and took the qualificationsof M.R.C.S. Eng. and L.R.C.P. Edin. in 1863 and 1870

respectively. He graduated M.D. St. Andrews in 1894. Dr.

Thomashad a large practice at Maesteg where he had residedfor the past 33 years. He was formerly medical officer tothe Maesteg Local Board and also surgeon to severalcollieries. Dr. Thomas was a magistrate for Glamorgan-shire and had been a member of the Maesteg District Councilfor several years. The deceased was highly respected inMaesteg and the district ; he leaves a widow with sevenchildren, for whom much sympathy is felt.

DEATHS OF EMINENT FOREIGN MEDICAL MEN.-Thedeaths of the following eminent foreign medical men areannounced :-Dr. G. L. K. Zedelius, who is described as theforemost of the German medical practitioners in Shanghai.He was chief medical officer of the hospital and was

attached both to the German and Austrian Legations asmedical attendant. He was 46 years of age.-Dr. JosephEngel, who was assistant to Rokitansky until, about 50 yearsago, he was appointed Professor of Pathological Anatomy inZurich. Thence he migrated to Prague, where he was professorof the same subject, and from there he returned to Vienna,where he held the corresponding chair, not in the university,but in the Josefs Academy, the Military Medical School. Hehad been in retirement for several years and was in his 84thyear.-Dr. Alfred Graefe, formerly Professor of Ophthalmologyin the University of Halle. In early life he was assistant tohis very eminent relative, Albrecht von Graefe. He was

obliged to resign his chair some seven years ago on accountof ill health. He published a number of papers on diseasesof the eye and in conjunction with Dr. Saemisch a largeHandbook of Ophthalmology.-Dr. Hullmann of Halle, towhom the profession in Germany is much indebted for hisactivity in the region of medical politics.-Dr. Eugen Seitzwho is well known as the author of a manual of Percussionand Auscultation and also from his connexion with Nie-meyer’s classical Handbook of Medicine. He was 82 yearsof age and died in Wiesbaden where he had lived for manyyears in retirement.-Dr. Theodor Neureuther, Professor ofthe Diseases of Children in the Bohemian University ofPrague.-Dr. W. W. van Arsdale, Professor of Surgery in theNew York Policlinic and Hospital.-Dr. J. A. Benson, Pro-fessor of Physiology in the College of Physicians andSurgeons, Chicago.

THE GERMAN SURGICAL CONGRESS.

(FROM OUR BERLIN CORRESPONDENT.)

THE twenty-eighth congress of the German SurgicalAssociation was opened on April 8th in Langenbeck House,Berlin, the president being Professor HAHN of Berlin.

Loose Cartilages in the Joints.Professor EoxiG (Berlin) read the first paper, the subject

being Loose Cartilages (Gelenkkorper) in the Joints. Hehad seen 70 cases of this condition, eight of them beingcaused by arthritis deformans and 16 as the result of injury.With the exception of 10 cases all of them involved eitherthe knee or the elbow. The great majority of the patientswere young and all of them with the exception of threewere of the male sex. There are as a rule rheumatic painsin different joints. The function of the joint is deranged, thepower of extension being especially interfered with. In thefirst stage the adventitious body is attached to the cartilagesso that it is sometimes difficult to remove it ; in thesecond stage there is only a loose connexion with thecartilage and finally no connexion at all. In rare cases

the free bodies may be absorbed. The etiology of the con-dition is not entirely known. Sometimes it follows injury ;but in experiments made on dead bodies Professor Konig didnot succeed in loosening any cartilaginous fragments. Thediagnosis is made easy by skiagraphy.

IntlíeaUonsfor Oerations in Epileps.Professor KoCHER (Berne), speaking on this subject, said

that current opinion as to the possibility of curing epilepsyby an operation was much less hopeful than formerly. Thestatistics published by Dr. Graf and Dr. Braun showed a,successful result in only from 2 to 4 per cent. of the cases.The excision of the cortical centre suggested by Professor vonBergmann was a real improvement, so that the results werenow better. The essential point is to diminish intracranialipressure and the dura mater ought therefore to be incised inevery instance. By this method a permanent cure was.

obtained in 54 per cent. of the cases. In the cured cases.he had found that the wound in healing had formeda soft and yielding cicatrix, whilst in cases which.

relapsed the cicatrix was very dense. The influence ofincreased pressure in producing epilepsy was made obvious.by experiments on guinea-pigs and the increase of pressure was.demonstrated by a cannula introduced through the cranium.Foreign bodies introduced into the brain did not produce the’disease. Sequestra must of course be removed, but the-principal thing is to diminish pressure by excising pieces ofthe dura mater : the hole must not be made too large.-Professor VON BERGMANN (Berlin) said that epilepsy was.caused by the so-called spasmophilic" " state of the brain,and that 90 per cent. of the cases were hereditary. Opera-tions were successful only in the non-hereditary cases.With regard to reflex epilepsy he was of opinion that inhereditary cases epileptic convulsions caused, for instance .by a cicatrix in the sciatic nerve would persist even afterthe removal of the cicatrix, whilst in cases independent ofheredity the operation might be successful. The only reliable-operation was excision of the cortical centre. A definite.

opinion as to the success of the operation ought not to begiven too early as he had seen a fatal issue even four years.after the operation.

Porencephaly.Professor voN BERGMANN said that four symptoms were

characteristic of porencephaly-paresis and contractures,.stunted growth of the extremities, epilepsy, and idiocy. Heshowed a young girl with a defect in the cranium in whom,the above symptoms had been present. The aperture was.closed by a plastic operation and the epilepsy ceased. A-small cyst in the cortex communicating with the lateral,ventricles was drained, but when the drain was removed,the convulsions reappeared.

Recovery frona Gunshot Wound of the Brain..Mr. A. E. BARKER (London) reported the case of a mar

who had attempted suicide by firing a seven millimetrerevolver bullet through his palate into the skull. There was.at first only a little haemorrhage from the nose and ptosis ofthe right side without loss of consciousness. On the twelfth,

day he vomited and on the twenty-eighth day there was.hemiplegia. On the thirty-second day he was admitted intc,University College Hospital, London, with paresis of the leftside. The patellar reflexes were increased and there was some-vomiting, but there were no convulsions and no difference.between the pupils. ’ On the forty-second day the man’s.state had improved. By the Roentgen rays two bullets wereseen, one being lodged in the corpus callosum and the other-on the sphenoid bone. On the sixty-fifth day the patient.had a severe epileptic fit preceded by giddiness and loss of’consciousness. On the sixty-eighth day two fits occurredwith convulsions, especially of the left side. On trephining.it was found that there was considerable intracranial’pressure and the bullets were removed. After the operation.paresis of the left side returned but became better on thefollowing day. The patient is now apparently recovered.

Professor KRONLEIN (Zurich), Dr. KÖSTL (Berlin), Dr.LAUENSTEIN (Hamburg), and ‘Dr. VON BECKH (Carlsruhe),.reported other cases of operation on the brain.

SECOND DAY.Resection of the Vertebral Areltes in Spondylitis.

Professor TRENDELEXBURG (Leipsic) said that paresis of-the extremities in spondylitis was caused by spinal pachy-meningitis and operation should be resorted to when there-was extradural exudation. Of 27 patients formerly treatedin the Leipsic Hospital more than 80 per cent. died. Ofthose operated upon one died eight months after havingleft the hospital, four recovered, one was not improved,and three were still under observation. The operator havingmade a large semicircular incision over the protuberance.removes the skin and the muscles from the bone and then.resects the vertebral arches with Luer’s forceps. It is neces

sary to remove the vertebral arches over the whole of the

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compressed dura mater ; the wound is then closed by sutures.In all the cases healing took place by first intention. Pro-rfessor Trendelenburg summed up as follows : (1) paresis inspondylitis is caused by compression ; (2) the compressionis due either to pachymeningitis or to narrowing of thevertebral canal ; (3) cases in the first stage should not beoperated upon ; and (4) success is possible even in very old-standing cases, the symptoms in one of his patients whorecovered extending back to 17 years ago.

Micro-organisms in Wounds.Dr. FRIEDRICH (Leipsic) said that it would be of interest

to know whether the micro-organisms in wounds were

dmmediately taken up by the circulation and whether theygrew at once in the wound even during operations. Thesecond question must be answered in the negative ; in openvessels filled with blood-serum kept at the temperature ofthe body and covered after a certain time Dr. Friedrichtround that the bacteria did not commence to grow for sevenhours. The degree of pressure under which the virus isintroduced into the wound is very important. It has beenfound, for instance, that the stump of the amputated tail ofan animal when only dipped into a virulent culture ofanthrax bacilli did not become infected, whilst injections made with the same culture killed the animal at once.

-Lateney of Micro-organisms.Dr. SCHNITZLER (Vienna) said that pathogenic micro-

.organisms were often found in apparently healthy persons,and were especially apt to persist for a long time in con-valescence after infectious diseases. This fact is of interestfor the surgeon as explaining the relapsing form of osteo-myelitis. Dr. Schnitzler found staphylococci in the scar in acase of osteomyelitis two years after healing bad occurred.When micro-organisms were injected into the veins of.animals he had found them after several weeks in the bonemarrow and by fracturing a bone he was able to produce.acute osteomyelitis 29 days after the injection.

Noma.’Dr. PERTHES (Leipsic) has made a bacteriological examina-

tion of two cases of noma. In the necrotic tissue there wasof course a great mass of bacteria of various kinds, but atthe margin of the necrotic part near the healthy tissue hefound a micro-organism very similar to streptothrix and

possessing a mycelium. These micro-organisms were pre-sent in both cases but only at the margin ; inoculation ofthem into dogs gave rise to a slight necrosis but not tonoma. Dr. Perthes, however, is of opinion that these micro-organisms are the specific cause of noma. ,

" Gangrène Foudroyante."’Dr. LINDENTHAL (Vienna) has observed six cases of this

comparatively rare condition. As a rule it results from- extensive lacerations of the extremities where the woundsfhave come into contact with earth or dust. Within 48 hours.after the injury there occur diffuse oedema of the extremi-ties, cyanosis of the skin, large vesicles on the skin,loss of sensation, and a peculiar crepitation of the tissues.The patient’s general state is very bad and jaundice is veryfrequent. The anatomical changes consist in a progressivenecrosis accompanied by the formation of gas. In five ofthe six cases he discovered an anaerobic bacterium and inthe sixth case bacterium coli commune. Early amputationmay perhaps save the patient, but death occurs in the greatmajority of cases.

NOTES FROM INDIA.(FROM OUR SPECIAL CORRESPONDENT.)

The Spread of Plague.- Vital Statistics.-The Jigger inBombay.-The English Plague Sisters.

’WHILE the severity of the plague epidemic in India isnot so marked (2689 deaths for the week ending April 1st)the disease seems to be spreading far and wide. Many freshplaces have been attacked. Cases have occurred at

Amritsar, at Falna, at Hyderabad (Sind), at Gurchah, at

Nagpore, in the Jullundur district, and in the Bhagulpurdistrict. Many places in the Bengal Presidency are showing’evidences of the disease for the first time. The officialaccount of plague in India gives the ;following figures, butthey are probably much under the correct numbers :Bombay (and Sind), 2051, of which 992 are entered for

Bombay city ; Baroda, 142 ; Karachi, 213 ; and Thanu, 132.In the Madras Presidency it seems quickly declining, only 50cases being recorded, of which North Arcot furnished 30.There were 108 in Mysore, 33 in Hyderabad (Deccan),and five in the Punjaub. In the Bengal Presidency therewere 370, of which 191 were furnished by Calcutta, 13 inDarbhunga, 24 in the 24 Parganas, and 74 in Saran. InKarachi the disease seems to be spreading notwithstand-

ing that the outbreak has already lasted nine weeks. InPoona, however, it keeps about stationary. In consequenceof the plague having infected several places in the BengalPresidency and being on the increase in Calcutta quarantineregulations have been instituted in Colombo. In Bombaythere are indications of improvement, but the mortality is

still terribly high, the rate for the past HEek being over 130per 1000 per annum.The differences of mortality among the various races and

castes are interesting. They stand as follows : Jains, 144’3per 1000 per annum; Brahmins, 93; caste Hindus, 159’6;low caste Hindus, 227’9; Mahomedans, 122’7; Parsees,56.9 ; native Christians, 106 0 ; and Europeans, 32-2. TheMahomedans and the low caste Hindus seem to givefalse returns as to the causes of death very frequently, fornotwithstanding their high rate of mortality very few casescomparatively are returned as plague. The outbreak ofmeasles in Bombay is increasing, but I suspect that manycases of plague are recorded under this disease. Relapsingfever also continues prevalent, but diseases of the respiratorysystem seem to be most popular for covering deaths fromplague. Judging from the number of births there is noreason to suppose that the population is above the average.In Poona, however, there is said to have been a great exodus,nearly half the town being empty.

In Calcutta the epidemic is only slowly increasing notwith-standing that the cases seem scattered all over the city. Theaverage normal death-rate is 45’3 per 1000 per annum forCalcutta, but it is now raised to 54 4. All persons connectedwith the Government of India proceeding to Simla have beenvery carefully examined and will be kept under observationfor 10 days. Measures have recently been instituted for theexamination of all passengers out of Calcutta, both by railand boat, with the object of protecting the Mofussil. As,however, this is already and considerably affected the

arrangements come much too late. Moreover, as the exa-mination of passengers is hasty and superficial only personswho are markedly ill can be recognised. An exodus ofnatives from Calcutta has commenced notwithstanding theattitude of non-interference taken by the authorities. Largenumbers are leaving by routes other than those generallyused in order to avoid medical inspection. The Marwaris arethe chief offenders in this respect.Minor disturbances are continually occurring at different

places in connexion with plague operations, but a somewhatserious one is reported from Nagpore. Plague officers ofhigh rank were stoned and were obliged to take refuge in theMayo Hospital. A washerman’s child was being removed to

hospital when the disturbance commenced. There is a

strong and widespread feeling among the poorer classes inNagpore against the plague regulations which is fostered bysome of their richer brethren and all sorts of false rumoursare maliciously circulated. ’

Various rumours have been put about in Calcutta as tosupposed forthcoming regulations, which have created a

feeling of discomfort among the native population, and itwill not be surprising if disturbances occur here also.Twelve patients are suffering from jigger in the Goculdas

Tejpal Hospital, Bombay, the disease having been newlyimported from British East Africa. Jigger is a very minuteflea and the disease is caused by the fertile female whichburrows under the skin. Any part of the body may beattacked but the feet are usually infested mainly betweenthe toes and near or under the toenail. The presenceof the insect under the cuticle is at first marked onlyby a minute black spot which may be invisiblewithout a magnifying glass especially in a dark skin.The parasite soon enlarges to the size of a small peaby development of the egg sac which when mature lookslike a drop of pus beneath the cuticle with the body of theflea as a black spot in the centre. If left alone the sacbursts and the eggs escape. Severe pain attends the presenceof the parasite and troublesome ulceration may follow.Captain Kilkelly, I.M S., first reported that jigger had firmlyestablished itself at Mombassa and when his regiment wasvoyaging to Bombay no less than 26 cases occurred. He