1365THE USE OF TOBACCO ON ACTIVE SERVICE.

which had ever been found in the raw water) might we notbe doing harm rather than good ? Still this pessimisticview need not trouble us much, for health statistics provedthat the risk of harm arising either from the presence in thewater of so-called pathogenic organisms or from the removalof the harmless ones was so small that it might be calmlydisregarded."These comfortable words of Mr. Mansergh with regard topathogenic germs were followed by a warning a9 to the

danger which may be apprehended from water derived fromsources hitherto considered pure. " A word of warningmight, however, be said about water obtained fromelevated and sparsely-populated moorlands, for," he said,"the danger was greater if such water became infected,especially if not passed into impounding reservoirs, thanif the supply were taken from a large river." We hopethat the members of the Institute of Civil Engineers and thedistinguished guests passed a pleasant evening and returnedhome reassured by the fact that the water of London withits pathogenic germs which can be calmly disregarded isstill derived chiefly from the Thames and the Lea, uncon-taminated with any water from " sparsely-populatedmoorlands"-the "pure nectar from Wales," as it wascharacterised by Lord Llandaff.

THE USE OF TOBACCO ON ACTIVE SERVICE.

THE war in South Africa has taught many things of

greater and of less importance. Perhaps nothing that it hasdemonstrated has been more marked than the important partwhich tobacco plays in the soldier’s existence. Whether thisis to be reckoned as a great fact or a small one there can beno doubt about the truth of it. Yet the Duke of Wellington’sarmies had no tobacco worth speaking of. If they did notforbid its use, at any rate the Iron Duke’s officers were

directed to advise their men strongly against it. What acurious contrast with the campaigning in South Africa,where marches and privations as long and as stern as anysuffered by our great-grandfathers were borne by the volun-teers and soldiers of to-day with a grumble only when their" smokes" failed them. We have it from many who took

part in the forced marches leading to Paardeberg, to Bloem-fontein, to Pretoria, and beyond, that when rations werebut two or three biscuits a-day the only real pbysicalcontent of each 24 hours came with the pipe smoked bythe smouldering embers of a camp fire. This pipe eased theway to sleep that might otherwise have lingered, delayed bythe sheer bodily fatigue and mental restlessness caused byprolonged and monotonous exertion. It is difficult, then, tobelieve that tobacco is anything but a real help to men whoare suffering long labours and receiving little food, and

i

probably the way in which it helps is by quieting cerebra-tion-for no one doubts its sedative qualities-and thusallowing more easily sleep which is so all-important whensemi-starvation has to be endured. The cases of acute

mental derangement in the course of campaigns such as thepresent are many. There have indeed been many in SouthAfrica. It would be most profitable and interesting couldmedical officers have taken special note of the capacity forsleep previously evidenced by those who broke down andalso of their indulgence or non-indulgence in tobacco. Weare inclined to believe that, used with due moderation,tobacco is of value second only to food itself when longprivations and exertions are to be endured. Two features areto be noted with regard to the smoking practised on activeservice. It is almost entirely in the open air and it is

largely on an empty stomach. The former is always anadvantage ; the latter we generally reckon a most unfavour-able condition. Shall we see in the near future patientswith tobacco amblyopia or smoker’s heart acquired whilethe trusting friend of tobacco thought that he was

enjoying unharmed the well-earned solace of a hard day’s

march ? We believe not, and that the open air will havesaved what might have been the untoward results of smokingwhen unfed.

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MEETING OF THE GENERAL MEDICAL COUNCIL.

SUMMONSES have been issued for a meeting of theGeneral Medical Council on Tuesday, Nov. 27th, at 2 P.M.The Penal Cases Committee will meet on the precedingSaturday and the Executive Committee on Monday,Nov. 26th.

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THE INSPECTION OF CONVENTS.

A LETTER which appeared in the Times of Nov. 5th raisesa most important point. We are not among those whoconsider that convents are dens of iniquity, that the

bricking up of recalcitrant nuns is of daily occurrence, orthat excavations in the back-gardens of convents wouldreveal facts such as those which horrified the pious inhabi-tants of Cologne when, in 1106, they dug anew the founda-tions of their walls and came across the bones of the 11,000virgins and others. But the correspondent to whose letterwe refer mentions facts, which so far have not been denied,which reveal a most dangerous state of things. The doors (ofthe convent to which the writer refers) into the street arelocked at night and the keys are handed over to the reverendmother, there being no means of exit until she is com-

municated with. An outbreak of fire occurred which

fortunately did not end in disaster ; but how easily it mighthave done so. To our minds, as regards sanitary and hygienicconditions, the palace, the ordinary dwelling-house, the con-vent, and the tenement house should all be under the sameregulations. Epidemics and fire are no respecters of personsor of religious communities, and though the promise of

angelic protection still holds good, yet it was only given tothose in a way —namely, in a definitely marked out path,a point which the Devil omitted when he quoted the passagefor his own purpose. Not to use means which have been

provided for our safety is universally recognised as demand-ing that punishment which is allotted for those who temptGod. True, there must be discipline, but discipline mustnot be such as to combine presumption.

THE annual dinner of the Aberdeen University Club,London, will be held at the Trocadero Restaurant on

Wednesday, Nov. 21st, at 7 P.M. Sir William McGregor,K.C.M.G., Governor of Lagos, will take the chair, andmembers intending to dine should communicate with thehonorary secretaries, Mr. J. A. Robson and Dr. James

Galloway, at 54, Harley-street, W.

DR. JOSEPH PRIESTLEY, medical officer of health of

Lambeth, who was recently selected by the Municipality ofBombay for the appointment of Executive Health Officer tothe City of Bombay, has not seen his way to accept theposition. The borough of Lambeth is to be congratulatedupon retaining the services of Dr. Priestley.

MR. HUTCHINSON, F.R.S., has offered, and his offer hasbeen accepted, to build and fit out an educational museum inconnexion with the Friends’ School at Ackworth, near

Pontefract, Yorkshire. Museums on similar lines have been

provided by Mr. Hutchinson’s generosity at Haslemere,Surrey, and at his native town, Selby, Yorkshire.

PROFESSOR A. H. YourrG, M.B. Edin., F.R.O.S. Eng., hasbeen appointed Representative of the Victoria University forfive years on the General Medical Council in succession tothe late Dr. D. J. Leech.

1 THE LANCET, Oct. 27th, 1900, p. 1220,

1366 PROFESSOR CALMETTE ON PLAGUE.

PROFESSOR CALMETTE ON PLAGUE.

PROFESSOR A. CAIMETTE, Director’ of the PasteurInstitute at Lille, in the course of ’the first HarbenLecture of the Royal Institute of Public Health, de-livered at the Examination Hall of the Royal Collegesof Physicians of London and Surgeons of England onNov. 7th, said that the recent appearance of plagueat Glasgow had decided him to choose the study ofthis disease as the subject of his lectures. Plaguenow menaced all the maritime nations of the globeand it had become necessary to take rigorous measures tostop its extension. The progress of hygiene and the know-ledge acquired during the last five years on the etiology,treatment, and prophylaxis of the affection enabled it to becombated very efficaciously and its centres to be rapidlycircumscribed. It was .known that the plague bacillus wasfound in the buboes and sputa of the patient, that it wasalso frequently found in the blood, that it had the formof a short bacterium, slightly ovoid, that it was easy to stainby the ordinary laboratory methods, and that it could becultivated on the usual media.From a clinical point of view the plague assumed two

clinical forms-bubonic plague and plague without buboes,the former being more commonly observed. Persons attackedby bubonic plague ordinarily suffered at the commencementof the illness from a sensation of great weakness with heavi-ness of the head and painful pricking or tingling at the

place where the buboes would appear. The patient wassuddenly taken with repeated shivering, of short dura-tion at first but getting longer and longer. Intensepain, great thirst, alimentary or bilious vomiting, anddiarrheea afterwards occurred. Glandular congestion, ordi-

narily limited to a single group of glands, appeared onthe same day or on the day after. A bubo appeared withlittle delay; it was accompanied by a painful tumefaction,the least pressure on which caused the patient to cry out.The temperature rose very quickly, the pulse was rapid, full,often dicrotic, but regular, and the breathing was quickened.The facies was typical: red, haggard, weeping eyes with anexpression of agony and terror, and the tongue dried, furred,and red at the edges and point. Sometimes at the com-mencement the patients, after a short period of excitationand mad terror, were smitten suddenly with an overpoweringsomnolence and collapse ; they then resembled subjectsstruck with serious adynamic typhoid fever. The head wasthrown back, the eyelids were half closed, the mouth wasslightly open. When they were spoken to in a loud voice theylooked around with a stupefied expression, replied with muchdifficulty, and dragged their words like intoxicated persons.When exciting phenomena dominated them the patientssuffered from hallucinations of sight or hearing, believingthemselves to be surrounded by extraordinary animals, asin alcoholic delirium. Sometimes they showed very clearsymptoms of meningitis, opisthotonos, converging strabismus,dilatation of the pupils, delirium, cramp of the arms,flexion of the legs, and fibrillary movements ofthe muscles of the face. The localisation of theglandular lesions determined the special attitudeof the patients. The least movement caused them to

shriek ; the skin was frequently covered with petechise;in grave cases turbid sero-sanguineous pustules formed.or even actual carbuncles, which latter characterised thespecial type to which ancient authors gave the name of" black plague." On auscultation signs were constantlyfound after the third or fourth day of broncho-pneumonia.The cough was dry and painful, terminated by the expectora-tion of frothy sputa, slightly viscid, yet streaked with bloodand containing the plague bacilli in great quantities. Ingrave cases the heart presented signs of an alteration ofthe myocardium, with prolongation of the first sound andother cardiac symptoms. In these grave cases thepatients scarcely micturated at all and the urine, attimes containing blood, was very acid and albuminous.Except in entirely benign cases, suppuration of the buboeswas the rule and was generally of good augury, as it indi-cated that the system was defending itself against theplague infection and that the infection remained localised.Convalescence was always long. The forms of plague withoutbuboes and without apparent glandular congestion were

much rarer than the forms of classical bubonic plague whichhe had just described, The primary pneumonic plague

resulted from the penetration of the microbe into therespiratory channels and it was to this exceedingly graveform that Dr. Muller and his laboratory assistants succumbedin 1898 at Vienna. Another and still rarer form of plaguewithout buboes was plague septicaemia or pesticasmia whichdeveloped with extreme rapidity and was caused by the intensepullulation of the plague bacillus in the blood and in theorgans. It was not exactly known where the virus firsteffected an entrance in these cases ; perhaps the microbepenetrated by the intestine or directly into the blood throughsome little open sore or cut. Post-mortem examinations ofpatients who bad succumbed to this particularly severe formshowed very congested mesenteric and retro-peritonealglands of a characteristic purplish colour like dregs of wine,which fact seemed to support the hypothesis of penetrationof the virus by the gastro-intestinal channels. When theplague was studied in an epidemic centre all the formsabove described were found, but it sometimes happenedthat the first cases did not present clear characteristicsand it was thus possible that they might be incorrectlydiagnosed. At Calcutta Dr. Simpson and Dr. Cobb reported thepresence of the plague bacillus in cases of inguinal glandularcongestion which had been noticed with extraordinaryfrequency among the men of a certain regiment stationedat Hong Kong during the epidemic of 1894. Anofficial Commission appointed to investigate the evidenceof Dr. Simpson and Dr. Cobb declared that they werecases of simple non-venereal buboes. In reality the com-mission was wrong. It was dealing with an exhausted non-malignant form of plague that ancient writers had alreadyrecorded under the name of pestis mitior, as frequentat the commencement and the end of great epidemics. Suchfacts proved how little the best clinical examinationalone could suffice to make a diagnosis of plague.

’

Such diagnosis could only be determined when the

bacteriological examination demonstrated the presence ofthe microbe of Yersin in the glandular fluid in theblood or in the sputum. At the commencement of a caseof bubonic plague, in order to ascertain whether theplague :microbe was present or not, it might be fearedthat to make a puncture with Pravaz’s syringe right intothe lymphatic tissues to extract therefrom some drops offluid to be fertilised in the usual manner and examinedimmediately after colouration would spread the infectiousgerms beyond the glands in which they had been localised.But to-day with the aid of sero-therapy there was no

foundation for that fear, because to put the patient beyondthe danger of any possible reinfection it was only necessary,directly after the puncture with Pravaz’s syringe, to

inject a small quantity (about five cubic centimetres) ofanti-plague serum into the middle of the gland or at a shortdistance from it. The extracted fluid should be placed

immediately in tubes of nutritive gelose and in tubes ofbouillon of beef or of veal at a temperature of from 25°ito 30° C. for a period of 24 hours. At the same time asmall quantity should be spread out on glass slides coloured

with methylene blue or thionin. On gelose the appearanceof the microbe colonies did not present any very specific cha-

racteristies, but their number indicated the degree of gravityof the infection. In the meat bouillon the specific character-isties were more precise. The bouillon remained clear andI transparent and contained some slight whitish clots; floating on the surface, which sank to the bottom of, the tube at the least movement. If the bouillon was

turbid it was evident that some microbe other thanthe plague bacillus, perhaps of a mixed infection, waspresent. In such circumstances the diagnosis should. be made more precise by inoculating susceptible animals. with the culture. The mouse especially took the plagueand it was only necessary to prick this little animal inthe thigh with a needle dipped in the culture on gelose inE order to give it the disease and cause its death in from 36L to 48 hours. When the inoculated animals succumbed verycharacteristic lesions were found on the bodies and thetplague bacilli were in great quantities in all the organs,. especially in the glands, the spleen, and the liver. To; diagnose a case of suspected pneumonic plague it was-

necessary to collect as much as possible of the rusty sputum, to dilute it with a small quantity of boiled water,. and to fertilise several tubes of gelose with platinum wire,t the temperature not exceeding from 20° to 23° C. At this

relatively low temperature the pneumococci did not germi-1 nate, the streptococci germinated badly and very slowly,. while the plague bacilli developed rapidly. At the end