MEDICINE AND LIFE ASSURANCE.

BRITISH MEDICAL ASSOCIATION.SUBSCRIPTIONS FOR I899.

SUBSCRIPTIONS to the Association for I89g became due onJanuary ist, i899. Members of Branches arerequestedtopay the same to their respective Secretaries. Members ofthe Association not belonging to Branches are requested toforward their remittances to the General Secretary, 429,Strand, London. Post-office orders and Postal orders shouldbe made payable to the British Medical Association at theGeneral Post Office, London.

SATURDAY, OCTOBER 21 sr, i 899.

MEDICINE AND LIFE ASSURANCE.WE live in an age of congresses, and the tendency to sub-divide subjects and thus to multiply these assemblies isto have full swing next year in Paris, where a perfectdeluge of talk is to be let loose. Even this year hasseen an addition to the already long list of theseinternational gatherings, but the result of the Con-gress of Medical Officers of Life Assurance Companiesrecently held at Brussels will confirm the opinionwhich has already found expression that it is possibleto specialise a congress too much. In this countryat all events the medical officers to life assurancecompanies regard life assurance as part, and probably onlya small part, of their daily work. There are no specialistsin this subject. It was for this reason perhaps that so fewof these British and American practitioners who take aspecial interest in questions connected with life assurancefelt impelled to put in an appearance at Brussels. As itis, a congress of life assurance medical officers at which noEnglish-speaking delegate spoke was too much like theplay of Hamlet with the Prince of Denmark omitted. Itmay safely be affirmed that everything that relates to thescience and practice of life assurance has been morethoroughly considered among the English-speaking peoplesthan among the rest of the world, and consequently theproceedings of the Section of Medicine in Relation to LifeAssurance at the annual meeting of the British MedicalAssociation last year were of great interest and practicalvalue. But the Committee of the Brussels Congressappears to have acted on the assumption that very littleif anything of value had been done up to the present timeas to vital statistics and medical science in connectionwith life assurance. Most of the papers w3re absolutelylacking in the practical character which might have beenexpected from the medical officers of companies.In no respect was the absence of British delegates more

felt than in drawing up the suggestion for a universalproposal form. Those who have much practical acquaint-ance with the working of life assurance know that if theproposal form be too long and contain too many questions,its object will be defeated. There is already a tendency toerr in this direction on the other side of the Atlantic; andif the forms to be laid before the next meeting of theCongress include all the questions looked upon as esseii-

tial by some of the speakers at the Brussels Congress, theywill greatly exceed the American standard. The proposalform issued by the Life Assurance Medical Officers'Association of London is probably as full as is desirable,and it is to be hoped that the Committee appointed todraw up a model form of report for presentation to theCongress which is to be held in I9OI will take an oppor-tunity of studying this form.The discussion on professional secrecy 'brought out the

difference between ,the [view commonly held on the Con-tinent and that usually received in this country. Here itis considered that the applicant for assurance, in supplyingto the company the name of his medical adviser, tacitlyauthorises that person to give any information which thecompany may require. We would lay some stress on thispoint, as we are frequently consulted as to the position tobe taken up by the family doctor under these conditions.In France, on the other hand, as will be seen from our re-port of the meeting,' themost extreme views as to the natureof professional secrecy are defended, and it is difficult to seehow life assurance can reach its full development in thatcountry until a more rational opinion is entertained. Allthinking persons must agree that life assurance is one ofthe most beneficial results of modern civilisation, and any-thing which tends to prevent its fullest extension is con-trary to the public weal. This being the case, any indi-vidual drawback must give place to the general good.In the opinion of the majority at the Congress, the sole

duty of the medical examiner was to distinguish betweengood and bad lives, and it was held that he was not calledupon to assist the companies in appraising the value of anyindividual life; in other words, it seemed to be assumedthat "loading" did not come within his purview.. In re-cent years the acceptance of impaired lives has eonstitutedan important part of life assurance work in this country,and it seems to us that one of the most useiul things whicha congress could do would be to discuss the factors whichrequire to be considered in "loading" a life. The mereacceptance or rejection of a life is comparatively easy, butthe estimation of how far an applicant for assurance de-parts from the normal, either on account of personal orfamily history or defective health, will exercise the utmostskill of the examiner, and on this very important questionthe Congress has practically given us no assistance.

Dr. Rend Verhoogen's paper on the early diagnosis ofgeneral paralysis was important in view of the increasingfrequency of general paralysis among the assured, for thecondition is one which is very apt to be overlooked in itsearly stages. Neurasthenia is another subject which hasnot received much attention from the assurance world,hence Dr. Mahillon's paper will be read with interest. Oneof the most complete papers was that by Dr. Bayet onsyphilis and life assurance, and the conclusions he arrivedat are practically those which are adopted in this country.On the whole, however, we cannot say that the Congresshas added much to the knowledge which may be gained byreading one of the manuals on life assurance published inthis country or America. Still, if it furthers the spread ofassurance, and leads to more reasonable views on the rela-tion existing between the family medical attendant andthe company, definite good will have been achieved.

1 BRITISH MEDICAL JOURNAL, October 7th, x899, p. 952.

tl%Lo4kOritis lUeb'toral ournal,

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OCT. 2 'I 1899.1 TM Su2mIVMTOAT, JOWMAZ III7

i8 MDCLORA]OT 2, 89THE WAR.

A RECENT PRONOUNCEMENT ON ETHER.THE narrative of the introduction, declination, and revivalin the use of ether as an anaesthetic in England is one ofthe most curious in the history of medical thought in thenineteenth century. Mr. Pridgin Teale's article on Etherin the recently-issued Encyclopaedia Medica presents uswith his view of the subject as an operating surgeon. Inthe opening pages of this article Mr. Teale traces the storyof the revival of ether, attributing it to the well-knownpaper of Joy Jeffries, Ether in Ophthalmic Practice, thestimulus which set the pendulum of English surgicalopinion in motion, and caused it to swing back from thealmost universal advocacy of chloroform to the adoption ofthe older but then obsolescent anaesthetic. At first etherhad been vaunted, and, as the pages of contemporary jour-nals show, used by all sorts and conditions of men withsmall regard to its peculiar properties, and scanty know-ledge of its possibilities and limitations. It was the first'volatile anaesthetic appealing for surgical suffrage, and washandled with a diffidence almost amounting to fear bythose who gave it, and looked upon somewhat askance bythe operator unaccustomed to deal with humanity in acondition of semi-anse4thesia or profound narcosis. In theone case the delirious shouts and struggles were discom-posing, and in the other the death-like calm gave rise tomisgivings. The various kinds of apparatus invented dur-ing the first year or so of ether-giving were appalling intheir complication and bulk, and in most instances wereextremely ill-adapted for the purpose for which they were-designed. Then came stories of difficulties and failures.'The pundits of surgery declared'ether was unreliable, andprobably unsafe.At the critical moment when the more thoughtful minds

were studying-and attempting to improve the means ofadministering this recalcitrant vapour, came Simpson witha pocket handkerchief and a vial of the new anaesthetic,ehloroform. All dangers and difficulties were to be re-moved, and the operating theatre, passing through whatSimpson himself called the " shambles " stage and the bear-garden experiences of imperfectly-given ether, became,calm. The surgeon could do his work without let orhindrance, and with a free mind. The unhappy death,however, which occurred ander the new anaesthetic withinthree months of its introduction put an end to the senseof security which at first reigned supreme. Then, as now,imany persons contended that the anaesthetic was less toblame than the method employed in giving it, but the in-creasing mortality under its use gave rise to an increasinganxiety, and prepared the way for a revival of the popu-larity of ether. The Committee of the Royal Medicaland Chirurgical Society was appointed to reinvestigate thecase of chloroform v. ether, and, although admitting theperils of the former, the Committee declared the slowaction and imperfect methods of using ether an insuper-able difficulty.This is, of course, ancient history, and Mr. Teale's work

lies not in traversing such a judgment. Clover's apparatusand the teaching of the modern ansesthetists have donethat already and have shown that ether can be given morerapidly than chloroform and without any of the drawbacksof former days The whole question has at present

assumed an entirely new phase. Given the best methodsof administering chloroform and of ether the conflict is stillwaged between the rival camps as to which is the best all-round anaesthetic. Mr. Teale after twenty years' experienceof chloroform adopted ether, and now after two moredecades in which he has used that anaesthetic affirms un-hesitatingly that ether is safer, and if properly given, quiteas serviceable as chloroform.The object of his paper is to teach how this proper

method can be acquired, but as his directions are prac-tically those found in the special manuals on ansestheticswe need not pause to consider them in detail. It isinteresting in view of recent discussions before the Societyof Ansesthetists to learn from Mr. Teale that he, asa surgeon, has found ether wholly satisfactory in ab-dominal surgery, in throat work, and for young childrenand aged persons. Those who heard the eloquent advocacyby Mr. Warrington Haward of the use of ether for all sortsand conditions of men, women, and children in one ofthose discussions will find in Mr. Teale's pages a whole-hearted agreement upon this subject.The two stock objections urged by those who use chloro-

form in preference to ether has recently been its after-perils, that is, bronchitis, pneumonia, etc., and the lessprofound narcosis which causes rigidity, hurried breathing,and so on. These, Mr. Teale's experience goes to show,are more theoretical than real. He has never seen etherbronchitis, and agrees with those anaesthetists who regardit as being most rare, and, when present, commonly due toexposure of the patient to cold before, during, or after theoperation.That surgeons like a patient to be profoundly ansesthet-

ised is natural, but whether the condition, always one ofextreme risk, is often desirable from the patient's point ofview seems fair matter for argument. We trust Mr. Teale'suseful directions will obtain a wide hearing, as they focusiD a small space his great experience. It is, perhaps, a pitythat Mr. Teale's space did not allow him to emphasise thekeen sense of responsibility which should exist in thosewho undertake to give anaesthetics. It is a matter ofregret that this frame of mind is not always met with inthe occasional ancesthetist, and its absence is a risk bothto the surgeon and to the patient.

THE WAR.WE published last week an official list of the officers ofthe Royal Army Medical Corps detailed for duty in SouthAfrica, together with a list of the field hospitals and thehospitals on the lines of command. It will have beennoticed that there will be twelve field hospitals, four sta-tionary hospitals, and four general hospitals, each withits complete staff, so that there will shortly be in SouthAfrica an adequate establishment for dealing with a largenumber of sick and wounded. The distribution ofthese hospitals will be determined by the officerscommanding in South Africa, and must depend uponthe manner in which the military operations develop.Attention has been drawn bya contemporary to the fact thatno sanitary officer has been appointed to the Army Corps.We presume that the Principal Medical Officer will makesanitary arrangements on the spot when the plan of cam-paign is developed. Should the advance be made, as seemsprobable, in more than one column, it may be thoughtdesirable to appoint a separate sanitary officer for each

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xix8 TRz BRrffw IMEDICAL JOURNAIJ [OCT. 21, 1899. --"

OC'T. 21, i 899.] PLAGUE ON AN INDIAN LINER.column. Particulars with regard to the dates of despatchof the hospital staffs from this country, so far as at presentavailable, and some further details as to the medical andambulance arrangements, will be found at page I 4I.

PLAGUE ON AN INDIAN LINER.THE P. and 0. Company's steamship Penrinsular arrived atPlymouth on October '4th flying the yellow flag, owing tothe fact that a coal trimmer had developed plague fivedays previously. The vessel was immediately visited byDr. F. M. Williams, Port Medical Officer of Health atPlymouth, to whom we are indebted for the followingnotes of the case: On October gth, at 1o A.M., PharosHassam, coal trimmer, reported himself to the ship'ssurgeon suffering from great pain in the left inguinalregion, which he stated had come on suddenly. The sur-geon observed that his eyes were bloodshot and the pupilsdilated. The tongue was tremulous and furred in thecentre, but clean at the margins. There was difficulty inarticulation at times, with involuntary contraction of thefacial muscles. In the left groin there was a glandularswelling, tender to the touch, and of the size of a walnut.The pulse was weak and rapid; the temperature was 1020.On the following day the patient's condition was muchworse; the temperature was IO30, the pulse feeble andrapid, twitchings of the facial muscles were very marked,there was increased difficulty of speech, and he was verydrowsy. The swelling in the groin was extending into thefemoral region and towards the abdomen. On Octoberi ith his condition was about the same. On October i2thhe was not so drowsy, but his general condition was aboutthe same. On October I3th marked improvement wasnoticed; he was brighter, and the glandular swelling hadnot increased. The condition of the patient when I ex-amined him on October 14th was as follows: Thepulse was feeble and intermittent. The temperaturewas 99.50, there was general prostration, and thepatient, who was drowsy and somewhat stupid, did notanswer questions readily. The conjunctivae were injected,the pupils dilated, the tongue much furred, the skin dry,and the urine was scanty and high-coloured. There wasno diarrhcea. The femoral glands on the left side wereenlarged and hard, with considerable infiltration of sur-rounding tissue. I had him and his native attendantremoved to the Pique hospital ship, where his conditionhas improved. Every preoaution had been taken by thesurgeon, the patient being isolated in a deck cabin. Thiswas disinfected under my supervision immediately thepatient was removed, and instructions were given thatafter a lapse of twelve hours the cabin was to beopened and scrubbed with carbolic solution. The ship'ssurgeon, who is familiar with plague, had the assistanceof Dr. L. W. Richards, who has been on plague dutyin Bombay and Poona for the past two years, andwho was a passenger by the vessel. He also sawthe patient with me, his diagnosis being that itwas an undoubted case of plague of a mild type.No satisfactory explanation could be given of the origin ofthe infection, it may have been that the period of incuba-tion was abnormally prolonged. The crew were all shippedin Bombay and medically examined before embarking.The Peninsular left there on September 23rd, calling atAden, Suez, and Port Said, arriving at Marseilles onOctober gth, a period of sixteen days. There is a possi-bility that the patient did not report himself at the com-mencement of bis illness, nor was his condition discoveredat the daily medical inspection of the crew. He may havebeen infected after leaving Bombay by inoculation fromthe dejecta of infected rats on board the vessel,although there is no direct evidence of this. Search hasbeen made, but no dead rats have been found about thevessel. The patient is at present convalescent, the glandu-lar swelling in the left groin hI inclined to suppurate, and

at night there is a rise of temperature of IO. At my visiton October 17th the temperature was normal, the conditionof pulse had improved, and the patient was taking hisnourishment well. The urine was normal in quantity, butcontained a slight trace of albumen. Theltreatment fol-lowed was the administration of brandy (5ij) in milkevery two hours, milk, beef-tea, fish, and custard pudding.A mixture containing strychnine andcarbonate of ammoni&was given every four hours, and boric acid fomentationswere applied to the glandular enlargement. Free ventila-tion is maintained, and the body is sponged twice dailywith carbolic solution. All dejecta are treated with disin-fectants.

HOUSING OF THE WORKING CLASSES;AT the meeting of the London County Council this weeka very important series of recommendations were sub-mitted by the Housing of the Working Classes Committeedealing with schemes for clearances of notoriously insani-tary areas in St. Luke's at a cost of 175,750, i n Holborn ata cost of 220,500, and in Southwark at a cOst of 187,950.These, together with a smaller scheme in Poplar, involvinga cost of i6,soo, will be dealt with by the Council at itsnext meeting. At the same meeting, the Council approvedcertain applications recommended by the Highway Com-mittee, under the Light Railways Act, I896, for the exten-sions of the tramway system to the boundaries of thecounty. The advantage of facilitating locomotion for theindustrial population and its bearing on the housingproblem was emphasised in the course of the debate.

THE INEBRIATES ACT, 1898.AT the weekly meeting of the London County Council onTuesday the Special Committee on the Inebriates Acts, ofwhich Dr. Collins is chairman, presented a further report,which was adopted unanimously by the Council. Itwill be remembered that the Committee as a temporarymeasure made arrangements with the Duxhurst House.Reformatory at Reigate, and the St. John's Reformatoryfor Roman Catholic Women at Ashford, to receive-women, under which immediate accommodation was.secured for i6 Protestant and 56 Roman Catholicwomen. The Committee, however, was unable to makearrangements for the reception of male inebriates,.and have now recommended the Council to establish areformatory of its own, as they believe that such a course.is justified both by the requirements of London and theprobable benefits of such an institute to inebriates. Theyrecommend that an institution for 40 patients should be,forthwith provided, and that an estate of 374 acresat Charlwood near Horley should be acquired. TheGovernment inspector has already visited the premisee,.and has reported that in his opinion they are suitable forthe purposes proposed, and can without difficulty be,adapted to comply with the requirements of the HomeOffice. The estimate of the cost of the site, of making thenecessary structural alterations and additions to thepremises, and of furnishing them, will not exceed 14,250.The annual cost in respect to up-keep and interest, if thepayment is spread over sixty years, would be about 50oa year. The average weekly cost of maintenance wasestimated by the Departmental Committee at i5s. gd.;the Committee of the London County Council state that inpraetical working it appears, judging by the terms ofcontribution towards maintenance they have received, thatthe actual cost would work out at 148. a week, which, asthe Government contributes ios. 6d. a week, would leavethe actual cost to the Council at 35. 6d. a week. There is,however, they add, a possibility of some recoupment ofmaintenance charges from the property of inmates, sincethe Act gives a power of recovery where there is more thansufficient to maintain the family of an inmate, and of stillgreater recoupment from the labour of inmates. Looking

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112 TNBITNIT EV CIAIN OFCRADHSDTE- OT 1

to the fact that the majori ty of the patients will have someknowledge of a trade or profession, that they will in mostinstances be, to a large extent, physically rehabilitatedwithin a comparatively short time of their admission, andthat their conditions of labour will be made as encouragingas possible, and afford them the opportunity of earning forthemselves as well as the institution, the Committee be-lieve that the recoupment from labour is likely to be notinconsiderable, and that the charge for maintenance maynot in the end greatly exceed that in the prisons or asy-lums. In the prisons the average rate per head, after de-ductions for labour, etc., is 98. id. per week, and the chargefor maintenance in the London asylums is 9S. i id. perweek.

THE VACCINATION OFFICER AND HIS DUTIES.A CORRESPONDENT of the Times, who signs himself "M.D.,"has called attention to the pressing importance of thisquestion, which, as will be seen from the article in theBRITISH MEDICAL JOURNAL of September 30th, is rapidlybecoming a burning one in some localities. The leadingcase of Leicester is prominently before the public, and theGovernment will shortly have to consider the legislationthey will introduce next session. The Act of I898 waspassed under conditions which, as we have more thanonce indicated, bind the Government to complementthat admittedly imperfect measure by further legislationon the subject of revaccination. But the writer of theletter referred to urges that, however great may be theneed for legislation in furtherance of the revaccination ofchildren about the time they leave school, the reconstruc-tion of the machinery for the local administration of thevaccination law is even more important. We cannot go sofar as this with him, but we heartily agree that both ques-tions are ripe for legislation. It is useless to make laws,or even to ordain facilities for the promotion of vaccination,if the machinery provided for the purpose will not work.The investment of Boards of Guardians with the duties ofvaccination authorities may have been unavoidable and*even unobjectionable in I840, when the first VaccinationAct was passed; their maintenance in that position at thepresent time is an anachronism, and "M.D." argues that,even if the constitution of Boards of Guardians were suchas to qualify the class of persons who are generally electedto them for undertaking important sanitary work, such as-the local administration of vaccination is, it is essentiallyabsurd that that this branch of sanitary organisationshould be divorced from all other local sanitary work, andbe retained in the hands of bodies who have no sanitaryduties or interests whatever, and who were only intended*to deal with the relief of destitution. It is unnecessary-to labour this side of the question, for no one disputes theanomaly. There is some reason for thinking that the in-disposition the Government has shown hitherto to dealwith this subject is due to the objection which has beenpressed from some influential quarters that if the localadministration were transferred from Boards of Guardiansto District Councils, who are the most appro-priate bodies to carry it on, little would be gainedin the way of defeating the organised agitation now carriedon against vaccination, which has lately sought to find anew vantage ground for itself by embroiling Boards ofGuardians with their vaccination officers. District Councils,it is said, are elected by the same constituencies as electBoards of Guardians, and in rural districts, at any rate,these bodies are composed of practically the same persons.M.D.," however, suggests that it is neither necessary norexpedient to transfer the whole local vaccination machineryen bloc to District Councils. The legal element of themachinery, he thinks, should be separated from themedical, and the latter alone transferred to the local sani-tary authorities. The legal work of vaccination, together

with that of registration, could be provided:for in anotherway, but care would, of course, have to be taken to keepthe sanitary authority in touch with the registrationmachinery, so that that body and its officers wouldbe promptly informed of all that they need to knowfor the protection of the public health, in the sameway as is now done in the case of general mor-tality and infectious sickness. The suggestion is thatprosecutions should be left to the police, as in the mattersof dog licensing and muzzling, and that they should beplaced under the general supervision of the Registrar ofBirths and Deaths. This official is generally alawyer, and holds a very independent position.As he is in touch with the local subregistrarof births, in whose hands it will probably be foundconvenient to leave the work of vaccination registration,this arrangement might probably work satisfactorily. Ifthis course were adopted, it is difficult to see who couldobject to it. Indeed, from a reply from a "Poor-lawGuardian," who is, he says, a member of the Antivaccina-tion League, it appears, rather strangely, that even thisbody would not oppose the change. There is every reasonto believe that most Boards of Guardians would be veryglad to be relieved of what is now a constant bone of con-tention, which interferes greatly with their proper work.There is, however, one consideration which should bekept in mind bythosewho aredisposed to urgethisview. Itisthis. The Government has made a promise regarding re-vaccination. It [has made no promise regarding theother matters, and it is a question whether if 'it wereasked to go beyond the subject of its-:promise it mightnot use the request as a reason for delaying all furtherlegislation until the end of the five years to which therecent Act is limited. In its own interest it shouldproceed in the next session of Parliament to deal both withrevaccination and with the arrangements for prosecutions,but in the public interest it would certainly be better thatit should take up the former question at once ratherthan leave both to the end of the quinquennium.

FOOD POISONING.A SERIES of cases of "food poisoning" is reported to haveoccurred at Sheffield on October i ith. No fewer than 23individuals were affected and the ages ranged from 2 to 89years. With the exception of one who went under the care ofher own medical man all the cases were treated at the RoyalInfirmary by Dr. Barker, house-surgeon, and as far as canbe ascertained they all had partaken at their midday mealof corned beef purchased at the same shop. The tin fromwhich the meat was taken had been opened by the shop-keeper that morning. He states that he did not detectany smell, neither did the appearance lead him to supposethat it was unfit for food. In all the patients sickness andpurging were the initial symptoms, followed by giddinessand prostration. At the infirmary the patients werepromptly 'treated by the stomach pump add emetics. Ninewere enabled to return to their homes, but 14 weredetained. With one exception, a child of 3, the cases haverecovered. The child died the next day, and the coronerhas adjourned the inquest, which he opened on October13th, until a bacteriological report which is being pre-pared by Dr. Robertson, Medical Officer of Health, isready.

THE INFLUENCE OF ZADIG ON THE PROGRESSOF MEDICINE.

SuciI was the title of the address delivered by Dr. G. W.Balfour at the inaugural meeting of the York MedicalSociety for the present session. He characterised Zadig'sphilosophy, which was also that ,of Sherlock Holmes, asthe application of common sense to matters of everyday

Tni BiLmm 11120 Kjm,cAL jouRNAL, [OCT. 21, I1899.THE VACCINATION OFFICER AND HIS DUTIES.

OcT. 21I8qq.1 MEIIE N CENEA CMRDE.I1

observation; and described the great change that hadoccurred in the practice of medicine within the last fiftyyears. At the middle of the century bloodletting was thechief remedy for diseases, especially those of an inflamma-tory character; on the other hand it had lately fallen intosuch disuse that few doctors now living had seen thismethod of treatment practised. For a time, however, theoverturning of the old beliefs was followed by a period ofcomparative chaos, and this again by the promulgation ofan entirely new system of pathology and of perfectly novelmethods of treatment, which promised to have unheard-ofinfluence on the life-history of mankind, not only as re-garded the cure of disease, but still more as regarded itsprevention. The method of Zadig had played no unim-portant part in the discoveries of Pasteur, who becameconvinced that behind the phenomenon of fermentationthere lay some great general law. His conclusions werelegitimate deductions from observations made by himself,and every step was proved by careful experiment before itwas accepted as truth. Pasteur's ideas had been para-phrased in these words:

All chaniges, nauglht is lost: the forms are changed,And that which lhas been is niot wlhat it was,Yet that which has been is.

Dr. Balfour described the experiments and reasoning bywhich Pasteur laid the foundation of the germ theory ofdisease, of curative antitoxins, and immunising vaccines,and discussed Lord Lister's application of the theory tosurgery and medicine, and the enormous benefit therebyaccruing to mankind. Thus, in spite of much oppositioD,advance had been made, under the influence of Zadigand the guidance of Pasteur, within the limits of onegeneration from a stage in which knowledge was dark andchaotic into one whei e light and order prevailed. Manydiseases, the scourges of the last generation, such assepticaemia and pyiemia, had been all but banished fromsurgery. By appropriate vaccines protection could now beattained against plague, typhoid fever, and other fatal dis-orders, and the mortality from diphtheria had beenenormously reduced. Thus, by a strict following ofZadig's method, medicine had attained its present develop-ment, whilst a vista of possibilities undreamt of fifty yearsago was opened up. What had been achieved was a merebeginning, and, as Pasteur had said, "You will see how itwill all grow by-and-by. Would that my time were longer."A vote of thanks to Dr. Balfour, proposed by Dr. Ramsay,and seconded by Mr. E. T. Wilkinson, was carried byacclamation and duly acknowledged. In the evening themembers of the Society and their guests dined together atthe Station Hotel, York, under the presidency of Mr.Henry Foster, the President.

A RARE MEDICAL BOOKIN the Glasgow Medical Journal for October, ProfessorHenry E. Clark gives an account of an old work, theSupplementum Chiruzrgix, or the Supplement to the Marrowof Chyrurgerie, by James Cooke, "practitioner in Physickand Chirurgery," London, i655. The book is extremelyrare, and Professor Clark has found it mentioned only inthe catalogue of the British Museum, which possesses twocopies. James Cooke, of Warwick, was a well-knownsurgeon in the seventeenth century. His MellificiumChirurgix, or Marrow of Surgery, passed through manyeditions, and in England appears to have taken the placeof Maister Peter Lowe's Discourse of the Whole Art ofehirurgerie. Cooke was born in I614, and died in i688,thus living through one of the most critical periods of ourrough island story. He had a very large practice, chieflyamong the nobility and gentry in the Midlands. He hada powerful patron in Lord Brooke. and was probably.himself a Roundhead. While at Stratford-on-Avon inI642 he bought some manuscripts and books that hadJbelonged to Dr. John Hall, who married Shakespeare's

eldest daughter Susannah. Mrs. Hall was then a widow,and there seems to have been a little difficulty in thetransaction, which is recorded by Cooke as follows:"Being in my art an attendant to parts of some regimentsto keep the pass at the bridge of Stratford-on-Avon, therebeing then with me a mate allyed to the gentleman thatwrit the following observations in Latin, he invited me tothe house of Mrs. Hall, wife to the deceased, to see thebooks left by Mr. Hall. After the view of them she toldme she had some books left, by one that professed physick,with her husband for some money. I told her, if I likedthem, I would give her the money again. She broughtthem forth, among which was this [to wit, Select Observa-tions, to be more particularly referred to presently], withanother of the author's, both intended for the presse. Ibeing acquainted with Mr. Hall's hand, told her that oneor two of them were her husband's, and showed them toher. She denyd; I affirmed, till I perceived she began tobe offended. At last I returned her the money." ProfessorClark shows that Mr. Sidney Lee has fallen into error inassuming that the negotiation did not end in a " deal." AnEnglish translation of one of the manuscripts bought byCooke was published by him in 1657, under the title of SelectObservation of English Bodies; or Cures both Empiricalland Historicall performed upon very Eminent Persons inDesperate Diseases. The work is described on the title-pageas "First written in Latin by Mr. John Hall, physician,living at Stratford-on-Avon in Warwickshire, where he wasvery famous, as also in the countries adjacent, as appearsby these Observations drawn out of several hundreds of hischoicest." It has been coDjectured that among the paperssold to Cook by Mrs. Hall there may have been some un-published writings of Shakespeare. Professor Clark, how-ever, thinks this very improbable, on the ground thatCooke, though a Puritan, was too good a man of businessto destroy what Mr. Wemmick would have called " portableproperty " which even at that time must have had aconsiderable money value. In the Supplementum Chirurgiwhe treats of fevers, small-pox, measles, etc. The book con-tains one of the earliest descriptions of rickets in theEnglish language. " This disease," he says, "' is as new; so,as peculiar to children, it hath received several names, asPtedesplanch nosteocaces; this I saw in print, in a Thesislong before the Doctor's [Glisson] Tract on the subject [pub-lished in 1650]; others Cachexia Scorbutica, and Doctor'sthe Rachitis, nearly bordering on the vulgar name Rickets,and signifying the spinal disease, the spine being the firstand principal, amongst the parts affected in this evil."One may venture to express thankfulness that among thenumerous burdens and grievances under which the medi-cal profession groans to-day, it has been mercifullydelivered from the affliction of such a term of art as"Paedesplanch nosteocaces."

MEDICINE AND SCIENCE AT CAMBRIDGE.DR. ALEX HILL, Master of Downing College, in hisspeech to Congregation on resigning the office of Vice-Chancellor of the University of Cambridge, stated thatthe amount already received towards the BenefactionFund instituted at the meeting over which the Dukeof Devonshire presided at Devonshire House amountedat the end of the financial year to 5o,ooo. It hadthus been made possible to consider the erection ofnew buildings for law, medicine, botany, and archaeology.The response, however, had not been sufficient to warrantany of the new developments of University work whichmany friends of the University desired. In the interestsof national progress, Dr. Hill said, it was greatly to bedesired that laboratories of applied science should not beisolated, but should be established in connection withschools which were already strong in pure science.Technical training in any limited sense of the expres-sion was impossible. In every subject of practical

1121[KXWMAZ!=UOCT. 21, I 899.] MEDICINE AND SCIENCE AT CAMBRIDGE.

I11 2T2TM -aR I112 UDCAL JOURJCALJ DANGERS OF THE GASOLIER. LOCT. 21, 1899.

application-whether it were to a learned professionor an industrial art-success depended upon breadthof knowledge of the sciences upon which the pro-fession or art was based. Advances in technologywere almost invariably due to the application bypractical men of principles discovered by those whocarried out investigations in pure science. Conversely thestrength and vitality of a school of pure science waslargely increased when opportunities were afforded to stu-dents of passing on to its applications. The remarkableprogress of natural science in Cambridge was closely asso-ciated with the growth of the medical school. During thepast twelve years a larger number of students had enteredfortheNatural Science Tripos than for any other examina-tion for honours, notwithstanding the fact that but fewstudents were in a position to allow their prospects in lifeto depend upon the discovery in themselves of a specialaptitude for pure science. Almost all those who had sincedistinguished themselves in various branches of sciencehad commenced their career by preparing to qualify for aprofession. The majority of the graduates, for example,who were at present prosecuting researches in the physical,chemical, botanical, zoological, physiological, anatomical,and pathological laboratories, making, to the great creditof the University, additions to knowledge which were notexceeded, if they are equalled in amount, by any otheruniversity in the world, entered as medical students.

DANGERS OF THE GASOLIER.THE fatality which occurred recently in Norwich oncemore draws attention to a household danger of whichpractically everyone knows, but which not a few who admitiLts existence are too careless to prevent. A young lady,before retiring to bed, went into the library to obtain abook, and drew down the sliding gasolier in order to lightthe gas. She turned out the gas, but omitted to push thegasolier up again before going to her bedroom, which wassituated immediately above the library. As a result, theescaping gas accumulated below the library ceiling, andfound its way in large volume into the bedroom above.The next morning the lady was found unconscious, andcontinued so until her death on the afternoon of the suc-ceeding day. Such accidents emphasise the importance ofseeing that the space between the two tubes of every slidinggasolier is converted into a shifting"gas-tight"1 joint bykeeping it filled with liquid. Water is commonly usedfor the purpose, but is open to the objection that it is liableto evaporation-rapid in the high temperature attained inthe upper part of a gas-lighted and ill-ventilated apart-ment-while the gas can itself pass through it more slowlyby continuous solution. The difficulty can be met fairlywell by covering the surface of the waterseal by an inch orso of oil; or by using some hygroscopic liquid, such asglycerine, in the place of water. It is important to seethat the glycerine is not acid in reaction; and a good classof "heavy'" paraffin oil-such as that used for high-classmachinery- should be used rather than ordinary oils,which are prone to damage the metal work orto become "gummy" by oxidation in course oftime. There is, however, another point which isfar from being generally understood. The ordinaryplaster ceiling is, after all, only a porous diaphragm, per-meable by gases with considerable freedom. The air of agas-lighted sitting-room, occupied for five or six hours inthe evening, becomes, especially in its upper strata, highlycharged with the effete products of human respiration andof combustion. Not a little of this passes through theordinary ceiling into the room above; and if this latter bea bedroom the result is not to the advantage of its occu-pants, Let any sceptic compare his bodily and mentalsensations after sleeping in such a room and in onesituated over a similar room well ventilated and not occu-pied or illuminated by gas during the evening. The sub-

stitution of incandescent electric lamps for gas or oil would.avoid a part of the mischief, and it is not impossible to,make ceilings and floors practically impermeable to gases.But this is very seldom accomplished in practice. Sinceeconomy forbids our houses being built of one storey only,the sanitary alternative would consist in sleeping on theground floor, and living, working, and cooking in rooms onthe upper floors, where the light and air so needed duringworking hours are much more easily obtainable. Such arevolution in our acquired habits may seem difficult, but,there is not a little to commend it. Amongst other con-2siderations we might suggest that the burglar would be lessattracted to a house whose inhabitants would be so muchmore easily aroused by an attempt at illegitimate entrance.

PAINLESS EXECUTION.OUR American cousins are-in spite of an occasional" devia-tion from humanity " in the direction of lynching-atender-hearted people. For a long time they dropped thetear of sensibility over murderers who were subjected to.the barbarous procedure of being "worked off," to use,the classic phrase of a great artist in that line. Indeference to this delicate sentiment hanging was someyears ago abolished in New York State, and victims ofthe law were helped to shuffle off their mortal coil withease and despatch by electrocution. But still the Trans-atlantic philanthropist is not happy. Electrocution issaid to be uncertain in its action; and, indeed, it has evenbeen suggested that the post-mortem examination which ismade immediately after the sentence of the law has beencarried out, is intended to be the coup de grdce, or at anyrate to"mak' sikkar." Moreover, it is believed that insome cases at least electrocution causes pain. With theview of making execution painless, therefore, it wasrecently suggested in a paper read before the AmericanAssociation for the Advancement of Science to inflictsthe last penalty of the law by the administration of hydro-cyanic acid under conditions that will ensure death beingpainless. For this purpose the criminal is to be taken to a"death chamber," which is to be connected by pipes withretorts generating the poisonous vapour, and some timewhen the patientis asleep the letbal gas is to be turned on,and he will quietly be absorbed into the infinite. The,plan only requires the addition of a little slow music tomake it realise the aspiration of the poet who prayed thathe might drift through sweet sounds to a dream, andthrough a dream to death. To prevent any needless har-rowing of the criminal's feelings by the contemplation ofa steadily approaching end, the date of execution is not tobe fixed, but is to be left to the discretion of the authori-ties within certain limits, extending over a period of severalmonths. The idea does the greatest credit to thehumani-tarian sentiment to which it owes its conception. The planappears to us, however, to have one trifling drawback: theprospect of soluxurious an exit from the stage of this, dullworld is likely to lead to a large increase of capital offences.Who, indeed, some may be disposed to exclaim, wouldfardels bear to grunt and sweat under a heavy, life whenhe mightfind such a quietus by the easy and pleasant.method of sticking a bare bodkin into some one whom hedisliked?

SANATORIA FOR CONSUMPTIVES.TIIE erection of sanatoria in Germany for the "1open-air"treatment of phthisis proceeds apace.One of the latest tobe opened is the Edmundsthal at Geesthacht, near Ham-burg. Situated in a little pine wood, some go feet abovethe Elbe, the sanatorium is sheltered on three sides by hilland wood, while to the south it facesa-little valley. It isan H-shaped edifice, consisting of a basement and two.storeys, and provides accommodation for ioo male patients.The more southerly of the two long buildings is given up

OCT. 21, 1899.] MARK TWAIN ON CHRISTIAN SCIENCF. r Tzu Bai 1123I.4EDICAL JOURICAt

entirely to patients. In the basement are baths, lavatories'etc., at its extremities are wards, while the spacious cor-ridors adjoining them form day rooms. Outside eachcorridor is a verandah. In the basement of the short con-necting limb of the H are kitchen and offices, above them a-dining hall. The ends of the other long limb of the H alsoform wards. The latter are of three sizes. Three smallwards have a single bed apiece, the next holds four, and thelargest twentybeds respectively. The large wards are dividedinto sections by T-shaped wooden partitions, 5 feet 6 incheshigh, covered with linoleum. A"comfortable corner" isthus provided for each bed, and a certain amount ofprivacy ensured. It is said that the partitions are not high,enough to interfere appreciably with the ventilation. Thetotal cost of building, laying out grounds, etc., amounted tonearly 17,3oo, no less than I2,5co, of which was givenby Herr Siemers, of Hamburg. The Hamburg authoritiespresented the site, and are to contribute 3,000 a year forfive years towards the expenses. The sanatorium hasalready made a good start, and will, we hope, soon be ableto do without this contribution. This happy combination.of private generosity and public support is worthy of theconsideration of our countrymen. The foundation stoneof the German Sanatorium at Davos will be laid on October22nd. The estimated cost is i86,ooo marks, and the fundsalready in hand for the maintenance of free beds amountto 96,200 marks.

MARK TWAIN ON CHRISTIAN SCIENCE.MARK TWAIN has fallen among the Christian Scientists,and relates his experiences in the October number of The,Co8mopolitan. Last summer, on his way back to Viennafrom the Appetite Cure in the mountains, he fell over acliff and " broke some arms and legs and one thing oranother." He was taken to a neighbouring village, wherethere was no surgeon. There happened, however, to bea lady from Boston, who was a Christian Science doctor,and could cure anything. So she was sent for. But theshades of night were falling, and she could not con-veniently come; she sent word, however, that it did not inthe least matter, as she would applv "absent treatment "and call in the morning. In the meantime the suffererwas bidden to make himself tranquil and comfortable, andremember there was nothing the matter with him. Thepatient was in some doubt whether the diagnosis had beenmade with sufficient care, but he tried to make himselfbelieve that his pain was a delusion. Morning broughtthe Christian Scientist, who declined even to listen tothe recital of his symptoms, assuring him that there isno such thing as feeling, and that nothing exists but mind,which cannot feel pain. "You should never," said she,4' allow yourself to speak of how you feel, nor permitothers to ask you how you are feeling; you should neverconcede that you are ill; nor permit others to talk about-disease, or pain, or death,.or similar non-existences in yourpresence. Such talk only encourages the mind to continueits empty imaginings." On the unfortunate suffererpleading that he was full of imaginary tortures, which-could not make him more uncomfortable if they werereal, and asking what he could do to get rid of them, hewas told that there was no occasion to get rid of themsince they did not exist, but were mere illusions propa-gated by matter which itself had no existence. Mark Twainattempted to argue this point, since, as he put it, if there isaio such thing as matter, how can matter propagate things?In pity for his dulness of perception the Christian Sciencepriestess condescended to inform him that it was quitesimple: "The fundamental principles of Christian Scienceexplain it, and they are summarised in the four followingself-evident propositions: (i) God is All in all. (2) God isgood. Good is Mind. (3) God, Spirit, being all, Nothing isMatter. (4) Life, God, omnipotent Good deny death, evil,sin, disease." By way of further elucidation she added:

" Soul is God, unchangeable and eternal; and Man coexistswith and reflects Soul, for the All-in-all is the Altogether,and the Altogether embraces the All-one, Soul-Mind, Mind-Soul, Love, Spirit, Bones, Liver, one of a series, alone andwithout an equal." Here Mark Twain was moved to reflecton the effect which Christian Science has upon the verbalbowels; it made him think of a dictionary with thecholera. The lady went on to inform him thatMrs. Eddy, the "revered and sacred Founder" ofChristian Science is distinctly referred to and hercoming prophesied in the twelfth chapter of theBook of Revelations where it is said that "there appeareda great wonder in heaven-a woman clothed with the sunand the moon under her feet, and upon her head a crownof twelve stars." Further on it is stated that " the womanfled into the wilderness, where she had a place prepared ofGod," the said place being considerately explained by thisnewest biblical commentator to be Boston. When the in-spired writer goes on to say, "And I saw another mightyangel come down from heaven clothed with a cloud, and arainbow was upon his head, and his face was as it werethe sun, and his feet as pillows of fire; and he had in hishand a little book," is it not plain that he referred to Mrs.Eddy's latterday bible, Science and Health? Mark Twainread this work, and the effect of it upon his mind may begathered from his statement that " of all the strange andfrantic and incomprehensible and uninterpretable bookswhich the imagination of man has created, surely this oneis the prize sample." Our readers have already had anopportunity of forming a judgment on this extraordinaryproduction, and nothing more need be said of it here.Mark Twain believes that the book was written by some-one for Mrs. Eddy, as that otherwise gifted lady cannotwrite English; but that is a small matter, for if it be true,the revered and sacred Founder of Christian Science is byno means alone among prophets of healing in needing thehelp of mortals with a tincture of grammar to translatetheir inspired revelations into human speech. Mark Twainadmits, as everyone who knows the healing power of faithmust admit, that cures are wrought in certain cases byChristian Science as well as by the Mind Cure, the FaithCure, the Prayer Cure, and the Mental Science Cure; but hebelieves that it might be shown that all the "mind" sects,except Christian Science, have " lucid intervals-intervalsin which they betray some diffidence, and in effect confessthat they are not the equals of the Deity; but if theChristian Scientist even stops with being merely the equalof the Deity, it is not clearly provable by his ChristianScience Amended Bible. In the usual Bible the Deityrecognises pain, disease, and death as facts, but theChristian Scientist knows better. Knows better and is notdiffident about saying so.IMPORTANCE OF' TEACHING DOMESTIC SCIENCE.

AT the recent Congress of the Institute of Public Health,Dr. Rogers McNeill, County Medical Officer, Argyllshire,contributed a paper in which he contended that "domesticscience " should be taught as an aid towards the improve-ment of public health. Under the head of "domesticscience " he included the elements of hygiene and physi-ology, the theory and practice of cooking, laundry work,dressmaking, and housewifery or general householdmanagement; in fact, " all the duties of a woman in chargeof a house and family," " so as to keep herself and all theother occupants, from the youngest to the oldest in ahealthy state of body and mind"; and this, too, " at thelowest possible cost or least possible waste." The difficultyat present is apparently to find capable teachers ofdomestic science; there are a few in towns, but inrural districts thev are very scarce. Very fewmothers can teach their daughters, themselves nothaving sufficient knowledge or capacity, time or inclina-tion for the purpose. But, wherever it is taught, domestic

1124 T I-i~~~~~~~Hscience is said to stimulate the intelligence of the pupilsand to make school life brighter and more pleasant. It isa subject of primary education in Germany, especially inBaden, where the present system dates from I891; inSwitzerland and Belgium also great attention is given to thesubject. In London some progress has been made, but atseven centres only. The course covered three stages inthree years, commencing in Standard V, and takingStandards VI and VII in the second and third years.The lessons, which are both theoretical and practical,comprise in the first year elementary food and cookery,clothing, and laundry work; in the second year theyinclude food and cookery again and elementary house-wifery; and during the third year housewifery and homenursing. Outside London very few School Boards have asyet taken up the subjects in this systematic manner. Infact, housewifery has only been recently recognised as agrant-earning subject. In some counties schools ofdomestic economy have been founded, which are assistedby grants from county technical education funds; alsoin London and elsewhere pontinuation schools teachdomestic science. But all school authorities shouldstrive to obtain instruction for those under their chargein this most important subject. When this comes to pass,we may expect that, as Dr. McNeill observes, "in theaggregate the nation will be enormously strengthened towork out its destiny in the ages to come.'

DIPHTHERIA BACILLI IN HEALTHY PEOPLE.Among the knotty problems which have yet to be solved bybacteriology two of great importance are those of the iden-tification of the Klebs-Loeffler bacillus and of the signific-ance of its occurrence in healthy persons. While Kober'swork' does not solve these problems it throws valuablelight on some points in connection with them. In thematter of distinguishing the Klebs-Loeffler from the pseudo-bacilli Kober relies on four tests: (i) Microscopic examina-tion of the serum culture six hours after it is made. Stressis laid on the importance of this early examination. Atthis time the development of the Klebs-Loeffler bacillus isat its height and the majority of the bacilli are of theshape described by Loeffler as typical; later on theyassume a variety oF forms, spindle, pear, dumbbell, lancet,and half-moon-shaped. At this early period the pseudo-bacilli are relatively undeveloped and therefore not solikely to be mistaken for the Klebs-Loeffler. Of the xerosisgroup, for instance, only an occasional bacillus is "plump,"the majority are thin and easily distinguished from thetrue diphtheria bacillus. While Kurth and others foundthat occasionally pseudo-bacilli were encountered whichtook up (2) Neisser's double stain, Kober asserts that thisdoes not take place with young bacilli (that is, from a cul-ture six hours old). (3) The pseudo-bacilli either produceno acid or much less than is formed by the Klebs-Loeffler.(4) The effect on animals is not a trustworthy test wherenegative, as numerous instances have been known of trueKlebs-Loeffier bacilli proving non-virulent in animals.Kolbe examined the throats of 6oo healthy school children,and found diphtheria bacilli in i5; io of these 15 had beenin contact, more or less remotely, with diphtheria patients,for example, by playing in the same playground, etc. In-jected in guinea-pigs the bacilli from 5 of these proved tobe virulent, io were harmless. Of I28 persons brought intocloser connection with patients, the diphtheria bacilli werefound in i5, and in every case the guinea-pigs inoculatedldied. Little is known about these variations in virulence.At the Breslau Laboratory for the Investigation of Diph-theria, of 139 persons who were in attendance on diph-theria patients, and whose throats were not quite healthy,the Klebs-Loeffier bacilli were found in 69.7 per cent.According to the literature on the subject, says Kober, the

Max Kober, Zeit?cA. f. Hyg. und Infect., July 31st, 1899.

percentage in people with healthy throats in similar posi-tions is i8.8, but according to his own researches it is only8.i per cent. The length of time the bacilli are found inthe throat varies apparently with their virulence. In theI5 (out of 6oo) children, the average for the virulent wasIO.2 days, for the non-virulent 6.3 days. In the case of theother I5 persons the average was i6.8 days (it ranged fromI I to 28 days). While the bacilli may cling for a long timeto articles used by the patient, Kober agrees with Reger inthinking that inanimate objects play only a secondary partin the spread of the infection.

THE MEDICAL PROFESSION IN HUNGARY.A CONGRESS of Hungarian medical practitioners was heldlast month at Grosswardein, for the consideration of ques-tions affecting the interests of the profession. Some 350practitioners attended. The Congress, which was presidedover by Professer K6tli, was formally received by Cardina)Schlauch, the Burgomaster, and other officials and repre-sentatives of the local Medical Committee. Resolutionswere passed asking that the Pablic-health law should bemodified so as to safeguard the moral and material interestsof the profession; that quackery should be suppressed;and that the conditions of hospital assistance should bereformed.

THE PATHOLOGICAL SOCIETY OF LONDON.DURING its coming session an important new departurewill be made in regard to the meetings of this Society.Four of the fifteen meetings which have hitherto been heldat the rooms of the Royal Medical and Chirurgical Societyare to be held at different London laboratories, in connec-tion or not, with medical schools, the object being thatdemonstrations may be given which it would be extremelydifficult or impossible to carry out elsewhere. This is therealisation of a proposal made some years ago by the lateProfessor Roy. The advantages likely to accrue from suchlaboratory meetings are obvious, for it is a matter of greatmoment that the resources of scientific education shouldbe within the reach of all members of the profession whomay care to avail themselves of such. It is only in thisway that the scientific advance of medicine and surgerycan be ensured. It has, moreover, been determined thatthe report of an author's communication or demonstrationgiven at anv of the four laboratory meetings shall bemade public only if the author himself so wish. Thechief reason for this regulation is that the work beingcarried out at laboratories may be at such a stage of pro-gress when brought forward that its publication would bepremature and injudicious. The next meeting of theSociety will be held at the Jenner Institute of PreventiveMedicine on November 7th, and subsequent laboratorymeetings will be held at University College, London (Feb-ruary 6th), at the Laboratories of the Royal Colleges ofPhysicians and Surgeons (March6th), and at King's College(May Ist).PROFESSOR CLIFFORD ALLBUTT will give an address on

Local and Constitutional Disease at a meeting of theMedical Society of University College, London, on Wed-nesday, November Ist, at 8 P.M.THE muzzling order has been revoked in the' West Riding

of Yorkshire, and in Worcestershire, Warwickshire, and Staf-fordshire by order dated October x6th.CARE OF INSANE IN WORKHOuSES.-At the recent meeting

of the Northern and Midland Division of the Medico-Psychologial Association at the West Riding Asylum,Menston, Leeds, the question of the care of the insane inworkhouses was discussed, and it was unanimously agreed b'the members present that in union workhouses in whichinsane persons are detained nurses properly qualified andtrained in mental nursing should be employed.

[O,cT. 219 1899.THE PATHOLOGICAL SOCIETY OF LONDON.