1671

every instance as the result of ether anaesthesia, that thereduction varies according to the length of the inhalation,that 10 per cent. of the reduction takes place during thefirst 20 minutes of the inhalation, and that hsemoglobinreaches its lowest level at from 24 to 30 hours after

the termination of the anaesthesia. There is less decidedloss during a second administration conducted soon

after the first and the reduction is more quickly recoveredfrom. Changes in the red cells are always present after theansesthetic state is reached, the individual cells being thickand compact. Leucocytosis occurred in two-thirds of theanimals experimented upon. In human beings the leuco-cytes were sometimes increased and sometimes diminished,always returning to the normal number soon after the

cessation of anaesthesia. Myelocytes in small numbers

appear in human blood after ether anaesthesia. As regardshaemoglobin Dr. Anders and Dr. Boston find that the colourindex reaches the normal 72 hours after the cessation ofanaesthesia. In general terms it may be said that etherisa-tion produces increased haemolysis, followed by rapid re-

generation of cells with increased number of red corpuscles.

THE HEREDITARY TRANSMISSION OFALKAPTONURIA.

Dr. Archibald E. Garrod sends us the following interestingnote :-" In the Gazzetta J.1fedioa Lombarda, 1889, vol. xl viii.,p. 115, Professor Francesco Orsi of Pavia gave an accountof Tre individni di una stessa famiglia colpiti da

Pirocatechinuria,’ and on p. 135 of the same volume

his assistant, Dr. Oesare Magni, has a further com-

munication Sulla Pirocatechinuria.’ These papers havehitherto escaped the notice of those of us who have

collected the recorded cases of alkaptonuria. The veryfull description of the urine given includes practicallyall the characteristic features of alkaptonuria, such as thedarkening on standing or on addition of an alkali, the

reduction of Fehling’s solution, the negative result of the

bismuth test for sugar, and the absence of rotation of the

polarised ray. The attribution of its properties to the

presence of pyrocatechin was merely a reflection of theviews prevalent at the time and Dr. Magni mentions

alkaptonuria as an alternative name for the condition. In

the absence of any direct evidence that pyrocatechin wasthe abnormal substance present in these cases we are

justified as classing them as examples of alkaptonuria. Thefirst patient, Signor 0. S., aged 20 years, was broughtto Professor Orsi by his cousin, a medical student, on thesupposition that he had diabetes. Professor Orsi goes onto say : I I had occasion later to analyse the urine of

Signorina R. S., a sister of Signor C. S., and found it toresemble that of her brother. Moreover, I have been assuredby the student, Signor F. S., that the urine of the motherof Signor C. S. and Signorina R. S. also presents the maincharacters of that of her children.’ Although a large pro-portion of alkaptonurics are brothers and isisters, only oneother instance of the direct transmission of the anomalyfrom parent to child is known-namely, in the family underProfessor W. Osler’s observation in which a father and sonand a brother of the father have exhibited the peculiarity.The fact that this hitherto overlooked record affords asecond example is my excuse for calling attention to it inthe present note." Dr. Garrod, as is well known, writes withauthority on the subject of alkaptonuria and its literature,having himself also worked at the chemical relations of thispeculiar substance. The above addition to the scanty numberof cases on record is of great interest as an example of thehereditary transmission of the condition and also as indi-cating that some cases may have escaped notice, the reductionof Fehlihg’s solution being attributed to some other substance

1 See THE LANCET, Dec. 13th, 1902, p. 1616, and Jan. 2nd, 1904, p. 10.

such as pyrocatechin or sugar. It is also a point worthy of’notice that several of the rarer anomalies of metabolism, such-as pentosuria and cystinuria, as noted in another column

(p. 1673), show peculiar family relations as do the more-common metabolic diseases-gout and diabetes.

ASH AN ASSET.

As everybody knows the ash left on burning tobacco isconsiderable and, as a matter of fact, the mineral matter ofthe tobacco leaf frequently amounts to as much as a fifthpart of its weight. Thus, a ton of tobacco leaf would/

yield four hundredweights of ash which represents valuable,mineral constituents withdrawn from the soil which have to-be replaced by abundant manuring. It has been calcu-lated that a ton of tobacco withdraws over a hundred-

weight of mineral constituents per acre of land. In 1901-the home consumption of tobacco in the United Kingdomwas at the rate of two pounds per head, or a total of-about 40,000 tons, which represents, at what is now a.

probably low computation, approximately 8000 tons of

ash annually committed to the winds or dissipated in,

some way or other. This would appear to be an astoundingwaste of material which must be of enormous value to thesoil considering that 75 per cent. consists of calcium and

potassium salts and 15 per cent. of magnesium and sodium,salts, including nearly 5 per cent. of the essential con-

stituent to all plants-phosphoric acid. On the face of:it there would seem to be a fortune in store for thatindividual who could devise a successful means forthe collection of tobacco ash, and it is great pity that. t

so much valuable material should for ever be lost to thesoil without any attempt at direct restoration being made.It means an economic loss which without artificial resources.would ultimately starve and ruin the soil used in the produc-tion of tobacco. Ash after all ought to be a valuable assetsin the economy of things. Similarly, in the form of animalexcreta there is annually an enormous loss of material of theutmost value to the soil, although the time may not be fardistant when we shall see even that economically restoredto the land. The late Sir John Lawes once argued that ther-discharge of sewage into the sea did not necessarily implywaste for we had it back in the shape of a bountiful fish"harvest, but the sequence of events is very doubtful.

JAUNDICE IN SECONDARY SYPHILIS.

THOUGH jaundice in secondary syphilis has been.described by writers from Paracelsus downwards it doesnot seem to have received much attention in this country.It is certainly far from common, for Werner in the.records of the Hamburg hospitals found only 57 cases of £

jaundice in 15,799 cases of secondary syphilis. In the.American Journal of the Medical Sciences for May Dr. W. J-Calvert has reported the case of a man, aged 27 years, whowas admitted to hospital on June 6th, 1902, with intensejaundice. Six weeks before a sore developed on the glanspenis. On June 3rd the patient first noticed the jaundice.On admission there were intense jaundice, an induratedchancre, one enlarged right inguinal gland, and slightgeneral glandular enlargement. There was no fever. Theliver was of normal size and not tender. The urine con--tained bile pigments but the fasces were not decolourised.Three days later a general macular eruption appeared. The

general condition of the patient was good ; there was neither.fever nor digestive disturbance. Under mercury and iodidethe jaundice and secondary symptoms disappeared in threeweeks. The pathology of jaundice in secondary syphilis isnot settled. It has been ascribed to various causes-en-

larged glands pressing on the bile-ducts, secondary eruptions.in the intestines obstructing the flow of bile, congestion ofr.

1672

the liver, and catarrh, similar to that of other infectiousdiseases. Two types can be distinguished, a benign and a,grave. In benign cases the jaundice develops rapidly withoutthe usual digestive disturbances of catarrhal jaundice. In

three-fourths of the cases the jaundice develops simul-

taneously with the secondary symptoms ; in the remainder itdevelops either before or after them. In degree it varies’from a light to a deep tint. Its course runs parallel to thatof the secondary symptoms. It lasts from a few days to twomonths, but if treatment is neglected it may become chronic.The hypochondriac region may be tender. In two ofWerner’s cases the liver was enlarged. The urine has the

ordinary characters of jaundice and the fasces are more orless decolourised. Pruritus is seldom present. Werner ob-served xanthopsia in three cases. In grave cases the

jaundice first develops as in benign cases, but on the fifthor sixth day delirium, haemorrhage, purpura, or coma occursand death often rapidly follows. In an annotation we have

recently described at greater length this form and related aremarkable case.l

___

THE REBUILDING OF ST. BARTHOLOMEW’SHOSPITAL.

ON the evening of June 3rd a concert in aid of the Rebuild-ing Fund of the Royal Hospital of St. Bartholomew was

given under the auspices of Signorina Giulia Ravogli atQueen’s Hall. The principal item of the performance wasGluck’s Orfeo in which Signorina Ravogli of course took thetitle part. She was assisted by Miss Lydia Nervil as Eurydiceand Miss Martha Cunningham as Amor. The choruses were

sung by the members of the Leeds Choral Union and thewhole performance was conducted by Mr. Alfred Benton.We are glad to say that the hall was well filled so that thefunds of the hospital must have benefited to a considerableextent. Signorina Ravogli’s rendering of the part of Orfeois too well known and too highly appreciated to be in needof any further praise here and she received every assistancefrom the other two principal singers. The choruses were

sung with the attack and precision and the beauty of vocaltone for which the Leeds Choral Union is so well known.We cannot omit to give special praise to Mr. Albert

Fransella’s perfectly beautiful rendering of the flute part inthe number entitled Ballet of the Happy Souls," a melodywhich always seems to us as perfect an expression in musicalterms of "Animula, Vagula, Blandula " as can be imagined.But Gluck’s music is invariably in exact accordance withthe feeling of ,the story which it illustrates. Mr. Malschalso deserves commendation for his playing of the hautboyobbligato to the air which follows almost immediatelyafterwards. After the performance of Orfeo the LeedsChoral Union sang two choral numbers by Elgar andMendelssohn. Altogether the performance was most

enjoyable. -

VACCINATION IN BURMA.

IN the Rangoon Gazette of April 27th Dr. T. F. Pedleymakes a very serious indictment of the management of theProvincial Vaccination Department of Burma. Briefly, hischarges are that "a sufficient staff of competent honestvaccinators and a regular supply of good lymph " are notprovided. In illustration of the latter complaint he statesthat in the Northern Shan States and Chin Hills the

successful results in 1900-01 were officially given as 22’ 49and 28 39 per cent. respectively. In Rangoon itself a

vaccination depot for the production of animal lymph wasestablished in 1883 and maintained until 1900, whenthe Government grant was withdrawn. Afterwards civil

surgeons and district vaccinators were directed to obtain

lymph from another station distant, as measured by1 THE LANCET, April 30th, 1904, p. 1221.

time, a week or more from many places requiring its

services. The lymph formerly provided in Rangoon hadseldom or never failed even a month after its issue, but thenew lymph is usually inert in a week or ten days andfailures are frequent even earlier. As a natural result theBurmese are said to be losing confidence in vaccination, andresorting more and more to the ancient practice of small-poxinoculation. The diminution is officially acknowledged andthe supeiintendent-general of vaccination attributes it tothree causes : (a) that outside municipal limits vaccina-tion is not compulsory or small-pox inoculation illegal; (b)that in the past the district vaccinators made false returns,which are now checked by closer supervision and bypunishment ; and (c) that an indifferent class of men

seek employment as vaccinators. The last statement

quite falls in with Dr. Pedley’s contention. Vac.

cinators, it seems, have an average pay of about 27

rupees a month and this includes travelling expenses, so

that coolies can earn more in the port of Rangoon. The

questions raised by Dr. Pedley are certainly serious anddemand full investigation. It is the boast of Britain that

subject races benefit by its control. Obviously healthadministration is among the most important functions ofcentral and local government. The Burmese are said to bea reasonable people, ready to accept vaccination if offeredto them by trustworthy hands. In such circumstancesthe proportion actually vaccinated, which is given as about300 per 10,000 of population in Lower Burma in 1902-03, ismiserably small, and Dr. Pedley makes out a strong case forgovernmental responsibility for this most unsatisfactory stateof affairs. The subject is very well worth the attention ofthose members of the British Parliament who take specialinterest in the welfare of our great dependencies in the

Far East. ___

ON THE USE OF ALCOHOL IN CASES OF

PNEUMONIA.

IN a suggestive and carefully reasoned paper on pneu-monia, read before the Liverpool Medical Institution byDr. John Hay and recorded in extenso at p.1643 of this issue,some strong views are expressed against the routine use ofalcohol in cases of threatened cardiac failure during thecourse of that disease, supported by statistics and tablesof somewhat startling character. He found that in con-

sidering a group of 150 cases, 47 of which were treated byhimself without administration of alcohol, while the remain-ing 103 were treated by his colleagues, alcohol being givenwhen the usually recognised indications for its administra-tion arose, the mortality in the former group (those untreatedby alcohol) was 16 per cent. less than that in the latter,or, eliminating the cases admitted moribund from both

groups, there was a difference of 15 per cent. in favour of thecases treated without alcohol. Dr. Hay states that he hastaken great care to eliminate every source of error and wemust accept his figures as showing the difference he claims.At the same time there would seem to us to be one or twofactors requiring elucidation, leaving out of considerationthe smaller number of cases dealt with in the former group.First, although the average age of the two groups of casesis practically identical, it would have been of interest to com-pare the age mortality of the two groups in decade periods.Again, considering the group of 103 cases treated by his col-leagues with alcohol there would seem to be three possibilities:first, that all the patients seen by them were treated withalcohol; or secondly, that the cases not treated by alcoholwere excluded, which would seem to be negatived by thestatement that no selection was made ; or thirdly, that thisgroup includes cases to which no alcohol was given, inwhich case it would be of interest to know what proportionthese form of the total. These are points which require