393THE DANGER OF USING SCOPOLAMINE AS AN ANAESTHETIC.

soon dry and their natural heat. In the case of the

very poor who look for relief from the parochial guardians,while they are being aided it is made a sine quâ non that theirchildren .hall not be irregular in their school attendance.

THE DANGER OF USING SCOPOLAMINE AS AN

ANÆSTHETIC.

THE employment of scopolamine as an anæsthetic, to

which reference was made in THE LANCET of Dec. 30th,1905, p. 1922, is losing favour in France. At a meeting ofthe Socieie de Therapeutique of Paris’ M. Bardet drew

attention to cases in which the injection of one milligramme(0’016 grain) of scopolamine and one centigramme (0-16grain) of morphine has provoked grave symptoms of poison-ing and even death. He considers that the initial dose of

scopolamine should not exceed one-tenth or two tenths

of a milligramme. In subjects who do not readilytolerate alkaloids owing to the lowering of the antitoxicfunction of the liver special care should be taken in adminis-tering scopolamine and morphine. It was pointed out thatPouchet and Lewin gave the toxic dose of scopolamine as onemilligramme. A further disadvartage in the employment ofscopolamine consists in the fact that, as found in commerce,it is not always identically the fame in constitution ; the

toxicity of different samples of scopolamine may thereforebe expected to vary.

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PROPOSED MEMORIAL TO THE LATE PRO-

FESSOR VON MIKULICZ-RADECKI.

THE following gentlemen form an international com-

mitee having for its object the raising of a monument

to the late professor of surgery at Breslau :-Bernhard

Erbprinz von Sachsen-Meiningen, Herzog von Sachsen ;Oberburgermeister Dr. Bender ; Wirkl. Geh. Rat. Dr. E. vonBergmann, Berlin ; Staats- und Justizminister Bseler,Berlin ; Polizeipläsident Dr. Bienko; Dr. 0. Borchgrevink,Christiania ; Mr. F. M. Caird, Edinburgh; Hofrat ProfessorDr. Carl Chun, Leipzig; Geh. Justizrat Professor Dr. FelixDahn; Generalarzt Dr. Demuth; Professor Dr. Depage,Bmssels; Dr. G. Dohrn, Dir. des Orchester Vereins ; Pro-fessor Dr. F. Durante, Rome ; Konsul Theod. Ehrlich ; HofratProfessor Dr. Freiherr von Eiselsberg, Vienna; Geb. Regier-ungrat Professor Dr. Foerster, Vorsitzender der Schles.Gesellschaft 1 iir Vaterländische Kultur; Geh. Justizr,it Dr.Freund; Geh. Medizinalrat Professor Dr. C. Gane; Pro’fessor Halsted, Baltiawre; Oberkonsistorialrat Professor Dr.von Hase; Dr. Furst von Hatzfeldt, Herzog zu T achenberg ;Dr. Jur. G. Heimann ; Regiernngs-Pfasident Wirk. Geh.

von Holwede ; Professor Dr. Kader,Krakau; Dr. F. Kammerer, New York; Professor Dr.

G. K1Ufmann, z. Z. Rektor der Königlichen Universität ;Professor W. W. Keen, Philadelphia ; Professor T. Kocher,Berne; Domprobst Professor Dr. Koenig ; Geh. SanitätsratProfes.or W. Körte, Berlin; Sanitiitsrat Dr. T. Korner;G Kardinal Kopp, Furstbischof von Breslau ; StadtaltesteHeinrnh von Korn ; Geh. Medizinalrat Professor Dr.

Kustner, Dekan der Medizinischen Facultat ; Geh. Re-

gierungsrat Professor Dr. Ladenburg ; Professor Dr. Lejars,Paris ; Professor Dr. K. Lennander, Upsala ; Geh. Ju:-tizratProfessor Dr. Leonhard ; Wirk. Geh. Rat. Graf zu Limburg-Stirum ; Mr. G. H. Making, London ; Professor P. Meyerheim,Berlin, Mitglied der Akademie der Kiinste Gen. a la suiteund Kommandant von Berlin, Graf Moltke ; Professor J. B.Murphy, Chicago ; Professor Dr. Naunyn, Strassburg; Geb.Medizinalrat Professor Dr. Neisser ; Dr. A. Pinsker, Vienna ;Hans Heinrich XV., Prinz von Pless ; Geh. Medizinalrat Pro-fessor Dr. Ponfick ; Herzog von Ratibor ; Landeshauptmann.

1 Journal de Pharmacie et de Chimie, 1905, No. 10, p. 476.

Freiherr von Richthofen ; Geb. Sanitiltsrat Dr. Senftleben ; ;.Professor Dr. Sombart ; Professor Dr. A. Tietze; Graf vonTschirschsky-Renard; Geh. Medizinalrat Professor Dr.

Uhthoff ; Professor Dr. A. von Winiwarter, Lu’.tich ; Pro-

fessor Dr. Woelfier, Prague ; Gen. der Infanterie und

Kommandierender General der VI. Armeekorps von Woyr6ch;und Universitäts Kurator Staatsminister Graf

von Zeditz-Trützschler. Probably many of the late Professorvon Mikulicz’s admirers and members of the profession whovisited his clinic at Breslau may wish to take part in thismovement. Subscriptions in aid of the necessary fund maybe sent to Mr. G. H. Makins at 47, Charles-street, Berkeley-square, London, W.

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ON Feb. lst, at the Ecole de Psychologic, Rue St. Andie-des-Arts, Paris, a bust of Dr. Liebeault, the pioneer ofhypnotic therapeutics in the city of Nancy, was unveiled,,

before a distinguished company. M. Bienvenu-Martin,Mini,ter of Public Instruction, who was accompaniedby M. Berthelot, presided and addresses were given by.Dr. J. Voisin, Dr. Berillon, Dr. Maul Magnin, Dr. C. Lloyd.Tuckey. and Dr. Raymond. A poem in honou-r of Dr.

Liebeault, by M. Jules Bois, was afterwards recited by-M. Paul Mounet of the Come lie Fraccaise. The proceedingsterminated with a banquet in honour of the foreign guests..at the Marquery Restaurant.

IN his reports presented to the sanitary committee of theCity of London for the period from Nov. 18th, 1905, to

Jan. 23rd, 19C6, Dr. William Collingridge, the medical officer-of health, mentions that in November last a medical mannotified an illness afft cting a beer-drinker as being probablyconnected with arsenical poisoning. Samples of the descrip-tion of beer drunk by the patient were accordingly obtainedfrom three public-houses which he patronised and all ofthem were found to contain minute traces of arsenic not

eTCeeding 0 I th of a grain per gallon. This small quantityof arsenic is not likely to be injurious, except possibly in thecase of very susceptible persons.

THE medical officer of health of the Cape Colony reportsthat for the week ending Jan. 13th the condition of the

Colony as regards plague was as follows. No case of plaguein man or other animal was discovered throughout thecolony except at Port Elizabeth where two rats and onemouse were found to be infected with plague. As regardsthe Mauritius a telegram from the Governor received atthe Colonial Office on Feb. 2nd states that for the w(ek

ending Feb. lst there were 2 cases of plague and 1 deathfrom the disease.

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A GENERAL meeting of the Medical Officers of Schools’Association will be held at 11, Chandos-street, Cavendish-square, London, W., on Thursday next, Feb. 15th, at,3.45 P.M., when a discussioa on Physical Education ixaSchools will be introduced by Dr. W. P. Herringbam andMr. T. C. Horsfall.

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THE Princess Royal has consented to lay the foundation.stone of the new wirg now being built at the Bolingbroke.Hospital, Wands worth Common.

A visit to London has been arranged for thefamous Paris Municipal Guards Band, this being the thirdoccasion on which the band has played in London. A seriesof promenade concerts have been fixed to commence on.

Saturday evening, Feb. 17tb, at the Opera House, CovenbGarden. The net proceeds of the performances will be de-voted to the Queen’s Fund for the Unemployed, the Frenchcharities in London, and the Hilda Disaster Fund.

394 ANNUAL REPORT OF MEDICAL OFFICER OF THE COUNTY OF LONDON.

THIRTEENTH ANNUAL REPORT (FOR1904) OF THE MEDICAL OFFICER OF

HEALTH OF THE ADMINIS-TRATIVE COUNTY OF

LONDON.

J..

WE now resume consideration of Sir Shirley F. Murphy’sreport, dealing particularly with those portions of it whichfor lack of space we were precluded from noticing in ourleading article of Jan. 20th, p. 171.A cursory review of the series of public health reports,

whereof the present is the thirteenth, reveals the factthat whereas the earlier numbers were principally concernedwith recording the loss of life caused by the various epidemicmaladies which, in the absence of recent methods of control,were at that time more or less rife in the poorer parts ofLondon, the present number, on the other hand, whilststill preserving a continuous record of the occurrence ofthese maladies, treats as of at least equal importance from apreventive standpoint the question of the prevalence of suchchronic diseases as tuberculosis and cancer, diseases which inthe early days of sanitation were considered hardly amenableto sanitary control but which are still in the aggregateresponsible for an excessive proportion of our annual

mortality. The London County Council could hardly desirea more complete justification of its preventive achieve-ments than the circumstance prominently apparent in thepresent report, that with respect to every one of the diseaseshitherto brought under notification influence a substantialdecrease of fatality, and inferentially of prevalence, hastaken place since the issue of Sir Shirley Murphy’s firstannual report. As a typical instance of life savingaccomplished by skilled municipal vigilance the case of

typhus fever may be cited-a disease which in earlier yearswas wont to destroy large numbers of the poorer classesof the community and to entail untold misery and destitu-tion on the survivors. With regard to this pestilence thecounty medical officer is able to affirm that in the year 1904not a single death was caused by it in the administrativecounty of London.

In order to reserve space for consideration of what appearto be the most important topics in this report it is necessaryto pass lightly over the record of diseases that are not atpresent notifiable during life, and we do so the more readilyinasmuch as the Registrar-General has already dealt fullyin his annual summary with London mortality from suchdiseases as measles, whooping-cough, and diarrhoea. The

abnormally low rate of marriage and of birth and thestill favourable general death-rate are matters that havealso been sufficiently discussed in the publication referred to.With respect to small-pox, Sir Shirley Murphy reports that

in London this disease has assumed a mild type but has,nevertheless, maintained some degree of prevalence duringthe year 1904, especially in the eastern, central, andsouthern districts. Throughout the previous year freshcases of small-pox had been notified week after week, 22attacks having occurred in the closing week of that year.In 1904, however, the attacks were few and scattereduntil towards the end of February ; but in March theyincreased somewhat suddenly, a man suffering fromunrecognised small-pox having obtained admision to a

Whitechapel common lodging-house and thus led to a

local spread of the disease. It was mainly at the end ofthe first and the beginning of the second quarter ofthe year that small-pox threatened to become seriouslyprevalent in the metropolis, as many as 53 fresh attacks

having been notified in a single week at the end of March.The common lodging-house populations of Poplar, Stepney,and Bethnal Green seem to have been concerned chiefly inspreading infection at this period and the report givesinteresting details of the insidious manner in which wide-spread mischief was caused by a single unreported case ofhasmorrhagic small-pox. At this stage of the outbreak theborough council of Bethnal Green made an order for thenotification of chicken-pox within its jurisdiction, whichorder came into force at the end of March. Shortly afterthis the county council made a similar order, so that fromthe beginning of April until November chicken-pox becamea notifiable disease throughout the metropolis. Moreover,

the county council appointed Mr. S. Bingham and Mr.W. McC. Wanklyn as experts to visit at the request ofmedical practitioners any doubtful case of small-pox occur-ring in London. This well-timed and energetic action onthe part, first of the Bethnal Green local authorityand then of the London County Council, had thedesired effect, for the report tells us that a diminu-tion of the attacks reported in each week at once

commenced and that in the subsequent months they becamefewer and fewer, only one case being recorded in the wholecounty between Sept. 24th and Nov. 12th. The preventivemeasures adopted during the year, in addition to those

already mentioned, included the speedy removal to hospitalof infected persons, the keeping of "contacts" under ob-servation, and their vaccination whenever practicable.Medical officers of health freely communicated with oneanother the occurrence of fresh foci of infection and

promptly reported to the central authority at Spring-gardensthe addresses of "contacts still at large for the informationof their colleagues in other parts of the metropolis. As in

previous years, unrecognised cases of small-pox, mistakenfor chicken-pox, played a large part in the dissemination ofthe disease. Sir Shirley Murphy speaks appreciatively of theassiduity with which the local medical officers of health

sought for " contacts " and unrecognised cases of small-poxin their several districts, expressing the opinion that thethoroughness with which this was done was largely in-strumental in controlling the spread of the disease.

Scarlet fever appears to have been somewhat more pre-valent in 1904 than in the immediately preceding year, though,as compared with the decennial average, the notified cases,some 13,000 in number, were still considerably fewer. Com-menting on the diminished prevalence of scarlet fever in recentyears the county medical officer expresses the belief that thiscircumstance, albeit desirable in itself, has produced theuntoward effect of obscuring, in particular instances, thesource of infection. In various parts of London the spreadof the disease has been traced directly or indirectly to schooattendance, whilst in others infection seems to have beencommunicated from convalescents to the healthy in thestreets or in school playgrounds. On July 21st the summerholidays of the London County Council schools began andthe schools were reopened on August 22nd. In the text ofthe report the effect of holiday influence is contrasted withthat of school influence, with the result obtained on previousoccasions-namely, that the re-assembling of children inschool after the vacation is attended with increased spreadof infection. On the other hand, the opposite effect is pro-duced by school closure and this effect is especially noticeableamong children at ages from three to 13 years. In thefamiliar table giving the age and sex distribution of scarletfever we note that although the prevalence of the disease is

greatest from the third to the sixth year of life, neverthelessthe fatality is by far the highest among children underthe age of two years. In 1904, as in previous years,not only the rate of attack but the rate of mortality andthe case fatality also were higher in male than in femalechildren.With respect to diphtheria, the increased prevalence

of which disease a few years since had caused consider-able anxiety in London, Sir Shirley Murphy is able to

report a still further decline in 1904, the proportion ofattacks to population being lower than in any year since1900. As in previous years, he recounts in the present reportparticular instances of the spread of diphtheria from personto person by means of intermediary persons who, althoughcapable of communicating infection to others, do not them-selves present obvious symptoms of the disease. The anuualreport in the appendix of Dr. J. Kerr, the education medicalofficer, also contains account of the finding of "carriercases" among children attending schools invaded by diph-theria, the exclusion of which children led to the terminationof the outbreak. Very obvious is the need for careful searchin cases like this for "carriers" among diphthei ia contacts"both in school and at home. As in previous reports, a tableis here included showing the relation of school attendance tothe spread of diphtheria ; the lesson taught is the nowfamiliar one that with every care on the part of the educationauthorities a marked increase in diphtheria prevalenceinvariably marks the reopening of schools and a correspond-ing decrease follows their closure for the holidays. Accordingto the report a supply of antitoxin for the use of medicalpractitioners is provided gratuitously by the municipalauthorities of certain parts of London but not by all. The