102

again felt and aspiration was performed. The fluid wa,

then of a light colour, but in March dark and bloodfluid was again withdrawn. After irrigation Thiersch’:

fluid was injected and then allowed to escape. After this ar

iodine solution (25 drops to the pint) was injected and

half a pint was allowed to remain in the chest. A reaction

with pain and a temperature of 1005° followed. In a week

fluid had returned and a quart was removed. Fluid neveI

collected in the right pleura again. But a week afterwards

dyspnoea recurred and fluid was found in the left pleura.A quart of basmorrhagic exudation similar to that of the

right side was removed. It had collected without chill,fever, or pain. In the succeeding three months the pleurawas aspirated seven times. An iodine injection was employedand the fluid collected once again, but never afterwards.In October, 1892, abdominal enlargement was observed.

In November 17 pints of bloody serum similar to the pleuralfluid were withdrawn from the peritoneum, and multiplefibroids were found springing from the fundus uteri. The

operation was repeated 41 times in the next five years,and for the last time in November, 1897. The fluid didnot collect after this, and a period of 20 months had

elapsed at the time of the report. Hasmorrhagic serous

effusions occur in association with cancer and tubercu-

losis, but there was no evidence of either in thiscase. Lawson Tait has written " On the Occurrence of

Haemorrhagic Pleuritic Effusion in associatioo witb í’iseaseof the Abdomen." 1 He has related two cases. One

exemplifies the familiar fact that malignant diseaseof the peritoneum and pleura may cause hasmorrhagioeffusions, the other that similar effusions may occur

with non-malignant abdominal disease (fibroma of the

ovary). In the latter case six pints of blood-stainedfluid were removed from the left pleura ; the right thenbecame affected. Dr. Cheesman and Dr. Ely conclude thatin their case the existence of the uterine fibroid cannot

explain the effusion because the pleuras were attacked beforethe peritoneum. They think that the case is an example ofwhat the French call primary hsemorrhagic effusions, of

which Osler cites rare cases. We cannot quite follow theirreasoning, for it is quite possible that the peritoneum wasnrst attacked, though noticeable effusion occurred much

later. ___

THE JENNER INSTITUTE OF PREVENTIVEMEDICINE.

DR. MACFADYEN’S introductory address at the JennerInstitute of Preventive Medicine on Monday possesses asignificance which must appeal to the public and themedical profession. In one sense it is a summary of

the history of the Institute, but it is more than this. It

recalls the fact that Germany and France were busy in thesame field of research before we in this country had evenregularly entered it. It sketches the original scheme ofwork laid down when after long delay a British Institute ofPreventive Medicine was founded in 1891, and it shows howthat scheme was from the first, notwithstanding the knownprejudice of some persons, accorded a large measure of

public support. The practical generosity of Lord Iveagh andof the Jenner Memorial Committee afforded further welcomeproofs that the excellence of the aims and work done at theInstitute were recognised. By these additions the perma-nence of its labours was assured. The general character ofthe work which is carried on is familiar to our readers,though some of its details probably are not. Briefly, theseinclude the primary business of research into the causes ofdisease attributable to the action of bacteria and the meansof their prevention. Among the latter the preparation of

1 Transactions of the Royal Medical and Chirurgical Society, 1891-92,vol. lxxv.

: antitoxins fills an important place. The bacteriologicaldiagnosis of disease is extensively practised on behalf of thechief London vestries, and similar assistance is renderedto local sanitary authorities. An interesting and mostuseful addition to the ordinary work is that carried out

by the Hansen laboratory for the application of bacterio-logy in connexion with industrial and technical processes.A post-graduate course of instruction is provided at the

Institute, while students from all parts of the world attendit for the purpose of original investigation. The fact thatso much has been organised and accomplished in the courseof a few years in this country where sanitary opportunitiesare constantly being sacrificed to the wishes of ill-informed

objectors brings no small credit to the perseverance of thepromoters of the Institute. It is at the same time somewhat

discouraging to remember that as yet the effort remains

virtually an isolated one. We trust that the British public,to whom this question of the prevention of disease is after allof the first importance, will see that the example set by themetropolis does not lack support when support is claimedin other centres of population.

THE ITALIAN RED CROSS.

ON the disastrous day of Adowa-" the Moscow of Italiancolonial expansion "-on the Kalends (why was it not theIdes ’!; of March, 1896, the combatant arm of GeneralBaratieri’s forces was put to shame by the medical, includingthat auxiliary to it, the ambulance service of the RedCross. Not only under fire, but throughout the hardly lesssanguinary retreat, the medico-military department, secondedby the "Croce Rossa aforesaid, displayed a courage, acoolness, and an efficiency all too inconspicuous in the

regiments of the line, and recalled to the world what Murat’s10,000 Italians endured and dared in the terrible Russiancampaign of 1813. Italy, indeed, has good cause to be

proud of her Red Cross organisation, and ever since the

"day of Adowa " has been lavish of her contributions toits support and development. The annual bulletin-thefifteenth of the series-issued by the Central Committeeof that organisation is now before us and will be foundfull of interest (it may be of instruction) to the sister

organisations of the other European Powers. One of its

special features is the account it gives of the "Red Cross-Afloat "-an innovation which Italy claims as her own-forutilising the water-way, consisting of lake, river, and canal, socharacteristic of that historic battle-ground the Lombardo-Venetian plain. The "ambulanza fluviale" (river ambu--lance) known as that of "Alfonso Litta of Milan," andfullydescribed in the "bulletino," might suggest valuableadditions to our own service, particularly in tropical warfareor wherever there is water-way sufficient for such a " medicalflotilla." The coolness, the silence it secures to the patientcannot but prove grateful to him as well as conducive to his.convalescence-to say nothing of the economy it effects inits exemption from draught cattle and their personnel.Reinforced, as indicated by the liberal contributions of thelast three years, the funds of the Italian Red Cross in cashand mccteriel now amount to 6,262,187 lire an. its hospitalaccommodation includes 49 "ospedali di guerra," 22.mountain ambulances, 15 hospital trains, two "ambulanzefluviali," two hospital ships, and 40 stations in con-

nexion with railways. All these may be augmentedin case of mobilisation-t,he " stazioni fluviali," for

instance, may be raised to eight. The professional staff

numbers 786 medical men and pharmacists, 771 "com-missari " (secretaries, clerks, and ministers of religion), and2032 "infermieri" (clinical attendants or porters with theirchiefs). Represented abroad by 49 "delegazioni," theItalian Red Cross, under its Central Committee, has 359

"sottocomitati," 98 ladies’ "sezioni," and 559 communal.

1030

delegates ; while the members of the organisation amount to I23,428, drawn from 49 provinces and 2348 communes.

The Central Committee, we may add, has obtained a

new and honourable distinction for the members of

the above-indicated committees-a regulation by which areciprocal salutation is rendered obligatory between the

omcers and marines of the Royal Navy and the officers andprofessional staff of the Red Cross. Certainly, the contrastbetween the combatant and the medical (including the RedCross) arms on " the day of Adowa " more than entitles thelatter to the respectful recognition of the former.

IODINE IN ARTICLES OF DIET.

IODINE has not hitherto been presumed to be present inany important quantity in alimentary materials, but accordingto recent researches which have opened up a very delicateprocess for the detection and estimation of iodine thiselement occurs certainly in the flesh of fish and shell-fish in not a negligible quantity. It is true that tracesof iodine have been found in cod-liver oil which with otherelements such as bromine and phosphorus probably exert aslight specific action and possibly a favourable influence onthe absorption of the oil, thus contributing in some measureto its tonic effects. The flesh of fish is peculiarly nutritivethough less satisfying and perhaps less stimulating thanordinary kinds of meat. It is able to be digested moreeasily and r ’idly than is animal flesh and on theseconsideratione affords a useful food for invalids. But

most fishes ( etain iodine, and thus the occurrence

of this element may be a factor of importancein the suitability of a fish diet for invalids. The

herring appears to be at the top of the list, containingtwo milligrammes of iodine per kilogramme. Next come

mussels, 1 9 milligrammes per kilogramme ; next salmon,1’4 milligrammes per kilogramme; then ling and cod, 1’2milligrammes per kilogramme, and the same amount in

oysters. The salmon trout appears to contain the smallestquantity, which is only 0’1 milligramme per kilogramme.These results are interesting and doubtless the inquiry willbe extended to other articles of diet, though on the faceof it there is more probability of iodine occurring in fish

than in mammals or vegetables.

PURULENT ENCEPHALITIS IN THE NEWLY-BORNDUE TO INFECTION FROM THE

UMBILICAL CORD.

DR. Guy HiNSDAl/E of Philadelphia reports in a

recent number of the American Journal of the MedicalSciences (September) an interesting case ot this conditionoccurring in a newly-born infant. The child was born of a

woman, aged 27 years, who had been suffering from uterineinflammatory trouble for which she had been treated by"curetting" two yeari previously in hospital. The preg-nancy in the present instance was attended with pain feltfrom time to time in the hypogastrium and pelvis, andduring the third stage of labour it was noticed that a

quantify of pus was passed with the placenta. The child atbirth beemed to be slightly emaciated in appearance but thisbecame marked on and after the third day. He suffered fromnystagmus since birth and from frequent and continuousretraction of the neck. The temperature was 103° F.From time to time the child uttered short, shrill cries,and had convulsions. The mouth showed appearancesof thrush. The umbilical cord had a foetid odour andit was dressed with boric acid lint and it separated onthe sixth day. The child continued to grow worse,

would not suck, seemed to be in great pain, and died onthe thirteenth day. A necropsy was made by permissionof the parents on the bead alone. The skull-cap wasremoved and the dura mater appeared to be free from

any inflammatory condition. On opening the dura mater,however, its inner surface, as well as the whole surface ofthe brain (convex aspect and base), seemed to be bathed ina layer of pus of pale-yellow colour and of thick creamyconsistence. The pus penetrated into the great longitudinalfissure and into the sulci of the brain. In the left frontallobe there was a small abscess of recent formation and with-out a distinct lining membrane or wall to it. It containedfrom 15 to 20 cubic centimetres of pus. In a correspondingposition on the frontal lobe of the opposite cerebral hemi-sphere there was a large local haemorrhage, and the wholecortex in both hemispheres showed numerous scattered

miliary haemorrhages. The cerebellum showed purulentencephalitis on its surface. On examination of the pusunder the microscope after staining, numerous bacteria of

rod-shaped appearance and slightly curved in outline werefound. In sections of the brain prepared and stained withthe aniline dyes (methyl-violet, fuchsin, &c.) these bacteriawere found in abundance in the inflammatory exudates sur-rounding the blood-vessels (peri vascular areas). The nerve-

cells showed advanced degrees of degeneration of the

granulo-fatty type combined with vacuolation of the proto-plasm. There were also foand abundant hsematoidih

granules and miliary haemorrhages as well as minutethrombi and softening throughout the cortex. Pure cultiva-tions from the pus in the meninges were made and thebacteria thus obtained were found to be of the formbefore mentioned-viz., of rod shape, with rounded endsand slightly curved in outline. Their width varied from0’5 to 0’8 of a micron. They were apparently without

mobility, stained with aniline dyes, and were decolourisedby Gram’s method. The cultures flourished well on all

media and did not liquefy gelatine. They formed a cloudygrowth and produced a granular deposit in bouillon. In

sugar solutions the cultures produced gas. They werefound to be virulent ; for example, guinea-pigs injectedwith one cubic centimetre of the bouillon culturesuccumbed in 12 hours or less. The microscopical appear-ances and the modes of growth on the media served to

establish the organism as the bacterium coli immobile. Itmust be added that the woman in the present case was freefrom puerperal fever or septicaemia and made an uneventfulrecovery. Dr. Hinsdale refers to a case reported by Dr.L. N. Bosworth, who had found the above colon bacteriumin the pus within the cranium of an adult who had died onthe fourth day from purulent meningitis. In the present casethe infection of the child evidently took place throughthe umbilicus, the original source of mischief having beensituated in the uterine wall at the site of attachment ofthe placenta. The lesions of the brain as found post mortemwere apparently consistent with a short duration of the

purulent meningitis due to infection of the child, probablya period not longer than that which elapsed between thebirth and death of the child.

INFANTILE MORTALITY IN THE WEST RIDINGOF YORKSHIRE.

THE annual report for 1898 of Dr. J. R. Kaye, medicalofficer of health for the West Riding of Yorkshire, containssome striking statistics as to infantile mortality in the dis-trict under his charge. He points out that out of every 1000children born in the West Riding during 1898 165 diedbefore completing their first year of life, the mortalitybeing higher in the urban than in. the rural districts bythe proportion of 170 to 151. There are individual districtswhere the figures become positively lurid. In Featherstone,Heckmondwike, and Ravensthorpe, says Dr. Kaye, "actuallyone child in every four never sees the first anniversary ofits birth." The remarks of several of the district medicalofficers-those of Mr. J. J. Jackson, medical officer of health