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VACCINATION BY THE MOUTH.THE idea of attempting to immunise animals by

the buccal route is no new one. Pasteur essayed itin his experiments on anthrax in 1880, but the resultsobtained were not encouraging. In the intervalvarious rather sporadic attempts at vaccination bythis route have been forthcoming, but interest in thematter languished until stimulated again by Besredka’swork on typhoidal infections, which we have alreadynoticed in previous issues. A critical survey of thepresent position of the subject is given by Prof. A.Calmette in the October issue of the Anrwles of thePasteur Institute, and is worthy of being consulted byall who are interested in this matter. After surveyingthe physiology of the intestine in reference to itsmicrobic flora, he passes to a consideration of thedifferent conditions in which oral vaccination has beenclaimed to be useful. These include infections so

widely differing as the typhoids, dysenteries, cholera,Malta fever, tuberculosis, diphtheria, plague, andseptic infections. The chief interest, however, centresaround the use of oral vaccination in typhoid anddysentery. For the former the method has beentried in France in two human epidemics. In each ofthese cases the subsequent incidence of the disease inthose who were vaccinated by the mouth comparedvery favourably with the incidence in those vaccinatedin the ordinary way by the T.A.B. vaccine ; in neithercase, however, were the conditions sufficiently wellcontrolled to enable exact deductions to be made.The possibilities of this method of immunisation hasperhaps even greater interest in connexion withbacillary dysentery, in which disease attempts toinoculate on the lines familiar in typhoid have notablyfailed, on account of the great toxicity of killedcultures of these organisms and the violent reactionswhich their injection provokes ; hence, if the oralroute were found satisfactory it would be a very greatgain indeed. Experiments on animals have beenencouraging, and the human experiments of Nicolleand Conseil, which we have previously noted, are

promising, but the method has yet to be tested on alarge scale. Calmette concludes that the method isonly, as yet, in the early days of its trial, and,especially with regard to ,the typhoidal diseases, heutters a warning against the possibility of the hurriedabandonment of current methods whose efficiencv hasbeen proved, in favour of others, easier of application,but as yet of doubtful value.

INCUNABULA.WHAT are incunabula ? The original meaning of the

word is swaddling clothes, then it came to mean" origins " or the early stages of anything, and finallyit was applied by the Germans with the particularmeaning of early printed books. " IncunabulaMedica: A Studv of the Earliest Printed MedicalBooks, 1487-1480," 1 takes its title from the presi-dential address delivered by Osler on the occasion ofhis election for the second time as President of theBibliographical Society in 1914. The address as

printed is not the address as delivered by Osler, buthas been expanded by the addition of some biblio-graphical details obtained by Mr. Scholderer, assisted Iby Dr. Francis and Dr. Malloch. The book alsocontains a list of medical works printed before 1481,edited by Mr. Scholderer, two indices, the one ofauthors and books and the other of printers andplaces, together with 16 facsimile plates of pages fromearly printed books. There is a learned and charmingpreface from the pen of " A. W. P.," who, we imagine,must be Mr. A. W. Pollard, giving an account ofOsler’s connexion with the Bibliographical Society ;he served as President for seven years. Mr. Pollardis Keeper of the Printed Books in the British Museumand Hon. Secretary of the Bibliographical Society,and we gather from the preface that he is responsible I1 By the late Sir William Osler, Bart., M.D., F.R.S., Regius

Professor of Medicine, Oxford. Printed for the BibliographicalSociety at the Oxford University Press. 1923. With 16 fac-simile plates. Pp. 137.

for the shaping of Osler’s address for printing. Issuedunder such auspices it is no wonder that the bookas a whole is a real treasure for book-lovers, while theformat, the printing, and the plates are worthy ofthe high standard of the Oxford University Press.Osler’s address is the very man himself, learned,cultured, and written both as regards matter andmanner in a way which would have delighted Richardof Bury, the famous book-loving Bishop of Durham.It deals with 67 medical writers, whereas Mr.Scholderer’s list contains some 218 entries, althoughthese, of course, are not all separate authors. Osler’sconclusion is that " one cannot say that, for the firsttwenty-five years of its existence, printing did much,

if anything, to free the profession from the shacklesof medisevalism. Not until the revival of Greekstudies did men get inspiration from the truemasters of science."Every medical man interested in medical history

should read this book and every book-lover too, whileas a cognate study we recommend a little book, nottoo well known, called the " Wanderings and Homesof Manuscripts," by that finished scholar and humanist,Dr. M. R. James, Provost of Eton. Books are noteverything, but good books represent the orderedarrangement of the experience and mental outputof many generations, and to use the words of theabove-mentioned Richard of Bury in his allocutionto books, they " are the wells of living waters, whichfather Abraham first digged, Isaac digged again, and

which the Philistines strive to fill up."THE PANDEMIC OF INFLUENZA IN INDIA

IN 1918.

Dr. E. S. Phipson,1 health officer of Simla, devoteshis London M.D. thesis to the consideration of thepandemic of influenza in India, with special referenceto the city of Bombay, of which he was recently theassistant health officer. After a review of pastepidemics he describes the genesis of the 1918 outbreak.Apart from influenza the latter half of 1918 wasunusually free from epidemic disease ; the incidenceof plague was the mildest for 20 years, and the failureof the monsoon had caused a subnormal incidence ofmalaria. On the other hand, the stock of food wasrelatively low, the rainfall was subnormal. Priceswere everywhere abnormally high, and the war hadgreatly depleted the medical staff, which at the bestof times was inadequate for the enormous population.The first phase of the epidemic occurred in June andlasted barely four weeks, during which time the epidemiccost Bombay over sixteen hundred lives, at leasta million working days, and an incalculable amount ofdiscomfort, expense, and inconvenience. The secondphase began after about an interval of two months onSept. 10th, reached its height on Oct. 6th, and subsidedin the second week of November. It differed from thefirst phase by the far greater frequency of complica-tions. Broncho-pneumonia, which tended to assumea markedly toxsemic type, was responsible for themajority of deaths, and was as fatal to strong adultsas to young children, and the old and debilitated.The mortality from influenza in Bombay City duringthe second phase, though very much less than that inIndia as a whole or in certain provinces such as theCentral Provinces and Delhi, was 14,678, which wasequivalent to 13.3 per 1000 of the estimated popula-tion or considerably more than three times themortality occurring in the urban populations ofEngland and Wales during the three epidemic wavesof 1918-19. The combined mortality for all thehospitals in Bombay City was 34.21 per cent., but asonly the worst cases and members of the poorest classeswere admitted, this figure could not be regarded as anindex of the case mortality in the general population ;36-2 per cent,. of the deaths occurred among personsaged 20 to 40, the highest mortality-61-6 per 1000 ofthe community-being among low caste Hindus andthe lowest mortality-8-3 per 1000-among Europeans.

1 The Indian Medical Gazette, November, 1923.