1566

arterio-sclerotic changes are not at first sufficiently markedto be recognisable. He maintains that the vaso-motor

phenomena are sequels or concomitant symptoms of the

condition and denies that they stand in a causal relationship.In the case recorded by Dr. FISCHER, soon after the

pain in the calf and foot came on, the leg and foot

became pale and corpse-like in appearance owing to a

marked ischemia, which was soon followed by an intense

hypersemia. On walking again this soon gave place to

ischoemia, to be again followed by hyperæmia. This case was

also of interest in that the condition was unilateral and that

the vaso-motor phenomena did not develop until the conditionhad existed for years, thus supporting Professor ERB’S con-tention.

In regard to the etiology of the condition, it is remark-able that it is rare among the poorer classes, the greatmajority of Professor ERB’S cases having occurred in his

private practice, the reasons for this being as yet obscure. It

is also comparatively infrequent in women, the proportionvarying from 1 woman to 16 or 18 men in certain collected

groups of cases. Some statistics also suggest a preponderanceof the cases among the Jews, but this is as yet uncertain. Thedisease usually manifests itself after the fortieth year, but

cases occur earlier. Both syphilis and alcoholism appear to

play a subordinate part in the production of intermittent

limping, but in regard to tobacco there is a general agree-ment that it is an important causal factor. More than 50 percent. of Professor ERB’S present series of cases confessed toexcessive use of tobacco, and he suggests that tobacco maylead to a localisation of arterio-sclerotic changes in the limb

vessels, thus confirming the statements of GOLDFLAM,STRUMPELL, VON q-CHR6TTER, and others, that misuse of

tobacco is an important cause of arterio-sclerosis. Exposureto cold seems also to exert an actual influence upon the

causation of the disease, a history of living in cold

rooms, of lying on wet ground, or of military exercise in

snow, occurring in about half of the cases. Diabetes was a

coexisting disease in a few of the cases. The influence of

bodily and mental overstrain, of neurasthenia and other

nervous diseases is as yet obscure, and Professor ERB suggests ’,that particular attention should be paid to these conditionsin recording cases. No doubt in most cases various

causes combine to produce the changes in the vessels

leading to intermittent limping, but among them it seems

probable that misuse of tobacco plays a predominant part.The diagnosis of the condition is a matter of con-

siderable urgency, since it is sometimes a precursorof arterio-sclerotic gangrene, and by appropriate treat-

ment this untoward sequel may be prevented. Among theconditions for which it appears to have been mistaken,according to Professor ERB, are various affections of the

spinal cord, neuritis, myositis, venous thrombosis, myasthenia,Raynaud’s disease, acro-parsesthesia, erythromelalgia, and

hysterial and neurasthenic dysbasias. Dr. CURSCHMANN

describes certain atypical cases in which at first the

diffilculty in walking became less after further effort. In

opposition to ERB and GOLDFLAM, he believes in functionalor angiospastic forms of the condition, and describes a casein which symptoms of intermittent limping coexisted withosteomalacia. Treatment directed to the latter condition

gave complete relief to the lameness. Professor ERB also

describes two cases of acute arteritis of sudden onset and of

idiopathic nature occurring in previously healthy young

men-in one case after exposure to cold, in the other withoutobvious cause. The condition was unilateral in both cases

and gave rise to symptoms similar to those of intermittent

limping, with absence of the pulse in the arteries of the footon the affected side. Professor ERB has not been able to

find any similar cases in the literature of the subject. The

pathology in all cases seems to be an affection, usually arterio-sclerotic, of the vessels of the lower limbs.The treatment of intermittent limping consists in

endeavouring to remove the causal factor, such as the

excessive use of tobacco or the exposure to cold and damp, andin applying measures directed to combat the progress of thearterio-sclerotic changes in the vessels of the limb. Various

iodide preparations are recommended in medium doses, suchas sodium and potassium iodides, iodipin, and sajodin, andthe use of iothion locally. The diet should be carefullyrestricted, as in cases of general arterio-sclerosis. Galvanic

footbaths are also recommended, and rest is an importantfactor. The use of vaso-dilator drugs has been recommended,but Professor ERB says their value has not yet been estab-lished. Dr. FISCHER. in the case to which we have

already referred, found amyl nitrite a valuable palliativeagent. The original explanation of the symptoms of

intermittent limping is that which we have already quoted-viz., that the sclerosed blood-vessels of the lower limbs areunable to supply the increased quantity of blood requiredfor muscular activity, but an alternative theory of vaso-constrictor spasm has been suggested to account for someof the cases. The condition of intermittent lameness is of

great interest also, from the light it throws upon otherobscure vascular conditions. As Professor W. OSLER has

pointed out, ALLAN BURNS, as long ago as 1809, suggestedan analogous explanation of angina pectoris, which under thename of the intermittent claudication theory is still widelyheld. In like manner some of the fleeting paralyses, parags-thesise, amnesias, and other conditions occurring in arterio-sclerosis have been attributed to a similar, condition affectingthe cerebral vessels.

The Scientific Evidence in theCrippen Case.

IN our issue of Oct. 29th, p. 1299, we published abrief account of the trial of HAWLEY HARVEY CRIPPEN

for the murder and mutilation of his wife, giving, save

in one direction, but the barest outline of the story, nomore being necessary from us having regard to the

prominence which the case, in all its gruesome details,had received in the daily press during the three inves-

tigations held respectively before the coroner, the magis-trate, and the LORD CHIEF JUSTICE of England. But

with the medical evidence we dealt at some lengthbecause it played an important part in the conviction of

the murderer, and proved once again, as in similar revoltingtragedies, what a weapon in the hands of justice the

right application of scientific principles may be. Now that

the convict has met his fate we think it right to make a

1567THE EPIZOOTIC OF PLAGUE IN EAST SUFFOLK.

few observations on that evidence. CRIPPENT was found

guilty of his crime on perfectly common-sense grounds-grounds which could be appreciated by those without

a trace of scientific knowledge. He had the oppor-

tunity to murder his victim, an opportunity which no oneelse possessed; he had a powerful motive for wishingto do so; he was the last person who saw her alive ;he fled from justice when suspicion was aroused ; he wasarrested with what must be regarded as evidence of a

confession in his possession; the remains of a woman, thesex being indicated by portions of hair and raiment, werefound in a house which he had occupied since 1905, envelopedin a fragment of his own attire which must have been purchasedat a date subsequent to the beginning of his tenancy. These

things might have been sufficient to condemn CRIPPEN,but the Crown called scientific evidence which removed

from all men’s minds that last shadow of doubt which mighthave been the prisoner’s benefit. CRIPPEN, having the oppor-tunity of purchasing hyoscine, did so, and evidence was foundin the remains of the presence of more than a poisonous doseof hyoscine. The victim was known to have undergone anabdominal operation, and evidence was found in the remainsthat an abdominal operation had been performed. There is

no case here of a verdict having gone against a mansolely, or mainly, on abstruse scientific points. Every episodein the revolting story pointed directly towards CRIPPEN asthe murderer, which the jury pronounced him to be, the

scientific evidence falling into its place in support of othertestimony. The Court of Criminal Appeal upheld the verdictuncompromisingly.A point was made in behalf of CRIPPEN which it was

inevitable that the counsel for the defence should make

and which it was right should receive all possible stress-namely, that the discovery of hyoscine in the remains

was largely discounted in importance by the fact that, owingto a paragraph in a newspaper, it was widely known thatCRIPPEN had purchas3d hyoscine not long before the pre-sumed date of the tragedy. The suggestion of course wasthat it was possible for the scientific witnesses to be so in-fluenced or biassed by this knowledge as to find wrongfully inthe remains traces of that which they expected to find. We were

glad to see that the LORD CHIEF JUSTICE, in his impartialbut deadly review of the evidence, dismissed the suggestion asof no significance. Indeed, no one who has any knowledgeof the procedure followed in such a scientific investiga-tion as was demanded of the expert witnesses for the

Crown could for a moment think that the chemist, everystep in whose procedure would be controlled by another

investigator, could be influenced in this way. It may be

pointed out that in the majority of cases of suspectedpoisoning the investigator possesses from the beginning aclue to what he is looking for. Sometimes the dejecta of thevictim give it. Sometimes the last symptoms of the dyingperson indicate clearly a poison or a group of poisons.Sometimes a receptacle in the bedroom contains a poison.Sometimes a poison is found in the possession of a

suspect. Lastly, and generally, the purchase of a poisonis traced by the police to someone concerned in the tragedy,a thing which we must presume would have occurred

in this case. Blandly unsuspecting as the authorities

were in the earliest stages of the investigation, we may beperfectly certain that when they saw the nature of the crimewith which they were confronted they would have madeinquiries at all the druggists’ shops where CRIPPEN dealt,and consequently would have come across evidence of thepurchase by CRIPPEN of the hyoscine. Hyoscine, as it

happens, gives very distinct reactions and, without any clueto what they were looking for, the investigators would have

certainly found it; all that happened in this particular casewas that they received information of the sort that is

generally received, and this information in no way influencedthe analytical procedure.The excitement which a singularly sordid story caused

is not pleasant to look back upon. The circumstances

which conspired to arouse in so marked a degreethe attention of the public were adventitious and

not essential to the drama, and it showed want of

public intelligence not to perceive this. The ocean race,

which culminated in the arrest of CRIPPEN, described in

such stirring terms in so many columns of our newspapers,was not necessary to the arrest, for CRIPPEN would have

been detained at the first Canadian port on the informationof the captain of the Montrose. Wireless telegraphy, thoughenlisted in the cause of justice, performed nothing that couldnot have been dispensed with ; if there had been no

Marconi installation on board the Montrose the arrest would

have been made as certainly. Divested of its sensational

trappings we have a revolting tale of lust and greed. From

the forensic point of view the evidence of identification was

interesting, while the employment of hyoscine as the deadlyagent was a novelty.

Annotations.

THE EPIZOOTIC OF PLAGUE IN EAST SUFFOLK.

"Ne quid nimis."

THE Local Government Board has issued an official state-ment as to the steps that are being taken in regard to theoccurrence of rat plague which has been observed in certaindistricts in East Suffolk. The statement confirms in detail

what we were able to convey to our readers last week-

namely, the activity of the department in face of an anxioussituation. For several weeks past Dr. H. T. Bnlstrode, oneof the medical inspectors of the Board, has been makinglocal inquiries with a view of ascertaining the extent of thedisease and of securing concerted action on the part of thevarious authorities. With him are associated Dr. W. W. E.Fletcher and Dr. R. J. Reece, also medical inspectors of theBoard, and the three inspectors are making investiga-tions over a wide area, including West Suffolk andEssex. An expert staff under the direct supervisionof Dr. C. J. Martin, director of the Lister Institute, and apractical and scientific authority on plague in its various

pathological and epidemic relations, has also been engagedfor some time in investigating on a larger scale the local

prevalence of disease among rodents, the kind of rats pre-dominating in the districts, and the flea parasites of these

I rodents. Other inspectors of the Local Government Boardhave also been instructed to make inquiries in various partsof England. Up to the present plague-infected rats haveonly been found in five districts. The inspectors of theLocal Government Board report that the various sanitary