249

Sometimes the reputation of the doctors is severely injured."The natural result of this system, Dr. Shastid points out,is that doctors do not want to be experts ; consequentlythere is no demand for the literature of medical juris-prudence, or for the teaching of the subject in the schools-research is checked and discouraged. Regrettably Americais not the only country in which this system exercises itsdemoralising effect. Still the medical profession cannot inthe premises escape all blame. Diametrically opposing viewscannot both be wholly right. If, therefore, such views areheld in the profession, those who hold them while expressingthem should frankly make it clear to their hearers that, how-ever strong may be their own convictions, the point is one onwhich there does exist, rightly or wrongly, a difference ofprofessional opinion, and should not attempt to foist theirown choice on the public as the consensus of thought of themedical profession. Of the biographical notices themselvesbut little need be added, save that they are for the most partclear but condensed, that so far as we have been able

to find by frequent reference, few if any important medicalpersonages in the United States or Canada have been omitted.

Perhaps a place, however, might fitly have been given to

Dr. Acland Oronhyatckha, the full-blooded Mohawk Indianchief who studied at the instance of the late King Edward,then Prince of Wales, at Oxford, under the tutelage of thelate Sir Henry Acland, completing his medical education atthe University of Toronto and practising for a time in thatcity. He died in March, 1907. His career was certainlyremaikable, and though fraternal organisations absorbedmost of his time in later years, he might surely have beenadmitted under Dr. Kelly’s qualification of those who

"attained great local prominence and widely influencedtheir fellows by a strong personality."

CAN KALA-AZAR BE SPREAD BY MOSQUITOES?

IN a note on "Leishmania and Mosquitoes " published inTHE LANCET of Nov. 4th, 1911, p. 1268, Professor G. Franchinigave a summary of the results of experiments carried out byhim in the laboratories attached to the Ospedale Maggiore,Bologna, and in which he sought to prove that leishmaniadonovani could live and multiply in the intestinal tract ofanopheles. More recently, in the last issued number of theAnnals of Tropical Medicine and Parasitology (Series T. M.,vol. vi., No. 1 B.), Professor Franchini has given furtherdetails of some of his experiments, and has set out the con-clusions at which he has so far arrived. He states that afternumerous experiments with fleas, lice, and bugs which hadbeen fed on cultures of leishmania no parasites that couldbe identified with the Leishman bodies" were found in

the gut of these insects. He therefore decided to continuehis investigations with mosquitoes, more especially withanopheles maculipennis, which species is very numerous incertain regions along the Mediterranean littoral, where

kala-azar is met with. As a result he found the Leishmanbodies in great numbers and in various stages of develop-ment in the digestive tract of that mosquito. He also foundthat the staining of the different parts of the parasites, thenucleus, the protoplasm, and the blepharoplast, was so evidentthat he thinks it must be admitted that the parasites werealive and capable of reproduction. In some of the parasitestrue nuclear karyokinesis was observed. Experimentswere also carried out with other mosquitoes and it wasshown that leishmania can live in the alimentary canalof some culicidas, including the stegomyia fasciata, althoughnot so frequently or so abundantly as in A. maculipennis.It therefore appears probable to Professor Franchini that,in Italy at least, the Leishman parasites are transmittedby anopheles. In this connexion he states that kala-azarand malaria co-exist in some localities in Southern Italy,

and that possibly the same species of mosquito is

responsible for transmitting both infections. He franklyadmits, however, that further experiments on animalsare absolutely necessary before it can be determinedwhether or not leishmania can be transmitted naturallyby mosquito to animals which are recognised as sus-

ceptible to the kala-azar parasite, such as dogs andmonkeys. At the conclusion of his paper Professor Franchinirefers to the researches of Dr. C. M. Wenyon, protozoologistto the London School of Tropical Medicine, who has quiterecently been making a study locally of ’’ the oriental soreof Bagdad," and who found that leishmania tropica couldlive and develop in the intestine of stegomyia fasciata ; fromthe non-flagellate form of oriental sore parasite he obtainedthe flagellate variety in the gut of the insect. We draw

our readers’ attention in this connexion to a letter which Dr.

Wenyon wrote to THE LANCET of Nov. llth, 1911, p. 1362,adverting to the note already referred to, in which ProfessorFranchini had discussed the question of the developmentof leishmania in mosquitoes. Dr. Wenyon, in his letter,suggested the probability that the parasites of the groupleishmania can develop to a certain extent in the gut ofvarious insects provided that they find there a suitable

pabulum rich in blood. The development of L. tropica inS. fasciata and of L. donovani in A. maculipennis may be ofthis nature-that is, accidental-owing to the rich nutrientfluid taken up with the parasite by the blood-suckinginsects. So far it cannot be said to be proved by any meansthat the insects in which leishmania has developed are ableto transmit the infection to healthy animals, and it

remains yet to be seen whether any species of anophelesor culicidæ is to be regarded as a natural agent in

the transmission of kala-azar. Already evidence has beenbrought forward to incriminate the bed-bug, the dog-flea,and the house-fly, showing that they are able in certain

circumstances to transmit the infection of leishmania in one

or another of its forms. It would, in our opinion, be

premature at the present moment to formulate any definiteopinion on the subject of whether or not the mosquito is tobe regarded as a natural transmitter of kala-azar, but it isobvious that further experiments on animals are required.Meanwhile, until these have been carefully carried out

judgment upon the mosquito, and particularly uponA. maculipennis, in relation to the spread of kala-azarmust be reserved.

____

THE SPREAD OF MEASLES.

IN his eleventh annual report Mr. D. L. Thomas, medicalofficer of health of the borough of Stepney, calls attentionto the prevalence of measles, not only in Stepney, but inother parts of the country. He suggests compulsory notifi-cation of measles and a closer cooperation with the medicalofficers of schools, removal of early cases to fever hospitals,and the extension of the system of health visitors to infectedhouseholds. The school question is undoubtedly a most

important factor in the spread of measles, and an object-lesson in this respect took place on July 16th at the NorthLondon police court before Mr. Hedderwick, when a womanliving in Highgate New Town district was summoned on behalfof the Education Committee of the London County Council byMr. J. J. Brown for keeping her children away from school. In

the evidence it came out that the children had had measles,and that one of the younger ones was still suffering fromthat disease, in spite of which fact the Council’s officers

insisted on the attendance of the elder children at school,

notwithstanding that one child in the house was still ill

with the disease. The defendant stated that every house in

her street was infected, but still the officers made the

children go to school. The magistrate expressed his

259

,disapprova,l of the practice of the education authorities and, telling the woman she had done quite right and : athat she was not to send any of her children to ! a

school until all were well, dismissed the summons. If, 1

as Mr. Brown asserted, it is the usual practice to insist ‘,on the elder children returning to school even if others in

the house are still ill, we must assume that the officers in such a case act officiously and without the knowledge or sanction of their superiors ; for it is incredible that any body -of intelligent authorities should countenance a proceeding so (

fraught with danger to the entire community.

THE INFLUENCE OF BENZOL ON LEUKÆMIA.

AN interesting note upon the treatment of leukaemia is

published in the Berliner Klinische IVockensohritt of

.July 15th by Professor A. von Koranyi. He states that in

Professor Barker’s wards at Baltimore three girls were underobservation who had to work with benzol in a factory Theysuffered from purpura hæmorrhagica. and very severe aplasticanæmia and two of the cases ended fatally. Impressed bythese observations Sellino- investigated the effects of benzolupon blood formation in the rabbit. He found that after a

transitory increase in the number of the white corpusclesbenzol caused them to disappear, while the red corpuscles,.after a moderate diminution, remained unaffected. At the

same time he found a marked aplasia of the bone marrow,the spleen, and the lymphatic apparatus. Regenerationoccurred after the benzol was no longer given. Theseobservations suggested to Professor von Koranyi the inves-tigation of the effects of benzol upon the blood in

leuktemia. A series of patients suffering from leukaemiahave been treated in his clinique and one of his assis-

tants, Dr. Kiràlyfi, is preparing a monograph upon thesubject. Professor von Koranyi gives a brief account in thenote before us of one of his cases, and appends a generalsummary of his results. The patient was a woman, aged32, who had noticed for seven months that her spleen was.enlarging. She became gradually weaker and was unable toattend to her household duties at the time she was

.admitted to hospital on Jan. 30th, 1912. Her spleenextended to the middle line and a hand’s breadth below the

umbilicus. Examination of her blood gave 3,100,000 redcorpuscles and 230,000 white per cubic millimetre. A

differential count of the latter gave 70 per cent. of poly-morphonuclears and 16 per cent. of myelocytes. On

Feb. 1st she was treated with Roentgen rays, and by the 6ththe white corpuscle count had fallen to 160,000, but by the16th it had risen to 200,300. From this date 3 grammes of

benzol were given daily until March 1st, when the dose was increased to 4 grammes. At this time the number of white

corpuscles had fallen to 198,000 per cubic millimetre, byApril 4th the number was 65,000. and on May 12th

it was 12,000. By the middle of May it had fallen to

8000, and at the beginning of Jnly it had remained

at this level, although the treatment had been stopped.The spleen diminished in volume. The red corpusclesfell at first to 3,000,000 per cubic millimetre, but rose

to 4,000,000 subsequently. The general condition of the

patient also improved. Professor von Koranyi concludesthan benzol produces a notable improvement in the leukæmicblood picure, after a transitory increase in the number ofwhite corpuscles. The diminution begins usually at the endof the second or beginning of the third week, at first slowly,then more rapidly. This result appears to occur in all formsof chronic leukaemia. In the later stages of the treatmentthe splenic enlargement becomes noticeably diminished, butthe lymphatic glands are less obviously influenced. The

1 Ziegler’s Beiträge, 1911, Band li., S. 576.

general condition of the patient improves in the same wayas after a successful treatment by Roentgen rays. Benzol

appears to act more slowly than the last-mentioned measure,but Professor von Korányi finds that results may be obtainedwith benzol even when Roentgen treatment fails. Patients

who have been treated by Roentgen rays usually react tobenzol more quickly than those who have not been subjectedto the rays. Small doses appear to stimulate the formationof white corpuscles ; it is, therefore, best to give largedoses in leukaemia; 3 to 4 grammes of benzol dailyseem to be borne satisfactorily over a period of months.

Unpleasant results sometimes occur, such as burning sensa-tions in the stomach, hiccough, transitory tracheo-bronchitis,and vertigo. The gastric symptoms are usually obviated ifoil is given with the benzol in gelatin capsules. If vertigooccurs it is best to try smaller doses. Professor von Korányihas also tried benzol with encouraging results in a case ofpolycythasmia with splenic enlargement in which the whitecorpuscle count was normal. At the end of the first weekthe number of red corpuscles had increased from nine to tenmillion per cubic millimetre, but with three more weeks ithad fallen to 6,700,000. Sufficient time has not yet elapsedsince the introduction of the treatment to allow a com-

parison to be made between its effects and those of Roentgenrays and thorium, as Professor von Koranyi points out, but theresults he has obtained are of a sort to render the method

worthy of note, and we shall await the further results

promised in Dr. Kirhlyfi’s paper with great interest.

THE HYGIENE CONGRESS AND THE RUSH TOAMERICA.

A FREQUENT correspondent writes the following words ofwarning :-Members of the forthcoming International Con-gress of Hygiene and Demography who have not yet securedberths should not neglect the matter any longer. It is

most unfortunate that the congresses when held in America

take place just at the season when there is the greatestrush of passengers, mostly returning tourists, anxious to

get back to the United States during the pleasantest seasonof the year. By the middle or end of September theterrible heat waves of summer are over and the winter

blizzards are still a long way off. Therefore, berths on shipssailing westwards in September and October must be bespokea long time in advance. There are plenty of ships, andexcellent ships, available, but not many berths remain free.The hygienist who wants to test practically one of the mostelaborate attempts at perfect ventilation ever made on boarda ship should sail by the L7tsitania on Sept. 7th. If this is

too early the Caronia, a steady and comfortable boat,sails on the 10th. For those who have no time to

spare, but must go straight through, there is the ocean

greyhound, the Campania, on Sept. 14th, by which

passengers would still reach Washington in time for the

opening of the Congress on the 23rd. The German

Norddeutscher Lloyd and the Hamburg-Amerika lines arealready so full that the only chance of a berth is the

possibility of some passengers altering their plans andgiving up their berths. The White Star quick liner, theOceanic, sails on the llth, and the large and comfortableBaltic on Sept. 12th. The only Atlantic transport ship,the 11-linnetonlta, leaves rather too soon-namely, the

7th, reaching New York on the 16th. The steady,slower, and cheaper boats of this line are much

appreciated by those who value real comfort and

economy more than the saving of a day or two. Viewedin this light, the French Transatlantic Co. are runningtwo ships that are really democratic ships--the Chicagoand the Rockambeau. They carry no first-class passengers,and offer no superfluous luxuries, but afford all that it