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- cholangitis following carcinoma of ’the bile-duct is not

unknown but its occurrence at such an early stage is rare.

In this case the obstruction of the common bile-duct led to

infective cholangitis and cholangiectasis. The infective

agent was probably the pneumococcus. Dr. Martin thinks

that although the peritoneal fluid yielded a pure culture of

the colon bacillus it was not the cause of the peritonitis butthat the latter was probably due to infection from the dilatedbile-ducts. Invasion of the colon bacillus would thus besecondary. The question of treatment is important.’ Onseeing the case Dr. Martin diagnosed infective cholangitisand would at once have had the biliary,system drained if thejall-bladder had been found enlarged. As this enlargementwas not present it is evident that it cannot be relied on as

the only indication for operation.

PRINCE RANJITSINGHJI’S GIFT TO A HOSPITAL.

THE Jam of Jamnagar, better known in England as PrinceRanjitsingbji, has given Rs. 1000 to the Jamsetjee JeejeebhoyHospital, Bombay. During his recent illness His Highnesswas attended by nurses from that institution, and in reco-

gnition of the skill and care bestowed upon him he asked thesenior medical officer to accept this donation and to dispose ofthe amount as he thought proper. The senior medical officer

has consequently allotted Rs. 600 to the hospital and Rs. 400to the nurses’ home. In his reply to an address pre-sented by his subjects at a grand durbar, in which itwas said that every moment of his illness had been

watched by all classes with the deepest anxiety, the Jam

expressed his thanks to a merciful Providence for send-

ing to his aid such an able physician as Major L. F.Childe, I.M.S., and such excellent nurses as Miss Irving and Miss Berry. His speedy recovery, he added, was due totheir continuous care and combined efforts. In accordancewith Major Childe’s advice, Prince Ranjitsinghji is now in

’England and intends to remain here at least a twelvemonthin order to recuperate from the effects of the severe attackof enteric fever by which he was prostrated soon after hisinstallation as Jam Saheb of Jamnagar.

THE TREATMENT OF GONORRHŒAL RHEU-MATISM WITH ANTI-GONOCOCCUS SERUM.

IN the Journal of the Royal Arnay Medival Corps for

November Major F. J. W. Porter, R.A.M.C., has reportedsix consecutive oases of severe gonorrhoea.1 rheumatism inwhich complete recovery followed treatment by anti-

gonococcic serum and in four this ensued rapidly. The

diagnosis in all the cases was confirmed by the

microscope. The following are some examples. A driver

was admitted into hospital on Feb. 21st, 1906, sufferingfrom gonorrhoea. On the 24th a right metacarpo-phalangeal joint was much enlarged and painful andthe lumbar articulations and both shoulder-joints were

also affected. On March 8th the following were affected :right thumb, both shoulders, lower spinal articulations,left plantar fascia, and the left knee. 25 cubic centi-metres of anti-gonococcus serum were injected into the

flank. This caused a good deal of local reaction and a riseof temperature to 101’ 2° F. On the following day the tem-perature was normal. There was no pain in the knee, thoughon the previous day it was so painful that he could not bendit. The plantar fascia, the back, and the left shoulder weremuch better. A second injection of the same dose causeda rise of temperature to 102°. The dose was repeatedon the 10th and 14th. The whole of the joints clearedup and he returned to duty on May 5th. In a

second case a private was admitted suffering from

gonorrhoea on April 27th, 1906. On May 4th the

right thumb was swollen, red, and shiny, and lookedas if it was going to suppurate. Subsequently both

wrists, the back, both shoulders, both elbows, and

several finger joints became affected. Six doses of anti-

gonococcic serum were given-on May 8th, 9th, 10th, llth,19th, and 20th. The urethral discharge ceased on May 22ndand he returned ’to duty on the 25th. A private wasadmitted with gonorrhoea, conjunctivitis, and arthritis of theright hip and ankle. 25 centimetres of anti-gonococcusserum were injected on Sept. 6th, 7tb, 8th, and 9th. A gooddeal of urticaria followed some of the injections. Rapidimprovement ensued and he returned to duty on the 26th.A private was admitted on Nov. lst, 1906, for synovitisof the knee which he said was due to havinghurt the joint on Oct. 18th, though he had done duty untiladmission. The temperature was normal and there was aprofuse urethral discharge. The joint was aspirated andgonococci were found in it. Four injections of 25cubic centimetres of anti-gonococcus serum were givenon Nov. lst, 2nd, 3rd, and 4th. No other joints becameaffected but a relapse occurred on Dec. 25th, for which twomore injections were given. The urethral discharge dis-appeared more rapidly than usual. Urticaria followed oneof the injections. He returned to duty on Jan. llth, 1907.As gonorrhoeal rheumatism is liable to be followed by dis-abling stiffness of joints Major Porter’s results are remark-able. He thinks that the injections should be given imme-diately after the onset of arthritis and in severe cases dailyfor five or six days. In cases of chronic changes in thejoints he does not believe that the serum is of the slightestuse. In most of the cases the urethral discharge diminishedand in some disappeared long before it usually does.Urethral injections were given in all cases.

"PREMATURE BURIAL."

ABOUT a fortnight ago a London newspaper chronicled thefact that a woman on the Continent had been buried with aloaded revolver in her hand ready to end her existence shouldshe subsequently in her coffin become cognisant of her sur-roundings. Directions of this kind which are frequentlyenjoined by testators upon their friends tend to keep thesubject of "premature burial" before the public. Alarmistsand sentimentalists would have us believe that burialsalive are numerous. This is, of course, extravagantexaggeration ; in this country, where burial seldom takes

place before the third day after death, the possibilityof the occurrence of such an event is extremelyremote. At the present moment there is a movement

to procure the passing of a Bill through Parliament

dealing with the subject, the main object being to make "itobligatory upon the medical man last in attendance uponthe dead to visit the corpse, or supposed corpse, signing aspecially drawn up certificate ere the person can be interred."An Act of this character if passed would present many diffi-culties though the medical profession probably would notobject to carrying out such an obligation if suitably remu-nerated. The promoters of the Bill suggest that the

fee should vary with the social status of the deceased,but who is going to fix the corpse’s position in thesocial scale and, far more important, who is goingto be responsible for the fee ? Again, why should it be

necessary for " the medical man last in attendance upon thedead to give the certificate ? The only solution seems to bethat the fee must be a fixed one for all persons and that itshould be paid by the local authorities, a practice analogousto the present one for the notification of infectious diseases.To compel the already underpaid medical man to relyon a relative paying the fee and if unable to recover itto be branded as inhuman for demanding it would be

manifestly unj ust. Such a Bill as alluded to would be quiteunnecessary if an alteration were to be made in .the presentmethod of death certifioation upon the lines advocated by the