1200

of 1904 the average number of days required for the curewas 29, while at the end of 1904 the number was only 15.Finally, the general average of sufferers has fallen from 28to 12 per cent. In five of the largest mines, where specialprecautions have been taken, there are now no cases of thisdisease.

____

PERNICIOUS VOMITING OF PREGNANCY.

OF late years the view has been gaining ground that themore severe cases of the pernicious vomiting of pregnancyare associated with a toxascnic condition of the patient, theso-called toxaemia of pregnancy. If we exclude all cases dueto causes acting apart from the uterus, such as variousaffections of the stomach which may happen to be associatedwith pregnancy, then we may divide the remaining cases intothree groups as regards their causation-namely, those ofreflex origin, those of neurotic origin, and those due to

certain toxic conditions. Among the first class may be

placed cases due to such causes as displacements or over-distension of the uterus. That cases of purely neuroticorigin occur seems to be proved by the cures obtained bymere suggestion or by a modified rest cure. Though manyobservers have been led by their clinical and post-mortemexperience to think that some, at any rate, of these caseswere really examples of toxic poisoning, yet the whole

matter up to now has been so largely speculation and thenature of the toxin so uncertain that a great deal of

scepticism has been aroused as to the possibility of such anorigin. In a piper read before the American Gyl3oacoloDicalSociety and published at page 1172 of our present issueProfessor J. Whitridge Williams brings forward some

important evidence as to the nature of these so called toxiccases. From his experience of six cases, three of which endedfatally, he has come to the conclusion that in a certain

proportion of the toxasmic cases characteristic lesions,identical with those seen in cases of acute yellow atrophyand icterus gravis, can be found in the liver. Out of tencases collected from the literature in five acute yellowatrophy and in the remaining five fatty degeneration of theliver was found at the necropsy. Such a relationship canhardly be due to mere coincidence. As long ago as 1879that astute clinical observer Matthews Duncan suggestedthat some of the fatal cases of vomiting were really examplesof acute yellow atrophy of the liver but his teaching appearsto have been forgotten. The nature of the lesions found

post mortem-namely, the necrosis and degeneration of thecentral portion of the liver lobule and the necrosis of thesecretory portions of the kidney-seems only explicable onthe assumption that some very powerful toxic substance iscirculating in the blood. As to the exact nature of this

poison we are in entire ignorance, although all the evidenceappears to point to its being connected with tissue meta-

bolism and directly due to the pregnancy. The most

important part of Professor Whitridge Williams’s observa-tions is, however, the fact he has ascertained that thereis a very striking increase in the percentage of nitrogeneliminated as ammonia compared with the total nitrogenof the urine, so that the former may rise to as much

even as 16, 32, or 46 per cent. instead of the normal

3 to 5 per cent. Whatever the cause of this may be-

possibly it is, as he suggests, to neutralise an excessive pro-duction of acids as in diabetes and phosphorus poisoning-the fact is of the utmost prognostic importance. The

practical outcome is that a marked increase in the ammoniacoefficient in such cases indicates a very grave conditionwhich demands the immediate induction of abortion. Iffurther experience should show that this condition is a

constant one then our knowledge of the appropriate treat-ment to be employed will be much more certain and the

distressing instances which occur from time to time in

which in spite of the uterus being emptied yet the patientdies should become less frequent. Another very interestingand important clinical fact pointed out is that in cases ofpernicious vomiting the total amount of nitrogen remainsapproximately normal and the ammonia coefficient is greatlyelevated, while, on the other hand, in cases of eclampsiathe total output of nitrogen is greatly diminished but theammonia coefficient remains practically normal. It maytherefore be said that a high ammonia coefficient is of

favourable prognostic value in eclampsia and of very un-

favourable import in the pernicious vomiting of pregnancy.The paper is a very valuable contribution to our knowledgeof this important subject and marks a considerable step inadvance of our power of forming a correct prognosis in

these two diseases. ____

AN EXTRAORDINARY CRIME.

THE Demerara Daily Chroniole of Sept. 16th contains theoutline of a charge of murder made against a young creolewoman of negro blood which is remarkable on account ofthe nature of the crime alleged against the accused and ofthe motives which are supposed to have actuated her. It isalso a case in which the evidence necessary to show the

guilt or innocence of the accused must be of a medicalnature and in which the want of power to compel a prisonerto submit to medical examination is made conspicuous. The

victim, a young creole woman of coolie extraction, was foundin a field at Plantation Melville, Mahaica, on the east

coast of the island, with her throat cut and at the mortuaryof the estate it was discovered by Mr. Francisco Fernandes,the Government medical officer, that her body had been

shockingly mutilated. The woman was married and wasknown to have been for some time eno6inte, and the foetus

had been removed, presumably, by the murderer. Beforethe post-mortem examination had been commenced a

woman named Andrews and a coolie driver named JoeSukul brought to the mortuary what they alleged to

be the stillborn body of an infant, the child of a

niece of the former and this body was examined and

allowed to be buried without suspicion being excited. The

niece, Eliza Jones, since arrested, was known to have

cohabited for some time with Joe Sukul, but he, althoughstill visiting her occasionally, had transferred his affectionsto another woman who had borne him a child. It is statedthat Eliza Jones had for a long time declared herself to bepregnant but as no result ensued her quondam lover hadtwitted her with the delay and expressed disbelief as to hercondition. It is now suggested that this was feigned in orderto excite his sympathy and to establish a claim upon him andthat in order to clinch her story the woman Jones murderedthe coolie Kissooneah, who was her intimate friend, andhaving invited her aunt to stay with her for her pre-tended confinement sent her with the foetus removedfrom Kissooneah to the hospital Ten days passed beforesuspicion grew and both women were arrested but Andrewshas since been released and it is possible that she maygive evidence against her niece. The difficulty whichhas arisen, and which is likely to lessen the force of theevidence on either side, is due to the fact that Jones

up to the time referred to in the Demerara Daily Ckronicleabsolutely refused to submit to medical examination.British law presumes an accused person to be innocent untihe is proved guilty, and as the result of this he cannot becompelled to do anything which may assist in securing hisconviction. Those aware of an attitude on the part of aprisoner which an innocent person would not be likely toadopt are likely to draw inferences from it, but the jurycannot be invited to do so at his trial. It is hardlynecessary to say more on the subjeot of the importance ofthe medical evidence in such an inquiry as that which is