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anti-diabetic measures, as not uncommonly present. Itsmost usual site is the genitalia, in men the prepuce and

scrotum and in women the pudendum, but it is also seen

on the palms of the hands and soles of the feet, and

on the ends of the fingers and toes, whilst it is

sometimes present on the dorsum of the foot and the

lower part of the thigh. This eczema is in most

features like ordinary eczema, but it presents a few

special characteristics. The skin becomes tough and theepidermis thickens and flakes off, forming little clefts

from which serum oozes and dries, leaving a thin scab

on the surface. The patches are very sharply marked off,the surrounding skin being perfectly healthy, so that a

diagnosis of syphilis is sometimes erroneously made. Again,owing to the dry condition of the epidermis and its impairedvitality, redness and excoriation frequently occur from thepressure of buttons, seams, or bands. Professor Ehrmann

further describes two cases of a hitherto unrecorded affec-

tion of the skin in diabetes in the form of a smallhard lump on the penis, in both cases mistaken fora primary syphilitic sore, which disappeared when the

patients were placed on a diet free from carbohydrates.In one of the cases two years after this treatment

the patient developed a typical primary sore and the

true secondary eruption of syphilis, an interesting con-

firmation of the non-syphilitic nature of the previousaffection. The pathogenesis of these cases ProfessorEhrmann attributes either to the increased quantity of sugarin the blood or to the diminished alkalinity of the plasma,in virtue of which the lymph which penetrates into the

epithelium is altered in composition, and hence there ariseincreased vulnerability of the epithelium and conditionsfavourable to the growth of micro-organisms ; and in supportof this he found in a case of pustular eczema in a diabeticpatient who was employed in a yeast manufactory a largenumber of yeast cells present in the pustules, while controlinoculations into his own skin failed to produce any lesion.

THE PREVALENCE OF SMALL-POX.

DR. J. C. THRESH reports that during the month of Octoberthere were notified in the county of E3sex 11 cases of small-pox. The total number notified from Jan. lst to Oct. 31stis 1312. Mr. E. G. Annis, medical officer of health of the

metropolitan borough of Greenwich, has just issued his

report concerning the recent outbreak of small-pox in thatborough. The report covers the period from October, 1901,to Sept. 27th, 1902. The total number of cases notifiedas small-pox was 110. Of these, however, six eventuallyturned out not to be cases of small-pox, so that a totalwas left of 104 cases of the disease. Of the total

number 58 occurred in East Greenwich and 18 of these

proved fatal. With regard to vaccination and small-poxMr. Annis divides his cases into three classes: (1) the

unvaccinated, (2) those vaccinated at some time or other

previous to the reception of small-pox, and (3) those statedto have been vaccinated but of whose vaccination there wasno evidence. In class (1) there were 23 cases, of which 10proved fatal, being a case mortality of 43’ 4 per cent. With

regard to disease incidence in these 23 unvaccinated cases,16, that is to say, 69 per cent., were under 15 years of age,and of these 16 cases seven died. In class (2) therewere 79 patients who had been vaccinated at some

period of their lives. Their ages varied from 14 yearsto 77 years and the case mortality was 17 - 7 per cent.

"Amongst the vaccinated cases there was none under fiveyears of age, none between five and ten years, one betweenten and 15 years, 24 from 15 to 25 years, 44 from 25 to 45

years, eight from 45 to 65 years, and two aged 65 years andupwards. From which particulars of our experience, itmight be considered that the period of absolute immunity

from an attack of this disease set up by vaccination ininfancy continues for the first 14 years of life, afterwhich time the degree of such immunity gradually de-creases as age advances. The deaths amongst this classamounted to a total of 14, occurring at the following ageperiods : none under 15 years ; one, or 4 per cent. of thecases at the age group from 15 to 25 years of age ; nine, or20 per cent., at the age group from 25 to 45 years ; three, or37 per cent., of the age group at 45 to 65 years ; and one, or50 per cent., amongst those over 65 years of age. The con-tinuous rise in proportionate fatality amongst these variousage groups as the age of the patient, and, therefore, usuallythe length of time which has elapsed since the period ofvaccination, generally in infancy, is very noticeable, show-ing that the degree of insurance against a fatal issue de-creases as the length of time after vaccination increases. "

In class (3) there were two cases of whom one died. Hewas a boy, aged 12 years, who was stated to have been vac-cinated in infancy but he had no scars. At the commence-ment of the outbreak all the sanitary staff were advised tobe and agreed to be revaccinated except one man who hadalready had small-pox. Among this sanitary staff no case ofsmall-pox occurred.

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ARREST OF HÆMORRHAGE FROM THE TONSILBY A COMPRESS AND SUTURE OF THE

PILLARS OF THE FAUCES.

IN the Revue Hebdomadaire de Laryngologie, d’ Otologie, etde Rhinotogie for September Dr. E. Escat has described aremarkable case of obstinate tonsillar hæmorrhage which,after the failure of all ordinary methods, he at last arrestedby a novel operation. He removed au morcellement with a

punch the hypertrophied tonsils of a man who suffered fromchronic follicular tonsillitis. The instrument had a sharpedge and was therefore wrongly made. Unfortunately, Dr.Escat did not follow his first impulse-to return it to themanufacturer. Slight haemorrhage, which was not arrestedby gargling with cold water, went on for a quarterof an hour. In the upper part of the cavity left afterthe removal of the right tonsil a jet of arterial blood wasseen. A tampon of cotton-wool held in a forceps was

pressed against the bleeding point but it did not arrest the

hæmorrhage. The galvano-cautery was then applied but itonly increased the hæmorrhage. Dr. Escat attempted to-

seize the artery with a forceps-a method he had previouslyfound successful in one case-but he could not. A tamponof cotton-wool held in the middle and index fingers waspressed against the bleeding part for ten minutes. As soon

as it was removed the haemorrhage recurred. Ice and

various haemostatics, including perchloride of iron, alsofailed. " Ricord’s compressor " was then applied and itarrested the haemorrhage, but the pain was so grear-that the instrument had to be removed and the bleed-

ing was greater than ever. It then occurred to Dr.Escat to try a method which Baum had used withsuccess. With a needle-holder used for staphylor-rhaphy he passed a large curved needle and silk thread

through both pillars of the fauces by one movement andtied the suture. This was not sufficient. He then passedanother suture two centimetres below the first, but in conse-quence of the greater distance between the pillars of thefauces at this spot through each pillar separately. Whenthis suture was tied the cavity left by the removal of thetonsil was closed but the haemorrhage continued. A clot

then formed and the haemorrhage seemed to be stopping.Gelatin was injected into the cavity but the haemorrhagewas only increased. With a naso-pharyngeal forceps Dr.Escat passed a cylindrical tampon of cotton-wool of the

size of the little finger from above the upper suture into thecavity and carried it downwards until it appeared below the

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lower suture. The haemorrhage, which had continued for

four houre, was permanently arrested. At the end of 24 hoursthe sutures and tampon were removed.

THE CITY AND THE MEDICAL PROFESSION.

WE regret to see that no official representatives of the I’medical profession were present at the Lord Mayor’sbanquet this year-the year that has seen His Majestythe King restored to his people through the instrumentality- of medical and surgical skill. We are certain that no

slur is intended upon our profession and we are not

- attempting to dictate to the City as to who its guests should’be ; indeed, we feel that the absence of any official representa-tive of our profession at such a function is due to an unluckyoversight. In THE LANCET of Nov. 30th, 1901 (p. 1518),we stated: "We are not unmindful of the banquet given tothe medical profession in May, 1898, by Colonel H. D. Davieswhen Lord Mayor, but we are nevertheless glad that the firstyear of a new reign should have seen our profession officiallyrepresented at the great City festival on Nov. 9th, which is,moreover, the King’s birthday." We hoped that Sir JosephDimsdale was establishing a precedent which would be

followed by succeeding Lord Mayors. Representatives of.all the other notable professions are invited to the Lord

Mayor’s banquet and the recognition of status thus impliedshould be extended to medicine. The two great corporations-of our profession and the General Medical Council have

their headquarters in London and their Presidents mightwell have been bidden to the feast.

THE INTERNAL SECRETION OF THE TESTIS IN

THE EMBRYO AND IN THE ADULT.

EVIDENCE seems to be accumulating that the several

glands of the body besides their outward and apparentsecretion also generate a secondary product which is

-absorbed into the blood and fulfils important purpoes inthe economy. A communication with the above headingrecently appeared in the Comptes Rendlls de l’Acurlémie

Française (No.4, 1902, second semestre) by M. Gustav

Loisel. M. Loisel has studied seven species of birds andfour species of mammals. The sections were made fromthe testes of these animals, were hardened for eight daysin a solution of osmic acid, and were then mounted in

glycerine jelly. The embryo, it was found, already displaysin the germinal epithelium the same secretion that is presentin the testis of the adult. This secretion presents itself inthe form of black spherules contained in the body of manyof the cells forming the epithelium. Treatment with ether

shows that they are not exclusively formed of fat but thatthey contain a basis of protoplasm. When the developing- gland is in the embryonic condition usually regarded as"indifferent" they augment in number and are found par-ticularly in the primordial ovules. As the organ becomes

differentiated into a testis the seminiferous tubes presentin their contents many black spherules, and a maximumhaving been reached, a diminution in their number takes

place before birth, and M. Loisel believes that their

rôle is to render more active the cellular metabolism ofthe embryo, and this is, in fact, their function when the

secretion at the period of rut appears, for then the black

spherules are formed in large numbers in the spermatic- cells. Whilst spermato-genesis lasts the germinal cellssituated at the base of the seminiferous epithelium preerve-their character of secretory elements, they enlarge, and

form the cells of Sertoli. In mammals these hypertrophiedgerminal cells, like the interstitial cells, till continue toelaborate fat, but in birds, at least in the sparrow, no fat-4s found in the summer. On the other hand, another,form of isolated spherules appears in the cells of Sertoli,

which, instead of turning black with hæmatoxylin con-

taining iron, turns blue with potassium ferrocyanide.In the autumn in birds the testes become quiescent, themorphological secretion altogether ceases, the specialepithelium of the springtime disappears, and the semini-ferous tubes resume the form of solid cords. The chemical

secretion, on the contrary, persists in the germinal cells andthough diminished in quantity resumes the power of reduc-ing osmic acid. In conclusion M. Loisel is of opinion that thetestis presents two distinct secretory functions--viz., a

chemical or internal secretion which is primordial and isdischarged into the blood and a morphological secretionwhich is secondary and is discharged externally. By itsinternal secretion the testis is a great destroyer of fat, whichexplains certain well-known facts-as the greater thinness ofthe male as compared with the female, the exaggeration ofthis condition during the period of rut, and the fattening andinertia which follow castration

THE DISTRIBUTION OF PLAGUE.

As regards Egypt the Director-General of the SanitaryDepartment states that for the week ending Nov. 2nd therewas 1 new case of plague reported which occurred at Alexan-dria. There were no deaths from the disease. During thesame week 3854 rooms were disinfected and 91 were lime-

washed ; 35 sacks of effects were disinfected and 8524 sacksof rubbish were burned. The number of rats killed andburned was 75. As regards the Cape Colony the medicalofficer of health of the colony states that for the week endingOct. llth no case of plague had occurred in any humanbeing at any place in the colony. The last case occurred on

Sept. 23rd and the patient died on Sept. 25th. During theweek under review plague-infected rats have been found atPort Elizabeth, the last having been discovered on Oct. 9th.As regards the Mauritius, a telegram from the Governorreceived at the Colonial Office on Nov. 7th states that forthe week ending Nov. 6th there were 28 cases of plague and14 deaths from the disease.

THE INDUCTION OF SLEEP AND OF GENERALINSENSIBILITY BY ELECTRIC CURRENTS.

A KECEKT number of the Comptes Rendus de i,’Académíe

Française (N0. 3, second semestre, 1902) contains a noteby M. Stephane Leduc on the Induction of Sleep andAnesthesia by Electrical Currents. He originally broughtforward the subject at a meeting of the Academy of Sciencesheld on July 21st, and some of the details here mentionedappeared in the letter from our’Paris correspondent, pub-lished in THE LANCET of August 23rd, p. 559. He employs acontinuous current with feeble internal resistance but permit-ting the electro-motor force in the circuit to be graduallyaugmented. An interrupter is placed in the circuit, givingfrom 150 to 200 interruptions in the second, and a milli-

ampere measurer the period of oscillation of which is

much longer than the duration of the interruption ofthe current. Under these conditions when the instru-

ment is traversed by an intermittent current the needle

undergoes a permanent deviation which enables the intensityof the currents having the same intermittence ar.d the sameduration to be compared. The animal is placed in the circuitwith the head shaved. The cathode is made of hydrophilouscotton impregnated with a solution of sodium chloride of thestrength of 0’60 per cent. and covered with a plate of metal.A large anode is placed on the hinder part of theskin of the back which is also shaved. The interrupterbeing now in action the electro-motor force is increasedtill general convulsions occur ; the animal then fallson its side and respiration ceases. The handle of the col-

lector is now brought backwards till the respiratory acts

iecommence, and now with a certain strength of current