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of the Gulf of Mexico and elsewhere. As showing the amountof this so-called " vomiting sickness " that prevails inJamaica, Captain Potter obtained a return which stated thatduring the first five months of 1911 no fewer than 223 casescame under observation, 126 of them being referred to one

parish. Some of the facts collected by Captain Potter varysomewhat from the experience of other observers. The

usual yellow fever season is said to be from April to

September, but the cases recorded above by Captain Potterwere mostly prior to that period of the year. Again, manyauthorities state that endemic yellow fever among the

coloured races is generally a mild disease, especially inchildren ; but we gather that in Jamaica many of those whoare attacked are black children, and that a number of themdie. On the other hand, there are some recorded facts which

appear to support his views. For example, in an army

departmental report published in 1908 reference is made tothe occurence of a local five to nine days’ fever in Jamaica,its leading characters being severe frontal headache, vomiting,an icteric tinge of the skin and conjunctivas, and albuminsometimes found in the urine. Paratyphoid fever had

been excluded, as also papataci fever, there being nophlebotomus flies on the island. It is unfortunately truethat the symptoms and post-mortem appearances of yellowfever vary greatly in individual cases, and that none are

sufficiently constant to be regarded as pathognomonic. Sothat the definite diagnosis of yellow fever, and especiallyamong a black population, is attended with extreme diffi-

culty. Up to the present time the specific organism ofthe disease has not been satisfactorily identified and

isolated, so that bacteriological confirmation of the diagnosiscannot be maintained. It may be mentioned that the

paraplasma flavigenum discovered by Dr. Harald Seidelin isbeing tested by other experts, but it is too early to say asyet that it is the parasite of yellow fever ; if his claims be

substantiated an enormous advance will be made and the

diagnosis greatly aided. The opinion that yellow fever is stillendemic in Jamaica has not been allowed to pass unchal-

lenged by the medical men of the colony. In particular, Dr.Angus G. Macdonald,2 medical officer of health of Kingston,the capital of the island, has with some vehemence disputedthe conclusions of Captain Potter, dwelling particularly uponthe absence of any typical examples among the allegedyellow fever cases investigated in the first quarter of 1911.He also suggests that possibly " vomiting sickness

"

may be

due to a tick infection introduced into Jamaica since yellowfever disappeared. In this connexion he urges further

investigation by local experts. It was obvious that so

important a dispute could not be left in this undecided state,and it is satisfactory to learn that the Colonial Office hasalready ordered a further inquiry to be conducted by a com-mission of experts, and that bacteriological investigationswill also be carried out on the spot.

A FOOD CONGRESS AT GHENT.

AN international exhibition is to be held in Ghent this

year, and the occasion has suggested the convening of aninternational congress on questions relating to foodadulteration. The date of this congress has been fixed forthe first three days of August. The regulations under whichthe proceedings are to be conducted have been issued andan agenda of the subjects for discussion formulated. It is

the view of the organisers that subjects should be approached not so much from a scientific as from a social standpoint. Amongst the topics which have already received a place for II

2 Is Yellow Fever Endemic in Jamaica ? A paper read before theJamaica branch of the British Medical Association in December, 1912.Presented to, and ordered to be printed by, the Mayor and Corporationof Kingston.

discussion are the protection of food substances from dirt,the regulation of the manufacture of table waters, the adop-tion of official methods of analysis for foods, the controlof the sale of milk, the desirability of including in

any scheme of education instruction about the nutritive

values of foods, the question of the sale and production offoods in places where there may be persons suffering frominfectious disease, the control of the use of preservatives,and the enforcement of regulations providing for the

washing of glasses in public-houses. The work of the

whole congress is divided into four sections : (a) chemistry,(b) hygiene, (c) popular education on food and cognatesubjects, and (d) legislation. From a list which has reachedus the congress has already received a distinguishedpatronage, including Government officials and members ofthe learned professions.

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COXALGIA IN CHRONIC APPENDICITIS.

IN the Maryland Medical Journal for February Dr.Thomas R. Brown has discussed a symptom of chronic

appendicitis which has received little attention-coxalgia.As chronic appendicitis is often attended by slight localsymptoms, its diagnosis is difficult and depends on the corre-lation of many signs and symptoms, each of comparativelyslight importance. Coxalgia occurs in a certain proportionof cases and is of great value in the diagnosis. The nature

and extent of the symptoms of chronic appendicitis dependsomewhat on the lesions in the appendix, which may take theform of adhesions, obliteration of the lumen, erosions, torpidulcers, or cysts, but far more on the direction in which theappendix points, whether towards the gall-bladder, urinarybladder, or thigh, and on the association of the disease withsplanchnoptosis, which Dr. Brown has found very common.There may be no local symptoms, and a clinical picturetypical of neurasthenia may be presented or one of gastric orintestinal dyspepsia, or cholelithiasis or cholecystitis may besimulated, or the main symptom may be pain in the

right hip or pain on micturition, or a combination of

both. In a series of 20 cases of chronic appendicitisdiagnosed as such and verified by operation Dr. Brown

found that in three the main symptom was pain in the righthip (appendicular coxalgia). In one the pain was so intenseand long standing, and so definitely related to exertion,that tuberculous coxitis was suggested. In each of the

three cases there was splanchnoptosis of the highest grade,and the appendix, cæcum, and a portion of the transversecolon were tightly bound down to the abdominal wall andpelvic floor. In chronic appendicitis coxalgia may be absentaltogether, or it may be absent when the patient is at restand noted after walking and increased by flexion of the

joint. The question arises, How can the coxalgia of chronicappendicitis be distinguished from that of latent tuberculosisof the hip-joint ? Q In both there may be slight remittentpyrexia, rarely reaching 1000 F. In the differential diagnosisskiagraphy after administration of bismuth is of paramountimportance. In chronic appendicitis it shows binding downof the intestines in the cæcal region with sluggish motilityand marked bismuth retention, the hip-joint being normal.Blood examination also is useful. Dr. Brown found a

leucocytosis of from 10,000 to 16,000, though rarely exceed-ing 13,000, with neutrophiles from 75 to 85 per cent., inchronic appendicitis, while leucopenia with relative mono-

nuclear increase occurred in tuberculosis. In one case

the pain in the hip was so marked that several sur-

geons diagnosed coxalgia secondary to relaxation ofthe sacro-iliac joint. However, skiagraphy showed denseadhesions binding down the appendix, cseoum, and ascend-ing colon to the lateral and posterior peritoneal surfaces.The abdomen was opened and adhesions over the head of

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the colon were divided. The base of the appendix wasclosely adherent to the cæcal wall. The appendix wasdirected posterior to the caecum with its tip over the

pelvic brim. It was found densely adherent throughout itswhole extent, the tip being acutely flexed and bulbous. The

ileum in its last three inches was kinked by a band of

adhesions drawing it posteriorly and towards the caecum.The appendix was removed, the adhesions about the ileumwere released, and the resulting raw surface was covered asfar as was possible without reproducing the kink in the

ileum. An interesting point is the frequent associationof chronic appendicitis without definite local symptomswith general splanchnoptosis. In considerably more thanhalf of the 20 cases a greater or less descent of the abdominalorgans was found, and in many this was very pronounced,so that the cxcum and a large portion of the transverse

colon were below the pelvic brim. Whether the chronic

appendicitis is primary or secondary to the ptosis of theintestines with the associated interference with the circula-tion and intestinal stasis, or whether the latter leads to alocal peritonitis in which the appendix is involved, cannotbe said. Not only was coxalgia the predominant symptomin three of the 20 cases, as stated, but it was present inmany of the others. Hence coxalgia, especially if associatedwith splanchnoptosis, should suggest the possibility of

chronic appendicitis with ileo-cæcal adhesions as the cause,and the case should be investigated on the lines describedabove. As to the cause of the coxalgia, it appears to be

due to the mechanical effect of the dense adhesions. The

direction in which the appendix points and the nature,extent, and position of the adhesions seem to be the

determining factors whether coxalgia occurs or not.

SIR THOMAS BROWNE ON SUPERFŒTATION.

THE report that the wife of a working man at Furness hasgiven birth to children at an interval of six weeks between

the two parturitions would not have appeared at all

incredible in the seventeenth century. In his Enquiriesinto Vulgar and Common Errors " Sir Thomas Browne statedhis belief that hares were prolific through a habit of super-fœtation. "An higher providence of nature," he avers,’’ especially promotes the multiplication of hares by super-fœtation-that is, a conception upon a conception, or an

improvement of a second fruit before the first be excluded,preventing hereby the usual intermission and vacant time ofgeneration." Aristotle, Herodotus, and Pliny refer to thisalleged fact, and we have often observed," says Browne,"that after the first cast, there remain successive concep-tions, and other younglings very immature, and far fromtheir terme of exclusion. No man need question this

phenomenon in hares, for the same often occurs in the caseof women." "Although it be true," continues our autlror,"that upon conception the inward orifice of the matrix

exactly closeth, so that it commonly admitteth nothingafter ; yet falleth it out sometime, that in the act of coition,the avidity of that part dilateth itself, and receiveth a secondburden, which if it happen to be near in time unto the first,they commonly doe both proceed unto perfection, and havelegitimate exclusions, periodically succeeding each other.

But if the superfœtation be made with considerable inter-mission, the latter most commonly proves abortive ; for thefirst being confirmed, engrosseth the aliment from the other."Julia, probably the wife of the young Marcellus and after-wards of Agrippa, and of Tiberius, is cited by Browne asa person fully cognisant of his theory of superfoetation."The project of Julia seems very plausible, and that wayinfallible, when she received not her passengers before shehad taken in her lading." Her lovers were Sempronius

Gracchus and Julius Antonius, of whom Tacitus has some-thing to say in his Annals. We, of course, mean no sort ofdisrespect to the mother in Furness when making mentionof the notorious Julia.

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POISONS IN DOMESTIC BOTTLES.

A CIRCULAR has been issued to sanitary authorities by theLocal Government Board directing attention to the Orderin Council prescribing that as from May 1st, 1913, all liquidpreparations sold as carbolic or carbolic acid or carbolic

substitutes or carbolic disinfectants containing not morethan 3 per cent. of phenols shall be substances to

which Section 5 of the Poisons and Pharmacy Act,1908, applies. The Local Government Board have recentlyhad under consideration the danger to life attendingthe distribution of poisonous liquid disinfectants-e.g.,preparations of caibolic acid-in receptacles such as

beer bottles, ordinarily used for liquid intended for con-sumption. Instances have occurred of omission on the

part of local authorities to observe, in the distribution ofsuch disinfectants, the provisions in regard to the shape andmarking of bottles made applicable to the retail sale of

liquid poisons by the Poison and Pharmacy Act, and byregulations made by Orders in Council. It is pointed outthat the precautions which are enforceable when carbolicacid or a liquid preparation containing it is sold should beobserved generally in the gratuitous distribution of dis-

infectants by a local authority, or in the use of such bytheir officers, whether the preparation contains carbolic acidor any other poisonous constituent.

RUPTURE OF THE TENDON OF THE BICEPS

DUE TO MUSCULAR ACTION.

In the Gazette Hebdomadaire des S’ciences Médicales de

Bordeaux of Feb. 9th Professor H. L. Rocher has reporteda case of an unusual accident-rupture of the tendon of thebiceps muscle due to muscular action. A printer, aged46 years, while trying to lift a lithographic stone weighing150 kilogrammes, suddenly felt something crack in his rightarm, heard a sound like that of the tearing of cloth, and hadthe sensation of something running up the arm. He at

once lost power in the arm as if it was broken. He supportedthe elbow at an acute angle with the left hand, because ifhe tried to extend it he felt acute pain. Eight hours afterthe accident he came to hospital. On examination he was

a muscular man, with a swelling of the size of a mandarinorange in the middle of the arm on its anterior aspect.The swelling felt like muscle at rest and was move-

able in all directions, but especially transversely. On

active flexion of the elbow it ascended towards theshoulder and became more globular and firmer, with-

out, however, attaining the firmness of muscle in a stateof contraction. Below the swelling the forearm was

abriormally flat as far as the elbow-joint. There was no

ecchymosis or hœmatoma. All passive movements of thearm were normal, and only active flexion of the elbow-jointwas lost. Rupture of the biceps tendon was diagnosed, andimmediate operation was decided upon. Under chloroform a

median incision was made in the lower half of the arm. The

aponeurotic sheath of the biceps was intact. It was openedand found completely empty ; the tendon, floating about,could just be perceived above. On drawing it down themuscular globe formed by the retracted biceps was foundlodged in the upper part of the sheath and free

from any tear. After careful examination of the

bicipital tuberosity of the radius it was found thatthe tendon was not ruptured in its continuity, but torn

off the bone. The end of the tendon was a little spread out.