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France from being represented at the Tenth InternationalCongress of Medicine and Surgery, which met in 1890 atBerlin, will arouse no German reprisals with regard to themeeting to be held at Bordeaux. French hospitality may betrusted to treat the delegates from the Fatherland with allcourtesy and consideration, in harmony with the philan-thropic motive which brings the Congress together. We mayadd that the provisions for the comfort and entertainment ofthe delegates from abroad are commendably liberal-interalia, the entrance ticket being presented gratuitously toeach on his announcing himself in Bordeaux.

THE LONDON AND COUNTIES MEDICALPROTECTION SOCIETY.

IN the report of the London and Counties Medical Protec-tion Society, Limited, for 1894, which we have just received,are some very interesting accounts of cases in which actionhas been taken by the society. The report refers to the Indianoculists prosecution, which has already been commentedupon in our columns,’ and expresses a hope that althoughthe trial of 1893 did not end in a conviction it may lead toan amendment of the Medical Acts. Several instances are

given of the successful prosecution of unqualified practi-tioners, and as regards the case of Mr. Anderson of Tobagothe report intimates that it must be carried before the

highest appellate tribunal in the realm. A short account ofthe abortive attempt at amalgamation with the MedicalDefence Union is given, from which it would seem that atpresent there is not much hope of union.

THE DIFFUSION OF SMALL-POX.

THE fresh cases of small-pox in London were last week 8 innumber, against 11 in the preceding week, and there was 1registered death, that of an unvaccinated person belongingto the parish of Marylebone. Some anxiety has been causedin that parish owing to recent events in connexion with theoccurrence of unremoved cases of small-pox. One house in

the locality of Lisson.grove was the residence for ten daysof a malignant case of small-pox, which proved fatal withina few hours of diagnosis and notification. During the nextfourteen days fully a score of fresh cases arose in the

parish which could be traced with certainty or great pro-bability to infection derived at the house in question,occupied as it was by five families. Great activity hasbeen manifested in dealing with the evil results of this case ;but anxiety is not yet at an end, inasmuch as at least 3additional cases have come to light after varying intervalsof residence of unremoved small-pox patients in the midstof other susceptible persons, and mischief may, it is

feared, yet result from these occurrences. We are

glad to learn that the vestry have resolved to erect a

shelter and baths for the use of persons who have been

exposed to the danger of contracting infectious diseases,together with means for the disinfection of their cloth-

ing. In West Ham, where in the first week of

February small-pox showed serious recrudsecence, only2 attacks were chronicled last week. At Birmingham, too,the attacks fell to half the previous week’s record, only6 being noted last week, with 1 registered death. At Liver-

pool and Bootie we hear of a dozen attacks. The Registrar-General for Scotland returns 8 deaths from small-pox in thegreat towns during January-namely, 2 in Glasgow, 5 inEdinburgh, and 1 in Leith. In Dublin there were admittedto hospital in the week ended Feb. 9th 60 small-pox cases, ascompared with 61, 64, and 69 in the three preceding weeks,the discharges numbering 84 and the number remainingunder treatment being 141, in addition to 142 convalescentsat Kilmainham, or 283 in all. Seven deaths from small-pos

1 THE LANCET, Nov. 4th, 1893.

in the week occurred, 2 in vaccinated adults and 5 in un-vaccinated persons, one a child aged five and the rest in adultlife. Of the 68 persons dying from small-pox in Dublin in1894, all in the last six months of the year, as many as 39were unvaccinated ; all the 16 children under five years ofage dying from the disease belonged to that class.

ENDOCARDIAL LESIONS IN TUBERCULOUSSUBJECTS.

THE effects of endocardial lesions on the course of tuber.culosis is an old and well-discussed subject, bnt in the

Annales de Médecine of Feb. 8th we find it dealt with fromrather the opposite standpoint-i. e., the effect of tuber.

culosis on diseases of the endocardium. The conclusionsthere given are those arrived at by Teissier in his work onthe subject. Endocardial lesions due to tuberculosis are

multiple in form and complex in pathology, the tuberclebacilli, toxines, and associated bacteria all combining toproduce the disease. The bacillus acts locally by producinga specific lesion, and generally by its deteriorating effect onnutrition. The tuberculine, on the other hand, is said toinfluence the vaso-motor system and so to be specially activein the sclerosing forms. The specific lesion showing itselfas granular or caseating nodules is rare, being less fre-

quent than tuberculous pericarditis. It is always a

secondary lesion due to presence of bacilli in the cir.

culation, and does not cause any characteristic cardiac

signs. The sclerosing form is frequent and the result of slowtuberculous infection. It occurs in the course of chronictuberculous cases, and shows itself by producing harshcardiac murmurs. Many of the cases of valvular diseasein scrofulous subjects are thought to be influenced bythe presence of tuberculous toxines. An acute form due to

secondary infection is also described, which appears to tallyby its clinical course with infective endocarditis. It may.like infective endocarditis, take a vegetative or an ulcerativeform, but more work has yet to be done before accurateconclusions can be drawn.

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INSANITY AMONG THE NATIVES OF SOUTHAFRICA.

IN the January number of the Journal of Mental ,ScienceDr. Duncan Greenlees, the Medical Superintendent of theGrahamstown Asylum, South Africa, has a very interestingpaper on this subject. He has gone over the cases of nativesadmitted to the asylum in the last nineteen years, and hasclassified his results under several headings. In regard toage he finds that in males the most frequent age is

between twenty-five and thirty years, while in females it isthirty to thirty-five years. By far the most common form ofinsanity is mania, melancholia being rare, and in the acuteform in which it is found among white patients extremelyuncommon. Epilepsy and epileptic insanity are not unknownamong native races, even apart from traumatic cases, butgeneral paralysis is so rare that amongst the pure nativesit may be considered not to exist. It is difficult to

get at the causes of insanity among natives, the historybeing, of course, necessarily imperfect. But Dr. Green-lees mentions two important causes-viz., excessive

drinking of alcoholic beverages and the smoking of dagga,a plant almost identical, it is said, with Indian hemp, whichproduces temporary intoxication, ending sometimes in anoutburst of maniacal excitement. As to the causes ofdeath, the frequency with which chest diseases are theimmediate cause is noteworthy, and also the rarity of actualgross brain disease as a cause. This last fact is probablyexplained by the absence of conditions of life likely tocause cerebral disease, while the former seems to indicatethat the clothing of the native, with the liability to sit inwet clothes, &c., renders_him liable to pulmonary affections.