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give rise to tuberculosis of the corresponding glandsand then heal spontaneously, or that tuberclebacilli may pass through the intact mucous mem-brane and produce glandular tuberculosis. Thisview is supported by the analogy of cervicallymphadenitis. In its numerous lymphatic folliclesthe appendix resembles the tonsil, and bacilli aresupposed to pass through this to produce lymph-adenitis. Turning to the clinical aspect, in fourof Dr. Gage’s cases the age varied from 7 to 12

years and in seven from 16 to 25. In none wasthere any palpable tumour, and in all but one theaffected glands were confined to the ileo-caecal

region. In the exceptional case there were a

few small glands palpable in the other partsof the mesentery. The predominant featurewas an attack of pain and tenderness localisedin the right iliac region with slight pyrexia.Nausea was present in almost all, but vomitingoccurred only in four. In one case there was a

history of two previous attacks of appendicitis. Inanother an attack of right iliac pain and vomitingoccurred eight months before, when six similarattacks followed. On operation two caseous glandswere found in the ileo-csecal angle. In smearstubercle bacilli were easily demonstrable. The

appendix was normal even on microscopic examina-tion. In another case the appendix had previouslybeen removed for the relief of the same symptoms,and more or less pain in the right side of theabdomen had persisted ever since the operation.Three glands of the size of walnuts were found inthe ileo-csecal angle. In none of the cases was

there any history, personal or family, of tuber-culosis, excepting in two or three cases in collateralbranches. The diagnosis from appendicitis is verydifficult. Indeed, Dr. Gage never opened theabdomen without expecting to find appendicitis.Fortunately, the differentiation is of no importance,as operation is necessary and the appendix shouldbe removed as well as the glands. The dissectionof the glands should, if possible, be accomplishedwithout rupture and without interfering more thanis necessary with the vessels of the mesentery.The prognosis after operation is good; there appearsto be no tendency to recurrence of the disease.

THE DIAGNOSIS OF LATENT MALARIA.

AN interesting and lucid communication on thissubject has just appeared in the July and Augustnumbers of Il Morgagni from the pen of Dr.

Ignazio di Pace, of the Institute of AgrarianBacteriology at Portici. A malarious patientusually considers himself cured when he no

longer suffers from fever and appears in goodhealth. That this criterion is erroneous is shownby the relapses that occur in those presumablycured, by the high mortality of pneumonia, hepaticcirrhosis, and other diseases aggravated by malariawhich is no longer manifest, by splenic enlarge-ment, nephritis, periodic neuralgia, cutaneous erup-tions, intermittent haemorrhages, gastric catarrh,and anaemia due to malaria of which thereare no definite signs. A negative result fromexamination of the blood does not authorisethe assumption that the malarial infection isextinct in the organism, for it may remainlatent and the sporidium still be present insome morphological equivalent hitherto unknown,and able to give clinical evidence of infection orto reappear as soon as new conditions disturb thephysiological balance, such as traumatism, surgicalintervention, climate, or any cause that diminishesthe organic resistance. Moreover, this may happen

after 2, 10, or even 15 years. Many diagnosticmethods have been tried by the author and foundunsatisfactory, such as urobilinuria, hsemolysins inthe urine, deviation of the complement in theserum, and the administration of hydrochlorate ofberberine. He therefore instituted a series of obser-vations with reference to the use of strychnine as ameans of revealing the presence of latent malaria.The subjects of his observations were 136, chosenfrom peasants who worked in malarious districtsand from other persons who either had not sufferedfrom any definite malarial manifestations, or,

having suffered, were clinically cured, who hadtaken no quinine for at least three months and whohad not the parasite present in their blood at thetime they were subjected to the experiment. Forthe administration of the drug, an aqueous solutionof nitrate of strychnine was used for subcutaneousinjection and granules of the same containing1 milligramme, this salt being chosen as beinganhydrous and of more constant composition thanthe sulphate. The doses for adults were 2 to 3 milli-grammes. Blood examination was made twice, onthe day before the experiment and two hoursafter the administration of the strychnine.Positive results were obtained in 38 cases, or

about 27 per cent. The mechanism of the actionof strychnine in this respect seems to be thatby stimulating the vaso-motor centre in thebulb it increases arterial pressure in conse-

quence of the vaso-constriction produced, andinduces a partial, if not total, emptying of the

spleen, and hence the extrusion into the circulationof any malarial parasites which are contained in it.This test is useful, easy to carry out, and practical.

REGISTRATION INQUIRIES 100 YEARS AGO.

Iv connexion with national registration therewas published recently in the Daily News a7aLLeader under the above title an interesting articleraising medical questions, the answers to whichshould illustrate the progress made in medicaland surgical science during the past century. The

point to which the article mainly draws attentionis that there was nothing in the form of registra-tion to indicate a case of " hopeless physical in-capacity." Such a case, therefore, and many othersnot quite so seriously afflicted, would be tabulatedas fit for military service. In the earliest yearsof the nineteenth century, when the Napoleonicwars were in progress, forms of registration wereemployed which took note of physical conditions,as is well shown in the two following examplesquoted by the Daily News and Leader:-

I - do swear That I have no Rupture, nor am I subjectto Fits, nor am I disabled by Lameness, or otherwise, buthave the perfect use of my Limbs; and that I am not an

Apprentice, or a Seaman, or Seafaring Man, and that I donot belong to His Majesty’s Navy, Army or Marines, nor tothe Militia.

I - do make Oath. That I am by my Trade a -, andhave been usually resident in the Parish of -, in theCounty of --, and that I have - Children born inwedlock, and that I have no Rupture, nor ever was troubledwith Fits, and am in no way disabled by Lameness or other-wise. but have the perfect use of my Limbs ; that I am nota Seaman, or Seafaring man, or an Apprentice; and thatI do not belong to His Majesty’s Navy, Army, or Marines,nor to any other corps of Militia. Witness my hand at- - the Day of - One Thousand Eight Hundredand _

The interesting medical point in these forms is theallusion to " rupture " and " fits." In both theforms containing any questions about the physicalcondition of men willing to join the colours there

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is an allusion to these afflictions. The author ofthe article in our contemporary concludes that"fits" were common among Englishmen of the

Napoleonic era, and doubts if the frequency of theiroccurrence to-day merits similar special mention.The fits referred to were presumably due to

epilepsy, at one time known in England as the"falling sickness," a disease presenting strikingphenomena which have been described by themost ancient medical writers and in all agesstudied by impostors, rogues, and malingerers.So far as we know epilepsy was not more commonamong men 100 years ago than at the present time;but what was more common-and this is the ex-

planation we offer for the special mention of thedisease in the official inquiries referred to-was thefeigning of epilepsy. Feigning, happily, throughthe progress made in the diagnosis of disease nowis almost unknown and is barely mentioned inmodern text-books of medicine. We have to turnto books published more than half a century agoto find any detailed account of the methodsof the impostors and of the methods invogue for detecting them. In the first halfof the last century amongst the number offeigned diseases epilepsy was one of the mostcommon. Sailors and soldiers pretended to haveepileptic fits in the hope of obtaining their

discharge from the services. It was thereforetaught that the means of detecting the feigneddisease from true epilepsy were of importance toall practitioners, and it was more particularlynecessary that they should be well known to thosewho were likely to join the medical departments ofour fleets and armies. The special mention of"rupture" in the forms of by-gone days may beexplained in a similar way. The word "rupture" informer days was more comprehensive,’and referrednot only to hernia but also to varicocele. Greatstress was laid on the -fact that the condition, likehernia, offered excuse for escaping some militaryduty. Hernia and varicocele for this reason wereboth held to be disqualifications for the services.The surgical operations now performed for theradical cure of these physical defects render anymention of them in a registration form to-dayquite unnecessary. The introduction of theclause, "I have no rupture, nor am I subjectto fits," in a sworn declaration probably acted ias a deterrent to malingering subsequent to

joining the colours. The article concludes with,"It happens, however, that our authorities com-pletely ignore the whole question of health. So

long as you are more than 15 or less than 65 itmatters nothing to them whether you are half deador very much alive." The writer, however, suppliesan answer to this objection in the earlier part of thearticle when, very rightly, the reader is asked toreflect for a moment on the infinite possibilities thatwould have been presented to conscientious andpainstaking folk if they had been asked to explainthe state of their health. Few subjects presentgreater attractions to many people, and they willenlarge in a painfully minute manner on theirsymptoms. On the other hand, there are worthyfolk who resent any inquiries about their physicalcondition, even when made by a friend.

THERE will be no meeting of the Section ofObstetrics and Gynaecology of the Royal Society ofMedicine until Thursday, Dec. 9th. In the Calendarof the society two earlier meetings have beenannounced, but it has been found impossible to

arrange for these.

BREATHING AND PHYSICAL EXERCISESFOR USE IN CASES OF WOUNDS IN

THE PLEURA, LUNG ANDDIAPHRAGM.

BY CORTLANDT MACMAHON, B.A. OXON.,INSTRUCTOR FOR SPEECH DEFECTS AT ST. BARTHOLOMEW’S

HOSPITAL, ETC.

THE exercises described have been used duringthe past months on soldiers suffering from woundsof the pleura, lung and diaphragm in St. Bartho-lomew’s Hospital, King Edward VII.’s Hospital forOfficers, Princess Henry of Battenberg’s Hospitalfor Officers, No. 1 Base Hospital, and the Hospitalsfor Officers at 17, Park-lane and Dorchester House.The progress of the patients has been carefullynoted by the physicians and surgeons in charge,and, as the improvement has been consideredremarkable, the exercises are now set out in thehope that they may be of general use in similarcases.

The chief objects of the exercises are :-(a) To prevent pleural adhesions forming and to

break down existing adhesions by careful andgradual movements.

(b) To enable lungs, which have collapsed owingto pressure due to empyema, haemothorax, andpneumothorax, to regain their normal condition.

(c) To reduce hsemothorax and pneumothorax.(d) To restore the normal shape of the chest

walls which have fallen in owing to collapse of thelungs.

(e) To assist the discharge of pus, where thereis a drained empyema, by increasing the lunginflation.

(f) To improve the general condition by thetonic effects of the exercises, and especially to-overcome breathlessness on exertion.The early exercises can be carried out without

moving the patient from his bed. At first an

operator is necessary, who should, if possible, givethe exercises daily for about a fortnight, afterwhich time the patient can perform most ofthem for himself, and they should then be carriedout night and morning half an hour before ameal. Great care must be taken that there is noexhaustion to the patient; only a few exercisesshould be given at each treatment, and after everysix movements of each exercise a rest of at leasttwo minutes should be given. I generally giveonly the first three movements (see below) for thefirst three days of the treatment, and, in a case ofempyema that has recently undergone operation,.the first four movements only should be givenuntil the drainage-tube is removed.When the patient can be moved from bed the

exercises should be carried out on a narrow

couch or table. The free movement of the armsin all directions is essential. Special attention iscalled to the fact that all the exercises are carriedout in a recumbent position, and that on thecorrect performance of the first three exercisesdepends the success of the others. Care must betaken that the upper chest is not drawn up northe abdominal wall contracted during inspiration.These are the two great faults often found. Anyprotrusion of the abdominal wall during inspira-tion must also be guarded against. The time ofcommencement of the exercises, their extent andduration are matters entirely for the physician orsurgeon who has charge of the case. A marked