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males and 46-2 for females, those who died from theeffects of the cirrhosis itself living somewhat longerthan those dying from other causes. The paper is so

full of concisely stated facts that it is not easy to selectany especial points, but we may give the following extracts from the carefully compiled conclusions based on this

reeearch :-" Cirrhotic livers are, on the average, consider-

ably increased in weight (65’59oz.)." "The alcoholiccirrhotic liver is heavier than the non-alcoholic cir-rhotic liver." " "Alcoholic cirrhosis is commoner thannon-alcoholic cirrhosis." " Malt liquors and spirits mayboth give rise to enlarged cirrhotic livers. Our figures,though scanty, are opposed to the view that beer

necessarily or usually gives rise to an enlarged and

spirits to a contracted cirrhotic liver. Fatty change wasmore marked, contrary to expectation, in spirit- drinkers’livers." "In women dying from the effects of cirrhosis a

large liver associated with head symptoms and with little orno ascites is more frequent earlier in life, while later a smallliver and ascites are often met with."

PUBLIC VACCINATORS AND "EFFICIENT"VACCINATION.

ME. T. S. PARRY has resigned his office of publicvaccinator for the North-Western District of the Chester

Union owing to his views as to what constitutes efficientvaccination being out of harmony with those of the LocalGovernment Board. It appears that for some time past Mr.Parry’s vaccinations have fallen below the required standardand his attention had been called to this before. His prac-tice has apparently been to vaccinate in two places only,whereas the instructions of the Local Government Boardare that such insertions should be made as to produceat least four separate good visicles not less than halfan inch from one another. In the letter addressed to

the Clerk of the Guardians by the Local GovernmentBoard stress is laid on the fact of the greater incidenceand fatality of small-pox amongst those imperfectly pro-tected by being vaccinated on the smaller scale, the con-clusion of the Royal Commission being cited that " the

greater the number of marks the greater the protection inrelation to small-pox enjoyed by the vaccinated person."Mr. Parry, considering that he could not conscientiously actup to the Board’s requirements, sent in his resignation.Indeed, we do not see how he could do otherwise, for theoffice of public vaccinator can only be held by one who isprepared to act up to the standard set by the authoritiesas to what constitutes efficient vaccination."

THE PATHOLOGY OF APHASIA.

THE carefully observed case which Dr. Bastian broughtbefore a recent meeting of the Royal Medical and ChirurgicalSociety will be of the greatest importance, not only tophysicians who are interested in the subject of aphasia, butalso to physiologists and psychologists. The patient, whohad been under almost continuous observation for eighteenyears, was almost completely aphasic, and yet at the

necropsy Broca’s convolution was found to be intact. Thosewho have followed Dr. Bastian’s luminous teaching on thesubject of aphasia will remember this case as frequentlymade use of during the patient’s lifetime to demonstrate Ipeculiar speech defects which Dr. Bastian, correctly as theresult proved, attributed to disease at the posteriorextremity of the fissure of Sylvius. But apart fromthe value of the case as showing that a lesion of Broca’sconvolution is not essential for the production of aphasiathe case is important with reference to the actual position ofthe centres for recording auditory and visual sense impres-sions. In Dr. Bastian’s case there was throughout ability tounderstand what was said, and to read, although the patient

could not read aloud. This appeared to imply that thesesensory centres were performing their function. But from

the careful pathological report of Dr. Risien Russell the

supra-marginal, angular, and temporo-sphenoidal convolu-

tions, where these centres are commonly believed to be

located, were entirely destroyed. It is difficult to find in the

pathological report any evidence that the lesion was of aprogressive nature, although Dr. Bastian feels compelledto assume that it was so and that the destruction of these

convolutions took place subsequently, the correspondingparts of the right hemisphere having gradually taken on thefunction. This, however, is purely hypothetical. The patientappears never to have had word-blindness or word-deafnessand there is no history pointing to any gradual education ofthe right hemisphere. The case was carefully observed andadmirably recorded, and it will be better to wait for furtherlight from similar cases before deciding exactly what its

teaching is with regard to the seat of the sensory processesconcerned in the expression of ideas by words.

THE SPREAD OF BUBONIC PLAGUE.

THE natural history of plague is a subject which willalways have an interest for the student of epidemiology,and although we may be well assured that we shall never

again witness in the streets of London the scenes so

graphically depicted by Daniel, Defoe in his "Memorials ofthe Great Pestilence in London in 1665," it is neverthelessof more than academic interest to note that some weeks

ago there were introduced into London from the East a

couple of cases which presented clinically and patho-logically a strong resemblance to bubonic plague.All necessary precautions were taken, and the autho-

rities concerned acted with every discretion in the

matter. The presence, too, of bubonic plague in our

Indian Empire, and the recent advances which have

been made in the bacteriology of the disease, are facts

which all contribute to invest the paper on the spread ofplague, which is to be read to-night (Friday) by Dr. Cantliebefore the Epidemiological Society of London at 11, Chandos-street, Cavendish-square, with exceptional interest. There

are many problems in the etiology of this extremely inter-esting subject which must be at present regarded as subjudice, and we may expect that this paper will be followedby an interesting debate. We hear, t90, that amongst thosewho have promised to speak are Dr. Lowson of Hong Kong,whose experience of plague is unique, Dr. Payne, and Dr.Patrick Manson.

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MENTAL EFFECTS OF HASHEESH.

IN a recent number af the Journal of Mental Science, inwhich Dr. Clouston gives an account of the Cairo Asylum,he also contributes some interesting information obtainedfrom Dr. Warnock, superintendent of that asylum, in refer-ence to the prevalence and the nature of the mentaldisturbance associated with the excessive use of hasheesh.Thus of 253 admissions to the asylum in the latter half ofthe year 1895 no less than 40 were admitted on account of

symptoms attributed to the excessive use of the drug. In 41

per cent. of all the male patients hasheesh alone or in

combination with alcohol caused the mental symptoms,while this was the case in only 7 per cent. of thefemales. As to whether there is a special recognisableform of mental disturbance produced by hasheesh, Dr.Warnock’s conclusions are that in a considerable numberof cases in Egypt hasheesh is the chief, if not the only,cause of the mental disease, although it is doubtful whetherhasheesh insanity can be diagnosed by its clinical charactersalone. The usual types are three in number. 1. Hasheeshintoxication-an elated, reckless, "swaggering" state, withoptical hallucinations and delusions of demoniac possession.