1217

were flabbv and oedematous. There was ulcerative endo-

metritis. The fluid in the uterus contained streptococciin abundance and they were also present in sections of allthe coats of the organ ; some of the venules were thrombosed.

There was no pelvic peritonitis, but there was a little

opaque serous fluid in the pelvic cavity. The liver

was large and a little softened. On section it showed

greenish and violaceous colours. The gall-bladder con-

tained transparent fluid devoid of bile-pigment but givingPettenkofer’s reaction. The fluid contained numerous

epithelial cells, a few polynuclear leucocytes, and strepto-cocci. There was no obstruction of the bile-duct or biliarypassages, and histological examination of the intra-hepaticducts showed no angiocholitis. Fragments of liver, the

surface of which was cauterised, yielded a culture of strepto-cocci. Histological examination of the liver was un-

satisfactory in consequence of decomposition. This case is

a further example of the thesis of M. Abrami and M.

Lemierre that infectious jaundice is usually only a localisa-tion in the liver of a general bacterisemia. It is generallysupposed that such cases are examples of angiocholitis,which, by causing swelling of the biliary passages, pro-duces retention. Angiocholitis, no doubt, occurs in some

cases of infectious jaundice, but such cases as the one nowrecorded suggest the question whether when present it isthe cause of the !jaundice or only an accessory condition.Further, marked angiocholitis has been found in cases

without the slightest trace of jaundice. It follows thatinfectious jaundice is due to parenchymatous changes inthe liver itself-in other words, to hepatitis.

COLD WEATHER AND PLANT LIFE.

THE present snap of cold weather in regard to its effect

upon the life-processes of the plant recall the results ofsome interesting experiments in which plants were submittedto artificial cold and to the action of certain volatile fluids.It is well known that the’potato develops a sweet flavour afterit’’has ’been exposed to frost, and there seems to be little

doubt that this is due to the formation and accumulation of

sugar by the enzyme. Under favourable conditions of

temperature there is no accumulation of sugar, because theoxidation or respiratory process proceeds unhindered andsugar disappears. Cold does not stop the enzyme working,but it arrests the respiratory process, which thus fails to

destroy the sugar, and so it accumulates in the tuber

and gives it the well-known sweet taste of a frost-

bitten potato. Further observations have shown that

cold precipitates an interaction between such glucosidesas are present in the leaves of certain plants. When, forexample, the leaves of crucifers are strongly chilled or

exposed to the vapour :of chloroform they soon give evidenceof mustard oil being present. Similarly, the leaves of

gaultheria produce methyl salicylate, the constituent of

winter-green oil. Then in the case of those plants whichproduce hydrocyanic acid, the so-called cyanogeneticplants, the leaves on chilling evolve prussic acid. Forsome reason not yet clear it would appear, therefore, thatthe chloroformisation or etherisation, or chilling of plantleaves sets up an interaction between what glucosidesand ferments are present, resulting in a premature for-mation of products which would be steadily and con-tinuously evolved under normal conditions of temperature.It is hardly surprising, in view of these results, that when ’,the even tenour of the spring or summer season is dis-turbed by the intrusion of a period of very cold andsevere weather a profound influence one way or another isbrought to bear upon vegetable life. It is difficult to con-clude that unseasonable weather is without similar dis-

turbances on the human mechanism. Apart from tempera-ture, the question of moisture alone has a greater bearing

upon the well-being of individuals than hitherto has beenconceded to it when we consider the important part whichmoisture plays in the great vital processes. The study ofmoisture in air as a factor in health is still in its infancy,and it is a question whether, after all, the great fluctua-tions in the degree of humidity of the air to which wein the English climate are exposed are not more directlyresponsible for unsteady health than are the variations oftemperature.

SUTURE OF THE RECURRENT LARYNGEAL

NERVE.

IN the Bost(ln Medical and Surgical J01lrnal of Feb. 24thDr. J. S. Horsley has reported what appears to be the onlycase on record of suture of the recurrent laryngeal nerve inman. A considerable amount of experimental work has beendone, chiefly by those interested in veterinary surgery, inwhich the left recurrent laryngeal nerve was divided and

implanted higher in the vagus. Most of these experimentswere successful in restoring the function of the laryngealmuscles supplied by the nerve. In Dr. Horsley’s case

the left recurrent was injured by a bullet and all

the laryngeal muscles supplied by it were paralysed.Three months after the injury an incision was made alongthe anterior border of the sterno-cleido-mastoid muscle and

the injured nerve was easily found in the groove between thecesophagus and trachea. The injured portion was excised,excepting a small filament consisting of the posterior partof the nerve sheath. The ends of the nerve were broughttogether with a single suture of No. 0 chromic catgutand a fine curved needle. Some muscle tissue was drawn

over the sutured nerve. The wound healed by first intentionand the patient left the hospital nine days after the operationwith no improvement in voice or breathing. Subsequentlygradual improvement occurred. About two months after

operation a laryngologist found improvement in the musclessupplied by the nerve ; 15 months after the operationrecovery was complete.

-

THE TREATMENT OF MENINGOCOCCUS

CARRIERS.

THE part played by the healthy carrier of certain infectiveorganisms in disseminating the diseases produced by themis now generally recognised, and measures for the diagnosisand quarantine of carriers have been frequently discussed,notably in regard to carriers of the typhoid and paratyphoidorganisms, the diphtheria bacillus, and the meningococcus.We published in THE LANCET of April 16th an annotationdealing with the measures employed to deal with the

carriers of the meningococcus in Belgium. An interestingpaper by Dr. Hans Bethge of Gelsenkirchen appears in theDeictsche lYledizinische Y’ochense2rift, No.2, 1910, describingthe means employed to deal with the carriers in an

epidemic of meningococcal meningitis at the Catholic

Orphan Asylum in that town. Nine cases of the disease

occurred, 8 of the patients being girls, one a boy.They were treated by intraspinal injections of Kolle-

Wassermann serum and all recovered, except one child whichdied some months later from pulmonary tuberculosis. All theinmates of the institution were examined for the presence of

meningococci in the naso-pharynx and 60 carriers were

found, distributed as follows : 5 nurses, 2 workmen, 32 girls,and 21 boys. Of these, 57 were isolated and systematicendeavours were made to get rid of the meningococcus byvarious means. In order to judge better of the relativevalue of the different measures employed, the 57 carriers

investigated were divided into six groups, and in all exceptone of these groups the naso-pharynx was first irrigated bymeans of 1 per cent. sodium chloride solution run in from

1218

a pressure height of one metre. The first group was 1

treated with a spray of pyocyanase, the second with 1an irrigation of 3 per cent. perhydrol, the third witha spray of Kolle-Wassermann serum, the fourth with

an irrigation of protargol in 1’5 per cent. solution,the fifth by simple washing out with salt solution,while the sixth group received no treatment of any kind.The irrigation with saline and the other forms of treatmentwere carried out twice daily. The results demonstrated that

the meningococcus persisted longer in the cases without

treatment than in the others. The spraying with serum gaveonly a slight result ; pyocyanase, perhydrol, and protargolacted fairly satisfactorily, the perhydrol giving the mostrapid effect, since the meningococci disappeared on an

average after 8’6 days of treatment, whereas nine days wererequired with protargol and 12-7 7 with pyocyanase.

AMERICAN MORTALITY STATISTICS.

IN view of the near approach of another decennial Britishcensus, and of the preparations now proceeding for thatevent, the experience of other countries enforcing periodicalcounting of their inhabitants becomes for us especiallyinteresting at the present time. The latest census returns ofthe United States of America have been utilised by Mr.Edward B. Phelps of New York for the preparation of anelaborate analysis 1 of American mortality statistics, the

necessary data having been derived from the special reportsof the Census Bureau at Washington. Until quite recently theonly trustworthy American vital statistics were those compiledannually for "a mere handful of States in the East." Thevital statistics of the decennial censuses are judged by theauthor to be practically worthless-comparisons of figuresfor single years a decade apart being for many reasons un-trustworthy. Owing to loose legislation respecting birth anddeath registration, the imperfection of death certificates, andthe frequent changes in the personnel of registration bureaus,no useful comparison has until recent years been possibleof the records of even the group of districts within

the registration area. Even now the data requiredfor accurately computing the death-rates of the

United States as a whole are lacking. Nevertheless,inasmuch as the existing registration area includesmore than half of the population of the United States,Mr. Phelps is satisfied that the foundations for com-

puting the nation’s annual death-rates have now been fairlylaid. In the present pamphlet the annual mortality recordsof the Census Bureau are presented in detail for each con-secutive year from 1900 to 1908, and as far as the author isaware this detailed information has not previously beenpublished, although comparisons have occasionally been

made for shorter periods of time. Before entering on hisdetailed analysis, the author is careful to make allowance forcertain factors that disturb his calculations. For example,(1) the constantly changing character of the population in Ithe registration areas, and (2) the circumstance that less

than 7 per cent. of the total deaths were those of coloured

persons ; from which it appears that the Southern States, witha large proportion of coloured races, are for the most partexcluded from the benefits of registration. Mr. Phelps includesa table in which the death-rates are compared for each ofthe nine years above specified, and in addition the averagerates are shown for the last four as contrasted with thefirst five years of that period. The mortality rates are givennot only for all causes but for 16 groups of causes, in theurban and in the rural parts of the registration area. From

this table it appears that in the last four years, as compared1 Analysis of Some Phases of American Mortality Statistics, 1900-1908,

by Edward Bunnel Phelps, M.A., F.S.S. Reprinted from the AmericanUnderwriter, vol. xxxii., No. 4, December, 1909.

with the first five of the nine-year period ended with 1908,the general death-rate fell from 16 - 6 to 16’0 0 per 1000. In

a. population of rather more than 40,000,000 this fall meansa. saving of nearly 90,000 lives in the four years as comparedwith the numbers that would have been lost had the average

general death-rate of the previous quinquennium been main-tained throughout the later period. The bulk of this life-

saving occurred in the chief cities of the registration area,where the decrease of the death-rate was equal to 36 per100,000 of the population, whilst the decrease in the

rural parts of the area did not exceed 4’4 in the samenumber living. Proceeding to deal with the fatality ofparticular diseases, as shown by their recorded death-rate,Mr. Phelps emphasises the need of extreme caution

in deducing conclusions from figures which cannot be

regarded as otherwise than mere approximations to thetruth. Speaking generally, however, we note that in theAmerican registration area the fatality from enteric fever,diphtheria, tuberculous phthisis, and pneumonia has recentlyshown a marked decrease, whilst that from cancer, heart

disease, diarrhoea., and enteritis has, on the contrary, con-siderably increased. With respect to the mortality fromdiseases of early infancy, Mr. Phelps remarks that 11 therecent talk about a vigorous campaign against infant

mortality has not yet produced any appreciable resultsin the American community at large." In support of Pro-fessor Irving Fisher’s estimate that about 40 per cent. of

existing American mortality is preventable, the author

remarks that never before in the entire history of the

country have so many agencies for social and sanitaryuplifting been in evidence ; never before have so many ofthe more intelligent class of Americans been actively identi-fied with such movements. But, at the present rate," hepertinently asks, "how long will it take for this thinkinghandful of Americans to arouse and leaven the general massof this country’s population ?

"

THE MEDICAL INSURANCE COMMITTEE.

A MEETING of the Medical Insurance Committee was held

on Wednesday, April 27th, at the offices of the BritishMedical Association, when the report of the chairman,Dr. G. E. Haslip, was read and adopted. The reportreferred first to the death of the late chairman, Dr. RadcliffeCrocker, in whom the committee lost a colleague who alwaysexhibited great practical interest in, and enthusiastic con-fidence as to the ultimate success of the objects in view. These

objects, it may be briefly stated, are to obtain, by acting asagents, favourable terms in all forms of insurance for medicalmen, while retaining out of the agency rebates a small

percentage to be employed in charitable movements wherethe medical profession is interested. The report showed thatduring the year the business of the committee has been

satisfactory and progressive in all directions. The totalincrease of premium income reached some <&725. Previous

to the period now under review motor-car insurance had notbeen touched, but in November, 1909, the committee was ableto issue through Lloyds a policy against all motoring riskswhich at once proved popular, and it seems that there is a

reasonable possibility of this branch of the work developingto a valuable extent. During the two months of 1909 thepremium income from this source reached <E236, whilefor the three months of the current year it has alreadyreached .6650. As to the working expenses of the agency,postages naturally show a slight increase, while with the ex-tended business more clerical assistance has been necessary.In connexion with the business of personal accident andemployers’ liability insurances, results tend to confirm theearlier experience that the renewal business involves con-

siderable labour and correspondence, as the percentage of