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air, ozone, water internally and externally, light, heat, mechanical movement, and gymnastics. Later chapters deal with the various conditions for which such remedies are used. These range from neuras­thenia and obesity to scoliosis and cancer. Illustrations and diagrams of apparatus are appended.

The author's aim appears to be to urge the use of physical means in opposition to drugs. At this time of day this is hardly necessary, and the only thing at all likely to discredit the remedies he vaunts so highly is the indiscreet application of them to unsuitable cases by their too enthusiastic advocates.

O. G. S . •

(turrent '1Ltt~rnture.

On the Stimulation of Antibody Elaborating Organs.-Lippmann (Deutsch. med. Woch., September 14, 1911, p. 1693), immunized a series of animals with dead emulsions of the typhoid bacillus. For four months the agglutinative power of the blood remained high at a constant level. A hypodermic injection of 0·1 grm. of arsacetin then caused a sudden rise in the agglutin'1tion curve which attained its maximum in about seven days. He notes that the work of previous investigators has shown that antibodies are elaborated in the bone marrow, lymphatic glands and spleen. In cholera, for instance, they exist in four times as great a quantity in the spleen as in the blood. While there are many agencies, such as coW, hunger, fatigue, alcohol and other poisons which retard, there are but few which hasten the production of protective substances. Among the latter are warmth, high altitudes, pilocarpin, hetol and arsenical preparations and venesection.

O. B. Antitoxin Treatment of Diphtheria.-Hoesch (Deutsch. med. Woch.,

September 14, 1911, p. 1683) deprecates the use of very large doses of diphtheria antitoxin. He recommends 1,000 to 2,000 units in mild cases, 3,000 to 4,000 in severe. He has observed no benefit arise from the administration of adrenaIin, or adl'enalin and saline fluid advocated by Meyer. The antitoxin should be injected at the earliest moment possible. O. B.

On the Curative Power of Quinine Derivatives.-Morgenroth and Halberstffidter (Berl. klin. Woch., August 21, p. 1558) have made systematic investigations on the action of quinine derivatives in experi­mental trypanosomiasis. They find that hydro-quinine and ethylhydro­cupreine, to some degree, exercise a preventive and therapeutic effect in the animal infection. They think that these substances in combination with other trypanocidal agents might be used in the human disease.' Morgenroth and Levy have experimented with ethylhydrocupreine on mice inoculat.ed with a tenfold lethal dose of pneumococci. They have saved a small proportion of the animals. They claim that this is the first occasion on which a virulent bacterial infection has been aborted by chemic~l means.

C. B.

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Vaccination against Trypanosomiasis.-Teicbmann and Braun (BerZ. klin. Woeh., August 21, 1911, p. 1502), state that tbey bave pre­pared a vaccine from dead trypanosomes wbich is able to protect mic.e from an otherwise fatal invasion, and that tbey have obtained an ant!-trypanosome serum by immunizing animals with it. C. B.

Silver-Atoxyl in Sepsis.-Eisenberg (BeTZ. !din. vVoch., September 4, 1911, p. 1643) states that tbis substance has been injected subcutan­eously in gonorrbCBal rheumatism with good result. Hirscb also has published a case of sepsis in which it was successful. Silver-atoxyl is atoxyl-the sodium salt of para-amidophenylarsonic acid-in which Ag takes the place of Na. It contains 33 per cent. of Ag and 23 per cent. of As. Eisenberg employed it in a patient who had been so reduced by six weeks' rigors, fever and sweating that death appeared imminent. Com­plete recovery ensued after a dose of 0·3 grm., emulsified in oil and in­jected subcutaneously. An abscess formed at the site of the injection.

C. B. Salvarsan in Bilharzia.-Joannides (Dentsch. med. Woch., No. 34,

1911), claims that he has cured eight cases of bilharzia by means of an intramuscular injection of 0'6 grm. of salvarsan. In B~d. de la Soc. de Path. Exotiq7lC, January, 1911, p. 45, it is recorded that salvarsan is of no value in this disease. 'rhis corresponds with the experience of the reviewer, who found that the ova were as numerous four months after an intravenous injection of salvarsan as before. C. B.

The Treatment of Syphilis with Joha and Mercury.-Schindler (BerZ. ldin. Woch., September 4, 1911, p: 1647) has given the name Joha to an oily emulsion of salvarsan which, he says, is not deteriorated by keeping, even in the Tropics. He claims to cure 85 per cent of his cases in fourteen days by means of two intramuscular injections each of Joha and mercurial cream which together represent 1 grm. of salvarsan and 0'56 grm. of mercury. He, however, does not state the number of patients thus treated. C. B.

The Reaction after Salvarsan.-:Marschalko (Deutsch. med. Woch., September 14, 1911, p. 1702) states tbat by the use of only 0'5 per cent. sodium chloride in water free from bacteria, living or dead, he has sup­pressed the reaction after intravenous injection of sal varsan in sixty -seven cases. C. B.

The Dimethyl Sulphate Test of Creosote Oils aud Creosote Dips j a Substitute for the Sulphonation Test. Robed M. Chapin (U. S. Department of Agriculture, Circ7biar 167, June 30, 1911).-'l'he dimethyl sulphate test herein described is intended to serve as a useful sorting test, leaving the sulphonation test to be employed as a check in more doubtful or important cases. It is claimed that it yields quick, clean and definite results even in wholly inexperienced bands, and requires but a minimum of apparatus and manipulation. After carrying out the method as described we have certainly found this to be the case. Tbe sulphonation test usually employed in most laboratories requires con­siderable skill and care and entails the manipulation of comparatively large quantities of concentrated sulphuric acid.

The dimethyl sulphate test is principally applied to creosote sheep

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dips and in the Biochemic Division of the Bureau of Animal Industry it has been found to be a helpful aid in arriving at certain data valuable in determining the source of origin of creosote oil. As sheep dips contain resin, which on heating decomposes and forms resin oil, which itself is but partially soluble in dimethyl sulphate, the test must only be applied to a fraction distilling between 2400 and 2700 O.

As the extraction of sufficient oil to allow of fractional distillation is tedious and involves the use of considerable quantities of ether, the author found that the test could be simplified by applying it to the oil separated by ether and potassium hydroxide without previous distillation.

In practice, the examination is carried out as follows: Between 20 and 50 grm. of dip, depending upon the character and scope of the subsequent examination, are treated with ether and caustic potash solution by shaking in a separating funnel, until separation into two layers results. The upper ethereal layer is washed with potash solution and water, the ether distilled off, and the hydrocarbons present in the dip, now freed from resin and tar acids, will be thus rendered susceptible to thorough examination; 5 c.c. are pipetted into a narrow 25 c.c. burette and shaken with 8 C.c. of dimethyl sulphate after closing the burette with a close-fitting cork. Separation of the residual oil occurs in a short time in the form of a clear, supernatant liquid layer, which if dark, as sometimes happens, should be looked for by reflected light. If the result is negative it is certain that the dip contains neither any large amount of creosote of doubtful origin nor petroleum oils. If the result of the test is positive and further information is desired, a sample of the dip should be subjected to distillation by one of the two ways described in the Circular and a test made on the fraction distilling between 2400 F. arid 2700 C. W. W. O. B.

Suggested Iron Ration for the Russian Army. - In the Vmnni Sbornik (Military Magazine) for September, 1911, appears an article by v. Mikini containing suggestions for an " iron ration" for the Russian army. The article is not written Ior the 'medical profession alone, and while entering into the scientific aspect of the question, the author endeavours to make this clear to those whose previous knowledge of the subject is small. He points out the advantages of issuing an emergency ration carried on the person and used only on the order of an army commander. He lays down that such a ration should be (a) light and portable; (b) not liable to be spoilt by keeping. Furthermore, that it should be (as in the case of an ordinary ration) sufficiently nourishing, digestible, and pleasing to the taste.

He gives the following table showing the composition of the Russian Army ration :-

RUSSIAN ARMY RATION.

Albumins Fats Carbo.hydrates (st"rch)

In Peace- grnl. grm. grm. grm.

Meat 205 33'6 13'4 Bread 1,228 73'6 6'0 567 Buckwheat groats 136 12'0 1'0 75.

In War-Meat 409 67'2 26 Bread 1,G24 61 5 472 Buckwheat groats 136 12 1 75 Suet (&c.) 38 1 27

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From this table it is seen that the Russian soldier receives in time of peace as well as in time of war a sufficient amount of proteids and a much great~r amount of carbo-hydrates than are theoretically required to maintain his bodily strength. But the ration of tinned meat, though satisfactory in quality as an ordinary war ration, is unsuitable for an emergency ration on account of its weight, which is largely due to its high proportion of water (55 per cent). Moreover, the tins of meats are in practice not. carried- on the person of the soldier, but in regimental and divisional transport. The emergency ration (or what serves as such) of the Russian soldier consists of half a Russian pound of preserved meat and two Russian pounds of sukhar daily (a Russian pou_nd = 0'9 lb. English). The sukhar is dried rye bread; the word is frequently trans­lated as "biscuit," which in one sense is a good translation, but a Russian would describe our army biscuit as galet.

Oonsidering that the meat ration is carried in the transport, and that the s~<khar is not (on account of its composition) suitable as the sole component of a ration, the Russian soldier cannot be considered as well provided for in all emergencies. The composition of sukhar is stated to be 13'1 per cent water, 10'86 per cent proteid, 2 per cent fat, 70·21 per cent non-nitrogenous material, 1'78 per cent gelatin and 2'05 per cent mineral salts.

The composition of biscuits made from a mixture of rye and wheat flour and of an ordinary European military biscuit made from wheat flour with 30 per cent of husk are given in comparison, as also the com­position of German, French, and Austrian emergency rations. The writer of the article considers that the question as to the provision of a suitable emergency ration has been satisfactorily settled in the French, German, and Austrian armies. He states that the difficulty in intro­ducing a similar ration into the Russian service is that the Russian soldier does not like pea-flour: the postulate as to the palatability of a ration would not, therefore, in his case be satisfied. Such vegetables as he prefers, potatoes, cabbages, &c., are useless for the purpose of providing an emergency ration rich in proteids. .

The author considers that a good solution of the difficulty is found in the provision of "albuminized bread." The idea is not new, and many experiments in this direction have been made, by the admixture of meat, &c. But the most satisfactory albuminized bread has been found to be that in which the extra proteid is supplied by the admixture of ox serum: this bread has been supplied to "out-of-works," and has been otherwise the subject of practical experiment. The serum is obtained simply by straining the coagulated blood of oxen killed in abattoirs. In order to make the bread 10 lb. of rye flour are mixed with 5 lb. of serum and t lb. of yeast is added. When the dough has risen, 6 lb. of rye flour and 6 lb. of serum are added. The freshly-mixed dough is for the requisite period of time placed where warmth may aid the action of the yeast, salt is added, and baking is carried out in the usual way. The bread may be dried to make sukhari, just as ordinary rye bread may be dried.

The cost of the serum is very little; at the present time vegetable albumin is used in manufactures, to the exclusion of animal albumin, and blood is not a normal article of food in Russia as it is. in some countries. The supply is plentiful: 600,000 head of cattle are killed

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yearly in one ababtoir in St. Petersburg alone. No special mechanical arrangements are required either for making or storing the bread.

The albuminized bread so prepared is as regards tasbe indistinguish­able from ordinary rye bread. White (wheaten bread) has a slightly rosy tinge, if prepared by the admixture of serum instead of water, but this is not noticeable in rye bread.

The albuminized sukhar keeps very well; if albuminized biscuits (gaZeti) are required they may be made by mixing the flour with serum as for bread making.

Eight hundred grammes of sukhar, albuminized as indicated, are stated to contain 221 grammes of proteid, and 576 grammes of non­nitrogenous food material.

It is not proposed that the meat ration (of frozen or tinned meat) should be lessened or withheld on account of any issue of albuminized bread, but it is considered that this kind of bread in the form of sukhari would be suitable as the main component of an emergency ration, as being in itself a good food for men in hard work. .

The complete emergency ration would consist of tea, sugar and preserved bouillon (in the form of cakes), in addition to the albu­mini zed bread. Tea-making is considered in Russia to be the practical solution of the water question on active service, and the meat extract is included on account of its valuable stimulant qualities. G. S. McJ-l.

Sterilization of Water by means of Ultra-violet Rays.-The Zeitschrijt Fir Hygiene und Injektionskrankheiten, vol. lxix, part 1, contains two papers by Dr. L. Schwarz and Oberarzt Dr. Aumann on the" Treatment of drinking water by means of the Ultra-violet Rays." In the first a series of experiments with the mercury vapour lamp of the Hanau-Q1larZZampengesellschajt are descrihed. In this lamp the mercury is enclosed in a double-walled tube of quartz glass, and is intended to burn under water. Unless immersed the temperature rises so rapidly as to injure the lamp, and this accident occurs sometimes even when it is in the water. The length of the arc is 6 cm. (2'4 in), the current necessary is one of 4 amperes at about 80 volts pressure. '1'he candle power is 1,800. The current must always be passed in the same direction, and the poles should invariably be tested with pole-test-paper to ensure that this is the case after any alterations in connections have been made. The lamp should be so arranged that the anode end only can be raised for the purpose of lighting; the cathode must be left fixed. The first experiments were made with still water to ascertain the shortest possible time in which complete sterilization could be attained. The sterilizing vessel, which measures 8 in. X 3·4 in. 'x 3'2 in., was carefully cleaned and then filled with clear .tap water, to which a carefully strained emulsion of one loopful to a test organism (Leucht vibrio) in tap water was added. The raw water contained about 2,000 organisms per centi­metre, which number was reduced to 700 in five seconds, 15 in ten seconds, 8 in fifteen seconds, and nil in twenty seconds. In twenty-five seconds no organisms were found in 200 C.c. It was impossible to con­tinue the experiment beyond thirty seconds owing to the great heat evolved. A distinct odour of ozone was perceptible after the current had been running twenty seconds. For experiments with running water the sterilizing chamber was connected with a tank holding 200 litres of

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water. It was first ascertained, by experiments with fluorescin, that with a delivery of 1 litre per minute the water took six seconds to traverse the sterilizing vessel, the period being three seconds with a 2-litre delivery. The period during which the water would be actually under the influence of the rays was thus much shorter than that which the previous experi­ment with still water had shown to be necessary, ensure complete sterilization, vi7-., twenty-five to thirty seconds.

Working at the more rapid rate, that is with an exposure of the water equivalent to three seconds, the authors found that with a water containing a considerable number of bacteria complete sterility was not attained in any case, though the number of organisms present was greatly reduced. Thus, dealing with B. coli, the bacterial content of the raw water, which was between 70,000 and 80,000 per cubic centimetre, was reduced to 40 on an average of six observations. B. prodigiows was reduced from 170,000 to 7. Spore-forming micro-organisms fell from 3,000 per cubic centimetre to 2.

With the longer exposure of six seconds (60 litres per hour delivery) the effect was greater. With 50,000 B. coli present per cubic centimetre sterility in 200 C.c. was produced on two occasions out of six, in 10 c.c. on four occasions. Similar effects were noted with prod1:giosus when present in somewhat larger numbers, 65,000 per cubic centimetre. Spore bearers (3,000 in the raw water) were absent from 1 C.c. of the treated water on six occasions, from 10 c.c. and 200 c.c. on three out of six.1

Another series of experiments was made in which only moderate amounts of bacteria were present, 3,000 to 4,000. With a three-second exposure B. coli were absent in 1 c.c. on four occasions out of six; in 10 c.c. and 200 c.c. on two occasions. As before, pTOdigiosus showed itself more sensitive, none being found in any observation with 1 c.c. or 10 c.c., and being present only three times out of six in 200 C.c. Not much improvement was noted when the exposure was lengthened to six seconds.

Dealing with a very slightly polluted water, such as the ordinary tap water of Hamburg, which contains only six to eight micro-organisms per cubic centimetre, good results were obtained even with only one-and-a­half seconds exposure and a delivery of 240 litres per hour.

Water to which sewage had been added in the proportion of 200 c.c. to 200 litres, and which had then been strained through filter-paper, showed an average reduction of from 1,350 micro-organisms per cubic centimetre to 1'6.

The authors submit the following conclusions, which they are careful to safeguard by saying that they must be held to apply only to water of a chemical nature similar to'that of Hamburg, and to the particular pattern of lamp experimented with on this occasion. With a water con­taining many micro-organisms ultra-violet rays produce a great reduc­tion of bacteria in a very few seconds. With a longer exposure, depending on the number, nature, and specific resisting powers of the organism pre­sent, sterility can in many cases be assured. The system, cannot, how­ever, be recognized in its present state as a substitute for the more common methods of water sterilization in use in hospitals and other

, In all these experiments six observations are recorc1ec1 with each germ.

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institutions. It is neither simple nor absolutely certain, and the neces­sity for previous filtration will stand in the way of its installation for even small supply systems. The number of organisms present is of great importance. It should preferably be somewhere between 500 and 2,000 per cubic centimetre. The authors refer to Deeleman's portable sterilizer for field service, and are apparently optimistic as to the future of the ultra-violet rays for use in this direction. They object very strongly to the use of Berkefeld candles for filtration and recommend the Sucro filter.

The second series of observations was carried out with the Westing­house-Cooper-Hewitt lamp. The apparatus used was similar to that described in the JOURNAL OF THE ROYAL ARMY MEDICAL COHPS, vol. xvi, 1911, p. 170. The current required is one of 3i to 4 amperes at 110 volts, and the resistance should be so adjusted as to give a tension of 75 volts across the arc after the lamp has been running for twenty minutes. Too high a tension injures the lamp, whilst too low a tension (according to the authors, 59 to 60 volts) seriously interferes with the sterilizing powers of the lamp. The advertisement claimed for the lamp that" no pathogenic germs are present in the water after two minutes' treatment. For complete sterilization, however, ten to twenty minutes must be allowed to lapse, since it is not till the close of this interval that the lamp attains its full powers." The authors state that the claim to possess a selective influence on pathogenic germs has not in their opinion been maintained;, on the contrary, they found that the common water bacteria succumbed earlier than those selected as test objects, the indi­vidual resisting power of the species being of considerablA importance.

After each period of use the apparatus must be completely emptied, and the authors recommend that it should be thoroughly cleaned by means of a reversed flow and thorough brushing. Previous clarification of the water is indispensable. They consider that this would render the use of the" rays" difficult on service.

Experiments were first made to ascertain the length of exposure to which the water was sUbjected when the delivery was 600 litres per hour, the advertised output. This was ascertained to be fifteen seconds, during part of which the water was partly shaded by the cone-shaped diaphragm. The first exposure, during the period in which the water flows over the first diaphragm lasts only five seconds, and the authors consider, in opposition to v. Recklinghausen, that this is not sufficient for sterilization. U sing ordinary tap water with 300 micro-organisms per cubic centimetre, these were reduced after five seconds to 3 in 1 c.c. and 12 in 2 c.c.; B. prodigiosus from 50 to 1 and 3; B. vioZaceus from 100 to 5 and 8; B. coli from 1,000 to 30 and 50, respectively. Using the longer ex­posure, fifteen seconds, complete sterility was attained even when large quantities, 10 and 200 c,c. were tested.

Dealing with a clear tap water, bacterial content 300 per cubic centimetre as above, and using the longer exposure, fifteen seconds, sterility was produced in 1 c.c. and 10 c.c., after the lamp had been working for five minutes, but in 200 c.c. not until ten minutes had elapsed.

The next point which was attacked was the number of bacteria which fixed the limit of efficiency of the lamp. The test organisms used were B. p1'odigioS7tS, B. coli, and the Leucht vibrio. B. prodigiosus

17

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was present in large numbers, 250,000 per cubic centimetre. With an exposure of fifteen seconds, this number was reduced to 12 per cubic centimetre in five minutes, whilst repeated observations at five-minute intervals up to forty minutes gave an average of 15 per cubic centimetre. B. coli, 50,000 per cubic centimetre, was reduced to 4 in five minutes, and the average up to forty minutes was 5 per cubic centimetre. A somewhat better result was obtained with this organism when only 5,000 per cubic centimetre were present, but absolute sterility did not result even in one hour. The vibrio was reduced from 5,000 to 15 in five minutes, and the average up to forty minutes was 3. From counts made in two cases at the end of two and four minutes, it was clear that a satisfactory result cannot be expected till the lamp has been working for at least five minutes. In no case with any of the test organisms was sterility produced, and the authors conclude that, dealing with water containing more than 5,000 bacteria per cubic centimetre, it is out of the question to expect to produce complete sterility by exposure to the ultra-violet rays, without some preliminary treatment. Further experiments with the same organisms showed the limit of efficiency to lie somewhere about 2,000 per cubic centimetre.

Thus with 1,500 B. coli per cubic centimetre, sterility was produced in 10 c.c. and 200 c.o. in eight minutes, but not in six, the exposure being as before, fifteen seconds. The same result was given with the other organisms experimented on when present in less quantities. (It would appear fairly certain that the current must be allowed to run for some minutes before the best result can be obtained. At the same time the reduction in B. coli was marked even in four minutes, only 8 being found in 1 C.c. out of 1,500 originally present.)

Experiments with spore-bearers showed results varying, as might be expected, with the resisting powers of the spores. Thus B. mesenteric1ls with spores possessing a ten-minute resistance to current steam, was killed ,by fifteen second exposure after the current had been running for eight minutes and the voltage had reached 62. Spores with a resisting power of half an hour to current steam showed very varying results, whilst those with a resistance equivalent to ninety minutes exposure to current steam were not completely killed off even by thirty seconds exposure to the rays. It is to be noted that the more resistant germs were unaffected until the tension of the current rose to 70 volts.

As regards the cost of sterilization the authors estimate that with a current of 110 volts and 3! amperes, the price of current being 20 pfg. per kilowatt hour, the cost of sterilizing 600 litres (131'25 gallons) would be 7'7 pfg. This does not include interest on capital cost, or depreciation. They are unable, unfortunately, to give cost of other Hamburg installa­tions for comparison.

They point out that in the particular apparatus with which they carried out these experiments, very careful cleaning with brushes, and also by means of reversed flow was necessary after each observation. The enamelling of the inside of the apparatus seems to have given them some trouble, through scaling off, and thus leading to accumulation of particles from the water.

They also complain of great difficulty met with as regards the current, which showed great alterations in pressure, attributed by them to varia­tions in the internal resistance of the lamp. There appears to have been

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some trouble with the lamp going out. They point out that even if automatic inlet valves are fitted, a certain amount of water would still come from the outlet, unsterilized. They estimate this amount at 20 C.c., containing a reduced but still considerable number of organisms. They offer the following conclusions :-

(1) That with the Westinghouse apparatus Type B2, and dealing with a water containing only a moderate number of organisms, that is under 2,000, it is possible to deliver sterile water which is "bacteriolo­gically free from objection" (bakteriologisch einwandfrei) at the rate of 600 litres (132'15 gallons) per hour as long as the lamp works satisfactorily.

(2) The cost of installation and upkeep is such as to render the method not generally applicable.

(3) It is the task of experts to provide a satisfactory lamp. Special regard should be had to ease of cleansing.

(4) It is absolutely necessary that means should be provided by which any flow of unsterilized water, subsequent to any actual extinction of the lamp, should be absolutely prevented.

[One conclusion is clearly to be drawn from these series of observa­tions, and that is, that a great deal of technical improvement in matters of working detail is necessary before the ultra-violet rays can be con­sidered a really practical method for field service. Once these difficulties are overcome, it seems to me that there is a great future for this method of water purification. Even with a high bacterial content the purification effected is very important. A previous process of clarification will, of course, be necessary in grossly polluted waters; but we know that this can easily be effected with our latest cloth clarifiers. It is probable that even with clear streams as those of chalk districts, some straining would be necessary. As the authors remark in a footnote, the bacteria in water do not necessarily exist in the form of isolated individuals but more probably, especially in the case of the motile bacteria, in clumps. I should imagine that this would be apt to be more especially the case with the bacteria of intestinal disease, which must frequently be enclosed in small masses of mucus or freces or other organic matter. Such aggregations are probably removed by even comparatively coarse filtra­tion. When a comparative count is made of the bacteria present in the water before and after such filtration, these small masses count merely for one colony each in the raw water, and the actual purification effected, that is the percentage of the total bacterial content that is removed, is in reality considerably underestimated. The ultra-violet rays probably act with difficulty on any but the superficial members of these aggregations, whilst they attack efficaciously the isolated germs or smaller masses that escape filtration. It must be remembered that the expression "a bacteriologically unobjectionable water" possesses a different meaning for the sanitary officer to that which it possesses for the surgeon. The former only desires the removal of a few specified non-sporing germs, the latter complete sterility.] C. H. M.

Army Water Purification (Extract from the Army and Navy Register, October 28, 1911, Washington, D.C.).-The Army medical officers in the Philippines are engaged in some important investigations into new methods of purifying water for troops in the field: A report of some recent work in that dir~ction has been received by the Surgeon-

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General of the Army from Major W. P. Chamberlain and Captain E. B. Vedder, of the Army Medical Corps. . . .

The apparatus, with dynamo and gasoline engine, may be readily carried in the escort wagon or automobile, in which latter case the motor of the vehicle could be utilized to drive the dynamo. The smaller appa­ratus is capable of supplying an entire regiment with a quart of water for each man after three hours' operation. The larger apparatus is capable of providing in twelve hours, 3 gallons of sterilized water for every soldier in a division of 20,000 men. It is important before adopting any method of water purification for tropical countries to show that the pro­cedure will protect the consumers against infection with animal parasites as well as against bacterial causes of disease. The experiments con­ducted by the medical officers in the Philippines were considered as demonstrating that the method accomplished this result.

Extract from the Annual Report of the Surgeon-General of the Army for the Year ending June 30, 1911 (Army a1~d Navy Register, Washington, D.C., November 4, 1911).

"Health of the Army.-The mean strength of officers was 4,216, as obtained from the reports of the sick and wounded of the medical depart­ment, and 4,416 from the office of the Adjutant-General.

" There were 2,515 admissions, 15 deaths, and 119'54 constantly non­effective from all causes, equal to ratios of 596'54, 3'40, and 28·35.

" Enlisted 11len.-The mean enlisted strength of the army, American troops, white and coloured, for the year 1910, as reported on the monthly sick reports of the medical department, was 71,534.

"The constantly non-effective rate, which is the true measure of the loss in efficiency of the army from sickness and injury, was 35·93 per 1,000, as compared with 41'48 for 1909, 4268 for 1908, 46'17 for 1907, and 49'79 for 1906.

" The total number of admissions to sick report was 67,940, equal to an admission rate of 949'76, as compared with 1,062'99 for the previous year, and 1,188'03 for 1908.

"The deaths from all causes numbered 320, of which 175 were from disease.

" The discharges for disability numbered 1,007, the rate being 14'02, as compared with 16·84 for 1909, 18'48 for 1908, and 20'15 for 1907.

"Non-effective Rates jor Disease.-The progressive improvement since 1898 has been due chiefly to sanitary control of the infectious fevers­malarial, typhoid, and yellow fever. It would be even greater than at present if it had not been offset to a considerable extent by the formidable increase in the venereal diseases and tuberculosis.

" There were 25,133 recruits examined as compared with 23,520 for the preceding year. Of each 1,000 examined 94'62 were rejected and 16·19 declined enlistment, as compared with 142·69 and 24'62 for 1909. Of each 1,000 examined by medical officers, 889'19 were accepted, as compared with 832'69 for 1909. Of the number enlisted 492 54 per 1,000 were re-enlistments, and 396·65 were original enlistments, as compared with 363·65 and 469·04 for 1909.

"The average weight of white recruits was 144'5 lb.; of coloured recruits, 15044 lb.

" The chest measurement of 47'15 per cent of the white recruits Wft,9

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34 in. and over; and 2'87 per cent were 30 in. and under, as compared with 47'77 and 2·54 per cent respectively for the preceding year.

"Heart disease caused the largest proportion of rejection, being 116'48 per 1,000, as compared with 104'18 for 1909. Venereal diseases were second, with diseases of the eye, ear, organs of locomotion, in the order given.

" Vaccination against Typhoid.-During tbe calendar year of 1910, 16,093 persons were nrotected against typhoid fever by means of prophy­lactic vaccination. Of these 73 per cent received three doses, 21 per cent two doses, and 5'7 per cent one dose. During the first six months of 1911, 27,720 persons were j'nmunized; of these 93 per cent received three doses, 6 per cent two doses, and 1 per cEmt one dose.

"I~ is worthy of remark that compulsory vaccination against typhoid had never been attempted in any military service until used in our army in Texas, and along the Mexican border in the spring of 1911. In this region troops to the number of about 15,000 have been immunized while under canvas, and engaged in the multitudinous activities of manCBuvres without interference with their duties and without any bad results. The almost complete absence of typhoid fever (only two cases with no fatalities being reported in this large number of men after a period of four months in the field) justifies the position that has repeatedly been taken with reference to immunizations against typhoid.

" Alcoholism in the United States.-The admission-rate for alcoholism for the United States for the year 1910 was 23·51 per 1,000, which is an improvement over the preceding year, when it was 25 per 1,000. It is gratifying to observe that this rate has shown a steady diminution for the last four years, following an equally steady rise for the eight years prior to 1907. This rise was synchronous with the enormous increase in the venereal rate, beginning also in 1899, and it is difficult to escape the conclusion that there has been some connexion between the two.

"It is of interest to observe the alcoholic rates for the last thirty-one years, dividing this time into three periods of a decade each: (a) Prior to the establisbment of the canteen in 1890; (b) the period of eleven years covering the time when the sale of beer was permitted; and (c) the decade since the prohibition of such sales at the beginning of 1901. (In the consideration of this period of thirty-one years the tropical possessions of the United States have been excluded, because the conditions in them

, are special, and prevent a fair comparison with the statistics before the acquisition of foreign territory by this government). The average admission-rate for the decade preceding the canteen was 55 per 1,000 ; for the canteen period it was 26 per 1,000, and for the decade since the abolition of the canteen, 28 per 1,000. A study of the rates show a steady fall from 1882 and 1883, when it was 69 per 1,000, down to include 1898, when it reached its lowest point, 16 per 1,000. This was followed by a rise covering eight years, followed by a fall. It will be observed that the improvement in the alcoholic rate began before the establishment of the canteen, and was continued during most of the canteen period. It is believed that this corresponds to the general progress of temperance in the United States, and that it would have been sustained but for the undoubtedly injurious effect of the abolition of the canteen, which destroyed the attractiveness of the soldier's club, and compelled him to go outside of the limits of the military post for amusement. In this way

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he is tempted to drink distilled liquors to excess III place of mild fermented liquors in moderation.

"Hospital Corps.-In my opinion there is urgent need for the re­adjustment of the rank of the non-commissioned officers and for an increase in pay for both the non-commissioned officers and privates of the hospital corps. There is no question but that service in the hospital corps is not as attractive since the Pay Bill of 1908 as it was before. This Bill made service for the enlisted men in the line and other staff departments much more attra,ctive than it had been previously, while it did not increase the pay of the privates, first class, and privates of the hospital corps and gave only a small increase for non-commissioned officers as compared with other non-commissioned officers of the army.

" I therefore recommend that the number of men allowed the hospital corps be increased to 4,000; that action be taken to increase the pay of the members of the hospital corps; and that the organization be as follows: Serjeant-majors, 30, at 75 dollars per month; serjeants, first class, 250, at 65 dollars per month; serjeants, 400, at 36 dollars per month; corporals, 120, at 24 dollars per month; privates, first class, 2,400, at 21 dollars per month; and privates, 800, at 16 dollars per month."

TABLE SHOWING OOMPARA'l'IVE STATISTICS OF BRITISH AND AMERICAN ARMY AT HOME AND ABROAD.

Admissions Deaths ,.

Ratios per 1,000

I nvalids discharged Average con. sick Admissions for alcoholism

American. Home and abroad.

1.7.10 to 30.6.11

949'76 4'47

14'02 35'93 23'51

* 837'5 inclnding barrack treatment.

British. Home and abroad. 1.1.10 to 31.12.10

443'1 * 3'44 911

25'38 '7

C. E. P.

Motor Transport for the Medical Services in War. Med. Major Duguet (La France Militaire, March 19, 1911).-Duguet calculates that at the end of an engagement an infantry division would have roughly 4,000 men wounded. Of these 800 could march, 1,000 would not be fit for transport, 1,400 would require sitting-up carriage and 800 would require to be carried lying-down. In order to remove the 1,400 sitting-np cases 116 horsed wagons moving at 3 kilometres an hour would be required and the journey would take seven hours to reach a stationary hospital 12t miles distant. The 1,400 wounded conld be removed to the same destination in eight hours by employing twenty-four motor wagons. Motor transport is five times as efficient as horse transport; thirty-eight motor wagons permit or a saving of 200 drivers and 400 horses. Medical units supplied with motor transport can be rapidly pushed up to the front when required.

A motor ambulance cCllumn should not consist of more than fifteen wagons and must observe strict march discipline. The officer in comma.nd should have a motor bicycle or motor car. C. E. P.

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Improvements in the Arrangements for the Care of Mental Patients in War. Stabsarzt Dr. Stier (Dwt. MilitiIriirzt. Zeitschr., June 5, 1911).-As a result of the experience gained in the Busso­Japanese war the German army medical authorities have made the following arrangements for dealing with insane patients in war time :-

Drugs.-The advanced depots of medical stores will keep supplies of the following drugs for use in maniacal cases: Prepared injections of hyoscine; each injection will contain hyoscine, scopolamine, hydrobromic acid, and chloride of morphia, and will he put up in a separate sealed tube; large quantities of veronal and trional will be kept ready for issue to convoys of insane patients before commencing the journey by train. The advanced depots will also hold a supply of articles required to equip hospitals for the insane. In order to provide the necessary personnel a certain proportion of that allotted to clearing hospitals will be specially trained in the care of mental cases, while additional personnel will, if necessary, be obtained from civil asylums. The question of adapting railway carriages for the transport of insanes has not been taken up as yet. A special return showing the accommodation available for insanes in the general hospitals in the home territory will be rendered regularly to the Senior Railway Staff Officer who will pass this information to the sick transport detachments. The Senior Medical Officer will also receive similar information from the medical department of the War Office.

The voluntary aid societies might with great advantage to the army medical department provide personnel specially trained in the care of insanes for escort duties on the homeward journey. O. E. P.

Wind Instruments and Longevity. (Extract from Lancet, April 29, 1911).-Without any definite grounds pathologists have ascribed to the blowing of wind instruments injurious effects on the heart and lungs. In the Yale Medical Journal for February, Dr. James F. Bogers states that he investigated the subject a few years ago and found that this teaching is not correct, and that there is no evidence that emphysema of the lungs is .produced, or that there is any increased proclivity to tuberculosis or . other pulmonary affections among performers on wind instruments. He also could find no evidence of any bad effect on the heart. Since the publication of these facts Dr. Forcheimer, in his" Prophylaxis and 'l'reat­ment of Internal Diseases," has stated that" just as many players of stringed instruments have emphysema as players of wind instruments," and after a long experience of musicians he has come to the conclusion that "neither emphysema nor its predisposition is a result of their occupation." To determine statistically the effects on longevity of playing upon wind instruments Dr. Bogers consulted Grove's "Dic­tionary of Music and Musicians," and Ohamplin's " Uyclopffidia of Music and Musicians," and calculated the average age of 100 performers upon wind inst~uments and of a like number upon stringed instruments. The average length of life of players upon wind instruments was 63·5 years and of players upon stringed instruments 62 years. Of the former, 34 per cent reached ages above 70 years. For the different wind instruments the average ages were as follows: Flute, 61'2 years; oboe, 63 years; bassoon, 63 years; horn, 64'4 years; clarionet, 65·2 years; trumpet and cornet, 69'1 years. It is interesting that the players on wind instruments who exert the greatest intrapneumonic pressure, namely, performers on

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the trumpet and cornet, were the longest lived, while the players who exert the least pressure, the flautists, were the shortest. Dr. Eogers does not attribute the greater longevity of the former to the higher pressure, but to the facts that the more vigorous would be apt to take an instrument requiring much effort, and that only such as could make a mark as virtuosi would secure a paragraph in an encyclopffidia. A COD sumptive, like Sidney Lanier, might be a brilliant flautist, but no consumptive could make a fine clarionetist or trumpeter. These figures therefore refute the current teacbing that playing upon wind instruments tends to sborten longevity. It appears to have been assumed that tbe high intrapneumonic pressure during the blowing, which may exceed 100 mg. of mercury, would tend to cause emphysema. But the fact is overlooked tbat this pressure is counterbalanced by the pressure of the chest walls on the lungs.

Voluntary Aid Detachments of the German Red Cross Societies (Das Deutsche Rote Kreuz, Entstehung, &c., vo!. i, p. 275, Berlin, 1910). On August 31, 1909, tbe total number of Voluntary Aid Detachments and their personnel in the German Empire was as follows :-

NUMBJiJR OF 1'RAINED PERSONNEL AVAILABLE FOR DUTY ON MOBILIZATION

Total Number number For sick trans-

of at port duties For nursing duties

Deta('h- mem-

ments bel'S of all For kinds For Home For For Home

L. of C. 1'erri- L.ofC. Territory tory

--------------------- ----~ ------ --------I. Voluntary Aid Detachments of 1,676 52,382 13,080 13,893 1,313 750

the Red Cross Society H. VOluntary Aid Detachments of 66 8,596 .. .. 1,456 847

the Society for providing male nurses for war

HI. Samaritan Branch of the Red 11 1,369 .. .. 112 251 men Cross Society 250 women

194 asstnt. nurses

IV. Profession al male nurses and .. 1,557 .. .. 511 824 pensioners of the Medical Corps, not helonging to any Detachment

.. \1,753- --.~- -----------Grand total .. 63,904 13,080 13,893 3,392 3,116

O. E. P.

Napoleon's Maladies.-Dr. Bonnette (Btdletin du Service de Sante lYIilitaire, October 1911) gives a sketch of tbe principal diseases from which Napoleon suffered at different periods of bis career.

At the siege of Toulon, Napoleon contracted itch from a gunner; he never quite recovered from the effects of this, as it left a recurring eczema. During the earlier period of bis consulate he was greatly troubled by his gouty diathesis. About this time he began to suffer from a persistent cough and difficulty in breathing. He became

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. emaciated, pale and depressed, so much so that a fatal termination seemed probable. For a long time he refused to have any medical advice, but finally he consented to see Desgenettes who apparently employed his best bedside manner, as Napoleon, after the interview, summed him up as a babbler and his art as an imposture. The advice given was not followed.

Napoleon's condition became steadily worse, and he was finally persuaded to allow Oorvisart to examine him. Oorvisart's diagnosis was" an itch driven inwards, loss of flesh and pulmonary disorders." Oorvisart, more shrewd than Desgenettes, told Napoleon that his trouble was not seriGus, "merely a humour which had been driven inwards and which must be fetched out again." He accordingly applied blisters to Napoleon's chest; the treatment was followed by a rapid improvement, and Napoleon showed his gratitude by bestowing substantial benefits on the fortunate physician.

When a post-mortem examination was made at Longwood, the upper lobe of the left lung was found to contain numerous tuberculous nodules and a few old cavities; the lung was also adherent to the chest wall and pericardium.

During his numerous campaigns Napoleon enjoyed excellent health. Whenever he felt out of sorts he took a very hot bath to induce free perspiration.

When about 40 Napoleon became stout and his mind somewhat lethargic; he failed to grasp situations or make his resolutions as rapidly as formerly, and even fell asleep when studying maps. At this time he became increasingly subject to attacks of acute dysuria. After death the bladder was found to be contracted and to contain a quantity of gravel and some fine calculi.

Napoleon was a very rapid eater, rarely allowing more than fifteen minutes for any meal. In later life he suffered from severe digestive troubles.

In 1819, at St. Helena, Napoleon suffered from a painful congestion of the liver, for which a naval surgeon recommended a change of climate.

At the autopsy Antommarchi found a scirrhous cancer near the pylorus which was adherent to the left lobe of the liver.

O. E. P .

• C:orresponbence.

THE TRANSPORT OF WOUNDED. TO THE EDITOR OF "THE JOURNAL OF THE ROYAL ARMY MEDICAL CORPS."

SIR,-In the new (1911) "Royal Army Medical Oorps Training," just issued, bearers are still taught, as in the old editions, that when they find a patient with a tranverse or punctured wound of the abdomen they are to " lay him on his back with his legs drawn up. . . . a pad or other· article being placed under his hams to keep his knees bent" (p. 147-in 1911 and p. 48 in 1908 editions).

Surely one of the most important lessons which we learnt in the South, African War was that a patient suffering from any wound of the abdomen

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