1069REVIEWS AND NOTICES OF BOOKS.

Hepburn : Adductor Muscles of the Thumb and Great Tee10. Mr. Jackson Clarke : Observations on the Temporal Bone,chiefly in Childhood.

LIBRARY TABLE.

Ueber Diabetes Mellitus. (On -Diabetes Mellitus.) Von Dr.KALLAY. Carlsbad : 1892.-The author of this pamphleton Diabetes, who has had ample opportunities of observingthe disease at the watering-place so much resorted to bysufferers from the malady, has executed his task with

ndustry and thoughtfulness. Having sketched the historyof our knowledge of the disease and entered with suffi-

cient fulness into questions of physiology, pathology andchemical analysis, he comes to what may be regardedas most important from a practical point of view-its

diagnosis, symptomatology and treatment. Dr. Kallay verycogently points out that the mere discrimination of a

severe and mild variety of the disease is unsatisfactory, aswe unfortunately frequently observe a diminished excretionof sugar accompanied by a grave aggravation in other

mportant particulars. He inclines to the adoption ofa classification into a primary and secondary form. Inthe former the saccharine urine, being unaccompanied byorganic lesion, is to be regarded as a disease per se whilst inthe latter sugar in the urine, being merely symptomatic oforganic disease, has not the importance attaching to its pre-sence in the first instance. It is encouraging to learn fromone having the author’s opportunities for observation thatprimary diabetes appropriately dieted and under the use ofthe waters of Carlsbad is frequently greatly ameliorated,"nay, cured." Dr. Kallay discusses with a terse adequacythe symptomatology of the disease and closes his interestingpamphlet with practical observations on treatment, believing"that if we take all things into consideration, we mustacknowledge that in Carlsbad we possess a sovereign remedyfor diabetes mellitus which eclipses all others. " This sen-

tence indicates a tendency on the part of the author to

bestow excessive praise on his own sphere of practice-atendency natural no doubt, but none the less to be deprecatedby the impartial critic.

-Das Augenleuchten und die Erfindung des Augenspiegels.(The Illumination of th e Eye and the Invention of the Ophtlialnio-scope.) VON ARTRUR KÖNIG. Hamburg und Leipzig. Pp. 154.Verlag von Leopold Voss. 1893.-This little volume is edited

by Arthur Konig of Berlin and is the first of an intendedseries of republications of essays on the physiology of thesensory organs. It comprises six essays that will prove ofinterest to every ophthalmologist, since they record the succes-sive steps by which the present form of the ophthalmoscopewas evolved. The essays are by E. von Brucke, W. Cumming,H. von Helmholtz and C. G. Theodore Ruete, and each formsa landmark in the history of ophthalmology, those of Helm-holtz and Ruete being the most complete and valuable.Annzls of Surgery ; a Monthly Revaew of Surgical Science

and Practice. Cassell and Co., Limited. February, 1893.-Although this is an international journal with two distin-guished British editors, the material is chiefly from the otherside of the Atlantic. Mr. Treves contributes a short paper ona, method of treating Compound Fractures, the main elementsof which are free exposure to the air and covering the woundwith a dry antiseptic powder without stint. Intestinal

Surgery is represented by a paper on Potato Plates for Intes-tinal Suture ; a careful anatomical report on the VermiformAppendix, and the report of a Discussion at the New YorkSargical Society on Typhlitis. Some other papers and reportsmake up a very interesting number. A little more care in theproof-reading might well be exercised. We find ‘° fsecus " for" focces, "ilium" for ileum," "three years, instead of"three days"; "300 miles" instead of (presumably) "300yards." :

The Chemist’s Legal Handbook. By A BARRISTER. Publishedat the Offices of the British and Colonial Druggist, Bishops-

gate-without, London, E C. 1892.-Chemists and druggistswill not be slow to appreciate the labours which have led to-

the compilation of this small volume, inasmuch as its publi-cation places in their hands a useful work of reference inwhich the various statutory enactments affecting them maybe consulted at a glance. More than this, it contains infor--mation bearing on the aspects in which the Acts, or sectionsof the Acts, have been treated in cases that have been

actually tried. By adopting this course the judicial con-

struction of the meaning of several of the clauses in the Actis made evident to the reader. Thus are treated the Sale ofFood and Drugs Act, the Sale of Explosives Act, the regulationof the sale of poisons, the laws relating to the Medicine Stamp.Duty, the legal qualifications of pharmacists, the Spirits Acts,the enactments in reference to the use of stills, and so on.

THE April number of the Veterinarian is interesting, if onlyfrom the fact that it contains such a full report of the proceed-ings of the various veterinary societies. In addition to these

reports, however, there is recorded a Successful Case of

Tracheotomy in the Horse. There also appears a note on

"Broncho v. Pleuro-the Corn-stalk Disease—Verdict, "fromwhich it may be gathered that the opinion of the com-

petent pathologists who have examined the specimens uncerdispute was that the animals were affected with pleuro-pneumonia. Mr. W. Littlewood, M.R.C.V S., gives a shortnote on two cases of Guinea-worm, which he met with when inJapan. The paper and demonstration on the Anatomy of theFacial Sinuses of the Horse, given by Professor Macqueenbefore the Central Veterinary Medical Society, is full of

interest, even to those outside the veterinary profession. Fromthe point of view of the comparative pathologist some mostinteresting facts, upon which even many veterinary surgeonsappear to have somewhat hazy ideas, are brought out.

The Scottish Metropolitan Veteiinary Medical Society appearsto have had its meeting taken up with the Broncho-pneu-monia ?,!. Pleuro-pneumonia Question, many of those presentnot being willing to agree with the report presented by the-referees. At a meeting of the North of England VeterinaryMedical Association it was " unanimously agreed that fiveguineas be given to the funds of the British Institute of Pre-ventive Medicine, this to be supplemented by further sub-scriptions from the members. "

PROPOSED NEW FEVER HOSPITAL.-On Mondaylast a meeting was held at Herne-hill for the purpose ofprotesting against the erection of a fever hospital on

a site which had been proposed at Redpost-hill, Herne-hill. The Local Government Board have refused theirsanction to the Tooting site. After a good deal of dis-cussion it was decided to ask for the use of the CamberwellVestry Hall in order that a public meeting might be convenedto discuss the question.THE METROPOLITAN HOSPITAL.-The annual

dinner in aid of the funds of this hospital was held on thelst inst. at the Whitehall Rooms of the Hotel Metropole,when the Duke of Portland occupied the chair and wassupported by many distinguished friends of the institution.The discouraging announcement was made that, owing tothe lack of funds, the number of beds had had to be reducedfrom seventy-eight to fifty-four. In 1892, 875 in-patients and71,000 out-patients had received relief at the hands of themedical officers of the institution. Sir James Paget proposed"The Lord Mayor and the Corporation of London." Inhis remarks Sir James Paget said that from his certain

knowledge a hospital was often a better place for a

patient than a private house. The President, in pro-posing the toast of the evening, spoke of the advancewhich had been made in the construction and the

general arrangements of hospitals. He also adverted tothe increase of special hospitals and thought it was needfulthat care should be taken that the general hospitals shouldnot be allowed to suffer on that account. The deficit in thefunds of the Metropolitan Hospital amounted to £5000. In nthe course of the evening donations to the amount of ;f2313were announced.

1070 THE REPORT OF THE LEPROSY COMMISSION.

THE LANCET.

LONDON: SATURDAY, MAY 6, 1893.

IN our remarks on the report of the Leprosy Commissionin last week’s issue we considered four of the six conclusions

in which the Commissioners summarise the results of their

observations and reflections. We now propose to consider the

remaining two, marked Nos. 3 and 6 in the report.In the one the Commissioners state that although in a

scientific classification of diseases leprosy must be regarded ascontagious and inoculable, the extent to which it is propa-

gated by these means is exceedingly small"; in the other theysupplement this statement by alleging that in the greatmajority of cases leprosy originates de novo. In order to

understand clearly what the Commissioners imply in thesestatements it is necessary to understand exactly what theymean by the use of certain terms. Following FLUGGE, theyconsider that the mode of transmission of an infective disease,which they hold leprosy to be, depends on the faculty patho-genic germs possess of leaving the body of the diseased in thefull possession of their power of setting up an infection. If

thrown off in sufficient quantity and in a state to transmit thedisease to a healthy person, the disease is "diffused by con-

tagion "; but if the germs which are reproduced in the bodyof a diseased person never leave the latter, or leave it withoutthe power of causing subsequent infection, the infective

disease caused by such germs is not contagious. "The germsin such cases must have a place somewhere whence they can

always de novo attack the healthy organism." To this

definition of FLUGGE they append a footnote, obviouslywith reference to leprosy, in which they state that when

germs or spores, which when thrown off may effect

contagion, are already become widely distributed through-out space the risk of contagion may be disregarded as

compared with the de novo acquisition of the disease.

When leprosy is endemic in an area they believe that threefactors coincide-namely, the contagium zivum "in space"(the bacillus), a certain disposition of the individual, whichmakes him susceptible to the contagium, and those badlydefined factors which they consider produce the predisposi-tion. They assume that when leprosy is highly prevalentthe bacillus is widely distributed throughout space in theseendemic areas, and that such facility is offered for the

.acquisition of the disease de novo that contagion may be prac-tically neglected, since all measures practised against it couldnot avail in stamping out the disease.On general grounds and by analogy it is reasonable to

suppose that a comparative predisposition to leprosy existsin certain persons ; but although considerable space is

devoted to the subject in the report, we have not beenable to gather that it is distinguished by any features orcharacters that might lead to its recognition. In attributingthe importance which they do to this special predispositionand to the factors which produce it, the Commissioners makea large assumption which practically begs the whole questionwhich is being considered. It is notorious that strong healthy

persons, with no apparent predisposition to any disease, from

countries in which no leprosy exists, may, after a short resi-dence in a district where lepers reside, carry away with themthe seeds of the disease. The Commissioners confess that

this assumed special predisposition is not hereditary, but inorder to meet the question of leper families without havingrecourse to the theory of contagion, they assume that thefactors in an endemic area cause the predisposition simul-

taneously or successively in the members of a household.

This really amounts to believing that whilst in one hut orhouse factors exist which predispose its inhabitants to offer afertile soil for the bacillus, these factors do not exist in

dwellings situated a few yards distant. To accept such abelief seems to us to substitute the products of the imagi-native faculty for reasonable inductions from observed facts.The part of the report which has the greatest interest both

for administrators and medical men is that which deals with

the question of contagion, and on the answer that is given tothat question will of course depend the views which legis-lators must take regarding isolation or segregation. In con-

nexion with this question the Commissioners have shownextraordinary diligence and care in accumulating facts, andit is not their fault if the results of their industry havebeen such that the problem remains very much where it wasbefore they entered on their researches. Although theyreport practically against the contagiousness of the disease,the statement is qualified in a manner which, to a consider-able extent, deprives it of the force which they probablymeant it to possess. The extent to which leprosy is pro-

pagated by contagion and inoculation is, they remark,"exceedingly small, " an admission of the greatest import-ance, because it concedes that leprosy may, in certain

instances, be communicated by contagion and inoculation.As against this mode of communication we have nothing but

vague generalities about climate and surroundings, and ascases of leprosy have yet to be found in which contagion wasnot possible, it follows that the only mode in which leprosyis known to be spread is by contagion and inoculation. On

the one hand we have, according to the report, an "exceed-

ingly small " number of cases so produced ; and on the otherhand a large majority of cases produced in so-called endemicareas, we know not how. The presumption that most simple-minded people would make in such a case is that the cases ofunknown origin were in every probability due to contagion.

In conclusion No. 6 the Commissioners have attempted tomeet this objection by stating that leprosy in the greatmajority of cases originates de novo-that is "from a sequenceor concurrence of causes or conditions dealt with in the report,which are related to each other in ways at present im-

perfectly known." Persons who read this sentence and who

have not read the report would assume that these causes andconditions have been definitely stated. Those who read it

will, we believe, like ourselves, find that there is no proofthat leprosy arises from any such sequence or concurrenceand have some difficulty in understanding in what thesecauses and conditions consist. The evidence in the report,such as it is, has not produced unanimity of opinion eitherin the Special Committee or the Executive Committee. Of

the medical members of these committees Dr. HERON and Mr.

MACNAMARA find that the evidence does not justify the Com-missioners in reporting against contagion ; whilst Sir ANDREW