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have been an embittered medical man, such as Tobias

Smollett, some of whose most mordant satire was written inthe sixties" of the eighteenth century.

I

EPIDEMIC CEREBRO-SPINAL MENINGITIS.

IT is of interest at the present time to refer to the

epidemic of cerebro-spinal fever which occurred in Dublinin the years 1866-67, an account of which was published intwo papers in the columns of THE LANCET of July 6th and13th, 1867, together with a leading article discussing thenature and the character of the disease. The first of these

papers dealt with the cases arising among the troops andwas written by Staff-Surgeon (now Surgeon-General) J. A.Marston, who recorded there some 27 cases among soldiersor their relatives and out of this number 22 died. The

cases occurred chiefly in the various barracks at Dublinbut a few were recorded from the Curragh and from otherparts of Ireland, while a flying column engaged in sup-

pressing a Fenian rebellion also afforded one or two cases.Some confusion arose owing to the coexistence of cases

of typhus fever at that time lending colour to the viewheld by the late Dr. Murchison that cerebro-spinal feverwas but a variety of typhus fever. The cases appear to have

been of severe character and were very frequently associatedwith purpuric eruptions, whence the name malignaatpurple or purpuric fever" applied to it. Staff-SurgeonMarston divided the cases into two groups-the first com-prising those associated with profound toxsemia, or, as

he described them, "presenting symptoms expressive of aprofound blood poisoning," and proving speedily fatal. The

second group consisted of cases showing symptoms typicalof meningitis, "the convulsion, the retraction of the head,the spastic contraction of muscles, &c." Some of thesecases recovered and Staff-Surgeon Marston commentedon the protracted character of the convalescence. The

second paper was by Dr. E. D. Mapother, then medicalofficer of health of Dublin, and dealt more generallywith the subject. He also recognised two types ofthe disease corresponding in all details with those of

Staff-Surgeon Marston. The disease was not notifiableand there was no registration of diseases, so that onlythe fatal cases could be investigated from a statistical

point of view. Up to July, 1867, 63 fatal cases occurredin the Dublin district (including Kingstown, Donny-brook, and Rathmines) among a population of 314,409persons. Of these fatal cases 41 were investigated byDr. Mapother as medical officer of health ; the averageduration of these cases was 42 hours, 14 of them havingterminated within 24 hours. The sex incidence of thesefatal cases was found to be nearly equal, 20 being malesand 21 females. With regard to age, the greater numberof the cases occurred among young people. "As to rank in

life," to quote Dr. Mapother, there were "a young noble-man, three medical students, two undergraduates, severalpersons in well-aired and well-drained houses, and somefrom wretched tenements where typhus always abides."

In only two instances was a possibility of contagiousnesssuggested and in both of these the sanitary conditions wereof the worst. Dr. Mapother considered that excitement andfatigue were to be regarded as predisposing causes. Duringthe period of this epidemic a somewhat similar disease

called "purples" was said to have been rife amongst pigsand this is stated to have been the case in the epidemicof cerebro-spinal fever of 1846 in Dublin and Belfast.Dr. Mapother on the whole inclined to the view of Dr.Murchison that the disease was a variety of typhus fever Iand quoted a suggestion of Dr. Farr that the caseswith purpuric eruption might be "only typhus seizingthe scorbutic. " In the leading article on the subject inTHE LANCET of July 6th, 1867, the nature of the disease

is critically considered and in it is recorded the discussionon the above papers at the Epidemiological Society, beforewhich, under the presidency of Dr. (afterwards Sir William)Jenner, they were read. Dr. Jenner, with characteristic

acumen, pointed out " the very startling difference" betweenepidemic cerebro-spinal fever and typhus fever--namely," that while true typhus rarely affected children andwas still more rarely fatal to them, the Dublin disease

frequently affected children and was most fatal to

them." Dr. A. P. Stewart also pointed out that, " unlike

typhus, the Dublin disease prevailed equally amongthe well-to-do and the ill-to-do and that no typhuseruption had been observed." The view that a scorbutictaint plays any ]61e in determining the clinical or patho-logical features was also destructively dealt with in this

leading article and the conclusion arrived at was thatthe Dublin disease was the epidemic cerebro-spinalmeningitis of continental and American writers, a view

in which Dr. (now Sir John) Burdon Sanderson, whohad investigated the outbreak of the disease at Dantzig inthe two previous years, concurred. The study of the cases isnowadays rendered simpler by bacteriological investigationwhich seems to have substantiated the view that epidemiccerebro-spinal fever is a primary meningitis and a diseasesui yeneras due to the definite organism of Weichselbaum,although it must be admitted that a primary meningitis dueto the pneumococcus does exist and may possibly occur inepidemic form. In our issue of April 29th we published anabstract of an important paper by Dr. W. T. Councilman,who has done so much to clear up this question, on thebacteriology of meningitis in general and an interestingclinical lecture by Dr. J. A. Ormerod on two cases of

meningitis, illustrating some points in the pathology of thiscondition. We publish in another column a letter from Dr.J. Hope Reford describing three cases of meningitis occurringin one family in Ireland about a year ago, of which one wasfatal, the other two cases convalescing rapidly. All threecases developed a petechial rash in addition to the ordinarysymptoms of meningitis. Unfortunately the complete proofof their nature is lacking owing to the absence of a bacterio-logical examination. This is the more to be regretted sincethe close relation between them strongly suggests the

possibility of direct contagion, the occurrence of which is

so rare in cerebro-spinal fever. A point of interest aboutthis group of cases is the decreasing severity of the later

ones-a condition which is the rule in epidemics.

THE CENTENARY OF THE ROYAL MEDICAL ANDCHIRURGICAL SOCIETY.

ON Monday, May 22nd, which is the anniversary of thefounding of the society, the President, Sir Richard DouglasPowell, President of the Royal College of Physicians ofLondon, will hold a reception at 5 P.M. at the society’srooms, 20, Hanover-square, when the new Honorary Fellowswill be welcomed. The centenary festival banquet will beheld at the Hotel Cecil on Monday, May 22nd, at

8 P.M., when His Royal Highness the Prince of Wales,who has signified his intention of being present, willbe admitted an Honorary Fellow of the society. The

centenary conversazione will be held on Wednesday,May 24th, at 9.30 P.M., at the Natural History Museum,Cromwell-road, S.W. All communications with regard tothese meetings should be addressed to the Secretary,20, Hanover-square, W., who asks us to announce that thereception of the Fellows and guests for the dinner willbe at 7.30, and it is especially requested that they comenot later than 7.45, and those Fellows who desire to sit

together at the dinner should communicate with the

Secretary at once. A few seats in the gallery of the dining-room will be reserved for ladies who wish to hear the

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speeches after dinner and for these also applicationsshould be made to the Secretary. A meeting of

the society will be held on Tuesday evening, May 23rd,at 8.30, during the centenary festival of the society, whenDr. H. Head will deliver the Marshall Hall Prize Address.

With regard to the conversazione on the following eveningtickets of admission have been sent out and all applicationsfor further tickets should be made at once. A CentenaryVolume, containing a history of the society and a short

account of its presidents, has been written by Dr. NormanMoore and Mr. Stephen Paget, and each Fellow will receivea copy. It is also proposed to have an exhibition at thesociety’s house of books, portraits, instruments, and so on,of 100 years ago. -

THE ADMINISTRATION OF OPIUM ALKALOIDSBY DIRECT INHALATION.

ABOUT the year 1864 Dr. A. Helwig of Mainz in Germanydiscovered that when morphine, strychnine, brucine, and

several other vegetable alkaloids were cautiously heated a por-tion sublimed unchanged and could afterwards be submittedto the ordinary well-known chemical tests. His results at firstappeared as articles in journals but were ultimately collectedin a treatise, "Das Mikroskop in der Toxikologie," whichwas published at Mainz in 1865. In 1867 Dr. W. A. Guy ofLondon published a memoir " On Microscopic Sublimatesand especially on the Sublimates of the Alkaloids," and inthe edition 0: his "Forensic Medicine which appeared in1875 he described at length the improvements which hehad made in Helwig’s original process. Helwig placedthe alkaloid in a hemispherical depression made in platinumfoil, covered it with a glass microscope lide, warmed thefoil gently with an alcohol lamp, aud observed the sublimatewhich was formed. He says that the morphine sublimate wasa perfectly homogeneous layer of sharply defincd round

granules closely packed together (bestelit ails einer ganzhorrcogeneoc Schichte dicht (J/ftt!Ìnandt1’ gelagerter runder sehrscharf conturirter K6rficken) without any trace of crystallisa-tion. Instead of platinum foil Dr. Guy used a closed cell ofwhich a shallow glass ring formed the sides and two

microscope cover glasses the top and the bottom, the wholebeing warmed on a hot brass plate provided with a

thermometer. Mr. A. Winter Blyth, medical officer of healthand analyst of St. Marylebone, used for the same purposea somewhat different process which lie has fully describedin his treatise on " 1’oisons " published in 1884. RetainingDr. Guy’s glass cell, he allowed it to float on a bath of

mercury or fusible metal in which the bulb of a thermometerwas immersed. The bath with its contents was covered by aglass screen and heat was supplied by a lamp underneath.Mr. Blyth found that morphine at 1500 C. clouded the upperdisc of the cell with a nebula consisting of minute dots ;these dots gradually became coarser and were generallyconverted into crystals at 188° C. The liquefied morphine inthe bottom of the cell turned brown at or about 200° C.

Although the volatility of morphine and some other alkaloidshas therefore been known to chemists for many years itdoes not seem to have received much attention from thera-

peutists. Dr. Herbert Snow, writing very recently to

us on the subject, mentions that the late Dr. J. L. W.Thudichum was an advocate of the use of opiumby means of the Chinese opium pipe in certain condi-tions and employed this method of administration ex-

tensively in asthma, tuberculosis, and a large numberof other maladies in which spasm, pain, or pro-gressive emaciation was a leading feature. Dr. Snowwrote in a similar sense in 1890 and still recommendsthe same method for cancerous patients as a most

useful adjunct to other treatment in inoperable cases. Heis convinced that this means of bringing medicinal sub-

stances into direct contact with the pulmonary air cells may

be usefully resorted to for the administration of a variety ofalkaloids or extracts containing alkaloids other than thosefound in opium and he believes that its introduction into thetreatment of maladies of the chest would involve a beneficialnew departure in therapeutics. Employed under the limita-tions specified by Dr. Snow and Dr. Thudichum the sugges-tion may prove serviceable but in all circumstances practi-tioners who may follow it mu,t be on their guard against apossible encouragement of the morphine habit among eitherpatients or their friends.

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HOURS OF SLEEP FOR SCHOOLBOYS.

AT the conference of school hygiene which was held inLondon in February last under the auspices of the RoyalSanitary Institute a resolution was passed calling attentionto the need for giving ample hours of sleep to the youngerboys at the public schools ; this resolution has been approvedby the council of the institute which has expressed the

opinion that in some of the public schools the present hoursof bleep are insufficient. A discussion on the same subjectwill be opened at the next meeting of the Medical Officersof Schools Association, which will be held in the MedicalSociety’s Rooms, 11, Chandos-street, Cavendish-square, onMay llth at 4 P.M., when Dr. T. D. Acland will read

a paper on the Hours of Sleep which are desirable forthe younger boys at Public Schools. The matter is one

of considerable importance to the well-being of growingboys and it is hoped that there may be a full meetingboth of schoolmasters and of medical officers of schoolsso that the discussion may be the means of calling theattention of the public school authorities to a question ofhygiene on which those who have studied the subject arepractically unanimous but which in many schools has notsecured sufficient attention.

REGENERATION OF THE FIBRES OF THE SPINAL

CORD.

COKSIDEUABLE doubt has been expressed as to whether

regeneration of the fibres of the spinal cord can occur. In

discussing transverse myelitis Sir William Gowers refers tothe possibility of regeneration and mentions a case of exten-sive destruction of the cord with symptoms resembling thoseof transverse division. After many months a fair return ofmotion and sensation took place. After the lapse of five yearsdeath occurred from an intercurrent ailment. Sections ofthe cord at the seat of the myelitis, in the pyramidal tracts,and in other areas, showed some minute fibres where

normally only large ones are found. These appearedto be regenerated fibres. In the Mcntreal gledical Journalfor April Dr. D. A. Shirres has reported the followingcase as showing the possibility of regeneration. A man, aged48 years, was admitted into the Montreal General Hospitalunder the care of Dr. Armstrong, suffering from fracture-dislocation of the spinal column in the region of the ninthand tenth dorsal vertebras with flaccid paraplegia, completeloss of sensibility and of the superficial and deep reflexesin the lower limbs, and retention of urine and fasces. Dr.

Armstrong removed the laminas of the ninth and the tenthdorsal vertebrae. On opening the dura mater the cord wasfound completely severed with a gap of fully half an inchbetween the ends. On stimulating the anterior roots of thefirst and the second lumbar segments or on stimulating theposterior roots with a faradic current the muscles of the legcontracted. This observation was carried out because of the

controversy as to the symptoms of transverse division of thecord. Dr. H. Charlton Bastian and others hold that totaltransverse division produces flaccid paraplegia and perma-nent abolition of reflexes. Others believe that while flaccid

paralysis may occur at first sooner or later it becomes