455THE COPENHAGEN CONGRESS.-PINEAPPLE JUICE.

while shaving would drop a razor to the groundfrom a helpless hand. Since that period dengue hasoccurred at intervals of years in epidemic waves,mainly in the early autumn months. In Europe ithas appeared in Southern Spain, Gibraltar, Malta,Turkey, and, notably in 1881, in the aegean Islands.In Asia Minor serious epidemics have occurred in

Smyrna, Cyprus, Beirut, Jaffa, and Jerusalem.While normally a coastal disease, in its pandemicform dengue spreads a considerable distance beyondits usual confines and may even, in Syria, ascendmountains to a height of 5000 feet. That the diseaseis spread solely by the agency of mosquitoes has beenrecognised since the original observations of H. GRAHAMin Beirut in 1903. At that time he suspected thatthe carrier was the common brown mosquito Culexjatigans, though since then the carefully conductedexperiments of CLELAND, BRADLEY, and McDoNALD,in Australia, have incriminated the common " tigermosquito," Aedes argenteus (formerly known as

Stegomzgia fasciata) as the sole vector. The exactnature of the dengue virus is unknown, but theresearches of CLELAND and his fellow workershave shown conclusively that the virus is attachedor agglutinated to the red blood corpuscles and canpass through the pores of a Pasteur-Chamberlandfilter. J. F. SiLER has demonstrated that the bloodin dengue is infective to the mosquito for 18 hoursbefore the onset to the end of the third day of theillness. The mosquito, after imbibing dengue blood,does not become infective for 11 to 14 days, butthereafter remains so for the rest of its life.For the development of an epidemic the vector

must be present in large numbers, and this

implies defective sanitation and abundant oppor-tunities, in the supply of stored water in close

proximity to the houses, for the mosquito to breed ;in short, the conditions which favour the spread ofdengue are similar to those conducive to yellowfever. At the present moment conditions in Athens must z,

be unusually favourable to the propagation of Aedes{L’tgenteHs. As regards potential disability during anattack dengue is serious enough, but as a rule it leaves110 permanent serious sequelae in its wake, and themortality-rate is very low. Perhaps it is for thisreason that no specific pathological lesions, gross ormicroscopic, have been discovered. Unfortunatelythe present epidemic at Athens appears to be excep-tional in having a high mortality-rate, the attacks

being often fatal. Probably, however, the infection iskilling only those who are the subjects of grave heartor kidney disorders, where it acts as the immediatecause of death. If dengue is the sole cause itmust be of an unprecedented virulence. Another

possibility is that the epidemic may be due to someother infection. If it is dengue there is no prospectof abatement until the advent of the cool weather,which cannot be expected for another two months.

PosT-vACCiNAL ENCEPHALITIS.—The Small-poxand Vaccination Committee of the Health Committee ofthe League of Nations met at Geneva, on August 22nd-under the presidency of Dr. R. Jorge, of Portugal, to considerthis among other questions. A report has been drawnup in which the rarity of these cases is emphasised, incomparison with the total number of vaccinations in anycountry. The committee points out that children between3 and 13 years of age are particularly susceptible, whereasinfants and adults are hardly ever affected ; this age incidencesuggests the inadvisability of postponing primary vaccina-tion, which is the most powerful weapon available againstsmall-pox, until after infancy. The appearance of enceph-alit,is is not held to be associated with any particular strainsof lymph or with accidents in preparation. The committeeconclude, on the evidence available, that post-vaccinalencephalitis is distinct from encephalitis lethargica.

Annotations.

THE COPENHAGEN CONGRESS.

" Ne quid nimis."

THE First International Congress of Oto-Rhino-Laryngology, which was held at Copenhagen at theopening of last month under the presidency of Prof.E. Schmiegelow, was fully attended. The meetingswere held in the Christiansborg, the Danish Housesof Parliament, and the opening ceremony was

honoured by the presence of the King of Denmark.The amount of material was so great that the Danesgenerously forwent the reading of their papers.There were four main subjects for discussion :(1) Septicaemia as a result of pharyngeal infection,opened by Prof. W. Uffenorde (Marburg) and G.Ferreri (Rome), the opening with excellent lanternslides showing invasion of vessels in the neck byorganisms. (2) The conservative radical operation,by Prof. H. B. Neumann (Vienna), well illustrated byslides of microscopical sections to show bony changesgoing on in apparently healed radical operations.Mr. H. Barnett (Bath) followed, condemning theradical operation. Considerable discussion took place,but nothing really new emerged. (3) The influenceof anatomical structure of the middle ear on thecourse of suppuration therein by Profs. F. J. Moureand G. Portmann (Bordeaux) and by Prof. K.Wittmaack (Hamburg). This is a subject on whichotologists in this country have long held definiteopinions, led by Mr. A. H. Cheatle. (4) Surgicaldiathermy for cancer of the pharynx, larynx, andoesophagus, opened by Dr. Dan McKenzie, followedby Mr. Norman Patterson (London) ; a strong casewas made out for removal of growths by the diathermyknife instead of the cold knife. In the subsequentdiscussion papers were given by French and Spanishauthors. The shorter papers read at the Congressdealt with practically every branch of the specialty.To mention one or two that were outstanding :Dr. A. Pohlman (St. Louis, U.S.A.) spoke on " mini-mal audition " ; experiments on this subject had beenmade with an audiometer and many interestingobservations emerged, notably that lengthened boneconduction is apparently not real. This property was,however, vigorously sponsored by clinical observersof the German school. It seems that the audiometerhas not been given enough attention in this country.Dr. Wells Eagleton’s (Newark, U.S.A.) study of sixthnerve involvement in connexion with the earlydiagnosis of meningitis called forth some interestingdiscussion. Dr. E. Iluizinga and Dr. C. E. Benjamins(Groningen) brought forward some interesting workon ablation of parts of the internal ear in pigeons ;they found that destruction of the lower part,including the saccule, produces no demonstrableeffect on the movements of the birds ; while ablationof the superior part containing the utricle and threeampullse has the same result as complete destructionof the labyrinth. Mr. V. E. Negus (London) putforward in his nanpT’ thf ingenious suggestion that

the function of the cricopharyngeus sphincter wasto prevent air passing into the oesophagus duringinspiration. In addition to the scientific work therewas much entertainment offered by the President,the Committee, and the civic authorities, and Dr.N. Rh. Blegvad deserves a special word of mentionfor his all-embracing labour as general secretary.

PINEAPPLE JUICE.I CHILDREN have always preferred the raw pine-apple, when obtainable and however crude, to theuniform and refined product in sealed tins ; and theirchoice is wise, for, as the Journal of the AmericanAssociation has reminded us again, fresh pineapplejuice contains an active proteolytic enzyme known as