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these statistics and also the effects of debilitating con-

ditions of all kinds, mental and physical, as predisposingcauses : a sudden onset is apparently not very uncommon.The same writers deal with the skiagraphic appeal ancesof affected joints, Mr. Strangeways further comparing thex ray photographs of dead specimens with the actual con-ditions found on dissection of the joints, while the morbidhistology of the malady is described by Dr. G. W. Nicholson.These investigations strongly support the view that at leasttwo distinct conditions are included under the name ofrheumatoid arthritis, one characterised by erosion of

cartilages and rarefaction of the bones forming the joint, andthe other by condensation of these bones and a tendency toankylosis, as well as to formation of bony outgrowths roundthe joints. It is noteworthy that one case which clinicallywas typical of rheumatoid change proved to be in reality anexample of chronic gout, and that the skiagraphic appear-ances of the second class described above were also indis-

tinguishable from those met with in gouty persons. Dr.

A. W. Wakefield has found good results to ensue, so far asrelief from pain and stiffness are concerned, from the applica-tion of Bier’s method of passive congestion. Unfortunatelyin many cases the efficacy of the procedure seems to diminishwith repetition. Further communications on the same

disease are promised and we await their appearance withinterest. Meanwhile the issue before us (August, 1907,Vol. I., Nos. 3-9) may be commended to the attention of allwho are interested in the pathology of a most troublesomeand obscure condition.

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WOMEN AND CHILDREN IN PUBLIC-HOUSES.

MANY of our readers have probably seen a Home Officereturn relating to the frequenting by women and children ofpublic-houses. The return or report in question is in theform of replies to inquiries addressed by the Secretary ofState to the Commissioner of Police of London and to thechief constables of Birmingham, Bristol, Leeds, Liverpool,Manchester, and Sheffield as to the practice in their dis-tricts of women and children frequenting public-houses. IThe answers make melancholy reading but they are hardly a revelation to our readers. In THE LANCET of some two

years ago the question so far as women in London wereconcerned was dealt with at some length and it was thenshown that in almost all parts of the metropolis womenwere frequenters of, and good clients at, the drinking bars.From the return just published we may see that women andchildren in all the large towns that contributed to the

contents of the report resort to public-houses in greatnumbers, the women taking with them very young childrenor infants in arms. It is also not uncommon for the public-houses to shelter other youthful visitors, under the age of

16 years always, and the majority being not older thanseven or eight, who do not seem to be there so entirelywithout motive as those taken by their parents. The figuresgiven by the various chief constables have not been obtainedwith the object of forming any statistical summary, at anyrate they do not lend themselves to such a summary,for the observations were not made upon any .definiteor uniform principle. However, the fact is made clearlyevident that many more women and children may be found inpublic-houses in certain districts of our large cities than theordinary citizen is aware of. The Commissioner of Police ofthe metropolis alludes to the practice of parents inducingchildren to sip strong drink and also states that during theyear ending April 30th last 1058 persons were apprehendedin London for being drunk whilst in charge of children

apparently under seven years of age. Of these, 220 weremen and 838 were women. It would be superfluous to dilateupon so glaring an evil, whilst it is easy to say that repressive

1 THE LANCET, Dec. 9th, 1905, p. 1731.

measures of the strictest character should be brought intoforce as quickly as possible. But we do not envy the

legislature which undertakes the framing of the Act.

INFECTIVE CHOLANGITIS.

INFECTIVE cholangitis has received attention fromclinicians only in recent years. In the Western CanadaMedical Journal for October Dr. Sidney H. C. Martinhas reported a case remarkable from its rapid course.

A man, aged 52 years, was admitted into hospitalsuffering from abdominal pain, jaundice, and irregularpyrexia. The history was that three weeks previously hebegan to suffer from discomfort after food and noticedthat he was becoming slightly yellow. The jaundiceand pain increased, and the latter had no relation to thetaking of food. There was no vomiting. The patienthad always been temperate and had been a total abstainerfor 27 years. On admission he was deeply jaundicedand the edge of the liver was felt two inches belowthe ribs. Pain and tenderness were limited to the

hepatic region. The motions were clay-like but con-

tained some green biliary colouring matter and pelletsof mucus like boiled sago. There was a large amountof bilirubin in the urine but no albumin. The pyrexiawas of an irregular type ; usually there was an eveningrise to 101°-103° F. Sometimes there was a double

rise-in the morning and afternoon-with a fall between.This irregular pyrexia lasted for 14 days. Then the patientwas seized with abdominal pain, accompanied by a fall of

temperature, signs of collapse, and a pulse of 120. Vomitingoccurred twice and severe pain lasted for 12 hours. Over theabdomen there were diffuse tenderness and increasedresistance. In the flanks was slight dulness. Peritonitiswas diagnosed and on consultation with Mr. R. J. Godleeit was decided to open the abdomen with a view to drain

the gall-bladder. Deeply bile-stained fluid and free

lymph were found in the peritoneal cavity. There wasalso lymph on the coils of intestine. The gall-bladderwas opened and contained no gall-stones but green bile.Death occurred a few hours after the operation. At the

necropsy the liver was found to be enlarged, deeply con-gested, and adherent to the diaphragm on its upper surface.It showed several small cavities containing a deeply bile-stained thick fluid. On microscopic examination thesewere found to be mainly dilated bile-ducts. Two stagescould be distinguished. In the first stage the wall of thebile-duct was greatly thickened and infiltrated with poly-morphonuclear leucocytes which had caused separationof the epithelium. In the second stage the epitheliumhad disappeared and a cavity was left, the walls ofwhich were composed of polymorphonuclear leucocytesand large fatty degenerated cells. The appearanceswere therefore those of infective cholangiectasis. There-was some increase of connective tissue in Glisson’scapsule. The walls of the gall-bladder were somewhatthickened and there was an oval erosion of the mucoas-membrane about a third of an inch in diameter. The commonbile-duct was greatly dilated, being at least an inch indiameter. The hepatic ducts were also greatly dilated. The

biliary papilla projected three-quarters of an inch into theduodenum and was occupied by a whitish hard mass. This

microscopic examination showed to be a columnar epi-thelioma. The peritoneal fluid gave a pure culture of anorganism with all the characters of the colon bacillus.From the contents of the gall-bladder removed at the

operation and from the contents of the cavities in theliver a diplococcus was cultivated which appeared to be thepneumococcus. Bacteria, mainly rods, which were not

identified, were found in the walls of the biliary canals.The case presents several noteworthy points. Infective’