1582 THE PREVALENCE OF INFLUENZA.

Annotations.

THE PREVALENCE OF INFLUENZA.

" Ne quid nimia."

IT is to be feared that the routine work in many parts ofihe country is being carried on at the present time under veryconsiderable difficulties owing to the prevalence of influenza,.and it seems to be probable that the disease will interfere in nosmall degree with Christmas festivities. Indications of these

things may be gathered from the fact that no less than fiftynurses of the London Hospital staff were stated a day or twoago to be incapacitated by influenza; and at a recent meeting,of one of the City companies, of 210 expected guests no lessthan 40 were absent suffering from the same complaint.The epidemic is stated to be spreading in the RossendaleValley at an alarming rate, and the Rawtenstall School Boardreport that in some of the schools in their district as manyas 50 children are absent owing to influenza. At Liverpoolduring the week ending Dec. 9th a great increase in thenumber of deaths from lung diseases was recorded and

13 deaths were registered as being due to influenza.In Bristol and its neighbourhood the disease is still

prevalent, whole families being attacked by it. In some

-of the streets of Rugby a large majority of the houses havesome of their inmates affected, and the epidemic has-seriously interfered with business. At Derby the medicalofficer of health states his belief that the disease is abating’there. In London during last week there were no fewer than164 deaths directly attributable to influenza, as against 22,.36, 74, and 127 for the four preceding weeks. Of thisnumber 21 were under five years of age, 5 between five and

twenty, 26 between twenty and forty, 46 between forty and- sixty, and 66 over sixty years of age. There was a declinein the number of deaths from diseases of the respiratory- organs, but they were still much in excess of the average.It would be interesting, were influenza a notifiable disease,to see what effect the interchange of persons from all partsof the country during the Christmas holidays would have,upon the epidemic.

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LONDON SEWERS AND BAKEHOUSES.

DR. WALDO, the medical officer of health of the parish of’St. George-the-Martyr, has brought to the knowledge of hissanitary authority and of the London County Council the needfor the better sewerage of his district. He was able to supply the’Council with the addresses and particulars of twenty cellars,most of them unventilated and unventilatable, in all of whichhe found abundant evidence of sewage flooding. Two of these

.cellars were part of premises occupied by butchers, and in one- case a meat safe had been invaded by the sewage ; three cellarswere occupied by publicans, another was occupied by a milk"vendor, and yet another by a baker. London has, in fact, out-grown its sewerage system, and other sewers must be providedin order to afford the necessary relief. The needs of London

in this matter are evidently understood at Spring-gardens,- for the subject has been considered by the Council onthe report of Mr. Binnie, its engineer, and of Sir BenjaminBaker ; but the work of making the necessary preparationsfor the additional main sewers which London needs must

occupy some time, and, as a result, in times of heavy rainfalllow-lying districts are subject to fiooding such as Dr. Waldodescribes. Dr. Waldo also discusses the need for further legis-lation as to bakehouses. He says that dark, damp, unventi-iatable cellars should not in the future be allowed to be utilised<either as dwelling-rooms or for the manufacture and storage<of such articles as are liable to deterioration and dangerouscontamination-e.g., bread, confectionery, sausages, andother meat and food-stuffs. With regard to the use of such i

premises Dr. Waldo will no doubt exercise his power to obtaina closing order for any house, or part of a house, unfit forhuman habitation. Again, the Factory and Workshops Act,1883, section 16, provides that "when a court of summaryjurisdiction is satisfied, on the prosecution of an inspectoror a local authority, that any room or place used as

a bakehouse (whether the same was or was not so used

before the passing of this Act) is in such a state as to

be on sanitary grounds unfit for use or occupation as a

bakehouse the occupier of the bakehouse shall be liable onsummary conviction to a fine not exceeding forty shillings,and, on a second or any subsequent conviction, not exceedingfive pounds. The court of summary jurisdiction, in additionto, or instead of, inflicting such fine, may order means to beadopted by the occupier, within the time named in the order,for the purpose of removing the ground of complaint." We

may anticipate that Dr. Waldo’s report will be followed byproceedings under this section. This provision relates only tobakehouses, but it should suffice for the improvement of theconditions in those premises to which he refers.

IN MEMORIAM JACOBI MOLESCHOTT.

JUST a year ago the University of Rome held high festivalon the occasion of Moleschott having attained his seventiethbirthday, and now the University of Turin inaugurates thenew locale of the subalpine" Accademia di Medicina" by acommemoration of the departed physiologist to whom, morethan to any other, she owes the rehabituation of herinstruction in the institutes of medicine. The occasion wasa solemn and a sad one. Its spokesman was one of themost distinguished pupils of the illustrious deceased, Pro-fessor Angelo Mosso, and among the company were theleaders of the sub-Alpine school and all that the Piedmontesecapital can boast in the spheres of science and letters. A touch-ing feature of the ceremony was the presence of Moleschott’stwo sons, Carlo and Elsa, who had come to make over tothe newly reconstituted "Accademia " their father’s magnifi-cent library, the value and extent of which seemed to justify,and even to necessitate, the removal of the "Accademia"to a more spacious building. And not only was it thematerial bulk of that noble "Biblioteca" that furnishedthe "Accademia" with a motive for its change of abode :it was the redoubled, nay the trebled, energy that Moleschotthad infused into Italian research ; it was the trebled, nay thequadrupled, fecundity in medical literature thence arising thathad caused the institution to outgrow its traditional surround-ings and to seek a wider arena for the display of its forces.Professor Mosso led up to the crowning event of the day byeliciting from Professor Gamba a brief but brilliant sketch ofthe history of the Accademia di Medicina, how, founded in1836 under the title of the Societa Medico-Chirurgica di Torino,it won royal recognition in 1846, in which year it was con-

stituted into an "Accademia," with King Charles Albert forits patron; how it investigated, discussed, and gave birthto a scientific and practical literature, which was recentlyestimated to fill 190 volumes; and how it succeeded in found-ing the Biblioteca Medica di Torino, being the Turin MedicalLibrary, which now numbers well-nigh 10, 000 volumes, besides

possessing a large assortment of rare and precious manuscripts,and which is open every day to the medical students and thepublic, by whom it is assiduously frequented. The" Acca-

demia, " moreover, issues a journal which is known through-out Europe, and it can boast a craniological museum which,for richness and convenience of arrangement, has few, if any,equals. Its annual and quinquennial prizes have given directoccasion to monographs of high and permanent value, oneof the writers of which, Professor Wilhelm His, of Leipzig,in recognition of the munificence that inspired his successfulwork, instituted a prize of 5000 fr. (200) for the encourage-ment of embryological studies in Italy. Other proofs

1583DEATH UNDER CHLOROFORM.

of the " Accademia’s" beneficent influence on medical

study followed, and then Professor Giacosa paid a

special tribute to the memory of Moleschott, to whose

splendid and persevering work the sub - Alpine schoolwas indebted for the high place it held in the republic ofmedicine. The two sons of the great physiologist were there-upon formally thanked for the gift of the Biblioteca Mole-schott, by the portal of which stands on one side his bust, andon the other the following epigraph :-

I libri di Jacopo Moleschottlo ricordino qui ove bbeprincipio il suo insegnamentoin Italia e fu per tantianni maestro.I figli Carlo ed Elsaper memore affetto a Torinoelessero questa citta acustode della biblioteca delpadre loro.

1893.

(Let the books of James Moleschott commemorate him here,where he initiated his instruction in Italy, and where he wasfor many years a teacher. His sons Carlo and Elsa, in

ever mindful affection for Turin, chose this city as the cus-todian of their father’s library. 1893.) The new building ofthe Reale Accademia Medica" of Turin, with its crowningornament of the " Biblioteca " of its greatest teacher, wasthen declared open, and at a banquet given by the students ’

in the evening, at which the Senator Professor Bizzozzero wasthe principal speaker, Professor Angelo Mosso received some-thing like an ovation for the success with which he had

inaugurated the "Accademia" and its memorial to Mole-schott earlier in the day.

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DEATH UNDER CHLOROFORM.

WE have received the following account of a case of adeath under chloroform from Surgeon-Captain Townsend ’,Shaw, of the Indian Medical Service:-" On Oct. 30th a ’’,man was admitted to hospital in a very emaciated condition,with a contracted chest, difficulty in swallowing and breathing,and a voice that was reduced to a hoarse whisper. Occupyingmainly the anterior and slightly the posterior triangle therewas a large mass of scrofulous glands, over which the skinwas red, tense, and shining, and in the lower part of whichthere was a small opening, through which some curdy mattercould be expressed. He stated that six months previouslyhe had first noticed the swelling. As he (like most nativesof India) was unwilling to remain in hospital, and I thoughtthat extirpation would give him the speediest relief, he wasput under chloroform on Nov. 2nd. It was given on an ordinary ’,flannel cone with cotton wool inside, but very slowly, so that ’,the patient really took but little of the vapour. He went’off’ perfectly quietly. When about four drachms had

been poured on the cone I had made the incision, andwas shelling out some of the glandular mass, when the

respiration suddenly ceased. The chloroform was stopped,and by means of artificial respiration the breathing wasrestored. No more of the drug was given. On continuingthe shelling process the respiration again ceased. Artificial lirespiration, lowering the head &c., ammonia, and hypo- Idermic injections of ether were all tried in vain. The liman was dead in about two minutes. When the respi- ’Iration failed I could not feel the pulse. I took the ’,opportunity of seeing how much the gland substanceramified. The centre of the sterno-mastoid muscle had prac-tically disappeared. On endeavouring to dissect out the

deep attachments running along the internal jugular vein I

opened unintentionally the latter and blood flowed freely.With difficulty I clamped the vein, and on trying to clear it Iwounded it again, clamped it and excised the ligaturedportion. A third ligature had to be put on beforethe bleeding stopped. The bleeding that would havetaken place had the man’s heart been beating would

probably have been fatal, though Mr. Treves has

wounded the vein twice without seeing any harm result.On page 351 of Surgeon-Lieutenant-Colonel Lawrie’s Reporton the Hyderabad Chloroform Commission, he says : Theclinical experience and statistics which THE LANCET calledfor after the Hyderabad Commission’s Report was publishedhave only brought out the curious fact that all chloroformdeaths nowadays are possibly the result of hypodermic injec-tions of ether, which is always resorted to as soon as possibleafter symptoms of danger appear.’" In reference to this.case we may note that the subcutaneous injection of ether asa means for resuscitating those apparently dead from chloro-form should only be resorted to when syncope from shockor loss of blood is present. The danger which is said to.

threaten the heart when chloroform is given arises fromthe toxic effects that drug shows towards protoplasm,and especially the non-striated muscular fibre of the myo-cardium ; and although it has never been shown that afew minims of ether injected under the skin can, even if theyever reach the tissues of the heart or nerve centres, act harm-

fully, yet they certainly cannot act as an antidote to a chloro-form toxaemia. On the other hand, when the danger threatenedis due to an overdose of chloroform affecting the respiratorycentre in the medulla oblongata, the injection of ether, ifit exerts any action at all, would be to still further paralysethe nerve centres.

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THE MEDICAL OFFICERSHIP OF HEALTH OF

LIVERPOOL.

THE Liverpool Cowrier of Dec. 15th says that at the"

meeting of the Health Committee of the Liverpool corpora-tion on the preceding day it was resolved on the proposal ofthe chairman, seconded by Mr. Grierson, "that, whilst.

acknowledging the past services of Dr. John Stopford Taylor,medical officer of health, the committee are of opinion thatit will (having regard to Dr. Taylor’s advancing years and.’the increasing duties of his office) be in the interests ofthe corporation for him to retire from the service, and!the committee recommend that he be required to retire

pursuant to Section 64 of Liverpool Corporation Act,1893." The unanimous desire was expressed that Dr. Taylorshould receive the utmost amount of superannuationallowance permitted by the statute. It is understood that.Dr. Taylor’s position will be vacated at the end of threemonths from the confirmation by the council of the resolu-tion of the committee. It is intelligible that, having:consideration to Dr. Taylor’s age, his seventeen years ofarduous service, and the ever-accumulating work of a

Liverpool medical officer of health, the committee should.think that the time had come for his retirement. It.is satisfactory to find that they are unanimously of

opinion that he should receive the fullest superannuation.allowance. At the same time we sympathise with Dr. Taylorin having to leave the work which he loves so well. It has

been our custom frequently to direct attention to his reports,as being of really public interest, and as dealing with problems.more difficult than are to be met with in almost any other

city of the kingdom. We congratulate him on many points.of progress in public sanitation and in the health of Liverpoolsince he took office. The town still continues to be the most

densely populated city in the kingdom. While Glasgow has.56 -9 persons per acre and London 57 ’1, Liverpool has a densityof 98-6 persons per acre. It is gratifying to know that in Dr.Taylor’s last report-that for 1892-he is able to say thatthe total deaths were 1266 below the average of the last ten.

years. It is especially satisfactory to learn that the deaths.from typhus fever were only 18-the lowest number registered’in any year. One of the greatest improvements which havecharacterised Dr. Taylor’s period of office is in the clearer-differentiation in the public records of Liverpool of cases oftyphus fever and typhoid fever-a distinction of much