1697

21,000,000; while of 1000 children born in these six ruralcounties only 63 died under the age of one year, the

mean proportion in the 218 towns was 142 per 1000. Duringlast summer quarter 11,119 deaths in England and Waleswere referred to diarrhoea, of which 8498 occurred in the218 largest towns, and but 2621 in the remainder of Englandand Wales, with a population of about 14,000,000, mainlyrural, but including all urban districts with populationsunder 20,000. The annual death-rate from diarrhoea duringlast quarter in the whole of England and Wales was equalto 1 25 per 1000, against 2’ 07, the average rate in the tenpreceding corresponding summer quarters. The annual

death-rate from diarrhoea last quarter was 1’ 71 per 1000 iin the 76 largest towns, ranging from 0’ 03 and 0’ 06in Hastings and Bournemouth, to 4-20 in Hull, 4-28in Middlesbrough, 4-50 in Burnley, and 6’ 09 in

Rhondda. In the 142 smaller towns the mean annual

diarrhoea rate was equal to 1’ 25 per 1000 and in the

remainder of England and Wales the mean rate did notexceed 0’ 73 per 1000. In order, however, to show more

clearly the comparative immunity from summer diarrhoea inrural populations, it should be noted that in the six

essentially rural counties enumerated above, although theyinclude several populous urban districts, the mean annual

death-rate from diarrhoea during last quarter did not exceed0’16 per 1000 and was less than one-tenth of the

mean rate that prevailed in the 76 largest towns.

Striking as is this contrast, however, these figures under-estimate the comparative immunity from fatal infantilesummer diarrhoea in rural districts, not only because it is

at present impossible to exclude from the statistics forrural counties the facts relating to urban districts situatedtherein, but because it is also impossible to ascertain fromthe Registrar-General’s returns how many of the deaths

attributed to diarrhoea in administrative counties and sani-

tary districts are of infants under one year of age or ofchildren aged under five years. It appears from the

Registrar-General’s last issued annual report relating to

1906 that in the whole of England and Wales 92 2 percent. of the deaths attributed to diarrhoea in that year wereof children aged under five years and 74 - 9 per cent. of

infants under one year of age ; but the proportions of thedeaths of young children from diarrhoea are probably muchlarger in the summer quarter of the year.

CATALYSIS VERSUS VITAL ENERGY.

As is well known, the discovery of a method of synthesisingurea was the first step in the destruction of the " vital theory

"

and it was soon found that many other products of animalmetabolism could be built up from inorganic materials with-out the aid of vital processes. Indeed, the term " organic "

chemistry had not long been adopted before it became a

misnomer. Many reactions were explained by the assumptionof a "vital energy" and the action of enzymes was gener-ally attributed to a vital force rather than a purely chemicalchange. In this connexion it is of interest to refer toa communication from the Johns Hopkins University byMr. S. F. Acree on the Catalytic Reactions Induced byEnzymes. 1 His work, supplementing that of Dr. Hudsonand other investigators, serves to clear up much of the

mystery that hitherto has surrounded the action of enzymes.According to the modern view the addition of an enzyme to areacting system brings about a catalytic change because theenzyme unites with some constituent, called a "substratum,"of the reacting system and forms a new compound whichfurnishes the same end-products more or less readily thandoes the substratum. This conception harmonises with the

1 Journal of the American Chemical Society, November, 1908,pp. 1755-60.

facts connected with enzymic catalysis and renders un-

necessary the assumption that an enzyme stores up withinitself a vital energy which is given up to the reactingsystem and, perhaps, after transformation causes an

acceleration of the reaction similar to that producedby heat, light, and other physical agents. The new

theory of catalysis clears up the mystery of catalyticaction and points to the probability that all organicreactions are essentially like the inorganic reactions. Thevital energy theory, on the other hand, fails to harmonisewith some known facts and there is no corroborative evidencethat enzymes store the energy necessary to bring about thereactions which they set up. For example, O’Sullivan andTompson showed that invertase can catalyse at least 100,000times its own weight of cane sugar without losing its

reactivity to a measurable extent. If it be assumed that the

action of the enzyme is due to the possession of a vital

energy invertase would be compelled to give off enormous

quantities of energy, perhaps as much as radium is capableof producing. While allowing that the question requires tobe tested further by experiment Mr. Acree holds that thediscoveries of the last few years have removed the doctrine

of vital energy beyond the reasonable limits of possibility.He who would revive this creed must first offer new facts.

RESUSCITATION OF THE APPARENTLYDROWNED.

EARLY in the present year the chief surgeon of the

Metropolitan Police, Mr. Clinton T. Dent, requested the RoyalSociety of Medicine to make a pronouncement as to the bestmethod now available for the resuscitation of the apparentlydrowned. The request was occasioned by the fact that theRoyal Life Saving Society, the influence of which on mattersrelating to rescue and resuscitation is coextensive with theBritish Empire, had adopted the method recently recom-mended by Professor E. A. Schafer, while the Royal HumaneSociety and Metropolitan police continued to employ themethod introduced by the late Dr. Silvester. The council of theRoyal Society of Medicine, following the custom of the RoyalMedical and Chirurgical Society, nominated the following asa committee to report on the matter : Sir William S. Church

(President), Dr. F. H. Champneys, Mr. F. WarringtonHaward, Dr. Leonard E. Hill, Professor Arthur Keith, Pro-fessor E. H. Starling, Dr. Arthur Latham, and Mr. HerbertS. Pendlebury, the two last named acting as honorarysecretaries, while Mr. J. Y. W. MacAlister acted as

official secretary. The committee, the report of which hasjust appeared, recommends Professor Schafer’s method

as preferable to either that of Marshall Hall or of

Silvester for the resuscitation of the apparently drowned.The recommendation is somewhat unexpected when we

remember the criticism to which Professor Schafer’s method

was subjected when brought before the Royal Medical andChirurgical Society in December, 1903. The reasons which

induced the committee to prefer the Schafer method are :

(1) the prone position favours the escape of water and

mucus from the mouth and trachea ; (2) it gives a largerexchange of respiratory air ; (3) it gives an effectual upwardpressure on the diaphragm, thus stimulating the heart ; and(4) there is in Schafer’s method less risk of injury to theabdominal viscera or to the ribs. It is sincerely to be

hoped that the finding of the last resuscitation committee

may have a more abiding value than those of its four pre-decessors. Certainly more than one of the reasons givenfor the adoption of the Schafer method are open to criticism,especially the second ; even Professor Schafer does not

claim a superior but only a sufficient respiratory exchangefor his method. It is a matter of regret that the records ofthe Royal Humane Society, kept for nearly 150 years and