106

subject shows that Biot’s breathing is supposed to occur notonly in meningitis, but in other cerebral conditions. It is

’therefore sometimes described as "cerebral breathing." In

three of the present cases the patients were infants underthe age of 2 years ; in two they were children of the age of8 years ; and in two they were adults. Of the six proved- cases of meningitis four were tuberculous, one was due tothe streptococcus pyogenes, and one to the diplococcusintracellularis. In a great variety of other diseases studied,including a number of cerebral ones, such as haemorrhage,thrombosis, syphilis, and various forms of coma, no case ofBiot’s breathing was found. In four of the cases in whichBiot’s breathing was present it was observed a few daysafter the onset of the symptoms. It may therefore be an

- early and important sign of meningitis. Its occurrence

seems to bear no special relation to the state of the pulse(whether rapid, slow, or irregular), or indeed to the presenceor absence of any other symptom. It was observed in casesof slight drowsiness as well as of deep coma. Biot’s breathingmay be further contrasted with Cheyne-Stokes breathing.’The dominant feature of the latter is the rhythmic succession

«af periods of dyspneea and apnœea. The periods of apnoea areuniform in length and occur at regular intervals. The periodsor dyspnœa are composed of the same number of respira-tions, which regularly wax and wane. The characteristic- feature of Biot’s breathing, on the other hand, is the absenceof any sort of rhythm. The periods of apncea vary in lengtha.nd occur at irregular intervals, and there is constant irregu-larity in both rate and depth of the respirations. Suchdifferences seem to point to a different pathogenesis of thetwo conditions. In a comprehensive study of Cheyne-Stokesrespiration Dr. G. A. Gibson of Edinburgh, accepting theconclusions of Marckwald that periodic breathing can

occur only when some of the higher brain centres have

<ceased to exert their influence on the automatic centreof the medulla, has suggested that Cheyne-Stokes breath-ing may require the total abolition of such influence,and that the meningitic or cerebral type of breath-

ing may result from the irregular discharge of unequalmpulses from the higher centres.

HEALTH ADMINISTRATION IN SOUTH AFRICA.

WE learn that two very well-known and efficient medical,,officers of health in South Africa have lately been informedby the authorities that they are about to be "retrenched"-in other words, that their services will no longer be neededdn the important posts which they now hold. Dr. A. J.

-Gregory is medical officer of health of Cape Colony and Dr.Pratt Yule is medical officer of health of the Free State,and each is to be " retrenched as from the end of August.In this connexion it is important to recall that the

Public Health Amendment Bill, introduced during the firstsession of the Union Parliament of South Africa, providedfor the establishment of a Chief Union Medical Officer,together with such assistant medical officers as might benecessary. This Bill was not passed, but it is believed

that the South African Government has not dropped the>idea of creating the post of principal medical officer of

health for the Union, although it does not see its way to

appoint a Minister of Public Health with a separate depart-ment, as was urged upon it by various medical authorities.It seems probable that a chief and an assistant medical officerof health for the Union will soon be appointed, and it was

generally anticipated in public health circles that Dr.

Gregory and Dr. Pratt Yule respectively would be selected forthese two important positions, since their claims are

- exceptionally strong. There seems to be a firm convictionthat no medical officer in South Africa is so well fitted bv- experience and ability for the chief officership as Dr.

Gregory. In these circumstances the news of Dr. Gregory’sapproaching retirement from his present post on a pensionhas come as a shock to a large number of medical

men and other authorities interested in the national

health of the Union, who fear that the Government

intends to overlook his undoubted claims. Dr. Gregory’srecord of past services, contained in the Cape Civil

Service List, suggests that it would be a publicmisfortune for him to be lost to the public health

service of that country at the most critical stage in its

history. --------

GOVERNMENTS AND ECONOMIC MEDICINE.

THE banquet and reception given to President Taft by theMedical Club of Philadelphia, at which more than 1000 medi-cal men were present, has a significance reaching far beyondthe United States of America. The function and the speechesof which it was the occasion emphasise the increasing recogni-tion, not merely pro forma, but with actual appreciation dueto intimate personal knowledge, by the governing powers ofthe economic and social significance of public hygiene andpreventive medicine. The speech of Mr. Taft particularlywas replete with an intimate knowledge made possible only byhis close association with the medical profession in his publiccapacities as former Governor-General of the Philippines,Governor of Cuba and Secretary of War, and his personalobservation of the effects of sanitation in Porto Rico and inthe Canal zone of the Isthmus of Panama. He spoke of thefact that the cleaning up of Havana, while useful in the

prevention of other diseases, had little or no effect in pre-venting yellow fever until Major Walter Reed and his

colleagues demonstrated the connexion between that diseaseand the stegomyia, which fact was promptly applied byColonel Gorgas, of the Army Medical Corps, with the resultthat the disease has been practically banished from Havana.In like manner uncinariasis, or tropical anasmia, is in a fair

way of banishment from Porto Rico; while in the Philippinescholera has been greatly reduced, small-pox (which hadpreviously flourished there in virulent type) has been practi-cally stamped out, bubonic plague has had its terrors

removed, the injurious effects of malaria have been

moderated, and even amoebic dysentery is being broughtunder control. Removal of lepers to the island ofCulion has reduced the new cases of leprosy in the

Philippines to 16 per cent. of what they were formerly,and beri-beri has been practically stamped out of

those islands. Moreover, the study of the dejecta of thenative Filipinos has shown that the intestinal flora hasbeen largely responsible for the enfeebled condition ofthat race, which by proper treatment founded on this know.ledge may be greatly strengthened. As to the Canal zoneof the Isthmus of Panama, what was formerly a pest-riddenzone has been converted into a pleasant and healthful placeto live in. " Colonel Gorgas," said President Taft, " stampedout yellow fever, so that for now more than four years therehas not been a case on the Isthmus, and he reduced themalignancy and extent of malaria on the Isthmus to such apoint that the percentage of deaths in the foreign populationof the zone is considerably less than in our large cities."Another evidence of the vast improvement in sanitation citedby President Taft is the fact that the United States now hasa division of 18,000 soldiers in Texas and California livingunder canvas for two months, " in a country soaked with rainand deep with profanity-provoking mud"; yet the per-centage of sick men is less than it was in the postsfrom which these men were mobilised. During the Spanish-American war, of the volunteer regiments mobilised

1 President Taft and the Medical Profession, American MedicalAssociation, 1911.