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placed in isolation, many were observed to carry the bacillusfor more than three weeks without any cholera symptoms, butout of 71 nurses and attendants at the lazarette hospitalnot one contracted the disease or showed the presence of thebacillus in the excreta. Amongst the complications onlytwo or three died from ursemic coma, but many suffered from

protracted ansemia. Twelve cases of urticaria were observed,and there were nine cases of intestinal heamorrhage. There

were ophthalmic symptoms, mainly conjunctivitis, in morethan 30 instances. The epidemic spent itself amongst themost careless, the dirtiest, and the least instructed of thepeople; and the general mortality would have] been greatlymitigated if the cases had been notified earlier, and if someeffective treatment had been possible before collapse set inand before it was attempted to remove patients so gravely illto a distant hospital. " But all is now over," writes our corre-spondent on the island. "Holidays are decreed, and Funchalis en fete. It becomes us, nevertheless, to press upon theauthorities the urgent need of works, both of ameliorationand development. During the last few weeks the barometer,standing at a high level, has hardly varied 1-lOth of an inch.The temperature has been steady at about 650 F., and theisland has been bathed in a dry, gentle, descending currentof air. The registered sunshine has been about 10 hoursper day. The hygrometer has shown 8°-10° of difference

(dry and wet) at the temperature of 650 F. In a more

concrete way the climate is illustrated by the profusion offlowers, the abundance of strawberries and English summervegetables at this season. Madeira is hardly more than threedays distant from England, and the policy of the Govern-ment, which in Republican form is working smoothly, shouldbe to make their priceless possession generally available."

PAINFUL DOUBLE TALIPES VALGUS OF TUBER-CULOUS ORIGIN.

IT has been known for a good many years that under theterm "rheumatism" there lies concealed a number of

different causal factors united only in the common clinicalfeatures of pain, chronicity, and the absence of marked

physical signs in the parts affected. Various micro-organismshave been described and figured by different workers as

related to rheumatism ; the gonococcus has been provedresponsible for some varieties ; ’’ painful heel," thanks toskiagraphy, has been successfully operated for ; and resultshave been published showing the success of various vaccinesand serums in ameliorating or curing certain conditions.the fact, however, that the tubercle bacillus may be theunderlying cause in certain of these rheumatic conditions,more especially of the feet, has not been sufficiently recog-nised in this country, although so long ago as 1905 Molinar,working under Poncet, published a thesis on the subject. Noapology, therefore, is necessary for drawing the attention ofthe profession to a case of painful double flat foot of tuber-culous origin described by Professor Poncet in the Gazette

des Hôpitaux of Dec. 31st, 1910. The patient was a semp-stress, 30 years of age, who came complaining of pains in thecalves of the legs and soles of the feet. As a child shehad been rather delicate. At the age of six she had eyetrouble lasting from 16 to 24 months, and leaving a per-manent opacity on the right cornea. Menstruation started atthe age of 13, and was regular. In 1901 she had a normal con-finement, and it was from that time that she dated the fre-quent rheumatic pains and persistent slight cough from whichshe had suffered every subsequent winter. In 1906, owingto the persistence of this cough and a gradually increasingloss of weight, she was medically examined and found to havesigns of pulmonary tuberculosis in both apices. For this she

1 Tarsalgie des Adultes d’Origine Tuburculeuse, Lyon, 1905.

was admitted to a sanatorium, where she remained six months,being discharged much improved but not cured. In February,1907, during a busy season for her, she first noticed pain inthe right foot. The pain grew gradually during the course ofthe day, was made worse by standing and walking, and wassituated in the sole of the foot in the region of the astragalo.scaphoid articulation, and underneath the external malleolus.Rest in bed at night caused it to disappear, though anindefinite tenderness persisted. Gradually, however, duringthe year pain became more constant, rest had less effect onit, the left foot also became involved, and eventually inNovember she had to give up work. At that time, whenexamined by Professor Poncet, there was no apparent lesion,swelling and discolouration were absent, and the jointsmoved freely. There was, however, some wasting of thecalf muscles. When seen again, however, four months later,on account of the severity of the pain, she had in the intervalacquired marked valgus, most pronounced in the right foot.The soles of the boots were worn away on the inner side,and with the boots off there was seen to be a marked sinkingof the plantar arch. The internal malleolus and the scaphoidprojected abnormally, the heel was inclined inwards, and thefore part of the foot made with the hind part an angle openoutwards. There was marked loss in the power of the

peroneus longus, and a finger could be inserted between theground and the head of the first metatarsal. The left footwas not so markedly involved, but in both feet the plantararch was obliterated. When fitted with specially designedcork boots she was able in a few months to walk a littlewithout much pain. Walking in slippers, however, was

impossible. A course of waters at Aix-les-Bains in 1909seemed to improve her condition, but in the spring of 1910the pains had spread to other joints, so that she was unableto move or do any work. The shoulders, knees, and articula-tions of the fingers became involved in succession, and theclamminess characteristic of joint affections was present. Thepains, however, were not constant, but moved from one

articulation to another. In August, 1910, she returned toAix for another cure," and at the time of writing is so muchbetter that she is able for a short time to discard the ortho-

paedic boots for ordinary footwear. The case as describedis one of ordinary rheumatism. There is apparently nosuspicion of gonorrhceal taint, and there is no leucorrhcealor other vaginal discharge ; and Professor Poncet does nothesitate to ascribe a tuberculous origin to the affections ofthe feet.

THE SEVENTEENTH INTERNATIONAL CONGRESSOF MEDICINE.

THE Seventeenth International Congress of Medicine willmeet in London in the summer of 1913, as perhaps our

readers hardly need to be reminded. The exact date is to

be fixed by the International Permanent Committee, whichwill assemble in London on April 21st and 22nd next, underthe presidency of Dr. F. W. Pavy. At the same meetingthe list of sections of the Congress will be constituted. Anywishes or propositions concerning the arrangement of thislist may be sent, up to April 1st, to the honorary generalsecretary of the Permanent Committee, Professor H. Burger,Vondelstraat 1, Amsterdam, or to the Bureau of the com-mittee, Hugo de Grootstraat 10, The Hague, Holland. Thecommittee will be glad to receive, before the same date andat the same addresses, any information or propositions con.

cerning the organisation of the Congress which interestedparties may desire to forward. Our last references to the

arrangements for the Congress will be found in THE LANCETof Oct. 22nd (p. 1234) and Nov. 5th, 1910 (p. 1368), andsome particulars of the International Permanent Committeewill be found in THE LANCET of April 16tb, 1910, p. 1091.