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obtained. Here some alterations will have tobeeffected Self- cleansing sewers cannot be obtained under such conditions.As it is there are often small floods in and about the pumpingstation. Bat it is probable that all the houses in this

neighbourhood will be pulled down and replaced bydocks when the harbour works are more advanced. Theabolition or the raising of this district will, however,make the fall of the sewers even less than it is at present.Thus an important, a radical alteration for the drainage of aportion of the town will become necessary. Works which werecommenced shortly after 1848 can scarcely be expected to meetmodern exigencies and the requirements of the very greatincrease of population which bas taken place since that time.It will, however, remain to the lasting honour of D.)ver thatthis town was among the first to lead the way in effectingthose reforms that have so materially contributed to reducethe death-rate of the towns of England.

THE CONGRESS OF MEDICINE IN MUNICH.(Continued from p. 950.)

April 2nd.THE THERAPEUTIC ACTION OF FERRUGINOUS COMPOUNDS.

PROFESSOR BUNGE (Basle), having referred to the import-ance of the part played by hsemoglobin in the animal

economy, said that it is very improbable that iron in theform of inOIganic salts introduced into the human body bythe food becomes converted into hæmoglobin by synthesis.The case is otherwise with organic ferruginous combinationssuch as are present in the yolk of egg in the form of nucleo-albumins, from which the hæmatogen originates. Severalcombinations of iron exist in milk and also in vegetables, thelatter containing a considerable amount, but milk only asmall quantity. This SEems to be incompatible with the factthat milk contains all the elements necessary for the growthof a young organism ; but this deficiency is compensated inyoung animals by a very large reserve stock of iron derivedfrom the placental circulation, and when this stock isexhausted they instinctively begin to take vegetable food.The same is the case in the human subject. The iron

necessary for her ofE=pring has been in process of accumula-tion by the mother not only during her pregnancy butever since her arrival at puberty. Perhaps the appearance ofchlorosis is caused by the fact that the solid tissues of awoman abstract iron from the blood without giving anythingin return. This compensation can only be effected by meansof organic preparations of iron, which alone are absorbed ;whether they are assimilated is very doubtful, and, therefore,the best way to provide the human body with the necessaryamount of iron is by the dietetic use of ferruginous vege-table products. Ferruginous drugs only act by suggestion-the iron which is to be assimilated must be obtained fromthe market-garden, and not from the pharmacy.

Professor Quincke (Kiel) stated that he had made investi-gations as to the quantity of free iron in the tissues, andhad found that it mcreabes or decreases according to thechemical qualities of the ferruginous preparations ingested.According to him there are three varieties of iron compoundspresent in the human body : (1) that in the tissues ; (2)the reserve stock ; (3) that in the circulation. Ferruginouspreparations he divides into six classes : (1) ferrocyaniccombinations, which have no influence on the organism ; (2)blood, which is usually held in reserve, but may ba usefullygiven in amomia; (3) diluted hæmoglobin; (4) citrate ofiron, which does not coagulate albumen ; (5) insoluble com-binations, which, if subcutaneously injected, are in course

of time absorbed ; (6) the other oxides and suboxides ofiron. These form albuminates in the stomach and intestines,and are but slightly absorbed in the normal body ; per-haps more so in anæmia, where thpy became directlyassimilated. He is ptrsuaded of the efficacy of ferruginouspreparations, especimly of the suboxides and albuminates ;but is not of opinion that organic compounds are preferableto inorganic, the inorganic iron being changed in the intes-tines into an organic combination. Sufficient experimentshave not yet been made on the therapeutical value of hæmo-

globin. He finally remaiked that drugs cannot be dispensedwith in the treatment of chlorosis.

Dr. Heubner (Berlin) said that infants ought not to be fedtoo long upon milk.

Dr. Siegfried (Rippoldsau) thought that ferruginous medi-

cines in conjunct,ion with residence in mountainous localitieswould lie successful.

Dr. Zimmermann (Basle) did not agree with ProfessorBunge’a opinion that the quantity of iron in the food wassufficient, and thought that suitable iron preparations weretherefore necessary.

Dr. Nothnagel (Vienna) advised chlorotic patients to staysome weeks in bed at the beginning of the treatment.

Dr. Edlefsen (Hamburg) recommended the administrationof hydrochloric acid with iron preparations.

Dr. Ewald (Berlin) thought that this combination shouldbe used only when the gastric hydrochloric acid was ascer.tained to be deficient.

April prd.THE DEBATE ON THE ANTITOXIN TREATMENT OF

DIPHTHERIA.-(Continued.)Dr. Treupel (Freiburg) reported that he had made injec.

tions of 200, 600, 1000, and 1500 antitoxin units on rabbitsand dogs. Their general state, the temperature, the respira.tiOD, and the blood pressure remained normal; skin eruptionsor changes at the places of injection were not observed, Inthe urine there was for some time after the injection a Emallquantity of albumen, but no microscopical elements, such ascasts. It is probable that the albumen in the urine consistsof albumose or peptone. It is doubtful whether albuminuriais a constant symptom after the injections, whether it isspecial to antitoxin, or whether it depends merely on theinjection of blood serum in general.

Dr. Siegert (Strasburg) had concluded from his experi.ments : (1) that the injection of antitoxin produces albumin.uria, diminution of the quantity of urine, and increase ofits specific gravity, these symptoms being more aggravatedwhen the kidney is irritated ; (2) that the injection ofcarbolic acid causes no albuminuria, but an increase of thediuresis and of the specific gravity; (3) that an injection ofcarbolic acid diminishes the effect of antitoxin ; (4) thatan intravenous injection of 10 cubic centimetres of antitoxinNo. II. is very well tolerated by healthy rabbits; (5) that asubcutaneous injection of defibrinised horse serum kills arabbit in from two to four days, the changes in the urinebeing the same as after antitoxin injections ; (6) that a sub.cutaneous injection of 10 cubic centimetres horse serum with

’ carbolic acid produces the same changes, but the animals. do not die. Dr. Siegert declared that he was far from assertingthat these results would be repeated in the case of the humansubj ecte Dr. Vierordt (Heidelberg) was not of opinion that thecourse of the fever in diphtheria, as suggested by DrHeubner, vas anything characteristic. He ranked himself; among those medical men who reserve their judgment as to, Behring’s methods.

At this point the discussion was closed, and Dr. Heubner’imotion, given at the end of the report of the first sitting, wasadodted.

April 4th.THE PATHOLOGY AND TREATMENT OF TYPHLITIS.

Professor Sahli (Berne) described typhlitis and perityphlitisas inflammations which arise from the interior of theintEStinaand in course of time attack the walls of the emenm, thevermiform appendix, and the surrounding tissues. This in.fection is caused by the presence of pyogenic bacteria in thec=um. The marked swelling in perityphlitis results frcman infiltration of the tissues round the cæcum, the vermiformappendix, the peritoneum, the omentum, and the fascia trans-versalia. This swelling becomes still more increased by theaccumulation of fsces. Every case of typhlitis with palpableswelling is attended by suppuration, but these cases teV/f’theless often recover, the pus partly being absorbed and partlyfitding its way spontaneously into the interior of the bowel,The disease at the outset should be treated by opiates and ab-solute rest, togetherl with total abstinence from food. Wtfthere is no improvement within three days an operatienbecomes necessary. An immediate operation should only beperformed if the patient suffers from continuous fever, if he isisseized with shivenng, and if the temperature and the painsuddenly increase after an apparently favourable initialstage of the disease. To avoid relapses the vermiformappendix must be removed, even if the pus is spontaneonslyevacuated into the intestines.

Professor Helferich (Greifswald) said that the presence afpyogenic bacteria produces purulent catarrh of the munconsmembrane of the caecum; and if the mucous membrane is

abraded by the passage of fasoes the resulting suppuration

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easily penetrates through its walls. As soon as the sym-ptoms of suppuration-f ever, pain, and sweating-arerecognised an operation should be performed. It wouldbe wrong to wait till the abscess becomes palpable or

to rely on the possibility of spontaneous care. Above all, the symptoms of approaching perforation of the peritoneum Ishould be attentively observed. Appendicitis, of course, is often present without any grave symptoms and only becomesmanifest by a sudden aggravation of the patient’s generalsta’e.Dr. Sannenburg (Berlin) made a distinction between simple

and purulent a,ppendicitis. The former he has observed intwelve cases post mortem ; it ii characterisEd by the abenceof all grave symptoms affecting the temperature and thepulse, and by a shoit and mil course. These cases should Ibe treated expectantly. Parulent appendicitis, whichbegins with shivering, vomitiog, diarrhoea,, severe pains, &c ,should be operated on. Whcxe the abscess has opened throughthe intestine the vermiform appendix must be removed.

Dr. Curschmann (Leipzig) stated that in his experiencethe mortality was at the rate of 5’4 per cent. in 452 cases. Hedid not agree with Professor Sihli that all cases were purulent.There is also a sero-fibrinous exudation. The swelling inpentyphtith often arises from accumulation of faeces, some-times also from a matting together of the infiltrated tissues.He declined to give general rules for operating, for in thisdisease it is essential to take into consideration the circum-stances of each ca’ p.Dr. Aufrecnt (Magdeburg) said that cases should be dis- I,

- tinguished according to the ite of the exudation. Thedisease is less dangerous when the exudation is merely extra- I,peritoneal, and much more dangerous where there is phleg-monous infiltration of the tistues behind the csecum. Inthe latter case an immediate operation is necessary, but in theformer it is permissible to wait till an abscess results.Dr. Qaincke (Kiel) thought that accumulation of fseces is

seldom a cause of real typhlitis. Very often the adminis-tration of an enema Effectually relieves the patient. Thistreatment, of course, should only be used when no alarmingsymptoms are present.

Dr. Augerer (Munich) reported some cases where after a; comparatively short time symptoms of grave ileus appeared.

The post-mortem examination only showed a small in-tumescence.Dr. Sonnenburg remarked that he bad also seen cases of

this kind. He was of opinion that these symptoms arisefrom an autointoxication of the body by bacteria.

Dr. Heubner (Berlin) stated that in fuch cases even a veryearly operation had not succeeded in averting the death ofthe patients.

April Eth.SUBCUTANEOUS NUTRITION. I

Dr. Leube (Wu zburg) said that for this method ofnutrition only fatty substances are suitable. In order toshow that fat is really absorbed and assimilated Dr. Leubeinjected fifty grammes of butter under the skin of emaciatEddogs. After the injection fat was once more found to be present in the subcutaneous tissues and in the internal organs of the animals. Chemically it proved to be partly the naturalfat of the dog and partly butter. When the animals werekept without food it again disappeared, so that it hadevidently been consumed like the natural fat of the body.

THE ABSORBENT POWER OF THE RECTUM.Dr. Posner (Berlin) reported that he had injected solutions

of aniline colours into the rectum of rabbits, and that infrom twelve to fifteen minutes they were totally absorbed.This fac: fbould make physicians very cautious in giving drugsby the rectum.Dr. von Ziemssen and Dr. R!per agreed with Dr. Posner.Dr. von Noorden recommended the administration of quinineby the rectum in whoopirg cough.

OTHER PAPERS.At the fical sitting Dr. Rampf (Ham burg) read a paper on

the treatment of Enteric Fever by itjecuons of cultures ofthe ba,il!us pyocyaneus. His experiments were of coursemade on an mals only.

Dr. Tnoma (Magdeburg) made some observations on theElastic Tii-sue of the Arterial Walls and on Angeiomalacia.

Dr. Noorden described a new means for the early diagnosisof Diabetes Mellitus. He administers glycose to patients whoeither from natural or hereditary predisposition are suspectedto suffer from diabetes, and if this substance appears in theurine the case must be treated as diabetic.

Dr. Ott spoke on Nucleo-albumins.Dr. Dehio (Dorpat) diecassed Cardiac Myofibroma and its

clinical symptoms.Many other pipers were also read before the Congress, which

exigencies of space compel us reluctantly to leave unrecordedin our columns.

The arrangements made for the comfort of the visitorswere excellent, and the reception on behalf of the professionof Munich was very cordial. It was a subject of general remarkthat a very great number of visitors came not only from theGerman Empire, but also from Austria, Switzerland, theRussian Bdltic provinces, and other countries where Germanisspoken.

Public Health and Poor Law.LOCAL GOVERNMENT DEPARTMENT.

REPORTS OF INSPECTORS OF THE MEDICAL DEPARTMENTOF THE LOCAL GOVERNMENT BOARD.

On tlie water-supply nf the Parish of Lympsham, byMr. T. W. THOMPSON.-This inquiry was undertaken owing toa complaint by the county council of Somerset to the effectthat the then existing rural sanitary authority of Axbridge hadfailed to provide the parish of Lympsham with a praperwater-suppty. The parish is a scattered one. The water-

supply is derived from certain wells, and also to a largeextent from ponds, ditches, &c.; and so scarce or bad is itat times and in certain places that some people send out ofthe district for a supply which is brought in by water-carts.Of the wells Mr. Tnompson says that they are of a generallyunsatisfactory character ; they contain mere surface water,and they are situated in such proximity to drains, privies,cesspools, and highly polluted ditches that they cannot failto become contaminated. Even the so-called parish well issituated in a grass field which is occasionally manured, andit has within about ten yards of it an offensive and almoststagnant ditch, into which a privy and the drainage of acottage discharge. It would be bad enough if theLympsham people were content with such water fortheir own consumption and purposes, but they palmit off on others and make money out of the trans-action. Thus dairy-tarming is theprincipal local industry;milk is largely produced there, and it is either distributed tolarge towns or made into cheese. Everyone knows how largea share water-supply bai to do with such operations, and it iswell, as far as Lympsham is concerned, that it should also beknown that even where Lympsham dairy farmers take thetrouble to send elsewhere for their drinkrng-water, and thusevidently admit the unfitness of their local supply for dieteticpurposes, they were found to be using that iocal supply for’’dairy operations," including a so- called cleansing of milk-vessels. In one case cans were "cleansed" with water froma dry-steined well alongside a pig-yard. But perhaps themost unsatisfactory circumstance in this Lympsham inquiryis the weak attitude adopted by the now happily deiunctrural sanitary authority, who, having had several schemesof water-supply under consideration, and having informedthe Local Government Board that one scheme had been foundnot only the least expensive, but the most feasible, practicallysay that because the parish have rejected it they dare notproceed unless the scheme is "ordered to be carried out."We can only hope that the new district council will hold ahigher view as to its duties, and that in the evidence beforethem they will take away the reproach of Lympsham andof those of its inhabitants who imagine that a water-supplywhich is subject to the constant risk of very filthy pollutionsis good enough for a parish which thrives on tfaoamittingdairy products to ndgbbouring populations, and does nothesitate to use such water in the various operations necessaryto the preparation of those products.

REPORTS OF MEDICAL OFFICERS OF HEALTH.

Whitechapel Urban Sanitary Listrict.-The condition asregards nationality of a considerable proportion of White-chapel may be judged by Mr. J. Loane’a remark that "astranger comiDg into some of the streets of Spitalfields mightbe excused for doubting that he was in the capital ofEngland at all " ; and it appears from Mr. Loane’s currentreport that in 1894, 1046 foreigners were added to the White-chapel population. The birth-rate of the district was a high