168 THE GERMAN CONGRESS OF INTERNAL MEDICINE.

Sir Robert Craven’s suggestion that Mr. Anderson’s wrongsare suitable matter for appeal to the whole profession metwith the favour of the meeting and the commendation of thechair; but appeals to the whole profession on suitablesubjects should, it would appear, be led by the leaders of theprofession ; and why not by the great professional corpora-tions, including the greatest, which is the College ?

I am, Sirs, your obedient servant,July 14th. A FELLOW OF THE COLLEGE.A FELLOW OF THE COLLEGE.

THE INTERNATIONAL MEDICAL CONGRESSAT MOSCOW.

To the Editors of THE LANOET.

SIRS,-May I call attention to certain matters concerningthe approaching International Medical Congress at Moscow ?

Fiistly, there is need for clear instructions as to how to sendmoney to Russia. Postal orders payable in Russia are notissued in England. English banks will not supply drafts onRashian banks for sums of less than £10. Bank-notes arenot allowed to be sent through the post in Russia. Moneycan be sent by English cheque crossed ° Credit Lyonnais" ;but then the rate of exchange seems hard to ascertain. Onefriend of mine sent a cheque for £1, which he thought wasequivalent to 25 francs, or 20 marks, or 10 roubles, but heonly got a receipt for 8 roubles 50.

Secondly, the Moscow managers of the Congress seem whatwe in England should call dilatory. Another friend of minesent his subscription a month ago, but has had neitherreceipt nor card of membership. I believe that no one in

Eogland has yet had a card of membership. The prepara- tions that have to be made before travelling in Russia as topassport and railway ticket will make inconvenience result ifthe issue of cards of membership is postponed till the lastmoment.

Perhaps the ventilation of these matters may lead to closerattention to the convenience of intending members. Ienclose my card. I am, Sirs, yours faithfully,July 14th, 1897. F.R.C.P.

* * The form of inscription says that a cheque of thevalue of 25 francs or 20 marks (10 roubles) may be sent,and in most cases we believe that a cheque for ill has beenfollowed by a receipt on a post-card stating that the senderwill be enrolled as a member of the Congress. In caseswhere the amount credited has been 9 roubles 50 webelieve that the sender will be inscribed. Of a creditfor a less sum in response to a cheque for ill we have hadno examples brought to our notice previously. The officialinstructions are not explicit, and our advice is that all

intending members should send a cheque for one guinea directto the secretary-general, Professor W. K. Roth. The cardsof membership ought to be issued, and we hope that thedelay in sending them will not be extended. We wouldremind those who are expecting them that they must indicateto the secretary-general their place of arrival on thefrontier.-ED. L.

THE GERMAN CONGRESS OF INTERNALMEDICINE.

(FROM OUR BERLIN CORRESPONDENT.)(Concluded from p. 57.)

The Use of tlte x Rays in Internal Medicine.PEOFESSOE BENDIKT (Vienna) said that the x rays were

an important addition to our methods of cardiac diagnosis.The size of the heart, which formerly could not be preciselyascertained when the organ was covered by the lungs, as inemphysema, is now easily measured; arterio-sclerosis canalso be recognised in an early stage, and the formation ofaneurysms may be observed. The rays are also valuable in

studying the respiratory system, for not only do they enablethe action of the diaphragm to be ascertained in health anddisease, but infiltration of the pulmonary apices and theformation of cavities become visible, and foreign bodies inthe thorax may be detected by the same means. The examina-tion of the abdominal organs by the rays had, however, notyet proved very successful.-In the course of the discussion

Dr. Levy-Dorn and Dr. Rosenfeld showed skiagraphs ofaneurysms, and Dr. Becher recommended that Esmarch’sartificial anasmia should be employed when the extremitiesare being examined, for the outline of the bones is therebyrendered more apparent.

The Use of Drugs in Modern Medical Practice.Professor Liebreich (Berlin), the well-known adversary of

bacteriology and serum treatment, said that the discovery ofmany powerful remedies was due to the systematic practicaltrial of a variety of substances-in fact, to the empiricmethod of inquiry, entirely without the assistance oftheoretical considerations. Digitalis and iodine were

notable examples of drugs which had been introduced intomedical practice in this way. The recent great advance$-in synthetical chemistry have resulted in the formation ofa host of compounds the properties of which remain forpharmacologists to investigate. Physicians may think tha&they are overwhelmed by the number of these new substances.which are pressed on their notice; they ought, however,not to complain, but rather to welcome such extendedopportunities of selection, whereby they are enabled tochoose drugs appropriate to individual cases. There areremedies, such as quinine and mercury, which are

specifics, inasmuch as they are directly antagonistic tothe morbid process or cause of illness, but the mode oftheir action is as yet far from being known. Since thediscovery of bacteria medical men have carefully studied thesubstances which are capable of destroying them, but in thioconnexion it is essential to take the cellular elements of theorganism equally into consideration, and to avoid the errorof concentrating attention exclusively on the micro-

organisms, for it often happens that the bacteria associatedwith a given illness are not the primary cause of it, but havemerely been developed to an unusual extent in consequenceof the vital energies of the tissues becoming lowered fromsome cause or other. The bacillus of tubercle, for instance,is to be found in the lungs of healthy persons, and itsdevelopment assumes the character of a pathological processonly after the vitality of the pulmonary cells has been

impaired. The treatment of pulmonary tuberculosis ought,therefore, to aim, not at the destruction of the bacilli, but atthe restoration of the vital energy of the pulmonarycells. For this reason nourishing food and attentionto hygiene are essential ; cantharidin has also proved useful.The bacteriologists are of opinion that diseases ought to beclassified according to the bacteria which are associatedwith them. Would they, however, give the name of "coli-bacillosis " to cases of arsenical poisoning in which thebacterium coli was discovered in the heart of animals 7 andlwould they try to destroy the bacteria in preference toendeavouring to get rid of the poison ? Professor Liebreich was,of opinion that Professor Koch’s new anti-tuberculin would!not be more successful than the former preparation. Witbregard to Behring’s diphtheria antitoxin, he said that themortality from diphtheria is reported to have diminishedsince the introduction of the treatment, but competent’observers like Kassowitz, of Vienna, and Rose, of Berlin).admit that they have not seen any good effect resulting from’it. The history of diphtheria prevalence also shows that"periods of low mortality have occasionally occurred. Inconclusion, Professor Liebreich asserted that -tetanus anti-toxin was useless, and that the practical results of the newserum treatment had by no means come up to the expecta-tions to which it gave rise.-A very animated discussion’followed Professor Liebreich’s address -Professor Baginskyclaimed that the good results of the serum treatment were-undeniable. - Professor Behring, after remarking that.Kassowitz published his observations five years ago, offered to-provide Professor Liebreich with a supply of toxins andantitoxins with which he could himself perform any experi-ments he might think desirable.-Professor Liebreich, in hi&reply, said that he did not question the statement thatmixtures of toxins and antitoxins made in a test tube werainert.

The Treatment of uaronic Diseases of the Heart.Dr. Rumpf (Hamburg) said that in the dietetic prescrip-

tions given to patients suffering from chronic heart diseaseonly albumin, fat, and carbohydrates had been hithertotaken into consideration. He has made experiments concern-ing the action of salts of lime in the organism, and ba&found (1) that when too much of these salts is present in thefood a good deal of it becomes retained in the body ; (2)that in calcification of the arteries the elimination of the limesalts decreases; and (3) that the amount of the lime salts in

169LIVERPOOL.

blood is very inconstant. A decrease of lime salts in thefood must thus be of therapeutical value. Dr. Rumpf hasinvestigated the influence of several substances on

the elimination of lime salts, and has found that

hydrochloric acid, lactic acid, and organic salts of

potassium promote it, whilst phosphoric acid had no

influence; experiments with oxalic acid and salicylicacid are in progress. As to the amount of albuminnecessary for the organism, Dr. Rumpf believed thatfrom sixty to eighty grammes were sufficient. He alsorecommended food containing a large quantity of potassiumand sodium salts such as vegetables and fruit, and expressedhis opinion that a mixed dietary was preferable to one

(consisting exclusively of meat and fat.Puncture of the Spinal Canal.

Dr. Lenhartz (Hamburg) has performed this operation ingrave cases of chlorosis where the increased pressure of thecerebral fluid caused violent headaches. In 10 cases outof 20 operated on the pains disappeared at once. Theprincipal indication for the operation is cerebro-spinal menin-gitis. He has resorted to puncture in 46 cases of tuberculous.and 24 cases of idiopathic cerebro-spinal meningitis In thefirst group the tubercle bacillus was found in 21 cases only.Of the second group, in 13 cases Weichselbaum’s, and in 9Fränkel’s, diplococcus was present ; in one instance thebacillus of enteric fever was discovered, and in one instancemo bacillus at all could be detected. Dr. Lenhartz was of

opinion that it was still uncertain whether the bacillusintercellularis was the cause of epidemic cerebro-spinalmeningitis; all his cases were sporadic and were not suffi-ciently numerous to found an opinion on -Professor

Fürbringer (Berlin) has performed the operation in a newseries of 26 cases of tuberculous meningitis, in 14 of whichthe tubercle bacillus was found. He had previously pub-hished a series of 37 cases, in 30 of which the bacilluswas present. He had also found the method veryuseful for the recognition of cerebro-spinal meningitis,and has succeeded in diagnosing cerebral hasmorrhage in 10cases by its means. In one instance, where it was doubtfulwhether the patient suffered from delirium tremens or fromFracture of the skull, the hæmorrhagic fluid obtained bypuncture proved the existence of a traumatic lesion.

Acute Leukæmia.

Professor Frankel (Berlin) said that a characteristic

symptom of acute leuksemia was the hasmorrhagic diathesistin conjunction with swelling of the glands, the liver, andthe spleen. He has seen 12 caes within seven years.A good many of them were erroneously believed to be

purpura hæmorrhagica, but a correct diagnosis could alwaysbe made by a microscopical examination of the blood. Theancrease of mononuclear leucocytes is very characteristic.Professor Fiankel terms them lymphocytes, and the whole,morbid process lymphocythæmia. He has once observed aperipheral paralysis of the facial nerve due to an immigration- of leucocytes into the substance of the nerve. In the same-.ase the enormous quantity of twelve grammes of uric acidwere discharged within forty-one hours.

Iodine in Disorders of the Circulation.Professor Vierordt (Heidelberg) said that he had been

giving iodine to patients suffering from disorders of thecirculation when the usual dietetic and mechanical treatmenthad not succeeded in relieving the pains. Cases of arterio-sclerosis were especially suitable for this treatment, but itwas not applicable to patients over sixty years of age suffer-ing from cardiac debility and albuminuria. At first from0.25 to 0’5 gramme of iodide of sodium as given severaltimes, so that from 1-2L to 3 grammes were taken in the coursewof a day; afterwards iodide of potassium was administered.It is essential that the patients should use the iodine for asomewhat long time-say, nine months in the first year.After an interval of from three to six months the administra-tion of iodine was resamed. The remedy was very wellborne ; sometimes, however, the digestion was interferecwith. The treatment was remarkably successful, espe.cially in the cases of six patients who had suffered fronsevere angina pectoris, but who improved so much that the3were able to ascend hills and also to return to businessWith regard to the theoretical explanation of thtaction of iodine he was of opinion that the lesion wa:prevented from extending, but was not actually repairedIt has been suggested by Sée, Hucbard, and others that aleffect is produced on the vaso-motor nerves, but this is noprobable.

Fatty Degereration.Dr. Rosenfeld (Breslau) said that the alleged difference

between fatty degeneration and fat infiltration was basedupon the hypothesis of a metamorphosis of the cellularalbumin into fat. He has examined the pathologicalconditions where this metamorphosis is believed principallyto occur, especially in the livers of animals poisonedby phosphorus and phloridzin. In starving dogs to whichphloridzin had been administered a quantity of fat wasstored in the cells of the liver. This fat did not proceedfrom the albumin of the cells, as the albuminous substanceswere not decreased. When mutton fat was injected into thecellular tissue of the skin poisoning by phloridzin made themutton fat pass from the skin into the liver. In phos-phorus poisoning also the fat only passed from thecellular tissue into the liver ; this fact was veryobvious in starving dogs where the fat had entirelydisappeared. In these animals poisoning by phosphoruswas not able to produce fatty degeneration of the liver.An artificial injection of mutton fat makes this fat againappear in the liver. Dr. Rosenfeld concluded his address bythe remarkable statement that fat is never formed fromalbumin and that the theory of fatty degeneration must thusbe abandoned. When the albuminous substances of a cellare destroyed the loss is supplied by fat passing into the cell.The fat of the organism consists exclusively either of thatwhich is taken as food or that which is formed from carbo-hydrates.

An abstract of all the papers read before the Congresswould occupy more space than can be spared. The principalones, next after those already enumerated, were as follows :Professor Kronecker, on Death by Thrombosis of the CoronaryArteries ; Dr. Friedlander, on Alterations of the Blood byThermic Inflaence; Professor Hochhaus, on ExperimentalMyelitis ; Professor Goldscheider, on the Neuronic Theory ;and Professor von Mering, on the Function of the Stomach.The next congress will be held in Wiesbaden.

LIVERPOOL.(FROM OUR OWN CORRESPONDENT.)

’17w Pressure of Lunacy Admissions at the LiverpoolWorkhouse.

THE pressure occasioned by the number of lunaticsadmitted to the Liverpool Workhouse last month was sogreat that it became necessary to notify the police thatfor the present the workhouse authorities were unable toreceive any more lunatics brought to the workhouse bythem. In order to find accommodation for lunatics tenepileptics had to be transferred from their proper wards tothe wards occupied by ordinary inmates. The vestryclerk pointed out that every board of guardiansin Lancashire is in a similar position as are, to a

large extent, others throughout the country. The LunacyBoard are making arrangements, and are now building forsomething like 1000 patients near Warrington. The clerkwas instructed by the Select Vestry to write to the LocalGovernment Board and the Commissioners in Lunacy, and topoint out to them the serious state of affairs prevailing inthis district. The Commissioners in Lunacy, in their reply,intimated that they could not help the Select Vestry in thematter, as the responsibility rested with the LancashireCounty Council and the Lancashire Asylums Board. Thereply from the Local Government Board was not encouraging.Altogether matters are in a very unsatisfactory state, all theother unions in this neighbourhood being in similar straits.

Bequest to the Medical Faculty of Univers’ity College,Liverpool.

By the will of Mrs. Gee, widow of the late Dr. Robert Gee,formerly lecturer in the diseases of children in the MedicalSchool, a sum of 7000 has been bequeathed to the MedicalFaculty of University College, Liverpool, for the promotion

. of study and research in medical science. It was decided by

, the Medical Faculty to institute a Robert Gee Fellowship in, Anatomy of the value of <&100 for one year; also fouri entrance scholarships of the value of .625 each for one year.; The late Dr. Gee was also a generous donor to the Liverpool,

Medical Institution, of which he had been treasurer andpresident.

The Lyon-Jones ScholarshipsThe Senior Lyon-Jones Scholarship, open to all second