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symptoms, but three of them seemed to show some im-

provement under the serum treatment. The total amount of

serum injected in each case was respectively 65, 120, 200,64, and 60 cubic centimetres. The amount of the indi-vidual injections varied from 10 to 40.cubic centimetres.

MORTALITY IN ITALY IN THE PROFESSIONSAND TRADES AND AMONG CHILDREN.

FROM the official statistics, dealing with the last statisticalyears 1898, 1899, and 1900, we gather that out of 100 males-of every profession whatever, dead from 20 years of age andupwards, only 40 have lived longer than 70 years. Takingthe media complessiva (the average collectively) the priestsand monks reach the highest figure, 57 per cent. having.exceeded the "term of the Psalmist," while the next

in order are the capitalists and landed proprietors with

53 per cent. ; the mariners, bargees, and ’ fisher-folk,with 46 per cent. ; the medical practitioners and veterinarysurgeons with 43 per cent. ; and the agriculturalpopulation with 43 per cent. Death is more prematureamong printers and lithographers, of whom only 19 haveattained 70 years. "Guards," which in Italy means thepolice service, become septuagenarians only in the propor-tion of 19 per cent. ; miners and quarrymen in that of 21per cent. ; commission agents and domestic servants, 23 percent. ; waiters in hotels and restaurants, 25 per cent. ;porters, 27 per cent. ; barbers, 28 per cent. ; coachmenand carters, 28 per cent. ; grooms, tavern-keepers, and

restaurateurs, 29 per cent. ; teachers and "professors," 29per cent. ; butchers, drysalters, and sausage-sellers, 30 percent. ; and smiths, farriers, and mechanics, 30 per cent.Infantile mortality is in marked diminution, thanks to theimproved condition of the country, sanitary and hygienic.In fact, in 1900 (a year of exceptional mortality amongchildren on account of the influenza), out of 1000 infantsunder one year of age 172 died, compared with 206 in 1897.The same proportion of deaths per 1000 is maintained in thecase of children up to five years of age.

THE CAUSES AND TREATMENT OF VERTIGO:A SYMPOSIUM.

AT a recent meeting of the New York Academy of Medi-cine, a report of which has appeared in the New York MedicalNe7vs of August 16th last, an important discussion was openedon the Causes and Treatment of Vertigo by Dr. Charles

S. Fisher of New York. ’. After referring to the description of" gastric vertigo " as given by Trousseau, Dr. Fisher said thatthe term should be limited to cases marked by sudden onset,intense dizziness, and a sense of fear or disaster, but not

accompanied by loss of consciousness. These cardinal

symptoms were nearly always associated with pain or

oppression felt in the epigastrium and the attack was

usually followed by a feeling of nausea. Actual gastro-intestinal disorder in the form of dyspepsia, gastric catarrh,or constipation was generally, but not always, present. It

seemed, however, in the light of our present knowledge ofgastric disorders that it was only when secretory gastrictroubles, with excess or deficiency of hydrochloric acid, werepresent that vertigo became a prominent morbid feature.

Ocular or aural troubles were sometimes found to exist insuch patients if looked for with care. The subjective dis-turbances causing vertigo were probably aroused by nervousexcitations carried from the stomach to the bulbo-spinalcentres by the vagtis nerve. Many observers had noticedthat vertigo followed the introduction of a stomach-tube.The term "secretory gastric disturbance," as above used,said Dr. Fisher, should include those local disorders whichpermit of the formation and absorption of toxins in the

alimentary tract, since the resulting toxaemia was often a

determining factor in vertigo. In some of Trousseau’s

cases attacks of vertigo were precipitated when the patientslooked at a revolving object, so that auto-suggestion wouldseem to play a role. Vertigo might be associated, saidDr. Fisher, with other forms of nervous disturbance in thesame patient, such as agoraphobia, or fear of open spaces.Here, however, the cause of the vertigo was psychical,while the agoraphobia was itself of psychical originand not associated with the stomach. In the discussionwhich followed the above communication Dr. Brandegeepointed out that congestive and inflammatory conditions

of the Eustachian tube and tympanum were produc-tive of vertigo, the immediate cause being an increase ofpressure within the labyrinth of the ear. Dr. Pearce Baileysaid that tea, coffee, and tobacco taken in excess producedvertigo, and that in some patients, both syphilitic and non-syphilitic, the administration of large doses of iodide of potas-sium was followed by pronounced vertigo and a staggeringgait. Vertigo was also an early symptom in general paralysisand coincided with commencing loss of memory. It occurredalso in other forms of cerebral syphilis and was often a

warning signal of threatened apoplexy. Professor MaxEinhorn said that the gastric conditions present in cases of

gastric vertigo were catarrh and secretory disturbances. The

hyperacidity of nervous indigestion was curable by Vichywater or other alkaline remedy, and when it disappeared theassociated vertigo was also abolished. He cited cases where

there was a deficiency of the stomach secretion with theresult that rough particles of food coming in contact withthe mucous membrane of the stomach caused a reflex

vertigo. If sufficient liquid was taken with the meals thistrouble disappeared. Dr. Dench pointed out that syphilisproduced labyrinthine vertigo, which, however, respondedwell to dosage with mercury and pilocarpine-a fact whichothers who took part in the discussion were able to con-firm. Most of the speakers also agreed that the localcorrection of aural and ocular troubles mitigated the

attacks of vertigo. -

THE LOCAL GOVERNMENT BOARD ANDMEDICAL WOMEN.

THE Burnley board of guardians is in a state of rebellionagainst the Local Government Board in respect of the

recent appointment of a lady as a resident medical officerat the workhouse. At the meeting of the guardians on

August 21st a letter was read from the Board in which it issaid that they consider that the appointment of a lady asassistant medical officer when a medical staff consists oftwo officers only is open to objection, having regard to thefact that it is to be her duty to act as medical officer-in-chief during the absence of that officer. The Board therefore

requests that the matter will* receive further considera-tion. " The guardians, however, were not to be turned fromtheir purpose and one of them moved that the "furtherconsideration" consist in the re-affirmation of the appoint-ment. "It was time they, at any rate, showed," hesaid, "that they were above the ordinary prejudiceswhich seemed to act against the appointment of womenwho were, as in this case, thoroughly well qualified, notonly by examination, but by practice." This was

seconded and the motion was carried unanimously. The

question of the appointment of a young unmarried woman asjunior medical officer to a workhouse where the senior is

also young and unmarried is a difficult one when looked

at from either the social or professional standpoint. There

can be no difficulty in indicating one of the principalobjections to such an appointment. In the absence of themale assistant medical officer his female colleague would beresponsible for the medical work of the establishment, andalthough she might be quite proficient in the use of thecatheter and in the arresting of haemorrhage, most members

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of her sex would feel themselves placed in an embarrassingposition by the admission of a man suffering from an extremedegree of retention of urine or bleeding profusely from arecent laceration of the external genitals. It is neither

necessary nor desirable to elaborate this argument, but it ismanifest that if the lady does not deal with such cases aspart of her ordinary work it is hardly in the interest of apatient suffering in the way we have suggested that sheshould have to treat him in an emergency.

SURRA IN THE PHILIPPINE ISLANDS.

THE existence of surra in the Philippine Islands is

definitely announced and is causing considerable mortalityamong the transport animals and cavalry horses of the

United States army of occupation, some 2000 animals

having died from it during the last six months of 1901.The disease has proved almost invariably fatal and has

caused some alarm owing to the possibility of its introductioninto the United States. Captain Curry, M.D, reports thatthe carrier of surra in the Philippines is a biting fly, theS’tomoxys calcitrans1 He has examined a large number offlies and mosquitoes but has found the trypanosome only inthis species, in which it may remain alive for 24 hours afterbiting an infected animal. This fly is very abundant in andabout Manila, especially in the stables and corrals, and itlays its eggs in the dung, in which the larvse and pupaethrive. As a prophylactic measure, all remedial agentshaving failed, the destruction or disinfection by lime orrebroleum of animal excrement in all stables and corrals is

recommended.

DURHAM COUNTY CONSUMPTION SANATORIUM.

WE have received a copy of the third annual report of the

Society for the Prevention and Cure of Consumption in thecounty of Durham. We cordially agree with the generaltone of the report. We have frequently urged that it

is the duty of medical men to educate their patientsas to the danger of infection which may arise from the

improper disposal of tuberculous sputum. The committeeof the Durham Society has been adopting this principle.Addresses have been given to meetings of workmen,members of the Sunderland board of guardians, and theCooperative Society, and letters have been sent to the variouslocal authorities asking them to adopt preventive measures.Several authorities now offer the free disinfection of rooms

vacated by consumptives and distribute leaflets showing thegreat danger of indiscriminate spitting, of breathing closeand vitiated air, and the need for the better ventilationand lighting of cow-byres, as well as the more stringentsupervision of the milk-supply. It is interesting to

note that voluntary notification of cases of consump-tion has been in force in Sunderland for a yearand the medical officer of health states that 96 cases

have been reported. Sunderland has a population of

over 146,000, so that the number notified cannot bestated to be large. Further, the borough of Gatesheadhas also adopted voluntary notification, so that this measureis now in force amongst over a quarter of a million of thepopulation in the county. We shall await with interest Ifurther intelligence of the result of this experiment. The

report of the medical officer (Dr. J. Gray) as to theresults of the sanatorium treatment ia certainly satis-

factory and we trust that the necessary funds will be forth-coming to provide more beds. Attached to the report is anarticle on " Consumption : Its Prevention and Cure." It isintended for the use of sanitary authorities, boards of

guardians, consumptives, and the general public." Informa-tion is given in a popular manner of the methods by which

1 American Medicine July 19th, 1902, p. 95.

tuberculosis is spread and the means which may be adoptedto diminish its dissemination.

ON THE "INTENSIVE" MERCURIAL TREAT-MENT OF GENERAL PARALYSIS AND

TABES DORSALIS.

PROFESSOR LEMOINE of Lille has contributed to the

Revue Neurologique of July 30th last an important practicalpaper on the treatment of general paralysis and tabes

dorsalis by the hypodermic injection of an organic saltof mercury in large doses and for prolonged periods.He refers to the view generally entertained by manyphysicians that general paralysis and tabes dorsalis are

but little capable of improvement under the so-called"intensive" form of mercurial treatment, and publishesa number of cases where the results of treatment,especially as regards general paralysis, are so strikinglybeneficial as to suggest that the question requires re-

consideration. 12 cases are recorded by him at some

length, six being cases of general paralysis and six of tabesdorsalis submitted to treatment. Two out of the six casesof general paralysis are recorded below as typical and illus.trative. Case 1. The patient was a man, aged 29 years,with a history of syphilitic infection. He had been welltreated with mercury after he had contracted the diseaseand had married subsequently and begotten two apparentlyhealthy children. He developed general paralysis later.

On then coming under observation he was submitted to theform of mercurial treatment alluded to at the heading ofthis annotation. He was given daily hypodermic injectionsof benzoate of mercury to the extent of two centigrammes(three-tenths of a grain) per dose, from Oct. 10th to Dec.25th, 1897. The treatment was carried out uninterruptedlywith the following results. Speech and memory, which hadhitherto been impaired and defective, were much improvedbut the general mental weakness remained the same. Fromtime to time since then, up to February, 1902, treatment wascontinued. The mental and physical conditions improvedfurther and only a slight pupillary inequality remained. Hehad since 1897 begotten four children, all of whom appearedto be healthy. Case 2. The patient was a man, aged 27years, of alcoholic habits, neuropathic predisposition, andimpulsive temper. He had had syphilis when a youth, andsome years afterwards he developed symptoms of generalparalysis with grandiose delusions and megalomania. He

was then admitted into an asylum and treated with

daily injections of benzoate of mercury to the extent

of two centigrammes (three-tenths of a grain) per dose,as in Case 1. The injections were given for 15 dayscontinuously and then discontinued for a similar period.The dose was then raised to three centigrammes (abouthalf a grain), the intervals of treatment and discon-

tinuance being as before, the whole period of treatment

extending from May to the end of September. DuringOctober considerable amelioration was seen both mentallyand physically. The treatment was now reduced to two

centigrammes (three-tenths of a grain) per dose, and this wascontinued for seven months. A slight apoplectiform seizureoccurred once during this period. At the end of the time itwas noticed that the disease (dementia) was arrested, though!the patient’s original character and disposition-viz., thoseof a neuropath-were clinically unmistakeable. ProfessorLemoine gives detailed accounts of four other cases of

general paralysis treated as mentioned. In all the six caseshe observed marked improvement of symptoms both mentaland physical, but, as he points out, longer periods of observa-tion are necessary before it can be conclusively establishedthat the disease has been definitely arrested in such cases.The excellent results obtained, however, in these cases oi

general paralysis he regards as justifying publication. Oi