389

colon on the right side near the liver and much pus gushed f

out." This may have been an appendix abscess but he goes (

on to say that much pus also was evacuated with the urine, 1so we cannot be sure that it was not a pyonephrosis. Here 1.and there through the following centuries we find cases 1

recorded which are fairly certainly examples of incision of t

an appendix abscess but it was not till 1759 that we Imeet with an operation for abscess which was definitely ishown to be due to disease of the vermiform appendix ; E

in that year Mestivier incised an abscess on the right (

side of the abdomen near the umbilicus and much pus was evacuated. The wound healed but the patient died before l

long and at the necropsy a pin was found in the appendix iwith many signs of inflammation. Seven years later Lamotte 1

described a large fascal concretion in the appendix but thediscovery was only made post mortem. In 1848 Hancock

reported the opening of an abscess immediately abovePoupart’s ligament on the right side and later two fæcalconcretions came away. The incision was made early, evenbefore fluctuation could be detected. In 1867 Parker pub- lished four similar cases and from that time the opening of abscesses in the right iliac fossa became less rare. The :earliest suggestion to remove the appendix appears to havebeen made by Fenwick in 1884 and this operation was per-formed by Krönlein in the same year. He opened the abdo-men of a boy aged 17 years who had general peritonitis andligatured and removed the perforated appendix. Some

temporary improvement followed but death occurred threedays after the operation. Symonds in 1885 removed a con.cretion from an appendix without opening the peritonealcavity. The first successful operation for the removal of theappendix was performed by Morton in 1887 and from thattime the operation has become common. We have thenanswered the question, " When was the first operationfor appendicitis performed ? " by showing that appendixabscesses have been opened many centuries ago; that

Hancock in 1848 incised an appendix abscess before

fluctuation could be felt ; that Kronlein in 1884 removed aperforated appendix but the patient died ; and that Mortonin 1887 had the first successful case of appendicectomy.

THE METROPOLITAN WATER-SUPPLY.THE report on the condition of the metropolitan water-

supply for last October shows that the rainfall in that monthwas 2’70 inches above the average mean rainfall of 24Octobers. It will be remembered that September was anexceptionally dry month and in consequence the Octoberrains were not able to bring the daily natural flow of theThames up to its 24 years’ average, but they caused the usualturbidity of the water and from the 17th to the 24th it wasmore or less coloured in consequence. On the remainingdays it was clear and in good condition. The filteredwater from the various works contained less organicmatter than in any preceding month last year exceptthat from the West Middlesex works which containedthe same quantity as in September. The Lea wateris reported as of very good quality throughout the month,and the Kentish chalk wells were as satisfactory as usual.All the samples of water collected from public taps andexamined were free from any appreciable quantity of

suspended matter. By the colour test the Lambeth water,as usual, showed the deepest average tint of brown, but percontra it contained the lowest average of microbes-viz.,3’ 8 per cubic centimetre. The worst offender in this respectwas the sample from the Grand Junction division of thesouthern district which showed the large number of 4625’ 1per cubic centimetre. We need hardly say that this is most

unsatisfactory and it is liable to recur whenever the

condition of the Thames is unfavourable or when an unusual

strain is thrown on to the filter beds at Kew Bridge, which

for lack of accommodation for storage and settlement areobliged to treat a large proportion of their water in a

practically raw condition. A marked improvement has takenplace in the Southwark and Vauxhall water since the

Hampton reservoirs were brought into use and it is urgentthat a similar measure should be adopted at Kew. Thebacillus coli was found in 10-7 per cent. of the filtered

samples of Thames water, 100 cubic centimetres of each beingexamined. It was found in 8 7 per cent. of similar samplesof Lea water and 13 7 per cent. of similar samples of NewRiver water respectively. Although the London water-supplyhas improved materially of late years it is obvious that thereis still room for much more improvement, especially in thisbacteriological respect. -

THE MODE OF TRANSMISSION OF TRYPANO-SOMES BY TSETSE FLIES.

A RECENTLY published Parliamentary paper, headed

"Miscellaneous No. 6 (1907)," contains a report preparedby Dr. Louis W. Sambon, the Italian delegate to the Inter-national Congress on the Sleeping Sickness held at Londonin June, 1907. The report is written in French but an

English translation is appended, and there is a note explain-ing that the time and labour necessary for its preparationmade it impossible for it to be included in the publishedproceedings of that conference. The subject of the reportis the mode of transmission of sleeping sickness. Dr.Sambon criticises the views expressed by Colonel David

Bruce, R.A.M.C., and Professor Minchin, and whilehe admits that it is possible that both nagana and

sleeping sickness may be transmitted by tsetse fliesin a purely mechanical way he is convinced that undernatural conditions this is not the usual mode. Hemaintains that in each case the fly acts as a true alter-native host and that the respective parasites go through apeculiar cycle of development and multiplication within thebody of the insect before they are returned to freshvertebrate hosts. He criticises the experiments describedby Colonel Bruce and other observers in support of the"mechanical" theory, which is in brief that the infectionof the disease is conveyed by the proboscis of the tsetse flyin much the same manner that the vaccinating needle carriesthe infection of vaccinia from child to child. The generalprinciple of these experiments is that of allowing tsetse fliesto feed upon an infected animal and subsequently upon anormal one. One of the chief objections which he raises isthat in these experiments the tsetse flies used have been

caught in infected localities and may therefore have harbouredtrypanosomes in their salivary secretion at the time when theywere caught. He also objects that if the mode of transmissionof trypanosoma Gambiense or trypanosoma Brucei is purelymechanical it is difficult to understand why the diseasescaused by these two parasites should be so strictly confined tothe localities where certain species of the tsetse fly are foundand why other blood-sucking diptera should not be ableto carry them and to infect animals in the same mechanicalmanner. He further claims as strong presumptive evidencein favour of some further development of the parasites intheir invertebrate hosts, the fact that trypanosomes takenfrom the gut of the tsetse fly and injected into vertebratesdo not produce the disease, although they are living, thesuggestion being that they belong to a sporogonic cycle inthe life of the trypanosome incapable of multiplication inthe blood of a vertebrate host. Unlike the diptera of thefamilies culicidas, simulidas, and tabanidas, in which thefemales alone are blood-suckers, in the glossinæ both sexeshave this property, and Dr. Sambon suggests that it is possiblethat the further growth of the trypanosome in the fly mayonly be capable of occurring in the female ; he thereforesuggests that in future experiments the sex of the flies

used shall be carefully determined and recorded. He affirms