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the provision of motor ambulances at various centres

in telephonic communication through a central bureau, withnumerous call-boxes in the streets under the control of the

constables on duty, all of whom would be trained to renderfirst-aid. More experienced ambulance men would accompanythe car to the scene of the accident, take charge of the

patient, and convey him to the hospital, a system which.hasthe additional advantage of enabling the policeman toremain on his beat. We have on previous occasions spokenstrongly about the urgent necessity of replacing hand-litters

by motor or horse ambulances and our main object nowis to support the scheme which would put the control

of the street ambulance service of London in the entire

charge of the police force, a body of men in whom the

public have rightly every confidence. We are glad to recallin conclusion that Sir WILLIAM COLLINS, a member of the

Parliamentary Committee now sitting, has thus expressedhimself in the public press. " As a hospital surgeon I cantestify that the present method of bringing injured personsinto hospitals in hansoms and four-wheelers is cruel and

fraught with grave peril to the injured,", an opinion towhich all who have any experience of hospital work willsubscribe.

The Relationship between Humanand Avian Tuberculosis.

FEW of the many problems connected with the tuberclebacillus have received more consideration than that of the

relationship of the forms of that organism found in tuber-culous lesions in man to those found in the lesions of the

similar diseases of other animals. Since the startling pro-nouncement of KocH in 1901 in regard to the non-infectivityof the bovine bacillus for man the relationship of the humanand bovine diseases to one another has engrossed the atten-tion of pathologists and sanitarians to such an extent thatother forms have been but little studied. The reports of theCommissions appointed in Germany and in this country to

investigate this particular aspect of the general problemhave incontestably proved that bacilli derived from bovinesources are pathogenic for man ; indeed, that from cases oftuberculosis in man two types of bacilli can be obtained, onewith properties identical with those of bovine bacilli and theother with a much less virulence for bovines and rabbits

constituting the human type. The more fundamental ques-tion as to whether the two types are actually different

organisms or simply modifications of a single organism pro-duced by repeated passage through certain animals cannot atpresent be said to be settled definitively, although some ofthe experiments recorded by the British Commission pointrather strongly to the latter view. Similar questions arise in

regard to the bacilli of human and avian tuberculosis. It

has long been known that birds, especially birds in cap.

tivity, are subject to a form of disease affecting the lungs,intestine, and other organs produced by an organism likEthe tubercle bacillus but showing certain differences it

biological and pathogenic properties.An interesting paper dealing with the relationship

between avian and human tuberculosis was communicated tc

the Pathological Section of the Royal Society of Medicineon Nov. 19th by Mr. S. G.. SHATTOCK, Dr. C. G

SELIGMANN, Mr. L. S. DUDGEON, and Dr. J. N. PANTONand will be found at p. 1443 of this issue of T oE LANCET.

They point out the practical importance of the questionin view of the extensive use of birds as articles of diet

by man. Their experiments were carefully devised to

elucidate certain definite points at issue, of which the firstwas to determine whether birds could be infected with tuber-

culosis by means of bacilli from human sources. It was

found that feeding pigeons upon materials to which humantuberculous sputum was added gave uniformly negativeresults, although the bacilli were absorbed and, at any ratein one case, deposited in the spleen without producing anylesion. On investigating the effects of inoculation with

tuberculous sputum from man into pigeons, in only two outof six pigeons injected was a tuberculous lesion obtained

and then it was a slight local tuberculosis. On inoculation

of pigeons with tuberculous material derived from guinea-

pigs which had been inoculated with human tuberculoussputum, in some cases local lesions were obtained,but it was found that these lesions tended towards

retrogression rather than progression, and the generalconclusion which was deduced was that birds show a

high resistance to infection with the human bacillus.

Avian tuberculosis is apparently common since it was

found in 150 out of 500 necropsies on birds dying in the

Zoological Society’s gardens, and experiments were madeto contrast with those just mentioned,, using bacilli fromavian sources. These were found to have a high infectivityfor pigeons and a low one for guinea-pigs, in which animalinoculation with tuberculous material from birds produceda local lesion without visceral implication. The process sometimes involved the neighbouring lymphatic glands, buteven then, if the animals were kept for some time, therewas a tendency to retrogression. Feeding a monkey withtuberculous material derived from birds gave a negativeresult. It is thus evident that the avian bacillus has a

markedly pathogenic action for the bird but has little or

none for the guinea-pig and monkey, while the human

bacillus is only very slightly pathogenic to the bird but,as is well known, markedly so for ,the guinea-pig and

monkey.Mr. SHATTOCK and his co-workers next endeavoured

to determine whether the human bacillus was con-

vertible into the avian by inoculation into the bird-

i.e., by "passage"-and they came to the conclusion

that it is not; in other words, that the two organismsare not identical. It appears to us, however, that their

experiments on this point are not exhaustive enough torender this conclusion convincing. One of the features of

the tubercle:bacillus, as is pointed out in the recent reportof the British Royal Commission on Tuberculosis to whichwe have already referred, is its relative stability, and in the

"passage" experiments made by the Royal Commission aseries of animals were generally employed and not a singleone as in the experiments under discussion. It would

require ’passage through a number of birds of the same

species to settle the question definitely. It would also be of

interest to know what would be the effects of inoculation of

other birds from the lesions produced in the few cases which ., were infected from human sources. An interesting series

of observations were made by .an ingenious application of

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the fact that saturation of an immune serum with tubercle

bacilli reduces the opsonic content of that serum very

markedly-indeed, almost to removal. It was found that

the avian bacillus was as effective as the human bacillus

in this respect, an observation which might be taken as

pointing to the identity of the two organisms. This indica-

tion, however, the writers of the paper reject, since two oftheir number (Mr. SHATTOOK and Mr. DUDGEON) have foundthat the opsonin may be extracted from tuberculous serumby other substances, such as a thick suspension of melaninand that it is, therefore, rather a mechanical than a specificaction. The general outcome of these experiments seems toindicate that birds are usually infected from avian sourcesand not from human, a conclusion which is in general accordwith those of LYDIA RABINOaviTSCH who found, however,that certain birds, such as parrots, might become infectedfrom human sources.

Annotations."Ne quid nimis."

ALPINE MISADVENTURE: THE STATISTICS OF1907.

"THE playground of Europe," as Sir Leslie Stephencalled the Swiss Alps, has for many been a graveyard-afact which experience from year to year emphasises ratheithan modifies. Statistics officially compiled for 1907 supplyus with the death-rate due to misadventure in the year now

closing on the Alps-Italian, Swiss, and Austrian-and thoseof Dauphine. Actual loss of life is noted in 75 cases, the

majority of the victims being divided between Swiss andGerman "peak-stormers" ; next in number are those fromthe British Isles ; and then come the Italians. Among thecauses of this fatality that which overtops all others is thefoolhardiness (every year more prevalent) of essaying themore difficult ascents without a guide ; in many cases, more-over, without even a companion. The Alps which figurefirst in the black list as the scene of most frequent I I mis-adventure " are those of Central Switzerland-the BerneseOberland particularly; next come the Graian Alps, the highestpeak of which is the Gran Paradiso, and the Pennine rangeculminating in Mont Blanc and Monte Rosa. Among the‘‘ incidents of fatality " 14 are classed under the head of"flower-gathering in dangerous localities," the edelweiss

tempting the majority of victims. Of those thus lured totheir destruction there were two ladies of mature years, two

young ladies, and three young men. Accidents not termina-

ting fatally but more or less grave were 350-some not

nguring in that number from not having been reported orregistered. As a " prophylactic measure " the compilersof the above statistics recommend "international action onthe part of Switzerland, France, Italy, and Austria to makethe ascent of dangerous mountains prohibitive unless the

adventurer is accompanied by a duly qualified and accreditedguide. So escorted he might be spared even such risks asthat which cost the young student Herr Mancken his life,’only a few days ago, when clambering up the Jungfrau-amass of ice, loosened by the summer heat, having finallydetached itself and crushed the unfortunate youth. Even

such causes of danger cannot always be foreseen and allowedfor, but there is one consideration which it is never

superfluous or inopportune to insist upon and that is thestate of health of the Alpine climber. In fact, some 12 yearsago a congress of Swiss medical men, convened at Arosa,issued, after full discussion, a unanimous recommendation

chat professional assistance should be available at the

stations both of departure and arrival of even the funicularmountain railways, to save the traveller from the danger ofbeing ballooned up" to an altitude of several thousand

feet with what Sir William Gull used to call " a tired heart,"and also, in case of sudden cardiac failure at the terminus,to render all assistance possible. In truth, as was pointedout in THE LANCET’S comments on the congress referred to,many cases of so-called ’’ misadventure " are simply cases ofinstantaneous arrest of the heart’s action on the brink of acrevasse or other danger point. This was exemplified in thetragic fate of Baron Peccoz, an enthusiastic Belgian "peak-stormer " who, some 12 years ago, in presence of QueenMargherita (now the Dowager) dropped down dead when"negotiating" one of those critical "hazards" on the

Lyskamm. There was no misplaced footing or loss of balancedue to a false step but the sudden failure of a heart knownto be atheromatous and exhausted by many hours’ exertion.

THE BRISTOL ROYAL INFIRMARY AND THEPLURALITY OF HOSPITAL APPOINT-

MENTS.

WE have on several occasions referred to the strainedrelations existing between the medical and surgical staff ofthe Bristol Royal Infirmary on the one hand and the

managing body of that institution on the other. It will beremembered that the difficulty arose from an attempt torestrict future physicians or surgeons to that hospital both inrespect of holding other public appointments and in respectof the nature of their professional practice. The medicaland surgical staff were willing to make certain concessionsbut some of the committee’s proposals were stoutly resisted.The attitude of the committee in regard to this serious

question may be inferred from the fact that on its instruc-tions the secretary issued a circular to the governors claim-ing that" the committee are just as anxious as anyone elsecan be to deal with medical men in a sympathetic and kindlyspirit, but they cannot allow the private interests of theholders of future appointments to interfere with the efficientworking of the Infirmary." We now learn that the objec-tionable features of these proposals have been withdrawn.This result is a satisfactory illustration of the advantages ofprofessional unity. -

THE SMOKE NUISANCE.

THAT section of the Public Health Act, 1891, which dealswith the smoke nuisance needs amendment badly. We object,to begin with, to any exemptions whatever remaining in forcebecause we are convinced that no trade operations necessarilyimply the production of smoke. In cases in which the smokereacted injuriously on the products of the manufacturersthemselves it has been abolished. Not only, moreover, wasthe defilement of the air by smoke prevented but themanufacturers have confessed that by employing smoke-preventing appliances they have saved money and haveeconomised fuel. Only last week at a meeting inManchester a manufacturer stated that at the factorieswith which he was connected, although perhaps200 tons of coal per week were consumed, no smokewas made. He did not say that no dense smoke was made ;he said no smoke was made. No sign that fire was beneaththe tops of the chimneys could be observed. That greatchange had been accomplished, he added, with economy inworking expenses and at the same time a better result hadbeen obtained than by the most careful hand-firing. Such

testimony as this is a complete answer to those who write usdown as mere faddists who speak, they say, in utter

ignorance of the peculiar requirements of manufacturingprocesses, whose only idea is to have a clean air at the riskof ruining industrial prosperity. Then, again, according to