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experienced by American physicians in collecting debtsdue to them, for practice is carried on almost wholly onthe credit system and it often happens that a patient afterconsulting a specialist does not leave his fee on the table.Why fees in the States should be generally so much higherthan in England is a matter somewhat difficult to com-

prehend. Less competition cannot be the cause, for in theStates there is one medical man to every 500 persons, whereasin England there is only one to every 1500. The workingclasses in America receive larger wages than in GreatBritain, and no doubt this partly accounts for the highermedical fees, but a still more potent reason is the fact thatin America the members of the medical profession stand welltogether and are resolved to resist as vigorously as possibleany attempts to lower the rate of fees.

COOKERY AND FOOD EXHIBITION.

THE Cookery and Food Exhibition, which is held annuallyunder the auspices of the Universal Cookery and Food Associa-tion, instituted and promoted to extend a better knowledge ofthe various substances used as food and the best and mosteconomical method of cooking, will be opened on Wednesday,May 12th, at the Niagara Hall, St. James’s-park, London,S.W., and will remain open till the following Wednesday.The exhibits will be classified under the headings of Educationin its connexion with Cookery; Plain or Household Cookery ;Army, Navy, and Mercantile Marine Cookery; Artistic

Cookery; Cookery Teachers’ Competition; Artistic Con-

fectionery, &c.; Bread and Pastry; and Provisions, &c.

Various demonstrations and lectures will be given. This is

the tenth exhibition of the kind that has been held, and wewish it every success. Bad cooking is answerable for someof the ills of the flesh, and to any efforts to improve what isalmost a neglected art in this country, especially amongstthe poor, we give our hearty support.

PHOTOGRAPHIC ENERGY OF THE LIGHT OFFIRE-FLIES

A VERY interesting investigation of the luminous andother radiations emitted by fire-flies has just been publishedin the ninth volume of the Journal of the College of Science,Imperial University, Tokyo, Japan. The author, Mr. H.

Muraoka, who writes in German, is Professor of Physics atKyoto. He mentions that the spectacle produced by thefire-flies about the middle of June is one of the sightsof the place, and he states that the present inquirywas suggested to him by the resemblance of their lightto that of fluorescent bodies, some of which have beenshown by H. Becquerel to emit radiations possessingproperties analogous to those of the Roentgen rays. Theflies are most luminous from about 6 P.M. to 11 P.M.The experiments were made by placing a number of them,varying from 300 to upwards of 1000, in a small flat box inwhich they were confined under a net made of hemp(11 deren Wegfliegen mit einem Hanfnetz verhindert wurde ").The box also contained a photographic dry plate, in contactwith which were plates of various metals (copper, aluminium,zinc, and brass), all of similar thickness, sheets of cardboard,both entire and also with cruciform patterns cut out of them,being sometimes interposed between the sensitive plate andthe metal and sometimes used alone with the sensitive plate.Thin wooden boards were also employed for the same pur-pose. The sensitive plate and the objects in contact with itwere wrapped in several thicknesses of black paper and left tin the box with the flies for two nights. The experimentswere made in a photographic dark room, sunlight andartificial light being carefully excluded. The sensitive plates,though thus wrapped up, and additionally protected bymetallic plates and layers of cardboard, gutta-percha, cloth,silk, &c., were always more or less blackened. Professor

Muraoka makes frequent reference to the papers published inNature in the early part of 1896 by Dr. John Macintyre ofGlasgow and Mr. J. J. Thomson. His experiments led him tothe following conclusions :-1. The light of the flies in its

original state behaves like ordinary light. 2. The lightcontains rays which pass through cardboard, metal plates,&c., and possesses properties analogous to those of Roentgenrays or Becquerel’s fluorescent rays. 3. When the photo-graphic plate is covered with layers of cardboard it presentsan appearance which calls to mind the permeability of ironto magnetic lines of force. 4. The properties of these’’ filtered" " rays appear to be influenced by the materials

through which they have passed, perhaps by thethickness of the materials. 5. The properties possessed bythe radiations and specified under No. 2 are apparentlynon-existent, or at least undiscoverable until after" filtration." The Roentgen rays are similarly undis-

coverable until after filtration "-i.e., through the glassof the Crookes’s tube-and filtration " may, perhaps, afforda means of rendering the x rays homogeneous. 6. The" filtered fire-fly rays undoubtedly admit of reflection.

Refraction, interference, and polarisation could not be

demonstrated, but Professor Muraoka is of opinion that theytake place. 7. The "filtered" firefly rays seem to resembleBecquerel’s fluorescent rays in possessing properties inter-mediate between the ultra-violet rays and the Roentgenrays. The volume of the Jo?trnal of the College of Sciencein which this article appears contains over 200 pages ; iall the other papers are in English, and are mostly chemical,except four, the subjects of which are electricity, magnetism,geology, and astronomy.

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TRICUSPID STENOSIS.

TRICUSPID stenosis is a disease of some rarity.Dr. James B. Herrick, having found three cases in

the post-mortem room not diagnosed during life, writeson the subject.l He has collected all the cases

published since Leudet’s thesis, which appeared in 1888and gave a complete bibliography to that date. To the 117cases (of which 114 had records of necropsies) furnished byLeudet the writer is able to add 40 with necropsies. He

gives abstracts of most of these, and on the basis of thewhole 154 cases constructs an account of the disease. But he

has little to add to Leudet’s conclusions, which must still bethe foundation of future work. Tricuspid stenosis may becongenital, and then it is either the result of a developmental defect or of intra-uterine endocarditis. It is usuallyaccompanied by other abnormalities-pulmonary stenosis,defects in the inter-ventricular septum, patent foramen ovaleand ductus Botalli. The symptoms are cyanosis, clubbed

fingers, and diastolic and systolic murmurs. Few patientssurvive until twenty years of age. In the acquired formantecedent rheumatism occurred in 30 per cent ; but therewere also doubtful cases, so that for this and other reasonsthe relationship is understated by the writer. Leudet,indeed, estimated it at 50 per cent., which appearsto be nearer the truth. The age at death of the

greatest number affected with the acquired form was

between thirty and forty years. As in mitral stenosis,the disease was more prevalent in females than males, theproportion being 114 to 32. The tricuspid leaflets are

generally found adherent by their free borders. The openingmay admit only one finger-tip or less. Naturally, with thestenosis there is regurgitation. The disease is rare as anisolated lesion ; in Leudet’s 114 cases this occurred in only11. Mitral stenosis was by far the commonest concomitant(78 cases). Mitral and aortic stenosis occurred in 21

cases, and pulmonary stenosis in 3. The right auricleis usually enlarged, sometimes considerably, " like a

1 Boston Medical and Surgical Journal, March 18th, 1897.

1105

supplementary heart." Where the stenosis was marked 1

there was usually a small right ventricle, and this in spite of c

the fact that there was also mitral stenosis. Commonly, ihowever, the combined lesions produce general enlargement Iof the heart. The symptoms are those common to valvulardisease. Dyspnoea may be extreme. Cyanosis is generallymarked, with perhaps oedema. The pulse, from deficientsupply of blood, is small. Presystolic venous pulse is

generally seen, often with systolic from concomitant insuffi-ciency. Percussion reveals an enlarged right heart, andcommonly left also, from mitral or aortic disease. Dulness

may commence as high as the second space to the right of thesternum, suggesting auricular enlargement. Thrills are at

times present. The murmur is diastolic, heard best over theright fifth and sixth cartilages, but it is frequently inaudible.The diagnosis presents great difficulty; only 6 of the 114 caseswere recognised during life. The disease may be suspected ina female who has mitral stenosis with a history of dyspnoea,palpitation, oedema with remissions, and cyanosis, especiallyif persistent. Right auricular enlargement is very sug-gestive. If, in addition, there is a presystolic or diastolicmurmur heard best over the ensiform or right fifth and sixthcartilages, particularly if this differs from the mitral in

character, or if there is an area between the two where noneis heard, the diagnosis is reasonably certain. The prognosisin general is bad, but must depend on all the circumstancesof the case. It should be remembered, however, that a

patient may live to sixty-five years. The treatment issimilar to that of heart disease in general.

A CHILD KILLED BY FERRETS, is

AT Bromsgrove, on the 6th inst., an inquest was held onthe body of Ernest Lewis, aged two years. On March 26ththe deceased and four other children, whose ages rangedfrom five months to seven years, were left in bed, locked upin a house at Dodford, whilst the parents went to market.Two ferrets which were kept in the house broke loose, andgetting upstairs attacked the sleeping children. The eldest

boy repeatedly threw the animals downstairs, but as therewas no door to the bedroom they returned. The boyErnest sustained a number of severe bites, to whichhe succumbed. A large part of his mouth and nose

were eaten away. The medical man stated that allthe children except the eldest would be permanentlymarked. The jury blamed the father for not takingproper precautions to secure the animals. Such is the

matter-of-fact account furnished by some of the daily papersof this gruesome tragedy. The sufferings of these unfor-tunate children both from physical pain and terror musthave been intense and long continued. It is difficultto conceive anything more ghastly. It does not appear to be

generally known how very ferocious these beasts are, espe-cially when hungry. To the censure of the jury on thefather we would add that the animals should not have beer

kept in the house at all. We trust the case will serve as 2

warning; but we fear it may not attain the publicity that i1should.

inTHE SMOKE NUISANCE IN SHEFFIELD.

THE air of Sheffield is proverbially in a chronic state ofmurkiness, and the town suffers considerable reproach on Ithis head. But in a most comprehensive report on the ’causes of prevention of smoke recently drawn up byDr. Littlejohn, the medical officer of health, he veryproperly points out that in contrast with other townsSheffield is seriously handicapped by the fact that it con-tains a much more closely packed smoke-producing area.The amount of coal consumed in Sheffield annually is

about one and a quarter million tons, and this within

an area of thirty square miles. In London in 1892

the amount consumed was the same, but the area of

distribution is 235 square miles, so that were Londonfactories brought into a square whose sides were three milesdistant north, east, south, and west of Charing-cross, it maybe assumed that the conditions of the metropolitan atmo-sphere would be much the same as that of Sheffield. Theamount of sulphuric acid corresponding to the amount ofsulphur in that quantity of coal would amount to 37,500tons, so that in Sheffield, while the sulphuric acid depositedin the rain would amount to 1000 tons to the square mile, inLondon it would only be equal to 140 tons. In other words,London receives on the ground just as much sulphuric acidas Sheffield, but over a larger area and consequently morediluted. It is probable, however, that London is more favour-ably situated than is Sheffield for the removal of smoke.It is, no doubt, the continued prevalence of winds duringthe last few winters-and London has no barrier against theonset of winds in any direction-which has resulted in thenotable absence of fogs in the metropolis of late. Dr.

Littlejohn, we are glad to see, points out to the SheffieldHealth Committee that much more may be done by efficientcontrol and regulation towards mitigating the evil still

further, and his report is a valuable contribution on thesubject.

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PARISH MORTUARIES.

WE have many times insisted upon the paramount necesssity which exists, especially in thickly populated town

parishes, for the erection of properly appointed mortuaries.To say nothing of the question of decency and reverence itis acknowledged by every one that the presence of a corpsein a small room, often less than eight feet square andinhabited day and night by several persons, is not con-ducive to health. A praiseworthy attempt is now beingmade by the vicar of the very poor parish of St.

Augustine’s, Stepney, to raise a fund for the erection ofa decent and well-fitted mortuary for the reception of thebodies of those who die in his parish. That such isneeded is obvious when it is remembered that the parish canbe walked in its length in four minutes and across in twominutes, while the population is 7500. A sum of Z915 has

already been raised and .S585 are required in addition.Donations may be sent to The Vicar, St. Augustine’s,Stepney, E., and we cordially commend this scheme to thegenerosity of those who have any money to spare. It must

be remembered that the mortuary will also serve for the

needs of adjacent parishes which are quite as crowded asis St. Augustine’s. -

PLAGUE AT HONG-KONG IN 1896.

WE have received a copy of the Blue-book dealing withthis epidemic. Plague is at all times an interesting disease,and is doubly so to us at the present juncture. The reportis drawn up by Dr. Wilm, a staff surgeon in the

Imperial German Navy, whose services were kindly placedat the disposal of the Colonial Government by the admiral incommand of the German Asiatic Squadron. He was placedin charge of the Kennedy Town Hospital and the bacterio-logical laboratory which was established there in May, 1896.During his term of office he treated 300 cases of plague andexamined the bodies of 867 persons who had died fromthe disease. In most of the cases there were no pro-dromata, the period of incubation was usually from threeto six days, but in one instance apparently fifteen days.There was intense prostration and delirium with fever, thetemperature ranging from 1006° F. to 106° F., but a high orlow temperature seemed to make no difference in the

fatality. The fever lasted from six to ten days, rising fromthe third to the fifth day, and then gradually falling to

normal ; but later a secondary fever appeared, apparently