1181

the cases have dropped to one-tenth of what would have

been their normal number, whilst since goats’ milk has

been forbidden in the Royal Naval Hospital not a singlecase has occurred or can be traced to residence in the

hospital. The commission of the Royal Society would thusseem to have made a most valuable discovery. Colonel

Bruce considers that Malta now has a chance of being con-verted from one of the unhealthiest stations of the British

navy to one of the most salubrious, and the expectation isfounded upon solid arguments. The Royal Society and themembers of the commission are to be congratulated on theinvestigation.

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A TWIN OVUM IN A TUBAL PREGNANCY.

IN THE LANCET of March 30th, p. 881, Dr. Allan F. Ruther-ford described a very interesting case of a twin ovum in atubal pregnancy which he had removed by abdominal section.This condition is one of considerable rarity but a sufficientnumber of cases have now been recorded to show that in this

variety of multiple gestation the two ova may be situatedin the same tube, or one in either tube, or an intra-uterine may be associated with an extra-uterine pregnancy.When the two ova are found in the same tube most commonlythere is one fcetal sac common to the two. Unfortunately, itis not quite clear from the description of Dr. Rutherford’s

specimen whether the two ova were contained in a singlechorion with a single placenta or not, although the illus-tration shows that each foetus was inclosed in its own amnion.A not inconsiderable number of cases have now been describedof a tubal twin pregnancy with a single fcetal sac, but veryfew have been met with in which the two ova in separate sacswere attached to different portions of the same tube. Someinstances of this arrangement have, however, been reported,one of the earliest being that of Boehmer cited by Webster, inwhich the tube was enlarged in two different parts, one ofwhich contained an early ovum and the other an ovum con-verted into a mole. In a case recorded by Saniter one ovumwas situated in the isthmal portion of the tube and hadapparently reached the third or fourth week of development,while the other sac in the neighbourhood of the abdominalostium contained an ovum four centimetres long. Twin ova

enveloped in the same foetal sac form, as we have said, thecommonest variety and have been found not only in the earlybut also in the later months of an extra-uterine gestation.In a case described by Krusen the condition was one of

triplets, the three foetuses, all about the second month of

development, being found in the blood mass of a hasmato-cele, the burst sac occupying the ampulla of the

tube. In a most remarkable case recorded by Folet, inwhich the extra-uterine sac probably had existed for some 16years, both foetuses were mummified. One had attainedalmost full term, while the second, which was flattened outagainst the sac wall, was of the size of a three months foetus ;there was a single placenta. That the foetuses in most ofthese observations are of very different degrees of develop-ment is no doubt to be explained by the imperfect growth ofthe two placentas, the direct result of their extra-uterine

attachments, since unequal development of twins in utero isof relatively uncommon occurrence. The third combinationin which both tubes are involved in the pregnancy has so far

only been met with in the early months of pregnancy. Oneof the best known cases is that of Walter ; in this instanceboth tubes contained a hmmatoma in one of which there wasa foetus six centimetres long in the amniotic cavity, whereasin the other the amniotic cavity was compressed and empty inthe middle of the blood mass. In a case recorded by Werthan operation undertaken for the removal of a hasmatocele ofrecent formation revealed the presence in the opposite righttube of an unruptured tubal gestation. In another case

operated upon by the same surgeon the left tube contained a

hsematoma and the right tube, the abdominal end of whichwas closed by old adhesions of some standing, a foetal sacwith no trace of any embryo. In this case it appears prob-able that the ovum contained in the right tube may havecome from the left ovary by internal migration, judging bythe fact that the obliteration of the abdominal end of the

right tube appeared to date from a period anterior to thecommencement of the twin tubal pregnancy. These varietiesof multiple pregnancies are of much interest and all suchcases should be carefully recorded.

EPIDEMIC CEREBRO-SPINAL FEVER.

THE epidemic of cerebro-spinal fever continues withoutmuch alteration in its incidence. In London during the lastfew days one case has been reported in the borough of

Finsbury and one in the borough of Stepney. SinceMarch 26th, when the order requiring the notification ofthe disease came into operation, 24 cases have been

reported to the London County Council. Cases have alsooccurred at Liverpool, at Smethwick in Staffordshire, at

St. Germans in Cornwall, at Chilvers Coton in Warwick-

shire, at Whitwell in Derbyshire, at Newburn in

Northumberland, at Wrexham in Denbighshire, and at

Crewe in Cheshire. In Scotland during the week endedApril 20th there were 18 deaths from the disease registeredin Glasgow, ten in Edinburgh, six in Leith, two in Greenoeksand one in Dundee. The weekly return of the Glasgowsanitary department issued on April 19th showed that therewere at that time 112 cases under treatment. In Edinburghfrom March 1st to April 22nd there were 66 cases with42 deaths. Other cases have occurred at Plains near Airdrie,at Haddington, at Kirkcaldy, and at Kirkintilloch. In

Belfast 30 fresh cases have been reported during the pastweek. There has now been in this city a total of 313 caseswith 200 deaths.

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FURTHER EFFECTS OF RECENT LEGISLATIONON THE DRUG TRAFFIC IN THE UNITED

STATES

IN the March number of the Áme’l’ilJan J01trnal ofPharniacy further evidence is given of the salutary effectsof the Pure Food Act, to which reference was made inTHE LANCET of Feb. 9th, p. 373. Since the Act has becomeeffective the products of certain large packing houses, whichwere formerly labeled " potted ham" or "potted tongue,*’now bear the names "potted meat, ham flavour," and

"potted meat, tongue flavour." The substance has not been

changed but it is now designated by its right name. Again;,for many years the public in the United States have beendeceived into buying coffee from which ’’ the poisonouscaffeine and the poisonous tannic acid have been removed."Preparations such as these are impossible to preparewithout completely destroying the properties of thecoffee and it is satisfactory to find that under thenew law they are amenable to the section on mis-

branding. Turning to drugs, one of the most importanteffects of the Act consists in the numerous changes-that have been made in well-known nostrums which formerlycontained alcohol, morphine, cocaine, chloral hydrate,cannabis indica, acetanilide, and other drugs of a poisonousnature named in the Act. As a declaration of the presenceof any of these drugs must now be made on the label themanufacturers have generally altered the formulae rather

than admit their presence. The medical profession as muchas the public has been fooled in this way. Mixtures oiacetanilide and other ingredients which were formerlyexploited as definite chemical compounds are now being soldas mixtures and, in some cases at least, their compositionhas been totally changed. Thus, ammonal now bears uponthe label the name " ammonium phenylacetamid " and it is