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representative of the profession aa a whole. Such an attempwould be altogether opposed to the spirit and object ofthe congress. For it is not a scientific medical congress.The object, on the contrary, has been to form a com-

mittee representing the efforts made to organise the pro-fession and able to speak on behalf of that small minoritywho have especially devoted themselves to the study of itseconomical interests. The medical profession as a wholeis not organised and does not pursue studies of this descrip.tion. Therefore, if the British members of the congresswere a faithful representation of the entire profession onlya minority of the members would understand the objectof the congress and be capable of taking practical part inits work. Viewed in this light it seems to us that the

British Committee comprises precisely the sort of elementsrequired for its purpose. Nearly all its members are

delegated by active and prosperous organisations engagedin solving economical problems. The presence of eminent

authorities on medicine or surgery as such is not neededat this congress. No scientific papers will be read. Whatis wanted is men who have experience in the vexed ques-tions usually discussed under the heading of the " Battle ofthe Clubs or "Hospital Abuse," men who have practicalknowledge of the difficulties of grouping medical practi-tioners together and of forming strong unions capable offighting in defence of their economical interests. Most ofthe members of the British Committee of Patronage havebeen actively engaged in such endeavours. They have wonlaurels in the struggle. Nor is this the case only withregard to the British section, as is shown by the presenceof Dr. Vandam and Dr. Cuylits, the president and secretaryrespectively of the Brussels Medical Union, among the

supporters of the movement. All who have read our accountof the fight these gentlemen organised against the BelgianMutualists will readily admit that they may have much toteach other workers on the same lines. Other countries-and notably France itself-will be represented also byleaders and organisers, men who have fought over everyinch of ground in the law courts and in Parliaments againstthose economic forces that tend to degrade and lower thestandard of the medical profession. Such men as theseshould ensure the success of the congress-they have thepractical experience which will enable them to indicate whatis the right course of action.

WHEN ADULTERATION IS GOOD.

OUR remarks on the alleged adulteration of golden syrupwith maize glucose published in our issue of Oct. 14th,1899 (p. 1034), have prompted a specialist on the subject toforward us a recently printed (January, 1900) pamphletcontaining, he avers, the whole truth about the ques-tion. Oddly enough he shows by a number of analysesthat adulterated syrup is, when regarded as a food, purerthan unadulterated. In fact, he says it would be more

reasonable to regard golden syrup as the adulterant insteadof maize glucose and Mr. H. W. Wiley, a recognisedauthority on the subject, states that syrups of commerce areglucose adulterated with so-called cane syrups-that is, withthe drippings and refuse of sugar refineries. Golden syrupwould seem, therefore, to need a new definition. The termwas at one time certainly applied to the by-product of loafsugar manufacture, but loaf sugar exists no longer. Before

1860, on the introduction of centrifugal machinery and thechange that it caused in the nature of syrup, golden syrupbecame a generic term like "syrup" but of narrower appli-cation and lost any significance it may have had in regardeither to composition or method of manufacture. From thattime golden syrup as known to the trade has been preparedin various ways from various substances. This declarationthrows an entirely new light on the nature and origin of I

modern "golden syrup." Still we fancy that the publicwould rather know that they were buying natural syrup fromthe cane than a sugar derived from the acid digestion ofmaize. The preparation of maize glucose is, however, con-ducted with great care and there is no reason for doubting thewholesomeness of the product. In regard to future actionunder the Sale of Food and Drugs Act the old difficultyarising from the want of a definition will be encountered.Definitions as to certain foods are, it seems to us, essential inthe clauses of the Act before certain cases of adulterationcan be satisfactorily established. We have pointed this outagain and again as a defect in the provisions of the Foodand Drugs Act. In any case the purchaser has a right toget exactly the article in nature, in substance, and in qualitythat he demands. Substitutes may be even better thanthe original article, but that does not justify deception.Fraud is nothing if not impertinent and a somewhat

astounding example of this occurred last week. A grocerhad purchased a cask of brandy which he thought wasHennessy’s brandy, so he purchased some labels closelyresembling that used by this well-known firm and attachedthem to the bottles. A person who asked for a bottle of

Hennessy’s three star brandy was supplied with a sampleof the defendant’s bottling. The magistrate pointed outthat the defendant was liable to be sent to prison withhard labour for four months without the option of a fine,but he decided to fine him .610, with r.10 10s. costs. No

steps apparently were taken against the printer who hadsupplied labels closely resembling those used for a well-known article, the vendors of which, however, have an

effective remedy in their hands in the provisions of thelaws of the land.

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GUARDIANS OF THE POOR AND THE

VACCINATION ACT.

THE minimum fee of 5s. or 5:. 6d. for a vaccination wheretwo or more visits have to be paid and an aseptic opera-tion performed is no better pay than a practitioner getswho visits for ls. per visit and 2s. 6d. for medicine, yetwith all this we find boards of guardians who appraise theservices of their public vaccinator at a less fee and passresolutions to ask the Local Government Board to reduceit. The real fact is that the anti-vaccinationist never dreamtthat the public were intelligent enough to accept vaccina-tion provided that it was offered to them on terms that

they could accept. It is gratifying, therefore, to findthat the new Act of 1898 has been more generally usefulthan was at first expected. But we have a report beforeus of the last meeting of the Wigan Board of Guardianswhich unanimously passed the following resolution: "Thatin the opinion of this board the maximum charge fixed

by the Local Government Beard by the Vaccination Order,1898, for vaccination is too high and requires revision, andthat a copy of the resolution be sent to all unions in Englandand Wales and also to the Poor-law Association with a

request that the Executive Council take steps to remedy thisdefect." That such a resolution should be passed by apublic body that has never yet paid or proposed to

pay the "maximum" fees to its vaccination officers,so far as we know, is beyond comprehension. Thestatement was made by the mover of the resolutionthat "the charges, as fixed by the Local Government

Board, undoubtedly constituted an outrage on the liberalityof the community." The italics are ours. He furthersaid that in 1898 the charge in Wigan was 30; in 1899it had risen to iC192, an increase of 162, but he failedto state that in 1898 vaccination was in abeyance, owing tothe guardians neglecting to order their vaccination cfficerto prosecute the delinquents, and that of those vaccinatedin 1899 a great many were children who should have

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been vaccinated in 1897 and 1898. Furthermore he failedto state that the emolument from this "extra" which goesto the district medical officer, as he happens to be the

public vaccinator. was very much below the average. One

guardian remarked that "vaccination ought to be at a

much less price than they are now paying for it." Probablywhen a new appointment is made this board will ask

medical men to tender at a contract price, and will then bewilling to publish the prices of the successful contractor.A borough with a population of over 63,000 is not payinga large sum in disbursing ;&212 in return for two years’vaccinations.

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THE COMMON FORMS OF MENINGITIS.

Dp. CHARLES L. DAXA of New York publishes an interest-ing and opportune paper on this subject in the dozcrnal ofNervous and Mental Disease for December, 1899. Few subjectsare more perplexing to a student than the different types ofmeningitis. The classification, never very simple, has under-gone constant changes during the last decade. In one ofthe earliest and most conscientiously made classifications ofmeningitis, that by Huguenin (published in Ziemssen’s" Cyclopaedia " nearly 25 years ago), 14 different forms ofcerebral meningitis were described. In Grasset’s masterlywork published about the same time the forms describedwere acute, chronic, and tuberculous meningitis. The pro-

gress made in the past two decades has been shown on theone hand by a gradual simplification of the classification,and on the other by clinical and pathological studies whichhave added richly to the store of knowledge and obliged usto add two or three new names to the list. Thus, in therecent treatises of Gowers, Oppenheim, and Mills from 10to 12 types of meningitis are recognised. The various typesof the new and the old added together make a total of about"20 different forms, without using the term ’meningismus,’or including acute cerebral cedema or acute and chronic

hydrocephalus." The forms of meningitis as seen in

ordinary practice are shown by an analysis of 137 cases

collected by Dr. Dana from the records of Bellevue Hospital,New York, during the past 15 years. In 46 cases the recordsof necropsies were also available. The forms of meningitisin the 137 cases referred to include the following :—Purulentor fibrino-purulent lepto-meningitis 52 cases, cerebro-spinalmeningitis 15 cases, serous meningitis of traumatic, alcoholic,or infectious origin 15 cases, tuberculous meningitis 14 cases,internal pachymeningitis (hasmorrhagio and syphilitic) 12

cases, chronic lepto-meningitis three cases, external pachy-meningitis from mastoid disease two cases, and unclassifiedforms 19 cases. Apart from these there were five cases ofspinal meningitis. Leaving out the spinal cases there were,therefore, only five kinds of meningitis recognised in

ordinary hospital practice. It will be seen that the puru-lent, tuberculous, cereb!o-spinal (epidemic and sporadic), andserous are the principal forms, while pachymeningitis is

practically only a chronic syphilitic manifestation. "Acute

syphilitic meningitis," says Dana, " is certainly most rare, ifit ever exists, at least, using the word acute in the same waywe apply it to other forms." And again, posterior basicmeningitis-a phase which only denotes its topographicaldistribution-is probably a syphilitic or tuberculous diseaseor a serous meningitis. These hospital figures in Dana’s

experience seem to coincide in the main with those of

ordinary and general practice. Acute spinal meningitis isa very rare disease. Dana confesses that he has never seen a

primary case and can find no record of one. It is well Ito abandon the distinction between cerebral and spinal I Imeningitis in ordinary clinical work, for if pus is foundon the cerebral membranes it is almost invariably pre-sent in the spinal canal also. Similarly tubercles are

often found in the spinal canal if there is a cerebral

tuberculous meningitis. Pachymeningitis is a disorderwhich has received an extraordinarily rich vocabularyof qualifying terms, and the distinction into external

and internal types is an academic one. Extra-duralabscess would be the correct term for acute suppurationsinvolving the outer surface of the dura. Intra-nasal, aural,and mastoid inflammations are really the morbid conditionsin such cases and they call for surgical treatment. A

non-surgical pachymeningitis is mostly an internal pachy-meningitis. This form of disease is commonly syphilitic-and not infrequently hsemorrhagic. The hsemorrhagicform is associated with disease of the blood and blood-

vessels and is found practically only in scorbutic children,in some forms of insanity, and in chronic alcoholism.

Leptomeningitis both clinically and pathologically occursin one of three forms, the epidemic cerebro-spinal, the

fibrino-purulent, and the tuberculous. The first is well

known, and in doubtful cases the employment of lumbar

puncture enables us to settle the diagnosis if we find the

diplococcus intracellulalÌs or the micrococcus lanceolatus.Most epidemics seem to be associated with the former anda few with the latter organism, but there is no way of

distinguishing between the two forms except by culture.Purulent or fibrino-purulent meningitis is usually a pyogenicinfection due to the streptococcus pyogenes or to the

pneumococcus of Fraenkel, but may sometimes be due toalmost any other pyogenic organism. Clinically it is not

possible to distinguish these from one another and all havea high mortality. While tuberculous meningitis is one of thebest known and most readily recognisable, the same cannotbe said of serous meningitis. Oar knowledge of thisaffection is far from complete. To this class of brain

affections should be added the so-called cases of meningismusdescribed by Quincke (1891) and later by Boenninghaus(1897), of which about 40 have been recorded. Some of

these have been traceable to the effects of alcoholism with its

resultant cerebral irritation, congestion, and cedema, or beenassigned to conditions rising from narcotic poisons, cerebraltrauma (traumatic serous meningitis), or cerebral exhaustionand starvation. Acute cerebral oedema, usually followingsevere blows on the head, is associated with symptoms likethose of true meningitis, lasting two or three days and thengenerally disappearing with rapidity. The acute serous

meningitis of alcoholism and allied toxic conditions called" wet brain closely simulates meningitis and lasts about 10days. A mild delirium, with a temperature of 101° or 102° Faand some muscular twitchings may be observed. The skin is

hypersesthetic and the irritability of its vascular mechanismis shown by the tache cérébrale which can be readily evoked.There is some rigidity of the neck with contraction of thepupils, while the tongue is coated and the bowels are con-

stipated. Eventually the patient dies or turns towards con-valescence at the close of the second week. The serous

meningitis of Quincke and Boenninghaus is an acute bydro-cephalus occurring most often in children or in youngadults. Sometimes it runs a short course ending in recovery,and sometimes it is rapidly fatal. A few cases are marked

by partial remissions and subsequently by gradually develop-ing hydrocephalus. It affects the sexes in equal proportionand pyrexia is present in about one-third of the number ofcases. The cause is some form of infective fever in abouthalf the cases. Traumatism, otitis media, and sepsis are

occasional factors and bacteriological tests so far have beennegative.

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FLOATING HOSPITALS FOR WEST AFRICA.

IN a lecture given at the Livingstone Exhibition, held atSt. Martin’s Town Hall on Jan. 5th, Miss Mary Kingsley,in urging the claims of the Colonial Nursing Association,said that what was wanted on the West Coast of Africa was