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VIENNA.(FROM OUR OWN CORRESPONDENT.)

Chronic Nephritis.ACCORDING to Dr. Chvostek chronic arthritis does not

- depend on the presence of micro-organisms in either the joints or the blood. The finding of bacteria in the joints,- either after death or when death is impending, provesnothing, and the hypothesis that a specific micro-organism isthe cause of arthritis is untenable. The symptoms of thedisease are not constant, the only characteristic feature’being a swelling of short duration affecting a joint-,a condition which may be induced by toxins alto-gether apart from living bacteria. On the other hand,Dr. Singer, who has examined the blood, the urine, andthe articular exudations in ninety-two cases, states thatboth staphylococci and streptococci are to be found. In threeinstances post-mortem examination showed the same bacteriaas in the living subjact; in one case the synovial membranecontained bacteria, but the exudation was free from them ;in a third case there were haemorrhages with numerous-streptococci in the peri-articular tissue. These facts explainwhy in a great many cases the articular exudations are free-from bacteria. The inflammation of the synovial membraneis symptomatic, the infiltrations which contain the bacteriabeing frequently in the peri-articular tissue. Dr. Singerconsiders that the erythema multiforme which frequentlyaceompanies arthritis is a typical pyasmic affection of the- akin ; he is opposed to the view that salicylic preparationshave a specific action, and he has seen very favourable resultsproduced by intravenous injections of a mercurial salt.

The Murphy Button.In an article published in the Medicinische Wochensehmift

Dr. Marwedel has given an account of the results obtainedwith the Murphy button in fifty-five operations. In thirty-five cases an anastomosis was made between the stomach andthe intestine and in three cases between the gall-bladder andthe intestine ; in twenty-nine cases there was carcinomatousstenosis. Twenty-three of the thirty-five cases of gastro-enterostomy showed an improvement ; two of the cases of’cholecystenterostomy showed an improvement, and the

remaining one died. The button was usually passed afterthe lapse of two weeks. According to statistics published byDr. Brentano cicatricial stenosis resulted in only three

among 328 button operations.Compulsory Insurance and Medical Aid Societies.

At the last meeting of the Medical Chambers Dr. Janovsky,<of Prague, called attention to the compulsory insurance ofworkmen-a subject of which I have already given an accountin THE LANCET.1 On the ground of the disastrous effectswhich this system of insurance produces on the incomes ofmedical practitioners Dr. Janovsky proposed a resolution thesubstance of which was that all the Medical Chambers shouldbe invited to declare that the holding of a permanentappointment in connexion with this work constitutes anethical misdemeanour, and that such practitioners will con-sequently be brought before the council of honour. Theresolution was unanimously adopted, and the meeting alsomade arrangements for presenting a petition to Parliamentpraying for the repeal of the compulsory laws. The followinggentlemen were then elected on the committee : Dr. Adler,Dr. Klotzberg, Dr. Kohn, Dr. Lerch, Dr. Mucha, and Dr.Witlacil.

Cyclic Albuminuria. Dr. Ostwalt has published in the Klin’ische Rundschau a

highly interesting paper on the pathology of cyclic albumi-nuria, a subject our knowledge of which is very imperfect,amounting to little more than the recognition of the fact thatthe upright position of the body causes albumin to make itsappearance in the urine, but that it is absent from the urineat night. In two cases of this condition observed by Dr.Ostwalt the patients suffered from intra-ocular haemorrhages,sometimes before the appearance of the albumin in theurine and sometimes during the cyclic albuminuria. Theurine, which was previously normal, then contained 2-75grammes of albumin per litre, and there was also oxaluria.Perverted metabolism has the effect of rendering the wallsof the vessels unfit for the complete performance of theirfunctions, and albumin consequently makes its way into the

1 THE LANCET, June 13th 1896, p. 1681; and Feb. 20th, 1897, p. 558.

urine when the renal vessels are under unfavourable hydro-static conditions-that is, when the body is in the uprightposture.

Oct. 24th.

RUSSIA.(FROM OUR OWN CORRESPONDENT.)

The Treatnaent of the Insane in Russia.IN the last number of the Russian journal, Arkhi’IJ

Psikhiatrii, appears an interesting article by Dr. Yakovenko,throwing much light upon the present state of Russianlunatic asylums, and comparing the provision now made bythe zemstvos for dealing with lunatics with the State ofaffairs before the days of zemstvos. Like so many othermodern institutions and methods in Russia the presentsystem dates from that great epoch of reforms whichincluded the emancipation of the serfs in 1861 and theintroduction of the system of local self-government byzemstvos in 1863. Before that period the care of theinsane in Russia was in the hands of a governmental bodyknown as the PrikaN, or Ministry of Social Supervision (Prikazobshtckestvennago prizri&eacute;nia). When the functions of thisbody passed over to the zemastvos there was asylum accom.modation in Russia for 1167 patients ; now this number hasgrown to 9050. Formerly the annual sum expended on eachpatient was 90 roubles (about &pound;9), now it is 215 roubles(over .E21). Consequently the total annual cost of theasylum population of Russia is at the present time not farshort of 2,000,000 roubles, instead of only a little over

100,000 as formerly. Great improvements have also beenintroduced in the methods of treating the insane. Fortyyears ago there was still a tendency to regard lunatics almostin the light of criminals and to treat them as prisonersrather than as the unfortunate victims of disease. All thishas now been altered. The chains and ropes, cages andbars, handcuffs and strait-waistcoats which were formerlyfound in every asylum in constant use are now thingsof the past and physical restraint is resorted to only inrare cases where it is absolutely necessary. In brief, thetreatment of the insane in Russia is now conducted on thesame principles of science, common-sense, and humanityas in other countries. But, writes Dr. Yakovenko, there isstill a good deal to be done before the asylum accommoda-tion in Russia can be regarded as adequate. He calculatesthat the number of insane persons in the governments"under zemstvo rule is somewhere between 127,000 and191,000. Consequently, at the present time only some 7 percent. of the total number are now treated in asylums.Comparing Russia in this respect with other countries, hefinds that in France the proportion of insane under control inasylums to the total number of insane is 40 per cent.; inSwitzerland, 58 per cent.; in America, 66 per cent. ; and inScotland it is as high as 83 per cent. The immediate aimof the zemstvos, the article concludes, should be at least toprovide accommodation for such cases as absolutely requireasylum treatment, and as these may be reckoned at about20 per cent. of the whole it follows that the present numberof available beds should be at least tripled.

.King Menelik as a Scientific Observer.A member of Colonel Leontief’s second expedition to

Abyssinia, Dr. Theodorof, writes to last week’s Vratch aninteresting note on the use of kousso in Abyssinia as ananthelmintic, and in the course of his letter he throws lightupon quite a new side of the many-sided character of KingMenelik. Kousso, or Halgenia Abyssinica, is, it seems, notonly a native product of the country but is in vast demandamong the inhabitants on account of its power ofexpelling intestinal parasites. The first description of theplant was published by the great English traveller,Bruce, who explored the region of the sources of theNile late in the last century. But it was only in themiddle of the present century that it came into general useas an anthelmintic. As such it is a valuable drug, but itsaction is accompanied by unpleasant symptoms, such as

nausea, vomiting, colic, and diarrhoea. The Abyssinians,however, employ it constantly, for, according to Dr.Theodorof, every person in the country is at some time orother the subject of T&aelig;ni&aelig;. Possibly the male-fern doesnot grow in this country or its vermifuge properties are

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unknown to the inhabitants; at any rate, kousso is the in.variable remedy to which they resort to expel theworm. They take it in the morning, fasting, and in theform of pellets, rubbed up with other herbs. Recently,it appears, the subject engaged the attention of King Menelik,who was struck by the unpleasant complications of the actionof the drug already mentioned, and he is said to have arguedin the following way. The vermifuge action of kousso residesin the flowers of the plant, and probably the active principleis in the juices of the flower ; consequently this active

principle probably is absorbed by bees when they suck thejuices, and therefore it was possible that it might still befound in the honey secreted by such bees. From theory toexperiment was a short step with the king. He summonedhis henchman, Takle-Georgis, and commanded him to planta grove of kousso trees and to establish an apiary hard by,to wait until the kousso had finally ceased to blossom,and then to collect the last honey from theneighbouring hives. This was done, and as the kingfurther argued that the active principle would probablybe in more concentrated form in the honey than inthe whole flower, he ordered that only a teaspoonful of thehoney should be given to the selected patient in a tumbler ofwater. The experiment is said to have succeeded to perfec-tion. The dose acted as a thorough vermifuge, and therewere none of the unpleasant complications associated withthe action of the kousso flower. The account of this interest-ing experiment was taken down by the writer of the letterdirect from the lips of Takle-Georgis, and he adds that thismethod of taking kousso is now general in Abyssinia, at leastamong those near the king. If the stoiy be true, and thereseems no reason to doubt it, it not only shows that KingMenelik is possessed of real scientific acumen, but seems topoint to a new field of experimentation in practical pharma-cology.

Russian Medical Conferences.It is announced that some time next year a Russian con-

ference of physicians will be held in St. Petersburg to dealwith the subject of leprosy in Russia. ,

The first steps towards preparing for the BalneologicalConference, already announced as to be held in Russia next)ear, have been taken. A preliminary commission has beenformed, and at its head is Professor Pasternatzki, thePresident of the balneological section of the RussianNational Health Society.

St. Petersburg, Oct. lith (23rd).

AUSTRALIA.

(FROM OUR OWN CORRESPONDENT.)

Medico-legal Cases.SBYEEAL cases of medico-legal interest have been before the

courts lately. The first is what is known as the 11 Eaglehawkmurder," a case that has been going on for some time, thejury at the first trial disagreeing. Briefly the case was asfollows. On Feb. llth the wite of Charles John Hall, ofEaglehawk (Victoria), was found dead in a tub of water byher husband. Dr. Thorn was called and made, as itproved, a somewhat cursory examination of the body. Aninquest was held by a police magistrate, no necropsy wasmade, and Dr. Thorn gave evidence that in his opinion Mrs.Hall had fainted and fallen into the tub, and being advancedin pregnancy was unable to extricate herself and wasdrowned. The jury returned a verdict of "Accidentaldeath from drowning" and the body was buried. Subse-quently, suspicious circumstances coming to the knowledgeof the police, Hall was arrested and the body exhumed. Dr.Neild, lecturer on forensic medicine at Melbourne University,made a post-mortem examination of the body and declaredthat death was not due to drowning, but to suffocation,his chief reason for this opinion being the absence of waterfrom the lungs and pleural cavities. There were also bruiseson the body, and the teeth had been displaced and the nosefractured by violence applied before death. Evidence wasgiven that Hall was improperly intimate with a barmaidnamed Eva Scott and on bad terms with his wife. At thetrial in the criminal court the jury disagreed. At the secondtrial the medical evidence was the same, except that theCrown called additional experts, one of whom, Dr. Mallison,said from the description given by Dr. Neild he was not pre-pared to say that the signs were inconsistent with drowning.

The woman Eva Scott said that she had written to Mrs. Hallinforming her that Hall was the father of Scott’s child, andhad done so to induce Mrs. Hall to leave her husbandand get a divorce. Hall had asked Scott to get poisonfor his wife, and had also said that if he put herhead in a tub of water no one would have any suspicion. Awax model of the body of Mrs. Hall, in the position in whichit was found, was made and brought into court and placedin the tub. Rigor mortis had set in when the body wasfound, and it was significant that one leg and thigh wereextended, and the position was incompatible with the theorythat she had fainted and fallen into the tub. The jury foundHall guilty of murder, and the conviction has been upheld bythe executive. - Another case of more special interestto the profession is that of Searle v. Gurdon, just con-

cluded in the County Court, Melbourne, before JudgeChomley and a jury. The plaintiff and his wife claimed&pound;500 damages on the ground of alleged unskilful, improper,and negligent treatment of Mrs. Searle by E. J. Gurdon,of Brighton, medical practitioner. The defendant counter-claimed &pound;63 10s. 6d. for medical attendance on Mrs. Searle.The evidence has not been published, but it would appearthat Searle asked Dr. Gurdon to see his wife. He did so,and found that she had some endometritis and trouble in the

Fallopian tubes. He advised a consultation with a specialist,with a view to operation. Dr. Balls Headley was called inand performed abdominal section. It was agreed that thefee was to be 100 guineas and that Dr. Gurdon was to attendher after the operation. She recovered and went for a tripto a neighbouring colony. She continued to consult Dr.Gurdon, who said that if she was not perfectly well it mightbe necessary to curette, and if so he would do it without

charging any special fee. She continued to improve, however,and in his opinion curetting was not necessary. The Searles.then removed to another district and called in the localpractitioner, Dr. R. E. Weigall. Shortly after Searle calledon Dr. Gurdon and demanded that he should curette hiswife free of crarge. Dr. Gurdon refused, as he said he didnot think it necessary, and also demanded payment of his.fees. Searle then said that he did not intend to pay, thathe would get Dr. Weigall to operate, and that Dr. Gurdonwould have to pay the expenses incurred. Dr. Weigalloperated and Searle then sued Dr. Gurdon. The jury foundfor the plaintiff, awarding one farthing damages and alsofor the defendant (Searle) on the counter claim. The judgesaid he took the verdict to mean that the plaintiff had nomeritorious claim and that the action should not havebeen brought, and that the counter claim was merely a.

consequence of the claim. He accordingly refused to allowcosts on either case. The jury added a rider that the firstoperation was properly performed and that professionaletiquette was detrimental to the interests of patients.

Cancer Curers Committed for Manslaughter Again.Not long ago reference was made to the trial of so-called

Professor " Davis and Dr. Spark for manslaughter in thecase of a Mrs. Steele, where Davis and Spark, who are inpartnership, had applied a p1aster, alleged to contain arsenic,to a cancer of the breast, the case ending fatally. At an

inquest concluded on Aag. 27th on the body of a Mrs.Beames the same pair were again committed for man-

slaughter. In this case the patient had a cancer of thetongue, and a plaster containing black sulphur and 4 percent. of crystalline arsenious acid had been applied. Postmortem, no evidence of arsenical poisoning was found, thecause of death being septic pneumonia. The legal advisers ofDavis and Spark maintained that the application of arsenicto cancer of the tongue was a perfectly proper proceeding,and in support of this view referred to an excerpt in theBrit’ish Medical Journal of July 3rd of a paper by Uerny and1’runecek (Semaine .lYlcdicale), in which this treatment was.advocated.Sept.14th.

DR A. M. BERGER has found in the VaticanLibrary (Cod. Vat., 3211) a collection of prescriptions anddirections for treating various eye diseases in MichaelAngelo’s own handwriting, obtained probably from medicalfriends mainly for his own personal benefit, as it is knownthat the great sculptor was nearly blind before he died.Dr. Berger has published this in its original Italian with a.few notes in German. It appears not to have been previouslypublished, though it is mentioned by Pierre de Nolhac as.forming an addition to Michael Angelo’s manuscript poema.