1066 MURDER BY MEANS OF BACTERIA.

the exudate. Where there is much lymph, drainageis unlikely to be of benefit for more than a few hours ;where the infection appears virulent and there arefew adhesions it would be dangerous to close theabdomen entirely. It is likely that in the futurethe surgeon will be guided by the naked-eye estimateof the clotting process and a microscopical examina-tion of the fluid to determine the resistance offeredto bacterial invasion. D. P. D. Wilkie has shown 1 thatit is possible by a rapid microscopical examinationof the peritoneal exudate performed in the theatre,to form an estimate of the resistance offered toinfection, and thereby to judge the proper course topursue. Such a proceeding might lead to a furtheradvance in abdominal drainage, comparable to thatachieved by a study of the mechanical factor ofgravity which resulted in the adoption of the Fowlerposition. It is time for a collation of availableexperience.

MURDER BY MEANS OF BACTERIA.

THE role of bacteria as friends and enemies has notyet been fully estimated. Lempp, in a recent issue ofthe Archiv fiir Kriminologie (Vol. lxxiii., Parts 3/4),has an interesting article on the homicidal employmentof bacteria, which is at present topical in view ofcertain proposals for the scientific development ofwarfare. Glancing at ancient literature, for instanceThucydides’s account of the Athenian plague, andmediaeval history, he pronounces, naturally enough,that these reports of pestilence spread through theaction of enemies are in the great majority of casesmerely fanciful. Just as baseless are the tales ofaviators dropping bon-bons containing pathogeniccultures, or of laboratory workers contaminatingwater-supplies, which were recently given currencyby, and perhaps often originated in, the sensationalpress. He states that on the German side suchreports received for the most part immediate officialinvestigation and discountenance. Probably the onlyauthenticated instance of the use of pathogenicbacteria in warfare is, curiously enough, the practiceof the warriors of the New Hebrides, of dipping thepoints of their weapons in marsh mud, which containsmany tetanus spores. Equally scanty is indubitableevidence of murder by the means under notice ; forprobably there are but two properly recorded cases ;and the second of these, that of the druggist andartist Hopf, did not go beyond an attempt. In 1914Hopf was convicted of poisoning his first wife witharsenic, and of attempting to murder his third oneby means of typhoid and of cholera germs. Thelatter infection was quite abortive, and examinationof the culture in his possession showed it to have lostall virulence. The typhoid bacilli, on the contrary,were extremely pathogenic, having particularly highagglutination, a quality evident also in a strainisolated from the blood of an attendant, who alsosickened, upon the wife. It was suspected thatHopf infected some of the entourage in order to givethe impression of an ordinary small epidemic. Fivedays after poisoning his wife’s food he began to takeher temperature regularly : it duly rose two dayslater, but she recovered. He had caused her to makea will directing that her body should be cremated.The cultures-to the number of 30 within nine months-he had obtained from a private laboratory, askingparticularly for the most virulent strains.

Accounts have appeared in American newspapersof murders, or attempted murders, in the UnitedStates by means of bacteria, the only specified kindbeing again typhoid bacilli; the statement even beingmade that it had been proposed to erect in Chicago-a city with one of the worst records for murder inthe world-an institute expressly for combating thisparticular crime. However, the only documentedexample of a fellow to Hopf is that of a Dr.Pantschenko, who, bribed by a relative (by marriage)of the victim, murdered a rich young Russian by

1 Internal Clinics, vol, iv., Twenty-second Series.

injecting, not bacteria, but a bacterial product-namely, diphtheria toxin. The injection was pre-tended to be of spermin, for therapeutic purposes, andthe defence was an admission that the syringe mighthave been not properly clean, thus causing fatalsepticaemia. Septicæmia was, indeed, the diagnosisfirst, arrived at, by an independent medical man,while a second one took the condition for septicgangrene. The site of injection became bluish-black,the temperature rose to 40° C., and death followed ina week. There were two autopsies, the second onlyrevealing the truth, by means of the discovery of adetachable grey membrane in the pharynx, of cardiacdilatation, and of peculiar thinning of the skin at thesite of injection, appearances closely paralleled inad hoc experiments on animals-namely, guinea-pigs-which also died on the seventh day. It was provedthat Pantschenko had obtained diphtheria toxinfrom a laboratory, and also, on a previous occasion,cholera endotoxin and cholera bacilli, a poisonsuggested by the instigator aforesaid. Pantschenkowas sentenced to 15 years’ forced labour. The paperconcludes with a review of current legal precautionsagainst such crime, which seem in many countriesto be altogether lacking, a state of things which itsapparent great rarity does not wholly excuse.

THE WHITE LEAD QUESTION.THE appearance at the present moment of a book’

dealing with white lead is opportune, since the questionis being keenly debated as to whether the use of thismaterial in paints should be interdicted by civilisednations (see THE LANCET, Nov. 12th, a Report ofthe International Labour Conference at Geneva).The author, Mr. F. L. Cantineau, who is frankly andwholeheartedly a prohibitionist, presents his case asan advocate rather than as a judge ; moreover, whendealing with the clinical aspect of the case, he suffersfrom not being a medical man. But we find here auseful summary based for the most part upon govern-ment inquiries and investigations carried out in manycountries. All lead compounds, whether soluble orinsoluble, are held to be poisonous ; while, of them,white lead-i.e., carbonate of lead--is considered tobe the most poisonous, and to claim most of itsvictims from among painters. Indeed, the number ofdeaths due t,o lead poisoning among painters is foundto exceed that occurring in all other industries puttogether ; nor does the damage cease there, since leadabsorption, even to a slight degree, predisposes thevictim to other diseases. We regret to find the skinplaced in the forefront as a portal of entry for lead,the digestive system placed second, with the inhala-tion of lead dust third, since Dr. T. M. Legge hasincontestably demonstrated that the order should beexactly reversed. Similarly, the author is at faultin speaking not unfavourably of the so-called electro-lytic treatment of plumbism, which appears topossess no value. Mr. Cantineau is at his best whenpointing out the. almost insurmountable difficultiesattending efforts to protect painters while working,for example, in private houses, from risk of leadpoisoning, so long as paints continue to contain lead.The question as to whether illness among paintersarises from breathing the vapour of turpentine andwhether such illness may not have been ascribed tolead poisoning (an opinion recently put forward inthis country by Sir Kenneth Goadby) is discussed byMr. Cantineau at some length. Manufacturers ofwhite lead, wishful to preserve their industry fromdestruction, have certainly attempted to maketurpentine a scapegoat : the position is, however,difficult to accept when lead poisoning disappears,while paints containing no lead, but turpentineas before, are employed. The painter may be exposedto two risks ; is that a reason for not abolishingone ? If turpentine is toxic, we can turn our atten-

"La Céruse." F. L. Cantineau. 1921. Pp. 480.Paris et Liége : Librairie Polytechnique.

1067ON THE MEASUREMENT OF RESULTS.

tion either to finding a substitute or to rendering itnon-toxic.The second part of the book is an excellent historical

account of the fight to abolish lead poisoning amongpainters. France has led the way, for there the

campaign started at the end of the eighteenth century,was active throughout the nineteenth, and becameacute at the commencement of the present century.It finally culminated in France in 1909 in a law

prohibiting the use of white lead, linseed oil con-

taining lead, or of any material containing white leadfor painting the inside or outside of buildings. A

period of five years was given before the law shouldbecome operative, and the war intervened. The lawwas not enforced, and even now that the war hasbeen over nearly three years, the difficulties ofenforcing it have not been overcome. The difficultiesarise from the fact that the manufacture of paintcontaining lead compounds is not abolished ; suchpaints can still be used in the coachbuilding trade ;meanwhile, inspectors cannot adequately control theuse of such paints in private houses and other places.Clearly, if France intends to abolish the use of leadin paints employed on buildings, the law will haveto be materially strengthened. No other countryhas yet proceeded so far. Regulations more or lessstringent have been tried in Austria and in Germany,but they have failed to abolish the evil. The move-ment in Belgium, where regulations have also beentried, is discussed by Mr. Cantineau at some length,and the successful result of abolishing the use of leadpaints on the State railways is quoted. The casewith regard to Great Britain, where up to the presentno action has been taken, is presented by relating thefindings of the committees appointed to consider thematter; indeed, throughout this book the evidencepresented to, and the conclusions arrived at, by theseimportant committees are frequently quoted atlength.The remedy recommended is considered in the last

part of the book. Here the conclusions of the author,who is an engineer, are of particular value. Hemaintains that substitutes such as zinc white andlithopone have been proved the equal, if not superiors,of white lead ; and that supposed difficulties in theiruse are entirely imaginary. 11-le shows, by quotingmarket prices, that both these materials to-day costless than white lead. The sources of supply are

looked into and declared to he adequate, so thatincreased demand should not inflate prices, butrather by calling more manufacturers into the field,tend to lower them. " If to-day white lead weresuppressed," he asserts that "our houses would bepainted as well as they are now and that we shouldnot suffer in any way ; and that very probably, aftera period of 20 years, we should almost have forgottenthe very existence of white lead."

PEDUNCULATED PERITONEAL TUBERCULOSIS.

THERE is a rare type of peritoneal tuberculosis,pathologically identical with that commonly foundin cattle and known as Perlsucht, which is charac-terised by the formation of caseous or calcareousmasses, surrounded by a fibrous capsule. In cattlethese masses occasionally reach a considerable sizeand may become pedunculated by dragging on theunderlying connective tissue. In a recent paperDr. Henry M. Rayl reports a case of this conditionin man in the belief that only two such cases havepreviously been recorded in medical literature, thefirst by Bizzozero in 1867, and the second by McCallumin 1901. Dr. Ray’s case is that of a Polish labourerof 25, admitted to hospital with a five years’ historyof constipation, anorexia, and severe intermittentcolicky pains, his later symptoms being a hackingcough,paininthechest and abdomen, general weakness,and loss of weight. On admission the patient wasacutely ill, the abdomen tender and rigid, and theankles cedematous, auscultation showing numerous

1 American Journal of the Medical Sciences, August, 1921.

moist rales all over the chest. Thirty-six hours afteradmission he died, the post-mortem disclosing a massconsisting of a diffusely thickened and fused peri-toneum and omentum, closely adherent to the rectimuscles and fusing with the capsules of liver andspleen. The intestines were found to be thicklycovered with subserous pedunculated firm nodules,varying in size from a pea to a large hazel-nut, withpedicles averaging 3 or 4 mm. reflected on to thenodules and merging into the serous coat of theintestine. The cortex of the kidneys containedmultiple tubercles of the size of a pin’s head, the cutsurfaces of spleen and lungs being peppered with smallnodules. Microscopical sections of nodules from theintestines showed typical tuberculous granulationtissue, with a distinct demarcation between the tuber-culous process in the nodule and the underlyingstructure of the intestine. The parietal peritoneumalso showed tuberculous granulation tissue with largeareas of caseation, while perfectly typical tubercleswith areas of caseous necrosis were found in lungs,liver, spleen, and kidneys. Although virulence testswere not carried out with emulsions prepared from thenodules owing to the fact that the tuberculous natureof the lesions was not suspected until the hardenedspecimens were subjected to routine histologicalexamination, Dr. Ray suggests that the type of lesionfound in his case and in the two described by Bizzozeroand McCallum can best be explained on the basis ofa specific reaction of the host to an infection with atubercle bacillus, probably of bovine type, of a lowdegree of virulence. If this view of the pathology ofthe condition be correct, the nodules may perhaps belooked upon as representing the intestinal equivalentof the multiple benign so-called " sarcoid growths "of the skin, or nodular cutaneous tuberculomata,described by Darier and others.

ON THE MEASUREMENT OF RESULTS.

THE prudent rate-payer likes to see the goodsdelivered. For this and other reasons the fall in thegeneral death-rate has been claimed by many differentworkers in the field of public health as evidence oftheir particular activity, and a salutary warning inthis respect was given by Sir Arthur Newsholme inone of his American addresses.l He was himselfonce taken to task by Prof. Karl Pearson forassociating as cause and effect the fall in the phthisisdeath-rate and the decrease in pauperism; Prof.Pearson alleged a similar correlation between cancerdeath-rate and expenditure per head on apples.Sir Arthur Newshohne rightly deprecated thequantitative assignment of credit for a giveneffort in public health work, when the circumstancesleading to the desired result were multiform andcomplex. A recent issue of the monthly bulletinspublished by the Metropolitan Life Insurance Com-pany of New York supplies an illustration of the needfor such precaution. This company has, with perhapsone or two exceptions, a larger number of insuredpersons on its lists belonging to the wage-earningclasses than any other society. Its work is carriedout in a manner which is worthy of great praise.Not only is its experience carefully collated and theresults from month to month and year to year madethe subject of careful study by its extremely com-petent statistician, Dr. Louis Dublin, but the occasionis taken in each monthly bulletin issued to membersand to the general public to give scientific informationand instruction of high value on health matters.Not only this, but the company have issued leafletsand pamphlets on various health problems, preparedby experts on their respective subjects, and they havefurthermore established an elaborate and almostnation-wide service of nurses, who are prepared,without cost to insured persons, to undertake nursingwhen acute illness occurs in the insured, and who alsoperform many of the functions of English healthvisitors in this country. The work thus briefly

1 THE LANCET, Oct. 15th, p. 833.