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sultations of the Fellows, but that at the present time isdebarred from acting in accordance with its desire and con-viction. It is a very great advance to have securedthis expression of opinion and intention from the Council,and the Fellows of the College are indebted forthe advance to the initiative and persevering actionof the Committee of the Association of Fellows, whichhas been working for the last two years with a single eyeto the elevation of the Fellows of the College of Surgeonsran the constitutional scale. Since the issue of the lastreport of the proceedings of the Association a great dealhas been done, and those Fellows who have not kept them-selves informed of the progress which has been made will,we believe, in a few months have an opportunity of making-themselves acquainted with the debt which they owe to theAssociation, as at the last meeting of the Committee a sub-committee was appointed for the purpose of drawing up areport of the proceedings of the Association since March,1890, when the last report was issued.

All that is needed for a complete realisation of theprogramme of the Association is that the Fellows of theCollege who desire an improvement in their position and anincrease of their power, privileges, and influence, shouldrally round those who have borne the burden and heat ofthe day. For the prosecution of the campaign the sinewsof war are required, and as the annual subscription is onlyhalf-a-crown, a considerable number of members is neededin order that the Committee may meet the necessary ex-penditure for printing and correspondence. The Committeedefrayed the cost of the last report by a private subscription,the regular income sufficing only for the regular expenditureThe cost of the next report ought to be borne by the Fellows.generally, as the work that is now being done by theAssociation will considerably enhance the value of theFellowship of the College.

THE VIRCHOW "FESTSCHRIFT."

(Concluded from page 1187.)THE second volume is devoted to Pathological Anatomy.

Tt opens with a memoir on the " Comparative Pathology ofInflammation," by Dr. E. Metchnikoff (Paris), and is an’exposition of the universality of "phagocytism " in presenceof irritation or the intrusion of foreign bodies, as observedin invertebrates. Even in those animals which have neitherblood nor leucocytes this reaction is evidenced by an accumu-lation of mobile connective tissue cells. Incidentally, Dr.Metchnikoff remarks that this doctrine of "phagocytism" cannot be called teleological when applied to infective

disease, for he points out that it is not invariably a salutaryprocess, and that it follows rather the doctrines of evolu-tion. It is, he claims, supported on the one hand by theDarwinian theory, and on the other by the cellular patho-logy of Virchow. Dr. E. Ziegler (Freiburg) discusses the" Causes of Pathological Neoplasia," and demonstrates howmuch in this question has arisen out of Virchow’s teachings.The subject of "Nuclear and Cell Division during Inflam-mation and Regeneration " is dealt with by Dr. C. J. Eberth{Halle). Professor Mosler (Greifswald), in describing in fulldetail a case of "Acromegaly," enters fully into the wholesubject of the evolution and symptomatology of the affec-’tion, and shows himself fully acquainted with its literature.He suggests as an alternative term that of "Pachyacry."Professor Notbnagel (Vienna) describes a case of a peculiar"Pernicious Bone Disease (Lymphadenia ossium) "in a youngman, running a febrile course, and characterised by pain inthesternal region, marked blood changes, with enlargement of,the cervical glands, thickening of the sternum, and muscularatrophy. The necropsy showed widespread invasion of themedullary cavities, with lymphadenomatous new formationas well as general hyperplasia of lymphatic glands. " Ochro-nosis of Cartilage" is the title of a paper by Professor’Bostroem (Giessen)-a condition of pigmentary degenera-tion first described by Virchow, and the cause of which isobscure, apparently related to some blood changes; it con-sists in the appearance in cartilage of areas of a brownish-yellow or blackish tint. Professor Zahn (Genf) writes onthe "Rib-markings on the Free Surface of Thrombi."’These familiar markings, seen so clearly in auricular

thrombi, but present also in parietal thrombi on veins andarteries, are due, he thinks, to conditions parallel to thoseproducing the "ribbed sea-sand "-namely, a rhythmic to-and-fro movement of the viscous fluid over their surface.The presence of these marks thus indicates the prioroccurrence of an intermittent blood stream, due to failingpropulsive power, aud in the veins therefore they show theprevious existence of a pulse. The " Metaplasia of MorbidTissues is discussed by Professor Sangalli (Pavia), withexamples of the sarcomatous conversion of uterine myomataand of fibroid thickening of the pylorus (he thinks manycases of so called "scirrhus pylori" are of this nature);a remarkable case of cirrhosis of the liver which becamesarcomatous is narrated; and there is also a discussionon epithelial new growths and the mode of genesisof metastatic formations. Dr. Miura (Tokio) contributesan account of a " Primary Giant-celled Sarcoma of theThoracic Aorta," the second case on record (the firstwas recorded by Brodowski). Although there was alsoinfiltration of the spine and right femur (which led tofracture of that bone), yet he points out that the earliestsymptoms were thoracic, that the growth on the aortic wallwas obviously of older date than these other infiltrations,and that the absence of any pulmonary growths practicallyexcludes the consideration that the latter was secondary tothe bone lesion. Moreover, secondary tumours of the aortaare unknown. Dr. H. Heiberg (Christiania) contributes amonograph on " Primary Urogenital Tuberculosis in theMale and Female." Of eighty-four cases of this form oftuberculosis, twenty-nine were primary and fifty-fivesecondary. He shows that it is comparatively rare for thelesions to be limited to one or other part of the tract, andgives a full description of the changes in each organ con-cerned. A comparatively novel subject is treated by Dr.Chiari (Prague)—namely, "Gastric Syphilis." It is theresult of a systematic examination of the bodies of syphiliticsubjects, 243 in number, extending over seven years.Amongst these he found two with gummatous formations inthe gastric mucosa, one in acquired and one in congenitalsyphilis. The growths were in the form of flattenedmasses projecting into the interior of the organ, andulcerating. In the acquired case they were associated withtubercular ulcers of the intestine. He also describes otherlesions of the stomach, inflammatory and ulcerative, moreor less directly related to syphilitic infection. ProfessorNeumann (Konigsberg in Preussen) treats of the interestingtopic of " Intestinal Diverticula and Persistent VitellineVessels as a Cause of Intestinal Obstruction," in a mono-graph which will afford material for many subsequentwriters ; and the cognate topic of " Inguinal Hernia," inrespect to its pathological anatomy, is discussed in a moreoriginal essay by Professor Eppinger (Graz). Here we havea detailed account of the regional anatomy and some in-teresting facts upon the mode of formation of some of theseherniae, which he shows to be of retro-peritoneal nature.Professor Uhthoff (Marburg) writes on "Metastatic Car-cinoma of the Choroid," a condition which, in comparisonwith the frequency of primary choroidal sarcoma, is veryrare. He gives the details, clinical and anatomical, of twocases he personally observed, in which the eye was impli-cated secondarily to mammary cancer. In both the ocularaffection was limited to the posterior part of the globe, andthe optic nerve was infiltrated as well as the choroid."Secondary Apoplexy from Traumatism is discussed byDr. Bollinger (Munich), in which the facts as to the con-sequences of cerebral concussion observed by Duret findample confirmation.The third volume embraces subjects in pathological

etiology and clinical medicine. It is pleasant to find thatthe first contribution is from a French source. M. Bouchard(Paris) here deals with the question of "Alleged BloodVaccination," in which he gives some of his own experi-mental studies upon the bactericidal properties of the bloodof inoculated animals. He thinks, however, that theimmunity so conferred cannot be regarded as "vaccina-tion " in the sense in which this term is applied, but ratheras a new method of procuring general antisepsis. Hedeprecates any premature attempt to introduce "hæmato-therapy " into practice. A similar topic is treated byProfessor Guido Tizzoni (Bologna) in his paper on "Arti-ficial Immunity from Tetanus." The "Etiology of Leprosy"forms the subject of an essay by Dr. G. Armauer Hansen(Bergen), whose experience of the disease in Norway entitleshim to be heard with attention. From that experience he

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is firmly convinced that contagion rather than directinheritance accounts for the prevalence of the disease,although he admits the possibility of an inherited pre-disposition. He gives the satisfactory assurance, supportedby many years’ statistics, of the diminution of leprosyin Norway since isolation has been in force. ProfessorBaumgarten (Tubingen) writes on the "Action of Koch’sRemedy (Tuberculin) in Inoculated Tubercle of Rabbits." Theinjections excite an acute exudative inflammation or acutehypersemia around tuberculous parts, which may end in

suppuration, and thus the isolation of the infected focus;but they have no effect at all on the bacilli, which evencontinue to develop. Nor does the method ensure anyimmunity in the tissues from further infection. So that itis no wonder that he is compelled to declare that tuberculinhas no curative value, in spite of its undoubted specificrelation to tuberculous tissue. This results from its notbeing anti-bacillary in its action, and he thinks the ex-perience of its employment in man fully bears out thisconclusion. A long paper of importance to the veterinarianis that on "Inoculation in Contagious Pleuro-pneumonia(Lungen-Seuche) and its Antisepsis," by Professor Schutz(Berlin). The interesting subject ot "Inheritance ofInfectious Diseases " is discussed by Professor Max Wolff(Berlin), in which he shows that there is, except in anthrax,not much evidence of direct transmission from the maternalto the fcetal organism. Bacillary transmission is, however,characterised by haemorrhages in the placenta. But it isnot possible to generalise from one disease on thispoint. Drs. Celli and Marchiafava (Rome) gather up alltheir extensive experience of the study of the blood inmalarial fevers in an exhaustive paper on the " Parasitesof Red Blood-corpuscles." Professor Iwanowski (St.Petersburg) gives an account of the "Pathological Ana-tomy of an Endemic Disease at Chankow," based ona case of a tea-dealer who had contracted it inChina, and who died at St. Petersburg. From thedescription given, the disease appears to belong to theclass of diarrhceal affections known as "psilosis" or

41 sprue," with which Dr. Thin has made us acquainted inthis country. It is conjectured to be of malarial origin andto be due to a micro-parasite, which, however, does not seemto have been isolated. Sir James Paget writes in his usualhappy manner on " Scientific Study in the Practice of Medi-cine and Surgery," especially directing attention to the ad-vantages which would accrue from a scientific nosology, froma more thorough observation of the effects of mingling ofdiseases by hereditary transmission or otherwise, and theinfluence of medicines as tests of disease. An article on the" Principles of Antiseptic Surgery " is contributed by SirJoseph Lister, in which he unfolds the methods that his ex-perience has shown him to be of best service. Dr. vonZiemssen (Munich) writes on "Rare Forms of Pleuritis,"particularly metapneumonic pleurisies, and a condition of"circumscribed indurating pleurisy" he has met with.Some valuable facts in "Regional Diagnosis of BrainDisease" are afforded in the paper on this subject byProfessor Leyden (Berlin). Professor Gerhardt writeson "Pneumonia with an Intermittent Type of Fever,"not, however, associated with malaria. The subject of"Pneumaturia" is discussed by Professor Senator, thesources of this admixture of gas with the urine beingsummarised as-(1) due to the entrance of atmospheric airinto the bladder ; or (2) of gases from communication of theurinary tract with the intestine; and (3) the development ofgas in the bladder from fermentation. He gives an accountof the last-named in connexion with diabetes. Dr. LeoPopoff (St Petersburg) draws attention to a clinical fact,which seems to have escaped record hitherto, in his paperon the " Difference of the Radial Pulses as a Symptom ofMitral Stenosis," a difference which he attributes to thepressure effect on the aorta and left subclavian artery ofthe enlarged left auricle and pulmonary veins, for it isinvariably the left radial pulse which is the smaller. Pro-fessor Stokvis (Amsterdam) writes on the "Antagonism ofPoisons and Remedies," detailing a series of experimentsmade on the frog’s heart. Dr. Horatio C. Wood (Phila-delphia) contributes a paper on "Strychnine as a Respira-tory Stimulant," showing that it is more powerful thanatropine, and citing a striking case of opium.poisoning,where its hypodermic injection proved of great service.Professor Rindfleisch (Würzburg) describes a very simple" Hsemochromoscope," in which all that is needed is to notethe number of drops of blood required to produce a standard

tint on bibulous paper. Lastly, this admirable collection of-monographs is completed by a very exhaustive paper on the" Development of the Doctrine of Motor Laryngeal Paralysessince the introduction of the Laryngoscope," contributedby Dr. Felix Semon.

THE ELECTION OF DIRECT REPRE-SENTATIVES.

I AT a largely attended meeting of the medical profession,of Oldham, held at the infirmary, Dec. 1st, 1891, under thepresidency of James Corns, Esq., M.D., the following reso-lutions were passed :-" 1. It is unadvisable that thestandard of the preliminary examination be raised. 2. Itis unadvisable that the age of qualification be raised. 3. Weapprove of the education and examination of midwives,and of the placing of such trained persons on local registersathe reasonable interests of the profession being protected.4. That a copy of these resolutions be sent to each candi-date for the General Medical Council, THE LANCET, and’the British Medical Journal."

VITAL STATISTICS.

HEALTH OF ENGLISH TOWNS.

IN twenty-eight of the largest English towns 5542 birthsand 3702 deaths were registered during the week endingNov. 28th. The annual rate of mortality in these towns,which had increased in the preceding four weeks from 18’1to 20-7 per 1000, declined again last week to 20’5. The ratewas 19’9 in London and 21’0 in the twenty-seven provincialtowns. During the first eight weeks of the current quarterthe death-rate in the twenty-eight towns averaged 19-3 per1000, which was 1-5 below the mean rate in the corresponding periods of the ten years 1881-90. The lowest ratesin these towns last week were 13’4 in Portsmouth, 14-3 inBlackburn, 14 4 in Brighton, and 14-5 in Hull; thehighest rates were 29’0 in Wolverhampton, 31’1 in New-castle-upon-Tyne, 32-2 in Sunderland, and 38-3 in Ply-mouth. The deaths referred to the principal zymoticdiseases, which had increased from 332 to 413 in the pre-ceding four weeks, declined again last week to 391; theyincluded 114 from whooping-cough, 96 from measles, 55from " fever " (principally enteric), 47 from diarrhoea, 41from diphtheria, 37 from scarlet fever, and one fromsmall-pox. The highest death-rates from these zymoticdiseases were recorded in Brighton, Birkenhead, Halifax,and Blackburn ; the highest in Salford, Wolver-hampton, Sunderland, and Newcastle-upon-Tyne. Thegreatest mortality from measles occurred in Wolver-hampton, Newcastle-upon-Tyne, and Sunderland ; fromscarlet fever in Huddersfield ; from whooping-cough inOldham, Bradford, Cardiff, and Newcastle-upon-Tyne;from "fever" in Preston, Wolverhampton, and Salford -,and from diarrhoea in Portsmouth, Salford, and Wolver-hampton. The 41 deaths from diphtheria included 26 inLondon, 5 in Manchester, 2 in Oldham, and 2 in Sheffield.One fatal case of small-pox was registered in Birmingham,but not one in any other of the twenty-eight towns; one-small-pox patient was under treatment on Saturday last inthe Metropolitan Asylum Hospital at Dartford, but notone in the Highgate Small-pox Hospital. The deathsreferred to diseases of the respiratory organs in London,which had increased in the preceding eight weeks from 171to 394, further rose last week to 414, but were 28 belowthe corrected average. The causes of 84, or 2’3 per cent.,of the deaths in the twenty-eight towns were not certifiedeither by a registered medical practitioner or by a coroner.All the causes of death were duly certified in Portamoutb,Bristol, Salford, Newcastle-upon-Tyne, and in three othersmaller towns; the largest proportions of uncertified deathswere recorded in Manchester, Nottingham, Sheffield, andHuddersfield.

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HEALTH OF SCOTCH TOWNS.

The annual rate of mortality in the eight Scotch towns,which had increased from 18-7 to 31-2 per 1000 in the pre-