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themselves to heal, but a great part of the substance of the carbuncle fairly exposed, and also under the necessity of healing. But you will observe that the whole of the space that now remains to heal is a series of openings in the middle of the carbuncle, through which the sloughs are to be separated, through which, indeed, nearly the whole of the sloughs have already been discharged, and which now merely remain to be healed like the cavities of small abscesses, In that way you narrow greatly the extent of wounded surface to be healed. Indeed, it by no means always follows that the whole carbuncle, or its whole base, sloughs. Carbuncles, if not divided, not unfrequently only suppurate about their centres, and slough only in their central parts, and the borders merely clear up by the softening and dispersion of the inflammatory products in them. In every case of that kind you save greatly the amount of healing which has to be gone through. Nay, in some cases 'carbuncles completely abort. One of these cases, of which I have the paper on the table, was that of a woman, aged sixty-four, who came in with a carbuncle nearly as large as this, in a condition which, it might be said, required incision at once; but, with the exception of two or three small points, no suppuration or sloughing ensued. That carbuncle dispersed, aborted, cleared away. This case shows the more ordinary course of events-the sloughing of the central part, the gradual discharge of the sloughs, and the comparatively small spaces which are left in the centre of the carbuncle as the sole space in which the process of healing has to be achieved.

On these three points, which are the grounds that have been assigned as reasons for cutting carbuncles, I have now given you the evidence on which I have ceased from the practice. I fully believe that crucial incisions do not prevent extension; that it is only a limited set of cases in which the incisions diminish pain; and that with regard to the time that is occupied in healing with or without incisions, the healing without incisions is very clearly and certainly a great deal the quicker.

The kind of incisions that I have been speaking of is the old plan of crucial incisions. Another method which I have occasionally tried, but of which I can only state the same 'general results, is that of subcutaneous incision. This has been supposed to have the same general effect as the other; and I think that the same general conclusions may be drawn respecting it: that it is a measure unnecessary in the treatment of carbuncle, and that it retards rather than hastens the healing. When I speak thus of the incision of carbuncles, however, I do not mean to say that there is no condition of carbuncle in which an incision is not useful. Sometimes a carbuncle sloughs in its central part, with one continuous slough of integument holding in a quantity of pus. In that case you would cut through the slough, or through any adjacent part of the carbuncle, to let out the pus, as you would open an ordinary abscess. But this is not a measure which is commonly understood by the "incision of a 'carbuncle."

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If you ask why one may not cut a carbuncle though it may do no good, I reply that you should never be actively useless, and that there are some cases in which the cutting does considerable harm. Carbuncles, for the most part, occur in persons broken down in health, exhausted by overwork, or by bad food, or in general deteriorated health— sometimes in diabetes or albuminuria; and in all these states it is a good general rule to save the blood they need for healing. The loss of blood from the carbuncle itself would not be considerable; the hard substance of the carbuncle, when cut into, does not bleed, or bleeds but little. But to carry out the incision perfectly, you have to cut into the adjacent healthy texture; and this sometimes bleeds very profusely, so as to lead to all the distress and pain of plugging the wound with this or that substance to arrest the blood.

Another measure in the treatment of carbuncles which is supposed to be necessary, is very high feeding and large quantities of stimulants. I learned the opposite of this in one of those cases which you will do always well to study those, namely, in which the patient refuses to do what you advise him. It is from such cases that we may often learn what is commonly called the "natural history of disease”— its course undisturbed by treatment. A case occurred to me once of an old gentleman, eighty years of age, who had a carbuncle, as big as it could be, on the back of his neck, for

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it extended from one ear to the other, and from his occipital spine to the third cervical vertebra. He measured it for his own amusement, and it was fourteen inches over its surface transversely, and nine inches vertically-a carbuncle, then, of the largest size, and one, it might have been supposed, attended with considerable risk to life. I urged him very strongly to take a large quantity of what is called support," for I was at that time under an impression of its necessity. He absolutely refused, however, and nothing would induce him to take it. I was therefore content to stand by and study the natural history of disease in this huge carbuncle; and the natural history of it was a history that one would have wished to witness in every carbuncle of its size, for no case could pass through its course in a better method. He led his ordinary abstemious life, took moderate quantities of food and of stimulant, lived through a carbuncle of the greatest severity, and finally made a complete recovery, and lived for several years after.

Another case which impressed me very much was that of a friend of my own in the profession, who had a carbuncle on the back of his neck, of very considerable size. Sir Benjamin Brodie and Mr. Stanley attended him with me, and under their advice the carbuncle was cut. I watched its course afterwards, and felt sure that the cutting had done neither good nor harm. It went on as carbuncles do when not cut. But the gentleman was subject to intense headaches, of which he knew by experience the only possible remedy was almost entirely to leave off food, and absolutely and entirely to leave off stimulants. One of these headaches occurred during the course of the carbuncle, at a time when we had put him upon very full diet and abundant stimulant. He said then that he must leave off his stimulants and food, and we looked with some alarm at what would be the result on the progress of the carbuncle. I remember Mr. Stanley saying to him, in his distinct manner, My dear fellow, if you don't take food, you will die." Very well," he said, "then I will die, but I will not take food and increase my headache." According to his own wish, therefore, we reduced his diet to a very low level. The course of the carbuncle was not affected at all, unless it were for good; and after three or four days of this, which might be called comparative starvation, he described himself in his own emphatic fashion as being as jolly as a sand-boy."

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Since that time I have watched carefully all cases that I have seen, and I am certain that there no good to be obtained by large feeding or abundant stimulants in ordinary cases of carbuncle. The whole of these cases that have been in the hospital were put on our ordinary meat diet, with a pint of porter daily; and I see that two of them have had four ounces of wine a day, one of these being a person aged sixty-four and the other sixty-three, and both having carbuncles of considerable size. You will find that for patients in private life it will do very well if you tell them that they may have about two-thirds of their ordinary amount of food, and about the same proportion of their ordinary quantity of stimulants. But indeed there is scarcely any reason to change in any material degree the ordinary mode of life of a patient with carbuncle. So far as he can with comfort take that to which he is accustomed, so far he may. If his diet has been habitually low, so it may remain; if habitually high, so, within certain limits and somewhat reduced, it may still remain.

Now you may ask what I should set down as the things to be done for a carbuncle. These boards, nearly bare as they are, may tell you. In local treatment one of the best things you can do, if the carbuncle is small, is to cover it with emplastrum plumbi spread upon leather, with a hole in the middle through which the pus can exude and the slough can come away. That, occasionally changed, is all the covering that a small carbuncle will need. It is difficult thus to cover the whole surface of a large carbuncle, and to keep it clean; therefore, I think that the best application for that is the common resin cerate. This should be spread large enough to cover the whole carbuncle, and over it should be laid a poultice of half linseed-meal and half bread. And, if you want to exercise your skill, learn to make that poultice well, and to put it on well, and to keep it in its place well. That mode of dressing the carbuncle, so far as the materials are concerned, will last through its whole course; but whilst the carbuncle is making progress and discharging its slough, you will find plenty of room for

the exercise of considerable skill in dressing it, and filling up the cavities with soft substance spread with this ointment. Besides this, the carbuncles are to be carefully washed, especially with some deodorising substance, as Condy's fluid, or weak carbolic acid, and the cavities may be syringed out with it. The importance of cleanliness is very great. You noticed in the man whom I showed you just now the spots of acne and boils around the edges of the carbuncle. This points out the necessity of care, which I suppose had not been taken there, to keep the surface of the skin adjacent to the carbuncle perfectly dry, and free from any contact with the discharge, which seems really to have the power of infecting the neighbouring skin, and so producing the boils which are apt to arise, sometimes in clusters, around the carbuncle. Of diet I have already spoken to you. Of medicines I say nothing. Quinine, bark, and other medicines of that class, may be given if you please, or in case of evident need, and so may aperients; but there is really no need of them in an ordinary case of carbuncle. But there is one medicine which you may find very valuable, and that is opium, especially in all the earlier painful stages of carbuncle, in which it relieves the suffering as thoroughly as incisions, or anything I know. After the early stages, even that is unnecessary, except for some patient who may be unable to sleep.

But there is one measure in the treatment of carbuncle which is seldom employed, and yet is of great importance, and that is letting the patient have very free air. The general idea that carbuncles are very dangerous diseases has commonly led to the patients being entirely confined to bed and kept shut up in their rooms. There is in that an unnecessary care; and this, too, I learned from a patient who refused to comply with injunctions-a gentleman with a large carbuncle on the back of his head, who would not keep his bedroom. He had been accustomed to an active life, and after seventy or eighty years of that custom he was quite indisposed to remain in his room. So with that carbuncle he daily came down stairs, changing his room and moving about the house as well as the pain and weakness would allow him. No carbuncle could go on better; all the stages were passed through without any risk or trouble, and it healed with unusual speed. After that I had a yet more striking case. A lady came to London "for the season," as she called it; and she had not been here more than a week or ten days before a carbuncle came out on the back of her head, just under her hair. It was a great vexation to her that she had to give up all her amusements; and so, as she did not mind the pain, she would go out. And it was then that, for the first time and the last, I saw any value in a "chignon." She dressed her carbuncle under the chignon, and she went to the park, to the theatre, and to dances unharmed, and with her carbuncle quite unseen, and no trouble whatever followed. It healed up after the ordinary fashion in about the ordinary time. But, indeed, you may see cases of this description

rations of surgery, and less really than that of any disease of equal severity that you can name. Of those four deaths, one occurred in a patient aged seventy-eight, who died of erysipelas after the carbuncle had nearly healed. Another was a gentleman of about fifty-five years of age, who died of chronic pyæmia. The third was a gentleman aged fifty, who died with acute pyæmia. And the fourth was a patient of about fifty years of age, who died rapidly exhausted. The first three were from causes which may almost be called accidental; for so we call them when occurring after an operation, and it would be unreasonable to suppose that any other method of treatment would have averted the consequences. The other died, possibly, on account of the deficient stimulation; for he was a man who had lived freely, and took during treatment less than he had been accustomed to have. The main point, however, to which I wish to direct your attention, is that the mortality may be as little as two per cent. I cannot doubt that the mortality was considerably larger when carbuncles were severely cut; for the severe cutting meant often severe bleeding, and was attended with all the consequences of large wounds. Thus, though I do not know the exact proportion, I believe that the general reputation of the danger of carbuncle was well founded, and that among the reasons for the diminished mortality of carbuncles may be set down as chief, the more frequent avoidance of the custom of cutting them. Speaking of the mortality of carbuncle, however, I must remind you that I am not speaking of a disease which sometimes passes under the name of carbuncle-the carbuncular inflammation of the lip which sometimes occurs in young persons: a disease which you may not have seen, and may pass many years without seeing. It was described by a former house-surgeon of this hospital, Mr. Harvey Ludlow, as malignant pustule of the lip. Dr. Budd, of Bristol, has also so described it. Commencing at one spot, inflammation of the whole lip follows and spreads to the face, and then disease of the lymphatics ensues, with pyæmia as its consequence. It is a disease so unlike carbuncle that it ought not to be known under the same name. It seems to me not like the accounts given of the malignant pustule abroad, and I have seen no other disease like it in England. It attacks especially young persons from fifteen to twenty-one; and of fifteen cases that I have seen, only one recovered. That disease is not carbuncle, nor is the mortality of that disease to be counted in estimating the mortality from carbuncle. Ordinary carbuncle on the lip and face has none of those special characters, and is not more fatal in those situations than in any other.

Abstract of a Lecture

ON THE

EPILEPSY.

By J. SPENCE RAMSKILL, M.D. LOND.,

on a much larger scale if you watch the carbuncles that USE OF BRUCINE IN STOMACHAŁ come to us in the out-patients' room. There we often see them of considerable size, and they do as well among the out-patients as among the in-patients; and yet these outpatients are freely in the air all day, and many of them continue at their work. So you may set it down as one point to be attended to in the management of carbuncles that patients should not be confined to their room. They should at least have change of air in their own house; and, unless they are too low, they should not avoid exposure to the fresh open air.

Treating your cases of carbuncle upon this plan, I believe you will find that the great majority will pass through their course well. I cannot tell you what the ordinary proportion of deaths from carbuncle is; but I know that carbuncles are commonly looked upon in the profession as dangerous things, and a large carbuncle on the back of the head is considered to be fraught with risk to the patient's life. But that is very far from being the case in my experience. Remembering, as far as I can, or rather guessing at the number of carbuncles I have had to treat, I should say that there is no other disease of the same extent and general severity which is attended with so little risk to life. During twenty years of hospital and private practice, I cannot have treated less than 200 carbuncles; and of these 200, four have died, giving a mortality, at a fair guess, of only two per cent.-a mortality which is less than that of most of the minor ope

PHYSICIAN TO THE HOSPITAL FOR PARALYSIS AND EPILEPSY; PHYSICIAN TO, AND LECTURER ON MEDICINE AT, THE LONDON HOSPITAL.

A LARGE proportion of the cases of epilepsy have, as an aura, or warning of the coming fit, some disturbance referred to the stomach-such as nausea, attacks of flatulence, undefinable sensations, represented as rising upwards, and consciousness ceasing when the sensation reaches the head; and these are the cases, also, in which vomiting follows the fit. The vomited matters always contain food, and sometimes in an undigested condition, although some hours may have elapsed since the last meal. There may be no proper symptoms of dyspepsia in the intervals between the fits beyond a constant disposition to the generation of flatus, indicating permanent disorder of the ganglionic nerves. The functions of the pneumogastric, moreover, become perverted; and the cause of this may be at the root of the nerve, or at its periphery. Supposing disorder of the centre

to be the starting-point, then perversion of the normal function of the nerve at its periphery in the stomach (and also sometimes elsewhere) is its natural expression. But supposing the nervous centres to be only in the usual condition belonging to epileptics--not healthy, but in a morbidly irritable state,-then a temporary disorder, produced by undigested or indigestible food, in its peripheral branches, will increase centric disturbance, cause reflex contraction of cerebral blood vessels governed by vaso-motor nerves, and an explosion in the shape of a fit.

cumulative action, or suddenly poisonous effect, from the administration of either alkaloid. You will find great satisfaction in giving bromide in large doses at bedtime, at the same time ordering brucine twice daily; thereby you ensure the sedative action of the bromide, and the tonic effect of brucine on the whole nervous system.

SCIENTIFIC INVESTIGATION INTO THE
CAUSES OF CHOLERA.
(Concluded from p. 41.)

The same argument applies to disorder of the small intestines, the splanchnic nerves furnishing the medium of III. communication between the mucous membrane and the reflex centres. The fit in that case is usually followed by diarrhoea, and not by vomiting. Such cases as these are not best treated by bromide of potassium alone. One of the bad effects of this drug, perhaps the only one caused by the bromide even in moderate doses, is what we call the bromide dyspepsia. The objective symptoms are foul breath, a white tongue, involving the edges as well as the dorsum, and not necessarily furred, with great languor and sleepiness. Anorexia must be added to the list. It will be found that when such a condition exists there will be an accession of fits, although up to the time of the stomachal disorder the attacks may have completely ceased.

Under such circumstances your best proceeding will be to use any ordinary alterative aperient with effervescing salines, and when the colour of the tongue has returned and by that time the other symptoms I have mentioned will have disappeared also-then to recommence the bromide treatment in conjunction with lactate of soda, in a dose of from five to fifteen grains, in some bitter infusion, the best of which is the infusion of chiretta. I prefer chiretta because it acts as a cholagogue, and the only objection is that it occasionally produces diarrhoea. You may give the bromide for a long period in this combination without having to suspend it on account of the " bromide dyspepsia."

Now a suspension of epileptic attacks is, for many reasons, always desirable. Yet suspension is not cure; and, for the most part, when you cease to give bromide of potassium, the attacks return. Can we prevent these? I think we can often do so by building up the patient, by using means to improve the nutrition of the tissues, of the nervous masses, and of the ganglionic nerves especially; for I hold that a convulsion is an impossibility in a perfectly healthy brain and nervous system; and I think these views should form the basis of all treatment. Is there any tonic remedy of value for this purpose? I think so; and I have found the best in brucine,-beyond many of recognised value. Mr. Tyrrell (of Malvern) has published some cases treated successfully by strychnine. I have used this drug extensively, and when the patient can remain under close observation, or if he be attended by intelligent friends, I should not hesitate in proper cases to recommend its use. But there are cases of idiosyncrasy, and small doses will sometimes evoke disagreeable toxic symptoms. I have not been annoyed in this respect with brucine, perhaps because it is a weaker alkaloid, and the patient gets more easily accustomed to its use. Its physiological effects, however, so closely resemble those of strychnia, that it may be taken for granted their therapeutical virtues are the same. I usually order it in a solution made of the same strength as the liquor strychnis of the Pharmacopoeia, and commence with a dose of ten minims, to be taken twice daily; every third day an addition should be made of five minims to the dose, until from a third to half a grain is reached. If any stiffness of jaws or other toxic symptom appear, the dose is to be diminished by five minims, and continued until any new objectionable symptom is manifest; then it is again lessened. You will not find any benefit from either brucine or strychnine till a full dose is reached; often the reverse effect. As a rule, patients will take twice as much brucine as strychnine, without any necessity for diminishing the dose. After the continuous administration of brucine for a month, I think it well to suspend its use for some days, and then again resume it. I may remind you that Dr. Marshall Hall used strychnine in epilepsy, but he gave it in very small doses, and without success. Given in large doses, and with the precautions already mentioned, I have not met with any case suggesting

REPORT OF INTERVIEWS WITH PROFESSOR
ERNST HALLIER, AT JENA, Oct. 1868.

BY

DR. D. DOUGLAS CUNNINGHAM

AND

DR. TIMOTHY LEWIS,

ASSISTANT-SURGEONS IN H.M. INDIAN AND BRITISH SERVICES.

PROFESSOR HALLIER received us with the greatest kindness, and endeavoured to show us his preparations and to explain his views as completely as possible; but he considered there was no time to do full justice to his plan of investigation or to the proofs of his opinions. It would require, he thought, at least two months' work for this.

I. Apparatus which Professor Hallier employs. These are generally rather complex, as Professor Hallier's method of observation depends for the value of its results on the supposition that isolation is as perfectly secured as possible. 1. The large apparatus, as described in his "GährungsErscheinungen," p. 14: It consists of a glass flask, fitted with two tubes, one of which is connected with the isolating media, whilst the other enters the receiver of a small airpump, by means of which any amount of air can be drawn through the whole apparatus. He thinks that, if it were possible (i. e., if a sufficient number were at hand), only this kind should be used. He considers its great advantages to lie: 1st. In its being as perfect an isolator as is possible to be obtained without resorting to great expense. 2nd. In its affording means for the supply of as much air as may be thought necessary. 3rd. In enabling the material cultivated to be used in considerable amount, which he considers almost essential for good results. Of course it has the disadvantage of not providing any means for the continuous observation of progressive development, as the results of the cultivation in it can only be examined on breaking open the flask.

2. The small apparatus: This consists of a small bellglass, communicating with the air by a bent tube, and standing in a basin of permanganate of potash. In this, as described in the "Gährungs-Erscheinungen," the substance to be cultivated is made to rest on a small glass or earthenware dish, so as to keep it out of the permanganate solution. (See Fig. 2, a.)

II. The substrata which Professor Hallier employs.

1. The freshly exposed pulp of a lemon, "which, as freshly exposed, may be presumed to be free from spores or fungal elements."

2. Thick starch paste, containing some salt of ammonia. 3. Solution of grape sugar.

4. Cork which has been previously soaked in alcohol. This is carefully dried, and "when employed as a substratum is kept so, but surrounded by moist air." 5. Fresh potato.

In making a series of observations on development, he employs the large apparatus for getting fully developed results, and several of the small ones for results which may be frequently examined, and so show the steps of development.

In making any series of observations, two pieces of lemon, cork, &c., should be employed, on one of which spores are sown, and on the other they are not, so as to be able to compare the one piece with the other.

III. A summary of Professor Hallier's views as gathered from explanatory statements made whilst demonstrating his preparations of cholera stools, &c.-Professor Hallier stated that the fundamental idea of the whole theory is that "moulds

THE LANCET,]

are mere unripe forms of ustilagines." This is a view of his own, and is not generally recognised. He believes that any fungus of this series may appear under various forms; these forms depending on the nature of the substratum, and on the degree to which ripening goes on. If the spores of an ustilago be cultivated, two forms always appear-viz., the schizosporangic and the cladosporic forms; if the soil on which any of these forms appear alters or ferments, the forms produced are different. He states that each species of ustilago has three ripe forms of fructification, and that each of these has a corresponding unripe representative, the use of the unripe form being probably, according to Professor Hallier, to prepare a more nitrogenised soil on which the higher forms may be developed. "If tilletia caries be cultivated on weak, poor soil, we get only unripe forms-i.e., moulds make their appearance.'

These ripe and unripe forms may be thus tabulated, taking as an example the fungus associated with cholera :Unripe.

1. Macroconidia.

2. Penicillium crustaceum. 3. Mucor racemosus.

Ripe.

1. Tilletia caries.
2. Cladosporium.
3. Schizosporangium
(cholera cyst).

The ripe forms are distinguished from the unripe ones by having a cuticula developed, which makes them much more resistant.

"Macroconidia" is the term which Professor Hallier applies to dilatations such as occur in mucor racemosus. He believes that they are unripe forms of fructification, and are capable by a ripening process of becoming tilletia caries spores; but in place of ripening they may, unlike the ripe spores, germinate at once. If the soil on which this germination takes place be sour and poor in nitrogen, penicillous forms result i. e., the unripe representative of the cladosporium. If, on the other hand, the soil be rich in nitrogen, mucor forms appear-i.e., the unripe representative of the schizosporangium. A schizosporangium is precisely the same as a mucor sporangium, save that it has a cuticula developed on its exterior, and that the contained spores are each provided with a sheath.

The mode of germination in the two forms is quite distinct. Each spore on a schizosporangium on germinating gives origin to a filament, which pierces both the sheath peculiar to the spore and the wall of the containing capsule, without rupture having taken place. In the mucor sporangium, on the contrary, rupture or disappearance of the capsule always takes place before germination, as it, being destitute of a cuticula, is not strong enough to resist the pressure of the swelling spores. (See Fig., and compare with Fig. 4 in the Halle report.) In Fig. 11, however, the schizosporangium had ruptured (a). The only form of the series asso. FIG. 11.

a. Schizosporangium.
bb. Macroconidia.

C.

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in "process of developing into tilletia spores." (Hallier.) "From Dr. Hallier's Preparations of Cholera Stools.) ciated with cholera which is peculiar to the disease is the

schizosporangium or the cholera cyst; but they may probably on investigation be found to occur on the rice plant in India. The schizosporangia of the cholera series are in this climate peculiar to the disease only. They can only be developed on a nitrogenous basis, and under a high temperature. Cholera originates under the same conditions in which true cysts can be produced. This may possibly cause the difference between Asiatic and European cholera-the first being due to the micrococci of the schizosporangia; and the second to the micrococci of their unripe representatives, mucor sporangia, as well as to the indigenous ripe form, tilletia spores.

Professor Hallier does not state positively that cholera is It is only due to the fungus, and he does not believe that any infectious disease can be caused by spores per se. micrococci that are efficient agents in producing disease. This may account for the fact that tilletia spores can be and constantly are swallowed in large quantities without producing any bad effects. They are not retained long enough in the intestinal canal to produce micrococcus, and therefore pass through quite passively.

The question of "micrococcus" being thus introduced, Professor Hallier stated his views on the subject. He defines micrococcus as "particles of plasma without any cell-wall." When these particles acquire such a wall they become either" cryptococcus" or "arthrococcus," according to the nature of the medium in which they are contained. Micrococcus, on being introduced into a fluid capable of alcoholic fermentation, becomes cryptococcus, corresponding with the bodies which are generally included under the vague term "yeast cells." If, on the other hand, micrococcus be introduced into a fluid capable of sour fermentation, they become arthrococcus-i.e., they assume an elongated form, and become one form of what are commonly termed bacteria. The term "bacteria," as usually applied, includes both arthrococcus and micrococcus, but no idea of their nature and relations had been attained until Professor Hallier discovered that they were merely the ultimate elements of fungi.

Micrococcus and arthrococcus are multiplied by fission; cryptococcus cannot be so multiplied, "from the strength Micrococcus may be deof its walls and hollowness of its centre," and it is therefore multiplied by gemmation.

veloped into higher forms in two ways:-
1. It may acquire a cell-wall, and pass on through the
arthrococcal or cryptococcal stage to the formation of a
fully-developed fungus.

2. It may under favourable conditions germinate at once, and give rise to mycelium.

In these views, as well as in those referred to above,
IV. Preparations.
Professor Hallier stands quite alone.

1. Micrococcus. Professor Hallier exhibited numerous preparations, some of which he considered proved the development of micrococcus, and others its direct germination. In those showing development the field presented bodies like yeast cells mingled with granular matter; but of course no preparations could show that they were mere modifications of one another. In those showing germination there were also granules present, but in this case mingled with fine filaments; but one could not see definitely that these were organically connected. And, as generally, fully-developed fungi existed in the same preparations, but one could not feel certain that the filaments were not mere detached portions of these, associated by mere juxtaposition with the granular matters

Professor Hallier instituted a culture of scarlatina blood in our presence, in order, if possible, to demonstrate this development and germination of micrococcus. The small apparatus already described was used for the purpose. A drop of the blood being placed on a glass slide (the blood having been preserved for about three weeks in a closed test-tube), a little grape-sugar solution was added as a substratum, and a covering glass placed over it, the latter being separated from the slide by a perforated piece of thin cardboard, which had been soaked in alcohol. This preparation exhibited under the microscope numerous more or less disintegrated blood-corpuscles, associated with granular matter and numerous minute circular bodies, which Dr. Hallier described as being various stages of micrococcus. (See Fig. 12, c.) However, owing to the short period of our stay with him, no result whatever was attained.

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a, Small cultivating apparatus.

b, Glass slide, with perforated cardboard between it and the

covering glass.

c, Blood from scarlatina patient, with micrococcus, crypto-
coccus, and arthrococcus.

2. Illustrative of the relation of moulds and ustilagines. Professor Hallier showed some preparations which, he considered, demonstrated the tendency on the part of mucor dilatations (i. e., macroconidia) to ripen into tilletia spores. These macroconidia (see Fig. 11) presented a double contour, which he ascribed to a tendency to the formation of a cuti cula. This condition was quite indistinguishable from the same appearance produced by the mere shrinking of the protoplasm, as noted at Halle. (See Fig. 5 in that Report.) In several of these preparations some tilletia spores undoubtedly existed, but they were always merely lying among the other materials of the preparations, and their existence in such preparation might have been due to mere accidental entrance into the cultivation. The preparations were chiefly derived from cultivations in the large apparatus; therefore, of course, the separate steps in the development were not seen to take place.

3. Preparations illustrative of the tendency of penicillium to form dilatations resembling macroconidia. A great number of these preparations were exhibited, as, in Professor Hallier's opinion, they prove the identity of mucor and penicillium. (See Figs. 13 & 14.)

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THE summer which has just passed has been very remarkable for its extreme warmth and dryness, and it might naturally be expected that so unusual a season should exercise an obvious influence on the forms of disease prevalent during its continuance, and since it has been succeeded by cold and wet weather. In this paper I propose to offer brief notes of some of the affections which have fallen under my own observation, prefacing them by some account of the weather, and of the amount and causes of mortality, derived from the Registrar-General's weekly and quarterly returns. Mr. Glaisher's reports very decidedly show the exceptional character of the season. He states that the first eleven days of the year were cold, but after that the temperature rose above the average, and continued so throughout the winter, spring, and summer. In the quarter terminating March 31st the exceptions to the excess of heat were few in number and small in amount. Altogether the

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