untreated, the cerebral arteries are more liable to become affected. (6) All cases of syphilis, presenting even slight cerebral symptoms, demand prompt and energetic treatment.

Amyloid disease of the Liver; do the liver cells become infiltrated with the amyloid material?—In a compilation dedicated to the memory of E. Wagner by his pupils, is an essay by Prof. Birch-Hirschfeld of Leipsic, in which he sets himself the task of settling this "quæstio vexata." He has devised an improved method of double staining by the anilin dyes, Bismarck brown and Gentian violet, taking care to stain first with the brown and afterwards with the violet. In this way the nuclei of the liver cells become somewhat deeply tinted, while the periplast or protoplasm is stained of a lighter brown tint, but quite sufficiently to sharply demarcate it from the red rose colour of the infiltrated amyloid material. B. H. upholds vigorously Wagner's original view, that the process affects not the liver cells, but the walls of the intercellular capillaries, or to put it more exactly, it is localized to the space between the cell border and the capillary wall, so that in early degrees of the affection, the capillaries appear ensheathed, as it were, with the amyloid substance. Moreover, in a series of observations in all stages of the disease he was unable to convince himself in any instance of the infiltration of the liver cells themselves with amyloid material. The changes they undergo relate chiefly to their form and size; they suffer pressure atrophy from the progressive swelling of the intercellular amyloid infiltration. He thus stands opposed to the views of Cornil and Böttcher, who, he believes, have based the results of their investigations either on imperfect technical methods, or even on errors of interpretation. [B. H. thinks they have mistaken amyloid masses adhering to surrounding atrophic liver cells as being included within the cells themselves; at the same time he admits that, without the help of very thin sections and successful staining, confusion is apt to arise as to the exact relation of the masses of amyloid substance to the liver cells.] The earliest deposition takes place in the tunica media of the small hepatic arteries running

in Glisson's capsule, without however at this period necessarily affecting the individual muscle cells, then the subendothelial connective tissue layer of the intima becomes infiltrated so as to define quite sharply the outlines of the lumen. In early stages of the affection of the capillaries within the lobules, he failed to observe any regularity in its distribution; it was quite erratic in its selection in all three zones of the lobule. B. H. concludes with some brief remarks upon the intimate nature of the amyloid infiltration. He is inclined to regard the process as an infiltration of the tissues with a coagulum, which is either separated directly from the blood, or what seems more probable, is formed from the plasma continually bathing the tissues by the union with it of a fermentlike substance that is derived from the blood itself.

A case of Nephritis of twenty years' duration, following scarlatina and terminating in small white contracted kidney, is reported by Aufrecht in the Deutsches Archiv. fïïr klin. Med., Bd. xlii., 1888. The patient suffered from scarlatina when nine years old, and six months later from anasarca and albuminuria, which eventually passed off. Nevertheless, for no less than twenty years from this time he exhibited, but with few intermissions, albuminuria. Whenever he caught a chill the urine was not only albuminous but also contained blood and casts. For five years he suffered from a headache resembling migraine that came on usually after dinner, and was only controlled by regulating his diet. Curious to relate the nephritis appears to have been quiescent during his boyhood, for it had no appreciable baneful influence on his development or school career. attended school, took part in various forms of bodily exercise, and even passed the usual examinations without difficulty. It was during the last two years of his life that the effects of the kidney lesion made themselves most felt, for since 1886 he showed symptoms of a decided uræmic nature, viz., headache and vomiting. The following are briefly the main clinical facts of the case during the year 1887, in which a fatal termination took place :-January: he was so ill that he was obliged to take

He

to bed; suffered from frequent vomiting and headache. General nutrition still good; no hypertrophy of the heart to be made out, pulse tension not particularly high; urine not excessive in amount, clear, but very albuminous.—End of March: uræmic convulsions and coma lasting six days; retinitis.-April: transitory improvement.-May: intense nausea, dyspepsia, leftsided hypertrophy of the heart now unmistakable; another attack of convulsions and coma.-June: continuous nausea and headache, transitory cedema of face, neck, and arms.-July: parotitis left side; death on the 9th, the patient having become rapidly and extremely emaciated during the last months of his illness. At the necropsy considerable hypertrophy of the left ventricle was found; the kidneys were atrophied and contracted and coarsely granular, of a white colour but variegated by some degree of hyperæmia.

As Aufrecht remarks, such authenticated* examples of transition from an acute nephritis to the small white kidney are rare. As is well known, Aufrecht recognises three forms of nephritis: (1) Parenchymatous; (2) amyloid kidney; (3) glomerulonephritis, each of which may go on to the contracted granular form; the parenchymatous, when it becomes chronic, passes into the small white; such an event however is of rare occurrence, because recovery is the general rule.

* See a similar case mentioned in Fagge's Medicine.

31.9 19 29

1.8

I

37 14 30

Sc. F. Diph. Wh. C. Fev. Dia.` 113 20 27 115 38 61

230 30 62 It will be seen that the death-rate, both from all causes and from zymotic diseases, has been lower than in the first half of 1887. No previous half-year in Dr. Hill's records has had, in fact, so low a total death-rate as the one just ended. The same remark, in fact, applies to the birth-rate, which continues to fall.

The Sheffield Water Supply and Lead Poisoning.-Mr. Allen, Public Analyst for Sheffield, has recently contributed to the Sanitary Record a paper on the above subject. In the summer of 1885 a medical man in Sheffield called the attention of Dr. Sinclair White, Medical Officer of Health, to certain cases of undoubted lead poisoning of which the origin was obscure. Upwards of 300 samples of the Company's water were submitted to Mr. Allen for analysis.

The investigation showed that, at the time experiments were made, the water derived from the Agden and Skines reservoirs and distributed to the low-lying parts of the town by means of the Godfrey Dam had practically no action on lead pipes, the water drawn from ordinary house taps containing no appreciable quantity of lead. On the other hand, in every instance in which the water was drawn from taps in houses supplied with the Redmires water, distributed to the higher districts of the town by means of the Hadfield Reservoir, a very notable quantity of lead was present. Meanwhile, scores of cases of undoubted lead poisoning occurred which were not traceable to

the occupation of the persons affected. On the other hand, every one of these cases occurred in houses supplied with highlevel water, and analysis always showed the tap-water to be seriously contaminated with lead.

Latterly, the number of cases has increased alarmingly. The great majority have occurred in the parts of the town supplied with the Redmires water. The proportion of lead in the water derived from Redmires has recently been found to be from one-half to one grain per gallon. It sometimes, however, reaches one and a-quarter grains per gallon, and occasionally exceeds even this proportion. On the other hand, the samples of low-level water rarely contain more than traces of lead.

The question has arisen why there should have been recently the marked tendency on the part of the Sheffield water to act on lead. It has been suggested that its cause was to be found in the water containing an acid, which was then, and is now, uncertain, but which it is highly probable is of vegetable origin, and arises from the oxidation of the peat on the moors from which the water is derived. The hot and dry summer would probably assist the oxidation, and when the autumn rains came the acid products would be dissolved and pass into the reservoir. The comparatively small quantity of rain which has fallen during the past six months has prevented the dilution of the acid to the usual extent. As a consequence the water running from the Redmires Reservoirs has latterly contained free acid of some sort equivalent to o'6 grains of sulphuric acid per gallon, while at the same time the hardness and proportionate lime is unusually small.

As to the marked difference in the tendency of the high and low level supplies to act on the lead, the only explanations are to be found in the fact that the latter supply is in part obtained from a reservoir, the water in which has been a long time in storage, and in the circumstance that the low level supply passes through a brick culvert two miles long, the mortar of which may not improbably effect the neutralisation of the free acid.

Disinfection of Germs on Walls.-According to a paper