visibly in the open air over a channel leading to a gully grating outside communicating with the drains.

"The drains should be laid in direct line and uniform gradient between the points where they change direction or gradient, and at these points it is convenient to provide means of access to the drains for the purpose of inspection or cleansing.

"Ample means of ventilating the drains of the building by suitable openings at their lower and upper. extremities, and of flushing them, should be provided.

"The soil pipe from any watercloset should always be outside the building, and be continued up beyond the point of junction with the highest closet, and without diminution of diameter, to some point where it will afford a safe outlet for drain-air.

"Where privies of any kind are in use, much care and attention is needed to prevent them from becoming a nuisance. They should be so arranged as to avoid any considerable accumulation of filth during a lengthened period. Hence the size of the receptacle or pit beneath the seat should be strictly limited, and the filth should be removed therefrom at regular and frequent intervals. Ordinarily, a very moderate capacity should suffice for the receptacle, when fixed, of each privy, whilst if the receptacle be movable, such as a tub or pail, a capacity of more than two cubic feet would be inconvenient. Where fixed receptacles are in use, they ought under no circumstances to be sunk in the ground, but should rather be raised at least three inches above the level of the adjacent ground, and the floor and sides should be made of stone-flagging or other nonabsorbent material. The privy receptacle should be so arranged that under no circumstances whatever would rain-water be allowed to enter it, and of course no slop-water should be emptied into it.

"The Board request that the foregoing remarks may receive the attention of the Guardians in so far as they are applicable to the buildings over which they have control.

BY CORRADO TOMMASI-CRUDELI,
Professor in the Royal University of Rome.

THE readers of the Practitioner will, I feel sure, be interested to hear of the results of the most recent investigations, made in Italy, during the present year, on the subject of malaria. The interest which this journal has taken in this subject since the publication, last year, of the studies and experiments made by Professor Klebs and myself, leads me to think that its readers may be glad to be informed of facts recently ascertained before they are communicated in all their details to the "Reale Academia dei Lincei," in its first session in December next.

After the investigations which I made last winter on some of the malarious districts of Sicily (Atti dei Lincei, March 6, 1880), in which I constantly found the Bacillus Malaria with all the characteristics described and represented by Professor Klebs and myself in our work "Sulla Natura della Malaria "-which Bacillus I was unable to find in non-malarious districts situated in the neighbourhood-other investigations have been made, at different times and in various places, by the following gentlemen:-Professor Perroncito, of the Superior Veterinary

NO. CXLIX.

Y

School of Turin, Professor Ceci, of the University of Camerino, Dr. Cuboni, Assistant Professor of Botany in the University of Rome, and Professor Marchiafava, Demonstrator of Pathological Anatomy in the University of Rome, under whose direction the following gentlemen have worked during the last summer in my laboratory-Drs. Valenti, Ferraresi, Sciamanna, and Piccirilli, of Rome.

The following is an abstract of the results of the investigations made by these gentlemen.

1. In the soil of all the malarious districts of the Roman Campagna and Marshes the Bacillus Malaria has been either found in a fully developed state (Cuboni), or else could be easily obtained in great quantities by means of artificial cultivation (Cuboni, Ceci). It has not, on the other hand, been found possible to obtain it by any means, whether artificial or otherwise, in some perfectly healthy districts (Cuboni).

2. This Bacillus rises in such quantity during the heat of summer in the atmosphere of malarious districts, that there is no need of any special appliances to collect it from the air. It is to be found in large quantities in the sweat of the face and hands (Cuboni).

3. In the blood of rabbits infected with malaria (Ceci), in the blood of human beings attacked by malarious fever (Marchiafava, Ferraresi, Sciamanna, Valenti and Piccirilli); and in the blood extracted from the spleens of the patients in question by a method invented by Dr. Sciamanna (Marchiafava, Ferraresi, Sciamanna, Valenti and Piccirilli), the spores of the Bacillus Malaria were constantly found during the acme of the fever. The artificial cultivation of this blood has constantly given rise to the development of the Bacillus, sometimes in very large quantities (Ceci, Cuboni, Ferraresi). The cultivation of the splenic blood of persons not affected by malarious fever has given, on the contrary, only negative results (Cuboni).

4. By injecting the blood taken from the veins of persons affected with malaria into the subcutaneous tissues of dogs, the disease is reproduced in these animals (Marchiafava, Ferraresi, Valenti, Sciamanna and Piccirilli).

5. In all cases where the blood has been extracted from patients affected with malaria, during the period of invasion of

the fever, it contained, often in great quantities, the fully developed Bacillus Malaria (Marchiafava, Ferraresi). In the acme of the fever, on the contrary (as has been mentioned above, S3), the Bacilli disappear, and no other traces of them are found beyond their spores.

The constant recurrence of this last phenomenon (analogous to those observed in the case of the spirillum of relapsing fever) is of the greatest importance in the question under consideration. It explains, in the first place, the difference in the results obtained by Marchiafava in 1879 by examining the blood of five persons who had died of febris perniciosa, the examination being made immediately after death. In three of these cases the blood of all the veins of the body and of the heart contained a large quantity of Bacilli in an advanced stage of development, while in the other two it was impossible to discover in the blood a single example of the Bacillus, but only a large number of its spores. The further investigations made this year in Rome render it probable that the first three patients died before the period of invasion of the fever was finished; the other two, on the contrary, during the acme. These facts, further, open to us the way, by multiplying and varying our observations, to determine the scientific theory of this infective disease.

Experiments made on animals have shown that the principal nidus of the parasite which produces malarial fever is in the spleen and in the marrow of the bones, the organs in which (especially in the first) we constantly find the most serious pathological changes in those who die of this fever. It is very probable that the production of new generations of parasites in these seats, varies in extent and in rapidity according to the condition of the individual, and probably also according to the quality of the soil from which the parasite originally came; which would also explain the great variations which we meet with in the duration of the intermittences of this fever. It is probable that the febrile attack does not take place until the discharge of the parasites, from their special nidi, has gone on to such an extent as to accumulate in the blood a vast number

1

1 Comp. the work of Pasteur on the parasite, discovered by Perroncito, which produces cholera among fowls.

of these organisms. It is probable that the chills of the febrile attack are produced by the simultaneous irritation of all the vaso-motor nerves, due to the presence of this army of invaders in the circulatory system. These invaders find in the blood the conditions most adapted to accelerate their development and their progress to maturity (i.e. a high temperature, abundant means of nourishment, and oxygen stored up in the red corpuscles), and hence it is not surprising if their disintegration is completed in the acme of the fever; while, on the other hand, the changes in the component elements of the blood and tissues due to their multiplied acts of assimilation and excretion affords a natural explanation of the development of the febrile heat.

The further investigations which I propose to make, personally or by means of others, will demonstrate if this scientific theory of malarial fever, suggested by the facts recently observed in my laboratory, be sound or not. I hope further that future observations will enable us to decide whether the resolution of the febrile attack is due merely to the elimination, by means of the secretions, of the products of the reduction of the albuminoids accumulated in the blood and in the tissues during the febrile attack; or whether it is partly also due to the elimination of the spores, which the disintegration of the Bacilli leave in the circulation, by means of the secretions, especially that of the kidneys. It will further be of great scientific, and possibly also practical, interest to examine the contents of the venous cavities of the spleen during the period of intermittence of the fever; and since the method has been discovered of extracting the blood from the spleen without danger to the patient, it is possible that we may be able to follow step by step, in this its principal nidus, the development of the parasite in the intervals of the febrile attacks.