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doses of iron and ammonium citrate with their

response to an " iron-rich " diet containing 16-20 mg.

of organic iron daily (10-12 mg. is considered morethan enough to meet ordinary metabolic needs). Itwas found that patients who showed no improvementin haemoglobin and hsemopoiesis on the iron-rich dietreacted well to 6 g. of iron and ammonium citratedaily. Then they compared the response to a dietrich in iron with the response to a diet previouslydigested in vitro with hydrochloric acid and pepsin.The meal consisted of two boiled eggs, 200 g. ofcooked spinach, and 300 g. of lean beef protein freedof fibrous tissue. This was found on analysis tocontain 12-5 mg. of iron. The response to such

therapy compared favourably with that obtained withiron alone. The investigators conclude thereforethat " chronic idiopathic hypochromic anaemia is onepresumably due to a deficiency of iron wherein

gastric dysfunction leads to failure in utilisation oforganic (dietary) iron." These observations confirma single experiment by W. Dameshek,2 who obtaineda definite reticulocytosis on giving a predigested dietof eggs and spinach to a patient with the same typeof anaemia. M. M. Wintrobe and R. T. Beebe, on theother hand, failed to get any response to Hamburgsteak predigested with normal gastric juice.

COMPARATIVE STUDY OF BRIGHT’S DISEASE

AT the section of comparative medicine of theRoyal Society of Medicine on Jan. 24th Dr. DorothyRussell reviewed the principal histological changes inchronic Bright’s disease in man, laying specialemphasis on the necessity for separating the ischaemicform of nephritis, due to progressive arterial degenera-tion, from the distinctive inflammatory changes of

Bright’s disease. Dr. T. Hare gave the results ofhis work on chronic nephritis in the dog. Althoughthe equivalent of acute and subacute nephritis inman is seldom seen in this animal, and is then usuallyassociated with some obvious infective focus suchas endocarditis, there is no doubt that a chronicprogressive nephritis corresponding to chronic inter-stitial nephritis or nephritis repens in man is

relatively common. The disease is manifested inmiddle age as a rapidly fatal illness of a

ursemic character, associated with the secretion ofa urine of low specific gravity containing albumin,hyaline, and granular casts. Dr. Hare also describeda syndrome of the greatest interest, in which thecondition known as "rubber jaw" or osteoporosisof the skull was found by him to be associated in11 dogs with chronic nephritis, along with foci ofmetastatic calcification in various organs and hyper-plasia of the parathyroid glands. Other bones seemto be rarely affected, but a similar change, which hedescribed as being histologically identical withosteitis fibrosa, was occasionally seen in the ribs and,more rarely, in the femur. Dr. Hare considers thenephritis to be the primary lesion in this syndrome,and his view is certainly supported by rare

cases in man in which chronic nephritis has beencomplicated by hypercalcaemia and metastatic calci-fication. Prof. J. Duguid described the productionin rats of a chronic nephritis by overdosage withvitamin D, combined with a diet rich in acid sodiumphosphate. The damage appears to affect first thetubules and later the glomeruli, which undergoatrophy. The final change is an arterial hypertrophy ;this is of particular interest, in view of the difficultyof producing cardiovascular hypertrophy by experi-mental means. Chronic nephritis can also be

2 Jour. Amer. Med. Assoc., 1933, c., 540.

produced in the rat by feeding them with a dietfrom which magnesium has been excluded. Experi-ments in illustration of this were described byDr. W. Cramer. The nephritis differs from the

nephritis produced byDuguid in that theglomeruli hereare affected first, the tubules later, and the arteriolesnot at all. This experimental work, though of

great intrinsic interest, does not seem to offer anysolution of the setiological problems in spontaneouschronic nephritis. Prof. J. G. Wright emphasised thedifficulty of discovering any factor of setiologicalsignificance in the anatomical investigation of chronicnephritis in the dog. The problem is, however, oneof the utmost importance from the human point ofview. The spontaneous occurrence in the dog of anephritis, which appears to be histologically identicalwith the insidious nephritis repens in man, opensup a field for research which should not be neglected.The discussion illustrates the value of close coöpera-tion between human and veterinary pathologists.In pursuing their work the latter frequently haverecourse to publications dealing with different aspectsof human pathology; this applies, on their ownadmission, to the study of Bright’s disease.

THE GRAEFENBERG MEDICAL INSTITUTE

IN the last bi-monthly issue of the Annals ofMedical History Dr. Roy Turner writes an interestingnote upon the Graefenberg Institute, which played aserio-comic role at Dadeville, Alabama, from 1846 to1873. This Institute had a remarkable history, inthat it was a family affair, started in a rural com-munity which only a few years before had been thehunting ground of Indians; it developed, whileretaining its family characteristics, into a degree-granting medical organisation. The founder, PhilipMadison Shepard, was the child of a poor farmer andfound himself, at his father’s death, only 13 years ofage and the head of his family, with a debt upon thefarm and his mother, brother, and four sisters to

support. His mother married again after an intervaland he was relieved of most of the family responsi-bilities, but six years had been spent in back-breakingtoil with only a few opportunities for self-education.He was drawn towards medicine, and was on the pointof beginning practice " on his own responsibility,"which would seem to be Dr. Turner’s way of suggestingthat he was meditating becoming an unqualifiedhealer, when he obtained, somehow, sufficientmoney to enable him to enter a recently foundedmedical school in Augusta, a town 125 miles awayfrom his home. He walked there and graduated aftera curriculum of two years’ duration. He married atonce and went into practice at Lafayette, Alabama,and held classes of preparation for young menwho wished to become doctors. He was prosperous inhis profession and his educational idea caught on, andin the year 1852, having migrated to Dadeville, hewas able to advertise that he had under his supervisiona medical school ready for students, which had receiveda charter from the State legislature ; the graduates,he promised, would be entitled to all the privilegesaccorded to those of leading medical schools.Shepard seems to have had governmental right to

say this, though the medical curriculum might beonly of four months’ duration. Practically the

teaching was in the founder’s own hands, while othermembers of the staff were relatives to whom he

granted diplomas. The students boarded with thefamily and lived in an annexe to the main house.In 1860 the founder occupied three professorialchairs in the Graefenberg Medical Institute andshared the responsibilities of two others with the