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into the tissues. Instead of proceeding to amputa-tion as was originally proposed, an incision was madeover the femoral artery. Much clot was removed,and the artery tied at the apex of Scarpa’s triangle.The incision was prolonged downwards along Hunter’scanal, masses of clot being cleared away, and theartery followed to the foramen in the adductor magnuswhere a circular perforation about 5 mm. in diameterwas found. The artery, which was atheromatousand calcareous in places, was ligatured above andbelow the perforation and the wound closed. Thevein was not interfered with. The patient made anuninterrupted recovery, and was walking aboutwithin a few weeks. He died about five years laterfrom pulmonary disease.

I am, Sir, yours faithfully,HERBERT H. BROWN, F.R.C.S.

Ipswich, Oct. 21st, 1932.HERBERT H. BROWN, F.R.C.S.

PROTEOLYTIC FERMENT IN AMŒBICDYSENTERY

To the Editor of THE LANCET

SIR,—In an annotation on the early differential

diagnosis between amcebic and bacillary dysenteryin your issue of Oct. 15th (p. 853) mention is made ofthe secretion of a proteolytic ferment in E. histolytica,suggested by J. Anderson in 1921 and again byA. Alexieff in the present year. There are to

my mind weighty reasons-phylogenetic, systematic,and biological-for doubting that amoebae giveoff such a ferment. The sole instance among theprotozoa in which digestive ferments are known tobe passed out of the body is in the case of the suctorialacinetaria, where (as is always the case) theyare secreted by the nucleus, which has finger-likeextensions prolonged towards the tentacles. Inno entamceba is there any suggestion of extracellular ’’,digestion, and the secretion of a proteolytic fermentimplies far too great a phylogenetic jump. Even I,in the intracellular sporozoa there is no evidenceof any

"

external " secretion of digestive ferments. ’I

In the malarial parasites, for instance, the residentproduct of digestion, the pigment is formed only inthe cytoplasm of the parasite, never in the more or lessused-up red corpuscle.

It must be remembered that the ectoplasm ofE. histolytica is peculiarly well developed, tough,and mobile. When the penetration, by mobilityof relatively delicate things like the germs ofcoccidia actually into the epithelial cells of theintestine is considered, there is no difficultyabout the ectoplasmic pseudopodia of histolyticabeing able to bore or scrape a way inwards. Phylo-genetically the extracellular secretion of digestiveferments undoubtedly began in the flagellates whereat the base of the stomodseum the endoplasm is for asmall area uncovered by the delicate investing cuticle.The different type of histolysis occurring in an amoebiculcer from that to be seen in the submucosa in

bacillary dysentery is probably explainable by theinvasion of ordinary intestinal bacteria, which aremore or less swept away in heavy infection withdysenteric bacilli.-I am, Sir, yours faithfully,Walton- on-Thames, Oct. 19th. H. M. WOODCOCK.H. M. WOODCOCK.

RESPIRATORY EFFICIENCY TESTS

To the Editor of THE LANCETSIR,—In his article of Sept. 24th (p. 665) and letter

of Oct. 15th (p. 869) on tests for respiratory function,Dr. Alan Moncrieff attributes the first spirometric

experiments to John Hutchinson (1846). Actually,Charles Thackrah, in his book on Industrial Diseases(I will not give its full title which contains 38 words), ),published in 1831, describes "

an apparatus whichmay be termed a pulmometer," about which he adds :

" This is a large graduated jar, inserted over and filledwith water. The person blows through a tube, the lowerend of which is under the jar-making, however, but oneexpiration at each trial.... This mode, it will be observed,does not show the mere capacity of the lungs. The resultof the experiment is the compound of the capacity of theair cells and the power of the respiratory muscles."

This apparatus Thackrah used very extensively,not only on workers in dusty trades, but also on suchpeople as clerks in offices and fashionable ladies in

tight stays, and suggested it might be of value inassessing recruits for the army, and used among hisnormals, " 19 individuals from the 14th LightDragoons," including apparently four members ofthe band.

I have been unable to determine whether Thackrahoriginated the idea, but his extensive and painstakingobservations deserve precedence over those ofHutchinson, to whom is attributed the invention ofthe spirometer even in such a work as Garrison’sHistory of Medicine.

I am, Sir, yours faithfully,F. F. HELLIER.

The Medical School, Leeds, Oct. 24th, 1932.F. F. HELLIER.

INFECTIOUS DISEASEIN ENGLAND AND WALES DURING THE WEEK ENDED

OCT. 15TH, 1932Notifications.—The following cases of infectious

disease were notified during the week :-Small-pox,12 (last week 17) ; scarlet fever, 2078 ; diphtheria,1007 ; enteric fever, 83 ; acute pneumonia (primaryor influenzal), 833 ; puerperal fever, 28 ; puerperalpyrexia, 102 ; cerebro-spinal fever, 30 ; acute polio-myelitis, 36 ; acute polio-encephalitis, 4 ; encephalitislethargica, 8 ; continued fever, 1 (Hampstead);dysentery, 21 ; ophthalmia neonatorum, 78. No caseof cholera, plague, or typhus fever was notified duringthe week.The number of cases in the Infectious Hospitals of the

London County Council on Oct. 18th-19th was as follows :-Small-pox, 49. under treatment, 0 under observation (lastweek 44 and 4 respectively) ; scarlet fever 1764 ; diphtheria,1657 ; enteric fever, 21 ; measles, 230 ; whooping-cough,311 ; puerperal fever, 24 (plus 8 babies) ; encephalitislethargica, 231 ; poliomyelitis, 6 ; " other diseases," 161.At St. Margaret’s Hospital there were 21 babies (plus9 mothers) with ophthalmia neonatorum.

Deaths.—In 117 great towns, including London,there was no death from small-pox, 3 (1) from entericfever, 12 (1) from measles, 5 (3) from scarlet fever,10 (2) from whooping-cough, 21 (6) from diphtheria,72 (19) from diarrhoea and enteritis under two years,and 46 (10) from influenza. The figures in parenthesesare those for London itself.

Of the deaths from diarrhoea, 6 were reported fromBirmingham, 5 from Leeds, 4 each from Gateshead andWest Bromwich. Liverpool, Newcastle-on-Tyne, and Wiganeach reported 2 deaths from measles. Diphtheria wasresponsible for 3 deaths at Dewsbury.The number of stillbirths notified during the weekwas 276 (corresponding to a rate of 45 per 1000 totalbirths), including 46 in London.

HOSPITAL NEEDS OP SHANGHAI.-The report for1931 of the Lester Chinese Hospital at Shanghai recordsthe transfer to a new building made possible by a legacyof one million taels from Mr. Henry Lester, a prominentBritish resident. During the year there were nearly54,000 out-patients who made over 133,000 attendances.The report points out some of the serious hospital needsof Shanghai.