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to cooperate as national representatives with the Munich

committee. It is understood that the memorial will take

the form of a monument to be set up in Munich. The sub-

scription list (for this country) will be closed on March 31t..All subscriptions should be sent to the honorary treasurer,Dr. Christopher Childs, 10, Manchester-square, London, W.

THE CRUSADE AGAINST MEASLES.

WE have frequently drawn attention in THE LANCET tothe very high death-toll which is annually levied by measlesin England and Wales, and especially among the infantilepopulation. Accordingly we are gratified to note that in

two important English cities, at any rate, the crusade

against this disease is proceeding in earnest. Thus we find

that in Norwich the city council has, on the advice of itsmedical officer of health, agreed to continue for another

year the payment of a fee to medical practitioners for thevoluntary notification of cases of measles. In the adminis-trative County of London the provisions of the Public

Health (London) Act of 1891 have been (by a vote of thecounty council) made to apply to measles. In other word,the county council has statutorily declared measles to be

a dangerous infectious disease and has resolved to take

steps under the Act for its suppression. Having regard tothe almost universal prevalence of this infantile scourge wefear that the authorities will find the cost of notificationsomewhat heavy, but there is no doubt that an accurate know-ledge of the whereabouts of fresh cases of measles, especiallyin s0hools, will enable the authorities to check the spreadof the disease. At any rate, the experiment is well worth

trying and we shall watch the result with keen interest.

THE BLOOD AND ITS REACTION IN MENTALDISEASE.

THE character and reaction of the blood in mental disease

and the variations which they undergo in the course of

different forms of insanity are matters regarding which littleis as yet known. That important changes occur in the blood,however, is now known from systematic observations madeby many investigators upon epilepsy and epileptic insanityand from isolated observations made on other forms of

mental disease. In the Jo2crnal of Mental Science for

January last Dr. Robert Pugh, assistant medical officer ofthe Claybury Asylum, has published an interesting series ofstudies on the reaction of the blood in mental disease. Themethod of estimating the relative degree of alkalinity ofthe blood was that introduced by Dr. A. E. Wright andalready described in THE LANCET.l In estimating the normalalkalinity of the blood "control cases" were selected fromthe staff of Claybury Asylum for comparison with the studiesmade on patients. Care was taken to avoid the times duringwhich the alkalinity of the blood is stated to vary-e g., afterfood and after severe muscular exercise-and the blood was

taken at a stated time, 11 A.M., on successive days for eachcase. In all 98 patients were thus examined. The informa-tion obtained in different classes of mental disease are sum-

marised as follows. Epilepsy : 40 cases were examined. The

typical conditions as regards the blood consisted of, first, alow average alkalinity in the period between epileptic fits ;secondly, a sudden and pronounced fall immediately prior toa fit ; and, thirdly, a further diminution soon after the fit wasover. All the cases studied showed low alkalinity. This

condition may be explained, adds Dr. Pugh, by "the gradualaccumulation of toxins of an acid nature in the blood,"probably arising from deficient metabolism of the body tissuesgenerally. The second condition was difficult to account for,while the third was regarded as due to the production of

1 THE LANCET, Sept. 18th, 1897, p. 719.

sarco-lactic and carbonic acids during the violent tonic andclonic convulsions of the epileptic fit. General paralysis ofthe insane : 23 cases were examined, two of these beingjuvenile cases. All showed a low degree of alkalinity of theblood much below the average of the control cases, the more

acute cases of general paralysis showing an exceptionallylow value in this respect. The lowering of the alkalinityin this disease, concludes Dr. Pugh, is constant, well-

marked, and varies according to the type, duration, and

rrogress of the disease. The most marked lowering of

the alkalinity occurred in connexion with the convulsive

seizures of general paralysis. Dementia : 10 cases were

examined. These included six cases of secondary dementia,three cases of senile dementia, and one of organicdementia. The alkalinity in these cases did not show anymarked variations beyond physiological limits. Mania :

15 cases were examined. Of these 10 were cases of acuteand five of chronic mania. In the acute cases and especiallyin those patients who manifested intense motor restlessnessthe alkalinity was lowered. During comparative repose thealkalinity remained within normal limits. Melancholia :10 cases were examined. Of these eight suffered from acuteand intense depression; the remaining two were chroniccases. The alkalinity in these cases was fairly constant andvaried within normal limits. One of the general conclusionsreached was that the alkalinity of the blood was normal inchronic mania, chronic melancholia, and chronic dementia.Lowering of the alkalinity occurred in epilepsy, especiallybefore a fit, in mania during the period of restlessness andagitation, and in general paralysis of the insane, and withthis lowered alkalinity there were associated a state of

depraved bodily nutrition and a co-existent toxfemia whichprofoundly disturbed consciousness.

RECENT OBSERVATIONS ON REFLEX ACTION AND

TENDON PHENOMENA IN HEALTH AND

DISEASE.

THE earlier observers were unable to obtain the knee-

jerk in a certain proportion of healthy children and adults-e.g., Eulenburg found it absent 16 times in 338 healthychildren and Mobius noticed that it was not infrequentlyabsent in the aged. However, since the introduction of

certain methods for "reinforcement," of which the best

known is that of Jendrassik, consisting in the execution ofsome voluntary movement, such as grasping the hands infront of the trunk and palling as if to separate them, it hasbeen hown by Sternberg and others that the knee-jerk is

rarely, if ever, absent in health either in infants, children,or adults even in advanced age. Dr. Jeno Kollarits in

the Deutsche Zeitsekrift fiir -1Yervenkeilknnde, Band xxiii.,1902, S. 89, records the results of his investigation ofthe condition of the knee-jerks, the Achilles and tricepstendon reflexes, and the scapula-periosteal renex in 100

healthy individuals and in 100 cases of tabes dorsalis. In

the former, by adopting various methods of reinforcementlike that of Jendrassik, he obtained all these reflexes in everycase. In the tabetics, adopting similar precautions, he foundthat all four were absent in 31 cases, all four were present in25, in 11 the tendo-Achillis jerk was alone absent, and in onecase the knee-jerk alone was not elicited. Dr. A. Bickel in thesame journal (Band xxii., 1902, 8. 163) records the result of aninvestigation of Babinsky’s sign (the dorsiflexion of the toeson stroking the sole of the foot) in 300 persons, in which hefound, as previous investigators have done, that the sign is

very seldom obtained in health and only exceptionally inhysteria, while it is always distinct in patients with a lesionof the pyramidal tract. On the other hand, in a considerablenumber of healthy persons it was obtained in a very definiteand striking manner during sleep, although quite absent in