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for themselves. In such propagandism the public spiritof Indian journalists would find unlimited scope. That

is a rough outline of the lines on which the committees

might work. The difficulties in front of them are obvious ;but I see no other way in which they can be surmounted ;and I am confident that the Indian members of this

conference will agree with me in regarding the question asone of the highest national importance." We are glad tosee that similar views are held by various native sanitarians,and may instance a paper contributed to the Medical Con-

gress in Bombay on the Etiology, Epidemiology, and Prophy-laxis of Malaria by Dr. Syed Mohamed Varis, in which hereviews all the accepted methods of prophylaxis, layingspecial stress on quinine distribution, and adding : "A wordmust be said on education that a doctor or administratorcould do nothing unless there was a willing cooperation onthe part of the people. The people should be taught to appre-ciate the sayings of science, and it could be accomplishedduring school training and through the newspapers and

society. Though my countrymen are educated, most of themare, however, not enlightened enough to appreciate the workof science. The diffusion of knowledge regarding the newepidemiology and prophylaxis of this infectious disease

ought to be undertaken by the social reformers to contradictold prejudice." It is the bounden duty of every medicalpractitioner in India, be he in the British service or native-born, to instil into the communities in his charge, so far asin him lies, the great lesson of the prevention of malaria.

THE BIO-CHEMICAL STANDARDISATION OF DRUGS.

SI[NCE there are certain drugs which at present cannot beassayed by chemical means, it is important that the physio-logical method of appraising their activity should be properlyappreciated. It is natural that such important drugs asdigitalis, squill, and strophanthus should have absorbed theattention of pharmacologists, for these endeavour to set upphysiological standards for preparations of drugs for whichthere is no test available that will give as true an indica-tion of their activity as a direct observation of their re-

action with living tissues. It is mainly with this groupof cardiac tonics that Dr. William Martin deals, in a

paper read before the Newcastle meeting of the British

Pharmaceutical Conference in 1909, which has been publishedas a brochure. In Some Experiences in the Testing ofDrugs by Bio-Chemical Methods with Special Reference toDigitalis, Squill, and Strophanthus" Dr. Martin gives theresults of his observations founded on experiments withcannabis indica, ergot, and epinephrine, before passing onto a consideration of the three drugs named in the title.

Cannabis indica he dismisses in a few words and confirms

the view held by another investigator that the chief causeof deterioration of this drug is oxidation of the active

principle. On the subject of ergot he offers a few generalremarks and shows two blood pressure tracings of suggestiveinterest. With regard to epinephrine-the vaso- constrictorprinciple of the suprarenal capsules-he explains the methodof testing which he uses in the pharmacological laboratoryof Brady and Martin, Limited, Newcastle-on-Tyne, where,indeed, all the experiments on which the paper is based wereperformed. In testing digitalis, squill, and strophanthus heconsiders that the most suitable method for practicalguidance in connexion with a manufacturer’s laboratory,and one which gives as good results as any others advo-

cated, is that which requires that a fatal terminationshall follow, within a certain time limit, the adminis- itration to a small animal of a fixed dose of the pre-

I

paration to be tested. He selects frogs as the animalsmost suited for the purpose, and deals minutely with

the precautions necessary in selecting them. He explainsin detail the methods he employs in testing the effectswhich the various preparations have upon them and recordsthe inferences which he draws. In concluding what is

undoubtedly an important contribution to the literature ofthis subject, Dr. Martin refers to the suggestion that sometests of a bio-chemical nature should be included in the

British Pharmacopoeia and expresses the opinion that the

time is not yet ripe for the introduction of tests of this kindunless they are made permissive and not mandatory. Failingthe application of physiological methods of standardisationto such drugs as cannot be assayed by other means, it is.

obviously necessary that pharmacists should utilise their

skill in selecting drugs of high quality and display great carein storing them.

-

CARCINOMA SUPERVENING ON TUBERCULOUS.LESIONS.

HOWEVER authorities may differ as to the cause of

malignant disease, on one point at least they appear to b&agreed, and that is that in numerous cases some previousdamage has been sustained by the part in which the new

growth arises. What this may be varies much in differentcases. In some it is simple trauma, as in those instanceswhere a sarcoma develops not long after a severe injury to abone, or an epithelioma of the tongue appears where a jaggedtooth has caused a septic ulcer. Sometimes the growthappears in the scar resulting from a former wound, and so-many instances of this have been put on record that all

surgeons are familiar with the occurrence. Sometimes, too,.malignancy may develop in a swelling produced by one ofthe infective granulomata. This is not at all rare with.

syphilitic gummata, many cases of carcinoma starting on thedorsum of the tongue having been preceded by gummatousulcers, and the same sequence has been noticed in syphilitie-ulcers of the leg and of the scalp. It is decidedly lesscommon for tuberculous lesions to be followed by the develop-ment of malignant growths, but in the present issue of

THE LANCET two writers refer to this point. Dr. J. L. Bunchmentions a case in which epithelioma supervened on a lupusvulgaris even as early as the age of nine, and Mr. C. B. Lockwoodrecords a very interesting case in which a carcinoma of thebreast was associated with tuberculous glands in the axillaof the same side. When we consider how widespreadtuberculous lesions are, and that carcinoma does not free

quently follow upon them, it is clear that there is no naturaltendency for the one condition to develop into the other.The number of cases recorded is small, while the super-vention of epithelioma on a lupus of the face is extremelyrare, though lupus of the face is so common. Curiouslyenough, when malignancy does manifest itself in a tuber-culous lesion, the result appears to be especially virulent.

THE FAILURE OF THE X RAYS IN THE TREAT-MENT OF HYPERTRICHOSIS.

WHEN it was discovered that exposure to the X rays causeshairs to fall out it was thought that a new remedy for hyper-trichosis, which was painless and easily applied, and there-fore destined to displace the tedious method of electrolysis,had been discovered. In the Journal of the A ’liu:?’ican IcicatAssociation of Jan. 8th Dr. May C. Rice has pointed out thatthis is unfortunately not true. Many patients were treatedwith apparent success, but almost invariably, after periodsranging from two to six months, the original growth hasbeen succeeded by a stronger growth and this by another andstill another. Nevertheless, determined operators persistedin the treatment and gave series after series of exposures inthe hope that eventually a permanent cure would be produced,which was achieved in rare cases. In treating most

317

diseases with the X rays there is the advantage that

’unhealthy tissues are more affected than healthy tissues, andtherefore the disease can be cured with the production of onlyslight dermatitis, but in hypertrichosis the hair papilla whichthe operator desires to destroy is healthy, and therefore itsdestruction will require considerable exposure to the rays;dermatitis must succeed dermatitis until frequently a per-sistent and chronic inflammation is produced. In conse-

quence of the selective action of the rays on glandular tissueatrophy of the sebaceous glands and hair follicles is pro-duced while the papillae remain. In addition, vaso-motor- disturbances resulting in telangiectases and scars, which- contrast with one another, are produced, causing an

’unsightly appearance. There is no remedy for this and

time, instead of improving the condition, renders it. worsefrom contraction of the scars. In cases of milder treatment

yet sufficiently protracted to cause the hair to remain out forany length of time, telangiectases are not produced but adecidedly wrinkled prematurely senile appearance. In one

case 75 exposures to the X rays had been given by aneminent dermatologist and experienced X ray operator. In

another case a woman of 40 looked as if she was 60 and.another undesired effect of the rays had been produced,strengthening of the downy hairs which had become blackand decidedly conspicuous. This stimulating action of therays in moderate dosage on hair growth can be utilised inthe treatment of alopecia. The fact that epithelioma some-times follows prolonged exposure to the rays must also betaken into account. Dr. Rice concludes that electrolysis isthe proper treatment for hypertrichosis.

PRIMARY INFECTIVE EPIDEMIC NEPHRITIS.

ONE of the etiological problems which have to be cleared upis that of the actual causation of that large group of cases ofacute and subacute diffuse nephritis in which there is a closeresemblance to the clinical picture of scarlatinal nephritis,without, however, any antecedent attack of scarlet fever toexplain the occurrence of the renal disorder. It seems prob-able that, while chill and other gross physical forces may pre-dispose to such a lesion, an inflammation of the kidney ofthis type can only be excited by the presence of some

appropriate infective agent in the blood stream, which is

deposited in the kidney as it passes through the circulatorypassages of that organ. Zannini 1 sends a short communica-tion of the greatest interest in this connexion. After

practising for some years in the neighbourhood of Bresciawithout seeing more than a single case of Bright’s disease, he’Was confronted at the beginning of last year by a small epidemicof this disorder. Within about seven weeks there were 10

<;ases, all of them from the same neighbourhood, and many ofthem living in the closest proximity to each other. Practi-

tioners in other districts saw no cases of the same type atthat same time. There were six boys, two women, and twobirls the ages ranged from 5 to 38 years. The onset was

acute in four instances, and in several cases there was a

- slight transient pyrexia. The principal symptoms were

- epigastric pain, dry cough, oedema, pallor, epistaxis, andurinary changes (albuminuria and oliguria, with passage ofblood and casts) ; while in several cases urasmic phenomena,vomiting, dyspno3a, and convulsions, were noted. The dura-

tion varied from three days (in the one case ending fatally)to 3$days ; in the great majority recovery appears to havebeen complete and absolute. Zannini refers to other similar

outbreaks that have been described ; the evidence as to their- causation is inconclusive, and in this epidemic there is no

Sight to be obtained as to its origin or nature apart from the

1 Rivista Medica, Milan, November, 1909.

fact that in most of the cases sore-throat was noted. This

was not of the scarlatinal type, and though it might be urgedthat the cases really represented an aberrant form of scarletfever it appears from Zannini’s comments that this was nothis own view.

Sir Alfred Jones, the chairman of the Liverpool School ofTropical Medicine and head of the shipping firm of Elder,Dempster, and Co., who died on Dec. 13th last, left estatevalued at .6674,259 gross. The bulk of the estate he left ontrust for such charitable purposes and objects in England orany British possession on the West Coast of Africa as histrustees may think proper. For their guidance he indicated,among other purposes, original research of all kinds into

the cause of disease on the West Coast of Africa.

WE regret to announce the death of Mr. William WarwickWagstaffe, M.B. Lond., F.R.C.S. Eng., formerly senior

assistant surgeon and lecturer on anatomy at St. Thomas’s

Hospital, which took place at Sevenoaks on Jan. 22nd, inhis sixty-eighth year. Mr. Wagstaffe had lived for many

years in retirement enforced by ill-health.

Mr. R. C. Punnett, of Gonville and Caius College, Cam-bridge, superintendent of the Museum of Zoology, has beenelected to the professorship of biology at the Universityof Cambridge, recently vacated by Professor W. Bateson.

THE congratulations of the King and of the Royal Collegeof Surgeons of England respectively have been conveyed toMr. Edgar Jones, M.R.C.S., of Brentwood, on the recentattainment of his hundredth birthday.

PLAGUE is declining in Mauritius, 10 cases with 7 deathshaving been reported during the week ending Jan. 21st.

THE MIDWIVES INSTITUTE.-The annual meet-ing of the Midwives Institute which took place last week,the President, Miss Wilson, being in the chair, was wellattended. The announcement of the death of Dr. StanleyB. Atkinson, who had represented the institute on the CentralMidwives Board for the past three years, cast a deep gloomover the proceedings. Dr. Atkinson had laboured unsparinglyin the cause of midwifery nursing with a quick under-standing of the needs and conditions of the work, and themidwives felt that they had indeed lost a friend. The whole

assembly stood in respectful silence and passed a vote ofcondolence with the bereaved family. The Midwives Institutewas founded nearly 29 years ago, although it was incor-

porated later in 1887. It was practically the first, andcertainly one of the.most energetic agents in the passingof the Midwives Act, and by keeping up the standard ofits members has striven to raise the status of midwiferynursing. The reports of the various committees showed alarge amount of work done, not only for its own members butin the cause of midwives throughout the country. Themost recent effort towards a very desirable end-

namely, the coordination of midwives into a more

united and corporate body of workers-has taken theform of a committee of representatives, whose work itis to organise local associations in London and the countryaffiliated to the institute. By this means, and the meetingsheld in the various branches for discussion of topics con-nected with their work, midwives are encouraged to take anintelligent and personal interest in their calling. The chair-man of the committee (Mrs. Stephen Glanville) stated thatten branch associations had already been organised, and theLiverpool Trained Midwives Association, numbering nearly200 midwives, was affiliated. Lectures are held at theinstitute at regular intervals, and among the lecturers duringthe past year were Dr. Tom Robinson, Dr. F. J. Warwick,Dr. J. S. Fairbairn, and Dr. J. Curtis Webb.