1352 THE TROPICAL DISEASES BUREAU.

and the tendency of the modern university is Lto promotethese loose unions with:practice. In regard to medicine itseems to us that the harmonisation of entrance requirementsis a more important thing to aim for than either the union ofthe technical school to the university or its divorce therefrom.The student once admitted as an undergraduate, the universitythat has accepted him should be free to follow its own

individuality in his future training, according to the specificcharacteristics that have been evolved by it under the con-ditions of its own specific environment. But it is in the highestdegree unfair to parents, to youth, and to those whose duty itis to prepare youth for a university career, that such varyingrequirements should exist as to render years of careful pre.paration for entrance to a particular university practicallyuseless if chance or circumstance should subsequently rendera change of university necessary. It is highly desirable thatan adequate preparation for admission to one universityshould qualify pro tanto :for admission to any university in

regard to all those subjects that all have in common, even

though particular universities may deem it necessary to add

specific additional tests,:as a consequence of their specificindividual bent. We hope that these points will receive i

careful consideration at the Congress. I

Annotations.

THE TROPICAL DISEASES BUREAU

II Ne quid nimis. "

IN a Memorandumlissued this weekly the Colonial Officethe important announcement is made that from July lst nextthe Sleeping Sickness Bureau will be known as the TropicalDiseases Bureau. The Memorandum gives an account of theorigin and progress of the present Bureau. At the Inter-

national Conference on Sleeping Sickness held in Londonin June, 1907, and March, 1908, it was proposed to founda Central International Bureau "to extract and circulate

all new literature on sleeping sickness," but this projectfell through because the delegates of the various countriescould not come to an agreement as to the site ofthe Bureau or even the necessity for its separate existence.Arrangements were therefore made by Lord Elgin, thenColonial Secretary, for the establishment of a British Bureaumaintained by Imperial funds, with a contribution from theSoudan Government, and the Royal Society generously con-sented to house the Bureau. During its four years of existencethe Bureau, under the direction of Dr. A. G. Bagshawe, hasissued 37 numbers of its Bulletin, each containing an accountof current work in the field and laboratory on sleeping sick-ness and other trypanosome diseases ; and last year it com-menced the issue of a quarterly Bulletin on kala-azar underthe editorship of Dr. C. M. Wenyon. These publications haveproved extremely helpful to investigators, and many of thenumbers have been reviewed from time to time in the I

columns of THE LANCET. Among its many other usefulfunctions the Bureau has, of course, also initiated the

despatch of special expeditions to investigate sleeping sick-ness in tropical Africa. The Memorandum, in explanationof the forthcoming change of title, says that it soon

became evident that what the Bureau was doing for

sleeping sickness could be done in the same way for

tropical diseases generally. Lord Crewe and his successor

at the Colonial Office, Mr. L. Harcourt, have both interested

themselves in the expansion of the Bureau, and the arrange-ments for this purpose are now complete. The TropicalDiseases Bureau will be quartered at the Imperial Institute,since the accommodation at Burlington House is no longersufficient. It will deal with all exotic diseases prevalent intropical and sub-tropical regions, and will publish at frequentintervals a Tropical Diseases Bulletin, which will take theplace of the present publications. The director will have the

help of an assistant director and a number of experts eachresponsible for his own subject. The tropical diseases of

animals will be dealt with in a separate publication, and forthis purpose Sir John Macfadyean and Mr. Stewart Stockmanhave joined the committee as representatives of veterinaryscience. We welcome the new Bureau and endorse the

anticipation expressed in the Memorandum that through itthe results of the most recent researches on every tropicaldisease in every country, as well as new methods of treat-ment and improved means of prevention, will quickly becomeavailable for the remote worker in the tropics.

THE TIME TO OPERATE IN APPENDICITIS.

FRUM almost the very beginning of the recognition of

appendicitis there has been much discussion as to the mostsuitable time for operation. The question is, Shall the

surgeon proceed to operate directly the diagnosis of

appendicitis has been made, or shall he postpone the

operation to the interval after the inflammatory signs havedisappeared, except in certain cases where an immediateoperation is required owing to the fac!i that the appendixis sloughing ? Each of these opinions is held by manysurgeons, but the relative proportions of those who hold theone opinion or the other has varied greatly from time totime. On the whole, it may be said that at the presentday the majority of surgeons advocate an immediate opera-tion in practically all cases of appendicitis. In the last issueof THE LANCET there was published a lecture by Sir GeorgeThomas Beatson, in which he expressed his opinion as to theright time to operate in appendicitis. He holds that ifdiffuse suppurative peritonitis is present an immediate opera-tion is desirable, and the peritoneum should be drained

through a right iliac incision, a suprapubic opening beingalso made; the appendix is only removed if it is easilyfound. He also operates if any collection of pus pointsexternally, but, except in these circumstances, he operatesonly in the interval period. When the blood count remains

high he takes this as an indication not to operate, but towait for three or four weeks until the pus becomes sterile.

The results of this plan of treatment in Sir GeorgeBeatson’s hands are certainly very good. In the last

14 years he has treated 273 cases of appendicitis,of whom 264 left the hospital well ; of these he

had operated on 256, while 8 refused operation; but

of the whole number only 9 died. This represents a

mortality of less than 3 per cent. Statistics are given ofthe death-rates of some other surgeons, and in every case

they are much higher, so that so far as we may depend onstatistics there is much to be said for his method. It

is, of course, impossible to say with certainty that thecases were absolutely comparable, but the probabilitiesare that there was no very great difference. Sir GeorgeBeatson operates immediately in some cases ; and the

real problem consists in the difficulty of recognisingthose cases in which an immediate operation is neces-

sary and those in which the operation may be postponedto the time when the pulse, the temperature, and the bloodcount have returned to the normal. Each surgeon must judgefor himself as to the cases which he feels he may leave with

safety, and it is difficult, if not impossible, to lay down rules;but Sir George Beatson has done good service in drawing

1353

attention to the need for discrimination in the choice of

cases and in showing the good results which can be obtainedby refusing to operate immediately in every case, and post-poning those which experience has shown may be left withsafety to the "interval."

"

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OZONISED AIR IN TUBE RAILWAYS.

THE supply of ozonised air in the Central London TubeRailway is an accomplished fact, and there can be littledoubt that the system adopted (ozonair) is so far givingsatisfactory and agreeable results. It was found that the

mere pumping of large volumes of ordinary air into the tubedid not deal with that " tube frowsiness " which is familiar

not only to travellers on the line, but to anybody whohappens to be in the neighbourhood of a lift just dis-charging its passengers in the street. However chemicallysatisfactory air may be shown to be, the merest trace ofoffensive smell renders it unfit for healthy respiration.There may be present a maximum of oxygen and a minimumof carbonic acid gas, but still the air may remain unhealthyon at least three counts. It must be free from disagreeablesmell, it must be in motion, it must be reasonably humid.These conditions appear now to be complied with by the useof a constant stream of air, washed, screened, and mildlyozonised. In the Central London Railway the air is stated tocontain rather less than one part of ozone in a million partsof air, and yet the presence of this gas is perceptible,not so much as an odour as by the agreeable freshcharacter which its presence gives to the air. The employmentof ozone probably suffices to remove those organic impuritieswhich render the air stale, fiat, and unprofitable. Ozonised

air, in fact, as was pointed out by Dr. Leonard Hill,relieves the depressing effect which air tainted by foul odourshas upon the nervous system. It will be interesting to watchthe progress of this big experiment, and we understand thatit has already given great satisfaction to the employees onthe line, who speak of the obvious relief from stuffiness andobjectionable odour which has resulted since the installationwas started. The whole of the plant and machinery is

operated by the same electric current which is used to workthe trains, and the ozone generator is of a special type whichdoes nothing more than condense a very small part of theoxygen of the air into pure ozone.

A CUTANEOUS INOCULATION TEST FOR THEDIAGNOSIS OF SYPHILIS.

IN an annotation published in THE LANCET of August 19th,1911 (p. 536), there appeared a brief account of the successfulefforts at cultivation of the spirochseta pallida made by Dr.Hideyo Noguchi at the Rockefeller Institute for Medical

Research, New York. This investigator has been pursuing theinquiry along several lines, and gives an account of various in-teresting and important results in the Journal of the Amerioan ’Medical Association of April 20th, 1912. He has isolated the

spiroohseta of syphilis in pure culture seven times from

chancres, condylomata, and skin papules in human subjects,and six times from experimentally infected rabbits. These13 strains are morphologically and culturally identical ;inoculation of the human strains into monkeys has producedtypical cutaneous lesions and a positive Wassermann

reaction ; and it has proved possible to differentiatethe spirochaeta pallida after cultivation from the other

spirochsetae (S. macrodentium, S. microdentium, andS. refringens) which resemble it most closely in form. Allthese results are of great interest and seem to prove the

validity of Dr. Noguchi’s claim that the spirochseta pallidacan be obtained in pure culture from suitable syphiliticlesions in the human subject. Even more interesting, how-ever, is the practical application to which Dr. Noguchi has

put his discoveries. He prepared an extract from purecultures of S. pallida, and after testing it successfully inrabbits experimentally infected he applied it to the clinicaldiagnosis of syphilis. A supply of the spirochsetal extract,to which he has given the name "luetin," has been sent toother investigators, two of whom report that it yields a

specific reaction. Dr. Noguchi’s own observations also bearout this conclusion. The extract was injected subcutaneouslyinto 315 syphilitics and into 250 normal persons. In the

normal subjects there was a slight reaction which dis-

appeared in 48 or 72 hours, leaving no induration. The positivereaction, which appeared in a large majority of the syphiliticpatients, was papular, pustular, or "torpid." In the first typea large papule appears in 24 to 48 hours, reaches its maximumby the fourth day, and then slowly recedes. The pustularreaction proceeds similarly until the fourth day, when thecentre of the papule begins to break down, forming a pustulewhich soon bursts, leaving a crust which falls off after a few

days. The induration round the pustule disappears aboutthe same time, and the pustule heals almost without

cicatrisation. There were practically no constitutional

symptoms. The reaction was positive after an interval ofquiescence in a few cases ; it is to this group that the term" torpid " is applied. In cases of primary syphilis, secondarysyphilis with symptoms, and congenital syphilis manifestingitself in the first year of life, the reaction usually failed ;but in secondary syphilis without symptoms, in tertiary andlatent cases, and in late congenital syphilis, the characteristicreactions appeared in a very large percentage of the casestested. The results in cases of cerebro-spinal syphilis wereindecisive. Dr. Noguchi suggests that the luetin reaction maysupplant the Wassermann test as an index of active infection,especially in late cases, and that it may prove serviceable asa measure of the defence which the patient is able to summonup against the infection. Of course, it would be prematureto regard these suggestions in the light of proved facts ; butat least the profession owes much to Dr. Noguchi for theattempt to place in its hands a diagnostic method easier ofapplication than the serum tests. How far this attempt isto be successful remains to be seen.

"THE FASHIONABLE DOCTORING SHOP."

UNDER the above heading, and in one of a series of

articles upon "Wonderful London," the Evening .LVems

recently described a person unnamed who was represented asprescribing for a constant stream of patients suffering mainlyfrom over-indulgence in social pleasures in a place of busi-ness unlike the average chemist’s shop mainly in the non-assertiveness of its character." The tradesman thus depictedmay have been a type and not an individual, but we give ourcontemporary credit for a fairly accurate picture of a form ofunqualified practice which, it informs us, 11 is becoming aninstitution in the West-End," the locality fixed in the articlebeing an off street not far from Piccadilly. " There can,indeed, be little doubt that trade of the kind describedin the article, consisting chiefly in the prescribing of drugscalculated to afford temporary relief from the unpleasantsymptoms produced by excessive self-indulgence, is carriedon without regard to the evil results which it entails, and wesuggest that the Society of Apothecaries might possibly testthe legality of what takes place in such "institutions."We regard the raising of the question of legality as beingdesirable, if evidence justifying such a step can be obtained,not because ve accept the opinion of the article writer thatthe druggist who seeks to alleviate the headaches andstomach-aches of the haunters of Piccadilly bars and

restaurants is a serious competitor of " the Harley-street physician," but rather because the number of