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buildings which communicate by tunnels and cause-ways, but the 11 cases of infection were confinedto the personnel of the building in which the psittacosisinvestigations were being pursued and did not spreadinto the two other buildings. The infected birds werereceived on Jan. 16th, and of the three workers whohandled them two fell ill on Jan. 25th and Feb. 6threspectively ; one case proved fatal. The remainingnine cases appeared on Feb. 15th, 28th, March 10th,Ilth, 12th, 13th (two cases) 14th, and 15th. It willbe observed that the last seven cases occurred close

together, suggesting, as G. W. McCoy points out2that they became infected about the same time froma common source. The nature of this common sourceof infection is obscure. Had any of the patientsinfected others in their homes one might have thoughtthat the laboratory outbreak was due to spread from man to man; but no home infections occurredand, moreover, the history of this disease suggeststhat the human case is a negligible source of infection.Why infections should spread from parrot to man withsuch ease and from man to man with such difficultyremains a mystery, but an almost identical problemis presented by tularæmia and a most interesting lineof research awaits the intrepid investigator of either of these infections. We have been fortunate in thiscountry for, with precautions certainly no more

elaborate than those adopted elsewhere, laboratoryinfections have not occurred apart from one relativelymild case.The clinical part of Petersen, Spalding, and Wild-

man’s communication covers ground now wellknown and brings no new facts to light. In his

investigation of this disease in the Argentine lastyear E. Barros 3 made free use of X ray examinationof the chest and spoke highly of its value. And ifconvalescent serum has not been used in this countryin the treatment of psittacosis, it is for the good reasonthat experiment has shown it to have little or no

protective value. 4 This finding is supported by theresults now reported, for in our opinion the evidenceprovided contains no justification for the conclusionthat the use of immune serum in daily doses wasof " apparent benefit." A. P. Thomson obtained

comparable results with serum from individuals

recently inoculated with T.A.B. vaccine.

"SOCIAL ORTHOPÆDICS."

SINCE 1924 the Cripples’ Jouryaul and the Cripplehave served a useful purpose in keeping the socialside of work for physically disabled children beforea wide public, and before these journals came to anend (at all events in their present form) their editor,Mr. Frederick Watson, called on the expert knowledgeof his collaborators to produce a book 5 which hedescribes as " nothing more ambitious than an outlineof some past and future problems of disablement indomestic life and industry." He does less than justiceto an enthralling account of the fate of the cripplethrough the ages, from the Old Testament conceptionof deformity as a thing accurst, and the persecutionof the Middle Ages, to the belated humanitarianismof the ninteenth century. In this historical surveyhe touches on the deformities once common amonglace-making children in England, one of the evilsof child labour which is still vigorously alive among

2 U.S. Public Health Reports, 1930, xlv., 843.3 Dia Médico, Dec. 30th, 1929.

4 Sacquépée, E., and Ferrabouc, L.: Presse Méd., 1930, xxxviii.,569, and London Hospital Investigations (unpublished).

5 Civilisation and the Cripple. London : John Bale, Sons andDanielsson. 1930. Pp. 120. 10s. 6d.

the carpet-makers in Persia. A chapter on theinfluence of the war shows the evolution of the

voluntary county and after-care clinics in Shropshire,as a result of the stimulation of public sympathytowards crippling ; following this came the Red Crosscampaign against rheumatism. In discussing theeducation and training of the cripple Mr. Watsonstresses the importance to the State of a man who canbear at least part of the burden of his maintenance.In this field America has far out-distanced us; aninteresting chapter is devoted to the American scheme,under which every citizen has a right to vocationaltraining for direct employment or rehabilitationafter accidental injury. In the final chapter isoutlined an abstract rather than a concrete constructivepolicy, but at the present time it is perhaps impossibleto do more. In the establishment of the new faith ofhumanitarianism and in the extension of voluntaryagencies for their relief and education cripples will,he believes, find salvation. The book is appropriatelydedicated to Sir Robert Jones.

THE TREATMENT OF TETANUS.

THE treatment of tetanus by massive doses of

antitoxin has a sound basis of experimental work.In 1917 Sherrington showed that antitoxin injectedin suitable amounts would protect monkeys in whichthe disease had been produced artificially by theinjection of toxin, but attempts to cure patientsalready showing signs of infection by this meanshave proved disappointing. Dr. A. E. Paterson 1

has just published the results of treatment of tetanusin children by larger doses of antitoxin than havepreviously been given. These results are so strikinglysuccessful in comparison with those of previousobservers that his method deserves wide publicity.The outstanding feature of his practice is the amountof antitoxin given both at the beginning and through-out the illness. As a routine 100,000 (American)units are given intravenously and 40,000 intra-muscularly in the first place; the former dose isrepeated in 12 hours and then again at 24-hourlyintervals according to the clinical progress of thecase, while the latter is repeated four-hourly, theamounts being gradually lessened and later given atless frequent intervals. With this method of 26consecutive patients 19 recovered, the dosage inthe successful cases ranging from 120,000 to 1,970,000units. Difficulties connected with this treatment arethat intravenous therapy in patients with tetanus,especially in children, usually requires a generalanaesthetic, and the expense of large doses of anti-toxin is considerable. Moreover, the injection ofa large amount of horse serum is not easy. Thelast-named obstacle has happily been considerablymitigated by the more concentrated antitoxin nowon the market, the volume of 100,000 units now being60 to 70 c.cm. instead of 300 c.cm. as formerly. Dr.Paterson quotes some cases in his series which areof especial interest. One patient with an incubationperiod of six days progressed well for five days butthen died suddenly during a spasm. He had onlybeen given 240,000 units of antitoxin in this time,and it is possible, in view of the results with later cases,that larger doses might have saved his life. Anothercase showed clearly that antitoxin should not bediscontinued too soon, but should be carried on wellinto convalescence. This was a moderatelv severeinfection which reacted well during the first few daysof treatment. The intravenous injections were,

1 Med. Jour. of Australia. 1930, i., 832.

537

therefore, discontinued during the fourth day, buton the fifth day the patient relapsed and the dose hadto be increased again. The patient then recovered.Topley and Vrilson 2 explain the discrepancy between Sherrington’s results and those obtained in clinical

practice by the facts that toxin and not bacilli wereinjected by him and that the doses he used wereenormous considering the weight of the animals.The dosage used by Dr. Paterson is relatively onlyslightly less than that used by Sherrington. Theauthor is the first to admit that his series is toosmall for any certain claims about the value of massivedoses of antitoxin to be made. They do, however,strongly indicate that the doses used hitherto havebeen much too small, and his results justify anextensive trial of larger doses particularly now thatconcentration of serum has overcome one of the chieftechnical difficulties.

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INCIDENCE OF CANCER IN MENTAL PATIENTS.

RELATIVE immunity to cancer in races and indi-viduals is always of interest and the detailed investiga-tion of the phenomenon has been considered a fruitfulpath of research. The incidence of cancer on certain races in Europe was studied in 1925 for theLeague of Nations Subcommittee on cancer statistics,and Prof. Eugene Pittard, after undertaking this

investigation, had little doubt that the Nordic racewas more subject to cancer than the other Europeanraces and the Mediterranean race least so. A less

complex problem for detailed research was suggestedby the Commissioners for Lunacy in England, whoin their annual report for 1909 made the observationthat the asylum patient appeared to be relativelyimmune to cancer, as also to bronchitis, comparedwith the general population. The Commissioners

pointed out that the age incidence was the same inthe two groups-that is to say, the normal population.and the mentally affected, and that there had beenthe same apparent increase in the incidence of cancerin both sections of the community in recent years.Although the subject came under notice again in1923, nothing was done till 1929 when the newlycreated infectious diseases subcommittee of the RoyalMedico-Psychological Association sent round a

questionaire to 72 mental hospitals and then referredthe replies to a professional statistician. The outcome3shows, first, that both in the sane and the insanethere has been a steady increase in the mortalityfrom cancer recorded during the last 10 years from1919-29. Whether this is a real increase or merelyan apparent one due to more accurate statisticsit is impossible to say; since medical statistics werequite inadequate in the past, an increase in cancercases with more carefully compiled figures is to be.expected. Secondly, the figures show that approxi-mately one-seventh of the deaths in England andWales are attributable to cancer whereas only one-twenty-sixth of the deaths in the mental hospitals aredue to this disease-a much lower figure. Finally, forthe period 1920-28 the death-rates from all causesin the 72 mental hospitals are compared with thoseamong persons aged 15 years and upwards in thegeneral population of England and Wales. Thetotal death-rates are 79 in the mental hospitalsand 13 in the general population, while a comparisonof cancer death-rates show that there are 306

2 Principles of Bacteriology and Immunity, Londen, 1930.3 (a) First Report on the Comparative Incidence of Cancer

In Mental Hospital Patients and in the General Population ofEngland. By J. R. Lord, C.B.E., M.D., F.R.C.P. Edin., andM. J. McGrath, M.B., D.P.M. (b) The Incidence of Cancer atRainhill Mental Hospital. By Arthur Pool, M.D., M.R.C.P.,D.P.M. London: Adlard and Son. 1930. Pp. 22. 9d.

in the mental hospitals to 176 in the general population-i.e., less than twice as high. Before accepting thesefigures as representative it is necessary to ascertainhow far the lower proportion of deaths from cancerin the mental hospitals is explainable by the veryheavy death-rates in these institutions from othercauses, such as general paralysis and tuberculosis. Theprofessional statistician’’ (unnamed) who analysedthe figures for the Association draws attention to thisneed, and it is to be hoped that this important partof the study will receive prompt attention. Mean-while an interesting addition to the report is theoutcome of an investigation carried out by Dr.Arthur Pool at the County Mental Hospital, Rainhill.Dr. Pool undertook a study of the incidence of cancerin this institution over a period of 25 years, basinghis figures upon an analysis of post-mortem records.He believes his results to confirm the low incidenceof cancer in mental hospitals compared with thegeneral community, but finds no increase in incidencewith the passage of years ; this last result, based as itis on actual port-mortem findings, is worthy of con-sideration. It is not, however, recorded what pro-portion of patients dying in the institution during theperiod covered by the inquiry were submitted to

autopsy. If this proportion was not very highindeed some cases of cancer may have been missed.This is a less unwieldly field of research than ispresented by the investigation of racial cancer; butmore work, will be necessary to eliminate possibleerrors before definite conclusions can be drawn on thelines of detailed research planned out.

INTERNATIONAL LEAGUE AGAINST TRACHOMA.

ir is proposed tnat me next meeting OI tms

League should be held in June, 1931, at Budapest.At the recent meeting of the League at Geneva,when Prof. de Grosz was elected President, thefollowing were chosen as vice-presidents and membersof the executive committee : Dr. Marquez (who waschairman of the International OphthalmologicalCongress in Madrid), Mr. Szymansky (President ofthe Polish Upper House), Mr. MacCallan (representingthe Ophthalmological Society of the United Kingdom),Mr. Morax (Paris), Mr. Angelucci (Naples), Mr. Birch-Hirschfeld (Konigsberg). Other members of the

executive committee are Mr. Brandes (Antwerp),Mr. Kadlicky (Prague), Mr. van der Hoeve (Leiden),Mr. de Lapersonne (Paris), Mr. Park Lewis (Buffalo,U.S.A.), and Mr. Miyashita (Tokyo).

THE ORAL ADMINISTRATION OF ŒSTRIN.

To the lay and also many medical minds it musthave caused some astonishment that the InternationalCongress for Sex Research, held in London duringAugust, was concerned less with the sociologicalaspect than with the chemical side of sexual activity.The papers and discussions for the most part centredround the physical, chemical, and physiologicalproperties of the internal secretions of the sex glands.It has long been known that the glands of internalsecretion which play a part in sexual functions are not tmerely the gonads themselves but include more

particularly the pituitary. In fact, recent work hasbeen concentrated on the pituitary and the placentato such an extent that oestrin and the testicularhormones have been temporarily eclipsed. Manyof the communications at the Congress emphasisedthe importance of the pituitary, but the gonads weregiven due prominence. At Chicago, T. F. Gallagher,