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maturity. His enthusiasm for some of the technicalprocedures which he himself has introduced remainsundiminished, although he writes modestly enoughof his results. His method of using an encircling suturein fractures of the patella-far more efficient than theconventional operation-should now be establishedas a routine. Mr. Hey Groves’s views on bonegrafting are particularly illuminating, especially hisexposition of the indications for using the inlay bonegraft and the intramedullary bone graft. The influenceof his wide experience, derived from a participationin the reconstructive surgery of the war during thepast five years, can now be traced in the criticalsurvey which he has made of the whole gamut of ’’,fracture therapeutics. Mr. Hey Groves leads us stepby step to, see that the modern treatment of fracturesimplies the application of an appropriate procedureto a given type of fracture or at a certain stage inany fracture : there is no real conflict between theschools representing, for instance, the non-operativeand the operative methods of treatment. The modernfracture surgeon must be a master of all methods,and must know ’when and where to apply anyparticular one. The thesis is developed and maintainedin a most lucid and convincing manner, and will serve eas a model for sections on fractures in future text-books of surgery. ____

TREATMENT OF SYPHILIS IN THE NAVY.

THE results of treatment for syphilis are more

patent in the Navy than elsewhere, in so far as thepatients are continuously under medical control andrarely pass out of sight. Two articles by Surgeon-Commander Laurence Kilroy, on the treatment ofsyphilis in the Mediterranean Fleet, are the morewelcome as the Fleet Medical Officer is not responsiblefor any single ship, but is advisory to the whole staffof medical officers. Commander Kilroy measures ’,the success of treatment by its effect on the Wasser-mann reaction, though he hopes that the quickerSigma test (THE LANCET, 1921, i., 956) may replacethat. He finds that intramuscular injections ofarsenobenzol once a fortnight produce more effectthan intravenous injections at shorter intervals,and that courses of mercury by the mouth increasethe effect of arsenobenzol on the W.R. He dis- tinguishes five classes of cases of syphilis, with I,appropriate treatment for each.

A. Early primary: In the first fortnight after theappearance of the sore, spirochæta pallida seen with dark-ground illumination. W’.R.-. B. Late primarv : Sore,and W.R.—. C’. Secondary : Usual signs, and W.R.—.D. Old cases: W.R. -1 , and perhaps other signs. E. Oldcases with nervous symptoms or positive Wassermann incerebro-spinal fluid.An A case gets a " unit course," that is in four months,

eight intramuscular injections of NAB, or sulpharsenol, atfortnightly intervals, and at the same time 4 gr. of grey i

powder daily. If at the end of the course there are no signsof syphilis and W.R.—, treatment ceases; but the serum Iis tested every three months for two years, and if on all theseeight occasions W.R.— patient is considered cured. If a I,W.R. + appears at any time, patient has become a B caseand is treated accordingly. A B case or a C case gets a I," unit course," then three months’ mercury by the mouthor by injection, followed by a second unit course, itself preceded and followed bv a W.R. If both tests are negative, ’Itreatment ceases and W.R. is tested every three months Ifor two years. If all are negative, patient is consideredcured. If the preceding W.R. is positive, but the second negative, repeat the unit course after three months’ mercury,with a W.R. before and after. A W.R. + at any time after Ithe second unit course makes the case a D case. All D cases should have their cerebro-spinal fluid completely examined Iin hospital: a W.R.+ makes the case an E case. If thecerebro-spinal fluid of a D case gives a W.R. -, send patientback to his ship, give him three unit courses, with mercuryin the intervals, testing the W.R. before and after the secondand third courses. If no two consecutive W.R.’s are

negative, give " half unit " (four injections) every fourmonths, the reaction being tested before and after. Assoon as two consecutive W.R.’s are negative stop treatmentand merely test the reaction every three months for two

1 Journal of the Royal Naval Medical Service, July andOctober, 1921.

years, and if all are negative consider patient cured. AW.R. + now at any time makes patient an E case, to betreated in hospital by a specialist.Commander Kilroy considers the appointment of

consultants in syphilis to be a great advance, but heholds that ordinary cases of syphilis up to E may betreated on board ; they do not require to be sent tohospitals. In hospital they cost 15s. 6d. per day (pay5s. 6d., hospital charges 10s.); in ships they cost 7s. 6d.per day (pay 5s. 6d., victualling 2s.), and the serviceavoids the trouble and time spent on transferringthem. Appeal is made for a specialist at head-quarters to coordinate the work of the specialists insyphilis throughout the service, and to advise whatmethods have been found most satisfactory. Thoseconcerned with the treatment of syphilis will findit well to study Commander Kilroy’s papers. Outof a total number of 46 cases in Iron Duke, all A and Bcases recovered, 83 per cent. of C, and 64 per cent. of D.

ANTI-ANAPHYLAXIS.

THE immunologist is the despair of the averagemedical reader, for he is constantly devising newterms to explain his discoveries and almost as

rapidly discarding them as newer discoveries renderthe old terms untenable. There is also a furtherdifficulty in the fact that a term devised by a foreignscientist has often to be incorporated into our voca-bulary as it stands, because it is not readily trans-latable ; as an example we may quote the terse butvaluable term " subintrant," introduced by Besredkato describe his special method of preventing anaphy-lactic shock. To Besredka also, in conjunction withSteinhardt, we are indebted for the introduction ofthe term " anti-anaphylaxis

" to describe the condi-tion of insensibility to further injections of theanaphylactic antigen. We are doubtful if the termcan really be regarded as a satisfactory one, and itswide use to cover a number of different immunologicalstates has weakened its significance not a little. Itwould strengthen our claim to consistency if weconfined this term to the actual state of being insensi-tive to the anaphylactic antigen, rather than enlargedit to cover the measures-often purely empirical-which the clinical pathologist devises to counteractanaphylactic symptoms in the patient. But thedeed is done and the term anti-anaphylaxis nowembraces in the minds of most physicians everyaspect of desensitisation. In a valuable reportl on thissubject by MM. P. Widal, P. Abrami and P. Vallery-Radot, read before the French Congress of Medicineat Strasbourg in October, after defining anaphylaxisas colloidoclasia or " the rupture of the physicalequilibrium of the colloids of the body," theauthors proceed to lay down the various methods ofdesensitisation. As they correctly point out, a

patient who has been deliberately sensitised withserum can be watched and protected from ill-effectsafter the second or anaphylactic injection, becausethe date of his first inoculation is, or should be, known.But in the case of patients who have become sensi-tised in some unknown way and at some remote timein their history, by absorption of protein throughgastro-intestinal or respiratory mucous membrane, adifferent problem confronts the physician. He mustfirst discover the protein which is at fault, and thenresort to his armoury of protective measures, such assubintrant doses, or vaccination with homologous orheterogeneous proteins, administration of peptone,crystalloids - e.g., sodium chloride - or finallyadrenalin. All these measures are fully discussed bythe authors, and also by M. Pélin in a subsequentpaper. They succeed in making anti-anaphylaxis alive issue whatever view may be taken of the termitself.Our current number contains an original article

by Prof. Storm van Leeuwen of Leiden, in whichhe records a series of cases of spasmodic bron-chial asthma treated with tuberculin. Excluding

1 Presse Médicale, Oct. 1st, 1921, p. 781.