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hygiene, since in the present war problems are mainlyconnected with the civil population. The book shouldhave special value to British medical ’practitioners whoare finding that war-time restrictions on imported litera-ture make it difficult to keep abreast of recent advancesin knowledge.

Medical Societies

ROYAL ACADEMY OF MEDICINE IN IRELANDAT a meeting of the Section of Obstetrics on Oct. 17,

with Mr. SETON PRINGLE in the chair, a presidentialaddress on

was read by Dr. N. M. FALKINER. He recalled the workpublished in 1914 by James Young, who accuratelydescribed the red infarct and drew attention to itsassociation with eclampsia. Recently workers inAmerica, especially Bartholomew and his colleagues,.have revived Young’s views. Careful examination ofplacentas from all toxæmic cases have resulted in therecognition of certain types of placental infarct in assoria-tion with different clinical manifestations. It has beenshown that placental infarcts of the more acute typesare definitely associated with the toxæmias of pregnancy,and it is possible to predict the type of infarct that will befound in the placenta from the clinical history. Withthe experience of examining placentas as " unknowns,"it has been possible to establish criteria for an exactclassification of placental infarcts and their relation totoxaemia. Bartholomew has put forward hypotheseswith regard to the significance of hypocholesterolsemia andhypothyroidism as predisposing to infarcts in theplacenta. Young and Bartholomew agree as to theaetiological significance of the acute placental infarct intoxaemias, but differ in their interpretation of the causalfactors producing these lesions. Dr. Falkiner showedsections from 20 cases of toxaemia of pregnancy anddemonstrated the constant occurrence of acute infarctsin pre-eclampsia and eclampsia and that the older ormore chronic infarcts are associated with nephritic

Dr. GIBBON FITZGIBBON said he had found a fewinfarcts, but had more or less discounted them as

causative elements in the toxaemias of pregnancy.Dr. BETHEL SOLOMONS urged that a series of placentas

from normal cases should be compared with a series fromtoxaemia cases. He asked if autopsies have been done oncases where the uterus has been removed with theplacenta in situ, for these might shed new light on thedecidual circulation. The relation of infarcts, and a goodor bad decidual circulation, to toxaemias is, he said, stillan unsolved puzzle ; the general belief is that wheninfarcts are present with good decidual circulation thetoxsemia is more severe.

Dr. JOHN CUNNINGHAM referred to the great delicacyof the vessels in the placenta, and said that the rate ofgrowth of these vessels is enormous. When growth isas rapid as this something is bound to go wrong some-times, and this to some extent explains the developmentof infarcts. The most interesting question is whetherthe toxaemia is due to the infarct or the infarct due to thetoxaemia. He personally thought that the infarct isdue to the toxaemia. In cases of chronic nephritis andvascular hypertension it is not unreasonable to expectthat the new blood-vessels in the placenta will beespecially affected.

Prof. A. H. DAVIDSON thought the chief question was :does infarction come from the maternal circulation orfrom the foetal circulation ? He thought that it comesfrom the latter. During his time as master of theRotunda Hospital a number of babies born of toxaemicmothers showed albuminuria, which suggested that theyhad nephritis.

Dr. R. M. CORBET said that if, as Bartholomew and hisco-workers maintain, the foetal vessels are primarilyaffected, there must be a hypercholesterolaemia in the foetalcirculation ; the question might also be raised why thefoetus is not always affected to the same degree as themother. Dr. Falkiner suggested that when the infarctionis acute the whole cotyledon is involved. If this is so,the toxins liberated may not be absorbed by that cotyle-don, but will be carried upwards in the maternal blood-

stream to the subchoriçmic pool where there is little or noabsorption, and thence into the general circulation, wherethey may be taken up by the maternal tissues before theblood returns to the placenta, hence leaving the foetusunaffected.

Dr. J. S. QuiN thought that if these lesions are thecause of the toxaemia the case of toxaemia from severeaccidental haemorrhage which Dr. Falkiner mentioned mustdemand another explanation. Whether the toxaemia,is maternal or foetal in origin, Dr. Falkiner consideredconsidered that both the maternal and the fcetal circula-tions were involved. How does the separation of theplacenta in these cases compare with the appearanceof the infarcted areas in a recent infarction ?

Dr. W. R. F. COLLIS had observed that in every casewhere there was toxsemia in the mother there wastoxaemia in the baby as well. Wherever the toxin is itcertainly gets into the foetal circulation. He asked whatis the mechanism of the actual thrombosis. Is it foetalor maternal ?

In his reply Dr. FALKINER said that this work is stillgoing on. The decidua had not been examined in anycase. It is very difficult to examine the decidua in theplacental circulation. There are reasons to back up theview that disturbance of the maternal circulation willcause infarction. The greater proportion of patientswho develop sugar in the urine during pregnancy developalbuminuria.

AMERICAN UNIT AT WORKTHE American Red Cross Harvard field hospital

unit, planned for the investigation and treatment ofinfectious diseases under war-time conditions, is now atwork. Soon after war broke out Harvard University offeredto send a field and laboratory unit to England to studyepidemiological problems. The offer was accepted, andin August, 1940, Prof. J. E. Gordon of the Harvardmedical school came here to confer on the details oforganisation. It was decided that a hospital shouldbe included, and at the invitation of Harvard theAmerican Red Cross agreed to provide hospital build-ings and equipment and recruit nursing and admini-strative staff. To assemble personnel and equipmentand move them across the Atlantic naturally tooktime. Now, however, a year after the development ofthe plan, transport of equipment and staff has beencompleted and the construction work is nearly done.There are twenty-two buildings, connected by coveredwalks, each building having its own oil-burning central-heating system. Beds are provided for 125 patients,over 40% of them in single rooms, the remainder in two-bed rooms. The hospital is affiliated with the Emerg-ency Medical Service, a,nd receives both military andcivil patients. One building is especially designed foradmitting and discharging of patients ; new arrivals areexamined and in some instances treated in this buildingbefore being transferred to a bed in the main hospital.Those ready to be discharged are brought back,to thisbuilding for tub bath and return of clothing. In otherbuildings are staff quarters, laboratories, operating-theatre, X ray, laundry, kitchen, dining-room, store-rooms, garage, offices and recreation-rooms. Thelaboratories are well equipped for diagnostic proceduresand research in infectious disease. Personnel broughtfrom America includes 60 nurses, 8 physicians, 6 labora-tory technicians, 3 secretaries, a hospital superintendent,a dietitian and a chef. Other employees are British.The aim of the unit is to attack problems of infectiousdisease by mean sof field study. laboratory investigationand clinical observations. Field units consisting ofphysicians, technicians and public health nurses will beavailable for work in any part of Britain. Cars and otherequipment for mobile operations have been provided.These units are being used to supplement local healthorganisations in times of need, and such help will bewelcome now when local agencies are often reduced instaff and burdened with extra war duties. So far as ispractical the base will be used by the field unit forlaboratory work and for supplies. Actual projects inwhich the unit is engaged must of course depend largelyon circumstances, but infections of the central nervoussystem and the pneumonias are special interests ofmembers of the staff.