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African foodstuffs is worked out by indophenoltitration and confirmed in some cases by biologicaltests. Indophenol titration is admittedly a roughmethod of estimating vitamin C, being subject tocertain well-recognised sources of error, but its useserves to give a general idea of the vitamin-C contentof foodstuffs. One material, lucerne, receives specialattention, since the leaves were found to have a

very high vitamin-C content, about four times that offresh citrus fruit juice. Lucerne, which is a vetch, iswidely used as a food for domestic animals-in SouthAfrica especially for ostriches-but there seems tobe no reason why it should not be adapted for humanconsumption as a salad or spinach, where there wouldotherwise be a shortage of fresh antiscorbutics.From Calcutta R. K. Chakraborty publishes a similarstudy,2 in which special attention is paid to theantiscorbutic value of milk, human, cow’s, goat’sand buffalo’s, and of foodstuffs of plant origin.Three fruits were found, species of zizyphus, physalis,and citrus, all of which were more potent sources ofvitamin C than the best Indian fruits previouslyknown, the Indian lemon and orange. Both theIndian and African studies will no doubt be extendedand investigations of the same sort will eventuallyhave to be undertaken in all parts of the world wherethe less usual foods are eaten.

ELEPHANTIASIS IN BANCROFTIAN FILARIASIS

DURING the last four years Prof. C. K. Drinker andhis colleagues have been working on the lymphaticsystem of the dog. They have produced typicalelephantiasis by repeated injections of two sorts

given slowly into the lymphatic trunks of the lowerlimb-namely, a watery suspension of crystalline silicawith particles about 1 !J. in diameter, and a solutionof quinine hydrochloride with a strength of 2-5 percent. In the lymph glands the particles of silica getcaught up in the endothelial reticulum of the sinuses,and these become filled with large pale cells whichlater form fibrous tissue ; the effect of quinine inbringing about the closure of varicose veins is wellknown. These repeated injections, made at normallymph pressures, act upon new collateral channels asthey are formed; and the final effect is that, as theresult of lymph blockage and transient periods ofsterile inflammation produced by purely physicaland chemical means, the part becomes typicallyelephantoid. Further inflammatory attacks are aptto occur in it, just as they do in elephantoid tissue inman ; they last normally about 48 hours, and eachof them adds to the amount of elephantiasis.

It has been much debated whether attacks of thiskind, occurring in elephantiasis due to Wuchereriabancrofti infection in man, are caused by the filaria,adult or embryo, or by an added bacterial -infection.Drinker has probably explained the different findings,on which these differing opinions are based, byshowing that in the first few hours, and in the firstfew hours only, of such an attack in a dog a h2emo-lytic streptococcus is present in the oedema fluidfrom inflamed elephantoid tissue, and that this fluidcan be obtained from a dependent leg without priorinjection of salt solution. If this pointer is followedit should be possible to settle whether or not these.attacks in man are due to bacterial infection seededon to a suitable soil. That the elephantoid tissue doesafford such a soil is seen in the fact that inflammatoryattacks could be induced by injecting into it a smallfraction of the number of streptococci needed toproduce the same effect in a healthy animal. During

2 Indian Jour. Med. Research, 1935, xxiii., 347.

these attacks the lymph of the inflamed part has ahigh protein content, amounting to about half thatof the plasma, instead of the normal percentage ofabout one; and in such a medium, used in vitro, con-nective tissue cells grow well. Further, when therupture of dilated lymph vessels has allowed of

escape of lymph through the epidermis, the proteincontent of the oedema fluid becomes low and the dogin question has shown little permanent fibrotic

enlargement of the limb. The disadvantage of

attempting to reproduce this state of affairs in manare clear, but there may be conditions in which

upward drainage is possible. The means of doing sowere apparently added to in the case of a womanof 19 with double elephantiasis nostras of the lowerlimbs. The obstruction was high up in the abdomenand by incising large lymphatic vessels lying on theiliac arteries the lymph was made to run into theretroperitoneal space-with what permanent resultcould not be stated when the report was published. 1

There is another feature in which these experimentshave fallen in with experience in man. In the typicalinflammatory outbreaks which have been mentionedthe blood has at all times been free of bacteria ; butin one dog, evidently as the result of infection by amore virulent strain of streptococcus, a septicaemiadeveloped reminiscent of the grave cases which havebeen so striking a feature of Bancroftian filariasis inBritish Guiana. In these various ways the newmethods used by the physiological laboratory of theHarvard School of Public Health have given a welcomeimpetus to the study and explanation of this infectionin man.

LE ROY EST MORT!

ANY doctor who has tried to make even a tentativediagnosis solely on the patient’s symptoms as

described to him by a friend or relative knows howludicrously he may be led astray. Nfr. Yearsleyis therefore to be congratulated on his courage indiagnosing the causes of death of the Rulers of

England on what, in many cases, is very slenderand unreliable testimony.2 Perhaps, as may be

necessary sometimes in surgery, he has had to learnnot only to make up his mind but also to act oninsufficient evidence. Be that as it may, and althoughwe cannot unreservedly accept all his diagnoses, itmust be admitted that he has written a very interestinglittle book. The Rulers of England, if Oliver andRichard Cromwell and the luckless Lady Jane Greyare included, number forty from the Norman Conquestto the death of King Edward VII. Of these, no lessthan eight (20 per cent.) died violent deaths, eitherin battle or at the hands of the murderer or headsman,but it is reassuring to loyal subjects to note thatthe practice of regicide grows less common as timegoes on. The acute infections and cardio-vascular-renal disease have each accounted for six; syphilis,congenital or acquired, and " dysentery," whichcovers a multitude of ignorances, have each disposedof four. " Senile decay," a diagnosis no longeraccepted as a certified cause of death, is mentionedin three cases and implied in one other. Stephenmay have had an appendix abscess, Edward III.gonorrhoea, and Richard II. anorexia nervosa, butMr. Yearsley thinks that Henry I.’s "surfeit of

lampreys " was more probably ptomaine poisoning.George IV. and William IV., pathologically speaking,had much in common ; both had hepatic cirrhosis,

1 Homans, J., Drinker, C. K., and Field, Madeleine : Ann. ofSurg., 1934, c., 812.

2 An Account of the Deaths of the Rulers of England. ByMacleod Yearsley, F.R.C.S. London: John Heritage, TheUnicorn Press. 1935. Pp. 164. 3s. 6d.