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sign was shown at the meeting by charts representingthe incidence of eclampsia and non-convulsive toxaemiaat different blood-pressure readings. Eclampsia wasseen to occur frequently with a blood tension of below160 mm. The mortality curve of all toxaemic patientsshowed the death-rate (of 105 cases) to be 5 per cent.where the tension was 150 mm. or below, 9 per cent.where the pressure reading lay between 151 and 190,and above 190 mm. the mortality rose sharply to27 per cent. In the discussion which followed Mr.Bourne’s remarks Mr. Eardley Holland drew attentionto the importance of regarding toxaemic pregnancyin the light of the possible after-history of the patient.The preliminary results of his investigations showedthat at least 12 per cent. of eclamptic patients sufferedsome permanent functional damage to their kidneys. IA subsequent morbidity rate of this extent cannot bewithout influence on our expectant treatment ofsevere toxaemia, where every day in the undeliveredstate may be adding fresh irreparable damage to thekidney. Mr. Holland gave figures of eight cases toshow the great danger and even futility of attemptinga " cure " of a case of eclampsia which does notinclude delivery. Dr. Mackenzie Wallis emphasisedthe difference in the blood and urinary analyses oftoxaemia and true nephritis, and showed how it waspossible to arrive at a diagnosis of these conditions byexamination of the blood and urine. Dr. Simmsalso gave the results of his pathological experiences,and referred to the anomalies of chloride excretion metwith in toxaemia. Sir William Willcox, who presidedover the meeting, summed up the chief points thathad emerged from the discussion as the difficulties ofimmediate prognosis and the dangers of permanentfern a) da.Tnae’e.

EFFICIENCY IN SILK WEAVING.

THE introduction of power-driven machineryobscured for the past generation the influences exertedupon output by the human factor in industry. To-daycareful observations are disclosing that this factormakes the difference between profit and loss, eventhough the machinery may be running perfectly. Arecent report issued by the Industrial Fatigue ResearchBoard, which deals with individual differences amongsilk weavers, establishes the value of the humanequation in what would at first sight appear to be anextreme case of machinery controlling output. Theinvestigator, Mr. P. M. Elton, first found that indi-viduals among groups of weavers, when distributedaccording to their differences in efficiency, gave adistribution similar to that of a probability curve, andthat they maintained this distribution when employedon different qualities of cloth. Variations on the samekind of cloth were found, ranging from an efficiency of43 per cent. to one of 90 per cent., which means thatthe earnings of the least efficient weaver and theproductivity of her loom were only half that of the mostefficient weaver. Careful observations of the methodsused disclosed that herein lay an explanation of muchof the differences observed. No little interest attachesto the way in which these observations were made andtabulated ; much of the importance of the presentreport for future inquiries depends on this. The betterweavers, although often appearing to be less busy,adopted labour-saving methods which allowed themto devote more of their energies to production ; whilepoor weavers, apparently working with an excess ofzeal, were doing much useless work, a fact which arosefrom lack of, or faulty, training. Here is exhibited thevalue to wage-earning, and so indirectly to health aswell as to productivity, of a study of the humanmachine. Mr. Elton holds the observations alreadymade have at least established that good silk weavers(1) possess good eyesight, (2) are observant, (3) aredexterous with both hands, (4) have a delicate sense oftouch, and (5) can stand for long periods. Clearly, agirl who has not these qualities should not waste time

1 An Analysis of the Individual Differences in the Output ofSilk Weavers. P. M. Elton. Industrial Fatigue ResearchBoard. Report No. 17. Pp. 38. H.M. Stationery Office.1922. is. 6d.

in learning weaving, and an employer should not incurexpenditure in training such a person. The advantagesto industrial contentment and well-being, and toprofits, from extension of work on these lines is obvious.

ANÆSTHESIA FOR INTRACRANIAL SURGERY.

THE best type of anaesthesia, for use in intracranialsurgery was discussed at a meeting of the Sectionof Anaesthetics of the Royal Society of Medicine onMarch 3rd. Dr. Z. Mennell briefly reviewed thegradual change in the methods used during thelast 20 years at the National Hospital, Queen-square. The danger of chloroform, which was atthe beginning of that time commonly employed,he explained by the much higher percentage necessaryin the blood for anaesthesia when the intracranialpressure was raised. Directly the tension is relievedan enormous increase takes place in the volume ofblood flowing through the brain, and a dangerous oreven lethal dose may suddenly bathe the medullarycentres. Anaesthesia deepens directly the dura isopened, whatever anaesthetic is being used. Etherwas then substituted for chloroform in the VernonHarcourt inhaler, and later still was habitually givenfrom a Junker bottle attached to an oxygen cylinder.Mechanical difficulties led to the substitution ofinfusion anaesthesia for these inhalation methods,and though, said Dr. Mennell, the technique was tire-some and expensive, hedonal gave good results till thewar rendered it unobtainable. Dr. Mennell now usesintratracheal ether for all cerebellar, pituitary, orhigh spinal operations. This is convenient inasmuchas it permits of the extreme flexion of the neckrequired for some of these operations, and vomitingcan be more certainly avoided than by any othermethod. To patients suffering temporal or parietaloperations Dr. Mennell frequently gives ether andoxygen by means of a Junker inhaler, since theintratracheal method is less essential in these cases.Mr. Percy Sargent dwelt on the need of close coöpera-tion between surgeon and anaesthetist, since thevariations in intracranial pressure were the mostimportant factor during operations for cerebraltumour. The brain, he added, was tolerant of changesof pressure provided that they were brought aboutgradually. ____

THE NEED FOR ANATOMICAL RESEARCH.

AT the recent discussion on Gastric Ulcer, whichtook place at the Royal Society of Medicine, severalspeakers alluded to the growth of knowledge concern-ing this and kindred diseases which has occurred sincethe advent of abdominal surgery. It would scarcelybe an exaggeration to say that it is the surgeon whohas stimulated all the modern interest in gastro-intestinal disease, and it is surgical initiative, andoccasionally surgical mistakes, which have led to theadvances. A review of present-day conceptions ofthe physiology of the stomach, such as that recentlypublished by Mr. Robert Mailer in the EdinburghMedical Journal, makes it clear, however, that thephysiologists and physicians have in their turn donevery notable work on these problems. Pavlov,Cannon, Hurst, and Rehfuss, each of these, andmany others have produced researches which placeour knowledge on a sound footing, and an examinationof their findings arouses in the mind of the critic thequestion, " What are the anatomists doing ? " Forit is very clear that these gastro-intestinal problemshave reached a stage where far more precise know-ledge is required. As an example, Mr. Mailer rightlycalls attention to the modification which has latelyoccurred in our previous ideas concerning the acidcontrol of the pylorus ; but what, we may ask, is thenervous mechanism of pyloric action ? Anatomiststo whom the question is put will vaguely talk of thevagus and sympathetic nerves ; pressed for moreprecise information they will say that each of thesecontains both motor and inhibitory fibres. And

1 Robert Mailer : Edin. Med. Journ., 1922, xxviii., 114.

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this is but one of the unanswered questions whichconfront us in later months when trying toharmonise the X ray appearance of the viscerawith descriptions given in the dissecting room. Itcannot, we think, be fairly urged that such questionsregarding the function of anatomical structures arepurely the province of the physiologist ; had suchan attitude been adopted by the great anatomists ofthe past little would be known to-day of the signi-ficance of all those minute ramifications of nervesand vessels, or the meaning of the small tuberositiesand markings of bones, the elucidation of which hasbeen the fruit gathered from the work of years.There has, we feel, been a regrettable tendency inanatomy schools of this country for many years toconfine investigation to small embryological prob-lems ; the mass of precise knowledge which everystudent has to acquire makes it difficult for his teachersto escape from the purely pedagogic side of their duties.Conversation with junior demonstrators at schools ofanatomy in Paris and Turin recently taught us thatactive investigation into problems such as we haveindicated is there in progress ; such questions aretechnically very difficult for the physiologist, theyare of too academic a character for the surgeon, butsurely we have still many anatomists who mightapproach them with enthusiasm and advantage.

SUBCUTANEOUS FIBROID SYPHILOMAS.

Dr. Howard Fox,’ of the Department of Dermatologyand Syphilis of the Harlem Hospital, New York,records a rare manifestation of late syphilis in anegress, aged 45, who presented other evidence of thedisease in a circinate group of nodules on one arm anda very strongly positive Wassermann reaction. Onboth elbows and knees were extremely hard, painless,subcutaneous nodules which had appeared two yearspreviously and remained unchanged during this time.They had no apparent relation to the bursae. Histo-logical examination of one of the lesions showed adense fibrous gumma. In addition to the histologicalproof of their syphilitic nature, the lesions responded,though somewhat slowly and incompletely, to specifictherapy. Dr. Fox alludes to two similar cases reportedby Goodman and Young in the United States and byParkes Weber in this country. The case also presentedsome resemblance to the rare condition of juxta-articular nodules which were first described byMacGregor and later carefully studied by Jeanselme,as occurring among the nations of many tropicalcountries, including Java, Siam, and especially tropicalAfrica. The lesions in these cases are round or

oval, painless, generally multiple and symmetricallyarranged, and of a board-like hardness. They have,however, no relationship to syphilis, tuberculosis, orxanthoma, and microscopical examination fails toreveal their nature, but Davey regards them as alate manifestation of yaws. They may reach thesize of a small orange, contain no fluid, and in rareinstances disappear spontaneously.

AUTOGENOUS BLOOD RE-INFUSION IN

RUPTURED ECTOPIC GESTATION.

SINCE Thies, in 1914, introduced the re-infusionof blood from the peritoneal cavity into the vein ofthe patient in cases of ruptured ectopic gestation,the method of re-infusion has been tried by manysurgeons, but chiefly during the war for haemothorax.From Topler2 we have a report of autogenous bloodre-infusion in 24 cases of ectopic gestation, withouta death, the mortality in the same clinic beforethe method was introduced being 5’7 per cent, Thecases chosen for the treatment were those showingsigns of severe internal haemorrhage with collapse1 American Journal of Dermatology and Syphilology, February,

1922.2 Deutsche medizinische Wochenschrift, Jan. 19th, 1922.

and air-hunger, and with t history of recent rupture.Cases of slight hemorrhage were treated with salineinfusion only, and are therefore not included in thisseries, while those showing signs of infection or

toxicity were not treated by blood infusion. In the24 cases the rupture occurred at about the sixthweek of pregnancy, in 22 cases a ruptured tube wasfound, and in two cases an intraperitoneal pregnancy.Nineteen cases were operated on within 24 hours ofrupture, two on the second day, and three cases gavea longer history. On opening the peritoneum, thetube was clamped, and the blood ladled out andpassed through eight thicknesses of muslin into anErlenmeyer flask, where it was diluted with an equalquantity of saline, and kept at body temperatureuntil a vein was ready for infusion. The infusiontook from 10 to 40 minutes. The blood was neitherdefibrinised nor citrated. The average quantityinfused was 520 c.cm. infusions, ranging from 150 to900 c.cm. In all the 24 cases no untoward effectsfrom the infusion, and no indication of destructionof corpuscles, emboli, &c., were observed. Theaverage length of stay in hospital was 20 days, whichwas shorter than most cases not treated with bloodinfusion.

MEAT INSPECTION.

THE Ministry of Health has displayed commendablezeal in giving effect, by means of a circular letter andmemorandum, to the recommendations of the MonroCommittee on Meat Inspection. The recommenda-tions of this Committee are generally approved by theMinister, but only a few are the subject of officialreference. Possibly the restraining effect of thenecessity for obtaining new powers from Parliamenthas been the deciding factor. The suggested systemof meat marking, which received the unanimousapproval of the Committee, is not referred to in thepresent official circular. The memorandum deals withmeat inspection proper, and, whilst containing nothingrepugnant to the recommendations of the RoyalCommission on Tuberculosis of 1898, with one excep-tion-namely, the standard of condemnation to beobserved in the case of pig carcasses affected withtuberculosis-it elaborates what were previously broadprinciples by setting out in considerable detail thewhole subject of meat inspection. This was obviouslynecessary in view of the fact that inspectors inter-preted these principles differently. Viewed as a whole,the chief result will be to regard carcasses affected withtuberculosis in a somewhat less stringent manner thanrigid adherence to the principles previously laid downmight have deemed to be desirable. It will appearthat generalised tuberculosis will be considered morefrom the standpoint of evidence of recent or remoteinfection.The memorandum sets out the obligations of those

slaughtering, and suggests that the offal of slaughteredanimals should be detained until inspection can bearranged. This will prove of great value to inspectorswho have to visit detached places and have not theadvantage of a central hall. Concentration ofslaughtering by the establishment of public abattoirsis not recommended, probably on account of thecapital expenditure which would be necessary. Thepractice of concentration which obtained during thewar is advised, and this appears a sound experimentalcompromise, the development of which we shall watchwith interest. Ante-mortem inspection is, of course,almost impracticable without concentration, but thesuggestions made under this heading will be of valueif only because official recognition is now given here.Uniformity of standard is aimed at both in respect ofthe amount of meat inspected and the standard ofjudgment displayed. To assist in this direction thequalifications of inspectors receive attention, andexpert inspectors working over a large area are

suggested to assist lay inspectors who work in thesmaller districts. A lay inspector should be competentto recognise that a discovered abnormality requires aperson of greater pathological knowledge than he