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respect to age-distribution, more cases developed theirillness between 10 and 20 years than in any other period,though no age-group appeared to be immune. Lengthof residence in the area seemed to be a more importantfactor than age in determining the onset of the disease.Most of the leprous patients developed their illness afterten or more years’ residence in the town. The bulk ofthose who suffered were poor persons of the labouringclass. Single cases occurred in 19 houses; two houses had Ieach two cases, and in one house there were three cases. I

The tubercular type was more common than theanaesthetic, the mixed type being more frequent thaneither of the others. The majority of the patients gavea history of contact or association with a previous casebefore the development of their own attack.As a result of their investigations the authors formed

the opinion that there existed in the town a number ofunrecognised lepers. The incidence of the malady inthis area is therefore probably greater than the previousfigures would lead us to suppose; in any case, itappears to be higher than in any other of the recognisedendemic foci of leprosy in the United States. In theannual report of the Surgeon-General of the U.S. PublicHealth Service for 1918 it is stated that the number ofcases of leprosy in the whole of the United States inthat year was 209. The spread of leprosy in this Texanseaport town is apparently due, to a great extent, tocontact with recognised or unrecognised cases of thedisease. Various other hypothetical modes of spreadwere considered, and as regards possible transmissionof. the infection to man by rats or by insects no satis-factory evidence was forthcoming. The relation of afish diet to the incidence of the disease was alsoexamined, but this was also dismissed as beingunsupported by any evidence. In concluding their con-tribution the authors draw attention to the fact that’’ absolutely no official control or supervision in anyform has ever been exercised over the leprosy cases "in this affected area. It is proper to mention thatthese studies of leprosy in the seaport town in questionwere undertaken by Dr. Boyd and Dr. Fox in anunofficial capacity. -

THE SUPRARENAL GLANDS IN DEFICIENCYDISEASES.

THE widespread effects of the absence of vitaminesin the diet on certain organs apparently remote fromtheir influence is perhaps only just becoming recog-nised. R. McCarrison, in his observations 1 on the

genesis of oedema in beri-beri states that in pigeonssuffering from experimental beri-beri the oedema is

always associated with considerable increase in the sizeof the suprarenal bodies and that four-fifths of theanimals with enlarged suprarenals show some form ofoedema. The adrenalin content was increased propor-tionately to the weight of the organs. The pigeons hadbeen fed on polished rice heated in an autoclave, untilthey showed signs of polyneuritis. In 10 out of 22 pigeonsoedema occurred. The increase in size of the supra-renals is a true hypertrophy at least of the medulla,and if the increase of the adrenalin content can reallybe brought into causal relation with the oedema itis possible that this factor may be found to play somepart in the production of oedema generally. Whilethe size of the suprarenals appears to have relationto the absence of the antineuritic factor, it wouldappear that the suprarenals are also affected by dietsdeficient in the antiscorbutic vitamine, as shown

by the experiments of Victor K. La Mer and H. L.Campbell, of Columbia University. These observersfed young guinea-pigs, weighing 250-300 g., on a dietdeficient in the antiscorbutic vitamine, and found anincrease of weight of the adrenal glands amounting toapproximately 100 per cent. when computed on thebasis of body weight minus alimentary canal. Controlanimals which have been subjected to starvation do notshow an increase of adrenal weight, which in those fedon scorbutic diet is directly proportional to the timeduring which their food has been deficient. It is mostpronounced in those animals whose life has been pro-

1 Proceedings of the Royal Society, 1920, vol. xci.

longed by the partial protection afforded by small butinsufficient quantities of tomato juice. La Mer andCampbell interpret the increased weight as indicating acompensatory response to the decreased adrenalin pro-duction known to exist in the scorbutic animal, a pointwhich has interest in connexion with the extensiveintramuscular and intestinal haemorrhages found in

scurvy. The heart and kidneys are increased on thescorbutic diet, while there is no evidence that the liveris affected by a lack of water-soluble C alone.

TESTING OF CLINICAL THERMOMETERS.

AN announcement was published last week by theBoard of Trade that there is reason to believe thatnumbers of imported thermometers are being offeredfor sale in this country without having been officiallytested. The reminder is therefore timely that, underthe provisions of the Clinical Thermometers Order, 1918,no person may sell, offer for sale, supply, or deliver anyclinical thermometers which have not been tested,approved, and marked at the National Physical Labora-tory. Purchasers should, in their own interests, seethat any thermometers offered to them bear the officialtest mark-namely, a monogram formed with thecapital letters N.P.L., followed by two figures denotingthe year of test. The requirements apply to foreignthermometers imported into this country equally withthose of British manufacture, although clinical thermo-meters exported from the United Kingdom need not atpresent be tested and marked.

A BICAMERAL HEART

LAST November a curious specimen of cardiacabnormality was brought before the Section ofMedicine of the Royal Society of Medicine byProfessor A. Keith and Dr. J. J. MacDonnell,and an illustrated and detailed description of it

appears in the current issue of the Society’sProceedings. As Professor Keith remarks, in hisreport on the specimen, every one of the abnormalitiesshown has been frequently seen before, but the peculiarcombination appears to be unknown. The case wasone of complete transposition of viscera, and the apexof the heart was in the right nipple line, but the

autopsy disclosed a strange state of affairs. Briefly,there was an apparently ordinary aortic arch, directedto the left, but attached to the heart in front of adilated vessel, which otherwise was in the place of anormal pulmonary artery. The normally situated ductusarteriosus was patent, and through it the systemic bloodpassed, for the aortic arch received no blood from itsventricle. This dummy aorta arose from a ventricle whichwas the ordinary right ventricle, morphologically anddescriptively, while the " pulmonary aorta " came froma ventricle to the left and in front of the other. Thus,the ventricles were not transposed, while the aorticstems were transposed so far as their ventricular rela-tions went. The relations between the big vessels arethose which would come into being as a result of areversal of the direction of the line of septum formationin the single aortic stem, in keeping with the generaltransposition, but not with the left-sided arch. Theventricular position is normal, and it may be pointedout that the heart sometimes does not share insitus inversus. The intra-ventricular conditions indi-cated that the embryonic development of the ventricularand bulbous regions had been more or less normal, sothat the inversion of the aortic septum is all that needbe postulated here. But at the auricular end of theheart the auricle on the left side received the twovense cavse as well as the pulmonary veins, andthere was no inter-auricular foramen, so that theauricle to the right received no blood and could notfeed the right ventricle and aortic arch. The pul-monary veins joined into a common trunk-a primitiveembryonic stage-and opened into the auricle throughwhat was really a greatly distended sinus venosus orcoronary sinus ; an additional upper pulmonary vein onthe right side, however, opened into the right innominatevein. This, as Professor Keith points out, is doubtless

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the remnant of a drainage into an embryonic vena cavaon that side. Possibly this last vein represents anopening into the azygos system and thence into thevena cava, and might be looked on as a modifiedbronchial vein. The other pulmonary veins are appa-rently in a persistent embryonic stage, but the rest ofthe arrangements in this curious auricular region wouldseem to defy probable analysis from a developmentalpoint of view; it is another example of the inadequacyof normal embryology to account for abnormalitiesunder certain conditions, in which we get occasionalglimpses of deeper causative genetic factors of whichwe know nothing. The specimen is a most interestingone as a pathological condition, and it is only necessaryto add that it was consistent with a measure of

independent life, as the child lived seven months, dyingapparently from capillary bronchitis.

HEREDITARY HÆMORRHAGIC TELANGIECTASIA.

IN a review of the literature of hereditary haemor-rhagic telangiectasia associated with familial epistaxis,Dr. Hyman I. Goldstein/ of Camden, N.J., who himselfreports 11 cases in one family, states that 31 familiesaffected with this disease are on record, as well asseveral cases which are not altogether typical. Isolatedexamples of the condition with no other instances

occurring in the patients’ families have been described.In some cases hereditary telangiectases have beennoted in one or several members of a family, butwithout recurring epistaxis; in others there werepersistent recurrent attacks of epistaxis of the familialtype, but without telangiectases either in the patient orother members of the family. Males and femalesare affected alike, and are equally capable of trans-mitting the disease to their offspring. Heemor-rhage is the one constant symptom. In the greatmajority of cases it occurs in the form of epistaxis,but in some cases haemorrhage may occur from thetelangiectases on the tongue, lips, fingers, buccalmucous membrane, or even from the rectum. Multipletelangiectases, which constitute the sole characteristicof this condition, are found most commonly on thebuccal and nasal mucous membranes and upon the lips.They may also occur on the face, feet, hands, ears,scalp, neck, forearms, and chest. The telangiectasesassociated with epistaxis may occur in three forms:(1) pin-point ; (2) spider form, the most common; and(5) nodular. The lesions are apt to become prominentand increase in numbers between the ages of 35 and 50.Many of the patients present symptoms of profoundsecondary anaemia. The diagnosis is not difficult. Thecases must not be confounded with hoemophilia, haemor-rhagic diathesis, purpura, scurvy, pernicious anaemia,or " the phthisical state with haemorrhages." The

clotting and bleeding time is always normal, and thereis no history of haemophilia. The blood platelets arenot appreciably reduced, and the resistance of the redcells remains normal. No general treatment seems tobe effective, but local treatment may reduce the numberand severity of the haemorrhages and improve the

patient’s general condition.

COMPARATIVE RESISTANCE OF TISSUES TOLOCAL ANÆMIA.

&bgr;.MONGt3’.1’ tne many experiments wmcn were madein the attempts to allocate the relative share of bloodpressure, blood flow, and the renal tubules in thesecretion of urine was the experimental ligature of therenal vein. It was found that its closure for even avery short time led to prolonged cessation of thesecretion, and that when this was resumed the urinecontained albumin. Loren R. Chandler, of Stanford,California, has now studied the effects of producing atemporary renal ansemia of two hours’ duration byplacing a ligature about the renal artery of a rabbit.The rabbit is killed from one to four days later, whenhistological study invariably shows necrosis of practi-cally the entire cortical tubular epithelium, with few, if

1 Archives of Internal Medicine, Jan. 15th, 1921.

any, changes in the glomerular and interstitial elements.This method of producing epithelial necrosis with theminimum amount of injury to other elements addsanother method for the study of epithelial regenerationand the pathology of renal secretion. It has beenapplied also to the study of hepatic function and

regeneration, and tests have been made of the effectsof temporary local anaemia of the liver of dogs. To

produce this anaemia Eck’s nstulse were made. Five toseven weeks later the abdomen of each dog wasreopened, and temporary ligatures placed about thehepatic artery and portal vein, and the ligatures keptin place from three to 12 hours. The animals werekilled two to six days later. During the period of

ligation the dogs showed no toxic symptoms. Afterremoval of the ligature they appeared in every waynormal until they were killed. At the autopsy thehistological examination showed that in those withvessels ligatured for three hours there was no thrombosis,no necrosis or atrophy of the hepatic parenchyma; amoderate degree of fatty degeneration was mainly con-fined to the central third of the lobule. In the animalssubjected to 12 hours of local anaemia there was

similarly no thrombosis or necrosis ; there was markedfatty degeneration of the central half of the lobule,with slight atrophy of the parenchyma immediatelysurrounding the central vein. It would appear thatthe power of the hepatic cells to resist local ansemiais in striking contrast to the sensibility of the secretingrenal epithelium. In fact, the infrequency of infarctsin the liver, usually attributed solely to the pressure ofthe double hepatic circulation, is probably due in largemeasure to this power. It affords yet another exampleof the wonderful stability of the liver cells, which,though apparently so simple in structure, are yet somanifold in their functions.

THE PERSONAL ELEMENT IN EFFICIENCY.

AN Efficiency Exhibition promoted by the pro"prietors of the Daily Mail is being held this weekat Olympia, West Kensington, and is to remain openuntil Feb. 26th. The promoters have shown throughtheir selection and arrangement of the exhibits howinterest is growing in the human side of efficiency, incontrast with the technical or mechanical side. Theexhibits of two hospitals, St. Mary’s and the Middlesex,imply a recognition that efficiency depends uponhealth, and health in its turn upon medical knowledge.A good idea is given to the public how chemical, physio-logical, and bacteriological research is carried out; theMiddlesex stall is particularly well equipped, and is

attracting much attention. In another place the

People’s League of Health are showing how inefficientin matters of health the nation is to-day, emphasisingthe need for further research and the necessityfor popularising knowledge. In the gallery MajorFrank Gilbreth, from America, who is himselfin attendance at the exhibition, has a display ofunusual interest, setting forth his methods of addingto efficiency by minimising industrial fatigue throughscientific motion and time study. The whole of theannexe, placed at the disposal of the Ministry of Labour,is devoted to disabled ex-Service men who have beentrained to become efficient craftsmen, and there theymay be seen weaving, cabinet-making, printing, layingbricks, and doing a number of other things-awonderful demonstration of what determined mencan do to overcome physical disabilities. The needfor the personal and human note, for physiological andpsychological health, in order to ensure efficiency, wasborne testimony to by both Sir Robert Horne and Dr.Macnamara in their speeches on the opening day.The same factor appeared in planning the scientificconferences which are taking place daily; for thepride of place was given to health questions, coveringsuch diverce subjects as maternity, child welfare, food,milk-supply, industrial hygiene, tuberculosis, and othermatters, each discussed by experts. Lady Barrett andProfessor W. M. Bayliss presided on Feb. 10th, whenDr. C. W. Saleeby and Professor E. L. Collis spoke.Sir H. Baldwin, Mr. E. B. Turner, and Dr. A. Latham