656

Annotations.UNIVERSITY GRANTS.

"Ne aaict nimis."

THE Universities Grants Committee have just issuedtheir report, which they describe as a preliminarysurvey of some of the outstanding difficulties of financeand organisation which confront the universities at thepresent time. The Committee consist of Sir WilliamM’Cormick (Chairman), Dr. W. Bateson, Sir DugaldClerk, Sir J. J. Dobbie, Miss S. M. Fry, Sir F. G.Kenyon, Sir Stanley Leathes, Sir Wilmot Herringham(who was appointed in place of the late Sir WilliamOsler), and Sir J. J. Thomson. The report opens withan expression of the Committee’s sense of the efficiencymaintained in the universities and colleges generally inthe face of serious difficulties; the members wereconvinced at an early stage in their investigationsthat the present resources of the universities areinadequate. Since the armistice the Treasury grantsas a whole have been increased by 83 per cent., andsupport has been obtained through increased tuitionfees, and, in some instances, assistance from localeducation authorities; but all expenditure has increasedenormously, and even if pre-war incomes had beendoubled it is doubtful whether the universities would beas well off as they were before the war. The Committeeare satisfied that the efficiency of university educationwill be seriously endangered unless further substantialimprovement is made in the salaries of teaching staffs.It was clear from evidence received that some membersof university staffs were living in circumstances quiteincompatible with continued efficiency; material re-adjustments of salaries were long overdue in 1914, andpresent economic conditions emphasise the urgency ofthe question. The Committee doubt whether universalflat rates and automatic increments are possible ordesirable, but they consider that it would be an

advantage if all grant-aided institutions could agreeupon basic minimum salaries within grades andfaculties. Hardly less important is the provision ofa suitable system of superannuation, with maintenanceof the autonomy of the universities, and facility forfree transference of teachers into other professions.The insufficient numbers of teachers are also

causing anxiety to university authorities; membersof the staffs are, as a rule, not only under-

paid but also overworked, and sufficient leisureto pursue research is as essential as adequateremuneration. With reference to tenure of appoint-ments the Committee are of opinion that greater fixityis in many cases desirable; and as regards status,lecturers below the rank of professor should be givenan effective voice in internal administration and theregulation of study and discipline. Passing on to thesubjects of equipment and accommodation, the Com-mittee refer to the necessity of adequate provision forincrease and upkeep of university libraries, and to thewider recognition of the importance of the librarian’sposition. The needs of the Faculty of Arts are mainlyfor personnel; the Faculty of Pure Science requires,in addition, accommodation and material equipment,particularly in view of the large numbers of ex-Servicestudents who have recently entered the latter depart-ment of study.Turning to applied science, the Committee take the

Faculty of Medicine as the best example of the theoreticaland practical in combination, as the requisite thorough I

grounding in the basic sciences of physics, chemistry,and biology, and in the intermediate anatomy and 1

physiology, illustrate the essential condition of a uni- fversity education in any applied subject. The Com-mittee are of opinion that no education can be called iliberal which leaves a student at 18 ignorant of ]the fundamental laws of nature; but there are i

too few secondary schools in which these subjectsare at present properly taught to permit the uni- i

versities to dispense with elementary instruction ’-in them. Within the past 25 years the teaching J

of students of medicine has been very widely extended,and is now passing into the hands of teachers devotingtheir entire time to the work, each subject of whichrequires much space and great expense for laboratorypurposes. It has not in England been considered anecessary qualification for teaching medicine that aman should have practised laboratory methods of

advancing the science; the Royal Commission of

University Education in London, reporting in 1913,recommended the setting up of a system which wouldprovide teachers and assistant staffs willing to devotethemselves to scientific investigation. This system isnow in operation by means of the clinical units estab-lished, with the assistance of grant aid from the Treasury,at the medical schools of four London hospitals, andthe Committee state that everywhere throughoutEngland and Scotland the principle has been seized uponand the need realised; they have issued a statementfor the guidance of university bodies contemplating theestablishment of new arrangements to this end.In considering general needs, the Committee recom-

mend throughout the provision of grant aid in the formof block grants. Reference is made in the report to theserious shortage of residential accommodation forstudents in most of the great cities, and to the wideextension of extra-mural work. In consultation withthe authorities of universities and colleges theCommittee have drawn up for annual presentation toParliament schedules displaying the essential items ofincome and expenditure, together with statistics ofstudents. They express the opinion that it is notperhaps an impossible ideal to look forward to a generalscheme whereby the areas served by different uni-versities should be defined, and all rating authoritiesshould contribute to their local university the proceedsof a penny rate. In conclusion, the Committeeemphasise the possibility of local support in futuregrant allocations, and urge upon university authoritiesthe importance of regarding their endowment funds astheir central source of revenue.

ACUTE PERITONITIS SIMULATING ENTERITIS.

CONSTIPATION is the rule in acute peritonitis and inthe cases in which diarrhoea occurs the peritonealsymptoms-abdominal pain and tenderness and repeatedvomiting-generally render the diagnosis clear. At ameeting of the Societe Medicale des H6pitaux of Paris,MM. A. Berge and J. Roberti reported a case in whichthe diarrhoea was so prominent a symptom and thesigns of peritonitis so slight that the diagnosis fromacute enteritis remained doubtful for a long time andprevented operation at the most favourable time. Adressmaker, aged 21 years, was admitted into hospitalon July 23rd, 1920. The history was that after dancingall night on the 17th and taking six or seven ices shehad slight rigors on the evening of the 18th. However,she was able to work on the 19th. That night she was.attacked with diarrhoea and pain in the abdomen, whichfrom the first was generalised. On the morningof the 20th she vomited her coffee. The diarrhaea,accompanied by colic, continued. Fifteen to 20 greenishglairy stools were passed daily. For five months shehad suffered from leucorrhoea. Menstruation was veryirregular. On examination she was prostrate, and theeyes were sunken. More than 10 greenish glairy foetidstools had been passed in 12 hours and one contained alittle blood. There was no nausea. In the hospital shevomited three-quarters of a litre of greenish fluid; fthis was the second time she vomited in four days.The abdomen was a little distended, tender allover, and especially in’the left iliac fossa. But thetenderness was neither exquisite nor superficial;strong pressure was necessary to provoke it. Therewas no cutaneous hyperaesthesia and no pain on

sudden depression of the abdominal wall. Thepatient could sit up without pain. The tongue wasmoist, the temperature 102’80 F., the pulse 116 andgood, and the respiration 35. There was oliguria andno albuminuria. Attempts at inducing abortion weredenied. Menstruation last took place at the end ofJune. Vaginal examination showed the cervix a little

657

soft, but the body of the uterus was normal. On thetwo following days there was considerable improve-ment, and on the 25th the abdomen was less distendedand less tender and more supple, and only a singlestool was passed in 17 hours ; but on the 26th her con-dition was distinctly worse, the features were pinched,the pulse 150 and thready, and the dyspnoea hadincreased. The abdomen was a little distended, tense,and a little painful. She vomited once and passed oneglairy stool. A surgeon was called in and performedexploratory laparotomy. There were tracks of pus, butno collection, all over the abdomen. The maximumamount of pus and membrane was in the pelvis around theleft tube. Salpingitis was considered the source of thetrouble and total hysterectomy was performed. Deathoccurred three hours after operation. The uterus wasfound normal, the tubes a little enlarged, but withoutanygross lesions. At the necropsy the intestines werefound injected and covered at numerous points withfibrino-purulent membrane. The whole intestine wasfilled with greenish-grey mucous liquid. It was thenascertained that on the 15th the patient had visited aprofessional abortionist, but what had been done wasnot known. Evidently the peritonitis was of genitalorigin and due to manoeuvres to induce abortion. Theintensity of the diarrhoea and the slightness of the

symptoms of peritonitis suggested enteritis. Slight ormoderate diarrhoea is recognised in pneumococcic andcertain septic forms of peritonitis with profoundintoxication, particularly streptococcic peritonitis. Thisdiarrhoea is serous or glairy and often foetid. But inthese cases the ordinary signs of peritonitis-vomitings,abdominal pain and hyperaesthesia, very rapid, feeblepulse, and hiccough-render the diagnosis clear.

T.N.T. IN THE ANIMAL BODY.

T.N.T. poisoning has fortunately lost most of its Iimmediate practical interest,’ but the study of itsremote effects on the body yielded results of sufficientinterest to warrant a full inquiry. The outcome ofthis inquiry is now before us in a special report,2 con-taining the most recent observations. Approach hasbeen made from the point of view of the clinicalfeatures, toxicology, and biochemical evidence. Thenet result tends to show that the workers in theseseparate fields of investigation come to similar con-clusions as regards certain aspects of the condition.The outbreak of toxic jaundice amongst workers inmunition factories revealed the fact that the trinitro-toluene itself was the causative factor, and this was allthe more surprising since up to this time it had beenregarded as a more or less harmless substance.Naturally impurities in the trinitrotoluene were atfirst looked upon as the cause, but these have beenproved to play no part in the production of toxicjaundice. The knowledge gained as a result of thisscientific inquiry is of undoubted value, and opens up afield of investigation into the effects. on the liver ofclosely allied substances. Trinitrotoluene is preparedby nitrating toluol, a compound produced from thedistillation of coal-tar. It is possible that a number ofclosely related chemical compounds derived from thesame source may exert a similar action on the liver.Their use in medicine is being extended daily, and wewant to know their exact action on the body, particu-larly on the liver, and whether this action is similar tothatproduced by T.N.T. It is in this respect that thepresent report offers such valuable information andsuggestions, and therefore merits careful attention.Dr. W. J. O’Donovan contributes a long memorandum

on the subject, and deals with the historical, technical,administrative, and clinical aspects of the problem.His paper affords an excellent illustration of the value of

combined work in approaching such a problem. The para-graph on the technical side is of interest, particularly asillustrations are given of the method of filling shells withT.N.T. Amongst the clinical features observed were toxicgastritis, toxic jaundice, dermatitis, and ansemia, the latter

1 Trinitrotoluene Poisoning: Officially Communicated by the Ministry of Munitions. THE LANCET, 1916, ii., 1026.2 Medical Research Council. Special Report Series. No. 58.

1921. Price 3s.

in the more severe forms being of the aplastic type. Theworkers who suffered from dermatitis, as a general rule,did not develop toxic jaundice or anaemia, and in this condi-tion susceptibility undoubtedly played a very large part inits production. In the latter months of the war T.N.T. inthe form of a fine yellow powder was mixed with ammoniumnitrate (80 per cent.), making the resulting mixture (amatol)much more hygroscopic, and it was with the use of thismixture that the skin lesions predominated. It appearstherefore that this mixture was absorbed by the skin, and itsmoist nature would naturally act as an additional aid to itsabsorption.The occurrence of toxic gastritis is of interest, especially

as it was observed so frequently in munition factories, andwas of outstanding importance. The symptoms were pain(colicky in character), nausea, vomiting, constipation, andcyanosis of lips and tongue. These were the typicalsymptoms of poisoning by coal-tar derivatives, and con-valescence appears in many cases to have been prolonged.It is more than probable that such cases may have receivedconsiderable damage to the liver, besides the gastric mucousmembrane, and yet insufficient to produce actual jaundice.That coal-tar derivatives do actually induce ’necrosis in theliver is well known, and this may be in the form of circum-scribed patches and so escape detection. The damage isstill there and may show itself after a lapse of time, whichmay be months or years. A case was reported recently wherea patient had received salvarsan treatment, and was operatedupon subsequently for condylomata. The patient died afterthe anaesthetic, and post mortem a number of atrophiednecrotic patches were found in the liver. Apart from slightjaundice following the salvarsan treatment there was noevidence of any permanent liver damage. The importanceof the toxic gastritis cannot be too strongly emphasised, andany cases known to have suffered from this form should befollowed up and observed. The production of cirrhosis ofthe liver and pernicious ansemia may receive a possibleexplanation on similar lines to the remote effects of T.N.T.poisoning. This latency in the production of toxic effectswas a characteristic feature of toxic jaundice, around which,of course, most of the interest connected with T.N.T.poisoning lies. This is well illustrated in the case publishedby Professor E. Glynn, of Liverpool, the latency being ninemonths, and a post-mortem examination yielded evidence ofextensive focal necrosis affecting about a third of each liverlobule. This toxic jaundice appears to have developedinsidiously and with very slight symptoms. The earlier thecases were removed from the factory the better was theprognosis, but there was no constancy between the severityof the symptoms and the ultimate outcome of the case.All the evidence given points to the fact that the T.N.T.was capable of producing necrosis in the liver without pro-ducing any grave symptoms, hence the difficulties that arosein diagnosis. There was no simple test that could beapplied to determine the extent of liver damage in anygiven case. A noteworthy feature was the absence ofWebster’s reaction in the urine of patients with toxicjaundice, which will be referred to later. The exact factoror factors which determined the onset of toxic jaundiceare at present unknown, but the possibility of an inter-current infection or lowered resistance is discussed by Dr.O’Donovan.Dr. G. A. Wyon reports his results obtained on

animals who received large doses of T.N.T.With such doses hepatic degeneration was produced in

cats, rabbits, rats, and monkeys. Chronic poisoning withsmall doses of T.N.T., however, did not produce any sucheffect. The comparison is made with poisoning by aldohol,chloroform, and tetrachlorethane, and Dr. Wyon concludesthat there is a second unknown factor which probablycooperates with T.N.T. in producing fatal poisoning in man.The animal experiments, however, did not throw much lighton the poisoning effects as observed in man, and illustratesone of the great difficulties encountered in this research.Mr. T. A. Webster contributes an interesting account

of his work on the metabolism and excretion oftrinitrotoluene.The question of how to detect small quantities of T.N.T.

in the urine of workers exposed to this compound was satis-factorily settled by Webster, and the discovery of the test isdue to his labours. The modification of the test wherebya beautiful blue colour is obtained was independently dis-covered by F. Tutin and described in THE LANCET, 1918, ii.,554. The chromogenic body-viz., azoxy-di-nitrotoluene-isexcreted in the urine, and is responsible for the Webstertest, and presumably formed in the kidney. It is here con-jugated with glycuronic acid and excreted in the urine.Attempts to obtain the chromogenic substance from theblood or organs failed.Dr. H. H. Dale deals with the fate of T.N.T. in the

animal body and the attempts made to trace the changeswhich T.N.T. undergoes before being excreted as the