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specific fevers in the two groups, nor was there anyobvious difference in the habitus of the children whohad albuminuria ’3>S compared with the other children.Blood counts, blood-pressure readings, and tuber-culin tests all gave the same result-namely, thatalbuminuria as a " functional " condition does not

appear in any special type of child. There is therefore,they hold, no definite clinical picture apart from theurinary findings. The occurrence of alternating posi-tive and negative phases is looked upon by theseinvestigators as the essential feature for diagnosis,and in five cases in their series where albuminuriawas constant the diagnosis of chronic nephritis wasconsidered to be the correct one.

THE HAUSA AND THEIR DIET.

THE northern provinces of Nigeria are inhabitedlargely by a negroid mixture of races spoken of as theHausa, and by a semitic race known as the Fulani,which has given up its original nomadic life andsettled in towns. Dr. W. E. McCulloch 1 hasconducted an inquiry into the dietetic habits of thesenatives and has attempted to correlate certain

specific food deficiencies which his investigationshave revealed with the very unsatisfactory state ofhealth existing in this part of the world. Theinhabitants are by no means savages, but general ill-health is widespread among them, and their infantmortality-rate is appalling. Their physique is notstrikingly different from that of European races,but their weight is less than that of individualEuropeans of the same height, and they reach theirmaximum height at an earlier age than white racesof mankind. Their resistance to infections isnotoriously low, as it appears to be throughout thenegroid races of Africa. Epidemics of relapsingfever and small-pox sweep through the country withdevastating results, and bronchitis, pneumonia, andtuberculosis steadily claim large numbers of victims.Gastro-intestinal disturbances are common, and mayfurnish half the cases that attend the native hospitals.The teeth of the women are usually well preserved,possibly owing to their habit of chewing the flowersof the tobacco plant which stain the teeth and appearat the same time to protect them from caries. Theteeth of the children and of the men are rarely good,and cannot be compared with the remarkably goodteeth of the West Indian negro who habitually chewssugar-cane. The birth-rate is low, largely on accountof the reduced fertility of the male, who indulges inpolygamy; abortions are very frequent, althoughsyphilis does not appear to be particularly wide-spread. In one of the chief towns the infant mortality-rate for 1927 was 412 per 1000. Specific fooddeficiency diseases are not uncommonly met with.Beri-beri and scurvy occur during times of scarcity,goitre is fairly prevalent both among the inhabitantsand among their cattle, and xerophthalmia is metwith in young children. Rickets appears to be arare disease ; chronic anaemias are common.The staple foods of the natives are millet seed,

Guinea corn, adulterated sour milk, and soup composedof green leaves. Ground nut oil and meat are usedsparingly by the masses and in relatively largequantities by the more wealthy families. Condi-ments, spices, and sweets are widely consumed.The native " salt " contains little or no chlorine.The glaring fault of the dietaries is that they are apt

1 An Inquiry into the Dietaries of the Hausas and TownFulani of Northern Nigeria, with some Observations of theEffects on the National Health, with Recommendations arisingtherefrom. By W. E. McCulloch, M.D. West African MedicalJournal, 1929-30, vol. iii.

to consist almost entirely of cereal products. Milkis purchased in fairly large quantities, but in view ofthe fact that it is habitually adulterated with morethan half its bulk of water before it is sold, the trueconsumption is not large, which means that thepopulation suffers from a deficiency of calcium andof protein of good biological value. Fat-solublevitamins must be markedly deficient, and though thelack of vitamin D in the food is to a great extentmade good by abundant sunshine, the shortage ofvitamin A is probably related to the susceptibilityof the population to infections. Vitamins B and Care present in insufficient quantities, so that with anyrestriction of diet definite symptoms of the correspond-ing deficiencies may become manifest with greatrapidity.

’ The recommendations made by the author for

improving the nutritional status of these peoplesare based on strictly practical and economic lines.In the first instance, every encouragement should begiven to increase the quantity and improve the

quality of the milk consumed by the masses. Thiscould be brought about by exempting milk-bearingcattle from the cattle tax on condition that they werekept for supplying milk to urban populations, andby making the adulteration of milk an offence punish-able only by imprisonment and not by fines. The

deficiency of mineral salts and vitamins could bepartly corrected by planting in the neighbourhoodof the towns large reserves of trees with edible leaves,of which a considerable variety are known. Thesweet potato is a valuable crop, not merely for thesake of its tubers but on account of the richness incalcium of its green leaves, and its cultivation shouldbe strongly encouraged. These comparatively simplesuggestions should help very materially to correctthe very imperfect diets in vogue at present, andthe obvious benefits to be expected from their wideadoption would make it easier to introduce in thefuture still further dietary improvements.

ANTITOXIN TREATMENT OF DIPHTHERITICPARALYSIS

THE employment of antitoxin in diphtheritic para-lysis, which has been advocated by several clinicianson the Continent, notably by Comby in France andHeubner and Jochmann in Germany, has receivedlittle support in this country, in view of the naturaltendency of this condition to spontaneous recoveryand the failure of the treatment in experimentaldiphtheritic paralysis. Commenting on a case

recorded by the late Dr. G. S. Middleton in thesecolumns many years ago, Dr. J. D. Rolleston 1

suggested that the success attributed to this treat-ment was due less to a specific than a psycho-therapeutic action. Last month, however, Prof.U. Friedemann and Dr. A. Elkeles, who appear tobe rather in favour of the method as the result oftheir clinical experience, record some experi-ments on rabbits which they think give some

evidence supporting the serum treatment of

diphtheritic paralysis. They found in the first placethat both in the normal rabbit and in the human

subject suffering from diphtheria, antitoxin could notpenetrate to the cerebral circulation, so that it mightbe supposed that diphtheritic paralysis could not beaffected by serum treatment. This supposition,however, was met by the fact that intracerebraldiphtheritic intoxication in the rabbit could be curedby large doses of antitoxin injected intravenously,

1 THE LANCET, 1908, ii., 261.2 Deut. med. Woch., Oct. 10th, p. 1725.

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the apparent discrepancy being explained by thetheory that cerebral diphtheritic intoxication rendersthe cerebral circulation accessible to antitoxin.The application of these experiments to diphtheriticparalysis in man is that in this condition diphtheriatoxin is firmly attached to the central nervous system,and therefore the possibility of the cerebral circula-tion being accessible to antitoxin must be considered.The experiments, however, indicate that onlyvery large doses of antitoxin offered any prospect ofsuccess. Moreover, the writers admit that their

experiments deal only with prophylaxis, whereas inclinical diphtheritic paralysis the question is one oftreatment. It may be mentioned in this connexionthat Rosenau and Anderson,3 to whose experimentalwork on guinea-pigs the German writers do not

allude, found that a very small quantity of anti-toxin, given 24 hours before or at the time of infectionwith diphtheria toxin, prevented the developmentof paralysis, and that antitoxin given 24 hours afterinfection modified the paralysis. On the other hand,they found that antitoxin administered during thevarious stages of the paralysis had no power to savelife or ameliorate the symptoms ; neither had anti-toxin any influence in preventing paralysis if

Iinjected shortly before the paralysis began. IAN AMERICAN PSYCHOPATHIC HOSPITAL.

VISITORS returned from the United States havea lot to say about the enlightened endowments andsystematic psychological and psychiatric educationwhich they find in that country, while those whoremain at home are irritated into believing that theseadvantages have been greatly exaggerated. Sinceit is always hard to draw the line in the right placebetween disparagement of one’s own country andother people’s it is interesting to compare the reportof an institution such as the Boston PsychopathicHospital with our British mental hospital reports.The medical director of the Boston Hospital

points out that its three main functions are so closelyrelated that any effect on the one must react on theothers. These functions are : caring for the mentallyand nervously disordered, carrying on con-

tinuous research into the causation and treatmentof this special form of illness, and providing a trainingcentre for a great variety of workers in this specialfield-from medical graduates to laboratory assistants." The fundamental test of the hospital," he says," is the care and treatment of the individual patient,but satisfactory treatment of the individual sickperson is only possible when there is, in addition to thegoodwill, sympathy, and conscience of the individualphysician, a keen interest in the special medicalproblems presented by the individual case ; not

only an interest in recognising what is familiar in thedisorder, but curiosity as to the significance of what isunfamiliar and eagerness in the systematic investiga-tion of what is still obscure." He goes on to show thatthis attitude must necessarily imply vital cooperationwith the pathologist, the nurse, the occupationaltherapist, the psychologist, and the social workeras well as with- the patient himself. He summarisesa number of cases to show the kind of work that isdone and the way in which the artificial barrierswhich separate so-called mental and other ailmentsare being steadily broken down. The cases quotedraise problems of the widest possible nature : problemsof internal medicine, of the varied endowment of humannature and its varied vulnerability, of the mouldinginfluences in individual life, of the occupational I

3 U.S. Public Health Service, Bull. No. 38, 1907.

field and conditions of work, of different standards ofsuccess and failure, of the organisation of the com-munity, and of the material and cultural satisfactionavailable for all sorts and conditions of men.

Special reports come from the out-patient depart-ment, where 1135 patients were seen during the year ;from the chief medical officer, with special referenceto X rays and therapeutics, including dental care ;from the biochemical laboratory, which emphasisesagain the impossibility of divorcing psychiatry andinternal medicine ; from the psychological laboratory,which has a large research output ; from the neuro-pathological laboratory ; from the department of

therapeutic research ; from the syphilis service,from the social service department; from the schoolof nursing; and from the department of occupationaltherapy. All these, with ample informative tables,are included in a pamphlet of 50 pages no larger thanmost of our own mental hospital reports. The resultmakes us feel that even if psychotherapists in thiscountry have nothing to learn from abroad in theirmethods or application, they might yet contrive toreport their endeavours and successes with more

of that infectious enthusiasm which makes for

progress. ____

TUBERCLE IN CHILDREN: A LANCASHIRESTUDY.

MOST authorities are agreed that the diagnosis ofpulmonary tuberculosis among children under the

age of 15 years is beset with difficulty, a fact whichmay account for the widely differing statistics ofits prevalence. Dr. G. Lissant Cox, in his reportfor the year 1929 on the prevention and treatmentof tuberculosis in the administrative county of

Lancaster, points out that the proportion of children(per 1000 of the child population) accepted by thecounty tuberculosis officers as suffering from pulmonarytuberculosis is very low as compared with that inother counties. In order to test whether manycases of the disease were being missed among thechildren referred as suspicious cases by practitionersand school medical officers, an investigation wasstarted to ascertain whether any considerable numberof these rejected cases were returning later in lifewith definite disease. This investigation was carriedout by listing the consecutive case-sheets of 1545

young adults between the ages of 15 and 25 diagnosedby the tuberculosis officers as suffering from tuber-culosis (all forms) during the past three years. It

was found that of 1084 young adults coming on thedispensary registers as new pulmonary cases, only0-64 per cent. had been previously rejected in child-hood by the tuberculosis officers. Moreover, of

17,000 children, excluding contacts, referred to thetuberculosis officers between 1928 and 1914, whenthe Lancashire Dispensary scheme began, some

59 per cent. were diagnosed as non-tuberculous.That this diagnosis was fully justified is evident bythe fact that these children did not return in theyoung adult age to the dispensary as definite cases ofpulmonary tuberculosis. These conclusions bear outthe findings of Dr. W. Burton Wood, who showed thatthe children of the dispensaries and sanatoriums arenot the children who develop consumption in adoles-cence, and that a history of " pre-tuberculous

"

childhood is practically unknown among adolescentconsumptives. The close connexion between thenumber of children taken on the dispensary registersby the tuberculosis officers in a given area and theamount of sanatorium accommodation providedfor the treatment of the children has not escapedthe notice of Dr. Cox. who draws attention to the fact