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than 5000 cases which have been discharged or havedied since the colony was started, there lms been arecovery rate of 3’2 per cent., the standard of recoverybeing freedom from seizures for at least two years.The most interesting feature of the report is a boldattempt at an ætiological classification of the last1500 patients admitted. Among every 100 such

patients the disease is supposed to have originatedin 12 cases from " inflammatory cerebropathics

"

(meningitis or encephalitis), often arising as conmplica-tions of an acute specific fever ; in 11 cases the assignedcause is heredity, in 10 cases developmental defect,in three cases trauma at birth, in five cases traumasince birth, in two cases cerebro-vascular sclerosis, andin two cases syphilis, hereditary or acquired. Of greatinterest are two other groups ; 5 per cent. are

reported as cases of essential epilepsy, due to " person-ality make-up," and 4 per cent. as endocrinopathic.Only 43 per cent. of cases remain as unclassified.The figures given are only a summary of results,and it is difficult to make any comment without someknowledge of the methods adopted in arriving atthem. Nothing is said of multiple factors in any givencase, but we assume that in each case an effort wasmade to select the major factor, and that it is uponthese major factors that the classification is based.It is to be noted that the investigation is an endeavourto state cause and effect. The endocrine conditionsand the developmental defects, for instance, are herecited not as concomitants but as causes of epilepsy.We hope that Dr. Shanahan and his collaboratorswill republish these figures in fuller detail and withsome account of the methods adopted in classification.The numbers are large, and the records, doubtless,thorough and complete. Explained, considered anddiscussed, the figures should prove a valuable aid toall who are seeking to understand epilepsy. Amongother information given in the report it may be noted that the incidence of tuberculosis is higher than Imight be expected, for during the last five yearstuberculous infection was present in 86 patients whodied. More surprising still is the fact that among thelast 165 deaths only one was due to status epilepticus.Pathological investigations during the year haveincluded researches into the rate of sedimentation ofthe red blood cells and into the calcium-content of theblood. In neither case did the figures for epilepticsfall outside the normal limits.

THE INJECTION OF FOREIGN INERT

PARTICLES INTO THE BLOOD.

IT is known that many blood-cells on contact witha non-greasy foreign material are, by capillary action,pulled progressively onward over the foreign surface.like a drop of water on a stone. To such cells, whichinclude mammalian platelets and certain cells of theblood of astacus, Prof. J. Tait has given the name ofthigmocytes. They are not distorted by contact withan oily or greasy surface, and are highly phagocytictowards minute particles of non-greasy matter. Theyhave the power to ingest very minute particles ofinsoluble material without apparently sufferingcytolysis, and are also a source of thrombin. Theplatelets or hyaline thrombocytes of mammals arepeculiar in at least two respects, in their small sizeand in apparent absence of a nucleus. In the courseof some experiments recorded in the Journal ofPhysiology (No.2, December, 1926, vol. lxii.) Tait,working with A. R. Elvidge, injected some excessivelyfine particles of fused quartz, and particles of Indianink and other inert substances such as barium sulphateand carmine, into the ear vein of rabbits. A prioriconsiderations seemed to indicate that an injection ofvery fine particles might fail to cause coagulation ofthe circulating blood, whereas an injection of coarseparticles might cause coagulation. It was found onintravascular injection that even coarse particlesdid not necessarily determine thrombosis. Additionof coarse particles to paraffin-held, drawn blood, bvcausing cytolysis of thrombocytes, eventually caused

coagulation. Addition of an adequate quantity tAfine particles to the drawn blood of the frog similarlycaused coagulation, while addition of a smalletquantity of fine particles did not. Admixture lj(

particles with the circulating blood. while failing tvcause thrombosis, nevertheless effect f-d a transfornca-tion of fibrinpgen into fibrin. According to thobservers the reason why thrombosis does not occuris that the particular conditions of formation of thefibrin allow of a successful response on the part ofthe " natural antithrombic mechanism" " ft thecirculation. However the thrombosis may be broughtabout, it would seem likely that the rate of injectionof the particles is the important factor. Rabbits willtolerate the intravenous injection of a thick suspensionof fine particles of silica with no apparent ill-effects,provided the injection is given fairly slowly. Arapid injection, however, is prone to be followedimmediately by convulsions and death. Tait andElvidge report that as a result of intravascularinjection of particles a fall in the number of circu-lating platelets occurs. After a heavy injection thefall is profound (though complete disappearance wasnever observed), and some days elapse before theprevious number is restored. With injection of asmaller amount the fall of platelets is less and thetime for recovery of the initial number is shorter. Bvrepetitions’of the injections at intervals less than thetime necessary for recovery the number of circulatoryplatelets can be kept low. S. P. Bedson,1 however,investigating the relationship of the reticulo-endV:thelial system to the number of circulating platelets.has shown that blockage of the splenic endothefialcells by carbon causes a considerable increase otplatelets in the blood. He suggests that the spleenregulates the number of circulating platelets byphagocytosing the old and effete elements; thesefindings are diametrically opposed to those of Tait

and Elvidge, and the matter is clearly in need offurther investigation. _____

ANTONIO CARDARELLI.

I WITH the passing away last month of this greatclinician at the advanced age of 96 years, Neapolitanmedicine has lost the most brilliant star it haspossessed in the last half century. It seemed almostas if the wings of Death feared to touch this grandold man who, old as he was, suffered from none ofthe drawbacks of age, and preserved a wonderfulfreshness of interest; but at last the summons cameand was heard with calmness and composure. AntonioCardarelli was born on March 29th, 1831, at

Civitanova del Sannio, his father being a much-respected provincial doctor. In 1890 he was called tothe chair of medical pathology at Naples as successorto Arnaldo Cantani. He was at one time a memberof the Chamber of Deputies and became famous forhis crusades against the high price of salt, alcoholism.and university reform ; in 1896 he was nominatedsenator. The various rivalries which existed amongthe professors at the hospital could not do other-wise than bring into prominence the brilliant gifts ofclinician and teacher, which were so well harmonisedin Cardarelli when he was still young. And aroundthe young professor there gathered a large crowdof pupils who were devoted to him and whom hetaught with untiring zeal. He was the discovererand exponent of much well-recognised physicaltechnique-for instance, laryngotracheal pulsation inaneurysm, percussion and auscultation of the sternumin affections of the mediastinum, transthoracic thrillin hyda,tid cysts of the liver, and a method ofestimating cardiac efficiency. Much interest attachesto his description of a group of morbid signs whichhe united under the name of cardiac neurosis in whichhe indicated the true meaning of Basedowian tremor.and signs relating to the pathology of the vagus anda special form (vasomotor) of angina pectoris. itwas also his conception that the condition of the

1 Brit. Jour. Exp. Path., vol. vii., No. 5.

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myocardium in heart, disease was of greater importancethan the nature of the valvular lesion, a conceptionthat was further realised by the late Sir J. Mackenzie.Cardarelli cultivated science for its own sake, not forsbr satisfaction it can give to those who follow itsleachings. but for the gladness it can give when appliedthe betterment of human life. As Prof. Maragliano as said of him in a recent obituary notice in theRgorma Medica, " If the human body of Antoniocardarelli is now lifeless and lovingly returned to;h. busom of his native land, his spirit remainsthe eternal symbol of a teaching that should neverbe forgotten in the Italian Schools."

PSYCHICAL RESEARCH.

WE have received the first part of Vol. I. of theProceedings of the National Laboratory of Psychical!ie-,4,-arcb, established in South Kensington for theseientific investigation of alleged abnormal pheno-ruena and forrning the Furopean headquarters of theAmerican Society for Psychical Research. Startingwith no preconceived theories the Council will.-ndeavour to ascertain and demonstrate the laws

underlying psychic or abnormal manifestations, andthey emphasise the fact that every person connectedwith the laboratory is, by personal investigation,convinced of the reality of physical and mentalphenomena, apparently abnormal, for which a normalexplanation cannot be found. The present fasciculus’.-. wholly occupied with an account of the telekineticand other phenomena witnessed through EleonoreZugun, a Roumanian girl 13 years old who, in herwn view and in that of her friends at home, is

possessed of a familiar spirit which plays all sorts oforange and useless tricks when she is about. Thegirl is described as healthy, very intelligent andhappy, and appears to enjoy nothing better thanplaying with clockwork trains ; while she is doing’hi" in the passage, a halfpenny which has been put onthe mantalpiece in a neighbouring unoccupied roommay quite likely be moved to the far corner of thecoom. Dracu, as the devil is called. did not eat thebi-cuits which Eleonore thoughtfully left for him (orher or it) in the laboratory overnight, but he seemshave quite a habit of biting the girl and his teethmarks may suddenly appear at any time as whitewheals. And so on. The whole forms a narrativewhich will confirm those who believe in their faithand will entirely fail to carry any conviction tounbelievers; it is an example of what has been doneover and over again during the last 40 years or

se and brings us no nearer a solution of the problems.For few serious-minded people will deny thatp-ychical research has really produced problems of a fundamental character which we should all like tosolve; but whether their spiritual sigpificance can beelucidated by this material technique is very doubtful.Meanwhile it is evident that a subject who showsfactitious urticaria as well as Eleonore does mightwell be passed on to Sir Thomas Lewis and hiscollaborators.

RATIONALE OF WASSERMANN REACTION.

ALTHOUGH brought to birth as the result of asatisfying system of ratiocination, the Wassermannreaction has in these latter days come to be recognisedas a sort of diagnostic trick. Its usefulness is less thanever disputed, but why the serum of a syphilitic Ipatient should give a positive reaction-which once ""emed so easy to explain-has become shrouded indeeper and deeper mystery. Even the inventionby American workers of a hypothetical substance,..

reagin," has thrown no real light on the facts,nor has the substitution of the term " immuneserum" for the hallowed name of "amboceptor."The problem has lately been attacked from a some-what unusual angle by Ameer Khan,1 working in the

’American Journal of Syphilis, vol x., No. 3.

laboratoriies of the Brooklyn State Hospital. Hesees the whole reaction in terms of hydrogen-ionconcentration, and though a good deal more in theway of experimental proof is required to supportthe considerations which lead him to this view, hisresults, so far as they go, are nevertheless interesting.The Wassermann reaction, lie believes, should beinterpreted as a reversible chemical reaction dependenton the proportions of free II and OH ions present in theelements employed ; a positive result he regardsas due to a preponderance of H ions and a negativeto a preponderance of the OH ions. As the onlyvariables in a properly carried out series of Wassermannreactions are the sera under investigation, it wouldfollow from this hypothesis that the change in theblood of syphilitic patients must be an alterationin distribution of the inorganic radicles, giving riseto a preponderance of acid ions. Such an alterationin a highly buffered substance like blood need notgive rise to any actual change in pH, but it mightlead to some change when the conditions of thebuffering are altered, as in the Wassermann reaction,by mixing the blood with other test ingredients.No investigations on this point are recorded inAmeer Khan’s paper.

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TRANSFUSION.

THERE are probably few therapeutic procedureswhich have a basis more securely founded on soundphysiological and pathological knowledge than trans-fusion. We welcome, therefore, the very thoroughreview of these fundamentals which is contributedby Dr. C. A. Doan from the Rockefeller Instituteto the current number of that useful periodicalPhysiological Reviews (vol. vii., p. 1) ; his bibliographyincludes 717 items and he gives a critical summaryof the whole. The outstanding clinical point is thatnothing can replace the direct testing of the bloodsof donor and recipient against each other if theoperator is as anxious as possible to avoid anythinglike an accident. A number of workers in recentyears have found anomalous bloods which do notfit into the established scheme of classification intofour types, and these instances are now so numerous(though relatively, of course, quite rare) that it is certainthat they cannot be put down to slipshod technique.It is also plain, as Prof. E. E. Glynn and Dr. A. R.Jones recently emphasised,l that the "universaldonor " cannot be used indiscriminately ; some ofthem have such a high titre of agglutinins in theirserum that it may cause agglutination even whenit is diluted in the blood stream of the recipient.The third agglutinating factor which was identifiedby Guthrie and Huck has been examined on a largescale at Sheffield by Dr. F. W. Simon 2 it complicatesthe normal grouping in a minor way though it isof more theoretical than practical importance.Preliminary grouping by type sera should, therefore,always be checked by direct testing of the two partiesto the transfusion against one another. Dr. Doan’ssurvey brings out two other conclusions from thenow considerable mass of experience : that though itmay occasionally prolong life in, e.g., perniciousanaemia, transfusion finds its real use in the replace-ment of blood lost by haemorrhage and that it is bestand most conveniently done by the citrate methodand any simple apparatus. Along broader linesthe outstanding feature of recent work is the sug-gestion of Bernstein, Snyder, and others that thefacts of the groups and their inheritance are bestexplained by an assumption of three heritable factorsinstead of the two originally proposed by Donathand Landsteiner. It certainly seems as if the anthro-pological data, which have so far given ratherdisappointing results, are more reasonably inter-preted on the new scheme and may yet throw light onthe origin and relationships of human races.

1 Jour. Path. Bact., 1926, xxix., 203.2 Ibid., p. 279.