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teers, who, though with little previous experience, didcapital work, especially when they had unlearnt theirfirst impression that they were working as a favour,and did not have to do as they were told. Conx-mander Horsfall, who had been a staff surgeon in theNavy, seems to have concentrated on essentials, andgenerally managed to see that they were got. The sixmedical officers under him were sent on board inplain clothes and the volunteers did not acknowledgetheir authority, which made things awkward, butCommander Horsfall, with the help of the nursingsisters, made them shoulder straps, " when the surgeonsbecame commissioned officers," and all went well.He adds : " The Navy is a great service and itsdiscipline is such as to give to one the greatest freedom."It will be easier to fit out a hospital ship in future,whether the action has to be taken in routine or underemergency, and those who want to know what to doand how to do it should consult Surgeon Rear-AdmiralSutton’s book on the subject. But personality willalways find outlets. No book instruction will help aman much during a strike of the firemen in theirforecastle, nor can a written recipe be given forCommander Horsfall’s arguments when he persuadedthem to call the strike off and let the ship go to sea.We notice a curious misprint in this issue of the

journal. The well-known Parkes Memorial Prize doesnot commemorate the distinguished R.A.M.C. officerSurgeon Parke, who crossed Africa with Stanley andwon high appreciation for his care of the sick ; butwas founded in honour of the famous E. A. Parkes,the father of modern military hygiene and firstprofessor of hygiene in the Army Medical School.

THE SUBNORMAL EX-SOLDIER.

ALTHOUGH it is now over five years since the armistice was signed, the time has not yet been Ireached when the care of the man who came backbroken from the war can be relaxed. Lord Haigpoints this out in an introduction to the fifth annualreport of the Enham Village Centre, adding that atthis centre the outlook of many disabled ex-Servicemen has again become happy and contented afteryears of hopelessness and uncertainty. It has alwaysbeen one object of this Centre, the policy of whichwas conceived and has largely been directed bymedical men, to establish a permanent settlementfor those men who, owing to the nature of theirdisability, -are considered unfit for re-entering thelabour market. Fifty disabled men are now per-manently employed or settled at Enham, 30 of themoccupying cottages, and a wood-working factory hasbeen erected, fitted with up-to-date machinery, andcapable of employing 100-125 men. The populationof the Centre has, indeed, risen from the originalnumber of 62 to the present large total of 468, all told.At the same time, during the last 15 months, a schemehas been developed under the Ministry of Labourto include industrial training for those able to do44 hours’ training per week. The actual number ofthese, naturally, is now diminishing from year toyear, as there become fewer cases eligible for combinedtreatment and training, but it is the ambition of thepromoters that as the supply of war victims falls,the Centre may remain as a national establishmentfor the restoration of health and for the physicalre-education of other persons injured in the serviceof the State. Dr. G. V. Stockdale. medical officer tothe Centre, tells us that of the 103 cases remainingin residence on the first day of the present year,46 were suffering from neurasthenia, 35 from generalsurgical conditions, half of them being gunshotwounds of the head, 19 from general medical con-ditions. three from the results of tropical diseases, theproportion being practically the same as last year.Pensioners who, bv reason of their disability, cannever become employable or work for themselves,should, Dr. Stockdale feels sure, be allowed to live-at home on an adequate pension ; but for those who

would tind difficulty in getting employment outside,the system adopted at Enham appears to offer themost satisfactory solution of the disabled ex-Serviceman’s problem. Employment is here offered undersheltered conditions ; the man is freed from anxietyand encouraged by a feeling of comparative inde-pendence. Of the 622 men,who had left the Centreup to the time of the report, 348 were reported-as employed and in training, 52 as unemployable(80-100 per cent. pensions), and 33 as unemployed.Every effort is being made to find work for thesemen, for all of whom references can be given. Thechief wants of the Centre are now more cottages,-an outlet for articles produced in the new workshops,and an endowment fund of £100,000 to supplementthe work of men suffering from severe disablementwho can never become economic productive units.The economic position of the Centre is not yetwhat it should be, and there are difficulties to bemet, but the report is a record of a successful andwell-administered piece of practical philanthropy.

BIOLOGY AND SOCIOLOGY.

Prof. Arthur Dendy 1 believes that the generalprinciples of biology can help us to solve the varioussocial and political problems which bother us to-day.With his primary postulates not everyone will agree,and it is well that he has set them out plainly. Thepyramid of society is based, he says, on what tookplace in the world of living things before mankindcame into existence. It may be so. But there is a notunimportant school that thinks it more likely thatman’s soul is qualitatively a new thing, added to theaccumulation of evolved attributes and not necessarilyarising from them. On the other hand, it has also beenurged that the dead and live worlds form one con-tinuous whole with qualities differing quantitativelyrather than qualitatively in its diverse parts. Prof.Dendy premises, too, that the laws which governedorganic evolution in its earlier stages were not repealedwhen man arrived on the scene. They may not havebeen repealed, it is true, but some people think thatthey have been added to to such an extent that, likea good many old laws, they no longer run. With thesepossible divergencies of outlook at the very beginning,anyone who believes that progress for the future maybe obtained by a study of the past will read the bookwith interest. It is intended more especially for thosewithout any special knowledge of biology : there ismuch more biology than political economy and thebiological exposition is of the high order that weshould expect from the author of the " Outlines ofEvolutionary Biology." The sociological conclusionsare put shortly and dogmatically, the position ofwomen, the House of Lords, birth-control, democracy,the colour question, and so on, are disposed of sum-marily enough. Broadly speaking, four main biologicaltopics are dealt with. The fact of organic evolutionshows that man is an animal in series with otheranimals. The study of the community of organswhich makes up the individual and of the integra-tion of individuals to make insect and similarsocieties points the way to the arrangements whichare desirable in human communities. The inherentvariability of live things indicates that the ideaof the essential equality of all men is delusory orworse. The facts of heredity and modern knowledge ofits mechanism are of prime constructive importance:‘‘ it is better to be born with the right kind of chromo-somes than with a silver spoon in one’s mouth." Such,with many subsections, is the main argument. Wecould wish that parts of it had been set out ingreater detail. Prof. Dendy mentions, for example(p. 63), " the instinctive aversion to foreigners whichlies at the root of national feeling." It would havebeen interesting to hear his discussion of "national"

"

1 Biology and Sociology: The Biological Foundations ofSociety. By Arthur Dendy, Professor of Zoology in King’sCollege in the University of London. London : Constable andCo. 1924. With 21 figures. Pp. 197. 7s. 6d.

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in contrast to " racial " foreigners (or, indeed, to knowwhether by " national " he means " racial ") and hisreply to the proposition that there is no

" instinctive "aversion to foreigners, a view set out well in Mr. J. H.Oldham’s recent book, " Christianity and the RaceProblem." But the book is, of course, small, and theauthor raises questions which would want an encyclo-paedia for adequate ventilation, so that what willappear to many to be cursory treatment is mostly anecessity of space and time, and sometimes, perhaps,a consequence of the author not having thought veryhard on matters outside his immediate professionalprovince. Generally, the book may irritate the pro-gressive revolutionary, because it finds in biologygrounds for defending the existing conservativeorder. And it will disappoint the visionary, becauseof its uncertain views about the future. If manimitates the numerous past evolutionary lines whichhave grown progressively longer and more com-

plicated, he is evidently destined to come to an endaltogether pretty soon. The share which chancetakes in his ontogeny inclines Prof. Dendy, inanother place, to the view that man is the sport of aNature which is indifferent to his welfare. Buthe thinks that the world is big enough to accom-modate the human race and he would have menchoose their own wives-which are more cheerfulthoughts.

There is a mistake (p. 62) about incompatibilityof bloods for transfusion in man. The blood of a nearrelative is not much more likely to be suitable than thatof a complete stranger: it depends on their precisegenetic constitution in respect of isoagglutinins.

THROMBOPENIC ANÆMIA AND

SPLENECTOMY.

THE fourth of the formed elements of the blood,the " platelet " or " thrombocyte," has laboured undera cloud in this country. Long ago it was pronouncedto be an artefact or at best a fragment of the nuclearmaterial of a dead and gone leucocyte, and as such ithas been dismissed as unworthy of the serious con-templation either of the practising medical man or ofthe laboratory worker. In the years during which ithas been regarded as a subject hardly suitable forconversation among polite British hæmatologists, how-ever, it has been enjoying a large degree of attentionabroad, particularly among the German and Americanworkers, and the time now appears to have arrivedwhen even in this country it must be admitted to aplace in the blood picture. That the blood plateletsundergo important alterations both in number andin appearance in at least one particular type of thehaemorrhagic diathesis was pointed out ten years agoby Dukel in America, and a little later by Frank2in Germany. Frank from Berlin, and Kaznelson3from Prague, both described a syndrome characterisedby purpura hæmorrhagica in association with spleno-megaly. In this condition they found the bloodinvariably to show a severe anaemia of aplastic type,together with a great reduction in the number of theplatelets ; usually there was also a leucopenia, some-times extreme in degree, with its main incidence uponthe granular leucocytes. Both Frank and Kaznelsonregarded the reduction of the platelets as the imme-diate cause of the purpuric manifestations; for thiscondition Frank used the term " thrombopenia,"which has come into more or less general use, thoughthe term " thrombocytopenia," suggested by Kaznelson,is preferable, if not on the grounds of euphony, atleast as an accurate statement of the state of affairswhich it is intended to indicate. Three cases of thisthrombopenic anaemia, all showing purpura andsplenomegaly, were recently reported by S. C. Dyke4

1 Duke: Arch. Int. Med., 1913, xi., 100.2 Frank: Berl. klin. Woch., 1916, xxxvii., 2, xli., and sub-

sequent vols.3 Kaznelson : Zeitsch. f. klin. Med., 1919, lxxxvii., 133.

4 Dyke: THE LANCET, 1924, i., 1048.

in THE LANCET; in Dyke’s cases infection of thehaematopoietic system was found post mortemin every case, but this was regarded bv the authoras secondary to the weakened state of this tissue.Both Frank and Kaznelson, though on differentgrounds, implicated the spleen through a disorderin its function as the cause of the condition. Frankregarded the thrombopenia as due to an aplasticstate of the bone-marrow, the source of the platelets,and this myelophthisic condition he thought to bebrought about by some toxic body produced in thespleen and acting through the blood-stream. Kaznelsonfound the enlarged spleen from one of his cases to becrammed with platelets, and on the strength of thisobservation concluded that the diminution of thesebodies was due to their abnormal destruction by thespleen. Both Kaznelson and Frank recommendedsplenectomy for this condition, and practised it withapparently beneficial results.

In the last published volume of the InternationalClinics, N. E. Brill, 5 of New York, records one furthercase of splenectomy for purpura haemorrhagica, anddemonstrates a second case in which operation hadnot been undertaken at the time of reporting ; inthis second case the spleen was also removed later,and the results of both operations have since beendescribed together by the same author. 6 In bothcases splenectomy resulted in the immediate cessationof the haemorrhages, which had been severe andlong-continued, and in the apparent restoration ofthe patients to complete health. So sudden was thecessation of the haemorrhages in his cases that Brillwas inclined to doubt whether the purpuric mani-festations could be entirely accounted for by theexisting thrombopenia. He found that, although theplatelet count rose immediately after the splenectomy,it fell within a week almost to its previous low level,and concluded that some factor other than merereduction in the number of the platelets must bepresent to produce purpura ; this factor, he suggested,might be some unknown substance produced by thespleen and acting through the blood-stream. Hisviews are thus seen to partake of those of both Frankand Kaznelson. Probably the end of the matter is notyet, but very strong evidence in support of the view ofKaznelson was produced by S. P. Bedson at the meetingof the Pathological Association of Great Britain andIreland, held in London a few days ago. Carryingon the previous observations of J. Co G. Ledingham7this worker was able some time ago, by the use of anantiplatelet serum prepared from rabbits by theinjection of guinea-pig platelets, to show that destruc-tion of the platelets in the guinea-pig was alwaysfollowed by purpura. 8 At the meeting in questionhe showed four guinea-pigs, two of which had under-gone splenectomy, and all of which had received thesame dose of antiplatelet serum. The unsplenecto-mised animals showed an intense purpura; thosefrom which the spleen had been removed, on the otherhand, showed no haemorrhagic manifestations. Bedsonoffered as an explanation of this phenomenon thefact observed by himself that after splenectomy theplatelets greatly increase in numbers, as a result, hesuggests, of the removal of the normal thrombocyto-lytic action of the spleen. He found that this increaseof platelets in the guinea-pig after splenectomy wasonly temporary, and that as other portions of thereticulo-endothelial system took on the function ofdealing with the thrombocytes, their numbers againfell to normal. On this supposition the benefitto be expected from splenectomy in purpura hæmor-rhagica should be only temporary; whether this willprove to be the case remains to be seen. Already theoperation has been performed at least twice in thiscountry for this condition and reports may be expectedin due course.

5 Brill : International Clinics, March, 1921, i., 34th series,p. 34.

6 Brill and Rosenthal : Arch. Int. Med., 1923, xxxii., 939.7 Ledingham : THE LANCET, 1914. i., 1673.

8 Bedson : Jour. Path. and Bact., 1922, xxv., 94.