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the infections. Even when liver was boiled, roasted, orbaked the eggs appeared to be unaltered, and it maybe concluded that with imperfect cooking eggs maybe passed alive in the faeces of the man who hasswallowed them. It is clear, then, that when hepaticsymptoms are absent a diagnosis of infection by theseflukes, based on the finding of their eggs in the faeces,may well be a mistake. They should be sought forrepeatedly by duodenal catheter, unless the ingestion of infected liver can be completely excluded. Thisobservation should bring about a careful scrutiny ofcases of supposed infection by these occasional parasites of man. ____

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PERCEPTION OF MOVEMENT.

IT is supposed by some that the perception ofmoving objects, together with a crude light sense,represents a primitive type of vision, in some respectsdiffering from the vision of stationary objects. Inorder to throw light on the problem some experimentshave been carried out 1 by Mr. Myer Salaman, M.A.,on the vision respectively of moving and stationaryobjects in the periphery of the visual field. The firstexperiment was planned with the object of discoveringwhether, when a moving object is observed peri-pherally, a perception of discontinuous change ofposition is ever obtained without perception ofmovement. An apparatus was employed by meansof which the speed of a horizontally moving objectand its angle of eccentricity could be exactly regulated,and numerous reports were obtained from six trainedobservers. All observers complained of the extremevagueness of the perceptions, but the majority agreedin reporting change of position of the spots at eccentricangles at which no movement was perceived. Thisapplies most decidedly to slow movement of under 02°of visual angle per second. When the rate of move-ment was more rapid it was, of course, more easilyperceived. A second experiment had for its objectto discover whether discontinuous change of positionof an object, observed peripherally, is ever perceivedas movement. In this experiment half of theobservers never obtained any illusory perception ofmovement at all. Of the rest the only ones who gaveany but negative results were those who had know-ledge of previous work on the subject and of thenature and purpose of the experiment. The conclusionsuggested is that the illusory perception of movementwas in these cases subjective and psychological, notthe outcome of any physiological process connectedwith the retina. The author is far too cautious todeny what others have maintained-that there maybe a special physical basis for the visual perception ofmovement, but at any rate he shows that no conclu-sions can be drawn from experiments on the subjectin which the psychological factors are ignored.

THE DOSAGE OF INTRAVENOUS GLUCOSE.

THOUGH intravenous glucose is recognised as a

serviceable agent in conditions of exhaustion, toxaemia,or dehydration and is widely used, dosage and generaltechnique are apt to be rather casually determined.Dr. P. Titus and Mr. H. D. Lightbody, working in theDepartment of Obstetrics and Gynaecology of theSt. Margaret Memorial Hospital at Pittsburgh, setthemselves to ascertain the quantity, concentration,and rate of injection of glucose which would yield thebest results. They were chiefly concerned with thetoxaemias of pregnancy and sundry gynaecologicalconditions, but their conclusions2 have wide medicaland surgical applications. They plead at the outsetfor as much care in calculating the dose and incontrolling the administration of intravenous glucoseas is used in the giving of any potent agent. Theyattribute clinical failure and " reactions " to faultytechnique or dosage, and remark that ill-effects would

1 Medical Research Council. Some Experiments on PeripheralVision. By Myer Salaman. H.M. Stationery Office. 1929. Pp.47.2s. 6d.

2 Amer. Jour. Obst. and Gyn., August, 1929, p. 208.

certainly be observed if in morphine therapy thedosage was casually arrived at anywhere between-grs. 5 and one-hundredth of a grain. To establish their-data the authors seized on the cardinal fact thatintravenous glucose causes a rise in blood-sugar up toa certain point, with a subsequent sharp and-inevitable fall. This fall is, of course, of the highestimportance, since hypoglycaemia is probably tne’cause of the convulsive reactions reported from timeto time. It is almost certainly due, according tothe charts presented, to an over-stimulation of thepancreas by the excess glucose and an over-productionof endogenous insulin. Proceeding along clinical experi--mental lines the authors tackled separately the threeproblems of quantity, concentration, and rate of

injection. The first consideration is the therapeuticdose. As a general rule probably too little is given.Indeed underdosage, combined with a too rapid rate ofinjection, may well account for the disrepute into’which glucose falls from time to time. On the otherhand, overdosage will lead, as has already been stated,.to a paradoxical hypoglycaemia with the possibility ofconvulsions. It seems that the best quantity for anaverage sick adult is 75 g. The concentration of thesolution should be decided upon after a review of theclinical condition. For example, in pneumonia whenthe patient has a weakened heart muscle, stronglyhypertonic solutions should be chosen, so as not to-overload or strain the right ventricle ; while in a caseof dehydration from vomiting and diarrhoea a weaker’hypertonic solution is preferred. It will surprise manyEnglish readers to learn that 50 per cent. is recom-mended for the stronger, 10 per cent. for the weakersolution. For the rate of injection the authors fall’back on the determinations of R. M. Wilder and,W. D. Sansum,3 who concluded that the rate shouldnot exceed 0-8 g. of glucose per kilo of body-weight perhour. This is very much slower than the rate usedin many hospitals and the disadvantages of rapidinjection should therefore be emphasised. A certainsequel is the immediate loss of the substance byheightened urinary excretion before it has had time toact; a probable sequel is an over-stimulation of thepancreas, leading to endogenous over-productionof insulin similar to that following overdosage.According to Dr. Titus and Mr. Lightbody, a basisfor the administration of glucose to adults should be75 g. of glucose in 300 c.cm. of water given over a totalperiod of one and a half hours. The injection need notbe continous but may usefully be given by instalmentsthroughout the day. In children proportionatelysmaller quantities of sugar should be given but thetime of injection should not be reduced.

CHANGES IN LOCAL GOVERNMENT.

THE end of September saw the expiration of theperiod allowed to the county councils and countyborough councils for the formulation of their plansfor taking over the public health and administrativework of the boards of guardians. On the last day ofMarch next those bodies will automatically bedissolved and their successors will receive a largeaddition of dignity and importance, tempered by theobligation to perform extensive and often complicatedfunctions familiar, in most instances, to a minorityonly of their members. So great a change in oursystem of local government entails careful and minutearrangements for smooth working, but in the mainthey must necessarily bear a family likeness. To whatextent they differ it is impossible to say, since manyscores of schemes have had to be prepared. Thegeneral outlines are, however, familiar. FromApril 1st the councils of counties and county boroughs-that is to say, all the great towns, and some thatare not so great-will be responsible for poor-lawfinance, indoor and outdoor relief, and the maintenanceof poor-law institutions, so long known as workhousesand poor-law infirmaries.

This is a heavy load of work to place upon theshoulders of authorities which grow busier every year,

3 Arch. Int. Med., 1917, six., 311.

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but the Local Government Act of 1929 provides for itto be met by delegation. Even as the councilsappointed education committees when they took overthe functions of the school boards, so will they nowappoint public assistance committees that will absorbthe paid officials of the guardians. These bodies willhave the general supervision of all poor-law work,subject, of course, as the education committees are,in matters of principle, to the approval of the councils.The composition of these committees is of greatpractical importance. They may consist only ofelected councillors, and in some places that coursehas been followed, or they may include cooptedpersons to the extent of not more than one-third, some- of whom must be women. The borough public assist-ance committees may and, as a rule no doubt will.appoint subcommittees consisting mainly of electedcouncillors, but here again, if outsiders are coopted,women must be among them. In the counties sub-committee are compulsory, for the obvious reasonthat it is impossible to administer relief from a singlecentre. These guardians’ committees will do work forwhich local knowledge is necessary, such as inter-viewing and investigations. They will consist ofmembers of the subsidiary councils, in the area,nominated by those councils, members of the countycouncil representing the area, and male and femalecoopted members-this is compulsory-to the extentof not more than one-third. The inclusion in thiscategory of as large a number as possible of the oldguardians and others with poor-law experience is verynecessary, and even where elected councillors onlynave been chosen it is probable that some of them are,or have been, members of boards of guardians.

It is probable that, in most instances, the difficultand complicated question of the most effective meansof cooperation between the poor-law hospitals andthe voluntary hospitals has, as yet, been settled onlyin broad outline, even if so much has been done.The details of such cooperation are necessarilyintricate, and whatever is arranged must needs besubject to the test of experience. The primary objectmust be to prevent waste and overlapping, and thatcrowding of one institution while a neighbouring onehas beds to spare which has been so serious a weaknessof the old system. Not less important will it be tocreate something like a uniform standard of efficiency,which was virtually impossible so long as we had twohospital systems existing side by side, one of which was,so to speak, under a cloud. From the point of viewof the public health the councils have a great oppor-tunity and, with goodwill on both sides, the voluntaryhospitals ought to be the stronger for the adoption ofrationalisation in quite a new sphere.

ANAEROBIC TOXÆMIA IN ACUTE OBSTRUCTION.

MiCRO-ORGANISMS, like people, have their phases Iof popularity. The bacillus of gas gangrene, forinstance, was long regarded as of no significance exceptin foul wounds, but M. Weinberg, in France, followedby B. W. Williams 2 in this country, has endeavouredto establish its importance in acute intestinal condi-tions, and in America it is being advanced as a causeof pernicious anaemia. As regards its action inobstruction of the intestine and acute peritonitis,Weinberg has urged that it produces an infection, andWilliams that it forms toxins which are absorbed.In a case lately published by J. Sailer, G. M. Laws,and J. Eiman 3 the afebrile collapse of a womanpatient after appendicectomy suggested to the authorsthe toxaemia of " gas gangrene." On her deathB. welchii was found in the small intestine and provedlethal to rabbits. The reporters of this case apparentlybelieve it to be unique, but it is of the type describedagain and again by Weinberg and Williams. Thewhole theory of the absorption of this toxin from thegut in acute obstruction has lately been traversed,

1 Ann. de l’Inst. Pasteur, 1928, xlii., 1167.2 Brit. Jour. Surg., 1926, xiv., 295 ; THE LANCET, 1927, i., 907.

3 Amer. Jour. Med. Sci., 1929, clxxviii., 309.

however, by A. W. Oughterson and J. H. Powers,<Iwho have repeated Williams’s experiments on a muchlarger scale. Eleven dogs were given acute obstruc-tion and the contents of their small intestines werefiltered and injected into the peritoneal cavity of mice.An equal number of mice received the filteredintestinal contents plus a B. welchii antitoxin ofestablished quality, and the results seemed to bequite arbitrary. Few mice died, protected or unpro-tected ; in many cases more protected mice died thanunprotected. A second series of dogs were thengiven acute obstruction and the intestinal contentswere this time injected into rabbits. It was hoped tofind evidence of anti-haemolysin to B. welchii haemo-lysin, if it was present, and as a control a sample ofknown B. welchii toxin was similarly injected. Theresults were negative, however, save in the controlrabbit. Lastly, cats were given acute obstruction,and it was found that no relief of symptoms wasafforded in the group to which antitoxin was given.The usefulness of the antitoxin treatment of acuteobstruction in practice has been emphasised by manywriters, including J. O. Bower and J. Clark,5 but theoriginal theory of intestinal absorption requiresconfirmation before it can be.held to be established.The therapeutic value of the method has not so farbeen denied in any publication, but the theoreticalbasis of the method, already resting on two contra-dictory arguments, is decidedly uncertain.

THE RIPENING OF BEEF.

IT is estimated that those English butchers whosupply the wealthier classes sell only 25 per cent. ofa beef carcass for roasting purposes, the remainderbeing destined for stewing, boiling, or pickling. Inindustrial districts over 54 per cent. of the carcassis sold for roasting, the cheaper and usually tougherjoints, such as silverside, topside, aitchbone, andmiddle ribs, being disposed of for this purpose as wellas the sirloin and fore-ribs. It is obviously desirablethat the palatability of the cheaper joints should beraised to as high a standard as possible. With thisend in view the Department of Scientific and IndustrialResearch recently undertook an investigation on theeffect of hanging, or conditioning, upon the palatabilityof meat, and their report on the subject has just beenissued. The investigation consisted essentially in acomparison of the palatability of samples of hot andcold roast beef derived from carcasses which had beenstored at suitable temperatures for varying lengths oftime. The palatability was assessed by teams ofexperts who allotted marks to each sample for suchqualities as tenderness, flavour, texture, juiciness, andcolour. Joints from one-half of each carcass were

cooked and tasted three days after the slaughter ofthe animal ; the other half of the carcass was storedat a temperature of 41’ F. for a further 4 or 14 days,after which interval corresponding joints from thishalf were similarly cooked and tasted. In almostevery case there was a marked progressive improve-ment in the palatability of the samples with theincrease in the period of storage, due mainly to anincrease in tenderness. The increase in tendernesswas more pronounced with the coarser joints thanwith those of the first quality, and was sufficientlyconstant and striking to lead the authors of thereport to suggest a scheme for the conditioning of beefat central depots such as municipal abattoirs. Undersuch a scheme the dressed carcasses would be cooledfor one to two days at a temperature of 31-33&deg; F.(short of actual freezing) and then stored for 10 to 12days at a temperature of 36-38&deg; F. Before removalto the retail shops, or at least before being cut upinto joints, the carcasses should be stored for about24 hours at ordinary temperature, or in summer at

4 Gushing Birthday Volume, 1929, p. 1085.5 Amer. Jour. Med. Sci., 1928, clxxvi., 97.

6 Food Investigation, Special Report, No. 36. Post-mortemChanges in Animal Tissues: the Conditioning or Ripening ofBeef. H.M. Stationery Office. 1929. Pp. 64. 2s.