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in a large number of human victims unless, of course,it could be substantiated by animal experiment. Inthe course of researches, published on p. 1192 of thisissue of THE LANCET, on guinea-pigs exposed to theinhalation of mustard gas in a concentration of1 in 20,000, Surgeon-Commander McCowen foundhistologically that the upper air passages, and thegreater part of the bronchial tree, in addition to thelungs, were invaded by leucocytes in every stage ofdisintegration. After subcutaneous injections of thegas or applications to the skin the same invasion is.seen at the sites involved, directly attributable tothe intense reaction set up by mustard gas. Surgeon-Commander McCowen regards the increase in thehsemobactericidal power of the blood after exposureto this gas or to other tissue-destroying substancessuch as hydrochloric acid, formic acid, and liquorepispasticus, as due to release of antibacterial elementsinto the blood from disintegration of leucocytes atthe site of damage. That the hsemobactericidal power,of the blood is undoubtedly increased-the more severethe exposure the more pronounced the increase-isevident from the protocols of the experiments attachedto his communication in the form of an appendixwhich space did not allow us to publish. This interest-ing observation, however, has little bearing on the Iproblem of permanent effects, since presumably the ’,blood reverts to normal in the course of a few days.But the histological study of the tissues, especiallythe respiratory passages, of guinea-pigs who havebeen exposed to the same concentration of inhaledgas and have survived for months or years mightwell throw light on the process of healing, of whichthe intense leucocytosis observed is presumably thefirst stage. The scarring may take some characteristicform which could be looked for in the autopsies ofmen known to have been gassed. By the correlationof such experimental findings with clinical observationit is at least possible that the Veterans Bureaumay collect enough evidence to abolish gas warfarefrom among the weapons of civilised warfare.

SOME EARLY AND LATER HOUSES OF PITY.

Dr. Hobson is already well known by his charminglittle Book of the Wandle (that rivulet whose defile-ment was eloquently mourned by Ruskin) and also as- a protagonist in defence of Whitgift’s Hospital, whichsome, unworthy of their inheritance, are anxious to pull-down. In fact, the book now before usI grew from thedesire of Dr. Hobson to write more fully than he hadhitherto done about this hospital, and therefore towrite about other hospitals prior to or contemporarywith Whitgift’s. The author says in his preface thathis book owes much to Miss R. M. Clay’s " MediaevalHospitals of England " and still more to Dugdale’s" Monasticon." He confesses that he has only madea selection from the many ancient hospitals and thusinevitably has left out something which somebodyelse thinks should be there. We for our part aresurprised that Dr. Hobson has omitted any mention,of St. Bartholomew’s, Rochester, or rather Chatham,a foundation older than the better known house inSmithneld by some 15 years ; it was founded before1108, is still in use, and the original chapel remains.Neither does he describe the Spital of St. Katherine- in Rochester, which is still in being ; this foundationis comparatively modern, being founded in 1316.It is sad to see how many of these useful foundationsfell on evil days, mostly in the great spoliation underHenry VIII., but some before this date owing, itmust be confessed, to unworthy masters or governors.The original intentions of the pious founders were asnothing in the eyes of Henry VIII., of his bully,Thomas Cromwell, or of sundry commissions of laterdate, an admirable sketch of whose actions and theresults thereof was given by Anthony Trollope in" The Warden." Dr. Hobson writes about Whitgift’s

1 Some Early and Later Houses of Pity. By John MorrisonHobson. M.D., B.Sc. London : George Routledge and Sons,Ltd. 1926. Pp. 199. 10s. 6d.

Hospital and its archiepiscopal sister, Abbott’sHospital at Guildford, with a, natural affection.We like his advice to his readers : " Go and see foryourselves, as, indeed, many do from all quartersof the world, including even some of the townspeopleof Croydon." A whole chapter is devoted to thebeautiful hospital (God’s House) at Ewelme. Thishospital, which was founded by William de la Pole,Duke of Suffolk, remained in the same familyuntil 1525, when the last de Pole was killed at Pavia.Later on James 1. annexed the mastership to theRegius Professorship of Medicine at Oxford, and untilquite recently the Regius Professor of Divinity wasex officio rector of the parish. Dr. Hobson notes(p. 72) the statue of Alice de la Pole representedin her shroud, and gives a footnote by Mr. R.Hutchinson stating that these shrouded figures camein about the fifteenth century and lasted throughTudor times. Among the most notable existing onesis that of Dr. Donne, now in St. Paul’s Cathedral,the only monument from the old building whichescaped the fire. There are also fine examples inMaidstone Parish Church, being monuments to theAstley family circa 1600.

CONTAGIOUS ABORTION.

THE organism which in the new nomenclature iscalled Alcaligenes melitensis lives naturally in goatsand causes Malta fever when it infects man. Themicrobe A. abortus commonly lives in cattle and causeswidespread losses of calves in this and other countries.The two species are extremely closely related to oneanother, and, apart from their pathogenic effects,the bacteriologist has to use his most refined pero-logical technique to distinguish one from the other.Evidence has now accumulated that abortus mayoccasionally cause a vague febrile disease in man ofthe genus P.U.O. ; some recent cases are describedby Dr. 1. F. Huddleson in America.I And it will,perhaps, be a surprise to many people to learn thatEnglish milk contains A. abortus quite frequently.In the last number of the Joicrnctl of Pathology andBarteriology, the principal contents of which have

already been summarised, Dr. G. S. Wilson andMiss Muriel Nutt, working in the Public HealthLaboratory of the University of Manchester, narratetheir discovery of this organism in about 8 per cent.of the samples of milk examined. This does notindicate any serious danger to human health ; con-

sidering the amount of exposure to which cowmenmust be subject, human infection is evidently veryrare. But the recognition of its possibility will helpto explain a few cases of obscure illness. The serumof a case of Malta fever will agglutinate both melitensisand abortus, and the serum from a case of abortusinfection will, by the ordinary methods of testing,give a positive Widal reaction with both organismstoo. Hence, presumably, come the odd examples ofMalta fever which have been suspected to arise in thiscountry. For it is now known that abortus anti-bodies can be found in a sensible proportion ofsamples of serum taken from children who haveconsumed cows’ milk. And the probability seems tobe that abortus in milk may actually be useful as apreventive of Malta fever; Khaled showed thatmonkeys and goats can be immunised againstmelitensis by vaccination with abortus, and Nicollesuggested that this might be a useful method ofhuman protection. The reverse can presumably alsooccur, and this may explain the old custom, more orless prevalent throughout Britain, of running a goatwith a herd of cows to prevent miscarriages. Atten-tion has several times been drawn to this.3 Farmershave invented a variety of explanations of thehal it; but the facts now known suggest at once

th t the goat acts as a prophylactic because the

1 Jour. Amer. Med. Assoc., 1926, lxxxvi., 943.2 Jour. Hygiene, 1924, xxii., 335.

3 THE LANCET, 1922, ii., 546, 743; Brit. Med. Jour., 1925;., 764.

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- melitensis which he so often carries vaccinates thecows against Bang’s bacillus. The French have latelybeen concerned with the increasing prevalence ofhuman Malta fever in their country and the come imission charged to examine into the facts haverecently published some extremely interesting maps 4which, at any rate, fit in well with this idea ofvicarious vaccination. Human Malta fever is confined- to the departments in the south-east, and epizootic.abortion in goats and sheep (due to JI. melitensis)has, as is natural, almost the same geographical.distribution. But another map shows that epizooticabortion in cattle (due to M. abortus) is prevalentthroughout France except in these same south-eastern.departments. It may be that where there are manygoats there are few cows, but the facts stronglysuggest that Malta fever and bovine abortion are insome way antagonistic to one another-which Englishfarmers seem to have found out before bacteriologywas thought of. ____

FAT METABOLISM IN INFANTILE ATROPHY.

THE pathogenesis of infantile atrophy has been formany years one of the vexed questions of pediatrics,and it would probably be a fair statement that, whilemuch has been written on the theoretical aspect ofthe subject, yet the theoretical considerations havebeen comparatively unhelpful from the point of viewof prevention or of treatment. The principal reason iof this slender therapeutic result, achieved by so muchlaborious work, is that so many of the theories ofthe pathology, with their consequent methods of treat-ment, rest upon major premisses which are feeblyestablished and have not stood the test of time.There are few medical problems on which so great avariety of opinions are held, but a rough line ofcleavage exists between the followers of the Frenchschool as represented by Prof. Nobécourt and Prof.Marfan, who adopt a somewhat non-committal clinicalclassification and stress the constitutional factor, andthe disciples of Czerny and Finkelstein, who have beenled by the result of biochemical experiment toassociate infantile atrophy with the deleterious effectsof various constituents of food. Czerny’s discoverythat the so-called curds found in infants’ stools werereally composed of fat was an observation of con-siderable clinical importance, and served to refute theolder idea that the casein of cow’s milk was the refrac-tory element in the diet. The theory which resultedfrom the work of Czerny and Keller based the patho-- genesis of infantile atrophy on a deficient assimilationof fats, and a consequent excess of fatty acids in thebowel, leading to a "demineralisation

" of the bodyby removal of the alkalies which were required toneutralise them. The experiments on which this viewrested have been repeated by a number of workers,notably by Holt in America, and have by no meansalways been confirmed. Dr. L. G. Parsons, whoseGoulstonian Lectures two years ago provided theEnglish reader with a most lucid and impartial surveyof this subject, has been foremost among Britishpediatrists in investigating fat metabolism in infantileatrophy. On a former occasion he studied the relationof the urinary ammonia output to the fat intake, and.did not confirm Keller’s observation that the ammoniawas increased by raising the fat content of the food.In a recent communication 2 he has presented theresults of experiments carried out by himself andMiss Hickmans, in the light of which Czerny’s majorpremiss appears to be of doubtful validity. A series-of marasmic infants were investigated, the fat contentof the food and the amount of fat-total, saponified,neutral, and fatty acid--of the faeces being determined.Dr. Parsons points out that if diarrhoea is present theassimilation of fat is necessarily defective owing toperistaltic hurry ; for this reason cases exhibitingdiarrhoea were excluded. The results of the investiga-tion are given in tabular form, and show that the

4 Reproduced in the Tropical Diseases Bulletin, 1926, xxiii.,349. 1 THE LANCET, 1924, i., 687.

2 Birmingham Medical Review, April, 1926.

absorption of fat took place to the normal extent ofabout 4 g. per kilo of body-weight, and hence that thereis no essential defect of’fat metabolism in atrophicinfants. The absorption of fat was found to varyconsiderably with different forms of diet; with thesame fat intake a higher degree of absorption wasobtained with diluted cow’s milk than with driedhumanised milk. Taken in conjunction with otherexperiments and clinical observations which are

referred to, these results have led Dr. Parsons to rejectCzerny’s views on the treatment as well as the patho-genesis of atrophic infants, and to believe that anadequate supply of fat (about 4 g. per kilo of body-weight) is essential to their dietary.

THE HENRY FORD HOSPITAL.

IN 1909 citizens of Detroit, Michigan, deeming anew hospital essential to meet the development ofthe city, inaugurated a campaign to provide one.In 1914, however, Mr. Henry Ford gave a hand,with the result that the hospital associated with hisname was opened in October, 1915. Its furtherdevelopment was to a certain extent handicappedby the war, but at the present day it comprisesbuildings scattered over an area of 20 acres in thecentre of Detroit, and includes a thoroughly equippedmodern hospital with a large educational establish-ment and a magnificent nurses’ home, which bearsthe name of Clara Ford. Thanks largely to themunificence of the founder, the staff of the hospitalhas recently published a large volume of collectedpapers,1 which testify that during the first ten yearsof its existence this hospital has served one of itsmain purposes-medical research. The volumecontains nearly 50 papers and articles with 151 illustra-tions and 42 charts. H. P. Doub, A. Bolliger, andF. W. Hartmann ’contribute an important study onthe immediate metabolic disturbances followingdeep X ray therapy, confirming to a large extentthe work in this country reported in these pages byE. C. Dodds and J. H. D. Webster.2 Interestingpapers on obstetrics are reprinted, including two onthe placental transmission of certain constituents ofthe blood by L. J. Bogert, E. D. Plass, and C. W.Matthew. F. J. Smith and R. D. McClure describetwo cases of angina pectoris treated by cervicalsympathectomy with substantial decrease in thefrequency of the seizures, but in neither case wasrelief complete. E. C. Davidson contributes a verycomplete study of tannic acid in the treatment ofburns. Tannic acid was used either in the form ofcompresses moistened with a 5 per cent. solutionor as a 5 per cent. ointment with lanolin and vaseline.A study of 25 cases leads to the conclusion that tannicacid acts as an analgesic, that its use lessens toxaemia,that its astringent action decreases the loss of bodyfluid, and that secondary infection is markedlylimited. On the medical side R. D. McClure dealswith the treatment of pernicious anaemia by splenec-tomy and repeated blood transfusions, and R. H.Major describes the treatment of empyema by simpleaspiration followed by the introduction of a solutionof gentian violet into the thoracic cavity. An appendixcontains notes on certain technical appliances, and aforeword by Dr. F. J. Sladen, physician in chief,is full of wise sayings on the subject of medicalresearch. The book is sumptuously produced.

1 Collected Papers by the Staff of the Henry Ford Hospital.First Series, 1915-25. New York : Paul B. Hoeber, Inc. 1926.Pp. 634. $8. 2 THE LANCET, 1924, i., 533.

EPSOM COLLEGE.-Founder’s Day will be held onJuly 24th. Viscount Grey of Fallodon will present prizes at2.45 P.M. and will then open the new chemical block, whichhas cost over 210,000. The important alterations andadditions recently made at the Lower School will be readyfor inspection, and the oak decoration of the chancel ofthe memorial chapel will be open to view for the first time.Expenditure this year has been over 20,000, and theproposed additions to the school will involve at leastanother .625,000 in the near future.