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and that with a pH about 5 the growth of thesegerms is considerably inhibited. In some of Prof.Ylppö’s experiments the pH showed figures as lowas 5-6-5-8, at which level of acidity the gastric juiceexercises only a negligible bactericidal action on thegerms of the typhoid and dysentery groups. Theseinteresting observations afford some clue to thegenesis of diarrhoea caused by parenteral injection orinfection.

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VACCINE TREATMENT OF EPIDEMIC

ENCEPHALITIS.

AT a recent meeting cf the Société de Théra-peutique of Paris, MM. A. Marie and Poincloux1reported the results of treatment of eight cases ofParkinsonism, following epidemic encephalitis, byintraspinal injection of the fixed virus of encephalitis.After removal of cerebro-spinal fluid, 1-5 c.cm. of acentrifugalised emulsion of the brain of a rabbitwhich had died of exper:mental encephalitis wasinjected. The emulsion represented a dilution of1 in 20 of a virulent brain which had been kept inthe ice-chest for 24-48 hours before use. The injectionwas followed by a rise of temperature rang;ng from101-2° to 104’ F., signs of meningeal irritation, cerebrospinal lymphocytosis, -and a change in the clinicalcondition. The rise of temperature occurred 20 hoursafter inoculation, and lasted 24-36 hours, when thetemperature fell to normal, except in two cases inwhich it remained between 100.4° and 102.2° for aweek. The emulsion of a normal brain or of a virulentbrain which had been inactivated by heat did notproduce any rise of temperature. Signs of meningealirritation consisted of pain in the head and spine,nausea, vomiting, pains in the limbs, and in one caseKernig’s sign. The cellular reaction was always alymphocytosis, which in several instances was very

Iintense. Cases in which clinical improvement tookplace were those in which the temperature was

highest and lymphocytosis was most marked. Asregards results, two of the cases had to be excluded,as the patients refused further treatment after onlytwo injections. Their present condition, however, isbetter than before, and at least tends to show theharmlessness of the method. Of the six others, twopresented no improvement, while four had maderemarkable progress. One patient in particular wasable to get up, dress herself, read a little, and play thepiano, which she had not done for four years. Thewriters suggest that even better results might beobtained if this treatment were adopted at the onsetof encephalitis, and that it might possibly be ofprophylactic service in epidemic times.

THE TREATMENT OF LEPROSY.

THE subject of leprosy engages more than ordinaryattention and interest at the present moment onaccount of the energetic measures that are beingtaken for the eradication of this dread disease in theBritish Empire, and Sir Leonard Rogers, chairmanof the Medical Committee of the British EmpireLeprosy Relief Association, reviews in the Marchnumber of the Tropical Diseases Bulletin (Vol. XXI.,No. 3) the recent literature dealing with the malady.The Bulletin further outlines the scope and objectof the campaign against leprosy, showing how themedical policy is directed towards extending theapplication of improved methods of treatmentthroughout the Empire, not only by supplying thenecessary drugs, but also by training those in chargeof lepers to apply them. Researches on the aetiologyand treatment of the disease are encouraged, andsupport is given to sound schemes of segregation.The method by which the work is carried out isillustrated by Dr. H. W. Wade, in a paper dealing with ,,the Culion Leper Colony in the Philippines. Prior ’,to May, 1921, he states, the staff was insufficient toenable any systematic treatment amongst the 4500 i1 Bulletin de la Société de Thérapeutique, March 12th, 1924.

lepers to be undertaken, but in 1923 it was

possible to record systematic observations on selecter!cases to the number of 4067. Intravenous injectionsof Rogers’s original preparations were soon droppedon account of venous troubles, and in their steadchaulmoogra esters, plain or iodised, were injectedintramuscularly. A survey on Sept. 30th, 1923,showed improvement in 55-9 per cent., while in afurther 36 per cent. the disease had been checked ; -,6-4 per cent. of the cases showed retrogression, andin 1-7 per cent. of the total death occurred. Furtherprogress of this crucial test will be watched with greatinterest. The principles underlying treatment are

set forth in a paper contributed by Dr. G. E. Muir.He believes it is necessary to strengthen the bodyresistance and to induce repeated small reactionsdue to the breaking up and setting free of the bacilliin the tissues-a process which must be carefullycontrolled. A rise of temperature may be beneficial,and a case is quoted in which the leprotic lesionsdisappeared with the onset of kala-azar. Muir believesthat injections of hydnocarpate esters into the skinlesions causes the most rapid improvement, andconcludes that early and persistent treatment arreststhe disease and causes gradual disappearance of thesigns and symptoms. In an informative and carefulstudy on prophylaxis, Rogers sums up the matter bysaying that the main point is the avoidance of contactbetween lepers and healthy individuals, and, in orderto do this successfully, cases must be detected in anearly stage of the disease. Instances are given ofthe good effects which have resulted from segregation

in Norway, Sweden, Iceland, and Eastern Canada.

CULTIVATION OF MICRO-ORGANISMS IN

TISSUE PLASMA CULTURES.

S. B. Wolbachl and M. T. Schlesinger, encouragedby the work of IT. Zinsser and E. G. Carey on ratleprosy, have succeeded in obtaining what theybelieve to be a multiplication of rickettsia organismsin guinea-pig plasma-tissue cultures. The strain otRocky Mcuntfin spotted fever virus was maintainedfor over a year in guinea-pigs, while that of typhuswas originally brought from Poland and was main-tained by passage in the laboratories at Harvard.Special technique was devised, guinea-pig tissuesbeing employed throughout; in the case of RockyMountain spotted fever the testicular and in the caseof the typhus the brain tissues were used. Bloodfrom half-grown guinea-pigs provided the source

of the plasma and a technique was adopted whichpermitted the collection of blood, its centrifugalisa-tion and a separation of the plasma with as fewmanipulations as possible. The tissue for cultivationwas obtained with aseptic precautions and keptimmersed in Ringer’s solution until the plasma wasprepared ; then portions for culture were cut intopieces 0-5 to 1-0 c.mm. in size. When tissue cultureswere transferred to fresh plasma, in order to prolongthe period of growth, the pieces of tissue were removedfrom the plasma, washed in sterile Ringer’s solution,transferred to fresh sterile cover-slips, and fresh plasmaadded. In this manner tissue cultures have beenkept in active growth for four to six generations,over a period of four to six weeks. For injection intoguinea-pigs the tissue cultures were teased intopieces small enough to pass through a No. 18’gauge hypodermic needle. The fragments of tissueunderwent fairly prompt degeneration. Endothelialcells tended to congregate at the periphery and theonly blood cells which survived for more than a fewdays were eosinophiles. The nerve cells underwentrapid disintegration. From tissue culture fixed andsectioned at intervals it was possible to follow thegrowth of the micro-organisms and to note theirincrease in numbers in endothelial cells in the vesselwalls. The effect of the micro-organisms on the cellsthemselves appeared to be deleterious ; it is evident

1 Journal Med. Res., December, 1923, vol. xliv., No. 2, 231-256.2 Journal Amer. Med. Assoc., 1912, lviii., 693.

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that the cells containing them rapidly die, and thelife of the organisms in turn is dependent upon thatof the endothelial cells. In the case of Rocky Moun-tain spotted fever occasional filamentous forms ofDermacentroxenus rickettsi were observed. In thecase of typhus the cells containing Rickettsia prowazekicongregate at the periphery of the tissue. The formsmost frequently found are exact replicas of thoseencountered in lice fed upon typhus patients.

LONDON SCHOOL OF HYGIENE AND

TROPICAL MEDICINE.

THE Charter of Incorporation granted to theLondon School of Hygiene and Tropical Medicine,as mentioned in our news columns last week, carriesinto effect the stipulation of the International HealthBoard of the Rockefeller Foundation of New York,made in offering to provide and equip a School ofHygiene in London, by associating the proposedschool with the University of London. The Charterlays down generally the constitution of the new bodyand appoints a provisional board of managementwho are to take steps for the erection and equipmentof such a school, pending the appointment of a perma-nent governing body, and to form a first board ofmanagement for a period of not more than 18 months.The appointment of a fresh board of nine membersafter that period is provided for. and there is to be inaddition a court of governors consisting of 35 members.Provision is made for the amalgamation of the existingschool (the London School of Tropical Medicine) withthe newly incorporated school, which will take over thework and functions of the existing school togetherwith its equipment, laboratory, library, and museum.devoting to the purposes of tropical medicine a sumnot less than the income of endowments for thatpurpose of the existing school at the date of transfer.The Charter further provides for the taking over of thestaff of the existing school by the London School ofHygiene and Tropical Medicine, and for that bodycontributing to the cost of reconditioning the premisesin Endsleigh Gardens of the Seamen’s Hospital Society,if those premises are vacated by the existing schoolby reason of the amalgamation. As long as theSeamen’s Hospital Society maintains a hospital fortropical diseases at Endsleigh Gardens, the LondonSchool of Hygiene and Tropical Medicine, so far asmay be practicable and to such an extent as may beagreed upon, is to make use of the hospital for theclinical instruction of students of tropical medicine.

TREATMENT OF SYMPTOMATIC SCIATICA.IT has long been recognised that one of the causes

of sciatica may be arthritis or periarthritic troubleabout the hip-joint. Indeed, some writers have goneso far as to attribute to this cause a majority at leastof the cases of sciatic pain. In a paper on the Ortho-paedic Treatment of Symptomatic Sciatica, publishedin the Journal of the American ]ý] edical Associationof March 22nd, Dr. Philip Lewin, of Chicago,attributes the symptoms of most of his cases tolumbo-sacral or sacro-iliac disease, and describes amethod of treatment which -is essentially the same inprinciple as that generally used for disease of thehip-joint. It involves extension by weight and pulleyand physiological rest in bed, followed by ambulatorytreatment, in which a plaster spica and a high booton the sound foot and crutches are used, and finally,after cure a special thigh and loin corset is to be worn.Dr. Lewin has treated thus about 50 cases, most ofwhich were cases of lumbar or lumbo-sacro-iliacosteo-arthritis. The results, he says, have been verysatisfactory. Of late years much attention has beengiven in the United States to the diagnosis andtreatment of sacro-iliac disease ; many more caseshave been reported in that country than in GreatBritain, where definite arthritis of the joint fromwhatever cause arising is comparatively rare. Theclimate of the Eastern and Middle States of the Union

is more extreme than that of our islands, and theseasonal alternation of severe cold with considerableheat may possibly be answerable for the amount ofarthritic disease noticeable there. Many of the casesof sacro-iliac disease which have been described inAmerican publications have been of slight severity,yet sufficiently disabling to drive sufferers to seeksurgical relief, and it is these patients who are liableto suffer the machinations and thaumaturgical per-formances of quacks. The evidence of underlyingarthritis may easily be overlooked, and we would callthe attention of British surgeons to Dr. Lewin’s paperas well as to others on similar affections of the spineand pelvis. ____

LUNACY LAW: THE HARNETT CASEAPPEAL.

THE arguments in this case, which is againadjourned, have been reported at considerablelength in the daily press, and no comment uponthe proceedings, which would be permissible, wouldsupply readers with any information which they havenot before them. The discussions point to a judgmentwhich will define for such cases in the future whatmeasure of protection is extended by the existinglaw to those who sign certificates of lunacy, and ifthat measure is seen to be too scanty, we mayassume that amendment of the law will follow.A comprehensive volume 1 on the law relating to

lunacy appears at this opportune moment. Thebook is the result of the author’s 15 years’ experienceas Master in Lunacy. Sir Henry Theobald deals inorder with the royal prerogative in relation tolunatics, administrative control by various authori-ties, the functions of Judge and Master in Lunacy, ofthe Chancery Visitors, of the Board of Control, andof Poor-law authorities. The many points of con-tact of the lunatic with the general law are alsodealt with at some length. While willing to forgothe word " lunacy " in legal proceedings and docu-ments intended to be brought to the notice of patients,the author desires to retain the word " asylum " asconcise, of pleasant sound, and with ancient associa-tion. The author’s blindness has left without a

cloud the mental vision which makes this tome a realcompendium of knowledge on lunacy law.

Sir Humphry Rolleston has been re-elected Presidentof the Royal College of Physicians for the ensuing year.

WE regret to announce the death on April 13thof Dr. Hugh Walsham, consulting radiologist to St.Bartholomew’s Hospital, London.

THE memorial to the late Prof. Sir G. Sims Woodheadat the Cambridgeshire Tuberculosis Colony, Pap-worth Hall, which has taken the form of a newpathological laboratory and X ray department, willbe opened on Thursday, May 8th, by the Hon. SirArthur Stanley The hospital, hostels, workshops,and village settlement will be open to visitors from2 to 4 30 P.M.

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AT the Royal Society of Medicine hospitality will beextended to a new movement of a modest character-which is not to say that it may not develop. A smallshow of artistic work by medical men will be onexhibition in the Marcus Beck Room of the Societyfrom May 26th to June 14th, and will be open toFellows and Members of the Society and their guestsand friends. The President of the Society is pro-moting the exhibition, Dr. Cuthbert Lockyer actingas hon. secretary, while Mr. Sydney Kendrick haskindly consented to select the work and supervise thehanging of the pictures.

1 The Law Relating to Lunacy. By Sir H. C. Theobald, K.C.London : Stevens and Sons, Ltd. 1924. Pp. 854. £2 10s.