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337 had, a plastic peritonitis was set np which led to matting of the intestines. This effect they regarded as an allergic reaction, and made the interesting observation that they could not produce these results in a rabbit which had previously refused to exhibit allergic reaction. They made the further suggestion that the formation of adhesions in the abdomen after operations may on occasion result from such reactions. There seems no good reason why injection with horse serum should make an animal sensitive to sheep protein. Among men, of course, some are sheep sensitive, a larger number horse sensitive, and others may be made horse sensitive by a previous injection of a therapeutic serum. In sensitive persons the use of catgut within the abdomen might well lead to the formation of adhesions. Recently W. Wayne Babcock 2 has observed, in lmmans, the difference in the reaction of the skin to silk and catgut. Around a catgut stitch there is a distinct tissue reaction, leading to necrosis, which is absent with silk. Babcock believes the allergic catgut reaction to be particularly pronounced in thyroid operations. Since he has given up the use of catgut he declares that his wounds heal with a less perceptible scar and that there is an absence of that blood-stained watery secretion which so commonly flows from the drainage-tube after thyroidectomy. lIe claims to have been able to discard the use of a drainage-tube since he has adopted the silk technique. In his hands the substance which produces the least reaction of any is stainless steel wire and he recommends its use wherever possible. It is clear that the icleal suture material has yet to be discovered. Catgut is far from ideal, but with all its disadvantages, most surgeons would agree that it remains to-day the most useful and most suitable material for general work. CARRIERS OF THE MENINGOCOCCUS THE problem of the carrier, his significance, and what to do with him when he is detected, is one of considerable administrative importance, and any fresh light thrown upon it is of interest to all those whose task it is to guard the health of the civilian population or of the fighting services. The light thrown on a particular problem of this kind, that of the meningococcal carrier, by a paper recently published by S. F. Dudley and J. R. Brennan,3 is somewhat disturbing. During the 15 months ending in March, 1933, 11 cases of cerebro-spinal fever occurred among the services stationed at Chatham. Of these only one died, so that the case-mortality was unusually low. During the greater part of the period over which these cases were occurring the carrier-rate remained relatively low-between March, 1932, and February, 1933, it varied between 9’4 and 14-3 per cent. Con- currently with the incidence of the tenth case it rose to 20 per cent., and in March, 1933, when the eleventh and last case occurred, it rose sharply to 61’6 per cent. Thereafter no case was reported during the period (March, 1933, to May, 1934) with which the report is concerned ; but the carrier-rate among service ratings and ranks-i.e., among random samples of non- contacts-remained obstinately high. Ten samples of men were examined, the number in each sample varying between 35 and 50, and the carrier-rate varied from 30 to 66 per cent., with a mean value of 54 per cent., and a standard error of b2’3 per cent. As a contrast to this surprisingly high rate, persisting over a period of 15 months during which no cases of cerebro-spinal fever were reported, the authors quote 2 Amer. Jour. Surg., 1935, xxvii., 67. 3 Jour. Hyg., 1935, xxxiv., 525. figures obtains) at Portsmoutit during the same period, when the admission of six eases of cercbro-spinal fever to the It.N. Hospital was associated with a carrier- rate of 5’1 1’7 per cent. among 177 contacts. The sinific.a,rrce of such findings as these seem unmistakable. A very high carrier-rate may persist in the entire absence of any overt cases of the disease. The incidence of such cases may, on the other hand, be associated with a low carrier-rate. The determina- tion of the carrier-rate among a given population thus gives no automatic indication of the probability of the occurrence of cases. It seems altogether probable, as Dudley and Brennan suggest, that the curious events at Chatham were due to the distribu- tion, among the population at risk, of a strain of meningococcus that had considerable powers of vegetation in the human nasopharynx, but very little power of producing the disease in its characteristic clinical form. It would seem that the case : carrier ratio over any particular period, or in any given group of the general population, depends in large part on the biological characters of the particular strain of meningococcus that is dispersed among them. Incidentally the Chatham experience affords another, and a very striking, example of the futility of any attempt to segregate meningococcal carriers-a 60 per cent. non-contact carrier-rate would present an impossible administrative problem even if there were any reason for believing such segregation to be necessary or desirable. The Chatham experience also affords data on the relation of density of popula- tion, especially in sleeping quarters, to the spread of nasopharyngeal infection. No correlation was found. The most senior ratings at Chatham, those with the most spacious accommodation, bad as high a carrier- rate (60 per cent.) as the recruits. who had the worst sleeping quarters. Those of the intermediate seniority, with intermediate accommodation, had a significantly lower rate (38 per cent.). DIGITALIS AND QUINIDINE THE practice of haphazard or routine administra- tion of digitalis in the absence of heart failure is roundly condemned in a recent address by Prof. P. Morawitz of Leipzig.l The doctrine that digitalis should be ordered on principle as a cardiac tonic for all old patients presenting symptoms of heart disease has been upheld in many quarters. Some doctors go so far as to prescribe it as a routine before any operation in elderly patients, irrespective of the presence or absence of heart symptoms. Morawitz emphasises the need for individual attention to every patient when this powerful drug is being considered, and sees few indications for its use except heart failure itself. As he points out, digitalis has its dangers in diseases of the conducting bundle and in coronary artery disease ; he would limit its exhibition -in the absence of heart failure-to those forms of arrythmia which are associated with a rapid pulse, and would avoid it altogether for patients showing extrasystoles. In the tachycardia and arrythmia of Graves’s disease he has found it of little value. When decompensation is present, however, he sees no contra-indication to its use, whatever the type of arrythmia. Morawitz believes quinine, or its isomer quinidine, to be of value in a much wider group of cases. He designates quinine the " digitalis of disorders of rhythm," and regards small continued doses of quinidine as a measure preventive of cardiac disorders, such as paroxysmal fibrillation, extra- systoles, and even of sudden death in angina pectoris ; 1Deut. med. Woch., 1935, lxi., 1.
