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illness, excluding those requiring certification, and toshare in the treatment of adults and children in an

outpatient department which before the war was oneof the busiest of its kind in the country. Patients willcome more readily at an early stage of their illness to ageneral hospital, and will have the advantage of easyaccess to first-class facilities in the other branches ofmedicine provided by a teaching school. The riskincurred in completing the building now will be welljustified if, at the end of the war, it is able to begin itswork at once.

DR. ALISON GLOVER’S RETIREMENT

BEFORE joining the staff of the Ministry of Health in1920 Dr. J. Alison Glover had gained valuable experiencein general practice, had spent two years as part-timeschool medical officer under the L.C.C., and six years asdeputy M.O.H. for Islington. In 1929 he was promoteddeputy senior M.O. at the Ministry, and in 1934 hesucceeded Dr. Ralph Crowley as senior M.O. of theBoard of Education. During this time he has madenotable additions to our knowledge of epidemiology.In the last war he showed that overcrowding was amore potent factor than season in raising the incidenceand carrier-rate of cerebrospinal fever. After that heturned to the purification of swimming-bath water,rheumatic diseases (witness the Milroy lectures), scarletfever, tonsillitis, measles, poliomyelitis, naso-pharyngealinfections in public and secondary schools ; finally hisepidemiological observations on the first four months ofevacuation were embodied in a presidential address tothe section of epidemiology, R.S.M. These things areon record. Hitherto unrecorded are his love of classical

poetry and his absorbing interest in lethal weapons.His office desk is adorned with relics of the last war,while in a drawer of the same desk is to be found a

copy of Milton. And his actual experience of warfare isworth recording. While still a student at Guy’s hejoined the C.I.Vs. as a private and saw service in SouthAfrica, gaining a commission in the New South WalesMedical Corps. During the last war he served as a

regimental officer in France, as a sanitary officer in

Malta, and ended up in charge of the cerebrospinal feverlaboratory, London district. Now at the age of 65 heis serving as a private in the Home Guard ; after a nightof duty he will appear at the office in the morning asfit as if he had just returned from a holiday. Gloverhimself attributes his physical fitness to his love of tworecreations-swimming and lawn tennis. An early dipin the Hampstead ponds was for many years part of hisdaily regime, summer and winter. Retirement will notmean lethargy, for Dr. Glover will be retained at theBoard of Education for special services.

HYPNOSIS BY HYPNOTICS

THE use 01 narcotic arugs 10 discover wnai a patientcannot communicate because of hysterical and otherpsychological disturbance is not new, any more than istheir use to discover what a suspected delinquent willnot disclose. In neither instance can they be reliedon ; the patient or the criminal may keep his secret, orperhaps the story he tells while under the influence ofthe drug is a misleading fantasy. But it is not merelyas an aid to mental exploration, a solvent of amnesia;that the narcotic method has its modest place in

psychiatric procedure. It may be employed, as Dr.

Stungo on p. 507 shows, much as hypnosis may beemployed. Indeed, it was as a device for makinghypnosis easier in resistant subjects that narcotic drugsentered this field. It is widely recognised that drugs,and especially placebos, can have a suggestive effectfar more important than their pharmacological effect ;and if a drug is used that, when given by injection,induces drowsiness and is preceded by the creation ofan expectancy of

" cure " in the patient corresponding

to the confidence of " cure " in the doctor’s mind andmanner, the suggestive effect can be therapeuticallypowerful. That there are drawbacks and even risksneeds no emphasis. Psychogenic factors disclosed maybe irrelevant or fantastic, the catharsis trivial, thepatient’s misunderstanding of his illness or his symptomsall the greater ;

"

narco-analysis " is not a treatment initself but a technical aid to the carrying out of a regularpsychiatric treatment whether it be brief or prolonged,re-educative or purely suggestive. The method is, inshort, not one for indiscriminate use by those withoutpsychiatric training. It is also important that the widereffect of narcotic and other drugs in mental disorder beborne in mind. It was, for example, the effect of SodiumAmytal on schizophrenic stupor that first made this drugconspicuous in psychiatric work. Yet none would be so

hardy as to suggest that this effect of amytal wasirrespective of its pharmacological action or had anythingto do with suggestion. These drugs do not act in thesame way in different forms of mental disorder, nor istheir application a simple undemanding procedure,coming as a godsend for the harassed outpatientphysician who is innocent of psychiatric subtleties andeager to clear up the patient’s troubles by a Gordian-knot attack. That they save time in dealing withhysterics is perhaps the only justification for their havingsuch terms as " hypnosis

" and " analysis " tacked onto their names. There are many differences betweensleep and hypnosis, and between either of these andnarcosis ; and to attach the word analysis, nowadays,to anything and everything in a psychological context isto go in for miching mallecho.

ELECTROPHORETIC COMPONENTS OFDIPHTHERIA ANTITOXIN

SOME attention has been paid during the last few yearsto the physicochemical changes occurring in the sera ofhorses undergoing immunisation. Important progresshas just been reported by Kekwick and Record 1 of theLister Institute, using the electrophoresis apparatus ofTiselius.2 In normal horse sera four protein componentscan be demonstrated—albumin and three -globulins, a,

3 and y. As immunisation with diphtheria toxoid

proceeds, the same four components are obtained,although the relative proportions of each become altered ;in diphtheria antitoxic horse sera the antitoxin isassociated with the and y globulins. By electro-

phoretic methods these components can be separated, andtheir properties compared with those of the sera fromwhich they were derived. Quite early in the course ofinjections the percentage of globulin rises. The im-mediate reaction is the production of a relatively smallamount of y globulin antitoxin, the percentage of whichremains fairly constant at a low level for most horses;but the main increase in globulin is due to the # con-stituent which is predominantly responsible for theantitoxic activity of most sera. The a globulin andalbumin components are not antitoxic. A study of the and y globulins and of a number of diphtheria antitoxicsera containing them has been made by Kekwick andRecord. These globulins possess a number of propertieswhich distinguish them sharply from one another. Fromthe immunologist’s standpoint perhaps the mostinteresting distinguishing property of the separate &bgr;and y globulins is the in-vivo/in-vitro ratio3 : 0.9 for

and 2 for y globulin. It has been noted that the y con-stituent, with its higher ratio, develops early in immunisa-tion, and in this connexion Glenny and others 4 previouslyobserved that early bleedings from horses tend to

1. Kekwick, R. A. and Record, B. R. Brit. J. exp. Path. February,1941, p. 29.

2. Tiselius, A., Biochem. J. 1937, 31, 1464.3. The in-vivo value of a serum is obtained from tests on laboratory

animals, and the in-vitro value by the Ramon flocculationmethod.

4. Glenny, A. T., Pope, C. G., Waddington, H. and Wallace, U.J. Path. Bact. 1925, 28, 463.

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show a high in-vivo/in-vitro ratio, while the generaltendency is for’ this ratio to fall as immunisation proceeds.The antitoxic y globulin from a very limited number ofhorses showed the same avidity characteristics, suggest-ing that the y globulin from these horses was of identicalcomposition. But Kekwick and Record point out thatoccasional in-vivo/in-vitro ratios greater than 2 have beendescribed, the origin of which is not yet clear. They alsomake the interesting observation that the nitrogenspecifically precipitated by diphtheria toxin from anti-toxic y globulin is twice that precipitated from j8 globulin,although the molecular weight as determined by theultracentrifuge is the same for both j8 and y globulin.Much of this technical analysis will be heavy going forthe uninitiated, but the suggestion that the y globulinantitoxin may have some advantage therapeuticallyshould not pass unobserved. The y globulin antitoxinflocculates with toxin more rapidly than the globulin,and appears to have greater avidity. Further researchmay show whether it is possible to produce greateramounts of the y globulin during immunisation, andwhether this special fraction is clinically more efficient.

CONTROLLED COUNTERIRRITATION

ALTHOUGH counterirritation has through the agesbeen one of the most popular ways of easing pain its usehas been empirical, and little effort has been made tounderstand its undoubted efficacy. Heat, cold, rubbingand scratching have from time to time been supersededby more drastic methods such as cupping, the cauteryor blistering ointments, and recently vibration andelectrical stimulation have also been used. The experi-ments of Gammon and Starr seem to explain some ofthe effects of counterirritation and to offer more effectivemethods for its employment. They produced prolongedpain in themselves with an irritant ointment rubbedinto the skin and by subcutaneous injection of 10%sodium chloride, and they then observed the effect oftemperature changes, vibration and of tactile andelectrical stimulation. On the application of a counter-irritant the pain was lessened or abolished, but it soonbegan to return and had reached its original intensitywithin a minute. When the counterirritant was

removed prompt relief again occurred, but the painreturned within a minute. When counterirritation wastoo strong a most disagreeable summation with theoriginal pain resulted, and if it was too weak there waslittle effect on the pain. The best counterirritant wascold and it was most effective between 4° and 10° C.,while heat was optimal at 40° C. Cold, electric stimu-lation, heat, tactile stimulation, vibration, and a jet ofair were relatively effective in that decreasing orderwhen applied to the pain produced by injection ofhypertonic saline, but only cold was effective in easingthe pain of skin irritation. As would be expected fromtheir early results, they found that interrupted counter-irritation gave far greater relief from pain than didcontinuous stimulation. The effects produced were notdependent on vascular changes ; on the contrary,animal experiment showed that streams of nerve

impulses from pain receptors were interrupted by thecounterirritation. Gammon and Starr then appliedtheir results to 80 patients, and found that the majoritypreferred 40 seconds of heat alternating with 30 secondsof cold but the choice of counterirritant varied somewhatwith the type and origin of the pain, and static electricitywas sometimes surprisingly effective. They agree withCushny2 that counterirritants act centrally, especiallyas relief could be obtained by irritation remote fromthe source of pain, and they think there may be centraldepression taking place within the thalamus. This

transitory central depression after stimulation may be

1. Gammon, G. D. and Starr, I. J. clin. Invest. January, 1941, p. 13.2. Cushny, A. R. Textbook of Pharmacology and Therapeutics

London, 1924, p. 75.

similar to that.recently described by Bronk.3 Whateverthe physiological basis for these observations, it is

stimulating to find medieval guess-work giving place tothe scientific control of pain through the cooperationof institutions for medical and for physical research.

SHARING OUR RISKS

MANY good practices have been interrupted bybombs, and many others have melted away as towns areevacuated ; hardship to individual practitioners hasoften been great. The Medical War Relief Fund,administered by a committee representing the RoyalColleges, the Royal Medical Benevolent Fund and theBritish Medical Association has already been able todistribute much-needed loans and gifts, so far amountingto E4000. A typical case is that of a doctor whosehouse and equipment were destroyed by an incendiarybomb; his income had fallen, owing to the war, so thathe was only just able to carry on. The need for newclothes and equipment faced him with an outlay whichwas quite beyond his means, and the fund was able tomake a timely lean. Another general practitionerrejoined the Army in which he had served in the lastwar, but was invalided out after taking part in theDunkirk withdrawal. His practice had gone down inthe interval and there was a gap between the datewhen his Army pay stopped and the date at whichprofessional bills became due. He was helped with agift and a loan. A number of doctors have been killedin raids which also destroyed the greater part of theirproperty. Their widows, some of whom have childrento rear, have received gifts or loans and have been helpedto obtain pensions from appropriate sources. Loansare made free of interest and those receiving them havewritten warmly of their intention of paying them backas soon as their circumstances permit. All the same,applicants are bound to increase in number while thewar lasts, and though contributions to the fund up tothe end of March had exceeded 20,000 the drain on itis likely to be heavy. Every member of the professionis asked to contribute, and those who have not receiveda local appeal may send subscriptions to the hon.treasurer, Medical War Relief Fund, B.M.A. House,Tavistock Square, London, W.C.I.

THE MORTALITY OF HUSBANDS AND WIVES

MANY years ago Karl Pearson and his colleagues4observed a positive correlation between the length oflife of husband and wife, an association they attributedmainly to " assortative mating" though they thoughtcommon economic backgrounds might well play a part.The subject has recently been taken up and extended,with value, to different causes of death, by Ciocco, whohas studied the registers of death in Washington County,Maryland.5 He finds not only a rather greater degreeof association than the earlier workers in length of lifebut also evidence that husbands and wives, in the caseof four diseases-tuberculosis, influenza and pneumonia,heart diseases, and cancer-tend to die of a commoncause more often than would be expected if chancealone was operating. For example, when the husbandsdied of tuberculosis 17-1% of the wives also died fromtuberculosis, but when the husbands died of other causesonly 5-8% of the wives died-from tuberculosis. Similarlywhen the husbands died from cancer 15-5% of the wivesalso died from cancer against 10-3% when the husbandsdied from other causes. With tuberculosis possibleexplanations are not far to seek : marital infection,marital selection and common economic levels may all

play a part, though the relative importance of each can-not be determined. Influenza and pneumonia are alsoinfectious diseases and influenced by economic circum-

3. Bronk, D. W. J. Neurophysiol. 1939, 2, 380.4. Biometrika, 1903, 2, 481.5. Hum. Biol. 1940, 12, 508.