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special immaturity in infants’ marrow cells was notedby Kato or the Chilean workers, except that hsemo-

, globinisation of the normoblasts tended to be relativelyincomplete. -

Information on the changes in disease is scanty,but it is ’ likely that several workers are assemblinginformation. It will help if they -use a uniformnomenclature, especially for erythroblasts.

RUBBER VERSUS ANTIBIOTICS

THE experiments of Cowan two years ago showedthat up to 50% of antibiotic activity may be lost duringthe passage of aqueous solutions of penicillin throughthe rubber tubing of a continuous-drip apparatus.This inactivating effect of rubber varies widely indifferent samples and is not confined to the syntheticproducts used in this country, for American workers 2have found that 4 of 11 samples of synthetic rubber and1 of 5 samples of natural rubber completely destroyedpenicillin in solution within 24 hours. Inactivation cannotbe correlated with the colour of the tubing, so the

pigmenting substances cannot be held responsible. The

suitability of a given type of rubber for use with penicillincan therefore be forecast only by experiment.

All materials-rubber, glass, or metal-that are tocome in contact with antibiotics should clearly be testedfor any inactivating effect. As a rule glass has hardlyany action on penicillin, but cheap soda glass may giveoff enough alkali to raise the pH and reduce the stabilityof penicillin solutions. Rubber tubing can, and should,be tested before it is used ; the simple tests describedvary from one in which an inch of tubing is placed in10 ml. of penicillin solution in a screw-capped bottle-this assumes that the glass is inert-to one in which3-feet lengths of tubing are filled with solution.; aftercontact for some hours the solutions are reassayed andthe’percentage loss in activity is determined. Thesetests have proved reliable with penicillin, and similarones should be applied to materials used with otherantibiotics. Preliminary tests 2 indicate that neithernatural nor synthetic rubber has any deleterious effecton solutions of streptomycin.

P.L.A. IN ARTHRITIS

THE lay press has lately discovered " a wonder sub-stance which is helping thousands of helpless cripples...back to normal activity " and which was " first tried outon a racehorse condemned to be shot because it hadbroken down with arthritis." The method referred towas described by Waugh 2 in 1938 as

" the treatment ofcertain joint lesions by injections of lactic acid," and hehas since been responsible for the injection of 10,000cases.

After investigating the reaction of the synovial fluidin cases of traumatic effusion Waugh argued that thedevelopment of acidity is a physiological response totrauma, designed to excite local leucocytosis and repair.He therefore set out to imitate this reaction in the treat-ment of traumatised joints which had failed to respondto ordinary therapeutic measures, using at first a solutionof lactic acid alone. This, however, caused considerablepain, so a solution of procaine acidified to pH 5 withlactic acid was later adopted. This solution, known asP.L.A., is injected within the capsule of the joint, whichis then moved to its full range in all directions. Ortho-paedic exercises are next employed, if necessary with theaddition of a plaster-of-paris support and/or elasticplaster strapping and rest. This procedure was success-ful in 24 out of 26 cases of mixed forms of arthritisreported by Mawson, 4 but no large classified series of cases1. Cowan, S. T. Lancet, 1945, i, 178.2. Huelsebusch, J. B., Foter, M. J., Gibby, I. W. Science, 1946,

104, 479.1. Sunday Dispatch, Nov. 24. 3. Brit. med. J. 1946, ii, 876.2. Waugh, G. Lancet, 1938, i, 487. 4. Mawson, R. Ibid, p. 691.

has yet been followed up and published. Active disease,in which the joint fluid is already acid, is a contra-indication. Other workers 5 have used slightly differentsolutions, chief among which is 1% acid potassiumphosphate, a buffered salt, in isotonic saline, the objectbeing to prolong the effect. Waugh himself has reportedchiefly on injections into the larger joints, such as

the hip, shoulder, knee, and wrist, but it has beenclaimed that nearly all joints are accessible.

Intra-articular injection, unless done in conditions ofsurgical asepsis, is dangerous; so this form of treatment,however promising it may be in selected cases, shouldnot be embarked on light-heartedly.

HYPNOSIS AND TELEVISION

HYPNOSIS, though sometimes useful in psychiatry,has not proved the good servant of medicine that JohnElliotson, in the last century, hoped to make it. Heforesaw its use, among other things, as the perfectanaesthetic; and, since his day, reports of successful

major operations on hypnotised patients have appearedfrom time to time. Elliotson’s credulity and lackof exact method helped to bring the practice into dis-repute ; and it has since acquired so many frivolousconnexions in fiction and vaudeville that serious inquirersare driven off.The mechanism of the process remains obscure, and

is not made much clearer by describing the hypnoticsleep as a state of increased suggestibility. In currentterms, hypnosis is thought to be an artificially producedstate of dissociation, akin to that found in hysteria.The hysteric accepts suggestions about the presence orabsence of symptoms in much the same way as thesubject under hypnosis, and hysterics are specially easyto hypnotise ; but it is likely that most people willingto cooperate would respond to hypnotic suggestion.For the rest, the legend of the powerful hypnotistdisastrously guiding his victim has long been thread-bare ; it is well known that the sleeper will not obeya command which infringes his moral principles or

even offends or embarrasses him. Offered such a

command, he wakes up. Spectacular hypnotic effectsare uncommon-they are more often seen on the music-hall stage than in the consulting-room-and though,on request, irrational deeds will be done on waking, theyare probably carried out in the same spirit as theobsessional and compulsive acts of some psychoneurotics,who realise well enough on the intellectual plane that theirrituals are futile and ridiculous. The hypnotised subjectis in a state of somnambulism in which his behaviouris governed by the suggestions of the hypnotist insteadof by the incidents of his dream. Left alone, he wakesspontaneously when refreshed or disturbed; slothful

types, however, are always ready to oversleep on anypretext and may need waking.

Recently the British Broadcasting Corporation thoughtof having a television programme on hypnosis, conductedby Mr. Peter Casson, a successful music-hall hypnotist ;but an experiment conducted on a closed circuit in thetelevision studios at Alexandra Palace convinced themthat there was " danger of hypnotising viewers whomight not have anyone at hand to wake them." Inthe first test about a dozen people had volunteered tobe hypnotised in the studio, and five went to sleep ;moreover, a person in a party watching the televisionscreen in a darkened room across the corridor also fellasleep. In a second experiment Mr. Casson deliberatelyattempted to hypnotise an audience of six watching the-television in another room ; four fell asleep, and two ofthem needed waking. The B.B.C. therefore decided thata television broadcast on hypnotism would not beadvisable ; and they are probably wise to avoid thechance of some susceptible person taking action for

5. Crowe, H. W. Lancet, 1944, i, 563.

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alleged harmful effects of hypnotic sleep, or even for

missing an appointment. We commiserate Mr. Cassonon his embarrassing success.

INSECTICIDES IN THE BLOOD-STREAM

MAN has shown considerable ingenuity in attemptingto protect himself and his possessions from noxiousinsects. Solids, liquids, and gases, with many kindsof apparatus, have been used to poison them in theirvarious stages. A simple way of destroying blood-sucking pests would be by feeding the insecticide tothe host and so poisoning the insect through the bloodit swallows. Some progress has been made towardsmaking this a practical proposition.The first quantitative experiments with this method

seem to have been made with D.D.T. and the pyrethrins.lBed-bugs fed on rabbits 3-5 hours after these had beengiven either D.D.T. or pyrethrins at the rate of 230-400mg. per kg. body-weight died a few hours afterwards.Pyrethrins were more rapidly effective than D.D.T.,causing prompt paralysis of the stable-flies (Stomoxyscalcitrans) which fed on the rabbits. Recently it has been.shown that Gammexane’ is very effective when usedin this way.2 Rabbits were given 50 mg. of pure gam-mexane per kg. body-weight daily ; after 4-5 daysbed-bugs were fed on the rabbits and were paralysed,some dying later. Mosquitoes which fed on the rabbitswere rapidly stupefied and all died; the tick ornithodoruswas temporarily intoxicated.

These experiments cannot yet be directly appliedin practice, because the insecticides used, especially thesynthetic ones, are definitely toxic to mammals. Torender the blood-stream insecticidal for reasonablylong periods it is necessary to give fairly large doses,bordering on the limits of safety for mammals. Theeffects of D.D.T. or gammexane on mammals are knownto be cumulative ; but the subject has not been so fullystudied that the safety-limits can be precisely defined.Pyrethrum would, no doubt, be safer; but repeateddoses, as well as being expensive, might give rise toa.Hersic rea,etions-

THE AMERICAN HOSPITAL

THE changes taking place in our own hospital systemhave whetted our interest in what is happening in otherparts of the world, and especially in America. But toooften this interest is concentrated upon buildings andequipment. We know what the skyscraper hospitals onthe other side of the Atlantic look like, but we are lessfamiliar with their background and the principles onwhich they are based. Many American books with theirenthusiasm for the latest techniques have not helped usto understand where their practice meets and where itdiverges from our own, and it is a relief to find in Dr.Corwin’s able monograph 1 a readable account of thebasic conceptions which animate the hospital world ofthe United States.

In America, as in this country, there has been in thelast fifty years an unprecedented development of hospitalprovision, and the need is recognised for a more generoususe of public money. The Hill-Burton Bill recently passedby the United States senate provides for a federal subsidyof 75 million dollars a year for the next five years for theconstruction of public and other non-profit hospitals inaccordance with plans approved by the surgeon-generalof the U.S. public-health service. Yet American opinionremains set against nationalisation of the hospitals withthe implication it carries of a hospital service free to all.1. Lindquist, A. W., Knipling, E. F., Jones, H. A., Madden, A. H.

J. econ. Ent. 1944, 37, 128.2. De Meillon, B. Nature, Lond. 1946, 158, 839.

1. The American Hospital. By E. H. L. Corwin, PH.D. New York:Commonwealth Fund. London : Oxford University Press.Pp. 241. 8s. 6d.

How is this possible ? Voluntary provision has beensupplemented, Dr. Corwin explains, not only by hospitalsmaintained at the public expense, as in this country, butalso by greater development of private and semi-privateaccommodation, and by payments by public bodies forindigent patients in non-profit hospitals. The income fromthese paying patients is the mainstay of voluntary-hospital finance in America, and the system has gonefar to enable voluntary finances to weather periods ofdepression.The system arose because in Colonial days no American

hospital had an endowment of any kind, voluntary incomewas considerable but inadequate, and " an American haslittle if any sympathy with pauperism." Thus thehospital managers determined to establish paying wards,and in the last dozen years or so the phenomenal develop-ment of Blue Cross plans have enabled the middle classesto take advantage of the extensive provision of privateand semi-private accommodation. The American hos-pital’s sensible preoccupation with diet may be due inpart to the presence of these paying patients. Whateverthe reason, in 1943 they employed 6482 full-time dieti-tians, whereas there are only about 300 qualified dietitiansin the whole of this country today, ,of whom only asmall proportion are employed in hospitals. But Dr.Corwin has little to say about the problem of the chronicsick which looms so large to us, and here perhaps at leastwe may be more awake than our friends in America toreality. Nevertheless Dr. Corwin considers that thepaying system has great merit, for it has saved " thevoluntary hospitals in the U.S. from a pauper or poor-lawsystem." Our own National Health Service adopts adifferent outlook. Our hospital service is to be free to all,with private beds as a mere adjunct and concession toprivate practice. Which is the right approach, andwhich system is, in the long run, least likely to succumbto the temptation to lower the standard of provision-available for the bulk of the community

MULTUM IN PARVO

THE two new monthly abstracting journals, sponsoredby the British Medical Association and edited by Dr. G. M,Findlay under the direction of the editor of the BritishMedical Journal, have- now been successfully launched.By their general plan and form Abstracts of WorldMedicine and Abstracts of World Surgery, Obstetrics,and Gyrccecology reveal their literary descent from theMedical Research Council’s Bulletin of War Medicine,which ceased publication last August ; but they are

also first cousins to the British Medical Bulletin, nowissued by the British Council but originally the workof the -B..M.JB editorial department.The abstracts are signed, and sufficient comment is

added, in parentheses, at the end of most of them toput the work into its proper perspective and to explaindoubtful points. With as fine a team as Dr. Findlayhas collected these comments are a valuable feature.Together the two journals cover over a thousandperiodicals. It is presumably impracticable to includea detailed subject index, but the subject matter isdivided into fairly small categories, and there is an indexof authors. It is to be hoped that it will be possiblelater to reduce the present 4-6 months’ gestation period,at any rate for the British journals and those otherswhich reach this country fairly quickly.The annual subscription rates are 3 guineas for the

medical and 2 guineas for the surgical journal, to be sentto the British Medical Association, Tavistook Square,W.C.I.

___

Sir ARNOLD LAwsoN, consulting ophthalmic surgeonto the Middlesex Hospital, who died on Jan. 19 at theage of 79, was one of the founders of St. Dunstan’s.He was president of the Royal Medical BenevolentFund.