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occur as a head-first presentation. Dr. Precechtelargues that gravity will not explain this position,for the specific gravity of the foetal head is found to belittle if at all higher than that of the breech, whilefoetuses experimentally floated in an artificial amnioticfluid were found to lower the pelvic pole. Hecriticises the so-called " accommodation " theories,by which the foetus adapts itself to the shape of theuterus, or, by pressure of the active lower limbs againstthe unyielding pelvis, tends to turn the caudal poleupwards, and quotes the observation of Warnekros,who studied by skiagraphy the position of twins in acase of hydramnios and found that they kept a head-downward position in all postures of the mother.He supports his thesis by the observation that the Iotolith reflexes were obtainable in a large proportion ofnew-born infants, and by the significant fact that thevestibular branch of the eighth nerve myelinizes atthe end of the fourth month, and considerablyearlier than the cochlear branch or than the othersensory nerves. He has tried in vain to find corro-boration by questioning the parents of congenital deaf- Imutes as to abnormal presentations, but explains thelack of such abnormality by the fact that congenitaldefects of the vestibule are far rarer than those of thecochlea. It is an interesting speculation, but one verydifficult of complete proof.

SYMBIOSIS AMONG ORCHIDS.

A REMARKABLE instance of symbiosis between Iflowering plants and fungi is afforded by the associationbetween orchids and their micorrhizal fungus, and wasdealt with by Mr. Somerville Hastings in his inauguraladdress at the recent sessional opening of the MiddlesexHospital. This important work, necessarily abridgedin our own columns, may now be read at length in thecurrent issue of the Middlesex Hospital Journal.With one doubtful exception every orchid so farexamined is known to be infested with at least onefungus. The importance of the fungus to the hostplant is shown by the fact that orchid seeds removedfrom the pod under aseptic conditions and sown onsterilised soil are unable to germinate, and, at most,swell up and turn green and then die. If, however,the seed is planted upon soil in which the parent plantwas growing, and which consequently contains thefungus, germination results and a normal seedling isproduced. With the entry of a single filament of the

fungus into an orchid seed rapid cell divison ensues,and the filament gradually advances into the seedpassing from cell to cell ; it is, however, not permittedto penetrate too far, the seedling being apparentlyable to exclude its entry into the stem and root. Theyoung root thus enters the soil free from fungus, andonly becomes infected subsequently by the penetrationinto it from the soil of a new filament. Throughoutthe life of the orchid the fungus is restricted to theregion of the root, only one case being known, that ofthe Bird’s Nest Orchid (Neottia), in which the fungalhyphae are allowed to penetrate all through the plant.The orchids thus infested with micorrhiza derivenourishment therefrom, being able to digest the coilsof fungus within their cells. The fungus was firstisolated and cultivated outside the plant by NoelBernard in France, and named by him Rhizoctoniafrom its close resemblance to Rhizoctonia violacea,which produces a form of potato disease. TheJapanese orchid (Gastrodia) produces tubers buriedunder ground and resembling those of the potato ;every year the tubers give off offsets, just as a potatodoes, without, however, producing leaves or flowers ;in succeeding years these offsets become progressivelysmaller until finally they become incapable of furthergrowth. If, however, the tubers come in contact withfungus threads of the well-known " stump tuft "toad-stool (Armellaria mellea) full grown offsets areproduced, which next year develop flowers andpresumably seeds. The beneficial effect of theinfection of this orchid by the stump tuft fungus is the

1 THE LANCET, Oct. 6th, p. 775.

more remarkable since this fungus is known all theworld over as a destructive parasite which oftensettles in large masses upon tree stumps ; it wouldappear that in attacking the thickened undergroundroot of this orchid it becomes worsted in the struggle,and is made to yield to the orchid some of the foodstolen from the neighbouring trees. These observa-tions appear to give the clue to the origin of micorrhiza,since it is suggested that the higher plants may havedeveloped an immunity against fungi originallyparasitic upon their roots, and that they have obtainedcontrol over them and actually derive benefit fromthem. According to Bernard the entry of a singlefilament into an orchid seed excludes all others, eventhough it be an attenuated form incapable of effectinggermination ; for this reason he concluded that thefirst infection immunises the seed and prevents furtherinfection, a process which he compared with vaccina-tion. The significance of these discoveries withregard to orchid micorrhiza have been fully appreciatedby commercial orchid growers, and in this countrymore particularly the growing of orchid seedlings underaseptic conditions has been brought to a high state ofperfection by Ramsbottom and Charlesworth.

INTRAPERITONEAL INJECTION OF ANTITOXIN

IN DIPHTHERIA.

WE recently drew attention to a method of admin-istration of antitoxin in diphtheria recommended byMM. Benhamou, Camatte, and Flogny,l of Algiers,which consisted in its injection by the intraspinalroute. Dr. E. S. Platou, of the Willard ParkerHospital and Research Laboratory, New York CityDepartment of Health, now advocates the intra-peritoneal route which is commonly employed forthe injection of saline solution in infants. The new

method was chosen owing to the absorptive powerof the peritoneum which had been demonstrated bymany observers. The technique employed was as

follows : The patient was placed in the recumbentposition with the arms and legs confined by a restrain-ing jacket. The most suitable site is the linea albajust below the umbilicus. The skin is prepared withiodine and alcohol, and the area may be renderedanaesthetic by ethyl chloride. The antitoxin indoses of 10-14,000 units, with 8-10 c.cm. of saline,is introduced by gravity from an infusion bottle.The skin and subcutaneous tissues are picked up-between the thumb and index finger and the needleis inserted obliquely, pointing upwards. After theantitoxin has penetrated the peritoneum it is allowedto flow into the peritoneal cavity. Dr. Platou hasused the intraperitoneal method in a group of 12severe cases, aged from 5 months to 14 years, inwhom it was impossible to administer antitoxinintravenously. Ten recovered without complica-tions, and two who were almost moribund on admis-sion died, death being due in one case to laryngealdiphtheria and extensive broncho-pneumonia, andin the other to septic diphtheria and hsemorrhagicmyocarditis. In both the peritoneum was freefrom any pathological condition. In none of the12 cases was there any evidence of local discomfortfrom the injection. One patient presented slighturticaria on the seventh day, but none had anyconstitutional symptoms. Estimation of the com-parative absorption of antitoxin by the intramuscularand intraperitoneal methods showed that within anhour of intraperitoneal injection the blood was

appreciably antitoxic, and up to seven hours theabsorption was about five times that found afterintramuscular injection. The peak of absorption forthe intraperitoneal method was about 36 hours,whereas for the intramuscular method it was some-where between 48 and 72 hours. Dr. Platou regardsthe method as particularly applicable in advancedcases where suitable veins are lacking for intra-

1 THE LANCET, June 16th, 1923, p. 1224.2 Archives of Pediatrics, September, 1923.

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venous administration, and in moderately advancedcases in which intravenous injection is not considerednecessary or advisable, but where more rapid absorp-tion is desired than can be obtained by the intra-muscular method. Further observations are requiredto confirm the value of the intraperitoneal method,but in the meantime it is obviously desirable in viewof the possibility of infection of the peritoneum thatthe method should not be employed as a routine inall cases of diphtheria, but should be reserved for theworst cases, especially those in which the intravenousroute cannot be employed.

THE PERIODICAL EXAMINATION OF LIFE

POLICY-HOLDERS.

AT a largely attended conference convened by theFederation of Medical and Allied Services at 12,Stratford-place, Oxford-street, London, W., on

Oct. 24th, an interesting discussion took place on thevalue of the periodical medical examination of theapparently healthy as a factor in preventive medicine.Sir Malcolm Morris presided, and representatives,both lay and medical, of the following societies werepresent, together with prominent members of theorganisation of the Federation :—

Eagle Star and British Dominions Insurance Company,Standard Life Assurance Company, Prudential AssuranceCompany, Legal and General Assurance Society, Wesleyarand General Assurance Society, Australian Mutual ProvidentSociety, National Provident Institution, Royal ExchangeAssurance, Refuge Assurance Company, Atlas AssuranceCompany, London and Manchester Assurance Company,Sun Life Assurance Company of Canada, Royal LondonMutual Insurance Society, Royal Liver Friendly Society,Commercial Union Assurance Company, Medical SicknessAnnuity and Life Assurance Society, Cooperative InsuranceSociety, Hearts of Oak Assurance Company, AssuranceMedical Society, Guardian Assurance Company, PublicHealth Advisory Committee, Clinical Research Association,Medical Sickness Annuity and Life Assurance Society, andthe Sydenham District Medical Society.

In opening the conference the chairman pointedout that the Federation was a union of the varioussocial activities concerned with health, and that itexists to promote the interests of the community asdistinct from the interests of any professional section.The object of the conference was to serve the interestsof the individual citizen-the policy-holder--whileextending among the people the wise practice ofseeking periodical examination or overhaul, in orderthat the early signs of departure from the standard ofnormal health might be detected. Already, he said,most sensible people visit their dentists regularly forexamination of the teeth ; why not of other bodilysystems ? Major L. G. S. Molloy, M.P., submitted aresolution stating : "That this conference approvesthe principle of periodical medical examination oflife assurance policy-holders," remarking that such Ia principle, if carried out, would tend to the prevention Iof disease and would be a great advantage to the ’,policy-holder if he did not have to pay for the examina- ’,tion. The medical profession would also benefit, but hefeared that the insurance companies would be involvedin expenses which they would not consider advan-tageous to themselves. Dr. Neville Spriggs, whoseconded, was of opinion that periodical medicalexaminations would be for the benefit of all concerned.A long discussion followed as to the advantages ordisadvantages to the public generally, and to theinsurance companies, of such a principle as thatadvocated in the resolution, and a letter was read byMr. N. Howard Mummery, Medical Director of theFederation, from Sir William Schooling, suggestingthat the most beneficial and economical arrangementfor both the original examinations for life assuranceand for periodical re-examinations, would be theestablishment of insurance medical institutes in theprincipal towns throughout the country. Finally,on the motion of Dr. Charles Buttar, seconded by Mr.Eric B. Nathan, the following resolution was unani-mously carried-: " That this conference approves

the principle of voluntary periodical medical examina-tion of citizens, and presses upon life assurance officesthe desirability of the adoption of this course with thepolicy-holders." ____

THE CAMBRIDGESHIRE TUBERCULOSIS

COLONY.

THE report on the Papworth Colony for 1922 is abeautifully illustrated work, printed by the membersof this community. The outstanding event of 1922was the formal opening of 31 new cottages, twohostels, and a nurses’ home by Sir Alfred Mond who,in his address, referred to Papworth as the mostwonderful institution of its kind in the world. He

hoped that Papworth would be a model which wouldbe copied in other parts of the country. Every pageof this report is full of the author’s vigorous optimism,and it is certainly to be hoped that the maker ofPapworth, if not Papworth itself, will be used as amodel and pattern by many imitators. Dr. P. C.Varrier-Jones, who further elaborated his ideas onvillage settlements on p. 912 of our issue of Oct. 20th,believes that all the progress made during 1922

has pointed to the soundness of the settlementidea. Of its success, if we are to judge bythis report, there can be no doubt. It is moredifficult to form a correct opinion of the reasons forthis success. Dr. Varrier-Jones would have us

believe that the principles on which he has workedare in themselves sound enough to warrant success.If this is so, and the problems of the TuberculosisSettlement have been long enough studied fora mass production of Papworths to be attempted,such a procedure might be considered justifiable,provided adequate means are available. But if,as some suspect, the success of the first Papworthdepends largely, and even mainly, on the personalityof its founder, we should do well to delay creatingreplicas of Papworth till we can be assured of anadequate supply of replicas of its founder. To return.to the first Papworth, it is worth noting that it is nolonger in its infancy ; 1922 was the seventh year ofits existence and the fifth since the transfer to PapworthHall. Cases of surgical as well as pulmonary tubercu-losis are admitted, and no patient is refused admission,however advanced the disease, if accommodationallows. The account given of the various industriesshows that the presiding genius of Papworth isblessed with a business instinct. He has come to theconclusion that chicken farming is an occupationsuitable only for those with marked resistance to thedisease. The notion that poultry farming consists ofdispensing grains of corn at odd hours to hens pouringout a steady stream of eggs is not quite correct.Boot-making and repairing is a trade the profits ofwhich are mulcted by the heavy charge of employinga canvasser for the collection and distribution ofrepairs. But portmanteau and other leather workhas yielded an annual turnover of nearly 24000 atPapworth, and this industry seems to be establishedon a firm basis. The total number of inhabitantsin the village is now 152.

PREGNANCY COMPLICATED BY HEARTDISEASE.

Prof. W. Frey, of Kiel, has published in Zentralblattfiir Gynäkologie for Oct. 6th a paper on the prog-nosis of heart disease complicated by pregnancy.His review of the literature of this subject shows onlytoo plainly that though it has been discussed formany generations, anything but unanimity has beenreached. He suggests that the observations ofvarious authorities are contradictory, partly becausethe material on which their observations were basedwas not similar, and therefore not comparable. Healso suggests that the material available in an out-patient department is more suitable for an investiga-tion of this problem than the inmates of a hospital,and he has, accordingly, conducted examinations of