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dental stress, or if this is greater an increase of

,peristalsis. Finally lack of normal psychic interestmay be as injurious as excessive emotion, and patients,he suggests, should be warned against eating " when.absent-minded, mentally upset, or greatly fatigued."’This is advice which could be very generally appliedwith profit, and to the I3ippocratic’ precept we mayadd a codicil to the effect that between labour andmeat a short interval of rest should intervene-sucha pause being desirable not only to get over theinhibitory effect of severe exercise (if any), but alsoto restore emotional harmony and allow the mind tosettle down as it should to enjoy the pleasures of thetable. After the meal is over it is reasonable tosuppose that we may safely obey our own internalprompting, whether this is to jump up and down onofas or recline on them at full length.

SEPTICÆMIA DUE TO BACILLUS

FUNDULIFORMIS.

A GENERAL infection, due to an anaerobic organismhitherto supposed to be entirely saprophytic, isreported by Teissier, Reilly, Rivalier, and Layani.l’The patient was a healthy male, aged 38, who was- suspected of small-pox. He was taken suddenly ill-with headache, backache, vomiting, and purpura.Later there was jaundice and generalised vesicular.and pustular eruption. The coagulation time wasprolonged-as was to be expected in the presence ofjaundice-and there was no change in the bloodpicture. He died within a week. Lesions were almostconfined to the liver which contained many abscesses ;the biliary tract was nowhere involved, and theabscesses were confined to the parenchymatous tissues.Small abscesses were present in the kidneys. From thepustules during life, and from the blood, pure cultures i- of an anaerobic Gram-negative bacillus, recognised bythe authors and by Veillon as B. funduliformis, wererown, and post mortem it was found in the hepatic.abscesses. This organism was first identified by Halléin the female genital tract, and has since been fairly iwidely found, but always saprophytically. It is not, ian a rule, pathogenic to laboratory animals ; but inthis case it proved fatal to guinea-pigs and rabbits,.always giving rise to hepatic abscesses on intravenousinjection. The authors of this paper believe that theorganism got through the intestinal tract into the

portal blood, since it cannot live in the presence ofbile, and did not infect the biliary passages. Theirdescription is noteworthy, since cases of generalisedinfection with anaerobic organisms, whether of.established virulence or not, are uncommon.

ENDEMIC AND EPIDEMIC MALARIA IN

SOUTHERN RHODESIA.

Dr. J. Gordon Thomson has done notable work onmalaria and blackwater fever in Southern Rhodesia,and in a paper read to the Epidemiological Section ofthe Royal Society of Medicine on April 26th he gave afurther critical review of the malarial conditions inthis attractive territory. The youngest of the self-governing Dominions, it is twice the size of GreatBritain, and enjoys for the most part a climate wellsuited to white settlers. The census of 1926 showed anindigenous negro population of just under a million.and about 39,000 Europeans. Since then some

10,000 new white settlers have probably been added.’The country is a high plateau lying between latitudes15° S. and 25° S.-i.e., within the tropics. Most ofthe whites live along the watershed running S.W. toN.E. at 5000 feet above sea-level. About a quarterof the entire area lies at 4000 feet, and there is muchgood agricultural land at 3000 feet above sea-level.The work of Christophers has established that

malarial hyperendemicity lies in the fact that whilethe adult indigenous inhabitant is tolerant to malaria

1 Paris Méd., March 30th, p. 297.

and seldom suffers from an acute attack, the infantssuffer for the first few years of life from acute malariawith numerous parasites in their blood, and a veryhigh infantile mortality is the result. The survivorsof this " acute infestation " gradually develop a

tolerance to the parasite and acute attacks becomeprogressively less frequent (" immune infestation "),till finally the adults are completely tolerant andseldom show parasites in the peripheral blood,although all are presumably infected with the parasite.In Southern Rhodesia hyperendemic malaria prevailswith yearly seasonal epidemics among the non-immunes-namely, the indigenous negro children,and the whites of all ages. All these non-immuneslive in a country where for about six months in theyear the density of anopheline mosquitoes whichbite man is high, and the atmospheric temperatureand humidity are eminently suitable for the develop-ment of the malaria parasite in the common carrier4y2opheles garnbiae (A. costalis). The hyperendemicityof malaria in Southern Rhodesia is shown by thefact that the enlarged-spleen rate in children is wellover 50 per cent. ; often over 90 per cent. in thosebetween 2 and 10 years of age. Moreover, theparasite rate (endemic index) in the negro childrenis extremely high. The charted records of 1924-26demonstrate that the amount of malaria varied fromyear to year directly with the rainfall; as the rainscontinue, so increases the number of cases of malariaand blackwater fever. The peak of the acute malariaincidence amongst the whites is in April; there is aquick drop in May and June with the onset of the coldweather, and it is interesting to note that Leesonreports that A. gambiae appears first in late Novemberand remains till early June, when it disappears.Hyperendemic factors such as those operating

now in Southern Rhodesia, and, moreover, associatedalmost entirely with the malignant tertian malariaparasite, make it plainly impossible for a non-immunewhite population to live there healthily unless theydevote some intelligent, withal simple, effort toprevent malaria. But, in fact, carelessness and thestubbornness of ignorance lead to needless deaths andto much sickness from malaria among the whitesettlers, especially in the rural areas. Dr. Thomson, atfirst-hand experience, agrees heartily that " theattractions of Rhodesia are manifold and well-nighirresistible, and to the right type of immigrant itoffers a home well worth living in, and developing forfuture generations." But he emphasises that thesettler must be of the right type; and clearly thismeans right-thinking about malaria and mosquitoes.He deplores the fact that to-day so many of the whitesettlers are as individuals apparently blind to thefact that prevention of malaria is for them a personalaffair, and many of these blind resist enlightenment.No doubt in the process of development the diseasewill some day, in Rhodesia, be reduced to a minimum,where now it is of maximum importance. Meanwhilean intelligent settler in that country may protecthimself and family from malaria by a well-constructedand screened house, with a strict and careful use ofwide mosquito nets for the beds, by destroyingmosquito larvae in and around his living quarters,and especially by keeping negro children far awayfrom his living quarters. Dr. Thomson points outthat there are many white settlers in rural SouthernRhodesia to-day who live free from malaria by justthese measures. These many might and should bemany more.

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" No practitioner is safe against becoming involvedin very costly litigation arising out of his practice.This risk is one against which insurance should alwaysbe effected." So runs a sentence in the annual reportof the Council of the London and Counties MedicalProtection Society, and it may be taken as the moralof the many instructive stories which the reportcontains. No one would claim any novelty for thesentiment, since it is repeated monotonously every

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week or two in our own columns and elsewhere ;yet a perpetual insistence on its truth is certainlyjustified by what the Society’s solicitors describe as" the growing critical and litigious spirit of thegeneral public." We are glad to say that the sensibleplea for Safety First is having its effect, and that notfar short of a thousand practitioners joined thisparticular defence society last year, bringing the totalon Dec. 31st, 1928, to 11,492. That the subscriptionis a very small premium for the insurance afforded isan obvious commonplace, and no one can be blind tothe advantage of belonging to such an organisationwhen faced with adverse damages of several thousandpounds. Not everyone, however, is aware of the largeamount of assistance in everyday problems that theSociety offers-an amount indicated by the fact that1067 applications for advice were received frommembers last year alone. In considering the situa-tions in which help is asked the solicitors, Messrs.Le Brasseur and Oakley, refer to the increase of casesarising under the National Health Insurance Acts andmake the following outspoken comment :-

‘’ Dental surgeons are now exposed, in much the samemanner as general panel practitioners, to that form ofprivate but statutory jurisdiction falling within the almostinexhaustible powers of the Minister of Health. It is amatter of surprise to us that those responsible for watchingthe interests of the medical and dental professions, andbodies concerned in matters pertinent to these professions,are so powerless to prevent the growth of bureaucraticpower which can usurp jurisdiction designed to give citizensthe fairest form of trial, and can vest in one man, who byvirtue of his statutory powers of making regulations can passwhat are virtually laws affecting so large a number withouttheir having a word to say antecedent to such regulationsbecoming effective, a power of decision and sentence withoutright of appeal."

Addressing the Society’s annual meeting on May 1stSir John Rose Bradford, F.R.S., the President, spokeof the loss sustained by the death of Dr. G. W. Hilland Sir Anthony Bowlby, vice-president andtrustee respectively, and of Mr. A. Neilson, K.C., whohad been a tower of strength to the Society." Inthe course of observations of the risks of practice hedrew attention once more to the advantages of radio-graphy in providing evidence of fractures, and insistedthat members should " take every precaution tosafeguard themselves and their interests " in thiskind of case. A statement had been drawn up, hesaid, of the steps which ought to be taken whereforeign bodies were alleged to have been left behindat operation. " So much," he added, " of the workof our Society, and of the expenditure also, could bediminished if quite simple methods of procedure wereadopted by the individuals concerned in such cases,"and few who study the report carefully will spurn theSociety’s good offices or imagine themselves qualified Ito play a lone hand in the game of law.

SIR RONALD ROSS.

A TESTIMONIAL has been started to Sir Ronald Ross,and we understand that subscriptions will be invitedimmediately. The object is to set free from financialanxiety Sir Ronald and Lady Ross in their decliningyears, and the appeal will be directed to the publicgenerally, who may be expected promptly to recognisethe claim on their generosity furnished by Ross’smagnificent work alike in the aetiology and theprevention of malaria.

,

LONDON CLINIC AND NURSING HOME.--The sharecapital necessary for the prosecution of the scheme toerect an institution for paying patients containing 175 bedswith full facilities for diagnosis and treatment on a sitebetween Devonshire-place and Harley-street has now beenacquired. Details of the organisation and an elevation ofthe proposed building were set out in THE LANCET, 1928,ii., p. 729, 783. The work of demolition of existing buildingson the site has commenced, and it is hoped that the Clinicwill be ready for use early in 1931.

The Clinical Interpretation of Aids to Diagnosis.

A Series of Special Articles contributed by Invitation.

XXX.-THE CLINICAL SIGNIFICANCE OFTHE BLOOD-PLATELETS.

PART I. *

IN view of the great importance attached byclinicians and pathologists to blood examinations asan aid to diagnosis, it is a curious fact that so littleattention has been paid to the blood-platelets. Theexplanation is partly that the technique of examiningblood-platelets is more difficult than that of the othercellular constituents of the blood. The main reason,however, is that ever since their discovery 50 yearsago, the majority of physiologists have, on quiteinadequate grounds, dogmatically denied theirexistence as independent cellular elements, so thatrelatively little is known concerning their physio-logical and pathological significance. It is onlyduring the last 15 years that interest in them hasreawakened.

There are two processes of importance from theclinical and pathological standpoint in which theblood-platelets play a part of outstanding importance-blood coagulation and thrombus formation. Infact, these processes cannot be understood if theexistence of the platelets is denied. The voluminousand confusing literature on blood coagulation bearseloquent witness to that statement. Recent workhas shown that, in addition, platelets play a part inthe defence against infection by micro-organisms.

It is impossible to understand the significance ofchanges in the platelets under pathological conditions.or even the technique of investigating them withouta knowledge of their physiological properties andfunctions. A very brief summary of our presentknowledge on these points must therefore be given.

Properties of Platelets.Platelets are minute discoidal particles of living

protoplasm possessing a definite structure andamoeboid movement. They vary slightly in size,their largest diameter being less than half that of ared corpuscle. They are present in normal blood indefinite numbers which vary within certain limits indifferent individuals of the same species. In mantheir numbers vary between 250,000 and 400,000per c.mm. They have a characteristic property whichdetermines their function. When they come intocontact with a water wettable surface larger than theirown they attach themselves to it and spread out overit. In doing so they disintegrate in an explosivemanner and shed into the blood a coagulating agent.This coagulating agent, which is not identical witheither " thrombin " or "thrombokinase," is capablein the presence of calcium salts of transformingfibrinogen into fibrin with the formation of thrombin(fibrin ferment). If the water wettable surface issmaller than that of the platelets, as is the case, forinstance, with colloids or many micro-organisms, theyattach themselves to it without disintegrating, sothat masses of agglutinated platelets are formedwhich settle in the liver, the spleen, and the bone-marrow. If removed from the body, even if allowedto remain in blood or plasma, the platelets eventuallydie. In doing so they contract and get agglutinatedto one ’another. It is important to note that thismanner of death of the platelets differs from thedisintegration by expansion, referred to above, inthis important point that the coagulating agent,liberated when the platelets disintegrate by expansion,is not liberated or liberated only in much smalleramounts when the platelets die in the contracted

* Part II. will appear next week.