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332 enzymes introduced into the surrounding fluid. The introduction of a potent adsorbent into the alimentary canal undoubtedly modifies the chemical sequences profoundly and with them the saprophytic flora too, this flora being the biological expression of the chemical and physical condition obtaining in the bowel. Whether this modification is to the advantage of the patient or not can only be ascertained by clinical observation. Each morbid condition for which adsorbents are pre- scribed presents its individual problems which cannot be solved entirely by experiments in test-tubes and reflection in the study chair. Answers have already been found to some of the questions raised. For example, the adsorption of vitamin B, on fuller’s earth does not prevent the vitamin from reaching the tissues when the adsorbate is administered by mouth. An adsorbate of this nature is an official pharmacopceial preparation. Furthermore, it has been shown that liberal doses of liquid paraffin given night and morning do not make any measurable difference to the amount of fat-soluble vitamin A or of its precursor, carotene, absorbed from the routine meals of the day. N. MUTCH. TRICHINIASIS SiB,—Dr. Sheldon, in his account of the epidemic of trichiniasis in Wolverhampton, suggests that the relative freedom from the parasite previously enjoyed by this country was attained by a high standard of meat inspection. I do not doubt that he is right in thinking highly of our meat inspections,. but surely no attempt has been made in this country to employ the special examination required for the detection of trichinised pork. According to reports this special examination has been abandoned in the United States, where the con- dition is a recognised problem, though it may still be practised in certain parts of Germany. It seems that in searching for the cause of the recent outbreaks attention should be directed to any war-time change in pig food, or to any new source of sausage meat developed to replace pre-war importations now unavailable. An order requir- ing garbage used for pig food to be boiled has been in force for many years, and though this measure was directed primarily against foot-and-mouth disease it possibly plays a part in making trichiniasis a rarity in home-produced pork. My interest in this disease was aroused 8 years ago when I saw two girls in this city whose condition left little doubt that they had become trichinised ; they had partaken of a form of undercooked porkmeat served in hors d’oeuvres. Chance recollection of a valuable note by Dr. R. A. Hickling (Brit. med. J. 1931, 2, 654) on a case of the puffy eye syndrome seen in his ophthalmic clinic provided the key to the diagnosis. IAN E. MCCRACKEN. GARGOYLISM BY ANY OTHER NAME SiR,-In your leading article of Feb. 22 you- take exception to the name gargoylism on architectural and humanitarian grounds, and advocate " Hurler’s lipoido- sis " as an alternative. While aware that it is sublimely unimportant whether the name gargoylism is retained or not, I would like to protest against a pontifical blessing being given to the alternative. You start with the statement that the condition was first described by Gertrud Hurler in 1919. This is a mistake which has been made by all continental writers on the subject, and some English ones (including, I regret to say, myself). Cockayne 2 however, pointed out that a good clinical description of the condition had been given by Hunter 3 two years before Hurler’s paper appeared, and now Henderson 4 (in a paper which you mention in your leading article but do not seem to have read to the end) again draws attention to Hunter’s priority of description and to the fact that in his clinical teaching John Thomson recognised gargoylism as a disease entity as early as 1908. Doubtless further research will show that Noah had two cases of gargoylism (both sexes being affected) inscribed in the inventory of the ark. In fact, it is just 1. Hurler, G. Z. Kinderheilk. 1920, 24, 220. 2. Cockayne, E. A. Proc. R. Soc. Med. 1936, 30, 104. 3. Hunter, C. Ibid, 1917, 10, 104. 4. Henderson, L. J. Arch. Dis. Childh. 1940, 15, 201. as easy to slip up on eponyms as to say gargoyle when you might (or possibly might not) have wished to say corbel. In conclusion I might add that it was John Poynton who first aptly compared one case under his care to a gargoyle, and the name gargoylism was adopted in a paper 5 in which it was suggested, on the very meagre pathological data- then available, that the condition might prove to be a lipoidosis. This has subsequently been confirmed, but it would be as well to wait until the pathogenesis has been more completely worked out before coining a more permanent and scientific name. If we must be burdened with a further eponym, let it at least be Hunter’s lipoidosis. RICHARD W. B. ELLIS. Public Health Diarrhoea this Winter EPIDEMICS of diarrhoea, for the most part mild and affecting people of all ages, have appeared this winter in different parts of the country. A questionnaire sent out to practitioners in various districts shows that some epi- demics have been associated with catarrhal or influenzal symptoms, others have been purely gastro-intestinal. The Flexner bacillus has been isolated in one or two places and the Sonne bacillus in others, but in many districts no organism has been found even when carefully looked for. No serious results seem to have been noted, apart from one death-that of an elderly debilit- ated mentally ill patient who contracted diarrhoea, probably due to Flexner dysentery, in Stobhill Hospital. Mild outbreaks are reported from such widely scat- tered regions as Northumberland, Lancashire, the Midlands and Devon. Cases have been appearing since December or even earlier, and in most places have persisted into February. The symptoms have ranged from trivial diarrhoea accompanying respiratory catarrh and lasting 24-48 hours to severe diarrhoea or vomiting or both, with sudden onset leading to shock and collapse. Among the Northumbrian cases during the autumn and winter were children with mild diarrhoea, vomiting, and tenderness over the liver ; more recently, middle-aged men and women have been affected with acute diarrhoea, lasting only 24 hours. In Devon mild diarrhoea with or without vomiting and lasting 3-6 days has been epidemic throughout the same period. These minor types of infection are presumably akin to the respiratory infec- tions which they sometimes accompany, or even perhaps replace. A suggestive case is that of a soldier who developed follicular tonsillitis while on leave ; two days later his wife had an attack of vomiting with a rise of temperature but no sore throat, and her sister, called in to nurse them both, developed within a day or two an attack of diarrhoea with nausea, but without vomiting or sore throat. There is at least presumptive evidence that all three infections were due to the same organism. Sporadic cases of diarrhoea only are reported from London and Aberdeen ; Sheffield appears to be free. Dysentery organisms have been isolated in connexion with epidemics of diarrhoea in Glasgow, Manchester and Birmingham. The Sonne bacillus has been implicated in Birmingham, where cases have been numerous and the symptoms have been nausea, small bile-stained vomits, headache, colicky abdominal pain, and diarrhoea, the stools occasionally containing blood and mucus. The temperature has not been greatly raised in most cases and the pulse has been slow. In a few cases the spleen has been palpable and in two " rose spots " appeared. The diarrhoea usually lasted only two or three days, but sometimes an acute onset was associated with collapse. In Manchester, where the Flexner bacillus was isolated, the illness lasted about 5 days, and began with abdominal pain and diarrhoea, the stools containing mucus ; the temperature was only raised for 48 hours. Another outbreak of Flexner dysentery occurred in Glasgow at Stobhill Hospital and the Maternity Hospital during January. Patients were ill for 2 or 3 days with abdo- minal discomfort, diarrhoea and occasional vomiting, and a temperature of 100°-103° F. The source of infection was found to be the milk supplied by a farm where there were 10 cases of diarrhoea among farm hands. Milk 5. Ellis, R. W. B., Sheldon, W. and Capon, N. B. Quart. J. Med. 1936, 5, 119.
