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modern remedies, collosol calcium has been given anextended trial and has been given up. Dr. Munrohas, indeed, never found any drug of any materialvalue in the treatment of pulmonary tuberculosis,and this is a verdict with which probably mostsanatorium physicians would reluctantly agree. Somecurious observations were made in six cases of haemo-ptysis. In every case a hsemolytic streptococcuswas found in the sputum, and after these patientshad been treated with autogenous vaccines, allimproved, and not one has again had an haemoptysis.Several cases of asthma were investigated on thelines laid down by Noon and Freeman, and aninteresting case is related of an epileptic patient whowas found sensitive to a coliform bacillus passedin the urine, and who was given an autogenousvaccine. Under this treatment the fits, which hadoccurred on an average twice a day, were reduced toone per week, tubercle bacilli disappearing from thesputum and the weight increasing by a stone. Theserological characteristics of 100 specimens of tuberclebacilli, obtained from the patients’ sputum, havebeen investigated and found to belong to one and thesame group. The Fife and Kinross Joint SanatoriumBoard is associated in its scheme of research withProf. W. J. Tulloch, of Dundee, and this association isdoubtless of reciprocal value. There are few sightsmore pathetic than that of a research worker ploughinga lonely furrow without the benefit of that stimuluswhich rubbing shoulders with other workers provides.And the value of the sanatorium as a research centreis doubtless greatly enhanced by its being linked upwith some other centre at which observations can bechecked and verified.

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EYELESS SIGHT.1

Jules Romains, less known as a physiologist thanas a dramatist and literary artist who is not altogetherenthusiastic about the medical profession, believesthat the general skin surface of the body and someof the adjacent mucous membranes are capable ofvision in the sense that completely blind or blind-folded people may recognise colours, persons, geo-metrical forms, and even read the newspaper bymeans of their skin. He identifies as accessory eyessome of the many varieties of end-organs in the skinwhose precise function has never been determined.The phenomena which he describes are certainlystriking. There is no inherent impossibility in theidea that the skin is responsive to the wave-lengthsin the ether which we recognise as light, and if thereare receptors scattered over the surface it is con-

ceivable that these impressions might be translatedinto conceptions of external appearances. But aworld steeped in the dogmas of physiological opticswill require more rigorous proof than the authoradvances. One pitfall at any rate is quite insuffi-ciently fenced-off. With one exception, the experi-ments which he cites take no account of telepathy,the object or word or numbers presented to andrecognised by, e.g., the chest of the subject beingknown to someone else who was actually present.If he would take Prof. Richet into collaboration, wecould be sure this source of error would be adequatelyexcluded. That telepathy is the explanation of hisresults is certainly supported by his observationthat some degree of attention and the correct frameof mind are necessary for success. The same is, ofcourse, true of common ocular vision, and Mr.Romains makes several points which are franklyagainst a telepathic interpretation. Success variesroughly with the area of skin exposed, and the skincannot see in the dark (though the experiments onthis point seem a little vague), nor if anything opaqueto ordinary light is interposed between it and theobject. There is nothing remarkable in his observa-tion that paroptic sight is possible only in the com-plete absence of ordinary visual sensations. On his

1 Eyeless Sight: A Study of Extra-retinal Vision and the Paroptic Sense. By Jules Romains (Louis Farigoule). Trans-lated by C. K. Ogden. London and New York : G. P. Putnam’sSons. 1924. Pp. 228. 5s.

thesis in general the only possible comment seemsto be, " Itmay be so." People talk easily of the blindmen who find their way so quickly and surely aboutthe streets having developed another sense. PerhapsMr. Romains has identified it.

GANGRENE OF EXTREMITIES IN PUERPERALFEVER.

Dr. Victor E. Chesky,1 of Halstead, Kansas, whorecords an illustrative case, remarks that puerperalperipheral gangrene, while not common, is liable tooccur in any case of puerperal sepsis or septic abortion.Stein in 1916 collected 76 cases, including two of hisown, in 63 of which gangrene followed labour, andin four septic abortion, while four occurred duringpregnancy, and five followed gynaecological operations.Knipe in 1917 recorded another case following septicabortion, so that with Dr. Chesky’s case there are now78 examples of obstetrical or gynaecological interest onrecord of gangrene of the extremities. In most casesone or both of the lower extremities was involved.Much less frequently the upper extremities were

affected. In only one instance was there symmetricalgangrene of the fingers, toes, and ears. The causativefactor in puerperal peripheral gangrene is alwaysinfection, which may vary from a very mild formwith a low temperature lasting only a few days to themost severe type of puerperal sepsis. Either a

streptococcic or a mixed infection is present. Thecirculatory block is usually situated in the arteries.Puerperal gangrene of venous origin is relatively rare.Contributory causes of thrombosis are low bloodpressure and sluggish blood-stream, caused by severehaemorrhage or weakened heart action, recumbentposition and rela.tive immobility of the body,lowered resistance against infection, and abnormalconstitution of the blood. The prognosis is bad, themortality being about 50 per cent. Early amputationof the gangrenous part is the most important step intreatment. Dr. Chesky’s case occurred in a vigorousprimipara, aged 19, in whom puerperal sepsis developedon the day after delivery. Five days later she com-plained of numbness in both feet, which becameswollen. Dry gangrene of the toes developed and com-plete recovery followed their removal. Dr. Cheskyattributes the gangrene in his case to arterial occlusion,the thrombus being localised in the pelvic vessels.

PURE ETHER.

Prof. Storm van Leeuwen, of Leiden University,in his paper to the Section of Anaesthetics of the RoyalSociety of Medicine on Friday of last week gavesome conclusive evidence as to the narcotic effect ofpure ether. The opening of his address showed howthe inability to procure ether from Germany, fromwhich country Holland had been accustomed todraw its supplies, gave Dutch manufacturers a newkeenness in the production of the drug. Conse-quently, when there came from England the expressionsof doubt as to the efficacy of pure ether, researchworkers in Holland were besought by the manu-facturers for guidance. Thus it was that Prof. vanLeeuwen started his admirable, and, as it appearsto us, well-nigh unanswerable investigation. Havingfirst of all procured from pure ethyl alcohol thepurest ether he could, which boiled at 34-6° C., andhaving found that this had true narcotic effect, theProfessor decided that even with this specimen thenarcotic qualities might be attributed to minuteimpurities present. He prepared, therefore, by theuse of benzidene, which crystallises with ether whenthey are heated together and then cooled, crystalswhich, when heated, gave an ether of absolute purity.This drug, which had the same boiling point as hisformer product, proved to be a good narcotic. Itwas carefully tested both quantitatively and quali-tatively on both animals and on man. A series ofanimals were rendered narcotic with it, observations

1 Surgery, Gynecology, and Obstetrics, January, 1924.

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on the blood content of ether being made at variouspoints of the narcosis up to that at which the respira-tory centre failed. With regard to the effect ofimpurities in ether, it appeared that, in the smallamounts present in ordinary good brands, theseplay no part in the anaesthetic action of the drug.The only reason for adding any other drug to etheris to render it stable, for pure ether, if kept exposedto light and air, becomes contaminated with peroxides.This happens with ordinary good ethers, but not withthe ether of crystallisation, or with ethanesal or

Cotton’s ether. In the discussion which followedProf. van Leeuwen’s paper Dr. H. H. Dale expressedhis concurrence with all the findings described in it,and declared that the apparently opposite conclusionsarrived at by Dr. Mackenzie Wallis and Dr. LangtonHewer could only be explained by the assumptionthat the drug they tested was not the same drug asthat tested by himself and by van Leeuwen. Con-sequently he invited Dr. Wallis when next he hadprepared a pure ether which he found to be non-anaesthetic to allow Dr. Dale and his co-workers tohave samples of it and test it in conjunction withDr. Wallis.

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MALARIA THERAPY IN GENERAL PARALYSIS

OF THE INSANE.

A WARNING as to the need of caution in the experi-mental treatment of general paralysis by the inocula-tion of malaria was the -subject of a consideredarticle by Prof. P. Muhlens, of Hamburg, in theKlinische TVochenschrijt of Dec. 24th, 1923. Indis-criminate use of this method in private practice isstrongly condemned, and even in hospitals the newtreatment should not be entrusted to any neuro-logist who has not made himself thoroughlyfamiliar with the clinical symptoms and signs andthe parasitology of malaria. Prof. Miihiens pointsout that the inoculations should only be carried outon individuals whose resisting powers are good andwhose paralysis is not of too long duration. Theearlier the treatment is started the better are theprospects of success. Before inoculation of a patientit should be ascertained that he can easily takequinine. For malaria inoculation only a pure benigntertian strain should be used, and the progress ofthe blood infection should be controlled by dailyblood tests, in order that when necessary the infec-tion may be checked in time. When it appears fromthese examinations or from the condition of the

patient that the blood infection has suddenly becomevery severe, quinine should immediately be given.Those treated with malaria should not be allowedto leave an institution before they have been definitelyfree from parasites for at least three or four weeks.Most of the malaria inoculation deaths which havecome to the author’s knowledge concerned ill-nourished elderly paralytics, or those whose infectionwas not continuously and expertly controlled, or whowere not early enough treated with quinine. Prof. ’,Miihlens’s warnings are based on his desire to avoidbringing into discredit a therapeutic measure whichhe considers the best method of treatment for general ’,paralysis. He claims that a very high percentage ’,of paralytics treated with malaria and relapsingfever infection have remained for’ years capable ofwork and free from relapse.A memorandum recently issued by the Board of

Control draws attention to the differences. some ofthem important, between the procedure adoptedfor carrying out the treatment in England andWales and the procedure which has been usuallyrecommended by the initiators of this therapeuticmeasure in Austria, and a plea is entered for unifor-mity of procedure and practice at least in all theBritish hospitals where trials are being arranged,in order that the merits of the treatment mayreceive fair consideration. It is recorded that insome instances the induced malaria in the inocu-lated cases in England has been of an unusuallysevere type accompanied by pronounced complica-

tions and with a tendency to fatality. It is hopedthat a strain of parasites which is free from objectionon grounds of severity will be available shortly, butin any case if the blood of all inoculated patientsis examined daily the occurrence of untoward symp-toms and complications may be avoided. Thisprocedure is also required in connexion with therisk, to which Prof. Muhlens draws attention, ofunwittingly conveying a mixed infection of benignand malignant parasites from donors of blood whocontract their malaria in the tropics. Since it hasbeen shown that the common malaria-carryingmosquito of England (Anopheles maculiprnni9), aftersucking blood from inoculated patients, readilybecomes infected and capable of spreading malariato other patients and to the general public, it isessential to take adequate measures to avoid thisrisk. During the summer months (April to Octoberinclusive) inoculated patients should be kept in amosquito-proof ward, or under satisfactory mosquitocurtains, from the onset of the malarial attacks untilcareful microscopical blood examination shall haveproved that the blood is free from the sexual formsof the parasite. This will usually be the case aboutthree days after commencing a proper course ofquinine treatment. As to the danger of relapse ithas been contended that an entire absence of relapsesis a particular feature of inoculated malaria. Inthis country, however, what are technically knownas

"

parasitic relapses " have been detected byexamination of the blood of patients some weeksafter apparent clinical recovery, and in order thatthese patients should not provide a potential sourceof spread of malaria it is recommended thatblood examinations should continue until freedomfrom parasites has lasted at least three weeks. It isalso considered necessary that, when a patient whohas undergone a course of malarial attacks is dis-charged from the hospital, his name and homeaddress should be notified to the medical officer ofhealth of the district to which he is discharged.The importance of effective quinine treatment and" after-treatment " in the interests equally of thepatients and of the public is emphasised.

Details of observations on the blood and cerebro-spinal fluid of 40 patients with G.P.I. treated byinoculation with malaria are recorded in our presentissue by Dr. A. R. Grant and Dr. J. D. Silverston.Sixteen of the patients received in addition a courseof salvarsan, after the malaria had been arrestedby quinine. A decrease of the lymphocytosis andin the globulin content of the C.-S.F., and a diminu-tion in the intensity of the W.R. occurred in nearlyhalf the cases. The W.R. of the C.-S.F., the colloidalgamboge reaction, and the colloidal gold test werefavourably influenced at a somewhat later periodin a smaller number of cases. The observers arecontent to record their findings at this stage withoutcomment.

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A NEW SERIES OF MEDICAL FACSIMILES.

AN interesting experiment has been made in medicalpublication by the Oxford University Press acting inconjunction with Messrs. Lier and Co., of Milan.They have produced in photographic facsimile theexcessively rare and finely illustrated folio first editionof the " Fasciculus Medicinae" of Johannes deKetham, printed at Venice in 1491. This edition,which had a larger page than any of the subsequentissues, is historically important as representing theturning-point for medicine from the Middle Ages tomodern times. Beside the facsimile of a remarkablework the volume before us contains also an elaborateaccount of its sources and affinities, written by Prof.Karl Sudhoff, of Leipzig, and adapted for Englishreaders by Dr. Charles Singer. Of the series of 14

1 Edition de Luxe, bound in half leather with eight platescoloured by hand, £3 10s. A cheaper edition at £2 6s. identicalwith the first save that only one plate is coloured and the bindingis half linen. The actual printing and publication is the workof Messrs. Lier, of Milan, for whom the Oxford University Pressare acting in this country.