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chemist seems to have been consulted with referenceto the action of water on such pipes, nor has the viewof any medical authority been obtained on the aspectfrom the health point of view, a course which issuggested by their admission that acid moorlandwaters do act upon copper. Moreover, the few wordssaid about the action of water on lead and copperrequires revision by the chemist. It is stated that" Lead is itself easily oxidised, and the oxide in generalforms a protective coating. It is the organic acids inthe plumbo-solvent water which, dissolving the layerof lead oxide, subjects the metal to successive attacks.Copper corrodes little, and, so far as it does, theproduct is protective." These statements, to say theleast, require confirmation, and unless they can beconfirmed, which is doubtful, the evidence from thechemical and medical point of view has no value.The Council would be well advised to give this matterits serious attention, as the subject is one of verygreat importance. No reference is made to the useof tinned copper pipes, save to say that the tinused to line such pipes often contains lead. Thisused to be the case, but it is alleged that the difficultyof coating the copper with tin free from lead hasbeen surmounted. If such is the case tinned pipeswould appear to be preferable to copper. The use ofcopper alone, as suggested, does not appear to have asyet received any practical trial, and such a trial withwaters of various types is absolutely essential beforetheir use can be recommended with confidence.

MICROSPORIDIA AS THE CAUSE OF RABIES.

THE setiological agent of rabies has been the subject of numerous researches, and several claimants are inthe field without any one of them being generallyaccepted at the present time. The latest suggestion isthat of Y. Manouelian and J. Viala,1 who describe aprotozoon of the microsporidia genus in the tissues ofaffected subjects. The possibility of a protozoalparasite was long ago suggested, and the questionwhether the well-known Negri bodies, small corpus-cular formations found within the cells of the nervoussystem, especially in the large cells of the hippocampalregion, are to be looked upon as protozoa, which is theview of many authorities, or merely as post hocdegeneration products of the diseased cell, which isperhaps the more favoured view, has not yet beendefinitely settled. The findings of Manouelian andViala undoubtedly have their origin in the disputeswhich have arisen over the causation of lethargicencephalitis. Discordant findings in the experimentalinvestigation of this disease in rabbits has led to thediscovery of the existence of a spontaneous form ofencephalitis in the rabbit, whose existence was firstdescribed in this country by F. W. Twort. C. Levaditi,whose positive results with human encephalitismaterial have been at variance with the resultsof C. Kling, H. Davide, and F. Liljenquist in Sweden,investigated the lesions in the rabbit’s brain in thespontaneous disease, and has described the formationof small spore-containing cysts of a parasite which hehas named Encephalitozoon cuniculi. The step fromthese findings to the suggestion that a like cause mayoperate in so similar a disease as rabies is a shortone, and such a suggestion was actually made byLevaditi soon after the description and figuring of theparasite we have just mentioned. He put forwardthe view that the Negri bodies are spore-containingcysts which represent only one phase in the life-history of a protozoal parasite of which the individualunits are, at another stage, so minute as to be ultra-microscopic and filtrable. Failure adequately toobserve the intimate structure of the Negri bodies is,in his opinion, due to the impermeability of thecapsule to chromatin stains, a property which can be modified by the use of acid fixatives. This suggestionhas apparently borne fruit in the work of the two I

1 Y. Manouelian and J. Viala: Encephalitozoon Rabei:parasite de la rage. Annales de l’Institut Pasteur, vol. xxxviii.,No. 3, March, 1924.

French investigators, which has appeared in a recentnumber of the Annales de l’Institut Pasteur. Bythe use of a special technique, which involves theemployment of an acid-fixing solution, they havedemonstrated the presence of small elongated or ovalbodies, occurring in various parts of the nervoussystem, both accompanying and appearing independentof the Negri bodies, which they resemble in beingusually intracellular, but in size are very muchsmaller. The figured appearances of these " para-sites " is very striking, as is also their similarity to thebodies described by Levaditi in the encephalitis ofrabbits to which we have just alluded. The relation-ship of the newly described formations to the Negribodies is not clear, the authors of the present paperconsidering the latter to consist of accumulated anddegenerated masses of the smaller parasite. Theparasites are also described as being present in thesalivary glands. It is not possible to pronounce anydefinite opinion upon this interesting piece of work,but, whilst waiting for further results, it may bepointed out that the newly described parasite does notin any way appear to resemble bodies figured byNoguchi in 1913, which he then claimed to havecultivated by the special technique associated with hisname and suggested as the causal factor of rabies.It is also interesting to note that on that occasion theclaim was associated with the then prominent investi-gations upon poliomyelitis, whilst the present onecomes obviously in the train of the investigation ofencephalitis.

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THE STORY OF "SAY NINETY-NINE."

ON June 24th Sir William Hale-White, as Presidentof the Royal Society of Medicine, and Lady Hale-White received the guests at a social evening, givenby the Society to welcome medical men from overseasnow in London. After cordially greeting the overseasvisitors the President proceeded to give a short addresson the history of percussion and auscultation. Hepointed out that nothing that doctors do has seizedthe popular imagination more than their habit oftapping the chest and listening to it with a stethoscope,to learn whether the sounds of breathing and ofthe heart are natural and whether the patient’s voiceis properly conducted. In the " Mystery of EdwinDrood," Durdles, from tapping a slab, concludesthat under it is an

" old ’un crumbled away in astone coffin." In Kipling’s ’’Marklake Witches "is a description of how Jerry listened with a woodentoy trumpet to Rene’s chest. Wendell Holmes relateswhat happened from using a stethoscope with a flyin it. The pages of Punch contain many pictures inwhich the stethoscope appears. By noting how hisspoken voice is carried through the chest by a

stethoscope to the trained ear a physician can obtainfurther evidence confirmatory of the percussion findingsas to whether a patient’s chest contains air, solid,or fluid. Since the words " ninety-nine " are producedin the larynx they are most suitable for this purposeand this phrase has become very popular. Thereexist " Say Ninety-nine " cough lozenges, " Say1B’inety-nine stays and " Say Ninety-nine " boots ;jokes about Say Ninety-nine " are common on thestage and in comic papers. Sir William Hale-Whiterecalled the fact that Auenbrugger was the first, ina little Latin book containing only 7000 words,published in 1761, to teach what may be learned frompercussing the chest. He recorded that the chestof a healthy person yields a note resembling thestifled sound of a drum covered with a thick cloth.He explained also how to strike it to obtain the bestresults, and discussed the varying note at differentparts of the chest and the differences of note accordingas the chest contains air, solid, or fluid. Auenbrugger’swork remained unnoticed until in 1788 Corvisartbegan to practise the method and in 1808 publisheda translation of Auenbrugger’s book. FortunatelyLaennec, who was born at Quimper in 1781, studiedunder Corvisart and it was to him that the introductionof percussion in medicine was chiefly due. He lived

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at Nantes with his uncle, William Laennec, whosuperintended his education in medicine at thehospital there, protecting him from the horrors ofthe Revolution and the parsimony of his niggardlyfather. He left for Paris in 1801 and continued hismedical studies there, taking his degree in 1804.He lectured constantly on morbid anatomy, whichsubject he was the first to raise to a science ; henot only gave admirable descriptions, but correlatedthe conditions found after death with the signs andsymptoms observed during life. In spite of wretchedhealth and many family troubles he worked extra-ordinarily hard, conducting a large fashionablepractice, studying languages, making post-mortems,and lecturing to those who came from all over theworld to hear him. In 1816 he announced his discoverythat it was possible to listen to the chest with astethoscope. In August, 1819, he published hisfamous " De 1’Auscultation Mediate," containingprecise and original descriptions of clinical symptomsand post-mortem appearances. Many of thesereferred to conditions previously unknown, of whichthe most celebrated was his demonstration thattubercle is a new formation, and that phthisis is tuber-culous. Laennec described all the multitude ofphysical signs that may be recognised with the stetho-scope, and in his first chapter explained what may belearned from listening with the stethoscope on thechest to the patient’s spoken voice. From thischapter in this book arose our practice of telling thepatient to say ninety-nine. Sir William Hale-Whiteillustrated an absorbing account of the story ofLaennec’s life with many pictures of the scenes

among which this great doctor worked, lived, and died.

A HOME FOR CHILDREN WITH RHEUMATICHEART DISEASE.

Kurandai, Hartfield, Sussex, was opened threemonths ago by the Invalid Children’s Aid Associationas a home for children suffering from rheumaticaffections of the heart, boys being taken up to 7 andgirls up to 14 years of age. There are three mainopen-air wards, two facing south, in which thechildren’s beds are placed, each ward having its ownbathrooms attached. The whole front of the sheds isopen to the garden, but some shelter can be securedon that side, when necessary, by means of shutters.There are also two small rooms on the ground floorof the house with large windows. The childrenreceive regular education by two trained teachers,and their games and exercise are arranged accordingto their capacity. The nursing staff consists of thematron, a sister, and six nurses. Fifty children canbe taken and 48 are actually in residence, includinga few cases of chorea. A garden party was given atKurandai by the I.C.A.A. on June 21st, when SirJohn Broadbent explained lucidly to the assemblythe need for such a home. He pointed outthat rheumatism was very prevalent in thiscountry, and that in childhood it attacked theheart rather than the joints, giving rise to lesions ofthe valves and muscular walls of the heart. Lesionsof the valves impaired the mechanism of the heart asa pump, and certain changes took place in the cavitiesand walls of the heart which were in part an effort byNature to counteract and overcome the difficultiesentailed by the valvular lesion. For the developmentof these changes a long period of time was oftennecessary, during which the child should be kept moreor less at rest and under supervision. Even moreimportant was the injury to the muscular wall of theheart, which might result from rheumatism, as thisdamaged the propulsive mechanism. As a result ofrheumatic pericarditis the tonicity of the heart-muscle might be greatly impaired, so that it resembledperished rubber and gave way under the strain of itsordinary work ; hence ensued great dilatation of allthe cavities of the heart and symptoms of heartfailure. Recovery was common even in serious cases,but it was obvious that patients could not be kept ina busy general hospital for the many months of rest

required, and if they returned home they might beseriously and unnecessarily handicapped for the restof their life for want of skilled care. In this new homepatients could be kept for several months if necessary,and would be regularly visited by Dr. J. W. Prince,of Hartfield ; periodically by a member of theconsulting staff.

Proof of the value to fitting cases of such a homeis afforded by the encouraging results obtained atthe Edgar Lee Home, Stonebridge Park. This is ahome founded for boys with rheumatic heart diseaseby the Invalid Children’s Aid Association in 1918.Since its inception 327 cases have been admitted. Theboys on leaving are advised as to the nature of thework they can safely undertake, and the Associationendeavours to keep in touch with them afterwards.At a medical inspection last year of some of those whohad passed through the home, of 39 boys only threewere considered to require further treatment. Dr. F. J.Poynton, who also spoke to the guests of the I.C.A.A.at Kurandai, pointed out that children with rheumaticheart disease are unsuitable for the ordinary con-valescent home where children are recovering fromsome surgical operation or minor illness. They arehigh strung, and the damaged heart requires muchcare. Those without special opportunities forinvestigation have not the slightest conception of thefrequency of rheumatic heart disease. Dr. Poyntonnoted that of 140 deaths at the Hospital for SickChildren, Great Ormond-street, from heart disease,90 were due to rheumatism and all were in childrenunder 12 years. It was not, however, the fatal casesand the totally incapacitated children that this homewould help, but those cases who had passed throughone or more attacks and had, as a result, heartsweakened or permanently damaged in slight degree.These children, he said, could lead useful, if restricted,lives provided they were given time to get stronghearts, that their hearts were tested by gradualincrease in physical exercise, and their educationcontinued. They should return to their homes withan indication as to their physical capacities, and reportto their hospitals or medical supervisors. At thishome the object would be to train hearts to renewedhealth and strength, to keep minds active and happy,to increase our knowledge of the power of the heartfor recuperation, to learn more of the life-history ofrheumatic heart disease, and to take a practical andliving part in the national study of the prevention ofrheumatism and its complications.

THE ROYAL SOCIETY CONVERSAZIONE.

A CONVERSAZIONE was held at Burlington Houseon June 18th, when Sir Charles Sherrington, thePresident, and Lady Sherrington received a numerouscompany. Many interesting exhibits were shown,and during the evening Prof. Lucien Bull, of theMarey Institute, Paris, gave two demonstrations ofrecent developments in high-speed cinematography.His beautiful slow films illustrating the flight of birds,and the equally graceful movements of a dancer, gavegreat pleasure. Among the exhibits Captain C. Diverand Prof. A. E. Boycott, F.R.S., demonstrated theresults of breeding experiments with the snail Limncr!zperegra. Whereas most snails are typically coiledin a right-handed spiral, occasionally left-handedexamples are found. Breeding from a sinistralrace of these animals records have been obtainedfor some 600 families (about 53,000 snails), and it isapparent that a definite system of inheritance is beingfollowed. Dr. T. S. P. Strangeways, Dr. R. G. Canti,Dr. M. Donaldson, and Dr. F. G. Hopwood demon-strated living cells growing in vitro under the influenceof radium. The internal cytological structure wasdisplayed by the use of dark-ground illumination. Alarge collection of permanent tissue-culture prepara-tions, illustrating the effect of exposure to X rays supon the different phases of mitosis, was also shownby Dr. Strangeways. Sir Almroth ZYright, Mr. A.Fleming, and Dr. L. Colebrook demonstrated newmethods for the exploration of bacterial disease, and