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614 concerned realise the work that is done by the almoner’s office in bridging the gap between the voluntary hospitals and the various State grants. Hospital departments dealing with school-children, pensioners, and tuberculous patients, venereal disease clinics with their hostels and after-care work, maternity and child- welfare centres all find in the almoner a connecting link. It is true, of course, that patients will from time to time abuse the voluntary hospital system by con- cealing their financial position, but the St. Thomas’s report places it on record that on the whole " patients are amazingly honest in their dealings with the hospital, and are apt quite as often to omit some liability, such as the support of an aged parent, as to conceal some source of income." The almoner, in fact, touches life at many points and in all her dealings the aim is not to pauperise but to help patients to help themselves, not to demoralise but to assist these victims of adverse circumstances to develop their own personalities under the stress of difficulties and hard times. ____ SYMBIOSIS. . SOMEONE has said profoundly that dirt is matter in the wrong place, and the aphorism has been accepted as condensing in a phrase the valuable lesson that much that in some circumstance appears to be merely repellent may in other circumstances be highly beneficent. The discovery of the agencies by which symbiosis is carried on in animals and plants goes one step further in showing that two things may be associated together in conditions hardly dis- tinguishable from parasitism, the partnership being necessary to insure their joint lives, while the word parasitism generally implies mischief to the host. The bacteroids in the nodules of leguminous plants fix the atmospheric nitrogen, and thereby render that nitrogen available for assimilation by the plants; that is a simple example of symbiosis where the micro-organisms carry on necessary work for a common life. Prof. Nuttall, the Quick Professor and Director of the Molteno Institute for Research in Parasitology at the University of Cambridge, made symbiosis the subject of his presidential address at the British Medical Association, and gave many interesting examples of the process in plants, animals, and insects. The subject has been much worked upon recently, and is of interest equally to the physiologist, the patho- logist, and the parasitologist. It may easily be imagined that the investigation of the various problems is fraught with difficulties, and sometimes conclusions as to the interrelations of the various bodies cannot yet be arrived at, but Prof. Nuttall concludes that further discoveries are approaching, and that a wide field of fruitful research is open to those British workers who enter upon it BLOOD PRESSURE IN THE NEW-BORN. IN a recent communication to the Chicago Gyneco- logical Society, Dr. Ralph A. Reis and Dr. Arthur J. Chaloupkal described their observations at the maternity of the Michael Reese Hospital, Chicago, on the blood pressure of 100 new-born infants following normal and pathological labour. The readings were all taken with a mercury manometer and an arm band 6 cm. wide. It was found that the average systolic blood pressure during the first day of life in 55 full-term infants following normal spontaneous labour was 43 mm. Hg, the minimum record being 32 and the maximum 58 mm. There was a gradual daily increase in the blood pressure until, on the tenth day, beyond which, owing to the mothers’ discharge from hospital, the observations were not continued, the average reading was 78 mm. The greatest rise was during the first three days, the reading being 59 mm. on the fourth day. As a general rule, the blood pressure was higher in heavy infants. The sex of the infant, the presence or absence of jaundice or fever, the pulse-rate, and caput succedaneum appeared to have no effect upon the blood pressure. 1 Surgery, Gynecology, and Obstetrics, August, 1923. Low readings were met with in premature infants and twins proportionate to the birth weight and pre- maturity, while the greatest increase in blood pressure was shown after midplane forceps extraction and version extraction, and lesser increases after low forceps extraction, relatively dry labours, prolonged second stages, and in infants with large cephalic measurements. The increased blood pressure in all these cases appeared to be due directly to increased trauma ,to the foetal head. With clinical improve- ment the blood-pressure readings gradually approached the normal. ____ CONGENITAL MIOSIS. I EXTREME contraction of the pupils, apart from the effects of iritis, is generally the result either of spinal disease or of drugs. An instance is recorded in the September number of the British Journal of Ophthalmology, by S. Holth of Christiania, where it was due to neither of these causes but was present as a family affection in two sisters and a brother, in each case the condition being permanent, having been noted in two of them as unchanged after an interval of more than 20 years. All three had pupils of about 0-5 mm. diameter, which, after the instillation of mydriatics, never dilated further than 2’5 mm. In one of the sisters the condition was associated with spasm of accommodation, but in the other two cases it was not. The interest of this observation lies in its affording a new instance of family inheritance. The parents were first cousins and the father, who was only seen once, was noted to have rather small pupils, 2-5 mm. in diameter. Two of the affected members died and their eyes were obtained for pathological examination. The anatomical explanation of the condition was pronounced to be the defective develop- ment of the dilator muscular fibres of the iris. As to this it might be objected that the dilator muscle of the iris is normally so slight in development that for many years its existence was doubted. On the other hand, the persistence of partial miosis after the use of mydriatics and the permanent nature of the condition negatives the idea that spasm of the con- tractor muscle can have been the cause, and an affection of the sympathetic was excluded by the instillation of cocaine which enlarged the palpebral fissure while having no effect on the pupil. The only symptom complained of was a certain degree of night blindness owing to the defect of normal dilatation of the pupil in the dark. Two of the three patients were myopic and in their case the daily use of atropine or hyoscine was found to be a sufficient treatment. In the case of a patient who is not a myope, a small optical iridectomy would appear to be indicated. THE WASSERMANN REACTION IN LEPROSY. Major R. B. Lloyd, Dr. E. Muir, and Mr. G. C. Mitral of the School of Tropical Medicine, Calcutta, examined the Wassermann reaction in a series of 286 unselected cases of undoubted leprosy, consisting of 228 adults and 58 children. The adult cases came from the leper asylums of Gobra and Allahabad, and from the out-patient department of the Calcutta School of Tropical Medicine, and the children from the Purulin Leper Asylum. Each blood was tested with three separate antigens-viz., (1) a cholesterinised alcoholic antigen, (2) Noguchi’s antigen, and (3) Bordet’s antigen, to which 0-4 per cent. of cholesterin was added. Among the adult patients a positive reaction was found in 41-7 per cent. of all cases, in 27 per cent. of the anaesthetic cases, in 47-4 per cent. of the mixed cases, and in 63 per cent. of the nodular cases. Among the children the figures were much higher, a positive reaction being found in 62 per cent. of all cases, in 47 per cent. of the anaesthetic cases, in 80 per cent. of the mixed cases, and in 100 per cent. of the nodular cases. The possible influence of syphilis in causing the positive reactions was investi- gated by careful inquiry and examination, which 1 Indian Journal of Medical Research, July, 1923.
