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varicella. Where it came from and what, if any, is itsbearing upon human disease is another and at presentunsolved question. To the two filtrable viruses ofwhich at present most is known-those of vacciniaand of symptomatic herpes-it apparently bears norelationship. In spite of these results, negative sofar as varicella is concerned, the work of Dr. Riversand Dr. Tillett is of the utmost importance, for theyhave succeeded in demonstrating yet one more ofthe filtrable viruses ; how many more may exist andwhat are their relationships to each other and to humandisease no one can yet even guess, but their natureand distribution is obviously a problem which criesout for elucidation.

In the same volume of studies from the RockefellerInstitute Dr. E. N. Cowdry and Dr. F. 1B1. Nicholsonmake a further contribution having importantindirect bearings upon this question. These authorsshow that in a certain proportion of supposedlynormal laboratory mice encephalitic lesions are

present in association with infection of the brain bya protozoan parasite. Attention has been drawn tothis same phenomenon in the case of rabbits bya number of authors, including Da Fano in thiscountry, within the last few years. A peculiar point,and one to make epidemiologists ponder, is thatthis widespread incidence of protozoan encephalitis.affecting rabbits and mice in laboratories throughoutthe world is a new thing. The condition is knownto have existed in 1921, but there is good reason tobelieve that it has appeared since 1917. It is apparentthat not only the human mammal has been afflictedwith new plagues in the last seven years.

SURGICAL HEADACHE.THERE appear to be a certain number of headaches

which are amenable to surgical treatment. Thecharacteristic nature of such headaches is that theyare usually severe, subject to exacerbations, increasedby movement or excitement, and frequently limitedto definite areas of the head. A. R. Campbell andC. K. Fuller have recently drawn attention to thisvariety of headache which they classify as beingdue, with few exceptions, to pressure, inflammation,or the two combined. They point out that theprinciple of referred visceral pain, so thoroughlyapplied in abdominal surgery, should be extendedto cover intracranial lesions. The symptom-complexof neuralgia, superficial tenderness, and segmentalheadaches should be looked upon as indicating somelocalisable intracranial lesion. They classify thesesegmental areas, which overlap to a certain extent,as frontal, temporal, vertical, parietal, and occipital,and for each of these situations is set out a list of lesionswhich may cause a headache. For example, the causesof a vertical headache are described under the headingsof posterior ethmoid sinus disease, sphenoidal sinusdisease, enlarged turbinates, deviated septum, middle-ear disease, depressed fracture, tumour, cyst or abscessat the base of the brain, pituitary disease, andAneurysm. In some of these lesions the headachemay be unilateral or it may be universal, but head-ache from the same lesion is stated always to occurin the same situation in the same patient. Intervalsof freedom from the pain may occur and it may onlycome on during certain times of the day or night.The application of adrenalin and cocaine to the nosemay relieve the headache, indicating that nasalor sinus disease is the cause, and such headachesusually become worse during acute nasal catarrh.The use of the ophthalmoscope is advocated as

essential in cases of severe continued headache, sothat optic neuritis may be detected early, beforeirreparable damage has been done to the vision.It will be seen that the complaint of headache mustvery frequently come under the surgeon’s notice,and Campbell and Fuller consider that there is needfor greater emphasis being laid upon the differentialdiagnosis of this most common symptom.

1 Canadian Med. Assoc. Jour., February, 1925, p. 144.

THE WORKMAN AND THE HOSPITAL.

IN the annual reports of hospitals which are justnow being presented in such profusion to theirsupporters, nothing is more significant than thealmost unbroken series of records of the success ofworkmen’s hospital funds. Wherever they have beenestablished they have almost invariably producedresults that at the worst have been satisfactory, andat the best have been brilliant. It is a mistake tosuppose that this method of bringing under contribu-tion the classes which most frequently have resortto hospitals is something new, a product of the after-war crisis in hospital finance. These funds have, nodoubt, greatly increased in number during the lastfew years, but a fair proportion of them have movedwell into maturity. Thus the Workpeople’s HospitalFund at York was started nearly a quarter of a centuryago. Last year it provided the York County Hospitalwith one-third of its income, and since it began it hascontributed a total of nearly IC60,000. This is merelyone outstanding instance among many. All over thecountry we hear of

" record " years of similar funds,of totals nearly doubled in 12 months, of the readinessof the artisan to take his share of the burden ofmaintaining the voluntary system. In more than1600 places of business in Manchester and Salfordthere are penny weekly collections, and similarschemes are at work not only in many other largetowns but in rural districts. Organisation and timeare the two essentials of success- experience showsthat enthusiasm is engendered without difficulty.In view of the vast amount of re-building andre-equipment which the hospitals, having, broadlyspeaking, surmounted their current difficulties, nowhave to face, these funds are certain to be of vitalimportance in the near future. They may not beable to provide the tens of thousands of poundsrequired for the provision of new wings, but they can,and do, act as splendid stimulants to the entirecommunity. ____

VACCINATION AGAINST TUBERCULOSIS.

IT has long been the aim of many workers, andparticularly of the French school led by Calmette,to obtain some method of vaccination againsttuberculosis which should imitate in a scientificmanner the natural process of vaccination by meansof which so many individuals, inoculated by a smalldose of tubercle bacilli in childhood, develop a com-plete and lasting immunity to the disease. Indeed,so effective is this natural process in the majority ofcases that the fear has been expressed that if wecompletely stamped out bovine tuberculosis in thiscountry we should remove the chances of thisinoculating dose of tubercle bacilli from many childrenand tend to rear a race which would present a" virgin soil " to infection in later life with disastrousconsequences. But the dose of bacilli obtained bythe inge tion of dairy produce contaminated bybovine tuberculosis is very uncertain and for somechildren unfortunately proves fatal. Calmette hastherefore devoted a long period of time to producinga type of tubercle bacillus which could be inoculatedin a living form without giving rise to any local orfocal lesions. After 230 successive cultures on amedium consisting of 5 per cent. glycerine potatoand ox-bile, over a period of 13 years, he believeshe has obtained a tubercle bacillus which is livingbut not tubercul gene." 1 .1 This bacillus,. known asthe bacillus-Calmette-GuSrin (B.C.G.), is apparentlyavirulent, while it secretes a " normal " tuberculin.WeiH-HaII6 and Turpin have employed the bacillusfor vaccination since 1922 in 300 children born intotuberculous families. Following Calmette’s teachingthat the ingestion of tubercle bacilli is the principalmode of infection in the natural process, they give theB.C.G. by the mouth in doses of 1 cg. half an hourbefore food for three doses either on the third, fifth

1 Calmette and others ; Presse Médicale, July 2nd, 1924.2 Weill-Hallé and Turpin : Paris Médical, Jan. 3rd, 1925.

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and seventh or the fourth, sixth and eighth days afterbirth. Treatment at this early age is important, for,according to Calmette, this method should only beused where there is no chance of previous infectionwith the tubercle bacillus. The device is usuallyemployed where tuberculous parents refuse to be

separated from their children. Of the first 178

cases, which have been closely followed up withmonthly medical examinations, nine have died-a mortality rate of 5 per cent., and the remaining 169continue to be well and healthy in spite of the factthat they are subject to constant infection in thehome. In this country Eric Pritchard has reportedsomewhat similar work.3 3 He has been using prophy-lactic injections of tuberculin at weekly intervalsfor the first six months of life in the case of infantsborn into a tuberculous environment. He has thustreated 40 cases during the past 13 years and allare alive and well, the eldest being 12 years old,although in each case either the mother or the fatherwas suffering from active tuberculosis. It is obviouslytoo early yet to estimate the value of such prophy-lactic measures, but the results both here and inFrance will be watched with interest.

TRADE DERMATITIS.

AN article on Lime Dermatitis by Dr. W. J.. 0’Donovan, which we publish on another page of

this issue, calls attention to an interesting form oftrade dermatitis-an important section of occupationaldisease. It is difficult to estimate accurately theextent to which trade dermatitis is responsible forattendances at clinics for diseases of the skin ; itdiffers in different clinics according to the occupationsfollowed by the local population, and variations inthe figures given by different authors must occur.Lane 4 considers that from 4 to 5 per cent. of all

patients admitted to the skin department of theMassachusetts General Hospital were suffering fromlesions due to their occupation. Fordyce gives2 per cent. for his own clinic, but quotes H. H.Hazen, who considered that 20 per cent. of his caseswere due to the patients’ occupations. Frank CrozerKnowles,6 in a review of nearly 25,000 skin cases,concluded that about 16 per cent. of all skin caseswere due to the patients’ work. MacLeod, in his text-book, " Diseases of the Skin " (p. 283), says, " aconsiderable percentage of the skin cases in adultsin hospital practice are due to their occupations."He gives a list of 33 common occupations in whichdermatitis is liable to occur, whereas Herxheimer 7

enumerates 74 trades provocative of eczematoiddermatitis, and the trades included in Prosser White’s" Occupational Affections of the Skin " (secondedition) must number well over 100. As would beanticipated from these figures, and as is confirmed by Ifact, new causes of dermatitis are constantly arisingowing to the invention of new chemical processesor the modification of old ones. A comparativelyslight change in a process may make a large differencein the incidence of dermatitis caused by it.That a dermatitis is one of occupation may be easily

missed in diagnosis, because many different agentsproduce a dermatitis superficially similar, or one

resembling some common skin condition not regarded.s due to an external irritant-witness the first caseof lime dermatitis quoted in Dr. O’Donovan’s article,where, in the original attack, the patient’s troublewas diagnosed as seborrhoeic. Secondary infectionswith staphylococci or streptococci are frequentlysuperimposed on a dermatitis originally due tooccupation and still further confuse the issue. Sometypes of trade dermatitis are, however, well markedand .easi]y recognisable when once known to theobserver; such are "chrome sores," "lime holes,"

3 Brit. Med. Jour., August 30th, 1924.4 Archives of Dermatology and Syphilology, 1922, p. 565.

5 Jour. Amer. Med. Assoc., 1912, lix., 2043.6 Ibid., 1917, lxviii., 79.

7 Deut. med. Woch., 1912. xxxviii., 18.

"

pitch skin," " tar acne," and " mule-spinners’cancer," whose names suggest their origin. Theagents causing trade or occupation dermatitis arenumerous, and many attempts to classify themsatisfactorily have been made by different authors.They may, for instance, be divided into physical,chemical, and parasitic groups. The physical wouldinclude such causes as mechanical injury, wind,light, X rays, extremes of heat and cold, of drynessand moisture. The chemical group is by far the largestand requires much subdivision ; it includes bothorganic and inorganic chemicals and the toxins ofcertain plants and trees. The parasitic group includesinfections due to bacteria and fungi, and the attacksof animal parasites, such as mites. Causes comingunder two or more of these headings may act together.The points of attack of the chemical irritants arealmost invariably, in the first instance, the mouths ofthe hair follicles, the sebaceous glands, and thesweat pores, with, in addition, the natural furrows onthe skin and any accidental abrasions. The macera-tion of the epidermis by the action of alkali materiallyincreases the danger of attack by chemicals. Inmany industries certain workers seem to be naturallyimmune to the risks involved, others acquire an

immunity, and it is important for all concerned forthe employer to build up an immune personnel by thedischarge of workers whose skins prove sensitive.In some cases, however, in workers who have appearedimmune for years, the immunity breaks down undertemporary ill-health or excessive exposure to theirritant. The treatment of trade dermatitis resolvesitself primarily into removal of the patient fromexposure to the irritant, and secondarily in protectiveor antiseptic treatment of the lesions, the possibilityof malignant disease being remembered. The adage," A stitch in time saves nine," applies with particularforce to trade dermatitis, where early and accuratediagnosis is of such vital importance if the patient is

to be speedily cured. ____

THE THERAPEUTIC ADMINISTRATION OFGLUCOSE.

OONSIDERABLE interest has been aroused by anarticle on the oral administration of large quantitiesof glucose, by Dr. T. Izod Bennett and Dr. E. C.Dodds, which appeared in THE LANCET of Feb. 28th.It will be remembered that these workers, impressedby the physical transformation often produced indiabetics by the administration of insulin, sought toascertain whether improvement in the nutrition ofwasting non-diabetic patients could be obtained byfeeding them with glucose, possibly in associationwith injections of insulin. Benefit could not, of course,be anticipated if the ingestion of large quantitiesof glucose were found to give rise to correspondingglycosuria ; but preliminary experiments on 15 noimalvolunteers showed that up to 500 g. of glucose inone dose could be taken without more than a traceof glycosuria. Clinical observations were then madeon cases of acute infection, cases where hamlatemesiswas the main symptom, and cases of marked under-nutrition. Distinct benefit appears to have resultedfrom the addition of large quantities of glucose totheir diet and no ill-effects were observed. The glucoseused by the authors was commercial glucose (glucoseB.P.), which they describe as a viscid syrup, preparedby the hydrolysis of Indian corn or other cerealstarch with mineral acids. Glucose B.P. is guaranteedto contain less than two parts per million of arsenic ;a number of samples from various sources gavenegative reactions to Marsh’s test. The cost of thiscommercial glucose is only about 6d. a pound, andwhen one pound is dissolved in a quart of water towhich two lemons are added it makes a palatabledrink. The price of this product is contrasted bythe authors with that of pure glucose, which, theystate, costs about 8s. 6d. a pound, whether in crystal-line or anhydrous form. More than one of the largedrug manufacturing firms have written to inform usthat this statement stands in need of revision. The