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possible alternatives, but the experiments made forthe Council have shown that it is one which is capableof ready application on a large scale, and which,according to the clinical indications, yields a satis-factory product.

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THE GROWTH OF POPULATIONS.

THOUGH it is difficult to wrench the mind to a fullrealisation of the implications of the prospect, thereseems to be very little doubt that the population ofthis country will become stationary in another 20years or so unless some revolutionary change in ourrelation to our environment intervenes. Experts whostudy ihe question all come to the same conclusion.Prof. A. L. Bowley takes the facts of death-rates andbirth-rates in relation to the age-distribution of thepopulation as they stand, and predicts the rapid attain-ment of a population in which births and deaths will justabout balance one another. Prof. Raymond Pearlreaches the same conclusion on broader biological lines,and publishes in the last number of his Quarterly Reviewof Biology 1 a revised version of a paper 2 which heread at the World Population Congress at Genevalast year when, as some of our readers may remember,he also lectured on the subject in London. He findsthat populations of all kinds-bacteria, yeast, thefly Drosophila, and man-follow the same curve ofgrowth, increasing slowly at first, then faster andfaster (as we did in the first two-thirds of the nine-teenth century), and then gradually slowing off untilthe rate of increase becomes imperceptible. Hisdiagrams certainly show a remarkable similarity whichmakes it easy to believe that the same explanationmust underlie the whole of them. He points outthat this uniform type of curve is derived fromdeath-rates and birth-rates if it is postulated (1) thatbirth-rates are much diminished by small increasesof density of population when the density is thin, andrelatively little afterwards when the density becomesgreater; and (2) that death-rates are not muchincreased by increasing density of population untilthe density becomes considerable. Experiments withDrosophila show these relations between births,deaths, and density, which between them accountadequately for the facts observed in the growth ofexperimental populations, and the similarity of themain phenomena with those observed in man makesit at least possible that the same factors are importantfor human populations too. " High " and " low "

densities of population cannot, of course, be definednumerically; they differ very widely in differentspecies and, in the same species, depend on theenvironment. Like other animals, man adjusts hisdensity to his surroundings and tends to have thelargest population which is compatible with thecomfort and convenience which he judges to be thenecessary minimum; the abundance of a plantpopulation depends chiefly on the room available, ofrats on the food-supply, and of man on the same andsimilar considerations ; the density in 1900 in thiscountry would have been impossible overcrowdingin 1600. The prospect of a stationary populationis cause for neither glee nor apprehension ; if man isfollowing a general biological law, it is inevitable andpresumably good for him.

CAROTINÆMIA.

IN a recent paper on this subject Dr. Willard C.Stoner,3 of St. Luke’s Hospital, Cleveland, whodescribes a case of his own, remarks that after thewar German authors described under the name ofcarotinaemia a number of cases with a peculiardiscoloration of the skin which was obviously dueto the high vegetable diet of the population. 4 The

1 Vol. ii., p. 532. Erglish agents : Messrs. Baillière, Tindalland Cox. 2 T HE LANCET, 1927, ii., 726.

3 American Journal of the Medical Sciences, January, 1928.4 See also THE LANCET, 1920, i., 106.

condition was most often seen in children who hadbeen having exclusively vegetable diets rich in carrotsand greens. The chief interest of the condition, whichis unaccompanied by any symptom of constitutionaldisturbance. lies in the fact that it may be confusedwith true jaundice, the principal difference being theabsence of pigmentation of the sclerotics of patientswith carotineemia. The cutaneous discoloration isdue to " lipochromes

" which are found in substancessuch as milk fat, yolk of egg, body fat, and certainvegetables such as carrots, green vegetables, andoranges. Their excretion sometimes alters the colourof the urine. Dr. Stoner’s case is unusual in that itoccurred in an adult, a woman aged 65, who had beenliving almost exclusively on a diet of vegetables,including carrots, for several months. The skinshowed a slight generalised yellowish pigmentation,which was most intense on the palms and soles. Therewas no pruritus-a symptom which is usual injaundice-and the sclerotics were not discoloured.The temperature was normal, and apart from flatulenceand constipation, which had been present for years.no other symptoms were noted. Examination of theurine was negative, but appropriate tests showedcarotin in the blood. What finally happened to thepatient is not reported, but presumably, as in othercases on record, the discoloration of the skindisappeared when the diet was changed.

WHAT IS CELL RESEARCH?

UNDER this title our Budapest Correspondent sendsan account (p. 572) of a lecture by Prof. MichaelLenhossék, in which attention is again drawn to therevival of interest in normal and pathological his-tology. For those who could see a little deeperthan the crest of the wave, these subjects never havebeen dead, they must always be the basis of ourknowledge of the structure of the normal and theabnormal. But the study of histology is tediousand difficult; results demand great industry, and aremuch more easy to obtain in other fields. Thoughaccepting the dictum that function is dependenton structure, both physiologists and pathologistshave tended to explore other paths in their searchfor the truth. It is, and has been, very necessary thatthey should do so, but- it is a matter for generalcongratulation that interest has become focusedonce more on what are, after all, basic studies. Thishappy result is entirely due to the adoption of theexperimental method. By vital staining methods,and by micro-dissection and manipulation, it hasbecome possible to learn more about the structureand behaviour of the living cell than could be hopedfor by the study of fixed and stained material alone.Probably the most important technique of all isthat of tissue culture. The possibility, first shownby Ross Harrison some 20 years ago, of growingcells outside the body, just as bacteria are grown,has opened up lines of investigation of great promise.For the most part this method has been used bypathologists, and for the investigation of cancer.

But it should have a much wider field. The substi-tution of artificial media for the fluids of the body hasmade the technique of tissue culture easier than itwas, but it is still much too difficult for universalapplication. If and when it becomes simplified itshould be feasible to study the growth and structureof the living cell in a way which is at presentimpossible ; and by using the growing cells as indi-cators of the nature of the medium on which they aregrowing, to investigate those problems of metabolismand environment which now elude us. It would beunwise, however, to draw inferences too readily fromthe behaviour of cells in vitro, for the cells of thetissue culture approximate closely to unicellularorganisms, and it would be just as fallacious to seek theanswer to the questions of human physiology fromthe behaviour of the amceba as to expect the tissueculture to be entirely representative of the bodytissues. While welcoming these new means of

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investigation, it should not be forgotten that theexperimental method can be applied with benefitto the older techniques-and inasmuch as the wholebasis of the experimental method is adequate control,the workers in the more dynamic forms of histologymust always be prepared to check their results byresort to the older techniques.

THE DISCOVERY OF ETHER ANÆSTHESIA.

THE granting of official rewards for scientific dis-coveries is always attended with the difficulty of

distinguishing between the claims. of rival dis-coverers, for the ground may be prepared byunrecognised workers, and the actual reaping isinevitable. The recognition of the truth maybe delayed perhaps, but sooner or later it mustbe perceived, and it is hard to say whether he whoenunciates it is more worthy of recognition thanthose who made his discovery possible. There seemsto be no doubt that Crawford W. Long performed onMarch 30th, 1842, the first operation to be carriedout under ether anaesthesia, and it is exceedinglyinteresting to learn how this came about. It appearsthat in the first half of the nineteenth century certainindividuals used to travel about England and theUnited States lecturing on chemistry. During theselectures it was the custom to invite members of theaudience on to the stage to inhale laughing gas andether vapour for the purpose of causing exhilarationand mirth-provoking antics. The inhalation of etherto produce excitement and exhilaration became quitepopular. Dr. Long introduced it to his circle, and itis amazing to us to read that he and his friends usedto indulge in " ether frolics." Long noticed that heand others sustained bruises and minor injurieswhile under the influence of ether without any con-sciousness of pain, and it occurred to him that hehad at his command a means of obviating the terrorof a surgical operation. And so from what we shouldregard as a highly reprehensible practice came thewonderful discovery of ether anaesthesia. Mrs.Frances Long Taylor, with the intent to establish herfather’s claim to be the discoverer of ether anaesthesia,has drawn the picture of a fine and distinguishedman.

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THE Lumleian lectures will be delivered at the

Royal College of Physicians of London, Pall MallEast, S.W., on March 22nd, 27th, and 29th, at 5 P.M.,by Dr. James Collier. His subject will be Epilepsy,and members of the medical profession will be admittedon presentation of a visiting-card.

1 Crawford W. Long and the Discovery of Ether Anæsthesia.By Frances Long Taylor. New York : Paul B. Hoeber. 1928.Pp. 237. $4.

EASTER TUBERCULOSIS CONFERENCE.-A provincialmeeting of the Tuberculosis Society and of the Society ofSuperintendents of Tuberculosis Institutions will be held atOxford from March 29th to 31st, and the Conference will dealin successive sessions with four subjects-Lupus and itsTreatment; speakers, Sir StClair Thomson, Dr. W. J.O’Donovan. The Potentially Tuberculous Child ; speakers,Dr. A. L. Ormerod, Dr. G. Macdonald, Dr. Esther Carling.Treatment of Haemoptysis in Pulmonary Tuberculosis ;speaker, Dr. Clive Riviere. Intestinal Tuberculosis ;speakers, Prof. M. J. Stewart, Mr. L. E. Barrington-Ward,Dr. Marcus Paterson. The Chairmen at successive sessionswill be Sir Farquhar Buzzard, Sir StClair Thomson, Prof.Lyle Cummins, Dr. F. R. Walters. The meetings will beheld in the pathological lecture theatre at the Dunn Labora-tory. The annual meetings of both Societies will take placeat the Clarendon Hotel on the evening of the 29th, and onthe following evening there will be a dinner to entertainvisitors. Accommodation can be arranged at the ClarendonHotel, for any who wish to avail themselves of it, on appli-cation to Dr. G. T. Hebert, Tuberculosis Department,St. Thomas’s Hospital, London, S.E. 1. ,

Modern Technique in Treatment.A Series of Special Articles, contributed by invitation,on the Treatment of Medical and Surgical Conditions.

CCLXVII.

THE TREATMENT OF HEAD INJURIES.

I. GENERAL MANAGEMENT.* *

THE treatment of head injuries causes more anxietythan almost any other emergency of practice, and inthe early stages prognosis is quite uncertain. Eachcase differs from the last in the manner of its evolution,and successful management depends on close andcontinuous observation of the signs during the periodof danger, and on a clear understanding of the manypathological processes that may be set in train.

Emergency Treatment.We are called, let us say, to treat a head injury

shortly after the accident has occurred. The uncon-scious patient has been removed to the nearest shelter.A hasty examination is made to answer the followingquestions : (1) Is the patient collapsed ? (2) Is therebleeding from the scalp ? (3) Are there any fracturesof the limbs ? At this stage the patient is interferedwith as little as possible, and if he shows signs ofcollapse it may be necessary to delay his removal tohospital for an hour or so, until his pulse has rallied.Stimulants are to be avoided ; the state of concussionis one which tends towards spontaneous recovery, andany artificial stimulation of the blood pressure is likelyto increase the risk of subsequent intracranialhaemorrhage. Cases which at this stage are showingsigns of increasing collapse are inevitably fatal.The patient is kept warm and is placed in such a

position that his breathing is free. Bleeding from a,lacerated scalp can be easily controlled by digitalcompression of the scalp against the intact part of theskull on each side of the laceration, if necessary atconsiderable distance from the wound itself. This isa matter which can be delegated to lay assistants afterslight tuition. Tourniquets for the scalp are lesssatisfactory than pressure by the fingers, for they areapt to slip. -

It is of great importance that the patient should beremoved to a hospital or nursing home rather thanto his own house. It is impossible to foretell at thisstage whether an operation will later be required.Moreover, in hospital it is more easy to make thesystematic observations that are necessary for thesuccessful management of each case, and to enforcethe prolonged rest in bed on which complete andpermanent recovery so often depends.

Systematic Observations.Apart from the care of open wounds of the head,

which will be considered later, the treatment of apatient who is suffering from a recent head injury isat first essentially conservative. He is placed in awarm bed in a room free from noise, and the followingobservations are made :-

(1) The state of consciousness. If the patient is uncon-scious the depth of coma should be investigated by notingthe pupillary and corneal reflexes, the response to pin-prick,the flaccidity of the limbs and so forth.

(2) The state of the pulse, temperature, respiration, andblood pressure.

(3) The size and reaction of the pupils.(4) The sensation and, if possible, the movements of the

limbs and face.

These observations should be made every hour, andthe facts noted should be committed to paper at thetime.

It is well to remember that an unconscious patientbearing the marks of a head injury is not necessarilysuffering from the effects of head injury. In hospitalpractice, especially, a number of other conditionsfrequently masquerade as head injury-notably

* A second pait will be published next week.