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blood-supply). This does not apply to grafts betweenidentical twins or members of an inbred strain, and thepower to destroy grafts may be lost after irradiation.Irradiated mice, which would have been expected to dieafter a week or two, recover when inoculated withmarrow. It has been shown that the homologousmarrow actually colonises the irradiated host. Even

grafts from another species (rat) may survive. Leuksemicmice have been successfully treated by irradiation heavyenough to destroy all the blood-forming tissue, followedby a marrow graft from a normal animal. Another meansof making homografting possible is to inject tissue fromanother animal before birth ; after reaching maturitythe recipient will tolerate further grafts from thedonor.

Other articles deal with the relationship betweenradiation and leukaemia, whooping-cough vaccines,protein turnover in tissues, the chemistry of proteinsand peptides and of antibiotics, and mass-spectrometryin gas analysis. The summary of work indicates the vast

range of the council’s activities-from hypogamma-globulinaemia to possible carcinogenic action of deter-

gents. The list of publications is as long and impressiveas ever.

Before Our Time

TOBACCO FASHIONS

WHEN the natives of North America discovered theEuropeans in the 15th century they introduced themto the pleasures of tobacco-snuffed, chewed, andsmoked. The form in which it was used in- their societywas probably governed to some extent by custom andfashion ; and pipe-smoking certainly had some religiousand symbolic meanings. The history of tobacco-takingin Europe has also been strongly influenced by fashion,which, although partly shaped by authority, propaganda,and economics, owes much more to individual desiresfor novelty, distinction, emulation, and uniformity.

In England pipe-smoking became the fashion of therich in the late 16th century, and, as the price of tobaccofell, the habit spread to all classes, both sexes, and almostall ages ; by the turn of the century it was a nationalpastime. On the Continent, on the other hand, thefashion was for snuffing. There was, of course, much

opposition to all forms of tobacco using ; and the first

important book against it-the opinions of sundrylearned physicians-was published as early as 1598.Two Papal Bulls proclaimed excommunication for beingfound guilty of using tobacco in the churches of Sevilleand within the walls of St. Peter’s in Rome. The GreekChurch forbade its use entirely ; and in Turkey, Persia,and India the death penalty was prescribed. A Russiantsar decreed that for the first offence the culprit shouldbe whipped and for the second executed, while snuff-takers were to have their noses cut off ; and Louis XIIIof France prohibited its use unless ordered by a physician.In England, James I imposed a heavy import tax in1604 and published his renowned Counterblaste with itsbitter invective against the habit. But the fashion grew.Then, in the early years of the 18th century, it changedrapidly and there appears to have been no organisedpropaganda, legislation, or economic circumstance toaccount for this. In the time of the Stuarts, accordingto Sir William Besant, " the use of tobacco penetratedall ranks and classes of society. The grave divine, thesoldier, the lawyer, the gallant about town, the merchant,the craftsman, the ’prentice, all used pipes.... Peoplewent to bed with tobacco box and pipe and candle ona table by the bedside ... it is even stated that the verychildren in school took a pipe of tobacco instead of

breakfast ..." But by the end of Queen Anne’s reignthe pipe had been deposed and the English were wellset for a century of snuff-taking.

Snuffing was already popular among all classes inPrance and in Scotland and Ireland. It seems probablethat in England it grew up slowly among the " youngbloods " as a protest against the excess to which smokinghad been carried by the " lower orders." They importedthe habit and the elegant ritual of snuff-taking from thefashionable French with the fastidious attention toblend and perfume, the exquisite snuff-boxes, the tapon the lid and the delicate lifting of the pinch to thenose, the inaudible inhalation and elaborate gesturesof the hands and dainty handkerchiefs. These affections,of course, were scorned by men such as Samuel Johnsonwho carried their snuff loose in their waistcoat pockets;but schools of etiquette gave instruction, as an advertise-ment of 1711 states, in " the exercise of the Snuff-box,according to the most fashionable Airs and Notions ...with the best plain and scented snuff." An accident ofwar may have contributed to the rapid spread of thehabit. In 1702 50 tons of fine Havana snuff captured inSpanish ships were distributed among the English sea-men as perquisites. They sold it cheaply in Englandand flooded the market in the southern counties withexcellent snuff at 3d. or 4d. a pound. By 1720 a con-temporary writer was able to say : "The world hastaken up a ridiculous fashion-the excessive use ofsnuff. All nations are snuffing. All classes snuff, from thehighest to the lowest.... Both sexes snuff, for the fashionhas spread to women ; the ladies began it and it isnow imitated by the washerwomen." Dr. Johnson,fifty years later, remarked that " smoking has gone out.To be sure, it is a shocking thing, blowing smoke outof our mouths into other people’s mouths, eyes andnoses ... yet I cannot account why a thing that requiresso little exertion, and yet preserves the mind from totalvacuity, should have gone out." According to Swift,the makers of snuff employed " by far the greatestnumber of hands of any manufacture of the kingdom."A snuff house was opened in the Haymarket in 1720that has continued to blend and sell snuff without

interruption to the present day. The ledgers and recordsprovide an interesting history of fashions in the use oftobacco over more than 200 years. Queen Charlotte-nicknamed " snuffy Charlotte "-was a heavy snuff-taker and regular customer. Like many others she

bought snuff by the pound, on Feb. 20, 1804, ordering12 lb. of " Marrocca " at 8s. 6d. a pound with 4s. fora " jar and bung " and another 6 lb. on May 26. Butby this time the craze of snuffing was waning. Themass of the people, among whom pipe-smoking hadnever lost its appeal, were slowly discarding the snuffhabit ; and cigars were becoming more popular among therich. Snuff remained highly fashionable in the foppishcircles in which the craze had originated. Indeed, itreached a peak of fashionable excess in the time of thePrince Regent and Beau Brummell.

By the middle of the 19th century the famous Hay-market shop was supplying as many smokers as snuffers,and in 1859 a work on the habits of " grand society"

"

recorded that the obsolete custom of snuffing was

" retained only by a few old gentlemen." The birthof cigar-smoking has been attributed to the Peninsularwar, when the soldiers acquired a taste for Spanishcigars. The rise of cigarette-smoking has been linkedwith the Crimean war and contact with the customsof the Turks and Russians. It may be significant thatthe snuff craze began about the time of the extendedwar of the Spanish succession on the Continent. But

changes of fashion are not caused by single circum-stances or events, though these may precipitate a changewhen the communal taste is ready for one. Both thesudden fashion of snuffing in the 18th century and the

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slower return to smoking in the 19th century followedperiods when the habit had risen in quantity and qualityto new heights of extravagance. It may be that the

people were satiated with the monotony of one crazeand ripe for the titillating novelty of another.

In the history of tobacco up to the appearance of

cigarettes there is little evidence that the fashions weregreatly influenced by the efforts of the tobacco trade.In the second half of the 19th century, however, tobaccoadvertising and intense competition for markets,together with increased production from the invention

of the cigarette-making machine in 1880, undoubtedlyinfluenced the fashion of smoking. In the past fortyyears the cigarette craze has blossomed as the pipeand the snuff crazes did before it. Changes of fashioncan still happen without prompting : in the past tenyears snuff sales in this country have been slowly butsteadily rising without the aid of advertisement or

preferential tax. The national fashion of ubiquitouscigarette-smoking may perhaps be reaching the limitof tolerable extravagance and be becoming ripe fordecline.

1. Paré, A. Cited by Buchanan, D. N. In Brennemann’s Practiceof Pediatrics. Hagerstown. Md., 1946 ; vol. IV, chap. 6, p. 1.

2. Virchow, R. Verh. phys. med. Ges. Würzb. 1857, 7, 134.3. Huguenin, O. In Ziemssen’s Cyclopedia. New York, 1877.4. Jores, L. Zbl. Path. Verh. path. Ges. 1898, 9, 841.5. Jores, L., Laurent, H. Beitr. path. Anat, 1901, 29, 486.6. Laurent, H. Zur Histogenese der Pachymeningitis hæmor-

rhagica interna. Düsseldorf, 1898.7. Aschoff, L. Med. Klinik, 1938, 34, 569.8. Robertson, G. M. J. ment. Sci. 1893, 39, 208, 358.9. Robertson, W. F. J. Path. Bact. 1896, 4, 119.

10. Fahr. T. Zbl. allg. Path. path. Anat. 1912, 23, 977.11. Wohlwill, F. Virchows Arch. 1913, 214, 388.

12. Ostertag, B. Ibid, 1925, 255, 129.13. Albertini, A. v. Schw. Z. allg. Path. 1941, 4, 442.14. Putnam, T. J., Cushing, H. Arch. Surg., Chicago, 1925, 11, 329.15. Putnam, T. J., Putnam, I. K. J. nerv. ment. Dis. 1927, 65, 260.16. Baker, A. B. Arch. Path. (Lab. Med.), 1938, 26, 535.17. Gardner, W. J. Arch. Neurol. Psychiat., Chicago, 1932, 27, 847.18. Putnam, T. J. Ibid, p. 856.19. Zollinger, R., Gross, R. E. J. Amer. med. Ass. 1934, 103, 245.20. Sherwood, D. Amer. J. Dis. Child. 1930, 39, 980.21. Ingraham, F. D., Matson, D. D. J. Pediat. 1944, 24, 1.22. Ingraham, F. D., Matson, D. D. In Levine, S. Z., Butler, A. M.,

Holt, L. E. jun., Weech., A. A. Advances in Pediatrics. NewYork, 1949 ; vol. IV, p. 231.

23. Korwitz, H. L. Virchows Arch. 1914, 215, 233.24. Link, K., Schleussing, H. In Lubarsch, Henke, and Rössle’s

Handbuch der pathologische, Anatomieund Histologie. Berlin,1955 ; vol. 13/3.

25. Gellerstedt, N. Ibid. Berlin, 1956 ; vol. 13/4.

Occasional Survey

SUBDURAL HaeMATOMA

THE first report on a traumatic subdural hsematoma isprobably that of Ambroise Paré.I He described the

necropsy findings in King Henry II of France, who diedin 1559 eleven days after being injured by a lance :

" His skull being opened after his death there was a greatdeal of blood found between the dura and pia mater pouredforth in the part opposite to the blow at the middle of thesuture of the hind part of the head and there appeared signsby the native colour turned yellow that the substance of thebrain was corrupted as much as one might cover with one’sthumb."

Many reports of subdural accumulations of blood, orbloodstained fluid, were published in the following threecenturies. In these a traumatic origin was usuallyassumed. But in 1857 Virchow 2 introduced the name"

pachymeningitis hsemorrhagica interna." He empha-sised the intradural origin of the chronic hsematoma andits inflammatory character. Others (e.g., Huguenin 3)postulated a traumatic origin for all hsemorrhagiceffusions on the inner aspect of the dura mater. Aboutthe turn of the century Jores and his pupils 4-6 empha-sised the need for examining membranes spread out flat,and sections of the dura cut in two directions at 90° andtaken from various parts. They advocated that twoconditions should be distinguished-i.e., traumaticsubdural hsematoma, and pachymeningitis hsemorrhagicainterna (which might show either degenerative changesand vasoproliferation or fibrinous exudation and cellularinfiltration). Aschoff 7 considered that the strikingcapillary proliferation, in the absence of fibrinous exuda-tion, and cellular infiltration were not inflammatory inorigin, and proposed the name

"

pachymeningosishsemorrhagica interna." Changes in the collagenousfibres of the subdural membranes, the appearance of

cystic spaces, the spread of fibroblastic proliferation, andvascular proliferation had been described by G. M.Robertson and by Ford Robertson,9 who quoted Wilksand Sperling’s finding of membrane-formation after

experimental injection of blood into the subdural space.Fahr 10 and W ohlwillll gave excellent accounts of thehistological findings in pachymeningitis haemorrhagicainterna, and emphasised the capillary and endothelialproliferation in the absence of fibrinous exudate andwithout signs of organisation. The formation of wideengorged " giant capillaries " in the areolar layer ofdura mater was generally recognised, particularly by

Ostertag,12 who studied the histology of pachymeningitisin whooping-cough. Albertini 13 came to conclusionssimilar to those of Jores and Laurent.

In the United States, Putnam and Cushing 14 andPutnam and Putnam 15 claimed that the traumatic andthe spontaneous forms showed histological differences.Baker 16 pointed out that the larger haemorrhages tookplace in the inner capillary bed of the dura mater anddissected along the loose connective tissue of the sub-mesothelial layer ; he considered trauma an importantcause but not the only one. But in general the unitariantraumatic theory was readily accepted, particularly whenGardner 17 and Putnam 18 put forward an attractive

hypothesis to explain the symptomless interval and thegradual increase in size of a subdural hsemorrhagic cyst.Zollinger and Gross 19 supported the hypothesis by model-experiments. They assumed that the membrane enclosinga subdural haematoma is semipermeable and that theproteins which arise from the disintegrating erythrocytesexert a colloid-osmotic pressure attracting fluids withlow protein content, such as cerebrospinal fluid and

possibly interstitial fluid of the dura mater. This is

certainly a better explanation than repeated bleedingbetween laminated neomembranes, because, though theconcentration of proteins in such a " blood cyst " is

high, it is lower than that of blood, indicating a dilutionwith protein-free fluid,.19 The same pathogenesis wasaccepted for the pachymeningitis hsemorrhagica ofinfants, and the alternative name " chronic subduralhaematoma " became popular.20-23 Birth injury or insig-nificant, often overlooked, postnatal trauma were heldto be the cause of the disorder.Two thorough investigations on a very large material

have lately been published. Link and Schleussing 24studied the necropsy and histological findings from 941patients aged over 16. They, like Gellerstedt,25 separatesharply the traumatic subdural h2ematoma from truepachymeningitis haemorrhagica. They believe that thefate of a post-traumatic hsematoma depends on its size.Thus small hsematomas are completely absorbed, leavingonly haemosiderotic pigmentation on the inner aspect ofthe dura mater ; and larger ones result in rusty, brown, orbrownish-grey thin neomembranes or pseudomembranes(often erroneously called pachymeningitic membranes).The largest are organised like haematomas in any otherpart of the body, beginning with fibroblastic proliferationand capillary budding in the inner areolar layer of the