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decided. It is easy to see one possible reason whyadvocates here and in America hesitate to call blood-group evidence in defending affiliation suits. The ’,legal profession have not yet realised that the testsare limited to proving non-paternity only, and arenever positive. It is probable that many solicitors,when the question of calling in a pathologist arises,feel that if the evidence does not go in their favourit will go against them. It is unnecessary to point outthe fallacy of this reasoning, but until lawyers arethoroughly reassured by a few practical demonstra-tions they will probably continue to play, as theythink, for safety. Another possible obstacle is the

question of whether a court can order a sample ofblood to be taken from a defendant. A New York

judgment, quoted by Dr. Swetlow, says quite definitelythat it can, in civil and criminal proceedings alike,but in this country such an order is’ out of the

question ; a test can only be made with the consentof the defendant, which is probably often withheldfrom a mistaken fear that the test may cut both ways.A barrister has suggested 3 that in time some form of"

discovery " of blood groups may be introduced. Acourt may order either side to

" discover " suchdocuments as it considers are necessary for estab-

lishing the truth ; it is not unreasonable that blood

groups should be placed on the same footing.

SKY-SHOUTING

THE report of the Select Committee on Sky-writing 4deals not only with smoke-writing by day and the IIprojection of words or patterns upon the clouds bynight, but also with " sky-shouting thebroadcasting of sound from aircraft either by directtransmission or by relaying. Sky-shouting has beenused for advertising purposes in America, Italy, andSweden, but is not at present regarded as a commercialsuccess. The Committee regard it as objectionablethat a raucous noise should be forced upon the hearingof men and women, whether they wish it or no.

Whether added to the existing volume of noise inurban areas or obtruded upon the quiet of thecountryside, this novel form of noise nuisance seemsto the Committee an unnecessary and intolerableimposition ; they therefore recommend that, if itshows signs of being developed in this country, itshould be prohibited by law for all private purposes.A brief Home Office memorandum, appended to theCommittee’s report, discusses the legal position.Noise which is a nuisance may be restrained by anaction in the High Court, but an application for aninjunction must be supported by evidence that thenoise causes a substantial interference with theordinary comforts and pursuits of life in the conditionslocally existing. Noises of a brief and transitorycharacter would not easily be checked by this method ;such litigation is apt to be difficult and expensive ;moreover an action against a particular transmitterwould be no shield against nuisance from otherpersons making similar noises. Statute law has- enabled local authorities to make by-laws restrictingnoise from the operation of wireless loud-speakersor gramophones. Such by-laws, which require con-firmation by the Secretary of State, are in practicelimited to streets and public places, and proof ofannoyance is required. The Home .Office observesthat by-laws might perhaps cover noise from overheadbut they could hardly go so far as to prohibit sky-

3 Trans. Med.-Leg. Soc., 1930-31, xxv., 35.4 House of Commons paper 85. 7s.

shouting altogether, without proof of annoyance.The maximum penalty for breach of such by-lawsis E5. Certain progressive local authorities, such asthe corporation of Edinburgh, have led the way inobtaining powers by private Act for dealing with thenuisance of noise. Precedents of this kind have beennoted in our columns during the last few years in ourannual summary of public health provisions in locallegislation. But it is one thing to pass an enactmentand another to enforce it.To turn from sky-shouting to sky-writing (which

was the main concern of the Select Committee), thereport advocates control rather than prohibition.The inventors of new methods of projection weremodest in stating the limits of their apparatus. Theilluminated words or pictures, it appears, cannotbe clearly seen from an area larger than one squaremile ; no projection is possible unless the sky isclouded ; summer-time restricts the duration of therequisite darkness, and as the method makes no

appeal to a sleeping or deserted world, it was suggestedthat the average suitable period for sky projectionin England is not longer than one hour per night. ’Conditions of public safety, especially in air defence,air traffic, and coastal navigation, required considera-tion, as well as the protection of natural amenities.Questions of health or medical treatment are somewhatremote. It may be noted, however, that the Com-mittee point out the undesirability of a sky projectorbeing operated near a hospital in such a way that theglare of the beam enters the windows of the building.The only other point of possible interest to the medicalprofession is the evidence (apparent in the questioningof witnesses by members of the Committee) that theubiquitous advertisements of pills and of promisesto cure constipation by various patent medicineshas exhausted the patience of the public.

PHRENICECTOMY IN BRONCHIECTASIS

THOSE who have charge of patients suffering fromone of the most distressing and fatal of pulmonarydiseases will read with sympathetic interest anycontributions of continental colleagues on the subjectof bronchiectasis, the cure of which continues tobaffle clinicians at home and abroad. A. Courcoux,A. Bidermann, and A. Alibert have lately recordedthree cases of this disease in which a measure ofsuccess followed paresis of the diaphragm on theaffected side. In each instance the bronchial dilata-tions were limited to the lung base. In one instanceclinical relief was associated with a satisfactorycollapse of the dilated bronchi, in two others, thoughsymptoms were ameliorated, radiographic examinationafter the injection of lipiodol showed little changein the bronchial dilatations. A possible explanationof the relief obtained in the latter might be foundin a temporary remission of symptoms due to restand special care during a period of hospital treat-ment. Anatomical displacement following the risein the diaphragm may however have facilitatedbronchial drainage in the affected area. E. Rist, whois an ardent advocate of collapse therapy in the treat-ment of bronchiectasis, has noted similar improvementafter phrenic avulsion. Another recent success inthe treatment of basal bronchiectasis in a child

is reported by M. Lereboullet.2 The experienceof English physicians has been less fortunate. Inthose cases in which an adherent pleura does not

1 Rev. de la Tuberc.. 1932, xiii., 401.2 See report of discussion, ibid., p. 55.

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prevent an artificial pneumothorax it is as a ruleimpossible to collapse the dilated and rigid bronchiand the danger of empyema cannot be ignored if aneffusion is provoked by pleural puncture. The riskof the latter complication is avoided when phrenicavulsion takes the place of pneumothorax, but atbest it can only be expected to produce a partialcollapse of a bronchiectatic lower lobe. It is seldomfollowed by apposition of the walls of the diseasedtubes without which permanent healing cannotbe obtained. The pain attending this little operationis however negligible and its risks are slight.For cases of basal bronchiectasis which are notrelieved by such means as posture, the creosotechamber, and medicinal treatment this method isworth a trial.

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RADIOGRAPHY OF LIVER AND SPLEEN

EARLY last year we referred to a method of render-ing the liver and spleen opaque to X rays 1 ; it isbased on the fact that the reticulo-endothelial systemhas the property of taking up certain foreign colloidsin a selective manner. The various thorium prepara-tions used for the purpose are given intravenously,and the dose is spread over several days, during whichthe drug accumulates in the spleen and liver,2 sothat the outlines of these organs become visible onradiography. The question arises at once, of course,whether there is any danger of toxic effects, butwork carried out at Toronto University on behalfof the manufacturers of Thorotrast is encouragingin this respect. D. A. Irwin 3 states that large quan-tities injected into rabbits were quite innocuous andcaused no reactions. While these experiments wereproceeding, the drug was only given to patients pastmedical or surgical aid, but as it appeared to beharmless its use has been extended. Even in a fewpatients with advanced cirrhosis it is said to havecaused no damage of any kind. The Canadianworkers give no contra-indications, but others mayprefer to wait for more clinical reports before relaxingtheir discrimination. Incidentally, W. H. Dickson 4quotes authority for saying that thorotrast is effectivein the arteriography of the limbs and brain, and heconsiders it superior to the iodine solutions for retro-grade pyelography, since it is more opaque andproduces no cramps. ____

HEALTH ORGANISATION AT GENEVA

IN issuing the first annual number of the LeagueYear Book 5 its joint editors, Miss Judith Jacksonand Commander Stephen King-Hall, profess onlyto have made a first experiment on which, in laterissues, they hope to improve. A year book of thissort must be a medley of basic information, forreference, and of chronicle of a more transient type.The reader wants to know what the organs of theLeague of Nations are, and also what they have beendoing in the period specially covered. Perhaps in thefirst number proportionally more basic informationhas been given than will be justified in the latereditions. The constitution of the League healthorganisation is rather elaborately set forth, withreferences to the resolutions of the Council and,Assembly of the League by which the various organswere set up ; and this letterpress is supplementedwith a table showing the ramification of committeesand subcommittees. The three main organs are the i

General Advisory Health Council, the Standing Health ,

1 THE LANCET, 1931, i., 144. 2 Ibid., 1932, i., 1256.3 Canad. Med. Assoc. Jour., August, 1932, p. 130. 4 Ibid., p. 125.

5 The League Year Book, 1932. London : Ivor Nicholson andWatson, Ltd. 12s.

Committee, and the Epidemiological IntelligenceService. The second of these is a purely League organ,the first being identical with the pre-existing Office’international d’hygiene publique, and the third a

joint emanation of the League and the RockefellerFoundation. Twenty-six subcommittees work forthe Standing Health Committee, with such variousspheres of activity as physical education, penaladministration, malaria, sleeping sickness, and price ofradium. The personnel of these organs is given in full.

In the topical section of the year book medicaland hygienic subjects are but briefly referred to.The recognition given by the-Eighteenth Assembly(1931) to the current work of the Health Organisationin general is reported, but from this the reader canonly gather that rural hygiene is the zone of the,Organisation’s most successful labours. Similarly the,work of the .League Medical Inquiry in China is

only touched upon. Against this, three full pagesare devoted to the constitution of the new Inter-national Leprosy Centre at Rio de Janeiro, of whichthe League is a sort of honorary patron. Perhapsin the year book for 1933 the current work of theHealth Organisation may be more fully discussed.In the first year the bulk of the narrative is devotedto the work of the International Labour Office, theDisarmament Conference, and The Hague Court.Evidently the greatest care has been taken to renderit accurate and authoritative.

NERVOUS DISEASE FOLLOWING SMALL-POX

AND VACCINATION

THE observation of cases of post-vaccinal encephal-itis during the last decade has drawn attention to the ,

occasionally recorded cases of nervous disease associ-ated with small-pox. The whole subject has latelybeen reviewed by Dr. J. P. Marsden and Dr. E. WestonHurst who have also described cases in detail. Theypoint out the want of uniformity in the symptoms andpathology of the older records, but they themselveshave collected a group of 11 recent cases, of which atleast seven resemble the typical syndrome and patho-logy of post-vaccinal encephalitis. In the presentstate of uncertainty regarding the ’immediate causeand pathogenesis of this group of diseases, they havedecided to classify by their pathological anatomy andhistology those cases which have been examinedcarefully post mortem. On these grounds they preferthe name " acute perivascular myelinoclasis " for the-typical so-called post-vaccinal encephalitis, with its,characteristic demyelination in the affected areas ofthe central nervous system. This pathological condi--tion undoubtedly follows other diseases besides.vaccinia and small-pox—especially measles-and mayalso be a sequela of anti-rabies inoculation. In the-seven definite cases reported, associated with variolaminor, the onset was 5-13 days after the outcrop ofthe rash, a period almost the same as in the post-vaccinal cases, and the age of the patients-i.e., 7 to.21 years, in the post-variola cases, was also verysimilar in the two groups. The recent cases following-variola have had a remarkable distribution in time.Six out of the seven occurred between September,-1929, and April, 1930, inclusive, and it is not apparentthat this incidence was closely related to the prevalenceof small-pox. The post-vaccinal cases also have notbeen clearly related to the maximal number ofvaccinations performed at a susceptible age ; more-

over, they are now very much rarer than a few _

years ago. A curiously local distribution is also to be1 Brain, 1932, lv., 181.