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carefully at most of the 33 exhibits, but also tosupplement the descriptions in the catalogue(" supplied by the exhibitors, who alone are responsiblefor their accuracy ") by cross-examining the long-suffering authors of these simplified statements.Some of them, with the best will, could not at thisstage add much to the written word. The exactnature of the resin or balsam, which, with nine timesits weight of neutral animal fat, made up the cosmeticfound in the tomb of Tut-ankh-Amen will never bedisclosed. The very smallorganism (diameter 01 fl.)recently discovered by the method of dark-groundillumination with ultra-violet light by Mr. J. E.Barnard, has not yet been named, nor its propertiesinvestigated. Still less could Miss M. A. Tazelaarand Prof. Julian Huxley explain the curiousinfluence of temperature gradients on development.By means of a simple apparatus, developing frog’s,eggs can be subjected to a temperature gradient inany direction required. When the gradient passesfrom side to side asymmetrical tadpoles may beproduced. Cold at the future head end alters thetype of gastrulation and may lead to double-tailedmonsters. The continuation of normal developmentoutside the bodv was one of the most attractivedemonstrations, shown by Miss Honor Fell, D.Sc.,with Dr. R. Robison. At the Strangeways ResearchLaboratory at Cambridge she has cultivated invitro the femurs removed from fowl embryos 5 daysand 6 days old. These isolated femurs have a
remarkable capacity for self-differentiation. Whenremoved from the body and cultivated in a watch-glass containing suitable culture-medium they mayincrease to more than three times their original lengthand at the same time undergo a remarkably normalanatomical and histological development, includingossification. They continue growing for three weeks,after which no further development takes place. Asin normal development, the femurs cultivated invitro form enlarged cartilage cells and osteoblasts andsynthesise a phosphatase which may effect calcificationby liberating inorganic phosphate from phosphoricesters. When three-day embryonic limb-buds are
cultivated they differentiate to form small-celledcartilage ; but no enlarged cartilage cells or osteoblastsare formed, nor is phosphatase synthesised. In theannual report of the Lister Institute of PreventiveMedicine, which we summarise on page 1373,these results are mentioned as providing strongevidence of the truth of Dr. Robison’s earlierconclusion that phosphatase is secreted by the
hypertrophic cartilage cells and osteoblasts, but notby small-celled cartilage which never ossifies. Theextension of experiments of this kind and of thosedesigned to establish the action of X rays and radiumon normal and malignant cells, will soon settle thedoubt whether tissue culture represents merely aninteresting phenomenon or whether the techniquecan be developed to yield results fruitful in othersciences.
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SKIN IMMUNISATION IN TUBERCULOSIS.
As a mechanical method of protection it is obviousthat the skin stands facile princeps in the first line ofdefence against infection. Long ago Robert Kochshowed, in the classical experiment known as
" Koch’sphenomenon," that, once the body had been sensitisedby a primary infection with the tubercle bacillus, theskin acquired the power of -holding up at the site ofinoculation a second dose of bacilli. But the actualvalue of the skin as an immunising agent has, on thewhole, been inferred rather than demonstrated.More recently Prof. A. Besredka showed that vaccinesof living organisms, such as staphylococci, applied ina, wet compress to the shaved skin of the guinea-pigacted as an immunising agent against subsequentinfection, and we have called attention to the signifi-cance of this observation. It would indeed be astonish-ing if the skin, with its blood capillaries under suchefficient vasomotor control, did not exhibit immunisingpowers, but when we come to examine step by step
the mechanism of this immunisation, it is by no meanseasy to determine precisely of what properties thisbacterial resistance consists. Phagocytosis is notdifficult to demonstrate, but the humoral side of thequestion is less open to direct experimentation.Dr. P. Woringer, of Strasbourg, in a recent article 1reviews the evidence for a specific cutaneous im-munisation against tuberculosis, based largely onthe work of A. Marfan and J. Paraf. Meanwhileremedies based upon the action of the skin as animmunising factor continue to be introduced in clinicalmedicine, and whatever may be the theoreticalexplanation -of their action there would appear tobe good reason for their continued trial.
Prof. A. Wolff-Eisner, of Berlin, in introducing 2 yetanother tuberculin into medicine bases his treatment onthe belief that these immunological properties of theskin have been hitherto much neglected. Reasoningfrom the tuberculides he suggests that in cutaneoustuberculosis two immunological reactions take place,first a bacteriolysis of the tubercle bacillus in the skin,and, second, a fixation of the tubercle toxin in theskin which prevents its harmful effect as a circulatingtoxin (Winkelriedfunktion). Santuben, which is a
tuberculin ointment manufactured under his control,is claimed to have been used in 16,000 cases during anexperimental period before the preparation was put onthe market. The ointment is rubbed into the skin forten seconds once a week. After 24 to 48 hours a slightreddening or swelling should appear at the site ofinunction, which remains visible for 3 to 5 days. Ifthe reaction is not obtained a larger inunction ismade on the next occasion. Marked erythema isconsidered to be an overdose and should be avoided.As an adjuvant of this treatment a tablet preparationof guaiacol and silica is administered by mouth, theformer for its antiseptic properties, the latter for itssupposed effect in promoting the formation of fibroustissue. After using the remedy in his variousinstitutions of the University of Berlin for 20 years,Wolff-Eisner has obtained a large experience andbelieves that he can achieve valuable results bycutaneous immunisation in many forms of earlytuberculous disease.
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THE CENTENARY OF KING’S COLLEGE.
ON June 21st, 1828, at a meeting held in theFreemasons’ Tavern, with the Duke of Wellington inthe chair, a college was inaugurated for the purposeof giving instruction in the various branches ofliterature and science, and the doctrines and duties ofChristianity as the same are inculcated by the UnitedChurch of England and Ireland. King’s College,London, obtained its Charter a year later, and thecentenary of the granting of this Charter is beingcelebrated this week. On Tuesday last the Duke andDuchess of York opened the proceedings in the College,and on Wednesday the Archbishop of Canterburydedicated the chapel and opened the library and newwing of the Hostel in Vincent-square. During thehundred years that have intervened King’s Collegehas set up faculties in many branches of literature andscience, and these have contained an astonishingnumber of names of world-wide repute. Those ofWheatstone, Adams, Clerk-Maxwell, and Daniell arehousehold words in the basic sciences on which medicineis built up, while the College is hallowed to the studentof medicine by the memory of Joseph Lister and morerecently of David Ferrier. It is very seemly that oneof the Colleges of the University of London should liewithin the precincts of the City, and now that thequestion of a central university site has been decidedonce and for all there is a wide feeling of satisfaction,we believe, that King’s College should continue tooccupy part of William Chambers’s famous palace.Many of those who parked their cars on Tuesday bypermission in the quadrangle of Somerset House,the home of the Board of Inland Revenue, may with
1 Ann. de Méd., 1929, xxv., 301.2 Münch. Med. Woch., 1928, lxxv., 1909.
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the eye of faith have seen the whole edifice tenantedby University students, and some other place foundfor the servants of the Treasury. One could hopethat the bleak stretch of London south of the Thamesmight acquire some university building of its own,to bring the southern boroughs into more intimatecontact with the academic life of a great city. CentralLondon, however, has become progressively lesssuited for school-children and students’ residence.King’s College School moved out to WimbledonCommon in 1898, ten years later the hospital nearbywas transferred with its attendant school of medicineto Brixton, and the social science department hasfound a permanent home on Campden Hill. Thesemoves left unchanged the question of accommodationfor the students attending the College, the number ofwhom has doubled since the war, while there are atpresent over a hundred visiting students from theDominions and continental countries. The threeCollege hostels in Bayswater, Denmark Hill, andWestminster have long outgrown their accommoda-tion. The last-named of these, lying centrally inVincent-square and overlooking a first-class playing-field (not, of course, its own), becomes with the newadditions one of the best equipped institutions of thekind. The increased number of students has ledto the need of larger College buildings, and they canonly be partly met by the superstructure over AldwychStation. The proposal to rebuild the south-west blockof the College, with new buildings for anatomy uponthe roof, will make it possible to bring together thevarious departments of the faculty of medical scienceshitherto separated. The estimated cost of all thesechanges is 125,000, and the money must be found.
THE NERVOUS ELEMENT IN CHRONICCONSTIPATION.
CHRONIC constipation is well called by the Germansa Kulturkrankheit, and is indeed so widespreadand in many eyes so serious as to be in danger oftaking its place as a definite disease. Perhaps halfthe patients that a doctor sees describe themselvesas constipated and the most far-reaching ills are
commonly attributed to this condition alone. Allthis has a basis of truth, for constipation is undoubtedlythe cause of much ill-health ; on the other hand,it is very often only a result or symptom of an
underlying disturbance. Since the conception ofintestinal toxaemia is pretty familiar to the publicthe fear of constipation looms large in the minds ofmany and gives rise to much anxiety. The consequentnervous factors in chronic constipation have latelybeen studied by Dr. Lewent 1 of the UniversityHydro-Therapeutic Station in Berlin, who finds,like other physicians, that the commonest symptomscomplained of are headache, anorexia, lassitude,insomnia, whilst flatulence and abdominal painare comparatively rare. The great majority of herpatients have been women at about the climacteric,and usually the condition has been attributed to" endocrine" disturbance, the cases falling intoa large group which she terms the " endogenous "or neuropathic constipation. She recognises alsoa smaller " exogenous " group largely composed ofwhat would usually be called atonic cases.A broad division into these two types, " endo-
genous " and " exogenous," has perhaps as muchvalue in practice as the customary division intospastic, atonic, and dyschezic types. The endogenousgroup includes that difficult patient, the bowelhypochrondriac, in whom it is often hard to determinehow far the symptoms are those of neurosis and howfar the result of intestinal toxaemia. The term" intestinal toxaemia " is certainly much abused, andfor a large proportion of those who have habitualconstipation it is actually less harmful to be constipatedthan to pass loose stools. In fact it is not definitelyknown if constipation alone is ever a cause of increased
1 Med. Klin., 1929, xv., 711.
absorption of toxins from the intestine, and everyone-is aware that in phlegmatic people an action of the-bowel once a week is compatible with perfect health.It will be remembered that Alvarez has shown thatmany of the symptoms of constipation-irritability,nausea, headache, and so forth-can be caused bymere mechanical distension of the rectum, as, for-example, by stuffing it with cotton-wool. Laboratoryexperiments so far furnish little proof of true intoxica-tion in chronic constipation, for the products of-protein putrefaction (indol, skatol, phenol) whengiven by the mouth or by injection have usuallyfailed to reproduce the symptoms. By givinglarge doses of such nitrogenous products by mouthPower and Sherwin2 have produced typical symptomsin man, which leads them to suggest that stasis.of the colon may bring about failure of the intestinalwall to detoxicate bodies of this kind, and thus-lead to their absorption into the blood unchanged.But their excretion, as judged by the degree ofindicanuria, is notoriously unreliable as a guide to-intestinal putrefaction, a fact which has led to thesuggestion of several alternative tests, including aproposal for the estimation of tyrosin recently made--in our own columns.3The whole question cannot be satisfactorily
answered at present. It is important, however,that in every case of constipation the relation ofcause to effect should be borne in mind ; that therelative harmlessness of delayed excretion of solidfaeces, as compared to the dangers of fluid motions-following the abuse of purgatives, should be remem-bered ; and that reassurance of the patient shouldnever be neglected in treatment.
Lord Donoughmore, treasurer of the Thank Offering:Fund for the King’s Recovery, organised by King:Edward’s Hospital Fund for London and the National-Radium Fund, has received an anonymous contribu-tion from " Grateful " of 1000 guineas as a tribute to.the work of the voluntary hospitals in forwarding the-progress of medicine.
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THE late Lord Revelstoke has bequeathed .6100,000’to King Edward’s Hospital Fund, 250,000 to Guy’S’Hospital, and 225,000 to St. Mary’s Hospital MedicalSchool.
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ON Thursday, July 18th, at noon, H.R.H. the-Prince of Wales will formally open the school buildingsof the London School of Hygiene and TropicalMedicine, the new School of the University of Londonwhich owes its building to the generosity of the-Rockefeller Foundation.
2 Power, F., and Sherwin, C.: Arch. Int. Med., 1927, xxxix., 60.3 Mutch, N.: THE LANCET, May 18th, p. 1034.
MANCHESTER MEDICAL SociETY.—The annual meet-ing of this Society was held on May lst in the Medical School.of the University, with Dr. R. W. Marsden, the President,.in the chair. In connexion with the visit of the BritishMedical Association to Manchester this year, Dr. CharlesHorace Mayo and Dr. William James Mayo, of the MayoClinic, Rochester, U.S.A., were elected honorary membersof the Society.
IRISH MEDICAL ASSOCIATION.—The annual meetingof this Association was summoned to be held at the RoyalCollege of Surgeons in Ireland on June 12th. A quorumfailed to attend within half an hour of the time fixed forthe meeting, and the meeting stood adjourned for a weekat the same hour and place. On the second occasion thosepresent were able to constitute a quorum, and to proceedwith the business. Mr. P. E. Hayden was elected unani-mously as President, and Dr. E. Byrne, of Slane, as Vice-President. The President delivered a brief address in whichhe pointed out the advantages attached to membership ofthe Association. The report of the Council, which wasadopted, stated that at the end of last year there were-409 members, being an increase of 19 during the year.
