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a real one, and there is evidence that bottles in the.past have been contaminated in this way even whencontaining a reasonable amount of antiseptic. Forsterilising the cap before puncture pure lysol or

tincture of iodine is usually employed. The Com-mission concludes that staphylococci had been intro-duced by the needle through the rubber cap when thbottle was in use some days before the fatal day late inJanuary, and that these organisms caused the deaths.These conclusions are said to rest partly on negativeevidence. From the evidence given before the Com-mission and reported in the Australian press we knowthat the first symptoms of illness in the children whohad been injected were vomiting, diarrhoea, andfever, coming on within eight hours. There is nomention of any organism of the food poisoning group.The symptoms described are not those usually causedby streptococci or other dangerous microbes whichmight suggest themselves, nor are they the commonlyaccepted symptoms of illness caused by staphvlococci,though we must admit that we do not know muchof what would happen after the injection sub-cutaneously or intramuscularly of the enormous

numbers of cocci that might be contained in a fluidrecognisable as " cloudy." The Commission apparentlyrecommended consideration of the use of detoxicatedtoxin-i.e., toxoid or

" anatoxine." (The cable,presumably in error, reads " antitoxin.") We havepreviously noted 1 that the prophylactic mixturemostly used in England contains toxoid and no un-treated toxin. Toxoid alone is being used tentativelyin England and by Park and others in U.S.A., and iswidely employed in French-speaking parts of Europe.The whole incident reaffirms that the price of

safety in these matters is eternal vigilance, but it doesnot indicate any loophole in the regulations or preva-lent practice in English-speaking countries, with whichwe are most concerned.

CONGENITAL ANEURYSM OF THE CEREBRAL

ARTERIES.

SPONTANEOUS subarachnoid haemorrhage of non-traumatic origin, of which Dr. Bruce Maclean reportsa case in our present issue, has proved of great interestboth to clinician and pathologist since 1859, whenSir Samuel Wilks published a paper entitled San-guineous Meningeal Effusion (Apoplexy): Spontaneousand from Injury. As the result of his work rupture ofsaccular aneurysms upon branches of the circle ofWillis slowly came to be recognised. H. Eppinger,in 1887, was the first to postulate a congenitalbasis for these aneurysms, and he demonstratedlocalised defects in the elastic and muscular elementsof the vessel wall. He pointed out that they almostalways occur at the bifurcation or branching-pointof vessels and generally in the fork between theparent trunk and the origin of a branch. In thiscountry H. M. Turnbull (1914) and E. G. Fearnsides(1916) have fully confirmed what Eppinger said.Turnbull describes the lesion as " an inherent weaknessdue to a congenital abnormality in the structure ofthe arteries at their points of junction." Theyestablished the observation, since confirmed byothers, that such aneurysms may be met with at allages from early infancy upwards and may in factrupture at any age.

Recently the co-existence of co-arctation of theaorta and ruptured cerebral aneurysm has beenrecorded by several independent observers-H. L.Parker (1926), F. Parkes Weber (1927), H. W. Woltmanand W. D. Shelden (1927). and F. H. K. Green.’,lThis last author points out that these observationssupport the hypothesis of Eppinger, for " where onecongenital abnormality exists it is’ by no means

uncommon to find others." He adds that " againstthis may be objected the fact that in patients withaortic co-arctation it is common to find an abnormallyhigh blood pressure in the vessels to the head, neck,and upper extremities, and this in itself might be

1 Green, F. H. K.: Quart. Jour. Med., 1927-28, xxi., 419.

adduced to account for the formation of aneurysmsin the brain."

It is important to remember that a large pro-portion of all cerebral aneurysms produce no

symptoms during life. A considerable numberpress upon or rupture into the brain, giving rise tosymptoms and signs which are indistinguishable fromcerebral tumour or from cerebral hsemorrhage. Thereis, however, one clinical picture which we owe prin-cipally to C. P. Symonds (1923), in which the aneurysmruptures minutely and leaks slowly into the subarach-noid space.. The leakage may be so gradual as tocause little or no cerebral compression, so thatconsciousness may not be lost. Signs of acutemeningeal irritation appear-headache, pain or

stiffness in the neck and limbs, a positive Kernig sign,and a dazed, irritable mental condition. The occurrenceof " haematolytic " fever in the first ten days may giverise to suspicion of an infective meningitis, but lumbarpuncture reveals a cerebro-spinal fluid which is highlycharacteristic (Froin, 1904). There is : (1) An evenadmixture of blood which is the same in a series ofspecimens collected at the same puncture; (2) absenceof coagulum ; and (3) pink. brown, or yellow coloura-tion of the clear supernatant fluid, which is apparentwhen the red cells have been allowed to sink to thebottom of the tube.The occasional occurrence of subretinal and vitreous

haemorrhages is another phenomenon of great import-ance. The earliest case recorded is that of Sir WilliamHale-White (1895). C. P. Symonds (1923), L. Paton(1924) and G. Riddoch, C. B. Goulden, and H. M.Turnbull (1924) have since discussed their aetiologyand significance. The haemorrhages result fromvenous obstruction due to distension with blood ofthe subarachnoid sheath of the optic nerve. Asmight be expected, they are particularly found in thosecases where the ruptured aneurysm is of the anterior

cerebral, anterior communicating, or internal carotidarteries. The question whether the subarachnoid

haemorrhage itself ever penetrates the lamina cribrosastill gives rise to dispute.

SUBSCRIBERS to the Dawson Williams Memorialare invited to attend a meeting to be held at the Houseof the Royal Society of Medicine, 1, Wimpole-street, W., on Tuesday, July 10th, at 5.30 P.M., toreceive the treasurer’s report and decide on the formof the memorial. The organising committee suggeststhat it should be a prize, to be awarded every two ormore years, for the best work which has been done inpaediatrics since the previous award. The list ofsubscribers will remain open until July 10th, andcontributors are invited to send their cheques to thehon. treasurer, Sir StClair Thomson, at 6i:, Wimpole-street, W. 1, before that date, as the list must be thenfinally closed. ____

THE eighteenth annual meeting of the OxfordOphthalmological Congress will be held from Thursday,July 5th, to Saturday, the 7th, under the mastershipof Mr. Philip Adams. The Doyne Memorial Lecturewill this year be delivered by Dr. Arthur Thomson, theDr. Lees professor of human anatomy in the Univer-sity of Oxford, whose subject will be Observationson the Eyes of Birds. The full programme of thecongress may be had from the hon. treasurer, Mr.Bernard Cridland, Salisbury House, Wolverhampton.An exhibition of ophthalmological instruments andapparatus will be on view during the meeting.

WE regret to record the death on June 16th ofLord Hambleden, chairman of King’s College Hospital,to whose generosity this hospital owes not only itspresent site but many other benefactions. LordHambleden was a firm friend to the voluntaryhospitals and a powerful worker in their interests.The institution of the Hospital Saving Association,over which he presided, and recently the developmentof the principle of admitting paying patients to privatewards, owe much to his initiative, and his wise counselwill be greatly missed by those concerned with thewelfare of the sick.