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tration-the provision has been made in the Ministryneurasthenic hospitals for the accommodation andtreatment by trained medical officers of the cases

referred to in the question.What question and answer did not elicit was whether

the provision of " Ministry neurasthenic hospitals "

has been sufficient, and whether the combinationof the neurasthenic hospitals with hospital treat-ment under the control of the Minister of Pensions isachieving success. It must best be known by the rela-tives of patients, and by medical men whose advice hasbeen invoked independently of the Ministry, whetherthe neurasthenic hospitals referred to are full andoverfull, or are able to receive suitable cases wheneverthey arise ; and, also, whether the treatment affordedin hospitals under the Minister’s control is always themost suitable for the individual case. We are inclinedto believe that the question of the Minister’s controlmay sometimes prevent the patient’s treatment atan institution which would be open to him, and suitablefor his case, and that questions of economy mayintervene to render the treatment of ex-service menmentally affected less effective than it should be. Theircase and that of their relatives is a very hard one. Inmany instances the disability will continue for a longtime or perhaps will be permanent. The removal ofall certified ex-service men from public asylums wouldno doubt entail some expense to the Treasury, butcamps and buildings must now be standing vacantand under Government control the use of which, it issubmitted, might be seriously considered. Moreover,the treatment now accorded is not being given withoutexpenditure. The public is rightly jealous of increasedexpenditure by any Government department, but theremoval of the stigma of the asylum from sailors andsoldiers broken in the war would make an appealto universal sympathy.

MONOPOLY IN POISON GAS.

WERE it not for such lurid writing as Mr. H. W.Nevinson’s account of his visit to the great Americanpoison gas-works at Edgewood. Baltimore, in theManchester Guardian for Dec. 2nd, interest in gaswarfare might be said to be flagging. The fact thatMajor V. Lefebure’s " Riddle of the Rhine "1 dealsin great part with the history of gas warfare, and theproduction of war chemicals does not commend thebook to the medical any more than to the generalreader at the present time. Nevertheless, it conveysa lesson for peace conditions, as for war, which cannotbe regarded lightly by the great nations other thanGermany. Major Lefebure, himself a trained chemist,had opportunities for investigating his subjectfrom many points of view, first in the field of battle,later as a liaison officer, and finally as a member ofInter-Allied Missions to the German ChemicalFactories after the Armistice. With this first-handinformation he has been able to place the issue beforethe public with praiseworthy clearness. He showsin detail how the success with which Germanywas able to deluge the Allies with new and unexpectedpoisons was directly due to the facilities providedby her highly organised chemical industry. The I,toxic materials employed in war were organic com-pounds prepared in great part from the same rawmaterials as had been used in peace-time for themanufacture of synthetic drugs and aniline dyes. Inmost instances, details of which are given, the manu-facturing plant normally devoted to the productionof ordinary commercial products was adapted withonly slight modifications for the elaboration of deadlypoisons. A striking example is mustard-gas, whichwas manufactured on the lines ordinarily followedin the preparation of synthetic indigo. Even forexplosives the chemical factories provided theessential elements, notably the Haber nitrogenfixation plant, by means of which ammonia andnitrates could be obtained when supplies of nitre were

1 London: W. Collins and Co., Ltd., 1921. Pp. 27910s. 6d.

stopped. The facilities enjoyed by Germany in thesecret and rapid provision of these war materialswere in strong contrast with the difficulties encounteredby the Allies, who not only had to build new andspecialised factories for the manufacture of specialsubstances, but in many cases to institute difficultand prolonged research before methods suitable forfull-scale production could be elaborated. For thefuture the moral is obvious. If wars are to recurany huge organic chemical industry must beregarded as potential armament in the modernsense, and it would be in the highest degree inadvisablethat one country alone should possess this over-

whelming initial advantage. But apart from anyconsideration of war, it is not to the advantage of anybranch of scientific progress in other countries thatGermany should in future retain the dominantposition that she has had in the past in the realm ofchemical research and manufacture.

EXPERIMENTAL RICKETS.

PRELiMrNAKY reports of the work done by Dr.E. Mellanby on the causation of rickets have appearedin previous numbers of THE LANCET.1 The presentmonograph gives the experimental evidence on whichthese reports were based, and it brings up to datethe record of five years’ work and the result ofobservations on no less than 400 puppies. A briefaccount is given of the earlier experiments which ledto the exclusion of certain possible causative factorsand which pointed to rickets being a problem indietetics, more particularly centring round a disturb-ance in calcium metabolism. The criteria by whichthe presence or absence and the severity are to bejudged are discussed and compared ; the externalappearance of the puppies, radiograms of their bones,the calcium contents of the shafts of the bones, andthe histological appearance form the basis for report.There is general agreement in the results obtained bythese methods, though there are occasions whensome difference is apparent, differences which are inpart capable of ready explanation and which in partpoint out the need for further research. The earlierexperiments led to the evolution of a diet whichproduced rapid and marked rickets in well-growingpuppies. This diet remains the basis of the laterwork except that the amount of bread it containswas controlled in the later experiments. By additionsto this basic diet of fats and oils the relative anti-rachitic influence of the various substances was

estimated ; thus it was found that cod-liver oil hadthe most effect in promoting calcification of bone, andlinseed oil and babassu oil little or no effect. Thequestion is discussed as to whether the anti-rachiticfactor, which ricket-preventing substances are pre-sumed to contain, is the same as fat-soluble A-vitamin,and from the identity in distribution in the severalfats and oils and their mode of action the authorinclines to the view that anti-rachitic and fat-solubleA-vitamins are the same. There are interestingexperiments testing the activity of other food factorsin the etiology of rickets. Thus it was found thatprotein has a definite anti-rachitic effect while carbo.hydrate tends to promote the development of rickets.Further experiments bear on the question of exercisein its relation to rickets, and the author compares itsinfluence to that of protein in preventing or modifyingthe disease.

The author takes a wide view of the subject, as isevident from the short summary given above, besideswhich other factors, such as infection and the possi-bility of thyroid extract modifying the disease, arediscussed. In fact, while there were at one time twosomewhat opposed schools of thought, the one holdingthe view that rickets is a food-deficiency disease andthe other maintaining that it is primarily the resultof bad external environment and deficient exercise, Dr.

1 THE LANCET, 1919, i., 407 ; 1920, i., 604.2 Experimental Rickets, by Edward Mellanby, M.A., M.D.,

Medical Research Council, Special Report Series, No. 61.

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Mellanby’s opinion, as expressed in this monograph,tends to compromise between these extreme opinions.Thus an anti-rachitic factor, " probably identical withthe fat-soluble vitamin," together with sufficientcalcium and phosphorus in the diet, are consideredfactors of first importance in preventing rickets ;meat and exercise assist in prevention. Restrictionof any of the four factors named or excess of carbo-hydrate food promotes the development of rickets.These results agree well with clinical opinion andpractice. The research emphasises the importance ofa balanced diet and indicates that too much of onesubstance may be as harmful as too little of another.The work is being actively prosecuted, and the authorstates that the present publication is to be regardedas an interim report. ____

PLAGUE AND SMALL MAMMALS.

WE commented last week on Dr. L. G. Haydon’sarticle (Tnn LANCET, Nov. 26th, p. 1103) which dealtwith sporadic outbreaks of plague in South Africa, anddrew freely upon information supplied to him by Dr.J. Alexander Mitchell, Secretary for Public Health andChief Health Officer to the Union of South Africa.Dr. Mitchell has since sent us a copy of a paper,read by him at the South African Medical Congress inOctober, which deals fully with the fauna of the infectedcountry, and includes an extremely valuable accountof the fleas found on the various animals that havecome under notice during these investigations. Dr.Mitchell lays particular emphasis on the fact that thehuman cases were nearly always infected fromgerbilles ; evidence of recent migration and desertionof gerbille burrows was obtained in a few instances,mummified carcases and skeletons actually beingfound, showing that the epizootic was a severe one.Most of the plague cases occurred in the area freqaentedby the gerbille. -

POIKILODERMA ATROPHICANS VASCULARE.

ACCORDING to Dr. John E. Lane 1 of New Haven,Connecticut, who reports a case under his care in a managed 30, and another under the care of Dr. Oliver S.Ormsby, of Chicago, only 12 previous cases have beenpublished, nine in German, two in French, and one inRussian literature, of the remarkable skin condition,described by E. Jacobi in 1906, under the name ofpoikiloderma atrophicans vasculare. Of the 14 caseson record, nine were males and five females. Theyoungest was 6 years of age, two were 41, and the restbetween 20 and 33. In all the cases in which referencewas made to it the Wassermann reaction was negative.In a few instances other diseases were associated withit, such as pulmonary tuberculosis, myositis, rheumaticor gouty manifestations, juvenile muscular atrophy,calcareous deposits, malaria, ichthyosis, and lympho-sarcoma. The dermatosis usually begins in late youthor early adult life, is of very slow evolution, and ofapproximately symmetrical distribution. It is attendedby mild pruritus and presents as its chief manifesta-tions telangiectasis, pigmentation, and later capillaryhaemorrhages and atrophy. Histologically there aretwo stages, an inflammatory and an atrophic. Theinflammatory stage is manifested by round-celledinfiltration and dilatation of the superficial vessels andalternate increase and diminution or absence of pig-ment, while the atrophic stage is characterised byflattening of*the papillse, degeneration and disappear-ance of the elastic tissue, and atrophy of the collagenbundles. Poikiloderma has been variously classed asa disease sui generis (Jacobi), a toxic erythema(Ehrmann), lupus erythematosus (Kreibich and Arndt),atypical scleroderma (Jadassohn), and diffuse idio-

pathic atrophy (Darier, Brocq). The conditions forwhich poikiloderma may possibly be mistakenare Schamberg’s progressive pigmentary disease,Majocchi’s disease and generalised telangiectasiaconnected with syphilis. Nothing is known as to theaetiology, but it has been suggested that toxic bodies

1 Archives of Dermatology and Syphilology, November, 1921.

acting on the vessels and connective tissue may be-factors in its causation, while the theory of an-

embryonic defect has been maintained by Gluckand Bettmann.

____

CORONERS’ JURIES AND THE L.C.C.

Two pieces of war legislation which have proved ofvalue under peace conditions were the Acts of 1917--18governing the size and attendance of coroners’

juries, and the London County Council is anxious topreserve both these measures as a permanent reformin the procedure of coroners’ courts. The Coroners(Emergency Provisions) Act, 1917, provided thatseven " and " eleven " should be substituted for" twelve " and twenty-three " as the minimum andmaximum numbers of jurors summoned by a coronerto form a jury. The question of reducing the number-of inquests held with a jury was dealt with by the-Juries Act, 1918. Section 7 empowered a coroner to.hold an inquest without a jury, if he was satisfied thatit was proper to do so. Ile was prohibited from exer-cising this discretion in cases where (a) death occurredin prison, (b) death occurred in such circumstancesas to require an inquest under an Act other than theCoroners Act. () there appeared to the coroner reasonfor summoning a jury or for suspecting that thedeceased had come to his death by murder or man-slaughter. Unless Parliament takes further steps bothActs will cease to operate on Feb. 28th, 1922. These-war-time relaxations of the law had previously beenadvocated by the London County Council, and theirworking has afforded a large measure of relief to thecommunity in the matter of jury service. Forinstance, the coroners’ vouchers in three districts,over a limited period, show that out of 152 inquestsno fewer than 140 were held without a jury. Nocomplaint has been received and considerable financialsaving has been effected. Before 1917, jurors’ feesin the County of London amounted to more thanE3000 a year, but this amount was reduced in 1919 tof533 10s. Moreover, in many cases of sudden deathsat infirmaries and hospitals, the coroners have beenable to view the body at the place of death, thus savingthe cost of its removal to a public mortuary. Thiscourse would not have been possible if a jury had beenrequired to view the body. Acting on the recom-mendation of its Public Control Committee, the CountyCouncil has therefore decided, in the interests ofeconomy and public convenience, to urge the Govern-ment to take steps to give permanent effect to these-useful provisions. ____

THE SAFETY OF CHLORINATED WATER.

IT is unreasonable to expect tap-water to taste likelemonade, but it should, at least, not be nauseating.The rapid and careless way in which chlorination hadto be carried out for troops on foreign service bred inmany of them a permanent prejudice against any kindof " doped " water which has carried over into civillife. Of course, the sterilisation of water by meansof chlorine long antedates the late war, and SirAlexander Houston recounts the well-meant criticism

directed against him in connexion with the chlorinationof the water-supply at Lincoln as long ago as 1905.During the war chlorination secured its place as auniversal method of making any doubtful sample ofwater safe for immediate use as a beverage, and alarge part of London’s water was treated in this way.The removal of the taste after sterilisation has beeneffected is now a simple matter, and was set out in arecent circular issued by the Ministrv of Health.Prejudice being thus on the wane, little alarm wascreated in June last, either on the spot or in othercountries having organised water-supplies, when acoroner’s jury in Chester County, Pennsylvania,returned the sudden death of a local citizen as

due to " general systemic debility caused bychemicalised water, which produced a severe gastro-enteritis followed by cardiac failure." Pendingthe completion of new filters, the PennsylvaniaDepartment of Health is prudently disinfecting its