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from his observations are not essentially correct-namely, that there is in pellagra: (1) A deficiency inthyroid secretion. (2) A neuritis of certain nervesin preference to others. (3) Skin lesions correspondingto tlm cutaneous distribution of those nerves." And1 should like to protest against the view often quotedby those who hold that pellagra is a deficiencydisease—namely, that the absence of some elementproduces pathological changes. The absence of some-thing cannot produce anything ! In pellagra, as inberi-beri, it is believed that in the absence of somevital element a toxin may develop and produce thepathological changes in the body.

I am- Sir. vours faithfully.

London, Jan. luth, 1927. HUGH S. STANNUS.

INFLUENZA AND SOME GLOOMYREFLECTIONS.

To the Editor of THE LANCET.

SIR,—In common with the majority of my professionalbrethren 1 am at the present time called upon to visitlarge numbers of people suffering from some diseaseto which the label of " influenza " is perforce given.This annual experience is always attended by con-siderable personal fatigue and discomfort and, in mycase at any rate, by a certain amount of shame.The laity jibe at our profession because we cannotcure a cold ; we acquire protective catchwords withwhich to change the conversation ; we suppress ourirritation and recover our self-esteem as best we can-the charge remains true. When the common coldis epidemic and approaches a severity sufficient tocause it to be renauled "influenza," the layman’saccusation becomes a serious one, and that is why Iam ashamed both of myself and my profession atthis moment. Nine years ago some 20 million hmnanbeings died within 12 months, apparently of this samedisease, and as a member of that group of their fellowswhich is supposed to be interested in the techniqueof the suppression of such catastrophes I find some-thing frankly disgraceful in the complacent indifferenceof the bacteriologists, physicians, and public healthauthorities at a time when serious endeavour couldbe made towards discovering the nature and cure ofthis disease.

Particularly are the bacteriologists to blame. Anyof us who have attended their meetings and discussionshave heard technicians, not all equally competent,recount their experience in growing a microbe whichthey call the influenza bacillus, the discussion beingenlivened by adherents of hypotheses which leavedeath and disease unaffected. They appear to bemaking no serious effort to discover the causalorganism. What is being done about the work ofOtitzky and Gates ? Whether this work is corrector not it is sufficiently suggestive to merit large-scale investigation ; it has gone on for a numberof years, neither dogs nor monkeys are required forits repetition, and there is no rival set of observationswith any serious number of adherents. But I havenot met a single bacteriologist in this country who isactively studying this work.There are certain researches which stand out as

being of such immense potential importance that anyself-respecting nation should imniediately take fulland proper steps to refute or confirm them. The workof Rosenthal on faecal sepsis is one instance, thework of Banting and Best on insulin is another, thework of Gye on cancer is a third, and the work ofOlitzky and Gates is clearly a fourth. Yet as far asI know there is no representative body of bacteriologistsin this country who can with authority tell us whetherOlitzky and Gates have isolated the virus of influenzaor not. And until they do we remain futile in the eyesof the layman.Phvsicians and public health authorities I blame

to a lesser degree for this supineness. But physiciansmight at least spare us imbecile articles in the news-papers on the prevention and cure of influenza whichmay endanger the mental balance of the convalescent.

Of what use is it to tell working girls not to eat white-bread or to warn clerks to take more exercise in orderto escape influenza when we have no gleam of certitudeas to the invading agent in that disease ? Can theseauthorities not join the natives of the Solomon Islandsor the peasants of Siberia and gorge themselves withvitamins in silence until the next pandemic carriesthem off :’ As to the public health authorities theirresponsibility is great. They have the power to enforceinvestigation by the laboratories. Instead of doingso they continue to exhibit tact in their dealings withtheir professional brethren, and diplomacy and inertiamake happy bedfellows.

Breaking away from these gloomy reflections (whichare shared by many) I must return to my work, whichwill probably be less interrupted if I subscribe myself,

Yours faithfully,Jan. Sth, 1927.

_

X. .

ADOLESCENT ALBUMINURIA.

To the Editor of THE LANCET.

SIR,-It must be confessed that the want o f asimple and reliable test for the condition of the kidneysis an opprobrium to modern medicine. The injectionof dyes and blood examination are disappointing wheremost required ; indeed, there seems no reason of ana priori nature why these methods should detect slightrenal defects. If we are thrown back on urinalysis twodesiderata are important in my experience. The firstis some common agreement as to what constitutesalbuminuria. If one practitioner examines by heatingand acidulating the upper layers of urine in the test-tube, or by salicyl-sulphonic acid, while another relieson nitric acid, or on heating the bottom of the test-tube, the discrepancy in results will be important.The second desideratum is the following up of theclue afforded by the modifying action of rest. Oneoften asks oneself : What is the active element in" rest." Is it the horizontal position, equable warmth,.muscular immobility, cessation of the ingestion ofproteids, or raising of a serum threshold ? This is afascinating problem which should make appeal tomany a biochemist, and which might eventually throwlight on the early stages of nephritis.

I am. Sir. vours faithfullv-Belfast, Jan. 4th, 1927. R. M. FRASER, M.D.

BACTERIAL CONTENT OF ICE-CREAM.To the Editor of THE LANCET.

SIR,-The report by Dr. E. G. Rawlinson thatappears under this heading in THE LANCET of Dec. 18thshould be of great interest to those who studyhealth as a positive entity, and not merely as the-absence of disease. The evidence, I believe so far-unchallenged, shows that great quantities of coliformorganisms, streptococci, and B. enteritidis sporogeneswere consumed in ice-cream last summer, and nobodyone pennyworth the worse-i.e., no resulting epidemicreported. One wonders whether an infantile type ofreaction such as " D and V " would not have been ahealthier response on the part of the consumer,especially if, as Dr. Rawlinson suggests, these organisms-may act detrimentally later on.The strains in these specimens must have come

from a variety of sources, but one naturally wonderswhether the one common factor, the low temperature,played a part in temporarily inactivating the cultures.Whatever the temperature of the ice-cream receivedat the laboratory, it is unlikely that the public wouldbuy and eat it unless cold enough to appear semi-solid.If this is the explanation, the ice-cream vendor’srole is that of a public alimentary vaccina,tor !The increase in numbers of street vendors and the

more rapid methods used in distribution in recentyears render Dr. Rawlinson’s results still more

significant.—I am. Sir. yours faithfullv.J. E. CHEESMAN.

Public Health Department, Leyton, K., Jan. loth, 1927.