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properties closely resembling those of the natural oxidases.These considerations may throw further light on the therapeuticapplication of compounds of manganese and iron with albuminand peptone, and may account for the reputed advantages ofpreparations of this type over the inorganic forms of ironand manganese. It is interesting to note that Garrigou hasfound that certain metals exist in a colloidal state in mineralwaters, and so possess the properties of natural oxidases.

In this way he accounts for the beneficial results whichattend the drinking of such waters, due to the setting upof more vigorous oxidations in the tissues. In confirmationof the work of Trillat it has been shown by Lumière andChevrotier that emulsions of iron, cerium, and manganesewith albumin, gelatine, or gum, produce artificial oxidaseswhich have the power of destroying the bacterial poisons.They found that the death of an animal by tetanus toxinwas greatly delayed by the administration of these artificial

oxidases, and that with a slightly acid oxidase and tetanustoxin the animal did not show the slightest sign of intoxica-tion. Dr. Kastle’s valuable review is accompanied by avery useful bibliography containing references to 467 originalpapers.

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THE PREVENTION OF INFANTILE MORTALITYIN GERMANY.

ON p. 1569 of ’our current issue will be found an article Ion the Prevention of Infantile Mortality in Hesse which

describes a practical means of lessening an evil that is

engaging the attention of almost every country. Other

German States we learn are about to follow the example ofHesse, while the city of Berlin intends to devote .617,550during the present year towards combating infantile mor-

tality. Next year the town of Dresden intends as an experi-ment to distribute nursing prizes." A mother who nurses

her infant for three months will at the end of this periodreceive 20 marks (.El); if she continues to nurse it for

another two months she will again receive the same amount,which will also be granted after a further period of two

months-i.e., if a mother nurses her child for a period ofseven months she will receive in all E3. For this purpose.E500 will be provided, as well as .E50 to be distributed asprizes to midwives interested in promoting this kind of socialreform.

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LATENT CANCER OF THE STOMACH WITHMETASTASES IN THE BONE MARROWAND BLOOD SUGGESTIVE OF PER-

NICIOUS ANÆMIA.

CANCER of the stomach is frequently accompanied bysevere anaemia, which is usually of the secondary type, andis likely to be more marked if there are numerous metastases.If the metastases occur in the bone marrow there may be ! 1

characteristic changes in the blood, of which the most im-portant is the presence of numerous erythroblasts andmyelocytes. In the Glasgow Medical Joitrnal for April Dr.A. W. Harrington and Dr. J. H. Teacher have reported a

I

case in which the changes were suggestive of pernicious 1

anasmia. A woman, aged 64 years, was admitted into the (

Glasgow Royal Infirmary on August 9th, 1909, complaining 1

of pains in the back and legs, which began in June. Occa- i

-sionally she vomited brownish material and passed black , smotions. On admission there were marked anasmia and i

emaciation. The sacral and gluteal regions and the back iof the left thigh were tender. Examination of the abdomen 7showed only slight distension. Blood examination revealed : E

erythrocytes 1,600,000, leucocytes 14,000, haemoglobin 35 c

per cent., and colour index I - 09. A differential count of r

the leucocytes gave the following percentages : polynuclear i:

neutrophiles 63, polynuclear eosinophiles 0’7, lymphocytes s

. 16 7, large mononuclears and transitionals 18 8, and myelo-é1 cytes 0 8. There were 29 megaloblasts and 4 normoblasts toi 500 leucocytes. On some days the stools were offensive andf tarry, and evidently contained much blood, but there was no-.i mela-na after August 15th. The patient rapidly lost ground3 and died on Sept. 15th. At the necropsy old fibrous

l adhesions and white patches of tumour were found on both. pleurae and on the diaphragm. The stomach was attached

i to the liver by hard, white, fibrous tissue. About 2 inches,. of the lesser curvature were occupied by what appeared to be. a simple chronic ulcer, but the gastrophrenic and gastro-l hepatic ligaments and the great omentum were permeatedi by hard white tissue. In addition all round the ulcer was a

I hard flat tumour with raised margins which almost encircledthe stomach and caused an hour-glass contraction about its

middle. The abdominal lymphatic glands were also

involved. The ribs showed no nodular thickening, but theywere brittle and their cancellous tissue was uniformlyoccupied by pale fibrous-looking material. Both femora and

, the right humerus and some vertebrae were examined andshowed metastases. It is noteworthy that the blood con-dition was quite different from that usually seen in theanaemia of cancer of the stomach and was suggestive ofpernicious anaemia. But there were points of difference.Such a large number of erythroblasts is unusual in

pernicious anaemia, and if they do occur it is only fora short period. In this case many examinations were

made and the erythroblasts were always numerous. Again,the leucocytosis with a large proportion of polynuclearneutrophiles did not favour the diagnosis of perniciousanaemia. The pains in the bones were evidently due to themetastases. The literature of the blood changes in the bonemetastases of cancer is still very scanty. The recorded cases.

have in common marked diminution of red corpuscles, highcolour index, megalocytosis, and constant presence of myelo-cytes and erythroblasts in considerable numbers, many of thelatter being megaloblasts. Grave anaemia may occur in

cancer without metastases, but the occurrence of meta.

stases in the bone marrow is followed by the appear-ance in the blood of erythroblasts and myelocytes in largenumbers. They appear to be due to stimulation of the

marrow by the metastases. In a case in which there is

reason to suspect cancer the constant presence of these cellsshould suggest bone metastases. The presence of pains inthe bones would support the diagnosis.

MEDICAL INSPECTION OF SCHOOLS IN THEDISTRICT OF COLUMBIA.

IN view of the importance which is now attached to the

medical inspection of school children, an American corre-spondent sends us the following note on medical inspec-tion of the schools of the district of Columbia, whichcontains the capital city of the States :-" For 55,000children in 135 buildings there are 12 inspectors, ofwhom eight are white. Each receives$500 per annum.The inspector visits the school at 9 A.M., after the

teacher has inspected the classes for acute illness. Sickchildren are sent to the principal’s room or to a special roomto meet the inspector, who, after making a diagnosis,informs the parent if the child requires an excuse fromschool. Only the newer buildings have special examiningrooms, and there is no routine inspection of all children,which would require a larger number of inspectors, as over1000 scholars enter each year. It is the general opinion thateven these few inspectors are a distinct protection to thecommunity. Epidemics are much mitigated and measlesno longer goes though a school like a prairie fire. But timein such circumstances is lacking to examine for defectivesight or hearing, for adenoids, unsound teeth, or nervous