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ANNOTATIONSCENTENARY OF THE ROYAL STATISTICAL

SOCIETY

ON April 17th the Royal Statistical Society willcelebrate its hundredth birthday. In the afternoonthe Prince of Wales, hon. president of the Society,will preside over the Centenary meeting, and in theevening Lord Meston, president, will take the chairat a centenary banquet. The International StatisticalInstitute, which was founded at the time of theSociety’s jubilee, is holding its biennial session inLondon, so that the meetings will be attended bydistinguished statisticians from all parts of the world.The founders of the Statistical Society of London(the style was changed to Royal Statistical Societyafter the jubilee) were men of insatiable curiosity ;the first volume of the Journal (now in its ninety-seventh volume) provides information respecting thenumbers of bibles in houses of working people, thenumber and proportion of perpetrators of burglariesescaping, the number of fourpenny pieces issued in1836-38, the dislike of the French by the NewZealanders, experiments with manure in North-umberland, and much, very much, besides.

Primarily the founders were interested in socialphenomena, and so it is not surprising that, from thefirst, medical topics occupied a good deal of attention.The first volume contains a detailed study of thesickness and mortality among the troops in theWest Indies, by Colonel A. M. Tulloch, and in thefourth volume the name of the greatest of medicalstatisticians, William Farr, appears as the author ofa paper on the mortality of lunatics. Medical menhave in fact served the Society with a zeal out ofproportion to their numerical strength. At the presenttime the number of medical fellows does not greatlyexceed the number of peers of the realm on theSociety’s roll, but, in our own generation, Sir ShirleyMurphy, Sir Arthur Newsholme, Dr. ReginaldDudfield, Dr. T. H. C. Stevenson, Prof. MajorGreenwood, and Sir William Hamer have been veryactive members; the three survivors, Newsholme,Hamer,and Greenwood, are members of the council nowin office. In earlier times the Society owed much tothe labours of four medical men, each of whombecame president. William Farr was president in1871, William Augustus Guy in 1873, T. GrahamBalfour in 1888, and Frederic J. Mouat in 1890. Ofcourse, as a statistician, the name of Farr standsfirst-indeed, we need not restrict our list to medicalpresidents if we wish to put the name of Farr at itshead-but in the grateful memory of the Society thename of William Augustus Guy (1810-85) has prece-dence of any other, lay or medical. Guy was anenthusiastic statistician, his first contribution to theJournal, " On the Value of the Numerical Methodas applied to Science, but especially to Physiologyand Medicine," appeared in the second volume, hislast in the forty-fifth volume ; he was hon. secretaryfrom 1843 to 1868, and at his death bequeathed alarge sum of money to the Society. In his honour,the medals presented by the Society to eminentstatisticians are called Guy medals and bear excellentportraits of the Society’s distinguished fellow andbenefactor.

With the increasing emphasis put upon the pre-ventive aspects of medical science-not to speak ofan increasing resort to quantitative methods in theevaluation of clinical data-the importance to ourprofession of the science for which the Royal Statistical

Society stands becomes greater. We hope that inthe second century of the Society’s existence theproportion of its medical fellows will increase andthat their enthusiasm may match that of Farr andGuy.

MALARIA IN THE ARMY IN INDIA

THE introduction of a new method of treatmentfor any disease is an event; malaria is of suchimportance among human ills that the finding of adrug to supersede quinine would be little less than arevolution. Isolated therapeutic trials may or maynot hold when tested out in the light of a widerexperience ; the public health commissioner with theGovernment of India has had to ask himself exactlyhow much the Army in India has profited from recentdevelopments in malaria therapeutics. His answeris contained in the second volume of a report recentlynoticed in this column.1 It would be too much toexpect that malaria had surrendered pride of placeas the chief scourge of the Army in India. It stillaccounts for 14-5 per cent. of admissions to hospitalfor all forms of injury and disease, and during 1932totalled some 4634 cases ; this does not include out-patient attendances, nor does it give any idea of theloss of general efficiency caused by malaria. But of asteady improvement during the last few years therecan be no doubt, for the rates per 1000 sick withmalaria have fallen from 291 in 1928 to 91 in 1932;and that in spite of the fact that climatic conditionsin 1932 were favourable for an outbreak and thatanti-malaria measures had been curtailed on groundsof economy. Presumably, then, some new factorhas been introduced which has influenced the situation.Partly by a process of exclusion, partly from accumu-lating clinical evidence, the conviction is growingthat a more extensive and intelligent use of Plasmo-quine is mainly responsible for the good record of1932. That this year, like its three antecedent years,was liable to a high malaria incidence, is made likelyby the number of sufferers among the Indian troops-a proportion considerably in excess of former years-who were not treated with plasmoquine, and whodo not contract malaria in cantonments but in theirnative villages. Although the amount allotted to

sanitary and engineering field works was only 10d.

per head of the military population (as compared withil 15s. 4d. for similar measures in the Panama zone),yet there has been a steady improvement in the

quality of the anti-malaria measures, owing to theinfluence of Lieut.-Colonel J. A. Sinton, V.C., whodirects the malaria survey of India. Anti-malariaofficers who have been through the course at the

experimental station at Karnal are filled with anenthusiasm which rises superior to the many practicaldifficulties with which they are faced.On the prophylactic value of quinine the consensus

of Army opinion is favourable on the whole, mainlybecause it diminishes the symptoms and reduces theliability to pernicious attacks of subtertian fever.The prophylactic value of plasmoquine was tried outon a large scale in Burma between September, 1931,and February, 1932. Well over 5000 officers and mentook part in this experiment. The dose given was0-02 g., above which toxic effects are occasionallyobserved, and it is probable that 0-03 g., in combina-tion with quinine or atebrin, would be more effective.It is clear however that the smaller dose has adefinitely delaying action without interfering in any

1 THE LANCET, March 17th, p. 581.

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way with the subject’s physical activities and generalwell-being. On the whole the results of the Burma

experiment were good, plasmoquine undoubtedlymaterially reducing the relapse rate. It was generallygiven in combination with quinine ; atebrin wasintroduced too late in the season for any conclusionsto be reached about its comparative value.

LANARKSHIRE MILK EXPERIMENT CONFIRMED

IT will be remembered that during a period offour months in 1930 an investigation on an unpre-cedented scale was carried out in Lanarkshire todetermine the effect of adding extra milk to the dietof school-children. Grade A tuberculin-tested milkwas supplied raw to 5000 children of 5 to 12 years ofage, while another 5000 children received the samemilk after it had been submitted to low-temperaturupasteurisation. Ten thousand children served as

controls. At the beginning and end of the investiga-tion the children were measured to the nearest eighthof an inch in height and to the nearest ounce inweight. The results, which were recorded 1 byLeighton and McKinlay, showed that the addition ofmilk to the diet led to an increase in the rate ofgrowth as reflected both by height and weight, andthat in so far as the conditions of the investigationpermitted there was no apparent difference in theireffect on growth between raw and pasteurised milk.This second conclusion was challenged by Bartlett,and by Fisher and Bartlett, who, on analysing thefigures in a different way, satisfied themselves thatthe growth-response of children on raw was greaterthan that of children on pasteurised milk. Thewhole plan of the investigation was criticised 2 by" Student " on the grounds that raw and pasteurisedmilk were never given in the same schools ; that theinitial heights and weights of the children in thecontrol series were greater than those of the childrenwho were given milk ; and that since the childrenwere weighed in their clothes, and since the first

weighing was in February and the second in June,there may have been a differential shedding of clothesby the more prosperous control and the less prosperousmilk-fed children. " Student " suggested that in anew investigation on the comparative value of rawand pasteurised milk probably more information atmuch less cost would be obtained by working withidentical twins.

Though this principle was not strictly applicable tothe Lanarkshire experiment, it occurred to Prof.Karl Pearson that a great deal of information mightbe obtained if the children in each class-controls,raw milk feeders, pasteurised milk feeders-havingapproximately the same height and weight could becompared. This suggestion was followed up, andMiss Ethel M. Elderton, D.Sc., working in Prof.Pearson’s laboratory, has recently recorded 3 theresults of such an analysis. The original cards wereobtained and sorted for each sex into the year ofbirth. Selection was then made of a child from thecontrol series who was of the same initial height,the same weight within 8 oz., and the same agewithin a month, as one who had been given milk.The following comparisons were then made : controlswith raw milk feeders ; controls with pasteurised milkfeeders ; and raw with pasteurised milk feeders.By this method only the average children could becompared ; the shortest and tallest, and the lightestand heaviest had to be excluded. It was found

1 See THE LANCET, 1931, i., 145.2 Biometrika, 1931, xxiii., 398.3 Ann. Eugenics, 1933, v., 326.

(1) that those who have extra milk generally gain inheight over those who do not, and that the oldergirls gain more than the younger when pasteurisedmilk is taken, but that otherwise younger and oldergain equally in height by having extra milk ; (2) thatthose who have extra milk generally gain in weightover those who do not ; that girls gain more thanboys, and the older girls than the younger ; andthat this difference associated with age is greaterwhen raw than when pasteurised milk is taken ;(3) that there is no evidence that raw milk has anadvantage over pasteurised or pasteurised over rawin increasing growth when the two are directlycompared on this selected material ; and that thequestion of the value of pasteurisation turns practi-cally on the elimination of possible sources of disease,or on determining whether cases of certain diseasesare less frequent when pasteurised rather than whenraw milk is taken. u

These conclusions are largely in agreement withthose originally drawn by Leighton and McKinlay,and lend no support to the view that low-temperaturepasteurisation produces a significant change in thecomposition and food value of milk.

LABORATORY DIAGNOSIS OF CHOLECYSTITIS

Two recent papers show how much can be done toclear up the diagnosis of acute and chronic chole-

cystitis respectively by laboratory tests. In the first,’Dr. Nils Liedberg, of Lund, Sweden, gives an accountof 145 clinically certain cases of cholecystitis themajority of which had been followed systematicallywith sedimentation tests. His material also includes31 cases of uncomplicated gall-stones, the diagnosisof which was in every case verified by operation andthe microscopic examination of the gall-bladder. Hefound that during the first 24 hours of an acute

cholecystitis there is, as a rule, no increased rate ofsedimentation of the erythrocytes. During the secondday 90 per cent. of the cases show an increased rate,the average one-hour rate being 29 mm. During thethird, fourth, and fifth days this rate rises continu-ously, the average for these three days being 48, 57,and 61 mm. respectively. The sedimentation-rateappears to behave as if it were quite independent ofany jaundice that may be present. In the majorityof cases of uncomplicated gall-stones the sedimenta-tion-rate is normal ; in the rare cases in which it isincreased the departure from normal is only slight.Dr. Liedberg concludes that the sedimentation testis, perhaps, better than any other in reflecting thepathological changes ; it may throw light on theclinical progress of acute cholecystitis, provided it iscarried out systematically. In chronic cholecystitisDr. Etienne Chabrol and Dr. Andre Busson2 havefound the quantitative analysis of biliary pigmentsin the blood useful in diagnosis and as a guideto treatment. They publish a table which includes45 patients who had been kept under observation forseveral weeks after a bout of pain without showingthe least tinge of jaundice of the conjunctiva. Never-theless, according to this table, 39 of these patientshad a degree of bilirubinaemia well above the 2’0 mg.limit. These authors regard the normal limits ofbilirubin in the blood-serum as 0-8-1-6 mg. per100 c.cm. of serum, although it might be imprudentto diagnose hypercholsemia for any reading below2-0 mg. The amount of cholesterin in the blood isless significant. After an examination of more than200 patients, the authors found that the concentration

1 Acta Chir. Scand., 1934, vol. lxxiv., Fasc. I.-III.2 Presse Médicale, Feb. 10th, 1934.