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for those who use sanocrysin, but for all who treattuberculosis. Dr. Secher follows the classificationof tuberculosis into the anatomical forms of exudative,degenerative or necrotic, and productive or prolifera-tive, which has now passed into common use on thecontinent, admitting that in practice it rarely givesa true picture of the clinical condition. The choiceof case for sanocrysin treatment is probably best madeon purely clinical grounds of history, signs, andsymptoms, with a good radiogram as a backing, andwithout reference to a supposed pathological picturewhich may or may not exist. To the actual admini’3tra-tion of the drug Dr. Secher finds three useful guides-temperature reaction (four types are recognised),erythema, and albuminuria, and he devotes a chapterto an analysis of all the untoward symptoms met withby various investigators. He agrees that it is notalways easy to differentiate between toxic symptomsdue to the gold-ion and those due to the liberation oftubercle endotoxin. Possibly the former may bemore easily detected now that minute quantities ofgold can be estimated in the urine and faeces bycolorimetric, electrolytic, or iodometric titration.Although most English workers appear to havediscontinued its use, Dr. Secher is a firm believer inthe value of antiserum combined with sanocrysin,as originally advocated by Mollgaard. The interest intuberculosis antiserum revived by sanocrysin investi-gation may itself lead to useful results. Dr. Secheradheres also to the large-dose method of administra-tion, never using less than 0-5 g. as a start, and aimingat a high concentration of sanocrysin, being guidedsubsequently by the patients’ reactions. Sanocrysinis a powerful drug, and cannot be used withoutfacilities for careful observation of patients at rest inbed and without expert nursing. There is no question.of ambulant treatment as in the case of tuberculin.All the necessary precautions have been taken byDr. Secher, and his records, given in full detail in thebook, are a monument of painstaking research. Ofthe ultimate results he is evidently convinced, forwriting of pulmonary tuberculosis he says: "Sano-crysin treatment (when employed in accordance with,right indications and carried through with sufficientenergy) will in all patients cause an improvement oftheir condition and will cure a large number...."Dr. Secher has had an extensive experience of sano-crysin and writes with conviction, but his readers maybe more reserved in their conclusions.

SPIDER BITES.IT is well established that some tropical spiders

are big enough and poisonous enough to catch andkill animals as large as small birds. But modernobservation has wiped out the tarantula myth, norare there now found in Gascony " spiders of thatvirulency that, if a man tread upon them, to crushthem, their poison will pass through the very soles ofhis shoes " as was once affirmed, Indeed, the pendulumhas swung so far the other way that arachnologistshave come to doubt whether spiders’ bites ever cause ill-ness in man. However, Dr. Emil Bogen, of Los Angeles, 1has seen 15 cases in recent years where a characteristicchain of symptoms has followed the bite of Latrodectusmactans, a big black spider which has an unfortunatehabit of lurking under the seats of privies. The chief,symptom is pain, which may occur in any or everypart of the body, irrespective of the site of the bite,and is accompanied with restlessness, nausea, dizziness,and other general signs. It is obvious from hisdescription that the patient’s complaints might easilybe put down to fright if only an odd case was seen ;they are, however, repeated with considerable regu-larity.in all the examples which have come to theLos Angeles General Hospital. The pain is oftenvery severe, and requires large doses of opiates tocontrol it. Dr. Bogen has had good results byinjecting the serum of convalescent cases. After afew days the patient recovers without any ill-effects.

1 Jour. Amer. Med. Assoc., 1926, lxxxvi., 1894; Archiv.Int. Med., 1926, xxxviii., 623.

The bibliography is, unfortunately, not printed in theArchivess " on account of lack of space," so that it isdifficult for anyone who is interested to follow thematter up; but in his summary of the literatureDr. Bogen points out that similar poisonings, often fromother species of Latrodectus, have been repeatedlydescribed in Southern Europe, Russia, Australia,New Zealand, Madagascar, and South America, andthere is evidently no reason to doubt that humanarachnidism is a reality.____

ROYAL MEDICAL BENEVOLENT FUND: THECHRISTMAS GIFTS.

IT has been the practice of the Royal MedicalBenevolent Fund for many years to present to theannuitants and some of the most necessitous granteesa Christmas gift. The Treasurer now makes an appealfor f370 to keep up this practice. The committeehas not in hand any special fund to draw upon tomeet this Christmas gift. The individual sum given,25s., is small, but the recipients are many ; in formeryears they have received this little augmentation oftheir narrow means and are no doubt looking forwardto its receipt this year. It is a friendly act on thepart of the managers of the Fund which should not beallowed to cease, and we trust that our readers willmake the continuance possible by finding the smallsum necessary. Subscriptions may be sent to theRon. Treasurer, Sir Charters Symonds, at theOffices of the Fund, 11, Chandos-street, Cavendish-square, London, W. 1.

MEDICAL SUPPLIES IN WAR.

TilE military authorities of the United States ofAmerica are clearly determined not to be caughtnapping by another war. All officers of the MedicalReserve are told precisely what will be their appoint-ments on mobilisation, whether to hospitals, fieldambulances, or as specialists. The question of medicalsupplies and their replacement is being carefullyconsidered, and so far as surgical instruments are

concerned, is discussed by Major R. C. Heflebower,Medical Corps, U.S. Army, in an address to theAmerican Surgical Trade, reported in the MilitaryStirneon for November. The arrangements for pro-viding instruments in war-time are in the hands of aspecial section of the Surgeon-General’s Office, a

section which has nothing to do with the presentsupply. First the section has to decide what instru-

.

ments will be wanted, and what specifications shall beput forward ; it is advised by certain Reserve officers,who are surgical instrument-makers, so that buyingshall be done commercially in the best way. Thenthe quantity of stores wanted must be defined.Ultimately that will be settled by the scale ofmobilisation, but at present tentative contracts areput out, and the tenders are advised upon by theReserve officers, who discuss whether they can bebetter assigned - whether, for instance, similarcontracts for forceps should be given to eachcontractor, or whether all large forceps should bemade by one and all small forceps by another. Thethird question is, whence shall the instruments beobtained ? At first some can be purchased; thiswill be the work of the Reserve officers, who (havingregard to the needs of the civil population) will buywhat is immediately available. The rest must bemade. The industry, however, may not itself be ableto cope with the demand, and it may be necessaryto call on workers in associated trades. Thus surgicalneedles or scissors might be roughed out by otherworkers and finished by the surgical instrument-makers provided that there were enough skilledmechanics. So as to avoid a shortage the trades canget a lien on the services of mechanics engaged else-where, and these men will be scheduled as indis-pensable. Moreover, the raw material, power, andtransport required for this work must all be arrangedfor in advance by the Assistant-Secretary for War,in the light of the needs of other essential services.It is hoped that working along thse lines there willbe little industrial confusion in the change from peace

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to war, and that the Army will never be held up forexpected supplies. The section has also in mind thedanger of accumulating a large surplus of storeswhich, if thrown on the market, must disorganiseindustry in the difficult post-war days. Such forcsightis astonishing. ____

A VACCINATION INQUIRY.IN an address delivered before the Berne Medical

Club, Dr. A. Hauswirth, the medical officer of healthfor that city, reports that a committee consistingof two medical men, including himself as chairman,and three laymen, one of whom was an antivaccina-tionist. and the other two opponents of all compulsorymeasures though alive to the advantages of vaccina-tion, was appointed by the Berne City Council toinquire into the supposed evil effects of vaccinationamong approximately 40,000 persons who had beencompulsorily vaccinated between the spring of 1922and the autumn of 1924 on the occasion of a small-poxepidemic. Only 14 cases in all were reported to thecommittee which after a careful investigation foundthat there were only four cases in which a possibilityor probability of a connexion between the diseaseand the previous vaccination could not be excluded.The first case was that of encephalitis lethargica ina youth aged 17, who developed the symptomsshortly after vaccination. and made an almost com-plete recovery. The second case was one of fatalsepticaemia following measles which occurred in a

girl aged 9 years, vaccinated on the third or fourthday of the incnbation period. In the third case agirl aged 14, six days after vaccination, developedfollicular tonsillitis, followed by fatal septicsemia.The fourth case was that of a boy aged 13, who wasvaccinated six days after recovery from an acutegastro-intestinal attack, accompanied by circulatorydisturbance. About a week later symptoms of acutesepticaemia developed, and death took place. Thethree deaths, therefore, were due to septic processes,in which the onset of the disease probably coincidedwith the performance of vaccination. The lesson tobe learnt from these cases is that on the slightestsuspicion of an acute infective or other acute diseasevaccination should not be performed. In conclusion,Dr. Hauswirth remarks that as in only 0-01 per cent.,or in 1 out of 10,000 vaccinations, could any evileffect be attributed to the process, the occurrenceof such cases is far outweighed by the enormousbenefit conferred by the absolute protection againstsmall-pox provided by vaccination.

SAPONIFIED TOXIN IN SCARLET FEVER.

Prof. W. P. Larson, of Minnesota University,attended a meeting of health officers of the State ofOhio in the middle of last month, and gave anaccount of his method of detoxicating toxin and theresults which he has had in producing active immunityagainst scarlet fever and diphtheria. Two years agohe was investigating the cause of pellicle formationin bacterial cultures, and to test his theory thatsurface tension rather than the presence of oxygenis the determining factor in this phenomenon, heintroduced soap solutions into the culture media.Finding the appropriate concentration of soap, hewas able to make all pellicle-forming organisms groweither in the liquid medium or at the bottom of theflask. The critical surface tension above whichpellicle formation will always occur he found to be42 dynes. Non-pellicle formers can be made to formpellicles if they will grow on a glycerine medium,and convert the glycerine into fatty bodies. Inci-dentally he observed that the tubercle bacillus losesits pathogenicity when grown on low-tension mediainstead of as a pellicle, and he claims that by usinga medium containing soap he can produce in a fewdays cultures similar to the B.C.G. cultures whichCalmette obtains by growing tubercle bacilli in bilemedium for 13 years. The soap found most suit-able as regards viscosity is a highly purified castor1 Schweizerische medizinische Wochenschrift, Nov. 20th, 1926.

oil soap. These experiments led Prof. Larson toinvestigate the possibility of obtaining non-pathogenicstrains of other bacilli. He was able to give detoxi-cated pneumococci to rabbits in doses which wouldhave been certainly lethal without the admixture ofsoap, and he even succeeded in immunising guinea-pigs to tetanus, at the same time bringing evidenceto support Ehrlich’s theory that the more sensitivean animal is to a given toxin the greater will be itsantibody formation in response to that toxin. Allbacterial toxins, he found, can be detoxicated bythis method without losing their immunising pro-perty, the only exception being that produced byB. botulinus. The first human volunteers were

treated with a 1/10 L. + dose of diphtheria toxin in1 per cent. castor oil soap, but it was found that thesame dose in 2 per cent. soap gave less reaction. Thelatter mixture was used on 800 medical students,and over 60 per cent. of Schick-positive reactorsbecame Schick-negative within 10 days. Applyingthe same principle to scarlet fever toxin (Dick), hefound that a 3000 skin-test dose could be covered with2 per cent. soap. This solution causes some reactionsin adults, for whom a 3 per cent. soap solution isfound to be more satisfactory. This dose immunises90 per cent. of positive reactors within three weeks,and has been used as a prophylactic in variousinstitutional outbreaks, apparently with success. Asa method of prophylaxis it has none of the unpleasantconcomitants of passive immunisation with Dochezserum. More recently a combined scarlet fever anddiphtheria saponified (3 per cent.) toxin has beenused; this is said to cause less reaction than theseparate use of two saponified toxins. It shouldbe added that Prof. Larson has been able to recoverthe toxin from his solutions by adding a simple saltsolution, and has thus satisfied himself that there isno truth in the suggestion that the toxin is destroyedby soap. At present he recommends that two dosesof the combined toxins be given at an interval oftwo to four weeks. Five thousand school-childrenin Minneapolis were given the first dose recently,and there was only one complaint-of a sore arm.The discussion which followed Prof. Larson’s addresswas led by Dr. Roger G. Perkins, professor of hygieneat Western Reserve University, who described thesuccessful use of Prof. Larson’s toxin in Cleveland,and uttered a warning against allowing the publicto believe that biological methods would ever besuccessful in 100 per cent. of cases. Dr. Petersdescribed successful arrest of epidemics of scarletfever in Cincinnati by the use of the same toxin,and other speakers also gave personal testimony toits efficacy in practice. In answer to inquiries aboutthe possibility of obtaining the toxin, Prof. Larsonsaid that he had sent out over 50,000 doses of scarletfever toxin, and that the present demand was beyondthe means of a teaching institution. He has thereforeinstructed one of the large commercial houses inhis technique, and his material will soon be on themarket.

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THE MEDICAL USES OF RADIUM.THE stock of radium salt entrusted by H.M.

Government to the Medical Research Council is beingused at 11 centres, distributed through the country,for the treatment of disease. Every year these centresfurnish a report of their activities to the RadiologyCommittee, appointed jointly by the Council and theBritish Empire Cancer Campaign, which body hasadded to the stock of available radium, and on thiscommittee falls the difficult duty of collating thereports-diverse as to manner as well as matter-into a readable account of progress made. Thisyear, in No. 112 of the special report series,t whichcontains reports on cancer of the breast, uterus,mouth, nasopharynx and larynx, oesophagus, rectum,bladder, and prostate, no reference is made to thetreatment of rodent ulcer or to non-malignant con-ditions. The reason given for these omissions isthat suitable radiological treatment for the former

1 H.M. Stationery Office, 1926, pp. 34, is. 6d.