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gastric and duodenal ulcer (8,cases) ; judging fromrecent work on the nervous factor in ulceration thesemay, perhaps, represent dissimilar reactions to similarcauses.

STATUS LYMPHATICUS REDIVIVUS

BEFORE the section of anaesthetics of the RoyalSociety of Medicine on Dec. 1 Dr. John Taylor 1reviewed the history of lymphatism or status lym-phaticus from its birth in the seventeenth century, andgave an account of the anatomical facts and theclinical phenomena which justify its acceptance as anentity. He showed how misleading had been theconception which regarded enlargement of the thymusas the chief sign of the condition and pressure by thethymus as the chief cause of the symptoms. Theessential feature, without which a pathologist wouldnot recognise lymphatism, is generalised excess of

lymphoid tissue. Dr. Taylor gave brief details offourteen patients in whom he had found this excesspost mortem. All these patients had died withoutshowing either in life or after death any lesion whichcould be held responsible for their demise, except thelymphatism. Several had died during or just aftertaking ether as an anesthetic, never for any operationinvolving serious shock or excessive hoemorrhage. Healso expounded the modern view which associateslymphatism with deficiency of the adrenal cortex aswell as the one which maintains that there is no suchthing as status lymphaticus. In contrast with thislatter Dr. Taylor read the recorded opinions of threewell-known living pathologists all of whom supportedits existence. Experienced anaesthetists gave instanceswhich had convinced them of its reality. But therewere others, younger and therefore more sceptical,who seemed to think that lymphatism as the cause ofdeath at operation was merely a synonym forinefficient anaesthetic practice.

HEPARIN IN SEPTIC ENDOCARDITIS

THE physician who is faced with a case ofseptic endocarditis tends-in the words of CozensBailey—to "pick up his ball and go on to the nexthole." This disease has shown such resistance to

therapeutic endeavour that interest is certain to beroused by any new form of treatment. Two papersfrom the United States record the use of heparin inthis condition, supplemented in one series with sulpha-pyridine. The hypothetical basis for its use is thatthe streptococcus lies immured in the cardiac vegeta-tion sheltered by the constantly growing plateletthrombus from the depredations of leucocytes andantibacterial substances. If the progressive accumu-lation of platelets which forms the vegetation couldbe prevented leucocytes, natural immune bodies andchemotherapeutic agents might be able to reach theorganisms in effective concentration. Best 2 has shownthat heparin will prevent the formation of plateletthrombi in dogs so that it would probably stop theincrease in size of the vegetations in the human disease,a contention for which Friedmann, Hamburger andKatz offer some corroboration. Kelson and White 4

have combined heparin and sulphapyridine in sevencases of streptococcus viridans endocarditis; two caseshad reactions from impure heparin and treatment hadto be abandoned, and two died from the disease withina few days, but the remaining three were free fromall symptoms and had negative blood-cultures 19, 18and 4 weeks respectively after discontinuing treatment.1. Dr. Taylor’s paper will be published in full in an early number

of the society’s Proceedings.2. Murray, D. W. G., Jaques, L. B., Perrett, T. S., and Best,

C. H., Surgery, 1937, 2, 163.3. Friedman, M., Hamburger, W. W., and Katz, L. N., J. Amer.

med. Ass., Nov. 4, 1939, p. 1702.4. Kelson, S. R., and White, P. D., Ibid, p. 1700.

Heparin in a strength of 2000 units per 100 c.cm. ofnormal saline was administered by continuous intra-venous drip at a rate of 15-20 drops per min. for14 days; sulphapyridine (4-6 g. daily) being given fora week before, during, and for a week after theinfusion of heparin. These results are reported in apreliminary communication and the authors are carefulto restrain their enthusiasm, but it is clear that notherapeutic measures have been followed in the pastby such a high proportion of remissions of such longduration; Kelson and White would certainly agreethat enough time has not yet elapsed to claim thatthey are cures.

OSTEO-ARTHRITIS

Heberden first described his nodes in the 18thcentury, but it is still uncertain whether after all thesecurious bone swellings on the last joints of the fingersmay not be a form of gout. Dr. Ernest Fletcher’sHeberden lecture on osteo-arthritis 1 fitly commemoratesone of the great forerunners in the differentiation ofdiseases of the joints. It is a thoughtful and pains-taking study of 340 cases, which in his opinion repre-sent the incidence of the various types of rheumatismin a poor East-end neighbourhood. In this total the" infective "-i.e., the rheumatoid-cases number 67,with an incidence in three women to one man, andan average age of onset of forty-one. An even greater,preponderance of women and a younger onset havebeen noted amongst factory girls in the north-west andin Scotland. Fletcher has 18 cases in which infectivearthritis led to osteo-arthritis and 3 in which thissequence was reversed. " General " osteo-arthritisaccounts for 103 cases. Other forms were: of the

spine 34, associated with gout 15, traumatic 10, occu-pational 7, and of the hip-joints 15 cases. Statisticscompiled from any large number of cases are ofcourse fundamentally affected by the classificationadopted, and Dr. Fletcher might have been wise tofollow the main divisions proposed by the Ministryof Health in 1923 or those of the International Leagueagainst Rheumatism or the Royal College of Phy-sicians. In a miscellaneous outpatient practice the

proportion of osteo-arthritic cases (nearly two-thirdsof the total number of rheumatic cases) seems

unusual. In looking for the cause of a disease it isalways important to note the age of onset. Apartfrom the earlier onset of the more acute forms ofrheumatoid disease the lecturer’s figures will be gener-ally accepted, that neuritis and fibrositis as well asosteo-arthritis belong to middle and later life. Heregards the type of arthritis, often with obesity, seenat the menopause as distinct from osteo-arthritis, theprobability being that rheumatoid and menopausaland osteo-arthritis are all distinct diseases. He admits,like others, that the X-ray findings may be deceptive,as they often show advanced osteo-arthritic changes,in the spine, for example, without any clinical signsof disease. Thus, osteo-arthritis cannot be regardedsimply as a disease of wear and tear; some otherfactor, infective, metabolic, endocrine, traumatic, mustintervene.

Stamm’s view,2 derived from orthopaedic obser-vations, is that osteo-arthritis is emphatically a

mechanical arthritis, the grinding of the central areaof the articulation being connected with failure oflubrication. An important factor is also the conditionof the blood-supply-in one phase of the diseaseexcessive (hypersemia), in another defective or

entirely wanting. The tissues of a joint, like others,undergo atrophy under constant pressure, but often

1. Brit. J. Rheum. October, 1939.2. Stamm, T. T., Lancet, Sept. 30, 1939, p. 754.

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show overgrowth and hypertrophy under intermittentpressure. Stamm concludes that osteo-arthritis israther a process than a disease, associated, it may be,with previous arthritis or metabolic changes, as in

gout, or with malnutrition in old age.

PURPOSE IN NATURE

IN republishing his lectures in book form (seep. 1268) Professor Wood Jones has us in debt forshowing us again how much more than an anatomistan anatomist can be. He is not content with themechanistic biology of 30 or 40 years ago, to whichso many biologists still adhere. In too many ways thecombination of physics, chemistry and Darwinismseems inadequate to explain the phenomena of whatwe recognise as life. In particular it takes no accountof the idea of purpose, without which many happen-ings in physiology and in ontogeny simply do notmake sense. Admittedly no-one has a convincing non-mechanistic theory with which to satisfy the doubters,but Wood Jones prefers to wait with Langdon-Davisfor a yet unborn Einstein of biology, rather than toacquiesce in the view that biology is a branch ofphysical science and nothing remains but to work outits details. And in one delightful passage, with histongue in his cheek and his eye on Lawrence Hender-son, he asks why it comes about that inorganicconditions on the earth are so favourable to thedevelopment of life. The temperature, the atmosphere,the wide distribution of carbon and of water with itsmost peculiar physical properties, and sundry otherfeatures of the earth are all unique, or nearly unique,in the universe; and the odds against their chanceoccurrence in conjunction seem overwhelming. Arewe to detect an element of purpose in the ordering of £the inorganic world, adapting it to the needs of life? °?At this point the professor takes refuge with the poets,willing to believe with Francis Thompson that, somehowor other, there is a mysterious nexus between theflower and the star.

DRUG TRAFFIC IN WAR-TIME

THE Central Opium Board constituted by theGeneva Convention of 1925 has been in communicationwith the states, parties and non-parties, to that con-vention urging that the activities of the board must becarried on. Drug addiction became a serious menaceduring the last war, and it is feared that unless thetraffic in narcotics continues under internationalcontrol similar evils may arise this time. By a world-wide mechanism, with an international centre at

Geneva, effective supervision of the traffic in danger-ous drugs has been largely secured and it is claimedthat the contractual basis of the work under the Per-manent Central Opium Board remains solid. Accord-ingly all the states have been requested to remit tothe board the statistics and estimates which for thelast ten years have been furnished and from whichthe legitimate requirements of the several schedulednarcotics by each country are determined. Thegovernments of France, Switzerland and the UnitedStates have promptly indicated their agreement. Thecordial response of the last named, though not a

member of the League of Nations, is especially wel-come. It will indeed be remembered that it was theearly interest of the United States in the opium trafficthat led to their cooperation with the League’s organi-sation while consistently refusing membership thereof.The secretary of state in his reply observes that " thegovernment of the United States has regularly andthoroughly cooperated with the Permanent CentralOpium Board, and its associated organ the DrugSupervisory Body since their establishment, and

expects to do so in future, as in the past, as long astheir independence is maintained." It is upon theoperations of these two bodies that the entire fabricof international drug control principally rests, andthat it is of the highest importance to the whole worldthat the Central Opium Board and the supervisorybody should continue to function, adequately, effec-tively and without interruption, notwithstanding thedisturbance of war.

CEREALS AND RICKETS

IT is now nearly twenty years ago that Mellanbyshowed that cereals may produce rickets in younganimals; increasing the cereals in diets deficient inthe antirachitic vitamin intensified the symptoms ofrickets. The explanation then suggested that cerealsspeeded up the growth of the animals without at thesame time supplying sufficient calcium and phosphorusfor the bones has since been found inadequate,although possessing some validity. On the whole, thecereals with the largest content of Ca and P, suchas oatmeal, 4Ìiaize and wheat-germ, cause the lowestretention of these elements in the bones and teeth.A large part of the organic phosphorus of cereals, asof seeds in general, is in the form of phytic (inositol-hexaphosphoric) acid in combination with calcium andmagnesium. Phytin itself is not absorbed in thealimentary canal, its utilisation being due to break-down into inositol and phosphoric acid from bacterialaction in the intestine. Hot dilute acids have similareffect, a significant fact in’ view of the reducedrachitic action of cereals which have been boiled withacid. Harrison and Mellanby have tried the effectof feeding phytic acid and its crystalline alkaline saltto dogs. Both were highly rachitogenic when added toa borderline diet, the action being roughly comparableto that of oatmeal of similar phytin content. Therachitogenic action of sodium phytate, as of cereals,is antagonised by adding extra calcium to the diet.Commercial phytin itself is slightly antirachitic. Theamount of phytic acid in oatmeal is about twice thatneeded to precipitate the calcium in the cereal. Onthe other hand, Palmer and Mottram trace thetendency of cereals to produce rickets to their lowcalcium and high phosphorus content. This tendencycan, they find, be counteracted entirely by addingcalcium lactate to the diet so as to make the Ca : Pratio 1 : 0’5, and they conclude that the rachitogenicaction of cereals does not reside in the phytin theycontain, for the reason that the addition of phytinactually reduces the rickets. The first of these con-clusions is consistent with the facts put forth byHarrison and Mellanby; the other may be explainedby the fact that the commercial brand of phytin usedby both groups of workers was found by Harrisonand Mellanby to have a Ca : P ratio of 1 1.8 whilethe phytin prepared from oatmeal gave a ratio of 1 : 3,with a Ca : Mg ratio of 1 1-5 against 1 : 0-125 in thecommercial preparation. Harrison and Mellanbydraw from their work the practical conclusion thatthe rickets-producing action of cereals is to be over-come, not by increasing the P of the diet (as wouldhold if it were true that the cereal action is due tounavailable P), but by increasing the Ca intake-e.g., by drinking more milk. It seems likely, in fact,that the rachitogenic action of cereals only comes intoeffect in diets on or below the borderline of necessaryCa and vitamin D. It is unfortunate that, foreconomic reasons, these borderline diets so oftencontain a disproportionately high amount of cereal.

1. Mellanby, E., Lancet, 1920, 1, 1290.2. Harrison, D. C., and Mellanby, Biochem. J. 1939, 33, 1660.3. Palmer, N., and Mottram, J. C., Ibid, p. 512.