805

dislikes, and attempts should be made, as in Aberdeen,!to induce them to eat unaccustomed but protectivefoods. The board have recognised that children must beproportionately better fed than adults ; but to put thisprinciple into practice they will need dietitians as well ascooks. -

ALLERGIC EPILEPSY

EPIL)i.PSY, with its recurring fits, is an obvious candi-date for the allergic pigeonhole ; and the papers thathave been written about the wisdom of this course wouldthemselves fill a good few pigeonholes. A study of thesepapers induces something of the state of bewildermentproduced by a search for truth about current events inwar-time. A valiant attack on the subject has recentlybeen made by D. C. Dewar,3 though one would hardlyexpect that the patients he investigated-chronicidiopathic epileptics in a mental hospital-would providethe most promising field. Strong prima facie evidenceof a connexion between epilepsy and allergy was affordedby his finding that two-thirds of these patients (four timesthe proportion in a control group) gave either a personalor a family history of allergy, but he does not specifywhat conditions constitute allergy. To intradermal skintests he found that 58% of his epileptics, as against 4%of controls, were positive, many of the former showingmultiple sensitivity. Offending foods having beeneliminated from their diet, twelve epileptics were treatedby specific desensitisation. The intramuscular routewas adopted, and in half the cases an attempt made tocontrol dosage and avoid the risk of oversensitisation,and consequent increase of fits, by repeated eosinophilcounts. Sensitivity tests made at the conclusion of thecourse of injections and again three months later showedthat desensitisation had been achieved in most of thecases. A year later Dewar found that there had been adefinite reduction, in one case a most dramatic reduction,in fit incidence in seven of the twelve patients ; and thedecrease in fits, as well as mental improvement, can befairly well correlated with the degree of desensitisation.The value of the paper is greatly enhanced by full detailsof the techniques employed. The treatment of epilepsyas an allergic manifestation is of necessity a painstakingand laborious process ; and brilliant results are likely toremain exceptional. Anyone who wishes to try it outshould make a detailed study of this paper before hestarts.

PHYSICAL TYPE IN PNEUMOCONIOSIS

PEOPLE who are exposed to apparently equal risksfrom pneumoconiosis-producing dusts do not, of course,all succumb to those hazards. One differentiating factorbetween the affected and the unaffected might lie inconstitutional type, and indeed this view has not onlybeen put forward but to some extent acted on in selectingentrants to the mining industry. The belief is that byexcluding certain anthropometric types the incidence ofpneumoconiosis, or of pneumoconiosis complicated bytuberculosis, could be reduced. Statistical data haveso far been lacking and Aslett, Hart, Martin and Russell 4give but little encouragement to the hypothesis. Theirmaterial is derived from part of the wide survey whichhas been made in South Wales under the direction ofthe industrial pulmonary diseases committee of theMedical Research Council. Measurements of 540 workersat an anthracite colliery were available and could bedivided into groups of unaffected workers and those withpneumoconiosis of varying degrees. They comprisestanding and sitting heights ; weight ; circumference,anteroposterior diameter, lateral diameter and length ofthe chest ; and radiological measurements. From thesevarious indices have been calculated as well, and

comparison is made between the normals and the casesof reticulation, nodulation and major consolidation.

3. J. ment. Sci. 1941, 87, 608. 4. J. Hyg., Camb. 1941, 41, 169.

The general result of this careful study is that there islittle difference in bodily make-up between the affectedand the unaffected. For instance, the average heightdiffers negligibly so that there is no reason to think thatthe normals tend to be the " short and tubby " pyknicsand the affected the " tall and thin " asthenics. Whileone or two of the indices-e.g., height/chest lateral

diameter-suggest a slight association between type andreaction to the environment there is clearly-no differentia-tion sufficiently well marked to permit the identificationof the future pneumoconiotic case. To avoid recruitingthose particularly susceptible to the dust hazard-if theyreally exist-is, it goes without saying, most desirable.There is, unfortunately, no evidence here that suchguidance can be usefully based on bodily measurements.

PARALYSED PAPER

PAPER is badly needed for munitions of war, butmost of us would rather do without a meal than give upa book or a packet of letters. It must be done, and donenow, as our own contribution to the cause. And thereis an added reason for a profession which has its ownbooks and journals. The medical journals are feeling thepinch of paper shortage, and if this shortage becomesworse progress in medicine, and particularly the dissemi-nation of new knowledge, will be held up by difficultyin getting new work published. Doctorg themselves cando much to avert this threat, for we are among the largerusers of paper and run lawyers a bad second as hoardersof it. Most of the compound celluloses from which ourpaper is made come from abroad and are not likely to beplentiful while war lasts, but fortunately paper, like

currency, can circulate, and our aim must be to keep itcirculating. The textbooks of our student days, nowof historical interest only, the ledgers of thirty years ago,the incomplete and unbound sets of journals which we .could not consult even if we would, these, with the oldletters and out-of-date receipts which every literatehousehold possesses; must go to the salvage authorities.A Sunday afternoon of selective rummaging will meanless dust in the home, more room in the attic, and newfacts for old.

NOT SO STERILE WATER

MOST hospital bacteriologists are familiar with thenon-purulent spinal fluid which on receipt at the labora-tory yields a small gram-negative bacillus or otherindeterminate organism. They have usually suspectedthese organisms to be contaminants from the so-calledsterile water or saline in which the spinal needle is placedafter boiling or with which it is rinsed after sterilisationin an antiseptic fluid. They will therefore be grateful toProfessor and Mrs. Wilson Smith for showing by systema-tic investigation of 223 specimens of cerebrospinal fluidand I samples of " sterile water " used for rinsing thespinal needles that two-fifths of the spinal fluids werecontaminated and that more than a.third of the contami-nants probably came from the sterile water. Besides the

gram-negative water bacillus, which grows best in pep-tone water at room-temperature, Staphylococcus albus,coliform bacilli, diphtheroids, non-haemolytio strepto-cocci and other organisms were encountered, suggestingthat spinal puncture is often carried out without regardto the ordinary rules of asepsis. The resulting contamina-tion is irritating enough to the bacteriologist and mayeven lead the unwary astray, but the matter becomesmuch more serious when the same laxity of technique isused in the injection of spinal anaesthetics. Barrie 1

has reported 11 cases of meningitis with one death among96 consecutive patients operated on under spinalanaesthesia in one theatre. The meningeal infection.which was seldom severe, was characterised by the abruptonset of headache 7-10 days after operation, usuallyassociated with drowsiness, irritability, photophobia

1. Barrie, H. J. Lancet, 1941, 1, 242.