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caretaker, a cleaner, and the canteen manager. Someclerical help may be needed too. The qualifications fora warden are noteworthy : it is not the’brilliant dominat-

ing figure, the life-and-soul of the party, who makes agood warden, but the " patient fellow, not too anxiousto lead, but willing to allow local interests to develop."These interests will include not only drama, hobbies,social evenings, and other forms of recreation, but educa-tional activities, in the form of lectures, discussion

groups, and’demonstrations. Poultry and rabbit clubsand an allotment section may prove popular, but itis for members to decide what form their activities areto take. Opportunities for outdoor games such as tennisand bowls will be welcome, though this must dependon the site. ’As to the cost, the report suggests that education

authorities should survey the needs of their areas andinclude proposals for community centres in their schemesfor further education under the Education Act. Oncethe centre is built, income will be derived from lettings,canteen profits, subscriptions, and profits on dances,.whist drives, and other social functions. The educationauthority will usually contribute towards maintenanceand half their expenditure is covered by the Ministry.The report suggests that the authority should meet thewarden’s salary and the costs of structural maintenance,but that members of the centre should make " themaximum contribution compatible with the generalstandard of their incomes " towards the cost of running it.

PEPTIC ULCER AND CAFFEINE

THE dyspepsia often associated with over indulgencein tea has commonly been attributed to the astringentand ferment-precipitating properties of the activetannins always present in the cup. But half a pint ofstrong tea may easily contain 2 grains of the alkaloidcaffeine, which forms the basis of the familiar euphoriaand relief from fatigue. Excessive tea-drinking mighttherefore aggravate some psychosomatic factors of

accepted importance in the evolution of chronic pepticulceration. The local action of caffeine has been studiedin many countries-sometimes revealing perplexinginconsistencies. For example, Pincussohn in 1906,using the Pavlov-pouch method in dogs, found thatcoffee increases the volume and acidity of the gastricsecretion ; but 22 years later Goldbloom employingthe same method could not observe any secretory changewhatsoever when caffeine was substituted for crudecoffee. The subject is of serious import not only in thiscountry of habitual tea-drinkers but also abroad. Itwas estimated in 1912 that an average of 10 lb. of coffeeand 1 lb. of tea were used annually per head in the’United States. The corresponding dose of pure caffeinewould be about 2 ounces per person, which would meanan even greater consumption among the adults of thecommunity.

In Chicago Roth; Ivy, and Atkinson have modifiedthe traditional caffeine test-meal technique and havemeasured not only the rise in gastric acidity but also thetotal volume of acid secreted. In " normal " subjectscaffeine consistently provoked a rise in acidity, volume,and total acid, the increased secretion continuing forabout 40 minutes. In ulcer patients the same effectin greater degree was noted, and the increased -rate ofsecretion continued unabated for 2 hours or more. Theyregard this prolongation of response as characteristicof the action of caffeine in ulcer or ulcer-predisposedpeople and found it much more pronounced than thelengthened response following alcohol. The mucosalchanges induced in the stomach have not been recordedin man, but well-marked hyperaemia of the mucosafollowed by cyanosis has been seen in cats receivingcaffeine intravenously or by mouth. The addition of

1. Roth, J. A., Ivy, A. C., Atkinson, A. J. J. Amer. med. Ass. 1944,126, 814.

caffeine in suitable form to a cat’s daily food soon causeswidespread gastric ulceration,2’but not of :a type remini-scent of the chronic lesion in man. By the alternateadministration of caffeine and histaanine such ulcerationcan be induced in a few hours, histamine being ineffectivewhen given alone. Dragstedt 3 has drawn attention to acognate synergism in man. He observed that the totalsecretion of acid provoked by histamine and caffeinein combination is much greater than the sum of the twoseparate responses. When the action of caffeine is

compared with that of actual beverages it is apparentthat caffeine is not the sole secretogogue involved. So-called decaffeinated coffee, and even substitutes preparedfrom roasted cereals, cause similar outpourings of acid,smaller in amount but nevertheless commensurate withthe caffeine response. The coffee effect itself probablyrepresents the combined actions of caffeine and of stimu-lant principles present in the coffee oil, responsible formuch of the flavour and aroma. Coffee contains about15% of oily matter, a mixture of higher fatty acidcompounds and lipoid-soluble constituents. After roast-ing, this oily portion, now called " caffeol," containsconsiderable amounts of the cyclic aldehyde furfurol,together with irritant pyridines, some valerianic acid,and other compounds.

It has been suggested that alcohol produces its effecton the stomach indirectly by releasing histamine. Thesame view might be taken of the action of any agentcapable of inflicting microchemical trauma, such as

the irritant principles of condiments, and the idea couldbe extended to cover many of the odd constituents of thetea-coffee group of beverages. Whatever their explana-tion, if the findings and deductions of Roth and hiscolleagues are accepted, patients with persistent or

relapsing peptic ulceration should be advised to restricttheir caffeine-containing drinks, to avoid especiallyany simultaneous use of caffeine and alcohol or condi-ments, and to be sparing even in their consumptionof coffee substitutes.

PATHOLOGY OF CONCUSSION

RECENT years have brought a fuller understanding ofthe nature of concussion. The careful work of Denny-Brown and Ritchie Russell 4 showed that, in animals,concussion might be unaccompanied by any grosspathological changes; and that, judging by the functionalchanges observed, the condition was due to transientparalysis of centres in the medulla oblongata. Fromtheir negative histological findings, they went so far asto suggest that these functional alterations were un-accompanied by any structural changes in the neurones.The disseminated petechial haemorrhages, often linkedwith the name of Duret, who stressed their importancein concussion, must therefore be regarded as an addi-tional and unessential feature resulting from severer

grades of trauma. Investigation of the more subtle

pathological changes occurring in neurones, particularlythe finer shades of chromatolysis, needs rigorous con-trolling, and obviously=since cadaveric changes alsoinvolve chromatolysis-the experimental method isessential. These conditions are fulfilled in a study byWindle, Grant, and Fox 5 who found, in guineapigs, thatvarying grades of chromatolysis were demonstrable inthe tegmental regionof the brain-stem, and in the spinalcord. The cells most constantly affected were the largeneurones of the red nucleus, and the lateral vestibularnuclei ; the basal ganglia and cerebellar cortex were notaltered. But the cells of any one group were not equallyaffected, and the number of neurones lost in post-concussion was probably only a fraction of the number2. Judd, E. S. Bull. Amer. Coll. Surg. 1943, 28, 46.3. Dragstedt, C. A., Gray, J. S., Lawton, A. H., Ramirez de Arellano,

M. Proc. Soc. exp. Biol. NY, 1940, 43, 26.4. Denny-Brown, D., Russell, W. R. Brain, 1941, 64, 93.5. Windle, W. F., Grant, R. A., Fox, C. A. Surg. Gynec., Obstet.

1944, 79, 561.

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functionally altered at an earlier stage. In one of theircontrol groups the animals were asphyxiated and re-vived, while in another group hemisectio nof the uppercervical cord was ’performed. In these groups theresulting chromatolysis in the affected neuiones -wasfound to differ from that observed in concussion, bothin character and in the time of onset. Petechial hmmor-rhages were found only with the severer grades oftrauma. Moreover there was no cedema of the brainand no glial reaction in the later stages afterconcussion.The localisation of these chromatolytic changes in

concussion thug agrees well with the observations of

Denny-Brown and Ritchie Russell on the functionaldisturbance. It may be supposed that, with slightdegrees of concussion, the alterations in the neurones arecorrespondingly trivial and reversible. Severer gradesof injury will result in proportionately heavy damage tothe neurones, with the ultimate loss of some of them.The frequent complaint of post-concussional giddiness,and sometimes tinnitus, without demonstrable clinicalsigns is also explained. Lastly the suggestion made byJefferson that the brain-stem has a good deal to do withthe control of consciousness receives further support.

INFECTION FROM DUCK’S EGGS

IN his annual report for 1926 the chief medical officerof the Ministry of Health drew attention to the possi-bility that improperly cooked duck eggs could causegastro-enteritis. This warning has been repeated manytimes, and W. M. Scott 4 described several salmonellaoutbreaks in which duck eggs caused severe and oftenfatal infections. Bacterium aertrycke-or to give it its

proper title, Salmonella pM-’MMMMH—has causedmost of the trouble, but other salmonella types may actin a similar way. Gordon and Buxton 5 have helped toclose another link in the chain of evidence against theduck. They describe a case of gastro-enteritis in a

man who had a fried duck egg breakfast and died sixdays later. Bact. aertrycke was found in his blood andfaeces. Three of the four ducks which supplied his eggsgave serological evidence of Bact. aertrycke infection, butthe results were variable. ’ Of 16 eggs laid by the ducks,3 contained the organism; it was isolated 3 times i romboth yolk and shell, from the ovaries of 2 of the ducks,and from the intestinal tract of the third. There is

good evidence, therefore, that the fatal illness and theduck egg breakfast were related to each other ; phage-typing of the duck and human strains of Bact. ae?-ti-ye7,emight have clinched it.

If there is no longer reasonable doubt about theoccasional contamination of duck eggs there are still

’ interesting questions to answer. Why, for example,should this particular type of salmonella be apparentlyso common among ducks while relatively few of thenumerous other types are reported ? Gordon and Garside6suggest that fluctuation in the agglutinins for Bact.lLertrycke of duck sera is associated with ovårian activity ;and ducks appear to have the antisocial habit of inter-mittent excretion of the organism. Are ducks the onlybirds, domestic or wild, in this country which commonlytransmit salmonella infections to man ? The hen suffersfrom infections caused by a considerable number ofsalmonella types, and recent American work has shownthat large epidemics of salmonella infections also occuramong turkeys. Wood-pigeons, pheasants, and otherbirds are also occasionally affected. It is important toascertain what part domestic fowls play in the spread ofthese infections and of the many new varieties of sal-monella which lately appear to have come to stay with

3. Jefferson, G. Brit. med. J. 1944, i, 1.4. Scott, W. M. J. Path. Bact. 1932, 35, 655.5. Gordon, R. F., Buxton, A. Bull. Min. Hlth emerg. publ. Hlth

Lab. Serv. February, 1945, p. 46.6. Gordon, R. F., Garside, J. S. J. comp. Path. 1944, 54, 61.

us. There is common ground here for the public-healthand veterinary pathologist, and it may well be that thedomestic duck will soon have new company in the dock.Meanwhile there is something to be said for the Germanlaw which compels duck eggs to be indelibly stamped as.such, and for the advice that they should be boiled forat least eight minutes or thoroughly baked.

PENICILLIN-ALBUMIN

IN their work on administration of penicillin by mouth,Harwood Little and Lumb 1 found that if penicillin i&dissolved in raw egg it will withstand changes of

hydrogen-ion concentration which will seriously affectpenicillin dissolved in plasma or milk and will destroysolutions in water, saline, or cholesterol. In studying theefficiency of various penicillin mixtures given by mouthafter a dose of alkali they concluded that a penicillin-eggmixture was the best; and, in their early experimentsat least, it seemed that the blood-serum remained bac-teriostatic longer.after such a dose than when penicillinis given intramuscularly. We now learn that, at theSquibb Institute in New Brunswick, Chow and McKee 2’have shown that, unlike sulphonamides, penicillin, com-bined with human serum-albumin, retains its antibioticactivity. The penicillin-albumin mixture can be preci-pitated in 50% alcohol and thus freed from unboundpenicillin, which dissolves. The compound can then beredissolved in water and finally obtained in a dry powder.When given intramuscularly to mice it was more slowlyexcreted than sodium penicillin. Studies of its stabilityin acids and alkalis have not yet been published, but fromthe observations of Little and Lumb we may hope thatit will prove more resistant than ordinary penicillin tochanges of pH such as it would encounter when given bymouth.

LIBRARY HOSPITALITY

TILL the beginning of this year the Royal Society ofMedicine placed a limit on the number of times outsidevisitors were allowed to use its library at 1, WimpoleStreet, London, Wl. As an experiment, it has temporar-ily relaxed this restriction, and a room on the secondfloor has been set aside for the use of visitors, with amember of the staff in attendance to fetch the books anddocuments thev want. Manv doctors and scientifieworkers who need the occasional help of the library havebeen glad of this facility, and at least until the beginningof Tune the society will continue its generous policy of theopen library door.

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The annual meeting of the Association of Surgeons ofGreat Britain and Ireland will be held at the RoyalCollege of Surgeons, Lincoln’s Inn Fields, London, WC2,on Wednesday and Thursday, May 2 and 3. The twomain subjects of discussion will be the education of thesurgeon (openers : Prof. Ernest Finch, Prof. J. R. Lear-month, Prof. John Kirk, Prof. W. G. Barnard, and Major-General W. H. Ogilvie) and carcinoma of the recto-sig-moid (openers : Mr. R. Scott Mason, Dr. Cuthbert Dukes,and Mr. 0. V. Lloyd-Davies).

1. Little, C. J. H., Lumb, G. Lancet, Feb. 17, 1945, p. 203.2. Chow, B. F., McKee, C. M. Science, Jan. 19, 1945, p. 67.

An advance party of UNRRA personnel has arrived in Yugo-slavia as part of a mission to Yugoslav relief authorities.Military-liaison relief supplies are arriving on the Dalmatiancoast, and about 150 tons (95% food and the rest medicalstores and clothing) entered the country in the first half ofFebruary. The United States government is allowing therelease of a limited amount of shipping to UNRRA for trans-porting civilian relief supplies for Italy, Czechoslovakia, andPoland. In Czechoslovakia these supplies will be issued bythe government, under whose direction an UNRRA missionwill work.